Matendawa odwala matenda ashuga malinga ndi ICD-10, amachititsa komanso amathandizira

Pankhani ya matenda a shuga a mellitus, munthu nthawi zina amakhala ndi zovuta zaumoyo, wodwala matenda ashuga amawonekera (ICD code - 10). Kuzindikira kumachitika, monga lamulo, chifukwa cha zolakwa za wodwalayo. Cholinga chake ndikuti samatsata zakudya zapadera komanso samatsata nthawi yoika akatswiri. E 10,5 - ICD code 10 ya phazi la matenda ashuga ndi matenda oopsa omwe amatha kuyambitsa minofu necrosis (gangrene).

Zolinga zamaphunziro

Kwenikweni, phazi la matenda ashuga, ICD code 10 yomwe ndi E 10.5, imawoneka chifukwa chonyalanyaza malamulo okhazikitsidwa ndi wodwalayo. Wodwala akapanda kuyang'anira thanzi lake, amadya mosayenera, amakana chithandizo. Kulingalira koteroko pa thanzi la munthu kumatha kudzetsa mavuto.

Chinthu chotsatira chomwe chimakwiyitsa odwala matenda a shuga (ICD 10 E10.5) ndi matenda akale ndi kuvulala. Kuphatikiza apo, zambiri zimatengera mankhwalawo pawokha, pa mtundu wake komanso momwe mulingo woyenera wa mankhwalawa ulili. Ndi chifukwa cha zonse zomwe zili pamwambapa kuti matenda a phazi la matenda ashuga amapangika - matenda a ziwiya zamagawo am'munsi. Makamaka omwe ali pachiwopsezo ndi anthu omwe ali ndi matenda ashuga a 2.

Kwa matenda ammimba a shuga, kuwonongeka kwa minofu kumapazi ndi kakhalidwe. Pamene mawonekedwe awo a kutupa, ndiye chifukwa chake pamakhala mphamvu yowonjezereka, yomwe imatha kulowa m'golosale la phazi la matenda ashuga, malinga ndi ICD 10, codeyo ili ndi E 10-14 yokhala ndi phindu lachinayi la 5.

Chimodzi mwazomwe zimayambitsa matendawa chimatha kukhala matenda ashuga a m'mimba - kuphwanya kwamatumbo am'mphepete, komwe kumavuta ndi matenda oyambitsidwa ndi bakiteriya.

Mitundu ya matenda

Pamenepa, zaka 90 zapitazo, International Symposium yoyamba idachitika, yomwe idaperekedwa kungoganizira zovuta za phazi la matenda ashuga. Mapeto ake, matendawa adapangidwa ndipo mitundu yake yopita patsogolo idadziwika.

Pali mitundu ya matendawa:

Neuropathic - imabweretsa kusokonezeka kwamanjenje. Imadziwoneka ngati kutupa, zilonda, kuwonongeka kwa minyewa yamitsempha.
Ischemic - zotsatira za mawonetseredwe a atherosulinotic, chifukwa cha momwe magazi amayenda m'munsi m'munsi amasokonezedwa.
Neuroischemic, wodziwika bwino monga wosakanikirana. Fomuyi ikuphatikiza Zizindikiro za mitundu iwiri yapitayo.

Mukazindikira imodzi mwa matendawa, simuyenera kumangoganiza nokha ndikusankha mankhwala achikhalidwe. Monga momwe mchitidwe umasonyezera, njira zotere sizothandiza ndipo nthawi zina zimatha kukhala zopititsa patsogolo chitukuko cha matenda.

Nthawi zambiri ndi matenda a shuga pali mawonekedwe a neuropathic, ocheperako nthawi zambiri - neuroischemic. Nthawi zina, mawonekedwe a ischemic amapezeka. Chifukwa chake, musanayambe chithandizo, katswiri ayenera kudziwa mtundu wa matendawo ndipo pamaziko a izi, pitani ndi chithandizo.

Chifukwa chiyani zovuta zimachitika?

Panthawi yophwanya matenda a shuga mellitus a diabetesic phazi (ICD - 10 E 10.5), kulumpha m'magazi a magazi kumachitika, izi zimakhala zowopsa, makamaka ngati zoterezi sizinasinthidwe kwa nthawi yayitali. Kuchuluka kwa shuga okwanira kumakhudza mitsempha ndi mitsempha yamagazi. Choyamba, capillaries amavutika, pang'onopang'ono amayamba kufa, matendawa atakhudza ziwiya zazikulu. Izi zimakhudza kuthamanga kwa magazi. Chifukwa cha izi, kuchira kumachitika, komwe kumayendetsedwa ndi minofu necrosis.

Vutoli limakulirakulira chifukwa phazi ndilogwira thupi kwambiri, limayenda mokhazikika, limakhudzidwa nthawi zonse ndi nkhawa. Gawo ili la thupi la munthu limavulala nthawi zambiri. Chiwopsezo chachikulu chotenga matendawa chimaphatikizidwa ndi nsapato, zopapatiza, nsapato zosavomerezeka, kapena nsapato zopangidwa kuchokera ku ulusi wopangidwa.

Nthawi zina anthu sangazindikire ming'alu yaying'ono, mabala, zipsera, mabala, ngakhale bowa, zonsezi zimakhala ndi phindu pakukwera kwa zilonda, popeza chifukwa chosowa magazi, ntchito yoteteza kumadera owonongeka sigwira. Zotsatira zoterezi zimawonekera pakanthawi kochepa osachiritsa mabala, komanso matenda, zilonda zazikulu, zomwe zimakhala zovuta kwambiri kuchotsa popanda zotsatira, kupatula chithandizo chamankhwala poyambira.

Ndi mapangidwe a phazi la matenda ashuga, ndizosowa kwambiri kuti zithetseretu matendawa, chifukwa chake, monga lamulo, chimakhala chachikulu. Chifukwa cha izi, wodwalayo ayenera kutsatira zakudya, kutsatira mosamalitsa zomwe wapatsidwa ndi dokotala. Ngati muli ndi mavuto, muyenera kulankhulana kuchipatala mwachangu.

Neuropathic

Mtundu uliwonse wamatendawa umawonetsedwa ndi zizindikiro zake. Mwachitsanzo, neuropathic imadziwika ndi kuchepa kwamphamvu kwamapazi, mapangidwe a chimanga pa iwo ndikusintha. Mukasinthira mawonekedwe owopsa pamalo omwe panali chimanga, zilonda zimawonekera, zomwe zimadziwika ndi mitundu yozungulira.

Phazi la matenda ashuga (ICD-10 code: E10.5, E11.5)

Dongosolo la zithandizo zamankhwala limaphatikizapo kuphatikiza kwakukulu kwamitsempha yamagazi poyerekeza zilonda zam'mimba, m'mimba msempha, mafupa aakazi ndi popliteal neurovascular, kusanthula kwakanthawi kazinthu zachilengedwe za ntchafu, mwendo wapansi, komanso kutsitsa kwachindunji kwa dera la trophic.

Malingaliro a laser chithandizo cha kufanana kwa magawo awonetsero ndikuyenda mosasintha kuchoka kumadera apakati kupita kufumbi. Pa magawo oyambilira a chithandizo, zochita zowonjezera zimachitika m'chigawo cha ulnar fossa ndi ziwiya zamagawo zam'munsi, zokhala m'chigawo cha inguinal fold ndi popliteal fossa. Pomwe kusokonezeka kwa hemodynamic mu nthambi yomwe ikukhudzidwa kumathetsedwa, kupita patsogolo kumapangidwira mbali zachigawo, mwachindunji kudera la zotupa. Kuchita motere ndikofunikira kuti muchepetse kukula kwa vuto la kuba m'magawo a miyendo ndi magazi osakwanira.

Nthawi za makulidwe a mankhwala a zigawo zochizira matenda a shuga

Phazi la odwala matenda ashuga: ICD-10 code, gulu, zomwe zimayambitsa ndi njira zamankhwala

Chimodzi mwazinthu zovuta kwambiri za matenda ashuga ndi matenda am'mimba a shuga.

Wodwala amene satsatira zakudya zomwe wapatsidwa, samayang'anira bwino shuga, pakubweza (kawirikawiri patatha zaka 15 mpaka 20 atazindikira kuti matendawa ndi omwe ali ndi matendawa), kupsinjika koteroko kumawonekera m'njira zosiyanasiyana.

ICD 10 diabetesic phazi ndimavuto owopsa, nthawi zambiri amatsogolera ku gangrene (minofu necrosis).

Mavuto a shuga

Nthawi zambiri, zovuta za matenda ashuga zimachitika chifukwa cha vuto la wodwalayo. Ngati anyalanyaza chithandizo, anyalanyaza malangizo azachipatala, sayang'anira momwe amadya, samapereka insulin panthawi, ngakhale atakhala ndi mtundu wanji wa matenda.

Nthawi zambiri zotsatira zake zimakhala zazikulu, ndipo nthawi zambiri zotsatira zakupha sizimachotsedwa. Mavuto amatha chifukwa cha matenda amodzi, kuvulala, Mlingo wolakwika wa insulin, kapena kugwiritsa ntchito mankhwala omwe atha.

Chimodzi mwazovuta zazikulu za matenda ashuga ndi:

lacticosis - kuphwanya chilengedwe cha acidic mthupi chifukwa cha kuchuluka kwa ma asidi a lactic,
ketoacidosis - kuchuluka kwa matupi a ketone m'magazi chifukwa cha insulin yokwanira,
hypoglycemic chikomokere - zotsatira zakugwa kwakukulu m'magazi a shuga,
hyperosmolar coma - zotsatira zakukwera kowonjezera kwamasamba,
odwala matenda ashuga phazi - oyambitsidwa ndi mtima pathologies kumapeto,
retinopathy - zotsatira zakuphwanya mu ziwiya zamaso,
encephalopathy - kuwonongeka kwa minyewa yaubongo chifukwa chosokoneza mitsempha yamagazi,
mitsempha - ntchito kuwonongeka kwa zotumphukira mitsempha chifukwa chosowa minofu mpweya machulukitsidwe,
zotupa zamkati - mawonetseredwe pafupipafupi amachitika chifukwa cha kusokonezeka kwa metabolic m'maselo a khungu.

Mwa 90% ya odwala matenda ashuga othamanga amakhudza odwala omwe ali ndi matenda a shuga 2.

