Современные тенденции в лечении венозных трофических язв у пожилых пациентов

Венозные трофические язвы являются проявлением терминальной стадии хронической венозной недостаточности. Проблема венозных трофических расстройств крайне актуальна ввиду высокой распространенности среди населения. В данном обзоре рассматривается сравнительная характеристика данных заболеваемости на примере Германии и Российской Федерации. Особое внимание уделяется влиянию течения заболевания на психоэмоциональное состояние пациентов во время лечения и возможные последствия несвоевременной или недостаточной по объему и длительности оказываемой квалифицированной помощи. Рассматриваются причины высокозатратного лечения с приблизительными расчетами на 1 клинический случай и общегодовых затрат, по данным зарубежных исследователей (Австралия, Великобритания, США). Перечислены факторы риска в виде определенных сопутствующих нозологий, значительно усугубляющих процесс заживления язвенных дефектов с кратким описанием патогенеза. В обзоре определены основные цели лечения венозных трофических язв, а также выделены отдельные группы направлений, по которым рекомендуется проводить лечебные мероприятия. Проведен сравнительный анализ между способами применения компрессионной терапии (эластическое бинтование, использование специальных трикотажных изделий) и влиянием выбора на качество жизни пациентов. Описаны различные способы местного ухода за дефектами кожи и подкожной клетчатки с обязательным учетом стадии раневого процесса, перечислены альтернативные методики местного лечения (к примеру, применение аутологичной плазмы, обогащенной тромбоцитами). Произведена оценка эффективности системной фармакотерапии при трофических расстройствах и влияния различных групп препаратов на скорость заживления язв. Определены преимущества применения оперативного лечения, перечислены основные хирургические техники с выделением преимуществ и недостатков каждой. По отношению к каждому из способов лечения параллельно проводилась критическая оценка с позиций выбора оптимальных схем в группе пожилых пациентов. Показаны сложности оценки эффективности новых методик и комплексного подхода к лечению, что в последующем поможет скорректировать направления поиска новых путей для решения проблемы венозных язв в данной возрастной категории больных.

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