Chizindikiro choopsa: kupuma movutikira ndi matenda a shuga ndi mndandanda wa matenda am'mapapu omwe angasonyeze

Pulmonary edema ndi kuwonjezereka kwa kuchuluka kwa madzi mu mapapu. Ndi edema ya pulmonary, madzimadzi amasonkhana m'malo osiyanasiyana kunja kwa mitsempha ya m'magazi. Mu mtundu umodzi wa edema, wotchedwa Cardiogenic pulmonary edema, thukuta la madzimadzi limachitika chifukwa cha kuchuluka kwa kupanikizika m'mitsempha ndi m'mapapo. Monga vuto la matenda a mtima, edema ya m'mapapo imatha kukhala yovuta, komanso palinso edema yam'mapapo yam'mimba, yomwe imayamba mwachangu ndipo imatha kudzetsa kuti wodwala aphedwe kwakanthawi.

Zomwe zimayambitsa pulmonary edema

Nthawi zambiri pulmonary edema imachitika chifukwa chosakwanira kwamanzere kwamitsempha, chipinda chachikulu cha mtima, chifukwa cha matenda amtima. M'mikhalidwe yina ya mtima, kupanikizika kowonjezereka kumafunikira kuti mudzaze gawo lamanzere lamanzere kuti muwonetsetse magazi okwanira kumadera onse a thupi. Chifukwa chake, kupanikizika kumachulukanso m'zipinda zina za mtima ndi m'mitsempha ya m'mapapo komanso ma capillaries.

Pang'onopang'ono, gawo la magazi limalowa m'malo omwe amapezeka pakati pa minyewa yam'mapapo. Izi zimalepheretsa kufalikira kwa mapapu komanso kusokoneza kusinthana kwa mpweya mkati mwake. Kuphatikiza pa nthenda ya mtima, pali zinthu zina zomwe zimayambitsa matenda a pulmonary edema:

• magazi owonjezera m'mitsempha
• Matenda a impso, kupsa kwambiri, matenda a chiwindi, kuchepa kwa zakudya,
• kuphwanya kutuluka kwa m'mimba m'mapapo, monga momwe amanenera ndi matenda a Hodgkin,
• kuchepa kwa magazi kuchokera kuchipinda chakumanzere kwa mtima (mwachitsanzo, ndi kuchepetsedwa kwa valavu ya mitral),
• zovuta zomwe zimayambitsa mitsempha ya m'mapapo.

Zizindikiro za pulmonary edema

Zizindikiro zake koyambirira kwa edema ya m'mapapo zimawonetsa kuchepa kwam'mapapo komanso kupangika kwa mapangidwe. Izi zikuphatikiza:

• kupuma movutikira
• kuvutika mwadzidzidzi kwa tulo tofa nato,
• kupuma movutikira, komwe kumathandizika kukhala pansi,
• kutsokomola.

Mukamawunika wodwala, zimachitika mwachangu, kupuma mwachangu, mawu osamveka mukamamvetsera, kutupa kwa mitsempha ya khomo pachibelekeropo komanso kupatuka kwa mawu wamba. Ndi edema yowopsa yamapapu, pamene ma alveolar sacs ndi ma airways ang'onoang'ono akadzaza ndimadzi, mkhalidwe wa wodwalayo umakulirakulira. Kupuma kufulumizitsa, kumakhala kovuta, sputum sputum yokhala ndi mitsempha yamagazi imamasulidwa ndi chifuwa. Kugunda kumafulumira, mitsempha ya mtima imasokonekera, khungu limayamba kuzizira, kumata ndikuyamba kusuntha, thukuta limakulirakulira. Mtima ukamapopa pang'ono, magazi amachepa, zimachitika ngati ulusi.

Kuzindikira kwa edema ya m'mapapo

Kuzindikira kwa edema ya pulmonary kumapangidwa pamaziko a zisonyezo ndi kuyesedwa kwakuthupi, ndiye kuti kafukufuku wa mpweya omwe ali m'magazi am'mimba amalembedwa, omwe nthawi zambiri amawonetsa kuchepa kwa okosijeni. Nthawi yomweyo, kuphwanya kwa acid-base balance komanso acid-base balance, komanso metabolic acidosis, titha kuonanso. Pifuba x-ray nthawi zambiri imawulula poyipa mumapapu ndipo nthawi zambiri matekinoloje a mtima komanso kutulutsa kwambiri m'mapapu. Nthawi zina, pulmonary artery catheterization imagwiritsidwa ntchito pozindikira, yomwe imatha kutsimikizira kulephera kwamitsempha yamagetsi ndikuwongolera matenda akulu a kupuma, zomwe zimafanana ndi za mapapu a edema.

Mukamayang'ana wodwala pakuwonekera, mawonekedwe a wodwalayo, malo okakamizidwa pabedi, ndi machitidwe ake (chisangalalo ndi mantha) ndizofunikira. Kutali, kupuma ndi phokoso kumveka. Mukamamvetsera (kukhudzika) kwa mtima, kutchulidwa kwa tachycardia kumadziwika (kugunda kwamphamvu kwa mtima mpaka 150 kugunda pamphindi kapena kupitilira), kupuma mosasamala, mawu amtima samveka chifukwa cha "phokoso" pachifuwa. Chifuwa chikukula. ECG (electrocardiogram) - mkati mwa edema ya pulmonary, kusokonezedwa kwamtundu wa mtima kumalembedwa (kuchokera ku tachycardia kupita ku zovuta zazikulu mpaka infarction ya myocardial). Pulse oximetry (njira yodziwira kuchuluka kwa magazi, mpweya) - wokhala ndi pulmonary edema, kuchepa kwambiri kwa oksijeni m'magazi kutsimikiziridwa kuti 90%.

Pulmonary edema mankhwala

Chithandizo cha pulmonary edema ziyenera kuchitika mu chipinda cha odwala osamalidwa bwino. Malangizo amathandizidwe mwachindunji zimatengera zizindikiro za kuzindikira, kuthamanga kwa mtima, kuthamanga kwa magazi, ndipo aliyense payekhapayekha amatha kusiyanasiyana. Mfundo zoyambira ndi izi:

• Kuchepetsa kukondwerera kwa kupuma kwapakati.
• Kuchulukitsa kwa mgwirizano wamtima.
• Kutsitsa kufalikira kwa m'mapapo.
• Mankhwala othandizira okosijeni (kuchuluka kwa mpweya wa okosijeni).
• Kugwiritsa ntchito mankhwala osokoneza bongo (sedative).

Wodwalayo amapatsidwa malo okhala pakama, miyendo yake imayendetsedwa pansi kuti achepetse magaziwo kumtima. Kuchepetsa kukondwerera kwa kupuma komanso kuchepetsa kupanikizika m'mapapo, 1 ml ya 1% morphine solution imayendetsedwa. Mochulukitsa, 2 ml ya droperidol imayendetsedwa kudzera m'mitsempha. Ndi tachycardia yayikulu, 1 ml ya 1% yankho la diphenhydramine kapena suprastin imayendetsedwa. Mankhwala othandizira okosijeni (mpweya wotsekemera wa magazi ndi inhalation) umachitika polumikizitsa wodwalayo ku chipangizocho ndi okosijeni kapena mpweya wa okosijeni wokhala ndi zotuluka zakumwa (kuphatikiza magazi ndi mpweya ndikuchepetsa thobvu). Ndi magazi abwinobwino, okodzetsa a 80 mg a furosemide amathandizira kudzera m'mitsempha.

Kuwongolera kutsekemera kwa mtima, ma glycosides amtima amaperekedwa (1 ml ya corglycon solution kapena 0,5 ml ya strophanthin solution, m'mbuyomu yankho limatsitsidwa mu 20 ml ya saline yamoyo). Kuti mumasulidwe myocardium, piritsi limodzi la nitroglycerin limatengedwa pansi pa lilime ndipo yankho la nitroglycerin limayendetsedwa motsatiridwa (mothandizidwa ndi magazi). ACE inhibitors (enalapril) amagwiritsidwa ntchito kukulitsa mitsempha yamagazi ndikuchepetsa katundu pamtima. Tiyenera kukumbukira kuti mosiyana ndi mapangidwe a pulmonary edema, kuthamanga kwa magazi kumatha kuchepa (mpaka kugwedezeka) kapena kuwonjezeka (mpaka vuto lalikulu kwambiri), kayendedwe ka mtima kamatha kusokonezeka. Kuchiza kuyenera kuchitika motsogozedwa ndi mkhalidwe wa wodwalayo ndi kuyesa kosalekeza kwa kuthamanga kwa magazi.

Matenda a shuga chibayo: mankhwala ndi zizindikiro za zovuta

Matenda a shuga amapezeka motsutsana ndi maziko a vuto la metabolic, momwe wodwalayo amakhala ndi shuga wambiri m'magazi. Pali mitundu iwiri yotsogolera. Poyamba, kapamba samatulutsa insulini, chachiwiri - timadzi timatulutsa timadzi tomwe timapanga, koma sizadziwika ndi maselo amthupi.

Chodabwitsa chachikulu cha matenda ashuga ndichakuti anthu samafa ndi matendawa omwe, koma kuchokera kuzovuta zomwe zimayambitsa matenda a hyperglycemia. Kukula kwa zotsatira kumalumikizidwa ndi njira ya microangiopathic komanso glycosation ya mapuloteni a minofu. Chifukwa cha kuphwanya kotero, chitetezo cha mthupi sichichita ntchito zake zoteteza.

Mu matenda a shuga, kusintha kumachitikanso ma capillaries, maselo ofiira amwazi, komanso metabolism ya oxygen. Izi zimapangitsa kuti thupi lizitha kutenga matenda. Potere, chiwalo chilichonse kapena dongosolo lililonse, kuphatikiza mapapo, limatha kukhudzidwa.

Chibayo mu shuga chimachitika pamene kupuma kwamphamvu kumayambitsa matenda. Nthawi zambiri kufalitsa kachilombo ka tizilomboka kumachitika ndi timadzola ta ndege.

Zoyambitsa ndi Zoopsa

Nthawi zambiri, chibayo chimayamba chifukwa cha kuzizira kapena nyengo. Koma pali zifukwa zina za chibayo mwa odwala matenda ashuga:

• aakulu hyperglycemia,
• kufooka chitetezo chokwanira
• pulmonary microangiopathy, momwe masinthidwe a pathological amapezeka m'matumbo a ziwalo zopumira.
• mitundu yonse yamatenda oyanjana.

Popeza shuga wokwera amapereka malo abwino mthupi la wodwalayo kuti mulowetse matenda, odwala matenda ashuga ayenera kudziwa kuti ndi mankhwala ati omwe angayambitse kutupa m'mapapo.

Wodziwika bwino wa causative wothandizira chibayo cha nosocomial ndi chikhalidwe chokhazikika ndi Staphylococcus aureus. Ndipo chibayo cha bakiteriya mu odwala matenda ashuga chimayambitsa osati matenda a staphylococcal, komanso Klebsiella pneumoniae.

Nthawi zambiri ndi matenda oopsa a hyperglycemia, chibayo cha atypical choyambitsidwa ndi ma virus chimayamba. Pambuyo pa bakiteriya atenga kachilomboka.

Kuzindikirika kwazomwe zimachitika mkati mwa mapapo omwe ali ndi matenda osokoneza bongo ndi hypotension komanso kusintha kwa malingaliro, pomwe odwala wamba zizindikiro za matendawa ndi zofanana ndi zizindikiro zopatsira matenda opumira. Kuphatikiza apo, odwala matenda ashuga, chithunzi cha chipatala chimatchulidwa.

Komanso, ndi matenda, monga hyperglycemia mu matenda a shuga, pulmonary edema nthawi zambiri imachitika. Izi ndichifukwa choti capillaries imalowa kwambiri, ntchito yama macrophages ndi neutrophils imasokonekera, ndipo chitetezo cha mthupi chimafookeranso.

Ndizofunikira kudziwa kuti chibayo choyambitsidwa ndi bowa (Coccidioides, Cryptococcus), staphylococcus ndi Klebsiella mwa anthu omwe ali ndi vuto la insulin kupanga ndizovuta kwambiri kuposa odwala omwe alibe zovuta za metabolic. Kuchepa kwa chifuwa chachikulu kumachulukanso.

