Systemic kapena generalised atherosulinosis

M'masiku ano, akukulira mokulira za vuto la atherosulinosis ndi kulumikizana kwake ndikupezeka kwa ischemic stroke ndi myocardial infarction. Koma zolembera za cholesterol zimatha kusokoneza mitsempha ya magazi osati mumtima komanso ubongo, komanso ziwalo zina, kusokoneza kugwira ntchito kwa thupi lonse. General atherosulinosis ndi matenda oopsa, chifukwa amatenga ziwiya zambiri m'magulu osiyanasiyana a thupi ndipo zitha kukhala ndi zotsatira zosayembekezereka kuumoyo waanthu.

Kufotokozera za matendawo ndi zomwe zingayambitse mawonekedwe ake

Generalised atherosulinosis ndi njira yomwe cholesterol imayikidwa kukhoma lamkati la mitsempha, chifukwa cha momwe khoma lamitsempha limakhala louma komanso kutsekeka kwake kumatha. Poterepa, kufalikira kwamwazi kumasokonezeka, chifukwa chomwe ziwalo zimadwala ischemia.

Pali zifukwa zazikulu ziwiri zowonekera kwa zolembedwa za atherosulinotic: kuwonongeka kwa intima (mkati mwa mtsempha wamagazi) komanso kuphwanya kagayidwe ka lipid. Cholesterol ndi mafuta ena amamizidwa mu endothelium ya chotengera, ndikupanga maziko a zolembedwa zam'tsogolo. Nthawi yomweyo, kamvekedwe ka khoma lake kamasintha, kamene kamatsogolera pakuchepa kwa lumen. Zotsatira zake, kutuluka kwa magazi kwaphokoso kumawonekera ndipo kusungidwa kwa chotengera kumasokonekera. Chifukwa chake, kupangika kowonjezereka kumachitika, mogwirizana ndi momwe lipid zolembera limakulira, kukulitsa vutoli.

Pali zinthu zambiri zomwe zimathandizira kukulitsa kwa atherosulinosis ndikuwonjezera kudwala kwa wodwala:

• Zaka ndi jenda. Pazowopsa, amuna opitilira 40 ndi akazi opitilira 50 (azimayi achepetsa kupanga kwa estrogen panthawi ya kusintha kwa thupi).
• Khalidweli. Familial hypercholesterolemia ndimatenda amtundu womwe munthu amakhala ndi vuto la lipid metabolism. Kuphatikiza apo, omwe abale awo akudwala matenda a shuga, kunenepa kwambiri komanso atherosclerosis ali pachiwopsezo.
• Zizolowezi zoipa, makamaka kusuta. Zinthu zovulaza zimayambitsa mwadzidzidzi vasospasm komanso kuwonongeka kwa khoma.
• Matenda oopsa. Chifukwa cha kuthamanga kwa magazi, magazi a ziwiya zam'madzi amavulala. Nthawi yomweyo, atherosulinosis imadzetsa kuwonjezeka kwa mavuto ("bwalo loipa" limapangidwa).
• Kuthetsa mtima kwambiri. Catecholamines (mahomoni opsinjika) amalimbitsa kukoka, kupanikizika ndi magazi, kukulitsa kukula kwake ndikupangitsa kupangika kwa magazi.
• Hypodynamia kumabweretsa kuwonjezeka kwa kulemera kwa thupi komanso kudziunjikira kwa lipids.

Kuphatikiza apo, lingaliro la atherosranceosis losadziwika limasiyanitsidwa, momwe sizingatheke kukhazikitsa chifukwa cha mawonekedwe a matenda.

Ndi zizindikiro ziti zomwe zimavutitsa munthuyo komanso momwe angadziwire matenda

Zizindikiro za matenda aliwonse zimayambitsidwa ndi kupezeka kwa mafupa am'madzi ndi kuchepa kwa lumen ya ziwiya. Ndi general atherosulinosis, madandaulo akhoza kuphatikizidwa. Kutengera ndi malo omwe blockage, mitundu yotsatirayi ya pathology imasiyanitsidwa.

• Zizindikiro za atherosulinosis yamitsempha yamutu:
  • chizungulire komanso kuthina kwa ntchentche pamaso pake ndi kusuntha kwadzidzidzi,
  • kudumphira m'magazi,
  • kumva kulira kapena kugona.
  • zithunzi zowoneka
  • kumva kutopa, kukwiya,
  • kusokonekera kwa mawu
  • ischemic stroke.
• Matenda am'mitsempha yama coronary:
  • kupweteka kwa paroxysmal mkati mwa mtima wa angina pectoris,
  • kupuma movutikira
  • electrocardiogram (ECG) ili ndi zizindikiro za ischemia,
  • kupezeka kwa kulephera kwa mtima,
  • zosokoneza pamiyeso ndi kutsika kwa mtima,
  • myocardial infaration.
• Kuwonongeka kwa ziwiya zam'munsi zam'munsi kumakhala kodziwika pang'onopang'ono. Mukamayenda, wodwalayo amamva kupweteka kwambiri, komwe pakapita kanthawi.
• Atherosulinosis ya mitsempha yam'mimba imawonetsedwa ndi kupsinjika kwam'mimba, kuwoneka thukuta lakuzizira, hypotension.
• Matenda a mitsempha ya impso amakhala asymptomatic kwa nthawi yayitali, koma ndi kupitilira kwa kutsata, kulimbikira, kovuta kuchitira matenda oopsa.

Kuzindikira kwa atherosulinosis kumatengera ndi mbiri ya wodwala (kuphatikiza mbiri ya banja), kupezeka kwa zizindikiro zamankhwala, kuyezetsa thupi, komwe kumaphatikizapo palpation, kukondweretsa, ndi kuyeza magazi. Chofunikira ndikuphunzira mbiri ya lipid, yomwe ikuwonetsa kuchuluka kwa cholesterol, triglycerides, kuchuluka kwa mafuta pamagawo angapo.

Kuchokera munjira zoyesera zochitikira zimachitika:

• chifuwa x-ray chotsimikizira kuwerengera kapena aortic aneurysm,
• angiography - kuphunzira mitsempha yamagazi yogwiritsira ntchito sing'anga yosiyanitsa kuti mudziwe kuchuluka kwa kuwonongedwa ndi kugwira ntchito kwa magazi,
• Ultrasound ya mitsempha yokhala ndi dopplerography imawulula komwe kuyang'ana kwa atherosermosis, kupezeka kwa magazi ndi kuwunika kuthamanga kwa magazi,
• ECG yodziwitsa ischemia, arrhythmia, blockade.

Madera azachipatala omwe alipo

Mankhwalawa atherosulinosis yodziwika bwino, njira zosiyanasiyana zimagwiritsidwa ntchito, zamankhwala komanso za opaleshoni, komanso zakudya komanso physiotherapy. Malangizo a mankhwalawa, mankhwala ndi kusankha kwa mankhwalawa amasankhidwa ndi adokotala pazochitika zonse zokha, mankhwala omwe amadzigwiritsa ntchito pakokha sakuvomerezeka.

Chithandizo chamankhwala chimaphatikizapo kumwa magulu otsatirawa a mankhwalawa:

• ma statin ndi ma fiber zimachepetsa kaphatikizidwe ka mafuta awo ("Rosuvastatin", "Atorvastatin", "Clofibrate"),
• nicotinic acid ndi zotumphukira zake zimachepetsa mulingo wa triglycerides, kukhazikitsa muyeso wofunikira wa lipids wapamwamba komanso wotsika,
• ma sequest of bile acids amachotsa m'thupi, kutsitsa mafuta m'thupi,
• mankhwalawa adapangidwanso kuti akonze ma concomitant pathology: antiplatelet agents, antihypertensives, antipyretic mankhwala, etc.

Njira zochizira opaleshoni:

• balloon angioplasty ndi stenting,
• chotupa cham'madzi chodutsa,
• ntchito yomanganso pamitsempha yamagazi (angioplasty, resection ndi ma prosthetics amitsempha yamagazi).

Njira zopangira opaleshoni pamwambazi cholinga chake ndikuchotsa zovuta za njira ya atherosulinotic.

Njira zopangira thupi zimaphatikizapo: mafunde a Bernard, chithandizo cha UHF, ma electrophoresis, malo osambira (hydrogen sulfide, radon), koma magwiridwe ake sanatsimikizidwe mwasayansi. Chofunikira ndi zochizira, kuphunzitsa kuyenda.

Njira yoyamba yokwanira yothetsera vuto la atherosulinosis ingathandize kupewa zovuta zazikulu, ndipo ngati zingatheke, pewani opaleshoni.

Kuneneratu, nthawi komanso moyo wabwino mtsogolo

Kukula kwa wodwalayo kumadalira mwachindunji nthawi yodziwitsa, zovuta za matenda, chithandizo chosankhidwa ndikutsatira malingaliro onse a dokotala. Choyambirira chomwe muyenera kuyamba kuchita kwa wodwala ndikudya moyenera. Ndikofunikira kupatula nyama yamafuta, zakudya zopakidwa, mankhwala okhala ndi mafuta ambiri (ma cookie, makeke, margarine, maswiti) kuchokera muzakudya zanu, pewani kugwiritsa ntchito zopepuka zamafuta (mafuta ophika buledi, makeke apapo, maswiti). M'malo mwake, tikulimbikitsidwa kuti muwonjezere zakudya zamafuta ambiri (masamba, zipatso, buledi wopanda tirigu, chimanga chambiri). Ndikofunika kuwonjezera nsomba zam'madzi zam'madzi, mafuta amitundu yosiyanasiyana (azitona, sesame, mpendadzuwa) patsamba lanu.

Ngati pali vuto la kunenepa kwambiri, muyenera kuchotsa mapaundi owonjezera. Izi zikuthandizani kudya mokwanira komanso kuchita masewera olimbitsa thupi: kuyenda, kupalasa njinga, kusambira. Ndi zoletsedwa kusuta fodya ndi kumwa mowa. Zizolowezi zoipa zimathandizira kukula kwa zolembedwa za atherosulinotic ndipo zimatha kupha.

Ngati malingaliro a dokotala pazamankhwala ndi kusintha kwaumoyo samatsatiridwa, zovuta zotsatirazi ndizotheka:

• myocardial infaration
• sitiroko kapena thirakiti ischemic attack (TIA),
• aneurysm ndi chotupa cha msempha,
• kulumikizana kosalekeza kwa magazi,
• arteriolonecrosis,
• aakulu aimpso kulephera.

General atherosulinosis ndi matenda opita patsogolo omwe amatha kutsogola pamavuto akulu ndi kufa. Kuti muchepetse zoopsa komanso kuti mupewe kuwonongeka kwa mtima kapena sitiroko, muyenera kutsatira zomwe dokotalayu akuwonetsa ndikuwonetsetsa kuti thanzi lanu ndi labwino. Ngakhale pakalibe zizindikiro zazikulu za matendawa, koma kukhalapo kwa zinthu zopangitsa kapena chibadwa, muyenera kupimidwa mayeso, kuwunika kuchuluka kwa cholesterol ndi lipids zina.

Zotsatira zotsatirazi zinagwiritsidwa ntchito kukonzekera.

Zimayambitsa kukula kwa General atherosulinosis

Ndi kusintha kwamitsempha m'mitsempha, wodwalayo nthawi zambiri amakhala ndi vuto la cholowa - milandu ya atherosulinosis pachibale. Ndi vuto la chibadwa, matendawa amakula m'mbuyomu ndipo matendawa amatchuka kwambiri.

Pali kulumikizana pakati pa kuyamba kwa matendawa ndi zaka (kuyambira zaka 45) ndi jenda. Amuna amapezeka ndi matenda pafupipafupi komanso zaka 7-8 m'mbuyomu, koma atatha kusintha kwa kusintha kwa kusintha kwa thupi kwa estrogen mwa akazi amachepetsa, ndipo zoopsa zimafanana.

Zomwe zikutsimikizidwa pakukula kwa atherosulinosis ndi:

• kukoka kwa chikonga (mtima kuphipha, kuchepa kwa cholesterol kagayidwe, kuwonongeka kwa khoma la mitsempha yokhala ndi ma resin ndi chikonga),
• kuphwanya malamulo azakudya (kuchuluka kwa mafuta a nyama komanso kusowa kwa mafelemu amtundu kumayambitsa cholesterol yambiri m'magazi),
• kusowa kwa zochita (kagayidwe kazakudya ndi ma lipid metabolism amachepetsa, zomwe zimayambitsa kunenepa kwambiri, mapangidwe amitsempha yamagazi m'mitsempha yamagazi, shuga),
• kuchuluka kwawonjezereka kumathandizira kulumikizidwa kwamafuta kukhoma lakumaso,
• matenda ashuga, metabolic syndrome ndi kunenepa kwambiri zimawonjezera chiopsezo cha atherosulinosis kasanu,
• matenda opatsirana pafupipafupi, kuledzera kosatha kumawononga makoma amitsempha yamagazi ndikuthandizira kuphatikizika kwa zolembedwa za atherosrance.

Ndipo izi ndizambiri za atherosulinosis ndi cholesterol.

Development ndi kutchukitsa

Zomwe zimayambitsa masinthidwe a atherosselotic m'mitsempha ndikuphwanya kusinthana kwamafuta ndi mapuloteni - kuchuluka pakati pamagawo ambiri a cholesterol m'magazi. Pali owonjezera zamalonda osalimba a lipoprotein ndi kusowa kwa maofesi okhala ndi kachulukidwe kakakulu. Kukula kwa zamatumbo kudutsa m'magawo:

1. Malo amafuta - m'malo omwe amachepetsa kayendedwe ka magazi (mawonekedwe a nthambi) ndikuwonongeka kwa gawo lamkati, ma protein a mafuta ndi mapuloteni a protein amawonekera, amabweretsedwa mkati mwa mtsempha.
2. Kukula kwa minofu yolumikizana ndikupanga zolembera. Zipilala zimamera m'magulu amafuta, zigawo zamagazi zimakhazikika m'malo amisala khoma la mtima. Pakadali pano, mapangidwe a atheromatous ndi otayidwa, amatha kusungunuka.
3. Mphamvu yamchere yamchere - pambuyo pophatikizana ndi kuphatikizika ndi calcium, zolembazo zimakula, pang'onopang'ono kutsekeka kwa magazi kapena zidutswa zake, zimayenda pabedi lamitsempha ndipo zimatseka nthambi zazing'ono.

Kutengera ndi malo poletsa kuyenda kwa magazi, kusintha kwa atherosselotic kumabweretsa matendawa:

• ziwiya zam'mimba - infarction ya myocardial, angina pectoris, mtima
• bongo - encephalopathy, kugunda kwakanthawi, stroko,
• zotengera za mesenteric (mesenteric) - ischemic colitis, enteritis, infarction yamatumbo,
• impso - kulowetsedwa kwa impso, kulephera kwa impso,
• miyendo - interla pakulankhula, gangrene.

Myocardial infarction - chimodzi mwazotsatira za atherosulinosis

Mawonetseredwe azachipatala a matendawa samachitika mpaka mawonekedwe a mitsempha yotsekedwa ndi theka. Mu gawo la asymptomatic, kusintha kwa kapangidwe ka magazi kumatha kupezeka - kuwonjezeka kwathunthu kwama cholesterol ndi zigawo zake zotsika kwambiri. Ndi chiwonetsero cha matenda, zimadutsa ndikuyenda pang'onopang'ono kwa zizindikiro:

1. Ischemia - kusowa bwino kwa magazi kwa chiwalo chomwe chakhudzidwa ndi magazi, kupweteka, kuchepa kwa ntchito panthawi yochita masewera olimbitsa thupi.
2. Thrombonecrosis - kufalikira kwa lumen, zovuta mu mawonekedwe a mtima.
3. Fibrosis - m'malo omwe magazi amayenderera, minofu yolumikizana imamera m'malo othandizira maselo, komanso kufooka kwa ziwalo.

Zizindikiro za atherosulinosis yodziwika bwino

Zizindikiro za atherosulinosis zimatsimikiziridwa ndi komwe kuwonongeka kwa mitsempha:

• coronary - kupweteketsa mtima kwakanthawi kovutikira, kenako ndikupuma, kusokonezeka mu kayendedwe ka mphamvu, kufupika, kulephera kwa magazi,
• aortic (thoracic) - kuwopsa kwa kupweteka kuyambira maora angapo mpaka masiku awiri mpaka awiri ndi kuchuluka kwa nthawi, hypertrophy ya myocardial makamaka mbali yamanzere yamanzere,
• m'mimba msempha - m'mimba kupweteka, kutulutsa, chosakhazikika. Ngati chidikacho chili pamalo opezeka bifurcation, ndiye kuti malekezowo amakhudzidwanso - dzanzi, kutupa, zilonda zam'mimba pakhungu, kupweteka poyenda,
• mesenteric (mesenteric) - kuukira kwa chifuwa cham'mimba (kupweteka kwambiri kwa maola 2 mpaka 3 atatha kudya), kuchepa kutulutsidwa kwa michere ndi kukula kwa matenda otsegula m'mimba, kusanza, nseru, kuchepa kwa chakudya,
• aimpso - kuwonjezeka kwa kukakamizidwa ndi mankhwala, mawonekedwe a mkodzo wa mapuloteni, ma cylinders. Ndi chilonda cham'mimba, kuchepa kwa impso ndi matenda oopsa, pang'onopang'ono, ndi chotupa chamatenda awiri, mawonekedwe owopsa a matendawo amawoneka ndi zovuta,
• bongo - kufooketsa mphamvu yakukumbukira, kukhazikika, kuphunzira, kuchepa kwa luntha, kusintha psyche ndi momwe zimakhalira, kusokonezeka kwa tulo, chizungulire komanso kusakhazikika kwa gait, zotsatira za matenda atherosulinosis ndi ischemic kapena hemorrhagic stroke,
• malekezero ochepa - kulumikizana pang'onopang'ono, dzanzi ndi kuzizira, khungu lowuma, khungu lamanja.

Myocardial hypertrophy - chimodzi mwazizindikiro za atherosulinosis

Zitha kupha

Ndi kupendekera pang'onopang'ono kwa chotengera chifukwa cha kukula kwa cholesterol plaque, wodwalayo amatenga mtundu wa matenda. Amadziwika ndi chitukuko:

• kuperewera kwa zakudya m'thupi
• kusowa kwa mpweya
• kutsika kwa metabolic,
• minyewa yokhala ndi minyewa,
• kuchuluka kwa zolumikizana minofu ulusi ndi sclerosis.

Zovuta za thromboembolism ndi:

• chithokomiro cha ziwalo
• kapangidwe ka aneurysm ndi kupasuka kwake,
• kusokonezeka kwakatundu
• gangrene wa zimakhala za m'munsi malekezero.

