RU2294767C1 - Method for lymphostimulation in case of affected disorders of hemolymphocirculation of inferior limbs in patients with diabetic foot syndrome - Google Patents

Abstract

FIELD: medicine, surgery.

SUBSTANCE: it has been suggested to carry out 3-fold lymphostimulating injections of medicinal mixture of the following composition: lidase 32 U, actovegin 80 mg, anicaine 4 ml, in lateral part of the upper third of patient's shin in projection of location of surface lymph vessels. The innovation favors the increase of the rate and the volume of peripheral lymph outflow and that of the rate and the volume of peripheral venous blood outflow.

EFFECT: higher efficiency.

1 ex, 5 tbl

Description

The invention relates to medicine, namely to surgery. It can be used in the treatment of patients with diabetic foot syndrome.

The present method has no analogues; it is distinguished by simplicity of execution, affordability, efficiency and low cost.

The method consists in introducing a complex mixture of drugs in the lateral part of the upper third of the leg in the projection of the location of the superficial lymphatic vessels. The composition of the drug mixture: lidase 32 units, Actovegin 80 mg, anikain 4 ml. The multiplicity of the manipulation is 3 with an interval of 48 hours.

The technical result consists in improving the lymph flow of the lower extremities - increasing the speed and volume of the outflow of peripheral lymph, improving the blood flow - increasing the speed and volume of the outflow of peripheral venous blood, which is clinically manifested in a decrease in edema at all levels of the lower extremities, a decrease in congestion in the distal parts of the lower extremities, improving the dynamics of the wound process. Contraindications for injections are: intolerance to any drug that is part of the drug mixture, local purulent processes in the field of this manipulation.

In order to assess the effectiveness of lymphostimulation in patients with lower limb hemolymphocirculation disorders in patients with diabetic foot syndrome, a comparative analysis of case histories of 42 patients with diabetic foot syndrome was performed. Assessment of the effectiveness of the therapy was carried out by means of a comparative analysis of reolymphasovographic and impedanceometric parameters. As a result, it was proved that the use of lymphostimulating injections (LI), carried out in the lateral part of the upper third of the leg in the projection of the location of the superficial lymphatic vessels, against the background of conventional therapy, in the treatment of patients with diabetic foot syndrome, leads to an increase in the speed and volumetric parameters of the regional lymph flow and venous blood flow, to increase the value of the active component of the specific resistance of soft tissues, at all studied levels. At the shin level, a 2.2-fold increase in the rate of regional lymphatic flow, a 1.9-fold increase in the volume of lymphatic outflow, a 1.8-fold increase in the peripheral venous outflow rate, and a 1.6-fold increase in the venous outflow volume were revealed. At the hip level, an increase in the rate of regional lymphatic flow was determined by 1.9 times, an increase in the volume of regional lymphatic flow by 1.7 times, an increase in the speed of peripheral venous outflow by 1.6 times, an increase in the volume of peripheral venous outflow by 1.4 times. At the level of the ankle joint, the increase in impedancemetry was 1.6 times, at the level of the middle third of the lower leg 1.5 times. Comparative data are given in the tables. In the control group, patients received conventional treatment (OL) for diabetic foot syndrome, which included sugar-lowering drugs to achieve optimal glycemia, anticoagulants, drugs that improve metabolism in the ischemia zone, alpha-lipoic acid preparation, B vitamins, antibiotics, local sorption treatment unloading the foot.

