Boleng ba bophelo ba batho ba nang le lefu la tsoekere hangata bo kotsing. Ntle le tšenyo ea bokong, liphi, analytez ea pono le tsamaiso ea methapo, karolo ea bohlokoa e fanoa ho lefu la tsoekere la lefu la tsoekere. Lipontšo tse ka sehloohong tsa pathology ke ho ba teng ha ulcers e sa foleng, ischemia ea bohlokoa le lefu la masapo le manonyeletso a tlhaho e sa tšoaetsanoang. Li-ulc li nkoa e le boemo bo tšosang ka ho fetisisa, hobane ho matahanya le tšoaetso ea bobeli ho kenyelletsa ho hola ha mpa le ho lahleheloa ke leoto.
Lefu la tsoekere - boemo boo li-endocrinologists li kenang ho tsona. Linaheng tse kantle ho naha, podiatry e ntse e ithuta taba ena, leha ho le joalo, naheng ea rona saense ena e nkoa e le nyane, litsebi tse ling tse patisaneng ha li eo.
Likhopolo tse akaretsang
Maoto a ka tlase a pepesetsoa khatello ea bohlokoa bophelong bohle. Boima bohle ba 'mele bo fetisetsoa linthong tsa maoto. Ke ka lebaka leo tšenyo ea methapo ea mali, methapo ea methapo le lisebelisoa tsa mokokotlo o loantšang lefu la tsoekere le tsosang nts'etsopele ea ho senya le ho fokola hoa leoto.
Lefu la lefu la tsoekere le nkoa e le bothata bo ikemetseng bo hlahang khahlano le semelo sa mafu a mang a sa foleng (retinopathy, nephropathy, angiopathy, neuropathy). Leoto le ka tlase le fetoha ka liphetoho tsa anatomical le 'mele, tse bonahatsoang ke lits'ebetso tsa purulent-necrotic.
Sistimi ea nts'etsopele
Ho tsoekere ea lefu la tsoekere, ho na le lefu le felletseng (mofuta oa 1 oa lefu) kapa lefu la setho sa 2 sa lefu la insulin pancreatic hormone. Ts'ebetso e joalo e lebisa maemong a phahameng a tsoekere maling le mafu a lits'ebetso tsohle tsa metabolic. Leoto la lefu la tsoekere ke lebaka la mathata a mang a morao a lefu lena le tlase: neuropathy, angiopathy, osteoarthropathy.
Lefu la tsoekere
Boemo bona bo baka ponahalo ea londa tsa trophic ho lefu la tsoekere le leng le le leng la bobeli. Litekanyetso tse phahameng tsa "glucose" tse ngata li baka tšenyo ea methapo ea methapo (lisele, likhoele, li-receptor), tseo, li hlahisoang ke ho fetisoa hoa litšusumetso. Ntle le moo, tšenyo ea methapo e boetse e bakoa ke angiopathie e etsahalang hoo e ka bang lefu la tsoekere le leng le le leng mme e lebisa ho bolaoa ke tlala ea "oxygen" ea litho tsa methapo.
Tšenyo ea methapo ea lefu la tsoekere ke se seng sa lisosa tsa nts'etsopele ea lehe la tsoekere
Ho senya matla a kutlo ho baka ho hlaseloa ha mesifa ea leoto. Defform ea hlaha, e tsamaeang le lipontšo tse latelang:
- keratinization ea letlalo libakeng tsa khatello ea kamehla;
- hematomas;
- ponahalo ea poone;
- sebopeho sa libaka tsa necrosis tsa letlalo;
- ho hlaha hoa liso.
Lefu la tsoekere la Osteoarthropathy
Mofuta o mong oa leoto o amanang le lefu la tsoekere o hlaha. Boemo bona ha bo fumanehe (1% feela ea batho ba nang le lefu la tsoekere) 'me le tsebahala ka lefu la methapo ea masapo. Lebitso la bobeli la osteoarthropathy ke "leoto la Charcot."
Lintlha tsa bohlokoa tse tsamaeang le ketsahalo ea osteoarthropathy:
- tlolo ea molao ea bolulo;
- mathata a microcirculatory ka keketseho ea phallo ea mali ea basal;
- ho fokotseha ha palo ea lisele tse nyane tsa masapo tse ikarabellang bakeng sa ho etsoa ha matrix;
- deformation ea masapo a motho ka mong;
- dislocations, subluxations le fractures li hlaha.
