Shuga insipidus - Zizindikiro, mankhwala

Matenda a shuga - Ichi ndi matenda osowa kwambiri, omwe amadziwika ndi ludzu lalikulu komanso chinsinsi cha mkodzo wowonjezera (polyuria).

Mwambiri, matenda a shuga insipidus amayamba chifukwa cha kupindika kwapazinthu, kudzikundikira ndi kutulutsidwa kwa ma antidiuretic mahomoni (ADH).

Koma insipidus ya shuga imatha kuchitika pamene impso sizingayankhe pokhudzana ndi zomwe timadzi timene timapanga. Pafupipafupi, matenda a shuga a insipidus amapezeka nthawi yapakati (gestationalabetes insipidus).

Anthu ambiri amasokoneza matendawa ndi mawu oti "shuga." Koma kupatula dzina, shuga insipidus ndi shuga mellitus (mitundu 1 ndi 2) alibe chilichonse chofanana.

Chithandizo chamakono cha matenda a shuga insipidus cholinga chake ndikuchotsa zomwe zimayambitsa, kuthetsa ludzu, komanso kutulutsa mkodzo.

Zoyambitsa matenda a shuga insipidus

Matenda a shuga amatuluka thupi lathu likalephera kutulutsa bwino magazi. Nthawi zambiri, impso zimatulutsa madzi ochulukirapo ngati mkodzo. Madzi awa amasefa kuchokera m'magazi m'mitsempha ya impso, kenako amadziunjikira mu chikhodzodzo ndipo amakhala pomwepo mpaka munthu akufuna kukodza.

Ngati impso imagwira ntchito molondola, ndiye kuti imawongolera kuchuluka kwa madzi mthupi - ngati timamwa kwambiri ndikutaya timadzi pang'ono, ndiye kuti mkodzo umatulutsidwa, ndipo tikakhala wopanda madzi, impso zimachepetsa kupanga mkodzo kuti muthere madzi. Kuchuluka ndi kapangidwe ka madzi amthupi kumakhalabe kosatha chifukwa chofunikira.

Kuchuluka kwa madzi akumwa kumapangidwira makamaka ndi ludzu, ngakhale zizolowezi zathu zimatha kutipangitsa kuti timwe madzi ambiri kuposa momwe timafunikira. Koma kuchuluka kwa madzimadzi zotumphukira kumayendetsedwa ndi antidiuretic mahomoni (ADH), wotchedwanso vasopressin.

Hormidi ya antidiuretic (vasopressin) imapangidwa mu hypothalamus ndipo imadziunjikira m'matumbo otaya - gawo laling'ono koma lofunikira kwambiri kumunsi kwa ubongo komwe limayang'anira njira zazikulu mthupi lathu. Ma hormone a antidiuretic amatulutsidwa m'mitsempha pakafunika. Imakhudza mkodzo, zomwe zimakhudza kubwezeretsanso kwa madzi m'matumbu a zida zosefera.

Matenda a shuga amayamba chifukwa cha zovuta zingapo:

1. shuga yayikulu insipidus.

Chomwe chimayambitsa matenda a shuga a shuga makamaka chimakhala kugonjetsedwa kwa pituitary kapena hypothalamus. Amatha kuchitika chifukwa cha kugwidwa ntchito kwa ubongo, kuvulala, kutupa, meningitis ndi matenda ena amkati amanjenje. Nthawi zina, chomwe chimapangitsa sichimadziwika. Dongosolo lowonongeka la hypothalamic-pituitary ndilo limayambitsa kuphwanya kupanga, kusunga ndi kutulutsa kwa ADH. Nthawi zambiri matendawa amaphatikizidwa ndi mavuto ena, chifukwa chida cha pituitary chimayendetsa ntchito zambiri zamthupi.

2. Nephrogenic shuga insipidus.

Nephrogenic shuga insipidus imachitika chifukwa cha chilema m'matumbu aimpso - nyumba zomwe zimapangidwanso madzi. Kusweka kumeneku kumapangitsa impso kukhala zosamvetsetseka ku ADH. Izi zimatha kukhala za cholowa (majini), kapena kutengedwa chifukwa cha matenda a impso. Mankhwala ena, monga lithiamu salt ndi tetracycline, amathanso kuyambitsa matenda a nephrogenic shuga insipidus.

3. Gestational shuga insipidus.

Gestational matenda a shuga a insipidus amapezeka pokhapokha ngati ali ndi pakati, pamene enzyme yopangidwa ndi placenta (njira yamagazi yopatsira mwana wosabadwayo) imawononga ADH ya amayi.

4. Dipsogenic shuga insipidus.

Mtundu uwu wa matenda a shuga insipidus umadziwika bwino monga pulydipsia yoyamba kapena psychogenic polydipsia. Ndi matendawa, kuchuluka kwamadzimadzi ambiri kumachepetsa mphamvu ya mahomoni a antidiuretic. Kudya kwamphamvu nthawi zonse, kosaletseka kumatha kuchitika chifukwa cha matenda amisala (mwachitsanzo, ndimavuto okakamira - OCD) kapena kuwonongeka kwa kapangidwe ka ludzu mu hypothalamus (mwachitsanzo, ndi sarcoidosis).

Nthawi zina, chomwe chimapangitsa wodwalayo kukhala ndi matenda a shuga sichidziwika bwinobwino, ngakhale kuti wodwalayo adamuyeza bwinobwino.

Zomwe zimayambitsa matenda a shuga insipidus

Nephrogenic matenda a shuga a insipidus, omwe amapezeka atangobadwa kumene, nthawi zambiri amakhala ndi vuto la chibadwa lomwe limalumikizidwa ndi kusokonezeka kwa mphamvu ya impso kukhazikika mkodzo. Nephrogenic shuga insipidus nthawi zambiri imakhudza amuna, pomwe azimayi amatha kukhala onyamula majini osalongosoka.

