Chithandizo cha matenda oopsa mu shuga

* Zowonjezera mu 2017 malinga ndi RSCI

Bukuli limaphatikizidwa mu Mndandanda wamabuku omwe asayansi anzawo amawunikiranso a High Higest Attestation Commission.

Werengani mu magazini yatsopano

Shuga mellitus (DM) ndi matenda ofala kwambiri a endocrine. Chiwerengero cha anthu omwe akudwala matendawa chikukula nthawi zonse. Pakadali pano, matenda ashuga ndi zovuta zake, monga zoyambitsa kufa kwa anthu, zili m'malo achiwiri, chachiwiri chokhacho cha khansa. Matenda a mtima omwe kale anali ndi mzerewu adasamukira kumalo a 3, chifukwa nthawi zambiri zimakhala zovuta za shuga.

Matenda oopsa a matenda oopsa komanso matenda ashuga

Matenda a shuga ndi matenda oopsa amitsempha yamagazi ndi ziwalo ziwiri zolumikizana zomwe zimakhala ndi mphamvu yolimbitsa mphamvu imodzi yolumikizira nthawi imodzi ziwalo zingapo: mtima, impso, mitsempha yaubongo, ziwiya zam'mimba. Zomwe zimayambitsa kupunduka kwakukulu komanso kufa kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto losakanikirana kwa matenda oopsa ndi izi: matenda a mtima, kuvulala kwamitsempha, kulowetsedwa kwamitsempha, kulephera kwa aimpso. Zinapezeka kuti magazi okwera kwambiri a diastolic (ADD) aliwonse a 6 mmHg kumawonjezera mwayi wokhala ndi matenda amtima wapadera ndi 25%, komanso mwayi wokhala ndi stroke H ndi 40%. Chiwopsezo cha kuyambanso kupweteka kwa aimpso ndi magazi osagawika kumawonjezera katatu. Chifukwa chake, ndikofunikira kwambiri kuzindikira ndikuzindikira matenda onse a shuga komanso matenda oopsa poyambitsa matenda kuti apereke chithandizo choyenera panthawi yake ndikuletsa kukulitsa zovuta zamitsempha.

Matenda oopsa a arterial amapanga mitundu yonse ya matenda ashuga a mtundu woyamba 1 komanso odwala matenda ashuga a 2. Kwa odwala matenda a shuga 1, omwe amayambitsa matenda oopsa ndi matenda ashuga a shuga. Gawo lake limakhala pafupifupi 80% mwa zina zonse zomwe zimayambitsa kuthamanga kwa magazi. Ndi matenda a shuga 2, mosiyana, mu 70-80% yamilandu, matenda oopsa amafunika, omwe amatsogolera chitukuko cha matenda osokoneza bongo okha, ndipo ndi 30% yokha ya odwala omwe amakhala ndi matenda oopsa chifukwa cha kuwonongeka kwa impso.

Chithandizo cha matenda oopsa (AH) sicholinga chake kuti muchepetse kuthamanga kwa magazi (BP), komanso kuwongolera zinthu zomwe zingachitike monga kusuta, hypercholesterolemia, ndi matenda ashuga

Kuphatikiza matenda ashuga komanso osathandizidwa ochepa matenda oopsa ndichomwe chimapangitsa kwambiri matenda a mtima, kugunda, mtima ndi impso. Pafupifupi theka la odwala matenda ashuga ali ndi matenda oopsa kwambiri.

Kodi matenda ashuga ndi chiani?

Shuga ndiye gwero lalikulu lamphamvu, "mafuta" m'thupi. Mwazi umakhala ndi shuga mu mawonekedwe a shuga. Mwazi umanyamula shuga mbali zonse za thupi, makamaka ku minyewa ndi ubongo komwe glucose amapatsa mphamvu.

