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MODERN METHODS OF COMPLEX TREATMENT OF PURULENT DISEASES IN
DIABETES MELLITUS
X.T.Musashayxov, S.M.Muxtorov, G.G.Juraev
Department of General and Military Field Surgery
Andijan State Medical Institute
Resume:
It is known that the interaction of diabetes and purulent infection with their
simultaneous development leads to a complex and peculiar pathological process, causing a
“syndrome of mutual burden" that requires a special comprehensive examination and treatment,
deep understanding and adequate correction of changes occurring in the div. The mortality rate
of patients with purulent diseases on the background of diabetes remains high and ranges from 6
to 44%, and it has been stable in recent years. Despite the successes achieved in the prevention
and treatment of diabetic foot, 40-60% of all amputations of the lower extremities are still
performed in patients with this pathology.
Key words:
gastrointestinal tract, endogenous intoxication index, colonies forming units,
leukocyte intoxication index, medium-weight molecules, non-clostridial anaerobic infection.
Relevance.
Normal wound healing is possible only with the elimination of ACex
damaging factors, an impeccable supply of oxygen to tissues, equalization of ACex deficiencies
in full-fledged microcirculation, and normal immunization (Rakhmanov R.K. et al., 2008;
Windsor J.A. et.al., 2011). Since these factors occur in DM, wound healing is disrupted. It is
known that the terminal stage of hemostasis disorders, regardless of the etiology and
pathogenesis of the underlying disease, is accompanied by the development of endogenous
intoxication (EI) (Kitabchi AE et.al ., 2006; Cheta D.et.al ., 2004) Endotoxicosis is understood as
a complex response of the div to a massive influx of endogenously formed toxic substances
into the bloodstream, accompanied by an intense effect on its defense systems of foreign
antigenic substances. Being to a certain extent a protective reaction, endotoxicosis at a certain
stage acquires the character of a painful phenomenon, leading to a significant disruption of the
activity of organs and systems of the div, while it is characterized, as for many biological
reactions, by an excessive response, inadequate to the stimulus that initiated it (Povzun S.A.,
2002). This concept should be distinguished from the term "endotoxemia", which often,
especially in foreign literature, refers to the presence of bacterial endotoxins of gram-negative
microflora in the blood (Svetukhin A.M. et al.,2010; Beutler B.A., 2009; Brown J.M. et.al., 2008;
Fast D.J. et.al, 2008; Marks J.D. et. al., 2006). EI suggests a link between the pathogenesis of the
disease and the effects on the div of toxic products formed as a result of certain other disorders
of vegetative functions (Vozianova J.I. et al., 2003). Another component of EI is associated with
the development of infection. At the same time, in understanding the polyvalent toxic effect, a
significant place is given to the essence of microbiological phenomena associated with the
release of microbial exo-and endotoxins into the external environment (Stepanov N.G. et al.,
2011; Jones S.L. et.al .,2009). As a result of these processes, multiple organ failure may develop,
closing the vicious circle of endotoxicosis in diabetes. In this case, the process acquires an
autocatalytic character and ends with a systemic violation of general and tissue metabolism
(Reshetnikov E.A. et al., 2010; Turner R.C. et.al., 2004). Careful surgical tactics against the
background of extreme lability and extensive metabolic disorders in patients with diabetes leads
to the fact that surgeons more often observe seriously or very seriously ill patients who
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simultaneously have an untreated purulent process and uncompensated diabetes. At the same
time, we must not forget that when a combined pathology occurs, there are not two
independently developing processes, but an interconnected, mutually aggravating new form of
the disease with peculiar qualities that require the surgeon not only to undergo surgical treatment,
but also to deeply comprehend and adequately correct the changes occurring in the div
(Shomansurova Z.M. et al., 2006; Heine R.J., 2004). Critical degrees of ischemia in DM patients
are characterized by the severity of hemorheological disorders, chronic intravascular
hypercoagulation of blood, and the presence of EI syndrome (Tolstykh P.I. et al., 2003). EI
syndrome is known to have a multidisciplinary nature. In patients with diabetic angiopathies, it is
manifested by hyperglycemia, ketonemia, dysproteinemia, and the presence of toxins of bacterial
origin (Caporale A. et.al ., 2006; Murakami K. et.al ., 2010), circulating immune complexes
(CIC) with capillarotoxic effects (Efimov A.S. et al., 2003), an increased content of killer cells
responsible for the autoimmune destruction of pancreatic b cells (R.M.Khaitov et al., 2009).
