Matenda a shuga - zotupa zotupa za m'matenda a shuga, kufalikira ku ziwiya zazing'ono (microangiopathy) ndi mitsempha yayikulu komanso yapakatikati (macroangiopathy).

Matenda a shuga a shuga - enieni matenda a shuga ndi kuchuluka kwa zotupa zazing'ono (arterioles, capillaries, venges), yodziwika ndi kusintha kwawo :

1. Matenda a shuga - chomwe chimayambitsa khungu m'maso mwa odwala omwe ali ndi matenda ashuga, osachulukana (kukhalapo kwa micaneurysms, hemorrhages, edema, exudates yolimba mu retina), preroliferious (+ kusintha kwamitsempha yam'mimba: kufotokozera bwino, kusokonekera, malupu, kusiya, kusinthasintha kwa mitsempha yam'mimba) komanso kuchuluka (+ mawonekedwe a ziwiya zatsopano) , zotupa zotuluka pafupipafupi mu retina ndi mawonekedwe ake komanso mapangidwe ofunikira a minofu yolumikizika), zodandaula za kutulutsa ntchentche patsogolo pa maso, mawanga, kumverera kwa chifunga, zinthu zosalongosoka, kupita patsogolo S zithunzi acuity.

Kuyeza matenda a shuga a retinopathy.

Kujambula kwa "Gold Standard" ndi kujambula zithunzi za fundus, fluorescence angiography ya retina, ndipo ophthalmoscopy mwachindunji ndiwofikira kwambiri kuwunika pakali pano.

Kuyesedwa koyambirira pambuyo pa zaka 1.5-2 kuyambira tsiku lopezeka ndi matenda ashuga, kupezeka kwa matenda ashuga, kuwunika kamodzi 1 zaka 1-2, ngati kupezeka - osachepera 1 pachaka kapena kuposerapo, komanso kuphatikiza kwa matenda ashuga a retinopathy. , AH, CRF - ndandanda yowunikira payekha, kuchepa kwadzidzidzi kwamawonekedwe owoneka - kuyezetsa kwakanthawi ndi ophthalmologist.

Mfundo zochizira matenda ashuga retinopathy:

1. Mankhwala

2. photocoagulation ziwiya retinal mu magawo oyambirira ashuga retinopathy (Local - laser coagulation foci ntchito m'dera la ndondomeko pathological kapena kukha magazi preretinal, focal - coagulates ntchito mizere angapo paramakulyarnoy ndi parapapillyarnoy m'madera panretinal - ntchito retinopathy proliferative, kuyambira 1200 mpaka 1600 laser zoyang'ana zimagwiritsidwa ntchito ngati cheke patoni ya retina, njira zonse kuchokera kumadera okongola ndi parapapillary mpaka ku equatorial zone ya retina).

3. Cryocoagulation - yowonetsedwa kwa odwala omwe ali ndi kuchuluka kwa matenda ashuga retinopathy, ophatikizika ndi kukokoloka pafupipafupi m'thupi lamatupi, kuwonjezeka kwamphamvu kwa minyewa komanso kuchuluka kwa minyewa, kumachitika koyamba m'magawo am'maso, ndipo pakatha sabata kumapeto kwenikweni, zimathandizira kusintha kapena kukhazikitsa masomphenya otsalira. khungu.

4. Vitrectomy - chikuwonetsedwa pakubowolezera kwamatumbo am'mimba ndikukula kwa kusintha kwa fibrotic mu vitreous ndi retina

2. Matenda a shuga - chifukwa nodular kapena kupukusa nephroangiosulinosis a aimpso glomeruli.

Matenda azachipatala komanso a labotale a matenda a shuga.

1. M'magawo oyamba, mawonekedwe owonekera samakhalapo, munthawi yomwe akuwoneka kuti ali ndi matenda, akuwonjezera proteinuria, ochepa matenda oopsa, nephrotic syndrome, chipatala chopita patsogolo cha matenda aimpso sichitha.

2. Microalbuminuria (kwamikodzo albin extretion, wopitilira muyeso wa proteinuria: 30-300 mg / tsiku) - chizindikiro choyambirira cha matenda ashuga, ndi mawonekedwe a pafupipafupi a microalbuminuria, gawo lomwe lafotokozedwatu limatengera zaka zisanu ndi ziwiri.

3. Hyperfiltration (GFR> 140 ml / min) - zotsatira zoyambirira za zotsatira za hyperglycemia pantchito ya impso mu shuga, zimapangitsa kuwonongeka kwa impso, ndikuwonjezereka kwa nthawi ya matenda ashuga, GFR imayamba kuchepa pang'ono pang'ono pofanana ndi kuchuluka kwa proteinuria komanso kuopsa kwa kuchuluka kwa matenda oopsa.

