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Choroba Buergera a trudno gojące się rany

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Choroba Buergera to wieloogniskowe, odcinkowe zapalenie małych i średnich naczyń krwionośnych o przewlekłym i postępującym przebiegu. Choć występują podobieństwa między chorobą Buergera a miażdżycą naczyń obwodowych, schorzenia te mają odmienną etiologię, epidemiologię i symptomy, a ich leczenie przebiega w inny sposób.

Etiologia choroby Buergera

Na chorobę Buergera zapadają najczęściej mężczyźni pomiędzy 20. a 40. rokiem życia. Zdecydowanie powszechniej występuje w Indiach i na obszarze Europy Wschodniej.

Za główny czynnik etiologiczny uznaje się palenie tytoniu (dotyczy on ok. 90 proc. przypadków). W części przypadków pacjenci przed zachorowaniem przyjmowali tytoń również w innych formach (papka do żucia, tabletki, plastry nikotynowe).

Przyczyny rozwoju tej jednostki chorobowej nie zostały do końca poznane. Wskazuje się na możliwą rolę czynników genetycznych oraz występowanie reakcji autoimmunologicznej.

Objawy choroby Buergera

Choroba Buergera objawia się pod postacią zakrzepowo-zarostowego zapalenia naczyń. W wyniku rozwoju zmian chorobowych w naczyniach krwionośnych dochodzi do ich stopniowego zwężenia, a następnie zamknięcia, czego skutkiem jest zaburzenie przepływu krwi i niedotlenienie tkanek.

Na początkowym etapie choroby u pacjentów występują zaburzenia czucia obejmujące najczęściej kończyny dolne (mrowienie, drętwienie, cierpnięcie, uczucie marznięcia). Rozwija się również chromanie przestankowe (w zaawansowanej chorobie Buergera występuje również ból spoczynkowy) i ból kończyn, który wraz z rozwojem choroby ulega nasileniu. Objawem chooby Buergera może być również nadmierna potliwość dłoni i stóp.

Na zaawansowanym etapie choroby tętno w głównych tętnicach stóp staje się słabo wyczuwalne. Kończyny ulegają zblednięciu, a następnie zsinieniu. Występują owrzodzenia i zmiany martwicze (przede wszystkim w obrębie dystalnych części kończyn górnych i dolnych). Mają one asymetryczną formę i mogą być zlokalizowane w obrębie tylko jednej kończyny. W przypadku znacznego zaawansowania zmian mogą one stanowić wskazanie do amputacji zmienionej chorobowo kończyny lub jej części.

U części pacjentów choroba Buergera może również wywoływać dolegliwości ze strony układu pokarmowego.

Leczenie choroby Buergera

Ważnym i nieodzownym elementem terapii choroby Buergera jest zaprzestanie stosowania wyrobów tytoniowych przez pacjenta. Istotne jest także chronienie kończyn przed urazami i zakażeniami poprzez noszenie wygodnego, nieuciskającego obuwia i odpowiednio dobranych wkładek ortopedycznych, zachowywanie odpowiedniej higieny (regularne mycie stóp, ostrożne obcinanie paznokci), a także stałe kontrolowanie stanu stóp i konsultowanie pojawiających się zmian z lekarzem.

W leczeniu stosuje się leki przeciwbólowe o dopasowanym do stopnia rozwoju choroby nasileniu działania oraz leki rozszerzające naczynia.

W zaawansowanych przypadkach, w których doszło do powstania zmian wrzodowych i martwiczych, zaleca się miejscowe zaopatrzenie zmienionych chorobowo obszarów z zastosowaniem specjalistycznych opatrunków, a w razie konieczności także opracowanie chirurgiczne.

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