Matenda a shuga a shuga

Matenda a shuga nthawi zambiri amayambitsa zovuta, imodzi mwazomwe zimakhala ndi matenda ashuga a macroangiopathy a m'munsi. Matendawa amapezeka patatha zaka zambiri chithandizo cha matenda ashuga, ndipo amakhudza thupi lonse. Ngati ma capillaries ang'onoang'ono ndi zombo zowonongeka, ndiye kuti zimayikidwa ngati microangiopathy, kenako, zazikuluzikulu, macroangiopathy zimayamba. Nthawi zambiri, matendawa ndi ena ambiri amatuluka ngati vuto la matenda ashuga. Macroangiopathy imatha kuwonekera padera lililonse lathupi ndipo imayambitsa zovuta zazikulu, ngakhale kufa.

ZOFUNIKA KUDZIWA! Ngakhale odwala matenda ashuga kwambiri amatha kuchiritsidwa kunyumba, popanda opaleshoni kapena zipatala. Ingowerenga zomwe Marina Vladimirovna akunena. werengani zonena zake.

Kodi matenda ndi chiyani?

Microangiopathy ndikuwonongeka kwa makoma a mitsempha yaying'ono ya magazi, macroangiopathy imasokoneza magwiridwe antchito a ziwiya zazikulu, ndipo ziwalo zilizonse za thupi zimakhudzidwa. Kukula ndi kupita patsogolo kwa matendawa kumayambitsa matenda opatsirana komanso a bakiteriya, komanso kusokonezeka kwa chiwindi mu shuga. Nthawi zambiri microangiopathy imamenya mfundo zofooka kwambiri za munthu. Mwa anthu odwala matenda ashuga, maso ali pangozi, mitsempha yamagazi yamaso imayamba kuonda ndikuyamba kugwa, ndipo masomphenyawo amayamba kugwa mwachangu. Zina mwa matenda omwe amatsogolera pakuwonongeka kwa makoma amitsempha yamagazi ndi:

Shuga amachepetsedwa nthawi yomweyo! Matenda a shuga m'kupita kwa nthawi angayambitse matenda ambiri, monga mavuto amawonedwe, khungu ndi tsitsi, zilonda zam'mimba, zilonda zam'mimba komanso matenda otupa! Anthu amaphunzitsa zinzake zowawa kuti azisintha shuga. werengani.

• necrotic foci,
• michere
• thrombosis
• hyalinosis.

Etiology ndi pathogenesis

Macroangiopathy mu shuga mellitus ndimachitika pafupipafupi; kuchuluka kwa glucose, komwe kumawononga, kumayenda m'mitsempha yamagazi. Zimatsogolera ku kusinthika kwa malo, m'malo ena khomalo limakhala locheperako komanso laling'ono, kwinakwake limakulitsidwa. Chifukwa cha kusokonekera kwa magazi m'magazi, kubanika, thrombosis kumachitika. Zingwe ndi ziwalo zimavutika chifukwa chosowa mpweya (hypoxia), womwe umayambitsa kusokonekera kwa machitidwe ambiri amthupi.

Kusintha koteroko kumachitika mthupi ndi chitukuko cha matendawa:

• Makoma a zotengera adasandutsa zovuta, kuwonongeka kumawonekera,
• mamasukidwe amwazi ukuwonjezeka
• kuthamanga kwa magazi kudzera m'matumbo kumachepera.

Thupi lonse limavutika ndi zotsatirapo zake, makamaka miyendo yam'munsi, yomwe imapangitsa kuti katundu azikhala kwambiri.

Zomwe zimayambitsa matendawa:

• cholowa
• kuvulala kwamadigiri osiyanasiyana (ndi matenda ashuga, kuchiritsa kumakhala pang'ono komanso kovuta),
• magazi ndi magazi a m'magazi,
• kuledzera kwa thupi ndi mankhwala
• matenda oopsa
• kuchepa kwa thupi.

Kuwonetsedwa kwa matenda ashuga- komanso macroangiopathy

Kuwonetsedwa kwa zizindikiro kumadalira kuchuluka kwa kuwonongeka kwa mtima komanso njira ya matenda ashuga. Chovuta kwambiri kuchiza ndi kuwonongeka kwa ubongo, kuphwanya kwa kayendedwe ka mitsempha komwe kumayambitsa ischemia, vuto la mtima, encephalopathy. Potengera zakumbuyo, Zizindikiro zimawonekera pang'onopang'ono:

• kulimbitsa mutu kosalekeza, mphamvu ya olumala sikugwira ntchito,
• kuchepa kwa ntchito zamaganizidwe,
• kutopa,
• masomphenya akugwa
• mayendedwe osagwirizana
• kusokonezeka kwa kukumbukira.

Matenda a shuga a shuga a m'munsi otsika amapezeka pakati pa ziwalo zina za thupi, popeza zochuluka za katundu zimapatsidwa. Pali kuphwanya kayendedwe ka magazi, poyamba mwendo wotsika, bondo lolumikizana limadwala. Pakapita kanthawi, vuto limakulirakulira, zizindikirazo zimayamba kufotokozedwanso. Mawonekedwe oyamba amawotcha komanso kupweteka poyenda, ndiye kuti ululu umakhala wosapirira, kuyenda sikungatheke. Miyendo yotupa; muzochitika zapamwamba, mawonekedwe a zilonda zam'mimba.

