• Zowonongeka zamitsempha yama mtima (matenda a mtima), akuwonetsa mu chitukuko cha angina pectoris (matenda omwe amawonetsedwa ndi kupweteka kapena kusasangalala kumbuyo kwa kumbuyo chifukwa chophwanya magazi mu mtima), kulowetsedwa kwa myocardial (kufa kwa gawo la minofu yamtima), kulephera kwamtima kosaletseka (ntchito ya mtima).
  Zowonetsedwa:
  • kupweteka, chilengedwe, kupanikizika, koyaka m'dera la mtima, kumbuyo kwa sternum, komwe kumachitika chifukwa cha kulimbitsa thupi (momwe matendawa akupitilira komanso kupuma), kudutsa kupuma kapena mutatha kumwa mankhwala a gulu la nitrate (kusintha magazi kulowa mumtima),
  • kupuma movutikira - poyamba ndi kulimbitsa thupi, pamene matendawa akupita komanso akupuma,
  • kutupa kwa miyendo
  • Kusokoneza ntchito ya mtima,
  • kuchuluka kwa kuthamanga kwa magazi (magazi),
  • mitundu yopanda ululu ya myocardial infarction (kufa kwa gawo la minofu ya mtima), yomwe imapezeka kawirikawiri chifukwa cha matenda osokoneza bongo chifukwa cha zovuta zomwe zimachitika m'mitsempha.
• Kuwonongeka kwa ziwiya zaubongo (matenda a ubongo):
  • mutu
  • chizungulire
  • kukumbukira, kusamala,
  • stroke ndi kuphwanya kwenikweni kwa kufalitsidwa kwa ziwalo ndi kufa kwa gawo laubongo.
• Zowonongeka zam'zigawo zam'munsi:
  • kupweteka kwa miyendo
  • lamumo
  • zilonda zolakwika (kuphwanya umphumphu wa khungu),
  • kufa kwa minofu yofewa (gangrene) - nthambi imakhala yakuda, ntchito yake imatha.

Kukhalapo kwa matenda osokoneza bongo a shuga (matenda omwe amadziwika ndi shuga wambiri) kumayambitsa kusokonezeka kwa mitundu yambiri ya kagayidwe m'thupi, kamene kamapangitsa chiwopsezo cha wodwalayo kuwonongeka kwa mtima. Kuphatikiza, palinso kuwonjezeka kwa chitukuko cha atherosulinosis (kuyika kwa cholesterol cholembera pamitsempha yamitsempha yamagazi) ndikuwonongeka makamaka kwa ziwiya zamtima, ubongo, komanso kutsika kwina.

Zomwe zimayambitsa chiopsezo cha matenda a mtima wamatenda:

• kusuta
• uchidakwa
• kuchuluka kwa kuthamanga kwa magazi (magazi),
• kunenepa
• kuchuluka kwa lipids (cholesterol ndi mafuta ena) m'magazi,
• cholowa cham'tsogolo (kupezeka kwa atherosclerosis mwa achibale),
• zaka (zopitilira zaka 50)
• fibrillation ya atria (kusokonekera kwa miyambo ya mtima).

• shuga wamagazi ambiri
• kuchuluka kwa insulini (mahomoni omwe amachititsa kutsika shuga) m'magazi,
• insulin kukana - "insensitivity" ku insulin,
• matenda ashuga nephropathy - kuwonongeka kwa impso mu matenda osokoneza bongo,
• kukhalapo kwa shuga kwa nthawi yayitali.

