Matenda a shuga > Chithandizo ndi kupewa

Diabetesic Phazi Syndrome (wodwala matenda ashugaChingerezi diabetesic phazi) - kusinthika kwa masanjidwe otsogola komanso magwiridwe antchito posintha maziko a matenda ashuga a m'mitsempha, ma micro- ndi macroangiopathy, osteoarthropathy, omwe amathandizira kukulira zowawa komanso matenda a minyewa yofewa ya phazi, kukhazikika kwa njira ya purulent-necrotic komanso machitidwe otsogola obweretsa kudulidwa. Matenda a shuga ndi matenda opatsirana a shuga ndi lingaliro lomwe limagwirizanitsa gulu la zovuta zakumapeto kwa matenda ashuga mellitus, momwe masinthidwe am'magazi a wodwala amapezeka mu mawonekedwe a purulent-necrotic process, zilonda zam'mimba ndi zotupa zomwe zimachitika motsutsana ndi maziko amasinthidwe amitsempha, zotupa zamagazi, khungu komanso minofu yofewa. ndi mafupa. Nthawi zina, lingaliro "Phazi la matenda ashuga" ngati mawonekedwe odziyimira pawokha sagwiritsidwa ntchito, koma matenda omwe amapezeka (abscess, phlegmon, gangrene ndi ena) akuwonetsedwa.

Gulu

Matenda a shuga a matenda am'mimba ndi omwe amayambitsa kudula kwamiyendo mu matenda ashuga. Pafupifupi 8-10% ya odwala matenda ashuga amakhudzidwa, ndipo 40-50% yaiwo amatha kuperekedwa m'magulu omwe ali pachiwopsezo. Nthawi 10 mowirikiza, matenda a shuga ammimba amayamba mwa anthu omwe ali ndi mtundu wina wa matenda a shuga. Pafupifupi 47% ya odwala, chithandizo chimayamba pambuyo pake. Zotsatira zake ndikuwadula zakumapeto, zomwe zimapangitsa kuti odwala azifa kawiri kawiri ndikuwonjezera mtengo wowonjezera wa chithandizo ndi kubwezeretsa odwala katatu. Kupititsa patsogolo njira zodziwitsa, kuwunika kwamankhwala, chithandizo cha odwala kumachepetsa pafupipafupi kukadulidwa kwa odwala ndi 43-85%.

Matenda a matenda ashuga amayamba pakati pa odwala ambiri omwe ali ndi matenda osokoneza bongo a mtundu wa 1 ndi zaka 7-10 kuyambira kumayambiriro kwa matendawa gwero silinatchulidwe masiku 2536 , odwala omwe ali ndi matenda a shuga 2 amayamba chifukwa cha matenda. Mu 85% ya milandu, imayimiriridwa ndi zilonda zam'mapazi zamitundu yosiyanasiyana. Amapezeka mu 4-10% ya chiwerengero chonse cha odwala matenda a shuga.

Sinthani Magulu |Zimayambitsa ndi njira za chitukuko cha matenda ashuga phokoso

Matenda a matenda ashuga amayamba chifukwa chodziwikiratu, monga:

peripheral polyneuropathy (kumabweretsa kuwonongeka kwa phazi, komwe kumalepheretsa mawonekedwe ake aumoyo poyenda ndikuyimirira, ndikuchepa kwamitundu yonse yamtundu wamtundu wamkati (kupweteka, kunjenjemera, kutentha, - chifukwa cha kusinthaku, chiwopsezo cha zotupa za purulent-necrotic zimawonjezeka),
angiopathy (kuwonongeka kwa mtima mu matenda a shuga, komwe kwenikweni ndi njira ya atherosulin - zotsatira zake, kuthamanga kwa magazi kudzera m'matumbo kumakhala kovuta ndipo ischemia yamasamba amtundu uliwonse imachitika),
neuroosteoarthropathy (mafupa am'mimba, mafupa am'mimba, chiwonongeko cha nkhope zowonekera, chiwonongeko cha magawo amtundu wa mafupa, mafupa a patological),
kufalitsa matenda am'mitsempha yam'munsi,
kuvulala ndi kuwonongeka kwa phazi,
matenda, makamaka matenda oyamba ndi fungus,
kuchepa kwakukulu ndi kwanuko.

Zowonetsera zamankhwala odwala matenda amishuga

Gulu logwira ntchito padziko lonse lapansi pamatenda a matenda ashuga limazindikira magulu omwe ali ndi tanthauzo lenileni la matendawa:

magazi kumapazi
kudziwa kwawo
kukula kwa chilema,
kuya kwakugonjetsedwa
matenda opatsirana.

Kutengera ndi mawonekedwe a zodwala, magulu atatu a matenda ammimba ammwazi amadziwika:

Fomu la Neuropathic ndizotsatira za neuropathy, kukakamira kwa minofu, kusintha kwawo, matenda ndi edema. Zilonda zam'mimba zimapezeka m'malo omwe phazi limakhalapo, lomwe limapangitsa kuti pazikhala katundu wambiri. Matendawa amapezeka 70% ya anthu odwala matenda ashuga, makamaka mwa anthu ochepera 40 omwe ali ndi vuto la matenda ashuga a zaka 5 kapena kuposerapo, nthawi zambiri amamwa mowa. Monga lamulo, zilonda zimakhazikitsidwa m'malo opsinjika kwambiri, malo a hyperkeratosis, pachokhacho, malo a malo ophatikizana, m'malo ovuta kwambiri a mapazi. Malingaliro osavulaza. Odwala amadandaula za paresthesia (kulumikizana, kupanikizika, kumva kutentha m'malo omwe akukhudzidwa) komanso kupweteka kwambiri usiku. Khungu la malekezero lakhala louma, lotentha, kupindika kwa zotumphukira zamapazi kumasungidwa, kumverera kwa ululu - kupweteka, kutentha ndi kugwedezeka - kumachepetsedwa, chidendene ndi mawondo amalefuka, minofu imagwedezeka, phazi limakhala lopindika, phazi limasokonekera.

Fomu ya Ischemic ndi chifukwa cha kufalikira kwamitsempha yamagazi ndi chifukwa cha necrosis yamitsempha yamagazi yomwe sililandira magazi. Amapezeka mu 10% ya anthu omwe ali ndi zaka zopitilira 55 omwe ali ndi vuto la mtima (IHD, ochepa matenda oopsa, atherosulinosis), komanso osuta ndewu. Imadziwoneka ngati cyanosis (buluu) wa gawo la nthambi, kupweteka m'derali. Pamene njirayi ikupita, mawonekedwe akhungu la zilonda pakhungu, omwe amakula msanga m'lifupi ndi kuya ndipo limatchulidwa kwambiri kumalo komwe magazi amayenda pang'ono. Khungu limakhala lotumbululuka, lacyanotic, lonyowa, lozizira mpaka kukhudza. Kuzindikira kwasungidwa. Ripple mu zotumphukira mitsempha ya mapazi imachepetsedwa kwambiri kapena kulibe. M'magawo a nthambi ndi pomwe magazi amatuluka kulibe, minofu imafa - khungu limayamba, likufuna kuti lidulidwe mbali ina ya chiwalo.

Fomu yosakanizika yodziwika ndi kuphatikiza kwa mitundu ya neuropathic ndi mitundu ya ischemic ndipo imawonetsedwa ndi kuwonongeka kwa mitsempha ndi mitsempha yamagazi. Zizindikiro zotsogola zimatengera komwe kulumikizana kwa pathogenesis. Matendawa ndi oopsa kwambiri, chifukwa ululu wammbuyo pamenepa ndi wofooka kapena kulibe konse - odwala samangothamangira kufunafuna thandizo ("sizipweteka") ndipo amabwera kwa dokotala pokhapokha zilonda zake zitakula ndipo zilipo. zosintha zosasinthika, zopanda mankhwala.

Matenda a matenda ammimba a shuga

Mwachidziwitso, pakuwonetsa izi, zitha kukhala zokwanira kupenda phazi la wodwala ndi matenda a shuga ndikuwona kusintha komwe kukufotokozedwa pamwambapa. Komabe, kuti afotokozere za matendawa, wodwalayo, monga lamulo, amapatsidwa njira zowonjezera zowunikira ndi kufunsira kwa akatswiri opapatiza.

Popanga matenda, komanso mwa kuyeserera kulikonse, wodwalayo adayikidwa:

kutsimikiza kwa glycemic mbiri ndi glycosylated hemoglobin,
Kutsimikiza kwa lipids yamagazi (LDL, HDL, cholesterol, triglycerides),
muyeso wa kalozera wamchifuwa,
kufunsa kwa endocrinologist,
kufunsira kwa dokotala wa opaleshoni (ndikuwunika kufooka kwa mitsempha ndi muyeso wam'munsi mwa kugwedezeka kwamphamvu),
kufunsa kwamisala,
kufunsira ndi ophthalmologist (ndi kuyeseza koyenera kwa tsiku la maso kuti mupeze matenda a mtima).

Odwala omwe ali ndi vuto lalikulu kumapazi amapatsidwa x-ray kumapazi, kenako kufunsidwa kwa mafupa.

Ultrasound dopplerography ndi mapangidwe obwereza amtundu wam'munsi miyendo yam'mimba imachitika kwa odwala omwe alibe kupweteka kwamitsempha yamapazi yamapazi kapena chipatala cholumikizira pakati, ndikutsatiridwa ndi kuonana ndi dokotala wamankhwala opaleshoni.

