Diabetesic polyneuropathy (ICD-10 code G63.2 * kapena E10-E14 p. 4) amatanthauza kukhalapo kwa zizindikiro zakuwonongeka kwa dongosolo lamanjenje kwa odwala omwe ali ndi matenda osokoneza bongo a shuga, ngati zifukwa zina za matenda zimaperekedwa. Kuzindikira kumatha kupangidwa ngakhale pakalibe kudandaula kuchokera kwa wodwala, pamene zotupa zimatsimikiziridwa panthawi yoyesedwa.
Matenda a diabetesic polyneuropathy samatsimikiziridwa pamaziko a chizindikiro chimodzi chachipatala. Malingaliro aposachedwa a WHO akuti mayeserowo ayenera kudziwa kupezeka kwa mawonekedwe awiri a chilondacho kuti atsimikizire za matenda amanjenje motsutsana ndi maziko a "matenda okoma".
Ngati njirayi ikuchitika mu minyewa yamanjenje, ndiye kuti tikulankhula za neuropathy. Pankhani ya zotupa zambiri, polyneuropathy imayamba. Odwala omwe ali ndi vuto la matenda ashuga 1 amalandira "kuzunzika mu 15-55% ya milandu, mtundu 2 - 17-45%.
Gulu
Kupatukana kwa polyneuropathy ndikovuta kwambiri, chifukwa kumaphatikiza ma syndromes angapo. Olemba ena amakonda kusiyanitsa zotupa malinga ndi magawo amomwe amathandizira amathandizira pa izi: mitundu ya zotumphukira (msana wamitsempha) ndi mafayilo odziyimira pawokha.
Gulu lina lomwe limakonda kugwiritsidwa ntchito:
- Polyneuropathy yofulumira (yosakhalitsa, yomwe imayamba chifukwa cha kudumphadumpha mu shuga).
- Symmetric khola polyneuropathy: kuwonongeka kwa minyewa yayikulu yamitsempha yamafuta (distal somatic); kuwonongeka kwa ulusi wochepa thupi; kudziletsa mtundu zotupa.
- Focal / multifocal polyneuropathy: mtundu wa cranial; mtundu woponderezana; mtundu wa proximal; mtundu wa thoracoabdominal; miyendo neuropathy.
Zifukwa
Mulingo wambiri wamagulu a shuga wambiri wodwala matenda ashuga amatha kutha kukhudza ziwiya zazing'onoting'ono, zomwe zimapangitsa kukula kwa microangiopathy, ndi mitsempha yayikulu, ndikupangitsa macroangiopathy. Kusintha komwe kumachitika m'mitima yayikulu ndikofanana ndi kapangidwe ka atherosulinosis.
Angiopathy ndiye cholumikizira chachikulu pakupanga kuwonongeka kwa mitsempha mu shuga
Ponena za arterioles ndi capillaries, zonse zimachitika mosiyana pano. Hyperglycemia imayendetsa ntchito ya puloteni ya kinase-C, yomwe imathandizira kukulitsa kamvekedwe ka makoma a mitsempha yamagazi, imakulitsa membrane wawo, komanso imathandizira magazi. Pa khoma lamkati la arterioles ndi capillaries, glycogen, mucoproteins ndi zinthu zina za carbohydrate chikhalidwe zimayikidwa.
Zowopsa za shuga zimatha kukhala zosiyana. Amalumikizana ndi mapuloteni, kuwapanga kukhala glycated, zomwe zimapangitsa kuwonongeka kwamitsempha yamagazi ndi kusokonekera kwa metabolic, mayendedwe ndi njira zina zofunika mthupi. Mapuloteni odziwika kwambiri a glycated ndi HbA1c hemoglobin. Mkulu akachuluka kwambiri, mpweya wochepa ukalandira ma cell a thupi, minofu ya m'magazi imayamba.
Matenda a diabetesic polyneuropathy amapezeka chifukwa cha kuwonongeka kwa endoneural (komwe kumakhala mu minyewa yolumikizana pakati pa minyewa yamitsempha ya thunthu). Izi zimatsimikiziridwa ndi ubale wotsimikizika pakati pa makulidwe amkati mwa mtima. Ndondomeko imagwira ma neurons ndi njira zawo, zomwe zimafa chifukwa cha kusokonezeka kwa metabolic m'thupi la odwala matenda ashuga.