Omaliza magawo a matenda ashuga nephropathy proteinuria yosalekeza, kuchepa kwa GFR, kuchuluka kwa azotemia (creatinine ndi urea wa magazi), kuchuluka ndi kukhazikika kwa matenda oopsa, komanso kukula kwa matenda a nephrotic.

Gawo lachitukuko cha matenda ashuga nephropathy:

1) Hyperfunction a impso - kuchuluka kwa GFR> 140 ml / mphindi, kuchuluka kwa magazi aimpso, matenda a impso, Normoalbuminuria 131 I ndi chithokomiro cha chithokomiro: kuchuluka kwa mayamwidwe kumawonjezeka kwambiri pambuyo pa maola 2-4 ndi 24.

6) kuwunika kwa chithokomiro cha chithokomiro cha chithokomiro - kumakupatsani mwayi wowona minyewa yogwira ntchito, kudziwa mawonekedwe ndi kukula kwa kutulutsa, kupezeka kwa mawonekedwe mkati mwake, chithunzi chokulirapo cha chithokomiro cha chithokomiro chowonjezeka cha isotope

7) radioimmune kutsimikiza kwamagazi a T3 ndi T4

8) kutsimikiza kwazomwe zili m'magazi a ayodini womangidwa kumapuloteni, osawonetsa ntchito ya chithokomiro

9) Reflexometry - kufupikitsika kwakukulu kwa nthawi ya Achilles tendon Reflex (njira yosadziwika yodziwira ntchito ya chithokomiro, yodziwika ndi kufalikira kwa mahomoni a chithokomiro)

Mfundo za chithandizo cha DTZ:

1. Othandizira a Thyrostatic: mercazolil / thiamazole 30-60 mg / tsiku pakamwa mu magawo 4 kuti agwiritsidwe ntchito kuchepetsa vutoli, ndiye kuti mankhwalawa amachepetsedwa ndi 5 mg pa sabata kuthandizira 2.5-10 mg / tsiku, potaziyamu pafupifupi 400 mg / tsiku pakamwa ( imagwiritsidwa ntchito pothana ndi mercazolilum), lithiamu carbonate, kukonzekera kwa microiodide (yankho la Lugol, mapiritsi a "Microiod")

2. GCS ikuwonetsedwa: 1) matenda ovuta kwambiri a chithokomiro komanso chiwopsezo chachikulu cha chithokomiro, 2) ndi leukopenia woopsa panthawi ya mankhwala a mankhwala aazazolil komanso osachiritsika ndi othandizira a leukopoiesis (ngati sizingatheke kuletsa zegolosic, 3) omwe ali ndi vuto la chithokomiro. , 4) Popeza kulibe vuto la mankhwalawa ndi thyreostatics, prednisone 15-30 mg / tsiku tikulimbikitsidwa (2/3 ya mlingo wa tsiku lililonse pa 7-8 a.m., 1/3 pa 11 a.m.), kusinthana ndikotheka kupewa kulepheretsa kwa adrenal cortex ( kusankha kwa 48-maola GCS m'mawa tsiku lililonse tsiku lililonse kapena kapena kusintha (kusintha masiku atatu a GCS ndi masiku atatu yopuma)

3. Katemera wa immunomodulating kuti magwiritsidwe ntchito a chitetezo cha mthupi: sodium nucleulin mu ufa wa 0,5 ga 4 nthawi / tsiku masabata 3-4, thymalin 10-30 mg / tsiku i / m masiku 5-20, tactivin 1 ml p / mpaka masiku 5-6, desaris / levamisole 150 mg 1 nthawi / tsiku kwa masiku 5

4. Beta-blockers - yowonetsedwa mwanjira iliyonse ya DTZ, makamaka yoopsa, komanso yolumikizidwa ndi matenda oopsa ndi arrhythmias: propranolol 40 mg 4 nthawi / tsiku pakamwa kapena kusankha beta-adrenolytics (talinolol / cordum)

5. Kuchiza ndi ayodini (131 I amadziunjikira mu chithokomiro cha chithokomiro ndipo amatulutsa tinthu tating'onoting'ono tomwe timawononga) - umachitika ndi kusakwanira kwa chithandizo cha chithokomiro, mitundu yayikulu ya myrotooticosis, zovuta, kubwereranso ku DTZ

6. Chithandizo: Kukula kwa MA

7. Chithandizo cha ophthalmopathy: tikulimbikitsidwa kuvala magalasi amdima, kugona ndi mutu wowukitsa, nthawi ndi nthawi kutenga okodzetsa (furosemide 40 mg pamlomo ka 2 kawiri / sabata), kutsanulira madontho a hydrocortisone m'maso ndikugwiritsa ntchito mafuta a hydrocortisone pamatumbo ammaso (amachepetsa conjunctivitis ndi keratitis) mu fiber GCS (4 mg dexazone ndi gawo la masiku 4, njira ya mankhwalawa ndi majekisheni 6-8), lidase (hyaluronidase) 1 ml mu 1 ml ya thupi. yankho, parlodel 25 mg 2 kawiri / tsiku pakamwa (akuletsa kupanga kwa thyrotropin, amachepetsa exophthalmos, edema ndi fibrosis mu fiberobulbar fiber).

