Matenda oopsa a matenda a shuga a mellitus: owopsa ndi otani?

Kusintha kwazomwe zimapangidwa mu heterogeneous pathologies kumawononga thanzi la wodwala aliyense.

Kuphatikizika kwa matenda ashuga kumapangitsa kuti michere iwonjezeke.

Kupenda kwa kachipatala kwawonetsa kuti mwa odwala omwe ali ndi vuto la insulin lokwanira kapena la wachibale, kangapo kumawonjezera kuthamanga kwa magazi kumakhala mwayi waukulu wamavuto aubongo.

Zomwe zimayambitsa kuthamanga kwa magazi mu matenda a shuga a insulin

Popanda insulini, shuga sitha kugwiritsidwa ntchito ndi minofu, minofu ya adipose ndi hepatocytes. Mukudwala matenda ashuga a mtundu woyamba wa I, gawo limodzi mwa maselo omwe amachititsa kuti timadzi timene timapanga timene timapanga.

Mankhwala osungidwa a endocrine pancreatic sangathe kuphimba zosowa zonse za insulin. Chifukwa chake, thupi limangogawana gawo laling'ono la kapangidwe kake ndipo limalandira shuga kuchokera ku chakudya.

Zakudya zowonjezera thupi zimakhalabe m'magazi. Gawo la glucose limalumikizana ndi mapuloteni a plasma, hemoglobin, gawo lina limatulutsidwa mu mkodzo.

Pazigawo zosungirako zakudya m'thupi, mafuta, ma amino acid ayamba kugwiritsidwa ntchito. Zomaliza zomaliza zopangidwa ndi michere yofunika zimatsogolera pakusintha kwa magazi. Pa mulingo wa impso, kusefedwa kwa zinthu kumasokonekera, makulidwe amadzimadzi amadzimadzi am'magazi, magazi amadzimadzi aimpso amayamba kuwipira, komanso kuwonekera kwa nephropathy. Vutoli limasinthika ndikulumikiza matenda awiri monga matenda a shuga komanso matenda oopsa.

Kutsika kwa magazi mu impso kumabweretsa kuchuluka kwa renin-angiotensin-aldosterone system (RAAS).

Izi zimapangitsa kuti chiwonetsero cha arterioles chiwonjezeke komanso kuwonjezereka poyankha kukondweretsedwa kwachisoni.

Kuphatikiza pa kusintha kwa morphological, gawo lofunikira mu pathogenesis ya kuthamanga kwa magazi imaseweredwa ndi kuchedwa kwa thupi la sodium pa plasma kusefedwa ndi impso ndi hyperglycemia. Mchere wambiri ndi glucose womwe umasungunuka m'magazi osavomerezeka ndi mpweya, womwe umapangitsa kuthamanga kwa magazi chifukwa cha kuchuluka kwa magazi (hypervolemia).

Kwezani kuthamanga kwa magazi ndi kuchepa kwa wachibale

Kukula kwa matenda oopsa ndi matenda a shuga a 2 kumachitika chifukwa cha kulumikizidwa kamodzi kwa kagayidwe kachakudya - insulin.

Kusiyana kwakukulu ndi kuphatikiza kwa zinthu kumeneku ndiko kuyambukira kwa ziwonetsero za matenda. Nthawi zambiri pamakhala matenda oopsa kwambiri omwe ali harbinger wa shuga yemwe samadalira shuga.

Ndi kuperewera kwa insulin, kumachitika zinthu zikakhala kuti kapamba amatulutsa kuchuluka kwa timadzi timene timafunikira. Komabe, maselo enaake amalephera kuzindikira kwawo.

Mwazi wa wodwalayo umakwera ndipo nthawi yomweyo amakhala ndi insulini yaulere, yomwe imakhala ndi zinthu zingapo:

• mahomoni amakhudza kayendetsedwe kazinthu zamagetsi, ndikulimbikitsa ntchito yolumikizana,
• imawonjezera kubwereranso kwa sodium ions mu impso (reabsorption),
• kumabweretsa kukula kwa makoma a arterioles chifukwa cha kuchuluka kwa minofu yosalala.

Mphamvu ya insulini imakhala cholumikizira chofunikira kwambiri pa matenda a matenda oopsa a matenda a shuga a mtundu II mellitus.

Zowonetsa pazachipatala

Poyerekeza ndi zakumayambiriro kwa matenda ashuga mwanjira yokoka pafupipafupi, thukuta, ludzu, chizungulire, mutu, mawonekedwe a ntchentche ndi mawanga patsogolo pa maso amadziwika.

Chowoneka mosiyana ndi zovuta zophatikizika ndikuwonjezereka kwa magazi usiku, kukula kwa orthostatic hypotension komanso kulumikizana kowonekeratu ndikugwiritsa ntchito zakudya zamchere kwambiri.

Osakhala Oseketsa komanso Osankha usiku

Matenda a shuga amawopa mankhwalawa, ngati moto!

Muyenera kungolemba ...

Odwala omwe ali ndi kayendedwe kazolimbitsa thupi ka dongosolo la Autonomic, kusinthasintha kwa tsiku ndi tsiku m'magazi kumakhala magawo 10-20%.

Potere, mitengo yayikulu yamankhwala imalembedwa masana, komanso osachepera - usiku.

Pa anthu omwe ali ndi matenda ashuga omwe ali ndi vuto la kudziyimira payekha, zochita za mitsempha ya maliseche panthawi yayikulu kugona.

