Matenda a shuga

Kugonjetsedwa kwa zinthu za chapakati komanso zotumphukira zamagetsi motsutsana ndi maziko a shuga kumatchedwa diabetesic neuropathy. Ichi ndi chizindikiro chazovuta, komwe ndi kusokonezeka kwa magwiridwe antchito amitsempha yonse yamitsempha motsutsana ndi kusinthaku komwe kumachitika m'mitsempha yamagazi yaying'ono. Matenda a diabetesic neuropathy (malinga ndi ICD-10 - G63.2 *) amafunika kuwunika moyenera momwe alili komanso kukhazikitsidwa kwa chithandizo chokwanira kuti athe kubwezeretsanso ntchito zomwe zidatayika ndikusinthanso moyo wa wodwalayo.

Gulu

Panthawi yoyeserera, matenda amapezeka mwa wodwala aliyense wachitatu zaka 10-15 atatha matenda ashuga. Kusiyanitsa neuropathy yamchigawo chapakati komanso chapamwamba. Kuwonongeka kwa ubongo ndi chingwe cha msana ndi zina mwa njira yayikulu ya matenda ndipo zimagawidwa motere:

• pachimake pachimake pa kuwonongeka kwa magawo a chapakati mantha dongosolo;
• pachimake cerebrovascular ngozi;
• kusokonekera ubongo ntchito motsutsana maziko a impso;
• neurosis;
• matenda ashuga encephalopathy;
• myelopathy motsutsana shuga.

Peripheral diabetesic neuropathy ilinso ndi magawano potengera madipatimenti owonongeka:

• chidwi - mitsempha yokhudza mtima imakhudzidwa ndi njirayi;
• mota - mkhutu magwiridwe a mitsempha yamagalimoto;
• sensorimotor - kuwonongeka kwa mota ndi mitsempha yamatsenga;
• Autonomous - neuropathy ya ziwalo zamkati.

Kutengera ndi zomwe zimachitika panjira ya zamankhwala, mitundu yotsatirayi ya diabetes ya neuropathy imasiyanitsidwa:

• mtundu wa subclinical - zosintha zokha zowululidwa pakuwunika zimawonetsa kukhalapo kwa matenda, wodwala alibe zodandaula;
• mtundu wamankhwala: mawonekedwe owopsa, limodzi ndi ululu; mawonekedwe osatha okhala ndi zowawa; mawonetseredwe azachipatala popanda kupweteka.
• zovuta (phazi la matenda ashuga, kupunduka kwa mitsempha ya neuropathic).

Limagwirira a chitukuko cha matenda

Poyerekeza ndi za matenda a shuga a shuga, pafupipafupi hyperglycemia (kuchuluka kwa shuga m'magazi) kumawonedwa. Izi zitha kukhala chifukwa cholephera kwa kapamba kupanga insulin yokwanira (matenda 1) kapena kuwoneka chifukwa cha kuchepa kwamphamvu kwa maselo ndi minyewa kupita ku insulin panthawi yake yopanga yokhazikika (matenda a 2).

Hyperglycemia ndiye chifukwa chachikulu chopangitsa matenda ashuga.

Mkulu shuga wambiri amasokoneza njira zonse za metabolic. Pa mtima endothelium, sorbitol, mapuloteni amtundu wa glycosylated. Izi zimapangitsa kusintha kwazomwe zimagwira komanso kapangidwe ka maselo amitsempha (ma neurons). Njala ya oxygen ndi madera omwe alibe magazi okwanira amathandizanso kukulitsa kupsinjika kwa oxidative. Zotsatira zake ndikuchepa kwa vuto la neurotrophic komanso kukula kwa matenda a shuga.

Chithunzi cha kuchipatala

Zizindikiro za matenda ashuga a m'matumbo zimatengera mawonekedwe, kuuma, kuchuluka kwa kupita patsogolo ndi mbiri yachipatala yomwe imagwiritsidwa ntchito.

Zosokoneza za Sensomotor

Mtundu uwu ndiwofala kwambiri pakati pa anthu omwe ali ndi "matenda okoma". Mawonekedwe a maphunziro akale:

• kupweteka kwachilengedwe china;
• paresthesia;
• dzanzi
• kuchepetsa mpaka kusazindikira kwathunthu pakusintha kwa kutentha ndi kugwedezeka;
• kufooka kwa minofu;
• madera a kumunsi;
• kusowa kwakhazikika kwakanthawi kokhazikika;
• maonekedwe a pathological Reflex.