Matenda onsewa ndi oopsa m'moyo ndipo, popanda chithandizo chokwanira kapena kuwonongeka kwakukulu, amathera pakufa kwa wodwalayo.

Onani vidiyo yokhudza zomwe zimayambitsa matenda a atherosulinosis, momwe amathandizira komanso chithandizo:

Kuzindikira wodwalayo

Kusintha kwa mitsempha ya mitsempha m'mitsempha yamagazi imatha kuwonetsedwa ndi deta yomwe ipezeka pakuyesa kwa thupi:

• Kutupa kwa m'munsi,
• kupezeka kwa wen thupi, mawanga a cholesterol (xanthomas, xanthelasma),
• khungu lowuma, kusintha kwa ma trophic (ming'alu, zilonda), kusisita,
• kutaya tsitsi
• kunenepa kwambiri kapena kukhumudwa kwambiri,
• kuphwanya miyambo yamkangano wamtima,
• kuthamanga kwa magazi
• ukalamba.

Tsimikiziranini matendawa ndikuzindikira zovuta za atherosulinosis pogwiritsa ntchito njira zothandizira ntchito:

• kuyezetsa magazi - cholesterol yayikulu, triglycerides ndi otsika kachulukidwe lipoprotein maofesi,
• ECG - Zizindikiro za myocardial ischemia, njira zama hypertrophic, arrhythmias ndi contraction, kusintha kwa kapangidwe ka mtima,
• radiography - msempha ndi wamtali, wokulitsidwa pamwamba pomwe panali chidikha, makoma ndi wandiweyani, calcium calcium, pali aneurysms,
• coronarography - m'mitsempha yama coronary, kayendedwe ka magazi kamasokonezeka chifukwa cha kutsekeka, kupendekera,
• angiography kapena rheovasography yam'munsi yam'mphepete - zowunikira zamatumbo zomwe zimapereka minyewa yamiyendo ndizotchinga, hemodynamics imalephera,
• Ultrasound yamitsempha ya impso, mtima, carotid mitsempha - zizindikiro za kuchepetsa, kufooka kwa magazi ndi kusokoneza ziwalo.

Mankhwala

Kuwongolera cholesterol yamagazi, mankhwala omwe ali hypolipidemic angagwiritsidwe ntchito:

• Ma fiber kuti achepetse kupangika kwa mafuta - Trazikor, Lipofen,
• ma statins - ziletsa ma enzyme omwe amaphatikizidwa ndi kaphatikizidwe wa cholesterol (Vasilip, Prazpresp, Leskol, Atokor, Rosucard, Livazo),
• othandizira amafuta a bile omwe amamanga ndikuwachotsa m'thupi, izi zimapangitsa kuti mafuta azichita m'chiwindi - cholestyramine,
• Nicotinic acid, Nicotinamide - kuchepetsa triglycerides ndi otsika kachulukidwe lipoproteins, kuonjezera msinkhu wa kachulukidwe kachulukidwe kamene kamalepheretsa kupitirira kwa atherosulinosis.

Kuphatikiza pa mankhwalawa, amalembera:

• manyanga achomera - Guarem, Beta-sitosterol, amalepheretsa kuyamwa kwa cholesterol m'matumbo ndikuchichotsa m'thupi,
• mafuta osakwaniritsidwa - achulukitse kuchuluka kwa mafuta m'thupi, kumapangitsanso chitetezo cham'mimba mwa mitsempha - Espa-Lipon, Thiogamma, Omacor, Linetol,
• kudyetsa mkati mwake (intima) yamadzi, musalole kuti zolembazo zigwirizane - AEvit, Triovit, Ascorbic acid, Selenium, Endotelon,
• angioprotectors ndi ma microcirculation kukonza - Actovegin, Oxebral, Bilobil, Curantil, Xanthinol nicotinate, Pentilin.

Ngati pakuwopsezedwa kuti magaziwo atha kufooka m'mitsempha ndi magazi kapena mbali ya zolembazo, ntchito zimachitika komwe kumachotsedwa gawo limodzi mwa gawo lamkati la chotengera (endarterectomy) kapena baluni kuti ayikenso, kuti ayikemo. Pokhala ndi chiwopsezo chachikulu chobwera ndi mtima komanso zovuta zake, opaleshoni yodutsa mosavomerezeka imalimbikitsa.

Zakudya za wodwala

Kuti muchepetse kudya mafuta a cholesterol ndi zakudya, muyenera kutsatira malamulo opatsa thanzi:

• Chotsani zakudya zonse zokhala ndi mafuta azinyama (offal, nkhumba mafuta, ng'ombe ndi mutton, broths nyama),
• chepetsa mazira, nyama yofiira, batala, zonona, shuga, makeke,
• lowetsani mndandanda wazakudya zomwe zili ndi lecithin wambiri, yemwe amadziwika kuti ndiwotsutsa wa triglycerides ndi cholesterol - buckwheat, nyemba, tchizi wopanda mafuta, mpunga wa bulauni, mbewu za oatmeal ndi mpendadzuwa.
• onjezani zomwe zili ndi utsi wazakudya - ndiwo zamasamba, zipatso, chimanga, zipatso, buledi, zimathandizira kumanga cholesterol yowonjezera ndikuchotsa m'matumbo, zimapangitsa secretion ya bile,
• gwiritsani ntchito mafuta amasamba monga gwero lamafuta, muli mafuta osakwaniritsidwa omwe amalepheretsa kusintha kwam mitsempha yamagazi.
• kuphatikiza nsomba zam'madzi ndi nsomba zamafuta ochepa m'zakudya, chifukwa chifukwa cha ayodini ndi ma amino acid, lipids, amateteza kagayidwe kamafuta.

Zolemba za matendawa

Chifukwa chapadera cha matendawa, zimakhala ndi zosiyana zambiri kuchokera ku classical atherosulinosis. Chimodzi mwazinthu izi ndi kusadzikayikira pakati pa asayansi chifukwa chake nthendayi imachitika. Amakhulupirira kuti kuwonongeka kwakukulu kwa mitsempha kumachitika chifukwa cha kuwonongeka kwa zipolopolo zamkati mwawo kapena chifukwa chakuthwa kwambiri komanso kuphwanya kwakukulu kwa mafuta kagayidwe. Zinthu zonsezi pamodzi zimatsogolera kuti matendawa ayamba kupita patsogolo.

Kodi ma lipids amachokera kuti m'magazi? Mafuta amalowa m'matumbo ndi chakudya (amathanso kubwera kuchokera mkati, amapangidwa kuchokera ku chakudya chama protein ndi mapuloteni), omwe amawonongeka ndimafuta ndi glycerin, ndipo amaphatikizidwa kukhala lipids m'chiwindi. Zochulukirapo zitha kutengera mitundu itatu:

1. hypercholesterolemia,
2. hypertriglyceridemia,
3. Hyperlipidemia yosakanikirana.

Fomu yotsirizirayi, monga lamulo, sizimachitika mwa iyo yokha, koma imawonekera mwa iwo omwe ali ndi chibadwa cholingalira matendawa. Komanso matendawa amatha kuchitika chifukwa cha moyo. Zambiri zomwe zimapangitsa izi ndi izi:

• kudya kwambiri
• matenda ashuga
• mowa
• kumangokhala
• matenda a chithokomiro
• kugwiritsa ntchito mahomoni a steroid, etc.

Zomwe zimachitika

Choyambitsacho ndi cholesterol yowonjezera, yomwe imawerengedwa kuti ndiyo wothandizira kwambiri atherogenic. Iyo, pamodzi ndi mafuta, imalowetsedwa kukhoma (mkati mwa khoma) la chotengera, kuyala maziko a chidikizo chamtsogolo. Njira yodutsitsa matendawa sikutha pamenepo. Maselo a endothelium ndi minyewa yosalala ya chotengera amasiya kugwira ntchito, kusiya kugwira ntchito zina, zomwe zimapangitsa kutsekeka kwa chotengera, mapangidwe a magazi osasinthika, komanso kuphwanya kwa mkati mwa mizere yamagazi.

Njira yosasinthika imayambitsidwa, yomwe thupi limavuta kusiya. Chifukwa chake, maoda amayesera kutaya mafuta m'thupi komanso mafuta. Koma malembawo ndi akulu kwambiri kotero kuti kuwameza kumabweretsa kufa kwa maselo. Zotsatira zake, zombozi zimayipitsidwanso ndi zinthu zowola. Izi zimapangitsa kukula kwakukulu kwa zolembedwa za atherosselotic onse kukula kwake komanso kukula kwake. Chokhacho chomwe chatsala kuti thupi lipange ndikutseka ndikutseka ndi chipewa cholumikizira, zomwe zimatsogolera pakupangidwe kwa parietal thrombus.

Zinthu zomwe zimathandizira kukulitsa kwa atherosulinosis

Ngakhale zomwe zimayambitsa kuwoneka kwa atherosulinosis yodziwika ndi chitukuko chake sizimamveka bwino, matenda angapo kapena mawonekedwe amachitidwe amadziwika omwe amakulitsa mwayi wa matenda. Izi ndi izi:

1. Kudziletsa. Pali gulu la anthu omwe amatengeka kwambiri ndi cholesterol yowonjezera komanso lipids m'thupi. Awa ndi omwe ali ndi achibale omwe akudwala atherosulinosis, kunenepa kwambiri, matenda a shuga, ndi zovuta zina za lipid metabolism. Vuto la metabolism la anthuwa ndikuti chiwindi sichichita bwino mafuta a cholesterol, motero chimayenda m'magazi, zomwe zimapangitsa mwayi wokhala ndi atherosulinosis.
2. Kusuta ndi zizolowezi zina zoyipa. Mankhwala a narcotic, kuphatikizapo chikonga, amasokoneza mitsempha yamagazi. Chifukwa chake, utsi wa fodya umayambitsa kupindika kwamitsempha yamagazi, yomwe imathandizira kupanga mapangidwe a atherosrance.
3. Kuthamanga kwa magazi. Mokulirapo kukakamira, mphamvu yochulukirapo mtima imakankhira magazi m'matumbo. Chifukwa cha izi, makoma awo owonda komanso osakhwima amavulala, zomwe zimathandizira mawonekedwe a atherosulinosis. Komanso, kupezeka kwa zikwangwani pazotengera kenako kumayambitsa kuwonjezeka, komwe kumakhala "bwalo loyipa".
4. Kupanikizika pafupipafupi ndi kupsinjika. Pakukokomeza, adrenaline imatulutsidwa m'thupi, zomwe zimapangitsa mtima kugunda mwachangu komanso mwamphamvu, ndipo izi zimakulitsa kuthinikizidwa m'matumbo. Kuphatikiza apo, ma catecholamines onse, omwe amaphatikizapo adrenaline, amathandizira magazi. Chifukwa chake, pansi pazinthu zoterezi, magazi amawundana msanga, makamaka ngati pali lipids yambiri, ndipo magazi ndiwakuda.
5. Khalidwe labwino. Kusuntha kosalekeza kumabweretsa kuti mafuta ochulukirapo ndi chakudya amawotchedwa. Koma ngati muleka kusuntha, minofu sidzafunika mphamvu, chifukwa ma lipids ambiri amalowa m'magazi. Mapeto ake, adzayamba kuyanjana m'mapepala ndikuyambitsa matenda a atherosulinosis mthupi.

Njira zopewera

Kupewa kusintha kwa mitsempha ndikofunikira kwambiri makamaka kwa kuchuluka kwa odwala omwe ali pachiwopsezo. Pofuna kupewa zovuta komanso zakupha zina, tikulimbikitsidwa:

• • sinthanso thupi
  • kusiya kusuta
  • pewani zovuta
  • Lolani osachepera mphindi 30 tsiku lililonse kuyenda, kuthamanga, masewera olimbitsa thupi, kusambira,
  • Sinthani zakudya zamafuta ochepa, zakudya zomwe zimakhala ndi mafuta, masamba a masamba m'malo mwa mafuta a nyama, kupatula maswiti,
  • kumwa mankhwala kusintha kagayidwe kachakudya.

Ndipo izi ndizambiri za ma statins mu atherosulinosis.

Atherosulinosis imakhudza mitsempha yama sing'anga komanso yayikulu.Zotsatira zake za cholesterol zimalepheretsa kayendedwe ka magazi ndikuthandizira kukulitsa ischemia kwamkati mwa ziwalo zamkati ndikuyamba kuthana ndi mtima. Mtima, ubongo, malekezero otsika, impso ndi matumbo zimakhudzidwa makamaka.

Matenda a matenda omwe amakhala nawo amasiyana kwambiri ndipo amafunikira chithandizo chovuta kwambiri. Odwala amaikidwa zakudya zapadera komanso mankhwala osokoneza bongo kuti achepetse magazi m'thupi. Mu pachimake komanso kufalikira kwa mtsempha wamagazi, chithandizo cha opaleshoni chimasonyezedwa.

Atherosulinosis yamitsempha yama khosi imakhala ndi zovuta zina kwa wodwala. Ndikofunika kwambiri kuti muchepetse kukula kwa matendawa. Nanga bwanji ngati matendawa ayamba kale?

Mapangidwe a atherosulinotic amapezeka pafupifupi chotengera chilichonse - mu carotid artery, aorta, zotupa za khosi, m'mimba msempha. Amatha kukhala osakanikirana, ophatikizidwa. Zomwe zimayambitsa amana ndi cholesterol yayikulu, cholowa. Chithandizo chitha kuchitidwa ndi njira zina, mankhwala, zakudya. Kuchotsa kumachitika ndi opareshoni.

Cerebral atherosulinosis yamitsempha yama ziwongo imawopseza miyoyo ya odwala. Mothandizidwa ndi munthu, munthu amasintha ngakhale umunthu. Zoyenera kuchita

Ngati atherosclerosis ikuwoneka, ndipo cholesterol satenga nthawi yayitali. Kodi cholesterol imadziwika bwanji? Zoyenera kuchita ukakanidwa?

Pazinthu zingapo, pali kuphwanya mafuta kagayidwe kapena dyslipidemia, chithandizo chomwe sichovuta. Ikhoza kukhala yamitundu inayi, atherogenic, cholowa, komanso gulu lina. Kuzindikira za vutolo kukuthandizani kusankha zakudya. Kodi muyenera kuchita ngati dyslipidemia ndi atherosulinosis, hypercholesterolemia?

Ngati mwadzidzidzi kulira, kupweteka poyenda, ndiye kuti zizindikirazi zitha kuwonetsa kuchepa kwa matenda a m'matumbo am'munsi. Mukadwala matendawa, omwe amadutsa m'magawo anayi, ntchito yodulira ingafunike. Kodi ndi njira ziti zomwe zingagwiritsidwe ntchito?

Chifukwa cha kuchuluka kwa shuga, cholesterol, kuthamanga kwa magazi, zizolowezi zoipa, kufukiza kwa atherosulinosis kumayamba. Ndikosavuta kuzindikira nthawi yayitali ya BCA, mitsempha ya m'mimba ndi carotid, ziwiya zamagawo am'munsi, matenda a ubongo, komanso ovuta kuchiza.

Tsoka ilo, matenda a atherosulinosis oyamba samapezeka nthawi zambiri. Amadziwika m'magawo amtsogolo, pamene zizindikiro za aortic atherosulinosis zikuwonetsedwa m'mavuto azaumoyo akuluakulu. Kodi ma ultrasound ndi njira zina zofufuzira zikuwonetsa chiyani?

Mavuto a atherosulinosis amachitika chifukwa chosagwirizana ndi zomwe dokotala akutsimikiza, chithandizo chamanthawi mothandizidwa. Monga lamulo, zovuta za kubwezeretsa ndi kusasinthika kwa ma atherosrance a ziwiya zamagawo am'munsi ndizosiyana, popeza awa ndi mitundu yosiyanasiyana. Owopsa kwambiri ndi gangore.

Zizindikiro zazikulu za matenda

Kutengera ndi omwe mitsempha yayikulu idakhudzidwa ndi atherosulinosis, mitundu ingapo yamitunduyi imasiyanitsidwa, imasiyana muzolemba:

1. Matenda a mitsempha ya mitsempha. Popeza mitsempha ya mtima imakhudzidwa, zizindikilo zazikulu zimaphatikizidwa ndi kusakwanira kwa magazi ku chiwalo ichi. Monga lamulo, izi ndizopweteka pachifuwa, arrhythmia, mtima pafupipafupi, kulephera kwa mtima, zizindikiro za angina pectoris, infarction ya myocardial ngakhale kufa. Matenda a mtundu uwu ndi oopsa kwambiri chifukwa nthawi zambiri amachitika mwachinsinsi, ndipo madokotala amangolankhula patokha kapena pamapeto omaliza a matenda amamvetsetsa zomwe zili zovuta kwa wodwalayo.
2. Matenda a mitsempha ya brachiocephalic. Mtundu wowopsa wa matendawa, monga momwe ziwiya zoperekera mpweya ku ubongo zimakhudzidwira. Chifukwa chake, Zizindikirozo ndizofanana ndi kuwonetsa kwa ischemic stroke.Uku kumakhala chizungulire pafupipafupi, komanso kuiwalika ndi magazi, komanso kuchepa kwamphamvu kwa miyendo. Zizindikiro zina sizachilendo - kutayika kwamaso, kugona, nseru, kuyamwa, ndi zizindikiro zina zamanjenje. Matenda a atherosulinosis amayambiranso popanda zizindikiro, choncho muyenera kuyang'anira thanzi lanu nthawi zonse kuti mudziwe matenda oyambira.
3. Atherosclerosis ya m'munsi malekezero. Mwa zisonyezo za mawonekedwe awa, m'modzi yekha ndi yemwe angathe kusiyanitsidwa - mawu ena apakati. Izi zikutanthauza kuti mwadzidzidzi kupweteka kumatha kupezeka m'miyendo (kapena miyendo) komwe kumalepheretsa kuyenda, koma pakapita kanthawi kamadutsa. Matendawa ndi owopsa kuposa atherosulinosis ya ziwiya zamkati ndi ubongo, koma amatha kukhala ndi zotsatirapo zake. Chifukwa chake, pakalibe chithandizo, mitsempha imapanikizika kwathunthu, zomwe zimapangitsa kuti miyendo, zilonda, zilonda zam'mimba, kenako zilonda zam'mimba zigwere. Mwa zisonyezo za magawo oyamba, dzanzi la zala, kutopa mosalekeza ngakhale poyenda mtunda waufupi, zilonda zazing'ono zamiyendo m'miyendo ndizodziwika.

Matenda a mitsempha ya mitsempha

Matenda a mitsempha ya brachiocephalic

Atherosclerosis ya m'munsi malekezero

Generalised atherosulinosis ndi kuphatikiza mitundu ingapo ya zotupa zam'matumbo, chifukwa chake zizindikiro zake zimatchulidwa kwambiri.

