Matenda ashuga insipidus: zimayambitsa, zizindikiro ndi zakudya

Matenda a shuga a insipidus (matenda a shuga insipidus, matenda a shuga insipidus syndrome) ndi vuto lomwe limabisala kapena kupanga mahomoni ena okhudzana ndi polyuria (urination) ndi polydipsia (ludzu lalikulu).

Mchitidwe wamkati ndi kachigawo kakang'ono komwe kamakhala pansi paubongo. Imodzi mwa mahomoni omwe amatulutsa amatchedwa antidiuretic mahomoni (ADH, vasopressin).

Vasopressin imagwira impso ndikuyambitsa kulowetsedwa kwamadzi kulowa m'magazi, potero kupewa kutayika kwamadzi ambiri mkodzo.

Ndi matenda a shuga a insipidus, mwina kuchepa kwa kapangidwe kake kapena kusakwanira kwa mphamvu ya ma antiidiuretic pa impso kumachitika, zomwe zimapangitsa kuti madzi ambiri amkodze mkodzo. Zotsatira zake, odwala amakhala ndi madzi am'madzi komanso ludzu lokwanira.

Zoyambitsa matenda a shuga insipidus

Matenda a shuga insipidus ndi matenda omwe amayamba chifukwa cha kuperewera kwa vasopressin, kuperewera kwathunthu kapena kuperewera. Vasopressin (mahomoni opatsirana) obisika mu hypothalamus ndipo, mwa ntchito zina, ndiye amachititsa kuti kukodzaku kumveke. Chifukwa chake, ndichizolowezi kusiyanitsa mitundu itatu yamatenda amtunduwu ndi zomwe zimayambira: genetic, anapeza, idiopathic.

Odwala ambiri omwe ali ndi matenda osowa awa sakudziwa chifukwa chenicheni chomwe chimachitikira. Matenda a shuga oterewa amatchedwa idiopathic ndipo pafupifupi 70% ya odwala amadwala matendawa. Matenda obadwa nawo amtundu wa chibadwa amayamba chifukwa cha chibadwa. Poterepa, limapezeka m'mabanja angapo kapena m'mibadwo ingapo motsatizana.

Mankhwala amakono amafotokozera za matenda am'mbuyomu chifukwa cha kusintha kwakukulu mu genotype, komwe kumayambitsa vuto la mahomoni antidiuretic. Kukhazikika kwa cholowa cha matenda awa ndi chifukwa chakupezeka kwa vuto la kubadwa mwa mawonekedwe a midbrain ndi diencephalon.

Poganizira zomwe zimayambitsa matenda a shuga insipidus, ndikofunikira kulingalira momwe zimachitikira.

Central matenda a insipidus - amapezeka mosakwanira katulutsidwe ka vasopressin mu hypothalamus kapena kuphwanya katulutsidwe kake m'magazi kuchokera m'matumbo a chiopsezo, mwina zifukwa zake ndi:

Choipa mu hypothalamus, popeza chimayang'anira kuchuluka kwa mkodzo ndikupanga mahomoni antidiuretic, motero, kuphwanya ntchito yake kumadzetsa matendawa. Zomwe zimayambitsa komanso zomwe zimayambitsa kukula kwa matenda a hypothalamus ndi matenda opweteka kwambiri komanso osachiritsika: chifuwa chachikulu, matenda opatsirana pogonana, chimfine, tonsillitis.

Zochita za opaleshoni pa ubongo ndi zotupa za ubongo.

Kukangana, kuvulala kwamtundu wamatumbo.

Cystic, chosachiritsika, zotupa za impso zomwe zimalepheretsa kuzindikira kwa vasopressin.

Tumor njira za hypothalamus ndi pituitary gland.

Komanso, kupezeka kwa matenda oopsa ndi zina mwazinthu zomwe zimakulitsa nthawi ya shuga.

Zilonda zam'mimba za hypothalamic-pituitary system, zomwe zimayambitsa mavuto a kufalikira kwamitsempha yamafuta m'matumbo omwe amadyetsa gland.

Hypal shuga insipidus ndi vuto lomwe vasopressin amapangidwa mokwanira, koma minyewa ya impso siyingayankhe moyenera. Zomwe zimapangitsa izi kukhala izi:

kuchuluka kwa potaziyamu kapena kuchepa kwa calcium calcium,

aakulu aimpso kulephera

amyloidosis (mawonekedwe amyloid mu minofu) kapena polycystosis (mapangidwe angapo a cysts) a impso,

kuwonongeka kwamatumbo oyamwa a nephron kapena medulla ya impso,

cholowa m'malo mwake -

kumwa mankhwala omwe amatha kukhala oopsa m'matumbo a impso ("Demeclocilin", "Amphotericin B", "Lithium"),

Nthawi zina matenda amapezeka muukalamba kapena kutsutsana ndi kufooka kwa matenda ena.

Poyerekeza ndi kupsinjika, nthawi zina, ludzu (psychogenic polydipsia) limayamba. Komanso, matenda a shuga a insipidus amatha kukhalapo mu nthawi yachitatu ya mimba, pomwe vasopressin imawonongeka ndi ma enzymes ena obisika. Iliyonse mwa mitundu iwiriyi ya kuphwanya malamulo imachotsedwa palokha atachotsa muzu.

Zizindikiro za matenda a shuga

Matendawa amathanso kuyamba kukhala mwa akazi ndi abambo, ngakhale atakhala ndi zaka zambiri, koma nthawi zambiri ali ndi zaka 20 mpaka 40. Kukula kwa zizindikiro zamatenda kumadalira kuchuluka kwa vasopressin. Ndi kuperewera kwenikweni kwa mahomoni, ma Symbomatology sangatchulidwe kapena kufafaniza. Nthawi zina, zizindikiro zoyambirira za matenda amtunduwu zimawonekera mwa anthu omwe ali ndi vuto la kumwa - maulendo, maulendo, maulendo, akamamwa corticosteroids.

Kukhazikika kwa mtundu uwu wa matenda a shuga ndikosavuta kuzindikira, chifukwa kuchuluka kwa mkodzo tsiku ndi tsiku kumawonjezeka kwambiri. Chizindikiro ichi chimatchedwa polyuria ndipo chimatha kukhala ndi magawo osiyanasiyana olimba. Nthawi zambiri, mkodzo ulibe mtundu, mchere ndi zinthu zina sizipezeka. Ndi kukula kwa madzi amtunduwu, thupi liyenera kubwezeretsanso madzi omwe adasowa.

Chifukwa chake, kwa odwala matenda ashuga, chizindikiro chokhala ndi polydipsia kapena kumva ludzu losatha. Kukhalapo kwa kukakamiza pafupipafupi kukodza kumakwiyitsa wodwala kumwa madzi ambiri. Zotsatira zake, pali kuwonjezeka kwakukulu kwa kukula kwa chikhodzodzo. Zizindikiro za matendawa zimabweretsa nkhawa zambiri kwa munthu, choncho nthawi zambiri kukaonana ndi dokotala sikuchedwa. Odwala amadandaula za:

kuchuluka ndi kusuntha kwa m'mimba,

kusamba kwa msambo (akazi),

kuchepa kwamphamvu (amuna),

ziume zopaka ndi khungu,

kuphwanya kwam'mimba,

kunenepa kwambiri kapena kunenepa kwambiri,

kugona kapena kugona,

ludzu lalikulu lomwe silimatha usiku,

kukula kwa chikhodzodzo,

kuperekera ndi kukodza pafupipafupi mpaka malita 4-30 / tsiku.