Njira Zodziwitsira

Mukamayesedwa, adotolo amatchula madandaulo a odwala, koma izi sizokwanira kuzindikira matendawo ndi zomwe zimayambitsa. Njira zotsatirazi zakugwiritsa ntchito:

Kuti muwonetsetse kapena kuwononga kuwonongeka kwa minyewa ya bongo, pitani ku MRI.

1. Kusanthula kwa magazi ndi mkodzo. Izi ndizofunikira kuti mulingo wa shuga ugonjetsedwe.
2. Ultrasound pogwiritsa ntchito Doppler njira. Ndi chithandizo chake, "amayenda" ndipo zowonongeka zawo zidzaululidwa. Kupsinjika kwa magazi pansi pa bondo kumayesedwanso.
3. MRI yovutitsidwa ndi ubongo.
4. X-ray

Njira zochizira

Microangiopathy mu shuga mellitus imaphatikizanso mankhwala ena omwe amagwiritsidwa ntchito pochiza. Kuti muthane ndi matenda, muyenera kuyamba ndi chinthu chosavuta - siyani zizolowezi ndikupenda zakudya za tsiku ndi tsiku. Zoikika zimangochitidwa ndi adotolo, kudzipatsanso mankhwala okha kumangokulitsa vutoli. Kugwiritsa ntchito kofunikira kwa metabolic othandizira omwe amaphatikiza mafuta acids ndipo amathandizira pa myocardium. Kenako, katundu pamitsempha yamagazi amayenera kufooka ndi kuchepetsa magazi, chifukwa, heparin kapena acetylsalicylic acid adzayikiridwa.

Ngati nthendayo imakhudza miyendo yam'munsi, mabala amatha kuyamba, omwe, ndi shuga wambiri, amakoka movutikira. Motere, chiwopsezo cha matenda chikuwonjezeka, chifukwa thupi limalimbana pang'ono. Izi zimatha kuyambitsa mafungo oyera, pamenepa, ngati pakuwopseza moyo wa wodwalayo, adokotala adzaganiza zodula dzanja lomwe lili ndi kachilombo, kupewa sepsis. Kuti muthane ndi vuto la mtima, kuwunikira nthawi zonse kumayenera kuchitika osati mopitilira kuchuluka kwa magazi, komanso kuthamanga kwa magazi. Ndi chiwopsezo chowopsa, kumwa mankhwala omwe amachepetsa kupsinjika akuwonetsedwa. Ndikofunika kukumbukira kuti matenda omwe amapangidwa chifukwa cha matenda ashuga ndi zotsatira.

Kupewa

Kuti muchepetse mwachangu, muyenera kuchotsa chomwe chimayambitsa kupsinjika kwa shuga, ndipo musaiwale za njira zopewera. Kupewa matendawa ndikosavuta kuposa kuthana ndi izi, izi zimagwira ku macroangiopathy. Kunenepa kwambiri kulibe vuto kwa thanzi lathunthu ndipo kumawonetsa cholesterol yayikulu. Tsatirani zonena za adotolo ndikuwonjezera mitolo ya Cardio: kuthamanga, kudumpha chingwe, masewera olimbitsa thupi. Kuwongolera zotsatirazi kumathandizira kuumitsa, komwe kumamveka thupi komanso kulimbitsa chitetezo chathupi chonse.

Zizindikiro

Kuti mudziwe zoyenera ndi kupereka mankhwala oyenera, madandaulo a odwala okha sikokwanira. Kuti mupange mbiri yonse, dokotala yemwe amakupatsani mankhwala amafunsira mitundu yotsatirayi:

• Laborator diagnostics. Kusanthula kwa magazi ndi mkodzo kokwanira kumawonetsa kuchuluka kwa shuga chifukwa ndiwokwera kwambiri.
• Kafukufuku pogwiritsa ntchito zida zoyenera. Wodwalayo amayesedwa pamakina a ultrasound ogwiritsa ntchito kujambula kwa Doppler, komwe kumakupatsani mwayi wowona magazi kudzera m'matumbo ndi ma capillaries. Kupanikizika kwa phazi ndi popliteal artery kumayesedwanso. Posachedwa, mtundu watsopano wa matenda wayamba kugwiritsidwa ntchito - makanema apakompyuta capillaroscopy.

Kuti muchiritse bwino mankhwala a microangiopathy, choyambirira, ndikofunikira kutsatira malangizo onse a dokotala. Kudzichitira nokha kapena kusiya mankhwala omwe atengedwa poyambira kusintha kumatha kubweretsa mavuto.

• Choyamba, wodwalayo ayenera kusiya zizolowezi zoyipa, azichita masewera olimbitsa thupi pang'ono, onetsetsani zakudyazo. Ndi kuchuluka kwa thupi, konzekerani moyo wanu m'njira yoti kuwonda pang'onopang'ono kumachitika.
• Pochiza zovuta zilizonse za matenda ashuga, chinthu chofunikira kwambiri choyambirira ndicho kuphatikizika kwa shuga m'magazi. Ngati mulingo wachoka kwambiri pazomwe zikuchitika, mphamvu ya mankhwalawa imachepa mpaka zero. Musaiwale za zakudya zapadera - chotsani zakudya zonse zokhala ndi zophatikizika m'thupi.

