Zilonda zingapo zamitse mitsempha zimawonedwa mwa odwala omwe ali ndi matenda a shuga kwa zaka zopitilira khumi, mu milandu ya 45-54%. Udindo wa gawo la mankhwalawa m'thupi ndizofunikira kwambiri. Izi minyewa amalamulira ubongo, palpitation, kupuma, chimbudzi, ndi minofu contraction. Diabetesic polyneuropathy yam'munsi malekezero (DPN) ndi matenda omwe amayamba kumapazi ndikufalikira kwambiri.

Makina a pathogenetic a matendawa ndi ovuta kwambiri ndipo samamvetsetsa bwino asayansi. Matenda a zotumphukira zamagetsi amakhala osiyanasiyana. Mtundu uliwonse wa DPN uli ndi chithunzi chake cha chipatala. Komabe, mitundu yonse ya zovutazi ndizowopsa ndipo imafuna chithandizo cha odwala, apo ayi vuto la miyendo limatha kusintha munthu kukhala wolumala. Diabetesic polyneuropathy imasungidwa ndi madokotala pansi pa code G63.2 malinga ndi ICD-10 yomwe ikusonyeza kusiyanasiyana kwa matendawa.

Mitundu ya Neuropathy

Popeza dongosolo la mantha amtundu wamagulu limagawidwa kukhala somatic and autonomic (autonomic), mitundu iwiri ya diabetesic polyneuropathy imatchedwanso. Yoyamba imayambitsa zilonda zam'mimba zambiri zam'mimba, chachiwiri - mavuto pokodza, kusabala komanso ngozi zamtima, zomwe nthawi zambiri zimapha.

Kugawika kwina kumadalira ntchito zamanjenje, zomwe zimaphwanyidwa chifukwa cha chitukuko cha matenda:

polyneuropathy yokhudzana ndi kupweteka kwamiyendo, kapena, mutero, ndi kuchepa kwa chidwi champhamvu,
motor polyneuropathy, yomwe imakhala yofanana ndi minyewa ya m'mimba komanso kulephera kuyenda,
sensorimotor polyneuropathy, kuphatikiza mawonekedwe a zovuta ziwiri izi.

Kuwonetsera kwa zotsiriza, zosakanikirana zamatenda ndi neuropathy yamitsempha yamavuto. Anthu odwala matenda ashuga omwe ali ndi matenda oterewa samva kupweteka m'malo ena phazi ndi phazi lakumunsi. Gawo lomwelo la miyendoyo silimayankha kuzizira kapena kutentha. Kuphatikiza apo, odwala amalephera kuwongolera mapazi awo. Odwala amakakamizidwa kuyenda, kukweza miyendo yawo mwanjira yonyansa ("tambala" gait).

A shuga a distal polyneuropathy

Ichi ndi matenda omwe amachititsa kuti minofu ya mitsempha ifere. Matendawa amatsogolera pakuwonongeka kwathunthu kwamphamvu tactile ndikumva zilonda zam'mphepete mwa m'munsi kwambiri - kumapazi. Mkhalidwe wamba wa odwala matenda ashuga okhala ndi distal DPN ndi ululu wosachedwa kupweteka womwe nthawi zambiri umakhala wolimba kwambiri kotero kuti munthu samatha kugona. Kuphatikiza apo, nthawi zina mapewa amayamba kupweteka. Polyneuropathy ikupita patsogolo, ndipo izi zimatsogolera ku minofu atrophy, kusintha kwa mafupa, mapazi osalala, kudula kwamiyendo.

Peripheral

Ndi matenda amtunduwu, kusokonezeka kwakukulu kwa sensorimotor ntchito miyendo kumachitika. Mu odwala matenda ashuga, osati mapazi, matako, miyendo yotsika ndi miyendo, komanso manja. Peripheral polyneuropathy imachitika makamaka pamene madokotala akuwapatsa mankhwala oopsa omwe angathe kuyambitsa mavuto ena: Stavudine, Didanosine, Saquinavir, Zalcitabine. Ndikofunika kuzindikira zamatendawa munthawi yake kuti tisiye mankhwalawo mwachangu.

Sensory polyneuropathy

Chofunikira kwambiri cha pathology ndikuchepa kwa chidwi cha miyendo, momwe iwo amatha kusiyanasiyana. Kuyambira zazing'onoting'ono zazing'onong'ono mpaka kumatha kukhala dzanzi, limodzi ndi ulceration ndi mapazi kumapazi.Nthawi yomweyo, kusowa kwa chidwi kumaphatikizika ndi kupweteka kwamphamvu kwambiri komwe kumachitika mosakhalitsa. Matendawa amakhudza mwendo umodzi woyamba, kenako umasunthira kwachiwiri, kukwera kwambiri, ndikukhudza zala ndi manja, thunthu, mutu.

Dysmetabolic

Kupezeka kwa zovuta zamtunduwu nthawi zambiri kumakhala kolimbikitsidwa, kuwonjezera pa matenda a shuga, matenda am'mimba, matumbo, impso, chiwindi. Mitsempha yambiri yophatikizira zakumapeto imatha kukhudzidwa. Posemphana ndi ma psychic, ma femor ululu, kupweteka, zilonda zam'mimba, zovuta zoyenda zimawoneka, bondo, tendon Reflexes imatha. Nthawi zambiri zowonongeka zam'mapewa, mitsempha yamagetsi, ma optic. Dysmetabolic polyneuropathy imatha kuchitika popanda kupweteka.

Chifukwa chiyani odwala matenda a shuga amakhala ndi neuropathy

Cholinga chachikulu ndi shuga wamagazi komanso kuchepa kwa insulin. Kuwonongeka kwa ma cell kagayidwe kachakudya kamene kamayipitsa minyewa yaziphuphu. Kuphatikiza apo, matenda ashuga a polyneuropathy amiyendo amatha chifukwa:

zovuta za endocrine
matenda owopsa a chiwindi kapena impso,
kukhumudwa, kufooka,
matenda
uchidakwa
poyizoni ndi mankhwala oopsa
zotupa.

Mawonetseredwe akuluakulu amatenda a mitundu yonse:

Zizindikiro zomveka - kupweteka, kufooka kapena kuwonjezereka kwa chizindikiritso cha kusintha kwa kutentha, kugwedezeka.
Zizindikiro zosunthika - kukokana, kunjenjemera, kuchepa kwa minofu ya miyendo.
Zizindikiro zamasamba - edema, hypotension, tachycardia, kusokonekera kwa tulo, kusabala.

Kuyaka ndi miyendo

Zomverera ngati kuti miyendo ya miyendo ikuyaka ndi moto ikuwoneka ngati ulusi wamitsempha yam'mphepete wochokera pachala mpaka kumapazi wawonongeka. Mapazi owotcha si matenda, koma chizindikiro chomwe chimawonetsa polyneuropathy mu shuga mellitus. Mitsempha yowonongeka imayatsidwa ndipo imatumiza zizindikiro zowawa zaubongo ku ubongo, ngakhale kuti miyendo yake ndiyokhazikika ndipo mulibe moto.

Kuwonongeka kwa phazi

Poyamba, odwala matenda ashuga amakumana ndi kufooka, kugona kumapazi. Kenako zotengeka izi zimatuluka m'miyendo, manja. Pamene polyneuropathy yam'munsi yam'munsi ikamapita, minyewa ya minofu imawonjezeka komanso kumva kwamtopola kumachepa. Mapazi amakhala ovuta kuwongolera ndi kupachika. Manja amanjenjemera, kuyambira pa nsonga za zala. Ndi njira yayitali yotsitsa, kuchepa kwa chidwi kumakhudza gawo la thunthu m'chifuwa ndi m'mimba.

Kuzindikira matendawa

Polyneuropathy ya malekezero am'munsi amadziwika pogwiritsa ntchito njira zofufuzira za wodwalayo:

kuyesa zinthu zopanda mawonekedwe,
kuyesa kwa kupweteka
kuyesa mwamphamvu
kuyesa kutentha
khungu misempha
electroneuromyography (ENMG), yomwe imatha kuwonetsa ngati kukhudzidwa kwa mitsempha kudutsa minyewa ya minofu.

Chithandizo cha matenda ashuga polyneuropathy a m'munsi malekezero

Mavuto oterewa sangathe kuchiritsidwa kwathunthu, koma kukula kwawo kumachepetsedwa. Kodi kuchitira m`munsi miyendo neuropathy? Chofunikira ndicho kuphatika kwa shuga m'magazi. Ma analgesics, nsapato zazikulu, kuyenda pang'ono, malo osambira ozizira amathandizira kuchepetsa ululu. Kusiyanitsa kusamba kumachepetsa mapazi oyaka. Ndikofunikira kugwiritsa ntchito mankhwala omwe amakulitsa zotumphukira, zomwe zimakhudza kufalitsa kwa mitsempha. Chithandizo cha polyneuropathy chokhala m'munsi chotsika chimakhala chothandiza kwambiri pakudya mavitamini a B .. Ndikofunikanso kusintha kagayidwe kazakudya.

Mankhwala

Zokhazikika pazovuta za odwala omwe ali ndi matenda a polyneuropathy a m'munsi malekezero:

antidepressants Amitriptyline, Imipramine, Duloxetine, kutsekereza kuyambiranso kwa mahomoni norepinephrine ndi serotonin,
anticonvulsants Pregabalin, Carbamazepine, Lamotrigine,
analgesics Targin, Tramadol (Mlingo wochepa - mankhwala!),
Milgamm Vitamin Complex
Berlition (thioctic kapena alpha lipoic acid), yomwe imatha kukonza mitsempha yomwe ikukhudzidwa,
Actovegin, yomwe imapangitsa kuti magazi azikhala ndi mitsempha,
Isodibut, Olrestatin, Sorbinil, omwe amateteza mitsempha ku glucose,
maantibayotiki - ndikuwopseza gangrene.

Chithandizo chopanda mankhwala

Chiyembekezo chofuna kuchiritsidwa mothandizidwa ndi othandizira kunyumba kapena wowerengeka azitsamba ndi utopia. Ndikofunikira kumwa mankhwala ndikugwiritsa ntchito mwachangu:

maginotherapy
kukondoweza kwa magetsi
Hyperbaric oxygenation,
Katemera
kutikita minofu
Zochita zolimbitsa thupi (masewera olimbitsa thupi).

Diabetesic polyneuropathy (mtundu wa distal, mawonekedwe a sensory) ndi imodzi mwazovuta zambiri za matenda ashuga. Mu mtundu II shuga mellitus, pofika nthawi yodziwitsa matenda, matenda akuwoneka a distal sensory polyneuropathy amapezeka mu 20-25%, ndipo atakhala ndi nthawi yoposa zaka 10, pafupifupi 50% ya odwala. Mosiyana ndi matenda ashuga retinopathy ndi nephropathy, matenda ashuga a polyneuropathy atha kukhala limodzi ndi zizindikiro zodwala. Madokotala a zaumoyo pachipatala cha Yusupov amagwiritsa ntchito njira zamakono zodziwitsira matenda kuti azindikire distal symmetric polyneuropathy. Pakufufuza odwala omwe akugwiritsa ntchito zida zaposachedwa kuchokera kwa opanga aku Europe ndi aku America.

Njira zatsopano zimagwiritsidwa ntchito pothandiza odwala. Kuphatikiza mankhwala a matenda ashuga a distal polyneuropathy kuchipatala cha Yusupov akuphatikizapo:

magazi a shuga ndikuwabwezera shuga,
Matenda a magazi,
chakudya
maphunziro odwala
kusintha kwa moyo.

Madokotala a matenda amitsempha amathandizira odwala omwe ali ndi matenda ashuga polyneuropathy mankhwala othandiza kwambiri omwe ali ndi zovuta zingapo zoyipa. Othandizira obwezeretsa malo obwezeretsanso matendawa abwezeretsa kuchiritsa kwamoto pogwiritsa ntchito njira zamakono zolimbitsa thupi. Ophika amaphika zakudya, zomwe sizikhala zosiyana ndi kuphika kwakunyumba. Odwala amathandizidwa panthawi yomwe amakhala m'mawodi okhala ndi chilimbikitso cha ku Europe.

Njira zakukula kwa distal diabetesic polyneuropathy

Tizilombo toyambitsa matenda a shuga mellitus zimatengera poizoni wamagazi. Amayamba chifukwa chosakwanira kupanga insulini kapena chilema pakuchita kapena kuphatikizidwa kwake. Kukwiya kwa hyperglycemia kumabweretsa kukula kwa matenda a shuga. Njira ya pathological pamatumba ang'onoang'ono (microangiopathy) ndi zombo za sing'anga yayikulu komanso yayikulu (macroangiopathy).

Kuwopsa kwa kutsika kwa glucose kumazindikirika m'njira zina, makamaka mwa kutsegula kwa mapuloteni a glycosylation. Zotsatira zakusapangika kwa michere ya glucose m'magulu a amino mapuloteni, mapuloteni omwe amapanga ma membrane am'mimba ndi mapuloteni am'magazi amawonongeka. Izi zimabweretsa kusokonezeka kwa metabolic, mayendedwe ndi njira zina zofunika mthupi.

Masewera a shuga m'magazi ambiri, mankhwala opatsirana mwaulere amayamba kupanga, oxidative kapena metabolic nkhawa imayamba. Thupi limaphwanya malire pakati pa prooxidants ndi zigawo za chitetezo cha antioxidant. Zimaphatikizidwa ndi kuperewera kwa insulin kapena kukana insulin kosiyanasiyana.

Kuperewera kwa michere ya antioxidant mu shuga kumatsimikiziridwa ndi ma genetic. Ischemia (magazi osakwanira), hypoxia (njala yokhala ndi mpweya) komanso pseudohypoxia, yomwe imawonedwa mu matenda a shuga, ndizowonjezera. Amawonjezera mapangidwe amathandizidwe okhatikiza amitundu mitundu ndi ziwalo zosiyanasiyana.

Matenda a diabetesic polyneuropathy ndi chifukwa cha kufala kwa zotupa za neuron ndi njira zawo pakatikati ndi potupa lamanjenje. Chifukwa chophwanya njira za kubadwanso mu shuga mellitus, kumwalira pang'onopang'ono kwa neurons kumachitika.

Magawo onse a zotumphukira zamanjenje amakhudzidwa:

kuchuluka kwa ma axon pamiyendo ya mitsempha yodutsa kumachepa (ndi kuchuluka kwa zolakwika m'mbali za ma neuron),
kuchuluka kwa maselo mu spinal ganglia ndi nyanga za kunja kwa chingwe kumachepa
cholinga cha magawo okhala ndi madongosolo obwezeretsanso amawonekera,
Kusintha kwawoneka kumapangika mu maselo am'magulu achifundo amzungu komanso ozizira.

Nthawi zambiri, kusinthika kwa maelyl komanso ma axial cylinders kumachitika. Njira ya pathological imayambira ku distal mpaka proximal. Kukula kwa Axonal kumapangitsa kusintha kwa minofu ndi kusintha kwa myography, mosiyana ndi zotupa zongowononga. Mu cytoplasm ndi axoplasm yama cell a Schwann, zinthu monga amyloid, ceramide, sulfatide, galactocerebroside kudziunjikira. Pali kusintha kwamitsempha yamagazi ndi mawonekedwe amtundu wa minyewa:

kuchulukana ndi kuchuluka kwa maselo a endothelial,
kupatulira komanso kuwirikiza pansi pa ululu wapansi wa capillaries,
kuchuluka kwa oyambira
kutsika kwa kachulukidwe kogona kosatha kokhala ndi ma cell ambiri.
kuchuluka malo amodzi a interfasicular ndi collagen amana.

Zomwe zimayambitsa kukhazikika kwa matenda a diabetesic polyneuropathy zimaphatikizapo kutalika kwa matendawa, kuchuluka kwa hyperglycemia, amuna, amuna ndi akazi, komanso kubereka.

Zizindikiro za matenda ashuga a distal polyneuropathy

Diabetesic polyneuropathy (mawonekedwe a sensorimotor, mawonekedwe a distal) ndi zovuta za matenda a shuga, momwe zotupa zingapo zamipweya zimayamba. Zimawonetsedwa ndi kupunduka kwa ziwalo, kuvulala kwamitsempha yamagazi kumadera akutali. Chizindikiro choyamba cha matendawa ndi kuphwanya kwa magwiridwe antchito a zala ndi zala zakumaso. Popita nthawi, popanda chithandizo, chimakwirira malo akuluakulu a mikono ndi miyendo. Chimodzi mwazinthu zodziwika bwino za matenda ashuga polyneuropathy ndi maonekedwe osasangalatsa mu miyendo yonse.

Zizindikiro zazikulu za matendawa ndi monga:

minofu atrophy, yomwe imayamba ngati kufooka kwa minofu, kumapita patsogolo kwambiri.
kusazindikira bwino,
kukomoka kwa malingaliro oyipa,
kuchuluka kwa zowawa
kumverera kokhazikika kwa goosebumps pakhungu, kumalumikizana ndi thupi.

Pa gawo loyamba la matenda, wodwalayo samva ululu. Akatswiri a zamitsempha amawona kusintha kwina mu minofu yamanjenje pazida zapadera - electroneuromyographs. Zimakhala zovuta kudziwa matenda pano.

Gawo lachiwiri la matendawa limadziwika ndi kupezeka kwa ululu, kuwotcha kapena kuzimiririka miyendo, komanso kusintha kosalekeza. Mu gawo lachitatu la matenda ashuga a distal sensory polyneuropathy am'munsi, zilonda zimapangika pakhungu la kumapazi ndi miyendo yotsika. Amakhala osapweteka kwambiri ndipo amakula mwa 75% ya odwala ngati sanachiritsidwe. Zilonda za 15% za odwala zimatsogolera pakufunika kwa kuduladula miyendo.

Wodwala akavomerezedwa ku chipatala cha neurology, madokotala pachipatala cha Yusupov amawunika kutentha, kupweteka, kudzimva komanso chidwi pakumvetsetsa kwa malekezero kuti awunikenso mbali ya distal peripheral neuropathy. Kuzindikira kwa kutentha kumawerengedwa kumachepetsedwa pakakhala cholakwika pakuwona mbali zotentha komanso zowala za sensor. Chizindikiro cha kusowa kwa chidwi ndi kulephera kwa wodwalayo kudziwa kusiyana komwe akukhudza mbali zofunda ndi zozizira za chipangizocho.Zomverera zamtima zimayesedwa ngati zabwinobwino, zochepetsedwa (wodwalayo samva kukhudzidwa ndi thonje) kapena kulibe (wodwalayo samva kukhudzidwa ndi thonje kapena dzanja).

Kuzindikira kwa Vibration kumawerengeredwa ndi njira ya biotheziometry ngati yabwinobwino (mpaka 9 V), yochepetsedwa (kuchokera pa 10 mpaka 25 V), osakhalapo (kuchokera 25 V ndi pamwambapa). Kuyesa kwamamvekedwe a ululu kumachitika pogwiritsa ntchito singano. Imawerengedwa kuti yachepetsa ngati wodwala walakwitsa posankha mbali zakuthwa komanso zowoneka bwino za singano kapena kuti chidwi chake chimachepetsedwa poyerekeza ndi miyendo yoyenda nayo. Wodwala ngati samva jakisoni, amalankhula za kusazindikira.

Madokotala a Neurophysiologists ku chipatala cha Yusupov amawona momwe magwiridwe amagetsi am'mimba am'mimba amathandizira komanso kuthamanga kwa zotumphukira za distal diabetesic polyneuropathy, kuthamanga kwa mafupa limodzi ndi mafayilo amagetsi a mitsempha yosakanikirana, komanso magawo a M poyankha kukwiya kamodzi kuchokera minofu yowonjezera yogwiritsa ntchito njira yothandizira. Ntchito zozindikira madotolo amapenda magawo a electroneuromyographic otsatirawa: impulse conduction velocity (STI) ndi matalikidwe a M-reaction. Kuyankha kwa M-mphamvu yamagetsi yonseyo potsatira kukondoweza kumagetsi kamodzi kwa mota kapena mitsempha yosakanikirana. Matalikidwe a M-mayankho amawonetsera kulumikizana komanso kuchuluka kwa magwiridwe antchito a miniti. Imfa ya gawo la motor neurons imabweretsa kutsika kwa matalikidwe a M-reaction.

SPI ndi liwiro lakufalikira kwa zomwe zingachitike mothandizirana ndi mitsempha. Ichi ndi chizindikiritso chowerengera kutengera mayendedwe amtundu wa mayankho awiri a M-may (a ma foda ma motor). SPI yowerengedwa mwanjira iyi imawonetsera kuthamanga kwa kayendedwe kazinthu zowoneka bwino kwambiri. Odwala omwe ali ndi vuto la zotumphukira za matenda a shuga a polyneuropathy, mothandizidwa ndi electroneuromyography, kuphwanya ntchito ya mota ululu wamitsempha yam'mphepete, kuphwanya kwamphamvu kutentha, kusowa kapena kuchepa kwa ululu, kugwedezeka ndi kusakhazikika kwa khutu.

Chithandizo cha matenda a shuga a distal polyneuropathy

Palibe mfundo zovomerezeka komanso zodalirika zochizira matenda ashuga a polyneuropathy. Madokotala pachipatala cha Yusupov amalipira chidwi makamaka popewa kuyambika kwa matendawa komanso kupitirira kwa zizindikiro zake. Odwala omwe amathandizidwa kuchipatala cha neurology amayang'aniridwa ndi endocrinologist. Madokotala amayang'anira kuchuluka kwa shuga m'magazi. Imasungidwa pamlingo woyandikira ndi chandamale cha glycosylated hemoglobin. Kuti mukhale ndi glucose woyenera, jekeseni wa insulin komanso mankhwala osokoneza bongo amagwiritsidwa ntchito.

Odwala amalimbikitsidwa kudya zakudya zoyenera, kuchuluka kwa zinthu zolimbitsa thupi, zomwe zimapangitsa kuti thupi lizigwira ntchito bwino, ndikuzisunga bwino. Ngati vuto la trophic likupezeka pakhungu, ogwira ntchito zachipatala amasamalira madera omwe akhudzidwa: gwiritsani ntchito mafuta odzola kuti muchepetse ululu kapena kuchepetsa mphamvu ya miyendo.

Alpha-lipoic acid ndi zokonzekera zomwe zimakhala ndi benfotiamine zimagwiritsidwa ntchito kwambiri pochiza matenda ashuga a polyneuropathy. Njira imodzi yothanirana ndi mankhwalawa ndikugwiritsa ntchito mankhwala ochepetsa ululu omwe amateteza ululu. Neurologists amaganizira contraindication kugwiritsa ntchito mankhwalawa, kuyamba mankhwala ndi ochepa Mlingo, kukulira mulingo woyenera waukulu. Madokotala amayang'anira mosamala kupezeka kwa zotsatira zoyipa za antidepressants (pakamwa pouma, kugona, kufooka), kukonza mankhwalawa ndikusintha mankhwala.

Chithandizo chotsogola chomwe chimakhudza njira zoyambira za matenda ashuga a distal sensor polyneuropathy a m'munsi am'munsi ndikugwiritsa ntchito antioxidants. Ichi ndichifukwa choti mu shuga mellitus ntchito yama antioxidant awo amachepa, ma radicals aulere amapangidwa mopitirira muyeso. Kuchepa kwa kupsinjika kwa oxidative kuphatikizika ndi kukhazikitsidwa kwa mankhwala omwe ali ndi antioxidant zotsatira kumayendetsedwa ndi izi:

kusintha kwamphamvu magazi,
kutsika kwa lipid peroxidation,
kusintha kwa zomwe zili ndi endothelial nitrous oxide,
kuchuluka pazopezeka pamapuloteni oteteza (oteteza) a kupsinjika kwa kutentha.

