Search

Purpose. The purpose is to find out the common and different features of the clinical course of erysipelas from other diseases that can imitate it. Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery in the Non-profit municipal enterprise “City Hospital № 3” in Zaporizhzhia for the period 2019-2020 were analyzed. 123 patients, who underwent hospital treatment in the center during this period of time, were with post-injection abscesses of soft tissue, 184 - with soft tissue abscesses, 203 - with phlegmons of various localizations, 49 - with complicated panaritium, 3 of which - subcutaneous. Over the past 5 years, 127 patients were consulted in the clinic and other therapeutic, infectious, neurological and other departments of the city. A number of criteria and signs have been identified to differentiate erysipelas from diseases that may have similar clinical symptoms and a number of circumstances that need to be clarified. Results. It is established that the diagnosis of erysipelas does not require special laboratory examination and is made on the basis of examination of the patient, epidemiological history and medical history. Provoking factors in the development of erysipelas are: violation of the integrity of the skin (abrasions, scratches, abrasions, cracks, bruises, injuries); mycoses; a sharp change in temperature (supercooling, overheating); emotional stress; increased insolation. Erysipelas has a characteristic summer-autumn seasonality. In people engaged in physical labor, the disease is registered more often than in other types of work. Hereditary predisposition to the disease is observed in 10-15% of cases. In this regard, the presence of such factors as congenital and acquired venous insufficiency of the lower extremities, fungal infection of the lower extremities, the presence of postoperative and post-traumatic scars, lymphostasis, diabetes, cardiovascular disease and diseases accompanied by the development of edema, intake of corticosteroids or cytostatics are of essential significance in the development of the disease. Conclusions. Mathematical modeling between erysipelas and other diseases that have similar syndromes in their clinical picture may be useful in making a differential diagnosis between them.

Purpose of the study. To evaluate the effectiveness of unilateral spinal anesthesia as a method of pain relief during foot surgery. Analyze the effectiveness of unilateral spinal anesthesia versus sciatic nerve block. To develop an algorithm for performing unilateral spinal anesthesia during foot surgery. Materials and methods. We examined 64 patients who were treated in the department of purulent surgery of the 3rd city hospital in Zaporozhye with a diagnosis of diabetic foot syndrome in the period from 2017 to 2019. Research methods. Assessment of the level of pain intensity using the standard visual analogue scale and the concentration of glucose in the blood serum. Monitoring of the parameters of the cardiovascular system, the temperature of the skin of the lower leg during anesthesia, Doppler scanning of the peripheral circulation in the foot. Results. 4 hours after performing anesthesia, the intensity of pain during movement of the lower limb, according to the visual analogue scale in the group with unilateral spinal anesthesia was 2,3 times less than in the group with sciatic nerve block (p < 0,05). After 10 hours – in the sciatic nerve block group there was a 9,4% increase in comparison with the unilateral spinal anesthesia group (p < 0,05). Compared with the unilateral spinal anesthesia group, in the sciatic nerve block group 20 minutes after anesthesia, the heart rate decreased by 7,2% (p < 0,05). After unilateral spinal anesthesia, the level of systolic blood pressure on 1 toe of the foot increased by 18,3% 20 minutes after anesthesia, and 20 minutes after sciatic nerve block – by 13,7% (p < 0,05). In patients with the unilateral spinal anesthesia group, the temperature on the operated lower limb after anesthesia increased by 3,8%, in the sciatic nerve block group – by 2,8% (p < 0,05). Conclusions. Regional anesthesia is the main method of choice for foot surgery compared to general anesthesia. sciatic nerve block does not in all cases lead to 100% surgical anesthesia and requires additional medical analgosedation. For foot surgery, unilateral spinal anesthesia is preferred.

