Atherosulinosis imadziwika kuti ndi imodzi mwazonse zokhudzana ndi mtima. Mukungoyenera kuganizira za ziwerengero izi: zotsatira zakupha kuchokera ku matenda omwe amayambitsidwa ndi njira yozungulira ya Russian Federation ndi anthu 800.9 pa anthu 100,000, pamene ku Japan - 187.4, ndi ku France - 182.8.
Kuwonjezeka kwa odwala omwe ali ndi atherosulinosis kumalumikizidwa makamaka ndi moyo wopanda ntchito komanso kuperewera kwa zakudya m'thupi. Kuzindikira koyambira kwa matenda am'mimba kumathandizira kupewa zovuta zazikulu - kukhazikika kwa kulephera kwa mtima, hypoxia, ischemia, etc. Chithandizo chimaphatikizaponso magawo angapo: kumwa mankhwala, mankhwala ochiritsira, komanso pazovuta kwambiri, ngakhale opareshoni.
Kodi atherosulinosis ndi chiyani?
Ambiri adamva za matendawa, koma atafunsidwa kuti atherosclerosis ndi chiyani, si aliyense amene angayankhe molondola. Matendawa ndi zotupa za ziwiya za minofu-zotanuka ndi zotanuka, zokhala ndi cholesterol ndi tizigawo tina ta mapuloteni apadera - lipoproteins. Pathology imayamba chifukwa cha kuphwanya kwa lipid ndi mapuloteni.
Pali mitundu ingapo ya lipoprotein yomwe imanyamula cholesterol kudzera m'magazi ndikuipititsa ku ma cell onse: ma kachulukidwe kwambiri (HDL), kachulukidwe kochepa kwambiri (LDL) komanso kachulukidwe kochepa kwambiri (VLDL). Maonekedwe a atherosulinotic plaques amagwirizanitsidwa ndendende ndi kuchuluka kwa LDL ndi VLDL mthupi, zomwe zidapereka lingaliro la cholesterol "yoyipa". Izi mankhwala ndi osakwanira amadzimadzi, chifukwa chake, zochulukazo m'magazi zimatsogolera pakuyimitsidwa kwa matope, choyamba mu mawonekedwe a mawanga amafuta, kenako ma plaque atheromatous.
HDL ("wabwino" cholesterol) imachita mwanjira yosiyana kotheratu: imasungunuka bwino m'magazi a anthu, kotero kuti msambo wawo wokwera amawonetsa thanzi labwino. Kukhalapo kwa kuchuluka kwa HDL kumalepheretsa kukula kwa zolembera zamatenda ndi zophuka, zomwe zimapangitsa kutayika kwa chotengera, kusintha kwake komanso kufalikira.
Masiku ano palibe mgwirizano pa matenda. Mankhwala amadziwa malingaliro angapo:
- kuchuluka kwa lipoproteins mu ochepa makoma;
- kuphwanya ntchito yoteteza ya endothelium (mkati mwa maselo) ndi oyimira pakati;
- mawonekedwe a pathological clone of laini minofu cell;
- kulakwitsa kwa dongosolo la antioxidant;
- kukanika kwa leukocytes ndi macrophages, kulowa kwawo kwa mtima khoma;
- endothelial kuwonongeka ndi cytomegalovirus, herpes, etc.;
- kukhalapo kwa cholowa cholowa kukhoma la chotengera;
- kuwonongeka kwa makoma a mtsempha wamagazi ndi chlamydia;
- kusintha kwa mahomoni komwe kumalumikizidwa ndi zaka.
Posachedwa, kuchuluka kwa atherosclerosis kwachulukitsa kuchuluka kwavulala, matenda opatsirana komanso kupweteka kwapakati.
Nthawi zambiri, amadziwika kuti ali ndi zaka 45-50, ndipo kuchuluka kwa odwala amuna kumakhala kokwanira katatu kuposa akazi.
Zomwe zimathandizira pakukula kwa matendawa
Pali zinthu zambiri zomwe zimawonjezera mwayi wokhala ndi atherosulinosis.