Odwala okhala ndi zilonda m'dera lamapazi amafesedwa ndi chilonda chowonongeka ndi kutsimikiza kwa chidwi cha chikhalidwe chofesedwa ku mankhwala othandizira, pakakhala zilonda zakuya - radiograph pamapazi.

Matenda a shuga matenda am'mimba

Kuphatikizika kwa njira zochizira matendawa kumaphatikizapo zinthu izi:

kuphunzitsa odwala pasukulu ya "Diabetesic phazi",
kulipira matenda a shuga mellitus (kukonza mankhwala omwe wodwala amalandira - kuwonjezera kuchuluka kwa mankhwala amkamwa a hypoglycemic, kutsimikiza insulin kapena kuwonjezera kuchuluka kwake, mafotokozedwe atsatanetsatane wazakudya),
mankhwala oletsa antibayotiki (monga lamulo, mankhwala ogwiritsa ntchito mwachisawawa amagwiritsidwa ntchito kapena omwe amagwiritsidwa ntchito ndi chikhalidwe chapadera cha bakiteriya),
chithandizo chamankhwala (mankhwala opweteka),
mankhwalawa kwanuko (kuchiritsa khungu kuzungulira chilema, kuthetsa edema ya miyendo ndi purulent-necrotic, kusintha kwa kutupa kwa chilonda palokha),
kuchuluka chitetezo - onse komanso wamba.

Poyambirira, mankhwala am'deralo othandizira zilonda zam'mimba, kutsitsa komwe kwakhudzidwa ndi phazi, mankhwala othandizira (Ceftriaxone), mankhwala omwe amasintha magazi (Actovegin, Pentoxifylline, Normoven), mankhwala a alpha-lipoic acid (Berlition, Espalipon), mankhwala a laser akulimbikitsidwa.

Pambuyo pake, chithandizo chimachitika kuchipatala cha opaleshoni, pomwe necenessomy, autodermoplasty ya vuto la zilonda ndipo, monga chomaliza, kuduladula miyendo ndi dzanja kungachitike.

Pali njira zatsopano zochizira matenda amtundu wa shuga, zomwe zimatsogolera kuchira msanga kwa zolakwika zam'mimba komanso kuchepetsa kufunika kwa kudulidwa. Tsoka ilo, zina mwa njirazi sizinaphunziridwe mokwanira, ndipo zina zimangoikidwa m'makliniki osankhidwa padziko lonse lapansi, chifukwa chake sizipezeka kwa wodwala aliyense yemwe ali ndi matenda awa. Njirazi ndi monga:

kukula chinthu mankhwala
extracorporeal mantha wave mankhwala,
tsinde cell mankhwala
mankhwala a plasma,
njira ya bio-mechanical, etc.

Chitetezo cha matenda a shuga

Popewa kuwoneka ndi zilonda za matenda ashuga, muyenera:

sinthani magazi a shuga m'magazi,
samalani malamulo aukhondo pakhungu lam'malo am'munsi (tsambirani kawiri patsiku ndi youma youma (osapukuta!) pakhungu, pakani madzi ofunda okha, kupewa kuyanjana ndi madzi ozizira kapena otentha),
tsiku lililonse muziyang'anitsitsa khungu la mapazi kuti mupeze nthawi yake ngati ma scuffs, callus, ming'alu,
Pewani kugwiritsa ntchito mapepala otenthetsera
tsiku ndi tsiku muziyang'ana nsapato za miyala ya miyala ndi zinthu zina zakunja, komanso zowonongeka zamkati zomwe zingapangitse mawonekedwe a chimanga,
osavala zovala zamkati ndi seams,
Musamavale nsapato zolimba, komanso nsapato zopanda insoles kapena mapazi opanda,
osapita opanda nsapato
osagwiritsa ntchito zigamba
Mbewu zikaoneka, musayese kuzichita nokha, koma pezani thandizo kwa katswiri.
ngati pachitika zovuta zilizonse zoopsa, pitani kuchipatala.

Dokotala uti kuti mulumikizane

Popewa ndi kuchiza matenda amishuga, ndikofunika kuonedwa ndi endocrinologist. Kuti adziwe momwe mitsempha yotumphukira imayendera ndi mitsempha yamagazi, dokotala adzayambitsa kuonana ndi dokotala wamankhwala ochita zamitsempha, opaleshoni ya maso, komanso opaleshoni ya mtima. Thandizo la orthopedist likufunika kusankha ma insoles a orthopedic ndi zida zina zomwe zimasintha moyo wa wodwala yemwe ali ndi matenda a shuga. Ndi chitukuko cha gangrene, opaleshoni imachitidwa.

Tanthauzo la matendawa. Zomwe zimayambitsa matendawa

Matenda a shuga (diabetesic foot syndrome, CDS) ndizovuta kwambiri za matenda a shuga m'matenda amtundu wa zilonda, zilonda kapena kuwonongeka kwa minofu yakuya, yomwe imachitika chifukwa chophwanya phazi lalitali komanso kuchuluka kwa magazi chifukwa cha kuwonongedwa kwa mitsempha mathero ndi mafupa amitsempha.

Choyambitsa chachikulu cha DS ndi matenda a shuga mellitus (DM). Ndipo ngakhale wodwala matenda ashuga samakhazikika kuyambira tsiku loyamba la kuchuluka kwa shuga m'magulu opitilira 7.0-8.0 mmol / l, wodwala aliyense yemwe ali ndi matenda a shuga ayenera kudziwa zovuta zowopsa.

SDS imakula ndikukula mosiyanasiyana.

Pambuyo pa zaka 5-7 mu 60% ya odwala omwe ali ndi matenda amtundu 1 shuga (glucose oposa 8 mmol / l),
Pambuyo zaka 15-20 mu 10% ya odwala omwe samadalira insulin 2 shuga (glucose level 8-9 mmol / l) - amapezeka kawirikawiri ndi osteopathology, trauma ndi dermatitis ya kumapazi osiyanasiyana etiologies.
itatha zaka 10-15, 90% ya odwala omwe ali ndi matenda a shuga 2 amadalira odwala matenda a shuga.

"Choyambitsa" chachikulu cha chitukuko cha zilonda mu CDS:

Kuvala nsapato zosamasuka. Zilakwika zilizonse za nsapato zimatha kusintha kusintha kwamalo kumapazi, phazi kapena kufinya kwa khungu, micro-ischemia, kulowetsedwa, kapena necrosis:
Kukula kwa nsapato zosayenera (zazing'ono kapena zazikulu kuposa zofunika)
Wovala ndi / kapena nsapato zazitali,
chilonda pa insole
chilema chokha
nsapato zonyowa
kusokonekera kwa nsapato za nyengo.
Kuchulukitsa thupi. Popeza dera lamapazi, ndi kuchuluka kwa thupi (ngakhale ndi 1 makilogalamu), katundu pa gawo lililonse la phazi limakulanso. Malo omwe ali osatetezeka kwambiri ndi malo oyimirako.
Kukula kwa khungu. Njirayi imachitika chifukwa cha kusokonezeka kwa kagayidwe kachakudya pakhungu motsutsana ndi matenda ashuga (pansi pa "callus" wonyezimira wa khungu lomwe limayambitsa khungu, kusokonekera kwa michere kusokonezedwa, komwe kumayambitsa microischemia ndi necrosis).
Microtrauma:
kuluma nyama
jakisoni wokhala ndi minga yazomera,
mabala ndi pedicure, etc.
Stenosis (kupatulira) ndi chidziwitso (chotupa) cha mitsempha yayikulu. Chifukwa cha kuchepa kwa magazi m'miyendo ndi miyendo, micro-ischemia ndi chitukuko cha gangrene chakumapeto kukajowina microischemia.

Nthawi zambiri pamakhala kuphatikiza zingapo zomwe zimayambitsa zilonda mu SDS.

Zizindikiro za phazi la matenda ashuga

Malo oyambira kukula kwa matenda ashuga si tsiku lodziwika bwino la matenda ashuga, koma nthawi yomwe zizindikiro zoyambirira za matenda a shuga zapezeka (kukwera kamodzi kwa shuga m'magazi, pakamwa kowuma ndi ena).

Zizindikiro za VDS:

dzanzi, kuzizira, kutentha, kutupa m'miyendo ndi zina zomverera zosasangalatsa,
kusowa kwa tsitsi kumapazi ndi miyendo, thukuta mapazi,
kusintha kwa khungu (hyperemia, hyperpigmentation, cyanosis),

Nthawi zambiri, malekezero a distal amakhudzidwa ndikusintha kwa trophic: zala zakumaso komanso chala chakumaso pakupendekera kwa mitu yamafupa apansi. Kutalika kwa mapangidwe a zilonda zam'mimba kumatengera zomwe zimachitika.

Zimayambitsa ndi njira za chitukuko cha matenda ashuga

Maulalo apamwamba kwambiri a pathogenetic mu diabetesic phokoso syndrome ndi angiopathy, neuropathy komanso matenda. Hyperglycemia yotalika kwa nthawi yayitali mu shuga mellitus imayambitsa kusintha kwamitsempha yamagazi (diabetesic macroangiopathy ndi microangiopathy), komanso mitsempha yotumphukira (diabetesic neuropathy).