8. Mankhwala othandizira (sedative, anxiolytics, mankhwala a anabolic, hepatoprotectors, antihypertensive mankhwala, etc.)

Mitundu yamavuto a Vascular

Kutengera kutengera kwa ziwiya zomwe zakhudzidwa, mitundu yamatenda ambiri ndi:

• nephropathy
• retinopathy
• Microangiopathy yam'munsi yotsika.

Ndi nephropathy, kusintha kwa ma pathological kumakhudza pafupifupi ziwiya zazing'ono zonse za impso. Pamodzi ndi izi, mitsempha yayikulu imakhudzidwanso, zomwe zimapangitsa kuti ziwalozi zisamayende bwino. Kagayidwe kachakudya komweko sikokwanira kwambiri, minofu ndi maselo samalandira oxygen yofunikira komanso michere. Kuphatikiza pa kusintha kwa mitsempha, ndi nephropathy, njira yosefera komanso zomwe zimayambitsa kukhazikitsidwa kwake (tubules ndi glomeruli) zimavutika.

Retinopathy ndi zotupa za retina. Zida zing'onozing'ono m'derali ndizomwe zimapangitsa kuti magazi azikhala ndi gawo lalikulu la gawo la masomphenyawo, kotero kusintha kwawo kowawa kumakhudza kwambiri kupenya kwa munthu. Kutengera ndi gawo la retinopathy, zizindikirazo zimatha kukhala zazing'ono komanso zosasangalatsa kwa wodwalayo. Zotsatira zoyipitsitsa za khungu la maso ndi khungu, chifukwa chake, odwala matenda ashuga amafunika kuwunikidwa pafupipafupi ndi ophthalmologist.

Zosintha m'matumbo am'munsi ndizimodzi mwazinthu zomwe zimapangitsa kuti matenda ashuga apatsidwe. Kuphwanya magazi, mitsempha yodzala ndi minyewa imapangitsa kuti minyewa ikhale yoperewera, motero minyewa imeneyi imasiya kutulutsa bwino komanso kumva. Khungu lomwe lili kumapeto limakhala louma, ming'alu iliyonse ndi zipsera zimatembenuka pachipata cholowera matenda. Kuwonongeka pakhungu la miyendo kumachiritsa kwa nthawi yayitali ndipo ndikovuta, munthu amatha kupweteka zilonda zam'mimba. Chovuta china chachikulu kwambiri cha angiopathy cha malekezero am'munsi ndichizimba, zomwe zimabweretsa kudulidwa kapena kufa.

Zomwe zimachitika

Matenda a shuga a shuga a shuga amachitika chifukwa chophwanya magazi a magazi, chifukwa chotengera chake chimasowa mpweya komanso michere. Kusokonezeka kwa kagayidwe kazakudya zomwe zimayambitsidwa ndi matenda ashuga kumayambitsa magwiridwe olakwika a ziwalo ndi makhoma a capillaries, arterioles ndi venules, chifukwa zinthu izi zomwe zimapangidwanso zimakhala ndi chakudya.

Chifukwa cha matenda ashuga, michere yotsalira ya mapuloteni imadziunjikira m'magazi a wodwalayo, omwe amayenera kutulutsidwa m'thupi. Izi zimabweretsa kusintha kwa magazi ndi kukula kwa makhoma a ziwiya zazing'ono. Nthawi zambiri, microangiopathy imachitika mchaka cha 10-15 maphunziro a matenda ashuga, koma palinso milandu yotsogola zamatenda pambuyo pa zaka 1-2 kuchokera ku matenda a endocrine. Ichi ndichifukwa chake odwala onse amalowa m'gulu lowopsa, ndipo kuti akhale ndi thanzi ayenera kumvetsera thupi lawo mosamala.

Kumayambiriro komwe chitukuko cha matenda a pathological (mosasamala kanthu komwe chili), Zizindikiro zake ndizosafunikira kotero kuti munthu samawalabadira. Ngati tikulankhula za zovuta ndi zotengera za miyendo, ndiye kuti zizindikilo zawo zoyambira zitha kukhala zikunjenjemera kapena kumverera kwadzuwa.