Zizindikiro za matenda a shuga insipidus

Zizindikiro zodziwika bwino za matenda a shuga a insipidus ndi monga:

• ludzu lamphamvu (polydipsia).
• Kutulutsa mkodzo kwambiri (polyuria).
• Osakhudzika mokwanira, mkodzo wowala.

Kutengera ndi kuopsa kwa matendawa, munthu amatha kufufuma tsiku lililonse kuchokera pamilingo 3 ya mkodzo wofatsa wa shuga wofika 15 (!) Zolemba za matenda oopsa. Nocturia imadziwikanso - odwala amadzuka usiku kuti akope. Nthawi zina, amatha kukodza atagona mwachangu (kugona).

Mosiyana ndi matenda amisala, omwe amaphatikizidwa ndi kudya kwamadzi nthawi zonse, okhala ndi matenda a shuga, odwala amadzuka ngakhale usiku, kuzunzidwa ndi ludzu.

Mwa ana aang'ono, matenda a shuga amatha kupezeka ndi zizindikiro zotsatirazi:

• Kukhala ndi nkhawa zosaneneka komanso kulira nthawi zonse.
• Kudzazidwa mwachisawawa kwa ma diapoti.
• Kuchuluka kwa kutentha kwa thupi.
• Kupukuta ndi kutsegula m'mimba.
• Khungu lowuma.
• miyendo Yozizira.
• Kukula msanga.
• Kuchepetsa thupi.

Ndi ludzu lachilendo komanso kuchuluka kwamkodzo, funsani dokotala. Posakhalitsa matenda atapezeka, madokotala atha kuyamba kulandira chithandizo, ndikuchepetsa chiopsezo cha zovuta.

Pozindikira matenda a shuga insipidus, njira zotsatirazi zimagwiritsidwa ntchito:

1. Yesani kuperewera kwa madzi m'thupi.

Njirayi imathandiza kudziwa chomwe chimayambitsa matenda a shuga insipidus. Mufunsidwa kuti musiye kumwa madziwo patangotsala maola awiri kuti muyeze mayeso. Dokotala azindikire kulemera kwanu, kuchuluka kwake komanso kapangidwe kake ka mkodzo, komanso kuchuluka kwa magazi a ADH panthawiyi. Mwa ana ndi amayi apakati, kuyezetsa uku ndikulimbikitsidwa kuti kuchitika molamulidwa kwambiri kuti kuchepa kwamadzi kusapitirire 5% ya kulemera koyambirira kwa thupi.

Uku ndi kusanthula kwathunthu kwamthupi ndi mankhwala. Ngati mkodzo sukhazikika mokwanira (ndiye kuti uli ndi mchere wocheperako kuposa momwe umakhalira), ndiye kuti izi zitha kunena m'malo mwa shuga.

3. Magnetic resonance imaging (MRI).

MRI Mutu ndi njira yosasinthika yomwe imalola kuti adotolo akhale ndi chithunzi chatsatanetsatane cha ubongo wanu ndi zida zake zonse. Dokotala adzakhala ndi chidwi ndi dera la pituitary ndi hypothalamus. Matenda a shuga atha kudwala chifukwa cha chotupa kapena zoopsa m'derali, zomwe zikuwonetsa MRI.

4. Kuunika ma genetic.

Ngati dotolo akuwaganizira kuti ndi cholowa cha matenda obadwa nawo, ndiye kuti ayenera kuphunzira mbiri yakale, ndikuwunikanso majini.

Njira zochizira matenda osiyanasiyana zitha kukhala:

1. shuga yayikulu insipidus.

Ndi matenda amtunduwu, omwe amaphatikizidwa ndi kuchepa kwa ADH, mankhwalawa amakhala ndi kutenga mahomoni opanga - desmopressin. Wodwala amatha kutenga desmopressin mu mawonekedwe a kuphipha kwammphuno, mapiritsi kapena jakisoni. Mahomoni opanga amachepetsa kukodza kwambiri.

Kwa odwala ambiri omwe ali ndi vutoli, desmopressin ndi chisankho chothandiza komanso chabwino. Mumamwa desmopressin, muyenera kumwa madzi pokhapokha ngati muli ndi ludzu. Kufunika kumeneku kumachitika chifukwa chakuti mankhwalawa amaletsa kuchotsa madzi mthupi, ndikupangitsa impso kuti zisatulutse mkodzo wochepa.

Pazifukwa zochepa za insipidus yapakati pa matenda a shuga, mungafunike kuchepetsa kuchepa kwanu kwamadzi. Dokotala amatha kusintha kuchepa kwamadzi tsiku lililonse - mwachitsanzo, malita a 2,5 patsiku. Ndalamayi ndiy payokha ndipo ikuyenera kuwonetsetsa kuti hydrate ikuyenda bwino!

Ngati matendawa amayamba ndi chotupa komanso matenda ena a hypothalamic-pituitary system, dokotala amalimbikitsa kuchitira matenda oyambawo.

2. Nephrogenic shuga insipidus.

Matendawa ndi chifukwa cha yankho lolakwika la impso ku mahomoni antidiuretic, chifukwa chake desmopressin sichigwira ntchito pano. Dokotala wanu akupatsirani zakudya zamafuta ochepa kuti muthandize impso zanu kuti muchepetse kutulutsa mkodzo.

Hydrochlorothiazide (Hypothiazide), wopangidwa yekha kapena ndi mankhwala ena, amatha kutsitsanso zizindikiro. Hydrochlorothiazide ndi diuretic (nthawi zambiri imagwiritsidwa ntchito poonjezera mkodzo), koma nthawi zina amachepetsa mkodzo, monga momwe zimakhalira ndi nephrogenic shuga insipidus. Ngati zizindikiro za matendawa sizitha, ngakhale mutamwa mankhwala ndi zakudya, ndiye kuti kusiya mankhwalawa kumatha kupereka zotsatira.

Koma popanda chilolezo choyambirira cha dokotala, simungathe kuchepetsa mlingo kapena kuletsa mankhwala aliwonse!

