Kev kho tus mob ntshav qab zib ko taw > Mob ceg, ntshav qab zib taw

Cov mob ntshav qab zib mob ko taw (SDS) yog ib qho kev mob tshwm sim ntawm decompensated ntshav qab zib mellitus, ua haujlwm los ntawm kev ua haujlwm thiab lub cev hloov ntawm cov nqaij mos ntawm ko taw. Pathology kev loj hlob tshwm sim los ntawm cov khoom noj ntawm lub cev zom zaub mov, uas nkag rau kev ua kom puas ntawm phab ntsa ntawm cov hlab ntsha thiab maj mam nyob rau hauv cov ntshav txaus hauv lub distal ceg. Nws cov tsos mob yog tus kab nrib pleb ntawm tus kheej, hyperkeratosis, mob ceg, ulcerative necrotic lesion.

Qhov tseem ceeb ntawm cov ntshav qab zib taw thiab nws cov cai raws li ICD-10

Hauv endocrinology, tus kabmob yog suav tias yog qhov nyuaj ntawm lub cev thiab lub cev hloov pauv uas tshwm sim tawm tsam ntawm keeb kwm yav dhau los ntawm osteoarthropathy, mob neurotrophic, macro- thiab microangiopathy. Qhov no nkag mus rau kev txhim kho purulent-necrotic kev hloov uas ua rau muaj kev pheej hmoo ntawm kev raug mob rau cov pob txha thiab cov qauv mos. Hauv cov xwm txheej siab, SDS nrog nrog mob caj dab, uas feem ntau txuas ntxiv tsis tsuas yog rau ko taw, tab sis kuj rau sab ceg qis. Hauv qhov xwm txheej no, cov neeg mob tau qhia txiav tu ncua ntawm qhov seem ntawm qhov xaus ntawm qis qis.

Ntshav qab zib ko taw yog lub sijhawm ntau yam uas ua ke nrog ntau qhov teeb meem ntawm ntshav qab zib decompensated. Xws li lawv txoj kev loj hlob, pathological hloov ntawm ko taw tau pom, nrog kev puas tsuaj rau pob txha-pob qij thiab cov leeg nqaij-ligamentous formations. Cov txheej txheem necrotic yog ua kom pom qhov txiaj ntsig ntawm qhov tsis muaj zog ntawm cov hlab ntsha hauv lub cev, tawv nqaij, qab haus huv, pob qij txha thiab pob txha.

Hauv International Kev faib Cov Kab Mob (ICD-10), endocrine pathology tau faib ua cov ntshav qab zib mellitus E10-E14. Nws tau muab kev tshaj lij tus lej E10.5 lossis E11.5, uas yog nyob ntawm etiology thiab daim ntawv ntawm tus kabmob.

Vim li cas thiab kev txhim kho mechanism

Lub hauv paus tseem ceeb ntawm kev sib txuas ntawm SDS suav nrog kev kis mob, mob plawv thiab neuropathy. Hauv cov neeg mob ntshav qab zib, qee zaum muaj kev tiv thaiv ntev ntev uas tsis paub meej hyperglycemia, uas tuaj yeem ua rau muaj kev hloov pauv hauv cov leeg thiab cov hlab ntsha, thiab cov leeg ntshav qab haus huv. Angiopathy provokes txo qis kev pom zoo thiab lub zog ntawm cov hlab ntsha capillary, qhov nce ntawm cov ntshav viscosity, vim tias muaj kev ua txhaum ntawm cov ntshav ncig thiab khoom noj khoom haus ntawm cov nqaij pob txha ligamentous.

Ib qho tseem ceeb hauv lub pathogenesis ntawm tus kab mob yog ua si los ntawm cov kev xav ua rau:

Neuropathy - kev puas tsuaj hauv kev ua haujlwm ntawm lub paj hlwb los ntawm kev puas tsuaj rau cov hlab ntsha thiab tsis muaj zaub mov tsis txaus ntawm cov ntaub so ntswg.
Macroangiopathy yog qhov txo qis cov vascular phab ntsa vim cov protein tsis txaus thiab lipid metabolism hauv cov neeg mob ntshav qab zib.
Osteoarthropathy yog kev rhuav tshem cov pob txha thiab pob qij txha txha tawm tsam tom qab ntawm qhov nce ntawm cov ntshav qab zib thiab kev hloov pauv sab hauv sab hauv taw vim yog txoj kev loj hlob ntawm neuropathy.

Mob ko taw yog ib qho ntawm qhov tsis tshua muaj txiaj ntsig thiab tsis txaus ntseeg ntawm cov kab mob endocrine pathologies. Vim tias cov glycosylation ntau ntxiv ntawm cov protein, qhov kev txav ntawm lub pob qij txha txuas ntxiv qis, cov duab ntawm cov pob txha hloov thiab lub nra ntawm lub ko taw puas tsuaj nce. Raws li qhov pom ntawm cov nqaij mos ua kom yoog qis, qhov mob me me yuav ua rau pom qhov tshwm sim ntawm qhov tsis zoo uas tsis ua kom ntev.

Mob raum ua rau cov tawv nqaij ntawm ob txhais ceg tuaj yeem kis tus kab mob pathogenic:

streptococci,
colibacilli
staphylococci.

Pathogens tsim hyaluronidase, uas ua rau cov nqaij mos xoob, thiab yog li ntawd tsim cov necrosis ntawm adipose nqaij, cov leeg nqaij thiab cov pob txha-ligamentous lug. Nrog kev kis tus mob rau ntawm daim tawv nqaij, qhov pheej hmoo ntawm kev txhim kho diffuse purulent o thiab mob caj dab ntawm ko taw nce ntxiv.

Nrog decompensated mob ntshav qab zib, qhov yuav muaj kev hloov pauv hauv zos nyob rau hauv nqua tau nce ntxiv. Lawv raug hu ua "teeb meem ko taw me me":

ntsia hlau ingrowth,
calluses
fungal tawv txhab,
corns,
onychomycosis,
tej kab nrib pleb hauv luj taws.

