Atherosulinosis ya ziwiya zam'munsi zodwala ndi matenda osachiritsika omwe amadziwika ndi mapangidwe a cholesterol plaque mkati mwa membrane wa mitsempha yomwe imapereka miyendo yam'munsi
Amakula makamaka atakula (zaka 60-75), ndipo zimapangitsa kuti thupi liwonongeke.
Zimayambitsa atherosulinosis ya m'munsi malekezero
Mukukula kwa mitsempha chifukwa cha hypercholesterolemia yotalikirapo komanso zinthu zina, madongosolo a ma atheromatous mamisili ndi minyewa yolumikizana imapangidwa.
Kutengera ndi kukula ndi kapangidwe ka cholesterol plaque, kuphwanya mphamvu ya chotengera ndi kuchepa kwa minofu yofewa ya trophic chifukwa cha ischemia.
Popita nthawi, zolembera zimayamba kuwonongeka, kuchuluka kwa mitsempha kumawonjezeka.
Kuphatikiza pa kuchepetsa kupendekeka kwa mtsempha womwe wakhudzidwa, mawonekedwe owonetsa matendawa amasiyanitsidwa: stenosis, kapena kupendekera kosakwanira kwa lumen; kuchepa kwa magazi (kufalikira kwathunthu kwa mitsempha yamagazi), kapena kufafaniza ma atherosulinosis.
Zomwe zimayambitsa matenda a atherosulinosis a m'munsi malekezero:
- Matenda oyamba a mtima dongosolo (matenda a mtima, matenda oopsa).
- Mchitidwe wochita kuperewera kwa hyperlipidemia ndi atherosclerosis (dyslipidemia), hyperfibrinemia, monocytosis, homocysteinemia.
- Zizolowezi zoyipa - kumwa kwambiri ndi kusuta fodya.
- Kuphwanya zakudya - kudya mafuta ambiri komanso mapuloteni ambiri, zakudya zopezeka mu cholesterol, kunyalanyaza zakudya zam'mera.
- Matenda a Endocrine, monga mtundu 2 shuga mellitus, hypothyroidism (kuperewera kwa mahomoni a chithokomiro), metabolic syndrome, kunenepa kwambiri, matenda a Itsenko-Cushing. Kunenepa kwambiri komanso kunenepa kwambiri kumapangitsa kuti katundu ndi miyendo yake iwonongeke.
- Kuchulukitsa zolimbitsa thupi kumapangitsanso kuwonjezeka kwa mitsempha.
- Kusakwanira zolimbitsa thupi - kumayambitsa kuphwanya hemodynamics ndi minofu ischemia.
- Contcomitant matenda - varicose mitsempha, matenda ashuga macroangiopathy kapena microangiopathy.
- Matenda a ziwalo za m'chiberekero, monga thrombosis ndi thromboembolism ya mitsempha ya m'chiuno.
- Kusokonezeka kwa mahormone ndi kupanga osakwanira kwa estrogeni chifukwa cha kusintha kwa thupi kumapangitsanso kuwonjezeka kwa cholesterol ndi zigawo zake.
- Kuvulala ndi chisanu cham'mphepete - kumayambitsa kusintha kwamatchulidwe a minofu yofewa komanso mafupa.
- Mikhalidwe yovuta ndi hypothermia.
Zomwe zimayambitsa kukula kwa matendawa zimatha kukhala zosintha zokhudzana ndi zaka (achikulire, kuchuluka kwa mitsempha kumachepa, ndipo ngakhale ma cholesterol ang'onoang'ono amatha kusokoneza magazi),
Gender imathandizanso pakukula kwa matendawa.
Nthawi zambiri, atherosulinosis imayamba kupezeka mwa amuna, chifukwa azimayi ogonana amatha kuteteza makoma amitsempha yamagazi.
Madera akumidzi okhudzidwa
Kuzindikira kwadera lomwe lakhudzidwa kwambiri kumakhudza kukula kwa matenda komanso kuopsa kwa zotsatirapo zake.
Kukula kwa matendawa kumatha kuchitika m'malo osiyanasiyana am'munsi.
Kutengera ndi komwe kuli, mitundu ingapo ya matenda am'mimba imasiyanitsidwa.
