Chithandizo chachikulu cha matenda ashuga: Zizindikiro zisanu

Matenda a shuga mellitus (DM) ndi amodzi mwa matenda ofala kwambiri obwera chifukwa chazachuma, kwachuma komanso kwazonse. Kafukufuku wowerengeka akuwonetsa chiopsezo chowonjezeka cha zovuta za nkhawa kwa odwala omwe ali ndi matenda a shuga a 2, 6. M'maphunziro a matenda opatsirana, kuwunika kwa zovuta kumachitika pogwiritsa ntchito milingo yodziwitsa, yomwe siyimaperekanso lingaliro lomveka la nosology yamavuto omwe amafunsidwa.

Ntchito zambiri zapanyumba ndi zakunja ndizodzipereka pakuphunzira kukhudzidwa kwa odwala omwe ali ndi matenda a shuga 3, 9. Komabe, zimakhazikitsidwa kuti nkhawa zimayambira kukula kwa kukhumudwa, makamaka kwa odwala omwe ali ndi matenda amtundu wa 2 m'matenda a 50%, ndi zovuta zopanda nkhawa zopanda nkhawa zimapezeka mwa 60% ya odwala matenda a shuga Mitundu iwiri. Izi zikugogomezera kufunikira kwakudziwitsa nkhawa, kuzindikira gawo lazodandaula kapena zovomerezeka zamtundu wothandizira kuti tipewe zochitika zovuta kwambiri zachipatala.

Kukhalapo kwa matenda okhumudwitsa omwe akuwonjezera nkhawa kumawonjezera chiwopsezo cha kukula ndi kupitilira kwa zovuta za matenda ashuga: matenda oopsa, matenda a mtima ndi matenda a sitiroko, omwe ndi omwe amafa kwambiri mwa odwala. Komabe, vuto lakuwona zovuta zamavuto kwa odwala omwe ali ndi matenda ashuga koyambirira sali kuthetsa.

Cholinga cha kafukufuku

Kutengera ndi zomwe tafotokozazi, cholinga cha phunziroli chinali kuzindikira zovuta zamatenda ndi psychopathological zamavuto omwe akudwala omwe ali ndi matenda a shuga a 2 komanso ubale wawo ndi magawo a matenda a endocrine.

Njira zakuthupi ndi kafukufuku

Kafukufuku wokhudzana ndi zamankhwala-psychopathological ndi matenda othandizira odwala matenda amisala anachitika pakati pa odwala 103 omwe ali ndi matenda a shuga a 2 omwe ali ndi zizindikiro za nkhawa, omwe azimayi 86 (83,6%) ndi amuna 17 (16.4%), omwe ali ndi zaka 53.8 Years zaka 6.3.

Odwala adalandira chithandizo cha inpatient m'madipatimenti apadera a endocrinology kuyambira 2007 mpaka 2010. Kuzindikirika kwa matenda amtundu wa 2 kunatsimikiziridwa malinga ndi mfundo za WHO (1999) ndi endocrinologists. Odwala onse adapereka chidziwitso chokwanira kuti atenge nawo mbali phunziroli.

Odwala a pakati, achikulire kwambiri azaka zapakati pa 44 mpaka 59 (anthu 72, 69.9%) anapambana. Kuyenerera kwapamwamba kwa gulu lophunziridwa la odwala omwe ali ndi matenda a shuga adadziwika (sekondale yapadera - 56.3%, apamwamba - 12,6%), kuwonetsa kuti odwala ndi nthumwi za chikhalidwe chofunikira kwambiri. Maphunziro osakwanira sekondale ndi sekondale adawonedwa mu 32 (31.1%) ya omwe adawunika. Ambiri mwa odwala anali okwatira (anthu 84, 81.6%), umasiye unawonedwa mu 13.6%, osakwatiwa - 4.8%.

