Chithandizo cha kupweteka kwa matenda ashuga polyneuropathy

Diabetesic distal symmetric sensory-motor polyneuropathy (DPN) ndi mtundu wofala kwambiri wa matenda ashuga, omwe amapezeka mwaoposa 50% ya odwala omwe ali ndi mtundu 1 ndi mtundu wa 2 matenda a shuga. DPN ndi yachiwiri yomwe imapangitsa kwambiri kupweteka kwa neuropathic (NI). Kupezeka kwa DPN kumasiyanasiyana kutengera njira zodziwitsa anthu zomwe zikugwiritsidwa ntchito. Pafupipafupi neuropathy yomwe yapezeka pamaziko a zisonyezo ndi pafupifupi 25%, ndipo pochita kafukufuku wama elexandroneuromyographic, ndi 100% mwa odwala omwe ali ndi matenda ashuga.

Kuzindikira kwa DPN kumakhazikitsidwa pa mbiri yomwe yatengedwa mosamala, kuwunika kwa mitsempha, kuyesa kwa ma elekitiroma. Zizindikiro zambiri ndizomverera kwa "tsekwe", kuwotcha, kupweteka m'miyendo ndi kumapazi, kukokana kwa minofu usiku. Kuunika kwa mitsempha kumawonetsa kufooka kwa ma Achilles reflexes, kufooka kwa chidwi cha mtundu wa "masokosi" ndi "magolovu", kuchepa kwa chidwi cha chidwi. Ndi chithandizo chamankhwala osagwirizana ndi chithandizo chamankhwala, zovuta za DPN monga zilonda zam'mapazi zimapangika, zomwe zimatha kubweretsa necrosis, gangrene (matenda a shuga) ndipo nthawi zambiri ndikadulidwa. Odwala omwe ali ndi matenda ashuga amafunikira kupimidwa kumapazi kwa chaka ndi chaka.

Zodziwika bwino kuti choyambitsa chachikulu cha DPN ndi kuchuluka kwa glucose. Chifukwa chake, njira yokhayo yotsimikizika yomwe ingachepetse ngakhale pang'ono kusintha kwa DPN ndikuwongolera glycemia mwa odwala omwe ali ndi matenda a shuga. Odwala omwe amasamalidwa kwambiri ndi matenda a shuga (3 kapena kuposa insulin tsiku lililonse kapena kulowetsedwa kosavuta kwa insulin pogwiritsa ntchito insulin dispenser (HbA level)_1c m'ndandanda wa 6.5-7.5)), kuchepa kwakukulu kwa chiwopsezo cha kukhala ndi zovuta za neurvasel ndi neuropathy kunawonedwa. Kuchiza kwambiri ndi sulfonylureas mwa odwala omwe ali ndi matenda osagwirizana ndi insulin kumathandizanso kuti kuchepa kwa pafupipafupi komanso kupitirira kwa neuropathy. Komabe, kungopeza kwa testoglycemia kokha sikungathetse mwachangu mawonetseredwe azachipatala a DPN. Pankhaniyi, chithandizo chowonjezereka cha pathogenetic ndi chidziwitso ndichofunikira, makamaka kupulumutsa ululu.

Alfa-lipoic (thioctic) acid (Espa-lipon, Thioctacid, Thiogamm, Tiolept) ndi okonzekera pathogenetic. Mankhwalawa ndi muyezo wagolide pa chithandizo cha DPN. Alpha Lipoic Acid ndi lipophilic antioxidant wamphamvu. Thioctic acid, yomwe imasonkhana mu minyewa yamitsempha, imachepetsa kuchuluka kwa ma radicals omasuka, imawonjezera kuyenda kwa magazi kwa endoneural, imasintha zomwe zili mu NO, chowongolera cha kupumula kwa khoma lamitsempha (ngati pali zambiri za izo, monga matenda a shuga, zimayamba kugwira ntchito mopanda kusintha mosavomerezeka, zimathandizira endothelial ntchito, zimachepetsa kuchuluka kwathunthu cholesterol, imawonjezera gawo la antiatherogenic kachigawo kakakulu kachulukidwe lipoproteins. Kafukufuku angapo adawonetsa kuti kugwiritsa ntchito alpha-lipoic acid pa mlingo wa 600 mg / tsiku iv kapena pakamwa kwa masabata atatu mpaka miyezi isanu ndi umodzi kumachepetsa zizindikiro zazikulu za DPN pamlingo wofunikira kwambiri kuphatikiza ululu, paresthesia ndi dzanzi 7, 8. Mulingo woyenera Amaganizira poika mankhwalawa kumayambiriro kwa mankhwalawa a alpha-lipoic acid (600 mg wa 200 mg wa saline) kwa masabata atatu (osiyidwa 15), akutsatiridwa ndi 600 mg ya mankhwala osokoneza mapiritsi (kamodzi pa tsiku kwa mphindi 30 mpaka 40 musanadye ) mkati mwa miyezi 1-2.

Kukonzekera komwe kumakonza kagayidwe kazomwe zimakhudzidwa ndimitsempha mwanjira zimaphatikizira mavitamini a B, chifukwa cha zomwe zimachitika mu neurotropic. Vitamini B₁ amatenga nawo kapangidwe ka acetylcholine, ndi B₆ - mu kapangidwe ka ma neurotransmitters, kufalitsa kwa zokondweretsa. Vitamini B₁₂ Amasintha mitsempha yotumphuka. Kugwiritsa ntchito kwambiri kwa mankhwala a Milgamm dragee mu chithandizo chovuta cha DPN kwawonetsedwa. Amakhala ndi 100 mg ya benfotiamine ndi 100 mg ya pyridoxine. Mankhwala amapatsidwa piritsi limodzi katatu patsiku masabata atatu. Ndikofunikira kuti Milgamma ikhale ndi benfotiamine, lipid solubility yake yomwe ili chifukwa chokwanitsira kuchuluka kwa thiamine m'magazi ndi zimakhala.

Zambiri pazakuwoneka bwino ndi chitetezo zimatithandizira kulingalira za alpha-lipoic acid ndi benfotiamine ngati mankhwala oyambira pamankhwala othandizira odwala matenda ashuga a polyneuropathy.

M'magulu awiri ophatikizidwa, omwe amaphunzitsidwa ndi placebo omwe amayendetsedwa ndi odwala 1335 omwe ali ndi DPN, adawonetsedwa kuti kutenga acetyl-L-carnitine pa mlingo wa 1000 mg katatu pa tsiku kwa miyezi 6 ndi 12 inachepetsa kwambiri zizindikiro za DPN.

Kuwongolera kwa chithandizo cha pathogenetic ndikofunikira kwambiri ndipo makamaka kumatsimikizira kudwala. Komabe, chithandizo chimachitika m'mayendedwe ataliatali ndipo nthawi zambiri samayenda limodzi ndi kusintha kwachidziwitso kwakanthawi kachipatala. Nthawi yomweyo, ngakhale ndi DPN yofatsa, kupweteka kwambiri kumatha kuchitika, komwe kumayambitsa kusokonezeka kwa kugona, kukhumudwa, nkhawa komanso kusokonekera kwa chikhalidwe. Ichi ndichifukwa chake, limodzi ndi pathogenetic therapy, ndikofunikira kwambiri kuchititsa mankhwala a NB panthawi yake.

Ndikufuna kutsimikiza pomwepo kuti ma analgesics osavuta komanso mankhwala osapweteka a antiidal omwe amathandizira kupweteka ndi DPN samalimbikitsidwa chifukwa chosakwanira. Tsoka ilo, mdziko lonse odwala oposa 60% omwe ali ndi NB akupitilizabe kulandira mankhwalawa, omwe ndi osavomerezeka komanso owopsa kwambiri pakugwiritsidwa ntchito kwa nthawi yayitali (zovuta zam'mimba zam'mimba (GIT), chiwindi ndi magazi). Magulu akuluakulu a mankhwalawa othandizira NB omwe ali ndi DPN ndi awa: antidepressants, anticonvulsants, opioids, antiarrhythmic mankhwala, mankhwala akumudzi.

Tricyclic antidepressants (TCAs) anali amodzi mwa mankhwala oyamba kukhala othandiza pochiritsa odwala omwe ali ndi NB. Komabe, TCA imodzi yokha ndiyomwe idalembetsedwa ku Russia - amitriptyline, yomwe imagwiritsidwa ntchito pochiza NB (postherpetic neuralgia, DPN). Amakhulupirira kuti zotsatira za analgesic za TCAs zimagwirizanitsidwa ndi kulepheretsa kwawo kubwezeretsanso kwa serotonin ndi norepinephrine, zomwe zimapangitsa kuti pakuwonjezeka zochitika zapansi pa noradrenergic ndi serotonergic, zomwe zimalepheretsa machitidwe a zopweteka za m'mitsempha yamkati yamkati.

