Pathogenetic substantiation of infusion therapy using modern methods of visualization in diabetic foot syndrome

Abstract

Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.