Chithandizo cha atherosulinosis obliterans a m'munsi malekezero

Kuthandiza odwala omwe ali ndi matenda osokoneza bongo ndi ntchito yovuta kwambiri. Itha kuchitika pang'onopang'ono, koma kulondola kwazindikiritso, kutsimikiza kwa gawo ndi kuchuluka kwa zowonongeka ndikofunikira, chifukwa si chipatala chilichonse chomwe chili ndi mikhalidwe yoyenera. Mwakutero, lingaliro lopanga malo opangira opaleshoni ya mtima linakhazikitsidwa. Tsopano m'chigawo chilichonse komanso m'mizinda yayikulu yamafakitale pali dipatimenti yochita ndi gulu la odwala. Palinso funso lofuna kusiyanitsa pakati pama dipatimenti ndi mtundu wa matenda, i.e. kupanga madipatimenti a phlebology ndi pathological arterial.

Njira zoposa mazana asanu ndi limodzi zakhala zikufunsidwa kuti zithandizire odwala omwe atha kuthana ndi matenda osokoneza bongo. Popita zaka 30 mpaka 40, pali mankhwala osiyanasiyana omwe agwiritsidwa ntchito: kuchokera kumadzi osungunuka kupita kumagazi osakhala a gulu, kuchokera ku streptocide kupita ku corticosteroids ndi kutembenuka. Tsopano, asayansi padziko lonse lapansi abvomereza kuti sipangakhale mankhwala amodzi ochizira matenda obalalitsa. Kutengera polyetiology ya matendawa, chithandizo chiyenera kukhala chokwanira. Palibe njira imodzi yodzithandizira yomwe amati ndi pathogenetic imatha kukhala yachilengedwe chonse, monga momwe sizingatheke pompano kufotokoza tanthauzo la matendawo ndi chinthu chimodzi. Choyamba, chithandizo chikuyenera kukhala ndi cholinga chothana ndi zowononga zachilengedwe (ntchito ndi kupumula, moyo wabwinobwino, kuletsa kusuta, kudya mokwanira, kuthetsa kupsinjika, kuziziritsa, ndi zina). Popereka mankhwala, mitundu ya dyslipidemia (malinga ndi gulu la WHO) iyenera kuganiziridwa.

Mwa mtundu woyamba, kuchuluka kochepa kwa cholesterol, kuchuluka kwa triglycerides, kuchuluka kwa cholesterol ya LDL, kuchuluka kwa chylomicron kumaonekera m'madzi a m'magazi.

II A Mtundu - wabwinobwino kapena wokwezeka wa cholesterol yathunthu, mulingo wabwinobwino wa triglycerides, kuchuluka kovomerezeka mu mulingo wa cholesterol ya LDL.

Type II B - kuchuluka kwa triglycerides, kuchuluka kwa LDL cholesterol ndi VLDL cholesterol.

Mtundu Wachitatu - zosintha ndizofanana ndi mtundu woyamba I, pali kuwonjezeka kwa zomwe zili ndi cholesterol-lowering steroids (ma dermity density lipoproteins).

Lembani IV - pakhoza kuwonjezeka pang'ono pa cholesterol yathunthu, kuchuluka kwa triglycerides ndi kuchuluka kwa mafuta a VLDL.

Mtundu wa V - cholesterol VLDL yowonjezera ndi chylomicron.

Monga tingaonere kuchokera pamawonekedwe omwe aperekedwa, ma atherogenic kwambiri ndi mitundu ya II A ndi II B ya dyslipidemia.

Chithandizo cha Conservative

Chithandizo cha Conservative chikuyenera kukhala chokwanira, chamunthu, cha nthawi yayitali komanso chofunikira pa zinthu zosiyanasiyana za pathogenesis:

• lipid kagayidwe kachakudya,
• kukopa kwa mapangano ndi kukonza kwa ntchito yawo,
• Kuperewera kwa angiospasm,
• matenda a neurotrophic ndi kagayidwe kachakudya njira mu zimakhala,
• kusintha kwakachulukidwe,
• kusintha kwa mawonekedwe a kusokonekera,
• matenda a chitetezo chamthupi,
• kupewa kukula kwa matenda oyamba,
• kubwezeretsa ndi chizindikiro.

Mankhwala omwe agwiritsidwa ntchito angagawidwe m'magulu otsatirawa:

1. Kukonzekera komwe kumapangitsanso ma cellcircule komanso kukhala ndi ma antiplatelet katundu: otsika komanso sing'anga masentimita kulemera kwa dextrans (reopoliglyukin, reoglyuman, reokhem, reomakrodeks, hemode), pentoxifylline (trental, vasonite, flexital), tiklid, plavica (clopulodexidel) , matamando (xavin, sadamin), theonicol, agapurin, nicotinic acid, enduracin, chimes (Persantine), aspirin (thrombo ace, aspirin Cardio). Trental imayikidwa pa 400-1200 mg patsiku, vasonite - pa 600-1200 mg, tiklid - 250 mg 2 kawiri pa tsiku, kusambira - 75 mg patsiku. Mankhwalawa amatha kuikidwa ndi aspirin. Mlingo wa aspirin wa tsiku ndi tsiku ndi 100-300 mg, malingana ndi momwe matenda aliri ndi kuchuluka kwa mankhwala ogwirizana ndi antiplatelet. Kuphatikiza kwa aspirin ndi ticlide sikuli koyenera chifukwa cha kutuluka kwa magazi. Sulodexide imayendetsedwa intramuscularly pa 600 LU (2 ml) 2 pa tsiku kwa masiku 10-24, kenako mkati mwa makapisozi a 250 LU 2 kawiri pa tsiku kwa masiku 30-70.

2. Mankhwala a metabolic (yambitsa njira ya reticuloendothelial ndi ma oxidative mu minofu): jekeseni 8-10 ml ya salcoseryl kapena actovegin mu njira yothandizira mwakuthupi kudzera mu intraarterally, kapena okonzeka kupanga actovegin ya 250-500 ml kudzera masiku 10-20.

3. Mavitamini: ascorbic acid imasintha kagayidwe kazakudya mu minofu, imalimbitsa chitetezo chathupi, vitamini B, akuwonetsedwa chifukwa cha ischemic neuritis ndi trophic matenda, vitamini B₂ imathandizira njira zosinthira, mavitamini B₆ ndi B₁₂ zimakhudza kagayidwe ka magazi phospholipids, nicotinic acid ndi zotumphukira zake zili ndi antiaggregant ndi antiatherogenic katundu ndikusintha ma cellcirculation, mavitamini A ndi E ndi ma antioxidants amphamvu, Vitamini F amathandizira kugwiranso ntchito kwa maselo a endocrine, kumathandizira kupezeka kwa maselo, ziwalo ndi minyewa. m'mitsempha.

4. Angioprotectors (yambitsa intravascular lysis ndikutchingira thrombosis, muchepetse kuchuluka kwa zotupa za mtima ndikulephera kuyimitsidwa kwa lipids mu khoma la chotengera): doxium, vasolastine, parmidin (prodectin, anginin), tanakan, liparoid-200. Parmidin amatchulidwa piritsi limodzi katatu pa tsiku (750-1500 mg) kwa miyezi 6-12. Mu matenda a shuga a shuga, ndikofunikira kupangira Doxium 0,25 g katatu pa tsiku kapena 0,5 g 2 kawiri pa tsiku kwa masabata 3-4, ndiye kuti piritsi 1 patsiku kwa nthawi yayitali, kutengera momwe matenda aliri.

5. Mankhwala ochepetsa anti-atherogenic kapena lipid-kuchepetsa: ma statins ndi ma fiber. Statins: cholestyramine, leskol (fluvastatin), lipostabil, lipanor, lipostat (pravastatin), lovastatin (mevacor), simvastatin (okuseor, vasilip), choletar. Anti-atherogenic katundu amakhala ndi kukonzekera kwa adyo (allicor, alisate), carinate, betinate, enduracin yokhala ndi 500 mg ya nicotinic acid (ziletsa biosynthesis ya cholesterol ndi triglycerides). Statins imayendetsa tizigawo ta lipid, kuchepetsa kuchuluka kwa LDL cholesterol, cholesterol VLDL ndi triglycerides (TG) ndikukulitsa cholesterol ya HDL, kubwezeretsa ntchito yofananira ya endothelial, potero kumathandizira kuyankha kwachilendo kwa mitsempha yamitsempha yam'mimba, kumakhala ndi zotsutsana ndi kutupa ndi aseptic komanso kutupa, lekani postoperative thrombocytosis, yomwe imalosera zovuta za thrombotic. Fibrate: bezafibrate (besalip), gemfibrozil (gevilon), fenofibrate (lipantil), michenized fenofibrate (lipantil 200 M), ciprofibrate. Ma Fabulates ali ndi mphamvu yotsika kwambiri ya lipid kuposa ma statins pa triglycerides; amatha kuonjezera kachidutswa ka cholesterol ya anti-atherogenic HDL. Ma Statin ndi ma fibrate ndi othandiza kwambiri makamaka ku generlipidemia yoyambira. Komabe, kukhazikitsidwa kwa ndalamazi kumafuna kuti adokotala adziwe zovuta zapadera za lipidology ya zamankhwala komanso zoyambira pakuphatikizidwa kwa mankhwala. Mwachitsanzo, ma statins sayenera kugwiritsidwa ntchito limodzi ndi fibrate ndi nicotinic acid, chifukwa kuphatikiza kwawo pamodzi kungayambitse myositis. Kugwiritsa ntchito ma statins onse kumayambira ndi mlingo wocheperako. Kutsitsa kwa lipid kumawonekera kwathunthu patatha milungu isanu ndi umodzi, chifukwa chake, kusinthaku kwa mankhwalawa kuyenera kuchitika osati koyambirira kuposa milungu 4. Ndi kuchepa kwa cholesterol yonse pansipa 3.6 mmol / L kapena LDL cholesterol pansi 1.94 mmol / L, mlingo wa statin ungachepe. Ma statin onse amagwiritsidwa ntchito kamodzi patsiku, usiku mutadya. Mlingo wa ma fiber komanso momwe amagwiritsidwira ntchito ndizosiyanasiyana kwa aliyense. Kukonzekera kwa mankhwala a atherogenic dyslipidemia kuyenera kuchitika kwa nthawi yayitali. Kwa odwala ambiri - moyo wonse.

6. Ma antioxidants amagwira ntchito yofunika kwambiri pakuchiza matenda a atherosulinosis mwa kuwongolera lipid peroxidation (LPO). Izi zikuphatikiza mavitamini A, E, C, dalargin, cytochrome c, preductal, emoxipin, neoton, probucol. Woimira ambiri pagululi ndi vitamini E (alpha-tocopherol acetate), pa mlingo wa 400-600 mg / tsiku, ali ndi zotsatira zochizira zomwe zimagwirizanitsidwa ndi hypocoagulation, kuchuluka kwa fibrinolysis ndikusintha kwachuma chamagazi, kuletsa njira za oxidation ndikuyambitsa dongosolo la antioxidant. Pakadali pano, othandizira pakudya ndi antioxidant katundu adapangidwa ndikuyambitsa ntchito zamankhwala: kukonzekera kochokera ku omega-3-poly-unsaturated fat acids (eikonol, dokanol), kukonzekera kwa nyanja kale (clamin), sewoka (splat, spirulina), masamba mafuta (mafuta a viburnum, sea buckthorn).

