Kutsimikizira mphamvu ya mankhwala a Milgamm compositum mu matenda ashuga ndi mowa wambiri

R.A. MANUSHAROVA, MD, pulofesa, D.I. CHERKEZOV

Dipatimenti ya Endocrinology ndi Diabetes ndi njira ya opaleshoni ya endocrine

GOU DPO RMA PO Unduna wa Zaumoyo, Moscow, Russia

Odwala matenda ashuga Matenda a mtima ndiwofala kwambiri kuposa anthu opanda shuga. Komabe, kukhalabe khola kuchuluka kwa shuga komanso kupewa / kuchirikiza koyambirira kumathandizira kuchepetsa kufa ndi kukonza moyo wabwino odwala matenda ashuga. Ndi chiwonjezeko cha matenda ashuga, kuchuluka kwa zovuta zam'magazi kumawonjezeka. Titha kuyerekezera kuti kufalikira kwa matenda ashuga, komwe kumawonedwa pakadali pano, gawo la zovuta za cellvasel lidzakulanso mtsogolo. Pafupipafupi mwadzidzidzi zinthu zazing'onoting'ono monga mitsemphazimasiyana kwambiri kutengera njira zodziwira matenda. Chifukwa chake, kuchuluka kwa neuropathy mukamaganizira za matenda azachipatala ndi 25% yokha, ndipo pochita kafukufuku wa electromyographic, amapezeka pafupifupi mwa odwala onse omwe ali ndi matenda osokoneza bongo.

Matenda a shuga Amachepetsa kwambiri moyo wa odwala ndipo ndiwopseza chitukuko cha zilonda zam'mapazi, gangrene. Chifukwa chake, kudziwika kwakanthawi ndiku mankhwalawa a matenda a shuga a polyneuropathy.

Mchitidwe wamanjenje waumunthu umakhala ndi chapakati, zotumphukira komanso zotha kuchita mantha. Mphamvu yamkati imakhala ndi ubongo ndi msana. Dongosolo lamanjenje la peripheral limapangidwa ndi ulusi wamitsempha womwe umapita kumadera akumtunda komanso otsika, thunthu, mutu. Mu matenda a shuga mellitus, makamaka kuwonongeka kwa zotumphukira zamitsempha kumachitika, chifukwa chake kuphatikizika uku kumadziwika kuti zotumphukira polyneuropathy. Nthawi zambiri, ndi matenda a shuga a polyneuropathy, mitsempha yovuta imakhudzidwa. Odwala amakhudzidwa ndi kuluma, dzanzi, kuzizira kwamapazi kapena kumva kuwawa, kupweteka m'miyendo. Kwa zaka zingapo, zochitika izi zimadziwika kwambiri pakupumula, kusokoneza kugona tulo, ndipo pambuyo pake timaganiza mosalekeza.

Kale kumayambiriro kwa kuwonekera kwa kupangika kumeneku, nthawi zambiri zimakhala zotheka kuzindikira kuchepa kwa chidwi (kupweteka, kutentha, kutentha, kugwedezeka) kwamtundu wa "masokosi" ndi "magolovu", kufooka kwa mawonekedwe, komanso kusokonezeka kwa magalimoto. Zowawa zake zimakhala zowawa, zoyaka, zamagulu. Nthawi zambiri ululu umakhala ndi nkhawa, kugona mokwanira komanso kusowa kudya. Kupweteka kumeneku kumathandizira kulimbikira, mosiyana ndi zowawa zowonongeka ndi ziwiya zotumphukira.

Zosokoneza zowoneka pang'onopang'ono zimayamba kufalikira kuchokera ku miyendo ya distal kupita pa proximal, ndiye kuti manja nawonso amatenga nawo mbali. Mitsempha ya zotumphukira ikakhudzidwa ndi odwala matenda a shuga, mayendedwe a axon amakhala ndi vuto lalikulu, lomwe limachitika ndi axoplasmic yomwe pano yokhala ndi zinthu zingapo zofunika pakugwira ntchito kwa minyewa ya m'mitsempha ndi minofu kuwongolera kuchokera ku motor neuron kupita ku minofu ndi mosemphanitsa. Axonopathies amakonda kuchepa ndi kupita patsogolo pang'onopang'ono kwa njira za pathological. Kubwezeretsanso kwa ntchito ya mitsempha yotumphuka yomwe ili ndi ma axonopathies amitundu yosiyanasiyana imachitika pang'onopang'ono komanso pang'ono, monga gawo la ma axon limamwalira kwathunthu.