Wodwala akazindikira zina za matendawa, ndikofunikira kumuyang'ana nthawi yomweyo. Kupanda kutero, atherosclerosis imakula msanga, mpaka zotsatirapo zoyipa kwambiri.

Njira Zodziwitsira

Popeza matendawa samadziwonetsa nthawi zonse, ndikofunikira kugwiritsa ntchito njira zonse zodziwitsira matenda kuti apange kuti matendawo azindikirike molondola komanso asunge zambiri zokhudzana ndi thanzi la wodwalayo. Kuti muchite izi, gwiritsani ntchito izi:

• onetsetsani ngati pali zovuta zina zamafuta a wodwala,
• chitani zowonera X-ray. A aneurysm, calcification, kufupika kapena kukulira kungasonyeze kuyambika kwa matendawa,
• kafukufuku wa angiographic amachitika kuti adziwe kuti ndi ngalawa ziti zomwe zimagwira. Pachifukwa ichi, mumakhala chinthu chapadera - zosiyana, zomwe mutha kuyesa momwe zilili m'mitsempha,
• pamapeto pake, kafukufuku wa ultrasound amachitika ndi sensor ya Doppler, yomwe imalola kuti tipeze osati ngati pali zolemba, komanso komwe zili, komanso momwe zimakhudzira magawo a hemodynamic.

Zachidziwikire, njira zophunzitsira si zonse zomwe dokotala angagwiritse ntchito. Mungafunike njira zonse ziwiri zowunikira, komanso zowonjezereka. Ndipo apa ndikofunikira kuti mudziwe zambiri za matendawa, chifukwa nthawi zambiri zimabisidwa kumbuyo kwa ma pathologies ena, ndipo chithunzi chokwanira chithandizira adotolo kuti azindikire komanso kupereka chithandizo chantchito.

Njira zochizira ndi kupewa

Mukayamba kuchiza matenda a atherosulinosis, ndibwino. Mukazindikira kuti matendawa akudziwika, musazengereze kulandira mankhwalawo, chifukwa tsiku lililonse limawerengeka pankhani zamitsempha yamagazi.

Nthawi iliyonse, zolembera za atherosselotic zimatha kukula, kukhala zigawo zikuluzikulu za magazi, kapenanso kufika paliponse, kudzetsa ngozi yayikulu mumtima mpaka imfa.

Ndipo popeza mtundu uwu wa atherosclerosis umakhudza ziwiya zambiri nthawi imodzi, kuzengeleza kuzikhala koopsa pano.

Mankhwala

Chithandizo chimaphatikizira magawo awiri - kumwa mankhwala osokoneza bongo komanso njira zosagwiritsa ntchito mankhwala. Lemberani mankhwala omwe amachepetsa kuchuluka kwa lipids ndi cholesterol m'magazi. Izi ndizotsatira za bile acid, fibrate, zotumphukira za nicotinic acid. Koma nthawi zambiri amagwiritsa ntchito ma statins, omwe mfundo zake ndi zoletsa kuti mafuta azipangidwe koyambirira.

Mankhwalawa atsimikizira kugwiritsidwa ntchito bwino komanso kwapamwamba kwa atherosulinosis, kusiya mapangidwe. Kuphatikiza apo, zimadziwika bwino ndi thupi ndipo sizikhala ndi zovuta zoyipa.Koma kuti muwonekere, njira ya chithandizo iyenera kukhala yayitali komanso kuyang'aniridwa ndi adokotala.

Mankhwala osagwiritsa ntchito mankhwala

Ngati pali mphindi zina m'moyo wa wodwala zomwe zimathandizira kukula kwa atherosulinosis, ayenera kuchotsedwa. Izi zikutanthauza kuti muyenera kusiya kusuta, zizolowezi zina zoyipa, kusintha kadyedwe kanu, kuyamba kusewera masewera, kukhala moyo wokangalika. Kuphatikiza apo, mutha kugwiritsa ntchito wowerengeka azitsamba (infusions, decoctions, tinctures, mafuta, etc.) mukakambirana ndi dokotala.

Pang'ono pang'ono za matenda ndi malo ake

Matenda aakulu omwe amayamba chifukwa cha cholesterol yayitali amatha kuchitika pazifukwa zosiyanasiyana. Madokotala pakuchitika kwa maphunziro ataliatali afika pakuganiza kuti arteriosulinosis imachitika osati chifukwa cha kuwonongeka kwa lipid metabolism m'thupi, komanso chifukwa cha kuwonongeka kwa makoma amitsempha yamagazi. M'malo otetezeka kwambiri a mitsempha, lipoprotein yotsika komanso yotsika kwambiri imayamba kukhazikika. Popita nthawi, mitundu ya atherosselotic plaque, yomwe imachepetsa pang'onopang'ono magazi Magazi osafunikira kwenikweni komanso michere imabwera ku ziwalo zofunika, zomwe pamapeto pake zimatha kufa mwadzidzidzi.

Ngakhale kuti cholesterol yambiri yomwe imakhudzidwa ndikupanga maselo atsopano, kapangidwe ka mahomoni ndi njira zina zofunika mthupi, zimapangidwa ndi chiwindi, gawo lazakudya siziyenera kuchepetsedwa. Kuchuluka kwa cholesterol yomwe imabwera ndi chakudya kungapangitse kagayidwe ka lipid, zomwe zimayambitsa kukula kwa atherosulinosis. Kuphatikiza apo, zifukwa zikuluzikulu zomwe zimayambitsa matendawa ndi monga:

• kusachita masewera olimbitsa thupi
• kugwiritsa ntchito mankhwala a mahomoni mu Mlingo wolakwika,
• zizolowezi zoipa (kusuta fodya ndi mowa),
• matenda a endocrine
• cholowa choyipa.

Anthu omwe ali ndi abale omwe akudwala matenda a mtima amafunika kuwunika kwambiri cholesterol. Chiwopsezo cha atherosclerosis mwa iwo chikukula ndi 50%.

Kutalika kwakutali kwa cholesterol yamagazi kumawonjezera mwayi wokhala wolimba wa lipoprotein yotsika pazitseko zamitsempha yamagazi. Thupi limayesetsa kulimbana ndi ma neoplasms pamakoma amkati amitsempha, ndikupanga zigawo za minofu yolumikizana. Ichi ndichifukwa chake pali kufupika kwa lumen, ndipo "mzere" womwewo umatha kutuluka, kusunthika komanso kusunthika. Mapeto ake, magazi amayamba mumitsempha yomwe yakhudzidwa, yomwe imatchinga magazi kupita ziwalo zina, miyendo.

Pafupifupi panthawiyi, mapangidwe a atherosulinosis amitsempha yamagazi amachitika. Komabe, odwala omwe ali pachiwopsezo amayeneranso kudziwa lingaliro lotere monga atherosranceosis. Kodi matenda ndi chiyani? Kodi ndichifukwa chiyani matendawa amawonetsedwa ngati chifukwa cha imfa kwa odwala omwe amamwa mankhwala a hypercholesterolemia kwa nthawi yayitali? Zitha kupewedwa, ndipo chifukwa chiyani nthendayi ndiowopsa?

Pomwe zidutswa zonse za utoto zimalembedwa ...

General atherosulinosis ingafanane ndi mosaic, yomwe pakupita miyezi yambiri, kapena ngakhale zaka, adayikidwa palimodzi pa chithunzi chimodzi chachikulu. Choyamba, njira ya pathological imapangidwa mu imodzi mwamitsempha yayikulu - malowa amatchedwa kuyang'ana matendawa. Pambuyo pa izi, mankhwala a cholesterol amayamba kupatsira mitsempha yamagazi imodzi mthupi lonse, zomwe zimapangitsa kuti wodwalayo afe. Tsoka ilo, madokotala sangathe kuthana ndi matendawa, popeza zamatsenga zimayamba mosalamulirika, ndikupangitsa "misewu" yayikulu mthupi ndi ziwalo zofunika.

Monga lamulo, njira ya pathological imayamba mu aorta, pambuyo pake ikhoza kupitiliza kukhala mbali zotsatirazi:

1. Mitsempha yama coronary.Ma lipoprotein mankhwala amatha kukhazikika pamakoma amitsempha yama coronary. Ngati matendawa "adapita" mbali iyi, ndiye kuphatikiza ndi zizindikiro za atortic atherosclerosis, wodwalayo azunzidwa ndi zowawa mu sternum, angina pectoris, palpitations. Ngati sanachiritsidwe, wodwalayo amakhala ndi vuto la mtima, ndipo nthendayo imayamba.
2. Mitsempha yama brachiocephalic. Zowonongeka zamitsempha yamagazi zomwe zimapereka magazi ku ubongo zimadziwika ndi zina. Munthu amakumana ndi mutu, chizungulire, kuchepa kwa zinthu kumachepa, kukumbukira ndi chidwi zimakulirakulira. Kunyalanyaza mankhwala osokoneza bongo ndi chithandizo china kumayambitsa kugwa mwadzidzidzi.
3. Mitsempha yam'munsi. Ndi matenda otere, wodwalayo amayamba kumva kulemera m'miyendo, akudwala kutupa, kusintha kwa kutentha ndi mtundu wa khungu, wokhala ndi matenda amtunduwu. Kutulutsa kwamphamvu kwamitsempha yamagazi kumabweretsa nthawi yayitali ya necrosis ya minofu yofewa, mawonekedwe a zilonda zam'mimba. Pomaliza, wodwalayo ayenera kudula miyendo yomwe ili ndi vuto.

Odwala omwe ali ndi matenda a atherosulinosis yodziwika bwino ayenera kukumbukira kuti ndi matenda omwe samatha nthawi yokha. Pokhapokha ngati pali mankhwala osankhidwa bwino, zakudya, masewera olimbitsa thupi komanso njira zina zowonongera zomwe zingachitike ndizotheka.

Atherosclerosis monga imodzi mwazomwe zimayambitsa kufa kwa munthu

Atherossteosis ndi matenda osachiritsika a endothelium (mkati mwa membrane) wama chotengera chachikulu komanso chapakatikati, chodziwika ndi mawonekedwe a lipid zolembera pa iwo. Kupanga koteroko pang'onopang'ono kumayambitsa kuchepetsedwa kwa lumen ya ziwiya, zomwe zimayambitsa kuperewera kwa gawo lomwe amadya. Kukula kwa atherosclerosis ikhoza kukhala chifukwa chachikulu chokhazikitsira matenda a mtima, stroko, matenda oopsa.

• Gulu la Atherosulinosis
• Zoyambitsa Atherosulinosis
• Limagwirira kukula kwa atherosulinosis
• Zizindikiro za Atherosulinosis
• Matenda a Atherosulinosis
• Chithandizo cha Atherosulinosis
• Mankhwala othandizira
• Kuteteza kwa Atherosulinosis
• Pomaliza

Masiku ano, matenda a atherosclerosis akukhala matenda ofala kwambiri pakati pa anthu otukuka kumene. Malinga ndi ziwerengero, zamatsenga zimakonda kukhudza anthu azaka zapakati komanso zachikulire, ndipo mwa amuna ndizofala kwambiri kuposa azimayi. Ndikofunika kudziwa kuti anthu okhala m'mizinda yayikulu amakhudzidwa kwambiri ndi atherosclerosis, pomwe izi ndizowopsa zomwe zimakhala m'midzi.

Zoyipa za chitukuko cha atherosulinosis zimaganiziridwa zaka zapakati pa makumi asanu, kukhalapo kwa matenda osachiritsika, kusintha kwa metabolic, kusintha kwa chibadwa.

Gulu la Atherosulinosis

Pali magawo angapo a atherosulinosis:

Malinga ndi gulu la ICD 10 (matenda apadziko lonse lapansi), kutengera ndi khoma, zotupa za atherosclerosis zilipo:

• Zombo za Coronary (coronary) - I 25.1.
• Aorta ndi nthambi zake - I 70.0.
• Vasal Vasel - I 70.1.
• Cerebral (ziwiya zamafuta) - I 67.2
• Zombo za Mesenteric (mitsempha yamatumbo) - K 55.1
• Zotengera zamagawo am'munsi (zotumphukira zotumphukira) - I 70.2
• Yodziwika bwino (yofala) komanso yotsimikizika ya atherosulinosis - I 70.9.

Mu gulu la A. L. Myasnikov, kuwonjezera pa mitundu yomwe ili pamwambapa, atherosulinosis yam'mapapo am'mimba imasiyanitsidwa. Cholinga cha mawonekedwe awa ndi kuchuluka kwakanthawi kwa kupsinjika m'mapapu.

Kugawidwa kwa atherosulinosis malinga ndi nthawi ndi gawo la njira yatsatanetsatane:

• 1 nyengo - preclinical (kusowa mawonekedwe awonekedwe):
• Presulinosis (gawo la vasomotor matenda, omwe sanali enieni zizindikiro za kumayambira kwa atherosulinosis).
• Latent atherosclerosis (gawo la zasintha zasayansi).
• Gawo la zizindikiro zosatsata.
• Kwambiri atherosulinosis.

2 nthawi - matenda (kukhalapo kwa chizindikiro cha matenda), komwe kumaphatikizapo magawo atatu a atherosulinosis:

• Gawo la kusintha kwa ischemic.
• Gawo la kusintha kwa necrotic (thrombonecrosis).
• Masintha a fibrotic.

Gawo logawidwa ndi matendawa:

• Gawo lothandizika (atherosranceosis).
• Gawo losagwira (gawo lolimbitsa).
• Gawo lokhumudwitsa (gawo lazikhululukiro).

Zoyambitsa Atherosulinosis

Masiku ano, akatswiri amadziwa zifukwa zambiri zomwe zimayambitsa matenda a atherosulinosis. Amadziwikanso kuti zinthu zowopsa. Pali zosintha zina (zomwe munthu angasinthe) komanso zosasinthika (sizosinthika ndi munthu) zomwe zimayambitsa matenda awa.

Zowopsa zomwe sizingasinthike zimaphatikizapo:

• Kusuta Kugwiritsidwa ntchito kwa ndudu katatu nthawi kumawonjezera mwayi wokhala ndi atherosulinosis, ndipo pambuyo pake zovuta zake. Izi ndichifukwa choti utsi wa fodya, umayambitsa hyperlipidemia (mafupa am'magazi), umathandizira kupanga mapangidwe amitsempha ya mtima.
• Kunenepa kwambiri Izi ndizomwe zimayambitsa kukula kwa matenda oopsa, chifukwa momwe zotanuka zam'madzi zimachepa. Zotsatira zoyipa zoterezi zimapangitsa kuti atherosulinosis ikhale patsogolo.
• Matenda a shuga. Izi matenda amabweretsa kuphwanya lipid kagayidwe - ichi ndi chimodzi mwazifukwa zopanga zolembera.
• Makhalidwe ongokhala. Mkhalidwe wa kusachita zinthu zolimbitsa thupi umaphwanya mafuta okha, komanso kagayidwe kazakudya.
• Zakudya zopatsa thanzi, monga kugwiritsa ntchito zinthu, zomwe zimaphatikizapo unyinji wamafuta am nyama.
• Kusokonezeka kwa mafuta kagayidwe (hyper- ndi dyslipidemia).
• Matenda opatsirana, omwe aphatikizidwa posachedwa m'ndandanda wazowopsa. Nthawi zambiri, atherosulinosis imatha kukhala motsutsana ndi maziko a cytomegalovirus kapena matenda a chlamydial.

Zowopsa zosavomerezeka:

• Paulo Mwa amuna, matenda amtunduwu amayamba kuchitika zaka khumi zapitazo kuposa azimayi, ndipo pofika zaka 50 chiwerengero cha kukula kwake m'magulu onse awiriwa chikufanana. Izi ndichifukwa choti azimayi atatha zaka makumi asanu, kusintha kwa mahomoni kumachitika.
• M'badwo. Maonekedwe a atherosclerosis amadziwika kuti ndi chimodzi mwazizindikiro zoyambirira za thupi la munthu.
• Khalidweli. Atherosulinosis imapezeka pafupifupi 75% ya anthu omwe ali ndi vuto lobadwa ndi matendawa.

Kudziwa zomwe zimayambitsa matenda a atherosulinosis, simungangopereka chithandizo chokwanira, komanso kupewa. Njira zodzitetezera zimaphatikizira kuchotsa ziwopsezo zomwe zingayambitse matenda.

Kodi matenda a atherosulinosis ndi njira yotani?

General atherosulinosis ndi matenda ofala kwambiri. Chaka chilichonse, kuchuluka kwa anthu omwe akudwala atherosulinosis kukukulira.

Ndizofunikira kudziwa kuti, ngakhale zimayambitsa matendawa, zimakula mosiyanasiyana mwa odwala osiyanasiyana. Izi zimasokoneza mayesowo komanso chithandizo chanthawi yake.

Limagwirira kukula kwa atherosulinosis

Lipids monga cholesterol, phospholipids ndi triglycerides amatenga nawo mbali popanga ma atherosulinotic zolembera - chifukwa chake atherosulinosis imadziwika kuti ndi matenda osinthana omwe lipid metabolism imalephera.

Lipids imakhudzanso thupi la munthu. Cholesterol imayikidwa pakuphatikizidwa kwamahomoni ogonana ndi ma acid bile, ma triglycerides ndiye gwero lalikulu lamphamvu kwa thupi, ndipo ma phospholipids amathandizira kukhazikika kwa zimimba zam'mimba.

Gawo limodzi mwa magawo atatu a lipids limapangidwa ndi chiwindi ndi matumbo, ndipo gawo limodzi mwa magawo atatu limalowetsedwa. Mu thupi, limakhalapo molumikizana ndi mapuloteni ndipo amatchedwa lipoproteins.

Mitundu yotsatirayi imasiyanitsidwa:

• Kutsika kwambiri kwa lipoproteins (VLDL).
• Low Density Lipoproteins (LDL).
• High Density Lipoproteins (HDL).

HDL imawonedwa ngati "yabwino" chifukwa imanyamula cholesterol kuchokera ku maselo kupita kuchiwindi komanso imalepheretsa kukula kwa atherosulinosis. "Zoyipa" zimaphatikizapo VLDL ndi LDL, monga momwe zimawerengedwa kuti atherogenic. Dyslipidemia kusintha kosunthira kukuchepa kwa lipoproteins "zabwino" ndikuwonjezereka kwa "zoyipa".

Ngati cholesterol yochulukirapo imachokera ku chakudya kapena imapangika kuposa momwe imakhalira, thupi limapanga mawonekedwe a mawonekedwe ake pazitseko zamitsempha yamagazi.

Nthawi za makulidwe a lipid zolembera:

1. Nthawi yopanga zolembera.
2. Dothi la Lipid (lingabwezeretse).
3. Kusintha kwawoneka bwino kwambiri.
4. Kusintha kwachikale.
5. Nthawi yamatenda oyamba.