Kodi matenda ammimba a shuga ndi otani?

Matenda amtunduwu amakhudza minofu ya miyendo. Njira zotupa mwa iwo zimayendetsedwa ndi kusefukira kwamphamvu, zomwe zimapangitsa kukula kwa gangrene.

Kukula kwa zilonda zam'miyendo

Zomwe zimayambitsa mawonetseredwe oterewa zimatha kukhala matenda a shuga, matenda osokonezeka m'matumbo am'munsi, omwe amakulitsidwa ndi matenda a bakiteriya.

Msonkhano woyamba wa International Symposium, womwe unachitika mchaka cha 1991 ndipo unadzipereka ku matenda a matenda ashuga, unapanga gulu lotengera momwe mitundu ya matendawa idayamba kusiyanitsidwa ndi zomwe zimayambitsa.

Mitundu yotsatirayi ndiosiyanitsidwa:

mawonekedwe a neuropathic - imadziwoneka yokha ngati zilonda zam'mimba, kutupa, kuwonongeka kwa minyewa yamitsempha, yomwe ndi zotsatira za zosokoneza pakugwira ntchito kwamanjenje. Mavutowa amachitika chifukwa cha kuchepa kwa kayendetsedwe ka mitsempha m'malo am'malo am'munsi,
mawonekedwe a ischemic - ndi chotsatira cha mawonetseredwe a atherosulinotic, pomwe magazi amayenda m'mizere yotsika,
neuroischemic (kapena wosakanikirana) mawonekedwe - amatenga zizindikilo za mitundu yonse iwiriyi.

Osatembenukira pakumamwa nokha komanso kulandira chithandizo ndi njira zina. Mwambiri, sizigwira ntchito ndipo zimangokulitsa matenda!

Nthawi zambiri, odwala matenda ashuga amawonetsa mawonekedwe a neuropathic mawonekedwe. Wotsatira pafupipafupi ndiye mawonekedwe osakanizika. Mtundu wa ischemic phazi la matenda ashuga limawonekera kawirikawiri. Kuchiza kumakhazikika pofufuza mwakuzindikira mitundu (mitundu) ya matenda.

Zifukwa zoyambitsa zovuta

Matenda a shuga m'magawo achibwibwi amadziwika ndi kusintha kwakukuru mu kuchuluka kwa shuga m'magazi, kapena chifukwa chakuti kuchuluka kwake kwa magazi kumakhalabe kwa nthawi yayitali. Izi zimakhudza mitsempha ndi mitsempha yamagazi.

Ma capillaries a microvasculature amayamba kufa, ndipo pang'onopang'ono matendawa amatenga ziwiya zazikulu.

Kusagwiritsidwa ntchito mosavomerezeka ndi magazi kumapangitsa kuti trophism isakwanitse. Chifukwa chake yotupa njira limodzi ndi minofu necrosis. Vutoli limakhudzidwa ndikuti phazi, lomwe limakhala gawo limodzi lolimbitsa thupi, limakhala likuwonetseredwa kupsinjika, ndipo, nthawi zambiri, kuvulala pang'ono.

Njirayi, yosavutikira, nsapato za mphira kapena nsapato zopangidwa kuchokera pazinthu zopangidwa nthawi zina zimawonjezera chiopsezo cha matenda!

Munthu, chifukwa cha kuchepa kwamkati (kumverera kwa manjenje), sangathe kulabadira kuvulala kwakung'ono (ming'alu, kudula, zipsera, mabala, mafinya, mafangasi), zomwe zimatsogolera pakukula kwa zotupa, popeza pakakhala magazi osakwanira m'magazi ang'onoang'ono ntchito yoteteza thupi m'malo awa sikugwira ntchito.

Zotsatira zake, izi zimatsogolera kuti mabala ang'ono samachiritsa kwa nthawi yayitali, ndipo ngati atatenga kachilomboka, amakula ndikuchulukanso zilonda, zomwe zimatha kuchiritsidwa popanda zotsatira zoyipa pokhapokha atapezeka kuti ali koyambirira.

A syndrome monga phazi la matenda ashuga sakhala amachotsedwa konse ndipo nthawi zambiri amakhala m'gulu la matenda opatsirana.

Chifukwa chake, wodwalayo akulangizidwa kuti adziyang'anire mosamalitsa, kutsatira mosamalitsa zakudya zomwe wapatsidwa komanso malangizo ena azachipatala, ndipo ngati mawonekedwe ena okayikitsa apite, pitani kuchipatala mwachangu.

Iliyonse mwa mafomuwo imadziwika ndi zizindikiro zake. Makamaka:

mawonekedwe a neuropathic kutsitsa kwa phazi, phazi lawo limakhala ndi mawonekedwe, mawonekedwe a chimanga, cholinga cha hyperkeratosis amawonedwa. Pakapita nthawi, zilonda zam'mimba zimapezeka pamasamba, pomwe zimakhala ndi mawonekedwe osalala ozungulira,
mawonekedwe a ischemic kumachitika popanda maonekedwe a chimanga ndi kupunduka, chidwi cha khungu sichimachepa, koma nthawi yomweyo kusintha kwa malo a mapazi kumakhala kofooka ndipo sikumveka kwenikweni. Khungu limasandulika, kuyamba kuzizira. Zilonda zopweteka zimatuluka. Mitundu yawo ilibe mafotokozedwe omveka bwino, m'mbali zawo nthawi zambiri amakhala osagwirizana,
mawonekedwe osakanikirana Zonsezi ndi mawonekedwe ena ali mawonekedwe.

Akatswiri amasiyanitsa magawo asanu ndi imodzi a matendawa:

kuwonongeka kwa phazi. Palibe zilonda pano
Zilonda zapamwamba zoyambirira,
kukulira zilonda zam'mimba, komwe minofu ndi minyewa ya tendon imakhudzidwa,
Zilonda zimakoka kwambiri mpaka zimakhudza minofu ya mafupa.
Chiyambireni ovulala pang'ono,
gangore ikukula.

Pazochitika zoyambirira za dzanzi m'dera lamapazi, ndi mawonekedwe a "goosebumps" muyenera kufunsa dokotala nthawi yomweyo. Izi ndi chizindikiro choyamba cha matenda omwe akubwera!

Njira Zodziwitsira

Kuzindikira kumachitika chifukwa cha mbiri yakale yakuchipatala, kuyezetsa wodwalayo ndi zotsatira za kuyesedwa, zomwe zimaphatikizapo maphunziro ndi machitidwe monga:

kuyezetsa magazi konse
kuwunika kwamitsempha
Ultrasound yamitsempha yamagazi, yofunikira poyesa kuchuluka kwa kayendedwe ka magazi (Doppler ultrasound),
chikhalidwe magazi kwa mabakiteriya
angiography (kusiyanitsa x-ray, yokhazikika pakuphunzira mitsempha yamagazi),
ma x-ray amapazi,
biopsy ndi kuwunika zamkati zam'mimba zilonda.

Mukamayesedwa, kutentha kwa thupi, kukakamizidwa, kupuma, komanso zimachitika. Pambuyo pake, kupenda kwamilondayo mozama kumachitika ndi kutsimikiza kwa kuchuluka kwa momwe amvera komanso zisonyezo zingapo. Kuti adziwe kukula kwa kuwonongeka kwa minofu, dokotalayo amatha kuyesa kufufuza ndi kuchitira opereshoni mabala.

Ndikofunikira kudziwa! Mavuto omwe ali ndi shuga m'magazi nthawi yayitali amatha kubweretsa matenda ambiri, monga mavuto amaso, khungu ndi tsitsi, zilonda zam'mimba, zilonda zam'mimba, komanso zotupa za khansa! Anthu amaphunzitsa zomwe zinawawa kuti azisintha shuga yawo kuti asangalale ...

Mankhwalawa amayamba ndikulipira shuga m'magazi ndikusintha kuchuluka kwa shuga m'magazi, popeza shuga wambiri amakhala ndi zotsatirapo zonse zoyipa.

Mwambiri, mankhwala othandizira a ischemic ndi ma neuropathic mitundu ndi ofanana ndipo amagwirizana ndi kayendedwe ka magazi mu miyendo ndi njira zochiritsira kapena opaleshoni. Pankhani ya achire, antibacterial mankhwala amawerengedwa, komanso mankhwala omwe amapangidwa kuti athandize magazi kutuluka komanso kuchepetsa kutupira.

Anthu odwala matenda ashuga phokoso la mantha

Ndi akatswiri othandiza opaleshoni, amatha kuyang'ana ku percutaneous Transluminal angioplasty, yomwe imatha kubwezeretsa kayendedwe ka magazi m'mitsempha yamagazi popanda mawonekedwe a pakhungu ndi puntery punction, komanso thrombarterctomy kapena distal bypass opaleshoni.

Zowopsa zomwe zimakhudzidwa ndi matenda am'mimba, pangani regimen yofatsa, pangani chithandizo cham'deralo cha zilonda zamtundu wa antiseptic. Pankhani ya mawonekedwe a neuropathic, akatswiri amapereka chidwi chapadera pakubwezeretsa kwachilengo miyendo, komwe mankhwala omwe amafunikira kukonza kagayidwe amatha kugwiritsidwa ntchito.

Kuchedwetsa chithandizo ndikupita kwa dokotala kumabweretsa zotsatira zosasinthika, chifukwa chomwe gawo limodzi kapena mbali zonse zingadulidwe!

Chimodzi mwazinthu zazikulu zamankhwala ndicho kusiya kusuta kwathunthu. Nikotine imakhudza kwambiri kama wam'kati mwa michere, chifukwa chomwe njira zochizira zobwezeretsanso magazi zimatha kukhala zopanda ntchito kapena zitha kukhala zazifupi.

Njira zopewera

Anthu omwe akudwala matenda a shuga amalangizidwa kuti azisamala kuchuluka kwa shuga omwe ali m'magazi awo ndikugwiritsa ntchito insulin yapamwamba kwambiri yopangidwa ndi makampani otchuka azamankhwala.

Komanso, nsapato zabwino zili ndi chikoka chachikulu.

Omwe adapezeka ndi matenda am'mimba pafupifupi zaka 10 kapena kupitilira ayenera kusamalira kugula nsapato zapamwamba zokha, zopanda khungu pomwe khungu la kumapazi silisunthika, ndikupanga ma microcracks ndi ma fractures.