7. Antispasmodics (papaverine, no-shpa, nikoshpan) angathe kupatsidwa magawo I ndi II a matendawa, pakabuka kuphipha.

8. Ma anticoagulants amodzi mwachindunji komanso osawerengeka amaperekedwa malinga ndi mawonekedwe omwe ali ndi vuto lalikulu.

9. Gulu lina liyenera kuphatikiza vazaprostan (prostaglandin E,). Mankhwala ali ndi antiaggregant katundu, amakulitsa kuthamanga kwa magazi ndikukulitsa mitsempha yam'magazi, kutsegula ma fibrinolysis, kusintha kukoka kwamatenda, kubwezeretsa kagayidwe kachakudya ka michere ya ischemic, kumalepheretsa kutseguka kwa neutrophils, potero kuteteza zotsatira za kuwonongeka kwa minofu, ndipo kumakhala ndi vuto lothana ndi vuto. Vazaprostan akuwonetsedwa kuti akupanga zotupa za miyendo yamipendo. Imaperekedwa kudzera m'mitsempha ya 20-60 μg kapena kuwonjezeka kwa 100-200 ml ya yankho la 0.9% NaCl tsiku lililonse kapena tsiku lililonse. Nthawi yoyambitsa ndi maola 2-3. Kutalika kwa maphunzirowa ndi masabata 2-4. Mankhwalawa amadziwika ndi kuwonjezeka kwa achire, komwe kumatha kupitilira sabata limodzi mpaka awiri atatha. Zotsatira zimatha kuyang'idwa chaka chonse.

Chofunikira ndikusankhidwa kwa mankhwala ndi momwe amagwiritsidwira ntchito mwatsatanetsatane poyesa momwe mankhwala ena amathandizira. Pulogalamu yoyenera yovomerezeka pazotsatira: Prodectin + trental, prodectin + ticlide, prodectin + plavica, prodectin + aspirin, plavica + aspirin, vasonite + prodectin, trental + aspirin, sodeodeide, etc. ndi kuwonjezera pazinthu zonse za anti-atherogenic mankhwala. Ndikofunika kusinthanitsa izi kapena mitundu ina ya mankhwalawa pakapita miyezi iwiri iliyonse. M'magawo aposachedwa komanso kuchipatala, pafupifupi njira zotsatirazi zimagwiritsidwa ntchito: mtsempha wa magazi kulowetsedwa 400 ml + trental 5-10 ml + nicotinic acid 4-6 ml kapena kutsata 4-6 ml, solcoseryl kapena actovegin 10 ml pa 200 ml ya saline, mu kwa masiku 10-15 kapena kupitirira apo. Mankhwala onse omwe ali pamwambapa amalipira chithandizo cha mankhwalawa. Mankhwala othandizira komanso othandizira matenda ofananira amakakamizidwa ndipo sayenera kukambirana.

Barotherapy (hyperbaric oxygenation - HBO) imawongolera momwe mpweya umaperekera minyewa pakupanga kukhumudwa kwambiri kwa okosijeni m'matipi ndikuwonjezera kuchuluka kwa mpweya womwe umadutsa minofu miniti imodzi. Kuthekera kwakukulu koperekera kuchuluka kwa okosijeni kumisempha yokhala ndi magazi ochepa otaya kumapangitsa HBO kukhala pathogenetic komanso njira yolondola kwambiri polimbana ndi minofu yachigawo. Zotsatira zimatengera mkhalidwe wa hemodynamics wapakati. Chizindikiro cha kusinthika kwa kuperekera kwa okisijeni minofu itatha HBO ndikuwonjezereka kwa magawo apakati komanso m'chigawo chapakati cha magazi (V.I. Pakhomov, 1985). Ndi kutulutsa kwamtima kochepa, mosasamala kanthu ndi kusintha kwa kayendedwe ka magazi am'deralo, kayendedwe ka okosijeni sikothandiza kwambiri. Sindinapeze zofalitsa zambiri pompopompo pogwiritsa ntchito zida za Kravchenko ndi Shpilt.

Njira ya ultraviolet yolowetsa magazi (UV) imafala, yoyambitsidwa ndi dokotala wa opaleshoni waku Czech ku 1934, adagwiritsa ntchito peritonitis. Mphamvu yachilengedwe ya UV rays ili m'kusintha kwa munthu yemwe amakhala nthawi zonse mikhalidwe ya dzuwa. Zotsatira zabwino za UFO pakuwononga matenda am'mitsempha zidakhazikitsidwa koyamba mu 1936 ndi Kulenkampf. UFO malinga ndi njira yachikhalidwe ya Knott imachitidwa motere: 3 ml ya magazi pa kilogalamu imodzi ya kulemera kwa thupi la wodwalayo amatengedwa kuchokera m'mitsempha. Mwazi umadutsa kupyola mu kachipangizo kokhala ndi gwero la nyali ya UV-mercury-quartz yokhala ndi mafunde a 200-400 nm. Chezani magawo 5-7 ndi gawo la masiku 2-6. Mwazi wa UFO uli ndi bactericidal, immunocorging ndi zolimbikitsa dongosolo lamagazi.

Njira ya Wisdomner ndi motere: 45 ml ya magazi amatengedwa kuchokera mu mtsempha, wophatikizidwa ndi 5 ml yankho lamadzimadzi a citrate mu quartz cuvette ndikuwotchedwa kwa mphindi 5 ndikuyatsa nyali ya HN 4-6 UV yokhala ndi chiwongolero cha 254 nm ndipo magazi amabwezeretsanso mtsempha wa wodwalayo.

Pali njira yotchedwa hemato native oskidant therapy - GOT (Verlif). Kufanana ndi kukwiya kwa magazi ndi nyali ya xenon yokhala ndi mafunde a 300 nm, imapangidwa ndi mpweya. Kuti izi zitheke, mpweya wabwino umadzazidwa: 300cm 3 mu 1 min kulowa m'mbale ya magazi. Maphunzirowa adatsatiridwa njira 8-12.

Gavlicek (1934) adalongosola momwe mphamvu ya radiation ya ultraviolet imachitikira, yomwe, pobwerera ku thupi, imakhala ngati mankhwala osokoneza bongo. Acidosis imachepa, kukoka kwam'mimba kumakhala bwino, hydrolyte homeostasis yachilengedwe imakhala yofanana.

Ntchito yomwe imagwiritsidwa ntchito ponse ponse mochizira odwala idalandira njira yochotsera. Mpainiyawa wakukhazikitsa njira imeneyi mu 1970 anali wophunzira wa Academy of Medical Science Yu.M. Lopukhin. Mosiyana ndi hemodialysis, pomwe zinthu zosungunuka zamadzi zokha zimachotsedwa, hemosorption imatha kuchotsa pafupifupi poizoni aliyense, chifukwa kumalumikizana ndi magazi ndi sorbent.

Yu.M. Lopukhin mu 1977 akufuna kukhazikitsa hemosorption mu zovuta mankhwala a atherosulinosis ndi cholinga cha decholesterolization. Kuphwanya lipid homeostasis kumachitika chifukwa cha poizoni wa xenobiotic - zinthu zakunja kwa thupi zomwe zimawononga oxidative dongosolo la chiwindi. Kudzikundikira kwa xenobiotic kumachitika muukalamba, ndi kunenepa kwambiri, mwa omwe amasuta fodya. Mosasamala kanthu kuti hypercholesterolemia ndi hyperbeta-lipoproteinemia ndizomwe zimayambitsa atherosulinosis malinga ndi chiphunzitso cha N.N. Anichkova kapena chifukwa cha peroxidation ya lipid peroxidation, dyslipoproteinemia ndi atherosulinosis imachitika. Hemosorption imakonzanso, ndikuchepetsa zomwe zili atherogenic lipoproteins of low (LDL) ndi kachulukidwe kotsika kwambiri (VLDL).

Hemosorption yolowera patatu imachotsa cholesterol kukhoma lamitsempha yamagazi ndi 30% (Yu.M. Lopukhin, Yu.V. Belousov, S.S. Markin), ndipo kwakanthawi kwakonzanso njira ya atherosselotic, kufalikira kwa ma microtcial kumachulukitsa, kusinthana kwa michere kumachulukitsa, kuchuluka kwa kusefa kumachulukitsa kuthekera kwa maselo ofiira am'magazi, kumapangitsa kusintha kwa ma cell.

Pa nthawi yovuta ischemia, kuchuluka kwa poizoni ischemic poizoni, histamine-zinthu, zopangidwa minyewa minye metabolism ndi ma cell necrobiosis kudziunjikira m'thupi. Hemosorption imakuthandizani kuti muchotse albinotoxin, lipazotoxin kuchokera mthupi ndipo amachita masewera olimbitsa thupi. Single hemosorption yokhala ndi SKN-4M sorbent imachepetsa zomwe zimapanga ma immunoglobulins G ndi 30%, kalasi A 20% komanso kalasi M ndi 10%, ma immunocomplexes (CEC) ozungulira amachepetsedwa ndi 40%.

Malinga ndi S.G. Osipova ndi V.N. Titova (1982), adawulula kuti kuwonongeka kwa atherosselotic ku ziwiya zapansi, chitetezo chokwanira. Nthawi yomweyo, maselo a immunocompetent - T-suppressors, omwe ali ndi B-cell activation komanso kuchuluka kwa ma immunoglobulins amakakamizidwa, zomwe zimapangitsa kuwonongeka kowonjezereka kwa mtima wa endothelium.

Mavuto (malinga ndi E.A. Luzhnikov, 1984) amawonekera mu 30-40% ya odwala.Izi ndi monga: kuvulala m'maselo a m'magazi, kudzimana limodzi ndi poizoni wa okosijeni komanso mapuloteni ofunikira amthupi ndi kufufuza zinthu. Pa opaleshoni, hypotension, kuzizira, thrombosis ya dongosolo, embolism yokhala ndi malasha tinthu tating'onoting'ono ndiyotheka (ma cell a 3-33 kukula kwake amapezeka m'mapapu, ndulu, impso, ubongo). Amatsenga abwino kwambiri ndi makala amoto ndi microfilm. Chiwerengero chathunthu cha maselo ofiira amachepetsa, koma mawonekedwe ake amakhala amokwanira. Hypoxemia imayamba, motero, oxygenation imapangidwanso nthawi ya hemoperfusion. Chemation oxygenation imachitidwanso. Amadziwika kuti yankho la 3% ya hydrogen peroxide imakhala ndi 100 cm 3 ya oksijeni, izi ndizokwanira kukwaniritsa 1.5 malita a magazi a venous. E.F. Abuhba (1983) adayambitsa 0.24% yankho la H₂O₂ (250-500 ml) munthambi ya iliac artery ndipo adalandira mpweya wabwino.