Dokotala endocrinologist amathandiza mankhwalawa

Zizindikiro

• Kusanthula madandaulo a matenda:
  • kupweteka, chilengedwe, kupanikizika, koyaka m'dera la mtima, kumbuyo kwa sternum, komwe kumachitika chifukwa cha kulimbitsa thupi (momwe matendawa akupitilira komanso kupuma), kudutsa kupuma kapena mutatha kumwa mankhwala a gulu la nitrate (kusintha magazi kulowa mumtima),
  • kupuma movutikira - poyamba ndi kulimbitsa thupi, pamene matendawa akupita komanso akupuma,
  • kutupa kwa miyendo
  • Kusokoneza ntchito ya mtima,
  • kuchuluka kwa kuthamanga kwa magazi (magazi),
  • mutu
  • chizungulire
  • kukumbukira, kusamala,
  • kupweteka kwa miyendo
  • lamumo.
• Kusanthula kwa mbiri yakale ya zamankhwala (mbiri yachitukuko) matendawa: funso la momwe matendawa adayambira ndikukula, zaka za shuga zidayamba bwanji.
• General mayeso (muyeso wa kuthamanga kwa magazi, kupenda khungu, kumvetsera kwa mtima ndi phonendoscope, palpation ya ziwiya zapansi).
• Kudziwitsa kuchuluka kwa cholesterol ndi lipids ina (mafuta) m'magazi.
• Pozindikira kuwonongeka kwa mtima dongosolo:
  • ECG (electrocardiography),
  • Kuwunika kwa Holter ECG (masana),
  • kuyezetsa nkhawa - kuyang'anira ECG, zimachitika, kuthamanga kwa magazi, thanzi la wodwalayo pansi pa zinthu zochulukitsa za ma simulators apadera (njinga, ma treadmill),
  • coronary angiography ndi njira yofufuzira yomwe imakuthandizani kuti mufufuze mitsempha ya mtima kuchokera mkati pogwiritsa ntchito chida chapadera cholowetsedwa ndi mtsempha wamagazi.
• Pozindikira matenda amisempha:
  • ma ultrasound a ziwiya zamutu ndi khosi,
  • CT (compute tomography) kapena MRI (magwiridwe amatsenga a ubongo).
• Kuzindikira zotupa zam'munsi zatsika:
  • kupimidwa kwa mafunde a ziwiya za m'munsi,
  • X-ray kusiyanitsa angiography - Kafukufuku wamitsempha yamagazi ogwiritsira ntchito othandizira mosiyanitsa omwe adalowetsedwa mu chotengera, ndikutsatiridwa ndi X-ray.
• Mphamvu yakuwongolera kwamwazi wamagazi (muyeso wa glucose masana).
• Kufunsidwa kwa katswiri wa zamanjenje, wamtima, phlebologist ndikothekanso.

Chithandizo cha matenda ashuga macroangiopathy

• Chithandizo cha matenda a shuga mellitus (matenda omwe amadziwika ndi shuga yayikulu).
• Zakudya ndi zoletsa mchere, mapuloteni, zakudya, zamafuta.
• Kusiya kusuta fodya komanso kumwa mowa.
• Zochita zolimbitsa thupi (osayambitsa matenda a angina (matenda owonetsedwa ndi kupweteka kapena kusasangalala kumbuyo kwa kumbuyo chifukwa chakuphwanya kwa magazi kumtima)).
• Tsiku ndi tsiku amayenda mumlengalenga.
• Kuchepetsa kunenepa kwambiri.
• Anti-ischemic mankhwala omwe amachepetsa kufunika kwa myocardium (minofu ya mtima) mu oxygen.
• Mankhwala osokoneza bongo ochepetsa kuthamanga (magazi).
• Mankhwala omwe amapangitsa kuti pakhale lipid pakhale magazi (kutsitsa cholesterol ndi mafuta ena).
• Mankhwala osokoneza bongo omwe amaletsa magazi kwambiri.
• Mankhwala a Neurotropic (kukonza zakudya zamagetsi).
• Mankhwala a Vasodilator.
• Chithandizo:
• Ndi chitukuko cha gangrene (minofu imfa) - kudula dzanja.

Kodi microangiopathy ndi chiyani?

Mu thupi la munthu muli zonyamula zikwizikwi, zomwe zimaphatikizapo ma capillaries, venule ndi arterioles. Amasunga khungu lililonse la ziwalo, kumabweretsa zinthu zofunikira ndikuchotsera zonse zosafunikira. Izi zimathandizira kugwira ntchito yofananira m'maselo ndi thupi lonse. Kusintha kwa m'matenda ang'onoang'ono m'matumbo ang'onoang'ono kumachitika chifukwa cha matenda a shuga a nthawi yayitali, matenda ashuga a shuga. Ndi vutoli, omwe akukhudzidwa kwambiri ndi:

Microangiopathy imayamba chifukwa choti glucose, zomwe m'magazi a odwala matenda a shuga amawonjezeka, amawononga endothelium ya makoma amitsempha yamagazi. Zotsatira zomaliza za metabolism ya glucose ndi sorbitol ndi fructose. Zonsezi zimalowa molakwika kudzera mu nembanemba ya cell, motero zimayamba kudziunjikira maselo a endothelial. Izi zimabweretsa izi:

- Kutupa kwa khoma la chotengera,

- kuchuluka kwa khoma,

- kuchepa kwa kupanga kwa kupumula kwa endothelium, kofunikira popuma minofu yosalala m'matumba.

Chifukwa chake, endothelium imakhala yowonongeka ndipo magazi amayenda m'munsi, zomwe zimayambitsa kuthana kwambiri. Izi zimatchedwa Virchow Triad.

Kugawa ndi kuwonetsera pazachipatala

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.

Njira zochizira

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.

Mavuto

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. Malo omwe ali pangozi kwambiri ndi 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.

Njira zopewera

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.