Palinso matenda obadwa nawo a shuga a insipidus, momwe zizindikiro za ana zimatchulidwira kwambiri, mpaka kukula kwa mitsempha, kusanza, ndi kuwonjezeka kwa kutentha kwa thupi. Nthawi yakutha msinkhu, achinyamata otere amatha kutsalira.

Wodwala akapezeka kuti ali ndi vuto lakuchepetsa kuchuluka kwa madzi am'madzi, zizindikiro za kuchepa kwa madzi zimachitika, chifukwa impso zimapitiliza kuchotsa mwamphamvu mkodzo wodwala. Zikatero, kusanza, kusokonezeka m'maganizo, kupweteka mutu, kutentha kwambiri kwa thupi, komanso tachycardia kumachitikanso.

Chithandizo cha matenda a shuga insipidus

Musanapereke mankhwala, muyenera kumveketsa bwino za matendawo, kudziwa mtundu wake komanso mtundu wa matenda ashuga, kudziwa zomwe zimayambitsa kukodza kwamkodzo (polyuria) ndi ludzu (polydipsia). Pachifukwa ichi, wodwalayo amayesedwa mokwanira, wophatikizapo:

urinalysis kwa shuga ndi kutsimikiza kachulukidwe,

kudziwa mphamvu inayake (ndi matenda a shuga a insipidus otsika) komanso kuchuluka kwa mkodzo tsiku lililonse, kuyesedwa kwa Zimnitsky,

Mutha kudziwa kuchuluka kwa kuchuluka kwa magazi a madzi am'magazi (osakwana 0.6 mg pa lita),

Kusiyanitsa, kuyesedwa kwa kudya kouma kumachitika, njira zazikulu zowunikira zotsatirazi ndi izi: kuchuluka kwa mapapo, kuchuluka kwa kuthamanga kwa magazi, kuchuluka bwino, kulemera kwamthupi la wodwala, kachulukidwe kachulukidwe ka mkodzo, kuchuluka kwa zotulutsa, ngati mkati mwa chitsanzo ichi kuchuluka kwa mkodzo kumachepa ndipo kuchuluka kwake kumawonjezeka mphamvu inayake, pomwe thanzi lathunthu, kuchuluka kwa thupi, kuthamanga ndi kuthamanga kwa magazi kumakhalabe kwabwinobwino ndipo zizindikiro zina zosasangalatsa sizikupezeka, kupezeka kwa matenda a shuga insipidus kulibe,

MRI yaubongo

Ngati choyambitsa chitukuko cha matenda a shuga insipidus ndi chotupa, wodwalayo amamuthandizira opaleshoni kapena chithandizo cha radiotherapy. Ngati njira yomwe ili ndi chotupacho siyiyikidwa pambali, chithandizo chiyenera kuchitika mbali ziwiri: kubwezeretsa kwakukulu kwa madzi kagayidwe m'thupi ndi kuthetseratu kwa pathological mu hypothalamic-pituitary dera.

Odwala omwe ali ndi vuto lalikulu la polyuria, momwe kuchuluka kwamkodzo kwamasiku onse kupitilira malita anayi, kuyenera kutchulidwa mwachindunji antidiuretic mankhwala. Izi ndichifukwa choti mu akulu, polyuria yoopsa imatsogolera chikhodzodzo ndi atony, ndipo mwa ana zimapangitsa kubweza kukula.

Masiku ano, kugwiritsa ntchito Desmopressin ndi njira yayikulu yodziwira pakakhala insipidus yapakati pa matenda ashuga. Izi zimapezeka m'mitundu iwiri: piritsi ("Minirin") ndi mawonekedwe a madontho a intranasal director ("Adiuretin").

Chithandizo cha matenda a shuga a nephrogenic insipidus nthawi zambiri amakhala ndi mankhwala ophatikizidwa ndi okodzetsa ophatikizika (Triampur Compositum, Amiloretic, Isobar), taizide (Hydrochlorothiazide), potaziyamu yosawononga diuretics (Spironolactone). Mankhwalawa, kudya mchere wa tsiku ndi tsiku sikuyenera kuchepera 2 g / tsiku. Pamaso pa shuga wapakati wa insipidus, thiazide diuretics ingagwiritsidwenso ntchito.

Koma ngati wodwala ali ndi matenda a shuga a shuga a dipsogenic, amadziwikiratu kuti amuchiza ndi thiazide diuretics kapena desopopin, popeza mankhwalawa amathanso kuledzera. Chifukwa chogwiritsa ntchito, madzi am'madzi amachepa, pomwe amachepetsa. Mtunduwu wa matenda a shuga insipidus uyenera kuthandizidwa ndikuchepetsa kumwa kwa madzi ndikutsatira zakudya zinazake, zomwe zimaphatikizapo kuchepetsa mchere, zakudya zamapuloteni ndikuwonjezera kudya masamba, zipatso, mkaka.

Kudzichitira nokha mankhwala omwe ali ndi matenda oopsa kwambiri ndichinthu chowopsa kwambiri. Ndi dokotala woyenerera yekha amene angadziwe matenda oyenera ndi kusankha chithandizo choyenera cha wodwalayo.

Matenda a shuga- matenda oyambitsidwa ndi kuperewera kwathunthu kapena wachibale wa hypothalamic timadzi vasopressin (AdH-antidiuretic hormone).

Pafupipafupi matendawa sakudziwika, amapezeka mu 0.5-0.7% ya odwala endocrine.

Kuwongolera kumasulidwa kwa vasopressin ndi zotsatira zake

Vasopressin ndipo oxytocin amapangika mu supraoptical ndi paraventicular nuclei ya hypothalamus, imadzaza m'miyala ndi ma neurophysins ogwirizana ndipo imayendetsedwa molumikizana ndi axons mu posterior pituitary gland (neurohypophysis), komwe imasungidwa mpaka kumasulidwa kwawo. Zosungidwa za vasopressin mu neurohypophysis ndi kukondoweza kwake kwachinsinsi, mwachitsanzo, posasiya kumwa, zimachepetsedwa kwambiri.

Kubisala kwa vasopressin kumachitika chifukwa cha zinthu zambiri. Chofunika kwambiri pa izi ndi kuthamanga kwa magazi a osmotic , i.e. osmolality (kapena osmolarity) wa plasma. Mu anterior hypothalamus, pafupi, koma mosiyana ndi supraoptical ndi paraventicular nuclei, iliosmoreceptor. Momwe plasma osmolality imakhala yocheperako, kapena mtengo woperewera, kuchuluka kwa vasopressin mmenemu ndizochepa kwambiri. Ngati plasma osmolality idutsa gawo loyikirali, osmocenter amadziwa izi, ndipo kuchuluka kwa vasopressin kumakwera kwambiri. Njira yosinthira mawu imayankha mwachidwi komanso molondola kwambiri. Kuwonjezeka pang'ono kwa zamphamvu za osmoreceptor kumalumikizidwapofika zaka .

Osmoreceptor samva chidwi chimodzimodzi ndi zinthu zingapo zam'madzi. Sodium (Na +) ndi anions ake ndizothandiza kwambiri zolimbitsa thupi za osmoreceptor ndi vasopressin secretion. Na ndi anions ake nthawi zambiri amatsimikiza 95% ya plasma osmolality.

Mothandizidwa kwambiri ndi vasopressin kudzera mwa osmoreceptor sucrose ndi mannitol . Glucose kwenikweni samalimbikitsa osmoreceptor, monganso urea.

Chinthu chodalirika kwambiri chodzetsa secretion ya vasopressin ndikutsimikizaNa+ndi plasma osmolality.

