Mankhwala abwino kwambiri a matenda oopsa mu shuga 2

Ndizovuta kusankha mankhwalawa kuti muchepetse kuthamanga kwa mtundu wachiwiri wa matenda ashuga, chifukwa vuto la carbohydrate metabolism limabweretsa zoletsa zambiri pa kugwiritsa ntchito mankhwala oopsa.

Posankha mankhwala othandizira kuthamanga kwa magazi, dokotala amayenera kuganizira kuchuluka kwa shuga m'magazi, momwe wodwalayo amalamulirira matenda ake osagwirizana, ndi ziti zomwe zimagwirizanitsidwa ndi mbiri yakale.

Mankhwala abwino olimbana ndi matenda a shuga a mellitus a kuthamanga kwa magazi ayenera kukhala ndi malo angapo. Mapiritsi ayenera kuchepetsa kwambiri shuga ndi DD, pomwe samapereka zotsatira zoyipa.

Muyenera kusankha mankhwalawa omwe samakhudzana ndi chizindikiro cha glucose, kuchuluka kwa cholesterol "yoyipa" ndi triglycerides, amateteza mtima ndi impso, zomwe zimakhala zovulaza shuga komanso kuthinikizidwa.

Malinga ndi ziwerengero, 20% ya anthu odwala matenda ashuga amapezeka ndi matenda oopsa. Ubalewu ndiosavuta, chifukwa njira zambiri za shuga zomwe zimapangidwa mthupi zimasokonekera, zomwe zimapangitsa kuti pakhale mahomoni ena. "Kuwomba" kwakukulu kumagwera pamitsempha yamagazi ndi mtima, motero, kukulitsa kuthamanga kwa magazi.

Kodi ndi mankhwala ati omwe angakakamizidwe kupatsirana matenda ashuga omwe amayenera kumwedwa, dokotala amasankha yekha, kupatsidwa masinthidwe onse azithunzi. Kupatula apo, ndikofunikira kuti muchepetse shuga komanso DD, komanso kuti mupewe kulumpha kwa glucose.

Kuchepa kwa matenda ashuga nthawi zambiri kumachitika chifukwa cha kuchuluka kwa madzi ozungulira. Komanso, odwala amatenga mchere mosavuta, chifukwa chake, ma diuretic mankhwala amaphatikizidwa ndimalamulo othandizira. Zochita zimawonetsa kuti okodzetsa amathandiza odwala ambiri.

Mankhwalawa matenda oopsa a matenda a shuga a 2 amaphatikizanso kugwiritsa ntchito mankhwala otsatirawa a diuretic:

• Hydrochlorothiazide (gulu la thiazide).
• Indapamide Retard (amatanthauza mankhwala ngati thiazide).
• Furosemide (loop diuretic).
• Mannitol (gulu la osmotic).

Mankhwalawa atha kugwiritsidwa ntchito kuchepetsa magazi ndi kuthamanga kwa magazi. Mwambiri, mankhwala a thiazide amakonda. Popeza amachepetsa mwayi wokhala ndi vuto la mtima komanso stroke ndi 15% mwa odwala.

Amadziwika kuti mankhwala ochepetsa mphamvu ya diuretic mu Mlingo wocheperako samakhudza shuga wamagazi ndipo matendawa amayambitsa matenda, samakhudza kuchuluka kwa cholesterol "yoyipa".

Gulu la thiazide silinasankhidwe ngati matenda awiri ali ovuta chifukwa cha kulephera kwa impso. Pankhaniyi, kukonzekera kwa loop ndikulimbikitsidwa. Amachepetsa kutupira kwa m'munsi. Komabe, palibe umboni wa chotengera cha magazi ndi choteteza mtima.

Ndi matenda oopsa osakanikirana ndi mtundu wachiwiri wa matenda ashuga, milingo yaying'ono ya okodzetsa nthawi zambiri imayikidwa limodzi ndi ACE inhibitors kapena beta blockers. Monga mankhwala osokoneza bongo, mapiritsi sakuvomerezeka.

Anthu omwe amadwala matenda ashuga samawuza osmotic komanso potaziyamu wochepetsa mphamvu. Mankhwala abwino odana ndi matenda oopsa ndi mapiritsi abwino opanikizika omwe amayenera kukhala ndi katundu wambiri: kuthamanga kwa magazi, osakhala ndi zoyipa, osakhumudwitsa shuga, osakweza cholesterol, kuteteza impso zanu, mtima.

Kuti muthane ndi matenda awiri osokoneza bongo ayenera kuphatikizidwa. Aliyense wodwala komanso wodwala matenda ashuga amachulukitsa chiopsezo cha mtima, mitsempha ya magazi, samapatula kutayika kwamaso, ndi zina zambiri, zotsatira zoyipa za pathologies osaphatikizidwa.

Beta-blockers amalembedwa ngati wodwala ali ndi mbiri ya matenda a mtima, mtundu uliwonse wa kulephera kwa mtima. Zofunikanso ngati kupewa kwa myocardial infarction.

M'mazithunzi onse awa azachipatala, opanga ma beta-blockers amachepetsa kwambiri ngozi yakufa kuchokera ku mtima ndi zina. Gulu la mankhwala amagawika m'magulu ena.

Mu matenda a shuga, ndikofunikira kumwa mankhwala osankha, chifukwa amapereka bwino pakuwapanikizika kwa 180/100 mm Hg, koma osakhudza kayendedwe ka metabolic m'thupi.

Mndandanda wa beta blockers a shuga:

1. Nebilet (chinthu nebivolol).
2. Coriol (yogwira pophika carvedilol).

Mankhwala osankha awa ali ndi zabwino zambiri. Amachepetsa kuthamanga kwa magazi, amachepetsa zizindikiro zoyipa, pomwe amathandizira kukonza kagayidwe kazachilengedwe. Zingakulitsenso chidwi cha zofewa zimakhala ndi insulin.

Pochiza matenda oopsa, chidwi chimaperekedwa kwa mankhwala a m'badwo watsopano, omwe amadziwika ndi kulolerana kwabwino, zotsatira zoyipa zochepa.

Mu matenda ashuga, osagwiritsa ntchito beta-blockers omwe alibe ntchito ya vasodilator sangathe kulembedwa, chifukwa mapiritsiwa amawonjezera matendawa chifukwa cha matendawa, amalimbikitsa chitetezo chokwanira cha minofu, ndikuwonjezera kuchuluka kwa cholesterol "yoopsa".

Ma calcium calcium blockers ndi mankhwala omwe amapezeka kwambiri m'gulu la mitundu yonse ya mankhwala a shuga ndi matenda oopsa. Koma mankhwala ali ndi zotsutsana zambiri, ndipo ndemanga za odwala sizikhala zabwino nthawi zonse.

Madokotala ambiri amavomereza kuti othandizira a calcium apatsidwe chimodzimodzi. Kuperewera kwa gawo lama mchere kumaphwanya kwambiri magwiridwe antchito amthupi, zomwe zimayambitsa kulumikizidwa kwa magazi.

Ma calcium calcium blockers amatsogolera kukumba, kupweteka mutu, kutupa kwa m'munsi. Mapiritsi a Magnesium alibe zotsatira zoyipa izi. Koma samachiritsa matenda oopsa, koma amangokulitsa zochitika zamkati wamanjenje, kuti atonthoze, kusintha magwiridwe am'mimba.

Zakudya zowonjezera zakudya zamagetsi zomwe zimakhala ndi magnesium ndizotetezeka kwathunthu. Ngati wodwala akukumana ndi impso, ndiye kuti sizingavomerezedwe kuzitenga.

Vutoli ndikuti odana ndi calcium amafunika kutengedwa, komabe, mlingo wocheperako samakhudza njira za metabolic, komanso samapereka zotsatira zathunthu zochizira.

Mukachulukitsa mlingo, ndiye kuti matendawa azikulirakulira, koma kupanikizika kumabwerera mwakale. Mlingo wambiri pakadali pano, matenda okoma amayang'aniridwa, kulumikizana ndi kuthamanga kwa magazi. Chifukwa chake, bwalo loipa limapezeka.

Otsutsa a calcium

• Matenda a mtima.
• Mawonekedwe osakhazikika a angina pectoris.
• Kulephera kwa mtima.
• Mbiri yokhudza matenda amtima.

Ndikofunika kugwiritsa ntchito Verapamil ndi Diltiazem - mankhwalawa amathandizira kuteteza impso, izi zatsimikiziridwa ndi maphunziro angapo. Ma calcium blockers omwe ali m'gulu la dihydropyridine amatha kugwiritsidwa ntchito limodzi ndi ACE zoletsa, chifukwa samapereka nephroprotective.

Kuchotsa kupsinjika kwambiri ndi ntchito yovuta. Wodwala amafunikira zakudya zapadera zomwe zimalepheretsa kulumpha mu shuga ndi shuga ndi DD, zolimbitsa thupi zolimbitsa thupi, moyo wathanzi ambiri. Zochitika zingapo zokha zomwe zimakupatsani mwayi wokhala popanda zovuta.

Kugwiritsa ntchito mapiritsi a kuthamanga kwa magazi m'magulu a 2 matenda a shuga sikungopanda gulu la mankhwala omwe amalepheretsa enzyme yotembenuka, makamaka ngati pali kuphwanya magwiridwe antchito a impso.

Komabe, sikuti nthawi zonse amakhazikitsidwa.Ngati wodwalayo ali ndi mbiri ya stenosis yamitsempha ya impso imodzi kapena yamkati, ndiye kuti ayenera kuthetsedwa.

Zotsutsana pakugwiritsa ntchito zoletsa za ACE:

1. Mkulu potaziyamu wa thupi.
2. Kuchuluka kwa serum creatinine.
3. Mimba, kuyamwa.

Pochizira kulephera kwa mtima kwa mtundu uliwonse, zoletsa za ACE ndi mankhwala oyambira, kuphatikiza odwala matenda ashuga a mtundu woyamba ndi wachiwiri. Mankhwalawa amathandizira kukonza minyewa yomwe imapangitsa kuti insulin ipite patsogolo, zomwe zimapangitsa prophylactic kuthandizira kwa matenda "okoma".

Inhibitors amalimbikitsidwa odwala matenda ashuga nephropathy. Popeza amathandizira kuteteza impso kuti zisasokonezedwe, zimalepheretsa kulephera kwa impso.

Ngakhale mukutenga ma inhibitors, ndikofunikira kuyang'anira kuthamanga kwa magazi, serum creatinine. Mukakalamba, musanagwiritse ntchito mapiritsi, mphamvu yamphumo yam'mimba imasiyanitsidwa.

Angiotensin-2 receptor blockers amawononga ndalama zambiri kuposa zoletsa. Komabe, samathandizira kuti pakhale chifuwa chosabereka, ali ndi mndandanda wocheperako wazotsatira zoyipa, ndipo odwala matenda ashuga amawalekerera bwino. Mlingo ndi pafupipafupi kugwiritsa ntchito zimatsimikiziridwa payekhapayekha. Ganizirani kuchuluka kwa kuthamanga kwa magazi ndi zizindikiro za shuga m'thupi.

Zochizira matenda oopsa mu shuga kutenga Losartan, Teveten, Mikardis, Irbesartan.

Monga mukuwonera, matenda oopsa ndi oopsa kwambiri. Ngati kuthamanga kwa magazi kuphatikizidwa ndi matenda a shuga, kuthekera kwa zovuta zoterezi kumakula kwambiri. Chithandizo chimafuna kuyesedwa kwa aliyense wodwala matenda ashuga, mosasamala mtundu wa matenda.

Monga taonera kale, kulumikizana pakati pa matenda awiriwa ndikudziwikiratu. Ngati sanalandiridwe, izi zimawonjezera mwayi wakufa chifukwa cha zovuta. Ndi nkhawa yoposa 150/100 ndi glucose okwanira m'magazi, mankhwala onse azikhalidwe ayenera kugwiritsidwa ntchito pokhapokha ngati dokotala akupezekapo. Ndi zoletsedwa konse kuletsa kulandira chithandizo chamankhwala, ngakhale kupanikizika kochepa kuonedwa.

Mankhwala ochiritsira pogwiritsa ntchito njira zina amakhala nthawi yayitali. Nthawi zambiri zimatha miyezi inayi mpaka chaka chimodzi. Masabata awiri aliwonse a maphunziro achire, muyenera kupuma masiku 7, onetsetsani kuti mwatsata zamphamvu za shuga ndi DD. Ngati mukumva bwino, magazi anu atachepa ndi 10-15 mmHg, ndiye kuti muyezo wowerengeka wowerengeka wamankhwala umachepetsedwa ndi kotala.

Ndizosatheka kunena mwachindunji kuti zidzadutsa nthawi yayitali bwanji asanakhale bwino. Popeza mbali ziwiri zamatenda awiri ndizopangidwa modabwitsa. Ngati panthawi ya chithandizo cha kunyumba wodwala akumva kuwonongeka pang'ono, kudumpha shuga kapena kuthinikizidwa, ndiye kuti muyenera kupita kuchipatala msanga.

Zithandizo za anthu a shuga a mtundu wachiwiri ndi matenda oopsa:

1. Sambani 200 ga zipatso za hawthorn, zouma. Pogaya mpaka gruel, kutsanulira 500 ml ya madzi. Lolani kuti aleke kwa mphindi 20. Tengani kasanu patsiku, 100 ml musanadye. Chinsinsi amateteza kuthamanga kwa magazi chifukwa cha vasodilating, amathandiza kuchepetsa shuga mthupi. Sitikulimbikitsidwa kumwa decoction panthawi ya gestation komanso nthawi yoyamwitsa.
2. Tengani masamba ofanana ndi masamba ndi nthambi zofanana. Thirani 250 ml ya madzi otentha, kusiya kwa ola limodzi. Mutabweretsa chithupsa pamoto, ozizira komanso kupsinjika ndi gauze. Tengani supuni zitatu kawiri pa tsiku. Kulandila sikudalira chakudya.
3. Kupirira kuthamanga kwa magazi komanso kuthamanga kwa shuga kumathandiza madzi amphesa. Ndikofunikira kupangira masamba ndi mitengo ya mphesa mu 500 ml ya madzi, kubweretsa kwa chithupsa pamoto wochepa. Tengani 50 ml musanadye chilichonse.
4. Kutenga kwazitsamba matenda a shuga ndi matenda oopsa kuthamanga komanso kothandiza, kuthandiza kukonza mkhalidwe wa wodwalayo.Sakanizani mitundu yofanana ya currant, viburnum, mamawort ndi masamba a oregano. Supuni imodzi mu kapu yamadzi, thonje kwa mphindi 15. Gawani angapo ofanana servings, kumwa patsiku.

Kuchiza matenda oopsa mu diabetes ndi ntchito yovuta. Kuti muchepetse kuthamanga kwa magazi, muyenera kugwiritsa ntchito mankhwala angapo a antihypertensive omwe samakhudza njira zam'mimba komanso za metabolic m'thupi. Zoyenera, zimathandizira chidwi cha zimakhala kuti insulini.

Mankhwalawa ndiwotalikirapo, kwa moyo wonse. Mapiritsi amasankhidwa payekhapayekha, poyamba, kuyang'anira nthawi zonse zamankhwala, kuwunika mphamvu zamagazi ndi glucose amafunikira, omwe amakupatsani mwayi kusintha mofulumira ngati pakufunika kutero.

Kuopsa kophatikizidwa kwa matenda ashuga ndi matenda oopsa kumawuza katswiri mu kanemayu.

Mapiritsi a kuthamanga kwa magazi (antihypertensives) m'magulu amakono amayimiridwa ndi magulu akuluakulu anayi: ma diuretics (okodzetsa), antiadrenergic (alpha ndi beta-blockers, mankhwala omwe amatchedwa "mankhwala opatsirana apakati"), vasodilators ophatikizana, calcium antagonists and ACE inhibitors ( angiotensin-kutembenuza enzyme).

Mndandandawu suwaphatikizapo ma antispasmodics, monga papaverine, popeza amapereka mphamvu yofooka, amachepetsa pang'ono chifukwa chotsitsa minofu yosalala, ndipo cholinga chawo ndi chosiyana.

Ambiri amagwirizana ndi mankhwala kuti akakamizidwe ndi mankhwala wowerengeka, koma izi ndizambiri, bizinesi ya aliyense, komabe tidzazilingalira, popeza nthawi zambiri zimakhala zothandiza ngati chithandizo chothandizira, komanso zina (poyambira matenda oopsa) sinthani wamkulu.

Mawu ngati amenewa ndi oona. Magulu a mapiritsi a kukakamiza operekedwa mu chipatala nthawi zambiri amakhala ndi okodzetsa:

• Poganizira mwachangu komanso mwamphamvu zochita za loop diuretics (furosemide), zimayikidwa limodzi ndi mankhwala ena opanikizika, makamaka kuti mukwaniritse zomwe mukufuna, mwachitsanzo, mavuto azovuta kwambiri. Kuti mugwiritse ntchito pafupipafupi komanso kwa nthawi yayitali, okodzetsa a gululi sakhala oyenera kwambiri, chifukwa amachotsa mwachangu ma microelements, makamaka potaziyamu ndi sodium, kusowa kwake komwe kumatulukira wodwalayo kupezeka kwa arrhythmias ndi zovuta zina, zomwe zikufotokozedwa mu nkhani yokhudza ma diuretics.
• Monga lamulo, kugwiritsa ntchito malupu okodzetsa kumafuna kutetezedwa kwa minofu ya mtima, yomwe imakwaniritsidwa mwa kukhazikitsidwa kwa mankhwala omwe ali ndi potaziyamu (panangin, aspark) komanso zakudya zopezeka potaziyamu.
• Liazide diuretics yatsimikizira okha bwino kwambiri, monga monotherapy m'magawo oyamba a matenda oopsa (indapamide, arifon) kapena kuphatikiza ndi ACE inhibitors. Ngakhale atagwiritsidwa ntchito nthawi yayitali, okodzetsa omwe tatchulawa samatsogolera ku hypokalemia, arrhythmias ndi zotsatira zina, ndikuti, nthawi zambiri samakhala ndi vuto loyipa.
• Potaziyamu yosalekerera okodzetsa (veroshpiron, spironolactone) ali ndi mphamvu zopanda mphamvu, motero, nthawi zambiri amatengedwa ngati mankhwala opsinjika palimodzi ndi okodzetsa ena - thiazide kapena loopback.

Mapiritsi a diuretic okakamiza sanafotokozeredwe kwa ochepa oopsa (AH) omwe amatsagana ndi kulephera kwambiri kwaimpso. Kupatula pamenepa ndi furosemide yokha. Pakadali pano, odwala oopsa omwe ali ndi zizindikiro za hypovolemia kapena zizindikiro za kuchepa magazi kwambiri, okodzetsa monga furosemide ndi ethacotic acid (uregitis) amatsutsana kwambiri.

Ngati matenda oopsa azigwirizana ndi matenda ashuga, ndiye yesetsani kuti musaganizire za hypothiazide kapena kupereka mankhwala mosamala kwambiri. Veroshpiron imadutsa ngati gawo lamphamvu la potaziyamu lidalembedwa pakuwunika kwa magazi a wodwalayo kapena ngati pali kulembetsa kwa atrioventricular blockade kwa digiri ya 1-2.

Amakhala ndiosiyanasiyana, amasiyana pakati pawo momwe amagwirira ntchito, motero amaphatikizidwa m'magulu:

1. Mankhwala omwe amagwira mkati mwa neuron ("chapakati"), awa akuphatikizapo guanethidine ndi alkauides a Rauwolfia snine: reserpine, raunatin,
2. Akuluakulu agonists, oimira omwe ndi clonidine (clonidine, hemitone, catapressan) ndi methyldopa (dopegyte, aldomet),
3. Ma blockers a zotumphukira za α-receptors, omwe ndi prazolin (pratsiol, minipress - mdani wosankha wa postynaptic α-receptors),
4. Β-adrenoreceptor blockers: osasankha - propranalol (anaprilin, obzidan), oxprenolol (trazikor), nadolol (korgard), sotalol, pindolol (viscene), timolol, mtima - cordum (talinolol), atenolol, metoprolol.
5. Blockers of α- ndi β-adrenergic receptors, omwe amaphatikizapo labetolol (tradet, albetol).

