Kurdachenko O. Optimization of surgical treatment and correction of a syndrome endogenous intoxications at patients with purulent - necrotic complications of diabetic foot syndrome

The dissertation is devoted to a problem of studying of features of current of a syndrome endogenous to an intoxication at patients with purulent - necrotic complications of diabetic foot syndrome, to improvement of methodical approaches of correction endotoxaemia, and also operative and local treatment of the specified contingent. It is carried out inspections and treatment of 182 patients with the verified diagnosis of a diabetes ІІ type which had available purulent - necrotic complications of diabetic foot syndrome and the retrospective analysis of representative group of 147 patients. Features of microbiological structure of the centers purulent - necrotic process are determined at diabetic foot syndrome in dynamics, changes of sensitivity of microorganisms for antibacterial preparations with application of an express - method of S.D. Shapoval are investigated and techniques of carrying out of antibacterial therapy are advanced. Clinical features of occurrence and current of syndrome endogenous intoxications are investigated at purulent - necrotic complications of diabetic foot syndrome with use of objective markers of endotoxaemia. Techniques of operative treatment purulent - necrotic processes in patients with diabetic foot syndrome with use programmed necrectomy are advanced. The way of local treatment of the centers purulent - necrotic process which included sorbtion - application therapy with use of a fabric carbon sorbent is developed. Criteria for a choice of medical products at carrying out of local treatment were: expressiveness exudative a component, character of microflora in the center of defeat and clinical characteristics of current purulent - necrotic process. Application of the advanced methodical approaches to carrying out of surgical and local treatment purulent - necrotic processes has allowed to improve results of treatment: in 83,6 % were lower limb salvage, has reduced amount of amputations with 17,4 up to 11,6 %, has reduced average term of stay in a hospital with up to 32,4±1,4 day.