Futuyma Yurii A B C D E F B C E F B C D E F, Kulbaba Ihor, Kritsak Myroslav, Konowalenko Siergiej
I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine: Department of Surgery No.1, Urology, Minimally Invasive Surgery and Neurosurgery.
I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine: Department of Surgery.
Pol Merkur Lekarski. 2022 Dec 22;50(300):370-373.
Currently, there is no reliable and ideal criterion for assessing the level of tissue viability in critical limb ischemia in patients with diabetic foot syndrome, which does not allow the selection of patients for revascularization.
The aim is to investigate the microcirculation of the lower extremities before and after balloon angioplasty and to develop an algorithm for its implementation depending on the characteristics of purulent-necrotic complications.
The study was performed in 67 patients with neuroischemic form of diabetic foot syndrome. 3 groups of research were created: the first group included 18 patients with dry gangrene of one toe, several toes or distal foot; in group II - 35 patients with wet gangrene with signs of purulent arthropathy of the toes, phlegmon of the foot and with chronic wounds on the feet and legs; Group 3 - 14 patients diagnosed with purulent-necrotic complications, which were observed in both the 1st and 2nd groups, where patients refused to perform balloon angioplasty. Such patients underwent conservative treatment of lower extremity ischemia.
It was shown that all patients have low levels of TcpO2- less than 30 mm Hg. The change in the value of TcpO2 during treatment turned out to be interesting: Group I indicator before revascularization was - 15.0±1.31 mm Hg, after the restoration of blood flow for 5- 7 days - 35.53±2.92 mm Hg. after 6 months - 36.67±2.35 mm Hg; Group II before revascularization - 10.35±0.74 mm Hg, for 5-7 days - 25.06±1.13 mm Hg, after 6 months - 34.43±1.97 III group at admission to the hospital - 12.14±0.86 mm Hg, for 5-7 days - 17.14±0.9 mm Hg, after 6 months - 13.71±2.2 mm Hg.
After revascularization, there is a reperfusion syndrome, the severity of which depends on the number of revascularized vessels of the lower extremity. Balloon angioplasty is one of the priority methods of surgical treatment of limb ischemia with lesions of the shin-foot segment.
目前，对于评估糖尿病足综合征患者严重肢体缺血时的组织活力水平，尚无可靠且理想的标准，这使得无法筛选出适合进行血运重建的患者。
旨在研究球囊血管成形术前后下肢的微循环情况，并根据脓性坏死并发症的特征制定其实施算法。
对67例患有神经缺血型糖尿病足综合征的患者进行了研究。创建了3组研究对象：第一组包括18例单趾、多趾或足部远端干性坏疽的患者；第二组为35例患有湿性坏疽且伴有趾部脓性关节炎、足部蜂窝织炎以及足部和腿部慢性伤口的患者；第三组为14例被诊断患有脓性坏死并发症的患者，这些患者在第一组和第二组中均有出现，他们拒绝进行球囊血管成形术，此类患者接受了下肢缺血的保守治疗。
结果显示，所有患者的经皮氧分压（TcpO2）水平均较低，低于30毫米汞柱。治疗期间TcpO2值的变化很有意思：第一组血运重建前指标为-15.0±1.31毫米汞柱，血流恢复5至7天后为35.53±2.92毫米汞柱，6个月后为36.67±2.35毫米汞柱；第二组血运重建前为10.35±0.74毫米汞柱，5至7天后为25.06±1.13毫米汞柱，6个月后为34.43±1.97毫米汞柱；第三组入院时为12.14±0.86毫米汞柱，5至7天后为17.14±0.9毫米汞柱，6个月后为13.71±2.2毫米汞柱。
血运重建后会出现再灌注综合征，其严重程度取决于下肢血运重建血管的数量。球囊血管成形术是治疗胫-足段病变导致的肢体缺血的优先手术方法之一。