Kuphatikiza pa kuletsa kubwezeretsa kwa serotonin ndi norepinephrine, TCAs block alpha₁adrenergic, N₁-histamine, M-cholinergic receptors, zomwe zimayambitsa zotsutsana zingapo ndi zoyipa zomwe zimaletsa kugwiritsa ntchito kwawo. Zotsatira zoyipa zimaphatikizira kuwonongeka kwa pakamwa, pakamwa pouma, sinus tachycardia, kudzimbidwa, kusungika kwamkodzo, kusokonezeka komanso / kapena kusokonezeka kwa malingaliro (zotsatira za anticholinergic), kupindika, kugona, kulemera (H1-histamine zotsatira), orthostatic hypotension, chizungulire, tachycardia (alpha₁adrenergic zotsatira). TCA imalekanitsidwa kwa odwala omwe ali ndi kuphwanya kwapakati komanso subacute myocardial infarction, omwe ali ndi vuto la intraventricular conduction, ndi angle-kutsekeka glaucoma, amatenga monoamine oxidase inhibitors (MAOIs). Mankhwalawa ayenera kugwiritsidwa ntchito mosamala kwa odwala omwe ali ndi matenda a mtima (CHD), arrhythmia, ochepa matenda oopsa, pambuyo pa stroko, komanso ndi kwamikodzo posungira kapena kusakwanitsa kwamphamvu. Izi zimapangitsa kuchepetsa kugwiritsa ntchito ma TCA munthawi zonse.

Kuchita bwino kwa TCA (amitriptyline, desipramine, clomipramine, imipramine) pochiza DPN zowawa zawonetsedwa m'mayesero angapo osasankhidwa, omwe amayang'aniridwa ndi placebo. Mankhwala ofala kwambiri pagululi omwe amagwiritsidwa ntchito pochiza polyneuropathies opweteka ndi amitriptyline ndi imipramine. Ogwiritsa ntchito kwambiri amitriptyline. Mlingo woyambirira wa mankhwalawa ndi 10-12,5 mg usiku, ndiye kuti mlingo umakulitsidwa pang'onopang'ono ndi 10-25 mg masiku 7 aliwonse mpaka zotsatira zake zitheke (pazokwanira 150 mg / tsiku). Mlingo wa tsiku ndi tsiku amatengedwa kamodzi usiku kapena kuphwanyika mu Mlingo wa 2-3. Ndi nkhawa yokhazikika, kuchuluka kwa mankhwalawa kwa mankhwala nthawi zambiri kumafunikira. Ndi tsankho la amitriptyline, ma TCA ena akhoza kutumikiridwa mwachitsanzo, imipramine kapena clomipramine. Kuyesedwa kwa antidepressants kumayenera kupitilira milungu isanu ndi itatu, pomwe wodwalayo atengere mlingo waukulu wololera kwa masabata osachepera 1-2. Ngakhale amitriptyline imagwira ntchito pafupifupi 70% ya odwala omwe ali ndi NB, zotsatira zoyipa zimachepetsa kugwiritsa ntchito. TCA asanaikidwe, TCA yoyambirira ndiyovomerezeka, makamaka kwa anthu okulirapo zaka 40.

Ngati TCA sigwirizana bwino, tetracyclic antidepressants (mwachitsanzo maprotiline, 25-100 mg / tsiku) kapena kusankha serotonin ndi norepinephrine reuptake inhibitors (SSRIs) (venlafaxine, 150-225 mg / tsiku, kapena duloxetine, 60-120 mg / tsiku angagwiritsidwe ntchito) ) Kuchita kwa venlafaxine kwatsimikiziridwa mobwerezabwereza m'maphunziro omwe akukhudza odwala omwe ali ndi DPN 17, 18, pomwe alibe zotsatira za postynaptic zotsatira za TCAs (zochita pa M-cholinergic receptors, alpha-adrenergic ndi histamine receptors). Izi zimapangitsa kuti mankhwalawo akhale otetezeka kuposa ma TCAs. Kukhazikika kwa analgesic zotsatira kumadziwika kale sabata yachiwiri ya mankhwala.

Chifukwa chake, venlafaxine ndi mankhwala othandiza, otetezeka, opatsiridwa bwino pochiza DPN. Mayeso atatu okhala ndi ma multicenter ambiri, osasinthika, akhungu kawiri, omwe amayesedwa ndi placebo kuyambira masabata 12 mpaka 13 anawonetsa mphamvu ya duloxetine pa mlingo wa 60 mpaka 120 mg / tsiku kwa odwala omwe ali ndi DPN yopweteka. Zotsatira zamaphunzirowa, kutsika kwa 50% kwa kupweteka kwambiri pakumwa mankhwala a duloxetine (mosasamala ndi mlingo womwe umagwiritsidwa ntchito) amapezeka mwa odwala 41%, poyerekeza ndi 24% ya odwala omwe akutenga placebo.

Kusankha serotonin reuptake inhibitors (SSRIs) (fluoxetine, paroxetine, sertraline, citalopram, ascitalopram) kumayambitsa zotsatira zoyipa zochepa, koma zimakhala ndi zotsatira zosagwirizana ndi analgesic, zomwe zingafotokozedwe ndi kusowa kwachindunji pakatundu ka noradrenergic. Amawonetsedwa makamaka m'malo omwe ululu umagwirizanitsidwa ndi kukhumudwa, ndipo wodwalayo salekerera othandizira ena.

Popeza NB nthawi zambiri imayendera limodzi ndi kukhumudwa, kusankha kwa mankhwala omwe amakhudza bwino dziko la psychopathological lino ndipo ali ndi mbiri yabwino yachitetezo ndikofunikira. Imodzi mwa mankhwalawa ndi pipofesin (Azafen). Makina antidepressant amatengera kusayeneraku kuletsa kwa serotonin ndi norepinephrine reuptake, komwe kumawonjezera chiwopsezo chawo mu chapakati mantha dongosolo. Mankhwala alibe cardiotoxic katundu. Chifukwa chosowa anticholinergic kanthu, Azafen ikhoza kuperekedwa kwa odwala omwe ali ndi glaucoma ndi matenda ena omwe kugwiritsa ntchito mankhwala okhala ndi anticholinergic ntchito, kuphatikizapo imipramine ndi amitriptyline. Kusowa kwa zovuta zomwe zimakupatsani mwayi kumakupatsirani mankhwala kuti mupereke kwa odwala omwe ali ndi matenda amtundu ndi okalamba, makamaka muzochitika zapaulendo.

Pakati pa anticonvulsants omwe amagwiritsidwa ntchito pochiza DPN yopweteka, othandiza kwambiri ndi gabapentin (Neurontin) ndi pregabalin (Lyric) 22, 23. Njira zoyeserera za gabapentin ndi pregabalin, zikuwoneka kuti, ndizokhazikitsidwa ndi kuthekera komangira ma alpha-2-delta subunits a alpha-2-delta subunits of the alpha-2-delta subunits of the calcium-based lannels zotumphukira mphamvu zamitsempha. Izi zimabweretsa kuchepa kwa kulowa kwa calcium mu presynaptic neuron, zomwe zimapangitsa kuchepa kumasulidwa kwa oyimira pakati opweteka kwambiri (glutamate, norepinephrine ndi chinthu P) ndi overexcited neurons, omwe amatsagana ndi kuchepa kwa ululu. Mankhwalawa onse amakhala ndi kulolera komanso kuthandizira kwakukulu pa sabata loyamba la chithandizo. Zotsatira zoyipa kwambiri zimakhala chizungulire komanso kugona. Mlingo woyambirira wa gabapentin ndi 100-300 mg usiku. Ndiye tsiku lililonse mlingo pang'onopang'ono kuchuluka kwa masiku 3-5 ndi 100-300 mg, kusunthira katatu.

Mlingo wothandiza kwambiri ndi 1800 mg / tsiku (600 mg 3 kawiri pa tsiku), upamwamba - 3600 mg / tsiku. Zingatenge milungu iwiri kapena itatu kuti mugwire mankhwala a gabapentin. Asanamalize kuti mankhwalawa ndi osathandiza, mlingo wake wololedwa wokwanira uyenera kumwedwa kwa masabata awiri. Pankhani yothandiza ndi chitetezo, pregabalin pafupifupi imafanana ndi gabapentin, koma mosiyana ndi gabapentin ili ndi ma cellarokinetics omwe akuwongolera, omwe amatsimikizira kuwonetseratu kwa kusintha kwa mankhwalawa mu plasma yamagazi ndikusintha kwa mlingo. Mlingo wa tsiku ndi tsiku wa preagabalin ndi 150-600 mg / tsiku mu Mlingo 2 wogawanika.