Vuto lowopsa la DPN ndichilonda cham'mimba chakumiyendo, zifukwa zikuluzikulu zopangidwira komwe ndiko kuchepa kwa mphamvu ya kupweteka ndi microtrauma ya khungu.

Kuwonekera pakati pa chosinthika ndi chowonjezera chakumapeto kumachepetsa ntchito ya "kakang'ono" minofu ya phazi, yomwe imatsogolera pakusintha kwamangidwe a phazi ndikupanga kusintha kwa phazi. Pankhaniyi, magawo a kuchuluka kwazomwe zimabweretsa zimawonekera m'malo ena a plantar. Kupanikizika kosalekeza m'malo awa kumayendera limodzi ndi kutukusira kwa minofu yofewa ndikupanga zilonda zamapazi. Poyerekeza ndi kuchepa kwa kuchepa kwa chidwi cha kupweteka komanso chizolowezi chomanga mafupa, komanso kuchuluka kwa magazi, zomwe zimapangitsa kuti mafupa ayambenso kudwala matenda a shuga, microtrauma ingapangitse kuti mafupa awonongeke komanso kuwonongeka kwa mafupa. Phazi lopindika, gait amasintha. Kuphwanya kwamchiberekero cha minofu kumapangitsa kuti chiwonetsero cha zilonda zam'mimba chizipezekanso.

Njira yayitali yothandizira odwala matenda ashuga imaphatikizapo njira za pathogenetic ndi chizindikiro. Mankhwala othandiza kwambiri omwe ali ndi zovuta zonse za pathogenetic komanso zodziwika bwino amaphatikiza mavitamini a B - thiamine ndi pyridoxine - mu milingo yayitali, yomwe imapangitsa njira zoyendetsera zokoka za axon.

Mavitamini a gulu B omwe ali mu Mlingo wambiri amakhala ndi zotsatira zambiri za metabolic ndi matenda, chifukwa chake amagwiritsidwa ntchito pachikhalidwe cha matenda ashuga a polyneuropathy ndi osachiritsika amtundu wina. Thiamine (Vitamini B1) monga coenzyme wa dehydrogenase complexes ya kayendedwe ka Krebs amawongolera kuzungulira kwa pentose phosphate, potero amawongolera machitidwe ogwiritsira ntchito shuga.

Pozama kwambiri, thiamine amatha kuchepetsa njira za pathobiochemical glycation, zomwe ndizofunikira kwa odwala omwe ali ndi matenda osokoneza bongo. Thiamine ali ndi vuto la neurotropic potenga nawo gawo pa kulowetsedwa kwa mitsempha, kayendedwe ka axonal, pakukonzanso minofu ya mitsempha, kusinthanitsa kwa kufalikira kwa mitsempha mu n-cholinergic receptors.

Benfotiamine

Mankhwala apadera a lipophilic okhala ndi ntchito yofanana ndi thiamin ndi mankhwala othandiza komanso opatsa chidwi mosamala pafupifupi 100% bioavailability. Madzi osungunuka a thiamine m'magawo a thupi amatengedwa ndi mayendedwe okhudzana ndi sodium. Pakakhala chidwi chachikulu m'matumbo, njira imeneyi imatha, ndipo kuyamwa kwamphamvu sikugwira ntchito. Kuyamwa kwambiri kwa thiamine sikupitirira 10%. Munetics ya benfotiamine imasiyana kwambiri. Ikamamwa m'matumbo am'mimba, palibe njira yodzikongoletsera. The bioavailability ya mankhwalawa ndi 8-10 peresenti kuposa ya thiamine, nthawi yofika kwambiri yozungulira imakhala 2 times, pafupifupi ndende ya benfotiamine m'magazi imasungidwa nthawi yayitali, zomwe zimapangitsa kuchuluka kwa mankhwalawa m'maselo.

