Hypertension 2 madigiri, chiopsezo 3: ndi chiyani?

Kuthamanga kwa magazi kumadziwika ndi kukana komwe mitsempha yamagazi imapereka panthawi yomwe amasulidwa magazi kuchokera pansi pamtima. Zimachitika systolic ndi diastolic, ndiye kuti, panthawi yodzikakamiza komanso kupumula kwa minofu ya mtima, motsatana.

Kukula kosalekeza kwa kuthamanga kwa magazi kuposa milimita 120/80 ya Mercury kumatchedwa matenda oopsa. Iyenera kusiyanitsidwa ndi matenda oopsa, momwe kuwonjezeka kwa ziwopsezo kumachitika kamodzi, kutengera nyengo, monga kupsinjika, ndikupita popanda kuvulaza thanzi.

Hypertension imakhala ndi magawo angapo azovuta:

• Digiri yoyamba imadziwika ndi kuwonjezereka kwa episodic mu kukana kwa mtima, komwe kumatha kukhala asymptomatic. Ngakhale chiwonetsero chachitetezo cha digiri iyi, chikuwoneka ndi zopinga zambiri, makamaka kuthekera kokulitsa vuto la matenda oopsa komanso kusintha mwachangu ku njira yoopsa;
• Kuchulukitsa kosalekeza kwa kupanikizika kwa systolic kuchokera pa 160 mpaka 180 ndi diastolic kuchokera pa 100 mpaka 110 millimeter ya Mercury kumatchedwa gawo lachiwiri la matenda oopsa. Nthawi yazizindikiro zabwinobwino zimachepetsedwa ndikuchepetsedwa, pakapita nthawi, popanda chithandizo chokwanira, kuwonongeka ndi kuwonongeka kwa ziwalo zomwe zikuyembekezeka zimayamba;
• Digirii yayikulu imadziwika ndi kuwonjezeka kwa systolic ndi diastolic kukakamiza kopitilira 180 ndi 110 millimeter of mercury, motsatana. Mlingo wa kukana minyewa nthawi zambiri umakhala wolumikizana ndi ziwerengero zovuta, ndikuwopseza kulowa pamavuto oopsa kwambiri kenako ndikulemala.

Gawo lachiwiri la matendawa ndilofala kwambiri padziko lonse lapansi, chifukwa zimadziwika kwambiri - odwala omwe ali ndi digiri yoyamba asanaone dokotala. Munthu aliyense ayenera kudziwa zizindikiro ndi chithandizo cha matenda oopsa. Kupatula apo, nthawi zambiri mankhwala amamuthandiza kuti asadutse mpaka digiri yachitatu ndi zovuta.

Nthawi zambiri mumatha kumva kuchokera kwa dokotala kuti akupezani matenda oopsa a grade 2 omwe ali ndi chiwopsezo cha 3, koma ambiri sadziwa kuti ndi chiyani. Mukapanga matenda, mwayi wakuwonongeka kwa ziwalo zimaganiziridwa, womwe umakhala chiopsezo. Agawidwa m'magawo anayi:

1. Chiwopsezo ndichoposa 15%;
2. Gawo lake likuyambira 15 mpaka 20%;
3. Kukula kwamavuto osaposa 30%;
4. Chiwerengero cha zovuta ndizoposa 30%.

Ziwalozi zimaphatikizapo mtima, ubongo, mitsempha yamagazi, komanso impso.

Zotsatira pa ziwalo zomwe mukufuna

Kuwonongeka kwa mtima kumachitika mu mawonekedwe a kuphipha kwamphamvu, komwe kumapangitsa kudzazidwa kwa makhoma ake ndi minofu yolumikizidwa. Izi zimapangitsa kuti khomalo lisakhale lotanuka, koma lokwera, lomwe limathandizira kukulitsa zolembera za atherosrance.

Hypertension imakhudza kwambiri mawonekedwe a impso, kusokoneza magwiridwe antchito ake. Izi zikuwonetsedwa ndi kukula kwa impso kulephera - kuchepa kwa ntchito ya parenchyma yochotsa poizoni m'thupi.

Ngati matenda oopsa sawalandiridwa, ndiye kuti kulephera kwa impso kumapita patsogolo ndipo m'kupita kwa nthawi wodwala adzafunika kumuwonjezera impso kapena hemodialysis.