Mankhwalawa DPN yopweteka, mlingo woyambira ukhoza kukhala 150 mg / tsiku. Kutengera mphamvu ndi kulolerana kwake, mlingowo ungathe kuwonjezeka mpaka 300 mg / tsiku atatha masiku 3-7. Ngati ndi kotheka, mutha kuwonjezera mlingo wa mankhwala (600 mg / tsiku) patadutsa masiku 7. Malinga ndi luso logwiritsa ntchito mankhwalawa, ngati kuli kofunikira, siyani kumwa ndikulimbikitsidwa kuti muchepetse pang'onopang'ono sabata limodzi. Pregabalin amalowetsedwa mwachangu m'magazi ndipo ali ndi bioavailability yapamwamba (90%) poyerekeza ndi gabapentin (33-66%). Zotsatira zake, mankhwalawa amagwira ntchito pamlingo wotsika ndipo amakhala ndi zovuta zingapo, makamaka kusinkhira 22, 23.

Kugwiritsa ntchito ma opioid pochizira ma syndromes a ululu kumatheka pokhapokha ngati mankhwala ena sangayambire. Pakati pa opioids, oxycodone pa mlingo wa 37-60 mg / tsiku ndi tramadol (mankhwala omwe ali ndi mgwirizano wotsika wa opioid μ receptors ndipo nthawi yomweyo inhibitor ya serotonin ndi norepinephrine reuptake) amapezeka kuti ndi othandiza kwambiri pochiza DPN. Chithandizo cha Tramadol chimayamba ndi mlingo wa 50 mg usiku (kapena 25 mg kawiri pa tsiku), pambuyo masiku 5-7, mlingo umakulitsidwa mpaka 100 mg / tsiku. Ngati ndi kotheka, onjezani mlingo mpaka 100 mg 2-5 pa tsiku. Njira yovomerezeka ndi tramadol iyenera kukhala osachepera milungu 4. Maopioid ndi amtengo wapatali chifukwa cha analgesic katundu wawo, koma mankhwalawa amathandizanso kwambiri komanso owopsa mthupi.

Kuphatikiza kwa tramadol ndi paracetamol (Zaldiar) kumakuthandizani kuti muchepetse mlingo wa tramadol ndipo potero kuopsa kwa zotsatira zoyipa, osapereka nsembe ya analgesic. Ndi kuphatikiza kwa mankhwalawa awiri omwe ali ndi magina osiyanasiyana ochita (mawonekedwe a analgesic zotsatira za paracetamol angagwirizanidwe ndi chopinga china chapakati pa prostaglandins, mwina chifukwa cha kuletsa kwa COX-3), zotsatira za synergistic zimachitika. Zokwanira analgesia mukamamwa mankhwala osokoneza bongo amawonedwa 1.53 nthawi zambiri kuposa momwe mumagwiritsira ntchito mankhwala aliwonse oyenera.

Kuphatikiza apo, paracetamol ndi tramadol amadziwika ndi mbiri yowonjezera ya pharmacokinetic, chifukwa chomwe mankhwalawa amayamba kuchitapo kanthu - pambuyo pa mphindi 15-20 (chifukwa cha paracetamol) komanso kwa nthawi yayitali amathandizira analgesic kwenikweni (chifukwa cha tramadol). Zaldiar imakhala ndi mlingo wochepa wa tramadol (piritsi limodzi lili ndi 37,5 mg wa tramadol ndi 325 mg wa paracetamol), motero mavuto mukamawagwiritsa ntchito sakhala wamba kusiyana ndi momwe mumagwiritsira ntchito tramadol. Cholinga cha mankhwalawa sikutanthauza kuti pakhale mlingo wotalikirapo, mankhwalawa atha kuyambitsidwa ndi mapiritsi a 1-2 patsiku, muyezo wotsatira ukhoza kuwonjezereka mpaka mapiritsi 4 patsiku.

Maloiletine, mankhwala othandizirana pakamwa, amakhalanso ndi mankhwala opha ululu. Amakhulupirira kuti mexiletine imalepheretsa njira za sodium, motero kukhazikika kwa membrane wa neurons ndikuletsa kufalikira kwa zopweteka. Kuyesedwa kwa kugwiritsa ntchito mexiletine ku NB kumapereka zotsutsana. Nthawi zina, mexiletine amachepetsa ululu, makamaka akamagwiritsidwa ntchito pa Mlingo waukulu. Komabe, zoyipa zimachitika nthawi zambiri, makamaka kuchokera m'mimba. Mankhwalawa ayenera kugwiritsidwa ntchito mosamala ngati pali mbiri yakale ya mtima kapena ngati zodwala zapezeka pa kafukufuku wa ECG.

Kafukufuku wambiri, adawonetsedwa kuti kugwiritsa ntchito ma anesthetics am'deralo (mafuta, ma gels ndi chigamba (Volatis) chokhala ndi 5% ya lidocaine kapena kukonzekera kochokera paziphuphu zotentha - capsaicin) idali yothandiza pochiza mawonekedwe a DPN 27, 28. Mphamvu ya lidocaine kutsekereza kayendedwe ka ma sodium ions kudzera mu membrane wa zotumphukira zotupa, chifukwa chomwe membrane wam'mimba umakhazikika, kufalikira kwa kuthekera kwa chochita kumachepetsedwa, chifukwa chake, ululu umachepa. Zotsatira zoyipa, kukhumudwa pakhungu m'dera logwiritsira ntchito kumawonedwa, komwe nthawi zambiri kumachoka pang'ono. Kuchita kwa capsaicin kukonzekera kumakhazikika pakuchepa kwa thunthu P m'mayendedwe amatsitsi am'mimba. Kuwotcha, redness, ndi kuyabwa pamalo omwe amagwiritsidwa ntchito ndizotsatira zoyipa kwambiri, ndipo ululu umadziwika nthawi zambiri pamene mankhwalawa ayamba kuikidwa.

Komabe, palibe mankhwala omwe angatengedwe ngati mankhwala okhawo ochizira ululu ku DPN. Nthawi zambiri pamakhala kugwiritsidwa ntchito kwa ndalama zomwe zili pamwambazi sizigwira ntchito mokwanira ndipo pakufunika kuphatikiza mankhwala. Chifukwa chake, ngakhale kuchuluka kwa mankhwalawa omwe amwedwa ndi wodwala nthawi yomweyo monga ulamuliro wambiri kuyenera kuyesedwa, nthawi zambiri, NB yokhala ndi DPN imatha kuwongoleredwa mokwanira pokhapokha ngati pali mitundu iwiri kapena yopitilira apo. Sizomveka kupereka mankhwala osakanikirana nthawi yomweyo: poyamba mankhwala amodzi amayenera kuyesedwa, ndipo pokhapokha pakuonetsetsa kuti muyezo womwe wodwalayo walola wodwalayo ali ndi gawo pang'ono, wothandizirayo akuyenera kuphatikizidwa ndi iwo, omwe, monga lamulo, ali ndi njira yosinthira.

Muzochita zamankhwala, mankhwala othandizira omwe ali ndi anticonvulsant nthawi zambiri amaphatikizidwa, anticonvulsant ndi tramadol kapena Zaldiar. Ndikulimbikitsidwa kupewa kuphatikiza kwa tramadol (makamaka kukula kwakukulu) ndi MAOI, SSRIs ndi SSRIs, popeza kuphatikiza koteroko kumatha kupangitsa serotonin syndrome. Mosamala, tramadol iyenera kuyikidwa limodzi ndi ma tridclic antidepressants (chifukwa cha chiwopsezo cha serotonin syndrome).

Njira zopanda mankhwala zochizira DPN zimaphatikizapo psychotherapy, balneotherapy, hyperbaric oxygenation (1.2-2 atm.), Phototherapy, magnetotherapy, electrophoresis, ma modhiyo a diadynamic, kukoka kwa minofu ya patretic, ma eleopaneous elekitiroma. Kutsutsana kwa kugwiritsa ntchito kwawo ndi vuto lalikulu la wodwalayo chifukwa cha matenda amisomali komanso / kapena kuwonongeka kwambiri kwa kagayidwe. Olembapo angapo adawonetsa kukhathamira kwamagetsi kwamphamvu kwa chingwe cha msana chomwe chimagwiritsidwa ntchito pochiza matenda am'mimba a shuga. Monga lamulo, kuphatikizidwa kwa zopatsirana kumachitika mwa odwala omwe ali ndi ululu syndromes refractory ku pharmacotherapy.

Pomaliza, ziyenera kudziwitsidwa kuti chithandizo cha wodwala aliyense ayenera kukhala payekha, poganizira zamankhwala, komanso kukhalapo kwa matenda a comorbid (nkhawa, kukhumudwa, matenda a ziwalo zamkati, etc.). Mukamasankha mankhwala, kuphatikiza pa analgesic kwenikweni, zotsatira zina zabwino za mankhwalawa (kuchepetsa nkhawa, kukhumudwa, kugona mokwanira komanso momwe mungavutikire), ziyenera kukumbukiridwa.

