Kuzindikira kwa matenda oopsa nthawi zina kumatha kuchitika molakwika, wodwalayo amatenga chithandizo kwa nthawi yayitali, koma sizibweretsa zotsatira zake. Odwala amataya chikhulupiriro chokhala ndi thanzi labwino, ndipo pang'onopang'ono amakumana ndi zovuta zingapo zowopsa.
Pafupifupi 15% ya milandu yothamanga magazi imakhudzana ndi matenda oopsa oopsa ochitika chifukwa cha ziwalo zamkati zomwe zimakhudzidwa ndi kayendetsedwe ka kuthamanga.
Vutoli limapezeka mu 20% ya anthu odwala matenda ashuga omwe ali ndi vuto loipa kwambiri, osayankhira mankhwala. Dzina lachiwiri la matendawa ndi matenda oopsa. Madokotala amati si matenda. Pafupifupi matenda 70 amadziwika omwe amayambitsa chizindikiro ichi.
Zomwe zimayambitsa ndi kugawana kwa matenda
Zizindikiro zamitsempha yamagazi zimayambika chifukwa chogwiritsa ntchito mankhwala ena, mwachitsanzo, corticosteroids, kulera kwapakamwa. Pali mitundu ingapo ya matenda a zamitsempha, zimatengera chifukwa chachikulu chomwe chikuwonjezera kukakamizidwa.
Matenda oopsa a renal (renoparenchymal, renovascular) amasiyanitsidwa. Ngati impso sizilandira magazi okwanira, mwachitsanzo, ndikupanga atherosulinosis ya mitsempha ya impso, zinthu zomwe zimathandizira kuwonjezeka kwa kukakamizidwa zimamasulidwa.
Kuphwanya kumadziwika ndikumayambitsa wothandizira wosiyana, wogwiritsa ntchito makina ojambula pamanja, ma ultrasound, mayeso a labotale. Matenda oopsa a sekondale amayamba chifukwa cha hematomas, vasoconstriction wobadwa nawo, zilonda kapena benign neoplasms, komanso njira yotupa.
Zifukwa zina zimaphatikizapo:
- kusintha kwa atherosulinotic;
- mapangidwe magazi omwe amafalikira ndi kufupikitsa minyewa yotupa ya mitsempha yaimpso;
- matenda ashuga nephropathy;
- aakulu njira ya pyelonephritis;
- kuvulala
- Chifuwa chachikulu cha mycobacterium.
Ndi matenda oopsa a endocrine, tikulankhula za chiwonetsero chowonjezereka cha aldeosterone, catecholamines, glucocorticosteroids. Pankhaniyi, matenda a pathological amapezeka pogwiritsa ntchito maluso a labotale, angiography, CT, ultrasound. Endocrine matenda oopsa amawonedwa ndi adrenogenital syndrome, acromegaly, matenda a Itsenko-Cushing, hyperthyroidism, endothelin opanga neoplasms.
Mtundu wina wamankhwala oopsa ndi ophatikizika ndi mankhwala, amayamba pamene mankhwalawa osagwirizana ndi matenda a kuthamanga kwa magazi samayang'aniridwa. Zimachitika ndikugwiritsa ntchito nthawi yayitali njira zakulera zam'mlomo, mankhwala osapweteka a antiidal, cyclosporins, zolimbikitsa zamanjenje.
Neurogenic matenda oopsa amagwirizana ndi organic zotupa za chapakati mantha dongosolo:
- sitiroko;
- kuvulala
- zotupa muubongo;
- kuthamanga kwazinthu zamkati;
- kupuma acidosis;
- encephalitis;
- chipolopolo poliomyelitis.
Matendawa amadziwika pa nthawi ya CT, ma ultrasound amitsempha yama bongo, angiography yamitsempha yamagazi pogwiritsa ntchito sing'anga.
Ndi matenda obadwa nawo kapena a mtima wamtima wodwala matenda ashuga, hemodynamic matenda oopsa amatha. Zinthu zoyambirira zomwe zingayambitse kukula kwa vutoli zitha kukhala kuchepa kwa msempha, vuto la minofu yamtima, aortic aneurysm, erythremia, lathunthu la atrioventricular block. Kuphwanya kukuwonetsa electrocardiogram, Echo-KG, angiography.
Wodwala wodwala matenda a shuga, matenda oopsa komanso oopsa amatha. M'nkhani yoyamba yomwe tikulankhula za poyizoni wa zakumwa zoledzeretsa, chakudya chokhala ndi milingo yayikulu, tyramine, thallium. Chifukwa chachiwiri chikuyenera kufufuzidwa m'malingaliro am'malingaliro am'maganizo, zovuta za kuvulala, maopaleshoni ovuta. Nthawi zambiri, madokotala amazindikira impso, neurogenic, endocrine ndi hemodynamic yachiwiri matenda oopsa.