Chifukwa chake, palibe kuchepa kwachilendo kwa kuthamanga kwa magazi usiku (odwala ndi osagwiritsa ntchito) kapena, m'malo mwake, cholakwika chimawonedwa ndikuwonjezereka kwa zowonetsa (kwa osankha owala).

Matenda a shuga ndi matenda oopsa

Kuwonongeka kwa maulalo azinthu zamagulu am'magazi a shuga kumayambitsa kuphwanya kwa mkati mwa khoma lamitsempha.

Mukadzuka pabedi kuchokera pamalo opingasa mwa odwala omwe ali ndi matenda ashuga, kuchepa kwambiri kwa magazi kumawonedwa chifukwa cha kusowa kwa kamvekedwe kokwanira ka ma arterioles chifukwa cha kukomoka kwa magazi.

Odwala omwe adadziwika panthawi yotere chizungulire, kumada khungu, kufooka mpaka kugwedezeka miyendo ndi kukomoka.

Kuti muzindikire momwe ziliri, ndikofunikira kuyeza kukakamiza pa kama wodwala ndikuyamba kusintha kwa malo okhazikika.

Zowopsa

Comorbidity ngati matenda oopsa komanso matenda ashuga mellitus (DM) osagwiritsika ntchito ndi matenda amapezeka ndi zoopsa zambiri zobweretsa ngozi za muubongo.

Multipactorial kuwonongeka kwa ochepa khoma, anasintha biochemical zikuchokera magazi, minofu hypoxia, ndi kuchepa kwa magazi kumabweretsa kuti ubongo zinthu akudutsa ischemia.

Odwala ali ndi mwayi wosakhazikika wa stroko ndi hemorrhege m'malo a subarachnoid.

Kuwonjezeka kwakukulu kwa kuthamanga kwa magazi kumapangitsa kuti wodwala azikhala ndi matenda ashuga chifukwa chakukula kwa micro- ndi macroangiopathies: zotumphukira zamagazi ndi magazi amatuluka kupita ku ziwalo zoperekedwa kuchokera ku dziwe lalikulu.

Kuzindikira ndi chithandizo

Kuti mutsimikizire ochepa matenda oopsa mwa wodwala yemwe ali ndi matenda osokoneza bongo, kuyeza kukakamizika kwapakati ndikofunikira.

Mitengo yowonjezera yoposa 140/90 mm RT. Art., Yolembedwa nthawi zosiyanasiyana, imakupatsani mwayi wofufuza matenda oopsa.

Kuphatikiza apo, kukhazikitsa kusintha kwamadongosolo mumagulu azungulira wamagazi, kuwunika kwa Holter kumachitika.

Cholinga chachikulu cha mankhwalawa ndikuwongolera matenda. Madokotala amasunga kuthamanga kwa magazi osakwana 130/80 mm Hg. Art. Ndikofunikira kudziwa kuti thupi la wodwalayo limagwiritsidwa ntchito pakusintha kwa hemodynamic. Kukwaniritsidwa mwadzidzidzi kwa zomwe mukufuna kumakhala nkhawa yayikulu.

Mphindi yofunikira panjira yochepetsera kupanikizika ndi kuchepa kwamphamvu kwa kuthamanga kwa magazi (osapitirira 10-15% yamalingaliro am'mbuyomu mu masabata 2-4).

Maziko a chithandizo ndi zakudya

Odwala amatsutsana pogwiritsira ntchito zakudya zamchere.

Ngati anthu athanzi amafunika kuchepetsa mcherewu mpaka 5 g patsiku, ndiye kuti odwala matenda ashuga ayenera kuchepetsa kuchuluka kwake kawiri.

Chifukwa chake, ndizoletsedwa kuwonjezera chakudya, ndipo pokonza mwachindunji zakudya mpaka pazokwanira kuti mupewe kugwiritsa ntchito chipatsochi.

Hypersensitivity sodium imayambitsa kuchepetsedwa kwa mchere mu odwala matenda ashuga 2,5-3 g patsiku.

Zosankha zonsezo ziyenera kufanana ndi tebulo No. 9. Chakudyacho chimaphika uvuni, kuwotchera, kuwiritsa. Chepetsani mafuta ndipo, ngati zingatheke, kanizani michere yaying'ono. Zakudya zophika, zosuta sizimaphatikizidwa. Kuchulukitsidwa kwa zakudya zochulukirapo mpaka 5-6 patsiku. Sukulu ya odwala matenda ashuga amafotokozera machitidwe a mkate, malinga ndi momwe wodwalayo amapangira chakudya.

Kusankhidwa kwa madokotala

Vuto kusankha mankhwala a antihypertensive mwa wodwala aliyense amene ali ndi matenda ashuga limachulukirachulukira chifukwa cha kupezeka kwa matenda a carbohydrate metabolism.

Mwa zina mwa mankhwala omwe amasankhidwa pochiza matenda oopsa mwa odwala omwe ali ndi matenda ashuga, mankhwala otsatirawa amasankhidwa:

• zogwira mtima momwe mungathere ndi zovuta zochepa,
• osakhudza kagayidwe kazakudya zam'mimba;
• ndi nephroprotection ndi zotsatira zabwino pa myocardium.