Zachidziwikire, maguluwa ali ndi kusiyana, pakati pawo komanso mkati mwawo, zomwe tiyesera kudziwa pofotokoza mwachidule za ena mwa oimira.

Mankhwala omwe akuchita mkati mwa neuron:

• Reserpine imapereka mphamvu yapakati yogwirizira, salola kuti ma catecholamine asungidwe mwina mu hypothalamus kapena pariphery. Reserpine pamapiritsi kuchokera kukanikizika amayamba kugwira ntchito kwa masiku 5-6, koma akaperekedwa ndi mtsempha, zotsatira zake zimachitika pambuyo pafupifupi maola 2-4. Kuphatikiza pazopindulitsa (kutsitsa magazi), ma reserpine ali ndi zoyipa zomwe zimapangitsa kuti chithandizo cha mankhwala chikhale chovuta. Mukamagwiritsa ntchito chida ichi, odwala nthawi zambiri amadandaula za kuchulukana kwammphuno, komwe sikumachotsedwa ndi mankhwala achilendo a vasoconstrictor, kuchuluka kwamatumbo ndi kutsekula m'mimba (mawonekedwe a vasotropic amawonekera). Pankhaniyi, pakufunika kusokoneza munthawi yomweyo impso zam'maso (atropine madontho), kumwa mankhwala am'mimba ndikusinthira ku chakudya chosasamala. Kuphatikiza apo, reserpine imatha kupatsa bradycardia, kufooka, chizungulire, kufupika, kutsika kwamaso, kukhudza psyche (psychosis, kuvutika maganizo), kotero musanayikidwe, ndikofunika kuchita chidwi ndi mbiri ya wodwalayo komanso abale ake okhudzana ndi matenda amisala. Reserpine pawokha siimakonda kutumizidwa, komabe, pamodzi ndi hypothiazide, ndi gawo la mankhwala odziwika bwino: adelfan, adelfan-ndikurex, trireside K. Amatulutsidwa pokhapokha ngati akupereka mankhwala.
• Raunatin (Rauwazan). Mphamvu ya antihypertensive imayamba pang'onopang'ono. M'njira zonse, imawoneka ngati yabwino komanso yopepuka kuposa reserpine. Kulimbitsa kusefukira kwa glomerular, kumawonjezera kuyenderera kwa magazi mu impso, kumathandizira kubwezeretsa mzere, zomwe zimapangitsa kuti mantha azikhala pakati.
• Guanedin (octadine, ismeline, isobarin) amadziwika ndi kuwonekera pang'onopang'ono kwa hypotensive zotsatira (mpaka sabata), zomwe zimatha kupitiliza mpaka milungu iwiri itatha kale. Imakhala ndi zovuta zingapo: orthostatic hypotension ikaimirira, kotero wodwalayo amaphunzitsidwa kuti azikhazikika kuti asagwe. Ndizovuta kwambiri kuti odwala oterowo ayime kwa nthawi yayitali kapena azikhala mukulimba komanso kutentha. Kutsegula m'mimba, kufooka mopitirira muyeso, kuchepa kwakanthawi kantchito, kusokonezeka kwamphamvu - izi ndi zovuta zina za guanedine. Contherindosis kwambiri matenda a mtima ndi mtima mitsempha, stroko, myocardial infarction, aakulu aimpso kulephera (CRF), pheochromocytoma (adrenal chotupa).

Mwachiwonekere, mankhwalawa pokakamiza ndizovuta koma amaperekedwa kuti achenjeze wodwala kuti mankhwalawo siabwino kwa aliyense ndipo ngakhale piritsi yaying'ono ikhoza kukhala yoopsa ndipo ingagwiritsidwe ntchito monga momwe udanenera.

Oimira gulu loyamba (agonists apakati) nawonso amatulutsidwa pamankhwala. Ena aiwo apeza zigawenga, ndipo nthawi zina amakhala ndi mbiri yomvetsa chisoni (kufa pamodzi ndi mowa). Akatswiri achigiriki apakati:

1. Methyldopa (dopegit, aldomet).Kusiya kutulutsa kwamtima kosasinthika, kumachepetsa kukana kwathunthu (OPS) ndipo, motero, kumachepetsa kuthamanga kwa magazi patatha maola 4-6 mutayang'anira, kukhalabe ndi zotheka mpaka masiku awiri. Methyldopa amakhalanso ndi zotsatira zoyipa, ali ofanana ndi a guanedine: mkamwa youma, kugona, kusokonezeka kwa ubongo, orthostatic hypotension (kufikira pang'ono), koma kugwiritsa ntchito methyldopa kumatha kubweretsa zovuta mu mawonekedwe a zovuta za chitetezo cha mthupi: hepatitis yayikulu, pachimake chiwindi, hemolytic anemia, myocarditis. Mankhwala sinafotokozedwe kuwonongeka kwa chiwindi, pa nthawi ya pakati komanso vuto la pheochromocytoma!
2. Clonidine (clonidine, hemiton, catapressan) - kachitidwe ka zochita kali kofanana kwambiri ndi methyldopa. Mphamvu ya antihypertgency ndi yotsimikizika. Pambuyo pa utsogoleri, kuthamanga kwa magazi kumakwera kwakanthawi kochepa, kenako kumayamba kutsika. Mukamamwa pakamwa, mphamvu ya mankhwalawa imachitika pakadutsa theka la ola, pomwe makonzedwe amkati amachepetsa nthawi mpaka mphindi 5, zomwe zimapangitsa kuti zizigwiritsidwa ntchito mwachangu ngati kukakamiza kwambiri kukuwopsezani ndi zovuta (stroke) ndikufunika kuyankha mwachangu kuchokera kwa dokotala. Zotsatira zoyipa, makamaka, zimasiyana pang'ono ndi zochita za anthu ena achifundo, koma clonidine ali ndi vuto lotengeka kwambiri, lomwe limapereka chithunzi cha zovuta zoopsa zomwe zimayendetsedwa ndi tachycardia, kukalamba, nkhawa, chifukwa chake imathetsedwa pang'onopang'ono (mkati mwa sabata). Kuphatikizika kwa clonidine ndi mowa kungapangitse wodwalayo kuti afe. Kutsutsana kwambiri kwa clonidine: kwambiri atherosulinosis yamatumbo ndi ziwiya, kugunda kwamtima, kukhumudwa, kuledzera.

Peripheral alpha receptor blockers ndi prazosin (pratsiol, minipress), omwe amatha kukulitsa ziwiya zam'kati mwa venous, amachepetsa preload, amachepetsa OPS, ndipo m'njira yopumulirako amakhudza minofu yosalala ya khoma lamitsempha ndipo potero amachepetsa kuthamanga kwa magazi. Mphamvu yotchulidwa yoyeserera imachedwa ndikuwonekera pokhapokha masiku 7-8 kuyambira poyambira mankhwalawa. Mankhwalawa ali ndi maubwino angapo kuphatikiza pama antihypertensives ena, chifukwa samasiyana pakachulukidwe kakang'ono, kupatula chizungulire komanso kupweteka kwamutu, ndichifukwa chake nthawi zambiri amadziwikiratu chithandizo cha matenda oopsa kwa odwala omwe ali ndi kuchepera kwa atrioventricular conduction ndi sinus bradycardia.

β-blockers ndi gulu lodziwika bwino komanso lofala la mankhwala kukakamiza osati kokha. Chithandizo cha matenda am'matumbo ambiri a mtima (angina pectoris, arrhythmia) sichokwanira popanda kugwiritsa ntchito nthumwi za gulu lino, mndandanda womwe ndiwokulirapo kotero kuti mwina nkhani yoposa imodzi ingafunikire mawonekedwe onse.

Beta-blockers ali ofanana kapangidwe katecholamine amkati, chifukwa chake amatha kuletsa zotsatira zoyipa zam'kati pamtima ndi zomangiriza ku to-adrenergic receptors of membynes a postynaptic. Zotsatira zamphamvu za mankhwalawa chifukwa cha kupanikizika zimadalira luso la kuyembekezera tachycardia komanso kuthamanga kwambiri pakachitika zinthu zolimbitsa thupi komanso kupsinjika kwa psychoemotional pasadakhale.

Mapiritsi opanikizika kuchokera ku gulu la beta-blocker samangogwira ntchito yayikulu, komanso amawonetsa luso lapadera popewa kukula kwa zovuta zazikulu za matenda oopsa: kulowetsedwa kwa myocardial komanso zosokoneza pamitima ya pachiwopsezo cha mtima. Wodwalayo nthawi zina samadziwa kuti beta-adrenergic blockers yoikika kwa matenda oopsa, nthawi yomweyo, amateteza modekha ku zovuta zoyambitsa matenda. Mankhwalawa amalimbikitsa kwambiri pakakhala matenda oopsa. Zonsezi pamwambapa sizitanthauza kuti wodwalayo amatha kudzipatsa okha, popeza nawonso ali ndi zotsatirapo zina komanso zotsutsana.

Mankhwala a gulu la mankhwalawa agawidwa kukhala osasankha komanso okonda mtima β-blockers. Gulu loyamba (posasankha) ndi:

• Propranolol (Obzidan, Anaprilin, Inderal),
• Nadolol (korgard),
• Oxprenolol (trasicor, slowly-trasicor),
• Sotalol
• Pindolol (Wisken),
• Timolol
• Alprenolol (aptin).

Mndandanda wa osankha beta osankha umaphatikizapo:

1. Cordum (talinolol),
2. Atenolol (tenormin, atcardil, betacard, catenol, prinorm, falitensin, tenolol),
3. Acebutolol (wozungulira),
4. Metoprolol (betalok, spesikor, seloken).

Mlingo wa beta-blockers umasankhidwa kwa wodwala aliyense payekhapayekha malinga ndi zovuta zamankhwala, kuthamanga kwa mtima (HR) ndi kutalika kwa kuthamanga kwa magazi! Ngati mlingo umasankhidwa, palibe mavuto, ndiye kuti wodwalayo amasinthana kwakanthawi kochepa pokonzekera mankhwalawa.

Zizindikiro zakugwiritsa ntchito beta-blockers, kuwonjezera pa kuthamanga, ndi:

• Angina pectoris,
• Cardiac arrhythmias,
• Cardiomyopathy
• Hypertensive vegetative-vascular dystonia (trasicor),
• Myocardial infaration.

Kuphatikiza apo, ena a beta-blockers (propanolol) nthawi zambiri amagwiritsidwa ntchito osati mankhwala osokoneza bongo komanso othandizira mankhwalawa, komanso mankhwalawa a thyrotooticosis, migraine, kupweteka kwa mutu chifukwa cha kuphipha kwamitsempha, kuteteza magazi ndi matenda oopsa a portal, komanso chithandizo cha mitundu yosiyanasiyana phobias, mantha, mitsempha.

Musamwe gulu la mankhwalawa ngati:

1. Sinus bradycardia,
2. Dongosolo losakwanira 2A (ndi pamwambapa) Art.
3. Atrioventricular block
4. Atrioventricular block (oposa 1 degree),
5. Cardiogenic mantha,
6. Mellitus wosadalira insulin,
7. Kuchulukitsa kwa zilonda zam'mimba kapena duodenum,
8. Kulephera Kwamtima Kwakukulu.

Osasankha β-blockers samatchulidwa ngati wodwala akudwala mphumu, bronchitis, matenda a Raynaud, matenda ogwetsa ziwiya zamiyendo. Amayesanso kuchita popanda kugwiritsa ntchito mankhwalawa kukakamiza, ngati wodwala ali ndi kuthamanga kwa magazi a 100 mm RT. Art. ndi kutsika, kapena kugunda kwa mtima kwa 55 kumenyedwa / mphindi kapena zochepa.

Ndikofunika kukumbukira kuti mukamamwa mankhwalawa (komabe, monga ena onse), zovuta zimachitika:

• Zosokoneza tulo (kusowa tulo, zolakwika),
• Kufooka kwathunthu, kuchepa kwa magwiridwe antchito, nthawi zina, kusokonezeka kwa luso la kugonana,
• Kutsika kwapadera kwa seramu glucose mwa anthu ashuga,
• Kukula kwa kupsinjika chifukwa cha kulephera mtima,
• Maonekedwe a atrioventricular block,
• Ululu m'mimba (mu "zilonda"),
• Cancellation syndrome pakachitika kupsa kwamphamvu kwa mankhwala (tachycardia, mutu, Cardialgia, nkhawa),
• Matenda oopsa chifukwa cha kupochromocytoma.

Labetolol (tradet, albetol) ndi amodzi mwa mankhwala omwe amaletsa ma alpha ndi ma beta receptors mu 1: 3. Kuchita kwake ndikufuna kuthana ndi PS (zotumphukira kukana), kusiya zomwe zikuchitika kapena kuchepa pang'ono kwa mtima, ndikuchepetsa ntchito ya plasma renin.

Intravenous makonzedwe amapereka zotsatira za mankhwala 2 Mphindi pambuyo jekeseni (kwenikweni pa singano), koma akatengedwa pakamwa, izi zimachedwa kwa maola 2.

Mu matenda oletsa a bronchi, atrioventricular blockade komanso nthawi ya pakati (trimester yoyamba), kugwiritsa ntchito labetolol sikovomerezeka.

Peripheral vasodilators (PV), omwe akuimira gulu la heterogeneous (arteriolar ndi vasodilators wosakanikirana). Ma arodolar vasodilators amaphatikizapo: hydralazine (apressin), diazoxide (hyperstat), minoxidil, osakanikirana - isosorbide dinitrate, sodium nitroprusside.

Ma arodolar vasodilators amachepetsa OPS, yomwe, komabe, imayambitsa kukhudzidwa kwa homeostasis, komwe kumathetsa izi. Dongosolo lachifundo lothandizira limathandizira ndikuwonjezera kugunda kwa mtima komanso kuchuluka kwa stroko, ndikuwonjezera ntchito ya renin. Izi ndizoyipa za PV.

Ma vasodilators osakanikirana amakhala ndi ziwiya zamagulu ochepa (arterioles). Nthawi yomweyo, zimakhudzanso venous, ndiko kuti, zimakulanso ndipo potero zimachepetsa kubweretsanso magazi a venous kumtima, komwe kumatha kubweretsa kuchulukana kwa venous. Ndipo izi ndizowabwezeranso.

Ma PV oyera ndi osayenera kuti azitha kudzichitira okha matenda oopsa, monga lamulo, amalembedwa ndi β-blockers ndi okodzetsa, omwe amachepetsa mavuto a zotumphukira za vasodilators.

Oimira otchuka kwambiri a PV akuphatikizapo:

1. Hydralazine (apressin) imapezeka m'mapiritsi, koma wodwalayo ayenera kukumbukira, ngati mwadzidzidzi akufuna kutsitsa kukakamiza kokha kwa iwo ndikunyalanyaza zifukwa zina, kuti zizindikiro monga mutu, tachycardia, kukula kwa angina osakhazikika kudzadzipangitsa kuti amve. Kuphatikiza apo, apressin ali ndi zotsutsana zingapo: SLE (systemic lupus erythematosus), hepatitis yayikulu, chapamimba komanso duodenal. Kutenga kwa nthawi yayitali mankhwala omwe ali ndi hydralazine amatha kupanga matenda ngati lupus ngati azimayi omwe amadziwika ndi ma cell (LE cell) mu seramu yamagazi.
2. Diazoxide (hyperstat) pamene imayendetsedwa mwachangu (2-5 min) imachepetsa kuthamanga kwa magazi (onse a systolic ndi diastolic). Palibe magome omwe alipo.
3. Minoxidil - amapangidwa m'mapiritsi kuchokera kuthamanga kwa magazi, koma amangogwiritsidwa ntchito ndi beta-blockers ndi okodzetsa (!).
4. Sodium nitroprusside imatha kuchepetsa mwachangu komanso pambuyo pake ndikuwonjezera voliyumu. Kwambiri kukhuthala kukhuthala! Zomwe zimapangitsa kuti magazi aziyang'anira magazi nthawi zonse! Inde, kuikidwa, chithandizo ndi kuwongolera ndi ntchito ya dokotala wakuchipatala, nthawi zina mankhwalawa sagwiritsidwa ntchito. Matenda oopsa, pachimake michere yolephera. Contraindation - coarctation kwa msempha, arteriovenous shunts.

Dhibazole wodziwika bwino amakhalanso ndi ma vasodilators otumphukira, omwe ali ndi antispasmodic ndipo, mwachidziwikire, oopsa. Mpaka posachedwa, dibazole adawonetsedwa ngakhale mu protocol yadzidzidzi yopulumutsa vuto la matenda oopsa (dibazole + papaverine). Komabe, atapatsidwa kuthekera kwake koyamba pang'ono, koma kwambiri, kukweza magazi, kenako ndikungoyiyitsa, sikunagwiritsidwe ntchito popsinjika ndi 200 mmHg. Art. ndi apamwamba (kuthekera kwakukulu kwa sitiroko). Tsopano mankhwalawa aperekanso njira zina zama antihypertensives ndipo asiya kugwiritsa ntchito ambulansi.

Odwala amadzipangira okha ndi papazol yosakanikirana ya mankhwala, yomwe imaphatikizapo dibazole yomwe yatchulidwa pamwambapa komanso ndi antispasmodic mphamvu ya papaverine (imathandizira kuphipha kwa minofu yosalala, ndiye kuti mitsempha yamagazi). Nthawi ndi nthawi, pakuwonjezereka kwa kuthamanga kwa magazi, papazol ikhoza kugwiritsidwa ntchito, koma zikuwonekeratu kuti sangathe kuthana ndi matenda oopsa ndipo posakhalitsa amayenera kusankha mapiritsi azovuta zamagazi ochokera m'magulu ena.

Mankhwala osangalatsa omwe ali ndi PV amatchedwa andipal. Andipal, kuwonjezera pa dibazole, imakhala ndi analgin, papaverine, phenobarbital ndipo, motero, imapereka zotsatira zambiri. Mankhwala, popewa kupindika kwamitsempha yama bongo, amathandizanso kupweteketsa mtima chifukwa cha migraine, amathandizira kuchepetsa kupanikizika pang'ono ndi mtundu wofatsa wa matenda oopsa. Imawonjezera hypotensive zotsatira za nitrate, calcium antagonists, beta ndi ganglion blockers, antispasmodics ndi okodzetsa. Pakadali pano, potengera kapangidwe kake (phenobarbital), sizokayikitsa anthu omwe ntchito yawo imafuna chisamaliro chowonjezereka, mwachitsanzo, oyendetsa. Ndipo anthu wamba omwe amayendetsa.

Omwe akutsutsana ndi calcium ali ndi mayina angapo, kuti wodwalayo asawasiyanitse ndi "pang'onopang'ono" calcium blockers kapena oletsa ma calcium ions omwe amalowa m'maselo osalala a minyewa, timathamanga kukudziwitsani kuti awa ndi mayina osiyanasiyana am'magulu amodzi.

Chithandizo chachikulu m'gululi chimawerengedwa kuti ndi nifedipine (Corinfar), chikuchita modekha, osawonetsa mbali zake zoyipa. Kuphatikiza apo, 1-5farum imaphatikizidwa bwino ndi β-blockers komanso ngakhale ndi dopegitis. Monga momwe ena ofufuza zamtima adawonetsera, mwa odwala oopsa omwe ali ndi zizindikiro za myocardial ischemia ndikutenga corinfar, gawo lomaliza la ECG limayamba kukhala labwinobwino. Tsoka ilo, nthawi yogwira mankhwalawa ndi yochepa, kotero iyenera kumwa katatu patsiku komanso osachepera. Mankhwala ena amagwiritsidwanso ntchito pa matenda oopsa, omwe ndi otsutsana ndi calcium ndipo amagawika m'magulu atatu.