Malo otsogola pakati pa antioxidants amakhala ndi α-lipoic kapena thioctic acid, lipophilic antioxidant wachilengedwe. Mankhwalawa amachepetsa zizindikiro za neuropathic komanso kuchepa kwa neuropathic. Madokotala a chipatala cha matenda a mitsempha amayamba kulandira chithandizo mosagwirizana ndi kulowetsedwa kwamitsempha yama thirigacid, 600 mg pa 200 ml ya phineological saline kwa masiku 15, kenako amupatse mankhwala a 600 mg a BV thioctacide kwa wodwala, omwe amamwa mosalekeza.

Kuti mupeze chithandizo chokwanira cha matenda ashuga a distal sensory polyneuropathy am'munsi, pezani nthawi yoonana ndi dokotala wamatsenga pa foni kuchipatala cha Yusupov. Madokotala a pachipatala cha Yusupov pachipatala amasankha mankhwalawo, amathandizira odwala matenda ashuga, omwe cholinga chake ndi kupewetsa kuchepa kwa madera ena. Chithandizo chokwanira cha matendawa chimathandizira kukhazikika mtima ndikuyenda bwino kwa moyo wa wodwalayo.

Malingaliro

ICD-10 (Kugawidwa Kwa Matenda Padziko Lonse Lapansi)
Chipatala cha Yusupov
Batueva E.A., Kaygorodova N.B., Karakulova Yu.V. Zotsatira za mankhwala a neurotrophic si ululu wa neuropathic komanso mawonekedwe am'magazi odwala odwala matenda ashuga // Russian Journal of Pain. 2011. Ayi. 2. P. 46.
Boyko A.N., Batysheva T.T., Kostenko E.V., Pivovarchik E.M., Ganzhula P.A., Ismailov A.M., Lisinker L.N., Khozova A.A., Otcheskaya O .V., Kamchatnov P.R. Neurodiclovitis: kuthekera kwa kugwiritsidwa ntchito kwa odwala omwe ali ndi ululu wammbuyo // Farmateka. 2010. Ayi 7. P. 63-68.

* Zambiri patsamba lino ndizongodziwa zambiri. Zida zonse ndi mitengo yotumizidwa patsamba lino siwopereka kwa anthu onse, motsimikiza ndi zomwe Art. 437 ya Civil Code ya Russian Federation. Kuti mumve zambiri, lumikizanani ndi ogwira ntchito kuchipatala kapena pitani kuchipatala.

M'nkhaniyi, tiona mwatsatanetsatane njira yofala kwambiri yamatenda a shuga omwe amachedwa - distal, symmetric, sensorimotor polyneuropathy .

Zizindikiro zazikulu za matenda ashuga ndi paresthesia, dzanzi, kuzizira komanso kupweteka m'malire am'munsi, komanso m'manja. Kusokonezeka kwamitundu yonse yamatenda amtundu (kupweteka, kutentha, tactile ndi kugwedezeka) mu zomwe zimatchedwa mzere wa "masokosi" ndi "magolovu" . Mwa odwala ambiri, mawonekedwe awa akhoza kufotokozedwa mofooka. Woopsa milandu, usiku paresthesias, ululu, kutentha kwa miyendo ndi manja ndizodziwika. Ngati sichichiritsidwa, matendawa amakula.

Zizindikiro Zoyambira za Neuropathy zimatsimikizika zala, ndi proximal kupita patsogolo kwa njirayi pali zizindikiro za kuchepa kwa chidwi mu zala. Zigawo zam'madera akutali sizikhudzidwa koyamba.

Ndi distal, symmetric, sensorimotor polyneuropathy, yopyapyala yopanda myelinated (C), ofooka myelinated (Aσ) ndi mafupa akhungu a myelinated (Acy, A A) amavutika. Neuropathy yodziwika ndi zotupa zazingwe zowonda ndizodziwika kuchepa kwa ululu ndi kutentha (kutentha ndi kuzizira) . Pamene ulusi wakuda kwambiri umakhudzidwa, kuthamanga kwa mitsempha kumayipa ndipo kutsekeka kwachilengedwe kumatha kuchepa kapena kutayika, komwe muzovuta kwambiri kungayambitse kumvaxia. Koma ziyenera kudziwitsidwa kuti zizindikiro zowonongeka kwa ulusi wamanjenje zowonda zimawonedwa kale kuposa zokhuthala.

Zizindikiro za matenda ashuga ogwidwa oposa 40% ya anthu odwala matenda ashuga ndipo pafupifupi theka la iwo ali ndi zowawa. Nthawi yammbuyo wammbuyo imakhala yodziwika: kupumula, kugwira ntchito kwambiri, kupsinjika, ndipo makamaka usiku, poyenda, mphamvu ya ululu imachepa, pomwe kusintha kwa mawonekedwe a dzanja kulibe kanthu. Acute ululu syndrome ndi neuropathy amafotokozedwa ngati gawo lodziyimira lazachipatala. Amadziwika ndi hypersensitivity ndi hyperalgesia. Nthawi yomweyo, ulusi wamitsempha yamagalimoto umasungidwa, ndipo ntchito zowonda zimavutika pang'ono. Zoterezi zimatchedwa Ellenberg "diabetesic cachexia." Acute ululu neuropathic syndrome amadziwika ndi insulin mankhwala komanso matenda a glycemia, omwe Caravati amawatcha "insulin neuritis." Pankhaniyi, zizindikiro zowawa zimagwirizanitsidwa ndi kubadwanso kwa mitsempha.

Kukula kwa matenda ashuga a polyneuropathy kumabweretsa kuwonongeka kwa zowongolera zamagalimoto (motor) - minofu atrophy ndi kufooka mu distal m'munsi malekezero . Ndi kukhudzidwa kwa maulalo am'madzi olimbitsa thupi, thukuta limachepa, khungu limakhala louma ndipo limakhala ndi hyperkeratosis. Malo omwe amawatcha "chiopsezo" amapangidwa. Knee ndi Achilles amawonetsa kuchepa, kufooka kwapafupipafupi kumawonekera: mitu yofalikira ya mafupa achitsulo, nyundo ndi zala zakukomedwa ndi mbedza. Khungu limakhala loyera la pinki kapena lofiirira, nthawi zambiri pamakhala zolingalira zamkati mwendo wapansi ndi kumbuyo kwa phazi (lotchedwa "lowoneka m'munsi mwendo"). Mbale ya msomali imatha kuphimba kapena, m'malo mwake, imakulitsidwa ndi kupunduka, yomwe imasankha kukula kwa onychomycosis. Pamapeto pake, phazi la osteoarthropathy kapena phazi la Charcot limapangidwa (kuwonjezereka kukula kwa phazi losunthika, kupindika ndi miyendo yayitali yokhazikika, kuwonjezeka kwa kuphatikizira kwa ankolo), kusintha pakukhazikika kwa phazi kumatha kukhala kwamodzi kapena mbali ziwiri, ndipo neuropathic edema imatha kuchitika. Chizindikiro chofunikira chodziwikitsa ndikusungidwa kwa pulsation m'mitsempha yama phazi.

Kupanikizika kwanthawi yayitali m'malo opuwala mafupa kumapangitsa kuti zilonda zam'mimba zizipangika komanso kupangika kwa zilonda zam'mimba, nthawi zambiri pamtunda ndi kumapazi. Zilonda zam'mimba izi zimatha kukhala zopanda ululu kwakanthawi kwakanthawi chifukwa chakuchepa kwa chidwi, ndipo nthawi zambiri matendawa ndi njira yotupa imakhudzana ndi vuto la zilonda zam'mimba. Chifukwa chake kuzindikira koyambirira kwa matenda ashuga polyneuropathy Chofunika kwambiri kuti muchepetse chiopsezo cha zilonda zam'mimba komanso kuduladula miyendo.

Tsoka ilo, palibe "golide woyenera" wazomwe wazidziwikitsa matenda amitsempha ya shuga. Mu 1998, San Antonio adasankhidwa kuvomerezedwa kwa njira zokhazikika zodziwira matenda ashuga a polyneuropathy amene amalimbikitsa ntchito zotsatirazi:

Kuzindikiritsa Zizindikiro zamankhwala.
Kuunika zamankhwala: Kusanthula kwa maumboni ndi okhudza zinthu zosiyanasiyana.
Phunziro la Electrodiagnostic: kudziwa kuthamanga kwa zolimbikitsira pamodzi ndi mitsempha.
Kuyesa kwamalingaliro mwamalingaliro.
Mayeso ogwiritsa ntchito pawokha.

Nthawi zambiri amagwiritsidwa ntchito kuti adziwe matenda a shuga Mulingo wa Zizindikiro - NSS (Neuropathy Syndromeom Score) ndi kukula kwa zizindikiro - VAT (Neuropathy Dysability Score). Pazakuchita zamankhwala, dongosololi linasinthidwa ndi M. Young et al.

kumva motentha, dzanzi (dzanzi) kapena kumverera kwa "kukwawa" = 2
kutopa, kukokana kapena kuwawa = 1
kugawa:
mapazi = 1
minofu ya ng'ombe = 1
zina = 0
phindu:
usiku = 2
usana kapena usiku = 1
nthawi = =
kudzuka ku tulo = 1
kuchepa:
poyenda = 2
kuyimirira = 1
kukhala kapena kunama = 0

Zambiri amapanga mtengo wokwera:
3-4 - Zizindikiro zazing'ono,
5-6 - Zizindikiro zoyenera,
7-16 - Zizindikiro zowopsa.

bondo
kugwedeza mwamphamvu
kumva kupweteka
kutentha kwa kutentha
malingaliro:
zabwinobwino = 0
onjeza = 1
kusowa = 2 mbali iliyonse
zomverera (zachifundo):
kupezeka = 0
kuchepetsedwa kapena kulibe = 1 mbali iliyonse

Zambiri :
3-5 - zizindikiro zazing'ono
6-8 - Zizindikiro zoyenera
9-10 - Zizindikiro zowopsa

Njira zochepa zodziwira matenda a diabetesic neuropathy malinga ndi NSS ndi VAT ndi:

Zizindikiro zoyenera kapena zopanda zizindikiro (VAT = 6-8 + HCC ≥ 0)
Zizindikiro zazing'ono zomwe zimakhala ndi zofatsa (VAT = 3-5 + HCC = 5-6)

Kuti muwone kuwopsa kwa mawonetseredwe azachipatala, ndikofunikira kuwunika kwamitsempha yama sensorimotor . Zimaphatikizaponso kuwerenga kwa mitundu yonse yamalingaliro ndi zomverera.

Zomverera zamtendere kuyesedwa pogwiritsa ntchito 10 g ya monofilament (5.07 Semmes-Weinstein). Malo momwe amafunikira kuchita kafukufuku ndi chomera chakumaso kwa distal phalanx ya chala chachikulu chakumaso, chomera chakumaso kwa distal mutu ndi V metatarsal fupa. Payenera kukhala kukhudza kawiri pa nthawi imodzi. Malo olumikizira amadzimadzi ndi otsimikiza pogwiritsa ntchito foloko kapena biotheziometer. Phunziroli limachitika pamlingo wokhazikika: m'munsi mwa chala ndi pachifuwa chamkati. Kuzindikira kwa Vibration sikumachepetsedwa ngati wodwalayo amasiya kugwedezeka pamene mtengo wamawonekedwe a foloko ndi 7 UE kapena kupitirira. Kutsika kwa kugunda kwa kugunda kwa chidziwitso cha ofufuza ambiri kumawerengedwa ngati chizindikiro chosavomerezeka kwambiri. Mphamvu yamatenthedwe amasinthidwa ndikusinthana ndikugwira chinthu chofunda ndi chozizira kumadera oyandikana ndi chala, kumbuyo kwa phazi, kumbuyo kwamapewa, mwendo wapansi ndi bondo. Zomverera zowawa zimaphunziridwa pogwiritsa ntchito singano yowoneka bwino kapena zida zapadera (Neuropen, Pin-wheel). Kuti muwone momwe dipatimenti yamagalimoto yamagalimoto imagwirira ntchito, ma Achilles ndi maondo amawongolera atsimikiza kugwiritsa ntchito nyundo yamanjenje. Kuzindikira autonomic neuropathy, njira yotsika mtengo kwambiri pochita zinthu nthawi zonse mayeso a orthostatic .

Kutengera kuwonekera kwachipatala, zotsatirazi magawo a distal diabetesic neuropathy (Maupangiri apadziko lonse a Outpatient Management of Diabetesic Neuropathy, 1995):

0 - palibe neuropathy, zizindikiro ndi zizindikiro sizikupezeka
1 - asymptomatic neuropathy
1 A - HCC = 0, chiwonetsero chazenera bondo
1 B - HCC = 0, Reflex ya bondo
2 - chizindikiro cha neuropathy
2 A - HCC ≥ 1, reflex yofananira ya bondo
2 B - HCC ≥ 1, Reflex ya bondo
3 - neuropathy yayikulu.

Ndi matenda a shuga, munthu amakumana ndi zovuta zingapo zomwe zimawononga ntchito ya ziwalo zamkati. The peripheral mantha system imakhudzidwanso - - ngati minyewa yamitsempha payokha ikasokonekera, dokotalayo amazindikira matenda a shuga, ndipo ngati pali chilonda chachikulu, matenda a shuga amadziwika.

Matendawa amakula ndi anthu odwala matenda ashuga amtundu woyamba komanso wachiwiri wa matenda a shuga, chiopsezo cha matendawa ndi 15-50 peresenti ya milandu. Nthawi zambiri, matenda ashuga a polyneuropathy amadziwika ngati munthu wadwala chifukwa chosowa insulin kwa nthawi yayitali ndipo wokweza kuchuluka kwa shuga m'magazi.

Mitsempha yamagalamu imasokonekera chifukwa cha kusintha kwamakina a metabolic mu tishu. Zingwe zam'mitsempha zimakomoka ndi mpweya wa okosijeni, kuchuluka kwa nitric oxide kumachepa, komwe kumayambitsa kusayenda bwino kwa magazi ndi kusokonekera kwa dongosolo lamanjenje.

Polyneuropathy. Kugawa, zoyambitsa, chithunzi cha matenda ambiri a polyneuropathies.Dysmetabolic ndi paraneoplastic polyneuropathies. Ma polyneuropathies omwe ali ndi vuto lama mavitamini ena. Guillain-Barré Syndrome

Tsambali limapereka chidziwitso pazachidziwitso chokha. Kuzindikira ndi kuchiza matenda kuyenera kuchitika moyang'aniridwa ndi katswiri. Mankhwala onse ali ndi contraindication. Kufunsira kwa akatswiri ndikofunikira!

Kodi polyneuropathy ndi chiyani?

Polyneuropathy (polyneuropathy, polyneuritis) Ndi matenda omwe amadziwika ndi zotupa zingapo zamitsempha yamafungo. Izi matenda akuwonetseredwa ndi zotumphukira ziwopsezo, vuto la kuchepa kwa magazi, kusokonezeka kwa mitsempha ya mtima (makamaka m'malire a distal).

Diabetesic polyneuropathy: Zizindikiro

M'magawo osiyanasiyana a matendawa, Zizindikiro zimatha kusiyanasiyana - ndi gawo la zero, zizindikiro sizipezeka konse. Gawo loyamba lilibe zizindikiro, koma adotolo amatha kudziwa za matendawa powerenga mayeso okonzekera magazi ndi zotsatira za kuyesedwa koyesa m'gawo la dipatimenti ya mitsempha.

Pa gawo lachiwiri lazachipatala, kupweteka kosatha, kupweteka kwapweteka, amyotrophy ndi mawonekedwe osapweteka zimasiyanitsidwa. Mu mawonekedwe opweteka kwambiri, odwala matenda ashuga amamva kuwawa komanso kupweteka m'miyendo, pomwe mphamvu imachepa mosavuta, chifukwa chomwe polyneuropathy yam'munsi imapezeka. Makamaka Symbomatology imatha kukulira usiku.

Pakakhala mawonekedwe owawa kwambiri, zopweteka zimayamba kufalikira thupi lonse, nthawi zina, chidwi chambiri chimawonedwa pamunsi. Amyotrophy imayendera limodzi ndi kufooka kwa minofu ndi kupweteka kwambiri usiku. Ndi mawonekedwe osapweteka, munthu samamvanso kupweteka komanso kutentha.

Dokotala amazindikira gawo lachitatu la matendawa pakafika zovuta zazikulu. M'dera lamapazi, mutha kuwona mabala ndi zilonda zambiri, ndizotheka kukula kwa phazi la Charcot, pankhaniyi, matendawa nthawi zambiri amatsogolera kudula phazi.

Zizindikiro zonse za matendawa zitha kugawidwa m'magulu atatu:

Zizindikiro zowoneka bwino zimaphatikizapo kusokonezeka mu mawonekedwe a kupweteka, kudula, kuwombera, ululu woyaka. Mu odwala matenda ashuga, kumva kuchepa kumachepa,, kapena, kusamva, kumawonjezeka, mikono ndi miyendo imatha. Komanso, wodwalayo sangamve kusinthasintha kapena kusintha kwa kutentha.
Zizindikiro za ntchito yamagalimoto zimayendera limodzi ndi kufooka kapena kuwongolera kwa minofu yam'mapazi, miyendo, kusoweka, miyendo, kunjenjemera, kupindika kwa minofu ya caviar.
Kuphatikiza pa matenda ashuga, dongosolo lodziyimira palokha limasokonekera, izi zimawonetsedwa ndi tachycardia, kuchepa kwa magazi, munthu akasintha thupi, kudzimbidwa, kutsegula m'mimba, kusabala, kusokonezeka thukuta, edema.

Kuzindikira ndi kuchiza matenda a polyneuropathy

Matendawa amadziwika chifukwa cha zodandaula za omwe ali ndi matenda ashuga, zomwe zilipo komanso zina zake. Matendawa ndi ovuta kuwazindikira, popeza anthu okalamba amatha kukumana ndi zizindikiro zamatenda zofananira chifukwa cha kusintha kwokhudzana ndi ukalamba.

Kuphatikiza nthawi zina chizindikiro cha matenda sichidziwoneka mwanjira iliyonse, chifukwa chake, ndizotheka kuzindikira kuphwanya kokha pakudutsa mayeso apadera.

Nthawi zambiri, matenda ngati awa amapezeka mwa amuna okalamba, palinso chiopsezo chokhala ndi matenda ashuga a polyneuropathy omwe ali ndi hyperglycemia, kukula kwambiri kwa odwala, kupezeka kwa matenda a shuga komanso nephropathy, kuchepetsa kuchepa kwa matendawa.

Ngati munthu ali ndi vuto la matendawa, pofuna kudziwa njira yodziwira matendawa, mphamvu ya kugunda imayesedwa pogwiritsa ntchito foloko, kuchuluka kwa chidwi pakusintha kwa kutentha kumatsimikiziridwa, chidwi cha kupweteka chimapezeka ndikunyambita miyendo ndi singano yapadera.Kuphatikizanso kukhudzidwa kwa chidwi chazomwe tikufuna kudziwa komanso momwe munthu wodwala matenda ashuga angawone malo omwe ali mthupi.
Ngati matendawa akuwoneka kuti akukayikira, mawonekedwe a tendon amawunikira ndikuwonetsetsa kuti ma electromyography, omwe amaphunzira ntchito za bioelectric minofu minofu.
Pankhani ya kudziyimira kokhazikika kwa polyneuropathy, kugunda kwa mtima panthawi ya kupumira komanso kupuma kumayesedwa, mkhalidwe wa gastroenterological ndi urological umayesedwa, ndipo munthu amayezetsa matenda a orthostatic hypotension.

Mukamayesedwa, adotolo amafufuza ngati odwala matendawa akumva kukhudza, kupweteka, kutentha, kuzizira, kugwedezeka ndi kukakamizidwa. Zipangizo zosiyanasiyana zimagwiritsidwa ntchito pamenepa, koma wodwalayo, ngati kuli kotheka, amatha kuyang'anitsitsa momwe akumvera ndi zinthu zina zotentha ndi zozizira. Zomverera zowoneka bwino zimatha kupezeka ndi swabs thonje, zomwe zimanyamulidwa pakhungu.

Ngati munthu wodwala matenda ashuga aulula diabetesic polyneuropathy, mankhwalawo amayenera kukhala okwanira, zifukwa zonse zomwe zimapangitsa kuti matendawa athe. Pachifukwa ichi, pazotsatira za adokotala, mankhwala osiyanasiyana amathandizidwa kuti athe kuchepetsa matenda komanso kuchepetsa vuto la wodwalayo.

Kuchepetsa shuga m'magazi, imwani mankhwala ochepetsa shuga.
Kuti athetse magwiridwe antchito a mankhwalawa, dokotalayo amalembera kuchuluka kwa mavitamini a B, mankhwala ochepetsa nkhawa pang'ono, komanso kukonzekera kokhala ndi thioctic acid.
Gabapentin ndi njira yothandiza yokhudza kukomoka, ndipo ma analgesics ndi mankhwala oletsa ululu amafunikanso. Kukonzekera kwa magnesium kumathandizira kuchepetsa kukokana, minofu yolumikizira minyewa.
Kuti muwonjezere zamagetsi zamagetsi, ndikofunikira kuti mumwe mankhwala Actovegin.
Ngati munthu ali ndi tachycardia, tengani Nebivolol kapena Metoprolol.
Pofuna kuthetsa mkwiyo pakhungu, Kapsikam, Apizartron, Finalgon amagwiritsidwa ntchito.

Physiotherapy yapadera, kutikita minofu yopumula, acupuncture, maginito othandizira, kukondoweza kwamagetsi kumatha kuchiritsa matenda ochokera ku mankhwala osagwiritsa ntchito mankhwala.

Njira zotsimikiziridwa ndi wowerengeka zimathandizira kuchotsa mabala ndi zilonda pakhungu ndi matenda ashuga polyneuropathy, chifukwa cha izi, mankhwala osokoneza bongo, mafuta ochiritsa, ndi mankhwala othandizira amagwiritsidwa ntchito.

Zakumwa zilizonse zomwe zimamwa mowa sizimachotsedwa muzakudya kuti thupi likhale lamphamvu komanso lathanzi.

Njira zopewera

Ndi matenda anthawi yake, chithandizo choyenera, komanso kupewa, kukulitsa matendawa kutha kutha nthawi. Kuti izi zitheke, ndikofunikira kuti odwala matenda ashuga azikhala zaka zisanu atazindikira kuti amachokera ku shuga kuti akaonane ndi dokotala kuti adziwe ngati ali ndi matenda a shuga kapena mwana wamkulu. Pambuyo pake, muyenera kupititsa ulamuliro chaka chilichonse.

M'nkhaniyi, tiona mwatsatanetsatane njira yofala kwambiri yamatenda a shuga omwe amachedwa - distal, symmetric, sensorimotor polyneuropathy .

Kuzindikiritsa Zizindikiro zamankhwala.
Kuunika zamankhwala: Kusanthula kwa maumboni ndi okhudza zinthu zosiyanasiyana.
Phunziro la Electrodiagnostic: kudziwa kuthamanga kwa zolimbikitsira pamodzi ndi mitsempha.
Kuyesa kwamalingaliro mwamalingaliro.
Mayeso ogwiritsa ntchito pawokha.

kumva motentha, dzanzi (dzanzi) kapena kumverera kwa "kukwawa" = 2
kutopa, kukokana kapena kuwawa = 1
kugawa:
mapazi = 1
minofu ya ng'ombe = 1
zina = 0
phindu:
usiku = 2
usana kapena usiku = 1
nthawi = =
kudzuka ku tulo = 1
kuchepa:
poyenda = 2
kuyimirira = 1
kukhala kapena kunama = 0

Zambiri amapanga mtengo wokwera:
3-4 - Zizindikiro zazing'ono,
5-6 - Zizindikiro zoyenera,
7-16 - Zizindikiro zowopsa.

bondo
kugwedeza mwamphamvu
kumva kupweteka
kutentha kwa kutentha
malingaliro:
zabwinobwino = 0
onjeza = 1
kusowa = 2 mbali iliyonse
zomverera (zachifundo):
kupezeka = 0
kuchepetsedwa kapena kulibe = 1 mbali iliyonse

Zambiri :
3-5 - zizindikiro zazing'ono
6-8 - Zizindikiro zoyenera
9-10 - Zizindikiro zowopsa

Njira zochepa zodziwira matenda a diabetesic neuropathy malinga ndi NSS ndi VAT ndi:

Zizindikiro zoyenera kapena zopanda zizindikiro (VAT = 6-8 + HCC ≥ 0)
Zizindikiro zazing'ono zomwe zimakhala ndi zofatsa (VAT = 3-5 + HCC = 5-6)

Kuti muwone kuwopsa kwa mawonetseredwe azachipatala, ndikofunikira kuwunika kwamitsempha yama sensorimotor . Zimaphatikizaponso kuwerenga kwa mitundu yonse yamalingaliro ndi zomverera.

