Transkutani parcijalni pritisak kiseonika u proceni efikasnosti hiperbarične oksigene terapije za ishod lečenja dijabetičnog stopala

Abstract

Dijabetičnim stopalom nazivamo patološke promene na stopalu kod pacijenata koji boluju od šećerne bolesti, a uzrokovane su angiopatijom, polineuropatijom i osteoartropatijom. Savremenu terapiju dijabetičnog stopala pored medikamentoznog i hirurškog lečenja čini i hiperbarična oksigenacija. Cilj. UtvrĎivanje efikasnosti hiperbarične oksigene terapije primenjene kod bolesnika sa dijabetičnim stopalom, odreĎivanje visine parcijalnog pritiska kiseonika na ishod lečenja i odreĎivanje PtcO2 u pektoralnom predelu i okoline dijabetične rane (torako-pedalni indeks) za ranu procenu sanacije rane. Materijal i metode. U Specijalnoj bolnici za hiperbarčnu medicinu u Beogradu i u Hirurškoj klinici KBC Zvezdara, 2016. i 1017. godine uraĎena je prospektivna klinička studija ambulantno lečenih bolesnika sa dijabetičnim stopalom, kod kojih je kliničkim pregledom pedalno brahijalnog indeksa (ABI) <0,6, kolor dopler ultrazvukom, arteriografijom i MSCT angiografijom utvrĎeno da ne postoji mogućnost hirurške ili endovaskularne revaskularizacije. Ispitanici su podeljeni u dve grupe, eksperimentalnu sa 62 pacijenta koji su pored konvencionalne terapije tretirani i hiperbaričnom oksigenom terapijom i kontrolnu grupu od 36 pacijenata lečenih samo konvencionalnom terapijom. Hiperbarična oksigena terapija sprovedena je u 20 seansi u trajanju od 70 minuta, pod povišenim pritiskom od 2,2 ATA udisanjem 100% kiseonika preko maske. Posmatrani su u obe grupe demografski podaci, trajanje dijabetesa i komplikacije dijabetesa, stanje koronarne bolesti, laboratorijski nalazi i lipidni status, opis dijabetične rane i merenje dimenzije i dubine rane. Preduslov za ulazak u studiju bila je rana u stadijumu II i većem prema Wagnerovoj klasifikaciji i stanje periferne ishemijske bolesti prema Fontenu u II stadijumu ili većem. Za statističku obradu podataka korišćena je SPSS metodologija...

Diabetic foot is the term for the pathological changes on foot in patients with diabetes and is caused by diabetic angiopathy, polyneuropathy and osteoarthopathy. Besides the medical and surgical treatment, the contemporary treatment of the diabetic foot is also the hyperbaric oxygenation. Aim. The determination of efficacy of hyperbaric oxygen therapy applied to the patients with diabetic foot, the determination of the altitude of oxygen partial pressure on the treatment outcome and the determination of PtcO2 in pectoral region and the surroundings of the diabetic wound (ankle-brachial index) for an early assessment of the wound healing. Materials and methods. During 2016 and 2017 at Special Hospital for Hyperbaric Medicine in Belgrade and at Clinic for Surgery, Zvezdara University Medical Center, Belgrade a prospective clinical study was conducted in patients with diabetic foot that were ambulatory treated. Among those patients by clinical examination of ankle-brachial index ABI<0,6, color doppler sonography, arteriography and MSCT angiography it was determined that there was no possibility of surgical or endovascular revascularization.The respondents were randomized into two groups, the experimental one consisting of 62 patients who were treated by the hyperbaric oxygen therapy besides the conventional therapy and the control group of 36 patients treated only by the conventional therapy. Hyperbaric oxygen therapy was carried out in 20 sessions of 70- minutes duration, under higher pressure of 2,2 ATA breathing 100% oxygen through the mask. In both groups there were observed the demographic data, the duration and the complications of diabetes, the status of coronary disease, the laboratory results and the lipid panel, the description of the diabetic wound and the measurement of the dimensions and the depth of the ulcer. Precondition for entering the study was the Wagner grade II ulcer or higher and the stage II or higher of peripheral ischemic disease according to the Fontaine classification. SPSS methodology was used for the statistical data analysis. Results. Before the beginning of the therapy all the above-mentioned parameters in both groups have shown that there was no significant difference between the groups by the statistical analysis. The dimensions of the wound (length, width, depth) after the therapy have statistically significant reduction in the experimental group. By the comparison of the stages, according to the Fontaine classification and according to the Wagner ulcer grade classification, it was demonstrated that the statistically highly significant difference after the therapy is in favor of the experimental group...