Nthawi zambiri ndi shuga, kuthamanga kwa magazi, komwe kumasokoneza dongosolo lamtima, kuvulaza impso ndi ziwalo zina zamkati. Mtundu woyamba wa matenda ashuga, matenda oopsa amawonekera chifukwa cha matenda a impso. Ngati munthu ali ndi mtundu wachiwiri, ndiye kuti kukula kwa matenda a Itsenko-Cushing's, pheochromocytoma, kumawonjezera kukakamizidwa. Odwala otere, matenda oopsa amathanso kupititsa patsogolo matendawa omwe amatsogolera kuimfa, chifukwa chake dokotala amalembera mapiritsi a antihypertensive. Magulu akuluakulu a mankhwalawa amaphatikizapo: okodzetsa, ACE zoletsa, beta-blockers, BKK, ARB.
Zodzikongoletsera
Ma diuretics ndi ma diuretics omwe amatengedwa molumikizana ndi mankhwala ena. Zimakhudza kugwira ntchito kwa impso ndikufulumizitsa kuchotsa kwamkodzo mthupi. Mu matenda ashuga, okodzetsa amatha kuchepetsa zizindikilo za matenda oopsa komanso kuthetsa kutupa.
Mankhwala a diuretic ndi amtundu awa:
- Loop - thandizani mwachangu kutengera kukakamiza. Furosemide amadziwika kuti ndi mankhwala ambiri.
- Thiazide - kuwonjezera kuchuluka kwa shuga, cholesterol ndi triglycerides. Awa ndi chlortalidone, clopamide, indapamide.
- Osmotic - chotsani madzi ochulukirapo mu michere ya edematous chifukwa kuchepa kwa kuthamanga kwa magazi. Zothandiza kwambiri: Potaziyamu acetate, Mannitol.
Odwala ambiri omwe ali ndi kuthamanga kwa magazi amapatsidwa thiazide diuretics, yomwe imayenera kutengedwa kwa nthawi yayitali. Koma zimatha kutsitsa kwambiri sodium. Kutenga mankhwalawa, odwala ayenera kudya zipatso ndi ndiwo zamasamba zambiri, zomwe zingabwezeretse kuwonongeka kwa magnesium, potaziyamu ndi sodium. Pa chithandizo, shuga wamagazi amayenera kuyang'aniridwa, ndikuwonjezera kuchuluka kwa diuretic, ngati pakufunika.
Ngati wodwala yemwe ali ndi matenda a shuga a m'matumbo a 2 atayamba kutupa kwamiyendo ndikukumana ndi kuthamanga, dokotalayo amamulembera Indapamide kapena Arifon. Mankhwalawa onse samakhudza kagayidwe kazakudya. Zopatsa zina ndizogwiritsidwa ntchito pafupipafupi.
ACE zoletsa
Chofunikira kwambiri kwa odwala matenda ashuga, omwe amathandizidwa ndi ochepa matenda oopsa, ACE inhibitors. Mankhwala oterewa amalepheretsa kupanga enzyme yomwe imayambitsa kupendekeka kwa magazi muubongo, ndikuthandizira kutulutsa kwa aldosterone, komwe kumakola sodium ndi madzi m'thupi lathu. Chifukwa cha kugwiritsidwa ntchito kwa ACE inhibitors, mitsempha ya m'magazi imachepetsa ndipo madzi ochulukirapo amachotsedwa m'thupi, zomwe zimapangitsa kuti magazi azikhala ochepa.
Mankhwalawa ali ndi tanthauzo la nephroprotective, lomwe limapitilira ngakhale kuchepa kwamphamvu kwa mavuto. Kuphatikiza apo, ali ndi phindu pamakoma a mitsempha ya magazi, kuletsa mapangidwe a atherosselotic plaque, komanso kukhala ndi mtima, kuteteza motsutsana ndi kugunda kwa mtima komanso sitiroko. Ma Ahibuloseti a ACE samasokoneza kagayidwe kazakudya zamafuta ndi chakudya ndikuwonjezera chidwi cha zimakhala kuti insulini.
