Matenda a shuga: Zizindikiro ndi mankhwala

Zomwe zimayambitsa nthawi yomweyo matenda a shuga ndi chifuwa chachikulu ndi izi:

Ofooka chitetezo chokwaniramotsutsana ndi komwe matenda amatenga. Chitetezo chokwanira, chimachepetsedwa chifukwa cha kuchepa kwa ma phagocytes, maselo oyera am'magazi ndi maselo ena.
Mu matenda a shuga mellitus nthawi zambiri amadziunjikira m'magazi matupi a acetone ketone, zomwe zimapangitsa ketoacidosis ndipo pambuyo pake acidosis. Chifukwa chake, kuledzera ndi kuwonongeka kwa minofu kumachitika mkati. Ndipo izi zimapangitsa kuti thupi lipezeke ndi tubercle bacillus.
Njira za metabolic zikasokonekera (chakudya, mapuloteni, mafuta, mchere), kuchepa kwa michere mthupi, zomwe zimabweretsa kudzikundikira kwa zinthu zopweteka za metabolic. Chifukwa cha izi, kufooka kwa ntchito zoteteza kumachitika.
Kugwedezeka kwina. Pankhaniyi, thupi limalephera kulimbana ndi tizilombo toyambitsa matenda, chifukwa cha zomwe tubercle bacillus imayambitsa.

Mutha kuphunzira za zotsatira za kafukufuku wamakono, komanso za mawonekedwe a chifuwa chachikulu komanso matenda a shuga, kuchokera mu kanema:

Ma Statntless

Kafukufuku akuwonetsa kuti chifuwa chachikulu chimakhudzidwa ndi anthu odwala matenda a shuga, kuphatikiza apo, amuna. Kuchuluka kwa matenda ashuga omwe ali ndi chifuwa chachikulu ndi 3-12%, ndipo pafupifupi 7-8%.

Ngati matenda a shuga apezeka ndi TB, manambala ndi 0.3-6%. Chifukwa chake, zikuwonekeratu kuti chifuwa chachikulu chimafikira ku shuga mu 80% ya anthu odwala matenda ashuga, komanso matenda a shuga amayamba ku TB - 10% yokha. Mu 10% yotsala, etiology siyodziwika.

Popeza pathogenesis ya chitukuko cha chifuwa chachikulu imakhudzidwa ndi kuchuluka kwa kuphwanya kagayidwe kazakudya, matenda amachitika ndi maulendo osiyanasiyana. Chifukwa chake, ngati mtundu wovuta wa shuga ulipo, ndiye kuti TB imachitika kangapo ka 15 koposa mwa munthu wamba. Ndi zolimbitsa mwamphamvu - pafupipafupi katatu. Ndipo ndi matenda abwinobwino a shuga, sindimasiyana kwenikweni ndi matenda omwe alibe matenda ashuga.

Mitundu ya matenda ndi mawonekedwe

Matenda a chifuwa chachikulu ali ndi mitundu itatu yayikulu, yomwe imasiyana malinga ndi nthawi yomwe matenda akachitika.

Kuchulukitsa kwa chifuwa cha shuga m'matenda a shuga kumadalira kuchuluka kwa chipukuta chodwalitsa cha carbohydrate metabolism. Mwachitsanzo, ngati katundu wopatsirana ali wosauka, ndiye kuti chifuwa cham'mimba chimakula mwachangu, mwachangu kukhudza minyewa yam'mapapo mu mawonekedwe ochulukirapo.

Kukula kwa chifuwa chachikulu pamaso pa matenda ashuga

Izi zimawerengedwa kuti ndi kuphatikiza komwe kumatengera matenda awiriwa. Cholinga chachikulu ndi kufooka kwa chitetezo chathupi komanso kulephera kwa thupi kukana matenda. Izi ndizowona makamaka kwa tubercle bacillus. Kuphatikiza apo, mu matenda ashuga, thupi silipanga ma antibodies okwanira olimbana ndi chifuwa.

Mu shuga mellitus, chifuwa chachikulu cha kulowetsedwa ndi mawonekedwe a fibro-cavernous nthawi zambiri amakumana. Chitha kuwoneka ngati chifuwa chachikulu.

Ngati TB sinapezeka munthawi yake, izi zimayambitsa matenda oopsa, chifukwa chamankhwala omwe onsewa amakhala ovuta. Chowonadi ndi chakuti chifuwa chachikulu cha matenda osokoneza bongo chimakhala chambiri kwambiri, motero wodwalayo sangakayikire ngakhale pang'ono kupezeka kwake, ndipo matenda atapezeka kale m'magawo amtsogolo. Chifukwa chake, ndikofunikira kwambiri kuchita fluorography kamodzi pachaka.

Zizindikiro za chifuwa chachikulu cha shuga

Gawo loyamba la kukula kwa chifuwa chachikulu mu matenda ashuga amadziwika ndi maphunziro asymptomatic. Komabe, chisamaliro chapadera chikuyenera kulipidwa pakusintha koteroko mthupi:

kuchepa kwa magwiridwe
kumva pafupipafupi kufooka
kuthetsa njala,
thukuta kwambiri.

Anthu ambiri odwala matenda ashuga amati izi zimachitika chifukwa cha zovuta za matenda ashuga, koma izi sizolakwika. Ndi zizindikiro zotere, fluorography iyenera kuchitidwa mwachangu.

Kupitilira apo, kuchuluka kwa glucose m'magazi kumakwera kwambiri. Komabe, palibe chifukwa chowonjezera chotere. Aliyense wodwala matenda ashuga amadziwa kuti shuga amatha kuchuluka kokha pazikhalidwe zina. Kodi chifukwa chiyani shuga amakwera? Ndikukonzekera kuti pakukula ndi Kukula kwa bacillus wa tuber, pamafunika insulin yambiri. Chifukwa chake, sichitha ntchito pakuwotcha shuga, koma pamtengo wokula.

Zizindikiro mu magawo apambuyo pachitukuko cha chifuwa chachikulu mu matenda ashuga:

Zowonongeka zam'mapapu m'makoko am'munsi.
Paroxysmal chifuwa cha chilengedwe. Zitha kuchitika m'mawa ndi madzulo. Masana, wodwala kwenikweni samakhosomola.
Mukakhosomola, ntchofu ndi sputum zimamasulidwa mwachangu, nthawi zina zimakhala ndi magazi.
Kuwonjezeka kwa kutentha kwa thupi, komwe sikumatayika mwanjira iliyonse.
Kuchepetsa thupi, komwe siiko kwa odwala matenda ashuga.
Kugona, kusuntha gait. Izi ndichifukwa choti ndi matenda ashuga, chifuwa chimakhala chopanda tanthauzo, ndipo chifuwa chachikulu chikukulirakulira.
Nthawi zambiri zimasintha, mpaka pamakhala kuchita zankhanza.

Ngati simumalabadira zizindikiro izi munthawi yake ndipo simukuyendera dokotala, kuphatikiza kwa matenda owopsa awiriwa kumatha kupha!

Zizindikiro

Ndi chithunzi chosadziwika bwino cha matenda osokoneza bongo omwe ali ndi chifuwa chachikulu, wodwalayo nthawi zambiri amagonekedwa m'chipatala ndi kuledzera ndikuwonjezera kuchuluka kwa njira yotupa. Izi zimabweretsa zovuta pakusankha njira yothandizira chithandizo chamankhwala ndipo zimakhala ndi imfa. Mukazindikira matendawa kale, zimakhala zosavuta kuthandizira.

Pozindikira matenda a shuga pamaso pa chifuwa chachikulu wodwalayo ayenera kudutsa yoyeserera yoyeserera ya magazi (magazi, mkodzo).

Ngati alipo akuwakayikira chifuwa chachikulu cha shuga, muyenera kutsatira njira zotsatirazi:

adotolo amatenga chidziwitso chonse chazizindikiro, kuthekera kwa kutenga kachilombo komanso kupezeka kwa mtundu woyambirira wa chifuwa chachikulu (wodwalayo mwina anali ndi matendawa kale),
adokotala amamuwunikira, ndiye kuti, amawadziwa momwe wodwalayo alili, amayang'anira zamitsempha ndi zina zotero,
kenako endocrinologist amatumiza wodwala kwa katswiri wa TB (amathandizira pakuzindikira komanso kuchiza TB),
Katswiri wa TB amayesa kuyesa palpation, kuzindikira ndi chidwi, amaika mayeso,
kuyezetsa kwa tuberculin, ndiye kuti, kuyesa kwa Mantoux, mwa zomwe zimatheka kuweruza matenda,
fluorografia (radiografia) ya chifuwa mumagulu 2 - ofananira nawo ndi anteroposterior,
compression tomography ikuwonetsa kukula kwamavuto,
wodwalayo akuyenera kudutsa kuwunika kwatsatanetsatane wamagazi ndi mkodzo, komwe kumapangitsa kuwonjezeka kwa leukocytes, kuchuluka kwa kuledzera, kusokonezeka kwa kapangidwe ka michere, etc.
kusanthula kwa zasayansi ya sputum (microscopic and bacteriological),
ngati kuli kotheka, tracheobronchoscopy imachitika.

Chithandizo - njira zoyambira

Chithandizo cha matenda a shuga osakanikirana ndi chifuwa chachikulu chiyenera kukhala chodalira njira zonse za matenda onsewa. Ngati chifuwa chikutseguka kapena chovuta, wodwala ayenera kuchipatala.

Aliyense amadziwa kuti kwazaka zambiri mankhwala azikhalidwe amalimbikitsa kudya mafuta owononga chifuwa chachikulu cha m'mapapo. Ambiri amamuwona ngati wopepuka wa matendawa. Kodi ndikotheka kutenga mafuta oyipa a shuga, muphunzira kuchokera pa kanema:

Zida za mankhwala othandizira odwala matenda ashuga

Choyamba, kwa odwala matenda ashuga, makamaka ndi mtundu wa 1 wa matenda, ndikofunikira kuwonjezera kuchuluka kwa insulini yoyendetsedwa, chifukwa yambiri imangotayidwa pa bacillus ya tubercle. Mlingo ukuwonjezeka pafupifupi magawo khumi. Amagawidwa wogawana tsiku lonse, chifukwa chomwe kuchuluka kwa jakisoni tsiku lililonse kumayenera kukhala kasanu. Pankhaniyi, insulin yokhala nthawi yayitali iyenera kulowetsedwa ndi mankhwala osakhalitsa. Ndi matenda a shuga a 2, kuchuluka komanso kuchuluka kwa mapiritsi ochepetsa shuga kumawonjezeka. Nthawi zina, mankhwala a insulin ndi omwe amapatsidwa.

Zinthu ndi mfundo zamankhwala:

Cholinga cha chakudya No. 9. Kutsatira kwake kuyenera kukhala kovuta. Zimakhazikika pakukulitsa kuchuluka kwa mavitamini ndi mapuloteni. Ndi zoletsedwa kotheratu kudya ufa ndi wokoma, mchere wambiri ndi mafuta, wokazinga komanso wosuta. Mukuyenera kukana ayisikilimu ndi kupanikizana, simungathe kudya nthochi.
Kuchiza ndi antibacterial wothandizila kumachitika pa munthu aliyense. Kuphatikiza kosiyanasiyana kwa mankhwala kumayikidwa.
Ndikofunikira kuchita mankhwala a chiferculostatic chemotherapy kudzera mwa mankhwala apadera. Kutalika kwa mankhwalawa kwa odwala matenda ashuga ndi 2 nthawi yayitali. Mankhwala omwe akupangidwira amafunikira kuti achepetse kupanga kwa insulin. Pankhaniyi, ndikofunikira kusintha kuchuluka kwa mankhwala ochepetsa shuga.
Mankhwala a Vitamini amafunika, chifukwa chomwe thupi limabwezeretsa chitetezo chake.
Mwina kuperekedwa kwa hepatoprotectors pamodzi ndi mankhwala "Timalin." Izi zimalimbitsa chitetezo cha mthupi.
Kuti muchepetse magazi komanso kuthana kwa ma chemotherapeutic othandizira ndi maselo omwe akhudzidwa, adotolo atha kukupatsirani mankhwala monga Sermion, Parmidin, Andekalin, Nicotinic acid ndi Actovegin.
Mwazovuta kwambiri, opaleshoni imalembedwa (kuchulukitsa kwamapapu).
Ndikofunika kumwa mankhwala omwe amathandizira kagayidwe kachakudya ndikusinthanso kukonzanso thupi.

