Mob taw taw raws li ICD-10, ua rau thiab kho mob > Mob ntshav qab zib muaj teeb meem

Thaum muaj ntshav qab zib mellitus, qee zaum qee tus neeg muaj kev noj qab haus huv tsis txaus, cov kab mob ntshav qab zib tau ua kom paub (ICD code - 10). Deterioration tshwm sim, raws li txoj cai, vim qhov ua txhaum ntawm tus neeg mob nws tus kheej. Qhov laj thawj yuav yog tias nws tsis ua raws li kev noj haus tshwj xeeb thiab tsis ua raws li cov kev teem caij tshwj xeeb. E 10.5 - ICD code 10 ntawm mob ntshav taw yog ib qho kab mob txaus ntshai heev uas tuaj yeem ua rau cov nqaij mos (necrosis) mob (nqaij hlav).

Vim li cas rau kev kawm ntawv

Yeej, mob ntshav qab zib taw, ICD code 10 ntawm qhov yog E 10.5, zoo nkaus li vim qhov tsis saib xyuas cov kev cai tsim los ntawm tus neeg mob nws tus kheej. Thaum tus neeg mob tsuas tsis saib xyuas nws kev noj qab haus huv, noj tsis raug, tsis kam kho. Kev coj tus cwj pwm li kev noj qab haus huv tuaj yeem ua rau txoj kev tu siab tas mus.

Tom ntej no uas ua rau muaj mob ntshav qab zib ko taw (ICD 10 E10.5) yog yav dhau los mob thiab raug mob. Tsis tas li ntawd, ntau yam nyob ntawm qhov tshuaj nws tus kheej, nyob ntawm nws qhov zoo thiab nyob ntawm seb qhov tshuaj kho tau yog li cas. Nws yog vim tias txhua yam ntawm cov saum toj no uas cov kab mob ntawm tus mob ko taw tau tsim - qhov kab mob ntawm cov hlab ntsha ntawm qhov qis qis. Feem ntau ntawm cov kev pheej hmoo yog cov neeg muaj ntshav qab zib hom 2.

Rau cov kab mob ntawm cov mob ntshav qab zib taw, cov nqaij ntawm lub ntsej muag puas tsuaj yog tus yam ntxwv. Thaum lawv cov ntawv kis mob, tom qab ntawd ua rau pom muaj qhov muaj zog txaus, uas tuaj yeem tsim mus rau qhov kev ua laib ntawm cov ntshav qab zib ko taw, raws li ICD 10, tus lej muaj E 10-14 nrog tus nqi plaub ntawm 5.

Ib qho ntawm cov ua rau tus kab mob tuaj yeem yog mob ntshav qab zib neuropathy - qhov kev ua txhaum nyob rau hauv cov hlab ntsha ntawm qhov qis qis, uas yog qhov nyuaj los ntawm kev kis kab mob.

Cov qauv ntawm tus kabmob

Hauv qhov no, thaum ntxov li 90s, thawj International Symposium tau tuav, uas tau mob siab rau tsuas yog xav txog qhov tshwm sim ntawm tus mob ko taw. Thaum kawg, kev faib tawm kev sib cais ntawm tus kab mob tau tsim thiab nws cov hom kev vam meej tau pom.

Nws muaj cov ntaub ntawv ntawm tus kabmob:

Neuropathic - ua rau muaj kev cuam tshuam ntawm cov hlab ntshav ntawm lub paj hlwb. Nws ua tau nws tus kheej xws li o, mob, rhuav tshem cov ntaub so ntswg articular.
Ischemic - qhov tshwm sim ntawm atherosclerotic ces, vim tias cov ntshav ncig hauv qhov qis qis yog cuam tshuam.
Neuroischemic, zoo dua lub npe hu ua sib xyaw. Daim foos no suav nrog cov tsos mob ntawm ob yam ua ntej ntawd.

Thaum kuaj pom ib qho ntawm cov kab mob, koj yuav tsum tsis txhob tus kheej noj tshuaj thiab kho cov tshuaj lom neeg ib txwm muaj. Raws li kev coj ua qhia, cov hau kev no tsis ua haujlwm tau zoo thiab qee qhov tuaj yeem ua tus nrawm ntawm kev txhim kho kab mob.

Feem ntau muaj ntshav qab zib muaj ib daim ntawv neuropathic, me ntsis tsawg dua - neuroischemic. Qee qhov tsis tshua muaj, daim ntawv ischemic tshwm sim. Yog li, ua ntej pib ua kev kho mob, ib tus kws kho mob tshwj xeeb yuav tsum txiav txim siab ntawm daim ntawv ntawm tus kab mob thiab, ntawm lub hauv paus ntawm no, ua tiav nrog kev kho.

Vim li cas teeb meem ho tshwm sim?

Thaum lub sijhawm ua txhaum kev mob ntshav qab zib mellitus ntawm tus mob ko taw (ICD - 10 E 10.5), dhia hauv ntshav qab zib tau tshwm sim, qhov no tau txaus ntshai, tshwj xeeb yog tias muaj qhov tshwm sim tsis hloov mus ntev. Kom cov ntshav qab zib ntau cuam tshuam tsis zoo rau cov leeg ntshav hlab ntshav. Ua ntej, capillaries raug kev txom nyem, lawv maj mam pib tuag, tom qab tus kab mob cuam tshuam rau cov hlab ntsha loj. Txhua yam no cuam tshuam rau cov ntshav ncig. Vim tias qhov no, rov qab tshwm sim, uas nrog cov ntaub so ntswg necrosis.

Qhov xwm txheej no thab plaub los ntawm qhov tseeb tias txhais taw yog ib tus nquag ua haujlwm ntawm lub cev, nws nyob tas li rau hauv kev txav, nws pheej cuam tshuam los ntawm kev ntxhov siab. Qhov no ntawm tib neeg lub cev yog raug mob ntau zaus. Kev pheej hmoo loj ntawm kev txhim kho tus kab mob yog txuas nrog cov roj hmab, nqaim, tsis khaus khau, lossis khau ua los ntawm cov xov hluavtaws.

Qee lub sij hawm tib neeg yuav tsis pom cov kab nrib pleb me me, txiav, khawb, tawg, ua pob thiab txawm tias muaj pwm, tag nrho cov no tau txais txiaj ntsig zoo ntawm kev nce hauv qhov txhab, txij li thaum tsis muaj ntshav txaus, txoj haujlwm tiv thaiv hauv thaj chaw uas puas tsuaj tsis ua haujlwm. Qhov tshwm sim ntawm cov teebmeem zoo li no tau tshwm sim hauv kev kho tsis tau ntev ntev, thiab nrog kev kis tus kab mob, cov hlwv loj, uas tuaj yeem nyuaj ua kom tsis muaj kev rau txim, tsuas yog zam kev kho thaum pib.

Nrog kev tsim ntawm tus mob taw, nws yog qhov tsis tshua muaj peev xwm ua kom tshem tawm tus kabmob, yog li ntawd, raws li txoj cai, nws dhau los ua mob ntev. Vim tias qhov no, tus neeg mob yuav tsum ua raws li kev noj zaub mov noj, nruj ua raws li cov ntawv sau thiab txhua yam uas tus kws kho mob yuav qhia. Yog tias koj muaj teeb meem, koj yuav tsum tau hu rau lub tsev kho mob sai.

Neuropathic

Txhua daim ntawv ntawm cov kabmob muaj qhia los ntawm cov tsos mob tshwm sim. Piv txwv, neuropathic yog tus cwj pwm los ntawm qhov txo qis hauv qhov rhiab ntawm ko taw, qhov tsim ntawm caj dab rau lawv thiab deformation. Thaum hloov mus rau daim ntawv hnyav nyob hauv thaj chaw uas lub pob ntseg mob, mob rau sab hauv, uas pom qhov txawv los ntawm cov qauv sib npaug.

Mob taw rau taw (ICD-10 code: E10.5, E11.5)

Cov phiaj xwm kev kho mob suav nrog supravenous irradiation ntawm cov hlab ntsha hauv qhov kev tshaj tawm ntawm lub cev ulnar fossa, mob plab aorta, femoral thiab popliteal neurovascular bundle, cuam tshuam rau kev soj ntsuam ntawm cov nqaij mos ntawm tus ncej, sab ceg qis, thiab ncaj qha rau irradiation ntawm thaj chaw trophic mob.

Lub tswv yim ntawm kev kho mob laser ntawm kev sib lawv liag ntawm qhov chaw muaj kev sib kis tau yog xwm yeem txav txav ntawm thaj chaw nruab nrab mus rau thaj chaw. Nyob rau theem pib ntawm kev kho, kev ua yeeb yam ntxiv rau thaj av ntawm ulnar fossa thiab cov nkoj nyob hauv ib thaj av ntawm tus ceg qis, muab tso rau hauv thaj av ntawm lub inguinal quav thiab popliteal fossa. Raws li hemodynamic kev cuam tshuam nyob rau hauv qhov cuam tshuam povtseg raug tshem tawm, kev tiv thaiv ua ntej mus rau thaj chaw peripheral, ncaj qha rau thaj chaw mob. Qhov kab ke ntawm no yog qhov tsim nyog los tiv thaiv kev txhim kho ntawm tus tub sab nyiag chaw nyob hauv thaj tsam ntawm nqaj nqaj ntshav muaj ntshav tsis txaus.

Cov cai ntawm irradiation ntawm cov chaw kho mob hauv kev kho mob ntshav qab zib angiopathy

Dlaim mob ntshav qab zib yog li cas: ICD-10 code, kev faib tawm, vim li cas thiab kho cov hau kev

Ib qho mob hnyav tshaj plaws ntawm ntshav qab zib yog mob ntshav qab zib ko taw.

Hauv cov neeg mob uas tsis ua raws li kev noj haus, tsis zoo saib xyuas cov ntshav qab zib kom tsawg, nyob rau theem ntawm decompensation (feem ntau 15-20 xyoo tom qab kuaj tus kab mob), xws li cov kev tsis txaus ntseeg yuav pom tshwm sim hauv ib daim ntawv lossis lwm qhov.

ICD 10 cov mob ntshav qab zib ntawm taw yog qhov kev phom sij txaus ntshai, feem ntau ua rau mob caj dab (ntaub so ntswg necrosis).

Lwm yam mob ntshav qab zib

Feem ntau, cov mob ntshav qab zib muaj tshwm sim vim qhov kev txhaum ntawm tus neeg mob nws tus kheej. Yog tias nws tsis saib xyuas kev kho mob, tsis quav ntsej cov lus pom zoo rau kev kho mob, tsis soj ntsuam nws kev noj zaub mov, tsis tswj hwm cov tshuaj insulin rau lub sijhawm, tsis hais hom mob twg, nws yeej yuav pib muaj teeb meem.

Feem ntau qhov tshwm sim tuaj yeem yog qhov hnyav, thiab nyob rau hauv ntau qhov xwm txheej ua rau neeg tuag tau tsis suav nrog. Teeb meem yuav tshwm sim los ntawm kab mob kev nkeeg, kev raug mob, kev noj tshuaj ntawm cov tshuaj insulin tsis raug, lossis kev siv cov tshuaj uas tas sij hawm (lossis tsis nkag siab).

Ib qho mob hnyav tshaj plaws ntawm ntshav qab zib yog:

lactic acidosis - kev ua txhaum ntawm acidic ib puag ncig hauv lub cev vim kev txuam nrog coob ntawm cov kab mob lactic acids,
ketoacidosis - qhov nce ntawm ketone lub cev hauv cov ntshav vim yog cov insulin tsis txaus,
hypoglycemic coma - qhov tshwm sim ntawm kev poob qis hauv cov piam thaj hauv qab,
hyperosmolar coma - qhov tshwm sim ntawm txoj kev nce qib hauv qab zib ntau ntau,
mob ntshav qab zib mob ko taw - tshwm sim los ntawm vascular pathologies nyob rau hauv qis dua qhov kawg,
retinopathy - qhov tshwm sim ntawm kev ua txhaum nyob rau hauv cov hlab ntsha lub qhov muag,
txha caj qaum - kev puas tsuaj rau cov ntaub so ntswg lub hlwb vim cuam tshuam ntawm cov hlab ntsha,
tshuaj mob hlwb - kev ua haujlwm tsis zoo ntawm qhov nruab nrab cov hlab ntsha vim tias tsis muaj cov ntaub so ntswg oxygen ntau ntau,
dermal lesion - nquag tshwm sim los ntawm cov teeb meem hauv cov zaub mov hauv cov tawv nqaij hlwb.