Kutengera kuwonekera kwachipatala, zotsatirazi magawo a distal diabetesic neuropathy (Maupangiri apadziko lonse a Outpatient Management of Diabetesic Neuropathy, 1995):

0 - palibe neuropathy, zizindikiro ndi zizindikiro sizikupezeka
1 - asymptomatic neuropathy
1 A - HCC = 0, chiwonetsero chazenera bondo
1 B - HCC = 0, Reflex ya bondo
2 - chizindikiro cha neuropathy
2 A - HCC ≥ 1, reflex yofananira ya bondo
2 B - HCC ≥ 1, Reflex ya bondo
3 - neuropathy yayikulu.

Polyneuropathy - Ichi ndi matenda oopsa, omwe ndi kugonjetsedwa kwamitsempha yamagetsi, komwe maziko ake ndi kusokonezeka kwa chidwi, kusokonezeka kwa chidwi, kuperewera kwa mitsempha, kufooka kwamizere, komwe kumachitika makamaka m'magawo amanja ndi miyendo. Matendawa nthawi zambiri amawatengera malinga ndi etiological factor, pathomorphology of the pathological focus ndi mtundu wa maphunzirowa.

Limb polyneuropathy imadziwika kuti ndi njira yodziwika bwino, nthawi zambiri imakhudza zigawo za distal ndikulowerera pang'onopang'ono kwa zigawo zowonjezera.

Zizindikiro za polyneuropathy

Matendawa poganizira polyneuropathy a kumtunda ndi m'munsi malekezero amayamba ndi kufooka kwa minofu, ndipo koyamba, kumadera akumiyendo ndi miyendo ndi manja. Izi ndichifukwa cha kuwonongeka kwa ulusi wamanjenje. Ndi matendawa, choyambirira, ziwalo zam'magazi zimakhudzidwa chifukwa chosowa chitetezo chokwanira cha zigawo zamkati mwa zotumphukira (mwachitsanzo, chotchinga cha magazi muubongo).

Kuwonetsera kwa ofotokozedwera a pathology kuwonekera m'dera la phazi ndikufalikira mwendo. Kutengera mtundu wa mitsempha yomwe imawonongeka kwambiri, mitundu yonse ya polyneuropathy imagawika m'magulu anayi.

Chifukwa chakugonjetsedwa, makamaka kwaothandizana nawo kwakutali kwa ma neurons, odwala ali ndi chizindikiro chabwino kapena chosavomerezeka. Choyamba - chimadziwika ndi kusowa kwa ntchito kapena kuchepa kwake, zizindikilo zabwino ndizomwe zimawonetsedwa.

Mu nthawi yoyamba, mu odwala matenda omwe amafunsidwa amawonekera ndi mitundu yosiyanasiyana ya maresthesia, monga kuwotcha, kumva, kutulutsa nyerere, kugona. Kenako chithunzi cha chipatala chimakhala chosakanikirana ndi ma algias osiyanasiyana osiyanasiyana, ndipo kuphatikizika kwa zovuta zopweteka kumalimbikitsidwa. Zizindikiro zikamakulirakulira, odwalawo amakhala ndi chidwi chambiri pakuwona kosavuta. Pambuyo pake, adawonetsera mawonedwe akumva, m'maso mwa matayala, makamaka ndi maso otsekeka, ndikugwirizanitsa mayendedwe. Zizindikiro zoyipa za polyneuropathy zimaphatikizanso kuchepa kwa chidwi cha malo pamavuto amitsempha yama mitsempha.

Pankhani ya kuwonongeka kwa axonal ku ma neuron, kuyenda kwa polyneuropathy kwam'munsi komanso m'munsi kumawonekera, mwakutembenuka koyamba, ndi minofu atrophy ndipo imapezeka mu kufooka kwa miyendo ndi mikono. Zizindikiro zomwe zafotokozedwazo zimapitirira mpaka ziwindi ndi paresis. Pafupipafupi, vuto limatha kuwonedwa, kuwonetsedwa ndi malingaliro osasangalatsa m'miyendo, kuwonekera kwambiri pakupuma komanso kukakamiza anthu kuti azichita ngati ali ndi vuto lotsogolera. Kuphatikiza apo, kukopeka ndi kukhudzika kumatha kuchitika.

Zovuta zamasamba zimagawika muzovuta zam'matumbo komanso minyewa. Zoyambazo zikuphatikiza mawonekedwe a khungu ndi mawonekedwe a khungu, maonekedwe pamphepete mwa ming'alu ndi zilonda. Matenda a mtima amaphatikizanso kuzizira kwa magawo owonongeka, kuzimiririka kwa khungu (lotchedwa "marble pallor").

Zizindikiro za Vegetative-trophic zimaphatikizanso kusintha kwamapangidwe amachokera kwa dermis (tsitsi ndi misomali). Chifukwa chakuti malekezero am'munsi amatha kupilira katundu wambiri, polyneuropathy miyendo imapezeka nthawi zambiri kuposa manja.

Polyneuropathy yam'munsi yotsika

Matendawa poganizira polyneuropathy ya malekezero ndi kuwonongeka koopsa kwamitsempha yama mitsempha, kuchititsa kusagwira bwino ntchito kwa zotumphukira zamagetsi. Matendawa akuwonetsedwa ndi kuchepa kwa mphamvu yamagalimoto, kuchepa kwa chidwi, kutengera ndi malo omwe mutuwu umayang'ana, gawo lililonse la miyendo, kupweteka kwa minofu. Ndi matenda omwe akufunsidwa, minyewa ya wodwalayo yomwe imadyetsa mapazi imawonongeka. Chifukwa cha kuwonongeka kwa maulalo mu minyewa yamanjenje, chidwi chamiyendo chimatayika, zomwe zimakhudza kuthekera kwa munthu kuyendayenda payekha.

Chithandizo cha polyneuropathy cha m'munsi kwambiri, monga lamulo, chimakhala chovuta komanso chotalika, chifukwa nthawi zambiri matendawa amakhala ndi machitidwe opita patsogolo ndipo amakula nthawi yayitali.

Kuti mudziwe zomwe zimayambitsa kukula kwa matenda omwe afotokozedwawo, poyambirira, muyenera kuthana ndi chipangizo chamanjenje, makamaka m'malo ake osiyanasiyananso - dongosolo la zotumphukira.Zimakhazikitsidwa munjira zazitali za ulusi wamanjenje, ntchito yake ndikufalitsa ma siginecha, omwe amathandizira kupanga magalimoto ndi ntchito zamagetsi. Matupi a mitsempha imeneyi amakhala m'mitsempha ya ubongo ndi msana, motero amakhala olumikizana kwambiri. Kuchokera pamawonekedwe othandiza, gawo lakumapeto la mitsempha limaphatikiza zomwe zimatchedwa "conductors" zomwe zimalumikiza malo amitsempha ndi ma receptors komanso ziwalo zogwira ntchito.

Pamene polyneuropathy imachitika, gawo lopatula la zotumphukira zamitsempha yam'mimba limakhudzidwa. Chifukwa chake, mawonetseredwe a matendawa amawonedwa m'malo ena. Amaganizira matenda amiyendo amadziwoneka okha.

Tiyenera kudziwa kuti matenda omwe amafotokozedwa ali ndi mitundu ingapo, yomwe imayang'aniridwa molingana ndi ntchito ya mitsempha yowonongeka. Chifukwa chake, mwachitsanzo, ngati ma neuron omwe amayambitsa kusunthika akukhudzidwa, kuthekera kosuntha kumatha kutayika kapena kuvuta. Polyneuropathy yotereyi imatchedwa motor.

Ndi mawonekedwe a chisokonezo omwe akufunsidwa, ulusi wamanjenje umakhudzidwa, ndikuyambitsa chidwi, chomwe chimavutika kwambiri gulu ili la minyewa ikawonongeka.

Kuperewera kwa ntchito za kayendetsedwe kazinthu zamagetsi kumachitika ndikuwonongeka kwa mafupa am'mitsempha ya autonomic (hypothermia, atony).

Chifukwa chake, zinthu zotsatirazi zomwe zimayambitsa kukula kwa matendawa zimasiyanitsidwa: metabolic (yomwe imakhudzana ndi kusokonezeka kwa metabolic), autoimmune, cholowa, zamentary (zomwe zimayambitsa vuto lakudya), poizoni komanso zowopsa.

Mitundu iwiri ya mafotokozedwe ofotokozedwazi amasiyanitsidwa malingana ndi komwe malo a lesion: demyelinating and axonal. Poyamba - myelin amakhudzidwa - chinthu chomwe chimapanga membala wamitsempha, wokhala ndi mawonekedwe a axonal, cholembera cha axial chimawonongeka.

Ma axonal mawonekedwe a polyneuropathy a miyendo amawonedwa pamitundu yonse yamatenda. Kusiyanako kukugona pakukula kwa mtundu wakuphwanya, mwachitsanzo, pakhoza kukhala kusokonezeka kwa ntchito yamagalimoto kapena kuchepa kwamphamvu. Fomuyi imawoneka chifukwa cha zovuta zama metabolic, kuledzera ndi mankhwala osiyanasiyana a organophosphorous, kutsogolera, mchere wamadzimadzi, arsenic, komanso uchidakwa.

Mitundu inayi imasiyanitsidwa, kutengera maphunzirowa: njira yokhazikika komanso yokhazikika, yovuta komanso yopepuka.

The pachimake mawonekedwe a axonal polyneuropathy nthawi zambiri amapanga masiku 2-4. Nthawi zambiri zimapwetekedwa ndi poyizoni wamphamvu wofuna kudzipha kapena wachifwamba, kumwa kwambiri chifukwa chodziwikiridwa ndi arsenic, kaboni monoxide, lead, mchere wa zebaki, mowa wa methyl. Fomu yovuta imatha kupitilira masiku khumi.

Zizindikiro za mtundu wa polyneuropathy zimawonjezeka mkati mwa masabata angapo. Fomuyi imakonda kupezeka ndi zovuta za metabolic kapena chifukwa cha toxicosis. Nthawi zambiri, kuchira kumabwera pang'onopang'ono ndipo kumatha kutenga miyezi.

Fomu yodwalayi imakonda kupitilira kwakanthawi kwa miyezi isanu ndi umodzi kapena kupitirira. Matendawa nthawi zambiri amawonekera motsutsana ndi zakumwa zam'mbuyo za zakumwa zoledzeretsa, matenda ashuga, lymphoma, matenda amwazi, kuchepa kwa mavitamini thiamine (B1) kapena cyanocobalamin (B12).

Pakati pa axonal polyneuropathies, zakumwa zoledzeretsa zimapezekanso nthawi zambiri, zimayamba chifukwa chovutitsa nthawi yayitali komanso kumwa madzi akumwa. Udindo wofunikira wa kupezeka kwa matenda omwe umaganizira samasewera osati kokha ndi "malita odziwidwa" a mowa, komanso ndi mtundu wa zomwe zimachitika, chifukwa zakumwa zambiri zakumwa zomwe zili ndi zakumwa zambiri zimakhala ndi zinthu zambiri zapoizoni m'thupi.

Chochititsa chachikulu chomwe chimapangitsa mowa kuledzera ndi zovuta zakumwa za poizoni, zomwenso ndi zakumwa zoledzeretsa, pamitsempha yama mitsempha, zomwe zimayambitsa zovuta za metabolic. Nthawi zambiri, matenda omwe amafotokozedwa amakhala ndi maphunziro apamwamba. Poyamba, m'magawo am'munsi am'munsi, kumverera kwa dzanzi kumachitika, ndipo minyewa ya ng'ombe - kupweteka kwambiri. Ndi kupanikizika kowonjezereka, ma algias mumisempha akuwonjezeka.

Pa gawo lotsatira la chitukuko cha matendawa, kusokonezeka kwakukulu kwam'munsi kumayang'aniridwa, komwe kumasonyezedwa ndi kufooka, nthawi zambiri ngakhale kufa ziwalo. Mitsempha yomwe imayambitsa kupindika-kokulirapo kwa phazi ndiowonongeka kwambiri. Kuphatikiza apo, chidwi cha mapindikidwe amkamwa m'dera lamanja ndi mtundu wa "magolovu" ndi mapazi mwa mtundu wa "sock" ndiwosokonekera.

Nthawi zina, matendawa amatha kukhala ndi zovuta. Izi zimachitika makamaka chifukwa cha kuzizira kwambiri.

Kuphatikiza pa zidziwitso zamankhwala pamwambapa, mawonetsedwe ena a pathological atha kukhalapo, monga kusintha kwakukulu pamaonekedwe amtundu wa khungu la miyendo ndi kutentha kwa malekezero, kutupa kwa mbali zamiyendo zamiyendo (kawirikawiri mikono), kuwonjezeka thukuta. Matendawa omwe amafunsidwa nthawi zina amatha kukhudza mitsempha ya cranial, yomwe ndi mitsempha ya oculomotor ndi mitsempha ya maso.

Zovuta zomwe tafotokozazi nthawi zambiri zimapezeka ndikuwonjezeka kwa masabata angapo / miyezi. Matendawa amatha zaka zingapo. Ndi kutha kwa kumwa mowa, matendawa amatha.

Mitundu yonyentchera ya polyneuropathy imawerengedwa kuti ndi matenda oopsa, limodzi ndi kutukusira kwa mizu ya mitsempha ndi kuwonongeka kwapang'onopang'ono kwa sheel yanga ya myelin.

Mawonekedwe omwe matendawa amatengera matendawa ndi osowa kwambiri. Nthawi zambiri, amuna achikulire amadwala matendawa, ngakhale amatha kupezeka a theka lofooka ndi ana. Demyelinating polyneuropathy nthawi zambiri imawonetsedwa ndi kufooka kwa minofu kumadera akumidzi ndi ovomerezeka a miyendo, chifukwa cha kuwonongeka kwa mizu yamitsempha.

Tsoka ilo, momwe zimapangidwira chitukuko komanso zomwe zimayambitsa matendawa sizikudziwika mwatsatanetsatane, kafukufuku wina wasonyeza mtundu wa autoimmune wa demyelinating polyneuropathy. Pazifukwa zingapo, chitetezo cha mthupi chimayamba kuwona maselo ake ngati achilendo, chifukwa chomwe chimakhala chizolowezi kupanga ma antibodies ena. Ndi mawonekedwe amtunduwu, ma antigen amawukira maselo a mizu ya mitsempha, ndikupangitsa kuwonongeka kwa nembanemba (myelin), potero zimayambitsa njira yotupa. Chifukwa cha kuukira kotere, mathero amanjenje amachotsa ntchito zofunika, zomwe zimayambitsa chisokonezo mkati mwa ziwalo ndi minofu.

Popeza amavomerezedwa kuti matenda amtundu uliwonse wa autoimmune ndi ofanana ndi chibadwa, vuto la majini omwe amapezeka ndi demyelinating polyneuropathy silingadziwike. Kuphatikiza apo, pali zinthu zina zomwe zingasinthe kugwira ntchito kwa chitetezo chathupi. Zinthu ngati izi zimaphatikizapo kusokonekera kwa metabolic ndi mahomoni, kulimbitsa thupi kwambiri, matenda amthupi, kupsinjika, kutemera, kuvulala, kupsinjika, matenda akulu ndi opareshoni.

Chifukwa chake, chithandizo cha polyneuropathy cha malekezero am'munsi chikuyimiriridwa ndi zinthu zingapo zomwe ziyenera kukumbukiridwa, chifukwa kuphwanya komwe kukufunsidwa sikungodziyambitsa nokha. Chifukwa chake, mukazindikira mawonetseredwe oyamba ndi zizindikiro za matenda, ndikofunikira kukhazikitsa zofunikira, chifukwa mankhwalawa, mwachitsanzo, matenda a shuga a shuga amasiyana ndi mankhwalawa a matenda omwe amayamba chifukwa cha mowa.

Polyneuropathy yam'manja miyendo

Kuphwanya kumeneku kumachitika chifukwa cha kuwonongeka kwa mitsempha ndipo kumayambitsa ziwalo zam'manja. Ndi zovuta zamtunduwu, kuwonongeka koyerekeza kwamitsempha yama mitsempha yammbali yam'mphepete kumadziwika.

Zizindikiro za manja a polyneuropathy pafupifupi zimakhala zofanana nthawi zonse. Odwala akuwonjezeka thukuta, kuphwanya zamkati, kupweteka, khungu, kusintha kwa tactile sensitivity, paresthesias amawoneka mu mawonekedwe a "goose bumps". Izi matenda amadziwika ndi mitundu itatu ya Inde, aakulu, pachimake ndi subacute.

Polyneuropathy yamtunda wapamwamba imawonetsedwa, choyambirira, ndi kufooka kwa manja, mitundu yambiri ya algias, yomwe pazinthu zawo ikuwotcha kapena kuphulika, kutupa, kutupa nthawi zina kumatha kumveka. Ndi matenda amtunduwu, kusinthasintha kwamphamvu kwamatenda kumatha kusokonezeka, chifukwa cha zomwe odwala nthawi zambiri amakumana ndi zovuta pochita manambala. Nthawi zina anthu omwe ali ndi vuto la polyneuropathy amakumana ndi kuchepa kwa chidwi cha manja m'manja.

Amayambitsa polyneuropathy ya manja, nthawi zambiri, kuledzera kosiyanasiyana, mwachitsanzo, chifukwa cha mowa, mankhwala osokoneza bongo, zakudya zosowa. Komanso, kupezeka kwa matendawa omwe akufunsidwa kungayambitse: kuchepa kwa mavitamini, njira zopatsirana (viral kapena bacteric etiology), collagenoses, chiwindi, kukanika kwa impso, chotupa kapena autoimmune njira, pancreatic ndi endocrine pathologies. Nthawi zambiri, matendawa amapezeka chifukwa cha matenda ashuga.

Matendawa amafotokozedwa m'njira zosiyanasiyana.

Mwa pathogenesis, polyneuropathy yam'mphepete mwa magawo ikhoza kugawidwa kukhala axonal ndi demyelinating, malinga ndi mawonetsedwe azachipatala, a vegetative, sensory, and motor. Mwanjira yake yoyera, zimakhala zovuta kukumana ndi mitundu yazodwala zamatenda, nthawi zambiri matendawa amaphatikiza zizindikiritso zosiyanasiyana.

Mankhwala a polyneuropathy

Masiku ano, njira zochizira matendawa zomwe zikufunsidwa ndizochepa. Chifukwa chake, mpaka pano, chithandizo cha polyneuropathies cha mitundu yosiyanasiyana chikadali vuto lalikulu. Mlingo wazidziwitso wa madotolo amakono pankhani yokhudzana ndi pathogenetic komanso chidziwitso chautali wa matenda adatsimikiza kuyenera kusiyanitsa magawo awiri achire, omwe ndi njira zosasiyanitsidwa ndi zina.

Njira zosiyana zochiritsira achire zimapereka chithandizo cha matenda akulu (mwachitsanzo, nephropathy, matenda ashuga) ngati mankhwala opatsirana amkati, komanso vuto la m'mimba dongosolo lomwe limayambitsa malabsorption, kukula kwa mavitamini B1 (thiamine) ndi B12 (cyanocobalamin).

Chifukwa, mwachitsanzo, mankhwala osokoneza bongo a shuga a polyneuropathy ndi kusankha kwawo chifukwa cha kukonzanso kwa glycemic ena. Chithandizo cha polyneuropathy chokhudza matenda ashuga chiyenera kutha. Pachigawo choyamba, kulemera kwa thupi ndi zakudya ziyenera kusinthidwa, magawo olimbitsa thupi apadera ayenera kukhazikitsidwa, ndikutsatira zizindikiro za kuthamanga kwa magazi ndi chizolowezi kuyenera kuyang'aniridwa. Njira za mankhwala a patathogenetic zimaphatikizira kugwiritsa ntchito mavitamini a neurotropic komanso jakisoni wa alpha-lipoic acid mu Mlingo waukulu.

Njira zochizira zosagwiritsidwa ntchito zimayimiriridwa ndi glucocorticoids, mankhwala a immunosuppressive ndi plasmapheresis.

Mankhwala othandizira a polyneuropathy ayenera kuyikidwa limodzi. Zambiri zosankha zochizira matenda omwe amawerengera nthawi zonse zimadalira zovuta zomwe zimadzetsa matendawa ndikupangitsa njira yake. Kotero, mwachitsanzo, zizindikiro za polyneuropathy zopangidwa ndi kuchuluka kwa pyridoxine (vitamini B6) zimatha popanda kufufuza pambuyo pokulitsa kukula kwake.

Polyneuropathy yoyambitsidwa ndi njira ya khansa imachiritsidwa ndi opaleshoni - kuchotsa kwa neoplasm, yomwe imayika zovuta pamapeto a mitsempha. Ngati matendawa adayamba kutsutsana ndi hypothyroidism, ndiye kuti mankhwala a mahomoni amagwiritsidwa ntchito.

Chithandizo cha poyizoni polyneuropathy, poyambirira, zimaphatikizapo njira zochotsa matenda, pambuyo pake mankhwala amathandizidwa kuti awongolere matendawa pawokha.

Ngati ndizosatheka kuzindikira kapena kuthetsa chomwe chinayambitsa kukula kwa matenda omwe tafotokozawa, cholinga chachikulu cha mankhwalawa chimaphatikizapo kuchotsa kupweteka komanso kuchotsa kufooka kwa minofu.

Muzochitika izi, njira zokhazikika za physiotherapeutic ndi kuperekedwa kwa mankhwala angapo omwe cholinga chake ndi kuchepetsa kapena kuchepetsa ululu womwe umachitika chifukwa cha kuwonongeka kwa minyewa yamitsempha imagwiritsidwa ntchito. Kuphatikiza apo, njira za physiotherapy zimagwiritsidwa ntchito mwachangu pamagawo onse ochizira.

Mothandizidwa ndi ma analgesics kapena mankhwala osokoneza bongo omwe amaletsa kutupa, ndizovuta kwambiri kuthana ndi Algia. Chifukwa chake, chizolowezi chopereka mankhwala opha opaleshoni, anticonvulsants ndi antidepressants pothandizira kupweteka kwapweteka kumachitika pafupipafupi.

Kuchita bwino kwa antidepressants kuli mwa kuthekera kwawo kuchititsa kutsegula kwa dongosolo la noradrenergic. Kusankhidwa kwa mankhwala m'gululi kumakhazikitsidwa payekhapayekha, chifukwa ma antidepressants nthawi zambiri amachititsa kudalira kwamaganizidwe.

Kugwiritsa ntchito ma anticonvulsants kuli koyenera chifukwa cha kuthekera kwawo kupewetsa kukhudzika kwa mitsempha kuchokera ku misempha yomwe ikukhudzidwa.

RCHR (Republican Center for Health Development of the Ministry of Health of the Republic of Kazakhstan)
Mtundu: Ma Protocol Achipatala a Unduna wa Zaumoyo wa Republic of Kazakhstan - 2017

Matenda a diabetesic polyneuropathy (E10-E14 + NDI MALO ACHINYAMATA ATHA 4.)