Pamene matenda a wodwala akupita patsogolo, zizindikiro zotsatirazi zimayamba kuvuta:

• zojambula zopweteka m'miyendo
• kutopa kwambiri
• kutupa
• kuyanika kwambiri pakhungu la miyendo ndi miyendo,
• kutayika kwa tsitsi m'derali,
• kukokana
• kuchepa kwa kutentha ndi (kapena) kupweteketsa mtima,
• mapangidwe a zilonda zam'mimba zomwe zimakhala zovuta kuchiza.

Miyendo ya wodwala nthawi zambiri imakhala yozizira ngakhale nthawi yotentha chifukwa chosayenda bwino magazi. Kuphatikiza pa zovuta ndi zotengera zazing'onoting'ono, mitsempha ndi mitsempha yayikulu ndi mitsempha imakokedwa ndikuchita. Chifukwa cha izi, khungu la miyendo limatha kutembenuka kapena kukhala lofiirira, cyanotic. Kusasamala kwa malamulo aukhondo waumwini, monga lamulo, kumakulitsa vutoli ndipo kumakhala chothandizira kukulitsa zotupa zopatsirana. Kusunga miyendo yanu kukhala yoyera komanso inauma ndi imodzi mwazinthu zazikulu zomwe zimayambitsa matenda ashuga.

Retinopathy kumayambiriro koyambirira sadzimva, ngakhale atayang'aniridwa ndi ophthalmologist, wodwala wotereyu akhoza kukhala atasintha kale. Nthawi zambiri, odwala amati mawonekedwe otere ndi kutopa, ndipo samawakomera iwo mwapadera. Poyamba, "ntchentche" zazing'ono kapena zonunkha zimatha kuwonekera pamaso, koma zowoneka bwino, monga lamulo, sizivutika. Kenako munthuyo amawona kuti zimamuvuta kugwira ntchito pakompyuta, kuwerenga ndi kulemba (maso ake amatopa kwambiri ndipo kumveka kwamaso kumachepa). Zizindikiro zimawonjezeka pamene mkhalidwe wa retina umakulirakulira, ndipo ngati simupita kukaonana ndi dokotala panthawi, ngozi ya khungu imakulanso.

Ndizovuta kukayikira nephropathy kumayambiriro kwa chitukuko chake, chifukwa chimatha kuwonetsedwa pokhapokha mapuloteni mumkodzo (izi zimatha kudziwika ndikudutsa kuwunikira). Kuwonongeka kwa impso kukakhala kodziwika komanso kosatha, munthu amatha kusokonezeka ndi edema, kudumpha m'magazi, kusokonekera kwamikodzo, kununkhira kwa ammonia kuchokera mkamwa komanso kufooka kosalekeza.

Zizindikiro

Kukhazikitsa matenda a microangiopathy a m'munsi am'munsi, kuyezetsa dokotala, kuyezetsa magazi a labotale ndi ma x-ray ndikofunikira. Zombo zazing'onoting'ono komanso zazikulu zamiyendo zimatha kuunikiranso pogwiritsa ntchito Doppler (mtundu wa ultrasound). Nthawi zina, MRI kapena composed tomography scan itha kuyatsidwa kuti ifotokoze zovuta zotsutsana. Kuti mupeze chithunzi cholondola, wodwalayo nthawi zambiri amalimbikitsidwa kuphunzira ndi wosiyana ndi ena, zomwe zimapangitsa kuti chithunzicho chimveke bwino.

Ndi nephropathy pakuwunika mkodzo pafupipafupi, kusintha kumapezeka kawirikawiri komwe kumakhala chifukwa chodziwika bwino.

Ndikotheka kudziwa zovuta zam'mtsempha mu impso pogwiritsa ntchito ultrasound, X-ray, MRI. Pofuna kudziwa momwe retina limakhalira komanso kudziwika koyambirira kwa retinopathy, wodwalayo amafunika kumamufufuza pafupipafupi ndi a ophthalmologist. Kuphatikiza pa kufunsidwa ndikuwunikidwa, adokotala nthawi zambiri amagwiritsa ntchito zofunikira pakuwunika zida za ma ocular, pamaziko omwe amalankhula za kukhalapo kapena kusakhalapo kwa kusintha kwa ma pathological.

Chithandizo cha microangiopathy mu matenda a shuga zimatengera kutanthauzira kwa matenda. Ndizovuta kwambiri kuyimitsa kuyambika kwa retinopathy, mavuto ndi ziwiya zamiyendo kapena nephropathy, komabe ndizotheka kuchepetsa kukula kwawo pang'ono. Zinthu zikuluzikulu zochizira matenda onse am'matumbo omwe amapezeka m'thupi ndikusunga shuga mumagazi ndikutsatira kadyedwe. Popanda izi, palibe njira zakomweko komanso mankhwala othandizira omwe angathandize kapena kubweretsa zotsatira zosatha.