Ming'alu, zolembera, zilonda, ("zinyenyeswa" zimayambitsa thromboembolism), kuunikira kwa chotengera kumachepa. Patsamba lochepetsera, pamakhala magazi enaake, ndipo mapulateni olemera amatuluka mumtsempha wamagazi, nakhazikika papulatifomu. Zotsatira zake, dongosolo la kuphatikiza magazi limasokonekera.

Zizindikiro za Atherosulinosis

Pa gawo loyambirira (preclinical), atherosulinosis sikuchitika nthawi yomweyo. Zindikirani mawonekedwe awa ndizotheka pokhapokha mothandizidwa ndi mayeso a labotale. Pang'onopang'ono, kachulukidwe ndi kuwonongeka kwa mitsempha kumayambira (chizindikiro cha nyongolotsi).

Kupitilira apo, chipatalachi chimatengera pomwe panali chotupa:

Kugonjetsedwa kwa mitsempha ya coronary (coronary) kumawonetsedwa ndi zizindikiro za matenda a mtima (coronary mtima matenda):

• kupweteka kumbuyo kwa sternum ndi radiation kumanzere clavicle, nsagwada, tsamba lamapewa, mkono (zizindikiro za angina pectoris),
• tachycardia (kuchuluka kwa mtima),
• tachypnea (kupumira mwachangu),
• chisokonezo,
• kulephera kwa mtima
• matenda a mtima.

Kuwonongeka kwa msempha kumawonetsedwa ndi izi:

• kupweteka kuseri kwa sternum yamitundu ingapo, yowongoka mpaka pamimba, khosi, kumbuyo. (mawonekedwe a ululuwo amasiyana ndi angina nthawi yayitali)
• kukulitsa kwachiwiri kwamitsempha yamagazi.

Kugonjetsedwa kwa mitsempha ya ubongo (zam'mimba) kumadziwika ndi izi:

• kupweteka kosalekeza m'mutu, chizungulire,
• tinnitus
• zosokoneza tulo
• kutopa,
• kusokonezeka kwa kukumbukira
• Choyipa chachikulu, kukula kwa kanthawi kochepa kugwedezeka kapena kupweteka kwa sitiroko.

Zizindikiro zowonongeka pamitsempha ya impso:

• chitukuko cha vasorenal matenda oopsa,
• CRF (kulephera kwa impso),
• Kusintha kwamachitidwe a mayeso a labotale.

Matenda a atherosulinosis a ziwiya am'munsi malekezero (zotumphukira mitsempha):

• mapazi achikazi
• kutopa,
• khungu pakama miyendo,
• trophic khungu kusokonezeka mpaka trophic zilonda.
• Chizindikiro cha kulowerera pang'ono, i.e. kuyima poyenda chifukwa chakumva ululu mwadzidzidzi miyendo.

Chipatala cha mesenteric artery chafotokozedwa:

• kupweteka mwadzidzidzi mukatha kudya, limodzi ndi zizindikiro za dyspeptic (nseru, kusanza),
• mawonekedwe a thrombosis, omwe amachititsa necrosis yamatumbo kapena mesentery,
• chopondapo chopondapo.

Zilonda zam'mapapo am'mimba zimawonetsedwa:

• hemoptysis, yomwe imayamba chifukwa cha kutuluka kwa magazi m'mapapu.
• kutupa kwa miyendo
• chotupa cha chotupa cha m'mapapo,
• kutupa kwa mitsempha ya khomo pachibelekeromo,
• kung'ung'udza kwa mapapo.

Matenda a Atherosulinosis

Kuti mupeze matenda a atherosulinosis, muyenera kuyesedwa. Ndikofunikira kuzindikira mtundu wa matendawa poika chithandizo chamankhwala othandizira, chifukwa munthu aliyense ndi payekhapayekha ndipo mawonekedwe ake akhoza kukhala osiyana. Komanso, pakudziwikitsa, ndikofunikira kudziwa zovuta za matendawa komanso kuchuluka kwa zovuta, zomwe zikulimbikitsidwa kuti zidziwike pakuwonetsa matendawa.

Kuti mudziwe zambiri za matendawa, wodwalayo akulimbikitsidwa kuti adziwe zoyenera kuchita.

Kuzindikira kumakhala ndi njira zofufuza zamankhwala komanso zowonjezera.

1. Kutolere madandaulo. Pochita kuonana ndi adotolo, fotokozerani mwatsatanetsatane zomwe zikukuvutitsani.
2. Kupenda wodwalayo pafupipafupi.Ndi kuyesedwa ndi palpation (palpation), dotolo amawona kuchuluka kwa kachulukidwe ndi kufinya kwa zotengera, momwe zimayambira kutulutsa kwake.
3. Matanthauzidwe ndi kuwerengera kwa zinthu zoopsa pakukula kwa matenda awa. Pakadali pano, muyenera kuuza dokotala za zoyipa zanu zonse.

Zowunikira zowonjezera zimakhala ndi njira zofufuzira zasayansi ndi zothandizira.

• kuyesa kwa magazi kwachemical: atherosulinosis mu biochemistry imawonetsedwa ndi kuwonjezeka kwa cholesterol (oposa 5 mmol / l),
• coagulogram - kuphunzira kwa hemostatic dongosolo, pakuphunzira komwe kuli hypercoagulation (kuchuluka kwa magazi).

• kupimidwa kwamagazi m'mitsempha yamagazi,
• angiography - kufufuza kwa x-ray kwamitsempha yamagazi,
• chifuwa x-ray,
• ECG (electrocardiography),
• malinga ndi zikuwonetsa - kufunsira kwa akatswiri opapatiza (Optometrist, neuropathologist).

Chithandizo cha Atherosulinosis

Chithandizo cha matenda monga atherosulinosis chimakhala chosagwiritsidwa ntchito ndi mankhwala osokoneza bongo.

Mankhwala osagwiritsa ntchito mankhwala ali ndi zinthu zotsatirazi.

Kuthetsa ziwopsezo zomwe zingasinthidwe:

Izi zitha kuchitika mwa kuwona moyo wokangalika, kusiya kusuta fodya ndi zizolowezi zina zoyipa, kuwongolera kunenepa kwambiri komanso kuchepetsa mavuto.

1. Kugwiritsa ntchito zakudya zama calorie otsika (2-2,5 calories patsiku).
2. Kudya zakudya zochepa m'mafuta a nyama ndi mafuta achilengedwe.
3. Kuchepetsa kugwiritsa ntchito zakudya zomwe zimakhala ndi zopatsa mphamvu m'mimba.
4. Kukana chakudya komwe kumakhala ndi cholesterol yambiri.

• Garlic (cloves 2-3 patsiku).
• Madzi anyezi + uchi wa njuchi (katatu pa tsiku).
• Madzi a Aronia (50 ml katatu patsiku, njira ya mankhwala - 1 mwezi).
• A decoction a chamomile ndi motherwort (1 nthawi patsiku m'mawa asanadye).

Mankhwala osokoneza bongo ali ndi magulu otsatirawa a mankhwala:

1. Kukonzekera kwa Nicotinic acid (niacin) - mavitamini PP ndi B3.
2. Fibates - Miskleron, Atromid.
3. Omwe amachokera ku bile acid - "Cholestyramine", "Cholestid".
4. Statins - Atorvastatin ("Liprimar"), Rosuvastatin ("Crestor").

Kodi matendawa amakula pazifukwa ziti?

Choyambitsa chachikulu cha matenda atherosulinosis amaonedwa kuti ndi mafuta ochulukirapo. Mapangidwe a lipids kuchokera ku mafuta omwe amabwera ndi chakudya.

Izi matenda zithandiza kukulitsa chifukwa cha:

1. Zakudya zomwe zimakhala ndi cholesterol yambiri.
2. Kuzunza.
3. Kulemera kwambiri.
4. Kukhala moyo wongokhala.
5. Mowa.
6. Kusuta.
7. Kulandila kwa kukonzekera kwa mahomoni aidididos pamiyeso yayikulu.
8. Kupsinjika kwakanthawi.

Zina zomwe ndizovuta kutengera ndikuphatikizaponso:

• Matenda a shuga.
• Matenda oopsa.
• Zaka zopitilira 40.
• Matenda a chithokomiro.
• Kuperewera kwa mahomoni ogonana mwa akazi.
• Kulephera kwa metabolism pamtundu wa majini pamene cholesterol sichimaphatikizidwa kwathunthu mu chiwindi.
• Kuchuluka coagulability, magazi mawonekedwe.

Pazifukwa zake mwatsatanetsatane

Zina mwazomwe zimayambitsa kukula kwa matendawa zimafunikira kuti tifotokoze mwatsatanetsatane. Chifukwa cha kuchuluka kwa zakudya zamafuta m'zakudya, ma lipids amapangidwa mopanga kwambiri. Amayikidwa osati kokha mu minofu ya adipose, komanso mkati mwa zotengera. Zakudya zambiri zimakhala ndi mafuta omwe thupi sangathe kuyamwa; izi zimayamba chifukwa cha mapangidwe atherosulinotic.

Generalised atherosulinosis (ICD-10 code - I70) nthawi zambiri imapezeka mwa osuta. Chowonadi ndi chakuti pali kudziunjikira kwa zosayipa zoyipa mkati mwa makhoma a mitsempha. Izi zimabweretsa magawo ambiri ogawika ndipo zimakwiyitsa maonekedwe a zolembera.

Ndani wina amene ali pachiwopsezo?

Kwa anthu omwe amasuntha pang'ono, chiopsezo chokhala ndi matenda a m'matumbo chikuwonjezeka kwambiri, izi zimathandizidwa ndi kuchepa kwa mpweya m'thupi. Pakusachita zolimbitsa thupi, magazi amayenda pang'onopang'ono. Kukhuta kwa oksijeni kwa thupi kumawonedwa, chifukwa, njira yamafuta oxidation imavuta.Chifukwa chake, akukhala ochulukirachulukira.

Poyerekeza zakumbuyo ya shuga ndi shuga owonjezera m'magazi, mafuta a metabolism amawonongeka, maselo amawonongeka ndipo matendawa amapezeka. Atherosulinosis yodziwika bwino komanso yosadziwika imasiyana chifukwa chakuti kwachiwiri, zomwe zimayambitsa matendawa sizinadziwikebe.

Kodi zimachitika bwanji?

Zokhudza kuwonongeka kwa thupi ambiri atherosulinosis amapezeka magawo angapo. Popeza lipid ndi mapuloteni a metabolism amakhala ndi vuto lalikulu, izi zimatsogolera pakuphatikizika kwakukulu kwa lipoproteins yotsika. Amakhala ndi cholesterol yambiri "yoyipa", mawonekedwe ake omwe nthawi zambiri amawonedwa pamakoma amitsempha yamagazi.

Ma lipoproteins apamwamba kwambiri, m'malo mwake, amakhala ndi cholesterol "yabwino", amasintha njira yake yoperekera chiwindi.

Kusintha koyipa kwa kagayidwe kamene kumayambitsa kuphwanya kuchuluka kwa phospholipids, cholesterol, komanso mapuloteni.

1. Gawo loyamba - mawonekedwe a mawonekedwe a lipid m'makoma amitsempha yamagazi amadziwika. Zomwe zimakhumudwitsa ndikuphatikizapo microtrauma yamitsempha ndi kutsika kwa magazi. Mothandizidwa ndi iwo, kumasula ndi kutupa kwamakoma a mtima kumachitika. Kuzindikira kwa milomo ya lipid kumatheka pokhapokha ndi maikulosikopu.
2. Gawo lachiwiri ndi liposulinosis. M'malo omwe mumayikamo mafuta, minyewa yolumikizana ndi malo opezeka atherosrance. Ngozi yawo yayikulu ndikuti ikasweka, zonunkhira zam'zombo zimatha kumata ndi zidutswa. Vuto lina ndi magazi omwe amapezeka m'malo omwe amaphatikiza zigawo.
3. Gawo lachitatu limadziwika ndi atherocalcinosis - mapangidwe a pathological amakula. Amasanduka owonda, mchere wa calcium umayikidwamo. Zikwangwani zikamakula, zonenepetsa za ziwiya zimayamba kuchepa, magaziwo amapita ziwalo. Kuphulika kwa chotengera sikuchotsedwa. Chifukwa cha magazi osayenda bwino kupita ku ziwalo ndi minyewa, zovuta monga stroko, vuto la mtima, ischemia yovuta kwambiri yam'munsi.

General atherosulinosis ndi zotulukapo zake ndi gawo limodzi la zochita za thupi, zomwe zimafotokozedwa mu mawonekedwe a matenda a lipid metabolism. Amatchedwanso "lipid nkhawa syndrome."

Pathology

Localization of generalized atherosulinosis (malinga ndi ICD-10 I70) imawonedwa m'mbali zotsatirazi: mu ubongo, khosi, coronary, zotumphukira ziwiya. Pali mapangidwe ofanana a foci a matenda. Chifukwa cha kuwonongeka kwa ziwiya zamagetsi, zinthu zimakhala zovuta kwambiri.

Zomwe akunenedwazo zimakhala zopanda chiyembekezo makamaka, njirayi imayendera limodzi ndi zovuta zambiri. Ngati pali zotupa za zotumphukira, komanso ziwiya zaubongo ndi khosi, ndiye kuti zolembazo zimagawidwa mosagawanika. Ichi ndichifukwa chake m'mimba mwake mwa mitsempha yomwe yakhudzidwa ndiosiyanasiyana pakulidwe.

Kodi matendawa ndi ati?

Generalised atherosulinosis (ICD-10 code - I70) imayendera limodzi ndi zizindikiro zosiyanasiyana. Izi zimatengera mwachindunji kuti ndi ziwalo ziti zomwe zimaperewera oxygen komanso michere.

Chifukwa chake, zotupa zimatha kupezeka mu:

• Zida zaubongo, khosi.
• Aorta.
• Mitsempha yama Mesenteric.
• Zombo za m'munsi.
• Zombo zama coronary.
• Zombo zamalonda.

Kodi matenda a atherosulinosis ndi ati?

Ndi kuwonongeka kwamitsempha yaubongo, kuchepa kwa mphamvu zamaganizo ndi thupi, kusamalira chidwi, kuchepa kukumbukira. Nthawi zina kugona kumasokonekera, chizungulire. M'mikhalidwe yovuta kwambiri, kuthekera kwa kusokonezeka kwa malingaliro, kusokonezeka kwa magazi pachimake muubongo, kukha mwazi, thrombosis sikuchotsedwa.

Ndi maonekedwe a cholesterol malo mu ziwiya za khosi, zizindikiro za kuphwanya magazi kuubongo zimayang'aniridwa, zomwe zimatsagana ndi:

• Kuwonongeka kwamtima.
• Chizungulire.
• Kuperewera koyanjana.
• Mutu.
• Kusokonezeka kwa mawonekedwe, kumva, kuyankhula.

Zizindikiro za kuwonongeka kwa msempha zimaphatikizapo:

• Kuthamanga kwa magazi.
• Zowawa pachifuwa, zikuwoneka kukhosi, m'mimba, mkono, kumbuyo.
• Chizungulire
• Kukomoka.
• Kupuma pang'ono.

Pamaso pa pathological process, aneurysm imachitika (kutulutsa kwa khoma la mtsempha wamagazi).

Kugonjetsedwa kwa sitima zapamadzi kumaonekera:

• Kupweteka pachifuwa.
• Kuchepa kwa mtima.
• Kuukira kwa angina pectoris.
• Zizindikiro zakulephera kwa mtima.

Vuto lalikulu la matenda amtunduwu ndi imfa mwadzidzidzi.

Poyerekeza ndi kukula kwa mapangidwe a atherosulinotic mu mesenteric mitsempha, dongosolo logaya chakudya limasokonekera (izi zikuwonetsedwa ndi kudzimbidwa kapena kutsekula m'mimba, kumatulutsa). Nthawi itatha kudya, kupweteka kwambiri kumawonekera. Nthawi zina wodwala amadwala matenda oopsa.

Pamaso pa atherosselotic amana m'mitsempha yam'munsi, zizindikiro zimayamba monga kutopa kosalekeza, kufooka, kutsika kwa malekezero, kulumikizana kwapang'onopang'ono (kupweteka kumachitika pakuyenda, kumazimiririka pakupuma). Mtsogolomo, kuphwanya khungu la trophic, lomwe limayendera limodzi ndi mapangidwe azilonda. Pali chiopsezo chachikulu cha gangore.

Zotheka ndi zotsatira za atherosulinosis

Zotsatira zazikuluzikulu za matendawa zimawonedwa ngati kupendekera kwa misempha ya mitsempha. Pali magazi osakwanira ku ziwalo, zomwe zimakhala ndi zovuta zotsatirazi:

• Ischemia.
• Hypoxia.
• Wamng'ono lozungulira sclerosis.

Kuchulukitsidwa kwa minofu yolumikizana kumachitika, zonsezi zimaphatikizidwa ndi kusintha kwa dystrophic. Ngati chotengerachi chophimba magazi, embolus, izi zimayambitsa kuperewera kwamisempha kapena vuto la mtima. Choyambitsa chachikulu cha kufa mu atherosulinosis yodziwika bwino ndi kutumphuka kwa aneurysm.

Kufotokozera kwapfupi

Malinga ndi tanthauzo la World Health Organisation: "Matenda opatsirana m'magazi ndi kusintha kosiyanasiyana kwa mitsempha yamkati, kuphatikizira kuchuluka kwa lipids, carbohydrate yovuta, minyewa yotupa, zigawo zamagazi, kuwerengera ndi kusintha kwina pakatikati (media)."

Mu atherosulinosis, mitsempha yamtundu wapakati komanso yayikulu, zotanuka (mitsempha yayikulu, aorta) ndi minofu-zotanuka (zosakanikirana: mitundu ya carotid, mitsempha ya muubongo ndi mtima) zimakhudzidwa. Chifukwa chake, atherosclerosis ndiyomwe imayambitsa kupatsirana kwa myocardial, matenda a mtima, matenda a ubongo

Etiology ndi pathogenesis

Maziko a kusokonezeka kwa metabolic mu atherosulinosis ndi dyslipoproteinemia omwe ali ndi prestinance ya VLDL ndi LDL, zomwe zimabweretsa kusinthanitsa kwa cellular cholesterol (Goldstein ndi Brown receptor theory of atherosulinosis), mawonekedwe a omwe amatchedwa "foamy" cell in the arterial intimaos.