Osteoarthopathy ke lefu le tsamaeang le ts'enyo ea masapo a leoto
Bohlokoa! Ts'ebetso hangata e ama masapo a menoana, tarsi, hangata leqaqailana.
Lefu la tsoekere
Ena ke lesapo la mokokotlo la litlatsetso tse fapaneng, tseo lefu la tsoekere le hlahisoang ke lona. Liponahatso tse hlakileng ke atherosclerosis le occlusion, hangata li hlaha ka tlasa lengole. Ts'ebetso tse ts'oanang li nkuoa e le tsa bohlokoa lits'ebetsong tsa purulent-necrotic, tse hlahisoang khahlanong le semelo sa leoto la tsoekere la mofuta oa ischemic.
Lintlha Tse Tsosang
Ho na le likotsi tse 'maloa tse shebahalang e le mathata a manyane, empa khahlanong le semelo sa lefu la tsoekere se ka baka mafu a tebileng mme ea fetoha mabaka a ntlafatsang lera la lefu la tsoekere.
Sehlopha sena se kenyelletsa lipekere tse kenang, ho hlatsuoa ha likhoto tsa lipekere ka lebaka la lieta tse thata tse sa khethiloeng, li-hemorrhages kapa likhoele tsa fungal. Sebopeho sa poone le poone. Sena se kenyelletsa tšenyo e sa sebetseng ea tšenyo ea botshepehi ba letlalo, lieta tse senyehileng, ho holofala ka lebaka la masapo a holisitsoeng.
Mekhahlelo
Karohano e nkoa e tšoana ebile e amoheloa ka kakaretso. Ho na le mefuta e meraro ea sehlooho ea lefu lena:
Lefu la tsoekere le kalafo ea lona- Leoto le tšoaelitsoeng la mofuta oa neuropathic (60-65% ea linyeoe) - le hlaha khahlano le semelo sa lefu la tsoekere le telele, le kopaneng le mathata a mang. Letlalo ha le fetoloe, pulsation ho methapo ea kutlo e bolokiloe, mefuta eohle ea maikutlo e ferekanngoa haholo, ha ho na bohloko.
- Leoto le letenya la mofuta oa ischemic (10-15% ea linyeoe) - bakuli ba tletleba ka bohloko bo boholo, letlalo le maotong le na le botala bo botala, bo bata ho ama. Ripple e fokotsehile haholo, empa maikutlo a lekane. Ha e le hantle, bakuli ka nako e tšoanang ba na le khatello e phahameng ea mali, ba na le cholesterol e ngata maling.
- Leoto la mofuta o tsoakaneng (20-25% ea linyeoe).
Haeba mokuli a e-na le ischemic pathology, lefu lena le sebelisa boemo ba maemo a litho tse ka tlase tsa setho:
- 1 - ho ba sieo ha matšoao (ho 70% ea linyeoe).
- 2a - bohloko ha u tsamaea ho feta 200 m;
- 2b - bohloko ha o tsamaea ka tlase ho 200 m;
- 3 - bohloko ba ho phomola ka botlalo;
- 4a - trophic pathology hammoho le bohloko;
- 4b - trophic patology e se nang bohloko.
Claudication e kenang ka hare - letšoao la tšenyo lipheletsong tse tlase, e bonts'ang bohloko ha o tsamaea
Classified of ulcerative vidonda ho lefu la tsoekere lefu la tsoekere:
- 0 degree - botshepehi ba letlalo ha boa robeha;
- 1 degree - trophic ulcer e fumanehang ka mokhoa o phahameng;
- 2 degree - trophic ulcer e amang likarolo tse tebileng tsa letlalo;
- Kereiti ea 3 - ho ruruha ha 'mele oa masapo a masapo kapa ho etsoa ha lekhopho;
- 4th degree - gangrene, e nang le tlhaiso-leseling e hlakileng;
- Tekanyo ea bohlano - bohloka bo tloaelehileng, boo ho pongoa tšohanyetso ho etsoang.
