Gastroparesis: Zizindikiro komanso chithandizo cha matenda ashuga

* Zowonjezera mu 2017 malinga ndi RSCI

Bukuli limaphatikizidwa mu Mndandanda wamabuku omwe asayansi anzawo amawunikiranso a High Higest Attestation Commission.

Werengani mu magazini yatsopano

ntchito (MEF) yam'mimba ndichinthu chofunikira kwambiri pakugaya. Matenda a MEF amatsimikizira mawonetseredwe azachipatala, luso la patsogolo ndi njira zamankhwala zothandizira matenda a gastroesophageal Reflux (GERD), zilonda zam'mimba (UB) zam'mimba ndi duodenum (duodenum), dyspepsia yogwira ntchito. Matenda a MEF am'mimba amayenda ndi matenda ambiri am'mimba, matenda a metabolic, endocrine, matenda amisala, zotsatira zoyipa za mankhwala angapo.

Mawu akuti "diabetesic gastroparesis" (DG) amagwiritsidwa ntchito ngati cholankhulira kuphwanya kwa MEF wam'mimba m'matumbo a shuga mellitus (DM). Lingaliro ili - "gastroparesis diabetesicorum" - linayambitsidwa ndi Kassander mu 1958. Boas mu 1925 kwa nthawi yoyamba adafotokozera chipatala chochepetsera MEF yam'mimba mu shuga. Ferroir mu 1937 adapereka chithunzithunzi cha kuphwanya kwa MEF. DG imatengedwa ngati magawo osiyanasiyana azovuta amachedwetsa kuyenda kwa zinthu kuchokera m'mimba kupita ku duodenum posakhala chopinga. Nthawi yomweyo, tanthauzo lachiwiri la liwu loti "gastroparesis" ndi njira yoopsa yophwanya MEF yam'mimba, kusowa kwa peristalsis ndi kutuluka.

Kukhazikitsidwa kwa MEF kumaphatikizaponso kusintha kosungiramo, kusakaniza, kupera chakudya m'mimba, koma kuchepa (kuchepetsa) kutulutsa ndikofunikira kwambiri. Zigawo zikuluzikulu za kusokonekera uku ndi kusokonezeka kwa ma peristalsis, malo okhala ndi mgwirizano.

Ngati zigawo za MEF sizigwirizana, pamakhala zotulukapo zosiyanasiyana: ngati pakusokonezeka kwa malo okhala - kukhudzika koyambirira, ngati kusokonezeka kwa mgwirizano - zovuta za epigastric ndi kumva kusefukira, ngati muli ndi vuto loipa - kusanza komanso kusanza.

Diabetesic autonomic (autonomic) neuropathy (DAN) 5-8 imawerengedwa ngati vuto lalikulu la DG. Mu 1945, pochita X-ray, Rundles adawona zoyambirira pakati pa matenda ashuga paripheral polyneuropathy ndikuchedwa kuchoka ku kuyimitsidwa kwa barium sulfate pamimba.

Funso la kulumikizana pakati pa mitundu yosiyanasiyana ya DAN limakhalabe losadabwitsa: mwachitsanzo, zidawonetsedwa kuti pamaso pa mawonekedwe a mtima wa DAN wodwala, ndikofunika kuyang'ana pazosokoneza za gastric MEF 10, 11, olemba ena sanawululire ubale wotere 12, 13.

Amadziwika kuti matenda oopsa a hyperglycemia amatenga gawo lalikulu pakupanga zovuta zambiri za shuga. Komabe, zopereka za kuwonongeka kwa kagayidwe kazakudya kwa kuphwanya kwa chapamimba m'mimba ya shuga sizidziwika bwino. Kafukufuku wambiri, HbA1c idatchedwa chiopsezo cha kusokonezeka kwa m'mimba 12, 14, pomwe maphunziro ena sanawonetse ubalewu 10, 13, 15. Ofufuza ena adazindikira kuti kutalika kwa matenda ashuga sikukhudza gastric MEF 11-13, 15.

Kuchepetsa MEF mwa odwala matenda a shuga kungayambitse kuwonongeka kwa kagayidwe kazakudya, kamene kamawonetsedwa ndi zochitika za hypo- ndi hyperglycemia. Postprandial hypoglycemia amayamba chifukwa chakuchepetsa mphamvu zamafuta m'matumbo aang'ono. Mu nthawi ya postabsorption, kusokonekera kwa mayamwidwe ndi zotsatira za insulin kumabweretsa hyperglycemia. Kudumpha kwa glycemia kungayambitse kukula kwa zovuta za matenda ashuga, ndipo samalekerera bwino ndi odwala. Kutuluka pang'ono pang'onopang'ono kumathandizanso kuti mankhwalawa asamayende bwino komanso kuti amasokoneza nthawi yothandizira. Itha kuganiziridwa kuti zizindikiro za kuphwanya kwa MEF zimakhudza kwambiri moyo.Palibe maphunziro okhutiritsa a momwe DH imakhudzira moyo wa odwala omwe ali ndi matenda ashuga. Titha kungowona cholembedwa kuti kuwonekera kwa DG sikukhudzanso chizindikiro.

Kukula kwa kusokonezeka kwa chapamimba m'matumbo a shuga ndi 25-65% 12, 13, 15. Kusintha kotereku kungafotokozeredwe ndi heterogeneity ya anthu omwe adawunikidwa komanso kugwiritsa ntchito njira zosiyanasiyana zodziwitsira matenda kuti aphunzitse ena. Kuchuluka kwa glycemia pophunzira 17, 18 ndi kuchuluka kwa mankhwalawa kumakhudzanso kuchuluka kwa madzi othawa.

Muzochita zamankhwala, DG nthawi zambiri samapezeka munthawi yoyenera. Izi zimachitika makamaka chifukwa cha kusowa kwa njira zamankhwala ndizovuta kudziwa. Mndandanda wazizindikiro womwe umapezeka ndi DG umaphatikizapo: kusowa kudya, kumva kuti watopa kwambiri, kumva kusefukira, kusanza, kupweteka, komanso kupweteka m'dera la epigastric, kusintha kwa nthawi ya hypo- ndi hyperglycemia thupi.

Komabe, ziyenera kudziwika kuti zizindikiro za pathognomonic zamavuto a MEF ndizochepa. Tsopanoak et al. adawonetsa kuti odwala matenda ashuga komanso m'matumbo a MEF akhumudwitsidwa amatha kumva kukhumudwa msanga, nseru ndi kusanza. Pakufufuza kwa K. Jones et al., Zidawonetsedwa kuti kumatulutsa ndicho chizindikiro chokhacho chomwe chimagwirizana ndi kusokonezeka kwa gastric MEF. Odwala ena omwe ali ndi kuphwanya kwa MEF pamimba ali ndi zisonyezo zina zakusokonezeka kwamatumbo, zomwe zimawonetsedwa ndi kudzimbidwa komanso / kapena kutsekula m'mimba. Milandu yayikulu, ndi gastroparesis, kusanza kosalekeza, zovuta zamagetsi ndi kuwonda zimadziwika.

Ndizofunikira kudziwa kuti zina mwazizindikiro ndizotheka kwambiri chifukwa cha gastroesophageal Reflux. Kwa GERD mu shuga, pali zambiri zofunikira za 20-25. Chachikulu choganiza kulephera kwa m'munsi esophageal sphincter chifukwa cha DAN. Amadziwika kuti kuchepa pothawira palokha ndikofunikira kwambiri pakukula kwa GERD.

Kukula kwa zilonda zam'mimba ndi duodenum kumakhudza kutuluka. Nthawi zambiri, zilonda zam'mimba zimachitika popanda ululu wamba. Zinawonetsedwa kuti mu 28% ya odwala omwe amaphatikiza zilonda zam'mimba ndi matenda am'mimba, zilonda zopanda pake zimadziwika. Zinadziwika kuti ndikuphatikiza zilonda zam'mimba ndi matenda a shuga mu 20-30% ya milandu, DH imawonedwa.

Chovuta kwambiri ndi funso loti pakufunika kuthetseratu Helicobacter (H.) pylori pakupezeka koloni yake. Kupezeka kwa chilonda kumatsimikizira morphologic kapena panthawi yophunzira pepsinogen I, II komanso matenda atrophic gastritis m'magazi, kufunika kogwiritsira ntchito kwa nthawi yayitali kwa proton pump inhibitors ndi kuphatikizika kwa mankhwala a GERD ndi matenda ashuga, komanso kugwiritsa ntchito mankhwala osagwiritsa ntchito antioxidal (NSAIDs) ndi anticoagulants mosakayikira kumafuna kuthetseratu. Colonization ya chapamimba mucosa ndi Helicobacter pylori matenda odwala matenda ashuga sizosiyana ndi zomwe zimapezeka mwa anthu 29, 30.

Kufufuza kwa odwala omwe ali ndi matenda ashuga ndi chizindikiritso cha dyspeptic kudandaula zomwe zimachitika chifukwa cha dyspepsia yopanda tanthauzo. Choyamba, zotupa ndi zilonda zam'mimba, komanso duodenum, zoyambitsa zamakanika, matenda oopsa a portal samachotsedwa. Kupeza zida za DG kumakupatsani mwayi kuti muwone mtundu wa zomwe mukuzindikira ndikuzindikira DG posakhalapo ndi madandaulo. Mwachilengedwe, maphunziro awa amachitika pambuyo pa kupatula kwa organic pathology.

Gastric scintigraphy yokhala ndi technetium ndiye "muyezo wagolide" wofufuzira matenda am'mimba a MEF. Mu 2000, njira yokhazikika idavomerezedwa: panthawi ya scintigraphy, wodwalayo amadya chakudya cholembedwa ndi technetium, kenako kutuluka kwake m'mimba amayeza mphindi 15 zilizonse kwa maola 4. Kulandila mankhwala omwe amakhudza gastric MEF kuyenera kuyimitsidwa mkati mwa maola 48-72 Phunziro lisanachitike. Kuchedwa kwa zakudya zopitilira 60% m'mimba pambuyo pa maola awiri kapena kupitirira apo, 10% patatha maola 4 mutatha kudya ndi njira yodziwira kuti aphwanya MEF. Kuzindikira kwa njirayo ndi 93%, kutsimikizika ndi 62%.

Kuyesedwa kwa mpweya pogwiritsa ntchito (caposterone) acid yolembedwa ndi mpweya kapena mpweya wa sodium ndi njira ina yozindikira kuchuluka kwa chakudya kuchokera m'mimba.Maziko a njirayi ndikuwunikira kwa kusintha kwa kuchuluka kwa 13C / 12C isotope mu mpweya wotulutsa mutatha kumwa mankhwala olembedwa ndi 13C isotope. Kugwiritsa ntchito ma isotopes okhazikika ndi Mlingo wocheperako wa mankhwala ozindikira poyesa kumapangitsa kukhala kotetezeka. Asanayambe kuyesedwa, wodwalayo amathira mu chubu choyesera kuti atengere zitsanzo za mpweya: tsamba ili lidzagwiritsiridwa ntchito poyerekeza pambuyo pake. Kenako wodwalayo amatenga chakudya cham'mawa chophatikiza ndi (mafuta a sodium), kenako amachoka m'matumba mphindi 15 zilizonse kwa maola 4. Acid ya Octanoic siziwola m'malo a acid am'mimba; ikalowa m'matumbo ang'onoang'ono, imatengedwa mwachangu kenako imayang'anitsidwa ndi kuperewera kwa chiwindi. Zotsatira zake, zimapangika, zomwe zimapangitsa kuti chiwonetsero cha 13C chiwonjezere mpweya woipa. Kuwunikira kwa chiyerekezo cha 13C / 12C isotope mu mpweya wokhala ndi mpweya kumachitika pogwiritsa ntchito yapadera. Zambiri pazomwe zimachitika pakupuma zimayenderana ndi scintigraphy. Kuzindikira kwa njirayo ndi 86%, kutsimikizika ndi 80%. Ubwino wa kuyesedwa kwa kupuma ndiyotheka kukhazikitsa ndi kutetezeka: kusowa kwa chidziwitso cha radiation kumalola kugwiritsa ntchito kwake ngakhale mwa amayi apakati ndi ana.

Ultrasound yam'mimba imakupatsani mwayi wosazindikira kutuluka kwa madzi kuchokera m'mimba, ndikuwunika zotsalira za zomwe zili mkati mwake patatha maola 4 mutatha kudya.

Kafukufuku wa X-ray wokhala ndi barium sulfate kuti ayesere MEF yam'mimba amagwiritsidwa ntchito mdziko lathu lokha, ndi njira yotsika mtengo kwambiri yodziwira matenda chifukwa cha mtengo wotsika kwambiri komanso kuthekera kochititsako pafupifupi kuchipatala chilichonse. Zoyipa za njirayi ndi:, kuthekera kwa kuzindikira kagawo kakang'ono ka kusokonezeka kwa MEF - gastroparesis,, kukhudzana kwakukulu ndi radiation komwe wodwala amawululira nthawi yophunzira. Chifukwa chake, kuvomerezedwa kwa barium sulfate mu lumen pamimba mwa odwala omwe ali ndi zilonda zam'mimba komanso matenda a shuga amadziwika pambuyo pa maola 20-24.

Tinachita kafukufuku wa MIMF wam'mimba pogwiritsa ntchito kuyesa kwa kupuma mwa odwala 84 omwe ali ndi matenda a shuga a 2. Amayi anali zaka 50 (59,5%), amuna - 34 (40,5%), zaka - 38 (29, 47) zaka, nthawi ya matenda ashuga - 22,5 (16, 30,8). Odwala onse anali ndi DAN.

Malinga ndi kuyesa kwa kupuma kwa isotope, kusokonezeka kwa gastric MEF (T½> 75 min) kudapezeka mu 38 mwa 84 (45.2%) omwe adayesedwa odwala (zikutanthauza T½ = 102.6 ± 31.1 min). Kutsika pang'ono pang'onopang'ono potulutsa chakudya kuchokera m'mimba kupita ku duodenum (75 min 120 min) kunawonedwa mwa odwala 8 (9.5%) (ambiri T½ = 147.7 ± 40.2 min). Kutulutsa kosakwana mphindi 75 (pafupifupi T½ = 52,5 ± 10.2 min) kunawonedwa mwa 46 mwa odwala 84.

Tasanthula madandaulo am'mimba kutengera mkhalidwe wa MEF wam'mimba (Gome 1).