Hauv 90% ntawm tus neeg mob, mob ko taw ua rau tus neeg mob uas mob ntshav qab zib hom 2.

Mob ntshav taw ua tau dab tsi?

Hom mob pathology cuam tshuam cov ntaub so ntswg ntawm taw. Cov txheej txheem inflammatory hauv lawv yog nrog los ntawm kev pom zoo loj, uas ua rau kev loj hlob ntawm kev ua qias neeg.

Kev loj hlob ntawm txhais ceg mob

Cov ua rau kev tshwm sim zoo li no tuaj yeem yog tus mob ntshav qab zib neuropathy, kev tsis sib haum xeeb hauv cov hlab ntsha ntawm qhov qis qis, ntxiv rau kev ua rau cov kab mob kis.

Thawj qhov International Symposium, tuav xyoo 1991 thiab mob siab rau kev mob ntawm tus mob ntshav qab zib ko taw, tau tsim kev faib tawm raws li cov ntaub ntawv ntawm cov kabmob pib pib qhov txawv ntawm qhov tshwm sim los ntawm lub hauv paus ntsiab lus.

Cov foos hauv qab no yog qhov txawv:

neuropathic daim ntawv - manifests nws tus kheej nyob rau hauv daim ntawv ntawm ulceration, o, rhuav tshem ntawm articular cov ntaub so ntswg, uas yog lub txim ntawm kev cuam tshuam nyob rau hauv kev ua haujlwm ntawm lub paj hlwb. Cov teeb meem no yog tshwm sim los ntawm ib qho kev poob qis ntawm kev coj ua ntawm cov hlab ntsha hauv cov chaw ntawm qis qis,
ischemic daim ntawv - yog lub txim ntawm atherosclerotic ces, tiv thaiv cov ntshav ncig uas cuam tshuam nyob rau hauv qis qis,
neuroischemic (los yog sib xyaw) daim ntawv - tshawb pom cov cim ntawm ob hom.

Tsis txhob siv qhov tshuaj nws tus kheej thiab kho nrog lwm txoj kev xaiv. Feem ntau, lawv ua tsis tau zoo thiab tuaj yeem tsuas ua rau hnyav dua pathology!

Feem ntau, cov neeg mob ntshav qab zib muaj cov tsos mob ntawm daim neuropathic. Tom ntej hauv zaus yog daim ntawv sib xyaw. Lub ischemic daim ntawv ntawm lub diabetic ko taw tshwm sim nyob rau hauv tsis tshua muaj mob. Txoj kev kho yog kho raws li kev kuaj mob raws ntau yam (daim ntawv) ntawm pathology.

Cov laj thawj rau kev loj hlob ntawm cov teeb meem

Mob ntshav qab zib mellitus nyob rau theem ntawm decompensation yog tus cwj pwm los ntawm cov kev hloov pauv siab hauv cov feem ntau ntawm cov piam thaj hauv cov ntshav, lossis qhov tseeb tias theem siab ntawm nws cov ntsiab lus hauv cov ntshav tseem nyob ntev. Qhov no cuam tshuam loj heev rau cov leeg thiab cov hlab ntshav.

Lub capillaries ntawm microvasculature pib tuag, thiab maj mam pathology captures cov hlab ntsha loj dua.

Kev tsis pom kev sab hauv thiab cov ntshav cov ntshav ua rau tsis txaus trophism ntawm cov ntaub so ntswg. Li no cov txheej txheem inflammatory nrog cov ntaub so ntswg necrosis. Qhov teeb meem nyuaj dhau los ntawm qhov tseeb ntawm ko taw, yog ib qho ntawm feem ntau ntawm lub cev, muaj kev cuam tshuam tas li los ntawm kev ntxhov siab, thiab, feem ntau, raug mob me.

Txoj kev nqaim, tsis xis nyob, khau roj hmab lossis khau ua los ntawm cov khoom siv hluavtaws nyob rau lub sijhawm yuav ua rau muaj kev pheej hmoo ntawm tus mob!

Ib tug neeg, vim kev txo qhov mob sab hauv (qhov tsis zoo ntawm lub cev), tsis tuaj yeem mloog zoo rau kev puas tsuaj me (tawg, txiav, khawb, nqaij doog, abrasions, fungus), uas ua rau muaj kev tawm tsam ntawm qhov txhab, txij li thaum tsis muaj ntshav txaus hauv lub nkoj me tiv thaiv kev ua haujlwm ntawm lub cev. hauv cov chaw no tsis ua haujlwm.

Raws li qhov tshwm sim, qhov no ua rau qhov tseeb tias qhov mob me me tsis tuaj yeem kho ntev ntev, thiab yog tias lawv kis tau, lawv loj hlob mus rau ntau qhov mob txhab, uas tuaj yeem kho kom tsis muaj teeb meem loj tsuas yog tias lawv kuaj pom thaum pib.

Cov tsos mob xws li mob ntshav tes taw yog tsis tshua tau tshem tawm thiab feem ntau yog nkag mus rau qeb ntawm cov kab mob ntev.

Yog li, tus neeg mob raug qhia kom ua tib zoo saib xyuas nws tus kheej, nruj me ntsis ua raws cov kev noj zaub mov noj thiab lwm cov lus qhia kho mob, thiab yog tias muaj kev txawv txav tshwm sim, sab laj nrog tus kws kho mob tam sim ntawd.

Txhua ntawm cov foos tau tshwm sim los ntawm nws tus kheej cov tsos mob. Hauv particular:

neuropathic daim ntawv qis qis ntawm lub taw rhiab rhiab, lawv cov deformation yog cov yam ntxwv, qhov pom ntawm corns, foci ntawm hyperkeratosis yog cai. Hauv cov theem tom qab, mob txhab tshwm rau ntawm qhov chaw ntawm corns, muaj cov qauv sib luag,
ischemic daim ntawv tshwm sim tsis muaj qhov pom ntawm caj dab thiab deformations, qhov rhiab ntawm daim tawv nqaij tsis txo, tab sis tib lub sijhawm cov mem tes hauv thaj chaw ntawm tus taw yuav tsis muaj zog thiab tsis hnov zoo. Cov tawv nqaij tig ua daj ntseg, dhau los ua khaub thuas. Cov mob rwj yuav tshwm sim. Lawv cov ntawv tsis muaj cov ntsiab lus meej, lawv cov npoo yog feem ntau tsis sib xws,
daim ntawv sib xyaw ob qho tag nrho cov thiab lwm yam kev qhia ua yam ntxwv.

Cov kws kho mob tshwj xeeb qhia qhov txawv txawv rau qib (qib) ntawm tus kabmob:

ko taw deformation. Tsis muaj mob txhab
cov tsos ntawm thawj tug mob txhab rau
tob hauv ntawm cov mob txhab, muaj kev sib txuas nrog cov leeg nqaij thiab cov leeg nqaij tau cuam tshuam,
mob txhab tob tob npaum li uas lawv cuam tshuam rau cov pob txha pob txha,
pib txwv muaj kev lom zem,
kev ua laib ua ntau yam.

Thawj thawj cov teeb meem ntawm loog hauv thaj chaw ntawm taw, nrog qhov pom ntawm qhov paub ntawm "goosebumps" koj yuav tsum sab laj nrog kws kho mob sai. Cov no yog thawj cov tsos mob ntawm ib qho kab mob tshwm sim tshiab!

Kev kuaj mob

Kev kuaj mob yog tsim raws keeb kwm kev kho mob, kev kuaj lub cev ntawm tus neeg mob thiab cov txiaj ntsig ntawm kev kuaj mob, uas suav nrog kev tshawb nrhiav thiab cov txheej txheem raws li:

kev kuaj ntshav dav
cov leeg kho mob neurological
Ultrasound ntawm cov hlab ntsha, tsim nyog rau kev ntsuam xyuas cov ntshav ntws (Doppler ultrasound),
ntshav kab lis kev cai rau cov kab mob
angiography (duab xoo hluav taws xob, tsom rau kev kawm txog cov hlab ntsha),
xoo hluav taws xob ko taw dav dav,
kuaj me me thiab tshuaj xyuas cov khoom sab hauv ntawm qhov mob txhab.

Thaum kuaj lub cev, ntsuas kub ntawm lub cev, siab, lub ntsws ua pa, thiab ntsuas mem tes yog ntsuas. Tom qab, kev soj ntsuam kom zoo ntawm cov qhov txhab txhab tau nrog kev txiav txim siab ntawm cov neeg kawm ntawv hauv lawv lub siab thiab tus lej ntawm lwm qhov ntsuas. Txhawm rau txiav txim siab qhov tob ntawm cov ntaub so ntswg puas, tus kws kho mob tuaj yeem rov soj ntsuam thiab phais qhov mob.

Tseem ceeb kom paub! Cov teeb meem uas muaj suab thaj ntau ntau hauv lub sijhawm tuaj yeem ua rau tag nrho cov kab mob, xws li teeb meem nrog lub zeem muag, tawv nqaij thiab plaub hau, mob qog, mob caj pas, thiab txawm tias mob qog nqaij hlav! Cov neeg qhia kev iab siab rau normalize lawv qab zib kom txaus siab ...

Kev kho yuav tsum pib them nyiaj rau ntshav qab zib mellitus thiab kho cov ntshav qab zib hauv cov ntshav ntau, txij li cov piam thaj ntau thiab ua rau txhua qhov muaj teeb meem tshwm sim.

Feem ntau, kev kho mob ntawm cov ischemic thiab neuropathic cov ntaub ntawv zoo ib yam thiab muaj nyob hauv qhov ib txwm muaj ntshav kev hauv cov nqua nrog cov kev kho mob lossis kev phais mob. Xws li kev kho mob, tshuaj siv tua kabmob (antibacterial) yog tsim rau kev noj tshuaj, ntxiv rau cov tshuaj uas tsim los txhim kho cov ntshav txaus thiab pab txo kev o.

Kev kho mob ko taw nrog kev kho mob yoj tes taw

Nrog rau cov kws phais tshwj xeeb, lawv tuaj yeem hloov kho kom zoo li lub pob txha caj qaum angioplasty, uas nws yog qhov ua tau kom rov qab los ntshav hauv cov hlab ntshav yam tsis muaj teeb meem ntawm daim tawv nqaij los ntawm cov leeg ntshav, nrog rau cov pob txha caj qaum los yog distal bypass phais.

Cov xwm txheej hnyav cuam tshuam los ntawm kab mob pathology, tsim kom muaj kev maj mam zoo, ua kom muaj kev kho mob hauv zos ntawm cov mob txhab nrog cov tshuaj tua kab mob ua ntej. Txheeb ntawm daim ntawv neuropathic, cov kws tshaj lij tau tshwj xeeb txog kev kho kom rov muaj sab hauv nyob hauv cov nqaj, rau cov tshuaj twg uas tsom rau kev txhim kho metabolism siv tau.

Ncua kev kho mob thiab mus cuag kws kho mob yuav ua rau lub txim tsis tau, vim qhov tshwm sim ntawm ib qho lossis ob qho ntawm ob sab ceg!

Ib qho ntawm cov kev mob tseem ceeb ntawm kev kho yog ua tiav kev txiav luam yeeb. Nicotine cuam tshuam tsis zoo rau lub txaj microvascular, vim tias qhov kev kho mob ua kom rov ua kom ntshav khiav tsis muaj zog lossis yuav tsis muaj sijhawm ntev.

Cov hau kev tiv thaiv

Cov neeg muaj kev mob ntshav qab zib tau raug qhia kom ua tib zoo saib xyuas lawv cov piam thaj hauv ntshav thiab siv cov insulin zoo uas tsim los ntawm cov tuam txhab lag luam muaj koob npe.

