Kuthamanga kwa magazi kwa odwala matenda ashuga

Hypertension ndi pomwe kuthamanga kwa magazi kumakhala kokwanira kwambiri kotero kuti njira zochiritsira zimakhala ndi phindu lalikulu kwa wodwalayo kuposa zovuta zoyipa. Ngati muli ndi kuthamanga kwa magazi okwanira 140/90 kapena kupitilira - ndi nthawi yoti muchiritse. Chifukwa matenda oopsa amathanso kutenga ngozi ya mtima, kugunda, kulephera kwaimpso, kapena khungu. Mtundu wa 1 kapena matenda a shuga a 2, gawo lalikulu kwambiri la kuthamanga kwa magazi limatsikira ku 130/85 mmHg. Art. Ngati muli ndi vuto lalikulu, muyenera kuchita chilichonse kuti muchepetse.

Ndi matenda a shuga a mtundu 1 kapena 2, matenda oopsa oopsa amakhala oopsa kwambiri. Chifukwa ngati matenda a shuga akuphatikizidwa ndi kuthamanga kwa magazi, chiwopsezo cha kugunda kwamtima chikuwonjezeka katatu, kumenyedwa ndi katatu, kusawona khungu nthawi 10 mpaka 10, kulephera kwa impso nthawi 20-25, zilonda zam'mimba. 20 nthawi. Nthawi yomweyo, kuthamanga kwa magazi sikovuta kwambiri kutulutsa matenda, pokhapokha ngati matenda a impso anu apita kutali kwambiri.

Zoyambitsa Hypertension ku shuga

Mtundu 1 komanso mtundu wachiwiri wa matenda ashuga, zomwe zimayambitsa kukula kwa matenda oopsa amatha kukhala osiyana. Mtundu woyamba wa matenda ashuga, matenda oopsa m'magazi 80 amapezeka chifukwa cha kuwonongeka kwa impso (matenda ashuga nephropathy). Mtundu wachiwiri wa matenda ashuga, matenda oopsa oopsa nthawi zambiri amakula mwa wodwala kwambiri kuposa zovuta za kagayidwe kazakudya komanso matenda a shuga enieni. Hypertension ndi imodzi mwazigawo za metabolic syndrome, yomwe imayambitsa matenda a shuga.

Zomwe zimayambitsa kukula kwa matenda oopsa mu shuga ndi pafupipafupi

Zolemba pagome. Isolated systolic hypertension ndi vuto linalake kwa okalamba. Werengani zambiri mu nkhani ya "Isolated systolic hypertension in the older." Matenda enanso a endocrine - atha kukhala pheochromocytoma, hyperaldosteronism, matenda a Itsenko-Cushing, kapena matenda ena osowa.

Chofunikira pa matenda oopsa - kutanthauza kuti dokotala sangathe kukhazikitsa chomwe chikuwonjezera kuthamanga kwa magazi. Ngati matenda oopsa aphatikizidwa ndi kunenepa kwambiri, ndiye kuti mwina, zomwe zimayambitsa ndikutsutsana ndi chakudya ndi chakudya komanso kuchuluka kwa insulin m'magazi. Izi zimatchedwa "metabolic syndrome," ndipo zimayankha bwino akalandira chithandizo. Zitha kukhalanso:

• kuchepa kwa magnesium m'thupi;
• kupsinjika kwamalingaliro osatha;
• kuledzera ndi Mercury, lead kapena cadmium;
• kuchepa kwa mtsempha waukulu chifukwa cha atherosulinosis.

Ndipo kumbukirani kuti ngati wodwalayo akufuna kukhala ndi moyo, ndiye kuti mankhwala alibe mphamvu :).

Mtundu 1 wa shuga wambiri

Mtundu woyamba wa matenda ashuga a mellitus, chachikulu komanso chowopsa cha kupsinjika kwakukulu ndikuwonongeka kwa impso, makamaka, matenda ashuga a nephropathy. Vutoli limayamba mu 35-40% ya odwala omwe ali ndi matenda amtundu 1 ndipo amadutsa magulu angapo:

• siteji ya microalbuminuria (mamolekyu ang'onoang'ono a proteinin a albumin amawonekera mkodzo);
• gawo la proteinuria (mafiyilo amiyeso amphongo, ndipo mapuloteni akuluakulu amawonekera mkodzo);
• gawo la matenda aimpso kulephera.

Malinga ndi Federal State Institution Endocrinology Research Center (Moscow), pakati pa odwala omwe ali ndi matenda amtundu woyamba 1 popanda matenda a impso, matenda oopsa amathanso 10%. Odwala omwe ali ndi gawo la microalbuminuria, mtengowu umakwera mpaka 20%, pamlingo wa proteinuria - 50-70%, pa gawo la kulephera kwa impso - 70-100%. Mapuloteni ochulukirapo omwe amachitika mumkodzo, magazi ake amayamba kukwera - uwu ndi lamulo wamba.

