Ndi matenda ambiri omwe amawononga ziwiya, ziwiya za retina zimavutikanso. Kusintha kotchulidwa kwambiri m'mitsempha yamagazi, nthawi zambiri kumayambitsa kuwonongeka kwa khungu ndi khungu, kumayambitsa matenda a shuga. Kusintha kwa mitsempha ndi mitsempha kumatchedwa "diabetesic retinal angiopathy". Zosintha izi nthawi zambiri zimadziwika m'maso onse.
Retina angiopathy kokha si matenda, koma amangolankhula za kusintha koyamba m'mitsempha yamagazi okhudzidwa ndi matenda a shuga. Kusintha kumeneku kumatchedwa microangiopathy; ndikoyamba kuphatikizika. Njira yayitali ya matenda a shuga, makamaka mwamphamvu, yowumbika, kumabweretsa kukula kwa macroangiopathies, momwe m'munsi malekezero, mtima, ubongo ndi maso zimavutika.
Kusintha kwa pathological kuli ndi code malinga ndi ICD-10 - H35.0 (kumbuyo retinal angiopathy).
Limagwirira a chitukuko cha retinal angiopathy
Mafuta akwezedwa amachititsa kuwonongeka pang'onopang'ono kwa makoma amitsempha yamagazi, kuyambira ndi ma capillaries ochepa kwambiri. Patsamba la endothelium yowonongeka, thrombi amawonekera, kenako cholesterol malo.
Popita nthawi, magazi amayenda m'magulu ang'onoang'ono amasiya kwathunthu, makoma amitsempha ndi ma arterioles amamasuka ndikuyamba kupezeka, choyamba chifukwa cha madzi a m'magazi, kenako ndi mawonekedwe. Kutuluka pabedi lamankhwala, gawo lamadzimadzi limayambitsa edema ya retina, "cottony" foci amawonekera. Pakachitika magazi, zotupa zimatuluka m'matumba kuyambira zazing'ono mpaka zazing'ono, mpaka zowonjezera zomwe zimakhala ndi gawo lalikulu la thupi lamphamvu. Gawo lino la kusintha m'matumbo am'mimba limatchedwa non-proliferative diabetesic retinopathy (DRP).
Kusintha kwina kumabweretsa kukula kwa zombo zongopangidwa kumene, zowonongeka makamaka m'malo oyang'anira ma macular, kuwonongeka kwa thupi lamphamvu komanso kuyendetsa ma mandala. Gawo ili la matendawa limatchedwa proliferative DRP.
Zizindikiro ndi matendawo
Kwa nthawi yayitali, matenda a retinal angiopathy ndi asymptomatic. Nthawi zina, ndi kuwonjezeka kwa shuga wamagazi kapena kuwonjezeka kwa kuthamanga kwa magazi, kuwonongeka kwakanthawi kwakanthawi, kupenyerera kawiri, "chifunga" chimawonekera, chomwe chimatha pomwe zinthu zomwe zimayambitsa zimachotsedwa.
Ndi kukula kwa DRP yopanda proliferative, zizindikiro nthawi zambiri sizikupezeka.
Ndi theka lokha la odwala omwe ali ndi izi:
- masomphenya osalala, "chifunga" m'maso;
- ntchentche, ma tiketi, maulendo osokonekera m'maso;
- maonekedwe akuchepetsa minda ya masomphenya.
Proliferative DRP imakhudza kwambiri mitsempha yamagazi komanso mafinya.
Pakadali panoosintha, pamakhala madandaulo nthawi zonse:
- kuchepa kwakukulu kwa mashuwidwe sikukwaniritsidwa pakuwongolera;
- opacities imayamba kutchulidwa, yomwe imalumikizidwa ndikuwonongeka kwa thupi la vitreous ndikukula kwa matenda a shuga.
Diagnostic diagnostic
Kuphatikizika kwa mayeso a shuga kumaphatikizapo kuyesedwa pachaka ndi a ophthalmologist. Kusintha kwodziwika kale m'maso, kumayesedwa kumachitika kamodzi miyezi isanu ndi umodzi.