Ngakhale kulephera kwa kagayidwe kachakudya kumabweretsa mphamvu pa chitetezo chathupi. Zotsatira zake, mwayi wokhala ndi chotupa cham'mapapo, asymptomatic bacteremia, ngakhale imfa imachulukanso.

Zizindikiro

Chithunzi cha chipatala cha chibayo mwa anthu odwala matenda ashuga ndi chofanana ndi zizindikiro za matendawa kwa odwala wamba. Koma odwala okalamba nthawi zambiri samatentha, chifukwa thupi lawo limafooka kwambiri.

Zizindikiro zikuluzikulu za matendawa:

1. kuzizira
2. chifuwa chowuma, pakapita nthawi chimasanduka chonyowa,
3. kutentha, kutentha mpaka madigiri 38,
4. kutopa,
5. mutu
6. kusowa kwa chakudya
7. kupuma movutikira
8. kusapeza bwino kwa minofu
9. chizungulire
10. hyperhidrosis.

Komanso, kupweteka kumatha kupezeka m'mapapo omwe akhudzidwa, kumawonjezeka panthawi ya kutsokomola. Ndipo mwa odwala ena, kuzindikira za khungu ndi cyanosis ya makona atatu amkati amodzi amadziwika.

Ndizachilendo kuti chifuwa cha matenda ashuga okhala ndi matenda opatsirana am'mapapo thirakiti sichitha kwatha miyezi iwiri. Ndipo mavuto kupuma kumachitika pamene fibrous exudate imadziunjikira mu alveoli, ndikudzaza mawonekedwe a ziwalo ndikuphatikizika ndi kayendedwe kabwinobwino. Mafuta m'mapapo amadziunjikira chifukwa maselo am'magazi amatumizidwa kuzotupa kuti ateteze matenda onse ndikuwononga ma virus ndi mabakiteriya.

Mwa anthu odwala matenda ashuga, mbali zam'mapeto kapena zotsika zam'mapapo zimakhudzidwa kwambiri. Kuphatikiza apo, nthawi zambiri, kutupa kumachitika m'chiwalo choyenera, chomwe chimafotokozedwa ndi mawonekedwe a anatomical, chifukwa chakuti pathogen imakhala yosavuta kulowa mkati ndi yayifupi ndi bronchus.

Pulmonary edema imayendera limodzi ndi cyanosis, kupuma movutikira komanso kumverera kwa kupindika pachifuwa. Komanso kudziunjikira kwamadzi m'mapapo ndi nthawi yopanga kulephera kwa mtima ndi kutupa kwa thumba la mtima.

Pankhani ya kupitirira kwa edema, zizindikiro monga:

• tachycardia
• kupuma movutikira
• hypotension
• chifuwa chachikulu komanso kupweteka pachifuwa,
• Kutulutsa kwamphamvu kwa ntchofu ndi sputum,
• kutsutsika.

Chithandizo ndi kupewa

Maziko a mankhwala a chibayo ndi njira yothandizira antibacterial. Komanso, ndikofunikira kwambiri kuti imalize mpaka kumapeto, apo ayi zibwererenso.

Mtundu wofatsa wa matenda nthawi zambiri umagwiritsidwa ntchito ndi mankhwala omwe amavomerezedwa bwino ndi odwala matenda ashuga (Amoxicillin, Azithromycin). Komabe, munthawi yomwe mumatenga ndalama zotere, ndikofunikira kuyang'anitsitsa zizindikiro za shuga, zomwe zingapewe kukula kwa zovuta.

Mitundu yambiri yamatenda omwe amathandizidwa ndi maantibayotiki, koma ziyenera kukumbukiridwa kuti kuphatikiza kwa shuga ndi maantibayotiki ndi okhawo omwe amapezeka ndi madokotala.

Komanso, ndi chibayo, mankhwala otsatirawa akhoza kulembedwa:

Ngati ndi kotheka, ma antiviral mankhwala amaikidwa - Acyclovir, Ganciclovir, Ribavirin. Pankhaniyi, ndikofunikira kusunga kugona pabedi, komwe kungalepheretse zovuta.

Madzi ambiri akachuluka m'mapapu, angafunike kuchotsedwa. Kupuma ndi chida cha oxygen zimagwiritsidwa ntchito kupangitsa kupumira. Kuti athandizire kudutsa mapapo, wodwala amayenera kumwa madzi ambiri (mpaka malita awiri), koma pokhapokha ngati palibe aimpso kapena mtima. Kanemayo munkhaniyi akukamba za chibayo.

Chizindikiro choopsa: kupuma movutikira ndi matenda a shuga ndi mndandanda wa matenda am'mapapu omwe angasonyeze

Zomwe zimayambitsa matenda kwa odwala omwe ali ndi matenda ashuga ndi stroko, kupweteka kwa impso kapena mtima, komanso mavuto a kupuma. Izi zimatsimikiziridwa ndi ziwerengero.

Ponena za vuto lomalizali, izi ndichifukwa choti minyewa yam'mapapo ndi yochepa thupi ndipo ili ndi ma capillaries ambiri ang'ono.

Ndipo zikawonongeka, malo ngati amenewa amapangika kuti mwayi wopezeka mu ma cell a chitetezo cha mthupi ndi mpweya umakhala wovuta. Zotsatira zake, mtundu wina wa zotupa kapena maselo a khansa zimatha kupezeka m'malo otere, omwe thupi silingathe kulimbana nawo chifukwa chosowa. Matenda a shuga ndi matenda am'mapapo ndi njira imodzi yopanda matenda.

Ubale pakati pa matenda

Matenda a shuga samakhudza mwachindunji misewu ya ndege. Koma kupezeka kwake munjira ina iliyonse kumathandizira ntchito ya ziwalo zonse. Chifukwa cha matendawa, kuwonongeka kwa ma capillary network kumachitika, chifukwa chomwe mbali zowonongeka zam'mapapu sizitha kulandira zakudya zokwanira, zomwe zimayambitsa kusokonezeka m'boma komanso ntchito yopuma kunja.

Zizindikiro zotsatirazi nthawi zambiri zimawonedwa mwa odwala:

• Hypoxia ayamba kukulira,
• kupuma kwamiseche kumachitika
• mphamvu yamapapo imachepa.

Matenda a shuga akapezeka mwa odwala, kufooka kwa chitetezo chathupi kumawonedwa nthawi zambiri, komwe kumakhudza nthawi ya matendawa.

Chifukwa cha chibayo, pali kuwonjezeka kwakukulu kwa shuga m'magazi, zomwe zimachulukitsa shuga. Vutoli litapezeka, matenda awiri amayenera kuchitidwa nthawi imodzi.

Chibayo

Chibayo mwa anthu omwe ali ndi matenda a shuga ndi chifukwa cha matenda opumira.

Kufalikira kwa tizilomboti kumachitika ndi timalovu tomwe timayendetsa mpweya. Chifukwa cha kuchuluka kwa glucose m'magazi a anthu, mikhalidwe yabwino imapangidwa kuti kulowetsedwa kwa matenda osiyanasiyana mthupi.

Chizindikiro cha chibayo mu shuga ndi hypotension, komanso kusintha kwa malingaliro a munthu. Mwa odwala ena, Zizindikiro zonse za matendawa ndi zofanana ndi zizindikiro za kupuma kwapafupipafupi.

Mu odwala matenda ashuga omwe ali ndi hyperglycemia, pulmonary edema imatha kuchitika. Izi zimachitika chifukwa chakuti ma capillaries a chiwalo amakhala ovomerezeka kwambiri, chitetezo cha mthupi chimafookeranso kwambiri, ndipo ntchito ya macrophages ndi neutrophils imasokonekera.

Ngati chibayo chikupezeka mu odwala omwe ali ndi matenda ashuga, zizindikiro zotsatirazi za matendawa zimawonedwa:

• kutentha kwambiri kwa thupi mpaka madigiri 38, pomwe kumatha kukhala ndi malungo (ndizodziwika bwino kuti mu odwala okalamba mulibe kuchuluka kwa kutentha kwa thupi, ndipo izi zimachitika chifukwa chakuti thupi lawo limafooka kwambiri),
• kuwuma chifuwa, pang'onopang'ono kusanduka kunyowa (ndi kutsokomola kwambiri m'dera lamapapo, kupweteka kumatha kuchitika),
• kuzizira
• kupweteka kwambiri m'mutu
• kupuma movutikira
• kusowa kudya kwathunthu,
• chizungulire pafupipafupi
• kusapeza bwino kwa minofu
• kutopa.

Nthawi zambiri, odwala matenda ashuga, magawo am'mapapo amakhudzidwa, ndipo chifuwa cha matenda ashuga oterewa sichitha masiku oposa 60.

Katemera wothandiza kwambiri wa chibayo ndi katemera:

• ana aang'ono (mpaka zaka 2),
• odwala matenda osachiritsika monga matenda a shuga ndi mphumu,
• odwala omwe ali ndi chitetezo champhamvu kwambiri m'thupi monga matenda opatsirana pogonana, khansa, komanso chemotherapy,
• Akuluakulu omwe gulu lawolo limaposa zaka 65.

Katemera amene amagwiritsidwa ntchito ndi otetezeka chifukwa alibe mabakiteriya amoyo. Palibe mwayi wokhala ndi chibayo pambuyo poma Katemera.

Chifuwa chachikulu

Matenda a chifuwa chachikulu nthawi zambiri amakhala amodzi mwa zovuta kwambiri za matenda ashuga. Amadziwika kuti odwalawa amakhudzidwa ndi matendawa nthawi zambiri kuposa enawo, ndipo amuna azaka za 20 mpaka 40 ndi omwe amakhudzidwa kwambiri.

Njira yayikulu ya chifuwa chachikulu imachitika mu odwala matenda ashuga chifukwa cha kagayidwe kachakudya ndi kugwa kwa chitetezo chathupi. Matenda awiriwa omwe amawaganizira amakhudzana. Chifukwa chake, ndi njira yovuta ya matenda ashuga, chifuwa chachikulu chidzakhala chachikulu. Ndipo, nayenso, amathandizira kuti pakhale zovuta zingapo za matenda ashuga.

Nthawi zambiri, chifuwa chachikulu chimapangitsa kudziwa kupezeka kwa matenda ashuga, kuwopsa kwake mthupi kumaonjezera zizindikiro za matenda ashuga. Amazipeza, monga lamulo, kuyezetsa magazi kwakanthawi ka shuga.

Zizindikiro zoyambirira za kupezeka kwa chifuwa chachikulu cha matenda a shuga mellitus:

• dontho lakuthwa,
• kuchuluka kwa zizindikiro za matenda ashuga,
• kufooka kosalekeza
• kusowa kapena kusowa kwa chakudya.

Mankhwala, pali malingaliro ambiri osiyanasiyana okhudza za chifuwa chachikulu cha odwala matenda a shuga.

Komabe, palibe chifukwa chotsimikizika, chifukwa zinthu zosiyanasiyana zimatha kuyambitsa kuoneka ndi chitukuko cha matendawa:

• kukomoka kwa thupi chifukwa cha matenda ashuga
• nthawi yayitali kuwonongeka kwa kagayidwe kachakudya,
• chopinga cha phagocytosis ndi kufooka kwambiri kwa chitetezo cha mthupi.
• kusowa kwa mavitamini
• matenda osiyanasiyana a thupi ndi machitidwe ake.

Anthu odwala matenda ashuga omwe ali ndi chifuwa chachikulu akuchipatala amathandizidwa m'maphunziro a chifuwa chachikulu.

Asanapereke chithandizo chofunikira, a chipatala amafunika kupeza zambiri zokhudzana ndi thupi la wodwalayo: mawonekedwe a matenda a endocrine, mlingo, komanso nthawi yakumwa mankhwala a antidiabetes, kupezeka kwa zovuta zingapo za matenda ashuga, chiwindi ndi impso.

Khunyu ndi kutukusira kwamapapu am'mapapu.

Amachitika pamene zolembera zimapangidwa pamaso pawo, zopangidwa ndi kuwola kwa magazi m'magazi (fibrin), kapena chifukwa chodzikundikira madzi mumapulaneti amtundu wina.

Amadziwika kuti nthawi zambiri izi zimachitika mu matenda ashuga. Kudwala matenda ashuga nthawi zambiri kumachitika kachiwirinso ndipo ndimavuto ovuta a m'mapapo.