According to modern concepts, the syndrome of "mutual burden", which occurs in patients
suffering from diabetes and purulent surgical infection, is mainly due to metabolic disorders and
immune defenses and is often accompanied by severe EI (Solerte S.B. et.al .,2004). When there
is a lack of insulin, carbohydrate metabolism is disorganized, which is manifested by
hyperglycemia, glucosuria and a decrease in glycogen in tissues, primarily in the liver. In
addition, the biosynthesis of fatty acids from glucose and protein biosynthesis is suppressed
(Kozlov L.V. et al., 2009; Dunn F.L., 2004; Betteridge D.J., 2010). Due to the accumulation of
nonesterified fatty acids in the blood, a state of ketoacidosis occurs (Orujeva S.A. et al., 2010;
Iwai M et.al .,2008; Noth R.H. et.al .,2004). All listed metabolic disorders are reflected in
significant shifts in blood biochemical parameters (metabolic acidosis, alkalosis, hyperlactate
acidemia, hypoalbuminemia, dysproteinemia, increased sodium content in red blood cells,
decreased amount of chlorides in both red blood cells and plasma). Tissues are constantly
experiencing oxygen starvation (Pearson G.C. et.al .,2011; Dangirdas J.T. et.al ., 2006; Parving
H.H. et.al ., 2010). In patients with diabetes, purulent surgical infection causes significant lability
of metabolic processes, which can lead to decompensation of the underlying disease as a result
of developing inflammatory acidosis and additional destruction of insulin by proteolytic enzymes
(Baynes C. et.al., 2012; Singer D.E. et.al., 2006).
The purpose of the study.
Improving the results of surgical treatment of purulent
diseases in DM by including new pathogenetically proven methods of ES and AS with
polyphepan in the complex of therapeutic measures.
Materials and methods of research.
To solve these tasks, we studied the results of
treatment of 159 patients with purulent-septic diseases on the background of diabetes. Depending
on the methods of detoxification, the fight against surgical infection and the effect on the
purulent wound, the studied patients were divided into 2 clinical groups (Table.1.): the first
group 107 consisted of patients who underwent ES and AS with polyphepan; the results were
compared with the control (2) group of 52 patients treated with conventional, traditional methods
of therapy.
The results of the study and their discussion.
In patients with severe diabetes, the
number of leukocytes at admission reached (14.20±0.79) x109/l, LII - 8.65±0.98 cu, IEI was
4.22±0.82 cu (Table 8). Despite the treatment, the number of leukocytes on 3-5 days continued
to remain high - (14.06±0.63) x109/l, an increase in LII by 8% was noted, and IEI increased by
only 9%. This indicates that in this category of patients, the disease was accompanied by severe
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intoxication. More significant shifts were observed on days 10-12. At the same time, the number
of leukocytes remained high and decreased by only 11% - (12.61±0.80) x109/l.
The LII decreased to 5.92±0.83 reference units (p<0.05), and the IEI exceeded the
baseline data by 36%. A significant decrease in leukocytes was noted only by days 14-15,
although it remained high - (11.87±0.66) x109/l, LII decreased by 37% (p<0.05), IEI increased
to 6.25±0.97 cu. Despite ACe treatment, these indicators, although there was a positive trend,
even After two weeks of therapy, the same values were significantly higher in healthy people.
This once again confirms the presence of severe intoxication in this category of patients and the
insufficiently high effectiveness of traditional detoxification measures. The significant frequency
of vascular lesions in DM indicates the relevance of hemostasis research in this disease (Ena
Ya.M. et al., 2008; Lokhvitsky S.V. et al., 2006; Shvalb P.G. et al., 2010).
Significant changes in hemostasis were noted in ASex patients with DM upon admission
(Table 9). The prothrombin index was increased and ranged from 114.69±3.34% (p<0.001).
Hyperfibrinogenemia is the most prominent indicator of ASA. In our observations, the
fibrinogen concentration was increased and reached 8.84±0.63 g/l, which is 3.2 times more than
in healthy individuals (p<0.001). The fibrinolytic activity of blood was significantly reduced -
123.62±12.42 min, when in healthy donors it reached 212.50±13.14 min (p<0.01). There was a
marked decrease in blood clotting time - up to 3.31±0.68 min and plasma recalcification time -
48.30±2.42 s, which is 1.8 and 2 times less, respectively, than in healthy individuals (p<0.001).