Mitundu iyi ya atherosulinosis ya m'munsi yam'munsi imasiyanitsidwa:
- atherosulinosis ya gawo la aorto-iliac;
- Kugonjetsedwa kwa tsamba la femal-popliteal;
- matenda a patali ndi gawo la popliteal-tibial.
- kukonzekera kwa mwendo;
- multilevel mtima kuwonongeka.
Komanso, kutengera mphamvu yakuchepa kwa lumen ya chotengera, atherosclerosis yamitsempha yam'munsi imagawikidwanso, ndipo ma occlusion opitilira 50% a lumen, osangowonongedwa, ndi ochepa.
Zizindikiro zamakhalidwe ndi magawo a matenda
Matendawa amatha kuonekera ndi zizindikiro zosiyanasiyana.
Zizindikiro za matendawa zimadalira kuchuluka kwa kusuntha, tsamba ndi kuchuluka kwa mitsempha yowonongeka.
Madandaulo oyamba amatha kutopa kwa miyendo poyenda, kupweteka kwakanthawi m'misempha, kuzirala kwamapazi.
Popita nthawi, zizindikiro zina zimayamba:
- Kuphwanya kutentha ndi kumva kupweteka kwa khungu la miyendo ndi miyendo, dzanzi.
- Matenda a trophic - khungu kapena khungu la pakhungu, kuonda kwake, kuuma, kuchepa tsitsi, kutulutsa kapena kutulutsa misomali. Ndi ischemia yayikulu komanso yayitali, zilonda zam'mimba ndi zilonda zam'mimba zimayamba.
- Mphamvu yolumikizira mafupa am'mitsempha imatupa, zomwe zimatha kudzetsa miyendo, nthawi zambiri usiku.
- Matenda a ululu amawoneka - kuchokera kufatsa mpaka pakapumira. Monga lamulo, ululu umawonjezeka poyenda.
Chizindikiro cha pathognomonic cha atherosulinosis obliterans am'munsi malekezero ndikulankhula kwapadera.
Kutengera ndi kukomoka, magawo angapo owonongeka miyendo amasiyanitsidwa, choyimira chachikulu ndi mtunda woyenda wopanda ululu.
Pa gawo loyamba, wodwalayo amatha kupitirira kilomita imodzi mosalekeza, kupweteka kumachitika ndi kulimbitsa thupi kwakukulu.
Gawo lachiwiri la "A" limadziwika ndi ma ululu akamayenda mtunda wamtunda wa 250 mpaka kilomita imodzi, "B" yachiwiri - kuchokera 50 mpaka 250 metres.
Gawo lachitatu - ischemia yovuta - imadziwika ndi kuchepa kwa mtunda woyenda osapweteka kwambiri osakwana 50 m, kuwonekera kwa zizindikiro zowonjezera, kupweteka kumapitirirabe ngakhale pakupuma.
Gawo lachinayi limaphatikiza zizindikiro za lachitatu komanso zovuta zina za trophic zimawonekera, mpaka ku gangrene yamapeto.
Njira zoyambira matenda
Kuzindikira matendawa kumatengera madandaulo a wodwalayo, kuchuluka kwa mbiri yakale yakuchipatala (pomwe zizindikirocho zikuwonekera koyamba, chikhalidwe chawo, nthawi, kuchuluka kwa zomwe zimachitika, kodi wodwalayo amagwirizanitsa matendawa ndi zinthu zina - kuvulala, hypothermia, mbiri ya moyo (matenda am'mbuyomu, zovuta zapabanja, matenda oopsa, angina pectoris, kupezeka kwa atherosulinosis kwina).
Komanso, pofuna kudziwa za matendawa, kufunikira koyesedwa ndikofunikira, ndiye kuti khungu ndi maupangidwe, minofu yofewa ndi minyewa ya miyendo, kupindika pazotengera za m'miyendo ndi kumapazi. Amagwiritsanso ntchito mayeso azidziwitso ndi katundu, mwachitsanzo izi: kuchokera pamalo owonekera, wodwalayo ayenera kukweza miyendo yake ndi madigiri 45 ndikuyigwira kwakanthawi. Pro atherosclerosis ikuwonetsa kuyambanso kwa kutopa, kuthamanga kwa miyendo.