Karohano ka lihlopha tsa ts'oaetso ea tšoaetso e etsahetseng nakong ea lefu la tsoekere la lefu la tsoekere:
- Ha ho na ts'oaetso ea ts'oaetso - leqeba kapa ulcophic ulcer ha e na lero la phello mme ha ho na matšoao a ts'oaetso ea ts'oaetso.
- Tšoaetso e bonolo - matšoao a mangata a ho ruruha a hlaha (edema, redness, pain, hyperthermia ea lehae). Hyperemia e bokella morero o sa feteng 2 cm ka mahlakoreng 'ohle ho tloha pheletsong ea leqeba kapa ulcer.
- Ts'oaetso e leka-lekaneng - e tsamaisana le lymphangitis, sebopeho sa lekhopho, gangren. Mohato ona o kenyelletsa likarolo tse tebileng tsa sebopeho.
- Tšoaetso ea tekanyo e boletsoeng - ho na le matšoao a tahi e tebileng ea 'mele, ho fokotseha ha khatello ea mali, sekhahla sa pelo, tsoekere e phahameng ea mali, azotemia.
Matšoao a lefu la kelello
Mofuta o mong le o mong oa complication o ka tsamaisana le li-peloma tsa necrotic. Matšoao a leoto la lefu la tsoekere a ipapisitse le hore na lefu lena le tsamaisoa ke lefu le matla la ho penta le hlokang tlhokomelo e potlakileng kapa che. Ha e le sieo, mofuta oa leoto la tsoekere o ka aroloa ho latela litletlebo tse tsoang ho bakuli.
Matšoao a pele a mofuta oa neuropathic a bonahatsoa ke bohloko bo bohloko bo hlahang maotong, maotong, thekeng. Matšoao a bohloko a fokotseha ka mor'a ho sisinyeha, phetoho boemong ba leoto le ka tlase. Bakuli ba tletleba ka maikutlo a fokotsehileng a ho fereha, ho bobola, ho hloka thabo, ho chesa, ho ikutloa eka ke li-goosebumps. Pontšo khafetsa ke keketseho ea ho ruruha, bofokoli ba mesifa.
Pontšo e hlakileng ea bohloko ke sesupo sa leoto la lefu la tsoekere la tlhaho ea neuropathic
Matšoao a mofuta oa leoto la ischemic a hlaha ka tsela e latelang:
- bohloko bo boholo maotong ha u tsamaea;
- bakuli ba qobelloa ho emisa e le hore bohloko ba mesifa bo fokotsehe;
- bohloko bo hlahang ha mokuli a le sebakeng se tsitsitseng mme a nyamela kamora hore mokuli a lule fatše;
- makhopho, haholo bosiu;
- ho utloa serame menoaneng.
Tlhahlobo e bonoang ea bakuli
Tafole e bonts'a lintlha tsa mantlha tse lumellang mefuta ea phapang ea lefu la tsoekere.
Ischemic pathology | Pathology ea tlhaho ea neuropathic |
Letlalo le boreleli, le bata ho ama, makhopho a bonahala | 'Mala le mocheso oa letlalo ha li fetoloe, libaka tse bonojana ba letlalo le hlahang, tse nang le bokhoni ba ho phumula |
Ho haella ha mokokotlo oa leoto | Phetoho e mpe ea maoto le matsoho, ho ruruha hoa bohlokoa |
Arterial pulsation e fokotsehile haholo kapa ha e eo ho hang | Arterial pulsation e maemong a matle |
Libaka tse sa bonahaleng tsa necrotic, li-uloph tsa trophic li na le maikutlo a phahameng, li bohloko | Li-uloph tsa trophic ha li tsamaisane le bohloko |
Matšoao a hlakileng | Matšoao a fokola |
Bohlokoa! Lifoto le litšoantšo tsa lipontšo tsa "pathology" li ka fumanoa webosaeteng kapa maqepheng a lingoliloeng tse ikhethileng.