Table 1
Dynamics of indicators of the speed of lymphatic outflow in patients with diabetic foot syndrome, Ohm / s, M ± m Study level Study period OL (n = 23) OL + LI (n = 19) Shin Before treatment 0.22 ± 0.02 0.21 ± 0.02 After treatment 0.24 ± 0.03 0.46 ± 0.04 • Hip Before treatment 0.23 ± 0.03 0.22 ± 0.02 After treatment 0.24 ± 0.03 0.42 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Table 2
Dynamics of indicators of the volume of lymphatic outflow in patients with diabetic foot syndrome, Ohm, M ± m Study level Study period OL (n = 23) OL + LI (n = 19) Shin Before treatment 0.23 ± 0.02 0.22 ± 0.02 After treatment 0.24 ± 0.03 0.42 ± 0.04 • Hip Before treatment 0.24 ± 0.02 0.23 ± 0.03 After treatment 0.26 ± 0.03 0.39 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Table 3
Dynamics of venous outflow velocity indices in patients with diabetic foot syndrome, Ohm / s, M ± m Study level Study period OL (n = 23) OL + LI (n = 19) Shin Before treatment 0.29 ± 0.02 0.28 ± 0.03 After treatment 0.31 ± 0.03 0.50 ± 0.04 • Hip Before treatment 0.31 ± 0.03 0.29 ± 0.03 After treatment 0.33 ± 0.03 0.46 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Table 4
Dynamics of indicators of venous outflow volume in patients with diabetic foot syndrome, Ohm, M ± m Study level Study period OL (n = 23) OL + LI (n = 19) Shin Before treatment 0.35 ± 0.05 0.34 ± 0.05 After treatment 0.37 ± 0.04 0.54 ± 0.04 • Hip Before treatment 0.36 ± 0.05 0.35 ± 0.05 After treatment 0.39 ± 0.04 0.49 ± 0.04 • Note: • - differences in indicators before and after treatment are significant, p <0.05 Table 5
Dynamics of impedancemetry indicators in patients with diabetic foot syndrome, Ohm, M ± m Study level Study period OL (n = 23) OL + LI (n = 19) Ankle joint Before treatment 35.21 ± 1.35 34.48 ± 1.41 After treatment 37.14 ± 1.51 55.17 ± 2.16 • Middle third of tibia Before treatment 47.88 ± 1.68 46.94 ± 1.89 After treatment 49.02 ± 1.79 70.41 ± 2.95 • Note: • - differences in indicators before and after treatment are significant, p <0.05

The use of lymphostimulating injections in the complex treatment regimen for patients with diabetic foot syndrome leads to a pronounced relief of edema and congestion of the lower extremities of this category of patients in comparison with conventional treatment due to the improvement of lymphovenous relationships.

Clinical example.

Patient G., 56 years old. Diagnosis: Diabetic foot syndrome, mixed form. Trophic ulcer of the left foot. Has been ill with diabetes for 12 years, noted the appearance of swelling of the lower extremities about 4 years ago, 3 months ago noted the appearance of a trophic ulcer in the calcaneal region of the left foot. Examination - general clinical, reolymphovasography of the lower extremities, impedancemetry of the lower extremities. Treatment is a common therapy. 3 sessions of lymphostimulating injections of a drug mixture consisting of lidase (32 PIECES), actovegin (80 mg), anikain (4 ml) were performed with an interval of 48 hours on both lower extremities in the lateral part of the upper third of the leg in the projection of the surface lateral lymphatic vessels. After completion of treatment, there is a decrease in swelling of both lower limbs, healing of trophic ulcers of the left foot by secondary intention. According to the reolymphasovographic study, the following dynamics of the indicators was revealed: the rate of lymphatic outflow at the shin level before treatment is 0.22 Ohm / sec, after the injection course - 0.43 Ohm / sec, the rate of lymphatic outflow at the hip level before treatment is 0.19 Ohm / sec, after the injection course - 0.45 Ohm / sec, the volume of lymphatic outflow at the shin level before treatment is 0.23 Ohm, after the injection course - 0.43 Ohm, the volume of lymphatic outflow at the hip level before treatment is 0.23 Ohm, after a course of injection - 0.38 Ohm, the speed of the venous outflow at the shin level before treatment - 0.27 Ohm / sec, after the injection course - 0.51 Ohm / sec, the speed of the venous outflow at the hip level before treatment - 0.33 Ohm / sec, after the course of the injection - 0.47 Ohm / sec, the volume of the venous outflow at the shin before treatment - 0.34 Ohm, after a course of injection - 0.52 Ohm, the volume of venous outflow at the hip level before treatment - 0.36 Ohm, after a course of injection - 0.51 Ohm. According to the results of the impedance measurement, the following dynamics of the indicators was revealed: the active component of the soft tissue resistivity at the ankle joint level was 34.87 Ohms before the treatment, 53.65 Ohm after the injection course, the active component of the soft tissue resistivity at the middle third of the leg to treatment - 47.49 Ohm, after a course of injection - 68.53 Ohm.

When applying the presented method, an effective effect is made on the pathological process in diabetic foot syndrome, a marked decrease in edema, a decrease in congestion of the lower extremities, an improvement in the dynamics of the wound process compared with conventional treatment, which is confirmed by reolymphasovographic and impedanceometric data.

Claims (1)

The method of lymphostimulation of hemocirculation disorders of the lower extremities in patients with diabetic foot syndrome during conventional therapy, characterized in that in the lateral part of the upper third of the leg in the projection of the location of the surface lymphatic vessels, the drug mixture is administered as a part of lidase 32 IU, actovegin 80 mg, anikaine 4 ml, the procedure is performed three times with an interval of 48 hours