Mukamasanthula kupezeka kwa zizindikiro, kunapezeka kuti pagulu la odwala omwe ali ndi vuto lakum'mimba, mawonekedwe a gysric dyspepsia anali opezeka pang'onopang'ono: kumverera koyaka m'gawo la epigastric (39,5% motsutsana ndi 19.6%, χ2 = 4.041, p = 0.044), nseru / kusanza ( 68.4% motsutsana 37.0%, χ2 = 0.108, p = 0.004), belching (86.8% motsutsana 56.5%, χ2 = 0.108, p = 0.002).

Pomwe makonzedwe onse othandizira odwala matenda am'mimba ophatikizidwa ndi matenda a shuga amaphatikizidwa ndikuwunikira, sitinakhazikitse kusiyana kwakukulu pazaka, jenda, nthawi ya matenda ashuga, kuchuluka kwa zovuta za matenda ashuga, komanso kagayidwe kazakudya pakati pamagulu a odwala omwe ali ndi gastric MEF ndi MEF yeniyeni m'mimba. Zizindikiro zitatu za kusokonezeka kwa m'mimba za MEF zidadziwika: nseru / kusanza - osamvetseka 2.8 (1.0, 7.6, 95% CI) ndikumanga - osamvetseka 3.8 (1.1, 12.8, 95% CI) ) N`zotheka kudziwa kuphatikiza kwa mawonetseredwe am'mimba, kusokonekera kwamimba ndi matumbo kukanika mu shuga. Izi zitha kukhala chifukwa cha etiopathogenetic chinthu chimodzi - DAN.

Kuyanjana kwa mawonetseredwe a gastroesophageal Reflux ndi postprandial dyspepsia, zikuwoneka kuti, zimagwirizanitsidwa ndi kuphwanya kwa MEF yam'mimba - DG.

Phunziro lathu, poyesa kuchuluka kwa hemoglobin ya glycated, panalibe kusiyana kwakukulu pakati pa odwala omwe ali ndi kuphwanya kwa MEF komanso popanda kuphwanya kwa chapamimba kwa MEF: Median 8.4 (6.4, 9.5) motsutsana ndi 8.0 (7.3, 9.0) ) mphindi (p = 0.216). Malinga ndi kafukufuku wathu, kusala kudya glycemia sikukhudzanso matumbo a MEF: Median 9.2 (4.4, 11.8) mwa odwala omwe ali ndi vuto la m'mimba motsutsana ndi 8.2 (5.7, 10.6) mwa odwala ndi MEF yachilendo yam'mimba (p = 0.611).

Chithandizo cha DG chimaphatikizapo zakudya zamankhwala komanso mankhwala othandizira.Zakudya za DH zimaphatikizapo kuphatikizidwa kwa zakudya zomwe zimafunikira kukonzanso kwakanthawi m'mimba (ma coarse osakola mafuta, nyama yofinya, masoseji osuta), ndikuchepetsa kutuluka (mafuta), zakudya zimayendetsedwa.

Mankhwala akuluakulu omwe amagwiritsidwa ntchito pochiza matenda a MEF ndi prokinetics. Mankhwala a gulu laling'ono ili, kuwonjezera pa kupukusa kwamatumbo, amathandizira mamvekedwe am'munsi esophageal sphincter. Zida za adotolo zimaphatikizapo osasankha mtundu wa dopamine receptor blockers (metoclopramide), mibadwo yosankha (domperidone) ndi prokinetics yokhala ndi njira yophatikizira yochita (itopride).

Metoclopramide ndi agonist, dopamine wotsutsana naye komanso wolimbikitsa mwachindunji maselo osalala a khoma lam'mimba. Mankhwalawa amathandizira kukhathamira kwa m'mimba, amakongoletsa kugwirizanitsa, komanso ali ndi antiemetic yodziyimira payokha poletsa ma dopamine receptors of the trigger zone of the center of vomiting. Kuchita kwa metoclopramide kuphwanya MEF yam'mimba kwatsimikiziridwa mu maphunziro angapo. Komabe, 30% ya odwala omwe amathandizidwa ndi metoclopramide amakhala ndi zovuta zoyipa: mavuto a extrapyramidal, kugona, kukhumudwa, hyperprolactinemia. Ichi ndichifukwa chakutha kulowa mu chotchinga cha magazi, chomwe chimaletsa kugwiritsa ntchito kwina kulikonse.

Drug Control Committee ya European Medicines Agency imalimbikitsa kuti metoclopramide isagwiritsidwe ntchito kukonza kuwonongeka kwa mota ndipo iyenera kuyikidwa kwa odwala khansa omwe akusanza kwambiri pa chemotherapy osaposa masiku 5 komanso osapitirira 30 mg / tsiku.

Domperidone ndi njira yosankha kwambiri yopanga dopamine yomwe siidutsa chotchinga magazi. Mankhwala kumawonjezera kukakamiza kwa m'munsi esophageal sphincter, imayendetsa motility ya esophagus ndi antrum. Imakhala ndi antiemetic chifukwa cha kuponderezedwa kwa zochitika za chemoreceptor trigger yomwe ili pansi pamunsi mwa chinayi chachilendo kunja kwa chotchinga cha magazi. Mankhwalawa sakuvomerezedwa ndi lipoti la Food and Drug Administration (FDA) la United States (FDA) lokhudza ngozi yowonjezereka ya kufa mwadzidzidzi akamagwiritsidwa ntchito, ndipo mankhwalawa amaloledwa m'maiko ambiri ku Europe.

Itopride ndi prokinetics yokhala ndi kachitidwe wophatikizira. Itopride imathandizira kusunthika kwa m'mimba ndikuthamanga, ndipo imatha kuthira, imakhala ndi antiemetic chifukwa chogwirizana ndi trigger zone chemoreceptors yomwe ili pansi pazitseko zinayi kunja kwa chotchinga cha magazi 33, 34. Mankhwalawa ali ndi magawo awiri a prokinetic kanthu (kutsekereza ndi kuletsa kwa acetylcholinestera. Mukamamwa itopride, palibe zovuta zoyipa zomwe zapezeka zomwe zimadziwika ndi ma prokinetics ena, makamaka, palibe kutalika kwa nthawi ya QT. Mankhwala amatha kuloza pang'onopang'ono chotchinga cha magazi. Itopride metabolism imapewa zosagwirizana ndi mankhwalawa pakumwa mankhwala omwe amapangidwa ndi ma enzymes a cytochrome P450 system.

M'maphunziro azachipatala, kufunikira kwa itopride mu machitidwe amtundu wa gastroenterological ndikuthandizira DH kwatsimikiziridwa. Mu kafukufuku wolemba Noritake et al. Odwala 12 omwe ali ndi matenda amtundu wa shuga omwe amakhala ndi diabetesic zotumphukira za polyneuropathy, kusokonezeka kwa m'mimba kwa MEF komanso kusapezeka kwa matenda opezeka m'mimba anaphatikizidwa malinga ndi esophagogastroduodenoscopy 38, 39. Pakati pa sabata, odwala adalandira itopride pa mlingo wa 150 mg / tsiku. Itoprid therapy yapezeka kuti ikuwonjezera kuchuluka kwa ma tag a radiopaque otulutsidwa m'mimba. Zotsatira zofananazo zidapezeka mu kafukufuku wopangidwa ndi Basque et al.. Tiyenera kudziwa kuti Stevens et al., Yemwe adaphunziranso za kuyimitsidwa kwa matumbo a m'mimba mwa odwala omwe ali ndi mbiri yayitali ya matenda a shuga, adazindikira kuchuluka kwamphamvu pothawira chakudya kuchokera m'mimba panthawi ya chithandizo ndi itopride poyerekeza ndi placebo. Panalibe kusiyana pamavuto a itopride ndi placebo pazizindikiro zamankhwala. Zabwino momwe chithandizo ndi itopride mu gastroenterological imatithandizira kuti tithandizire DG.

Kuzindikira kwakanthawi ndi chithandizo cha matenda am'mimba a MEF kumachepetsa kuopsa kwa zizindikiro za hyperinsulinemia, kukonza kubwezeretsa kwa kagayidwe kazinthu kenakake ndipo potero kuchepetsa chiopsezo chakulitsa ndikupita patsogolo kwa zovuta za matenda ashuga komanso kukonza moyo wa odwala.

1. Kassander P. Asymptomatic gastric retitis in diabetesics (Gastroparesis Diabetesicorum) // Ann Int Med. 1958. Vol. 48. R. 797-812.
2. Boas I. Matenda a Mimba // Edition Wachisanu ndi chinayi. Leipzig, Georgia Thieme. 1925.P. 200.
3. Ferroir J. Mimba ya odwala matenda ashuga // Thesis pamankhwala. Paris 1937.
4. Waseem S., Moshiree B., Draganov P.: Zovuta zodziwikiratu zamtsogolo ndi kulingaliridwa kwa manejala // World J Gastroenterol. 2009. Vol. 15 (1). R. 25-37. Unikani
5. Pogromov A.P., Baturova autonomic neuropathy ndi ziwalo zam'mimba // Farmateka. 2011. - Na. 5 (218). S. 42-45.
6. Tkacheva O.N., Vertkin autonomic neuropathy: malangizo kwa madokotala. M., 2009.
7. Jones KL, Russo A, Stevens JE. et al. Omwe amathandizira kuchepetsedwa kwa chapamimba kupatsa matenda a shuga // Matenda a shuga. 2001. Vol. 24 (7). R. 1264-1269.
8. Moldovan C., Dumitrascu D.L., Demian L. et al. Gastroparesis mu shuga mellitus: kafukufuku // Rom J Gastroenterol. 2005. Vol. 14 (1). R. 19-22.
9. Rundles neuropathy. Ndemanga ndi lipoti la milandu yokwana 125 // Mankhwala 1945. Vol. 24. R. 111-160.
10. Kojkar M.S., Kayahan I.K., Bavbek N. Diabetesic Gastroparesis mu Mgwirizano ndi Autonomic Neuropathy ndi Microvasculopathy // Acta Med. Okayama. 2002. Vol. 56. Ayi 5. R. 237-243.
11. Merio R., Festa A., Bergmann H. et al. Kuchepa kwa m'mimba mwa mtundu woyamba wa shuga: kutengera kulumikizana kwa ubongo ndi zotumphukira, kuchepa kwa magazi ndi kuwongolera glycemic // Matenda a shuga. 1997. Vol. 20. R. 419-423.
12. De block C.E., De Leeuw I.H., Pelckmans P.A. et al. Kuchedwa kwa m'matumbo ndikutsuka kwa m'mimba mwa mtundu 1 shuga // Matenda a shuga. 2002. Vol. 25 (5). R. 912-927.
13. Jones K.L., Russo A., Stevens J.E. et al. Olosera za Kuchedwa kwa Gastric Emptying mu Diabetes // Matenda A shuga. 2001. Vol. 24. R. 1264-1269.
14. Cucchiara S., Franzese A., Salvia G. et al. Kuchepetsa kwa m'mimba ndi kuchepa kwa magetsi m'mimba mu IDDM // Matenda a shuga. 1998. Vol. 21. R. 438-443.
15. Punkkinen J., Frkkila M., Mtzke S. et al. Zizindikiro zakutsogolo zam'mimba mwa odwala omwe ali ndi matenda amtundu wa 1: osayenderana ndi kukhumudwa m'matumbo am'mimba omwe amayamba chifukwa cha autonomic neuropathy // Diabetes. Med. 2008. Vol. 25. R. 570-577.
16. Kong M.F., Horowitz M., Jones K.L. et al. Mbiri Yachilengedwe Ya Diabetesic Gastroparesis // Chisamaliro cha Mashuga. 1999. Vol. 22. R. 503-507.
17. Russo A., Stevens J.E., Chen R. et al. hypoglycaemia Iyamba Kuthira chapamimba kuthira mafuta ndi zakumwa mu kuleza mtima mtundu 1 shuga // J Clin Endocrinol Metab. 2005. Vol. 90. R. 448-4495.
18. Samsom M., Akkermans L.M., Jebbink R.J. et al. Matumbo oyenda m'mimba mu hyperglycemia anachititsa kuti kuchepetsedwa kwa m'mimba ndikulembera mtundu wanga wa shuga mellitus // Gut. 1997. Vol. 40. R. 641-646.
19. Tsopanoak T. Johnson C.P., Kalbfleisch J.H. et al. Kutulutsa kotsika kwambiri kwamatumbo kumadwalika odwala omwe ali ndi matenda a shuga a mellitus // Gut. 1995. Vol. 37. R. 23-29.
20. Leites Yu.G., Galstyan G.R., Marchenko mavuto a shuga mellitus // Consilium Medicum. 2007. Na. 2.
21. Basieva Z.K., Basieva O.O., Shavlohova E.A., Kekhoeva A.Yu., Kusova akugwiritsa ntchito esophagus mwa odwala GERD a esophagus omwe ali ndi matenda a shuga mellitus // Mavuto amakono asayansi ndi maphunziro. 2013. Ayi 6.
22. Fedorchenko wa matenda ashuga komanso kuphatikiza ndi zilonda zam'mimba // Pacific Medical Journal. 2005. Ayi 1. P. 20-23.
23. Sirotin B.Z., Fedorchenko Yu.L., Vitko L.G., matenda a shuga a Marenin ndi matenda a m'mitsempha // Chiyembekezo chamatenda a gastroenterology, hepatology. Ayi 6. P. 22-25. 2009.
24. Fedorchenko Reflux matenda a shuga mellitus // Nkhani zamankhwala ndi mankhwala. 2012. No. 407 (gastroenterology). S. 13.
25. Korneeva N.V., Fedorchenko Yu.L., Wolemera mu nthawi ya matenda a gastroesophageal Reflux mu shuga mellitus // Siberian Medical Journal. 2011.T 26. Ayi. 3. Kutulutsa. 1, mas. 57-61.
26. Zinnatullin M.R., Zimmerman Y.S., Cowards shuga ndi zilonda zam'mimba // Kafukufuku woyeserera ndi wazachipatala. 2003. Ayi 5. P. 17-24.
27. Fedorchenko Yu.L., Koblova NM, Obukhova maphunziro a zilonda zam'mimba za gastroduodenal mu shuga mellitus ndi chithandizo ndi quamatel // Ros. magazini gastroenterol., hepatol. ndi coloproctol. 2002. Ayi. 2. P. 82-88.
28. Kuleshov E.V., matenda a shuga a Kuleshov ndi matenda opaleshoni. M. 1996.216 p.
29. De Luis D.A., Cordero J.M., Caballero C. et al. Mphamvu ya chithandizo cha Helicobacter pylori matenda am'mimba ndikuchotsa kwake magwiridwe amtundu wa matenda a shuga 1 a matenda a shuga. Clin. Chitani 2001. Vol. 52. P. 1.
30. Wamitundu S., Turco S., Oliviero B. et al. Udindo wa autonomic neuropathy monga chiopsezo cha matenda a Helicobacter pylori mu dyspeptic odwala omwe ali ndi matenda a shuga 2 a mellitus // Matenda A shuga. Clin, Khalani. 1998. Vol. 42. P. 41.
31. Waseem S., Moshiree B., Draganov P.: Zovuta zodziwikiratu zamtsogolo ndi kulingaliridwa kwa manejala // World J Gastroenterol. 2009. Vol. 15 (1). R. 25-37. Unikani
32. Leites Yu.G., Nevmerzhitsky VI, Klefortova-kutuluka kosatulutsa kwam'mimba dongosolo ngati chiwonetsero cha autonomic neuropathy mwa odwala omwe ali ndi matenda a shuga mellitus // Matenda a shuga. 2007. Ayi. 2. P. 25–32.
33. Ivashkin V.T., Sheptulin amalimbikitsa kuyesedwa ndi chithandizo cha odwala omwe ali ndi vuto la motor pamimba. M., 2008.
34. Kuthamanga - malingaliro ndi malingaliro apano // Medscape J Med. 2008. Vol. 10 (1). R. 16. Bwerezani.
35. Sheptulin ya mota ntchito yam'mimba komanso mwayi wogwiritsa ntchito prokinetics yatsopano ya itopride pa mankhwalawa // Consilium mankhwala. 2008. V. 9. Ayi 7. P. 9-13.
36. Zakudya zam'mimba za Lazebnik prokinetics // Bulletin Yachipatala. 2014. Ayi 7 (656). S. 13.
37. Strauss S.M., Sturkenboom M.C., Bleumink G.S. et al. mankhwala osokoneza bongo komanso chiwopsezo cha kufa mwadzidzidzi kwamtima wamtima // Eur Mtima J. 2005. Vol. 26. R. 2007-2012.
38. Seema Gupta, Vinod Kapoor et al. Zotsatira za Itopride hydrochloride pa QT nthawi yayitali odzipereka athanzi labwino //. 2005. Vol. 12. N. 4.
39. Noritake M. et al. Zotsatira za itopride hydrochlorid pa diabetesic gastroparesis // Kiso kupita ku Rinsho. 1997. Vol. 31 (8). R. 2785–2791.
40. Chi Basque., Noritake M., Mizogami H. et al. Kugwiritsa ntchito kwa itopride hydrochlorid pamatumbo kutsitsa mwa odwala matenda ashuga gastroparesis // Gastroenterology. 2005. Vol. 128.P. 969.
41. Stevens J.E., Russo A., Maddox A.F. et al. Zotsatira za itopride pa kutsika kwa chapamimba pakutsalira kwa shuga mellitus // Neurogastroenterol Motil. 2008. Vol. 2 (5). R. 456-463.