Secretion wa Vasopressin amakhudzidwa kuchuluka kwa magazi ndi kuthamanga kwa magazi . Izi zimachitika kudzera mu baroreceptors omwe ali mu atria ndi aortic chipilala. Baroreceptor stimuli kudzera ku ulusi wothandizirana nawo amapita ku tsinde laubongo monga gawo la mitsempha ya vagus ndi glossopharyngeal. Kuchokera pa tsinde laubongo, ma sign amaperekedwa ku neurohypophysis. Kutsika kwa kuthamanga kwa magazi kapena kuchepa kwa magazi (mwachitsanzo, kuchepa kwa magazi) kumalimbikitsa kwambiri chinsinsi cha vasopressin. Koma dongosololi ndilosavuta kwenikweni poyerekeza ndi zomwe zimayambitsa osmotic.

Chimodzi mwazinthu zothandiza zomwe zimapangitsa kuti vasopressin amasulidwe nseru ozungulira, kapena chifukwa cha machitidwe (glogi, mowa, chikonga, apomorphine). Ngakhale ndi mseru, popanda kusanza, msambo wa vasopressin mu plasma umakwera nthawi 100-1000!

Osagwira mtima kuposa nseru, koma zolimbikitsanso zotere za vasopressin ndi hypoglycemia,makamaka lakuthwa. Kuchepa kwa shuga m'magazi ndi 50% ya magawo oyamba m'magazi kumawonjezera zomwe zili vasopressin nthawi 2-4 mwa anthu, komanso makoswe nthawi 10!

Kuchulukitsa kwa vasopressin secretion renin-angiotensin dongosolo . Mlingo wa renin ndi / kapena angiotensin ofunikira polimbikitsa vasopressin sichikudziwika mpaka pano.

Amakhulupiriranso kuti nkhawa zopanda pake chifukwa cha zinthu monga kupweteka, kutengeka, zolimbitsa thupi, zimathandizira chinsinsi cha vasopressin. Komabe, sizidziwika momwe kupsinjika kumathandizira kubisalira kwa vasopressin - mwanjira ina yapadera, kapena kudzera kutsitsa magazi ndi mseru.

Pewani chinsinsi cha vasopressinmtima yogwira zinthu, monga norepinephrine, haloperidol, glucocorticoids, opiates, morphine. Koma sizinadziwikebe ngati zinthu zonsezi zimachitika pakati, kapena mwakuwonjezera kuthamanga kwa magazi ndi voliyumu.

Kamodzi pakuzungulira kwadongosolo, vasopressin imagawiridwa mwachangu kumadzi onse akunja. Kuyenera pakati pa intra- ndi extravascular space kumatheka mkati mwa mphindi 10-15. Kugwiritsa ntchito vasopressin kumachitika makamaka mu chiwindi ndi impso. Gawo laling'ono silidawonongeke ndikuchotsa mkodzo mu mawonekedwe owoneka.

Zotsatira.Chofunikira kwambiri mwachilengedwe cha vasopressinkusunga madzi mthupi pochepetsa kutulutsa mkodzo. Momwe mungagwiritsire ntchito yake ndi epithelium ya distal ndi / kapena tubules ya impso. Popanda vasopressin, maselo membala omwe ali mbali iyi ya nephron amapanga cholepheretsa kulowetsedwa kwamadzi ndi zinthu zosungunuka. M'mikhalidwe yotero, kusefukira kwa hypotonic komwe kumapangidwa m'malo ophatikizika kwambiri a nephron kumadutsa mu tubal ndikukutola ma ducts popanda kusintha. Kukula kwakanthawi (kachulukidwe kakang'ono) ka mkodzoyu ndi kochepa.

Vasopressin imachulukitsa kuchuluka kwa distal ndi kusungira tubules kwa madzi. Popeza madzi amawabwezeranso popanda zinthu za osmotic, kuchuluka kwa zinthu zosmotic mmenemo kumawonjezeka, ndipo voliyumu yake, i.e. kuchuluka kukuchepa.

Pali umboni wosonyeza kuti timadzi tomwe timakhala ndi minyewa, prostaglandin E, timalepheretsa zochita za vasopressin mu impso. Nawonso, mankhwala osapweteka a antiidal (mwachitsanzo, Indomethacin), omwe amalepheretsa kuphatikizika kwa ma prostaglandins mu impso, amathandizira kusintha kwa vasopressin.

Vasopressin amagwiritsanso ntchito machitidwe osiyanasiyana owonjezera, monga mitsempha yamagazi, m'mimba, chapakati chamanjenje.

W ludzu amagwira ntchito monga yofunika kwambiri ya ntchito yotsutsa ya vasopressin. Wamva ludzu amazindikira kufunika kwa madzi. Thupi limalimbikitsidwa ndi zinthu zambiri zomwe zimayambitsa kutulutsa kwa vasopressin. Zothandiza kwambiri pamenepahypertonic chilengedwe. Mulingo wamphumphu wa madzi am'madzi, pomwe pali ludzu, uli 295 mosmol / kg. Ndi osmolality wamagazi awa, mkodzo wokhala ndi chindapusa chachikulu nthawi zambiri umatulutsidwa. M ludzu ndi mtundu wammawu, ntchito yayikulu yomwe imateteza kuchepa kwamadzi, yomwe imapitirira mphamvu zowonjezera pathupi.

M ludzu umachulukira mwachangu motsatira kuchuluka kwa madzi am'madzi ndipo umakhala wolekerera pamene osmolality imangokhala 10-15 mosmol / kg kuposa gawo lofika. Madzi akumwa amagwirizana ndi ludzu. Kutsika kwa magazi kapena kuthamanga kwa magazi kumadzetsanso ludzu.

Kukula kwa mitundu yapakati pa matenda a shuga a insipidus kumakhazikitsidwa ndikugonjetsedwa kwa magawo osiyanasiyana a hypothalamus kapena posterior pituitary, i.e. neurohypophysis Zifukwa zake zingaphatikizeponso zinthu izi:

matendapachimake kapena matenda: fuluwenza, meningoencephalitis, malungo ofiira, pertussis, typhus, sepsis, tonsillitis, chifuwa, syphilis, rheumatism, brucellosis, malungo,

kuvulala kwamtopola: mwangozi kapena opaleshoni, kugwedezeka kwamagetsi, kuvulala pakubala pakubala,

hypothalamic kapena chotupa pituitary: metastatic, kapena choyambirira. Cancer ya mammary ndi chithokomiro, bronchi metastases kupita ku tchire England nthawi zambiri. Kulowetsedwa ndi zotupa mu lymphogranulomatosis, lymphosarcoma, leukemia, matenda a xanthomatosis (Hend-Schuller-Crispen). Zotupa zoyambira: adenoma, glioma, teratoma, craniopharyngioma (makamaka nthawi zambiri), sarcoidosis,

matenda endocrine: Simmonds, Skien, Lawrence-Moon-Beadl syndromes, pituitary dwarfism, acromegaly, gigantism, adinogenital dystrophy,

chidziwitso:mu 60-70% ya odwala, chomwe chimayambitsa matendawa sichikudziwika bwinobwino. Mwa mitundu ya idiopathic, chiwonetsero chodziwika bwino chimakhala ndi matenda amtundu wa shuga. Mtundu wa cholowa ndiwosankha komanso wosinthika,

autoimmune: chiwonongeko cha mikanda ya hypothalamus chifukwa cha njira ya autoimmune. Fomuyi imaganiziridwa kuti imapezeka mu idiopathic shuga insipidus, momwe ma autoantibodies opanga maselo otulutsa vasopressin amawonekera.

Ndi zotumphukirashuga insipidus vasopressin kupanga imasungidwa, koma mphamvu ya zolumikizira za tubul ya impso imachepa kapena kulibe, kapena timadzi timene timawononga mu chiwindi, impso, placenta.