Kufotokozera kwapfupi

Zovomerezeka
Joint Commission for Quality of Medical Services
Ministry of Health of the Republic of Kazakhstan
ya Novembara 28, 2017
Protocol No. 33

Matenda a shuga - Kuwonongeka kwamitsempha chifukwa cha matenda ashuga, kwawonekeratu kapena koperewera, popanda etiology ina (WHO). Mtundu wa matenda a shuga wambiri womwe umawerengedwa kwambiri ndipo ndi distal symmetric polyneuropathy. DSPN - kukhalapo kwa zizindikiro za kuperewera kwa mitsempha yodutsa kwa odwala omwe ali ndi matenda osokoneza bongo atatha kupatula zifukwa zina.

Kukula kwa protocol / kukonzanso : Chaka cha 2017.

Zifupikitso zomwe zimagwiritsidwa ntchito pa protocol:

GPP	Njira Zabwino
WHO	World Health Organisation
ANU	mawonekedwe analogue
DAN	diabetesic autonomic neuropathy
DMN	matenda ashuga mononeuropathy
DN	matenda ashuga polyneuropathy
DPN	matenda ashuga polyneuropathy
DSPN	diabetesic sensorimotor polyneuropathy
ICD 10	gulu lonse la matenda okonzanso 10
NA	dongosolo lamanjenje
RCT	mayeso azachipatala osankhidwa
SD I	lembani matenda ashuga
SD 2	mtundu II matenda ashuga
ENMG	Electroneuromyography

Ogwiritsa Ntchito Protocol : akatswiri amatsenga, akatswiri azachipatala, akatswiri azamankhwala.

Mulingo wambiri:
Gome 1 - kukula kwa misambo yambiri

A	Kuwunikira kwapamwamba kwambiri kwa meta, kuwunika mwadongosolo ma RCTs kapena RCT yayikulu kwambiri yokhala ndi mwayi wocheperako (++) wolakwitsa mwatsatanetsatane, zotsatira zake zomwe zimatha kufalikira kwa chiwerengero chogwirizana.
Mu	Maphunziro apamwamba kwambiri (++) cohort kapena maphunziro owongolera milandu kapena maphunziro apamwamba kwambiri (++) kapena maphunziro owongolera milandu omwe ali ndi chiopsezo chochepa kwambiri cholakwika mwadongosolo kapena ma RCT omwe ali ndi chiopsezo chotsika (+) cholakwika mwatsatanetsatane, zotsatira zake zomwe zimatha kuperekedwa kwa anthu ofanananira .
Ndi	Kafukufuku wowerengeka kapena wowongolera zochitika kapena kafukufuku wotsogozedwa popanda kusinthaku ndi chiopsezo chochepa cha tsankho (+). Zotsatira zomwe zimatha kugawidwa kwa anthu omwe amagwirizana kapena ma RCT omwe ali ndi chiwopsezo chochepa kwambiri kapena chotsika kwambiri cha zolakwika mwadongosolo (++ kapena +), zotsatira zake zomwe sizingagawidwe mwachindunji kwa anthu omwe amagwirizana.
D	Kufotokozera kwamilandu yotsatizana kapena kafukufuku wosalamulirika kapena lingaliro laukatswiri.
GRP	Zochita zabwino zamankhwala.

Kusiyanitsa mitundu

Kusiyanitsa mitundundi zifukwa zopangira kafukufuku wowonjezera
DSPN ndizodziwitsa za ena. Kukhalapo kwa matenda a shuga ndi zizindikiro za polyneuropathy sikutanthauza zokha kukhalapo kwa matenda ashuga a polyneuropathy. Kuzindikira koyenera kumafunikira kuzindikira koyenera.

Gome 3 - Kuzindikira mosiyana kwa DSPN

Kuzindikira	Cholinga chodziwitsira matenda osiyanasiyana	Kafukufuku	Njira yodziwitsa ena
Mowa Mowa	Kuyesa kwamwazi wamagazi. Ultrasound	Zotsatira zam'madzi. Kukhalapo kwa mowa wa chiwindi wa chiwindi, mawonekedwe ena a NS: zakumwa zoledzeretsa, zakumwa zoledzeretsa, zakumwa zoledzeretsa za polyradiculoneuropathy
PN mu matenda a autoimmune	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kuyesedwa kwamwazi wamagazi.	Mbiri yakale ya matenda a autoimmune. Matenda azachipatala komanso a labotale za matenda awa.
PN yokhala ndi vuto la vitamini B12	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kudziwitsa kuchuluka kwa B12 m'magazi.	Low seramu vitamini B12 ndende. Mwina kuphatikiza ndi kuchepa kwa magazi m'thupi la macrocytic megaloblastic.
PN mu zovuta zina za metabolic (hypothyroidism, hyperthyroidism, kunenepa kwambiri)	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kuyesa kwa magazi kwa mahomoni a chithokomiro. Ntchito ya chithokomiro	Zotsatira zam'madzi. Matenda azachipatala, a labotale ndi othandizira matenda awa.
Paraneoplastic syndromes	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Malinga ndi matenda a KP oncological.	Zotsatira zam'madzi. Zotsatira za maphunziro othandizira omwe akuwonetsa kukhalapo kwa pulogalamu ya oncological.
Kutupa kufooketsa PN (katemera pambuyo katemera, pambuyo matenda owopsa)	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	ENMG. Kuwunikira kwa CSF. Biopsy n.suralis	Zotsatira zam'madzi. Zambiri mwatsatanetsatane pa ENMG. Kuzindikira kwa mapuloteni mu madzi a cerebrospinal. Zosintha Zapadera ku n.suralis Biopsy
Mon cholowa	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kafukufuku wazopanga ma genetic laboratories. ENMG	Zotsatira zam'madzi. Mbiri yabanja. Matenda azachipatala ndi a labotale a matenda ena obadwa nawo.
PN pa zakumwa zoledzera zakunja (lead, arsenic, phosphorous, etc.)	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kuyesa kwa magazi ndi mkodzo wa zinthu zakupha.	Zotsatira zam'madzi. Matenda azachipatala ndi a labotale a kuledzera kwina.
PN mu zakumwa zoledzeretsa (aakulu chiwindi kulephera, aimpso kulephera)	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Magazi am'mwazi ndi mkodzo mayeso. Ultrasound ndi / kapena MRI ya OBP ndi impso	Zotsatira zam'madzi. Matenda am'chipatala, a labotale komanso othandiza kwambiri kutha kwa chiwindi kapena matenda aimpso.
PN matenda opatsirana (syphilis, khate, HIV, brucellosis, herpes, diphtheria, etc.)	Zizindikiro za polyneuropathy zomwe sizigwirizana ndi DPNP *	Kuyesedwa kwa magazi (ELISA, PCR, ndi zina) kupezeka kwa matenda ena.	Zotsatira zam'madzi. Matenda azachipatala komanso a labotale matenda enaake

* asymmetric / predominely motor / localised in the top miyendo / kali kwambiri polyneuropathy

Pezani chithandizo ku Korea, Israel, Germany, USA

Pezani malangizo azachipatala

Podzilimbitsa nokha, mutha kuyambitsa mavuto ena ambiri.
Zambiri zomwe zikupezeka patsamba la MedElement sizingachitike ndipo siziyenera kulowetsa m'malo moonana ndi madokotala. Onetsetsani kuti mukumane ndi zipatala ngati muli ndi matenda kapena zizindikiro zomwe zikukuvutitsani.
Kusankhidwa kwa mankhwala ndi kuchuluka kwake kuyenera kuvomerezedwa ndi katswiri. Ndi dokotala yekhayo amene angakupatseni mankhwala omwe akufuna komanso mlingo wake, poganizira matendawo komanso momwe thupi la wodwalayo lilili.
Tsamba la MedElement ndi buku logwiritsidwira ntchito pokhapokha. Zambiri zomwe zalembedwa patsamba lino siziyenera kugwiritsidwa ntchito kusinthira mwatsatanetsatane zomwe dokotala wakupatsani.
Okonza a MedElement sakhala ndi vuto lililonse pakuwonongeka kwa thanzi kapena kuwonongeka kwa zinthu pogwiritsa ntchito tsamba lino.

Gulu logulika la matenda lodziwika ndi zowonongeka mwatsatanetsatane ku zotumphukira zamitsempha. Ma polyneuropathies amagawidwa kukhala axonal yoyamba komanso demyelinating yoyamba. Mosasamala mtundu wa polyneuropathy, chithunzi chake chazachipatala chimadziwika ndi kukula kwa kufooka kwa minofu ndi atrophy, kuchepa kwa tendon Reflex, kusokonezeka kwamaganizidwe kosiyanasiyana (paresthesias, hypo- ndi hyperesthesia) komwe kumachitika m'madera am'mphepete, komanso zovuta za autonomic. Mfundo yofunika yodziwitsa za kupezeka kwa polyneuropathy ndiyo kudziwa chomwe chachitika. Chithandizo cha polyneuropathy ndichizindikiro, ntchito yayikulu ndikuchotsa chifukwa cha causative.

Zambiri

Etiology ndi pathogenesis a polyneuropathies

Mosasamala kanthu za etiology mu polyneuropathies, mitundu iwiri ya njira za pathological imawululidwa - kuwonongeka kwa axon ndi kuchepa kwa mitsempha ya mitsempha. Ndi axonal mtundu wa zotupa, kuponderezedwa kwachiwiri kumachitika, ndi chotupa cha demyelinating, gawo la axonal limalumikizanso. Makamaka axonal ndi ambiri mwa mankhwala oopsa a polyneuropathies, mtundu wa axonal wa GBS, mtundu II NMS. Ma demneelinating polyneuropathies aphatikizira mtundu wakale wa GBS, HVDP, paraproteinemic polyneuropathies, mtundu I NSC.

Ndi axonal polyneuropathies, kayendedwe ka ma axial silyl amakhudzidwa makamaka ndi axoplasmic yamakono, yomwe imakhala ndi zinthu zingapo zofunikira pakuchita bwino kwa minyewa ndi minyewa ya minofu kulowera kuchokera ku motor neuron kupita ku minofu ndi mosemphanitsa. Mitsempha yomwe imakhala ndi ma axon atali kwambiri ndiyochita nawo njirayi. Kusintha kwa ntchito ya trophic ya axon ndi axonal mayendedwe kumabweretsa kuwoneka kwa kusintha kwa minofu.Kuwonongeka kwa ulusi wa minofu kumathandizira kukulitsa kwa kudwala kenako kuphukira kozungulira, kukula kwa malo omalizira ndi kukonzanso kwa minofu ya minofu, zomwe zimabweretsa kusintha kwa kapangidwe ka DE.

Ndi demyelination, kuphwanya kwa mchere wa conduction wa mitsempha kumachitika, chifukwa chomwe kuthamanga kwa conduction pamodzi ndi mitsempha kumachepa. Kuwonongeka kwa mitsempha ya demyelinating kumawonetsedwa mwaubwino ndi kukula kwa kufooka kwa minofu, kutayika koyambirira kwa tendon reflexes popanda chitukuko cha minyewa. Kupezeka kwa atrophy kumawonjezera gawo lina la axonal. Kuchepa kwa mitsempha kumatha chifukwa cha kukwiya kwa autoimmune ndikupanga ma antibodies osiyanasiyana omwe amapanga mapuloteni a myelin, zovuta zamtundu, kukhudzana ndi exotoxins. Kuwonongeka kwa axon ya mitsempha kumatha kukhala chifukwa cha kuwonekera kwa mitsempha ya zoopsa zakunja kapena zamkati zamkati, zinthu zamtundu.

Gulu la Polyneuropathies

Mpaka pano, palibe magulu ambiri ovomerezeka a polyneuropathies. Malinga ndi chizindikiro cha pathogenetic cha polyneuropathy, amagawidwa kukhala axonal (makamaka kuwonongeka kwa axial silyl) ndi demyelinating (pathology ya myelin). Ndi chikhalidwe cha chithunzi cha chipatala, ma motor, sensory ndi autonomic polyneuropathies ndizosiyanitsidwa. Komabe, mwa mawonekedwe ake osadetseka, mitundu iyi imawonedwa kawirikawiri, nthawi zambiri imawululira kuphatikizika kwa mitundu iwiri kapena itatu ya ulusi wamitsempha (motor-sensory, sensory-vegetative ena).

Malinga ndi etiological factor, polyneuropathies agawika kukhala cholowa (, Russi-Levy syndrome, Degerin-Sott syndrome, Refsum matenda, etc.), autoimmune (Miller-Flasher syndrome, axonal mtundu wa GBS, paraproteinemic polyneuropathies, paraneoplastic neuropathies, etc.), metabolic polyneuropathy, uremic polyneuropathy, hepatic polyneuropathy, etc.), anamentary, poizoni komanso woopsa.

Chithunzi cha chipatala cha polyneuropathy

Chithunzi cha chipatala cha polyneuropathy, monga lamulo, chimaphatikiza zizindikiro zowonongeka zamagalimoto, zomverera komanso zotulutsa. Kutengera kuchuluka kwa kuphatikizika kwa ulusi wamitundu yosiyanasiyana mu mawonekedwe a minyewa, ma motor, sensor kapena zizindikiro za autonomic zimatha kuchuluka. Kuwonongeka kwa ulusi wamagalimoto kumayambitsa kukulira kwa flaccid paresis; chifukwa ma polyneuropathies ambiri, zotupa zakumtunda komanso zotsika zokhala ndi distal kugawa minofu yofooka ndizofanana, ndi zotupa za axon zazitali, minofu ya atrophies imayamba. Axonal ndi cholowa cha polyneuropathies amadziwika ndi kufalikira kwakutali kwa minofu (kawirikawiri m'munsi yam'munsi), yomwe imatchulidwa kwambiri mu minofu ya extensor kuposa minofu yosinthasintha. Ndi kufooka kwakukulu kwa gulu la minyewa yolumikizidwa, ma steppage amakula (omwe amatchedwa "jogo's gait").

Kuchepetsa demyelinating polyneuropathies amatha kuwonetsa ngati kufooka kwa minofu. Woopsa milandu, zotupa za CN ndi minofu ya kupuma imatha kuzindikira, zomwe zimawonedwa nthawi zambiri ndi Guillain-Barré syndrome (GBS). Ma polyneuropathies amadziwika ndi kufananizidwa kwachibale kwa kufooka kwa minofu ndi atrophy. Zizindikiro za asymmetric ndizodziwika ndi ma mononeuropathies angapo: multifocal motor neuropathy, multifocal sensorimotor neuropathy Sumner-Lewis. Tendon ndi ma periosteal Reflexes omwe amakhala ndi polyneuropathy nthawi zambiri amachepetsa kapena kugwa, choyambirira, Achilles tendon reflexes amachepetsa, ndikutukuka kwina kwa njirayi - bondo ndi carporadial, tendon Reflex yochokera ku biceps ndi triceps ya minofu yamapewa.

Kusokonezeka kwa m'maganizo mu polyneuropathy kumakhalanso kofanana kwambiri, kumayamba kuchitika kumadera akutali (monga "magolovesi" ndi "masokosi") ndikufalikira.Mu kuwonekera kwa polyneuropathy, zizindikiro zabwino zamaganizidwe (paresthesia, dysesthesia, hyperesthesia) nthawi zambiri zimapezeka, koma ndikupitilizidwa kwa ndondomekoyi, zizindikiro zakukwiyitsa zimasinthidwa ndi zizindikiro za prolapse (hypesthesia). Kugonjetsedwa kwa ulusi wamafuta opyapyala kumapangitsa kuti minofu ikhale yolimba komanso kugwedezeka kwamphamvu, kugonjetsedwa kwa ulusi wopyapyala wa myelised kumabweretsa kuphwanya kwamvuto komanso kutentha kwa khungu.

Kuphwanya ntchito za autonomic kumatchulidwa kwambiri ndi axonal polyneuropathies, popeza ulusi wa autonomic siwomwe umakhala wokha. Zizindikiro za prolfall zimawonedwa pafupipafupi: kuwonongeka kwa ulusi wamatsenga womwe umapanga zotumphukira m'mitsempha kumawonetsedwa ndi khungu lowuma, kutsekeka kwa kayendedwe ka mtima, kuwonongeka kwa michere ya visceral ikuyambitsa disautonomia (tachycardia, orthostatic hypotension, kuchepa kwa ntchito ya erectile.

Amyloid transthyretin polyneuropathy

... chifukwa cha kusazindikira kwa madotolo, nthawi kuchokera kumayambiriro kwa zidziwitso mpaka kuzindikiritsa ikhoza kupitilira zaka zitatu.

Mawu oti "amyloidosis" amagwirizanitsa matenda omwe amadziwika kuti ndi mapuloteni enaake amadzimadzi a protein amyloid fibrils - mapuloteni apadera okhala ndi mulifupi wa 5-10 nm ndi kutalika kwa 800 nm, ophatikizika ndi ma 2 kapena kuposerapo pazinthu zingapo. . Mphamvu za kapangidwe ka michere ndi michere ya amyloid zimatsimikiziridwa ndi puloteni wamkulu wotsogola, zomwe zili mu fayilo zimafikira 80% ndipo ndi chizindikiro chazinthu zamtundu uliwonse wa amyloidosis (mapuloteni oposa 30 apadera omwe amatha kupanga michere ya amyloid amadziwika).

Ndisanawerenge zomwe zalembedweratu, ndikulimbikitsa kuti muwerenge: Amyloidosis (pa laesus-de-liro.livejournal.com) werengani

Transthyretin amyloidosis (ATTR) ndi nthenda yamatenda yodziwika ndi kuphatikizika kwa extracellular ya amyloid, komwe kumayambira komwe kumakhala transthyretin (TTR), puloteni yomwe imakhudzana ndi kayendedwe ka chithokomiro cha thyroxine ndi retinol, imathandizanso pakukula kwa mitsempha. Mpaka 95% ya TTR imapangidwa m'chiwindi, 5% yotsalayi imapangidwa ndi ma cell a ubongo komanso ma epithelium a retina (mu plasma, TTR imazungulira pakumenyetseka kwa 20-40 mg / dl L. Obici et al., 2005).

ATTR imaphatikizidwa ndi senile systemic amyloidosis (mtundu wa amyloidosis - ATTRwt), yomwe imayamba chifukwa cha kusintha kwokhudzana ndi zaka mu kapangidwe ka chibadwa TTR (ziwalo zomwe zimasokoneza senile amyloidosis ndi mtima, mitsempha yamagazi ndi aorta), komanso cholowa cha ATTRm amyloidosis (onani kupitilira apo, chifukwa cha kusintha kwa mtundu wa TTR (encoding TTR), wopanga ma exons anayi ndipo ali pamanja chromosome 18. Mpaka pano, masinthidwe opitilira 120 a mtundu wa TTR afotokozedwa. Mitundu yotchuka kwambiri ya TTR yomwe imatsogolera pakupanga kwa ATTR ndi kusintha kwa methionine ndi valine pamalo 30 (ATTR Val30Met). Chimodzi mwazinthu zosowa kwambiri zamtundu wa TTR ndikusintha kwa cysteine ndi tyrosine pamalo a 114 (Tyr114Cys).

Transthyretin ndi Homotetramer, gawo lililonse lomwe limakhala ndi zotsalira 127 amino acid ndipo lili ndi mawonekedwe a beta. Zotsatira za kusinthika kwa jini la TTR, kusintha kwapadera pa mapuloteni kumachitika, zomwe zimayambitsa kusinthasintha kwa thermodynamic kwa tetramer ndikuwonongeka kukhala monomers. Ma monomers okhala ndi mapuloteni, nawonso, amasinthidwa kukhala ma oligomers am'magazi omwe amapanga amyloid, omwe amawonongeka mwachindunji pazinthu zomanga mwa kukakamiza, komanso zimabweretsa kuwonongeka kwa mtima ndipo, chifukwa chake, ischemia. Kumbali inayi, kafukufuku akuwonetsa kuti si mafyuliyule amyloid, omwe ndi ma cell ochepa kulemera kwa transthyretin oligomers omwe amachititsa njira zama calcium zomwe zimadalira magetsi, zomwe zimabweretsa kufa.

Herederal ATTR imatha kupezeka m'magulu atatu azachipatala: 2.1 transthyretin Familia amyloid polyneuropathy (pano - TTR-SAP), 2.2 transthyretin banja amyloid zamtima ndi 2.3 transthyretin banja leptomeningeal amyloidosis.Chonde dziwani: TTP-SAP ndi mtundu wofala kwambiri wa cholowa ndi mtundu wina wa cholowa.

TTP-SAP ndimatenda opita patsogolo, osokoneza, oopsa a neurodegenerative otengera amyloid deposition (ATTR) mu epineuria, perineuria, endoneuria ndi mitsempha yamagazi, zomwe zimatsogolera ku axonal degeneration of somatic and autonomic nerves. Ngati sanachiritsidwe, TTP-SAP idzadwala patatha zaka 7 mpaka 12 kuchokera pachiwonetsero cha matendawa. Kuchulukana kwa TTR-SAP ku Europe ndi United States ndi pafupifupi munthu pafupifupi zana limodzi. Chiwerengero chachikulu cha odwala chidapezeka kumayiko akutali monga Japan, Portugal, Brazil ndi Sweden, omwe amasiyana kuchokera pa 0.9 - 204 pa anthu 1 miliyoni, mpaka 3,8 - 1631 pa 1 miliyoni pa magawo amodzi.

TTP-SAP imadziwika ndi heterogeneity yachipatala (chifukwa cha kuchuluka kwakukulu kwa kusintha kwa mtundu wa TTR). Monga tafotokozera pamwambapa, kusintha kwa Val30Met nthawi zambiri kumalumikizidwa ndi TTP-SAP, ndipo mawunikidwe ake azachipatala ndiwo amaphunziridwa kwambiri. Matendawa amatha kukhala ndi zaka zapakati pa 20 ndi 70. Maziko a chithunzi chachipatalachi ndi sensorimotor yomwe imapangika pang'onopang'ono, ndipo imayamba kukula kuchokera kumbali mpaka kumitsempha yama proximal, kuyambira kumapazi, pang'onopang'ono kufalikira mpaka kumiyendo ndi mikono.

Choyamba, ulusi wofowoka wa minyewa yofowoka umakhudzidwa, womwe umapangitsa kupweteka komanso kutentha kwa kutentha, komwe kumapangitsa kuti odwala azikhala ndi magazi kumapazi, matenda amitsempha yama neuropathic kumayambiriro kwa TTP-SAP - kuwotcha kozungulira ndi kupweteka kochokera m'magazi kumawonekera mu mawonekedwe a kuzizira kwa allodynia chifukwa cha kuwonongeka ndi chidwi cha mafupa owonda ( ulusi wofowoka womwe umatha kufa, ululu woyaka umasiyiratu, pambuyo pake magawo oyaka amadzachotsedwa ndi ma paroxysms a ululu. ndipo mu mawonekedwe a "kupititsa magetsi pano" ndi ma meodynia allodynia oyambira chifukwa cha kukhudzidwa kwapakati).

Pambuyo pake, ulusi wamanjenje wa myelised kale umavutika, kusokonezeka kwamagalimoto, ma presis amawoneka, ndipo chidwi champhamvu chimasokonekera ndipo inaxia yolimba imayamba. Nthawi yomweyo, ulusi wamatsenga wa autonomic (vegetative) wamanjenje umakhudzidwa - odwala amakhala ndi zotumphukira za kusokonekera - kuchepa thupi, kuchepa kwa magazi, kusokonezeka kwa m'mimba (chikhodzodzo cha neurogenic), kusabala, matumbo a m'mimba - kutsekeka, kutsatiridwa ndi kudzimbidwa.