Olembapo angapo amalimbikitsa kugwiritsa ntchito mankhwala oyamba pothana ndi mitundu yopweteka ya polyneuropathies TCAs ndi gabapentin kapena pregabalin. Mankhwala a mzere wachiwiri ndi monga SSRIs - venlafaxine ndi duloxetine. Ndiwosagwira ntchito, koma otetezeka, okhala ndi zotsutsana pang'ono kuposa ma TCA, ndipo ayenera kusankhidwa mu chithandizo cha odwala omwe ali pachiwopsezo cha mtima. Mankhwala a mzere wachitatu ndi opioids. Mankhwala osokoneza bongo omwe ali ndi mphamvu yofooka akuphatikiza capsaicin, mexiletine, oxcarbazepine, SSRIs, topiomat, memantine, mianserin.

Zolemba

Strokov I. A., Strokov K. I., Akhmedzhanova L. L., Albekova J. S. Thioctacid pa matenda a matenda ashuga a polyneuropathy // Wovuta. Archive. 2008. Ayi 12. P. 19-23.
Galieva O. R., Janashia P. Kh., Mirina E. Yu. Chithandizo cha neuropathic neuropathy // International Neurological Journal. 2008. Ayi 1. S. 77-81.
American Diabetes Association. Kusamalira miyendo mwa anthu omwe ali ndi matenda ashuga // Matenda a shuga. 2002. No. 25 (Suppl. 1). P. 69-70.
Feldman E. L., Russell J. W., Sullewan K. A., Golovoy D. Zidziwitso zatsopano mu pathogenesis ya matenda ashuga a neuropathy // Curr. Opin. Neurol. 1999. Vol. 12, No. 5. P. 553-563.
Retinopathy ndi nephropathy odwala mtundu 1 shuga pambuyo zaka zinayi atayesedwa kwambiri mankhwala. The Disabetes Control and Complication T kesi / Ep>S. A. Gordeev *, MD
L. G. Turbina **, Doctor wa Medical Science, Pulofesa
A. A. Zusman **, oyimira masayansi azachipatala

*Woyamba MGMU iwo. I. M. Sechenova, ** MONICA iwo. M.F. Vladimirsky, Moscow

Zizindikiro ndi mitundu ya matenda a shuga

Mawonekedwe a matendawa ndi ochulukirapo.

Poyamba, zizindikiro za matenda ashuga a shuga zimachepa, koma pakapita kanthawi, mavuto amakulirakulira.

Matenda a diabetes a neuropathy ali ndi izi:

kufooka kwa minofu
dontho lakuthwa magazi.
chizungulire
ochepa kukokana
dzanzi ndi kubinya kwa miyendo,
mavuto akumeza chakudya,
yafupika libido
Mavuto am'mimba, kupezeka kwamatumbo pafupipafupi,
kuphwanya kwamaso
kupweteka kwa minofu
fecal ndi kwamikodzo kusala,
thukuta lalikulu kapena kusowa kwake,
kutsika kwa kutentha, kupweteka komanso kumva tactile,
kusokoneza kayendedwe ka kayendedwe.

Matenda a diabetes a neuropathy amakhudza minyewa yamitsempha, koma kuchuluka kwa zovuta kumatha kusintha. Mtundu wamatenda umatengera zomwe ulusi umakhudzidwa kwambiri. Ponena za mitsempha yaubongo, gulu limatchula kuphwanya kwapakati pa neuropathy. Ngati zotupa zina ndi mitsempha zimakhudzidwa, izi ndizowonjezera zam'mimba kapena matenda a shuga.

Mitsempha yamagalimoto ikasokonekera, munthu sangathe kudya, kuyenda ndi kuyankhula, ndi mitsempha yam'mutu, chidwi chimatha. Ndi kuwonongeka kwa ulusi wamanjenje, autonomic neuropathy imachitika. Panthawi imeneyi, chizindikiritso chimagwira bwino ntchito kwa ziwalo zingapo nthawi imodzi, kuphatikizapo mtima.

Autonomic Neuropathy Syndrome:

kupuma
urogenital
zamtima
m'mimba,
injini zam'madzi.

Zodziwika bwino:

malingaliro
wotsogola
wodziyimira pawokha
chachikulu neuropathy.

Ndi ma neuropathy apakati ali ndi chikhalidwe:

migraines wolimba ndi chizungulire,
kukumbukira, kusamala, kusamalira.

Munthu nthawi zambiri amavutika kukomoka, komanso kukodza pafupipafupi kumawonedwanso.

Ndi sensorimotor neuropathy, kumva kumachepa, minofu yaumunthu imafooka, ndipo mgwirizano umakhala wopanda mphamvu. Monga lamulo, kusokonezeka kwa mikono kapena miyendo kumakulabe madzulo. Pa gawo lotsogola, munthu samamvanso mkhalidwe wonyentchera wopindika kapena wowonongeka wina.

Zizindikiro za matenda ashuga a m'mimba zimaphatikizanso kuchepa kwamphamvu kwakanthawi. Chifukwa chake, zilonda ndi zofooka zazala zakumiyendo ndi mapazi zimatuluka.

Autonomous diabetesic neuropathy imawonekera chifukwa cha kusachita bwino kwa dongosolo la Autonomic. Mpweya wa oxygen umakhala wochepetsedwa, michere siyidyeredwe mokwanira, zomwe zimayambitsa kusokonekera kwa ntchito:

matumbo
chikhodzodzo
mtima ndi ziwalo zina.

Nthawi zambiri pamakhala mavuto ndi chilakolako cha kugonana komanso kuchuluka kwa thukuta lomwe limatulutsidwa. Ndi genitourinary neuropathy, munthu amasokonezeka ndi kukhudzika kwa mkodzo womwe umatsala mu chikhodzodzo. Nthawi zina, mkodzo umayenda pambuyo pake pokonzekera kukokoloka, kusathandizanso kumawonedwa.

Kusokonezeka kwa urodynamic kumawululidwa - kuchepetsedwa kwa kuchuluka kwa mkodzo. Nthawi yokodza imachulukirachulukira ndipo cholowa cha Reflex kukodza chimakwera. Chikhodzodzo cha mkodzo ndikuwonetsa kufunika kokodza. Zonsezi zimasokoneza njira yamoyo.

Proximal neuropathy imawoneka ngati ululu m'matako ndi m'chiuno, ndipo mafupa a m'chiuno amakhudzidwanso. Munthu amayamba kuwona kuti minofu yake siyimvera, ndipo zimatha pakapita nthawi.

Focal neuropathy nthawi zambiri imawoneka mwadzidzidzi ndipo imakhudza mitsempha payokha ya thunthu, miyendo kapena mutu. Munthuyu ali ndi masomphenya awiri, kupweteka kwapadera m'thupi kumawonekera, kupuwala kwa theka la nkhope kumatha kuchitika. Matenda a diabetes a neuropathy ndi matenda osatsimikizika, matchulidwe ake omwe nthawi zambiri samadziwika.

Diabetesic optic neuropathy ndi matenda omwe angayambitse kutaya kwamaso kwakanthawi kapena kwamuyaya. Neuropathy yam'munsi yayikulu ndizovuta zingapo zamatenda, zomwe zimagwirizanitsidwa ndi kukhalapo kwa mavuto amitsempha yamapazi yamiyendo.

Zomwe zimayambitsa matenda ashuga a shuga

Pathology imawoneka pang'onopang'ono, motsutsana ndi komwe kunatenga nthawi yayitali mtundu 1 kapena matenda a shuga. Madokotala ati matendawa amatha kuonekera patatha zaka 15-20 atazindikira kuti ali ndi matenda ashuga.

Monga lamulo, izi zimachitika ndi chithandizo chokwanira cha matendawa komanso osagwirizana ndi zomwe dokotala akutsimikiza pankhani yokhala ndi moyo wathanzi. Chifukwa chachikulu chakuwonekera kwa matenda ndi kudumpha pafupipafupi m'magazi a glucose, pomwe chizolowezi chimasowa, zomwe zimayambitsa kusokonezeka kwa ziwalo zamkati, komanso dongosolo lamanjenje.

Fayilo yamitsempha imakwaniritsa chotengera chamagazi, ndipo mothandizidwa ndi shuga, zakudya zimasokonekera ndipo kufa ndi njala kumayamba. Chifukwa chake, zizindikiro zoyambirira za matendawo zimachitika.

Ngati zakudya za munthu wodwala matenda ashuga zadzaza ndi ma michere ndi mavitamini, ndiye chifukwa cha zovuta zamachitidwe a metabolic, mafupa amitsempha amatha kupezanso zinthu izi m'moyo wawo.