Kuchepa kwa magazi ndi kuwonongeka kwa impso kumayamba chifukwa chakuti impso siziyenda bwino mkodzo. Sodium m'magazi imakhala yayikulu ndipo madzimadzi amapanga kuti ayipiritse. Kuchuluka kwa magazi ozungulira kumawonjezera kuthamanga kwa magazi. Ngati kugundidwa kwa glucose kumachulukitsidwa chifukwa cha matenda ashuga m'magazi, ndiye kuti kumakoka madzi ambiri ndi magazi kuti magazi asakhale onenepa kwambiri. Chifukwa chake, kuchuluka kwa magazi ozungulira kukukulirakulira.

Matenda oopsa komanso matenda a impso amapanga njira yoipa. Thupi likuyesera kulipirira kusagwira bwino ntchito kwa impso, chifukwa chake kuthamanga kwa magazi kumakwera. Iyenso, imakulitsa kupanikizika mkati mwa glomeruli. Zomwe zimatchedwa kusefa mkati mwa impso. Zotsatira zake, glomeruli imafa pang'onopang'ono, ndipo impso zimagwira ntchito kwambiri.

Izi zimatha ndi kulephera kwa aimpso. Mwamwayi, m'magawo oyamba a matenda a shuga, nephropathy yovuta, imatha kuthyoka ngati wodwala amathandizidwa mosamala. Chinthu chachikulu ndikuchepetsa magazi kuti akhale abwinobwino. ACE inhibitors, angiotensin receptor blockers, komanso okodzetsa amathandizanso. Mutha kuwerenga zambiri za iwo pansipa.

Matenda oopsa komanso matenda a shuga a 2

Kale kwambiri asanayambike shuga yachiwiri “yeniyeni,” matendawa amayambanso ndi insulin. Izi zikutanthauza kuti mphamvu ya minofu ya zochita za insulin yafupika. Kuti alipire insulin, kuchuluka kwambiri kwa insulin kumazungulira m'magazi, ndipo pakokha kumawonjezera kuthamanga kwa magazi.

Pakupita kwa zaka, kuunikira kwa mitsempha yamagazi kumachepa chifukwa cha atherosulinosis, ndipo izi zimakhalanso "zopereka" pakukula kwa matenda oopsa. Mofananamo, wodwalayo amakhala ndi kunenepa kwam'mimba (mozungulira m'chiuno). Amakhulupirira kuti minofu ya adipose imatulutsa zinthu m'magazi zomwe zimapangitsanso magazi.

Kuphatikiza konseku kumatchedwa metabolic syndrome. Zotsatira zake kuti matenda oopsa amathanso kuyamba kale kuposa mtundu wa shuga wachiwiri. Nthawi zambiri amapezeka wodwala nthawi yomweyo akapezeka ndi matenda a shuga. Mwamwayi, kudya wamafuta ochepa kumathandizira kuwongolera matenda amtundu wa 2 komanso matenda oopsa nthawi imodzi. Mutha kuwerenga zambiri pansipa.

Hyperinsulinism ndi kuchuluka kwa insulini m'magazi. Imachitika poyankha kukana insulin. Ngati kapamba amayenera kutulutsa insulin yochulukirapo, ndiye kuti "imatopa" kwambiri. Akasiya kupirira pazaka zambiri, shuga m'magazi amadzuka ndikuwonjezera matenda a shuga a 2.

Momwe hyperinsulinism imathandizira magazi:

• imayendetsa mtima wamanjenje;
• impso excrete sodium ndi madzimadzi woipa mkodzo;
• sodium ndi calcium zimadziunjikira mkati mwa maselo;
• insulin yochulukirapo imathandizira kukhazikitsa makoma amitsempha yamagazi, yomwe imachepetsa kuthamanga kwawo.

Mawonekedwe akuwonetsera matenda oopsa mu shuga

Ndi matenda a shuga, phokoso lachilengedwe la kusinthasintha kwa magazi limasokonekera. Nthawi zambiri, mwa munthu m'mawa komanso usiku nthawi yogona, kuthamanga kwa magazi kumakhala kotsika 10-20 kuposa masana. Matenda a shuga amabweretsa chifukwa chakuti odwala ambiri oopsa kuthamanga usiku sikuchepa. Kuphatikiza apo, kuphatikiza kwa matenda oopsa ndi matenda ashuga, kupsinjika kwa usiku nthawi zambiri kumakhala kwakukulu kuposa kupsinjika kwa usana.

Vutoli limaganiziridwa kuti limabwera chifukwa cha matenda ashuga a m'mimba. Mwazi wakukwera wamagazi umakhudza dongosolo lazinthu zamagetsi, zomwe zimayang'anira moyo wa thupi. Zotsatira zake, kuthekera kwa mitsempha yamagazi kuwongolera kamvekedwe kawo, i., Kupendekera ndi kumasuka kutengera katundu, kukuwonongeka.