Mashuga a macroangiopathy

Mashuga a macroangiopathy - kusintha kwakukulu kwa atherosulinotic komwe kumapangika m'mitsempha yapakati komanso yayikulu motsutsana ndi maziko a matenda a shuga. Matenda ashuga macroangiopathy imayambitsa matenda am'mitsempha, matenda oopsa, matenda oopsa a m'mitsempha, zotupa zam'mitsempha yamagazi. Kuzindikira matenda ashuga macroangiopathy akuphatikizapo kuphunzira zamadzimadzi kagayidwe kachakudya matenda a lipid, kupatsirana kwa mitsempha ya malekezero, mitsempha, impso, ECG, echocardiography, etc. Mfundo zazikulu zamankhwala othandizira matenda ashuga macroangiopathy, kuwongolera magazi, komanso kusintha kwa magazi m'mitsempha yamagazi.

Zambiri

Matenda a shuga a macroangiopathy ndi ophatikizika a matenda osokoneza bongo, opangitsa kuti azikhala ndi chotupa cham'mimba, cham'mimba, impso komanso zotumphukira m'mitsempha. Kwambiri, matenda ashuga a macroangiopathy akuwonetsedwa pakupanga angina pectoris, myocardial infarction, ischemic stroke, renovascular hypertension, and matenda a matenda ashuga. Kuvulala kwamitsempha yamavuto ndikofunikira kwambiri pakukula kwa matenda osokoneza bongo, kuonjezera ngozi ya kugwidwa ndi matenda a mtima ndi 2-3, gululi ya cyland - pofika 20.

Atherossteosis, yomwe imayamba m'matenda a shuga, imakhala ndi zochitika zingapo. Mu odwala matenda ashuga, zimachitika zaka 10-15 m'mbuyomu kuposa mwa anthu omwe alibe vuto la kagayidwe kazakudya, ndipo amapita patsogolo mwachangu. Kwa matenda ashuga a macroangiopathy, chotupa chachikulu cha m'mitsempha yambiri (korona, chithokomiro, visceral, zotumphukira) ndizachilendo. Pankhaniyi, kupewa ndi kukonza matenda ashuga a macroangiopathy ndikofunikira kwambiri mu endocrinology.

Mu matenda ashuga macroangiopathy, chapansi membala wa mitsempha ya sing'anga ndi yayikulu calitter amakula ndi mapangidwe a atherosclerotic zolembera pamenepo. Kuwerengera kwawo kwotsatira, zilonda zam'mimba ndi necrosis zimathandizira kupanga mapangidwe amwazi wam'magazi komanso kuwonetsa kwa lumen yamitsempha yamagazi, yomwe imayambitsa kusokonezeka kwamagazi m'malo ena.

Zowopsa zomwe zimayambitsa kukula kwa matenda ashuga a macroangiopathy mu matenda osokoneza bongo zimaphatikizapo hyperglycemia, dyslipidemia, insulin kukana, kunenepa kwambiri (makamaka matenda am'mimba, kuthamanga kwa magazi, kuchuluka kwa magazi, kusokonekera kwa endothelial, kupsinjika kwa oxidative, ndi kuperewera kwa dongosolo.Zomwe zimayambitsa chikhalidwe cha anthu kuopsa kwa matenda aubongo ndi kusuta, kuledzera, kugwira ntchito zolimbitsa thupi, zaka (mwa amuna azaka zopitilira 45, mwa akazi opitirira zaka 55), cholowa.

Gulu

Dongosolo la matenda ashuga angiopathy ndi lingaliro losakanikira, lomwe limaphatikizapo kugonjetsedwa kwa ziwiya zazing'ono - ma capillaries ndi precapillary arterioles (microangiopathy), ma kati ndi akuluakulu oopsa a macarrangiopathy. Matenda a shuga angiopathies amachedwa kupezeka ndi matenda ashuga, omwe amapezeka pafupifupi zaka 10-15 atachira matendawa.

Matenda a shuga a macroangiopathy amatha kuwonekera mu ma syndromes angapo: atherosulinosis ya mitsempha ya mitsempha ndi msempha, atherosulinosis yamitsempha yamagazi ndi mitsempha ya mitsempha yamitsempha yamagazi. Matenda a shuga a shuga atha kuphatikizira retinopathy, nephropathy, microangiopathy yokhala m'munsi. Komanso, kuwonongeka kwa mtima kumatha kuchitika ngati angiopathy yapadziko lonse, kuphatikiza ma macro- ndi microangopathy. Nawonso, michereopathy ya endoneural imathandizira kuwonongeka kwamitsempha yamagazi, i.e., chitukuko cha matenda a shuga.

