A shuga a retinopathy: zovuta zovuta za matenda ashuga

Matenda a shuga a retinopathy ndi njira ya ziwalo zamawonedwe zomwe zimachitika chifukwa cha hyperglycemia yomwe yakhalapo kwanthawi yayitali. Tizilombo toyambitsa matenda tomwe timatengera matenda a microvasculature (ma microaneurysms, zotupa m'mimba, zotupa, zotengera zatsopano), zomwe zimayamba chifukwa cha machitidwe a hypoxic, omwe, amayamba chifukwa cha dziko la hyperglycemic. Gawo loyambirira la zotupa popanda maphunziro apadera ndizovuta kuzindikira, mwanjira yodziwika, sizimapangitsa. Kuwonongeka kowoneka bwino (kapena khungu) ndi zizindikiro za matenda omwe apita kale, omwe sangathetsedwe.

Popewa kuwonongeka kawonedwe kameneka, anthu omwe ali ndi matenda ashuga amayenera kukaonana ndi ophthalmologist kamodzi pachaka ndikutsatira mosamalitsa zomwe awalimbikitsa. Zachidziwikire, kuti chithandizo chachikulu chimalimbana ndikuchepetsa shuga, magazi ndi ntchito zamagalimoto. Komabe, pakufunika kugwiritsa ntchito mankhwalawa omwe amakhudza ziwalo zamasomphenya. Chimodzi mwazithandizo zoterezi ndi madontho amaso malinga ndi Filatov, yomwe imakhala ndi zinthu zothandiza kupanga thupi zomwe zimathandizira kukhala ndi thanzi lamaso.

Amayang'aniridwa makamaka pakudya mavitamini a B (dokotala amatha kupereka mankhwala kwa makolo komanso pakamwa), komanso C, P ndi E, omwe ali ndi zinthu zambiri. Nthawi ndi nthawi, muyenera kumwa mankhwala omwe ali ndi tanthauzo lenileni la khoma la chotengera: Prodectin, dicinone, ndi zina zambiri.

Njira ina yowonjezera - laser coagulation ya retina - lingaliro lakumaso, kuletsa kupangika kwamitsempha yamagazi. Njirayi nthawi zina imabweretsa zovuta (mwachitsanzo, kukoka kwa magazi m'thupi la vitreous), komwe kumafunikira njira zina zochiritsira - kusintha kwa thupi la vitreous ndikusintha ndi njira yina yosabala.

Njira yatsopano yochizira retinopathy imawonekeranso - jekeseni wa choletsa wa endothelial vascular grow factor (ranibizumab) kulowa mkati mwa diso.

Wodwalayo, ndikumalingalira kuchokera pazomwe zanenedwaku, ayenera kumvetsetsa kuti njira zovuta zachipatala zitha kupewedwa ngati mutsatira malamulo oletsedwa a moyo wathanzi: osamadya kwambiri, kudya chakudya chopatsa thanzi, pewani zakudya zoyipa komanso muzichita masewera olimbitsa thupi pamlingo wabwino.

Momwe retinopathy imakhalira

Ndi matenda ashuga, ziwiya za retina zimasintha pang'onopang'ono. Popita nthawi, minyewa yovutikira ya ziwalo zowoneka imalandira mpweya wocheperako. Matenda a shuga a retinopathy amakula pang'onopang'ono, magawo amakhala mwachindunji ndi "zomwe adakumana nazo" odwala matenda ashuga. Chofunikanso ndi zaka za wodwala.

Mwa anthu ochepera zaka 30, mwayi wokhala ndi retinopathy umachulukitsa mpaka 50% patatha zaka 10 kuchokera ku matenda a endocrine. Pambuyo pa zaka 20 zodwala, chiopsezo chotsutsana ndi masomphenya ndi 75%.

Pang'onopang'ono shuga imawononga makhoma amitsempha yamagazi. Kulola kwawo kumakwera mpaka gawo lachilendo. Chifukwa cha izi, gawo lamadzi limatha kulowa m'malo osiyanasiyana pakati pa mitsempha ndi ma capillaries. Kutupa kwa retina, lipid complexes (zotulutsa zolimba) zimayikidwa mu minofu, kapena kungolankhula mafuta, omwe samayamwa bwino chifukwa cha kulephera kwa metabolic. Kusintha kofananako kumadziwika ndi gawo loyamba la matenda ashuga retinopathy. Amadziwikanso kuti maziko kapena osachita zambiri, zomwe sizovuta.

Kupita patsogolo

Popita nthawi, njira zowonongera zimayamba kutchuka. Pa gawo la kusintha kwatsopano, magawo ena a retina samalidwa kwathunthu kuchokera kumagazi. Apa, mawonekedwe ngati thonje amayamba kupanga. Amawonetsa minofu yam'madzi yam'maso. M'madera ena, zotupa zakumalo zimatha. Masamba omwe amachoka pantchito yowoneka amakhala akhungu.