Ndi chithandizo chanthawi yovomerezeka ya matenda a shuga, pali mwayi woletsa matenda ndi kupewa zovuta zingapo zowopsa. Koma ndi dokotala wokhayo amene amadziwa njira yochizira matenda. Kudzichita nokha nkoletsedwa.

Ngati chithandizo sichichitika mokwanira, ndipo ngati palibe njira zoletsa, ndiye kuti matendawo angabwerenso modetsa nkhawa.

kutalika kwa matenda ashuga
shuga wambiri nthawi zonse
kuchuluka kwa lipid
kutupa kwamitsempha
zizolowezi zoipa.

Algorithm yodziwika bwino yamatendawa: shuga wambiri amayamba kuwononga ziwiya zazing'ono zomwe zimadyetsa mitsempha. Ma capillaries amataya patency, ndipo mitsempha imayamba "kukwana" chifukwa cha kuchepa kwa oxygen, chifukwa chomwe mitsempha imataya ntchito.

Nthawi yomweyo, shuga amawononga mapuloteni ndipo amayamba kugwira ntchito yawo molakwika, amawonongeka pakapita nthawi ndipo zinyalala zimakhala chiphe m'thupi.

Zizindikiro

Matendawa ali ndi mitundu yambiri yokhala ndi zizindikiro zapadera. Pakumuwunika, dokotala amawunika mapazi, mafupa ndi manja, kusintha komwe kumawonetsa neuropathy. Zimadziwika ngati pali kuuma, redness, kapena zizindikiro zina zamatenda pakhungu.

Kuunika kwa munthu kumavumbula kutopa, komanso mawonetsedwe ena ofunikira a matendawa. Matenda a shuga a shuga ndi matenda opitilira muyeso, pomwe munthu akusowa mafuta am'mimbamo ndipo amatayika m'mimba.

Pambuyo pofufuza miyendo yam'munsi komanso yam'mwamba, kafukufuku wazolimbitsa thupi amachitika pogwiritsa ntchito zida zapadera. Phunziroli liyenera kuchitika katatu.

Kuti mudziwe mtundu wa matenda, ndikuwona momwe mankhwalawo amathandizira, njira zina zodziwira matenda zimafunikira zomwe zimatha kudziwa matenda. Chisoni chikuwululidwa:

Kuphatikiza apo, zovuta zowunikira zimaphatikizapo kuwunika kwa kuchuluka kwa mawonekedwe a Reflex.

Njira yosiyanasiyana imadziwika ndi neuropathy, kotero nthawi zambiri chisankho chimapangidwa kuti chidziwitse njira zosiyanasiyana zowunikira.

Matendawa amatha kuchiritsidwa pakapita nthawi ndikusankha mankhwala moyenera.

Palinso kusiyanasiyana kwamankhwala a mtundu woyamba kapena wachiwiri wa matenda ashuga.

Zochizira

Matenda a shuga, matenda a m'mimba omwe amadziwika, amafunikira chithandizo chamankhwala.

Chithandizo cha matenda a shuga a shuga Ndikofunikira kuchepetsa kuchuluka kwa shuga m'magazi, kuchepetsa mkhalidwe waumunthu, kuchepetsa ululu ndikubwezeretsa ulusi wamitsempha wolakwika.

Ngati munthu akudwala matenda a shuga, ndiye kuti chithandizo chimayamba ndi kukonza shuga m'magazi. Ntchito yayikulu ndikuyiphatikiza ndi shuga ndikukhazikika m'malo oyenera. Muzochitika izi, othandizira omwe amachepetsa shuga m'thupi la munthu amalimbikitsidwa.

Mapiritsi ochepetsa magazi a shuga amabwera m'magulu angapo. Gulu loyamba limaphatikizapo mankhwala omwe amalimbikitsa kupanga insulin mthupi.

Gulu lachiwirili limaphatikizapo mankhwala omwe amachititsa chidwi cha minofu yofewa - Metformin 500. Gulu lachitatu, mapiritsi omwe amatsekera pang'ono kuyamwa kwa chakudya chamafuta m'mimba, tikulankhula za Miglitol.

Ndi genesis iyi, adokotala amasankha mankhwala mosiyanasiyana. Mlingo komanso pafupipafupi njira zoperekera mankhwala a matenda amishuga 1 zimasiyana kwambiri.

Ngati kuli kotheka kukhazikika kwa mulingo wamagazi m'magazi a wodwalayo, pakhoza kukhalabe kuchuluka kwa neuropathy. Zizindikiro zimayenera kuchotsedwa ndi ma pinkiller. Mawonekedwe akuwonetsa kuti zosinthazi ndizosintha. Matenda a diabetesic neuropathy, omwe amathandizidwa panthawi yake, amatha kuchiritsidwa ndikutsitsanso minyewa yamitsempha.

Mankhwala osiyanasiyana amagwiritsidwa ntchito pofuna kukonza ntchito ya mitsempha ndi analgesia. Choyamba, ndikofunikira kudziwa kuti Tiolept amawongolera njira za metabolic, kuteteza maselo amitsempha kuti asagwiritsidwe ntchito mopanda mphamvu ndi zinthu zina zakupha.

Cocarnit ndi zovuta za mavitamini ndi zinthu zomwe zimakhudza kagayidwe ka munthu. Zinthu zomwe zimapangidwa zimathandizira ululu ndikuwonetsa momwe ma neurometabolic amathandizira. Mankhwala kutumikiridwa angapo ma patsiku intramuscularly. Kutalika kwa chithandizo kumatengera mtundu wa matenda.

Nimesulide imathandizira kutupa kwa mitsempha, komanso amachepetsa ululu. Maloiletine amatseka njira za sodium, kotero kufalikira kwa zopweteka kumasokonekera ndipo kugunda kwa mtima kumasintha.

Ndi diabetesic neuropathy, mankhwala amafunikira kuti akwaniritse zofunika pochiritsa. Njira yopweteka ya matenda ashuga omwe amachititsa kuti odwala azigwiritsa ntchito analgesics, anticonvulsants amagwiritsidwanso ntchito palimodzi.

Ndikofunikira kuchiza matenda am'munsi a minyewa ya mankhwalawa pogwiritsa ntchito mankhwala osokoneza bongo:

Pentoxifylline
Instenon
Nicotinic acid
Maluwa.

Ma antioxidants otsatirawa amagwiritsidwa ntchito:

Njira zopewera

Ngati neuropathy ilipo kale, ndikofunikira kumwa mankhwala mwadongosolo. Koma kuti izi zisachitike, njira za prophylactic ziyenera kugwiritsidwa ntchito. Choyamba, muyenera kuthana ndi kukakamizidwa, chifukwa matenda oopsa amatha kubowoleza ma capillaries, omwe amathandizanso kuti afe ndi njala.

Ndi zowonjezera, muyenera kutsatira zakudya kuti muchepetse kunenepa. Kunenepa kwambiri kumakhudza mkhalidwe wa mathero amsempha. Ndikofunikira kusiya zizolowezi zoyipa, chifukwa mowa ndi chikonga zimawononga mathero a mitsempha.

Ndikofunikira kutsogolera masewera olimbitsa thupi komanso kuchita masewera olimbitsa thupi, izi zimapangitsa kuti kagayidwe kazinthu ka kagayidwe kake kazigwira bwino ntchito ndikuwonjezera chitetezo chokwanira. Ndi matenda a shuga, simuyenera kuchita kuyenda opanda nsapato kuti musawononge pakhungu pakhungu lanu. Mwendo wowonongeka uyenera kuthandizidwa mwachangu ndi mankhwala apadera, amatha mafuta kapena zonona.

Ndi matenda a shuga a 2, madokotala amakulangizani kuti muzichita masewera olimbitsa thupi pafupipafupi. Ndikofunikira kusinthasintha kwa magazi m'miyendo ndikupewa kuwoneka kwa atherosulinosis. Muyenera kusankha nsapato zoyenera komanso zapamwamba zopangidwa ndi chikopa chenicheni. Dokotala wanu amatha kukupatsaninso nsapato zamatenda a odwala matenda ashuga.

Zambiri zokhudzana ndi neuropathy zimaperekedwa mu kanema munkhaniyi.

Zolemba zaukadaulo wazachipatala

Njira yayikulu yothandizira kupewa ndi kuchiza matenda a diabetesic neuropathy ndikukwaniritsa ndikukonza zomwe glycemic ikufuna.

Malangizo othandizira pathogenetic chithandizo cha matenda ashuga neuropathy (benfotiamine, aldolazoreductase inhibitors, thioctic acid, kukula kwa mitsempha, aminoguanidine, protein kinase C inhibitor) akupita patsogolo. Nthawi zina, mankhwalawa amachepetsa ululu wa neuropathic. Chithandizo cha kupukusa ndi ma neuropathies oyang'ana kwambiri ndi chizindikiro.