Nsapato ziyenera kukhala zazifupi, zopumira, makamaka zopangidwa ndi zinthu zachilengedwe.. Palibe chifukwa chomwe kuyitanitsa kuyimbira ndi kubwereketsa. Payokha, ndikofunikira kutchulapo ukhondo wamapazi. Muyenera kuigwiritsa ntchito mozama, kutsuka mapazi anu ndi sopo ochapira nthawi zonse, kupewa matenda oyamba ndi fungus ndi kuvulala pang'ono, abrasions.

Wodwala yemwe ali ndi matenda ashuga omwe amasamala mosamala zonse zofunikira pamwambapa, matenda awa sangawakhudze.

Zamkatimu:

Amayamba chifukwa cha kuperewera kwa okosijeni ku minofu kapena kutsiriza kwathunthu. Malo omwe akukhudzidwa nthawi zambiri amakhala kutali ndi mtima: miyendo yonse kapena gawo la chala. Chifukwa cha kuchepa kapena kuperewera kwa mpweya, njira yosasinthika ya kufa kwa cell imayamba.

Amatchulanso zifukwa zingapo za necrosis kuchokera ku frostbite yayikulu mpaka matenda opatsirana monga matenda a shuga. Mitsempha yamagazi yotchinga magazi nthawi zambiri imakhala "yothandizira" pakhungu.

Matenda a matenda ashuga

Mtundu woyamba wa matenda a shuga

E-10,4 wokhala ndi zovuta zamitsempha

E-10.5 ndiofoola kufalikira kwatsoka

E-10.6 ndi arthropathy

Type 2 matenda a shuga

E-11.4 yokhala ndi matenda amitsempha

E-11.5 ndi kufooka kwapakati kwazungulira

E-11.6 ndi arthropathy

Matenda a matenda ashuga - Uku ndi kusinthika kwa kusintha kwamatumbo ndi makina pantchito yolumikizana ndi matenda ashuga a m'mitsempha, ma micro ndi / kapena macroangiopathy, omwe njira zazikulu za purulent necrotic zimayamba.

Fomu yosakanikirana (neuro-ischemic).

Kuchuluka kwa 0Khungu limagwira.

Kuchuluka kwa 1Zilonda zapamwamba

Kuchuluka kwa 2Zilonda zozama zomwe zimalowa m'matumbo, mafupa, olowa

Kuchuluka kwa 3Osteomyelitis kapena chotupa chachikulu

Kuchuluka kwa 4Odziwika wamba

Kuchuluka kwa 5 Matenda wamba omwe amafunika kudula kwakukulu.

Zizindikiro za phazi la neuropathic:

Khungu lowuma, malo a hyperkeratosis m'malo opanikizika kwambiri.

Kutentha kwa pakhungu sikusintha.

Kusintha kwapadera kwamapazi, zala (phazi la Charcot), mafupa amapewa, mbali ziwiri zamiyendo ndi miyendo.

Ripple pamitsempha yamapazi imasungidwa mbali zonse ziwiri.

Zilonda zopweteka zopanda ululu m'malo oponderezedwa.

Zizindikiro zothandizidwa sizinafotokozeredwe.

Zizindikiro za phazi la ischemic:

Mtundu wa pakhungu ndi wotumbulika kapena wamanjenje.

Khungu limakhala lozizira, lopanda, pali ming'alu, kuchepa kwa tsitsi.

Kusintha kwa miyendo sikunatchulidwe mwachindunji kapena kulibe.

Ripple m'mitsempha ya kumapazi kulibe kapena kuchepetsedwa.

Pali kung'ung'udza kwa systolic chifukwa cha mitsempha yayikulu.

Acral necrosis ndi / kapena zilonda zam'mimba ndizopweteka kwambiri.

Pali mawu akuti subjective Symbomatology - azingokhala

kulira, kupweteka popuma.

Njira zakufufuzira za SDS

—Zotengeramalekezero apansi: palpation, chidwi cha mitsempha

—Mkhalidwe:kupweteka, tactile, kutentha, chidwi chachikulu, mawonekedwe a bondo ndi Achilles tendons

Njira zowonjezera zakufufuzira za SDS

magazi ndi mkodzo mayeso ambiri

kudya glycemia ndi mbiri ya tsiku ndi tsiku

magazi am'magazi ma cell

thanki. chikhalidwe magazi ndi akasinja. kufesa ku bala

Njira zopangira zida: ECG, x-ray ya phazi mu 2 pang'onopang'ono, ultrasound yam'munsi yamitsempha yamanja, kutsimikiza kwa LPI.

IneMankhwala osagwiritsa ntchito mankhwala a purulent pathology omwe ali ndi SDS

Kutsitsa: kupuma pabedi, kuyenda pa njinga ya olumala, kugwiritsa ntchito ndodo, kugwiritsa ntchito kunyamula nsapato.

II. Mankhwala ochizira matenda a purulent matenda a SDS

Zomwe zimapangitsa cell kufa

Zomwe zimayambitsa necrosis zimatha kukhala zakunja ndi zamkati pazakukopa.

kuwonongeka kwamakina pakhungu, mitsempha yamagazi, mathero a mitsempha,
zironda
kutentha kwambiri - chifukwa, chisanu,
Kutentha kwakukulu kumayambitsa kuyaka,
kuzunza kwamphamvu kwamankhwala,
kuipitsidwa kwa radiation.

kuwonongeka kwamitsempha yamagazi, zomwe zimayambitsa kuwonongeka kwa kagayidwe kazakudya mu minofu,
kusintha kwa thupi la zinthu za m'magazi ozungulira (kukhazikika kwa makoma amitsempha yamagazi, mapangidwe a malo okhala ndi kupendekera pang'onopang'ono kwa lumen kuti kudutsa kwathunthu),
matenda a shuga, matenda a a Raynaud, matenda a kugwedezeka, etc.,
chakudya chamafuta.

Magazi sangathenso kupereka okosijeni ndi michere yofunika kuzinthu zofunikira zochuluka. Pang'onopang'ono, kufa kwa maselo amodzi payekha pang'onopang'ono kumachitika.

Neuroischemic

Neuroischemic imaphatikizapo mawonetsedwe a mitundu yonse yam'mbuyomu. Mankhwala, pali magawo asanu ndi limodzi a matenda amadzimadzi am'mapazi:

Kusakhalapo kwa zilonda kwakanthawi.
Zilonda zoyambirira.
Mlingo wapamwamba kwambiri pamene minyewa ya tendon ndi minofu ikukhudzidwa.
Mawonekedwe osasamalidwa, kupezeka kwake, minofu ya mafupa imavutika.
Gawo loyamba la gangore.
Kukula kwambiri, kumakhudza gawo lalikulu.

Zizindikiro zoyambirira zimayambitsa kuyambika kwa matendawa: kugona kwa mapazi ndi kumverera kwa tsekwe. Ngati zizindikiro zotere zikuwoneka, pitani kuchipatala nthawi yomweyo.

1. Kubwezera kwa glycemia:

— Mtundu wopangidwa ndi ma insulins anthu. Mlingo ndi makonzedwe ali amodzi. Ma insulin achidule: Actrapid NM, Humulin R, Insuman mwachangu. Ma insulini apakatikati: Protafan HM, Humulin N, Insuman basal.

Mtundu woyamba wa shuga. Kwambiri insulin mankhwala. Mlingo ndi makonzedwe ali amodzi. Cholinga cha mankhwala: kusala glycemia 5.1 - 6.5 mmol / L, glycemia patatha maola awiri mutadya 7.6-9.0 mmol / L, HbA1s 6.1-7.5%.

Mitundu ya Gangrene

Mitundu iwiri yayikulu ya gangore imadziwika.

Zouma. Amayamba motsutsana ndi maziko a kuthana kwambiri kwa oxygen m'maselo. Utoto umawuma, makwinya, umachepa kukula. Choyamba, izi zimachitika chifukwa cha kuwonongeka kwa zinthu zamagazi ndi kuphatikizika kwa mapuloteni. Kunja, zikuwoneka ngati zotsalira. Ntchito za chala kapena phazi zimatayika kwathunthu. Kuzindikira khungu kumatha. Wodwalayo amamva ululu wopitiliza miyendo yovulala, yodziwika pamalo opangidwa ndi gangrene. Imfa ya minofu imafalikira pang'onopang'ono pa mwendo. Khungu la malo opendekera limayatsidwa. Pali kukanidwa kwa minofu yakufa. Chofala kwambiri ndi chida chala chala (zala).

Mtundu umodzi wamagulu owuma ndi owuma

Chonyowa kwambiri ndi gasi wandewu. Fomuyi nthawi zambiri imapezeka kunkhondo, pomwe anaerobic matenda (kuchokera pansi kapena fumbi) adalowa mabala osaphunzitsidwa ndi asitikali. Matendawa amafalikira mwachangu, popanda thandizo la opaleshoni - chithandizo kudzera pakudula kumene - wodwalayo sanakhale ndi moyo nthawi yayitali.

ICD 10 (International Classization of Diseases of the 10th Revision) imalongosola matenda onse omwe akudziwika masiku ano. Muli mu ICD 10 ndime ya necrosis, yomwe ili ndi gawo laling'ono la gangrene. Mu ICD 10, mutha kupeza maumboni angapo za matendawo:

Matenda opatsirana komanso oyambitsa matenda - code A00-B99 ICD 10,
matenda ena obwera ndi bakiteriya - code A30-A49 ICD 10,
matenda mabakiteriya omwe sanapatsidwe mutu uliwonse - code A48 ICD 10,
golini pandulu - code A48.0 ICD 10.

Zizindikiro

Kuzindikira kumatha kuchitika kokha ndi katswiri pofufuzira mwatsatanetsatane wodwala, komanso pamaziko a kufufuza koyenera, komwe kumaphatikizanso kuyesedwa kwa magazi, ma ultrasound a ziwiya, kufufuza kwa mitsempha, Doppler ultrasound, x-ray yamatumbo ndi mapazi, komanso kopanda zotsimikizira zam'mapazi.

Pakufufuza, kutentha kwa thupi, kukoka, kupsinjika ndi kupuma kumayesedwa. Kenako, werengani zotupa ndikuwonetsa kuchuluka kwa matendawa. Kuti mupeze tsatanetsatane wa vutoli, dokotalayo amatha kuchita opereshoni ndi kuchitira opaleshoni mabala.

