Zaka khumi zapitazi zimadziwika ndi kuwonjezeka-2 kwa chiwerengero cha odwala matenda ashuga padziko lapansi. Chimodzi mwazomwe chimayambitsa imfa mu matenda "okoma" ndi matenda a shuga. Pachaka, pafupifupi 400,000 odwala amakhala ndi vuto la kutha kwa impso, lomwe limafunikira hemodialysis ndi kupatsirana kwa impso.
Kupanikizika ndi njira yopitira pang'onopang'ono komanso yosasinthika (pa proteinuria), yomwe imafunikira kulowererapo ndikuwongolera komwe matenda ashuga. Chithandizo cha nephropathy mu shuga chikufotokozedwa m'nkhaniyi.
Zochitika Pang'onopang'ono Zakuwala
Mitundu yambiri ya shuga yomwe imadziwika ndi odwala ndi yomwe imapangitsa kuti pakhale zovuta. Ndi hyperglycemia yomwe imayambitsa zinthu zina:
- intracranial matenda oopsa (kuchuluka kwapanthawi mkati mwa impso);
- zokhudza zonse ochepa matenda oopsa (kuchuluka magazi okwanira);
- hyperlipidemia (kuchuluka kwamafuta m'magazi).
Ndi machitidwe awa omwe amatsogolera kuwonongeka kwa mawonekedwe a impso pamaselo a ma cell. Kugwiritsa ntchito zakudya zamapuloteni ambiri (omwe ali ndi nephropathy, kotero kuchuluka kwamapuloteni mumkodzo, komwe kumapangitsa kupitilira kwamphamvu kwa matenda) ndi kuchepa kwa magazi m'thupi kumawerengedwa kuti ndi zinthu zina zowonjezera.
Maonekedwe a mapuloteni mumkodzo ndi chizindikiro chotsogola cha matenda a shuga
Gulu
Gawoli lamakono la matenda a impso motsutsana ndi matenda ashuga lili ndi magawo asanu, awiri oyamba amawonedwa ngati anzeru, ndipo ena onse ndi azachipatala. Kuwonetsera kwamtsogolo ndi kusintha mwachindunji mu impso, palibe zodziwika bwino za matenda.
Katswiri angathe kudziwa:
- Hyperfiltration kwa impso;
- kukula kwa glomerular chapansi kupezeka;
- Kukula kwa masangial matrix.
M'magawo awa, palibe kusintha pakumveka kwamkodzo, kuthamanga kwa magazi kumakhala kwabwinobwino, palibe kusintha komwe kutchulidwa mu ziwiya za fundus. Kuchitapo kanthu kwakanthaŵi ndi kuikidwa kwa chithandizo kungabwezeretse thanzi la wodwalayo. Magawo awa amawonedwa ngati osinthika.
Magawo azachipatala:
- kuyambira matenda ashuga nephropathy;
- kwambiri matenda ashuga nephropathy;
- uremia.
Pre-dialysis chithandizo
Therapy imakhala ndikutsatira zakudya, kukonza kagayidwe kazinthu, kuchepetsa magazi, komanso kubwezeretsa mafuta kagayidwe. Chofunikira ndichakuti mukwaniritse chindapusa cha matenda ashuga kudzera mu mankhwala a insulin kapena kugwiritsa ntchito mankhwala ochepetsa shuga.
Nephrologist - katswiri yemwe amalimbana ndi mavuto a impso kwa odwala matenda a shuga
Mankhwala osagwiritsa ntchito mankhwala atengedwa motere:
- kuchuluka kwa zochitika zolimbitsa thupi, koma m'malo ochepa;
- kukana kusuta ndi kumwa mowa;
- Kuchepetsa kuchepa kwa zovuta;
- kusintha kwa malingaliro am'maganizo.