Polyneuropathy ikupita patsogolo mokhazikika, odwala akuyenda mkatikati ndipo pang'onopang'ono zimakhala zosatheka, chikuyenda njinga yamoto ndiyofunika kuyenda, odwala amadalira thandizo lakunja. Magawo 4 (0 - 3) a TTR-SAP amasiyanitsidwa, kutengera kuteteza kwa magwiridwe antchito a wodwala:

Ndi TTR-SAP, kukhazikitsa kwa mitundu ingapo yamatumbo (kuphatikiza njira ya carpal tunnel syndrome) ndikotheka chifukwa cha kuyika kwa amyloid mu zida za ligamentous ndikutsatira kwatsoka kwa mitsempha yapang'onopang'ono.

Kuwonetsedwa kwa neuropathy kumawongolera nthawi yonse ya matendawa. Komabe, TTR-SAP imapanganso kuwonongeka kwa mtima (kupumira kwa mtima, kusokonezeka kwa miyendo), impso (proteinuria yotsatiridwa ndi kukula kwa kulephera kwa impso), maso (yachiwiri glaucoma, vitreous opacization ku Sweden; milandu ya zilonda zam'mimba atangoyamba matendawa afotokozedwa) (khunyu kugwedezeka, ischemic kapena hemorrhagic stroko, chidziwitso kuwonongeka). Imfa imachitika chifukwa cha matenda a mtima (kulephera kwa mtima, kusokonezeka kwa miyendo), cachexia, kulephera kwa chitetezo, komanso matenda ena.

Kusintha "osati Val30Met" komwe sikunaphunzire zambiri pokhudzana ndi mwadzidzidzi, kumasiyana mu chithunzi cha chipatala. Nthawi zambiri matendawa amayamba (pambuyo pa zaka 50), manja - ma carpal (carpal) matendawa amatha kukhudzidwa koyambirira (chizindikiro chamtundu wa carpal tunnel syndrome imayamba, dziwani: chizindikiro choyamba cha TTP-SAP mwa odwala chingakhale matenda oopsa a carpal okha autonomic polyneuropathy, kuwonongeka kwakukulu pamtima kapena maso.

Diagnosis ya TTR-SAP idakali ntchito yovuta, makamaka kwa malo omwe sanathe, kumene nthawi zambiri palibe mbiri ya banja yokhudza matendawa komanso kutengera zizindikiro zomwe zilipo (mitsempha, mtima, ophthalmology), odwala amatembenukira kwa akatswiri osiyanasiyana. Chifukwa cha kusazindikira kwa madotolo, nthawi kuchokera kumayambiriro kwa zidziwitso mpaka kuzindikiritsa imatha kupitirira zaka zitatu. Mkhalidwe wabwino kwambiri pokhudzana ndi kupezeka nthawi yodziwika bwino komanso chithandizo chake ndi chodziwika bwino m'maiko.

Tcherani khutu! TTP-SAP iyenera kuganiziridwa ngati wodwala ali ndi sensorimotor axonal polyneuropathy yomwe ikupita patsogolo komanso kuphatikiza kwazovuta za autonomic (kuchepa kwa thupi, kuchepa kwa mitsempha ndi m'mimba, orthostatic hypotension) komanso kusapezeka kwa zifukwa zina zofotokozera polyneuropathy.

Njira zopangira zida zomwe zimagwiritsidwa ntchito poyerekeza kuwonongeka kwa mitsempha ndizophatikizira ndi electroneuromyography (ENMG), kuyesa kuchuluka kwa malingaliro, komanso kufufuza kwa zomwe zingapangitse mtima womvera. Kunja, MR mitsempha imachitidwa, komanso sudoscan, njira yachangu komanso yosasokoneza yomwe imayesa momwe uliri wa mitsempha yopyapyala umathandizira kuyeza kukoka kwa electrochemical pakhungu, komwe kumachepera pomwe kusungika kwa zotupa thukuta kumasokonekera.

Ziwalo zina zomwe zikuvutika ndi ATTR zimawunikiranso: mtima (ECG, kuwunika kwa Holter ECG, Echocardiography), maso (kuyang'ana ndi maso), impso (urinalysis, ultrasound). Ngati sensorimotor ndi kudziyimira pang'onopang'ono kwa polyneuropathy kwapezeka, ubale wake ndi ATTR uyenera kutsimikiziridwa. Amyloid madipoziti amapezeka mu biopsy toyesa, msempha wamkamwa, zotupa zam'mimba, komanso mucosa. Zomera za Biopsy zimayang'ana dzimbiri ku Congo kuti ziziwone ngati ma amyloid amana omwe amatulutsa kuwala kobiriwira kopepuka. Phunziro la immunohistochemical lofunikira kukhazikitsa mapuloteni amyloid precursor. Chonde dziwani: kusowa kwa amyloid misa mu tisiti biopsies sikumapatula kupezeka kwa TTP-SAP, pankhaniyi, kafukufuku wa morphological ayenera kuchitika ndi katswiri wazachipatala, ndikofunikira kuphunzira zitsanzo za 2 - 3 zosiyana, ndikufunikanso kafukufuku wama genetic. Mabanja omwe ali ndi kusintha kwa TTR komwe kumadziwika kale kumatsimikizira kukhalapo kwa kusintha kwina; pakumveka kozizira, kuyang'anira mtundu wonse wa TTR ndikulimbikitsidwa (zindikirani: kuyesedwa kwa majini kwa TTR-SAP ndikulimbikitsidwa kwa odwala onse omwe ali ndi axonal neuropathy yomwe ikupita patsogolo.

werengani nawonso: Zabwino fiber neuropathy (pa laesus-de-liro.livejournal.com) werengani

Kuchiza kwa TTP-SAP kumakhala kothandiza pa gawo loyamba la matendawa, ngati kuli kotheka kuchepetsa kuchepa kwa polyneuropathy ndikuwonjezera kupulumuka kwa odwala .. Mu 1990s, chithandizo chokha cha TTP-SAP chinali kupatsirana kwa chiwindi cha orthotopic, ndikuthandizira kupulumuka kwa zaka 20 kwa odwala ≈1 / 2 .. Kuchita opaleshoni kumakhala kothandiza kwambiri ndi mbiri yayifupi ya matendawa, kuchepa kwa wodwalayo, kupezeka kwa masinthidwe a Val30Met, komanso kusowa kwa mtima wakulephera.Pochotsa gwero lalikulu la masinthidwe ophatikizika a chiwindi, chiwindi kupatsirana, sichimaletsa kuyika kwa amyloid mu minofu ya mtima, thupi lamatenda, komanso dongosolo lamanjenje. Ngati wodwala amakhala ndi vuto la mtima kwambiri kapena kulephera kwa impso, kumuwonjezera pamodzi nthawi zina kumachitika - chiwindi ndi mtima, mtima ndi impso.

M'zaka zaposachedwa, mwayi wa chithandizo chokhazikika cha pathogenetic cha magawo oyamba a TTP-SAP aonekera. Tafamidis (kukonzekera kwa Vindakel), komwe kumalimbikitsidwa kuti kugwiritsidwe ntchito ku Europe ndi Russia pa gawo loyamba la TTP-SAP, kumathandizira kukhazikika kwa molekyulu ya transthyretin, kupewa kuti ingasokonekere kukhala amyloidogenic monomers. Diflunisal ya non-steroidal anti-yotupa imakhudzanso chimodzimodzi, koma kugwiritsidwa ntchito kwake kumachepetsedwa ndi zovuta zoyipa kuchokera m'mimba. Kuphatikiza pa chithandizo cha pathogenetic, chithandizo chamankhwala chikugwiritsidwa ntchito - njira yoletsa kupweteka kwamitsempha, zotupa za antidiarrheal, chithandizo cha orthostatic hypotension, kulephera kwa mtima, kukhazikika kwa pacemaker ngati zingachitike kusokonezeka kwa mitsempha. Ngati chisamaliro chamankhwala sichithandiza ndipo matendawa amapita patsogolo, kupatsirana kwa chiwindi kumachitika, ndipo ngati kuli kotheka, ndikusintha kwa mtima.

Werengani zambiri za TTR-SAP ndi ATTR muzinthu zotsatirazi.:

nkhani "Nkhani ya transthyretin ya banja amyloid polyneuropathy: kufufuza kwa matenda" Smirnov AP, Serdyuk AV, Kovrazhkina EA, FSBEI HE "RNIMU im. N.I. Pirogova ”(Consilium Medicum Magazine No. 9, 2018) werengani,

cholembedwa "Transthyretin amyloid polyneuropathy: pathogenesis, mawonekedwe azachipatala, ziyembekezo zamankhwala" O.E. Zinoviev, E.I. Safiulina, Federal State Autonomous Sukulu Yophunzitsa Maphunziro Apamwamba "Yoyamba University State Medical University idatchedwa I.M. Unduna wa Unduna wa Zaumoyo ku Russia Federation (Magazini ya "Manage ululu" No. 4, 2017), wawerengedwa,

kuwunikira zambiri za matendawa ndi matenda a "Transthyretin Familia amyloid polyneuropathy (TTR-SAP)" Pfizer Innovation LLC, Moscow (www.pfizerprofi.ru), 12/08/2016 werengani,

cholembedwa "Banja la amyloid polyneuropathy TTR Cys 114 mwa abale amapasa a monozygotic (chipatala)" M.O. Kovalchuk, I.A. Strokov, Utrecht University Medical Center, Netherlands, Utrecht, Federal State Autonomous Sukulu Yophunzitsa Maphunziro Akulu Kwambiri Yoyamba Moscow State Medical University I.M. Sechenova Ministry of Health of the Russian Federation, Moscow (mtolankhani "Matenda a Neuromuscular" No. 1, 2017) adawerenga,

nkhani "Transthyretin amyloidosis: momwe zinthu ziliri pamavuto" I.A. Dyudina, State Institution "NSC" Institute of Cardiology otchedwa Acad. N.D. Strazhesko "NAMS of Ukraine", Kiev (mtolankhani "Mtima ofooka ndi comorbidity", Na. 1, 2017) anawerenga,

nkhani "Matenda a transthyretin amyloidosis osachedwa kutsimikizira wodwalayo '1S. Naumova, S.S. Nikitin, T.A. Adyan, 3, D.S. Druzhinin, V.A. Warsaw, Medical Center "Yogwira Ntchito" N.I. Pirogov »Ministry of Health of the Russian Federation, Moscow, FSBEI HE" Yaroslavl State Medical University "Ministry of Health of Russian Federation, Yaroslavl, FSAEI of HE First Moscow State Medical University I.M. Undhenova Ministry of Health of the Russian Federation, Moscow (magazini ya "Matenda a Neuromuscular" No. 1, 2018) adawerenga,

cholembedwa "Amyloid neuropathy wodwala yemwe ali ndi transthyretin Famal amyloidosis" Zinovieva O.E., Umari D.A., Solokha O.A., Yakhno N.N., GBOU VPO "MGMU woyamba a I.M. Sechenov ", Clinic of Nervous matenda otchedwa pambuyo A.Ya. Kozhevnikova, Department of Neurology, Center of Research, Moscow (Neurological Journal, No. 5, 2016) anawerenga,

cholembedwa "Zowonongeka kwa zotumphukira zamanjenje mu systemic amyloidosis" Safiulina E.I., Zinovieva O.E., Rameev V.V., Kozlovskaya-Lysenko L.V., FGAOU VO "Yoyamba University State Medical University yotchedwa pambuyo I.M. Sechenova ”Unduna wa Zaumoyo ku Russian Federation, Moscow (nyuzipepala ya“ Neurology, Neuropsychiatry, Psychosomatics ”No. 3, 2018) werengani

Dziwani za polyneuropathies

Ngati pang'onopang'ono pang'onopang'ono sensorimotor polyneuropathy, yomwe imadziwika kuchokera pagulu la minofu ya peroneal, ndikofunikira kufotokozera mbiri yobadwa nayo, makamaka kupezeka kwa kutopa ndi kufooka kwa minyewa ya mwendo, kusintha kwa gait, ndi kupunduka kwamapazi (kukwera kwakukulu). Ndi chitukuko cha kufalikira kwa ma symmetric of the extensors of the hand, zotsogola za utsi ziyenera kuyikidwa pambali. Monga lamulo, ma polyneuropathies oopsa amadziwika, kuwonjezera pazowoneka zamitsempha, ndi kufooka wamba, kutopa kochulukirapo, komanso madandaulo am'mimba ochepa. Kuphatikiza apo, ndikofunikira kudziwa zomwe wodwala adatenga / kumwa kuti apewe mankhwala a polyneuropathy.

Pang'onopang'ono kukula kwa asymmetric minofu kufooka ndi chizindikiro cha multifocal motor polyneuropathy. Matenda a diabetesic polyneuropathy amadziwika ndi pang'onopang'ono matenda a m'munsi olimbitsa thupi, ophatikizidwa ndi chidwi choyaka ndi mawonekedwe ena kumapazi. Uremic polyneuropathy imachitika, monga lamulo, motsutsana ndi maziko a matenda a impso (CRF). Ndi chitukuko cha sensory-vegetative polyneuropathy, yodziwika ndi kuwotcha, dysesthesia, pakati pakuchepa kwambiri kwa thupi, ndikofunikira kupatula amyloid polyneuropathy.

Kwa cholowa cha polyneuropathies, cholimbitsa cha kufooka kwa minofu ya kumapazi, kupondera, kusakhalapo kwa Achilles tendon Reflex, phokoso lalitali phazi. Pambuyo pake matenda, palibe bondo ndi carporadial tendon Reflex, kuwunika kwa minyewa ya miyendo ndi miyendo. Chotupa cham'mimba chofanana ndi kusungidwa kwa mitsempha yamtundu uliwonse, popanda kusokonezeka kwamalingaliro, ndi khalidwe la ma motor angapo a polyneuropathy. Nthawi zambiri, kuwonongeka kwa malekezero kumakhala kosangalatsa.

Sensory polyneuropathies amadziwika ndi kufalitsa kwakatali kwa hypesthesia. M'magawo oyamba a matendawa, hyperesthesia ndiyotheka. Sensomotor axonal neuropathies imadziwika ndi distal hypesthesia ndi kufooka kwa minofu ya distal. Mu autonomic polyneuropathies, kuphatikiza ndi kukwiya kwa ulusi wamitsempha ya autonomic ndizotheka. Pazithunzi zapamwamba za polyneuropathy, hyperhidrosis, minyewa yamitsempha yamanja ndizofanana, chifukwa cha matenda ashuga a polyneuropathy, m'malo mwake, khungu lowuma, kusokonezeka kwa ma trophic, kusowa kwa ziwalo zamkati.

Kafukufuku wama antibodies a GM1 ganglycosides akulimbikitsidwa kwa odwala omwe ali ndi motor neuropathies. Ma titerm apamwamba (akulu kuposa 1: 6400) ndi achindunji a motor multifocal neuropathy. Mitundu yotsika (1: 400-1: 800) ndi yotheka ndi demyelinating polyradiculoneuropathy (HVDP), matenda a Guillain-Barré ndi ma autoimmune neuropathies ena. Tiyenera kukumbukira kuti gawo lowonjezera la antibodies ku GM1-gangglycosides limapezeka mu 5% ya anthu athanzi (makamaka achikulire). Ma antibodies a glycoprotein ogwirizana ndi myelin amapezeka mu 50% ya odwala omwe amapezeka ndi paraproteinemic polyneuropathy ndipo, nthawi zina, ma autoimmune neuropathies ena.

Ngati ma polyneuropathies akuwakayikira kuti adalumikizidwa ndi kuledzera ndi lead, aluminium, ndi mercury, kuyezetsa magazi ndi mkodzo pazitsulo zolemera kumachitika. Ndikotheka kuchita ma genetic genetic pamafomu onse akuluakulu a mitundu ya IMSS I, IVA, IVB. Kuchita ma electromyography a singano ndi polyneuropathies kumakuthandizani kuzindikira zizindikiritso zakuwongolera. Choyamba, ndikofunikira kupenda minofu ya distal yomwe ili pamwamba komanso kumbuyo, ndipo, ngati kuli kotheka, minofu yoyesa. Mitsempha ya mitsempha imakhala yoyenera pokhapokha ngati akukayikira amyloid polyneuropathy (kupezeka kwa ma amyloid amana).

Chithandizo cha Polyneuropathy

Ndi chibadwa cha polyneuropathies, mankhwalawa ndiwodziwika.Mu autoimmune polyneuropathies, cholinga cha mankhwalawa ndikwaniritsa chikhululukiro. Pa matenda ashuga, kuledzera, uremic ndi mitundu ina ya ma polyneuropathies osakhazikika, chithandizo chimachepetsedwa kuchepa kwamphamvu kwa zizindikiro ndi kutsika pang'ono pang'onopang'ono. Chimodzi mwamagawo ofunikira osagwiritsa ntchito mankhwala osokoneza bongo ndi masewera olimbitsa thupi omwe umalimbana ndikukhala ndi kamvekedwe ka minofu ndikutchingira kulera. Pankhani ya kukula kwa vuto la kupuma ndi diphtheria polyneuropathy, mpweya wabwino ungafunike. Kugwiritsa ntchito mankhwalawa moyenera ngati mapangidwe a polyneuropathies kulibe. Kukonzekera kwa Vitamini ndi ma neurotrophic othandizira kumagwiritsidwa ntchito ngati kukonza mankhwala. Komabe, kupambana kwawo sikunatsimikiziridwe mokwanira.

Mankhwalawa porphyria polyneuropathy, shuga ndi mankhwala, zomwe nthawi zambiri zimayambitsa kusintha kwa wodwalayo, komanso ma pinkillers ndi mankhwala ena opatsirana. Chithandizo cha mankhwala osachiritsika chotupa cha demneelopathy chimaphatikizira kuphatikizapo machitidwe, kugwiritsa ntchito anthu immunoglobulin kapena prednisolone. Nthawi zina, kugwiritsa ntchito mphamvu ya immunoglobulin sikokwanira, chifukwa chake ngati pakhale kuti palibe contraindication, chithandizo chiyenera kuyamba ndi glucocorticosteroids. Kusintha kumachitika, nthawi zambiri pambuyo pa masiku 25-30, pakatha miyezi iwiri, mutha kuyamba pang'onopang'ono kuchepetsa mlingo kukhala muyeso wokonzanso. Ndi kuchepa kwa mlingo wa glucocorticosteroids, kuyang'anira EMG ndikofunikira. Monga lamulo, prednisolone imathetsedweratu mkati mwa miyezi 10-12, ngati kuli kofunikira, mutha "kutsimikiza" ndi azathioprine (mwina cyclosporine kapena mycophenolate mofetil).

Chithandizo cha matenda ashuga polyneuropathy chikuchitika molumikizana ndi endocrinologist, cholinga chake chachikulu ndicho kukhalabe ndi shuga. Pothandizanso kupweteka, ma tridclic antidepressants amagwiritsidwa ntchito, komanso pregabalin, gabapentin, lamotrigine, carbamazepine. Nthawi zambiri, mankhwala a thioctic acid ndi mavitamini B amagwiritsidwa ntchito. Nephrologists amakwaniritsa chizindikiritso kumayambiriro kwa uremic polyneuropathy mukamakonza kuchuluka kwa poizoni wa uremic m'magazi (pulogalamu ya hemodialysis, kupatsirana kwa impso). Mwa mankhwalawa, mavitamini a B amagwiritsidwa ntchito, ndi ululu waukulu - ma tridclic antidepressants, pregabalin.

Njira yayikulu yochizira mankhwalawa poizoni polyneuropathy ndi kusiya kukhudzana ndi mankhwala oopsa. Ndi mankhwala omwe amapezeka ndi mlingo wa polyneuropathies, ndikofunikira kusintha mlingo wofanana ndi mankhwala. Ndi matenda a diphtheria, kutsimikizira antitoxic seramu kumachepetsa mwayi wokhala ndi diphtheria polyneuropathy. Nthawi zina, chithandizo cha opaleshoni chitha kukhala chofunikira chifukwa cha kupangika kwa ziwalo ndi kufooka kwa mapazi. Komabe, tiyenera kukumbukiranso kuti kusasinthasintha kwa nthawi yayitali pambuyo pakuchita opaleshoni kungasokoneze kwambiri magwiridwe antchito.

Kuzindikira kwa polyneuropathy

Ndi matenda osachiritsika a demyelinating polyradiculoneuropathy, zakutsogolo kwa moyo ndizabwino. Imfa yachepa kwambiri, komabe, kuchira kwathunthu ndikosowa kwambiri. Pafupifupi 90% ya odwala omwe ali ndi immunosuppress tiba amalandira chikhululukiro chokwanira kapena chosakwanira. Nthawi yomweyo, matendawa amatha kutulutsa magazi ambiri, kugwiritsa ntchito mankhwala a immunosuppressive mwina chifukwa cha zovuta zake, zomwe zimabweretsa zovuta zambiri.

Ndi chibadwa cha polyneuropathies, sizotheka kuchita bwino, popeza matendawa akumka pang'onopang'ono. Komabe, odwala, monga lamulo, amasintha momwe alili ndipo, nthawi zambiri, mpaka magawo omaliza kwambiri a matenda amasungabe kudzisamalira.Ndi matenda a shuga a polyneuropathy, zovuta za m'moyo zimakhala zabwino, ngati chithandizo cha panthawi yake ndikuwonetsetsa glycemia. Pambuyo poti matendawo atha kudwala matendawa ndi omwe amachititsa kuti wodwalayo akhale ndi moyo wabwino.

Kukula kwa moyo ndi uremic polyneuropathy kumadalira kwenikweni kuwopsa kwa matenda aimpso kulephera. Dongosolo la panthawi yake hemodialysis kapena kupatsirana kwa impso kumatha kuyambitsa kuzungulira kwathunthu kapena pafupifupi kwathunthu kwa uremic polyneuropathy.

Nkhaniyi imapezekanso m'zilankhulo izi: Thai

Chithunzi cha matenda

Munthawi zonsezi, njira ya dysmetabolic polyneuropathy ikhoza kukhala yosiyana. Ngati matendawa amayamba msanga ndipo akuwoneka ndi kuchepa kwakukulu kwamphamvu yogwira mtima, kutayika kwa bondo ndi mawonekedwe a Achilles kumatha kuonedwa.

Milandu yaying'ono iyi ya polyneuropathy siyimabweretsa kupweteka, koma imayamba zaka zingapo motsatizana.

Matenda a shuga a polyneuropathy amatha kudziwika ndi kukula kwa subacute kapena ngakhale pachimake. Potere, kuwonongeka kwa magawo ena a mitsempha ya mitsempha kumachitika. Monga lamulo, kuwonongeka kwa mitsempha kumachitika:

Mavutowa atha kukhala limodzi ndi ma presis a minofu yofanana, kupweteka komanso kumva. Ngati mitsempha yachikazi idakhudzidwa, ndiye kuti kutayika kwa mawondo kumawonedwa.

Kuphatikiza apo, kuwonongeka kwa mitsempha ya cranial (kubedwa, trigeminal, oculomotor) kudadziwika.

Pali mtundu wachitatu wa matenda ashuga polyneuropathy. Amadziwika ndi kuwonongeka kwa mitsempha ina yamapeto ndi chitukuko cha zovuta zamagalimoto ndi ma mota (makamaka malekezero apansi).

Tendon reflexes amatha kutha kwathunthu, ndipo palpation soreness ya mitsempha yamitsempha imamveka.

Ndi polyneuropathy, zovuta zamasamba ndi trophic sizachilendo. Mavuto pokodza ndi postural hypotension amakula.

Kodi kuchitira?

Choyamba, ndikofunikira kusintha kagayidwe kazakudya mothandizidwa ndi jakisoni wa insulin komanso zakudya zopatsa thanzi. Dokotala angalimbikitse:

ma pinkiller
Mavitamini B,
Finlepsin,
zigawenga blockers (gangleron),
espa lipon (zipatso).

Ndondomeko ya zomwe zimagwiritsidwa ntchito pochotsa neuropathy zidzawonetsedwa.