Purpose of the study. Improve postoperative treatment of phlegmonous and necrotic forms of erysipelas by alternating HAC therapy of wounds and staged necrectomies, reduce the time of cleaning and preparation of the wound for dermatoplasty. Materials and metods. The results of treatment of 87 patients with complicated forms of erysipelas who were treated in the purulent-septic center of KNP «City Hospital № 3» in Zaporozhye for the period 2020–2021 were analyzed. Results. The effectiveness of treatment, including topical therapy, was evaluated by improving laboratory parameters (leukocyte formula), the number of microbial bodies per 1g of tissue and the duration of wound cleansing. In the phlegmonous form of erysipelas, normalization of the leukocyte formula was observed on day 3, which is probably faster than among patients in the control group – on day 4 (t = 4,01375; P = 0,000182). In patients with necrotic form of erysipelas in the main group, the normalization of the leukocyte formula occurred probably faster, almost 2 days, than in the control group – 4 and 6 days, respectively (t = 2,16682; P = 0,042499). At the same time there was a decrease in microbial contamination of wounds. The terms of wound cleansing in the postoperative period in patients of the main group were probably shorter than in patients of the control group – by 1,87 ± 0,23 days in phlegmonous form (t = 3,75213; P = 0,000320) and 2,89 ± 0,34 in necrotic (t = 2,33969; P = 0,026659). Conclusion. Improvement of postoperative local treatment of patients with phlegmonous and necrotic forms of erysipelas allowed to significantly reduce the length of stay of patients in the hospital by 3,26 ± 0,43 days (t = 6,47461; P < 0,000001).

The action for survival in sepsis: International Guidelines for Management of Sepsis and Septic Shock, 2021 yr.

Purpose of the study. To study the features of the microbial landscape of AP at different stages of their formation. Materials and methods. The results of examination and treatment of 80 patients with pyogenic liver abscesses for the period 2019–2020 were analyzed. The average age of patients was 48,4 ± 4,7 years. The duration of the disease at the time of hospitalization averaged 10,2 ± 3,4 days. The condition of all patients was assessed as moderate and severe, hospitalization was carried out on urgent indications. The inclusion criterion was the presence of pyogenic liver abscesses, the exclusion criteria were cholangiogenic and specific abscesses. Microbiological studies of the species composition of pathogens and their sensitivity to antibiotics were performed in all patients during surgery and in the dynamics of the postoperative period. Results. The microbial landscape of pyogenic abscesses in their different stages of formation differed both in quantitative and qualitative ratio. Seeding of aerobic monoinfection from purulent foci in stage I was predominant (P 0,05). There have been cases of seeding of facultative anaerobes of the genus Peptostreptococcacea and facultative anaerobic bacteria of the genus Clostridium. Conclusion. Carrying out of adequate combined ABT to patients with AP according to the developed algorithms, allowed to reduce terms of recovery of patients: for 3–4 days normalization of body temperature (t = 5,66176; P

Objective. The aim is to find out the common and different features of the clinical course of erysipelas from other diseases that can imitate it. Materials and methods. 114 case histories of patients who were hospitalized in the center of purulent-septic surgery in the City Hospital No 3 in Zaporizhzhia for the period 2019-2020 were analyzed. 123 patients, who underwent hospital treatment in the center during this period of time, were with post-injection abscesses of soft tissue, 184 - with soft tissue abscesses, 203 - with phlegmons of various localizations, 49 - with complicated panaritium, 3 of which - subcutaneous. Over the past 5 years, 127 patients were consulted in the clinic and other therapeutic, infectious, neurological and other departments of the city. A number of criteria and signs have been identified to differentiate erysipelas from diseases that may have similar clinical symptoms and a number of circumstances that need to be clarified. Results. It is established that the diagnosis of erysipelas does not require special laboratory examination and is made on the basis of examination of the patient, epidemiological history and medical history. Provoking factors in the development of erysipelas are: violation of the integrity of the skin (abrasions, scratches, abrasions, cracks, bruises, injuries); mycoses; a sharp change in temperature (supercooling, overheating); emotional stress; increased insolation. Erysipelas has a characteristic summer-autumn seasonality. In people engaged in physical labor, the disease is registered more often than in other types of work. Hereditary predisposition to the disease is observed in 10-15% of cases. In this regard, the presence of such factors as congenital and acquired venous insufficiency of the lower extremities, fungal infection of the lower extremities, the presence of postoperative and post-traumatic scars, lymphostasis, diabetes, cardiovascular disease and diseases accompanied by the development of edema, intake of corticosteroids or cytostatics are of essential significance in the development of the disease. Conclusions. Mathematical modeling between erysipelas and other diseases that have similar syndromes in their clinical picture may be useful in making a differential diagnosis between them.

