Mob ko taw > Kev khomob thiab kev tiv thaiv

Mob Ntshav Qab Zib (ntshav qab zib tawLus Askiv tus kab mob ntshav qab zib) - ib qho nyuaj ntawm tej qhov ntawm lub cev thiab kev hloov pauv hloov tawm tsam ntawm keeb kwm ntawm tus kab mob ntshav qab zib, micro- thiab macroangiopathy, osteoarthropathy, ua rau muaj kev raug mob ntau ntxiv thiab kis mob ntawm cov nqaij mos ntawm ko taw, kev txhim kho ntawm cov txheej txheem purulent-necrotic thiab hauv kev ua kom zoo ua rau txiav tawm. Diabetic foot syndrome yog lub tswvyim sib koom ua ke uas muaj kev sib koom ua ke ntawm ib qho kev mob lig rau tus mob ntshav qab zib mellitus, uas cov kab mob hloov pauv hauv tus neeg mob ko taw tsim nyob rau hauv cov txheej txheem purulent-necrotic, mob rau sab hauv thiab osteoarticular txhab uas tshwm sim rau keeb kwm yav dhau los ntawm kev hloov pauv ntawm cov hlab ntsha leeg, ntshav hlab ntsha, tawv nqaij thiab cov nqaij mos, pob txha. thiab pob qij txha. Muaj qee kis, lub tswvyim "Taw taw" raws li daim ntawv ywj siab nosological tsis siv, tab sis nws cov kab mob sib kis (ua paug, phlegmon, mob caj dab thiab lwm tus) tau qhia.

Kev faib tawm

Ntshav qab zib mob ko taw yog qhov tseem ceeb uas yuav ua rau tus leeg ntshav txhav ua ntshav qab zib. Li ntawm 8-10% ntawm cov neeg mob ntshav qab zib muaj feem cuam tshuam, thiab 40-50% ntawm lawv tuaj yeem raug faib rau cov pab pawg muaj feem. 10 lub sijhawm ntau dua, mob ko taw mob ntshav qab zib tau tshwm sim hauv cov neeg uas muaj hom mob ntshav qab zib hom thib ob. Tsawg kawg yog 47% ntawm cov neeg mob, txoj kev kho mob pib tom qab qhov ua tau. Qhov tshwm sim yog txiav tawm ntawm qhov kawg, uas ua rau kom cov neeg mob tuag ntau dua 2 zaug thiab nce tus nqi ntxiv rau kev kho mob thiab rov kho cov neeg mob los ntawm 3 zaug. Txhim kho cov cai ntawm kev kuaj mob, kev soj ntsuam mob, kev kho mob ntawm cov neeg mob tuaj yeem txo cov zaus ntawm txiav tes rau hauv cov neeg mob los ntawm 43-85%.

Mob ko taw mob ko taw feem ntau pib ua rau cov neeg mob feem ntau uas mob ntshav qab zib mellitus li 7-10 xyoo pib txij li pib mob qhov chaw tsis tau teev 2536 hnub , hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus tuaj yeem tshwm sim los ntawm qhov pib ntawm tus kab mob. Hauv 85% ntawm cov neeg mob, nws sawv cev los ntawm kev mob rwj ntawm qhov txawv txav. Nws kuaj tau hauv 4-10% ntawm tag nrho cov naj npawb ntawm cov neeg mob ntshav qab zib.

Kev faib tawm cais |Qhov ua rau thiab cov txheej txheem ntawm kev txhim kho mob ntshav qab zib ko taw mob

Mob ko taw mob ko taw tshwm sim los ntawm kis rau kis tus kab mob sib xyaw ua ke, xws li:

peripheral polyneuropathy (ua rau deformation ntawm ko taw, uas tiv thaiv nws lub cev txoj haujlwm thaum taug kev thiab sawv, thiab qhov poob ntawm txhua hom kev hnov mob (mob, kev co, tawv, qhov kub thiab txias) - vim los ntawm cov kev hloov pauv no, qhov kev pheej hmoo ntawm purulent-necrotic txhab ntxiv),
angiopathy (mob ntshav hauv ntshav qab zib mellitus, uas yog qhov tseem ceeb ntawm cov txheej txheem atherosclerotic - vim li ntawd, ntshav ntws los ntawm cov hlab yuav nyuaj thiab ischemia ntawm ib tug neeg cov ntaub so ntswg tshwm sim),
neuroosteoarthropathy (mob txha, txha, txhawm rau rhuav tshem pob txha, rhuav tshem ib leeg ntawm pob txha, mob pob txha).
obliterating kab mob ntawm cov hlab ntsha ntawm cov qis qis,
kev raug mob thiab deformations ntawm ko taw,
mob, tshwj xeeb tshaj yog fungal kab mob,
qhov dav dav thiab hauv zej zog txo qis hauv kev tiv thaiv.

Cov chaw kho mob tshwm sim ntawm tus mob ko taw mob ko taw

Pab pawg neeg ua haujlwm thoob ntiaj teb txog cov teeb meem ko taw mob ntshav qab zib txheeb xyuas cov qeb uas cuam tshuam txog qhov tseem ceeb ntawm tus mob no:

cov ntshav muab rau cov nqua
lawv rhiab
mob rwj loj,
tob ntawm swb
cov txheej txheem sib kis.

Ua raws li cov yam ntxwv ntawm cov tsos mob hauv pawg kho mob, 3 pawg ntawm tus kab mob ko taw ua yam ntxwv:

Neuropathic daim ntawv yog qhov tshwm sim ntawm kev mob hlwb neuropathy, kev zaws ntawm cov ntaub so ntswg, lawv kev hloov kho, kis thiab edema. Kev mob peptic muaj tshwm sim nyob rau hauv cov chaw ntawm ko taw, uas suav tus thauj khoom siab tshaj plaws. Daim ntawv no ntawm tus kab mob no tau txheeb xyuas hauv 70% ntawm tus neeg mob ko taw, feem ntau yog cov neeg muaj hnub nyoog 40 xyoo uas tau kuaj mob ntshav qab zib tau 5 xyoos lossis ntau dua, feem ntau haus dej cawv. Raws li txoj cai, mob txhab nyiaj hauv thaj chaw ntawm qhov chaw siab, qhov chaw ntawm hyperkeratosis, ntawm ib leeg, nyob rau thaj tsam ntawm thaj chaw sib kis, hauv thaj chaw ntawm kev deformation loj ntawm cov taw. Palpations yog tsis mob. Cov neeg mob yws ntawm cov tawv nqaij txha caj qaum (tingling, pinching, hlawv cov nqaij hauv thaj chaw muaj kev cuam tshuam) thiab mob hnyav hmo. Cov tawv nqaij ntawm qhov kawg yog qhuav, sov, qhov hloov ntawm qhov tawm ntawm caj pas ntawm qhov taw ntawm lub taw yog khaws cia, qhov rhiab - qhov mob, qhov kub thiab lub cev tshee - yog txo, lub pob taws thiab lub hauv caug tsis muaj zog, cov leeg nqaij atrophied, ko taw yog deformed, osteoarthropathy yog txiav txim siab.

Ischemic daim ntawv yog qhov tshwm sim ntawm kev txhaws ntawm cov hlab ntshav thiab qhov tshwm sim necrosis ntawm cov nqaij mos hauv qab uas tsis tau txais cov ntshav. Nws tau kuaj pom hauv 10% ntawm cov neeg hauv ntau tshaj li 55 xyoos uas muaj mob hlab ntsha hlab plawv (IHD, mob ntshav nce hlwb, atherosclerosis), zoo li hauv cov neeg haus luam yeeb phem. Nws ua tawm nws tus kheej li cyanosis (xiav) ntawm ib feem ntawm nqaj, mob hauv thaj chaw no. Raws li cov txheej txheem hloov zuj zus lawm, cov txheej txheem ua tsis zoo ntawm cov tawv nqaij, uas nce nrawm thiab qhov tob thiab muaj feem ntau tshaj tawm rau thaj chaw uas ntshav txaus tsawg heev. Daim tawv nqaij yog daj, cyanotic, noo, txias rau qhov kov. Hnov ruag. Ripple nyob rau hauv peripheral hlab ntsha ntawm ob txhais taw yog sharply txo los yog tsis tuaj. Hauv qee ntu ntawm nqua ntshav qhov ntshav ntws tsis ua tiav, cov ntaub so ntswg tuag - mob qog nqaij hlav tawm, ua rau txiav tu ntawm ib feem ntawm nqua.

Daim ntawv sib xyaw tsiag ntawv los ntawm kev sib txuam ntawm cov cim ntawm neuropathic thiab ischemic cov ntawv thiab yog ua kom pom los ntawm kev puas tsuaj rau ob leeg thiab leeg ntshav. Cov tsos mob ua ntej nyob ntawm txoj kab txuas twg pathogenesis tau meej dua. Daim ntawv no ntawm tus kab mob no yog qhov txaus ntshai tshaj, vim tias qhov tsos mob mob hauv qhov no tsis muaj zog lossis tsis tuaj koom ua ke - cov neeg mob tsis maj maj mus nrhiav kev pab ("nws tsis mob") thiab mus cuag kws kho mob tsuas yog thaum lub qhov txhab tau loj thiab tau tsim hauv cov nqaij kev hloov pauv tsis tau, yam tsis muaj yeeb tshuaj.

Kev kuaj mob ntawm tus mob ko taw mob ko taw

Hauv txoj hauv kev, rau kev ua qhov kev kuaj mob no, nws yuav txaus los soj ntsuam tus neeg mob ko taw nrog tus mob ntshav qab zib mellitus thiab kuaj xyuas cov yam ntxwv hloov uas tau piav qhia saum toj no. Txawm li cas los xij, txhawm rau qhia meej txog kev kuaj mob, tus neeg mob, raws li txoj cai, yog kom kho cov kev kuaj ntxiv thiab kev sab laj ntawm cov kws tshwj xeeb nqaim.

Thaum ua qhov kev kuaj mob, nrog rau nrog rau kev kuaj txhua zaus, tus neeg mob tau sau tseg:

kev txiav txim siab ntawm glycemic profile thiab glycosylated hemoglobin,
kev txiav txim siab ntawm cov ntshav lipids (LDL, HDL, cov roj cholesterol, triglycerides),
ntsuas ntawm pob luj-brachial Performance index,
sab laj endocrinologist,
kev sab laj ntawm cov kws phais neeg (nrog kev txheeb xyuas ntawm cov leeg puas siab puas ntsws thiab ntsuas qhov ntsuas ntawm qhov pib ntawm kev co lub siab),
kws kho mob sab laj,
sab laj nrog kws kho qhov muag (nrog rau yuav tsum kuaj lub qhov muag hnub kom paub txog kab mob vascular).