Kutalika kwa matenda ashuga kunayamba kuyambira mwezi umodzi mpaka zaka 29 ndipo zaka zapakati pa 10 ndi ± 0,5. Kutalika kwa matenda ashuga ochepera zaka 10 kumawonedwa mwa odwala 54 (52.4%), opitilira zaka 10 - mwa odwala 49 (47.6%). Olamulidwa ndi odwala omwe ali ndi zovuta komanso zovuta za matenda a shuga - 77 ndi 21 (74.8% ndi 20.4%), motero. Kuzonda kwamphamvu kwambiri kwa shuga kunawonedwa mwa anthu 5 (4.8%).

Njira yayikulu yofufuzira inali yachipatala-psychopathological. Kuwunika kwa nosological kwamilandu yomwe idawonedwerako kunachitika molingana ndi njira yodziwira matenda omwe amatsata mu psychiatry yaku Russia. Kuzindikira matenda osokoneza bongo kunachitika pogwiritsa ntchito njira za ICD-10. Poyesa kuwuma kwa vutoli, njira yachipatala ya psychometric idagwiritsidwa ntchito pogwiritsa ntchito masikelo a Hamilton pakuwunika nkhawa (Hars) ndi kukhumudwa (HDRS-17).

Zomwe zidapezedwa zidasinthidwa ndi njira zowerengera zotsatirazi: kusiyana kwa ma intergroup kudawerengedwa pogwiritsa ntchito chitsimikizo cha Kolmogorov-Smirnov, ndipo kusiyana kwamagulu angapo komwe kunawerengedwa pogwiritsa ntchito mayeso a Kruskal-Wallis, malumikizidwe a mtundu wa Spearman, kusanthula kwa njira imodzi ya ANOVA kunagwiritsidwa ntchito kusanthula kudalirana kwa otchulidwa. Kusanthula kwamasamba kunachitika pogwiritsa ntchito pulogalamu iyi Statistica 6.0.

Anthu omwe ali ndi magawo ena a zovuta za carbohydrate metabolism (matenda ashuga chifukwa cha majini, matenda a kapamba, matenda a endocrine, matenda ashuga azimayi apakati), matenda a mtima, kulephera kwa aimpso, mbiri yamikwingwirima, kugunda kwa mtima, komanso kupweteka kwamtundu wina wamtunduwu sikunaphatikizidwe kuchokera ku zitsanzo. komanso odwala omwe ali ndi matenda oopsa a m'maganizo monga psychos amkati, kusokonezeka kwa umunthu, kusokonezeka kwa malingaliro ndi chikhalidwe chifukwa chogwiritsa ntchito zinthu zama psychoactive zachilengedwe, kubwezera m'maganizo.

Zotsatira zakufufuza

Malinga ndi main diagnostic (ICD-10), odwala omwe ali ndi nkhawa yosokonezeka ndi nkhawa (F41.2) - 39.8% ndi nkhawa yonse (F41.1) - 32.0% yolamulidwa. Monga gawo la zovuta zosinthika, nkhawa yosakanikirana ndi kukhumudwa (F43.22) kudadziwika mu odwala 12 (11.7%) ndi zina zomwe zimapangitsa kupsinjika kwakukulu (F43.8) mwa odwala 17 (16.5%), pomwe zotsatira zamkati mwa thupi zimayesedwa kuyambika chifukwa cha matenda oopsa a somatic. Matenda a shuga chifukwa cha kusowa kwa njira za etiopathogenetic pamankhwala amachitika monga zopweteka.

Anthu omwe amakhala ndi nkhawa nthawi yayitali kuyambira miyezi isanu ndi umodzi mpaka zaka ziwiri (anthu 57, 55.3%) adakula, mwa 32 (31.1%) odwala nthawi yayitali yodutsa miyezi 6, ndipo 14 (13.6%) - anali wazaka zopitilira 2.

