Stenosis amatanthauza kuchepetsa. Mtsempha wam'mimba umapangitsa kuchepa kwa mitsempha yamagazi yomwe imadyetsa impso chifukwa chotupa m'magawo awo a atherosranceotic. Kwa odwala okalamba omwe ali ndi matenda a shuga a 2, ichi ndi chimodzi mwazomwe zimayambitsa matenda a impso. Ral stenosis imachititsanso matenda oopsa kwambiri, omwe ndi osavulaza.
Kuchuluka kwa magazi komwe mitsempha ya impso imatha kudutsa yokha, mopitilira, imapereka ziwalo zofunikira ndi mpweya. Chifukwa chake, a impso artery stenosis imatha kukhala kwa nthawi yayitali popanda chizindikiro. Madandaulo mu odwala amawoneka, monga lamulo, kale pamene mtima wa patency umalephera ndi 70-80%.
Ndani ali pachiwopsezo cha a impso artery stenosis
Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, kupweteka kwa minyewa ya impso kumakhala kofala kwambiri. Chifukwa amayamba kukhala ndi kagayidwe kachakudya, kenako shuga yawo yamwazi imakwezedwa kwambiri. Matenda a metabolic awa amachititsa kuti atherosulinosis, i.e., blockage ya ziwiya zazikulu zikuluzikulu zomwe zimapereka mtima ndi ubongo. Nthawi yomweyo, lumen mumitsempha yomwe imadyetsa impso.
Ku USA, kupulumuka kwa odwala omwe ali ndi impso artery stenosis anaphunziridwa kwa zaka 7. Zinapezeka kuti odwala oterewa ali ndi chiopsezo chachikulu cha ngozi yamtima. Ndipafupipafupi kawiri kuposa ngozi yolephera impso. Komanso, kubwezeretsa kwa aimpso patency sikuchepetsa mwayi wakufa ndi vuto la mtima kapena sitiroko.
Mtsempha wamagololo umatha kukhala unilateral (monolateral) kapena wamagulu awiri. Bilateral - Apa ndi pamene mitsempha yomwe imadyetsa impso zonse imakhudzidwa. Mbali imodzi - pamene patency imodzi yampweya imasokonekera, ndipo inayo imakhalabe yachilendo. Nthambi za mitsempha ya impso zimathanso kukhudzidwa, koma ziwiya zazikulu siziri.
Atherosclerotic stenosis ya impso imabweretsa matenda ischemia (osakwanira magazi) a impso. Pamene impso “zikuvutika ndi njala” komanso “zikukula,” machitidwe awo amachepa. Nthawi yomweyo, chiopsezo cha kulephera aimpso chimawonjezeka, makamaka kuphatikiza ndi matenda a shuga.
Zizindikiro ndi Kudziwitsa
Zomwe zimayambitsa zovuta za aimpso a stenosis ndizofanana ndi kwa "wamba" atherosulinosis. Timalemba:
- kuthamanga kwa magazi;
- onenepa kwambiri;
- amuna kapena akazi;
- milingo yokwezeka ya fibrinogen m'magazi;
- ukalamba;
- kusuta
- cholesterol osauka ndi mafuta amthupi;
- matenda ashuga.
Zitha kuwoneka kuti zambiri mwazinthu izi zowopsa zimatha kuwongoleredwa ngati wodwala matenda ashuga adachita thanzi lake ali mwana kapena zaka zapakati. Ngati stenosis ya m'magazi a impso itayamba, ndiye kuti mwayi wachiwiri umavutikanso.
Dokotala atha kukayikira kuti aimpso am'minyewa wam'magazi wodwala matenda a shuga pamaso pa zizindikiro zotsatirazi ndi chidziwitso chatsatanetsatane:
- zaka odwala zimaposa zaka 50;
- Kulephera kwa impso kumapita patsogolo, nthawi yomweyo, proteinuria <1 g / tsiku komanso kusintha kwamkodzo kwamkodzo kumakhala kochepa;
- matenda oopsa a arterial - kuthamanga kwa magazi kumachulukitsidwa kwambiri, ndipo sizingatheke kuchepetsa ndi mankhwala;
- kukhalapo kwa mtima matenda (mtima matenda, kufalikira kwa ziwiya zazikulu, phokoso mu kuchuluka kwa aimpso);
- mankhwalawa ACE zoletsa - kuchuluka kwa creatinine;
- wodwala amasuta kwa nthawi yayitali;
- mukayang'aniridwa ndi ophthalmologist - chithunzi chojambulidwa pa retina cha malo a Hollenhorst.