Tsis tas li ntawd, qhov zoo ntawm nkawm khau muaj qhov cuam tshuam zoo.

Cov neeg kuaj mob ntshav qab zib mellitus li ntawm 10 lossis ntau xyoo dhau los yuav tsum saib xyuas kev yuav khoom tsuas yog cov khau siab dawb, uas tawv tawv ntawm ko taw yuav tsis ua kom me, ua kom cov microcracks thiab pob txha tawg.

Cov khau yuav tsum dav, nqus tau, nyiam dua los ntawm cov ntaub ntawv ntuj.Cov. Nyob hauv ib qho xwm txheej twg yuav tsum tsis pub hu thiab chafing. Cais, nws tsim nyog hais txog kev nyiam huv ntawm taw. Koj yuav tsum ua kom nws mob siab, ntxuav koj txhais taw ntau zaus nrog xab npum ntxhua khaub ncaws, zam kev kis kab mob fungal thiab kev raug mob me, abrasions.

Tus neeg mob ntshav qab zib uas ua tib zoo saib xyuas txhua qhov yuav tsum tau hais saum toj no, cov kab mob no yuav tsis cuam tshuam.

Cov txheej txheem:

Nws tshwm sim vim yog qhov tsis tshua muaj cov pa oxygen rau cov ntaub so ntswg lossis nws qhov kev ua tiav. Cuam tshuam rau thaj chaw yog feem ntau nyob deb ntawm lub siab: ob txhais ceg thoob plaws lossis ib feem ntawm tus ntiv taw. Vim tias tsis tshua muaj pa lossis tsis muaj oxygen, txoj kev tsis khiav haujlwm ntawm lub cell tuag pib.

Lawv npe ntau yam ua rau mob necrosis los ntawm mob hnyav los ntawm kev mob rau cov kab mob xws li ntshav qab zib. Cov hlab ntshav thrombosis kuj feem ntau dhau los ua "tus neeg sawv cev txaus siab" ntawm kev mob ntshav siab.

Ntshav qab zib mob ko taw

Hom 1 mob ntshav qab zib mellitus

E-10.4 nrog lub paj hlwb cov leeg

E-10.5 nrog cov ntu tsis zoo

E-10.6 nrog arthropathy

Yam 2 ntshav qab zib mellitus

E-11.4 nrog cov leeg ntshawb ntshawv siab

E-11.5 nrog cov hluav taws xob tsis zoo

E-11.6 nrog cov mob caj dab

Ntshav qab zib mob ko taw - Qhov no yog qhov nyuaj ntawm cov ua haujlwm ntawm lub cev thiab ua haujlwm hloov ntawm ko taw cuam tshuam nrog mob ntshav qab zib neuropathy, micro thiab / lossis macroangiopathy, tawm tsam cov kev ua txhaum loj purulent necrotic tsim.

Daim ntawv sib xyaw (neuro-ischemic).

Qib muaj 0Cov tawv nqaij tsis tu ncua.

Qib muaj 1Pob ntseg yoov tshaj cum

Qib muaj 2Mob duav tob tob rau txoj hlab ntsha, pob txha, pob txha

Qib muaj 3Osteomyelitis lossis mob siab heev

Qib muaj 4Zos laus

Qib muaj 5 Tus poj niam cev khaub ncaws uas yuav tsum tau txiav kom loj.

Cov tsos mob ntawm tus mob neuropathic:

Qhuav ntawm daim tawv nqaij, thaj chaw ntawm hyperkeratosis nyob rau hauv qhov chaw ntawm ntau dhau.

Daim tawv nqaij kub tsis hloov.

Kev deformation tshwj xeeb ntawm tus taw, ntiv tes (Charcot tus taw), pob qij txha pob qij txha, ob tog ntawm taw thiab ceg.

Ripple ntawm cov hlab ntsha ntawm ko taw yog tshwj tseg rau ntawm ob sab.

Tsis mob qhov txhab qhov tsis xws ntawm qhov chaw siab.

Cov tsos mob tshwm sim tsis qhia.

Cov tsos mob ntawm ischemic ko taw:

Cov xim tawv nqaij yog daj ntseg lossis cyanotic.

Daim tawv nqaij yog atrophic, txias, muaj tawg, plaub hau poob.

Kev kho qhov muag ntawm lub taw tsis hais meej lossis tsis tuaj.

Ripple hauv cov hlab ntsha ntawm txhais taw tsis tuaj lossis txo qis.

Muaj systolic yws ntau dua ntawm cov hlab ntsha loj.

Acral necrosis thiab / lossis mob rau qhov mob siab sai sai.

Muaj qhov hais txog cov ncauj lus symptomatology - sib quas ntus

lameness, mob thaum so.

SDS kev tshawb fawb

—Txog ntshaqis qis dua: palpation, auscultation ntawm cov hlab ntsha

—Neurological xwm txheej:qhov mob, nruj, qhov kub thiab txias, qhov tob tob, tig ntawm lub hauv caug thiab Achilles tendons

Cov hauv kev tshawb fawb ntxiv rau SDS

kuaj cov ntshav thiab zis

yoo mov glycemia thiab txhua hnub

ntshav ntshav ntshav electrolytes

tank. ntshav kab lis kev cai thiab tank. sowing los ntawm lub qhov txhab

Cov hau kev seev: ECG, xoo hluav taws xob ntawm ko taw hauv 2 qhov kev kwv yees, kev ntsuas ntawm cov ceg qis ntawm txoj leeg, kev txiav txim siab ntawm LPI.

KuvCov tshuaj tsis siv tshuaj kho cov kab mob purulent nrog SDS

Caum tshem tawm unloading: lub txaj so, kev txav ntawm lub rooj muaj log, siv khoom siv crutches, kev siv ntawm khau tsis siv khau ib nrab.

IICov. Kev siv tshuaj kho cov kab mob purulent nrog SDS

Vim li cas cell tuag tshwm sim

Cov ua rau mob necrosis tuaj yeem yog ob qho tib si ntawm sab nraud thiab sab hauv.

txhua yam kev puas tsuaj rau ntawm daim tawv nqaij, cov hlab ntsha, cov leeg ntshav,
siab tawm
tsawg kub - vim li ntawd, frostbite,
siab kub ua rau kub nyhiab,
kev tawm tsam tshuaj lom neeg,
hluav taws xob sib kis.

kev puas tsuaj rau cov hlab ntsha, ua rau muaj kev tsis txaus ntseeg ntawm cov metabolism hauv cov nqaij mos,
kev hloov ntawm lub cev ntawm lub cev ntawm cov ntsiab lus ntawm cov hlab ntshav (tuab ntawm phab ntsa ntawm cov hlab ntsha, qhov tsim cov quav hniav nrog maj mam nqaim ntawm lumen kom nws ua tiav kev sib tshooj),
mob ntshav qab zib mellitus, Raynaud's syndrome, kab mob kev co, thiab lwm yam.
rog tsim txom khoom noj tsis zoo.

Cov ntshav tsis tuaj yeem muab pa oxygen thiab cov tseem ceeb ntxiv rau cov ntaub so ntswg hauv cov khoom noj txaus. Maj mam, kev tuag ntawm ib tus neeg lub hlwb nrog kev hloov chaw loj dua tshwm sim.

Neuroischemic

Neuroischemic suav nrog kev nthuav tawm ntawm ob daim ntawv dhau los. Hauv kev siv tshuaj, muaj rau theem ntawm tus kabmob ntawm deformation ntawm taw:

Ib ntus kev mob rwj.
Thawj lub paum.
Qib siab tshaj thaum cov leeg thiab cov leeg nqaij cuam tshuam nrog.
Daim ntawv tso tseg tsis zoo, hauv nws lub xub ntiag, cov leeg pob txha muaj mob.
Thawj theem ntawm kev ua laib.
Coob tus neeg tso tseg, nws cuam tshuam thaj av loj heev.

Thawj qhov pom taw qhia tias yog pib ntawm tus kab mob: loog ntawm ko taw thiab qhov zoo nkaus ntawm goosebumps ntawm lawv. Yog tias cov tsos mob zoo li no, sab laj rau tus kws kho mob tshwj xeeb.

1. Kev Them Nyiaj ntawm glycemia:

— Txhob kaw cov tib neeg cov insulinsCov. Koob tshuaj thiab kev tswj hwm yog tus kheej. Cov yeeb yam luv luv: Actrapid NM, Humulin R, Insuman sai sai. Cov yeeb tshuaj nruab nrab-sijhawm: Protafan HM, Humulin N, Insuman basal.

Yam 1 ntshav qab zib. Intensive kev kho mob insulin. Koob tshuaj thiab kev tswj hwm yog tus kheej. Lub hom phiaj ntawm txoj kev kho: yoo mov glycemia 5.1 - 6.5 mmol / L, glycemia 2 teev tom qab noj 7.6-9.0 mmol / L, HbA1s 6.1-7.5%.

Cov Hom Khaub Ncaws

Ob lub ntsiab ntawm cov neeg loj leeb yog raug cais nyias.

Qhuav. Nws kev txhim kho tiv thaiv keeb kwm ntawm dhau ntawm kev txiav tawm ceev ceev cov pa oxygen rau lub hlwb. Cov ntaub dries, wrinkles, txo nyob rau hauv loj. Ua ntej tshaj plaws, qhov no tshwm sim los ntawm qhov tawg ntawm cov ntshav ua ke thiab kev coagulation ntawm cov protein. Outwardly, nws zoo li mummified seem. Lub luag haujlwm ntawm tus ntiv tes lossis ko taw tsis ploj. Kev hnov mob ntawm daim tawv nqaij ploj mus. Tus neeg mob tau hnov mob tsis tu ncua nyob rau hauv kev raug mob ntawm caj npab, ib ncig ntawm thaj chaw ntawm kev tsim cov chaw mos. Kev tuag ntawm cov nqaij mos maj mam kis rau ntawm txhais ceg. Daim tawv nqaij ntawm thaj chaw muaj ciam nrog o. Muaj ib qho kev tawm tsam ntawm cov ntaub so ntswg tuag. Feem ntau yog qhuav gangrene ntawm cov ntiv taw (ntiv tes).

Ib daim ntawv ntawm tus kabmob caj dab yog qhuav

Lub cev ntub dej yog cov roj khoob khoob. Daim ntawv no feem ntau pom nyob rau hauv tshav rog, thaum muaj kab mob tsis huv (hauv av los yog hmoov av) tau nkag mus rau hauv cov qhov txhab uas tsis kho. Kev sib kis tau kis mob sai sai, tsis tas yuav tsum tau kev phais mob - kev kho mob los ntawm kev txiav tawm sai - tus neeg mob tsis tas yuav nyob ntev.

ICD 10 (Thoob ntiaj teb Kev Sib Tw Cov Kab Mob ntawm 10 Kho) qhia txog txhua yam kabmob neeg tam sim no paub. Muaj nyob hauv ICD 10 ib kab lus txog kab mob kev qhuab qhia, nrog rau kab lus ncua ntawm kev sib deev. Hauv ICD 10, koj tuaj yeem pom ntau cov ntawv xa mus rau tus kab mob no:

ib tug kis kab mob thiab cab sib kis - code A00-B99 ICD 10,
lwm cov kab mob sib kis - code A30-A49 ICD 10,
cov kab mob ntawm tus kheej uas tsis muab faib rau ib qho kev faib ຫົວ npe - code A48 ICD 10,
cov pa roj ntsha laib-code A48.0 ICD 10.

Kev kuaj mob

Kev kuaj mob tsuas yog txiav txim los ntawm tus kws tshaj lij los ntawm kev soj ntsuam ntxaws ntawm tus neeg mob, nrog rau kev kuaj mob, uas, dhau los, suav nrog kev kuaj ntshav dav dav, ultrasound ntawm cov hlab ntsha, tshuaj xyuas lub paj hlwb, Doppler ultrasound, xoo hluav taws xob ntawm cov hlab ntsha thiab ko taw, thiab kuaj me me ntawm cov ntsiab lus ntawm lub qhov txhab.

