DIAGNOSIS AND TREATMENT OF THE SYNDROME OF ENDOGENOUS INTOXICATION IN PATIENTS WITH COMPLICATED FORMS OF THE DIABETIC FOOT SYNDROME

Aim. To improve diagnosis and treatment of the syndrome of endogenous intoxication in patients with complicated forms of the diabetic foot syndrome.

Material and methods. The study is based on the results of clinical observation and treatment of 110 patients with complicated forms of DFS. The study group included 65 (51.9%) men and 45 (48.1%) women.

The age of patients ranged from 30 to 70 years. Type, the severity of the course and stages of diabetes were determined according to the WHO classification (1985). Diabetes type 1 was detected in 4 (6.5%) cases, type 2 diabetes in 106 (93.5%) cases, and in 5 (3.8%) cases DM was detected for the first time.

Results. The results of the study showed that in patients with complicated forms of the diabetic foot syndrome, critical increase in the content of lipid peroxidation products in the blood plasma was: MDA- 6.3 ± 1.25, DK 0.92 ± 0.14, SOD 11.4 ± 0,2. In patients with a prevalent purulent-septic processes the numbers were: MDA - 7.82 ± 0.92, DK - 1.24 ± 0.05, SOD 10.1 ± 0.2. In patients of the control group the MDA was 5.9 ± 1.23 μm / ml, DK - 0.90 ± 0.32 and SOD up to 10.1 ± 0.2 μm / ml. These numbers were significantly higher before the treatment in patients of the main group with complicated forms of diabetic foot syndrome, which was the reasons of the rapid development and spread of the purulent-septic process under the influence of LPO products.

Conclusion. Oxidation stress was revealed in patients with complicated forms of the diabetic foot syndrome, where a direct relationship between the intensity of LPO and the severity of the purulent-necrotic process was noted. An excessive amount of products of disturbed metabolism, intermediate and final products of LPO that have a toxic effect, which leads to damage and cell death, appears with the progression of the pathological process and the activation of LPO. But the most significant cause is probably the developing antioxidant deficiency, which confirms the positive effect of antioxidants that hinder oxidative stress.

1. Voynov A. V., Bedrov A. Ya., Voynov V. A. Sindrom “diabeticheskoy stopy” [Diabetic foot syndrome]. Vestnik khirurgii – Herald of surgery, 2012, No. 3, pp. 106-109.

2. Galimov O. V., Khanov V. O., Sayfullin R. R. Sindrom diabeticheskoy stopy: printsipy kompleksnogo lecheniya [Diabetic foot syndrome: principles of the compex treatment]. Vestnik khirurgii – Herald of surgery, 2015, Vol. 174, No. 5, pp. 61-65.

3. Osincev E. Yu., Slobodskoy A. B., Melsitov V. A. Optimizatsiya aspiratsionno-promyvnogo drenirovaniya gnoynykh ran [Optimisation of aspirational drainage of purulent wounds]. Vestnik khirurgii – Herald of surgery, 2012, No. 5, pp. 61-64.

4. Petrova V. V., Spesivtsev Yu. A., Larionova V. I. Patogeneticheskie i klinicheskie osobennosti techeniya gnoyno-nekroticheskikh oslozhneniy sindroma diabeticheskoy stopy: obzor [Pathogenic and clinical peculiarities of purulent necrotic complications of diabetic foot syndrome]. Vestnik khirurgii – Herald of surgery, 2010, No. 2, pp. 121-124.

5. Sukovatykh B. S., Pankrusheva T. A., Abramova S. A. Optimizatsiya lecheniya gnoynykh ran u bolnykh s sindromom diabeticheskoy stopy [Optimisation of a treatment of purulent wounds in patients with diabetic foot syndrome]. Khirurgiya. Zhurnal im. I.I. Grekova - Surgery. Journal named after I. I. Grekov, 2014, Vol. 173, No. 3, pp. 28-32.

6. Yusupova Sh. Yu., Nabiev M. Kh., Zokirov R. A Rasprostranyonnost oslozhnyonnykh form sindroma diabeticheskoy stopy v Respublike Tadzhikistan [Spread of the complicated forms of diabetic foot syndrome in Tajikistan]. Vestnik Avitsenny – Herald of Avicenna, 2015, No. 4, pp. 13-18.

7. Dinh T. L. Veves A Treatment of diabetic ulsers Dermatol. Ther, 2006, No. 6, pp. 348-355.

8. Morbach S.,Furchert H.,Groblinghoff U. et. al. Long-term prognosis of diabetic foot patients and their limbs: amputation and death over the course of a decade. Diabetes Care, 2012, Vol. 35, No. 10, pp. 2021-2027.

9. Clayton W.. Elasy T. A review of th pathophysiology . classification . and treatment of foot ulcers in diabetic patients. Clinical diabetes, 2009, Vol. 27, No. 2, pp. 52-58.