Teeb meem ntawm tus mob ko taw yog tshwm sim los ntawm hnav cov khau tsis khaus. Vim tias qhov poob qis hauv cov nqaij hauv lub cev tsis haum, cov neeg mob tsis xav tias nkawm khau lossis khau yuav yog rub los yog nyem tus ntiv tes thiab taw.

Ntshav qab zib taw kev faib tawm

Ua raws li cov kev mob tshwm sim ntawm tus kab mob, peb hom mob ko taw muaj peev xwm paub qhov txawv:

Ischemic - tshwm sim tawm tsam keeb kwm ntawm angiopathy thiab tshwm sim hauv 7-10% ntawm tus neeg mob. Nws yog tus cwj pwm los ntawm cov ntshav tsis txaus nyob hauv cov nqua, kev tsis zoo rau khoom noj khoom haus thiab roj sib pauv ntawm cov nqaij. Lub ischemic daim ntawv ntawm lub diabetic ko taw feem ntau yog nrog los ntawm obliteration lossis kev puas tsuaj ntawm cov leeg thiab cov hlab ntsha. Cov yam ntxwv tseem ceeb ntawm pathology yog: o ntawm taw, mob hnyav ntawm ob txhais ceg, hyperpigmentation ntawm daim tawv nqaij, qaug zog thaum taug kev, ceg tawv.
Neuropathic - qhov tshwm sim ntawm kev ntxhov siab sab hauv tsis tuaj sab nrauv ntawm lub davhlau ya nyob twg. Nws tshwm sim hauv 60-75% ntawm tus neeg mob los ntawm txhua daim ntawv ntawm SDS. Cov tsos mob tshwm sim ntawm daim ntawv neuropathic ntawm tus mob ko taw muaj xws li: anhydrosis, hyperkeratosis thiab nti puas, txo qhov rhiab (kub, tactile), tawv nqaij qhuav, metatarsus deformity, ca taw.
Sib xyaw - muab cov kev pom ntawm cov ntawv saum toj saud ntawm SDS. Daim ntawv neuroischemic ntawm tus mob ntshav qab zib taw yog kuaj pom ntawm 25-30% ntawm tus neeg mob.

Nyob ntawm cov teeb meem, lwm qhov kev faib tawm ntawm tus kabmob yog siv hauv endocrinology, raws li nws tau muab faib ua tsib hom:

pathological puas
nqua nqaj ischemia,
ko taw deformity
Menkeberg calcifying sclerosis,
mob rwj, ib cheeb tsam, qib raws Wagner.

Mob hnyav ntawm VDS

Ua raws li qhov mob hnyav ntawm cov tsos mob ntawm tus kab mob ntshav qab zib ko taw nyob rau hauv cov ntshav qab zib mellitus, cov theem hauv qab no ntawm pathology tuaj yeem paub qhov txawv:

0 - hloov pauv pathological nyob rau hauv nqua tseem tsis tuaj txog, txawm li cas los xij, qhov tsim nyog ua ntej rau lawv qhov tshwm sim tshwm sim: deformation ntawm ko taw, poob ntawm cov nqaij hauv lub cev, tev tawv nqaij.
1 - thawj qhov txhab trophic yog tsim rau saum npoo ntawm epidermis, tab sis lawv txoj kev sib kis tsuas yog los ntawm txhais ko taw nkaus xwb.
2 - tsis tsuas yog lub dermis, tab sis kuj yog cov leeg nqaij nrog cov nqaij mos subcutaneous pib raug kev puas tsuaj. Cov pob txha-articular cov qauv hauv qhov chaw hauv foci ntawm cov mob tseem tsis muaj kev cuam tshuam.
3 - ligaments thiab pob txha koom nrog cov txheej txheem o, vim tias qhov kev pheej hmoo ntawm ko taw txhawm ntxiv nce.
4 - vim yog necrotic qhov txhab ntawm ob txhais ceg, tus neeg caj ceg tsis zoo ntawm ntau hom kev tsim tawm.
5 - kev sib kis sai sai ua rau muaj kev puas tsuaj rau cov ntaub so ntswg ntau ntxiv, tsis yog txhais ko taw xwb, tabsis tseem txhais ceg qis dua.

Ntawm cov theem pib ntawm kev txhim kho mob ntshav qab zib taw, cov neeg mob ntshav qab zib mellitus tseem tsis tau paub txog muaj cov teeb meem tshwm sim. Cuam tshuam tus taw zoo li qub, txawm hais tias qhov mob thiab qhov kub thiab txias hauv nws txo qis. Cov neeg mob nrog neuropathic daim ntawv ntawm tus kab mob hnav cov khau tsis xis, uas tso rau ntawm cov ntiv tes thiab cuam tshuam cov ntshav mus rau cov ntaub so ntswg mos, tab sis tsis hnov kev tsis xis nyob.

Cov kab nrib pleb tom qab ntawm tus kheej, abrasions, thiab tawg ntho ua rau mob mycotic txhab ntawm daim tawv nqaij thiab rau tes.

Cov tsos mob thiab pawg pheej hmoo

Cov kab mob kev kuaj mob ntawm SDS raug txiav txim los ntawm hom kab mob thiab theem ntawm kev txhim kho pathology. Thawj yam qhia hais txog tus mob ko taw yog:

o ntawm qis qis dua,
mob thaum taug kev
hloov pauv qhov rhiab heev ntawm daim tawv nqaij.

Tus neeg mob ntshav qab zib yuav tsum ceeb toom nkees thiab tsis xis nyob hauv ob txhais ceg txawm tias yog so. Cov tsos mob ntawm tus mob ntshav tes taw yog feem ntau qhia los ntawm qhov hloov xim ntawm daim tawv nqaij cuam tshuam nrog kev ua haujlwm tsis txaus ntshav thiab cov nqaij mos ischemia. Tsis tas li, cov neeg mob yuav tsum tau ceeb toom los ntawm kev kho ntev ntawm kev ua kom me me thiab puas tawg.