Zoyambitsa
Zotsatirazi zimathandizira kukulitsa kwa polyneuropathy mu matenda a shuga:
- kuphwanya kudziyang'anira pawekha magazi;
- nthawi yayitali ya matenda oyamba;
- kuthamanga kwa magazi;
- kukula kwakukulu;
- ukalamba;
- kukhalapo kwa zizolowezi zoipa (kusuta, kumwa mowa);
- dyslipidemia;
- chibadwa.
Mawonekedwe a pathological process omwe ali ndi zotupa zingapo zamitse mitsempha
Masiteji
Kutengera kuwuma kwa mawonetseredwe, magawo otsatirawa owonongeka amasiyanitsidwa, pamaziko omwe chithandizo chofunikira cha polyneuropathy chatsimikiziridwa:
Matenda a shuga Angiopathies- 0 - palibe zowoneka;
- 1 - asymptomatic njira ya kusokonezeka;
- 1a - palibe zodandaula kuchokera kwa wodwala, koma kusintha kwa pathological kungathe kutsimikizika kale pogwiritsa ntchito mayesero azidziwitso;
- 1b - palibe zodandaula, kusintha kumatha kutsimikiziridwa osati kokha ndi mayeso apadera, komanso mwa kuyesa kwa mitsempha;
- 2 - gawo la mawonetseredwe azachipatala;
- 2a - Zizindikiro za zotupa zimawonetsedwa pamodzi ndi mayeso abwino azidziwitso;
- 2b - siteji 2a + kufooka kwa kusinthasintha kwa miyendo;
- 3 - polyneuropathy yovuta ndi kulumala.
Zizindikiro
Zizindikiro za matenda a shuga a polyneuropathy amadwala mwachindunji pamtundu ndi mawonekedwe a kukula kwake, komanso mankhwala omwe amagwiritsidwa ntchito.
Mavuto Osautsa
Makhalidwe amawonetsera zamatsenga. Amatha kutsimikiziridwa pokhapokha ngati atayezetsa matenda ena (mawonekedwe amtundu wina) kapena kukhala madandaulo a odwala (mawonekedwe a chipatala). Odwala amavutika ndi ululu. Ululu ukhoza kuwotcha, kuphika, kuwombera, kuwopseza. Maonekedwe ake amathanso kuyambitsidwa ndi zinthu zomwe sizimabweretsa chisangalalo mwa anthu athanzi.
Wodwalayo amatha kudandaula kuti ali ndi dzanzi, akumakhala ngati wagundika, kumverera kozizira, kuthamanga kwa zotsatira za kuzizira, kutentha, kugwedezeka. Kusintha kwachilengedwe kumapitirira, ndipo kwaubweya kungakhale kulibe.
Monga lamulo, zosokoneza zazovuta ndizofanana. Ndi mawonekedwe a asymmetric pathology, ululu wammbuyo umayamba kuchokera m'chigawo ndipo umatsikira m'chiuno. Izi zimaphatikizidwa ndi kuchepa kwa kuchuluka kwa dzanja lomwe lakhudzidwa, kuphwanya kuchuluka kwake mokhudzana ndi thupi lonse.
Kusokonezeka kwa chidwi cha kupweteka ndi chimodzi mwazinthu zowala kwambiri za polyneuropathy
Kuphatikiza matenda
Kukula kwa sensory-motor polyneuropathy nthawi zambiri kumakhala ndi koopsa. Anthu odwala matenda ashuga amadandaula za izi:
- kumverera kwa tulo;
- kupweteka kwachilengedwe;
- kuphwanya zamkati mpaka pakalibe kwathunthu;
- kufooka kwa minofu;
- kusowa kwachilengedwe ndi mawonekedwe a pathological Reflex;
- kukokana kwa usiku kumalire akumunsi ndi kumtunda;
- kusowa kwa kukhazikika poyenda.
Vuto lamafupipafupi la njira zophatikizika ndi kuwonongeka kwa makina ndi phazi la anthu odwala matenda ashuga - njira yodutsitsa madzi momwe lesion imagwirira ziwalo zonse, kuphatikizapo cartilage ndi mafupa. Zotsatira - kusinthika ndi chisokonezo cha gait.