Polyneuropathy yokhudza matenda

Ngati wodwala ali ndi lupus erythematosus, yomwe imakhudza khungu, impso ndi mafupa, ndiye kuti polyneuropathy imadziwika ndi kukula kwa ziwalo kapena paresis ya minofu yovunda, kutayika kwa ena a tendon Reflex. Kutsika kwakukulu kwa kupweteka kwapweteka kwakanthawi.

Nthawi zina, zizindikiro za polyneuropathy zimatha kukhala zisonyezo zoyambirira za matenda omwe akudwala. Mankhwala amadziwa mitundu yowonongeka kwambiri pamitsempha yama mikono ndi miyendo.

Poterepa, tikambirana za mononeuropathy. Mu nyamakazi yovuta kwambiri, polyneuropathy imawonedwanso. Poyamba, imadziwonetsa ngati zovuta zowoneka bwino, kenako zowopsa za sensorimotor neuropathy.

Ngati periarteritis nodosa alipo, neuropathy yotsatira ya misana ndi misempha ya msana imayamba. Zophwanya zofananazi zimaphatikizidwa ndi zovuta zazikulu:

zamasamba
mota,
wogwira mtima.

Mawonekedwe a neuropathy nthawi zambiri amakhala limodzi ndi zizindikiro za kutupa kwa angiopathy mu ziwalo zina ndi machitidwe.

Herederal polyneuropathy

Choyamba, ndi polyneuropathy, yomwe imayamba ndi matenda a porphyria (genetic enzyme). Zizindikiro zazikulu za matenda obadwa nawo ndi awa:

kupweteka pamimba,
kuchuluka kwa kuthamanga kwa magazi
kuwonongeka kwa dongosolo lamanjenje lamkati,
Kupanga mkodzo ndi mtundu wakuda.

Porphyric polyneuropathy iwonetsedwa chifukwa cha kuchepa kwa mitsempha yazizindikiro. Pankhaniyi, kupweteka, kufooka kwa minofu, paresthesia (malekezero apamwamba ndi otsika) kumachitika. Kuwonetsera kwa magalimoto kumatha kuwonjezeka pang'onopang'ono, mpaka kufalikira kwa paralysis kapena paresis.

Ndi matenda awa, wodwalayo amamva:

kuuma kwa mitsempha ya mitsempha,
kutayika kwa mitundu yonse ya zomverera.

Kuti adziwitse bwino, adokotala aziganizira zonse zomwe zimapangitsa matenda a porphyrin metabolism. Pofuna kuthana ndi matendawa, adotolo amalimbikitsa kukonzekera kwamkati ndi pakamwa paziphuphu mpaka 400 mg (chithandizo chomwechi chimasonyezedwa mitundu ina ya polyneuropathy).

Amyloid polyneuropathy

Amyloid mtundu wa polyneuropathy umayamba mwa odwala omwe ali ndi mbiri ya chibadwa cha amyloidosis. Zizindikiro zake zazikulu zamakliniki ndi:

kusokonekera kwa stool (kudzimbidwa ndi kutsekula m'mimba),
kupukusa kwam'mimba thirakiti
kulephera kwa mtima
macroglossia (kukula kwa lilime).

Ndi matendawa, kusokonezeka kwa malingaliro kumachitika makamaka, kuwonda kwamalo ndi miyendo, kuchepa kwa ululu komanso kutentha kwa kutentha. Pambuyo pake, paresis amalumikizanso matendawa.

Za chithandizo chokwanira, pakadali pano sizipezeka.

Distal sensory-motor polyneuropathy

Ndi matenda ashuga, ulusi wamanjenje wautali nthawi zambiri umakhudzidwa. Diabetesic polyneuropathy imawonedwa mu 40% ya odwala matenda ashuga. Matendawo amtunduwu amadziwika ndi kusowa kwa chidwi cha kupsinjika, kusintha kwa kutentha, kupweteka, kugwedezeka ndi malo okhudzana ndi zinthu zina.

Sensory polyneuropathy ndiowopsa chifukwa munthu wodwala matenda ashuga sangamve kupweteka kapena kutentha kwambiri.

Zilonda zimapezeka m'malo otsika, mabala pachikondwerero cha mwendo. Zowonongeka zazikulu komanso zolumikizana siziperekedwa.

Sensomotor polyneuropathy imatha kuwonetsedwa ndi zizindikiro zogwira, mwachitsanzo, kupweteka kwamphamvu mokwanira m'miyendo, yomwe imakhala yoyipa kwambiri usiku.

Matendawa akamakula, kusokonezeka kwa machitidwe a minofu ndi mafupa kumaonekera. Izi zikachitika:

mafupa
minofu dystrophy
kuyanika kwambiri pakhungu,
mawonekedwe a mibadwo ya zaka,
khungu lamaso ofiira
thukuta thukuta.

Zizindikiro zazikulu kwambiri za distal polyneuropathy mu matenda ashuga zimakhala zilonda zam'mimba zomwe zimachitika pakati pa zala zakumaso ndi kumapazi kumapazi. Zilondazo sizitha kuyambitsa chisangalalo chifukwa cha kupweteka. Pazinthu zapamwamba, tidzalankhula za kudula miyendo.

Autonomic polyneuropathy mu shuga

Pamaso pa zotupa za dongosolo lodziyimira palokha motsutsana ndi maziko a matenda ashuga, wodwalayo amamva:

kuyera mumaso
kukomoka pamene owongoka,
chizungulire.

Njira yamtunduwu ya polyneuropathy imayendera limodzi ndi zosagwira ntchito pakulimbitsa thupi, komwe kumawonetsedwa ndi kuchepa kwa chakudya. Chifukwa cha izi, ndizosatheka kukhazikika kwa shuga m'magazi a odwala matenda ashuga.

Zomwe zimayambitsa kufa mwadzidzidzi zimatha kukhala kuphwanya mzere wamtima mu matenda ashuga a polyneuropathy.

Anthu omwe akudwala matendawa amamva mavuto kuchokera ku genitourinary system - kwamikodzo kumachitika. Chikhodzodzo sichitha kutaya chilichonse, chomwe chimakhala chofunikira pakukula kwa matenda opatsirana. Mwa amuna, kukanika kwa erectile kumbuyo kwa autonomic polyneuropathy kudzadziwika, ndipo mwa akazi dyspareunia (kulephera kukwaniritsa orgasm).

Mitundu ya polyneuropathies

Ma Polyneuropathies amatha kufotokozedwa kuchokera koyambira (etiology), kumene komanso mawonedwe azachipatala.

Mapangidwe a Polyneuropathies ndi mawonekedwe a chipatala atha kukhala motere:

motor polyneuropathies (monga kuwonongeka kwa motor CHIKWANGWANI, kukula kwa kufooka kwa minofu, ziwalo, paresis),
polyneuropathieskuwonongeka kwa ulusi wamtundu, dzanzi, kuyaka ndi kupweteka),
autonomic polyneuropathies (kuphwanya ntchito za ziwalo zamkati, kuwonongeka kwa minyewa yamitsempha yomwe imayang'anira kugwira ntchito kwa ziwalo zamkati),
ma polyneuropathies oyendetsa motoZowonongeka zamagalimoto ndi zomverera zimakhala ndi khalidwe).

Malinga ndi mfundo ya pathogenetic ya polyneuropathy ikhoza kugawidwa m'magulu:

axonal (chotupa chachikulu cha axon - njira yayitali ya maselo a mitsempha),
kuchepetsa nkhawa (myelin matenda - mitsempha ya msempha ya mitsempha).

Mwa chiyambi (etiology) itha kugawidwa polyneuropathy mu:

autoimmune (Miller-Fisher syndrome, paraproteinemic polyneuropathy, paraneoplastic polyneuropathies, pachimake yotupa axonal polyneuropathy, Sumner-Lewis syndrome),
cholowa (cholowa chotengera motor-sensor neuropathy ya mtundu I, mtundu wa Rus-Levy, cholowa cham'madzi-mtundu wa neur II),
metabolic (matenda ashuga polyneuropathy, uremic polyneuropathy, hepatic polyneuropathy, polyneuropathy mu endocrine matenda, polyneuropathy mu matenda oyambira amyloidosis),
amazentary (ndi kuchepa kwa mavitamini B1, B6, B12, E),
poizoni (woledzera polyneuropathy, mankhwala polyneuropathies, polyneuropathies poizoni ndi zitsulo zolemera, organic sol sol ndi zina zapoizoni),
polyneuropathies mu matenda matenda (zokhudza zonse lupus erythematosus, scleroderma, nyamakazi, sarcoidosis, vasculitis, matenda a Sjogren),
poizoni (diphtheria, pambuyo pa fuluwenza, chikuku, matendawa, matenda opatsirana, kupatsirana katemera, ndi matenda abwinobwino, kachilombo ka HIV,).

Njira ya matenda a polyneuropathy ikhoza kukhala:

lakuthwa (Zizindikiro zimachitika patatha masiku angapo kapena milungu),
kugonjera (Zizindikiro zimachulukanso patatha milungu ingapo, koma osapitilira miyezi iwiri),
aakulu (Zizindikiro za matenda zimayamba kupitilira miyezi yambiri kapena zaka).

ICD-10 polyneuropathy

Malinga ndi gulu la padziko lonse matenda obwereza lakhumi (ICD-10) polyneuropathy imakhazikika ndi cipher G60 - G64. Kalasi iyi ili ndi mayina a polyneuropathies ndi zotupa zina za zotumphukira zamagetsi. Mtundu wa matendawa amafotokozedwanso ndi munthu wina, mwachitsanzo, mowa wa polyneuropathy - G62.1.

ICD-10 polyneuropathy coding

Magetsi a minyewa yamitsempha yama nevaMatenda a Charcot-Marie-Tooth, matenda a Degerin-Sott, cholowa chotchedwa motor I)

Neuropathy yophatikizika ndi cholowa cha hexia

Idiopathic enduropathy

Magenopathies ena obadwa nawo komanso idiopathic (Matenda a Morvan, Nelaton syndrome, neuropathy yamatsenga)

Osadziwika mwabadwa ndi idiopathic neuropathy

Guillain-Barré Syndrome (Miller-Fisher syndrome, pachimake pambuyo-matenda / polyneuritis)

Matenda ena otupa a polyneuropathies

Polyneuropathy yosadziwika

Polyneuropathy yoyambitsidwa ndi zinthu zina zapoizoni

Ma polyneuropathies ena

Polyneuropathy matenda opatsirana ndi parasitic otchulidwa kwina (polyneuropathy ndi diphtheria, matenda a mononucleosis, khate, syphilis, chifuwa chachikulu, matumbu, matenda a Lyme)

Polyneuropathy mu neoplasms

Polyneuropathy mu matenda ena a endocrine ndi zovuta zama metabolic

Polyneuropathy ndi kuperewera kwa zakudya m'thupi

Polyneuropathy ndi zokhudza zonse zotupa za zolumikizana minofu

Polyneuropathy ndi zotupa zina zotupa

Polyneuropathy matenda ena gulu linauremic neuropathy)

Zovuta zina za zotumphukira zamanjenje

Chithunzi chachikulu pazachipatala cha polyneuropathies

Monga tanena kale, polyneuropathies amatha kuwonetsa mota (mota), zomverera (wogwira mtima) ndi zizindikiro za autonomic zomwe zingachitike ndikuwonongeka kwa mtundu wolingana wa ulusi wamitsempha.

Madandaulo akuluakulu a odwala omwe ali ndi polyneuropathy ndi ululu. Mwachilengedwe, zimatha kukhala zosiyana, koma zomwe zimachitika pafupipafupi ndizowotchera kapena kupweteka kuwawa kapena kubowola kapena kupweteka kwambiri. Kukula kwa kupweteka kwa polyneuropathy kumatengera kuuma kwa njira ya pathological, mtundu ndi mawonekedwe a zophatikizika. Nthawi zambiri, ululu wokhala ndi polyneuropathies umayamba ndi distal kwambiri (kutali) madipatimenti, omwe amachokera kumapazi a mapazi.

Ndi polyneuropathies, muthanso kukumana ndi omwe amadziwika kuti ndi miyendo yosakhazikika. Matendawa ndi omwe amadziwika ndi zosasangalatsa m'madera akumunsi omwe amawoneka kuti akupuma (nthawi zambiri madzulo ndi usiku) ndikukakamiza wodwalayo kupanga mayendedwe owathandizira ndipo nthawi zambiri zimayambitsa chisokonezo cha kugona. Mawonekedwe amtundu wa matenda osakhazikika miyendo imatha kukhala zomverera, zoyenda, kukoka, kusoka, kuphulika kapena kuphwanya. Nthawi zina pamatha kumamveka kulira kwa tsekwe, zopweteka kapena zodukaduka, zomwe nthawi zambiri zimatha kupezeka kumapazi kapena kuzama kwamiyendo.

Kuwonetsera kwamoto kwa polyneuropathy kumaphatikizapo izi:

kufooka kwa minofu (nthawi zambiri tetraparesis kapena paraparesis wotsika),
minofu hypotension (kuchepetsedwa pang'ono kwa kukanika kwa minofu kapena kukana kuyenda),
kuwukira (kufooka kapena kuchepa kwa mphamvu) minofu
kunjenjemera (kunjenjemera),
neuromyotonia (mkhalidwe wokhazikika kapena kupindika kwa minofu),
zokonda (minofu yochepa yosalamulirika yokhala pakhungu),
minofu kukokana.

Nthawi zambiri, mawonekedwe omwe ali ndi kuwonongeka kwa mitsempha yam'mapapo amasemphana ndi adokotala ndipo samadziwika kuti ndi amodzi mwa mawonekedwe a polyneuropathy. Odwala omwe awonongeka ndi ulusi wamasamba, pali mawonekedwe a kukanika kwa mtima, m'matumbo, kusabala, kukodza pokodza, mayankho a ophunzira, ndi thukuta.

Mawonetsedwe akulu azachipatala a autonomic neuropathy ndi awa:

orthostatic hypotension (kutsika kwa kuthamanga kwa magazi chifukwa cha kusintha kwa malo amthupi kuchoka pamlingo kupita pamlingo),
kusokonezeka kwa mtima
kuyanʻanila kusinthasintha kwachilengedwe kwa magazi masiku onse,
postural tachycardia (kuwonjezeka kwa kugunda kwa mtima pakuimirira komanso kuchepa kobwerera pamalo opingasa),
latent myocardial ischemia (kuwonongeka kwa mtima chifukwa chakuchepa kapena kuchepa kwa magazi kwa minofu ya mtima),
chiopsezo cha kufa mwadzidzidzi,
kukomoka ndi kusowa kwa m'mimba,
matumbo kusagwira (kudzimbidwa kapena kutsegula m'mimba),
kuwonongeka kwa ndulu (kusayenda kwa bile, cholecystitis, matenda a ndulu),
kuphwanya kwamikodzo (kuvuta kuchotsa chikhodzodzo, kufooketsa mtsinje wa mkodzo, kusintha pafupipafupi kukodza, kusungika kwamikodzo),
kukanika kwa erectile (kuthekera kwa mwadzidzidzi kapena kukonzanso kwa erection, kubwereza kukopeka),
thukuta
kuphwanya kwamtundu wa ana.

Ma polyneuropathies ambiri amadziwika ndi kutenga gawo lalikulu la mbali zam'mphepete komanso kufalikira kwa zizindikiro, ndikuti miyendo imayendetsedwa kale kuposa manja. Zonsezi zimatengera kutalika kwa ulusi womwe umakhudzidwa ndi pathological process.

M'mafilimu ena a polyneuropathies, kuwonjezera pa misempha yammbuyo, mitsempha ina yamkati imatha kukhudzidwa, yomwe ikhoza kukhala ndi phindu lazidziwitso muzochitika.

Chithandizo cha Guillain-Barré Syndrome

Chithandizo cha Guillain-Barré syndrome ndi chithandizo chamankhwala. Komanso, ziyenera kudziwidwa kuti ngakhale ndi zovuta zingapo, pali chifukwa chodwalitsira odwala mwadzidzidzi. Odwala omwe ali ndi matenda a Guillain-Barré angagonekere kuchipatala chachipatala chachikulu.

Pa chithandizo cha matenda ndi kuwonjezeka kwa kuthamanga kwa magazi, nifedipine amaperekedwa kwa wodwala (10 - 20 mg pansi pa lilime) Propranolol imagwiritsidwa ntchito kuchepetsa tachycardia (mlingo woyambirira wa 20 mg katatu patsiku, ndipo kenako pang'onopang'ono mlingo umakhala 80 - 120 mg wa 2 mpaka 3 Mlingo womwe umayang'aniridwa ndi kuthamanga kwa magazi, kugunda kwa mtima ndi ECG) Mu bradycardia, wodwala yemwe ali ndi Guillain-Barré Syndrome amamuika atropine kudzera m'mitsempha (0,5 - 1 mg motsogozedwa ndi ECG ndi kuthamanga kwa magazi, ndipo ngati pakufunika kutero, kubwerezako kumabwerezedwa pambuyo pa mphindi 3 - 5) Pofuna kuchepetsa ululu, ma analgesics, mankhwala osapweteka a antiidal, monga ketorolac (pakamwa kamodzi pa 10 mg kapena mobwerezabwereza, malingana ndi kupweteka kwa ululu, 10 mg mpaka 4 pa tsiku), diclofenac (intramuscularly, limodzi mlingo ndi 75 mg, ndipo pazipita tsiku lililonse ndi 150 mg) Ibuprofen (1 kapena 2 mapiritsi 3 kapena 4 pa tsiku, koma osapitilira mapiritsi 6 patsiku).

Zolemba za matendawa ndi mitundu yake

Omasuliridwa kuchokera ku Greek polyneuropathy amatanthauza "kuvutika kwamitsempha yambiri." Zomwe zimayambitsa matendawa ndizosiyanasiyana - pafupifupi chinthu chilichonse chomwe chakhala ndi vuto linalake pa zotumphukira zamitsempha chingayambitse polyneuropathy.

Popeza ntchito yofunika yokhudza thupi imatengera kufalikira kwa malamulo ku ubongo ndi kutha kwa mitsempha, ndikakulitsa kwa polyneuropathy, kuphwanya kwamphamvu kwa magwiridwe antchito ndi miyendo.

Zofunika! Polyneuropathy ya malekezero achepa ndicofala, chifukwa miyendo ili ndi katundu wamkulu kuposa thupi lakumtunda.

Ndi polyneuropathy, nthawi zambiri misempha yaying'ono imakhudzidwa, chifukwa mchenga wawo wa myelin ndi woonda, ndipo zinthu zovulaza ndizosavuta kulowa mkatikati. Chifukwa chake, polyneuropathy yam'mwamba komanso yotsika kwambiri imakonda kuchitika - kuwonongeka kwa mapazi ndi manja.

Nthawi zambiri, posankha matenda, wodwala samangolembera mawu oti "polyneuropathy a miyendo kapena manja", akuwonetsetsa kuti awonjezera tanthauzo lomwe limatengera mtundu wa matenda. Gulu la matenda padziko lonse lapansi limaphatikizapo mitundu ingapo ya polyneuropathy (ICD code - G60-G64), yomwe imasiyana malo, digiri ndi dera la chotupa, pazifukwa zadzidzidzi.

Ndi digiri ndi dera lowonongeka

Zingwe zamitsempha zimatha kugawidwa m'mitundu ingapo - mota, autonomic, sensenti. Kutengera ndi malo omwe minyewa yam'mitsempha imakhazikika, polyneuropathy imatchulidwanso:

Galimoto (mota). Mkhalidwe wabwinobwino wa minofu imakulirakulira, zomwe zimabweretsa kulephera pantchito yawo: minofu kufooka, kukokana, atrophy ndi minofu hypotrophy kumachitika.Zizindikiro zimafalikira kuchokera pansi mpaka pansi ndipo zimatha kuyambitsa kutayika kwathunthu.

Zamasamba. Ulusi wamitsempha ya Autonomic umakhudzidwa, momwe mkhalidwe wamkati wamkati umatengera. Pali kuchuluka kwa thukuta, mavuto pokodza, chizolowezi, khungu louma limawoneka.
Sensory polyneuropathy. Mavuto azisoni amadzuka: kumverera kwa kugunda, kuwotcha, kugona, "kukwawa," kumverera kowawa komanso kosokonekera ngakhale ndi kukhudza pang'ono pa dzanja.
Sensomotor polyneuropathy. Zimaphatikiza zizindikiritso zowonongeka mumalingaliro am'mimba ndi ma motor.
Zosakanizidwa. Zimaphatikizapo zizindikiritso zamitundu mitundu.

Mwanjira yake yoyenera, mitundu iyi imatha kupezeka kawirikawiri, nthawi zambiri imakhala yopatsa mphamvu, yamagalimoto, ndi mitundu yosiyanasiyana ya matendawa.

Ndi mtundu wa pathological process

Polyneuropathy imakhudza ulusi wamitsempha, womwe umapangidwa ndi ma axon ndi ma sheels a myelin. Kutengera zotupa, amasiyanitsa:

Axonal polyneuropathy - imachitika pamene axon iwonongeka m'magulu osiyanasiyana a metabolic: kuledzera ndi arsenic, lead, zebury, mowa,
Demyelinating polyneuropathy - imachitika ndikuwonongeka kwa minyewa yam'mitsempha, matendawa amakula mwachangu, makamaka magalimoto a motor ndi sensory amakhudzidwa.

Mwa mawonekedwe ake oyera, mitundu yotereyi simakhalapo kwa nthawi yayitali: ndi kuwonongeka kwa axon, vuto la demyenilizing limalowerera pang'onopang'ono, ndipo ndi demyelination, mtundu wa axonal.

Kutengera ndi kutengera kwawo, distal polyneuropathy ndi proximal amakumana: ndi distal, choyambirira, miyendo yomwe ili pansi imakhudzidwa, ndi proximal, magawo a miyendo yomwe ili pamwambapa.

Zomwe zimachitika

Kuti mankhwalawa a polyneuropathy apereke zotsatira, ndikofunikira kuzindikira zomwe zimayambitsa.

Chifukwa chiyani polyneuropathy yam'manja miyendo ndi miyendo imapezeka:

Matenda A shuga . Kugonjetsedwa kwa ziwiya zazing'ono, monga zovuta, kumachitika mwa odwala ambiri omwe akudwala matendawa. Chifukwa chake, ndichinthu choyamba pamndandanda wazomwe zimayambitsa polyneuropathy. Vuto lofananalo limachitika kawirikawiri kwa iwo omwe ali ndi matenda a shuga kwa nthawi yayitali (zaka 5 mpaka 10).
Fomu yoopsa. Zimachitika pamene zinthu zakunja kwa thupi la munthu zilowa m'magazi: arsenic, lead, methanol, mercury ndi mankhwala ena. Nthawi zina poizoni wa polyneuropathy amatha kuchitika pogwiritsa ntchito mankhwala kwa nthawi yayitali, koma mowa polyneuropathy ndiwo mtundu wofala kwambiri. Fomu yauchidakwa imayamba pafupifupi anthu atatu% omwe ali ndi vuto la chidakwa, ndipo pafupipafupi amapezeka wachiwiri pambuyo pa matenda ashuga.
Kuperewera kwa mavitamini a B . Mitundu ina ya mavitamini a B (B12, B1, B6) imakhala ndi vuto la neurotropic, ikukhudza bwino mitsempha yapakati ndi dongosolo lamanjenje lamkati. Chifukwa chake, kusowa kwawo kumatha kuyambitsa matenda a axonal polyneuropathy.
Mtundu wa Dysmetabolic. Matendawa amapezeka chifukwa cha kusokonezeka kwa magwiridwe antchito a minyewa chifukwa cholowetsa zinthu zomwe zimapangidwa m'thupi pambuyo poti kudutsa matenda ena.
Kuvulala. Chifukwa cha kuvulala, kuwonongeka kwamankhwala kumanjenje kumatha kuchitika, komwe kumayambitsa chitukuko cha neuropathy cha kumtunda komanso m'munsi.