Nephrogenic shuga insipidus Nthawi zambiri zimawonedwa mwa ana, ndipo zimayambitsidwa chifukwa cha kuchepa kwa matenda a impso tubules (kobadwa nako malformations, cystic degenerative process), kapena kuwonongeka kwa nephron (amyloidosis, sarcoidosis, poyizoni wa lithiamu, methoxyfluramine). kapena kuchepa mphamvu ya impso tubule epithelium receptors ku vasopressin.

Matenda Achipatala

chifukwa cha ludzu kuyambira kuwonetseredwa mochuluka mpaka kuwawa, osalola odwala kupita masana kapena usiku. Nthawi zina odwala amamwa malita 20-25 amadzi patsiku. Pankhaniyi, pali kufunitsitsa kotenga madzi oundana,

polyuria ndi kuyamwa mwachangu. Mkodzo ndi wowala, wopanda urochromes,

mwakuthupi ndi m'malingalirokufooka ,

kuchepa kwamtimakuwonda mwina chitukukokunenepa ngati matenda a shuga a insipidus amakula monga chimodzi mwazizindikiro zamatenda oyamba a hypothalamic.

mavuto a dyspeptic kuchokera m'mimba - kumverera kwodzaza, kupindika, kupweteka kwa epigastrium, matumbo - kudzimbidwa, chikhodzodzo - kulemera, kupweteka kwa hypochondrium yoyenera,

kusokonezeka kwa malingaliro ndi malingaliro : kupweteka mutu, kusalingalira bwino, kusowa tulo, kuchepa m'maganizo, kusokonekera, kusoka, psychosis nthawi zina kumayamba.

kusokonekera kwa msambo, mwa amuna - potency .

Kuyambika kwa matendawa kumatha kukhala pachimake, modzidzimutsa, pang'onopang'ono pang'onopang'ono, ndipo zizindikiro zake zimayamba kukulira. Zomwe zimayambitsa zimatha kuvulala kwambiri mu ubongo kapena m'maganizo, matenda, njira zina za opaleshoni bongo. Nthawi zambiri, chomwe chimayambitsa sichidziwika. Nthawi zina cholowa m'magawo a anthu odwala matenda ashuga chimakhazikika.

Zamakonomatenda osachiritsika.

khungu liuma, tachepa,

kulemera kwa thupi kumatha kuchepetsedwa, wamba kapena kuchuluka,

lilime limakhala louma nthawi zambiri chifukwa cha ludzu, malire am'mimba amatsitsidwa chifukwa chodzaza madzi nthawi zonse. Ndi chitukuko cha gastritis kapena bysary dyskinesia, kuchuluka chidwi ndi kupweteka palpation wa epigastrium ndi hypochondrium yoyenera n`zotheka,

mtima ndi kupuma machitidwe, chiwindi sichimavutika,

kukodza kwamkati: kukodza pafupipafupi, polyuria, nocturia,

Zizindikirokusowa kwamadzi thupi, ngati madzimadzi otayika ndi mkodzo, pazifukwa zina, osabwezeredwa - kusowa kwa madzi, kuyesa mayeso "ndikudya kowuma", kapena kumverera kwa malo am'madzi kumachepa:

kufooka kwakukulu, mutu, nseru, kusanza mobwerezabwereza, kufooketsa madzi m'thupi,

Hyperthermia, zopweteka, psychomotor

CCC chisokonezo: tachycardia, hypotension mpaka kugwa ndi chikomokere,

kukula kwa magazi: kuchuluka kwa Hb, maselo ofiira am'magazi, Na + (N136-145 mmol / L, kapena meq / L) creatinine (N60-132 mmol / L, kapena 0.7-1,5 mg%),

kukoka kwapadera kwa mkodzo kumakhala kochepa - 1000-1010, polyuria imapitirira.

Izi izi hyperosmolar kuchepa madzi m'thupi makamaka amakhala ndi kobadwa nako nephrogenic shuga insipidus mwa ana.

Chidziwitsidwa kutengera ndi zizindikiro zapamwamba za matenda a shuga a insipidus ndi maphunziro a labotale ndi othandizira:

kukoka mwachindunji kwa mkodzo - 1000-1005

plasma hyperosmolarity,> 290 mosm / kg (N280-296 mosm / kg madzi, kapena madzi a mmol / kg),

mkodzo hypoosmolarity, 155 meq / l (N136-145 meq / l, mmol / l).

Ngati ndi kotheka zitsanzo:

Kuyesedwa ndi kudya kowuma. Kuyesedwa uku kumachitika kuchipatala, nthawi yake imakhala nthawi zambiri maola 6-8, ndi kulekerera kwabwino - maola 14. Palibe madzi. Zakudya ziyenera kukhala zomanga thupi. Minkhole imasonkhanitsidwa ola lililonse, kuchuluka kwake ndi kuchuluka kwake kwa gawo lililonse la ola kumayesedwa. Kulemera kwa thupi kumayesedwa pambuyo pa 1 lita imodzi ya mkodzo utachotsedwa.

Mulingo : kusowa kwa mphamvu yayikulu pakukoka kwamikodzo m'njira ziwiri zotsatizana ndi kuchepa kwa 2% ya kulemera kwa thupi kumawonetsa kusapezekapo kwa kukondoweza kwa amkati vasopressin.

Zitsanzo ndi iv makonzedwe a 50 ml ya 2,5% yankhoNaCl pasanathe mphindi 45 Ndi matenda a shuga a insipidus, kuchuluka ndi mkodzo wa mkodzo sikusintha kwenikweni. Ndi psychogenic polydipsia, kuchuluka kwa osmotic plasma ndende kumalimbikitsa kutulutsa kwamkati vasopressin ndipo kuchuluka kwa mkodzo kumachepa, ndipo mphamvu yake yeniyeni imawonjezeka.

Kuyesedwa ndikuyambitsa kukonzekera kwa vasopressin - 5 I / O kapena / m. Ndi shuga weniweni insipidus, mkhalidwe waumoyo umakhala bwino, kuchepa kwa polydipsia ndi polyuria, plasma osmolarity amachepetsa, mkodzo osmolarity ukuwonjezeka.

Kusiyanitsa matenda a shuga insipidus

Malinga ndi zizindikiro zazikuluzikulu za matenda a shuga insipidus - polydipsia ndi polyuria, matendawa amasiyanitsidwa ndi matenda angapo omwe amapezeka ndi zizindikiro izi: psychogenic polydipsia, shuga mellitus, polyuria yolumikizira kuperewera kwa aimpso kulephera.

Nephrogenic vasopressin zosagwira matenda a shuga insipidus (wobadwa kumene kapena wotenga) amasiyanitsidwa ndi polyuria ndi aldosteronism yoyamba, hyperparathyroidism ndi nephrocalcinosis, malabsorption matenda aakulu enterocolitis.

Neurogenic shuga insipidus

Neurogenic shuga insipidus (wapakati). Amayamba chifukwa cha kusintha kwa ma pathological mu manjenje amanjenje, makamaka, mu hypothalamus kapena gland yotsatira. Monga lamulo, chomwe chimayambitsa matenda pamenepa ndi ntchito yochotsa chofufumitsa, njira yolowera mdera lino (hemochromatosis, sarcoidosis), kuvulala kapena kusinthika kwachilengedwe.

Nawonso mtundu wapakati pa matenda a shuga

• idiopathic - mtundu wamtundu wa matenda, omwe amadziwika ndi kuchepa kwa kapangidwe ka ADH,
• chidziwitso - amakula motsutsana ndi maziko a matenda ena a pathologies. Itha kupezeka zonse ziwiri (zimakula nthawi ya moyo), mwachitsanzo, chifukwa cha kuvulala kwa ubongo, kukula kwa chotupa. Kapena obadwa nawo (ndi majini kusintha).