Cov neeg mob uas muaj lub cev tsis zoo ntawm lub cev tau raug xoo hluav taws xob ntawm taw, tom qab ntawd kev sab laj orthopedic.

Ultrasound dopplerography thiab xim duplex npauj ntawm cov ceg qis ntawm cov leeg ntshav yog nqa tawm rau cov neeg mob uas tsis muaj mem tes hauv cov hlab ntsha ntawm caj pas lossis lub tsev kho mob ntawm kev sib quas ntus, ua raws li kev sib tham nrog tus kws phais vascular.

Cov neeg mob nrog mob rau sab hauv ntawm thaj chaw ntawm lub taw yog sown nrog lub qhov txhab uas tshem tawm nrog kev txiav txim siab tom qab ntawm qhov kev nkag siab ntawm cov noob kab lis kev cai rau cov tshuaj tua kab mob, nyob rau hauv cov ntaub ntawv ntawm mob tob - radiography ntawm taw.

Kev kho tus mob ntshav qab zib ko taw

Cov nyuaj ntawm cov txheej txheem kho rau cov kab mob no suav nrog cov hauv qab no:

kev cob qhia cov neeg mob hauv tsev kawm "mob ko taw",
kev them nyiaj rau cov ntshav qab zib mellitus (kev kho ntawm kev kho tau txais los ntawm tus neeg mob - nce qhov koob tshuaj ntawm qhov ncauj hypoglycemic, kho tshuaj insulin lossis nce nws ntau npaum li cas, cov lus qhia ntxaws ntsig txog kev noj zaub mov),
siv tshuaj tua kab mob (raws li txoj cai, siv tshuaj tua kab mob ntau-los siv lossis cov neeg siv tshuaj tua kab mob sib kis),
mob kev kho mob (kev muab tshuaj rau qhov mob),
kev kho mob hauv zos (kho cov tawv nqaij ib ncig ntawm qhov tsis xws luag, tshem tawm ntawm qhov nqaij ntawm lub cev thiab purulent-necrotic, mob hloov ntawm qhov txhab nws tus kheej),
nce kev tiv thaiv - ob qho tib si dav thiab hauv zos.

Thaum nyuam qhuav pib, kev kho mob hauv zos rau kev kho mob ulcerative, tsis xa tawm ntawm thaj chaw muaj mob ntawm ko taw, sau tshuaj tua kab mob (Ceftriaxone), cov tshuaj uas txhim kho cov ntshav txaus (Actovegin, Pentoxifylline, Normoven), alpha-lipoic acid npaj (Berlition, Espalipon), cov tshuaj tua kab mob laser tau pom zoo.

Ntawm cov theem tom qab, kev kho mob yog nqa tawm hauv tsev kho mob phais, qhov twg necrectomy, autodermoplasty ntawm lub qhov txhab tsis zoo thiab, ua qhov kawg, kev txiav tes taw ntawm tus ceg tawv tuaj yeem ua.

Muaj ntau txoj kev tshiab los kho tus mob ko taw mob ko taw, uas ua rau kev kho sai sai ntawm qhov mob ua kom tsis zoo thiab txo qhov xav tau txiav tu. Hmoov tsis zoo, qee qhov ntawm cov qauv no tseem tsis tau muaj kev kawm txaus, thiab qee qhov tau muab coj los siv rau hauv cov chaw kho mob hauv ntiaj teb xwb, uas yog vim li cas lawv tsis nkag mus rau txhua tus neeg mob nrog tus kab mob no. Cov hau kev no suav nrog:

kev loj hlob tau muab kho
kho pob hluav taws xob,
kev kho cov kab mob ntawm tes
ntshav dav hlau kho,
bio-mechanical txoj kev, thiab lwm yam.

Kev Tiv Thaiv Kab Mob Ntshav Qab Zib

Txhawm rau tiv thaiv cov tsos mob ntawm tus mob ntshav qab zib, koj yuav tsum:

nruj tswj ntshav qabzib hauv cov ntshav,
saib xyuas txoj cai kev tu cev ntawm daim tawv nqaij ntawm qis qis (ntxuav 2 zaug hauv ib hnub thiab qhuav kom qhuav (tsis txhob so!) ntawm daim tawv nqaij, siv cov dej sov xwb, tsis txhob sib chwv nrog dej txias lossis dej kub),
txhua txhua hnub ua tib zoo tshuaj xyuas cov tawv nqaij ntawm tus taw kom raws sijhawm kom paub tseeb qhov pom ntawm rab txiab, calluses, kab nrib pleb,
Tsis txhob siv cov ntaub qhwv cua sov
txhua hnub xyuas cov khau rau pebbles thiab lwm yam khoom txawv teb chaws, nrog rau kev puas tsuaj sab hauv uas tuaj yeem ua rau pom kev zoo nkauj,
tsis txhob hnav cov ris tsho sab hauv nrog cov seams,
Tsis txhob rau khau khov, cov khau khov kho, thiab cov khau tsis muaj insoles lossis ntawm ko taw xwb,
tsis txhob mus ko taw
tsis txhob siv kab lis kev cai
thaum pom mob pob txha, tsis txhob sim kho lawv tus kheej, tab sis nrhiav kev pab ntawm cov kws tshaj lij,
yog tias muaj kev raug mob, kuj tuaj ntsib kws kho mob.

Tus kws kho mob twg yuav hu tau

Txog kev tiv thaiv thiab kho tus mob ko taw, nws yog qhov yuav tsum tau ua los ntawm tus kws kho mob endocrinologist. Txheeb xyuas qhov mob ntawm cov leeg ntshav hlab ntsha thiab cov hlab ntsha, tus kws kho mob yuav xaiv cov kev sab laj ntawm kws kho paj hlwb, kws kho qhov muag, thiab kws phais vascular. Kev pab ntawm orthopedist yog xav tau los xaiv orthopedic insoles thiab lwm yam khoom siv uas txhim kho lub neej ntawm tus neeg mob uas mob ko taw mob ko taw. Nrog kev loj hlob ntawm kev mob caj dab, phais neeg ua haujlwm.

Cov ntsiab lus ntawm tus kabmob. Ua rau muaj tus kabmob

Mob ko taw (mob ntshav qab zib ko taw, CDS) yog qhov mob hnyav ntxiv ntawm ntshav qab zib mellitus nyob rau hauv daim ntawv ntawm kev kis tus kab mob, mob rau sab hauv lossis kev rhuav tshem cov ntaub so ntswg sib sib zog nqus, uas tshwm sim vim kev ua txhaum ntawm ko taw macrostructure thiab ntshav microcirculation vim muaj kev puas tsuaj ntawm cov hlab ntaws thiab cov leeg.

Qhov tseem ceeb ua rau DS yog ntshav qab zib mellitus (DM). Thiab txawm hais tias tus mob ntshav qab zib mob ko taw tsis tau pib txij thawj hnub ntawm kev nce rau hauv cov ntshav cov ntshav ntawm ntau tshaj 7.0-8.0 mmol / l, txhua tus neeg mob uas muaj mob ntshav qab zib yuav tsum paub txog cov kev mob uas tsis txaus ntseeg.

SDS txhim kho raws qib thiab ntau yam qauv:

tom qab 5-7 xyoo hauv 60% ntawm cov neeg mob uas muaj mob ntshav qab zib hom 1 (Cov piam thaj ntau tshaj 8 mmol / l),
tom qab 15-20 xyoo hauv 10% ntawm cov neeg mob uas tsis muaj tshuaj insulin-tiv thaiv hom ntshav qab zib 2 (ntshav qabzib qib 8-9 mmol / l) - feem ntau tshwm sim nrog osteopathology, mob plig thiab ko taw dermatitis ntawm ntau yam etiologies.
tom qab 10-15 xyoo, 90% ntawm cov neeg mob uas muaj ntshav qab zib hom 2 insulin-raws kev noj haus.

Lub ntsiab "chiv" ntawm txoj kev txhab ntawm kev txhim kho hauv CDS:

Rau khau tsis xisCov. Txhua qhov kev ua tsis zoo rau khau tuaj yeem ua rau hloov pauv ntawm lub nra ntawm lub pob qij txha, nyem lossis puas ntawm daim tawv nqaij, lub zos me me ischemia, infiltrate, lossis necrosis:
Cov khau tsis haum (me dua lossis loj dua li tsim nyog)
hnav thiab / lossis siab siab,
ib qho caws pliav ntawm insole
ib leeg tsis xws luag
nkawm khau ntub dej
tsis sib xws ntawm lub caij khau.
Lub cev hnyav dua qubCov. Muab thaj tsam ntawm tus taw, nrog qhov nce hauv lub cev hnyav (txawm tias los ntawm 1 kg), lub nra rau txhua qhov sib koom tes ntawm tus taw kuj nce. Thaj chaw yooj yim tshaj plaws yog tsob ntoo nto.
Kev loj hlob ntawm cov epidermis (saum npoo) ntawm daim tawv nqaijCov. Cov txheej txheem no tshwm sim vim cuam tshuam cov txheej txheem metabolic nyob rau hauv daim tawv nqaij tiv thaiv keeb kwm yav dhau los ntawm cov ntshav qab zib (hauv qab cov kab mob "callus" hauv cov tawv nqaij txheej, microcirculation cuam tshuam, uas ua rau microischemia thiab necrosis).
Microtrauma:
tsiaj tom
txhaj nrog pos ntoo ntawm cov nroj tsuag,
txiav nrog pedicure, thiab lwm yam.
Stenosis (nqaim) thiab occlusion (thaiv) ntawm cov hlab ntsha tseem ceebCov. Raws li qhov tsis muaj teeb meem ntawm cov ntshav hauv cov taw thiab txhais ceg, micro-ischemia thiab kev txhim kho kev ua haujlwm ntawm kev sib deev ntawm qhov tsis txaus ntshai koom nrog microischemia.

Feem ntau muaj kev sib txuam ua ke ntawm ntau qhov ua rau mob ncauj plab hauv SDS.

Cov tsos mob ntawm tus mob ko taw

Lub sijhawm pib rau kev txhim kho ntshav qab zib tsis yog hnub ntawm kev kuaj mob ntshav qab zib mellitus, tab sis lub sijhawm thaum pom thawj cov tsos mob ntshav qab zib (ib qho nce ntxiv hauv ntshav qabzib, lub qhov ncauj qhuav thiab lwm tus).