Angiopathies amatsogolera kuchepa kwa kutanuka ndi patency yamitsempha yamagazi, kuwonjezeka kwa mamasukidwe amwazi, komwe kumayendetsedwa ndi kuphwanya kwa innervation ndi minofu yamtundu wa trophic, kuchepa kwa chidwi cha mathero a mitsempha.

Kuchulukitsa kwa glycosylation kwamapuloteni kumayambitsa kuchepa kwa mgwirizano wophatikizika, komwe kumakhudza kusinthika kwamanthawi imodzi kwa mafupa a miyendo ndi kuphwanya kwachilendo kwa katundu wazotupa pansi.

Poyerekeza ndi kuzungulira kwa magazi kosinthika, kuchepa kwa chidwi cha chitetezo cha m'thupi, chilichonse, ngakhale kuvulala pang'ono mpaka kumapazi (kupweteka pang'ono, kupindika, ming'alu, micropores) kumayambitsa kukhazikitsidwa kwa zilonda zam'mbuyomu zosachiritsa.

Zilonda zam'mimba za peptic nthawi zambiri zimayambukiridwa ndi staphylococci, colibacilli, streptococci, anaerobic microflora. Bacterial hyaluronidase imamasula tiziwalo tating'onoting'ono, ndikuthandizira kufalikira kwa matenda komanso kusintha kwachilendo komwe kumakhala ndi mafuta ochepa, minofu yamatumbo, komanso zida zamafupa.

Ndi matenda a zilonda zam'mimba, chiopsezo chokhala ndi zilonda zam'mimba, ma phlegmon ndi gangren of the limb.

Ngakhale chiwopsezo chokhala ndi phokoso la matenda ashuga chilipo mu odwala onse omwe ali ndi matenda osokoneza bongo, gulu lowonjezereka limaphatikizapo anthu omwe ali ndi zotumphukira za polyneuropathy, mtima atherosclerosis, hyperlipidemia, matenda amitsempha yamagazi, matenda oopsa, uchidakwa.

Kusintha kwachulukidwe ka minofu - komwe kumatchedwa mavuto ang'onoang'ono phazi: kulowetsedwa kwamatumbo, misempha ya pakhungu, chimanga ndi chimanga, zidendene zosweka, ukhondo wosakwanira m'miyendo kumawonjezera chiopsezo cha kuwonongeka kwa matenda ashuga.

Zomwe zimayambitsa kusokonezeka kumeneku zimatha kukhala nsapato zosankhidwa bwino (zopapatiza kapena zolimba). Kuchepetsa mphamvu ya chiwalo sikulola wodwala kuti azimva kuti nsapato zikukanikiza kwambiri, kupukusa ndi kuvulaza phazi.

Zoyambitsa Mavuto

Kuchuluka kwa shuga wambiri m'magazi kumawononga thupi. Ndi shuga wambiri omwe ndimomwe amachititsa kuti mitsempha yamagazi iwonongeke komanso mafupa.

Kuphatikiza apo, chifukwa cha kutalikirana kwam'munsi kuchokera pansi pamtima, magazi amayenda osalowa nawo, ndikupangitsa kusintha kwamitsempha. Mkulu shuga wambiri amawonongeka kumapeto kwa mitsempha.

Kuzindikira kumachepa, munthu samamva bwino miyendo, samva kuwawa.

Chithandizo choyenera cha matenda amtundu wa 1 ndi mtundu wa 2 chingathetse chiwonongeko ndikubwezeretsa mathero a mitsempha.

Chomwe chimapangitsa kukula kwa matenda a diabetesic phokoso ndi neuropathy, kuwonongeka kwa minyewa yamitsempha yomwe imayamba chifukwa cha kuchuluka kwa shuga m'magazi.

Sensory neuropathy imatsogolera ku chochitika chakuti khungu limagwira, kugwedezeka, kukakamiza, kusintha kwa kutentha ndi zinthu zina zimatayika.
Motor neuropathy imayambitsa minyewa ya atrophy, kufooka kwa phazi.
Chifukwa cha autonomic neuropathy, khungu limataya thukuta, limakhala louma komanso limasweka mosavuta.

Mitundu yonse yamtunduwu ya neuropathy imakhala yophatikizana nthawi zonse.

Mukamayenda, zigawo za phazi zimaponderezedwa kwambiri. Chifukwa cha izi, minofu yofewa imawonongeka pang'onopang'ono ndipo zilonda zam'mimba zimapangidwa.

Nthawi zina kuphwanya umphumphu wa khungu kumatha kuchitika mwachangu pansi pa kuvulala kwamakina ndi chinthu chakuthwa kapena kuwotcha kwamoto, komwe wodwalayo samamverera chifukwa cha neuropathy. Komanso, shuga imathandizira kukulitsa kwa atherosclerosis, chifukwa chake kufalikira kwa magazi m'miyendo kumasokonezedwa.

Gulu la zotupa pakhungu ndi zotupa odwala matenda ashuga

Popeza kuchuluka kwa gawo linalake la pathological, ischemic (5-10%), neuropathic (60-75%) ndi osakanikirana - mawonekedwe a neuroischemic (20-30%) a phazi la matenda ashuga amadziwika. Mu mawonekedwe a ischemic phazi la odwala matenda ashuga, kuphwanya magazi kumiyendo chifukwa chakugonjetsedwa kwa ziwiya zazikulu komanso zazing'ono ndizofunikira kwambiri.

Matenda a Coronary amachitika ndi edema yosalekeza, kulowerera pakatikati, kupweteka m'miyendo, kutopa kwa miyendo, kupaka khungu pakhungu, ndi zina zambiri.

Neuropathic diabetesic phazi limayamba ndi kuwonongeka kwa dongosolo lamanjenje la distal malembedwe. Zizindikiro za phazi la neuropathic ndi khungu louma, hyperkeratosis, anhydrosis yokhala malekezero, kuchepa kwamitundu yosiyanasiyana yamtundu (kutentha, kupweteka, tactile, etc.), kusinthika kwa mafupa a phazi, phazi lathyathyathya, mapangidwe ozungulira.

Kusintha kulikonse pakhungu la munthu kumawonetsa mavuto amkati mthupi. Madokotala azowoneka ndi khungu chifukwa cha ma genermis nthawi zambiri amayambitsa matenda ndikutumiza wodwala kwa katswiri wina.

Matenda a shuga amakhalanso ndi mtundu wowonetsera kwakunja, womwe uyenera kukhala chizindikiro cholumikizana ndi othandizira kapena dotolo wa khungu. Zomwe zimayambitsa matenda a shuga m'thupi la munthu nthawi yayitali asanazindikire za matendawa kapena zomwe zikuthandizira kudwala, aliyense wophunzira ayenera kudziwa.

Gulu la mavuto amkhungu ozindikira matenda ashuga

Kutengera kuti shuga wambiri amakhala m'mitsempha yamagazi, mitsempha ndi ma capillaries atha kusintha pa malo oyamba. Njira ya kagayidwe kazakudya imasokonekera, zomwe zimayambitsa zolephera pakaperekedwe ka chakudya kuma cell cell. Khungu limataya kuchepa kwake, limakhala louma, kusenda.

Kusintha kotereku sikungachitike panthawi zosiyanasiyana za chitukuko cha matenda ashuga, chifukwa kulibe mtundu umodzi wamatendawa. Nthawi zina munthu sadziwa ngakhale vuto lakumakomoka, ndipo zotupa pakhungu zimapereka chizindikiro.

Pali njira zingapo zophatikizira zotupa zomwe zimayambitsa matenda a shuga. Komabe, njira zonsezi sizovomerezeka.

Mwachitsanzo, zilonda zimatha kugawidwa ndi kuya kwake. Mukamakula bala, ndiye kuti matendawa akuchulukirachulukira komanso kuchuluka kwake komwe kudulidwa kudzayenera kuchitidwa.

Chochulukitsa chomwe chimapangitsa kuti matenda awonongeke kwambiri chimapangitsa magazi kulowa m'miyendo chifukwa cha atherosclerosis, yomwe imatchedwa ischemia.

Choyambitsa chachikulu cha mavuto anu mwendo

ndi kudziwa momwe mungachotsere izi. Amathandizika, mosiyana ndi khungu komanso vuto lalikulu la impso. Ngati mungayesere, mutha kubwezeretsa thanzi la mitsempha ndi mitsempha yamagazi m'miyendo. Momwe mungachitire izi akufotokozedwa mu kanema. Nkhani zopambana za odwala omwe adatha kupewa kudulidwa, ndipo nthawi yomweyo zovuta zina zimaperekedwa.

Gulu la Wagner la phazi la matenda ashuga limadziwika. Amazindikira magawo 5 (makamaka 6) a matendawa:

0 - kusintha kwa mafupa, zilonda zam'mimba zisanafike,
1 - zilonda zapamwamba - khungu limawonongeka, koma minofu ndi minyewa yodukiza sizikhudzidwa,
2 - zilonda zakuya - ma tendon, mafupa ndi mafupa amawonekera pachilonda.
3 - osteomyelitis - necrosis ya mafupa, mafuta m'mafupa ndi minofu yofewa yozungulira, ndikupanga mafinya ambiri,
4 - khungu lowonda, laling'ono lamapazi,
5 - gangrene amafalikira kumapazi, kudula mwachangu ndikofunikira kuti mupulumutse moyo wa wodwalayo.