3. Gestational shuga insipidus.

Chithandizo cha matenda a shuga ambiri maka mwa amayi apakati akutenga mankhwala a syntmopressin. Nthawi zina, matenda amtunduwu amayamba chifukwa cha vuto loti limva ludzu. Ndiye desmopressin sichikudziwika.

4. Dipsogenic shuga insipidus.

Palibe chithandizo chamankhwala amtunduwu wa insipidus. Komabe, ndimavuto angapo amisala, chithandizo chamankhwala chimakakamiza wodwalayo kuti achepetse kuthamanga kwamadzi ndikuchepetsa zizindikiro za matendawa.

Malangizo kwa odwala matenda a shuga a insipidus:

1. Pewani madzi m'thupi.

Dokotala wanu akukulimbikitsani kuti mugwiritse ntchito madzi enaake tsiku lililonse kupewa madzi am'madzi. Sungani madzi ndi inu kulikonse komwe mungapite, makamaka ngati mukupita ulendo wautali. Ana ayenera kupatsidwa madzi akumwa maola awiri aliwonse, usana ndi usiku.

2. Valani chizindikiro chochenjeza.

Sizachilendo kumadzulo kuvala zibangili zapadera kapena makadi ochenjeza achipatala mchikwama chanu. Izi zikuthandizani adotolo kuti azitha kuyenda mwachangu ngati china chake chachitika mwa iwo eni.

Zizindikiro zakutha kwamadzi zikuphatikiza:

• Pakamwa pakamwa.
• kufooka kwa minofu.
• Zovuta.
• Hypernatremia.
• Maso otupa.
• Kwezani kutentha.
• Mutu.
• Mumtima.
• Kuchepetsa thupi.

2. Electrolytic kusalingani.

Matenda a shuga angayambenso kusakhazikika mu ma electrolyte mthupi. Ma electrolyte ndi mchere monga sodium, potaziyamu, calcium, womwe umasunga madzimadzi ndikugwira ntchito moyenera kwa maselo athu.

Zizindikiro za kusakhazikika kwa electrolytic ndi monga:

• Arrhasmia.
• kufooka.
• Mutu.
• Kusakwiya.
• kupweteka kwa minofu.

3. Madzi owonjezera.

Ndi kumwa kwambiri madzi (dipsogenic shuga insipidus), zotchedwa poyizoni wamadzi ndizotheka. Amawonetsedwa ndi kuchuluka kochepa kwa sodium m'magazi (hyponatremia), komwe kungayambitse kuwonongeka kwa ubongo.

Vasopressin: kaphatikizidwe, malamulo, zochita

Vasopressin ndi njira yobisika yogwira ya hypothalamus (chilengedwe cha peptide). Mayina ake ena: mahadi antidiuretic, argipressin.

Vasopressin amapangidwa makamaka mu neurons ya supraoptic nucleus ya hypothalamus. Hormoni iyi imadziunjikira ndipo imasungidwa m'magazi ndi maselo a chothandizira pituitary gland. Pamenepo vasopressin amalowa kudzera ma axons a ma cell akulu ma cell.

Hormone ya antidiuretic imaperekedwa m'magazi pazomwe zimapangitsa:

• kuchuluka kwa osmolarity (osmolality) wa plasma,
• kuchepa kwa magazi magazi.

Osmolarity ndiye kuchuluka kwazinthu zonse zomwe zimasungunuka. Mchere wambiri m'madzi a m'magazi, umawonjezera chizindikiro ichi. Kugwiritsidwa ntchito kwina kwa thupi kumatheka pokhapokha ngati munthu ali ndi plasma osmolarity kuyambira 280 mpaka 300 mOsm / l. Kuwonjezeka kwa kuchuluka kwa mchere kumakhazikitsidwa ndi osmoreceptors apadera. "Zomvera mwachilengedwe" zomwe zili mu hypothalamus, khoma lachitatu la ubongo, m'chiwindi.

Kuchuluka kwa magazi ozungulira ndi gawo lina lofunikira lomwe limakupatsani mwayi wopezera minyewa yokhala ndi mpweya komanso michere. Ngati madzimadzi mu ziwiya akhala ochepa, ndiye kuti kuthinikizidwa kwa dongosolo kumatsika ndikuchepetsa mphamvu pang'ono. Kutsika kwamagazi kwamphamvu kumadziwika ndi ma receptor atria ndi intrathoracic. Maselo achilengedwewa amatchedwa ma cell receptors.

Kutsegulira kwa osmoreceptors ndi voleptors voliyumu kumalimbikitsa kutulutsa kwa antidiuretic timadzi mu magazi. Yake kwachilengedwe amachepetsa kukonza zakukwiya kwa madzi amchere kagayidwe.

Miyezo ya Vasopressin imawonjezeka ndi:

• kusowa kwamadzi
• kuchepa kwa magazi
• kuvulala
• kupweteka kwambiri
• zododometsa
• ma psychoses.

Komanso kapangidwe ndi katulutsidwe ka timadzi ta antidiuretic kumawonjezera mankhwala ena.

• imathandizira kukonzanso kwamadzi kuchokera mu mkodzo woyamba,
• amachepetsa
• kumawonjezera kuchuluka kwa magazi ozungulira,
• Amachepetsa plasma osmolarity,
• amachepetsa zomwe zimapezeka mu sodium ndi chlorine mu plasma,
• zimawonjezera mamvekedwe a minofu yosalala (makamaka m'mimba,)
• imakulitsa kamvekedwe ka mtima,
• kumawonjezera magazi dongosolo,
• ali ndi chochitika chachikulu pakuwonongeka kwa capillary,
• imawonjezera kukhudzika kwa mitsempha yamagazi kupita ku catecholamines (adrenaline, norepinephrine),
• Nthano zaukali
• mwanjira ina yakhazikitsa chikondi cha bambo,
• pang'ono ndimomwe zimakhalira pamakhalidwe (kusaka bwenzi, kukhulupirika muukwati).

Kodi shuga ndi chiyani?