Proliferative diabetesic retinopathy amadziwika kuti gawo laposachedwa mu zovuta za matenda ashuga. Mavuto oyendayenda akuwonjezereka. Zombo zonyansa zimayamba kukula pamtunda wa retina. Komanso ndi magawo omwe amatulutsa magazi nthawi zonse. Chifukwa cha izi, thupi lamphamvu limavutika, ndipo masinthidwe amayamba kuchepa.

Neoplasms, magazi, ndi zinthu zina zowonongeka zimayambitsa kuwonekera kwa minofu yaying'ono pamtunda. Zomeranso sizofanana ndi chiwalochi. Ma cicatricial conglomerates amayamba kugwira retina, ndikupangitsa kuti achulukane komanso asaone.

Mitundu ya matenda

Kugawidwa kwa matenda ashuga retinopathy kumaphatikizapo kugawanika kwa mtundu uwu wa zovuta za shuga m'mitundu iwiri. Amatchulidwa poyambapo, poganizira pathogenis ya matendawa. Zambiri pansipa.

1. Mbiri Yabwino Kwambiri
   Njira yamtunduwu wa pathological imadziwika ndi kusintha kwachilendo komwe kumachitika mu retina, koma sikuwoneka koyambirira. Fomuyi ndi yokhazikika mu "odwala matenda ashuga omwe ali ndi chidziwitso", nthawi zambiri amapezeka ali ndi zaka zambiri. Matendawa amadziwika ndi waulesi wamasomphenya
2. Proliferative retinopathy
   Chifukwa cha kuchuluka kwa kuperewera kwa oksijeni m'matupi, mawonekedwe am'mbuyo a retinopathy amatha kusintha nthawi iliyonse kukhala ophatikizika a pathology. Muubwana, kusintha kowonongeka komwe kumayambitsa kuwonongeka kwakukulu kwa mawonekedwe kumachitika pakapita miyezi. Kutsatira kwina kwa retinal kumayambitsa kuyamwa kwathunthu. Ndondomeko yowonjezera retinopathy yomwe imadziwika kuti ndi imodzi mwazomwe zimayambitsa kusowa kwamaso mu achinyamata ogwira ntchito.
   Magawo a chitukuko cha matendawa

Pali magawo atatu a shuga a retinopathy:

• Gawo loyamba. Kusintha kopanda phindu sikufunikira chithandizo chotere. Wodwalayo amawonedwa ndi dokotala mosalekeza. Masinthidwe amawonedwe samawonedwa. Malo akutali a ziwiya zazing'ono za retina,
• Gawo lachiwiri. Preproliferative retinopathy imadziwika ndi kusintha kwakukuru mu fundus. Sitimazo ndizovomerezeka kwambiri, ndipo kutuluka magazi pafupipafupi kumayambitsa kuwonongeka pang'onopang'ono kwa ntchito zowoneka,
• Gawo lachitatu. Matenda oopsa kwambiri komanso otsogola kwambiri amakhala obwera chifukwa cha kusasamala kwa wodwala ku thanzi lake, komanso kulephera kwa dokotala yemwe amayang'anira odwala matenda ashuga. Zombozo zimakhala zotsekeka kwathunthu, madera akuluakulu a retina "adafa". Zombo zankhondo motsutsana ndi maziko a "kufa" komaso kwa retina zimakula pamlingo wachilendo. Zotsatira zake ndi kuzungulira kwa khungu ndi khungu.

Zizindikiro za matenda a shuga a retinopathy

Matenda a shuga a retinopathy ndi matenda "osayankhula", zizindikiro zimapezeka kumapeto komaliza pamene kusintha kusintha. Mawonekedwe owonekera a matenda ashuga retinopathy akuphatikizapo:

• Ntchentche ndi mawanga omwe akuwoneka kuti "akuyandama" pamaso panu. Awa ndimagazi omwe amalowa mu thupi lamatupi. Wodwala akayang'ana gwero lililonse lowala, zimasokoneza kuzindikira.
• Kutukwana kowoneka popanda chifukwa. Wodwala matenda ashuga amatha kuvutika kuti awerenge lembalo pogwiritsa ntchito zinthu zazing'ono. Ichi ndi chizindikiro chowoneka bwino chowonetsa edema yowonjezereka,
• Chophimba chakuthwa pamaso pake ndi chizindikiro kuti magazi akutuluka.

Zizindikiro

Chithandizo cha retinopathy mu shuga, choyambirira, chimafuna njira zoyenera zowonera. Pofuna kutsutsa kapena kutsimikizira matendawa, pakufunika njira zingapo zodziwitsira:

• Kafukufuku wamaonekedwe (mawonekedwe oyipa) amakupatsani mwayi wowunika momwe mawonekedwe a retina alili pachuma,
• Kafukufuku wam'magetsi amaphunzira maselo amtsempha a retina, komanso mitsempha ya optic yokha,
• Kuyesa kwa Ultrasound kwa minofu ya maso,
• Ophthalmoscopy (kufufuza kwa fundus).