Plasma tolerance to heparin was increased 1.5 times and reached 12.70±0.54 min
(p<0.001). As a result of the complex therapy, the PTI decreased by 5% on days 7-8 relative to
the baseline data, and on days 14-15 it decreased to 103.40±2.25%, which is 10% less than upon
admission (p<0.01). The fibrinogen concentration decreased to 6.73±0.41 g/l on days 7-8, which
is 24% less than the initial data (p<0.01), and by days 14-15 this difference was 36%. (p<0.01),
but the ACe still remained above normal values. Fibrinolytic activity increased by 20% on days
7-8, and by 56% on days 14-15, reaching 192.70±18.76 minutes, although it was below normal.
The blood clotting time and plasma calcification time increased by 20% on days 7-8, and
on days 14-15 reached 4.61±0.48 minutes and 71.44±1.34 seconds, which is 39% and 48%
higher, respectively, than before the start of treatment, but did not reach the indicator in healthy
individuals. Plasma tolerance to heparin remained stable, decreasing by only 6% on days 14-15.
As a result of the conventional treatment, the pH of the wound medium on day 3 was
characterized by a tendency to alkalinization. In the following days, this dynamics increased, and
by day 7, the pH increased by 17% relative to the baseline values. On day 10, the reaction of the
medium became less acidic and reached 6.88±0.30, which significantly differed from the initial
values (p<0.05).
On day 14, the acidity of the wound exudate decreased to normal values - 7.04±0.27
(p<0.05). The MSM level in patients with severe diabetes at admission was very high -
0.713±0.082 CU (Fig.2). A significant decrease in MSM was noted only on 10-12 days after the
start of treatment and amounted to 0.468±0.054 CU, which is 1.5 times lower than the baseline
values (p<0.05). On days 14-15, this difference was 57%-0.310±0.053 CU (p<0.01), but the ACe
was still significantly higher than normal values, which indicates that intoxication, although
reduced, has not yet been completely eliminated. On the contrary, the PC value was very low on
the 1st day of admission to the hospital - 0.68±0.16 CU, on the 3rd-5th day this indicator
increased slightly - by 12%, and on the 14th-15th day to 1.05±0.13 cu, but did not reach the
norm and significant differences from the baseline values (Fig3.). Immediately after the opening
of the purulent focus in the wound, these patients showed marked acidosis, reaching 5.09±0.42.
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In the following days, the tendency towards alkalinization was very slight. On day 10, the
reaction of the medium became less acidic and reached 6.16±0.32 (p< 0.05). On day 14, the
acidity of the wound exudate decreased to 6.65±0.29 (p<0.01), but it did not reach normal values.
One of the main difficulties in the problem of wounds and wound infection in DM patients is the
lack of objective laboratory criteria for assessing the course of the wound process. Clinicians
need objective tests to predict the course of wound infection and the degree of risk of infectious
complications for an objective comparative assessment of various methods of treating purulent
wounds in patients with diabetes.
A quantitative test for determining the microbe content in 1 g of wound tissue is an
objective indicator of the severity of a wound infection and, in combination with other clinical
and laboratory data, can be successfully used as a diagnostic and prognostic indicator in
assessing the activity of the infectious process, in particular, in the diagnosis of wound sepsis and
the effectiveness of treatment.
Conclusions.
1. ES with polyphepan in combination with application sorption with
polyphepan is an effective measure in the complex treatment of purulent-septic diseases in
patients with DM and complement each other, synchronously acting on various links of a
complex multiphase wound process.
2. The inclusion of efferent therapies in a complex of therapeutic measures leads to rapid
relief of the purulent-inflammatory process, reduces the frequency of gangrene, reduces it to a
dry form, reduces the level and number of amputations, reduces the duration of treatment and the
risk of death.
3. The use of efferent methods of therapy for extensive purulent-necrotic processes,
severe microcirculation disorders and severe violations of the function of neutralization and
elimination is pathogenetically justified and improves the results of treatment of the disease.
4. Due to their effectiveness and technical simplicity, ES and AS polyphepan can be
recommended for use in the practice of treating purulent diseases in patients with diabetes both
in the hospital and in outpatient settings.
List of literature:
1. Abdumazhidov A.S. The state of immunity in patients with purulent-inflammatory diseases
of soft tissues on the background of diabetes mellitus // International Congress of
Diabetologists of Central Asia. Collection of abstracts. Tashkent, 2006, p. 55.
2. Abikenova F.S. Hypoglycemic and antidiabetic properties of geraine // II-International
Congress of Diabetologists of Central Asia. Collection of abstracts. Tashkent, 2006, p. 17.
