Angiopathy ntawm qis qis hauv kev mob ntshav qab zib mellitus: cov tsos mob, kho mob, kev tiv thaiv

Mob ntshav qab zib angiopathy nyob hauv qis qis, lossis taw mob ntshav qab zib, yog qhov kev mob nyhav uas tshwm sim hauv cov neeg mob ntshav qab zib. Cov neeg mob ntawm txhua lub hnub nyoog thiab poj niam txiv neej tau cuam tshuam los ntawm tus kab mob. Txhawm rau tiv thaiv kev txhim kho kev mob ntsws, nws yog ib qho tsim nyog yuav tsum tau them sai sai rau cov tsos ntawm lub suab ceeb toom lub sijhawm, kho cov kab mob hauv qab thiab tiv thaiv cov teeb meem.

Ntshav qab zib taw - yog dab tsi nws

Mob ntshav qab zib mellitus tsis yog tsuas yog muaj kab mob ntawm cov endocrine system, nws yog feem ntau vascular pathology. Cov ntshav qab zib siab ntau ua rau kev puas tsuaj rau cov hlab ntsha ntawm ceg, retina, paj hlwb. Tawm tsam keeb kwm ntawm cov ntshav qabzib siab, cov cuam tshuam sab hauv txheej ntawm cov hlab ntshav - endothelium - tsis ua txoj haujlwm ntawm kev tswj ntshav siab, tiv thaiv cov ntshav txhaws thiab ua rau cov txheej txheem ua paug rau lawv. Raws li cov vascular puas tsuaj, ntshav stagnates nyob rau hauv qis qis, pab txhawb rau kev muaj mob ntawm pathology.

Kev puas tsuaj los ntawm cov piam thaj thiab nws cov khoom lag luam hauv lub cev, cov txheej txheem sab hauv ntawm cov ntshav khaws cov kua dej rau hauv phab ntsa, txo cov ntshav kev mus rau ob txhais ceg. Thrombi ua sai sai rau sab hauv cov roj ntsha, ntxiv kev pheej hmoo ntawm clogging ntawm lumen. Ua haujlwm dhau sijhawm, cov nkoj me me sclerosize, thiab cov nkoj loj loj stratify thiab tsim cov leeg pob txha.

Kev faib tawm

Nyob ntawm qhov ntsuas ntawm cov hlab ntsha puas, muaj:

macroangiopathy - kev puas tsuaj rau cov hlab ntsha loj,
microangiopathy - pathology ntawm me me,
ua ke - kev koom tes ntawm cov nkoj me me thiab loj caliber hauv cov txheej txheem pathological.

Cov kws kho mob tseem coj mus rau hauv tus account qhov chaw ntawm lub tsom xam:

kev mob caj dab angiopathy ntawm cov hlab ntsha ntawm qhov qis qis,
kev mob hlwb retinopathy ntawm cov hlab ntsha ntawm lub qhov muag retina,
cov kab mob ntshav qab zib cuam tshuam rau txoj hlab ntshav ntawm lub raum.

Tsis muaj tsawg dua, cov kws kho mob kuaj tau mob plawv thiab ntshav qab zib thaum cov hlab ntsha ntawm lub plawv thiab lub paj hlwb koom nrog cov txheej txheem pathological.

Cov pab pawg muaj kev pheej hmoo

Txheeb cais qhia tias qis qis tshaj plaws hauv lub ntsws mob ntshav qab zib yog qhov muaj kev phom sij tshaj plaws.

20% ntawm tag nrho cov neeg mob mob ntshav qab zib ntsib ua rau cov leeg ntshav qis. Li ntawm 70% ntawm tag nrho cov kev txiav txim siab ntawm qhov qis qis yog vim mob ntshav qab zib ceg angiopathy. Ntau tshaj 40% ntawm cov neeg mob thawj zaug hnov lawv cov kev kuaj mob tom qab qhov kev hloov pauv tsis tau pom muaj nyob rau hauv cov hlab ntsha.

Mob ntshav qab zib mellitus yog ib qho muaj mob hnyav thiab tsis tuaj yeem tswj tau, cov chav kawm tuaj yeem tswj hwm tau yog tias kuaj xyuas lub sijhawm tsis tu ncua, mus ntsib koj tus kws kho qhov muag endocrinologist thiab ua raws nraim li cov lus pom zoo.