Mankhwala otsatirawa amagwiritsidwa ntchito pochiza matenda:

• Mankhwala omwe ali ndi metabolic. Izi zikuphatikiza ndi nolronate, thiatriazolin ndi ena. Mukamamwa mankhwalawa, mafuta acids amawonongeka, chifukwa chomwe njira ya glucose oxidation imayendera myocardium.
• Heparin, acetylsalicylic acid, vazaprostan mankhwala onsewa amachepetsa magazi. Mafuta akhungu kwambiri ndi owopsa kutsekeka kwamitsempha yamagazi ndi mapangidwe a microthrombi.
• Kuti mupewe matenda a mtima kapena stroke, muyenera kuyang'anira kuthamanga kwa magazi. Zizindikiro zoyenera ndi 130 pa 85 mm Hg. Art. Chifukwa chake, ndi kukakamizidwa kwa mafunde, muyenera kumwa mankhwala omwe amachititsa chizindikirochi.
• Ngati munthawi ya chithandizo, wodwalayo alibe zilonda, kutupa, zotupa za malo ena pakhungu pamiyendo, kudula kwamiyendo ndikofunikira. Kudzipatula ndi opaleshoni kukhoza kuwonongera wodwala moyo.
• Matenda a shuga a shuga, okhala ovuta a shuga, amafunika kuwunika pafupipafupi komanso kupewa. Mankhwala osokoneza bongo amaphatikizidwa bwino ndi physiotherapy, magnetotherapy, laser ndi acupuncture. Ndi njira iyi, makoma a zotengera amakhala ochulukirapo, chiopsezo cha kuwundana kwa magazi kumachepetsedwa.

Ndi chithandizo cha panthawi yake komanso chololera, chiopsezo chotenga phazi la phazi limachepetsedwa kangapo.

Kuneneratu komanso kupewa matenda ashuga a macroangiopathy

Imfa chifukwa cha zovuta za mtima ndi odwala omwe ali ndi matenda a shuga ukufika 35-75%. Mwa awa, pafupifupi hafu ya milanduyo, kufa kumachitika chifukwa cha kulowetsedwa mwa myocardial, mu 15% - kuchokera pachimake pachimake.

Chinsinsi cha kupewa matenda ashuga a macroangiopathy ndikusunganso kuchuluka kwa shuga wamagazi ndi kuthamanga kwa magazi, kudya, kuwongolera thupi, kusiya zizolowezi zoyipa, kukwaniritsa malingaliro onse azachipatala.

Micro ndi macroangiopathies mu shuga: ndi chiyani?

Matenda ashuga macroangiopathy ndi matenda ophatikizika komanso amtundu wamatumbo omwe amapezeka pakatikati kapena m'mitsempha yayikulu ndikutalika kwa mtundu wa 1 ndi mtundu wa 2.

Chochitika chofananacho sichina koma pathogenesis, chimayambitsa mawonekedwe a mtima wamatumbo, ndipo munthu nthawi zambiri amakhala ndi matenda oopsa, zotupa zokhudzana ndi mitsempha yam'mphepete, ndipo kufalikira kwa mitsempha kumasokonekera.

Dziwani za matendawa pogwiritsa ntchito ma electrocardiograms, echocardiograms, ultrasound dopplerography, impso, ziwongo, mitsempha yamiyendo imayesedwa.

Chithandizo chimakhala pakuwongolera kuthamanga kwa magazi, kukonza kayendedwe ka magazi, kukonza hyperglycemia.

Munthu akayamba kudwala matenda a shuga kwa nthawi yayitali, ma capillaries ang'onoang'ono, makoma ochepa ndi mitsempha mothandizidwa ndi kuchuluka kwa glucose kumayamba kuwonongeka.

Chifukwa chake, kupendekera mwamphamvu, kusakanikirana, kapena, koteroko, uku ndi ukukulitsa mitsempha yamagazi.

Pachifukwachi, kayendedwe ka magazi ndi kagayidwe pakati pa ziwalo zamkati zimasokonezeka, zomwe zimayambitsa matenda a hypoxia kapena okosijeni a minyewa yozungulira, kuwonongeka kwa ziwalo zambiri za odwala matenda ashuga.

• Nthawi zambiri, ziwiya zazikulu zam'munsi komanso mtima zimakhudzidwa, izi zimachitika mu 70 peresenti ya milandu. Ziwalo zathupi izi zimalandira katundu wambiri, kotero zotengera zimakhudzidwa kwambiri ndikusintha. Mu diabetesic microangiopathy, fundus imakhudzidwa nthawi zambiri, yomwe imapezeka ngati retinopathy, yomwe imakhalanso milandu.
• Nthawi zambiri, matenda ashuga macroangiopathy amakhudzanso matenda am'mimba, aimpso, aimpso. Izi zimaphatikizidwa ndi angina pectoris, myocardial infarction, ischemic stroke, matenda ashuga, komanso matenda okonzanso. Ndi kuwonongeka kwakanthawi kwamitsempha yamagazi, chiopsezo chotenga matenda a mtima ndi matenda a sitiroko amachulukitsa katatu.
• Matenda ambiri okhudzana ndi matenda ashuga amatsogolera ku arteriosulinosis yamitsempha yamagazi. Matendawa amapezeka mwa anthu omwe ali ndi mtundu woyamba wa 2 ndi mtundu wa 2 matenda a shuga zaka 15 m'mbuyomu kuposa mwa odwala athanzi. Komanso, matenda omwe ali ndi matenda ashuga amatha kupita patsogolo mofulumira.
• Matendawa amachepetsa zipinda zapansi panthaka zazikulu komanso zam'mitsempha, momwe mapangidwe a atherosclerotic amapanga. Chifukwa cha kuwerengera, kuwonekera ndi necrosis ya zolembera, kuwundana kwa magazi kumapangika kwanuko, kuwunikira kwa ziwiya kumatseka, chifukwa, kuthamanga kwa magazi m'dera lomwe lakhudzidwa kumasokonezeka mu matenda ashuga.