Mpaka pano, tsamba la European Cardiology Society lidapangidwa, pomwe mutha kuwerengera za chiwopsezo cha mtima.
Zinthu zotsatirazi ndi matenda zimathandizira kwambiri pakufotokozeredwa kwa zifanizo za atheromatous.
Kusuta. Resins ndi chikonga, zomwe ndi gawo la kapangidwe kake, zimakhudza makoma a mtima. Kusuta kwa nthawi yayitali kumawonjezera mwayi wa matenda a mtima, matenda oopsa komanso hyperlipidemia.
Hyperlipoproteinemia. Kuwonjezeka kwa milomo ya magazi ndi ma lipoproteins ndizovuta zomwe zimachitika. Ndikofunikira kumveka phokoso pamene kuchuluka kwa cholesterol yonse ikukwera pamwamba 5 mmol / L ndi LDL yoposa 3 mmol / L.
Matenda oopsa. Ndi kuthamanga kwa magazi (kuposa 140/90 mm Hg), kuchuluka kwa mitsempha kumachepa ndipo mwayi wothandizidwa ndi mapangidwe a atheromatous ukuwonjezeka.
Matenda a shuga. Matendawa amadziwika ndi kuwonjezeka kwa glucose chifukwa chosakwanira kupanga kapena atasiya kupanga insulin. Njira yayitali ya matenda amakhudzana ndi mavuto amitsempha yamagazi ndi mitsempha yamitsempha, kotero matenda a atherosulinosis nthawi zambiri amawonekera motsutsana ndi maziko a matenda a shuga.
Kulephera kuchita masewera olimbitsa thupi. Tsiku lililonse, munthu ayenera kuyenda mu mpweya wabwino komanso kuchita masewera olimbitsa thupi. Kuchita zinthu zochepa kumayambitsa zovuta za metabolic, zomwe zimapangitsa kuchuluka kwa thupi, matenda ashuga ndi atherosulinosis.
Kunenepa kwambiri komanso zizolowezi zoyenera kudya. Ndi onenepa kwambiri, pali kukulira kwa lumen kwa mitsempha yamagazi ndi kuwonjezeka kwa kuthamanga kwa magazi. Katundu wotere wamitsempha yamagalamu imakhala ndi ma pathologies osiyanasiyana. Kukhalapo kwa zakudya zamafuta ambiri amnyama kumapangitsa kuti pakhale matenda a lipid.
Zaka ndi jenda. Munthu akamakula, amakhala ndi mwayi wokhala ndi matendawa. Kuyamba kwa kutsimikizika kwa zolembedwa zamtundu wa atheromatous kumachitika pazaka za 45-50. Kuphatikiza apo, mwa amuna matendawa amapangidwa kangapo, ndipo matendawa amakula zaka 10 zapitazo kuposa theka.
Makamaka. Atherossteosis nthawi zambiri amapezeka pamaso pa achibale omwe ali ndi matenda omwewo. Zatsimikiziridwa mwasayansi kuti anthu omwe ali ndi vuto lofooka la lipid metabolism ali ndi atherosclerosis oyambirira (osakwana zaka 50).
Zina zomwe zimayambitsa ndi hypothyroidism, postmenopause, hyperfibrinogenemia (kuchuluka kwa fibrinogen m'magazi), homocysteinemia (kuchuluka kwa homocysteine m'magazi) ndi Homocysteinuria (kukhalapo kwa Homocysteine mkodzo).
Limagwirira kukula kwa atherosulinosis
Pophunzira za matendawa, zidadziwika kuti pali magawo a chitukuko cha matendawa omwe amasiyana ndi zizindikilo za pathophysiological.
Kupitilira kwa matendawa kumachitika magawo atatu - kudzikundikira kwa malo a lipid, kuphatikizana kwa lipid komanso kukula kwa zovuta.
Posemphana ndi metabolid ya lipid, pali kusintha kwa chiŵerengero cha cholesterol, phospholipids, mapuloteni komanso mapangidwe a beta-lipoproteins.