Pozindikira, njira zingapo zofufuzira zitha kugwiritsidwa ntchito zomwe zimapereka chithunzi cha momwe mitsempha imakhalira. Mndandanda wawo ukuphatikizapo:
- Ultrasound kubwereza kusanthula (ultrasound) a impso mitsempha;
- Kusankha angiography
- Magnetic resonance angiography;
- Cotography tomography (CT);
- Positron emission tomography (PET);
- Captopril scintigraphy.
Zina mwazomwezi zimafunikira kuti ziyambitsidwe zamagulu ena m'magazi, zomwe zimatha kukhala ndi nephrotoxic, ndiko kuti, kuvulaza impso. Dokotalayo amawafotokozera ngati phindu lomwe lingakhalepo pofotokoza bwino za matendawo limaposa ngozi yomwe ingakhalepo. Izi zimakhala choncho makamaka ngati opaleshoni yakonzekera kukonzanso kuchuluka kwa mitsempha ya impso.
Chithandizo cha aimpso a stenosis
Kuchita bwino kwa matenda aimpso a stenosis kumafuna kupitiliza, kuyesetsa kwathunthu kuti aletse kukula kwa njira ya atherosulinotic. Udindo waukulu kwa iwo wagona ndi wodwalayo komanso anthu am'banja mwake. Mndandanda wazofunikira kuchita ndi:
- kusiya kusuta;
- matenda a shuga shuga;
- kutsitsa kuthamanga kwa magazi kukhala kwazonse;
- vuto la kuchuluka kwa thupi - kuchepa thupi;
- mankhwala mankhwala - anticoagulants;
- kumwa mankhwala kuchokera ku gulu la ma statins kuti muchepetse cholesterol ndi triglycerides m'magazi.
Timalimbikitsa kudya zakudya zamagulu ochepa a shuga 1 ndi matenda ashuga a 2. Iyi ndiye njira yabwino yochepetsera shuga m'magazi anu kuti akhale abwinobwino ndipo potero amateteza impso zanu ku matenda ashuga. Zakudya zamafuta ochepa sizimangochepetsa shuga, komanso zimachepetsa triglycerides, "zabwino" komanso "zoipa" mafuta m'thupi. Chifukwa chake, ndi chida champhamvu chochepetsera matenda a atherosulinosis, kuphatikizapo kuletsa kwamitsempha yamafupa. Mosiyana ndi mankhwala a statin, chithandizo chamankhwala sichikhala ndi zotsatirapo zoyipa. Gawo lazakudya zathu za impso la shuga ndilofunika kwambiri kwa inu.
Renal Artery Stenosis ndi Mankhwala
Mwa zovuta za matenda a impso a shuga, odwala nthawi zambiri amapatsidwa mankhwala ochokera m'magulu a ACE inhibitors kapena angiotensin-II receptor blockers (ARBs). Ngati wodwala ali ndi aimpso yotupa ya minyewa, ndiye kuti ndi bwino kupitiliza kumwa mankhwalawo. Ndipo ngati stenosis yamitsempha ya impso ndi yapakati, ACE ndi ma ARB zoletsa ayenera kuthetsedwa. Chifukwa amatha kuthandizira kuwonongeka kwa aimpso.
Mankhwala ochokera ku kalasi ya statins amachepetsa cholesterol "yoyipa" m'magazi. Izi nthawi zambiri zimakuthandizani kuti muzitha kukhazikika kwa ma atherosselotic plaque mu mitsempha ya impso ndikuletsa kupita patsogolo kwawo. Ndi atherosulinotic zotupa za aimpso, odwala nthawi zambiri zotchulidwa Asipirin. Nthawi yomweyo, kuyenera ndi chitetezo cha kagwiritsidwe kake ka zinthu zoterezi sizinatsimikiziridwe ndipo zimafunanso kuti apitirize kuphunzira. Zomwezi zimapezekanso kwa ochepa maselo olemera heparins ndi glycoprotein receptor blockers.
Zisonyezero zochizira opaleshoni yam'mimbayo (American Heart Association, 2005):
- Makamaka hematodynamically a reorganic artery stenosis;
- Artery stenosis ya impso imodzi yogwira ntchito;
- Unilateral kapena bilodyal hemodynamically kwambiri aimpso mtsempha wamagazi, womwe unachititsa kuti magazi asamalamulidwe;
- Matenda aimpso kulephera ndi unilateral stenosis;
- Mobwerezabwereza milandu ya m'mapapo edema ndi hemodynamically kwambiri stenosis;
- Osakhazikika angina pectoris ndi hemodynamically kwambiri stenosis.
Zindikirani Hemodynamics ndikuyenda kwa magazi kudzera m'matumbo. Hemodynamically yofunika chotengera stenosis - imodzi yomwe imalowetsa magazi. Ngati magazi a impso amakhalabe okwanira, ngakhale stenosis yamitsempha yamafungo, ndiye kuti chiopsezo chamankhwala opaleshoni chingadutse phindu lomwe lingakhalepo.