Kugonjetsedwa kwapaulendo
Maselo amitsempha omwe amapezeka mkati mwa ziwalo zamkati amathanso kukhudzidwa. Zizindikiro zimatengera gawo kapena dongosolo lomwe lakhudzidwa. Pathology ya mtima ndi mitsempha ya magazi imawonetsedwa ndi orthostatic matenda oopsa, pulmonary edema, chidwi cha zolimbitsa thupi. Odwala amadandaula za kusinthasintha kwa mtima, kuchuluka kwa magazi, kufupika, kutsokomola. Kuperewera kwa chithandizo cha panthawi yake kumatha kupha.
Kusokonezeka kwa mitsempha ya mtima - chizindikiritso cha matenda amisempha
Zowonongeka pamtunda wamatumbo zimawonetsedwa ndi paresis, kuchepa kwamatchulidwe a madipatimenti ake, kuphwanya wamba microflora, ndi matenda a Reflux. Odwala akuvutika kwambiri ndi kusanza, kutentha kwa mtima, kutsegula m'mimba, kuchepa thupi, kupweteka.
Genitourinary polyneuropathy imayendera limodzi ndi ma atony a chikhodzodzo, kusinthanso mkodzo Reflux, matenda opatsirana pogonana, matenda opatsirana amatha. Ululu umawoneka m'munsi kumbuyo ndipo pamwamba pa pubis, kukodza kumachitika pafupipafupi, kutsatana ndi kupweteka komanso kutentha, kutentha kwa thupi kumakwera, kutuluka kwamitsempha kuchokera kumaliseche ndi urethra kumawonekera.
Zotupa zina:
- kuphwanya kwa thukuta njira (kuchuluka kapena kufupikitsa mpaka pakukwana kwathunthu kwa thukuta);
- zamatsenga zojambula (zojambulazo zimachepera m'mimba mwake, kupenyerera kwakanthawi kochepa kumachepa, makamaka madzulo);
- polyneuropathy ya adrenal gland ilibe mawonekedwe owonetsa.
Zizindikiro
Asanapereke chithandizo cha matenda a shuga a polyneuropathy a m'munsi, wodwalayo amayesedwa osati kokha ndi neurology, komanso ndi endocrinologist kuti afotokozere bwino momwe kulipira kuchokerako kumayambitsa matenda.
Katswiriyu amafotokozera mulingo wamitundu yosiyanasiyana yamtundu wamtundu (kutentha, kugwedezeka, tactile, kupweteka). Mwa izi, ubweya wa thonje, ma monofilaments, ma malashi okhala ndi burashi ndi singano kumapeto kwake, mafoloko oyendetsera ntchito amagwiritsidwa ntchito. Mwapadera, nkhani imatengedwa ndi biopsy kuti itenge mbiri ina. Kuunika kwa mitsempha kumakhalanso ndi njira zotsatirazi:
- Zomwe zimayambitsa - ulusi wamanjenje umakhudzidwa, mayankho omwe amalembedwa ndi zida zapadera.
- Electroneurography ndi njira yodziwitsa momwe kuthamanga kwa kufalikira kwa mitsempha kuchokera kumadipatimenti a dongosolo lamanjenje kupita ku ma receptors kutsimikizika.
- Electromyography ndikuwunika komwe kumawunikira momwe kufalikira kwa zotengera kuchokera ku maselo a mitsempha kupita ku zida zama minofu.
Kuzindikira Kwathunthu - Njira Yofunika Yokufufuzira
Njira zodziwonera zasayansi ndizovomerezeka: kumveketsa kuchuluka kwa glycemia, kusanthula kwa zamankhwala amitundu, zizindikiro za C-peptide ndi glycated hemoglobin. Panthawi yomwe akuwaganizira kuti awonongeka, wodwalayo adayikiridwa ndi ECG, echocardiography, ultrasound ya mtima, dopplerografia ya ziwiya, ma ultrasound am'mimba thirakiti, endoscopy, x-ray.
Mkhalidwe wa kwamikodzo ukhoza kutsimikiziridwa ndikuwunika mkodzo tsiku ndi tsiku, kusanthula malinga ndi Zimnitsky ndi Nechiporenko, komanso nthawi ya ultrasound, cystography, cystoscopy ndi electromyography.