Gawo loyamba la chithandizo ndi matenda a shuga m'magazi, monga zimadalira, kuphatikizapo zotsatirapo zonse zoyipa. Chithandizo cha ma ischemic ndi ma neuropathic madigiri ndi ofanana, chochita chawo chachikulu ndicholinga choika magazi mumiyendo mwadongosolo. Izi zitha kuchitika pogwiritsa ntchito njira yochizira kapena yopangira opareshoni.

Ndi njira yochizira, ma antibacterial othandizira ndi mankhwala amathandizidwa kuti athe kuchepetsa kutupa ndi kupititsa magazi. Pakupanga opaleshoni, zimatha kuyambiranso kuzungulira m'matumbo, popanda kudula khungu. Njirayi imagwira ntchito chifukwa cha kubooleza m'mitsempha kapena opaleshoni yam'mbali mwa mbali. Kwa odwala, amapanga regimen yopweteka kwambiri, zilonda zimathandizidwa mosamala ndi mankhwala a antiseptic.

Ndi digiri ya neuropathic, madokotala makamaka amayang'ana kubwereranso kwa miyendo, chifukwa izi nthawi zina amagwiritsa ntchito mankhwala omwe zochita zawo zimakonzanso kusintha kwa metabolic. Ndi chithandizo chamwadzidzidzi komanso mtundu wonyalanyaza wa matendawa, zotsatirapo zake zingakhale zachisoni, ndiye kuti madokotala ayenera kupanga chisankho pochepetsa mwendo.

Mkhalidwe wofunikira pakuchiritsa bwino ndiko kukana kwathunthu zizolowezi zoyipa, makamaka kusuta. Monga mukudziwa, chikonga chimasokoneza ma microvessels, ndi chifukwa cha ichi kuti mankhwalawa sagwira ntchito kapena amathandiza kwakanthawi kochepa.

Kwa wodwala yemwe ali ndi matenda a matenda a shuga, njira zochizira pagulu zingalimbikitsidwe ngati zowonjezereka, chifukwa chikagwiritsira ntchito mankhwalawa kwa nthawi yayitali zimatha kupereka zotsatira zabwino. Ubwino wina wogwiritsiridwa ntchito ndi kupatsa kwawo kofatsa, popanda tsankho.

Kuchiritsa phazi la anthu odwala matenda ashuga ndi mankhwala wowerengeka, monga lamulo, mankhwala osiyanasiyana achilengedwe amagwiritsidwa ntchito ngati malo osambira, lotions ndi compress. Zodzikongoletsera ndi ma infusions a zitsamba zamankhwala amagwiritsidwa ntchito kwambiri - chamomile, sage, eucalyptus, celandine. Mitengo yothira imapangidwa pamaziko azitsamba kapena njuchi, zomwe zimayikidwa pansi pa bandeji kwa mphindi zingapo mpaka maola angapo.

Zizindikiro

Zizindikiro zakunja za mkhalidwe wa zimakhala zimapereka kumvetsetsa koyamba kwa mtundu ndi mawonekedwe a chotupa. Zizindikiro zoyambirira zitha kudziwonetsa zokha chifukwa cha kufalikira kwa mitsempha ya m'magazi (kuchepa kwa mitsempha ya magazi). Acute arterial thrombosis imayambitsa kukula kwa gangrene mwachangu. Zizindikiro zopweteka zambiri zimafunika kuyankhidwa mwachangu.

Zonse zimayamba ndikuwoneka ngati malo owoneka bwino pamiyendo. Amakula, amasintha mtundu, amasintha kukhala amdima amdima, mpaka kukhala akuda.

Zizindikiro za mawonekedwe owuma:

malo okhala ndi minofu yakufa yakuda,
malire pakati pa mnofu ndi wakufa akuwonekera bwino,
Palibe kutentha ndi zizindikiro zina zakuwonongeka kwathupi kwamunthu.
Zizindikiro zowawa zimakhala ndi mphamvu zosiyanasiyana.

Zizindikiro za khungu louma lam m'munsi

Zizindikiro za mawonekedwe onyowa:

kuda khungu la zopindika m'dera lomwe lakhudzidwalo,
kusowa kwa malire otchulidwa pakati pa kachilombo koyambitsa matenda ndi matenda osafunikira: chakuda chimasandulika buluu,
kutupa
Kufupika pakhungu pakhungu,
kuchuluka kwa kutentha kwa thupi, kuwonongeka msanga kwa wodwala,
Kukula mwachangu kwa madera achitukuko.

Zizindikiro zotsatirazi zimanenedwanso:

Zizindikiro za dzanzi, kuchepa kwa chidwi,
kuchuluka kwambiri kwa khungu lakhudzidwa ndi khungu,
kutopa kwa mwendo poyenda,
kumverera kosalekeza kwa miyendo yachisanu, ngakhale chilimwe,
kukokana
Khungu lanu limakhala pakhungu losapola, lomwe ndi zizindikiro za kuyamba kwa zilonda zam'mimba.
Ululu womwe umamvekedwa koyambirira si wakuthwa kwambiri, motalikirana, kowonjezereka komanso kowopsa.

Matendawa ayenera kuthandizidwa. Zachidziwikire, sizidzatha: mabala sadzachiritsidwa, khungu silidzachira. Kusayankha (ndiko kuti, kusowa kwa chithandizo chokwanira) sikukukhala kokha ndi kuwonongeka kwa mkhalidwe wa wodwalayo, komanso ndizotsatira zoyipitsitsa. Dziwani kuti zipsera zomwe zimayambitsidwa ndimomwe zimayambitsa zimavuta kudziwa.

Kupewa matenda

Anthu omwe akudwala matenda a shuga amalangizidwa kuti aziyang'anira thanzi lawo nthawi zonse, kuyeza kuchuluka kwa shuga m'magazi awo, kugwiritsa ntchito mankhwala apamwamba okha omwe adutsa kufufuza ndi kuyesa konse.

Ndikofunikira kuvala nsapato zapamwamba zopangidwa ndi zida zapamwamba kwambiri. Mukamavala nsapato sikuyenera kuwoneka ma microcracks aliwonse, kuvulala.

Nsapato ziyeneranso kuloleza, kuti khungu lipume. Kapangidwe ka chafing ndi chimanga kuyenera kupewedwa mpaka pomwepo.

Ndikofunikanso kuyang'anira ukhondo wamapazi, mutha kugwiritsa ntchito mafuta okumbika komanso zopopera kuti muthandize kupewa thukuta kwambiri.

Tsiku lililonse, mosalephera, muyenera kusambitsa mapazi anu ndi sopo ochapira, kupewa bowa, abrasions ndi kuvulala kwina.

Zothandiza kupewa komanso zochizira

Akatswiri akuti ndizothandiza kwambiri kuchiritsa odwala matenda akhungu. Kutengera ndi kukula kwa dera lomwe lakhudzidwalo, gawo ndi mawonekedwe, mawonekedwe ochepa kapena makadinala okonzedwa a malo omwe adafa akhoza kuchitidwa.

Cardinal kudulidwatu kwa malo akufa achibereko

Ndizoyenera kunena kuti gangrene atha kupewedwa (ndiye kuti palibe chifukwa chochitira izo). Mwachitsanzo, pali matenda angapo, omwe kuphatikizika kwake kumatha kukhala ofewa minofu necrosis:

mtima ndi mtima,
opaleshoni yayikulu
chomvetsa chisoni ndi chatsoka,
endarteritis ndi ena

Ndiye, ndi chithandizo chiti chothandiza matendawa? Minofu yakufa singathe kukonza. Chifukwa chake, njira yokhayo yotsimikizika ndikuchotsa izi. Kuchiza kuyenera kuchitidwa mwachangu kuti matenda a necrosis asafalikire thupi lonse ndikugwira mbali zazikulu za miyendo.

Monga tafotokozera pamwambapa, mawonekedwe onyowa ndiowopsa kuposa owuma. Gawo loyamba ndikusintha necrosis kuchokera ku boma limodzi kupita ku lina. Zovala zakumwa zoledzeretsa zimayikidwa kwa wodwala pamadera omwe akhudzidwa. Ndipo kenako, opaleshoni, mnofu wopanda thanzi umadulidwa mzere wokhudzana ndi necrosis.

Zingachotsedwe? Kutengera mtundu wa mawonekedwe, kukula kwa dera lomwe lakhudzidwalo. Komabe, mankhwalawa amachitika m'njira yosungira minofu ndikubwezeretsanso magazi kumalo omwe akhudzidwa. Chithandizo cha mankhwalawa ndichizolowezi chochita opaleshoni ya mtima.

Nthawi zambiri amagwiritsidwa ntchito shunting, stenting, mtima prosthetics, thrombendarterectomy.

Njira izi zamankhwala zokhala ndi zotsutsana zingapo, makamaka, ntchito zotere sizikulimbikitsidwa kwa odwala omwe ali ndi ukalamba, komanso matenda oopsa a mtima.

Chofunikira pakugwiritsa ntchito: antibacterial, anti-kutupa, mankhwala a analgesic. Komanso chithandizo chofuna kukonza kukweza kwa miyendo.

Magawo oyambilira a chitukuko cha matenda a matenda ndiosavuta kuthana nawo.Izi zitha kutumizidwa:

physiotherapy
kumwa maantibayotiki
kugwiritsa ntchito njira zapadera zakunja,
Chitani masewera olimbitsa thupi
pneumopressotherapy.

Ndi matenda opita patsogolo ndikovuta. Sikoyenera kukhala ndi nthawi yopempha thandizo. Chifukwa chake, kudula ndi kulumala zitha kupewedwa. Komanso, musamachiza matenda a necrosis, kuti musayambitse njira zosasintha mu thupi lanu.

ICD phazi gangrene yolemba 10

Matendawa si chidziwitso chodziyimira pawokha, koma ndi chophatikizika cha njira iliyonse yamatenda.

Chifukwa cha mawonekedwe amtunduwu wa nosological syndrome, gangrene ya phazi malinga ndi ICD 10 ili ndi code yomwe imadalira etiological.

Njira yolumikizira khungu ndi gawo la minofu ya necrosis ya gawo lililonse la thupi, koma nthawi zambiri matenda amakhudzana ndi m'munsi, makamaka pamapazi.