Ntawm kev tshuaj xyuas, ntsuas lub cev kub, tus mem tes, lub siab thiab tus pa ntsuas tau raug ntsuas. Tom ntej no, tshawb xyuas cov qhov txhab txhab thiab tsim kom muaj qhov kub ntawm cov kab mob kev loj hlob. Txhawm rau ntxaws ntxaws ntxaws teeb meem, tus kws kho mob tuaj yeem ua tiav kev soj ntsuam thiab phais mob ntawm qhov txhab.

Thawj kauj ruam ntawm kev kho mob yog qhov ib txwm ua rau cov piam thaj hauv ntshav, ntau npaum li nws nyob ntawm nws, suav nrog txhua yam tsis zoo. Kev kho mob ntawm ischemic thiab neuropathic degrees yog qhov zoo sib xws, lawv qhov kev ua haujlwm tseem ceeb yog muab tso rau hauv cov ntshav ntawm cov ceg tawv hauv kev txiav txim. Qhov no tuaj yeem ua tiav los ntawm kev siv tshuaj khomob lossis phais mob ntawm kev ua haujlwm.

Nrog rau txoj kev kho kom zoo, tshuaj tua kab mob thiab tshuaj siv tau los ntawm kev kho mob kom txo qis o thiab txhim kho cov ntshav. Thaum phais mob, nws tuaj yeem rov ua dua hauv cov hlab ntsha, tsis muaj txiav daim tawv. Cov txheej txheem no yog ua vim ua haujlwm ntawm cov hlab ntsha lossis cov pob phais hlais. Rau cov neeg mob, lawv tsim kev mob siab tshaj plaws, qhov mob txhab yog ua tib zoo kho nrog cov tshuaj tua kab mob.

Nrog rau kev kawm qib neuropathic, cov kws kho mob tshwj xeeb tshaj yog tsom rau kev xa rov qab sab hauv sab hauv ntawm cov ceg tawv, rau qhov no qee zaum lawv siv tshuaj uas lawv ua yog txhawm rau txhim kho kev zom zaub mov. Nrog kev kho tsis raws cai thiab daim ntawv tsis saib xyuas ntawm tus kab mob, qhov tshwm sim tuaj yeem tu siab, tom qab ntawd cov kws kho mob yuav tsum tau txiav txim siab txog kev txiav tu tes taw.

Ib qho tseem ceeb rau txoj kev kho kom zoo yog ua tiav qhov tsis nyiam ntawm qhov tsis zoo, tshwj xeeb tshaj yog haus luam yeeb. Raws li koj paub, nicotine tsis zoo cuam tshuam rau microvessels, nws yog vim qhov no tias kev kho mob tsis muaj txiaj ntsig lossis pab rau lub sijhawm luv luv.

Rau cov neeg mob uas muaj mob ntshav qab zib ko taw, pej xeem cov kev kho mob tuaj yeem pom zoo raws li cov ntxiv, vim tias siv lub sijhawm ntev ntawm kev siv tshuaj kho mob lawv tuaj yeem muab tau txiaj ntsig zoo. Lwm qhov zoo dua ntawm kev siv yog lawv cov txiaj ntsig me me, yam tsis xaiv ntsej muag.

Txhawm rau kho mob ntshav qab zib ko taw nrog tshuaj ntsuab tshuaj, raws li txoj cai, ntau yam tshuaj muaj peev xwm ntawm ntuj tau siv nyob rau hauv daim ntawv ntawm da dej, pleev thiab compresses. Decoctions thiab infusions ntawm cov tshuaj ntsuab cov tshuaj siv tau dav siv - chamomile, sage, eucalyptus, celandine. Kho pastes yog ua rau lub hauv paus ntawm tshuaj ntsuab los yog beekeeping khoom, uas yog thov nyob rau hauv ib daim ntaub qhwv rau ib lub sij hawm ntawm ob peb feeb txog rau ob peb teev.

Symptomatology

Cov tsos mob sab nraud ntawm lub xeev ntawm cov ntaub so ntswg tau nkag siab thawj zaug ntawm hom thiab daim ntawv ntawm qhov chaw txhab. Thawj cov cim qhia tuaj yeem qhia lawv tus kheej vim yog kev txhim kho ntawm obliterating atherosclerosis (maj mam txhaws ntawm cov hlab ntshav). Mob caj dab mob thrombosis provokes txoj kev loj hlob ntawm gangrene sai. Cov tsos mob hnyav yuav tsum tau teb tam sim ntawd.

Txhua yam nws pib nrog qhov zoo li ua ntsej muag daj nyob saum ceg. Nws hlob, hloov xim, hloov mus rau hauv qhov tsaus tsawv ntxoov ntxoo, ua xim dub.

Cov tsos mob ntawm daim ntawv qhuav:

thaj chaw nrog cov nqaij mos ntawm cov xim tsaus,
tus ciam teb ntawm kev noj qab haus huv thiab cev nqaij daim tawv yog pom meej,
tsis muaj qhov kub thiab txias thiab lwm cov tsos mob ntawm kev cuam tshuam dav dav hauv lub cev,
cov tsos mob hnov mob sib txawv.

Cov tsos mob ntawm kev ua paug dej qhuav ntawm qis qis

Cov tsos mob ntawm daim ntawv ntub:

blackening ntawm cov nqaij mos sib xyaw rau thaj tsam cuam tshuam,
qhov tsis muaj ciam teb ntawm cov ntaub so ntswg kis thiab kis tsis tau: dub hloov mus ua liab,
o tuaj
dav dav liab ntawm daim tawv nqaij ntawm ib ceg mob,
qhov nce hauv lub cev kub, qhov ua rau muaj kev cuam tshuam sai sai hauv qhov mob ntawm tus neeg mob,
kev nthuav dav ceev ntawm thaj chaw hauv cheeb tsam.

Cov tsos mob hauv qab no tseem pom:

cov cim ntawm loog, tsis hnov,
ntev dhau (waxy) pallor ntawm thaj tsam cuam tshuam ntawm daim tawv nqaij,
qaug zog ntawm tus ceg thaum taug kev,
tas li kev xav ntawm khov ceg, txawm tias lub caij ntuj sov,
cramps
qhov tsim nyob rau ntawm daim tawv nqaij ntawm qhov tsis kho qhov tsis zoo, uas, qhov tseeb, yog cov tsos mob ntawm qhov pib ntawm gangrene,
kev hnov mob thaum pib ntawm qib tsis yog ib qho ntse heev, kom deb dua, pom dav dua thiab muaj zog ntxiv.

Mob tob tob yuav tsum tau kho. Ntawm chav kawm, nws yuav tsis dhau: lub qhov txhab yuav tsis zoo, daim tawv yuav tsis rov qab los. Qhov tsis teb (uas yog, tsis muaj kev kho mob txaus) yog qhov tsis zoo nrog kev ua kom tsis zoo ntawm tus neeg mob, tab sis kuj nrog ntau qhov txiaj ntsig ua tau zoo. Nco ntsoov tias kev ua laib vim los ntawm qhov mob sab hauv yog qhov nyuaj rau kev paub thiab nyuaj kho.

Kev tiv thaiv kabmob

Cov neeg uas muaj ntshav qab zib tau qhia kom lawv soj ntsuam lawv txoj kev noj qab haus huv, ntsuas cov piam thaj hauv lawv cov ntshav, tsuas yog siv cov tshuaj zoo uas tau dhau tag nrho cov kev tshawb fawb thiab kev sim.

Nws yog ib qho tseem ceeb ntawm kev hnav khau kom yooj yim ua los ntawm cov khoom siv zoo. Thaum hnav cov khau yuav tsum tsis txhob tshwm ib qho microcracks, kev raug mob.

Cov khau kuj yuav tsum tso cua tawm, pub rau ntawm daim tawv nqaij ua pa. Qhov tsim ntawm chafing thiab corns yuav tsum zam qhov siab tshaj plaws.

Nws yuav yog qhov tseem ceeb rau kev saib xyuas kev nyiam huv ntawm tus taw, koj tuaj yeem siv cov roj pleev thiab tshuaj txau kom pab zam dhau hws.

Txhua txhua hnub, yam tsis poob, koj yuav tsum ntxuav koj txhais taw kom huv si nrog xab npum ntxhua khaub ncaws, txhawm rau tiv thaiv kom tsis txhob muaj fungi, abrasions thiab lwm yam kev raug mob.

Kev tiv thaiv thiab kho mob los

Cov kws tshaj lij hais tias nws zoo dua los kho kev mob caj dab. Ua raws li qhov loj ntawm thaj chaw muaj kev puas tsuaj, theem thiab daim qauv ntawm kev nthuav dav, tsawg kawg lossis cardinal txiav ntawm qhov chaw tuag tuaj yeem ua.

Cardinal txiav tawm ntawm qhov chaw mos neeg tuag

Nws tsim nyog hais tias kev mob raum tuaj yeem tiv thaiv (tom qab ntawd tsis tas yuav kho nws). Piv txwv, muaj qee tus naj npawb ntawm cov kab mob, qhov tshwm sim ntawm cov uas tuaj yeem ua cov nqaij mos ntawm cov nqaij mos (necrosis):

mob plawv thiab leeg tshav,
mob phais mob
kev raug mob thiab tom qab mob siab,
endometitis thiab lwm tus

Yog li, yog dab tsi kho tau zoo rau tus mob no? Cov ntaub so ntswg tuag tsis tuaj yeem kho. Yog li, tsuas yog txoj kev paub tseeb yog tshem tawm cov ntaub so ntswg no. Txoj kev kho yuav tsum ua nrawm rau txhawm rau txhawm rau tiv thaiv kom tus mob necrosis tsis txhob sib kis thoob plaws lub cev thiab ntes thaj chaw dav dav.

Raws li tau teev los saum no, daim ntawv ntub dej yog qhov muaj kev phom sij ntau dua li ib qho qhuav. Thawj kaujruam yog hloov pauv necrosis ntawm ib lub xeev mus rau lwm lub. Kev haus dej caw tau siv rau tus neeg mob ntawm thaj chaw cuam tshuam. Thiab tom qab ntawd, kev phais mob, nqaij tsis huv raug txiav tawm raws txoj kab kev sib cuag ntawm necrosis.

Ntau npaum li cas yuav raug tshem tawm? Ua raws li cov qauv ntawm kev nthuav dav, qhov loj me ntawm thaj chaw muaj teeb meem. Txawm li cas los xij, kev kho mob yog ua tiav txoj hauv kev los khaws cov ntaub so ntswg nrog kev rov qab muab cov ntshav mus rau thaj chaw muaj kev puas tsuaj. Kev kho mob caj dab yog lub meej mom ntawm tus kws phais vascular.

Feem ntau siv shunting, stenting, vascular prosthetics, thrombendarterectomy.

Cov hau kev ntawm txoj kev kho no muaj ntau lub contraindications, tshwj xeeb, kev ua haujlwm zoo li no tsis raug pom zoo rau cov neeg mob hauv cov laus, thiab rau cov kab mob plawv heev.

Yuav tsum tau siv: tshuaj tua kab mob, los tiv thaiv, mob analgesic. Raws li kev kho mob los tsim kho kev txhim kho microcirculation hauv ceg.

Thawj theem ntawm kev txhim kho pathology yog yooj yim kov yeej.Ntawm no tuaj yeem muab:

kev tawm dag zog
noj tshuaj tua kab mob
kev siv tshwj xeeb sab nraud txhais tau tias,
Kev kho ua kom tawm dag zog
tshuaj mob ntsws.

Nrog ib tug mob kab mob nyuaj dua. Nws tsis tsim nyog lub sijhawm los nrhiav kev pab uas tsim nyog. Yog li, kev txiav tes taw thiab kev tsis taus yuav zam tau. Tsis tas li ntawd, tsis txhob kho necrosis nrog kev tsis pom zoo rau pej xeem tshuaj, yog li kom tsis txhob ua rau kev tsis tuaj yeem ua rau cov txheej txheem nyob hauv lub cev koj tus kheej.