Ts'oaetso
Ho ikemisetsa ka nako ea lefu lena ho tla liehisa ho phahama ha boemo, ho khetha kalafo e nepahetseng, le ho thibela tlhokeho ea ho khaoloa leoto le tlase. Pele ho tsohle, setsebi se bokella datha mabapi le lefu le ka tlase mme se hlakisa boteng ba litletlebo. Ka mor'a moo, ho hlahlobisisa likarolo tse tlase: sethala le dorsum, sebaka se pakeng tsa menoana.
Setsebi se hlakisa 'mala oa letlalo, mocheso oa lona, boteng ba moriri. E lekola botonopo ba letlalo la mokokotlo le letlalo, ho phunyeha ha methapo ea methapo, ho ba teng hoa puffiness le bofokoli ba trophic. Haeba ngaka e sa khone ho mamela pulse e holim'a methapo ea kutlo, Dopplerography e etsoa ka sesebelisoa se nkehang.
Dopplerograph e nkehang habonolo - sesebelisoa se u lumellang hore u mamele ho ba teng ha pulse ho methapo ea methapo ea kutlo
Ka thuso ea setsebi sa methapo ea kutlo, boemo ba kutlo bo hlahlojoa:
- tactile - monofilament;
- bohloko - ka hamore e nang le nale ka qetellong;
- vibration - tokololo ea fereko;
- mocheso - dintho tse batang le tse futhumetseng.
Radiography e u lumella ho hlakisa boemo ba likarolo tsa kahare le lisebelisoa tsa "osteoarticular". Bakeng sa pono e ntle, ho sebelisoa lithunya tse peli tsa projeke.
Mehlala
Mekhoa e khethehileng ea ho khetholla boteng ba methapo ea mafu:
- Mohlala Alekseev. E lekola phetoho ea mocheso oa libaka tse tlase kamora ho tsamaea. Ho bakuli ba nang le potoloho ea potoloho, matšoao a fokotseha ka 1-2 ° C kamora 400 m.
- Mohlala Marburg. Khahlano le pallor ea sebaka sa leoto sa leoto, matheba a maputsoa a bonahala hantle.
- Hallmark Ratshaw. Mokuli o robala holim'a eona e thata, o phahamisa maoto ka bobeli ebe oa e tšela. Kamora metsotso e fokolang feela, pallor ea maoto e hlaha.
- Mohlala Cazascu. Bokapele bo ka pele ba leoto kaofela bo entsoe ka ntho e sa hlabang. Ho senyeha ha phepelo ea mali ho paka ho phatloha ho hoholo hoa hyperemia letlalong.
Tlhahlobo ea mokuli
Ha a netefatsa lefu la lefu la tsoekere, mokuli o kena sepetlele sepetlele sa endocrinological ho lokisa boemo le ho fana ka kalafo. Mekhoa e tlamehang ea ho etsa lipatlisiso mothating ona ke:
- ho hlahloba le ho phahamisa maoto ka mokhoa o hlakileng, ho hlaka ha kutloelo-bohloko;
- boteng ba li-trophic ulcers - "inoculation" ea kokoana-hloko ea se kahare se nang le lithibela-mafu.
- ho hlahlojoa ka makhetlo a mabeli ka methapo ea methapo - ultrasound, e lumellang ho hlakisa boemo ba methapo ea mali le phallo ea mali ka bona;
- arteriography ea libaka tse tlase - mokhoa oa radiopaque, o etsoang ka ho hlahisa se fapaneng le ho tsamaisa x-ray hape;
- oximetry - ho hlakisoa ha boteng ba ischemia, tekanyo ea eona;
- X-ray, CT, MRI - tlhahlobo ea boemo ba methapo e ka hare ea leoto;
- liteko tsa laboratori (liteko tse akaretsang, mali bakeng sa tsoekere, biochemistry, coagulogram);
- tlhatlhobo ke ngaka ea methapo, nephrologist, optometrist.
Teko ea tsoekere ea mali ke mokhoa o tlamang oa ho hlahloba lefu o u lumellang ho fumana tekanyo ea matšeliso bakeng sa lefu la tsoekere
Litšobotsi tsa kalafo
Bothata ba ho phekola mathata a lefu la tsoekere ha a so rarolloe ka botlalo. Joalo ka pele, halofo ea bakuli bohle ba khaoloang lithutong tse tlase ke ba nang le lefu la tsoekere. Ba qala ho phekola lefu la kelello le sesosa sa lona - hyperglycemia. Ho bohlokoa haholo ho lefella lefu la tsoekere ka ho boloka tsoekere e ka fihla ho 6mmol / l, le hemoglobin ea glycated ho fihlela ho 6,5%.