Matenda atakhala chimodzi mwazizindikiro zamatenda, sichizindikiro chachikulu, mwina sichingatchulidwe pakuwonetsa matendawa.
Mwachitsanzo, izi zimachitika ndi matenda kapena matenda a Itsenko-Cushing, kuphatikiza poyizoni.
Zizindikiro Zoyipa
Mochulukirapo milandu ikamawonekera kwa matenda oopsa oopsa amadzimva okha pakuwonjezera magazi. Zizindikiro zina zidzakhala kuwoneka kwa kulira ndi ma tinnitus, kupweteka mutu, chizungulire, mseru komanso kusanza, ntchentche zowala pamaso pa maso, kutopa kosalekeza.
Mkhalidwe wamatumbo umayendera limodzi ndi thukuta lochulukirapo, kupweteka kwa gawo la occipital, mu mtima, nthawi ndi nthawi kumawonjezeka potentha thupi, kusachita chidwi, komanso kuchuluka kwa thupi.
Pakuwunika, dokotala azindikiritsa zizindikiro za kumanzere kwamitsempha yamagazi, kutsindika kwa kamvekedwe kachiwiri pa msempha, kusintha kosiyanasiyana m'mitsempha yamagazi ya ocular fundus.
Matendawa amayambitsa matenda oopsa oopsa kwambiri nthawi zonse koma amakhala ndi matendawa. Zikatero, nkovuta kwambiri kukayikira chizindikiro cha matenda oopsa.
Nthawi zambiri zimakhudzana ndi zifukwa:
- chitukuko pachimake, kuthamanga kwa matenda oopsa;
- wachichepere kapena atatha zaka 50;
- kusowa kwa mankhwala othandiza kuthamanga kwa magazi.
Nthawi zambiri njira ya impso imayamba popanda chizindikiro chodziwika bwino, imayendera limodzi ndi kusintha kwamkati ndi kochepa m'mkodzo. Proteinuria amapeza phindu la kuzindikira akamaganizira kuchuluka kwa mapuloteni omwe amatayika ndi mkodzo tsiku ndi tsiku. Proteinuria yoposa 1 g patsiku imawonetsedwa ngati chizindikiro cha kukula kwa matenda oopsa ndi kuwonongeka kwa aimpso.
Mwa odwala matenda ashuga okalamba ambiri, matenda oopsa osakhazikika amakhala osakhazikika, nthawi ndi nthawi chifukwa zopanda pake zimatuluka ndikuchepa kwa kuthamanga kwa magazi kumayamba. Matenda awo oopsa amodzi amadziwika ndi kuwonjezeka kwa kuthamanga kwa ma systolic ndi kuchuluka kwa diastolic. Vutoli limatchedwa atherosulinotic kapena matenda okhudzana ndi zaka.
Zizindikiro za zotumphukira ochepa atherosulinosis zimapangitsa kupezeka kwa matenda oopsa a atherosulinotic.
Ndi iyo, kupindika m'mitsempha yam'munsi yam'munsi kumatsika, miyendo imakhala yozizira mpaka kukhudza.
Njira zosiyanasiyana zodziwonera
Dokotala amatha kudziwa zomwe zimayambitsa matenda oopsa pambuyo poti atolere mbiri ya wodwalayo, ndikofunikira kukhazikitsa milandu yovulala, matenda am'mbuyomu, komanso chiyembekezo chakuwonjezera magazi.
Ndikofunikira kuyeza kupanikizika kangapo, odwala matenda ashuga kunyumba ayenera kusunga diary yapadera komwe amakhala ndi zidziwitso pazotsimikizira magazi.
Kudziwa zomwe zimayambitsa madontho oponderezedwa kumaphatikizapo kuperekedwa kwa mayeso a labotale: kuyezetsa magazi ndi zamankhwala ambiri, kuphunzira kuchuluka kwa mahomoni, urinalysis, echo-kg, electrocardiogram, ultrasound ya impso, zotupa za impso, angiography, compact tomography.
Pambuyo pokhazikitsa mkhalidwe waumoyo, kupeza zotsatira za mayeso a labotale, njira zowunika zowonjezereka zitha kuperekedwa kwa wodwala:
- electroencephalography;
- intravenous urography;
- impso;
- rheoencephalography.
Odwala ena adzafuna isotopic renography, kuphunzira kwa mphamvu ya sodium ndi potaziyamu mu mkodzo, chikhalidwe cha mkodzo ku Gulda, kusankha adrenal gland phlebography.
Kutsimikizira kukhalapo kwa miyala ya impso, kukula kwamitsempha yama impso yomwe ingayambitse micro- ndi macrohematicsuria. Ndi hematuria, pofuna kupatula ma neoplasms, kuwonjezera pa maumboni amtunduwu, kusanthula kwa impso, kusakanikirana kwa patsekeke, kupikisana pamatumbo, aortography akuwonetsedwa.