Kwa olembetsa okha

Zizindikiro za matenda a shuga a gastroparesis

Pa gawo loyamba, matendawa amakhala asymptomatic. Mwa mitundu ikuluikulu yokha yomwe gastroparesis imatha kuzindikira ndi izi:

• Kutentha kwadzuwa ndi kupindika mutatha kudya,
• Kumverera kolemetsa ndi chodzaza m'mimba ngakhale mutakhala kovuta kudya,
• Kudzimbidwa, kutsatiridwa ndi matenda am'mimba,
• Zowawa, kulawa koyipa mkamwa.

Ngati zizindikiro sizikupezeka, gastroparesis imatha kupezeka ndi kuchuluka kwa shuga m'magazi. Dibetic gastroparesis imapangitsa kukhala kovuta kukhala ndi shuga wabwinobwino, ngakhale wodwala matenda ashuga atatsata zakudya zochepa.

Zotsatira za matenda ashuga a gastroparesis

Gastroparesis ndi matenda a shuga a shuga ndi njira ziwiri zosiyana. Poyamba, ziwalo zam'mimba zimatchulidwa pang'ono. Lachiwiri - m'mimba yofooka mwa odwala omwe ali ndi shuga osakhazikika m'magazi.

Chifukwa chachikulu chomwe chimatithandizira kukula kwamatendawa ndikuphwanya ntchito za mitsempha ya vagus yomwe imayamba chifukwa cha kuchuluka kwa glucose m'magazi.

Mitsempha iyi ndiyopadera, imawongolera ntchito zambiri za thupi, zomwe zimachitika popanda kutenga nawo mbali mwachidziwitso. Izi zikuphatikiza:

• chimbudzi
• kugunda kwa mtima
• mamembala amuna, etc.

Chimachitika ndi chiyani ngati wodwala atayamba kudwala gastroparesis?

1. Popeza m'mimba mukutuluka pang'onopang'ono, imakhalabe yodzadza ndi chakudya chotsatira itatha yapita.
2. Chifukwa chake, ngakhale magawo ang'onoang'ono amayambitsa kukhumudwa ndi kulemera m'mimba.
3. Woopsa matenda, mitundu ingapo ya chakudya imatha kudzikundana.
4. Pankhaniyi, wodwalayo amadandaula za zizindikiro monga kupindika, kufinya, kupweteka, kupweteka m'mimba.

Poyambirira, matendawa amapezeka pokhapokha ngati ali ndi shuga wambiri. Chowonadi ndi chakuti gastroparesis, ngakhale mofatsa, samakulolani kuti muwongole kuchuluka kwa shuga m'magazi. Kulimbana ndi zakudya kumapangitsanso zinthu zina.

Chofunikira: mukamadya mafuta, zakudya zama calorie ambiri, zakudya zokhala ndi khofi, mowa kapena kumwa mankhwala oletsa kupweteka, kutsitsa kwam'mimba kumachepetsa kwambiri.

Zokhudza shuga

Kuti mumvetsetse momwe kuchuluka kwa shuga m'magazi kumatengera kutsika kwa m'mimba, muyenera kudziwa zomwe zimachitika mthupi la wodwala yemwe ali ndi matenda a shuga 1.

Asanadye, amafunika kuti alowetsedwe ndi insulin yofulumira.

PPambuyo pa jakisoni, wodwala ayenera kudya kena kake. Izi zikapanda kuchitika, shuga wamagazi ayamba kutsika ndipo zimayambitsa hypoglycemia. Ndi zakudya gastroparesis, chakudya chikapanda kusakhazikika m'mimba, chimodzimodzi zimachitika. Thupi silinalandire michere yofunika, hypoglycemia imayamba. Ngakhale kuti insulin idaperekedwa pa nthawi molingana ndi malamulo onse, ndipo chakudya chinachitika.

Vuto ndilakuti wodwala matenda ashuga sangadziwe nthawi yeniyeni yomwe m'mimba mwake mudzayendetsere chakudya komanso chopanda kanthu. Pankhaniyi, adatha kubaya insulin pambuyo pake. Kapenanso m'malo momwera mwachangu mankhwala, gwiritsani ntchito mankhwala ochepetsa kapena a nthawi yayitali.

Koma chinthu chodziwikiratu ndikuti diabetesic gastroparesis ndichinthu chosayembekezereka. Palibe amene anganene motsimikiza kuti m'mimba mudzatuluka chiyani. Palibe ma pathologies komanso osokoneza ntchito oyang'anira chipata, kayendedwe kazakudya kamatha kuchitika patangopita mphindi zochepa chilandilireni. Nthawi yayikulu yotsanulira kwam'mimba ndi maola atatu.

Ngati phula phulusa ndipo valalo yatsekedwa, ndiye kuti chakudyacho chimatha kukhala m'mimba kwa maola ambiri. Ndipo nthawi zina masiku angapo. Pansi pamzere: kuchuluka kwa shuga m'magazi kumatsika pang'ono mpaka kukayikira, kenako mwadzidzidzi kukangotuluka.

Ichi ndichifukwa chake vutoli limabweretsa zovuta zazikulu ngati pakufunika kuwongolera kuchuluka kwa shuga m'magazi kuti apereke mankhwala oyenera. Kuphatikiza apo, mavuto amabwera mwa iwo omwe, m'malo mwa jakisoni wa insulin, mumamwa insulin pamapiritsi.

Pankhaniyi, timadzi ta pancreatic sitingamwe, titagona m'mimba limodzi ndi chakudya chopanda.

Kusiyana kwa gastroparesis mu mtundu 2 shuga

Popeza kapamba amatha kuphatikiza insulin mu shuga yachiwiri, odwala omwe ali ndi matenda amtunduwu amakhala ndi mavuto ochepa. Amakhalanso ndi zovuta: inshuwaransi yokwanira imangopangidwa kokha ngati chakudya chasunthira kumatumbo ndikugaya kwathunthu.

Ngati izi sizingachitike, shuga wochepa wokha amasungidwa m'magazi, okwanira kokha kupewa hypoglycemia.

Pokhapokha ngati pali zakudya zochepa za carb zomwe zimapangidwira odwala matenda ashuga a mtundu 2, palibe chifukwa chachikulu cha insulin. Chifukwa chake, mawonekedwe a gastroparesis pankhaniyi siowopsa.

Kuphatikiza apo, ngati kuchotsako kumachedwa koma kosakhazikika, mulingo wofunikira wamagazi ukadasungidwa. Mavuto amatuluka mwadzidzidzi komanso kutulutsa kwam'mimba kwathunthu. Kenako kuchuluka kwa shuga kumadutsa kwambiri malire ovomerezeka.

Mutha kubwezeranso mwakale mothandizidwa ndi jakisoni wa insulin wofulumira. Koma zitatha izi, maselo ochepa mphamvu a beta okha omwe amatha kuphatikiza insulin yambiri kotero kuti shuga yayamba kukula.

Vuto lina lalikulu, komanso chifukwa china chomwe chithandizo cha gastroparesis chikufunikira, ndicho matenda a m'mawa. Apa mungazindikire:

• Tiyerekeze kuti wodwala wadya chakudya chamadzulo, kuchuluka kwa shuga m'magazi ake ndikwabwinobwino.
• Koma chakudyacho sichinakudya nthawi yomweyo ndipo chinangokhala m'mimba.
• Ngati imayenda m'matumbo usiku, m'mawa wodwala matenda ashuga adzuka ndi shuga wambiri.

Mothandizidwa ndi chakudya chamafuta ochepa komanso kuwonjezereka kwa insulin yachiwiri mtundu wa 2 shuga, chiopsezo cha hypoglycemia ndi gastroparesis ndi chocheperako.

Mavuto amayamba mwa odwala omwe amatsatira zakudya zapadera ndipo nthawi yomweyo amaperekanso insulin. Nthawi zambiri amavutika ndi kusintha kwamwadzidzidzi m'magulu a shuga ndi kuvutidwa kwambiri kwa hypoglycemia.

Zoyenera kuchita mukatsimikizira gastroparesis

Ngati wodwalayo ali ndi zizindikiro zochepa za matenda a diabetesic gastroparesis, komanso kuchuluka kwa shuga m'magazi kumatsimikizira matendawa, ndikofunikira kupeza njira yothanirana ndi shuga. Kuchiza pakusintha mosinthika a insulin sikungapereke chifukwa, koma kungovulaza.

Chifukwa chake, mutha kungokulitsa zinthuzo ndikukhala ndi zovuta zatsopano, koma simungathe kupewa kuukira kwa hypoglycemia. Pali njira zingapo zochizira kuchepetsedwa kwa m'mimba, zonse zomwe zalongosoledwa pansipa.

Zoyambitsa ndi zizindikiro

Chochita chotsogola kwambiri cha mawonekedwe amanjenje ndi kuchuluka kwa magazi a magazi pamene mitsempha ya vagus iwonongeka. Zomwe zimayambitsa zimathandizanso kuti pakhale matenda a paresis - hypothyroidism, kuvulala ndi matenda am'mimba (zilonda zam'mimba), mtima wamitsempha, kupsinjika, anorexia amanosa, scleroderma, mavuto obwera chifukwa cha mankhwala omwe amapangitsa magazi kukhala achilendo.

Nthawi zina gastroparesis mu matenda a shuga amapezeka motsutsana ndi maziko azinthu zingapo zomwe zikudziwikiratu. Mwachitsanzo, munthu amene amamwa mankhwala osokoneza bongo, zakumwa za khofi komanso mowa amakhala ndi chiopsezo chachikulu chotenga matendawa.

Ndikofunika kukumbukira kuti mtundu wa diabetes wa paresis umasiyana ndi momwe zimakhalira kuti m'mimba mumafooka odwala omwe ali ndi matenda oopsa a hyperglycemia. Ndipo chachiwiri, ziwalo zochepa zomwe sizakwanira zimadziwika.

Popeza kutsanulira kwam'mimba kumachitika pang'onopang'ono, wodwalayo amakhala ndi nkhawa akatha kudya, panthawi yopuma, komanso ngakhale akudya kumene. Chifukwa chake, ngakhale gawo laling'ono la chakudya limapangitsa kumva kupsinjika pamimba.

Ndi matenda omwe adakula matendawa, zakudya zingapo zimasonkhanitsidwa m'mimba nthawi imodzi. Pankhaniyi, zizindikiro zotsatirazi zimayamba:

Komanso, kuchedwa kutulutsa m'mimba kumabweretsa mavuto pakapangidwe kazakudya, komwe kamakhudza thanzi lonse la wodwalayo.

Ndikofunika kudziwa kuti mawonekedwe oyamba a gastroparesis amatha kupezeka pokhapokha pokhapokha akuwonetsetsa kuti pali shuga.

Popeza minyewa yotulutsa minyewa imasokosera njira zotsata shuga. Vutoli limakulirakulira kwambiri chifukwa chosatsatira zakudya zoyenera.

Zotsatira za gastroparesis pa glycemia ndi zomwe zimachitika mu mtundu wachiwiri wa matenda ashuga

Wodwala matenda ashuga akabaya insulin musanadye kapena kugwiritsa ntchito mankhwala omwe amachititsa kuti pancreatic insulin ipange, ndiye kuti glucose imakhazikika. Koma ngati kumwa mankhwala kapena jakisoni wa insulin kunachitika popanda kudya chakudya, ndiye kuti kuchuluka kwa shuga kumatha kuchepa kwambiri. Ndipo gastroparesis mu shuga amachititsanso hypoglycemia.

Ngati m'mimba ikugwira ntchito moyenera, ndiye kuti mukatha kudya imatsata matumbo pomwepo. Koma pankhani ya matenda ashuga paresis, chakudya chimatha kukhala m'matumbo maola ochepa kapena masiku.

