Pafupipafupi matenda a mtima pakati pa odwala matenda a shuga (9.5-55%) amaposa kwambiri kuti ponseponse (1.6-

d%). Malinga ndi zotsatira za kafukufuku wofufuzira womwe udachitika ku Moscow mu 1994, kufala kwa matenda (IHD) ndi matenda oopsa kwa odwala omwe ali ndi NIDDM zaka 10 atazindikira kuti ali ndi matenda ashuga anali 46.7 ndi 63.5%, motsatana. Kupulumuka kwa zaka zisanu pambuyo poti myocardial infaration pakati pa odwala omwe ali ndi matenda ashuga ndi 58%, ndipo mwa anthu opanda shuga - 82%. Odwala omwe ali ndi matenda ashuga, kuchuluka kwa zotupa za m'munsi kwambiri ndikutukuka kwa zilonda zam'mimba ndikuwadulidwa kwamphamvu kumawonjezeka kwambiri. Matenda oopsa a arterial amathandizanso kupititsa patsogolo kwa nephropathy ndi retinopathy. Gawo laimfa kuchokera ku matenda oopsa ogwirizana ndi kuchuluka kwa kufa kwa 20-50%, pomwe odwala omwe ali ndi matenda amtunduwu amakhala ndi 4-5 nthawi yayitali. Kuphwanya carbohydrate ndi lipid metabolism yokhala ndi matenda oopsa mu shuga kumawonjezera chiopsezo ndikupititsa patsogolo chitukuko cha atherosulinosis; chiopsezo cha matenda a mtima m'matumbo mwa odwala chimawonjezeka nthawi 14 pazaka 10 zawo.