Kufunika kwa zinthu zamagulu am'magazi pakupanga atherosclerosis ndikotsimikiza. Chifukwa chake, matenda a shuga mellitus ndi hypothyroidism amathandizira, ndipo hyperthyroidism ndi estrogens zimalepheretsa kukula kwa atherosulinosis. Pali kulumikizana mwachindunji pakati pa kunenepa kwambiri ndi atherosulinosis. Udindo wa hemodynamic factor (ochepa matenda oopsa, kuchuluka kwa mtima wam'mimba) mu atherogene ndiwosatsutsika. Osatengera mtundu wamankhwala oopsa, njira ya atherosselotic imachulukana nawo. Ndi matenda oopsa, atherosulinosis imayamba ngakhale m'mitsempha (m'mitsempha ya m'mapapo chifukwa cha matenda oopsa a bwalo laling'ono, m'mitsempha ya portal matenda oopsa).
Udindo wapadera mu etiology ya atherosulinosis umaperekedwa kwa zomwe zimayambitsa mantha - zovuta komanso mikangano, zomwe zimagwirizanitsidwa ndi psycho-mtima overstrain zomwe zimayambitsa kuphwanya kwa mitsempha ya neuroendocrine yama protein-metabolism komanso vasomotor zovuta (neuro-metabolic theory of atherosulinosis A.L. Myasnikov). Chifukwa chake, atherosclerosis imawonedwa ngati matenda a kusokosera.
Vuto la mtima, i.e., khoma lamitsempha, limatsimikizira kukula kwa atherosulinosis.Matenda (matenda, kuledzera, matenda oopsa) omwe amatsogolera kuwonongeka kwa khoma (arteritis, plasma akuwuka, thrombosis, sclerosis) ndizofunikira, zomwe "zimathandizira" kupezeka kwa kusintha kwa atherosclerotic. Pankhaniyi, pombietal komanso intramural thrombi, pomwe zolembedwa za atheroscrotic "zidamangidwa" (malingaliro ofikira a Rokytansky-Duged), ndizofunikira posankha.
Ofufuza ena amaphatikizira kufunikira kwakukulu pakukula kwa atherosclerosis pakusintha kwokhudzana ndi zaka khoma lakale ndikuwona atherosulinosis ngati "vuto la zaka", ngati "vuto la gerontological" (Davydovsky IV, 1966). Lingaliro ili silomwe limagawidwa ndi akatswiri ambiri amisala.
Udindo wa cholowa chathu mu atherosulinosis watsimikiziridwa (mwachitsanzo, atherosulinosis kwa achinyamata omwe ali ndi mabanja hyperlipoproteinemia, kusowa kwa aporeceptors). Pali umboni wa gawo lomwe limapangitsa kuti mafuko azikula.
Chifukwa chake, atherosulinosis imayenera kuganiziridwa ngati matenda a polyetiological, kuchitika ndi chitukuko chake komwe kumalumikizidwa ndi mphamvu ya zinthu zakunja ndi zamkati.

The pathogenesis of atherosulinosis

Pathogenesis ya atherosulinosis ndi yovuta. Malinga ndi malingaliro amakono, kupezeka kwa atherosulinosis kumakhazikitsidwa mogwirizana ndi zinthu zambiri za pathogenetic, zomwe zimatsogolera pakupangidwe kwa plaque ya fibrous (yosavuta komanso yovuta).

Pali magawo atatu apamwamba omwe amapanga atherosulinotic plaque (atherogeneis):

1. Kupangidwe kwa mawanga a lipid ndi mikwingwirima (gawo la lipoidosis).
2. Mapangidwe a fibrous plaque (gawo la liposulinosis).
3. Kapangidwe kovuta kwambiri kwa zolengedwa zam'madzi.

Gawo loyambirira limadziwika ndi mawonekedwe ndi mawanga omwe ali ndi lipids mukuyandikira kwa mitsempha.

Mapangidwe a mawola a lipid ndi mikwingwirima

Malo okhala ndi Lipid ndi ochepa (mpaka 1.0-1.5 mm) pamtunda wa aorta ndi mitsempha yayikulu yomwe ili ndi mtundu wachikasu. Malo okhala ndi lipid amakhala ndi maselo a chithovu okhala ndi kuchuluka kwa lipids ndi T-lymphocyte. Pochulukirapo, ma macrophages ndi maselo osalala owoneka bwino amapezekanso. Popita nthawi, mawanga a lipid amawonjezeka, amaphatikizana komanso amapanga zomwe zimatchedwa lipid strips, zikukwera pang'ono pamwamba pa endothelium. Amakhalanso ndi ma macrophages, ma lymphocyte, minofu yosalala ndi maselo a thovu okhala ndi lipids. Pakadali pano pa chitukuko cha atherosulinosis, cholesterol imakhala mozungulira kwambiri ndipo ndi ochepa okha omwe amapezeka kunja kwa maselo. Malo ndi lipid zam'mapapo zimapangidwa chifukwa cha kutsika kwa lipid pamkokomo wa mitsempha. Ulalo woyamba munjira iyi ndi kuwonongeka kwa endothelial ndi kupezeka kwa vuto la endothelial, limodzi ndi kuchuluka kwa zotchingira izi.

Zomwe zimayambitsa kuwonongeka koyambirira kwa endothelial zimatha kukhala zingapo:

1. Mawotchi amakhudzidwa ndi endothelium ya magazi osokonekera, makamaka m'malo a nthambi yama mitsempha.
2. Matenda oopsa oopsa, kuwonjezeka kwa ubweya wa ubweya.
3. Kuwonjezeka kwa magazi a atherogenic tizigawo ta LDL ndi lipoprotein (a), makamaka mitundu yawo yosinthidwa, chifukwa cha lipid peroxidation kapena glycosylation (mu shuga mellitus) ndi mphamvu yotchedwa cytotoxic.
4. Kuwonjezeka kwa ntchito ya sypatadrenal ndi renin-angiotensin machitidwe, limodzi ndi cytotoxic zotsatira za catecholamines ndi angiotensin II pa mtima endothelium.
5. Hypoxia yosatha ndi hypoxemia yamtundu uliwonse.
6. Kusuta.
7. Kuwonjezeka kwa magazi a homocysteine, mwachitsanzo, ndi kuchepa kwa vitamini B 6, B 12 ndi folic acid.
8. Viral ndi chlamydial matenda, limodzi ndi chitukuko cha matenda kutupa mu mtsempha wamagazi.

Zotsatira za kuwonongeka kwa endothelium, kuperewera kwa endothelial kumapangidwa, komwe kumawonetsedwa ndi kuchepa pakupanga zinthu za vasodilating (prostacyclin, nitric oxide, etc.) ndi kuwonjezeka kwa kupanga kwa vasoconstrictor zinthu (endothelin, AII, thromboxane A2, ndi zina), zomwe zimawononga kwambiri endothelium ndikuwonjezera kulekerera kwake. LDL yosinthidwa ndi lipoprotein (a) ndi ma cell ena am'magazi (monocytes, lymphocyte) amalowa m'mitsempha yama cell ndikukumana ndi oxidation kapena glycosylation (zosintha), zomwe zimapangitsa kuwonongeka kwambiri kwa endothelium ndikuthandizira kusamuka kuchokera kumagazi kupita kuzinthu zama cell.

Popita nthawi, maselo a foam amakhala ndi apoptosis. Zotsatira zake, lipids imalowa m'malo amtundu wakunja. Malo a Lipid amawoneka m'mitsempha kuyambira ubwana. Ali ndi zaka 10, mawanga a lipid amakhala pafupifupi 10% ya kum'mawa, ndipo pofika zaka 25 - kuyambira 30 mpaka 50% ya pamwamba. M'mitsempha yama mtima, mtima wa lepidosis umapezeka zaka khumi ndi zinayi, komanso m'mitsempha yamaubongo pakatha zaka 35 mpaka 485.

Mapangidwe a zolembera za fibrous

Pamene pathological process ikupita patsogolo, minyewa yolumikizana yaying'ono imamera m'malo a lipid, zomwe zimapangitsa kuti pakhale mafupa am'mimba, pakati pomwe zimadziwika kuti lipid maziko.

Pa nthawi yomweyo, vasasmization wa malo a atherosulinotic lesion amapezeka. Zombo zatsopano zomwe zimapangidwa zimadziwika ndi kuchuluka kwawonjezereka komanso chizolowezi chopanga micothrombi ndi kupasuka kwa khoma la mtima. Pamene minofu yolumikizira ikayamba kukhazikika, kuchuluka kwa ma cellular kumachepa, ndipo ulusi wa collagen umayamba kulimba, ndikupanga minyewa yolumikizana ya zolembedwa zamtundu wa atherosranceotic zomwe zimalekanitsa pakati ndi lipid pakati ndi lumen ya chotengera ("ling"). Fayilo yokhala ndi ulusi wamkati, imalowerera ndikuwunika kwa chotengera ndikusokoneza kuthamanga kwa magazi mkati mwake.

Kufunika kwapachipatala komanso kupendekera kwa mapangidwe a atherosulinotic plaque kumadalira kapangidwe ka matayala ake am'mimba komanso kukula kwa lipid pachimake. Nthawi zina (kuphatikiza magawo oyambilira opanga zolembera), maziko ake a lipid amawonetsedwa bwino, ndipo kaphatikizidwe kazinthu zowoneka bwino ndi kochepa thupi ndipo kakhoza kuwonongeka mosavuta ndi kuthamanga kwa magazi, kuthamanga kwa magazi mu mitsempha ndi zina. Zolemba zofewa ndi zowonjezera zoterezi nthawi zina zimatchedwa mapepala achikasu. Monga lamulo, iwo amachepetsa lumen ya chiwiyacho pang'ono, koma amagwirizanitsidwa ndi chiopsezo chowonongeka ndi kupukutika kwa kapisozi kakakulu, ndiko kuti, ndikupanga kachipangizidwe kotchedwa "zovuta" ka atherosranceotic.

Nthawi zina (kawirikawiri m'magawo apambuyo pake), matayala am'mimba amamasuliridwa bwino, owonda komanso samakonda kuwonongeka ndi kuwononga. Mapepala oterewa amatchedwa "zoyera". Nthawi zambiri zimatuluka ndikubowoleza m'mimba ndipo zimapangitsa kupendekeka kwakukulu kwambiri, komwe nthawi zina kumakhala kovuta chifukwa cha parietal thrombus.

Magawo awiri oyamba a atherogenesis amathera ndikupanga cholembera chosavuta cha atherosrance. Kupita patsogolo kwa njira ya atheromatous kumayambitsa kupanga "zovuta" atherosulinotic plaque, zomwe zimapangitsa kuti pakhale mawonekedwe a parietal thrombus, omwe angayambitse kutsekeka kwadzidzidzi komanso kowopsa kwa kayendedwe ka magazi m'mitsempha.

Kapangidwe ka "zovuta" zolembedwa

Kupita patsogolo kwa machitidwe a atheromatous kumabweretsa kuti apange "zovuta" atherosulinotic. Gawo ili la atheromatosis limadziwika ndi kuwonjezeka kwakukulu kwa lipid pachimake (mpaka 30% kapena kuposerapo kuchuluka kwa zolembazo), kupezeka kwa zotupa m'mapulogalamu, kupyapyala kwa kapisozi kake kamene kamawononga komanso kuwononga matayala ndikupanga ming'alu, misozi ndi zilonda zam'mimba.Detritus yomwe imagwera mu mtima lumen imatha kuyambitsa embolism, ndipo zilonda zam'mimba zokha zimatha kukhala maziko a mapangidwe am magazi. Gawo lomaliza la atherosulinosis ndi atherocalcinosis, kuchuluka kwa mchere wa calcium m'magulu atheromatous, zinthu zamkati ndi minyewa ya fibrous. Chotsatira chachikulu cha kupangidwa kwa "zovuta" atherosulinotic plaque ndikupanga kwa parietal thrombus, yomwe mwadzidzidzi komanso mozungulira imachepetsa magazi kulowa mumtsempha. Nthawi zambiri, ndi munthawi imeneyi pamene matendawo amawonetsa matendawa chifukwa cha kukokoloka kwa matendawa.

Ichi ndi chiyani

Kuti mumvetse momwe mungathanirane ndi matendawa, muyenera kumvetsetsa - - General atherosulinosis ndi matenda amitsempha omwe ma atherosulinotic plaques amawonekera. Malinga ndi dzinalo, zombo zingapo zimakhudzidwa.

Matendawa amatengera ziwiya za mutu, khosi, komanso ziwiya za m'mitsempha. Potere, zolembazi zimapezeka mosiyanasiyana, ndichifukwa chake zombo zina zimavutika kwambiri kuposa zina.

Kukula kwa matendawa kumachitika m'magawo angapo:

1. Pazotengera m'malo omwe magazi amayenda pang'onopang'ono kapena pali microtraumas, mawanga amafuta amapezeka. Zotsatira zake, makoma azombo amazungulira ndipo amatupa.
2. Lipossteosis Malo okhala ndi lipid amayamba kuchuluka ndi minofu yolumikizana, zolembedwa za atherosclerotic zimawonekera. Kupezeka kwawo m'matumbo kumapangitsa kuti magazi azisokonekera komanso kuti magazi azipanga.
3. Atherocalcinosis. Mchere wa calcium umayikidwa m'mipangiri, lumen ya ziwiya zimachepera, zomwe zimakhudza thanzi la ziwalo ndi minofu. Pali chiopsezo chotchingira chotengera.

Zoyambitsa ndi Zoopsa

Chifukwa chachikulu cha kukhazikitsidwa kwa atherosulinosis yosadziwika mu matenda a metabolic. Ndi chakudya chamafuta ambiri, lipid synthesis yowonjezera imachitika, yomwe imayikidwa osati mu adipose minofu, komanso imakhudza makoma amitsempha yamagazi. Kulephera kuchita masewera olimbitsa thupi komanso kusuta kumangokulitsa zinthu.

Kuperewera kwa oxygen kumapangitsa kuti mafuta asawonongeke. Kuchuluka kwa milomo ndi kutsika magazi pang'onopang'ono kumayambitsanso mawonekedwe a atherosulinotic malo.

Zomwe zimathandizira pakukula kwa matendawa:

• chakudya chamafuta kwambiri
• kudya kwambiri
• onenepa kwambiri
• kusowa zolimbitsa thupi,
• kusuta
• kumwa pafupipafupi
• kupsinjika
• matenda ashuga
• kusokonezeka kwa endocrine,
• matenda oopsa
• magazi okwera kwambiri
• kagayidwe kachakudya matenda, kobadwa nako ndipo mwapeza.

Gulu loopsalo limaphatikizapo anthu azaka zopitilira 40, omwe amakhala moyo wongokhala, wosuta fodya komanso kudya zakudya zamafuta.

Kuwonongeka kwa mitsempha ya brachiocephalic

Nthawi zambiri, ndi chitukuko cha matendawa, mitsempha ya mkati mwa carotid imavutikazomwe zimakhudzidwa mu gawo la proximal.

Kumene amapezeka m'matumbo a khosi ndi m'mutu kumabweretsa chitukuko cha zizindikiro monga:

• kusokonezeka kwa kukumbukira
• mutu
• chizungulire
• kutayika kwakanthawi kwamaso, kumva, kusokonekera kwa mawu,
• kusokoneza kayendedwe ka kayendedwe.

Zofunika! Ngati mukumva zilizonse zomwe zafotokozedwa pamwambapa, funsani dokotala nthawi yomweyo kuti mumupeze.

Njira zochizira komanso kupewa

Nthambi iyi ya zamankhwala ikufuna kuthana ndi zinthu zomwe zimayambitsa kukhazikika kwa mtundu wina wa atherosulinosis:

• kukonza zakudya
• zolimbitsa thupi
• kusiya zizolowezi zoipa,
• Chithandizo cha matenda osachiritsika
• matenda a m'mimba
• kuchepetsa nkhawa.

Zowopsa ndi ziti?

Generalised atherosulinosis ndi matenda oopsa omwe amakhala ndi zotsatira zoyipa. Zombozo zimakutidwa ndi mafelemu amafuta, zokhala ndi minofu yolumikizidwa, ndipo mawonekedwe ake amachepa.

Izi zimabweretsa zovuta zotsatirazi:

• scalosis yaying'ono
• ischemia
• hypoxia
• zilonda zam'mimba
• angina pectoris
• arrhasmia,
• zigawenga
• kutayika kwa kugonana
• kusintha kwa ziwalo zamkati,
• myocardial infaration
• thrombosis
• sitiroko.

Matendawa amakhalanso oopsa chifukwa, chifukwa cha zovuta zomwe zimayambitsa, zimapangitsa kuti vutoli liziwonongeka komanso nthawi zambiri kufa.

Zofunika! Kuletsa kukula kwa atherosulinosis ndikosavuta kuposa kuchiritsa. Osanyalanyaza njira zopewera.

Kupewa azitsamba

Poletsa kupangika kwa cholesterol pamakoma amitsempha yamagazi komanso kukulira kwa atherosulinosis, ndizovomerezeka kugwiritsa ntchito mitundu ina ya mankhwala. Komabe, ndikofunikira kulingalira kuti njira zowerengeka za anthu sizothandiza aliyense, komanso kukhala ndi zotsutsana. Chifukwa Musanagwiritse ntchito njira izi, funsani dokotala.

Zotsatirazi zingakuthandizeni kuchepetsa magazi m'thupi:

1. Imwani supuni zitatu za mafuta masamba tsiku lililonse.
2. Imwani msuzi wa mbatata imodzi m'mawa uliwonse.
3. Sakanizani uchi, mandimu ndi mafuta a masamba mwofanana.
4. Tengani supuni imodzi pamimba yopanda kanthu kamodzi patsiku.

Pomaliza

Generalised atherosulinosis ndi matenda owopsa omwe amatsogolera pakupanga zotsatira zoyipa zambiri, zomwe nthawi zambiri zimabweretsa imfa. Chifukwa chake, ndikofunikira kuyesetsa kupewetsa matendawa. Ngati izi sizingatheke, ndikofunikira nthawi yomweyo kuyamba kulandira chithandizo.

Ngati mukufuna kufunsa akatswiri a tsambalo kapena kufunsa funso lanu, ndiye kuti mutha kuchita kwathunthu zaulere

Atherosulinosis yodziwika bwino komanso yosafotokozedwa (I70.9)

Popanda mawonetseredwe azachipatala a atherosulinosis, kusintha kwa moyo kumalimbikitsidwa kwa wodwala yemwe ali pachiwopsezo chochepa (mpaka 5% pa sikelo ya SCORE) komanso kuchuluka kwa cholesterol yokwanira pamwamba pa 5 mmol / L.

Zimaphatikizapo: kusiya kusuta, kumwa mowa, kudya anti-atherosulinotic, kuwonjezera zolimbitsa thupi.

Mukafika pachimake cholesterol cholephera (cholesterol yokwanira mpaka 5 mmol / L, LDL cholesterol pansi pa 3 mmol / L), kuwerenganso mobwerezabwereza kuyenera kuchitika osachepera 1 zaka 5.

