Diabetic foot treatment, care products. Circulatory disorders of the brain in diabetes mellitus Diabetic neuropathy treatment program

High level of cerebrovascular pathology - medical and social the problem of indisputable relevance due to the significant level of mortality and early disability. Diabetes mellitus is recognized as an independent and direct factor in its development

Hyperglycemia, by stimulating the process of glycosylation of protein molecules and stimulating protein catabolism, violations of water-electrolyte homeostasis, increases the degree of organ dysfunction and contributes to an increase in the area of \u200b\u200bthe lesion in acute conditions. Glucose level ≥6.1 mmol / L is an extreme unfavorable prognostic factor in acute circulatory disorders. The presence of diabetes mellitus increases the risk of brain stroke by 1.5-6 times.

Acute circulatory disorders of the brain

Both hyper- and hypoglycemic states cause the development of disturbances of consciousness with minimal focal symptoms. Hypoglycemic coma is an independent risk factor for stroke. Quite often, a brain stroke in diabetics is disguised as episodes of hypoglycemia, and vice versa, the symptoms of the latter are often assessed as an acute cerebrovascular event. Hyperglycemic coma in a quarter of patients is accompanied by neurological symptoms with pronounced polymorphism (paresis, paralysis, nystagmus, dysarthria, vestibular disorders, quadrant hemianopsia) due to a decrease in cerebral perfusion.

Diagnostics

Diagnosis of acute cerebrovascular events includes physical and neurological examination, Doppler ultrasonography of intra- and extracranial arteries of the head and neck, angiography, ECG, neuroimaging (CT, MRI), the results of which are decisive in the presence of clinical picture with atypical symptoms. In the absence of changes in CT and MRI, it is necessary to use a lumbar puncture in case of a high probability of hemorrhage. The range of laboratory studies includes general blood and urine tests, biochemistry, lipidogram, ionogram, coagulogram.

Healing activities

The complex consists of both standard schemes, corresponding to general therapeutic, and specific, aimed at the maximum possible optimization of carbohydrate metabolism and elimination of indicators of organ decompensation caused by diabetes.

General therapeutic activities include recanalization (thrombolysis), the use of anticoagulants (inhibitors of platelet aggregation, heparins and heparinoids) and neuroprotectors, neurorehabilitation.

Specific treatment is aimed primarily at controlling and correcting glycemia. Insulin therapy is indicated for glucose levels ≥10 mmol / L. Short-acting or ultra-short-acting insulin is administered fractionally, up to 6 times / day. Upon reaching normal glycemic levels, clear consciousness and no changes that prevent oral intake drugs, antidiabetic therapy may follow an acceptable standard patient regimen.

It is especially important to avoid the occurrence of hypoglycemia, which contributes to an increase in the area of \u200b\u200bcerebral infarction and significantly worsens the prognosis of the disease. With a decrease in glycemia ≤ 2.8 mmol / l, administration of a 10% glucose solution is indicated.

Chronic disorders of cerebral circulation

Micro- and macroangiopathy of cerebral vessels in diabetes mellitus is aggravated by metabolic changes. Chronic impairment of cerebral blood flow in diabetes is called diabetic encephalopathy.

Diabetic encephalopathy - is a persistent cerebral pathology, which is formed by acute and chronic diabetic metabolic and vascular disorders, clinically manifested by neurological symptoms, as well as psychopathological changes.

Etiology and pathogenesis

Decompensation of diabetes mellitus, tendency to ketoacidotic and hypoglycemic conditions, diabetic nephropathy, obesity, arterial hypertension, dyslipidemia are the main risk factors for diabetic encephalopathy.

Diabetic encephalopathy is a complex of neurological, metabolic and vascular disorders. The progression of diabetes and fluctuations in glycemic levels gradually modifies the "intima-media" system of the cerebral arteries - leading to a thinning of the muscle layer simultaneously with thickening of the intima. As a result, the risk of parietal thrombus formation, the formation of hemodynamically significant stenosis with the threat of absolute vessel occlusion, and the occurrence of ischemic hypoxia increases significantly. As a result of the latter mechanisms, atrophic changes in neurons occur, with the destruction of the axial cylinder and the myelin sheath. "Dumb strokes" (heart attacks of small areas of the deep sections of the white matter) - a consequence of the defeat of small arteries.

Clinic

Cognitive disorders, as determined during psychodiagnostics, are characteristic signs of diabetic encephalopathy. Patients are diagnosed with disorders of interhemispheric interaction, praxis, gnosis, visual and auditory memory, speech and spatial functions. These signs can be both mildly pronounced and manifest as dementia with complete helplessness of patients. As a result, self-monitoring and adherence to medical recommendations are difficult, which significantly reduces the chance of diabetes becoming compensated.

Characterized by complaints of a persistent nature headache, emotional lability, dizziness, attention and memory disorders, coordination disorders, changes in the sleep formula. With the progression of the disease, subjective symptoms give way to polymorphic objective ones: vestibular and cerebellar syndromes, manifestations of pyramidal and extrapyramidal insufficiency, neurosis-like and autonomic disorders.

Diagnostics

The diagnosis of diabetic encephalopathy requires a thorough study of the history, neurological examination, studies of cerebral hemodynamics and structural changes in the brain, and psychodiagnostics.

Among the set of diagnostic criteria are the type and stage of diabetes, clinical indicators (emotional-affective, cognitive and neurological disorders), paraclinic of cerebrovascular deficiency, data of cerebral hemodynamics.

Neuroimaging picture (CT, MRI) characterized by cerebral atrophy, expansion of the ventricles and subarachnoid space. Bilateral formations are also recorded with a decrease in the density of the surrounding area of \u200b\u200bthe lateral ventricles - leukoaraiosis ("luminescence of the perintricular space"). Small focal single or multiple lacunar infarctions are noted in the white matter and subcortical nodes. They are localized in the area of \u200b\u200bthe location of small vessels, primarily responding to changes in hemodynamics.

Method duplex doppler the most optimal for the study of cerebral hemodynamics. Atherosclerotic plaques with foci of calcification, heterogeneous structure are recorded. Changes in the differentiation of the "intima-media" complex of cerebral vessels are characteristic. Stenosis of predominantly carotid arteries and a decrease in cerebral blood flow are also noted.

Treatment

Preventive and therapeutic algorithms for chronic diabetic encephalopathy are based on the correction of arterial hypertension and obesity. coagulation disorders, hyper- and dyslipidemia, compensation of carbohydrate metabolism.

Pathogenetic therapy involves the use of preparations of alpha-lipoic (thioctic) acid 600 mg / day, antioxidants, vitamins of group B. In order to improve cerebral metabolism and hemodynamics, neurotrophic (cerebrolysin 10-20 mg / day), membrane stabilizing (citicoline 600 mg / day) are prescribed , vasoactive (nicergoline 30 mg / day), anticholinesterase (gliatilin 1.2 g / day), nootropic (piracetam 2, 4 g / day, pramiracetam 1.2 g / day) drugs.