Mwa zina mwazovuta za nkhawa, kutopa (kutopa, kufooka, kutopa kwambiri) kudalembedwa kawirikawiri - odwala 94 (91.3%), kusokonezeka tulo, kugona tulo (kugona "tulo"), kugona tulo mosagonja ndi kudzutsidwa pafupipafupi - 91 (88.3%), kuchuluka kwa kusokonekera ndi kusapilira - 90 (87.4%), thukuta kwambiri - 85 (82,5%), kupweteka kapena kusasangalala pachifuwa - 83 (80.6%), kupweteka kwa mutu ndikumverera kusokonezeka - 82 (79.6%), nkhawa yokhala ndi chisangalalo chamkati, nkhawa komanso kulephera kumasuka - 82 (79.6%), amavutika moganizira chidwi - 78 (75.6%) odwala. Madandaulo awa atha kugwiritsidwa ntchito pozindikira msanga zovuta za nkhawa kwa odwala omwe ali ndi matenda a shuga a 2 ndi akatswiri wamba kuchipatala chomwenso.

Mlingo wa nkhawa pamlingo wa Hamilton pagulu loyesedwa la odwala amachokera ku 11 mpaka 38 mfundo, pafupifupi - 24.1 ± 0,5 point. Mulingo wa kukhumudwa pamawonekedwe a Hamilton unachokera ku mfundo zitatu mpaka 34, avareji ya 16.1 ± 0,5 mfundo. Zosanthula za crelation zinaonetsa mgwirizano pakati pa mulingo wa nkhawa komanso kutha kwa kuvutika maganizo (r = 0.72, p.

1. hemoglobin yanu ya glycated nthawi zonse imakhala pansi pa 7%

Kuyeza kumeneku kumayesa kuchuluka kwa shuga m'magazi anu miyezi iwiri yapitayi. Nthawi zambiri mwa anthu opanda matenda a shuga amakhala ochepera 5.7%, ndipo mwa anthu omwe ali ndi prediabetes kuyambira 5.7 mpaka 6.4%.

Ndipo ngakhale mukuganiza kuti Zizindikiro pamwamba 6.4% zidzavulaza thanzi lanu, mukulakwitsa. Cholinga chakuwongolera shuga sikumawachepetsa mpaka kukhala owopsa. Ndi kuchepetsa izi kuti mupewe kukula kwa zovuta zowopsa.

Ichi ndichifukwa chake akatswiri ochokera ku European Community of Endocrinologists amakhulupirira kuti kwa munthu amene ali ndi matenda a shuga a 2, mtundu wa hemoglobin wa glycated ndi 7-7.5%.

3. Ndi msinkhu, dongosolo lanu la mankhwala limakulirapo.

Mukalamba, chithandizo cha matenda ashuga sichofunikira. Nthawi zambiri, njira zothetsera matenda a shuga zimapangidwira kupewa mavuto amtsogolo. Chifukwa chake ngati muli ndi zaka 80, kumwa mankhwala ambiri kapena jakisoni kuti muchepetse chiopsezo cha matenda a mtima sikungakhale kwanzeru kwenikweni. Chifukwa, makamaka, mumakhala osamva zovuta chifukwa chamankhwala opatsirana kuposa kuletsa kuukiridwa.

5. Mumawona Zizindikiro za hypoglycemia

Ngati mudakhalapo ndi magawo a kutsika koopsa mu misempha ya shuga, makamaka ofunika chithandizo chamankhwala mwachangu, itha kukhala nthawi yoti mulankhule ndi dokotala za kusankha koyenera kwa mankhwala ndi mankhwala. Dokotala yekha ndi amene angathetse mavuto ngati amenewa, koma palibe amene amakuvutitsani kuti muyambitse kukambirana.

Chonde musapange chisankho chokhudza chithandizo chanokha, chitha kukhala chowopsa pamoyo wanu!