Cov tsos mob ntawm VDS:

loog, chilliness, hlawv, o hauv taw thiab lwm qhov tsis hnov zoo siab,
cov plaub hau poob ntawm taw thiab ceg, tawm hws,
kho cov tawv nqaij (hyperemia, hyperpigmentation, cyanosis),

Feem ntau, cov distal kawg yog cuam tshuam los ntawm kev hloov pauv trophic: ntiv tes thiab plantar saum npoo ntawm ko taw hauv kev kwv yees ntawm lub taub hau ntawm cov pob txha metatarsal. Lub cheeb tsam ntawm kev tsim cov mob rau qhov muaj pob txha ntau yog nyob ntawm qhov ua kom tshwm sim.

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 muaj mob ntau yam 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 subcutaneous rog, cov leeg nqaij, thiab cov leeg pob txha-txhaws.

Nrog rau kev kis tus mob rau sab hauv, qhov kev pheej hmoo ntawm kev txhim kho qog ntshav, phlegmon thiab mob caj pas ntawm lub cev 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.

Ua rau muaj Kev Nyuaj Siab

Ntev kom cov ntshav qab zib ntau ntau cuam tshuam tsis zoo rau lub cev. Nws yog cov piam thaj ntau ntawm cov piam thaj uas yog qhov ua rau cov rhuav tshem cov hlab ntshav thiab cov pob txha.

Tsis tas li ntawd xwb, vim yog txoj kev kho qhov chaw qis dua hauv lub siab los ntawm lub siab, ntshav ntws tsis zoo rau hauv lawv, ua rau kev hloov pauv ntawm cov leeg ntshav. Cov ntshav qab zib kom siab yog qhov ua rau lub hlwb puas.

Hnov rhiab heev, ib tug neeg tsis hnov mob ceg, tsis hnov qhov mob.

Kev kho mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2 tuaj yeem nres kev rhuav tshem thiab rov qab ua kom lub paj.

Qhov laj thawj tseem ceeb ntawm kev loj hlob ntawm tus mob ntshav qab zib mob ko taw yog neuropathy, kev puas tsuaj rau cov hlab ntsha los ntawm cov ntshav ntawm cov ntshav qabzib.

Kev hnov mob neuropathy ua rau qhov tseeb tias qhov rhiab ntawm daim tawv nqaij mus kov, kev co, lub siab, qhov hloov ntawm qhov kub thiab lwm yam tsis ploj.
Lub cev muaj zog neuropathy ua rau mob leeg nqaij, ko taw deformity.
Vim yog lub zog ntawm lub cev yuag, cov tawv nqaij poob lub peev xwm tawm hws, nws yuav qhuav thiab yooj yim tawg.

Txhua yam ntawm cov neuropathy zoo yuav luag txhua lub sijhawm sib xyaw ua ke.

Thaum taug kev, ntu ntu ntawm ko taw yog raug ntau dhau. Vim tias qhov no, cov nqaij mos muag tau maj mam rhuav tshem thiab lub plab peptic yog tsim.

Qee zaum kev ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij tuaj yeem tshwm sim sai sai nyob rau hauv kev ua ntawm kev raug mob tshuab nrog cov khoom ntse los yog lub siab kub, uas tus neeg mob tsis hnov vim muaj mob neuropathy. Tsis tas li, ntshav qab zib ua kom sai ntawm kev txhim kho atherosclerosis, uas yog vim li cas cov ntshav ncig hauv ob txhais ceg tau cuam tshuam.

Kev faib tawm ntawm pob khaus thiab ua mob rau cov neeg mob ntshav qab zib

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 dab tsi, 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.

Txhua yam pauv hloov ntawm daim tawv nqaij ntawm tus neeg tau qhia tias muaj teeb meem sab hauv lub cev. Cov kws kho kaus hniav tshwj xeeb los ntawm cov tsos mob ntawm daim epidermis feem ntau ua kev kuaj mob ua ntej thiab xa tus neeg mob mus rau tus kws tshaj lij tshwj xeeb.

Mob ntshav qab zib mellitus kuj muaj ib hom kev qhia sab nraud, uas yuav tsum yog lub teeb liab rau kev tiv tauj nrog tus kws kho mob lossis kws kho mob tawv nqaij. Cov pob khaus uas mob ntshav qab zib tshwm sim rau tib neeg lub cev ntev ua ntej kev kuaj mob ntawm tus kab mob lossis yuav ua rau muaj tus mob no, txhua tus neeg kawm paub yuav tsum paub.

Kev faib tawm ntawm cov tawv nqaij muaj teeb meem taw qhia cov ntshav qab zib

Raws li qhov tseeb tias cov piam thaj ntau dhau mus ua ke hauv cov hlab ntshav, leeg ntshav thiab hlab ntsha yog qhov raug hloov pauv hauv thawj qhov chaw. Txheej txheem carbohydrate metabolism yog cuam tshuam, uas ua rau cov ua tsis tiav hauv kev muab zaub mov xa mus rau cov kab mob epidermal. Daim tawv nqaij poob nws elasticity, nws ua qhuav, tev tawm.

Cov kev hloov pauv no tej zaum yuav tsis tshwm sim txawv sijhawm ntawm kev txhim kho ntshav qab zib, vim tsis muaj ib daim ntawv ntawm tus kabmob no. Qee lub sij hawm ib tus neeg tsis paub txog qhov teeb meem nrog kev nqus ntawm cov piam thaj, thiab pob xoo ntawm daim tawv nqaij ua lub teeb liab.

Muaj ntau txoj kev xaiv rau kev faib tawm qhov chaw mob txhab ntshav taw ntawm tus mob ko taw. Txawm li cas los xij, tsis muaj ib qho ntawm cov cwj pwm no feem ntau lees txais.

Piv txwv, mob rwj tuaj yeem raug cais raws lawv qhov tob. Lub qhov txhab tob, qhov ntau ntawm theem ntawm tus kab mob thiab qhov siab dua qhov uas txiav tau yuav tsum tau ua.

Qhov txiaj ntsig tsis zoo uas cuam tshuam tias qhov kev tshawb pom yog qhov ua kom tsis muaj ntshav txaus hauv cov ceg vim yog atherosclerosis, uas yog hu ua ischemia.

Lub hauv paus tseem ceeb ntawm koj cov teeb meem ceg yog

thiab paub txog yuav ua li cas kom rov zoo los ntawm cov kev tsis txaus siab no. Nws tuaj yeem kho tau, tsis zoo li dig muag thiab mob raum tsis zoo. Yog tias koj sim, koj tuaj yeem thim kev noj qab haus huv ntawm cov leeg thiab cov hlab ntshav hauv cov ceg. Yuav ua li cas thiaj ua tau qhov no tau piav qhia hauv video. Cov dab neeg zoo ntawm cov neeg mob uas tau tswj kom tsis txhob txiav tawm, thiab tib lub sijhawm muaj lwm yam teeb meem.

Tus Wagner kev faib tawm ntawm kev mob ntshav qab zib taw yog nrov. Nws txheeb xyuas 5 (tiag 6 hauv theem) ntawm tus kab mob no:

0 - pob txha deformation, mob txhab ua ntej,
1 - mob rwj ntawm sab nraud - lub cev nqaij tawv raug mob, tab sis cov nqaij mos thiab nqaij tawv tseem tsis tuaj yeem koom nrog,
2 - mob ncauj plab - pob txha, pob txha thiab pob qij txha yog pom hauv lub qhov txhab,
3 - osteomyelitis - necrosis ntawm pob txha, mob pob txha thiab cov nqaij mos uas nyob ib puag ncig, nrog kev tsim cov kua paug ntau,
4 - kev ua tub sab kis, qhov muag pom ntawm ib thaj chaw me me ntawm ko taw,
5 - kev sib kis tau mob tob tob hauv ko taw, yuav tsum tau txiav tu haujlwm hnyav kom cawm tus neeg mob lub neej.

Kev kuaj mob tseem yuav qhia cov ntaub ntawv ntxiv. Hauv tshwj xeeb, polyneuropathy yog qhov mob ntshav qab zib ntawm cov hlab ntsha. Vim tias qhov poob ntawm cov hlab ntaws hloov pauv, tus mob ntshav qab zib tsis pom tias nws raug mob thiab puas rau ntawm txhais ceg uas nws tau txais thaum taug kev. Yog hais tias cov qhov txhab kho mob tsis raug kho, ces microbes ntau nyob rau hauv lawv thiab tsis ntev nws tawm mus rau kev ua laib.

Ischemic daim ntawv ntawm cov ntshav qab zib taw - qhov kev kuaj mob no txhais tau hais tias cov ntshav ncig hauv ob txhais ceg yog cuam tshuam vim kev txhaws ntawm cov hlab ntshav los ntawm atherosclerotic plaques. Hauv cov xwm txheej zoo li no, qhov txhab kho tau zoo qeeb. Ob txhais ceg yuav muaj ib lub bluish xim. Feem ntau muaj kev loj hlob qeeb ntawm cov ntsia hlau. Cov teeb meem ntawm ischemia tuaj yeem ua ke nrog polyneuropathy.

Yuav muaj dab tsi tshwm sim ntawm cov kab mob ntshav qab zib no?

Qhov kev tsis txaus siab tshaj plaws yog kev lom zem rau menyuam yaus, uas yuav tsum muaj qhov txiav ntawm ntiv tes, ko taw lossis ko taw. Tus neeg mob kuj tuaj yeem tuag vim qaug vim tshwm sim los ntawm cov kab mob pathogenic.

Kev kho kab mob ntshav qab zib yog txhawm rau zam kev tuag, txiav tes taw thiab kev xiam oob khab. Nco ntsoov tias txhais ceg tau txiav txoj cai tsis yog qhov kawg ntawm lub ntiaj teb.

Tom qab nws, koj tuaj yeem hnav cov hnoos qeev thiab coj lub neej tag nrho. Mob ntshav qab zib tuaj yeem ua rau mob nyhav dua, teeb meem loj tiag tiag.

Uas yog, dig muag lossis lub raum tsis ua haujlwm uas yuav tsum tau lim ntshav.

Mob ntshav qab zib mellitus hauv cov menyuam yaus: cov tsos mob, kuaj mob, kho mob, tiv thaiv

Ntshav qab zib mellitus hauv cov menyuam yaus yog ib qho kev mob nyhav rau ntev ntev. Hauv qab no koj yuav paub nws tus yam ntxwv thiab tsos mob yog dab tsi, yuav ua li cas kom paub meej lossis tsis rov ua qhov mob.