The presence of diabetes mellitus significantly increases the risk of death in cerebrovascular events of different nature and significantly worsens the further prognosis of the disease. This requires special attention in relation to such patients. Rehabilitation measures involve the control of hemodynamics, the maximum possible specific compensation for disturbed carbohydrate and other types of metabolism, the organization of proper care, attention and tolerance on the part of the patient's relatives

With diabetes mellitus, the circulatory system suffers one of the first. In the body healthy person blood circulates freely through the veins and capillaries. Together with it, oxygen and nutrients are delivered to the cells of various organs. From cells, in turn, decay products are removed and transported to the excretory organs.

Functioning with age circulatory system is violated, it can no longer cope with the full performance of its tasks. If, at the same time, such a pathology as diabetes mellitus develops in the body, this process is significantly accelerated.

Due to insufficient nutrition and oxygen saturation, any organ can malfunction. The lower extremities are often seriously affected.

Patients with diabetes initially complain of rapid fatigability of the legs, heaviness in the calves, swelling of the ankle joint. And later - on bloating of veins, varicose veins and thrombosis. The main danger is that with weakened immunity, damaged vessels quickly form nodes, ulcerations appear on the skin, turning into extensive trophic ulcers.

With diabetes mellitus, any, even minor wounds, are very difficult to treat and are prone to suppuration. A trophic ulcer can cause gangrene, and this entails amputation of a limb. Therefore, all diabetics need to know how to improve blood circulation in the legs.

Why blood circulation is impaired

To fix the problem, you need to know the cause of the problem. Circulatory disorders are caused by:

• Sedentary lifestyle;
• Overweight;
• Bad habits, especially smoking;
• Improper nutrition;
• Wrong metabolism.

If labor activity associated with prolonged standing or in one position, carrying or lifting weights, this also leads to insufficient blood supply to the lower extremities.

How is blood circulation disorder in the legs manifested?

Anyone who is attentive to their health can independently understand when problems with blood flow begin. Discomfort in lower limbs and pain in the evening for no apparent reason, for women - pain after several hours in narrow high-heeled shoes first of all indicate that the vessels are not in order.

In diabetes mellitus, swollen veins and spider veins are often visually visible on the skin of the legs. If the swelling and swelling persists even after a night's rest, you should see a doctor immediately. A condition in which the legs swell with diabetes is not uncommon.

For accurate diagnosis, an ultrasound method is used. With its help, the state of even the intramuscular vessels of the lower extremities is revealed.

How to normalize blood flow in your legs

The sooner a problem is discovered and measures are taken to eliminate it, the easier it will be to cope with it and not remember for as long as possible. The very first and main method of dealing with impaired blood circulation is remedial gymnastics. It is also not contraindicated in diabetes mellitus - moderate physical activity is necessary.

1. "Bike". Starting position - on your back, lying on the floor. Bend your legs at the knees, bend your arms at the elbows, place your palms under your head. Start "pedaling" with your feet in the air. In this case, it is important to stretch your legs and socks as much as possible, tension should be felt in the muscles. Perform daily for at least 20 minutes.
2. "Birch". The starting position is lying on your back. Pull your knees to your chin, then straighten your legs up, perpendicular to the floor, supporting your back with your palms just above the waist. You need to lean on your elbows and shoulder blades. You need to try to keep your legs straight, breathe evenly. Hold in this position for at least 1 minute, then carefully return to the starting position. Repeat the exercise 5-10 times.

Improvements will be noticeable after 2-3 weeks of regular training.

Morning jogging, walking, fitness, rollerblading and ice skating are recommended. You should try to move as much as possible, preferring walking to public transport and elevators. At the same time, the shoes must be not tight and without a heel.

How to improve blood circulation in the legs for those who are forced to sit for many hours at work? In this case, you need to put a small bench under the table, in extreme cases - a stack of books or magazines. From time to time, you should raise your legs on this support to facilitate the outflow of blood.

Certain foods can help cope with poor circulation. Sour apples, boiled beets, raw garlic have a tonic and strengthening effect on blood vessels.

The improvements will not be noticeable right away, but they will take hold for a long time if you use these products every day. With diabetes, they are allowed.

Traditional medicine recipes

IN folk medicine adonis is used to prevent circulatory disorders in the legs. To prepare the broth, pour one teaspoon of raw materials with a glass of water, bring to a boil and cook over low heat for 5 minutes. Then they insist for three quarters of an hour, filter and bring the volume to 200 ml with boiled water. You need to take the broth in a tablespoon three times a day.

In the same way, a decoction of marsh wild rosemary is prepared. The course of treatment lasts 3 weeks, after which there should be improvements.

It is very important to normalize weight and give up bad habits... It is imperative to exclude alcohol, fatty foods, smoked meats, semi-finished products and fast food.

If all these measures in combination with physical exercises do not bring results, you should consult a doctor - he will prescribe an additional ointment or other medications to restore blood circulation.

Prevention

Since in diabetes mellitus circulatory disorders in the legs lead to the most serious complications up to amputation, diabetics should especially carefully monitor the condition of their legs and be sure to follow preventive measures.

1. The lower limbs should always be in an elevated position, even when the person is lying. For this, benches, rollers and pillows are used.
2. Do not leave your legs motionless for a long time. It is enough just to at least move your fingers from time to time if there is no way to warm up. When open wounds physical exercise should be abandoned - it can delay the healing process.
3. Regular foot baths with sea or aromatic salt help to normalize blood circulation.
4. You should carefully choose socks and stockings - the upper elastic should not be tight, preventing blood flow. Now special anti-varicose socks and knee-highs for diabetics are produced.
5. Be sure to use an ointment for varicose veins, thrombosis, you can homemade or pharmacy (after the approval of the attending physician). A special ointment for the feet helps with diabetes mellitus.
6. Most diabetics already adhere to a strict diet. This is especially important in case of impaired circulation of the lower extremities. High cholesterol and obesity greatly affect blood flow, making it difficult. Therefore, it is important to prevent the deposition of slags and toxins in the vessels.
7. High blood pressure is another negative factor that affects blood circulation. Limit your intake of caffeinated foods, eliminate alcohol, and avoid any stress.

Massage of the feet will help to quickly improve the outflow of blood - you can do it yourself, additionally rubbing in an ointment that stimulates blood flow.

The most important task blood vessels is the provision of nutrition and oxygen to all cells of the body. Through them, the blood is transferred from the heart to all cells, tissues and organs, and then returns to it again.

By vessels we mean:

• capillaries;
• veins;
• arteries.

Capillaries are microscopic tubular elements that branch out a thousand times along the way from one organ to another. It is in the capillaries that vital substances are exchanged between cells and arterial blood. Also, the vessels remove metabolic products and carbon dioxide from the body, which the tissues give back, receiving nutrition and oxygen in return. Even with the smallest circulatory disorders, failures occur that impede this process and develop diseases associated with a violation of the blood supply to the tissues and cells of the body. In this article we will try to competently answer the question of how to improve blood circulation in the legs.

