Zilonda za trophic - kuwonongeka pakhungu ndi zopangidwe zozama mwanjira ya mabala amachiritso a nthawi yayitali. Zolakwika zotere zimachitika chifukwa chophwanya magazi mu gawo linalake la thupi. Makonda okhudzidwa a trophic ulcers - zala, zidendene, m'munsi miyendo. A chimodzimodzi matenda a shuga mellitus, imawerengedwa ngati kuchuluka ndi mawonekedwe a matenda ashuga phokoso.
Chithandizo cha zilonda zam'mimba mu shuga imawonedwa ngati njira yayitali yomwe imaphatikiza njira zingapo. Chithandizo cha zovuta chikuyenera kuchitika modabwitsa, popeza ndi zolakwika zina zomwe zimayambitsa kudukidwa kwapadera.
Mfundo zachithandizo
Kuti chithandizo cha zilonda zam'mimba mu shuga chikhale bwino, muyenera kutsatira njira zotsatirazi:
- chithandizo chokwanira m'deralo;
- Kutula miyendo yam'munsi;
- Kupha microflora ya bakiteriya;
- kubwezera zomwe zayambitsa matenda;
- mpumulo wa puffuff;
- kuzindikiritsa komanso kuchiza kwa ma concomitant pathologies omwe salola kuti kuchiritsidwa kuchitika mokwanira (kuchepa kwa magazi, chiwindi, matenda a impso).
Kuphatikiza pa magawo awa, kusokonekera kwa ischemic trophic kumafuna kusinthanso (kubwezeretsa kayendedwe ka magazi mu nthambi yomwe yakhudzidwa), chifukwa ndiye kutsekeka kwa lumen kwa ziwiya zomwe zimatsogolera pakupanga kwawo.
Kusankhidwa kwa njira zamankhwala ndikofunikira kwa dokotala
Ngati mabala amasokonezeka ndi njira zazikulu za purulent, chithandizo chamankhwala opangira opaleshoni ndikutulutsa thupi la wodwalayo chimafunika.
Chithandizo cha zilonda zapakhungu
Chithandizo cha zilonda zam'mimba za trophic mu shuga zimaphatikizapo zochitika wamba komanso zam'deralo. Mankhwala am'deralo amatengera njira izi:
- necrectomy (kuchotsa madera akufa) ndi mawonekedwe a chimanga;
- kutsuka mabala ndi njira zamafuta;
- kugwiritsa ntchito kavalidwe.
Khalid
Minofu yakufa imawoneka ngati malo abwino mabakiteriya. Kuphatikiza apo, amalepheretsa kutuluka kwamadzi kuchokera pachilonda pamtunda ndikupanga minofu yatsopano kuti ichiritse. Chifukwa chake, ndikofunikira kuchotsa gawo la necrosis kuti likhale lokwanira.
Kusuntha kumatha kuchitika pogwiritsa ntchito scalpel ndi lumo, pamakina, pogwiritsa ntchito zida zapadera zomwe zimatulutsa timadzi ta madzi, pogwiritsa ntchito njira ya mankhwala, pogwiritsa ntchito ma enzymes a protein. Njira ina - adokotala amayika chovala chonyowa kuthandiza minofu yakufa kuti ichoke.
Kuchotsa zigawo za necrosis zokhala ndi scalpel ndi lumo ndiyo njira yofala kwambiri, komabe, sigwiritsidwa ntchito ngati pansi pa chilondacho chikuyimiriridwa ndi articular kumtunda kapena ngati vuto la trophic ndi ischemic. Pochita opaleshoni, supuni ya Volkman imagwiritsidwa ntchito - chida chofanana ndi supuni yokhala ndi malo ochepa. Zimakuthandizani kuti muchotse bwino zidutswa zakufa popanda kuwononga zotengera.
Necrectomy ndi gawo lofunikira pochiza matenda otupa
Zofunika! Zilonda zam'miyendo pamiyendo ziyenera kupendedwa ndi vuto la batani, chifukwa chilema chosawoneka bwino chimatha kukhala ndi ngalande yakuya kwambiri.
Nthawi yomweyo, chimanga chomwe chimapangidwa m'mphepete mwa chilondacho chimachotsedwa. Izi zimakuthandizani kuti muchepetse kupanikizika pachilonda palokha ndikuwongolera kutuluka kwake. Pali nthawi zina zomwe zimafunikira kuchotsa mbale ya msomali. Izi zimachitika ngati zilonda zili pang'ono pabedi la msomali kapena pamwamba pa chala.
Chithandizo chowawa
Gawo ili la chithandizo cha zilonda zam'mimba za m'mimba mwa shuga zimachitika kuti muchepetse kuchuluka kwa tizilombo toyambitsa matenda pamwamba pa malo okhudzidwawa. Pali zida zingapo zomwe zimagwiritsidwa ntchito pakusamba, komabe, zatsimikiziridwa kuti kugwiritsa ntchito syringe ndi singano sikuwonetsa zotsatira zoyipa.