Matenda a shuga a insipidus ndi matenda omwe amadziwika chifukwa chosowa zotsatira za vasopressin mthupi.

Kuchepa kwa mahormoni kumatha kuphatikizidwa ndi kuphwanya kapangidwe kake kapena matenda a vasopressin zolandilira pazowonjezera (makamaka impso).

Njira yokhayo yomwe imathandizira kukonzanso kwa madzi kuchokera mu mkodzo woyamba mwa anthu ndikuchita kwa mahomoni antidiuretic. Izi zikasiya kugwira ntchito, ndiye kuti kuphwanya kwamphamvu kwamadzi kagayidwe kamayamba.

Matenda a insipidus amadziwika ndi:

• kuchuluka kwamkodzo kwamkodzo (mkodzo kwambiri kuposa malita 2 patsiku),
• mchere wambiri mumkodzo,
• kusowa kwamadzi
• chisokonezo cha elekitirodi
• hypotension, etc.

Gulu

Malinga ndi kuchuluka kwa matenda, matenda ashuga a shuga agawidwa:

1. chapakati (vuto mu kaphatikizidwe ndi kutulutsidwa kwa mahomoni m'mwazi),
2. aimpso (vuto ndi chitetezo cha m'thupi cha mahomoni)
3. mitundu ina.

Njira yapakati yamatendawa imatha kuphatikizidwa ndi zoopsa, chotupa muubongo, ischemia mu pituitary kapena hypothalamus, matenda. Nthawi zambiri, matenda a shuga amayamba pambuyo pa chithandizo chachikulu cha pituitary adenoma (opaleshoni kapena ma radiation). Komanso, shuga ngati iyi imawonedwa ndi Wolfram genetic syndrome (DIDMOAD syndrome). Mwa kuchuluka kwakukulu kwa odwala onse omwe ali ndi mawonekedwe apakati, zomwe zimayambitsa matendawa sizipezeka. Pankhaniyi, matenda a shuga a insipidus amadziwika kuti ndi idiopathic.

Mawonekedwe aimpso angatengedwe ndi zovuta zokhudzana ndi kubereka kwamapangidwe a ma receptors a antidiuretic mahomoni. Kulephera kwamkati, kusokonezeka kwa ionic, kugwiritsa ntchito mankhwala ena, komanso hyperglycemia kumayambitsanso matendawa.

Matenda a shuga nthawi zina amakhala ndi pakati. Matendawa amatenga nthawi yayitali. Atangobereka, zizindikiro zonse za matenda zimatha. Gestagenic shuga insipidus amafotokozedwa ndikuwonongeka kwa vasopressin ndi michere ya placental.

Mtundu wina wosakhalitsa wa matendawa ndi matenda a shuga a ana a chaka choyamba cha moyo.

Kukula kwa matenda a shuga insipidus amatsimikiza ndi kuchuluka kwa kuphwanya kwa homeostasis. Tikamanena kuti kusowa kwamadzi m'thupi, matendawa ndi oopsa kwambiri.

Magulu amakulu:

• mawonekedwe owopsa (diuresis oposa malita 14 patsiku),
• zovuta zolimbitsa thupi (diuresis kuchokera malita 8 mpaka 14 patsiku),
• mawonekedwe ofatsa (diuresis mpaka malita 8 patsiku).

Ngati madzi am'madzi atayika pang'ono kuposa malita 4 tsiku ndi tsiku, ndiye kuti mulankhule za tsankho

Progestogenic komanso matenda osakhalitsa a ana nthawi zambiri amakhala ofatsa. Fomu la iatrogenic chifukwa chogwiritsa ntchito mankhwala nthawi zambiri limafika pamlingo woyenera. Milandu yayikulu kwambiri ya matendawa nthawi zambiri imachitika chifukwa cha mawonekedwe apakati kapena aimpso.

Epidemiology ya matenda ashuga

Pathology imawonedwa ngati yosowa kwambiri. Malinga ndi ziwerengero, kuchuluka kwa mitundu mitundu yonse ya matenda ashuga amitundu yambiri kumachokera ku 0.004-0.01%. Posachedwa, chiwopsezo chosasunthika cha ziwerengero zamatenda zalembedwa. Choyamba, zochitika za mtundu wapakati wa matenda a shuga zimawonjezereka. Vutoli limafotokozedwa ndi kuwonjezeka kwa kuvulala kowopsa kwa ubongo ndi kulowererapo kwa ubongo.

Amuna amadwala matenda a shuga a insipidus nthawi zambiri monga azimayi. Milandu yambiri yatsopano ya pathology imawonedwa mwa achinyamata. Nthawi zambiri, matendawa amagwira ntchito mwa odwala azaka zapakati pa 10 mpaka 30.

Zizindikiro zamatsenga

Zizindikiro za matenda a shuga insipidus amafotokozedwa mosiyanasiyana mwa odwala. Zomwe zimadandaula zazikulu zimaphatikizidwa ndi ludzu lalikulu, khungu louma, pakamwa louma komanso kuchuluka kwamkodzo.

• kufunikira kwa madzi ndi madzi opitilira malita 6 patsiku,
• kuchuluka kwa mkodzo mpaka malita 6-20 patsiku,
• kuchuluka kwamkodzo kwamkati usiku,
• zosokoneza tulo
• kufooka kwakukulu ndi kutopa,
• katemera wamasamba
• matenda ammimba
• Kusokoneza ntchito ya mtima,
• kuchepetsedwa kwa mavuto
• kugunda kwa mtima
• kuwonda
• Khungu lowuma komanso loyera
• kusanza ndi kusanza
• chigoba minofu kukokana
• zamitsempha
• malungo
• kwamikodzo kutuluka (mwa ana atatha zaka 4).

Wodwala akakhala ndi zizindikiro za matendawa, ndiye kuti amafunika kumuyesa kuchipatala kapena kuchipatala. Nthawi zambiri, kuzindikira kumachitika ndi endocrinologist.