Zodabwitsazi nthawi zambiri zimayambitsa kuchepa kwakukulu kwa ndende yamagazi, yomwe imachitika pambuyo pa mphindi 60-120. mutatha kudya. Ndipo pakatha maola 12, chakudya chikalowa m'matumbo, shuga, m'malo mwake, zimachuluka kwambiri.

Ndi mtundu woyamba wa shuga, njira ya gastroparesis imakhala yovuta kwambiri. Komabe, ndimatenda odziyimira pawokha a insulin, kapamba amadzipangira payokha payokha, motero wodwala yemwe ali ndi vuto la m'mimba amamva bwino.

Kupanga kwa insulin kumachitika chakudya chikamalowa m'mimba kulowa m'matumbo. Chakudya chili m'mimba, kupezeka kwa shuga woyambira kumadziwika. Komabe, wodwalayo akatsatira mfundo zamankhwala othandizira odwala matenda ashuga, amafunikira timadzi tambiri tomwe timagwiritsa ntchito, zomwe sizimathandizira pakuwoneka kwa hypoglycemia.

Ngati m'mimba mukutuluka pang'onopang'ono, kuthamanga kwa njirayi ndikofanana. Komabe, mu mtundu 2 wa shuga, kuchuluka kwa shuga m'magazi ndikwabwinobwino. Koma pakagwa mwadzidzidzi komanso mwadzidzidzi, kuwerengera kwama glucose kumatha kuchuluka kwambiri. Komanso, izi sizimayima asanayambitse jakisoni wa insulin.

Ndizofunika kudziwa kuti matenda a shuga a shuga amatha kukhala chifukwa chomwe chimakhudza kuchuluka kwa shuga m'mawa asanadye chakudya cham'mawa.

Chifukwa chake, ngati chakudya chatha kudya m'mimba, ndiye kuti chakudya chamatumbo chitha kuchitidwa usiku ndipo shuga atadzuka azikhala wonenepa.

Kuzindikira ndi chithandizo

Kuti muzindikire matenda a m'mimba m'matenda a shuga ndikudziwa gawo lake la chitukuko, muyenera kuyang'anira nthawi zonse ndikujambulira shuga m'masabata atatu. Kuphatikiza apo, wodwalayo ayenera kuyesedwa ndi gastroenterologist.

Kupezeka kwa matenda amitsempha ya minyewa kumawonetsedwa ndi zochitika zotsatirazi, zomwe zitha kupezeka ndikusunga buku lowonera. Chifukwa chake, pambuyo pa maola 1 kapena atatu mutatha kudya, kuchuluka kwa glucose kumakhalabe kwabwinobwino, ndipo shuga yofulumira imachulukitsidwa ngakhale ndi chakudya chamadzulo.

Komanso, ndi paresis, msambo wa glycemia m'mawa umasintha mosasintha. Ndipo nditatha kudya, shugawo amakhalanso wabwinobwino ndipo amangowonjezera maola 5 chakudya chatha.

Mutha kuonanso gastroparesis mu shuga ngati mumayesa mayeso apadera. Kuyesaku sikukufuna kupaka insulin musanadye, komanso muyenera kukana chakudya chamadzulo, ndikupatsanso jakisoni usiku. Sutra pamimba yopanda kanthu iyenera kujambula zikwangwani za shuga.

Ngati njira ya shuga siyovuta, ndiye kuti m'mawa glycemia iyenera kukhala yabwinobwino. Komabe, ndi paresis, hypoglycemia imakonda kukhala ndi matenda a shuga.

Chithandizo cha matenda a shuga a gastroparesis ndikutsatira moyo wina ndikuwunikira shuga wambiri.Cholinga chachikulu cha mankhwalawa ndikubwezeretsa ntchito ya mitsempha ya vagus, chifukwa chomwe m'mimba imayambiranso kugwira ntchito bwino.

Kupsinjika kwa shuga kuyenera kuthandizidwa kwambiri:

1. kumwa mankhwala
2. olimbitsa thupi apadera
3. kudya.

Chifukwa chake, kuti muchepetse kuthamanga, dokotalayo amamulembera mankhwala osokoneza kapena mapiritsi. Ndalamazi ndi monga Motilium, Betaine hydrochloride ndi pepsin, metoclopramide ndi ena.

Masewera Olimbitsa Thupi ndi Zakudya

Ndi matenda a diabetes a gastroparesis, masewera olimbitsa thupi apadera ayenera kuchitidwa, omwe mungalimbikitse khoma lam'mimba lanu. Izi zimalola kukhazikitsa zomwe zimachitika mthupi ndipo zimathandizira kuti kuchotsera mwachangu.

Chochita chophweka kwambiri ndikuyenda mukatha kudya, chomwe chimayenera kukhala pafupifupi mphindi 60. Ndikofunika kusuntha mukatha kudya chakudya chamadzulo. Ndipo odwala matenda ashuga omwe akumva bwino amatha kuthamanga.

Kutembenuza mozama m'mimba kumathandizanso kuthamanga kwamatumbo. Izi zimachitika mukatha kudya. Kuti mukwaniritse zomwe mukufuna, ndikofunikira kuzichita pafupipafupi ndipo patatha milungu ingapo minofu ndi makhoma am'mimba azikhala olimba, zomwe zingakhale ndi zotsatirapo zabwino pakugaya.

Kuchita masewera olimbitsa thupi kuchitike kwa mphindi 4. Kwa nthawi yochulukirapo, m'mimba muyenera kuyambiranso nthawi 100.

Kuphatikiza apo, ndikofunikira kupanga malo otsetsereka akuya kutsogolo ndi kumbuyo, zomwe zimapangitsa kupititsa patsogolo chakudya pakatikati pa m'mimba. Kuchita masewera olimbitsa thupi kuchitike tsiku lililonse osachepera 20.

Kuti muchepetse zovuta zosasangalatsa za matenda a diabetesic gastroparesis, ndikofunikira kutsatira zakudya zapadera ndikutsatira malamulo ena:

• musanadye, muyenera kumwa makapu awiri amadzi kapena tiyi wopanda shuga,
• Ngati sipafunikanso jakisoni wa insulin musanadye, ndiye kuti zakudya ziyenera kupitilizidwa kukhala zazakudya zisanu ndi imodzi patsiku,
• Zakudya zamafuta ambiri ziyenera kuyika pansi musanagwiritse ntchito,
• chakudya chotsiriza sichikhala mochedwa kuposa maola 5 asanagone,
• Mitundu yanyama yovundikira iyenera kutayidwa (nkhumba, masewera, ng'ombe),
• osamadya agologolo chakudya chamadzulo,
• Zakudya zonse ziyenera kutafuna nthawi makumi anayi.

Makonda amayenera kuperekedwa ku nyama yodya (nkhuku, nkhuku, kalulu), yoikika mu chopukusira nyama. Ndikofunika kuti musadye nsomba zam'madzi mpaka mutachira kwathunthu.

Ngati chithandizo cha zakudya sichidabweretsa zotsatira zoyenera, ndiye kuti wodwalayo amasamutsidwa ku chakudya chambiri kapena chadzimadzi.

Si anthu ambiri amene amadziwa kuti kutafuna chingamu ndi njira yabwino yothandizira gastroparesis. Kupatula apo, zimapangitsa njira yosinthira minofu yosalala pamakoma am'mimba, kufooketsa phula la pyloric.

Nthawi yomweyo, simuyenera kuda nkhawa za kuchuluka kwa shuga, chifukwa kutafuna kumatheka kumangokhala ndi 1 g ya xylitol, yomwe ilibe chidwi ndi glycemia. Chifukwa chake, mukatha kudya chilichonse, chingamu chizitha kutafuna pafupifupi ola limodzi. Kanemayo munkhaniyi akuperekanso zambiri pazovuta za matenda ashuga.

Kusintha kwa zakudya kuti muziwongolera gastroparesis

Chithandizo choyenera kwambiri chomwe chimachepetsa kwambiri matenda ashuga gastroparesis ndichakudya chapadera. Moyenera, liphatikize ndi masewera olimbitsa thupi omwe cholinga chake ndi kulimbikitsa ntchito yam'mimba ndikuwongolera matumbo a matumbo.

Zimakhala zovuta kuti odwala ambiri asinthane ndi kudya ndi zakudya zatsopano. Chifukwa chake, ndikulimbikitsidwa kuti muchite izi pang'onopang'ono, kuchoka pazovuta zosavuta kupita kuzambiri. Kenako mankhwalawo adzakhala otetezeka komanso othandiza.

1. Musanadye, muyenera kumwa mpaka magalasi awiri amadzimadzi aliwonse - chinthu chachikulu ndikuti sichotsekemera, mulibe caffeine ndi mowa.
2. Chepetsani kudya kwa fiber kwambiri momwe mungathere. Ngati zinthu zomwe zili ndi izi zidaphatikizidwanso m'zakudya, tikulimbikitsidwa kupukuta mu gruel mu blender musanagwiritse ntchito.
3. Ngakhale zakudya zofewa ziyenera kutafunidwa mosamala kwambiri - nthawi 40.
4. Muyenera kusiyiratu nyama yovuta kugaya mitundu - iyi ndi ng'ombe, nkhumba, masewera. Makonda ayenera kuperekedwa kwa mbale za nyama yophika kapena nyama yophika nkhuku, yoboola kudzera chopukusira nyama. Osamadya nsomba.
5. Chakudya chamadzulo sichikhala mochedwa kuposa maola asanu asanagone. Nthawi yomweyo, chakudya chamadzulo chimayenera kukhala ndi mapuloteni ochepa - ndibwino kusamutsa ena kuti adye chakudya cham'mawa.
6. Ngati palibe chifukwa chobweretsera insulin musanadye, muyenera kudya zakudya zitatu masiku atatu.
7. Woopsa matendawa, pamene chithandizo cha zakudya sichinabweretse zotsatira zomwe zikuyembekezeka, ndikofunikira kusinthana ndi chakudya chamadzimadzi ndi theka.

Ngati m'mimba mwa odwala matenda ashuga amakhudzidwa ndi gastroparesis, CHIKWANGWANI chilichonse, ngakhale chosungunuka mosavuta, chimatha kuyambitsa mapangidwe a pulagi. Chifukwa chake, kugwiritsidwa ntchito kwake ndikovomerezeka pamitundu yaying'ono yodwala, koma pang'ono.

Izi zipititsa patsogolo shuga. Zotupa zokhala ndi ma coarse ngati filakisi kapena mbewu zodulira ziyenera kutayidwa kwathunthu.

Kodi gastroparesis ndi chiyani?

Matenda a shuga a gastroparesis ndi ziwalo pang'ono zam'mimba, zomwe zimapangitsa kuti achedwetse kuyeretsa m'mimba atatha kudya. Kukula kwa matendawa kumakwiyitsa ntchito yochepetsetsa ya minofu yam'mimba, kusokonezeka komwe kumagwira ntchito komwe kumapangitsa kupangika kwa chakudya. Madongosolo ataliatali a chakudya chosakhudzidwa chimayamba kuvunda. Zotsatira zake, kubereka kwa pathogenic maluwa kumachitika, komwe kumakhala ndi zovulaza pamimba.

Mtundu wa matenda amtunduwu amadziwika osati kokha kwa anthu omwe ali ndi matenda ashuga, komanso kwakukulu mwa iwo. Ndi matenda amtundu 1, gastroparesis ndiofala kuposa anthu omwe ali ndi matenda a shuga a 2.

Matenda a ICD-10: K31.8.0 * Atony yam'mimba (gastroparesis).

Zizindikiro zazikulu zakukula kwa matendawa

Ndi gastroparesis, wodwalayo amadandaula za kudya mwachangu msanga, ngakhale kwenikweni chakudya chochepa chidadyedwa. Nthawi yomweyo, m'mimba mwadzaza, zimapweteka, monga zimachitika ndi kudya kwambiri. Komabe, munthuyo amayamba kuchepa thupi. Amadwala kudzimbidwa, kumatulutsa, komanso kusanza pafupipafupi atatha kudya.

Izi matenda sangathe kukayikiridwa nthawi yomweyo, chifukwa chake ndikofunikira kuyesedwa mosamala ndi katswiri wa gastroenterologist pamene zizindikiro zoyipa zimayamba.

Zakudya zopanda pake, kuzunza okazinga, mafuta ndi mowa zimakulitsa matendawa ndikukulitsa kukula kwa gastroparesis odwala matenda ashuga.

Kwa zaka zambiri ndakhala ndikuphunzira za zovuta za DIABETES. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russia Academy of Medical Science idatha kupanga mankhwala omwe amachiritsiratu matenda ashuga. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 100%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipilira mtengo wonse wa mankhwalawo. Ku Russia ndi mayiko a CIS odwala matenda ashuga kale Julayi 6 alandire mankhwala - ZAULERE!

Nthawi zambiri, matenda a diabetes a gastroparesis amakhala osiyana ndi kuwonongeka kosiyanasiyana. Koma nthawi zambiri ndi gastroparesis, zizindikiro zotsatirazi zimawonedwa:

• nseru, kusanza mutadya,
• ukufalikira
• Kukhazikika kwa kumverera kwachisoni,
• kupweteka m'mimba,
• malamba, kutentha kwache,
• osati mawonekedwe am'mimba,
• kukomoka.

Vomiting Reflex matenda amatuluka, monga lamulo, mukatha kudya. Komabe, kuukira kosanza m'njira yamatendawa kumatha kupweteka popanda chakudya (ndi kuchuluka kwa chakudya ndi madzi am'mimba m'mimba). Popeza zamatenda zimakhudza kukonza kwa chakudya, masanzi amakhala ndi zikuluzikulu zazakudya ndi bile.

Matenda owopsa a matendawa amakhudza chimbudzi, chomwe sichichita ntchito yake, ndikumasiya kukhutitsa thupi ndi zinthu zina zofunika kuzitsatira. Zotsatira zake, kusowa kwakukulu kwa zinthu kumathandiza kuchepetsa thupi, pang'ono ndi pang'ono madzi am'madzi ndipo thupi limatsikira.

Zizindikiro za gastroparesis amasintha modabwitsa moyo. Anthu ovutika amakhala ndi kumva kufooka, kutopa, kukwiya. Uku ndi kuzungulira mosalekeza, komwe kumawonetsedwa mthupi nthawi zonse ndipo sikuloleza kuti zizigwira ntchito mokhazikika. Kusintha kwa mahomoni tsiku ndi tsiku komanso kuchuluka kwa glucose kumayambitsa vuto. Anthu omwe ali ndi matenda amisempha amawonongeka ndikusokonekera kwamanjenje ndipo mothandizidwa samatuluka mu kukhumudwa.