Mankhwalawa amatchulidwa mosamala mu kulephera kwa aimpso iwo akuchedwa kuchotsedwa kwa potaziyamu m'thupi. Nthawi zina, kusiyanitsa zakumwa zawo, zotsatira zoyipa zimachitika ngati chifuwa champhamvu, chomwe chimafuna kuti mankhwalawo asiyiretu kugwiritsa ntchito mankhwala. Iwo ali contraindicated pa mimba, yoyamwitsa, apakati aimpso mtsempha wamagazi stenosis.
Mankhwala othandiza kwambiri:
- Enalapril, Attoril, Burlipril, Enap.
- Quinapril, Quinafar, Accupro.
- Lisinopril, Vitopril, Diroton, Zonixem.
Beta blockers
Beta-blockers amalembera matenda ashuga komanso kuthamanga kwa magazi, pamene zoterezi zimakhudzidwa ndi kulephera kwa mtima, angina pectoris ndi tachycardia. Nthawi zambiri, adokotala amakonda mankhwala osokoneza bongo omwe samabweretsa zotsatira zoyipa za matenda a shuga mellitus.
Izi zikuphatikiza:
- Atenolol, Atenol, Atenobene.
- Metoprolol, Corvitol, Emzok.
- Bisoprolol, Concor, Coronal, Bicard, Bidop.
Koma mankhwalawa amatha kuwonjezera kuchuluka kwa shuga ndi cholesterol m'thupi ndikukulitsa kukana insulini.
Beta-blockers monga Nebilet, Coriol, Atram, ali ndi zowonjezera vasodilating. Mapiritsi opanikizika awa a shuga amachepetsa kukana kwa insulin ndipo amakhala ndi phindu pa lipid ndi carbohydrate metabolism.
BKK (olimbana ndi calcium)
Calcium calcium blockers nthawi zambiri amalembera kukakamizidwa, chifukwa sizimakhudza metabolidi ya lipid ndi carbohydrate. Amagwiritsidwa ntchito ngati wodwala nawonso akudwala ischemia ndi angina pectoris. Choyamba, mankhwalawa amaperekedwa kwa okalamba.
Makonda amapatsidwa mankhwala omwe amakhala ndi mphamvu yayitali, omwe amayenera kumwa nthawi 1 patsiku:
- Lercanidipine.
- Felodipine.
- Nifedipine.
- Amlodipine.
Amlodipine ali ndi mphamvu yayitali.
Ma calcium antagonists amatsogolera pakupanga zotsatira zoyipa monga kutupa ndi kuwonjezeka kwa mtima, zomwe nthawi zambiri zimawabwezera. Mankhwala okhawo omwe alibe zoterezi ndi Lerkamen.
ARB (angiotensin receptor antagonists)
Angiotensin II receptor blockers amagwira ntchito mochizira matenda oopsa omwe amakhala ndi matenda ashuga. Ali ndi izi:
- kuchepetsa insulin kukana;
- kukhala ndi nephroprotective zotsatira;
- kuchepetsa hypertrophy yamanzere yamitsempha yamtima;
- sizimakhudza kagayidwe kachakudya;
- wolekeredwa bwino komanso wokhala ndi zovuta zoyipa.
Kuchita kwa mankhwala kumayamba pang'onopang'ono ndikufikira pakapita patatha milungu iwiri itayambika.
Mankhwala othandiza kwambiri:
- Sartokad, Diosar, Vasar.
- Makandulo, Oyenera, Omanga.
- Closart, Lorista, Cozaar, Lozap.