Anthu onse omwe amapezeka ndi matenda ashuga ayenera kukumbukira kuti nthawi zonse pamakhala zovuta za mitundu yonse. Kupewa mavuto ammaso kumakhala kosavuta kuposa kuyamba kulandira matenda a shuga. Odwala onse omwe ali ndi matenda ashuga amalimbikitsidwa kukaonana ndi ophthalmologist kamodzi pamiyezi isanu ndi umodzi chifukwa cha kuyeserera koyeserera. Dokotala azindikire kusintha komwe kungachitike ndikuchita zina zofunika.

Kuthana ndi Mavuto a shuga

Malinga ndi ziwerengero, mwaoposa 80% yazovuta zonse za anthu odwala matenda ashuga, ndizotheka kupewetsa khungu. Ndikofunikira kumvetsetsa kuti chiopsezo cha kuwonongeka kwa retinal sichimakhudzana ndi zaka za wodwalayo zokha komanso kutalika kwa matendawo omwe. Udindo wofunikira umachitika ndi kusinthasintha kwa shuga m'magazi ndi kuthamanga kwa magazi.

Odwala omwe ali ndi retinopathy yayikulu ayenera kukaona ofesi ya dokotala wa opaleshoni ya laser. Katswiriyu azitha kuzindikira mavuto akuluakulu munthawi ndikuwathetsa, pogwiritsa ntchito zomwe zikuchitika mu opaleshoni ya laser.

Njira imodzi yochitira opaleshoni ndi laser coagulation (laser cauterization). Chithandizo chotere cha matenda ashuga retinopathy chimapezeka m'magulu onse a odwala ndipo amakupatsani mwayi kuti muchepetse magazi.

Chofunika cha laser coagulation (cauterization)

Mchitidwewo umachitika pang'onopang'ono pansi pa mankhwala oletsa ululu. Pogwiritsa ntchito mtanda wa laser wopangira matenda a mtima, dokotalayo amapita patsogolo pazoyenera. Izi zimakupatsani mwayi wopewa kukha magazi mkati mwa mtsogolo komanso kuti musawonongeke. Nthawi yobwezeretsa ndiyochepa - osaposa sabata 1.

Vitrectomy - njira yomaliza

Pamaso pa kupatuka kwakukulu kuchokera ku chizolowezi, wodwala amawonetsedwa kuti ali ndi vuto. Kuchitapo kanthu kumawerengedwa kuti ndiyo njira yokhayo yopezekera kwa hemophthalmus (ngati hematoma yayikulu ikupezeka mu minofu).

Chotsani zidutswa zowonongeka za thupi lotseguka, yeretsani nembanemba kuchokera kumtunda wa retina. Komanso, mankhwala a neoplasms a minofu minofu ya retina amachitidwa. Dokotalayo, ngati zingatheke, abwezeretsa mawonekedwe olondola a retina.

Kulimbana ndi Maculopathy
Ngati retinopathy imayendera limodzi ndi kuwonongeka kwa gawo laling'ono la retina, mankhwalawa amathandizidwa ndi mankhwala. Pachifukwa ichi, jakisoni wa intravitreal imagwiritsidwa ntchito - mapangidwe apadera a mankhwala amachokera mu minofu, yomwe adokotala amasankha.

Njira zopewera

Matenda a shuga ndi matenda osachiritsika omwe mungathe kukhala nawo koma osachira. Kutsatira malamulo onse ndi malingaliro a dokotala yemwe akupezekapo, mutha kukhala moyo wautali komanso wopanda tanthauzo la matendawa. Odwala ayenera kuyang'anitsitsa shuga wawo wamagazi ndi kuthamanga kwa magazi. Mfundo ina yofunika ndi kuyeserera kwa mayeso nthawi zonse. Kusamalira thanzi lanu kumathandiza kupewa zovuta zovuta za shuga, kuphatikizapo matenda ashuga.

Kodi matenda ashuga retinopathy ndi ati?

Matenda a shuga a retinopathy ndi imodzi mwazovuta zazikulu za matenda ashuga. Matendawa, khungu la diso limavutika, lomwe limapangitsa kuti kuwala kuyambe kuyenda.

Kuwonongeka kumayambira pamigawo yaying'ono yamitsempha yamagazi, ma capillaries, kupereka retina ndi michere, chifukwa cha momwe ma cellensitive cell amafa "ndi njala".

Matenda a shuga a retinopathy amatha kuchitika ndi matenda amtundu wa 1 komanso matenda amitundu iwiri.

Njira zopangira matenda ashuga retinopathy

Maonekedwe a shuga a retinopathy amayamba chifukwa cha kusintha kwa khoma la ma capillaries a retina, ndiko kuti, timitsempha ting'onoting'ono ta magazi timene timanyamula magazi kupita ku retina.