Osagwiritsa ntchito pakusamba zolakwika:
Matenda a shuga a m'munsi am'munsi- potaziyamu permanganate yankho;
- ayodini;
- wobiriwira wonyezimira;
- rivanol;
- zakumwa zoledzeretsa zamankhwala.
3% yankho la hydrogen peroxide imagwiritsidwa ntchito munthawi ya kuyeretsa bala kuchokera ku mafinya ndi magazi. Amaloledwa kutsuka zilonda zam'madzi zamchere za sodium chloride, Miramistin, Chlorhexidine, Dioxidin. Kunyumba, mutha kugwiritsa ntchito utsi wa Acerbin.
Kuvala
Zomwe amagwiritsidwa ntchito kuvala ziyenera kukhala ndi izi:
- atraumatic;
- kuthekera kokhalitsa malo achinyezi (zimatsimikiziridwa kuti m'malo otere kuchiritsa kwa zilonda zam'mapazi m'miyendo ndimatenda a shuga kumathandizira kwambiri);
- kuthekera kotenga zomwe zili m'mabala;
- zotchinga zoteteza (kuteteza mabakiteriya);
- kusowa kwa zopinga kuyenda kwa mpweya wabwino kwa zimakhala.
Mavalidwe a Alginate - chovala chamakono chomwe chimagwiritsidwa ntchito polimbana ndi mabala a trophic
Maso oyenera kuvala ndi osayenera, chifukwa amatha kupukuta pachilonda ndikuphwanya umphumphu wa granulations mukachotsedwa. Itha kugwiritsidwa ntchito ngati fistulas, yokhala ndi necrosis kapena zilonda zam'mimba kwambiri.
Njira zamakono zamankhwala zimagwiritsa ntchito kuvala ma mesh, alginate, ma hydrogels, masiponji a polyurethane, ulusi wa hydrophilic, etc.
Zothandizira
Zinthu zomwe zaperekedwa zimawonetsa kuyendera limodzi ndi zovala zamakono.
- Mankhwala ochepetsa mphamvu ya chifuwa - Argosulfan, Dermazan, Betadine.
- Zowonjezera mphamvu - Bekaplermin, Curiosin, Ebermin.
- Ma protein a Proteolytic - Iruksol, Chymotrypsin.
Mafuta amagwiritsidwa ntchito pazopopera madzi (Levomekol, Dioxizol) ndi mafuta-based (Solcoseryl, Actovegin).
Kutula miyendo yakumunsi
Gawo lina lofunika pochotsa chilema. Mankhwala omwe agwiritsidwa ntchito, chilonda cha trophic sichichira mpaka wodwalayo atapinda mwendo. Kutulutsa kokwanira ndi kiyi ya zotsatira zabwino za matenda.
Ngati bala lili pachilonda chakumunsi kapena kumbuyo kwa phazi, zida zina zowonjezera sizofunikira. Chokhacho ndichofunikira pakusowa kwa chilonda ndi nsapato. Ngati zilonda zili pachidendene kapena kumbali ya phazi, zida zapadera ndizofunikira. Pakadali pano, chovala chosavomerezeka chomwe chimapangidwa ndi zinthu za polymeric chimagwiritsidwa ntchito. Amayikidwa pamapazi ndi mwendo wotsika. Amawonetsedwa ngati mawonekedwe a buti, omwe amatha kuchotsa kapena osachotsa (monga adalimbikitsa dokotala). Njirayi ndi yabwino chifukwa imakuthandizani kuti muziyenda mumsewu, ntchito, kuchotsa katundu pagawo lomwe lakhudzidwa.
Kutula nsapato za theka - njira imodzi yochotsera katundu pamalo omwe akhudzidwa
Kutumiza kumachitika chifukwa cha njira zingapo:
- pafupifupi 35% ya katunduyo imasamutsidwa kuchokera kuphazi kupita kumunsi;
- kukula kwa kupanikizika kumagawidwa chimodzimodzi;
- chilondacho chimatetezedwa pakukangana;
- kutupa kwa dzanja lakhudzidwa kumachepa.
Zotsutsana pakugwiritsa ntchito boot ya polymer:
- Mtheradi - yogwira pur purosesa-necrotic ndi chitukuko cha sepsis kapena gangore.
- Wachibale - kuphwanya kwakukulu magazi, magazi akuya pang'ono komanso m'mimba mwake, chinyezi chofunikira pakhungu pamalo omwe amagwiritsidwa ntchito, kuwopa kugwiritsa ntchito chipangizo cha polima.
Kugwiritsa ntchito ndodo, nsapato zamadzimadzi, njira yochepetsera kuyenda kunyumba, kapangidwe ka "zenera" la chilonda mu insole ndi njira zosavomerezeka pochiza zilonda zam'mimba.
Kuyang'anira matenda
Kugwiritsa ntchito antiseptics kwawoko kuwononga tizilombo toyambitsa matenda sikunatsimikizire kugwira kwake, zomwe zikutanthauza kuti njira yokhayo ndikugwiritsa ntchito mankhwala antibacterial. Othandizira awa amawonetsedwa osati pokhapokha chilema chikuwonekera kale, komanso pokhapokha ngati pali chiwopsezo chokukula kwa bakiteriya (necrosis of ischemic minofu, kukula kwakukulu kwa zilonda, bala lalitali).