3. Avdeeva T.V., Varshaevsky I.M., Shabanov I.Ya., Boklin A.A. Analysis of the results of
surgical treatment of diabetic foot // Problems of endocrinology. -2010. - C. 6. - pp.13-16.
4. Agzamkhodzhaev S.M., Keinova I.E., Khusainov Yu.U. Magnetic therapy of purulent
diseases in diabetes mellitus //Medical Journal of Uzbekistan. 2009. | N4.- pp. 32-34.
5. Agzamkhodzhaev S.M., Rakhmanov R.K., Yanbaeva T.A. Treatment of purulent wounds
with adsorbents // Republican conference with international participation "Wounds and
wound infection". Collection of abstracts. - Andijan. - 2008. - p. 34.
6. Adamyan A.A., Dobysh S.V., Kochergina L.D., Glossitsev S.P. Sorption and application
therapy of the wounded in the conditions of medical care during disasters //International
conference. "Disaster Medicine". Collection of abstracts. - Moscow. - 2003. - p. 155.
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7. Adamyan A.A., Lizanets M.N., Dobysh S.V. and others. Laboratory results of powdered
medical sorbents and prospects for their use in surgery //Bulletin of Surgery. -2002. - N 7-8.
- pp. 37-41.
8. Adamyan A.A., Muradyan R.G., Kochergin L.D. Modern means of local wound treatment
that stimulate reparative processes //Surgery. - 2004. - No. 1.-pp. 57-60.-184.
9. Adamyan A.A., Dobysh S.V., Glossev S.P. and others. Treatment of purulent wounds with
gelatin and biologically active draining sorbents //Surgery. -2004. - No. 8.-pp. 28-31.
10. Azizov G.A., Yulchiev A.K., Jalilova F.M. Lymphatic therapy in the complex treatment of
purulent-inflammatory complications of soft tissues in postthrombophlebitic syndrome
//Republican conference with international participation "Wounds and wound infection".
Collection of abstracts. - Andijan, 2008, pp. 30-11.
11. Akmatov B.A., Rafibekov D.S., Zholdoshbekov E.Zh., Shabdanaliev A.Sh. The use of
sorption methods and laser irradiation in the combined treatment of purulent wounds in
patients with diabetes mellitus // II -International Congress of Diabetologists of Central Asia.
Collection of abstracts. Tashkent, 2006, p. 55.
12. Alekseev A. A., Buyanov V.M., RadzikhOAsky A.P., Shimanko I.I. Lymphogenic
detoxification. - Kiev, Naukova dumka, 1988. - 232 p.
13. Aliev M.A., Popov T.A., Albazarov B.S. Application of sodium hypochlorite in purulent
surgery //Republican conference with international participation "Wounds and wound
infection". Collection of abstracts - Andijan - 2008.-p. 35.
14. Alimov A.T., Nurmukhammedov M.E., Babajanov A.B., Mukhammadiev D.D. Clinical and
bacteriological analysis of purulent-septic diseases in diabetes mellitus //Republican
conference with international participation "Wounds and wound infection". Collection of
abstracts. - Andijan. - 2008. - p. 24.
15. Andreychik M.L., Gebesh V.V., Gnatyuk M.S. and others. Enterosorption: achievements,
problems, prospects //Medical business. -2002. - N9. - pp. 12-19.
16. Ancipovich E.A., Molchanov V.F., Kadyshev Yu.G., Brusnitsina M.A. Selective
intraarterial use of small doses of thienam and vasaprostan in the treatment of purulent foot
diseases in patients with diabetes mellitus //Bulletin of Surgery. 2004. No. 1. pp. 76-78.
17. Antsiferov M.B. Complications of diabetes mellitus (clinic, diagnosis, treatment,
prevention). - M., Medicine, 2008. - pp. 44-50.
18. Aripov U. A., Asamov R.E., Jamalov S.I. New perspectives in the treatment of diabetic foot
// Scientific and practical conference “Modern aspects of diagnosis, treatment, and
prevention of lower limb lesions in patients with diabetes mellitus.” Collection of abstracts.
Moscow, 2006. pp. 15-17
19. Aripov U.A., Asamov R.E., Jamalov S.I., Imamov A.A. Transplantation of pancreatic islets
in the complex treatment of diabetic foot syndrome //Surgery of Uzbekistan. - 2010. - No. 2.
- pp. 22-25.
20.
Asamov R.E., Jamalov S.I., Shukurov B.I. Modern tactics of treatment of patients with
“diabetic foot”//International Conference "Surgery-2000". Collection of abstracts. - Moscow.
- 2000. - pp. 487-48
