Zakudya zopatsa thanzi za matenda a impso ndi matenda a shuga zimathetsa kugwiritsa ntchito mafuta odzola komanso kupukusa chakudya cham'mimba mosavuta. "Matenda okoma" akapita patsogolo, amakhudza pafupifupi ziwalo zonse, zimayambitsa zovuta zosiyanasiyana.
Zotsatira zofala kwambiri za matendawa zimawonedwa ngati matenda a impso, omwe ndi omwe amatsogolera anthu odwala matenda ashuga. Amachitika motsutsana maziko a matenda a shuga - nephropathy.
Matenda a shuga ndi matenda ogwirizana ndi matenda a metabolic. Zinthu zopangidwa ndi metabolic ndi zinthu zapoizoni zikadziunjikana m'magazi a munthu wathanzi, impso zimatha kupirira kusefedwa kwake.
Komabe, ndi matenda ashuga, kusayenda bwino kwa ziwalo zophatikizika kumayambitsa kudzikundikira kwa zinthu zoopsa m'magazi zomwe zimayambitsa thupi. Chifukwa chake, madokotala nthawi zambiri amapereka njira yoyeretsera magazi. Kodi hemodialysis ndi shuga zimagwirizana bwanji? Kodi ndiyenera kudya zakudya zamtundu wanji? Tiyeni tiyese kuzindikira.
Kuchepa kwa impso mu shuga
Chiwalo chophatikizidwa chimakhala ndi "glomeruli" yopitilira 100,000 - zosefera zapadera zomwe zimatulutsa magazi pazinthu za metabolic ndi poizoni zosiyanasiyana.
Magazi akamadutsa m'mitsempha yaying'ono ya zoseferaizi, zinthu zovulaza zimatumizidwa kuchokera ku impso kupita ku chikhodzodzo, ndipo timadziti ndi zofunikira zimabwezeretsanso kuthambo. Kenako, mothandizidwa ndi urethra, zinthu zonse zonyansa zimachotsedwa m'thupi.
Popeza matenda ashuga amadziwika ndi kuchuluka kwa glucose, katundu pazolo lolocha limakulitsidwa kwambiri. Kuti muchotse shuga owonjezera m'thupi, impso zimafunikira madzi ambiri, chifukwa, kukakamira kulikonse kumawonjezeka.
Njira zoterezi pakapita nthawi zimayambitsa kuchepa kwa kuchuluka kwa mafayilo omwe amagwira ntchito, omwe mwachindunji amakhala ndi vuto pakudziyeretsa magazi.
Ndi nthawi yayitali ya "matenda okoma", impso zimatha kotero kuti kulephera kwa impso kumayamba. Zofunikira zake ndi:
- kupweteka mutu komanso kutopa;
- kutsegula m'mimba komanso kusanza;
- kupuma movutikira ngakhale ndi kulimbitsa thupi pang'ono;
- Khungu;
- kulawa kwazitsulo;
- kukokana ndi malo otsetsereka a m'munsi, kuyipa kwambiri usiku;
- kupuma koipa kuchokera kumkamwa wamkamwa;
- kukomoka komanso kukomoka.
Vutoli limayamba pambuyo pa zaka 15 mpaka 20 zosathandiza odwala matenda ashuga. Kuti awone momwe impso zimagwirira ntchito, dokotalayo atha kuwongolera kuyesa kwamkodzo kapena magazi a creatinine kapena kuyesa kwamikodzo kwa albumin kapena microalbumin.
Potsimikizira kuti adziwe, dokotalayo atha kupereka njira yoyeretsa magazi. Akatswiri ambiri amavomereza kuti hemodialysis ya matenda ashuga imafunikira chithandizo chapadera. Chifukwa chake, odwala ayenera kusinthana ndi regimen yapadera ya mankhwala a insulini - jakisoni wokhala ndi insulin yaumunthu. Chofunika cha mankhwalawa ndikuletsa jakisoni wa mahomoni nthawi yayitali m'mawa.
Kuphatikiza apo, tisaiwale za kuyang'anira glycemia pafupipafupi kuti tipewe zovuta zina.
