Mwa odwala ambiri omwe ali ndi matenda ashuga, mtima umakhudzidwa. Chifukwa chake, pafupifupi 50% ya anthu ali ndi vuto la mtima. Kuphatikiza apo, mavuto oterewa amakula ngakhale adakali ang'ono.
Kulephera kwamtima mu shuga kumagwirizanitsidwa ndi zomwe zimakhala ndi shuga m'thupi, chifukwa chake cholesterol imayikidwa pamakoma a mtima. Izi zimabweretsa kuchepetsedwa pang'onopang'ono kwa kuwala kwawo ndi mawonekedwe a atherosulinosis.
Poyerekeza ndi machitidwe a atherosulinosis, ambiri odwala matenda ashuga amakhala ndi matenda a mtima. Komanso, ndi kuchuluka kwa glucose, kupweteka m'dera lachiwalo kumatha kuloledwa kwambiri. Komanso, chifukwa cha kukula kwa magazi, mwayi wa thrombosis umakulanso.
Kuphatikiza apo, odwala matenda ashuga nthawi zambiri amatha kukulitsa magazi, zomwe zimapangitsa kuti pakhale zovuta pambuyo pa vuto la mtima (aortic aneurysm). Pothana ndi vuto lakusintha kwa infa, kumachitika kwambiri mobwerezabwereza kwa mtima kapenanso kufa. Chifukwa chake, ndikofunikira kwambiri kudziwa kuwonongeka kwa mtima mu shuga komanso momwe mungachitire ndi zovuta zoterezi.
Zimayambitsa zovuta za mtima ndi zomwe zimayambitsa chiopsezo
Matenda a shuga amakhala ndi moyo waufupi chifukwa cha kuchuluka kwa shuga m'magazi. Matendawa amatchedwa hyperglycemia, yomwe imakhudza mwachindunji mapangidwe a atherosulinotic malo. Yotsirizika kapena yotseka lumen ya ziwiya, zomwe zimatsogolera ku ischemia ya minofu yamtima.
Madokotala ambiri ali ndi chitsimikizo kuti shuga yowonjezera imakhumudwitsa kusokonekera - malo okhala ndi lipid. Chifukwa cha izi, makoma azotengera amakhala mawonekedwe ovomerezeka ndi mawonekedwe.
Hyperglycemia imathandizanso kutsegula kwa kupsinjika kwa oxidative ndikupanga ma free radicals, omwe amakhalanso ndi vuto la endothelium.
Pambuyo pa maphunziro angapo, ubale unakhazikitsidwa pakati pamatenda a mtima wamatenda a shuga ndi kuchuluka kwa hemoglobin ya glycated. Chifukwa chake, ngati HbA1c iwonjezeka ndi 1%, ndiye kuti chiopsezo cha ischemia chikuwonjezeka ndi 10%.
Matenda a shuga ndi matenda amtima atha kukhala zogwirizana ngati wodwala akumana ndi zovuta zina:
- kunenepa
- ngati m'modzi wa abale a wodwalayo adwala matenda amtima;
- nthawi zambiri kukweza magazi;
- kusuta;
- uchidakwa;
- kukhalapo kwa cholesterol ndi triglycerides m'mwazi.
Ndi matenda ati amtima omwe atha kukhala chopinga cha matenda ashuga?
Nthawi zambiri, ndi hyperglycemia, matenda ashuga a mtima amayamba. Matendawa amawoneka pomwe malungo osokoneza bongo a myocardium ali ndi odwala omwe ali ndi vuto la shuga.
Nthawi zambiri matendawa amakhala ngati asymptomatic. Koma nthawi zina wodwala amakhala ndi vuto lopweteka komanso kugunda kwa mtima (tachycardia, bradycardia).
Nthawi yomweyo, gawo lalikulu limaleka kupopa magazi ndikugwira ntchito mopangika, chifukwa cha zomwe kukula kwake kumakulira. Chifukwa chake, matendawa amatchedwa mtima wodwala. Pathology mu ukalamba imatha kuwonetsedwa ndi kuyendayenda kuzungulira, kutupa, kufupika ndi kupweteka pachifuwa komwe kumachitika pambuyo pochita masewera olimbitsa thupi.