Zizindikiro za matenda ashuga macroangiopathy

Atherosulinosis ya coronary artery and aorta in diabetesic macroangiopathy imawonetsedwa ndi kukula kwa matenda a mtima ndi mawonekedwe ake oyipa (myocardial infarction) ndi mawonekedwe (mtima wamtima), angina pectoris. IHD mu matenda ashuga imatha kuchitika atypically (malingana ndi njira yoyenera kapena yopweteka), potero kumakulitsa chiopsezo cha kufa mwadzidzidzi kwa coronary. Matenda a shuga a macroangiopathy nthawi zambiri amaphatikizidwa ndi zovuta zingapo za pambuyo pake pakuyambitsa: aneurysms, arrhythmias, thromboembolism, Cardiogenic shock, mtima kulephera. Ndi matenda ashuga a macroangiopathy, mwayi wokhala ndi kubwerezabwereza kwa myocardial infarction ndiwokwera kwambiri. Chiwopsezo cha kufa chifukwa cha vuto la mtima mwa odwala omwe ali ndi matenda ashuga ndiwonjeza kuchulukirapo kawiri kuposa kwa anthu omwe alibe shuga.

Atherosulinosis ya mitsempha ya mitsempha chifukwa cha matenda ashuga macroangiopathy amapezeka 8% ya odwala. Itha kuwonetsedwa ndi matenda osokoneza bongo a ischemia kapena ischemic stroke. Kuchepa kwa zovuta za shuga m'misempha kumachulukitsa katatu pakadutsa matenda oopsa.

Kuphwanya zotupa zotupa za zotumphukira (zowononga ma atherosclerosis) kumakhudza 10% ya odwala matenda a shuga. Kuwonetsedwa kwamankhwala a matenda opatsirana a matenda ashuga macroangiopathy pamenepa amaphatikizapo dzanzi ndi kuzizira kwamapazi, kuchepa pakatikati, kutupa kwakumapeto, kupweteka kwambiri m'misempha ya mwendo, m'chiuno, ndipo nthawi zina matako, omwe amawonjezeka ndi kulimbitsa thupi kulikonse. Ndi kuphwanya kowopsa kwa kayendedwe ka magazi m'magawo a distal, ischemia yovuta imayamba, chifukwa chomwe necrosis ya m'munsi ndi miyendo ya kumapazi imayamba. Necrosis ya pakhungu ndi minofu yolowerera imatha kuchitika popanda kuwonongeka kwamakina owonjezera, koma nthawi zambiri zimachitika motsutsana ndi kumbuyo kwa kuphwanya umphumphu wa khungu (ndi pedicure, mapazi osweka, matenda oyamba ndi khungu ndi misomali, etc.). Pokhala ndi vuto lotaya magazi pang'ono, zilonda zam'mimba zam'mimba zimayamba mu matenda ashuga a macroangiopathy.

Chithandizo cha matenda ashuga macroangiopathy

Chithandizo chake ndikuchepetsa kuchepa kwa zovuta zowopsa za mtima zomwe zimawopseza wodwala wolumala kapena kufa. Mfundo zazikuluzikulu zochizira matenda ashuga macroangiopathy ndikukonza kwa hyperglycemia syndromes, dyslipidemia, hypercoagulation, ochepa matenda oopsa.

Kuti akwaniritse kulipidwa kwa chakudya cha carbohydrate metabolism, odwala matenda a shuga a macroangiopathy amawonetsedwa ndi insulin mankhwala motsogozedwa ndi misempha yamagazi. Kuwongolera kusokonezeka kwa kagayidwe kazakudya kamene kamapezeka mwa kupezeka kwa mankhwala opatsirana ndi lipid (ma statins, antioxidants, fibrate), komanso zakudya zomwe zimaletsa kudya nyama.

Ndi chiwopsezo chowonjezereka cha zovuta za thromboembolic, ndikofunikira kupangira mankhwala a antiplatelet (acetylsalicylic acid, dipyridamole, pentoxifylline, heparin, etc.). Cholinga cha antihypertensive therapy mu matenda ashuga macroangiopathy ndikukwaniritsa ndikusunga kuchuluka kwa kuthamanga kwa magazi a 130/85 mm Hg. Art. Pazomwezi, ndikofunikira kupereka ACE inhibitors (Captopril), diuretics (furosemide, spironolactone, hydrochlorothiazide), odwala omwe ali ndi vuto la mtima - beta-blockers (atenolol, etc.).

Chithandizo cha zilonda zam'mimba za malekezero zimachitika moyang'aniridwa ndi dokotala. Pazowopsa za mtima. Malinga ndi zomwe zikuwonetsa, chithandizo cha opaleshoni chimachitika (CABG, mankhwalawa opaleshoni ya kuchepa kwa magazi m'thupi, endarterectomy, kuduladula miyendo, etc.).

Zotsogola ndi kupewa

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.