Objective. To investigate the efficacy of immunomodulating and immunostimulating therapy in complex treatment of patients, suffering surgical forms of erysipelas.Materials and methods. Retrospectively and prospectively there were analyzed 284 patients’ hospital charts, who were treated stationary in Centre of Purulent-Septic Surgery of Zaporizhzhya Municipal Hospital №3 in 2016 - 2021 yrs. Results. In patients, suffering erythematous form of erysipelas, disorders in cellular and humoral chains of immunity were not revealed. The immune disorders formula in bullous form was following: CD3 + 1, CD4 + 1, CD8-1, CD16-2, CD22-1, what witnessed about misbalance of the immune system Degree I, of possibly compensatory character; in a phlegmonous one - CD3 + 1, CD4-1, CD8-1, CD16-2, CD22-1, witnessing actuality of the immune disorders of Degree І, while in the necrotic one - CD3-2, CD4-2, CD8-1, CD16-2, CD22-1, trusting presence of the immune disorders of Degree ІІI. Conclusion. Administration of erbisol-extra and laferon for destructive forms of erysipelas is pathogenetically substantiated and may be applied in complex treatment of the disease.

Objective. To study the incidence and to determine the main trends of treatment of the erysipelas surgical forms. Materials and methods. There were retrospectively and prospectively analyzed 114 histories of the patients’ cases, who were treated in stationary in the centre of purulent-septic surgery of the Municipal Hospital No 3 of Zaporizhzhya in 2019 - 2020 yrs. Results. Mostly often the affection site was localized on the lower extremities. In bullous and phlegmonous forms of erysipelas the most frequent clinical signs of intoxication were general weakness, hyperthermia, muscular pain. In necrotic form of erysipelas the signs of severe intoxication with nausea, regurgitation and confusion were observed. In complex treatment of erysipelas the main principles are antibioticotherapy and early surgical processing of the pathological process zone. Determination of indices of the procalcitonin content in the blood serum gives possibility to estimate progression and generalization of the process and constitutes a sensitive test for efficacy of the treatment conducted. Conclusion. Radical surgical intervention and timely targeted antibioticotherapy constitutes basic elements of successful treatment for surgical forms of erysipelas, and this position must not be revised. Procalcitonin content in the blood serum constitutes a diagnostic marker, permitting to prognosticate the sepsis development timely.

Topical issues of modern diagnostics of sepsis, potential problems of assessing the patient's condition and ways of solving problematic issues of timely diagnosis and prevention of sepsis development are analysed.

Cytokines are specific proteins that are produced by lymphocytes. Cytokine production and release occurs rapidly and is rigorously controlled. Their activity is characterized by ensuring the interaction between cells and systems, regulation of inflammatory reactions and responsible for the development of autoimmune processes. Patients with sepsis develop immunosuppression, when immune deficiency can progress to immunoparalysis. Cytokines cause effects similar to manifestations of acute and chronic infectious diseases having an ability to cause inflammation (pro-inflammatory) or inhibit the inflammatory process development (anti-inflammatory). The aim of the work is to find out the dynamics of changes in the most important cytokines in patients with sepsis caused by diabetic foot syndrome. Materials and methods. A total of 146 patients with sepsis who received treatment in the Zaporizhzhia Purulent-Septic Center with diabetic foot beds between 2006 and 2019 were examined and followed up. Patients were distributed according to the forms of the disease: group 1 – 104 (71.2 %) patients with sepsis, group 2 – 42 (28.8 %) patients with septic shock. The average age of the patients was 62.8 ± 3.4 years, and the duration of type 2 diabetes mellitus was 12.3 ± 3.4 years. The groups were representative in terms of sex, age and concomitant pathology. The studies were conducted in dynamics: upon admission, on the 7–8th and 12–16th days of the postoperative period. Results. The disease in sepsis patients was caused by wet gangrene of the lower extremities which occurred in 84.6 % of cases (88 patients). In 16 patients (15.4 %), the complications were caused by foot phlegmon and extended osteomyelitis. The cause of sepsis in patients with septic shock was wet gangrene of the extremities in 100 % of cases. Postoperative mortality in sepsis patients was 18.3%, and in patients with septic shock – 70.8 %. The dynamics of changes in serum cytokines has been found to be indicative of these indicators imbalance which depends on the inflammatory process severity. The balance between cytokines is an important point in the regulation of inflammatory process onset and development. The course of the disease and its outcomes depend on this balance. Conclusions. Determining the cytokine status is of great prognostic value because the level of pro- and anti-inflammatory cytokines, their ratio in patients with sepsis and septic shock reflects the intensity of alterative-destructive and regenerative-restorative processes as well as the dynamics and progression of the disease.