Insulin ndi chinthu chomwe chimathandiza kuti glucose alowe mu khungu kuti akwaniritse zofunika kuchita. Matenda a shuga amatchedwa "matenda a shuga," chifukwa ndi matendawa thupi limalephera kukhala ndi shuga m'magazi. Zomwe zimayambitsa matenda amtundu wa II matenda a shuga ndizosakwanira kupanga insulini kapena kuchepa kwa khungu kwa insulin.

Kodi chiwonetsero choyambirira cha matenda a shuga ndi chiani?

Mawonetsero oyamba a matendawa ndi ludzu, kamwa yowuma, kukodza mwachangu, kuyabwa khungu, kufooka. Pankhaniyi, muyenera kuphunzira shuga.

Kodi ndi chiopsezo chiti cha matenda ashuga a 2 omwe munthu angapeze?

Khalidweli. Anthu omwe ali ndi matenda ashuga m'banjamo amatha kukhala ndi matenda ashuga.

Kudya kwambiri komanso kunenepa kwambiri. Kudya moperewera kwambiri, makamaka kuchuluka kwa chakudya chamagulu m'zakudya, komanso kunenepa kwambiri sikuti ndi chiopsezo cha matenda ashuga okha, komanso kumawonjezera matendawa.

Matenda oopsa. Kuphatikiza kwa matenda oopsa ndi shuga kumawonjezera chiopsezo cha matenda a mtima, kugwidwa, kulephera kwaimpso ndi katatu. Kafukufuku wasonyeza kuti kuchiza matenda oopsa kungachepetse izi.

M'badwo. Matenda A Type A shuga amatchedwanso shuga okalamba. Ali ndi zaka 60, munthu aliyense wazaka 12 amakhala ndi matenda ashuga.

Kodi odwala matenda ashuga ali ndi chiopsezo chowonjezereka cha matenda oopsa?

Matenda a shuga amayambitsa kuwonongeka kwa mtima (mitsempha yayikulu komanso yaying'ono), yomwe imathandizira kukulira kapena kukulira kwa matenda oopsa a matenda oopsa. Matenda a shuga amathandizira kukulitsa kwa atherosulinosis. Chimodzi mwazifukwa zowonjezera kuthamanga kwa magazi kwa odwala omwe ali ndi matenda ashuga ndi matenda a impso.

Komabe, theka la odwala omwe ali ndi matenda ashuga, matenda oopsa anali kale kale panthawi yopezeka ndi shuga wamagazi ambiri. Mutha kuletsa kukula kwa matenda oopsa m'magazi a shuga ngati mutsatira malangizowa okhalira ndi moyo wathanzi. Ngati muli ndi matenda ashuga, ndikofunikira kuyeza kuthamanga kwa magazi ndikutsatira malangizo a dokotala anu pazakudya ndi chithandizo.

Kodi chiwopsezo cha matenda a shuga ndi ati?

Kuthamanga kwa magazi ndi mulingo woyenera kwambiri wa kuthamanga kwa magazi, kukwaniritsa kwake komwe kungachepetse chiopsezo chotenga zovuta zamtima. Ndi kuphatikiza kwa matenda osokoneza bongo a shuga ndi matenda oopsa, kuchuluka kwa kuthamanga kwa magazi ndi kochepera pa 130/85 mm Hg.

Kodi ndi chiani chomwe chingayambitse kukula kwa aimpso komanso kuphatikiza matenda ashuga ndi matenda oopsa?

Ngati ngakhale mapuloteni ochulukirapo apezeka mumayeso anu amkodzo, mumakhala pachiwopsezo chotenga matenda a impso. Pali njira zambiri zowunikira impso. Chosavuta kwambiri komanso chodziwika bwino ndi kutsimikiza kwa magazi creatinine. Mayeso ofunikira owunikira nthawi zonse ndi kutsimikiza kwa shuga ndi mapuloteni m'magazi ndi mkodzo. Ngati mayesowa ndi abwinobwino, pali mayeso apadera kuti mupeze mapuloteni ochepa mumkodzo - microalbuminuria - kusokonezeka koyambirira kwa ntchito ya impso.