Matenda a matenda ashuga macroangiopathy

• Chithandizo chokwanira komanso chapanthawi yake cha matenda a shuga a mellitus (matenda omwe amadziwika ndi shuga wambiri).
• Zakudya ndi zoletsa mchere, mapuloteni, zakudya, zamafuta.
• Kusiya kusuta fodya komanso kumwa mowa.
• Zochita zolimbitsa thupi (osayambitsa matenda a angina (matenda owonetsedwa ndi kupweteka kapena kusasangalala kumbuyo kwa kumbuyo chifukwa chakuphwanya kwa magazi kumtima)).
• Tsiku ndi tsiku amayenda mumlengalenga.
• Kuchepetsa kunenepa kwambiri.
• Kuwunika kwamphamvu kwa shuga m'magazi (muyeso wa tsiku ndi tsiku).
• Mphamvu yolamulira pamlingo wa lipids (mafuta) m'magazi (kamodzi miyezi isanu ndi umodzi).

Dziwani ZOTHANDIZA

Kukambirana ndi dokotala ndikofunikira

Endocrinology - Dedov I.I., Melnichenko G. A, Fadeev V.F., - GEOTAR - Media, 2007
Ma algorithms othandizira chithandizo chamankhwala kwa odwala omwe ali ndi matenda a shuga, 2012

Angiopathy ya "mtima" ziwiya

Kuphatikizika kwa shuga kumeneku kumachitika mwa anthu omwe ali ndi vuto la kuthamanga kwa magazi, komanso kutha kuwonekanso kwa iwo omwe alibe zovuta zopsinjika. Matenda a shuga a shuga a mtima amawonetsedwa ndi izi:

- kupweteka pachifuwa, kuyambitsa kusakhazikika m'khosi, kumbuyo, chibwano chamkono, mkono wamanzere,

- kupweteka ndi kumva kufinya, kukakamira kuseri kwa sternum, kukulitsidwa ndi zolimbitsa thupi, komanso pamavuto ena,

- kutupa ndi kupweteka mu hypochondrium yoyenera,

Zizindikiro zofananazo zimachitika ndi matenda ena amtima. Kuti mudziwe bwino, coronary angiography ndi MRI yamatumbo amtima, komanso thunthu lokha limachitika.

Monga othandizira othandizira odwala, odwala amapatsidwa mankhwala omwe amaletsa mitsempha ya magazi kuchepetsedwa, kusintha magazi, kupewa magazi, kutsika magazi, komanso kuchepetsa cholesterol "yoyipa". Awa ndi "Nitroglycerin", "Aspirin", "Bisoprolol", "Verapamil", "Ramipril", "Lozartan" ndi ofanana nawo.

Nephropathy

Diabetesic microangiopathy ya impso imayang'aniridwa mu odwala matenda ashuga omwe akudziwa bwino kapena omwe satsatira malangizo onse a dokotala pokhudzana ndi zakudya komanso kumwa mankhwala. Zizindikiro

- Kutopa kwambiri kosalephera,

- nseru, nthawi zambiri musanatsuke,

- m'mawa kutupa kumaso,

- proteinuria (mapuloteni amatsimikiza mu mkodzo).

- kuyesa kwa magazi (biochemical, komwe kumatsimikizira kuchuluka kwa creatinine ndi urea),

Chithandizo cha matenda a shuga a shuga a impso m'magawo oyamba a kukula kwa zovuta zimayang'anira kuwunika kwa shuga m'magazi ndikukhalabe ndi magazi. Izi zimathandizira kupewa kuwonongeka kwa impso kwa nthawi yayitali. Mtsogolomo, hemodialysis imalembedwa, ndipo makamaka muzovuta - kupatsidwa kwa impso.

Retinopathy

Retina laumunthu lilinso ndi mitsempha yaying'ono yamagazi. Kulephera kwawo, komwe kudachitika chifukwa cha matenda ashuga, kumatchedwa retinopathy. Vutoli limatha kukhala kwa nthawi yayitali, zaka 20 kapena kuposerapo, ngati wodwalayo akwaniritsa mosamala zomwe dokotala wanena, ndipo atha kudziwonetsa ngati ali ndi zaka ziwiri kuchokera pachiwonetsero cha matenda a shuga. Tsoka ilo, posachedwa retinopathy imakhudza wodwala aliyense.

Diabetesic retinal microangiopathy imadziwika ndi zizindikiro zotsatirazi:

- kuwonongeka kowonera mpaka kutayika kwathunthu,

- chophimba chikuyima m'maso mwanga,

- zinthu "zoyandama" pamunda wowonera,

- kuvutika kuwona zazing'ono,

- mawanga, nthyole, mikwingwirima, mikwingwirima pamaso pa maso,

- magazi okhathamira,

- kupweteka m'maso.