Popeza wodwalayo amakhala ndi matenda osokoneza bongo okhalitsa, wodwalayo amakhala ndi vuto la kupweteka kwa timadzi timene timatulutsa timadzi tothandiza. Chifukwa chake, chithandizo cha matenda osokoneza bongo omwe amayamba chifukwa cha matenda amtunduwu ayambitsidwa, chidwi cha matendawa chimayamba.

Matenda a shuga a shuga

Ichi ndi chiyani NDE kapena nephrogenic ND - imalumikizidwa ndi kuchepa kwamphamvu kwa minyewa ya impso ku zotsatira za vasopressin. Matenda amtunduwu siachilendo. Choyambitsa matendawa chimakhala chocheperako cha ma nephrons, kapena kukana kwa impso receptors ku vasopressin. Matenda am'mimba amatha kubereka, ndipo amatha kuchitika chifukwa cha kuwonongeka kwa maselo a impso mothandizidwa ndi mankhwala.

Nthawi zina mtundu wachitatu wa matenda a shuga insipidus, womwe umakhudza azimayi panthawi yoyembekezera, umasiyanitsidwanso. Izi sizachilendo. Zimachitika chifukwa cha kuwonongeka kwa mahomoni ndi ma enzyme a placenta omwe adapangidwa. Mwana akabadwa, mtunduwu umadutsa.

Odwala aimpso matenda a insipidus mu akulu amakula chifukwa cha kulephera kwaimpso kwa maumboni osiyanasiyana, chithandizo chotalika cha kukonzekera kwa lithiamu, hypercalcemia, etc.

Matenda a shuga amayamba kukhala kuperewera kwa vasopressin antidiuretic (ADH) - kuperewera kapena kwathunthu. ADH imatulutsa Hypothalamus ndipo imagwira ntchito zosiyanasiyana, kuphatikizapo kukhudza kuyendetsa bwino kwamkodzo.

Matenda a shuga sindiwo matenda obadwa nawo, koma ena obwereza omwe amatenga matenda obadwa nawo (mwachitsanzo, matenda a Wolfram, insipidus wathunthu kapena osakwanira) ndi gawo limodzi mwa chipatalachi, chosonyeza kusinthika kwa majini.

Zinthu zomwe zikulosera zakukula kwa matenda awa:

• matenda opatsirana, makamaka mavairasi,
• zotupa za mu ubongo (meningioma, craniopharyngioma),
• metastases ku dera la hypothalamus khansa yowonjezera bongo (kawirikawiri bronchogenic - yochokera minofu ya bronchi, ndi khansa ya m'mawere),
• kuvulala kwa chigaza
• kukangana
• chibadwa.

Ndi mawonekedwe a idiopathic a shuga a insipidus m'thupi la wodwalayo, popanda chifukwa, ma antibodies amapangidwa omwe amawononga ma cell omwe amapanga mahomoni a antidiuretic.

Renal shuga insipidus (mawonekedwe a impso) amachitika chifukwa cha kuledzera kwa thupi ndi mankhwala, kusokonezeka kapena matenda am'mbuyomu a impso ndi kwamikodzo (kulephera kwa impso, hypercalcinosis, amyloidosis, glomerulonephritis).

Zizindikiro za matenda a shuga insipidus mwa akulu

Matendawa amapezeka chimodzimodzi kwa abambo ndi amayi, pazaka zilizonse, nthawi zambiri pa zaka 20 mpaka 40. Kukula kwa zizindikiro za matendawa kumatengera kuchuluka kwa vasopressin. Ndikusowa pang'ono kwa mahomoni, zizindikiro zamankhwala zingathetsedwe, osatchulidwa. Nthawi zina zizindikiro zoyambirira za matenda a shuga insipidus zimawonekera mwa anthu omwe amamwa moperewera - kuyenda, kukwera maulendo, kutuluka, komanso kumwa corticosteroids.

Zizindikiro zazikulu zomwe zimapezeka ndi shuga insipidus ndi izi:

• kukodza kwambiri (mpaka malita 3-15 a mkodzo patsiku),
• kukodza kwakukulu kumachitika usiku,
• ludzu komanso kuchuluka kwamadzi ambiri,
• khungu lowuma, nseru ndi kusanza, kukokana,
• kusokonezeka m'malingaliro (kusowa tulo, kutengeka mtima, kuchepa m'maganizo).

Ngakhale wodwalayo atachepera kugwiritsa ntchito madzimadzi, mkodzo umatulutsidwabe zochuluka, zomwe zingayambitse kuchepa thupi kwakuthupi.

Kuphatikiza pazizindikiro zofala, pali zingapo za zizindikiro zomwe zimapezeka mwa odwala osiyana zaka ndi zaka:

Zizindikiro zake
Matenda a shuga kwa amayi	Amuna amadwala matenda a shuga a insipidus nthawi zambiri monga azimayi. Milandu yambiri yatsopano ya pathology imawonedwa mwa achinyamata. Nthawi zambiri, matendawa amagwira ntchito mwa odwala azaka zapakati pa 10 mpaka 30.

Zizindikiro zikuluzikulu zomwe zikuwonetsa kuphwanya kwa katulutsidwe ka vasopressin ndi chitukuko cha insipidus ya matenda ashuga:

• Kuchepetsa kwamitseko
• Ludzu lalikulu
• Anatsika libido
• Kusakhazikika mtima
• Mutu
• Mavuto ogona komanso kugona tulo,
• Kuchepetsa thupi
• Khungu lowuma
• Kuchepa kwa impso,
• Kuthetsa madzi m'thupi.

Matenda a shuga ndi amunaKukula kwa matendawa kumayamba mwadzidzidzi, kumayendera limodzi ndi zochitika monga polydipsia ndi polyuria - kumverera kwamphamvu kwa ludzu, komanso kukwera kwa pafupipafupi komanso kuchuluka kwa kukodza. Zizindikiro zatsatanetsatane zazambiri mwa akazi zimaphatikizapo:

• kusadya bwino
• kuwonda
• kudya kwakachepa kapena kusakhalapo kwathunthu,
• kupweteka m'mimba, kumva kuwawa ndi nseru,
• kusakhazikika kwa chopondapo, kuyambitsa matumbo, kumva kutulutsa, kupindika kapena kumva kuwawa mu hypochondrium yoyenera,
• kutentha kwadzuwa, kupindika ndi kusanza,
• kuphwanya kwamwambo kwa kusamba kwachilengedwe, nthawi zina - kudzimva kolakwika komanso kubereka.

Kukhalapo kwa shuga wodwala matenda a shuga kumawonetsedwa ndi zizindikiro izi:

• kachulukidwe ka mkodzo pansi pa 1005,
• kuchuluka kwa vasopressin m'magazi,
• kutsika kwa potaziyamu m'magazi,
• kuchuluka kwa sodium ndi calcium m'magazi,
• kuchuluka kwa kutulutsa mkodzo tsiku lililonse.

Mukazindikira mawonekedwe a shuga a impso, kufunsira kwa urologist ndikofunikira. Mukakhudzidwa ndi ziwalo zoberekera komanso kuphwanya njira ya msambo, dokotala amafunikira. Mu anaKusiyana kwa zizindikiro za matenda a shuga insipidus mwa odwala ndi ana ochepera msinkhu ndi kofunikira. Potsirizira pake, chiwonetsero chodabwitsa kwambiri cha matenda ndizotheka:

• kuchepa kwamtima
• kuchuluka pang'ono kapena kuchepa kwake
• kusanza mwachangu pakudya,
• matumbo ovuta
• nocturnal envesis,
• zilonda m'malumikizidwe.