Chinsinsi cha njira ya hemodialysis
Hemodialysis ndi njira yowonjezera yoyeretsera magazi.
Pulogalamu yapadera imasefa magazi a wodwalayo kudzera mu umwini, ndikuyeretsa poizoni ndi madzi zosiyanasiyana. Chifukwa chake, chipangizocho nthawi zambiri chimatchedwa "impso yokumba."
Mfundo zoyendetsera chipangizochi ndi motere. Magazi ochokera mu mtsempha amalowa mkati, ndipo machitidwe ake oyeretsa amayambira.
Kumbali imodzi ya nembanemba yapadera, magazi amayenda, ndipo mbali inayo, dialysate (yankho). Muli zinthu zomwe zimakopa madzi ochulukirapo komanso mitundu yambiri ya poizoni. Kuphatikizika kwake kumasankhidwa kwa wodwala aliyense payekhapayekha.
"Impso yokumba" ili ndi zinthu zotsatirazi:
- Amachotsa zinthu zowola. Tiyenera kudziwa kuti m'magazi a munthu wodwala matenda ashuga omwe amalephera kupweteka kwa impso, kuchuluka kwambiri kwa poizoni, mapuloteni, urea ndi zinthu zina kumawonedwa. Komabe, palibe zinthu zotere mu dialysate. Malinga ndi malamulo a mayamwidwe, zonse zomwe zimachokera ku zakumwa zomwe zili ndizambiri zimasunthira zakumwa zomwe zimakhala ndizochepa.
- Amachotsa madzi owonjezera. Izi zimachitika ndi ultrafiltration. Chifukwa cha pampu, magazi amadutsa mu fyuluta ikapanikizika, ndipo mu chubu chomwe chili ndi dialysate, kukakamiza kumakhala kotsika. Popeza kusiyana kwakapanikizika ndikokulira, madzi ochulukirapo amapitilira mu dialysis solution. Njirayi imalepheretsa kutumphuka m'mapapu, ubongo ndi mafupa, komanso imachotsa madzimadzi omwe amasonkhana mozungulira mtima.
- Matendawa pH. Kuti kukhazikika kwa acid-base usawa, gawo lapadera la sodium bicarbonate lilipo mu dialysis solution. Imalowa mu plasma, kenako m'magazi ofiira, ndikupangitsa magaziwo kukhala ndi besi.
- Amasinthasintha misinkhu yama electrolyte. Pofuna kuti asachotse magazi pazinthu zofunika monga Mg, K, Na ndi Cl, ali mgulu lofanana ndi gawo la dialysate. Chifukwa chake, zochulukirapo zamagetsi zimadutsa mu yankho, ndipo zomwe zili mkati mwake zimakhazikitsidwa.
- Zimalepheretsa kukula kwa embolism ya mpweya. Kuchita izi kumayesedwa ndi kukhalapo kwa "msampha wamlengalenga" pa chubu, yomwe imabwezeretsa magazi m'mitsempha. Ndi kudutsa kwa magazi, kupanikizika koipa kumapangidwa (kuchokera 500 mpaka 600 mm Hg). Chipangizocho chimatenga thovu ndipo chimawalepheretsa kulowa m'magazi.
Kuphatikiza apo, kugwiritsa ntchito impso yochita kupanga kumalepheretsa mapangidwe magazi.
Chifukwa cha heparin, chomwe chimayendetsedwa pogwiritsa ntchito pampu, kuphatikizika kwa magazi sikuchitika.
Hemodialysis: Zizindikiro ndi ma contraindication
Ndondomeko ikuchitika katatu mu masiku 7.
Pambuyo pakuchitika hemodialysis, kuchuluka kwa kusefera kwa magazi, kapena m'malo mwake, kutsitsa kuchuluka kwa urea, kutsimikiza.
Mchitidwewo ukachitika katatu pa sabata, ndiye kuti chizindikirocho chikuyenera kukhala osachepera 65%. Ngati hemodialysis ikuchitika kawiri pa sabata, ndiye kuti kuchuluka kwa kuyeretsa kumayenera kukhala pafupifupi 90%.
