Настанови 2023 року Міжнародної робочої групи з діабетичної стопи, Європейського товариства судинно ї хірургії, Товариства судинної хірургії щодо захворювання периферичних артерій у пацієнтів із цукровим діабетом і виразкою стопи
DOI:
https://doi.org/10.30978/CEES-2024-3-46Анотація
Ускладнення стопи, пов’язані з цукровим діабетом, є основною причиною захворюваності та причиною більшості великих і малих ампутацій у всьому світі. Близько 50 % осіб із діабетом та виразкою стопи мають захворювання периферичних артерій (ЗПА), наявність ЗПА значно підвищує ризик несприятливих подій із боку нижніх кінцівок і серцево‑судинної системи.
Міжнародна робоча група з діабетичної стопи (IWGDF), починаючи з 1999 р., публікує науково обґрунтовані рекомендації щодо лікування та профілактики ускладнень стопи, пов’язаних із діабетом. Ця настанова є оновленням настанови IWGDF 2019 р. щодо діагностики, прогнозу та лікування захворювань периферичних артерій в осіб із цукровим діабетом і виразкою стопи. Для цієї оновленої настанови IWGDF, Європейське товариство судинної хірургії та Товариство судинної хірургії вирішили співпрацювати, щоб розробити узгоджений набір рекомендацій для клініцистів усіх країн.
Ця настанова ґрунтується на трьох нових систематичних оглядах. Використовуючи Систему класифікації, оцінки, розробки та експертизи рекомендацій (GRADE), були сформульовані клінічно релевантні питання, також систематично переглядалася нова література. Після оцінки достовірності доказів були сформульовані рекомендації, які були оцінені щодо співвідношення користі та шкоди, цінності для пацієнта, здійсненності, прийнятності, справедливості, наявності необхідних ресурсів і, якщо доступно, витрат. Завдяки цьому було розроблено п’ять рекомендацій щодо діагностики ЗПА в осіб із діабетом, виразкою стопи або гангреною, або без них. Також розроблено п’ять рекомендацій щодо прогнозу, пов’язаного з оцінкою ймовірності загоєння та результатів ампутації в особи із діабетом і виразкою або гангреною стопи. Розроблено п’ятнадцять рекомендацій щодо лікування ЗПА, що охоплюють визначення пріоритетності пацієнтів для реваскуляризації, вибір процедури та післяопераційний догляд. Крім того, комісія з написання рекомендацій визначила ключові питання для дослідження, щодо яких бракує поточних доказів.
На думку авторів, дотримання цих рекомендацій допоможе медичним працівникам надавати кращу допомогу та зменшити тягар ускладнень, пов’язаних із цукровим діабетом.
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