Zosokoneza zotulutsa

Sensory diabetesic neuropathy imayendera limodzi ndi madandaulo otsatirawa a odwala:

• kuchuluka tactile chidwi kusintha kwa kutentha, kukhudza, kugwedezeka;
• kusokonezeka kwamalingaliro munjira yakusazindikira;
• mawonekedwe a ululu poyankha zovuta zomwe zimapangitsa kuti pakakhala zovuta sizimapangitsa kupweteka;
• mawonekedwe amatha kukhalabe abwinobwino;
• kwambiri ululu matenda.

Zowawa zimatha kutentha, kukoka, kuwombera, choyambirira chimawonekera kumapazi ndi miyendo, pomwe ziwiya zimasinthika kwambiri.

Kunenepa, kumva kuwawa, kuwawa - mawonekedwe a minyewa ya minyewa

Ndi mawonekedwe a asymmetric neuropathic, kuwonda kumawonekera m'dera la pelvic, m'chiuno molumikizana, kutsika pansi mwendo kuchokera kumbali yomwe ma neurons adawonongeka. Vutoli limaphatikizidwa ndi kuchepa kwa kuchuluka kwamafuta, kuchepa kwa minofu yochulukitsa mwendo "wowawa".

Mutha kuphunzira zambiri zokhudzana ndi matenda ashuga a m'munsi am'munsi uno.

Fomu ya Standalone

Zilonda zam'mitsempha yama cell a ziwalo zamkati zimayendera limodzi ndi chiwopsezo chachikulu cha kufa pakati pa odwala omwe ali ndi matenda a shuga. Njira za pafupipafupi komanso zamikhalidwe zimafotokozedwa pagome.

Kuzindikira kwamitsempha

Kuchiza kumayikidwa pokhapokha kusiyanitsa komanso kuzindikira. Kuyendera ndi kusonkhanitsa madandaulo a odwala kumayendetsedwa ndi kuyesedwa kwa mitsempha. Katswiriyu amafotokozera za ululu, kupweteka, kutentha, kuzizira. Gulu la akatswiri a matenda amitsempha yamafufuzidwe amaphatikizapo:

• malleus wokhala ndi singano yokhazikika - kuyerekeza momwe ululu wammbuyo ulili;
• Wav - amawunika kutulutsa kosangalatsa kwa wodwalayo;
• monofilament - tanthauzo la tactile sensitivity;
• kuwongolera mafoloko - onetsani mulingo wa kugwedeza kwamphamvu;
• malleus burashi - tactile zomverera.

Mitundu yovuta ya kupsinjika ingafune kuyang'aniridwa kwa mitsempha ya ng'ombe ndi khungu lachiwonetsero ndi kufufuza kwina kwa mbiriyakale.

Kuyesereranso Reflex ndi imodzi mwamagawo azidziwitso za mitsempha

Neurologist amapereka mankhwala a electrophysiological. Electromyography imawonetsa ntchito ya bioelectric ya minofu zida zamagetsi ndikufalitsa kwa mitsempha. Zomwe zapezedwa zimapangitsa kuti zidziwike momwe magwiridwe antchito a mitsempha, omwe amachititsa kuti gawo lina la thupi lizigwiritsa ntchito, kuwulula kuwonongeka kwa mbali zina zamanjenje.

Electroneurography ndi njira yowonetsera yomwe ikuwonetsa kuthamanga kwa kusintha kwa mitsempha m'misewu yamagalimoto ndi zomverera kuchokera kumalo komwe amapita ndi dongosolo lamanjenje kupita kumitsempha yam'mitsempha ndi khungu.

Zomwe zimayambitsa - izi ndizowerengera zomwe zikuwonetsa zochitika zam'magazi am'mitsempha ndi ma minofu ogwiritsa ntchito kukweza kosiyanasiyana (zowoneka, zomvera, zoyipa).

Njira zina zofufuzira

Kuphatikiza pa endocrinologist, dokotala wa gastroenterologist, urologist, mtima, ophthalmologist, orthopedist amatenga nawo mbali pakuwunika kwa wodwala. Laborator diagnostics amapatsidwa:

• Kutsimikiza kwa shuga;
• magazi zamankhwala;
• glycosylated hemoglobin;
• kutsimikiza kuchuluka kwa insulin;
• C peptide.

Dokotala wamtima wamtima amayesa kuyesa kwa Valsalva, Holter ECG, echocardiography, mayeso a orthostatic. A gastroenterologist amawunika momwe m'matumbo amtunduwu ulili ndi ultrasound, endoscopy, x-ray yam'mimba, mayeso a labotale kuti adziwe kupezeka kwa Helicobacter pylori.