Zochizira
Zochizira matenda ashuga polyneuropathy, chofunika ndi kukonza shuga. Izi zimachitika ndi endocrinologist, yemwe akuwunikiranso njira zamankhwala othandizira insulin komanso kugwiritsa ntchito mankhwala ochepetsa shuga. Ngati ndi kotheka, ndalamazo zimasinthidwa ndi ena ogwira ntchito kwambiri kapena mankhwala owonjezera amalembera.
Kuwongolera zakudya kumachitika, njira zofunikira zolimbitsa thupi zimasankhidwa. Dokotalayo amapereka malangizo amomwe angapangire kuthamanga kwa magazi ndi kulemera kwa thupi pamilingo yovomerezeka.
Magulu otsatirawa a mankhwala amalembedwa:
- Zotupa za alpha lipoic acid ndi mankhwala osankha. Amatha kuchotsa cholesterol owonjezera, kuyimitsa zoopsa zakunja kwa chiwindi ndi mitsempha yamagazi. Oimira - Berlition, Lipoic acid, Thiogamm. Njira ya mankhwala osachepera miyezi iwiri.
- Mavitamini a B - kusintha magwiridwe antchito amitsempha yamagazi ndi zotumphukira, kumathandizira kuti matendawa azitha kufalitsa matenda a neuromuscular impulses (Pyridoxine, Cyanocobalamin, Thiamine).
- Ma antidepressants - amagwiritsidwa ntchito pochepetsa mawonetsedwe owawa (amitriptyline, nortriptyline). Amatchulidwa ang'onoang'ono Mlingo, pang'onopang'ono kukwaniritsa zofunika achire kwenikweni.
- Aldose reductase inhibitors - machitidwe abwino pamankhwala pogwiritsa ntchito gululi adawonetsedwa, koma sananene zifukwa zonse zomwe akuyembekezera. Gwiritsani ntchito molingalira kwa dokotala wopezekapo (Olrestatin, Izodibut, Tolrestat).
- Ma anesthetics am'deralo - amagwiritsidwa ntchito kuyimitsa zilonda zamawonekedwe. Zotsatira zimawonekera pambuyo pa mphindi 10-15.
- Anticonvulsants - Carbamazepine, Finitoin. Gululi lifunika kusankha mosamala. Yambani ndi milingo yaying'ono, ndikukulira kwa milungu ingapo.
Zotsatira za alpha-lipoic (thioctic) acid - mankhwala osokoneza bongo kuti apangitse matenda a mitsempha ndikuchotsa kusokonezeka chifukwa cha kuwonongeka kwa matenda ashuga
Zithandizo za anthu
Ndikotheka kuchitira odwala matenda ashuga polyneuropathy osati ndi mankhwala amwambo, komanso njira zosiyanasiyana ndi infusions okonzedwa kunyumba.
Chinsinsi 1
Lalirani mapesi akhonde okonzedwa kale. Wodwala akuyenera kuwathina kwa mphindi zosachepera 7-10 patsiku.
Chinsinsi 2
Mizu yophwanyika ya burdock ndi masamba a blueberry amasakanikirana. 3 tbsp zotsatira zosakaniza zimathiridwa ndi lita imodzi ya madzi otentha ndikuwumirira kwa maola osachepera 8. Kenako ikani moto ndikuwotha kwa maola atatu ena. Msuzi utatha, uyenera kusefedwa. Imwani kuchuluka kwamadzi omwe amalandiridwa masana.
Chinsinsi chachitatu
Kapu ya oats imathiridwa ndi madzi okwanira 1 litre. Kuumirira kwa maola 10, ndiye kuti muyenera kuwiritsa kusakaniza kwa mphindi zosachepera 40. Chotsani pachitofu ndi kutumiza kumalo otentha. Pambuyo osasankhidwa ndikumwa mu kapu kwa theka la ola musanadye.
Kumbukirani kuti ndizosatheka kuchotsa polyneuropathy ndi wowerengeka azitsamba popanda mankhwala amchikhalidwe ndikuwongolera shuga. Koma kuphatikiza kwa zinthu izi kumatha kubweretsa zotsatira zabwino za matenda.