Kodi amadziwika bwanji?

Kuwona matenda a shuga insipidus kumaphatikizapo kufufuza kwawoko ndi mayeso apadera.

Madokotala ali ndi funso lokhuza zomwe zimayambitsa kupangika kwamikodzo kwamatumbo (polyuria) komanso kusowa kwamadzi mu wodwala. Kuzindikiritsa kosiyanako kumapangidwa pakati pa matenda a shuga kapena aimpso a insipidus ndi ludzu lalikulu (polydipsia).

Pachigawo choyamba, odwala omwe ali ndi polyuria ndi polydipsia amatsimikizira kukhalapo kwa hypotonic diuresis (mkodzo wocheperako). Kuti muchite izi, werengani kuchuluka kwa mkodzo patsiku, kuchuluka kwake komanso kusowa kwazinthu zina.

Kwa odwala matenda ashuga ali ndi vuto:

• mkodzo woposa 40 ml ya kilogalamu imodzi ya thupi patsiku,
• kuchuluka kwa mkodzo kochepera 1005 g / l,
• mkodzo osmolality zosakwana 300 mOsm / kg.

Kupitilira apo, zifukwa zikuluzikulu za matenda a shuga a nephrogenic insipidus zimachotsedwa (hyperglycemia, hypercalcemia, hypokalemia, hyperkalemia, kulephera kwaimpso, matenda amkodzo thirakiti.

Kenako wodwalayo amayesedwa:

• kuyesa kowuma
• kuyesa ndi desmopressin.

Odwala omwe ali ndi vuto lenileni la shuga, kusowa kwamadzimadzi kumapangitsa kuti thupi lizitha kuchepa thupi komanso kuchepa thupi. Kuphatikiza apo, mawonekedwe apakati a matendawa amasinthidwa mosavuta ndi desmopressin.

Kuzindikira kwa matenda amatsirizidwa ndikufufuza zomwe zimayambitsa matenda a shuga insipidus. Pakadali pano, zotupa za mu ubongo (pogwiritsa ntchito MRI), zolakwika zamtundu, ndi zina zambiri.

Chithandizo cha matenda a shuga insipidus

Mlingo wogwira ntchito bwino wamankhwala umayesedwa ndi thanzi la wodwala komanso kuchuluka kwa madzi amawonongeka.

Pali magawo atatu:

1. kubwezera
2. kulipira
3. kubwezera.

Odwala omwe ali ndi chipukutiro cha matenda alibe zizindikiro za matenda a shuga insipidus. Mu gawo la subcomproll, polyuria yochepa ndi polydipsia imawonedwa. Odwala kuwonongeka, chithandizo sichithandiza kwenikweni (kuchuluka kwa mkodzo tsiku ndi tsiku kumakhalabe m'migawo yapita).

Chithandizo cha matenda a shuga insipidus zimatengera mtundu wa matenda:

• mawonekedwe apakati amathandizidwa ndi mapiritsi, madontho kapena utsi ndi mankhwala opangira mahomoni desmopressin,
• aimpso insipidus amathandizidwa ndi thiazide diuretics ndi mankhwala ena osapweteka a antiidal.

Desmopressin ndi analogue yopanga ya vasopressin. Zinayamba kugwiritsidwa ntchito pochiza matenda apakati pa matendawa kuyambira 1974. Desmopressin imapereka kutchulidwa kotsalira komanso kopitilira muyeso. Ma synthet mahomoni kwenikweni sasokoneza mtima kamvekedwe ndi kayendedwe ka magazi.

Koyamba mlingo wa desmopressin 0,5 mg wa ola musanadye katatu pa tsiku kapena 10 mcg intranasally 2 kawiri pa tsiku. Wapakati tsiku ndi tsiku ali mkati 0,1-1.6 mg kapena 10-40 μg mu mawonekedwe a madontho kapena utsi. Kufunika kwa mankhwala sikugwirizana ndi jenda la wodwala. Nthawi zambiri, mlingo wotsikirapo umafunika kwa odwala omwe ali ndi postoperative kapena post-traumaticabetes insipidus. Ndipo zosowa zazikulu ndizofunikira kwa odwala omwe ali ndi mawonekedwe a idiopathic. Mlingo wofunikira umafunikira kwa wodwala aliyense wakhumi yemwe ali ndi matenda a shuga. Ndikofunika kuperekera mankhwala a intranasal.

Mankhwala osokoneza bongo amachititsa zovuta:

• kutsika kwa sodium ndende m'magazi,
• kuchuluka kwa mavuto
• chitukuko cha edema,
• chikumbumtima.

Zizindikiro zonsezi zimakhudzana ndi kuledzera kwa madzi.

Matenda a shuga a matenda a shuga amakhala ovuta kwambiri kuchiza. Nthawi zambiri, kuchuluka kwamkodzo kumatsika osati monga momwe zimakhalira, koma kokha mwa 40-50% ya zoyambirira zoyambira. Chithandizo chimachitika ndi thiazide diuretics ndi osagwiritsa ntchito mankhwala a antiidal. Mankhwalawa amakhudza mwachindunji impso. Kuchiza sikuchotsa chomwe chimayambitsa matendawa - vasopressin receptor pathology. Kuphatikiza apo, kugwiritsa ntchito mankhwalawa kwa nthawi yayitali kumatha kukhala ndi vuto pa thanzi la wodwalayo.

Pankhani ya matenda a shuga a tsankho kapena odwala matenda ofatsa, mankhwala osagwiritsa ntchito mankhwala angagwiritsidwe ntchito ngati mankhwala. Maziko ake ndi mtundu wanthawi zonse wa zakumwa. Kuperewera kwa madzi kumaletsedwa ndikudya madzi ndi mchere wofunikira.

Kukula kwa matenda a shuga insipidus: zimayambitsa ndi makina

Kuti madzi abwerere m'magazi kuchokera mkodzo woyamba, vasopressin ndiyofunikira. Ndiwo mahomoni okha m'thupi la munthu omwe amatha kugwira ntchito yotere. Ngati sichikagwira, ndiye kuti vuto lalikulu la metabolic lidzayamba - matenda a shuga insipidus.