Zotumphukira za phenylalkylamines, zomwe zimasiyanitsidwa ndi gawo lalikulu pa minyewa yamkati yamtima, khoma lamitsempha yama cell ndi myocardial conduction system:

• Verapamil (isoptin, phenoptin), wogwiritsidwa ntchito ngati chithandizo chamankhwala osokoneza bongo kwambiri, chifukwa akapatsidwa mankhwala othandizira, imapereka zotsatira pambuyo pa mphindi 5, pomwe mumamwa mapiritsi amathandizanso pokhapokha maola 1-2,
• Anipamil
• Falipamine
• Tiapamil.

1. Kukhala ndi luso la vasodilating nifedipine (Corinfar),
2. Mbadwo wachiwiri wa otsutsana ndi calcium ndi nicardipine ndi nitrendipine,
3. Kuwonetsa makamaka pamatumbo amitsempha yamagazi,
4. Nisoldipine, yomwe imakhudza makamaka ziwiya zapamadzi,
5. Amadziwika ndi mphamvu yayitali, yokhala ndi zotsatira zazitali - zotsatira za felodipine, amlodipine, isradipine.

Mankhwala, omwe ali m'malo ake pakati pa corinfarum ndi verapamil, amatchedwa diltazem, akuphatikizidwa mu gulu lachitatu la blockers of "slowly calcium channels" ndipo ndi a benzothiazepine zotumphukira.

Kuphatikiza apo, pali gulu la mankhwala omwe amalepheretsa kuchuluka kwa calcium ion mu cell (osasankha okonda Ca), awa ndi ma piperazine omwe amachokera (flunarizine, prepilamine, lidoflazin, etc.).

Contraindication poika calcium antagonists ndi koyamba otsika kuthamanga, sinus node kufooka, pakati, ndi zovuta zake ndi redness wa khungu la nkhope ndi khosi, hypotension, posungira patali, ndizothekanso kuwonjezera kukoka, kutupa komanso kawirikawiri (poyambitsa verapamil kudzera m'mitsempha) - bradycardia, atrioventricular blockade.

Angiotensin synthesis inhibitors ndi gulu lokongola lomwe limagwiritsidwa ntchito pochiza matenda oopsa. Ntchito yawo yayikulu ndikuletsa enzyme yomwe imatembenuza angiotensin I kukhala mawonekedwe ake - angiotensin II ndikuwononga nthawi yomweyo bradykinin.

ACE inhibitors amaonedwa ngati mankhwala osokoneza bongo, komabe, kuwonjezera apo, ali ndi maubwino ena ndipo amagwiritsidwa ntchito moyenera kuchitira zinthu zosiyanasiyana zamatenda: zovuta za myocardial infarction (kutsekeka kwa ntchito yamanzere yamitsempha), kuteteza kupangika kwa matenda oopsa a mtima ngati njirayo ikupita patsogolo (LV hypertrophy), matenda a mtima, matenda ashuga nephropathy.

Mndandanda wa oimira mankhwalawa mokulira kuposa ma antihypertensives ena amathandizidwanso ndimankhwala aposachedwa kuti azikakamizidwa. Mpaka pano, mankhwala otsatirawa, omwe amatchedwa ACE inhibitors, amagwiritsidwa ntchito kwambiri:

• Captopril (Kapoten) - ikhoza kuletsa ACE. Captopril amadziwika poyambitsa matenda oopsa komanso anthu odziwa bwino ntchito yamtunduwu, monga thandizo loyambirira pakuwonjezera kuthamanga kwa magazi: piritsi pansi pa lilime - patatha mphindi 20 kupanikizika kumachepa,
• Enalapril (renitec) ndiwofanana kwambiri ndi Captopril, koma sadziwa momwe angasinthire kuthamanga kwa magazi mwachangu, ngakhale imadziwonekera ola limodzi pambuyo pa kuperekedwa. Zotsatira zake zimakhala zazitali (mpaka tsiku), pomwe zinafika pakatha maola 4 ndipo palibe kufufuza,
• Benazepril
• Ramipril
• Quinapril (acupro),
• Lisinopril - amachita mwachangu (pambuyo pa ola limodzi) komanso kwa nthawi yayitali (tsiku),
• Lozap (losartan) - amatengedwa ngati wotsutsana naye wa angiotensin II receptors, amachepetsa kuthamanga kwa magazi ndi systolic, amagwiritsidwa ntchito kwanthawi yayitali, chifukwa mphamvu yayikulu yamankhwala imatheka pambuyo pa masabata 3-4.

Ma Ahibulose ACE salembidwa milandu:

1. Mbiri ya angioedema (mtundu wa tsankho kwa mankhwalawa, womwe umawonetsedwa ndi kuphwanya kwa chinthu chokhudza kumeza, kupuma movutikira, kutupa kwa nkhope, miyendo yam'mwamba, kuwonda). Ngati izi zikuchitika kwa nthawi yoyamba (pa mlingo woyamba) - mankhwalawo amachotsedwa pomwepo,
2. Mimba (ACE inhibitors imasokoneza chitukuko cha mwana wosabadwayo, zomwe zimayambitsa zovuta zingapo kapena kufa, chifukwa chake zimathetsedwa pambuyo pokhazikitsidwa kwa chowonadi ichi.

Kuphatikiza apo, kwa ACE inhibitor, pali mndandanda wa malangizo apadera omwe amachenjeza za zotsatira zoyipa:

• Ndi SLE ndi scleroderma, kuyenerera kogwiritsa ntchito mankhwala a gululi ndikokayikira kwambiri, popeza pali chiopsezo chachikulu cha kusintha m'magazi (neutropenia, agranulocytosis),
• Stenosis ya impso kapena onse awiri, komanso impso yowazidwa, imatha kuwopsa pakuwonongeka kwa impso,
• Kulephera kwa impso kumafuna kuchepetsa mlingo
• Kulephera kwamtima kwambiri, kuwonongeka kwa impso ndikotheka, ngakhale kupha.
• Kuwonongeka kwa chiwindi ndi ntchito yopuwala chifukwa kuchepa kwa kagayidwe ka mankhwala ena a ACE inhibitors (Captopril, enalapril, quinapril, ramipril), omwe angayambitse kukula kwa cholestasis ndi hepatonecrosis, amafunikira kuchepetsedwa kwa mlingo wa mankhwalawa.

Palinso zovuta zomwe aliyense amadziwa za iwo, koma sangathe kuchita nawo chilichonse. Mwachitsanzo, mwa anthu omwe ali ndi vuto la kuwonongeka kwa impso (makamaka, koma nthawi zina popanda iwo), mukamagwiritsa ntchito ACE inhibitor, magawo amwazi a biochemical amatha kusintha (zomwe zili za creatinine, urea ndi potaziyamu zimachepa, koma mulingo wa sodium amachepetsa). Nthawi zambiri, odwala amadandaula za mawonekedwe a chifuwa, omwe amayamba makamaka usiku. Ena amapita kuchipatala kukatenga mankhwala ena okhathamiritsa matenda oopsa, pomwe ena amayesa kupirira ... Zowona, amasamutsa zoletsa za ACE m'maola ndipo ena amadzithandiza.

Mankhwala ena amagwiritsidwa ntchito pochotsa matenda oopsa, omwe, mwanjira zambiri, alibe mawu omwe amatchulidwa mu gulu lililonse la antihypertensives. Mwachitsanzo, dibazole yemweyo kapena, titi, magnesium sulfate (magnesia), yomwe imagwiritsidwa ntchito bwino ndi madokotala azidzidzidzi kuti ayimitse vuto la matenda oopsa. Yoyambitsidwa mu mtsempha, magazi a sulfate ali ndi antispasmodic, sedative, anticonvulsant komanso pang'ono hypnotic. Kukonzekera kwabwino, komabe, sikophweka kuyendetsa: ziyenera kuchitika pang'onopang'ono, choncho ntchito imadutsa kwa mphindi 10 (wodwalayo amakhala wotentha mosalekeza - adokotala amayimilira ndikuyembekezera).

Zochizira matenda oopsa, makamaka, pamavuto oopsa kwambiri, pentamine-N (cholinoblocker of a sympathy and parasympathetic ganglia, amene amachepetsa mamvekedwe a ziwiya zam'mbuyo komanso venous), benzohexonium, ofanana ndi pentamine, arfonad (ganglioblocker), ndi aminazine (phenothiazineiv. Mankhwalawa amapangidwira chisamaliro chodzidzimutsa kapena chithandizo chambiri, kotero amatha kugwiritsidwa ntchito ndi dokotala yemwe amadziwa bwino zomwe ali!

Pakadali pano, odwala amayesa kupitiliza kudziwa zomwe apeza posachedwapa mu pharmacology ndipo nthawi zambiri amafunafuna mankhwala aposachedwa kwambiri kuti awakakamize, koma atsopano sakutanthauza zabwino, ndipo sizikudziwika momwe thupi lidzachitikire ndi izi. Konzekerani kale izi sizingadziwike zachidziwikire. Komabe, ndikufuna kufalitsa wowerenga pang'ono kwa mankhwalawa aposachedwa kwambiri, omwe ali ndi chiyembekezo chachikulu.

Kuphatikiza pa mndandanda wazinthu zatsopano, angiotensin II receptor antagonists (ACE inhibitors) mwina zakhala opambana kwambiri. Mankhwala osokoneza bongo monga Cardosal (olmesartan), thermisartan, omwe, akuti, tsopano siwotsika poyerekeza ndi ramipril wotchuka, adapezeka pamndandandawu.

Ngati muwerenga mosamala za mankhwala a antihypertensive, mutha kuwona kuti kuthamanga kwa magazi kumachulukitsa chinthu chodabwitsa - renin, chomwe palibe mankhwala omwe ali pamwambawa omwe amatha kupirira nawo. Komabe, pofuna kusangalatsa odwala omwe ali ndi kuthamanga kwa magazi, mankhwalawa apezeka posachedwa - rasylosis (aliskiren), yomwe imalepheretsa renin ndipo amatha kuthana ndi mavuto ambiri.

Mankhwala aposachedwa kwambiri opanikizika akuphatikizapo olimbana ndi endothelial receptor antagonists: bosentan, enrasentan, darusentan, amene amaletsa kupanga kwa vasoconstrictive peptide - endothelin.

Poganizira njira zamtundu uliwonse zomwe zimatha kuthana ndi kuthamanga kwa magazi, sizingatheke kunyalanyaza maphikidwe a tincture, decoctions, madontho omwe asiya anthu. Ena a iwo atengedwa ndi mankhwala ovomerezeka ndipo agwiritsidwa ntchito bwino pochiza matenda oopsa (a m'malire ndi "ofewa") ochepa oopsa. Odwala amakhulupiriranso kwambiri mankhwala, omwe amapanga zitsamba zomwe zimamera m'matanthwe aku Russia kapena ziwalo za mitengo zomwe zimapanga maluwa ku dziko lathu lalikulu la Mama:

1. Tincture wa mistletoe yoyera, yotengedwa malinga ndi 2 tbsp. supuni katatu patsiku (kukakamira: 10 g. mbewu 200 200 zamadzi),
2. Kutola kwa mankhwala ophatikiza ndi maluwa a hawthorn, udzu wamahatchi, mistletoe oyera, yarrow ndi masamba a periwinkle ang'ono. Mlingo umodzi umakhala ndi magalamu 10 osakanikirana ndi mbeu ndi 200 ml ya madzi otentha owiritsa, otenthetsedwa kwa mphindi 15 mumadzi osamba, ndiye kuti akutsanulira, onjezerani madzi ku buku lake loyambirira ndi chakumwa masana (1 chikho). Mankhwalawa kumatenga milungu 3-4,
3. Tincture wa udzu wa sinamoni (15 g), clover wokoma wa mankhwala (g g), munda wamahatchi (20 g), astragalus woolly (20 g) umakonzedwanso molingana ndi njira iyi,
4. Tiyi wowerengeka wokonzekera ali wofanana ndi akale, koma wopanga (m'magalamu) a hawthorn (40), sinamoni sinamoni (60), mchenga wosafa (50), clover wokoma (10), masamba a birch (10), muzu wa licorice (20), masamba coltsfoot (20), akavalo akavalo (30), udzu wobowola (30).
5. Madzi a Chokeberry aledzera mu 50 ml theka la ola musanadye katatu katatu patsiku,
6. Viburnum imagwiritsidwa ntchito ngati njira yolumikizira matenda oopsa: tincture wa zipatso zouma kapena zatsopano ndi uchi, wokonzedwa ngati tiyi, kupanikizana ndi kupanikizana, komanso khungwa la mbewu iyi, yophika ndi madzi. Anthu ena amakonda kugwiritsa ntchito Chinsinsi ichi: kutsanulira magalasi atatu okhala ndi zipatso zatsopano za viburnum ndi madzi otentha owira (2 l), chokani maola 8 kutentha. Kenako kulowetsako kumafunika kusefedwa, ndipo zipatso zotsalazo ndikupukuta mu kapu kapena mbale ya enamel, onjezerani theka la lita. Tengani mphindi 20 musanadye chikho 1/3 katatu patsiku kwa mwezi umodzi. Sungani tincture m'malo abwino. Dziwani kuti viburnum ili ndi contraindication, yomwe iyenera kukumbukiridwa posankha kugwiritsa ntchito mankhwalawa ngati mankhwala: gout, mimba, amakonda thrombosis,
7. Zithandizo za wowerengeka, zomwe zimakhazikitsidwa ndi adyo, zimaperekedwa kuzomwe zimaperekedwa pamasamba osiyanasiyana azachipatala, mwachitsanzo, timangopereka kaphikidwe kamodzi kokha, kamene kali ndi mitu iwiri yayikulu ya adyo ndi kapu (250 g) ya vodka. Mankhwalawa amakonzekera milungu iwiri ndipo amatenga madontho 20 mu supuni ya madzi ozizira owiritsa kotala la ola limodzi musanadye katatu patsiku.

Kugwiritsa ntchito ndalama ya amonke pa matenda oopsa kuyenera kunenedwa padera, ndi mafunso ochulukirapo kuti "njira yatsopanoyi" yomwe ikubwera, yomwe, ngati njira yothandizira kapena yodzitetezera, yatsimikiziradi bwino. Ndizosadabwitsa - chophatikizira chophatikizira matenda oopsa chili ndi mndandanda wazitsamba zamankhwala zomwe zimapangitsa ntchito zamtima, kugwira ntchito kwa ubongo, zimakhudza mphamvu yogwira khoma la mtima ndikuthandizira kwambiri poyambira matenda oopsa.

Tsoka ilo, mankhwalawa sangathe kusintha mapiritsi a kuthamanga kwa magazi omwe atengedwa zaka zapitazo ndi zovuta zapakati pa matenda oopsa, ngakhale ndizotheka kuchepetsa kuchuluka kwake ndi mlingo. Ngati mumamwa tiyi nthawi zonse ...

Kuti wodwalayo athe kumvetsetsa bwino zakumwa, tikuwona kuti ndizabwino kukumbukira kapangidwe ka tiyi wa amonke:

Mwakutero, pali zosiyana zina za mankhwala, zomwe siziyenera kudabwitsani wodwalayo, chifukwa m'chilengedwe muli mitundu yambiri ya mankhwala.

Chithandizo cha odwala omwe ali ndi matenda oopsa pamafunika nthawi yambiri. Pogwiritsa ntchito njira yoyeserera ndi yolakwika, dotolo amafufuza wodwala aliyense mankhwala ake, poganizira momwe ziwalo zonse zilili, zaka, jenda, ngakhale ntchito, popeza mankhwala ena amapereka zovuta zomwe zimapangitsa ntchito ya akatswiri kukhala yovuta. Inde, zimakhala zovuta kwa wodwalayo kuthetsa vuto lotere, pokhapokha, atakhala dokotala.

Hypertension ndi pomwe kuthamanga kwa magazi kumakhala kokwanira kwambiri kotero kuti njira zochiritsira zimakhala ndi phindu lalikulu kwa wodwalayo kuposa zovuta zoyipa. Ngati muli ndi kuthamanga kwa magazi okwanira 140/90 kapena kupitilira - ndi nthawi yoti muchiritse. Chifukwa matenda oopsa amathanso kutenga ngozi ya mtima, kugunda, kulephera kwa impso, kapena khungu. Mtundu wa 1 kapena mtundu wa matenda ashuga 2, gawo lalikulu la kuthamanga kwa magazi limatsikira ku 130/85 mm Hg. Art. Ngati muli ndi vuto lalikulu, muyenera kuchita chilichonse kuti muchepetse.

Ndi matenda a shuga a mtundu 1 kapena 2, matenda oopsa oopsa amakhala oopsa kwambiri. Chifukwa ngati matenda a shuga akuphatikizidwa ndi kuthamanga kwa magazi, chiwopsezo cha kugunda kwamtima chikuwonjezeka katatu, kumenyedwa ndi katatu, khungu khungu nthawi 10, kulephera kwa impso nthawi 20-25, gangrene ndi kuduladula miyendo - 20 nthawi. Nthawi yomweyo, kuthamanga kwa magazi sikunakhale kovuta kutengera matenda, ngati matenda anu a impso sanapite patali kwambiri.

Werengani za matenda a mtima:

Zoyambitsa Hypertension mu shuga

Mtundu 1 komanso mtundu wachiwiri wa matenda ashuga, zomwe zimayambitsa kukula kwa matenda oopsa amatha kukhala osiyana. Mtundu woyamba wa matenda a shuga, matenda oopsa mu 80% amayamba chifukwa cha kuwonongeka kwa impso (matenda ashuga nephropathy). Mtundu wachiwiri wa matenda ashuga, matenda oopsa oopsa nthawi zambiri amakula mwa wodwala kwambiri kuposa zovuta za kagayidwe kazakudya komanso matenda a shuga enieni. Hypertension ndi imodzi mwazigawo za metabolic syndrome, yomwe imayambitsa matenda a shuga.

Zomwe zimayambitsa kukula kwa matenda oopsa mu shuga ndi pafupipafupi

Matenda ashuga nephropathy (mavuto a impso) - 80% Chofunika (chachikulu) matenda oopsa - 10% Isolated systolic hypertension - 5-10% Matenda ena a endocrine - 1-3%

Chofunikira (chachikulu) matenda oopsa - 30-35% Isolated systolic hypertension - 40-45% Matenda a shuga - nephropathy Matenda oopsa chifukwa cha kuwonongeka kwa impso m'mitsempha - 5-10% Matenda ena a endocrine - 1-3%

Zolemba pagome. Isolated systolic hypertension ndi vuto linalake kwa okalamba. Werengani zambiri mu nkhani ya "Isolated systolic hypertension in the older." Matenda enanso a endocrine - atha kukhala pheochromocytoma, hyperaldosteronism, Syenko-Cushing's syndrome, kapena matenda ena osowa.

Chofunikira pa matenda oopsa - kutanthauza kuti dokotala sangathe kukhazikitsa chifukwa cha kuchuluka kwa magazi. Ngati matenda oopsa aphatikizidwa ndi kunenepa kwambiri, ndiye kuti, chifukwa chake, kusalolera kumapangitsa kuti pakhale chakudya chamafuta komanso kuchuluka kwa insulin m'magazi. Izi zimatchedwa "metabolic syndrome," ndipo zimayankha bwino akalandira chithandizo. Zitha kukhalanso:

• kuchepa kwa magnesium m'thupi,
• kupsinjika kwamalingaliro
• kuledzera ndi Mercury, lead kapena cadmium,
• kuchepa kwa mtsempha waukulu chifukwa cha atherosulinosis.

Ndipo kumbukirani kuti ngati wodwalayo akufuna kukhala ndi moyo, ndiye kuti mankhwala alibe mphamvu :).