Chithandizo cha zakudya
Kuwongolera kwa zakudya sikungokhala kokha pakukana kudya zakudya zamafuta othamanga, zomwe zimakonda matenda a shuga, komanso motsatira mfundo za tebulo No. 7. Ndikulimbikitsidwa kudya zakudya zamagulu ochepa zamkati, zomwe zitha kudzaza thupi la wodwalayo ndizofunikira, mavitamini, komanso zinthu zina.
Kuchuluka kwa mapuloteni omwe amalandilidwa m'thupi sayenera kupitilira 1 g pa kilogalamu imodzi ya kulemera kwa thupi patsiku, ndikofunikanso kutsitsa milids ya lipids kuti athandizire kusintha kwamitsempha yamagazi, pochotsa cholesterol "yoyipa". Zotsatirazi ziyenera kukhala zochepa:
- buledi ndi pasitala;
- zakudya zamzitini;
- marinade;
- kusuta nyama;
- mchere;
- zamadzimadzi (mpaka 1 lita imodzi);
- misuzi;
- nyama, mazira, mafuta.
Kutsatira zakudya zama protein ochepa ndizomwe mungagwiritse ntchito nephropathy
Zakudya zotere zimapangidwa panthawi yobala mwana, ndimatenda amtundu wa matenda opatsirana, ali mwana.
Kukonza shuga kwamwazi
Popeza ndi glycemia wokwera kwambiri yomwe imawoneka kuti ndiyomwe imayambitsa chitukuko cha matenda ashuga, ndikofunikira kuchita zonse zowonetsetsa kuti shuga ali mgulu lololedwa.
Chizindikiro pamwambapa 7% chololedwa kwa odwala omwe ali pachiwopsezo chachikulu chotenga matenda a hypoglycemic, komanso kwa odwala omwe ali ndi matenda a mtima ndipo chiyembekezo chawo cha moyo amayembekezeredwa.
Ndi mankhwala a insulin, kukonza kwa vutoli kumachitika ndi kuwunika kwa mankhwalawa omwe amagwiritsidwa ntchito, kayendetsedwe kake komanso mitundu ya mankhwala. Njira yabwino kwambiri imawonetsedwa kuti ndi jakisoni wa insulin yayitali pakanthawi 1-2 patsiku komanso mankhwala "achidule" musanadye chilichonse mthupi.
Mankhwala ochepetsa shuga a mankhwalawa odwala matenda ashuga nephropathy nawonso amagwiritsidwa ntchito. Mukamasankha, ndikofunikira kulingalira njira zochotsa zinthu zogwira ntchito mthupi la wodwalayo ndi pharmacodynamics ya mankhwala.
Mfundo zofunika
Malangizo amakono a akatswiri:
Matenda a shuga Angiopathy- Biguanides sagwiritsidwa ntchito chifukwa cha kulephera kwa impso chifukwa choika lactic acidosis chikomokere.
- Thiazolinediones satchulidwa chifukwa chakuti amachititsa kuti madzi azisungika m'thupi.
- Glibenclamide ingayambitse kuchepa kwakukulu kwa shuga m'magazi chifukwa cha matenda a impso.
- Ndi yankho lachilendo la thupi, Repaglinide, Gliclazide amaloledwa. Pokhapokha kugwira ntchito, mankhwala a insulin amasonyezedwa.
Kuwongolera kwa magazi
Kugwira bwino ntchito sikuchepera 140/85 mm Hg. Art., Komabe, manambala ndi ochepera 120/70 mm RT. Art. Tiyeneranso kupewa. Choyamba, magulu otsatirawa a mankhwalawa ndi omwe amamuyimira amagwiritsidwa ntchito pochiza:
- Zoletsa za ACE - Lisinopril, enalapril;
- angiotensin receptor blockers - Losartan, Olmesartan;
- saluretics - Furosemide, Indapamide;
- calcium blockers - Verapamil.