Angiotensin-converting enzyme inhibitors (ACE inhibitors) ndi angiotensinogen II receptor antagonists (ARA II) amakwaniritsa zofunikira pakuchita bwino kwa matenda ashuga. Ubwino wa ACE inhibitors ndiwothandiza pa minyewa ya impso. Zomwe zimagwiritsidwa ntchito pagululi zimaphatikizidwa ndi stenosis ya onse aimpso.

ARA II ndi nthumwi za ACE zoletsa amaonedwa ngati mankhwala a mzere woyamba wa mankhwalawa a matenda ashuga.

Kuphatikiza kwa mankhwala ena kumathandizanso pochiza matenda oopsa kwa odwala omwe ali ndi matenda ashuga. Mankhwala omwe angafotokozedwe amaperekedwa pagome:

Akatswiri azachipatala amawona kukwaniritsidwa kwa zotsatira zabwino pomwe mukugwiritsa ntchito oimira 2-3 a magulu osiyanasiyana. Nthawi zambiri zimalimbikitsidwa kuphatikiza kutenga ACE zoletsa ndi indapamide. Kuphatikiza pa izi, kusaka kukupitilizabe njira zina zamankhwala zomwe zimasintha moyo wa wodwala wina.

Makanema okhudzana nawo

Chithunzithunzi cha mankhwalawa kwa matenda oopsa omwe amaperekedwa kwa odwala matenda ashuga:

Nkhani yothandizira odwala omwe ali ndi matenda ophatikizika komanso njira yovuta ya matenda ashuga imakhalabe yothandiza kwaoposa mazana masauzande a odwala. Njira yokhayo yophatikizira chithandizo, kutsatira kwa wodwala, kudya, kukana mowa ndi fodya, kuwongolera glycemic ndikwaniritsa mfundo zenizeni zamagazi kumathandizira kuti kudalitsika kwa matendawa kukhale bwino kwa wodwalayo komanso kumachepetsa kuopsa kwa zovuta zomwe zikuwopseza moyo.

Shuga mellitus - matendawa ndi chiyani?

Matenda a shuga amatchedwa endocrine disorder, chifukwa chake kupanga kwa insulin kumasokoneza. Pali mitundu iwiri yamatenda - mtundu 1 ndi matenda ashuga 2.

Matenda a shuga amtundu 1 amadziwika ndi insulin chifukwa cha kuwonongeka kwa maselo omwe amapezeka mu kapamba omwe amapanga timadzi timeneti. Zotsatira zake ndikulephera kwathunthu kwa thupi kuwongolera kuchuluka kwa glucose popanda kupereka insulin kuchokera kunja (jekeseni). Matendawa amakula ali aang'ono ndipo amakhala ndi munthu moyo wonse. Pothandizidwa ndi moyo, jakisoni wa insulin tsiku lililonse amafunikira.

Matenda a 2 a shuga ndi matenda omwe amapezeka paukalamba. Pathology imadziwika ndi kuphwanya kwa kayendedwe ka maselo amthupi ndi mahomoni opangidwa ndi kapamba. Poterepa, insulin imabisidwa mokwanira kuti ilamulire kuchuluka kwa glucose, komabe, maselo sazindikira zotsatira zake.

Matenda oopsa a arterial ndi mnzake wa mtundu wa matenda ashuga a 2, chifukwa ngati nthenda ya 1 ya matenda, kutsata insulin tsiku lililonse kumayang'anira ntchito ya ziwalo zofunika.

Matenda a 2 a shuga amatchedwa metabolic matenda. Amakula chifukwa cha kunenepa kwambiri, kulephera kuchita masewera olimbitsa thupi, kudya moperewera. Zotsatira zake, kagayidwe kazakudya zamafuta zimasokonekera, pali kuwonjezeka kwa kuchuluka kwa shuga ndi cholesterol m'magazi. Mkulu wokwera amachititsa kuti minyewa ikhale yovuta. Ndi shuga wowola wa mtundu wachiwiri, ndi mtima wamtima womwe umalandira kuwonongeka koyamba.

Matenda a 2 a shuga nthawi zambiri amakula mwa anthu onenepa kwambiri

Zoyambitsa Hypertension mu shuga

Kuphwanya kwa kulolera kwa glucose kumabweretsa kukula kwa zolakwika zingapo pantchito ya thupi lonse. Choopsa chachikulu ku thanzi ndi moyo wa wodwalayo si shuga a mtundu wachiwiri, koma zovuta za matendawa, kuphatikiza:

• angiopathy
• encephalopathy
• nephropathy
• polyneuropathy.

Chimodzi mwazinthu zomwe zikukulitsa matendawa ndikukulitsa kwambiri moyo wa wodwalayo ndi matenda oopsa.

Kupsinjika kwakukulu mu shuga kumachitika chifukwa cha zinthu zingapo:

• kuphwanya zakudya
• kuchuluka kwa madzi mthupi komanso kugwira ntchito kwa impso,
• kuphwanya kapangidwe ka mitsempha yamagazi chifukwa cha kuchuluka kwa shuga,
• zovuta zama metabolic zomwe zimachulukitsa katundu pa myocardium.

Kutsika kwa chidwi cha minofu kupita ku insulin yopangidwa m'thupi la wodwalayo nthawi zonse kumakhala chifukwa cha kusokonezeka kwa metabolic. Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, onenepa kwambiri alipo, zomwe ndi zina mwazinthu zomwe zimapangitsa kuti magazi azikhala ndi matenda oopsa.