Pakufunika kuwunikiridwa mwatsatanetsatane kwa pathogenesis ya atherosulinosis:
- Kuchulukitsidwa kwa malo a lipid. Pakadali pano, munthuyu samazindikira chilichonse, osazindikira matendawa. Komabe, njira ya pathological yayamba kale: pali kusintha kosinthika m'makoma amitsempha, omwe mawonekedwe ake amafanana ndi timiyala yachikasu kutalika konse kwa mtsempha. Komanso, magawo ena amtsempha wamagazi amakhudzidwa. Kupititsa patsogolo kwa matenda a zamitsempha kumathandizira chifukwa cha matenda amodzimodzi.
- Kudzikundikira kwa Lipid. Zomwe zimapangidwa ndi minofu yolumikizira lipid zimayamba kupunduka, komwe kumachitika thupi likamangoyerekeza. Popita nthawi, cholinga cha kutupa chimayambitsa kuwonongeka kwa mafuta wosanjikiza komanso kumera kwa minofu. Chifukwa chake, zochuluka zamafuta zimayamba kusokonekera ndikukwera pamwamba pa khoma la chotengera.
- Kukula kwa zovuta. Kukula kwa matenda kupititsa patsogolo kumakhala ndi njira ziwiri - kukhomedwa kwa cholesterol plaque kapena kupangika kwa magazi. Zomwe zimakhazikika pokhapokha, kupangika kwa madongosolo atsopano kapena kumasulidwa kwa magazi ambiri ndizotheka. Mitsempha yamagazi ikapangika, chowopsa kwambiri chimakhala kusokonezeka kwa mitsempha yayikulu, komwe kumayambitsa stroke, necrosis ya minofu kapangidwe ka khungu.
Ndikosatheka kuneneratu kuti matendawa amakula mwachangu bwanji: amatha kuchitika moyenera kapena mwachangu kwambiri. Limagwirira a chitukuko cha matendawa amachoka kwa miyezi ingapo kupita zaka zingapo.
Izi zimakhudzidwa ndi machitidwe a kagayidwe kachakudya, kupezeka kwa majini komanso zinthu zina.
Mitundu ndi zizindikiro za atherosulinosis
Magulu ambiri amtunduwu amatengera matenda omwe akhudzidwa ndi mitsempha ya m'magazi.
Mitundu ya matenda imatha kudziwonekera, ngakhale kuwonongeka kwamitsempha kumawonedwa nthawi zambiri.
Komanso, zizindikiro za atherosulinosis zimasiyana kutengera mtundu wake.
Ndikofunikira kusiyanitsa mitundu yotsatila yamatenda:
- Matenda a mitsempha ya mitsempha. Ndi kuwonongeka kwa mitsempha ya mtima, zotsatira zoyipa monga matenda a mtima, kugunda kwa mtima ndi angina pectoris. Madandaulo a wodwalayo amaphatikizidwa ndi kupweteka kwa mtima komwe kumatuluka mpaka phewa kapena kutalika konse kwa mkono, kufinya pakumva kupweteka, kumva kupweteka, kupuma, kufupika, kupuma kapena kusanza, kupweteka kumbuyo, kumva kuzizira, thukuta ndi kuzizira, kufooka m'miyendo.
- Atherosulinosis ya ziwiya za brachiocentral (BCC). Imadziwoneka yokha chizungulire posintha malo, migraine, dzanzi la miyendo ndi manja, kukomoka, kusawona bwino, "ntchentche kapena madontho" patsogolo pa maso.
- Kuletsa atherosulinosis ya m'munsi komanso kumtunda. Chizindikiro choyambirira cha matenda ndikumverera kuzizira komanso "zopumira" pamiyendo ndi mikono. Gawo linalake komanso khungu lotuwa. Pakapita nthawi, kupweteka m'miyendo, kutsika kwa tsitsi kumphepete, zilonda zam'mimba, kutupa, kufalikira kwa zala, vuto lalikulu, kukula kwa necrosis kumawonedwa.
