Lemberani mankhwala a shuga atatu

Vuto lomwe kuchuluka kwa kuthamanga kwa magazi kumapitilira malire ovomerezeka amatchedwa matenda oopsa. Monga lamulo, tikulankhula za 140 mm RT. Art. kupanikizika kwa systolic ndi 90 mm RT. Art. diastolic. Hypertension ndi matenda a shuga ndi njira zomwe zimatha kukhalira limodzi, kulimbikitsa zovuta zoyipa.

Kuwonjezeka kwa kuthamanga kwa magazi motsutsana ndi nthenda ya "matenda okoma", chiopsezo chotenga matenda amtima, kulephera kwa impso, khungu ndi vuto la m'munsi kwambiri zimawonjezeka kasanu. Ndikofunikira kuti manambala azikhala ovomerezeka. Kuti izi zitheke, madokotala amalimbikitsa kudya komanso kupereka mankhwala. Kodi mapiritsi opanikizika omwe amapatsidwa mtundu wa shuga 2, ndi ziti zomwe amagwiritsa ntchito, akufotokozedwa m'nkhaniyi.

Chifukwa chiyani kuthamanga kwa magazi kumabuka ndi matenda ashuga?

Mitundu yosiyanasiyana ya "matenda okoma" ili ndi njira zosiyanasiyana zopangira matenda oopsa. Mtundu wodalira insulini umaphatikizidwa ndi kuchuluka kwa kuthamanga kwa magazi motsutsana ndi zotupa za glomerular. Mtundu wosadalira insulini umawonekera makamaka mu matenda oopsa, ngakhale chizindikiro chazomwe chimayambira matenda akuluakulu chisanaonekere, popeza kuthamangitsidwa kwakukulu ndi gawo limodzi la zomwe zimadziwika kuti metabolic syndrome.

Matenda osiyanasiyana a matenda oopsa opezeka kumbuyo kwa mtundu wachiwiri wa matenda ashuga:

• mawonekedwe oyamba - amapezeka mu wodwala aliyense wachitatu;
• mawonekedwe apadera a systolic - amakula mwa odwala okalamba, amadziwika ndi manambala abwinobwino komanso ambiri apamwamba (mu 40% ya odwala);
• matenda oopsa pa maziko a kuwonongeka kwa impso - 13-18% ya milandu yamankhwala;
• kuthamanga kwa magazi mu matenda a adrenal gland (chotupa, Itsenko-Cushing's syndrome) - 2%.

Mtundu wa shuga wosadalira insulini umadziwika ndi kukana insulini, ndiye kuti, kapamba amatulutsa kuchuluka kokwanira ka insulini (chinthu chogwiritsa ntchito mahomoni), koma maselo ndi minyewa yomwe imafulumira kuzungulira thupi. Njira zopangira zamagetsi zimapangidwira kuphatikiza mahomoni aphatikizidwe, omwe mwa iwo eni amawonjezera kukakamiza.

Mu shuga mellitus, kuwunika kwa zizindikiro zofunika kumayenera kuchitika pafupipafupi monga kuchuluka kwa shuga

Izi zimachitika motere:

• pali kukhazikitsidwa kwa dipatimenti yachifundo ya National Assembly;
• chimbudzi cha madzi amchere ndi mchere womwe umachitika chifukwa cha impso;
• mchere ndi ayoni a calcium amasonkhana m'maselo a thupi;
• hyperinsulinism imakwiyitsa zimachitika zosokoneza za elasticity mitsempha.

Ndi kukula kwa matenda oyamba, zotumphukira ndi ziwalo zamatumbo zimavutika. Mapilogalamu amayikidwa mkati mwake, zomwe zimayambitsa kuchepetsedwa kwa minyewa yam'mimba komanso kukula kwa atherosulinosis. Ichi ndi cholumikizira china pamakina oyambira matenda oopsa.

Kuphatikiza apo, thupi la wodwalayo limakulirakulira, makamaka zikafika pamafuta omwe amayikidwa kuzungulira ziwalo zamkati. Lipids zoterezi zimatulutsa zinthu zingapo zomwe zimapangitsa kuti magazi azitha.