Mtundu woyamba wa matenda a shuga a mellitus, chachikulu komanso chowopsa chowonjezera cha mavuto ndi kuwonongeka kwa impso, makamaka, matenda a shuga. Vutoli limayamba mu 35-40% ya odwala omwe ali ndi matenda amtundu 1 ndipo amadutsa magulu angapo:

• gawo la microalbuminuria (mamolekyu ang'onoang'ono a proteinin a albumin amawonekera mkodzo),
• gawo la proteinuria (impso limasefukira bwino ndipo mapuloteni akuluakulu amawonekera mkodzo),
• gawo la matenda aimpso kulephera.

Malinga ndi Federal State Institution Endocrinological Research Center (Moscow), pakati pa odwala omwe ali ndi matenda amtundu woyamba 1 popanda matenda a impso, 10% amadwala matenda oopsa. Odwala omwe ali ndi gawo la microalbuminuria, mtengowu umakwera mpaka 20%, pamlingo wa proteinuria - 50-70%, pa gawo la kulephera kwa impso - 70-100%. Mapuloteni ochulukirapo omwe amachitika mumkodzo, magazi ake amayamba kukwera - uwu ndi lamulo wamba.

Kuchepa kwa magazi ndi kuwonongeka kwa impso kumayamba chifukwa chakuti impso siziyenda bwino mkodzo. Sodium m'magazi imakhala yayikulu ndipo madzimadzi amapanga kuti ayipiritse. Kuchuluka kwa magazi ozungulira kumawonjezera kuthamanga kwa magazi. Ngati kuchuluka kwa glucose kumachulukitsidwa chifukwa cha matenda ashuga m'magazi, ndiye kuti kumakoka madzi ambiri ndi magazi kuti magazi asakhale onenepa kwambiri. Chifukwa chake, kuchuluka kwa magazi ozungulira kukukulirakulira.

Matenda oopsa oopsa komanso matenda a impso amapanga chizolowezi choopsa. Thupi limayesetsa kulipirira ntchito yovuta ya impso, chifukwa chake kuthamanga kwa magazi kumakwera. Iyenso, imakulitsa kupanikizika mkati mwa glomeruli. Zomwe zimatchedwa kusefa mkati mwa impso. Zotsatira zake, glomeruli imafa pang'onopang'ono, ndipo impso zimagwira ntchito kwambiri.

Izi zimatha ndi kulephera kwa aimpso. Mwamwayi, koyambirira kwa matenda ashuga nephropathy, kuzungulira kwazovuta kungathe kuthyoka ngati wodwala amathandizidwa mosamala. Chinthu chachikulu ndikuchepetsa magazi kuti akhale abwinobwino. ACE inhibitors, angiotensin receptor blockers, komanso okodzetsa amathandizanso. Mutha kuwerenga zambiri za iwo pansipa.

Kale kwambiri asanayambike matenda a shuga enieni a 2 enieni, matendawa amayamba ndi insulin. Izi zikutanthauza kuti mphamvu ya minofu ya zochita za insulin yafupika. Kuti alipire insulin, kuchuluka kwambiri kwa insulini kumazungulira m'magazi, ndipo pakokha kumawonjezera kuthamanga kwa magazi.

Pakupita kwa zaka, kuunikira kwa mitsempha yamagazi kumachepa chifukwa cha atherosulinosis, ndipo izi zimakhalanso "zopereka" zambiri pakukula kwa matenda oopsa. Mofananamo, wodwalayo amakhala ndi kunenepa kwam'mimba (mozungulira m'chiuno). Amakhulupirira kuti minofu ya adipose imatulutsa zinthu m'magazi zomwe zimapangitsanso magazi.

Kuphatikiza konseku kumatchedwa metabolic syndrome. Zotsatira zake kuti matenda oopsa amathanso kuyamba kale kuposa mtundu wa shuga wachiwiri. Nthawi zambiri amapezeka wodwala nthawi yomweyo akapezeka ndi matenda a shuga. Mwamwayi, kudya zakudya zamagulu ochepa kumathandizira kuwongolera matenda amtundu wa 2 komanso matenda oopsa nthawi imodzi. Mutha kuwerenga zambiri pansipa.

Hyperinsulinism ndi kuchuluka kwa insulini m'magazi. Imachitika poyankha kukana insulin. Ngati kapamba amayenera kutulutsa insulin yochulukirapo, ndiye kuti "imatopa" kwambiri. Akasiya kupirira pazaka zambiri, shuga m'magazi amadzuka ndikuwonjezera matenda a shuga a 2.

Momwe hyperinsulinism imathandizira magazi:

• amathandizira mantha amanjenje,
• impso zimapindika sodium ndi madzimadzi kulowa mkodzo,
• Sodium ndi calcium zimadziunjikira mkati mwa maselo,
• owonjezera insulin amathandizira kukulitsa makoma amitsempha yamagazi, omwe amachepetsa kuthamanga kwawo.

Ndi matenda ashuga, gawo lachilengedwe la kusinthasintha kwatsiku mu magazi limasokonekera. Nthawi zambiri, mwa munthu m'mawa komanso usiku nthawi yogona, kuthamanga kwa magazi kumakhala kotsika 10-20 kuposa masana.Matenda a shuga amabweretsa chifukwa chakuti ambiri odwala matenda oopsa kuthamanga usiku sikuchepa. Kuphatikiza apo, kuphatikiza kwa matenda oopsa ndi matenda ashuga, kupsinjika kwa usiku nthawi zambiri kumakhala kwakukulu kuposa kupanikizika kwa usana.

Vutoli limaganiziridwa kuti limabwera chifukwa cha matenda ashuga a m'mimba. Mwazi wakukwera wamagazi umakhudza dongosolo lazinthu zamagetsi, zomwe zimayang'anira moyo wa thupi. Zotsatira zake, kuthekera kwa mitsempha yamagazi kuwongolera kamvekedwe kawo, i., Kupendekera ndi kumasuka kutengera katundu, kukuwonongeka.

Mapeto ake ndikuti kuphatikiza kwa matenda oopsa ndi matenda ashuga, sikuti kungoyeserera kamodzi kokha ndi tonometer ndikofunikira, komanso kuwunika kwa maola 24 tsiku lililonse. Imachitika pogwiritsa ntchito chipangizo chapadera. Malinga ndi zotsatira za kafukufukuyu, mutha kusintha nthawi yomwe mukumwa komanso muyezo wa mankhwala kuti mukapanikizike.

Zochita zimawonetsa kuti odwala omwe ali ndi matenda amtundu woyamba 1 komanso mtundu wa 2 amakhala amakonda kwambiri mchere kuposa omwe amakhala ndi matenda osokoneza bongo omwe alibe shuga. Izi zikutanthauza kuti kuchepetsa mchere mu chakudya kumatha kukhala ndi mphamvu yochiritsa. Ngati muli ndi matenda ashuga, yesani kudya mchere wocheperako kuti muchepetse kuthamanga kwa magazi ndikuwunika zomwe zimachitika mwezi umodzi.

Kuthamanga kwa magazi mu shuga kumakhala kovuta ndi orthostatic hypotension. Izi zikutanthauza kuti kuthamanga kwa magazi a wodwalayo kumachepa kwambiri ndikusuntha kuchoka pakulankhula kukhala pamalo oyimirira kapena kukhala. Orthostatic hypotension imadziwonetsera pambuyo pakuwuka kwakuthwa kwa chizungulire, kumachita khungu m'maso kapenanso kukomoka.

Monga kuphwanya gawo la circadian kuthamanga kwa magazi, vutoli limachitika chifukwa cha chitukuko cha matenda ashuga. Mchitidwe wamanjenje mwapang'onopang'ono umataya mphamvu yake yolamulira mamvekedwe a mtima. Munthu akamadzuka mwachangu, katunduyo amadzuka. Koma thupi lilibe nthawi yowonjezera kutuluka kwa magazi kudzera m'matumbo, ndipo chifukwa cha izi, thanzi likuipiraipira.

Orthostatic hypotension imasokoneza kuzindikira ndi chithandizo cha kuthamanga kwa magazi. Kuyeza kuthamanga kwa magazi mu shuga ndikofunikira m'malo awiri - kuyimirira ndikugona. Ngati wodwala ali ndi vutoli, ndiye kuti ayenera kudzuka pang'onopang'ono, "monga thanzi lake".

Tsamba lathu lidapangidwa kuti ipititse patsogolo zakudya zamafuta ochepa a mtundu 1 ndi matenda ashuga a 2. Chifukwa kudya zakudya zamagulu ochepa ndiye njira yabwino yochepetsera ndikukhala ndi shuga. Kufunika kwanu kwa insulini kudzachepa, ndipo izi zikuthandizani kukonza zotsatira za chithandizo cha matenda oopsa. Chifukwa chakuti insulin yochulukirapo imazungulira m'magazi, magaziwo amathanso. Takambirana kale mwatsatanetsatane pamwambapa.

Tikupangira zolemba zanu:

• Insulin ndi chakudya chamafuta: chowonadi chomwe muyenera kudziwa.
• Njira zabwino zochepetsera shuga wamagazi ndikuzisunga bwino.

Zakudya zotsika mtengo zamatenda a shuga ndizoyenera ngati simunayambe kulephera impso. Mtundu wakudya uwu ndiotetezeka kwathunthu komanso wopindulitsa panthawi ya microalbuminuria. Chifukwa chakuti shuga wa m'magazi akayamba kukhala wabwinobwino, impso zimayamba kugwira ntchito mwachizolowezi, ndipo zotsalazo za albin mkodzo zimayamba kukhala zabwinobwino. Ngati muli ndi gawo la proteinuria - samalani, kuonana ndi dokotala. Onaninso Zakudya za Matenda a Impso.

Maphikidwe a chakudya chamafuta ochepa a mtundu 1 ndi matenda ashuga 2 amapezeka pano.

Odwala omwe ali ndi matenda oopsa omwe ali ndi matenda opatsirana a shuga ndi odwala omwe ali ndi chiopsezo chachikulu kapena chovuta kwambiri cha mtima. Amalimbikitsidwa kuti achepetse kuthamanga kwa magazi mpaka 140/90 mm RT. Art. M'milungu inayi yoyambirira, ngati amalola kugwiritsa ntchito mankhwala osankhidwa bwino. M'masabata otsatirawa, mutha kuyesa kuchepetsa kupanikizika mpaka pafupifupi 130/80.

Chinthu chachikulu ndikuti kodi wodwalayo amalola bwanji kugwiritsa ntchito mankhwala osokoneza bongo komanso zotsatira zake? Ngati zili zoipa, ndiye kuti kuthamanga kwa magazi kuyenera kukhala pang'onopang'ono, m'magawo angapo. Iliyonse ya magawo awa - mwa 10-15% ya magawo oyambirira, mkati mwa masabata 2-4.Wodwala akangosintha, onjezani kuchuluka kapena muonjezere kuchuluka kwa mankhwalawa.

Ngati mumachepetsa kuthamanga kwa magazi m'magawo, ndiye kuti izi zimapewa zigawo za hypotension motero zimachepetsa chiopsezo cha myocardial infarction kapena stroke. Malire otsika a ngalande yokhazikika magazi ndi 110-115 / 70-75 mm RT. Art.

Pali magulu a odwala matenda ashuga omwe amachepetsa kuthamanga kwa magazi awo "kumtunda" mpaka 140 mmHg. Art. ndipo kutsika kumakhala kovuta kwambiri. Mndandanda wawo ukuphatikizapo:

• odwala omwe ali kale ndi ziwalo zolimbana, makamaka impso,
• odwala matenda amtima,
• okalamba, chifukwa cha ukalamba wokhudzana ndi msana kuwonongeka kwa atherosulinosis.

Zitha kukhala zovuta kusankha mapiritsi opondera magazi kwa wodwala yemwe ali ndi matenda ashuga. Chifukwa kuchepa kwa chakudya m'thupi kumabweretsa kuletsa kugwiritsa ntchito mankhwala ambiri, kuphatikizapo matenda oopsa. Posankha mankhwala, adotolo amaganizira momwe wodwalayo amalamulirira matenda ake a shuga komanso matenda omwe ali nawo, kuphatikiza matenda oopsa, omwe amapanga kale.

Mapiritsi abwino opanikizika a shuga ayenera kukhala ndi zinthu zotsatirazi:

• Amachepetsa kuthamanga kwa magazi, pomwe amachepetsa mavuto
• osachulukitsa magazi, musachulukitse cholesterol yoyipa ndi ya triglycerides,
• Tetezani mtima ndi impso ku zovuta zomwe matenda ashuga komanso kuthamanga kwa magazi zimayambitsa.

Pakadali pano pali magulu 8 a mankhwalawa olembetsa matenda oopsa, pomwe asanu ndi omwe ali akulu ndi atatu owonjezera. Mapiritsi, omwe ali m'magulu owonjezera, amadziwika, monga lamulo, ngati gawo la mankhwala ophatikiza.

Magulu Othandizira Mankhwala

Diuretics (mankhwala okodzetsa) Beta blockers Omwe akutsutsana ndi calcium ACE zoletsa Angiotensin-II receptor blockers (angiotensin-II receptor antagonists)

Rasilez - zoletsa mwachindunji za renin Alfa oletsa Imidazoline receptor agonists (omwe akuchita mankhwala osokoneza bongo)

Pansipa timapereka malingaliro othandizira kuti mankhwalawa athandizidwe kwa odwala omwe ali ndi matenda oopsa omwe ali ndi vuto la matenda a shuga a mtundu woyamba kapena a 2.

Gulu la okodzetsa

Thiazide okodzetsa	Hydrochlorothiazide (dichlothiazide)
Thiazide-ngati diuretic mankhwala	Kubweza kwa Indapamide
Zojambula zotuluka m'miyendo	Furosemide, bumetanide, ethaconic acid, torasemide
Potaziyamu-yosasamala okodzetsa	Spironolactone, triamteren, amiloride
Osmotic okodzetsa	Mannitol
Carbonic anhydrase inhibitors	Diacarb

Zambiri pazamankhwala onse a diuretic awa zimatha kupezeka pano. Tsopano tiyeni tikambirane momwe okodzetsa amathandizira matenda oopsa mu shuga.

Matenda oopsa mwa odwala omwe ali ndi matenda ashuga nthawi zambiri amakula chifukwa chakuti kuchuluka kwa magazi ozungulira kumakulitsidwa. Komanso, odwala matenda ashuga amasiyanitsidwa ndi kuwonjezereka kwa mchere. Pankhaniyi, ma diuretics nthawi zambiri amathandizidwa kuti azichiza kuthamanga kwa magazi mu shuga. Ndipo kwa odwala ambiri, mankhwala a diuretic amathandiza bwino.

Madokotala amayamika thiazide diuretics chifukwa mankhwalawa amachepetsa chiwopsezo cha kugunda kwa mtima ndi stroke ndi 15-25% mwa odwala omwe ali ndi matenda oopsa. Kuphatikiza ndi omwe ali ndi matenda ashuga a 2. Amakhulupirira kuti mumadontho ang'onoang'ono (ofanana ndi hydrochlorothiazide ndi 6 mmol / L,

kuchuluka kwa seramu creatinine wopitilira 30% kuchokera pamlingo woyambirira mkati mwa sabata 1 atayamba chithandizo (pang'onopang'ono - onani!),

mimba ndi nthawi yoyamwitsa.

Pochizira kulephera kwa mtima kwazovuta zilizonse, ma inhibitors a ACE ndi mankhwala oyambira kusankha posankha, kuphatikiza odwala omwe ali ndi matenda amtundu wa 1 komanso a 2. Mankhwalawa amathandizira chidwi cha zimakhala mpaka insulin motero amakhala ndi prophylactic pakukula kwa matenda a shuga a mtundu 2. Siziwonjezera kuyipa kwa shuga wamagazi, musachulukitse cholesterol "yoyipa".

ACE zoletsa ndi # 1 mankhwala ochizira matenda a shuga.Odwala a Type 1 ndi 2 a shuga amapatsidwa mankhwala ochepetsa a ACE akangoyesedwa atawonetsa microalbuminuria kapena proteinuria, ngakhale kuthamanga kwa magazi kukhalabe kwabwinobwino. Chifukwa amateteza impso komanso kuchedwetsa kukula kwa impso kulephera pakapita nthawi.

Ngati wodwala akutenga zoletsa za ACE, ndiye kuti ndi bwino kuti azithira mchere wambiri osaposa magalamu atatu patsiku. Izi zikutanthauza kuti muyenera kuphika chakudya chopanda mchere konse. Chifukwa imawonjezedwa kale ndi zinthu zomalizidwa ndi zinthu zotsiriza. Izi ndizokwanira mokwanira kuti musakhale ndi vuto la sodium m'thupi.

Mukamalandira chithandizo ndi ACE inhibitors, kuthamanga kwa magazi kuyenera kuyesedwa pafupipafupi, ndipo serum creatinine ndi potaziyamu ziyenera kuyang'aniridwa. Okalamba okalamba omwe ali ndi atherosclerosis ambiri amayenera kuyesedwa kwa matenda amitsempha yamagazi a artery stenosis asanafotokoze zoletsa ACE.

Mutha kudziwa zambiri zamankhwala atsopano awa. Pofuna kuthana ndi kuthamanga kwa magazi komanso vuto la impso mu shuga, angiotensin-II receptor blockers amalembedwa ngati wodwala watulutsa chifuwa chowuma kuchokera ku ACE inhibitors. Vutoli limapezeka pafupifupi 20% ya odwala.

Angiotensin-II receptor blockers ndi okwera mtengo kuposa ACE zoletsa, koma sayambitsa chifuwa chowuma. Chilichonse cholembedwa munkhaniyi pamwambapa pa ACE inhibitors chimagwira ntchito kwa angiotensin receptor blockers. Zowonongera ndizofanana, ndipo ziyeso zomwezi ziyenera kumwedwa pomwa mankhwalawa.

Ndikofunikira kudziwa kuti angiotensin-II receptor blockers amachepetsa michere yamitsempha yamanzere kwambiri kuposa zoletsa za ACE. Odwala amalekerera bwino kuposa mankhwala ena aliwonse okhathamira magazi. Zilibe zotsatira zoyipa kuposa placebo.

Awa ndi mankhwala atsopano. Idapangidwa pambuyo pake kuposa ACE inhibitors ndi angiotensin receptor blockers. Rasilez adalembetsedwa movomerezeka ku Russia
mu Julayi 2008. Zotsatira zamaphunziro a nthawi yayitali ogwira ntchito ake zikuyembekezeredwa.

Rasilez - zoletsa mwachindunji za renin

Rasilez imayikidwa limodzi ndi ACE inhibitors kapena angiotensin-II receptor blockers. Kuphatikiza kwa mankhwalawa kwa mankhwala kumapangitsa kuti mtima ndi impso ziziteteza. Rasilez amasintha cholesterol m'mwazi ndikuwonjezera chidwi cha minofu kufikira insulin.

Pakusamalira kwakanthawi kochepa kwa matenda oopsa, osankha alpha-1-blockers amagwiritsidwa ntchito. Mankhwala omwe ali mgululi akuphatikizapo:

Pharmacokinetics ya kusankha alpha-1-blockers

Prazosin	7-10	2-3	6-10
Doxazosin	24	12	40
Terazosin	24	19-22	10

Zotsatira zoyipa za alpha-blockers:

• orthostatic hypotension, mpaka kukomoka,
• kutupa kwa miyendo
• kusiya magazi (kuthamanga kwa magazi kudumpha "rebound" mwamphamvu)
• wolimbikira tachycardia.

Kafukufuku wina wawonetsa kuti alpha-blockers amawonjezera chiopsezo cha kulephera kwa mtima. Kuyambira pamenepo, mankhwalawa sanakhale otchuka kwambiri, kupatula nthawi zina. Mankhwalawa amaperekedwa limodzi ndi mankhwala ena oopsa, ngati wodwalayo ali ndi vuto la Prostatic hyperplasia.

Mu matenda a shuga, ndikofunikira kuti akhale ndi phindu pa metabolism. Alfa-adrenergic blockers amachepetsa shuga m'magazi, kuwonjezera minyewa kumva insulin, komanso kusintha cholesterol ndi triglycerides.