Mapeto ake ndikuti kuphatikiza kwa matenda oopsa ndi matenda ashuga, sikuti kungoyesa nthawi imodzi ndi tonometer ndikofunikira, komanso kuwunika kwa maola 24. Imachitika pogwiritsa ntchito chipangizo chapadera. Malinga ndi zotsatira za kafukufukuyu, mutha kusintha nthawi yomwe mukumwa komanso muyezo wa mankhwala kuti mukapanikizike.

Zochita zimawonetsa kuti odwala omwe ali ndi matenda amtundu woyamba 1 ndi mtundu wa 2 amakhala amakonda kwambiri mchere kuposa omwe amakhala ndi matenda osokoneza bongo omwe alibe shuga. Izi zikutanthauza kuti kuchepetsa mchere mu chakudya kumatha kukhala ndi mphamvu yochiritsa. Mu shuga, pofuna kuthana ndi kuthamanga kwa magazi, yesani kudya mchere wochepa ndipo patatha mwezi umodzi, onetsetsani zomwe zimachitika.

Kuthamanga kwa magazi mu shuga kumakhala kovuta ndi orthostatic hypotension. Izi zikutanthauza kuti kuthamanga kwa magazi a wodwalayo kumachepetsa kwambiri ndikusuntha kuchoka pakulankhula kukhala pamalo oyimirira kapena kukhala. Orthostatic hypotension imadziwonetsera pambuyo pakuwuka kwakuthwa kwa chizungulire, kumachita khungu m'maso kapenanso kukomoka.

Monga kuphwanya gawo la circadian kuthamanga kwa magazi, vutoli limachitika chifukwa cha chitukuko cha matenda ashuga. Mchitidwe wamanjenje mwapang'onopang'ono umataya mphamvu yake yolamulira mtima. Munthu akamadzuka mwachangu, katunduyo amadzuka. Koma thupi lilibe nthawi yowonjezera magazi kudzera m'matumbo, ndipo chifukwa cha izi, thanzi likuipiraipira.

Orthostatic hypotension imasokoneza kuzindikira ndi chithandizo cha kuthamanga kwa magazi. Kuyeza kuthamanga kwa magazi mu shuga ndikofunikira m'malo awiri - kuyimirira ndikugona. Wodwala akakhala ndi vuto ili, ndiye kuti ayenera kudzuka pang'onopang'ono, "monga thanzi lake".

Zakudya za Matenda Aakulu a shuga

Tsamba lathu lidapangidwa kuti ipititse patsogolo zakudya zamagulu am'thupi ochepa a mtundu 1 ndi matenda ashuga a 2. Chifukwa kudya zakudya zamagulu ochepa ndiye njira yabwino yochepetsera ndikukhala ndi shuga. Kufunika kwanu kwa insulini kudzachepa, ndipo izi zikuthandizani kukonza zotsatira zanu zamankhwala oopsa. Chifukwa chakuti insulin yochulukirapo imazungulira m'magazi, magaziwo amathanso. Takambirana kale mwatsatanetsatane pamwambapa.

Tikupangira zolemba zanu:

• Insulin ndi chakudya chamafuta: chowonadi chomwe muyenera kudziwa.
• Njira zabwino zochepetsera shuga wamagazi ndikuzisunga bwino.

Zakudya zamagulu ochepa zamatenda a shuga ndizoyenera ngati simunayambe kulephera impso. Mtundu wakudya uwu ndiotetezeka kwathunthu komanso wopindulitsa panthawi ya microalbuminuria. Chifukwa chakuti shuga wa m'magazi akayamba kukhala wabwinobwino, impso zimayamba kugwira ntchito mwachizolowezi, ndipo zotsalazo za albin mkodzo zimayamba kukhala zabwinobwino. Ngati muli ndi gawo la proteinuria - samalani, kuonana ndi dokotala. Komanso phunzirani za Diabetes Kidney Diet.

Kodi shuga ayeneranso kutsitsidwa mpaka pati?

Odwala omwe ali ndi matenda oopsa omwe ali ndi matenda opatsirana a shuga ndi odwala omwe ali ndi chiopsezo chachikulu kapena chovuta kwambiri cha mtima. Amalimbikitsidwa kuti achepetse kuthamanga kwa magazi mpaka 140/90 mm RT. Art. M'milungu 4 yoyambirira, ngati amalolera kugwiritsa ntchito mankhwala mosamala. M'masabata otsatirawa, mutha kuyesa kuchepetsa kupanikizika mpaka pafupifupi 130/80.

Chinthu chachikulu ndikuti kodi wodwalayo amalola bwanji kugwiritsa ntchito mankhwala osokoneza bongo ndi zotsatira zake? Ngati zili zoipa, ndiye kuti kuthamanga kwa magazi kuyenera kukhala pang'onopang'ono, m'magawo angapo. Iliyonse ya magawo awa - mwa 10-15% ya magawo oyambirira, mkati mwa masabata 2-4. Wodwala akangosintha, onjezani kuchuluka kapena muonjezere mankhwala.