- Fomu yaortort. Atherosulinotic zotupa za mitsempha yayikulu imakhudza kugwira ntchito kwa ziwalo zonse. Mwa odwala ena, mchere wa calcium umasonkhana motsutsana ndi maziko a atortosulinosis. Popita nthawi, njira ya pathological imayambitsa kuwonongeka kwa ma cusps a valve ndikuchepetsa mphete ya fibrous valve. Kuwonetsera kowopsa kwambiri kwa matendawa ndi stenosis ya orortice.
- Cerebral atherosulinosis ya mitsempha yazitsamba. Ndi matenda opatsirana a atherosulinosis, cephalgia amakula, i.e. kupweteka mutu popanda kudziwa kutulutsa kwachilengedwe, kugona, tinnitus, mavuto okhala ndi masanjidwe, mgwirizano, ulesi, kusintha umunthu, kusokonekera kwa mawu, kupuma komanso kudya. Pamapeto omaliza, kusayenda bwino, kuchepa kwa chidwi, komanso kuchepa kwa nzeru kumachitika.
Payokha, amathandiziranso mtundu wamatendawa monga matenda a mitsempha ya impso. Maonekedwe a cholesterol plaques amaphatikizira kupweteka pakukodza, kuphatikizika kwa magazi kumayang'anidwa mkodzo. Wodwalayo amadandaula za mseru pafupipafupi komanso kusanza, kupweteka pamimba ndi kutsika kumbuyo.
Mu kafukufuku wazamalonda, kuchuluka kwa potaziyamu m'magazi kumawonedwa.
Ubale wa atherosulinosis ndi matenda ashuga
Cholesterol amatenga nawo kaphatikizidwe wa timimba ta m'mimba komanso timadzi ta pancreatic. Izi sizomwe zimayambitsa matenda ashuga, koma zimakhudza njira yake.
Ndi misere yokwezeka, mwayi wopanga atherosulinosis ukuwonjezeka kwambiri. Komanso, atherosulinosis imawonjezera zovuta za matenda ashuga. Anthu odwala matenda ashuga, mosaganizira jenda ndi zaka, amavutika ndi zotupa zam'matumbo mosiyanasiyana.
Atherosulinosis imatha kuoneka motsutsana ndi maziko a matenda a shuga omwe amadalira insulin komanso osadalira insulini. Pokhala ndi shuga wambiri pafupipafupi, kagayidwe kamasokonezedwa, kamene kamayambitsa kulephera kwa lipid metabolism ndi chimbudzi. Makoma olimbitsa amakhala osalimba komanso opezeka kuti munthu azilowa m'magazi a "cholesterol" oyipa.
Ngati atherosclerosis imayendera limodzi ndi matenda a shuga a mtundu woyamba kapena wachiwiri, ndiye kuti wodwalayo angakumanenso ndi zovuta zotsatirazi:
- mtima matenda atha kukhala ocheperako, ngakhale atapezeka kuti ali ndi zaka zopitilira 45-50;
- kutsekeka kwamitsempha kumachitika, kumakhala kosalimba komanso kuwonda, mogwirizana ndi izi, mwayi wokhala ndi stroke komanso kukula kwa aneurysms kumawonjezeka.
Atherossteosis, monga lamulo, limakula machitidwe, zomwe zimakhala zowopsa ku ubongo, miyendo, mtima ndi ziwiya zazikulu.
Mavuto a Kusagwiritsa Ntchito Mankhwala
Kuleza mtima kapena kugwiritsa ntchito mankhwala osathandiza kumabweretsa mavuto ambiri. Popeza chithunzithunzi cha chipatala sichimawonekeranso poyambira kukula kwa matendawa, kuzindikira kwa nthawi yake kumatenga gawo lofunikira.
Atherosclerosis ya mtima dongosolo ndi kupatutsa kusintha kwamitsempha pakapita nthawi kumakhala kosalekeza kapena pachimake mtima ziwalo. Njira ya pathological imachitika motsutsana ndi maziko a stenosis olimbitsa a ziwiya.
Kukhazikika kwakanthawi kochepa kwa magazi ku ziwalo zomwe zimayambitsa hypoxia, ischemia, atrophy ndi dystrophy, kupezeka kwa scalosis yaying'ono, komanso kufalikira kwa minofu yolumikizira.