Kuzindikira kungawonekenso zowonjezera. Makamaka, polyneuropathy ndimatenda a shuga a mitsempha. Chifukwa cha kuchepa kwa chidwi chamanjenje, wodwalayo samazindikira kuvulala komanso kuwonongeka kwa miyendo yomwe amapeza poyenda. Ngati mabala sanalandiridwe, ndiye ma virus amafanana nawo ndipo posakhalitsa amabwera.

Njira ya Ischemic phazi la matenda ashuga - kuzindikira izi kumatanthauza kuti magazi m'miyendo amasokonezeka chifukwa chotupa m'mitsempha yamagazi ndi ma atherosulinotic plaques. Zikatero, zotupa zimayamba pang'onopang'ono. Miyendo imatha kukhala ndi mtundu wamtambo. Nthawi zambiri pamakhala kukula kwa misomali. Vuto la ischemia likhoza kuphatikizidwa ndi polyneuropathy.

Kodi zotsatirapo za shuga izi ndizotani?

Zotsatira zosasangalatsa kwambiri ndi gangrene, zomwe zimafuna kudulidwa kwa chala, phazi kapena phazi. Wodwalayo amathanso kufa ndi kuledzera komwe kumayambitsidwa ndi mabakiteriya okhala ndi tizilombo.

Chithandizo cha matenda ashuga odwala matenda a shuga ndicholinga chopewa kufa, kudulidwa komanso kulumala. Kumbukirani kuti kudula miyendo si mathero a dziko.

Pambuyo pake, mutha kuvala chovala ndi kukhala ndi moyo wonse. Matenda a shuga angayambitse zovuta zowopsa kwambiri.

Mwakutero, khungu kapena kulephera kwa impso komwe kumafunikira dialysis.

Matenda a shuga ana: Zizindikiro, matenda, mankhwala, kupewa

Matenda a shuga mu ana ndi vuto lalikulu. Pansipa mupeza kuti zomwe zizindikiro ndi chizindikiro chake ndi chiyani, momwe mungatsimikizire kapena kukana kumutsimikizira.

Njira zogwiritsira ntchito moyenera zimafotokozedwa mwatsatanetsatane. Izi zikuthandizani kuteteza mwana wanu ku zovuta komanso matenda aakulu.

Werengani momwe makolo angathandizire ana awo Kukula Mwabwinobwino Onaninso njira zopewera - momwe mungachepetsere chiopsezo chanu cha matenda ashuga aubwana ngati muli ndi kholo lomwe likudwala.

Zizindikiro zake

Chizindikiro chachikulu cha phazi la matenda ashuga ndi zilonda zamiyendo zomwe sizichiritsa kwa nthawi yayitali. Ngati mabakiteriya oyipa akuchulukirachulukira, ndiye kuti zilondazo zimawoneka ngati zenizeni kwa munthu wachilendo.

Pakakhala chithandizo choyenera, matenda angayambitse gangore. Kudulidwa kwa chala chakumanzere, phazi kapena mwendo wathunthu pakufunika.

Kupanda kutero, wodwalayo amatha kufa chifukwa cha kuledzera. Kuphatikiza zilonda zam'mimba, zizindikilo za phazi la matenda ashuga zitha kuphatikizaponso:

calluses
matenda oyamba ndi misomali ndi khungu la kumapazi,
zala zopota
misomali yovomerezeka
ming'alu pakhungu.

Nthawi zina pamakhala ululu chifukwa chakuti nsapatozo sizisankhidwa bwino, sizinapangidwe kuti zizitupa miyendo.

Kuwonongeka kwa magazi chifukwa cha atherosulinosis kumatha kupangitsa kupweteka kwambiri kotchedwa claudication. Ngati mukukhudzidwa ndi kupweteka kwa mwendo, werengani zamankhwala opweteka pano.

Komabe, nthawi zambiri, mphamvu zowawa za wodwalayo zimatayika chifukwa cha matenda ashuga a m'mimba. Kuchepa, kutupa - chizindikiro cha matenda kapena kutikita khungu ndi nsapato zosayenera.

Zimachitika kuti kutentha kwa dera la kachilombo ka kachilomboka pakukhudza ndi magawo awiri kapena kuposa pamenepo. Poizoni wamagazi amatha kubweretsa malungo kapena kuzizira.

Zizindikiro zamakhalidwe

Gawo loyamba silimayambitsa kupweteka. Gawo lamapeto amsempha limawonongeka, satumiza zowawa, chifukwa chake anthu amawona zovuta ndi miyendo mochedwa. Zizindikiro zoyambirira za phazi la matenda ashuga zimafotokozedwa ndi kuwonongeka kosavuta kwa miyendo mu shuga:

calluses
kutupa kwamalovu pachala,
matenda oyamba ndi miyendo ndi misomali,
msomali wa msomali (onychocryptosis),
khungu lowuma la kumapazi
kusintha kwa zala.

Fomu ya Ischemic

Pazowoneka, mawonekedwe a ischemic a matenda am'magazi a shuga amawonetseredwa kupweteka m'miyendo poyenda, kutopa kwamiyendo, kusinthana ndi limp, pambuyo pake phazi lakumimba limayamba. Phazi limakhala lotumbululuka ndi kuzizira kukhudza, kupindika mumitsempha ya phazi kumakhala lofooka kapena kulibe. Poyerekeza ndi khungu lotumbululuka, madera oopsa nthawi zambiri amawonekera.

Mwachizolowezi, kupezeka kwa chimanga chomwe sichichiritsa kwa nthawi yayitali pa zala, zidendene, mbali yotsatira ya mafupa a I ndi V metatarsophalangeal, chidendene. Pambuyo pake, zilonda zopweteka zimakhazikika m'malo mwake, pomwe pansi pake amaphimbidwa ndi khungu la mtundu wakuda. Kutuluka kochulukirapo ndi atypical (necrosis yowuma pakhungu).

Matenda a matenda ammimba

Pozindikira koyambirira, kudzifufuza ndikofunikira. Munthu ayenera kuyang'ana nyumbayo tsiku ndi tsiku ndikuwunika momwe phazi likuwonekera: mapazi owuma, khungu, kusintha kwa zala. Kuphatikiza apo, podziwidwa ndi matenda a shuga, munthu ayenera kumayesedwa ndi endocrinologist, orthopedist, ndi opaleshoni ya mtima.

Kuzindikira koyambirira kwa phazi la matenda ashuga kumatengera mayeso angapo. Algorithm yowunikira ndi kuyang'ana odwala omwe ali ndi matenda a shuga yapangidwa:

Kuyang'ana koyambirira:
- mbiri kutenga, kufotokoza kwa zizindikiro,
- kuyang'anira
- kufufuza.
Kusanthula mkhalidwe wamanjenje:
- kugwedeza mwamphamvu
- kumva kupweteka, kukhudza ndi kutentha,
- kuchuluka kwa kuwonongeka kwa minofu minofu,
- boma la mitsempha yotentha yomwe imagwiritsa ntchito electromyography.
Kusanthula kwamachitidwe amitsempha yamagazi:
- Dopplerometry
- dopplerography.
X-ray yamapeto (digiri yowonongeka imawoneka pa x-ray).
Zoyesa zasayansi:
- shuga m'magazi
- bacteriological ndi ambiri magazi kuwunika.

Odwala omwe ali ndi chiopsezo chokhala ndi phokoso la matenda ashuga ayenera kuwonedwa osati kwa endocrinologist-diabetesologist, komanso kwa podologist, opaleshoni ya mtima, orthopedist. Udindo wofunikira pakuzindikiritsa kusintha umaperekedwa pakudziyesa nokha, cholinga chake ndikuwona nthawi yeniyeni chizindikiro cha phazi la matenda ashuga: kusintha kwa khungu, mawonekedwe auma, kutupa ndi kupweteka, kupindika kwa zala, matenda a mafangasi, etc.

Kuzindikira phazi la matenda ashuga kumaphatikiza kusuntha kwa anamnesis kutanthauza kutalika kwa matenda a shuga, kupenda miyendo ndikuzindikira kalozera wam'mbuyo ndi brachial, ndikuwunikira chidwi, kutentha komanso kutentha.

Chidwi chachikulu mu matenda am'mimba matenda a shuga amapatsidwa njira yothandizira matenda - matenda a glucose, glycosylated hemoglobin, cholesterol, lipoproteins, kukhalapo kwa shuga ndi matupi a ketone mumkodzo.

Ndi mawonekedwe a ischemic phazi la matenda ashuga, ma ultrasound a ziwiya zamagawo akumunsi, ma X-ray osiyanitsa angiografia, ndi zotumphukira za ar arogografi amachitika. Ngati osteoarthropathy ikukayikiridwa, phazi la x-ray m'mapulogalamu awiri, x-ray ndi densitometry ya ultrasound imachitika. Kupezeka kwa chilonda cha peptic kumafunikira kupeza zotsatira za kufesa kwa gawo lochotsekeralo ndi m'mphepete mwa zilonda pa microflora.

Ndi chithandizo chiti chomwe chikufunika?

Momwe mankhwalawa agwiritsidwira ntchito zimadalira kuuma kwa njirayi. Wodwala alibe zilonda zam'mimba, zowonjezera, zam'tsogolo zakuwonjezereka.