Matenda a mtima omwe ali ndi matenda a shuga amayamba kuchulukitsidwa ka 3-5 nthawi zambiri kuposa mwa anthu athanzi. Ndizofunikira kudziwa kuti chiwopsezo cha matenda a mtima sichimadalira kukula kwa matenda oyamba, koma kutalika kwake.
Ischemia mu odwala matenda ashuga nthawi zambiri amakhala popanda zizindikiro zotchulidwa, zomwe nthawi zambiri zimabweretsa kukula kwa kupweteka kwa minofu ya mtima. Komanso, matendawa amapitilira mafunde, pomwe kuukira kwadzaoneni kumaloledwa ndi matenda osachiritsika.
Zomwe zimachitika ndi matenda a mtima. Chithunzi cha matenda a ischemia mu odwala matenda ashuga:
- kupuma movutikira
- arrhythmia;
- kuvutika kupuma
- kukanikiza ululu mumtima;
- nkhawa zokhudzana ndi mantha a imfa.
Kuphatikiza kwa ischemia ndi matenda a shuga kungayambitse kukulitsa kwa myocardial infarction. Kuphatikiza apo, kuphatikizika uku kumakhala ndi zochitika zina, monga kugunda kwamtima kosokoneza, edema yamapapu, kupweteka kwamtima kumayang'ana kumbali ya kolala, khosi, nsagwada kapena phewa. Nthawi zina wodwala amamva kupweteka kwambiri pachifuwa, mseru komanso kusanza.
Tsoka ilo, odwala ambiri amakhala ndi vuto la mtima chifukwa sazindikira ngakhale shuga. Pakadali pano, kudziwitsidwa ndi hyperglycemia kumabweretsa zovuta zakupha.
Mu odwala matenda ashuga, mwayi wopanga angina pectoris amawirikiza. Mawonetsero ake akuluakulu ndi palpitations, malaise, thukuta ndi kufupika kwa mpweya.
Angina pectoris, yomwe idawuka motsutsana ndi maziko a matenda ashuga, ili ndi mawonekedwe ake. Chifukwa chake, kukula kwake sikukhudzidwa ndi kuopsa kwa matenda oyambitsidwa, koma kutalika kwa chotupa cha mtima. Kuphatikiza apo, mwa odwala omwe ali ndi shuga ambiri, magazi osakwanira kupita ku myocardium amakula msanga kuposa mwa anthu athanzi.
Mu anthu ambiri odwala matenda ashuga, Zizindikiro za angina pectoris ndizofatsa kapena sizipezeka konse. Kuphatikiza apo, nthawi zambiri amakhala ndi zolakwika mu nthito ya mtima, yomwe nthawi zambiri imatha ndi imfa.
Zotsatira zinanso za matenda a shuga a mtundu wachiwiri ndi kulephera kwa mtima, komwe, monga zovuta zina zamtima zomwe zimachitika chifukwa cha hyperglycemia, ndizomwe zimafotokozera. Chifukwa chake, kulephera kwa mtima ndi shuga wambiri kumakonda kumangidwa adakali aang'ono, makamaka amuna. Zizindikiro za matendawa ndi monga:
- kutupa ndi kupindika kwa miyendo;
- kukulitsa kwa mtima kukula;
- kukodza pafupipafupi
- kutopa;
- kuwonjezeka kwa kulemera kwa thupi, komwe kumafotokozedwa ndikusungidwa kwa madzimadzi m'thupi;
- Chizungulire
- kupuma movutikira
- kutsokomola.
Diabetesic myocardial dystrophy imatithandizanso kuphwanya mtundu wa kugunda kwa mtima. Pathology imachitika chifukwa cha kusayenda bwino kwa kagayidwe kachakudya, komwe kanayambitsidwa ndi kuchepa kwa insulin, komwe kumapangitsa gawo la glucose kupyola maselo a myocardial. Zotsatira zake, mafuta ac oxidized amadziunjikira mu minofu ya mtima.
Njira ya dystrophy ya myocardial imatsogolera ku mawonekedwe a foci a kusokonezeka kwa conduction, kusinthasintha kwa arrhythmias, extrasystoles kapena parasystoles. Komanso, microangiopathy mu shuga imathandizira kugonjetsedwa kwa ziwiya zazing'ono zomwe zimadyetsa myocardium.