Zolemba za matendawa mu mtundu 1 ndi matenda ashuga 2

Anthu odwala matenda amtundu woyamba amakhala ndi zovuta zambiri kuposa anthu odwala matenda ashuga a 2 omwe ali ndi insulin. Nthawi zambiri, mphindi yobwereza imachitika mutangoyendetsa matumbo m'matumbo. Koma chakudya chomwe chimatengedwa chikhala m'mimba momwemonso, shuga wambiri m'magazi ndi wocheperako.

Makhalidwe a matenda

Matenda a shuga a gastroparesis ndi mkhalidwe womwe kufooka kwamisempha yam'mimba kumachitika. Izi zimaphatikizidwa ndi zovuta pakudya chimbudzi cha chakudya ndikupita kwake kwamatumbo. Ndi matenda a shuga a gastroparesis, kupita patsogolo kwamitundu yosiyanasiyana yamatumbo kumatha.

Matendawa amatuluka motsutsana ndi maziko a kuchuluka kwa shuga m'magazi. Sichimawoneka nthawi yomweyo, njirayi imatenga zaka zingapo. Nthawi zambiri mavutowa amakumana ndi anthu omwe amadalira insulin. Mwa odwala matenda ashuga a mtundu wachiwiri, gastroparesis imayamba kangapo.

Mwa anthu athanzi, minyewa yam'mimba, pomwe chakudya chimakonzedwa ndipo magawo amasunthira matumbo. Mu matenda a shuga, dongosolo lamanjenje limasokonezeka, kuphatikizapo kayendetsedwe ka kayendedwe ka m'mimba. Izi ndichifukwa choti kuwonjezeka kwa glucose kumatha kuwononga mitsempha ya vagus. Mitsempha yomwe imayang'anira kuphatikiza kwa ma acids, ma enzyme, minofu yomwe imakhudzidwa ndikugaya umakhudzidwa. Mavuto amatha kuyamba m'mbali iliyonse yamatumbo am'mimba.

Zizindikiro za matenda

Odwala matenda ashuga ayenera kudziwa momwe gastroparesis imachitikira mu shuga. Ngati wodwalayo anali ndi mbiri yolephera kuzimitsa thupi, panali kuwonongeka m'maganizo, mapazi owuma, ndiye kuti mavuto azakudya amatulutsa.

Zizindikiro za gastroparesis zikuphatikiza:

• kubwatula kapena hiccups
• nseru mutatha kudya, kusanza,
• mawonekedwe a chidzalo cha kudzaza m'mimba pambuyo pazipikiro zoyambirira,
• kupweteka ndi kusasangalala m'mimba mutatha kudya,
• kuchepa kwa chidwi cha kudya,
• kutentha kwapakati kosalekeza
• ukufalikira
• kutsegula m'mimba
• kudzimbidwa
• amadumphira m'magazi a glucose ngakhale motsatira kwambiri zakudya zomwe analimbikitsa.

Ndi kuphwanya kulikonse kwa zakudya, zizindikiro za gastroparesis zimakulanso. Vutoli limakulirakudya nditatha kudya yokazinga, ma muffin, mafuta, zakudya zam'mimba, koloko. Kukula kwa zizindikiro kumatengera kuopsa kwa matendawa komanso mawonekedwe a thupilo.

Pa magawo oyamba, madokotala sangathe kukayikira nthawi zonse kutukuka kwa gastroparesis. Chikhalidwe cha matendawa ndikuti nkosatheka kukhala ndi shuga.

Zomwe zimayambitsa matendawa

Popeza kuti odwala matenda ashuga onse amakhala ndi gastroparesis, ndikofunikira kudziwa zomwe zimapangitsa kuti pakhale zovuta zina. Cholinga chachikulu ndikuphwanya magwiridwe antchito amanjenje ndikuwonongeka kwa mitsempha ya vagus. Koma nthawi zambiri matendawa amapezeka mwa odwala omwe:

• mavuto ndi m'mimba thirakiti
• hypothyroidism
• zilonda zam'mimba,
• matenda a mtima
• scleroderma,
• Pali mbiri yovulala kwam'mimba, matumbo,
• anayamba kudwala
• kupsinjika kwakukulu.

Gastroparesis imatha kukhala zovuta pakugwiritsa ntchito mankhwala a antihypertensive. Nthawi zina, zomwe zimayambitsa izi ndizophatikiza pazinthu zina, kotero kuti mumvetsetse, chifukwa cha mavuto omwe abuka, ndikofunikira limodzi ndi dokotala.

Ndimakonda kwambiri khofi, zakudya zamafuta, mowa, mwayi wokhala ndi gastroparesis ukuwonjezeka. Kupatula apo, chakudya chotere chimapangitsa kuti m'mimba musamavutike.

Zinthu Zofunika

Odwala omwe ali ndi matenda omwe amadalira insulin ayenera kupatsidwa insulin asanadye. Mtundu wachiwiri wa matenda ashuga, odwala amamwa mankhwala apadera omwe amathandizira kupanga insulini ndikupanga kusintha kwa mayeso ndi maselo. Nthawi yomweyo, chakudya chizilowa m'thupi, ngati sichikupezeka, kuchuluka kwa shuga kumatsika kwambiri.

Matendawa gastroparesis amadziwika chifukwa chakuti chakudya chimalephera kulowa bwino mthupi. Izi zimawononga thanzi lanu. Ndi matendawa, chakudya kuchokera m'mimba kulowa m'matumbo chimatha kulowa nthawi yomweyo, kapena mwina patatha masiku angapo. Pakusowa chakudya, odwala matenda ashuga amawonetsa zizindikiro za hypoglycemia. Zakudya zikamayenda m'matumbo, hyperglycemia imayamba.

Odwala omwe ali ndi matenda a shuga a mtundu wachiŵiri, gastroparesis amayambitsa mavuto ochepa kuposa odwala omwe ali ndi matenda a shuga. Zowonadi, ndi mtundu wodziyimira pawokha wa insulin, njira yachilengedwe yopanga mahomoni siyidodometsedwa (kupatula matendawo mu mawonekedwe owopsa). Chifukwa chake, kupanga kwake kumayambira panthawi yomwe chakudya chimachoka kuchokera m'mimba kupita m'matumbo.

Ngati matumbo atachotsa pang'onopang'ono kuposa zabwinobwino, koma pamlingo womwewo, ndiye kuti shuga mu odwala matenda ashuga a mtundu 2 azikhala otsalira. Koma m'malo pomwe chakudya chimalowetsedwa m'matumbo m'magawo akulu kwambiri, kuchuluka kwa shuga kumawonjezeka kwambiri. The odwala matenda ashuga sangathe payokha kulipira hyperglycemia.

Ndi matendawa, shuga ambiri amatha kuwonedwa m'mawa. Izi ndichifukwa choti chakudya chamadzulo sichilowa m'matumbo mwachangu ndikuyamba kugayidwa. Mchitidwewu umayamba usiku kapena m'mawa. Chifukwa chake, mutagona, shuga amakwezedwa.

Kuzindikira matendawa

Kuti mudziwe matenda a diabetes a gastroparesis, kuyezetsa ndi kufunsa wodwalayo ndi gastroenterologists ndikofunikira. Madokotala amayenera kupanga matenda osiyanasiyana. Ndipo kuti mudziwe bwino, kudziwunikira kwathunthu kwamagazi a glucose kumafunika. Kuwona kumachitika kwa milungu ingapo.

Mukawunika momwe wodwalayo alili, wodwalayo ayenera kuyang'anitsitsa kuchuluka kwa shuga:

• Maola 1-3 atatha kudya, shuga sawakhalitsa (sayenera kukhala yomweyo),
• mukatha kudya, kulumpha kwa glucose sikumachitika, koma mphamvu yake imadzuka patatha maola 4-6 mutatha kudya,
• mayendedwe a shuga osala kudya ndiokwera kwambiri, koma ndizosatheka kuneneratu pasadakhale, amasintha tsiku ndi tsiku.

Matenda a shuga a gastroparesis amatha kukayikiridwa ndi kukhalapo kwa 2-3 mwa zizindikirozi. Koma chidziwitso cholondola kwambiri chazakuwonetsero ndikukula kwa shuga m'mawa.

Nthawi zambiri, gastroparesis ikachitika, wodwalayo sangathe kuyendetsa shuga, amayamba kuwonjezera kuchuluka kwa mankhwala omwe amachepetsa shuga. Zotsatira zake, matendawo amangokulira: kulumpha mu shuga kumakhala kwamuyaya.

Odwala omwe amadalira insulin amalangizidwa kuchita izi. Chakudya chamadzulo chikuyenera kudumphidwa, insulini nayenso siyiyenera kuperekedwa. Koma usiku muyenera kupanga jakisoni wa insulini, imwani mankhwala ochepetsa shuga. Yang'anani kuchuluka kwa shuga mutatha kumwa mankhwala (jakisoni wa insulin) ndi m'mawa pamimba yopanda kanthu. Ndi njira yokhazikika ya matenda ashuga osavutitsa magwiridwe am'mimba a m'mimba, zizindikirazo ziyenera kukhala zabwinobwino. Ndi gastroparesis, ndende ya shuga idzachepetsedwa.

Ndikulimbikitsidwanso kuyika chakudya cham'mbuyo mpaka nthawi yoyambirira ndikuwona kusintha kwamasamba. Ngati shuga amakhala wabwinobwino m'mawa popanda chakudya chamadzulo, ndipo amadzuka m'mawa ndi chakudya chamadzulo, adokotala amatha kudziwa matenda a shuga.

Payokha, madokotala amalemba mayeso otere.

1. Radiography pogwiritsa ntchito kuyimitsidwa kwa barium. Kafukufukuyu amatilola kupatula kusintha komwe kumapangitsa kuti mu mayesowo azikhala komanso kuwunika momwe alili.
2. Kuchita ma gastric manometry. Panthawi yonseyi, kupanikizika m'malo osiyanasiyana m'mimba kumayesedwa.
3. Pogwiritsa ntchito ultrasound, mutha kuwona zolimba zamkati mwamkati.
4. Endoscopic kupenda kwam'mimba gawo. Pakati pa njirayi, mkhalidwe wamkati wam'mimba umawunikiridwa.
5. Kuchita electrogastroenterography. Kupenda kumakupatsani mwayi kuti muyeze ntchito yamagetsi yam'mimba.

Gastroenterologist amayenera kuona zilonda zam'mimba, ziwopsezo zama gluteni, kuchuluka kwa msana wam'mimba, komanso matendawa.

Njira zamankhwala othandizira

Potsimikizira matenda a shuga a gastroparesis, tiyenera kukumbukira kuti ndizosatheka kusintha boma posintha mtundu wa insulin. Izi zimangobweretsa shuga mu shuga komanso kukulira kwa omwe akudwala matenda ashuga. Tsatirani njira inayo. Wodwalayo ayenera kuchita bwino pakutulutsa m'mimba ndikuyendetsa chakudya m'matumbo.

Pambuyo povomereza matendawa, muyenera kuyamba kuwunikira mosamala mawonekedwe a moyo. Chifukwa chachikulu ndikusokonekera kwa mitsempha ya vagus. Ngati nkotheka kubwezeretsa ntchito zake, ndiye kuti ndikotheka kutulutsa ntchito yam'mimba ndi chikhalidwe chamitsempha yamagazi ndi mtima.

Madokotala amasiyanitsa magulu anayi a njira zomwe zimapangitsa kuti zinthu zikhale bwino:

• mankhwala
• kuchita zolimbitsa thupi mutatha kudya,
• kusintha pang'ono zakudya
• kukonzanso kwathunthu kwa zakudya zopatsa thanzi, kugwiritsa ntchito chakudya m'madzimadzi kapena mawonekedwe amadzimadzi.

Koma mutha kukwaniritsa zofunika kwambiri ngati mumagwiritsa ntchito njira zonse pamodzi.

Mankhwala, mankhwala apadera amathandizira kuti apititse patsogolo kugaya chakudya. Ndi mitundu yofatsa ya gastroparesis, muyenera kumwa mapiritsi okha usiku. Kupatula apo, chakudya chamadzulo ndichakudya chambiri. Mwina izi zikuchitika chifukwa cha kuchepa kwa ntchito ya odwala madzulo.

Mankhwala amapezeka mu mawonekedwe a syrups kapena mapiritsi. Kuchita bwino kwa izi ndikotsika kwambiri, chifukwa chake ndikofunikira kugwiritsa ntchito mitundu ya mankhwala.

Njira zotere zitha kuperekedwa:

• Motilium (domperidone),
• Metoclopramide
• Mapiritsi otsekemera olemeretsedwa ndi michere pansi pa dzina la SuperPapayaEnzymePlus,
• "Acidin-pepsin" (betaine hydrochloride kuphatikiza pepsin).

Odwala olimbitsa thupi amatha kuyamba kuchita okha. Kuchita bwino kwa njirayi ndikokwera poyerekeza ndi kugwiritsa ntchito mankhwala. Anthu odwala matenda ashuga ayenera kuchita masewera olimbitsa thupi omwe amafulumira kuti madzi atuluke m'matumbo atalowa m'mimba. Amakulolani kuti mulimbikitse makoma am'mimba, omwe amakhala aulesi, komanso kusintha kukula kwa chimbudzi.

1. Njira yabwino yothandizira kuyambitsa m'mimba ndikuyenda. Kukhazikika kapena kugona mutatha kudya, makamaka pambuyo chakudya chamadzulo, ndizoletsedwa.
2. Kuthanso kwamimba m'mimba kumathandizanso - izi ziyenera kuchitika mukangodya. Pakupita mphindi 4, m'mimba muzikoka maulendo oposa 100.
3. Sinthani njira yopititsa ntchito patsogolo chakudya popendekera mmbuyo ndi mtsogolo. Kubwereza 20 ndikokwanira.

Chitani izi mwachindunji.

Pa matenda a diabetes a gastroparesis, kutafuna chingamu ndikulimbikitsidwa: izi zimathandiza kulimbikitsa kupindika kwa minofu yosalala yam'mimba.

Zakudya za odwala siziyenera kukhala zamafuta komanso zamafuta, ndizovuta kuzikumba, njira yotseka imachepetsa. Makonda ayenera kuperekedwa ku chakudya chamafuta ndi theka lamadzi.

Ndi zovuta ziti zomwe diabetesic gastroparesis imabweretsa?