Koma ngakhale mutazindikira zovuta zamiyendo zomwe zimakhudzana ndikumverera, ndikofunikira kuyambitsa chithandizo chokwanira munthawi yake momwe chimabwezeretsanso boma. Chithandizo cha phazi la matenda ashuga ndi mankhwala wowerengeka chimatheka pokhapokha magawo oyamba komanso chilolezo cha dokotala.

Chithandizo cha matenda osokoneza bongo chimachitika zingapo:

shuga kagayidwe kachakudya,
opaleshoni yamankhwala mabala,
kumwa maantibayotiki
kumasulira madera omwe akhudzidwa ndikuyenda,
kuyang'anira tsiku ndi tsiku, kutsatira malamulo osamalira mapazi.

Njira zina zofunika zitha kuchitidwa kokha m'malo azachipatala, koma chithandizo chachikulu chili kunyumba. Mwachidziwikire, muyenera kuyesetsa kubweretsa kuchuluka kwa glucose pafupi kwambiri ngati kungatheke.

Werengani nkhani yakuti “Momwe Mungachepetsere Mwazi wa Magazi” mwatsatanetsatane. Pamaso pa bala lomwe lili ndi kachilombo, chithandizo cha opaleshoni nthawi zambiri chimafunikira.

Simungakhale ochepa pakugwiritsira ntchito maantibayotiki popanda kutenga nawo mbali opaleshoni. Amayenera kuchotsa tupi lonse losagwira.

Odwala amaphunzitsidwa kuyesedwa tsiku ndi tsiku ndikuwasamalira bala mpaka atachira kwathunthu. Izi zimachitika ndi akatswiri omwe amagwira ntchito m'maofesi a phazi la matenda ashuga.

Mitundu yambiri yosiyanasiyana ya mabakiteriya imatha kuyambitsa mabala ndi zilonda zam'mapazi. Choyamba, mothandizidwa ndi kusanthula, zimazindikira kuti ndi ma virus ati omwe amayambitsa mavuto, kenako maantibayotiki amaikidwa omwe amagwira ntchito molimbana nawo.

Mankhwala apadziko lonse lapansi omwe ali ndi mawonekedwe osiyanasiyana amathandizira pamilandu yopitilira 50-60%. Zambiri zokhudzana ndi maantibayotiki sizimalembedwa patsamba lino kuti mulimbikitse odwala kuti azidziyimira okha.

Choyipa koposa, ngati wodwala matenda ashuga agwidwa ndi mabakiteriya omwe ayamba kukana mankhwala amakono.

Wet gangrene, phlegmon, zotupa zozama ndizovuta zazikulu zomwe zimawopseza moyo kapena chitetezo cha dzanja la wodwalayo. Mankhwala awo, mankhwalawa amayenera kuperekedwa ndi jakisoni kuchipatala.

Kuchita bwino kumatengera momwe mabala amathandizira mosamala. Zikakhala zofatsa, mapiritsi a antibayotiki amatengedwa kunyumba kuti azichiza matenda ashuga.

Dokotala amayenera kusintha mankhwala ake mosamala, poganizira kuti wodwala matenda ashuga amatha kukhala ndi vuto la impso.

Kuletsa kuvala zothina

Njira zazikulu zochiritsira phazi la matenda ashuga ndi izi: kukonza kagayidwe kazakudya ndi magazi, kutsitsa miyendo, matenda am'deralo, mabala a mankhwala, ngati simuthandiza.

Pofuna kukhathamiritsa kuchuluka kwa glycemia mu mtundu 1 wa shuga, mapiritsi a insulin amasinthidwa, mu mtundu 2 wa shuga, wodwalayo amapatsidwa insulin. Β-blockers, ACE inhibitors, olimbana ndi calcium, okodzetsa amagwiritsidwa ntchito kupangitsa magazi kukhala achilendo.

Pamaso pa zotupa za purulent-necrotic (makamaka ndi mawonekedwe a neuropathic phazi la matenda ashuga), ndikofunikira kuwonetsetsa kuti boma litulutse miyendo yomwe yakhudzidwa ndikuchepetsa miyendo, kugwiritsa ntchito ndodo kapena chikuku, zida zapadera za orthopedic, insoles kapena nsapato.

Kupezeka kwa zilonda zolakwika matenda ashuga phazi kumafuna dongosolo la mankhwalawa - kukhudzana ndi minofu ya necrotic, mavalidwe omwe amagwiritsidwa ntchito antibacterial ndi antiseptic agents.

Zomwe zimayambitsa matenda a Diabetes

Chifukwa chachikulu chomwe chikuyambira matenda a shuga ndi matenda osachiritsika a hyperglycemia, omwe amadziwonetsa m'magazi a shuga ambiri nthawi zonse. Ndibwino kuti musalipidwe ndi shuga yomwe imayambitsa zovuta zonse za matenda ashuga, kuphatikizapo kuwonongeka kwa miyendo.

Kuzungulira kwa shuga m'magazi kumawononga makhoma amitsempha yamagazi, ndikuwonongeka kwambiri ndi mtima. Makamaka chowopsa ndichomwe chimayambitsa matenda ashuga pazotumphukira zamagetsi, zomwe zimasokoneza magazi m'magawo akumtunda komanso otsika.

Zotsatira zake, minofu ya miyendo imayamba kuwona kuperewera kwambiri kwa mpweya ndi michere, yomwe imawatsogolera pang'onopang'ono. Kusayenda bwino kwa magazi kumapangitsanso kuwonongeka kwa minyewa yam'mitsempha, yomwe imapangitsa kuti miyendo isamveke bwino ndikuwapangitsa kuti atengeke ndikuvulala kosiyanasiyana, mabala, sprains, deformations, burns and frostbite.

Choyambitsa matenda ashuga othamanga:

Angiopathy - kuwonongeka kwa zotumphukira za mtima,
Neuropathy - chiwonongeko cha zotumphukira za mitsempha,
Neuroosteoarthropathy - matenda osiyanasiyana a mafupa: mafupa am'mimba, mafupa am'mimba, kuwonongeka kwa mafupa, kuwonjezeka kwa mafupa, kufooka kwa mafupa,
Kuvulala kowopsa kwa phazi, kuyambitsa kuwonongeka kwake,
Matenda opatsirana komanso fungal khungu
Kuwonongeka kwakukulu mu chitetezo chokwanira, chonse komanso kwanuko.

Malamulo posankha nsapato za shuga

Chofunikira kwambiri pakupewedwa kwa matenda ashuga ndi kusankha koyenera nsapato. Ngakhale kusokonezeka kocheperako mukavala kumatha kubweretsa zotsatira zoyipa kwa odwala matenda ashuga, monga mapangidwe a zilonda zam'mimba zosachiritsika ndi kupunduka kwa phazi.

Mukamasankha nsapato, muyenera kukonda mitundu yosalala yopangidwa ndi zinthu zachilengedwe zomwe zimapangitsa kuti phazi lipume. Izi ndizofunikira kwambiri ku matenda ashuga, chifukwa kuphwanya kutulutsa kapena kutentha thukuta kwambiri kumatha kuyambitsa kukulitsa kachilombo koyambira.

Kuphatikiza apo, popewa komanso kuchiza chifukwa cha kupunduka kwa phazi, wodwalayo amatha kugwiritsa ntchito ma insoles apadera omwe amapereka chitonthozo ndi miyendo. Zotulutsa zoterezi zimatha kupangidwa ndi zinthu zosiyanasiyana, kuphatikizapo silicone ndi gel, komanso kukhala ndi ma CD opukutira ndi kukumbukira mawonekedwe.

Momwe mungasankhire nsapato zoyenera:

Nsapato za anthu odwala matenda ashuga ayenera kukhala ndi masitepe ocheperako komanso ndibwinopo ngati ali pafupifupi osawoneka. Njira yabwino ndi nsapato zopanda zingwe,
Utali wa nsapato ukhale wokulirapo pang'ono kuposa kupyola phazi la wodwalayo,
Z nsapato zabwino kwambiri za anthu odwala matenda ashuga ndi nsapato zokhala ndi liding kapena Velcro, zomwe zimapangitsa kuti kusinthidwe kwake kukhale kosavuta.
Nsapato za matenda ashuga siziyenera kunyamulidwa kuti muziwoloka, koma mofananirana,
Kusankha nsapato za odwala matenda ashuga kuyenera kukonda mitundu yokhala ndi cholimba chokha,
Pamwamba pa nsapato ndi zingwe zake zizikhala zopangidwa ndi zotanuka zofewa,
Pogula nsapato, odwala matenda ashuga ayenera kuyang'anitsitsa kupezeka kwa buku lina lofunikira pakuphatikizidwa ndi orthopedic insole,
Nsapato zabwino ziyenera kukhala ndi insole yosalala yosachepera 1 cm,
Kupita kukagula nsapato zatsopano ndikwabwino mutatha kudya nkhomaliro. Pakadali pano, miyendo ya wodwalayo idzatupa pang'ono, ndipo adzatha kusankha kukula kwakukulu,
Ngati wodwalayo wavomereza kuti mapazi ake ndi osazindikira, ndiye kuti mungasankhe kukula komwe simukuyenera kuyeza nsapato kumapazi, koma ndibwino kuyikapo tsamba lomwe linadulidwapo kale pamakatoni,
Mukazindikira kuperewera kwa phazi kwa wodwala, ndikofunikira kufunafuna thandizo kuchokera kwa akatswiri opanga ma insoles amtundu waumwini.