Thioctic acid - kudzera mkati mwa 30 mins, 600 mg mu 100-250 ml ya 0,9% sodium kolorayidi njira imodzi patsiku, jakisoni 10-12, kenaka mkati, 600-1800 mg / tsiku, mu 1-3 kuvomereza, miyezi 2-3.

Benfotiamine - mkati mwa 150 mg, katatu pa tsiku, masabata a 4-6.

Analgesic ndi anti-kutupa mankhwala

Zowawa, kuphatikiza ndi NSAIDs, mankhwala oletsa ululu amagwiritsidwa ntchito:

Diclofenac pakamwa, 50 mg 2 kawiri pa tsiku, nthawi ya mankhwala imatsimikiziridwa payekha kapena
Ibuprofen mkati 600 mg 4 pa tsiku, kutalika kwa mankhwala kumatsimikiziridwa payekha kapena
Ketoprofen mkati 50 mg katatu patsiku, nthawi ya mankhwala imatsimikiza payekha.
Lidocaine 5% gel osakaniza, opaka pamodzi ndi wochepa thupi wosanjikiza pakhungu mpaka katatu patsiku, nthawi ya mankhwala imatsimikiza payekha kapena
Capsaicin, 0,075% mafuta / zonona, kupaka ntchito ndi wosanjikiza pakhungu mpaka katatu patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

, , , , , ,

Mankhwala ochepetsa nkhawa ndi anticonvulsant

Ngati NSAIDs sizothandiza, antidepressants (tricyclic ndi tetracyclic, kusankha serotonin reuptake inhibitors) kungakhale ndi zotsatira za analgesic:

Amitriptyline mkati 25-100 mg kamodzi patsiku (usiku), nthawi yamankhwala imatsimikiziridwa payekhapayekha.
Maprotiline pakamwa 25-50 mg katatu patsiku (koma osapitirira 150 mg / tsiku), nthawi yayitali yamankhwala imatsimikiziridwa payekha kapena
Fluoxetine pakamwa 20 mg katatu patsiku (koyamba mlingo 20 mg / tsiku, kuonjezera mlingo 20 mg / tsiku 1 sabata), nthawi ya mankhwala imatsimikiziridwa payekha kapena
Citalopram pakamwa 20-60 mg kamodzi patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

N`zothekanso kugwiritsa ntchito mankhwala anticonvulsant:

Gabapentin pakamwa 300-1200 mg katatu patsiku, nthawi ya mankhwala imatsimikiziridwa payekha kapena
Oral carbamazepine 200-600 mg katatu patsiku (mlingo waukulu 1200 mg / tsiku), nthawi ya mankhwala imatsimikiziridwa payekhapayekha.

Mankhwala ena

Pazithandizo za neuronomous diabetesic neuropathy, njira zosagwiritsa ntchito mankhwala ndi mankhwala zimagwiritsidwa ntchito.

Ndi odziyimira pawokha am'mimba, chakudya chimalimbikitsidwa m'magawo ang'onoang'ono, ngati pali vuto lokhala ndi hypoglycemia ya postprandial, ndikofunika kumwa zakumwa zokhala ndi shuga musanadye. Gwiritsani ntchito mankhwala omwe amachititsa kuti m'mimba pakhale kugaya, ndipo ma atomu am'mimba, maantibayotiki ndi omwe amapatsidwa mankhwala:

Domperidop mkati 10 mg katatu patsiku, nthawi ya mankhwala imatsimikiziridwa payekha kapena
Metoclopramide mkati 5-10 mg katatu patsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.
Erythromycin mkati mwa 0.25-4 nthawi patsiku, masiku 7-10.

Pa matenda am'mimba ophatikizidwa ndi matenda ashuga a m'magazi, ma antibayotiki otambalala komanso mankhwala omwe amalepheretsa matenda a m'mimba kugwiritsidwa ntchito:

Doxycycline pakamwa 0,1-0.2 g kamodzi patsiku, kwa masiku 2-3 mwezi uliwonse (popanda dysbiosis).
Loperamide mkati 2 mg, ndiye 2-12 mg / tsiku kwa chopondapo pafupipafupi 1-2 patsiku, koma osapitirira 6 mg / 20 kg wodwala thupi patsiku.

Ndi odziyimira odwala matenda ashuga mitsempha ya mtima ndi orthostatic hypotension, kumwa kwambiri, kusamba kosiyana, atavala zotsekemera ndikulimbikitsidwa, ndikofunika kuwonjezera pang'ono kudya mchere wambiri. Wodwala amafunika kuti atuluke ndikugonera pang'onopang'ono. Ngati njira zotere sizikuyenda bwino, mineralocorticoid amakonzekera:

Fludrocortisone mkati mwa 0.1-0.4 1 nthawi patsiku, nthawi ya chithandizo imatsimikiziridwa payekhapayekha.

Ndi kusinthasintha kwa mtima

Maloireine mkati mwa 400 mg, ndiye 200 mg maola 8 aliwonse, atatha kukwaniritsa, 200 mg 3-4 pa tsiku, kutalika kwa mankhwala kumatsimikiziridwa payekhapayekha.

Mukamapereka mankhwala othandizira antiarrhythmic, ndikofunika kuchitira odwala limodzi ndi mtima.

Mu ufulu matenda a shuga a neuropathy okhala ndi vuto la chikhodzodzo, catheterization amagwiritsidwa ntchito, mankhwala omwe amakhala ndi matenda osokoneza bongo <лечение проводят="" совместно="" с="">

Ndi kukokoloka kwa erectile, ndizotheka kugwiritsa ntchito alprostadil malinga ndi malingaliro wamba (pakalibe zotsutsana).

Zolakwika ndi kupangana kosaganiza

Mukapereka mankhwala a NSAIDs, ndikofunikira kukumbukira za kuthekera kwawo kwa nephrotoxic, pomwe kusowa kwa analgesic kwenikweni sikutanthauza kuchuluka kwa mankhwalawa, koma kuwunika kwa zifukwa zomwe zikulepheretsa NSAIDs.

Dziko lathuli lili ndi chikhalidwe chofala pakugwiritsa ntchito mankhwala othandizira pothandiza odwala matenda ashuga <водорастворимых витаминов="" группы="" в,="" антиоксидантов,="" препаратов="" магния="" и="">

Komabe, zambiri kuchokera ku maphunziro apamwamba apadziko lonse lapansi ogwira ntchito zoterezi amagwira ntchito sizokwanira, ndipo malinga ndi akatswiri ambiri, maphunziro owonjezera apadziko lonse amafunikira pankhaniyi. Tiyeneranso kukumbukiranso kuti palibe chabwino chomwe chingalowe m'malo mwa chiphuphu cha matenda ashuga.

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Matenda a shuga amachititsa kuti odwala matenda ashuga azindikire. Izi ndizowona makamaka kwa kudziyimira pawokha kwa matenda ashuga; kuwonongeka kwa kayendedwe kazinthu zamagetsi kumawonjezera chiopsezo chamitsempha yamagazi (kuphatikiza ma ventricular tachycardia ndi ventricular fibrillation) nthawi zinayi, motero, kufa mwadzidzidzi.

Kulipira kwa shuga mellitus - cholimbitsa insulin mankhwala, maphunziro a wodwala ndikusunga chindapusa chabwino cha kagayidwe kazakudya - kumachepetsa chiopsezo chokhala ndikuwonetsedwa kwamankhwala ndi ma electrophysiological a pafupifupi 50-56%. Zikuwonetsedwanso kuti kukhalabe kwa standardoglycemia, kuwongolera cholesterol yamagazi, kuthamanga kwa magazi kuphatikiza kugwiritsa ntchito ma angiotensin-kutembenuza enzyme inhibitors kumachepetsa chiopsezo chokhala ndi neuronomic diabetesic pafupi ndi katatu.

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Kuwerengedwa kwamagulu a shuga

Vuto lalikulu la matenda a shuga ndi kuchuluka kwa shuga m'magazi. Chifukwa cha izi, zovuta zina zonse zimabuka, ndipo matenda a shuga amasiyana. Ngati kuchuluka kwa shuga m'magazi kumangosungidwa mokhazikika, ndiye kuti palibe zovuta za shuga zomwe zingachitike. Kuti izi zitheke, mankhwalawa amayenera kugwiritsidwa ntchito ngati mitundu ya matenda ashuga. Chifukwa chake, ndi mtundu 1 wa matenda a shuga, ichi ndi mankhwala a insulin, komanso mtundu wachiwiri wa matenda ashuga - mapiritsi ochepetsa shuga (sulfonylureas, biguanides, meglitinides, alpha-glucosidase inhibitors, ndi ena). Nthawi zina ndi mtundu wachiwiri wa matenda ashuga, insulin imagwiritsidwanso ntchito.