Mankhwala, pali mitundu yodziwira matenda:

• serous.
• zodandaula.
• serous hemorrhagic.
• purulent.
• aakulu

Monga lamulo, matendawa amakula chifukwa cha zovuta za m'mapapo. Mu odwala matenda ashuga, maphunzirowa amakhala ovuta kwambiri komanso opita patsogolo.

Kukhalapo kwa pleurisy kumadziwika ndi izi:

• kuwonongeka kwakuthwa konsekonse,
• malungo
• kupweteka pachifuwa, komanso m'dera lomwe lakhudzidwa ndi matendawa.
• kutuluka thukuta kwambiri
• kupuma movutikira.

Kuchiza kwa njira yopanda pur purosesa ya shuga mellitus kumachitika makamaka pogwiritsa ntchito njira zowonjezera mphamvu. Pachifukwa ichi, antibacterial therapy, ukhondo wa mtengo wa bronchial, ndi detoxification amagwiritsidwa ntchito nthawi zambiri. Chithandizo choterechi ndichothandiza kwambiri ndipo chimakupatsani mwayi wopeza zomwe mukuyembekeza.

Maantibayotiki amagwiritsidwa ntchito pochiritsa pleurisy.

Mu mtundu wamafungo amilandu okodzetsa, chithandizo cha opaleshoni chimagwiritsidwa ntchito nthawi zambiri. Pankhaniyi, chithandizo chosasamala sichingapereke zotsatira zomwe zimafunikira, izi sizingachiritse wodwala ku mtundu woopsa wa matenda.

Opaleshoni imachitidwa mu dipatimenti yapadera yamankhwala ndipo, monga lamulo, njira zotsatirazi zimagwiritsidwa ntchito:

• ngalande zotseguka
• kusintha
• thoracoplasty.

Kupewa

Pali njira zingapo zopewera matenda am'mapapo mwa odwala omwe ali ndi matenda ashuga:

• kuyang'anira shuga wamagazi ndikofunikira. Kukonzanso pafupipafupi kangapo ka 10 kumachepetsa kuwonongeka kwa ma capillaries,
• kuyesedwa kwapadera pogwiritsa ntchito ultrasound ya kukhalapo kwa kuwundana kwamagazi pazitseko zamitsempha yamagazi. Kutulutsa kwa capillaries kumachitika chifukwa exfoliation yamagazi magazi kapena makulidwe a magazi. Pofuna kuchepetsa mamasukidwe ake, ndizomveka kugwiritsa ntchito mankhwala apadera potengera acetylsalicylic acid. Komabe, popanda kufunsa dokotala, kugwiritsa ntchito mankhwala ndikuloledwa.
• zolimbitsa thupi zolimbitsa thupi pafupipafupi.
• kuyenda kwakanthawi mlengalenga kumathandizanso kupewa. Kuphatikiza apo, ndikofunikira kusiyiratu chikonga, ndikugwiritsanso ntchito mpweya woyeretsa m'chipindacho.

Makanema okhudzana nawo

Pazakukula kwa chifuwa chachikulu cha m'mapapo mu shuga mu kanema:

Matenda am'mapapu omwe ali ndi matenda osokoneza bongo amatha kusokoneza wodwalayo, nthawi zina zimatha ngakhale zakupha. Chifukwa chake, ndikofunikira kugwiritsa ntchito njira zodzitetezera kuti zisachitike. Izi zimachitika makamaka kwa odwala matenda ashuga, chifukwa chifukwa cha kupezeka kwawo, thupi limafooka komanso zimakonda kutenga matenda.

• Imakhazikika pamisempha ya shuga kwa nthawi yayitali
• Zimabwezeretsa kupanga kwa insulin

Phunzirani zambiri. Osati mankhwala. ->

Dyspnea wa matenda ashuga: chithandizo cha kupuma

Kupuma pang'ono ndi chizindikiro chomwe chimalumikizidwa ndi matenda ambiri. Zoyambitsa zake zazikulu ndi matenda a mtima, mapapu, bronchi ndi kuchepa magazi. Komanso kusowa kwa mpweya komanso kumva kuti uli ndi kukhutira kumatha kuonekera ndi matenda ashuga komanso kuchita masewera olimbitsa thupi kwambiri.

Nthawi zambiri, kuyambika kwa chizindikiritso cha matenda ashuga sichimodzicho, koma zovuta zomwe zimayambitsa maziko ake. Chifukwa chake, nthawi zambiri ndimakhala ndi matenda oopsa a hyperglycemia, munthu amakhala ndi vuto la kunenepa kwambiri, kulephera kwa mtima komanso nephropathy, ndipo ma pathologies onsewa nthawi zonse amakhala limodzi ndi kupuma movutikira.

Zizindikiro zakufupika kwa mpweya - kuperewera kwa mpweya ndi mawonekedwe a kumverera kwadzuwa. Nthawi yomweyo, kupuma kumapangitsa, kukhala phokoso, ndipo kuya kwake kumasintha. Koma kodi nchifukwa ninji mkhalidwe wotere umabuka ndi momwe ungapewere?

Zizindikiro za Mapangidwe A Zizindikiro

Madokotala nthawi zambiri amagwirizanitsa kuwoneka kufupika kwa mpweya ndi kutsekeka kwa mpweya ndi mtima. Chifukwa chake, wodwalayo amapezeka kuti ali molakwika ndipo amamuthandizira chithandizo. Koma zenizeni, pathogenis wazinthu izi zimatha kukhala zovuta kwambiri.

Chotsimikizika kwambiri ndi lingaliro lozikidwa pa lingaliro la kuzindikira ndi kusanthula pambuyo pake ndi ubongo wamalingaliro omwe amalowa mu thupi pamene minofu yopuma siyidatambasulidwa ndikuvutitsidwa molondola. Nthawi yomweyo, mulingo wakukwiyitsa kwamitsempha yamitsempha yomwe imawongolera kusokonezeka kwa minofu ndikutumiza chizindikiro kuubongo sikugwirizana ndi kutalika kwa minofu.

Izi zimatsogolera ku mfundo yoti mpweya, poyerekeza ndi minofu yam'mimba yopumira, ndi yochepa kwambiri. Nthawi yomweyo, zikhumbo zochokera kumapeto am'mapapo kapena minyewa ya kupuma yolumikizana ndi mitsempha ya vagus imalowa mkati mwa dongosolo lamanjenje, ndikupanga kuzindikira kapena kuzindikira kwa kupuma kosakhazikika, mwa kuyankhula kwina, kufupika.

Ili ndi lingaliro lambiri la momwe dyspnea imapangidwira mu shuga ndi zovuta zina mthupi. Monga lamulo, makina amtunduwu wa kupuma movutikira amadziwika ndi kuchita masewera olimbitsa thupi, chifukwa pankhaniyi, kuchuluka kwa mpweya woipa m'magazi ndikofunikira.

Koma kwenikweni mfundo ndi njira za maonekedwe a zovuta kupuma pansi osiyanasiyana zimakhala zofanana.

Nthawi yomweyo, zomwe zimapangitsa kuti pakhale kupunthwa kolimba komanso zosokoneza pakupuma.

Mitundu, kuuma komanso zomwe zimayambitsa kufupika kwa odwala matenda ashuga

Kwenikweni, zizindikiro za dyspnea, mosasamala kanthu za mawonekedwe awo, ndizofanana. Koma kusiyana kwake kungakhale mu magawo a kupuma, chifukwa chake pali mitundu itatu ya dyspnea: kudzoza (kumawonekera pakamapuma), kutulutsa mpweya (kumayamba pakupuma) ndikusakanikirana (kovuta kupumira mkati ndi kunja).

Kukula kwa dyspnea mu matenda ashuga amathanso kusintha. Pa zero, kupuma sikovuta, kupatula kumangowonjezera zolimbitsa thupi. Ndi digiri yofatsa, dyspnea imawoneka poyenda kapena kukwera mmwamba.

Ndi kusakhazikika kwenikweni, kusokonezedwa mwakuya komanso kupuma pafupipafupi kumachitika ngakhale mukuyenda pang'onopang'ono. Pazowopsa mawonekedwe, akuyenda, wodwalayo amayimitsa mita 100 iliyonse kuti apume. Ndi gawo lalikulu kwambiri, zovuta kupuma zimawonekera pambuyo poti tichita masewera olimbitsa thupi, ndipo nthawi zina ngakhale munthu atapuma.

Zomwe zimayambitsa kupuma pang'ono kwa matenda ashuga nthawi zambiri zimagwirizanitsidwa ndi kuwonongeka kwa mtima, chifukwa ziwalo zonse zimakumana ndi kuperewera kwa oxygen. Kuphatikiza apo, motsutsana ndi maziko a nthendayi yayitali, odwala ambiri amakhala nephropathy, yomwe imawonjezera kuchepa kwa magazi m'thupi ndi hypoxia. Kuphatikiza apo, mavuto a kupuma amatha kuchitika ndi ketoacidosis, magazi atadziwika, momwe ma ketoni amapangidwira chifukwa cha kuchuluka kwa glucose m'magazi.

Mtundu wachiwiri wa matenda ashuga, odwala ambiri ndi onenepa kwambiri. Ndipo monga mukudziwa, kunenepa kumapangitsa ntchito yam'mapapu, mtima ndi ziwalo zopumira, kotero kuchuluka kwa mpweya ndi magazi sizimalowa m'matumbo ndi ziwalo.

Komanso, matenda oopsa a hyperglycemia amasokoneza ntchito ya mtima. Zotsatira zake, odwala matenda ashuga omwe ali ndi vuto la mtima, kupuma movutikira kumachitika panthawi yolimbitsa thupi kapena poyenda.

Matendawa akamakula, mavuto a kupuma amayamba kuvutitsa wodwala ngakhale atapuma, mwachitsanzo, kugona.

Chochita ndi kupuma movutikira?

Kuwonjezeka kwadzidzidzi kwa glucose ndi acetone m'magazi kungayambitse vuto la dyspnea pachimake. Panthawi imeneyi, muyenera kuyimbira ambulansi nthawi yomweyo. Koma pakuyembekezera kwake, simungamwe mankhwala aliwonse, chifukwa izi zimangokulitsa vutolo.

Chifukwa chake, ambulansi isanafike, ndikofunikira kuti mpweya wabwino mchipindacho ukhale wodwala. Ngati zovala zilizonse zimapangitsa kupuma kukhala kovuta, muyenera kumasula kapena kuchichotsa.

Ndikofunikanso kuyeza kuchuluka kwa shuga m'magazi pogwiritsa ntchito glucometer. Ngati glycemia ikukula kwambiri, ndiye kuti kuyambitsidwa kwa insulin ndikotheka. Komabe, pankhaniyi, kufunsa achipatala ndikofunikira.

Ngati, kuwonjezera pa matenda ashuga, wodwalayo ali ndi matenda a mtima, ndiye kuti akuyenera kuyeza kukakamizidwa. Pankhaniyi, wodwalayo azikhala pampando kapena pakama, koma osamuyika pabedi, chifukwa izi zimangokulitsa vuto lakelo. Komanso, miyendo iyenera kutsitsidwa, zomwe zitsimikizire kutuluka kwamadzi ochulukirapo kuchokera pansi pamtima.

Ngati kuthamanga kwa magazi kukwera kwambiri, ndiye kuti mutha kumwa mankhwala a antihypertensive. Itha kukhala mankhwala monga Korfar kapena Kapoten.

Ngati kupuma movutikira ndi matenda ashuga kwakhala kwadwala, ndiye kuti ndizosatheka kuyichotsa popanda kulipiritsa matenda omwe akudwala. Chifukwa chake, ndikofunikira kukhazikika m'magazi a shuga ndikutsatira zakudya, zomwe zimatanthawuza kukanidwa kwa chakudya cham'thupi chofulumira.

Kuphatikiza apo, ndikofunikira kumwa mankhwala ochepetsa shuga panthawi komanso muyezo woyenera kapena jekeseni insulin. Komabe muyenera kusiya zizolowezi zilizonse zoyipa, makamaka kusuta.