Chifukwa cha nthawi yayitali yovuta kwambiri ya mtima kuperewera, kuvala mitsempha ndi thrombus kapena embolus - tinthu tating'onoting'ono topezeka m'zigawo zophulika. Vutoli limawonetsedwa ndi zizindikiro za kugunda kwa mtima komanso ischemia yayikulu.
Zotsatira zoyipa kwambiri zamatenda a atherosulinosis ndi kupasuka kwa chotengera aneurysm. Nthawi zina, izi zimabweretsa imfa.
Pofuna kupewa zovuta, ndikofunikira kutsatira zakudya, kumwa mankhwala omwe mumalandira ndikutsatira malangizo onse a dokotala.
Mfundo zodziwikitsa matendawa
Kuzindikira matendawa kumakhala ndi njira zingapo zothandizira ntchito.
Choyamba, wodwalayo amabwera kwa dokotala kuti amupime, yemwe amatenga deta ya anamnesis.
Katswiri wodziwa ntchito amathandizira chidwi cha kusowa kwa tsitsi pa miyendo, zopindika za msomali, kuchepa kwa magazi, kuthamanga kwa magazi, kupezeka kwa kung'ung'uza kwa mtima, arrhythmia, kutulutsa kwambiri kwa zotupa za sebaceous ndi thukuta, kutupira posakhalapo ndi matenda a impso.
Ngati dokotala akuganiza kuti wodwala atherosulinosis wodwala, amamuuza kuti akayezetse zotsatirazi:
- Kuyesa kwa magazi kuchokera m'mitsempha kuti muwone kolesterol yathunthu komanso kuchuluka kwa mphamvu ya ma atrogengenicity.
- Chizindikiro cha chidziwitso chowongolera cha msempha wamtundu wa atherosulinosis. Matendawa akuwonetsedwa ndi kuwerengera, kupezeka kwa aneurysms, zisindikizo, kutalika ndi kufalikira kwa mtsempha wamagazi mu sternum kapena peritoneum.
- Coronography, yomwe imathandizira kudziwa momwe mitsempha ya mtima ilili komanso kukhalapo kwa cholesterol yomwe imayikamo.
- Angiography - kafukufuku wamagazi oyenda m'mitsempha ina pogwiritsa ntchito kuyambitsa kwa sing'anga ndi radiology.
- UZDG yamitsempha yama impso imathandizira kudziwa kuphwanya kwamphamvu kwa chiwalo ndi kukulitsa kwa atherosulinosis yomwe ilimo.
- Kukonzanso kwa malekezero am'munsi kumatsimikizira kuphwanya kwa magazi m'miyendo, komanso kupezeka kwa cholesterol malo ndi zophuka.
Ultrasound ya ziwalo zaumwini imagwiritsidwanso ntchito, zimathandizira kuwunika kuthamanga kwa magazi m'mitsempha. Njira imatsimikiza molondola kupatuka pang'ono komanso kuchuluka kwa kusowa kwa magazi.
Chithandizo chamankhwala ndi opaleshoni
Malinga ndi ziwerengero ndi kuwunika, mu 80% ya milandu, kumwa mankhwala ndikokwanira kuti kuthetseratu zizindikiro za atherosclerosis ndikuwongolera kupitanso patsogolo kwake.
Poyerekeza ndi chithandizo cha mankhwala osokoneza bongo, chofunikira ndicho kusunga zakudya zapadera komanso zochita zolimbitsa thupi.
Popereka chithandizo, njira yolumikizira kukhazikitsidwa kwa mankhwalawa iyenera kutsatiridwa.
Mankhwala othandiza mankhwalawa atherosulinosis ndi:
- Statins (Atorvastatin, Rosuvastatin) - mankhwala omwe amachepetsa ntchito ya chiwindi popanga cholesterol. Gulu la mankhwalawa limaperekedwa nthawi zambiri.
- Fibates (Atromide, Tricor) ndi mankhwala omwe zochita zawo zimayang'aniridwa kuti awononge triglycerides.