Kuzindikira matenda angiopathy komanso kusintha kwina kwa maso chifukwa cha matenda ashuga nthawi zambiri sikubweretsa zovuta. Kuunikaku kumayambira ndi cheke chofufuza momwe zinthu ziliri.
Kenako, madontho 1-2 a mydriacil, mankhwala apadera omwe amachepetsa mwana, amaphatikizidwa mu sac ya conjunctival. Pakatha mphindi 10-15, mwana akukulitsa, kuyesedwa kumachitika ndi nyali yoyaka pogwiritsa ntchito magalasi apamwamba kwambiri. Ndi nthawi ya biomicroscopy mikhalidwe ya mydriasis kuti zosintha zambiri mu retina ndi zotengera zake, zotupa za m'mimba, ndi edema zimapezeka.
Bedi lamkati limasinthidwanso - makoma a arterioles amakhala ocheperako, ndikuwunikira kumawonekera. Pafupi ndi ziwiya zotere nthawi zambiri mumakhala mzere wa mtundu woyera - mawonekedwe a lymphocyte ndi ma cell am'magazi a plasma. Mu magawo oyamba, kusintha koteroko kumachitika kawiri kawiri pa fundus, ndipo mwina amasemphana ndikakuwona kuchokera kwa wophunzira.
Palibe kudalira kwenikweni kwa gawo la matendawa pamlingo wa shuga wamagazi ndi nthawi yayitali ya matenda ashuga. Odwala ena omwe ali ndi matenda a shuga a mtundu wa Type I amapitilira zaka 20, ndipo kukhala ndi shuga pamlingo wa 10-12 mmol / l, samanenapo zovuta. Ndipo, m'malo mwake, odwala omwe ali ndi mafuta ochepa a shuga a 7-8 mmol / L ndi "chidziwitso" cha matenda a zaka 2-3 pamakhala zovuta zina.
Ambiri azachipatala azachipatala omwe amathandizira anthu kudziwa zamankhwala amachita Photoregization ya fundus kuti awunikenso kuwunika kwa matendawa.
Ngati mukukayikira kukhazikika kwa matenda a shuga a macular edema, retinal detachment, kapena neovascularization, Optical coherence tomography (OCT) tikulimbikitsidwa.
Njira yakuyeserani imakuthandizani kuti muone retina pa kagawo, komwe kanali kosatheka komanso kovuta kuti mudziwe matenda ake, ndikuzindikira njira zamankhwala.
Njira ina yophunzitsira yowunika ndi fluorescence angiography ya retina, yomwe imakulolani kuti musonyeze molondola malo omwe magazi amayamba thukuta kuchokera m'mitsempha yamagazi. Njirayi imalimbikitsidwa pambuyo pakupanga kwa laser kwa retina, komanso pamaso pa SNM.
Chithandizo cha matenda ashuga
Matenda a shuga a retitis angiopathy safuna chithandizo chapadera. Wodwalayo akulimbikitsidwa kutsatira zakudya zapadera, kuyang'anira shuga ndi kuthamanga kwa magazi, hemoglobin ya glycated. Kuchiza kuyenera kuyamba ndikukula kwa zovuta.
Zodzikongoletsa
Akatswiri ambiri a ophthalmologists, pozindikira angiopathy kapena nonproliferative DRP, amatsitsa maso akutsikira Taufon ndi Emoksipin. Mankhwalawa amatsika m'maso onse awiri kwa masiku 30, komanso pafupipafupi katatu patsiku.
Pamaso pa glaucoma, yomwe nthawi zambiri imakhala ndi matenda a shuga a retinopathy, antihypertensive ndiyovomerezeka.
Ngati matenda a diabetes a macular edema atapezeka, mankhwala osapweteka a antiidal - Mankhwala Nevanak 1 amagwa katatu patsiku kwa mwezi umodzi.
Kutengeka kwa laser
Chithandizo cha opaleshoni kuti apeze matenda a shuga a retic angiopathy sichinawonetsedwe. Katswiri wofufuza m'maso akazindikira zotupa m'matumbo komanso m'mbali mwa ma cell, ma laser retinal coagulation amachitika.
Laser cauterize zotumphukira zotupa kuti muchepetse magazi ena. Nthawi zambiri izi zimachitika kawiri kawiri, ndipo ma laser amayamba kuphimba dera lonse la retina.