Cov tsos mob ntawm tus mob ntshav qab zib neuropathic txhais taw

SDS yog tus cwj pwm tshwm sim los ntawm kev tshwm sim ntawm pathological nyob hauv cov chaw ntawm ko taw uas muaj kev kub siab tshaj plaws thaum taug kev lossis sawv. Cov qhov txhab raug feem ntau cuam tshuam los ntawm thaj chaw interphalangeal, pob taws thiab lub hauv ncoo ntawm tus ntiv tes xoo. Cov cim tseem ceeb thiab cov tsos mob ntawm tus mob ko taw yog:

o ntawm cov ceg hauv qab pob taws ua ke,
qhov pom ntawm caj ces ntawm ko taw,
tuab ntawm daim tawv nqaij ntawm tus kheej,
qhuav dermis
mob rau sab saum npoo ntawm ko taw,
deformation ntawm cov ntiv tes.

Nrog rau daim ntawv neuropathic ntawm SDS, cov qhov txhab trophic pom nyob rau hauv cov chaw uas tau hais txog qhov siab tshaj plaws thaum taug kev. Thaum cov pob txha raug mob, deformation ntawm cov ntiv tes tshwm sim, thiab yog li ntawd lawv dhau los ua qhov zoo li tus nuv.

Kev ua ntawm ischemic ntshav qab zib taw

Qhov pib ntawm tus kab mob yog tus cwj pwm los ntawm qhov tshwm sim ntawm qhov mob thaum taug kev thiab nrawm nrawm ntawm cov leeg thaum mus txav. Cov yam ntxwv ntawm tus qauv ntawm pathology yog sib quas ntus claudication. Vim tsis muaj ntshav txaus rau cov nqaij thiab qhov mob ntawm ob txhais ceg, tus neeg mob tau quab yuam kom txo qis ntawm qhov tsis xis nyob.

Cov kws tshwj xeeb sib txawv cov tsos mob hauv qab no ntawm ib hom ischemic ntawm ko taw mob ntshav qab zib:

o nyob rau hauv pob luj taws,
daim tawv nqaij blanching,
hyperpigmentation ntawm lub dermis,
ulceration ntawm tus tib,
tsis muaj pulsation nyob rau ntawm cov hlab ntsha ntawm ko taw,
dub-xim av scabs on mob.

Yog tias qhov rhiab ntawm qis qis tshaj qhov txo qis, thiab thaj chaw ntawm hyperpigmentation tshwm sim rau saum npoo ntawm daim tawv nqaij, qhov no yuav qhia tau qhov kev txhim kho ntawm ischemic daim ntawv ntawm SDS.

Txhawm rau txiav txim siab theem ntawm tus kab mob, tshuaj xyuas qhov kev ncua deb uas tus neeg mob tuaj yeem kov yeej yam tsis muaj kev pab. Yog tias qhov ntev ntawm qhov kev ncua deb tsis tshaj 200 m, kuaj qib 3 ntawm SDS. Nrog kev muaj mob ntawm tus kab mob, cov ntaub so ntswg necrosis tau pom, vim tias tom qab tus neeg mob qog tom qab.

Cov cim qhia ntawm cov neeg mob ntshav qab zib

Kev zas plab yog qhov tshwm sim feem ntau ntawm kev mob ntshav qab zib thiab SDS. Nws tshwm sim vim qhov ua kom cov ntshav khiav tsis zoo hauv qhov av qis, noj zaub mov tsis zoo ntawm cov nqaij thiab kis mob ntawm qhov chaw ntawm daim tawv nqaij. Ib qho kev tshwm sim ntawm kev mob caj dab yog kev tuag ntawm tus neeg mob, yog li ntawd, yog tias pom ib qho teeb meem, lawv hloov mus rau kev txiav tawm ntawm thaj chaw muaj kev cuam tshuam ntawm nqaj.

Cov pab pawg muaj kev pheej hmoo

Qhov phom sij txaus ntshai tshwm sim rau txhua tus neeg mob ntshav qab zib, tab sis feem ntau SDS tshwm sim hauv cov neeg mob uas raug:

leeg ntshav siab
polyneuropathy
hyperlipidemia,
hyperkeratosis
mob plawv plawv
ko taw deformity
atherosclerosis, thiab lwm yam.

Raws li kev txheeb cais, ntau dua 40% ntawm cov neeg mob ntshav qab zib muaj qhov pheej hmoo siab. Txhawm rau tiv thaiv cov teeb meem phom sij, nws raug nquahu kom mus kuaj ib txwm nrog cov kws tshaj lij tsawg kawg 1 zaug hauv ib xyoos. Hauv daim ntawv decompensated ntawm tus kabmob, kev kho mob prophylactic yog saib xyuas txhawm rau txhim kho cov ntshav ncig hauv nqua thiab txhim kho cov nqaij mos trophic.

Kev kuaj mob

Thaum kuaj xyuas cov neeg mob SDS, yuav siv ntau txoj hauv kev. Kev kuaj mob ntawm tus mob ntshav qab zib mus koom nrog kev sib tham tsis yog nrog tus kws kho ntshav qab zib, tab sis kuj nrog kws kho mob ntawm cov kws tshwj xeeb - kws kuaj mob endocrinologist, orthopedist, kws kho pob txha, kws phais plawv, thiab lwm yam Kev kuaj tus kheej ua lub luag haujlwm tseem ceeb hauv kev kuaj pom tus kabmob, lub hom phiaj yog sijhawm uas tau tshawb pom lub sijhawm hloov cov kab mob:

ntiv tes deformity
daim tawv nqaij qhuav
mob thaum taug kev,
mycotic txhab ntawm ntsia hlau,
blanching ntawm daim tawv nqaij.