Monga lamulo, matenda ashuga a macroangiopathy amakhudza mitsempha, ubongo, mawonekedwe amitsempha, zotupa, motero, madokotala akuchita zonse kuti aletse kusintha kumeneku pogwiritsa ntchito njira zopewera.

Chiwopsezo cha pathogenesis ndi hyperglycemia, dyslipidemia, insulin, kunenepa kwambiri, matenda oopsa, kuchuluka kwa magazi, kuperewera kwa endothelial, kupsinjika kwa oxidative, kuchepa kwamatenda a cellic ndikofunikira kwambiri.

Komanso, atherosclerosis nthawi zambiri imayamba kukhala osuta, pamaso pa zinthu zopanda ntchito, komanso kuledzera kwa akatswiri. Pangozi ndi amuna azaka zopitilira 45 ndipo azimayi opitirira 55.

Nthawi zambiri chomwe chimayambitsa matendawa chimakhala cholowa chamabadwa.

Diabetes angiopathy ndi lingaliro lophatikizira lomwe likuyimira pathogeneis ndipo limaphatikizapo kuphwanya kwamitsempha yamagazi - yaying'ono, yayikulu komanso yapakati.

Vutoli limadziwika kuti ndi chifukwa cha matenda obwera chifukwa cha matenda ashuga, omwe amapezeka zaka 15 patadutsa matendawa.

Matenda a shuga a macroangiopathy amaphatikizidwa ndi ma syndromes monga atherosulinosis ya msempha ndi mitsempha ya m'mimba, zotupa za mitsempha kapena mitsempha.

1. Pa microangiopathy mu matenda a shuga, retinopathy, nephropathy, ndi matenda ashuga a m'munsi amawonedwa.
2. Nthawi zina, mitsempha yamagazi ikawonongeka, angiopathy yapadziko lonse imapezeka, lingaliro lake limaphatikizapo matenda a shuga-macroangiopathy.

Endoneural diabetesic microangiopathy imayambitsa kuphwanya kwamitsempha yamafungo, izi zimayambitsa matenda a shuga.

Ndi atherosclerosis ya msempha ndi coronary mitsempha, zomwe zimayambitsa matenda ashuga macroangiopathy am'munsi komanso mbali zina za thupi, wodwala matenda ashuga amatha kudziwa matenda amtima, matenda amitsempha yamagazi, angina pectoris, mtima.

Matenda a mtima pamenepa amayamba mu mawonekedwe aumunthu, osamva ululu ndipo amakhala ndi arrhythmia. Matendawa ndi oopsa kwambiri, chifukwa amatha kupha mwadzidzidzi matendawa.

Pathogenesis mu odwala matenda ashuga nthawi zambiri amaphatikizapo zovuta pambuyo-infaration monga aneurysm, arrhythmia, thromboembolism, Cardiogenic mantha, mtima. Ngati madotolo awulula kuti chomwe chimayambitsa matenda osokoneza bongo ndi matenda ashuga a macroangiopathy, zonse ziyenera kuchitidwa kuti vuto la mtima lisabwezenso, popeza chiwopsezo chake ndi chachikulu.

Pamene vuto la kuthamanga kwa magazi silimatchulidwa kokwanira, matenda ashuga a macroangiopathy amachititsa mawonekedwe a zilonda zam'mimba zam'mimba zokhala ndi matenda osokoneza bongo m'miyendo.

Kuzindikira ndikuwonetsetsa momwe ziwiya zam'mimba, zam'mimba komanso zotumphukira zimakhudzidwira.

Kuti mudziwe njira yoyenera yofunsira, wodwalayo ayenera kufunsa dokotala.

Kuunikiridwa kumachitika ndi endocrinologist, katswiri wa matenda ashuga, mtima, katswiri wa zamitsempha, opaleshoni yamtima, wamisala.

Mtundu woyamba wa 1 komanso wa matenda ashuga a mtundu wachiwiri, mitundu yotsatirayi ya diagnostics imayikidwa kuti idziwe pathogenesis:

1. Kuyesedwa kwa magazi kwamomweku kumachitika kuti mupeze shuga, triglycerides, cholesterol, mapulateleti, lipoproteins. Kuyesedwa kwa magazi kumapangidwanso.
2. Onetsetsani kuti mumayesa mtima wamagazi pogwiritsa ntchito electrocardiogram, kuwunika kwa magazi pafupipafupi, kuyezetsa kupsinjika, echocardiogram, ultrasound dopplerography ya aorta, myocardial perfusion scintigraphy, coronarography, computer tomographic angiography.
3. Kusintha kwamitsempha kwa wodwalayo kumawonetsedwa pogwiritsa ntchito ziwonetsero za ultrasound za ziwongo, kusanthula mobwerezabwereza ndi angiography yamitsempha yamitsempha imachitidwanso.
4. Kuti muwone momwe mitsempha yamitsempha yamapazi ilili, miyendo imawunikidwa pogwiritsa ntchito kuwunika kwapawiri, ma dopplerografia, kupindika kwa arteriography, rheovasography, capillaroscopy, arterial oscillography.