ECG - imodzi mwanjira zophunzirira kuwonongeka kwa mantha mkati mwa mtundu wodziyimira pawokha

Kuunika kwa magwiridwe antchito a kwamikodzo kumadalira urinalysis, ultrasound, cystoscopy, intravenous urography, ndi electromyography yamitsempha yamkati ya chikhodzodzo.

Chithandizo

Matenda a diabetesic neuropathy, mankhwalawa omwe amayenera kuyamba ndi kukonza magazi, amafunika chithandizo chamankhwala. Kuti muchite izi, gwiritsani ntchito jakisoni wa insulin (wa mtundu 1 wa shuga) kapena mankhwala ochepetsa shuga (a matenda a 2). Chofunikira ndikuwongolera shuga mumphamvu pogwiritsa ntchito njira zasayansi ndi njira yodziletsa.

Chithandizo cha zovuta zimatsatiridwa ndi kukonza zakudya, zolimbitsa thupi ndi kupuma, kuchepetsa thupi, kupangira zinthu zofunika kukhalabe ndi nkhawa pazokhazikika.

Zolimbitsa thupi za matenda ashuga

Mankhwala ochepetsa shuga omwe amagwiritsidwa ntchito pokonza shuga:

• Metformin
• Maninil
• Victoza
• Januvius
• Diabetes
• Novonorm.

Kukonzekera kwa Thioctic acid

Mankhwala amateteza matenda a lipid metabolite, yang'anani cholesterol. Njira zimathandizira kukonza chiwindi, kuchepetsa mavuto. Oimira gulu:

• Malipidwe,
• Tiogamma
• Liopthioxone
• Lipoic acid.

Ma antidepressants

Mankhwalawa amagwiritsidwa ntchito kuletsa ululu wammbuyo womwe unayambika motsutsana ndi maziko a neuropathy. Ikani amitriptyline, imipramine, nortriptyline. Mankhwala awiri oyamba alibe mankhwala oopsa ndipo amayambitsa mavuto ochepa. Kutha kwa ululu kumawonekera pang'onopang'ono kuposa momwe zochita za antidepressant zimakhalira.

Amitriptyline ndi mankhwala othandizira kupewetsa matenda osokoneza bongo omwe ali ndi poizoni wambiri m'thupi.

Okalamba komanso omwe ali ndi vuto la encephalopathy, neurosis, zochitika zowonera ayenera kumwa mankhwala motsogozedwa ndi akatswiri kapena abale. Mankhwala osakwanira amatha kupha.

Analgesics ndi mankhwala ochititsa dzanzi

Amagwiritsidwanso ntchito kuti muchepetse ululu. Mapulogalamu omwe amagwiritsidwa ntchito ndi mankhwala opha tulo (Lidocaine, Novocaine) amagwiritsidwa ntchito. Poyerekeza ndi antidepressants, mphamvu yawo ya analgesic ndiyochepa, koma imagwiritsidwa ntchito pochita. Kusintha kwa mkhalidwe wa wodwalayo kumachitika pambuyo pa mphindi 10-15.

Ma analgesics mwanjira ya Analginum, Paracetamol ndiwothandiza, komabe, milandu yawo yopanda maziko imadziwika.

Mavitamini a B-Series

Kukonzekera kwa Vitamini kumagwiritsidwa ntchito kutulutsa khungu lathunthu, kufalitsa zikhumbo. Pyridoxine amasankhidwa (B₆), thiamine (B₁) ndi cyanocobalamin (B₁₂) Njira yofunsira imasankhidwa ndi katswiri aliyense payekha.

Anticonvulsants

Carbamazepine, Finitoin ndi oyimilira ogwira ntchito pagululi, omwe amafunikira kusankha mosamala Mlingo chifukwa cha zovuta zina. Yambani kutenga ndi yaying'ono Mlingo, pang'onopang'ono kubweretsa achire. Izi zimafunikira ngakhale masiku angapo, koma masabata 3-4.

Mankhwala ena

Chithandizo cha matenda ashuga a m'magazi amagwiritsa ntchito njira zotsatirazi:

• ntchito laser;
• kuwonongeka kwa mitsempha yayikulu;
• magnetotherapy;
• katemera;
• kusuntha kwamagetsi.

Kutsimikiza kwakanthaŵi kwa chitukuko cha matenda a m'matumbo ndi kuthandizidwa ndi akatswiri odziwa bwino ntchito yake kumathandizira thanzi la wodwalayo pamlingo wambiri komanso kupewa zovuta zazikulu.