Pakadali pano, katswiri wazachipatala mu mankhwala aliwonse amatha kupatsa mapiritsi osiyanasiyana kukakamiza kwa matenda ashuga a 2, mndandanda wawo ndi wokulirapo.
"Matenda okoma" osagwiritsa ntchito mankhwalawa kumabweretsa zovuta zambiri, chimodzi choopsa kwambiri ndi matenda oopsa. Amadziwika ndi kuwonjezeka kwakukulu kwa kuthamanga kwa magazi (BP).
Matenda a shuga ndi kupsinjika mu zovuta kumawonjezera chiwopsezo cha sitiroko, ischemia, uremia, gangrene ya malekezero kapena kutayika kwamaso. Chifukwa chake, ndikofunikira kudziwa momwe mungathanirane ndi kuthamanga kwa magazi mu shuga mellitus kuti mupewe kukula kwa ma pathologies osafunikira.
Zoyambitsa Hypertension
Ndikudabwa kuti kupanikizika kwa shuga kumavomerezeka bwanji? Kupatula apo, mwa anthu athanzi labwino liyenera kukhala 120/80.
Kupanikizika kwa matenda ashuga sikuyenera kupitirira mtengo wapadera wa 130/85. Ngati chizindikiro ichi chikupitilira, tifunika kufunafuna thandizo kwa katswiri.
Kodi ndizomwe zimayambitsa kuthamanga kwa magazi mwa odwala matenda ashuga? Alipo ambiri a iwo. Kuwonjezeka kwa kuthamanga kwa matenda amtundu wa shuga m'mitundu 80% kumachitika chifukwa cha matenda a impso.
Mu mtundu wachiwiri wa matenda, matenda oopsa, ndiye kuti, magazi ochulukitsa, nthawi zambiri amakhala asanafike pakuwonekera kwa metabolic.
Kutengera mtundu wamtundu wamankhwala okhathamira, zimakhala ndi mtundu wina wa zochitika. Pansipa pali mitundu yayikulu komanso zoyambitsa za matenda:
- Chofunikira, chotchedwa matenda oopsa, omwe amapezeka mu 90-95% ya milandu yokhala ndi kuthamanga kwa magazi.
- Isstated systolic, chifukwa cha kuchepa kwa elasticity a mtima makoma, komanso kukomoka kwa neurohormonal.
- Renal (nephrogenic), zomwe zimayambitsa ndizokhudzana ndi kugwira ntchito kwa chiwalo chophatikizira. Izi zimaphatikizapo matenda a shuga, nephropathy, polycystic, pyelonephritis, komanso glomerulonephritis
- Endocrine, akukula kwambiri. Komabe, zoyambitsa zazikulu za matendawa ndi Cushing's syndrome, pheochromocytoma, ndi hyperaldosteronism yoyamba.
Kukula kwa matenda oopsa a matenda a shuga a 2 kungayambenso chifukwa china. Mwachitsanzo, mwa amayi omwe amatenga njira za kulera za mahomoni, chiopsezo cha matenda oopsa chimawonjezeka nthawi zina. Komanso, mwayi wa wodwala yemwe ali ndi matenda osokoneza bongo amakhalanso ndi matenda oopsa, ngati ndi wokalamba, amakhala ndi mavuto onenepa kwambiri kapena ali ndi "chidziwitso" chambiri cha kusuta.
Nthawi zina kupezeka kwa matenda oopsa mu shuga kungayambitsidwe chifukwa cha kusowa kwa magnesium, kuledzera ndi zinthu zina, kuperewera kwa mtsempha waukulu, komanso zovuta zina.
Zomwe zimayambitsa matendawa, monga momwe tikuonera, ndizambiri. Chifukwa chake, ndi matenda a shuga a mellitus, ndikofunikira kutsatira malamulo oyambira chithandizo chake, kuphatikizapo zakudya zapadera, masewera, mankhwala (Metformin, ndi zina) ndikuwunika pafupipafupi kuchuluka kwa glycemia.
