Abstract
Aim:to study the state of lipid metabolism, hemostasis, inflammatory reaction and the potential for their correction after indirect revascularization in patients with distal steno-occlusion of arteries and critical ischemia of lower extremities (critical ILE).Material and methods.Changes in hemostasis and dynamics of its parameters during the complex surgical treatment in 131 patients with critical ILE and distal arterial stenoocclusion were analyzed. To achieve the targeted goals, patients were divided into the following groups: 34 patients had traditional care (control group); 32 patients had intravenous laser blood irradiation in combination with standard therapy (Group I); 32 patients had cytokine therapy with roncoleukin in combination with standard therapy (Group II); 33 patients had intravenous laser blood irradiation combined with cytokine therapy and standard therapy (Group III). Parameters of lipid metabolism were studied in dynamics (total cholesterol, very low density lipoproteins, high density lipoproteins, triglycerides); products of lipid peroxidation (malondialdehydes, conjugates, superoxide dismutase); inflammatory mediators (C-reactive protein, sialic acids, seromucoids, fibrinogen A, circulating immune complexes); hemostatic parameters (fibrinogen, fibrinolytic activity, fibrin degradation products, antithrombin III activity). Hemostatic indices were compared with identical parameters of 48 apparently healthy individuals (reference group).Results.On admission, patients with critical ILE and distal wall occlusion had sharp changes in their lipid metabolism, inflammatory reaction, and hemostasis. Conclusion. The inclusion of intravenous laser blood irradiation and cytokine therapy separately and in combination in a set of therapeutic measures led to the leveling of the studied homeostasis indicators. The best results were obtained in the group where patients had combined perioperative intravenous laser blood irradiation with cytokine therapy in indirect revascularization.
Highlights
Relation of changes in lipid peroxidation parameters depending on the curative modality at the perioperative period in indirect revascularization in patients with critical lower limb ischemia без изменения no changes уменьшен
Relation of changes in hemostatic parameters depending on the curative modality at the perioperative period in indirect revascularization in patients with critical lower limb ischemia
Relation of changes in inflammatory mediators depending on the curative modality at the perioperative period in indirect revascularization in patients with critical lower limb ischemia
Summary
Проанализированы изменения гомеостаза и динамика его показателей при комплексном хирургическом лечении у 131 больного с КИНК при дистальной стено-окклюзии артерий в возрасте от 31 до 74 лет. Этиологическими факторами КИНК были облитерирующий атеросклероз (у 87 чел., 66,4 %) и облитерирующий тромбангиит (у 44 чел., 33,6 %). Из-за невозможности проведения шунтирующих операций для стимуляции регионарного кровообращения были произведены следующие виды непрямой реваскуляризации: реваскуляризирующая остеотрепанация (РОТ) – у 42 больных; поясничная симпатэктомия (ПСЭ) – у 51 больного; ПСЭ + РОТ – у 38 больных. Для установления диагноза КИНК и оценки результатов лечения прослежены изменения в клиническом статусе пациента, проводили ультразвуковую допплерографию с ангиосканированием, мультиспиральную компьютерно-томографическую ангиографию, реовазографию, определили сатурацию кожи кислородом в дистальной части.
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