Cov kev kho mob tau zoo tau piav qhia txhua yam. Cov ntaub ntawv no yuav pab koj tiv thaiv koj tus menyuam los ntawm kev mob hnyav thiab mob nyuaj.

Nyeem seb cov niam txiv tuaj yeem muab lawv cov menyuam li kev loj hlob thiab loj hlob li cas. Kuj tseem saib txog cov hauv kev tiv thaiv - yuav ua li cas pab txo koj cov kev mob ntshav qab zib thaum tseem yau yog tias koj muaj niam muaj txiv uas muaj mob.

Cov tsos mob thiab cov tsos mob

Cov tsos mob tseem ceeb ntawm tus mob ntshav qab zib txhais ko taw yog txhais ceg mob uas tsis zoo ntev ntev. Yog hais tias muaj cov kab mob phem ntau nyob hauv lawv, ces cov kiav txhab no zoo li ua rau tib neeg txawv txawv.

Thaum tsis muaj kev kho kom zoo, kev kis tau tuaj yeem ua rau neeg vwm. Kev txiav tawm ntawm cov ntiv taw, ko taw lossis tag nrho txhais ceg yuav tsum muaj.

Txwv tsis pub, tus neeg mob tuaj yeem tuag los ntawm intoxication. Ntxiv nrog rau qhov mob txhab, pom tus mob ntshav taw yuav muaj:

calluses
fungal kis ntawm cov rau tes thiab tawv nqaij ntawm taw,
nkaub ntiv tes
ingrown ntsia hlau
tej kab nrib pleb hauv daim tawv.

Qee lub sijhawm muaj mob vim qhov tseeb tias nkawm khau xaiv tsis raug, tsis yog tsim rau txhaws ntawm ob txhais ceg.

Kev puas ntshav txaus vim yog atherosclerosis tuaj yeem ua rau mob heev hu ua sib quas ntus claudication. Yog tias koj muaj kev txhawj xeeb txog mob ceg, nyeem txog tshuaj kho mob ntawm no.

Txawm li cas los xij, nyob rau hauv Feem ntau, tus neeg mob qhov mob rhiab vim ploj vim mob ntshav qab zib neuropathy. Liab, o - cov tsos mob ntawm qhov tawv nqaij los yog tawv muag nrog daim tawv tsis tsim nyog.

Nws txawm tshwm sim hais tias qhov ntsuas kub ntawm thaj tsam mob ntawm ko taw los ntawm kov yog 2 lossis siab dua qib siab tshaj qhov ntawm cov ntaub so ntswg nyob ib puag ncig. Kev mob ntshav tuaj yeem ua rau kub taub hau lossis ua daus no.

Cov yam ntxwv ntawm tus yam ntxwv

Cov theem pib tsis ua rau mob. Ib feem ntawm txoj hlab ntaws txuas tau pov tseg, lawv tsis xa cov kev mob siab, yog li cov neeg pom tias muaj teeb meem nrog lawv cov ceg lig. Thawj qhov pom ntawm tus mob ko taw yog qhia los ntawm kev puas tsuaj yooj yim ntawm txhais ceg hauv cov ntshav qab zib:

calluses
o ntawm cov pob qij txha ntawm cov ntiv tes,
fungal tau mob ntawm ob txhais ceg thiab cov ntsia hlau,
ntsia thawv (onychocryptosis),
qhuav ntawm daim tawv nqaij ntawm tus taw
deformation ntawm cov ntiv tes.

Ischemic daim ntawv

Hauv kev tshwm sim thawj zaug, ischemic daim ntawv ntawm diabetic ko taw syndrome tau tshwm sim los ntawm qhov mob ntawm 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 cov 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).

Kev kuaj mob ntshav qab zib ko taw

Hauv kev txheeb xyuas thaum ntxov, kev kuaj tus kheej yog qhov tseem ceeb. Ib tus neeg yuav tsum ua kev soj ntsuam txhua hnub ntawm lub tsev thiab saib xyuas seb ko taw zoo li cas: ko taw qhuav, xim, deformation ntawm cov ntiv tes. Ib qho ntxiv, nrog kev kuaj mob ntshav qab zib mellitus, tus neeg yuav tsum tau kuaj los ntawm endocrinologist, orthopedist, thiab kws phais vascular.

Kev paub thaum ntxov ntawm tus kab mob ntshav qab zib yog nyob ntawm cov kev kuaj mob ua ntej. Lub tswv yim tswj hwm thiab soj ntsuam cov neeg mob ntshav qab zib tau tsim:

Kev soj ntsuam thaum xub thawj:
- keeb kwm coj, piav qhia ntawm cov tsos mob,
- soj ntsuam
- kev sojntsuam.
Kev ntsuas ntawm lub xeev ntawm lub paj hlwb:
- kev co rhiab
- qhov mob rhiab, kov thiab qhov kub thiab txias,
- qib ntawm kev puas tsuaj rau cov leeg nqaij,
- peripheral hlab ntsha lub xeev siv hluav taws xob electromyography.
Kev tsom xam ntawm lub xeev ntawm cov hlab ntsha:
- Dopplerometry
- dopplerography.
Xoo hluav taws xob ntawm qhov kawg (qhov kev puas tsuaj ntawm kev pom nyob ntawm xoo hluav taws xob).
Kev kuaj sim:
- ntshav qab zib
- kuaj mob bacteriological thiab ntshav dav dav.

Cov neeg mob uas muaj kev pheej hmoo siab ntawm kev tsim cov ntshav qab zib taw yuav tsum tau pom tsis yog nyob ntawm endocrinologist-diabetologist, tab sis kuj ntawm tus kws tshaj lij, kws phais vascular, orthopedist. Lub luag haujlwm tseem ceeb hauv kev txheeb xyuas qhov hloov pauv tau muab rau kev kuaj tus kheej, lub hom phiaj yog txhawm rau txhawm rau lub sijhawm paub txog tus yam ntxwv ntawm tus mob ko taw: qhov hloov xim tawv nqaij, qhov tsos ntawm lub cev qhuav, o thiab mob, curvature ntawm cov ntiv tes, kab mob fungal, thiab lwm yam.

Kev kuaj mob ntawm tus mob ntshav qab zib txhais tau tias yog mus kuaj qhov mob ntawm cov ntshav qab zib mellitus, kuaj xyuas tus taw nrog qhov txiav txim pob qij taws-txha caj dab thiab ntsuas qhov ntsuas, thiab ntsuas kev sim qhov muag, kev xav thiab qhov kub.

Kev saib xyuas tshwj xeeb tshaj yog nyob rau hauv cov ntshav qab zib mob ko taw tau muab rau cov ntaub ntawv kuaj ntsuas - ntsuas cov ntshav qabzib, glycosylated hemoglobin, cov roj cholesterol, lipoproteins, qhov muaj suab thaj thiab ketone lub cev hauv cov zis.

Nrog ib daim ntawv ischemic ntawm tus mob ko taw, ultrasound ntawm cov hlab ntsha ntawm qhov qis qis, xoo hluav taws xob tsis sib xws ntawm angiography, thiab peripheral CT arteriography yog ua. Yog tias qhov mob osteoarthropathy xav tau, xoo hluav taws xob xoo hauv 2 qhov kev ntsuas, kev ntsuas duab xoo hluav taws xob thiab duab hluav taws xob ultrasound. Lub xub ntiag ntawm peptic rwj yuav tsum tau txais cov txiaj ntsig ntawm kev tseb ntawm qhov sib cais hauv qab thiab cov npoo ntawm qhov txhab ntawm microflora.

Yuav tau kho li cas?

Cov kev kho mob yuav ua li cas nyob ntawm qhov mob hnyav ntawm cov txheej txheem. Tus neeg mob tsis muaj mob txhab, muaj kev tos txais, twv ua ntej kom nce ntxiv.

Tab sis txawm tias tom qab pom qhov teeb meem thawj cov ceg ntawm txuam nrog kev nkag siab zoo, nws yog ib qho tseem ceeb kom pib kho cov kev kho mob kom raws sij hawm txhawm rau kho kom muaj kev noj qab haus huv. Kev kho mob ntawm ko taw mob ntshav qab zib nrog tshuaj ntsuab tshuaj yog ua tau tsuas yog nyob rau hauv thawj zaug thiab nrog kev tso cai los ntawm kws kho mob.

Kev kho mob ntshav qab zib taw yog nqa tawm hauv ntau qhov kev qhia:

piam thaj metabolism tswj,
kev phais mob ntawm qhov txhab,
noj tshuaj tua kab mob
tshem tawm cov cheeb tsam cuam tshuam thaum taug kev,
kev soj ntsuam txhua hnub, ua raws li cov cai ntawm kev saib xyuas ko taw.

Qee cov kauj ruam tsim nyog tuaj yeem ua rau hauv cov chaw kho mob tshwj xeeb, tab sis kev kho mob tseem ceeb yog nyob hauv tsev. Pom tseeb, koj yuav tsum sim coj cov piam thaj kom ze rau ib txwm muaj li sai tau.

Nyeem cov lus "Yuav Ua Li Cas Kom Cov Ntshav Qab Zib Ntawm Cov Ntshav Qab Zib" kom ntxaws. Thaum muaj lub qhov txhab mob uas kho tau, yuav tsum tau kho mob li kev phais mob.

Koj tsis tuaj yeem txwv kev noj tshuaj tua kab mob yam tsis muaj kev koom tes ntawm tus neeg phais. Nws yuav tsum tshem tawm tag nrho cov ntaub so ntswg uas tsis siv neeg ua haujlwm.

Cov neeg mob tau qhia kev tshuaj xyuas txhua hnub thiab saib xyuas ntawm lub qhov txhab kom txog thaum nws kho kom zoo. Qhov no yog ua los ntawm cov kws tshwj xeeb uas ua haujlwm hauv chaw ua haujlwm ntawm tus mob ko taw.

Ntau hom kab mob tuaj yeem ua rau mob txhab thiab mob ko taw. Ua ntej, nrog kev pab los ntawm kev tsom xam, lawv txiav txim siab seb tus kab mob microbes tsim teeb meem dab tsi, thiab tom qab ntawd cov tshuaj tua kab mob tau sau tseg uas ua haujlwm zoo rau lawv.