Kuthandizira matendawa mu odwala matenda ashuga makamaka kumakhala ndi njira zomwe zingachepetse kupita patsogolo kwa mitsempha yoopsa, yomwe ikhoza kumuwopseza wodwala olumala kapena ngakhale kufa.

Zilonda za trophic zam'mwamba komanso zotsika zimayang'aniridwa ndikuyang'aniridwa ndi dokotala. Pankhani ya zovuta pachimake mtima, chithandizo choyenera chikuchitika. Komanso, adotolo atha kuloza ku opaleshoni, yomwe imakhala mu endarterectomy, kuchotsa kuchepa kwa magazi m'thupi, kuchepa kwa dzanja lanu, ngati ali kale ndi matenda osokoneza bongo.

Mfundo zazikuluzikulu zamankhwala zimagwirizana ndi kukonza ma syndromes owopsa, omwe amaphatikizapo hyperglycemia, dyslipidemia, hypercoagulation, ochepa hypertension.

• Kuti alipire chakudya cha anthu odwala matenda ashuga, dokotala amamulembera mankhwala a insulin komanso kuwunika pafupipafupi shuga. Mwa izi, wodwalayo amatenga mankhwala ochepetsa a lipid - ma statins, antioxidants, fibrate. Kuphatikiza apo, ndikofunikira kutsatira zakudya zapadera zochiritsira komanso zoletsa kugwiritsa ntchito zakudya zomwe zili ndi mafuta azinyama.
• Pakakhala chiopsezo chokhala ndi zovuta za thromboembolic, mankhwala a antiplatelet amalembedwa - acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
• Mankhwala othandizira antihypertensive pokhudzana ndi kupezeka kwa matenda ashuga a macroangiopathy ndikwaniritsa ndikusunga kuthamanga kwa magazi a 130/85 mm RT. Art. Chifukwa chaichi, wodwala amatenga zoletsa za ACE, okodzetsa. Ngati munthu wavutika ndi myocardial infarction, beta-blockers amayikidwa.

Malinga ndi ziwerengero, ndi mtundu 1 komanso mtundu wa 2 matenda a shuga, chifukwa cha zovuta zamtima mu mtima mwa odwala, amafa amachokera pa 35 mpaka 75 peresenti. Mu theka la odwalawa, kufa kumachitika ndi matenda obanika, mu 15 peresenti ya zomwe zimayambitsa matendawa ndi pachimake.

Pofuna kupewa kukula kwa matenda ashuga a macroangiopathy, ndikofunikira kuchita zonse zodzitchinjiriza. Wodwalayo amayenera kuwunika shuga nthawi zonse, kuyeza kuthamanga kwa magazi, kutsatira zakudya zochizira, kuyang'anira kulemera kwake, kutsatira malangizo onse azachipatala ndi kusiya zizolowezi zoyipa momwe angathere.

Mu kanema munkhaniyi, njira zochizira matenda ashuga a macroangiopathy a malekezikulu amakambidwa.

Macroangiopathy mu shuga mellitus - zoyambitsa ndi njira zamankhwala

Macroangiopathy mu shuga mellitus ndi gulu lodziwika bwino lomwe atherosulinosis ya mitsempha yayikulu imamveka. Matenda a shuga amayambitsa kukula kwa matendawa, omwe amaphatikizidwa ndi kuwonjezeka kwa shuga m'magazi. Pankhaniyi, njira zama metabolic, kuphatikizapo mafuta kagayidwe, zimakhudzidwa. Izi zimabweretsa mapangidwe a atherosselotic zolembera pamitsempha yamitsempha. Choyamba, mtima, ubongo ndi miyendo zimavutika.

Zina mwa zinthu zomwe zimatsogolera pakukula kwa matenda awa:

• Kulemera kwambiri
• Zizolowezi zoipa - kumwa ndi kusuta,
• Matenda oopsa
• Kapangidwe ka michere
• Mafuta akulu mtima,
• Zaka zopitilira 50
• Makamaka.

Kuphatikiza apo, pali zinthu zina zomwe zimakhudzana mwachindunji ndi chitukuko cha matenda ashuga. Izi ndi monga:

• Hyperglycemia,
• Kuchuluka kwa insulini - matendawa amatchedwa hyperinsulinemia,
• Zomwe zimachitika chifukwa cha mphamvu ya mahomoni - mkhalidwewu umatchedwa insulin kukana,
• Matenda A Impso Akutsatira Matenda A shuga
• Zambiri za matendawa.

Insulin imayambitsa mawonekedwe a cholesterol plaque ndi zidutswa za lipoprotein payekha. Izi zitha kukhala chifukwa cha kuwongolera makoma ochepa kapena kukhudzika kwa metabolidi ya lipid.

Matenda a shuga a macroangiopathy amatha kukhala ndi zosankha zingapo zachitukuko. Mtundu uliwonse wamatenda amadziwika ndi zina.

Ndi kuwonongeka kwa mitsempha yamtima, kupezeka kwa angina pectoris kumawonedwa. Kuphwanya uku kumalumikizidwa ndi kuphwanya njira zoperekera magazi. Imadziwonekera mu mawonekedwe a ululu mu sternum. Palinso chiopsezo chokhala ndi myocardial infarction komanso mtima wosalephera.