Vasopressin amapangidwa mu neurons ya hypothalamus - mu supraoptic nucleus. Kenako, kudzera mu ma process a ma neuron, amalowa mu ma pituitary gland, pomwe amadziunjikira ndikubisalira m'magazi. Chizindikiro cha kutulutsidwa kwake ndikuwonjezereka kwa osmolarity (ndende) ya plasma ndi kuchepa kwa kuchuluka kwa magazi.

Osmolarity amawonetsa kuchuluka kwa mchere wonse wosungunuka. Nthawi zambiri, amachokera ku 280 mpaka 300 mOsm / l. Poterepa, thupi limagwira ntchito mthupi. Ngati ikweza, ndiye kuti ma receptor omwe ali mu hypothalamus, chiwindi komanso pakhoma 3 mwa mawonekedwe a ubongo amatumiza chizindikiro chofunsira kuti madzi asungidwe, ndikukutenga mu mkodzo.

Gland imalandira zikwangwani zofananira kuchokera ku volumoreceptors ku atria ndipo mitsempha mkati mwa chifuwa ngati kuchuluka kwa magazi ozungulira kumakhala kochepa. Kusunga voliyumu yabwinobwino kumakupatsani mwayi woperekera minofu ndi michere ndi mpweya. Ndi kuchepa kwa magazi, kupanikizika kwamatumbo kumatsika ndikuthothoka kwa michere.

Kuti athetse zovuta zakusowa kwamadzi ndi mchere wambiri, vasopressin imamasulidwa. Kuwonjezeka kwa kuchuluka kwa mahomoni a antidiuretic kumachitika pazifukwa zotsatirazi: kuwopsa kwa kupweteka panthawi ya zoopsa, kuchepa kwa magazi, kufooka, psychosis.

Zochita za vasopressin zimapezeka motere:

1. Kukodza kumachepa.
2. Madzi ochokera mkodzo amalowa m'magazi, ndikuwonjezera kuchuluka kwake.
3. Plasma osmolarity amachepetsa, kuphatikizapo sodium ndi chlorine.
4. Kamvekedwe ka minofu yosalala kumawonjezeka, makamaka m'mimba, magazi.
5. Kupsinjika kwa mitsempha kumawonjezeka, amayamba kukonda kwambiri adrenaline ndi norepinephrine.
6. Kukhetsa kumaleka.

Kuphatikiza apo, vasopressin imakhudza machitidwe aumunthu, mwanjira yina yokhudza chikhalidwe chamunthu, machitidwe amtunduwu ndikupanga chikondi cha ana a abambo.

Ngati timadzi timalolekeka kulowa m'magazi kapena kutayika, ndiye kuti matenda a shuga amakhala.

Mitundu ya matenda ashuga

Matenda a shuga a m'matumbo a insipidus amakula ndi kuvulala ndi zotupa za mu ubongo, komanso kuphwanya magazi mu hypothalamus kapena gland pituitary. Nthawi zambiri, kuyambika kwa matendawa kumayenderana ndi neuroinfection.

Chithandizo cha opaleshoni ya pituitary adenoma kapena radiation panthawi yamankhwala imatha kuyambitsa matenda a shuga insipidus. Tungsten genetic syndrome imayendera limodzi ndi kupanga kosakwanira kwa vasopressin, komwe kumalimbikitsa kupezeka kwa matenda awa.

Ndi zovuta zokhazikitsa chomwe chimayambitsa, chomwe chimawonedwa mu gawo lalikulu la odwala onse omwe ali ndi mawonekedwe apakati a matenda a shuga insipidus, kusiyanasiyana kwa matendawa kumatchedwa idiopathic.

Mu mawonekedwe aimpso, ma vasopressin zolandilira samayankha kupezeka kwake m'magazi. Izi zitha kukhala chifukwa cha zifukwa izi:

• Kubadwa kwatsopano kwa receptors.
• Kulephera kwina.
• Kuphwanya kwa mawonekedwe a ionic a plasma.
• Kumwa mankhwala a lithiamu.
• Matenda a matenda ashuga nephropathy akukulira.

Matenda a shuga omwe amapezeka m'mayi oyembekezera amadziwika kuti amakhala osachedwa (kupitilira), zimagwirizanitsidwa ndikuti ma enzymes opangidwa ndi placenta amawononga vasopressin. Pambuyo pobadwa, matenda osokoneza bongo a insipidus amazimiririka.

Kusakhazikika kwa matenda ashuga osokoneza bongo kumakhudzanso ana a chaka choyamba cha moyo, omwe amalumikizidwa ndi mapangidwe a pituitary ndi hypothalamus.

Kukula kwa maphunziro a matendawa komanso kusokonezeka kwa kagayidwe kazinthu zamagetsi kamatengera mphamvu ya thupi. Pali mitundu yotere ya shuga ya insipidus:

1. Zambiri - pokodza malita 14 patsiku.
2. Avereji - diuresis kuchokera malita 8 mpaka 14 patsiku.
3. wofatsa - odwala mpaka 8 malita patsiku.
4. Ndi kutaya kwa zosakwana 4 malita tsiku ndi tsiku - pang'ono (pang'ono) shuga insipidus.

Matenda a shuga osakhalitsa mwa ana ndi amayi apakati nthawi zambiri amakhala osakhazikika. Mukamamwa mankhwala (iatrogenic) - odziletsa. Ndi mafomu apakati komanso aimpso, njira yovuta kwambiri ya matenda ashuga imadziwika.

Matenda a shuga amawoneka ngati njira zachilendo. Koma posachedwa, kukhazikika kwa mitundu yapakati kwalembedwa pokhudzana ndi kuwonjezeka kwa kuvulala kwa craniocerebral ndi kuchitapo kanthu kwa opaleshoni yamatenda aubongo.