Makamaka, zimachitika:

• Kuwonongeka kwa ma cell: i.e. maselo endothelial maselo ndi ma cell omwe amazungulira maselo a endothelial.
• Kutentha kwa ma capillaries: gawo lapansi pa capillaries, lomwe limatsogolera kutsitsa kwa mtsempha wamagazi ndikuchepetsa magazi.
• Zosintha pamalumikizidwe pakati pa maselo: kutayika kapena kuwonongeka kwa maubwenzi pakati pa maselo a endothelial kumapangitsa kufooketsa khoma lamitsempha ndikupangika kwa edema pamlingo wa retina.

Zowopsa ndi zotsatira za matenda ashuga retinopathy

Onse odwala matenda ashuga ali ndi chiopsezo cha matenda ashuga retinopathy. Komabe, pali zinthu zina zoopsa zomwe zimawonjezera mwayi wa chiphunzitsochi.

Zina mwamavuto omwe tili nawo:

• Kutalika kwa matenda ashuga: amaganiza kuti akapeza matenda ashuga mwa munthu wazaka 30, atatha zaka zisanu ali ndi mwayi 20% wokhala ndi retinopathy, patatha zaka khumi izi mwina zimawonjezereka mpaka 40-50%, ndipo pambuyo 15 - oposa 90%. Chifukwa chake, kutalika kwa matendawa, kumakhala kotenga matenda a retinopathy.
• Matenda a shuga operewera bwino: izi zikutanthauza kuti kuchuluka kwa shuga nthawi zambiri kumakhala ndi malire. Izi zimachitika pamene wodwala sagwiritsa ntchito mankhwala okwanira kapena safuna kusintha moyo wake.
• Kupezeka kwazinthu zina zowopsa: kupezeka kwakanthawi imodzi kwa zinthu zoopsa monga kusuta, mowa, matenda oopsa komanso kudya zamafuta ambiri kumapangitsa kuti matenda ashuga akhale ochepa.

Magawo a retinopathy: ochulukirachulukira komanso osachulukirachulukira

Matenda a shuga a retinopathy amatha kugawidwa m'magulu a kupita patsogolo, omwe amapita kumapazi ndi kuwonjezeka kwa zovuta zamatenda.

Pali magawo awiri akuluakulu:

Nonproliferative retinopathy: Imatchedwanso mtundu wosavuta komanso wowopsa wa retinopathy. Amadziwika ndi mapangidwe a ma micaneurysms, ndiko kuti, kukula kwa makoma a ziwiya, zomwe zimatsogolera kufooka kwawo ndikupanga mapangidwe a hemorrhages pamlingo wa retina ndi macular edema.

Exudate imawonekanso, chifukwa chake mawonekedwe awa amatchedwa exudative, amayamba chifukwa cha kutulutsa kwamadzi kuchokera m'matumbo chifukwa cha zovuta zomwe sizigwira ntchito pakhoma. Zinthu zotere panthawi yoyamba ndi zamtundu wokhazikika, ndiye kuti zimakhala ndi mafuta ndi mapuloteni, monga fibrin.

Proliferative retinopathy: iyi ndi gawo lotsogola kwambiri komanso lolimba kwambiri, lomwe limadziwika ndi kukhalapo kwa mitsempha yamagazi yowonjezereka yomwe imapanga kuti iwononge owonongeka.

The exudate pakadali pano ali ndi mtundu wofatsa, amafanana ndi zidutswa za ubweya wa thonje, ndipo amapangidwa nthawi ya ischemia m'malo osiyanasiyana a retinal ulusi ndi kudziunjikira kwa endoplasmic zakuthupi zomwe zimadutsa endothelium yowonongeka.

Zida zatsopano, zomwe zimapangidwa kuti ziwathandize magazi kumadera a ischemia, zimakhala ndi makoma osalimba komanso osweka mosavuta, zomwe zimatsogolera pakupanga kwamatumbo. Komanso, mawonekedwe amtundu wa retina chifukwa cha kulumikizidwa kosalekeza kwa zotengera izi, izi zimatha kudziwa makina oyipa ndi kupindika kwake.

Mankhwala a shuga a retinopathy

Pakati pazinthu zatsopano zamankhwala zomwe zimagwiritsidwa ntchito pochiza matenda ashuga retinopathy, jakisoni wa intravitreal uyenera kuzindikirika. Ndi mankhwalawa, mankhwalawa amalowetsedwa mu malo a vitreous ndi singano, omwe amachepetsa mapangidwe amitsempha yatsopano yamagazi.

Mwa mankhwala omwe amagwiritsidwa ntchito nthawi zambiri:

• Kukonzekera kwa Anti-VEGF: Avastin ndi Lucentis ali m'gulu lino.
• Corticosteroids: triamcinolone ndi dexamethasone. Amagwiritsidwa ntchito chifukwa cha mphamvu yawo yotsutsa-yotupa, yomwe imachepetsa mapangidwe a edema.