Njira zamtunduwu zimadziwika ndi mawonekedwe:

1. Kukanikiza, kuwotcha, kupondereza kupweteka mdera la mtima ndi kumbuyo. Pa gawo loyambirira la matendawa, matendawo amatuluka pokhapokha chifukwa cholimbikira. Zikamakula, kusapeza bwino kumakhalapo m'malo opanda phokoso ngakhale kugwiritsa ntchito mankhwala kuchokera ku gulu la nitrate.
2. Kupuma pang'ono. Poyamba, imawonedwa pokhapokha katundu, kenako pamtunda.
3. Kutupa kwamiyendo.
4. Kuwonongeka kwa mtima.
5. Kuchulukitsa kwa magazi.
6. Kuvulala kwamtima. Izi matenda nthawi zambiri zimawonedwa mu shuga. Izi zimachitika chifukwa cha kusayenda bwino kwa ulusi wamanjenje.

Kuwonongeka kwa ziwiya zamafuta zimatchedwa cerebrovascular pathology. Ndi chitukuko chake, mawonekedwe otere amawonekera:

1. Mutu.
2. Kuzindikira kwa ndende.
3. Chizungulire
4. Kuchepetsa kukumbukira.
5. Stroko Pansi pa mawuwa tikumvetsetsa kuphwanya kwamphamvu kwa magazi, komwe kumakhudza kumwalira kwa malo ena.

Matenda ashuga macroangiopathy a malekezero a m'munsi amakhala ndi mawonekedwe:

1. Ululu m'miyendo.
2. Zilonda zam'mimba. Akawoneka, umphumphu wa khungu umakhala wopanda pake.
3. Lameness.
4. Imfa ya minofu yofewa. Vuto lanjala likayamba, mwendo umakhala wakuda ndipo umataya zonse ntchito.

Cholinga cha chithandizo cha matenda amtunduwu ndikuchepetsa kukula kwa zovuta zochokera m'matumbo, zomwe zingayambitse kulemala kwa wodwala kapena kufa. Mfundo yayikulu yothandizira mankhwalawa ndikukonzanso koteroko:

• Hypercoagulation
• Hyperglycemia,
• Matenda oopsa
• Dyslipidemia.

Kupititsa patsogolo mkhalidwe wa munthu, mankhwala ochepetsa lipid ndi omwe amapatsidwa. Izi zikuphatikiza ma fibrate, ma statins, antioxidants. Chosafunika kwenikweni ndi kusunga kwa chakudya, komwe kumaphatikizapo kuletsa kudya nyama.

Pokhala ndi chiwopsezo chachikulu cha zotsatira za thromboembolic, ndikofunikira kugwiritsa ntchito antiplatelet agents. Izi zimaphatikizapo heparin ndi pentoxifylline. Madokotala nthawi zambiri amapereka acetylsalicylic acid.

Chithandizo cha antihypertensive chodziwitsa izi zimachitika kuti zitheke ndikukhalabe ndi nkhawa. Iyenera kukhalabe pamlingo wa 130/85 mm RT. Art. Kuti muthane ndi vutoli, ACE inhibitors, Captopril, amagwiritsidwa ntchito.

Mufunikanso kugwiritsa ntchito diuretics - furosemide, hydrochlorothiazide. Odwala omwe anali ndi vuto loyambitsa matenda osokoneza bongo amapatsidwa beta-blockers. Izi zimaphatikizapo atenolol.

Chithandizo cha trophic zilonda zam'mphepete ziyenera kuchitika moyang'aniridwa ndi dokotala. Pazowopsa zam'mitsempha, chisamaliro chachikulu chimaperekedwa. Ngati pali umboni, opaleshoni ingachitike.

Kuopseza kwa macroangiopathy kumanenedweratu mwa anthu omwe ali ndi matenda ashuga a 2. Chiwopsezo cha kufa chifukwa cha zovuta zamtunduwu ndi 35-75%. Mu theka la milandu, imfa imachitika chifukwa cha kulowerera kwa myocardial.

Chidziwitso chosavomerezeka ndi pamene magawo atatu a mtima - ubongo, miyendo, ndi mtima - zimakhudzidwa nthawi yomweyo. Zoposa theka la ntchito zonse zotsitsa zimagwirizanitsidwa ndi macroangiopathy.

Ndi kuwonongeka kwa miyendo, zolakwika zam'mimba zimayang'aniridwa. Izi zimapangitsa kuti pakhale kupangika kwa phazi la matenda ashuga. Ndi kuwonongeka kwa ulusi wamitsempha, mitsempha yamagazi ndi minofu yamafupa, necrosis imawonedwa ndipo njira za purulent zimawonekera.

Maonekedwe a zilonda zam'miyendo ya m'miyendo yakumbuyo kumachitika chifukwa cha kuzungulira kwamitsempha yama miyendo. Kofala kwambiri pagore ndiko chala chachikulu.

Ululu ndi kuwoneka kwa odwala matenda ashuga samawonekera kwambiri. Koma umboni ukawonekera, si bwino kuchedwetsa opareshoni. Ngakhale kuchedwetsa pang'ono kumakhala ndi machiritso a mabala omwe amakhala nthawi yayitali. Nthawi zina ndikofunikira kuchita kuchitanso opaleshoni yachiwiri.

Pofuna kupewa kuwoneka kwa matenda amenewa, malingaliro ambiri akuyenera kuonedwa:

1. Khalani ndi nthawi ya matenda ashuga
2. Tsatirani zakudya zomwe zimaphatikizapo kuletsa zakudya zama protein, chakudya, mchere komanso zakudya zamafuta,
3. Sinthani kulemera kwa thupi
4. Pewani kusuta ndi kumwa,
5. Chitani zolimbitsa thupi zolimbitsa thupi, zomwe sizipangitsa kuti maonekedwe a angina pectoris,
6. Tsiku lililonse kuyenda moyenda
7. Fotokozerani zamphamvu za lipid - kamodzi pa miyezi 6,
8. Chitani zotsatira zamphamvu za kuchuluka kwa shuga m'magazi - chizindikiro ichi chimayezedwa kamodzi patsiku.