Nthawi yomweyo, kulephera kwa mtima ndi kuphwanya kugwiritsa ntchito kwawo. Ngati wodwala ali ndi autonomic neuropathy yowonetsedwa ndi orthostatic hypotension, ndiye kuti ma alpha-adrenergic blockers sangadziwike.

M'zaka zaposachedwa, madokotala ochulukirachulukira akukhulupirira kuti ndibwino kupereka mankhwala osapatsa mmodzi, koma mwachangu 2-3 mankhwala ochizira kuthamanga kwa magazi. Chifukwa odwala nthawi zambiri amakhala ndi njira zingapo zopangira matenda oopsa nthawi imodzi, ndipo mankhwala amodzi sangakhudze zomwe zimayambitsa.Mapiritsi opsinjika amagawidwa m'magulu chifukwa amachita mosiyanasiyana.

Mankhwala amodzi amachepetsa kukakamizidwa kwa odwala osaposa 50%, ngakhale matenda oyamba atakhala ochepa. Nthawi yomweyo, kuphatikiza chithandizo kumakupatsani mwayi wogwiritsa ntchito Mlingo wochepetsetsa wa mankhwala, komabe mumapeza zotsatira zabwino. Kuphatikiza apo, mapiritsi ena amafooketsa kapena kuthetseratu mavuto omwe amadzetsa mzake.

Hypertension siikhala yoopsa palokha, koma zovuta zomwe zimayambitsa. Mndandanda wawo ukuphatikizapo: kugunda kwa mtima, sitiroko, kulephera kwa impso, khungu. Ngati kuthamanga kwa magazi kuphatikizidwa ndi matenda ashuga, ndiye kuti chiwopsezo cha zovuta zimachuluka kangapo. Dokotala amawunika kuopsa kwa wodwala wina kenako asankhe ngati angayambe mankhwalawa piritsi limodzi kapena kugwiritsa ntchito mankhwala mosakaniza nthawi yomweyo.

Kufotokozera kwa manambala: HELL - kuthamanga kwa magazi.

Russian Association of Endocrinologists ikuvomereza njira yotsatirayi yochizira matenda oopsa a shuga. Choyamba, angiotensin receptor blocker kapena ACE inhibitor imayikidwa. Chifukwa mankhwala ochokera m'maguluwa amateteza impso ndi mtima bwino kuposa mankhwala ena.

Ngati monotherapy yokhala ndi ACE inhibitor kapena angiotensin receptor blocker sichithandiza kutsika magazi mokwanira, tikulimbikitsidwa kuwonjezera diuretic. Zomwe diuretic kusankha zimadalira pakusungika kwa impso ntchito kwa wodwala. Ngati pali kulephera kwa impso kosatha, thiazide diuretics ikhoza kugwiritsidwa ntchito. Mankhwala a Indapamide (Arifon) amadziwika kuti ndi amodzi a otetezeka kwambiri othandizira matenda oopsa. Ngati kulephera kwa impso kwayamba kale, okodzetsa m'chiuno ndi mankhwala.

Kufotokozera kwa manambala:

• HELL - kuthamanga kwa magazi
• GFR - kuchuluka kwa impso kumaso, kuti mumve zambiri onani "Zoyeserera ziti zomwe zikuyenera kuchitika kuti muwone impso zanu"
• CRF - kulephera kwa impso,
• BKK-DHP - calcium blocker dihydropyridine,
• BKK-NDGP - blockcide-non-dihydropyridine calcium blocker,
• BB - beta blocker,
• ACE inhibitor ACE inhibitor
• ARA ndi angiotensin receptor antagonist (angiotensin-II receptor blocker).

Ndikofunika kuperekera mankhwala omwe ali ndi 2-3 zomwe zimagwira piritsi limodzi. Chifukwa ochepa mapiritsiwo, amalolera kumawamwetsa kwambiri.

Mndandanda wachidule wamankhwala ophatikiza matenda oopsa:

• Korenitec = enalapril (renitec) + hydrochlorothiazide,
• foside = fosinopril (monopril) + hydrochlorothiazide,
• co-diroton = lisinopril (diroton) + hydrochlorothiazide,
• lehar = losartan (cozaar) + hydrochlorothiazide,
• noliprel = perindopril (prestarium) + thiazide-ngati diuretic indapamide retard.

ACE inhibitors komanso calcium blockers blockers amakhulupirira kuti zimathandizira kuthekera kwa wina ndi mnzake kuteteza mtima ndi impso. Chifukwa chake, mankhwala ophatikiza otsatirawa nthawi zambiri amaperekedwa:

• tarka = trandolapril (hopten) + verapamil,
• prestanz = perindopril + amlodipine,
• equator = lisinopril + amlodipine,
• khulusa = valsartan + amlodipine.

Tikuchenjezani odwala: musadzipangire nokha mankhwala oopsa. Mutha kukhudzidwa kwambiri ndi mavuto, ngakhale imfa. Pezani dokotala woyenera ndipo muthane naye. Chaka chilichonse, adotolo amawona odwala mazana ambiri omwe ali ndi matenda oopsa, chifukwa chake adziwa zambiri, momwe mankhwalawa amagwirira ntchito komanso omwe ndi othandiza kwambiri.

Tikukhulupirira kuti mupeza nkhaniyi kukhala yothandiza pa matenda oopsa pa matenda ashuga. Kuthamanga kwa magazi kwa odwala matenda ashuga ndi vuto lalikulu kwa madokotala ndi kwa iwonso odwala. Zinthu zomwe zaperekedwa pano ndizothandiza kwambiri. M'nkhani “Zomwe Zimayambitsa Matendawa ndi Momwe Mungawathetsere. Kuyesedwa kwa matenda oopsa ”mutha kuphunzira mwatsatanetsatane mayesero omwe muyenera kuchita kuti mupeze chithandizo choyenera.

Mukatha kuwerenga zida zathu, odwala azitha kumvetsetsa bwino matenda oopsa mu mtundu 1 ndikulembapo matenda ashuga 2 kuti athe kutsatira njira yothandizirana ndikuwonjezera moyo wawo komanso kuvomerezeka mwalamulo. Zambiri zokhudzana ndi mapiritsi opanikizika zakonzedwa bwino ndipo zimakhala ngati "pepala chinyengo" kwa madokotala.

Tikufuna kutsimikizanso kuti kudya zakudya zamagulu ochepa ndi chida chothandiza kuti muchepetse shuga m'magazi a shuga, komanso kuchepetsa matenda a kuthamanga kwa magazi. Ndikofunika kutsatira zakudya izi kwa odwala omwe ali ndi matenda a shuga osati a 2 okha, komanso a 1st pokhapokha ngati ali ndi vuto lalikulu la impso.

Tsatirani pulogalamu yathu ya matenda a shuga a 2 kapena mtundu wa matenda ashuga 1. Ngati mungolekere zakudya zopatsa mphamvu m'zakudya zanu, zimakulitsa mwayi kuti muthanso kukhala ndi magazi abwinobwino. Chifukwa insulini yocheperako imazungulira m'magazi, ndizosavuta kuzichita.

Ziwerengero zamanyumba zikuchepa kwambiri chaka chilichonse! Russian Diabetes Association imati munthu m'modzi mwa anthu 10 m'dziko lathu ali ndi matenda a shuga. Koma chowonadi ndichakuti si matenda omwewo omwe amawopsa, koma zovuta zake ndi moyo womwe umawatsogolera. Kodi ndingathane bwanji ndi matendawa, akutero poyankhulana ...

Mtundu wamoyo umakukakamiza kupita patsogolo, kuiwala za iwe, osasamala zaumoyo komanso kupuma. Zotsatira zake, ndi anthu ochepa omwe amatha kufikira zaka 40-50. Komwe maphwando ambiri matenda opatsirana amakula bwino chaka chilichonse. Mankhwala amakono amakulolani kuchiritsa ambiri aiwo.

Koma bwanji ngati mankhwalawa omwe amasintha machitidwe a "zilonda" zina amatsutsana mwa ena? Ndi mapiritsi ati a shuga omwe ndingamwe kumwa kuchokera kukakamiza?

Mawu oti "matenda ashuga" potanthauzira amatanthauza "kumaliza". Limafotokoza ndendende zomwe zikuchitika mthupi la munthu wodwala matenda ashuga - kwenikweni, manyuchi amayenda m'mitsempha.

Zakudya zilizonse, kupatula mafuta, zimadyedwa ndi maselo amthupi mthupi la glucose - shuga wosungunuka m'magazi. Thanzi limalowa m'maselo athu kudzera mu insulin. Pagawo lililonse la glucose lomwe limalowa m'magazi, thupi limakhudzana ndi kupanga kwa insulin.

Mwa munthu wathanzi, kapamba amalimbana ndi ntchito yake munthawi yake. Pambuyo pochita ntchito ya chimbudzi cha glucose kudzera m'mitsempha yama cell, imatumiza zochuluka ku chiwindi ndi malo okupaka mafuta. Mwa odwala matenda ashuga, izi zimalephereka.

Insulin mwina singapangidwe kuchuluka kokwanira, kapena kumasulidwa kwake kuchedwa. Matenda a shuga ndi matenda omwe shuga wambiri amapangidwa m'magazi.

Pali mitundu iwiri yayikulu ya matenda a shuga:

1. Dependent insulin (mtundu I shuga) - kapamba amasiya kutulutsa insulin, kapena amatulutsa kwambiri, osakwanira kagayidwe kachakudya.
2. Independent insulin (mtundu II matenda ashuga) - insulin imapangidwa nthawi zonse kapena ngakhale kuchuluka, koma maselo amthupi sazindikira, chifukwa chake shuga salowa mkati ndipo samakhala gwero lamphamvu, koma limapachikidwa m'magazi.

Kenako mitunduyi imawumbika m'magulu angapo ang'onoang'ono. Tatsimikizira kale za mitundu isanu ya shuga. Koma ofufuza ali ndi mitundu yoti pakhoza kukhala mitundu yambiri. Onse onyamula matendawa ali ndi vuto la metabolism.

Zomwe zimayambitsa matenda ashuga ndizambiri: kuyambira kupsinjika kwambiri, kunenepa kwambiri, kuchokera ku zovuta za majini mpaka zovuta zamatenda ena.

Chifukwa chake, kupanikizika kosalekeza kungayambitse kukula kwa matenda ashuga. Poterepa, mathero amtsempha amasiya kumva, ndipo kusefukira kwa impso kumawonongeka. Kulephera kwa mahomoni kumachitika, ndipo zikondazo zimaleka kulandira chizindikiritso polandila shuga m'magazi munthawi yake.

Mkulu shuga akayamba kuchepera, insulin imayamba kupangidwa ndipo "modzidzimutsa" imagwiritsa ntchito kwambiri chiwindi ndi ma deposits a mafuta.Komanso, mafuta ochulukirapo amalimbikitsa chitetezo chokwanira cha khungu ku insulin.

Mbale zokhala ndi Mlingo wambiri wa shuga zimachepa ndipo zimawonongeka pakapita magazi. Thupi limasuntha mabala ang'onoang'ono awa ndi zolembera za cholesterol, zomwe zimapangitsa kuti azikhala ndi voliyumu yambiri, kusokoneza metabolidi ya lipid. Vuto lamavuto am'mimba limasokonekera, kuponderezedwa kumakwera, ndipo kumachepetsa kusefera, ndipo bwalo loipa limayamba kuzungulira ...

Wodwala amasonkhanitsa gulu lonse la matenda omwe amadalirana. Matenda a shuga ndi

Tsoka ilo, nthawi zambiri zimakhala masatelo.

Chithandizo cha matenda oopsa mu shuga

Hypertension imawononga kwambiri thupi la munthu komanso maluso ake. Zimapweteketsa dongosolo la mtima, kukhala chifukwa cha matenda a mtima, kusokoneza ubongo, kukhala chinthu cholakwika m'maso ndimatenda amaso, ndikuvulaza impso ndi ziwalo zina zamkati. Nthawi zina, ngakhale atakwanitsa zaka 40-50, zimatha kukhala zakufa.

Ngati matenda ashuga ndi kukakamizidwa zilipo nthawi yomweyo, ntchitoyi imapanikizika chifukwa chofunikira kusankha chithandizo chomwe sichikugwirizana ndi kuchuluka kwa shuga m'magazi.

Ndiye chifukwa chake njira zina zolimbana ndi matenda oopsa sizili bwino kwa odwala matenda ashuga:

• Simungathe kutsitsa kuthamanga kwa magazi mu shuga komanso matenda okodzetsa ambiri omwe amachotsa madzi ochulukirapo kuchokera ku minofu, chifukwa ndi kuchepa kwa magazi, kuchuluka kwa shuga kumawonjezeka,
• Mankhwala osokoneza bongo a shuga m'magazi a shuga sayeneranso kutsika shuga, chifukwa vuto la hypoglycemic, kukomoka, ngakhale kukomoka ndikotheka ndi mankhwala ochepetsa shuga
• Chenjezo liyenera kumwedwa chifukwa chopanikiza zakudya zambiri, monga zipatso, mkaka, sinamoni. Ambiri aiwo amakhala ndi chakudya chamagulu, momwe thupi limasinthira kukhala glucose ndikuwonjezera vuto la odwala matenda ashuga. Pansi pa chiletso chonse cha uchi.

Pamaso pa matenda awiri oopsa komanso oopsa monga matenda oopsa komanso matenda ashuga, ndiye kuti timadzipatsa tokha mankhwala.

Katswiri wodziwa bwino yekha ndiamene angawonetsetse zovuta ndi zovuta za ndalama zina ndikuwona njira yamankhwala.

Mankhwala onse a antihypertensive amagawidwa ndi chikhalidwe cha chochitikacho:

1. Diuretics (okodzetsa) - amathandizira pakuchotsa chinyezi kuchokera ku minofu, ndipo kupanikizika kumachepa,
2. ACE inhibitors (angiotensin-akatembenuka enzyme) - amachepetsa kuchuluka kwa enzyme, popanda zomwe sizingatheke kutembenuza mahomoni angiotensin I kukhala mahomoni angiotensin II, potero kuteteza kuphipha kwamitsempha yamagazi ndi kupanikizika kwamankhwala pambuyo pake,
3. Sartans kapena Angiotensin II Receptor blockers (ARB) - zotchinga zovuta za angiotensin II, vasospasm sizimachitika, ndipo magazi amayenda m'mitsempha momasuka, kupanikizika kumachepa,
4. Ma Beta-blockers - achepetsa kapena kufulumizitsa kugunda kwa mtima, chifukwa chomwe kugawa kwamwazi kumachitika, katundu pamitsempha imachepa,
5. Ma calcium calcium blockers (BCC) - amalepheretsa kusunthika kwa calcium ion kudzera mu ma membala am'mimba, potero amachepetsa kuyika kwake m'maselo ndi kuthamanga kwa njira ya metabolic mwa iwo. Kufunika kwa mpweya wa minyewa kumachepa, ndipo katundu pamtima amachepa, kuchuluka kwa magazi omwe amayamba kutulutsa kumacheperachepera.

Mankhwalawa amachepetsa kuchuluka kwa madzi omwe amayenderera m'thupi, omwe amakhudza kuthamanga kwa magazi. Komabe, ndi matenda 2 a shuga, mankhwalawa amatha kukhala owopsa. Choyamba, ambiri mwa mapiritsi awa kuchokera ku kukakamiza kuletsa impso, zimapangitsa kuti pakhale zovuta kuti pakhale popanda kuchotsa shuga wambiri ndi hyperglycemia.

Kachiwiri, ndi kuchepa kwa magazi, kuchuluka kwa shuga mkati mwake kumakulanso. Ndipo ngati ndi matenda amtundu wa 1 shuga ndikotheka kuchitapo kanthu nthawi yomweyo kuti athe kudula insulin, ndiye kuti odwala T2DM abwezeretsa shuga kwa masiku angapo.

Komanso, odwala ambiri omwe ali ndi matenda ashuga a 2 samamwa mankhwala, amatulutsa shuga pokhapokha pomangokhala ndi zakudya komanso masewera. Kwa iwo, kutenga ma diuretics kungatanthauze kusintha kwa mankhwala osokoneza bongo.

Popereka mankhwala othandizira odwala matenda ashuga kuti achepetse magazi, dokotala nthawi zonse amalingalira zaubwino ndi zovuta zake. Kudzisintha kuti mukhale okodzetsa ndikosayenera kwambiri!

Ma diuretics, omwe dokotala atha kukuwuzani kuti akupanikizidwe ndi matenda ashuga, ndi awa:

1. Zinthu monga ziwazi za thiazide ndi thiazide ndi mankhwala amphamvu kwambiri, mphamvu zawo zimachitika patatha pafupifupi maola awiri ndipo zimakhala maola 11-13. Amakhala ndi mawonekedwe ofatsa, koma amalimbikitsa zotsatira za okodzetsa a magulu ena. Liwazides nthawi zambiri limasankhidwa pamodzi ndi ATP zoletsa komanso beta-blockers. Izi ndi monga: hydrochlorothiazide, indapamide, chlortalidone, clopamide, hypothiazide, arifon retard, ndi zina zambiri.
2. Ma loop diuretics ndi gulu lamphamvu kwambiri la okodzetsa, kutsuka calcium, sodium, potaziyamu ndi magnesium kuchokera ku zimakhala. Ndi kuchepa kwa chiwerengero chawo, gawo la mtima limasokonekera, arrhythmia, matenda ena a mtima amakula. Kulandila njira zodontha ndikotheka kwa kanthawi kochepa kwambiri, kuti muchepetse zovuta komanso kuphwanya kwambiri. Kuphatikiza apo, mphamvu zawo ziyenera kuthiridwa ndi nthawi yomweyo kudya kwa potaziyamu ndi magnesium. Zina mwazabwino za gulu la okodzetsa ndi kusapezeka kwa cholesterol. Mankhwalawa ndi monga: furosemide, lasix, ethaconic acid.
3. Osmotic diuretics imagwiritsidwa ntchito makamaka mu nthawi ya postoperative kuti athandize puffility yozunza. Ali ndi malo osokoneza bongo a odwala matenda ashuga - amathandizira kupanga glycogen. Katunduyu amamasulidwa ndi chiwindi kulowa m'magazi pomwe munthu sanadye kwa nthawi yayitali, ndipo misempha ya shuga imatsitsidwa. Makamaka, mpweya woterewa umachitika nthawi zambiri kugona tulo. Kuchuluka kwadzidzidzi mu shuga kumakhudza thanzi la anthu odwala matenda ashuga, chifukwa chake sikuti amaikidwiratu okodzetsa a gulu la osmotic (bumetanide, torsemide, chlortalidone, polythiazite, xipamide).
4. Potaziyamu yosawononga okodzetsa - musachotse potaziyamu m'thupi. Izi zikuphatikizapo spironoxan, veroshpiron, unilan, aldoxone, spirix, triamteren, amiloride. Amakhala ndi zofewa zowoneka bwino, koma amasinthasintha liwiro lawo. Nthawi zambiri zotchulidwa nthawi imodzi ndi zina okodzetsa.

Mankhwala omwe ali mgululi ndi mapiritsi oponderezedwa kwambiri a matenda ashuga. Kuphatikiza pa ntchito yake yayikulu, zoletsa za ACE zimathandizira kusefera kwa impso, kuziteteza ku zotsatira za kuthamanga kwa glucose, zimakhudza kagayidwe ka lipid, kuteteza mawonekedwe am'maso, kuchepa kukula kwa matenda ashuga, kuchepetsa chiopsezo cham'magazi ndi matenda a mtima, komanso kusintha shuga.

Zoletsa zotchuka kwambiri za ATP: enalapril, quinapril, lisinopril, komanso ma jini a mankhwalawa.

Perekani kwa odwala matenda a shuga omwe ali ndi mavuto amtima, monga angina pectoris, kugunda kwa mtima, kulephera kwa mtima. Ma beta-blockers ena amakhala ndi mtima wambiri ndipo alibe phindu lililonse pakumanga kwa chakudya. Pakati pawo: bisoprolol, atenolol, metoprolol ndi mankhwala ena omwe ali ndi zinthu izi.