Cov neeg mob muaj qhov pheej hmoo:

nrog kev tshuaj ntsuam genetic predisposition rau tus kab mob,
kub siab nrog kev paub
lipid metabolism hauv ntshawv siab,
hnub nyoog 55 xyoos
haus luam yeeb
feem ntau haus dej haus cawv.

Cov qauv ntawm tus kabmob

Nyob ntawm seb cov nkoj twg cuam tshuam, mob ntshav qab zib angiopathy ntawm qis qis (chaws rau ICD 10 E11.5) tuaj yeem tshwm sim nws tus kheej hauv daim ntawv ntawm microangiopathy mob ntshav qab zib thiab macroangiopathy.

Microangiopathy

Kev mob ntshav qab zib microangiopathy ntawm qis qis tsaws tsub zuj zus nrog kev swb, kev rhuav tshem thiab sclerosis ntawm cov hlab ntsha me ntawm cov ceg. Nyob ntawm qhov kev tsis saib xyuas, cov kws kho mob ua kom sib txawv 6 qib qhov hnyav ntawm daim ntawv no ntawm tus kabmob:

Xoom, lossis pib, - qhov tsis muaj kev tsis txaus siab los ntawm tus neeg mob, tab sis muaj cov yam ntxwv ntawm tus cwj pwm ntawm kev txhim kho pathology (tsis muaj plaub hau ntawm txhais ceg, nruj thiab ci ntawm daim tawv nqaij, zoo li txias nyob hauv qis qis).
Thawj zaug yog daim tawv nqaij nyias nyias, tsis tu ncua muaj qhov mob ntawm txhais ceg thaum taug kev, qhov tawv nqaij me me liab tshwm tsis muaj cov yam ntxwv ntawm tus mob.
Qhov thib ob yog mob kub siab rau ntawm ob txhais ceg, uas cuam tshuam tsis tsuas yog ua kom tawv nqaij xwb, tab sis kuj ua rau cov nqaij mos, thiab qee zaum ncav cuag tus pob txha. Lub sijhawm no ntawm tus kabmob yog tsiag ntawv los ntawm mob hnyav.
Thib peb, dub foci ntawm necrosis tshwm sim nyob rau hauv qhov chaw ntawm lub qhov txhab mob.
Plaub - sib txawv ntawm qhov ua ntej dhau los hauv qhov ntawd ntxiv rau necrosis, edema thiab hyperemia ntawm cov ntaub so ntswg ze yog pom. Nyob rau lub sijhawm no, ua mob qog, phlegmon lossis osteomyelitis ntawm ceg qis dua feem ntau kuaj pom.
Thib tsib - kuaj mob nyob rau kis uas cov nqaij ze ze tuag.
Thib rau - cov txheej txheem necrotic swept tag nrho ko taw.

Macroangiopathy

Kev mob ntshav qab zib macroangiopathy, nyob rau hauv cov hlab ntsha loj yog qhov cuam tshuam, txhim kho maj mam, muaj 5 theem ntawm kev nce ntawm pathological hloov:

Tsis muaj cov cim qhia los ntawm tus kab mob, cov neeg mob yws yws sai thiab mob lub cev thaum tawm dag zog lub cev; thaum kuaj, feem ntau kuaj mob ntshav liab thiab cov mob atherosclerosis.
Ib qho kev xav ntawm qhov txias nyob hauv ob txhais ceg, nquag loog, atrophic hloov hauv taw thiab qhov pom ntawm lameness thaum taug kev.
Kev mob ntawm cov nqaj txawm tias thaum ua tiav qhov chaw siab, qhuav thiab tev ntawm daim tawv nqaij, hmo tu.
Cov tsos ntawm cov mob txhab me me uas ceev nrooj tig mus rau foci ntawm necrosis.
Kev tuag ntawm cov nqaij mob ntawm cov ntiv tes thiab taw, mob caj dab ntawm cov ceg qis.

Cov theem pib kawg ntawm tus kab mob yog cov tsos mob tshwm sim ntawm malaise rau hauv daim ntawv tsis muaj zog, mob taub hau, tsis qab los noj mov, ua daus no, thiab kub cev.