Ngati muchepetsera kuthamanga kwa magazi m'magawo, ndiye kuti izi zimapewa zochitika zamankhwala osokoneza bongo motero kuchepetsa chiopsezo cha myocardial infarction kapena stroke. Malire otsika a ngalande yokhazikika magazi ndi 110-115 / 70-75 mm RT. Art.

Pali magulu a odwala matenda ashuga omwe amachepetsa kuthamanga kwa magazi awo "kumtunda" kufika ku 140 mmHg. Art. ndipo kutsika kumakhala kovuta kwambiri. Mndandanda wawo ukuphatikizapo:

• odwala omwe ali ndi ziwalo zomwe akutsata, makamaka impso;
• odwala mtima ndi mavuto;
• okalamba, chifukwa cha ukalamba wokhudzana ndi mitsempha yowonongeka kwa atherosulinosis.

Matenda Oseketsa Matenda a shuga

Zitha kukhala zovuta kusankha mapiritsi opondera magazi kwa wodwala yemwe ali ndi matenda ashuga. Chifukwa kuchepa kwa chakudya m'thupi kumalepheretsa kugwiritsa ntchito mankhwala ambiri, kuphatikizapo matenda oopsa. Posankha mankhwala, dokotala amaganizira momwe wodwalayo amalamulirira matenda ake a shuga komanso matenda omwe amakhalapo, kuphatikiza matenda oopsa, omwe amapanga kale.

Mapiritsi abwino opanikizika a shuga ayenera kukhala ndi zinthu zotsatirazi:

• kuchepetsa kwambiri kuthamanga kwa magazi, komanso nthawi yomweyo kuchepetsa mavuto;
• musamakulitse shuga yamagazi, musachulukitse cholesterol “yoyipa” ndi triglycerides;
• Tetezani mtima ndi impso ku zovuta zomwe matenda ashuga komanso kuthamanga kwa magazi zimayambitsa.

Pakadali pano pali magulu 8 a mankhwalawa olembetsa matenda oopsa, pomwe asanu ndi omwe ali akulu ndi atatu owonjezera. Mapiritsi, omwe ali m'magulu owonjezera, amadziwika, monga lamulo, ngati gawo la mankhwala ophatikiza.

Magulu Othandizira Mankhwala

Pansipa timapereka malingaliro othandizira kuti mankhwalawa athandizidwe kwa odwala omwe ali ndi matenda oopsa omwe ali ndi vuto la matenda a shuga a mtundu woyamba kapena a 2.

Diuretics (okodzetsa) pokakamiza

Gulu la okodzetsa

Zambiri pazamankhwala onse okodzetsa awa zimapezeka pano. Tsopano tiyeni tikambirane momwe okodzetsa amathandizira matenda oopsa mu shuga.

Matenda oopsa mwa odwala omwe ali ndi matenda ashuga nthawi zambiri amakula chifukwa chakuti kuchuluka kwa magazi ozungulira kumakulitsidwa. Komanso, odwala matenda ashuga amasiyanitsidwa ndi kuwonjezereka kwa mchere. Pankhaniyi, ma diuretics nthawi zambiri amathandizidwa kuti azichiza kuthamanga kwa magazi mu shuga. Ndipo kwa odwala ambiri, mankhwala a diuretic amathandiza bwino.

Madokotala amayamikira thiazide diuretics chifukwa mankhwalawa amachepetsa chiwopsezo cha kugunda kwa mtima ndi stroke mwa odwala omwe ali ndi matenda oopsa ndi 15-25%. Kuphatikiza ndi omwe ali ndi matenda ashuga a 2. Amakhulupilira kuti mumadontho ang'onoang'ono (ofanana ndi hydrochlorothiazide <25 mg patsiku) samachepetsa kuyendetsa magazi ndipo samachulukitsa cholesterol "yoyipa".

Thupi monga thiazide ndi thiazide okodzetsedwa amalekanitsidwa kwa odwala omwe ali ndi vuto laimpso. Ma loop okodzetsa, mosiyana, amagwira bwino ntchito pakulephera kwa impso. Amayikidwa ngati matenda oopsa akuphatikizidwa ndi edema. Koma palibe umboni kuti amateteza impso kapena mtima. Potaziyamu-yosungirako ndi osmotic diuretics ya matenda ashuga sizigwiritsidwa ntchito konse.

Ndi matenda oopsa osakanikirana ndi shuga, milingo yaying'ono ya thiazide diuretics nthawi zambiri imayikidwa limodzi ndi ACE inhibitors kapena beta-blockers. Chifukwa ma diuretics okha, popanda mankhwala ena, sigwira ntchito mokwanira pamikhalidwe yotere.

Beta blockers

Mankhwala ochokera pagulu la beta-blocker ndi:

• kusankha komanso osasankha;
• lipophilic ndi hydrophilic;
• ndi ntchito yopanda tsitsi.

Zonsezi ndi katundu wofunikira, ndipo ndikofunika kuti wodwalayo azitha mphindi 10-15 kuti amvetsetse. Ndipo nthawi yomweyo phunzirani za contraindication ndi zoyipa za beta-blockers. Pambuyo pake, mutha kumvetsetsa chifukwa chomwe adokotala adakuwuzani izi kapena mankhwalawa.