Sinus tachycardia kumachitika ndi mantha kapena thupi kwambiri. Kupatula apo, kuthamanga kwa mtima kugwira ntchito ndikofunikira kuti thupi lipereke zakudya komanso mpweya wabwino. Koma ngati shuga wamagazi akukulira pafupipafupi, ndiye kuti mtima umakakamizidwa kugwira ntchito mopitilira muyeso.
Komabe, mwa anthu odwala matenda ashuga, myocardium sangathe kudwala mwachangu. Zotsatira zake, okosijeni ndi zakudya sizilowa mumtima, zomwe nthawi zambiri zimayambitsa matenda a mtima ndi kufa.
Ndi matenda ashuga a mtima, kusinthasintha kwa mtima kumayamba. Kwa mkhalidwe wotere, arrhasmia imachitika chifukwa cha kusinthasintha pakukaniza kwa zotumphukira zamitsempha yamagetsi, yomwe NS iyenera kuwongolera.
Vuto lina la matenda ashuga ndi orthostatic hypotension. Amawonetsedwa ndi kuchepa kwa kuthamanga kwa magazi. Zizindikiro za matenda oopsa ndi chizungulire, malaise, ndi kukomoka. Amadziwikanso ndi kufooka atadzuka komanso kupweteka kumutu kosalekeza.
Popeza kuwonjezeka kwa shuga m'magazi kumakhala zovuta zambiri, ndikofunikira kudziwa momwe mungalimbitsire mtima matenda ashuga komanso njira zamankhwala zosankha ngati matendawa adayamba kale.
Mankhwala ochizira matenda a mtima odwala matenda ashuga
Chithandizo cha mankhwalawa ndikuti tilewe kukula kwa zovuta zomwe zingachitike ndikuyimitsa kupitilira kwa zovuta zomwe zilipo. Kuti muchite izi, ndikofunikira kusintha glycemia, kuchepetsa kuchuluka kwa shuga ndikuletsa kuti isakwere ngakhale maola awiri mutatha kudya.
Pachifukwa ichi, ndi matenda amtundu wa 2 shuga, othandizira ochokera ku gulu la Biguanide ndi omwe amapatsidwa. Awa ndi Metformin ndi Siofor.
Mphamvu ya Metformin imatsimikiziridwa ndi kuthekera kwake kulepheretsa gluconeogeneis, kutsegula glycolysis, yomwe imapangitsa kuti khungu lizisungidwa ndi pyruvate ndi lactate mu minofu ndi mafuta. Komanso, mankhwalawa amalepheretsa kukula kwa kufalikira kwa minofu yosalala ya mtima ndikukhudza mtima.
Mlingo woyambirira ndi 100 mg patsiku. Komabe, pali zotsutsana zingapo za kumwa mankhwalawa, makamaka kukhala osamala kwa iwo omwe ali ndi vuto la chiwindi.
Komanso, ndi matenda a shuga a mtundu 2, Siofor nthawi zambiri amalembedwa, omwe amagwira ntchito makamaka pamene zakudya ndi masewera olimbitsa thupi sizimathandizira kuchepetsa thupi. Mlingo watsiku ndi tsiku amasankhidwa payekha kutengera kuchuluka kwa shuga.
Kuti Siofor ikhale yogwira mtima, kuchuluka kwake kumatsitsidwa nthawi zonse - kuchokera pa mapiritsi 1 mpaka 3. Koma mlingo waukulu wa mankhwalawa suyenera kupitanso magalamu atatu.
Siofor imaphatikizidwa chifukwa cha matenda a shuga omwe amadalira insulin 1, kulowetsedwa kwa myocardial, kutenga pakati, kulephera kwa mtima komanso matenda oopsa a m'mapapo. Komanso, mankhwalawa satengedwa ngati chiwindi, impso komanso matenda a matenda ashuga sizigwira bwino ntchito. Kuphatikiza apo, Siofor sayenera kuledzera ngati ana kapena odwala opitilira 65 amathandizidwa.
Pofuna kuthana ndi angina pectoris, ischemia, kuti muchepetse kukhazikika kwa myocardial infarction komanso mavuto ena a mtima omwe amapezeka chifukwa cha matenda ashuga, ndikofunikira kumwa magulu osiyanasiyana a mankhwala:
- Mankhwala a antihypertensive.
- Ma ARB - kupewa myocardial hypertrophy.
- Beta-blockers - sinthasintha kugunda kwa mtima ndikuchepetsa kuthamanga kwa magazi.