Kev kuaj mob rau cov mob ko taw mob ntshav qab zib yog txiav txim los ntawm kev soj ntsuam cov tsos mob thiab cuam tshuam nrog lwm yam teeb meem. Thaum tsis muaj cov tsos mob hnyav, cov txheej txheem tshuaj xyuas hauv qab no yog siv:

Kev ntsuam xyuas ntshav - txiav txim siab seb cov piam thaj, cov roj cholesterol thiab lipoproteins hauv cov ntshav ntshav npaum li cas.
Kev kuaj lub cev - tso cai rau koj los txiav txim siab qhov ntau ntawm qhov mob, kev co, ua kom nruj thiab qhov kub thiab txias ntawm cov ntaub so ntswg.
Urinalysis - qhia txog qhov kev cia siab ntawm ketone lub cev thiab qab zib.

Cov qib ntawm kev puas tsuaj rau cov leeg-ligamentous thiab pob txha qauv hauv ischemic ntawm SDS yog txiav txim siab siv cov hau kev xws li:

Xoo hluav taws xob xoo hluav taws xob xoo hluav taws xob xoo - kev soj ntsuam ntawm qhov xwm txheej ntawm cov hlab ntsha txhaws hauv qhov qis qis.
Ultrasonic densitometry yog qhov tsis yog-tus txheej txheem rau kev ntsuas cov pob txha ntxhia lub cev.
Peripheral CT arteriography yog kev kuaj mob tomographic ntawm cov hlab ntshav uas tau ua los nrhiav cov qhov txhab tawv nqaij.
Ultrasound ntawm cov hlab ntsha ntawm ob txhais ceg - ib qho kev ntsuas qhov ceev ntawm cov hlab ntsha cov ntshav khiav hauv qis qis
Kev rov qab los ntawm purulent tawm - lub ntsiab txhais ntawm tus neeg sawv cev tiv thaiv kev kis tus mob nrog necrotic cov ntaub so ntswg puas tsuaj.

Thaum lub sij hawm kuaj pom, qhov tshwm sim ntawm txhua yam ntawm cov kev tshawb fawb kho vajtse saum toj no raug coj mus rau hauv tus account. Yog tias tus kws tshaj lij xav tias yog osteoarthropathy, xoo hluav taws xob ntawm ko taw tau ua nyob rau hauv ob qhov kev kwv yees.

Mob ntshav qab zib kho ko taw

Lub hauv paus ntsiab lus ntawm txoj kev kho yog nyob ntawm daim ntawv thiab theem ntawm kev txhim kho mob ntshav qab zib mellitus hauv cov neeg mob ntshav qab zib. Kev kho mob ntawm tus mob ko taw mob ko taw suav nrog:

tshuaj kho
kev kho mob hauv zos ntawm mob txhab,
ua raws li txoj kev noj haus,
kev phais mob.

Yuav kom ua kom cov ntshav qab zib ntau ntau, yuav tsum hloov pauv qhov tshuaj insulin lossis hloov pauv ntawm tus neeg mob mus rau kev kho mob insulin ntau ntxiv. Thaum muaj qhov txhab tsis zoo thiab qhov mob txhab tawv nqaij, lawv yuav mus rau kev phais mob.

Tshuaj Kho Mob

Kev saib xyuas cov kab mob ntshav qab zib hauv tsev tej zaum yuav suav nrog qhov yooj yim thiab ntsuas ntxiv. Txhawm rau tiv thaiv kab mob kev hloov pauv nyob rau hauv kev nruj, tshuaj siv los kho tus kab mob hauv qab, i.e. mob ntshav qab zib. Thaum pom kev mob hnyuv tawm, kev siv tshuaj tua kab mob siv tau cov tshuaj tua kab mob hauv qab no:

Clindamycin, Rifampicin - rhuav tshem staph.
Ertapenem, Ceftriaxone - rhuav tshem cov xovtooj ntawm tes ntawm cov kab mob coliform.
Erythromycin, Amoxicillin - inhibit kev txhim kho ntawm tus mob streptococci.
Daptomycin, Linezolid - rhuav tshem cov kab mob methicillin-tiv thaiv kab mob ntawm microbes.

Nyob rau hauv cov mob hnyav ntawm tus kab mob, kev tso dej khov ntawm cov tshuaj tua kab ke yog nqa tawm. Kev poob qis hauv kev tsim ntawm cov kab mob hauv lub cev txhawb nqa kev kho neeg mob thiab nqaij ua kom rov zoo tuaj. Kev kho kab mob hauv plab ko taw yuav ua rau kho cov qhov txhab nrog cov tshuaj pleev uas muaj urea, tshuaj tua kab mob thiab tshuaj tua kab mob - Diaderm, Vitra, Ureata, Diaultraderm.

Kev siv tshuab tsis muaj zog tiv thaiv kev mob ntawm cov txheej txheem necrotic thiab o.

Kev tawm dag zog yog qhov zoo prophylaxis ntawm cov ntshav qab zib mellitus hauv cov neeg mob uas mob ntshav qab zib decompensated. Kev thauj khoom nruab nrab ntawm ko taw pab txhawb rau qhov ua ntshav ntawm ntshav hauv nqua thiab cov nqaij mos. Cov kev tawm dag zog no tuaj yeem siv los ua kom cov leeg muaj zog thiab nce ntawm elasticity ntawm cov hlab ntshav:

nyem nyem roj hmab pob nrog cov ntiv taw,
sawv kev ntiv taw
taug kev ntawm sab hauv thiab sab nraud ntawm ko taw,
caij nrog ib pawg ntawm cov khoom cylindrical,
Txhom ib daim ntaub los ntawm hauv pem teb nrog koj cov ntiv tes.

Txhawm rau kom ua tiav qhov kev kho mob tsim nyog, nws raug nquahu kom ua kev tawm dag zog txhua hnub thaum sawv ntxov thiab yav tsaus ntuj. Raws li kev soj ntsuam tiag tiag, kev tawm dag zog tawm dag zog txo cov kev pheej hmoo ntawm cov teeb meem los ntawm 2.5 zaug.