Kuyamba kwa chithandizo kwa wodwala yemwe ali pachiwopsezo chachikulu (pamtunda wa 5% pa sikelo ya SCORE) komanso kuchuluka kwa cholesterol yokwanira 5 mmol / L kuyeneranso kuyamba ndi malingaliro osintha moyo pakatha miyezi itatu ndikuwunikanso koyesedwa kumapeto kwa nthawi yino.

Wodwala akamafika pa cholesterol yokwanira mpaka 5 mmol / L ndi cholesterol ya LDL pansi pa 3 mmol / L, kuwunika kwa lipid kwamtunda kumachitika mtsogolo. Ngati chiwopsezo chikhalebe chokwera (pamwamba pa 5% pa sikelo ya SCORE), mankhwala othandizira ndi mankhwala ndi omwe amapatsidwa.

Odwala omwe ali ndi vuto la atherosulinotic zotupa zamtundu uliwonse amalimbikitsidwa kusintha kwamankhwala ndi mankhwala.

Zakudya za antiatherossteotic

Malangizo omwe amaperekedwa kwa zakudya amaperekedwa kwa odwala onse, poganizira kuchuluka kwa cholesterol ndi zina zomwe zimayambitsa ngozi: kunenepa kwambiri, matenda oopsa, shuga. Zakudyazo ziyenera kukhala zosiyanasiyana, malinga ndi miyambo ya wodwalayo. Zopatsa mphamvu za zakudya za tsiku ndi tsiku ziyenera kukhala zokwanira kukwaniritsa ndi kukhalabe ndi thanzi labwino.

Kudya mafuta okwanira sayenera kupitirira 30% ya zakudya zopatsa mphamvu.
Ndikulimbikitsidwa kuti muchepetse kumwa kwamafuta a nyama (batala, zonona, nyama, mafuta anyama), ndikusintha ndi mafuta a masamba. Zakudya zamtundu uliwonse zamasamba atsopano ndi zipatso ziyenera kukhala zosachepera 400 g patsiku.

Ndikulimbikitsidwa kudya nyama yokhala ndi mafuta ochepa komanso nkhuku yopanda khungu, mankhwala amkaka, tchizi chotsika mafuta, mkate wa chinangwa, chinangwa, zinthu zopangidwa ndi mafuta ω3-osasinthika amafuta achilengedwe (nsomba zam'nyanja ndi nsomba - nsomba, mackerel, tuna, ndi zina). Kuchepetsa kumwa kwa mchere wa 6g patsiku, komwe kumafanana ndi supuni 1 imodzi. Kutsatira zakudya kumatha kuchepetsa cholesterol ndi 10%.

Masewera olimbitsa thupi atherosulinosis

Kuwonjezeka kwa zolimbitsa thupi kumapereka chiyembekezo kwa odwala omwe ali ndi atherosulinosis.
Odwala popanda chiwonetsero cha matenda a atherosulinosis akuwonetsedwa zolimbitsa thupi kwa mphindi 40 tsiku lililonse. Kuchulukitsa kwa katunduyo kuyenera kukhala 60% ya okwera mtima kwambiri (owerengedwa = 220 - zaka).

Odwala omwe ali ndi matenda amtima amafunika kukhala ndi zochita zolimbitsa thupi, mosaganizira zotsatira za mayeso opsinjika. Kuyenda kothandiza, kusambira, kuvina - mphamvu zolimbitsa 60-90 mphindi pasabata. Mitundu ya isometric (yamphamvu) siyololedwa.

Ndikulimbikitsidwa kugwiritsa ntchito mwayi uliwonse wolimbitsa thupi: kuyenda, osagwiritsa ntchito galimoto.

Kusuta kufafaniza

Kusuta (yogwira komanso kungokhala), chifukwa chakuchepa kwambiri kwa HDL (anti-atherogenic class of lipoproteins), zotsatira zamagetsi pamitsempha yamagazi, kuphwanya magazi m'magazi, kumawonjezera chiopsezo cha kuvulala komanso kufa kwa mtima chifukwa cha zovuta zamtima ndi 20%. Osuta amakhala ndi chiopsezo chowirikiza kawiri kupezeka kwa stroke ya ischemic kuposa osuta.

Kumwa mowa

Kumwa mowa mosamala - osapitilira 20-30 ml ya ethanol yoyenera patsiku kwa amuna ndipo osaposa 20 ml patsiku - kwa akazi, kokha kwa anthu athanzi, amachepetsa kufa chifukwa cha zovuta zamtima.

Kumwa mowa (12-24 g patsiku la ethanol yoyera) kumachepetsa chiopsezo cha matenda a mtima (kugunda kwa mtima ndi sitiroko) ndi 20%, ndipo kumamwa mowa wambiri (60 g patsiku) kumawonjezera vuto la mtima ndi 65%.

Kugwiritsa ntchito mankhwala osokoneza bongo, monga cocaine, amphetamine, heroin, kumayambitsa kusintha kwakukulu m'magazi, kusintha kwa kutupa kwamitsempha yamagazi, kumabweretsa kuphwanya kwamatsenga a magazi. Amawonjezera chiopsezo chakuthwa ndi 6.5 mwa anthu ochepera zaka 35, ndi kupitirira zaka 35 - ndi 11.2 zina.

Mankhwala a atherosulinosis

Hypolipidemic mankhwala Muzochita zamankhwala, magulu angapo a mankhwala opatsirana a lipid amagwiritsidwa ntchito: ma statins (HMG-CoA reductase inhibitors), ezetimibe, bile acid sequestrants, fibrate, nicotinic acid ndi zotumphukira zake, Omega-3 polyunsaturated mafuta acids (PUFA), lipase inhibitors ya m'mimba. odwala atherosulinosis nthawi zambiri zotchulidwa statins ndi ezetimibe.

Statins (HMG-CoA reductase inhibitors). .

Statin ndi mankhwala othandizira othandizira HFD IIa, IIb, III phenotypes. Pakadali pano, mankhwala otsatirawa ochokera ku gulu la statin akupezeka: lovastatin (mevacor), simvastatin (Zokor), atorvastatin (Liprimar), pravastatin (Lipostat), fluvastatin (Leskol), rosuvastatin (Krestor). Mankhwala onse otsatirawa ali ndi umboni wotsimikizika.

Intestinal Cholesterol Absorption Inhibitor (ezetemib) .

Ezetimibe (Ezetrol) ndi nthumwi ya gulu latsopanolo la mankhwala ochepetsa lipid. Ndikulimbikitsidwa ngati mankhwala owonjezera a ma statins kuti achepetse cholesterol yathunthu, plasma LDL cholesterol mwa odwala omwe ali ndi mtundu wa IIa, IIb, III hyperlipidemia.

Otsatira a bile acid .

Bile acid sequestrants (ma ion-exchange resins) agwiritsidwa ntchito ngati othandizira kutsitsa kwa lipid kwa zaka zoposa 30. M'mayiko ambiri ku Europe ndi USA, bile acid sequestrants amawonetsedwa ngati zowonjezera kwa main statin chithandizo kwa achibale a hypercholesterolemia.

Fibroic Acid Derivatives (Fibates) .

Ma fibrate omwe amagwiritsidwa ntchito pakadali pano akuphatikizapo gemfibrozil, bezafibrate, ciprofibrate (Lipanor) ndi fenofibrate (Lipantil 200 M, Tricor 145), clofibrate (yotsirizirayi siigwiritsidwa ntchito chifukwa cha zovuta zambiri, makamaka cholelithiasis).Mu mayeso osakhudzidwa, mayesero azachipatala, ma fibrate amachepetsa kufa kwa matenda amtima (pafupifupi 25%), koma zomwezo sizowonjezera monga ma statins.

Nicotinic acid ndi zotumphukira zake .

Niacin (niacin) ndi wa mavitamini a B. Pamiyeso yayikulu (2-4 g / tsiku), niacin imakhala ndi vuto la lipid-kuchepetsa, kutsitsa cholesterol ndi triglycerides ndikuwonjezera cholesterol ya HDL. Ndi mankhwala okhawo omwe amachepetsa kuchuluka kwa lipoprotein - (a).

Omega-3 Polyunsaturated Fatty Acids (PUFAs) .

Omega-3 PUFAs mu waukulu Mlingo (3-4 g / tsiku) amagwiritsidwa ntchito pochiza hypertriglyceridemia (IV-V phenotypes ya hyperlipidemia). Komabe, monotherapy ya hypertriglyceridemia yokhala ndi mankhwalawa poyerekeza ndi kuchuluka kwa mtengo / kuchuluka kwa chithandizo sikokwanira

GIT lipase zoletsa.

Ma inhibitors apadera a m'mimba a m'mimba amaphatikizira orlistat (Xenical). The achire zotsatira za xenical ikuchitika mu lumen m'mimba ndi yaying'ono matumbo ndipo amapanga mapangidwe mgwirizano wolumikizana ndi yogwira serine dera gastric ndi pancreatic lipases. Enzyme yosatsegulidwa nthawi yomweyo imataya mphamvu yake yakuwononga mafuta omwe amabwera ndi chakudya mu formetriglycerides. Popeza ma triglycerides osaphatikizidwa samakhudzidwa, pali kuchepa kwa kuchuluka kwa mafuta ndi zopatsa mphamvu zomwe zimalowa m'thupi la nyama.

Kuphatikiza mankhwala.

Masiku ano, mankhwala ophatikiza amagwiritsidwa ntchito kwambiri, omwe amatilola kukwaniritsa zolinga zathu, koma pamafunika kuyang'anitsitsa wodwalayo ndikuwunika pafupipafupi kwa ma transaminases (AST, ALT) ndi CPK.

Hyperlipoproteinemia	Mankhwala oyambira mzere woyamba	Mankhwala mzere wachiwiri	Kuphatikiza kwa mankhwala
Hypercholesterolemia (mtundu IIa)	Madera	Ezetimibe, nicotinic acid, mafuta omwe amadzaza ma acid	Statin + Ezetimibe
Hyperlipoproteinemia wophatikiza (cholesterol yowonjezereka, kuchuluka kwa triglycerides) (IIb, III, Y mtundu)	Ma Statins, ma fibrate	Niacin, omega-3 PUFAs	Statin + Fibrate Fibrate + Ezetimibe
Hypertriglyceridemia (I, IYtypes)	Fibates, Nicotinic Acid	Statins, omega-3 PUFAs	Fibrate + Statin Niacin + Statin

Chidziwitso: Kuphatikiza kwa ma statins omwe ali ndi fibrate kumawonjezera chiopsezo cha myopathy, kuphatikiza kwa ma statins omwe ali ndi enduracin kumawonjezera chiopsezo cha myopathy ndi kulephera kwa chiwindi, kuphatikiza kwa fibrate ndi enduracin kungayambitse ntchito yotanthauzika ya hepatic. Mankhwala aliwonse omwe amatsitsa lipid makamaka amakhudza kulumikizana kwina kwa lipid ndi lipoprotein metabolism. Mankhwala amatha kuneneratu kuti kuchepa kwa cholesterol ya LDL ndi 55-60% chifukwa chogwiritsa ntchito kwambiri Nyanja statin kapena statin osakaniza ezetimibe chingayambitse ziwiri kuchepa kwa chiwerengero cha zochitika inatsekeratu odwala ndi chiopsezo mtima zabolevaniy.Perspektivy kuphatikiza mankhwala ndi zabwino kwambiri, kupanga kuphatikiza atathana mankhwala osiyana. Ma Statin komanso kuphatikiza kwa ma statins omwe ali ndi ezetimibe makamaka m'munsi mwa LDL cholesterol, samakhudza kwambiri kuchuluka kwa triglycerides, komanso kukulitsa cholesterol ya HDL. Imakhazikika m'munsi triglycerides ndikuwonjezera cholesterol ya HDL, popanda pafupifupi mphamvu ya cholesterol ya LDL. Nicotinic acid imagwira moyenera pazolumikizira zonse za metabolidi ya lipid, koma kugwiritsa ntchito kwake kumakhala kochepa chifukwa cha kuchuluka kwa zotsatira zoyipa. Statins imalepheretsa kukula kwa zovuta zazikulu (myocardial infarction, angina pectoris, sitiroko), ndipo ma fupa amalepheretsa kukula kwa matenda a shuga a diangiicathy (diabetesic retinopathy, diabetes ), chifukwa chake, odwala omwe ali ndi matenda a shuga a 2 komanso odwala omwe ali ndi metabolic syndrome omwe ali ndi vuto lalikulu la hypertriglyceridemia, kuphatikiza kwa ma statins ndi fibrate. Komabe, kuti mutsimikizire phindu la kuphatikiza koteroko, komanso kuphatikiza kwa ma statin omwe ali ndi nicotinic acid, zambiri zowatsimikizira kuchokera ku maphunziro azachipatala zimafunikira.

• Chithandizo cha extracorporeal cha atherosulinosisMilandu yomwe mankhwala ochepetsa lipid amachepetsa mphamvu sagwira mokwanira ndipo / kapena sangathe kufotokozeredwa, amayamba kugwiritsa ntchito mankhwalawa omwe amapezeka mu zipatala zapadera.

Mankhwala othandizira

ndi atherosclerosis, amasonyezedwa milandu yowopsa kapena kukula kwa mitsempha yodutsa mitsempha yokhala ndi chisonyezo kapena thrombus. M'mitsempha, ntchito yonse yotseguka (endarterectomy) ndi endovascular opaleshoni imachitika ndi kuchepetsedwa kwa mitsempha pogwiritsa ntchito balloon catheters ndikuyika stent pamalowo pakutsitsa mtsempha, komwe kumatchinga chotchinga.

Ndi atherosclerosis yayikulu yamitsempha yama mtima, yomwe imawopseza kukhazikika kwa myocardial infarction, aortocoronary bypass opaleshoni imachitidwa.

Multifocal atherosulinotic mtima chotupa: mawonekedwe ndi chithandizo

Matenda a atherosulinotic ndi amodzi mwa matenda owopsa a nthawi yathu. Ngakhale chitukuko chachikulu cha mankhwala, kuchuluka kwa odwala omwe ali ndi atherosulinosis m'zaka zaposachedwa sikunachepe. Kupita patsogolo kwa matendawa kumabweretsa kutsekeka kwa lumen ya ziwiya zikuluzikulu zotsogola, ndichifukwa chake ntchito yathanzi la thupi limakhala losatheka.

Choopsa chachikulu ndi mtundu wa atherosulinosis, womwe wodwala aliyense amatha kuwonetsa, kuwadzetsa mavuto. Gawo lomwe lanyalanyazidwa matendawa limatha kupha.

Zopereka Zambiri

Choyamba, ndikofunikira kudziwa kuti atherosulinosis yodziwika bwino ndi yotani. Chochulukacho ndichomwe chimapangidwira: ndi mtima wam'magazi womwe umatha kulanda mbali zosiyanasiyana za thupi, nthawi zambiri umapanga mbali zingapo za malo osiyanasiyana.

Mtundu wamatendawa uli ndi zinthu zingapo zapadera. Chachikulu ndikusowa kwa zomwe zimayambitsa matenda a mtima. Masiku ano, asayansi azindikira zinthu ziwiri zomwe zimapangitsa kuti matendawa athe:

1. Kuwonongeka kwa zipolopolo zamkati zamitsempha yamagazi.
2. Kuphwanya kwakuthwa kwa mafuta kagayidwe.

Kuphatikizidwa kwa zinthu zomwe zili pamwambazi kumakwiyitsa kudziunjikira kwa lipids, pomwe zolembedwa za atherosulinotic zimakhazikika pamakoma amitsempha yamagazi. Izi zimabweretsa kukula kwa hyperlipidemia, izi mwina zingakhale chifukwa cha chibadwa chamtsogolo.

Pakugawana kwamatenda padziko lonse (malinga ndi ICD-10), matenda am'mimba ali ndi nambala ya 170. Omwe amayambitsa matendawa ndi:

• kudya mwadongosolo,
• kumangokhala
• zizolowezi zoipa (kumwa mowa mwauchidakwa komanso kusuta),
• matenda ashuga
• kugwiritsa ntchito mahomoni a steroid pamtunda waukulu,
• chithokomiro chosokoneza.

Zizindikiro

Zizindikiro za atherosulinosis yodziwika bwino zimadalira komwe anakhudzidwa ndi matendawa. Pamene pathological ikuyang'ana m'dera la mitsempha ya coronary, kupweteka kwa sternum kumachitika, kugunda kwa mtima kosweka, ndipo pamakhala chiwopsezo chodwala. Kukula kwake kwamatenda kumayambira kumapeto kwa zizindikiro. M'magawo oyamba, ndizovuta kudziwa.

Kukula kwa zotumphukira mtima atherosclerosis wodwala zitha kuwonetsedwa ndi kuwoneka kwa ululu waukulu mu sternum poyenda. Chifukwa cha izi, lameness yosakhazikika imachitika. General atherosulinosis ya ubongo ndi khosi amawonetsedwa ndi chizungulire ndikusuntha kwakadzidzidzi kwa thupi. Komanso, magazi a wodwalayo amachepa. Zizindikiro zodziwika bwino za matendawa ndi:

• kufooka miyendo,
• nseru
• mavuto amawonedwe
• dzanzi
• mawu osamveka.

Nthawi zambiri, kuphwanya koteroko, wodwalayo amangosintha maonekedwe a thupi. Ngati matendawa sadziwoneka mwanjira iliyonse, ndiye kuti pakalibe chithandizo chokwanira, kutuluka kwathunthu kwa zotengera kumachitika ndikuwonetsa zizindikiro zoyipa.

Mu magawo apambuyo, mapangidwe otupa miyendo ndi kukula kwa gangrene ndikotheka. Pankhaniyi, wodwalayo amatha kumva kuti ndi otsika m'munsi, kufooka kwa zala, kutopa poyenda.

Njira zamakono zodziwonera

Kuti adziwitse matenda omwe ali ndi vuto lawoli, maphunziro angapo azantchito ndi a labotale ayenera kuchitika. Kuzindikira kwamakono kumakupatsani mwayi wosazindikira mtundu wamatendawa, komanso kudziwa molondola malo omwe akuwunikirayo.

1. Angiography. Njirayi imaphatikizanso kuyambitsa gawo losiyana ndi magazi, chifukwa chomwe makoma a chotengera atsimikiziridwa. Zimakuthandizani kuti mufufuze njira yoyendera magazi, kuzindikira mavuto pang'ono omwe amakumana ndi vuto la kuthamanga kwa magazi.
2. X-ray Kugwiritsa ntchito kuzindikira zovuta ndi kuchuluka kwa aortic stenosis.
3. Ultrasound Cholinga cha njirayi ndikutsimikiza zolembera komanso magazi omwe amasokoneza magazi.