Kuti musinthe maonedwe, mutha kugwiritsa ntchito magalasi ndi magalasi omwe amachepetsa kuwala ndikuwongolera machitidwe owunikira.

Gulu

Kutengera ndi gawo la matendawa, momwe masinthidwe am'magazi m'matumbo, komanso minyewa ya diso, gulu lotsatirali limalandiridwa:

• Matenda a shuga
• Prerolopathy matenda a shuga
• kuchuluka odwala matenda ashuga retinopathy.

Njira yopititsira patsogolo

Gwero lalikulu lamphamvu yogwira ntchito mokwanira ndi thupi la glucose. Mothandizidwa ndi insulin, timadzi ta kapamba, glucose timalowa m'maselo momwe timakonzekera. Mu shuga mellitus, pazifukwa zina, kuphwanya insulin katulutsidwe kumachitika. Shuga wosakonzedwa amadzaza m'magazi, chifukwa chomwe metabolic metabolism m'thupi amasokonezeka. Zimabweretsa kufalikira, kuwonongeka kwa mitsempha yamagazi ya ziwalo zosiyanasiyana, kuphatikizapo ziwalo zamasomphenya. Ngati kukonza kwa glucose okwanira mwa odwala omwe ali ndi matenda osokoneza bongo sikungayambike panthawi, ndiye kuti matenda a shuga amayamba kukula.

Zomwe zimachitika

Choyambitsa chachikulu cha matenda ndi kuchuluka kwa shuga m'magazi (shuga) kwa nthawi yayitali.

Nthawi zambiri, kuchuluka kwa shuga m'magazi sikuyenera kukwera pamwamba pa 5.5 mmol / L pamimba yopanda kanthu komanso 8.9 mmol / L atatha kudya.

Kuphatikiza apo, kupezeka kwa zinthu zothandizanso kwa odwala omwe ali ndi matenda a shuga kumakhudzanso kuchuluka kwa retinopathy. Sangathe kupangitsani kupangika koteroko, komanso kuwonjezera njira yake.

• kuchuluka kwa magazi
• kulimbitsa matenda oopsa (kuthamanga kwa magazi),
• mimba
• matenda osiyanasiyana a impso,
• onenepa kwambiri
• kusuta
• mowa
• zosintha zokhudzana ndi zaka mu mtima
• chibadwa kutsimikiza.

Mankhwala othandizira

Anthu omwe ali ndi matendawa ayenera kutsatira zakudya zoyenera, yomwe ndi njira imodzi yayikulu yovuta yogwiritsira ntchito.

Pazakudya musatchule:

• shuga, m'malo mwake ndi m'malo mwa (xylitol, sorbitol),
• kuphika ndi kuwononga makeke,
• mkate woyamba ndi woyamba
• nyama yamafuta, nsomba,
• zotsekemera zotsekemera ndi ma curds, zonona,
• ankasuta nyama
• pasitala, semolina, mpunga,
• mafuta msuzi, msuzi wophika mkaka ndi chimanga, Zakudyazi,
• zokometsera zotentha, msuzi, zonunkhira,
• zakumwa zozizilitsa kukhosi komanso zopanda mpweya, zakumwa, kuphatikizapo mphesa,
• wokondedwa, ayisikilimu, kupanikizana

• imvi, mkate wabwino kwambiri, komanso buledi
• Mitundu yamafuta ochepa nyama, nkhuku, nsomba - yophika ndi michere,
• nguluwe, oat, kapena barele ya ngale (chifukwa cha kuletsa mkate),
• tsiku lomwe simuyenera kudya mazira awiri kapena owiritsa,
• tchizi, wowawasa wowawasa m'mitundu yambiri,
• zipatso, monga ma cranberries, blackcurrant kapena zipatso zosafunikira, maapulo osagwiritsidwa ntchito, koma osaposa magalamu 200 patsiku,
• phwetekere ndi zipatso zina zopanda zipatso ndi mabulosi,
• khofi imayenera kusinthidwa ndi chicory.

Chofunika kwambiri ndi phytodiet. Odwala omwe ali ndi matenda osokoneza bongo, acidization amapezeka m'thupi, chifukwa chake kugwiritsa ntchito masamba omwe ali ndi alkalizing akulimbikitsidwa:

Imwani kapu ya birch mu theka lagalasi mpaka katatu patsiku, mphindi khumi ndi zisanu musanadye.

Mankhwala

Mankhwala, malo akuluakulu amakhala:

• magazi cholesterol kutsitsa mankhwala
• anabolic steroids
• antioxidants
• mavitamini
• angioprotectors
• immunostimulants
• zopatsa mphamvu za biogenic,
• michere
• kukana mankhwala
• coenzymes ndi ena.
• Hypocholesterolemic mankhwala:
• kumachikon
• missterron.

Mankhwalawa amalimbikitsidwa kuti azigwiritsidwa ntchito mu matenda a shuga a retinopathy, omwe amapezeka pamodzi ndi atherosulinosis.