Mavuto

Chiwopsezo cha matenda a shuga insipidus ndi chiopsezo cha kuperewera kwa madzi m'thupi, komwe kumachitika mu zochitika zomwe kutaya kwamkodzo kwamthupi kuchokera mthupi sikulipiridwa mokwanira. Pakusowa kwamadzi, mawonekedwe omwe ali:

• kufooka wamba ndi tachycardia,
• kusanza
• mavuto amisala.

Kutseka kwa magazi, kusokonezeka kwa mitsempha ndi hypotension, komwe kumatha kufika pakugwa, kumasonyezedwanso. Ndizachilendo kuti ngakhale kutulutsa kwamphamvu kwambiri kumayendera limodzi ndi kusunga kwa polyuria.

Zizindikiro

Dokotala yemwe amathana ndi ma pathologies amenewa ndi endocrinologist. Ngati mukumva zambiri za matenda, ndiye kuti chinthu choyamba ndikupita kwa endocrinologist.

Paulendo woyamba, adokotala azichita “zoyankhulana”. Kukudziwitsani kuchuluka kwamadzi omwe mkazi amamwa patsiku, ngati pali zovuta ndi kusamba, kusokonekera, ali ndi endocrine pathologies, zotupa, ndi zina zambiri.

Nthawi zambiri, kupezeka kwa matenda a shuga a insipidus siovuta ndipo kwachitika:

• ludzu lalikulu
• kuchuluka kwa mkodzo wa tsiku ndi tsiku kumaposa malita atatu patsiku
• plasma hyperosmolality (zopitilira 290 mosm / kg, kutengera madzi akumwa)
• sodium wamkulu
• Hypoosmolality kwamikodzo (100-200 mosm / kg)
• kachulukidwe kakang'ono ka mkodzo (Chithandizo

Pambuyo povomereza matendawa ndikuzindikira mtundu wa matenda a shuga a insipidus, mankhwala amathandizidwa kuti athetse zomwe zimayambitsa - zotupa zimachotsedwa, matenda omwe amayambitsidwa amathandizidwa, ndipo zotsatira zake kuvulala kwaubongo kumachotsedwa.

Kuti alipire kuchuluka kwa ma antidiuretic mahomoni amitundu yonse yamatendawa, desmopressin (analogue yopanga ya mahomoni) ndi mankhwala. Amagwiritsidwa ntchito ndikulowetsa m'mphuno.

Masiku ano, kukonzekera kwa Desmopressin kumagwiritsidwa ntchito kwambiri kulipiritsa insipidus yapakati pa matenda ashuga. Amapangidwa m'mitundu iwiri: madontho a intranasal makonzedwe - Adiuretin ndi piritsi la Minirin.

Malangizo azachipatala amaphatikizanso kugwiritsa ntchito mankhwala monga carbamazepine ndi chlorpropamide kuti athandize kuti thupi lipangidwe. Popeza kumwa kwambiri mkodzo kumabweretsa kuchepa kwa madzi, mchere umaperekedwa kwa wodwala kuti abwezeretse mchere wamchere.

Pochiza matenda a shuga insipidus, mankhwala omwe amakhudza dongosolo lamanjenje amathanso kutumikiridwa (mwachitsanzo, Valerian, Bromine). Matenda a shuga a Nephrogenic amaphatikizapo kukhazikitsidwa kwa mankhwala omwe amaletsa kutupa ndi thiazide diuretics.

Chofunikira pakuthandizira matenda a shuga insipidus ndikukonzanso kwamchere wamchere ndi kulowetsedwa kwa kuchuluka kwa mayankho a saline. Kuchepetsa bwino diuresis, sulfonamide diuretics tikulimbikitsidwa.

Chifukwa chake, matenda a shuga a insipidus ndi omwe amayamba chifukwa cha kuchepa kwa ma antidiuretic mahomoni amunthu pazifukwa zosiyanasiyana. Komabe, zamakono zamankhwala zimakupatsani mwayi kuti mulipirire momwe mungabwezeretsere chithandizo ichi m'malo mothandizidwa ndimalo ena okhala ndi mahomoni opanga.

Chithandizo chaukadaulo chimabweza wodwala ku moyo wathunthu. Izi sizitchedwa kuti kuchira kwathunthu mu lingaliro lenileni la mawu, komabe, pankhani iyi, thanzi laumoyo lili pafupi kwambiri.

Zakudya zopatsa thanzi komanso zakudya za anthu odwala matenda ashuga

Cholinga chachikulu cha chithandizo cha zakudya ndikuchepetsa kukodza, ndipo kuwonjezera apo, kudzazanso thupi ndi mavitamini ndi michere yomwe "amasiya" chifukwa chokodza pafupipafupi.

Ndikofunika kupatsa chidwi pakuphika motere:

• wiritsani
• kwa okwatirana
• zakudya zophika mu msuzi wokhala ndi mafuta ndi maolivi,
• kuphika mu uvuni, makamaka mu malaya, pofuna chitetezo cha michere yonse,
• ophika pang'onopang'ono, kupatula ngati "mwachangu".

Munthu akakhala ndi matenda a shuga, amadyetsanso zakudya zomwe sayenera kumwa, mwachitsanzo, maswiti, zakudya zokazinga, zonunkhira ndi mchere.

Zakudya zake zimatengera mfundo izi:

• sinthani kuchuluka kwa mapuloteni omwe amwedwa, kusiya zakudya zamafuta ndi mafuta,
• chepetsa kuchuluka kwa mchere, kuchepetsa kuchuluka kwake kwa 5 g patsiku,
• chakudya chizikhala ndi zipatso ndi ndiwo zamasamba zambiri,
• kuti muchepetse ludzu lanu, gwiritsani ntchito misuzi yachilengedwe, zakumwa zakumwa zipatso ndi zakumwa zamalungo,
• Idyani nyama yokonda,
• kuphatikiza nsomba ndi nsomba zam'madzi, mazira a mazira,
• Tenga mafuta a nsomba ndi phosphorous,
• kudya nthawi zambiri m'magawo ang'onoang'ono.

Zosankha zamasiku:

• kadzutsa koyamba - omelet (wotentha) wa mazira 1.5, vinaigrette (ndi mafuta a masamba), tiyi wokhala ndi mandimu,
• nkhomaliro - maapulo ophika, zakudya,
• nkhomaliro - msuzi wamasamba, nyama yophika, beets stewed, chakumwa cha mandimu,
• tiyi wamadzulo - msuzi wa duwa lakuthengo, kupanikizana,
• chakudya chamadzulo - nsomba yophika, mbatata yophika, kirimu wowawasa, tiyi ndi mandimu.

Chakumwa chochulukirapo ndichofunika - chifukwa thupi limataya madzi ambiri ndikusowa madzi m'thupi ndipo limafunikira kulipidwa.

Zithandizo za anthu

Musanagwiritse ntchito wowerengeka azitsamba a matenda a shuga insipidus, onetsetsani kuti mukumane ndi endocrinologist, chifukwa contraindication ndizotheka.