Gastroparesis amatanthauza "kupuwala pang'ono pamimba", ndipo matenda a shuga a m'magazi amatanthauza "m'mimba ofowoka odwala odwala matenda ashuga." Cholinga chake chachikulu ndikutha kwa mitsempha ya vagus chifukwa cha shuga wokwezeka wamwazi. Mitsempha iyi imagwira ntchito zambiri mthupi zomwe zimachitika popanda kudziwa, kuphatikizira kugunda kwa mtima ndi chimbudzi. Mwa amuna, matenda a shuga a neropathy a vagus amathanso kumayambitsa mavuto ndi potency. Kuti mumvetse momwe matenda ashuga a gastroparesis amawonekera, muyenera kuphunzira chithunzichi pansipa.

Kumanzere kuli m'mimba mutatha kudya. Zapakati pake zimadutsa m'matumbo kudzera pylorus. Mawotchi olondera pachipata ndi otseguka (minofu imatsitsimuka). Gawo lam'munsi lophageal sphincter limatsekedwa mwamphamvu kuti lisatengeke ndi chakudya kuti chisalowe m'mimba. Makoma a minofu ya m'mimba nthawi ndi nthawi amalumikizana ndikuthandizira kuyenda kwachakudya.

Kudzanja lamanja tikuwona m'mimba mwa wodwala matenda ashuga yemwe wadwala gastroparesis. Kuyenda kwazosangalatsa kwa minofu ya m'mimba sikuchitika. Pylorus imatsekedwa, ndipo izi zimasokoneza kuyenda kwa chakudya kuchokera m'mimba kupita m'matumbo. Nthawi zina pamatha kukhala phula laling'ono pokha, ndi m'mimba mwake osapitirira pensulo, pomwe chakudya chamadzimadzi chimalowa m'matumbo ndi madontho. Ngati alonda a pachipata amasuka, ndiye kuti wodwalayo amamva kupsinjika kuchokera pansi pa Mchombo.

Popeza kupindika kwapansi kumatha kupuma komanso kutseguka, zomwe zili m'mimba, zodzaza ndi asidi, kutumphukira kumbuyo kwa esophagus. Izi zimapweteketsa mtima, makamaka pamene munthu wagona tulo. Emophagus ndi chubu chachikulu chomwe chimalumikiza pharynx pamimba. Mothandizidwa ndi acid, kuwotcha makoma ake kumachitika. Nthawi zambiri zimachitika kuti chifukwa cha kutentha kwanthawi zonse, mano amatha kuwonongeka.

Ngati m'mimba mulibe, monga momwe ziliri, ndiye kuti amadzaza kwambiri ngakhale chakudya chochepa. M'mavuto ovuta kwambiri, zakudya zingapo motsatana zimadzaza m'mimba, ndipo zimayambitsa kuphuka kwambiri. Komabe, nthawi zambiri, wodwalayo samakayikira ngakhale pang'ono kuti ali ndi gastroparesis mpaka atayamba kukhazikitsa pulogalamu yothana ndi matenda a shuga 1 kapena mtundu wa 2 wodwala. Malamulo athu othandizira odwala matenda a shuga amafunika kuwunika kwambiri shuga wanu wamagazi, ndipo apa vuto la gastroparesis limapezeka nthawi zambiri.

Matenda a shuga a gastroparesis, ngakhale pang'ono mawonekedwe, amasokoneza kayendedwe ka shuga. Ngati mumamwa kafefe, zakudya zamafuta, mowa kapena mankhwala ochepetsa mphamvu ya m'mimba, amachepetsa kutsanulira kwam'mimba ndikuwonjezera mavuto.

Chifukwa chomwe gastroparesis imayambitsa spikes mu shuga

Ganizirani zomwe zimachitika kwa munthu wodwala matenda ashuga yemwe alibe gawo loyambirira la insulin chifukwa cha chakudya. Amadzivulaza ndi insulin yofulumira musanadye kapena kumwa mapiritsi a shuga omwe amalimbikitsa kupanga insulin. Werengani chifukwa chomwe muyenera kusiya kumwa mapiritsiwo komanso mavuto omwe amabwera nawo. Ngati adalowetsa insulin kapena kumwa mapiritsi, kenako ndikulumpha chakudya, shuga yake yamwazi imatsika kwambiri, mpaka kufika pamlingo wa hypoglycemia. Tsoka ilo, matenda ashuga a gastroparesis ali ndi zotsatira zofanana ndi kulumpha zakudya.

Ngati wodwala matenda ashuga amadziwa nthawi yake yam'mimba kuti apereka zomwe zili m'matumbo atatha kudya, amatha kuchepetsa jakisoni wa insulin kapena kuwonjezera NPH-insulin kuti insulini isachedwe. Koma vuto la matenda ashuga a gastroparesis ndikosazindikira kwake. Sitikudziwa m'mbuyomu momwe kudya kwam'mimba kumatha kudya. Ngati palibe pyloric spasm, ndiye kuti m'mimba mumatha kupatula mphindi zochepa, komanso mkati mwa maola atatu. Koma ngati alonda a pachipata atsekedwa mwamphamvu, ndiye kuti chakudya chimatha kukhalabe m'mimba masiku angapo.Zotsatira zake, shuga wamagazi amatha "kutsika pansi" pamatha maola awiri atatha kudya, kenako ndikuwuluka mwadzidzidzi patatha maola 12, pomwe m'mimba umapereka matumbo ake.

Tidawerengera kusakonzeka kwa chimbudzi mu diabetesic gastroparesis. Zimapangitsa kuti zikhale zovuta kwambiri kuwongolera shuga m'magazi odwala odwala matenda a shuga omwe amadalira insulin. Mavuto amapangidwanso kwa odwala matenda ashuga ngati amamwa mapiritsi omwe amalimbikitsa kupanga insulin ndi kapamba, omwe timalimbikitsa kuti ataye.

Zina za gastroparesis mu mtundu 2 shuga

Kwa odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, matenda a shuga a gastroparesis amayambitsa zovuta zochepa kuposa odwala omwe ali ndi matenda amtundu 1, chifukwa adakali ndi insulin yawo yopanga. Kupanga kwambiri kwa insulin kumachitika pokhapokha chakudya kuchokera m'mimba chikalowa m'matumbo. Mpaka m'mimba mulibe kanthu, insulin yotsika yokha (yosala) yotsalira m'magazi. Ngati wodwala yemwe ali ndi matenda a shuga a 2 amawona zakudya zamagulu ochepa, ndiye kuti jakisoni amalandira insulin yaying'ono, yomwe siziwopseza kwambiri hypoglycemia.

Ngati m'mimba mukutuluka pang'onopang'ono, koma mosalekeza, ndiye kuti odwala odwala matenda ashuga a 2, zochitika za maselo otetemera a pakancreatic nthawi zambiri zimakhala zokwanira kusunga shuga wabwinobwino. Koma ngati mwadzidzidzi m'mimba mulibe kanthu, ndiye kuti kulumpha m'magazi amwazi, omwe sangathe kuzimitsidwa nthawi yomweyo popanda jakisoni wa insulin yofulumira. Maola ochepa chabe, maselo ofooka a beta amatha kupanga insulin yokwanira kuti shuga ibwererenso.

Matenda a shuga a gastroparesis ndi achiwiri kwambiri omwe amachititsa kuti shuga asinthe kwambiri pambuyo pa m'bandakucha. Ngati chakudya chanu sichinachoke m'mimba yanu panthawi, ndiye kuti kudzimbidwa kumachitika usiku. Zikakhala zotere, wodwala matenda ashuga amatha kugona ndi shuga wabwinobwino, kenako nkudzuka m'mawa ndi shuga wowonjezera. Mulimonsemo, ngati mutsatira zakudya zamafuta ochepa ndikuwonjezera ma insulin ochepa kapena ngati simunayankhe mtundu wa 2 shuga, ndiye kuti gastroparesis sikukuwopsezeni ndi hypoglycemia. Odwala omwe ali ndi matenda ashuga omwe amatsata zakudya "zopatsa thanzi" komanso kupaka jakisoni wambiri wa insulin amakhala ndi zovuta zambiri. Chifukwa cha matenda a diabetes a gastroparesis, amakumana ndi kuchuluka kwa shuga komanso zochitika zambiri za hypoglycemia.

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

Momwe mungadziwire kupsinjika kwa shuga

Kuti mumvetsetse ngati muli ndi matenda a diabetes a gastroparesis kapena ayi, ndipo ngati ndi choncho, ndi olimba bwanji, muyenera kuphunzira zolemba za zotsatira za kudziletsa kwathunthu kwa shuga kwa masabata angapo. Ndikofunikanso kuti dokotala wofufuza m'magazi adzifufuze kuti adziwe ngati pali zovuta zilizonse zam'mimba zomwe sizikugwirizana ndi matenda a shuga.

Muzoyang'ana pazotsatira za kudziletsa kwathunthu kwa shuga, muyenera kulabadira ngati zochitika zotsatirazi zilipo:

• Shuga wamagazi pansipa yokhazikika amachitika pambuyo pa maola 1-3 (osati nthawi iliyonse).
• Mukatha kudya, shuga amakhala wabwinobwino, kenako amakwera pambuyo pa maola 5 kapena pambuyo pake, popanda chifukwa.
• Mavuto a shuga m'mawa m'magazi opanda kanthu, ngakhale kuti wodwala matenda ashuga adadya chakudya dzulo - maola 5 asanagone, kapena ngakhale koyambirira. Kapena shuga m'mawa amakhala ndi mosadalirika, ngakhale wodwalayo amadya msanga.

Ngati zochitika No. 1 ndi 2 zimachitika palimodzi, ndiye kuti zakwanira kukayikira gastroparesis. Vuto No. 3 ngakhale osapumira limakupatsani mwayi wofufuza odwala matenda ashuga. Ngati pali zovuta ndi shuga m'mawa m'magazi opanda kanthu, ndiye kuti wodwala matenda ashuga amatha kuwonjezera kuchuluka kwa insulin kapena mapiritsi usiku.Mapeto, zimapezeka kuti usiku amalandira Mlingo wambiri wa matenda a shuga, omwe amaposa mlingo wa m'mawa, ngakhale kuti amadya m'mawa kwambiri. Pambuyo pake, kusala kudya kwam'mawa shuga azichita mosayembekezera. Masiku ena, imakwezedwa, pomwe ina imakhala yokhazikika kapena yotsika kwambiri. Kusasinthika kwa shuga ndi chizindikiro chachikulu choganiza kuti gastroparesis.

Ngati tiona kuti m'mawa othamanga magazi amakhazikika mosadabwitsa, titha kuyeserera kutsimikizira kapena kutsutsa matenda a shuga. Tsiku lina mudumphe chakudya chamadzulo, motero, musamwe jakisoni mwachangu musanadye. Pankhaniyi, usiku muyenera kugwiritsa ntchito mlingo woyenera wa insulin komanso / kapena mapiritsi a shuga oyenera. Pimani shuga m'magazi anu asanagone, kenako m'mawa pamimba yopanda kanthu mukadzuka. Amayesedwa kuti mudzakhala ndi shuga wabwinoko usiku. Ngati wopanda shuga, shuga m'mawa adakhala wamba kapena amachepera, ndiye kuti gastroparesis imayambitsa mavuto nayo.

Pambuyo poyesererako, idyani chakudya chamadzulo m'masiku angapo. Onani momwe shuga yanu imakhalira madzulo asanagone komanso m'mawa wotsatira. Bwerezaninso kuyesanso. Kenako, idyani chakudya masiku angapo ndikuwonera. Ngati shuga m'magazi ndilabwinobwino kapena wotsika m'mawa popanda chakudya, ndipo mukadya chakudya chamadzulo, nthawi zina chimadzuka m'mawa, ndiye kuti muli ndi matenda a shuga. Mutha kuthandizira ndikuwongolera pogwiritsa ntchito njira zomwe zalongosoledwa pansipa.

Ngati wodwala matenda ashuga amadya chakudya chamagulu "owonjezera," omwe amakhala ndi shuga, magazi ake amathanso kukhala osadalirika, mosasamala kanthu za kukhalapo kwa gastroparesis.

Ngati kuyesaku sikumapereka zotsatira zosatsutsika, ndiye kuti muyenera kuyesedwa ndi dokotala wa gastroenterologist kuti mudziwe ngati pali zovuta zotsatirazi:

• zilonda zam'mimba kapena zam'mimba,
• erosive kapena atrophic gastritis,
• m'mimba kukwiya
• mng'oma wamphongo
• matenda osokoneza bongo
• matenda ena a m'matumbo.

Kuyesedwa ndi gastroenterologist kungakhale kothandiza mulimonse. Mavuto omwe ali ndi matenda am'mimba, omwe atchulidwa pamwambapa, amayankha bwino ngati mukutsatira malangizo a dokotala mosamala. Mankhwalawa amathandizira kusintha kwa shuga m'magazi.

Njira zowongolera odwala matenda ashuga

Chifukwa chake, zidatsimikiziridwa kuti mwapanga matenda a shuga a shuga, malinga ndi zotsatira za kudziletsa kwathunthu kwa shuga wamagazi, komanso pambuyo pobwereza kangapo koyesera komwe tafotokozazi. Choyamba, muyenera kudziwa kuti vutoli silitha kuthandizidwa ndi insulin. Kuyesayesa koteroko kumangowonjezera kuchuluka kwa shuga m'magazi ndikukulitsa zovuta za matenda ashuga, komanso kumawonjezera chiopsezo cha hypoglycemia. Kuti muthane ndi matenda a diabetes a gastroparesis, muyenera kuyesa kukonza matumbo mukatha kudya, ndipo njira zingapo zalongosoledwa pansipa momwe mungachitire izi.

Ngati muli ndi gastroparesis, ndiye kuti kuvutikira m'moyo kumakhala kwakukulu kwambiri kuposa odwala ena onse omwe akukhazikitsa pulogalamu yathu yothandizira odwala matenda ashuga a mtundu wa 2 kapena pulogalamu yachiwiri yothandizira matenda ashuga. Mutha kuthana ndi vutoli ndikukhala ndi shuga wabwinobwino pokhapokha ngati mumatsatira mosamala. Koma izi zimapereka zabwino. Monga mukudziwa, matenda a diabetes a gastroparesis amachitika chifukwa cha kuwonongeka kwa mitsempha ya vagus yomwe imayamba chifukwa cha shuga wokwezeka wamwazi. Ngati matenda ashuga amalangidwa kwa miyezi ingapo kapena zaka, ntchito ya mitsempha ya vagus imabwezeretseka. Koma mitsempha iyi imangolamulira chimbudzi, komanso kugunda kwa mtima ndi zina zochitika mthupi. Mudzalandira kusintha kwathanzi labwino, kuwonjezera pa kuchiritsa gastroparesis. Matenda a mitsempha ya diabetes akamachoka, amuna ambiri amatha kusintha potency.