Pali ntchito mwachidule zomwe zimapangitsa enterosorption mankhwalawa amathetsa matenda am'munsi. Malangizo a enterosorption ogwiritsidwa ntchito:

• ma carb osadziwika (IGI, SKT, AUV),
• kusinthana kwamagetsi ion
• maubwenzi apadera ogwirizana ndi glycosides sequestrating exo native and endo native cholesterol.
• Masiku awiri kapena atatu a enterosorption ali ofanana mu gawo limodzi la hemosorption. Enterosorption ikakwaniritsidwa:
• kusintha kwa zinthu zapoizoni kuchokera m'magazi kupita m'matumbo ndikumangika kwawo kwa sorbent,
• kuyeretsa chakudya cham'mimba cha m'mimba, chomwe chimakhala ndi poizoni wambiri.
• kusintha kwa lipid ndi amino acid mawonekedwe am'matumbo,
• Kuchotsa zinthu zoopsa zomwe zimapangidwa m'matumbo omwe, zomwe zimachepetsa katundu pachiwindi.

Mankhwala opangira opaleshoni

Njira zopangira opaleshoni zitha kugawidwa m'magulu awiri: 1) opaleshoni yamanjenje, 2) opaleshoni yamatumbo.

Mphamvu ya vasoconstrictor yamphamvu yamagetsi pamatenda apamadzi inapezeka idapezeka ndi a Claude Bernard (Claude Bernard, 1851). Kenako a M. Zhabuley (M. Jaboulay, 1898) anasimba za chithandizo chokwanira cha zilonda zam'mapazi za phazi ndikuphwanya kwachidziwikire kwakubwebweta kwa mchombo. Mu 1924, a J. Diez adapanga njira yolumikizira anthu m'maganizo pochotsa ganglia kuchoka pa lumbar yachiwiri kupita ku yachitatu ya sacral node. Odwala ambiri, zotsatira zabwino zimapezeka: vasodilation ndi kusintha kwamankhwala matenda. Ku Russia, mwambo woyamba womvera anthu pomvera unachitika mu 1926 ndi P.A. Herzen. Kuchita opareshoni kumakhala ndi zisonyezo zovuta, chifukwa maresi amitsempha amitsempha am'mimba amatha kuyambitsa chisokonezo ndikukulitsa mkhalidwe wa wodwala.

a) yathunthu - kuyikanso kwa mtengo wamalire ndi chingwe chachifundo kwotalikira,

b) truncular - kukhazikikanso kwa malire pakati pa ganglia achifundo,

c) ganglioectomy - kuchotsedwa kwa gulu la anthu achifundo.

Mwakumvera chisoni, kupuma kumatha kuchitika ponseponse kuchokera pachilonda ndikupangitsa kukakamira kosalekeza kwa msana ndiubongo, komanso kusokonekera kwa centrifugal kumapangitsa kapena kukulitsa zovuta za trophic, humoral and vasomotor. Kutumiza kuphipha kwamankhwala, kuponderezana kumakulitsa kuchuluka kwa kolala. Pambuyo pomvera chisoni, kuchuluka kwa capillaries owonekera kumawonjezeka kwambiri. Ndi zizindikiro za ululu, mu pathogenesis yomwe kusakwanira kothandizidwa kuchokera pachilonda ndikofunikira, ndipo ischemia kulibe, zochizira zotimvera chisoni sichikhala chokhazikika. Ndi kuwonongeka kwa ziwiya zam'munsi, makamaka achiwiri ndi achiwiri lumbar ganglia amachotsedwa. Pamaso pa opareshoni, ndikofunikira kuti muyesedwe ndi novocaine blockade a ganglia achifundo omwe akukonzekera kuti achotsedwe.

B.V. Ognev (1956), pamaziko a data ya patorenis, amakhulupirira kuti kubisa kwachisoni kwa malo otsika kumachitika ndi mtengo wamanzere wamalire, motero kuchotsa kumanzere kwachitatu kwachifundo ndikokwanira. Madokotala ambiri ochita opaleshoni samatsatira lamuloli ndipo amamuchita opaleshoni kumbali ya zotengera zomwe zikukhudzidwa. Lingaliro loti kumvera anthu chisoni liyenera kutengera molakwika. Ndi magawo oyamba ndi kuperewera kwa magazi komwe kumatha kupatsirana kwachifundo komwe kumamveketsa zotsatira zabwino komanso nthawi yayitali.

Lumbar sympathectomy imawonetsedwa kwa odwala omwe ali ndi mawonekedwe amtundu wa kuwonongeka kwamtundu, pamene kuchitanso opaleshoni yolimbitsa thupi pamatumbo sikungatheke kapena sangagulidwe ndi chikhalidwe chamatendawa. Pamaso pa kusintha kwa ulcerative necrotic, chithandizo cha chisoni chimakhala bwino kuphatikiza ndi kulowetsedwa kwa nthawi yayitali kwa mankhwala osokoneza bongo komanso kudulidwa kwachuma. Sympatectomy ndiwowonjezera pakuthandizanso opanga opaleshoni. Kuchepa kwa kukokana kwa zotumphukira ndi kuwonjezeka kwa kuthamanga kwa magazi chifukwa chochotsa arteriospasm ndikupewa wa retrombosis mu mtsempha wobwezeretsedwa. Ndi retrombiosis, lumbar sympathectomy imapangitsa kuti pachimake ischemia asatchulidwe komanso kumawonjezera mwayi wokhala wobwezera magazi.

Zotsatira zosakhutiritsa ndi zomvera chisoni zitha kufotokozedwa ndi mawonekedwe amachitidwe amanjenje achifundo, mawonekedwe amomwe matendawa amafalikira, kuwonongeka kwa ziwiya zazikulu komanso kusintha kosasinthika pamlingo wa microcirculation.

Ndikumvera chisoni, zovuta zotsatirazi zingachitike:

• magazi ochokera m'mitsempha ndi m'mitsempha (0.5%),
• embolism mu mitsempha ya m'munsi malekezero okhala atherosulinotic malo aorta (0.5%),
• neuralgia, yowonetsedwa ndi kupweteka m'mbali mwa ntchafu ya anterolatal (10%), yomwe imazimiririka pambuyo pa miyezi 1-6,
• kumvekera kwamisempha pambuyo poti amumvera mosiyanasiyana (0,05%),
• kufa (osakwana 1%, malinga ndi A.N. Filatov - mpaka 6%). Opaleshoniyo idasinthidwa mosavuta chifukwa cha kuyambitsa kwa endoscopic njira.

R. Lerish akufuna kuchita desympathization of the femal females, kuchotsa ma adventitia ndipo potero kukhudza mamvekedwe a mitsempha yam'mbali yakutali. Mtundu wa kanjedza (Palma) unatulutsa kutulutsa kwa mtsempha wamagulu achikazi kuchokera kuzomata komanso matupi ozungulira mu Hunter Canal.

Ntchito zotsatirazi zimachitika pa zotumphukira zamitsempha:

• shin denervation (Szyfebbain, Olzewski, 1966). Momwe ntchitoyo imapangidwira pamagawo amakono a minyewa yopita kumanjenje ndi minofu ya ng'ombe, yomwe imathandiza kuyimitsa ntchito ya gawo la minofu poyenda, potero kuchepetsa kufunikira kwa okosijeni.
• ntchito pa zotumphukira msana mitsempha (A.G. Molotkov, 1928 ndi 1937, etc.).

Adrenal gland surge idakonzedwa ndikuchitidwa ndi V.A. Oppel (1921). Zokambirana pa upangiri wogwiritsa ntchito ma adrenal gland opaleshoni kwa odwala omwe atha zaka zambiri zakhala zikuchitika kwa zaka zopitilira 70.

Chisamaliro chachikulu cha mankhwalawa chimaperekedwa chifukwa cha mankhwala osakanikirana amitundumitundu yosiyanasiyana. Zosakaniza zimayambitsidwa: saline, reopoliglukin, heparin, trental, nicotinic acid, ATP, novocaine solution, painkillers, maantibayotiki. Pakadali pano, kwa infusions mkati ndi intraarterial, infusomats imagwiritsidwa ntchito. Kwa mankhwala opatsirana masiku ambiri, kuwongolera m'munsi mwa epigastric mtsempha kapena imodzi mwa nthambi za chithokomiro cha akazi imachitidwa.

Njira zina zochizira matenda am'munsi ischemia afunsidwa:

• kukonzanso minofu molunjika (S. Shionga et al., 1973),
• masinthidwe a capillary dongosolo ntchito arterio-fistulas fupa (R.H. Vetto, 1965),
• kusintha kwachulukidwe kam'mimba kwambiri (Sh.D. Manrua, 1985),

Njirazi, zopangidwira kusintha kayendedwe ka mgwirizano, sizitha kukwaniritsa mwachangu zochitika za ischemic ndipo sizingagwiritsidwe ntchito mu gawo IV la matenda osakwanira ochepa.

Zoyesayesa zakonzedwa kuti zisinthe gawo la ischemic kudzera mu venous system pogwiritsa ntchito fistula ya arteriovenous ku ntchafu (San Martin, 1902, M. Jaboulay, 1903). Pambuyo pake, ambiri adayamba kufunafuna njira zina. Mu 1977 A.G. Chigoba (A.G. Shell) chimagwiritsa ntchito kugunda kwa kumbuyo kwa phazi laphazi. Wolemba adapeza zotsatira zabwino za 50% mu ischemia yovuta. Ntchito zofananazo zidayambitsidwa ndi B.L. Gambarin (1987), A.V. Pokrovsky ndi A.G. Horovets (1988).

Zizindikiro za kuchira ntchito zimatsimikiziridwa molingana ndi kuuma kwa miyendo ischemia, magwiridwe antchito, komanso kuchuluka kwa chiwopsezo cha opareshoni. Mikhalidwe yam'deralo imawunikidwa potengera deta ya aortoarteriography. Mulingo woyenera kwambiri wa opaleshoniyo ndikusunga chogona cha kama. Zochitika zamankhwala zimatitsimikizira kuti sipangakhale opareshoni padziko lonse lapansi chifukwa cha matendawa, koma akuyenera kutsogoleredwa ndi njira zamunthu zomwe zimagwiritsidwa ntchito. Chizindikiro chazomwe zimagwiritsidwa ntchito pakumanganso kwa munthu zimatsimikiziridwa kutengera mtundu wake komanso kuchuluka kwa matchulidwe, zaka ndi momwe wodwalayo alili, kupezeka kwa zinthu zomwe zingachititse opareshoni ndi opaleshoni. Zinthu zokhazo zomwe zikuwonetsa opereshoni ndikuwonjezera chiopsezo cha opaleshoni ndi: matenda a mtima a ischemic, kuperewera kwa magazi, kuperewera kwa magazi, kupweteka kwam'mimba komanso aimpso, kupweteka kwa m'mimba ndi duodenal, kupweteka kwa matenda a shuga, kuchepa kwa matenda a shuga, ndi kuchepera zaka. Ndi chiwopsezo chenicheni chodula miyendo, chiwopsezo china choyesa kuchitanso opareshoni chovomerezeka ndi chovomerezeka, popeza ngakhale atadulidwa mutu kwambiri, kufa kwa odwala okulirapo 60 ndi 21-28% kapena kuposerapo.