Beta-blockers amayenera kulembedwa kwa wodwala yemwe ali ndi matenda ashuga akapezeka ndi zina zake pamndandanda wotsatira:

• matenda a mtima;
• kulephera kwa mtima;
• pachimake pambuyo infarction nthawi - kupewa kupewa obwereza myocardial infarction.

Munthawi zonsezi, beta-blockers kwambiri amachepetsa chiopsezo cha kufa ndi matenda amtima komanso zifukwa zina.

Nthawi yomweyo, beta-blockers ikhoza kuphimba zizindikiro za hypoglycemia yayikulu, komanso zimapangitsa kuti zikhale zovuta kuchokera mu boma la hypoglycemic. Chifukwa chake, ngati wodwala matenda ashuga asokoneza kuzindikira hypoglycemia, ndiye kuti mankhwalawa amatha kuyikidwa kokha mosamala.

Osankha beta-blockers ali ndi vuto lochepera pa kagayidwe kachakudya ka shuga. Izi zikutanthauza kuti, malinga ndi zomwe zikuwonetsa, wodwalayo ayenera kumwa beta-blockers, ndiye kuti mankhwalawa ayenera kugwiritsidwa ntchito. Beta blockers omwe ali ndi ntchito ya vasodilator - nebivolol (Nebilet) ndi carvedilol (Coriol) - atha kukonza kagayidwe kazakudya ndi mafuta. Amawonjezera kukhudzika kwa minofu ku insulin.

Zindikirani Carvedilol sikuti ndi beta-blocker yosankha, koma ndi amodzi mwa mankhwala amakono omwe amagwiritsidwa ntchito kwambiri, amagwira ntchito moyenera ndipo, mwina, sikuti akuipiraipira kagayidwe kachakudya matenda ashuga.

Ogwiritsa ntchito beta-blockers amakono, kuposa mankhwala am'mibadwo yam'mbuyomu, amalimbikitsidwa kuti azikonda odwala omwe ali ndi matenda ashuga, komanso odwala omwe ali pachiwopsezo chokhala ndi matenda a shuga a 2. Mosiyana ndi izi, ma beta-blockers osasankha omwe alibe ntchito ya vasodilator (propranolol) amawonjezera chiopsezo cha matenda ashuga a 2.

Amapangitsanso kukana kwa insulini mu zotumphukira, komanso kumakulitsa cholesterol "yoyipa" ndi triglycerides (mafuta) m'magazi. Chifukwa chake, salimbikitsidwa kwa odwala omwe ali ndi matenda ashuga kapena omwe ali ndi chiwopsezo chokhala ndi matenda a shuga a 2.

Ma calcium blockers (a calcium calcium Antagonists)

Gulu la calcium blockers

Ma calcium antagonists ndi omwe amamwa mankhwala oopsa, omwe nthawi zambiri amauzidwa padziko lonse lapansi. Nthawi yomweyo, madokotala ndi odwala ochulukirachulukira “pakhungu lawo” akukhulupirira kuti mapiritsi a magnesium ali ndi vuto lofanana ndi calcium calcium blockers. Mwachitsanzo, izi zidalembedwa m'bukhu la Reverse Heart Illase Now (2008) ndi madokotala aku America a Stephen T. Sinatra ndi a James C. Roberts.

Kuperewera kwa magnesium kumapangitsa kuti kagayidwe kachakudya, ndipo izi ndizomwe zimayambitsa matenda oopsa. Mankhwala ochokera pagulu lotsutsana ndi calcium nthawi zambiri amachititsa kudzimbidwa, kupweteka mutu, kutupa ndi kutupira pamapazi. Kukonzekera kwa Magnesium, mosiyana, sikumakhala ndi zotsatirapo zoyipa. Samangothandiza matenda oopsa, komanso amachepetsa mitsempha, kusintha matumbo, ndikuwongolera premenstrual syndrome mwa akazi.

Mutha kufunsa kuti amwe mapiritsi okhala ndi magnesium. Mutha kudziwa zambiri za kukonzekera kwa magnesium pochiza matenda oopsa pano. Ma virnesium othandizira amakhala otetezeka kwathunthu, pokhapokha ngati wodwala ali ndi vuto lalikulu la impso. Ngati muli ndi matenda ashuga a nephropathy pa gawo la kulephera kwa impso, funsani dokotala ngati kuli koyenera kutenga magnesium.

Calcium calcium blockers mu sing'anga achire Mlingo samakhudza kagayidwe kazakudya ndi mafuta. Chifukwa chake, samakulitsa chiwopsezo chokhala ndi matenda ashuga amtundu wa 2. Nthawi imodzimodzi, ma diydropyridine omwe amangokhala pakatikati komanso pamtunda waukulu amawonjezera ngozi yakufa kwa odwala omwe ali ndi mtima ndi zina.