Asayansi apeza kuti vuto linanso la nthawi yathu, yomwe ndi kusowa tulo, komanso yomwe ili pachiwopsezo cha matenda ashuga amtundu wa 2

Matenda a shuga amatchedwa mliri wopanda matenda m'zaka za zana la makumi awiri ndi limodzi. Masiku ano, anthu 285 miliyoni padziko lonse lapansi akudwala matenda ashuga, ndipo pofika chaka cha 2025, malinga ndi kulosera kwa World Health Organisation, padzakhala kale ndi 435 miliyoni odwala.

Ziwerengero zaku Russia zikupereka ziwerengero izi: mamiliyoni atatu a achibale athu akudwala matenda ashuga, 2.8 omwe amadwala matenda amtundu wa 2, koma zambiri kuchokera ku kafukufuku wamaphunziro zikuwonetsa kuti kwenikweni pali odwala ochulukirapo katatu motere.

Matenda a shuga a Mtundu Wachiwiri ayenera kuganiziridwanso mwatsatanetsatane, chifukwa matendawa ndi zotsatira za moyo wathu: masewera olimbitsa thupi (onani //www.miloserdie.ru), zakudya zopanda thanzi ndikuwongolera kwambiri. Ndipo posachedwa, asayansi apeza kuti vuto linanso la nthawi yathu, ndilo kusowa tulo, komanso ngozi ya matenda ashuga a 2. Koma tisanalankhule zotsatira za kafukufuku watsopano, tiyeni tiwone matenda amtundu wanji.

Ngati matenda a shuga a mtundu woyamba amaphatikizidwa ndi kuchepa kwa insulin, ndiye kuti, kuchepa kwa kupanga kwa mahomoni a insulin ndi maselo a beta, ndiye kuti kuswa kwa shuga kwa mtundu wachiwiri kumachitika chifukwa cha kukana insulini. Ichi ndi chikhalidwe chomwe maselo amthupi, pomwe kuchuluka kwakulu kwa mahomoni amatulutsidwa m'magazi, sangathe kuwagwiritsa ntchito. Kulandira chizindikiro chabodza chokhudza kuchepa kwa insulini, maselo a pancreatic beta amapanga mahomoni ochulukirapo. Pang'onopang'ono amatha mphamvu ndipo sangathenso kupanga insulin yokwanira, kuchuluka kwa shuga m'magazi kumakwera ndipo matenda oopsa a hyperglycemia amakula, omwe amatchedwa shuga mellitus.

Tsoka ilo, poyambira msanga, zizindikiro za matenda a shuga sizimayambitsa nkhawa munthu wodwala, simungangowaganizira. Ngati mukuzindikira zomwe zalembedwa pansipa, muyenera kukaonana ndi dokotala.

Kuyamwa mwachangu. Izi ndichifukwa choti impso zikugwira ntchito mwachangu kuti uchotse shuga wambiri. Ngati mukuyenera kudzuka kangapo usiku kuti mumasuke, ndizotheka kuti ili ndi vuto.

Udzu wambiri. Zikuwonekeratu kuti thupi liyenera kubwezeretsanso chinyezi chomwe chatayika.

Kuchepetsa thupi kwambiri. Popeza glucose samalowa m'maselo mu kuchuluka kofunikira, thupi limagwiritsa ntchito mphamvu ina, ndikuphwanya mapuloteni a minofu, ndipo ntchito yogwira impso imayambitsa kuwotcha kwama calorie ena.

Kumva njala. Ndi chifukwa cha kuphuka kwa shuga m'magazi. Ikatsika kwambiri, thupi limapereka chizindikiro kuti likufunika kupatsidwa shuga watsopano.

Kuuma mucous nembanemba khungu chifukwa cha kuchepa madzi m'thupi. Kuphatikiza apo, matenda osowa khungu monga acanthosis, kuchepa kwa khungu kumatha kukhala mwa odwala matenda ashuga. Ngati khungu kuzungulira khosi kapena m'khosi mwake ndi lakuda kwambiri, izi zikuwonetsa kukana insulini, ngakhale mulingo wotseketsa magazi sukweza.

