Kuthamanga kwa magazi kwa odwala matenda ashuga

Hypertension ndi mkhalidwe momwe kuthamanga kwa magazi kudutsa malire onse abwinobwino (140/90) ndipo munthawi yomweyo "mawonekedwe" ake a spasmodic amadziwika mwadongosolo. Kupanikizika kwa matenda ashuga ndi owopsa makamaka, chifukwa zoopsa zomwe zimapangitsa kuti munthu akhale ndi matenda osokoneza bongo, matenda opha ziwalo, matenda am'mimba am'munsi komanso matenda ena amawonjezeka kangapo. Chifukwa chake, tikulimbikitsidwa kuti wodwala matenda ashuga azisamala osati kuchuluka kwa shuga m'magazi, komanso kukakamizidwa.

Zifukwa zachitukuko

Matenda a shuga ndi kupsinjika ndi matenda omwe nthawi zambiri amathandizana. Komanso, chomwe chimayambitsa matenda oopsa mu T1DM ndi matenda ashuga nephropathy, omwe amadziwika ndi kuwonongeka kwa impso komanso kusokonekera kwa magwiridwe antchito.

Zomwe zimapangitsa kupachika magazi mu matendawo zitha kukhalanso:

• kuchuluka kwa ziwiya za impso;
• chofunikira kapena chapadera systolic matenda oopsa;
• zovuta za endocrine.

Ponena za zovuta za endocrine m'thupi zomwe zimayambitsa chitukuko cha matenda oopsa mu shuga, ambiri omwe ali pakati pawo ndi awa:

• Itsenko-Cushing's syndrome;
• pheochromocytoma;
• hyperaldosteronism ndi ena.

Kuphatikiza apo, kuthamanga kwa magazi mu T1DM ndi T2DM kuonedwa:

• ndi kuperewera m'thupi la chinthu choterocho monga magnesium;
• kusokonezeka kwamaganizidwe komwe kumachitika motsutsana ndi maziko a zopsinjika pafupipafupi, kupsinjika kwa malingaliro, mayiko okhumudwitsa, ndi ena;
• kukhudzana ndi zinthu zoopsa (mwachitsanzo, mercury, lead kapena cadmium);
• atherosulinosis, kupangitsa kupindika kwa mitsempha yayikulu.

Kukakamizidwa ku T1

Monga tafotokozera pamwambapa, choyambitsa chachikulu cha matenda oopsa mu mtundu 1 wa shuga ndi matenda a shuga, omwe amadziwika ndi kuwonongeka kwa impso. Monga mawerengero adziko lonse lapansi akuwonetsa, kudutsaku kumachitika pafupifupi 40% ya odwala ndipo amadutsa m'magawo angapo:

• yoyamba imadziwika ndi mawonekedwe mu mkodzo wa tinthu tating'onoting'ono ta proteinin;
• Lachiwiri limawonetsedwa ndi kuwonongeka kwa impso ndi mawonekedwe a mkodzo wa mapuloteni akuluakulu a proteinin;
• lachitatu limadziwika ndi kuchepa mphamvu kwa impso ndi kukula kwa matenda aimpso.

Zotsatira za matenda oopsa

Impso zikagwira bwino ntchito, kuchoka kwa sodium m'thupi kumasokonezeka. Amayikidwa m'magazi, ndipo kuti athyole, madzi amayamba kudziunjikira m'matumbo. Kuchulukitsa kwake kumayambitsa kupanikizika kwambiri pazitseko zamitsempha yamagazi, zomwe zimakweza magazi.

Kuchuluka kwa glucose m'magazi kumapangitsa kuti madzi amitsempha azikhala ochulukirapo. Uku ndikudzitchinjiriza kwachilengedwe kwa thupi ndipo kumachitika ndi cholinga chofupikitsa magazi, popeza shuga ndi sodium zimapangitsa kuti ukhale wonenepa. Chifukwa cha njirazi zonsezi, kuchuluka kwa magazi ozungulira kumawonjezeka ndipo kuthamanga kwa magazi kumakwera pafupipafupi.

Izi, zimakhudzanso kugwira ntchito kwa impso, popeza ndi omwe amadutsa magazi okha, akukumana ndi zovuta zambiri. Kuchuluka kwa kuchuluka kwa magazi kumayambitsa kuchuluka kwa ziwalo mkati mwa ziwalo glomeruli, chifukwa zimatha pang'onopang'ono ndipo nthawi iliyonse impso zimayamba kukulira.

Monga lamulo, mankhwala otsatirawa amagwiritsidwa ntchito pochiza matenda oopsa m'magazi a shuga ndi nephropathy:

• mankhwala omwe amachepetsa shuga;
• ACE zoletsa;
• mankhwala okodzetsa;
• angiotensin receptor blockers.

Tiyenera kudziwa kuti mankhwalawa amathandizidwa mosiyanasiyana ndipo zimatengera zinthu zingapo:

• kuopsa kwa matenda ashuga;
• kuchuluka kwa matenda a shuga;
• kukhalapo kwa matenda ena wodwala.