Universal tshuaj nrog rau kev pom dav ntawm qhov kev txiav txim siab pab nyob rau hauv tsis pub tshaj 50-60% ntawm cov neeg mob. Cov ncauj lus kom ntxaws qhia txog tshuaj tua kab mob tsis nthuav tawm nyob rau nplooj ntawv no thiaj li tsis txhawb nqa cov neeg mob siv tshuaj rau tus kheej.

Qhov tsis zoo tshaj plaws, yog tias tus mob ntshav qab zib tau tawm tsam los ntawm cov kab mob uas tau tsim kho cov tshuaj niaj hnub no.

Kev ntub dej hiav txwv, phlegmon, mob plab kem tob tob yog cov kev mob nyhav heev uas yuav tsim kev puas tsuaj rau lub neej lossis kev nyab xeeb ntawm tus ceg ntawm tus neeg mob. Rau lawv txoj kev kho mob, feem ntau yuav tsum tau muab tshuaj tua kab mob tso rau hauv lub tsev kho mob.

Kev vam meej yog nyob ntawm kev kho lub qhov txhab kom zoo. Hauv cov mob hnyav dua li, cov ntsiav tshuaj tua kab mob tau noj hauv tsev los kho mob ko taw.

Tus kws kho mob yuav tsum ua tib zoo kho lawv cov koob tshuaj, suav nrog qhov tseeb tias tus mob ntshav qab zib yuav mob raum.

Immobilizing paug hnav khaub ncaws

Lub tswv yim tseem ceeb ntawm kev kho mob ntshav qab zib ko taw yog: kev kho cov teeb meem carbohydrate metabolism thiab ntshav siab, tsis xoom ntawm cov ceg ntawm qhov cuam tshuam, kev kho mob hauv zos ntawm qhov txhab, kev siv tshuaj tua kab mob, thiab yog tias tsis muaj txiaj ntsig, kev kho mob phais.

Txhawm rau ua kom zoo dua qib ntawm glycemia hauv hom 1 mob ntshav qab zib mellitus, ib qho tshuaj insulin raug kho, hauv ntshav qab zib hom 2, tus neeg mob pauv mus rau tshuaj insulin. Β-blockers, ACE inhibitors, calcium antagonists, diuretics yog siv los ua kom ntshav siab.

Nyob rau ntawm qhov muaj mob purulent-necrotic lesions (tshwj xeeb tshaj yog nrog neuropathic daim ntawv ntawm cov ntshav qab zib ko taw), nws yog ib qho tsim nyog los xyuas kom cov tsoomfwv ua haujlwm ntawm cov ceg tawv uas muaj kev cuam tshuam los ntawm kev txwv kev txav, siv cov pas nrig lossis lub rooj muaj log, tshwj xeeb orthopedic li, insoles lossis khau.

Lub xub ntiag ntawm ulcerative tsis xws luag nyob rau hauv mob ko taw mob syndrome yuav tsum tau kho txoj kev kho mob ntawm lub qhov txhab - kho ntawm daim ntaub necrotic, kev hnav khaub ncaws siv cov tshuaj tua kab mob thiab tshuaj tua kab mob.

Ua rau mob ntshav qab zib taw

Qhov laj thawj tseem ceeb ntawm kev loj hlob ntawm tus mob ko taw mob ntshav qab zib yog mob ntshav qab zib hyperglycemia, uas ua rau nws tus kheej txuas ntxiv kom cov ntshav qab zib ntau ntau. Nws yog cov nyiaj them rau cov ntshav qab zib tsis txaus uas ua rau muaj kev txhim kho rau txhua tus mob ntshav qab zib, suav nrog kev puas tsuaj rau ceg.

Kev siab ntxiv ntawm cov piam thaj hauv cov ntshav ua rau phab ntsa ntawm cov hlab ntshav, ua rau muaj kev puas tsuaj rau cov hlab plawv cov ntshav ntau heev. Tshwj xeeb tshaj yog cov neeg tuag yog qhov ua rau cov ntshav qab zib ntawm cov kab ke ntu ntshav, uas cuam tshuam cov ntshav hauv cov ntshav sab saud thiab sab qis.

Raws li qhov no, cov ntaub so ntswg ntawm ob txhais ceg pib muaj qhov tsis zoo ntawm cov pa oxygen thiab cov as-ham, uas ua rau lawv kawm tiav necrosis. Cov ntshav ncig tsis txaus kuj ua rau kev puas tsuaj ntawm cov hlab ntaws, uas ua rau cov ceg ntawm lub cev tsis zoo thiab ua rau lawv raug rau ntau yam kev raug mob, txiav, pob txha taub hau, deformations, kub hnyiab thiab frostbite.

Ua rau mob ko taw mob ko taw:

Angiopathy - kev puas tsuaj rau cov hlab ntsha ntawm lub plawv,
Neuropathy - rhuav tshem ntawm peripheral hlab ntsha xaus,
Neuroosteoarthropathy - ntau yam kab mob pob txha: txha, txha, txha, kev sib koom tes, muaj pob txha tsis muaj zog, kab mob pob txha,
Kev raug mob hnyav ntawm ko taw, provoking nws deformation,
Kis thiab kab mob ntawm daim tawv nqaij mob
Ib qho tseem ceeb tsis muaj zog hauv kev tiv thaiv kab mob, ob leeg dav dav thiab hauv ib cheeb tsam.

Cov cai tswj kev xaiv khau rau mob ntshav qab zib

Ntawm qhov tshwj xeeb tseem ceeb hauv kev tiv thaiv tus mob ko taw yog txoj cai xaiv ntawm nkawm khau. Txawm tias qhov tsis yooj yim me ntsis thaum hnav yuav ua rau muaj kev phom sij rau ntshav qab zib, xws li kev tsim ntawm qhov tsis ua haujlwm rau qhov mob tsis zoo thiab ua kom lub cev tsis zoo.

Thaum xaiv cov khau, koj yuav tsum muab kev nyiam rau cov qauv xis ua los ntawm cov ntaub ntawv ntuj uas tso cai rau ko taw ua pa. Qhov no yog qhov tseem ceeb rau cov ntshav qab zib, vim tias qhov kev ua txhaum ntawm lub tshav kub hloov thiab tawm hws ntau dhau tuaj yeem ua rau kev txhim kho ntawm tus mob fungal.

Tsis tas li ntawd, rau kev tiv thaiv thiab kho tus mob ntawm ko taw tsis zoo, tus neeg mob tuaj yeem siv cov kab orthopedic uas tshwj xeeb uas muab kev nplij siab thiab kev tiv thaiv rau ceg. Cov insoles tuaj yeem ua ntau yam ntaub ntawv, suav nrog silicone thiab gel, ntxiv rau muaj cov zaws khaub ncaws thiab cim xeeb.

Yuav ua li cas xaiv cov khau haum:

Nkawm khau rau cov neeg mob ntshav qab zib yuav tsum muaj qhov tsawg kawg ntawm cov stitches thiab zoo dua yog tias lawv yuav luag tsis pom. Cov kev xaiv zoo tshaj plaws yog khau tsis duav,
Qhov dav ntawm nkawm khau yuav tsum me ntsis dav dua qhov dav ntawm tus taw ntawm tus neeg mob,
Cov khau yooj yim tshaj plaws rau cov ntshav qab zib yog cov khau nrog lacing lossis Velcro, uas ua rau nws yooj yim los kho nws lub ntim,
Cov khau rau ntshav qab zib yuav tsum tsis txhob laced hla kev sib haum, tab sis nyob rau hauv parallel,
Xaiv cov khau rau cov ntshav qab zib yuav tsum tau muab kev nyiam rau cov qauv nrog lub cev ruaj khov nrog cov yob,
Sab saum toj ntawm cov khau thiab nws txoj kab yuav tsum tau ua los ntawm cov khoom siv muag muag muag,
Thaum nriav khau, cov neeg mob ntshav qab zib yuav tsum them sai sai rau qhov muaj cov ntim ntxiv tsim nyog rau kev txuas ntawm orthopedic insole,
Cov khau zoo yuav tsum muaj lub qhov muag xis nyob hauv tsawg kawg 1 cm tuab,
Mus yuav nkawm khau tshiab yuav zoo dua tom qab noj su. Nyob rau tam sim no, tus neeg mob ob txhais ceg yuav o me ntsis, thiab nws tuaj yeem xaiv cov khoom me me kom raug,
Yog hais tias tus neeg mob muaj qhov tsis txaus siab ntawm lub taw, tom qab ntawd kom xaiv qhov loj me koj yuav tsum tsis txhob ntsuas khau ntawm ko taw, tab sis nws yog qhov zoo dua los ntxig rau tus taw kev contour yav tas los txiav los ntawm cardboard,
Thaum kuaj pom tus mob deformity hauv tus neeg mob, nws yog qhov yuav tsum tau nrhiav kev pab ntawm cov kws tshwj xeeb rau kev tsim khoom ntawm tus kheej orthopedic insoles.

Ntshav qab zib ko taw prophylaxis

Lub hauv paus rau kev tiv thaiv kab mob ntshav qab zib yog txoj kev kho mob ntshav qab zib mellitus, uas yog kev soj ntsuam cov ntshav qab zib kom tsis tu ncua. Nws yog qhov zoo tshaj plaws yog tias cov piam thaj hauv lub cev yuav ze rau qhov qub ib txwm muaj thiab tsis ntau tshaj 6.5 mmol / L.

Txhawm rau ua qhov no, tus neeg mob yuav tsum txhaj tshuaj insulin txhua hnub lossis noj tshuaj uas tsis muaj piam thaj. Ib qho ntxiv, txhawm rau kho cov ntshav qab zib kom ntau, tus neeg mob yuav tsum ua raws li cov zaub mov muaj roj tsawg thiab ua kom ib ce muaj zog tas li.

Qhov tseem ceeb tseem ceeb yog kev saib xyuas ko taw kom zoo, uas yuav tsum sib txawv ntawm qhov tau txais los ntawm cov neeg ib txwm. Nrog rau cov txheej txheem kev tu cev no, nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias qhov rhiab ntawm ko taw yog pom meej txo qis hauv cov ntshav qab zib, uas txhais tau tias lawv tsis tuaj yeem ntsuas tus mob lossis qhov kub tau.

Ib qho ntxiv, cov neeg muaj ntshav qab zib siab yuav tsum zam kom raug mob ntawm daim tawv nqaij ntawm lawv ob txhais ceg, vim tias muaj ntshav qab zib, cov qhov txhab zoo kho tsis zoo thiab kis tau yooj yim. Qhov no tuaj yeem ua rau kev tsim cov kabmob ntawm trophic mob rau cov nqaij mos thiab cov nqaij mos necrosis, thiab yav tom ntej ua rau qhov muaj povtseg.