Pazomwe zimapangidwanso, ma prostate osiyanasiyana opangidwa, omwe atchulidwa pamwambapa, ndi autogene amagwiritsidwa ntchito. Mitundu ina ya mitundu yosinthira sikugwiritsidwa ntchito kawirikawiri.

Mitundu yosiyanasiyana ya endarterectomies (yotseguka, yotseguka, yopunguka, yokhala ndi mpweya wa carbodis Assembly, ultrasound) amagwiritsidwa ntchito ngati njira zodziyimira pawokha zokhudzana ndi stenosis ndi occlusion, komanso monga kuwonjezera kwa shunting kapena ma prosthetics. Madokotala ambiri ochita opaleshoni amawona kuti ndizoyenera kuphatikiza opaleshoni yokonzanso ndi lumbar sympathectomy.

Mu Leriche syndrome, kulowa kwa aorta ndi Median laparotomy kapena gawo limodzi ndi Rob (C.G. Rob). Gawo la Rob limayambira kuchokera ku nthiti ya XII ndikupitilira mpaka pakati mpaka masentimita 3-4 pansi pa umbilicus, pomwe minofu ya rectus abdominis pang'ono kapena imatsutsana kwathunthu, minyewa yakhoma ya anterolateral imatayidwa kapena kupatukana pafupi ndi peritoneum, ndipo peritoneum exfoliates ndipo imachotsedwa limodzi ndi matumbo. Kuti musankhe machitidwe otupa a mbali ya mbali yakumaso, mawonekedwewo amatha kuwonjezeredwa ndi kudutsana kwa minofu ina ya rectus abdominis. Izi zilibe zowopsa, pafupifupi sizimayambitsa matumbo, zimapatsa mwayi wodwalayo atamuchita opaleshoni. Kufikira kwa mitsempha yachikazi kudzera mu mawonekedwe a lateral vertical pansi pa inguinal ligament. Makona odulidwa apamwamba ndi 1-2 masentimita pamwamba pa khola la inguinal. Ndikofunika kutulutsa ma lymph node mwapakati (pakatikati) osawoloka.

Ndi kukonzekera kwapamwamba kwam'mimba kwa msempha ndikuphatikizika ndi kuwonongeka kwa nthambi za impso kapena visceral, thoracophrenolumbotomy imagwiritsidwa ntchito.

Pakangodutsa mtsempha wamafuta wa nje, ndiye kuti mugwiritsidwa ntchito opaleshoni yam'mimba kapena ma endarterectomy. Ntchito zambiri zodutsa mbali ya akazi zimatha ndi kuphatikizira kwa mtsempha wakuya wachikazi kulowa m'magazi. Mu 4-10% ya odwala, magazi ogwirizana omwe amapita mkati mwa chithokomiro chachikazi sakulipira gawo la ischemia, m'malo oterewa kumanenedwanso kwa gawo la chikazi-popliteal. Kubwezeretsa kutuluka kwa magazi m'chigawo chachikazi-popliteal, autovein imagwiritsidwa ntchito nthawi zambiri. Ntchito zomwe zimapangidwanso pamtundu wa femor-popliteal gawo la 60-70% ya mitundu yonse yogwira ntchito pamitsempha yamafinya (Nielubowicz, 1974). Kuti mupeze gawo lakumaloko la chotupa cha popliteal komanso malo a nthambi yake (trifurcation), mawonekedwe a medial nthawi zambiri amagwiritsidwa ntchito (kufikira kwa tibial malinga ndi M. Conghon, 1958). Kuwonetsa gawo lapakati kapena mtsempha wonse wam'madzi, mawonekedwe am'mimba ndi gawo la tendons pes ansevinus (tsekwe paws) ndi mutu wamankhwala m.gastrocnemius (A.M. Imperato, 1974) akufuna.

Kugwiritsa ntchito profundoplasty. Odwala angapo omwe ali ndi vuto lowonongeka kwamiyendo ya mwendo, kumanganso mkati mwa chithokomiro chachikulu cha akazi ndi njira yokhayo yomwe ingapulumutse miyendo kuti ikadulidwe. Opaleshoniyo angathe kuchitidwa pogwiritsa ntchito mankhwala oletsa ululu kapena pochita opaleshoni yam'mimba. Profundoplasty imachepetsa kuwonongeka kwa ischemia, koma sikuchotsa kwathunthu kulankhulirana kwapang'onopang'ono. Kupititsa patsogolo kufalikira kwa magazi ndikokwanira kuchiritsa zilonda zam'mimba ndi mabala atadulidwa mwachuma. Kukonzanso kwa mtsempha wamagetsi wozama mu ischemia yayikulu kumapereka chiwongolero chapadera pakuyenda kwamwazi m'miyendo mu 65-85% ya odwala (J. Vollmar et al., 1966, A.A. Shalimov, N.F. Dryuk, 1979).

Odwala a zaka za senile omwe ali ndi matenda oopsa, maopareshoni ya aorta ndi mitsempha yamatumbo amayanjana ndi chiwopsezo chachikulu komanso kufa kwakukulu. Mu gulu la odwala, ma femal-femoral suprapubic ndi axillary-femoral bypass grafting angagwiritsidwe ntchito. Chiwopsezo chachikulu cha shunt thrombosis chimachitika m'miyezi isanu ndi umodzi yoyamba ndikufika 28%.

Pambuyo pazaka 5-7, patency yamadzi yokhazikika ya femal-popliteal zone imapitilira mu 60-65%, ndipo pambuyo pa endarterectomy, patency ya mtsempha wamagazi 23%. Pali umboni kuti patatha zaka zisanu, kuvomerezeka kwa azimayi-popliteal shunt kunali kotheka mu milandu 73%, komanso kapangidwe kazipembedzo mu 35% ya odwala (D.C. Brewstev, 1982).

Gawo latsopano pantchito yopanga maopaleshoni okonzanso a mitsempha ya popliteal-ankle inali yogwiritsira ntchito maopaleshoni omanganso pogwiritsa ntchito njira zazikuluzikulu. Kuvuta kwa ntchito yamitsempha yama tibial yokhala ndi mulifupi wa 1.5-3 mm, kusokonezeka kwapafupipafupi komanso kuwonongeka kwa nthambi ndi miyendo poyerekeza ndi nthawi ya opaleshoni, kuchuluka kwakukulu kwa zovuta zoyambirira komanso mochedwa mawonekedwe a thrombosis ndi supplement ndizomwe zimapangitsa kuti maopaleshoni ambiri azioneka kuti ntchito zotere zimangowonetsedwa milandu ya miyendo yayikulu ischemia, ndikuwopseza kuti adzadulidwa. Ntchito zoterezi zimatchedwa "ntchito zolimbitsa miyendo". Ngakhale zidali nthawi yayitali, ntchito izi sizowawa. Kufa kwa postoperative kumakhala kotsika - kuchokera 1 mpaka 4%, pomwe kumadulidwa kwamankhwala kwam'mimba kumafika 20-30%. Chochita chodziwika bwino pakuwonetsa chithandizo chamankhwala othandizira opaleshoni nthawi zambiri sichowopsa, koma magwiridwe antchito, i.e. kukhalabe ndi mbali imodzi mwa mitsempha itatu ya tibial komanso momwe mungagwiritsire magazi magazi ake.

M'zaka zaposachedwa, ndi atherosselotic stenosis yam'mitsempha yayikulu, njira yothandizira kupumira komanso kukomoka kwafala tsopano. Mu 1964, kwanthawi yoyamba, njira yochizira anthu osagwiritsa ntchito njira yodziwika ndi akazi pogwiritsa ntchito catheter (Ch. Dotter ndi M. Yudkins) idafotokozedwa. Njira iyi imatchedwa "translateuminal dilatation", "translateuminal angioplasty", pulasitiki yotsiriza, etc. Mu 1971, E. Zeitler (E. Zeitler) adaganiza zothetsa zilonda zolaula pogwiritsa ntchito fogarty catheter. Mu 1974

A. Gruntzig ndi X. Hopt (A. Gruntzig ndi N.Hopt) adasankha catheter yokhala ndi ulalo wopukutira kawiri, yomwe idapangitsa kuti ntchitoyo ikhale yosavuta komanso "ntchito" ndikuchita angioplasty pafupifupi m'madziwe onse am'mitsempha okhala ndi zovuta zochepa. Pakadali pano, zapezeka zambiri ndi angioplasty za zotupa za m'mimba za m'mimba. Zotsatira za balloon angioplasty, m'mimba mwake mwa mitsempha imakulanso chifukwa cha kupatsidwanso kwa zinthu atheromatous popanda kusintha makulidwe a khoma lakale. Popewa kupindika kwa mtsempha wochotseka komanso kusunga kwa lumen kwa nthawi yayitali, fungo la nitinol limayikidwa m'mitsempha. Ankapanga zomwe zimatchedwa endovascular prosthetics. Zotsatira zabwino kwambiri zimawonedwa ndi magawo a stenosis okhala ndi kutalika kosaposa 10cm m'magawo aorto-iliac komanso a femor-popliteal, osawerengera makoma amtsempha, mosasamala kanthu za gawo la matenda. Kafukufuku wazotsatira zomwe zakhala zikuwonetsa kuti njirayi singapikisane ndi minyewa yomanganso, koma nthawi zina imawakwaniritsa.

Kwazaka 10 zapitazi, ntchito yakhala ikuwoneka pakupanga komanso kukhazikitsa njira zamankhwala zochitira opaleshoni yotsika pamafupa am'munsi - osteotrepanation and steoperforation (F.N. Zusmanovich, 1996, P.O. Kazanchan, 1997, A.V. .Masamba, 1998). Opaleshoni ya osteotrepanation (ROT) yotsitsimutsa idapangidwa kuti iyendetse magazi m'magazi, kuwulula ndikuwongolera magwiridwe antchito a paraossal, minofu ndi khungu ndikuwonetsedwa kwa odwala omwe ali ndi kuwonongeka kwa mbali zam'magazi, pomwe sipangachitike opereshoni yowonjezereka. Kuchita opareshoni kumachitika pansi pa mankhwala oletsa ululu. Mabowo okonzanso ndi mulifupi wa 3-5 mm m'lifupi mwake 8-12 kapena kupitilira apo, amawaika pa ntchafu, mwendo wotsika ndi phazi pa malo obisika. Zotsatira zabwino kwambiri zimapezeka kwa odwala omwe ali ndi gawo II B ndi matenda a phase III.