Dokotala wamaso, atamufufuza, amatha kudziwa zizindikiro za retinopathy ngakhale wodwalayo asanawone kuti pali cholakwika ndi masomphenya ake. Zizindikiro zoyambirira zavutoli ndi:

- mitsempha yopuwala (nthawi zambiri ndi micaneurysms),

Kupewa kwa retinopathy ndikuwunikira pafupipafupi ndi ophthalmologist, kuwunika kuchuluka kwa shuga m'magazi, komanso kudya.

Chithandizo cha retinopathy chimakhala ndi jakisoni wamankhwala m'maso amkati, laser cauterization yamitsempha yamagazi ya fiber, ndikuthandizira opaleshoni, yomwe imachotsa magazi ndi minyewa yamaso m'maso.

Encephalopathy

Microangiopathy mu shuga imatha kukhudza ziwiya zaubongo. Kupsinjika kotere kumachitika mwa odwala omwe akudziwa bwino komanso mwa omwe samvera zomwe dokotala wamupatsa. Zizindikiro zoyambirira za encephalopathy:

- madandaulo okhudza mutu "wowuma",

- kugona tulo usiku, kugona tulo masana,

- mavuto a kukumbukira,

Zizindikiro zina zimawonjezeredwa:

- kupezeka kwa zinthu zakale,

Kuzindikira ndi MRI yaubongo.

Kubwezeretsanso zombo zowonongera sizingatheke. Cholinga cha mankhwalawa ndikuchepetsa njira yopititsira patsogolo zovuta zina. Maziko a chithandizo ndikuwonetsetsa kuchuluka kwa shuga m'magazi ndikuwachepetsa.

Angiopathy a ziwiya zamiyendo

Matenda a shuga a shuga a shuga amakhalanso ndi zovuta zovuta za matenda a shuga. Ntchito yapagulu, kunenepa kwambiri, kusuta, matenda oopsa, kudziwa zam'tsogolo zimathandizira kuti pakhale zovuta.

- kumverera kwadzidzidzi kumapazi,

- Kuuma m'mawa,

Ndi kukula kwa zovuta, phazi la matenda ashuga limapangidwa (kukula kwa misomali, kusintha kwa mtundu wawo, mawonekedwe a chimanga, ming'alu ndi zilonda zam'mimba), ndipo, izi, zimathandizira kuwoneka kwa gangrene, sepsis.

Kuzindikira kumachitika chifukwa cha kuyesedwa kwamankhwala ndi mayeso ena apadera:

Chithandizo chikuchitika mbali zitatu:

1. Zakale kwambiri matenda ashuga (kuwongolera shuga wamagazi, chakudya chomwe sichilola kunenepa kwambiri, kuwongolera kuthamanga kwa magazi).

2. Kupititsa patsogolo kuchuluka kwa magazi ndi michere yamagazi (odwala amatenga ma statins, angioprotectors, antioxidants, othandizira a biogenic, metabolics, othomoka magazi, othandizira ma biogenic).

3. Kuthandizira opaleshoni, cholinga chake ndikobwezeretsa magazi ndikuchotsa malo omwe anafa.

Kodi macroangiopathy ndi chiyani?

Masinthidwe amomwe amachitika chifukwa cha matenda ashuga amakhudza ziwiya zazing'onoting'ono komanso zazikulu, kupezeka kwa matenda a shuga a macroangiopathy amapangidwa. Zomwe zimayambitsa izi:

- kukula kwa zipinda zamkati zamitsempha ndi mitsempha chifukwa cha magazi ambiri,

- mapangidwe ziwiya atherosselotic zolembera,

- calcification zamitsempha yamagazi, awo necrosis wotsatira.

Zonsezi zimayambitsa matenda a thrombosis, occlusion ndi matenda ozungulira.

Kunenepa kwambiri, hyperglycemia, dyslipidemia, insulin kukana, kutupa njira, kupsinjika, kuthamanga kwa magazi kumathandizira kuti macroangiopathy ipangidwe. Zotsatira zake, atherosulinosis ya zotengera zotere imayamba:

1. Msempha wamatsenga ndi chotupa. Zimatengera mtima ischemia, vuto la mtima, angina pectoris, mtima.

2. Mitsempha yamagazi. Zitha kuchititsa kuti ischemic stroke kapena ischemia ya (aakulu) bongo.

3. Zotupa zam'mbali. Amadziwika ndi chiwopsezo cha gangore ndi kuduladula miyendo. Ndi atherosclerosis ya zotumphukira mitsempha, minofu necrosis nthawi zambiri kumachitika. Chomwe chimapangitsa izi kukhala mabala ang'onoang'ono, mwachitsanzo, omwe amapezeka panthawi ya pedicure, komanso ming'alu, mycoses.