Ndi anthu angati omwe akuapanikizika akufunika kutsitsidwa?

Anthu odwala matenda ashuga - odwala omwe ali pachiwopsezo chotenga ma pathologies ochokera mu minofu ya mtima ndi mitsempha yamagazi. Ngati odwala alabadira bwino chithandizo, m'masiku 30 oyambirira a mankhwala, ndikofunikira kuchepetsa kuthamanga kwa magazi mpaka 140/90 mm Hg. Art. Chotsatira, muyenera kuyesetsa kuwerengetsa kwa masentimita a 130 mm Hg. Art. ndi diastolic - 80 mm RT. Art.

Ngati wodwala akulephera kulolera mankhwala, siyani kuthamanga kwambiri, pang'onopang'ono, pafupifupi 10% kuchokera pamasiku oyamba m'masiku 30. Ndi kusinthasintha, regimen ya mlingo amawunikiranso, ndizotheka kuwonjezera kuchuluka kwa mankhwalawa.

Malangizo amathandizidwa ndi katswiri woyenera, yemwe amadzisankhira yekha mankhwala osavomerezeka

Kugwiritsa ntchito mankhwala osokoneza bongo

Kusankhidwa kwa mankhwala ochiritsira kumachitika ndi katswiri woyenera yemwe akufotokozera mfundo izi:

• mulingo wa glycemia wodwala;
• Zizindikiro zamagazi;
• Mankhwala omwe amagwiritsidwa ntchito pofuna kulipiritsa zomwe zimayambitsa matenda;
• kukhalapo kwa zovuta zamafuta a impso, zojambula zowonera;
• matenda ophatikizika.

Mankhwala othandiza kupanikizika mu matenda ashuga amayenera kuchepetsa zizindikiro kuti thupi la wodwalayo liyankhe popanda kukulitsa zovuta ndi zovuta. Kuphatikiza apo, mankhwalawa amayenera kuphatikizidwa ndi othandizira a hypoglycemic, osakhala ndi vuto lililonse pakumeta kwa lipid. Mankhwala ayenera "kuteteza" zida zaimpso ndi minofu ya mtima pazotsatira zoyipa za matenda oopsa.

Mankhwala amakono amagwiritsa ntchito magulu angapo a mankhwala:

• mankhwala okodzetsa;
• ARB-II;
• ACE zoletsa;
• BKK;
• β-blockers.

Mankhwala owonjezera amatengedwa ngati α-blockers ndi Rasilez.

ACE zoletsa

Ndalamazi zimaperekedwa koyamba. Zinthu zomwe zimagwira gululi zimalepheretsa kupanga enzyme yomwe imalimbikitsa kapangidwe ka angiotensin-II. Zinthu zomaliza zimakwiyitsa kuchepa kwa ma arterioles ndi ma capillaries ndipo zimapereka chidziwitso ku gren ya adrenal yomwe muyenera kusunga madzi ndi mchere m'thupi. Zotsatira zamankhwala ndizotsatira: Madzi ndi mchere wambiri zimapukusidwa, mitsempha yamagazi imakulitsidwa, ziwopsezo zimachepa.

Chifukwa chiyani madokotala amalimbikitsa gululi kwa odwala:

• Mankhwala amateteza impso ku mavuto obwera chifukwa cha matenda oopsa;
• kuletsa kupitilira kuwonongeka kwa zida za impso ngakhale pang'ono mapuloteni mu mkodzo aonekera kale;
• HELL sikugwa pansi mwachizolowezi;
• Mankhwala ena amateteza minofu ya mtima ndi ziwiya za mtima;
• Mankhwala kukhathamiritsa mphamvu ya maselo ndi zimakhala kuti zochita insulin.

Kuchiza ndi zoletsa za ACE kumafuna kuti wodwalayo akane mchere kwathunthu m'zakudya. Onetsetsani kuti mukuwunika ma elekitirodi a magazi m'magazi (potaziyamu, makamaka).