Tsoka ilo, mankhwalawa amalimbikitsa cholesterol yamagazi, komanso zimawonjezera kukana kwa insulin mu mtundu 2 wa shuga, womwe umapangitsa kuti shuga ayambe kutengeka ndi thupi. Pocheperapo, carvedilol ndi nebivolol, komanso ma genetic awo, zimakhudza kagayidwe ka lipid.

Kutenga beta-blockers kumatha kutsitsa zizindikiro za hypoglycemia (kutsika kwambiri kwa shuga m'magazi), ndipo ayenera kumwedwa mosamala.

Mankhwala a antihypertensive ochokera ku gululi ndi oyenera kuchitira matenda oopsa a shuga mellitus.Kuphatikiza pa kuponderezedwa, iwo, monga zoletsa za ACE, ali ndi nephroprotective, amachepetsa kukana kwa maselo ku insulin, osakhudza metabolidi a lipid ndi carbohydrate, ndipo amaloledwa bwino ndi odwala okalamba.

Mwanjira yabwino kwambiri, sartan amatulutsa zochita zawo, masabata awiri 2-3 atayamba kulandira. Izi ndi mankhwala: losartan, candesartan, valsartan, telmisartan, eprosartan.

Mankhwala ochokera ku gulu la othandizira calcium calcium blockers samakhudzanso kagayidwe kazakudya zam'mimba ndi lipids, chifukwa chake, amatha kugwiritsidwa ntchito pochiza matenda oopsa mu matenda ashuga. Zotsatira zawo sizitchulidwa kocheperako kuposa za ACE ndi ARB zoletsa, koma zimakhala ndi phindu pa machitidwe a IHD ndi angina pectoris.

Ena mwa mankhwalawa amakhala ndi mphamvu yayitali, ndipo amayenera kumwa kamodzi kokha patsiku, zomwe ndizofunikira ndi kuchuluka kwa mankhwala, komanso ukalamba. Gululi limaphatikizapo: nifidipine (pamapiritsi a Corfar Retard), amlodipine, felodipine, lercanidipine ndi mankhwala ena omwe ali ndi zosakaniza izi. Zina mwazotsatira zoyipa ndizotupa ndi kutuluka mofulumira.

Pomaliza ndemanga, tikugogomezeranso kuti, ngakhale atalemba zochuluka motani pazapanikizidwe ndi matenda ashuga, sangasinthe maphunziro ndi zamankhwala.

Osadzisilira! Ndipo khalani athanzi!

Hypertension imakhala yofala kwambiri mwa anthu odwala matenda ashuga a 2. Kuphatikiza kwamatendawa ndi kowopsa kwambiri, chifukwa kuopsa kwa kuwonongeka kwa kuwona, kuwonongeka kwa mtima, kulephera kwa impso, kugunda kwamtima ndi gangore kumachulukanso. Chifukwa chake, ndikofunikira kusankha mapiritsi abwino opanikizika a matenda a shuga a 2.

Ndi chitukuko cha matenda oopsa kuphatikiza ndi matenda ashuga, ndikofunikira kukaonana ndi dokotala munthawi yake. Kutengera ndi deta ya kusanthula ndi maphunziro, katswiri adzatha kusankha mankhwalawa.

Kusankhidwa kwa mankhwalawa mu matenda oopsa a shuga sikophweka konse. Matenda a shuga amaphatikizidwa ndi kusokonezeka kwa metabolic mthupi, kusokonezeka kwa impso (diabetesic nephropathy), ndipo mtundu wachiwiri wa matenda umadziwika ndi kunenepa kwambiri, atherosulinosis, ndi hyperinsulinism. Si mankhwala onse a antihypertensive omwe angathe kumwa mankhwala otere. Kupatula apo, ayenera kukwaniritsa zofunika izi:

• sizikhudza kuchuluka kwa lipids ndi glucose m'magazi,
• khalani ogwira mtima
• khalani ndi zovuta zochepa
• kukhala ndi nephroprotective ndi mtima zotsatira (kuteteza impso ndi mtima ku mavuto obwera chifukwa cha matenda oopsa).

Chifukwa chake, ndi matenda amtundu wa 2 shuga, ndi omwe angayimidwe a magulu otsatirawa a mankhwala omwe angagwiritsidwe ntchito:

• okodzetsa
• ACE zoletsa
• opanga beta
• ARB
• calcium blockers.

Ma diuretics amaimiridwa ndi mankhwala ambiri omwe ali ndi njira yosiyana yochotsa madzi owonjezera mthupi. Matenda a shuga amadziwika ndi kuphatikizika kwapadera kwa mchere, zomwe nthawi zambiri zimapangitsa kuti magazi azungulira komanso chifukwa chake, ukuwonjezeka kwa kukakamizidwa. Chifukwa chake, kutenga ma diuretics kumapereka zotsatira zabwino ndi matenda oopsa mu shuga. Nthawi zambiri amagwiritsidwa ntchito kuphatikiza ACE inhibitors kapena beta-blockers, omwe amalola kuwonjezera kuchuluka kwa mankhwalawa ndikuchepetsa kuchuluka kwa zoyipa. Zoyipa za gululi la mankhwalawa ndizotetezedwa bwino aimpso, zomwe zimachepetsa kugwiritsa ntchito.

Kutengera ndi makina a zochita, okodzetsa amawagawa:

• matembenukidwe
• thiazide
• ngati thiazide,
• kuteteza potaziyamu
• osmotic.

Oyimira thiazide diuretics amalembedwa mosamala mu shuga. Cholinga cha izi ndi kulepheretsa kugwira ntchito kwa impso ndikuwonjezera mafuta m'thupi ndi shuga m'magazi mukamamwa waukulu. Nthawi yomweyo, thiazides amachepetsa kwambiri vuto la kugwidwa ndi matenda a mtima.Chifukwa chake, ma diuttics oterewa sagwiritsidwa ntchito kwa odwala omwe amalephera kupweteka kwa impso, ndipo akatengedwa, tsiku lililonse mlingo sayenera kupitirira 25 mg. Omwe amagwiritsidwa ntchito kwambiri ndi hydrochlorothiazide (hypothiazide).

Mankhwala ngati a Thiazide nthawi zambiri amagwiritsidwa ntchito kupanikizika kwa matenda ashuga. Pochepera pang'ono, amachotsa potaziyamu m'thupi, kuwonetsa kufatsa kotsitsa ndipo kwenikweni sikukhudza kuchuluka kwa shuga ndi lipids m'thupi. Kuphatikiza apo, nthumwi yayikulu ya subgroup indapamide ili ndi nephroprotective. Mtundu wonga thiazide woterewu umapezeka pansi pa mayina:

Zopaka za loop zimagwiritsidwa ntchito pamaso pa kulephera kwa impso ndi edema. Njira ya kayendetsedwe kake iyenera kukhala yochepa, chifukwa mankhwalawa amalimbikitsa mphamvu ya diuresis ndi potaziyamu, zomwe zimapangitsa kuti thupi lithe kusowa madzi m'thupi, hypokalemia ndipo, chifukwa chake, arrhythmias. Kugwiritsa ntchito malupu okodzetsa kuyenera kuphatikizidwa ndi kukonzekera kwa potaziyamu. Chida chodziwika komanso chogwiritsidwa ntchito kwambiri cha gulu laling'ono ndi furosemide, yotchedwanso Lasix.

Osmotic ndi potaziyamu woteteza okodzetsa a shuga nthawi zambiri satchulidwa.

Akatswiri ambiri amalingalira zoletsa za ACE ngati mankhwala osankhira matenda oopsa mu shuga mellitus. Kuphatikiza pakuchepetsa kuthamanga kwa magazi, mankhwalawa:

• khalani ndi zotsatira zotchulidwa,
• onjezani zamphamvu za maselo a thupi kupita ku insulin,
• onjezani shuga
• khalani ndi zotsatira zabwino pa lipid metabolism,
• chepetsa kuchepa kwa zotupa m'maso,
• kuchepetsa chiopsezo cha stroke komanso myocardial infarction.

Ndikofunikira kudziwa kuti kutengeka kwa glucose komwe kumachitika bwino kungayambitse hypoglycemia, kotero kusintha kwa mankhwala ochepetsa mphamvu ya shuga kungafunike. ACE inhibitors amakhalanso ndi potaziyamu m'thupi, zomwe zingayambitse hyperkalemia. Chifukwa chake, chithandizo ndi mankhwalawa sichingatheke ndi zina za potaziyamu.

ACE inhibitors amakula pang'onopang'ono, pakapita milungu iwiri. Zotsatira zoyipa kwambiri za mankhwalawa ndi chifuwa chowuma, chomwe chimafuna kuti achotse ndi kuperekedwa kwa mankhwala omwe amakakamizidwa kwambiri ndi gulu lina.

ACE inhibitors amaimiridwa ndi mankhwala ambiri:

• enalapril (Enap, Burlipril, Invoril),
• quinapril (Akkupro, Quinafar),
• lisinopril (Zonixem, Diroton, Vitopril).

Beta blockers

Kukhazikitsidwa kwa beta-blockers kukuwonetsedwa kwa matenda oopsa mu shuga mellitus, omwe amaphatikizidwa ndi kulephera kwa mtima, kugunda mwachangu komanso angina pectoris. Nthawi yomweyo, zokonda zimaperekedwa kwa oyimira amtundu wa gulu, omwe samakhala ndi vuto pa kagayidwe ka matenda a shuga. Awa ndi mankhwala:

• atenolol (Atenobene, Atenol),
• bisoprolol (Bidop, Bicard, ConcorCoronal),
• metoprolol (Emzok, Corvitol).

Komabe, ngakhale mankhwalawa ali ndi vuto pa shuga, kuwonjezera kuchuluka kwa cholesterol ndi shuga mthupi, komanso kuchuluka kwa insulin. Chifukwa chake, pakadali pano palibe malingaliro osatsimikizika pazakutsogolo kwa ndalama izi.

Malo ovomerezeka kwambiri a beta a shuga ndi awa:

• carvedilol (Atram, Cardiostad, Coriol),
• nebivolol (Nebival, Nebile).

Ndalamazi zimakhala ndi zowonjezera vasodilating. Mapiritsi opanikizika kwambiri amathandizira kuchepetsa kukana kwa insulini ndipo amakhala ndi phindu pa kagayidwe kazakudya zam'mimba ndi lipids.

Kumbukirani kuti beta blockers akhoza kufinya zizindikiro za hypoglycemia. Izi ndizofunikira kwambiri kwa anthu omwe samasiyanitsa kuyambika kwa hypoglycemia kapena samamva konse.

Ma Sartan kapena ma ARB (angiotensin II receptor blockers) ndiwothandiza pochiza matenda oopsa ogwirizana ndi matenda ashuga. Mapiritsi a matenda oopsa, kuwonjezera pa antihypertensive action:

• khalani ndi zotsatira zabwino,
• kutsika kwa insulin
• sizimakhudza zoyipa zama metabolic,
• chepetsa michere yamitsempha yamanzere,
• Amasiyanitsidwa ndi kulekerera bwino komanso nthawi zambiri kuposa mankhwala ena a antihypertensive omwe amayambitsa thupi.

Zochita za sartan, komanso zoletsa za ACE, zimayamba pang'onopang'ono ndikufika pazovuta zazikulu mu masabata 2-3 oyendetsa.

Ma ARB odziwika kwambiri ndi:

• losartan (Lozap, Kazaar, Lorista, Closart),
• candesartan (Candecor, Adible, Candesar),
• valsartan (Vasar, Diosar, Sartokad).

Otsutsa a calcium

Ma calcium calcium blockers amatha kugwiritsidwanso ntchito kutsitsa magazi ndi kuphatikiza kwa matenda oopsa ndi matenda osokoneza bongo, chifukwa sizikhudza kagayidwe kazakudya zam'mimba komanso lipid metabolism. Ndiwosagwira ntchito kwambiri kuposa ma sartans ndi ACE inhibitors, koma ndi abwino kwambiri pamaso pa concomitant angina pectoris ndi ischemia. Komanso, mankhwalawa amaperekedwa makamaka pochiza odwala okalamba.

Zokonda zimaperekedwa ndi mankhwala omwe amakhala ndi mphamvu yayitali, omwe amakwaniritsidwa kuti azichita kamodzi patsiku:

• amlodipine (Stamlo, Amlo, Amlovas),
• nifidipine (Corinfar Retard),
• felodipine (Adalat SL),
• lercanidipine (Lerkamen).

Choipa cha otsutsana ndi calcium ndi kuthekera kwawo pakupangitsa kuchuluka kwa mtima kwa mtima ndikupangitsa kutupa. Nthawi zambiri kutaya mtima kwambiri kumayambitsa kuchoka kwa mankhwalawa. Pakadali pano, woimira yekhayo yemwe alibe izi zoyipa ndi Lerkamen.

Nthawi zina matenda oopsa sangathe kuthandizidwa ndimankhwala omwe afotokozedwa pamwambapa. Ndiye, kupatula, alpha-blockers angagwiritsidwe ntchito. Ngakhale sizikhudza kayendedwe ka metabolic mthupi, zimakhala ndi zotsutsana ndi thupi. Makamaka, alpha-blockers angayambitse orthostatic hypotension, yomwe imadziwika kale ndi matenda a shuga.

Chizindikiro chokhacho chotsimikizira gulu la mankhwalawa ndi kuphatikiza kwa matenda oopsa, matenda ashuga mellitus ndi adenoma a prostate. Oimira:

• terazosin (Setegis),
• doxazosin (Kardura).

Matenda oopsa - kuthamanga kwa magazi. Kupanikizika kwa mtundu wa shuga 2 kumayenera kusungidwa pa 130/85 mm Hg. Art. Mitengo yapamwamba imachulukitsa mwayi wokhala ndi stroke (nthawi 3-4), vuto la mtima (nthawi 3-5), khungu (nthawi 10-20), kulephera kwa impso (nthawi 20-25), gangrene ndikoduladula wotsatira (nthawi 20). Kuti mupewe zovuta zotere, zotsatira zake, muyenera kumwa mankhwala othandizira odwala matenda ashuga.

Ndi chiyani chophatikiza matenda ashuga ndi kukakamiza? Zimaphatikiza kuwonongeka kwa ziwalo: minofu ya mtima, impso, mitsempha yamagazi, ndi kuwala kwa diso. Matenda oopsa m'magazi a shuga nthawi zambiri amakhala oyambira, amatengera matendawa.

Mitundu ya Hypertension	Mwina	Zifukwa
Chofunikira (choyambirira)	mpaka 35%	Chifukwa sichinakhazikitsidwe
Isolated systolic	mpaka 45%	Kutsika kwamitsempha, kuperewera kwa mitsempha
Matenda a shuga	mpaka 20%	Kuwonongeka kwa ziwonetsero zamafuta a impso, kuchepa kwawo, kukhazikika kwa kulephera kwa impso
Renal	mpaka 10%	Pyelonephritis, glomerulonephritis, polycitosis, matenda ashuga nephropathy
Endocrine	mpaka 3%	Endocrine pathologies: pheochromocytoma, chachikulu hyperaldosteronism, Itsenko-Cushing's syndrome

1. Mtundu wa kuthamanga kwa magazi umasweka - poyeza zizindikiro za nthawi yausiku ndizokwera kuposa nthawi yamasana. Cholinga chake ndi neuropathy.
2. Kuchita bwino kwa ntchito yolumikizana ya dongosolo laumwini la autonomic ndikusintha: kayendedwe ka kayendedwe ka mitsempha yamagazi kamasokonekera.
3. Orthostatic mawonekedwe a hypotension amayamba - kuthamanga kwa magazi mu shuga. Kukwera kwakuthwa m'munthu kumayambitsa kuwukira kwa hypotension, kuyipa m'maso, kufooka, kukomoka kumawonekera.

Muyenera kuyamba liti kulandira matenda oopsa mu shuga? Kodi ndimatenda ati omwe amakhala owopsa kwa matenda ashuga? Patangotha ​​masiku ochepa, kupanikizika kwa mtundu wa 2 shuga kumakhala pa 130-135 / 85 mm. Hg. Art., Amafuna chithandizo. Kukwera bwino kwambiri, kumakhala koopsa la zovuta zingapo.

Kuchiza kuyenera kuyamba ndi mapiritsi a diuretic (okodzetsa). Zofunikira pakubwezeretsa kwa mitundu yachiwiri ya odwala matenda ashuga 1

Wamphamvu	Mphamvu Yapakatikati	Zofooka zofooka
Furosemide, Mannitol, Lasix	Hypothiazide, Hydrochlorothiazide, Clopamide	Dichlorfenamide, Diacarb
Anapemphedwa kuti muchepetse edema yozama, yamkaka ya edema	Mankhwala ogwiritsa ntchito kwa nthawi yayitali	Anayikidwa mu zovuta kukonza yokonza.
Amachotsa msanga madzi m'thupi, koma amakhala ndi zovuta zina. Amagwiritsidwa ntchito kwakanthawi kochepa mu pathologies acute.	Chofewa, kuchotsa kwa hypostases	Imawonjezera zochita za okodzetsa ena

Chofunikira: Diuretics imasokoneza bwino ma electrolyte. Amachotsa mchere wamatsenga, sodium, potaziyamu kuchokera m'thupi, chifukwa chake, kuti abwezeretse mawonekedwe a electrolyte, Triamteren, Spironolactone adayikidwa. Ma diuretics onse amalandiridwa pokhapokha pazachipatala.

zomwe zili ↑ Mankhwala osokoneza bongo a antihypertensive: magulu

Kusankhidwa kwa mankhwala ndikofunikira kwa madokotala, kudzipereka nokha ndiwowopsa kuumoyo komanso moyo. Posankha mankhwala opondera odwala matenda ashuga komanso mankhwala ochizira matenda amishuga a 2, madokotala amatsogozedwa ndi momwe wodwalayo alili, mawonekedwe a mankhwala, kaphatikizidwe, ndikusankha mitundu yotetezeka ya wodwala wina.

Mankhwala a antihypertensive malinga ndi pharmacokinetics amatha kugawidwa m'magulu asanu.

Chofunikira: Mapiritsi a kuthamanga kwa magazi - Beta-blockers yokhala ndi vasodilating - mankhwala amakono kwambiri, otetezeka - kukulitsa mitsempha yamagazi, imakhala ndi phindu pa carbohydrate-lipid metabolism.

Chonde dziwani: Ofufuza ena amakhulupirira kuti mapiritsi otetezeka kwambiri a matenda oopsa mu shuga, matenda osagwirizana ndi insulin ndi Nebivolol, Carvedilol. Mapiritsi otsala a gulu la beta-blocker amawonedwa ngati owopsa, osagwirizana ndi matenda oyambitsawa.

Chofunikira: Beta-blockers imatchinga zizindikiro za hypoglycemia, chifukwa chake iyenera kuyikidwa mosamala kwambiri.

Chofunika: Osankha blockers a alpha ali ndi "mphamvu yoyamba." Piritsi loyamba limatha kugwa kwa orthostatic - chifukwa cha kuchuluka kwa mitsempha yamagazi, kukwera kwakuthwa kumayambitsa kutulutsa magazi kuchokera kumutu mpaka pansi. Munthu amasiya kuzindikira ndipo amatha kuvulala.

Mapiritsi a ambulansi ochepetsa kuthamanga kwa magazi: Andipal, Captopril, Nifedipine, Clonidine, Anaprilin. Chochitikacho chimatha mpaka maola 6.

Mankhwala ochepetsa kuthamanga kwa magazi sakhala pamndandanda izi. Mndandanda wamankhwala umasinthidwa nthawi zonse ndi zochitika zatsopano, zamakono kwambiri.

Victoria K., 42, wopanga.

Ndakhala ndi matenda oopsa kwambiri komanso matenda ashuga a 2 kwazaka ziwiri. Sindinamwe mapilitsiwo, ndimalandira mankhwala azitsamba, koma sathandizanso. Zoyenera kuchita Mnzanu akunena kuti mutha kuthana ndi kuthamanga kwa magazi ngati mutenga bisaprolol. Ndi mapiritsi ati akumwa omwe ali bwino kumwa? Zoyenera kuchita

Victor Podporin, endocrinologist.