Zomwe zimachitika posagwiritsa ntchito mankhwala osokoneza bongo

Ndi za kukonza moyo. Njira iyi ndiyofunikira pochiza matenda a atherosulinosis, chifukwa popanda kusintha koteroko, njira zina zochiritsira sizingabweretse zotsatira zomwe mukufuna. Kuti muthane ndi matendawa moyenera, wodwalayo ayenera kutsatira izi:

1. Lekani kwathunthu zizolowezi zoipa (kusuta fodya ndi kumwa). Nicotine ndi ethanol zimawononga mitsempha yamagazi.
2. Tsatirani chakudyacho. Chakudya chizikhala chopatsa thanzi komanso chopatsa thanzi, chokhala ndi zipatso, ndiwo zamasamba, mazira, tchizi chinyumba, nsomba ndi nyama yazakudya. Zakudya zamafuta, zokazinga, zosuta komanso zonunkhira ziyenera kutayidwa.
3. Pewani zochitika zovuta. Zokumana nazo zamphamvu zimakhudza mkhalidwe wamtima wamtima.
4. Onjezerani zolimbitsa thupi. Kukhala moyo wongokhala ndiye mdani wamkulu wamtima ndi mitsempha yamagazi.

Zida za opaleshoni

Ngati matendawa ali oopsa, ndipo pali chiopsezo cha zovuta, dokotala amamulembera opaleshoni. Cholinga chake ndikubwezeretsa patency yam'mimba.

Njira yodziwika kwambiri ndiyo kusinthanso mosazungulira. Ndi opareshoni yapadera yomwe imakupatsani mwayi wobwezeretsa magazi m'mitsempha yaying'ono, yophwanyika chifukwa cha zotupa za atherosulinotic. Posachedwa, laser-mtundu revascularization yakhala ikugwiritsidwa ntchito pazolinga izi, kuphatikiza kupanga njira zowonjezera mu myocardium pogwiritsa ntchito laser.

Njira zachikhalidwe zobwezera mtima wamagazi zobwezeretsa ndikuchita opaleshoni yodutsa ndi balloon angioplasty. Koma sikuti amakhala othandiza mu atherosclerosis, ndipo mkhalidwe wa wodwalayo nthawi zonse umakhala wabwino ndi kagwiritsidwe kake.

Wodwala akayamba ischemia motsutsana ndi maziko a matenda oyamba, ndiye kuti pofuna kupewa matenda a mtima, opaleshoni yam'mitsempha yamagazi imagwirira ntchito kapena kuuma. Pofuna kupewa matenda a sitiroko, stenting yamitsempha yamafuta amachitika pochotsa matenda amtundu wa atherosulinosis.

Ngati dokotalayo akuganiza kuti ali ndi miyendo, ndiye kuti wodwalayo amamuika kuti akhale ndi ziwongo kwambiri. Voliyumu yake imatsimikiziridwa payekha, kutengera kuwonongeka kwa bedi lamitsempha.

Zotsatira za matendawa

Ndi chithandizo chosadziwika kapena cholakwika motsutsana ndi atherosulinosis, ma pathologies osiyanasiyana amatha kupanga. Amasokoneza kwambiri matendawa ndipo angayambitse mavuto akulu, ngakhale kufa. Tikulankhula za ma pathologies otsatirawa:

• zilonda zam'mimba ndi zilonda zam'mimba,
• sitiroko, mavuto ndi ubongo
• matenda a mtima, angina pectoris,
• yafupika libido
• mavuto mu ntchito ziwalo zamkati.

Mitundu yokhazikika komanso yosadziwika ya atherosulinosis: ndi chiyani?

Matenda a atherosulinosis ndi omwe amachititsa kuti anthu ambiri aphedwe, chifukwa matendawa amachepetsa ndipo pamapeto pake kutsekeka kwa ziwiya zikuluzikulu za thupi.

Kusintha kwachidziwitso kumayambitsa kusokonekera kwa thupi.

Zowopsa zomwe zimayambitsa thupi ndizolimbitsa thupi kwambiri, zomwe zimapangitsa kuti wodwala yemwe ali ndi matenda awa azitha kufa.

Vutoli ndikuti kusintha komwe kumachitika m'thupi kumabweretsa matendawa mosiyanasiyana mthupi la munthu, ndipo kufalikira kwa nthawi yayitali kumatha kupha.

Doctor of Medical Science, Pulofesa G. Emelyanov:

Ndakhala ndikuchiza matenda oopsa kwa zaka zambiri. Malinga ndi ziwerengero, mu 89% ya milandu, matenda oopsa amachititsa munthu kugunda kwamtima kapena kugunda kwam'magazi ndipo munthu akafa. Pafupifupi magawo awiri mwa atatu a odwala tsopano amafa zaka 5 zoyambirira za matendawa.

Zotsatirazi - ndizotheka komanso zofunikira kuti muchepetse kupanikizika, koma izi sizichiritsa matendawa palokha.

Mankhwala okhawo omwe amavomerezedwa ndi Unduna wa Zaumoyo pa zamankhwala oopsa ndipo amagwiritsidwanso ntchito ndi akatswiri a mtima pantchito yawo ndi awa.

Mankhwalawa amakhudza zomwe zimayambitsa matendawa, zomwe zimapangitsa kuti athetseretu matenda oopsa. Kuphatikiza apo, pansi pa pulogalamu ya feduro, aliyense wokhala ku Russian Federation akhoza kulandira ZAULERE.

Nthawi zambiri, matendawa amakhudza thupi la munthu wokhwima komanso ukalamba.

Zomwe zikukula pamatendawa

Matendawa ali ndi zovuta zosiyanasiyana pakupanga kwake kuchokera ku classical atherosulinosis. Asayansi pakali pano sakudziwa chifukwa chenicheni cha matendawo.

Malinga ndikuganiza kwa ofufuza ambiri, kuwonongeka kwakukulu m'mitsempha yamagazi yamagazi kumayang'ana ngati kuwonongeka kwa zigawo zamkati zamitsempha yamagazi. Komanso, malinga ndi asayansi, chomwe chimayambitsa chitukuko cha matendawa chimatha kukhala kuphwanya kwakukulu kwa njira za lipid metabolism.

Zovuta zonse ziwiri zomwe zimagwirizanitsidwa zimayambitsa kudwala koopsa.

Lipids amalowa m'thupi limodzi ndi chakudya chomwe chimatha. Mafuta amalowa m'matumbo, omwe amapezeka mafuta acids ndi glycerin. M'matumbo a chiwindi, lipids mawonekedwe amthupi amapangidwa kuchokera pazinthu zomwe zimabwera ndi mafuta azakudya. Zowonjezera izi pazomwe zimapanga thupi zimakhala ndi mitundu itatu:

• hypercholesterolemia,
• hypertriglyceridemia,
• Hyperlipidemia yosakanikirana.

Mawonekedwe omaliza nthawi zambiri samadzimanga okha, koma pagulu la anthu omwe ali ndi chibadwa chodziwika bwino matenda.

Chimodzi mwazinthu zomwe zikuthandizira kukulitsa kwa matenda a atherosselotic mu generalization ndikukonzanso moyo wosalondola.

Zomwe zimayambitsa matenda ambiri ndi:

1. Kudyetsa pafupipafupi.
2. Kukula kwa matenda ashuga.
3. Mowa.
4. Amakhala akuwongolera moyo wongokhala.
5. Matenda omwe amaphatikizidwa ndi zovuta pakuchitika kwa chithokomiro.
6. Kugwiritsa ntchito mankhwala okhala ndi mahomoni a steroid.

Tisaiwale za zoopsa za matendawa kuti ziwonekere komanso kukulitsa matendawa, kupezeka kwa matenda oopsa kwambiri mthupi, komanso momwe kupsinjika kwa thupi kumachitika pafupipafupi.

Chofunikira kwambiri chotsogola ndi kupezeka kwa chizolowezi cha chikonga mwa wodwala.

Zizindikiro zamatendawa

Zizindikiro zokhala ndi matendawa zimatengera kwathunthu gawo logawidwa ndi zotupa za kama.

Ngati matenda apezeka m'mitsempha yama coronary, wodwalayo amawona mawonekedwe opweteka m'dera la chifuwa ndi vuto la mtima.

Kuphatikiza apo, vuto la mtima limayang'aniridwa, kulephera kwamtima kumayamba.

Nthawi zambiri, mawonekedwe a matenda omwe amadziwika ndi matendawa amawonekera kumapeto kwa kuthamanga kwa matenda. Gawo loyambirira la matendawo, silimadziwonetsa lokha.

Ndi kupezeka kwa generalised atherosulinosis ya ziwiya za khosi ndi ubongo wodwala, maonekedwe a zizindikiro monga:

• chizungulire chizungulire chomwe chimachitika mwadzidzidzi kayendedwe,
• kutsika kwa magazi
• maonekedwe akumimba m'mizimba yam'munsi ndi kumbuyo kwamiyendo,
• kuyamba kwa nseru,
• Kusintha kwadzidzidzi kwa thupi mlengalenga,
• mawonekedwe a dzanzi,
• maonekedwe osokoneza bongo.

Nthawi zambiri, ndi mtundu wamtunduwu, chizindikiro cha matenda poyambira matendawa chimakhala chosawoneka.

Kwa matenda a atherosclerotic omwe amapezeka m'mitsempha yamafinya ya kayendedwe ka magazi, mawonekedwe a lameness osakhazikika komanso kupweteka kwambiri poyenda ndi mawonekedwe. Ngati mumanyalanyaza zizindikiritso ndi kusowa kwa chithandizo, kupita patsogolo kwa matendawa kumabweretsa kutsekeka kwathunthu kwamatumbo. Izi zimabweretsa kutayika kwa minofu trophism.

Popita nthawi, kupita patsogolo kwa mtundu uwu wa atherosulinosis kumabweretsa kutupa, zilonda zam'mimba ndipo nthawi zina, gangrene.

Pa gawo loyambirira la mapangidwe a matenda, munthu amatha kumva kuzizira kumadera akumunsi, dzanzi la zala, dzanzi lakutsogolo komanso kutopa kwambiri pakayenda.

Njira zodziwira matenda

Kuti mupange kuzindikira koyenera, njira zosiyanasiyana zothandizira kuzindikira matenda a atherosulinosis zimagwiritsidwa ntchito. Kuunika kwa X-ray, angiography, ultrasound. Kuphatikiza apo, adotolo omwe amapezekapo, panthawi ya mayeso, amadziwa mbiri yachipatala ya wodwalayo kuti adziwe kupezeka kwa matenda oyamba mthupi.

Kuunika kwa X-ray kumalola kuzindikira aortic atherosulinosis ndi zovuta mu thupi zomwe zachitika chifukwa cha kupitirira kwa matenda.

Angiography imatha kuzindikira kukhalapo kwa mavuto ndi kukhazikitsidwa kwa magazi m'zigawo zosiyanasiyana zamagazi. Chinsinsi cha njirayi ndikuwunikira komwe kumapita magazi amipanda ina yomwe imakulolani kudziwa momwe makhoma amitsempha yamagazi amathandizira.

Nkhani za owerenga athu

Kumenya matenda oopsa kunyumba. Patha mwezi kuchokera pamene ndayiwala za kupanikizika. O, momwe ndimayesera zonse - palibe chomwe chinathandiza. Ndi kangati kamene ndinapita kuchipatalako, koma ndinalandira mankhwala osapindulitsa kangapo konse, ndipo nditabwerako, madotolo adangokhala osagwirizana. Pomaliza, ndinalimbana ndi ziyesozi, ndipo zikomo zonse. Aliyense amene ali ndi mavuto opsinjika ayenera kuwerenga!

Njira yowunika ya akupanga imapangitsa kudziwa komwe kumakhalapo magazi ndi zikwangwani pakhoma lamitsempha zomwe sizimalola kayendedwe ka magazi kupita ziwalo ndi minyewa.

Atherosulinosis yodziwika bwino komanso yosafotokozeredwa ili ndi code ya ICD ya 10,170.9. Matendawa amtunduwu amakhala ndi liwiro lotsogola motero amafunikira chithandizo chodzidzimutsa. Pakukonzekera chithandizo, njira ziwiri zochizira zimagwiritsidwa ntchito, mankhwala osokoneza bongo komanso osagwiritsa ntchito mankhwala

Pogwiritsa ntchito mankhwalawa, mumagwiritsidwa ntchito mankhwala ena apadera, zomwe zimapangitsa kuti muchepetse cholesterol m'thupi la wodwalayo.

Chifukwa chakuti atherosulinosis ndi njira yodwala yomwe imayamba m'thupi la wodwalayo, mankhwalawa amayenera kumwa mankhwalawa kwa nthawi yayitali malinga ndi malingaliro omwe dokotala amawunikira.

Kugwiritsa ntchito njira yosagwiritsa ntchito mankhwala osokoneza bongo kumaphatikizapo kusintha kwa moyo wa wodwalayo. Kukana kumwa mowa ndi kukana kwathunthu zoyipa.

Mwa lingaliro la adotolo, njira zina zamankhwala ngati zingagwiritsidwe ntchito. Chifukwa chaichi, mitundu yosiyanasiyana ya mankhwala osakanikirana ndi mankhwala ochokera kuzomera zamankhwala ndizophatikizira zovuta zimakonzedwa.

Mukamalosera za chitukuko cha matendawa, kukula kwa matendawa, nthawi yomwe imadutsa komanso kupezeka kwa thupi pamavuto oyambitsidwa ndi atherosulinosis.

Zomwe zimapangitsa kuti matendawo azikhala ndi okosijeni komanso zinthu zina zofunikira zimasokonekera.

Ngati matendawa ayamba kuthandizidwa munthawi yake, ndiye kuti matendawo ndi abwino, munthu amatha kutha kuwongolera matendawa nthawi yamankhwala.

Matenda a mtima komanso mikwingwirima ndizomwe zimayambitsa pafupifupi 70% ya imfa zonse padziko lapansi. Anthu asanu ndi awiri mwa anthu khumi amafa chifukwa chotseka mitsempha ya mtima kapena ubongo.

Choyipa chachikulu ndikuti anthu ambiri saganiza kuti ali ndi matenda oopsa. Ndipo amaphonya mwayi wokonza kena kake, kumadzipangitsa kufa.

• Mutu
• Zosangalatsa pamtima
• Madontho akuda patsogolo pa maso (ntchentche)
• Kupanda chidwi, kusakwiya, kugona
• Masomphenya opanda pake
• Kutukwana
• Kutopa kwambiri
• Kutupa kwa nkhope
• Nambala komanso chala chala
• Kupanikizika kumapitilira

Ngakhale chimodzi mwazizindikirozi chikuyenera kukupangitsani kuganiza. Ndipo ngati pali awiri, musazengereze - muli ndi matenda oopsa.

Momwe mungathanirane ndi matenda oopsa pakakhala kuchuluka kwa mankhwala omwe amawononga ndalama zambiri?

Mankhwala ambiri sangachite bwino, ndipo ena amatha kupweteketsa! Pakadali pano, mankhwala okhawo ovomerezeka ndi Unduna wa Zaumoyo pa mankhwalawa ndi awa.

Kuti Institute of Cardiology, pamodzi ndi Unduna wa Zaumoyo, ikuchita pulogalamuyi “ wopanda matenda oopsa". Momwe mankhwalawo amapezeka ZAULERE, onse okhala mumzinda ndi dera!

Kodi matendawa amapezeka bwanji?

Kuzindikira kwa atherosulinosis yodziwika bwino kumapangidwa malinga ndi madandaulo komanso zotsatira za kafukufuku.

Kuti muwone tanthauzo la zizindikiro zowonongeka m'mitsempha, kuyesedwa kwapadera kumachitika panthawi ya:

• Kuchepetsa thupi.
• Kudzisunga.
• Zovuta za trophic.
• Kukhalapo kwa wen.

Kukopa kumachitika, pomwe dotolo amamvera zochitika zaphokoso zomwe zimachitika m'thupi la wodwalayo. Kupezeka kwa manong'onong'ono a systolic, kusintha kwa pulsation m'matumba kungalankhule za matenda.

Monga kupezedwa kwa lipid nkhawa syndrome, kuyesa kwamwazi wamagazi kumayikidwa. Ndi mawonekedwe apadera a matendawa, cholesterol yayikulu, kupezeka kwa osachulukitsa lipoproteins, komanso triglycerides amapezeka.

Amawunikiranso chiwindi, ma microbiosphere am'mimba omwe amagaya (amapanga Coprogram, kafukufuku wa bacteriological).

Njira Zothandiza Kudziwitsa

Njira zothandizila kudziwa matenda anu ndi monga:

1. Angiography.
2. Mbiri.
3. Aortography.
4. Ultrasound
5. Kusintha kopanga.

Chifukwa cha zisonyezo zosiyanasiyana, kuyezetsa kokwanira kumakhazikika.

Chithandizo cha matenda

Malinga ngati matendawa adapangidwa molondola komanso chithandizo chamankhwala chikuyambitsidwa munthawi yake, kuwongolera koyenera kwa wodwalayo kutha kuchitika. Koma ngati mawonekedwe a general atherosulinosis (code malinga ndi ICD-10 I70) atasiyidwa, matendawa amathandizidwa kwambiri. Mankhwalawa amachitidwa motsimikiza komanso mokakamiza.

Njira yokhazikika ndiyo kugwiritsa ntchito mankhwala a hypocholesterolemic, omwe cholinga chake ndi kutsitsa cholesterol yamagazi.

Mankhwala omwe amakonda kutumizidwa nthawi zambiri monga:

• Omwe amachokera ku bile acid ("Cholestyramine", "Colestipol").
• Nicotinic acid ("Enduracin", "Acipimox", "Niceritrol").
• Statins ("Simvastatin", "Lovastatin", "Pravastatin", ndi zina).

Ngati atherosulinosis yokhala ndi zigawo zam'munsi zimayang'aniridwa, mankhwala amathandizidwa kuti akhale ndi kamvekedwe ka minyewa komanso kusintha kagayidwe kazinthu zazikulu. Mlingo, nthawi ya kukonzekera imatsimikiziridwa ndi dokotala.

Chifukwa cha chithandizo chosagwiritsa ntchito mankhwala osokoneza bongo, zomwe zimayambitsa ngozi zazikulu zimachotsedwa. Izi zikuphatikiza:

• Kusintha kwa moyo.
• Matenda a kulemera.
• Kuchulukitsa zolimbitsa thupi.
• Kusiya zizolowezi zoyipa.
• Kuwunika ntchito yam'mimba.
• Kupewa kupsinjika.
• Chithandizo cha matenda ophatikizika (matenda oopsa, matenda ashuga).

General atherosulinosis imathandizidwanso opaleshoni. Chikwangacho chimachotsedwa, stent imayikidwa mu lumen ya chotengera, lumen ya chotengera imatsitsidwa, etc. Chifukwa cha izi, chiwopsezo cha chimphona cha coronary syndrome kapena sitiroko chimachepetsedwa.