Mndandanda wa oimira gululi:

• Enalapril;
• Captopril;
• Lisinopril;
• Fosinopril;
• Spirapril et al.

Enalapril - m'modzi mwa oimira gululi, wodziwika bwino kwa odwala matenda ashuga ambiri

Mwina kugwiritsidwa ntchito kovuta kwa ACE inhibitors ndi oimira mankhwala a diuretic. Izi zimapereka kuchepa kwamphamvu kwa kuthamanga kwa magazi, chifukwa chake amaloledwa kokha kwa odwala omwe amalabadira bwino mankhwalawo.

Zodzikongoletsera

Ngati pakufunika kugwiritsa ntchito gululi, muyenera kusankha oyimilira omwe ali ndi zotsatira zabwino kwambiri. Sikoyenera "kuchita nawo" zodzikongoletsa, chifukwa amachotsa mphamvu kwambiri m'miyendo ya potaziyamu, amakonda kusunga calcium, ndikuwonjezera kuchuluka kwa cholesterol m'magazi.

Ma diuretics amatengedwa ngati mankhwala omwe amaletsa chiwonetsero cha matenda oopsa, koma osachotsa zomwe zimayambitsa. Pali magulu angapo am'magazi a diuretic mankhwala. Madokotala amalemekeza kwambiri thiazides - amatha kuchepetsa chiopsezo cha kuwonongeka kwa minofu ya mtima chifukwa cha kuthamanga kwa magazi ndi kotala. Ndi gulu ili lomwe limagwiritsidwa ntchito pochiza matenda oopsa motsutsana ndi mtundu wa matenda a shuga 2.

Mlingo wocheperako wa thiazides samakhudza kuthekera kopezera chipukuta cha "matenda okoma", osasokoneza njira za lipid metabolism. Thiazides amatsutsana mu kulephera kwa impso. Amasinthidwa ndi loop diuretics, makamaka pamaso pa edema m'thupi la wodwalayo.

Β-blockers

Oimira gulu agawidwa m'magulu angapo. Ngati wodwala adalandira chithandizo cha β-blocker, amatha nthawi yayitali kuti amvetsetse gulu lawo. β-blockers ndi mankhwala omwe amakhudza β-adrenergic receptors. Zotsirizirazi ndi za mitundu iwiri:

• β1 - amapezeka mu minofu ya mtima, impso;
• β2 - yotchulidwa mu bronchi, pa hepatocytes.

Oimira osankhidwa a β-blockers amachita mwachindunji pa β1-adrenergic receptors, osati osankha pamagulu onse a receptors a cell. Magulu onse awiriwa ndi othandizanso polimbana ndi kuthamanga kwa magazi, koma mankhwala osankhidwa amadziwika ndi zovuta zochepa zomwe zimachitika m'thupi la wodwalayo. Amalimbikitsidwa odwala matenda ashuga.

Mankhwala a gulu amagwiritsidwa ntchito motere:

• Matenda a mtima a Ischemic;
• kuchepa kwa mtima;
• pachimake pambuyo kugunda kwa mtima.

Ndi insulin-yodziyimira pawokha ya matenda a shuga, mitundu yotsatirayi yogwiritsidwa ntchito ngati mankhwala kukakamiza:

• Tikiti yopanda tikiti;
• Coriol;
• Carvedilol.

Musanagwiritse ntchito, ndikofunikira kuwerenga malangizo a mankhwalawa

BKK (olimbana ndi calcium)

Mankhwala a gulu agawidwa m'magulu akulu awiri:

• non-dihydropyridine BCC (Verapamil, Diltiazem);
• dihydropyridine BCC (Amlodipine, Nifedipine).

Gulu lachiwiri limakulitsa lumen ya ziwiya popanda chilichonse pa ntchito ya minofu ya mtima. Gulu loyamba, mmalo mwake, limakhudza mgwirizano wa myocardium.