Txoj Kev Kho Mob Hirudotherapy

SDS tau ua tiav zoo nrog kev kho mob. Nyob rau lub sijhawm ntawm kev nqus mus rau lub ntsej muag ntawm daim tawv nqaij, lawv pib zais hirudin, uas cuam tshuam rau cov hemodynamic tsis dhau ntawm cov ntshav, thiaj li txhim kho cov ntshav ncig hauv cov ceg tawv. Hirudotherapy tsis yog qauv rau kev kho mob ntshav qab zib, tab sis feem ntau siv vim nws txoj kev ua haujlwm zoo.

Ntxiv nrog rau hirudin, kev kho mob leeches tso tawm ntau cov tshuaj uas ua rau muaj txiaj ntsig zoo rau kev mob ntawm tus mob ntshav qab zib:

viburnum - tiv thaiv kev ua kom tsis txhob muaj cov leeg ntshav thiab tsim cov ntshav txhaws hauv cov leeg ntshav ntawm ob txhais ceg,
destabilase - muaj cov nyhuv bacteriostatic, yog li txo qhov kev pheej hmoo ntawm kev kis mob ntawm qhov mob ntawm ko taw,
hyaluronidase - ua kom nrawm nrawm ntawm cov kua dej intercellular, uas tiv thaiv qhov tshwm sim ntawm edema.

hauv kev siv hirudotherapy, tsuas yog qee lub leeches ntawm lub ntsej muag daj lossis xim av yog siv, uas zais tawm cov enzymes tshwj xeeb uas tiv thaiv cov ntshav txhaws.

Kev noj zaub mov kom tsim nyog thaum lub sij hawm kho tus kab mob no muaj qhov cuam tshuam rau kev ua haujlwm ntawm kev kho mob thiab qhov nrawm nrawm ntawm cov neeg mob. Kev noj tshuaj rau SDS yog npaj los daws ob peb yam teeb meem:

txo cov roj,
stabilization ntawm cov ntshav qab zib
lub cev yuag thiab thauj mus rau ntawm nqua,
hloov pauv hauv lub cev uas tsis muaj cov vitamins.

Txawm tias ib nrab rov qab los ntawm cov txheej txheem kev zom zaub mov hauv cov ntshav qab zib tau tiv thaiv kev txhim kho ntawm cov hlab ntsha nyuaj, ischemia thiab gangrene. Raws li cov kws qhia noj haus, cov tshuaj ntsuab yuav tsum yeej nyob hauv kev noj haus. Lawv tiv thaiv qhov nqus ntshav qab zib los ntawm zaub mov rau hauv cov ntshav, uas yuav pab kom cov ntshav qabzib ntau ntau.

Raws li cov kev pabcuam noj zaub mov noj qab zib, cov ntshav qab zib yuav tsum muaj cov khoom lag luam xws li:

ntsuab taum
txaij
dib
ntsuab peas
zaub qhwv
beets
radish
nceb
Txiv lws suav
zaub ntsuab
zucchini
ntsuab tshuaj yej.

Cov kws tshaj lij pom zoo kom tshem tawm cov khoom tsis txaus siab, haus dej cawv, semolina, cov rog tsiaj, ncuav dawb, nplej zom thiab taum pauv los ntawm cov khoom noj tau. Hauv ntau cov ntsiab lus, lawv muaj suab thaj, ua rau muaj ntshav nce ntxiv hauv cov ntshav.

Cov tshuaj kho neeg mob

Txhawm rau txo qis qhov mob ntawm cov txheej txheem ua rau tawv nqaij nrog SDS, cov tshuaj npaj los ntawm cov tshuaj ntsuab thiab cov khoom noj tau tuaj yeem siv. Ntau ntawm lawv muaj antiflogistic, qhov txhab kho mob thiab antiseptic zog.

Kev kho mob ko taw mob ntshav qab zib nrog tshuaj ntsuab tshuaj siv tau los ua ib qho chaw kaw lus rau kev kho kab mob thiab hauv zos.

Cov zaub mov zoo tshaj plaws suav nrog:

Cov tshuaj pleev nrog cov roj clove: ib daig ntawm daim ntaub nyias nyias tais hauv ob peb txheej yog moistened nyob rau hauv cov kua thiab ua ntawv thov rau thaj chaw cuam tshuam rau 2-3 teev. Cov txheej txheem tau ua ob peb zaug hauv ib hnub mus ua kom cov tawv nqaij ua kom tawv nqaij thiab nrawm nrawm kho kom zoo ntawm qhov mob qog.
Cov hmoov nplej tortilla: txhuv yog minced thiab tom qab ntawd tov nrog hom yaj siv. Ib lub ncuav mog qab zib me me los ntawm cov khoom sib xyaw tuab, uas tau thov rau ko taw, npog nrog cov ntaub nplaum thiab cov phuam sov sov.
Kev sib txuam nrog ntshav dej: ib daim ntawm paj rwb ntaub plaub los yog daim ntaub nyias nyias yog ntub rau hauv cov kua thiab thov kom tawg rau hauv pob taws los yog mob rau sab hauv, thiab tom qab ntawd qhwv nrog ntaub zaj duab xis. Cov txheej txheem yuav tsum tau ua dua 3-4 zaug hauv ib hnub los tiv thaiv suppuration.

Koj yuav tsum tsis yog siv rau txoj kev kho mob pej xeem yam tsis muaj kev sab laj nrog tus kws kho mob.

Orthopedic nkawm khau

Demineralization ntawm cov pob txha thiab txo qis ntawm kev ywj pheej ntawm tus taw ntawm cov leeg yuav ua rau muaj kev raug mob ntau dua. Txhawm rau tiv thaiv deformation ntawm cov pob txha qauv thiab zam kom tsis txhob muaj pob txha lov, cov ntshav qab zib tau qhia kom hnav cov khau orthopedic nkaus xwb. Thaum yuav nws, koj yuav tsum tau ua los ntawm cov kev xaiv hauv qab no:

Qhov tsawg kawg nkaus cov naj npawb ntawm cov seams sab hauv.
Rigid thiab tsis yog-hauv qab xib taws.
Ncab sab sauv.
Txaus cov insole tuab (tsawg kawg 1 cm).
Lub peev xwm kho qhov ntim tau siv Velcro.