Kuphatikiza pa kusintha kwamapangidwe amitsempha yamagazi chifukwa cha kuchuluka kwa shuga, kuwonongeka kwa impso kwa odwala omwe ali ndi vuto la shuga kumakhudzidwa kwambiri ndi magwiridwe antchito a mtima.

Chifukwa chake, choyambitsa chachikulu cha kuthamanga kwa magazi mu shuga ndi thanzi la wodwalayo. Tiyeneranso kudziwa kuti odwala omwe ali ndi matenda a shuga a 2 ali ndi zaka 55, zomwe zimapangitsa wodwalayo kukhala pachiwopsezo chotenga matenda amtima.

Kugwirizana kwa matenda ashuga ndi matenda oopsa kumapangitsa kuti pakhale zovuta zina pamankhwala. Kusankha mankhwala othandizira odwala matenda ashuga ndi ntchito yovuta yomwe akatswiri okha amatha kuigwira, chifukwa mankhwala ena a antihypertgency amatsogolera kukuwonjezeka kwa shuga wamagazi, omwe ali oopsa ndi mtundu wophatikizika wa matenda ashuga.

Matenda a shuga amakhudza ziwalo zambiri, kuphatikizapo mtima

Kodi ndichifukwa chiyani matenda oopsa a shuga ali oopsa makamaka?

Matenda a shuga ndi matenda oopsa ndi “akupha pang'onopang'ono” a m'zaka za zana la 21 lino. Matenda onsewa sangachiritsidwe kamodzi. Matenda a 2 a shuga amafunikira kudya pafupipafupi komanso njira zotithandizira kuti kagayidwe kake kagayidwe kake, ndipo matenda oopsa oopsa amafunika kuwunika kuthamanga kwa magazi ndi mankhwala.

Nthawi zambiri, chithandizo cha matenda oopsa chimayamba ndi kuwonjezeka kwamphamvu kwa kupanikizika kuposa 140 mmHg. Ngati wodwala sanapeze matenda ena, mankhwala othandizira pakudya ndi mono-mankhwala omwe ali ndi mankhwala amodzi amachitidwa, pofuna kupewa kukulitsa zovuta. Madokotala nthawi zambiri amayesa kuchedwetsa nthawi yomwe wodwala amayenera kugwiritsa ntchito mankhwala a antihypertensive. Kuwonongeka kwakanthawi koyamba kwa digiri yoyamba kumatha kubwezeretsedwa kwa nthawi yayitali mothandizidwa ndi zakudya komanso masewera. Mu shuga, matenda oopsa amathamanga kwambiri.

Chithandizo cha matenda oopsa mu matenda ashuga lero ndizovuta kwambiri. Ndiowopsa kugwetsa magazi kwambiri mu shuga ndi mankhwala osokoneza bongo, chifukwa zovuta zomwe zimakhala ndi odwala matenda ashuga zimakhala zowawa kwambiri. Nthawi yomweyo, zolembera zamtundu wa 2 shuga zimawonjezeka mofulumira. Ngati munthu wathanzi magazi amatha kupitirira kwa zaka zambiri, odwala matenda ashuga palibe nthawi yayitali, matendawa amapeza mphamvu pakatha miyezi ingapo. Pankhani imeneyi, amayesedwa kuti apereke mankhwala ngati mankhwala ochizira matenda oopsa a 2 shuga. Kuchulukana kosalekeza kwa anthu 130 mpaka 90 mwa anthu odwala matenda ashuga kumatanthauza kufunika kwa mankhwala kuti achulukane.

Kuthamanga kwa magazi kwa anthu odwala matenda ashuga ndiwotheka kukhala ndi chiopsezo chokhala ndi zotsatirazi:

• myocardial infaration
• kugwidwa muubongo
• kulephera kwambiri kwaimpso
• kutayika kwamaso
• matenda oopsa a encephalopathy.

Mavuto obwera chifukwa cha kupanikizika kwa matenda ashuga 2 ndi ovuta kuchiritsa ndipo nthawi zambiri sasintha. Cholinga chothira matenda oopsa m'magazi a shuga ndimawonekedwe amodzimodzi a kuthamanga kwa magazi ndi shuga wamagazi. Ndikofunikira kudziwa mwachangu gawo loyambirira la matenda oopsa ndikuchita zonse zofunika popewa kupitilira.

Kuti mumvetsetse chifukwa chake ndikofunikira kuti ndiyambe kulandira chithandizo pa nthawi, ziwerengero zingakuthandizeni. Pafupifupi, aliyense munthu watatu amadwala matenda oopsa mwanjira iliyonse.Matendawa amatsogolera ku kulumala koyambirira komanso kufupikitsa zaka zomwe amakhala ndi moyo zaka pafupifupi 7-10. Matenda a shuga mukamakula ndi owopsa pamavuto omwe nthawi zambiri sasintha. Odwala ochepa omwe ali ndi matenda a shuga a 2 amakhalabe ndi zaka 70. Kupsinjika kwakukulu kwa odwala matenda ashuga omwe ali ndi mtundu wachiwiri wa shuga kungafupikitse moyo wazaka zisanu. Ndi zovuta zam'mtima mu mtundu 2 wa shuga zomwe zimapangitsa kufa 80% ya milandu.

Mavuto sasintha ndipo nthawi zambiri amafa.