Mankhwala mothandizidwa ndi njira zosakhudzika amaloledwa, koma kufunsira kwa akatswiri ndikofunikira.

Makamaka, ndimatenda otere, mankhwala achikhalidwe amalimbikitsa kudya matebulo atatu patsiku. supuni ya mafuta masamba kapena chakumwa m'mawa madzi a 1 mbatata.

Osakaniza bwino uchi, mandimu, mafuta a masamba, otengedwa chimodzimodzi. Chidacho chikuyenera kugwiritsidwa ntchito nthawi 1 patsiku (m'mawa pamimba yopanda kanthu) pa tebulo limodzi. supuni.

Chofunikanso kwambiri ndi kusunga chakudya chokwanira. Zogulitsa zamafuta amanyama sizipezeka muzakudya zokha:

• Mafuta onenepa.
• Mafuta.
• Zakudya zakusuta.
• Zoyipa.
• Zakudya zamatenda.
• Msuzi ndi nyama.
• Batala.
• Wowawasa zonona.
• Masoseji.

Zakudya zamafuta zosavuta ndizofunikira kupatula (ufa ndi zotsekemera). Kugwiritsa ntchito mayonesi, zakumwa zina za khofi ndizoletsedwa. Palibe mchere wopitilira 4 g womwe ungagwiritsidwe ntchito patsiku.

Njira zopewera

Kupewa kwa ma atherosulinosis ambiri kumaonedwa ngati kutsatira malamulo osavuta. Ndikofunikira kukhala ndi moyo wathanzi. Kuletsedwa kumaphatikizapo mowa ndi fodya.

Kuchita masewera olimbitsa thupi kumagwiritsidwa ntchito kuthandiza thupi kuti lichotse cholesterol yowonjezera, mafuta. Mutha kuchita masewera olimbitsa thupi, kusambira, kuthamanga kapena kumangoyenda. Maola okwanira patsiku. Mitundu yambiri imachepetsa chiwopsezo cha matenda opatsirana mosiyanasiyana, kusintha ntchito yam'kati, kumathandizira kulemera.

Chaka chilichonse, ndikofunikira kuyang'ana magazi kuti athe kuwongolera mahomoni, kuphatikizapo omwe ali m'gulu la steroid. Amathandizira kukulitsa cholesterol.

Ndikofunikira kuthana ndi chithandizo cha matenda ophatikizika (matenda ashuga, matenda oopsa). Zinthu zopsinjika ziyenera kupewedwa. Njira zonse zodzitchinjiriza ndizofunikira kwa anthu azaka zopitilira 50.

Zinthu ndi magulu oika pachiwopsezo

Zowopsa za Atherosclerosis

Zosasinthika

• M'badwo
• Gender (amuna amadwala atherosulinosis nthawi zambiri)
• Matenda a kubadwa - mbiri yabwino yabanja lakukhazikitsidwa kwa atherosulinosis

Chosintha

• Kusuta
• Matenda oopsa
• Kunenepa kwambiri

Zitha kusintha kapena pang'ono

• Hyperlipidemia - hypercholesterolemia ndi / kapena hypertriglyceridemia
• Hyperglycemia ndi matenda ashuga
• Mitundu yotsika kwambiri ya lipoproteins yapamwamba

Zina zomwe zingachitike
Zochita zolimbitsa thupi
Kupsinjika kwa m'maganizo ndi / kapena mtundu wa T

Kuzindikiritsa magulu omwe ali pachiwopsezo mwa odwala popanda chiwonetsero cha matenda a atherosulinosis. Chiwopsezo cha odwala chitha kutsimikizika pogwiritsa ntchito kuchuluka kwa SCORE (kuwunika kwazomwe zimayambitsa matenda a coronary), omwe angagwiritsidwe ntchito poyerekeza kuwonongeka kwa zochitika zam'mtima zokhudzana ndi matenda osokoneza bongo (infarction, myocardial infarction, stroke) zaka zoposa 10. Chiwopsezo chochepa - 8%.

Zizindikiro, kumene

Zizindikiro zamatenda a atherosulinosis zimawonekera pang'onopang'ono pang'onopang'ono kwa lumen chifukwa cha kukula kwa cholembera cha atherosulinotic, pamene magazi atayika ndi 50-70%.

Kutengera kutchukitsidwa mu mtima, atherosulinosis ndiye maziko a matenda otere:

1. Coronary matenda a mtima (angina pectoris, kulowerera m'mitsewa yamtima, kufa kwadzidzidzi kwamtima, arrhythmias, kulephera kwa mtima).
2. Cerebrovascular matenda (kufupika kwa ischemic, ischemic stroke).
3. Atherosclerosis yamitsempha yam'munsi yopanda malire (kupindika pang'ono, kuphwanya kwamiyendo ndi miyendo yotsika).
4. Atherosulinosis ya msempha.
5. Atherosclerosis ya mitsempha ya impso.
6. Atherosulinosis ya mesenteric artery (matumbo infarction).

Matenda a mitsempha ya mitsempha ali ndi zizindikiro zambiri, kutengera kuuma kwa atherosulinosis, yowonetsedwa ndi angina pectoris kapena kuperewera kwa mphamvu ya m'magazi, yodziwika ndi kukhazikika kwa kulowerera kwa mtima, kuchepa kwa mtima. Mitundu yonse yamatenda a mtima yapamtima imachitika motsutsana ndi maziko a atherosulinosis. Pafupifupi theka la zotupa zonse za atherosulinotic zimayambitsa matenda a mtima.

Aortic Atherosulinosis nthawi zambiri amawonetsedwa zaka 60. Ndi atherosulinosis ya thoracic aorta, kupweteka kwakukulu kumawoneka kumbuyo kwa kumbuyo, kufalikira mpaka khosi, kumbuyo, pamimba. Ndi masewera olimbitsa thupi komanso kupsinjika, ululuwo umakulirakulira. Mosiyana ndi angina pectoris, kupweteka kumatenga masiku, kumachulukana komanso kufooka. Kusokonezeka kwa kumeza, kulephera kwa mawu, chizungulire, kukomoka kumatha kuwonekera. Atherosulinosis ya m'mimba msempha amakhala ndi ululu wam'mimba, bloating, kudzimbidwa. Pankhani ya atherosclerotic lesion of aortic bifurcation (malo ogawika kwa msempha kukhala nthambi), vuto la Lerish limayamba ndi mawonekedwe monga kupatsirana pang'ono pang'ono, kuzizira kwa malekezero ena, kusabala, zilonda zam'mapazi. Vuto lalikulu la atherosulinosis ya msempha ndi aneurysm (stratization) ndi chotupa cha msempha.

Atherosulinosis yamatumbo a mesenteric kuwonetsedwa ndi ululu wowonda, wowotcha, wodula m'mimba nthawi yachakudya, maola 2-3

Pa matenda a mitsempha ya mitsempha kuchuluka kosalekeza kwa kuthamanga kwa magazi, kusintha pakuwonetsa mkodzo ndi kakhalidwe.

Atherosulinosis ya zotumphukira mitsempha kumawonetsedwa ndi kufooka komanso kutopa kwa minofu ya mwendo, kumva kudzikundika miyendo, kusinthana ndi lameness (kupweteka m'miyendo kumawoneka poyenda, kukakamiza wodwala kuti ayime).

Laborator diagnostics

1. General cholesterol - mu ntchito, njira ya enzymatic, njira yamafotokozedwe, zomwe zimachitika mpaka 5.17 mmol / l, mtengo wamalire ndi 6.2, mkulu - woposa 6.2. Kukhazikika panthawi yosungirako seramu kwa maola 24, mulingo wake sukutengera nthawi yakudya, masana msinkhu wake ndi wokhazikika. Cholinga cha chithandizo cha statin ndi kuchepa kwa zosakwana 4.5 mmol / L.
2. TG ndi njira ya enzymatic, mtunduwo umakhala mpaka 2.3 mmol / l, mtengo wamalire umakhala mpaka 4.5, ndipo mtengo wake umaposa 4.5. Kusungidwa kwa Serum kumaloledwa mu mawonekedwe achisanu, kusonkhanitsa magazi - mosamala pambuyo pakusala kwa maola 12 (kupewa mafuta ochulukirapo a chisonyezo chifukwa cha kufupika kwa XM m'magazi). Pali mizere ya circadian - osachepera maola atatu, okwanira maola 15.
3. LDL, HDL, VLDL - njira yotchulira ndi ultracentrifugation, ELISA, ma gel electrophoresis amagwiritsidwa ntchito pazasayansi, pochita, magulu azachipatala amatsimikiziridwa ndi kuchuluka kwa cholesterol yomwe ilimo, popeza izi ndi njira zachangu, zotsika mtengo komanso zosavuta kugwiritsa ntchito njira zamankhwala ambiri.

HDL-C imatsimikiziridwa ndi njira yachindunji ya enzymatic itatha kuchuluka kwa magawo ena, chizolowezicho ndi 0.9-1.9 mmol / l, mulingo wochepera 0.9 ndi chiopsezo chachikulu cha CHD, mulingo wazopitilira 1.6 ndichinthu chabwino chodzitetezera ku matenda a corteryary artery.

XL-VLDLP imawerengedwa ngati TGx0.46 (kokha ngati TG sinapamwamba kuposa 4.5).

LDL-C imatha kutsimikizika ndi njira yachindunji. Pofuna kupulumutsa ma reagents, nthawi zina gwiritsani ntchito kuwerengera malinga ndi njira yotsatira: XC totonse. - (HDL cholesterol + VLDL cholesterol) - pomwe zotsatira zoyesedwa zimawonetsedwa kuti ndizowonetsa. Nthawi zambiri, LDL-C ya akuluakulu sayenera kupitirira 3.34 mmol / l, kwa ana - osaposa 2.85.

Apothecules pochita amatsimikiza ndi immuno-turbidimetric njira, njira yofotokozera ndi radioimmunoassay.

Apo A1 - muyezo kwa akazi ndi 106 - 228 mg / dl, kwa abambo 109 - 184 mg / dl. Misinkhu yoposa 125 mg / dl imawerengedwa kuti ndi chinthu choteteza ku CHD.

ApoB100 - chizolowezi ndi 56-182 mg / dL kwa amayi ndi 63-188 kwa amuna, ochulukitsa malire akumalire amafunika chithandizo chovomerezeka ndi zakudya ndi mankhwala omwe amaletsa synthesis wa lipid chifukwa cha chiwopsezo chowonjezeka cha kukhala ndi matenda a mtima, chifukwa ApoB100 imafanana kwambiri ndi mulingo wa LDL ndi VLDL.

LP (a) ndi chidziwitso chodalirika chodziwitsa mtundu wamtundu wa matenda a mtima. Nthawi zambiri, zomwe zili mu 0-30 mg / dl, sizisintha mothandizidwa ndi ma statins, kuchuluka kwa matenda ashuga ndi nephrotic sikutsimikiziridwa. Amagwiritsidwa ntchito pozindikira matenda a mtima wam'banja mwa achinyamata. Sichikulimbikitsidwa kuwunika kwakukulu kwa odwala asymptomatic.

Homocysteine ​​(HC) ndi njira yodziyimira payokha yowonongeka pamitsempha. Kuwonjezeka kwa msanga wake kwambiri kumawonjezera mwayi wokhala ndi matenda a mtima ndi matenda a mtima m'magulu onse, ngakhale ndi cholesterol yokhazikika. Ndi mankhwala achilengedwe a methionine metabolism, nthawi zambiri samadziunjikira m'magazi chifukwa chakuwonongeka mwachangu m'maselo ndikupanga folic acid, vitamini B12 ndi B6. Kuola kwake kukachepetsedwa m'maselo, kumasungidwa m'magazi ndikuwonjezera makina opangira ma free radicals omwe amawononga endothelium ndi oxidize LDL. GC imalepheretsanso kaphatikizidwe ka nitric oxide ndi prostacyclin mu ochepa endothelium. Nthawi zambiri, mulingo wa HC ndi 5-12 μmol / L, kuchuluka kwapakati pa 15-30 μmol / L, ndi chiwopsezo chachikulu cha 30-100 μmol / L. Kuwonjezeka kwa 22 μmol / L kumawerengedwa kuti ndi gawo lalikulu la mitsempha yakuya, kuchuluka kwa HC yopitilira 13 kutsata chiopsezo cha kugunda kwa mtima mwa amuna, kumathandizira kwambiri kuwonongeka kwamitsempha yam'mimba. Mwa amayi apakati, HC yokwezeka imatsogolera kumavuto oyambilira ndi kusokonekera kwa placental, kubadwa kwa ana omwe ali ndi vuto lotukuka.

Choyambitsa hyperhomocysteninemia ndi: chilema cha kubadwa kwa homocysteine ​​metabolism, kuchepa kwa folate, vitamini B12, B6 (kuperewera kwa zakudya m'thupi, matenda am'mimba).

Owonjezera-labotale zolakwika pophunzira lipids.

1. Kutenga magazi pamimba yopanda kanthu (kusala kudya kwa maola 12 musanatsutse magazi ndikofunikira) - TG, VLDL imaphatikizidwa, LDL siziwonongedwa.
2. Kugwiritsa ntchito machubu osambitsidwa bwino chifukwa chotenga magazi (chifukwa chake ma machubu otayika ndikofunikira)
3. Kugwiritsa ntchito alendo kwa mphindi zopitilira 2 (kwa mphindi 5 - kumachulukitsa cholesterol ndi 10-15 peresenti, mwa 15min. - mwa 20-40 peresenti!). Kugwiritsa ntchito machubu a vacuum kumakuthandizani kuti muzisonkhanitsa magazi mukachotsa maulendo pamasekondi 5-7 okha.
4. Seramu ikhoza kusungidwa mpaka maola 48 mufiriji, mpaka mwezi umodzi kwa -20 (kokha pokhapokha popanda dongosolo la chisanu mufiriji!).
5. Asanatenge magazi, wodwalayo ayenera kukhala phee kwa mphindi 5 mpaka 10.
6. Diagnostic kutsimikiza kuyenera kuchitika musanayambe mankhwala mankhwala mwachizolowezi, kuyang'anira - kuganizira chithandizo ndi zakudya

Zinthu zomwe zimakhudza magazi a lipids.

1. Zakudya: Zakudya zopatsa mphamvu kwambiri zamafuta ndi mafuta zimachulukitsa TG, cholesterol, LDL, VLDL mwa anthu 30%. Kwa azinyama, cholesterol ndi LDL cholesterol ndizochepa kwambiri poyerekeza ndi chakudya chokhazikika. Mukamadya mafuta a nsomba, TG ndi VLDL amachepetsa kwambiri ndi 15-25 peresenti.
2. Kusuta: kumawonjezera kwambiri LDL ndi VLDL, kumachepetsa ApoA1.
3. Mowa: muyezo mpaka 36g / tsiku. amachulukitsa ApoA1, pa mlingo wa 100 g / tsiku, amatsitsa HDL-C ndikuwonjezera TG.
4. Zochita zolimbitsa thupi: onjezerani ApoA1, muchepetsani ApoV, TG, LDL.
5. Kupsinjika: muchepetse apoAA1 ndi HDL.
6. Hypothyroidism: ukuwonjezeka ndi 30 peresenti onse a ma atherogenic.
7. Matenda A shuga: PaliA1 amachepetsa, cholesterol, triglycerides, LDL, ApoV (kuchepa kwa insulin kumachepetsa kutsegulitsa kwa puloteni ya LPL m'magazi).
8. Nthawi ya pachimake ya AMI: kwa masabata a 6-8, milingo yoyambirira ya cholesterol, LDL, ApoA1, ApoB100 imachepetsedwa, kotero magazi amatengedwa mwina tsiku la 1, kapena kumapeto kwa nthawi yovuta kwambiri.
9. Njira zotupa za pachimake: kuchuluka kwa TG, kutsika kwathunthu cholesterol, cholesterol-HDL kwa nthawi yovuta kwambiri.
10. Mankhwala: diuretics - thiazides amawonjezera cholesterol, triglycerides, m'munsi ApoA1, mahomoni oletsa kubereka amathandizanso, mankhwala a estrogen amawonjezera apoA1, kuchepetsa magawo a atherogenic, ma statins amachepetsa kapangidwe ka cholesterol cha LDL, apoV kuchokera masiku 4-5 kuyambira poyambira kukhazikitsidwa ndi 25-50 peresenti (osati kusintha kapangidwe ka LP (a), hemofibrozil, mafuta am'madzi, polyene amachepetsa TG ndi 30-35 peresenti, asidi a nicotinic amachepetsa TG ndi 40%, cholesterol ndi 10-20 peresenti.

Laboratory ulamuliro mankhwalawa ma statins.

Pochiza ma statins, kusankha kwa munthu wogwira ntchito ndi mtundu wa mankhwala ndikofunikira komanso kupezeka kwa zotsatira zoyipa pogwiritsa ntchito mayeso a labotale.

Cholesterol yonse - 3.1-5.2 mmol / l yokhazikika, ndi chithandizo - chochepera 4.2 mmol / l LDL (njira yowonjezera) - ingagwiritsidwe ntchito ngati chodziimira, chowonetsa kwambiri kuposa cholesterol yathunthu. Ndizabwinobwino 1.56-3.4 mmol / l, nthawi ya mankhwalawa iyenera kuchepa mpaka 2.2-2.5 mmol / l. Choyambirira chimawonekera pambuyo pa masiku 4-5, pazotheka mokhazikika - pambuyo pa miyezi 1-3 kuyambira chiyambi cha mankhwala. Mphamvu yotchulidwa kwambiri imapatsa rosuvastatin (mtanda).

• HS - cholesterol
• TG - triglycerides
• XM - ma chylomicrons
• LP - lipoproteins (mitundu yamagalimoto oyendetsera zinthu, yophatikiza ma apoprotein ndi zigawo zamafuta).
• LPL - lipoproteidlipase (enzyme yothetsa ChM ndi LP m'magazi)
• FL - phospholipids
• Mafuta acids
• LHAT - lecithin cholesterol acyltransferase-enzyme yopanga cholesterol esters mu chiwindi
• Apobelki - magawo a protein a lipoprotein
• HDL - lipoproteins yapamwamba kwambiri - kachidutswa ka antiatherogenic
• LDL - kachulukidwe kochepa lipoproteins-atherogenic kachigawo
• VLDLP - lipoproteins otsika kwambiri - kachigawo ka atherogenic
• IA - atherogenicity index - chiyerekezo cha cholesterol cha tizigawo ta atherogenic ku cholesterol ya kachigawo ka atherogenic, kaŵirikaŵiri kosakwana 3.5

Miyezo ya cholesterol yomwe ikuyang'aniridwa yomwe ikufunika kukwaniritsidwa ndi chithandizo, komanso mulingo wa LDL momwe mankhwalawa amayenera kuyambitsidwa, amaperekedwa pagome.