Necrotic phenomena imayamba chifukwa cha kuperewera kwa okosijeni ku minofu kapena kuperewera kwa oxygenation. Choyamba, chilonda cha trophic chimakula mu tsamba la hypoxia, lomwe limayamba pang'onopang'ono kuti mumalize necrosis.

Imfa yamatumbo imatha kukhala youma kapena yonyowa, kutengera ndi ulaliki wamankhwala. Mtundu woyamba umadziwika ndi necrosis yopanda khungu komanso zigawo zakuya, popanda kumasulidwa kwa mafinya amadzimadzi. Wet gangrene imayamba pamene othandizira amalowa m'thupi la minofu youma ya necrotic, zomwe zimapangitsa kuti malo omwe akulira azikhala ndi mafinya.

Zowonjezera

Gangrene wa phazi ku ICD 10 umasungidwa kutengera kutengera thupi. Njira ya pathological imatha kukhala m'magulu osiyanasiyana komanso makalasi, chifukwa pali zifukwa zambiri zomwe zimayambitsa necrosis. Zosankha zotsatirazi za necrosis ya phazi zimatchulidwa:

I2 - atherosclerotic necrosis ya distal m'munsi malekezero,
E10-E14 - necrosis ya chala ndi phazi yoyambitsidwa ndi matenda a shuga, okhala ndi chizindikiro chachinayi,
I73 - zochitika za necrotic zosiyanasiyana za zotumphukira vasculature,
A0 ndiye gasi woopsa kwambiri wagasi,
L88 - poderma gangrens zachilengedwe,
R02 - necrosis ya zimakhala zamagawo am'munsi, osagawika m'magulu ena.

Kulekanitsidwa kumene kwa kusintha kwa phazi la necrotic kumachitika chifukwa cha njira zosiyanasiyana zodziwira matendawa komanso kupewa malo owopsa. Njira zochizira nthawi zonse zimakhala zofanana - necrosis ndi chosasinthika, chifukwa chake, minofu yakufa imachotsedwa modabwitsa, nthawi zambiri ndikudula phazi kapena ziwalo zake.

Njira Zopewera

The zosiyanasiyana etiologies a gangrene mu gulu la mayiko matenda amatengedwa ngati vuto limodzi lililonse matenda. Matendawa ndi osachiritsika ndipo amafuna njira zozama kupulumutsira moyo wa wodwalayo. Chifukwa chake, kusintha kwamagulu osokoneza bongo ndikosavuta kupewa potsatira mfundo izi:

chithandizo choyambirira cha opaleshoni yamavuto opaka,
kupezeka kwa matenda ashuga komanso kukonza munthawi yoyenera,
Chithandizo cha atherosulinosis ndi kulephera kwa mtima,
kudziwitsidwa koyambirira ndi chithandizo chamankhwala chamitundu yosiyanasiyana yamatsenga a mtima: thrombosis, embolism, kutupa ndi zina zambiri,
Chithandizo cha bakiteriya matenda a dermatological chikhalidwe.

Maonekedwe osintha ovuta kwambiri mwa wodwalayo akuwonetsa kusazindikira kwa wodwala (kunyalanyaza zizindikiritso, kudzichiritsa nokha, kulephera kutsatira malingaliro a dotolo) kapena kusasamala kwa dokotala yemwe walephera kubadwa kwa vuto la necrotic. Kutsatira mapuloteni ozindikira ndi kuchiza matenda omwe amabweretsa gangore, ndizotheka kupewa kukula kwa zovuta.

Sungani ulalo, kapena gawani zothandiza pagulu. maukonde

Zizindikiro ndi zizindikiro zokhudzana ndi kuzungulira komanso kupuma (R00-R09)

mtima arrhythmias munthawi yamavuto (P29.1)
arrhythmias (I47-I49)

Zapadera: zimachitika mu nthawi ya perinatal (P29.8)

zigawenga ndi:
- atherosulinosis (I70.2)
- shuga mellitus (E10-E14 wokhala ndi chikhalidwe chachinayi .5)
- matenda ena a zotumphukira zotumphukira (I73.-)
zigawenga zatsatanetsatane mwatsatanetsatane - onani Index
golidi wandala (A48.0)
pyoderma gangrenous (L88)

Ku Russia, International Classization of Diseases of the 10th revid (ICD-10) idalandiridwa ngati chikalata chokhacho choganizira zodandaula, zomwe zimayambitsa kupempha kwa anthu ku mabungwe azachipatala m'madipatimenti onse, komanso zoyambitsa kufa.

ICD-10 idayambitsidwa machitidwe azachipatala ku Russian Federation mu 1999 mothandizidwa ndi Unduna wa Zaumoyo ku Russia wa 05.27.97. Ayi. 170

Kusindikiza kwa kukonzanso kwatsopano (ICD-11) kukonzedwa ndi WHO mu 2017 2018.

Ndikusintha ndi zowonjezera za WHO.

Nambala yachiwiri ya matenda ashuga a mcb-10

Kuwerengera ndi kugawika kwa matenda, kuphatikizapo matenda ashuga, ndikofunikira kwambiri kwa asing'anga ndi asayansi omwe akufuna kuyimitsa miliri ndikupeza machiritso awo. Pachifukwa ichi, kunali kofunikira kukumbukira zonse zomwe zimapezeka ndi WHO (World Health Organisation) ndipo pazomwezi, IBC idapangidwa. Chikalatachi chimadziwika kuti ndi matenda padziko lonse lapansi, omwe amawerengedwa kuti ndiwo maziko a mayiko onse otukuka.

Kupanga mndandandandawu, anthu adafunafuna kuti azitha kupeza zidziwitso zonse zokhudzana ndi njira zingapo za malo amodzi m'malo amodzi kuti agwiritse ntchito manambala awa kuti apewe kusanthula mosavuta ndikuchiza matenda. Kunena za Russia, m'gawo lake bukuli lakhala likugwira ntchito nthawi zonse ndipo kuwunikanso kwa ICD 10 (komwe kukugwira ntchito) kuvomerezedwa ndi Unduna wa Zaumoyo ku Russia Federation mu 1999.

Ndemanga zaposachedwa

Ndikuyang'ana ku GANGRAIN YA MALO OGULITSIRA NDI DIABETES DIABETES ICD 10. LAMWILI! Mtundu wamagesi uli ndi nambala malinga ndi MKB-10 - A48.0, youma kapena yonyowa - R-02. Gangrene wa m'munsi kwambiri mu matenda a shuga ndi E10-E14, ndipo amapangidwa ndi atherosulinosis - I70.2.

ICD-10. Kugawidwa Kwa Matenda Padziko Lonse. . Gangrene, osatchulidwa kwina. Kupatula:

. atherosulinosis (I70.2). shuga mellitus (E10-E14 wokhala ndi chikhalidwe chofala chinayi .5). ena.

Kugawika Kwa Matenda ICD-10. . gang gangrene (A48.0) gangrene ya malo ena - onani malangizidwe a zilembo za Gangrene a:

• atherosulinosis (I70.2) • shuga mellitus (E10-E14 yokhala ndi wachinayi.

Matenda am'munsi kwambiri ndi necrosis (imfa) ya minofu. . shuga mellitus, matenda a Raynaud, matenda a kugwedezeka, etc. golide gangrene - code A48.0 ICD 10. Zizindikiro.

gang gangrene (A48.0) gangrene ya malo ena - onani malangizidwe a zilembo za Gangrene a:

- atherosulinosis (I70.2) - shuga mellitus (E10-E14 wokhala ndi chizindikiro chachinayi .5) - matenda ena amphumo a mtima (I73.

Madzi am'magawo am'munsi ndi mitsempha ya necrosis. Gangrene wa m'munsi malekezero a shuga

Matenda a shuga ICD 10 ndiwowopsa. Mavuto a shuga. Nthawi zambiri mavuto a shuga. Matenda a shuga - pathological mkhalidwe wa zimakhala zam'munsi malekezero.

ICD-10. Kodi zigawenga zimayamba bwanji?

ICD-10. . Matenda owuma nthawi zambiri amakhudza miyendo. Ndi iyo, kufalikira kwamitsempha yamagazi kumachitika pang'onopang'ono, kwa miyezi yambiri komanso zaka. . Matendawa amakula kwambiri odwala matenda a shuga.

matenda ashuga a m'munsi malekezero, gangrene a malowa. kusokoneza endarteritis, matenda a Raynaud, etc.), matenda opatsirana, matenda a shuga. . Kugawidwa Kwa Matenda Padziko Lonse (ICD-10)

Malo owuma nthawi zambiri samayenda, amangokhala gawo lamanja. . Gangrene m'gulu la ICD:

- Zizindikiro za R00-R09 Zizindikiro ndi zizindikiro zokhudzana ndi kufalikira kwa magazi ndi kupuma.

R02 - Gangrene, osatchulidwa kwina. Onaninso m'gulu. Kuzindikira sikuphatikiza:

• atherosulinosis (I70.2) • shuga mellitus (E10-E14 wokhala ndi chizindikiro chachinayi .5) • matenda ena.

Katswiri ofooketsa ziwengo za ziwiya za m'munsi mu ICD 10 .. Matenda owuma nthawi zambiri amakhala ndi matenda opatsirana a shuga.

Matenda a shuga sikukuchuluka kwa glucose wamagazi, komanso zovuta zina zosafunika zomwe zimachitika chifukwa cha zovuta za metabolic zomwe zimayamba ndi matendawa.

Phazi la matenda ashuga :: Zizindikiro, zoyambitsa, chithandizo ndi code malinga ndi ICD-10

Matenda a matenda ashuga

Mutu: Phazi la matenda ashuga.

Matenda a shuga. Kusintha kwatsatanetsatane komanso kachitidwe ka phazi mu phazi chifukwa cha kusokonezeka kwa metabolic kwa odwala omwe ali ndi matenda osokoneza bongo a mellitus.

Zizindikiro za phazi la matenda ashuga zimaphatikizira kupweteka m'miyendo, hyperkeratosis ndi ming'alu ya pakhungu, kusinthika kwa malekezero a distal, zolakwika zam'mimba komanso necrosis ya minofu yofewa, ovulala kwambiri, gangrene phazi kapena mwendo wotsika.

