Matenda a shuga retinopathy

Diabetesic retinopathy (ICD-10 code - H36 kapena E10-E14 p .3) ndizovuta zovuta za shuga mellitus, zomwe zimapangitsa kuchepa kwambiri kapena kuwonongeka kwathunthu kwa masomphenya pakati pa odwala azaka zogwira ntchito. Kuthekera kopezeka ndi izi kumatengera mtundu wa matenda, chithandizo ndi chipukutiro.

Zowopsa

Kukula kwa matenda a mawonedwe ophatikizidwa amalimbikitsidwa ndi:

• Kutalika kwa matenda oyamba. Matenda a shuga a retinopathy samapezeka kwambiri mzaka zoyambirira za 6 ndi 7, komanso atatha msinkhu, komabe, amapezeka mu 5% ya odwala omwe ali ndi matenda osokoneza bongo omwe amadalira insulin panthawi yolumikizana ndi akatswiri.
• Kulephera kuyendetsa bwino magazi shuga kumawakhumudwitsa.
• Nthawi yobereka mwana. Chofunika kwambiri ndikutukuka kwa mochedwa gestosis (preeclampsia).
• Kuthamanga kwa magazi. Matendawa amatipangitsa kudwala matenda a shuga.
• Zovuta za impso (nephropathy). Asayansi atsimikizira kuti chithandizo cha matenda a impso limodzi ndi photocoagulation chitha kusintha mkhalidwe wa wodwalayo.
• Kunenepa kwambiri.
• Zizolowezi zoipa.

Njira yopititsira patsogolo

Matenda a shuga ndi matenda omwe mitundu yonse ya kagayidwe imasokonekera. Choyamba, zombo zazing'onoting'ono zazing'ono zimavutika ndi izi.

Matenda a glycemia ndi omwe amayambitsa chitukuko cha matenda owonera

Pathogenesis ya diabetesic retinopathy imakhazikika pakusintha kwa metabolic pamilingo yonse, komanso kuwonjezeka kwa coagulation ya magazi, hypoxia ndi mapuloteni ambiri a glycated. Zofunikira kwambiri za glucose zimayambitsa kusalinganika, motsutsana ndi momwe masinthidwe amachitika m'thupi, amadziwika ndi kuchepa kwa oksijeni minofu ndi maselo. Poyambirira, njira zowonjezera mphamvu zimayendetsedwa, koma ndikupita patsogolo kwa matenda ashuga, kuchepa kwa lumen ya ziwiya kumawonekera chifukwa cha kutalika kwa makoma awo.

Kupanga kwa mapuloteni a glycosylated (mamolekyu a glucose omwe amaphatikizana ndi molekyulu) kumayendera limodzi ndi kutulutsidwa kwa zinthu zomalizira, kuchuluka kwake komwe kumayambitsa kusokonezeka kwa kagayidwe kazakudya, komanso kukula kwa ma membrane a maselo. Potengera zomwe zasintha, mapangidwe a mapuloteni achilendo amapezeka, omwe thupi likuyesera kuti liwononge, kuyambira zomwe zimachitika "kuphatikiza". Zotsatira zake ndi kuwonongeka kwa makoma a capillaries, kutsika kwawo kwakukulu.

Matenda a metabolism yamafuta amakhumudwitsa kapangidwe kake ka cholesterol, triglycerides ndi zinthu zina zofananira zomwe zitha kutseka lumen ya ziwiya zam'mimba. Izi zimatipatsa gawo latsopano la kuperewera kwa vuto la kuperewera kwa zakudya m'thupi ndi kukoka kwa magazi.

Hypoxia ya retinal imawonetsedwa ndikupanga kwatsopano ya pathological vascular network (neovascularization) ndi mawonekedwe a arteriovenous shunts (workarounds for magazi).

Gulu

Pali magulu angapo amtundu wa retinopathy mu shuga. Izi zimagwirizanitsidwa ndi mawonekedwe ambiri a matenda. Chimodzi mwazomwe zimagwiritsidwa ntchito kwambiri:

• gawo lopanda kufalikira;
• gawo lowonetseratu;
• gawo lochulukirachulukira.