Chithandizo cha opaleshoni chimasinthidwanso motere:
- pamene subretinal neovascular membrane (SNM) iwoneka m'zigawo za macular. Vutoli limatsogolera kuchotsekera, chomwe chikuwopseza kuti masomphenyawo atayika;
- ndi chiwonongeko cha thupi losavomerezeka lomwe lili ndi chiopsezo chachikulu cha kukulitsa kukokoloka kwa minyewa, zigwiritsidwe zimapangidwa.
Zakudya za matenda
Pali zinthu zingapo zofunika paumoyo wa mtundu I ndi mtundu wachiwiri wa matenda ashuga. Izi zofunikira ziyenera kukwaniritsidwa mosasamala kanthu za kukhalapo kapena kusowa kwa zovuta.
Ndikulimbikitsidwa kudya zakudya zotsatirazi, zomwe sizikuwonjezera kuchuluka kwa shuga, chifukwa chake zimatha kudyedwa kosatha:
- masamba: nkhaka, tomato, mitundu yonse ya kabichi, tsabola, zukini, biringanya, radish, radish;
- bowa watsopano;
- amadyera, sipinachi, sorelo;
- tiyi ndi khofi wopanda shuga ndi zonona;
- madzi amchere.
Gulu lachiwirili limaphatikizapo zinthu zomwe kugwiritsidwa ntchito kuyenera kuchepetsedwa ndi mfundo ya "kugawidwa ndi awiri":
- nyama yokonda: nkhuku, nkhuku, ng'ombe;
- Mitundu yamafuta ochepa: nsomba zamkati, pollock, zander, hake.
- soseji yophika yopanda mafuta.
- mkaka wokhala ndi mafuta ochepa a 1.5-2%.
- tchizi chamafuta ochepa;
- mbatata
- nyemba - nandolo, nyemba, mphodza;
- mikate ndi buledi;
- Pasitala
- mazira.
Ndikulimbikitsidwa kuti zinthu zotsatirazi zizisiyidwa kwathunthu:
- mafuta a nyama ndi masamba;
- mafuta anyama, margarine ndi mayonesi;
- kirimu, tchizi ndi mafuta ophikira kanyumba;
- nyama yamafuta: nkhumba ndi mwanawankhosa, bakha, tsekwe;
- mafuta amitundu yamitundu: trout, nsomba, hering, chum nsomba;
- mtedza ndi mbewu;
- shuga, uchi, kupanikizana, makeke, kupanikizana, chokoleti, ayisikilimu, zakumwa zotsekemera;
- zakumwa zokhala ndi mowa;
- mphesa, nthochi, masimoni, masiku, nkhuyu.
Zambiri za angiopathy mwa ana
Muubwana, matenda a shuga amakula chifukwa cha kuperewera kwa pancreatic cell.
Kukhazikika kwa vuto la matenda ashuga mwa ana, komanso kuwunika kwawo, kuli ndi zina:
- chifukwa cha khoma lofooka lam'mimba, ana amakhala ndi mawonekedwe owonetsa zovuta - kuchuluka kwa DRP, matenda a shuga.
- ana asukulu yasekondale sangawone madandaulo, ngakhale ali ndi vuto lowona kwambiri;
- Kuunika kwa ana aang'ono ndi dokotala wamaso kumadzetsa zovuta zina;
- Ana sangayang'anire pawokha zakudya, kuchuluka kwa jakisoni wa insulin, ndikuwonetsetsa kuchuluka kwa shuga m'magazi, komwe kumayeneranso kuwopsa.
Makanema okhudzana ndi kupezeka kwa matendawa ndi matenda a retina:
Njira zopewera zomwe zimalepheretsa chitukuko cha matenda ashuga a m'mimba komanso zovuta zina zam maso ndizophatikizira:
- zakudya okhwima;
- kudya pafupipafupi komanso moyenera mankhwala a insulin ndi kuchepetsa shuga;
- kayendedwe ka shuga, glycated hemoglobin ndi kuthamanga kwa magazi;
- kupita pafupipafupi kwa endocrinologist ndi ophthalmologist.