• Angioprotectors:
• zilonda zapakhosi
• Parmidin
• Doxium
• Dicinone "kapena" Etamsylate,
• wamkulu
• pentoxifylline.
• Zochizira za prroliferative gawo la matenda, mankhwalawa "Phosphaden" amagwiritsidwa ntchito, omwe amasintha hem hemnamics, zomwe zimachitika chifukwa cha fundus komanso zimapangitsa kagayidwe kachakudya.
• Mphamvu ya immunomodulating kumayambiriro kwa matendawa imatheka chifukwa chogwiritsa ntchito piritsi la Levomesil, ndi jakisoni Tactivin ndi Prodigiosan.
• Mavitamini a gulu B, C, E, R.
• Kubwezeretsa ndikuwongolera kagayidwe kazinthu m'maso: kukonzekera "Taufon", "Emoksipin".
• Intraocular makonzedwe a enzyme kukonzekera "Lidaza", "Gemaza" amagwiritsidwa ntchito pamaso pa zotupa zotupa.

Kuti mupeze zotsatira zabwino zamankhwala, mutha kugwiritsa ntchito Magalasi a Sidorenko, chipangizo cholimbitsa thupi chomwe ndi chofunikira kugwiritsa ntchito kunyumba, komanso kusintha magazi.

Tsoka ilo, chithandizo cha mankhwala chitha kukhala chothandiza magawo oyamba a mtundu wa retinopathy. Pakapita nthawi chitukuko chake, mankhwala a laser amagwiritsidwa ntchito.

Kuphatikiza kwa laser kumakupatsani mwayi kuti muchepetse kapena ngakhale kuyimitsa kuchuluka kwa zombo zomwe zangopangidwa kumene, kumalimbitsa makoma awo ndikuchepetsa kuperewera. Kuthekera kwa kukanidwa kwa retinal kumachepetsedwa.

Ndi mawonekedwe apamwamba a matenda a shuga a retinopathy, opaleshoni ndiyofunikira - vit sahihi.

Kutulutsidwa kwa zoopsa: kukhazikika kwa kulemera kwa thupi, chithandizo cha matenda oopsa, kukana mowa komanso kusuta kumathandizira kubwezeretsa njira za metabolic, kumawonjezera zotsatira zamankhwala.

Kodi retinopathy ndi chiyani?

Pathogenesis yakukula kwa vuto lalikulu chonchi imasokoneza kwambiri komanso imapangitsa chidwi chambiri.

Zotsatirazi zimapangitsa gawo lalikulu pakukhumudwitsidwa kwamawonedwe:

1. Microangiopathy. Matenda oopsa a hyperglycemia amakhumudwitsa scerosis ya arterioles ndi ma venass, chifukwa chomwe sclerosis yawo imachitika komanso kufalitsidwa kwa magazi muwonetsedwe koipa kumakulirakulira. Retina salandira magazi okwanira. Kulimbitsa thupi kumawonjezera kutuluka kwamadzimadzi, komwe kumawononga ma microvessels ndikuwatsogolera kuvulaza.
2. Kuchulukana kwa malowedwe a capillary. Poterepa, zinthu zambiri zomwe sizimatha kulowa m'maso zisanafike pomwepo zimayendetsedwa molimbika kumeneko. Izi zimagwiranso ntchito poizoni ndi mankhwala ena osafunikira.
3. Kuwonongeka kwokhazikika kwa kapangidwe ka magazi kumapangitsa njira ya neovascularization kuyambitsa - kupanga ma arterioles atsopano. Amakhala ofooka kwambiri kuposa masiku onse, motero, zochitika za hemorrhage zimakhala pafupipafupi.

Pamapeto pake, pakalibe chithandizo chokwanira chamankhwala, retinopathy mu matenda ashuga amapita patsogolo kuti athetse kuona.

Matenda a shuga a retinopathy

Diabetesic retinopathy ndi vuto lakumapeto kwenikweni kwa matenda ashuga, onse omwe amadalira insulin komanso osadalira insulini. Mu ophthalmology, matenda ashuga retinopathy amachititsa kuwonongeka kwa odwala omwe ali ndi matenda ashuga a 80-90% milandu. Mwa anthu omwe ali ndi matenda ashuga, khungu limakula ka 25 kawiri kuposa oyimira ambiri. Pamodzi ndi matenda ashuga a retinopathy, anthu omwe ali ndi matenda ashuga ali ndi chiopsezo chachikulu cha matenda a m'matumbo, matenda a shuga, polyphary, nephropathy, matenda am'mimba Chifukwa chake, mankhwalawa a matenda a shuga amafunika njira zingapo, kuphatikizapo kutenga nawo mbali kuchokera kwa akatswiri kuchokera ku endocrinologists (a diabetes), ophthalmologists, cardiologists, podologists.