Kuphatikiza apo, malingaliro ena onse akuyenera kutsatidwa:

1. Tsiku lililonse, yendani mpweya wabwino kwa mphindi pafupifupi 30.
2. Ngati thanzi lanu limalola, Chitani masewera olimbitsa thupi.
3. Idyani nthawi zambiri komanso pang'ono.
4. Pamaso pa mphumu ndi matenda a shuga, ndikofunikira kuchepetsa kulumikizana ndi zinthu zomwe zimayambitsa kuwopsa kwa matenda.
5. Pimani shuga ndi kuthamanga kwa magazi pafupipafupi.
6. Chepetsa mchere wambiri ndikutha madzi ambiri. Lamuloli limagwira ntchito makamaka kwa anthu omwe ali ndi matenda ashuga nephropathy komanso matenda a mtima.
7. Yendetsani kulemera kwanu. Kuwonjezeka kwakukulu kwa kulemera kwa 1.5-2 makilogalamu m'masiku angapo kukusonyeza kuchepa kwamadzi m'thupi, komwe ndi harbinger wa dyspnea.

Kuphatikiza apo, ndi kufupika, osati mankhwala okha, komanso chithandizo cha wowerengeka chothandizira. Chifukwa chake, kupukusira kupuma, uchi, mkaka wa mbuzi, muzu wa horseradish, katsabola, lilac, turnips, komanso ngakhale mapokoso othamanga amagwiritsidwa ntchito.

Kupuma pang'ono kumakonda kupezeka mwa asthmatics. Pazambiri za matenda amphumo a bronchial mu shuga adzauza vidiyoyi munkhaniyi.

Sonyezani shuga yanu kapena sankhani jenda kuti muyimikize.

Zoyambitsa kufupika: Upangiri kuchokera kwa akatswiri onse

Chimodzi mwazinthu zodandaula zomwe zimakambidwa nthawi zambiri ndi odwala ndi kupuma movutikira. Izi zitha kukakamiza wodwalayo kupita kuchipatala, kuyimbira ambulansi ndipo mwina kungakhale chisonyezo chakugonekedwa kuchipatala msanga. Nanga kupuma movutikira ndi ziti ndi zifukwa zazikulu zomwe zimayambitsa? Mupeza mayankho a mafunso awa m'nkhaniyi. Chifukwa chake ...

Kodi kupuma movutikira ndi chiyani

Monga tafotokozera pamwambapa, kupuma movutikira (kapena dyspnoea) ndikumverera kwamunthu, kupweteka kwambiri, kuchepa kapena kusowa kwa mpweya, komwe kumawonetsedwa ndi kukhathamira pachifuwa, mwa chipatala - mwakuwonjezeka kwa kupuma kwapamwamba kwa 18 pamphindi ndi kuwonjezeka kwa kuya kwake.

Munthu wathanzi akapumulapo samasamalira kupuma kwake. Ndi mphamvu zolimbitsa thupi zolimbitsa thupi, ma pafupipafupi komanso kuzama kwa kusintha kwa kupuma - munthu amadziwa izi, koma izi sizimamupangitsa kusasangalala, komanso, mawonekedwe ake opumira abwereranso kwina patapita mphindi zochepa atangolimbitsa thupi. Ngati kupuma movutikira pakulimbitsa thupi kumakhala kutchulidwa kwambiri, kapena kuwoneka ngati munthu akuchita zoyambira (pomanga mashopu, kuyenda mozungulira nyumba), kapena, moyipitsitsa, osachoka pakupumula, uku ndi kufupika kwa matenda, kuwonetsa matenda ena .

Gulu la dyspnea

Ngati wodwalayo akuda nkhawa kuti apuma movutikira, kupuma movutikira koteroko kumatchedwa kudzutsa. Zikuwoneka pamene lumen ya trachea ndi bronchi yayikulu imachepetsedwa (mwachitsanzo, mwa odwala mphumu ya bronchial kapena chifukwa cha compression ya bronchus kuchokera kunja - ndi pneumothorax, pleurisy, etc.).

Pakakhala kusamvana kumachitika pakupuma, kufupika kwamtunduwu kumatchedwa kupuma. Zimachitika chifukwa chochepetsera lumen ya bronchi yaying'ono ndipo ndi chizindikiro cha matenda osapatsika a m'mapapo kapena emphysema.

Pali zifukwa zingapo zofupikitsa kupuma kosakanikirana - ndikuphwanya kwa mpweya ndi mpweya wonse. Zomwe zikuluzikulu ndizo kulephera kwa mtima ndi matenda am'mapapo kumapeto, magawo apamwamba.

Pali magawo asanu azovuta zakufupika, kutsimikizika pamaziko a madandaulo a wodwala - muyeso wa MRC (Medical Research Council Dyspnea Scale).

Dyspnea yokhala ndi mapapu

Chizindikiro ichi chimawonedwa m'matenda onse a bronchi ndi mapapu. Kutengera ndi matenda, kupuma movutikira kumatha kuchitika kwambiri (pleurisy, pneumothorax) kapena kusokoneza wodwala kwa masabata ambiri, miyezi, ndi zaka (matenda osatha a pulmonary matenda, kapena COPD).

Dyspnea mu COPD ndi chifukwa chochepetsera kuunikira kwa thirakiti la kupuma, kuchuluka kwa ma viscous secretions mwa iwo. Ndiwokhazikika, imakhala ndi umunthu ndipo, pakapanda kulandira chithandizo chokwanira, imayamba kuchuluka. Nthawi zambiri wophatikizidwa ndi chifuwa komanso kutsuka kwa sputum.

Ndi mphumu ya bronchial, kupuma movutikira kumadziwoneka ngati njira yodzidzimutsa mwadzidzidzi. Imakhala ndi umunthu wotuluka kunja - kupumira pang'ono pang'ono kumatsatiridwa ndi mpweya wofuula, wovuta. Mukamapuma mankhwala apadera omwe amakulitsa bronchi, kupuma msanga kumathandizanso. Zovuta za kukomoka zimachitika pambuyo poyanjana ndi ma allergen - pakupumira kapena kudya. M'madera ovuta kwambiri, kuukiridwa sikuyimitsidwa ndi bronchomimetics - mkhalidwe wa wodwalayo umakulirakulira, amalephera kudziwa. Ichi ndi chikhalidwe chowopsa kwambiri pamoyo wa wodwalayo, chofunikira kuchipatala.

Pamodzi ndi kupuma movutikira komanso matenda opatsirana - bronchitis ndi chibayo. Kukula kwake kumadalira kuopsa kwa matenda omwe ali pachiwonetsero komanso kukula kwa njirayo. Kuphatikiza pa kupuma movutikira, wodwalayo amasokonezeka ndi zizindikiro zina zingapo:

• malungo kuyambira subfebrile mpaka manambala achabechabe,
• kufooka, ulesi, thukuta ndi zizindikiro zina za kuledzera,
• Kusakhwima (kouma) kapena kotulutsa (kokhala ndi sputum),
• kupweteka pachifuwa.

Ndi chithandizo cha panthawi yake cha bronchitis ndi chibayo, zizindikiro zawo zimatha m'masiku ochepa ndikuchira kumabwera. Milandu yayikulu ya chibayo, mtima umagwirizanitsidwa ndi kupuma - kupuma movutikira kumakulitsidwa kwambiri ndipo zizindikiro zina zamunthu zimawonekera.

Ma tumor m'mapapu mu magawo oyambirira ndi asymptomatic. Pakachitika kuti chotupa chaposachedwa sichinapezeke mwangozi (munthawi ya prophylactic fluorography kapena ngati mwangozi mwapezeka mukupeza matenda omwe si a m'mapapo), pang'onopang'ono imakula ndipo, ikafika kukula kwakukulu mokwanira, imayambitsa zizindikiro zina:

• poyamba, osati wowawa kwambiri, koma pang'onopang'ono kuwonjezeka kufupika kwakumapeto,
• kutsokomola ndi khunyu pang'ono,
• hemoptysis,
• kupweteka pachifuwa
• kuwonda, kufooka, kutsika kwa wodwalayo.

Chithandizo cha zotupa zam'mapapo zingaphatikizepo opaleshoni yochotsa chotupa, chemo ndi / kapena radiation, ndi njira zina zamakono zamankhwala.

Choopsa chachikulu pa moyo wa wodwalayo chimachitika ndi zochitika zomwe zimawonetsedwa ndi kupuma movutikira, monga pulmonary embolism, kapena pulmonary embolism, kutsekedwa kwa mpweya wa mderalo, ndi edema ya pulmonary edema.

TELA - mkhalidwe womwe nthambi imodzi kapena zingapo za m'mapapo zimatsekeka chifukwa cha magazi, chifukwa chomwe m'mapapu mumakhala kupatula kuti mupume. Mawonetseredwe azachipatala a matenda awa amatengera kuchuluka kwa zotupa zam'mapapo. Nthawi zambiri, imadziwoneka ndi kupumira mwadzidzidzi komwe kumavutitsa wodwalayo movutikira kapena pang'ono pang'onopang'ono kapena ngakhale kupuma, kukokomeza, kukoka komanso kupweteka pachifuwa chimodzimodzi ndi angina pectoris, nthawi zambiri hemoptysis. Kuzindikira kumatsimikiziridwa ndi kusintha kofanana mu ECG, chifuwa x-ray, panthawi ya angiopulmography.

Kulepheretsa kwa mpweya kumawonekeranso ngati chizindikiro cha kuperewera. Kupuma pang'ono ndi kolimbikitsa, kupuma kumamveka patali - phokoso, ndikuyang'ana. Wothandizanapo ndi kufupika kwapafupipafupi ndi matenda am'mimba awa ndi chifuwa chowawa, makamaka ndikusintha kwa thupi. Kuzindikira kumapangidwa pamaziko a spirometry, bronchoscopy, x-ray kapena tomography.

Kutseka kwa airway kumatha kuchitika:

• kuphwanya patency ya trachea kapena bronchi chifukwa cha kulumikizidwa kwa ziwalo kuchokera kunjaku (aortic aneurysm, goiter),
• zotupa za trachea kapena bronchi ndi chotupa (khansa, papillomas),
• kudya kwa thupi lachilendo,
• mapangidwe a cicatricial stenosis,
• kutupa kosalekeza komwe kumabweretsa chiwonongeko ndi fibrosis ya minyewa ya minyewa ya trachea (yamatenda amiseche - systemic lupus erythematosus, nyamakazi yamatumbo, Wegener granulomatosis).

Mankhwala omwe amapezeka ndi bronchodilators omwe ali ndi matenda awa ndi osathandiza. Udindo waukulu pakukhazikitsa mankhwalawa ndi wa chithandizo chokwanira cha matenda oyambitsidwa ndi kubwezeretsedwa kwamakina a airway patency.

Vuto la poizoni ya m'mapapo limatha kuchitika motsutsana ndi maziko a matenda opatsirana omwe amayamba chifukwa cha kuledzera kwambiri kapena chifukwa cha kupezeka kwa zinthu zoopsa za m'mapapo thirakiti. Pachigawo choyamba, izi zimangowonekera pang'onopang'ono kuwonjezera kupuma komanso kupumira mofulumira. Pakapita kanthawi, kupuma movutikira kumalowedwa m'malo ndi kupweteka kwakumapeto, komwe kumakhala limodzi ndi kupuma kwamphamvu. Chowongolera chotsogoza chamankhwala ndi kuchotsedwako.

Matenda otsatirawa am'mapapo samachitika kawirikawiri ndi dyspnea:

• pneumothorax - nyengo yovuta kwambiri yomwe mpweya umalowa mkatikati mwa zitseko za m'mimba ndi zotchinga pamenepo, kupinikiza mapapu ndi kutsekemera pompumira, kumachitika chifukwa cha kuvulala kapena njira zoperewera m'mapapu, zimafunikira chisamaliro chamankhwala opangidwira,
• chifuwa chachikulu cha m'mapapo - matenda opatsirana oyambitsidwa ndi chifuwa chachikulu cha mycobacterium, amafunikira chithandizo chautali,
• m'mapapo actinomycosis - matenda oyambitsidwa ndi bowa,
• pulmonary emphysema ndi matenda omwe alveoli amatambasulira ndikulephera kusinthana kwachilengedwe, ndikupanga ngati njira yodziyimira pawokha kapenanso kutsatina.
• silicosis - gulu la ogwira ntchito m'mapapo matenda chifukwa cha fumbi tinthu tating'onoting'ono m'mapapo minofu, kuchira n`zosatheka, wodwalayo mankhwala kukonza kukonza,
• scoliosis, zolakwika za thoracic vertebrae, ankylosing spondylitis - ndi izi, mawonekedwe a chifuwa amasokonezeka, zomwe zimapangitsa kupuma kukhala kovuta komanso kumayambitsa kupuma pang'ono.