Kuti mupeze matenda a nephritis apakati, omwe amasonyezedwanso ndi microcaluria, biopsy ya impso imalimbikitsa. Phunziroli limathandiza kuti pamapeto pake zitsimikizire kupezeka kwa kuwonongeka kwa ziwalo za amyloid. Ngati dokotala akuwonetsa kuti vasorenal matenda oopsa, masiyanidwe angiography amaperekedwa. Njira zonse ziwiri zakuzindikira zimagwiritsidwa ntchito pazowonetsa mosamalitsa.
Angiography amachitidwa kwa odwala matenda ashuga achichepere komanso azaka zapakati pomwe amakhala ndi matenda osakhazikika a diastolic.
Njira zochizira
Chithandizo cha matenda oopsa ochita kuyesa kuthana ndi cholinga chochotsa zomwe zimayambitsa kuthamanga kwa magazi. Chithandizo chamankhwala ndikuchita opaleshoni chikuchitidwa, kudalirika kwa ntchito mwachindunji kumadalira kuopsa kwa matenda oyambitsidwa.
Anthu odwala matenda ashuga amawerengera njira ya antihypertensive mankhwala, amasankhidwa payekhapayekha, kutengera zovuta zowonetsera, kupezeka kwa zotsutsana ndi zinthu zomwe zimayambitsa, zomwe zimayambitsa matenda oopsa.
Ndi chitsimikiziro cha matenda a impso, zimawonetsedwa kuti atenge diuretics, ACE inhibitors. Zotsatira za hypotensive sizichitika, zotumphukira vasodilators, ma P-blockers ayenera kumwedwa. Pa zovuta za impso, hemodialysis imachitika.
Dziwani kuti njira imodzi yothandizira odwala matenda oopsa siyopezekapo. Mankhwala ena ochokera mndandanda wa mankhwala omwe amalimbikitsidwa pamayendedwe oyamba a matendawa amakhala atapangidwa milandu:
- ubongo;
- impso
- mitsempha yamagazi.
Mwachitsanzo, ACE inhibitors amaletsedwa mu aimpso stenosis oyambitsidwa ndi kubwezeretsanso matenda oopsa. Beta-blockers sangathe kutumikiridwa chifukwa cha mitundu yayikulu ya arrhythmia, pomwe chipatalachi chikutsagana ndi kusokonezeka kwa minofu ya mtima, coarctation kwa msempha.
Chithandizo chophatikizika ndi kugwiritsa ntchito mankhwala am'magulu osiyanasiyana chimasonyezedwa pakukhazikika kwa diastolic, ochepa matenda oopsa a pathophysiology iliyonse.
Kuti akwaniritse kusintha kwa kamvekedwe ka mitsempha ya magazi muubongo, kukonza magwiridwe amanjenje, madokotala amatipatsa mankhwala ochepetsa khansa, Cordiamine. Njira zimatengedwa m'mawa, magazi akakhala otsika kwambiri.
Njira ya mankhwalawa imasankhidwa kwa wodwala aliyense, kusankha kumapangidwa ndi kuyesa pamodzi kwa neurologist, cardiologist, opaleshoni ndi endocrinologist. Ndikofunikira kuganizira mosamala kusankha kwa mankhwalawa, izi ndizofunikira makamaka kwa odwala okalamba.
Kutsika kwakukulu kwa zisonyezo kumapangitsa kuti kuphwanya kwamatumbo, ubongo komanso kufalikira kwa impso.
Kuzindikira, njira zothetsera mavuto
Ndizotheka kuwerengera kuchotsedwa kwathunthu kwa matenda oopsa poyerekeza ndi kufafaniza kwake komwe kumayambitsa. Kuchulukana kwotalikilapo kwa magazi kumapangitsa kuti khungu likhale bwino komanso kuti mbali ya arteriosulinosis ipite patsogolo, ndipo makina ochita kupangika ndi impso nawonso amalumikizana ndi pathogenesis. Pankhaniyi, kuthekera kwa kusintha kwazinthu ndizovuta.
Ngati kuchira sikungatheke, kudalaku kumadalira kuopsa kwa matenda, kukana kwa antihypertensive mankhwala, zomwe zimayambitsa matenda, komanso thanzi lonse la odwala matenda ashuga.
Njira zopewera matenda oopsa oopsa zimatsikira popewa matenda omwe amatenga. Chofunikira ndi chithandizo cha panthawi yake cha pachimake pyelonephritis, glomerulonephritis, atherossteosis. Pakakhala chithandizo chokwanira, matendawa amakhala machitidwe.
Zambiri pazidziwitso zowopsa zimaperekedwa mu kanema munkhaniyi.