Kuti achepetse kayendedwe ka metabolic mu retina, wodwalayo angafotokozedwe kulimbikitsa madontho amaso, mavitamini ndi kutikita minofu yaying'ono. Njira ngati izi sizichotsa vutoli kwathunthu, koma zimachedwetsa kupitirira kwake. Ndi nephropathy, ndikofunikira kutsatira zakudya, kusiya mchere ndi mapuloteni ambiri, ndikuwongolera kuthamanga kwa magazi.Ndi matenda ogwirizana, wodwala ayenera kumwa mankhwala a antihypertensive (mwachitsanzo, zoletsa za ACE).

Unyinji waukulu umakhudza mkhalidwe wam'munsi, chifukwa pamenepa amakhala ndi katundu wambiri. Masewera olimbitsa thupi komanso kuyenda maulendo angapo ndizofunikira kuti magazi azithamanga, kusintha minofu ing'ono ndi kuwonjezera njira zama metabolic. Kuchita masewera olimbitsa thupi tsiku ndi tsiku komanso kuchita masewera olimbitsa thupi kumachepetsa chiopsezo chokhala ndi matenda ammimba a shuga. Nthawi zina wodwala amatha kupatsidwa mankhwala othandizira kulimbitsa thupi ndi mafuta ogwiritsira ntchito popakidwa ntchito, omwe amasintha minofu yofewa komanso mitsempha yamagazi m'miyendo.

Kupewa

Njira yothandiza kwambiri yopewa zovuta zilizonse zamatenda a shuga ndikusunga shuga mumagazi. Kuti muchite izi, ndikofunikira kutsatira zakudya, kukayezetsa ndi nthawi ya endocrinologist, ndikuchita magazi.

Komanso, kupewa, ndikofunikira kwambiri:

• lekani kusuta ndi kumwa mowa,
• Chulukitsani mchere womwe mumadya ndi chakudya,
• Nthawi zonse muziwonetsetsa kuchuluka kwa cholesterol m'magazi ndipo, ngati kuli kofunikira, muchepetse.
• khalani moyo wokangalika
• kuthana ndi magazi, kuteteza kuti lakuthwa lithe.

Matenda a shuga, zimakhudzanso mitsempha yamagazi, ndipo ndizosatheka kuletsa kwathunthu kusintha kosasangalatsa mwa iwo. Koma pozindikira zovuta kumayambiriro, mutha kupewa kuwonongeka kwa matenda. Kukhala ndi moyo wathanzi komanso kutsatira malangizo a adotolo amalola odwala matenda ashuga ambiri kuiwala za zovuta za matendawo kwa nthawi yayitali.

Matenda a shuga a shuga - kuzindikira ndi kulandira chithandizo

Diabetesic microangiopathy ndi zotupa zazing'onoting'ono - ma capillaries, arterioles ndi ma venols. Izi ndizofala kwambiri, zimabweretsa zotsatira zoyipa. Popewa kuyambika kwa matendawa, ndikofunikira kutsatira nthawi zonse azachipatala. Ngati zizindikiro ngati izi zikuchitika, kuchitapo kanthu mwachangu.

Chofunika cha matenda

Matenda a shuga a shuga a shuga amadziwika ngati kuwonongeka kwa mtima, komwe kumachitika chifukwa cha hyperglycemia yomwe imatenga nthawi yayitali. Kwenikweni, pali kusintha kwa zombo zazing'ono - ma capillaries, venule ndi arterioles. Pathology sangathe kudziwonetsa yokha kwa zaka 10-15 - izi zimatsimikiziridwa ndi kulimba mtima kwa wodwala.

Kuwonjezeka kwa shuga m'magazi kumatsutsa kuchuluka kwa zinthu zakale pamitsempha yamagazi. Izi zimayambitsa kutukusira kwa nembanemba komanso kuchepera kwa lumen ya ziwiya, zomwe zimayambitsa kuphwanya magazi.

Njirayi imayendetsedwa ndi kuphwanya kwa magazi, mapangidwe ang'onoang'ono wamagazi, kusintha kwa kagayidwe kazinthu. Kwa nthawi yayitali, maselo amakhala osakwanira mu okosijeni. Izi zimabweretsa kutsika mu magawidwe awo ndikuwonjezera kuvunda.

Zinthu zingapo zimayambitsa kupezeka kwa microangiopathy mu matenda a shuga:

• Njira zosasinthika chifukwa cha kuwonjezeka kwadzidzidzi kwa kufatsa kwam'mimba,
• Kuphwanya kwa kapangidwe ka zinthu zolumikizana,
• Thrombosis - mawonekedwe m'mitsempha yamagazi omwe amasokoneza kayendedwe ka magazi,
• Hyaline dystrophy - yodziwika ndi mawonekedwe a mapuloteni okhala ndi mawonekedwe ofiira,
• Necrosis - kufa ndi kufa kwa minofu.