Causes of the phenomenon

The reasons that cause impaired blood supply are divided into several groups:

• peripheral angiopathy (often develops in diabetes mellitus, peripheral atherosclerosis);
• blockage of blood vessels in atherosclerotic diseases;
• inflammation of the artery walls, which leads to their spasm.

The above violations provoke the following diseases:

1. Atherosclerosis of the legs, which is called obliterating (a chronic ailment characterized by numbness of the legs and lameness). The disease develops due to the accumulation of lipids and cholesterol plaques in the vessels, which lead to blockage of the capillaries (in whole or in part).
2. Thromboangiitis obliterans (endarteritis). The disease is of an autoimmune nature. It is manifested by the fact that the spasmodic vessels of the thigh do not feed well with blood, as a result of circulatory disorders. The disease affects mainly young men who abuse nicotine.
3. Vascular damage as a result of the presence of diabetes mellitus. In medicine, the term "diabetic foot" is well known. As a result of circulatory disorders in the legs, gangrene (necrotic lesion of the foot) begins, which is not given to conservative treatment. Typically, a diabetic foot leads to its amputation.
4. Thrombophlebitis.

Symptoms of circulatory disorders

Violation of blood supply in the legs is manifested by painful sensations when walking, which disappear at rest. This symptom is a hallmark of diseases that indicate serious problems with the arteries. It's called intermittent claudication.

There are several factors that trigger the development of intermittent claudication:

• abuse of nicotine and alcohol;
• elderly age;
• violation of lipid metabolism;
• obesity;
• psycho - emotional stress;
• genetic predisposition;
• diabetes.

With this symptom, the following are observed:

• pain in different parts of the leg: in the lumbar region, foot, knee or hip;
• numbness and chilliness of the limb;
• weakness in the legs;
• heaviness in the legs, a person can hardly move his legs;
• frequent convulsions.

In some cases, atherosclerosis of the lower extremities does not show any symptoms.

Diagnosis of circulatory disorders

In order to take measures to improve blood supply, it is necessary to accurately diagnose such disorders.

For diagnosis, you should contact a vascular surgeon (angiosurgeon), who will prescribe a variety of instrumental studies:

1. Doppler (Doppler) of the vessels (ultrasound of the vessels of the legs). The essence of the method lies in the ability of ultrasonic waves to penetrate into tissues and repel from the surface of erythrocytes, which are part of the blood and move with it. Doppler detects areas where blood is stagnant. In other words, if the mobility of these blood cells in certain areas is reduced, then a violation of the blood supply is diagnosed.
2. Angiography of the vessels of the legs. It is an instrumental contrast study of capillaries, veins and arteries, which allows you to determine the state of the walls of blood vessels, as well as the presence of barriers that impede normal blood circulation.
3. Thermometry (determination of the temperature of the skin of the lower extremities).
4. Contrast magnetic resonance imaging (MRI). In order to receive top scores, the MRI procedure is combined with the introduction into the body contrast agent... It is given intravenously for better diagnosis.
5. Capillaroscopy. A method that evaluates the condition of soft tissue capillaries. But on the basis of this method it is possible to determine the level of blood microcirculation.

How to improve blood circulation in the legs?

Poor circulation in the legs affects the functioning of the whole body. Therefore, this condition is subject to urgent correction. Violation of blood supply is treated in two ways:

• Conservatively;
• Surgically.

In order not to resort to surgical intervention, it is necessary to start in a timely manner conservative treatment... It consists in carrying out treatment with:

• physiotherapy procedures;
• pharmacological preparations;
• physiotherapy exercises;
• massage.

For successful treatment it is necessary to completely change your lifestyle and get rid of bad habits (alcohol and nicotine consumption, fatty foods, a sedentary lifestyle).

Pharmacological treatment involves taking:

• antiplatelet agents (drugs that improve blood circulation);
• anticoagulants (drugs that prevent blood clots);
• statins (drugs that lower cholesterol production);
• phlebotonics (drugs that improve vascular tone);
• diuretics (diuretics that relieve congestion in the legs)

In advanced cases (with untimely access to a doctor), there will be a need for surgical treatment, which is carried out in two directions:

• angioplasty;
• open surgery.

Angioplasty speaks for itself. This is a surgical procedure to replace an affected vessel with a stent, a metal device that is implanted into the vessel to ensure its patency.

Open surgery is a full-fledged surgical operation that is performed with the aim of creating an artificial vessel (shunt), bypassing the affected. To create such vessels, a donor artery (from the patient's own vessels) is taken and shunting is performed. The shunt can also be made of plastic.

Therapeutic exercises for circulatory disorders of the legs

The state of health will improve completely only when the person starts to do moderate physical exercise. You don't have to visit fitness centers or gyms for this. Taking short walks, swimming, hiking, cycling, dancing and yoga can improve blood flow. When performing special exercises to correct blood supply, it is necessary to choose those that are suitable for a person according to his illness and well-being. In addition, it should be remembered that there are activities that are strictly contraindicated for people with impaired blood circulation in the legs. These include:

• mountaineering;
• weightlifting (lifting the barbell);
• track and field athletics (all its types).

Otherwise, serious complications may appear that will require surgical treatment... Why is it so important in a short time restore normal blood circulation in the lower extremities? Thanks to high-quality blood supply to the lower extremities, tissues are enriched with nutrients, get rid of metabolic end products, which contributes to the health and strength of the legs. Unfortunately, diseases that provoke violations of blood circulation in the lower extremities are chronic and cannot be completely eliminated. In this case, the most best effect, which can be achieved is the suspension of the progression of the disease.

Exercises to improve circulation in the legs

Since the most effective and simple way to normalize blood circulation in the legs is physiotherapy exercises, they should be started immediately after the problem is detected. Moderate exercise is encouraged even if the patient has diabetes. These exercises can be done at home as they are simple and very easy to do.

Improves blood circulation and appearance legs, the following exercises:

1. Slowly rise and fall on your toes, while feeling the tension in each muscle of the legs.
2. Take turns lifting your legs off the floor, while doing circular motion foot.
3. Exercise scissors. Lie on the floor, lift both legs up, then cross your straight legs, making the "scissor" movements.
4. Exercise bike. Lie on the floor, bend your knees, make movements imitating the rotation of the bicycle pedals.
5. Exercise "Birch". Lying on the floor, raise your legs up, perpendicular to the floor and bend them to your chin. Place your arms on your back slightly above your waist. The entire body weight should rest on the arms and shoulder blades. Stay in this position for a few seconds, and then gently lie on the floor.

All exercises must be repeated 5-10 times. Roller skating and ice skating are very useful, provided that the person has similar skills. If you learn to do this on purpose, you can get injured, which is not at all conducive to leg health. You need to move as much as possible, walk often, climb stairs on your own without an elevator, and try to avoid public transport.

