Micro ndi macroangiopathies mu shuga: ndi chiyani?

Matenda ashuga macroangiopathy ndi matenda opatsirana kapena a atososcotic omwe amapezeka pakatikati kapena mitsempha yayikulu yomwe imakhala ndi nthawi yayitali ya mtundu 1 ndi matenda a 2.

Zodabwitsazi sizachinthu chilichonse koma za pathogenesis, zimayambitsa kuwonekera kwa matenda a mtima, ndipo munthu nthawi zambiri amakhala ndi matenda oopsa, zotupa zokhudzana ndi zotumphukira za m'mitsempha, ndipo kufalikira kwa magazi kumasokonezeka.

Dziwani za matendawa popanga ma electrocardiogram, ma echocardiograms, Doppler ultrasound, impso, mitsempha yama ubongo, mitsempha yam'manja imayesedwa.

Chithandizo chimakhala pakuwongolera kuthamanga kwa magazi, kukonza kayendedwe ka magazi, kukonza hyperglycemia.

Zimayambitsa macroangiopathy mu shuga

Munthu akamadwala matenda a shuga kwa nthawi yayitali, ma capillaries ang'onoang'ono, makoma ochepa ndi mitsempha motsogozedwa ndi kuchuluka kwa shuga kumayamba kuwonongeka.

Chifukwa chake, kupendekera mwamphamvu, kusakanikirana, kapena, koteroko, uku ndi ukukulitsa mitsempha yamagazi.

Pachifukwachi, kayendedwe ka magazi ndi kagayidwe pakati pa ziwalo zamkati zimasokonezeka, zomwe zimayambitsa matenda a hypoxia kapena okosijeni a minyewa yozungulira, kuwonongeka kwa ziwalo zambiri za odwala matenda ashuga.

• Nthawi zambiri, ziwiya zazikulu zam'munsi komanso mtima zimakhudzidwa, izi zimachitika mu 70 peresenti ya milandu. Ziwalo zathupi izi zimalandira katundu wambiri, kotero zotengera zimakhudzidwa kwambiri ndikusintha. Mu diabetesic microangiopathy, fundus imakhudzidwa nthawi zambiri, yomwe imapezeka ngati retinopathy;
• Nthawi zambiri matenda ashuga macroangiopathy amakhudza chithokomiro, coronary, aimpso, zotumphukira mitsempha. Izi zimaphatikizidwa ndi angina pectoris, myocardial infarction, ischemic stroke, matenda ashuga, komanso matenda okonzanso. Ndi kuwonongeka kwamitsempha yamagazi, chiopsezo chotenga matenda a mtima ndi matenda a sitiroko amachulukitsa katatu.
• Matenda ambiri okhudzana ndi matenda ashuga amachititsa kuti mitsempha ya magazi iyambe. Matendawa amatapezeka mwa anthu omwe ali ndi mtundu woyamba wa 2 komanso mtundu wa 2 matenda a shuga zaka 15 m'mbuyomu kuposa mwa odwala athanzi. Komanso, matenda omwe ali ndi matenda ashuga amatha kupita patsogolo mofulumira.
• Matendawa amachepetsa zipinda zapansi panthaka zazikulu komanso zam'mitsempha, momwe mapangidwe a atherosclerotic amapanga. Chifukwa cha kuwerengera, kuwonekera ndi necrosis ya zolembera, kuwundana kwa magazi kumapangika kwanuko, kuwunikira kwa ziwiya kumatseka, chifukwa, kuthamanga kwa magazi m'dera lomwe lakhudzidwa kumasokonezeka mu matenda ashuga.

Monga lamulo, matenda ashuga a macroangiopathy amakhudza mitsempha, ubongo, mawonekedwe amitsempha, kotero madotolo amachita chilichonse kuti aletse kusintha kumeneku pogwiritsa ntchito njira zopewera.

Chiwopsezo cha pathogenesis ndi hyperglycemia, dyslipidemia, insulin, kunenepa kwambiri, matenda oopsa, kuchuluka kwa magazi, kuperewera kwa endothelial, kupsinjika kwa oxidative, kuchepa kwamatenda a cellic ndikofunikira kwambiri.

Komanso, atherosclerosis imakonda kukhala osuta, pamaso pa zinthu zopanda ntchito, komanso kuledzera kwa akatswiri. Pangozi ndi amuna azaka zopitilira 45 ndipo azimayi opitirira 55.

Nthawi zambiri chomwe chimayambitsa matendawa chimakhala cholowa chamabadwa.

Matenda a diabetes angiopathy ndi mitundu yake

Dongosolo la matenda ashuga angiopathy ndi lingaliro logwirizanitsa lomwe limayimira pathogenesis ndipo limakhudza mitsempha yamagazi - yaying'ono, yayikulu komanso yapakati.

Vutoli limadziwika kuti ndi chifukwa cha matenda obwera chifukwa cha matenda ashuga, omwe amapezeka zaka 15 patadutsa matendawa.

Matenda a shuga a macroangiopathy amaphatikizidwa ndi ma syndromes monga atherosulinosis ya msempha ndi mafupa amitsempha yamagazi, zotumphukira kapena mitsempha ya mitsempha.

1. Pa microangiopathy mu matenda a shuga, retinopathy, nephropathy, ndi matenda ashuga a m'munsi amawonedwa.
2. Nthawi zina, mitsempha yamagazi ikawonongeka, angiopathy yapadziko lonse imapezeka, lingaliro lake limaphatikizapo matenda a shuga-macroangiopathy.

Endoneural diabetesic microangiopathy imayambitsa kuphwanya kwamitsempha yamafungo, izi zimayambitsa matenda a shuga.

Matenda a shuga a macroangiopathy ndi zizindikiro zake

Ndi atherosclerosis ya msempha ndi coronary mitsempha, zomwe zimayambitsa matenda ashuga macroangiopathy am'munsi komanso mbali zina za thupi, wodwala matenda ashuga amatha kudziwa matenda amitsempha yama mtima, kulowetsedwa kwa myocardial, angina pectoris, mtima.

Matenda a mtima pamenepa amayamba mwa mawonekedwe aanthu, osamva ululu ndipo amakhala ndi arrhythmia. Matendawa ndi oopsa kwambiri, chifukwa angayambitse kufa mwadzidzidzi kwa coronary.

Pathogenesis mu odwala matenda ashuga nthawi zambiri amaphatikizapo zovuta pambuyo-infaration monga aneurysm, arrhythmia, thromboembolism, Cardiogenic, kugunda kwa mtima. Ngati madotolo awulula kuti chomwe chimayambitsa matenda osokoneza bongo ndi matenda ashuga macroangiopathy, zonse ziyenera kuchitidwa kuti vuto la mtima lisabwezenso, popeza chiwopsezo chake ndi chachikulu.

• Malinga ndi ziwerengero, a Type 1 and Type 2 diabetesics ali ndi mwayi wowirikiza kufa ndi matenda osachiritsika monga anthu omwe alibe matenda ashuga. Pafupifupi 10 peresenti ya odwala amadwala matenda amitsempha yamagazi chifukwa cha matenda ashuga macroangiopathy.
• Atherosulinosis mu matenda ashuga amadzipangitsa okha kumva kupukusa kwa ischemic stroke kapena matenda a ischemia osachiritsika. Ngati wodwalayo ali ndi matenda oopsa, chiwopsezo chokhala ndi vuto la ubongo chimakulitsa katatu.
• Mu 10 peresenti ya odwala, zotupa zophera ziwalo zam'madzi zimapezeka mu mawonekedwe a atherosulinosis obliterans. Matenda a shuga a macroangiopathy amaphatikizidwa ndi dzanzi, kuzizira kwamapazi, kulumikizana kwina, kupsinjika kwa hypostatic.
• Wodwalayo akumva kupweteka kwambiri minofu yamatumbo, ntchafu, mwendo wapansi, womwe umalimbana ndi zovuta zilizonse zolimbitsa thupi. Ngati magazi akuyenda m'mphepete mwa distal asokonezeka kwambiri, izi zimayambitsa ischemia, yomwe pamapeto pake imayambitsa necrosis yamiyendo ndi miyendo yotsika ngati mawonekedwe a gangrene.
• Khungu komanso minyewa yolumikizira khungu limatha kudzipanga okha, popanda kuwonongeka kwa makina. Koma, monga lamulo, necrosis imachitika ndi kuphwanya kwamkati kwa khungu - mawonekedwe a ming'alu, zotupa zam'mimba, mabala.

Pamene vuto la kuthamanga kwa magazi silitchulidwa pang'ono, matenda ashuga a macroangiopathy amachititsa mawonekedwe a zilonda zam'mimba zam'mimba zokhala ndi matenda osokoneza bongo m'miyendo.

Kodi matenda ashuga a macroangiopathy amapezeka bwanji?

Kuzindikira ndikuwonetsetsa momwe mitsempha ya coronary, ubongo, ndi zotumphukira zimakhudzidwira.

Kuti mudziwe njira yoyenera yofunsira, wodwalayo ayenera kufunsa dokotala.

Kuyeserera kumachitika ndi endocrinologist, katswiri wa matenda ashuga, mtima, katswiri wa zamitsempha, opaleshoni yamtima, wamisala.

Mtundu woyamba wa 2 komanso wa matenda ashuga a mtundu wachiwiri, mitundu yotsatirayi ya diagnostics imayikidwa kuti mudziwe pathogenesis:

1. Kuyesedwa kwamwazi wamagazi kumachitika kuti mupeze kuchuluka kwa shuga, triglycerides, cholesterol, mapulateleti, lipoproteins. Kuyezetsa magazi m'magazi kumachitidwanso.
2. Onetsetsani kuti mumayang'anitsitsa mtima wamagazi pogwiritsa ntchito ma electrocardiogram, kuwunika magazi pafupipafupi, kuyezetsa kupsinjika, echocardiogram, ultrasound dopplerography ya aorta, myocardial perfusion scintigraphy, coronarography, computer tomographic angiography.
3. Kusintha kwamitsempha kwa wodwalayo kumatchulidwa pogwiritsa ntchito ziwonetsero za ultrasound dopplerografia ya ziwongo, kusanthula mobwerezabwereza ndi angiography yamitsempha yamitsempha imachitidwanso.
4. Kuti muwone momwe mitsempha yamitsempha yamapazi imayendera, miyendo imawunikidwa pogwiritsa ntchito kuwunika kwapawiri, ma dopplerografia, kupindika kwa arteriography, rheovasography, capillaroscopy, arterial oscillography.

Chithandizo cha matenda a shuga a shuga

Chithandizo cha matenda odwala matenda ashuga chimakhala makamaka popereka njira zomwe zingachepetse kupita patsogolo kwa mitsempha yoopsa, yomwe ikhoza kuwopseza wodwala olumala kapena ngakhale kufa.

Zilonda za trophic zam'mwamba komanso zotsika zimayang'aniridwa ndikuyang'aniridwa ndi dokotala. Pankhani ya zovuta pachimake mtima, chithandizo choyenera chikuchitika. Komanso, adotolo atha kuloza ku opaleshoni, yomwe imakhala mu endarterectomy, kuchotsa kuchepa kwa magazi m'thupi, kuchepa kwa dzanja lanu lomwe lakhudzidwa, ngati ali kale ndi matenda osokoneza bongo.

Mfundo zazikuluzikulu zamankhwala zimagwirizana ndi kukonza ma syndromes owopsa, omwe amaphatikizapo hyperglycemia, dyslipidemia, hypercoagulation, ochepa hypertension.

• Kuti alipire chakudya cha anthu odwala matenda ashuga, dokotala amamulembera mankhwala a insulin komanso kuwunika pafupipafupi kuchuluka kwa shuga m'magazi. Mwa izi, wodwalayo amatenga mankhwala ochepetsa a lipid - ma statins, antioxidants, fibrate. Kuphatikiza apo, ndikofunikira kutsatira zakudya zapadera zochiritsira komanso zoletsa kugwiritsa ntchito zakudya zomwe zili ndi mafuta azinyama.
• Pakakhala chiopsezo chokhala ndi zovuta za thromboembolic, mankhwala a antiplatelet amadziwika - acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
• Mankhwala othandizira antihypertensive ngati atapezeka kuti ali ndi matenda ashuga a macroangiopathy amakhala kuti akwaniritsa kuthamanga kwa magazi pa mulingo wa 130/85 mm RT. Art. Chifukwa chaichi, wodwala amatenga zoletsa za ACE, okodzetsa. Ngati munthu wavutika ndi myocardial infarction, beta-blockers amayikidwa.

Njira zopewera

Malinga ndi ziwerengero, ndi mtundu 1 komanso mtundu wa 2 matenda a shuga, chifukwa cha zovuta zamtima mu mtima mwa odwala, amafa amachokera pa 35 mpaka 75 peresenti. Mu theka la odwalawa, kufa kumachitika ndi matenda obanika, mu 15 peresenti ya zomwe zimayambitsa matendawa ndi pachimake.

Pofuna kupewa kukula kwa matenda ashuga a macroangiopathy, ndikofunikira kuchita zonse zodzitchinjiriza. Wodwalayo amayenera kuwonetsetsa kuchuluka kwa shuga m'magazi, kuyeza kuthamanga kwa magazi, kutsatira zakudya, kuyang'anira kulemera kwake, kutsatira malangizo onse azachipatala ndi kusiya zizolowezi zoyipa momwe angathere.

Mu kanema munkhaniyi, njira zochizira matenda ashuga a macroangiopathy a malekezikulu amakambidwa.