Kuwongolera kwa chiwonetsero cha kuthamanga kwa magazi - gawo logwira mtima la mankhwala
Zofunika! Magulu awiri oyambawa amatha kusintha wina ndi mzake pamaso pa anthu ochita kusintha pakakhala magawo omwe amagwira ntchito.
Malangizo a zovuta zama metabolism
Odwala omwe ali ndi matenda a shuga, matenda a impso ndi dyslipidemia amakhala ndi chiopsezo chachikulu cha matenda a mtima ndi mitsempha yamagazi. Ndiye chifukwa chake akatswiri amalimbikitsa kukonza zizindikiritso zamafuta amwazi m'malo mwa matenda "okoma".
Mfundo Zotsimikizika:
- kwa cholesterol - ochepera 4.6 mmol / l;
- kwa triglycerides - osakwana 2.6 mmol / l, komanso matenda a mtima ndi mitsempha yamagazi - osakwana 1.7 mmol / l.
Mankhwalawa amagwiritsa ntchito magulu awiri akuluakulu a mankhwalawa: ma statins ndi ma fibrate. Chithandizo cha Statin chimayamba pomwe ma cholesterol afika 3,6 mmol / l (malinga ngati palibe matenda m'thupi). Ngati pali ma concomitant pathologies, chithandizo chikuyenera kuyamba ndi mfundo zilizonse za cholesterol.
Madera
Amaphatikizapo mibadwo ingapo yamankhwala (Lovastatin, Fluvastatin, Atorvastatin, Rosuvastatin). Mankhwala osokoneza bongo amatha kuchotsa cholesterol yowonjezereka m'thupi, kuchepetsa LDL.
Atorvastatin - nthumwi ya mankhwala opatsirana ndi lipid
Statins amalepheretsa ma enzyme enaake omwe amayang'anira kupanga mafuta m'thupi m'chiwindi. Komanso, mankhwalawa amachulukitsa kuchuluka kwa maselo otsika a lipoprotein m'maselo, zomwe zimabweretsa kutulutsa kwakukulu kwa thupi.
Fibates
Gululi la mankhwalawa lili ndi njira zingapo zochitira. Zinthu zomwe zimagwira zimatha kusintha kayendedwe ka cholesterol pamtundu wa gene. Oimira:
- Fenofibrate;
- Clofibrate;
- Waprofibrate.
Kukonzanso kwa Filter Permeability
Umboni wamankhwala umati kusinthidwa kwa shuga wamagazi ndi kusamalidwa kwambiri sikungalepheretse nthawi zonse kukula kwa albuminuria (mkhalidwe womwe mapuloteni amawonekera mumkodzo, omwe sayenera kukhala).
Monga lamulo, nephroprotector Sulodexide ndi mankhwala. Mankhwalawa amagwiritsidwa ntchito kuti abwezeretse kupezekanso kwa impso glomeruli, zomwe zimapangitsa kuchepa kwa mapuloteni obwera kuchokera mthupi. Mankhwala a Sulodexide akuwonetsedwa miyezi isanu ndi umodzi iliyonse.
Electrolyte bwino kuchira
Njira zotsatirazi zochizira zimagwiritsidwa ntchito:
- Kulimbana ndi milingo yayikulu ya potaziyamu m'magazi. Gwiritsani ntchito yankho la calcium gluconate, insulin yokhala ndi shuga, sodium bicarbonate solution. Kusakwanira kwa mankhwala ndi chizindikiro cha hemodialysis.
- Kuthetsa azotemia (kuchuluka kwa zinthu za nayitrogeni m'magazi). Enterosorbents (mpweya wothandizidwa, Povidone, Enterodeum) ndi omwe amapatsidwa.
- Kuwongolera milingo yayikulu ya phosphate ndi kuchuluka kwa calcium. Yankho la calcium carbonate, iron sulfate, Epoetin-beta limayambitsidwa.