Mwa njira zowonjezera zodziwira, njira zambiri zamankhwala zimagwiritsidwa ntchito - kuchuluka kwa magazi, kuwunika kwamkodzo, kuchuluka kwa shuga (kupatula matenda ashuga), kuyamwa kwa magazi ndi kutsimikiza kwa cholesterol yokwanira (kawirikawiri mpaka mamilimita 5.5 pa lita), lipoproteins ochepa (atherogenic), lipoproteins kupindika kwakukulu (chidutswa cha anti-atherogenic), maphunziro a mahomoni - kuchuluka kwa mahomoni a chithokomiro, mahomoni ogonana.
Njira zoimbira zimagwiritsidwa ntchito - kukonzanso kwamitsempha yamagazi, kuthamanga kwa kutsimikiza ndi kutsimikiza kwa chidendene-brachial index, angiography, magnetic resonance angiography, multispiral compute angiography, peripheral arteriography, duplex scan (US) of artery.
Chithandizo chimatengera kuuma kwa vutolo, kuchuluka kwa zotupa, kuchuluka kwake, magawo a matendawa, komanso kuphatikizidwa kwa kusintha kwaumoyo, zotsatira za mankhwala ndi chithandizo cha opereshoni.
Malangizo a moyo wamatenda am'munsi
Gawo loyamba mankhwalawa atherosulinosis limayamba nthawi yomweyo atazindikira kuti ali ndi matenda.
Izi zimaphatikizapo zakudya kapena zakudya zamankhwala, kukana zizolowezi zoyipa, kuwongolera zolimbitsa thupi.
Zakudya zopatsa thanzi kapena zochizira ndizochita zoyambirira zochizira matenda onse a mtima, chifukwa kuchuluka kwa cholesterol yoyipa m'magazi komanso kuthamanga kwa magazi kumadalira chakudya chomwe munthu amadya.
Madokotala amalimbikitsa kutsatira zakudya zotsutsa atherogenic kupatula mafuta a nyama ndi mapuloteni, zakudya zamafuta a cholesterol - mafuta anyama, zipatso, mazira a nkhuku, masoseji. Magwero a fiber ayenera kukhala abwino pakudya - masamba obiriwira (masaladi, kabichi, zukini, broccoli), zipatso, phala ndi nyemba (monga gwero lama protein ndi michere yama protein), mtedza (monga gwero lamafuta athanzi).
Monga gwero la mapuloteni, nkhuku (nkhuku, bakha, zinziri), nsomba (mitundu yamafuta ochepa), ndi nyemba ndizovomerezeka. Ndikofunikira kuwona boma lakumwa - mamilimita 30 mpaka 50 a odefa osasunthika a kilogalamu imodzi ya thupi, madzi okoma a kaboni ayenera kuthetsedweratu. Muyeneranso kusiyiratu kudya mwachangu, zakudya zosavuta, kusuta, zakudya zowukidwa kwambiri, zamzitini ndi mbale zowuma.
Chofunika kwambiri ndi kukana zizolowezi zoipa - uchidakwa, kusuta.
Zochita zolimbitsa thupi kumayambiriro kwa matendawa zimatha kudwala matendawa. Mutha kuyamba ndikuyenda tsiku lililonse kwa mphindi 30-60, kuthamanga, kuchita masewera olimbitsa thupi, kusambira. Ndikofunika kuti pang'onopang'ono muwonjezere katundu pakapita nthawi, poganizira zizindikiro za matendawo, kuchuluka kwa zoletsedwa.
Kusamalira miyendo ndikofunikanso kwa odwala - kuyeretsa tsiku ndi tsiku, pedicure yoyenera, kuchiritsa mabala ndi kuvulala kwina ndi antiseptic agents.
Kugwiritsa ntchito mankhwala
Gawo lotsatira la chithandizo ndikuwongolera kuchipatala kwa zomwe zimachitika mwa wodwalayo. Mukangoyamba kuchiritsa, zovuta za atherosulinosis zomwe mungathe kuziletsa ndikuchepetsa kuwonongeka kwa miyendo.