Alfa oletsa
Pogwiritsa ntchito alpha-blockers, ntchito ya α-adrenergic receptors yomwe ili mumisempha yambiri ndi ziwalo zimatsekedwa. Mankhwalawa ndi osankha komanso osasankha. Zochizira matenda oopsa mu shuga, osakaniza-alpha-blockers amagwiritsidwa ntchito komanso pokhapokha pothandizira.
Izi zikuphatikiza:
- Terazosin.
- Doxazosin.
- Prazosin.
Mankhwalawa amachepetsa kuchuluka kwa shuga ndi lipids, komanso kukana kwa insulin. Chifukwa cha alpha-blockers, kupanikizika kumachepetsa bwino, osayambitsa kuwonjezeka kwambiri kwa kugunda kwa mtima. Koma mankhwalawa amayenera kuthandizidwa mosamala ndi neuropathy yayikulu, yomwe imadziwika ndi dontho la kuthamangitsidwa kwa orthostatic. Amaphatikizidwanso m'matenda amtima.
Terazosin amachepetsa kuchuluka kwa shuga ndi lipids.
Rasilez (woyang'anira mwachindunji renin inhibitor)
Ichi ndi mankhwala atsopano omwe amachepetsa kuthamanga kwa magazi tsiku lonse. Pambuyo pa milungu iwiri yokhudza kudya pafupipafupi, zimachitika modabwitsa ndipo zimabwezeretsa magawo a hemodynamic magawo.
Rasilez imagwiritsidwa ntchito kuphatikiza mankhwala ndi angiotensin ii receptor blockers kapena ACE inhibitors. Chifukwa cha kuphatikiza uku, impso ndi mtima zimatetezedwa bwino. Mankhwalawa amathandizira kukonza cholesterol m'magazi ndikuwonjezera chidwi cha minofu kuti insulin.
Ndi mapiritsi ati omwe ndi bwino kupewa kupezeka ndi matenda ashuga?
Ngakhale kuti pali kuchuluka kwa mankhwalawa komwe kumachepetsa kuthamanga kwa magazi, si mankhwala onse omwe ali oyenera kwa anthu odwala matenda a shuga. Mankhwala otsatirawa ndi oletsedwa - Xipamide, Hydrochlorothiazide, Hypothiazide. Izi ndizopukusa zomwe zimachulukitsa shuga wamagazi ndikuwonjezera kuchuluka kwa cholesterol yoyipa. Kuphatikiza apo, mankhwalawa amakhudza kwambiri magwiridwe antchito, omwe ndi owopsa kwambiri kwa anthu omwe ali ndi vuto la impso.
Kugwiritsa ntchito mankhwala a antihypertensive monga calcium antagonists okhudzana ndi dihydropyridines yocheperako sikulimbikitsidwa kuthamanga kwa magazi komanso matenda ashuga. Ngakhale muyezo wochepa, amakulitsa mwayi wokhala ndi vuto la mtima ndipo amatsutsana ndi matenda a mtima. Izi zikuphatikizapo mankhwala Nifedipine.
Atenolol, omwe ali m'gulu la beta-blockers, ndi oletsedwa, chifukwa zimathandizira kulumpha lakuthwa mu shuga wamagazi ndi kukula kwa hypo- ndi hyperglycemia. Kuphatikiza apo, mankhwalawa amachepetsa kukhudzika kwa minofu kupita ku insulin, yomwe imapangidwa ndi kapamba.
Momwe mungakulitsire kuthamanga kwa magazi mu shuga?
Kuthamanga kwa magazi kwamtundu wa shuga wachiwiri nthawi zambiri kumachitika mwa akazi. Poterepa, pali kuphwanya kayendedwe kazinthu, ndipo ma cell amasiya kulandira zofunikira. Ngati matendawa sanalandiridwe, izi zimapangitsa kuti pakhale zovuta zamtima. Kuphatikiza apo, zovuta monga:
- matenda ashuga;
- thrombosis
- imfa ya minofu m'munsi malekezero;
- zilonda zam'mimba.
