Atherosulinosis ndi matenda osakhalitsa a mtima ndi ziwiya zazikulu, zotchulidwa ndi kuwonongeka kwa khoma lakumaso ndi mawonekedwe a ma atheromatous masheya pamenepo ndikutseka kwina kwa lumen komanso kukula kwa zovuta kuchokera ku ubongo, mtima, impso, kutsika kwakumapeto.
Nthendayo imapezeka makamaka mwa okalamba, ngakhale tsopano ma cholesterol ang'onoang'ono omwe amakhazikika pamitsempha yamagazi amapezeka ngakhale mwa ana ndi achinyamata.
Pakakhala chithandizo choyenera, atherosulinosis ya kutulutsa kwina kulikonse kumabweretsa ischemia ndi hypoxia ya ziwalo ndi machitidwe, kusintha kwa trophic ndi necrotic pakhungu ndi minofu yofewa.
Zomwe zimayambitsa izi zimatha kugawidwa m'magulu awiri - osinthika komanso osasinthika.
Loyamba limaphatikizapo zifukwa zomwe zimatha kusinthidwa ndi kusintha kwa moyo ndi mankhwala, awa ndi ena:
- Kukhala moyo wongokhala ndi ntchito yambiri yokhala.
- Kuphwanya zakudya zomvekera bwino - chakudya chosakhazikika chomwe chimakhala ndi mafuta ambiri, ophika zakudya okhala ndi mafuta m'thupi.
- Zizolowezi zoipa - kumwa kwambiri, kusuta.
- Kupsinjika ndi kuchuluka kwa malingaliro.
- Matenda oopsa a arterial ndi zizindikiro za kukwezedwa pamwambapa 140 ndi mamilimita 90 a mercury popuma ndi miyeso ingapo.
- Matenda a shuga ndi matenda osavomerezeka a glycemic komanso pafupipafupi ketoacidotic.
- Hypercholesterolemia - kuchuluka kwa cholesterol yokwanira (oposa 5.5 mmol / l), dyslipidemia - kuphwanya chiŵerengero pakati pa lipotroteins zamagawo osiyanasiyana (kuchuluka kwa lipoproteins, triglycerides, kuchepa kwa lipoproteins yapamwamba.
- Kunenepa kwambiri pamimba ndi chiuno mwa amuna kumaposa 102 masentimita, ndipo mwa akazi oposa 88 cm.
Zomwe sizingatengeke zimaphatikizapo mbiri yolemetsa yabanja (mabanja a hypercholesterolemia ndi dyslipidemia, omwalira ndi achibale a matenda amtima mpaka zaka 50), zaka (mwa abambo, atherosulinosis imayamba pambuyo pa zaka 45, mwa azimayi - pambuyo pa zaka 55), jenda ( Nthawi zambiri zimayamba kupezeka mwa amuna, chifukwa mahomoni ogonana achikazi amatha kuteteza mitsempha ya magazi).
Njira za pathogenetic zopanga zolembera
Kuphatikiza kwa hyperlipidemia ndi kuwonongeka kwa mtima kumabweretsa mapangidwe osinthika a cholesterol omwe amakhala ndi mapuloteni, ndikusunthidwa kwawo motsogozedwa ndi mitsempha.
Lipids imagwidwa ndi macrophages, omwe amasandulika kukhala maselo a xanthomatous, omwe amawonjezeka kwambiri.
Maselo amenewa amatulutsa kukula ndi kusunthika kwa zinthu za m'magazi oyera ndi mapulateleti. Pali kuphatikiza ndi kuphatikizika kwa mapulosi, kugawidwa kwa zinthu za thrombotic.
Chingwecho chimakula mwachangu, kutsekereza lumen zija chifukwa cha mapangidwe a minofu yolumikizana ndi matayala.
Kuphatikiza apo, mothandizidwa ndi kukula, ma capillaries amapangidwa kuti aziwapatsa magazi kwa anthu odziwika kwambiri. Gawo lomaliza la chitukuko ndi necrosis ya pakatikati pa zolembazo, kuperewera kwake ndi kuwerengeka.
Kusintha kwa morphological pakupezeka kwa atherosulinosis kumadziwika ndi kupitilira kwa matendawa, kuyambira ang'ono mpaka akulu.