Mankhwala ochizira chifuwa chachikulu

Nthawi zambiri zotchulidwa mankhwala:

"Isoniazid" ndi "Paraaminosalicylic acid"
Rifampicin ndi Pyrazinamide
Streptomycin ndi Kanamycin
"Cycloserine" ndi "Tubazid"
Amikacin ndi Ftivazid
Protionamide ndi Ethambutol
Capreomycin ndi Rifabutin
Mwa mavitamini, ndikofunikira kumwa vitamini B1, B2, B3, B6, B12, A, C, PP

Mukamapereka mankhwala, dokotala wa chifuwa chachikulu amatengera mtundu wa matenda ashuga, popeza pali zovuta zina zomwe zimakanidwa. Mwachitsanzo, ndi shuga wovuta, simungatenge Isoniazid ndi Ethambutol, komanso Rifampicin.

Matendawa amatha kuchitika patadutsa zaka zinayi atatha matenda ashuga, ndipo matenda ashuga amatha zaka pafupifupi 9 mpaka 10 atadwala TB. Chifukwa chake, ndikofunikira panthawi imeneyi kuti muzisamalira kwambiri zodwala ndikuwonana ndi dokotala munthawi yake. Kuzindikira koyambirira kumakupatsani mwayi kuti muchepetse zovuta zam'tsogolo komanso mwachangu!

Chipatala cha Matenda a Chifuwa

Phthisiology imapereka chidwi chapadera ku vuto la hyperglycemia. Izi ndichifukwa choti mu shuga mellitus chifukwa cha kusokonekera kwa ntchito ya legocytes, carbohydrate-fat balance and general metabolism, njira yochiritsira ndikubwezeretsa mapapu ndizovuta kwambiri.

Nthawi zambiri, chifuwa chachikulu cha chifuwa cha shuga chitasinthidwa kukhala njira yodwala, ndikupangitsa kuti masinthidwe owonongeka mu minofu ndikupangitsa kuti pakhale mitundu yochepa yolowerera (chifuwa chachikulu, foci) kapena ziwalo.

Malinga ndi ziwonetsero za matenda owonera mliri, kuchuluka kwa chifuwa chachikulu kwa odwala omwe amadalira insulin ndikwambiri nthawi 5-10 kuposa mwa anthu wamba. Mwa odwala 9 mwa 10 oterowo, matenda ashuga anali matenda oyambitsidwa ndi matenda.

Komanso, chifukwa cha kusinthika kwa metabolic komanso immunological komwe kumabwera chifukwa cha kuperewera kwa insulin, njira ya chifuwa chachikulu mu matenda ashuga imadziwika kwambiri, komwe, limakulitsa zochitika zam'chipatala ndipo zimayambitsa zovuta zazikulu - zoyipa zam'mbuyomu mu ziwonetsero, kuwonongeka koyambirira ndi bronchogenic kubzala.

TB imayamba mu matenda a shuga monga njira yachiwiri yokhazikika makamaka kumadera otsika a m'mapapo. Mawonetsedwe azachipatala a matendawa ndiwotsimikizika ndipo amadalira mtundu ndi matenda omwe amayambitsidwa (DM). Kudziwidwa kumayambiriro, chifuwa chachikulu chimakhala ndi mawonekedwe abwino kuposa matenda kumapeto kwake.

Matenda ovuta kwambiri amapezeka mwa odwala omwe amadalira insulin aubwana ndi unyamata. Pankhaniyi, nthawi zambiri pamakhala kuledzera kwamphamvu kwa thupi, kuwonjezereka kwa matendawa, kupanga mapangidwe a fibro-cavernous komanso kuwonongeka kwa ziwalo.

Magulu angapo a odwala amadziwika chifukwa cha nthawi ya matenda a shuga ndi chifuwa chachikulu:

Nthawi imodzi kapena pang'ono pakadutsa miyezi 1-2,
Kuzindikira matenda pamatenda a shuga a gawo lililonse,
Kuzindikira kwa hyperglycemia kumbuyo kwa chifuwa chachikulu.

Kukula kwa matenda kumatha kuphatikizidwa ndi matenda oyamba komanso kubwezeretsanso zakale (zipsera) zakale chifukwa cha chifuwa cham'mbuyomu. Kulunjika kwa kufanana kwa mitundu iwiriyi ndikuti chifukwa cha kuchuluka kwa matenda ashuga, ngakhale ndi chithandizo chokwanira cha matenda, wodwala wodalira insulin, chizolowezi chowonjezereka komanso kutembenuka kwa chifuwa chachikulu chimatsalira.

Etiology ya chifuwa chachikulu odwala omwe ali ndi matenda ashuga

Nthawi zambiri, matendawa amalumikizana ndi shuga omwe alipo. Zomwe zikuluzikulu zomwe zimapangitsa kuti pakhale kumwa kwambiri ndizosasamala za kuopsa kwa chifuwa chachikulu pakuwonekera kwake, ndipo pokhudzana ndi izi, chithandizo chosadabwitsa.

Zina zomwe zimayambitsa kufalikira kwa matendawa ndi monga:

Acidosis (kuchuluka kwa acidity ndi kuchepa kwa pH m'thupi,
Pancreatitis pachimake kapena chodwala,
Kuchotsa kapamba
Kusagwirizana kwa homeostasis ndi immunobiological reactivity ya thupi.

Zizindikiro

Ngakhale zovuta za pathologies, zizindikiro za chifuwa chachikulu m'matenda a shuga sizidziwika nthawi zonse ndipo zimatha kubisala ngati kuwonongeka, acidosis, kapena matenda ena.

Zizindikiro zotsatirazi zimapangitsa kupezeka kwa matenda mthupi kuti mukaikire:

Kuchepetsa thupi kwambiri komanso kusowa kwa chakudya,
Mkhalidwe wotsika
Kutaya kwa sputum, mwina ndi zosafunikira zamagazi,
Kutentha kwambiri
Kuzizira pafupipafupi - ARI, herpes,
Hypodynamic komanso zoyipa.

Kusintha kumawonekanso pamlingo wathanzi - wodwala wodalira insulin amayamba kugona, ndipo chifuwa chake chimakhala chopanda kanthu. Kuchita bwino kwa munthu kumasinthanso, kumayamba kugwedezeka pang'ono ndi pang'ono.

Tekinoloje yamankhwala

Chifuwa chachikulu cha chifuwa chachikulu cha m'mimba ndi shuga ndizophatikiza zovuta za standard chemotherapy. Kuchuluka kwa zovuta ndi zoyipa kuchokera ku chithandizo kwa odwala omwe amadalira insulin ndi 1.5 nthawi zambiri kuposa kwa odwala opanda matenda a shuga. Mankhwalawa pawokha amatenga nthawi yayitali ndipo amangochitika kuchipatala chothandizira.

Kusankhidwa kwa kuphatikiza kwa mankhwala ndi dongosolo la kayendetsedwe kake kumachitika mogwirizana ndi chiwembu, mogwirizana ndi matenda, gulu la anthu odwala matenda ashuga, gawo la chifuwa chachikulu, kufalitsa kwake komanso kuchuluka kwa kumasulidwa kwa ofesi. Mfundo zazikuluzikulu za njira yonse yochiritsira ndiyothandiza mosiyanasiyana.

Matendawa amapezeka pogwiritsa ntchito njira zofufuza zamankhwala ndi zamankhwala:

Kusanthula kwamphamvu magazi ndi mkodzo,
Kusanthula kwa zamankhwala,
Kuyeserera kwakanthawi ndi ma X-ray,
Kuyesa kwa Tuberculin kapena katemera wa Mantoux / Pirke,
Microscopy ya sputum ndi chikhalidwe chake kuti azindikire ntchito ya mycobacteria,
Matenda a bronchoscopic,
Minofu kapena maselo a histological biopsy,
Matenda a immunological omwe cholinga chake ndi kuzindikira ma antibodies a bacillus mu seramu yamagazi.

Tuberculosis ya odwala omwe amadalira insulin amathandizidwa mothandizidwa ndi kuphatikiza mankhwala ndikuwonetsetsa kuchuluka kwa shuga. Kuphwanya regimen ya mankhwala kumabweretsa multidrug kukana chifuwa kapena kukula kwake kukana mankhwala.

Njira yodziwika ndi anti-TB yothandizira odwala matenda ashuga imaphatikizapo:

Chemistry - Isoniazid, Rifampicin, Ethambutol ndi maantibayotiki ena,
Immunostimulants - Sodium Nucleinate, Tactivin, Levamiol,
Inhibitors - b-tocopherol, sodium thiosulfate, etc.,
Mankhwala a Hormonal omwe amayang'anira shuga nthawi zonse,
Othandizira odwala matenda ashuga, kuphatikiza insulin,
Chithandizo cha manambala 9.

Ndi kusinthika pang'onopang'ono kwa matenda, kugwiritsa ntchito njira zothandizira zosagwiritsa ntchito mankhwala othandizira chifuwa chachikulu ndikuloledwa - ultrasound, laser ndi inductotherapy.

Njira yonse yochiritsira wodwala yemwe ali ndi matenda a shuga kuchokera pakumwa amachitika moyang'aniridwa ndi achipatala. Ntchito yayikulu munthawi imeneyi, kuwonjezera pakuchotsa kulowa, ndikupanga chipukuta, komanso kusintha mtundu wa glucose, mapuloteni, lipids ndi metabolism.

Ndi bwino kupatsidwa mankhwala a chemotherapy komanso kuchira, wodwala matenda a shuga amawonetsedwa chithandizo cha spa.

Njira zopewera

Popeza odwala omwe amadalira insulin ndi omwe ali pachiwopsezo chachikulu chotenga kachilombo ka chifuwa chachikulu, tikulimbikitsidwa kuti agwiritse ntchito njira zingapo zodzitetezera popewa kukula kwa matendawa.

Kuti mudziteteze ku mowa, muyenera:

Mumayesedwa X-ray kapena fluorography pachaka,
Khalani ndi moyo wokangalika
Nthawi zambiri muziyenda mumlengalenga,
Kutsatira dongosolo lolondola la tsiku ndi tsiku, zakudya komanso nthawi yopuma pantchito,
Chotsani komwe kungayambitse matenda, kuphatikiza ndi wodwala chifuwa chachikulu,
Sinthani zakhalidwe,
Kanani zizolowezi zoipa - mowa, kusuta,
Mankhwalawa, kuphatikizapo matenda ashuga,
Onani zaukhondo
Pentheni ndi kunyowetsa malowa nthawi zonse
Idyani zakudya zokhala ndi mavitamini, chakudya chamafuta ndi zinthu zina.

Kuphatikiza apo, wodwala yemwe amadalira insulin ayenera kudwala chemoprophylaxis ndi Isoniazid kuyambira miyezi iwiri mpaka isanu ndi umodzi. Moyo wonse wa munthu wodwala matenda ashuga ayenera kuangika pantchito yake, thanzi labwino komanso kuchita masewera olimbitsa thupi, kulola kuti thupi lizikumana ndi mphamvu komanso kulimbitsa chitetezo chokwanira.

Musaiwale za kusamala. komanso yesani kupewa kutsokomola anthu, mavairasi oyambitsa nyengo (chimfine, zotupa zopumira), mafuta otentha ndi maulendo a sauna. Kugwiritsa ntchito UV kwambiri kumapangidwanso. Zakudya ziyenera kukhala zabwino, m'magawo angapo. Onetsetsani kuti mukuyendera dokotala wanu pafupipafupi.

Ndi njira yabwino komanso yolondola yokhudza vuto la chifuwa chachikulu komanso chifuwa chachikulu cha shuga, matenda omwe amatenga matendawa sakhala owopsa ndipo nthawi zonse amakhala ndi chitsimikiziro chabwino.

Chowonekera cha chifuwachi pamaso pa matenda ashuga

Monga momwe machitidwe amasonyezera, mwa amuna azaka zapakati pa 20 mpaka 50 okhala ndi shuga wambiri, mabakiteriya a chifuwa chachikulu amatha kukhudzidwa. Mu magawo oyamba, matenda amapitilira mu mawonekedwe obisika, ndiye kuti, popanda zizindikiro zotchulidwa, zomwe zimasokoneza kutsimikiza mtima kwa matendawo.

Chifuwa chachikulu ndi shuga zimaphatikizidwa mu milandu iwiri:

Kukula kwa matenda kumachitika palokha. Onsewa amachita ngati matenda odziyimira pawokha.
Kuwonekera kwa gawo lazachipatala za matenda ashuga kumabweretsa matenda a chifuwa chachikulu.

Chomwe chagona ndikuti matenda a shuga amawononga chitetezo chamthupi, thupi limasowa mavitamini ndi mchere wofunikira. Nthawi zina, kumwa kumayamba chifukwa cha njira zomwe kale zidasamutsidwa. Wodwala akadakhala kuti ali ndi kachilomboka, koma zotupa zimazimiririka, zomwe zimapangitsa kuti zinthu zisamuyendere bwino zitha kuwayambitsanso.