Kukakamizidwa ku T2

Matenda a 2 a shuga amayamba pang'onopang'ono. Ndipo magawo oyambirira a chitukuko chake, pakachepa kuchepa kwa minyewa, insulin, odwala nthawi zambiri amakhala ndi kuthamanga kwa magazi. Chomwe chimapangitsa izi ndi kuchuluka kwa insulin m'magazi, yomwe pakokha imayambitsa kupezeka kwa magazi.

Mavuto a kagayidwe kachakudya matenda

Ndi nthawi yayitali ya T2DM, minyewa yam'mimba imachepa, yomwe imayamba chifukwa cha matenda opatsirana monga atherosulinosis. Mofanananso ndi izi, pamimba pamakhala kuchuluka kwa maselo amafuta omwe amatsekanso magazi, potero amawonjezera kufalikira kwake ndikuwonjezera kuthamanga kwa magazi.

Njira zonsezi zomwe zimachitika mthupi ndimankhwala zimatchedwa metabolic syndrome. Ndipo likukhalira kuti chitukuko cha matenda oopsa pankhaniyi chimayamba kale kwambiri kusiyana ndi mtundu wachiwiri wa matenda ashuga womwe umawonekera.

Kuchuluka kwa insulin m'mwazi kumakhalanso ndi dzina lake lovomerezeka - hyperinsulinism, lomwe limachitika chifukwa cha kukana insulini. Zikondazo, zomwe zimaphatikizidwa ndikupanga insulin, zimayamba kugwira ntchito mwachangu, "zimatopa" ndipo zimaleka kuthana ndi ntchito zake, zomwe zimayambitsa kukula kwa matenda ashuga amtundu wa 2.

Hyperinsulinism ikachitika m'thupi, zotsatirazi zimachitika:

• CNS ndi yokondwa;
• Mphamvu ya impso imachepa, zomwe zimabweretsa kudzikundikira kwa sodium m'thupi;
• kuchuluka kwa insulini m'magazi kumakuza makoma amitsempha yamagazi ndikuwachepetsa.

Kuyendetsa magazi m'magazi kumakupatsani mwayi wolamulira magazi

Njira zonsezi zimadzetsa kuchuluka kwa magazi komanso kuwonongeka konsekonse mu thanzi. Komabe, pankhaniyi, ngati wodwalayo angafunse adokotala ndikuyamba kulandira chithandizo, kuthamanga kwa matenda oopsa ndi matenda a shuga 2 kungapeweke. Komanso, ndizosavuta kuchita kuposa SD1. Ingotsatirani zakudya zamafuta ochepa komanso kumwa mapiritsi okodzetsa.

Mawonekedwe a kuthamanga kwa magazi mu shuga

Mwa munthu wathanzi, kuchepa kwa magazi kumachitika pokhapokha m'mawa ndi madzulo. Ndi matenda a shuga, amalumpha tsiku lonse. Komanso, usiku odwala matenda ashuga, kupanikizika kumakula kwambiri kuposa m'mawa.

Monga asayansi akusonyeza, izi zimachitika chifukwa cha matenda a shuga. Izi ndichifukwa choti kuchuluka kwambiri kwa glucose m'magazi kumasokoneza ntchito ya mtima wamanjenje, yomwe imayang'anira ntchito yofunikira ya thupi. Zotsatira zake, mamvekedwe am'mimba amachepa ndipo malingana ndi katundu, amayamba kuchepa kapena kumasuka.

Ndipo mwachidule, ziyenera kudziwika kuti ngati matenda ashuga amaphatikizidwa ndi matenda oopsa, kuthamanga kwa magazi sikuyenera kuyesedwa katatu patsiku, koma tsiku lonse, panthawi zina. Mutha kugwiritsanso ntchito kuwunikira, komwe kumachitika m'malo ogwiritsira ntchito zida zapadera.

Matenda a shuga ndi matenda oopsa nthawi zambiri amakhala limodzi ndi matenda ena omwe amafunikira chithandizo mosiyana.

Kuphatikiza pa matenda oopsa, odwala matenda ashuga nthawi zambiri amakhala ndi orthostatic hypotension, yomwe imadziwika ndi kuchepa kwambiri kwa magazi. Izi zimachitika makamaka pamene wodwala asintha mawonekedwe ake (mwachitsanzo, kuchoka pa kukhala wokhala pomwepo). Vutoli limadziwoneka ndi chizungulire, "goosebumps" patsogolo pa maso, mawonekedwe a mabwalo amdima pansi pamaso, akukomoka.

Orthostatic hypotension imapezekanso motsutsana ndi maziko a chitukuko cha matenda ashuga komanso kuwonongeka kwa kuthekera kwa kuwongolera kamvekedwe ka mtima. Mu nthawi ngati izi munthu akakwera kwambiri, katundu pa thupi lake amadzuka pomwepo, chifukwa chomwe alibe nthawi yowonjezera magazi, zomwe zimawonetsedwa ndi kuchepa kwa magazi.