Ntxiv rau cov cim saum toj no ntawm tus kab mob, cov duab hauv qab no yog cov yam ntxwv ntawm tus mob ntshav qab zib angiopathy:

paresthesias, uas tau pom los ntawm kev loog ntawm ob txhais ceg, uas cuam tshuam nrog cov ntaub so ntswg ischemia los ntawm kev ua pa oxygen tshaib plab,
tua phom cuam ntawm ob txhais ceg, uas sib zog ua thaum taug kev thiab txo qis thaum so,
mob plab thaum pw tsaug zog,
txo qis kev ua haujlwm ntawm cov plaub hau kev loj hlob ntawm ob txhais ceg,
daim tawv nqaij ua kom qhuav, txob nrog cov kab nrib pleb thiab tev tawm,
txhais ceg o thiab redden
qhov tsis hnov tsw tsw tshwm sim los ntawm ib qho lossis ob qho ntawm cov ceg ntoo,
tes taw yog txias thiab ntub rau qhov kov
tus ntsia thawv phaj ua tuab, ntu, daj daj,
qhov pom ntawm kev quaj loj ntawm qhov chaw qub thiab qhov mob uas tsis kho.

Cwj pwm ntawm cov tsos mob no, cov neeg mob yws ntawm qhov tsis muaj zog, ntxhov siab thaum pw tsaug zog, npau taws ntev, nquag mob taub hau thiab ua npaws.

Kev kuaj mob

Kev kuaj mob meej tseeb tuaj yeem tsim los ntawm tus kws kho mob, raws li cov ntaub ntawv ntawm kev sim hom phiaj thiab kev tshawb fawb ntxiv. Txhawm rau xav tias mob angiopathy ntawm qis qis hauv kev mob ntshav qab zib mellitus, nws yog qhov txaus rau tus kws tshaj lij sau cov anamnesis thiab kev soj ntsuam ntawm tus neeg mob. Ua tib zoo saib cov paib no:

pallor ntawm daim tawv nqaij,
nqaj tawv,
muaj qhov mob thiab lameness,
tsis muaj mem tes rau ntawm cov ceg ntsha,
txos qhov ntsuas kub ntawm ob txhais ceg.

Tus kws kho mob yuav muab tshuaj ntxiv thiab kuaj hauv tsev kawm ntawv:

Doppler ntsuas ntawm cov hlab ntsha ntawm cov qis qis,
Kev kuaj mob xoo hluav taws xob, zoo ib yam li kev sib piv ntawm cov duab hlwb,
MRI
khoos phis tawm capillaroscopy.

Nrog rau cov tsos mob ntawm osteomyelitis, radionuclide scan siv pyrophosphate tuaj yeem ntxiv rau cov kws kho mob, uas tso cai rau koj tshawb pom kev hloov me ntsis hauv pob txha hauv daim duab. Ib qho ntxiv, ntau cov kev sim ntsuas hauv ntshav thiab tso zis yog qhov yuav tsum tau txiav txim siab txog qib siab ntawm cov piam thaj, creatinine, lipid profile thiab lub ntsej muag txhawm rau kev ntsuas.

Thaum muaj kev paub tseeb ntawm angiopathy ntawm qis qis hauv kev mob ntshav qab zib mellitus, kev kho yog nqa tawm kom nkag siab thiab yog tsom rau:

tshem tawm ntawm cov tsos mob tabkaum,
normalization ntawm ntshav qabzib theem,
cov roj (cholesterol) tsawg
kev ua kom muaj ntshav khiav hauv cov hlab ntsha.

Kev noj haus yog qhov khoom thib ib hauv txoj kev kho nyuaj. Txij li thaum angiopathy tsim tawm tsam keeb kwm ntawm ntshav qab zib mellitus, kev kho mob yuav tsum pib nrog kev kho ntawm noj zaub mov li qub. Nws yog qhov tsim nyog yuav tsum tau txwv kom tsis txhob muaj ntau ntau ntawm cov rog, kib thiab cov kaus poom zaub mov.

Yooj yim zom cov carbohydrates muaj qhov txwv lossis tshem tawm tag nrho. Nws raug nquahu kom haus cov fiber ntau, zaub, zaub ntsuab. Taug qab txog kev haus cov dej haus: cov dej haus rau cov neeg laus yuav tsum tsis pub tsawg dua 2 litres ib hnub. Noj ntau, nyob rau qee qhov me txhawm rau txhawm rau cov metabolism thiab tiv thaiv kom txhob muaj ntshav nce ntxiv hauv cov ntshav qabzib.