Zofunika! Kulekanitsa kotereku kumatsimikizira momveka bwino nthawi yomwe chithandizo cha laser chikufunika.

Zosintha mu choroid - mawonekedwe akulu a retinopathy omwe ali ndi matenda ashuga

Gulu lotsatira:

• retinopathy yamtundu wosavuta (maziko);
• maculopathy;
• preproliferative retinopathy;
• kuchuluka retinopathy.

Gawo losakulitsa

Ma retina a visualzerzer ali kale ndi ma micaneurysms, zotupa zazing'ono zomwe zimawoneka ngati madontho amdima ndipo zimawonekera mukamayang'ana fundus. Mitsempha, monga lamulo, imapezeka pakatikati pa choroid a maso onse kapena mkati mwa venous system. Nthawi yomweyo, zolinga za kudzikundikira exudate zimawonekera (zopangidwira pakatikati, zofanana ndi zoyera kapena zachikaso zomwe zilibe malire omveka) ndi kutupa.

Preproliferative siteji

Ma anomalies a venous dongosolo lachilendo amaonekera. Mitsempha imakhala yopindika, yofanana ndi rosary, malupu amawonekera, mawonekedwe a zotengera amasintha. Ulusi wamankhwala umaphimbidwa ndi kuchuluka kwa mapangidwe ake exudative. Matendawa amakula kwambiri.

Kukula gawo

Pakadali pano, mapangidwe a neovascularization amachitika (kuchuluka kwa mitsempha yamagazi komwe sayenera kukhala). Choyamba, zimawonekera pakati pa choroid ndi posterior vitreous membrane, kenako zimakula kukhala vitreous lokha.

Neovascularization ndi chimodzi mwazomwe zimawonetsa proliferative retinopathy.

Ngati neovascularization ikhudza iris, chiopsezo chachiwiri cha glaucoma chikuwonjezeka kangapo. Kuphatikiza apo, kukha kwa magazi kumaloledwa ndi minyewa yotupa, yomwe imatha kupangitsa kuti mawonekedwe a retinal azindikire.

Zizindikiro zamatsenga

Poyamba matenda ashuga retinopathy amatha kukhala asymptomatic kapena kuwoneka motere:

• kuchepa kowoneka bwino;
• chophimba kapena malo amdima oyandikana ndi maso - zizindikilo za kukha magazi;
• kulephera kuwona zinthu zazing'ono;
• magawo oyandama oyera - chizindikiro cha edema;
• kusapeza bwino m'diso.

Kuchepetsa kapena kuwonongeka m'maso ndi chizindikiro chakumapeto kwa matenda ashuga retinopathy. Kukula kwawo kukuwonetsa kusatsutsika kwa njirayi. Malinga ndi ziwerengero, khungu lonse limapezeka mu 2% ya odwala matenda ashuga.

Kusiyana pakati pa masomphenya a munthu wathanzi ndi matenda ashuga omwe ali ndi matenda a openda owonera

Zambiri pazowonetsera

Ma Microaneurysms ndi zotumphukira m'makoma a zombo zazing'ono-zopepuka. Chitukuko chawo ndi malire a madera omwe alibe magazi. Vasodilation m'magawo oyamba ndi chizindikiro cha kuphatikizidwa kwa njira.

Ngati ma micaneurysms alipo popanda mawonekedwe a wasanthule, sizikhala ndi vuto lililonse, koma zimangowonetsa chiyambi cha zovuta. Komabe, matendawa akamakula, zimachulukirachulukira. Zotsatira pafupipafupi za ma micaneurysms m'chigawo chapakati cha retina ndikuwoneka kutiwopusa.

Kukha magazi

Amatha kuwoneka m'magulu osiyanasiyana a choroid, kukhala ndi mawonekedwe osiyana. Ngati zigawo zakuya zakhudzidwa, hemorrhages ndi madontho kapena mawanga owonongera kapena mawonekedwe ozungulira. Akasankhidwa mwapamwamba kwambiri, amakhala ngati mizere yolowera.