Matenda a shuga a matenda ashuga

Chomwe chimalepheretsa phazi la matenda ashuga ndi njira yoyenera yothandizira odwala matenda ashuga, monga kuwunika kawirikawiri shuga. Ndibwino ngati mulingo wa glucose m'thupi ukakhala woyandikira kwambiri komanso wosaposa 6.5 mmol / L.

Kuti muchite izi, wodwalayo ayenera kubaya insulin tsiku lililonse kapena kumwa mankhwala ochepetsa shuga. Kuphatikiza apo, pofuna kukonza bwino kuchuluka kwa shuga m'magazi, wodwalayo ayenera kutsatira kwambiri zakudya zama carb zochepa ndikuchita masewera olimbitsa thupi pafupipafupi.

Chofunikanso chisamaliro choyenera chamapazi, chomwe chiyenera kusiyanasiyana ndi zomwe zimavomerezedwa mwa anthu wamba. Ndi njirazi zaukhondo, ndikofunikira kukumbukira kuti kutentha kwa miyendo kumachepetsedwa moyenera odwala matenda ashuga, zomwe zikutanthauza kuti sangathe kuwunika bwino ululu kapena kutentha.

Kuphatikiza apo, anthu omwe ali ndi shuga ambiri ayenera kupewa ngakhale kuvulala pang'ono kwa khungu la miyendo yawo, chifukwa ndi matenda ashuga, mabala amachiritsa moipa kwambiri ndipo amatenga kachilomboka mosavuta. Izi zimapangitsa kuti pakhale zilonda zam'mimba ndi minofu necrosis, komanso mtsogolo kutayika kwa miyendo.

Malamulo Akusamalira Makazi:

Osambitsa mapazi omwe ali ndi matenda ashuga azikhala madzi ofunda tsiku ndi tsiku ndi sopo wofatsa. Osapukuta mapazi anu ndi chovala chotsukira, apo ayi zitha kukupweteketsani,
Pukuta mapazi ndi chopukutira chofewa, ndikunyowetsa madzi. Ndikofunikira kupukuta khungu pakati pa zala, chifukwa ndi pomwe zilonda zimawonekera kwambiri,
Anthu odwala matenda ashuga salimbikitsidwa kuti azisamba kapena kusamba kapena kusamba, kapena kuwongolera mapazi kapena kuwawotcha ndi phukusi lotenthetsera. Ngati miyendo yatayika, ndiye kuti musanasambe muyenera kuona kutentha kwa madzi ndi dzanja,
Valani masokosi oyera, masokosi kapena matayala tsiku lililonse. Pankhaniyi, muyenera kugula masokosi popanda seams komanso popanda zotanuka zolimba. Sokosi iyenera kukhala yolimba, kuphatikiza popanda mabowo osoka kapena osanjidwa,
Valani masokosi a odwala matenda ashuga ngakhale kunyumba, kapena kuposa apo, oterera. Odwala omwe ali ndi matenda ashuga samalimbikitsidwa kuyenda opanda nsapato kuti asavulaze miyendo yawo. Kuyenda pamalo otentha, ngati mchenga wotentha, ndizowopsa,
Nsapato ziyenera kumafanana ndi nyengo yonse. Miyendo ya odwala matenda ashuga sayenera kuloledwa kuzizira kapena thukuta,
Muyenera kusankha nsapato zokhazikika zomwe zimakhala ndi wandiweyani. Nsapato sizimaloledwa kuloledwa kapena kupukutira. Zovala zotsekedwa ziyenera kuvalidwa nthawi zonse ndi masokosi,
Nsapato kapena nsapato ndibwino kuti musamavale konse. Mitundu yoopsa kwambiri ya nsapato yomwe ili ndi chingwe kudutsa pakati pa chala chachikulu ndi chala chakumaso,
Musanaveke nsapato zanu, muyenera kusintha kaimidwe kake ndikuchotsa miyala ndi zinthu zina zowonjezera zomwe zimatha kupukusa phazi lanu ndikupangitsa zilonda,
Ndikofunikira kuteteza khungu pamiyendo ngakhale pakuvulala pang'ono. Ngati chimanga kapena chimanga chikuwonekera, simuyenera kuzichitira nokha, koma ndibwino kufunsa thandizo la dotolo,
Musamachiritse mabala ndi othandizira ankhanza monga ayodini, wobiriwira wanzeru kapena mowa. Ndi bwino kuwapaka mafuta a miramistin, chlorhexidine kapena dioxidine, ndikuyika kuvala koyera pamalo ovulalawo,
Dulani misomali yanu mosamala kwambiri. Izi ziyenera kuchitika molunjika, osayesa kudula ngodya ya msomali. Ngati mbale ya msomali inayamba kunenepa, ndiye kuti isanadulidwe idakonzedwa ndi fayilo,
Tsitsi lililonse tsiku ndi tsiku ndi kirimu wapadera wa odwala matenda ashuga, omwe amathandiza kukonza khungu, kuwonjezera magazi ndi kuteteza miyendo kuti isatenge matenda,
Madzulo aliwonse, yang'anirani mosamala mapazi kuti awonongeke, monga chimanga, kuvulala pang'ono komanso kudula.

Kuchita masewera olimbitsa thupi & Massage

Kutikita minofu pafupipafupi kwa matenda ashuga kumathandizira kusintha magazi m'miyendo, kuthetsa kupsinjika kwa minofu ndikuwongolera kuyenda kozungulira, komwe kumawateteza ku kusokonezeka. Kusisita pamapazi kumatha kuchitika palokha kapena posinthira ntchito za katswiri.

Kusisita popewa phazi la matenda ashuga liyenera kuchitika modekha, kupewa kutikita khungu. Kupatula kuwonongeka pakhungu, panthawi ya kutikita minofu, ndikofunikira kugwiritsa ntchito mafuta a massage kapena zonona.

Mukamaliza kumalizira, muyenera kusambitsa mapazi anu ndi madzi ofunda, kupukuta ndi chopukutira zofewa, mafuta ndi zonona zomwe zimalepheretsa phazi la matenda ashuga ndikuvala masokosi oyera.

Kuchita masewera olimbitsa thupi pafupipafupi kungapindulitsenso matenda a mwendo mu shuga. Pali gawo lonse la kulipiritsa kwa miyendo, komwe kumathandizira kulimbitsa minofu, kubwezeretsa zilonda zolumikizana, kuwonjezera chidwi komanso kuwonjezera magazi.

Masewera olimbitsa thupi kumapazi:

Khalani pampando, tambasulani miyendo yanu patsogolo panu ndikuyiyika zidendene. Tsopano kokerani masokosi kwa inu, kenako nkutalikirani.
Komanso ndikukhala pampando, gwadani maondo anu ndikuyika pamaso panu. Chotsatira, muyenera kupatula masokosi, momwe mungathere, kenako ndikuchepetsa. Pankhaniyi, zidendene zimayenera kukhala palimodzi.
Kwezani mwendo umodzi ndi kuwuwongolera kuti uzungulire miyendo, kuzungulira koyamba, kenako ndi mawola.
Popota Finyani ndi zala zosadziwika bwino.

Kuti tipewe zovuta zoopsa ngati phazi la matenda ashuga, kupewa komwe kumafunikira kuyesetsa kwakukulu, ndikofunikira kusiya zonse zoyipa. Choyamba, izi zimakhudzana ndi kusuta, komwe kumayambitsa kwambiri magazi.

Kusuta ndi chimodzi mwazifukwa zazikulu zomwe zimapangitsa kuti mitsempha ya mitsempha ipangike komanso thrombophlebitis, yomwe imalepheretsa magazi kulowa mthupi. Kusuta tsiku lililonse ngakhale ndudu zochepa, kumapangitsa kuti mitsempha ikhale magazi, makamaka m'munsi ndipo kumathandizira kuti pakhale matenda ashuga.

Zakumwa zoledzeretsa zimapezekanso m'matenda a shuga, chifukwa zimayambitsa shuga m'magazi. Mwachidziwitso, kusakhazikika kwa shuga m'magazi kumabweretsa chitukuko chonse cha zovuta za matenda ashuga, kuphatikizapo matenda a shuga.

Katswiri kuchokera pa kanema munkhaniyi akamba za njira zopewera komanso mtundu wa phazi la matenda ashuga.

Chifukwa chiyani phazi la matenda ashuga limayamba?

Kukula kwa phazi la matenda ashuga kumayambitsidwa ndi matenda a shuga a matenda a shuga kwa zaka 15-20 komanso kukhalapo kwa zovuta zina zomwe zimawonekera chifukwa cha kubwezera koyipa kwa mtundu wa 2 kapena matenda ashuga a 1.