Mu matenda ashuga, chifuwa chachikulu chimayenderana ndi kuperewera kwamanjenje. Nthawi zambiri zizindikiro za matenda oyamba zimatulutsa zizindikiritso za m'mapapu. Nthawi zambiri, pali mtundu wa fibro-cavernous kapena kulowetsedwa kwa matenda. Nthawi zina, zimawoneka ngati chifuwa chachikulu.

Kuphatikiza kwa ma pathologies amadziwika ndi kuphatikiza kwapang'onopang'ono kwa kagayidwe kazakudya, nthawi yayitali pakutsimikiza kwa chifuwa chachikulu. Mitsempha yowola imathandizanso pang'onopang'ono. Kuzindikira kwakanthawi matenda onsewa kumawonjezera mwayi wodwalayo.

Etiology yamatenda omwe ali ndi odwala matenda ashuga

Nthawi zambiri, bacillus wa tubercle amalowa mthupi ofooka ndi matenda ashuga ndipo amayambitsa kukula kwa matendawa. Pali zinthu zingapo zomwe zimapangitsa kuti matendawa achulukane:

kuchepa kwa zochitika za phagocytes, maselo oyera am'magazi ndi maselo ena a chitetezo chamthupi. Ndi kulowa kwa Koch kumamatira m'thupi, kumayamba kukula, popeza chitetezo cha mthupi sichingasinthe.
chisokonezo mu mineral, mafuta ndi mapuloteni kagayidwe. Zotsatira zake, zinthu zofunika zimatayika zomwe zimathandizira kugwira bwino ntchito kwa ziwalo zamkati ndi machitidwe,
ketoacidosis. Zimathandizira kupanga minofu acidosis. Izi zimachitika kawirikawiri odwala matenda ashuga. Zotsatira zake, matupi a acetone ndi ketone amadziunjikira m'magazi a wodwala, omwe amachititsa kuledzera komanso kuwonongeka kwa minofu. Izi zimawapangitsa kutenga kachilomboka,
pachimake kapena mawonekedwe a kapamba,
kuperewera kwa zakudya m'thupi ndi zizolowezi zoyipa,
kuvutika kwa chitetezo cha immunobiological ndi homeostasis.

Maumboni amaphatikizika kwambiri mwakuti kusokonekera kwa chimodzi mwazomwe zikuwonekera mu gawo lachiwiri. Mabakiteriya a chifuwa chachikulu amafalikira thupi lonse, ndipo matendawa akukula msanga, chifukwa pali zolephera mu kagayidwe kazachilengedwe.

Mitundu yayikulu ndikuwonetsa matendawa

Akatswiri amasiyanitsa mitundu yayikulu yayikulu yophatikizira matendawa. Amatsimikizika ndi nthawi yakubadwa kwawo:

Kupita patsogolo kwa chifuwa chachikulu pakudziwitsa matenda ashuga. Uku ndiye kuphatikiza kofala kwambiri. Thupi lomwe lakhudzidwa limatulutsa chitetezo chokwanira cha chifuwa cha chifuwa. Matenda osakhudzika pakapita nthawi amakhala akuuma ndipo amakhala ovuta kwambiri kuchiza. Pofuna kupewa zovuta, odwala matenda ashuga amafunika kupita ku fluorography kamodzi pachaka.
Munthawi yomweyo matenda. Fomuyi ndiyotheka ndikupanga matenda a shuga a latent. Nthawi zambiri amapezeka mwa oimira theka lolimba la anthu opitilira zaka 45. Etiology yamatendawa sichikudziwika pakadali pano. Umu ndi mtundu wowopsa kwambiri womwe ungayambitse kudwala kwa wodwala.
Matenda a shuga amapita patsogolo ndi chifuwa chachikulu. Ili ndiye mawonekedwe osowa kwambiri. Zotsatira zake, kusagwirizana kwa asidi-based kumawonedwa, wodwalayo amakula mwachangu kutopa. Amakhala ndi ludzu komansouma pakamwa. Ndi mawonekedwe awa, chidwi chowonjezera cha mowa chimachitika.

Mitundu yosiyanasiyana yophatikiza matenda imakhala ndi purnosis yosakanikirana. Choyamba, zonse zimatengera kuuma komanso umunthu wa thupi.

Zizindikiro zamakhalidwe

Mu magawo oyamba, kumwa ndi asymptomatic. Kudziwa kukhalapo kwa foci m'mapapu ndikotheka kokha mothandizidwa ndi x-ray. Zizindikiro zodziwika bwino za matendawa ndi:

mphwayi, kuchepa kwa ntchito,
thukuta lidakulirakulira, komwe kunalibe kale. Ichi ndi chizindikiro choyamba cha matenda m'thupi,
kudya kwakachepa kapena mawonekedwe azikhalidwe zatsopano,
kuchuluka kwambiri kwa shuga m'magazi.

Tsoka ilo, zizindikiro zoyambirira ndizopanda pake, kotero anthu samawaganizira kwenikweni ndipo amatha kuzindikira kuti ndi gawo lomwe likuwonjezera shuga.

TB yothamanga imadziwika ndi zizindikiro zowonekeratu:

kutentha kwambiri kwa thupi. Ngakhale mankhwala a antipyretic samapereka zotsatira zabwino,
masinthidwe a gait ndikuyenda pansi kosavuta. Izi ndichifukwa choti katundu pa chifuwa chodzaza amawonjezeka kwambiri.
kutsokomola ndi sputum kapena ntchofu. Nthawi zambiri anthu amawukira m'mawa kapena madzulo,
kupsa mtima kosadziwika,
kuchepetsa thupi.

Pamapeto omaliza, matendawa amafunikira kuthandizidwa kuchipatala mwachangu ndikusankhidwa kwa njira zabwino kwambiri zochiritsira, kusiyanitsa kuphwanya kwina sikuvutikanso.

Zolemba zamatsenga

Monga momwe zamankhwala zimasonyezera, chifuwa chachikulu cha matenda ashuga chimakhudza gawo lotsika la kupuma. Imayamba msanga komanso kukhudza minofu yofewa yamkati. Kuwongolera mkhalidwe wa wodwalayo, chithandizo chovuta chikufunika.

Pakadali pano, matendawa amadwala kwambiri, motero vuto la chifuwa cham'mbuyomu lakhala lofunika kwambiri.

Njira ya pathology ili ndi zinthu zingapo:

Kuchepetsa kukonza,
Kusintha kwakuthwa kukufika gawo lakuwonongeka,
chizolowezi chopita patsogolo mwachangu,
kuchuluka kwa zochitika zazosangalatsa kapena zopweteka,
microangiopathy yamapapu.

Chemotherapy imagwiritsidwa ntchito pochiza chifuwa chachikulu cha matenda ashuga. Ndizofunikira kudziwa kuti ndi mtundu wa 2 shuga, kutha kwake kumachepetsedwa kwambiri. Matenda opezeka ndi nthawi yake amakulolani kusankha njira zabwino kwambiri zamankhwala.

Njira zochizira

Chofunikira pakuthandizira kwa mitundu iwiri yovuta ndikutsata njira. Pamaso pa chifuwa chachikulu cha matenda ashuga kapena wodwala, wodwalayo ayenera kuchipatala.

Chithandizo cha chifuwa chachikulu ndi matenda a shuga a mtundu woyamba ndi wachiwiri ndizokhazikitsidwa ndi mfundo zosiyanasiyana, koma choyamba, wodwalayo amapatsidwa maphunziro a chemotherapy.

Ntchito yayikulu m'masiku oyambirira ndikubwezeretsa shuga m'magazi kuti abwerere mwakale. Kuti muchepetse kuchira, ndikofunikira kulipiritsa zovuta za metabolic.

Mankhwala oyenera kwambiri kuti athetse matenda a chifuwa chachikulu: Kanamycin, Isoniazid, Amikacin, Protionamide. Kukhazikitsa munthawi yomweyo anti-TB ndi anti-matenda ashuga kudzapereka zotsatira zabwino.

Komanso, adotolo amatipatsa ma immunostimulants (Taktivin, Nuclerate, Levamiol ndi ena). Ngati machiritso akuchedwa, wodwalayo amatumizidwa kwa laser kapena phokoso lothandizira. Makamaka kwambiri, opaleshoni ingakhale yofunikira.

Munthawi yonse ya chithandizo, wodwalayo ayenera kutsatira chithandizo chamankhwala No. 9, chomwe chimapangidwira odwala matenda ashuga okha. Mfundo yake ndikukana zakudya zotsekemera, zokometsera, zonunkhira komanso mchere. Kudzichitira nokha mankhwala nkoletsedwa. Ndi dokotala yekha, atayang'aniridwa mozama, omwe amatha kupereka mankhwala oyenera.

Zoneneratu komanso njira zodzitetezera

Njira yonyalanyazidwa imodzi mwazomwe zimayambira imabweretsa zovuta. Komanso, kusowa kwa kuyenererana kwa thupi kumatha kudzetsa vuto lakudwala. Kupitilira kwa shuga kumabweretsa zowononga. Kuphatikiza pa kukula kwa chifuwa chachikulu cha chifuwa chachikulu, zimatha kuyambitsa:

retinopathy
nephropathy
kapangidwe ka matenda a matenda ashuga,
hypoglycemia.

Akatswiri sangapereke yankho lenileni lokhudza zomwe zanenedweratuzi.Chowonadi ndi chakuti zotsatira zake zimakhudzidwa ndi zinthu zingapo nthawi imodzi. Choyamba, zonse zimatengera kuchuluka kwa kunyalanyaza kwa matenda onse awiri. Mkhalidwe wamba wodwala ndi momwe amakhalira.

Anthu omwe amadalira insulin ndi omwe amatha kuwonongeka ndi matenda a chifuwa chachikulu. Ndipo izi zikutanthauza kuti ayenera kusamalira thanzi lawo mwapadera. Popewa kutenga matenda a chifuwa chachikulu, muyenera kupewa:

Chitani chithunzithunzi kamodzi pachaka,
pewani kucheza ndi anthu omwe ali ndi kachilombo,
azichitira matenda ashuga
kutsatira moyo.

Pangakhalenso kofunikira kuti muthane ndi chemoprophylaxis ndi Isoniazid (maphunzirowa amatenga miyezi 2-5). Sibwino kumwa mankhwalawo. Ndikwabwino kukambirana kaye ndi dokotala wanu.

Akatswiri amati kusiya zizolowezi zoyipa, kudya mokwanira komanso kuchita masewera olimbitsa thupi ndizofunikira kwambiri pakulimbitsa thupi. Ngati m'thupi ziwalo zonse ndi machitidwe zikugwira ntchito moyenera, amatha kupewa matenda a chifuwa chachikulu.

Kuphatikiza apo, ndikofunikira kukumbukira kuti posachedwa matenda atapezeka komanso njira zamankhwala zimasankhidwa, mwayi womwe munthu amakhala nawo wopitilira kusintha chikhalidwe chake komanso kubwerera ku moyo wokangalika. Chifukwa chake, muyenera kupita kukaonana ndi katswiri ndikuyang'anira thanzi lanu.

Matenda a chifuwa chachikulu cha shuga

Ndi kuphatikiza kwa matenda a shuga mellitus (DM) ndi chifuwa chachikulu cha m'mapapo, muzochitika zambiri (mpaka 90%), matenda a shuga ndi matenda am'mbuyomu, omwe chifuwa chachikulu chimayamba nthawi zosiyanasiyana. Ngati matenda onsewa atapezeka nthawi yomweyo, ndiye kuti, zachidziwikire, matenda oopsa a shuga amawonjezeka mchikakamizo cha chifuwa chachikulu.

Palibe mgwirizano pazomwe zimachitika kawirikawiri chifukwa cha chifuwa chachikulu cha odwala matenda a shuga. Ndichofunika kwambiri kuti chifuwa chachikulu chikukula mthupi momwe matenda amachepetsedwa, omwe amatsimikiziridwa ndi kutsika kwa odwala omwe ali ndi mitundu ina ya matenda ashuga, kusintha kwa zinthu za immunobiological, makamaka, kuchepa kwa kuthekera kwa kupanga ma antibodies ndi antitoxin ndi wodwala wodwala matenda ashuga. Matenda osawerengeka kapena omwe sanapatsidwe shuga amathandizira kukulitsa chifuwa chachikulu mu zotere.

Chipatala cha chifuwa chachikulu cha odwala matenda a shuga. Ngati chifuwa chachikulu chidapezeka mu nthawi yoyambilira, chitukuko chokwanira cha matendawa chitha kupezeka ngakhale limodzi ndi matenda ashuga. Zoopsa, chifuwa chachikulu cha chifuwa chachikulu chomwe chimakonda kupita patsogolo komanso kuwola msanga, zimachitika makamaka ndi chithandizo chosayenera cha matenda ashuga kapenanso chifukwa cha chifuwa chachikulu.