Nthawi yogwira ntchito

Ntchito yayikulu ya nthawi yoyambirira yogwira ntchito ndikuletsa thrombosis, magazi ndi kuwonjezera chilonda. Kusunga ma hemodynamics apakati komanso apakati ndikofunikira pakupewa wa thrombosis. Ngakhale kutsika kwakanthawi kothamanga magazi panthawi imeneyi kumatha kuyambitsa kuwonongeka kwa magazi. Popewa kupanikizika kwa kukakamiza ndikofunikira:

• kulembetsa ndi kubwezeretsanso madzi ndi magazi omwe adatayika pakuchita opareshoni,
• munthawi yake komanso kukonza mokwanira metabolic acidosis, makamaka pambuyo pakuphatikizidwa kwa dzanja la ischemic m'magazi.

Kubwezeretsanso kwathunthu kwa madzi kuyenera kukhala kosaposa 10-15% kuposa kutayika kwake (kupatula magazi). Ndikofunikira kuyang'anira ndikuwonetsetsa ntchito ya impso (kayendedwe ka diuresis, kukhazikitsidwa kwa maselo olemera a maselo, aminophylline), kukonza zosokoneza za acid-base usawa (ASC), mchere wamchere komanso metabolic acidosis.

Funso la kugwiritsa ntchito ma anticoagulants limasankhidwa payekha, kutengera mawonekedwe a opaleshoni yokonzanso. Kupititsa patsogolo kufalikira kwa magazi kumadera, ma microcirculation komanso kupewa ma thrombotic zovuta, ma antiplatelet othandizira amalembedwa: reopoliglyukin, chiyamikiro, kufunikira, fluvide, ticlide, etc. Kugwiritsa ntchito maantibayotiki ndi chithandizo chamankhwala ndichosakayikitsa. Pofuna kupewa matumbo paresis atatha kulowetsedwa kwa mitsempha ya aorta ndi yaac m'nthawi ya masiku atatu, zakudya zamakolo zimalimbikitsidwa.

Mwa zovuta zomwe zimachitika nthawi yaposachedwa, zimachitika: magazi - 12%, thrombosis - 7-10%, matenda a mabala a postoperative - 1-3% (Liekwey, 1977). Ndi kupitiliza kwa ma protein a aortic femoral dera, kufa kumafikira 33-37%, kudzicheka - 14-23% (A.A. Shalimov, N.F. Dryuk, 1979).

Zovuta zomwe zimawonedwa pakumanganso ntchito (H.G. VeeY, 1973) zitha kugawidwa m'magulu:

• kuwonongeka kwa ziwalo zam'mimba, m'mimba mwake ndi m'mitsempha ya iac, ureter,
• kuwonongeka kwa ziwiya nthawi yopanga
• prosthet thrombosis pa mkondo wa msempha,
• embolism
• magazi chifukwa cha kuchepa kwa magazi,
• minyewa yovuta (kukomoka kwa ziwalo za m'chiberekero chifukwa cha ischemia ya msana).

2. Mavuto oyambilira atatha:

• magazi
• kulephera kwa impso (kwakanthawi oliguria pasanathe maola 48),
• thrombosis ya prosthesis ndi mitsempha yamagazi,
• matumbo paresis,
• ischemia yamatumbo ndi necrosis chifukwa chovulala ndi mesenteric thrombosis,
• lymphorrhea ndi kuwonjezera mabala a postoperative.

3. Kuchepetsa mavuto:

• thrombosis ya zotengera ndi Prosthesis chifukwa cha kufalikira kwa matenda (atherosulinosis),
• anuromms wabodza wa anastomoses (matalala opatsirana kapena kusiyanasiyana kwa mafelekedwe opangira ma cell),
• aortic matumbo fistulas
• matenda opatsirana
• kusabala.

Kupewa zovuta za purulent ndikofunikira. Mavuto a purulent pambuyo poti agwiritse ntchito mapangidwe ake amapezeka mu 3-20% ndi imfa ya 25-75%. Kuwonjezeka kwa kuchuluka kwa chithandizo cha postoperative kumalumikizidwa ndi:

• kuyambitsa ntchito zatsopano zovuta komanso zopatsa nthawi,
• zaka odwala
• matenda opweteka kwambiri (mwachitsanzo, matenda a shuga),
• kuchepa kwa magazi m'thupi, hypoproteinemia, kuchepa kwa mavitamini,
• kopanira
• chithandizo chamankhwala cham'mbuyomu
• kukhetsa (kusakwanira) kukhetsa kwa mabala,
• bandeji yothina ndi mavalidwe osowa, chidwi chochuluka ndi maantibayotiki komanso kutuluka kwa mitundu yolephera ya tizilombo,
• kuchuluka kwa staphylococcal kunyamula mu antchito ndi odwala,
• kufooketsa chidwi cha madokotala ochita opaleshoni ku malamulo apamwamba a asepsis ndi antiseptics. G.V. Lord (G.W. Lord, 1977) amagawa kuchuluka kwa ma prostheses molingana ndi kuya kwa matenda:
  • I degree - zotupa za pakhungu,
  • II digiri - kuwonongeka pakhungu ndi minyewa yofinya,
  • Digiri ya III - kuwonongeka kwa dera lomwe limalowetsedwa.

1. Njira zodzitetezera: kuchotsa mabala ndi zilonda zam'mimba, kuchepa kwa magazi m'thupi, kuyera kwa matenda oyambitsidwa ndi matenda, kuyeretsa kwam'mimba thirakiti masiku atatu asanafike opareshoni.

2. Intraoperative: Kusamalira khungu kokwanira, njira ya hemostasis, kusintha kwa magolovesi pamalopo otsogolera opaleshoni, kukhetsa kwa bala.

3. Mu nthawi yogwira ntchito: kukonzanso magazi, ma anti-siputikesi am'masiku ambiri, kulandira chithandizo chokwanira cha kulowetsedwa.

Ndi kupindika komanso kuwonekera kwa ma prosthesis, ndikofunikira kukhetsa mwachangu, kukonza bala ndi kutseka ndi kupindika kwake ndi kulumikizidwa kwa minofu. Ngati chithandizo sichikuyenda bwino, njira yodutsapo yochotsa prostapo iyenera kuchitidwa. Kuchita opaleshoni yolimba mtima komanso yolingaliridwa bwino ndikwabwino kuposa njira zamantha, zopanda chidwi komanso zopanda thandizo. Pankhani yakugwiritsa ntchito maantibayotiki koyambirira, munthu ayenera kuganizira za kuwonongeka kwa ntchito, kukhalapo kwa zilonda zam'mimba ndi kuchuluka kwa ziwonetsero. Kutsegula kwa odwala kumadalira momwe alili ndi kuchuluka kwa kuchitira opaleshoni. Kuyenda nthawi zambiri kumaloledwa pa tsiku la 3-5, komabe, nkhaniyi imasankhidwa payekhapayekha.

Opaleshoni iliyonse yobwezeretsa, odwala nthawi zonse amayenera kumwa prophylactic Mlingo wa antiplatelet ndi anti-atherogenic, opaleshoni yokhazikitsidwa bwino, ndikuyang'aniridwa ndi angiosurgeon.

Chifukwa chake pakalipano, pakhala pakuchitika zambiri pofufuza komanso kuchiza matenda ofooketsa mitsempha, zomwe zimapangitsa kuti aliyense athe kuzindikira moyenera ndikusankha njira zoyenera zamankhwala.

Nkhani zosankhidwa pa angiology. E.P. Kohan, I.K. Zavarina

Atherosclerosis obliterans of the malekezero: Zizindikiro ndi chithandizo

Kuwonongeka kwa atherosclerosis ya m'munsi yotsika kumayendera limodzi ndi matenda osachiritsika, omwe nthawi zambiri amakhudza anthu azaka zopitilira 40. Ndi kuwonongeka pang'ono kwa ziwiya zamiyendo, zizindikiro za hypoxia zimawonekera - dzanzi la miyendo, kuchepa kwa chidwi, kupweteka kwa minofu poyenda.

Kupewa kosalekeza kumatha kulepheretsa kukula kwa vuto la zilonda zam'mimba, koma odwala ambiri ali ndi chiopsezo:

• Kunenepa kwambiri
• Kuchulukitsa kwamafuta,
• Kuphwanya magazi kumapeto am'munsi chifukwa cha mitsempha ya varicose.

Atherosulinosis obliterans a m'munsi miyendo mitsempha

Kusintha kwa Ischemic mumtsempha wamachikadzi kumachitika osati kokha ndi malo a atherosulinotic. Matenda a ziwalo za m'chiberekero, dongosolo la kubereka, mitsempha ya varicose imayendera limodzi ndi kuperewera kwa zakudya, kupatsirana kwa oxygen kwa khoma la chotengera. Popewa atherosulinosis ya mtima, chithandizo chanthawi yovutikira pamafunika.

Kutalika kochuluka kwa mapangidwe amkati mwa wamkazi ndi chifukwa cha kukhalapo kwa bifurcation mu msempha pafupi ndi chotengera ichi, malo olekanitsidwa kukhala mitengo ikuluikulu iwiri. Kuderali kuli malo ena amitsempha yamagazi pamene akuyenda, zomwe zimapangitsa kuti ngozi zizigwera khoma. Choyamba, kudzikundikira kwamafuta kumachitika mu aorta, kenako kugwera pansipa.

Kulowerera claudication mu atherosulinosis yamtsempha wamagazi

Chizindikiro chofala kwambiri cha miyendo ndi chikhazikitso. Pathology imabweretsa mawonekedwe owawa, kupweteka kwa miyendo. Kuphatikizika kwa minofu ya minofu kumayambitsa kupweteka kwapang'onopang'ono.

Ndi matenda am'mimba, munthu amakhala ndi chizindikiro cha pathological. Mkhalidwe umadziwika ndi kusasangalala, kupweteka.

Ndi claudication pang'onopang'ono, zizindikiro za pathological zimawoneka mu nthambi imodzi. Pang'onopang'ono, nosology imapeza kulumikizana, komwe kumayendetsedwa ndi mawonetsedwe a mgwirizano wapakati. Mukamayenda, kupweteka kwa minofu kumawonekera mumisempha ya ng'ombe, choyamba mbali imodzi, kenako mbali ziwiri.

Kuopsa kwa vutolo kumatsimikiziridwa ndi mtunda womwe munthu amayenda musanayambe kupweteka. Milandu yayikulu, ululu suwoneka pompopompo posuntha malo osapitirira 10 metres.

Kutengera kutengera kwawawa, kupatsirana kwapakati kumagawidwa m'magulu atatu:

Ndi gulu lalikulu, ululu wammbuyo umapangidwira mwachindunji mu minyewa ya gluteal. Nosology nthawi zambiri imaphatikizidwa ndi matenda a Lerish (omwe ali ndi zolengeza m'dera la aortic bifurcation).