Gawo loyamba la chitukuko cha atherosulinosis ndi dolipid, lilibe kusintha kwakuthupi kwa morphological. Amadziwika ndi kuwonjezeka kwa permanability kwa mtima khoma, kuphwanya umphumphu wake - woyang'ana kapena wathunthu, thukuta la gawo lamwazi m'magazi a subendothelial space.
Kutupa kwa Mucoid, kudzikundikira kwa fibrin ndi fibrinogen, mapuloteni ena a plasma, lipoproteins otsika ndi cholesterol amapangidwa.
Kuti muwone gawoli, ndikokwanira kugwiritsa ntchito kafukufuku wamakonzedwe a mtima wa khoma ndikugwiritsa ntchito utoto winawake - thionine ya buluu, momwe metachromasia amawonedwa ndipo madera omwe akhudzidwa ndi zodetsedwa.
Gawo lachiwiri - lipoidosis - imadziwika ndi kupezeka kwa cholesterol ndi lipoproteins mwa mawonekedwe amizere yamafuta ndi mawanga achikasu omwe samakwera pamwamba pa gawo la endothelium.
Kusintha kotereku m'magazi a mitsempha yamagazi kumatha kuonedwa ngakhale mwa ana ndi achinyamata, ndipo sikuti kumapita patsogolo. Lipids imayikidwa pansi pa intima muma macrophages, kapena maselo ofunda, ndi maselo osalala amitsempha yamagazi. Ndikothekanso kuzindikira gawoli m'mbiri, kutsika kumachitika ndi Sudan 4, 5, mafuta ofiira O.
Popeza kuti atherosulinosis ndi matenda opita pang'onopang'ono, gawoli limatha kukhala nthawi yayitali koma osayambitsa zizindikiro zazikulu zamankhwala.
Zida zazikulu, monga aorta, coronary mitsempha, ziwiya zaubongo, impso, ndi chiwindi, zimasintha.
Kuzindikiritsa kwazomwe zimachitika kumadalira ma hemodynamics pamasamba obisika a ziwiya, monga kuwongolera kolowera m'mitsempha ya iliac.
Gawo lachitatu la chitukuko cha atherosulinotic plaque ndi liposulinosis - mapangidwe a zotanuka ndi kolala mu endothelium, kuchuluka kwa fibroblasts, kudzipatula kwawo kwazinthu zokhudzana ndi kukula kwa minofu yokhudzana ndi minyewa.
Kuphatikiza kwachuma kwapangidwe kazinthu zopanga
Morphologic, malembawo amakwezedwa pamwamba pamlingo wapamtima, pamwamba pa chotengera chimakhala chachikulu, chopanda mphamvu. Mapale oterewa amatha kufupikitsa kuwunikira kwa mtsempha wamagetsi ndikupangitsa ischemia ya ziwalo ndi machitidwe, kutengera malo omwewo, zimabweretsa zovuta monga kugwidwa, kusakhalitsa kwa ischemic kuukira, kulowerera kwa myocardial, kuwononga ziwiya zam'munsi.
Gawo lotsatira la kupita patsogolo kwa matenda ndi atheromatous, wodziwika ndi kuwonongeka kwa gawo lapakati pa chinsalu, kuphatikizika kwake.
Makristali a cholesterol, mafuta acids, zidutswa za ulusi wa collagen, maselo a xanthoma ndi T ndi B lymphocyte amapezeka mu misa yonyansa. Mkuluwu umalekanitsidwa ndi luso la chotengera ndi kapisozi wa zolembazo, zomwe zimakhala ndi minyewa yolumikizana.
Gawo lotsatira ndi zilonda zam'mimba, zodziwika ndi misozi ya membrane, ndikutulutsa zomwe zili m'magazi, ndikupanga zilonda zapakhomo. Kuopsa kwa gawoli ndi kusakhazikika kwa zolembera zotere, kuthekera kotukusira pachimake ndi zotupa zotupa za ziwalo ndi minofu.
Patsamba la mapangidwe a zilonda, aneurysm imatha kukhala - kutulutsa kwa khoma la mtima, komanso kupasuka. Gawo lomaliza la njira ya pathological ndikudziwikitsa kwa zolembazo, ndiko kuti, kuyika kwa mchere wamchere mkati mwake.