Wokondedwa Victoria, sindingakulangizeni kuti muzimvera bwenzi lanu. Popanda mankhwala a dotolo, kumwa mankhwala sikofunikira. Kuthamanga kwa magazi m'magazi a shuga kumakhala ndi etiology yosiyanasiyana (zomwe zimayambitsa) ndipo imafunikira njira ina yothandizira. Mankhwala othandizira kuthamanga kwa magazi amaperekedwa ndi adokotala okha.

Matenda oopsa amachititsa kuti kuphwanya kwa kagayidwe kazakudya mu 50-70% ya milandu. 40% ya odwala, ochepa matenda oopsa amakhala mtundu 2 shuga. Cholinga chake ndi kukana insulini - kukana insulini. Matenda a shuga ndi kupsinjika amafuna chithandizo chamankhwala.

Chithandizo cha matenda oopsa ndi mankhwala wowerengeka a anthu odwala matenda ashuga chiyenera kuyamba ndi kutsatira malamulo a moyo wathanzi: kukhalabe wathanzi, kusiya kusuta, kumwa mowa, kuchepetsa kuchuluka kwa mchere komanso zakudya zovulaza.

Chithandizo cha matenda oopsa ndi mankhwala wowerengeka azikhalidwe za anthu odwala matenda ashuga sichothandiza nthawi zonse, chifukwa chake, pamodzi ndi mankhwala azitsamba, muyenera kumwa mankhwala. Zithandizo za Folk ziyenera kugwiritsidwa ntchito mosamala, atakambirana ndi endocrinologist.

Zakudya kwa matenda oopsa ndipo matenda a shuga a 2 amachepetsa kuthamanga kwa magazi komanso kuchepetsa matenda a shuga. Zakudya zamagulu olemba matenda oopsa komanso mtundu wachiwiri wa matenda ashuga ziyenera kuvomerezedwa ndi endocrinologist ndi wathanzi.

1. Zakudya zoyenera (kuchuluka kwake ndi kuchuluka kwake) kwamapuloteni, chakudya, mafuta.
2. Low-carb, wamphamvu mavitamini, potaziyamu, magnesium, kufufuza zinthu.
3. Kumwa mchere woposa 5 g pa tsiku.
4. Wokwanira masamba ndi zipatso.
5. Zakudya zopatsa thanzi (osachepera 4-5 patsiku).
6. Kuphatikiza zakudya No. 9 kapena No. 10.

Mankhwala othandizira matenda oopsa amaimiridwa kwambiri pamsika wamankhwala. Mankhwala enieni, zamagetsi zamapulogalamu amitengo osiyanasiyana ali ndi zabwino zawo, zikuwonetsa komanso kuphwanya. Matenda a shuga ndi matenda oopsa amayenda limodzi, amafunikira chithandizo chamankhwala. Chifukwa chake, musayerekeze kuti mulingalire. Njira zokhazokha zochizira matenda ashuga ndi matenda oopsa, kuikidwa koyenerera ndi endocrinologist ndi cardiologist kumabweretsa zotsatira zomwe mukufuna. Khalani athanzi!

Nkhani yam'mbuyo Kodi shuga ya magazi imati: miyambo ndi njira zopatuka Nkhani yotsatira → Kuyesedwa kwa magazi ndi matenda a shuga ndi mitundu yake

Matenda oopsa a arterial nthawi zambiri amapezeka mwa odwala omwe ali ndi matenda a shuga a mtundu woyamba 1. Nthawi zina matenda a m'matumbo amayamba kale kwambiri kuposa metabolic cidrome, nthawi zina, chifukwa cha kuthamanga kwa magazi ndikuphwanya impso (nephropathy). Mikhalidwe yovuta, atherosclerosis, poizoni wazitsulo, komanso kuchepa kwa magnesium imatha kukhalanso zinthu zina zolimbikitsa. Chithandizo cha matenda oopsa ndi odwala omwe samadalira insulin 2 shuga amathandiza kupewa zovuta zovuta, kukonza mkhalidwe wa wodwalayo.

Kodi ndingamwe mankhwala ati omwe ndimamwa ndi shuga kuti ndichepetse magazi? Kukonzekera kwa gulu la ACE inhibitor block block enzymes komwe kumapanga mahomoni angiotensin, omwe amathandiza kutsika mitsempha ya magazi komanso kumapangitsa kuti adrenal cortex apange mahomoni omwe amakopa sodium ndi madzi mthupi la munthu. Pa mankhwalawa antihypertensive mankhwala a ACE inhibitor kalasi yothamangitsa mtundu wachiwiri wa matenda a shuga, vasodilation imachitika, kudzikundikira kwa sodium ndi madzimadzi owonjezera amasiya, chifukwa chake kuthamanga kwa magazi kumachepa.

Mndandanda wamapiritsi azovuta kwambiri omwe mungamwe ndi shuga yachiwiri:

Mankhwalawa amalembedwa kwa odwala omwe ali ndi matenda oopsa chifukwa amateteza impso ndikuchepetsa kukula kwa nephropathy. Mlingo wochepa wa mankhwala amagwiritsidwa ntchito popewa njira yothandizira ziwalo za kwamikodzo.

Zowonjezera zochizira kutenga ACE zoletsa zimawonekera pang'onopang'ono. Koma mapiritsi oterewa sioyenera aliyense, mwa odwala ena amakhala ndi zotsatira zoyipa kutsokomola, ndipo chithandizo sichithandiza odwala ena. Zikatero, mankhwala a magulu ena amaperekedwa.

Angiotensin II receptor blockers (ARBs) kapena ma sartans amalepheretsa kusintha kwa mahomoni mu impso, zomwe zimapangitsa kuchuluka kwa magazi. Ma ARB sakukhudzana ndi kagayidwe kachakudya, kamapangitsa chidwi cha minofu yathupi kuti insulin.

Ma Sartan ali ndi vuto labwino ndi matenda oopsa ngati mpweya wamanzere wakakulitsidwa, zomwe zimakonda kupezeka motsutsana ndi maziko azopanikizira magazi komanso kulephera kwa mtima.Mankhwala oponderezedwa ndi gululi amavomerezedwa bwino ndi odwala omwe ali ndi matenda a shuga a 2. Mutha kugwiritsa ntchito ndalamazo ngati monotherapy kapenanso chithandizo chamankhwala othandizira okodzetsa.

Mndandanda wa mankhwala (sartans) olembetsa matenda oopsa kuti muchepetse kuthamanga komwe kungachitike ndi matenda a shuga a 2:

Chithandizo cha ARB chimakhala ndi zovuta zochepa kuposa ACE zoletsa. Kuchuluka kwa mankhwala kumawonedwa pakatha masabata awiri chiyambireni chithandizo. Ma Sartan atsimikiziridwa kuti ateteza impsozo mwakuchepetsa kutulutsa kwa mapuloteni mumkodzo.

Ma diuretics amalimbikitsa zochitika za ACE zoletsa, motero, amapatsidwa mankhwala osokoneza bongo. Liazide-like diuretics imakhala yofatsa mu mtundu wachiwiri wa matenda osokoneza bongo, imakhala yochepa kwambiri pazotsatira za potaziyamu, kuchuluka kwa glucose ndi lipids m'magazi, ndipo osasokoneza kugwira ntchito kwa impso. Gululi limaphatikizapo Indapamide ndi Arefon Retard. Mankhwala ali ndi nephroprotective kwambiri pa gawo lililonse la ziwalo.

Indapamide imalimbikitsa vasodilation, imathandizira kupanga mapulatini osakanikirana, chifukwa chotenga mankhwalawa a matenda a shuga a 2, kuchuluka kwa magazi ndi kuchepa kwa magazi. Mu mankhwalawa achire, indapamide imangoyambitsa hypotensive zotsatira popanda kuwonjezera mkodzo. Malo ofunikira kwambiri ku Indapamide ndi mtima ndi minofu yaimpso.

Kuchiza ndi Indapamide sikukhudza kagayidwe kachakudya mthupi, chifukwa chake sikukweza kuchuluka kwa glucose, lipoproteins wotsika kwambiri m'magazi. Indapamide imatenga mwachangu mawonekedwe awo am'mimba, koma izi sizimachepetsa kugwira ntchito kwake, kudya pang'ono kumachepetsa kuyamwa.

Kugwira ntchito kwa nthawi yayitali kumatha kuchepetsa kuchuluka kwa mankhwalawa. Chithandizo chamankhwala chimatheka pomaliza sabata yoyamba kumwa mapiritsi. Ndikofunikira kumwa kapisozi imodzi patsiku.

Ndi magome ati okodzetsa omwe ndingamwe kumwa kuthamanga kwa magazi kwa matenda ashuga?

Mapiritsi a diuretic amalembedwa kuthamanga kwa magazi (matenda oopsa) mu mtundu 2 wa shuga. Dokotala wopezekapo amayenera kusankha mankhwalawa, makamaka kuopsa kwa matendawa, kupezeka kwa kuwonongeka kwa minyewa, komanso kuponderezana.

Furosemide ndi Lasix amalembedwa kuti atupire kwambiri kuphatikiza ndi ACE inhibitors. Komanso, odwala omwe ali ndi vuto la aimpso, kugwira ntchito kwa chiwalo chokhudzidwayo kumakhala bwino. Mankhwala amatsukidwa kuchokera potaziyamu wa thupi, motero muyenera kuphatikiza mankhwala okhala ndi potaziyamu (Asparkam).

Veroshpiron samatulutsa potaziyamu m'thupi la wodwalayo, koma amaletsedwa kuti agwiritse ntchito kulephera kwa aimpso. Ndi matenda a shuga, chithandizo chamankhwala ngati amenewo chimaperekedwa mankhwala osamveka.

LBC imalepheretsa njira zamkati pamtima, mitsempha yamagazi, kuchepetsa ntchito zawo za kulera. Zotsatira zake, pali kukulitsa kwa mitsempha, kutsika kwa kuthamanga ndi matenda oopsa.

Mndandanda wa mankhwala a LBC omwe angatengedwe ndi matenda a shuga:

Ma calcium calcium blockers satenga nawo mbali mu kagayidwe kachakudya, amakhala ndi zotsutsana ndi kuchuluka kwa glucose, kuthamanga kwa mtima, ndipo alibe katundu wa nephroprotective. Ma LBC amakulitsa ziwiya zaubongo, izi ndizothandiza popewa kuthana ndi okalamba. Kukonzekera kumakhala ndi kusiyana pamlingo wachitidwe ndi chiwopsezo pantchito ya ziwalo zina, chifukwa chake, amapatsidwa aliyense payekhapayekha.

Ndi mapiritsi ati a antihypertgency omwe ali ovuta kwa odwala matenda ashuga? Zoletsa, zowononga okodzetsa a shuga zimaphatikizapo Hypothiazide (a thiazide diuretic). Mapiritsiwa amatha kuwonjezera shuga wamagazi ndi kuchuluka kwa cholesterol. Pamaso kulephera kwa aimpso, wodwala amatha kuwonongeka pakugwira ntchito kwa chiwalo. Odwala omwe ali ndi matenda oopsa amathiridwa okodzetsa a magulu ena.

Mankhwala Atenolol (β1-adenoblocker) a matenda a shuga a mtundu 1 ndi 2 amachititsa kuchuluka kapena kuchepa kwa matenda a glycemia.

Mochenjera, amalembera kuwonongeka kwa impso, mtima. Ndi nephropathy, Atenolol ingayambitse kuchepa kwambiri kwa magazi.

Mankhwalawa amasokoneza kagayidwe kachakudya kagayidwe kachakudya, kamakhala ndi zotsatira zoyipa zingapo kuchokera ku mantha, m'mimba, mtima. Poyerekeza ndi kumbuyo kwa kutenga Atenolol mu mtundu 2 wa matenda a shuga, kuthamanga kwambiri kwa magazi kumawonedwa. Izi zimadzetsa kuwonongeka kwakukuru m'moyo wabwino. Kumwa mankhwalawa kumapangitsa kuti vutoli lizindikire kuchuluka kwa shuga m'magazi. Odwala omwe amadalira insulin, Atenolol amatha kuyambitsa hypoglycemia chifukwa cha kuwonongeka kwa glucose kwa chiwindi, ndikupanga insulin. Zimakhala zovuta kwa dokotala kuti azindikire molondola, chifukwa zizindikiritso zake sizimatchulidwa.

Kuphatikiza apo, Atenolol imachepetsa chidwi cha minofu ya thupi kupita ku insulin, yomwe imayambitsa kuwonongeka kwa odwala omwe ali ndi matenda a shuga a 2, kusayerekezeka pamlingo wa cholesterol yoyipa komanso yopindulitsa, ndikuthandizira ku hyperglycemia. Kulandila kwa Atenolol sikungayime mwadzidzidzi; ndikofunikira kufunsa dokotala za momwe adasinthira ndikusamutsira njira zina. Kafukufuku wa sayansi akuwonetsa kuti kugwiritsa ntchito nthawi yayitali kwa Atenolol odwala omwe ali ndi matenda oopsa pang'onopang'ono kumayambitsa kukula kwa mtundu wa 2 matenda a shuga, chifukwa chidwi cha minofu kupita ku insulin chimachepa.

Njira ina ya Atenolol ndi Nebilet, β-blocker yemwe samakhudza metabolism ndipo amakhala ndi tanthauzo la vasodilating.

Mapiritsi a matenda oopsa mu shuga mellitus ayenera kusankhidwa ndi kuikidwa ndi dokotala kuganizira za munthu wodwala, kupezeka kwa ma contraindication, kuopsa kwa matenda. Sitikulimbikitsidwa kugwiritsa ntchito β-blockers (Atenolol), malupu okodzetsa, chifukwa mankhwalawa amakhudza kayendedwe ka metabolic, amathandizira kuchuluka kwa glycemia ndi cholephera kuperewera kwa cholesterol. Mndandanda wamankhwala othandizira amaphatikizapo sartans, thiazide-like diuretics (Indapamide), ACE inhibitors.

Mankhwala othandizira matenda oopsa: ndizani

Hypertension ndikuwonjezereka kwamphamvu kwa kuthamanga kwa magazi: kupanikizika kwa systolic "kumtunda"> 140 mm Hg. ndi / kapena diastolic "m'munsi" kuthamanga> 90 mm Hg Pano mawu akulu ndi "okhazikika". Matenda oopsa a arterial sangawonekere kutengera muyeso umodzi wokha. Miyeso yotere iyenera kuchitika osachepera 3-4 pamasiku osiyanasiyana, ndipo nthawi iliyonse magazi akachuluka. Ngati mukupezeka kuti muli ndi matenda oopsa kwambiri, ndiye kuti muyenera kufunikira kumwa mapiritsi kuti mukapanikizike.

Kwa zaka zambiri, kulimbana ndi matenda oopsa osagonjetseka?

Mkulu wa Sukulu: “Mudzadabwitsidwa momwe kumakhalira kosavuta kuchiza matenda oopsa tsiku lililonse.

Awa ndimankhwala omwe amachepetsa kuthamanga kwa magazi ndikuthandizira kusintha kwa magazi - kupweteka kwa mutu, kuwuluka pamaso, maso, mphuno.

• 
  Matenda a mtima
• 
  Myocardial infaration
• 
  Kulephera kwa mtima
• 
  Matenda a shuga

Zimatsimikiziridwa kuti mapiritsi opsinjika, omwe amaphatikizidwa m'makalasi asanu apamwamba, amasintha kwambiri mtima wam'mbuyo komanso a impso. Mwakutero, izi zikutanthauza kuti kumwa mankhwala kumapereka kuchedwa kwa zaka zingapo pokonzekera zovuta. Zoterezi zimachitika pokhapokha ngati odwala oopsa atamwa mapiritsi awo pafupipafupi (tsiku lililonse), ngakhale ngati palibe chomwe chimapweteka ndipo thanzi lawo silili bwino. Kodi ndi magulu asanu ati apamwamba a mankhwalawa omwe ali ndi matenda oopsa - ofotokozedwa mwatsatanetsatane.
Chofunikira kudziwa zamankhwala oopsa:

1. Ngati kukakamiza kwa "kumtunda" kwa systolic kuli> 160 mmHg, ndiye kuti muyenera nthawi yomweyo kumwa kamodzi kapena zingapo kuti muchepetse.Chifukwa ndi kupanikizika kwambiri kotero, pamakhala chiwopsezo chachikulu cha kugunda kwamtima, kugwidwa, matenda a impso ndi kupenya.
2. Kutetezeka kochulukirapo kapena kotsika kumayesedwa ngati kupsinjika kwa 140/90 kapena kutsika, komanso kwa odwala matenda a shuga 130/85 kapena otsika. Kuti muchepetse kuthana ndi izi, nthawi zambiri simuyenera kumwa kamodzi, koma zingapo nthawi imodzi.
3. Ndiosavuta kutenga mapiritsi awiri a 2-3 osapanikizika, koma piritsi limodzi lokha, lomwe lili ndi zinthu 2-3 zogwira ntchito. Dokotala wabwino ndi yemwe amamvetsetsa izi ndikuyesera kupereka mankhwala ophatikiza, osati amodzi.
4. Chithandizo cha matenda oopsa ziyenera kuyamba ndi mankhwala amodzi kapena zingapo zazing'ono. Ngati patadutsa masiku 10 mpaka 14 zitapezeka kuti sizithandiza mokwanira, ndiye kuti ndibwino osachulukitsa mlingo, koma kuwonjezera mankhwala ena. Kumwa mapiritsi oponderezedwa pamlingo waukulu ndi okufa. Werengani nkhani "Zomwe Zimayambitsa Matendawa ndi Momwe Mungawathetsere". Tsatirani malingaliro omwe afotokozedwamo, osangochepetsa kukakamiza ndi mapiritsi.
5. Ndikofunika kuthandizidwa ndi mapiritsi azikakamizo, zomwe ndikokwanira kutenga nthawi imodzi patsiku. Mankhwala amakono ambiri ndi amenewo. Amadziwika kuti mankhwala osokoneza bongo omwe akhala akuchita kwa nthawi yayitali.
6. Mankhwala ochepetsa kupanikizika amatalikitsa moyo ngakhale kwa anthu achikulire 80 ndi akulu. Izi zikuwonetsedwa ndi zotsatira za kafukufuku wautali wapadziko lonse wokhudzana ndi odwala masauzande okalamba omwe ali ndi matenda oopsa. Mapiritsi opanikizika samayambitsa kwenikweni demilea, kapena kuletsa kukula kwake. Kuphatikiza apo, ndikofunikira kumwa mankhwalawa kwa matenda oopsa pakati pa zaka zapakati kuti vuto la mtima kapena la stroke lisachitike.
7. Mankhwala othandizira matenda oopsa amayenera kumwa mosalekeza, tsiku lililonse. Ndizoletsedwa kupuma mosaloledwa. Tengani mapiritsi a antihypertensive omwe mudayesedwa, ngakhale masiku omwe mumamva bwino ndipo kupanikizika ndikwabwino.

Mankhwala amagulitsa mpaka mazana a mitundu yosiyanasiyana ya mapiritsi opanikizika. Amagawika m'magulu akulu akulu, kutengera kapangidwe kake ka mankhwala ndi momwe zimakhudzira thupi la wodwalayo. Gulu lirilonse la mankhwalawa la matenda oopsa limakhala ndi zake. Kusankha mapiritsi oti mupereke, adokotala amawunika momwe wodwalayo amasanthula, komanso kupezeka kwa matenda ophatikizika, kuphatikiza kuthamanga kwa magazi. Pambuyo pake, amapanga chisankho choyenera: mankhwala ati a matenda oopsa komanso mulingo wotani wopereka kwa wodwala. Dotolo amatithandizanso kudziwa zaka za wodwalayo. Werengani mawu akuti "Ndi mankhwalawa olembetsa matenda oopsa omwe anthu okalamba amapereka."