Mankhwala oyamba pa mankhwalawa komanso kupewa atherosulinosis ya kuthekera kwina kulikonse ndi ma statins - Atorvastatin, Lovastatin, Rosuvastatin. Zimakhudza kagayidwe ka cholesterol ndi momwe imamangidwira ndi chiwindi, kuchepetsa kuchuluka kwake m'magazi. Komanso, kuchepetsa kuchuluka kwa lipoprotein m'magazi kumalola michere, nicotinic acid, protein.
Gwiritsani ntchito ma antiplatelet othandizira - Aspirin, Cardiomagnyl, Magnikor, Thrombo-Ass, mankhwalawa amakhudza kuphatikizana kwa ma atheromatous misa ndi kuphatikiza kwa ma cell ambiri m'malo owonongeka a endothelium. Popeza contraindication (peptic ulcer m'mimba kapena duodenal zilonda, magazi, munthu kutsutsana), akulimbikitsidwa kudya Aspirin nthawi yayitali ndi 75 milligrams patsiku pofuna kupewa thrombotic zovuta.
Pamaso pa zovuta za thrombotic mu anamnesis ndi matenda ena ammagazi omwe ali ndi vuto la kuthamanga kwa mankhwalawa, ndikofunika kugwiritsa ntchito anticoagulants - Warfarin, Heparin, Fraxiparin.
Malangizo a mankhwalawa akuphatikizapo mankhwala a vasodilator - antispasmodics No-spa, Drotaverin, Papaverine, mankhwala opatsirana a Vazoprostan, Trental, Agapurin.
Kuchepetsa zizindikiro ndi kuchepetsa ululu, Pentoxifylline, Cilostazole amagwiritsidwa ntchito; kusintha trophism mu bwanji zofewa zimakhala - Zincteral.
Chithandizo chakumalo chimasonyezedwa pakupanga zovuta zamatenda ndi trophic zilonda; Oflokain, Levomekol, mafuta a Delaskin amagwiritsidwa ntchito.
Kuphatikiza apo, mavitamini tata amagwiritsidwa ntchito, chithandizo cha physiotherapy - electrophoresis ya novocaine kapena lidocaine, darsonvalization.
Ndikofunikira kuchiza osati atherosulinosis, komanso matenda opatsirana (matenda oopsa, angina pectoris, shuga mellitus) ndi zovuta.
Njira zopangira opaleshoni
Kusankha ndi kugwiritsa ntchito njira yopangira opaleshoni kumachitika ndi dokotala, poganizira zinthu zingapo.
Mankhwala othandizira ndi ofunikira ndikofunikira ngati akudwala kwambiri, kukana mankhwala osokoneza bongo kapena kutsutsana nawo.
Kuchuluka kwa kuchitapo kanthu kwa opaleshoni kumadalira mutu wa zotupa, kuchuluka kwa chotengera, kupezeka kwa zotupa za pakhungu ndi minofu yofewa, komanso zovuta za atherosulinosis.
Pali mitundu yamachitidwe yotere:
- Opaleshoni ya Bypass ndikulowerera kosawonongeka, tanthauzo lake ndikupanga njira ina yotaya magazi kudzera modutsa malo omwe akhudzidwa ndikubwezeretsa minofu trophism motere.
- Kukwapula ndi kukhazikitsidwa kwa chubu chopangidwa ndi zinthu zopangika mkati mwa chotengera, chomwe chimalepheretsa lumen kuti isachepetse.
- Balloon angioplasty - kukulira kwa lumen kwa mitsempha ndi baluni.
- Endarteriectomy - kuchotsa kwa mtsempha womwe wakhudzidwa pamodzi ndi magulu atheromatous, omwe amapanga ma prosthetics.
- Autodermoplasty - njira yothandizira zilonda zam'mimba, imakhala ndikusintha khungu lakhudzidwa ndi khungu la wodwalayo, lomwe limatengedwa m'malo ena.
- Ndi chitukuko cha zovuta, monga gangrene, kuduladula masamba a necrotic ndi miyendo ya manja.
Kupewa kwa atherosulinosis kuyenera kukhala kokwanira komanso kosalekeza, kuphatikiza kuyang'ana kuthamanga kwa magazi, kuyang'anira mawonekedwe a magazi a lipid, kufunsa katswiri wamtima wamankhwala ndi opaleshoni ya mtima ngati kuli kotheka.
Momwe mungachiritsire atherosulinosis ya miyendo akufotokozedwa mu kanema munkhaniyi.