Zotsatira zake, gawo lomwe lakhudzidwalo la chotengera limapangidwa, patency imalephera kapena palibe.
Kuwonetsedwa kwa zovuta zamitsempha zamagazi kumatha kukhala polymorphic, ndiko kuti, malo okhwima omwe ali ndi mawonekedwe ndi mawanga amafuta amatha kuonedwa munthawi yomweyo.
Matende a atherosulinotic amathanso kukhala ovuta kutulutsa magazi, kuundana kwa magazi, ndi kuphulika kwa kapisozi.
Mwachidziwitso, malo opangira ma atherosselotic amagawidwa pokhazikika komanso osakhazikika.
M'mapepala amtundu woyamba, chivundikiro cha minofu cholumikizidwa chimafotokozedwa bwino, makulidwe, sichimangochita kung'aluka ndikumasulidwa kwazomwe, motero sichikuyambitsa zovuta za atherosclerosis. Izi malembedwe amakhala ndi zovuta zovuta - ischemia aakulu a ziwalo kapena zimakhala, awo sclerosis, dystrophy kapena atrophy, khola angina pectoris, aakulu mtima chosakwanira.
Mu mtundu wachiwiri, matayala amatha kupukusa ndi kutuluka m'mitsempha yake, zovuta - zotupa za mtima komanso kusokonekera kwa ziwalo, angina osakhazikika komanso chithokomiro cha m'mimba, kupindika kwa imvi, kugunda kwa malekezero.
Zoyambira zochizira atherosulinosis ndi kupewa
Chithandizo cha mapangidwe opangidwa ndi ma atherosselotic malo omwe amadziwika kuti ali ndi matenda komanso mapangidwe ake, amakhala ndi njira yolumikizira, komanso amafunika kukonza zina ndi zina zotheka kuzisintha.
Izi zikuphatikiza - malamulo okhudzana ndi zakudya, kugwiritsa ntchito masamba komanso zipatso zambiri, chimanga, zinthu mkaka ndi kukhazikitsa boma lakumwa.
Ndikofunikanso kusiya kusuta fodya, kumwa mowa kwambiri, kuchita masewera olimbitsa thupi (kuyenda, kuthamanga, aerobics).
Chithandizo chachikulu ndimankhwala, izi zimaphatikizaponso mankhwala omwe njira yake ya mankhwala imatsitsa kuchepetsa cholesterol ndi zigawo zake:
- ma statins (Atorvastatin, Lovastatin, Simvastatin);
- mafupa;
- phenucol;
- nicotinic acid.
Zogwiritsidwanso ntchito:
- antiplatelet agents (Acetylsalicylic acid, Magnikor);
- anticoagulants (heparin);
- mankhwala osokoneza bongo (Cilostazolum);
- antispasmodics (Drotaverinum, Papaverineum);
- Kukonzekera kwa vitamini.
Woopsa matendawa, ndi zovuta pachimake, zotupa za minyewa yofewa ndi cholimba miyendo, opaleshoni ntchito - ntchito otsika zoopsa kuti abwezeretse magazi (stenting, bypass opaleshoni, balloon angioplasty), kuchotsedwa kwa ziwiya zomwe zakhudzidwa (endarterectomy ndi zina ma prosthetics) Kuchotsa tinthu tating'onoting'ono tomwe timagwira ntchito (necrectomy, kudulidwa mwendo)
Kupewa kukulira cholesterol ndi chitukuko cha atherosulinosis chachikulu - mwa anthu athanzi, komanso sekondale - wokhala ndi matenda omwe apezeka kale.
Njira zazikuluzikulu zopewera koyamba ndi zakudya zopatsa thanzi, kuchita masewera olimbitsa thupi pang'ono, kusiya zizolowezi zoyipa, kuwunika kuthamanga komanso kuchuluka kwa mafuta m'thupi, kuyezedwa pafupipafupi ndi akatswiri onse.
Popewa kwachiwiri, ndikofunikira kuyamba ndi matenda a concomitant matenda, kutsitsa magazi, kutenga ma statins ndi ma antiplatelet othandizira, kuzindikira kwakanthawi ndi chithandizo cha zovuta.
Etiology ya atherosulinosis ikufotokozedwa mu kanema munkhaniyi.