Miyezi ya shuga ikamakwera, ma radicals aulere ndi peroxide amapangidwa m'thupi. Amayambitsa kuwonongeka ndi poyizoni wa endothelium, komwe ndikofunikira kwambiri pakukonzanso kwathunthu kwa minofu ndi ntchito zina.

Nthawi zambiri, endothelium imapanga nitric oxide. Ndi chitukuko cha matenda a zamizere, kupanga zinthu zamtunduwu kumachepa. Panthawi imeneyi, zombo zimalephera kutukula pawokha. Izi zimayamba chifukwa cha matenda a mtima ndi mitsempha yamagazi.

Gulu

Anthu ambiri ali ndi chidwi ndi zomwe zimanena za microangiopathies mu shuga. Kutengera kutengera kwadzidzidzi kwa anomatic, mitundu yotsatirayi yamadwala imawonedwa:

• Nephropathy,
• Retinopathy
• Microangiopathy ya miyendo.

Retinopathy imamveka kutanthauza kuwonongeka kwa retina ocular. Zida zing'onozing'ono m'derali ndizomwe zimayendetsa magazi pazinthu zofunika za gawo la masomphenya. Chifukwa kusintha kwazomwe zimapangitsa kuti anthu aziona. Kutengera gawo la retinopathy, mawonetserowa atha kukhala ochepa kapena angapangitse zovuta kwa wodwalayo mpaka atha kuwona kwathunthu.

Ndi nephropathy, kusintha kwachilendo kumakhudza pafupifupi ziwiya zazing'ono zonse za impso. Kuphatikiza apo, mitsempha yayikulu imatha kuvutika, zomwe zimabweretsa zovuta mu ntchito ya thupi. Kagayidwe kachakudya komweko sikokwanira. Izi zimapangitsa kuperewera kwa oxygen komanso zinthu zopindulitsa.

Komanso, ndi nephropathy, kusefedwa kumasokonezedwa ndipo zida zomwe zimayang'anira ndondomekoyi zimakhudzidwa.

Zilonda zamiyendo zamiyendo zimakhala chimodzi mwazomwe zimayambitsa mawonekedwe a phazi la matenda ashuga. Kusintha kwa mitsempha yotulutsa ndi kayendedwe ka magazi kumayambitsa kuperewera kwa michere m'miyendo. Chifukwa chake, matenda a shuga a shuga a m'munsi amakwiyitsa amachititsa kuti kamvekedwe kabwino ka khungu. Amakhala wouma, ndipo kuwonongeka kulikonse kumayambitsa matenda.

Zilonda zilizonse zam'mimba zimachiritsidwa kwa nthawi yayitali. Wodwala amatha kuoneka zilonda zam'mimba. Vuto lowopsa kwambiri lomwe lingayambitse microangiopathy yotsika m'matenda a shuga ndi gangren. Zimayambitsa kudula miyendo kapena kufa.

Chithunzi cha kuchipatala

Pa gawo loyambirira lachiwonetsero cha matenda, zizindikiro zake sizowoneka bwino kotero kuti wodwalayo amangowanyalanyaza. Ndi kuwonongeka kwa ziwiya zamiyendo, kulumikizana ndi dzanzi ndizofunikira kwambiri.

Pomwe kukondwerera kumayamba, mawonetsedwe otsatirawa amachitika:

• Ululu m'miyendo yaukoka,
• Kutupa
• Kutopa kwambiri,
• Kuuma kwambiri kwa miyendo ndi miyendo,
• Matenda opatsirana
• Kutayika kwa tsitsi
• Kutaya mtima
• Maonekedwe a zilonda zam'mimba, zomwe zimakhala zovuta kuchiza.

Mavuto oyendayenda amachititsa kuti miyendo ya wodwalayo ikhale yozizira ngakhale kutentha. Kuphatikiza pa kugonjetsedwa kwa zombo zazing'ono, ulusi wamanjenje, mitsempha ndi mitsempha nthawi zambiri zimathandizira pakuchita zovutazo. Izi zimatha kubweretsa kusintha kwa khungu - limakhala loyera, lamtambo kapena lotuwa.

Kuphwanya malamulo aukhondo nthawi zambiri kumapangitsa kuti zinthu ziziwonjezereka komanso kumapangitsa kuti matenda azilonda. Chifukwa chake, madokotala amalimbikitsa mwamphamvu kuti mapazi anu akhale owuma komanso oyera.

Pa magawo oyambirira a retinopathy, njira ya asymptomatic imawonedwa. Komabe, katswiri wa maso pa nthawi ya mayeso amatha kujambula kusintha kotere. Poyamba ntchentche kapena nthochi zimatha kuwoneka patsogolo pa maso, koma mphamvu zowoneka sizimachepa.