Zoyambitsa ndi Zoopsa

Kupanga kwa chitukuko cha matenda ashuga retinopathy kumalumikizidwa ndi kuwonongeka kwa mitsempha yamitsempha yamagazi (ma cell a retina): kuchuluka kwawo kwachulukidwe, kuchuluka kwa capillaries, mawonekedwe a ziwiya zatsopano komanso kukula kwa minofu yowonjezereka.

Odwala ambiri omwe ali ndi nthawi yayitali matenda a shuga amakhala ndi zizindikiro kapena zina zowonongeka ku fundus. Ndi nthawi yayitali ya matenda a shuga mpaka zaka 2, matenda a shuga a retinopathy amapezeka pamlingo wina kapena wina mu 15% ya odwala, mpaka zaka 5 - mu 28% ya odwala, mpaka zaka 10-15 - mu 44-50%, pafupifupi zaka 20-30 - mu 90-100%.

Zowopsa zomwe zimakhudza pafupipafupi komanso kukula kwa matenda ashuga retinopathy zimaphatikizapo kutalika kwa matenda ashuga, hyperglycemia, matenda oopsa, kulephera kwa impso, dyslipidemia, metabolic syndrome, ndi kunenepa kwambiri. Kukula ndi kupitilira kwa retinopathy kumatha kuthandizira kutha msinkhu, kutenga pakati, chibadwa chamtsogolo, komanso kusuta.

Popeza kusintha komwe kumachitika mu fundus, kusakhudzana, kuchuluka kwa odwala komanso odwala matenda ashuga retinopathy kumasiyanitsidwa.

Mankhwala okweza, osayendetsedwa bwino m'magazi amayambitsa kuwonongeka kwa mitsempha yamagazi ya ziwalo zosiyanasiyana, kuphatikizapo retina. Mu gawo losakulitsa la matenda ashuga retinopathy, makoma amitsempha ya m'mimba amathandizika ndipo amakhala osakhazikika, komwe kumayambitsa hemorrhages, mapangidwe a micaneurysms - kuchepa kwamitsempha yam'mbali. Magazi ochepa amanjoya kudzera m'mitsempha yolowera m'matumbo kupita mu retina, zomwe zimapangitsa kuti akhale ndi edema. Pankhani yokhudzana ndi gawo la chapakati pa retina, macular edema amakula, zomwe zimapangitsa kuti masomphenyawo athe kuchepa.

Mu gawo la prroliferative, ischemia yopita patsogolo imayamba chifukwa cha kuchepa kwa matenda a arterioles, kugunda kwamtima kwa hemorrhagic, matenda a venous.

Preproliferative diabetesic retinopathy imayamba gawo lotsatira, lomwe limapezeka mu 5-10% ya odwala matenda a shuga. Zomwe zimapangitsa kuti pakhale kuchuluka kwa odwala matenda ashuga retinopathy akuphatikizika ndi myopia yayikulu, kuchuluka kwa mitsempha ya carotid, patterior vitreous detachment, optic atrophy. Pakadali pano, chifukwa cha kuchepa kwa mpweya wa okosijeni wa retina, zotengera zatsopano zimayamba kupangika kuti zikhale ndi mpweya wokwanira. Mchitidwe wa neovascularization wa retina umabweretsa kubwerezabwereza kwa preretinal ndi retrovitreal hemorrhages.

Nthawi zambiri, kutaya magazi pang'ono m'magawo a retina ndi vitreous thupi kumadziyimira palokha. Komabe, ndimatumbo akulu am'magazi am'maso (hemophthalmus), kuchuluka kosasintha kwa microus mu thupi lotakasuka kumachitika, kodziwika ndi kuphatikizika kwa fupa komanso kumangika, komwe pamapeto pake kumayambitsa kukokoloka kwamatumbo. Mukatseka njira ya HPV, glaucoma yachiwiri imayamba.

Matenda a shuga a retinopathy

Pamodzi ndi mfundo zambiri zochizira retinopathies, mankhwalawa amaphatikiza kukonza kwa kagayidwe kachakudya, kukhathamiritsa kwa kayendetsedwe ka glycemia, kuthamanga kwa magazi, kagayidwe ka lipid. Chifukwa chake, panthawiyi, chithandizo chachikulu chimadziwika ndi endocrinologist-diabetesologist ndi mtima.

Kuwunikira mosamala kuchuluka kwa glycemia ndi glucosuria, kusankha kwa insulin yokwanira kwa matenda a shuga kumachitika, angioprotectors, antihypertensive mankhwala, antiplatelet othandizira, etc. amatumizidwa. Intravitreal jakisoni wa mankhwala am'madzi amathandizira kuchitira macular edema.

Odwala omwe ali ndi matenda ashuga apamwamba a retinopathy amawonetsedwa chifukwa cha laser retinal coagulation. Kuphatikizika kwa laser kumakupatsani mwayi woponderezera njira ya neovascularization, kuti mukwaniritse kuthana ndi mitsempha yamagazi ndi kuwonjezereka kwa fragility ndi kupenyerera, kuti mupewe chiopsezo cha kufinya.