Mankhwala a hematodialysis ayenera kuchitika pokhapokha atazindikira dokotala komanso mgwirizano wa adokotala. Njira yoyeretsera magazi imafotokozedwa motere:
- pachimake aimpso kulephera chifukwa pachimake glomerulonephritis, pyelonephritis ndi kutsekeka kwa kwamikodzo thirakiti;
- aakulu aimpso kulephera;
- ndi poyizoni wa mankhwala osokoneza bongo (maantibayotiki, sulfonamides, mapiritsi ogona, sedative ndi ena);
- kuledzera ndi ziphe (toadstool or arsenic);
- kuledzera ndi methyl mowa kapena ethylene glycol ali ndi mowa;
- ndi hyperhydrate (madzi owonjezera mthupi);
- kuledzera ndi mankhwala a narcotic (morphine kapena heroin);
- vuto la kukanika mu electrolyte okhutira chifukwa cha kutsekeka kwamatumbo, cystic fibrosis, kuchepa madzi m'thupi, kutentha, Peritonitis kapena kutentha kwamphamvu kwa thupi.
Komabe, kugwiritsa ntchito "impso yakupanga" ngakhale mutakhala ndi imodzi mwazomwezi sikunali kofunikira nthawi zonse. Munthu wodwala matenda ashuga kapena wodwala yemwe ali ndi shuga wokwanira amakhala ndi hemodialysis ngati:
- Voliyumu yatsiku ndi tsiku yotulutsidwa mosakwana malita 0,5.
- Impso zimagwira ntchito yawo ndi 10-15% yokha ndikuyeretsa magazi osakwana 200 ml mphindi imodzi.
- Zomwe mumapanga mu urea m'magazi a magazi zimaposa 35 mmol / L.
- Ndende ya magazi a potaziyamu imaposa 6 mmol / l.
- Bicarbonate wamba wamagazi ndi ochepera 20 mmol / L.
- Plasma creatinine ili ndi zoposa 1 mmol / L.
- Kutupa kwa mtima, mapapu ndi ubongo sizingathetsedwe ndi mankhwala.
Kwa mitundu ingapo ya odwala, hemodialysis ikhoza kukhala yotsutsana. Siloledwa kugwiritsa ntchito chipangizo chosulira magazi pazinthu zotsatirazi:
- mukakhala ndi matenda;
- ndi chitukuko cha zama psychology (schizophrenia, psychosis kapena khunyu);
- ndi kulimbikira kwa kuthamanga kwa magazi;
- pambuyo sitiroko kapena myocardial infaration;
- ndi zotupa zoyipa;
- ndi kulephera kwa mtima;
- ndi chifuwa chachikulu komanso shuga;
- ndi magazi magazi (leukemia ndi aplastic anemia);
Kuphatikiza apo, hemodialysis sigwiritsidwa ntchito pazaka zopitilira 80.
Zomwe zimapatsa thanzi mu shuga ndi hemodialysis
Wodwala yemwe ali ndi vuto la impso ayenera kukaonana ndi dokotala za zakudya.
Kudya, poganizira kuchuluka kwa shuga, kupezeka kapena kusapezeka kwa zovuta zake, nthawi yayitali ya chithandizo, kulemera ndi ukalamba, akupanga dongosolo la zakudya.
Kuti wodwalayo azikhala wathithithi komanso azitha kupewa kuwonongeka kwa aimpso, wodwalayo ayenera kutsatira malangizo onse a dokotala.
Malamulo akulu azakudya za hemodialysis ndi "matenda okoma" ndi awa:
- Kuchuluka kwa mapuloteni okwanira 1.2 g pa 1 kg ya kulemera kwa thupi. Gawo limapezeka mu mazira, nsomba zamafuta ochepa, nyama ndi mkaka.
- Kuchuluka kwa zinthu zomwe zawonongeka sikuyenera kupitirira 2500 kcal. Umu ndi momwe mapuloteni achilengedwe amatha kupangidwira.
- Kuletsa madzi. Pakadutsa pakati pa njira zoyeretsera magazi, ndizoletsedwa kudya zoposa 5% zamadzi mwakulemera kwa wodwalayo.