Cov khau uas raug xaiv yuav pab txo kev thauj mus rau ntawm taw thiab pob taws, ntxiv rau kev tiv thaiv kev zawm ntawm ob txhais ceg thiab tsim cov pob txha.

Kev phais mob

Qhov xav tau kev phais mob yog vim muaj cov teeb meem tshwm sim ntau heev. Kev qhia rau kev phais yuav muaj:

ntaub so ntswg necrosis
phlegmon
rwj
txhaws ntawm cov hlab ntshav
kev raug mob.

Ua raws li qhov muaj teeb meem hauv kev kho SDS, kev ua haujlwm hauv qab no tuaj yeem siv:

necrectomy - kev zam ntawm cov nqaij uas tsis tuaj yeem,
angioplasty - tshaj tawm los ntawm cov hlab ntsha cuam tshuam nyob rau hauv thiaj li yuav nthuav lawv lub puab diameters thiab normalize ntshav txaus,
txiav tes txiav - tshem tawm cov davhlau ya nyob twg nyob rau hauv cov ntaub ntawv ntawm kev txhab.

Cov kev phais niaj hnub muaj peev xwm pub tsawg kawg 10 ntau yam kev ua kom tsawg tsawg tus txheej txheem txhawm rau rov ua kom ntshav txhaws rau hauv ko taw. Yuav kom cov nqaij mos trophism li qub, chaw kho mob hauv Moscow ua cov kev phais vascular xws li autovenous bypass, thromboembolectomy, endovascular dilatation, thiab lwm yam.

Cov kev kho tshiab kawg

Tau ntau xyoo, cov kws tshawb fawb tau txhim kho txoj hauv kev tshiab los mus tshem tus kabmob, tsom rau kev kho sai ntawm cov mob ncauj thiav thiab tiv thaiv kev mob caj dab. Hauv tebchaws Ntsaws Mes Nis, kev kho kom zoo dua rau CDS twb tau pib ua kev paub, uas suav nrog:

kev kho mob biomechanical
ntshav dav hlau txoj kev
kev loj hlob tau muab kho
kev kho cov yoj tes nrawm nrawm.

Raws li ntau tus kws kho mob, ib qho ntawm thaj chaw muaj txiaj ntsig tshaj plaws hauv kev kho mob ntshav qab zib ko taw yog txheej txheem siv qia hlwb. Nws siv nyob rau ntau theem ntawm kev kho mob ntawm tus kabmob ua rau nws tus kheej rov ua haujlwm ntawm cov ntaub so ntswg uas raug mob thiab kho qhov mob ntawm qhov txhab trophic.

Kev Saib Xyuas Ko Taw: Cov Lus Qhia Ntxiv

Yog tias ib tug neeg tau mob ntshav qab zib, nws txhais tau hais tias nws cia li poob rau hauv pawg neeg pheej hmoo. Yog vim li cas cov neeg mob ntshav qab zib yuav tsum nrhiav kev pab los ntawm kws kho mob thaum pom cov tsos mob me ntsis tshwm sim ntawm tus taw. Kev saib xyuas ko taw rau VDS suav nrog ntau txoj cai:

Txhua hnub ntxuav. Tsawg kawg yog ob zaug hauv ib hnub, koj yuav tsum ntxuav koj txhais taw, them nyiaj tshwj xeeb rau thaj chaw ua haujlwm. Tom qab cov txheej txheem, daim tawv nqaij yuav tsum tau muab ziab kom huv thiab kho nrog antiseptic.
Kev zam ntawm qhov kub sib txawv. Tus neeg mob ntshav qab zib yuav tsum tau ceev faj txog kev kub siab thiab ua kom lub siab txias dhau mus, vim tias qhov no tuaj yeem ua rau cov ntshav tsis zoo hauv ko taw thiab txhim kho cov hlab hlwb.
Kev soj ntsuam txhua hnub ntawm nqua. Yog tias pom kev khawb, tawg lossis tawg, yuav tsum kho cov tawv nqaij uas ntxuav thiab pleev qhov txhab pleev kom zoo.
Kev hloov pauv txhua hnub ntawm thom khwm. Kev nyiam huv txo qhov kev pheej hmoo ntawm kev tsim mycosis ntawm daim tawv nqaij thiab cov rau tes. Yog li, cov kws kho mob pom zoo kom hloov thom khwm lossis thom khwm tsawg kawg 1 zaug hauv ib hnub.
Ua kom haum cov ntsia hlau. Txhawm rau tiv thaiv txoj kev tawm ntawm cov ntsia hlau daim hlau rau hauv cov ntaub so ntswg mos, lawv yuav tsum txiav ncaj qha nkaus xwb yam tsis muaj kev sib hloov ntawm cov ces kaum.

Kev kwv yees thiab kev tiv thaiv kab mob ntshav qab zib ko taw

SDS yog ib qho kev phom sij txog txoj sia. Txawm li cas los xij, nrog lub sijhawm dhau los ntawm kev siv tshuaj thiab ua raws li kev tiv thaiv kev tiv thaiv, nws muaj peev xwm los txo kev pheej hmoo ntawm kev mob qog thiab mob caj dab. Kev tiv thaiv tus mob ko taw muaj xws li:

niaj hnub ntxuav thiab kuaj xyuas ob txhais ceg,
hnav tsuas yog orthopedic nkawm khau,
soj ntsuam tsis tu ncua ntawm cov piam thaj hauv ntshav,
kev siv ntawm nkawm thom khwm seamless thiab thom khwm,
tsis lees txais ntawm kev siv pob kws plasters,
mus cuag kws kho mob rau o los yog tawv nqaij puas.