Zifukwa zazikulu zomwe zimathandizira pakuwonekera kwa matenda awa ndi:

Kugonjetsedwa kwamitsempha yamagazi yam'munsi yotsika - hyperglycemia yomwe imatenga nthawi yayitali imabweretsa kusintha kwamapangidwe amitsempha yamagazi yama calibers osiyanasiyana.
A Diabetes Angiopathy ndi Neuropathy - kusintha m'matumbo kumayambitsa kutsika kwa kutanuka kwawo, patency, komanso kusokonekera ndikuchulukitsa kwamitsempha yamagazi. Zotsatira zamitsempha yama mtima, pamakhala kuchepa, kenako kutayika kwathunthu kwa mathero a mitsempha. Njira izi zimayambitsa kuchepa kwa magwiridwe osakanikirana, zomwe zimabweretsa katundu wolakwika pamapazi. M'tsogolomu, kusinthika kwake komanso kukula kwa matenda a shuga kapena phazi la Charcot kumachitika.
Bacteria matenda - motsutsana ndi kusinthika kwa kusintha kwa ma neurotrophic mu minofu yofewa, kuphatikiza ndi kuchepa kwa chitetezo, kupweteka kulikonse pakhungu kumayambitsa njira yolonda yovuta kupweteka komanso kuchiritsa kwa nthawi yayitali. Nthawi zambiri mabala amatenga kachilombo ka staphylococcus kapena anaerobic, komwe kumayambitsa kufalikira kwa njirayi ndikupanga necrosis. Pankhaniyi, pamakhala ngozi ya abscess, phlegmon kapena gangrene.

Misomali ya Ingrown, chimanga, ming'alu zidendene kapena zotupa za msomali zimatha kupangitsanso kukula kwa phazi la matenda ashuga.

Zizindikiro zoyambira ndi zizindikiro

Kuwoneka kwa kusintha kulikonse pakhungu la miyendo kapena maula a msomali, komanso kuchepa kwamvekedwe, ndi chizindikiro chosavomerezeka pokhudzana ndi kukula kwa zovuta za matenda ashuga.

Zizindikiro zoyambira zokhala ndi matenda ashuga:

kuchepa kapena kusapezeka kwa mitundu yonse yazomverera (chamtundu, ululu, kutentha),
kusasangalala ndi nsapato zodziwika bwino komanso zakale,
kapangidwe ka chimanga ndi chimanga,
Maonekedwe a msomali wosakhazikika,
khungu la misomali
kutupa ndi kusinthasintha mapazi popanda chifukwa chodziwika bwino,
khungu louma, loyenda ndi msambo,
zomverera zosasangalatsa m'miyendo mu mawonekedwe a kumva kulira, dzanzi, kumverera kwa "kukwawa."

Chizindikiro mu mawonekedwe a matenda am'munsi a matenda ashuga ndi kukhalapo kwa ma callus osachiritsika, ming'alu ya pakhungu kapena zilonda zam'munsi. Ngati matenda adayamba, njirayi imasinthidwa ndi kutulutsa kwa purulent, limodzi ndi fungo losasangalatsa.

Kupweteka kwakanthawi mwendo, kukulitsidwa ndi katundu, kusinthanitsa mawu, kumakhala cholepheretsa mayendedwe ogwira ntchito. Kuphwanya magazi m'mapazi kumayambitsa kutupa kwa dzanja, chifukwa khungu la mwendo limapeza kuwala pang'ono komanso kuwala. Kunenepa, kugundana miyendo kumakhala kwamuyaya.

Nthawi zina, popanda chithandizo chamankhwala osakwanira kapena chosakwanira, njirayi imatha kuphatikizidwa ndi kukula kwa phazi la Charcot, momwe mumakhala chiwonongeko chopita patsogolo cha mafupa a phazi ndi cholowa. Njira ya pathological iyi siyopatsirana komanso mbali imodzi.

Gulu la odwala matenda ashuga

Kutengera kufalikira kwa zizindikiro zina zamankhwala, mitundu yotsatirayi imasiyanitsidwa ndikugawika kwamiyendo ya matenda ashuga:

Fomu ya Ischemic (mpaka 10% ya milandu) - Chizindikiro chachikulu ndicho kuphwanya magazi mu phazi chifukwa cha kuwonongeka kwa mitsempha yamagazi ya opatsirana angapo. Mu chipatala cha matendawa, zizindikiro zimafotokozedwa ngati kupsinjika kwamiyendo kumapazi, kupweteka m'miyendo, kulumikizana pakati, kuthamanga kwamiyendo, kusinthika khungu. Pali kufooka kapena kusowa kwa kukoka pa phazi, komanso kutsekemera kosalekeza ndikumamva kuzizira. Kuzindikira kumakhalabe kosungidwa.
Fomu la Neuropathic (mpaka 75% ya milandu) - kuwonongeka kwa mitsempha ya m'mphuno kumapangitsa kuti khungu lizipuma komanso kutsekeka kwa khungu la kumapazi, kuchepa mphamvu, kuchepa kwambiri thukuta, kukula kwa phazi lathyathyathya komanso kuphwanya mapazi. Chizindikiro cha matenda amtunduwu ndi kupezeka kwa ma scuffs ndi ming'alu yakuzama phazi, mawonekedwe a zilonda pa iye kapena m'malo pakati pa zala. Khungu limakhala lotentha, kupukusira kwamitsempha yamafinya kumasungidwa. Kusintha kwa phazi, limodzi ndi atrophy ya minofu, kumadziwika.
Mawonekedwe osakanikirana a neuroischemic (mpaka 30% ya milandu) - Zizindikiro zowonongeka kumapeto kwa mitsempha ndi mtima wama phazi. Fomuyi ili ndi gawo lowopsa - kusowa kwa ululu, zomwe zimachitika chifukwa chamankhwala omwe amachedwa kulandira odwala kupita kwa dokotala. Kupezeka kwa chilonda chachikulu ndikukula kwa njira zosasinthika mu minofu imapangitsa kusungidwa kwa matenda a matenda osagwira ntchito.

Gulu la Wagner F. W Diabetesic Foot Gulu:

siteji zero - mawonetseredwe akunja a nthendayo amadziwika mu mawonekedwe a khungu la kumapazi, limodzi ndi kutsekeka, kupezeka kwa chimanga ndi kupindika kwa phazi,
Gawo 1 - mawonekedwe a zilonda zapamwamba pakhungu,
Gawo lachiwiri - kukula kwa zilonda zakuya popanda kuwononga minofu yamafupa.
Gawo lachitatu - kupita patsogolo kwa zilonda zamkati ndi kukhudzidwa kwamafupa.
Gawo 4 - kukula kwa gulu lovulala kwambiri laling'ono,
Gawo 5 - kukulitsa njira yowonjezerera zigawenga.

Zodzikongoletsa

Conservative chithandizo cha matenda ashuga amayamba ndi kukakamiza kukonza kagayidwe kachakudya, pofuna kukhalabe shuga m'magazi. Malinga ndi zomwe zikuwonetsa matenda a shuga 1, kusintha kwa insulin kumachitika. Mtundu 2 wa shuga, kuwonjezeka kwa mankhwala ochepetsa shuga + ndi mankhwala a insulin.

Zizindikiro za kuthamanga kwa magazi zimakonzedwanso, kuti zikhale zovuta momwe magulu otsatirawa a mankhwala amagwiritsidwira ntchito:

beta-blockers - Nevibolol, Carvedilol,
ACE zoletsa - Burlipril, Captopril,
olimbana ndi calcium - Corfin, Nicardipine,
okodzetsa - Hypothiazide, Indapamide.

Kutengera ndi gawo la matendawa, mankhwalawa amathandizira odwala matenda ashuga odwala matenda osiyanasiyana. M'magawo oyamba a phazi la odwala matenda ashuga, njira zochizira ndizofunikira kuti muchepetse kupweteka, kuchepetsa kuphipha, komanso kukonza minyewa. Pachifukwa ichi, mankhwalawa akutsatiridwa:

antispasmodics ndi minofu yopuma omwe amachepetsa ululu - Papaverine, Drotaverin,
othandizira a mtima kapena angioprotectors omwe amasintha ma microcirculation ndi metabolism mu minofu - Pentoxifylline, Venoruton,
antioxidants omwe amasintha kagayidwe kazakudya ndi kusokoneza njira zophatikiza ndi okosijeni - Lipoic acid, Tocopherol,
mankhwala omwe amabwezeretsa khoma lamitsempha - Troxerutin, Detralex,
ma anti-spectrum mankhwala - Cephalosporins, Macrolides,
detoxification mankhwala - mtsempha wa magazi njira zingapo zothetsera,
mankhwala obwezeretsa,
vitamini mankhwala.

Chofunika kwambiri ndi zotupa za purulent-necrotic za phazi ndikutsitsa kwake pamodzi ndi chithandizo chakumaloko. Pachifukwa ichi, nsapato zapadera zamtundu wamatumbo kapena ma insoles, ndodo, chikuku chimagwiritsidwa ntchito pothandiza kupsinjika ku dzanja lanu.

Chithandizo cha zilonda zam'deralo zimaphatikizapo kugwiritsa ntchito ma antibacterial osiyanasiyana, antiseptic othandizira komanso kuvala kwapadera kwa hydrogel kwa bala. Ndikofunikanso kuchotsa chimanga ndi chimanga pozungulira zilonda, zomwe zimachepetsa katundu pamapazi opweteka.

Opaleshoni

Mankhwala othandizira odwala a phazi la matenda ashuga amagwiritsidwa ntchito ngati palibe zotsatira zochizira, komanso zofunikira pakukula kwa gwere lonyowa ndipo njirayi imafalikira mpaka kumiyendo.

