Cov kab mob ntsig txog - ntshav qab zib thiab kub siab: ua rau thiab kho mob

Tsis hais hom twg, cov neeg mob ntshav qab zib tuaj yeem kuaj tau kub siab. Nws exacerbates cov xwm txheej dav dav ntawm tus neeg mob, nce qhov kev pheej hmoo ntawm kev tsim cov kab mob pathologies. Txo qhov mob, koj yuav tsum siv tshuaj pov thawj thiab hloov koj txoj kev ua neej. Txog dab tsi ua rau qhov tshwm sim ntawm kev mob ntshav siab hauv ntshav qab zib mellitus, cov hau kev rau nws txoj kev kuaj thiab kho, nyeem ntxiv hauv peb tsab xov xwm.

Nyeem kab lus no

Ua rau Cov Ntshav Qab Zib Mob Ntshav Qab Zib

Ob tus kab mob no muaj kev sib txuam zoo, lawv sib pab thiab txhawb nqa ib leeg. Nws yog ib qho tseem ceeb xav txog tias kev kub siab yog tshwm sim ntawm lub raum puas hauv ntshav qab zib los yog tiv thaiv keeb kwm ntawm cov ntshav qab zib kom tsawg.

Ntawm hom 1 ntshav qab zib, thawj qhov kev xaiv yuav yeej. Mob ntshav qab zib ua rau cov ntshav qab zib ua rau muaj kev tsim muaj renin ntau dua los ntawm ob lub raum, uas ua rau muaj cov xov ntawm kev lom neeg. Raws li qhov tshwm sim, lub suab vascular nce ntxiv, theem ntawm sodium hauv ntshav, kua dej yog khaws cia.

Hauv ob hom kab mob, hom tseem ceeb, hom tseem ceeb ntawm kev kub siab loj hlob, rau cov ntshav qab zib yog tom qab. Nws tuaj yeem ua ntej lossis tshwm sim nrog mob ntshav qab zib metabolic ntshawv siab. Raws li qhov laj thawj loj, muaj peev xwm tiv thaiv cov tshuaj insulin.

Tus neeg mob tsim cov tshuaj insulin nyob rau hauv ib txwm, tab sis cov cell poob lawv lub peev xwm los teb rau nws. Cov piam thaj hauv cov ntshav tseem nyob hauv siab, thiab lub cev tsis muaj lub zog ua haujlwm. Lub txiav ua lwm yam kua dej ntxiv rau los them.

Tus mob no feem ntau tshwm sim rau cov neeg mob uas lub cev nyhav dhau los. Yam txaus ntshai muaj xws li:

rog deposition tsuas yog nyob hauv plab plab,
muaj mob muaj keeb predisposition
qib qis ntawm kev tawm dag zog,
noj ntau dhau, rog dhau ntawm cov nqaij thiab qab zib ntawm cov zaub mov,
haus dej cawv, suav nrog npias.

Adipose cov ntaub so ntswg muaj peev xwm ua kom lub tebchaw muaj sia nyob sib luag. Nws txawm hu ua hom qog endocrine. Cov kev tshawb fawb tshaj plaws yog: angiotensinogen, leptin, adiponectin, prostaglandins, insulin-zoo li kev loj hlob yam.

Lawv ib txhij nce cov ntaub so ntswg tiv thaiv cov tshuaj insulin thiab txwv cov hlab ntshav. Nrog lawv cov kev koom tes, cov tshuaj tiv thaiv ntawm cov hlab ntsha mus rau adrenaline, cortisol (kev nyuaj siab cov tshuaj hormones) nce, sodium thiab dej tau tuav, tus lej ntawm cov leeg nqaij hauv cov hlab ntsa nce ntxiv, uas txwv tsis pub nws so. Qhov no qhia txog kev sib xyaw ua ke ntawm cov tshuaj insulin, kev kub siab thiab kev rog rog, kev tawm tsam ntawm cov rog, uas yog hu ua cov tuag taus.

Thiab ntawm no yog hais ntau txog cov khoom noj muaj ntshav qab zib hom 2.

Cov tsos mob ntawm ntshav siab

Rau mob me txog qib nrab, qhov kev tsis txaus siab tseem ceeb yog mob taub hau. Nws yog ua ke nrog kiv taub hau, dav dav tsis muaj zog, flickering ntawm cov ntsiab lus nyob rau hauv pem hauv ntej ntawm lub qhov muag, tinnitus. Tsis muaj ib qho ntawm cov tsos mob no tau hais meej, thiab feem ntau cov neeg mob tsis hnov muaj kev nce siab, tshwj xeeb tshaj yog cov lej muaj mob hauv lub sijhawm ntev.