1. Magalamu makumi awiri a mafuta owuma a elderberry amathiridwa mu kapu yamadzi otentha kwambiri, ndipo msuzi womwe umayambitsidwa umathiridwa kwa ola limodzi. The zikuchokera amaphatikizidwa ndi supuni ya uchi ndi kudya katatu tsiku lililonse.
2. Kuti muchotse ludzu kwambiri ndikuchepetsa kutulutsa kwamkodzo, ndikofunikira kuthandizidwa ndi kulowetsedwa kwa burdock. Kuti mukonzekere malonda, muyenera magalamu 60 a muzu wa mbewu iyi, womwe muyenera kupera momwe mungathere, ikani lita thermos ndikuthira madzi otentha kwathunthu. Kuumirira pa mizu ya burdock mpaka m'mawa, pambuyo pake mankhwalawa amatengedwa katatu patsiku mugalasi.
3. Kulowetsedwa kwa amayi kuchokera kwa matenda ashuga. Zosakaniza: motherwort (1 gawo), valerian muzu (1 gawo), ma hop cones (1 gawo), m'chiuno ndi rose (timagawo 1), madzi otentha (250 ml.). Zitsamba zonse zosakanizidwa zimasakanizika bwino. Tengani supuni 1 ya osakaniza ndi kutsanulira madzi otentha. Kuumirira ola. Tengani kuchuluka kwa 70 - 80 ml. musanagone. Phindu: kulowetsedwa kumachepetsa thupi, kuchepetsa nkhawa, kusintha kugona.
4. Kuchepetsa ludzu ndikubwezeretsani thanzi lanu, mutha kugwiritsa ntchito masamba ophatikizidwa. Masamba achomera awa amatengedwa, wowuma ndi wophwanyika. Pambuyo pake, supuni ya tiyi yowuma imapangidwa ndi kapu (mililita 250) yamadzi otentha. Patatha mphindi 15, msuzi wotsatira ungathe kudyedwa ngati tiyi wokhazikika.
5. Kutolere zitsamba zosiyanasiyana kudzathandizanso kuthana ndi matendawa: fennel mamawort, valerian, fennel, mbewu zochotsa. Zosakaniza zonse ziyenera kumwedwa zofanana, zosakanizidwa bwino. Zitatha izi, supuni ya chisakanizo chouma imathiridwa ndi kapu ya madzi otentha ndikuikiramo mpaka madzi atazirala. M'pofunika kumwa mankhwalawa mu theka kapu musanagone.

Mitundu ndi zoyambitsa matenda

Chizindikiro cha NSAID ndi kukodza mopitilira mpaka malita 20 patsiku.

Zomwe zimayambitsa matenda a shuga a nephrogenic insipidus zimatengera mtundu wa matenda:

• Cholowa. Choyambitsa matendawa ndi matenda a AVP receptor gene. Nthawi zina chomwe chimayambitsa ndikusintha kwa majini a aquaporin-2. Mu odwala a homozygous, pali kusowa kwathunthu kwa vuto la impso ku ADH. Mu heterozygous, zomwe zimachitika mu ADH ndizabwinobwino kapena zochepa.
• Walandidwa. Matendawa amakula chifukwa chakuwonongeka kwa minyewa ya muubongo ndi mphuno za impso chifukwa cha ma pathologies enaake kapena zomwe zimapangitsa thupi la mankhwala. Impso zopanda thanzi zimataya chidwi ndi ADH ndikusiya kuyamwa madzi, ndikupanga mkodzo wambiri wosakhudzidwa. Matenda a impso a Polycystic, pyelonephritis, amyloidosis, kumwa mankhwala ndi lifiyamu kungayambitse matenda.

Kodi kuchitira matenda?

Chithandizocho chimakhazikika pobwezeretsanso mchere wamchere wamthupi.

Chithandizo cha zovuta kuphatikizira mankhwala monga Ibuprofen.

Nkhondo yolimbana ndi matenda a shuga a nephrogenic insipidus imaphatikizapo kugwiritsa ntchito thiazide diuretics. Ngakhale kuti mankhwalawa gululi ndi okodzetsa, amalepheretsa kubwezeretsanso kwa chlorine m'matumbo aimpso, chifukwa chomwe mulingo wa sodium m'magazi umachepa ndipo ntchito yaimpso yobwezeretsanso madzi ibwezeretsedwanso. Wodwalayo adalembedwa "Hydrochlorothiazide", "Indapamide." Mothandizidwa ndi mankhwala othana ndi zotupa, monga Ibuprofen, Indomethacin, zinthu zina sizilowa m'matumbo a impso, chifukwa mkodzo wa mkodzo umachuluka ndipo kuchuluka kwake kumachepa. Ndikofunika kuchiza matenda a shuga monga kuphatikiza ndi zakudya.

Zakudya zoyenera

Popanda kukonza zakudya, mankhwalawa sakhala othandiza. Cholinga cha chakudyacho ndikuchepetsa kutulutsa mkodzo, kuthetsa ludzu ndikupereka thupi ndi michere yotayika chifukwa cha polyuria. Mchere wamasiku onse ndi mchere wa 5-6 g, womwe munthu amalandila, ndipo chakudya chimakonzedwa popanda mchere. Ndi zoletsedwa kumwa mowa ndi maswiti, muyenera kuchepetsa kudya mapuloteni. Mafuta ndi chakudya chamagulu amaloledwa. Masamba atsopano ndi zipatso, timadziti, nsomba ndi nsomba zam'madzi ziyenera kupezeka mu chakudya.

Zoyambitsa matenda a shuga insipidus

Matenda a shuga ndi matenda omwe amayamba chifukwa cha kuperewera kwa vasopressin, kuperewera kwake kapena kuperewera kwathunthu. Ma antidiuretic mahomoni (vasopressin) amapangidwa mu hypothalamus ndipo, mwa zina ndi zinthu zina mthupi, amachititsa kukodzetsa. Mwa zisonyezo zamatsenga, mitundu itatu ya shuga ya insipidus imasiyanitsidwa: idiopathic, anapeza, komanso chibadwa.

Odwala ambiri omwe ali ndi matenda osowa, chifukwa chake sichidziwika. Matendawa amatchedwa ideopathic, mpaka 70% ya odwala amadwala matendawa.

Mitundu ndi chibadwa. Potere, matenda ashuga nthawi zina amadziwonekera m'mabanja angapo komanso kwa mibadwo ingapo motsatana.

Medicine amafotokoza izi posintha kwambiri mtundu wa genotype, zomwe zimapangitsa kuti pakhale zovuta m'magulu a antidiuretic hormone. Komwe kudachokera matendawa kumachitika chifukwa cha kulumala komwe kumachitika pakapangidwe ka diencephalon ndi midbrain.

Poganizira zomwe zimayambitsa matenda a shuga insipidus ayenera kuganizira njira za kakulidwe:

Central shuga insipidus - imayamba ndi osakwanira kupanga vasopressin mu hypothalamus kapena kuphwanya mawonekedwe ake obisika kuchokera ku chiwalo kupita m'magazi, akuwonetsa kuti zomwe zimayambitsa ndi:

• Matenda a hypothalamus, popeza ndi omwe amayang'anira kuwongolera kwa mkodzo ndi kaphatikizidwe ka mahomoni a antidiuretic, kuphwanya ntchito yake kumabweretsa matendawa. Matenda owopsa kapena opatsirana opatsirana: tonsillitis, chimfine, matenda opatsirana pogonana, chifuwa chachikulu ndi chomwe chimayambitsa komanso kupatsirana kwa matenda a hypothalamic dysfunctions.
• Kuvulala kwamtundu wamatumbo, conco.
• Opaleshoni yaubongo, matenda otupa a muubongo.
• Zotupa zam'mimba za hypothalamic-pituitary system, zomwe zimayambitsa kusokonezeka m'mitsempha yamaubongo yomwe imadyetsa pituitary ndi hypothalamus.
• Tumor njira za pituitary ndi hypothalamus.
• Zotupa za cystic, zotupa, zopweteka za impso zomwe zimasokoneza kuzindikira kwa vasopressin.
• Matenda a autoimmune
• Hypertension ndi chimodzi mwazinthu zomwe zikukulitsa kupezeka kwa matenda ashuga.