Kukula kwa macroangiopathy mu matenda ashuga kumachitika kawirikawiri. Izi ndizowopsa zomwe zimawoneka ndikuwoneka zazotsatira zowopsa komanso zimatha kupha. Chifukwa chake, ndikofunikira kuchita nawo kupewa, ndipo ngati zizindikiro zikuwoneka, pitani kuchipatala msanga.

Kodi matenda ashuga a macroangiopathy: mafotokozedwe akuwonetsa a shuga

Odwala ambiri omwe ali ndi matenda ashuga ali ndi mitundu yonse yamatenda omwe amakumana ndi vuto lomwe limakhudza munthu komanso limakhudza ziwiya zonse ndi ziwalo. Chimodzi mwazovuta izi ndi matenda a shuga.

Chinsinsi cha matendawa ndikuti dongosolo lonse la mtima limakhudzidwa. Ngati ziwiya zochepa zokha zowonongeka, ndiye kuti matendawa amatchulidwa kuti ndi diabetesic microangiopathy.

Ngati ziwiya zazikulu zokhazokha zagwidwa, matendawa amatchedwa matenda ashuga macroangiopathy. Koma siliri vuto lokhalo lomwe wodwala matenda ashuga angakhale nalo. Ndi angiopathy, homeostasis imakhudzidwanso.

Chizindikiro Chokhudza Matenda Aakulu a shuga

Mukamaganizira za zazikulu za microangiopathy, zinthu zitatu zazikulu zimadziwika, zotchedwa Virchow-Sinako triad. Zizindikiro izi ndi ziti?

1. Makoma azombo amayenda.
2. Kuphatikizika kwa magazi kumakhala kusokonezeka.
3. Kuthamanga kwa magazi kumachepa.

Zotsatira za kuchuluka kwa ntchito ya magazi a m'magazi komanso kuchuluka kwa magazi, kumayamba kuchepa. Zida zathanzi zimakhala ndi mafuta apadera omwe samalola magazi kutsatira khoma. Izi zimathandizira kutuluka kwamagazi koyenera.

Zida zosokoneza sizitha kutulutsa mafuta awa, ndipo pamakhala kutsika kwa magazi. Zophwanya zonsezi zimangobweretsa kuwonongeka kwa mitsempha yamagazi, komanso mapangidwe a microtubus.

Pakupanga matenda a shuga, mtundu uwu wa kusinthika umaphatikizapo zombo zambiri. Nthawi zambiri gawo lalikulu lowonongeka ndi:

• ziwalo zamasomphenya
• myocardium
• impso
• zotumphukira zamanjenje dongosolo
• khungu mawonekedwe.

Zotsatira za kuphwanya izi, monga lamulo, ndi:

1. mitsempha
2. matenda ashuga nephropathy,
3. mtima
4. dermatopathy.

Koma zizindikiro zoyambirira zimawonekera m'munsi, zomwe zimayambika chifukwa chophwanya mitsempha yamagazi m'derali. Kulembetsa kwamilandu yotere ndi pafupifupi 65%.

Madokotala ena amakonda kunena kuti microangiopathy si matenda osiyana, ndiye kuti ndi chizindikiro cha matenda ashuga. Kuphatikiza apo, amakhulupirira kuti microangiopathy ndi zotsatira za neuropathy, zomwe zimachitika kale.

Asayansi ena amati mitsempha ya m'mimba imayambitsa neuropathy, ndipo izi siziphatikizidwa ndi kuwonongeka kwa mtima. Malinga ndi lingaliro ili, matenda a shuga amachititsa neuropathy, ndipo microangiopathy ilibe kanthu.

Koma palinso lingaliro lachitatu, omwe amatsatira omwe amati kuphwanya kwamanjenje kungathandizire mitsempha ya magazi.

Matenda a shuga a shuga a shuga amagawidwa m'mitundu ingapo, omwe amayamba chifukwa cha kuwonongeka kwakumapeto.

• Ndi zero zero yakuwonongeka khungu pakhungu la munthu kulibe.
• Mulingo woyamba - pali zolakwika zochepa pakhungu, koma sizikhala ndi zotupa ndipo zimangokhala zochepa patokha.
• Pa gawo lachiwiri, zotupa zowonekera kwambiri pakhungu zimawonekera zomwe zimatha kuzama kuti ziwononge tendon ndi mafupa.
• Gawo lachitatu limadziwika ndi zilonda za pakhungu ndi zizindikiro zoyambirira za kufa kwa minofu pamiyendo. Mavuto oterewa amatha kuchitika limodzi ndi njira zotupa, matenda, edema, hyperemia, abscesses ndi osteomyelitis.
• Pa mulingo wachinayi, gulu la chala chimodzi kapena zingapo zimayamba kukula.
• Gawo lachisanu ndi phazi lonse, kapena ambiri amakhudzidwa ndi gangrene.

Chochititsa chachikulu pakufa kwakukulu kwa odwala omwe ali ndi matenda ashuga ndi matenda ashuga macroangiopathy. Ndi macroangiopathy yomwe nthawi zambiri imapezeka mwa odwala matenda ashuga.