Zolemba zamtundu wa matenda oopsa
Mtundu woyamba wa matenda ashuga, kupanikizika kowonjezereka kumachitika chifukwa cha kukanika kwa impso. Zimadutsa magawo angapo - microalbuminuria, proteinuria ndi kulephera kosatha.
Kafukufuku wambiri akuwonetsa kuti mwa odwala onse omwe ali ndi matenda a shuga 1, ndi 10% yokha omwe alibe matenda a impso. Popeza impso sizingachotse sodium kwathunthu, matenda oopsa amayamba mu shuga. Popita nthawi, kuchuluka kwa sodium m'magazi kumatha kuchuluka, ndipo ndi madziwo umadzunjikana. Magazi ochulukitsa ozungulira amatsogolera pakuwonjezeka kwa magazi.
Matenda a diabetes nephropathy ndi matenda oopsa ndi bwalo loipa. Kufooka kwa impso kumatha chifukwa chakuwonjezeka kwa magazi. Yotsirizirayi imakweza kukhudzika kwina, komwe kumabweretsa kuwonongeka pang'onopang'ono kwa zosefera.
Matenda oopsa komanso matenda amtundu wa 2 amalumikizana kusanachitike chizindikiro chake chachikulu. Zonsezi zimayamba ndi njira yotaya zomwe zimachitika kuti minyewa ipange mphamvu yotsitsa shuga. Kuti alipiritse kukana insulini, insulin imayamba kudziunjikira m'magazi, ndikuwonjezera kuthamanga kwa magazi mu shuga. Zodabwitsazi pakapita nthawi zimayambitsa kuchepetsedwa kwa lumen ya mitsempha yamagazi chifukwa chazovuta za atherosulinosis.
Chowonjezera chazomwe zimachitika mu matenda osokoneza bongo omwe amadalira matenda a shuga m'mimba ndi kunenepa kwambiri pamimba (kudzikundikira kwa mafuta m'chiuno). Ndi kuphwasika kwa mafuta, zinthu zimamasulidwa, ndikuwonjezera kukakamiza kwambiri. Kulephera kwamkaka kumachitika pakapita nthawi, koma kumatha kupewa ngati chithandizo chikugwiritsidwa ntchito mozama.
Kuchuluka kwa insulin (hyperinsulinism) kumabweretsa kupanikizika kwambiri kwa matenda a shuga a 2. Hyperinsulinism imatha kuukweza, chifukwa:
- sodium ndi madzi sizikwaniritsidwa kwathunthu ndi impso;
- dongosolo lamanjenje lamanjenje limayendetsedwa;
- kuchuluka kwa calcium ndi sodium kumayamba;
- kutanuka kwamitsempha yamagazi kumachepa.
Pofuna kupewa matenda oopsa, shuga wambiri komanso wotsika magazi ayenera kukhala nawo.
Kukula kwake ndi 5.5 mmol / L, muyenera kuyesetsa.
Chithandizo cha ACE inhibitors ndi ARB
Popeza taphunzira momwe magazi amakwera m'matenda a shuga, titha kupitiriza kufunsa kuti titha bwanji kuchepetsa mapiritsi komanso matenda oopsa.
Poyamba, timakhala mwatsatanetsatane ma inhibitors a ACE, chifukwa ndi gulu lofunikira la mankhwala omwe amatha kutsitsa magazi.
Tiyenera kudziwa kuti nthawi yomweyo mankhwalawo ayenera kutha ngati wodwala yemwe ali ndi matenda ashuga apanga stenosis ya mtsempha wama impso kapena wa stenosis.
Mankhwalawa matenda oopsa a 2 mtundu mellitus a ACE zoletsa amathetsa pamene wodwala:
- Creatinine amadzuka ndi oposa 30% atatha masiku 7 achithandizo cha mankhwalawa.
- Hyperkalemia idapezeka momwe mulingo wa potaziyamu sosachepera 6 mmol / L.