Ua raws li cov lus qhia saib xyuas ko taw yooj yim pab kom tsis txhob muaj teeb meem hauv 84% ntawm tus neeg mob. Nws yuav tsum nkag siab tias SDS yog ib qho ntawm lub hauv paus tseem ceeb ntawm txoj kev txiav caj dab. Txhawm rau tiv thaiv cov ntaub so ntswg necrosis, cov neeg mob yuav tsum saib xyuas lawv kev noj qab haus huv, kho cov kab mob ua kom mob raws sijhawm thiab tuaj yeem tiv thaiv kev raug mob ko taw.

Cov ntaub ntawv dav dav

Hauv cov kab mob endocrinology, cov tsos mob ntawm tus kab mob ntshav qab zib yog to taub raws li ua rau cov kab mob microcirculatory thiab neurotrophic mob nyob rau hauv cov qhov tsis sib luag ntawm qhov qis qis, uas ua rau kev txhim kho ntawm ulcerative necrotic txheej txheem ntawm daim tawv nqaij thiab cov nqaij mos, pob txha thiab cov tawv nqaij sib koom ua ke. Cov kev hloov pauv uas txawv txav ntawm tus mob ko taw feem ntau pib 15-20 xyoo tom qab pib mob ntshav qab zib. Qhov kev tsis txaus ntseeg no tshwm sim hauv 10% ntawm cov neeg mob, 40-50% ntawm cov neeg mob ntshav qab zib yog qhov pheej hmoo. Tsawg kawg yog 90% ntawm cov neeg mob ko taw muaj feem nrog tus mob ntshav qab zib hom 2.

Tam sim no, lub koom haum ntawm kev saib xyuas rau cov neeg mob uas muaj tus kab mob ntshav qab zib yog nyob deb ntawm qhov zoo meej: nyob rau hauv yuav luag ib nrab ntawm cov xwm txheej, kev kho mob pib ntawm cov theem pib, uas ua rau xav tau kev txiav tawm ntawm caj npab, kev tsis taus ntawm cov neeg mob, thiab nce kev tuag.

Cov laj thawj thiab cov txheej txheem ntawm kev txhim kho mob ntshav taw

Lub ntsiab pathogenetic txuas rau mob ntshav qab zib mob ko taw yog angiopathy, neuropathy thiab mob kis. Lub sij hawm ntev tsis paub meej hyperglycemia nyob rau hauv cov ntshav qab zib mellitus ua rau kev hloov pauv hauv cov hlab ntsha (ntshav qab zib macroangiopathy thiab microangiopathy), nrog rau cov hlab ntsha ntsig (mob ntshav qab zib neuropathy). Angiopathies ua rau txo qis ntawm elasticity thiab patency ntawm cov hlab ntsha, nce ntshav viscosity, uas yog nrog cov kev ua txhaum ntawm lub sab hauv thiab cov ntaub so ntswg trophic li qub, poob ntawm qhov kawg ntawm cov leeg.

Nce glycosylation ntawm cov protein ua rau txo qis kev sib koom ua ke, uas ua rau muaj kev cuam tshuam ib txhij ntawm pob txha caj ceg thiab kev ua txhaum ntawm qhov qub biomechanical load ntawm ko taw (mob ntshav qab zib osteoarthropathy, Charcot tus taw). Tawm tsam keeb kwm yav dhau los ntawm kev hloov cov ntshav ncig, txo qis rhiab thiab tiv thaiv kev ua haujlwm ntawm cov ntaub so ntswg, ib qho twg, txawm tias qhov mob me mus rau ko taw (mob me, doog, puas, tawg, micropores) ua rau kev tsim cov mob ntev ntev tsis ua rau mob raum. Peptic rwj ua rau feem ntau muaj tus mob staphylococci, colibacilli, streptococci, micalora anaerobic. Cov kab mob hyaluronidase ua rau cov nqaij mos nyob ib puag ncig, pab txhawb kev kis tus kab mob thiab cov kev hloov necrotic uas ua rau muaj roj, nqaij nqaij, thiab cov leeg pob txha-pob txha. Nrog rau kev kis tus mob ntawm mob txhab, kev pheej hmoo ntawm kev tsim muaj mob qog, phlegmon thiab gangrene ntawm tus ceg nce ntxiv.

Txawm hais tias muaj kev pheej hmoo ntawm kev mob ntshav qab zib ko taw nyob rau hauv txhua tus neeg mob ntshav qab zib mellitus, ib pawg muaj kev pheej hmoo ntau ntxiv suav nrog cov neeg mob peripheral polyneuropathy, vascular atherosclerosis, hyperlipidemia, mob plawv, mob ntshav tawm tsam, haus dej cawv thiab haus luam yeeb tus neeg tsim txom.

Kev hloov pauv ntawm cov nqaij hauv zos - qhov hu ua cov teeb meem me me: txhawm rau ua kom tus ntiv tes xoo, kab mob fungal ntawm cov rau tes, mycoses ntawm daim tawv nqaij, pob txha thiab pob txha, tawg pob taws, kev tsis huv ntawm ob txhais ceg nce qhov kev pheej hmoo ntawm kev puas tsuaj rau ntshav qab zib. Qhov ua rau muaj qhov tsis xws luag no tuaj yeem xaiv cov khau tsis raug (ntau dhau nqaim lossis nruj). Txo qhov tsis tshua muaj siab ntawm tus nqaj tsis ua rau tus neeg mob hnov tias cov khau tseem nyem dhau, rub tawm thiab raug mob rau ko taw.