Atherosulinosis ya coronary artery in shuga imadziwika ndi kale kwambiri kukula ndi kufalikira. Zovuta zomwe zimadziwika chifukwa cha matenda a mtima (hypercholesterolemia, matenda oopsa, kunenepa kwambiri ndi kusuta) mwa odwala omwe ali ndi matenda osokoneza bongo zimayambitsa imfa katatu nthawi zambiri kuposa kuchuluka kwa anthu ambiri. Ngakhale pakalibe zinthu izi, kuchuluka kwambiri komanso kufalikira msanga kwa matenda a shuga kumafotokoza njira zina zothandizira kukula kwake. Kuwonjezeka kwa chiwopsezo cha kupititsa patsogolo ndi kupititsa patsogolo kwa matenda ashuga kumalumikizidwa ndi zinthu monga hyperinsulinemia, hyperglycemia, ndi kuphwanya kwamphamvu dongosolo la magazi. Chisamaliro chachikulu chimaperekedwa ku zovuta za lipid metabolism. Ubale wapakati pakati pa dyslipidemia ndi kukula kwa mtima matenda, makamaka mtima matenda, wakhazikitsidwa. Kuwonjezeka kwa kuchuluka kwachulukitsa lipoproteins (LDL) kumatengedwa ngati chinthu chachikulu cha pathogenetic ku atherosulinosis. Cholumikizanso chofananira ndi pathogenesis yake ndikuchepa kwa zomwe zili ndi milingo yapamwamba ya lipoproteins (HDL) yokhala ndi katundu wa antiatherogenic.
Udindo wa triglycerides pakukula kwa matenda a mtima samaphunziridwa pang'ono. Kupatula kupatula kwa mtundu woyamba wa hyperlipidemia, hypertriglyceridemia imadziwika kuti ndi kuphwanya kwa lipid metabolism. Komabe, yachiwiri hypertriglyceridemia mu matenda ashuga itha kuchita mbali yofunika kwambiri pakukula kwa atherosulinosis kuposa hypercholesterolemia.
Mavuto a lipid metabolism mu shuga mellitus amadalira zinthu zingapo ndipo makamaka pamlingo wa hyperglycemia, insulin kukana, kunenepa kwambiri, microalbuminuria, komanso zakudya. Chikhalidwe cha dyslipidemia chimadziwika ndi mtundu wa matenda ashuga. Ndi IDDM, kuchepa kwa insulin kumayambitsa kuchepa kwa lipoprotein lipase ntchito, komwe kumayambitsa hyperlipidemia, hypertriglyceridemia komanso kuchuluka kwa kuchuluka kwa p-lipoproteins.
Pankhaniyi, kaphatikizidwe ka mpumulo wa endothelial amasokonezeka ndipo kudziphatika kwa leukocytes pamtunda wa endothelium kumakulimbikitsidwa. Chofunikira pakuphwanya kwa ma microcirculation ndikusintha ndi masinthidwe amitsempha yamagazi yokhudzana ndi kuchuluka kwa kuphatikiza kwa mapulateni. Amakhulupirira kuti kuphatikiza kwaulere kwa zinthu zopitilira muyeso kumabweretsa chiwonongeko cha nitric oxide, vasodilator wamkulu wopangidwa ndi maselo a endothelial. Kuwonongeka kwa endothelium, kukula kwa khoma lamitsempha chifukwa cha hypertrophy ndi hyperplasia yosalala minofu imathandizira kuchepa pakutsatira komanso kuthamanga kwa mitsempha yamagazi, ndipo kuphwanya kwa hemostasis kumathandizira kupanga mapangidwe a atherosselotic plaque mu coronary shipping. Hyperinsulinemia yomwe imakhalapo kwa nthawi yayitali imasokoneza hypertrophy yama cell minofu. Kuphatikiza kwa zinthu izi kumapangitsa kukula kwa atherosulinosis.
Pathogenesis. Njira zachitukuko cha matenda oopsa mu IDDM ndi NIDDM ndizosiyana. Ndi IDDM, kuthamanga kwa magazi kumakhazikika pambuyo pa zaka 10-15 kuchokera pachiwonetsero cha matendawa ndipo nthawi zambiri amayamba chifukwa cha matenda ashuga a nephropathy. Pazochepa zochepa zokha, kuwonjezeka kwa magazi kumayenderana ndi matenda ena a impso. Odwala omwe ali ndi NIDDM, kuchuluka kwa kuthamanga kwa magazi sikungakhale kwachindunji ndi matenda ashuga ndipo nthawi zambiri kumayamba chifukwa cha matenda oopsa, matenda amiyendo ya impso, pyelonephritis, gout kapena zifukwa zina zowonjezera - zotupa za impso, paraneoplastic syndrome. Matenda a diabetes nephropathy odwala NIDDM ndi gawo lachitatu lokhalo pakati pazomwe zimayambitsa kuthamanga kwa magazi. Kuwonjezeka koteroko kwa magazi kumatha kukhala chifukwa cha matenda ena a endocrine omwe amafanana ndi matenda ashuga (thyrotooticosis, acromegaly, matenda a Itsenko-Cushing kapena matenda, matenda a Conn, pheochromocytoma, etc.). M'pofunika kuganizira kuthekera kwa kukhalapo ndi occlusive zotupa za zotengera - coarctation wa msempha, aimpso mtsempha wamagazi stenosis. Mukakusonkhanitsa anamnesis, ndikofunikira kuti muzisamala ndikugwiritsa ntchito njira zakulera kapena corticosteroids zomwe zingakulitse magazi.
Imodzi mwa njira zopangira matenda osokoneza bongo mu shuga ikhoza kukhala chiwopsezo chachindunji cha insulin reabsorption mu nephron, komanso zochita zina zosakhudzana ndi mahomoni kudzera munjira zomvera chisoni-adrenal ndi renin-angiotensin-aldosterone, kukulitsa chidwi cha minofu yosalala minofu yosindikiza, komanso kukulitsa kukula kwa zinthu.
The angiotensin akatembenuka enzyme (ACE), dipeptidyl carboxy peptidase, motsogozedwa ndi momwe angiotensin ine ndimasinthidwa mu octapeptide yogwira, angiotensin II, imagwira nawo gawo pogwira ntchito ya renin-angiotensin. Mwa kumangirira ku ma receptor enieni pamitsempha yama cell, angiotensin II imakulitsa kutulutsa kwamtima, kumayambitsa vasoconstriction kwamitsempha yama coronary, hyperplasia ndi hypertrophy ya maselo osalala am'mitsempha, ndikulimbikitsa kutulutsidwa kwa makatekolamines.
Angiotensin II wopangidwa kwanuko, kupangika kwake komwe kumachulukitsa kwa nthawi yayitali, kumagwira ntchito modzilemekeza monga wogwirizira. ACE imachepetsa kuthekera kwa khoma la mtima kupanga N0 (endothelial relaxation factor).
M'zaka zaposachedwa, kupezeka kwa kutsimikizika kwa majini kukukula kwa matenda oopsa kwatsimikiziridwa. Kuwona kumeneku kumalumikizidwa ndi vuto la genetic mu transmembrane transport of cations and polymorphism of genes yomwe imayendetsa kaphatikizidwe ka ACE.
Kuphatikizikanso kunapezekanso pakati pa polymorphism ya jini ya paraoxonase enzyme ndi kusintha kwa atherosulinotic m'mitsempha yama coronary ya odwala omwe ali ndi NIDDM. Paraoxonase mu HDL imapangitsa lipid peroxides mu LDL, kukhala yachilengedwe anti-atherogenic factor.
IHD mwa odwala matenda ashuga mellitus ndi chiwonetsero cha matenda ashuga a macroangiopathy: ali ndi atherosulinosis osati am'mitsempha yama coronary, komanso mitsempha ya ubongo, m'munsi am'munsi komanso ziwiya zina zazikulu. The morphological mawonekedwe a atherosulinosis mu shuga mellitus akhoza chifukwa cha kuchulukana kwa kutulutsa kwa atheromas.
Kuzindikira. Ndikofunikira kudziwa kuchuluka kwa kuthamanga kwa magazi mu magawo awiri. Kupanikizika kwa magazi kuyenera kuyesedwa m'manja monse ndi manja oyenera ndi kuwongolera pamalo omwe wodwalayo amakhala, atakhala ndikugona. Ndikofunikira kulingalira kuthekera kwa kuchepa kwa magazi mu orthostatic chifukwa cha kusowa kwa mtima wamanjenje.
Malinga ndi malingaliro a WHO, kuthamanga kwa magazi sikuyenera kupitilira 145/90 mm Hg. Komabe, mwa odwala omwe ali ndi matenda a shuga a misinkhu yocheperako, njira zake (makamaka pamaso pa Microalbuminuria kapena kusintha koyamba mu fundus) ziyenera kukhala zovuta kwambiri - 135/85 mm Hg Mlingo ndi kukhazikika kwa kuthamanga kwa magazi ndizofunikira kwambiri popewa zovuta zamtima. Mu 1992, Komiti Yadziko Lonse yaku United States ya Kuzindikiritsa, Kuunika, ndi Chithandizo cha Kuthamanga Kwa Magazi idaganiza za kuthamanga kwa magazi kwa 130 ndi 85 mm Hg, matenda oopsa - gawo I (modekha) 140-159 / 90-99 mm Hg, II siteji (zolimbitsa) 160-99 / 100-109 mm Hg, gawo III (lolemera), 180- 209 / 110-119 mm Hg, siteji IV (yolemera kwambiri), 210/120 mm Hg .
Kuzindikira kwa matenda oopsa pakadali pano kutengera nkhani ya zotupa zam'mimba ndi ziwalo, gulu lomwe limatengera ziphunzitso za G.F. Lang ndi A.P. Myasnikov.
Chithunzi cha chipatala. Mu shuga mellitus, matenda oopsa amakhala ndi mawonekedwe amtunduwu a matenda awa. Nthawi zambiri, makamaka ndi mtundu “wofatsa” wa matenda oopsa, odwala samadandaula. Nthawi zina, pamakhala madandaulo am'mutu (omwe amakhalabe chizindikiro chokhacho kwa nthawi yayitali), kutopa, kuchepa kwa ntchito, kupweteka pachifuwa, kumverera kwa "kusokonezedwa", zina. Kufufuza kwakuthupi kumawonjezera kukula kwa malire ndi kutsimikiza mtima kwamanzere kumanzere, kukulitsa chidwi II mamvekedwe aorta.