Zizindikiro zoyambirira zamatenda a chifuwa chachikulu mu shuga ndi izi: kufooka kowonjezereka, kuchepa kwa chakudya, kuchepa thupi, zizindikiro zowonjezereka za matenda a shuga. Poyamba, matendawa amatha kupitilira mobisa, chifukwa chake chifuwa chachikulu cha m'mapapo nthawi zambiri chimapezeka ndimayeso a prophylactic fluorographic a anthu kapena ndikuwunika kwa x-ray.

Mayeso a Tuberculin nthawi zambiri amakhala olimbikitsa. Komabe, ndi kukula kwa mitundu yamatenda a chifuwa chachikulu - fibrous-cavernous, hematogenous imafalitsidwa - kufooka kwa chitetezo cha chitetezo chake kumachitika ndipo kumva kwa chifuwa cha chifuwa cha m'magazi kumachepa.

Zomwe zimapangitsa kuti mitundu ya chifuwa chachikulu ichepetse kukula (ndikuyang'ana pang'ono komanso chifuwa chachikulu) ndikusayang'anira ntchito ya chifuwa chachikulu chatsopano, chifukwa chake, chithandizo chosagwirizana ndi chifuwa chachikulu, zovuta za zakudya komanso chithandizo cha matenda ashuga, zomwe zimayambitsa kusowa kwa chindapusa cha matenda a shuga.

Njira ya matenda ashuga oyambitsa matenda a chifuwa chachikulu imadziwika chifukwa chakuti chifuwachi chimakulitsa matendawa. Kwa odwala, kuchuluka kwa shuga m'magazi kumachulukitsa, diuresis ndi glucosuria zimachulukirapo, acidosis imatha kuwoneka.

Kuwonongeka kwa metabolism kumawonetsedwa pakusintha kwakukulu m'magazi a masana masana, zomwe zimapangitsa kuti odwala azimva pakamwa owuma, ludzu, kukodza pafupipafupi. Kuchepetsa thupi kumapita patsogolo. Izi ndizofunikira kwambiri: kuwonongeka kulikonse mwadzidzidzi pakati pa matenda ashuga kuyenera kupangitsa kuti dokotala akaganize kuti ali ndi matenda a chifuwa chachikulu.

Zambiri za njira ya chifuwa chachikulu kwa odwala omwe ali ndi matenda osokoneza bongo komanso zovuta zoyipa za chifuwa chachikulu cha matenda ashuga zimafuna kuphatikizika mwaluso kwa njira zonse zochiritsira kuchokera kwa dokotala. M'mbuyomu, theka la odwala adamwalira ndi chifuwa chachikulu, omwe adalumikizana ndi matenda ashuga. Ndi kuyambitsidwa kwa zakudya zolimbitsa thupi, insulin ndi antibacterial mankhwala mchitidwewu, chithandizo cha odwala omwe ali ndi chifuwa chachikulu ndi matenda ashuga chatha.

Kuchulukana kwa chifuwa chachikulu pakati pa odwala matendawa kumafunika chidwi chapadera popewa chifuwa chachikulu. Achinyamata, omwe matenda ashuga nthawi zambiri amakhala ovuta ndipo nthawi zambiri amakhala ovuta kwambiri ndi chifuwa chachikulu, amafunikira kuwunikira mosamala ndikuwunika mwatsatanetsatane kwa chifuwa chachikulu.

Chithandizo cha antidiabetesic cha odwala chikuyenera kukhala chokwanira komanso chawanthu, kutengera mtundu wa thupi, mawonekedwe ndi gawo la chifuwa chachikulu, komanso kuopsa kwa matenda ashuga. Mankhwala a antibacterial a chifuwa chachikulu cha odwala matenda a shuga ayenera kuchitika kwa nthawi yayitali, mosalekeza, mophatikiza mankhwala osiyanasiyana osankhidwa wodwala. Aliyense wodwala matenda ashuga opezeka ndi chifuwa koyamba ayenera kugonekedwa kuchipatala.

Matenda a shuga ndi odwala chifuwa chachikulu

Vuto la matenda ashuga ndilofunika kwambiri ku TB. Izi ndichifukwa choti odwala omwe amadwala matenda a shuga amayamba kudwala chifuwa chachikulu cha m'mapapo nthawi 5-10 mochulukirapo kuposa omwe satero.

Amakhudza makamaka amuna azaka 20 mpaka 40. Matenda a chifuwa chachikulu odwala ambiri omwe ali ndi matenda ashuga amapanga ngati njira yachiwiri ya chifuwa chachikulu chifukwa chotenganso kusintha kwa zotsalira za chifuwa chachikulu m'mapapu ndi ma intrathoracic lymph node.

Ndi chitukuko cha chifuwa chachikulu mwa odwala, zotheka za exudative-necrotic zimachitika m'mapapu, kuvunda koyambirira ndi kubereka kwa bronchogenic kuli kotheka. Chifukwa cha kuvuta kwa matendawa shuga, kusakwanira kwakukhalira kwa njira zoyipa za metabolic, ngakhale mothandizidwa ndi chifuwa chachikulu, chizolowezi chowonjezera ndikuyambiranso.

Pofotokoza kuchuluka kwapadera kwa chifuwa chachikulu cha matenda ashuga, kuyenera kutsimikiziridwa kuti kuwonekera kwakuchipatala ndi kuopsa kwa zizindikiro za matendawa nthawi zambiri kumadalira kwambiri kuwopsa kwa matenda ashuga otere, koma pamlingo wolipiridwa wa matenda a endocrine.

Ndi chipepeso chabwino, mitundu yochepa ya njirayi imakhala yofala kwambiri komanso, chifuwa chachikulu, chomwe chimapangidwa motsutsana ndi maziko a matenda ashuga omwe amapezekanso, monga lamulo, ndikutanthauzira kwachinyengo.

Mitundu yochepa ya chifuwa chachikulu cha m'mapapo mwanga kwa odwala omwe ali ndi matenda osokoneza bongo amachotsedwa. Kufooka, kuchepa kwa chilakolako chofuna kudya, thukuta, kutentha thupi kocheperako nthawi zambiri kumawerengedwa ngati kuwonongeka pakapita nthawi ya shuga. Zizindikiro zoyambirira za chifuwa chachikulu cha m'mapapo zimatha kuwonongeka kwa kagayidwe kazakudya (chifuwa chachikulu chothandizira chifuwa chachikulu).

Chithunzi chachipatala cha chifuwa chachikulu mwa odwala omwe ali ndi matenda osokoneza bongo amadziwika ndi mawonekedwe otsika a mawonekedwe, ngakhale ndi kusintha kwakukulu komwe kwapezeka ndi radiological. Chimodzi mwazinthu za chifuwa chachikulu cha m'mapapo mwanga kwa odwala omwe ali ndi matenda ashuga ndikuwonetsetsa m'mapapu.

Chifuwa chachikulu, chomwe matenda a shuga amalumikizana, chimadziwika kwambiri ndi maphunzirowa, kutalika kwa malo omwe akhudzidwa m'mapapu, chizolowezi chowonjezera komanso kupita patsogolo.Mukachiritsidwa, mawonekedwe akuluakulu obwera pambuyo pa chifuwa chachikulu.

Matenda a shuga, omwe adayamba chifuwa chachikulu chisanachitike, amakhala ndi chikomokere pafupipafupi, amakonda kwambiri matenda a shuga. Mukayezetsa magazi ndi kunena kuti eosinopenia, lymphopenia ndi lymphocytosis, monocytosis, kusuntha kwamtundu wa magazi mbali ya kumanzere. Chifukwa chake, hemogram nthawi zambiri imafanana ndi yotupa yomwe imayamba m'mapapu, koma mu shuga yovuta kwambiri imayambitsidwa chifukwa cha matenda a shuga komanso zovuta zake.

Kuzindikira kwa chifuwa chachikulu mwa odwala chifuwa chachikulu cha m'mapapo ndi shuga kumachepetsedwa, makamaka muzovuta kwambiri, ndipo nthawi zambiri kumakhala vuto la chifuwa chachikulu pamene chifuwa chachikulu chidayamba kale kuposa matenda ashuga.

Chifukwa chake, chifuwa chachikulu cha m'mapapo mwanga odwala omwe ali ndi matenda osokoneza bongo amadziwika ndi chizolowezi chopita patsogolo, chomwe chitha kuyimitsidwa pokhapokha ngati nthawi yayitali chithandizo chovuta kwambiri m'magulu apadera odana ndi chifuwa chachikulu.

Kuchita kumawonetsa kuti kupambana kwa chithandizo cha chifuwa chachikulu ndikokwanira kokha ngati zovuta za metabolic zimalipidwa. Ndikofunikira kukwaniritsa kukhazikika kwa glucose wamagazi pomwe mukumwa mankhwala antidiabetesic ndi anti-TB. Chemotherapy ya chifuwa chachikulu cha m'mapapo mwanga odwala omwe ali ndi matenda osokoneza bongo ndizovuta chifukwa cha kupezeka kwa zovuta zingapo za anthu odwala matenda ashuga.

Chimodzi mwazomwe zimawonetsa kwambiri matenda ashuga mellitus, osatengera mtundu wake, ndi matenda a shuga a shuga, omwe, kukhala njira yophatikizira yomwe imakhudza dongosolo lonse lamatenda am'mimba, makamaka limatsimikiza kukula ndi kuuma kwa zovuta zake, kufa ndi kulumala kwa odwala.

Kupanga kwa kuwonongeka kwamankhwala am'mimba kwa odwala omwe ali ndi matenda osokoneza bongo ndikovuta kwambiri komanso kosiyanasiyana. Udindo wofunikira pakukula kwake umaseweredwa ndi chitetezo cha autoaggression, kuchepa kwa ntchito ya phagocytic ya neutrophils.

Pankhaniyi, njira iliyonse yotupa pakubwera kwa matenda ashuga ndi atypical, omwe ali ndi vuto losatha, torpid ku chithandizo chanthawi zonse.

Kuopsa kwa odwala matenda ashuga a shuga (retinopathy, neuro- ndi nephropathy), kufalikira kwa mitsempha ya mitsempha, matenda amitsempha yamagazi, mitsempha ya magazi ndi mitsempha yaubongo, kuwonongeka kwa chiwindi, ndi zina zambiri.

Mtundu wa I wa matenda a shuga a mellitus (wodalira insulin), zovuta zomwe zimachitika kwambiri ndi matenda ashuga, omwe amafunika kuchepetsa kuchuluka kwa mankhwala ochepetsa a chifuwa cha pakati ndi theka malinga ndi mankhwala tsiku lililonse kapena katatu.

Mankhwala osankha pano ndi phenazide. Kuwoneka kwa acetone mu mkodzo kungakhale chizindikiro choyamba cha hepatitis ya poizoni kwa odwala omwe ali ndi matenda a shuga komanso chifuwa chachikulu, makamaka kwa achinyamata.

Kutupa kwa chifuwa chachikulu ndi mankhwala a anti-TB kumawononga kwambiri ntchito ya pancreatic ndi minofu ya insulin.

Pankhaniyi, kufunikira kwa insulin mosalephera kumawonjezera njira yolimbana ndi chifuwa chachikulu: ndi matenda a shuga a mtundu wa I, mpaka 60 IU / tsiku. Odwala omwe ali ndi matenda a shuga a mtundu woyamba, omwe ali ndi chifuwa chachikulu cha m'magazi, njira yochepetsera shuga yotsutsana ndi shuga imayikidwa ndi othandizira pakamwa ndi insulin.

Chifukwa cha kukhalapo kwa chinthu pakukhazikitsa komanso kupitilira kwa zovuta za matenda ashuga, kugwiritsidwa ntchito kwa mankhwala olimbitsa thupi ndiwowopsa komanso osaneneka pakuchiza matenda ashuga.

Monga immunocorrector, ndizotheka kugwiritsa ntchito polyoxidonium - immunomodulator yanyumba yomwe imabwezeretsa ntchito ya phagocytic ya neutrophils, komanso kutchulanso detoxifying, antioxidant ndi membrane-kinga.

Chifukwa cha chiwopsezo chachikulu cha chifuwa chachikulu cha m'mapapo mwanga kwa odwala omwe ali ndi matenda a shuga, ndikofunikira kuti afufuze chifuwa chachikulu chaka chilichonse pakufufuza kwamankhwala. Kuphatikiza apo, ndikofunikanso kuchita ntchito zomwe cholinga chake ndi kuzindikira matenda a chifuwa chachikulu cha kupuma.