General tips to improve blood circulation in the lower extremities

In everyday life and at work, the following rules should be observed:

1. Do not stand too long on your feet and do not sit for a long time at your desk. It is necessary to move throughout the day for blood to circulate normally through the veins and arteries. If there is a need to stay in the same position for several hours, then you should interrupt and perform several exercises that improve blood circulation in the legs. Office workers are encouraged to take a break every hour. You can just walk a few steps and return to your workplace.
2. It is necessary to adopt a body posture that will promote normal blood circulation. Do not cross your legs while sitting at the table, as this position of the legs interferes with normal blood circulation. You need to sit so that your legs are slightly apart on the sides, and your feet rest on the floor. But even in this position, one should not stay too long. It is also recommended to get up and walk, to raise your legs so as not to stay in one position for a long time. You can raise your legs on a small chair or stool to improve blood flow.
3. Do leg exercises. Any exercise that can engage your legs improves circulation. It is also important to do leg relaxation exercises. There are many relaxing postures and exercises that improve the condition of not only the lower limbs, but also the cardio - vascular system.
4. Wearing comfortable shoes. Tight, uncomfortable shoes with high heels and stiletto heels severely impede normal blood circulation. In addition, blood circulation from the legs to the heart is impaired. Therefore, uncomfortable high-heeled shoes should be avoided or only worn on certain occasions. A good substitute for heels is a platform. If, for example, a woman needs extra height, then you should wear platform shoes that are not so detrimental to the condition of the legs.
5. Wearing compression stockings... These stockings improve blood flow and are specially designed to stimulate it. They can be purchased at the pharmacy or ordered according to your individual needs.
6. To give up smoking. It is this addiction that contributes to the development of peripheral diseases. In this case, the veins and arteries of the lower extremities lose their elasticity and are no longer able to circulate blood. Therefore, people with poor circulation should give up this bad habit.
7. Accept quality nutritional supplements... Dietary supplements are able to stimulate blood circulation in the cardiovascular system and dilate blood vessels. The best remedy from this category are nutritional supplements containing the extract of the ginkgo biloba plant. It is used internally as a tea, after adding fresh ginger to it. Such a drink should be included in the daily diet of a person who has a violation of blood circulation. Birch bark tea has the same properties. It tastes very good, especially with the addition of natural honey. Cayenne pepper tea dilates blood vessels and improves blood circulation. Cayenne pepper can also be added to food. Fish oil supplements are good for stimulating blood circulation. Because the fish fat contains omega-3 acids, such supplements are essential for healthy fat metabolism. They are available in capsules and tablets.
8. Proper nutrition. The daily diet should be balanced, with a lot of fresh vegetables and fruits. It is very important to reduce the amount of salt consumed, as salt retains water in the body and contributes to the formation of edema.
9. Control your body weight. It is necessary to monitor the amount of calories consumed, since excess weight loads the joints and the circulatory system, and excessively fatty food contributes to the formation of sclerotic plaques and blockage of blood vessels.

Diabetic angiopathies - generalized vascular lesion in diabetes mellitus, extending both to small vessels (microangiopathy) and to medium and large (macroangiopathy).

Diabetic macroangiopathy - This is atherosclerosis of arteries of large and medium caliber, which develops in patients with diabetes mellitus.

Diabetic microangiopathy - This is a widespread defeat of small vessels (capillaries, arterioles, venules) specific to diabetes mellitus.

9.1. Treatment of diabetic microangiopathies

The basic principles of treatment of diabetic microangiopathies are as follows.

9.1.1. Diabetes compensation

Thorough compensation of diabetes mellitus, normalization of carbohydrate, protein, lipid metabolism, elimination of multivitamin deficiency prevent the progression of microangiopathies and reduce their severity.

9.1.2. Coursework coenzyme treatment

Cocarboxylase (coenzyme of vitamin Bi) - injected intramuscularly at 50-100 mg 1 time per day for 20 days.

Pyridoxal phosphate (coenzyme of vitamin Bb) - available in tablets of 0.02 g, 1-2 tablets are prescribed 3 times a day for 1-2 months.

Riboflavin Mononucleotide (coenzyme of vitamin B2) - applied intramuscularly or subcutaneously, 1 ml of 1% solution once a day for 20 days.

Flavinate (coenzyme formed from riboflavin) - applied intramuscularly at 0.002 g 1-3 times a day for 15-20 days.

Coenzyme treatment helps to normalize all types of metabolism in diabetes mellitus.

9.1.3. The use of angioprotectors

Angioprotectors - group medicinesthat improve the condition of the vascular wall and reduce its pathological permeability.

Angina (prodectin, parmidin) - available in tablets of 0.25 g. The drug reduces increased vascular permeability, exerting an inhibitory effect on bradykinin, reduces infiltration into the vascular wall of atherogenic pre-β- and β-lipoproteins, reduces platelet aggregation, improves microcirculation, promotes resorption of hemorrhage , reduces trophic disorders and manifestations of nephroangiosclerosis. It is prescribed 0.25-0.5 g 3 times a day for 2-5 months or more.

Dicinon (etamsilate) - available in 0.25 g tablets and 2 ml ampoules of 12.5% \u200b\u200bsolution. The drug significantly increases the stability of capillaries, improves microcirculation, causes a hemostatic effect, at the same time does not increase blood coagulation. Dicinone is used mainly for diabetic retinopathies with hemorrhages, it is administered orally at 0.25 g 3 times a day for 2-3 weeks.

Dicinone is administered intramuscularly, 2 ml 1-2 times a day, the course of treatment is 20-50 injections. You can also use the drug subconjunctivally or retrobulbar 1 ml.

When intravenous administration the hemostatic effect occurs after 7-15 minutes, the maximum effect is manifested after 1-2 hours, the duration of the drug's action is 4-6 hours.

Doxium (calcium dobesilate) - available in tablets of 0.25 g. Reduces capillary permeability and platelet aggregation, has antihemorrhagic and antiexudative effects. The drug is especially effective in diabetic retinopathy. Doxium is prescribed orally at 0.25 g 3-4 times a day, the course of treatment lasts 4-6 months. Treatment with courses can be carried out for 5-6 years.

Doxilek - available in capsules, 1 capsule contains 500 mg of calcium dobesilate monohydrate. The drug is prescribed 1-2 capsules 2-3 times a day after meals for several months.

Emoxipin - is available in ampoules of 1 ml in the form of a 1% solution. Along with the angioprotective and anticoagulant effect, it also has the ability to suppress lipid peroxidation (antioxidant effect).

Emoxipin promotes resorption of hemorrhages and is used mainly for diabetic retinopathies.

The drug is injected retrobulbar, 0.5 ml daily for 10-15 days, subconjunctivally and parabulbarly, 0.2-0.5 ml once a day or every other day for 10-30 days. The treatment is repeated 2-3 times a year.