Dyspnea ndi matenda a mtima dongosolo

Anthu omwe akudwala matenda amtima, amodzi mwa madandaulo akulu amati kupuma movutikira. M'mayambiriro oyamba matenda, kupuma movutikira kumazindikiridwa ndi odwala ngati kumverera kwa kusowa kwa mpweya panthawi yolimbitsa thupi, koma pakapita nthawi, kumva kumeneku kumayambitsidwa ndi kupsinjika pang'ono, pang'onopang'ono sikusiya wodwalayo ngakhale pakupuma. Kuphatikiza apo, magawo akutali kwambiri a matenda amtima amadziwika ndi dyspnea ya paroxysmal nocturnal - kuukira kwa kukodza komwe kumachitika usiku, zomwe zimatsogolera kudzutsidwa kwa wodwalayo. Matendawa amatchedwanso mtima. Chomwe chimapangitsa ndikusokonekera kwamadzi m'mapapu.

Dyspnea yokhala ndi vuto la mitsempha

Madandaulo a dyspnea a digiri imodzi kapena zingapo amaperekedwa ndi ¾ odwala a neurologists ndi psychiatrists. Kumverera koperewera kwa mpweya, kulephera kuyamwa kwathunthu, nthawi zambiri kumakhala ndi nkhawa, kuwopa kufa chifukwa chokwanira, kumverera kwa "chotsekera", chotchinga pachifuwa chomwe chimalepheretsa kupuma kwathunthu - madandaulo a odwala ndi osiyanasiyana. Nthawi zambiri, odwala oterewa amawoneka bwino kwambiri, amamva bwino kupsinjika, nthawi zambiri amakhala ndi hypochondriacal. Mavuto opuma a Psychogenic nthawi zambiri amapezeka motsutsana ndi maziko a kuda nkhawa ndi mantha, kukhumudwa, pambuyo pokumana ndi chisangalalo chopitilira muyeso. Pali ena omwe amabwera chifukwa cha mphumu yabodza - mwadzidzidzi akuwonekera kupuma kwa psychogenic kupuma movutikira. Mbali yachipatala ya kupumula kwa mawonekedwe a psychogenic ndi kapangidwe kake ka phokoso - kupuma pafupipafupi, kubuula, kubuula.

Chithandizo cha dyspnea mu zovuta za neurotic ndi neurosis zimachitika ndi neuropathologists ndi psychiatrists.

Dyspnea ndi magazi m'thupi

Anemia ndi gulu la matenda omwe amadziwika ndi kusintha kwa magazi, monga kuchepa kwa zomwe zili hemoglobin ndi maselo ofiira m'magazi. Popeza mpweya umatengedwa kuchokera kumapapu mwachindunji kupita ku ziwalo ndi minyewa mothandizidwa ndi hemoglobin, pamene kuchuluka kwake kumachepa, thupi limayamba kudwala matenda a oxygen - hypoxia. Zachidziwikire, akuyesera kulipirira mkhalidwewu, polankhula momveka bwino, kupopera mpweya wambiri m'magazi, chifukwa chomwe kupumira ndi kufalikira kwamphamvu kumachitika, i.e. kupuma kwapang'onopang'ono kumachitika. Matendawa amatha kukhala amitundu yosiyanasiyana ndipo amayamba chifukwa cha zifukwa zosiyanasiyana:

• kusowa kwachitsulo ndi chakudya (mwachitsanzo zamasamba),
• magazi osachiritsika (okhala ndi zilonda zam'mimba, uterine leiomyoma),
• atadwala posachedwapa matenda opatsirana kapena matenda ena,
• Ndi zovuta za metabolic metabolic,
• monga chizindikiro cha khansa, makamaka khansa ya magazi.

Kuphatikiza kufupika kwa magazi ndi magazi m'thupi, wodwalayo amadandaula:

• kufooka kwambiri, kuchepa mphamvu,
• kugona pang'ono, kugona pang'ono,
• chizungulire, kupweteka mutu, kuchepa kwa ntchito, kusokonezeka ndende, kukumbukira.

Anthu omwe ali ndi vuto la kuchepa magazi amadziwika ndi pallor pakhungu, ali ndi mitundu ina yamatenda - ake tint, kapena jaundice.

Kuzindikira magazi m'thupi sikovuta - ndikokwanira kukayezetsa magazi ambiri. Ngati pali kusintha zina zomwe zikuwonetsa kuchepa kwa magazi, mayeso angapo, onse othandizira komanso othandizira, adzapatsidwa ntchito kuti afotokozere bwino za matendawo komanso kuzindikira zomwe zimayambitsa matendawa. Chithandizo cha mankhwala ndi hematologist.

Dyspnea ndi matenda a endocrine dongosolo

Anthu omwe akudwala matenda monga thyrotooticosis, kunenepa kwambiri komanso matenda a shuga komanso nthawi zambiri amadandaula za kupuma movutikira.

Ndi thyrotoxicosis - chikhalidwe chodziwika ndi kuphatikiza kwakukulu kwa mahomoni a chithokomiro, njira zonse za metabolic mthupi zimachulukira kwambiri - pomwe mukukumana ndi kufunika kwa oxygen. Kuphatikiza apo, kuchuluka kwama mahomoni kumapangitsa kukulira kwa kuchuluka kwa mtima, chifukwa chomwe mtima umataya mphamvu kupopa magazi kwathunthu ku ziwalo ndi ziwalo - amamva kusowa kwa mpweya, womwe thupi limayesetsa kulipiritsa - kufupika kwa mpweya kumachitika.

Kuchulukitsa kwa minofu ya adipose m'thupi pakanenepa kwambiri kumapanikizika ndi ntchito ya minofu yopuma, mtima, mapapu, chifukwa chomwe minofu ndi ziwalo zake sizimalandila magazi mokwanira ndikusowa oxygen.

Ndi matenda a shuga, posakhalitsa, mphamvu yam'mimba imakhudzidwa, chifukwa ziwalo zonse zili mu vuto la kufera kwa oxygen. Kuphatikiza apo, impso zimakhudzidwanso pakapita nthawi - matenda a shuga a nephropathy amakula, omwe amakhumudwitsa magazi, chifukwa chomwe hypoxia imakulirakulira.

Dyspnea mwa amayi apakati

Pa nthawi ya pakati, kupuma ndi mtima dongosolo la mkazi limakumana ndi kuchuluka katundu. Katundu uyu akuchitika chifukwa cha kuchuluka kwa magazi ozungulira, kuponderezana kuchokera pansi pa chimbale cha chiberekero chokulirapo (chifukwa chomwe ziwalo za chifuwa chimasokonekera komanso kusuntha kwa kupuma kwake ndi kugunda kwa mtima ndizovuta zina), kufunikira kwa okosijeni osati amayi okha, komanso mwana wosabadwayo yemwe akukula. Kusintha konseku kwamthupi kumabweretsa kuti azimayi ambiri amakhala ndi kupuma movutikira panthawi yapakati. Kuchuluka kwa kupuma sikudutsa 8-10 pamphindi, kumakhala pafupipafupi pakulimbitsa thupi komanso kupsinjika. Mimba ikayamba, dyspnea imakulanso. Kuphatikiza apo, amayi oyembekezera nthawi zambiri amakhala ndi vuto la kuchepa kwa magazi, chifukwa cha kufupika kwake kumakulirakulira.

Ngati kupuma kumapitilira ziwerengero zomwe tatchulazi, kufupika sikumadutsa kapena sikuchepa kwambiri pakupuma, mayi wapakati ayenera kufunsa dokotala - obstetrician-gynecologist kapena Therapist.

Dyspnea mwa ana

Kuchuluka kwa kupuma mwa ana a mibadwo yosiyana ndi kosiyana. Dyspnea iyenera kukayikiridwa ngati:

• mu mwana 0-6 miyezi kuchuluka kwa kupuma kwamphamvu (NPV) kupitilira mphindi 60,
• mu mwana wa miyezi 6-12, NPV yoposa 50 pamphindi,
• mwa mwana wamkulu kuposa chaka chimodzi cha NPV yoposa 40 pamphindi,
• mwa mwana wamkulu kuposa zaka 5, NPV yatha 25 pamphindi,
• mwa mwana wazaka 10 mpaka 14, NPV imatha 20 pa miniti.

Ndibwino kwambiri kuganizira kayendedwe kakupumira pamene mwana wagona. Dzanja lotentha liyenera kukhazikitsidwa pachifuwa cha mwana ndikuwerengera kuchuluka kwa chifuwa pamphindi 1.

Pakukhumudwa, pakulimbitsa thupi, kulira, ndi kudyetsa, kupuma kumakhala kwabwinoko, komabe, ngati NPV imapitilira muyeso ndikumapuma pang'onopang'ono, muyenera kudziwitsa dotolo za izi.

Nthawi zambiri, dyspnea mu ana imachitika ndi zotsatirazi matenda:

• kupuma kuvutikira matenda a wakhanda (omwe nthawi zambiri amalembetsa ana osabereka, omwe amayi awo amadwala matenda ashuga, matenda amtima, matenda amtunduwu, amathandizira kulumikizana kwa intrauterine, asphyxia, amawonetsedwa ndi kupuma pang'ono ndi NPV yopitilira 60 pamphindi, utoto wamtambo ndi khungu lawo pallor, kuuma pachifuwa kumanenedwanso, chithandizo chiyenera kuyambitsidwa mwachangu - njira yamakono kwambiri ndikukhazikitsidwa kwa surmonant surmonant mu neonatal trachea mu S munthawi ya moyo wake)
• pachimake stenosing laryngotracheitis, kapena zabodza croup (mawonekedwe a kapangidwe ka larynx mwa ana ndi chida chake chaching'ono, chomwe ndi kusintha kwamkati mwa mucous nembanemba wa thupilo kumatha kuyambitsa kuwonongeka kwa mpweya kudzera mwa iyo, nthawi zambiri abodza abodza amakula usiku - mdera lamalomo dyspnea yolimbikitsa ndi kukhuta, pamenepa, amafunika kupatsa mwanayo mpweya wabwino ndipo nthawi yomweyo ayimbire ambulansi),
• zolakwika za mtima wobadwa nawo (chifukwa cha vuto la kukula kwa intrauterine, mwana amapanga mauthenga am'mitsempha pakati pa ziwiya zikuluzikulu kapena mtima, zomwe zimabweretsa kusakanikirana kwa magazi a venous and arterial, chifukwa cha izi, ziwalo ndi minyewa yamthupi imalandira magazi omwe sanadzazidwe ndi mpweya ndikukumana ndi hypoxia, kutengera kuuma chilema chikuwonetsedwa ndi kuwonera kwamphamvu ndi / kapena kuchitira opareshoni),
• ma virus ndi bacteria bronchitis, chibayo, mphumu, chifuwa,
• kuchepa magazi.

Pomaliza, ziyenera kudziwika kuti ndi katswiri yekha yemwe angadziwe chomwe chodalirika cha kupuma movutikira, chifukwa chake, ngati dandaulo likupezeka, simuyenera kudzinamizira - njira yoyenera kwambiri ndiyo kufunsa dokotala.

Zizindikiro zoyambirira za mavuto amtima zomwe siziyenera kunyalanyazidwa

Dokotala uti kuti mulumikizane

Ngati wodwalayo akudziwikabe kuti sakudziwika, ndibwino kufunsa katswiri wazachipatala (wa ana). Pambuyo pa kufufuza, adotolo azitha kukhazikitsa matenda owunika, ngati pakufunika kutero, pititsani wodwalayo kwa akatswiri. Ngati dyspnea imalumikizidwa ndi matenda am'mapapo, ndikofunikira kukaonana ndi pulmonologist, komanso matenda a mtima, a mtima. Anemia amathandizidwa ndi hematologist, endocrine gland matenda - ndi endocrinologist, wamanjenje dongosolo la matenda - ndi wamatsenga, matenda amisala omwe amaphatikizidwa ndi kupuma movutikira - ndi a psychiatrist.