In this review the most effective markers of septic process like Procalcitonin, C-reactive protein, and cytokines compared to the new marker – Presepsin (PSP) are analyzed. At sepsis initiation, PSP increases 30 to 60 minutes after the onset of systemic infection. PSP levels at admission to the hospital predict the risk of adverse and adverse effects that other markers used for the diagnosis of sepsis do not have.

Thearticlepresentsthetheoreticaljustification and comparative experience in the formation of a unilateral spinal block by tachyphylaxis in urgent surgery during operations on the lower extremities. The possibility of influencing the duration and severity of motor blockade on the operated side was established using the tachyphylaxis method for administering the anesthetic without decreasing the quality of anesthesia as a whole and without increasing the amount of anesthetic administered. The possibility of reducing the development time of full anesthesia to a minimum fixation time of anesthetic on nerve tissue (10 minutes) due to preliminary «sensitization» to nerve fiber anesthetics was established. The possibility of reducing the need for postoperative analgesia by increasing the duration of the postoperative painless period has been established.

Objective. To improve the results of treatment in patients, suffering diabetic foot syndrome (DFS), using conduction of the directed antibacterial therapy, taking into account the resistance of microflora revealed, and to reveal the role of a gram-positive microflora in occurrence of complications. Materials and methods. There were examined 1824 patients, suffering DFS for period from 2015 to 2019 yr., who suffered purulent-necrotic affections of the foot - abscess, phlegmon, purulent tendovaginitis, purulent arthritis, gangrene. All the patients suffered diabetes mellitus Type 2, average duration of which have constituted (12.3 ± 2.7) yrs. Qualitative content of microflora and sensitivity of cultures for antibiotics were revealed on automatic microbiological analizators «Vitek2» and BacT/ALERT (France). Results. The cause of purulent-necrotic complications was a gram-positive microflora, which in 57.1 - 66.8% patients was diagnosed in monoinfection and prevailed in a content of microbial associations. Phenomena of resistance to the main antibacterial preparations was revealed in 37.4% bacteria. The biggest resistance have had Staphylococcus aureus and Enterococcus faecalis. In 62.5% patients, owing Staphylococcus aureus, a resistance gene to Staphylococcus aureus with three genetic variations were revealed, which differed in accordance to resistance for certain groups of antibiotics. The most significant MRSA Type 3 - panresistant (in 6/2% patients). Conclusion. Investigations of purulent-necrotic foci in patients with the DFS witnesses, that the leading microorganism while development of complications constitutes a gram-positive microflora, which is characterized by presence of polyresistant and panresistant strains. Such a condition gives background to necessity for correcting of the antibacterial therapy administered.

Abdominal sepsis (AS) is one of the most severe complications in abdominal surgery. Mortality from the AS according to various data can reach up to 80–90% depending on the etiology, peculiarities of pathogenesis and comorbidities. Purpose of the study is to determine the current state of the problem of abdominal sepsis, to identify problems and discussion issues and to outline possible perspectives for their solution. AS remains one of the important problems of modern urgent abdominal surgery, and ii is characterized by a large variety of etiological factors and polymorphism of the clinical picture. Changing the paradigm of sepsis (Sepsis-1, 2, 3) requires correction of treatment-diagnostic approaches in patients with acute abdominal surgery. Existing methods of diagnosing and treating abdominal sepsis are not effective enough, and therefore there is a need to improve them and develop new, adequate therapeutic approaches.