Lameness yotsika imadziwika ndi zowawa za ng'ombe. Imachitika ndi chidwi atherosselotic mu projekiti ya m'munsi mwa ntchafu, bondo palimodzi.

Kuzindikira pang'onopang'ono pang'onopang'ono ndikosavuta. Kuphatikiza pa kudandaula kwa wodwalayo kupweteka kwa minofu ya ng'ombe poyenda, palinso chimbudzi cha kusowa kwa chikwatu komwe kuli chombo chomwe chakhudzidwa - chiac ndi chikazi cham'mimba, ndi ziwiya zam'munsi.

Njira yoopsa imayendetsedwa ndi kuphwanya minofu ya trophic, yomwe imawonetsedwa ndi kuchepa kwa kuchuluka kwawo, khungu la khungu, cyanosis ya zala. Chiwalo chomwe chakhudzidwa chimazizira kukhudza.

Kuwonongeka kwa Ischemic kumadera akumunsi kumayendetsedwa ndi kuwonongeka kwa mitengo yamanjenje, kutupa kwa mwendo, phazi. M'matenda, odwala amakhala ndi kukakamiza - amasunga miyendo yawo atagundika.

Makulidwe a osokoneza bongo atherosulinosis:

1. Ululu mukasuntha zoposa kilomita imodzi. Pali ululu pokhapokha ngati tichita zolimbitsa thupi kwambiri. Kutalika kwakutali sikuvomerezeka chifukwa cha miyendo yolimba,
2. Gawo 1 limadziwika ndi ma parla pakadutsa pang'onopang'ono kuchoka pa mita 250 kupita pa kilomita imodzi pakapita nthawi. M'mizinda yamakono, zinthu zotere sizimalengedwa kawiri kawiri, chifukwa chake munthu samadzimva wachisoni. Anthu akumidzi amakhala ndi vuto la atherosulinosis,
3. Gawo 2 limadziwika ndi zowawa mukamayenda mtunda wopitilira 50m. Vutolo limatsogolera pakugona mokakamiza kapena pampando wa munthu poyenda,
4. Gawo lachitatu - ischemia yovuta, yopanga ndi kufupika kwa mitsempha ya miyendo. Pathology imadziwika ndi zowawa poyenda mtunda waufupi. Mkhalidwe umadziwika ndi kulumala ndi kulumala. Kusokonezeka kwa tulo kumachitika chifukwa cha ululu usiku,
5. Gawo 4 la zovuta za trophic amawonekera mwa kupangika kwa necrotic foci, kuphwanya kwamphamvu kwa magazi ndi chitukuko champhamvu cha zigawo zam'munsi.

Ndi makulidwe a occlusal-stenotic, pali kutchulidwa kochotsedwa kwa gawo la aorto-iliac, kuwonongeka kwa dera la popliteal-tibial. Ndi matenda, a morphologists amawona zomwe zimatchedwa "kuwonongeka kwamiyala yambiri m'mitsempha." Mukukula konse kwa chinthu chophunziridwacho, ma cholesterol oyimitsidwa amawonedwa.

Kuchuluka kwa atherosulinosis obliterans agawika magawo:

• Kugawika kwa magawo - gawo limodzi lokha limagwa kuchokera pamasamba ochulukitsa,
• Matenda wamba (kalasi 2) - chotchinga cha mtsempha wamagetsi achikazi,
• Kuletsa mitsempha yotupa ndi yachikazi yokhala ndi vuto lowonongeka la malo owerengeka,
• Kutulutsa kwathunthu kwa ma microcirculation mu opliteal and femoral mtsempha - 4 digiri. Ndi matenda, magazi amapita ku dongosolo la mitsempha yakuya yachikazi imasungidwa,
• Zowonongeka zakugalamu yamkati yaku akazi ndi kuwonongeka kwa dera lachikazi-popliteal. Gawo 5 limadziwika ndi hypoxia yayikulu yam'munsi yam'munsi komanso necrosis, zilonda zam'mimba za trophic. Vuto lalikulu la wodwala wonama ndilovuta kuwongolera, kotero chithandizo chake chimangokhala chisonyezo.

Mitundu ya michere ya stlotic stenotic mu atherosulinosis imayimiriridwa ndi mitundu itatu:

1. Zowonongeka kumadera akumidzi a tibia ndi mitsempha ya popliteal, momwe magazi am'miyendo yam'munsi amasungidwa,
2. Minofu occlusion ya m'munsi mwendo. Patency pa tibia ndi popliteal mitsempha imasungidwa,
3. Kulowa kwa ziwiya zonse za ntchafu ndi mwendo wotsika ndikukhalabe ndi zigawo zosiyanasiyana za mitsempha.

Zizindikiro zakuwonongeka kwa atherosclerosis ya ziwiya zamagawo am'munsi

Zizindikiro zakuwonongeka kwa malekezero am'mbali zimaphatikizidwa. Ndi mawonetsedwe onse mu malo oyamba, kulumikizana kwina, komwe kumakhala chizindikiro cha matenda.

Zizindikiro zonse za kuwonongeka kwa mitsempha ya ziwalo zamiyendo zimagawika mosavuta ndikuyamba. Zizindikiro zoyambira zamafuta m'matumbo a miyendo:

• Hypersensitivity ku chozizira. Madandaulo a kukwawa, kuyera, kuwotcha, kuyamwa, kupweteka kwa mwana wa ng'ombe,
• Matenda a Lerish amaphatikizidwa ndi kupweteka m'misempha yokomera, malo am'mbuyo ndikutulutsa kwachigawo komwe kuli gawo la aortic-iliac,
• Kukula kwa mafuta osunthika, mafupa a minofu,
• Kutayika kwa tsitsi la mwendo ndi ntchafu,
• Hyperkeratosis ya misomali,
• Manyani a mbale,
• Zilonda zam'mimba zopanda machiritso,
• Mapangidwe a chimanga poyang'ana kuwonongeka kwa khungu.

Kugwetsa ma atherosulinosis kumadziwika ndi kusokonezeka kwakukulu ndi kusintha kwa miyendo ya trophic mpaka gangren.

Mu 45% ya odwala, ululu umapangidwa chifukwa chogwirira ntchito pambuyo poti kuthetsedwako pamankhwala othandizira ndikusintha njira zothandizira. Chithandizo cha inpatient cha nthawi ndi nthawi chimalimbikitsidwa kwa anthu omwe amabwerera pafupipafupi.

Zizindikiro

Ngati zizindikiro zomwe zili pamwambazi zizindikiridwa, wodwalayo ayenera kufunsira malangizo a angiosurgeon, amene atamuyesa wodwalayo amupatse mayeso. Kuti muzindikire za matenda amtunduwu, mitundu yotsatila ya mayeso ndi othandizira ikhoza kulembedwa:

• magazi kuyesa kwa lipids, kuchuluka kwa fibrinogen, shuga,
• kusanthula kuti mudziwe kutalika kwa magazi,
• Ultrasound ya zombo zokhala ndi dopplerography,
• angiography ndi wotsutsana naye,
• rheovasography
• MRI
• CT jambulani ndi wothandizira.

Pambuyo podziwa gawo la matendawo, wodwalayo amapatsidwa chithandizo chokwanira.

Malingaliro othandizira atherosulinosis obliterans a ziwiya zamagetsi am'munsi zimatengera gawo la chitukuko cha pathological process ndipo atha kuphatikizira njira zosasamala kapena za opaleshoni.

Kumayambiriro kwa mankhwalawa, zinthu zomwe zimapangitsa kuti matendawa azitha

1. Kunenepa.
2. Kusiya kusuta fodya komanso zizolowezi zina zoyipa.
3. Nkhondo yolimbana ndi kupanda thupi.
4. Kukana kudya zakudya zamafuta ambiri ndi mafuta a nyama (zakudya No. 10).
5. Kuyendetsa magazi kuthamanga ndi kuthetsa matenda oopsa.
6. Kuchepetsa kwambiri cholesterol "yoipa".
7. Kupitiliza kopitilira muyeso wa shuga mu shuga.

Odwala omwe ali ndi magawo oyamba a matenda atha kulimbikitsidwa kuti amwe mankhwala awa:

• mankhwala ochepetsa cholesterol - Lovastatin, Quantalan, Mevacor, Cholestyramine, Zokor, Cholestid,
• mankhwala kuchepetsa triglycerides - clofibrate, bezafibrat,
• Kukonzekera kwa kukhazikika kwa microcirculation komanso kupewa thrombosis - Cilostazol, Pentoxifylline, Clopidogrel, Aspirin, Warfarin, Heparin,
• mankhwala ochepetsa kuthamanga kwa magazi - Atenolol, Betalok ZOK, Nebilet,
• mankhwala kusintha minofu trophism - Nicotinic acid, Nikoshpan, mavitamini B,
• ma multivitamin.

Njira za physiotherapeutic (ma microcurrents, laser therapy), balneotherapy ndi hyperbaric oxygenation zitha kutumikiridwa pochiza matenda am'munsi am'munsi.

Zizindikiro za opaleshoni zingaphatikizepo:

• Zizindikiro zakuwala
• kupweteka kwambiri pakupuma,
• thrombosis
• kupita patsogolo msanga kapena gawo la III-IV la atherosulinosis.

Mu gawo loyambirira la matendawa, wodwalayo amatha kuchita opaleshoni yovuta kwambiri:

• balloon angioplasty - catheter yapadera yokhala ndi baluni imayikidwa mu mtsempha kudzera pakapumira, pomwe mpweya umalowetsedwa mu balloon, makoma a mtsempha wowongoka amawongola.
• cryoplasty - kubwezeretsaku kuli kofanana ndi balloon angioplasty, koma kukulitsa kwa mtsempha kumachitika pogwiritsa ntchito zoziziritsa kukhosi, zomwe sizingangokulitsa lumen ya chotengera, komanso kuwononga ma atherosulinotic amana,
• stenting - stents zapadera zimayambitsidwa mu lumen ya artery, yomwe imakhala ndi kukonzekera kosiyanasiyana kwa chiwonongeko cha sclerotic plaques.

Mukamagwira ntchito zowononga pang'ono, angiography imagwiritsidwa ntchito kuwongolera njira zomwe zimachitika. Izi zitha kuchitidwa zipatala zapadera. Pambuyo pa opaleshoni, wodwalayo amayang'aniridwa ndi achipatala kwa tsiku limodzi, amatha kupita kunyumba tsiku lotsatira.

Ndi kupendekera kwakukulu kwa kuwala kwa thambo la opaleshoni, njira zotseguka zimagwiritsidwa ntchito:

• Kugwedezeka - mkati mwa opareshoni, chotengera cholimba chimapangidwa kuchokera ku zinthu zopangidwa kapena kuchokera ku ziwalo zina zotengedwa kuchokera kwa wodwala,
• endarterectomy - mkati mwa opaleshoni, dera la mtsempha womwe wakhudzidwa ndi zolembera zamtundu wa atheroscrotic amachotsedwa.