Kanema wa nkhaniyi

Zoyambitsa kufupika: Upangiri kuchokera kwa akatswiri onse

Zolemba za ntchito yasayansi pamutu wakuti "Zinthu zamatenda am'mapapu m'matumbo a shuga"

Zokhudza matenda am'mapapo mu shuga

Matenda a shuga a mellitus (DM) afala kwambiri kumadera onse padziko lapansi, ndipo kuchuluka kwa odwala matenda ashuga kukupitirirabe patsogolo. Zosintha zamasiku ano za shuga Ngakhale zili choncho, zovuta za matenda ashuga zomwe zimakhala ndi vutoli zimakhalabe vuto lalikulu ndipo zimapweteketsa kwambiri odwala komanso anthu onse. Zowonongeka zodziwika bwino m'maso, impso, mtima, mantha, kuzungulira, kukulira monga zovuta za matenda ashuga, pomwe kusintha m'mapapu ndi matenda a shuga sikuphunziridwa pang'ono. Mitundu yonse ya ubale womwe ulipo pakati pa matenda ashuga ndi mapapu ndi awa:

• matenda otupa am'mapapo mwachilengedwe amayambitsa kuwonongeka kwa matenda ashuga, okhazikika omwe amasokoneza kayendedwe ka matenda a shuga ndikuwonjezera chiwopsezo cha chitukuko chake,

• Matenda osagwirizana a shuga amachititsa kuti matenda a m'mapapo apangidwe,

• DM imakulitsa maphunzirowa ndipo imachepetsa kuchiza kwa matenda ambiri am'mapapo,

• Kuchiza matenda am'mapapo mwa wodwala yemwe ali ndi matenda a shuga nthawi zonse kumafuna yankho la vuto lina - kukwaniritsa kuwongolera matenda ashuga.

Nkhaniyi ikuyesa chidule mwachidule chokhudza kuwonongeka kwa mapapo ndi zina za matenda am'mapapo a shuga.

Zilonda zazikulu m'mimba

Umboni wa histopathological wa kuwonongeka kwa m'mapapo mu shuga ndi kukula kwa chipinda chapansi pamatumbo a pulmonary capillaries chifukwa cha microangiopathy. Hyperglycemia mu shuga imakhudza kapangidwe kake ka mphamvu ya ma endothelial cell a alveolar capillaries, chifukwa chake timatha kulankhula za kukhalapo kwa matenda a m'mapapo a shuga chifukwa cha Microangiopathy. Kutsika kwama voliyumu am'mapapo nthawi zambiri kumapezeka mwa mtundu I wa shuga mwa anthu osakwana zaka 25. Kuchepetsa kufinya kwamapapo kumachitika pa nthawi iliyonse, pomwe kusokonezeka kwa mapapo chifukwa cha kuchepa kwa magazi m'matumbo am'mapapo amadziwika ndi okalamba. Matenda odziwika omwe amathandizira amalola kuti mapapo awoneke ngati gawo lopangika mu shuga 1, 2.

Igor Emilievich Stepanyan - Pulofesa, Wofufuza Wotsogolera, Mutu. pulmonology dipatimenti ya Central Research Institute of Tuberculosis RAMS.

Kuchepa kwa mavoliyumu, kuphatikizika kwa mphamvu ya kapangidwe kake m'mapapo a shuga kumalumikizidwa ndi mitundu yopanda enzymatic glycosylation ya mapuloteni a minofu, zomwe zimapangitsa kuwonongeka kwa minofu yolumikizana. Odwala omwe ali ndi neuronomic ya autonomic, kamvekedwe ka basal kovutikira mpweya kumatha kuchepa, chifukwa chomwe mphamvu ya bronchodilation imachepa. Kuphatikiza apo, mwa odwala matenda a shuga, chiwopsezo cha matenda ammapapo, makamaka chifuwa chachikulu ndi mycoses, ukuwonjezereka, zifukwa zomwe kuphwanya mankhwala a chemotaxis, phagocytosis ndi bactericidal ya polymorphonuclear leukocytes.

Posankha zomwe zikuwonetsa kupuma kwapanja (HFD) mwa odwala 52 omwe ali ndi matenda ashuga, zidapezeka kuti mapapu amadzaza (mphamvu yofunika ya mapapu, kuchuluka kwam'mapapo komanso voliyumu yotsalira), komanso kuchuluka kwa mapapu komanso kukakamizidwa pang'ono kwa mpweya m'magazi am'mimba omwe ali ndi matenda ashuga anali ochepa kwambiri kuposa mitu 48 yopanda matendawa. Kafukufuku woyerekeza wazinthu zam'mapapo za autopsy mwa odwala 35 omwe ali ndi matenda a shuga adawonetsa kukula kwa makoma a alveolar capillaries, arterioles ndi makoma a alveoli mu shuga, omwe amatha kuwonetsedwa ngati chiwonetsero cha matenda ashuga komanso maziko a zovuta zamagulu.

Matenda a FVD mu shuga

Kuyeza kwa EFD ka matenda ashuga ndikofunikira chifukwa:

• Izi zomwe siziri zachulukidwe zimakupatsani mwayi wofufuza momwe mapapo ambiri amakhudzira mtima,

• kuchepa kwapadera kwa ntchito yam'mapapo kumawonekera ndi zaka, ndi kupsinjika, kukula kwa matenda am'mapapo, m'malo okwera, kuchepa kwa magazi chifukwa cha mtima kapena kulephera kwa impso,

• mosiyana ndi minyewa yamtima kapena mafupa, mkhomo wam'mapapu umangodalira kulimbitsa thupi,

• Zosintha mu HPF zimakupatsani mwayi kuti mufufuze mosapita m'mbali za kuchepa kwa systemic microangiopathy.

Komabe, palibe mgwirizano pa matenda a shuga kwa odwala matenda amtundu wa HFD komanso kulekerera. Pali malingaliro akuti HPF indices ndi kuchuluka kwa mapapu m'matenda a shuga sizivutika, ndipo kuchepa kwa kulolerako zolimbitsa thupi kumachitika chifukwa cha zovuta zamtima, chifukwa chake palibe chifukwa chowunikira kwa spirometric mwa anthu omwe ali ndi matenda ashuga. Kumbali ina, pali umboni kuti kuchepa kwa mapangidwe am'mapapo mwanga komanso kutsekemera kwa mpweya mu mtundu II wa shuga kungaganiziridwe.

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kung'ambika ngati zovuta za matendawa, kuopsa kwake komwe kumachitika chifukwa cha hyperglycemia, komanso kuwonongeka kwa mpweya mu mtundu II wa matenda ashuga ndi m'modzi mwa olosera za kufa.

Ubwenzi wakhazikitsidwa pakati pa misempha yotsika kwambiri ya insulin m'magazi ndi kuponderezana ndi chidwi cha M-cholinergic receptors. Kuzindikiritsa kwa bronchial hyperreacaction kwa odwala omwe ali ndi mtundu wachiwiri wa shuga omwe amapezeka m'miyezi itatu yoyambirira pambuyo pa kuperekedwa kwa insulin kumawonetsa kufunikira kwa kuwunika kwa spirometric ndi kuwerengera kwa kupuma kwa zochitika zoterezi, makamaka kwa odwala omwe ali ndi matenda opumira.

Matenda a shuga komanso matenda a bronchial

Ubwenzi wolunjika pakati pa matenda ashuga ndi matenda opatsirana a bronchial. Amanenanso kuti matenda obwera chifukwa cha kufooka kwa m'matumbo a bronchial asthma (BA) komanso matenda osokoneza bongo a m'matumbo (COPD) amatha kuyambitsa matenda a insulin ndikumayambitsa matenda a shuga a metabolism, omwe amachititsa kuti akhale ndi matenda osokoneza bongo kapena apangitse matenda a shuga 9 omwe alipo. 10.

Ntchito yomwe imagwira ntchito kwa odwala omwe ali ndi COPD yokhala ndi matenda amtundu wachiwiri wa shuga ndikuti nthawi zambiri amakhala ndi ziwonetsero osati zopinga, koma ndi mtundu wosakanizika wa FVD.

Funso loti lingachitike mokwanira mankhwala omwe ali ndi insaled glucocorticosteroids (IHC) mwa odwala omwe ali ndi vuto la shuga ndi mphumu amakhalabe nkhani yovuta. Ofufuza ena akuti mwa odwala omwe ali ndi AD ndi shuga omwe adalandira fluticasone propionate kapena montelukast, kuchuluka kwa hemoglobin sikunali kosiyana kwambiri. Kumbali ina, zafotokozedwa kuti kugwiritsa ntchito IHC kwa odwala omwe ali ndi matenda ashuga kumabweretsa kuwonjezeka kwakukulu kwa seramu glucose: aliyense 100 μg IHC (malinga ndi beclomete zone dipropionate) imakulitsa glycemia ndi 1.82 mg / dl (p = 0.007). Mwanjira ina, mankhwalawa a IHC odwala omwe ali ndi matenda ashuga, kuyamwa mosamala glycemic kumalimbikitsidwa, makamaka pofotokoza kuchuluka kwa mankhwalawa.

Zowoneka za matenda am'mimba ndi matenda a chibayo sizinaphunziridwe mokwanira, komabe, pali umboni wazotsatira zabwino za chibayo mwa anthu odwala matenda ashuga poyerekeza ndi kuchuluka kwathunthu. Kupenda zomwe zimayambitsa kufa kwa odwala 221 omwe ali ndi matenda ashuga zaka zopitilira 10, zikuwonetsa kuti mu 22% ya milandu imachitika chifukwa cha matenda opatsirana ndi chibayo.

Matenda a shuga mu cystic fibrosis

DM, yomwe nthawi zambiri imagwirizanitsidwa ndi cystic fibrosis, imasiyana pakatikati pa mtundu wa "classical" I kapena mtundu II shuga. Izi zinapereka chifukwa cholozera mtundu wapadera wa matendawa - shuga wokhudzana ndi cystic fibrosis ("cystic fibrosis-dia-

kubetcha "). Ku Netherlands, kulolerana kwa glucose komwe kunapezeka mu 16% ya odwala omwe ali ndi cystic fibrosis, komanso 31% ya matenda ashuga. Mwa odwala omwe ali ndi cystic fibrosis wamkulu kuposa zaka 40, matenda ashuga amapezeka 52%. Mwa azimayi omwe ali ndi cystic fibrosis, matenda a shuga amakula atangoyamba kumene kuposa amuna. Kuthana ndi matenda a shuga ndi cystic fibrosis, zakudya sizokwanira, ndipo ndikofunikira kugwiritsa ntchito mankhwala a hypoglycemic kapena insulin 15, 16.

Matenda a shuga ndi mycosis ya m'mapapo

Mu matenda a shuga, ntchito ya neutrophils ndi macrophages imavutika, chitetezo cham'magazi komanso chinyezi, komanso metabolism yachitsulo, imalephera. Kuphatikiza pa matenda a shuga a shuga, izi zimayambitsa chiopsezo chotenga matenda opatsirana, makamaka mycoses (candidiasis, aspergillosis, cryptococcosis).

Mucormycosis (zygomycosis) imayamba chifukwa cha bowa wa genus zyomycetes ndipo nthawi zambiri imayamba kupezeka mwa anthu omwe ali ndi vuto lalikulu la chitetezo chamthupi, makamaka ndi neutropenia, yomwe imadziwika ndi matenda osokoneza bongo. Kuzindikira kwa mucormycosis kumalumikizidwa ndi zovuta zopatula pachikhalidwe cha zygomycete komanso kusowa kwa mwayi wa serodignosis. Chithandizo chimaphatikizanso kuchotsa kwa immunosuppression factor, resection ya mbali yam'mapapo ndi kugwiritsa ntchito milingo yayikulu ya amphotericin B 18, 19.

Matenda a shuga ndi chifuwa chachikulu

Kuphatikiza kwa matenda ashuga ndi chifuwa kwadziwika kuyambira nthawi zakale: Avicenna adalemba za kuyanjana kwa matenda awiriwa m'zaka za zana la 11. Zomwe zimapangitsa kuti chiwopsezo cha odwala omwe ali ndi matenda ashuga ku chifuwa chachikulu chikule chifukwa cha kuponderezedwa kwa ma cell amapangidwa ndi kupondereza chitetezo cha ma cell komanso kupanga ma cytokines motsogozedwa ndi zinthu zopanda-enzymatic glycosylation. Udindo wa chifuwa chachikulu cha chifuwa chachikulu cha matenda a shuga ukadalipobe.