Kenako zimavuta kuti wodwala alembe, kugwira ntchito pakompyuta kapena kuwerenga. Chithunzi cha chipatala chimakulirakulira pamene retina ikukhudzidwa. Ngati simukulankhula ndi ophthalmologist, pamakhala chiwopsezo cha kutayika kwathunthu kwa masomphenya.

Kuzindikira nephropathy kumayambiriro kwa chitukuko kumakhala kovuta kwambiri. Pathology imawonetsedwa pokhapokha pakupanga mapuloteni osafunikira mkodzo. Kusanthula kwamankhwala kumathandiza kuzindikira chinthu ichi.

Ngati kuwonongeka kwa impso kumayamba kutchulidwa, pali kutupa, kutsika kwa mavuto, mavuto pokodza. Anthu ambiri amakhala ndi kufooka kosalekeza, amanunkhira ammonia kuchokera mkamwa.

Kudzifufuza

Choyamba, muyenera kudziwa mtundu wa matenda ashuga. Matenda a mtundu woyamba amadalira insulin, matenda a mtundu wachiwiri safunikira kuyambitsa insulin.

Madokotala amafufuzanso za mbiri ya glycemic mbiri, C-peptide, glycated hemoglobin.

Katswiriyu ayenera kuphunzira mbiri ya matenda, kuunika ndi kuzindikira zovuta. Ngati mukukayikira za microangiopathy, chitani maphunziro awa:

1. Fundusgraphy - ma microscope amasanthula kapangidwe ka thumba lamaso. Mchitidwewo umakuthandizani kuzindikira kuzungulira kwa mitsempha yamagazi, kuzindikira kuwonekera kwa magazi ndi kuwunika kwa mandala.
2. Kupenda kwa Ultrasound kwamkati mwa ziwalo zamkati - kumakuthandizani kuti muzindikire zovuta zamagazi, kuwonjezeka kwa kukula kwa impso, komanso kuchuluka kwa mkodzo mu mafupa a impso. Njirayi imathandizanso kuzindikira kupendekera kwa lumen ya ziwiya zosiyanasiyana.
3. Kuyerekezera ndi maginito oyeseza - amathandizira kutsata kapangidwe ka ziwalo ndikuwunika kusintha kosazolowereka.
4. Angiography miyendo - imaphatikizapo kukhazikitsidwa kwa zithunzi za x-ray pogwiritsa ntchito zosiyana. Chifukwa cha njirayi, ndizotheka kudziwa kukula kwa zombozo komanso kukula kwa matimidwe awo mosiyana.
5. Rheovasography - amagwiritsidwa ntchito poyesa magazi othamanga m'miyendo. Phunziroli limathandizanso kudziwa kukula kwa ma capillaries komanso mtundu wa kutulutsa kwapang'onopang'ono.

Njira zochizira

Kuti muthane ndi matenda a zamitsempha, ndikofunikira kutsata bwino malangizo onse a dokotala. Onetsetsani kuti mukusiya kusuta, muzichita masewera olimbitsa thupi komanso musanenepe kwambiri.

Kuchokera pachakudyacho ndikuchotsa zakudya zomwe zimapakidwa mosavuta. Nthawi zina, chakudya chokhala ndi mchere wofunikira chimafunika.

Kuphatikiza pa insulin, gawo limodzi mwa zovuta kuchiritsa kwa matenda ndi kugwiritsa ntchito ma colloidal phytoformulas omwe amakhudza mbali zonse za chitukuko cha matenda ashuga. Ali ndi vuto la hypoglycemic, amateteza kukhathamiritsa kwa ma cell, kupulumutsa zinthu zomwe zimafunikira chindalama chifukwa cha zovuta za matendawa.

Mu chipatala, angioprotectors angagwiritsidwe ntchito, omwe amathandizira kubwezeretsa ndi kuteteza mitsempha yamagazi. Gawoli limaphatikizapo mankhwala monga parmidin, angin, dicinone.

Kupititsa patsogolo kagayidwe ka metabolic, trimetazidine ndi mildronate amagwiritsidwa ntchito. Kugwiritsa ntchito ma statins, monga atorvastatin, simvastatin, kuyenera kuthandizidwa mosamala kwambiri. Kuphatikiza pa kutsitsa cholesterol, amatha kupweteketsa mtima kwambiri.

Malinga ndi zikuwonetsa, anticoagulants angagwiritsidwe ntchito. Amathandizira kuchepetsa magazi. Ndalamazi zimaphatikizapo fraxiparin, heparin, etc.