Kuphatikiza pa ntchito zomangamanga zotere, njira zowonjezerera zothandizira zingagwiritsidwe ntchito:

• revasasmizing osteotomy - kukula kwa mitsempha yaying'ono yatsopano kumalimbikitsidwa ndi kuwonongeka kwa mafupa,
• sympathectomy - njira yolumikizira mitsempha yomwe imayambitsa kuphipha kwa mitsempha, imachitika ndikupanga kubwereza kwa mitsempha mobwerezabwereza.

Ndikapangira zilonda zazikulu zopanda machiritso kapena zilonda zam'mimba, opaleshoni yamapulasitiki imatha kuchitika ndi khungu labwino pambuyo pochotsa mbali zam'mimba kapena kuduladula mbali ina yam'munsi.

Zoneneratu zochizira zowononga ma atherosulinosis a ziwiya zamagetsi zam'munsi zimakondwera ndi chithandizo choyambirira cha wodwalayo ndi angiosurgeon. Pakadutsa zaka 10 chitukuko cha matenda amenewa, chitukuko cha thrombosis kapena gangore chikuwoneka mu 8% ya odwala.

Kupewa

Popewa kukula kwa atherosulinosis yamitsempha yam'munsi, mungathe kutsatira izi:

1. Kuthandiza pa nthawi yake matenda osachiritsika.
2. Kupitiliza kwakanthawi kachipatala pambuyo pa zaka 50.
3. Kukana zizolowezi zoipa.
4. Zakudya zabwino.
5. Nkhondo yolimbana ndi kupanda thupi.
6. Kuchotsedwa kwa zochitika zopsinja.
7. Kulimbana ndi kunenepa kwambiri.

Ichi ndi chiyani

Atherosulinosis obliterans ndi mtundu wa atherosulinosis. Ndi matendawa, cholesterol plaques amapanga m'makoma amitsempha, amasokoneza kayendedwe kamagazi, ndikupangitsa vasoconstriction (stenosis) kapena kufalikira kwathunthu, kotchedwa occlusion kapena kufalikira, chifukwa chake amalankhula za zotupa za stellotic zam'mimba.

Malinga ndi ziwerengero, chofunikira kwambiri cha kukhalapo kwa matenda a zam'thupi ndi cha amuna okulirapo zaka 40. Kugawanitsa atherosulinosis ya malekezero akumunsi kumachitika mu 10% ya anthu onse a Dziko Lapansi, ndipo chiwerengerochi chikukulirakulirabe.

Zomwe zimachitika

Choyambitsa chachikulu cha atherosulinosis ndi kusuta. Nikotini yomwe ili mu fodya imayambitsa mitsempha kuti isamenye, motero imalepheretsa magazi kuyenda m'mitsempha ndikuwonjezera mwayi wamagazi mkati mwake.

Zowonjezera zomwe zimapangitsa atherosclerosis yamitsempha yama m'munsi ndipo zimayambitsa kumayambiriro komanso matenda oopsa:

• cholesterol yayikulu yokhala ndi zakudya zamafuta a nyama nthawi zambiri,
• kuthamanga kwa magazi
• onenepa kwambiri
• chibadwire
• matenda ashuga
• kusowa mokwanira zolimbitsa thupi,
• zopsinjika pafupipafupi.

Frostbite kapena kuzizira kwa miyendo kwa nthawi yayitali, kusamutsidwa kuubwana wa frostbite, amathanso kukhala pachiwopsezo.

Njira yopititsira patsogolo

Nthawi zambiri, atherosulinosis ya ziwiya zam'munsi zimadziwonetsa mu ukalamba ndipo amayamba chifukwa cha kupindika kwa lipoprotein metabolism. Njira yotukula imadutsa magawo otsatirawa.

1. Ma cholesterol ndi ma triglycerides omwe amalowa m'thupi (omwe amalowetsedwa mu khoma lamatumbo) amagwidwa ndi ma protein apadera oyendetsa - mapuloteni - ma chylomicrons ndikusamutsira magazi.
2. Chiwindi chimagwira zinthu zomwe zimapangidwira ndikupanga mafuta ena apadera - VLDL (choletsa mafuta ochepa).
3. M'magazi, lipoproteidlipase enzyme imachita pa mamolekyulu a VLDL. Pachigawo choyamba cha kupangika kwa mankhwala, VLDLP imadutsa kukhala pakati pamagawo apakati pa lipoprotein (kapena STLPs), kenako pagawo lachiwiri la zomwe zimachitika, VLDLP imasinthidwa kukhala LDLA (cholesterol otsika kwambiri). LDL ndiye cholesterol yotchedwa "yoyipa" ndipo ndiyomwe imayambitsa atherogenic (ndiye kuti, imatha kuyambitsa matenda atherosulinosis).
4. Zidutswa zamafuta zimalowa m'chiwindi kuti zikonzenso. Apa, cholesterol yapamwamba kwambiri (HDL) imapangidwa kuchokera ku lipoproteins (LDL ndi HDL), yomwe ili ndi zotsutsana nazo ndipo imatha kuyeretsa makhoma amitsempha yamagazi kuchokera kumagawo a cholesterol. Ichi ndiye cholesterol yotchedwa "chabwino". Gawo limodzi la mafuta omwe amaphatikizidwa limapangidwa kukhala michere ya bile, yomwe ndi yofunikira pakuchita bwino kwa chakudya, ndipo imatumizidwa m'matumbo.
5. Pakadali pano, ma cell a hepatic amatha kulephera (mwabadwa kapena chifukwa cha ukalamba), chifukwa chomwe m'malo mwa HDL kutuluka, magawo ochepa a mafuta osakhalitsa sangakhale osasinthika ndikulowa m'magazi.

Osachepera, komanso mwina ma atherogenic, amasinthidwa kapena kusinthidwa lipoprotein. Mwachitsanzo, oxidized powonetsedwa ndi H2O2 (hydrogen peroxide).

1. Zingwe zamafuta ochepa (LDL) zimakhazikika pamakoma amitsempha yama m'munsi. Kukhalapo kwachilendo kwa zinthu zakunja mu lumen yamitsempha yamagazi kumathandizira kutupa. Komabe, ma macrophages kapena leukocytes sangathe kuthana ndi tizigawo ta cholesterol. Ngati njirayi imakoka, magawo am'mowa - amapangidwa. Izi madanga amakhala ndi kachulukidwe kakang'ono kwambiri ndipo amasokoneza kayendedwe ka magazi.
2. Chuma chambiri cha cholesterol "choyipa" chimatsegulidwa, ndipo magazi amawonekera pakumenyekedwa kapena kuwonongeka kwa kapisozi. Kuwaza magazi kumakhala ndi chiwonetsero chowonjezereka cha occlusive ndi mitsempha yovunda kwambiri.
3. Pang'onopang'ono, kachigawo ka cholesterol kamene kamaphatikizidwa ndi magazi kumatenga kokhazikika, chifukwa cha kuchuluka kwa mchere wa calcium. Makoma a mitsempha amasiya kutalika kwawo ndikulimba, zomwe zimapangitsa kuti zitheke. Kuphatikiza pa chilichonse, ischemia yokhazikika komanso necrosis ya zimakhala zapafupi zimapangidwa chifukwa cha hypoxia komanso kusowa kwa michere.

Pakusokoneza ma atherosulinosis a m'munsi, magawo otsatirawa ndi osiyana:

1. Gawo I (mawonetseredwe oyamba a stenosis) - kumverera kwa tsekwe, kuchekera pakhungu, kumva kuzizira ndi kutsuka, thukuta kwambiri, kutopa msanga poyenda,
2. II A siteji (gawo lodzigudubuza) - kumva kutopa ndi kuwuma mu minofu ya ng'ombe, kupondereza ululu poyesera kuyenda pafupifupi 200 m,
3. Gawo la II B - ululu ndi kumva kuwuma sikulolani kupita 200 m,
4. Gawo lachitatu - ululu wopanikizika mu minofu ya ng'ombe imakhala yolimba kwambiri ndikuwonekera ngakhale pakupuma,
5. Siteji ya IV - pamwamba pa mwendo pali zizindikiro za kusokonezeka kwa trophic, zilonda zazitali zosachiritsa ndi zizindikiro za gangrene.

Pa magawo apamwamba a atherosulinosis am'munsi, kukula kwa gangrene nthawi zambiri kumabweretsa kutsitsa kwathunthu kapena pang'ono pang'ono. Kuperewera kwa chithandizo chokwanira cha opaleshoni mu zochitika zoterezi kumatha kupangitsa kuti wodwalayo afe.

Kuchuluka kwa atherosulinosis obliterans agawika magawo:

1. Kugawika kwa magawo - gawo limodzi lokha limagwa kuchokera pamasamba ochulukitsa,
2. Matenda wamba (kalasi 2) - chotchinga cha mtsempha wamagetsi achikazi,
3. Kuletsa mitsempha yotupa ndi yachikazi yokhala ndi vuto lowonongeka la malo owerengeka,
4. Kutulutsa kwathunthu kwa ma microcirculation mu opliteal and femoral mtsempha - 4 digiri. Ndi matenda, magazi amapita ku dongosolo la mitsempha yakuya yachikazi imasungidwa,
5. Zowonongeka zakugalamu yamkati yaku akazi ndi kuwonongeka kwa dera lachikazi-popliteal. Gawo 5 limadziwika ndi hypoxia yayikulu yam'munsi yam'munsi komanso necrosis, zilonda zam'mimba za trophic. Vuto lalikulu la wodwala wonama ndilovuta kuwongolera, kotero chithandizo chake chimangokhala chisonyezo.

Mitundu ya michere ya stlotic stenotic mu atherosulinosis imayimiriridwa ndi mitundu itatu:

1. Zowonongeka kumadera akumidzi a tibia ndi mitsempha ya popliteal, momwe magazi am'miyendo yam'munsi amasungidwa,
2. Minofu occlusion ya m'munsi mwendo. Patency pa tibia ndi popliteal mitsempha imasungidwa,
3. Kulowa kwa ziwiya zonse za ntchafu ndi mwendo wotsika ndikukhalabe ndi zigawo zosiyanasiyana za mitsempha.

Zizindikiro za OASNK mumagawo oyamba, monga lamulo, ndizowona zambiri kapena sizikupezeka paliponse. Chifukwa chake, matendawa amawonedwa ngati opusa komanso osatsimikizika. Ndi kuwonongeka kwa mitsempha yomwe imayamba kukula pang'onopang'ono, ndipo kuuma kwa zizindikiro zamankhwala kumadalira mwachindunji gawo la kukula kwa matendawa.

Zizindikiro zoyambirira za kuchepa kwa matenda a m'matondo am'munsi (gawo lachiwiri la matendawa):

• phazi limayamba kuwuma mosalekeza
• miyendo nthawi zambiri imasowa
• kutupa kwa miyendo kumachitika
• ngati nthendayo yakhudza mwendo umodzi, nthawi zonse kumakhala kozizira kuposa kathanzi.
• kupweteka m'miyendo mutayenda kwakanthawi.