ICD txhais taw tus menyuam laib laus 10

Kev mob caj pas tsis yog kev kuaj mob ywj pheej, tab sis yog ib qho kev cuam tshuam ntawm ib qho txheej txheem pathological.

Vim tias qhov tshwj xeeb ntawm tus mob nosological, mob caj dab ntawm ko taw raws li ICD 10 muaj tus lej uas nyob ntawm etiological yam.

Kev ua tub rog yog lub xeev ntawm cov nqaij mos necrosis ntawm txhua qhov ntawm tib neeg lub cev, tab sis ntau zaus pathology cuam tshuam txog qis qis dua, tshwj xeeb tshaj yog ko taw.

Cov kev tshwm sim mob siab loj vim tias cov pa oxygen tsis txaus rau cov ntaub so ntswg lossis ua kom tiav tsis muaj oxygen. Ua ntej, qhov mob thiav thwv yuav tshwm sim hauv qhov chaw hypoxia, uas maj mam dhau mus ua kom tiav necrosis.

Cov ntaub so ntswg tuag tuaj yeem qhuav lossis ntub dej, nyob ntawm qhov kev nthuav qhia hauv chav kho mob. Thawj hom yog qhov tsis muaj qhov mob ntawm daim tawv nqaij thiab cov khaubncaws sab nraud povtseg tob dua, tsis tas yuav tso cov kua paug tawm. Kev ntub dej cawv yog kev loj hlob thaum cov neeg kis tau rau hauv thaj chaw ntawm cov nqaij qhuav necrotic, uas ua rau hauv cov chaw weeping nrog cov ntsiab lus purulent.

Cov Nta Cov Nta

Mob tob tob ntawm ko taw hauv ICD 10 yog encrypted nyob ntawm etiological yam. Cov txheej txheem pathological tuaj yeem nyob hauv ntau pawg thiab txawm tias chav kawm, vim tias muaj ntau yam laj thawj uas ua rau necrosis. Cov kev xaiv hauv qab no rau kev mob ko taw necrosis tau faib rau:

I2 - atherosclerotic necrosis ntawm distal qis dua qhov kawg,
E10-E14 - ntiv tes thiab ko taw necrosis tshwm sim los ntawm ntshav qab zib mellitus, nrog rau cov cim plaub,
I73 - necrotic tshwm sim nyob rau hauv ntau pathologies ntawm peripheral vasculature,
A0 yog cov phom sij txaus ntshai tshaj plaws,
L88 - pyoderma kev zwm nyob hauv xwm,
R02 - necrosis ntawm cov ntaub so ntswg ntawm qhov qis qis, tsis txwv kom lwm yam.

Qhov kev sib cais ntawm necrotic hloov pauv ko taw yog vim muaj ntau qhov sib txawv rau kev kuaj mob thiab tiv thaiv kev mob txaus ntshai. Cov kev kho kom zoo tas li nyob li qub - necrosis yog qhov mob uas tsis hloov rov qab, yog li ntawd, cov ntaub so ntswg tuag yog raug tshem tawm phais, feem ntau los ntawm txiav tes taw lossis nws tus neeg.

Cov Tswv Yim Tiv Thaiv

Qhov ntau etiologies ntawm gangrene nyob rau hauv qhov kev faib tawm thoob ntiaj teb ntawm cov kab mob yog suav tias yog ib qho ntawm kev tsis txaus ntseeg tshaj plaws ntawm ib qho txheej txheem pathological. Tus kab mob yog inherently kho thiab yuav tsum tau ntsuas kev ntsuas los cawm tus neeg mob lub neej. Yog li, kev hloov pauv kev yooj yim yog yooj yim los tiv thaiv los ntawm kev siv cov cai hauv qab no ntawm kev tiv thaiv:

muab kev phais kho kom zoo ntawm cov qhov txhab tsis huv,
kuaj xyuas ntshav qab zib raws sij hawm thiab nws cov txij nkawm nyob rau hauv lub xeev muaj txiaj ntsig,
kho kab mob atherosclerosis thiab lub plawv tsis ua haujlwm,
paub ntxov thiab kho mob ceev ceev ntawm ntau hom vascular occlusion: thrombosis, embolism, mob thiab lwm yam,
kev kho mob ntawm cov kab mob pathologies ntawm lub cev nqaij tawv.

Cov kev tshwm sim ntawm kev hloov pauv ntawm tus neeg mob qhia tias tsis muaj lub siab nco qab tus neeg mob (tsis quav ntsej cov tsos mob, kev siv tus kheej, tsis ua raws li tus kws kho mob pom zoo) lossis kev saib xyuas tus kws kho mob uas tsis nco qab thaum yug tus txheej txheem necrotic. Ua raws li cov txheej txheem rau kev soj ntsuam thiab kho cov kab mob uas ua rau kev mob caj dab, nws muaj peev xwm kom zam kev txhim kho ntawm kev phom sij txaus ntshai.

Txuag qhov txuas, lossis qhia cov ntaub ntawv muaj txiaj ntsig hauv kev sib raug zoo. tes hauj lwm

Cov tsos mob thiab cov paib cuam tshuam txog cov pa ncig thiab pa ua pa (R00-R09)

mob plawv dhia hauv lub sijhawm ncua sij hawm tsis haum tshuaj (P29.1)
kev tiv thaiv tsis tu ncua (I47-I49)

Tsis suav: tshwm sim hauv lub sijhawm perinatal (P29.8)

menyuam yaus nrog:
- atherosclerosis (I70.2)
- mob ntshav qab zib mellitus (E10-E14 uas muaj tus cwj pwm plaub .5)
- lwm yam kab mob ntawm cov hlab ntsha ntu (I73.-)
kev ua tub rog ntawm qee qhov kev qhia tshwj xeeb hauv zos - saib Index
roj ntsha caj dab (A48.0)
Cov neeg laus txhawm dej (L88)

Hauv tebchaws Lavxias, Kev Hloov Kab Mob Thoob Ntiaj Teb ntawm 10 kev kho dua tshiab (ICD-10) tau raug coj los ua ib tsab cai tswjfwm rau kev suav nrog qhov teebmeem, qhov laj thawj ntawm pej xeem thov mus rau cov chaw khomob ntawm txhua lub chaw haujlwm, thiab ua rau muaj kev tuag.

ICD-10 tau qhia rau hauv kev coj ua hauv kev noj qab haus huv thoob plaws hauv Lavxias Lavxias xyoo 1999 los ntawm kev coj ua ntawm Ministry of Health ntawm Russia ntawm 05.27.97. No. 170

Kev tshaj tawm ntawm kev hloov kho tshiab (ICD-11) yog npaj los ntawm WHO xyoo 2017 2018.

Nrog kev hloov pauv thiab ntxiv ntawm WHO.

Type 2 mob ntshav qab zib rau mcb-10

Kev ntsuas thiab cais pawg ntawm cov kab mob, suav nrog ntshav qab zib, yog cov ntaub ntawv tseem ceeb rau cov kws kho mob thiab cov kws tshawb fawb xav nrhiav kom tsis txhob muaj kabmob sib kis thiab nrhiav kev kho rau lawv. Vim li no, nws tsim nyog yuav tsum nco ntsoov tag nrho cov ntaub ntawv tau los ntawm WHO (Lub Koom Haum Noj Qab Haus Huv Ntiaj Teb) thiab rau qhov no, IBC tau tsim. Daim ntawv no yog txiav txim siab raws li kev faib tawm thoob ntiaj teb ntawm cov kab mob, uas tau pom tias yog lub hauv paus rau txhua lub tebchaws tsim.

Tsim cov npe no, tib neeg tau tshawb nrhiav los sau tag nrho cov ntaub ntawv paub txog ntau cov txheej txheem pathological hauv ib qho chaw kom thiaj li siv cov cim no rau kev tshawb nrhiav thiab kho mob yooj yim. Raws li rau Russia, ntawm nws thaj chaw cov ntaub ntawv no tau ib txwm siv tau thiab ICD 10 kev kho dua tshiab (tam sim no muaj cai) tau pom zoo los ntawm Minister of Health ntawm Lavxias Federation xyoo 1999.

Cov lus tsis ntev los no

Kuv tau nrhiav LUB TSWV YIM NTAWM sab qis ua qhov uas muaj DIABETES DIABETES ICD 10. FOUND! Cov pa roj hom muaj tus lej raws li MKB-10 - A48.0, qhuav lossis ntub - R-02. Mob qog caj dab qis qis hauv cov kab mob ntshav qab zib mellitus yog E10-E14, thiab tsim nrog atherosclerosis - I70.2.

ICD-10. Thoob Ntiaj Teb Cov Kab Mob. Cov. Kev ua laib, tsis cais rau lwm qhov. Tsis suav:

Cov. atherosclerosis (I70.2). mob ntshav qab zib mellitus (E10-E14 nrog rau tus xeeb ceem plaub .5). lwm tus neeg.

Thoob ntiaj teb kev faib cov kab mob ICD-10. Cov. roj tso zis tso quav (A48.0) kev sib deev ntawm qhov chaw tshwj xeeb - saib Gangrene cov ntawv sau cim zoo rau:

• atherosclerosis (I70.2) • mob ntshav qab zib mellitus (E10-E14 uas muaj plaub).

Mob qa txha ntawm qis qis dua yog necrosis (kev tuag) ntawm cov ntaub so ntswg. Cov. mob ntshav qab zib mellitus, Raynaud's syndrome, kab mob kev co, thiab lwm yam. tso pa nkev nyuav-code A48.0 ICD 10. Cov tsos mob.

roj tso zis tso quav (A48.0) kev sib deev ntawm qhov chaw tshwj xeeb - saib Gangrene cov ntawv sau cim zoo rau:

- atherosclerosis (I70.2) - ntshav qab zib mellitus (E10-E14 uas muaj qhov cim thib plaub .5) - lwm yam kab mob ntsig txog ntshav (I73.

Kev ntub dej cawv ntawm cov leeg qis hauv qab yog cov nqaij mos necrosis. Qaug zog ntawm qhov qis qis hauv kev mob ntshav qab zib mellitus

Kev mob taw rau ICD 10 yog qhov kev phom sij txaus ntshai, feem ntau. Lwm yam mob ntshav qab zib. Ntau zaus mob ntshav qab zib. Mob taw ntawm taw - lub pathological mob ntawm cov ntaub so ntswg ntawm qis qis.

ICD-10. Tus neeg mob qau loj no zoo li cas?

ICD-10. Cov. Mob qhuav qhawv txhauv feem ntau cuam tshuam rau cov nqua. Nrog nws, txhaws ntawm cov hlab ntsha tshwm sim maj mam, ntau lub hlis thiab txawm xyoo. Cov. Qhov mob loj zuj zus hauv cov neeg mob ntshav qab zib mellitus.

kev lim hiam kev loj dua ntawm qis dua, kev ua qias neeg ntawm qhov chaw. obliterating endarteritis, Raynaud's disease, thiab lwm yam), kis kab mob, ntshav qab zib mellitus. Cov. Thoob ntiaj teb kev faib cov kab mob (ICD-10)

Mob caj dab qhuav tsis tuaj yeem loj hlob, tau qee ntu ntawm ntu ntawm ntu. Cov. Kev Qaug Zog Loj hauv ICD kev faib tawm:

- R00-R09 Cov tsos mob thiab cov paib cuam tshuam nrog cov pa ncig thiab pa ua pa.

R02 - Tub Rog, Tsis cais rau lwm qhov. Saw hlau hauv kev faib tawm. Kev kuaj mob tsis suav nrog:

• atherosclerosis (I70.2) • mob ntshav qab zib mellitus (E10-E14 uas muaj qhov cim thib plaub .5) • lwm yam kab mob.

Kev txiav txim siab ntawm obliterating atherosclerosis ntawm cov hlab ntsha ntawm qhov qis qis hauv ICD 10 .. Mob caj dab qhuav feem ntau pib muaj decompensated mob ntshav qab zib.

Mob ntshav qab zib mellitus tsis yog tsuas yog nce ntxiv ntawm cov ntshav qab zib, tab sis kuj muaj ntau cov teeb meem tsis txaus ntseeg tshwm sim los ntawm kev mob plab zom mov uas tshwm sim nrog tus kab mob.