Hypotension mu shuga imayamba chifukwa:
- kusowa tulo
- matenda am'mimba;
- kusowa kwa mavitamini ndi michere mthupi;
- kupsinjika
- matenda a mtima
- chithandizo cha mankhwala osokoneza bongo
- matenda amanjenje.
Odwala achulukitsa thukuta, malekezero ozizira, kumva kuti ali ndi vuto, mantha amayamba, kufooka komanso kugona. Kuti muwonjezere kupsinjika kwa shuga, mankhwala apadera amalembedwa. Mankhwala abwino kwambiri ndi Eleutherococcus ndi Leuzea. Amatengedwa masiku 7, kenako amapuma kwa mwezi umodzi.
Ndi hypotension, wowerengeka azitsamba amathandizira. Mutha kuphatikiza tiyi wobiriwira komanso ascorbic acid. Kugwiritsa kulowetsedwa kwa kabichi kabichi. Kuti muchite izi, kutsanulira 20 ga chomera chouma ndi kapu yamadzi otentha ndikuumirira maola atatu. The kulowetsedwa umasefedwa ndipo amatengedwa katatu patsiku. Malo osambira ogwiritsira ntchito mafuta onunkhira amathandizanso kuwonjezera kukakamiza. Kwa izi, ma cloves, bergamot, ndimu, lalanje, bulugamu ndi oyenera.
Kodi mungasankhe bwanji mapiritsi a vuto linalake lachipatala?
Madokotala amalimbikitsa kugwiritsa ntchito mankhwala angapo a magulu osiyanasiyana nthawi imodzi. Izi zimathandiza chithandizo chothandiza kwambiri cha matenda oopsa mu shuga. Kuphatikiza chithandizo, mitundu yaying'ono yamankhwala imagwiritsidwa ntchito, ndipo mankhwala ambiri amatha kuyimitsa zotsatirapo zake. Dongosolo la chithandizo limasankhidwa ndi adokotala kuti ateteze chiwopsezo cha matenda a mtima ndi sitiroko.
Ndi chiopsezo chochepa, monotherapy yotsika mtengo imachitika. Ngati sizotheka kuchepetsa kukakamira kwa manambala olondola, adotolo amakupatsirani mankhwala ena, ndipo ngati sangathe, kuphatikiza kwa mankhwala angapo a magulu osiyanasiyana.
Pachiwopsezo chachikulu cha kuwonongeka kwa mtima ndi mtima, chithandizo chamankhwala 2 omwe mumagwiritsa ntchito mankhwala ocheperako chimafunika. Ngati chithandizo chotere sichinadze, ndiye kuti wofunsayo amapereka mankhwala lachitatu muyezo wochepa kapena ndikuwapatsa mankhwala onse mu muyeso wokwanira. Ngati palibe zotsatirapo zake, mankhwala a 3 a mankhwala omwe ali pakatikati kwambiri amawagwiritsa ntchito.
Algorithm posankha mankhwala opanikizika mu shuga (m'magawo):
- Kuchulukitsidwa kwakukulu kwa kuthamanga kwa magazi - mankhwala a ARB kapena ACE inhibitors.
- Kuthamanga kwa magazi kumachulukitsidwa, koma kulibe protein mu mkodzo - kuwonjezera okodzetsa, BKK.
- Kuthamanga kwa magazi ndiwokwera kuposa masiku onse, mapuloteni ochepa amapezeka mumkodzo - thiazides ndi BKK yayitali amawonjezeredwa.
- Kuthamanga kwa magazi limodzi ndi kulephera kwa aimpso - onjezani BKK ndi kuzungulira kwa diuretic.
Asanapangire dongosolo la chithandizo, dokotala amayang'ana zotsatira za maphunziro othandizira komanso a labotale. Simungadzipatse nokha mankhwala osakanikira a shuga, chifukwa ambiri a iwo amatsogolera pamavuto akulu ngakhale kufa.