Raws li kev ua kis las, nrog angiopathy nws yog qhov nyuaj heev rau mus xyuas lub gym lossis khiav hauv lub tiaj ua si, vim tias qhov nqaj qis yog cuam tshuam. Tab sis txhua tus neeg tuaj yeem ua luam dej hauv pas dej, ua si ua pa lossis npaj ib ce yooj yim hauv tsev.

Tshuaj kho mob nkeeg

Txoj kev kho cov tshuaj nyuaj suav nrog cov tshuaj:

Cov kab mob tua cov kab mob ntawm cov kab mob hauv nroog thiab hauv zej zog los tua kab mob hauv lub qhov txhab (Levofloxacin, Cefopectam),
cov tshuaj tiv thaiv kabmob (Lisinopril, Bisoprolol, Valsacor),
statins rau normalize ntshav roj (Atorvastatin, Lovastatin, Rosuvastatin),
cov ntshav ua ntshav (Aspirin, Akard, Kleksan),
diuretics thiab edema-txo cov tshuaj (Torsid, Lasix, Furosemide),
angioprotectors uas tshem tawm vascular edema thiab kev ua haujlwm ntawm cov metabolism hauv lawv (Anginin, Ditsinon, Etamsylate),
tshuaj los ua kom cov metabolism hauv cov ntaub so ntswg (Trimetazidine, Mildronate),
tshuaj tiv thaiv kab mob antioxidant, B vitamins (Nerviplex, Neuromidin).

Kev txuag tshwj xeeb

Tsim los pab zoo:

Trental - rov ua kom cov ntshav ncig, txo qhov mob ntawm cov nqaij (1 t. 3 zaug hauv ib hnub),
Pentoxifyline - ua kom cov ntshav khiav hauv cov ntaub so ntswg, txo edema (1 t. 2-3 zaug hauv ib hnub),
Lipoic acid - nce vascular permeability (1 ntsiav tshuaj hauv ib hnub),
Venoruton yog thawj cov tshuaj kho kab mob, pab txo kev o, txhim kho cov ntshav ncig, tshem tawm qhov mob (1 tsiav tshuaj 3 zaug hauv ib hnub),
Dialipon - tiv thaiv qhov tshwm sim ntawm tus mob ntshav qab zib polyneuropathy, suav nrog rau sab hauv ntawm qhov kawg (2 tsiav tshuaj 1 zaug hauv ib hnub),
Cardiomagnyl - ib cov tshuaj txo ntshav viscosity thiab tiv thaiv cov ntshav txhaws (1 ntsiav tshuaj 1 zaug hauv ib hnub).

Kev tawm dag zog lub cev

Nws raug nquahu los ntxiv cov kev kho kom zoo nrog cov txheej txheem zaws thiab cov txheej txheem ntawm lub cev, qhov kev txiav txim ntawm kev tsom mus rau kev rov ua kom cov ntshav khiav hauv cov hlab ntsha ntawm qhov qis qis:

plasmophoresis
hluav taws xob txhawb
siv cov av nkos.

Cov txheej txheem raug qhia rau cov neeg mob uas pib theem pib ntawm tus kab mob, nrog rau thaum lub sijhawm ncua mus so. Hauv theem mob, qhov kev siv sov ua kom sov yog qhov tsis tuaj yeem lees paub.

Ib lo lus tshiab hauv kev kho tawm dag zog niaj hnub yog lymphomodulation. Txoj kev kho mob no yog siv rau ntau yam kabmob, nrog rau mob caj dab. Cov cuab yeej siv rau lymphomodulation ib txhij ua:

cov pa oxygen txaus
hluav taws xob kho qhov muag ntawm peb tsom iav,
hluav taws xob xob
mechanical kev co ntawm tsawg zaus.

Nrog nws cov kev pab, cov ntaub so ntswg cuam tshuam los ntawm ischemia tau txais qhov tsim nyog oxygen thiab cov as-ham.

Kev phais mob

Mob ntshav qab zib angiopathy qiv nws tus kheej rau kev saib xyuas kev kho mob, tab sis nws kav los ntawm ntau lub hlis mus rau ib xyoos lossis ntau dua. Thaum mob rwj tshwm sim, kev tu vaj tu yog tsim nyog. Hauv kev ua tiav, kev txiav tawm ntawm cov ceg uas raug cuam tshuam yuav tsim nyog. Xws li kev txiav txim siab yog txiav txim siab los ntawm kev sib tham hauv kev kho mob.