"Chokhazikika" exudate

Ndi kudzikundikira kwa lipids ndi zinthu zawo zosokonekera. Amakhala ndi mtundu wachikasu komanso mawonekedwe owoneka bwino. "Okhazikika" exudates ali m'malo omwe akuwonjezereka ma capillaries komanso m'malire a puffuff. Kuyika komweko mkati mwa choroid kumapangitsa kuchepa kwakanema kwamawonedwe owoneka.

Zofewa Zofewa

Ndi magawo ang'onoang'ono a ischemia (necrosis) a ulusi wamitsempha womwe umatuluka chifukwa cha ma capillary occlusion. "Ofewa" opusa amawoneka ngati maboma oyera omwe alibe malire.

Matenda a shuga a maculopathy

Chimodzi mwazida za angioretinopathy, zomwe zimadziwika ndi zotupa za macula.

Matenda a shuga a maculopathy amapezeka chifukwa cha kuchuluka kwa ma capillaries komanso ma cellocclusion oyamba. Zomwe zilipo pakadali pano zikutsindika kusowa kwa gulu la macular ovomerezeka

Edulatous maculopathy akhoza kukhala:

Chithandizo cha polyneuropathy mu shuga

• wamba (ochepa) - kuwunika kumawonetsa kukhalapo kwa malo amodzi kapena zingapo zogwirizana pakati pa retina;
• kusokoneza - edema yofunika imawoneka, yomwe ilibe malire omveka, kuphatikizapo kapangidwe kakang'ono ka cysts.

Ischemic maculopathy imakhala ndi zotulukapo zoyipa kwambiri poyerekeza ndi ntchito ya visual analyzer and visual acuity. Ndikosavuta kusiyanitsa mukamayang'ana ndalama. Ma Optometrists, monga lamulo, amalingalira za kakonzedwe ka mtundu wamtunduwu ndi zolakwika pakati pa zochitika zotsika zowoneka ndi kusintha kwakung'ono kowoneka. Pozindikira, fluorescence angiography imagwiritsidwa ntchito.

Kuzindikira

Ophthalmologist amawunika odwala matenda ashuga pafupipafupi:

• patatha zaka 5 kuchokera pachiwonetsero cha "matenda okoma" omwe amadziwika ndi matenda 1 shuga;
• mukayamba kulumikizana ndi endocrinologist ndi matenda a 2;
• 1 nthawi pachaka popanda kukhalanso kwa retinopathy;
• miyezi 6 iliyonse ndi matenda a retinopathy osapindulitsa;
• gawo la prroliferative - kamodzi miyezi 3-4;
• "prinositive retinopathy" m'mbiri ya zamankhwala - kamodzi pamiyezi iwiri kapena itatu.

Ophthalmologist - wothandizira wamkulu pa chithandizo ndi kupewa matenda

Njira zofotokozera:

• Kudziwitsa za minda yotsalira - imachitika pogwiritsa ntchito kujambula kwa stereoscopic. Njira imadziwika ndi kukhudzika kwambiri, kusanja zithunzi mwachangu. Kufufuza ndikokwera mtengo.
• Direct ophthalmoscopy - adotolo amatsogolera kuwala m'maso mwa wodwala, komwe kumakupatsani mwayi wofufuza momwe zinthu ziliri.
• Biomicroophthalmoscopy - magalasi okhudzana ndiubweya amagwiritsidwa ntchito pofufuza.
• Fluorescence angiography - chinthu chapadera chimalowetsedwa m'magazi a nkhaniyi, omwe amatha kuyatsa poyankha kuwunikira. Amakulolani kuti muwunikire kuchuluka kwa ma cellcirculation, kutulutsa kwamitsempha yamagazi, kukhalapo kwa ischemia, hemorrhage.
• Mgwirizano wogwirizira Tomography - imakupatsani mwayi wofufuza momwe kutupa.
• Echography - pogwiritsa ntchito njirayi kudziwa kuchuluka ndi kutulutsa kwa zinthu zam'kati mwa diso.
• EFI ndizovuta zomwe zimaphatikizapo maphunziro angapo. Amatilora kuti tifotokozere bwino za njira ya bioelectrogenesis ya zigawo za choroid zojambula zowonera.