Cov Cai Saib Xyuas Ko Taw:

Ntxuav ko taw nrog ntshav qab zib yuav tsum yog dej sov thiab dej xum txhua hnub. Tsis txhob txhuam koj ob txhais taw nrog ib txoj phuam ntxuav muag, txwv tsis pub nws tuaj yeem ua rau raug mob,
So cov taw nrog cov phuam huv muag muag, maj mam muab so dej. Nws yog ib qho tseem ceeb kom ntxuav cov tawv nqaij ntawm cov ntiv tes, vim tias nws muaj qhov ncauj mob feem ntau tshwm sim,
Cov neeg mob ntshav qab zib tsis pom zoo kom siv da dej kub lossis txias, lossis los so taw lawv txhais taw lossis muab dej sov so nrog lub ncoo kub. Yog hais tias tus taw tau ploj mus rhiab, tom qab ntawd ua ntej koj mus rau hauv da dej koj yuav tsum kuaj xyuas qhov kub ntawm dej los ntawm txhais tes,
Hnav tsuas yog thom khwm huv si, thom khwm lossis cov ris tsho zoo nkauj txhua hnub. Hauv qhov no, koj yuav tsum yuav cov thom khwm tsis muaj nqaws thiab tsis muaj nruj ywj. Cov thom khwm yuav tsum nyob ruaj khov, suav nrog tsis muaj qhov xaws los yog lub qhov taub,
Hnav thom khwm rau cov neeg mob ntshav qab zib txawm nyob hauv tsev, lossis zoo dua, cov khau khiab muag. Cov neeg mob ntshav qab zib tsis pom zoo kom taug kev liab qab kom tsis txhob ua rau tus leeg ntawm lawv ob txhais ceg. Taug kev ntawm qhov chaw kub, xws li kub xuab zeb, tshwj xeeb tshaj yog muaj teeb meem,
Cov khau yuav tsum sib phim txhua lub caij. Ob txhais ceg ntawm cov ntshav qab zib yuav tsum tsis txhob pub kom khov lossis tawm hws,
Koj yuav tsum xaiv khau kom xis nyob nrog tus tuab tuab. Txwv tsis pub cov khau los yog rub. Kaw cov khau yuav tsum ib txwm hnav nrog cov thom khwm,
Nkawm khau lossis khau khiab yog qhov zoo tshaj plaws kom tsis txhob hnav txhua. Cov phom sij tshwj xeeb tshaj yog muaj hlua nrog txoj siv ntawm tus ntiv tes xoo thiab ntiv taw thib ob,
Ua ntej koj rau koj nkawm khau, koj yuav tsum kho qhov insole tas li thiab tshem cov pob zeb thiab lwm yam khoom uas tshaj uas tuaj yeem rub koj txhais ko taw thiab ua rau mob txhab,
Nws yog ib qho tsim nyog los tiv thaiv daim tawv nqaij ntawm ob txhais ceg txawm tias los ntawm qhov kev raug mob me me. Thaum mob kaus hniav los yog ceg tawv, koj yuav tsum tsis txhob saib lawv tus kheej, tab sis nws zoo dua yog nrhiav kev pab ntawm kws kho mob,
Tsis txhob kho cov qhov txhab nrog cov kab mob hnyav xws li iodine, lub ci ntsa iab ntsuab lossis dej cawv. Nws zoo dua rau ntub lawv nrog miramistin, chlorhexidine lossis dioxidine, thiab tom qab ntawd muab cov khaub ncaws huv rau ntawm qhov chaw raug mob,
Txiav koj cov rau tes kom zoo zoo. Qhov no yuav tsum tau ua nyob rau hauv txoj kab ncaj nraim, tsis xav txiav tawm lub ces kaum ntawm tus ntsia thawv. Yog hais tias tus ntsia thawv phaj pib ua tuab, ces ua ntej txiav nws yuav tsum ua tiav nrog ntawv,
Txhua hnub ntub cov taw nrog lub qab zib tshwj xeeb rau cov ntshav qab zib, uas pab txhawm rau txhim kho kev mob ntawm daim tawv nqaij, nce ntshav thiab tiv thaiv ob txhais ceg los ntawm kev kis kab mob,
Txhua thaum yav tsaus ntuj, ua tib zoo tshuaj xyuas lub taw rau qhov puas tsuaj, xws li txhav, raug mob me thiab raug txiav.

Ce & Massage

Kev mus ko taw zaws rau cov ntshav qab zib pab kom ntshav khiav zoo nyob rau hauv ob txhais ceg, daws cov leeg mob thiab txhim kho kev sib koom tes, uas tiv thaiv lawv ntawm kev deformation. Zaws taw yuav ua tau ntawm nws tus kheej lossis los ntawm kev pabcuam rau tus pabcuam tshwjxeeb.

Zaws rau kev tiv thaiv kab mob ntshav qab zib yuav tsum tau ua nrog kev tshem tawm maj mam, zam kev tawv nqaij. Txhawm rau tshem tawm kev puas tsuaj rau ntawm daim tawv nqaij, thaum zaws, nws yuav tsum siv roj zaws lossis pleev.

Tom qab qhov zaws tiav tiav, koj yuav tsum ntxuav koj txhais taw nrog dej sov, so qhuav nrog phuam muag muag, roj nrog cov qab zib uas tiv thaiv kev txhim kho cov taw taw thiab muab thom khwm huv si.

Kev tawm dag zog lub cev yog tseem tuaj yeem muaj txiaj ntsig kev noj qab haus huv hauv cov ntshav qab zib. Muaj lub sijhawm them tag nrho rau cov taw, uas pab ntxiv dag zog rau cov leeg, rov qab sib koom ua ke, nce siab thiab nce ntshav ntxiv.

Ib ce ntawm lub taw:

Zaum ntawm ib lub rooj zaum, ncab koj ob txhais ceg nyob pem hauv ntej ntawm koj thiab muab tso rau ntawm koj luj taws. Tam sim no rub lub thom khwm rau koj, thiab tom qab ntawd deb ntawm koj.
Kuj tseem zaum saum lub rooj zaum, khoov koj lub hauv caug thiab tso lawv ua ntej. Tom ntej no, koj yuav tsum cais cov thom khwm, kom deb li deb tau, thiab tom qab ntawd dua los txo qis. Hauv qhov no, lub luj taws yuav tsum tau sib koom ua ke.
Tsa ob txhais ceg thiab tuav nws qhov hnyav kom ua kev voj voog ntawm ko taw, ua ntej nws thawb moos, thiab tom qab ntawd suav rov qab.
Hloov nyem thiab ntiv taw ntiv taw.

Txhawm rau kom tsis txhob muaj qhov phom sij txaus ntshai xws li mob ntshav qab zib ko taw, kev tiv thaiv ntawm uas yuav tsum tau siv zog hnyav, nws yog qhov yuav tsum tau tso pov tseg txhua qhov kev coj ua tsis zoo. Ua ntej tshaj plaws, qhov no txhawj xeeb txog kev haus luam yeeb, uas cuam tshuam rau qhov kev tsis txaus siab ntawm cov ntshav ncig.

Kev haus luam yeeb yog ib qho ntawm cov laj thawj tseem ceeb rau kev txhim kho vascular atherosclerosis thiab thrombophlebitis, uas cuam tshuam cov ntshav ncig hauv lub cev. Kev haus luam yeeb txhua hnub ntawm txawm tias me me ntawm luam yeeb, pab txhawb kev txhaws ntawm cov hlab ntshav, tshwj xeeb tshaj yog nyob rau hauv qis qis thiab pab txhawb kev tsim cov ntshav qab zib taw.

Cov dej cawv haus cawv kuj tseem cuam tshuam rau cov ntshav qab zib mellitus, vim lawv ua rau muaj ntshav qab zib kom tsawg. Namely, qhov tsis txaus ntseeg tso ntshav qab zib cov ntshav ua rau kev loj hlob ntawm txhua yam kev cuam tshuam hauv ntshav qab zib, suav nrog ko taw mob ntshav qab zib.

Tus kws tshaj lij los ntawm daim yeeb yaj kiab hauv tsab xov xwm no yuav tham txog cov hau kev ntawm kev tiv thaiv thiab qhov xwm txheej ntawm tus mob ko taw.

Vim li cas ntshav qab zib taw ho hlob tuaj?

Kev txhim kho ntawm tus mob ntshav qab zib taw yog ua ntej los ntawm cov kab mob ntshav qab zib mus ntev ntev li ntawm 15-20 xyoo thiab muaj lwm cov teeb meem uas tshwm sim vim tsis them nyiaj zoo los ntawm hom 2 lossis hom 1 ntshav qab zib.

Cov laj thawj tseem ceeb ua rau pom qhov tshwm sim ntawm cov kab mob no yog:

Kev swb ntawm cov hlab ntshav ntawm qis dua - ntev ntev hyperglycemia ua rau kev hloov pauv ntawm cov phab ntsa ntawm cov hlab ntshav ntawm ntau yam calibers.
Ntshav qab zib Angiopathy thiab Neuropathy - kev hloov pauv ntawm cov hlab ntsha ua rau muaj kev txo qis hauv lawv lub cev kev ywj pheej, kev sib haum xeeb, nrog rau ua rau stagnation thiab nce ntshav viscosity. Raws li qhov tshwm sim ntawm vascular pathology, muaj qhov poob qis, thiab tom qab ntawd ua tiav qhov kev tsis txaus ntseeg ntawm qhov kawg ntawm cov hlab. Cov txheej txheem no ua rau txo qis kev sib koom tes, uas ua rau lub nra tsis raug ntawm ko taw. Nyob rau hauv lub neej yav tom ntej, nws kev hloov kho thiab kev txhim kho mob ntshav qab zib osteoarthropathy lossis Charcot tus mob tshwm sim.
Cov kab mob tua tau - tiv thaiv keeb kwm yav dhau los ntawm kev hloov neurotrophic ntawm cov nqaij mos, ua ke nrog kev tiv thaiv kab mob txo qis, txhua qhov kev raug mob ntawm daim tawv nqaij ua rau cov txheej txheem ulcerative uas nyuaj kho thiab tsis kho ntev. Feem ntau cov qhov txhab muaj tus kab mob staphylococcus lossis tus mob anaerobic, uas ua rau muaj kev sib kis ntawm cov txheej txheem thiab kev tsim cov necrosis. Hauv qhov xwm txheej no, muaj kev txaus ntshai ntawm qog, phlegmon lossis gangrene.