Kuzindikira matenda ashuga oyenda ndi matenda ashuga kumaphatikiza kuyesa kwakunja, kutsimikiza kwamalingaliro amitsempha yamagazi, kuchepa kwamitsempha yamagazi, kupenda kwamankhwala osokoneza bongo pazomwe zilonda zam'mimba. zotupa - njira za opaleshoni zimagwiritsidwa ntchito.

Mu endocrinology, matenda a diabetic phazi amadziwika ngati zovuta za microcirculatory ndi neurotrophic m'magawo am'malo am'munsi, zomwe zimayambitsa kukulitsa kwa ulcerative-necrotic process of the khungu ndi minofu yofewa.

Kusintha komwe kumakhala kofanana ndi phazi la matenda ashuga nthawi zambiri kumatha zaka 15-20 pambuyo pa matenda a shuga. Vutoli limapezeka mwa 10% ya odwala, enanso 40-50% ya odwala matenda a shuga ali pachiwopsezo.

Osachepera 90% ya odwala matenda amishuga amakhudzana ndi matenda a shuga 2.

Pakadali pano, bungwe losamalira odwala omwe ali ndi phokoso la matenda ashuga silabwino kwenikweni: pafupifupi theka la mankhwalawa, chithandizo chimayamba kumapeto, zomwe zimapangitsa kuti pakhale kudulidwa miyendo, kuvomerezeka kwa odwala, komanso kuwonjezeka kwa kufa.

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

Coronary syndrome kumachitika ndi kulimbikira edema, kusinthana claudication, kupweteka kwa mwendo, kutopa msanga kwa miyendo, khungu pigmentation. Neuropathic diabetesic phazi limayamba ndi kuwonongeka kwa dongosolo lamanjenje la distal malembedwe.

Zizindikiro za phazi la neuropathic khungu louma, hyperkeratosis, anhydrosis yokhala malekezero, kuchepa kwamitundu yosiyanasiyana yosiyanasiyana (kutentha, kupweteka, tactile), kusinthika kwa mafupa a phazi, phazi lathyathyathya, mafupa ozungulira. Ndi mawonekedwe osakanikirana a matenda ashuga, ischemic ndi neuropathic zinthu zimatchulidwanso chimodzimodzi.

Kutengera kuwonongeka kwa mawonetseredwe omwe ali ndi matenda a shuga matenda am'magazi, magawo amasiyanitsidwa:

Pali chiopsezo chachikulu chokhala ndi phazi la matenda ashuga - kupunduka kwa phazi, chimanga, matenda am'mimba, koma zilibe zilonda zam'mimba 1 - siteji yopanda zilonda zam'mimba, zokhazokha pakhungu lachiwiri - zilonda zakuya zophatikizana ndi khungu, mafuta ochepa, minofu yam'mimba, minyewa, koma popanda kuwonongeka kwa mafupa. 3 - siteji ya zilonda zamkati ndi kuwonongeka kwa mafupa 4 - siteji ya gangrene yochepa 5 - siteji yolimba kwambiri.

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 wekha, cholinga chomwe chizindikiritse nthawi yake zizindikiro za phazi la matenda ashuga: kusintha kwa khungu, mawonekedwe auma, kutupa ndi kupweteka, kupindika kwa zala, matenda a mafangasi, ndi zina zambiri. matenda ashuga, kuwunika miyendo ndikutanthauzira kalozera wam'mbuyo-brachial ndikuwunikira, kuwunika kwamtunda, kugwedezeka ndi kutentha kwa 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.

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. M'pofunikanso kuchotsa chimanga, chimanga, malo a hyperkeratosis kuzungulira chilonda kuti muchepetse katundu pamalo omwe akukhudzidwa. Systemic mankhwala oletsa matenda ashuga phokoso amachitika ndi mankhwala osiyanasiyana masakanizo antimicrobial kanthu. Monga gawo la mankhwala osokoneza bongo a matenda ashuga, makonzedwe a a-lipoic acid, antispasmodics (drotaverin, papaverine), ng'ombe ya seramu hemodialysate, ndi kulowetsedwa kwa mayankho.

Zilonda zozama za m'munsi zomwe sizingagwiritsidwe ntchito pochizira zimafunikira opaleshoni.

Mu mawonekedwe a ischemic phazi la matenda ashuga, endovascular dilatation ndi stenting ya zotumphukira mitsempha, thromboembolectomy, popliteal-footppass, arterialization of the veins veins, etc. amapangidwa. Autodermoplasty imachitidwa kutsekeka kwapulasitiki kotupa kwakukulu.

Malinga ndi zomwe zikuwonetsedwa, puritive foci yakuya imatsitsidwa (abscess, phlegmon). Ndi gangrene ndi osteomyelitis, pamakhala chiopsezo chodula / kutulutsa kwa zala kapena phazi.

Zofooka zoperewera mu phazi la anthu odwala matenda ashuga ndizovuta kuzikakamiza, zimafunikira chithandizo cha nthawi yayitali.

Ndi kukula kwa zilonda zam'mapazi, kudula kumafunika odwala 10-16%, omwe amathandizana ndi kulumala komanso kuwonjezeka kwa kufa chifukwa chodwala.

Vuto la phazi la matenda ashuga limapereka lingaliro lakukwaniritsa kusintha kwa matenda, chithandizo ndi kuyesedwa kwa odwala omwe ali ndi matenda a shuga.

Kupewa matenda ashuga a m'magazi kumaphatikiza kuyang'anira kuchuluka kwa shuga kunyumba, kuwunika pafupipafupi ndi katswiri wa matenda ashuga, kutsatira dongosolo lofunikira la zakudya komanso mankhwala.

M'pofunika kukana kuvala nsapato zolimba m'malo mwa ma insoles apadera ndi nsapato, kusamalira bwino mapazi, kuchita masewera olimbitsa thupi kumapazi komanso kupewa kuvulaza m'munsi.

Matenda am'munsi kwambiri: Zizindikiro ndi chithandizo

Gulu: Zovuta za pakhungu: 21410

Matenda am'munsi kwambiri ndi matenda oopsa, omwe nthawi zambiri amakhala ndi vuto losatsata. Pafupifupi aliyense 3 wodwala amafa chifukwa cha kuwonongeka kwa minofu ndi necrosis, ndipo aliyense 2 amakhala wolumala.

Pathology sindiye matenda oyima pawokha, koma nthawi zonse, mosasamala mtundu, amapangidwa motsutsana ndi maziko a matenda ena. Zomwe zimayambitsa zimatha kuphatikizira matenda a shuga, matenda a Raynaud, atherosulinosis ndi njira zina za pathological.

Chizindikiro cha gangore ndichowonekera komanso chofunikira, chomwe chimakakamiza anthu kuti afunefune thandizo munthawi yake. Zizindikiro zazikulu zimaphatikizaponso kufooka kwa miyendo, kumverera kwa "zikopa zazikulu" pakhungu, kutsekeka kwa khungu komanso kuzirala kwa dzanja.

Kuzindikira koyenera kumatha kuchitika pamaziko a kuyesedwa koyenera, kuyesedwa kwa labotale ndi kuyesedwa kochitachita. Kuphatikiza apo, kudziwikako kumakhala kosavuta chifukwa cha zisonyezo.

Chithandizo cha matendawa chimakhala chikuchita opareshoni nthawi zonse - kuchuluka kwa opaleshoni kumatha kusiyanasiyana ndikuchotsa minyewa yomwe ikukhudzidwa (ngati nkotheka kupulumutsa mwendo) kapena kuduladula miyendo.

The International Classization of Diseases of the Tenth Reviting of Mg Gangrene imasiyanitsa ma cipher angapo osiyanasiyana mwanjira yake. Mtundu wamagesi uli ndi nambala malinga ndi MKB-10 - A48.0, youma kapena yonyowa - R-02. Gangrene wa m'munsi kwambiri mu matenda a shuga ndi E10-E14, ndipo amapangidwa ndi atherosulinosis - I70.2.

Ngakhale kuti matenda oterewa tsopano amawawona kuti ndioperewera, zomwe zimayambitsa gangore ndizosiyanasiyana komanso zambiri. Zomwe zimayambitsa kwambiri ndi:

kuvulala kwakukulu kwa minyewa yolumikizira kapena cartilage,
kuyaka kwakuya
kukhudzana nthawi yayitali ndi kutentha pang'ono
kugwedezeka kwamphamvu kwamphamvu kapena munthu akumenyedwa ndi mphezi.
kukopa kwa mankhwala, mwachitsanzo, acid, alkali kapena zinthu zina zamtopola,
mabala olandila kwa mpeni kapena mfuti,
mapangidwe a zilonda zam'mimba, zomwe nthawi zambiri zimachitika chifukwa cha mitsempha ya varicose ya miyendo,
kuphwanya minofu kapena mafupa,
zironda
nthenda yamanjenje
kukulitsa kwa matenda opatsirana motsutsana ndi kumbuyo kwa chisonkhezero cha pathogenic kapena microflora ya pathogenic - izi zikuyenera kuphatikizira streptococci ndi enterococci, Staphylococcus aureus ndi Escherichia, komanso clostridia,
njira ya atherosulinosis kapena matenda ashuga,
Matenda a Raynaud
matenda a mtima dongosolo, makamaka mtima kulephera, mapangidwe magazi, ischemia kapena embolism,
kusokoneza endarteritis,
polyneuropathy
kuphwanya kwa chophukacho chapezeka pamalo opangira mafuta,
kugwiritsa ntchito bandeji yolimba, maulendo atali kapena njira zina zamankhwala zomwe zimapangitsa kuphatikizira kwamitsempha yamagazi,
kuwonongeka kwakatundu ziwiya zam'munsi.

Zinthu zotsatirazi ndizodziwikiratu zomwe zimawonjezera ngozi za khungu la miyendo:

kusinthasintha kwakuthwa m'thupi - kupindula kapena kuchepa kwake,
kupezeka kwa kuchepa kwa magazi m'mbiri ya matendawa,
matenda a endocrine system,
kusowa kwa mavitamini m'thupi la munthu,
Kulephera kwa chitetezo chamthupi
Njira zopatsirana matenda opatsirana,
matenda oopsa owopsa
kusala kudya kwanthawi yayitali
kagayidwe kachakudya
kuledzera kapena kufooka kwa thupi.