Momwe mungachiritsire chifuwa chachikulu cha shuga

Asanatulukire maantibayotiki, kuphatikiza kwa chifuwa chachikulu ndi chifuwa chachikulu cha shuga chinali 40-50% ya odwala onse omwe ali ndi matenda a shuga. Mu 80s yathu, idatsikira mpaka 8%. Koma ngakhale pano, odwala matenda a shuga amakhala pachiwopsezo chotenga chifuwa chachikulu katatu kuposa akazi.

Odwala ndi chifuwa chachikulu 8-10 nthawi zambiri kuposa anthu ena onse, matenda abwinoko a shuga apezeka. Njira ya chifuwa chachikulu ndi chemotherapy zimawononga ntchito yokhudzana ndi kapamba komanso kuchepa mphamvu kwa insulin. Ndi matenda ashuga, omwe amapezeka motsutsana ndi kusintha kwatsoka kwatsoka, kuyambiranso matendawa nkotheka, koma njira ya chifuwa chachikulu ndi yabwino.

Chemotherapy

Gawo loyambirira la chemotherapy kwa wodwala yemwe wapezeka kumene ndi kuphatikiza chifuwa chachikulu ndi shuga ayenera kuchitika kuchipatala. Odwala omwe ali ndi matenda ophatikizikawa, zimayambitsa zovuta za chifuwa chachikulu.

Ndikofunikira kukwaniritsa kukhazikika kwa shuga m'magazi pomwe mukugwiritsa ntchito mankhwala antidiabetesic and anti-TB (makamaka rifampicin). Kutalika kwa mankhwalawa kuyenera kuchuluka mpaka miyezi 12 kapena kupitilira apo.

Matenda a diabetes nephropathy amaletsa kugwiritsa ntchito aminoglycosides. Polyneuropathy, yodziwikanso ndi shuga, imapangira mankhwala ndi isonazide ndi cycloserine. Ndi chitukuko cha ketoacidosis, kugwiritsa ntchito rifampicin kumatsutsana.

Matendawa omwe adayamba kudwala matenda oopsa amakhala ndi chifuwa chachikulu cha chifuwa chachikulu.

Matenda a shuga, omwe adayamba chifuwa chachikulu chisanachitike, amakhala ndi chikomokere pafupipafupi, amakonda kwambiri matenda a shuga. Matenda a chifuwa chachikulu, omwe amapezeka kumbuyo kwa matenda ashuga, amadziwika ndi zizindikiro zazing'ono, amapita patsogolo pang'onopang'ono.

Vuto la kuphatikiza kwa matenda awiriwa limapangitsa kuti magazi a odwala matenda ashuga aoneke bwino. Odwala omwe ali ndi matenda a shuga a mellitus omwe ali ndi zotsalira zotsutsana ndi chifuwa chachikulu amatha kuyang'aniridwa ndikuwunika malinga ndi gulu la 7 la subsensary usajili.

Kuchita kumawonetsa kuti kupambana kwa chithandizo cha chifuwa chachikulu ndikofunikira kokha ngati zovuta za metabolic zimalipidwa. Amadziwika kuti insulini imakhudza bwino njira ya chifuwa, chifukwa chake, mu gawo logwirako ndikofunika kusankha insulini yoperekera chithandizo chofuna kuchepetsa shuga. Ngati glucocorticosteroids amagwiritsidwa ntchito povuta mankhwala, kuchuluka kwa chakudya kwamoto kumayenera kulipiridwa ndi kuwonjezeka kwa mlingo wa insulin.

Chithandizo cha odwala omwe ali ndi chifuwa chachikulu cha pulmonary ndi matenda a shuga ayenera kukhala ovuta kugwiritsa ntchito zakudya, antidiabetes, othandizira, ophatikizira nthawi yayitali komanso opitilira ABT, mavitamini, othandizira komanso othandizira. Milandu yomwe yawonetsedwa, collapsotherapy ndi njira zamankhwala othandizira ndizotheka.

Kuchita kumawonetsa kuti chithandizo chotsutsana ndi chifuwa chachikulu chimagwira bwino m'gulu lino la odwala pokhapokha ngati zovuta za metabolic zimalipiridwa. Akuti, ndi chithandizo chamankhwala choyenera komanso cha nthawi yayitali cha matenda a shuga, sichingakhudze matenda a chifuwa chachikulu cha m'mapapo.

Izi zimatheka pokhazikitsa zakudya zamagulu olimbitsa thupi, kuchuluka kwa insulin, komanso, nthawi zina, mankhwala a sulfa.Mukamasankha mankhwala othandizira odwala odwala chifuwa chachikulu, amakonda kupatsidwa insulin.

Mfundo zachikhalidwe za chifuwa chachikulu zimavomerezedwa. Chifukwa cha zovuta zosiyanasiyana zogwira ntchito komanso za metabolic, kugwiritsa ntchito mavitamini a magulu B, C, lipotropic, komanso chithandizo cha pathogenetic ndikulimbikitsidwa.

Popeza odwala omwe ali ndi chifuwa chachikulu komanso matenda a shuga amadziwika chifukwa cha kuchuluka kwa lipid peroxidation komanso kusakwanira mu antioxidant dongosolo la thupi, adawonetsa kufunikira kwa antioxidants (Na thiosulfate, vitamini E) pakuchitika kolowerera kwambiri komanso kusintha kowononga m'matumbo am'mapapu.

Pokhudzana ndi kuphatikiza kwamtunduwu kwamatenda ambiri a odwala, kuchepa kwachilendo kwa thupi, ndikofunika kugwiritsa ntchito ma immunostimulants muzovuta zawo.

Ichi ndichifukwa chake nthawi yayitali ya chifuwa chachikulu cha odwala omwe ali ndi kuphatikiza kwa matendawa iyenera kukhala yotalikirapo katatu kuposa momwe zilili ndi chifuwa chachikulu cha odwala popanda kuphatikizidwa ndi matenda a shuga.

Matenda a chifuwa chachikulu nthawi zambiri amapezeka mwa odwala omwe ali ndi matenda ashuga

Tuberculosis nthawi zambiri imakhala yovuta kwambiri ya matenda ashuga ndipo imasintha kwambiri njira yake. Nthawi yomweyo, kuyambika kwa matenda ashuga kumachulukitsa kwambiri njira ya chifuwa chachikulu, kumapangitsa kukhazikitsa njira zina zachithandizo ndipo zimakhudza kuthekera kwa kuchiritsa kwa wodwala.

Odwala omwe ali ndi matenda ashuga amatenga chifuwa chachikulu 2-6 nthawi zambiri kuposa anthu athanzi. Odwala ambiri omwe ali ndi chifuwa chachikulu amakhala ndi matenda osokoneza bongo, omwe amadziwonetsa pokhapokha pakuchitika kwa chifuwa chachikulu. Muzochitika izi, chifuwa chachikulu ndi shuga zimapezeka nthawi imodzi.

Kukhazikika ndi koopsa kwa chifuwa chachikulu kumalimbikitsidwa ndimatenda a metabolic komanso chitetezo chokwanira cha matenda ashuga. Chifukwa cha kuchuluka kwa matenda ashuga, njira ya chifuwa chachikulu imakulirakulira. Chifukwa chake, chifuwa chachikulu chimakulitsa njira ya matenda a shuga ndikuthandizira kukulitsa zovuta za matenda ashuga.

Odwala ambiri omwe ali ndi matenda osokoneza bongo amapezeka ndi chifuwa chachikulu cha m'matumbo a pulmonary, omwe amapezeka ndi kuchuluka kwa minyewa yotupa, chizoloŵezi chovunda komanso kubzala kwa bronchogenic.

Njira zomwe zimabwezeretsa m'magazi a shuga zimafooka, kotero kusintha kwamatenda kumatha kusungunuka pang'onopang'ono, ndikusintha kwa ziguduli zam'minyewa kukhala tiziwalo tosalala ndi ulesi ndipo zimatenga nthawi yayitali.

Chizindikiro choyamba cha chifuwa chachikulu kwa odwala omwe ali ndi matenda osokoneza bongo nthawi zambiri ndicho kuwonongeka kwa chipukutiro cha matenda a carbohydrate metabolism, omwe amafotokozedwa ndi zoyipa zomwe zimachitika chifukwa cha kuledzera kwa chifuwa chachikulu cha carbohydrate metabolism ndi kufunikira kwakukulu kwa insulin. Kukula kwa matenda kuwonekera kwa kuwonongeka kwa bronchi, mapapu ndi pleura zimatengera mtundu wopezeka wa chifuwa chachikulu komanso kuleza kwa matenda.

Kuzindikira kwa chifuwa chachikulu cha odwala chifuwa chachikulu ndi matenda a shuga nthawi zina kumachepetsedwa. Amatchulidwa kwambiri kwa odwala omwe ali ndi chifuwa chachikulu, omwe adayamba matenda ashuga. Bakiteriya excretion mwa odwala omwe amaphatikiza chifuwa chachikulu cha m'mapapo komanso matenda a shuga zimatengera kupezeka kwamitsempha yowonongeka m'mapapu.

Pamene chiwonongeko chimapezeka nthawi zambiri MBT, yogonjetsedwa ndi mankhwala oyamba a anti-TB. Hemogram ndi ESR nthawi zambiri zimafanana ndi kupsinjika kwa mapapo otupa m'mapapu, komabe, ndi mawonekedwe amtundu wa shuga, kusintha kosunthika kwakukulu kwa magazi kumatha chifukwa cha kusokonezeka kwa metabolic.

Chifukwa cha chiwopsezo chachikulu cha chifuwa chachikulu, odwala onse omwe ali ndi matenda ashuga amafunika kutsatira pafupipafupi fluorography.

Mukazindikira kusintha m'mapapu, kuyezedwa mwatsatanetsatane kwa x-ray ndi bacteriological kumasonyezedwa.Zisonyezo za bronchoscopy zimangokhala milandu ya chifuwa chachikulu cha minyewa yokhudzana ndi chifuwa chachikulu cha bronchi komanso kuphwanya kwawo ntchito.

Chithandizo cha odwala ndi chifuwa chachikulu komanso matenda ashuga ayenera kukhala okwanira. Poyerekeza ndi njira zochizira matenda ashuga, mankhwalawa onse omwe ali ndi anti-TB amagwiritsidwa ntchito, poganizira kupewa zomwe zingachitike.

Kuthamanga kwa kuchuluka kwa rifampicin pa biotransfform ya oral hypoglycemic othandizira kuyenera kuganiziridwanso. Ngati ndi kotheka, njira zopangira opaleshoni zitha kugwiritsidwa ntchito pochiza chifuwa cham'mapapu. Mapangidwe ang'onoang'ono am'mapapu amakonda.

Matenda a chifuwa chachikulu ndi matenda oopsa

Vutoli lili ndi mbiri yayitali ndipo limayambira nthawi ya Avicenna (980 - 1037). Munthawi ya insulin isanachitike, chifuwa chachikulu chimagwirizanitsidwa ndi matenda a shuga mu 40-50% ya milandu, ndipo odwala anamwalira zaka 1-2.

Pambuyo pa kukhazikitsidwa kwa insulin (1922), komanso mankhwala ochepetsa matenda a chifuwa chachikulu (1944-1945), kuphatikiza kwa matendawa kunachepa, chiyembekezo cha moyo wa odwala chinawonjezeka, ndipo nthawi yomweyo, chitukuko cha chifuwa chachikulu cha pulmonary motsutsana ndi matenda osokoneza bongo chinawonedwa kanthawi 49 nthawi zambiri kuposa anthu ena onse.

Kuphatikiza apo, ena 4-6% ali ndi mitundu ya shuga yotsalira kapena yolowera m'malire, yotchedwa "kulekerera shuga. Ku Russia, kuli anthu 16 miliyoni omwe ali ndi matenda a shuga. Chifuwa chachikulu sichikhala chotsika pamlingo wake. Malinga ndi akatswiri a WHO, kuchuluka kwakukulu kwa chifuwa chachikulu kumayembekezeredwa ndi 2050 - anthu pafupifupi 500 miliyoni pachaka. Ku Russia, anthu 378,820 akudwala chifuwa chachikulu (2003).

Popeza achinyamata ali ndi 3-4, ndipo okalamba ndi osakhazikika ali ndi matenda osiyanasiyana 7- 7, komanso vuto lomwe likukulira la HIV, pomwe odwala opitilira 50% amakhala ndi chifuwa chachikulu mtsogolo. kuneneratu kuchuluka kwa odwala omwe ali ndi chifuwa chachikulu komanso matenda ashuga.