Peripheral arterial occlusion and microvascular disorders are important factors that contribute to the onset of lower limb disease in patients with diabetes. Monckeberg's sclerosis (arteriosclerosis) arteriosclerosis is diagnosed as a random finding when performing radiography of the upper or lower extremities, but may be a complicating factor in systemic response syndrome and sepsis in patients with diabetic foot syndrome. Purpose of the study. Analyze the condition of the blood flow of lower limb in patients with diabetes foot syndrome with signs of sepsis, in dependence on the level of Monckeberg's sclerosis. Materials and methods. 75 patients with diabetes were examined, due to diabetic foot syndrome. 11 (14,7%) patients had type I diabetes, the average duration of which was 16,41 ± 3,85 years, 64 (85,3%) patients had type II diabetes, with of 12,25 ± 2,54 years duration. The age of patients with type I diabetes was 35 ± 5,72 years, with type II diabetes was – 63,51 ± 10,22 years. Men with type I diabetes were 63%, with type II diabetes – 53%. According to the latest recommendations Sepsis-3 (2016) and classification criteria, patients had signs of sepsis, which required a certain combination therapy. Patients with sepsis were divided into two groups: group I consisted of 38 patients with an infected ulcer, abscess and phlegmon; to group II of 37 patients with gangrene of the toes, forefoot, gangrene of the entire foot or lower limb. The first group of 38 patients included 5 with type I diabetes and 33 with type II diabetes. By age, sex, concomitant pathology of the group was representative. Main vessels were investigated using ultrasound duplex scanning. Determined arterial systolic pressure at the level of the ankle, with the subsequent calculation of the ankle-humeral index, Arterial systolic pressure was also determined at the level of I toe. We had conducted radiography of the foot in two projections. We had Used X-ray classification of Monckeberg's sclerosis (V. A. Gorelysheva et al., 1989) in stages. Research results. Patients in both groups were examined identically. The treatment was carried out in accordance with the standards of patient management with the development of sepsis; surgical intervention was justified on the basis of information obtained from the survey and clinical data. Patients of group I were performed: dissection of an abscess, phlegmon, sequestrectomy and arthrotomy. In group II – one or several fingers amputation, transmetatarsal amputation of the foot, amputation at the level of the calf or thigh. 33 (86,8 %) patients of group I and 30 (81,0%) patients of group IIhad signs Monckeberg's sclerosis varying stages. In 19 (58%) patients, group I, the X-ray picture of the distal arteries matched to grade 3 according to the presented classification Monckeberg's sclerosis, 9 (27%) patients had signs of grade IV, 3 (9%) – grade V. 6 (20%) patients, II groups had an X-ray picture of grade III, 13 (43%) patients had signs of grade IV, 11 (36%) had signs of grade V. All 9 patients with type I diabetes had signs of arteriosclerosis. Using X-ray data, it is possible to classify Monckeberg's sclerosis by stages. However, with the duration of the disease for more than 10 years, the calcifications of the walls of the arteries of the foot in the form of a convoluted dense rope or column with simultaneous defeat of the smaller branches, which is characteristic of the final stages of the disease. Despite the fact that as a result of calcifications, the vascular wall becomes rigid and loses the ability to reduce and dilate, the blood flow in it is preserved, and the level of SAT varies from > 200 to 80 mmHg. The presence of Monckeberg's sclerosis by radiography of the lower extremities was detected in 33 (86.8%) patients in group I and 30 (81,0%) in group ІІ. With an increased level of vascular involvement, Monckeberg's sclerosis increases the likelihood of developing critical ischemia and gangrene (х2 = 5,41; р = 0,02). In patients of group I with systolic blood pressure of more than 120 mmHg the disease outlook was more favorable than in patients without a pulse wave or systolic blood pressure of the finger less than 80 mmHg (х2 = 11,76; р = 0,0006). With a decrease in systolic blood pressure of less than 30 mmHg to save the distal part of the foot or the limb did not succeed. Calcification of the vascular wall does not affect the arterial patency directly, but after the formation of thrombosis, the blood flow stops. Conclusions. In patients with sepsis, with signs of diabetic foot syndrome, which are characterized by a neuropathic form (ulcer, abscess, phlegmon), the presence of Monckeberg's sclerosis, even the last stages, with preserved systolic blood pressure of 200–120 mmHg does not lead to the development of critical deterioration blood circulation. Deterioration of the rheological conditions of the lower extremity, with a systolic arterial pressure 80–50 mmHg below in combination with stage III–IV Monckeberg's sclerosis increases the risk of gangrene of the foot and limb. In the presence of Monckeberg's sclerosis of 3–5 stages in the small arteries of the foot, it is possible to maintain the integrity of the foot by maintaining a generally sufficient volume of blood flow, due to the fight against atherosclerosis of main vessels, to maintain systolic blood pressure not lower than 80–60 mmHg.