Cov tshuaj kho neeg mob

Lwm txoj kev kho tuaj yeem siv cov ntawv qhia rau lwm cov tshuaj, tab sis lawv txoj kev siv yuav tsum raug pom zoo los ntawm tus kws kho mob uas koom nrog. Thaum nws los txog qhov ua tau gangrene lossis osteomyelitis, tshuaj ntsuab suav tshuaj yuav tsis muaj teebmeem kho. Nyob rau thaum ntxov ntawm tus kab mob thiab thaum lub sijhawm kho, pej xeem tshuaj muaj qhov cuam tshuam rau qhov cuam tshuam ntawm cov nqaij hauv qhov qis qis. Txoj kev kho yuav tsum tau ua nyob ntawm kev saib xyuas ntawm tus kws kho mob uas koom nrog.

Calendula compress thiab kho da dej

Nws yog qhov zoo sib xws rau kev tshem tawm cov tsos mob ntawm kev mob txhawm rau them sai sai rau kev kho kom zoo ntawm cov tshuaj ntsuab rau siv tshuaj pleev thiab dej da. Rau lub hom phiaj no, siv calendula, chamomile, nettle. Tshuaj ntsuab tuaj yeem noj nyias, tab sis nws zoo dua los npaj tshuaj ntsuab khaws cia. Txhawm rau npaj 2 l ntawm kua zaub, noj 50 g ntawm cov khoom siv qhuav, ncuav dej npau, tso rau 30-40 feeb, lim thiab siv rau compresses lossis da dej.

Kev ntsuas ntawm chav kawm ntawm tus kab mob

Nrog rau kev kho mob raws sijhawm, kev mob ntshav qab zib yog mob kho tau. Nws tsis tuaj yeem ua kom tiav cov kab mob, tab sis, ua raws li txhua yam kev pom zoo rau kev kho mob, koj tuaj yeem ua tiav txoj kev kho kom ruaj khov thiab tiv thaiv kev txhim kho ntawm cov teeb meem hauv daim ntawv ntawm:

ntshav qab zib taw
aseptic necrosis,
poj laib
txiav tes ua taw.

Kev Tiv Thaiv

Txhawm rau tiv thaiv kab mob ntshav qab zib, nws yog qhov yuav tsum tau ua ntu zus los ntawm kev tiv thaiv prophylaxis, uas suav nrog:

kuaj ntshav thiab cov piam thaj nyob rau hauv nws,
noj qab nyob zoo neej
sib cuag tau sai li sai tau ntawm tus kws kho mob nqaij ntuag yog hais tias muaj tawv nqaij ua pob ua paug, mob txhab lossis mob txhab.

Hauv kev tiv thaiv txoj kev tiv thaiv, nws yog ib qho tsim nyog los saib xyuas kev noj qab haus huv thiab kev mob ntawm daim tawv nqaij ntawm ceg. Qhov mob me me lossis khawb ntawm cov ceg yuav ua rau mob. Yog li ntawd, nws raug nquahu kom nqa tawm kev kho mob txhua hnub thiab tshuaj xyuas cov ceg. Kev ua kom tawv nqaij thiab ua kom tawv nqaij nrog kev pab ntawm cov khoom lag luam tu kom zoo nkauj, thiab txiav cov rau tes kom nruj ntawm cov ces kaum sab xis. Nyob rau hauv kev muaj abrasions thiab khawb, nws yog ib qho tsim nyog yuav tsum tau ua kom huv si nrog lawv cov tshuaj tua kab mob, tab sis tsis txhob siv pob kws plasters thiab cov khoom lag luam nrog cov ntsiab lus zoo ntawm cawv los yog lwm yam tannins. Nkawm khau zoo rau hnav, uas tsis rub thiab tsis nyem lub taw. Txav tsis txhob txhav dhau thiab txau ntawm cov ceg.

Ntshav qab zib yog kab mob insidious uas cuam tshuam rau cov hlab ntshav. Txhawm rau kom txo qis txoj kev pheej hmoo ntawm kev tsim mob ntshav qab zib mob ko taw, nws yog qhov yuav tsum tau txheeb xyuas txhua yam kev hem thawj, kho tus kab mob hauv qab thiab tiv thaiv cov teeb meem uas yuav tshwm sim.