Lenaneo la kalafo le kenyelletsa ho laolla leoto le kulang, le nkoang e le tlamo bakeng sa mofuta o mong le o mong oa khatello, haholo-holo ka mor'a ho buuoa. Mehato e joalo e reretsoe ho fokotsa ho ruruha, ho ruruha, ho thibela ho sithabela ka mpeng. Pholiso e potlakileng e etsahala. Li-ulcers tse sa kang tsa fola ka likhoeli tse 'maloa kapa esita le lilemo li fetoloa ka libeke tse 6.
Ho phomola ka likobong le lithupa ha li sebetse ntlheng ena. Tsela e 'ngoe ke lieta tsa kalafo, tse ka etsoang ka lisebelisoa tsa bongaka kapa lapeng (mohlala, ho tsoa ho li-sneaker tsa khale). Bohlokoa ba lieta tse joalo ke hore malebela a menoana kapa serethe a lule a bulehile.
Meriana e sebelisitsoeng ho phekola lefu lena:
- meriana ea phallo ea mali;
- li-cholesterol tsa mali tse theolang litho;
- meriana e amang boemo ba molumo oa lerapo la pelo.
Phekolo ea ulophic ulcer
Pele ho tsohle, li-poone tse thehileng haufi le selala lia tlosoa. E buloa ka sekhahla le seka. Haeba ho hlokahala, tlotsa li-abscesses, hloekisa likarolo tsa necrotic ka hohle kamoo ho ka khonehang.
Phekolo ea lehae e latela molao o reng: "Bofokoli ba metsi bo hloka meaparo e mongobo, 'me e omileng e hloka e omileng." Bohareng ba leqeba la ho ruruha le phekoloa ka Dioxidine, tharollo ea hypertonic, Miramistin, Chlorhexidine. Khafetsa ea kalafo e khethoa ka bonngoe (hangata makhetlo a 2 ka letsatsi). Lumella ho tlotsa bofokoli ka tharollo e nang le iodine ea iodine e tsoang ka ntle - litlhare tse loants'etsang le litlolo (Ibuprofen, Hydrocortisone).
Litokisetso bakeng sa kalafo ea bofokoli ba "metsi" ba "metsi"
Bohlokoa! Tharollo ea iodine ea 5%, botala bo botala, potasiamo permanganate ha e sebelisoe ho phekola bofokoli ba ulcerative.
Li-uloph tsa trophic le necrosis e nang le matšoao a tšoaetso li phekoloa ka litlhare tsa antibacterial. Khetho ea lichelete e etsoa ka mor'a ho jala peo ea kokoana-hloko le ho hlakisoa ha kutloisiso ea likokoana-hloko ho lithibela-mafu.
Bala ka ho eketsehileng ka kalafo ea lefu la tsoekere ho sengoloa sena.
Phekolo ea kalafo
Ho kenella ha ngaka bakeng sa lefu la tsoekere le maoto ho na le matšoao a latelang:
- ts'ebetso ea tšoaetso e sokelang bophelo ba mokuli;
- ho ruruha ha likarolo tsa masapo, lefu la masapo a manonyeletso;
- sekoli se tebileng sa ho ruruha;
- liphoso tse kholo kamora ts'ebetso e fetileng;
- ischemia ea bohlokoa, haeba ho se na li-contraindication.
Maemong a joalo, ho khaoloa hoa hlokahala. Bophahamo bo khethoa ke ngaka e sebetsang ho latela boemo ba lisele tse sebetsang, bohlokoa ba boemo.Khalemelo ea ho se lekane ha arterial e etsoa ho sebelisoa ts'ebetso ea angiosuction: balloon angioplasty, ho behoa ka thata, ho sebetsoa ka thipa ka thipa, endarterectomy.