In the treatment of diabetic retinopathy by laser coagulation, emoxipin is administered at a dose of 0.5 ml retrobulbar one day and 1 hour before coagulation, and then once a day at the same dose for 2-10 days.

Endotheyaon - contains a dimer of procyanidol, the most active substance from the group of biflavonoids, reduces permeability and strengthens the capillary wall, interacting with collagen and mucopolysaccharides. Available in 50 mg tablets. It is prescribed 1 tablet 2 times a day.

Complamin (xanthinol nicotinate, theonikol) - available in tablets of 0.15 g and in ampoules of 2 ml of 5% solution.

The drug improves microcirculation, oxygen supply to tissues, reduces capillary permeability, increases blood fibrinolytic activity, reduces platelet aggregation, and has an antiatherogenic effect.

Complamin consists of two components: a xanthine base and an antiplatelet agent (pyridine-3-carboxylinic acid). The drug is administered orally at 0.15 g 3-4 times a day for a month or longer.

Divascan (iprazochrome) is a serotonin antagonist and an inhibitor of the synthesis of group E prostaglandins. It normalizes vascular permeability and has an antiplatelet effect. It is administered orally 2.5 mg 3 times a day for 1-3 months.

9.1.4. Antiplatelet treatment

Antiplatelet agents reduce platelet aggregation and the formation of microthrombi in the microcirculation system, significantly improving it functional state.

Heparin - along with anticoagulant and antiplatelet properties, it is injected under the skin of the abdomen, 5000 units 4 times a day for 2-3 weeks with a gradual dose reduction (used mainly for diabetic retinopathies, retinal vascular thrombosis).

Trental (pentoxifylline) - available in tablets of 0.1 and 0.3 g and in ampoules of 100 and 300 mg. 2 tablets are used 3 times a day for 1 month, then 1 tablet 3 times a day for 1-2 months. After taking trental, flushing of the face, a feeling of heat are possible.

Curantil (dipyridamole) - available in tablets of 0.025 g, 1-2 tablets are prescribed 3 times a day for 1-2 months.

Acetylsalicylic acid - used as an antiplatelet agent in a daily dose of 0.16-0.3 g. Preference is given to microcrystallized preparations acetylsalicylic acid - micristina et al. Mikristin is prescribed 0.1 g 3 times a day. Microcrystallized preparations of acetylsalicylic acid are less likely to cause gastropathy and dyspeptic symptoms.

Ticlopidine (tiklid) - available in tablets of 0.2 g, 1 tablet is prescribed 1-2 times a day for 3-4 weeks.

Reopoliglyukin - 10% solution of low molecular weight dextran in isotonic sodium chloride solution, administered intravenously, 400 ml, 2-3 times a week. The course of treatment is 6-8 intravenous infusions.

9.1.5. The use of actisorbitol drugs

For the treatment of diabetic neuropathy and angiopathies, aldose reductase inhibitors are used, which affect the normalization of polyol glucose metabolism - alrestatin, sorbinal, isodibut.

Under the influence of treatment with isodibut, the conductivity of both sensory and motor nerves improves and even normalizes, decreases clinical manifestations diabetic polyneuropathy (M.I. Balabolkin, 1994). Isodibut is prescribed in tablets of 0.5 g 3 times a day.

Treatment with nicotinamide also contributes to a decrease in the activity of the polyol shunt. In addition, nicotinamide promotes the regeneration of the islets of Langerhans.

9.1.6. Suppression of lipid peroxidation activity

In diabetes mellitus, lipid peroxidation is activated, excessive formation of free radicals occurs, which contributes to cell damage and death, the development of angio- and neuropathies.

Treatment with antioxidant agents improves lipid metabolism and significantly reduces peroxidation.

Sh.A. Erzhakova and M.I. Balabolkin (1994) recommend carrying out complex antioxidant therapy, including α-tocopherol (vitamin E) 100 mg per day, nicotinamide 75 mg per day, ascorbic acid 650 mg per day for 3 weeks.

9.1.7. Increased activity of pyruvate dehydrohecase

It has been found that a decrease in the activity of pyruvate hydrogenase (PDH) and the accumulation of pyruvic acid in the body of a patient with diabetes mellitus contribute to the development of microangiopathies, neuropathies, and activation of lipid peroxidation (V.V. Ostapova, 1984).

The mechanism of action of dipromonium is that it converts inactive phosphorylated PDH into active dephosphorylated one.

With a decrease in the content of pyruvate in the blood under the influence of drugs that increase the activity of PDH, there is an improvement general condition patients, a decrease in glycemia, a more stable course of diabetes mellitus, a decrease in pain and numbness in the legs, an improvement in gastrointestinal motility.

9.1.8. Decrease in vasospastic reactions

In order to reduce vasospastic reactions, nikoshpan (1-2 tablets 3 times a day for 3-4 weeks), andecalin (in tablets of 0.005 g, 2 tablets 3 times a day for 1 month or intramuscularly 10-40 IU once a day for 2-4 weeks; the drug is a purified extract of the pancreas that does not contain insulin), aCE inhibitors (see “Treatment of Diabetic Nephropathy”)

9.1.9. Physiotherapy treatment

Physiotherapy treatment is carried out differentially depending on the localization and severity of angio- and neuropathy (see below).

9.2. Diabetic retinopathy treatment

Diabetic retinopathy treatment program:

• normalization of metabolic disorders;
• the use of angioprotectors and antiplatelet agents; treatment with endothalon and ticlopidine has certain advantages;
• the introduction of emoxipin retrobulbar or subconjunctivally;
• the introduction of subconjunctival antiproteolytic drugs (trypsin) for resorption of hemorrhages; for the same purpose, transorbital electrophoresis of lidase is carried out;
• treatment with heparin subcutaneously or using transorbital electrophoresis for retinal vascular thrombosis;
• conducting laser photocoagulation in case of excessive vascular formation.

9.3. Diabetic Nephropathy Treatment

Diabetic Nephropathy Treatment Program:

• compensation of diabetes mellitus and metabolic disorders;
• treatment with antiplatelet agents and angioprotectors;
• with the development of chronic renal failure - a diet with limited protein and salt;
• diuretic therapy (furosemide, hypothiazide) with the appearance of edema and arterial hypertension;
• antihypertensive therapy in the development of arterial hypertension (reserpine, brinedrine, cristepine, calcium antagonists);
• treatment with ACE inhibitors;
• combination therapy with diabetes and insulin in patients with IDDM and stage I diabetic nephropathy (EP Kashirina, 1990); this treatment not only prevents the progression of microangiopathy, but also helps to improve the functional state of the kidneys;
• with the development of chronic renal failure, treatment is carried out as described in Ch. "Treatment of chronic renal failure."

An important role in the development and progression of diabetic nephropathy is played by hemodynamic disorders - intraventricular and systemic hypertension. ACE inhibitors have not only antihypertensive activity, but also the ability to normalize intraglomerular hemodynamics, thereby exerting a nephroprotective effect (Anderson et al., 1985).