Mawonetseredwe azachipatala nthawi zambiri amayamba chifukwa cha kupezeka kwa matenda a mtima a ischemic, atherosulinosis, coronary kapena ubongo. Pa ECG, zizindikiro zamanzere zamitsempha zam'mimba zimawonekera nthawi zambiri: kupatuka kwa axis yamagetsi amtima kumanzere, kuwonjezereka kwa matalikidwe a zovuta za QRS kumatsogolera V5-V6, mawonekedwe a ST gawo la kukhumudwa komanso kusokonezeka kwa mafunde a T. Njira ya fundus nthawi zambiri imadalira zomwe zimayambitsa matenda oopsa a hypertension kapena matenda a shuga. diabetesic retinopathy). Ndi matenda oopsa, chodabwitsa cha Salus-Hunn crossover (mitsempha yosindikizidwa imapanikizika mitsempha), chifuwa cha arterioles, kusalinganika kwa mawonekedwe awo, kusasinthika kwa edema, ndi zina zotere.
Zizindikiro zamatenda am'mtima mwa odwala omwe ali ndi matenda osokoneza bongo amasiyana pang'ono ndi kupweteka kwapweteka kwapafupipafupi, koma nthawi zambiri (mpaka 20-30% ya milandu) angina pectoris ndi infarction ya myocardial imachitika popanda kupweteka. Mwa odwala omwe ali ndi matenda a shuga a zaka 35 mpaka 50, kumwalira kwa magazi ndi matenda obwera mwadzidzidzi amafa 35% yaimfa.
Ndi "chete" myocardial ischemia, kuchepa kwa malo okhala kumawonedwa pokhapokha pakuwonekera kwa kuchuluka kwa kuchuluka kwa mbali yamanzere. Zochitika zamtundu wa IHD ndi kulowetsedwa kwa m'mnyewa wamtima mwa odwala matenda a shuga zimayenderana ndi kudziyimira kwina kwa shuga, komwe kumayambitsa kusokonezeka kwakukulu kwa magwiridwe antchito a myocardium ndi hemodynamics yapakati, i.e. kuchepa kwa sitiroko ndi miniti yamagazi, index yamtima, mphamvu yamanzere yamitsempha, kuchuluka kwa mtima ndi kukana kwamphamvu kwamphamvu. Tachycardia pafupipafupi (kusiyana kwa kuchuluka kwa mtima masana ndi usiku) kukuwonetsa kuphwanya kwa parasympathetic innervation.
Odwala omwe ali ndi matenda a shuga, kuphatikizika kwa matenda a mtima a ischemic, mtima neuropathy (mtima wolimbana ndi mtima), mtima umawonedwa, izi zimasintha chithunzi cha matenda omwe amayambitsa, zimayambitsa kulephera kwa mtima, komanso zimapangitsa kuti azindikire matendawa. Kukula kwa kudziyimira pawokha kwa matenda a shuga kumayambitsa kuphwanya mphamvu yogwira thupi, kuchepa kwa kulolerako zolimbitsa thupi.
M'zaka zaposachedwa, "matenda ang'onoang'ono okhala m'matumbo" adayimbidwa kuti akuchititsa kuchepa kwa malo okhala ndi ziphuphu. Kuphatikiza kwa matenda oopsa, kunenepa kwambiri, hypertriglyceridemia, kukana insulini kumaphatikizidwa ndi lingaliro la "metabolic syndrome", kapena "matenda X". Odwala omwe ali ndi matendawa amatha kugwidwa ndi matenda a mtima komanso kulowetsedwa kwa mtima.
An anamnesis, madandaulo a wodwala, zofunika kudziwa, komanso njira zofufuzira zazachipatala zimapangitsa kudziwa matenda amtima komanso matenda oopsa a matenda ashuga popanda kugwiritsa ntchito njira zovuta zowonera matenda. Kuzindikira matenda obisika "osasinthika" ndi zovuta zosinthika nthawi zambiri kumakhala kovuta, chifukwa chake njira zophunzitsira zovuta zimagwiritsidwa ntchito (kuyang'ana njinga, kuyang'anira ECG, scyography yama myocardial panthawi yochita masewera olimbitsa thupi komanso kuyesedwa ndi dipyridamole). Radionuclide ventriculography yokhala ndi thallium yolembedwa ndi MRI imatha kufotokozera mtundu ndi kuwonongeka kwa myocardium, bedi la capillary ndi sitima za coronary.
Muzochitika zovuta, pokhudzana ndi njira zomwe zikubwera za chithandizo cha opaleshoni (coronary artery bypass grafting, balloon balloon opaleshoni ya pulasitiki), coronarography imagwiritsidwa ntchito pozindikira kuwonongeka. Komabe, kukwera mtengo kwa zida zofufuzira kumachepetsa kugwiritsa ntchito njirazi. Kuwunika kwa Holter ndi njira imodzi yodziwika kwambiri yodziwira matenda oti "chete" ischemia.
Kafukufuku wokhudzana ndi kuyanjana kwa majini polymorphism ndi odwala omwe ali ndi vuto la mtima wamatenda a shuga amayesa kuwopsa ndikuwonetseratu kukula ndi kupitilira kwa zovuta zotere nthawi yayitali asanawonekere.
Chithandizo. Kuwongolera koyenera kwambiri kwa glycemia ndi lipemia, zizindikiro zazikuluzikulu zakuchulukitsa kwamachilengedwe, ndizofunikira pamagawo onse azithandizo za odwala omwe ali ndi matenda osokoneza bongo. Chithandizocho chikuyenera kuthandizira kuchepetsa kuthamanga kwa magazi kuti muchepetse zovuta za matenda ashuga komanso matenda oopsa kapena kuti achepetse kukula. Pochita izi, munthu ayenera kuyesetsa kutsitsa magazi mpaka kufika ku 90/90 mm Hg. Kutsika kwina, makamaka kwa okalamba, kumawonjezera chiopsezo cha CHD. Paubwana, njira zitha kukhala zovuta. Ndikofunikira kuyeza kuthamanga kwa magazi: si odwala onse omwe ali ndi matenda ashuga omwe ali ndi mawonekedwe owongoka, chifukwa kuchepa kwa kuthamanga kwa magazi kumatha kuchitika chifukwa cha autonomic neuropathy. Izi ziyeneranso kukumbukiridwa popanga mawonekedwe a antihypertensive therapy komanso pakukonzekera.
Mankhwala antihypertensive mankhwala ayenera kukhala pathogenetic, ochitika mosalekeza kwa zaka zambiri. Vuto lalikulu ndikuti wodwalayo samadzimva kuti ali ndi zovuta zina. Kufunitsitsa kumwa mankhwala kumatsika ngati mankhwalawa amayamba chifukwa chotsatira. Kuphatikizanso ndi kuganizira za zomwe magazi amathandizira pa antihypertensive mankhwala, zinthu zina ziyenera kukumbukiridwa: jenda (amuna nthawi zambiri amafunikira kukonzekera kwamankhwala), mawonekedwe amtundu (pamaso pa matenda amitsempha yamavuto m'mbiri ya banja, pharmacotherapy ya matenda oopsa imayamba kale. Ndi matenda a mtima kapena kuchepa kwamitsempha, kulowetsedwa kwamphamvu kwa magazi kumafunika. Odwala omwe ali ndi matenda a shuga komanso matenda a mtima, akaphatikizidwa ndi kunenepa kwambiri, hyperliproteinemia kapena kulephera kwaimpso, kuchepa kwamitsempha yamagazi, kuchepa kwambiri kwa thupi, kuchepa mosamala kwa magazi kumafunika. Mankhwala a antihypertensive kwa odwala matenda a shuga ayenera kuyambitsidwa ngakhale ndi matenda oopsa. Mankhwala amachepetsa chiopsezo chamikwingwirima yamatumbo. Chifukwa chake, kuyera
Kafukufuku wa 7 - 2050 adawonetsa kuti kuchepa kwa kuthamanga kwa magazi kunali kokha 20/8 mm Hg. amachepetsa kuthekera kwa zovuta pamtima ndi 40%.
Zotsatira zamankhwala zimapangidwa makamaka ndi kuphatikiza kwawo osagwirizana ndi mankhwala. Malangizo ena akuyenera kukumbukiridwa: Kusankha kwa antihypertensive mankhwala, kupezeka, nthawi ya zotsatira. Mafomu okonda kusintha. Munjira yamankhwala, mayeso a ophthalmoscopic, ECG imachitika, mulingo wa lipids m'mwazi umatsimikiziridwa, mayeso ofunika a nephrological amachitika.
Ndikofunika kuyamba chithandizo ndi monotherapy (miyezi 3-6), ndipo ndi kusakwanira kwake, chithandizo chophatikizidwa chimasonyezedwa. Olemba ambiri amakhulupirira kuti monotherapy yokhala ndi mankhwala a sympatholytic (clonidine, dopegite, rauwolfia kukonzekera) sikofunikira chifukwa chogwirira ntchito pang'ono, zotsatira zoyipa zambiri, komanso kuchepa kwa moyo. . *
Othandizira amakono a antihypertensive agawidwa m'magulu otsatirawa: 1) ACE inhibitors, 2) olimbana ndi calcium, 3) p-adrenoreceptor blockers, 4) diuretics.
ACE zoletsa ndi mankhwala osankha kuphatikiza matenda a shuga ndi matenda oopsa omwe ali ndi matenda a mtima a ischemic, infarction ya myocardial, kulephera kwa mtima, vuto la sinus, matenda a m'mapapo komanso matenda a Raynaud. Mukamagwiritsa ntchito ndalamazi, pali zizindikiro za kusintha kwakumanzere kwamitsempha yamitsempha yamagazi ndi kusintha kwake. Amaphatikizidwa kwambiri mu mitral ndi aortic stenosis, stenosis ya carotid ndi aimpso. Mankhwala osafunikira a gululi pakatha kubereka komanso aimpso. ACE inhibitors amaloledwa bwino ndi odwala. Zotsatira zoyipa zimaphatikizapo chifuwa chowuma. Mosiyana ndi mankhwala ena a antihypertensive, mankhwalawa samakhudza chakudya chambiri, lipid kapena purine metabolism, amatha kuphatikizidwa ndi okodzetsa, ma p-blockers, othandizira calcium. Ma A inhibitors ali ndi phindu pa kagayidwe kazakudya, ndikuwonjezera minyewa yamtundu wa insulin.
Ntchito za antianginal zamagulu am'gulu lino poyerekeza ndi zomwe amatsutsa a calcium amachepetsa pang'ono. Nthawi yomweyo, kugwiritsa ntchito nthawi yayitali kwa ACE zoletsa mwa odwala pambuyo poyambira kumalola kuti muchepetse kukonzanso kwa chomaliza. Capoten ndi wa zoletsa za ACE m'badwo woyamba, mfundo yogwira yomwe ndi kaphatikizidwe. Muli wamba tsiku lililonse 50 mg mu 2-3 waukulu. Kapoten imatchinga malo a ACE omwe amagwira ntchito ndipo amaletsa mapangidwe a angiotensin