Asanafufuze insulin komanso kukula kwa mankhwala oletsa anti-TB, chifuwa chachikulu cha m'mapapo chinapezeka pa autopsy pafupifupi theka la odwala matenda ashuga omwe amwalira m'mizinda yayikulu ku Europe. Mphamvu zakuwongolera zomwe zachitika masiku ano za matenda ashuga komanso anti-TB zasintha kwambiri ziwerengerozi, koma kuchuluka kwa chifuwa chachikulu cha odwala matenda ashuga ndipo m'zaka za zana la 21 kumakhalabe nthawi 1.5-57.8 kuposa anthu ambiri 3, 22, 23. mavuto obwera chifukwa cha chifuwa chachikulu.

Mdziko lathu, kwazaka zambiri, odwala matenda a shuga ali pachiwopsezo cha chifuwa chachikulu, chomwe chimatanthawuza kuwunika kwa chaka ndi chaka kuti awone kusintha m'mapapu. International Tuberculosis Union ikuwona kuti ndikofunikira kukhazikitsa njirazi mmaiko omwe ali ndi chifuwa chachikulu cha TB.

Kuchulukana kwa chifuwa chachikulu cha m'mapapo mwanga kwa odwala omwe ali ndi matenda ashuga nthawi zambiri kumakhala chizindikiro chotsika cha matendawa, kusintha kwa mapapo m'mapapo, kupangitsa zovuta kuzindikira, komanso kuchepetsa kugwiritsa ntchito kwina

Atm ^ magawo. Pulmonology ndi allergology 9

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mankhwala antituberculosis, chifukwa cha kukhalapo kwa zovuta za matenda ashuga. Kukula kwa chifuwa chachikulu cha m'mapapo mwanga kwa odwala omwe ali ndi matenda ashuga, monga lamulo, kumabweretsa zovuta pakulimbana ndi matenda ashuga, ndi hyperglycemia wolimba, nawo, amasokoneza njira yokhazikika yamapapu obwera chifukwa cha anti-chifuwa chachikulu.

Matenda a shuga komanso matenda a m'mapapo

Ubwenzi wolunjika pakati pa matenda am'mimba ndi matenda am'kati mwa mapapo (LLL) ndizokayikitsa, kupatula kusintha m'mapapu chifukwa cha microangiopathy ndi nonenzymatic glycosylation ya zinthu za pulmonary interstitium. Komabe, shuga imabweretsa zopinga zazikulu pakukhazikitsa chithandizo chokwanira cha glucocorticosteroid, chofunikira kwa odwala omwe ali ndi maphunziro a ILI, makamaka sarcoidosis ndi fibrosing alveolitis. Muzochitika zotere, kuwongolera kwa shuga kumatheka ndikuwongolera njira yochepetsera shuga, ndipo ndizotheka kusintha njira yogwiritsira ntchito IDL yokhala ndi milingo yotsika ya glucocorticosteroids pogwiritsa ntchito plasmapheresis ndi lymphocytoplasm-phoresis 26, 27.

Matenda a shuga ndi m'mapapo matenda a mwana wosabadwayo

Amadziwika kuti kusayendetsa bwino kwa matenda ashuga mwa amayi apakati kumakhudza kwambiri kukula kwa mapapu mu fetus. Kuphwanya kapangidwe ka phospholipids chachikulu (phosphatidylcholine ndi phosphatidylglycerol) kumawonjezera chiopsezo cha kupsinjika kwa kupsinjika kwa matendawa (ARDS) mwa akhanda. Chiwopsezo cha ARDS chimachepetsedwa kwambiri ndikulamulira bwino kwa matenda ashuga mwa amayi apakati. Kufufuza kwa Ultrasound pa sabata la 37 la mimba kumakupatsani mwayi kuti mufufuze momwe mapapo alili mu fetus, chiwopsezo cha ARDS ndikuchotsa kufunika koti muphunzire zomwe zili phosphatidylcholine ndi phosphatidylglycerol mu amniotic fluid 28, 29.

AD ndi ARDS mwa akulu

Mfundo yokhayo yomwe imakhudzana ndi matenda a shuga inali kuchepa pachiwopsezo cha kupezeka kwa ARDS mwa achikulire, zomwe zimachitika chifukwa chotsatira cha kuyankha kwamphamvu kwa hyperglycemia, kusokonekera kwa kagayidwe kachakudya ndi mankhwala omwe amagwiritsidwa ntchito pa matenda a shuga.

Palibe kukayikira kuti kufalikira kwa matenda ashuga monga microangiopathy sikungatheke koma kumakhudza mapapu a chiwalo chokhala ndi intaneti yayikulu, ndipo maphunziro angapo a ma 1990 amapereka umboni wotsimikizira mfundoyi. Komabe, zambiri zokhudzana ndi zomwe zimapezeka m'matenda a pulmonary matenda a shuga sizachilendo, m'derali pali zotsutsana zambiri komanso "malo opanda kanthu", ndipo tili ndi zambiri zoti tidziwe za matenda a m'mapapo a shuga.

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Kulembetsa ku magazini ya sayansi ndi yothandiza "Atmosphere. Pulmonology and Allergology ”

Mutha kulembetsa ku positi iliyonse ku Russia ndi CIS. Magaziniyi imasindikizidwa kanayi pachaka. Mtengo wolembetsa kwa miyezi isanu ndi umodzi molingana ndi chikwangwani cha bungwe la Rospechat ndi ma ruble 100, pa nambala imodzi - ma ruble 50.

Onani zolemba zotchuka

Kupuma pang'ono (dyspnea) ndikumva kupweteka kwakusowa kwa mpweya, mwa njira zoperewera zimatenga mawonekedwe a kuperewera.

Ngati kupuma movutikira kumachitika mwa munthu wathanzi motsutsana ndi maziko olimbitsa thupi kapena kupsinjika kwambiri kwa psychoemotional, kumawerengedwa ngati thupi. Choyambitsa chake ndikufunika kwakuchepa kwa mpweya m'thupi. Nthawi zina, dyspnea amayamba chifukwa cha matenda ena ndipo amatchedwa pathological.

Malinga ndi zovuta pagawo la kudzoza kapena kutha, dyspnea imasiyanitsidwa ngati yolimbikitsa komanso yotulutsa, motsatana. Dyspnea yosakanikirana imatha kukhalanso ndi malire a magawo onse awiri.

Pali mitundu ingapo ya kupuma movutikira. Kupuma movutikira kumawerengedwa kuti kumachitika ngati wodwala akuvutika kupuma, kusakhutira ndi mpweya, koma izi ndizosatheka kuyesa ndipo palibe zomwe zimachitika. Nthawi zambiri, ndi chizindikiro cha hysteria, neurosis, chifuwa radiculitis. Kupuma movutikira kumadziwika ndi kuphwanya pafupipafupi, kupuma movutikira, kutalika kwa mpweya kapena kupumira, komanso ntchito yowonjezereka yam'mapapo.

Matenda a Dyspnea

Mu matenda am'mapapo, kupuma movutikira kumatha kukhala chifukwa chododometsa m'mphepete mwa mpweya kapena kuchepa kwa gawo la kupuma kwamapapu.

Kulowera kumtunda kwa kupumira (thupi lachilendo, chotupa, kuchuluka kwa sputum) kumapangitsa kuti zikhale zovuta kutulutsa ndikutulutsira mpweya kumapapu, potero kumapangitsa dyspnea yolimbikitsa. Kuchepetsa lumen kwa magawo omaliza a mtengo wa bronchial - bronchioles, bronchi yaying'ono yokhala ndi edema yotupa kapena kuphipha kwa minofu yawo yosalala kumalepheretsanso kuphipha, kuchititsa kuperewera kwa dyspnea. Potha kuchepa kwa trachea kapena bronchus yayikulu, dyspnea amaganiza mawonekedwe osakanikirana, omwe amalumikizidwa ndi malire a mbali zonse za kupuma.

Dyspnea imasakanizikanso chifukwa cha kutupa kwa m'mapapo parenchyma (chibayo), atelectasis, chifuwa, Actinomycosis (matenda oyamba ndi mafangasi), silicosis, infarction ya pulmonary kapena compression yochokera kunja ndi mpweya, madzi mu pleural patsekeke (ndi hydrothorax, pneumothorax). Dyspnea wosakanikirana wokwanira mpaka kukhuta umawonedwa ndi pulmonary embolism. Wodwalayo amakhala m'malo mokakamizidwa atakhala m'manja ndi manja. Kubalira mwa kuukira mwadzidzidzi ndi chizindikiro cha mphumu, bronchial kapena mtima.

Ndi kupukutika, kupuma kumakhala kwapamwamba komanso zopweteka, chithunzi chofananacho chimawonedwa ndi kuvulala pachifuwa komanso kutupa kwamitsempha yam'kati, kuwonongeka kwa minofu yopuma (ndi polio, ziwalo, myasthenia gravis).

Kufupika kwa matenda amtima ndi chizindikiro chodziwika bwino komanso chidziwitso cha matenda. Chomwe chimapangitsa kupuma pang'ono apa ndikufooka kwa ntchito yopukuta kwa chamanzere kwamitsempha yamagazi ndikusunthika kwa magazi m'magazi.

Mwa kupuma pang'ono, munthu akhoza kuwunika kuwuma kwa kulephera kwa mtima. Pachigawo choyamba, kupuma movutikira kumawonekera pakulimbitsa thupi: kukwera masitepe oposa 2-3, kuyenda pansi, motsutsana ndi mphepo, kusuntha mwachangu. Matendawa akamakula, zimavuta kupuma ngakhale pang'ono, tikamalankhula, kudya, kuyenda modekha, kugona tulo. Mokulira matendawa, kupuma movutikira kumachitika ngakhale kulimbitsa thupi pang'ono, ndipo chochita chilichonse, monga kutuluka pabedi, kusuntha nyumba, torso, kumakhala ndi kumverera kosowa kwa mpweya. Pamapeto omaliza, kupuma movutikira kulipo komanso kupuma kwathunthu.

Mavuto amtundu wa kupuma movutikira, kupuma komwe kumachitika pambuyo pa kupsinjika kwa thupi, m'maganizo kapena mwadzidzidzi, nthawi zambiri usiku, kugona. Wodwala amakhala m'malo mokakamizidwa. Kupuma kumakhala kaphokoso, kuwulutsa, kumveka patali. Kutulutsidwa kwa thonje lonyansa kumawonedwa, komwe kumawonetsa kuyambika kwa pulmonary edema, ndi maliseche amiseche, kutenga nawo gawo kwamathandizo othandizira kupuma, kudziwikirana kwa malo okhala ndi pakati ndikuwonekera.

Kuphatikiza apo, kupuma movutikira kuphatikiza ndi kupweteka pachifuwa, palpitations, kusokonezeka kwa ntchito ya mtima kumatha kukhala chizindikiro cha infarction yanyengo ya myocardial, kusokonezeka kwa miyendo (paroxysmal tachycardia, atration fibrillation) ndipo chifukwa cha kuchepa kwambiri kwa ntchito ya mtima, kuchepa kwa mafuta ndi kuperewera kwa okosijeni kuzinthu komanso ziwalo.

Gulu la matenda amwazi, chimodzi mwazizindikiro zomwe ndi kupuma movutikira, zimaphatikizapo kuchepa kwa magazi ndi matenda a m'magazi (chotupa). Onsewa amadziwika ndi kuchepa kwa hemoglobin komanso maselo ofiira am'magazi, gawo lalikulu lomwe kunyamula ndi mpweya. Momwemo, mpweya wa ziwalo ndi minofu imamipira. Kuchita kwakubweza kumachitika, pafupipafupi ndi kupumira kumawonjezeka - potero thupi limayamba kudya mpweya wambiri kuchokera kumalo okhala panthawi imodzi.

Njira yosavuta kwambiri komanso yodalirika yodziwira zinthu izi ndi kuyezetsa magazi konse.

Gulu lina ndi endocrine (thyrotooticosis, shuga mellitus) ndi matenda okhudzana ndi mahomoni (kunenepa kwambiri).