Owerenga athu adagwiritsa ntchito bwino ReCardio kuchiza matenda oopsa. Kuwona kutchuka kwa malonda, tidaganiza zoperekera chidwi chanu.

Kutsatsa kumatsimikizira kuti moyo wanu udzakhala "wokoma" mukangoyamba kumwa izi kapena chida chatsopano (chotsitsa magazi). Koma, kwenikweni, chilichonse ndi chophweka. Chifukwa "mankhwala" aliwonse omwe ali ndi matenda oopsa oopsa amakhala ndi zotsatira zoyipa, zowonjezereka kapena zopanda mphamvu. Mavitamini achilengedwe komanso michere yachilengedwe yokha yomwe imachepetsa kuthamanga kwa magazi imatha kudzitamandira chifukwa chosowa zotsatira zoyipa.

Zowonjezera zowonjezera komanso zotsika mtengo kuti muchepetse kupanikizika:

• Magnesium + Vitamini B6 kuchokera ku Source Naturals,
• Taurine wolemba Jarrow Forula,
• Mafuta A nsomba Kuchokera Tsopano Zakudya.

Werengani zambiri za njirayi m'nkhani "Chithandizo cha matenda oopsa popanda mankhwala." Momwe mungayitanitsire othandizira othandizira matenda oopsa kuchokera ku USA - kutsitsa malangizo. Bweretsani mavuto anu popanda zovuta zoyipa zomwe mapiritsi a "mankhwala" amapangitsa. Sinthani mtima ntchito. Khalani odekha, chotsani nkhawa, gonani usiku ngati mwana. Magnesium wokhala ndi vitamini B6 amagwira ntchito modabwitsa. Mudzakhala ndi thanzi labwino kwambiri, nsanje ya anzanu.

Pansipa tikambirana mwatsatanetsatane magulu omwe mankhwalawa amapezeka kuti ali ndi matenda oopsa ndipo pazomwe zimachitika odwala ochokera pagulu limodzi kapena lina amapatsidwa odwala. Pambuyo pake, mudzatha kuwerengera mwatsatanetsatane zolemba zokhudzana ndi mapiritsi enaake omwe mumawakonda. Mwina inu ndi dokotala mwasankha kuti ndibwino kusintha mankhwala anu a antihypertensive (kutsitsa magazi), i.e. yambani kumwa mankhwala ena. Ngati mukufunsidwa funso, ndimankhwala ati oopsa, mutha kufunsa dokotala mafunso oyenera. Mulimonsemo, ngati mumadziwa bwino zamankhwala, komanso zifukwa zomwe adawalembera, ndizosavuta kwa iwo kumwa.

Zizindikiro za mankhwala opatsirana matenda oopsa

Dokotala amamulembera mankhwala odwala matenda oopsa ngati chiwopsezo cha zovuta zikupitilira chiwopsezo cha mavuto:

• Kuthamanga kwa magazi> 160/100 mm. Hg. Art.
• Kuthamanga kwa magazi> 140/90 mm. Hg. Art. + Wodwalayo ali ndi zoopsa zitatu kapena zingapo zowonjezera pazovuta zina,
• Kupsinjika kwa magazi> 130/85 mm. Hg. Art. + shuga mellitus kapena cerebrovascular ngozi, kapena matenda a mtima, kapena kulephera kwa impso, kapena retinopathy yayikulu (kuwonongeka kwa retina).

• Mankhwala a diuretic (okodzetsa),
• Beta blockers
• Otsutsa a calcium
• Vasodilators,
• Inhibitors a angiotensin-1-otembenuza enzyme (ACE inhibitor),
• Angiotensin II receptor blockers (sartans).

Popereka mankhwala kwa wodwala matenda oopsa, dokotala amayenera kukonda mitundu yamagulu omwe alembedwa. Mapiritsi olembetsa magazi ochokera m'maguluwa samangokulitsa kuthamanga kwa magazi, komanso amachepetsa kufa kwathunthu kwa odwala, kuletsa kukula kwa zovuta. Iliyonse yamagulu a mapiritsi omwe amachepetsa kuthamanga kwa magazi ali ndi njira yakeyake yapadera yochitira, zomwe akuwonetsa, contraindication ndi zovuta zake.

Otsatirawa ndi malingaliro othandizira mankhwala othandizira matenda oopsa a magulu osiyanasiyana, kutengera mtundu wa odwala:

Magulu a mankhwala oopsa

ZizindikiroZodzikongoletseraBeta blockersACE zoletsaAngiotensin II receptor blockersOtsutsa a calcium Kulephera kwa mtimaIndeIndeIndeInde Myocardial infarctionIndeInde Matenda a shugaIndeIndeIndeIndeInde Matenda a impsoIndeInde Kuteteza kwa StrokoIndeInde

Malangizo a European Society of Cardiology:

Mankhwala Ochizira

Diuretics (okodzetsa)Kulephera Kwamtima Kwakukulu

• Thiazide okodzetsa

• Ukalamba
• Matenda a mtima
• Ochokera ku Africa

• Zojambula zotuluka m'miyendo

• Kulephera kwina
• Kulephera Kwamtima Kwakukulu

• Aldosterone Antagonists

• Kulephera Kwamtima Kwakukulu
• Myocardial infarction

Beta blockers

• Angina pectoris
• Myocardial infarction
• Collstive mtima kulephera (ndi kusankha kwa munthu wogwira ntchito pang'ono)
• Mimba
• Tachycardia
• Arrhasmia

Calcium calcium blockersUkalamba

• Dihydroperidine

• Matenda a mtima
• Angina pectoris
• Matenda otumphukira a mtima
• Carotid Atherosulinosis
• Mimba

• Verapamil, Diltiazem

• Angina pectoris
• Carotid Atherosulinosis
• Cardiac Supraventricular Tachycardia

ACE zoletsa

• Kulephera Kwamtima Kwakukulu
• Wodala kumanzere kwamitsempha yamafuta ntchito
• Myocardial infarction
• Nondiabetesic Nephropathy
• Nephropathy ya matenda a shuga a mtundu woyamba
• Proteinuria (kukhalapo kwa mapuloteni mumkodzo)

Angiotensin II receptor blockers

• Nephropathy a Type 2abetes
• Matenda a shuga a shuga a shuga
• Proteinuria (kukhalapo kwa mapuloteni mumkodzo)
• Hypertrophy yamanzere yamanzere
• Khunyu mutatha kutenga ACE zoletsa

Alfa oletsa

• Benign Prostatic hyperplasia
• Hyperlipidemia (mavuto ndi cholesterol yamagazi)

Zowonjezera zomwe muyenera kuziganizira mukamasankha mankhwala oopsa:

Magulu a mankhwala oopsa

Thiazide okodzetsaMatendawaBeta blockers

• Thyrotooticosis (maphunziro apifupi)
• Migraine
• Kugwedeza kofunikira
• Postoperative Hypertension

Otsutsa a calcium

• Syndrome la a Raynaud
• Mitundu ina ya mtima wasokoneza

Alfa oletsaProstatic hypertrophyThiazide okodzetsa

• Gout
• Kwambiri hyponatremia

Beta blockers

• Mphumu ya bronchial
• Matenda owopsa a m'mapapo
• Atrioventricular block II - degree ya III

ACE inhibitors ndi angiotensin II receptor blockersMimba

Kusankha kwa mankhwalawa kwa matenda oopsa pazovuta zina (zofunikira za 2013)

Hypertrophy yamanzere yamanzereACE inhibitors, otsutsana ndi calcium, sartani Asymptomatic atherosulinosisOmwe akutsutsana ndi calcium, ACC zoletsa Microalbuminuria (pali mapuloteni mumkodzo, koma osati zochuluka)ACE zoletsa, sartani Kuchepa kwa impso, komabe popanda zizindikiro za kulephera kwa impsoACE zoletsa, sartani StrokoMankhwala aliwonse kuti muchepetse kuthamanga kwa magazi kukhala opanda chitetezo Myocardial infarctionBeta-blockers, ACE zoletsa, sartani Angina pectorisBeta-blockers, olimbana ndi calcium Kulephera kwamtima kosalekezaMa diuretics, beta blockers, sartans, othandizira calcium Aortic aneurysmBeta blockers Fibrillation ya Atrial (kuteteza zochitika)Sartans, ACE inhibitors, beta-blockers, aldosterone antagonists Fibrillation ya Atria (kuwongolera kuchuluka kwamkati waminga)Beta-blockers, osagwirizana ndi dihydropyridine calcium antagonists Mapuloteni ambiri mumkodzo (kuchuluka kwa proteinuria), matenda a impsoACE zoletsa, sartani Kuwonongeka kwa zotumphukira (zotupa za miyendo)ACE inhibitors, otsutsa calcium Isolated systolic hypertension mwa okalambaMankhwala a diuretic, otsutsana ndi calcium Metabolic syndromeACE inhibitors, otsutsana ndi calcium, sartani Matenda a shugaACE zoletsa, sartani MimbaMethyldopa, beta-blockers, otsutsa calcium

• Sartans ndi angiotensin-II receptor blockers, omwe amatchedwanso angiotensin-II receptor antagonists,
• Omwe akutsutsana ndi calcium - amatchedwanso calcium blockers,
• Aldosterone antagonists - spironolactone kapena eplerenone mankhwala.

• Njira zabwino zochizira matenda oopsa (othamanga, osavuta, abwino kwaumoyo, popanda mankhwala "mankhwala" ndi zakudya zowonjezera)
• Hypertension ndi njira yodziwika bwino yobwereranso ku gawo 1 ndi 2
• Zoyambitsa matenda oopsa komanso momwe mungazithetsere. Kuyesa kwa matenda oopsa
• Kugwiritsa ntchito mankhwala popanda matenda oopsa

Mankhwala okodzetsa a matenda oopsa

Mu malingaliro a 2014, okodzetsa (okodzetsa) amakhazikika pomwe amodzi mwa gulu lotsogola la mankhwala oopsa. Chifukwa ndizotsika mtengo komanso zimathandizira mapiritsi ena alionse pakukakamizidwa. Hypertension imatchedwa yoyipa, yolimba kapena yolimbikira pokhapokha ngati singayankhe kuphatikiza kwa mankhwala a 2-3. Komanso, imodzi mwazomwezi mankhwalawa iyenera kukhala okodzetsa.

Nthawi zambiri, diuretic imalembedwa kuti ikhale ndi matenda oopsa, indapamide, komanso hydrochlorothiazide wakale (aka dichlothiazide ndi hypothiazide). Opanga akuyesera kukakamiza indapamide kuti ichotse hydrochlorothiazide pamsika, yomwe yakhala ikugwiritsidwa ntchito kwa zaka pafupifupi 50. Kuti muchite izi, lembani nkhani zambiri m'magazini azachipatala. Indapamide sakhulupirira kuti imayipa matenda a metabolism. Zatsimikiziridwa kuti zimachepetsa chiopsezo chodwala matenda a mtima ndi stroke mwa odwala omwe ali ndi matenda oopsa.Koma amachepetsa kupsinjika kuposa hydrochlorothiazide ang'onoang'ono Mlingo ndipo mwina sikuti bwino kuchepetsa chiopsezo cha matenda oopsa. Ndipo zimatengera zochulukira.

Spironolactone ndi eplerenone ndi mankhwala apadera a diuretic, aldosterone antagonists. Amalandira mankhwala oopsa (osagwirizana) ndi mankhwalawa 4, ngati kuphatikiza kwa mankhwalawa 3 sikungathandize kokwanira. Choyamba, odwala matenda oopsa oopsa amathandizidwa ndi renin-angiotensin system blocker + wamba diuretic + calcium Channel blocker. Ngati kupanikizika sikuchepa mokwanira, ndiye kuti spironolactone kapena eplerenone yatsopano imawonjezeredwa, yomwe imakhala ndi zovuta zochepa. Contraindication poika aldosterone antagonists ndi kuchuluka kwa potaziyamu m'magazi (hyperkalemia) kapena glomerular kusefera kwa impso m'munsimu 30-60 ml / min. Mu 10% ya odwala, matenda oopsa amachitika chifukwa cha hyperaldosteronism yoyamba. Ngati mayesowa atsimikizira chachikulu cha hyperaldosteronism, ndiye kuti wodwalayo amapatsidwa spironolactone kapena eplerenone.

• Diuretics (okodzetsa) - zambiri,
• Dichlothiazide (hydrodiuryl, hydrochlorothiazide),
• Indapamide (Arifon, Indap),
• Furosemide (Lasix),
• Veroshpiron (Spironolactone),

ACE zoletsa

Kafukufuku wambiri wazomwe wachitika, zotsatira zake zikuwonetsa kuti zoletsa za ACE zokhala ndi matenda oopsa zimachepetsa chiopsezo cha kugunda kwa mtima ndi sitiroko, titeteze mitsempha yamagazi ndi impso. Mankhwalawa amaperekedwa makamaka kwa odwala omwe ali ndi kuthamanga kwa magazi chifukwa cha matenda owopsa a mtima kapena matenda a mtima, kulephera kwa mtima, matenda a shuga, komanso matenda a impso.

Mankhwala othandizira matenda opatsirana amafunikira kwambiri, omwe ali ndi zophatikizira ziwiri piritsi limodzi. Izi nthawi zambiri zimaphatikizidwa ndi ACE inhibitor ndi okodzetsa kapena calcium. Tsoka ilo, 10-15% ya anthu omwe amatenga zoletsa za ACE amatenga chifuwa chowuma. Ichi chimawonedwa ngati vuto limodzi ndi gulu la mankhwalawa. Ngati odwala awerenga zochepa izi, ndiye kuti kutsokomola kwawo kumayamba kuchepa pafupipafupi. Zikatero, zoletsa za ACE zimasinthidwa ndi sartani, zomwe zimagwira chimodzimodzi, koma osayambitsa chifuwa.

• ACE zoletsa - zambiri
• Captopril (Capoten)
• Enalapril (Renitec, Burlipril, Enap)
• Lisinopril (Diroton, Irume)
• Perindopril (Prestarium, Perineva)
• Fosinopril (Monopril, Fosicard)

Angiotensin II receptor blockers (sartans)

Chiyambire zaka 2000s, zizindikiritso zogwiritsira ntchito ma angiotensin-II receptor blockers zakula kwambiri, kuphatikiza pa matenda oopsa ngati mankhwala osankha oyamba. Mankhwalawa amalekeredwa bwino. Amayambitsa mavuto nthawi zambiri kuposa placebo. Amakhulupirira kuti ndi matenda oopsa amachepetsa chiopsezo cha kugunda kwa mtima ndi sitiroko, kuteteza mitsempha ya m'magazi, impso ndi ziwalo zina zamkati siziri zoyipa kuposa zoletsa za ACE.

Mwina sartan ndiwosankha kuposa ma ACE ovomerezeka osaneneka matenda oopsa, komanso kwa odwala omwe ali ndi matenda a shuga a 2 chifukwa cha matenda a shuga a impso. Mulimonsemo, amathandizidwa ngati wodwala atayamba kutsokomola chifuwa cha ACE. Vuto lokhalo ndiloti blockceptor Angiotensin-II receptor blockers samamvetsetsa bwino. Kafukufuku wambiri wachitika pa iwo, koma ochepera pa ACE zoletsa.

Pa matenda oopsa, ma angiotensin-II receptor blockers amagwiritsidwa ntchito kwambiri pamapiritsi omwe amakhala ndi zosakaniza ziwiri kapena zitatu zogwira ntchito. Kuphatikiza wamba: sartan + thiazide diuretic + calcium chimbale blocker. Angiotensin-II receptor antagonists atha kuphatikizidwa ndi amlodipine, komanso ACE inhibitor. Kuphatikizikaku kumathandizira kuchepetsa kutupa m'miyendo mwa odwala.

Hypertension angiotensin-II receptor blockers amalembedwanso motere:

• matenda a mtima
• kulephera kwa mtima
• mtundu 2 shuga
• lembani matenda a shuga 1, ngakhale mutakhala kuti vuto la impso layamba kale.

Ma Sartan sanasankhidwe ngati mankhwala oyamba, koma makamaka chifukwa cha kuletsa kwa ACE zoletsa. Izi siziri chifukwa chakuti angiotensin-II receptor antagonists amachita moperewera, koma chifukwa chakuti sanamvetsetsedwe bwino.

• Angiotensin II Receptor blockers - General
• Losartan (Lorista, Cozaar, Lozap)
• Aprovel (Irbesartan)
• Mikardis (Telmisartan)
• Valsartan (Diovan, Valz, Valsacor)
• Teveten (Eprosartan)
• Makandulo (Atacand, Candecor)

Mankhwala othandizira matenda oopsa a mzere wachiwiri

Mankhwala othandizira matenda oopsa a mzere wachiwiri, monga lamulo, kuchepa kwa magazi kulibe vuto kuposa mankhwala ochokera m'magulu asanu omwe tidawafotokozerawa. Chifukwa chiyani mankhwalawa anali ndi maudindo othandizira? Chifukwa zili ndi zoyipa zoyambilira kapena samamvetseka bwino, pakhala kafukufuku pang'ono pa iwo. Mankhwala olembetsa a mzere wachiwiri amalembedwa kuwonjezera pa piritsi yayikulu.

Ngati wodwala ali ndi matenda a prosten adenoma, adokotala amupatsa mankhwala a alpha-1-blocker. Methyldopa (dopegy) ndi mankhwala osankhidwa pakuwongolera kuthamanga kwa magazi panthawi yapakati. Moxonidine (physiotens) amaphatikiza chithandizo chophatikizira matenda oopsa mwa anthu omwe ali ndi matenda a shuga a 2, metabolic syndrome, komanso ngati ntchito ya impso yafupika.

Clonidine (clonidine) amachepetsa kuthamanga kwa magazi, koma amakhala ndi zovuta zina - mkamwa youma, ulesi, kugona. Musalandire chithandizo chamankhwala oopsa ndi clonidine! Mankhwalawa amayambitsa kudumpha kwakukulu mu kuthamanga kwa magazi, chopanda-rollercoaster chomwe chimakhala chovulaza m'mitsempha yamagazi. Mankhwala ndi clonidine, vuto la mtima, kugunda kwa mtima, kapena kulephera kwa impso zimachitika mwachangu kwambiri.

Aliskren (rasylosis) ndi inhibitor mwachindunji wa renin, imodzi mwamankhwala atsopano. Pakadali pano, amagwiritsidwa ntchito pochiza matenda oopsa. Sitikulimbikitsidwa kuphatikiza ma genilesis ndi ACE inhibitors kapena angiotensin-II receptor blockers.

• Methyldopa (Dopegit)
• Clonidine (Clonidine)
• Physiotens (Moxonidine)
• Coenzyme Q10 (Kudesan)

Kodi ndizofunika kuti wodwalayo athe nthawi yambiri kuti amvetsetse momwe mapiritsi osiyanasiyana amasiyana wina ndi mnzake? Zachidziwikire, inde! Kupatula apo, zimatengera zaka zambiri zomwe hypertonics ikhala ndi momwe "zaka" zingakhale zaka. Ngati mungasinthe ndikukhala ndi moyo wathanzi ndikusankha mankhwala oyenera, ndiye kuti ndizotheka kuti mavuto omwe amadza chifukwa cha matenda oopsa angathe kupewedwa. Kupatula apo, kugunda kwamtima mwadzidzidzi, kugunda kapena kuwonongeka kwaimpso kungachititse munthu wamphamvu kukhala wopanda mphamvu. Asayansi akufufuza mwankhanza magulu atsopano, apamwamba kwambiri a mankhwala opatsirana matenda oopsa, omwe angathandize kuchepetsa kuchuluka kwa zovuta.

• Kugwiritsa ntchito mankhwala popanda matenda oopsa
• Momwe mungasankhire mankhwala ochizira matenda oopsa: mfundo zazikuluzikulu
• Momwe mungamwere chithandizo cha matenda oopsa kwa munthu wokalamba