yomwe ndi vasoconstrictor wamphamvu kwambiri mthupi la munthu. Kapoten alibe mwachindunji vasodilating kwenikweni.

Ramipril (Hehst Tritace) amalepheretsanso dongosolo la renin-angiotensin, kutsitsa milingo ya plasma ya angiotensin II ndi aldosterone, ndikuwonetsa zochita za bradykinin, zomwe zimapangitsa kuchepa kwa zotumphukira zamitsempha. Ndikofunika kuperekera ramipril kwa odwala omwe ali ndi matenda a shuga, makamaka ngati matenda a hemodynamics ndi zovuta zam'magazi apezeka, popeza imakhala ndi mphamvu yotulutsa mitsempha yapakati komanso yaying'ono, ma arterioles, ndi ma network a capillary. Chofunika

Ubwino wa mankhwalawa ndikuti amatha kugwiritsidwa ntchito mu Mlingo wochepa (kuyambira 1 mpaka 5 mg patsiku).
Renitec (enalapril maleate, MSD) ndimtundu wautali wa ACE inhibitor. Mankhwalawa amawonetsedwa kwa odwala omwe ali ndi matenda a shuga komanso ischemic matenda a mtima. Zimathandizira kuwonjezeka kwa mtima komanso kutuluka kwa magazi aimpso, zimathandizira, komanso zimakhudza mawonekedwe a plasma lipoproteins. Mankhwala othandizira amachokera ku 5 mpaka 40 mg kamodzi patsiku.
M'badwo watsopano wa ACE zoletsa umaphatikizira Prestarium (gulu la azachipatala a Servier), omwe amathandizira kuchepetsa hypertrophy ya maselo osalala a minofu ndikuwongolera kuchuluka kwa elastin / collagen khoma la mtima. Zothandiza zake pamalo osungirako ziwonetsero zimawonetsedwa. The achire mlingo wa mankhwalawa ndi 4-8 mg patsiku.
M'zaka zaposachedwa, zapezeka kuti ACE zoletsa zimachepetsa pang'ono zotsatira za mtima wa activation wa renin-angiotensin.
Wotsutsa wa Angiotensin II - losartan (cozaar) ndi woimira gulu lina latsopano la antihypertensive mankhwala. Imatseka makamaka ma receptors a angiotensin II ndipo imakhala ndi zotsatira zazitali komanso zofananira. Ndi kapangidwe ka mankhwala, ndimtundu wa imidazole. Chithandizo cha Cozaar tikulimbikitsidwa kuti muyambe ndi 25 mg kamodzi patsiku, mlingo wake ukhoza kuwonjezeka mpaka 50-100 mg / tsiku. Njira yayikulu yothetsera mankhwalawa ndi metabolite yake yogwira ndiye chiwindi, mankhwalawa sanapatsidwe chifukwa cha kulephera kwa impso.
Monga antianginal othandizira omwe amasintha kayendedwe ka magazi ndi kuchepetsa zotumphukira zamagazi, othandizira othandizira calcium amagwiritsidwa ntchito. Kukonzekera kwa gululi kumalepheretsa kulowa kwa Ca2 + kulowa myofibrils ndikuchepetsa ntchito za myofibrillar Ca ^ + - activated ATPase. Mwa mankhwalawa, gulu la verapamil, diltiazem, nifedipine limasiyanitsidwa. Ma calcium antagonists samachulukitsa glycemia ndipo samakhala ndi vuto pa metabolidi ya lipid. Ndi kugwiritsa ntchito nthawi yayitali kwa verapamil, kusintha kwamankhwala amkati kumadziwika.
Acute myocardial infarction, sinus bradycardia, atrioventricular block, sinus node kufooka, systolic mawonekedwe olephera a mtima - awa ndi magawo omwe kuli bwino kugwiritsa ntchito verapamil ndi diltiazem, koma mankhwala a nifedipine. Chithandizo ndi kakanthawi kochepa kashiamu wotsutsana wa nifedipine gulu contraindicated mu pachimake koronare insufficiency - pachimake myocardial infarction ndi wosakhazikika angina. Mankhwala omwe amagwira ntchito kwa nthawi yayitali (adalat) samayambitsa kuchepa kwambiri kwa kuthamanga kwa magazi ndi chiwonetsero cha Refidic pamlingo wa catecholamines, womwe umadziwika ndi nifedipine. Amagwiritsidwa ntchito mu 10 mg (1 kapisozi) katatu patsiku kapena 20 mg (mapiritsi) 2 kawiri pa tsiku.
Mlingo wautali wa mankhwala amkati a calcium amathandizira kwambiri kulimbitsa thupi kwa wodwala. Ndi "chete" myocardial ischemia, amakulolani "kuteteza" myocardium kuzungulira koloko, yomwe imathandiza kupewa kufa mwadzidzidzi.
Odwala omwe ali ndi proteinuria yolumikizana ndi ochepa matenda oopsa komanso matenda a shuga oopsa kapena aimpso kulephera (CRF), olimbana ndi calcium a gulu la dihydropyridine sakhala othandiza kuposa verapamil kapena diltiazem.
Ma blockers a p-adrenergic receptors amagawidwa malinga ndi kusankha kwa zochita pa pg ndi p2-adrenergic receptors. Mankhwala omwe amasankha kusankha ma rg receptors (atenolol, metoprolol, etc.) amatchedwa mtima. Ena (propranolol, kapena anaprilin, timolol, etc.) amachita nthawi imodzi pamasamba a p ndi p2.
Beta-blockers amachepetsa pafupipafupi komanso nthawi yayitali ya "chete" komanso zowawa m'matumbo a mtima, komanso zimathandizira kusintha kwa moyo chifukwa cha kuchepa kwa thupi. Mphamvu ya antianginal ya mankhwalawa imafotokozedwa ndi kuchepa kwa mphamvu zamagetsi, komanso kugawa magazi m'magazi a coronary. Mphamvu ya antihypertensive imalumikizidwa ndi kuchepa kwa mtima. Kuphatikiza apo, ma p-blockers amatha kuchepetsa insulin komanso kulekerera shuga, komanso kutsekereza kuyankha kwachisoni ku hypoglycemia. Osasankha ma p-blockers ogwiritsira ntchito nthawi yayitali amawonjezera kuchuluka kwamafuta acids ndikuthandizira kuyambiranso kwa triglycerides m'chiwindi. Nthawi yomweyo, amatsitsa HDL. Zotsatira zoyipa izi sizikhala ndi mawonekedwe a mtima -oselective p-blockers. Kukhazikitsidwa kwa ma block-p-block mwa odwala omwe ali ndi vuto lalikulu la neuronomic sikuwonetsedwa. Ngati matenda a impso akuwonongeka, mlingo wawo uyenera kuchepetsedwa, chifukwa amamuchotsa impso. p-blockers ndi chithandizo cha matenda osokoneza bongo omwe amakhala ndi mtima arrhythmias, hypertrophic cardiomyopathy, stenosis ya orortice orortice.
Alfa | --adrenergic blockers (prazosin) ali ndi mphamvu pa lipid metabolism. Komabe, pogwiritsa ntchito matenda osokoneza bongo a nthawi yayitali okhala ndi vuto lodziyimira m'mimba, ayenera kugwiritsidwa ntchito mosamala, chifukwa amayambitsa matenda amtundu wa orthostatic.
Ma diuretics a ochepa oopsa komanso matenda a mtima kwa odwala omwe ali ndi matenda osokoneza bongo sakonda kugwiritsidwa ntchito ngati monotherapy, nthawi zambiri amagwiritsidwa ntchito limodzi ndi mankhwalawa. Pakati pamagulu osiyanasiyana a diuretics (thiazide, loop, potaziyamu, osmotic), ndikofunikira kugwiritsa ntchito mankhwala osokoneza shuga ndi kulolerana kwa lipid. Pazakuwonongeka kwa impso, kusankhidwa kwa potaziyamu wotsekemera sikuwonetsedwa. Pakadali pano, zokonda zimaperekedwa ku loop diuretics (furosemide, ethaconic acid), yomwe imakhala yofooka kwambiri pamatumbo ndi lipid metabolism. Mankhwala a m'badwo watsopano arifon (indapamide) ndi mankhwala osankhidwa mwa odwala matenda a shuga. Izi sizisintha cholesterol, sizimakhudza kagayidwe kazakudya ndipo sizimayambitsa ntchito yaimpso. Mankhwala ndi mankhwala

mg (piritsi 1) tsiku lililonse.