Otsutsa a calcium amayenera kulandira odwala omwe ali ndi matenda a mtima omwe amakhala ndi matenda a mtima.

• angina pectoris wosakhazikika;
• pachimake nyengo ya m`mnyewa wamtima infarction;
• kulephera kwa mtima.

Ma dihydropyridine omwe amakhala atatenga nthawi yayitali amadziwika kuti ali otetezeka kwa odwala omwe ali ndi matenda ashuga omwe amakhala ndi vuto la mtima. Koma popewa kulowetsedwa kwa myocardial ndi kulephera kwa mtima, amakhala ochepetsedwa ndi ACE zoletsa. Chifukwa chake, amalimbikitsidwa kuti azigwiritsidwa ntchito limodzi ndi ACE inhibitors kapena beta blockers.

Kwa odwala okalamba omwe ali ndi systolic yokhazikika, othana ndi calcium amawerengedwa ngati mankhwala oyambira kuthana ndi sitiroko. Makamaka kwa odwala matenda a shuga a 2. Izi zikugwira ntchito pa onse dihydropyridine komanso osakhala dihydropyridine.

Verapamil ndi diltiazem atsimikiziridwa kuti ateteza impso. Chifukwa chake, awa ndi ma calcium blockers omwe amaperekedwa kwa odwala omwe ali ndi matenda ashuga. Ma calcium antagonists ochokera ku dihydropyridine gulu alibe nephroprotective. Chifukwa chake, amatha kugwiritsidwa ntchito limodzi ndi ACE inhibitors kapena angiotensin-II receptor blockers.

ACE zoletsa

Ma Ahibuloseti a ACE ndi gulu lofunikira kwambiri la mankhwala othandizira kuthamanga kwa magazi ku matenda ashuga, makamaka ngati vuto la impso likukula. Apa mutha kupeza zambiri mwatsatanetsatane za ACE inhibitors.

Chonde dziwani kuti ngati wodwala atayamba kupindika minyewa ya m'magazi kapena kuti impso imayimitsidwa mu mtima, ndiye kuti zoletsa za ACE ziyenera kuletsedwa. Zomwezo zimapita kwa angiotensin-II receptor blockers, omwe tikambirana pansipa.

Zotsutsana zina pakugwiritsa ntchito zoletsa za ACE:

• Hyperkalemia (kuchuluka kwa potaziyamu m'magazi)> 6 mmol / l;
• kuchuluka kwa seramu creatinine wopitilira 30% kuchokera pamlingo woyambirira mkati mwa sabata 1 atayamba chithandizo (pang'onopang'ono pakuwunikira - onani!);
• mimba ndi nthawi yoyamwitsa.

Pochizira kulephera kwa mtima kwazovuta zilizonse, ma inhibitors a ACE ndi mankhwala oyambira kusankha posankha, kuphatikiza odwala omwe ali ndi matenda amtundu wa 1 komanso a 2. Mankhwalawa amathandizira chidwi cha zimakhala mpaka insulin motero amakhala ndi prophylactic pakukula kwa matenda a shuga a mtundu 2. Siziwonjezera kuyipa kwa shuga wamagazi, musachulukitse cholesterol "yoyipa".

ACE zoletsa ndi # 1 mankhwala ochizira matenda a shuga. Odwala a Type 1 ndi 2 a shuga amapatsidwa mankhwala ochepetsa chitetezo cha ACE akangoyesedwa atawonetsa microalbuminuria kapena proteinuria, ngakhale kuthamanga kwa magazi kukhalabe kwachibadwa. Chifukwa amateteza impso komanso kuchedwetsa kukula kwa impso kulephera pakapita nthawi.

Ngati wodwala akutenga zoletsa za ACE, ndiye kuti akulangizidwa kuti achepetse mchere wambiri osaposa magalamu atatu patsiku. Izi zikutanthauza kuti muyenera kuphika chakudya chopanda mchere konse. Chifukwa imawonjezedwa kale pazinthu zomalizidwa ndi zinthu zotsiriza. Izi ndizokwanira mokwanira kuti musakhale ndi vuto la sodium m'thupi.

Mukamalandira chithandizo ndi ACE inhibitors, kuthamanga kwa magazi kuyenera kuyesedwa pafupipafupi, ndipo serum creatinine ndi potaziyamu ziyenera kuyang'aniridwa. Okalamba okalamba omwe ali ndi atherosclerosis ambiri amayenera kuyesedwa kwa matenda amitsempha yamagazi am'mimbamo asanafotokoze zoletsa ACE.

Angiotensin-II receptor blockers (angiotensin receptor antagonists)

Mutha kudziwa zambiri zamankhwala atsopano awa. Pofuna kuthana ndi kuthamanga kwa magazi komanso vuto la impso mu shuga, angiotensin-II receptor blockers amalembedwa ngati wodwala watulutsa chifuwa chowuma kuchokera ku ACE inhibitors. Vutoli limapezeka pafupifupi 20% ya odwala.