- Nthawi yobereka mwana kapena yoyamwitsa.
Captopril, Kapoten, Perindopril, ndi zina zotere zitha kugulidwa ku malo ogulitsa motero., Kuthamanga kwa magazi mu shuga kungalephereke kugwiritsa ntchito zoletsa za ACE. Koma musanawatenge, muyenera kufunsa dokotala.
Kwa mtundu wachiwiri wa matenda ashuga a mellitus, chithandizo chimaphatikizapo kutenga angiotensin receptor blockers (ARBs) kapena ma sartan kuti muchepetse magazi. Tiyenera kudziwa kuti ma ARBs samakhudza njira za metabolic mwanjira iliyonse, kuwonjezera kukhudzidwa kwa kapangidwe ka minofu pakupanga mahomoni mu odwala ashuga omwe ali ndi shuga m'magazi.
Mankhwala oterewa a kuthamanga kwa magazi mu shuga amaloledwa mosavuta ndi odwala ambiri. Chifukwa chake, mutha kusankha mankhwalawa: - Valsartan, Azilsartan, Candesartan, etc.
Poyerekeza ndi ACE inhibitors, ma sartan samakhala ndi zotsatira zoyipa zochepa, ndipo zochizira zimatha kuwonedwa patatha milungu iwiri.
Kafukufuku watsimikizira kuti kuchiritsa koteroko kumachepetsa mapuloteni a mkodzo.
Kugwiritsa ntchito ma diuretics ndi olimbana ndi calcium
Ndi mankhwala ati okakamiza omwe angagwiritsidwe ntchito ngati kusunga kwa sodium kumachitika m'thupi la munthu? Kwa izi, kutenga ma diuretics kapena okodzetsa ndizokwanira.
Mukamasankha mapiritsi opanikizika a shuga, zinthu zambiri ziyenera kuganiziridwanso.
Chifukwa chake, ndi kukanika kwa impso kuchokera ku kukakamiza, ndibwino kumwa "kuzungulira" okodzetsa.
Mu shuga mellitus wa mtundu wachiwiri, madokotala sawalimbikitsa kugwiritsa ntchito mitundu yotsitsa ya mitundu iyi:
- osmotic (mannitol), chifukwa amatha kuyambitsa kukomoka kwa hypersmolar;
- thiazide (Xipamide, Hypothiazide), chifukwa mankhwala osokoneza bongo omwe amawonjezera shuga amachititsa matenda oopsa;
- carbonic anhydrase inhibitors (Diacarb) - mankhwala omwe samawonetsa zotsatira zoyenera za hypotensive, kugwiritsa ntchito kwawo sikugwira ntchito mokwanira.
Mapiritsi othandizira kwambiri a shuga ndi loop diuretics. Mu mankhwala, mutha kugula Bufenox kapena Furosemide. Mitengo ya mankhwala omwe amachepetsa kupanikizika imatha kusiyanasiyana ngati muwalamula pa intaneti.
Nayi ndemanga ina yabwino kuchokera kwa Anna (wazaka 55): "Ndakhala ndikudwala matenda ashuga amtundu wa 2 kwa zaka 8. Posachedwa, kupanikizika kwayamba kuda nkhawa. Ndinathandizidwa ndi Diakarb, koma mankhwalawa sanathandize kwenikweni. Koma kenako ndinamwa Bufenok ndipo ndinayamba kumva bwino. nditha kuchitanso wina mankhwala mwachangu komanso moyenera, koma ndimakondwera ndi mankhwalawa. "
Mlingo umatsimikiziridwa payekha ndi katswiri wopezekapo. Posankha mankhwala ochepetsa kuthamanga kwa magazi, zinthu zotsatirazi ziyenera kuganiziridwa:
- Mukamamwa Nifedipine (wogwira ntchito mwachidule), mwayi wokhala ndi vuto la mtima umatha kuchuluka.