Thupi limakhala ndi poizoni wochepa. Kafukufuku wokhudza kuwopsa kwa benfotiamine mu Mlingo wa 100 mg / kg kulemera kwa thupi (m'magazi) adawonetsera kuleza mtima kwa mankhwalawa komanso kusapezeka kwa kusiyana kwakukulu poyerekeza ndi kuwongolera. Mukamagwiritsa ntchito mankhwalawa muyezo wowerengeka, palibe zotsatira zoyipa. Zisonyezero zakugwiritsidwa ntchito kwa benfotiamine mu kapangidwe ka mankhwala a Milgamma compositum ndi ma polyneuropathies chifukwa cha matenda osokoneza bongo a shuga ndi kuchepa kwa vitamini B1.

Pyridoxine (Vitamini B6)

Fomu yogwira thupi - pyridoxalphosphate, ili ndi coenzyme komanso metabolic. Pokhala coenzyme, pyridoxal phosphate imagwira ntchito yofunika kwambiri pakukula kwa ma amino acid angapo, makamaka tryptophan, sulfure wokhala ndi amino acid ndi hydroxy amino acid, ndipo imakhala yofunika kwambiri kwa odwala matenda a shuga. Pyridoxalphosphate amakhudzidwa ndi kaphatikizidwe ka oyimira pakati - makatekolamaines, histamine, aminobutyric acid, omwe amatsogolera kukhathamiritsa kwamanjenje.

Pyridoxine imawonjezeranso mphamvu zama magnesium mkati mwa khungu, chomwe ndi chinthu chofunikira kwambiri cha metabolic chomwe chimakhudzidwa ndi kayendedwe kazinthu zamagetsi ndi zochita zamanjenje, zimakhala ndi zovuta, ndipo zimagwira nawo ntchito ya hematopoiesis. The mayamwidwe pyridoxine m'mimba thirakiti alibe machulukitsidwe, chifukwa chake kuyika kwa magazi kumatengera zomwe zili m'matumbo. Pyridoxalphosphate imatengedwa mwachangu kuchokera kumimba, yomwe imatuluka kudzera impso. Imalowa mkati mwa chotchinga ndikuyamwa mkaka wa m'mawere.

Coenzyme Vitamini B6

Ili ndi kagayidwe kachakudya, imachepetsa kuchuluka kwa mafuta m'thupi ndi lipids, imachulukitsa kuchuluka kwa glycogen mu chiwindi, imasintha bwino katundu wake, imathandizira kagayidwe ka histamine. Imapangitsa kagayidwe kachakudya pakhungu ndi mucous nembanemba.

Pyridoxalphosphate nthawi zambiri imalekeredwa. Thupi lawo siligwirizana, kuchuluka acidity wa chapamimba madzi ndizotheka.

Mankhwalawa a matenda a shuga a polyneuropathy, amodzi mwa mankhwala abwino kwambiri ndi Milgamma compositum, yomwe imaphatikizapo 100 mg ya benfotiamine ndi 100 mg ya pyridoxine. Mankhwala amapezeka mu mawonekedwe a dragees, omwe amalimbikitsanso pamene akutenga komanso osagwirizana ndi zigawo zikuluzikulu. Chifukwa cha kusungunuka kwamafuta, benfotiamine imakhala ndi bioavailability yokwanira 8-10 poyerekeza ndi mchere wosungunuka wa thiamine. Ndi mkamwa makonzedwe, mulingo wa benfotiamine mu madzi a cerebrospinal amafika pazabwino zomwe zimatheka pokhapokha ndi kholo la parenteral la madzi osungunuka a thiamine. Benfotiamine imayambitsa kugwira ntchito kwa transketolase detoxifying enzyme, komwe kumayambitsa zoletsa zomwe zimayambitsidwa ndi hypergikemia ya metabolic methicsms, monga hexosamine njira. Milgamm compositum imatengedwa pakamwa pa mlingo wa 150- 900 mg patsiku, yonse monga monotherapy komanso kuphatikiza mankhwala ena.