Angiotensin-II receptor blockers ndi okwera mtengo kuposa ACE zoletsa, koma sayambitsa chifuwa chowuma. Chilichonse cholembedwa munkhaniyi pamwambapa pa ACE inhibitors chimagwira ntchito kwa angiotensin receptor blockers. Zowonongera ndizofanana, ndipo ziyeso zomwezi zimayenera kumwa mukamamwa mankhwalawa.

Ndikofunikira kudziwa kuti angiotensin-II receptor blockers amachepetsa michere yamitsempha yamanzere kwambiri kuposa zoletsa za ACE. Odwala amalekerera bwino kuposa mankhwala ena aliwonse okhathamira magazi. Zilibe zotsatira zoyipa kuposa placebo.

Rasilez - zoletsa mwachindunji za renin

Awa ndi mankhwala atsopano. Idapangidwa mochedwa kuposa ACE inhibitors ndi angiotensin receptor blockers. Rasilez adalembetsedwa movomerezeka ku Russia
mu Julayi 2008. Zotsatira zamaphunziro a nthawi yayitali ogwira ntchito ake zikuyembekezeredwa.

Rasilez - zoletsa mwachindunji za renin

Rasilez imayikidwa limodzi ndi ACE inhibitors kapena angiotensin-II receptor blockers. Kuphatikiza koteroko kwa mankhwalawa kumapangitsa kuteteza mtima ndi impso. Rasilez imasintha magazi m'thupi komanso imapangitsa kuti minofu ikhale yolimba.

Alfa oletsa

Pakusamalira kwa nthawi yayitali matenda oopsa, osankha alpha-1-blockers amagwiritsidwa ntchito. Mankhwala omwe ali mgululi akuphatikizapo:

• prazosin
• doxazosin
• terazosin

Pharmacokinetics ya kusankha alpha-1-blockers

Zotsatira zoyipa za alpha-blockers:

• orthostatic hypotension, mpaka kukomoka;
• kutupa kwa miyendo;
• kusiya magazi (kuthamanga kwa magazi kumadumphira "rebound");
• wolimbikira tachycardia.

Kafukufuku wina wawonetsa kuti alpha-blockers amawonjezera chiopsezo cholephera mtima. Kuyambira pamenepo, mankhwalawa sanakhale otchuka kwambiri, kupatula nthawi zina. Mankhwalawa amaperekedwa limodzi ndi mankhwala ena oopsa, ngati wodwalayo ali ndi chithokomiro cha prostatic hyperplasia.

Mu shuga, ndikofunikira kuti akhale ndi phindu pa metabolism. Alfa-adrenergic blockers amachepetsa shuga m'magazi, kuwonjezera minofu kumverera kwa insulin, ndikukweza cholesterol ndi triglycerides.

Nthawi yomweyo, kulephera kwa mtima ndi kuphwanya kugwiritsa ntchito kwawo. Ngati wodwala ali ndi autonomic neuropathy ndi orthostatic hypotension, ndiye kuti ma alpha-adrenergic blockers sangadziwike.

Ndi mapiritsi ati oti musankhe pochiza matenda oopsa mu shuga?

M'zaka zaposachedwa, madokotala ochulukirachulukira akukhulupirira kuti ndibwino kupatsa mankhwala osagwiritsa ntchito kamodzi, koma mwachangu, mankhwala a 2-3 ochizira kuthamanga kwa magazi. Chifukwa odwala nthawi zambiri amakhala ndi njira zingapo zopangira matenda oopsa nthawi imodzi, ndipo mankhwala amodzi sangakhudze zomwe zimayambitsa. Chifukwa mapiritsi opanikizika amagawika m'magulu, amachita mosiyana.

Mankhwala amodzi amachepetsa kukakamizidwa kwa odwala osaposa 50%, ngakhale ngati matenda oopsa kwambiri poyamba. Nthawi yomweyo, kuphatikiza chithandizo kumakupatsani mwayi wogwiritsa ntchito Mlingo wochepetsetsa wa mankhwala, komabe mumapeza zotsatira zabwino. Kuphatikiza apo, mapiritsi ena amafooketsa kapena kuthetseratu mavuto omwe amadzetsa mzake.

Hypertension siikhala yoopsa pakokha, koma zovuta zomwe zimayambitsa. Mndandanda wawo ukuphatikizapo: kugunda kwa mtima, sitiroko, kulephera kwa impso, khungu. Ngati kuthamanga kwa magazi kuphatikizidwa ndi matenda ashuga, ndiye kuti chiwopsezo cha zovuta zimachuluka kangapo. Dokotala amawunika kuopsa kwa wodwala wina kenako asankhe ngati angayambe mankhwalawa piritsi limodzi kapena kugwiritsa ntchito mankhwalawa nthawi yomweyo.

Kufotokozera kwa manambala: HELL - kuthamanga kwa magazi.

Russian Association of Endocrinologists ikuvomereza njira yotsatirayi yochizira matenda oopsa a shuga. Choyamba, angiotensin receptor blocker kapena ACE inhibitor imayikidwa. Chifukwa mankhwala ochokera m'maguluwa amateteza impso ndi mtima wabwino kuposa mankhwala ena.