Mu zovuta mankhwala a odwala matenda a shuga ndi ischemic matenda a mtima ndi ochepa matenda oopsa, ndikofunikira kuyesetsa kuti matenda a lipid kagayidwe. Mayeso olamulidwa mosasinthika akuwonetsa kuti kutsitsa cholesterol mwa odwala omwe ali ndi matenda amtima kumalepheretsa kubwerezabwereza kwa myocardial infarction ndikuchepetsa kufa kwa matenda a mtima ndi matenda ena amitsempha.
Mfundo za mankhwalawa komanso kupewa atherosulinosis zimaphatikizapo kuchotsedwa kwa zinthu zomwe zingayambitse vutoli, kubwezeretsa insulin, komanso kugwiritsa ntchito mankhwala. Otsatirawa amagwiritsidwa ntchito ngati omaliza: a) fibroic acid yomwe imachokera - ma fiber omwe amachepetsa kaphatikizidwe ka VLDL, amalimbikitsa ntchito ya lipoprotein lipase, achulukitse cholesterol ya HDL ndi m'munsi fibrinogen, b) anion-exchange resins (cholestyramine), yomwe imalimbikitsa kuphatikizira kwa bile, c) Prucucol, yomwe ili ndi antioxidant zotsatira ndikuwonjezera kuchulukitsa kwa hepatic LDL, d) hydroxymethyl-glutaryl-coenzyme A-reductase inhibitors (kiyi yofunika kwambiri kwa kaphatikizidwe ka cholesterol) - lovastatin (mevacor), e) lipostabil (phospholipids yofunika) s).
Kupewa kwamatenda amtima mu mtima mwa odwala omwe ali ndi matenda amitsempha yamagazi kumakhalapo pakuchotsa kapena kuchepetsa ziwopsezo. Kusintha kwa moyo kapena kusintha moyo wamunthu kumalumikizidwa ndi njira zosagwirizana ndi zamankhwala pakuwongolera gululi ndipo zimaphatikizanso kuchepa kwa thupi index index (BMI) komanso kuletsa kwa mchere wa patebulo mpaka 5.5 g / tsiku. Mphamvu ya antihypertensive mankhwala imathandizidwanso ndi mchere wopanda mchere, kuphatikiza micronutrients, multivitamini, fiber fiber, zochitika zolimbitsa thupi, kusuta kusiya mowa. Chiwopsezo chotsika kwambiri cha kufa chifukwa cha kulephera kwa mtima kumawonedwa mwa anthu omwe samamwa konse. Zotsatira za njira zakulera komanso mankhwala osapatsirana omwe amachititsa kuti magazi azikhala ndi magazi zimayenera kuganiziridwanso. Matenda oopsa a ubongo amachepetsa mphamvu ya zotupa za impso.
Kufunika kwa njira yodzitetezera kumawonekera makamaka akafika kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda oopsa. Kuchita bwino kwa chithandizo chamankhwala makamaka kumadalira pakumvetsetsa kwakufunika kwa kayendedwe ka magazi. Ndikofunikira kukhazikitsa kwa wodwalayo luso lodziyimira pawokha la kuthamanga kwa magazi, kukambirana ndi wodwalayo magawo onse azithandizo, moyo, njira zochepetsera thupi, ndi zina zambiri.
Ku United States, ntchito yophunzitsa kuthana ndi kuthamanga kwa magazi yakhala ikuchitika kwa zaka zoposa 20, zomwe zathandiza kuti matenda ashuga a mtima azikhala ndi 50-70%. Pulogalamu yoyenera yophunzirira ku Russia ingakhale yofunikira popewa matenda ashuga.

Matenda a mtima ndi matenda a shuga

Kuzindikira matenda a mtima ndi matenda a shuga nthawi zambiri kumakhala kovuta. Njira zopewera zosagwiritsa ntchito mankhwala osokoneza bongo, kusankha kwa antianginal and anti-ischemic mankhwala osakanikirana ndi matenda osokoneza bongo a shuga ndi matenda a mtima komanso zinthu zina zingapo zofunika.

Matenda a shuga ndi vuto lalikulu komanso loziyimira pawokha la matenda amtima. Pafupifupi 90% ya anthu odwala matenda ashuga samadalira insulin (mtundu 2 wa matenda a shuga). Kuphatikiza kwa matenda osokoneza bongo a shuga ndi matenda amkati amtima sikungakhale koyenera, makamaka ndi glycemia yosalamulira.

Zolemba patsamba lasayansi pamutu wakuti "Matenda a shuga ndi matenda a mtima: kupeza yankho"

■ Matenda A shuga ndi Matenda a Mtima Wothandiza: Kupeza Yankho

■ An. A. Alexandrov, I.Z. Bondarenko, S.S. Kuharenko,

M.N. Yadrikhinskaya, I.I. Martyanova, Yu.A. Zosakaniza mchere

E.N. Drozdova, A.Yu. Zazikulu. Dr

Kuvala kwamtima kwa Endocrinological Science Science Center I * (Doctor of Medical Science - Maphunziro a RAS ndi RAMS II I. Dedov) RAMS, Moscow I

Kufa kwa matenda amitsempha yama mtima m'magulu a anthu odwala matenda a shuga 2 (MM 2) akupitiliza kuwonjezeka padziko lonse lapansi, ngakhale kuwonjezeka kwa mtengo wamankhwala komanso kupewa matenda amtima odwala omwe ali ndi matenda ashuga.

Chiwopsezo chachikulu cha zovuta zam'mitsempha yamtundu wa 2 shuga chinapatsa American Cardiology Association chifukwa chodziwitsa matenda ashuga ngati matenda amtima.

Idipatimenti yamtima, yomwe cholinga chake chachikulu ndikupeza njira zochepetsera kufa kwa mtima ndi odwala omwe ali ndi matenda a shuga, adapangidwa ku ESC RAMS mu 1997. Zomwe anapeza omwe amagwira ndi ESC RAMS E. L. Kilinsky, L. S. Slavina, E. S. Mayilyan pankhani ya zamtima, adafotokozedwa mwachidule mu 1979 munkhani yotchedwa "Mtima mu Endocrine Diseases", yomwe kwa nthawi yayitali idali buku lodziwika bwino la madokotala othandiza m'dziko lathu, lomwe limafotokoza za njira ya chipatala ya mtima.

Kuwongolera kwapadera kwa ESC RAMS pakukonzekera mavuto a matenda ashuga ku Russia kunawonetsedwa pakupanga mkati mwa ESC RAMS ya dipatimenti yamtima yamakono yomwe imagwiritsa ntchito mtima matenda a odwala matenda a shuga. Malinga ndi oyambitsa ntchitoyi, Acad. RAS ndi RAMS I.I. Dedova, mavuto akulu azachuma komanso oyendetsa ntchito pakupanga dipatimentiyi ayenera kulipira pakukonzekera kwatsopano kwa njira zamakono zodziwikitsa ndi kuchiza matenda a mtima (CHD) mwa odwala matenda a shuga.

Pakadali pano, ndikudziwika kuti odwala matenda ashuga, angina pectoris, infarction ya myocardial, kufooka kwa mtima komanso mawonekedwe ena a coronary atherosulinosis ndiofala kwambiri kuposa mwa anthu opanda matenda a shuga. Pakufufuza kwa anthu azaka zopitilira 45, zidapezeka kuti pamaso pa matenda ashuga 1, mwayi wokhala ndi IHD mwa odwala ukuwonjezeka nthawi 11 poyerekeza ndi odwala opanda matenda a shuga.

Matenda a shuga amakhala ndi zovuta komanso zovuta kuzimvetsa pamtima. Kafukufuku wachipatala komanso woyeserera wasonyeza mbali yayikulu pakapangidwe ka chithunzi cha matenda a zovuta zina za metabolism yamphamvu mu myocar

dialysis maselo amtima. Kugwiritsa ntchito kwa matenda a positron emission tomography kwawonetsa kuti kuchepa kwamphamvu kwa magazi omwe amapezeka mwa odwala omwe ali ndi matenda osokoneza bongo kumalumikizana kwambiri ndi kuwonongeka kwa kama wodwala.