Mob taw taw :: Cov tsos mob, ua rau, kho thiab chaws raws li ICD-10

Ntshav qab zib mob ko taw

Title: Mob taw vwm.

Mob ko taw. Qhov tshwj xeeb anatomical thiab kev ua haujlwm hloov ntawm lub cev ko taw vim qhov kev cuam tshuam ntawm metabolic hauv cov neeg mob uas decompensated ntshav qab zib mellitus.

Cov tsos mob ntawm tus mob ko taw muaj xws li mob ntawm txhais ceg, hyperkeratosis thiab tawv nqaij tawg, deformation ntawm qhov distal kawg, ulcerative tsis xws luag thiab necrosis ntawm cov nqaij mos, nyob rau hauv mob hnyav, mob caj dab lossis txhais ceg qis.

Kev kuaj mob ntshav qab zib mob ko taw muaj xws li kev soj ntsuam sab nraud, kev txiav txim siab ntawm ntau hom rhiab, dopplerography thiab angiography ntawm cov hlab ntsha, radiography ntawm ko taw, kev kuaj mob microbiological ntawm cov ncauj lus kev kho mob. qhov txhab - txoj kev phais siv.

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 txhab txhab.

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 thaum ntxov lig, uas ua rau kev xav txog kev txiav ntawm tes taw, kev tsis taus ntawm cov neeg mob, thiab qhov nce ntawm lub neej tuag.

Mob taw rau tus kab mob ntshav siab Ua ntej qhov tshwj xeeb ntawm txoj kev tiv thaiv kab mob, ischemic (5-10%), neuropathic (60-75%) thiab sib xyaw - neuroischemic (20-30%) daim ntawv ntawm tus kab mob ntshav qab zib 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 ntxiv, hloov nrog claudication, mob ceg, nrawm nrawm ntawm ob txhais ceg, tawv nqaij pigmentation. 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), 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:

Muaj qhov pheej hmoo loj ntawm kev tsim cov mob ntshav qab zib - muaj kev deformity ntawm ko taw, mob pob txha, mob hyperkeratosis, tab sis tsis muaj qhov tsis zoo ulcerative 1 - theem mob txhab rau sab hauv, txwv tsis pub rau daim tawv nqaij 2 - theem mob tob hau uas muaj feem cuam tshuam rau ntawm daim tawv nqaij, rog rog subcutaneous, nqaij leeg, nqaij, tab sis tsis muaj pob txha puas 3 - theem ntawm lub qhov ncauj ntxiag nrog cov pob txha puas 4 - theem ntawm tus neeg raug vauv ntau 5 - theem ntawm tus neeg mob caj dab ntev.

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 kev hloov pauv tau muab rau kev kuaj tus kheej, lub hom phiaj yog txhawm rau txhawm rau txheeb xyuas cov cim ntawm tus kab mob ntshav qab zib: kev hloov xim tawv nqaij, qhov tsos ntawm dryness, o thiab mob, curvature ntawm cov ntiv tes, kab mob fungal, thiab lwm yam. mob ntshav qab zib, kev kuaj mob ntawm tus taw nrog lub ntsiab lus ntawm pob taws-brachial index thiab reflexes, kev txheeb xyuas ntawm kev ua kom yuag, kev co thiab qhov kub tsis hnov tsw. 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.

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. Nws tseem yog qhov yuav tsum tau tshem tawm cov pob txha, pob txha, thaj chaw ntawm hyperkeratosis nyob ib ncig ntawm lub qhov txhab txhawm rau kom txo tau cov ntsaws rau ntawm thaj chaw cuam tshuam. Cov tshuaj tiv thaiv kab mob rau ntshav qab zib mob ko taw yog nqa nrog cov tshuaj ntawm qhov ntau ntawm cov tshuaj tua kab mob. Raws li ib feem ntawm kev saib xyuas kev kho mob ntshav qab zib ko taw, npaj ntawm a-lipoic acid, antispasmodics (drotaverin, papaverine), calf serum hemodialysate, thiab Txoj kev lis ntshav ntawm cov kev daws teeb meem yog kho.

Kev mob ntxiv rau sab qis qis uas tsis zoo rau kev kho kom zoo yuav tsum muaj kev phais mob.

Nyob rau hauv ischemic daim ntawv ntawm cov ntshav qab zib taw, endovascular dilatation thiab stenting ntawm cov hlab ntsha peripheral, thromboembolectomy, popliteal-ko taw bypass, arterialization ntawm ko taw leeg, thiab lwm yam tau ua. Autodermoplasty tau ua rau cov yas kaw ntawm qhov txhab loj tsis xws luag.

Raws li kev qhia, sib sib zog nqus purulent foci yog nqus dej (abscess, phlegmon). Nrog mob caj dab thiab osteomyelitis, muaj kev pheej hmoo siab ntawm kev tshem tawm / exarticulation ntawm cov ntiv tes lossis ko taw.

Cov qhov txhab uas tsis zoo nyob rau hauv cov taw mob ntshav qab zib yog qhov nyuaj rau kev txuag kho, xav tau kev kho mob hauv zos ntev thiab cov kab ke.

Nrog rau kev txhim kho mob rwj, txiav mus rau 10-24% ntawm cov neeg mob, uas nrog cov neeg xiam oob khab thiab qhov kev nce ntxiv ntawm kev tuag los ntawm kev tsim cov kev mob tshwm sim.

Qhov teeb meem ntawm cov ntshav qab zib taw qhia qhov kev xav tau los txhim kho qib ntawm kev kuaj mob, kev kho mob thiab kev kuaj mob ntawm cov neeg mob ntshav qab zib mellitus.

Kev tiv thaiv kab mob ntshav qab zib ko taw yuav tsum tau soj ntsuam cov ntshav qabzib hauv tsev, kev saib xyuas tas li los ntawm tus kws kho ntshav qab zib, kev ua raws kev noj haus thiab kev noj tshuaj.

Nws yog qhov tsim nyog kom tsis txhob pub hnav cov khau nruj rau hauv qhov tshwj xeeb orthopedic insoles thiab khau, nqa tawm kev tu kom huv si ntawm taw, ua kev tawm dag zog tshwj xeeb rau ko taw, thiab zam kom tsis txhob raug mob sab hauv qis.

Mob qog ntawm cov leeg hauv qab: cov tsos mob thiab kho mob

Qeb: Cov mob ntawm daim tawv Views: 21410

Mob qog ntawm qhov qis qis yog qhov kab mob txaus ntshai, uas nyob rau hauv qhov teeb meem feem ntau muaj qhov tshwm sim tsis txaus ntseeg. Txog txhua tus neeg mob thib 3 tuag los ntawm kev puas tsuaj nqaij thiab necrosis, thiab txhua2 tus neeg ua tsis taus.

Pathology tsis yog kev mob ywj pheej, tab sis ib txwm, tsis hais ntau yam, yog tsim tawm tsam keeb kwm ntawm lwm yam kab mob. Cov laj thawj yuav suav nrog mob ntshav qab zib mellitus, Raynaud tus kab mob, atherosclerosis thiab lwm yam txheej txheem pathological.

Cov tsos mob ntawm kev zawm caj dab yog qhov tseeb thiab tshaj tawm, uas yuam tib neeg los nrhiav cov kev pab tsim nyog hauv lub sijhawm. Cov tsos mob tseem ceeb suav nrog qhov tsis muaj zog ntawm nqaj, qhov kev xav ntawm "txhawm ploj mus" ntawm daim tawv nqaij, pallor ntawm daim tawv nqaij thiab txias ntawm nqua.

Kev txheeb xyuas qhov tseeb tuaj yeem ua raws li kev soj ntsuam lub hom phiaj, kev sim hauv chaw kuaj thiab kuaj cov twj paj nruag. Ntxiv mus, kev kuaj mob tau yooj yim dua vim yog cov yam ntxwv tshwm sim.

Kev kho mob ntawm tus mob yog ib txwm phais - qhov ntim ntawm qhov phais tuaj yeem sib txawv los ntawm kev tshem tawm cov ntaub so ntswg uas raug cuam tshuam (yog tias nws muaj peev xwm cawm tau ceg) lossis txiav tawm ntawm sab ceg qis.

Qhov kev faib tawm thoob ntiaj teb ntawm cov kab mob ntawm kaum kev kho dua ntawm ko taw gangrene pom qhov txawv ob peb ciphers sib txawv raws li daim ntawv ntawm nws chav kawm. Cov pa roj hom muaj tus lej raws li MKB-10 - A48.0, qhuav lossis ntub - R-02. Mob qog caj dab qis qis hauv cov kab mob ntshav qab zib mellitus yog E10-E14, thiab tsim nrog atherosclerosis - I70.2.

Txawm hais tias muaj tseeb hais tias tam sim no tus mob no tau pom los ntawm cov kws kho mob ua rau muaj tsawg, qhov ua rau mob caj dab yog ntau thiab ntau. Cov teeb meem tshwm sim feem ntau yog:

kev raug mob ntau rau cov nqaij sib txuas lossis pob txha mos,
sib sib zog nqus hlawv
Lub caij nyoog ntev kis tau qhov tsawg kub taw
lub tshuab hluav taws xob muaj zog lossis tus neeg raug hluav taws xob,
cawv ntawm tshuaj, piv txwv li, acidic, alkaline los yog lwm yam kev txhoj puab heev,
cov qhov txhab tau los ntawm riam los yog rab phom,
qhov tsim ntawm trophic mob txhab, uas feem ntau yog tshwm sim los ntawm varicose leeg ntawm txhais ceg,
kev sib tsoo ntawm cov nqaij mos lossis pob txha,
siab tawm
kev mob deeg
kev txhim kho ntawm cov txheej txheem sib kis los tiv thaiv keeb kwm yav dhau los ntawm kev cuam tshuam ntawm cov kab mob pathogenic lossis micallylo pathogenic - qhov no yuav tsum suav nrog streptococci thiab enterococci, Staphylococcus aureus thiab Escherichia, nrog rau clostridia,
chav kawm ntawm atherosclerosis los yog ntshav qab zib,
Raynaud's disease
pathologies ntawm cov hlab plawv system, tshwj xeeb hauv lub plawv tsis ua haujlwm, kev tsim cov ntshav txhaws, ischemia lossis embolism,
obliterating endarteritis,
polyneuropathy
Kev ua txhaum ntawm hernia tsim nyob rau hauv cheeb tsam puab tais,
daim ntawv thov ntawm cov ntaub qhwv nruj, ncig saib lossis lwm yam txheej txheem kev kho mob uas ua rau muaj kev cuam tshuam loj heev ntawm cov hlab ntshav,
ntau qhov kev puas tsuaj rau cov hlab ntsha ntawm cov ceg qis.

Cov ntsiab lus hauv qab no yog cov txheej txheem kev paub uas ua rau muaj kev pheej hmoo ntawm necrosis ntawm daim tawv nqaij ntawm txhais ceg:

ntse hloov kom haum hauv lub cev qhov hnyav - nws nce lossis tsawg dua,
muaj qhov tsis txaus nyob hauv keeb kwm ntawm tus kab mob,
kab mob ntawm cov endocrine system,
tsis muaj cov vitamins nyob hauv tib neeg lub cev,
kev tiv thaiv kab mob ua haujlwm tsis muaj zog
lub hom phiaj ntawm mob ntev pathologies ntawm kev kis tus xwm,
malignant arterial kub siab,
lub caij nyoog yoo mov
teeb meem ntawm metabolic
intoxication lossis lub cev qhuav dej ntawm lub cev.

Txawm hais tias tus yam ntxwv ntawm ib qho los yog lwm qhov ua kom mob caj dab ntawm qis qis dua, nyob rau hauv txhua kis, muaj kev ua txhaum ntawm cov ntshav cov txheej txheem.

Kev faib tawm

Raws li txoj kab kev txuas ceg twg cuam tshuam, tus kab mob tau muab faib ua:

cov menyuam yaus kis tau raws kis raws tag nrho ntev ntawm ceg,
kev lom zem ntawm ko taw
kev lom zem ntiv taw,
kev lom zem ntawm cov ntsia hlau.