Kuphatikiza kwa matenda ophatikizika kumakhala kochulukirapo mwina 1.5 mpaka 2 mwa amuna azaka zapakati pa 30 mpaka 39 ndipo azimayi azaka zapakati pa 50 mpaka 55. Nthawi zambiri, matenda ashuga amayamba chifuwa chachikulu, mu 15 mpaka 20% - amapanga limodzi, 20%, matenda a shuga amayamba chifuwa chachikulu. Udindo waukulu wa chifuwa chachikulu umachitika chifukwa cha matenda ashuga, kuopsa kwake komanso chithandizo chomwe chikuchitika.

Odwala omwe ali ndi matenda ashuga omwe samalandira chithandizo ndikusatsatira malamulo oyambira aukhondo komanso zakudya amadwala nthawi zambiri kuposa omwe amatsatira thanzi lawo ndikutsatira malangizo a dokotala. Zadziwika kale kuti thupi la wodwala yemwe ali ndi matenda ashuga limapangidwira matenda osiyanasiyana chifukwa cha kusintha komwe kumachitika mu immunological ndi minofu. Kuchepa kwa chitetezo chathupi kumachitika mchikakamizo cha kagayidwe kachakudya, komwe mahomoni, zamankhwala am'magazi ndi zovuta zina zimalumikizana.

Vuto limodzi lalikulu la matenda ashuga ndi zovuta zake, zomwe zimachepetsa moyo wa wodwalayo ndipo nthawi zambiri zimadzetsa kulumala msanga ndi kufa. Izi zimakhudzana ndi mtima wam'matumbo, womwe umathandizidwanso ndi chifuwa chachikulu cha m'mapapo, chomwe microvasculature imavutika.

Mawonetseredwe azachipatala a chifuwa chachikulu cha m'mapapo am'mimba mwa odwala matenda a shuga amadziwika makamaka ndi njira yotsogola (yolowerera chifuwa chachikulu komanso chibayo), zomwe zimadziwika ndi kufalikira kwa ndondomekoyi (zotupa za 1-2 kapena kuposerapo komanso kutsika kwa bronchogenic), mapangidwe osintha owononga komanso kuwonongeka kwakanthawi kaamba ka ziwopsezo zina. , kukula kwa hypoventilation ndi malo a atelectasis, hemoptysis ndi magazi.

Nthawi zambiri mnzake wa matenda ashuga ndi fibro-cavernous m`mapapo mwanga TB ndi zovuta zake:

hemoptysis, magazi, ozungulira pneumothorax.

Vuto lovuta kufotokoza ndi njira yotalikirira - 20.8% ya chifuwa chachikulu, chifuwa chachikulu cha TB - 2.3% motsutsana ndi maziko akuti chifuwa chachikulu cha m'matumbo a pulmonary ndi 65%, chibayo chachikulu - 12,5%. Pali zovuta zamankhwala pazizindikiro ndi mapangidwe a chifuwa chachikulu cha pulmonary mwa odwala omwe ali ndi insulin-amadalira (T1DM) ndi mitundu yosadalira insulini (T2DM).

Chifukwa chake, chiwonetsero choyambirira cha chifuwa chachikulu cha m'mapapo ambiri mwa odwala matenda ashuga amtundu wambiri ndi opita patsogolo, komanso kupuma kwakukulu komanso kuledzera, ndipo odwala omwe ali ndi matenda amtundu wa 2 ali ndi matenda oopsa, ngakhale, malinga ndi madokotala ambiri, kuyambika ndi njira ya chifuwa chachikulu popanda matenda ashuga sizinasiyane kwambiri, ngakhale kwa achichepere kapena achikulire komanso achichepere.

Zinapezekanso kuti njira ya chifuwa chachikulu imakhudzanso njira ya matenda a shuga, kukokomeza zovuta za kagayidwe kazakudya, ndipo mu 90% yamilandu imatsogolera kuwonongeka kwake, komwe kumafunikira kuchuluka kwa insulin.

Izi zimachitika chifukwa cha zovuta zoyipa za chifuwa chachikulu cha chifuwa chachikulu komanso zotsatira zoyipa za anti-TB. Chifukwa chake, kuthekera kwa isoniazid, rifampicin ndi pyrazinamide kuyambitsa hyperglycemia ndi ketoacidosis, ndi boma la ethionamide hypoglycemic, limadziwika.

Zomwe zimapangidwira pafupipafupi chifuwa chachikulu cha m'mapapo komanso matenda a shuga, kupatsirana kwawo kosamvetseka sikumveka bwino. Amadziwika kuti mu shuga mellitus pali kutanthauzira kwamtsogolo pakukula kwa kutupa ndi kuchuluka kwa zigawo zikuluzikulu zokhala ndi zotupa zomwe zimapangitsa kuti khungu lipangidwe mosavuta komanso mapangidwe otukukira.

Momwe mungafotokozere kuchuluka kwakukulu - 20.8% - kapangidwe ka chifuwa chachikulu? Mu chifuwa chachikulu, chifuwa chachikulu chimatengedwa ngati chifukwa cha kuchepa kwa matenda otupa komanso oopsa (nthawi zina amatengedwa ngati chifuwa chachikulu) komanso chifukwa cha mitundu yosiyanasiyana ya chifuwa chachikulu cha m'mapapo (chifupipafupi komanso kulowerera kwa chifuwachi cham'mimba) chifukwa chakuchulukanso kwa thupi komanso kuthandizira kwa anti-chifuwa chachikulu.

Mpaka pano, zidakhazikitsidwa kuti njira zophatikiza pafupipafupi za chifuwa chachikulu cha m'mapapo komanso matenda a shuga zimafotokozedwa ndikuphwanya osati chakudya, komanso mitundu ina ya kagayidwe. Kuphatikiza apo, zidapezeka kuti odwala omwe ali ndi matenda osokoneza bongo kuchuluka kwa CD4 - T-lymphocyte, omwe amagwira ntchito yofunika kwambiri pakulimbana ndi chifuwa chachikulu, amachepetsa kwambiri.

Chithandizo cha odwala omwe ali ndi chifuwa chachikulu cha m'mapapo komanso matenda opatsirana a shuga zimabweretsa zovuta zina, makamaka chifukwa cha kusiyana kwachithandizo cha matenda amodzi ndi matenda ena: mphamvu zamitundu yosiyanasiyana, zopangidwa mosiyanasiyana zakudya, poganizira kuopsa kwa matenda onsewa.

Mchitidwe wochizira odwala omwe amaphatikiza ndi matenda ophatikizika umawonetsa kuti chithandizo cholinganizidwa bwino chimatha kukwaniritsa zotsatira zabwino: siyani mabakiteriya, kupatsirana, kugwiranso ntchito kwa chinthu chatsopano komanso kulowetsedwa. Izi zimafuna chithandizo chowonjezera mpaka miyezi 9-12.

Tiyeneranso kukumbukira kuti mitundu yambiri ya mankhwala osokoneza bongo komanso mitundu yambiri yamankhwala, yodziwika bwino komanso yachiwiri, imakhala yofala kwambiri kuposa odwala omwe alibe matendawa. Malangizo a katswiri wa matenda ashuga angathenso kuchita zabwino.

Chithandizo cha odwala omwe ali ndi chifuwa chachikulu komanso matenda ashuga amafunika kusankha njira ya chemotherapy: munthu chifukwa cha zotsatira zoyipa kapena njira yovomerezeka yomwe ilimbikitsidwa ndi WHO, ndi kuvomerezedwa kwa isoniazid, rifampicin, prinazinamide ndi ethambutol (kapena streptomycin).

Chofunikira kwambiri pakupititsa patsogolo chithandizo chazachipatala ndicho chizindikiritso cha odwala omwe ali ndi chifuwa chachikulu pogwiritsa ntchito x-ray fluorography ndikuwunika kwa sputum (katatu) kwa chifuwa chachikulu cha mycobacterium.

Matenda a shuga ndi chifuwa chachikulu cha m'mapapo

Pafupipafupi kupezeka kwa chifuwa chachikulu cha m'mapapo mwa odwala matenda a shuga. Mwa anthu onse m'chigawo cha Minsk, pali anthu 31,2% omwe ali pachiwopsezo chodwala chifuwa chachikulu, pomwe gawo la odwala omwe adapezeka kumene ndi 79% ya chiwerengero chonse cha anthu omwe adapezeka ndi chifuwa chachikulu cha TB.

Awa ndi, choyamba, anthu omwe ali ndi chithandizo chosakwanira komanso omwe ali ndi vuto lopuma losakhazikika, uchidakwa, matenda oopsa, komanso anthu omwe ali ndi kachilombo ka HIV.

Kafukufuku amene asayansi ambiri apeza akuwonetsa kuti chifuwa chachikulu cha matenda a shuga chimapezeka ka 59 nthawi zambiri kuposa mwa anthu omwe ali ndi metabolism yachilendo, ndipo ziwerengerozi zikukula. Anthu omwe ali ndi matenda oopsa a shuga komanso zovuta za matendawa amatenga matendawa mosavuta.

Malinga ndi ofufuza ambiri, kuphatikiza kwa chifuwa chachikulu ndi matenda ashuga ndizofala kwambiri mwa amuna kuposa akazi. Matenda a chifuwa chachikulu nthawi zambiri amaphatikizana ndi matenda ashuga. Titha kuvomereza njira ziwiri zophatikiza shuga ndi chifuwa chachikulu:

Matenda onsewa amakula palokha
chifuwa chachikulu ndi chomwe chikuwonetsa chiwonetsero cha matenda a shuga pomwe chikukulitsa njira ya chifuwa chachikulu.

Matenda a shuga ndi chifuwa chachikulu nthawi zambiri samawonetsedwa kwa nthawi yayitali. Pokhapokha ngati mukuyesa magazi mwachangu kwa odwala omwe ali ndi chifuwa chachikulu, kupezeka kwa endocrine matenda kumapezeka. Nthawi zina, kuyambika kwa chifuwa chachikulu cha odwala matenda ashuga ndikosavuta kubereka.

Sitikukayikira kuti nthawi yamasika imatenga nthawi yayitali. Ngati wodwala wodwala matenda a shuga samayang'aniridwa kawirikawiri kuchipatala ndikuwunika, ndiye kuti chifuwacho chimapezeka mochedwa, moyenera.

Zomwe zimayambitsa chifuwa chachikulu cha m'mapapo mwanga m'magulu a shuga. Pali malingaliro osiyanasiyana okhudzana ndi zovuta zomwe zimayambitsa matenda a shuga pakachitika chifuwa chachikulu. Olemba ambiri adawona chifukwa chophatikizira matenda a shuga ndi chifuwa chachikulu pakakonzedwe kamatenda a shuga, pakubowoleza kosalekanitsa kwa njira za metabolic, kusowa kwa mavitamini, kuletsa kwa phagocytosis ndi kufooka kwakuthwa kwa mphamvu ya immunobiological ya thupi, komanso kusokonezeka kwamphamvu kwa ziwalo ndi machitidwe.

Zosafunikira kwenikweni mu pathogenesis ya chifuwa chachikulu ndi chakuti odwala omwe ali ndi matenda osokoneza bongo m'mapapo amatha kudziwa njira yomwe idasamutsidwa kale. Izi, zomwe nthawi zambiri zimangokhala makutu, zimatha kukulira mu mphamvu ya zinthu zovuta ndikupanga njira yodziwika.

Chizindikiritso ndi chithunzi cha matenda. Kuzindikira chifuwa chachikulu cha kupuma kumakhazikika pakuwunika konse wodwalayo, popeza palibe chizindikiro chimodzi chokha chokhudza matendawa.

Ngakhale kuzindikiridwa kwa asidi - komanso mabakiteriya osagwirizana ndi zakumwa zozizilitsa khosi m'mimba kapena bronchi sikuti ndi njira yodalirika yodziwira matenda a chifuwa chachikulu. Monga momwe mumadziwira, ndi chithupsa komanso khungu la m'mapapo, ndi bronchiectasis, saprophytes nthawi zina morphologically ofanana ndi tizilombo toyambitsa matenda komanso chifuwa chachikulu cha mycobacteria chimasungidwa ndi sputum.

Kuphatikiza apo, ndimatendawa, komanso khansa ya m'mapapo, kuchulukitsa kamodzi kapenanso kubwereza m'mbuyo kumatha chifukwa chakuwonongeka kwa chifuwa chachikulu chomwe chawonongeka kudera ili. Pakadali pano, odwala omwe ali ndi chifuwa chachikulu cha mapapo am'mimba kwa nthawi yayitali sangathe kubisalira chifuwa chachikulu cha chifuwa chachikulu.

Nthawi zambiri pamakhala popanda zizindikiro zamatenda amitundu ina yoyambirira ya chifuwa chachikulu. Nthawi yomweyo, mawonekedwe osiyanasiyana a kuledzera kwa chifuwa chachikulu nthawi zambiri amafanana ndi zovuta zamagulu mu autonomic neurosis, matenda osiyanasiyana owopsa komanso osachiritsika, matenda opatsirana komanso chotupa.