Zida zamankhwala osokoneza bongo

Mfundo zazikuluzikulu zochizira matenda oopsa, zomwe zimagwiritsidwa ntchito mokwanira pochiza odwala matenda a shuga:

• kuwunika kuthamanga kwa magazi ndi mankhwala,
• kusankha mankhwala,
• kutenga zotupa kuti zisale,
• kusintha kwa moyo.

Mapiritsi othandizira odwala matenda ashuga ayenera kusankhidwa kokha ndi katswiri. Mapiritsi opanikizika sayenera kuyanjana ndi mankhwala a shuga omwe amaperekedwa kwa wodwala kuti azilamulira kuchuluka kwa shuga m'magazi. Kusankhidwa kwa mankhwala kumachitika molingana ndi izi:

• kusamalira moyenera zizindikiro za kuthamanga kwa magazi ndi kupewa kudumphadumpha,
• kuteteza mtima ndi mtima
• kusowa kwa zoyipa ndi kulolerana kwabwino,
• kusowa kwa kagayidwe.

Mankhwala ena opsinjika mu matenda a shuga angayambitse hypoglycemia ndi proteinuria, monga anachenjeza m'ndandanda wazotsatira zoyipa. Izi zimakhala zowopsa kwa odwala matenda ashuga ndipo zimatha kubweretsa zotsatira zoopsa.

Ndikofunikira kuchiza kuthamanga kwa magazi mu shuga moyenera. Muyenera kusankha mankhwalawa omwe amachepetsa kuthinana komanso kupewa kuthamanga kwawo. Ndikofunika kudziwa kuti kuchepa kwambiri kwa mapiritsi mukamamwa piritsi ndi mayeso akulu a mtima.

Ngati wodwalayo ali ndi matenda oopsa komanso matenda a shuga, omwe mapiritsi oti azimwa amadalira thanzi lathu. Mu shuga mellitus, olemedwa ndi matenda oopsa, ndikofunikira kuti zitheke kuthana ndi zovuta pogwiritsa ntchito mankhwala osokoneza bongo. Pachifukwa ichi, mankhwala omwe amathandizika kwa nthawi yayitali amapatsidwa kuti azitha kuthana ndi nthawi

• Zoletsa za ACE: enalapril ndi renitek,
• Angiotensin II receptor blockers: Cozaar, Lozap ndi Lozap Plus,
• calcium antagonists: fosinopril, amlodipine.

Ma A inhibitors ali ndi zinthu zopitilira 40, koma kwa odwala matenda ashuga, tengani mankhwala ozikidwa pa enalapril. Thupi limakhala ndi nephroprotective. ACE inhibitors amachepetsa kuthamanga kwa magazi ndipo samachulukitsa shuga, kotero amatha kugwiritsidwa ntchito ngati matenda a shuga a 2.

Angiotensin II receptor blockers sizimakhudzanso impso. Cozaar ndi Lozap amaperekedwa kwa odwala matenda ashuga, mosatengera zaka. Mankhwalawa samayambitsa zotsatira zoyipa, amasinthasintha zochitika za thupi ndipo amakhala ndi mphamvu yayitali, chifukwa chomwe amatha kuthekera kuthana ndi kumwa piritsi limodzi la mankhwala patsiku.

Lozap Plus ndi mankhwala ophatikiza omwe ali ndi angiotensin receptor blocker ndi hydrochlorothiazide diuretic. Mukakwaniritsa chindapusa chokhazikika cha matenda ashuga, mankhwalawa ndi amodzi mwa mankhwala abwino kwambiri osankha, koma odwala kwambiri matenda ashuga komanso owopsa chifukwa cha kuwonongeka kwa impso, mankhwalawa sanadziwe.

Ma calcium antagonists ali ndi ntchito yapawiri - amachepetsa kuthamanga kwa magazi ndipo amateteza myocardium. Zoyipa za mankhwalawa ndizoyendetsa zawo mwachangu, ndichifukwa chake sangatengedwe kwambiri.

Hypertension kapena ochepa hypertension mu shuga mellitus samathandizidwa ndi beta-blockers, chifukwa mankhwalawa gululi amakhudza metabolism ndipo amachititsa hypoglycemia.

Mankhwala aliwonse omwe ali ndi matenda oopsa mu shuga ayenera kutumizidwa ndi adokotala okha. Malangizo ogwiritsira ntchito mankhwalawa kapena mankhwalawa zimatengera kuopsa kwa matenda ashuga komanso kupezeka kwa zovuta za matenda odwala.

Kupewa matenda oopsa

Popeza kuchuluka kwa matenda ashuga ndi zotsatira zachindunji zamagulu a shuga, kupewa kumatsika ndikukwaniritsa malingaliro onse a endocrinologist. Kuthana ndi zakudya, kusintha kwa kagayidwe kachakudya pochepetsa thupi, kumwa mankhwala olimbitsa thupi ndi mankhwala ochepetsa shuga - zonsezi zimapereka chindapusa chokhazikika cha matenda osokoneza bongo, pomwe chiopsezo cha zovuta ndizochepa.