Kuchiritsa pang'onopang'ono mabala ndi mikwingwirima. Izi ndichifukwa choti mitsempha yamagazi imawonongeka chifukwa cha kuchuluka kwa shuga ndikuyenda kwa magazi, komwe kumapangitsa kuti machiritso am'mimba athetsedwe.

Zizolowezi kumatenda pafupipafupi, makamaka matenda oyamba ndi fungus, chifukwa chakuchepa kwa ntchito ya chitetezo chamthupi.

Kutopa kwakanthawi ndi kusakwiya ndi chifukwa choti thupi liyenera kuchita zina zowonjezera kufooketsa shuga m'maselo.

Masomphenya opanda pake. Pamaso panga pakazungulira, mawanga amdima. Mwazi wambiri umatsogolera kusintha kwa ma mandala amaso, zomwe zimabweretsa zotsatira zosawoneka bwino. Nthawi zambiri amadutsa pomwe shuga amabwerera mwakale.

Kudzera ndi kumva kulimba miyendo. Kuchulukitsa kwa shuga kumayambitsa mitsempha ya mitsempha ya zotumphukira, komabe, monga momwe zimakhalira pakuwona, zizindikiro zimatha ndikulowerera kwakanthaŵi. Ndikofunika kwambiri kuti muyambe kulandira chithandizo cha matenda ashuga posachedwa kuti neuropathy isadwalike.

Kodi kugona kugona kungathandize bwanji kukulitsa insulin? Kafukufuku yemwe asayansi aku University of Chicago, USA, adapeza kuti kusowa tulo (maphunziro amagona maola 4 okha patsiku) kwa masiku awiri kumabweretsa kusintha kwa metabolic: milingo ya leptin imatsika ndi 18%, ndipo ma ghrelin akukwera ndi 28%. Leptin ndi mahomoni omwe amawongolera mphamvu zama metabolism komanso kupondereza chilakolako cha chakudya, ghrelin ndi mahomoni olimbitsa thupi. Zachidziwikire, woyamba atachepetsedwa ndipo wachiwiri ukachulukitsidwa, chilakolako chake chimafika pachimake ndipo zimamuvuta kuti atsutse chilichonse, kupatula chakudya chamasana kwambiri kapena - chomwe sichabwino - chakudya chamadzulo. Kuphatikiza apo, kusowa tulo ndi chimodzi mwazifukwa zokhumba maswiti. Izi ndizosadabwitsa: ubongo wotopa umafunikira "mafuta" ena, ndiye kuti, glucose, komwe ndi komwe kungapangidwe mphamvu kwambiri m'thupi lathu.

Mu Okutobala 2012, kafukufuku watsopano adafalitsidwanso ku University of Chicago Clinical Center, wopangidwa ndi American National Institutes of Health. Zimawonetsa kuchepa kwa chidwi cha insulin receptors poyankha nthawi yokwanira kugona. Maphunziro asanu ndi awiri adakhala maola 4,5 akugona kwa masiku anayi, ndipo anagona maola 8.5 kwa masiku 4 otsatira. Ofufuzawo adatenga kuchokera kwa omwe atenga nawo gawo pazoyeserera zamafuta kuchokera kuzinthu zina zowunikira ndikuwunikira momwe amvera kuti akhale ndi insulin. Zinapezeka kuti patangotha ​​masiku 4 osowa tulo, amatsika ndi 16%. Mphamvu yonse ya insulivivity, yomwe imayesedwa pamaziko a kuyesa kwa magazi a maphunziro, idatsika ndi 30%. "Kuchepera kumeneku ndikofanana ndi ma metabolic okalamba pofika zaka 10 mpaka 20," akutero a Matthew Brady, pulofesa ku University of Chicago, omwe adatsogolera kafukufukuyu, "maselo amafuta amafunika kugona, ndipo ngati sakwanira, sangathe kuthana ndi michere." ". Ngati kukana kwa insulini kotereku kumakhala kosalekeza, kuthamanga kwa magazi ndi cholesterol kungayambitse matenda a shuga ndi mtima.