Kodi mankhwala osagwiritsa ntchito mankhwala a shuga ndi ati?

Kusintha kwamachitidwe kumakuthandizani osati kungoyendetsa kuthamanga kwa magazi, komanso kukhalabe ndi shuga. Kusintha kumeneku kumaphatikizaponso: kutsatira kwambiri malangizo a kadyedwe, kuchepa kwambiri, kuchita masewera olimbitsa thupi nthawi zonse, kuchepa kwa mowa womwe wadwala, komanso kusiya kusuta.

Ndi mankhwala ati a antihypertensive omwe amakonda kuphatikizidwa ndi matenda oopsa komanso matenda ashuga?

Mankhwala ena a antihypertensive amatha kusokoneza kagayidwe kazakudya, motero kusankha mankhwala kumachitika ndi dokotala. Panthawi imeneyi, zokonda zimaperekedwa ku gulu la osankhidwa a imidazoline receptor agonists (mwachitsanzo, Physiotens) ndi otsutsana nawo a AT receptors omwe amalepheretsa angiotensin (wamphamvu wamitsempha wolimba).

Popewa ndi kuchiza matenda oopsa ndi mtundu 2 shuga Kunyumba, gwiritsani ntchito Wrist and Nose-type Pulsed MED-MAG Laser.

Zimayambitsa ochepa matenda oopsa mu shuga

Matenda a shuga mellitus (DM), monga tafotokozera ine. I. Dedov, ndimatenda osakanikirana omwe amayamba chifukwa cha kuperewera (mtundu 1) kapena wachibale (mtundu 2) wa insulin, omwe amayambitsa kuphwanya kagayidwe kazakudya, ndipo mitundu yonse ya kagayidwe zinthu, zomwe zimatsogolera pakugonjetsedwa kwa machitidwe onse a thupi (1998).

M'zaka zaposachedwa, matenda a shuga amadziwika kuti ndi matenda osachiritsika padziko lonse lapansi. Zaka khumi zilizonse, kuchuluka kwa anthu odwala matenda ashuga kumakhala pafupifupi kuwirikiza. Malinga ndi World Health Organisation (WHO), mu 1994 chiwerengero cha odwala matenda ashuga chinali pafupifupi 110 miliyoni, mu 2000 pafupifupi miliyoni 170, mu 2008 - 220 miliyoni, ndipo akuti mwina pofika chaka cha 2035 chiwerengerochi chidzaposa Anthu 300 miliyoni. Ku Russian Federation, malinga ndi State Register mu 2008, odwala pafupifupi 3 miliyoni omwe ali ndi matenda a shuga a 2 adalembetsa.

Pa nthawi ya matendawa, kupweteka kwa msana komanso mochedwa kumatha kuchitika. Kuchulukana kwa zovuta zopweteka kwambiri, zomwe zimaphatikizapo hypoglycemic ndi hyperglycemic coma, zachepa kwambiri m'zaka zaposachedwa chifukwa cha chisamaliro cha shuga. Kufa kwa odwala chifukwa cha zovuta zotere sikupitirira 3%. Kuwonjezeka kwa chiyembekezo chodwala kwa odwala omwe ali ndi matenda ashuga kunawonetsa vuto la kuchepa kwa mitsempha, komwe kumayambitsa kulumala koyambirira, kumakulitsa thanzi la odwala ndikuchepetsa kutalika kwake. Vuto la minyewa limazindikira kuchuluka kwa vuto lodana ndi matenda ashuga. Kusintha kwachilengedwe mu khoma lamitsempha kumasokoneza kayendedwe ka kayendedwe ka zinthu ndi ziwiya.

DM ndi ochepa hypertension (AH) ndi maulalo awiri olumikizidwa omwe ali ndi mphamvu yolimbitsa mphamvu yowononga yomwe imayendetsedwa mwachindunji pamagawo angapo olimbana: mtima, impso, mitsempha yaubongo ndi retina.

Pafupifupi 90% ya odwala omwe ali ndi matenda ashuga ali ndi matenda a shuga a 2 (osagwirizana ndi insulin), opitilira 80% ya odwala matenda a shuga 2 amakhala ndi matenda oopsa. Kuphatikizidwa kwa matenda ashuga ndi matenda oopsa kumabweretsa kulumala koyambirira ndi kufa kwa odwala. Hypertension imasokoneza mayendedwe a mitundu iwiri ya matenda ashuga 1 ndi mtundu 2 shuga. Kuwongolera kwa kuthamanga kwa magazi (BP) ndikofunikira kwambiri pochotsa matenda a shuga.

Zimayambitsa ochepa matenda oopsa mu shuga

Njira zopititsira patsogolo matenda oopsa mu mtundu 1 ndi matenda ashuga 2 ndizosiyana.

Mtundu woyamba wa matenda ashuga, matenda oopsa ndi chotsatira cha matenda a shuga - 90% mwa zina zonse zomwe zimapangitsa kuti magazi azikhala ochepa. Diabetesic nephropathy (DN) ndi lingaliro lomwe limaphatikiza mitundu yosiyanasiyana ya kuwonongeka kwa impso mu matenda ashuga, kuphatikizapo aimpso arteriosclerosis, matenda a kwamikodzo thirakiti, pyelonephritis, papillary necrosis, atherosranceotic nephroangiossteosis, ndi zina. Microalbuminuria (gawo loyambirira la DN) imapezeka mwa odwala omwe ali ndi matenda amtundu wa 1 omwe ali ndi matenda osakwanitsa zaka 5 (malinga ndi kafukufuku wa EURODIAB), ndipo kukwera kwa kuthamanga kwa magazi nthawi zambiri kumawonedwa zaka khumi ndi zisanu chiyambire shuga.

Njira yakukula kwa DN imatha kuyimilidwa mu njira yolumikizirana pakati pa zomwe zimayambitsa, zomwe zimapangitsa kupita patsogolo, komanso kupita patsogolo kwa "oyimira pakati".

Chochititsa chachikulu ndi hyperglycemia. Vutoli limakhala ndi zowonongeka pa microvasculature, kuphatikizapo ziwiya zama glomerular. Pansi pa machitidwe a hyperglycemia, njira zingapo zamankhwala amodzi zimayendetsedwa: ma glycosylation osakhala enzymatic, chifukwa chake masinthidwe a capillary basement membrane (BMC) mapuloteni a glomerulus ndi mesangium amasokonekera, ma processor ndi kukula kwa BMC adasungunuka ndi gawo la metabolcose. . Izi zimachitika makamaka mu minofu yomwe sizimafunikira kupezeka kwa insulin kuti ilowe mkati mwa glucose m'maselo (mitsempha ya mandala, mandala, maselo endothelium ndi maselo a impso glomerular). Zotsatira zake, sorbitol imadziunjikira mumtunduwu, ndipo zosungira za intracellular myoinositol zimatha, zomwe zimayambitsa kuphwanya osrogellular osmoregulation, minofu edema ndi kukula kwa zovuta za microvascular. Komanso, njirazi zimaphatikizira kawopsedwe wa glucose wophatikizidwa ndi kukhazikitsidwa kwa puloteni kinase C, komwe kumabweretsa kuwonjezeka kwa zipupa za chotengera, kuthamanga kwa minyewa ya minyewa, komanso kusokonekera kwa intraorgan hemodynamics.

Hyperlipidemia ndichinthu chinanso choyambitsa: matenda a shuga 1 ndi matenda a shuga 2, vuto lodziwika bwino la matenda a lipid ndi kudzikundikira mu magazi a seramu ya atherogenic cholesterol ya density lipoproteins (LDL) ndi kachulukidwe kochepa kwambiri (VLDL) ndi triglycerides. Zimatsimikiziridwa kuti dyslipidemia ili ndi nephrotoxic. Hyperlipidemia imapangitsa kuwonongeka kwa capillary endothelium, kuwonongeka kwa membrane ya glomerular chapansi, kuchuluka kwa mesangium, komwe kumaphatikizapo glomerulossteosis ndipo, chifukwa chake, proteinuria.

Zotsatira za zinthu izi ndi kupita patsogolo kwa vuto la endothelial. Pankhaniyi, bioavailability wa nitric oxide imaphwanyidwa chifukwa cha kuchepa kwa kapangidwe kake ndikuwonjezereka kwa chiwonongeko, kuchepa kwa kachulukidwe kachulukidwe kofanana ndi masekinolojeni otsogola, kutsegulira komwe kumapangitsa kuphatikizika kwa NO, kuwonjezeka kwa ntchito ya angiotensin-kutembenuza enzyme pamtunda wa maselo a endothelial, ndikuwonetsa kutembenuza kwa Iinotensin komanso angiototin. endothelin I ndi zinthu zina za vasoconstrictor. Kuwonjezeka kwa mapangidwe a angiotensin II kumabweretsa kupendekera kwapakati pa arterioles komanso kuwonjezeka kwa kuchuluka kwa kubweretsanso kwa arterioles mpaka 3-4: 1 (mwachizindikiro ichi ndi 2: 1), ndipo, chifukwa chake, intracubic matenda oopsa amakhala. Zotsatira za angiotensin II zimaphatikizanso kukondoweza kwa kupangika kwa maselo a mesangial, chifukwa cha momwe kuchuluka kwa kusefukira kwa glomerular kumachepa, kutsekeka kwa membrane wapansi wa glomerular kumawonjezeka, ndipo izi, zimayambitsa microalbuminuria (MAU) mwa odwala omwe ali ndi matenda ashuga. Mapuloteni amaikidwa mu minangy ndi ma process of impso, zinthu za kukula, kuchuluka ndi kupindika kwa mesangium zimayambitsidwa, kupatsirana kwa zinthu zofunika kwambiri kum'meza kwapansi kumachitika, komwe kumayambitsa sclerosis ndi fibrosis ya minofu ya impso.

Angiotensin II ndiye chinthu chofunikira kwambiri pakukula kwa impso komanso matenda oopsa mu matenda 1 a shuga. Kukhazikitsidwa kuti m'deralo aimpso ambiri a angiotensin II ndi okwera kwambiri kuposa ma plasma ake. Njira za pathogenic zochita za angiotensin II zimayambitsidwa osati ndi mphamvu yamphamvu ya vasoconstrictor, komanso ndi proliferative, prooxidant ndi prothrombogenic ntchito. Ntchito yayikulu ya aimpso angiotensin II imayambitsa kukula kwa matenda oopsa a intracranial, amathandizira ku sclerosis ndi fibrosis ya minofu yaimpso. Nthawi yomweyo, angiotensin II imapangitsa zowononga zimakhala zina zomwe ntchito yake imakhala yapamwamba (mtima, mtima endothelium), kukhalabe ndi kuthamanga kwa magazi, kuchititsa njira zokonzanso minofu ya mtima komanso kukula kwa atherosulinosis. Kukula kwa arteriosulinosis ndi atherosulinosis kumalimbikitsidwanso ndi kutupa, kuchuluka kwa calcium-phosphorous mankhwala ndi kupsinjika kwa oxidative.

Mtundu wachiwiri wa matenda ashuga, kukula kwa matenda oopsa mu 50-70% ya milandu kumayambitsa kuphwanya kagayidwe kazakudya. Odwala awa akhala akuwonetsetsa kuti ali ndi matenda oopsa kapena matenda oopsa. Monga lamulo, ali onenepa kwambiri, opuwala lipid kagayidwe kenakake, pambuyo pake amawonetsa zizindikiro za kulolerana kwamatumbo (hyperglycemia poyankha kuchuluka kwa shuga), omwe amasinthidwa kukhala chithunzi chatsatanetsatane cha mtundu wa 2 shuga mu 40% ya odwala. Mu 1988 G. Reaven adaonetsa kuti chitukuko cha matenda onsewa (matenda oopsa, matenda oledzera, kunenepa kwambiri, kulekerera kwa chakudya chokhazikika) zimayambira pa chinthu chimodzi chogwiritsira ntchito pathogenetic - kuperewera kwa ziwalo zotumphukira (minofu, mafuta, maselo a endothelial) ku zochitika za insulini (zomwe zimatchedwa kuti insulin) kukana insulini).Chizindikiro ichi chimatchedwa "insulin resistance syndrome", "metabolic syndrome" kapena "syndrome X". Kukana kwa insulini kumabweretsa chitukuko cha inshuwaransi hyperinsulinemia, yomwe imatha kusunga kagayidwe kazinthu kangapo kwa nthawi yayitali. Hyperinsulinemia, imapangitsanso kuchuluka kwa njira zam'magazi zomwe zimapangitsa kuti magazi azikhala ndi matenda oopsa, dyslipidemia, ndi kunenepa kwambiri. Ubwenzi wapakati pa hyperinsulinemia ndi matenda oopsa umakhala wolimba kwambiri ngati wodwala atakhala ndi plulin yambiri ya insulin, amatha kulosera zamtsogolo.

Hyperinsulinemia imawonjezera kuthamanga kwa magazi kudzera m'njira zingapo:

- insulin imachulukitsa ntchito ya dongosolo lachisoni,

- insulin imawonjezera kukonzanso kwa sodium ndi madzimadzi mu ma proximal tubules a impso,

- insulini monga chinthu chofunikira kupangitsa kuti maselo azikhala osalala, omwe amachepetsa kuwala kwawo,

- insulin imaletsa ntchito ya Na-K-ATPase ndi Ca-Mg-ATPase, potero imakulitsa chidwi cha Na + ndi Ca ++ ndikuwonjezera chidwi cha mitsempha yamagazi kupita ku vasoconstrictors.

Chifukwa chake, matenda oopsa a shuga a mtundu wachiwiri ndi gawo limodzi la zovuta, zomwe zimachokera ku insulin kukana.

Zomwe zimayambitsa kukula kwa insulini palokha sizikudziwikabe. Zotsatira zakufufuza kuchokera kumapeto kwa zaka za 90s zikuwonetsa kuti kukulitsa kwa insulin kukokana kumatengera mphamvu ya dongosolo la renin-angiotensin. Pozama kwambiri, angiotensin II amapikisana ndi insulin pamlingo wa insulin receptor substrates (IRS 1 ndi 2), potero amatseka ma sign-receptor a post-receptor kuchokera ku insulin pamaselo a khungu. Kumbali ina, insulin kukana ndi hyperinsulinemia activate angiotensin II AT1 receptors, zomwe zimayambitsa kukhazikitsa njira zopangira matenda oopsa, matenda a impso, ndi atherosulinosis.

Chifukwa chake, onse amtundu wa shuga 1 komanso mtundu wa 2 shuga, gawo lalikulu pakukweza matenda oopsa, mtima, kulephera kwa impso komanso kupita patsogolo kwa atherosulinosis imaseweredwa ndi ntchito yayikulu ya renin-angiotensin dongosolo ndi chimaliziro chake, angiotensin II.

Popewa ndi kuchiza matenda oopsa ndi mtundu 2 shuga Kunyumba, gwiritsani ntchito Wrist and Nose-type Pulsed MED-MAG Laser.

Matenda azachipatala omwe ali ndi matenda ashuga

Kukhazikika kwa kuchepa kwa magazi usiku

Kuyang'anira kuthamanga kwa magazi kwa anthu athanzi kumawonetsa kusinthasintha kwa mapangidwe a magazi nthawi zosiyanasiyana masana. Kuchuluka kwa kuthamanga kwa magazi kumawonedwa munthawi yamasana, komanso ochepera - panthawi yogona. Kusiyanitsa pakati pa nthawi yamasana ndi nthawi ya kuthamanga kwa magazi kuyenera kukhala kosachepera 10%. Kusintha kwatsiku ndi tsiku m'magazi kumadalira zochitika zamachitidwe amanjenje ndi parasympathetic. Komabe, nthawi zina, mpweya wabwino wabwinobwino wosinthasintha magazi umatha kusokonekera, zomwe zimapangitsa kuti magazi azikhala mwamphamvu usiku. Ngati odwala omwe ali ndi matenda oopsa magazi amatha kusinthasintha magazi m'magazi, ndiye kuti wodwalayo amawerengedwa kuti "ma dippers". Odwala omwe alibe kuchepa kwa kuthamanga kwa magazi nthawi yogona usiku amawerengedwa kuti ndi osagwira.

Kuyesedwa kwa odwala matenda a shuga omwe ali ndi matenda oopsa kunawonetsa kuti ambiri a iwo ali m'gulu la omwe samatulutsa, kutanthauza kuti, alibe kuchepa kwakuthupi kwamthupi m'magazi a kuthamanga kwa magazi usiku. Zikuwoneka kuti, matendawa amayamba chifukwa cha kuwonongeka kwa dongosolo la ziwonetsero zamagetsi (autonomic polyneuropathy), lomwe lasiya kuyendetsa kamvekedwe ka mtima.

Kuwonongeka kwa magazi koteroko kozungulira komwe kumachitika chifukwa cha kuthamanga kwa magazi kumalumikizidwa ndi chiopsezo chotenga matenda a mtima ndi onse omwe ali ndi matenda a shuga komanso opanda matenda a shuga.

Hypertension ya udindo ndi orthostatic hypotension

Izi ndizovuta zomwe zimawonedwa kwa odwala omwe ali ndi matenda ashuga, kupangitsa kuti azindikire komanso azichiza matenda oopsa. Munthawi imeneyi, kuthamanga kwa magazi mmalo a supine komanso kuchepa kwake kwakukulu pomwe wodwalayo asintha kukhala pansi kapena malo okhazikika.

Kusintha kwa Orthostatic pamavuto am magazi (komanso kupotoza kwa kayendedwe ka magazi ka tsiku ndi tsiku) kumalumikizidwa ndi mawonekedwe a zovuta za matenda ashuga - autonomic polyneuropathy, chifukwa chomwe kusungika kwa mitsempha yamagazi ndikukhalanso kamvekedwe kake kumasokonekera. Orthostatic hypotension imatha kuganiziridwa ndi madandaulo amomwe wodwala amakhala nawo ndikuwonetsa khungu m'maso ndi kuwuka kwakuthwa kuchokera pabedi. Pofuna kuti musaphonye kukula kwa kuphatikizika uku ndikusankha chithandizo choyenera cha antihypertensive, kuchuluka kwa kuthamanga kwa magazi kwa odwala omwe ali ndi matenda ashuga kuyenera kumayezedwa kawiri m'malo awiri - kunama ndikukhala.

Zowopsa pazovala zoyera

Nthawi zina, odwala amawonjezera kuthamanga kwa magazi pokhapokha ngati dokotala kapena ogwira ntchito kuchipatala akupanga muyeso. Kuphatikiza apo, m'malo abata kunyumba, kuchuluka kwa kuthamanga kwa magazi sikumapitilira zikhalidwe wamba. Mu milandu iyi, amalankhula za zomwe zimatchedwa matenda oopsa pazovala zoyera, zomwe zimakonda kupezeka mwa anthu omwe ali ndi vuto lamanjenje. Nthawi zambiri, kusinthasintha kwamalingaliro kotereku m'magazi kumabweretsa hyperdiagnosis ya matenda oopsa ndipo mankhwala osagwirizana ndi mankhwala a antihypertensive, pomwe mankhwala othandizira amatha kukhala othandiza kwambiri. Njira yogwiritsira ntchito popima magazi kwa maola 24 ikuthandizira kuzindikira matenda oopsa pazovala zoyera.

Chodabwitsa cha matenda oopsa pazovala zoyera ndizofunikira kuchipatala ndipo chimafunikira phunziroli mozama, chifukwa ndizotheka kuti odwala oterewa ali pachiwopsezo chachikulu chokhala ndi matenda oopsa ndipo, chifukwa chake, ali ndi chiopsezo chokhala ndi mtima ndi aimpso.

Popewa ndi kuchiza matenda oopsa ndi mtundu 2 shuga Kunyumba, gwiritsani ntchito Wrist and Nose-type Pulsed MED-MAG Laser.

Chithandizo cha ochepa matenda oopsa mu shuga

Kufunika kwa chithandizo chankhanza cha antihypertensive kwa odwala omwe ali ndi matenda osokoneza bongo ndikosakayikitsa. Komabe, matenda a shuga a mellitus, omwe ndi matenda omwe amaphatikizika ndi zovuta za metabolic komanso matenda angapo a ziwalo, amabweretsa mafunso ambiri kwa madokotala:

- Mukufunika kuthira magazi pamlingo uti?

- Kodi ndi otani kuchepetsa magazi a systolic ndi diastolic?

- Ndi mankhwala otani omwe amayenera kuperekedwa kwa shuga dianbet, kupatsidwa mtundu wa matendawa?

- Ndi mitundu iti ya mankhwala omwe ali ovomerezeka pochotsa matenda oopsa a shuga?

Kodi odwala matenda ashuga ayenera kuyamba kulandira chithandizo chotani?

Mu 1997, msonkhano wa VI wa Joint United States Committee on the Diagnosis, Prevention, and Treatment of Arterial Hypertension unazindikira kuti kwa odwala omwe ali ndi matenda ashuga, gawo lovuta la kuthamanga kwa magazi kwa anthu azaka zonse pamwambapa lomwe chithandizo chake chiyenera kuyambitsidwa ndi systolic magazi> 130 mmHg. ndi kuthamanga kwa magazi> 85 mmHg Ngakhale kuwonjezerapo pang'ono izi mwa odwala omwe ali ndi matenda ashuga kumawonjezera chiopsezo cha mtima ndi 35%. Nthawi yomweyo, zidatsimikiziridwa kuti kukhazikika kwa kuthamanga kwa magazi pamlingo wofanana komanso wotsika kumakhala ndi mphamvu yeniyeni yoteteza.

Kodi kuthamanga kwa magazi kwa diastolic kuli pabwino mpaka pati?

Posachedwa, mu 1997 kafukufuku wamkulu kwambiri adamalizidwa, cholinga chake chinali kudziwa kuchuluka kwa kuthamanga kwa magazi (500 μmol / l) komwe adakakamizidwa kuti ayambe kuphatikiza mankhwala opitilira 4 a antihypertensive.

Kuphatikiza kothandiza kwambiri kwa mankhwalawa pochiza matenda oopsa a matenda a shuga mellitus ndi kuphatikiza kwa ALP inhibitor ndi diuretic, ACE inhibitor komanso othandizira calcium.

Malinga ndi zotsatira za kafukufuku wama multicenter, kuwongolera bwino kwa kuthamanga kwa magazi pamlingo wosaposa 130/85 mm Hg amapewa kupita patsogolo kwamphamvu kwa vuto la mtima la matenda a shuga ndi kupititsa patsogolo moyo wa wodwalayo pofika zaka 15 mpaka 20.

Popewa ndi kuchiza matenda oopsa ndi mtundu 2 shuga Kunyumba, gwiritsani ntchito Wrist and Nose-type Pulsed MED-MAG Laser.