Mosasamala kanthu za chisonkhezero cha chimodzi kapena china chazovuta zam'magawo apansi, mulimonse, pali kuphwanya kayendedwe ka magazi.

Gulu

Kutengera ndi gawo lomwe mwendo wakhudzidwa, matendawa amagawidwa:

Matendawa akufalikira m'mbali zonse za mwendo,
gangrene wa phazi
zala zazala,
gangland wa msomali.

Kutengera ndi ukadaulo, pali:

ischemic gangrene
chakumwa choopsa
matenda opatsirana
chakumwa choopsa
zilonda zamkati
anaerobic gangrene,
chipatala chaching'ono chifukwa cha opareshoni.

Mitundu ya gangrene malinga ndi maphunziro:

youma - imapangidwa motsutsana ndi maziko azovuta za nthawi yayitali m'magazi aseptic, i.e., popanda matenda. Nthawi zambiri zimakhudza miyendo yonse. Ndikofunikira kudziwa kuti malo owuma am'malo ochepa sichiopseza moyo wa munthu - ngozi imangobwera ndi kachilombo,
mpweya - chimodzi mwazomwe zimachitika - kukhalapo kwa chilonda chakuya momwe ma tizilombo tosokoneza bongo tadutsamo ndikulakwika.
chonyowa gangrene nthawi zonse ndizosavomerezeka. Izi ndichifukwa choti njira ya pathological nthawi zonse imayendera limodzi ndi matenda.

Ndi zotupa za phazi, mtundu 1 ndi matenda 3 ndizofala kwambiri.

Dry gangrene ali ndi magawo otsatirawa:

kusokonezeka kwa magazi,
minofu necrosis
mapangidwe a khushoni yotupa,
mtembo
Kukhazikika kwa njira zosafunikira,
kudulira.

Madzi am'magawo am'munsi, pomwe amakula, amadutsa magawo otsatirawa:

kukhetsa kwadzidzidzi kwa magazi,
mofulumira minofu ya necrosis, nthawi zina imakwaniritsidwa,
kuwola kapena kuwonongeka kwa minofu yakufa,
kulowerera kwa poizoni m'magazi,
kusokonekera kwa magwiridwe antchito a ziwalo zambiri ndi machitidwe, mpaka kulephera kwamitundu yambiri.

Gawo la mapangidwe a phazi la matenda ashuga:

kuyabwa kwambiri
kuphwanya umphumphu wa khungu,
mawonekedwe a ischemic zone popanda kutupa,
Kulowa m'magazi,
kupezeka kwa foci ya necrosis,
zigawenga.

Zovuta zotheka

Milandu yakusowa kwa chithandizo chamankhwala am'miyendo, ngakhale mawonekedwe a matchulidwe, odwala ali pachiwopsezo chotenga zotsatirazi:

kulephera kwa ziwalo zingapo
kugwedezeka kapena kukomoka,
sepsis
kudula miyendo
kulemala

Kupewa komanso kudwala

Njira zapadera zothetsera kukula kwa gangrene ya zigawo zapansi sizinapangidwe. Komabe, kuti muchepetse matendawa, tifunika kutsatira malamulo amenewa pofuna kupewa ischemic gangrene ndi mitundu ina:

kupewa khungu kapena kutentha kwambiri kwa khungu la miyendo,
munthawi yake mankhwala a pathologies omwe amatha kuphatikizidwa ndi kuphwanya magazi ndi minofu necrosis,
kulimbitsa thupi
zakudya zopatsa thanzi
kupewa kumwa ndi kuledzera kwamthupi,
kugwiritsa ntchito zida zodzitetezera mukamagwiritsa ntchito mankhwala kapena zinthu zina zankhanza,
kupimidwa pafupipafupi ndi akatswiri oyenera - ndi kupezeka kwa matenda, mwachitsanzo, matenda ashuga.

Ngakhale kuti zachiwerewere zam'munsi zimawoneka ngati matenda osowa, nthawi zambiri zimakhala ndi vuto labwino. Kudulidwa kwa mwendo kumabweretsa kudwala kwa wodwala, ndipo kuwonjezera kwa zovuta kumapha.

Matenda okhala ndi zofananira:

Dysmenorrhea (zikufanana ndi izi: 4 mwa 20)

Dysmenorrhea ndimatenda amodzi omwe amadziwika ndi kupezeka kwa kupweteka kwambiri kwa mkazi mu nthawi ya kusamba ndi nthawi ya kusamba, pomwe mu nthawi yanthawi zonse mulibe kupweteka.

Kuphwanya kotere kumachitika nthawi zambiri, makamaka mwa azimayi achichepere azaka 20-25, komanso azimayi omwe ali ndi nthawi ya premenopausal. Dysmenorrhea samangopatsa mkazi mavuto, komanso limawonjezera moyo wake, popeza akakhala ndi ululu waukulu, mtima wa mayiyo umachepa, mphamvu yake yogwira ntchito imachepa, ndi zina zambiri.

Chifukwa chake, ndikofunikira kufunsa dokotala munthawi yake kuti mupeze zomwe zikuyambitsa ndikulandila chithandizo choyenera.

... Pelvioperitonitis (Zizindikiro zofananira: 3 mwa 20)

Kutupa kwa peritoneum ya pelvis m'thupi la mkazi kumatchedwa pelvioperitonitis. Matendawa amayambitsidwa ndi tizilombo toyambitsa matenda monga staphylococci, E. coli, gonococci, chlamydia ndi ma virus angapo. Nthawi zina, kuyambitsa matendawa kumapangika, komwe kumapangitsa kuti matendawa athe, komanso kulimbana nawo.

... Kutsekeka kwamkati (zofananira: 3 mwa 20)

Kutsekeka kwamkati ndi njira yovuta ya pathological, yomwe imadziwika ndi kuphwanya njira yotulutsa zinthu m'matumbo. Matenda ngati amenewa nthawi zambiri amakhudza anthu omwe amapanga masamba.

Kusiyanitsa pakati pamphamvu ndi makina osokoneza. Ngati zizindikiro zoyambirira za matendawa zapezeka, ndikofunikira kupita kwa dokotala wa opaleshoni. Ndi iye yekha omwe angadziwike molondola chithandizo.

Popanda chithandizo chanthawi yake, wodwala amatha kufa.

... Thrombosis (zofananira: 3 mwa 20)

Thrombosis ndimatenda omwe magazi amawundana (mapangidwe amitsempha yamagazi) amapanga mkati mwa mitsempha ya magazi yomwe imasokoneza kufalikira kwa magazi mu dongosolo lonse la magazi. Kutupa kwa mitsempha yamagazi ndimagazi kumayambitsa kukhumudwa kosavomerezeka m'manja kapena miyendo (kutengera komwe kuli magazi).

... Wambiri bwino: Zizindikiro: 3 mwa 20)

Matendawa, omwe amapezeka nthawi zambiri, amatupa komanso obwera chifukwa cha kusefukira kwa thupi, amatchedwa tuburulous pleurisy. Matendawa ali ndi chidziwitso chowonekera kudzera pakulimbana ndi ma virus a chifuwa chachikulu. Khunyu nthawi zambiri imachitika ngati munthu ali ndi chifuwa chachikulu cha m'mapapo.

Kodi ma code ndi ati?

Gulu la matenda padziko lonse lapansi limapangidwa kuti lipangitse kuti ntchito yosinthira akatswiri azindikire matenda ndi nthawi yochizira. Anthu wamba safunikira kudziwa ma ICD, koma kuti chitukuko chambiri chidziwitsochi chisapweteke, chifukwa ngati sizotheka kukaonana ndi dokotala, ndibwino kugwiritsa ntchito chidziwitso chovomerezeka chambiri.

Zizindikiro, Zizindikiro ndi matenda a matenda ashuga

Matenda a shuga ndi limodzi mwa matenda opatsirana, omwe amakhalapo ndi zovuta zingapo. Chowopsa kwambiri ndi phazi la matenda ashuga, zimakhudza ulusi wamitsempha, mitsempha yamagazi, mafupa, komanso khungu.

Kuopsa kwa matendawa kumawonjezeka ndi kuwonongeka kwa nthawi yayitali kwa matenda ashuga komanso chidziwitso cha matendawa kwa zaka 5. Kuzindikira koyambirira kumatha kuyimitsa kukula kwa zovuta, ndipo pakakhala kuti palibe njira zakuchiritsira kwakanthawi, mwayi wothandizidwa ndi opaleshoni ukuwonjezeka.

Zomwe zimayambitsa matendawa

Matenda a shuga a shuga ali ndi ICD code ya 10 - E10.5 kapena E11.5, yomwe imatanthauzira mtundu 1 kapena mtundu wa 2 wodwala.

Kupanikizika kumatanthauza kusintha komwe kumakhudza dongosolo lamanjenje ndi lamanjenje.

Chifukwa cha zovuta zotere, zilonda zam'mimba zimatha kupanga thupi ndipo khungu limakula.

Zilonda za trophic - zimapezeka 85% ya milandu,
phlegmon
zotupa
tenosynovitis,
osteomyelitis
matenda a shuga
nyamakazi yamatsenga.

Tizilombo toyambitsa matenda tosokoneza bongo ndi kusakwanira kwa kupanga kwa insulini komwe kumafunikira kuti magazi asungunuke.

Zotsatira zake, mulingo wa glycemia umakwera, osasokoneza kayendedwe ka magazi ndi mphamvu yamitsempha yama mitsempha. Chithunzichi chikuwonetsa momwe zovuta zikuwonekera mu gawo lotsogola.

Neuropathic - dongosolo lamanjenje limakhudzidwa. Fomuyi imadziwika ndi mapangidwe achilonda, cholowa cha a Charcot kapena kuwoneka ngati wotuwa.
Ischemic - limachitika chifukwa cha atherosulinosis, yomwe imakhudza mitsempha ya miyendo ndikuwonetsa kutuluka kwa magazi mkati mwake.
Zosakanizidwa - amaphatikiza kuwonongeka kwa ulusi wamitsempha ndi mitsempha yamagazi.

kuchepa kapena kuchepa kwa chidwi m'mphepete chifukwa cha neuropathy ndi matenda a shuga,
zovuta zamagazi zomwe zimakhudza ma capillaries ndi mitsempha (angiopathy),
atherosulinosis - nthendayi imakonda kupezeka motsutsana ndi maziko a cholesterol yowonjezereka m'magazi,
Kusintha kwa mapazi,
khungu lowuma
kuvala nsapato zolimba, komanso nkhawa zilizonse zomwe zimapangitsa khungu kuwonongeka.
matenda oyamba ndi fungus
kusasamala kwa dokotala panthawi ya opaleshoni yochotsa msomali wovomerezeka.