Phunziroli lili ndi malire ake: panali maphunziro 7 okha mmenemo, onse ang'ono, athanzi komanso owonda, kotero ndikofunikira kuyang'ana kuti zitsimikiziro zazomwe zakhala zikugwirizana ndi magulu ena azaka komanso odwala omwe ali ndi matenda osachiritsika. Ndipo koposa zonse, ndikofunikira kuti mudziwe ngati insulini imaletsa pang'ono ndi nthawi yoletsa, koma osakhala masiku 4, monga mukuyesera, koma miyezi kapena zaka.

Madokotala ambiri amalabadira gawo loyipa lomwe limayambitsa matenda a odwala awo. Ngati kusowa tulo kumatsogolera thupi kukakhala ndi matenda ashuga, kumapangitsa kuti thupi lizikula kwambiri komanso kuti inshuwaransi isamayende bwino, ndiye kuti pamlingo wotsatira wodwalayo atayamba kudwala, kuzungulira koyipa kumayamba: polyuria imayamba (kukodza pokodza), ndipo kugona kwa wodwalayo kumakulabe, chifukwa amafunika kudzuka kangapo usiku chifukwa chokodza pafupipafupi, kugona mokwanira kumathandizanso kukulitsa kukana kwa insulin.

Mwa njira, akatswiri amalankhula za mzere woipa womwewo pokhudzana ndi kusokonezeka kwa tulo chifukwa cha ziphuphu, kulephera kupuma, nthawi zambiri kumatsagana ndi munthu wonenepa kwambiri. Kugona koyipa kumapangitsa kuti munthu achepetse thupi, ndipo mafuta am'magazi angayambitse kupuma kwamtunda, komwe kumayambitsa ziphuphu.

Apa m'nkhaniyi //www.miloserdie.ru ikufotokozedwa mwatsatanetsatane za gawo lomwe kugona kumagona m'moyo wathu, mumapezanso malangizo ena othandiza popewa kugona ndi kukulitsa kugona tulo usiku. Ndikofunikira kumvetsetsa kuti maola 8 patsiku ndi chizindikiro chokhacho, ndipo kwa aliyense wa ife kufunika kwa kugona kumayesedwa ndi nthawi yomwe thupi la munthu aliyense liyenera kubwezeretsa mphamvu. A director of the Regional S sleep Disways Center (Minnesota), Dr. Mark Mahowald, atafunsidwa kuti agone nthawi yayitali bwanji, amayankha motere: "Mukadzuka pa foni yodzuka, ndiye kuti simukugona mokwanira. Mukamagona mokwanira, ubongo wanu umadzuka ma alamu asanalire. ”

Woyang'anira wamkulu wa Seattle Medical Center for S sleep Research, Dr. Nathaniel Watson, yemwe adachita nawo kafukufuku wa asayansi aku America, akukhulupirira kuti kafukufuku wazotsatira zoyipa zakugona pa thanzi la anthu, makamaka, pa chitukuko cha matenda ashuga a mtundu 2 ayenera kupitilizidwa. Nkhani yabwino ndiyakuti ngati kafukufuku wotsatira akatsimikizira zotsatira zomwe wapeza kale, ndiye kuti chithandizo cha kukana insulini chingakhale chosavuta: wodwalayo amangofunika kugona kwambiri. "Kugona ndikofunikira pa thanzi labwino monga kudya bwino komanso kuchita masewera olimbitsa thupi," Dr. Watson akukhulupirira, "Mpaka mutapeza njira yapadera kapena piritsi yomwe ingalowe m'malo mwa kugona, zonse zomwe muyenera kuchita ndikulipiritsa kukhala njira yosavuta kwambiri ... Ndiwosavuta thimitsani kompyuta ndikugona mapema. ”