Gulu lopanda dihydropyridine limagwiritsidwa ntchito ngati njira yowonjezera yolimbana ndi matenda oopsa. Oyimira amachepetsa kuchuluka kwa mapuloteni ochulukitsa ndi albumin mu mkodzo, koma osakhala ndi chitetezo pamatumbo a impso. Komanso, mankhwalawa samakhudza kagayidwe ka shuga ndi lipids.

Gulu la dihydropyridine limaphatikizidwa ndi β-blockers ndi ACE inhibitors, koma silinafotokozedwe pamaso pa matenda amitsempha yama mtima mwa odwala matenda ashuga. Makulidwe othandizira a calcium omwe amagwiritsa ntchito magulu onse awiriwa amagwiritsidwa ntchito moyenera kuthana ndi matenda oopsa a systolic odwala okalamba. Pankhaniyi, chiwopsezo cha kukhala ndi stroko chimachepetsedwa kangapo.

Zotsatira zoyipa za mankhwalawa:

• Chizungulire
• kutupa kwa m'munsi;
• cephalgia;
• kumva kutentha;
• kukoka kwamtima;
• gingival hyperplasia (motsutsana ndi maziko azithandizo zamanthawi yayitali ndi Nifedipine, popeza amatengedwa pang'ono).

ARB-II (angiotensin receptor antagonists)

Wodwala aliyense wachisanu yemwe akulandira chithandizo cha matenda oopsa ndi ACE inhibitors amakhala ndi chifuwa monga zotsatira zoyipa. Pankhaniyi, dokotala amasamutsa wodwalayo kuti alandire olimbana ndi angiotensin receptor antagonists. Gulu la mankhwalawa pafupifupi limagwirizana kwathunthu ndi mankhwala a ACE inhibitor. Ili ndi contraindication ofanana ndi mawonekedwe ogwiritsa ntchito.

Oimira gulu:

• Losartan;
• Tewetsa;
• Mikardis;
• Irbesartan.

Rasilez

Mankhwala ndi osokoneza inhibitor wa renin, ali ndi ntchito yotchulidwa. Chithandizo chogwira chimalepheretsa kusintha kwa angiotensin-I kukhala angiotensin-II. Kutsika kwamphamvu kwa kuthamanga kwa magazi kumatheka chifukwa chothandizidwa nthawi yayitali ndi mankhwalawa.

Mankhwalawa amagwiritsidwa ntchito kuphatikiza mankhwala, komanso mawonekedwe a monotherapy. Palibe chifukwa chosinthira kuchuluka kwa mankhwalawa kwa okalamba. Mphamvu ya antihypertensive komanso kuchuluka kwake kumayambira sikudalira mtundu wa wodwalayo, kulemera kwake komanso msinkhu wake.

Yogwira pophika mankhwala ali aliskiren

Rasilez sinafotokozeredwe nthawi yakubala ndi amayi omwe akukonzekera kubereka mwana posachedwa. Mimba ikachitika, mankhwalawa amayenera kusiyidwa nthawi yomweyo.

Zotsatira zoyipa:

• kutsegula m'mimba
• zotupa pakhungu;
• kuchepa magazi
• kuchuluka kwa potaziyamu m'magazi;
• chifuwa chowuma.

Potengera maziko a kuchuluka kwa mankhwala, kutsika kwa magazi kumatheka, komwe kuyenera kubwezeretsedwanso ndi mankhwala akukonzanso.

Otsatsa-blockers

Matenda a shuga komanso kupanikizika

Pali mitundu itatu yayikulu yamagulu yomwe imagwiritsidwa ntchito pochiza matenda oopsa. Awa ndi Prazosin, Terazosin, Doxazosin. Mosiyana ndi mankhwala ena a antihypertensive, oimira ma cy-blockers amakhudzanso mafuta a cholesterol, samakhudza glycemia, kuchepetsa kuchuluka kwa magazi popanda kuchuluka kwakukulu kwa mtima.