Kev raug ntsia hlau, rau tes, tawg rau hauv pob luj taws lossis mob txhab ntawm cov ntsia hlau phaj kuj tuaj yeem ua rau muaj kev txhim kho rau tus mob ntshav qab zib taw.

Thawj qhov tsos mob thiab tus mob

Cov tsos ntawm kev hloov pauv ntawm daim tawv nqaij ntawm tus taw lossis cov ntsia hlau, thiab ntxiv rau qhov txo qis rhiab, yog qhov kev mob tsis zoo hais txog kev txhim kho ntshav qab zib muaj teeb meem.

Thawj yam qhia paub ntawm tus mob ko taw:

txo qis lossis plam ntawm txhua yam kev rhiab (tactile, mob, qhov kub),
tsis xis nyob rau hauv kev paub thiab yav tas los xis khau,
tsim ntawm corns thiab corns,
ntsia pom ntawm tus ntsia thawv ingrown,
ntsia thawv ntsia hlau phaj,
o thiab tshem tawm ntawm txhais taw rau qhov tsis muaj qhov pom tseeb,
tawv nqaij qhuav, nrog los ntawm tev,
kev tsis kaj siab nyob rau hauv ob txhais ceg nyob rau hauv daim ntawv ntawm tingling, loog, kev xav ntawm "nkag mus creeps."

Cov yam ntxwv ntawm kev kho mob tshwm sim ntawm tus mob ko taw yog qhov muaj qhov tsis zoo rau qhov mob hu ua, nqaij tawv lossis mob rau ntawm sab qis. Yog hais tias muaj tus mob tshwm sim, txoj kev ua tau los ntawm cov tshuaj ntxuav kom huv, nrog tus ntxhiab tsw phem.

Kev mob siab rau ntawm cov ceg, ua phem rau ntawm lub nra, hloov mus rau sab nraud, dhau los ua ib qho kev cuam tshuam rau cov kev hloov mus los. Kev ua txhaum ntawm cov ntshav khiav hauv ko taw provokes o ntawm nqua, raws li cov txiaj ntsig ntawm qhov tawv nqaij ntawm txhais ceg tau txais qhov pleev plhu thiab qhov ci tshwj xeeb. Tsa pluag, tingling hauv nqua los ua tas mus li.

Tsawg tsawg zaus, nrog kev kho tsis raws sijhawm lossis kev kho mob tsis txaus, cov txheej txheem tuaj yeem nyuaj los ntawm kev txhim kho ntawm Charcot tus taw, uas muaj kev puas tsuaj ntawm cov pob qij txha me me ntawm ko taw thiab pob taws qij txha. Qhov txheej txheem pathological no tsis yog sib kis thiab ib sab.

Ntshav qab zib taw kev faib tawm

Nyob ntawm tus kis ntawm qee qhov kev soj ntsuam mob, cov ntawv hauv qab no yog qhov txawv ntawm kev faib tawm ntawm tus mob ko taw:

Ischemic daim ntawv (txog li 10% ntawm cov neeg mob) - cov tsos mob tseem ceeb yog kev ua txhaum ntawm cov ntshav ntws hauv ko taw vim kev puas tsuaj rau cov hlab ntshav ntawm ntau yam calibers. Hauv qhov chaw kuaj mob ntawm tus kabmob, cov tsos mob tau qhia nyob rau hauv daim ntawv ntawm kev pheej tawv nqaij ntawm tus taw, qhov mob ntawm ob txhais ceg, sib quas ntus claudication, nkees sai ntawm ob txhais ceg, tshem tawm ntawm daim tawv nqaij. Muaj qhov ua kom tsis muaj zog los yog tsis muaj mem tes nyob ntawm ko taw, zoo li lub pallor tas li thiab qhov kev xav txias. Qhov rhiab tseem tshua khaws cia.
Neuropathic daim ntawv (txog 75% ntawm qhov mob) - peripheral hlab ntsha puas tsuaj feem ntau nyob rau hauv daim ntawv ntawm dryness thiab tev ntawm daim tawv nqaij ntawm ko taw, poob qis rhiab, qhov tawm hws tsis zoo, kev tawm hws ua rau lub tiaj tiaj thiab deformation ntawm lub taw. Cov yam ntxwv ntawm tus yam ntxwv ntawm tus kabmob no yog qhov muaj rab txiab thiab pob tob tob hauv ko taw, qhov pom ntawm lub qhov txhab ntawm nws lossis hauv qhov chaw ntawm cov ntiv tes. Cov tawv nqaij sov, qhov tso tawm rau hauv cov hlab ntsha peripheral yog tshwj tseg. Deformation ntawm ko taw, nrog cov leeg mob atrophy, yog sau tseg.
Mixed neuroischemic daim ntawv (txog li 30% ntawm cov mob no) - cov tsos mob ntawm kev puas tsuaj rau cov hlab ntsha xaus thiab vascular network ntawm ko taw. Daim foos no muaj qhov txaus ntshai - qhov tsis muaj qhov mob, uas yog ib lub txiaj ntsig ntawm kev kho mob lig rau cov neeg mob rau tus kws kho mob. Lub xub ntiag ntawm lub qhov txhab loj thiab kev txhim kho ntawm cov txheej txheem tsis tuaj yeem hauv cov ntaub so ntswg ua rau kev saib xyuas kev kho mob ntawm pathology tsis muaj txiaj ntsig.

Wagner F. W Kev Ntsuas Cov Mob Ntshav Qab Zib:

theem pib - qhov tshwm sim sab nraud ntawm tus kabmob raug sau tseg hauv daim ntawv pallor ntawm daim tawv nqaij ntawm tus taw, nrog los ntawm tev, qhov muaj qhov tsis huv thiab deformation ntawm ko taw,
Theem 1 - Qhov tshwm sim ntawm txheej txheem dag sab hauv tawv nqaij,
Theem 2 - kev txhim kho ntawm lub qhov txhab tob tob yam tsis muaj kev puas tsuaj rau cov pob txha nqaij,
Theem 3 - kev vam meej ntawm cov txheej txheem mob hauv siab nrog kev koom tes ntawm pob txha,
Theem 4 - kev txhim kho tus txheej txheem kev ua laib ntawm qhov tsis tshua muaj qhov,
Theem 5 - kev txhim kho ntawm kev coj ua loj.

Txom Txwm Pov

Kev saib xyuas tus kab mob ntshav qab zib yog pib los ntawm kev kho kom zoo ntawm cov metabolism hauv kev ua kom rog, tswj kev tswj cov ntshav qabzib. Raws li kev ntsuas rau ntshav qab zib hom 1, ib qho kev hloov kho tshuaj insulin yog ua tiav. Hauv hom 2 mob ntshav qab zib, nce ntxiv ntawm cov koob tshuaj txo cov ntshav qab zib ntau + cov tshuaj kho mob insulin.

Qhov ntsuas ntshav siab kuj tseem yuav raug kho, rau qhov ib txwm ua uas cov pawg hauv qab no ntawm kev siv tshuaj:

beta-blockers - Nevibolol, Carvedilol,
ACE inhibitors - Burlipril, Captopril,
calcium antagonists - Corinfar, Nicardipine,
diuretics - Hypothiazide, Indapamide.

Nyob ntawm theem ntawm tus kab mob, kev kho mob rau mob ntshav qab zib ua mob ko taw yuav sib txawv. Hauv cov theem pib ntawm tus mob ntshav qab zib taw, kho kev ntsuas yog tsom rau kev txiav qhov kev mob siab, txo tus mob spasm, thiab tseem txhim kho cov nqaij mos. Rau lub hom phiaj no, cov tshuaj hauv qab no tau sau tseg:

antispasmodics thiab cov leeg ua kom cov leeg txo qis qhov mob - Papaverine, Drotaverin,
cov kab mob vascular los yog angioprotectors uas txhim kho microcirculation thiab cov metabolism hauv cov ntaub so ntswg - Pentoxifylline, Venoruton,
cov tshuaj tiv thaiv kab mob uas txhim kho cov metabolism hauv kev ua kom yuag thiab ua rau cov kev ua haujlwm oxidative - Lipoic acid, Tocopherol,
cov tshuaj uas rov qab vascular phab ntsa - Troxerutin, Detralex,
cov tshuaj tua kab mob ntau - Cephalosporins, Macrolides,
detoxification txoj kev kho - kev tso dej num ntawm ntau cov kev daws teeb meem,
tshuaj kho,
kev kho vitamin.

Ntawm qhov tseem ceeb nrog purulent-necrotic qhov txhab ntawm ko taw yog nws cov khoom tsis sib haum nrog kev kho hauv zos. Rau lub hom phiaj no, cov khau tshwj xeeb orthopedic los yog cov insoles, ib tus pas nrig, lub rooj zaum muaj log yog siv los daws kev ntxhov siab los ntawm txhais caj npab cuam tshuam.

Kev kho mob hauv zos ntawm ulcerative teem meem muaj xws li siv ntau yam tshuaj tua kab mob, siv tshuaj tua kab mob thiab tshwj xeeb hydrogel cov ris tsho hnav rau lub qhov txhab. Nws tseem yog qhov yuav tsum tau tshem tawm pob txha thiab pob txha ncig ntawm lub qhov txhab, uas txo cov ntsaws rau ntawm qhov mob taw.

Kev phais mob

Kev phais mob ntawm tus mob ntshav qab zib taw yog siv yog tias tsis muaj kev cuam tshuam los ntawm kev kho txoj kev kho, nrog rau cov cim tseem ceeb hauv kev txhim kho kev mob caj dab thiab cov txheej txheem kis mus rau sab ceg qis.

Kev phais mob ntawm cov hlab ntsha tso cai rau koj kom tsis txhob muaj kev vam meej ntawm tus kab mob thiab rov qab noj cov zaub mov zoo li qub, uas ua rau kho kom sai ntawm daim tawv nqaij tsis xws luag. Txoj kev siv ntau txoj kev phais mob los kho qhov mob ko taw mob ko taw yog:

Kev phais plab - kev tsim cov haujlwm ua haujlwm ntxiv rau cov ntshav ntws siv kev hloov ntshav.
Zais pa angioplasty - kev qhia ntawm cov khoom zais tshwj xeeb rau hauv nws tus kheej txoj hlab nqaim, uas cov tshuab tau pab txhawb nws txoj kev nthuav dav thiab kho kom rov muaj ntshav ntws. Tom qab ntawd, cov ceg ntoo tau muab tso rau hauv lub nkoj uas txum tim rov qab los, uas yog, ua cov hlau uas txwv tsis pub lub nkoj nqaim.
Sympathectomy - tshem tawm qee qhov hlab ntsha hauv lub lumbar nqaj qaum, lub luag haujlwm rau leeg ntshav vau. Cov txheej txheem no nyuaj rau kev ua haujlwm rau cov kws phais neeg thiab feem ntau tsuas yog siv rau qee yam cim.