Yog li ntawd, ib qho tsis tuaj yeem tsom mus rau qhov kev hnov, tab sis qhov ntsuas ntawm qhov ntsuas yog qhov yuav tsum tau ua. Rau cov neeg mob ntshav qab zib, lawv tsis muaj tsawg dua li ntshav qab zib. Vim qhov tseeb tias cov neeg mob ntshav qab zib muaj qhov ua rau lub cev tsis muaj zog, nws yog qhov yuav tsum tau saib xyuas ntshav siab tsawg kawg ib zaug ib lub lim tiam - ib teev ua ntej noj mov, ob teev tom qab, thaum sawv ntxov tom qab tsaug zog thiab yav tsaus ntuj ob teev ua ntej nws. Ib zaug ib hnub, kev ntsuas yuav tsum tau ntsuas thaum sawv, zaum thiab zaum ntawm txhua sab caj npab.

Raws li ntshav qab zib thiab kub siab dhau kev loj hlob, kev puas tsuaj rau lub hom phiaj cov kabmob tshwm sim: mob hauv plawv, hnyav dua los ntawm kev nce siab hauv kev kub siab, kev ntxhov siab. Tsis zoo li angina pectoris, lawv tsis cuam tshuam nrog kev ntxhov siab hauv lub cev thiab tsis raug tshem tawm los ntawm Nitroglycerin. Nrog lub plawv dhia, ua tsis taus pa, o ntawm ob txhais ceg, thiab lub plawv dhia ceev ceev tau ntxiv rau lawv.

Rau cerebrovascular kev huam yuaj, nco ploj, txob taus, thiab insomnia yog cov yam ntxwv. Lub peev xwm ntawm kev txawj ntse ua haujlwm maj mam poob qis, tsaug zog tshwm sim thaum nruab hnub, tshee tshee thaum taug kev, kev nyuaj siab, thiab tshee ntawm tes.

Nrog kev nce ntxiv, pos huab los yog daim ntaub thaiv tshwm sim ua ntej lub qhov muag. Vim cov lus hais hloov pauv hauv qhov retina, lub zeem muag raug txo qis, ob chav sib kis tau tshwm sim, muaj qhov tsis zoo lossis tseem tsis pom kev.

Muaj teeb meem rau cov ntshav qab zib

Kev sib xyaw ua ke ntawm ntshav qab zib thiab ntshav siab ua rau muaj kev tshwm sim thiab sai sai ntawm:

atherosclerosis - mob myocardial ischemia (angina pectoris, mob plawv), hlwb (discirculatory encephalopathy, mob hlab ntsha tawg), nqua ceg (obliterating lesion nrog sib deev claudication syndrome),
lub plawv tsis ua haujlwm nrog stagnation ntawm cov ntshav hauv lub ntsws, lub siab,
hypertensive thiab ntshav qab zib nephropathy nrog kev tshwm sim hauv lub raum tsis ua haujlwm,
retinopathy (kev hloov pauv hauv cov hlab ntsha ntawm qhov retina), lub ntsej muag daj, cov ntshav tawm hauv retina, nws cov exfoliation nrog kev tsis pom kev,
kev sib deev tsis muaj zog hauv cov txiv neej, txo qis hauv ob hom poj niam.

Yam tshuaj dab tsi kom haus tawm ntawm lub siab

Raws li kev tshawb fawb, tsuas yog ib feem peb ntawm cov neeg mob ntshav qab zib tswj ntshav siab, thiab tsawg dua 17% tau ua tiav theem yam xav tau. Qhov xwm txheej no thab ntxiv los ntawm qhov tseeb tias lub tsev muag tshuaj muaj ntau cov tshuaj lom thiab tshuaj ntawm qhov tseem ceeb thib ob. Txij li kub siab thiab ntshav qab zib muaj ntau, muaj ntau tshaj li txaus tshaj tawm kev tshaj tawm rau nrawm pov tseg nrog kev pab ntawm "txuj ci tseem ceeb txhais tau tias".

Nws yog ib qho tseem ceeb kom nkag siab tias koj tuaj yeem siv tshuaj noj, tab sis qee leej muaj qhov ua pov thawj kho tau. Piv txwv li, cov leej faj muaj cov amino acid Taurine npaj siab siv rau cov ntshav qab zib mellitus, kub siab thiab lub plawv tsis ua haujlwm.

Cov tshuaj normalizes rog metabolism hauv, txhim kho kev coj ua ntawm kev ua rau lub hlwb, thiab muaj cov haujlwm ua haujlwm anticonvulsant. Nws cov nyhuv ntawm cov ntshav siab tseem muaj, tab sis nws tsis tuaj yeem raug ntaus nqi rau tus neeg saib xyuas hypotensive. Txhua qhov kev sim nrog kev noj qab haus huv, kev noj tshuaj rau tus kheej xaus nrog cov teeb meem.