Kuopsa kwa zovuta kukufotokozedwa chifukwa chakuti odwala kwa nthawi yayitali sazindikira kukhalapo kwa mapazi a chimanga, ming'alu, abrasions pakhungu, omwe pambuyo pake amasintha kukhala zilonda zotseguka kapena zotsekeka.

Zizindikiro zake

Syndrome limadutsa 5 magawo a chitukuko chake:

Zilonda zapamwamba zimapezeka yodziwika ndi zotupa za zigawo zapamwamba za khungu.
Pali chilonda chachikulu, koma popanda kuwonongeka kwa mafupa.
Zilonda zakuya kwambiri zimawonekera, limodzi ndi zotupa za fupa, komanso minofu yofewa yomwe ili kuzungulira.
"Phazi la Charcot" limapangidwa, limadziwika ndi maonekedwe ovuta m'malo ena (mwachitsanzo, chala).
Mimba yambiri imapangidwa, yomwe imatha kubweretsa zotsatira zakupha ndikupanga kuti manja ake azidulidwa pomwepo.

Zomwe zikuwonetsa matendawa ndi monga:

pang'ono kapena kutaya kwathunthu kwa zomverera, zomwe zimafotokozedwa popanda kuchitapo kanthu kugwedezeka, kenako kusintha kwa kutentha, kenako kupweteka ndi kukhudza,
kutupa
kutopa m'miyendo mukuyenda,
kumva kupweteka m'mwendo wapansi, womwe umadziwonetsera pakupuma, kuyenda, komanso usiku,
kumva kulira
kuyaka m'mapazi
kudzisunga
Kusintha kwa khungu (mawonekedwe ofiira kapena ofiira a kiyidi),
kuchepa kwa gawo la tsitsi pamiyendo,
kusintha kwa maonekedwe kapena mawonekedwe ambale ya misomali,
nthawi yayitali yochiritsa,
kuwoneka kwa mikwingwirima pansi pa misomali, kuwonetsa kukula kwa matenda oyamba ndi fungus ndi chiopsezo cha necrosis,
kapangidwe ka zilonda kumapazi.

Kuti mupeze zambiri mwazizindikirozi, muyenera kuyang'ana miyendo mothandizidwa ndi kalilore woyikidwa pansipa. Mukamayesedwa, ndikofunikira kuyang'ana malo osiyanasiyana, okhawo ndi chidendene.

Mapazi a Charcot (diabetesic osteoarthropathy)

Njira zowonongeka m'malire, ndikupita patsogolo miyezi ingapo, zimathandizira kuti phazi lisasinthe. Vutoli limatchedwa cholumikizira Charcot. Kusintha kwachilengedwe komwe kumakhala ndi izi nthawi zambiri kumakhudza miyendo, komanso manja.

Zotsatira zake, odwala matenda ashuga samva kuwonetsedwa kwa ululu panthawi yamafinya, yomwe imakulitsa mkhalidwe wake. Pang'onopang'ono, zovuta za neuropathic zimachitika m'mapazi, limodzi ndi mapangidwe azilonda.

mafupa am'mimba - amadziwika ndi kuwonda kwa fupa, kuchepa kwa mphamvu yake,
osteolysis - mkhalidwe womwe fupa limatengekeratu.
hyperostosis - limodzi ndi kuchuluka kwa kotakata wosanjikiza fupa.

"Charcot cholumikizira" omwe adatsatiridwa ayenera kumasulidwa momwe angathere pamitolo kuti minofu ya mafupa ichiritse mofulumira. Odwala amalangizidwa kuti azivala nsapato zamankhwala zokha zamankhwala zotere.

Matenda a matenda ashuga

Kutumiza kwa wodwalayo panthawi yovomerezeka kumadera omwe akukhudzidwa ndi zilonda zamatenda am'mimba kumapangitsa kuyimitsidwa kwa chiwonetsero cha phazi la matenda ashuga ndikusintha momwe alili.

Kugwiritsa ntchito mankhwalawa kumagwira ntchito pokhapokha pakukula kwa zovuta. Chithandizo cha matendawa chimachitika kale opaleshoni.

Kodi zilonda zimathandizidwa bwanji?

Chithandizo cha zovuta ziyenera kukhala zokwanira. Njira zochizira zilonda zam'mimba zimatengera momwe magazi akuyenda mchiwendo.

Chithandizo cha magazi othamanga

chilonda ndi zilonda zam'mimba,
katundu wochepetsedwa pa nthambi,
kuthetsa matenda pogwiritsa ntchito antibacterial mankhwala,
glycemic control ochitikira kunyumba,
kupatula mowa, komanso kusuta.
mankhwalawa a concomitant pathologies omwe amalimbikitsa chiopsezo chodulidwa mwendo (matenda a chiwindi, oncology, kuchepa magazi).

Ndi magazi osayenda bwino, kuphatikiza pazomwe zili pamwambapa, njira zimatengedwa kuti zibwezeretsedwe.

Chithandizo cha zopangidwa minofu necrosis ndi zilonda zam'mimba zimaphatikizapo:

othandizira opaleshoni
kudzicheka ngati palibe zotsatira zochizira.

Ndikofunikira kumvetsetsa kuti kudula miyendo kumawerengedwa kuti kumawerengedwa ngati gawo lovuta ndipo kumachitika mwa odwala omwe ali ndi vuto lalikulu.

Mankhwala

Mankhwala otsatirawa amatha kuperekedwa kwa odwala omwe awonetsa mawonetsedwe a matenda:

Mankhwala okhala ndi alpha lipoic acid (Thiogamma, Thioctacid, Berlition "). Zigawo zogwira ntchito za mankhwalawa zimathandizira pakuchotsa ma radicals omwe alipo kale, kubwezeretsa magazi, komanso kusangalatsa kwa ulusi wamitsempha.
Mavitamini a gulu B (Milgamma, Neuromultivit). Zithandizo zimapangira kuchuluka kwa zinthuzi zomwe zimafooka motsutsana ndi matendawo.
Mankhwala omwe amagwiritsidwa ntchito pochiza matenda. Kugwiritsa ntchito ma analgesics ochiritsira kapena mankhwala othana ndi kutupa kumatha kugwira ntchito pokhapokha kuwonekera kwa matendawa, chifukwa mtsogolomo, odwala amachepetsa mphamvu zawo ndipo palibe kumva kuwawa.
Mankhwala a anticonvulsant, antidepressants. Kugwiritsa ntchito kwawo kumatheka pokhapokha glaucoma ikadwala. Kupanda kutero, chithandizo chamankhwala chimakhudza kwambiri intraocular anzawo.
Njira zomwe zimathandizira kubwezeretsanso minyewa kumadera a zilonda (Eberprot-P). Kuthira mankhwala oterowo kumawonjezera mwayi wowachiritsa mabala omwe atuluka ndikuthandizira wodwalayo popanda kudulidwa.
ACE zoletsa. Amakulolani kuti muchepetse kuthamanga kwa magazi.
Otsutsa a calcium. Kumwa mankhwala ndikofunikira kubwezeretsa kuchuluka kwa chinthuchi mthupi.
Liazide diuretics zotchulidwa matenda oopsa.
Mankhwala ochepetsa mafuta a cholesterol.
Ma antiplatelet. Kukonzekera komwe kumakhala ndi acetylsalicylic acid kumachepetsa mwayi wokhala matenda osokoneza bongo.
Mankhwala osokoneza bongo. Amathandizira kukonza kufalikira kwa magazi mu ischemic zone.

Kuchiza ndi zomwe zalembedwazo kumachepetsa kupitilira kwa matenda, kumachepetsa zizindikiro.

Njira zopangira opaleshoni

Zochita za opaleshoni zomwe zimagwiritsidwa ntchito kwa odwala omwe ali ndi matenda ashuga akuphatikiza njira izi:

opaleshoni ya bypass - yokonzedwa kuti ipange njira yodutsa mitsempha yamagazi,
sympathectomy - opaleshoni yochotsa gawo lina lumbar ganglia,
Balloon angioplasty - amathandiza kubwezeretsa lumen yam'mimba,
kudula - kuchotsa zimakhala ndi moyandikana ndi mafupa am'mimba omwe ataya kugwira ntchito.

Njira zopangira opaleshoni zimagwiritsidwa ntchito pokhapokha ngati mankhwala osokoneza bongo samapereka mphamvu yofunikira.

Kuteteza matenda

Ndikofunika kumvetsetsa kuti kupewa zovuta ndizosavuta kuposa kuyesa kuwachiritsa. Njira zopewera zimakhazikitsidwa potsatira malamulo amasamaliro a nsapato za tsiku ndi tsiku komanso malingaliro a nsapato.

Kusamalira miyendo kumaphatikizapo kutsatira malingaliro ena.

Izi zikuphatikiza:

kupita kwa dokotala ngati kuwonongeka kwa phazi kwakapezeka,
kutsuka kwamapazi tsiku ndi tsiku
kuyang'anitsitsa miyendo ndi kalilore kuti muwone kuvulaza komwe kungachitike,
kuwongolera kutentha kwa phazi
tsiku lililonse masokosi ndi masheya,
kupewa kuvulala kwamiyendo
kulondola kwa pedicure,
kugwiritsa ntchito kirimu kuchotsa miyendo yowuma.

Zolemba kanema zamomwe mungatetezere miyendo yanu mu shuga:

Anthu omwe ali ndi mtundu wina uliwonse wa matenda ashuga ayenera kukhala ndi udindo wokhudza nsapato zawo. Chachikulu ndichakuti ayenera kukhala omasuka, omasuka komanso kukhala bwino pamiyendo yake. Kukhalapo kwa kupindika kwa phazi kumafunika kuvala nsapato zamadzimadzi.

Ndikofunikira kumvetsetsa kuti kutenga nawo gawo kwodwala pakuchotsa zizindikiro za phazi la matenda ashuga kumawonjezera mwayi wochira msanga.