Ndi chithokomiro cha chithokomiro, chithokomiro chamafuta chimapangidwa, mothandizidwa ndi zomwe njira zonse za metabolic zimathandizira, metabolism ndi kumwa kwa okosijeni zimachuluka. Pano, kupuma movutikira, monga kuchepa kwa magazi, kumabweza zachilengedwe. Kuphatikiza apo, milingo yayikulu ya T3, T4 imathandizira kugwira ntchito kwa mtima, ndikupangitsa kusokonezeka kwa miyambo monga paroxysmal tachycardia, fibrillation ya atria ndi zotsatira zomwe tafotokozazi.

Dyspnea mu shuga mellitus imatha kuganiziridwa ngati chifukwa cha matenda ashuga a shuga, zomwe zimayambitsa kuphwanya kwa trophism, kuperewera kwa mpweya wa maselo ndi minofu. Ulalo wachiwiri ndi kuwonongeka kwa impso - matenda ashuga nephropathy. Impso zimatulutsa chifukwa cha hematopoiesis - erythropoietin, ndipo kuchepa kwa magazi m'thupi kumachitika.

Ndi kunenepa kwambiri, chifukwa chakuwoneka kwa minofu ya adipose mkati mwa ziwalo zamkati, ntchito yamtima ndi mapapu ndizovuta, kuyenda kwa diaphragm kumakhala kochepa. Kuphatikiza apo, kunenepa kwambiri nthawi zambiri kumayendetsedwa ndi atherosulinosis, matenda oopsa, izi zimaphatikizanso kuphwanya kwa ntchito yawo komanso kupezeka kwa kufupika.

Kufupika kwapang'onopang'ono mpaka pamlingo wakwanitsa kutha kuwonedwa ndi ma poizoni osiyanasiyana. Kupanga kwake kwa kukula kumaphatikizapo kuwonjezeka kwa kupumira kwa mtima kwa khoma la microcirculatory komanso poyizoni wa pulmonary edema, komanso kuwonongeka mwachindunji kwa mtima ndi kusokonekera kwa ntchito ndi kuchepa kwa magazi m'mitsempha yamagazi.

Kufupika kwamankhwala othandizira kupuma

Ndikosatheka kuthetsa kufupika popanda kumvetsetsa zomwe zimayambitsa, kukhazikitsa matenda omwe amayamba chifukwa chake. Kwa digiri iliyonse ya dyspnea, kuti mupeze thandizo panthawi yake komanso kupewa zovuta, muyenera kuwona dokotala. Madokotala omwe luso lawo limaphatikizapo kuchiza matenda ndi kupuma movutikira ndi akatswiri, a mtima, endocrinologist.

Akatswiri azachipatala cha AVENUE azoyankha mwatsatanetsatane komanso mwamafomu mafunso onse okhudzana ndi vuto lanu ndipo azichita zonse kuti athetse.

wazachipatala, wamtima wa MC Avenue-Alexandrovka

Zhornikov Denis Alexandrovich.

Kufupika kwamapumidwe: zifukwa zazikulu, malingaliro a katswiri

Kufupika ndi vuto la kupuma, kuwonjeza pafupipafupi kwake ndi / kapena kuya kwake, komwe nthawi zambiri kumayendetsedwa ndi kumverera kosowa kwa mpweya (kubowoleza), ndipo nthawi zina mantha, mantha. Sizingatheke kuyimitsa ndi ufulu wa kusankha.

Kufupika nthawi zonse kumakhala chizindikiro cha matenda. Komabe, kupuma movutikira kuyenera kusiyanitsidwa ndi kupuma kwamphamvu ndi kuphwanya kwamanjenje kapena mafinya (pamapeto pake, kupuma kwamiseche kumasokonezedwa ndi kuwusa kwakukuru).

Zomwe zimawoneka ngati kupuma pang'ono ndizambiri. Njira ndi mtundu wa chisamaliro zimasiyana kutengera kuti ali pachimake (modzidzimutsa) monga kuukira kwa kupuma kapena kufupika kumawonjezeka pang'onopang'ono komanso kudwala.Dyspnea nthawi zonse ndi chizindikiro cha matenda.

Pachimake kupunthwa kupuma

Zambiri zomwe zimayambitsa kupweteketsa mtima kupuma, kupuma.

1. Kuukira kwa mphumu ya bronchial.
2. Kuchulukitsa kwa bronchitis yovuta.
3. Kulephera kwa mtima - "mphumu wamtima".
4. Kuwonjezeka kowopsa kwa shuga m'magazi ndi acetone mu shuga.
5. Kuphipha kwa larynx ndi chifuwa kapena kutupa kwambiri.
6. Thupi lakunja munjira zamlengalenga.
7. Thrombosis yamitsempha yamapapu kapena ubongo.
8. Matenda oopsa otupa komanso opatsirana omwe ali ndi kutentha kwambiri (chibayo chachikulu, meningitis, abscess, etc.).

Dyspnea mu mphumu ya bronchial

Ngati wodwalayo wakhala akudwala matenda opatsirana kapena a mphumu kwakanthawi ndipo madotolo amupeza, ndiye kuti muyenera kugwiritsa ntchito botolo la sponchodilator wapadera, monga salbutamol, fenoterol kapena berodual. Amathandizira kuphipha kwa bronchi ndikukulitsa mpweya kupita m'mapapu. Nthawi zambiri Mlingo wa 1-2 (wokwanira pakubwezeretsa) ndi wokwanira kuyimitsa kuwonekera kwa matenda.

Pankhaniyi, malamulo otsatirawa akuyenera kuwonedwa:

• Simungathe kuchita inhalations wopitilira 2 - "jakisoni" mzere, osachepera mphindi 20 ayenera kuyang'aniridwa. Kugwiritsa ntchito inhaler pafupipafupi sikukula kwake, koma maonekedwe ake, monga palpitations, kusintha kwa kuthamanga kwa magazi - inde.
• Osapitilira muyeso ya tsiku ndi tsiku ya inhaler, yogwiritsidwa ntchito pakanthawi masana - ndi katatu pa tsiku.
• Kugwiritsa ntchito mankhwala osokoneza bongo mosasinthasintha. Kupuma kovuta kumatha kulowa mu komwe kumatchedwa mphumu, zomwe ndizovuta kuyimitsa ngakhale m'chipinda chothandizira kwambiri.
• Ngati mukugwiritsidwa ntchito mobwerezabwereza (mwachitsanzo 2 jekeseni 2 "jakisoni") wa inhaler, kufupika sikuyenda kapena kukulirakulira, imbani ambulansi mwachangu.

Kodi chingachitike ndi chiyani ambulansi isanafike?

Kupereka mpweya wabwino kwa wodwalayo: tsegulani zenera kapena zenera (mawonekedwe a mpweya sayenera!), Chotsani zovala zolimba. Zochita zina zimadalira chifukwa cha kupuma movutikira.

Mwa munthu yemwe ali ndi matenda ashuga, ndikofunikira kuyeza kuchuluka kwa shuga m'magazi ndi glucometer. Pa mishuga yambiri, insulin imawonetsedwa, koma izi ndizopangira madokotala.

Ndikofunikira kuti munthu wodwala matenda amtima ayesere kuthamanga kwa magazi (amatha kukhala okwera), akhazikike. Kugona pabedi sikofunikira, chifukwa kupuma pamenepa kumayamba kuvuta. Kwezani miyendo kuti gawo lowonjezera lamadzi kuchokera mumtima lipite kumiyendo. Pothamanga kwambiri (kupitirira 20 mamilimita Hg. Art. Koposa zabwinobwino), ngati munthu ali ndi matenda oopsa kwa nthawi yayitali ndipo pali mankhwala oponderezedwa kunyumba, ndiye kuti mutha kumwa mankhwala omwe adanenedwa ndi adokotala kuti muimitse zovuta zanu, monga capoten kapena corinfar.

Kumbukirani, ngati munthu amadwala koyamba m'moyo wake - musamupatse nokha mankhwala.

Mawu ochepa za laryngospasm

Ndiyeneranso kunena mawu ochepa okhudza laryngospasm. Ndi laryngeal spasm, kupuma kwamaso kopanda phokoso (stridor) kumakhala kotchuka, kumveka patali ndipo nthawi zambiri kumayendera limodzi ndi chifuwa choyipa "chokhazikika". Vutoli limachitika nthawi zambiri ndimatenda oyambitsa kupuma a ma virus, makamaka ana. Kupezeka kwake kumalumikizidwa ndi laryngeal edema yayikulu ndi kutupa. Pankhaniyi, osakulunga khosi lanu ndi ma compress ofunda (izi zimatha kutupira). Tiyenera kuyesa kukhazika mtima pansi mwana, kum'patsa chakumwa (mayendedwe akumeza kufewetsa kutupira), kupereka mwayi wokhala ndi mpweya wonyowa. Ndi cholinga chosokoneza, mutha kuyika mpiru kumapazi anu. Muzochepa, izi zitha kukhala zokwanira, koma ambulansi iyenera kutchedwa, chifukwa laryngospasm imatha kuchuluka ndikuletsa kwathunthu mpweya.

Kupuma movutikira

Maonekedwe ndikuwonjezera pang'onopang'ono kufupika kwapafupipafupi nthawi zambiri kumapezeka m'mapapo kapena matenda a mtima. Nthawi zambiri kupumira msanga komanso kusowa kwa mpweya kumayamba kumachitika nthawi yayitali. Pang'onopang'ono, ntchito yomwe munthu angathe kuchita, kapena mtunda womwe angapite, umachepa. Chitonthozo cha zochitika zolimbitsa thupi chimasinthika, moyo wamunthu umachepa. Zizindikiro monga palpitations, kufooka, kusasalala kapena khungu la khungu (makamaka malekezero) kulumikizana, kutupa ndi kupweteka pachifuwa ndizotheka. Amalumikizidwa ndikuti zidakhala zovuta kuti mapapo kapena mtima ugwire ntchito yake. Mukapanda kuchitapo kanthu, kupuma movutikira kumayamba kuvutitsa kuyesetsa kochepera komanso kupuma.

Ndikosatheka kuchiritsa kupumira kwakanthawi popanda chithandizo cha matenda omwe adayambitsa. Chifukwa chake, muyenera kufunafuna chithandizo chamankhwala ndikuyesedwa. Kuphatikiza pa zifukwa zomwe zalembedwa, kupuma movutikira kumawonekera ndi magazi m'thupi, matenda ammagazi, matenda amitsempha, matenda amitsempha, etc.

Pambuyo pokhazikitsa njira yodziwitsira matenda ndi njira yothandizira matenda oyamba kunyumba, ndikofunika kutsatira malangizo otsatirawa:

1. Imwani mankhwala okhazikitsidwa ndi dokotala wanu pafupipafupi.
2. Lumikizanani ndi dokotala zamankhwala ndi zomwe mungatenge nokha mwadzidzidzi ndikusunga mankhwalawa m'nyumba yanu.
3. Kuyenda tsiku lililonse mumawonekedwe abwino, makamaka theka la ola.
4. Siyani kusuta.
5. Osadya kwambiri, ndibwino kudya nthawi zambiri m'magawo ang'onoang'ono. Zakudya zambiri zimathandizira kufupika kapena kumawonjezera mawonekedwe ake.
6. Kwa ziwengo, mphumu, yesetsani kupewa kulumikizana ndi zinthu zomwe zimayambitsa mphumu (fumbi, maluwa, nyama, fungo loipa, etc.).
7. Yanikani kuthamanga kwa magazi, ndi shuga - shuga.
8. Ziphuphu zimayenera kudyedwa pang'ono, kuchepetsa mchere. Ndi matenda amtima ndi impso, matenda a chiwindi, kugwiritsa ntchito madzi ambiri ndi mchere kumakhalabe ndi madzi mthupi, zomwe zimapangitsanso kupuma movutikira.
9. Chitani masewera olimbitsa thupi tsiku lililonse: masewera olimbitsa thupi omwe amasankhidwa mwapadera komanso masewera olimbitsa thupi. Zochita zolimbitsa thupi zimasangalatsa thupi, zimawonjezera zosungika za mtima ndi mapapu.
10. Zimalemedwa pafupipafupi. Kulemera msanga kwa makilogalamu 1.5-2 m'masiku ochepa ndi chizindikiro cha kusungunuka kwamadzi m'thupi ndi kupumira kwakanthawi.

Malangizo awa ndi othandiza mu matenda aliwonse.