Kuchita opaleshoni yamatumbo kumakulolani kuti muimitse kupititsa patsogolo kwa matendawa ndikubwezeretsanso zakudya zopezeka m'thupi, zomwe zimatsogolera kuchira kwamphamvu kwa vuto la khungu. Njira zofala kwambiri zomwe zimagwiritsidwa ntchito pochiza matenda am'magazi a shuga ndi izi:

Opaleshoni yam'mimba - kupanga zina zowonjezera kuti magazi azigwira ntchito ngati akuyika.
Balloon angioplasty - kukhazikitsidwa kwa baluni yapadera mu chotengera chake chopapatiza, chomwe pamakina chimathandizira kukulitsa kwake ndikubwezeretsa kutuluka kwa magazi. Pambuyo pake, stents imayikidwa mchombo chobwezeretsedwa, ndiko kuti, chitsulo chachitsulo chomwe chimalepheretsa chombo kuti chisachepetse.
Sympathectomy - kuchotsedwa kwa mitsempha ina mu msana wa lumbar, womwe umayambitsa kuphipha kwamankhwala. Njira iyi ndi yovuta pakukonza kwaudokotala ndipo sikuti amangogwiritsidwa ntchito pazowonetsa zina.

Kuphatikiza pa kuchitapo kanthu kwa opaleshoni yamtunduwu, pochiza mabala pamiyendo, opaleshoni "yaying'ono" imagwiritsidwa ntchito, ndiye kuti, kuchotsa ziwalo za necrotic, chimanga, chimanga chokhala ndi scalpel. Ntchito zoterezi ndizofunikira kuyeretsa bala ndi kupewa kufalikira kwa kachilonda.

Pambuyo pa kulowererapo, kuthamanga kwa magazi kumakonzedwa pogwiritsa ntchito opaleshoni ya mtima. Koma ngati njira yofalitsira matenda osokoneza bongo singathe kuyimitsidwa, ndiye kuti phazi lonse limadulidwa.

Chithandizo chatsopano

Kuphatikiza pa njira zachikhalidwe zochizira matenda ashuga, madokotala akuyamba kugwiritsa ntchito njira zaposachedwa zochizira, zomwe zimaphatikizapo:

mankhwalawa amanjenje - mankhwalawa amachitidwa pogwiritsa ntchito ziphuphu,
gwiritsani ntchito maselo
njira ya plasma jet - chilonda chimathandizidwa ndi mtengo wopangidwa ndi plasma ya ion,
mankhwalawa amachiza mabala.

Kusankhidwa kwamankhwala othandizira odwala matenda ashuga nthawi zonse kumatsimikiziridwa ndi katswiri, kukumbukira cholinga cha deta, gawo la chitukuko cha matenda a pathological ndi machitidwe a thupi.

Kusamalira miyendo

Odwala omwe ali ndi matenda osokoneza bongo sayenera kungoyang'anira kuchuluka kwa shuga m'magazi, komanso amasamalira miyendo yawo, chifukwa matenda ashuga amapereka zovuta kwambiri zomwe zingayambitse kulumala. Njira yofunikira kwambiri yopewera kusamalira ndi kusamalira mapazi, ili ndi njira zotsatirazi:

Amasankhidwa kuti aziyenda popanda nsapato kulikonse, kuphatikiza nyumba. Izi zimapewa kuvulala kosiyanasiyana, monganso jekeseni pang'ono kapena jekeseni pa mwendo amatha kusintha kukhala vuto lalikulu.
Ngati miyendo ikuzizira, pamafunika kugwiritsa ntchito masokosi amkaka. Nthawi yomweyo, zotanuka siziyenera kumangiriza mwendo wapansi kuti zisasokoneze kufalitsa kwaulere. Kugwiritsa ntchito chotenthetsera phazi sikumachotsedwa, chifukwa ndikumverera kuchepa kutentha kwa khungu la mapazi ndikotheka.
Onetsetsani kuti mwatsuka mapazi anu tsiku ndi tsiku ndi madzi otentha chipinda, nkumapukuta mokwanira, makamaka m'malo ophatikizika.
Kuthira tsiku ndi tsiku mapazi ndi mafuta apadera okhala ndi urea, kupatula kukonza pakati pa zala.
Kutuluka thukuta kwambiri pamiyendo pambuyo pa njira zamadzi, kugwiritsa ntchito talcum ufa kapena ufa wa ana ndikulimbikitsidwa.
Kudula kwa misomali ndi lumo kapena mafinya kumasiyidwa kuti tipewe kuvulala pakhungu. Poterepa, fayilo ya msomali wagalasi imagwiritsidwa ntchito pokonzanso misomali, makamaka chidwi ndi ngodya za mbale ya msomali.
Chithandizo cha zidendene, ma chimanga owuma kapena chimanga chikuyenera kuchitika kokha mothandizidwa ndi ma pumice kapena mafayilo azodzikongoletsa. Kukhazikika koyambirira kwa miyendo, kugwiritsa ntchito njira zapadera ndi plasters pochotsa chimanga sichimaphatikizidwa.

Zochita zolimbitsa thupi

Kuchita masewera olimbitsa thupi kwa odwala omwe ali ndi matenda ashuga ndikofunikira, chifukwa amathandizira kuti achepetse kuchuluka kwa shuga m'magazi, komanso kuwonjezera chitetezo cha mthupi. Choyamba, ndikutuluka. Kuphatikiza apo, masewera otsatirawa amapereka zotsatira zabwino:

kumayenda
kusambira
masewera a badminton
masewera a tennis ya tebulo.

Ntchito zapadera zochita zolimbitsa thupi ziyenera kusankhidwa kokha ndi dokotala wamankhwala olimbitsa thupi, poganizira momwe wodwalayo alili komanso gawo la chitukuko cha zovuta za matenda a shuga. Kukhazikitsa kwa ntchito zolimbitsa thupi kumachitika pang'onopang'ono, pang'onopang'ono kuwonjezera katundu ndi nthawi yamakalasi.

Kuphatikiza kwabwino kwa zovuta zamagetsi olimbitsa thupi ndi njira zoyeserera, zomwe zimapangidwanso ndi katswiri. Njira iyi yothandizira odwala matenda ashuga imapereka zotsatira zabwino pokhudzana ndi kukonza thanzi la wodwala.

Nsapato zamatsenga

Nsapato kwa odwala matenda ashuga ayenera kukwaniritsa zofunika zapadera, chifukwa zimalepheretsa kuchepa kwamtundu wa moyo, womwe ndi kupewa kukula kwa zovuta za matenda ashuga. Zovala zamatsamba zimakhala ndi mawonekedwe awo, omwe amawonetsedwa motengera:

kusowa kwa gawo lolimba
okhazikika (okhwima yekhayekha),
kusowa kwa nsapato,
voliyumu yowonjezera yamkati mkati mwa nsapato zamatumbo a orthopedic, omwe amasankhidwa ndi katswiri poganizira mtundu wa momwe amapangira matenda,
Zipangizo zapamwamba kwambiri zopangira nsapato, kuphatikizapo kumaliza mkati ndi zida zomwe zimamwa kuti zisalephere kupindika.

Chithandizo chanthawi yoyambira, kukhazikitsa madongosolo onse a dokotala pakuyambitsa matenda a matenda ashuga, kumapereka chiyembekezo chokhudza thanzi komanso momwe wodwalayo angagwirire ntchito. Koma ngati njirayi ikulowerera kwambiri ndikupanga zilonda zakuya, matendawa amakhala osavomerezeka, chifukwa nthawi zambiri kuphwanya kotere kumapangitsa wodwala kudwala.

Pathogenesis wa matenda ashuga

Makina a chitukuko cha SDS ndi kutsatira njira zotsatirazi:

kuperewera kwa mphamvu ya insulin
hyperglycemia (kuchuluka kwa shuga m'magazi),
blockade wa kukoka kwa magazi, mpweya ndi zinthu zina kudzera m'mitsempha.
kuwonongeka kwa ulusi wamanjenje ndi ma receptor,
yaying'ono- ndi macroischemia ya phazi,
kupezeka kwa zilonda zam'mimba.

Chifukwa chake, ndi SDS, kuwonongeka kwa ziwalo zonse zam'munsi kumachitika.

Chifukwa cha kusowa kwa insulini mu matenda ashuga, kuchuluka kwa glucose m'magazi kumawonjezeka. Izi, zimakhudzanso zoyipa zazing'ono ndi zazikulu:

zinthu zakale zimadziunjikira pamakoma amitsempha yamagazi,
nembanemba imakhala yodyeka,
Kuwala kwa ziwiya kumachepa.

Chifukwa cha kusintha kumeneku, kayendedwe ka magazi kamasokonezeka ndipo mawonekedwe ang'onoang'ono am magazi. Kusintha kumeneku m'thupi kumalepheretsa kulowa kwa zinthu zochuluka zokwanira ndi mpweya m'maselo ndipo zimayambitsa kusokonezeka kwa metabolic. Kufa kwa mpweya wa okosijeni kumachedwetsa kayendedwe ka maselo ndikuwonjezera kuvunda kwawo.

Kuwonjezeka kwa shuga wamagazi kumapangitsanso kuwonongeka kwa minyewa yamitsempha - kukhudzika kumachepa.

Njira zonse zowonongeka zomwe zimachitika m'minyewa ya phazi zimatsogolera kuti kuwonongeka kulikonse pakhungu kumakhala njira yosavuta, ndipo kuchiritsidwa ndikutalika. Kukulitsa zomwe phazi limatha kulumikizana ndi matendawa, zomwe zingayambitse mapangidwe a gangore - minofu necrosis.