Mfundo zachithandizo

Choyamba, ndikofunikira kusintha momwe magazi amayambira ndikulipirira boma chifukwa chodwala. Ndikofunika kuti magazi othamanga asakhale okwera kuposa 6 mmol / L, ndipo mulingo wa glycated hemoglobin ndi 6.5%.

Komanso, kusowa kwa matenda oopsa kumawerengedwa kuti ndi mfundo yofunika. Cholinga chachikulu cha odwala matenda ashuga ndi kuthamanga kwa magazi osati kupitirira 140/90 mm Hg. Kuti manambala achulukane, magulu ogwiritsira ntchito mankhwalawa amagwiritsidwa ntchito:

• ACE zoletsa - Captopril, Lisinopril.
• Ma calcium Antagonists - Verapamil, Tiapamil.
• Diuretics - Dichlothiazide, Furosemide.

Zizindikiro zachilendo za BP - cholumikizira pakuletsa retinopathy

Chilangizo cha Cholesterol

Mankhwala omwe agwiritsidwa ntchito pacholinga ichi amachititsa kuti pakhale malipiro a shuga mellitus ndikuchepetsa kukula ndi kupitilira kwa zovuta. Gwiritsani ntchito ndalama kuchokera ku gulu la ma statins (Lovastatin, Fluvastatin) ndi fibrate (Fenofibrate, Bezafibrat).

Kupititsa patsogolo magazi ndi magazi khoma

Matenda a shuga a retinopathy amaphatikizidwa ndi kuwonjezeka kwa kuphatikiza kwa maselo ambiri. Izi zikufotokoza kufunikira kwakukhazikitsidwa kwa ndalama zotsatirazi:

• Acetylsalicylic acid;
• Heparin;
• Sulodexide;
• Ticlopidine;
• Pentoxifylline.

Pofuna kusintha mamvekedwe a khoma la mtima, vitamini C, Rutozid, Pirikarbat, Etamzilat ndi omwe adayikidwa.

Antioxidants ndi kuphatikiza kagayidwe

Kugwiritsa ntchito vitamini E, methylethylpyridinol, Ginkgo biloba yotulutsa posachedwapa. Mankhwalawa ali ndi antioxidant momwe, amamangirira ndikuchotsa ma radicals omasuka m'thupi.

Njira zomwe zimasintha kagayidwe kachakudya mu retina (kothandizidwa ndi makolo, pakamwa komanso periocularly):

• Dihydroergocriptine;
• Inosine;
• youma zipatso za mabulosi abulu;
• zipatso za mabulosi abulu ndi beta-carotene.

Kutengeka kwa laser

Njirayi imadziwika kuti ndi imodzi yothandiza kwambiri pa matenda ashuga a retinopathy. Cholinga chake ndi:

• kutsekedwa kwa zigawo za ischemic;
• kuponderezedwa kwa mapangidwe atsopano a ziwiya zamatumbo;
• kutsekeka kwa lumen ya mtima kwa ma capillaries omwe achulukitsa kuchuluka kwa makhoma;
• mapangidwe a adhesions, kuchepetsa mwayi wa kufalikira.

Laser retinal coagulation - njira yothandiza yoletsa kupitilira kwa matendawa

Kupanga kumachitidwa ndi lason, solid-state kapena diode (infrared) laser. Pali njira zingapo zopangira laser, zomwe zimasiyana wina ndi mnzake ndicholinga chokwaniritsa, zikuwonetsa, maluso.

Panretinal coagulation

Ntchito mankhwalawa prroliferative ndi kuchuluka prinopathy zosiyanasiyana etiologies. Ma coagulates amayikidwa kumalo onse a choroid, kupatula Corpus luteum, kuti ateteze kapena kuchepetsa kuwoneka kwa ziwiya zatsopano. Izi zimatithandizira kuti tizitha kusintha madera amtundu wa retina omwe sanakhudzidwe ndi matenda.