Zolemba pazaka yasayansi pamutu wakuti "Hypertension and shuga mellitus: mfundo zamankhwala"

Ubwenzi wapakati pa impso ndi matenda oopsa (AH) wakopa chidwi cha asayansi azachipatala kwazaka zoposa 150. Woyamba pakati pa ofufuza odziwika omwe adathandizira kwambiri pamavuto awa anali mayina R. Bright (1831) ndi F. Volhard (1914), omwe adanenanso za kuwonongeka kwakukulu kwa ziwiya za impso pakukweza matenda oopsa ndi nephrossteosis ndikuwonetsa ubale pakati pa impso ndi AH mu mawonekedwe azinthu zoyipa, pomwe impso ndizo zinali zonse zomwe zimapangitsa matenda oopsa komanso cholowa. Zaka 50 zapitazo, mu 1948-1949, E.M. Tareev mu chithunzi chake cholemba "Hypertensive matenda" komanso zolembalemba adafotokoza mwatsatanetsatane gawo lomwe impso zimakhazikitsa ndikupanga matendawa ndikuwonetsa matenda oopsa monga matenda odziyimira pawokha ndikuwatsimikiziranso ubale wapafupi wa matenda oopsa komanso aimpso. Izi zikusonyezabe mpaka lero, zomwe zimapangidwanso ndi chidziwitso chatsopano cha zomwe impso zimachita popanga matenda oopsa a genesis iliyonse. Awa ndi ntchito zakale za N. Goldblatt ndi omutsatira, kuyala maziko a chidziwitso cha dongosolo la aimpso endocrine lomwe limatha kuwongolera kuthamanga kwa magazi, kafukufuku wa A.C. Guyton (1970-1980), yemwe adavomereza gawo la kusunga impso poyambira matenda oopsa, omwe pambuyo pake adalandira chitsimikizo chosaneneka cha "kusintha kwa matenda oopsa" pakuthana kwa impso kuchokera kwa wopereka magazi oopsa ndi ena ambiri. etc. Nthawi yomweyo, asayansi adapanga bwino njira ya kuwonongeka kwa impso mu matenda oopsa, monga

chandamale cholowa: gawo la ischemia la impso ndi vuto la intracranial hemodynamics - kuwonjezeka kwa nkhawa mkati mwa impal capillaries (intracubic hypertension) ndi kukula kwa hyperfiltration - pakuyambitsa njira za matenda a impso zimaganiziridwa.

Wolembedwa ku Moscow pa Okutobala 20 mpaka 22, 1999, seminar ku French-Russian semerar pa nephrology "Matenda oopsa a impso ndi impso" mwachidule zomwe zapeza sayansi posachedwapa mu gawo lofunikira lachipatala chamkati.

Msonkhanowu udakumana ndi asayansi otsogola kuchokera ku Russia ndi France komanso akatswiri opitilira 300 kuchokera kwa akatswiri a zamankhwala, akatswiri a mtima, komanso akatswiri wamba ochokera m'mizinda yosiyanasiyana ya Russia. Pazokambirana zomwe zidaperekedwa pamsonkhano, apulofesa ochokera ku malo achitetezo azachipatala ku France (Paris, Reims, Lyon, Strasbourg) ndi ku Moscow adawunikira nkhani zovuta kwambiri zavutoli. Madokotala omwe adatenga nawo gawo pamsonkhanowu adatenga nawo gawo pazokambirana, zomwe zidatsimikiza kufunika kwa mutuwu komanso nthawi yake yosiyirana.

Tikuthokoza kwathunthu kwa oyambitsa onse a nkhani yosiyiranayi omwe adawonetsetsa kuti mwambowu uchitike bwino, komanso kwa omwe akuthandizira, Nozra1, chifukwa chothandizira ndi bungwe lawo.

Prof. I.E. Tareeva Prof. Z. SapaY Prof. I.M. Kutyrina

DIPO LOPHUNZITSIRA NDIPONSO ZOPHUNZITSA: MIYAMBO YOPHUNZITSIRA MWA V. Shestakova

KUGWIRITSA NTCHITO KWA DZIKO LAPANSI NDI ZIWILIZO:

Matenda a shuga ndi matenda oopsa amitsempha yamagazi ndi njira ziwiri zophatikizirana zomwe zimagwiritsa ntchito mphamvu zolimbitsa zomwe zimaperekedwa mwachangu motsutsana ndi omwe

DIABETIC KIDNEY DZIWANI

1) CHITSITSO CHA MTIMA

Mafuta akuchotsa Na * komanso madzimadzi

il Local aimpso ASD

(1 Na *, Ca "pakhoma lamitsempha yamagazi /

Ndondomeko 1. Pathogenesis ya ochepa matenda oopsa mu IDDM. ASD - renin-angiotensin dongosolo, OPSS - zotumphukira zonse

ft Sympathetic ft Reabsorption Kukwaniritsidwa kwa Na * ndi Ca "Kuchulukana

Na * ndi madzi ali pakhoma la chotengera 1_

ft MTIMA WODULA

kuchuluka kwa ziwalo zomwe mukufuna: mtima, impso, ziwiya zaubongo, ziwiya zam'mbali. Zomwe zimayambitsa kupunduka kwakukulu komanso kufa kwa odwala omwe ali ndi matenda osokoneza bongo omwe ali ndi vuto losakanikirana kwa matenda oopsa ndi izi: matenda a mtima, kuvulala kwamitsempha, kulowerera kwamitsempha, kulephera kwamchiwindi. Zinapezeka kuti kuwonjezeka kwa kuthamanga kwa magazi kwa diastolic (ADC) kwa 6 mm RT iliyonse. Art. kumawonjezera chiopsezo cha matenda a mtima ndi 25%, ndi chiopsezo cha stroke - ndi 40%. Chiwopsezo cha kuyambanso kupweteka kwa aimpso ndi magazi osagawika kumawonjezera katatu. Chifukwa chake, ndikofunikira kwambiri kuzindikira koyambirira ndikuzindikira onse omwe ali ndi matenda ashuga komanso ogwirizana ndi matenda oopsa kuti apereke chithandizo chamankhwala munthawi yake ndikuletsa kukula kwa zovuta zamankhwala.