Ntawm cov ntaub ntawv uas mob ko taw

Muab qhov kev cia siab ntawm ib qho kev tiv thaiv kab mob pathological, ischemic (5-10%), neuropathic (60-75%) thiab sib xyaw - neuroischemic (20-30%) daim ntawv ntawm diabetic ko taw yog qhov txawv. Hauv ischemic daim ntawv ntawm lub diabetic ko taw, qhov kev ua txhaum ntawm cov ntshav muab rau txoj kev nqaj vim qhov yeej ntawm cov hlab ntsha loj thiab me me yog qhov tseem ceeb. Coronary syndrome tshwm sim nrog kev mob hnyav tsis haum, cuam tshuam ntawm lub cev, mob ntawm ob txhais ceg, qaug zog ntawm ob txhais ceg, tawv nqaij tawv nqaij thiab lwm yam.

Neuropathic cov kab mob ntshav qab zib muaj kev tsim kho nrog kev puas tsuaj rau cov hlab ntshav ntawm cov dej tsis sib luag. Cov tsos mob ntawm lub ko taw neuropathic yog cov tawv nqaij qhuav, hyperkeratosis, anhydrosis ntawm qhov kawg, ib qho kev poob qis rau ntau yam kev hnov mob (cua sov, mob, ntaus nrig, thiab lwm yam), deformation ntawm cov pob txha ntawm ko taw, ko taw tiaj, pob txha lov.

Nrog kev sib xyaw ua ke ntawm cov mob ntshav qab zib taw, ischemic thiab neuropathic yam sib npaug hais tau zoo. Ua raws li qhov mob hnyav ntawm cov tsos mob pom zoo thaum mob ntshav qab zib ko taw, cov theem tau pom qhov txawv:

0 - kev pheej hmoo siab ntawm kev tsim mob ko taw: muaj kev deformity ntawm ko taw, corns, hyperkeratosis, tab sis tsis muaj ulcerative tsis xws luag 1 - theem txhab dag txhab rau sab hauv, ntau ntawm daim tawv 2 - theem ntawm lub qhov txhab tob uas muaj feem cuam tshuam ntawm daim tawv nqaij, rog rog subcutaneous, cov leeg nqaij, cov leeg nqaij, tab sis tsis muaj kev puas tsuaj rau cov pob txha 3 - theem ntawm qhov ncauj mob tob nrog pob txha puas 4 - theem kev ua laib ntau 5 - theem kev ua neeg siab phem.

Ischemic daim ntawv

Hauv kev tshwm sim thawj zaug, ischemic daim ntawv ntawm diabetic ko taw syndrome tau tshwm sim los ntawm kev mob hauv ob txhais ceg thaum taug kev, nrawm nrawm ntawm ob txhais ceg, hloov pauv nrog ceg tawv, tom qab uas pheej edema ntawm ko taw txhim kho. Lub taw yog daj thiab txias rau qhov sib chwv, mem tes hauv txoj hlab ntsha ntawm txhais taw yog tsis muaj zog lossis tsis tuaj. Tawm tsam cov keeb kwm yav dhau ntawm cov tawv nqaij daj, qhov chaw ntawm hyperpigmentation feem ntau pom.

Feem ntau, muaj cov xaim uas tsis kho ntev ntev ntawm tus ntiv tes, luj taws, sab tom qab ntawm tus I thiab V metatarsophalangeal pob qij txha, pob taws. Tom qab, mob txhab mob tshwm sim hauv lawv qhov chaw, hauv qab ntawm uas yog them nrog ib daim npliav ntawm cov xim dub-xim av. Kev tso tawm ntau dhau yog atypical (qhuav tawv necrosis).

Thaum lub sijhawm ischemic daim ntawv ntawm cov ntshav qab zib taw, 4 theem tau pom qhov txawv: tus neeg mob nrog thawj theem tuaj yeem taug kev txog 1 km tsis hnov mob, los ntawm ob - txog 200 m, los ntawm qhov thib peb - tsawg dua 200 m, nyob rau qee kis mob tshwm sim ntawm so, theem plaub yog tus cwj pwm ntawm ischemia tseem ceeb thiab necrosis ntawm cov ntiv taw, ua rau kev ua laib ntawm txhais taw lossis qis ceg.

Neuropathic daim ntawv

Daim ntawv neuropathic ntawm lub diabetic ko taw tuaj yeem ua raws li neuropathic mob rau sab hauv, osteoarthropathy, thiab mob hlab ntsha neuropathic. Cov leeg mob neuropathic tshwm sim nyob rau thaj chaw ntawm ko taw uas raug rau qhov kev nyuaj siab tshaj plaws - nruab nrab ntawm cov phalanges ntawm cov ntiv tes, ntawm tus ntiv tes xoo, thiab lwm yam Calluses, thaj chaw tuab ntawm hyperkeratosis, nyob rau hauv uas daim ntawv mob txhab, tsim nyob ntawm no. Nrog rau qhov mob khaus khaus, tawv nqaij sov thiab qhuav, abrasions, sib sib zog nqus, mob sib kis nrog hyperemic, npoo qhov muag tau pom ntawm ko taw.

Osteoarthropathy lossis Charcot sib koom ua ke, ua ib daim ntawv ntawm lub diabetic ko taw, yog tus cwj pwm los ntawm kev rhuav tshem osteoarticular apparatus, uas yog pom los ntawm txha, txha, pob txha lov, o thiab deformation ntawm cov pob qij txha (feem ntau yog hauv caug). Nrog neuropathic edema, kua dej ua kua interstitial ntxiv nyob rau hauv cov nqaij mos subcutaneous, uas ntxiv kev ua rau kev hloov pauv hauv lub taw.

Rau ntau hom neuropathic daim ntawv ntawm cov ntshav qab zib taw, nws yog qhov ib txwm los tswj kev xoo hauv cov hlab ntsha, txo qis hauv qhov tsis zoo thiab qhov rhiab, qhov tsis mob qhov ncauj ntawm cov leeg nqaij mob nrog qhov tseem ceeb ntawm exudate, hauv zos ntawm cov mob rau hauv qhov chaw ntawm nce load (ntawm cov ntiv tes, ntawm tus taw tes), qhov tsis txawv txav ntawm ko taw (khawm zoo li tus, hammer zoo li ntiv tes, tiv pob txha pob txha hau).