Kuphatikiza pa mankhwala omwe adatchulidwa a DPN, njira yothetsera jakisoni wa Milgamma imagwiritsidwa ntchito, yomwe ili ndi mankhwala a mavitamini a B komanso mankhwala ena osokoneza bongo a lidocaine:

- Thiamine hydrochloride - 100 mg.

- Pyridoxine hydrochloride - 100 mg.

- Cyanocobalamin hydrochloride - 1000 mg.

- Lidocaine - 20 mg.

Mankhwala ali ndi analgesic kwenikweni, amasintha magazi ndipo amalimbikitsa kukonzanso kwamanjenje. Mavitamini B okhala ndi mlingo waukulu omwe akuphatikizidwa pokonzekera, monga tafotokozera pamwambapa, amathandizira matenda opatsirana a m'mitsempha ndi zida zamagetsi. Mlingo wambiri, mphamvu ya analgesic imawonetsedwa bwino, ntchito ya mitsempha ndi njira ya hematopoiesis imakhala yofanana. Ndikofunika kudziwa kuti kupezeka kwa lidocaine komanso kochepa ka njira yovulazidwayo kumapangitsa kuti jakisoniyo asamve kuwawa, zomwe zimapangitsa kuti wodwalayo azitsatira pomupatsa chithandizo.

Milgamm ndi Milgamma compositum akukonzekera matenda amanjenje amachokera kumayendedwe osiyanasiyana:

- Neuropathy (matenda ashuga, mowa, etc.),

- Neuritis ndi polyneuritis, kuphatikizapo retobulbar neuritis,

- Peripheral paresis (kuphatikizapo mitsempha ya nkhope),

- Neuralgia, incl. Mitsempha itatu

Mankhwala sangathe kumwedwa ndi mitundu yayikulu komanso yowopsa ya mtima wosakhazikika, munthawi ya neonatal komanso ndi hypersensitivity kwa mankhwalawa.

Chithandizo cha matenda a shuga a m'magazi ndi monga:

- Kubwezeretsa shuga mellitus (kukulitsa mphamvu ya shuga).

- Pathogenetic chithandizo cha mitsempha yowonongeka (Kukonzekera kwa Milgamm mu mawonekedwe a jakisoni ndi kaphatikizidwe ka Milgamm mu mawonekedwe a mapiritsi a pakamwa pakamwa kapena a-lipoic acid kukonzekera + Milgamm compositum).

- Chizindikiro chothandizira kupweteka.

Sachse G. ndi Reiners K. (2008) amalimbikitsa chithandizo chokwanira cha matenda ashuga a mtima monga:

Gawo lachitatu

Kuphatikiza mankhwala (thioctic acid + benfotiamine):

- Thiogamm - kudzera mu mtsempha wa magazi, mumagwiritsa ntchito 600 mg patsiku

- Milgamma compositum - piritsi 1 katatu patsiku

- Mankhwala awiri kwa milungu 4-6.

Maphunziro ambiri azachipatala akunja komanso apanyumba amatsimikizira kuyendetsa bwino komanso chitetezo cha Milgamm ndi Milgamm compositum pochiza matenda a shuga.

Pantchito yathu, tidagwiritsa ntchito njira yoyamba yothandizira odwala 20 odwala matenda ashuga a m'mimba (Milgamma 10, kenaka Milgamm compositum kwa masabata 6) ndikuwona mawonekedwe osangalatsa a chithunzi cha chipatala cha DPN, chomwe chimaphatikizidwa ndi chizolowezi chowongolera maginito a electrophysiological. Malinga ndi mabukuwa, kugwiritsa ntchito mphamvu ya Milgamma compositum kunadziwikanso mu mtima neuropathy odwala matenda a shuga a mellitus.