M.V. Shestakova et al. (1995) found that the appointment of an ACE inhibitor renitek (enalapril) is indicated for all patients with onset (microalbuminuria) and severe diabetic nephropathy (proteinuria). The daily dose of the drug ranges from 5 mg in patients with normal blood pressure to 10-25 mg in patients with arterial hypertension... Already after 1 month and especially after 6 months, a significant decrease in albuminuria is found.

The antiproteinuric effect of ACE inhibitors in patients with normal blood pressure at doses that do not cause arterial hypotension has been proven. In patients with diabetes mellitus and arterial hypertension, the antiproteinuric effect correlates with the degree of decrease in systemic blood pressure.

After the abolition of ACE inhibitors, the antiproteinuric effect lasts from several weeks to 6 months, depending on the stage of kidney damage and the severity of morphological changes renal tissue... The less pronounced sclerotic changes in the glomeruli and the earlier treatment is started, the greater the likelihood of reverse development of initial changes and long-term preservation of the antiproteinuric effect after drug withdrawal.

Early treatment (at the stage of microalbuminuria - i.e. excretion of albumin in the urine no more than 300 mg per day) allows therapy with ACE inhibitors in courses (for 6 months a year) under the control of albumin excretion in the urine at least once every 2 months ...

If the treatment of a patient with diabetic nephropathy is started for the first time at the stage of proteinuria, then it should be carried out continuously or in more frequent courses.

In patients with diabetes mellitus without diabetic nephropathy (urinary albumin excretion no more than 30 mg per day) with preserved functional renal reserve (i.e., the ability of the kidneys to increase the glomerular filtration rate by no more than 5% in response to protein load), treatment with ACE inhibitors impractical. These patients have no risk of developing diabetic nephropathy in the near future, and treatment with ACE inhibitors causes the development of hyperfiltration and worsens the functional state of the kidneys.

Currently, ACE inhibitors are considered the means of choice in the treatment of diabetic nephropathy, as well as means of preventing and inhibiting chronic renal failure (OM Eliseev, 1995).

9.4. Treatment of diabetic angiopatin of the lower extremities

Treatment program for diabetic angiopathy of the lower extremities:

• thorough compensation of diabetes mellitus;
• drug therapy for hyperlipoproteinemia;
• treatment with angioprotectors and antiplatelet agents;
• treatment with nicotinic acid (it activates fibrinolysis, has a vasodilating effect); the drug is injected intramuscularly in 2 ml of 1% solution 1 time per day for 20 days;
• treatment with andecalin (angiotrophin);
• physiotherapeutic treatment in order to improve microcirculation and trophism (magnetotherapy, SMT, endovascular low-intensity laser blood irradiation, local barotherapy for 4-6 hours daily for 20 days, the use of turpentine, iodine-bromine, hydrogen sulfide baths);
• stimulation of trophic processes in the tissues of the lower extremities by treatment with solcoseryl - a protein-free extract of the blood of young calves; the drug is administered intramuscularly, 2 ml once a day for 20-30 days;
• intra-arterial injection of a mixture of the following composition: 100 ml of a 0.5% solution of novocaine, 1 ml of a 2.5% solution nicotinic acid, 5000 U of heparin; the mixture is injected once every 3-5 days, the course of treatment is 7 injections.

9.5. Diabetic neuropathy treatment

Diabetic neuropathy- defeat nervous system in patients with diabetes mellitus.

Diabetic Neuropathy Treatment Program:

• achieving full compensation for diabetes mellitus;
• intense metabolic therapy with the wide use of coenzymes (pyridoxal phosphate, cocarboxylase, riboflavin mononucleotide, lipoic acid).

Lipoic acid is a coenzyme that is part of the enzymatic system for decarboxylation of pyruvic and other a-keto acids. Under the influence of lipoic acid, more intense oxidation of excess pyruvic and α-ketoglutaric acids occurs and their irritating effect on the nerve endings is eliminated. Optimal dosage form lipoic acid is a drug Liponsaureratiopharm 300 containing 300 mg of substance in one tablet. It is prescribed 1 tablet 1-2 times a day, regardless of food intake for 1-2 months;

• the use of antiplatelet agents and angioprotectors, which improves the state of the vasa nervorum and helps to normalize the functional state nerve fibers;
• treatment with proserin 0.01-0.015 g 2-3 times a day for
• 15-30 days to improve conduction along the nerve pathways;
• a decrease in the activity of the sorbitol shunt with the help of aldose reductase inhibitors (isodibut, etc.), which helps to improve the function of the nerve trunks;
• widespread use of physiotherapeutic methods. They have an analgesic effect, improve the functional state of nerve endings, reduce the sensation of paresthesias, and restore sensitivity.

The most commonly used physiotherapy procedures are as follows.

9.5.1. Electrotherapy

In diabetes mellitus, the content of free sulfhydryl groups in blood serum is reduced. The deficiency of sulfhydryl groups is pathognomonic for diabetic polyneuropathy. In order to replenish them, it is recommended electrophoresis of 5% sodium thiosulfate solution from a negative electrode with a current of 10 mA for 10 minutes, the course of treatment is 10 procedures. A similar effect has unitiol electrophoresis.

With a combination of diabetic angiopathies of the lower extremities with polyneuropathy, it is recommended to start physiotherapy with a UHF course using procedures lasting 5-10 minutes, the dosage is oligothermal. Electrodes are placed on the feet and calf muscles, or one electrode is placed on the lumbar region and the other on the calf muscles or feet. UHF causes thermal, analgesic, anti-inflammatory, hypotensive, trophic effects. UHF goes well with radon baths.

Diadynamic (Bernard) currents (DCT) have pronounced analgesic properties, have a positive effect on arterial venous blood flow, lymph flow. DCT is prescribed to the area of \u200b\u200bthe spinal cord with severe trophic disorders. The procedures are performed with the help of SNIM-1, Tonus-G, Tonus-2 devices, they begin with a low intensity of exposure, gradually increasing the current strength by the end of the procedure and the course of treatment. The total duration of the session with one localization of exposure is 10-12 minutes, with 2-3 localizations - up to 30 minutes. The procedures are carried out daily or every other day, the course of treatment is 10-12 procedures. DDT is recommended to be combined with therapeutic baths (carbon dioxide, oxygen, iodine bromine), massage of the extremities.

For pain syndrome caused by diabetic angiopathies, polyneuropathies or their combination, as well as osteochondrosis of the spine, it is indicated amplipulse therapy (sinusoidal modulated currents). The procedures are performed using the Amplipulse-3, Amplipulse-ZT, Amplipulse-4 apparatus. Treatment of CMT improves blood circulation in tissues, has an analgesic effect.

Shown also inductothermy, it has an analgesic, sedative, vasodilatory, anti-inflammatory effect. The duration of the procedure gradually increases from 10 to 20 minutes, and sometimes up to 30 minutes. Inductothermy is prescribed daily.