Ntlafatso ea kalafo
Lingaka tsa Cuba li hlahisitse mokhoa o mocha oa kalafo o reretsoeng ho thibela tsoelo-pele ea methapo ea mafu, ho fokotsa kotsi ea makhopho, ho potlakisa ho nchafatsoa hoa mesifa le ho folisa likotsi. Cber ea ho hlophisoa ha Eberprot-P e emeloa ke karolo ea "genermalal" ea motho ea ho eketseha ea mafu bakeng sa lisele tse phetseng hantle. Mokhoa oa phekolo o khethoa ka bomong maemong 'ohle a kliniki. Ka bomalimabe, ho reka sesebelisoa sena sebakeng sa sechaba ka nako ena ho thata.
Eberprot-P - sethethefatsi se enteloang se sebelisoang kalafo ea lefu la tsoekere
Litlhare tsa setso
Tšebeliso ea limela tsa meriana ke e 'ngoe ea mekhoa e thusang ea ho phekola lefu lena. Ho sebetsa hantle ho bontšitse ts'ebeliso ea makhasi le monokotsoai oa "Blueberry" Hoa hlokahala ho kenyelletsa monokotsoai lijong tsa letsatsi le letsatsi (ho fihlela likhalase tse 3 ka letsatsi), 'me tee e folisang e monko o monate e tsoa makhasing.
Pheko e 'ngoe ke makhasi a boreleli. Li-compress li etsoa ho bona, kaha pele a ne a phekola leoto ka tharollo ea Furacilin mme a tlotsitsoe ka linotši tse nyane. Makhasi a semela a lutse holimo. Pheta mokhoa ona hoseng le mantsiboea.
Ho hlatsoa ha liphoso tsa letlalo ho etsoa ka decoction ea litholoana tse halikiloeng tsa ciliegia. Khaba ea lihlahisoa tse tala e tšeloa ka khalase ea metsi a belang, ebe e belisoa ebe e belisoa metsotso e 15 ka lebaka la mocheso o tlase ebe e ea hloekisoa. Tharollo e ikemiselitse ho sebelisoa.
Lintlha tse ling mabapi le kalafo ea lefu la tsoekere lapeng li ka fumanoa sengoloeng sena.
Tlhokomelo ea maoto a lefu la tsoekere
Ntho ea bohlokoa ke ho hlatsoa maoto a hau ka sesepa le metsi a futhumetseng letsatsi le letsatsi. Ebe hoa hlokahala ho omisa letlalo ka botlalo, empa u se ke oa itlotsa. Tlhokomelo ea maoto e kenyelletsa ho itlhahloba ho bona hore na letlalo le omme joang, ho senyeha, mabili, makhopho, poone, lipekere tse kenang.
Letlalo le hlahlojoa bakeng sa bofubelu, ho songoa libakeng tse itseng, le keketseho ea mocheso oa lehae. Haeba ulcer kapa callus e fumanoe, ho bula eona ka boeona ho thibetsoe. Roala sebaka ka thuso ea sehlopha, chencha lieta 'me u tlalehe ngaka.
Ho khetha seeta se nepahetseng ke mohato o ka u thusang ho theola mathata.
Melao e latelang e tla fokotsa kotsi ea mathata:
- o hloka ho kuta lipekere tsa hau ka mor'a ho hlapa (li fetoha bonolo);
- o se ke oa roba likhutlo tsa poleiti ea lipekere;
- ho hloa meepa ho lokela ho etsahala ka lieta tse phutholohileng tse nang le boholo bo nepahetseng e le hore ha e patisane ebile ha e pikitla li-callus);
- u se ke oa tsamaea u sa roala letho maotong;
- hana lieta ka lirethe;
- li-socks li lokela ho etsoa ka masela a tlhaho;
- haeba ho hlokahala, sebelisa lieta tsa masapo;
- ha u itlhatsoa, hlahloba mocheso oa metsi ka matsoho a hau eseng ka maoto a hau (kutloisiso e ka fokotsoa haholo);
- Se ke oa tšela maoto.
Ho lumellana le boeletsi ba litsebi, tšehetso ea glycemia e nepahetseng le tlhokomelo ea maoto ea letsatsi le letsatsi ke lintlha tse ka fokotsang kotsi ea ho ba le leoto la lefu la tsoekere, mme haeba ho etsahala, fokotsa lebelo tsoelo-pele.