Chinsinsi cha chiyambi cha angiopathy

Zoyipa, kwanthawi yayitali, zotsatira za shuga pamthupi zimadziwonekera mu mawonekedwe a zovuta mochedwa - angiopathy (kuwonongeka kwa mitsempha yamagazi). Mawonekedwe owopsa a matenda a endocrinological amaphatikizapo zochitika zadzidzidzi ndi kuchepa kwakukulu kwa shuga m'magazi (hypoglycemia) kapena kuchuluka kwake kosalekeza (ketoacidosis), chikomokere.

Mitsempha yamagazi imalowa mu thupi lonse. Chifukwa cha kusiyana komwe kulipo mu calibire yawo (yayikulu ndi yaying'ono), macro- ndi microangiopathy amadziwika. Makoma a mitsempha ndi capillaries ndi ofewa komanso owonda, amakhudzidwa chimodzimodzi ndi shuga wambiri.

Zimalowa m'matumbo, organicinthu amapanga poizoni wa mankhwala omwe ali ovulaza maselo ndi zimakhala. Kusintha kumachitika komwe kumayambitsa kusokonezeka kwa magwiridwe antchito a ziwalo. Choyamba, macroangiopathy mu matenda a shuga amakhudza mtima, ubongo, miyendo, microangiopathy - impso, maso, mapazi.

Kuphatikiza pa shuga wambiri, mitsempha yamagazi imawononga cholesterol ndi zinthu zomwe zimapangidwa chifukwa cha kusuta kwa wodwalayo kapena anthu ena omwe amakhala nawo pafupi. Misewu yamagazi imatsekeka ndi cholesterol plaques. Mwa odwala matenda ashuga, ziwiya zimaphulika kawiri (glucose ndi cholesterol). Wosuta amadziwonetsera yekha zinthu zitatu zowonongeka. Amayendetsa matenda obwera ndi matenda a atherosulinosis, osachepera munthu yemwe wapezeka ndi matenda a shuga.

Kuthamanga kwa magazi (BP) kumapangitsanso kuwonongeka kwa minofu mkati mwa chotengera (aorta, mitsempha). Mipata imapangika pakati pa maselo, khoma limakhala lololeka, komanso mawonekedwe a kutupa. Kuphatikiza pa cholesterol plaque, mabala amapanga mawonekedwe pazenera zomwe zimakhudzidwa. Ma neoplasms amatha pang'ono kuletsa kwathunthu lumen m'matumba. Pali mtundu wapadera wammenya - hemorrhagic kapena matenda a m'magazi.

Matenda a shuga a macroangiopathy kapena kupendekera kwamatumbo akulu amadziwika ndi matenda amtundu wa 2. Monga lamulo, wodwalayo ali ndi zaka zopitilira 40 ndipo kusintha kwachilengedwe kwamitsempha kwam'mimba kumayambitsa zovuta za matenda ashuga. Ndikosatheka kutembenuzira njira kumbali ina, koma mapangidwe a minofu yochepa amatha kuyimitsidwa.

Udindo wa chinthu china chotsogolera pakupanga mitundu yonse ya angiopathies sichimveka bwino - chibadwa chamtsogolo cha matenda amtima.

Zizindikiro za macroangiopathy

Odwala omwe ali ndi atherosulinosis amawoneka okalamba kuposa zaka zawo, akudwala kunenepa kwambiri. Amakhala ndi zikaso zachikasu pamapewa komanso m'maso - mawonekedwe a cholesterol. Odwala, kuphipha kwamitsempha yamafupa ndi ya popliteal kumafooka, osapezeka kwathunthu, kupweteka kwa minofu ya ng'ombe kumawoneka poyenda komanso patapita kanthawi atasiya. Matendawa amaphatikizidwa ndi kudalirana kwapang'onopang'ono. Kuti apange matenda olondola, akatswiri amagwiritsa ntchito njira ya angiography.

Magawo otsatirawa adadziwika pachitukuko cha macro- ndi microangiopathy zam'munsi zatsika:

• preclinical
• zothandiza
• organic
• zilonda za necrotic
• achifwamba.

Gawo loyamba limatchulidwanso kuti asymptomatic kapena metabolic, popeza ngakhale malinga ndi kuchuluka kwa mayeso ogwira ntchito, kuphwanya malamulo sikuwoneka. Gawo lachiwiri lili ndi zizindikiro zazikulu zakuchipatala. Mothandizidwa ndi chithandizo, zovuta zomwe zingagwiritsidwe ntchito nawo zimatha kusintha.

Kuchepetsa mtsempha wamagazi komwe kumadyetsa chiwalo china kumatsogolera ku ischemia (magazi m'deralo). Zochitika zoterezi nthawi zambiri zimawonedwa m'chigawo cha mtima. Mphamvu ya mtsempha wamagazi yomwe imachitika imayambitsa vuto la angina. Odwala amazindikira kupweteka kumbuyo kwa sternum, kusinthasintha kwa mtima.