Nthawi zambiri, matenda a shuga komanso matenda ake amadziwika mwa amuna azaka zapakati pa 10 mpaka 30.

Matenda a shuga insipidus

Zizindikiro za matenda a shuga insipidus zimalumikizidwa ndi kuchuluka kwamkodzo wamkati komanso kukula kwa madzi am'mimba. Kuphatikiza apo, kusokonezeka pamiyeso yamagetsi pamagazi ndi kutsika kwa magazi kumayamba.

Kukula kwawoko kumatsimikiziridwa ndi kuopsa kwa matendawa ndi zomwe zimachitika. Dandaulo lalikulu la odwala, monga matenda a shuga a shuga, ndi ludzu lalikulu, mkamwa wowuma, pouma, khungu ndi ziwalo zamkati, komanso kukodza kawirikawiri.

Odwala patsiku amatha kumwa madzi opitilira malita 6 ndipo kuchuluka kwa mkodzo kumawonjezera mpaka 10 - 20 malita. Kuchulukitsa kwakukulu usiku.

Zizindikiro zambiri za matenda a shuga a insipidus ndi:

• Kutopa, kusabala.
• Kusowa tulo kapena kuchuluka kugona.
• Kuchepetsa mphamvu.
• Kudzimbidwa kosalekeza.
• Kulemera m'mimba mutatha kudya, belching.
• Kusanza ndi kusanza.
• Thupi.

Kumbali ya mtima, kupangika kwa mawonekedwe amitsempha yamagetsi kumachitika - kutsika kwa kuthamanga kwa magazi, kukoka mwachangu, kusokonezedwa mu ntchito ya mtima. Kulemera kwa thupi kumachepa, kwamikodzo kumatha kukula kwa ana atatha zaka 4, odwala ali ndi nkhawa ya kuyang'anira khungu kosalekeza.

Zizindikiro zamitsempha zimayamba chifukwa cha kuchepa kwa ma electrolyte mkodzo - kupweteka kwa mutu, kukokana kapena kupindika kwa minofu, kunenepa kwa zala ndi mbali zina za thupi. Insipidus yachimuna imakhala ndi mawonekedwe amtundu wotere monga kutsika kwa kuyendetsa kugonana ndikukula kwa vuto la erectile.

Kuti mutsimikizire kuzindikira kwa matenda a shuga insipidus, diagnostics a labotale komanso mayeso apadera amachitidwa kuti afotokozere bwino komwe kunayambira matenda a shuga. Kusiyanitsa kwakumveka kwa impso ndi mitundu yapakati ya matendawa kumachitika, ndipo matenda a shuga samaphatikizidwa.

Pa gawo loyamba, kuchuluka kwa mkodzo, kachulukidwe kake ndi osmolality kumayesedwa. Kwa odwala matenda a shuga, zotsatirazi ndizothandiza:

1. Pa kilogalamu iliyonse yakulemera kwa thupi patsiku, mkodzo woposa 40 ml umachotsedwa.
2. Kuchepa kwa kupindika kwamkodzo pang'onopang'ono 1005 g / l
3. Mimbulu osmolality zosakwana 300 mOsm / kg

Mu mawonekedwe a matenda a shuga a insipidus, zizindikiro zotsatirazi zimawonekera: hypercalcemia, hyperkalemia, kuchuluka kwa creatinine m'magazi, zizindikiro za kulephera kwa impso kapena matenda mumitsempha. Mu diabetesic nephropathy, chizindikiritso chazindikiritso ndikuwonjezera shuga.

Mukamayeza mayeso ndi kudya kowuma, Zizindikiro zakuchepa ndi kuchepa thupi zimawonjezeka mwachangu kwa odwala. Mtundu wapakati wa matenda a shuga insipidus amachotsedwa mwachangu pakuyesa kwa desmopressin.

Onetsetsani, ngati matendawa sakudziwika, chitani kafukufuku waubongo, komanso kafukufuku wamtundu.

Chithandizo cha matenda a shuga insipidus

Kusankhidwa kwa njira zochizira matenda a shuga insipidus zimatengera mtundu wa matendawa. Kuthira mawonekedwe apakati chifukwa cha kuwonongeka kwa hypothalamus kapena gitu planditary, analog ya vasopressin yomwe imapezeka imagwiritsidwa ntchito.

Mankhwala okhala ndi desmopressin amapezeka mu mawonekedwe a mapiritsi kapena kupopera kwammphuno. Mayina amalonda: Vasomirin, Minirin, Presinex ndi Nativa. Zimalimbikitsa kusinthanso kwamadzi m'm impso. Chifukwa chake, mukamagwiritsa ntchito, muyenera kumwa kokha ndi ludzu, kuti musamamwe madzi.

Ngati bongo wa desmopressin kapena kugwiritsa ntchito madzi ambiri pakugwiritsa ntchito, zotsatirazi zingachitike:

• Kuthamanga kwa magazi.
• Kukula kwa minofu edema.
• Kutsitsa kuchuluka kwa sodium m'magazi.
• Chikumbumtima.

Mlingo amasankhidwa payekha kuchokera 10 mpaka 40 mcg patsiku. Itha kutengedwa kamodzi kapena kugawidwa pawiri. Nthawi zambiri mankhwalawa amalekeredwa bwino, koma mavuto amatha kupezeka m'mutu ndi chizungulire, kupweteka m'matumbo, mseru, komanso kukwera kwamphamvu kwa magazi.

Mukamagwiritsa ntchito mankhwala a desmopressin kapena madontho, muyenera kukumbukira kuti ndi mphuno yolimba chifukwa cha kutukusira kwa mucous membrane, kuyamwa kwa mankhwalawa kumacheperachepera, motero pazinthu zoterezi zimatha kugwetsedwa pansi pa lilime.

Pakatikati mwa matenda a shuga a insipidus, kukonzekera kochokera ku carbamazepine (Finlepsin, Zeptol) ndi chloropropamide amagwiritsidwanso ntchito polimbikitsa kupanga vasopressin.