Kulowetsedwa mankhwala ndi gawo limodzi la matenda a matenda ashuga nephropathy
Chithandizo cha odwala siteji ya nephropathy
Mankhwala amakono amapereka njira zitatu zazikulu zochizira mu gawo lomaliza la kulephera kwa impso, komwe kungatalikitse moyo wa wodwalayo. Izi zikuphatikizapo hemodialysis, peritoneal dialysis ndi kupatsirana kwa impso.
Kudina
Njira imapangidwa poyeretsa magazi pamagazi. Pachifukwa ichi, adotolo amakonzekeretsa mwayi wamitsempha womwe magazi amatengedwa. Kenako imalowetsa zida "zopangira impso", pomwe zimatsukidwa, kuphatikizidwa ndi zinthu zofunikira, komanso kubwerera mthupi.
Ubwino wa njirayi ndi kusowa kwa kufunika kwa tsiku ndi tsiku (nthawi zambiri kawiri pa sabata), wodwalayo amakhala akuyang'aniridwa ndi achipatala nthawi zonse. Njirayi imapezeka ngakhale kwa odwala omwe sangathe kudzipulumutsa.
Zoyipa:
- nkovuta kupereka ma venous, chifukwa mabwatowa ndi osalimba;
- zovuta kuyang'anira kuthamanga kwa magazi;
- kuwonongeka kwa mtima ndi mitsempha yamagazi kumapita patsogolo mwachangu;
- ndizovuta kuyang'anira kuchuluka kwa shuga m'magazi;
- wodwalayo amakhala kuchipatala kwamuyaya.
Peritoneal dialysis
Njira zamtunduwu zitha kuchitidwa ndi wodwala. Catheter imayikidwa mu pelvis yaying'ono kudzera khoma lamkati lakunja, lomwe limasiyidwa kwa nthawi yayitali. Kudzera mu catheter iyi, kulowetsedwa ndikutulutsa yankho linalake kumachitika, yomwe imafanana ndi plasma ya magazi.
Zoyipa ndizofunikira pakuwonetsera kwatsiku ndi tsiku, kulephera kuchita bwino ndi kuchepa kowoneka bwino kwa chidwi, komanso ngozi yomwe ingayambike chifukwa cha kutupa kwa peritoneum.
Kupatsira impso
Kuthamangitsidwa kumaonedwa ngati chithandizo chodula, koma chothandiza kwambiri. Pogwira ntchito poika zina, kuthetseratu matenda a impso ndikotheka, chiopsezo chotenga zovuta zina za matenda a shuga (mwachitsanzo, retinopathy) zimachepa.
Kuika - njira yothanirana ndi gawo la zovuta
Odwala amachira msanga atachitidwa opaleshoni. Kupulumuka mchaka choyamba kuli pamwamba pa 93%.
Zoyipa zakusintha ndi:
- chiwopsezo chakuti thupi lidzakana cholocha chija;
- motsutsana ndi kagwiritsidwe ntchito ka mankhwala a steroid, nkovuta kutsata kagayidwe kachakudya mthupi;
- chiopsezo chachikulu chotenga zovuta za matenda opatsirana.
Pambuyo kanthawi, matenda ashuga nephropathy amathanso kukhudzana.
Ziwonetsero
Mankhwala a insulin kapena kugwiritsa ntchito mankhwala ochepetsa shuga amachepetsa chiopsezo cha matenda ashuga ndi 55%. Izi zimakupatsaninso mwayi wolipirira matenda a shuga, omwe amalepheretsa zovuta zina zamatenda. Chiwerengero chaimfa chimachepetsa kwambiri chithandizo choyambirira ndi ACE inhibitors.
Kuthekera kwa mankhwala amakono kumatha kusintha moyo wa odwala omwe ali ndi vuto la impso. Mukamapanga kuyeretsa kochokera m'magazi a Hardware, kuchuluka kwa kupulumukirako kumafika pa 55% pazaka 5, ndipo pambuyo pakufalikira kwa chiwindi, pafupifupi 80% munthawi yomweyo.