Renal shuga insipidus - pomwe vasopressin imapangidwa mwanjira wamba, komabe, minyewa ya impso siyilandira moyenera. Zifukwa zake zitha kukhala izi:

• Odwala cell anemia ndi matenda osowa
• Kuberekera kwa chiberekero ndi chinthu chobadwa nawo
• Kuwonongeka kwa medulla kwa impso kapena kwamkodzo wa nephron
• polycystic (ma cysts angapo) kapena amyloidosis (amene amapezeka mu minofu ya amyloid)
• aakulu aimpso kulephera
• kuchuluka kwa potaziyamu kapena kuchepa kwa calcium
• kumwa mankhwala oopsa m'matumbo a impso (mwachitsanzo, Lithium, Amphotericin B, Demeclocilin)
• nthawi zina amapezeka mwa odwala ofooka kapena okalamba

Nthawi zina, motsutsana ndi kumbuyo kwa kupsinjika, ludzu lochulukirapo (psychogenic polydipsia) lingachitike. Kapena matenda a shuga a insipidus panthawi yomwe ali ndi pakati, omwe amapezeka mu 3 trimester chifukwa cha kuwonongeka kwa vasopressin ndi michere yopangidwa ndi placenta. Mitundu iwiriyi yophwanya malamulo imachotsedwera iwowo atachotsa chomwe chimayambitsa.

Kodi pali kusiyana kotani pakati pa matenda ashuga ndi shuga?

Matenda a shuga a shuga sayenera kusokonezedwa ndi matenda a shuga a mellitus (DM), omwe ndi omwe amayamba chifukwa cha kuchepa kwa insulin kapena chitetezo chokwanira, zomwe zimabweretsa kuchuluka kwa shuga m'magazi, omwe amatchedwanso shuga. Matenda a shuga samayenderana ndi matenda amisala, ngakhale atha kukhala ndi zofanana.

Shuga ndiwofala kwambiri kuposa matenda a shuga. Matenda a shuga wamba ali ndi mitundu iwiri yayikulu: mtundu 1 ndi 2. Matenda a shuga ndi mtundu wina wamatenda.

Gulu la odwala matenda ashuga

Matendawa amagawidwa m'mitundu yayikulu yayikulu:

• matenda apakatikati a shuga— amapangidwa pamene kupanga vasopressin (mahomoni omwe amalamulira kagayidwe kamadzi m'thupi) mu hypothalamus (hemisphere mu diencephalon, yomwe imaphatikizapo kuchuluka kwa magulu am'magulu omwe amawongolera zochitika zaubongo neuroendocrine) sikokwanira,
• nephrogenic shuga insipidus (NIDDM)— Amayamba chifukwa cholephera kukhazikika mkodzo chifukwa cha kusokonezeka kwa ma impso a vasopressin, komwe kumapangitsa kuchotsedwa kwa mkodzo wambiri mosagwirizana ndi thupi.
• insipidar syndrome— yodziwika ndi polydipsia (ludzu lalikulu), polyuria (kuchuluka kwamikodzo kwamkati patsiku),
• matenda a shuga a gestagen insipidus— zimakhudzana ndi kuchuluka kwa ntchito yamphamvu ya placenta, yomwe imawononga vasopressin.

Nthawi zambiri, pali mitundu iwiri: yapakati ndi nephrogenic.

Malinga ndikuvuta kwa maphunzirowa, mitundu yotsatila ya shuga ya insipidus imasiyanitsidwa:

• kuwala - mpaka malita 8 a mkodzo patsiku,
• pafupifupi - magawo 8 malita / tsiku,
• lolemera - oposa malita 14 / tsiku.

Komanso matendawa amachitika kubadwa kapena zopezeka mitundu.

Zakudya ndi zakudya kwa odwala matenda ashuga

Cholinga chachikulu cha zakudya zamatenda a shuga insipidus ndikuchepa pang'onopang'ono kwa zotulutsa mkodzo patsiku ndikulimbana ndi ludzu lalikulu.

Ndikofunikira kupewa kudya zakudya zomwe zimakhala ndi mapuloteni, ndikuyambitsa mafuta ndi chakudya chamagulu ambiri. Chakudya chimaphikidwa popanda kuwonjezera mchere.

Zinthu zomwe ziyenera kuphatikizidwa ndi zakudya za matenda a shuga:

• nyama yodontha (mwachitsanzo nkhuku, yofiira kapena yoyera),
• mtedza
• mbewu zosiyanasiyana. Ndikulimbikitsidwa kuti ndiziyika kukonda ballet, oat ndi mpunga,
• masamba ndi zipatso
• zipatso
• mkaka
• msuzi wa rosehip,
• nsomba zam'nyanja
• tiyi wobiriwira
• madzi ndi ndimu.

Ndi zoletsedwa kudya:

• tsabola wakuda ndi wofiyira
• mpiru
• viniga
• wosuta mbale
• ma pickles ndi ma pickles,
• olanda, tchipisi ndi chakudya chofulumira.

Zakudya za tsiku ndi tsiku

Ndi matendawa, muyenera kutsatira kadyedwe kena. Pafupifupi zakudya za tsiku lililonse za anthu odwala matenda ashuga:

• kadzutsa koyamba - omelet (wotentha) wa mazira awiri, vinaigrette (ndi mafuta a masamba), tiyi ndi mandimu,
• nkhomaliro - oatmeal, matailosi atatu a chokoleti chakuda, odzola,
• nkhomaliro - msuzi wamasamba, nyama yophika yoyera, kaloti wowotchera, mkaka,
• Chakudya chamadzulo - saladi wa nkhaka ndi phwetekere mumafuta a masamba, dzira limodzi lophika,
• chakudya chamadzulo - nsomba yophika, mbatata yophika, kirimu wowawasa, tiyi ndi mandimu.

Tsiku lonse muyenera kuyang'anira kwambiri zakumwa zoledzeretsa. Ndi matenda a shuga a insipidus, thupi limasowa madzi ambiri kuposa kale kuti athandizire kuchepa kwamadzi nthawi yamadzi.

Zakudya ziyenera kumwedwa pang'ono: 4-5 pa tsiku.

Zofunika! Wodwalayo amayenera kuwunika ntchito, koyamba, ndi mikate yoyera, ndipo chachiwiri, batala ndipo, komaliza, chachitatu, chinthu chovulaza panthawiyo - shuga.

Kutsatira zakudya kumathandiza wodwala yemwe ali ndi matenda ashuga kufulumizitsa kuchira ndipo posachedwa abwerere ku moyo wathunthu.

Kupewa matenda a shuga insipidus

Kulimbikitsidwa munthawi yovomerezeka ya dongosolo lamanjenje lamkati, kutsatira kuchuluka kwamadzimadzi tsiku lililonse, kupuma pafupipafupi ndi mpweya wabwino, komanso kukana zizolowezi zoyipa ndikulimbikitsidwa.

Anthu omwe ali ndi chiyembekezo cha izi, sikuti zimakhala zowonjezera nthawi zina, osachepera kawiri pachaka, kuti achite X-ray ya impso.

Ngati muli ndi zizindikiro za polyuria kapena ludzu losalekeza, muyenera kufunsa dokotala kuti mupewe zomwe zingachitike.

Ndi chithandizo choyenera, matendawo aanthu omwe ali ndi matenda a shuga insipidus ndiabwino. Central shuga insipidus amayankha chithandizo mosavuta kuposa nephrogenic shuga insipidus.

Ngakhale odwala omwe ali ndi matenda ashuga amalowa kwambiri m'thupi, kufa kwa izi mwa odwala akuluakulu omwe ali ndi thanzi labwino ndikosowa. Koma ana ndi achikulire omwe ali pachiwopsezo chachikulu cha kufa chifukwa cha madzi okwanira.