Opaleshoni ya laser retina ya matenda ashuga retinopathy amagwiritsa ntchito njira zingapo zingapo. Kuletsa kwa laser kukondoweza kwa retina kumakhudzanso kugwiritsa ntchito mitundu ina ya "latisi", m'mizere ingapo, ndipo akuwonetsedwa mwanjira ina yopanda retinopathy ya macular edema. Focal laser coagulation imagwiritsidwa ntchito pouterize micaneurysms, exudates, ndi zotupa zazing'ono zowululidwa nthawi ya angiography. Mukukonzekera kwa panretinal laser coagulation, ma coagulates amawagwiritsa ntchito mu retina, kupatula dera la macular, njirayi imagwiritsidwa ntchito makamaka pa siteji ya prolliferative kuti isapitirire.

Ndi mawonedwe ophatikizika amaso, njira yina ya kuwala kwa laser ndi transscleral cryoretinopexy, kutengera kuzizira kwa ziwalo zam'mimba za retina.

Pankhani ya zovuta zowonjezereka za matenda ashuga retinopathy ophatikizika ndi hemophthalmus, macular traction kapena retinal detachment, vitrectomy amatengedwa kuti, pomwe magazi, thupi la vitreous limachotsedwa, minyewa yolumikizira minofu imadulidwa, mitsempha yotulutsa magazi imatenthedwa.

Magawo a shuga a retinopathy

Matenda a shuga a retinopathy amakhala ndi magawo angapo. Gawo loyambirira la retinopathy limatchedwa non-proliferative, ndipo limadziwika ndi mawonekedwe a micaneurysms omwe amakulitsa mitsempha, mawonekedwe a hemorrhages m'maso mu mawonekedwe a mawanga ozungulira akuda kapena mikwingwirima yakusweka, mawonekedwe a ischemic retinal madera, retema edema kudera lam'mapapo, komanso kuchuluka kwachulukidwe ndi kuwonongeka kwa makoma a chotengera. Mwanjira imeneyi, kudzera mu ziwiya zowonda, gawo lamadzi limalowa mu retina, zomwe zimatsogolera pakupanga edema. Ndipo ngati gawo lapakati la retina likuchita nawo njirayi, ndiye kuti kuchepa kwamawonedwe kumawonedwa.

Tiyenera kudziwa kuti matenda amtunduwu a shuga amatha kuchitika pagawo lililonse la matendawa, ndipo akuimira gawo loyambirira la retinopathy. Ngati sichichiritsidwa, ndiye kuti nthenda yachiwiri ya matendawa imachitika.

Gawo lachiwiri la retinopathy ndilowonjezereka, lomwe limayendera limodzi ndi zovuta m'magazi a retina, zomwe zimabweretsa kuchepa kwa okosijeni mu retina (njala yokhala ndi mpweya, ischemia). Kubwezeretsa kuchuluka kwa oxygen, thupi limapanga mitsempha yatsopano ya magazi (njirayi imatchedwa neovascularization). Zombo zatsopano zomwe zimapangidwa zimawonongeka ndikuyamba kutuluka, chifukwa chomwe magazi amalowa mu Vitreous nthabwala, zigawo za retina. Zotsatira zake, mawonekedwe osayenda akuwoneka m'maso motsutsana ndi maziko am'maso akuchepa.

M'mapeto a retinopathy, popitiliza kukula kwa ziwiya zatsopano komanso minyewa yochepa, zimatha kuyambitsa khungu komanso kukula kwa khungu.

Cholinga chachikulu cha matenda a shuga a retinopathy ndi osakwanira, omwe amatsogolera kuchuluka kwa fructose ndi sorbitol, omwe amachititsa kukakamizidwa, amakulitsa makoma a capillaries ndikuchepetsa mipata yawo.

Chitetezo cha matenda a shuga a retinopathy

Kupewera kwa retinopathy ndikusunga kuchuluka kwa shuga m'magazi a anthu odwala matenda ashuga, kulipidwa kwabwino kwa kagayidwe kazakudya, kayendedwe ka magazi, kukonza lipid metabolism. Izi zimakuthandizani kuti muchepetse zovuta m'maso.

Zakudya zoyenera komanso kuchita masewera olimbitsa thupi nthawi zonse zimakhudza kwambiri odwala omwe ali ndi matenda ashuga. Ndikofunikanso kukayezetsa pafupipafupi ndi a ophthalmologist. Kupewera kwakanthaŵi kwa matenda ashuga retinopathy ndi kuwonongeka kwa maso ndikofunikira kwambiri. Popeza mtsogolomo matendawo, chithandizo sichothandiza.Komabe, chifukwa chakuti magawo oyamba a retinopathy, kusokonezeka kowonekera sikumawonedwa, odwala amafunafuna thandizo pamene kukha magazi kwakutali ndi kusintha kwapakati pa retina zikuchitika.