RU2004245C1 - Method for treating diabetic angiopathy - Google Patents

Description

The described effects develop in patients with diabetic angiopathy after iv administration of NaCIO (in the central veins) at an initial dose of 600 mg / l 400 ml with an infusion rate of 50-70 cap / min, under the control of the level of volemia, glycemia, Hb A 1c, hemostasis and KShchS.

PRI me R 1. Ershova NP, 60 years old, № and / b 3520, was admitted to the I surgical department 23 GKB 03.24.92. with a diagnosis of phlegmon of the scalp. Diabetes mellitus, 1st century, subcompensation. Diabetic angiopathy of the lower extremities. Upon admission, the patient is of moderate severity. Complaints of general weakness, malaise, thirst, cooling of the feet, pain in the lower extremities, alternating lameness. Weakened pulsation in the arteries of the back of the foot and the posterior tibial, BP 140/80 mm Hg, pulse 112 beats / min, NPV 24 per min.

The daily dose of insulin is 20 units.

Laboratory data: blood glucose 12.2 mmol / l; pH 7.40; pCOa 36.9 mm Hg; BE 4.0; NT 42; pOa 87.8 mm Hg; Hb 128.5 r / d; glucosuri 1-1.5%; an effective albumin concentration (ECA) of 25.5 g / l; glycosylated hemoglobin (HbA 1c) 20% (at a rate of 5-6%).

03.03.92 punctured and catheterized the right subclavian vein, started infusion of 0.006% NaCIO 400 ml at a rate of 60-70 cap / min.

The day after NaCIO infusion: glucose level of 6.2 mmol / l; glu-, kozuri 0.5%; pH 7.45; pC02 35.4 mmHg; BE +1; NT 42; p02 94.5; Hb 135 g / l; ECA 35 g / l; NYA 1s 7%.

Clinically, the patient noted a warming of the lower extremities, unpleasant dragging, pains disappeared, and the syndrome of endogenous intoxication stopped. Pulse in the arteries of the back of the foot and the tibia good filling. Heart rate 92 bpm; HELL 140/80 mm Hg; NPV 22 per min. Subsequently, traditional antidiabetic, antibacterial therapy was carried out. The patient's condition is stably compensated.

PRI me R 2. Patient Korneechiva A.S., 68 years old, n / a 2878, was admitted to Surgery Unit II of the 23rd Clinical Hospital on March 9, 1992 with a diagnosis of type II diabetes mellitus, decompensation. Diabetic gangrene of the left foot.

At the time of the examination, the patient's condition of moderate severity due to intoxication. Locally expressed edema of the foot and lower leg to the middle third, skin hyperemia, cyanotic staining of the rear of the foot. On the rear of the foot, a detachment of the epidermis with hemorrhagic contents. No peripheral arterial pulse is detected.

It was planned to amputate the foot according to Shar.

The daily dose of insulin is 18 units.

Laboratory data: glycemia level of 9.2 mmol / l; glucosuri 0, pH 7.39; pCO 33.7 mmHg; BE 3.7; pOg 89.8 mm Hg; Hb 130 g / l; ECA 19.0 g / l; NY 1 with 24%.

Puncture and catheterization of the right subclavian vein was performed, infusion of 0.06% NaCIO 400 ml was started at a rate of 60-70 cap / min. 24 hours after NaCIO infusion, clinical improvement was noted: edema, hyperemia, cyanosis disappeared, and pulsation appeared on the arteries of the rear foot and the tibia. The pain was stopped. Laboratory changes: glycemia level of 6.2 mmol / g; there is no sugar in the urine; pH 7.43; pSOg 40.0 mm Hg; BE 0.2; NT 40; p02 93.3 mm Hg; Hb 128 g / l; ECA 28.5 g / l; Hb 1c 7%.

All this made it possible to distinguish between the zone of necrosis and the level of previously proposed amputation. Amputation is performed at the level V of the toe of the left foot.