Widely applied proserin electrophoresis and nicotinic acid according to the lower Vermel technique: current strength - from 5 to 15 mA, duration - 15-20 minutes, course of treatment - 10 procedures, procedures are performed every other day, combining with inductothermy with a cable electrode to the lower extremities, 15 minutes each, current strength - 150 -160 mA, the course of treatment is 10 sessions.

Effective also microwave therapy (centimeter waves - “Luch-58”; decimeter waves - “Wave-2”).

9.5.2. Heat therapy

Applications of mud, peat, paraffin, ozokerite are used.

9.5.3. Balneotherapy

Sulfur-alkaline, carbonic-hydrogen, radon, hydrogen sulfide-iodine-bromine baths, as well as 2- and 4-chamber baths (in case of sensitivity disorders - with proserin, dibazol; for pain - with novocaine, sodium salicylate) are recommended. With lumbosacral radiculitis, Charcot's shower is prescribed.

9.5.4. Microwave resonance therapy

In recent years, the method of microwave resonance therapy for diabetic neuropathy has become widespread. It consists in the impact on the human body \\ '(including through the BAP) by resonant electromagnetic radiation of extremely high frequency (EHF) at a low power level. The device "Port-1" is used, the duration of exposure is 3-5 minutes, the course of treatment is 5-7 procedures.

9.5.5. Massage

Massage of the upper and lower extremities, chest, spine is applied.

9.5.6. Acupuncture

Acupuncture is successfully used in diabetic neuropathy of the lower extremities to relieve or reduce pain, normalize vascular reactivity.

In the mechanism of the analgesic effect of acupuncture, an increase in the production of endorphins is important.

Usually 3-4 points are used along the paravertebral lines in the lower thoracic region and 2-3 distant points.

In recent years, laser puncture using the APL apparatus has been widely used. They affect points of general action, segmental and regional.

The duration of exposure to one BAP is 5-10 s. During one session, 10-12 points are irradiated; in subsequent sessions, they affect the same points as the day before, or others that have not been irradiated before. The course of treatment is 10-12 sessions (S. T. Zubkova, 1987).

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Everyone knows that the human body works fully if every smallest cell receives oxygen and nutrients in full. And this, in turn, requires good functioning of the microvasculature - the smallest vessels in the body, or capillaries. It is in them that the exchange of gases and nutrients between the blood and surrounding tissues.

It looks like this - blood cells (erythrocytes) receive oxygen in the lungs, and thanks to the branched network of vessels in all organs and tissues of the body, deliver it to every organ. All intraorgan vessels are divided into ever smaller arteries, arterioles and, finally, capillaries, in which, thanks to the thinnest wall, gas exchange between blood and organ cells takes place. After the blood has “donated” oxygen to the cells, it collects waste products (carbon dioxide and other substances), which are delivered to the lungs by means of smaller and larger veins and are excreted with exhaled air. In a similar way, cells are enriched with nutrients, which are absorbed in the intestines.

Thus, it is on the state of the liquid part of the blood and the walls of the capillaries themselves that the functioning of the vital important organs - brain, heart, kidneys, etc.

Capillaries are represented by the thinnest tubes, the diameter of which is measured in nanometers, and the wall does not have a muscular membrane and is most suitable for the diffusion of substances in both directions (into the tissue and back into the lumen of the capillaries). The blood flow velocity and blood pressure in these small vessels is extremely slow (about 30 mm Hg), compared to large ones (about 150 mm Hg), which also has favorable value for full-fledged gas exchange between blood and cells.

If, due to any pathological processes, the rheological properties of blood change, ensuring its fluidity and viscosity, or the vessel wall is damaged, then microcirculation disorders occur, which affect the supply of cells internal organs essential substances.

Causes of microcirculation disorders

Such violations are based on the processes of damage to the vascular wall, as a result, its permeability increases. Stagnation of blood develops and the release of its liquid part into the pericellular space, which leads to the compression of small capillaries by an increased volume of intercellular fluid, and exchange between cells and capillaries is disrupted.In addition, in the case when an integral capillary wall is damaged from the inside, for example, in atherosclerosis, as well as in inflammatory or autoimmune diseases vessels, platelets “stick” to it, trying to close the formed defect.

So, the main pathological conditions that lead to a violation of blood flow in the vessels of the microvasculature are:

• Pathology of the central organs of the circulatory system - acute and chronic, all types of shock (traumatic, painful, due to blood loss, etc.), myocardial ischemia, (an increase in blood volume and its stagnation in the venous part of the bloodstream).
• Pathological changes in the ratio of liquid and cellular parts of blood - dehydration or, conversely, an increase in the volume of the liquid part of the blood with an excessive intake of fluid into the body, with increased thrombus formation in the lumen of the vessels.
• Vascular wall diseases:
  1. (literally, vascular inflammation) - primary hemorrhagic, vasculitis in autoimmune diseases (, rheumatoid arthritis, rheumatism), vasculitis in hemorrhagic fevers and with bacteremia (sepsis - the penetration of bacteria into the blood and the generalization of infections),
  2. large and small arteries, when atherosclerotic plaques are deposited on the inner wall of blood vessels, which interfere with normal blood flow,
  3. Damage to the vascular wall and attachment to it in diseases of the veins - with and,
  4. , in which the toxic effect of excess glucose on the inner lining of blood vessels occurs, ischemia (insufficient blood supply) of soft tissues develops.

What are the symptoms of these disorders?

Microcirculation disorders can occur in any organ. However, the most dangerous damage to the capillaries in the heart muscle, in the brain, in the kidneys and in the vessels of the lower extremities.

A heart

typical causes of impaired blood supply heart muscle (myocardium)

Microcirculation disorders in the heart muscle indicate the development of myocardial ischemia, or. This is a chronic disease (IHD), the danger of which is in the development of acute, often fatal, as well as in the formation of chronic heart failure, which leads to the fact that the heart is not able to supply the entire body with blood.

TO initial symptoms disorders of blood flow in the myocardium include such signs as increased fatigue, general weakness, poor tolerance physical activity, when walking. At the stage when severe myocardial ischemia develops, pressing or burning pains appear behind the sternum or in the projection of the heart on the left, as well as in the interscapular region.

Brain

Disorders of microcirculation in the vessels of the brainappears due to acute or chronic. The first group of diseases includes, and the second develops due to a long-term existence, when the carotid arteries feeding the brain are in a state of increased tone, as well as due to damage carotid arteries atherosclerotic plaques or due to a pronounced spine, when the cervical vertebrae put pressure on the carotid arteries.

cerebral ischemia, due to impaired blood supply

In any case, when the nutrition of the brain cells is disturbed, since edema of the intercellular substance also occurs, microinfarctions of the brain substance are possible. All this is called chronic dyscirculatory (CDEP).

The symptoms of DEP include changes in cognitive and mental functions, disturbances in the emotional spectrum, forgetfulness, especially loss of everyday memory, resentment, tearfulness, unsteadiness of gait, and other neurological symptoms.