Makamaka, chifuwa chachikulu cha chifuwa chachikulu chimafanana ndi chibayo, chindapusa - eosinophilic chibayo, chifuwa - zotumphukira, hamartochondroma, aspergilloma, cyst, etc.

Malinga ndi mabuku, nthawi zambiri mu 70-85% ya anthu odwala matenda a shuga amayambitsidwa ndi chifuwa chachikulu cha m'mapapo, mu 15-20% ya matenda onse omwe amapezeka nthawi imodzi ndipo mu 5-10% ya matenda a shuga amaphatikizidwa ndi chifuwa chachikulu.

Pamenepa, zikuwonekeratu kuti kuzindikira kwa chifuwa chachikulu nthawi komanso molondola kumatheka chifukwa chogwiritsa ntchito njira zosiyanasiyana zofufuzira, osati mapapu okha, komanso ziwalo zina.

Mbiri yamatenda

Cholinga cha anamnesis ndikukhazikitsa zomwe zimayambitsa matendawa komanso zomwe zingayambitse matendawa kapena kuthandizira pakukula kwake, komanso kudziwa momwe zilili, chilengedwe ndipo, ngati kuli kotheka, nthawi yakudzachitika, mphamvu za zizindikiro zosiyanasiyana. Tiyenera kudziwa kuti chifuwa chachikulu cha m'mapapo chimayamba ndikuyenda mosiyanasiyana: pachimake, subacute, nthawi yayitali kapena kapangidwe kake.

Poyamba, wodwalayo amakumbukira nthawi yomwe akuwoneka wotentha kwambiri, kupweteka kwambiri pachifuwa, kufupika mwadzidzidzi, hemoptysis, kapena hemorrhage. Komanso, nthawi zambiri amatha kuwunikira zinthu zomwe, mwa lingaliro lake, zitha kupangitsa kuti zangochitika.

Komabe, zikuyenera kutsimikiziridwa kuti ambiri mwa anthu akuluakulu, achinyamata ngakhale ana omwe amakumana ndi bacilli m'malo abwino aukhondo komanso kulipira koyenera kwa odwala matenda ashuga amakhalabe athanzi. Ndiye chifukwa chake, popeza ma anamnesis, ndikofunikira kuti musangoganizira zodwala zokha, komanso zinthu za pathogenetic.

Nthawi zambiri ndizotheka kudziwa kuti zoyambira za chifuwa chachikulu mwa akulu nthawi zina zimangotanthauza ubwana kapena unyamata. Zikatero, pali mbiri yakale ya bronchadenitis kapena zotumphukira lymphadenitis, coxitis, spondylitis, ma driver, epididymitis, erythema nodosum, keratoconjunctivitis, kaphatikizidwe kapena kuwuma kambiri, meningitis kapena polyserositis.

Kutalika kwa zidziwitso zamatenda a chifuwa chachikulu cha m'mapapo ndi kwakukulu. Izi zimachitika chifukwa cha mitundu yosiyanasiyana, zovuta za paraspecific zomwe zimayamba chifukwa chodziwitsidwa ndi chifuwa chachikulu cha mycobacterium chifuwa cha poizoni ndi poizoni wopangidwa ndi iwo, komanso nthawi zina zosakhala zapadera. Udindo waukulu umachitika ndi mawonekedwe a kubadwanso kwamthupi la wodwalayo, komanso matenda ophatikizika ndi zovuta zina.

Chithunzi cha chipatala chophatikiza ndi chifuwa chachikulu ndi matenda a shuga chimakhala chokongola kwambiri. Komabe, nthawi zina matendawa akufotokozedwanso za matenda osiyanasiyana a chifuwa chachikulu ndi matenda a chifuwa, pomwe, amatchula zovuta za matenda ashuga komanso matenda oyanjana, chifukwa cha kuwonetsa kwawo komanso maphunziro awo mwa odwala ena, amatha kuphimba chizindikiro cha matenda a chifuwa chachikulu. .

Kuphatikizidwa kwa zizindikiro ndi kukhalapo kwa "madandaulo wamba" ndichimodzi mwazinthu zowonetsa pakuwonekera kwa matenda ophatikizika. Makamaka, thukuta kwambiri limadziwika ngati chifuwa chachikulu, makamaka usiku (chizindikiro cha "pilo yonyowa"), koma zimawonekeranso m'magawo oyamba a matenda a shuga.

Zowona, ndi kuwonjezeka kwa kutalika kwa matendawa, kuchepa kwake kumawonedwa mpaka ku anhidrosis a m'munsi, koma nthawi yomweyo, mwa odwala ambiri, thukuta limachulukitsa kumtunda kwa thupi (mutu, khosi, chifuwa), makamaka usiku, komwe kumayerekeza hypoglycemia.

Kapena, mwachitsanzo, kufooka kwathunthu kumatha kukhala chiwonetsero cha kuledzera chonse cha chifuwa chachikulu komanso matenda ashuga othana ndi vuto la orthostatic.Zotsirizirazi nthawi zambiri zimawonedwa ngati mkhalidwe wa hypoglycemic. Zachidziwikire, kutanthauzira kotere kwa zizindikiro nthawi zina ndi chifukwa chokwanira chothandizira wodwala yemwe ali ndi matenda osokoneza bongo kwa dokotala wa TB komanso kudziwidwa ndi chifuwa chachikulu cha m'mapapo.

Malinga ndi zomwe tawona, 36,8% ya odwala omwe ali ndi matenda ophatikizika akuwonjezera mkhalidwe wawo (kufooka kwathunthu, kufooka, kusadya, kupweteka mutu, thukuta, ndi zina). .

Nthawi zambiri, kuyambika kwa matenda ashuga kwa odwala matenda a chifuwa chachikulu kunali kovuta mpaka pano. Ngakhale mu milandu yomwe matendawa adapezeka nthawi yomweyo, pogwiritsa ntchito mafunso ambiri odwala, zimatheka kuzindikira kuti zizindikiro za matenda ashuga zimadwalitsa odwala kwa mwezi wopitilira. Odwala (omwe nthawi zambiri amakhala kumidzi) sanalabadire khungu lowuma lomwe, kuyimitsidwa mu perineum (mwa akazi), furunculosis ndi zizindikiro zina za matenda ashuga, matendawa amapita patsogolo, zomwe zimapangitsa kuwonekera kwakukulu.

Nawonso, pazochitika zina, chifuwa chachikulu cha m'mapapo mwanga odwala omwe ali ndi matenda osokoneza bongo amatha kukhala asymptomatic. Kuyambanso ndi chifuwa chachikulu cha chifuwa chachikulu kumawonedwa nthawi zambiri kuubwana, unyamata, ndi ukalamba, makamaka kwa abambo, ophunzira kapena anthu omwe akuchita ntchito zamanja, ndipo nthawi zambiri amakhala mwa anthu omwe samalabadira zaumoyo wawo.

Zachipatala chotere cha chitukuko ndi njira ya matendawa chimadziwika kwambiri makamaka chifuwa chachikulu, koma zadziwika, makamaka, posachedwa, zakuphatikizidwa, komanso njira zowonongeka, komanso chifuwa chachikulu.

Mwa odwala ena, mwachitsanzo, chifuwa chachikulu cham'mapapo, kutentha thupi kotsika kumatenga nthawi yayitali, nthawi zina ngakhale amachita ma chemotherapy komanso njira zina zochizira.

Koma ziyenera kukumbukiridwa kuti nthawi yayitali ya subfebrile mkhalidwe, makamaka odwala matenda a shuga, amawonedwanso m'matenda ena (matenda oopsa a tenillitis, subacute sepsis, collagenoses, cholecystitis, salpingoophoritis, thyrotoxicosis, etc.).

Kutentha kokhazikika, kotenga nthawi yayitali, kungakhale zotsatira za thermoneurosis zamavuto osapatsirana. Ichi ndichifukwa chake mkhalidwe woperewera popanda zina zamankhwala ndi ma radiology sungaganizidwe ngati pathognomonic kokha chifuwa chachikulu.

Malingaliro omwewo ayenera kufotokozedwa pokhudzana ndi kufunika kwa matenda oyamba ndi kutentha kwa azimayi. Kawonedwe kambiri kaonetsa kale kuti kusinthasintha koteroko kumawonedwa mu gawo lalikulu la amayi achichepere athanzi. Nthawi yomweyo, pogwiritsa ntchito chifuwa chachikulu cha m'mapapo komanso ziwalo zina zowononga, mapindikidwe awo a kusamba nthawi zambiri samakhudza mtundu wa kutentha.

Nthawi zambiri, limodzi ndi kuwonjezeka kwa kutentha, ndipo nthawi zina patsogolo pake, zizindikiro zina zamankhwala zimayambikanso: kuwonjezereka kwa kusokonekera kapena, m'malo mwake, kusayang'ana, kusakhala ndi chidwi komanso kusayang'anira chilengedwe, kugona kapena kugona, kuchepa kwa mphamvu yogwira ntchito, kulira kapena kukokomeza.

Zizindikiro zonsezi zimawonetsa gawo la chithokomiro cha m'mimba mwa kuledzera kwa chifuwa chachikulu. Chifukwa chomwechi chimayambitsa zizindikiro za kukanika kwa dongosolo la mantha am'magazi: thukuta makamaka usiku kapena m'mawa, tachycardia, kuchepa kwa chakudya, vasomotor ndi matenda osokoneza bongo.

Kuledzera kochulukirapo kumawonetsedwa pakulowerera kwachulukidwe ka njirayi, kuwonongeka kwa minyewa yam'mapapo ndi kupangika kwa patsekeke, pa nthawi ya bronchogenic yokhala ndi chifuwa-cavernous m'mapapo am'mimba, komanso chifukwa cha mawonekedwe a kuphatikizika kwamphamvu, kuwonongeka kwamatumbo, impso kapena ziwalo zina.

Pankhaniyi, detoxization imatha kuchitika kale chisanachitike chitukuko cha obwerezabwereza mu zotupa, kwathunthu matenda a hemogram, ESR, mapuloteni zigawo zamagazi seramu.Muzochitika zotere, lingaliro lolakwika la kuyamba kwa thanzi labwino lingapangike, ndipo kuwunika kokwanira komanso kokwanira kwa wodwalayo kumatha kukhazikitsa zenizeni zomwe zikuchitika.

Monga mukudziwira, chizindikiro chofala cha chifuwa chachikulu cha m'mapapo ndi chifuwa - chouma kapena kupanga sputum. Zomwe zimayambitsa kutsokomola ndi kudzikundikira kwa ntchofu, mafinya, magazi munjira ya kupuma, kusintha kwamatenda mu bronchi kapena kukakamira kwawo mwakukulitsa ziwalo za hilar lymph, kuchoka kwa ziwalo zam'mimba, komanso kuwonongeka kwa pleura.

Chifukwa cha kuyipa kwa mitsempha kumatha mucous nembanemba wa pharynx, larynx, trachea, bronchi, nthawi zina mwa pleura kumayambitsa kukondwerera kwa malo ofananira mu medulla oblongata ndi chifuwa chowonetsa.

Madera osamala kwambiri ndi khoma lakutsogolo kwa larynx, malo am'munsi mwa zingwe zenizeni za mawu, malo omveka bwino a trachea ndi pakamwa pa lobar ndi segonchi. Madipatimenti oyambira a bronchial system ndi alveoli amadziwika ndi kuchepa kwa chidwi.

Kuchuluka ndi mawonekedwe a sputum omwe amatulutsidwa ndi chifuwa kumadalira mtundu wa njira yayikulu ya kupuma m'mapapu ndi bronchi, zokhudzana ndi matenda osapindulitsa a kupuma, msambo wa odwala, kusuta, etc. Ndi njira zowonongeka kwambiri m'mapapu, kuchuluka kwa spopum ya mucopurative kapena purulent nthawi zina imafika pa 100 ml ndi zina zambiri.

Komabe, ziyenera kukumbukiridwa kuti odwala ambiri, makamaka ndi kusintha koyambirira komanso kosakwana m'mapapu, makamaka kwa ana ndi achinyamata, kutsokomola kumatha kusakhalapo kapena sikumawonedwa kawirikawiri.

Sipangakhale nthawi yopanga thukuta, ngati pali kufalikira kapena kuwonongedwa kwa bronchi komwe kumatsitsa. Kukhosomola kumazimiririka ndipo kupanga kwa sputum kumayima mu odwala omwe ali ndi mitundu yosiyanasiyana ya ndondomekoyi akathandizidwa ndi mankhwala a antibacterial.