Tcherani khutu! Polyneuropathy nthawi zambiri imayamba chifukwa cha matenda momwe thupi limadziunjikira zinthu zovulaza zomwe zimasokoneza dongosolo lamanjenje.

Mitundu yayikulu yamatendawa imaphatikizapo mtundu wobadwira wa polyneuropathy ndi mawonekedwe a ideopathic (Guillain-Barré syndrome). The etiology ya mitundu iyi siyimafotokozeredwa kwathunthu, zomwe zimapangitsa zovuta za matenda.

Mitundu yachiwiri ya polyneuropathy yam'mwamba komanso yotsika imaphatikizapo mitundu yomwe idayamba chifukwa cha matenda opatsirana, kusokonezeka kwa metabolic, poyizoni, matenda a impso ndi chiwindi, kusokonekera kwa magawo a endocrine, ndi zotupa zamitundu mitundu.

Zizindikiro ndi kukula kwa matendawa

Polyneuropathy ali ndi mawonekedwe azachipatala. Chizindikiro chachikulu cha matendawa chimatha kuganiziridwa ngati kuyanjana kwa zigawo zam'munsi komanso zapamwamba, chifukwa zinthu za m'magazi zimafalikira kudzera m'magazi.

Zizindikiro zodziwika bwino za matendawa:

Ululu wamitundu yosiyanasiyana, wokhala ndi neuropathic ("yoyaka") hue.
Zithunzi zanjenjemera.
Maonekedwe a minofu yolumikizana yomwe imachitika mosadzipereka.
Kuphwanya mphamvu zakumvera (kupweteka, tactile, kutentha). Ndi chitukuko cha matendawa, wodwalayo samatha kumva ngati nsapato mu nsapato, malo otentha komanso ena osokoneza.
Kufooka minofu, kuvuta mayendedwe okhala ndi matalikidwe akulu.
Kutupa m'malire am'munsi,
Gawo lambiri la miyendo.

Zizindikiro zake zamatendawa zimaphatikizira kuwoneka kwa kudzisala, kufooka m'minwe, kusokonezeka kwa magazi (mtundu wamalungo ndi miyendo, kuchiritsa kwamabala, ndi zina zotere).

Matenda a shuga a polyneuropathy a m'munsi malekezero chimayambitsa chithunzi chachipatala chotsatira:

Kuwoneka kowawa, kupweteka kwambiri m'miyendo ndi kumapazi, komwe kumakhala kwamphamvu pamatenthedwe otentha:
Pali kufooka kumapazi.
Zizindikiro zamasamba zikukula
Ululu umayamba kuwonjezeka, kwinaku kuyamwa kumawonekera ndipo khungu limasintha (utoto wofiirira, pafupifupi wakuda),
Anapangidwa.

Mowa polyneuropathy amakula pang'onopang'ono, zizindikiro zake zimawonekera chifukwa cha zovuta za ethanol pamitsempha yamanjenje yayikulu ndi kusokonezeka kwa metabolic m'mitsempha:

Choyamba, kupweteka m'dera la ng'ombe kumachitika, komwe kumakulirakulira
Pali kufooka, ziwalo zimachitika, kumbuyo komanso miyendo yam'munsi,
Kuwoneka kwa minofu ya paretic kumachitika
Kusokonezeka kwenikweni kwa malingaliro kumawoneka (zomwe zimatchedwa "masokosi ndi magolovesi" zotulutsa),
Pali thukuta lomwe limachulukirachulukira, kutupa kwa malekezero akumidzi, kusintha kwa khungu.

Polyneuropathy imatha kuchitika chifukwa chomwa mowa mopitirira muyeso, zomwe zimapangitsa kuti dongosolo lamkati lamanjazi lizidwala ndi ethanol.

Polyneuropathy sizimachitika kawirikawiri pang'onopang'ono: ndi mawonekedwe owopsa, Zizindikiro zimatha kukhala mkati mwa sabata, ndi mtundu wa subacute - mawonetseredwe akuwonjezeka pafupifupi mwezi wathunthu, ndi mawonekedwe osakhazikika - matendawa amatha kuyamba zaka.

Njira zochizira

Pamaso pa chithandizo chachindunji cha polyneuropathy, kuzindikira kwake kumachitika, momwe mawonetseredwe am matendawa amasanthula, ndipo zomwe zimayambitsa zimakhazikitsidwa, kuti athe kufafaniza ma pathologies omwe amawonetsedwa ndi zofananira zofananira.

Kodi matendawa amachitika bwanji:

Zodandaula za odwala zimawunikidwa.
Nthawi imakhazikitsidwa pomwe zizindikiro zoyambirira za matendawa zimawonekera.
Zili ngati ntchito ya wodwalayo imalumikizidwa ndi kukhudzana ndi mankhwala.
Zimadziwika ngati wodwalayo amadalira mowa.
Khazikitsani zinthu za cholowa.
Kuyesedwa kwa magazi kumachitika.
Mapeto amitsempha amaikidwa.
Electroneimography imachitidwa.
Kuunika kumayendetsedwa, nthawi zina, kwa akatswiri.

Popeza polyneuropathy si matenda odziyimira pawokha, chithandizo chake chachikulu chizikhala ndikuchotsa zomwe zidapangitsa kuti matenda ayambire. Komabe, njira zochiritsira ziyenera kuchitika mokwanira, kuti nthawi imodzi tichotse zosasangalatsa za polyneuropathy nthawi yomweyo monga chithandizo chachikulu.

Zochita Zamathupi

Physiotherapy imagwira ntchito kwambiri pakuchiza matenda a polyneuropathy, makamaka ngati matendawa ali ndi chibadwa kapena matenda osakhazikika.

Ndondomeko zotsatirazi zimachitika:

Kuwonetsedwa kwamitsempha yamagetsi yamagetsi.
Massage Therapy
Electrophoresis

Massage yokhala ndi polyneuropathy imathandizira kulimbitsa minofu, imawongolera komanso imathandizira magwiridwe awo. Chifukwa cha izi, ntchito zamagalimoto zimachokeranso mwachangu, chiwopsezo cha minofu atrophy chimachepetsedwa kwambiri. Komabe, ziyenera kukumbukiridwa kuti mu mitundu yovuta ya matendawa, kutikita minofu sikuyenera kuchitidwa.

Tcherani khutu! Ngati poizoni, makamaka mowa woledzeretsa, njira zamankhwala zimachitika pokhapokha kuyeretsa magazi komwe kumachitika pang'onopang'ono.

Zochita zolimbitsa thupi zitha kuchitidwa, modziyimira palokha kunyumba, komanso motsogozedwa ndi dokotala. Amathandizira kulimbikitsa ntchito ya minofu, yomwe imakupatsani mwayi pang'ono kapena kubwezeretsa bwino miyendo yanu.

Mavuto ndi ukadaulo

Ngati simukufuna chithandizo chamankhwala panthawi, ndiye kuti matendawo angayambitse zovuta zazikulu.

Choyamba, polyneuropathy imatha kukhala mawonekedwe osachiritsika, omwe samachiritsidwa kwathunthu. Popita nthawi, munthu amasiya kumvetsetsa miyendo yawo, ndipo minofu imabwera mwanjira yoti munthu amatha kulumala, chifukwa zinapangitsa kuti azitha kusuntha.

Zofunika! Ndikothekanso kuchiritsa kwathunthu polyneuropathy wokhala ndi matenda monga opatsirana, uchidakwa, komanso woopsa. Ndi mtundu wa matenda ashuga, ndizotheka kuchepetsa pang'ono matendawa.

Mitundu yayikulu ya matenda yovutikira mitsempha yomwe imayendetsa ntchito ya mtima, imatha kuchitika mwamphamvu, yomwe imatha kupha.

Mwanjira ya matenda ashuga, matenda opatsirana, matenda a septiki, kuchiritsa kwamabala osavulala ndikotheka.

Ndi chithandizo chokwanira chomwe chikuyamba munthawi yake, matulukidwe a matendawa ndi abwino kwambiri, komabe matendawa ndibwino kuti tipewe kusiyana ndi kuchiza kwa nthawi yayitali, tikuvutika ndi zizindikiro zosasangalatsa.

Ndikosatheka kupewetsa polyneuropathy, koma zomwe zimayambitsa chitukuko chake zitha kuchepetsedwa: kusiya mowa, kuchiritsa matenda opatsirana ndi ma virus munthawi yake, kuwunika mtundu wa zinthu zomwe zikugwiritsidwa ntchito, kuchepetsa kulumikizana ndi mankhwala oopsa a mankhwala.

Polyneuropathy ndi gulu la matenda omwe amakhudza kuchuluka kwa mathero amitsempha m'thupi la munthu. Matendawa ali ndi zifukwa zingapo. Zinthu zomwe zimayambitsa matendawa, zimakhumudwitsa minyewa, kenako zimayambitsa kusokonezeka kwa magwiridwe antchito awo. Zizindikiro za matendawa ndi kufooka kwa minofu ndi kupweteka m'dera lomwe lakhudzidwa.

Matendawa amawonetsedwa ndi ziwalo, kusokonekera tctile kukhudza tactile, kusokonezeka kosiyanasiyana pantchito ya kumtunda komanso m'munsi mwa thupi. Zizindikiro za matendawa komanso kuchuluka kwa matendawa kumatengera mtundu ndi mtundu wa matendawa. Polyneuropathy nthawi zambiri imayambitsa mavuto ambiri kwa odwala, mankhwalawo amakhala. Njira yamatendawa imayenda pang'onopang'ono ndipo njirayi imatha kusinthidwa. Nthawi zambiri, matendawa amapezeka m'munsi mthupi.

Polyneuropathy imatha kuchitika mwaulesi, komanso kukhala ndi chitukuko cha mphezi.

Zomwe zimayambitsa polyneuropathy ndizosiyanasiyana. Zomwe zikuluzikulu ndi izi:

poyizoni ndi mowa weniweni, gasi, arsenic (poyizoni wa mankhwala),
matenda osachiritsika (,),
zoyambira zam'thupi,
Kugwiritsa ntchito kwa nthawi yayitali magulu ena azamankhwala
uchidakwa
Kuphwanya chitetezo
cholowa
kagayidwe kachakudya

Pathology ikhoza kukhala yamtunduwu:

yotupa. Poterepa, pali kutupa kwambiri kwa minyewa yamanjenje,
poizoni. Amayamba chifukwa cha kumeza kwa zinthu zochuluka za poizoni,
matupi awo onse
zopweteka.

Masiku ano, mtundu wofala kwambiri ndi matenda ashuga polyneuropathy. Ndikofunika kudziwa kuti polyneuropathy ndi njira yoopsa, yomwe imafuna chithandizo chanthawi yake komanso chokwanira. Ngati kulibe, ndiye kuti kupita patsogolo kwa matendawa kungayambitse matenda a minyewa ndi zilonda zam'mimba. Chovuta kwambiri ndikuwuma kwamiyendo kapena mikono, ndikapuma minofu.

Zosiyanasiyana

Mwa limagwirira zowonongeka, matendawa amagawidwa m'mitundu iyi:

demyelinating polyneuropathy. Kukula kwa matendawa kumalumikizidwa ndi kuwonongeka kwa mapuloteni m'thupi, omwe amaphimba mitsempha ndipo amachititsa kuthamanga kwa mapangidwe kudzera mwa iwo,
axonal. Mtunduwu umalumikizidwa ndi kuphwanya ntchito mu ndodo yamanjenje. Mtunduwu umatsatiridwa ndi chithandizo chachikulu komanso kuchira kwakutali,
neuropathic. Ndi iyo, kuwonongeka kwa matupi amitsempha yama mitsempha mwachindunji kumawonedwa,
diphtheria ndi matenda ashuga polyneuropathy,
polyneuropathy yam'munsi,
zakumwa zoledzeretsa za polyneuropathy.

Malinga ndi zoyambira zowonongeka zamitsempha, polyneuropathy ndi:

malingaliro. Imadziwonekera yamtundu wa dzanzi kapena kupweteka,
mota. Zingwe zamagalimoto zimakhudzidwa, zomwe zimatsatana ndi kufooka m'matumbo,
zamagetsi zamagalimoto. Zizindikiro za chotupa ndi kuchepa kwa chidwi ndi ntchito zama minofu,
zamasamba. Pali kuphwanya ntchito kwa ziwalo zamkati chifukwa chotupa m'mitsempha,
kusakaniza. Kuphatikiza zonse zamtunduwu pamwambapa,
polyneuropathy yam'munsi yotsika.

Kutengera zomwe zimayambitsa chitukuko, polyneuropathy ikhoza kukhala:

chidziwitso. Zomwe zimachitika zimakhudzana ndi zovuta zam'mthupi,
cholowa. Adutsa kuchokera kumibadwo kupita ku ina.
dysmetabolic. Kupita patsogolo chifukwa cha zovuta zama metabolic,
polyneuropathy wa poizoni amapezeka m'zakudya zoopsa zomwe zimalowa mthupi,
pambuyo. Amachitika ndi matenda opatsirana m'thupi,
paraneoplastic. Kukula kumayendera limodzi ndi matenda a oncological,
ndi matenda amthupi, amakula ngati mbali ya matenda.
zakumwa zoledzeretsa za polyneuropathy.

Ndi mtundu wa maphunzirowa:

zokometsera. Nthawi yachitukuko ikuchokera masiku awiri mpaka anayi. Mankhwalawa amatha milungu ingapo,
kugonjera. Amayamba mu masabata angapo, chithandizo chimatenga miyezi,
aakulu Imayamba kuyambira miyezi isanu ndi umodzi kapena kupitilira apo, imakhala ndi nthawi yothandizira munthu aliyense payekha.

Mosasamala mtundu wa matenda omwe munthu ali nawo, kaya ndi mowa kapena matenda ashuga, cholowa kapena poizoni polyneuropathy kapena demyelinating, zizindikilo zimafanana.

Zinthu zingapo zomwe zimayambitsa matendawa, nthawi zambiri zimakhudza mitsempha, kenako zimayambitsa kusokonezeka kwa ntchito yawo. Zizindikiro zazikulu za matendawa ndi:

kufooka m'miyendo yamiyendo ndi miyendo,
kulephera kupuma
kuchepa kwa chidwi ndi chidwi, mpaka kufika kwawo,
chidwi chazitali cha "goosebumps" pakhungu lonse,
kutuluka thukuta kwambiri
kugwedezeka kapena kukokana
Kutupa kwa mikono ndi miyendo,
zokonda mtima
Shaky gait ndi chizungulire,
kudzimbidwa.

Kupewa

Njira zodzitchinjiriza za polyneuropathy cholinga chake ndikuchotsa zomwe zimayambitsa minyewa ya mitsempha. Njira Zopewera:

kukana zakumwa zoledzeretsa konse,
ngati ntchitoyo ikuphatikiza mankhwala, yingochitani mwa zovala zoteteza,
yang'anirani mtundu wa chakudya chomwe mumadya
musamwe mankhwala popanda mankhwala a dokotala,
munthawi yochizira matenda amtundu uliwonse komanso zovuta,
phatikizani ndi mavitamini muzakudya zanu,
kuchita masewera olimbitsa thupi
Nthawi zonse amayang'anira shuga
Nthawi ndi nthawi pitani ku ma massage achire.

Kodi chilichonse ndicholondola m'ndimeyi malinga ndi zamankhwala?

Yankho lokha ngati mwatsimikizira chidziwitso chachipatala.

Matenda okhala ndi zofananira:

Guillain-Barré syndrome ndi gulu la matenda oopsa a autoimmune omwe amadziwika ndi kupita patsogolo mwachangu. Nthawi yakutukuka mwachangu ndi pafupifupi mwezi umodzi. Mankhwala, matendawa ali ndi mayina angapo - Landry paralysis kapena pachimake idiopathic polyneuritis. Zizindikiro zazikulu ndi kufooka kwa minofu ndi kusakhalapo kwa Reflex komwe kumachitika motsutsana ndi maziko akuwonongeka kwakukulu kwa mitsempha (chifukwa cha njira ya autoimmune). Izi zikutanthauza kuti thupi la munthu limalandira ziwalo zake ngati zachilendo, ndipo chitetezo cha mthupi chimapanga chitetezo mthupi motsutsana ndi nembanemba yamitsempha yomwe yakhudzidwa.

Distal polyneuropathy yam'munsi malekezero Amaphatikiza matenda angapo omwe amatuluka pazifukwa zosiyanasiyana, momwe magwiridwe antchito amtundu wamunthu amakulirakulira.

Nthawi zambiri, matendawa amakhudza miyendo, kukulitsa ntchito ya minofu, kayendedwe ka magazi, kuchepetsa chidwi. Zotsatira za polyneuropathy ndizowopsa chifukwa zimatha kupangitsa kuti manja ndi miyendo yathu ikhale pang'ono kapena kuti ithetsere zidutswa zowonongeka.

Matendawa amakula pazifukwa zambiri, zinthu zosiyanasiyana zomwe zimakhudza dongosolo lamanjenje laumunthu zimatha kupangitsa polyneuropathy. Popeza kugwira ntchito kwa thupi kumatsimikiziridwa ndi mtundu wa kufalikira kwa zokopa kudzera mu minyewa ya muubongo kupita ku ubongo, ndi mawonekedwe a matenda oterewa, kuwonongeka kwa kayendedwe ka mphamvu ndi chidwi m'miyendo kumachitika.

Polyneuropathy yokhala m'munsi yotsika imapezeka pafupipafupi, popeza katundu wochititsa chidwi amayikidwa pamiyendo poyerekeza ndi kumtunda. Pathology nthawi zambiri imakhudza mitsempha yaying'ono, chifukwa imakhala ndi mafuta ochepa kwambiri a myelin sheathin, ndipo zinthu zovuta kuzitsatira sizifunikira kulowa ulusi wamitsempha. Chifukwa chake, polyneuropathy ya manja ndi mapazi, kuwonongeka kwa manja ndi mapazi kumachitika kawiri kawiri.

Nthawi zambiri pozindikira, madotolo amawonetsa matendawa matendawa, chifukwa cha mitundu mitundu ya matenda. Pali mitundu ingapo ya polyneuropathy yomwe imasiyana mdera, malo omwe adawonongeka, komanso zinthu zolimbikitsa.

Vuto lama mota limachitika pomwe minofu yakula, kugwira ntchito kwawo kulephera, kufooka, kukakamira, kuwonekera komanso kuperewera kwa zakudya m'thupi kumawonekera. Zizindikiro zimayambira pansi mpaka pamunsi, zimayambitsa vuto la magalimoto:

Zamasamba . Zimayambitsa kuwonongeka kwa minyewa yam'mitsempha, zimayambitsa chikhalidwe cha ziwalo zamkati. Kutupa, kusokonezeka kwamikodzo ntchito, kudzimbidwa, kuuma kumakulitsidwa.
Sensory polyneuropathy , amachepetsa kumva, kugunda, kuwotcha, kumva thukuta, kumakhala ndikumveka kwa tsekwe, kumva kulira, kupweteka pang'ono osalumikizana pang'ono.
Sensorimotor polyneuropathy . Kuphatikiza zizindikiro zowonongeka mumalingaliro amagetsi ndi ma motor.
Kuphatikizidwa. Mumakulolani kugwiritsa ntchito mitundu yonse yamavuto.

Mwa mawonekedwe ake oyera, mitundu yotere ndiyosowa, nthawi zambiri imakhala yopatsa chidwi komanso mitundu ina ya matenda amapezeka.

Zizindikiro

Matendawa akawonekera, kugwira ntchito kwa mota ndi ulusi wamatsenga kumachepa. Pankhaniyi, pali zizindikiro za polyneuropathy pamiyendo:

Kudzera.
Kudzisunga.
Ululu
Kung'ung'udza.
Kufooka mu minofu minofu.
Kuzindikira kochepa.

Zolemba zamankhwala

Chithandizo cha polyneuropathy cha malekezero am'munsi chimasiyana mu mawonekedwe ake, mwachitsanzo, mawonekedwe a matenda ashuga samachotsedwa pakukana mowa. Zoterezi sizimangokhala zokha. Pakuwonekera koyamba kwa zizindikilo, kutsimikiza kwake komwe kumayambitsa vutoli kumafunikira.

Pambuyo pake, ndizotheka kudziwa zomwe zikupangitsani.Chithandizo cha polyneuropathy chikuyenera kukhala chokwanira komanso chofuna kuthetseratu mizu iyi. Chifukwa chake, zosankha zina sizingapangitse zotsatira zomwe mukufuna.

Asanachiritsidwe, njira yodziwira imachitika momwe matenda amapezeka ndi zomwe zimatsimikiziridwa kuti athe kupatula chitukuko cha matenda omwe akuwonetsa ndi zofanana ndi zomwezi.

Methylprednisolone imagwiritsidwa ntchito pakupanga zovuta za matenda.
Tramadol imagwiritsidwa ntchito kupweteketsa mtima.
Flowerpot imalimbikitsa magazi m'malo owonongeka.
Vitamini B.
Mankhwala omwe amathandizira maselo okhala ndi micronutrients.

Kusisita
Kuwonetsedwa pamagetsi.
Mankhwala amitsempha.
Chithandizo cha ziwalo zamkati.

Poizoni atapezeka m'thupi, muyenera kuyeretsa magazi. Madokotala nthawi zambiri amapereka mankhwala angapo olimbitsa thupi.

Mankhwala

Mankhwala amatchulidwa poganizira mitundu ya matenda ndi gawo la kukula kwa polyneuropathy ndi zizindikiro zake:

Vitamini ovuta. Zokonda zimaperekedwa ku mavitamini a gululi Kuphatikiza ndi mchere wina. Mankhwala othandizira a Vitamini amathandizira kulimba kwa ulusi wamanjenje kuti abwezeretse mawonekedwe awo, amalimbikitsa chitetezo cha antioxidant.
Ophera. Kuti athetse ululu, ma analgesics kapena mankhwala osokoneza bongo omwe amaletsa kutupa amapatsidwa mankhwala. Pafupipafupi, odwala amapatsidwa morphine kapena codeine.
Hormone mankhwala ndi immunosuppressants. Malangizo a mankhwalawa amatsimikiziridwa ndi katswiri woganizira kuchuluka ndi kuchepa kwa mulingo. Hormone therapy imathandizidwa ndi ma immunoglobulins. Njira zotere zimachitika kuchipatala.
Mankhwala omwe amalimbikitsa magazi kupita m'mitsempha ya mitsempha.
Mankhwala omwe amathandizira kupereka micronutrients opindulitsa kwa minofu.

Mukachotsa polyneuropathy, muyenera kumvetsetsa kuti kuchotsa matenda mothandizidwa ndi mankhwala sikungathandize. Zakudya ndizofunikira kwambiri; kukonzanso komanso kusamalira odwala ndi ena kumatanthauzanso zambiri.

Zovuta zotheka

Ndikosayenera kuyambitsa matenda ndikupangitsa zovuta. Kupanda kutero, mawonekedwe osatha komanso zovuta zingapo zingakhale. Ngati munthu sangathe kuchira matendawa, miyendo yake imaduka. Zotsatira zake, wodwala sangathe kusuntha bwino.

Ngati mankhwala ayamba pa nthawi yake, kudwala kwa matendawa kumakhala koyenera. Pokhapokha ngati ndi mawonekedwe osatha mungakhale mavuto. Sichingagwire ntchito kwathunthu, koma pali njira zochepetsera kukula kwa chitukuko chake.

Sensory polyneuropathy ndi matenda omwe zizindikiro zake zimayamba chifukwa cha kugonjetsedwa kwa ma neuron omwe amachititsa ntchito zamagalimoto, chifukwa chomwe ntchito zamagetsi zimatha kusokonekera kwambiri. Matendawa ndi oopsa kwambiri kwa odwala matenda ashuga. Monga mitundu ina ya polyneuropathies, chimodzi mwamafunso posankha chithandizo ndi zotsatira zake zotsatirapo ndikuwonetsetsa matendawa panthawi yake.