Diabetic foot or the syndrome of diabetic foot (SDF) is the problem due to a high frequency of ablations of the lower extremities followed with a significant social, psychological and economic consequences. The research objective is to estimate diagnostic opportunities of ultrasound doppler scanning (UDS) of arteries of lower extremities in the patients with diabetes mellitus (DM) in development of purulent-necrotic complications. The main group consisted of 141 patients with DM who were treated at purulent-septic center «City Hospital N 3» in Zaporizhzhya, during 2017-2018. Control group – 274 patients who were receiving treatment during 2009-2013. The average duration of DM was 12,8±2,9 years. Average age of patients was 56,3±5,3 years. 63 (44,7%) were men, women – 78 (53,3%). The groups were representative by key indicators and the accompanying pathology. During hospitalization patients had signs of purulent-necrotic lesion of the lower extremity. The complex of diagnostic actions included obligatory diagnostics of a vascular bed of the lower extremities by means of UDS. By comparison with retrospective data it was defined that the number of DM patients with vascular problems in development of purulent-necrotic complications has increased. If earlier the percentage of distribution to etiological forms made up: neuropathic - 36,9%, ischemic - 23,4%, mixed – 39,7%, currently, mixed form (p

Комплексне лікування синдрому діабетичної стопи з позицій фізичної та реабілітаційної медицини

Objective: To improve methods of early diagnosis of diabetic neuropathy and suggest options for surgical prophylaxis possible purulent and necrotic complications in patients with diabetic foot syndrome. Materials and Methods. The study involved 64 patients with complicated diabetic foot syndrome (DFS). The average age of patients - 61,9 ± 3,8 years, duration of diabetes - 11,47 ± 3,2 years. The patients had neuropathic and mixed forms of DFS, fingers or arched foot deformations with the presence of pressor venous trophic ulcers in the forefoot. Patients were randomized into two groups: the main group - 34 and comparison group - 30 patients. There were representative characteristics for all groups: age, sex, comorbidity and did not differ significantly (P> 0,05). There were no statistically significant difference between the groups of these data (χ2 = 0,05; P = 0,8195). Results. After 6 months of complex treatment the ulcers were healed in more than half of patients in both groups - 19 (63,3%) of patients in the comparison group and 25 (73,5%) of the main group. In 8 (26,7%) patients in the comparison and 7 (20,6%) of the main group positive dynamics was observed, but over a longer period of treatment . After 12 months, the number of patients whose ulcers were completely healed differed significantly by the main group (P = 0,0007; χ2 = 11,41). Also in the main group was only 1 (3,0%) patient with ulcer that was not healed, in contrast to the comparison group - 7 (23,3%) patients (P = 0,0373; χ2 = 4,34). Conclusions. Operations aimed at correction of fingers and feet deformations in combination with standard therapy and unloading of the lower limb, allow improving the results of patients with complicated DFS treatment by reducing the number of relapses.

Мета. З’ясувати діагностичну цінність ранніх маркерів запального процесу в диференціальній діагностиці гнійно-некротичних процесів діабетичної стопи та розвитку сепсису. Матеріали і методи. Обстежено 989 хворих із ускладненим синдромом діабетичної стопи (СДС), із них у 97 (9,8%) перебіг захворювання був обтяжений сепсисом. Результати. За динамікою змін вмісту цитокінів IL-1β, IL-6, IL-10, системного цитокіну TNF-α, а також С-реактивного білка (СРБ) та прокальцитоніну (ПКТ) у сироватці крові можна диференціювати ускладнений СДС, обтяжений сепсисом. Висновки. Визначення цитокінового статусу, вмісту СРБ, ПКТ має діагностичну цінність в диференціальній діагностиці гнійно-некротичних процесів діабетичної стопи та розвитку сепсису.

Objective. Conduction of retrospective and prospective analysis of the final results of treatment in patients, suffering sepsis on background of complicated diabetic foot syndrome (DFS). Маterials and methods. The results of treatment of 938 patients, suffering complicated DFS, were investigated retrospectively. In 92 (9.8%) patients the disease was complicated by sepsis. All the patients were divided into two Groups: Group I - 724 (77.2%) patients, suffering complicated DFS and sepsis, who were treated in accordance to decision of The Cosensus Conference; Group II - 214 (22.8%) patients, who were treated in 2016 - 2018 yrs in accordance to Guidelines «Sepsis-3». Results. Comparative analysis of the treatment results has been shown, that administration of intensive therapy and inotropic support in accordance to Guidelines «Sepsis-3» gives possibility to stabilize the patients’ state and to prepare them for operative intervention. Conclusion. Results of diagnosis of sepsis in accordance to new bed-side clinical index quick Sequential Organ Failure Assessment (qSOFA) and performance of Guidelines «Sepsis-3» in the intensive therapy conduction are hopeful, but the need for further detailed analysis of clinical data is present.