Asananyengedwe, wodwalayo ayenera kudziwa kuti njirayi siyichita ndi cholinga chobwezeretsanso maonedwe, koma pofuna kupewa kupitilira kwake.

Chithandizo cha antiangiogenic

Njira yomwe mankhwalawa amaphatikizidwa mwachindunji mu vitreous. Pofuna kupewa neovascularization, angiogenesis blockers amagwiritsidwa ntchito. Zotsatira zake ndi kuchepa kwa edema m'thupi lachikasu.

Njira yake sikugwiritsidwa ntchito ngati njira ina. Chithandizo cha antiangiogenic chimawerengedwa kuti ndi gawo la zovuta mankhwala ndipo chimaphatikizidwa ndi laser coagulation kapena opaleshoni.

Vitrumomy

Kuthandizira opaleshoni ndikofunikira kuti muchepetse kupita patsogolo kwa njira ya pathological, komanso kukonza momwe wodwalayo akuvutikira. Vitungileomy sichimachitika mu milandu yotsatirayi:

• rubeosis ya Iris;
• sekondale yachiwiri yamkati;
• atrophy ya optic;
• corneal matenda;
• gawo lodziwika bwino;
• kuwonongeka kwa matenda ashuga komanso matenda ena mwatsatanetsatane.

Malinga ndi ophthalmologists, kukhazikika kwa ntchito za wofufuza wowonera pambuyo pa opaleshoni kumachitika mu 45% yamilandu, pomwe mwa odwala omwe samatsatira uphungu wa madokotala, 14% yokha.

Zithandizo za anthu

Kuchiza ndi wowerengeka azitsamba kumalola kuti musamangogwira ntchito zamagetsi, komanso kuti shuga ya magazi ikhalebe pakati pa zovomerezeka. Kugwiritsa ntchito bwino kunawonetsa nettle. Masamba atsopano amaphwanyidwa, ndikupeza madzi. Ndikofunikira kumwa gawo limodzi mwa magawo atatu agalasi katatu patsiku. Masamba a nettle amatha kuwonjezeredwa ku saladi, maphunziro oyamba.

Madzi a nettle - nyumba yosungiramo zinthu zofunikira osati odwala okha, komanso anthu athanzi

Zofananazo zimakhala ndi msuzi wa masamba a aloe. Asanachotse madzimadzi ochiritsa, masamba amayikidwa mufiriji kwa maola angapo. Kenako amaphwanyidwa, msuzi umapezeka, umawiritsa osaposa mphindi 3-4. Gwiritsani 1 tsp. katatu patsiku, usiku mutha kukoka m'maso (2 akutsikira aliyense).

Mutha kugwiritsa ntchito kulowetsedwa kwa mabuliberiya (kumwa pang'ono pang'onopang'ono tsiku lonse), msuzi wa lingonberry, mankhwala opangira mankhwala azitsamba.

Njira zopewera

Chofunikira ndikusungidwa kwa zizindikiro zovomerezeka za shuga, kuthamanga kwa magazi, kunenepa kwambiri. Izi zimakuthandizani kupewa kapena kuchedwetsa kukula kwa retinopathy, komanso zovuta zina zopweteka za matenda a shuga.

Kupewa ndi motere:

• kutsatira zakudya zamagulu ochepa;
• zolimbitsa thupi zokwanira;
• kuyendera pafupipafupi ndi ophthalmologist;
• munthawi yomweyo chithandizo cha matenda ndi magawo oyamba a zovuta.

Tsoka ilo, ndizosatheka kuchiritsa kusokonezeka, makamaka m'magawo apambuyo, ndipo ndizotheka kuteteza chitukuko chake, kusunga mawonekedwe owoneka ndi kuletsa kupititsa patsogolo. Chachikulu ndikutsatira upangiri ndi malingaliro a akatswiri ndipo ndichokhudza matenda oyambitsawa.