Ntxiv rau qhov kev phais mob volumetric, hauv kev kho cov qhov txhab ntawm ko taw, kev phais mob "me" yog siv, uas yog, tshem tawm cov ntaub so ntswg, cov tawv nqaij, mob caj dab. Cov haujlwm no yog tsim nyog los ntxuav lub qhov txhab thiab tiv thaiv qhov kis mob ntawm qhov txhab.

Tom qab kev cuam tshuam zoo li no, cov ntshav ntws tau raug kho siv phais vascular. Tab sis yog tias cov txheej txheem ntawm kev kis tus neeg tsis tuaj yeem nres, ces tag nrho txhais taw yuav txiav.

Cov kev kho mob tshiab

Ntxiv nrog rau txoj kev ib txwm ua los kho kev mob ko taw, cov kws kho mob tab tom pib siv cov kev kho tshiab, uas suav nrog:

kev kho lub cev yoj tes taw - kev kho mob ua kom tiav yog siv lub suab ntawm lub suab,
siv qia hlwb,
ntshav dav hlau txoj kev - ib lub qhov txhab raug kho nrog tus nqaj suav nrog ionized ntshav,
biomechanical kev kho mob ntawm qhov txhab.

Cov kev xaiv ntawm kev kho mob rau tus mob ko taw yuav tsum tau txiav txim siab los ntawm tus kws tshaj lij, coj mus rau hauv tus account cov ntaub ntawv lub hom phiaj, theem ntawm kev loj hlob ntawm cov txheej txheem pathological thiab cov tib neeg cov yam ntxwv ntawm lub cev.

Kev saib xyuas ko taw

Cov neeg mob ntshav qab zib mellitus yuav tsum tsis txhob tsuas yog soj qab theem ntawm cov piam thaj hauv cov ntshav, tab sis kuj hla lawv ko taw, vim tias cov ntshav qab zib ua rau muaj teeb meem loj uas tuaj yeem ua rau muaj mob xiam oob qhab. Qhov yuav tsum tau ua ntej rau kev tiv thaiv yog saib xyuas ko taw, muaj raws li cov kev ntsuas hauv qab no:

Nws yog nruj me ntsis tshem tawm taug kev barefoot txhua qhov chaw, suav nrog lub tsev hauv tsev. Qhov no yuav zam ntau yam kev raug mob, xws li txawm tias tus paresis me me lossis txhaj tshuaj rau ntawm txhais ceg tuaj yeem dhau los ua teeb meem loj.
Yog tias cov taw tsis tu tas li, nws yuav tsum siv cov thom khwm woolen. Nyob rau tib lub sijhawm, ywj yuav tsum tsis txhob nruj ceg qis kom tsis txhob cuam tshuam kev ncig dawb. Kev siv ntawm ko taw ua rau lub cev kub hnyiab tau raug tshem tawm, txij li nrog txo qhov kev cuam tshuam qhov kub nyhiab ntawm daim tawv nqaij ntawm tus taw yog tau.
Nco ntsoov ntxuav koj txhais taw txhua hnub nrog chav dej kub, tom qab ntawd ntxuav kom huv, tshwj xeeb tshaj yog hauv cov chaw sib dus.
Kev siv roj txhua hnub ntawm tus taw nrog cov cream tshwj xeeb muaj urea, tsis suav nrog kev ua ntawm ntiv tes.
Nrog kev tawm hws ntau ntawm cov ceg tom qab cov txheej txheem dej, kev siv talcum hmoov lossis hmoov menyuam yaus pom zoo.
Txiav ntawm cov ntsia hlau nrog txiab lossis forceps raug cais tawm hauv kev txiav txim kom tiv thaiv kev raug mob rau daim tawv nqaij. Hauv qhov xwm txheej no, ntaub ntawv ntsia thawv iav siv los ua cov ntsia hlau, nrog tshwj xeeb saib rau cov fab ntawm tus ntsia thawv phaj.
Kev kho pob taws, pob taws qhuav lossis corns yuav tsum tau nqa tawm tsuas yog nrog kev pab ntawm pumice lossis cov ntaub ntawv zoo nkauj. Ua ntej ntog ntawm txhais ceg, kev siv cov kev daws teeb meem tshwj xeeb thiab plasters tshem tawm cov pob txha yog tsis suav nrog.

Kev kho mob kev dhia paj paws

Kev tawm dag zog lub cev rau cov neeg mob ntshav qab zib yog qhov tsim nyog, vim lawv pab tsis tsuas yog kom txo qis cov ntshav qabzib hauv cov ntshav, tab sis tseem ua rau lub cev tiv thaiv. Ua ntej ntawm txhua yam, nws yog dosed taug kev. Ib qho ntxiv, cov kis las hauv qab no muab cov txiaj ntsig zoo:

caij ntoo saum daus
ua luam dej
kev ua si tis qaib
kev ua si ntawm lub rooj ntaus pob tesniv.

Cov kev tawm dag zog tshwj xeeb uas tawm dag zog yuav tsum raug xaiv los ntawm tus kws kho mob txoj kev kho mob nkaus xwb, suav txog tus mob ntawm tus neeg mob thiab theem ntawm kev loj hlob ntawm cov kev mob ntshav qab zib mellitus. Kev siv ntawm kev tawm dag zog qoj ib ce yog nqa tawm hauv lub suab qeeb, maj mam nce lub nra thiab lub sijhawm ntawm cov chav kawm.

Ib qho zoo ntxiv rau cov txheej txheem ntawm kev kho pob txha dhia ua si yog cov kev ua kom nruj, uas kuj tau sau tseg los ntawm cov kws tshaj lij. Txoj hauv kev no los kho tus mob ntshav qab zib ua rau muaj txiaj ntsig zoo ntawm kev txhim kho kev noj qab haus huv ntawm tus neeg mob.

Orthopedic nkawm khau

Nkawm khau rau cov neeg mob ntshav qab zib yuav tsum ua tau raws li qhov tshwj xeeb, vim nws lom zem ntau tiv thaiv qhov txo qis hauv lub neej, uas yog kev tiv thaiv kev txhim kho ntawm kev mob ntshav qab zib. Orthopedic nkawm khau muaj lawv tus kheej cov yam ntxwv, uas tau ua pov thawj hauv daim ntawv hauv qab no:

tsis muaj qhov nyuaj ntawm cov ntiv taw thaj tsam,
txhav (tawv tib leeg),
tsis muaj ntsaws ruaj ruaj hauv qhov khau,
cov ntim ntxiv hauv cov khau rau orthopedic insoles, uas yog xaiv los ntawm tus kws tshaj lij coj mus rau hauv tus lej ntawm cov txheej txheem pathological,
cov khoom lag luam zoo siab rau kev tsim cov khau, suav nrog ua tiav cov npoo sab hauv nrog lawv cov khoom siv kom tiv thaiv kom tsis txhob ua pob khaus.

Kev kho mob kom raws sij hawm pib, kev coj ua nruj ntawm txhua tus kws kho mob cov lus pom zoo rau kev pib tshwm sim ntawm tus mob ko taw mob ko taw, ua rau muaj qhov tsis zoo txog ob qho kev ua neej zoo thiab tus neeg mob lub peev xwm los ua haujlwm. Tab sis yog tias cov txheej txheem nkag mus rau hauv ib qho kev kawm hnyav ntxiv nrog kev tsim ntawm lub qhov txhab ntxaum, qhov kev tshawb pom yuav tsis zoo, vim tias feem ntau cov kev ua txhaum cai no ua rau tus neeg mob lub cev tsis taus.

Pathogenesis ntawm ntshav qab zib taw

Tus txheej txheem ntawm kev loj hlob ntawm SDS yog cov kab hauv qab no:

Kev tsim tawm tsis txaus ntawm cov tshuaj insulin
hyperglycemia (muaj piam thaj ntau hauv cov ntshav),
thaiv ntawm microcirculation ntawm cov ntshav, oxygen thiab lwm yam kab ntawm lub vascular phab ntsa,
kev puas tsuaj ntawm cov hlab ntsha thiab cov txais khoom,
micro- thiab macroischemia ntawm ko taw cov ntaub so ntswg,
qhov tshwm sim ntawm qhov txhab trophic.

Yog li, nrog SDS, kev puas tsuaj rau tag nrho cov ntaub so ntswg ntawm ceg qis dua tshwm sim.

Vim yog cov tshuaj insulin nyob rau hauv cov ntshav qab zib, cov piam thaj hauv cov ntshav nce ntxiv. Qhov no, nyeg, cuam tshuam tsis zoo rau cov xwm txheej ntawm ob lub nkoj me thiab loj:

cov tshuaj tiv thaiv kab mob kis rau ntawm cov hlab ntshav,
week ua edematous,
lub lumen ntawm cov hlab ntsha nqaim.

Raws li cov txiaj ntsig ntawm kev hloov pauv no, cov ntshav ncig tau cuam tshuam thiab ntshav khov ua cov ntshav khov. Cov kev hloov pauv hauv lub cev tiv thaiv kev nkag mus ntawm qhov muaj txiaj ntsig ntawm cov ntsiab lus thiab cov pa mus rau hauv cov hlwb thiab ua rau cov kev cuam tshuam ntawm cov metabolic. Oxygen kev tshaib plab ntawm cov ntaub so ntswg ua rau cov txheej txheem ntawm cell faib thiab provokes lawv lwj.

Ib qho kev nce ntxiv hauv cov piam thaj hauv ntshav kuj tseem ua rau kev puas tsuaj rau cov hlab ntsha - qhov chaw hauv lub cev tsis raug.

Txhua qhov kev ua haujlwm uas tshwm sim hauv cov ntaub so ntswg ntawm ko taw ua rau qhov tseeb tias txhua qhov kev puas tsuaj rau ntawm daim tawv nqaij ua ib qho txheej txheem yooj yim, thiab kho tau ntev. Txhawm rau ua rau mob ntawm ko taw tuaj yeem koom nrog tus kab mob, uas tuaj yeem ua rau kev tsim ntawm gangrene - ntaub so ntswg necrosis.