Matenda a shuga pamagazi amathandizira kuimitsa kukhazikika kwa matenda ashuga, koma sizitsogolera pakutha kwa zizindikiro zomwe zilipo. Nthawi zina, ngakhale atakwanitsa kuchuluka kwa glucose, pakapita nthawi, zizindikiro za matenda a shuga zimawonjezeka. Izi ndichifukwa choti m'mitsempha ya mitsempha yokhala ndi shuga wamba, njira zobwezeretsa zimayamba. Izi zimachitika kwakanthawi, patatha milungu kapena miyezi yochepa zizindikirozo kumapita. Wodwalayo ayenera kumvetsetsa kuti uku ndikubweza kwakanthawi muumoyo, womwe udzasinthidwe ndikusintha kwamachitidwe abwino ndikukhalanso wopirira.

Kuti mafupa am'mitsempha achira bwino, ndikofunikira kugwiritsa ntchito magulu ena a mankhwala - antioxidants ndi zinthu za neurotrophic.

Ma antioxidants ndi mankhwala a neurotrophic

Zinthu izi zimathandizira kukonzanso kukhazikika kwa kusintha kwamapangidwe amkati mwa mitsempha yomwe idachitika mothandizidwa ndi matenda a shuga. Kuchira kwathunthu ndikotheka ndi matenda omwe apezeka panthawi yake. Izi zikutanthauza kuti ngati matenda ashuga a m'magazi sanalandire kwa nthawi yayitali, ndiye kuti kuchira kwathunthu sikungatheke.

Pali mankhwala ambiri a antioxidant, monga amtundu wa neurotrophic. Komabe, owerengeka okha ndi omwe ali oyenera kuthandizira odwala matenda ashuga. Tiona kwambiri za iwo omwe phindu lake matendawa latsimikiziridwa ndi mankhwala ovomerezeka.

Mwina antioxidant wofunika kwambiri wa matenda ashuga ndi thioctic acid (alpha lipoic). Zimapangidwa ndi makampani osiyanasiyana azamankhwala omwe ali ndi mayina monga Berlition, Espa-lipon, Tiogamma, Thioctacid, Oktolipen, Neuroleepone. Mankhwala onse ndi ofanana pazomwe zimagwiritsidwa ntchito popanga mankhwala ndipo amasiyana mu zowonjezera komanso mtengo.

Thioctic acid imathandizira kukonza kwa minyewa ya mitsempha, kubwezeretsa magazi mozungulira maselo amitsempha, ndikulepheretsa mapangidwe a ma radicals aulere omwe amawononga mafupa amitsempha. Zotsatira zimaperekedwa pokhapokha kugwiritsa ntchito mankhwalawa. Njira yokhayo imatanthawuza poyamba kulowetsedwa kwa kulowetsedwa kwa masiku 10-20, 600 mg ya mankhwalawa, kutsatiridwa ndikusintha mapiritsi. Mwanjira yamapiritsi, ndikofunikira kupitiliza kumwa mankhwala a thioctic kwa miyezi ina iwiri (mankhwalawa amatengedwa ndi 600 mg theka la ola musanadye).

Kutalika kwa nthawi yonse ya chithandizo akutsimikiza payekhapayekha, poganizira kuopsa kwa zizindikiro za matenda ashuga a mtima. Njira ina yothandizira pakali pano akuyesedwa pogwiritsa ntchito Mlingo wapamwamba kwambiri (1800 mg patsiku). Thioctic acid, kuwonjezera pa antioxidant momwe, amasiya amachepetsa kuwawa kwa kupweteka kwa matenda ashuga a m'mimba, potero kusintha moyo.

Pakati pazinthu za neurotrophic, gawo la mavitamini a B (B1, B6, B12) liyenera kukumbukiridwa. Amalola kuti minyewa yamitsempha ichotse (zonse pachimake komanso pachimake), kuchepetsa ululu, kusintha makonzedwe, potero kuthetseratu zovuta zamagalimoto. Pali zinthu zina zomwe zimagwiritsidwa ntchito ndi gululi. Zimatsimikiziridwa kuti, mwachitsanzo, vitamini B1 iyenera kukhala ndi mawonekedwe osintha mafuta (benfotiamine) kuti ilowe mkati mwa minyewa yamanjongo yokwanira. Kuphatikiza apo, mavitamini B a matenda am'mimba a shuga ayenera kugwiritsidwa ntchito muyezo wokwanira. Amagwiritsidwanso ntchito m'makosi.

Kuti mugwiritse ntchito mosavuta, zovuta za mavitamini a B zimapezeka nthawi yomweyo ngati piritsi limodzi (dragee). Mwachitsanzo, Milgamma, Kombilipen, Vitagammma, Compligam V. Milgamm amapatsidwa piritsi 1 katatu patsiku kwa masabata 2-4, kenako piritsi limodzi 1-2 kamodzi patsiku kwa masabata angapo. Ndi mtundu wopweteka wa matenda ashuga a m'mimba, mankhwalawa amatha kuyamba ndi mitundu ya jakisoni ndikusintha kwa iwo oikidwa.

Mavitamini a Gulu B akuyenera kusamala, chifukwa akagwiritsidwa ntchito mu Mlingo wambiri, amatha kuyambitsa mavuto. Zikatero, kugwiritsidwa ntchito kwawo kuyenera kusiyidwa (ngati ndikudziwika bwino kuti ndi vitamini B yemwe amachititsa tsankho, ndiye kuti ndiye kuti kuthe.) Nkusiya enawo.

Mankhwala enanso okhala ndi vuto la neurotrophic ndi Actovegin. Imayamba kugwiritsidwa ntchito ngati jakisoni wambiri wa 5-10 ml kwa masabata awiri, kenako ndikupitiliza kutengedwa ngati dragee (piritsi 1 katatu patsiku mpaka miyezi iwiri). Actovegin angagwiritsidwe ntchito nthawi imodzi ndi thioctic acid ndi mavitamini a gulu B.

Monga mankhwala a neurotrophic, Pentoxifylline (Vasonite, Trental) angatchulidwe. Ichi ndi chinthu chomwe chimakongoletsa ma microcirculation, ndiye kuti, magazi amayenda m'dera la capillaries. Molunjika, chifukwa cha kuyenda bwino kwa magazi, Pentoxifylline imathandizira kubwezeretsa ulusi wamitsempha, ndichifukwa chake umagwiritsidwa ntchito pochiza matenda a shuga. Kukonzekera kwa 5 ml kumayendetsedwa kudzera m'mitsempha, mchere wambiri wa sodium chloride, kwa masiku 10, ndikupitilira mankhwala a piritsi 200 mg katatu patsiku. Njira ya mankhwala ndi mwezi umodzi.

Vuto la mpumulo wa kupweteka kwa matenda a shuga

Ululu wa matenda ashuga a m'mimba ndi imodzi mwazovuta zazikulu zomwe zimaphimba kale zovuta za odwala. Chowonadi ndichakuti ululu wammbuyo umapweteka (nthawi zambiri umawotcha, kuphika) ndipo suchepa mukamamwa mankhwala wamba (angapo a analgin ndi ena ofanana ndi mankhwala). Usiku, ululu umakulitsa, umasokoneza kupumula koyenera, komwe kumachiritsa odwala.

Magulu angapo a mankhwalawa amagwiritsidwa ntchito pothana ndi kupweteka kwa matenda ashuga a m'mimba. Ena a iwo akhala akugwiritsidwa ntchito kwa nthawi yayitali (tricyclic antidepressants), ena - khumi okha omaliza. M'zaka zaposachedwa, kutsimikizika kwakhala pa mankhwala am'badwo watsopano - Gabapentine ndi Pregabalin. Komabe, mtengo wawo wokwera umakhala chifukwa chomwe kale mankhwala osagwiritsidwa ntchito samataya kufunika kwawo.

Chifukwa chake, pofuna kuthana ndi ululu wa matenda ashuga angathe kugwiritsidwa ntchito:

antidepressants
anticonvulsants (anticonvulsants),
mankhwala osokoneza bongo
antiarrhythmic mankhwala
zinthu zosokoneza bongo (ma opioids).

Ma antidepressants - iyi ndi imodzi yakale kwambiri (ponena za momwe angagwiritsire ntchito) njira zamankhwala zothana ndi ululu m'mishuga. Amitriptyline nthawi zambiri amagwiritsidwa ntchito. Mlingo wofunikira umasankhidwa pang'onopang'ono malinga ndi mawonekedwe owonjezeka. Yambani ndi 12.5 mg kamodzi patsiku, pang'onopang'ono mukukulitsa mlingo ndi 12,5 mg. Mlingo wa tsiku ndi tsiku umatha kufika 150 mg, umagawidwa pawiri.