- Ma diuretics - kuchepetsa kutupa.
- Mitsempha - siyani kugunda kwamtima.
- ACE zoletsa - ali ndi mphamvu zolimbitsa mtima;
- Ma Anticoagulants - amachepetsa magazi.
- Ma glycosides amawonetsedwa kwa edema ndi atrase fibrillation.
Kuchulukirapo, ndi matenda a shuga a 2, omwe amayenda ndi mavuto a mtima, adokotala amapatsa Dibicor. Imayendetsa kagayidwe kachakudya minofu, kuwapatsa mphamvu.
Dibicor imakhudza bwino chiwindi, mtima ndi mitsempha yamagazi. Kuphatikiza apo, pakatha masiku 14 kuyambira chiyambi cha mankhwalawa, pali kuchepa kwa ndende yamagazi.
Kuchiza ndi vuto la mtima kumatenga mapiritsi (250-500 mg) 2 p. patsiku. Komanso, Dibikor tikulimbikitsidwa kumwa mu mphindi 20. musanadye. Mlingo wokwanira wa tsiku lililonse wa mankhwalawa ndi 3000 mg.
Dibicor imaphatikizidwa muubwana nthawi yapakati, mkaka wa m`mawere ndi vuto la taurine tsankho. Kuphatikiza apo, Dibicor sangatengedwe ndi mtima glycosides ndi BKK.
Mankhwala opangira opaleshoni
Ambiri odwala matenda ashuga amasamala za momwe angachitire ndi matenda a mtima opaleshoni. Chithandizo chowongolera chimachitika polimbitsa mtima ndi mothandizidwa ndi mankhwala sizinabweretse zotsatira zomwe mukufuna. Zisonyezo za opaleshoni ndi:
- kusintha kwa mtima;
- ngati chifuwa chimakhala chowawa nthawi zonse;
- kutupa
- arrhythmia;
- kukhudzidwa mtima
- pang'onopang'ono angina pectoris.
Kuchita opaleshoni ya mtima kulephera kumaphatikizapo balloon vasodilation. Ndi chithandizo chake, kupendekera kwamtsempha, komwe kumalimbitsa mtima, kumathetsedwa. Panthawi ya ndalamayi, catheter imayikidwa mu mtsempha, pomwe baluni imabweretsa kudera lamvuto.
Kuluma kwa aortocoronary nthawi zambiri kumachitika ngati ma mesh adalowetsedwa m'mitsempha omwe amalepheretsa mapangidwe a cholesterol. Ndipo kulumikizana kwa mitsempha yodutsa m'mitsempha yamagetsi kumapangitsa kuti magazi azitha kwaulere, zomwe zimachepetsa kwambiri ngozi yobwereranso.
Ngati wodwala matenda a shuga a mtima, chithandizo cha opaleshoni chokhazikitsidwa ndi pacemaker chimasonyezedwa. Chipangizocho chimagwira kusintha kulikonse mu mtima ndikuwakonza nthawi yomweyo, zomwe zimachepetsa mwayi wa arrhythmias.
Komabe, musanachite izi, ndikofunikira kuti musapangitse shuga kuchuluka, komanso kulipira matenda a shuga. Popeza ngakhale kulowererapo pang'ono (mwachitsanzo, kutsegula thumba, kuchotsedwa kwa misomali), komwe kumachitika pochiza anthu athanzi pamalopo, odwala matenda ashuga amachitidwa kuchipatala cha opaleshoni.
Komanso, asanafike opaleshoni yofunika, odwala omwe ali ndi hyperglycemia amasamutsidwa ku insulin. Pankhaniyi, kuyambitsa insulin yosavuta (3-5 Mlingo) kukuwonetsedwa. Ndipo masana ndikofunikira kuwongolera glycosuria ndi shuga wamagazi.
Popeza matenda amtima ndi matenda ashuga ndi malingaliro othandizana, anthu omwe ali ndi glycemia amafunika kuwunika kayendedwe ka mtima. Ndikofunikanso kuwongolera kuchuluka kwa shuga m'magazi, chifukwa ndi hyperglycemia yayikulu, vuto la mtima likhoza kuchitika, mpaka kumwalira.
Mu kanema mu nkhaniyi, mutu wa matenda a mtima mu shuga akupitilizidwa.