Njira zothandizira kutsuka kwa m'mimba mutatha kudya zimagawidwa m'magulu anayi:

• kumwa mankhwala
• zolimbitsa thupi ndi kutikita minofu mukatha kudya,
• kusintha kwakung'ono pakudya
• Kusintha kwakukuru pakudya, kugwiritsa ntchito zakudya zamadzimadzi kapena zamadzimadzi.

Monga lamulo, njira zonsezi zokha sizigwira ntchito mokwanira, koma palimodzi zimatha kukwaniritsa shuga yabwinobwino ngakhale muzovuta kwambiri. Mukawerenga nkhaniyi, mutha kuwona momwe mungazisinthire kuzolowera zomwe mumakonda komanso zomwe mumakonda.

Zolinga zochizira odwala matenda a shuga:

• Kuchepetsa kapena kufafaniza kwathunthu kwa zizindikiro - kukwiya koyamba, nseru, kupindika
• Kuchepetsa kuchuluka kwa shuga wotsika mukatha kudya.
• Matenda a shuga m'magazi m'mimba yopanda kanthu (chizindikiro chachikulu cha gastroparesis).
• Supu yosalala imayenda, zotsatira zokhazikika za kudziletsa kwathunthu kwa shuga.

Mutha kufikira mfundo zitatu zomaliza kuchokera pamndandandawu ngati mungagwiritse gastroparesis ndipo nthawi yomweyo mumatsata zakudya zamagulu ochepa. Mpaka pano, palibe njira yochotsera shuga kwa odwala matenda ashuga omwe amatsata zakudya “zopatsa thanzi” zomwe zadzaza ndi mafuta. Chifukwa chakuti zakudya zotere zimafunikira jakisoni waukulu wa insulin, yemwe amakhala osakonzekera. Dziwani momwe njira zoyezera kuwala zili ngati simunachitebe.

Mankhwala mu mawonekedwe a mapiritsi kapena madzi manyumwa

Palibe mankhwala omwe angachiritse odwala matenda a shuga. Chokhacho chomwe chitha kuthana ndi zovuta za shuga uyu ndi shuga wabwinobwino kwa zaka zingapo motsatizana. Komabe, mankhwala ena amatha kufulumizitsa kutulutsa m'mimba mutatha kudya, makamaka ngati gastroparesis yanu ili yofatsa kapena yochepa. Izi zimathandiza kusinthasintha kusinthasintha kwa shuga m'magazi.

Anthu ambiri odwala matenda ashuga amayenera kumwa mapiritsi asanadye. Ngati gastroparesis ali wofatsa, ndiye kuti mwina mungathe kumwa mankhwala musanadye chakudya chamadzulo. Pazifukwa zina, kugaya chakudya chamadzulo mwa odwala omwe ali ndi matenda ashuga ndizovuta kwambiri. Mwina chifukwa atatha kudya chakudya samachita masewera olimbitsa thupi kuposa masana, kapena chifukwa amadya chakudya chamadzulo chachikulu. Amayesedwa kuti m'mimba mutatha kudya chakudya chamagulu athanzi ndimachedwachedwa kuposa chakudya.

Mankhwala a matenda a shuga a gastroparesis atha kukhala ngati mapiritsi kapena madzi amadzimadzi. Mapiritsi nthawi zambiri sagwira ntchito, chifukwa asanayambe kuchita zinthu, ayenera kusungunuka ndikuyamba kulowa m'mimba. Ngati ndi kotheka, ndibwino kugwiritsa ntchito mankhwala amadzimadzi. Mapiritsi aliwonse omwe mumamwa a matenda a shuga a gastroparesis ayenera kutafuna mosamala musanameze. Ngati mumwa mapiritsi osatafuna, ndiye kuti ayamba kumangokhala maola ochepa.

Super Papaya Enzyme Plus - Mapiritsi a Enzyme Chewable

Dr. Bernstein mu buku lake Dr. Diabetes Solution ya Bernstein imalemba kuti kumwa michere yamafuta kumathandizira odwala ambiri omwe ali ndi matenda a shuga a gastroparesis. Makamaka, akuti odwala makamaka amatamanda Super Papaya Enzyme Plus. Awa ndi miyala yosiyanasiyana yosinthika. Amathetsa mavuto a kutulutsa magazi ndi kuyamwa, ndipo odwala matenda ashuga ambiri amathandiza kusinthasintha kwa shuga m'magazi omwe amakumana nawo chifukwa cha gastroparesis.

Super Papaya Enzyme Plus ilinso ndi ma enzymes papain, amylase, lipase, cellulase ndi bromelain, omwe amathandiza kugaya mapuloteni, mafuta, chakudya ndi michere adakali m'mimba. Ndikulimbikitsidwa kutafuna mapiritsi a 3-5 pachakudya chilichonse: musanayambe kudya, ndi chakudya, komanso mukatha. Izi zimakhala ndi sorbitol ndi zotsekemera zina, koma zochepa, zomwe siziyenera kukhala ndi chidwi ndi shuga m'magazi anu.Pano ndikunena za mankhwala omwe ali ndi michere yokugaya, chifukwa Dr. Bernstein amalemba za iye mbuku lake. Tsitsani malangizo a momwe mungayitanitsire malonda pa iHerb poperekera ma phukusi amakalata.

Motilium (domperidone)

Kwa matenda a shuga a shuga, Dr. Bernstein amafotokoza mankhwalawa mwanjira yotsatirayi - kutafuna mapiritsi awiri a 10 mg ola limodzi musanadye ndi kumwa kapu yamadzi, mutha kumwa. Musachulukitse mlingo, chifukwa izi zimatha kubweretsa mavuto ndi potency mwa amuna, komanso kuchepa kwa msambo kwa akazi. Domperidone ndiye chinthu chogwira ntchito, ndipo Motilium ndi dzina lamalonda lomwe mankhwalawo amagulitsidwa.

Motilium imalimbikitsa kutuluka kwa chakudya kuchokera m'mimba mutatha kudya mwapadera, osati monga mankhwala ena omwe afotokozedwera. Chifukwa chake, ndikofunikira kugwiritsa ntchito kuphatikiza ndi mankhwala ena, koma osati ndi metoclopramide, yomwe tikambirana pansipa. Zotsatira zoyipa ngati zimachitika chifukwa chotenga Motilium, ndiye kuti amazimiririka akasiya kugwiritsa ntchito mankhwalawa.

Metoclopramide

Metoclopramide mwina ndiyomwe imalimbikitsanso mwamphamvu kwambiri pambuyo poti wadya. Imagwira chimodzimodzi monga domperidone, inhibiting (inhibiting) zotsatira za dopamine m'mimba. Mosiyana ndi domperidone, mankhwalawa amalowa mu ubongo, chifukwa chake nthawi zambiri amayambitsa zovuta zoyipa - kugona, kukhumudwa, nkhawa, komanso ma syndromes omwe amafanana ndi matenda a Parkinson. Mwa anthu ena, izi zimachitika nthawi yomweyo, pomwe ena - atatha miyezi ingapo ya chithandizo ndi metoclopramide.

Mankhwala okhala ndi vuto la metoclopramide ndi diphenhydramine hydrochloride, yomwe imadziwika kuti diphenhydramine. Ngati makina a metoclopramide adayambitsa zotsatira zoyipa kwambiri kotero kuti amafunika kuthandizidwa ndi diphenhydramine hydrochloride, ndiye kuti metoclopramide iyenera kusiyidwa kosatha. Kulekeratu mwadzidzidzi kwa metoclopramide ndi anthu omwe amathandizidwa kwa miyezi itatu kapena kupitilira apo kungayambitse chikhalidwe cha psychotic. Chifukwa chake, mlingo wa mankhwalawa mpaka zero uyenera kuchepetsedwa.

Pochiza matenda a shuga a shuga, Dr. Bernstein amati mankhwala a metoclopramide okha atakhala kwambiri, chifukwa zotsatira zoyipa zimachitika ndipo zimakhala zoopsa. Musanagwiritse ntchito chida ichi, yesani zina zonse zomwe talemba mndandandandawu, kuphatikizapo masewera olimbitsa thupi, kutikita minofu ndi kusintha kwa zakudya. Mutha kutenga metoclopramide pokhapokha malinga ndi madokotala komanso muyezo womwe akuwonetsa.

Betaine hydrochloride + pepsin

Betaine hydrochloride + pepsin ndi kuphatikiza kwamphamvu komwe kumapangitsa kusokonezeka kwa chakudya chodyedwa m'mimba. Chakudya chochuluka chikamabedwa m'mimba, nthawi zambiri chimatha kulowa m'matumbo. Pepsin ndi enzyme yokumba m'mimba. Betaine hydrochloride ndi zinthu zomwe zimapangidwa ndi hydrochloric acid, zomwe zimawonjezera acidity yam'mimba. Musanayambe kumwa betaine hydrochloride + pepsin, pimani ndi katswiri wa gastroenterologist ndikuwonana naye. Ganizirani kuchuluka kwa madzi mumimba wanu. Ngati acidity ndi yokwera kapena yabwinobwino - betaine hydrochloride + pepsin siyabwino. Ichi ndi chida champhamvu, koma ngati chikugwiritsidwa ntchito popanda kutsimikizira kwa dokotala, zotsatira zake zimakhala zazikulu. Amapangidwira anthu omwe ali ndi acidity yowonjezera yam'mimba. Ngati acidity yanu ndiyabwinobwino, ndiye yesani Super Papaya Enzyme Plus enzyme kit, yomwe tidalemba pamwambapa.

Betaine hydrochloride + pepsin angagulidwe ku mankhwalawa monga mapiritsi Acidin-Pepsin

kapena oda kuchokera ku USA ndikutumiza makalata, mwachitsanzo, mwanjira yowonjezera iyi

Dr. Bernstein adalimbikitsa kuyamba ndi piritsi limodzi kapena kapisozi mkati mwa chakudya.Osamamwa betaine hydrochloride + pepsin pamimba yopanda kanthu! Ngati kutentha kwa m'mtima sikuchitika kuchokera kapisozi imodzi, ndiye kuti nthawi ina mukadzayesa kuwonjezera kuchuluka kwa mankhwalawa mpaka 2, kenako pamabotolo atatu pachakudya chilichonse. Betaine hydrochloride + pepsin simalimbikitsa mitsempha ya vagus. Chifukwa chake, chida ichi chimathandizira ngakhale muzovuta kwambiri za matenda a shuga. Komabe, ali ndi ma contraindra ambiri komanso zolephera zake. Contraindication - gastritis, esophagitis, zilonda zam'mimba kapena zilonda zam'mimba.

Zolimbitsa Thupi Zomwe Zimathamanga Mafuta Atatha Kutha

Mankhwala olimbitsa thupi ndi othandiza kwambiri kuposa mankhwala pochiza matenda a shuga. Komanso ndi yaulere ndipo ilibe zotsatira zoyipa. Monga momwe ziliri ndi zovuta zina zonse zokhudzana ndi matenda a shuga, mankhwala amafunikira okhawo omwe ali ndi ulesi kwambiri kuti athe kuchita masewera olimbitsa thupi. Chifukwa chake, tiyeni tiwone zomwe zimathandizira kutifulumizire chakudya kuchokera m'mimba mutatha kudya. Pamimba yathanzi, minyewa yosalala ya makoma imakhala yokhazikika kuti chakudya chizitha kudutsa m'mimba. M'mimba yomwe idakhudzidwa ndi matenda a diabetes a gastroparesis, mawonekedwe a makhoma ndi otupa ndipo sagwidwa. Ndipo mothandizidwa ndi masewera olimbitsa thupi osavuta omwe tidzafotokozere pansipa, mutha kuyeseza izi ndikuchita mwachangu komanso kuthamanga ndi chakudya kuchokera m'mimba.

Mwina mwazindikira kuti kuyenda mukatha kudya kumakongoletsa kugaya. Izi ndizofunika kwambiri kwa odwala omwe ali ndi matenda ashuga a gastroparesis. Chifukwa chake, zolimbitsa thupi zoyambirira zomwe Dr. Bernstein adalimbikitsa zikuyenda mwachangu kapena mwachangu kwa ola limodzi mutatha kudya, makamaka mutadya chakudya chamadzulo. Timalimbikitsa kuti musayende nkomwe, koma kuthamangitsana molingana ndi luso la Chi-run. Pogwiritsa ntchito njirayi, simusangalala kuthamanga ngakhale mutadya. Onetsetsani kuti kuthamanga kumatha kukupatsani chisangalalo!

Ntchito yotsatira idagawidwa ndi Dr. Bernstein ndi wodwala yemwe adamuzindikira kuchokera kwa wophunzitsa ake a yoga ndipo adawonetsetsa kuti zimathandizadi. Ndikofunikira kujambula m'mimba mwakuya momwe mungathere kuti amamatire nthiti, kenako ndikuwakhomerera kotero kuti imakhala yayikulu komanso yotumphuka, ngati ng'oma. Mukatha kudya, mungolankhula mobwerezabwereza izi mobwereza bwereza monga momwe mungathere. Pakupita milungu kapena miyezi ingapo, minofu yanu yam'mimba imakhala yolimba komanso yolimba. Mutha kubwereza zolimbitsa thupi pafupipafupi musanatope. Cholinga ndikuchipha nthawi zingapo. Ma reps 100 amatenga mphindi zosakwana 4. Mukaphunzira kuchita kubwereza 300-400 ndikugwiritsa ntchito mphindi 15 mukatha kudya, kusinthasintha kwa shuga m'magazi kumakhala kosalala.

Ntchito yofananira yomwe muyenera kuchita mutatha kudya. Kukhala kapena kuyimirira, kugwada m'mbuyo momwe mungathere. Kenako yendani mtsogolo momwe mungathere. Bwerezani kangapo mzere momwe mungathere. Ntchito iyi, komanso yomwe yaperekedwa pamwambapa, ndiyophweka, ingaoneke yopusa. Komabe, zimathandizira kutuluka kwa chakudya kuchokera m'mimba mutatha kudya, kuthandizira odwala matenda a shuga, komanso kusintha shuga m'magazi mukalangidwa.