Mankhwalawa ali ndi zovuta zingapo, zomwe nthawi zambiri zimapangitsa kuti asamagwiritse ntchito. Pakati pa antidepressants, munthu amatha kukhala osankha serotonin ndi norepinephrine reuptake inhibitors (Duloxetine, Venlafaxine, Sertraline, ndi ena otero). Amakhala ndi zovuta zochepa, koma mtengo wake ndiwokwera kwambiri.Kuti mulimbikire kupitiliza, antidepressants iyenera kugwiritsidwa ntchito kwa nthawi yayitali (osachepera mwezi, ndipo nthawi zambiri yotalikirapo).

Maanticonvulsants amagwiritsidwanso ntchito ngati mankhwala opha matenda a shuga kwa nthawi yayitali. Woyambirira wa gululi adayamba kugwiritsa ntchito carbamazepine (Finlepsin). Komabe, mankhwalawa ali ndi tanthauzo lakusintha. Mwachidule, ndi kugwiritsa ntchito kwake, odwala amakhala ndi tulo, oopsa, amaganiza zolimba. Mwachilengedwe, palibe amene amakonda mbali iyi. Ichi ndichifukwa chake posachedwapa anticonvulsants awa akuyesera kuti asapereke mankhwala.

M'badwo wapano wa anticonvulsants ulibe zotsatirapo zoyipa. Pakati pawo, Gabapentin ndi Pregabalin amagwiritsidwa ntchito nthawi zambiri. Gabapentin (Gabagamm, Neurontin) amafunikira kupatsidwa mlingo. Kodi izi zikutanthauza chiyani? Kusunthira kumatanthauza kukonzekera pang'onopang'ono kwa kuchuluka kwa mankhwala. Patsiku loyamba lovomerezeka, wodwalayo amatenga 300 mg usiku, wachiwiri - 300 mg m'mawa ndi madzulo, wachitatu - 300 mg katatu patsiku. Ndipo motere, pakukula, njira yofunikira ya analgesic imatheka (amatsogozedwa ndi zotengera za wodwalayo). Nthawi zambiri zokwanira 1800 mg pa tsiku. Pa nthawi imeneyi amasiya ndikuyimilira kwakanthawi.

Pregabalin (Lyric) safuna mlingo titation. Amamuika 75-150 mg 2 kawiri pa tsiku. Nthawi yogwiritsira ntchito imasiyanasiyana malingana ndi kuuma kwa ululu wodwalayo mwa wodwala wina, komabe, ndizosatheka kugwiritsa ntchito mankhwalawa pafupipafupi.

Anesthetics wamba azitsimikizira okha mu zowawa. Nthawi zambiri amagwiritsidwa ntchito ngati mafuta, mafuta komanso ngakhale pulasitala (mwachitsanzo, patch ya Versatis imakhala ndi 5% lidocaine). Matiwuni amalola kuti zovala zanu zizikhala zaukhondo, osakhalitsa kwa maola 12, zomwe ndizothandiza kwambiri kwa anthu omwe ali ndi moyo wakhama.

Kukonzekera ndi komwe kwakhumudwitsa kwanuko sikoyenera kwa odwala onse omwe ali ndi matenda ashuga. Chowonadi ndi chakuti machitidwe awo ochitapo kanthu amatengera kufooka kwa kupweteka, ndiye kuti, akatha kugwiritsa ntchito, ululu umakulirakulira poyamba, ndipo pokhapokha gawo lothandizira limayamba. Koma nthawi iyi, ululu ukakulirakulira, ungakhale wosiyana. Palibe amene anganenere kuti zidzatenga nthawi yayitali bwanji. Momwe wodwalayo amasamutsira gulu la mankhwalawa akhonza kukhazikitsidwa pokhapokha poyesa kugwiritsa ntchito mankhwala omwewo. Izi zimaphatikizapo mafuta onunkhira monga Kapsaicin, Capsicam, Finalgon, Viprosal, Apizartron.

Mankhwala a antiarrhythmic si mankhwala ambiri omwe amalimbana ndi kupweteka kwa matenda a shuga. Mwa iwo, ndichizolowezi kugwiritsa ntchito lidocaine (munjira ya kulowetsedwa pang'onopang'ono pa mlingo wa 5 mg pa kilogalamu ya thupi) ndi mexiletine (munthawi ya mapiritsi tsiku lililonse la 450-600 mg). Zolepheretsa kugwiritsa ntchito kwawo zimakhudzana ndi momwe zimawakhudzira mtima.

Mankhwala a narcotic ndiwo cholumikizira chomaliza pa matenda a matenda amitsempha ya matenda ashuga. Inde, ndi othandiza kwambiri, koma osokoneza bongo ndikugwiritsa ntchito nthawi yayitali. Ichi ndichifukwa chake amasankhidwa kuti akhale nthawi yayitali, pomwe njira zina sizothandiza. Odziwika kwambiri m'gululi ndi oxycodone ndi tramadol. Pali kuphatikiza kwa Tramadol ndi paracetamol wachilengedwe (Zaldiar), womwe umakulolani kugwiritsa ntchito Mlingo wocheperako wa mankhwala ndi mphamvu yomweyo ya analgesic. Mwachilengedwe, ma opioid amayankhidwa ndi dokotala (mankhwala okhawo amapatsidwa).

Mwachilungamo, ndikofunikira kunena kuti, mwatsoka, sizotheka nthawi zonse kuthandiza wodwala yemwe ali ndi matenda ashuga amathetseratu kupweteka. Nthawi zina amakhala omangika kwambiri ndipo amathandizidwa kuti azitha kuchiza pokhapokha ngati awiri, ngakhale atatu atamwa. Ichi ndichifukwa chake kufunafuna olimbitsa mtima pakadali pano kumapitilira pakadali pano.

Mankhwala othandizira odwala matenda ashuga a m'mimba nthawi zambiri amaphatikizidwa ndi njira zolimbitsa thupi. Maonekedwe amawoneka osiyanasiyana komanso osiyanasiyana, momwemonso zizindikiro za matenda ashuga omwewo. Pafupifupi njira zilizonse zolimbitsa thupi zingagwiritsidwe ntchito pochiza matenda. Nthawi zambiri amatengera magnetotherapy, acupuncture, electrophoresis, kukondoweza kwa magetsi.

Njira zina zochizira

Pamodzi ndi njira zachikhalidwe, odwala nthawi zambiri amagwiritsa ntchito mankhwala achikhalidwe. Zomwe ochiritsa samalimbikitsa! Ena mwa malangizowa ali ndi tanthauzo. Njira zambiri zachikhalidwe zimatha kuphatikizidwa ndi chithandizo chachikhalidwe (poyamba, kumene, atakumana ndi dokotala).

Njira zodziwika bwino zothandizira anthu polimbana ndi matenda ashuga ndi kulowetsedwa kwa calendula, nettle, maluwa a chamomile, decoctions a eleutherococcus, tsamba la bay, tinctures a rosemary ndi leadum, peel yobiriwira ndi dothi lamtambo. China chake chimagwiritsidwa ntchito mkati, china chakomweko monga mawonekedwe odzola. Zachidziwikire, zovuta za chithandizo chotere, komanso zachikhalidwe, sizowoneka mwachangu. Komabe, polimbana ndi matenda a shuga a matenda ashuga, monga momwe nkhondo, njira zonse zili bwino.

Chifukwa chake, chithandizo cha matenda ashuga a m'mimba ndi ntchito yovuta kwambiri. Choyamba, kuti akwaniritse kusintha kwina, njira yochizira kwa miyezi ingapo ndiyofunikira. Kachiwiri, sizotheka nthawi zonse koyamba kupeza mankhwalawa othandizira odwala. Chachitatu, kusintha kwa glucose palokha kuti mupewe kupitirira kwa neuropathy ndikovuta. Koma ngakhale pali zovuta zonse, nkhondo yolimbana ndi matenda ashuga a m'mimba iyenera kugwiritsidwa ntchito nthawi zonse kuti muchepetse zovuta zina za matenda ashuga.

Dokotala uti kuti mulumikizane

Munthu yemwe ali ndi matenda ashuga ayenera kulembetsa ku endocrinologist. Ndikofunikira kudziwitsa dokotala panthawi yake ngati maonekedwe akumva kupweteka, kutekeseka, kutopa kwa minofu ndi zina zatsopano kwa wodwala. Pankhaniyi, endocrinologist ayenera kuchitapo kanthu pochiza matenda a neuropathy. Kufunsira kwa neurologist ndikofunikira. Chithandizo cha physiotherapeutic nthawi zambiri chimawonetsedwa.

Kanema woyamba, pulogalamu ya "Live Healthy" ndi Elena Malysheva, mu gawo "About Medicine", amalankhula za matenda a shuga (kuyambira 32: 10):

Makanema ojambula pamakina a chitukuko cha neuropathy mu shuga: