Matenda a shuga a insipidus (matenda a shuga insipidus) ndi matenda osowa a endocrine omwe amachitika chifukwa cha kupindika pituitary, hypothalamus, kapena impso. Matendawa amadziwika ndi polydipsia (kumverera kwa ludzu kosatha) ndi polyuria (kuchuluka kwa mkodzo - kuchokera pa malita 6 mpaka 50 patsiku).
Matendawa ndi osachiritsika, amatha kukhala mwa amayi ndi abambo ali ndi zaka zilizonse, koma nthawi zambiri matenda a shuga a insipidus amapezeka mwa anthu azaka za 18- 28.
Tizilombo ta pituitary ndi hypothalamus ndi timimba ta endocrine tomwe timalumikizana. Zimayimira gulu linalake lolamulira lomwe limayendetsa glands ya thupi la endocrine.
Tcherani khutu! Gawo lama neurons la hypothalamus limatulutsa mahomoni - oxytocin ndi vasopressin.
Mahomoni a antidiuretic - vasopressin amasonkhanitsidwa mu thumbo lachiberekero lakumaso. Hormoni imamasulidwa ngati pakufunika ndikuwongolera kuyamwa kwa madzi mu nephrons.
Pankhani ya kuchuluka kocheperako kwa ma antidiuretic timadzi m'magazi mu impso mu njira ya kusintha mayamwidwe madzi - amakhumudwa, chifukwa chake polyuria imapangidwa.
Zizindikiro ndi zomwe zimayambitsa matenda a shuga insipidus
Matenda a shuga a shuga amawoneka ngati kusintha kwadzachitika m'thupi, zomwe zimayambitsa:
- kuwonongeka kwa vasopressin;
- kupezeka kwa mawonekedwe mu pituitary gland ndi hypothalamus;
- mu chandamale chandamale mu impso, kusokonezeka kwa chidwi cha timadzi tating'onoting'ono kumachitika;
- kulakwitsa kwa hypothalamus kapena pituitary gland;
- cholowa m'malo mwake (kudziwiratu mtundu wamitundu ikuluikulu);
- kuwonongeka kwa mutu kapena ma opaleshoni aubongo omwe sanachite bwino, omwe amachititsa kuwonongeka kwa ma neuropressin neurons;
- metcases a oncological omwe ali ndi vuto pa ntchito ya tiziwalo timene timatulutsa;
- autoimmune ndi matenda opatsirana omwe amawononga ma neurons a antidiuretic mahomoni.
Zizindikiro zazikulu za matenda a shuga ndi polydipsia ndi polyuria, okhala ndi kusiyanasiyana kosiyanasiyana.
Zizindikiro zomwe zimawonekera ndikapita nthawi yayitali matenda
Kwa nthawi yayitali ya matendawa, zizindikiro monga kuwonjezereka kwa chikhodzodzo, kupindika komanso kuwonekera kwam'mimba ndizodziwika. Zizindikiro za matenda a shuga insipidus syndrome amakhalanso ndi anorexia (kunenepa kwambiri), kusanza, ndi nseru.
Zizindikiro zotsatirazi ndi kuthamanga kwa magazi, ulesi, ndi asthenia. Matenda a shuga amakhalanso ndi matendawa monga migraine komanso kusokonekera kwa malo owonera.
Zizindikiro zambiri za matenda a shuga a insipidus zili mu kusowa kwamadzi:
- khungu lowuma komanso la atonic;
- zotheka;
- dzuwa.
Komanso, nthawi zina pakakhala kusintha kwamphamvu pakulimbitsa thupi, wodwalayo amakhala ndi zizindikiro monga kutsika kwa orthostatic.
Zizindikiro
Mukafuna kudziwa za matendawa, ndikofunikira kukhazikitsa mawonekedwe a matendawa kuti mankhwalawo akhale abwino. Pozindikira matendawa, anamnesis ndi zizindikiro zosonyeza polydipsia ndi polyuria (oposa malita awiri patsiku) ndizofunikira.
Ngati matenda azachipatala komanso mbiri ya zamankhwala zisonyeza matenda a shuga insipidus syndrome, ndiye kuti dokotala amakupatsani mayesero ena. Potere, munthu ayenera kusiya madzi kwakanthawi.
Wodwalayo amaperekanso mkodzo ndikuwunika magazi kuti adziwe:
- kachulukidwe ka mkodzo;
- osmolarity;
- kuchuluka kwa nayitrogeni, potaziyamu, shuga, sodium, calcium m'magazi;
- glucosuria.
Kusanthula kwina kumachitika chifukwa cha kudya kouma, komwe wodwala samamwa madzi kuyambira maola 8 mpaka 24. Poyesa, kulemera, kachulukidwe ndi kuchuluka kwa mkodzo amalembedwa ola lililonse ndipo zomwe zimapezeka mu mkodzo zimayesedwa.