- Otsutsana ndi calcium amalembedwera kupewa matenda a sitiroko ndi mtima.
- Felodipine (zochita nthawi yayitali) ndiotetezeka, koma osagwira ntchito monga ACE inhibitors. Kuti muchepetse kupanikizika bwino, ndikofunikira kuphatikiza ndi njira zina.
- Ma Negidropelins (Diltiazem ndi Verapamil) ndi othandizira odwala matenda a shuga, amakondweretsa kusintha kwa impso.
Ma calcium antagonists ndi mapiritsi othandizira kuthamanga kwa magazi, ngakhale atagwiritsidwa ntchito nthawi yayitali amatha kuletsa kupanga insulin.
Mukasiya kumwa mankhwala othandizira odwala matenda ashuga, ndiye kuti ntchito za kapamba zimapola pang'onopang'ono.
Kugwiritsa ntchito alpha ndi beta blockers
Ma alpha-blockers monga Terazosin kapena Prazosin, mosiyana ndi beta-blockers a shuga, kusintha kagayidwe kazakudya ndi lipid metabolism, komanso kuwonjezera chiwopsezo cha zomanga za minyewa kumachepetsa mphamvu ya shuga.
Ngakhale zabwino zonse, mankhwalawa opanikizika mu shuga angayambitse zovuta zina - kutupa, kulimbikira kwa tachycardia ndi orthostatic hypotension (kuthamanga kwa magazi). Mapiritsi mulimonsemo musamamwe ndi kulephera kwa mtima.
Pogwiritsa ntchito beta-blockers, shuga ndi mtima pathologies zimatha kuwongoleredwa. Mukamasankha mapiritsi oti amwe, munthu ayenera kuganizira kusankha, hydrophilicity, vasodilating kwenikweni ndi lipophilicity ya mankhwala oopsa mu shuga.
Mutha kumwa mankhwala osokoneza bongo a beta-blockers, chifukwa amathandizira magwiridwe antchito a mtima ndipo, mosiyana ndi omwe sanasankhe, samaletsa kupanga insulin.
Komanso, ndi kupanikizika kwakukulu komanso matenda ashuga, madokotala ambiri amalangiza kumwa mankhwala a vasodilator, chifukwa amakhudza bwino kagayidwe kazakudya ndi mafuta, kukulitsa chidwi cha mahomoni a hypoglycemic. Komabe, mapiritsi oponderezawo amatha kumwa kokha moyang'aniridwa ndi dokotala, chifukwa ali ndi mndandanda waukulu wa zotsutsana.
Kudya lipophilic ndi madzi osungunuka beta-blockers nthawi zambiri osayenera, chifukwa zimakhudza chiwindi ndi psychoemotional state.
Potengera momwe mankhwalawa amathandizira, mankhwalawa amathanso kuchitira matenda oopsa. Zida zotchuka kwambiri zamankhwala ndi ma pine cones, mbewu za fulakesi ndi adyo. Pali njira zosiyanasiyana zakukonzekera - tincture, decoctions, etc. Folk maphikidwe a shuga angachiritsidwe, sikofunikira kufunsa katswiri kale.
Palibe choopsa chilichonse ndi kupsinjika kochepa mu matenda a shuga mellitus (hypotension), chifukwa magazi ochepa atha kufa. Mulimonse momwe zingakhalire, ndikofunikira kuwunika kuthamanga kwa mtundu wa 2 shuga.
Matenda a shuga ndi kuthamanga kwa magazi ndi malingaliro awiri ofanana. Chifukwa chake, popewa kukula kwa zovuta zazikulu, ndikofunikira kutenga mapiritsi opanikizika a matenda a shuga, komanso kukhala ndi chakudya choyenera, kuchita ntchito zakunja ndikugwiritsira ntchito wowerengeka azitsamba pambuyo pokambirana ndi dokotala.
Ndi mapiritsi ati a matenda oopsa omwe odwala matenda ashuga angamuuze katswiri muvidiyoyi.