Choyamba, ziwiya zazikulu zam'munsi zimakhudzidwa, chifukwa cha momwe mitsempha yam'mimba komanso matenda ammimba imagwirira ntchito.

Macroangiopathy imatha kukulira njira yowonjezera kukula kwa matenda a atherosulinotic. Matendawa amagawidwa m'magawo angapo chitukuko.

1. Poyamba, m'mawa wodwalayo wawonjezera kutopa, thukuta kwambiri, kufooka, kugona, kumva kuzizira m'miyendo ndi kugona kwawo pang'ono. Izi zimawonetsera kubwezeretsedwa kwa kufalikira kwazungulira.
2. Mu gawo lachiwiri, miyendo ya munthu imayamba kugoneka, amasungika kwambiri, mawonekedwe akumisomali akuyamba kusweka. Nthawi zina lameness amapezeka pamenepa. Ndipo pamakhala kupweteka m'miyendo, poyenda komanso popuma. Khungu limakhala lotuwa komanso loonda. Zosokoneza m'malumikizidwe zimawonedwa.
3. Gawo lomaliza ndilopanda matenda a shuga kumapazi, zala ndi mwendo wotsika.

Macro ndi microangiopathy mu shuga amathandizidwanso chimodzimodzi. Choyambirira chomwe wodwala amayenera kuchita ndikubweretsa njira zamthupi za thupi kukhala zabwinobwino. Carbohydrate metabolism iyenera kubwezeretsedwanso, chifukwa ndi hyperglycemia yomwe ndiyomwe imayambitsa kukula kwa mitsempha ya mitsempha.

Chofunikanso kwambiri pakuthandizira mankhwalawa ndikuwunika momwe metabolidi a zamadzimadzi amagwirira ntchito. Ngati miloproteins yokhala ndi zizindikiro zotsika kwambiri imachulukana mwadzidzidzi, ndipo mlingo wa triglycerides, m'malo mwake, utachepa, izi zikusonyeza kuti ndi nthawi yophatikiza mankhwala a hypolipidic pamankhwala.

Tikulankhula za ma statins, ma fibrate ndi ma antioxidants.Macro- ndi microangiopathy mu matenda osokoneza bongo amachitidwa ndi kukakamizidwa kuphatikiza achire mankhwala a metabolic kanthu, mwachitsanzo, trimetazidine.

Mankhwalawa amathandizira kuti makutidwe ndi okosijeni a glucose mu myocardium, omwe amapezeka chifukwa cha oxidation wamafuta acids. Mankhwalawa onse amtundu wa matendawa, odwala amapatsidwa anticoagulants.

Awa ndimankhwala omwe amathandizira kuthetsa kuundana kwa magazi m'magazi ndikuchepetsa mphamvu ya maselo othandiza magazi akapezeka ndi macroangiopathy.

Chifukwa cha zinthuzi, magazi samakhala osasinthasintha ndipo mikhalidwe yotseka mitsempha yamagazi sinapangidwe. Ma Anticoagulants akuphatikizapo:

• Acetylsalicylic acid.
• Tiklid.
• Vazaprostan.
• Heparin.
• Dipyridamole.

Zofunika! Popeza matenda olembetsa magazi nthawi zambiri amakhala alipo m'matenda a shuga, ndikofunikira kupereka mankhwala omwe amathandizira magazi. Ngati chizindikirochi ndichabwinobwino, chikulimbikitsidwa kuti chizitha kuwunikira nthawi zonse.

Mu shuga mellitus, mulingo woyenera kwambiri ndi 130/85 mm Hg. Njira zowongolera zoterezi zikuthandizira kupewa kukula kwa nephropathy ndi retinopathy munthawi yake, kuchepetsa kwambiri kuopsa kwa matenda a stroko ndi mtima.

Mwa mankhwalawa, otsutsana ndi calcium njira, othandizira ndi zoletsa zina amadziwika.

Mankhwalawa, ndikofunikira kusintha zizindikiro za autonomic homeostasis. Chifukwa cha izi, madokotala amatipatsa mankhwala omwe amalimbikitsa ntchito ya sorbitol dehydrogenase. Ndikofunikanso kuchita ntchito zomwe zimalimbikitsa chitetezo cha antioxidant.

Inde, ndibwino kupewa matendawa poyamba. Kuti muchite izi, muyenera kukhala ndi moyo wabwino ndikuwunikira thanzi lanu nthawi zonse. Koma ngati zizindikiro za matenda ashuga zikuwonekera, muyenera kufunsa kuchipatala.

Njira zamakono zochizira matenda ashuga komanso kuthandizira kupewa zingathandize munthu kupewa zovuta zoyipa monga macro- ndi microangiopathy.

Onerani kanema: Kodi chifukwa chiyani cystitis imatha kuoneka ngati munthu ali ndi matenda ashuga?

1. 
   Matenda a chithokomiro mwa akazi amsinkhu wobereka. Kuwongolera kwa madokotala, GEOTAR-Media - M., 2013. - 80 p.
2. 
   Dreval A.V., Misnikova I.V., Kovaleva Yu.A. Kupewa kwa ma macrovascular mochedwa a mellitus a shuga, GEOTAR-Media - M., 2014. - 80 p.
3. 
   Akhmanov M. Wokoma wopanda shuga. SPb., Tessa Publishing House, 2002, masamba 32, kufalitsa makope 10,000.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka patsamba lino kuti athetse zovuta koma osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.