Komabe, kuchuluka kwamatenda amtima wamtundu wa 2 wodwala kumayenderana ndi kuthamanga kwa atherosulinosis kwamitsempha yayikulu yamitsempha yama mtima. Zinapezeka kuti matenda ashuga a dyslipidemia, omwe ndi chikhalidwe chachikulu chomwe ndi hypertriglyceridemia, amathandizira kuti pakhale kuphulika kwa malo ambiri a ziwongo za atherosselotic. Khalidwe ili la atherosselotic njira yovuta ya carbohydrate metabolism yadzetsa kupangidwe kwa matenda a shuga monga matenda ophulika. .

Chikwangwani chosasunthika, chosasinthika cha atherosulinotic pakadali pano chimawonedwa ngati njira yofunika kwambiri yopangira matenda acute coronary syndrome mu mawonekedwe a osakhazikika a angina pectoris kapena infaration ya pachimake ya myocardial.Acute myocardial infarction ndimomwe amafa mu 39% ya odwala matenda ashuga. Imfa pasanathe chaka chimodzi pambuyo poti vuto loyambira limafikira 45% mwa amuna omwe ali ndi matenda ashuga ndi 39% azimayi, omwe amapitilira muyeso womwewo

Mkuyu 1. Chithunzi cha chitukuko cha mtima "wa matenda ashuga".

Zizindikiro (38% ndi 25%) mwa anthu omwe alibe shuga. Pafupifupi 55% ya odwala matenda a shuga amwalira mkati mwa zaka 5 pambuyo panjira yolowerera kwambiri, poyerekeza ndi 30% mwa odwala opanda matenda a shuga, ndipo vuto la mtima lomwe limadza limadwalanso odwala omwe ali ndi shuga 60% pafupipafupi kuposa odwala opanda shuga. Odwala omwe ali ndi matenda osokoneza bongo pambuyo poyambitsa matenda amiseche, kumwalira kuli pafupifupi kawiri, ndipo mtima wosakhazikika umakula katatu poyerekeza ndi kuchuluka kwa odwala opanda matenda a shuga.

Kufunika kozindikirika koyambilira kwa matenda amtima wodwala omwe ali ndi matenda ashuga kumatsimikiziridwa ndi njira yake yoopsa komanso kufa kwamphamvu. Kuwonongeka msanga kwa maphunziro a IHD kwa odwala omwe ali ndi matenda osokoneza bongo patangotha kuwonekera kwa zamankhwala zam'mimba kumawonetsa nthawi yayitali ya asymptomatic kupita patsogolo kwa coronary atherossteosis ambiri odwala omwe ali ndi matenda osokoneza bongo. Komabe, ndi matenda a shuga pali zovuta zovuta pakudziwika koyambirira kwa matenda amtima.

Mwa odwala ambiri, njira zambiri zodziwira matenda a mtima zimayang'ana pa kukhalapo, pafupipafupi komanso kukula kwa ululu - njira yayikulu ya kukhalapo ndi kuopsa kwa matenda a mtima. Kafukufuku wambiri waopopsy, matenda opatsirana ndi matenda adatsimikizira kuti njira imeneyi siigwiritsidwa ntchito mwa odwala omwe ali ndi matenda osokoneza bongo. Kuphatikiza pazovuta za "stereotypical" za angina okhazikika, m'matenda a shuga, mitundu yosiyanasiyana yokhudzana ndi coronary atherosulinosis ndi yofala - yopweteka komanso mitundu ya IHD.

The atypical maphunziro a matenda a mtima mu odwala omwe ali ndi matenda a shuga amadziwika ndi kupezeka kwa madandaulo okhudzana ndi zochitika zolimbitsa thupi, monga kupuma movutikira, kutsokomola, zochitika zam'mimba (kutentha kwapamtima, nseru), kutopa kwambiri, osawoneka ngati zizindikiro za angina pectoris kapena kufanana kwake. Kuzindikiritsa mosiyanasiyana ndi madandaulo otere kwa wodwala yemwe ali ndi matenda ashuga kumawoneka kuti kovuta kwambiri ndipo ndizotheka kokha ndikutsimikiziridwa ndi mayeso apadera azidziwitso.

Matenda osapweteka a matenda a mtima, omwe nthawi zambiri amatchulidwa kuti "sinyole yopanda matenda," ndiwowoneka osakhalitsa omwe amatsutsana ndi angina pectoris kapena ofanana nawo. ,

Chodabwitsa cha njira yofala ya asymptomatic ya IHD mwa odwala matenda a shuga mellitus idafotokozedwa koyamba mu 1963 ndi R.F. Bradley ndi J.0 Partarnian, yemwe, malinga ndi autopsy, adapeza gawo lalikulu la odwala matenda ashuga omwe amwalira chifukwa cha infrection yovuta kwambiri ya myocardial,

Zizindikiro zosachepera umodzi wam'mbuyomu.

Zomwe mabuku amawonetsa pofalikira kwa matenda opweteka a myocardial ischemia kwa odwala matenda a shuga ndizotsutsana kwambiri.

Mu kafukufuku yemwe Waller et al. Malinga ndi morphology, mpaka 31% ya odwala matenda a shuga osawerengeka amtundu wamatumbo a mtima adanenapo stenosis ya mtima umodzi. R.F. Bradley ndi J.O. Partarnian adawonetsa zisonyezo zam'mbuyomu zosapweteka zomwe zimapweteka pafupifupi 43% ya ma autopsies.

Malinga ndi maphunziro a matenda am'mimba komanso azachipatala, zochitika za ischemia zosapweteka zimachokera ku 6.4 mpaka 57%, kutengera njira zosankhira odwala komanso kuzindikira kwa njira zofufuzira zomwe zimagwiritsidwa ntchito, chifukwa cha njira zosiyanasiyana zophunzirira ndi kusanthula kwazinthuzo.

M'dipatimenti yamtima ya ESC RAMS kuti mupeze matenda oyamba a matenda a mtima kwa odwala omwe ali ndi matenda a shuga a 2, timagwiritsa ntchito kuyezetsa nkhawa kwa echocardiography. Nthawi yomweyo, tikuwunikira zolemba za spiroergometric kuti zikhazikike mwachindunji cha gawo la anaerobic katundu, zomwe zikuwonetsa kukwaniritsa kuyesedwa kofunikira kwambiri.

Tidapeza kuti odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi chiopsezo chachikulu cha matenda a mtima, kupsinjika kwa echocardiography kumalola nthawi zopitilira 1.5 (32.4% motsutsana ndi 51.4%) kukulitsa kudziwika kwa mitundu yopanda matenda a mtima wapamtima poyerekeza ndi mayeso opanikizika. Pogwiritsa ntchito kupsinjika kwa echocardiography, tinatha kudziwa matenda a mtima ngakhale kwa odwalawo omwe sanachite kusintha kwa ECG pamlingo wochita masewera olimbitsa thupi. Izi zitha kuchitika kokha ngati chidwi cha ECG chokhudza kupezeka kwa ischemia yafupika pazifukwa zina. Pankhaniyi, echocardiography ikhoza kuthandizira, yomwe imakonza kukhalapo kwa ischemia ndi mawonekedwe a dyskinesia a magawo a myocardium. Chifukwa chake, mu 19% ya odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi chiopsezo chachikulu cha matenda a mtima, koma popanda mawonekedwe ake a chipatala, matenda a mtima adapezeka, omwe samangopanga mawonekedwe osapweteka, komanso analibe zizindikiro zoyipa pa ECG.

Chifukwa chake, malinga ndi deta yathu, kuchuluka kwapamwamba kwa mitundu ya ECG-hasi ya IHD kungachitike chifukwa cha zomwe zimachitika mu IHD mu shuga mellitus. Zikuwoneka kuti, izi zimachitika chifukwa cha kuphwanya kwa mapangidwe a transmembrane angachite mu mtima martitus. Pansi pa zochitika zakuthupi, chifukwa chachikulu cha kupangika kwa transmembrane kuchitapo kanthu ndikusintha kusiyana pakati pa intracellular ndi extracellular wozungulira wa sodium ndi potaziyamu. Ndi matenda a shuga, matenda a metabolic

shuga mu myocardium imadziwoneka mwachangu ndikusokonekera kwa ionic homeostasis ya maselo a myocardial. Mu diabetesic myocardium, kukakamiza kwa pampu ya Ca2 + ion ya Ca / josh-reticulum Ca, Ca + / K + pampu, sarcolemal Ca3 + pampu ndi Na + -Ca2 + metabolism imadziwika nthawi zonse, zomwe zimapangitsa kuti pakhale calcium yambiri mkati mwa matenda osokoneza bongo.

Mankhwala ochepetsa shuga, makamaka sulfonylamides, amathandizanso kusintha kwa ion fluxes mu cardiomyocyte. Amadziwika kuti kukonzekera kwa sulfonylurea blockbotamu njira zotengera potaziyamu wa cell wa cellP, kuphatikizira mtima. Pakadali pano, zikudziwika kuti kusintha kwa mayendedwe a K + ATP-amadalira njira kukugwirizana mwachindunji ndi gawo la 8T pamwambapa kapena pansi pa contour pa myocardial ischemia.

Tili kutali kuti tidziwe kudalirika kwa ma electro-cardiographic sign a ischemia pamlingo wokulipira shuga matenda a shuga. Chiyanjano chovuta kwambiri chinapezeka pakati pa kuya kwakuchepa kwa gawo la 8T ndi msambo wa glycated hemoglobin (g = -0.385, p = 0.048). Matenda oyipa kwambiri a shuga adalipidwa, kusintha pang'ono kwa ischemia kunawonekera pa ECG.

Khalidwe la asymptomatic la myocardial ischemia lidalembedwa zoposa 1/3 za odwala matenda ashuga omwe amatsimikiziridwa matenda amitsempha yamagazi, omwe adalola Komiti Yogwirizanitsa ya American Heart Association kuzindikira matenda am'mitsempha mwa odwala omwe ali ndi matenda osokoneza bongo kuti alangize mayeso a electrocardiographic monga njira yoyamba. M'malingaliro athu, ngati pali chithunzi chamankhwala cha exertional angina kapena mawonekedwe ake, kuwunika kwa matenda a mtima m'mitima mwa ambiri mwa odwala matenda a shuga kungathe kutsimikiziridwa ndikugwiritsa ntchito mayeso apadera a ECG. Odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto la kusowa kwa matenda a mtima komanso a electrocardiographic a matenda a mtima, pozindikira koyambirira kwa myocardial ischemia, kupsinjika kwa malingaliro kumayenera kugwiritsidwa ntchito kale gawo loyambirira la mayeso. Kusowa kwa chithunzi cha matenda a mtima wamatumbo sikuyenera kuchepetsa chidwi chodwala cha matenda omwe ali ndi odwala omwe ali ndi matenda amtundu wa 2, popeza mitundu yopweteka yamatenda a mtima imatha kupezeka mu 34-51% ya odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi chiopsezo cha matenda a mtima.

Zambiri pazotsatira za hypoglycemic therapy pamatendawa komanso njira yodwala matenda a mtima odwala omwe ali ndi matenda osokoneza bongo amadzutsa funso loti asankhe mankhwala oyenera kwa odwala omwe ali ndi matenda a 2 a matenda a mtima. Makamaka chidwi cha ofufuza kuti

zimabweretsa mtima wa sulfonamides. Zotsatira zakugwiritsira ntchito kukonzekera kwa sulfonylurea zikuwonetsa kuti, kuchokera pamalingaliro, zotsatira za mtima za sulfonamides sizingaganizidwe ngati gulu logawanika ndipo izi ziyenera kukumbukiridwa polosera kugwiritsidwa ntchito kwawo kwa mankhwalawa. Amadziwika kuti mtima wa ntchito za sulfonylurea sizikukhudzana ndi kuchuluka kwa kutsika kwa shuga.

Cholinga cha dipatimenti yamtima ya ESC RAMS chinali kuwunika momwe mungatengere mbadwo watsopano wamankhwala ochepetsa shuga a sulfonylurea pa matenda a mtima a ischemic odwala matenda a mtima a 2 omwe ali ndi matenda a mtima. Zinapezeka kuti patatha masiku 30 a monotherapy okhala ndi glimepiride, kuchuluka kwa mayamwidwe okosijeni (MET) omwe akwaniritsidwa ndi odwala pamtunda wochita masewera olimbitsa thupi kunali kwakukulu kwambiri kuposa momwe zimakhalira. Kuchotsa mankhwala osokoneza bongo kumayendetsedwa ndi kuchepa kwakukulu kwa mpweya wokwanira wa okosijeni.

Kusintha kwa "ischemic thirs" mwa odwala omwe ali ndi matenda a shuga a 2 omwe ali ndi matenda amtima wamphamvu motsogozedwa ndi sulfonamides ya m'badwo watsopano sikugwirizana ndi kusintha kwamalipiro a carbohydrate metabolism. Izi zidatilola kuvomereza gulu ili la sulfonamides ngati chisankho choyenera kwambiri chokwanira kulipira kagayidwe kazakudya kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi matenda a mtima a ischemic. Mu 2003, pomwe izi zidanenedwa ku 1PO Congress ku Paris, malingaliro awa adangotanthauza udindo wa dipatimenti yamtima wa ESC. Msonkhano woyamba wa IO mu 2005 ku Atene, ofufuza otsogola ku Great Britain, Denmark ndi maiko ena aku Europe adanenanso za malingaliro ofotokoza za m'badwo watsopano wa sulfanilamides.

The sinyoopic ischemia yopanda ululu, yokhala ndi odwala omwe ali ndi matenda osokoneza bongo, amafunikira chithandizo choyenera. Mpaka nthawi yomaliza

sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Kulumikizana pakati pa matenda ashuga ndi matenda a mtima

Adzapeza yankho la funsoli kwa nthawi yayitali. Matenda a kapamba ndi ntchito ya mtima ndizogwirizana kwambiri. Makumi asanu ndi anayi mwa odwala ali ndi mavuto a mtima. Ngakhale adakali aang'ono, vuto la mtima silimachotsedwa. Pali matenda omwe amatchedwa matenda a mtima wa matenda ashuga. Kodi matenda ashuga amakhudza bwanji mtima?

Insulin yotulutsidwa ndi kapamba imafunikira thupi kuti isamutse glucose kuchokera m'mitsempha yamagazi kupita ku minofu ya thupi. Matenda a shuga amadziwika ndi kuchuluka kwa shuga m'mitsempha yamagazi. Izi zimayambitsa mavuto mthupi. Chiwopsezo cha kulephera kwa mtima - kumasulidwa kwa cholesterol pamitsempha yamagazi - ikukulira. Matendawa amapezeka.

Atherosulinosis imayambitsa matenda a ischemic. Chifukwa cha kuchuluka kwa shuga mthupi, kupweteka m'dera la chinthu chodwala kumakhala kovuta kwambiri kulekerera. Atherosulinosis imadzetsa kuwoneka kwa magazi.

Anthu odwala matenda ashuga amakhala ndi mavuto ambiri. Pambuyo kugunda kwa mtima, mavuto mwanjira ya aneuricm amatha. Vuto lachivuto chakumapeto lingachiritsidwe, zomwe zimayambitsa kubwereza kwa mtima.

Kodi mawu oti “matenda ashuga” amatanthauza chiyani?

Matenda a shuga a mtima ndi matenda omwe akuwonetsa kuwonongeka kwa mtima chifukwa chodwala matenda a shuga. Kusowa kwa Myocardial kumachitika - gawo lalikulu kwambiri la mtima. Zizindikiro palibe. Odwala amawona kupweteka m'dera lamavuto. Zovuta za tachycardia ndi bradycardia ndizofala. Ndi kukomoka, myocardium nthawi zina imachepetsedwa. Kugundika kwa mtima kumachitika, kumatsogolera kuimfa.

Ntchito yayikulu ya mtima ndikuyendetsa magazi kudzera m'mitsempha yamagazi, pokopa. Matenda a shuga a mtima ndiwosavuta nthawi zonse. Mtima kuchokera kulemera kwambiri umachulukitsa voliyumu.

Myocardial edema ndi kupuma movutikira pamene akuyenda.
Ululu m'dera lomwe lakhudzidwa.
Kusintha kwa malo a odwala.

Yang'anani! Paubwana, Zizindikiro nthawi zambiri sizimachitika.

Matenda a shuga

Njira yayitali ya matenda a shuga imayambitsa zizindikiro zomwe zimayenderana ndi matenda ashuga othana ndi vuto la matenda ashuga. Matendawa amawononga mitsempha ya mtima chifukwa cha shuga wambiri. Kufika pamtima kumasokonezeka, kumayendera limodzi ndi zizindikiro.

Kuchuluka kwa mtima kapena sinus tachycardia. Matendawa amachitika modekha komanso osangalala. Kutalikirana kwa mgwirizano kumayambira makumi asanu ndi anayi mpaka zana limodzi mphambu makumi awiri pamphindi. Muzovuta kwambiri, chiwerengerocho chimafika zana limodzi ndi makumi atatu.
Mlingo wamtima suyimira kupuma. Ndi mpweya wakuya, umakhazikika mwa munthu wathanzi. Odwala, kupuma sikusintha. Chizindikiro chimayamba chifukwa chophwanya mitsempha ya parasympathetic yomwe imayambitsa pafupipafupi contractions.

Chipatala chimatenga mayeso ogwira ntchito kuti adziwe matendawa. Amazindikira mkhalidwe wa kuchepa kwamitsempha yama mtima. Matenda a diabetes a neuropathy amathandizidwa ndimankhwala omwe amachepetsa dongosolo lazachifundo.

Mchitidwe wamanjenje umakhala ndi dongosolo lazomera komanso masanjidwe. Chisomatiki chimagonjera zofuna za anthu. Masamba amagwira ntchito padera, modziyang'anira pawokha ngati ziwalo zamkati.

Mitundu ya matenda ashuga a shuga

Dongosolo lamanjenje la autonomic limagawidwa mu dongosolo lazachifundo komanso parasympathetic. Yoyamba imathandizira pa ntchito ya mtima, yachiwiri imachedwa. Makina onsewa ndi osalala. Ndi matenda a shuga, ma parasympathetic node amavutika. Palibe amene amachepetsa dongosolo lazachifundo. Chifukwa cha izi, tachycardia imachitika.

Kugonjetsedwa kwa dongosolo la parasympathetic kumayambitsa matenda a mtima a ischemic - matenda a mtima. Pali milandu yofooketsa kapena kusowa kwathunthu kwa ululu matendawa. Pali ena opweteka mtima.

Zofunika! Ischemia yopanda zizindikiro zopweteka imapangitsa munthu kukhala ndi moyo wabwino. Ndi tachycardia wokhazikika wa mtima, funsani dokotala mwachangu kuti muchepetse kukula kwa mitsempha.

Kusintha mtundu wa parasympathetic, ntchito zimachitika. Pochita opaleshoni, kuyambitsa mankhwala a narcotic m'thupi ndikofunikira. Ndi matenda a shuga, mankhwalawa ndi owopsa. Kumangidwa kwa mtima ndi kufa mwadzidzidzi. Kupewa ndi ntchito yayikulu ya madotolo.

Matenda a shuga a myocardial dystrophy

Myocardial dystrophy mu shuga ndi kusokonezeka kwa kugunda kwa mtima. Metabolism imasokonezeka chifukwa cha shuga osakwanira mu minofu ya mtima. Myocardium imalandira mphamvu posinthana ndi mafuta acids. Selo imalephera kuphatikiza asidi, zomwe zimapangitsa kuchuluka kwa mafuta mu cell. Ndi matenda a ischemic ndi myocardial dystrophy, mavuto amabuka.

Zotsatira zam'mnyewa wam'mnyewa wamatsenga, kuwonongeka kumachitika m'matumbo ang'onoang'ono omwe amadyetsa mtima, omwe amaphwanya mzere wamtima. Chithandizo cha matenda a mtima odwala matenda ashuga chimayamba ndi matenda a shuga. Popanda izi, kupewa mavuto sikungatheke.

Myocardial infaration

Matenda a Coronary ndiowopsa kwa odwala matenda ashuga. Amayambitsa matenda amtima womwe umabweretsa imfa. Myocardial infaration ndi imodzi mwamawopsa. Ili ndi mawonekedwe.

Ululu, wokhala ndi matenda ashuga, oyambitsidwa m'nsagwada, mapesi amkati mwa clavicle ndi khosi, sasunthika mothandizidwa ndi mankhwala. Ndi infrction ya myocardial, mapiritsi samathandiza.
Kupumira koyambitsidwa ndi nseru yachilendo. Ndiosavuta kusiyanitsa ndi poyizoni wa chakudya.
Kupweteka pachifuwa kwa mphamvu zachilendo.
Kugunda kwa mtima kumasiyanasiyana.
Pulmonary edema.

Odwala samwalira ndi matenda ashuga, koma matenda oyambitsidwa ndi iwo. Nthawi zina anthu amadwala matendawa chifukwa cha vuto la mtima. Amayambitsidwa ndi shuga wambiri wamagazi, omwe amapangidwa chifukwa chapanthawi yovuta.Zinthu za mahormoni zimatulutsidwa m'mitsempha yamagazi, zomwe zimayambitsa kuphwanya kwa kagayidwe kazakudya, kamene kamayambitsa kusungika kwathunthu kwa insulin.

Angina pectoris

Angina pectoris akuwonetsedwa mu mawonekedwe ofooka amthupi, kupuma movutikira, thukuta lomwe limawonjezeka, kumverera kwa palpitations. Mankhwala, ndikofunikira kudziwa mawonekedwe a matendawa.

Angina pectoris amayamba chifukwa cha matenda ashuga, koma ndi matenda a mtima omwe amakhala nawo kwa nthawi yayitali.
Anthu odwala matenda ashuga amatenga liwongo kwambiri ngati anthu omwe ali ndi shuga.
Anthu odwala matenda ashuga samva kupweteka chifukwa cha angina pectoris, mosiyana ndi anthu athanzi.
Mtima umayamba kugwira ntchito molakwika, osayang'anira mtundu wamba.

Pomaliza

Matenda a shuga ndi matenda oopsa omwe amachititsa kuti mtima wake usamayende bwino. Ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga m'magazi kuti mupewe kupangika kwa matenda a mtima. Matenda ambiri alibe zizindikiro, ndikofunikira kuti adokotala azimuyendera pafupipafupi.

Dzina langa ndine Andrey, ndakhala ndikudwala matenda ashuga kwa zaka zoposa 35. Zikomo chifukwa chakuyendera tsamba langa. Diabei za kuthandiza anthu odwala matenda ashuga.

Ndimalemba nkhani zokhudzana ndi matenda osiyanasiyana ndipo ndimalangiza pandekha anthu aku Moscow omwe amafunikira thandizo, chifukwa pazaka zambiri zapitazi ndawona zinthu zambiri kuchokera pazomwe ndakumana nazo, ndayesera njira zambiri ndi mankhwala. Chaka chino cha 2019, ukadaulo ukupanga kwambiri, anthu samadziwa za zinthu zambiri zomwe zidapangidwa pakalipano kuti akhale ndi moyo wabwino kwa odwala matenda ashuga, motero ndidapeza cholinga changa ndikuthandizira anthu omwe ali ndi matenda ashuga, momwe angathere, kukhala osavuta komanso osangalala.