Sensory polyneuropathy imatha kuchitika kaamba ka zifukwa zosiyanasiyana, kuphatikiza njira zazikulu za autoimmune, kuledzera, cholowa ndi matenda, pomwe vuto lowopsa ndiloti matenda amatengedwa kapena atapezeka chifukwa cha chibadwa chapadera.

Zizindikiro zazikulu za polyneuropathy yoopsa yamalingaliro ndi kutayika kwa mphamvu, kupsa kwamphamvu, kumangika ndi kuyabwa, kumva kugwedezeka kwamiyendo, komanso wodwalayo akuyamba kuzindikira kutentha ndi kuzizira, kusiyana kwa kutentha. Ndi sensne polyneuropathy, zizindikiro zoyipa zosokoneza pamalingaliro, kumverera kwa "magolovesi" ndi "masokosi", ndikuphwanya kuzindikira kwam'mimba kwam'mimba ndizothekanso.

Kutengera mtundu wa ma neurons omwe amawonongeka, mitundu yayikulu ikuluikulu ya sensor polyneuropathy ikhoza kusiyanitsidwa: mawonekedwe a hyperalgesic, mawonekedwe a atactic ndi mawonekedwe osakanikirana. Ndi atactic mawonekedwe a matendawa, zizindikiro monga kufooka kwa kayendedwe ka kayendedwe, paresthesia, dzanzi, kusakhazikika (makamaka ndi maso otsekeka) zimadziwika. Mphamvu ya minofu nthawi zambiri imakhala yosasinthika, komabe, ikafufuzidwa ndi dokotala ndikuwunika mphamvu zomwe zimagwirizanitsidwa ndi kuchepa kwa chidwi chachikulu, zimatha kuchepa kwambiri.

Fomu ya hyperalgesic imatanthawuza zizindikiro monga kukomoka kwa magazi, kupweteka (nthawi zambiri kuwotcha kapena kuwombera), kuchepetsera chidwi cha kupweteka, kunachepetsa chidwi cha kutentha. Njira yosakanikirana yamalingaliro a polyneuropathy imaphatikizapo zizindikiritso za mitundu yomwe tatchulayo ya matendawa.

Ndi sensor polyneuropathy, zizindikiro zazikulu nthawi zambiri zimakhala asymmetric, makamaka kumayambiriro kwa matenda. Chifukwa, mwachitsanzo, matendawa amatha kuyamba ndi mwendo umodzi, pomwe wachiwiri ukhalabe wathanzi kwanthawi yayitali, komabe, matendawa akamakula, zizindikirazi zimakulirakulira. Nthawi zambiri m'mayambiriro a matendawa, si miyendo yokha yomwe imakhudzidwa, komanso miyendo yam'mwamba, ndipo nthawi zina ngakhale thunthu ndi nkhope. Zizindikiro zimatha kukhala m'masiku ochepa, ndipo 1 - 2 miyezi.

Pofika pamlingo wina, tinganene kuti, pazizindikiro zambiri, zambiri nthawi zambiri zimakhazikika kwa nthawi yayitali. Nthawi zambiri zimachitika kuti matendawa amachepa, koma nthawi zambiri, makamaka ndi nthenda ya monophasic ya matendawa, imakhalabe imodzimodzi, yomwe imakhala yokwera kwambiri, kapena kupitilirabe kuwonjezeka. Mosiyana ndi matenda a Guillain-Barré, polyneuropathy yodziwika bwino imadziwika chifukwa chogwira ntchito bwino.

Kuchepa kwa m'maganizo kumatha kuyambira pakuwonda pang'ono mpaka kutsekeka kwamkati ndi arthropathy ndi zilonda zam'mimba. Ndi matendawa, paresthesia ndi kupweteka kosalekeza kosalekeza kumawonedwa. Pakadali pano, kulongosola kwathunthu kwa matenda apaderawa, omwe amaphatikiza kuchepa kwa chidwi cha kupweteka kwapweteka komanso kupweteka kwakanthawi kochepa, sikunapezeke.

Kuzindikira kwa polyneuropathy yokhala ndi chidwi kumafunikira anamnesis wodziwitsa matenda ena, zakudya zopatsa thanzi, mndandanda wamankhwala omwe wodwala amagwiritsa ntchito, kufotokozera zamkati, matenda am'mbuyomu omwe angayambitse kukula kwa polyneuropathy, kuwunika kwa malo antchito, komanso momwe angadziwire zakumwa zoopsa Zotsatira za ENMG, komanso zotsatira zenizeni za khungu la khungu la khungu, etc.

Mpaka pano, chithandizo cha methane polyneuropathy sichinayambike bwino. Mankhwalawa, corticosteroids, cytostatics, plasmapheresis ndi immunoglobulin amagwiritsidwa ntchito nthawi zambiri, komabe, nthawi zambiri, kuyesera kwa mankhwalawa kumalephera. Poyerekeza ndi maziko a immunotherapy, kupindika pang'ono pang'ono ndi kukhazikika kwa matendawa kumawonedwa, koma zifukwa zotsatila sizimamveka bwino, mulimonse, chithandizo chanthawi yake chimagwira ntchito yayikulu.

Monga mitundu ina yonse ya ma polyneuropathies, kuwunika kwakanthawi koyamba ndi chiyambi cha chithandizo kumathandizira, ngati sichiri kuchira, ndiye kukhazikika kwa mkhalidwe wa wodwalayo. Pankhani ya polyneuropathy yam'maganizo, ngati matendawa sanapezeke koyambirira, ndiye kuti mbali yayikulu ya ma neurons itamwalira, sizingatheke kuchira kwakukulu, komabe, munthu angayembekezere kusiya kupita patsogolo kwa matendawa ndikukhazikitsa mkhalidwe wodwala.

Matenda a mitsempha amawonekera monga zizindikiro zamanjenje.Munthu amatha kudwala matenda olumikizika, kupindika, miyendo, kunjenjemera (kufooka) komanso kufooka kwa minofu, kuchepa kapena kuzama kwa zinthu zina komanso zizindikilo zam'mimba. Mfundo yomaliza imaphatikizanso kumva kuthamanga kwa tsekwe, kumva kutopa komanso kumva gawo lina la thupi.

Zizindikiro zimakhazikitsidwa makamaka pamalo a malo amitsempha omwe akhudzidwa, mwachitsanzo, nthambi yamtundu ikawonongeka, nkhope yonse imavulala. Nthawi zina zifukwa zimabisika m'mayendedwe a pathological omwe adatulukira mu msana ndi ubongo. Payokha, ndikofunikira kuwonetsa matenda monga polyneuropathy (polyneuropathy). Zimayimira kuwonongeka kwa misempha ingapo nthawi imodzi, makamaka ndi zinthu zakunja. Zomwe zimayambitsa, monga matenda kapena matenda ashuga, zomwe ndizofunikira kudziwa musanayambe kulandira chithandizo, zitha kutsogola njirayi.

Chifukwa cha kuwonongeka kwa mitsempha yambiri, madokotala nthawi zambiri amazindikira polyneuropathy, koma ndi anthu ochepa omwe amadziwa zomwe zimakhala. Vuto lotupa limakhala lachigawo makamaka mu gawo la chapakati lamitsempha yamagetsi ndipo makamaka zinthu zakunja, zomwe kwanthawi yayitali zimasokoneza ntchito yawo, zimatsata izi.

Polyneuropathy yoopsa ndiye njira yayikulu yodutsira zilonda zingapo. Kwa iye, chinthu choyambachi chingakhalenso matenda omwe zinthu zakupha anthu zimadziunjikira. Mwa iwo, kusokonezeka kwa endocrine, mwachitsanzo, matenda a shuga, amatha kusiyanitsidwa. Distal polyneuropathy imadziwika ndi matendawa ndipo imachitika nthawi zopitilira theka. Kuchita koteroko kumawonekera chifukwa cha kukhudzana ndi shuga wambiri. Mankhwala, mtundu uwu wa matenda am'mimba umatchedwa dysmetabolic polyneuropathy chifukwa cha zovuta zomwe zimachitika mu metabolism.

Neuropathy yoopsa imatha kuchitika osati chifukwa cha shuga wambiri, komanso chifukwa cha zinthu zina zomwe zimawononga mafupa amitsempha.

Mwachitsanzo, chinthu chimatha kusakhala mkati mwa thupi, koma uzilowetsa kunja nthawi zonse. Kwenikweni, mowa ndiye zoledzeretsa ndipo mtundu uwu wa matenda umatchedwa alcoholic polyneuropathy wa m'munsi. Pamene matenda akukulira, manja a wodwalayo amakhudzidwa pang'ono ndi pang'ono. Matendawa alinso m'gulu la zolephera za dysmetabolic ndipo chimakwirira makamaka zizindikiro zamagalimoto.

Matenda owopsa a oncological siachilendo mu neuropathy. Amayamwa thupi lonse ndikuwachotsa kumakhala kovuta kwambiri, kotero kudalirika kwa kuchira kumakhala koyipa. Ma neoplasms ali m'gulu lamatenda a paraneoplastic.

Nthawi zina, matenda, monga diphtheria bacillus, amayambitsa matendawa. Zida zake zonyansa zimapweteketsa minyewa yamitsempha ndipo pang'ono ndi pang'ono zimayamba kulephera. Matenda amtunduwu ndi opatsirana komanso oopsa nthawi yomweyo.

Zomwe zimayambitsa polyneuropathy sizogwirizana nthawi zonse ndi zovuta za zinthu zosiyanasiyana. Matendawa nthawi zina amapezeka chifukwa cha kuperewera kwa chitetezo m'thupi, momwe ma antibodies amawononga myelin sheath ya mitsempha yama cell. Matendawa amatchedwa demyelinating ndipo ndi wa gulu la autoimmune pathological process. Nthawi zambiri mtundu uwu wa neuropathy umakhala ndi chibadwa chomwe chimapangitsa kuti chitukuko chikhale, ndipo cholowa chamtundu wa makolo chimadziwonetsa mu kuwonongeka kwa minofu yama motor.

Mitundu yamatenda

Polyneuropathy yam'mwamba komanso yotsika imawonetsedwa mwa mawonekedwe amtundu wa minyewa ndipo kukula kwake kumawonekera kumatengera mtundu wamatendawa komanso mitundu ya kuwonongeka.

Mwa mtundu wa kuwonongeka kwa ulusi wamanjenje, ma psychology ndi amtundu wotsatirawa:

Demyelinating polyneuropathy (axonically demyelinating matenda). Njira ya pathological iyi ndikuwonongeka kwa myelin sheath pama process (axons) omwe amachokera ku ma neurons,
Axonal polyneuropathy. Imachitika chifukwa cha zovuta mu ma axon,
Neuropathic polyneuropathy. Matenda oterewa amawoneka chifukwa cha kuwonongeka kwa thupi la neuron (cell nerve).

Pathology ikhoza kugawidwa m'magulu ena a mawonekedwe, monga:

Sensory polyneuropathy. Zizindikiro zake zimaphatikizira kuphwanya kwamphamvu kwa mathero amitsempha, mwachitsanzo, kumva kupweteka, kuwotcha komanso kugona tulo,
Polyneuropathy. Zowononga minofu zimawonedwa. Izi zimachitika monga kufooka, kufooka, ziwalo, ndi zina zambiri,
Sensomotor polyneuropathy. Mu zowonongeka zamtunduwu, zovuta zamagetsi ndi zamagalimoto zimaphatikizidwa,
Autonomic polyneuropathy. Kulephera pamenepa kumachitika mu autonomic mantha system, yomwe imayang'anira magwiridwe antchito amkati. Zingwe zamtunduwu ndizothandizanso ndi ma kachitidwe ena omwe munthu sangathe kuwongolera, mwachitsanzo, kugunda kwa mtima, kutsika, thukuta, ndi zina zambiri.
Maonedwe ophatikizika. Zimaphatikizapo zizindikiritso zosiyanasiyana zophwanya magulu onse.

Malinga ndi etiological factor, matendawa amagawidwa m'magulu otsatirawa:

Fomu ya Idiopathic (polyneuropathy yachilendo osadziwika). Palibe chifukwa chotsimikizika chotere, koma mtundu waukulu wa chitukuko umawoneka ngati maluso a chitetezo cha mthupi,
Fomu yolowa. Izi zimafalikira kuchokera kwa makolo,
Dysmetabolic mawonekedwe. Imachitika chifukwa cha kusokonezeka mu kagayidwe,
Fomu yoopsa. Kukula kwamtunduwu kumachitika chifukwa cha kuchuluka kwa poizoni m'thupi,
Mtundu wa postinf maambukizi. Polyneuropathy yamtunduwu imawoneka chifukwa cha matenda omwe akhudza machitidwe ambiri a thupi, monga kachilombo ka HIV kapena diphtheria,
Mawonekedwe a Paraneoplastic. Ikuwoneka kumbuyo kwa khansa yamakhalidwe oyipa,
Matenda achilengedwe. Polyneuropathy yamtunduwu ndi gawo limodzi mwa njira zina zamatumbo zomwe zimapezeka mu minyesi yolumikizana, mwachitsanzo, scleroderma (kulephera pakupanga kollagen).

Polyneuropathy imakhudza miyendo ndi manja a munthu, makamaka, miyendo ndi manja. Izi zimachitika chifukwa chakuti makamaka mitsempha yaying'ono imawonongeka, popeza poizoni amawonongeka mosavuta. Nthawi zina matenda a polyneuritic amapezeka ndipo zizindikiro zomwezo m'malekezero am'munsi komanso otsika zimadziwika. Nthawi zambiri, zowonongeka zimachitika mozungulira, monga poizoni wofalitsa m'magazi.

Ndi polyneuropathy, zizindikiro za kuwonongeka kwa mitsempha ndizotsatirazi:

Zowawa zamtundu wina wowonekera ndi chinthu choyaka,
Kutentha (kunjenjemera) m'munsi ndi m'munsi, kowonekera kwambiri paminwe.
Mitundu yosalamulirika, yomwe ndimtambo wamisempha,
Zovuta zolakwika, zomwe zimaphatikizira kuzizira kwa kutentha, kupweteka, ndi kukhudza (dzanzi) ndizolakwika kwambiri. Mu matenda a shuga, odwala sangathe kuzindikira kalilore kapena mwala wolowa mu nsapato ndi polyneuropathy ya phazi,
Paresis (kufooka) kwa minofu, chifukwa chomwe chimakhala chovuta kuti munthu ayende mtunda wautali ndikugwira ntchito za tsiku ndi tsiku. Chizindikirochi nthawi zambiri chimaphatikizidwa ndi kamvekedwe kakang'ono ka minofu ndi kuchepa mphamvu kwa wodwala, ndipo zimachitika makamaka ndi polyneuropathy yam'munsi yotsika.

Choopsa chachikulu ndikuwonetsa zizindikiro za matendawa ndipo pakati pawo pali zotsatirazi:

Kutentha kudumpha
Ntchito yayikulu ya timadzi tamadutsa totchedwa sebaceous,
Khungu loyera
Kulephera kwazungulira
Arrhythmia yamtima.

Ndi polyneuropathy yam'munsi yotsika, zizindikiro zimafotokozedwa bwino nthawi zambiri zimakhala:

Kuchepetsa mphamvu
Minofu paresis
Achilles wakuchepa,
Zosintha pamawu.

Polyneuropathy yamtunda wamtunda imadziwonekeranso momwemo, koma khungu limakhala lodetsa ndipo kunjenjemera kumakhala kwamphamvu kwambiri. Komabe, matendawa samakula nthawi zonse pazaka.Nthawi zina, imadziwonekera pakatha maola awiri ndi atatu, mwachitsanzo, itatha kutulutsa kapena poizoni wambiri ndi poizoni.

Nthawi zina, chifukwa cha kusowa kwambiri kwa vitamini B12 kumachitika. Ndizowonongeka pamizere yakumbuyo ya chingwe cha msana. Amakhala ndi nthambi zamanjenje zomwe zimayang'anira malingaliro a mafupa ndi minofu. Mchitidwe wamagulu awa uli ndi mawonekedwe ake, chifukwa ndi ataxia munthu samatha kuyenda mumdima, chifukwa samazindikira komwe miyendo ndi manja ake ali. Komabe, ndi kuyatsa kwabwino, vutoli limazimiririka lokha ndipo wodwalayo samamva kusintha kulikonse.

Ndi autonomic polyneuropathy, munthu amatha kufa mwadzidzidzi chifukwa chomangidwa ndi mtima, zomwe zimachitika chifukwa cha arrhythmias yayikulu kapena kusokonezeka kwa zochitika zamitsempha yamagazi. Njira yamatumboyi imanena za mtundu wa mtima wa polyneuropathy.

Mankhwala

Chithandizo cha polyneuropathy ndikupita ku njira yayitali yochiritsira. Kutalika kwake kumadalira kuchuluka kwa zowonongeka ndi zomwe zimayambitsa, chifukwa ndikofunikira kubwezeretsa njira zamanjenje m'njira yatsopano, ndipo ndizovuta kwambiri kuchita izi. Ndiye chifukwa chake polyneuropathy amatanthauza zotupa zamanjenje, osati zothandiza.

Choyamba muyenera kudziwa chomwe chimayambitsa matendawa ndikuchotsa. Mutha kumvetsetsa momwe mungachitire polyneuropathy ndi zitsanzo za odwala matenda ashuga. Amayang'aniranso shuga wawo wamagazi kuti nthawi zonse lizikhala labwino. Ngati zakumwa zauchidakwa, ndiye kuti ziyenera kusiya mowa. Kupanda kutero, mankhwalawa sangathandize gulu loyamba kapena lachiwiri. Ndi matenda a oncological, musanachiritse matenda a matenda a m'mimba, ndikofunikira kuti muchepetse ma neoplasms omwe abwera mthupi.

Ndi polyneuropathy, chithandizo chikuchitika mothandizidwa ndi mankhwalawa:

Mavitamini ovomerezeka, mwachitsanzo, Milgamma,
Mitundu ya antioxidants,
Mankhwala osokoneza bongo omwe ali ndi kagayidwe kachakudya kamene kamathandizire kuyambiranso kwa ma Trental,
Zothandizira monga mankhwala oletsa kukongoletsa a Versatis.

Kugwiritsa ntchito mafuta ndi mapiritsi pochotsa polyneuropathy ndikulimbikitsidwa pamodzi ndi zakudya zoyenera. Muyenera kuwonjezera zamasamba ndi zipatso zambiri m'zakudya zanu ndipo ngati kuli kotheka, musakanize yokazinga, kusuta komanso zakudya zam'chitini. Ndikofunika kuphika chakudya kapena kuchiwotcha.

Physiotherapy imathandizira kuchira ndipo njira zotsatirazi zimagwiritsidwa ntchito nthawi zambiri:

Dibazole ndi thiamine-based electropharis,
Chithandizo cha zojambulazo (kukulunga molumikizana),
Kuchiritsa osambira
Katemera

Chothandiza kwambiri ndi kutikita minofu ya polyneuropathy. Iyenera kuchitika ndi katswiri wodziwa, kuti achulukitse matendawa.

Chithandizo cha polyneuropathy cha m'munsi kwambiri sichikhala chongogwiritsa ntchito mankhwala, komanso masewera olimbitsa thupi. Zimakuthandizani kuti mukhale ndi kamvekedwe ka minofu ndikusintha momwe wodwalayo alili. Therapy Therapy (LFK) iyenera kukhazikitsidwa kutengera momwe munthu aliri, chifukwa nthawi zambiri thupi silikhala lovomerezeka.

Nthawi zambiri, zomwe zimachitika m'mbuyomu chifukwa cha polyneuropathy sizitonthoza. Matendawa ndi ovuta kuchiza ndipo amayamba kupita patsogolo. Pakapita nthawi, munthu amatha kukhala wolumala ngakhale kufa chifukwa chakugwira ntchito bwino mumtima. Mitundu ina ya matendawa ilibe chithandizo konse, mwachitsanzo, chifukwa cha kulephera kwa autoimmune. Zikafika poyizoni wa zakumwa zoledzeretsa kapena matenda ashuga, matendawa amakhala abwino, koma malinga ndi momwe wodwalayo amasinthira kuchuluka kwa shuga ndi kukana mowa.

Polyneuropathy imawononga kwambiri minyewa ya mitsempha ndipo iyenera kuthandizidwa ngati zizindikiro zoyambirira zikuchitika, mwinanso matenda atha kupita patsogolo. Izi zimachitika nthawi zambiri zimapangitsa kuti munthu azikhala wolumala komanso afe.

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Matenda amiyendo omwe ali ndi matenda ashuga: ndi chiyani, momwe mungachitire?

Matenda a shuga
Zizindikiro zogwiritsidwa ntchito ndi Fraxiparin mu IVF

Chithandizo ndi kupewa

*Herederal and idiopathic neuropathy*
	*Kutupa kwa polyneuropathy*
		*Ma polyneuropathies ena*
			*Polyneuropathy, matenda omwe amapezeka kwina*
				*Zovuta zina za zotumphukira zamanjenje*

Dysmetabolic (kudziyimira pawokha, cholowa, distal, sensorimotor, amyloid) polyneuropathy

Mitundu ya Neuropathy

A shuga a distal polyneuropathy

Peripheral

Sensory polyneuropathy

Dysmetabolic

Chifukwa chiyani odwala matenda a shuga amakhala ndi neuropathy

Kuyaka ndi miyendo

Kuwonongeka kwa phazi

Kuzindikira matendawa

Chithandizo cha matenda ashuga polyneuropathy a m'munsi malekezero

Mankhwala

Chithandizo chopanda mankhwala

Njira zakukula kwa distal diabetesic polyneuropathy

Zizindikiro za matenda ashuga a distal polyneuropathy

Chithandizo cha matenda a shuga a distal polyneuropathy

Malingaliro

Polyneuropathy. Kugawa, zoyambitsa, chithunzi cha matenda ambiri a polyneuropathies.Dysmetabolic ndi paraneoplastic polyneuropathies. Ma polyneuropathies omwe ali ndi vuto lama mavitamini ena. Guillain-Barré Syndrome

Kodi polyneuropathy ndi chiyani?

Diabetesic polyneuropathy: Zizindikiro

Kuzindikira ndi kuchiza matenda a polyneuropathy

Njira zopewera

Zizindikiro za polyneuropathy

Polyneuropathy yam'munsi yotsika

Polyneuropathy yam'manja miyendo

Mankhwala a polyneuropathy

Kufotokozera kwapfupi

Kusiyanitsa mitundu

Pezani chithandizo ku Korea, Israel, Germany, USA

Zambiri

Etiology ndi pathogenesis a polyneuropathies

Gulu la Polyneuropathies

Chithunzi cha chipatala cha polyneuropathy

Amyloid transthyretin polyneuropathy

Dziwani za polyneuropathies

Chithandizo cha Polyneuropathy

Kuzindikira kwa polyneuropathy

Chithunzi cha matenda

Kodi kuchitira?

Polyneuropathy yokhudza matenda

Herederal polyneuropathy

Amyloid polyneuropathy

Distal sensory-motor polyneuropathy

Autonomic polyneuropathy mu shuga

Mitundu ya polyneuropathies

ICD-10 polyneuropathy

Chithunzi chachikulu pazachipatala cha polyneuropathies

Chithandizo cha Guillain-Barré Syndrome

Zolemba za matendawa ndi mitundu yake

Ndi digiri ndi dera lowonongeka

Ndi mtundu wa pathological process

Zomwe zimachitika

Zizindikiro ndi kukula kwa matendawa

Njira zochizira

Zochita Zamathupi

Mavuto ndi ukadaulo

Zosiyanasiyana

Kupewa

Zizindikiro

Zolemba zamankhwala

Mankhwala

Zovuta zotheka

Mitundu yamatenda

Mankhwala

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