Ngati kulemera kwa wodwala kumatsika ndi 5%, ndipo kuchuluka kwa sodium kuposa 3 mmol / l, ndiye kuti kafukufukuyo watha. Chifukwa chake, ndizotheka kutsutsa kapena kutsimikizira kukhalapo kwa matenda a shuga insipidus, momwe mulibe mankhwala opatsirana, omwe amachititsa kuti azitha kuyendetsa matenda osokoneza bongo omwe ali ndi manjenje.
Kuzindikira kusiyanasiyana kwa matenda a nephrogenic ndi hypothalamic matenda a shuga a insipidus kumaphatikizapo kafukufuku wogwiritsa ntchito Minirin: kuyesedwa kumachitika molingana ndi Zimnitsky asanatenge Minirin komanso atatha kugwiritsa ntchito mankhwalawa. Ngati, mutamwa mankhwalawo, kuchuluka kwa mkodzo kumachepa ndipo kukanika kwake, izi zikutsimikizira kuti matenda a shuga a hypothalamic insipidus.
Pozindikira mosiyanasiyana mtundu wa nephrogenic ndi hypothalamic, zomwe zili vasopressin m'magazi ndizofunikira kwambiri: ndi matenda a nephrogenic shuga, kuchuluka kwa timadzi timeneti kumawonjezeka, ndipo chachiwiri sikumayesedwa.
Pofuna kudziwa matenda a shuga a mtundu wampira, MRI yachitika, yomwe imatsimikiza kukhalapo kwa ma pathologies, mawanga owala ndi mapangidwe a gitu.
Chithandizo
Matenda a shuga apakati
Chithandizo cha matenda amtunduwu matenda a shuga chimaphatikizanso kugwiritsa ntchito mosinthira mankhwala. Chithandizo chachikulu chomwe mankhwalawa amathandizira ndi Desmopressin ndi mitundu yake:
- Minirin (mapiritsi) - analogue yokula ya ma antidiuretic;
- Adiuretin (ma ampoules) - ogwiritsira ntchito intraasal.
Minirin (vasopressin wochita kupanga)
Pambuyo pakukonzekera, mankhwalawa amatha kupezeka m'magazi pambuyo pa mphindi 15-30, ndipo amamufika pambuyo pa mphindi 120.
Dotolo amasankha payekha payekha, kuwunika zotsatira za mankhwalawo ngati chithandizo chili pachiyambiriro. Mlingo umayikidwa, kutengera kuchuluka kwa madzimadzi omwe adamwa komanso kuchuluka kwa kwamikodzo. Monga lamulo, ndi mapiritsi 1-2 patsiku.
Mankhwalawa amatengedwa theka la ola musanadye kapena pambuyo pa maola awiri mutatha kudya. Kutalika kwa Minirin ndi kuyambira maora 8 mpaka 12, choncho ayenera kumwedwa katatu patsiku.
Ngati mankhwala osokoneza bongo amatha kuonekera:
- kutupa;
- mutu
- utachepa mkodzo.
Zomwe zimayambitsa bongo zimagwiritsidwa ntchito mosiyanasiyana ndi mlingo wolakwika, kusintha kwa nyengo, kutentha thupi komanso kusintha kwa moyo.
Chithandizo cha matenda a shuga a insipidus nephrogenic
Chithandizo cha matenda amtunduwu chimaphatikizapo kugwiritsa ntchito mankhwala osakanikirana, okhala ndi mitundu yosiyanasiyana ya okodzetsa omwe alibe mchere wochepa. Izi ndizofunikira kuwonjezera mphamvu ya thiazide diuretics.
Ngati mankhwala a adjunct, ma inhibitors a prostaglandin amagwiritsidwa ntchito: ibuprofen, aspirin, indomethacin.
Tcherani khutu! Ndi mtundu wa nephrogenic wa matenda a shuga a insipidus, Desmopressin ndiwothandiza.
Chithandizo cha mtundu wa dipsogenic yamatendawa safuna mankhwala. Cholinga chake chachikulu ndikuchepetsa kuchuluka kwa madzi omwe amwedwa.
Ndi matenda a shuga insipidus syndrome, wodwalayo ayenera kuchepetsa kuchuluka kwa mchere, mowa ndi zakudya zama protein zomwe zimadyedwa. Gawo lalikulu la zakudya zake liyenera kukhala zinthu zamkaka, zipatso ndi masamba.
Ndipo kuti muchepetse ludzu, muyenera kumwa zakumwa zozizilitsa bwino za apulosi ndi mandimu.