Ndi chifuwa chachikulu cha m'mapapo, hemoptysis ndi hemorrhage ya m'mapapo zimawonedwa, pachifukwa chake gawo lofunikira limaseweredwa ndikuwonongeka kwa minofu ya m'mapapu komanso kukhulupirika kwa mitsempha yamagazi. Maonekedwe a hemoptysis kapena magazi kwa odwala chifuwa chachikulu amathandizidwanso ndi vuto la hyperergic la thupi, komanso kusintha kwa zomwe zimachitika m'magazi chifukwa cha, mwachitsanzo, kuwonongeka kwakukulu kwa ntchito ya chiwindi.

Zomwe zimayambitsa komanso magwero obisika a magazi zimatha kukhazikitsidwa pokhapokha ngati wodwala akufufuza mozama komanso mozama. Ngati sizikudziwika bwino m'ndondomeko ya matenda, kudziwa komwe kumayambira hemoptysis, munthu ayenera kugwiritsa ntchito bronchoscopy ndi kusankha angiography yamitsempha yama bronchial.

Ndi chifuwa chachikulu, chizindikiro china chimakhalanso chofala - kupweteka pachifuwa. Amatha kuyambika pazifukwa zosiyanasiyana:

kuphatikizidwa kwa parietal pleura, diaphragm, khoma pachifuwa komanso mitsempha yodutsitsa mkati, kuwonongeka kwa trachea ndi bronchi yayikulu, kuphipha kwamitsempha yamagazi mkati mwa pulmonary embolism komanso kuwonjezeka kwakukulu kwa kukakamizika kwa kufalikira kwa m'mapapo, kufalikira kwakukulu kwa ziwalo zam'mimba.

Choyambitsa chachikulu cha kupweteka pachifuwa ndi chifuwa chachikulu cha m'mapapo ndikuwonongeka kwa parietal pleura. Kutengera kutengera momwe ntchitoyi idakhalira limodzi mwa madipatimenti ake, kostalny, diaphragmatic, Mediastinal kapena apical pain syndrome imawonedwa. Ndi kusamutsidwa kwa ziwalo zapakati, kupweteka pachifuwa kumachitika makamaka chifukwa cha zomatira ndi zomatira, makamaka ndi pericardium.

Odwala ena, amaphatikizidwa ndi chifuwa chachikulu cha bronchi, komanso kuphipha kwa mitsempha yaying'ono yam'mapapo komanso mitsempha chifukwa chakuchepa kwa okosijeni komanso kuwonjezeka kwa kaboni dayokisi mu alveoli ndi magazi (alveolar-vascular Refx).

Nthawi zina, ndi chifuwa chachikulu cha m'mapapo, kupweteka kwakutali motsatira mitsempha ya sciatic kapena lumbosacral kumawonedwa.Ngati palibe enieni a coxitis kapena spondylitis, ndiye kuti ululu muzochitika zotere uyenera kuphatikizidwa ndi kupsa mtima kwa mitengo ikuluikulu ya mitsempha yokhala ndi poizoni.

Khalidwe la "moto" ndikumva kuwawa pachimake komanso panthawi yopanga pneumothorax. M'mitundu inanso ya chifuwa chachikulu, ululu nthawi zambiri umakhala wowuma, nthawi zambiri umatayika komanso osakhazikika.

Amachepa kapena kutha pomwe njira yayikulu imakhazikika m'mapapu ndi ma bronchial lymph n motso mothandizidwa ndi chemotherapy, ena othandizira ndi physiotherapeutic process.

Odwala ena omwe ali ndi chifuwa chachikulu cha m'mapapo, kupuma movutikira kumawonedwa, kachitidwe ka kamene kamadalira zinthu zosiyanasiyana zomwe zimakhudza malo opuma.

Kufupika kwa mpweya (dyspnea) kumachitika makamaka mu odwala omwe ali omwazika, obisika kwambiri, a chifro-cavernous ndi cirrhotic pulmonary pulmonulosis, pamodzi ndi kuchuluka, kunenedwa kwa kuledzera, nkhawa yayikulu ya mitsempha ndi mtima. Potere, kupuma kwapang'onopang'ono kapena kufupika kwa cholinga kungawonedwe.

Poyamba, imadziwonetsera ngati kumatha kupuma bwino komanso kufunikira kwa kupumira kwakanthawi. Dyspnea yamtunduwu nthawi zambiri imagwiritsidwa ntchito limodzi ndi matenda osokoneza bongo ndipo imakhala yofala kwambiri m'matenda a mtima, mitsempha, chifuwa, chifuwa radiculitis, komanso osachepera chifuwa chachikulu cha m'mapapo.

Kufupika kwa kufotokozedwa moyenera kumadziwika ndi kuphwanya osati kupuma, komanso mpweya wabwino, ndiye kuti, m'malo omwe mpweya wopuma umachepa kwambiri. Kuphatikiza apo, nthawi zina sizingagwiritsidwe ntchito ndi zotengeka zokomera, ngakhale zimawonedwa ndi kulimbitsa thupi pang'ono, kusintha kwa udindo, kapenanso ngakhale wodwalayo akamalankhula. Koma kupuma kambiri kumakhala kosakanikirana, ndiye kuti, kumagwirizana komanso cholinga.

Amatchulidwa makamaka ndi chifuwa chachikulu cha chifuwa chachikulu komanso chibayo, koma zimapezekanso mgawo loyambira kapena lopuma, ndi chibayo champhamvu chokhudzana ndi ziwalo zam'mimba, ndikuvotera kwamapeto

Kutsindikiza gawo la njira zakufufuzira kwakanthawi kofotokozera za chifuwa chachikulu cha odwala matenda a shuga, ife, mwachidziwikire, sitimaganizira zopitilira muyeso wazotsatira zake, makamaka pozindikira mitundu yoyambirira ya chifuwa cham'mapapo, komanso kuzindikira kusiyanasiyana kwa matenda am'mapapo.

Nthawi yomweyo, ziyenera kutsimikiziridwa kuti sipayenera kukhala mpikisano pakati pa njira zakuthupi, radiology, ndi njira zina zofufuza zamankhwala. Njira zonsezi, monga lamulo, zimathandizana wina ndi mnzake.

Kuzindikira kwa X-ray

Kuwunika kwa chifuwa cha X-ray kumachitika patsogolo pakati pa njira zina zodziwira ndi kusiyanitsa chifuwa chachikulu cha m'mapapo.

Njira ya X-ray imakupatsani mwayi kuti muwone kupezeka kwa kusintha kwa pathological mu minyewa yam'mapapu, mizu, mapangidwe a hilar lymph, milomo ya pleural, ziwalo zam'mimba, komanso njira zapadera zophunzirira mu bronchial system ndi mitsempha yamagazi yotulutsa magazi. Pogwiritsa ntchito njirayi, mutha kudziwa za kusintha kwa kuthekera, kuchuluka, ziyeneretso komanso kuchuluka kwa kusintha kwa ma pathological.

Panalinso kusiyana kwazachilengedwe ndi kutalika kwa njirayi. Makamaka, odwala omwe ali ndi nthenda yachilendo, zotupa m'mapapu onsewo zimakonda kulembedwa, nthawi zambiri njira yonseyo inkakhudza lobe yonse ndipo pafupifupi katatu nthawi zambiri imafalikira kwa lobes yonse.

Komabe, njira yama radiology, monga ina iliyonse, njira yodziwitsira matenda imakhala ndi malire, makamaka chifukwa cha zinthu zakuthupi zomwe zimapangitsa kuti pakhale mawonekedwe ena a mawonekedwe pazenera kapena filimu yokhayo ndi kukula kokwanira komanso kutulutsa kwina.

Ndi kupimidwa koyenera kwa x-ray, nkovuta kudziwa ngati ili mkati mwa chifanizo, m'magawo am'mapapo.Chifukwa chake, kuyesedwa koyenera kwa x-ray ndikotheka kuzipatala zokhazokha, zomwe ndizopatsirana TB.

Odwala onse omwe ali ndi matenda ashuga amafunikira nthawi 1 (komanso ovuta kwambiri matenda ashuga, kupezeka kwa matenda ena - kawiri) pachaka kuyesedwa kwa X-ray mu dispensary ya TB. Pankhaniyi, kafukufukuyu akuyenera kutsimikiziridwa ndi fluorogram yofotokozedwa ndi radiologist (radiograph), yomwe imasungidwa pamodzi ndi khadi la wodwala lomwe limatuluka.

Kafukufuku wowongolera amafunikira kwa odwala onse omwe ali ndi matenda ashuga, opereka madandaulo a "chifuwa", mosasamala nthawi yanthawi yomwe amaphunzira kale fluorographic. Endocrinologists ayenera kudziwa kuti chifuwa chamakono cham'mapapo mwanga, chodziwika ndi chifuwa chachikulu cha mycobacterium, chomwe chimagwirizana kwambiri ndi mankhwala a antibacterial, nthawi zambiri chimakhala ndi njira yolimbikitsa kwa odwala omwe ali ndi matenda osokoneza bongo, omwe ndi owopsa kwambiri pamoyo wa wodwalayo, osatchula kuthekera kwa matenda ena.

Pankhaniyi, gawo la kuyesedwa kwa sputum kwa chifuwa chachikulu cha mycobacterium kwa anthu atali nthawi yayitali, mwa anthu omwe ali ndi vuto la chibayo, bronchitis, akukula. Monga momwe zomwe tawonera zawonetsera, kufalikira kwa mabakiteriya a chifuwa chachikulu pakati pa "mayiko oopsezedwa" kuli pafupifupi 3%.

Anthu ambiri (makamaka okhalamo okalamba akumidzi), chifukwa chokhala ndi zovuta zambiri pantchito yachipatala, ogwira ntchito kumalo opangira ma feldsher, samatengera mayeso a radiology ndi chipatala.

Ena mwa iwo sapeza thandizo la kuchipatala panthawi yake, molakwitsa akukhulupirira kuti zina mwazomwe adawona (kufooka, kutsokomola, kusadya bwino, kuchepa thupi, kupuma pang'ono, ndi zina zotere) zimaphatikizidwa ndi chimfine, chimfine, kapena chiyembekezo cha munthu wokalamba. Pazinthu ngati izi, matendawa nthawi zambiri amadziwika mu gawo lotulutsa komanso osasamalidwa.

Pa chifukwa chomwechi, odwala ena omwe ali ndi chifuwa chachikulu cha kupuma, makamaka azaka zopitilira 70, amafa ndi matendawa osadziwika kwa ma dispensaries. Zotsatira zake, kudziwika kwa anthu oterewa omwe akukhala kudera la zamankhwala, malo operekera amzamba, komanso kuyesedwa kwawo pakuyang'aniridwa ndi dokotala wa TB kungathandize kupewa kukula ndi kufalikira kwa matendawa.

Chithandizo. Kupenyerera. Odwala onse omwe ali ndi matenda a shuga omwe ali ndi chifuwa chachikulu cha pulmonary yogwira amathandizidwa ndi chithandizo cha inpatient. Asanapereke mankhwala othandizira chifuwa chachikulu, dokotala wa TB ayenera kukhala ndi tsatanetsatane wa momwe matenda amtundu wa endocrine aliyense payekha, Mlingo ndi nthawi ya kumwa mankhwala opatsirana, muzindikire kupezeka kwa zovuta za matenda ashuga, komanso chiwindi ndi impso.

Izi ndizofunikira, choyambirira, chifukwa odwala onse amafunikira chithandizo chanthawi yayitali (mkati mwa 6-12) mankhwala mosalekeza, ndipo chachiwiri, chifukwa mankhwala onse odana ndi TB, mwatsoka, ali ndi zovuta zomwe zimakulitsidwa kwambiri chifukwa chodzikundikira mankhwala a metabolites m'magazi chifukwa chakuchepa pang'onopang'ono m'thupi lawo.

Mu matenda a shuga a nephropathy okhala ndi kuphwanya kwambiri kwa impso, streptomycin, kanamycin amatsutsana, zotupa za chiwindi, kugwiritsa ntchito ethionamide, pyrazinamide ndizochepa, ndi retinopathy ethambutol imatsutsana, ndi neuropathies, kugwiritsidwa ntchito kwa isoniazid kungayambitse kuchepa kwa mitsempha, etc.

Kuchokera pamndandanda wofupikawu wa zotsutsana zimatsata kuti dokotala wodziwa kuchitira odwala otere ayenera kuchitira wodwala matenda ophatikizika.

Pambuyo pa chithandizo, anthu omwe ali ndi matenda ophatikizika amayenera kuyang'aniridwa ndi a endocrinologist ndi katswiri wa chifuwa chonse.

Kuzindikira kwakanthawi, chithandizo choyenera cha chifuwa chachikulu, chithandizo chokwanira cha matenda osokoneza bongo komanso zovuta zake sizingangopulumutsa miyoyo, komanso kubwezeretsa munthu kuntchito yogwira ntchito.