- LCD sequestrants (Colestyramine, Kolesevelam) - mankhwala omwe amalepheretsa kuphatikiza kwa bile acid ndi chiwindi. Zotsatira zake, chiwindi chimagwiritsa ntchito cholesterol yambiri kupukusa chakudya.
- Nicotinic acid ndi zotumphukira zake ndi mankhwala omwe amachepetsa cholesterol, komanso okhala ndi antispasmodic ndi vasodilating.
Poyerekeza ndi maziko a chithandizo chachikulu, mankhwala ena amawonjezeranso - ma antiplatelet othandizira, mavitamini, angioprotectors, mankhwala osokoneza bongo, mankhwala othandizira kupatsa thanzi komanso kuzungulira kwa magazi, antispasmodics ndi vasodilator. Musanagwiritse ntchito mankhwala, muyenera kufunsa dokotala ndikuwerenga tanthauzo lake.
Pazinthu zotsogola, chithandizo chamankhwala ndi zakudya chimakhala chothandiza. Pofuna kupewa zovuta zazikulu, opaleshoni imachitika:
- opaleshoni yodutsa - "kucheka" kwa chotengera chomwe chakhudzidwa ndi atherosulinosis kumitsempha wama magazi komanso kukhazikitsa magazi atsopano.
- mtima prosthetics - m'malo wathunthu chotengera ndi kubwezeretsa magazi.
Ngati ndi kotheka, angioplasty amagwiritsidwa ntchito - kuyeretsa ndi kukulitsa chotengera poyambitsa catheter kudzera mu mtsempha wamajere wamkazi.
Zakudya zochizira atherosulinosis
Kuphatikiza pa chithandizo chamankhwala, zakudya za atherosulinosis zimathandizanso.
Ngakhale kuti ziwalo zamkati zimatulutsa 80% ya cholesterol, 20% yotsalayi ilowa m'thupi ndi chakudya.
Mfundo yayikulu yothandizira kudya pothandizira mankhwalawa ndi kuthana ndi kuchuluka kwa cholesterol kuchokera kunja.
Pachifukwa ichi, ndikofunikira kusiya izi:
- nyama zamafuta ndi mafuta a nyama - nyama ya nkhumba, bakha, tsekwe, mafuta anyama, ndi zina zambiri;
- offal - chiwindi, ubongo;
- mitundu yamafuta am'madzi - mackerel, carp siliva, hering'i, halibut, ndi ena otero;
- pickles, kuzifutsa, kusuta ndi zakudya yokazinga;
- mafuta mkaka;
- soseji ndi soseji;
- dzira;
- zakumwa zozizilitsa kukhosi za khofi, khofi wamphamvu komanso tiyi;
- zinthu zophika mkate za premium;
- maswiti - chokoleti, maswiti, makeke, ndi zina zambiri.
Palibe chifukwa chokhumudwitsidwa kuti muyenera kusiya zinthu zambiri zodziwika bwino. Ngakhale mankhwala a atherosulinosis, mutha kudya zakudya zabwino komanso zopatsa thanzi. Amawotchera, kuwiritsa kapena kuwatumiza ku uvuni. Simungathe kuwonjezera mchere wambiri (kuchuluka kwa tsiku lililonse - magalamu 5), umatha kusinthidwa ndi tsabola wofiira kapena wakuda ndi zonunkhira zina. Chakudyacho chimalola kudya izi:
- nyama yokonda - nyama ya kalulu, nkhuku, ndi zina;
- zinthu zamafuta amkaka ochepa;
- mitundu yamafuta ochepa-nsomba - hake, pike perch, bream, carp, ndi zina zambiri;
- mafuta ophika ophika mkate;
- zipatso zatsopano, zipatso, zitsamba ndi masamba;
- tiyi wopanda mphamvu wobiriwira, timadziti zachilengedwe.
Kuthana ndi zakudya komanso kuchita masewera olimbitsa thupi ndi njira yabwino kwambiri yopewera matenda a atherosclerosis ndi matenda ena a mtima, omwe amayenera kutsatira onse odwala komanso athanzi.
Kodi atherosulinosis ndi chiyani idzauza katswiri wa kanemayu munkhaniyi.