Kidney

Disorders of microcirculation in the vessels of the kidneysmay occur due to acute or chronic processes. So, in a state of shock, blood does not enter the vessels of the kidneys, as a result of which an acute renal failure... In chronic kidney processes (arterial hypertension, vascular lesions in diabetes mellitus, pyelonephritis and glomerulonephritis), capillary blood flow disorders develop gradually, throughout the entire period of the disease, and manifest clinically, as a rule, with minor signs - rare urination, nocturia (urination at night ), edema on the face.

An acute condition is manifested by the absence of urine (anuria) or a sharp decrease in its amount (oliguria). Acute renal failure is an extremely dangerous condition since without treatment, the body is poisoned with the products of its own metabolism - urea and creatinine.

Lower limbs

Microcirculation disorders in the vessels of the lower extremitiesmost often develop due to acute arteries or veins of the lower extremities, as well as with - damage to the microvasculature in patients with high blood glucose levels. In addition, violations of capillary blood flow in the muscles of the legs and feet occur in smokers due to constant vasospasm of the corresponding vessels and are clinically manifested.

Acute blood flow disturbances in thrombosis are manifested by a sharp edema, paleness or blue discoloration of the limb, and a pronounced pain syndrome in it.

Chronic microcirculation disorders, for example, with or diabetic angiopathy, are characterized by recurrent pain, swelling of the feet, impaired skin sensitivity.

Deserves special attention. This is a condition that develops as a result of prolonged damage to the vascular wall by glucose indigestible by cells, as a result of which macro- and microangiopathy (vascular pathology) develops from minor to severe disorders.

ischemia of the lower extremities and trophic disorders due to diabetes

Minor microcirculation disorders in diabetes are manifested by a feeling of crawling, numbness and cold feet, ingrown nails, fungal infection and cracks in the skin of the soles. Severe disorders develop as a result of the attachment of a secondary bacterial flora due to a decrease in local and general immunity and are manifested by long-term non-healing trophic ulcers. In severe cases, the feet develop and may even require amputation of the feet.

Leather

Also, mention should be made of microcirculation disorders in the vessels of the skin.

In the skin, changes in blood flow and, as a consequence, oxygen supply to cells occur not only with the indicated pathological conditions, for example, in the skin of the extremities with thrombosis or diabetes mellitus, but also in perfectly healthy individuals with the aging process of the skin. Moreover, premature aging can occur in young people and often requires the close attention of cosmetologists.

So, there are variants of spastic, atonic and spastic-stagnant disorders of blood flow in the microvessels of the skin:

Are microcirculatory disorders dangerous?

Undoubtedly, many microcirculation disorders are dangerous to the health and even life of the patient, primarily if they occur acutely. So, blood flow disturbances in small vessels of the heart muscle, which have arisen in acute coronary thrombosis, lead to severe myocardial ischemia, and after a few minutes or hours - to necrosis (death) of heart muscle cells - develops acute heart attack myocardium. The wider the affected area, the worse the prognosis.

For acute thrombosis femoral arteries and veins, any delay in terms of medication and surgery can lead to the loss of a limb.

The same applies to individuals with diabetic angiopathy and diabetic foot syndrome. Such patients should be trained proper care behind your feet, so as not to lose your legs with the development of a purulent infection or gangrene of the foot.

In the case of long-term processes in the body, for example, with microcirculation disorders in the kidneys and in the brain with hypertension, there is, of course, an organ dysfunction, but there is no acute threat to life.

Age-related disorders of blood flow in microvessels of the skin do not pose any danger to life and health at all, but only causes aesthetic problems.

Which doctor should I go to?

Disorders of blood microcirculation are a common process, therefore, an appeal to a specific specialist depends on the presence of primary pathology and clinical manifestations.

If you notice frequent or, conversely, rare urination, accompanied by high blood pressure numbers, as well as heart symptoms (pain in chest, shortness of breath, heart failure), you should consult a physician or cardiologist.

In case of edema, cold snap and discoloration of the extremities (paleness, blue discoloration or redness), it is necessary to visit a vascular or at least a general surgeon. Diabetic foot syndrome is jointly treated by endocrinologists and surgeons.

Disturbances of microcirculation of cerebral vessels due to strokes, hypertension, or osteochondrosis of the spine (the so-called DEP of complex genesis) is the prerogative of neurologists.

Correction of impaired blood flow in the skin and the associated skin aging are performed by cosmetologists and dermatologists.

Improving microcirculation, drugs that improve blood flow

Is it possible to somehow improve or restore blood flow in the smallest vessels of the body? The answer to that is yes, to the present stage In the development of medicine, there are sufficient means capable of regulating the tone of blood vessels, as well as influencing their inner wall and the ability of blood to thrombus, and, thus, contribute to the improvement of microcirculation.

To improve blood circulation in the lower extremities the following groups of drugs are mainly used to improve microcirculation:

1. Antispasmodics (papaverine, spasmalgon) - relieve the tone of large and small vessels due to the effect on the smooth muscle layer in their wall,
2. Angioprotectors and (pentoxifylline (vasonite), trental, curantil) help to improve metabolic processes in the vascular wall itself, due to which its permeability to the liquid part of the blood is stabilized,
3. Biogenic stimulants (solcoseryl, actovegin) have a similar effect as protectors,
4. Vasodilators (nifedipine, amlodipine) also weaken the vascular tone.
5. In acute conditions, drugs are used that reduce blood coagulation and prevent further thrombus formation - (heparin, warfarin), antiplatelet agents (aspirin), fibrinolytics (urokinase, streptokinase, alteplase).

Improve microcirculation in the brain perhaps using the same drugs, but the following are more often used - antispasmodics (drotaverin), vasodilators (cinnarizine, vinpocetine), antiplatelet agents (trental, curantil), microcirculation correctors (betahistin), as well as (piracetam, nootropil), polypeptides (cortexin, cerebrolexin ), preparations of gamma-aminobutyric acid (pantogam, phenibut).

As correctors of microcirculation for the heart muscle, In addition to these drugs, antioxidants and antihypoxants (Mexidol, Preductal) are highly effective, which not only improve blood flow in the capillaries of the myocardium, but also increase the resistance of its cells to oxygen starvation (hypoxia).

From the means allowing to correct microcirculation disorders in the kidneys, more often pentoxifylline, trental and courantil are prescribed.

For facial skinrestoration of microcirculation consists mainly in the use of external cosmetic procedures, such as laser exposure to the skin, mesotherapy, installation of mesothreads, plasmolifting, peeling, massage, various masks with retinoids and many other methods of improving microcirculation. All of them are able to stimulate the work of blood vessels in the skin so that the cells receive enough nutrients and oxygen.

In conclusion, it should be noted that disturbances in blood flow in small vessels is a rather broad concept that includes a large number of diseases as causal factors. Therefore, the search for these factors should be dealt with only by a physician at a full-time appointment, and patients who have some of the above symptoms should seek help from specialists.