Kutuluka kwadzidzidzi kwa mtima kumasokoneza thupi. Tissue necrosis imachitika (necrosis of organ site) ndi myocardial infarction. Anthu omwe adadwala matendawa amadwala matenda a mtima. Opaleshoni yam'mimba amatha kusintha kwambiri moyo wa odwala omwe ali ndi matenda amitsempha yamagazi.

Atherosclerosis ya mitsempha ya ubongo limodzi ndi chizungulire, kupweteka, kuwonongeka kwa kukumbukira. Vuto loti sitiroko limachitika pakakhala kuphwanya kwa magazi ku ubongo. Ngati "kuwomba" munthu kumakhalabe wamoyo, ndiye kuti pamakhala zotsatira zoyipa (kusowa chonena, ntchito zamagalimoto). Atherosulinosis imatha kukhala chifukwa cha kupsinjika kwa ischemic, pomwe magazi amathira ku ubongo asokonezeka chifukwa cha cholesterol yayikulu.

Chithandizo chachikulu cha angiopathy

Mavuto ndi chifukwa cha kufooka kwa kagayidwe m'thupi. Mankhwalawa cholinga chake ndikugwiritsa ntchito mankhwalawa omwe amachititsa mitundu yosiyanasiyana ya kagayidwe kachakudya matenda ashuga macroangiopathy.

• chakudya (insulin, acarbose, biguanides, angapo sulfonylureas),
• mafuta (mankhwala ochepetsa lipid),
• mapuloteni (mahomoni a anabolic a anabolic),
• madzi-electrolyte (hemodeis, reopoliglyukin, kukonzekera kwa potaziyamu, calcium, magnesium).

Nthawi zambiri, chizindikiritso chowonjezera cha cholesterol chimawonedwa mu mtundu 2 shuga mellitus, kuchuluka kwa thupi. Imafufuzidwa kawiri pachaka. Ngati kuyesedwa kwa magazi ndiwokwera kuposa kwakhalidwe, ndiye kuti ndikofunikira:

• Choyamba, kuphatikiza zakudya za wodwalayo (kupatula mafuta a nyama, kuchepetsa chakudya chambiri kugaya chakudya mpaka 50 g patsiku, kulola mafuta a masamba 30 ml, nsomba, masamba ndi zipatso),
• kachiwiri, imwani mankhwala osokoneza bongo (Zokor, Mevacor, Leskol, Lipantil 200M).

Kuyenda kwa magazi mu ziwiya zotumphukira kumasinthidwa ndi angioprotectors. Kugwirizana ndi chithandizo chachikulu, ma endocrinologists amalimbikitsa kugwiritsa ntchito mavitamini a B (thiamine, pyridoxine, cyanocobalamin).

• matenda a kuthamanga kwa magazi ndi mankhwala (Envas, Enalopril, Arifon, Renitek, Corinfar),
• kuwonda pang'ono pang'ono
• kusiya chizolowezi chosuta fodya ndi mowa,
• kuchepa kwa mchere,
• kupewa kupewa kuvutikira nthawi yayitali.

Monga njira yothandizira mankhwalawa a mtima, endocrinologists amalimbikitsa kugwiritsa ntchito njira zina zamankhwala. Pachifukwa ichi, kukonzekera kwa mankhwala kumagwiritsidwa ntchito (khungwa la buckthorn, matebulo a chimanga okhala ndi stigmas, mizu yayikulu ya bokosi, zipatso zofesa kaloti, udzu wobisika).

Matenda okhudzana ndi matenda ashuga amakula kwa miyezi yambiri, zaka, komanso makumi. Ku United States, Dr. Joslin Foundation yakhazikitsa mendulo yapadera. Matenda opambana a shuga, omwe adatha kukhala ndi moyo zaka 30 popanda zovuta, kuphatikiza angiopathy, amapatsidwa mphotho ya dzina lomwelo. Menduloyi ikuwonetsa kuyendetsa bwino matenda a zaka zana lino.

Zimayambitsa macroangiopathy mu shuga

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.

Matenda a diabetes angiopathy ndi mitundu yake

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.

Kodi matenda ashuga a macroangiopathy amapezeka bwanji?

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

Kuti mudziwe njira yoyenera yofunsira, wodwalayo ayenera kufunsa dokotala.

Kuyeserera 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 ma electrocardiogram, kuwunika 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 dopplerografia ya 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.

Chithandizo cha matenda a shuga a shuga

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 chotenga 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.

Njira zopewera

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 kuwonetsetsa kuchuluka kwa shuga m'magazi, kuyeza kuthamanga kwa magazi, kutsatira zakudya, 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.