Monga zowonjezera pazachipatala chachikulu, akatswiri amatsatsa njira monga kuwonekera kwa laser, magnetotherapy, acupuncture. Njira zina za physiotherapy zomwe zimathandizira kupanga morphology komanso kuthana ndi kupweteka kwa mwendo zimatha kugwiritsidwa ntchito.

Microangiopathy mu shuga ndi vuto lalikulu, lomwe limabweretsa zoopsa. Kukhazikitsa kwachidziwikire zoikidwiratu kuchipatala ndikuwongolera moyo kumathandiza kupewa izi. Ngati zizindikiro za matenda zimapezeka, muyenera kulankhulana ndi endocrinologist. Pambuyo pakuzindikira matenda ake, amafunika kukonzekera mayeso apachaka okonzekereratu.

Mawonetseredwe akulu am matendawa

Chithunzi chachipatala cha matendawa chimadalira malo ndi zotupa.

Chifukwa cha kuchuluka kwa magazi a osmotic, omwe amayamba chifukwa cha kuchuluka kwa shuga m'magazi komanso kudya kwambiri, wodwalayo amatupa m'maselo a minyewa. Chifukwa chophwanya mapuloteni ndi mafuta kagayidwe, magawo amitsempha yamagazi amawonongeka, maselo ofiira amwazi amawonongeka, zotupa za m'mimba (phenura) zimawonekera, ndipo kulephera kwa aimpso kumachitika.

Mitundu ina yamatendawa:

• matenda ashuga nephropathy - anati mwa atatu mwa odwala. Ndi iyo, ntchito ya impso imalephera, kutupa kumachitika, protein yambiri imapezeka mkodzo,
• matenda a zombo zomwe zili kumapeto kwenikweni,
• kuwonongeka kwa ziwiya zam'maso (angioretinopathy).

Kusintha kwofananira kwa kusintha koyamba kwa ziwiya m'mankhwala amathandizira kumatanthawuza njira zochiritsira mosiyana poyerekeza ndi chithandizo cha zotupa zam'mimba kwambiri.

Kutengera izi, magawo atatu a angiopathy mu shuga amadziwika:

1. zamankhwala
2. zothandiza
3. organic.

Odwala omwe ali ndi gawo loyamba la madandaulo nthawi zambiri sizichitika. Palibe ma pathologies panthawi ya mayeso. Komabe, malinga ndi zotsatira za kusanthula kwachilengedwe, chiwonetsero chachikulu cha cholesterol chimawululidwa, kuchuluka kwa zala zakumaso kumawonjezeka.

Mu gawo lachiwiri, ululu wofatsa komanso wodutsa m'miyendo umawoneka pakuyenda kwakutalika, kukokana kumawonekera, kutentha kwa khungu kumunsi kotsika kumatsika ndi madigiri 2-3. Biochemical kusuntha, pakapita magazi magazi ndi matenda oopsa.

Mu gawo lachitatu, zotupa za zotengera zamiyendo zimafotokozedwa, zomwe zimabweretsa kuwonda, kupweteka m'mapazi, zilonda zam'mimba, asystole wa dorsal artery of the foot. Kusintha kwa mtima, mphamvu yaying'ono yothandizidwa ndi chithandizo imasinthika. Magawo pamene matenda ashuga a macroangiopathy amawonekera amawonjezeredwa.

Kuphatikiza pa kusanthula kwamayendedwe ofunika pakufunika:

• Fundus ultrasound,
• compression tomography,
• Maphunziro a X-ray
• maginidwe amatsenga,
• kupimidwa kwamagazi kwa mitsempha.

Chithandizo chimatengera kutengera kwa mapangidwe a kagayidwe kachakudya, zomwe zimayambitsa ndi zomwe zimachitika mu microangiopathy. Nthawi zambiri, odwala amathandizidwa ndi mankhwala kuti athandize kuti magazi achuluke.

Kuphatikiza apo, physiotherapy ikhoza kutumizidwa. Chimodzi mwazinthu zabwino zothandizira odwala kuchiritsira ndikutsatira mfundo zaumoyo komanso njira yovomerezeka ndi dokotala.

Malangizo apamwamba pankhaniyi ndi kukana kudya zakudya zokhala ndi "chakudya chambiri" - confectionery, maswiti otsekemera ndi zakumwa, pasitala, makeke ndi mitundu ina ya masamba ndi zipatso. Mchere wamchere ungakhale wochepa.

Kulekana ndi chizolowezi chonga kusuta kumakhala kofunika kwa odwala. Ma Resins ndi mankhwala osiyanasiyana a utsi wa fodya amathandizira vasoconstriction ndi necrosis.

Mwa malingaliro omwe amathandizira kuti achire azitha kukhala ndi kutsata njira zolondola za tsikulo ndikugawa zolimbitsa thupi.