Ngati monotherapy yokhala ndi ACE inhibitor kapena angiotensin receptor blocker sichithandiza kutsika magazi mokwanira, tikulimbikitsidwa kuwonjezera diuretic. Zomwe diuretic kusankha zimadalira pakusungika kwa impso ntchito kwa wodwala. Ngati pakhale kulephera kwa aimpso, thiazide diuretics ikhoza kugwiritsidwa ntchito. Mankhwala a Indapamide (Arifon) amadziwika kuti ndi amodzi a otetezeka kwambiri othandizira matenda oopsa. Ngati kulephera kwa impso kwayamba kale, okodzetsa m'chiuno ndi mankhwala.

Kufotokozera kwa manambala:

• HELL - kuthamanga kwa magazi;
• GFR - kuchuluka kwa kusefukira kwa impso, kuti mumve zambiri onani "Zoyeserera ziti zomwe zikuyenera kuchitika kuti muwone impso zanu";
• CRF - kulephera kwa impso;
• BKK-DHP - dihydropyridine calcium channel blocker;
• BKK-NDGP - non-dihydropyridine calcium blockchain;
• BB - beta blocker;
• ACE inhibitor - ACE inhibitor;
• ARA ndi angiotensin receptor antagonist (angiotensin-II receptor blocker).

Ndikofunika kuperekera mankhwala omwe ali ndi 2-3 zomwe zimagwira piritsi limodzi. Chifukwa ochepa mapiritsiwo, amalolera kumawamwetsa kwambiri.

Mndandanda wachidule wamankhwala ophatikiza matenda oopsa:

• Korenitec = enalapril (renitec) + hydrochlorothiazide;
• foside = fosinopril (monopril) + hydrochlorothiazide;
• co-diroton = lisinopril (diroton) + hydrochlorothiazide;
• lehar = losartan (cozaar) + hydrochlorothiazide;
• noliprel = perindopril (prestarium) + thiazide-ngati diuretic indapamide retard.

ACE inhibitors komanso calcium blockers blockers amakhulupirira kuti zimathandizira kuthekera kwa wina ndi mnzake kuteteza mtima ndi impso. Chifukwa chake, mankhwala ophatikiza otsatirawa nthawi zambiri amaperekedwa:

• tarka = trandolapril (hopten) + verapamil;
• prestanz = perindopril + amlodipine;
• equator = lisinopril + amlodipine;
• khulusa = valsartan + amlodipine.

Tikuchenjezani odwala: musadzipatse mankhwala ochepetsa matenda oopsa. Mutha kukhudzidwa kwambiri ndi mavuto, ngakhale imfa. Pezani dokotala woyenera ndipo muthane naye. Chaka chilichonse, adotolo amawona odwala mazana ambiri omwe ali ndi matenda oopsa, chifukwa chake adziwa zambiri, momwe mankhwalawa amagwirira ntchito komanso omwe ndi othandiza kwambiri.

Matenda oopsa komanso matenda ashuga: mawu omaliza

Tikukhulupirira kuti mupeza nkhaniyi kukhala yothandiza pa matenda oopsa pa matenda ashuga. Kuthamanga kwa magazi kwa odwala matenda ashuga ndi vuto lalikulu kwa madokotala ndi kwa iwonso odwala. Zinthu zomwe zaperekedwa pano ndizothandiza kwambiri. M'nkhani “Zomwe Zimayambitsa Matendawa ndi Momwe Mungawathetsere. Kuyesedwa kwa matenda oopsa ”mutha kudziwa mwatsatanetsatane mayeso omwe muyenera kuchita kuti mupeze chithandizo choyenera.

Mukatha kuwerenga zida zathu, odwala azitha kumvetsetsa bwino matenda oopsa mu mtundu 1 ndikulembapo matenda ashuga 2 kuti atsatire njira yabwino yothandizira ndi kuwonjezera moyo wawo ndi kuthekera kwawo. Zambiri zokhudzana ndi mapiritsi opanikizika zimapangidwa bwino ndipo zimakhala ngati "chinyengo" chokwanira kwa madokotala.

Tikufuna kutsimikizanso kuti kudya zakudya zamagulu ochepa ndi chida chothandiza kuti muchepetse shuga m'magazi a shuga, komanso kuchepetsa matenda a kuthamanga kwa magazi. Ndikofunika kutsatira zakudya izi kwa odwala omwe ali ndi matenda osokoneza bongo osati 2 yokha, komanso a 1st, kupatula ngati ali ndi vuto lalikulu la impso.

Tsatirani pulogalamu yathu ya matenda a shuga a 2 kapena mtundu wa matenda ashuga 1. Ngati muchepetsera chakudya chamagulu m'zakudya zanu, zimakulitsa mwayi kuti muthanso kukhala ndi magazi abwinobwino. Chifukwa insulini yocheperako imazungulira m'magazi, ndizosavuta kuzichita.