Kuchiza ndi gulu la mankhwalawa kumayendera limodzi ndi kuchepa kwamphamvu kwa kuthamanga kwa magazi motsutsana ndi maziko akusintha kwa thupi m'malo. Ndi kotheka kutaya chikumbumtima. Nthawi zambiri, zotsatira zoyipa zoterezi zimadziwika kuti munthu woyamba kumwa mankhwalawo. A pathological mkhalidwe amapezeka mwa odwala omwe akukana kuti aphatikize mchere muzakudya ndikuphatikiza muyezo woyamba wa alpha-blockers ndi mankhwala a diuretic.

Kupewa matendawa kumaphatikizapo malingaliro otsatirawa:

• kukana kutenga okodzetsa masiku angapo tsiku loyamba la mankhwala;
• mlingo woyamba uyenera kukhala wocheperako;
• Mankhwala oyamba amathandizidwa asanagone usiku, wodwalayo atagona kale.

Kodi mungasankhe bwanji mapiritsi a vuto linalake lachipatala?

Akatswiri amakono amalimbikitsa kugwiritsa ntchito mankhwala angapo a magulu osiyanasiyana nthawi imodzi. Kufanana mbali zosiyanasiyana za limagwirira a matenda oopsa amachititsa kuti mankhwalawa azigwira bwino ntchito.

Kuphatikiza mankhwala kumakupatsani mwayi wogwiritsa ntchito mitundu yaying'ono ya mankhwala, ndipo mankhwala ambiri amaletsa mavuto. Malangizo a mankhwalawa amasankhidwa ndi adotolo poyerekeza ndi chiwopsezo cha matenda a shuga (matenda a mtima, sitiroko, kulephera kwa impso, matenda amawonedwe).

Pokhala pachiwopsezo chochepa, monotherapy yotsika mtengo imalimbikitsidwa. Ngati ndizosatheka kukwaniritsa kuthamanga kwa magazi, katswiriyo amalemba mankhwala ena, ndipo ngati sangathe, kuphatikiza kwa mankhwala angapo a magulu osiyanasiyana.

Chiwopsezo chachikulu cha kuwonongeka kwa mtima ndi mitsempha yamagazi chimafuna chithandizo choyambirira chophatikiza ndi mitundu iwiri ya mankhwala osachepera. Ngati chithandizo sichilola kukwaniritsa zotsatira zabwino, dokotalayo atha kukuwuzani kuti muwonjezere mankhwala ena atatu muyezo wochepa kapena kupereka mankhwala omwewo, koma pa mlingo wokwanira. Pokhapokha kukwaniritsa kuchuluka kwa kutsata kwa magazi, njira yochiritsira yamankhwala atatu imayikidwa muyezo waukulu kwambiri.

Dokotala ndi wodwala ayenera kugwira ntchito limodzi pazotsatira zake.

Algorithm posankha mankhwala osakanikirana ndi matenda oopsa pamunsi pa "matenda okoma" (m'magawo):

1. Kuchulukitsa kwakukulu kwa kuthamanga kwa magazi ndikusankhidwa kwa ACE inhibitor kapena ARB-II.
2. Kuthamanga kwa magazi ndiwokwera kuposa masiku onse, koma mapuloteni samapezeka mkodzo - kuwonjezera kwa BKK, okodzetsa.
3. Kuthamanga kwa magazi ndiwokwera kuposa kwawamba, mapuloteni ochepa amawonekera mumkodzo - kuwonjezera kwa BKK, thiazides.
4. CHIWONSE chachikulu pazophatikizira ndi kulephera kwa aimpso - kuphatikiza kwa gawo lotsekemera, BKK.

Kumbukirani kuti katswiri amapaka mitundu yonse ya mankhwala pokhapokha atachitanso maphunziro onse othandizira odwala ndi othandizira. Mankhwala odzipatula sawachotsa, chifukwa zotsatira zakumwa mankhwala zimatha kubweretsa zotsatirapo zoopsa komanso ngakhale kufa. Zochitika za katswiri zimakuthandizani kusankha njira yabwino kwambiri yoperekera chithandizo popanda kuwononga thanzi la wodwalayo.