Mankhwala a antibacterial - njira yolimbana ndi matenda
Ambiri causative wothandizila matenda bala:
- staphylococci;
- streptococci;
- Proteus;
- E. coli;
- enterobacteria;
- Klebsiella;
- pseudomonad.
Kukhazikitsidwa kwa maantibayotiki kumachitika pambuyo pa nkhani yokhudza bakseva pachilonda ndikutsimikiza mtima kwa pathogen. Zothandiza kwambiri ndizo penicillin, fluoroquinolones, cephalosporins, lincosamides, carbapenems.
Mitundu ikuluikulu ya matenda amafunika kukhazikika kwa maantibayotiki pakakhazikika. Mofananamo, ngalande za opaleshoni zam'madzi, detoxification therapy, ndi matenda othandizira a shuga zimachitika. Njira ya mankhwala ndi milungu iwiri. Magawo ochepera a matendawa amalola kuti mankhwalawa amwe mankhwala pakamwa. Maphunzirowa ali mpaka masiku 30.
Kulipira shuga
Gawo lina lofunikira, popanda iwo madokotala sangathe kuchiritsa zilonda zam'mimba. Endocrinologist ikugwira ntchito yokonza chithandizo cha matenda oyambitsidwa. Ndikofunika kusungitsa kuchuluka kwa shuga m'magazi osati kupitirira 6 mmol / L. Kunyumba, kuwongolera kuzisonyezo kumachitika mothandizidwa ndi glucometer. Ndi matenda amtundu wa 1, zotsatira zake zimalembedwa maola atatu aliwonse, ndi mtundu 2 - 1-2 kawiri pa tsiku.
Kuti mukwaniritse chipukutira, mankhwala a insulin kapena mankhwala ochepetsa shuga amagwiritsidwa ntchito. Ma insulin amafupika - kuti muchepetse msanga shuga komanso mankhwala a nthawi yayitali (kutumikiridwa 1-2 pa tsiku, kusungabe nthawi zonse tsiku lonse).
Kuwongolera glycemic tsiku ndi tsiku ndi gawo lofunikira pokwaniritsa chiphuphu cha "matenda okoma"
Kubwezeretsa kwa magazi
Pali njira zamankhwala komanso za opaleshoni zomwe cholinga chake ndikukonzanso magazi ku malo omwe akhudzidwa. Mankhwala onse omwe amagwiritsidwa ntchito amagawika m'magulu akulu awiri:
- osakhala ma prostanoids;
- ma prostanoids.
Gulu loyamba limaphatikizira Pentoxifylline, Ginkgo biloba, kukonzekera asidi wa nicotinic, owonda magazi, Heparin, Reopoliglyukin. Gulu lachiwiri ndilothandiza kwambiri. Owayimira ndi Vazaprostan, Alprostan.
Mwa njira zopangira opaleshoni yobwezeretsa kutuluka kwa magazi, balloon angioplasty imagwiritsidwa ntchito kwambiri. Iyi ndi njira "yopukutira" chotengera chomwe chikukhudzidwa kuti chidziwike. Pofuna kuwonjezera mphamvu ya kuchitapo opaleshoni, stent imayikiridwa mchombo ichi - chipangizo chomwe chimapangitsa kuti mitsempha isamatalikirane.
Kukhazikika kwa stent - njira yotsitsimuka ya miyendo
Njira ina ndikuchita opaleshoni yodutsa. Angiosurgeons amapanga ma magazi a magazi kuchokera ku zinthu zopangira kapena ziwiya za wodwalayo. Njirayi ikuwonetsa zotsatira zomaliza.
Ngati matenda a necrosis ofala atasinthanso, opaleshoni pamiyendo ingathe kuchitidwa:
- kudulira pang'ono pang'ono;
- khalidal
- sutting wa bala kapena pulasitiki.
Menyani ndi zowawa
Kuchotsa ululu sikofunikira chimodzimodzi kuposa pamwambapa. Mankhwala otsatirawa amadziwika kuti ndi othandizira:
- Ibuprofen;
- Ketanov;
- Ketorol;
- Solpadein;
- Phenazepam.
Kugwiritsa ntchito nthawi yayitali kwa NSAIDs koletsedwa chifukwa chakuwopsa kwa magazi m'mimba. Kutsatsa kwa metamizole (Baralgin, Tempalgin) kumatha kupangitsa agranulocytosis.
Chithandizo cha anthu odwala matenda ashuga ndi mankhwala wowerengeka chimagwiritsidwanso ntchito kwambiri, komabe, ziyenera kukumbukiridwa kuti mankhwala omwe mumadziletsa ndi oletsedwa. Izi zitha kukulitsa vutoli. Kugwirizana ndi upangiri wothandizira akatswiri ndikofunikira kuti izi zitheke.
