В статье анализируется роль микроциркуляторных нарушений в патогенезе рубцовых изменений кожи, в том числе у пациентов с проявлениями метаболического синдрома. Исходные показатели микроциркуляторно-тканевых систем у пациентов с метаболическим синдромом свидетельствуют о более низких значениях уровня общей перфузии, чем у пациентов без признаков метаболических нарушений, что свидетельствует об угнетающем влиянии инсулинорезистентности на микроциркуляцию. Выявленная положительная динамика показателей микроциркуляторно-тканевой системы при проведении ультрафонофореза ферменкола в сочетании с методикой фракционной лазерной терапии позволяет рассматривать сосуды микроциркуляторного звена в качестве основной мишени при проведении коррекции рубцовых изменений кожи. Наблюдаемое через 4 недели после заключительной процедуры усиление нутритивного компонента кровотока и связанного с ним повышения скорости потребления кислорода и уровня окислительного метаболизма указывает на формирование пролонгированного эффекта. Преимущественное влияние рассмотренного способа коррекции рубцо-измененной кожи на отдельные компартменты микроциркуляторно-тканевой системы свидетельствует об эффективности технологии комплексного применения фракционного фототермолиза и ультрафонофореза коллагеназ, обладающей патогенетически ориентированным терапевтическим действием. Наличие в качестве фонового заболевания метаболического синдрома существенно ограничивает выраженность корригирующего эффекта, что обуславливает необходимость применения средств и методов из арсенала восстановительной медицины на основе преимущественного использования немедикаментозных лечебных факторов, которые, обладая выраженным саногенетическим потенциалом, позволяют максимально полно восстановить нарушенные функции при метаболическом синдроме и улучшить качество жизни человека The article analyzes the role of microcirculatory disorders in the pathogenesis of cicatricial changes in the skin, including in patients with manifestations of metabolic syndrome. The initial parameters of microcirculatory-tissue systems in patients with metabolic syndrome indicate lower values of the level of general perfusion than in patients without signs of metabolic disorders, which indicates the inhibitory effect of insulin resistance on microcirculation. The revealed positive dynamics of the indicators of the microcirculatory-tissue system during ultraphonophoresis of fermencol in combination with the method of fractional laser therapy allows us to consider the vessels of the microcirculatory link as the main target when correcting cicatricial changes in the skin. The increase in the nutritional component of the blood flow and the associated increase in the rate of oxygen consumption and the level of oxidative metabolism observed 4 weeks after the final procedure indicates the formation of a prolonged effect. The predominant influence of the considered method of correction of scar-altered skin on individual compartments of the microcirculatory-tissue system indicates the effectiveness of the technology of complex application of fractional photothermolysis and ultraphonophoresis of collagenases, which has a pathogenetically oriented therapeutic effect. The presence of metabolic syndrome as a background disease significantly limits the severity of the corrective effect, which necessitates the use of means and methods from the arsenal of restorative medicine based on the predominant use of non-drug therapeutic factors, which, having a pronounced sanogenetic potential, allow the most complete restoration of impaired functions in MS and improve the quality human life
The article analyzes the efficiency of complex physiotherapy in combination with internal intake of medium-mineralized water “Essentuki № 17” in patients with cicatricial skin changes in the presence or absence of metabolic syndrome. It was found that internal mineral water intake supplementing physiotherapy effectively corrected carbohydrate and lipid metabolism disorders by reducing the insulin resistance index, which contributed to a greater regression of clinical manifestations of cicatricial skin changes in patients with metabolic syndrome. Meanwhile, in the absence of metabolic syndrome, the course intake of mineral water did not signifi cantly affect complex physiotherapy, although the index of insulin resistance and body weight of patients significantly decreased. It is suggested that, given the presence of nonspecifi c preventive potential of the course of drinking mineral waters intake, there is some theoretical and possibly practical interest in research on pre-course mineral water intake before performing cosmetic operations to accelerate the process of skin regeneration and the formation of scarring in a less pronounced form.
The article analyzes the effectiveness of combined application of fractional photothermolysis and fermencol ultraphonophoresis against the background of metabolic syndrome in patients with cicatricial skin changes. It is shown that the efficiency of combined physiotherapy is reduced if it is performed against the background of metabolic syndrome. It is proved that the leading pathogenetic factors of the metabolic syndrome that reduce the therapeutic potential of physiotherapy procedures are insulin resistance and lipid metabolism disorders. It is found that the use of fractional photothermolysis and fermencol ultraphonophoresis does not affect significantly the main parameters of the metabolic syndrome in patients with or without metabolic syndrome. It is suggested that to increase the effectiveness of physiotherapy in patients with cicatricial skin changes in the presence of disorders of carbohydrate and lipid metabolism, provoked by the development of insulin resistance, additional use of therapeutic factors used to correct metabolic disorders is necessary.
The variation of indicators that characterize skin scarring increases in patients with metabolic syndrome, which may affect the effectiveness of therapeutic measures. It has been found that pathological processes in the skin scar in the initial state correlate to the greatest extent with the index of insulin resistance, the atherogenic coefficient and the coefficient of antioxidant protection. It is proved that the effectiveness of complex physiotherapy with the addition of the internal intake of medium-mineralized water «Essentuki №17» directly correlates with an increase in tissue sensitivity to insulin and the activation of antioxidant enzymes, as well as with a decrease in dyslipidemia. Linear regression equations are presented to determine significant predictors of treatment effectiveness, which can lead to the creation of individualized therapeutic programs using preformed and natural physical factors.
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