Chungamu - njira yothetsera matenda a shuga a gastroparesis

Mukafuna kutafuna, ma cell amamasulidwa. Simangokhala ndi ma enzymes am'mimba, komanso imathandizira kusintha kosavuta kwa minofu pamakoma am'mimba ndikutsitsimutsa pyloric vala. Chungamu chopanda shuga sichikhala ndi gramu imodzi yokha ya xylitol, ndipo ndizokayikitsa kuti zingakhale ndi vuto lalikulu m'magazi anu. Muyenera kutafuna mbale imodzi kapena ngalande kwa ola lathunthu mutatha kudya. Izi zimathandizira patsogolo pa matenda a diabetesic gastroparesis, kuwonjezera pa masewera olimbitsa thupi komanso kusintha kwa zakudya. Osagwiritsa ntchito ma mbale angapo kapena ma dumplings motsatana, chifukwa izi zimatha kukweza shuga lanu lamagazi.

Momwe mungasinthire zakudya za odwala matenda ashuga kuthana ndi gastroparesis

Njira zopewera kudya matenda a shuga a gastroparesis ndi othandiza kwambiri kuposa mankhwala. Makamaka ngati muwaphatikiza ndi masewera olimbitsa thupi omwe afotokozedwa gawo lapita. Vutoli ndikuti anthu omwe ali ndi matenda a shuga sakonda kwenikweni kusintha kwa zakudya zomwe zimayenera kukhazikitsidwa. Tiyeni tiwonetse zosintha izi, kuyambira zazing'ono mpaka zovuta:

• Muyenera kumwa magalasi awiri amadzi musanadye chilichonse. Madzi awa sayenera kukhala ndi shuga ndi zakudya zina, komanso khofi ndi mowa.
• Chepetsani magawo a fiber, kapena siyani kudya. CHIKWANGWANI chomwe chimakhala ndi masamba, chomwe kale chimaperera mu blender, mpaka theka lamadzi.
• Tafuna zakudya zonse zomwe mumadya pang'onopang'ono komanso mosamala. Tchafu aliyense kuluma kangapo 40.
• Chotsani nyama muzakudya zomwe sizinayikidwepo mu chopukusira nyama, mwachitsanzo pitani kuma-nyama. Pewani nyama zonse zomwe ndizovuta kugaya. Iyi ndi ng'ombe, mbalame yamafuta, nkhumba ndi masewera. Ndiosafunanso kudya nsomba za nkhono.
• Idyani chakudya cham'mawa kwambiri, maola 5-6 musanagone. Chepetsani gawo la mapuloteni pakudya chamadzulo, ndikusintha gawo la mapuloteni kuchokera pakudya cham'mawa ndikuyamba kudya m'mawa.
• Ngati simukubaya jakisoni mwachangu musanadye, ndiye kuti musadye katatu pa tsiku, koma pafupipafupi, katatu, m'malo ochepa.
• Muzovuta kwambiri za matenda ashuga gastroparesis, sinthani ku zakudya zamadzimadzi ndi zamadzimadzi.

Mimba yomwe imakhudzidwa ndi matenda a shuga a gastroparesis, sungunuka komanso osakonzeka kupanga ubongo ungapangitse nkhata ya nkhumba ndikugudubuza koloko yolowera pachipata. Mu nthawi yokhazikika, izi sizovuta, chifukwa valavu yolondera pachipata ndi lotseguka. Ngati matenda ashuga a gastroparesis ali ofatsa, magazi amawongolera shuga mukamachepetsa gawo lazakudya, muzichotsa, kapena kupera masamba mu blender kuti athandizire kugaya. Osagwiritsa ntchito mankhwala othimbirira omwe ali ndi CHIKWANGWANI mumtundu wa nthomba za fulakesi kapena nthata yamabala.

Tumizani gawo lamapuloteni anu pakudya kwa nkhomaliro komanso chakudya cham'mawa m'malo mwa chakudya chamadzulo

Kwa anthu ambiri, chakudya chachikulu masana ndi chakudya chamadzulo. Chakudya chamadzulo, amadya kwambiri nyama kapena zakudya zina zama protein. Kwa odwala matenda ashuga omwe apanga gastroparesis, chakudyachi chimapatsa mphamvu shuga wamagazi m'mawa m'mimba yopanda kanthu. Mapuloteni anyama, makamaka nyama yofiyira, nthawi zambiri amatchinga pyloric vala m'mimba, yomwe imapangidwa chifukwa cha kuphipha kwa minofu. Chithandizo - Sinthani zina mwa mapuloteni anu aminyama chakudya cham'mawa komanso nkhomaliro.

Musasiye zosaposa 60 magalamu a mapuloteni pazakudya, ndiye kuti, zosaposa 300 magalamu a chakudya chama protein, ngakhale zochepa ndizabwino. Itha kukhala nsomba, nyama monga ma cutlets kapena nyama yokhala ndi ng'ombe, tchizi kapena mazira. Onetsetsani kuti chifukwa cha izi, shuga m'mawa pamimba yopanda kanthu ayandikira kwambiri. Inde, mukasamutsa mapuloteni kuchokera ku chakudya chamadzulo kupita ku chakudya china, ndiye kuti kuchuluka kwa insulin yofulumira musanadye kuyeneranso kusunthidwa pang'ono. Mwinanso, kuchuluka kwa mapiritsi a insulin kapena a shuga usiku amatha kuchepetsedwa popanda kuwononga shuga m'mawa.

Zitha kuzindikirika kuti chifukwa chosamutsa gawo la mapuloteni kuchokera ku chakudya cham'mawa ndikuyamba kudya masana, shuga wanu ayamba kuchuluka pambuyo pa chakudya, ngakhale mutasintha molondola mlingo wa insulini musanadye. Ichi ndi choyipa chocheperako kuposa kupilira shuga wambiri usiku wonse. Ngati simukubayira insulin mwachangu musanadye, idyani zakudya zazing'ono kangapo patsiku kuti shuga akhale yokhazikika komanso yoyandikira. Ndipo ngati simukubayira insulini konse, ndiye kuti ndibwino kudya kangapo ka 5-6 patsiku m'magawo ang'onoang'ono. Kumbukirani kuti ngati mutaba jakisoni wambiri musanadye, muyenera kudya maola asanu aliwonse kuti zotsatira za mankhwala a insulin zisadutse wina ndi mnzake.

Kumwa mowa ndi khofi kumachepetsa kuthamangitsidwa kwa chakudya m'mimba mutatha kudya. Zomwe zimachitika peppermint ndi chokoleti.Zinthu zonsezi ziyenera kupewedwa, makamaka pakudya chamadzulo, ngati matenda anu a shuga a gastroparesis ali ochepa kapena oopsa.

Zakudya zamadzimadzi ndi zamadzimadzi - njira yothandiza kwambiri ya gastroparesis

Njira yayikulu yochizira matenda ashuga gastroparesis ndikusinthira ku zakudya zamadzimadzi kapena zamadzimadzi. Ngati izi zachitika, ndiye kuti munthu amataya gawo lalikulu la chisangalalo cha kudya. Anthu ochepa ngati izi. Komabe, iyi ingakhale njira yokhayo yotsimikizira kuti shuga mumagazi odwala matenda ashuga ayandikira kwambiri. Ngati mukuyang'anira kwa miyezi ingapo kapena zaka, ndiye kuti kugwira ntchito kwa mitsempha ya vagus kumachira pang'onopang'ono ndipo gastroparesis ikadutsa. Kenako ndizotheka kudya mwachizolowezi popanda kusiya kuwongolera shuga. Njira iyi nthawi ina anali Dr. Bernstein mwiniwake.

Zakudya zowonjezera zamadzimadzi zokhala ndi matenda am'mimba a shuga a gastroparesis zimaphatikizapo chakudya cha ana ndi yogurt yoyera yonse ya mkaka. Mutha kugula ndiwo zamasamba ochepa mafuta ogulitsira, komanso zakudya zamafuta zopanda nyama zamafuta m'mitsuko yokhala ndi zakudya za ana. Muyenera kuphunzira malembedwe mosamala posankha zinthu izi. Momwe mungasankhire yogati, tidzakambirana pansipa. Yogati okha ndioyenera, omwe siamadzimadzi, koma mawonekedwe a zakudya. Zikugulitsidwa ku Europe ndi United States, koma ndizovuta kulowa m'maiko olankhula Russia.

M'nkhani yopanga menyu wazakudya zamagulu owonjezera, tanena kuti masamba omwe adapangidwa bwino, amalimbikitsa shuga mwachangu. Kodi izi zikugwirizana bwanji ndikulimbikitsidwa kudya masamba owerengeka amadzimadzi a shuga a gastroparesis? Chowonadi ndi chakuti ngati vuto la shuga ili likukula, ndiye kuti chakudya chimalowa m'mimba kuchokera m'mimba kulowa m'matumbo pang'onopang'ono. Izi zimagwiranso ntchito kumasamba amadzimadzi amadzimadzi okhala ndi zakudya za ana. Ngakhale masamba “okoma” kwambiri sakhala ndi nthawi yokwaniritsa magazi munthawi kuti agwirizane ndi insulin yofulumira, yomwe mumabayidwa musanadye. Ndipo, mwachidziwikire, zidzakhala zofunikira kuchepetsa kuchepa kwa insulin yochepa musanadye, kusakaniza ndi sing'anga NPH-insulin protafan.

Ngati mungasinthe zakudya zosafunikira kuti muchepetse matenda a shuga, ndiye yesetsani kupewa kuperewera kwa thupi lanu. Munthu yemwe amakhala moyo wongokhala amayenera kudya 0,8 magalamu a mapuloteni pa 1 kg ya thupi lake labwino patsiku. Zakudya zamapuloteni zimakhala ndi pafupifupi 20% ya mapuloteni oyera, i.e., muyenera kudya pafupifupi magalamu anayi a mapuloteni pa 1 makilogalamu olemera a thupi. Ngati mukuganiza za izi, ndiye kuti izi sizokwanira. Anthu omwe amachita maphunziro akuthupi, komanso ana ndi achinyamata omwe amakula, amafunikira mapuloteni 1.5-2 nthawi yambiri.

Yogwiritsa ntchito mkaka yoyera mkaka ndimtundu wambiri (!) Yoyenera kudya zakudya zamagulu ochepa a shuga, kuphatikizapo matenda ashuga a shuga. Izi zikutanthawuza yogati yoyera mu mawonekedwe a zakudya, osati amadzimadzi, opanda mafuta, popanda kuwonjezera shuga, zipatso, kupanikizana, etc. Zimapezeka kwambiri ku Europe ndi USA, koma osati m'maiko olankhula ku Russia. Mu yogati iyi pofuna kulawa, mutha kuwonjezera Stevia ndi sinamoni. Osamadya yogurt yamafuta ochepa chifukwa imakhala ndi zakudya zochuluka kuposa matenda ashuga.

Timagwiritsa ntchito zakudya zamadzimadzi kuti tiletse matenda a diabetes a gastroparesis ngati theka la madzi silithandiza kwenikweni. Izi ndi zinthu zapadera kwa anthu omwe akuchita ntchito yolimbitsa thupi. Zonsezi zimakhala ndi mapuloteni ambiri, zimagulitsidwa ngati ufa womwe muyenera kuswana m'madzi ndi zakumwa. Ndife oyenera okha omwe amakhala ndi mavitamini pang'ono osakhala owonjezera a "chemistry" monga anabolic steroid. Gwiritsani ntchito mapuloteni omanga opangidwa kuchokera ku mazira kapena Whey kuti mumange asidi onse amino omwe thupi lanu limafunikira. Zogulitsa Zoyimbitsa Mapuloteni a Soy Sindizo Zabwino Kwambiri. Zitha kukhala ndi zinthu - ma sterols - mu mawonekedwe ofanana ndi estrogen yaikazi.

Momwe mungabayitsire insulin musanadye kuti agwirizane ndi gastroparesis

Njira zachilendo zogwiritsira ntchito insulin mwachangu musanadye sizoyenera kudwala matenda a shuga. Amawonjezera chiopsezo cha hypoglycemia chifukwa chakuti chakudya chimatengedwa pang'onopang'ono ndipo alibe nthawi yakukweza shuga m'magazi panthawi. Chifukwa chake, muyenera kuchepetsa kuchepa kwa insulin. Choyamba, pezani mothandizidwa ndi glucometer, momwe chakudya chodyedwacho chimachepetsedwa. Ikani insulin yambiri musanadye ndi yochepa. Mutha kuyesa kuwaza osati mphindi 40-45 musanadye, monga timakonda, koma musanakhale pansi kuti mudye. Pankhaniyi, gwiritsani ntchito njira zowongolera gastroparesis, yomwe tafotokozera pamwambapa.

Ngati, ngakhale zili choncho, insulin yochepa imagwiranso ntchito mwachangu, ndiye kuti yesani kubayira pakati pakudya kapena mukamaliza kudya. Njira yotsogola kwambiri ndikusintha gawo lina la insulin yochepa ndi sing'anga NPH-insulin. Matenda a diabetesic gastroparesis ndi okhawo omwe amaloledwa kusakaniza mitundu ingapo ya insulini imodzi.

Tiyerekeze kuti mukufunikira kubaya mankhwala osakanikirana a magawo anayi a insulin yifupi ndi 1 unit ya sing'anga ya NPH-insulin. Kuti muchite izi, mumayamba jekeseni magawo anayi a insulini yochepa, monga mwachizolowezi. Kenako ikani singano ya syringe mu vial ya NPH-insulin ndikugwedeza gawo lonse kangapo mwamphamvu. Nthawi yomweyo tengani 1 UNIT ya insulin kuchokera ku vial, mpaka ma protein a protamine akhale ndi nthawi yokhazikika atagwedezeka, komanso pafupifupi 5 U ya mpweya. Mafuta otulutsa mpweya amathandizira kusakaniza kufupikitsa ndi NPH-insulin mu syringe. Kuti muchite izi, tembenuzirani syringe kangapo. Tsopano mutha kubaya insulini yosakanikirana ndi mpweya wocheperako. Mabatani am'mlengalenga osavulaza sangawononge chilichonse.

Ngati muli ndi matenda a diabetes a gastroparesis, ndiye kuti musagwiritse ntchito insulin yolimba mwachangu mwachangu musanadye. Chifukwa ngakhale insulini yocheperako wamba imakhalanso mwachangu pamachitidwe otere, ndipo makamaka, ultrashort, yomwe imagwira ntchito mwachangu kwambiri, siyabwino. Ultrashort insulini ingagwiritsidwe ntchito ngati chowongolera kuti achulukitse shuga. Ngati mungabaye jekeseni yafupikitsa ndi NPH-insulin musanadye, mutha kulowa m'manda pokhapokha mutadzuka. Monga insulin yachangu musanadye, mutha kugwiritsa ntchito yochepa chabe kapena osakaniza pang'ono ndi NPH-insulin.