Nephrogenic shuga insipidus imalumikizidwa ndi kusowa kwa impso kuyankha vasopressin, yomwe ikhoza kukhala yokwanira m'magazi. Komabe, mukamayesa ndi desmopressin, zotsatira zake sizimachitika.

Zochizira mawonekedwe awa, thiazide diuretics komanso mankhwala osapweteka a antiidal - Indomethacin, Nimesulide, Voltaren amagwiritsidwa ntchito. Pazakudya, kuchuluka kwa mchere kumakhala kochepa.

Gestational matenda a shuga a insipidus amathandizidwa ndi desmopressin kukonzekera, chithandizo chimachitika pokhapokha pakati, pambuyo pobala palibe chifukwa chothandizira.

Mu shuga wofatsa kwambiri kapena mwa njira ina, mankhwala osagwiritsa ntchito mankhwala angagwiritsidwe ntchito ngati njira yodalirika yothanirana popewa kuchepa madzi m'thupi.

Zakudya za matenda a shuga insipidus amatchulidwa kuti achepetse nkhawa za impso. Mfundo zake zazikulu:

1. Kuletsedwa kwa mapuloteni, makamaka nyama.
2. Mokwanira mafuta ndi chakudya chambiri.
3. Pafupipafupi chakudya chamagulu.
4. Kuphatikizidwa kwa masamba ndi zipatso.
5. Kuti muchepetse ludzu lanu, gwiritsani ntchito zakumwa zakumwa zipatso, misuzi kapena zakumwa zamphesa.

Kuwona momwe mankhwalawo amathandizira kumawunikidwa ndi thanzi la odwala komanso kuchepa kwa mkodzo wambiri.

Ndikulipirira kwathunthu, zizindikiro za matenda a shuga insipidus zimatha. Inscompensated shuga insipidus imayendera limodzi ndi ludzu lolimbitsa ndi kuchuluka kukodza. Ndi maphunziro obvomerezeka, zizindikirazo sizisintha mothandizidwa ndi mankhwala.

Chithandizo chovuta kwambiri ndi aimpso insipidus mwa ana, ndipo nthawi zambiri chimayamba kulephera, komwe kumapangitsa hemodialysis ndi kupatsirana kwa impso. Mitundu ya idiopathic ya matenda a shuga insipidus nthawi zambiri imakhala pachiwopsezo cha moyo, koma milandu yothandizira kwathunthu ndiyosowa.

Ndi mawonekedwe apakati a matenda a shuga a insipidus, othandizira olowa m'malo amalola odwala kuti azigwira ntchito komanso azichita nawo zinthu zina. Matenda a shuga, komanso matenda opatsirana ndimankhwala komanso matenda mwa ana omwe ali ndi chaka choyamba cha moyo, nthawi zambiri amatha kuchira. Kanemayo munkhaniyi akutsutsa mutu wa matenda a shuga.

Kufotokozera Matenda

Malangizo a impso ndi impso, komanso machitidwe ena m'thupi amachitika chifukwa cha vasopressin ya mahomoni. Amapangidwa ndi hypothalamus, pomwepo amadzisonkhanitsa ndi chotchinga cha pituitary England ndipo kuchokera pamenepo amatulutsidwa m'magazi.

Vasopressin yekha amene amawongolera madzi am'madzi kuchokera ku impso, komanso amathandizira pakuwongolera anthu mwankhanza, contractile ntchito ya minofu ya mtima ndi chiberekero.

Matenda a shuga amapezeka pamene mahomoni sanapangidwe kokwanira, kapena atapangidwa kwambiri ndi vasopressinases, omwe amapezeka ndikuzungulira magazi.

Zotsatira zake, njira yotsatsira madzi kuchokera kumiyendo ya impso imasokonekera, chakudya cha maselo ndi madzi amachepa, ndipo ludzu lamphamvu limayimiriridwa ndi maziko a matenda am'madzi.

Pali mitundu itatu yamatendawa, yomwe imayambitsa matenda a shuga a impso.

Mavuto

• Chovuta chachikulu kwambiri cha matenda ashuga omwe amayamba chifukwa cha amuna ndi kutopa madzi. Amawonedwa mwa odwala omwe sanamwe madzi ofunikira komanso ofunikira am'madzi, akukhulupirira kuti izi zitha kuchepetsa mkodzo komanso pafupipafupi kutulutsa. Kuchepa kwa madzi kumawonetsedwa kuwonda kwambiri, chizungulire, kutayika kwa nthawi ndi malo, kusokonezeka kwamaganizidwe, kusanza. Mkhalidwe uwu ndiwowopsa chifukwa popanda kusiya kumatsogolera ku kugwa ndi kufa.
• Mtundu wina wamavuto ndi kutuluka kwa m'mimba thirakiti. Madzi okwanira otambalala amatambasula osati makoma a chikhodzodzo, komanso m'mimba. Zotsatira zake, m'mimba amatha kumira. Komanso, madzi amachepetsa msuzi wa m'mimba ndikuthandizira kugaya bwino chakudya. Izi zimapangitsa kuti pakhale vuto losachedwa kupweteka m'mimba, lomwe limadzipangitsa kusanza, kupweteka, kusanza, chizungulire.
• Pakhoza kukhala zovuta kuchokera ku ureters ndi chikhodzodzo, kuwonetsedwa mu bedwetting.

Pomaliza

Zizindikiro za matenda a shuga insipidus mwa amuna ali munjira zambiri zofanana ndi zomwe zimayambitsa kusamba kwa kusintha kwa msambo kapena matenda a urological. Chifukwa chake, akapezeka, kuonana sikumangofunika kokha kwa andrologist ndi urologist, komanso ndi endocrinologist, yemwe adzapereka mayeso ofunikira ndikupanga chisankho pazamankhwala.

Kupanda kutero, matenda a shuga a insipidus amangochepetsa moyo ngati chithandizo choyenera chikuchitika ndikutsatira zakudya zoyenera.