Медикаментозне лікування ішемії за синдрому діабетичної стопи

М. Б. Горобейко

doi:10.24026/1818-1384.1(46).2014.75308

Автор(и)

М. Б. Горобейко Український науково-практичний центр ендокринної хірургії, трансплантації ендокринних органів і тканин МОЗ України, Київ, Україна

DOI:

https://doi.org/10.24026/1818-1384.1(46).2014.75308

Ключові слова:

diabetic foot syndrome, fibrinolytic drugs, treatment

Анотація

Conducted to study the effectiveness urokinase for the treatment of patients with a TcPO 2 within 20- 30 mm Hg in cases of diabetic foot syndrome. Research Group – RG – (25 patients) received 1,0-0,05 million IU/day of urokinase for 20-26 days. Control Group – CG – (11 patients) – recruited retrospectively. Estimated dynamics of fibrinogen, TcPO2 and dynamics of ulcer healing (assessed by the beginning of treatment, at 10 and 20 days). In RG dynamics of fibrinogen was as follows – 4,15±1,16 g/l at the begin-ning of treatment, at 10 and 20 days – 2,96±1,31 g/l and 1,94±0,31 g/l, respectively. Decreasing is significant. It is also significant the difference between RG and CG during and after treatment (fibrinogen levels in CG from beginning 3,56±0,67 g/l and 3,12±0,68 g/l in the end. The difference in the CG is statistically nonsignificant. Just significantly improved level TcPO2 in RG (from 23,44±2,25 to 33,20±5,96 mm Hg). Compared to the dynamics in the CG (22,36±1,37 mm Hg in beginning and 22,73±1,81 mm Hg at the end of treatment) in the RG dynamics was signifi-cantly better. The average area of the ulcer at the beginning of treatment in the RG was 2,70±1,13 sq cm in 10 days – has decreased, but not significantly to 2,26±1,02 sq cm, and 20 days later – 1,41±0,94 sq cm – the difference is significant with exponents 0 and 10 days. Thus, demonstrated the efficacy of urokinase on the healing of ulcers in patients with DFS through a reduction in fibrinogen levels and improve blood circulation in the lower limbs.

Біографія автора

М. Б. Горобейко, Український науково-практичний центр ендокринної хірургії, трансплантації ендокринних органів і тканин МОЗ України, Київ

M. Gorobeiko

Посилання

Факторы риска, ведущие к ампутации у больных сахарным диабетом [Текст] / М. Мотта, А. Василе, Н. Митрой [и др.] // Международный эндокринологический журнал. – 2005. – No 1 (1). – С. 46-49.

Міжнародна угода з проблеми діабетичної стопи – Київ. – 2004. – 96 с.

Consensus Development Conference on Diabetic Foot Wound Care – American Diabetes Association // Diabetes Care. – 1999. – Vol. 22, No 8. – Р. 1354-1360. https://doi.org/10.2337/diacare.22.8.1354

Angiographic scoring of vascular occlusive disease in the diabetic foot: relevance to bypass graft patency and limb salvage [Text] / B. Toursarkissian, M. Agala, D. Stefanidis [et al.] // J. Vasc. Surg. – 2002. – V. 35, No 3. – P. 494-500. https://doi.org/10.1067/mva.2002.120046

White J.V. Chronic subcritical limb ischemia: a poorly recognized stage of critical limb ischemia [Text] / J.V. White, R.B. Rutherford, C. Ryjewski // Semin. Vasc. Surg. – 2007. – V. 20, No 1. – P. 62-67. https://doi.org/10.1053/j.semvascsurg.2007.02.001

Wyffels P.L., DeBord J.R., Marshall J.S. et al. Increased limb salvage with intraoperative and postoperative ankle level urokinase infusion in acute lower extremity ischemia // Journal of vascular surgery. – 1992. – Vol. 15. – Р. 771-779. https://doi.org/10.1016/0741-5214(92)90711-g

Ouriel K., Welch E.L., Shortell C.K. et al. Comparison of streptokinase, urokinase, and recombinant tissue plasmogen activator in an in vitro model of venous thrombolysis // Journal of Vascular Surgery. – 1995. – Vol. 22. – Р. 593-597. https://doi.org/10.1016/s0741-5214(95)70045-5

Затевахин И.И. Лечение пациентов с синдромом диабетической стопы и имеющих трофические язвы низкими дозами урокиназы: Материалы 23 (XXYII) Международной конференции г. Санкт-Петербург [Текст] / И.И. Затевахин, В.Н. Золкин, И.Н. Коротков // Ангиология и сосудистая хирургия. – 2012. – Т. 18, No 3 (Приложение). – С. 135-136.

Компендиум 2003 – лекарственные препараты / Под ред. В.Н. Коваленко, А.П. Викторова. – K.: Морион, 2003. – 1388 с.

Weck M., Laage C., Schab T., Molle A. Low-dose-Urokinase-Therapie bei akuten angioneuropathischen diabetischen Fusssyndrom (DFS) // Diabetes und stoffwechsel. – 2001. – Vol. 10. – Р. 3-11.

Diagnostik und Therapie des diabetischen Fusses / M. Weck. – Kreischa, 2002. – 67 p.