Zakudya zoyenera zimachotsa kunenepa kwamafuta. Chifukwa chake, muyenera kusiya nkhumba, mwanawankhosa, mackerel, tuna, hering'i, sardines ndi nsomba. Kuphatikiza apo, simungadye masamba omwe amaphatikiza ndi oxalic acid (rhubarb, sipinachi, udzu winawake, radish, anyezi wobiriwira ndi biringanya. Muyenera kuyiwala za soseji, masosefa, nyama zosuta ndi zakudya zam'chitini. Eya, ndipo, zoona, amakana magwero azakudya zamagetsi zosavuta, ndiye kuti, shuga, chokoleti, makeke ndi maswiti ena.
M'malo mwake, muyenera kudya zipatso zopanda zipatso monga malalanje, maapulo obiriwira, ma plamu, mandimu ndi zina zambiri. Chulukitsani zakudyazo ndi masamba atsopano (tomato, nkhaka) ndi zakudya zamafuta (barele, buckwheat ndi oatmeal).
Amaloledwa kudya nyama komanso nsomba (nyama yamwana wankhuku, nkhuku, hake) ndi zinthu mkaka wosenda.
Zakudya nambala 7 za hemodialysis
Zakudya zoterezi za odwala matenda ashuga omwe amadalira insulin amagwiritsidwa ntchito hemodialysis kuti azitha kudya zakudya zabwino komanso kupewa kutulutsa zotsatira zoyipa chifukwa cha kusefera kwa magazi.
Nthawi zambiri, chakudya # 7 chimatchedwa "impso."
Chofunikira chake ndikuchepetsa kudya kwa potaziyamu tsiku ndi tsiku, ndi madzi.
Pali mitundu ingapo ya zakudya, koma onse sapatula kugwiritsa ntchito zakudya kuphatikiza potaziyamu, ndi mbale zomwe zimakhala ndi mchere wambiri. Komabe, zonunkhira zina ndi msuzi zimaloledwa kulipirira kuchepa kwa mchere.
Malinga ndi chakudya No. 7, zakudya ndi mbale zotsatirazi ndizololedwa:
- msuzi wazipatso ndi masamba ndi kuwonjezera kwa mbatata, katsabola, parsley, batala, anyezi (owiritsa kapena stewed);
- buledi, zikondamoyo ndi zikondamoyo zopanda mchere;
- ng'ombe yokhala ndi mafuta ochepa, nkhumba yosenda, nkhumba, kalulu, nkhuku, (ingaphike kapena kuwiritsa);
- nsomba yamafuta ochepa mu mawonekedwe owiritsa, mutha kuchepera kapena kuphika;
- vinaigrette yopanda mchere, saladi kuchokera ku zipatso ndi masamba atsopano;
- soseji ndi zonunkhira - phwetekere, mkaka, zipatso ndi msuzi wamasamba, sinamoni, viniga;
- mazira otentha owiritsa kawiri pa tsiku, momwe amapangira ma omelet, yolks pakupanga mbale;
- zipatso zosaphatikizika monga pichesi, lalanje, ndimu, maapulo wobiriwira;
- mbewu monga chimanga - barele, chimanga;
- mkaka, kirimu, kirimu wowawasa, tchizi tchizi, mbale zokhotakhota, mkaka wowotchera, kefir ndi yogati;
- tiyi wopanda shuga, timadziti tosatulutsa, decoctions wa rose m'chiuno;
- mafuta a masamba.
Kuphatikiza pakuwona zakudya zapadera, ndikofunikira kuti musinthe ntchito ndi kupumula kwabwino. Kupsinjika m'maganizo kumathandizanso kwambiri pakugwira ntchito ya impso ndi shuga m'magazi.
Pakudya, odwala ayenera kutsatira malingaliro onse a dokotala kuti apewe zovuta zingapo. Pankhaniyi, kudzipereka nokha ndi koletsedwa, chifukwa wodwalayo amangodzivulaza.
Kanemayo munkhaniyi akufotokoza mwatsatanetsatane ntchito ya impso mu shuga.