Chikhalidwe cha kuthamanga kwa magazi mu shuga

Pofuna kuchepetsa kuthamanga kwa magazi, madokotala amatipatsa mankhwala ena apadera. Koma muyenera kuzitenga mosamala kwambiri. Chowonadi ndi chakuti kuchepa kwambiri kwa kuthamanga kwa magazi kumatha kuvulaza mkhalidwe wa wodwalayo, zomwe zingasokoneze mkhalidwe wamtima wamtima.

Kodi matenda amtundu wa 2 angachiritsidwe?

Chifukwa chake, chithandizo cha matenda oopsa chiyenera kuchitika pang'onopang'ono. Poyamba, muyenera kukhazikitsa cholinga, kuchepetsa kuthamanga kwa magazi kufika ku 140/90 mm RT. Art. Izi zikuyenera kuchitika pakadutsa milungu 4 yoyambirira. Ngati wodwala akumva bwino komanso alibe mavuto kuchokera ku mankhwala, ndiye kuti mankhwalawa apamwamba kwambiri amagwiritsidwa ntchito pochepetsa kuthamanga kwa magazi kufika pa 130/80 mm Hg. Art.

Ngati, akalandira chithandizo chamankhwala, wodwalayo akuwoneka bwino, kuchepa kwa magazi kuyenera kuchitika pang'onopang'ono. Ngati kumwa mankhwala kwapangitsa kuti pakhale hypotension, othandizira amagwiritsidwa ntchito omwe angakulitse magazi. Koma ziyeneranso kugwiritsidwa ntchito mosamala komanso mwaukadaulo wokhazikitsidwa ndi adokotala.

Chithandizo cha matenda oopsa mu shuga

Ndi mankhwala ati omwe amayenera kuchepetsedwa kuthamanga kwa magazi m'magazi a shuga, adokotala okha ndi omwe amasankha. Monga achire othandizira, mankhwalawa osiyanasiyana osiyanasiyana amatha kugwiritsidwa ntchito.

Mfundo zofunika kwambiri zochizira matenda oopsa mu shuga

Zodzikongoletsera

Mwa mankhwala a diuretic omwe amagwiritsidwa ntchito pochiza matenda oopsa, omwe ali ambiri ndi awa:

• Furosemide;
• Mannitol;
• Amiloride;
• Torasemide;
• Diacarb.

Pankhaniyi, okodzetsa amapereka zabwino kwambiri zochizira. Amapereka kuchotsedwa kwa madzi owonjezera kuchokera mthupi, potero amachepetsa kuchuluka kwa magazi ndi kukakamiza kwa makoma amitsempha yamagazi.

Beta blockers

Anthu odwala matenda ashuga amawayikidwa ngati wodwala ali ndi:

• matenda a mtima;
• nthawi ya infaration;
• sitiroko.

Ndi mikhalidwe yonseyi, kuthamanga kwa magazi kungayambitse kufa mwadzidzidzi. Kuchita kwa beta-blockers ndikofunikira kukulitsa mitsempha yamagazi ndikuwonjezera chidwi cha minofu kuti insulin. Chifukwa cha izi, zochizira ziwiri zimachitika nthawi imodzi - matenda a kuthamanga kwa magazi ndi kuchuluka kwa shuga m'magazi.

Kutenga beta blockers kumachepetsa chiopsezo cha stroke komanso myocardial infarction

Mpaka pano, otsatsa beta-blockers nthawi zambiri amagwiritsidwa ntchito ngati mankhwala ochizira matenda oopsa mu shuga:

• Tikiti yopanda tikiti;
• Coriol.
• Carvedilol.

Dziwani kuti palinso opanga ma beta pamsika wamankhwala omwe alibe mankhwala osokoneza bongo. Ndi zoletsedwa kotheratu kuzitenga ndi matenda ashuga, chifukwa zimachulukitsa kukana kwa insulin, komanso zimadzetsa kuchuluka kwa cholesterol "yoyipa" m'magazi, zomwe zimapangitsa kuti matenda ayambe kudwala komanso zovuta zina.

Calcium calcium blockers

Izi ndi monga mankhwalawa:

• Amlodipine;
• Nifedipine;
• Lacidipine;
• Verapamil;
• Isredipine.

Mankhwalawa ali ndi phindu pakubwera kwa magazi ndipo amapereka chitetezo chodalirika ku impso, chifukwa chake nthawi zambiri amalembedwa kwa odwala omwe ali ndi matenda ashuga. Ma calcium calcium blockers alibe nephroprotective zotsatira ndipo angagwiritsidwe ntchito limodzi ndi ACE inhibitors ndi angiotensin-II receptor blockers.

Mankhwala ena ochizira matenda oopsa mu shuga

Monga achire othandizira angagwiritsidwenso ntchito:

• ACE zoletsa;
• angiotensin-II receptor blockers;
• alpha adrenergic blockers.

Kuphatikiza apo, madyerero awo amayenera kugwiritsidwa ntchito pophatikiza zakudya zochizira, zomwe sizikuphatikiza ndi zakudya zomwe zimapakidwa mchere, wokazinga, wosuta, wamafuta, ufa ndi mbale zotsekemera. Ngati munthu azitsatira malingaliro onse a dokotala, amatha kuthana ndi matenda oopsa osokoneza bongo ndikuwongolera shuga.