PRI me R 3. Patient Soloviev V.A., 41 years old, n / a 2518, was admitted to the II surgical department of 23 KGB 1.03.92 with a diagnosis of type I diabetes mellitus, severe course. Diabetic angiopathy. Wet gangrene of the left leg. From the anamnesis: amputation of the right foot at the level of the thigh in 1984. In 1988, amputation of the fingers of the left foot.

At the time of the examination, the patient's condition is severe due to intoxication. Severe pain syndrome, hyperthermia up to 39 ° С, heart rate 120 beats / min; HELL 130/80 mm Hg; NPV 26 in 1 min, Coagulation time 5 min. The daily dose of insulin is 54 units. Pronounced edema of the foot and lower leg, hyperemia and cyanosis of the skin of the rear of the foot, and epidermal detachment with hemorrhagic contents are locally noted.

Laboratory data: glycemia level of 7.6 mmol / l; pH 7.32; pC02 40.4 mm Hg; BE 5.4; p 02 89.6 mm Hg: Ht 41; Hb 108.8 g / l; ECA 17.5 g / l; NYA 1s 25%; glucosuri 1.5%.

Puncture and catheterization of the right subclavian vein was performed. An infusion of 0.06% NaЈIO 400 mm was started at a rate of 60-70 drops / min. A day after NaCIO transfusion, the phenomena of endogenous intoxication stopped, the temperature returned to 37 ° C, the swelling of hyperemia and cyanosis of the affected limb disappeared, and the pain syndrome stopped. Heart rate 92 beats per 1 min, blood pressure 120/80 mm Hg, NPV 22 in 1 min

Laboratory shifts: glyce level. At the same time, the positive effect of polium is 7.2 mmol / l; there is no sugar in the urine, a scientist in all the patients observed, improve coagulation by 10 minutes; pH 7.38; peripheral oxygenation of pC0239.7; BE 1.0; NT37; p0294.3; Hb 105 tissues by increasing the partial load / l (against hemodilution); ECA 22 g / l; 5 strains of oxygen and release of HENA 1c 10% .moglobin from a strong bond with glucose (Hb

8 was further conducted traditional-A 1s decreased by 5-7%). Clinically, the withdrawal is infusion-related, antidiabetic: a decrease in the degree of intoxication,

concrete, antibacterial therapy, the improvement of the local symptomatology of the pathophone of which the patient's condition is stable-10 logical process (reduction of edema

but compensated. extremities, relief of pain; number of patients with diabetic, delineation of the necrosis zone),

I get lower limb angmopathy - In all variants of application of NaCIO

In addition to the traditional treatment, precautionary hypochlorite administration should be observed: NaCIO infusion should be carried out; administered to the catheterized central

ъ In case of diabetes mellitus of the 1st stage, diabetic veins in a concentration of not higher than 600 mg / l under

ska angiopathy, lesions of INUst., gang-control of the level of volemia (after the hemodieren of the foot - 12 people luc up to NT-a 40%), glycemia level (glugolen - 4 people 20 goat blood not lower than 8 mmol / l), hemostasis

hips -15 people h (blood coagulation time not more than 20

In case of diabetes mellitus I st., Diabetic), eka aihiopathy HI st. 5 pax

Infusion NaCIO 600 mg / l in a volume of 400 (56) Efimov A.S. Diabetic angiopamles were performed in 28 patients. 25 type, M .: 1989.

Infusion NaCIO 600 ml / l in a volume of 800 Resolution of the FC of the Ministry of Health of the USSR No. 718 of

ml - 8 patients. 3.04.91.

Formula, Inventions UA

„Iju

METHOD FOR TREATING DIABETIC Tissue Improvement of Tissue due to Disruption ANGIOPATHY, including administration of glycosylated hemoglobin lesser, royalties that improve rheole, additionally introduce intravenous blood properties 5 and oxygenation 1, a 0.06% solution of tissue hypochlorite, characterized in that, for the purpose of 5, three in a volume of 400-800 ml per day.