Izi zikuwonekera mu gawo lachiwiri. Pakadali pano pa chitukuko cha atherosulinosis, munthu amatha kuyenda mamita 1000-1500 popanda kupweteka.

Anthu nthawi zambiri samatengera kufunikira kwa zizindikiro monga kuzizira, kuzungulira kwa nthawi, kupweteka poyenda mtunda wautali. Koma pachabe! Kupatula apo, kuyambira pachipatala chachiwiri cha matenda, mutha kuthana ndi 100%.

Zizindikiro zomwe zimapezeka m'magawo atatu:

• misomali ikukula pang'onopang'ono kuposa kale
• miyendo imayamba kutuluka
• kupweteka kumatha kuchitika kamodzi usana ndi usiku,
• Ululu umachitika pambuyo poyenda mtunda waufupi (250- 900 m).

Munthu akakhala ndi gawo 4 losokoneza atherosulinosis ya miyendo, sangathe kuyenda 50mapa popanda kupweteka. Kwa odwala oterowo, ngakhale ulendo wokagula umakhala ntchito yayikulu, ndipo nthawi zina umangopita kunja, kukwera masitepe ndikumazunzidwa. Nthawi zambiri, odwala omwe ali ndi gawo 4 amatha amangoyendayenda mnyumba. Ndipo zovuta zikamakula, samayambiranso.

Pakadali pano, chithandizo cha matenda omwe chimasokoneza ma atherosclerosis am'malo ochepa chimakhala chopanda mphamvu, chimatha kuchotsera zizindikiro kwakanthawi ndikupewanso zovuta zina, monga:

• Khungu lakuda m'miyendo,
• zilonda
• gangrene (ndi kuphatikiza uku, kuduladula miyendo ndikofunikira).

Zochitika pamaphunzirowa

Zizindikiro zonse za matendawa zimayamba pang'onopang'ono, koma nthawi zina, kuwonongeka kwa atherosulinosis kwamitsempha yam'munsi kumadziwonekera mu mawonekedwe a arterial thrombosis. Kenako, m'malo mwa artery stenosis, thrombus imawonekera, pomwepo ndikutseka mwamphamvu kuwala. Matenda ofananawo kwa wodwala amakula mosayembekezereka, akumva kuwonongeka koopsa m'moyo wabwino, khungu la mwendo limasunthika, kumazizira. Potere, kuitana mwachangu (kuwerengera nthawi kuti zinthu zisinthe - kwa maola ambiri) kwa dokotala wa opaleshoni yam'mimba kumakupatsani mwayi wopulumutsa mwendo wa munthu.

Ndi nthendayi yolumikizana - matenda ashuga, njira yowathetsa matenda a atherosulinosis imakhala ndi yake. Mbiri ya pathologies otere si yachilendo, pomwe matendawa amakula mwachangu kwambiri (kuchokera maola angapo mpaka masiku angapo) kotero kuti m'nthawi yochepa imayambitsa necrosis kapena gangrene m'chigawo cham'munsi. Tsoka ilo, madokotala nthawi zambiri amakhala atadulidwa miyendo - ichi ndi chinthu chokha chomwe chingapulumutse moyo wa munthu.

Zambiri

Atherosulinosis obliterans - matenda osakanikirana a zotumphukira mitsempha, amadziwika ndi occlusive lesion ndikupangitsa ischemia yam'munsi. Mu mtima ndi opaleshoni ya mtima, atherosulinosis obliterans imawerengedwa kuti ndiyo njira yoyambira yamatenda a atherosulinosis (lachitatu lomwe limadziwika kwambiri pambuyo pa matenda a m'mitsempha ya m'mimba ndi matenda ofooketsa ziwongo. Kuwonongeka kwa atherosclerosis ya m'munsi malekezero kumachitika mu 3-5% ya milandu, makamaka mwa amuna okulirapo zaka 40. Chotupa cha Occlusive-stenotic nthawi zambiri chimakhudza ziwiya zazikulu (aorta, mitsempha ya iliac) kapena mitsempha yapakatikati (popliteal, tibial, femoral). Ndi atherosclerosis obliterans a mitsempha yam'mphepete yam'mphepete, mitsempha ya subclavian imakhudzidwa.

Zimayambitsa kufooketsa atherosulinosis

Kugwetsa ma atherosulinosis ndi mawonetseredwe a systemic atherosulinosis, chifukwa chake kupezeka kwake kumalumikizidwa ndi njira zomwezo zomwe zimayambitsa ma atherosulinotic njira zina zamtundu uliwonse.

Malingana ndi malingaliro amakono, kuwonongeka kwa mitsempha ya atherosselotic kumalimbikitsidwa ndi dyslipidemia, kusintha kwa mkhalidwe wamakhoma wamitsempha, kugwira ntchito kwa zida zamphamvu zolandirira, komanso cholowa (chibadwa). Kusintha kwakukulu kwa pathological pakuwonongeka kwa atherosulinosis kumakhudza mphamvu ya mitsempha. Kuzungulira kwa cholidosis, minyewa yolumikizana imakula ndikukula, yomwe imayendera limodzi ndi mapangidwe amtundu wa fibrous, magawo a mapulateleti ndi ma fibrin.

Ndi zovuta zamagazi ndi zolembera za necrosis, mapangidwe amkati amadzaza ndi minyewa yotsekemera komanso ma cell atheromatous. Wotsirizika, yemwe akuphwanya gawo la minyewa, amatha kulowa m'magazi am'magazi, ndikupanga embolism yamitsempha.Kuyika kwa mchere wamchere mu malo osinthika amatsenga kumalizitsa zotupa zomwe zimasungunuka, zomwe zimapangitsa kuti zikhale zovuta. Arterial stenosis yoposa 70% yachilendo m'mimba mwake imabweretsa kusintha mu chikhalidwe ndi kuthamanga kwa magazi.

Zinthu zomwe zikuwonetseratu kuti zidzachitike ndi vuto la kufalikira kwa matendawa ndi kusuta fodya, kumwa mowa mwauchidakwa, cholesterol yambiri, cholowa cham'tsogolo, kusowa zolimbitsa thupi, mitsempha yambiri, kusamba. Atherosulinosis obliterans nthawi zambiri amakumana motsutsana ndi maziko a matenda ophatikizika - matenda oopsa, matenda oopsa a shuga (matenda ashuga macroangiopathy), kunenepa kwambiri, hypothyroidism, chifuwa chachikulu, rheumatism. Zinthu zakomweko zomwe zikuthandizira kuchepa kwa maselo a mitsempha ya m'magazi zimaphatikizapo frostbite wam'mbuyomu, kuvulala kwa miyendo. Pafupifupi odwala onse omwe ali ndi atherosulinosis obliterans, atherosulinosis yamitsempha yamtima ndi ubongo amapezeka.

Gulu la osokonezaer a atherosulinosis

Pa nthawi ya kugawanika kwa atherosclerosis yam'munsi, magawo anayi amasiyanitsidwa:

• 1 - Kuyenda wopanda ululu ndikutheka pamtunda wa mamita opitilira 1000. Kupweteka kumachitika pokhapokha ngati muli ndi masewera olimbitsa thupi.
• 2a - kuyenda kosapweteka mtunda wa 250-1000 m.
• 2b - kuyenda kosapweteka mtunda wa 50-250 m.
• 3 - siteji yovuta ischemia. Mtunda woyenda wopanda ululu umakhala wochepera mamita 50. Ululu umapezekanso pakupuma komanso usiku.
• 4 - gawo la zovuta za trophic. M'malo okhala ndi calcaneal ndi zala pali malo a necrosis, omwe mtsogolomo angayambitse chiwalo chamanja.

Popeza kufalikira kwa njira ya ma occlusal-stenotic, zotsatirazi zitha kusiyanitsidwa: gawo la atherosclerosis obliterans la gawo la aorto-iliac, gawo la fem-popliteal, gawo la popliteal-tibial, kuwonongeka kwamitsempha yamagetsi. Ndi chikhalidwe cha zotupa, stenosis ndi occlusion zimasiyanitsidwa.

Kupezeka kwa atherosulinosis obliterans a femal and popliteal mitsempha kumasiyanitsa V mitundu ya Vuto la occlusal-stenotic:

• Ine - ochepa (ochepa)
• II - chotupa wamba cha chotupa chachikulu chachikazi,
• III - kufalikira kwa mafupa am'mimba kwambiri komanso achikazi, dera lomwe limapangitsa kuti mitsempha yodutsamo ndi yotumphukira ndiyotheka,
• IV - kuwonongedwa kwathunthu kwa chotupa chachikazi komanso cham'mimba, kuwonongedwa kwa chotupa cha mtsempha wamagazi, chotupa chamkati mwa mkazi sichimalephera,
• V - chotupa cha stylotic-chotupa cha gawo lazachikazi-popliteal komanso mtsempha wamagetsi wakuya wamkazi.

Zosankha za occlusal-stenotic zotupa za gawo la popliteal-tibial pakutha kwa atherosulinosis zimayimiriridwa ndi mitundu ya III:

• I - kuwonongedwa kwa mitsempha ya popliteal mu distal gawo ndi mitsempha ya tibial m'magawo oyambira, patency ya 1, 2 kapena 3 yamitsempha yam'miyendo imasungidwa,
• II - kuwonongeka kwamitsempha yamagumbo am'munsi, gawo lamkati mwa mitsempha ya popliteal and tibial is passable,
• III - kuwonongeka kwa mitsempha ya popliteal and tibial, magawo a mitsempha ya m'miyendo ndi kumapazi amatha kutha.

Kuneneratu komanso kupewa kuthana ndi vuto la atherosulinosis

Atherosulinosis obliterans ndi matenda oopsa omwe amakhala m'malo achitetezo atatu pamatenda a mtima. Ndi kufooketsa kwa atherosulinosis, pamakhala ngozi yayikulu yotupa, yomwe imafuna kuti dzanja lizidulidwa. Kukula kwa matenda osokoneza bongo a malekezero kumatsimikiziridwa makamaka ndi kupezeka kwa mitundu ina ya atherosulinosis - ubongo, coronary. Njira yolepheretsa atherosulinosis, monga lamulo, siyabwino kwa anthu odwala matenda ashuga.

Njira zopewera kuchitira limodzi ndi kuphatikizira kuchotsa kwa ziwopsezo za atherosulinosis (hypercholesterolemia, kunenepa kwambiri, kusuta, kusachita zina ndi zina, etc. Ndikofunikira kwambiri kupewa kuvulala kwamapazi, ukhondo komanso chitetezo pamiyendo, komanso kuvala nsapato zapamwamba. Maphunziro olongosoka mwatsatanetsatane othandizira kuthana ndi matenda a atherosulinosis, komanso opaleshoni yoyambitsanso panthawi yake, amatha kupulumutsa mwendo ndikuwongolera kwambiri moyo wa odwala.