Pali zosankha zitatu zowonongeka pamtima.

Choyamba ndi kusintha kwa diastole mu chamanzere kumanzere. Izi zikutanthauza kuti pambuyo pakupsinjika kwakukulu mu systole, myocardium sangathe kupumula kwathunthu. Pankhaniyi, kuchuluka kwa minofu ya mtima ndi mpweya kumachepa, ischemia imayamba, yomwe ingayambitse necrosis;

Chachiwiri ndi kuwonjezeka ndi makulidwe a khoma lamkati lamanzere lamanzere. Izi zimabweretsa kusinthika kwa mtima, komwe kumayambitsa kuphatikizika kwa kutulutsa magazi mu kama wamitsempha. Matendawa akamakula, mtima wake umayamba kukula ndipo, motero, ntchito yamtima imachepa. Tizilombo ta m'thupi simalandira mpweya wokwanira, zomwe zimapangitsa kufooka komanso kufupika kwa mpweya.

Chachitatu - kulephera kwa mtima, kumayamba ndi ntchito yayitali ya mtima m'mikhalidwe yokhala ndi mpweya wochepa. Izi zimadziwika ndi kuwonongeka kwa kusapumula kokha, komanso kukhazikika mtima. Ndizovuta kuchiza matenda amtunduwu, ovuta kwambiri kuposa matenda oopsa. Ndipo ngati matenda enanso monga atherosulinosis kapena matenda ashuga atagwirizana ndi matenda oopsa, kupita patsogolo kwa kulephera kwa mtima kumathandizira.

Hypertension imatha kuyambitsa zovuta. Wodwala akhoza kuyamba kudwala matenda opha ziwalo. Zimachitika hemorrhagic kapena ischemic. Poyamba, mitsempha ya m'mimba imayamba, yomwe imachitika chifukwa chotumphukira ziwiya zaubongo. Mukamalimbana ndi mavuto, pamakhala mwayi waukulu wopanga izi. Ndi ischemic stroke, makoma a zotengera sagwa, koma amachepetsedwa kwambiri, zomwe zimapangitsa kuti oxygen isamakwanitse komanso kufa kwa madera omwe akhudzidwa ndi ubongo.

Matenda oopsa amathanso kupangitsa kuti encephalopathy - iyi ndi vuto lalikulu, pamene kuwonjezeka kwa zovuta kumayambitsa kupweteka kwam'mutu komanso kuwonongeka kwa ubongo, kusinthidwanso ndi chithandizo chokwanira.

Kuphatikiza apo, kusintha kwazindikiritso kumachitika - chifukwa cha kugona kwa nthawi yayitali okosijeni, ma cell aubongo amafa, kuchuluka kwa ubongo kumachepa, zizindikiro za kuchepa kwa mtima ndi dementia zimayamba.

Mawonetseredwe akulu a matenda oopsa

Kuphatikizika kwa digiri yachiwiriyo kumakhala ndi zizindikiro zingapo, pakuzindikiritsa komwe ndikofunikira kufunsa dokotala kuti akuuzeni malangizo ndi chithandizo.

Mwachitsanzo, kupweteka kwam'mutu m'khosi ndi ma tempulo kumayambitsidwa ndi kukula kwa vasospasm.

Kukhalapo kwa mitsempha yambiri ya mafupa ndi ulusi m'malo awa kumapangitsa chitukuko cha Reflex kupweteka kwambiri.

Mawonetsero otsatirawa ndiothekanso:

• Kuchepa kwa khungu la nkhope kumalongosoledwa ndi magazi nthawi zonse kupita ku ziwiya, chifukwa cha kuchuluka kwa zovuta, chifukwa chomwe ma capillaries amawonjezeredwa nthawi zonse ndikuyamba kutanuka, kuwala kudzera pakhungu. Itha kupanganso zotsatira za chotupa pakhungu la nkhope ndi khosi.
• Edema, makamaka nkhope ndi zikope, zimagwirizanitsidwa ndi kusungidwa kwa madzi ndi thupi chifukwa cha kuwonongeka kwa impso, kumachitika pafupipafupi m'mawa ndipo kumaonekera patatha maola ochepa mutadzuka.
• Kutopa kwambiri ndi kusachita chidwi kumayamba chifukwa cha kusokonekera kwa minofu, makamaka bongo ndi mafupa. Chifukwa cha kuchepa kwa mpweya, amagwira ntchito kuvala ndi kung'amba, pang'onopang'ono kuchepa, komwe kumabweretsa mawonekedwe - choyamba, kutopa mutagona, kuchepa tulo komanso kugwiranso ntchito, ndiye kumva kutopa kosalekeza.
• Kuwala kwa ntchentche pamaso, kumachita khungu m'maso pambuyo pakuchita zolimbitsa thupi - zizindikirozi zimayambitsidwa ndi hypoxia ya mitsempha ya optic ndikuchepetsa ziwiya za retina. Chifukwa cha kuchepa kwa hemoglobin ya okosijeni, retina yovutikayo imayamba kulimba, nthawi zambiri izi zimachitika ndi kuwonjezeka kowopsa kwa kukakamiza, mwachitsanzo, ndi kupsinjika. Ngati njirayi siyilamulidwa, kuyambiranso kwa khungu komanso khungu.
• Tachycardia, kapena kuchuluka kwa kugunda kwa mtima, kumachitika modabwitsa pomwe mavuto akayamba. Ichi ndichifukwa chakukwiyitsika kwa zolandilira za mtima, zomwe zimasowa okosijeni, maukonde amachitika. Cholinga chowonjezera kuthamanga kwa magazi pofuna kutulutsa zinthu bwino. Izi zimachitika ndikukulitsa kupendekeka kwa myocardium, yomwe imamvekedwa ndi malingaliro osasangalatsa kumbuyo kwa sternum.
• Mavuto amakumbukidwe ndi kusunthika ndi chifukwa chakuti minyewa yaubongo imapanikizika mosalekeza chifukwa cha ischemia, zolumikizana zamitsempha zimasweka ndipo ntchito zamavuto zimavutika.
• Tinnitus pakukwera masitepe komanso masitepe ofulumira chifukwa chakuyenda bwino kwa zida zamagetsi chifukwa cha kusowa kwa oxygen. Zowoneka bwino za tsitsi, pamakhala phokoso m'mutu. Pambuyo pake, imatha kupanikizika ndi chizungulire chambiri, kukhumudwa komanso kukomoka.
• Kusakwiya ndi kutengeka mtima kumabwera chifukwa chodwaladwala, nthawi zambiri kumayima ndi chithandizo cha matenda oopsa.

Kuphatikiza apo, jakisoni wa zotengera zonyansa amawonedwa - zotumphukira zazing'onoting'ono kwambiri chifukwa cha kuchuluka kwa khoma la mtima.

Chithandizo chachikulu cha kuthamanga kwa magazi

Mukakhazikitsa chithandizo, njira yolumikizidwa iyenera kugwiritsidwa ntchito.

Pazachipatalazi, dotolo woyeserera amalimbikitsa kugwiritsa ntchito mankhwalawa omwe ali ndi mphamvu zosiyanasiyana mthupi.

Awa ndi mankhwala a magulu osiyanasiyana omwe amakhudza njira zosiyanasiyana mthupi. Mogwirizana, gwiritsani ntchito thupi mosiyanasiyana.

Magulu otsatirawa a mankhwalawa amagwiritsidwa ntchito: mankhwala a antihypertensive kuti achulukitse ziwopsezo ndikukopa pazomwe zimayambitsa matendawa; okodzetsa kuti muchotse madzimadzi owonjezera kuchokera ku zimakhala; njira yochepetsera kachulukidwe ka magazi kuti magazi azigwiritsa ntchito; mankhwala ochepetsa mafuta m'thupi chifukwa kupewa atherosulinosis; Kukonzekera kwa shuga wamagazi, ngati pakati pa matenda omwe ali ndi matenda a 2 a shuga.