Nyob ntawm cov qauv etiological, muaj:

ischemic kev ua tub rog
lom neeg phem lom zem
kis tus menyuam laib laus
lom neeg phem lom zem
kev ua xua
anaerobic kev ua neeg phem,
tsev kho mob kev mob vwm los ntawm kev phais mob.

Hom kev ua laib los ntawm chav kho mob:

qhuav - yog tsim tawm tsam keeb kwm ntawm lub sijhawm ntev ntawm kev mob nyob rau hauv cov kab mob aseptic, i.e., tsis muaj kab mob. Feem ntau cuam tshuam rau tag nrho cov nqua. Nws yog qhov tsim nyog hais tias qhov kev ua paug qhuav ntawm qis qis tsis tshua muaj kev hem thawj rau tib neeg lub neej - kev phom sij tshwm sim tsuas yog nrog kev sib kis kab mob theem ob,
roj - ib qho ua rau muaj tshwm sim - muaj lub qhov txhab tob tob uas cov kab mob pathological tau nkag mus rau thiab cuam tshuam tsis zoo,
kev ua ntub dej thawm plab yog ib txwm muaj qhov tsis pom tseeb. Qhov no yog vim qhov tseeb hais tias cov txheej txheem pathological ib txwm nrog kev kis tus kab mob.

Nrog ko taw voos, hom 1 thiab hom 3 yog ntau tus.

Tus neeg mob qhuav qhuav caj ceg muaj cov theem hauv qab no ntawm qhov muaj mob:

tabkaum ncig,
ntaub so ntswg necrosis
tsim ntawm qhov o tiv,
hais lus ncaj ncees
kev loj hlob ntawm putrefactive cov txheej txheem,
txiav tes txiav taws.

Kev ntub dej cawv ntawm cov leeg hauv qab qis, raws li nws txhim kho, mus raws theem hauv qab no:

sai tsis muaj ntshav txaus,
ceev cov ntaub so ntswg necrosis, qee zaum fulminant,
decomposition los yog lwj ntawm daim ntaub uas tuag,
kev nkag mus ntawm co toxins rau hauv cov ntshav,
kev cuam tshuam ntawm kev ua haujlwm ntawm ntau lub nruab nrog cev thiab kab ke, nce mus rau ntau lub cev tsis ua haujlwm.

Qhov theem ntawm tsim muaj ntshav qab zib taw:

khaus heev
ua txhaum ntawm kev ncaj ncees ntawm daim tawv nqaij,
cov tsos ntawm thaj chaw ischemic tsis muaj o,
koom nrog cov txheej txheem o,
qhov tshwm sim ntawm foci ntawm necrosis,
poj laib.

Muaj teeb meem tshwm sim

Thaum tsis muaj kev kho rau tus mob ceg txhawm, txawm tias pom cov tsos mob hais tawm, cov neeg mob muaj qhov pheej hmoo loj uas yuav tshwm sim:

ntau yam hauv nruab nrog cev tsis ua haujlwm
poob siab lossis tsis nco qab,
sepsis
nqua poob
kev tsis taus

Kev tiv thaiv thiab kev kwv yees

Cov kev ntsuas tshwj xeeb tsom rau kev tiv thaiv kev txhim kho kev sib tw ntawm kev sib deev ntawm qhov qis qis tsis tau tsim. Txawm li cas los xij, txhawm rau txo qhov ntxim nyiam ntawm tus kab mob, nws yog ib qho tsim nyog yuav tsum ua raws li cov kev cai no rau kev tiv thaiv ntawm ischemic gangrene thiab lwm yam:

kev tiv thaiv kev tiv thaiv frostbite lossis ua rau kub nyhiab ntawm daim tawv nqaij ntawm ob txhais ceg,
kev kho mob raws sij hawm ntawm cov kab mob uas yuav nyuaj los ntawm kev ua txhaum ntawm cov ntshav ncig thiab cov nqaij mos necrosis,
kev tswj lub cev hnyav
kev noj zaub mov zoo
kev tiv thaiv ntawm intoxication thiab lub cev qhuav dej ntawm lub cev,
kev siv cov khoom tiv thaiv thaum ua haujlwm nrog tshuaj lom neeg lossis tshuaj yeeb dej caw,
kev tshuaj xyuas tas li los ntawm cov kws tshwj xeeb tsim nyog - nrog qhov tshwm sim ntawm tus mob mus ntev, piv txwv li, ntshav qab zib.

Txawm hais tias qhov tseeb tias kev ua qias neeg ntawm qhov qis qis hauv qab yog suav tias yog kev mob tsis tshua muaj, nws feem ntau muaj qhov tshwm sim tsis zoo. Kev txiav tawm ntawm txhais ceg ua rau muaj mob xiam oob qhab ntawm tus neeg mob, thiab ntxiv ntawm qhov muaj mob yog tuag taus.

Cov kab mob nrog cov tsos mob zoo sib xws:

Dysmenorrhea (cov tsos mob sib xws: 4 tawm ntawm 20)

Dysmenorrhea yog mob pathological cim los ntawm kev tshwm sim ntawm qhov mob hnyav rau tus poj niam lub sijhawm premenstrual thiab lub sijhawm ntawm coj khaub ncaws, thaum lub xeev ib txwm tsis muaj mob.

Cov kev ua txhaum cai no feem ntau tshwm sim, tshwj xeeb tshaj yog rau cov poj niam hluas hnub nyoog 20-25 xyoo, thiab nyob hauv cov poj niam lub sijhawm premenopausal. Dysmenorrhea tsis tsuas yog muab rau tus poj niam tsis xis nyob, tab sis kuj ua rau nws lub neej tsis zoo, vim tias thaum nws muaj mob loj heev, tus poj niam lub siab poob qis, nws lub peev xwm ua haujlwm zuj zus, thiab lwm yam.

Yog li, nws yog ib qho tseem ceeb kom sab laj nrog kws kho mob kom raws sijhawm kom paub lub hauv paus ua txhaum cai thiab tau txais kev kho mob txaus.

... Pelvioperitonitis (cov tsos mob sib xws: 3 ntawm 20)

Kev mob voos ntawm peritoneum ntawm lub plab hu ua tus poj niam lub cev yog hu ua pelvioperitonitis. Tus kab mob yog tshwm sim los ntawm cov kab mob xws li staphylococci, E. coli, gonococci, chlamydia thiab ntau yam kab mob. Muaj qee zaus, kev nyuaj los ntawm tus kabmob yog xam qhovkev, uas ua rau lub sijhawm tsis yog tus kabmob xwb, tabsis tseem yuav kis tau tus kabmob ntawd.

... Kev cuam tshuam cov hnyuv (cov tsos mob sib xws: 3 ntawm 20)

Kev cuam tshuam ntawm txoj hnyuv yog qhov mob hnyav heev, uas yog tus cwj pwm los ntawm kev ua txhaum ntawm txheej txheem ntawm kev tso tawm cov tshuaj ntawm txoj hnyuv. Xws li cov kev mob cuam tshuam feem ntau cuam tshuam rau cov neeg tsis noj zaub.

Qhia qhov txawv ntawm cov khoom siv hloov kho lub plab thiab lub plab. Yog tias pom thawj cov tsos mob ntawm tus kab mob pom, nws yog qhov yuav tsum tau mus cuag kws phais. Tsuas yog nws thiaj li tso cai kho mob kom ncaj.

Yog tias tsis muaj kev kho mob hauv lub sijhawm, tus neeg mob tuaj yeem tuag.

... Thrombosis (cov tsos mob sib xws: 3 ntawm 20)

Thrombosis yog ib yam kab mob thaum lub caij cov ntshav txhaws ua ke (txhab ntshav) ua rau hauv cov hlab ntshav uas cuam tshuam txoj kev ntshav dawb thoob plaws lub cev. Kev txhaws ntawm cov hlab ntshav los ntawm cov ntshav txhaws ua rau muaj kev tsis txaus siab nyob rau sab caj npab lossis txhais ceg (nyob ntawm thaj chaw ntawm ntshav txhaws).

... Tuberculous pleurisy (txuam nrog cov tsos mob: 3 ntawm 20)

Tus kab mob, nyob rau hauv uas tshwm sim ntawm mob huam, mob ntev thiab rov ua dua ntawm pleura yog yam ntxwv, yog hu ua tuberculous pleurisy. Tus kab mob no muaj qhov peculiarity kom pom los ntawm kev kis mob ntawm lub cev nrog cov kab mob ntsws. Pleurisy feem ntau tshwm sim yog tias ib tus neeg muaj qhov nyiam ua mob ntsws ntsws.

Cov kev cai rau rau yog dab tsi?

Kev faib tawm thoob ntiaj teb yog tsim kom yooj yim rau kev ua haujlwm ntawm cov kws tshwj xeeb thaum lub sijhawm kuaj mob thiab kev teem sijhawm kho. Cov tib neeg tsis yooj yim yuav tsum paub ICD cov lis dej num, tab sis rau kev txhim kho dav dav cov ntaub ntawv no yuav tsis raug mob, txij li thaum tsis tuaj yeem mus ntsib kws kho mob, nws yog qhov zoo dua los siv cov ntaub ntawv feem ntau lees paub.

Cov cim, tsos mob thiab kho tus mob ko taw

Mob ntshav qab zib mellitus yog ib qho ntawm cov kab mob ntev, nrog ntau yam mob. Cov mob txaus ntshai tshaj plaws yog ntshav qab zib taw, cuam tshuam cov hlab ntsha, cov hlab ntsha, pob qij txha, ntxiv rau daim tawv nqaij.

Kev pheej hmoo ntawm nws tshwm sim nce nrog ntev ntev decompensation ntawm cov ntshav qab zib thiab nrog kev paub ntawm tus kab mob tshaj 5 xyoos. Kev paub thaum ntxov tuaj yeem nres kev txhim kho ntawm cov teeb meem, thiab tsis tuaj yeem kho cov sijhawm, qhov zoo li ntawm kev phais mob ntau ntxiv.

Ua rau muaj tus kabmob

Tus mob ntshav qab zib mob ko taw muaj ib qho ICD code 10 - E10.5 lossis E11.5, uas tsim qauv ntshav qab zib hom 1 lossis hom 2, ntsig txog.

Teeb meem cuam tshuam kev hloov pauv cuam tshuam cov leeg hlwb thiab leeg ntshav.

Raws li qhov tshwm sim ntawm lub cev tsis zoo no, ulcerative necrotic cov txheej txheem tuaj yeem tsim nyob rau hauv lub cev thiab kev ua haujlwm gangrene.

trophic mob - tshwm sim hauv 85% ntawm cov neeg mob,
phlegmon
abscesses
tenosynovitis,
osteomyelitis
txha osteoarthropathy,
purulent mob caj dab.

Lub pathogenesis ntawm kev rov qab yog qhov tsis txaus tsim ntawm cov kua dej yuav tsum tau ua kom tawg ntawm cov piam thaj.

Raws li qhov tshwm sim, qib ntawm glycemia nce siab, cuam tshuam tsis zoo rau cov ntshav khiav thiab tsis hnov qhov muag ntawm cov hlab ntaws. Daim duab no qhia tias qhov kev tshwm sim zoo li cas nyob rau hauv ntu kawg.

Neuropathic - cov leeg mob hlwb cuam tshuam. Daim foos no yog tsim los ntawm qhov tsim muaj qhov ua kom mob, Charcot sib koom ua ke lossis qhov zoo li ntawm lub puffiness.
Ischemic - tshwm sim vim yog atherosclerosis, uas cuam tshuam cov hlab ntsha hauv ob txhais ceg thiab cuam tshuam cov ntshav ntws hauv lawv.
Sib xyaw - muab kev puas tsuaj rau cov leeg thiab cov hlab ntshav.

poob lossis poob qis ntawm qhov rhiab heev vim yog neuropathy nrog ntshav qab zib,
circulatory ntshawv siab cuam tshuam rau cov hlab ntsha thiab hlab ntsha (angiopathy),
atherosclerosis - kab mob feem ntau tshwm sim tiv thaiv keeb kwm ntawm cov roj (cholesterol) hauv cov ntshav,
deformation ntawm taw,
qhuav tawv nqaij nto
hnav cov khau kom nruj, nrog rau txhua qhov kev ntxhov siab uas ua rau daim tawv nqaij puas,
fungal kis
kev saib xyuas tsis zoo ntawm tus kws kho mob thaum phais mob tshem tawm ntawm tus ntsia thawv ingrown ntsia hlau.