Tidawona odwala 20 omwe ali ndi matenda ashuga a 2, pafupifupi odwala anali ndi zaka 58, kutalika kwa matenda ashuga anali zaka 9, ndipo kutalika kwa mitsempha anali zaka zitatu.

Odwala onse omwe timawawona anali ndi vuto la matenda a shuga a m'mitsempha. Mwa odwala 7, Zizindikiro zake zinali zowopsa, ndipo mwa odwala omwe adatsalira, zizindikiro za matenda ashuga polyneuropathy anali odziletsa. Mlandu woyamba, chithandizo chinayambika ndi jakisoni wa Milgamma 2 ml tsiku ndi tsiku (majekeseni 10), kenako ndikusinthidwa kukamwa kwa Milgamma compositum 1 piritsi 3 katatu patsiku kwa masabata osachepera 4-6. Odwala omwe ali ndi zodziwika bwino za DPN, chithandizo chinachitika ndi piritsi la Milgamma 1 katatu patsiku kwa masabata a 4-6. Njira zamankhwala izi sizothandiza komanso osati zolemetsa kwa wodwala ndi banja lake, komanso zotsika mtengo, chifukwa sizifunikira kuchipatala, zomwe zimachepetsa mtengo wamankhwala. Pofuna kupewa kubwereranso ku DPN, maphunziro obwereza mobwerezabwereza adachitika miyezi isanu ndi umodzi ndi umodzi kuchokera koyambirira kotsutsana ndi maziko a kubwezeretsedwa kwakukulu kwa metabolic.

Zotsatira zamankhwala, kuchepa kwa chidwi cha kupweteka komanso kusinthasintha kwakukwaniritsa zizindikiritso zina zonse zidatheka. matenda ashuga polyneuropathy ambiri (mwa 17) odwala. Kupweteka kwapakati tsiku ndi tsiku kunachepa ndi 60-70%, ndipo kunapezeka kuti kugwiritsa ntchito kwa Milgamma ndi Milgamm compositum kunayambika mwachangu - masabata awiri atangoyamba kumene chithandizo. Mukumwa mankhwalawo mosakaniza (jakisoni ndi mankhwala amkamwa), zizindikiro zotsatirazi zidachepa: kuwotcha, kuwombera ndi kupweteka. Mu gulu la odwala omwe zowawa za usiku zimadziwika, kuchepa kwa mphamvu yawo kudadziwika. Ululu wa usiku ndizomwe zimayambitsa kuchepa kwa moyo wa odwala, chifukwa chake, atalandira chithandizo, odwala amakhala ndi kusintha kwa moyo chifukwa chakuchepa kwa nthawi masana makamaka kupweteka kwamadzulo. Zotsatira za mankhwala a Milgamm compositum zidachulukirachulukira nthawi yonse ya chithandizo, chomwe chidatenga milungu 4-6.

Kafukufukuyu adawonetsa kuti Milgamma ali ndi kulolera bwino komanso chitetezo. Zotsatira zoyipa zimawonedwa kumayambiriro kwa mankhwalawa makamaka mawonekedwe a nseru, chizungulire. Zotsatira zake zinali zofatsa kapena zolimbitsa thupi ndipo zimakonda kufooka kapena kuzimiririka patatha masiku 10 atamwa mankhwalawo.

Chifukwa chake, polyneuropathy mu shuga mellitus ndi zovuta ndipo imachitika makamaka chifukwa cha kusokonezeka kwamitsempha yamagetsi. Kupita patsogolo pakuphunzira pathogenesis kumatsegula mwayi watsopano wofunafuna mankhwala omwe amakhudza mwachindunji njira zopangira matenda a DPN, zomwe zimaphatikiza Milgamma ndi Milgamma compositum, ndizovuta zake zomwe zimapangitsa kuti magazi azikhala bwino, kulimbikitsa kukonzanso kwa minyewa yamitsempha, ndikuwonjezera kuthamanga kwa mitsempha ndikuwonetsa .Mankhwala amakhala ndi gawo lofunikira pa matenda a diabetesic neuropathy.