Mankhwala a antihypertensive ndi awa:

1. Beta-blockers omwe amachepetsa kugunda kwa mtima. Chifukwa cha izi, kutulutsa kwamtima kumatsika ndikuwonetsetsa kuti kutsika kumatsika. Awa ndi amodzi mwa magulu apamwamba; anali oyamba kuthandizira matenda a mtima ndi mtima. Choyipa chowopsa ndikukula kwa bronchospasm, chifuwa chachikulu komanso kupuma movutikira, motero, ndikofunikira kuganizira dokotala poyerekeza ndi odwala omwe ali ndi matenda osatha a m'mapapo, chifuwa cha bronchial kapena chifuwa chachikulu. Gululi limaphatikizapo miyala monga Metoprolol, Sotalol, Labetalol ndi analogues awo.
2. ACE zoletsa - ntchito yawo ndikuletsa eniotensin-kutembenuza enzyme, ndikuchepetsa kuchuluka kwa angiotensin omwe angagwirizane ndi mtima receptors ndikuwonjezera kukana kwamitsempha. Amapereka chithandizo chothandiza pamlingo wa chitukuko cha mtima kulephera, kuteteza minofu yamtima ku necrotizing. Osavomerezeka kuti agwiritsidwe ntchito kwa odwala omwe amalephera kupweteka kwa impso komanso odwala hemodialysis, chifukwa zinthu zomwe zimagwira ndi impso ndi amayi apakati, chifukwa choopsa cha gestosis.
3. Makulidwe othandizira a calcium omwe amachepetsa mphamvu ya ion pama mtima receptors. Nthawi zambiri amagwiritsidwa ntchito ngati mankhwala othandizira. Mosiyana ndi beta-blockers, alibe mphamvu pa kupuma, motero, amagwiritsidwa ntchito mwachangu kwa odwala omwe ali ndi vuto la bronchial ndipo amawunikira bwino. Gululi limaphatikizapo Nifedipine ndi Diltiazem.

Kuphatikiza apo, alpha-blockers amagwiritsidwa ntchito. Amawerengedwa kwa odwala omwe ali ndi matenda amodzimodzi, monga matenda ashuga, adrenal hypertrophy syndrome ndi pheochromocytoma. Amatha kuchepetsa kwambiri kupanikizika, motero ndikoyenera kuona kuchuluka kwa mankhwalawa omwe adokotala amupatsa. Doxazosin ndi m'gululi.

Mankhwala Owonjezera a Hypertension Therapy

Pofanana ndi mankhwala a antihypertensive, ma diuretics amagwiritsidwa ntchito. Amayambitsa kuwonjezeka kwa madzi am'mimbamo kuchokera m'maselo mwakukulitsa mkodzo. Amatha kukhala osiyana mu mphamvu yakulimbikitsa, kotero kusankha kwa mankhwala kumakhala kwamunthu payekha. Amphamvu kwambiri ndi ma loop diuretics. Amachotsa osati madzi okha, komanso potaziyamu, chlorine ndi sodium ion, omwe odwala omwe ali ndi vuto la mtima amachititsa kukula kwa vuto la mtima. Izi zimaphatikizapo furosemide.

Thiazide diuretics, yomwe imachotsa madzi mu nephron loop komanso ma potionum ion, ndikusiya sodium ndi chlorine m'magazi a interellular, imawerengedwa kuti ndi yofooka. Chithandizo chachikulu m'gululi ndi hydrochlorothiazide.

Mankhwala osokoneza bongo a Potaziyamu siothandiza kwenikweni, koma amawonedwa kuti ndi ochepa kwambiri poyerekeza ndi ena onse. Woimira gululi ndi Spironolactone.

Mothandizanso ndi mankhwalawa, ma statins adalembedwa kuti achepetse cholesterol ndikuletsa kukula kwa atherosulinosis, ndi mankhwala ochepetsa shuga a odwala matenda ashuga.

Kuphatikiza pa chithandizo chachikulu, madokotala amalimbikitsa kutsatira moyo wathanzi, kuwonjezera zipatso ndi ndiwo zamasamba m'zakudya, ngati kuli kotheka perekani mphindi makumi atatu zolimbitsa thupi ndikuwasiya kusuta ndi kumwa mowa. Ngati mumatsatira izi, ndiye kuti chiwopsezo cha zovuta zimachepetsedwa ndi 20%, zomwe zimapangitsa kukhala ndi moyo wautali. Kudzichiritsa nokha sikuli koyenera, chifukwa mankhwala ambiri ali ndi contraindication ndipo amatha kuyikidwa ndi katswiri woyenera, ngakhale kuti malangizo alionse ogwiritsira ntchito mankhwalawa akhoza kutsitsidwa. Izi zili ndi thanzi labwinobwino.

Zambiri zokhudzana ndi matenda oopsa a giredi 2 zimaperekedwa mu kanema munkhaniyi.