Вступ. Гнійні захворювання відзначають більш ніж у 35% пацієнтів хірургічних стаціонарів, з яких особливою групою є пацієнти з сепсисом на тлі ускладненого синдрому діабетичної стопи (СДС). Реакція організму на септичний процес проявляється змінами метаболічних процесів, у регуляції яких важливу роль відіграють перекисне окиснення ліпідів (ПОЛ) та система антиоксидантного захисту (АОЗ). Матеріали і методи. Обстежені в динаміці 724 хворих з приводу ускладненого СДС. Стан ПОЛ оцінювали на основі аналізу його первинних та вторинних продуктів – дієнових кон’югат (ДК), малонового діальдегіду (МДА), шифових основ (ШО). Результати. Встановлено, що у хворих як за ускладненого СДС, так і сепсису, зміни вмісту продуктів ПОЛ в сироватці крові при госпіталізації були достовірними (р < 0,05), при сепсисі, більш вираженими, ніж за ускладненого СДС без сепсису. Обговорення. Аналіз отриманих даних свідчить, що тяжкість перебігу сепсису у хворих за ускладненого СДС залежить від стану вільнорадикального окиснення ліпідів. За результатами дослідження, первинні й вторинні продукти ПОЛ є об’єктивними маркерами тяжкості ендогенної інтоксикації, визначають оксидантний стрес організму. В системі комплексної терапії таких хворих слід застосовувати антиоксиданти як один з варіантів патогенетично обгрунтованої інтенсивної терапії.

У хворих на цукровий діабет (ЦД) ІІ типу, яких лікували за період 2015 - 2016 рр. з приводу ускладненого синдрому діабетичної стопи (СДС), визначали систолічний артеріальний тиск (САТ) на рівні І пальця стопи та проводили рентгенографію стопи у двох проекціях. САТ пальця від 120 до 200 мм рт. ст. і вище свідчив про наявність склерозу Менкеберга III - V ступеня. Прогностично сприятливим є САТ 80 мм рт. ст. і вище, несприятливим – зниження САТ менше 80 мм рт. ст., САТ нижче 30 мм рт. ст. свідчив про облітерацію або тромбоз судини.

Обстежені в динаміці 724 пацієнта, у яких діагностований ускладнений синдром діабетичної стопи (СДС), у 71 (9,8%) з них захворювання обтяжене сепсисом. Тяжкість стану хворих при СДС залежала від тривалостігнійно-некротичного процесу на стопі, у хворих на сепсис така залежність не виявлена. Всі хворі з приводу СДС без сепсису оперовані. Померли 36 хворих, (летальність 5,5%), за наявності сепсису - 42 (летальність59,1%). Причиною сепсису у хворих за ускладненого СДС була переважно волога гангрена нижніх кінцівок. Померли 13 (30,9%) хворих на сепсис, яких не оперували, з них 5 - відмовились від оперативного втручання, померли в перші години після госпіталізації внаслідок необоротного пошкодження органів і систем.

Мета. Провести порівняльний аналіз показників летальності у хворих із сепсисом на тлі ускладненого синдрому діабетичної стопи (СДС) з урахуванням протоколу Погоджувальної конференції (1992) та рекомендацій ІІІ Міжнародного консенсусу з визначення сепсису та септичного шоку («Sepsis-3»). Матеріали і методи. Ретроспективно та проспективно проаналізовано 938 історій хвороб пацієнтів з ускладненим СДС. У 92 (9,8%) пацієнтів захворювання було обтяжене сепсисом. Згідно з рекомендаціями «Sepsis-3» використовували нову шкалу під час обстеження біля ліжка - qSOFA. Результати. Аналіз летальних випадків з урахуванням рекомендацій «Sepsis-3» показав, що деякі форми септичного процесу віднесені до ускладнених невиправдано, тобто їх кількісна оцінка за шкалою qSOFA не перевищувала 1 бала. Це дало можливість визначити сепсис причиною смерті у 5 (11,9%) хворих, а септичний шок (СШ) - у 37 (88,1%). Висновки. Впровадження рекомендацій «Sepsis-3» в клінічну практику дасть змогу уникнути розбіжностей у постановці діагнозу. За допомогою шкали qSOFA можна швидко і без значних матеріальних витрат диференціювати сепсис і СШ.