Matenda oopsa a arterial amapanga magawo a mitundu iwiri ya matenda a shuga a insulin-amadalira (IDDM) omwe amadwala matenda ashuga a mtundu II. Odwala omwe ali ndi matenda a shuga a mtundu woyamba, chifukwa chachikulu chophatikizira matenda oopsa ndi matenda ashuga a m'mimba (Scheme 1). Gawo lake limakhala pafupifupi 80% yazinthu zina zonse zomwe zimayambitsa kuthamanga kwa magazi. Pankhani ya matenda a shuga a mtundu P, mu 70-80% ya milandu, matenda oopsa amafunika kupezeka, omwe amatsogolera chitukuko cha matenda ashuga okha, ndipo ndi 30% yokha yomwe amakhala ndi matenda oopsa chifukwa cha kuwonongeka kwa impso. The pathogenesis of hypertension in NIDDM (mtundu II matenda ashuga) akuwonetsedwa mu Chiwembu 2.

Njira 2. Pathogenesis ya ochepa matenda oopsa mu NIDDM.

KUTHENGA KWA DZIKO LAPANSI

MU ZIWANDA ZA SUGAR

Kufunika kwa chithandizo chankhanza cha antihypertensive kwa odwala omwe ali ndi matenda osokoneza bongo ndikosakayikitsa. Komabe, matenda a shuga a mellitus, omwe ndi matenda omwe amaphatikizika ndi zovuta za metabolic komanso matenda angapo a ziwalo, amabweretsa mafunso ambiri kwa madokotala.

• Kodi magazi ayenera kuyambitsidwa pamlingo uti?

• Kodi ndichotetezedwa motani kuti muchepetse kuthamanga kwa magazi a systolic ndi diastolic?

• Ndi makhwala ati omwe amayenera kuperekedwa kwa matenda ashuga, chifukwa cha matendawo?

• Ndi mitundu iti ya mankhwala omwe amavomerezeka mankhwalawa pa matenda ashuga?

Kodi odwala ayenera kuyamba liti ndi matenda ashuga?

Mu 1997, msonkhano wachisanu ndi chimodzi wa United States National Committee for the Diagnostics, Prevention, and Treatment of Arterial Hypertension unazindikira kuti kwa odwala matenda ashuga, gawo lofunikira la kuthamanga kwa magazi kwa azaka zonse pamwambapa lomwe chithandizo chiyenera kuyambitsidwa ndi systolic magazi (ADS) yoposa 130 mmHg . Art. ndi ADD> 85 mmHg. Art. Ngakhale kuwonjezerapo pang'ono izi mwa odwala omwe ali ndi matenda a shuga kumawonjezera ngozi za mtima ndi 35%. Nthawi yomweyo, zidatsimikizika kuti kukhazikika kwa kuthamanga kwa magazi molondola motere komanso pansi pamakhala kwenikweni ndi organoprotective.

Kodi kuthamanga kwa magazi kwa diastolic kuli pabwino mpaka mpaka pati?

Posachedwa, mchaka cha 1997, kafukufuku wamkulu kwambiri wa Hypertension Optimal Treatment adamalizidwa, cholinga chake chinali choti adziwe mulingo wa ADD sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

2) masewera olimbitsa thupi nthawi zonse,

3) Kuchepa kwa kunenepa kwambiri,

4) Kumwa mowa kwambiri

5) Kusuta,

6) kuchepa kwa kupsinjika kwa malingaliro.

Zonsezi zalembedwa zopanda mankhwala

Njira zowongolera kuthamanga kwa magazi zitha kugwiritsidwa ntchito ngati chithandizo chodziimira pakokha mwa anthu omwe ali ndi vuto la magazi (komanso kuchuluka kwa kuthamanga kwa magazi oposa 130/85 mm Hg, koma osapitirira 140/90 mm Hg). Kusakhalapo kwa zotsatira za zomwe zimatengedwa kwa miyezi itatu kapena chizindikiritso cha kuthamanga kwa magazi ndi kuthamanga kwa magazi kwa odwala omwe ali ndi matenda osokoneza bongo amafunika kuwonjezerapo posachedwa kwa njira zopanda mankhwala ndi mankhwala.

Kusankha kwa antihypertensive mankhwala a shuga.

Kusankha kwa antihypertensive mankhwala kwa odwala omwe ali ndi matenda osokoneza bongo sikophweka, chifukwa nthendayi imayika ziletso zingapo pakugwiritsa ntchito mankhwala ena, chifukwa chowunikira cha zotsatira zake ndipo koposa zonse, zimapangitsa kagayidwe kazakudya ndi lipid metabolism. Kuphatikiza apo, posankha mtundu woyenera wa antihypertensive wodwala yemwe ali ndi matenda osokoneza bongo, nthawi zonse ndikofunikira kuganizira zovuta zamtundu wa mtima. Chifukwa chake, mankhwala a antihypertensive omwe amagwiritsidwa ntchito pochiza odwala matenda a shuga mellitus ayenera kukwaniritsa zofunika:

a) amakhala ndi zochita zapamwamba zokhala ndi zovuta zochepa,

b) osaphwanya chakudya

c) kukhala ndi katundu wa mtima ndi wophatikizana,

d) osavutanso ndi zovuta zina (zopanda mtima) za matenda ashuga.