Kev txaus ntshai ntawm cov teeb meem yog piav qhia los ntawm qhov tseeb tias cov neeg mob rau lub sijhawm ntev tsis pom tias muaj nyob ntawm ko taw ntawm corns, kab nrib pleb, abrasions ntawm daim tawv nqaij, uas tom qab ntawd tig mus rau hauv qhib lossis kaw qhov mob.

Cov tsos mob thiab cov tsos mob

Tus mob huam vam zuj zus los ntawm 5 qib ntawm nws txoj kev loj hlob:

Muaj qhov txhab tsis zoo tshwm tuaj tsiag ntawv los ntawm qhov chaw mob ntawm cov txheej hauv av ntawm daim tawv nqaij.
Muaj tus mob loj ua haujlwm, tabsis tsis muaj pob txha.
Mob rwj ntau hauv qhov tob pom, nrog daim tawv nqaij mob, nrog rau cov nqaij mos uas nyob ib ncig ntawm.
A "Charcot tus taw" yog tsim, tus yam ntxwv pom ntawm laib plab hauv qee thaj chaw (piv txwv li tus ntiv tes).
Ib qho kev sib deev tsis sib haum yog tsim, uas tuaj yeem ua rau lub txiaj ntsig tuag thiab xav kom txiav tawm tam sim ntawd ntawm tus caj npab cuam tshuam.

Qhov tshwm sim ntawm tus mob tshwm sim yog:

ib feem los yog tag nrho qhov kev poob siab, uas tau hais tawm thaum tsis muaj qhov tshuaj tiv thaiv rau kev vibration, tom qab ntawd hloov mus rau qhov kub thiab txias, thiab tom qab ntawd ua rau mob thiab kov,
o tuaj
qaug zog hauv ob txhais ceg thaum taug kev,
kev hnov ntawm mob hauv sab ceg, uas qhia tau nws tus kheej hauv kev so, txav mus los, thaum tsaus ntuj,
tingling
hlawv hauv taw
chilliness
kev tshem tawm ntawm daim tawv nqaij (qhov pom ntawm liab lossis cyanotic ntxoov),
ib qho kev txo qis hauv cheeb tsam ntawm kab plaub hau ntawm ceg,
hloov pauv ntawm cov xim lossis cov duab ntawm cov ntsia hlau,
ntev kho lub sij hawm rau qhov txhab, hu lossis txawm tias me me khawb,
cov tsos ntawm bruises nyob rau hauv cov rau tes, taw qhia cov kev loj hlob ntawm fungal mob thiab muaj kev pheej hmoo ntawm necrosis,
tsim muaj mob rau ntawm taw.

Txhawm rau txhawm rau pom ntau cov tsos mob no, koj yuav tsum soj ntsuam ob txhais ceg tsis tu ncua nrog kev pab ntawm daim iav tsom hauv qab. Thaum lub sijhawm tshuaj xyuas, nws yog ib qho tseem ceeb kom kuaj xyuas qhov chaw sib nrug, ib leeg thiab pob taws thaj chaw.

Charcot tus taw (mob ntshav qab zib osteoarthropathy)

Kev ua haujlwm hauv kev ua kom tsis zoo, ntau zuj zus mus rau ntau lub hlis, pab txhawb kom lub cev puas tsuaj ntawm ko taw. Tus mob no yog hu ua Charcot ua ke. Kev hloov pauv pathological cov yam ntxwv ntawm qhov kev cuam tshuam no feem ntau cuam tshuam tsis tsuas yog txhais ceg, tab sis kuj txhais tes.

Raws li qhov tshwm sim, cov neeg mob ntshav qab zib tsis hnov cov kev mob tshwm sim thaum lub pob txha puas nyob rau hauv cov chaw puas, uas ntxiv rau nws tus mob. Maj mam, cov leeg mob neuropathic tshwm sim hauv tus taw, nrog ua ke ntawm kev tsim cov mob txhab.

txha txawj - yog cim los ntawm thinning ntawm pob txha, qhov txo qis hauv nws lub zog,
osteolysis - ib qho mob uas cov pob txha tau nqus tag nrho,
hyperostosis - nrog kev loj hlob ntawm cortical txheej ntawm pob txha.

Qhov tshwm sim "Charcot sib koom ua ke" yuav tsum tau tso dag zog kom sai li sai tau los ntawm cov thauj khoom kom cov leeg pob txha tuaj yeem rov zoo dua. Cov neeg mob tau qhia kom hnav cov khau orthopedic nkaus xwb hauv cov xwm txheej zoo li no.

Mob ntshav qab zib kho ko taw

Kev xa mus rau sijhawm rau tus neeg mob mus rau cov chaw haujlwm tshwj xeeb koom nrog kev kho mob ntshav qab zib ua rau nws muaj peev xwm tso tseg qhov kev vam meej ntawm cov tsos mob tshwm sim ntawm tus mob ko taw thiab txhim kho lawv tus mob.

Kev siv cov tshuaj muaj txiaj ntsig tsuas yog thaum nyuam qhuav pib ntawm kev txhim kho ntawm kev muaj teeb meem. Kev kho mob caj dab yog twb tau ua phais mob.

Yuav kho cov mob kiav txhab li cas?

Txoj kev kho rau cov teeb meem yuav tsum muaj kev nthuav dav. Cov hau kev ntawm kev kho cov mob txhab ua pob ua qias tuaj nyob ntawm lub xeev cov ntshav khiav hauv nqua.

Txoj kev kho kom ntshav ntws muaj xws li:

mob thiab qhov txhab kho mob,
txo load exerted nyob rau ntawm lub nqua,
tshem tawm cov mob sib kis los ntawm kev siv cov tshuaj tua kab mob,
glycemic tswj tau ua nyob hauv tsev,
kev tshem tawm cawv, nrog rau kev txiav luam yeeb.
kev kho mob ntawm concomitant pathologies uas ua rau muaj kev pheej hmoo ntawm txhais ceg txiav (daim siab mob, oncology, mob ntshav qab zib).

Nrog cov ntshav ntws tsis zoo, ntxiv rau cov khoom saum toj no, ntsuas tau coj los kho nws.

Kev kho mob ntawm cov nqaij mos thiab necrosis mob rau sab hauv:

kev pab cuam phais mob
txiav tes taw yog tias tsis muaj kev cuam tshuam los ntawm txoj kev kho.

Nws yog ib qho tseem ceeb kom nkag siab tias kev tshem tawm tes taw yog suav tias yog kev ntsuas hnyav thiab tau ua rau cov neeg mob hnyav xwb.

Cov Tshuaj Kho Mob

Cov tshuaj hauv qab no tuaj yeem raug kho rau cov neeg mob uas tau hais tawm qhov tshwm sim ntawm pathology:

Cov tshuaj muaj alpha lipoic acid (Thiogamma, Thioctacid, Berlition "). Cov nquag ua haujlwm ntawm cov tshuaj no pab txhawb rau kev tshem tawm cov dawb radicals uas twb muaj lawm, rov qab los ntshav, nrog rau kev ua kom zoo dua ntawm cov hlab ntsha.
Cov vitamins los ntawm pawg B (Milgamma, Neuromultivit). Cov tshuaj daws tau ntxiv rau qhov nyiaj ntawm cov ntsiab no tsis muaj zog tiv thaiv keeb kwm ntawm tus kab mob.
Tshuaj siv rau kev kho mob tus yam ntxwv. Kev siv cov pa tshuaj tiv thaiv kev puas tsuaj lossis tshuaj tiv thaiv kev ua kom zoo tsuas yog pib thaum ntxov ntawm kev ua kom paub tus mob, txij li yav tom ntej, cov neeg mob txo lawv lub siab thiab tsis muaj qhov hnov ntawm qhov mob.
Cov tshuaj anticonvulsant, tshuaj tiv thaiv kab mob. Lawv qhov kev siv yog ua tau tsuas yog thaum tsis muaj glaucoma hauv cov neeg mob. Txwv tsis pub, kev kho mob tuaj yeem cuam tshuam rau lub siab ntawm txoj leeg ntshav.
Txhais tau tias txhawb nqa cov ntaub so ntswg tsim dua tshiab hauv thaj chaw mob plab (Eberprot-P). Kev txhaj tshuaj ntawm cov tshuaj no ua rau muaj qhov pheej hmoo sai ntawm qhov mob uas tau tshwm sim thiab pab tus neeg mob ua yam tsis tau txiav tu.
ACE inhibitors. Lawv pub koj tswj cov ntshav siab.
Calcium antagonists. Kev siv tshuaj yog qhov tsim nyog los rov qab cov nyiaj ntawm lub cev no hauv lub cev.
Thiazide diuretics kho rau kev kub siab.
Cov tshuaj noj muaj roj ua kom tsawg.
Antiplatelet tus neeg sawv cev. Kev npaj muaj acetylsalicylic acid txo qhov ntxim nyiam ntawm kev zwm plab menyuam yaus.
Cov tshuaj vasoactive. Lawv pab txhim kho ntshav kev nyob hauv thaj chaw ischemic.

Kev kho mob nrog cov teev tau txhais tau qeeb qeeb ntawm kev kho mob ntawm pathology, txhawb nqa cov tsos mob.

Kev phais mob

Kev phais mob siv hauv cov neeg mob uas mob ko taw muaj xws li cov hauv qab no:

bypass phais - tsim los tsim kev hla hauv cov hlab ntsha rau ntshav,
sympathectomy - ib qho kev khiav haujlwm tawm ib feem ntawm lumbar ganglia,
zais pa angioplasty - yuav pab kho vascular lumen,
txiav tes txiav - tshem tawm cov ntaub so ntswg thiab sib txuas ntawm pob txha taub hau-pob txha uas tau ploj kom zoo dua.

Txoj kev phais mob tsuas yog siv nyob rau hauv kev mob hnyav, thaum kev siv tshuaj kho mob tsis muab cov nyhuv tsim nyog.

Kev tiv thaiv pathology

Nws yog ib qho tseem ceeb kom nkag siab tias kev tiv thaiv kev mob nyhav yooj yim dua li sim kho lawv. Cov kev tiv thaiv kev tiv thaiv yog txiav txim siab los ntawm kev saib xyuas txhua hnub kev cai khau thiab kev paub khau.

Kev saib xyuas ko taw yog ua raws li qee cov lus pom zoo.

Cov no suav nrog:

mus rau tus kws kho mob yog tias muaj kev puas tsuaj ntawm ko taw tau pom,
txhua hnub ntxuav ko taw
kev soj ntsuam tsis tu ncua ntawm ob txhais ceg nrog daim iav kom paub seb puas muaj kev raug mob,
ko taw kev tswj qhov kub thiab txias
txhua hnub hloov cov thom khwm thiab thom khwm,
zam kev raug mob ceg
qhov tseeb ntawm pedicure,
kev siv cov nplaum ua kom tshem tawm cov ceg qhuav.

Cov khoom siv vis dis aus hais txog yuav tiv thaiv koj ob txhais ceg ntshav qab zib li cas:

Cov neeg uas muaj ntshav qab zib txhua yam yuav tsum tau ris lawv lub khau. Qhov loj tshaj plaws yog tias nws yuav tsum xis nyob, dawb thiab haum rau ntawm nws txhais ceg. Lub xub ntiag ntawm deformation ntawm ko taw yuav tsum tau hnav cov khau orthopedic.

Nws yog ib qho tseem ceeb kom nkag siab tias qhov kev koom tes tsis tu ncua ntawm tus neeg mob rau kev tshem tawm cov tsos mob ntawm tus mob ko taw yuav ua rau muaj kev pheej hmoo sai.