The dissertation is devoted to increase of efficiency of treatment of patients with pyoderma, taking into account the state of peripheral circulation, microbial landscape of the skin, determination of their role in the development of pathological process, using differentiated therapy.
It is proved that in patients with acute pyoderma, both superficial and acute, there are identical changes in the peripheral circulation, which consist in preserving the functional possibilities of vascularization in the submandibular and superficial femoral arteries and in violation of its condition in the shoulder, popliteal, elbow, radial, anterior and posterior large-cell arteries, that is, they have signs of segmentation.
It is shown that patients with chronic pyoderma, regardless of clinical course of infection, undergo total changes in vascularization of both upper and lower extremities, which consist in slowing down Vps and Ved, S / D imbalance, suppression of vascular resistance and their pulsation inertia.
It was revealed that S.aureus acts as the dominant participant of microbial associations in the foci of lesions with pustular processes on the skin.
Under observation, there were 111 patients with pyoderma (69 men and 42 women) aged 16-64 years. The control group comprised 15 healthy individuals, gender-specific.
Most patients were previously treated in medical institutions or on their own by standardized means and methods. The effectiveness of the therapy was negligible, temporary or absent.
DC peripheral blood flow was performed in 103 patients under observation. The subfamily, shoulder, elbow, radial, superficial femur, popliteal, anterior and posterior large hematopoietic arteries were studied. Vps, Ved, S / D, PI, RI were determined. The control group was formed by 15 healthy individuals.
As a means of adjusting the state of peripheral circulation and, accordingly, contributing to the elimination of clinical manifestations of pyoderma, naftirofuryl ("Enelbin 100-Retard") and standardized extract of Ginkgo biloba ("Bilobyl"), which have vasodilatory activity, were used. In order to clarify their effect on vascularization, an analysis of the appropriateness of their purpose was made comparing with the use of standardized therapy alone. Therefore, the observed patients were divided into 2 groups (comparative and basic), comparable to the clinical course of the infection. The comparative contingent was 45 patients (14 with staphylococcal impetigo, 15 with chronic superficial pyoderma and 16 with chronic deep pyodermia). These patients received only standardized treatment in accordance with the guidelines, namely: cefazolin, doxycycline, "Ribomunil", methyluratsil, chymotrypsin, pecorutin, locally - "Bactroban", "Fusiderm", applications of pure ichthyol, methyluratsilum and solcoserilum ointment.
The post-therapy investigation of the state of peripheral circulation revealed a lack of targeted corrective effect of standardized treatment on vascularization, both upper and lower extremities.
The main group consisted of 58 patients. In 15 of them, boils were diagnosed, 21 were chronic superficial, and 22 were chronic deep pyoderma. This contingent of patients received the above standardized therapy and naphthyrrofuryl. Patients with chronic (both superficial and deep) piodermia additionally, consistently, as against a relapse, a standardized extract of Ginkgo biloba was prescribed.
It was established that patients with boils of the main group achieved a significant vasodilating effect. In particular, in the submandibular and superficial femoral arteries, both high-speed and index values retained their reference values. At the same time, Vps, Ved, S / D, RI and RI in the shoulder, elbow, radial, popliteal, anterior and posterior vesicle arteries were subject to probable correction, reaching control values. In chronic superficial pyoderma on the upper extremities, these indicators also acquired physiological values. However, there was a certain slowdown, despite the accuracy of the correction, blood circulation of all sections of the lower extremities. These probable changes were registered in patients with chronic, deep pyoderma.
The analysis of the clinical efficacy of the proposed differentiated therapy showed more encouraging results of its appointment compared with the use of only standardized means. Thus, "clinical recovery" was achieved in all 15 (100.0%) patients with boils, in 15 (71.4%) persons with chronic superficial and in 13 (59.1%) - with chronic deep pyoderma. "Significant improvement" was noted in 6 (28.6%) patients with chronic superficial and in 8 (36.4%) patients with chronic deep piodermia.
Thus, differentiated therapy can significantly improve the efficiency of treatment of patients with pyoderma due to targeted corrective effect on the state of peripheral circulation and, accordingly, the clinical course of the pathological process.