Pakadali pano, mankhwala amakono a antihypertensive m'misika yam'nyumba komanso yapadziko lonse lapansi akuyimiridwa ndi magulu akuluakulu asanu ndi awiri. Magulu awa alembedwa pagome.

Magulu amakono a antihypertensive mankhwala

Dzina la gulu la mankhwala

Mankhwala apakati

Angiotensin II Receptor Antagonists

ZINSINSI. Mwa gulu la mankhwalawa zochizira matenda oopsa kwa odwala matenda a shuga, lopure okodzo (lasix, furosemide, uregit) ndi mankhwala a thiazide (indapa mid - Arifon ndi xipamide - Aquaphor). Mankhwalawa alibe matenda a shuga, musasokoneze kagayidwe ka lipid, komanso amatha kukhala ndi phindu la aimpso hemodynamics. Mankhwalawa amatha kuperekedwa kwa odwala omwe ali ndi vuto laimpso. Thiazide okodzetsa salimbikitsidwa chifukwa cha kutchulidwa kwa matenda ashuga, zimapangitsa kagayidwe ka lipid komanso kuthekera kozungulira aimp hemodynamics.

BETA-BLOCKERS Makonda pakumenya koopsa kwa matenda oopsa a shuga amapatsidwa kwa a mtima-beta-blockers (atenolol, metoprolol, betaxolol, etc.), omwe amayendetsa bwino kuthamanga kwa magazi popanda kukhudza ma carbohydrate ndi metabolidi ya lipid.

ALPHA-BLOCKERS. Alfa-blockers (prazosin, doxazosin) ali ndi zabwino zingapo kuposa mankhwala ena a antihypertensive mogwirizana ndi zotsatira zawo za metabolic. Chifukwa chake, mankhwalawa samangokhala osaphwanya lipid kagayidwe, koma, m'malo mwake, amachepetsa ma aturgenicity a seramu yamagazi, kutsitsa otsika-kachulukidwe lipoprotein cholesterol ndi triglycerides. Komanso, alpha blockers pafupifupi gulu lokhalo la pre-

Mankhwala omwe amatha kuchepetsa kukana kwa insulin, mwakulankhula kwina, amachulukitsa kumva kwa insulin. Izi ndizofunikira kwambiri pakugwiritsa ntchito odwala omwe ali ndi matenda amtundu II.

Komabe, ma alpha-blockers ayenera kugwiritsidwa ntchito mosamala odwala omwe ali ndi hypotension ya postural (orthostatic), yomwe ikhoza kukulitsidwa ndi kugwiritsa ntchito gulu la mankhwalawa.

ZITSANZO ZA KAKULIMBIKITSIRA. Pakadali pano, mankhwala apakati pachikhalidwe (clonidine, dope-git) chifukwa cha kukhalapo kwa zotsatira zoyipa zingapo (sedative athari, kudzipatula, ndi zina zambiri) sizigwiritsidwa ntchito pochizira matenda oopsa. Amalimbikitsidwa kuti azigwiritsidwa ntchito pokhapokha poyimitsa mabvuto oopsa. Mankhwala akale achigawo chapakati adasinthidwa ndi gulu latsopano la mankhwala - agonist 1., - imidazoline receptors (moxonidine "Cint"), omwe alibe zotsatirapo zoyipa izi.Kuphatikiza apo, gulu latsopano la mankhwalawa limatha kuthetsa kukana kwa insulin ndipo, potero, limasintha kagayidwe kazakudya, ndipo limapangitsanso kaphatikizidwe ka insulin ndi maselo a beta a kapamba.

CALCIUM ANTAGONISTS. Mankhwala omwe ali mgulu la calcium olimbana nawo (kapena calcium chitsekere) samakhudzana ndi chakudya cham'madzi ndi lipid metabolism (mwanjira ya metabolism), chifukwa chake, amatha kugwiritsidwa ntchito mopanda mantha komanso mwaluso kwambiri kwa odwala omwe ali ndi matenda osokoneza bongo komanso matenda oopsa. Komabe, kusankha kwa mankhwala osokoneza bongo m'gulu la anthu odwala matenda ashuga kumatsimikiziridwa osati ndi ntchito zawo zowonjezera, komanso kuthekera kochita ndi organoprotective. Ca olimbana nawo a magulu osiyanasiyana ali ndi zochitika zosagwirizana za cardio ndi nephroprotective. Ca olimbana nawo a nondihydropyridine mndandanda (verapamil ndi gulu la diltiazem) ali ndi tanthauzo loteteza pamtima ndi impso, zomwe zimawonetsedwa pakuchepa kwakukulu kwa hypertrophy yamanzere, kuchepa kwa proteinuria, ndikukhazikika kwa ntchito yosefera. Otsutsa a Dihydropyridine a Ca (gulu la zochita za nthawi yayitali: amlodipine, felodipine, isradipine) sanena zambiri, komanso chitetezo chodalirika. Nifedipine wongokhala mwachidule, m'malo mwake, amakhala ndi zovuta pamtima (zimayambitsa vuto la kuba komanso kudziwika), komanso ku impso, kukulitsa proteinuria.

Chifukwa chake, mankhwalawa ochepa matenda oopsa kwa odwala matenda a shuga