ACE inhibitors thiab angiotensin receptor antagonists

Angiotensin-hloov enzyme (ACE) txhawb txoj kev tsim cov tshuaj angiotensin 2. Cov tshuaj no nrog cov muaj zog vasoconstrictor, nrog nws cov theem nce ntxiv ntawm cov ntshav siab. Ib pawg ntawm ACE inhibitors tiv thaiv cov tshuaj tiv thaiv no, thiab receptor antagonists tsis tso cai twb tau tsim cov tshuaj angiotensin 2 rau nws cov nyhuv.

Ob pawg tshuaj no yog qhov tseem ceeb tshaj plaws hauv kev kho ntshav qab zib nrog kub siab. Qhov no yog vim qhov tseeb tias lawv:

tiv thaiv lub raum cov ntaub so ntswg los ntawm kev rhuav tshem tsis tsuas yog los ntawm kev kho mob ntshav siab, tab sis kuj nthuav cov hlab ntsha ntawm lub raum, txo lub siab hauv cov glomerulus, poob protein, ua haujlwm rau cov txheej txheem ntawm cov zis.
pab txo lub nra ntawm lub plawv nrog lub plawv tsis ua haujlwm,
txhim kho cov ntaub so ntswg rhiab rau insulin.

Angiotensin 2 antagonists tau zam zoo, vim tias lawv muaj cov khoom xaiv rau lub cev, thiab tseem tuaj yeem txo qhov tuab ntawm lub plawv mob ntawm cov leeg ventricle. Qhov ua tau zoo ntawm ACE inhibitors:

Qhov zoo tshaj plaws receptor blockers:

Cov tshuaj diuretic

Rau kev kho mob siv cov diuretic los ntawm pawg thiazides - Hypothiazide hauv kev txhaj tshuaj me. Feem ntau cov feem ntau, nws yog kws kho raws li ib feem ntawm cov tshuaj antihypertensive. Ntawm kev noj tshuaj li 25 mg rau ib hnub, nws tsis cuam tshuam qhov pauv ntawm cov piam thaj thiab cov roj cholesterol, cov hlaus tso zis, thiab kev sib xyaw ntsev. Contraindicated hauv nephropathy. Kev npaj Thiazide-zoo li Arifon, Indapamide tau pom zoo thiab tiv thaiv lub raum los ntawm kev puas tsuaj. Cov nyhuv ntawm lwm cov diuretics hauv ntshav qab zib tsis yog qhov tseeb.

Beta blockers

Qhia rau concomitant lub plawv tsis ua hauj lwm, angina pectoris, tom qab lub plawv nres. Nws yog ib qho tseem ceeb uas yuav tsum xav txog tias lawv siv lub qhov ncauj qhov ntswg tau tshwm sim ntawm kev poob hauv cov ntshav qab zib. Yog li, tus mob ntshav qab zib tuaj yeem ploj qhov pib ntawm kev tawm tsam ntawm kev mob ntshav qab zib, tshwj xeeb tshaj yog nyob rau thawj lub lim tiam ntawm kev nkag. Cardioselective tshuaj noj kom zoo dua. Qhov no txhais tau hais tias lawv thaiv cov receptors hauv lub plawv cov leeg thiab yuav luag tsis muaj lwm yam hauv lub nruab nrog cev.

Nrog ntshav qab zib cardiomyopathy (mob plawv), Nebival, Carvedilol, muaj kev nyab xeeb tshaj plaws.

Calcium antagonists

Lawv tau txais txiaj ntsig yog qhov tsis muaj ntxim rau cov metabolism. Cov neeg mob ntshav qab zib tau pom tias yog cov tshuaj yeeb dej ntev, lawv pab tiv thaiv kom tsis txhob mob stroke. Lawv siv ntau zaus hauv kev kho kab mob ua kom kub siab. Cov neeg mob tau sau ntawv rau Norvask, Nimotop, Lerkamen, Adalat retard. Hauv pre-infarction mob lossis lub plawv tsis ua hauj lwm, luv luv ua yeeb yam raug txwv.

Nrog nephropathy, lawv siv tsawg, feem ntau ntau Cinnarizine thiab Diacordin qeeb qeeb.

Agonists (stimulants) ntawm imidazoline receptors

Vim tias qhov kev nqis tes ua ntawm lub hlwb qia, qhov kev ua si ntawm qhov kev xav hloov tawm ntawm lub hlwb tau raug txo qis: lawv tau so lub vij ntsa ntsa, nyob ntsiag to, ib txwm muaj los ntawm cov mem tes. Lawv suav hais tias yog pab pawg rau kev mob ntshav qab zib, vim lawv txo cov tshuaj tiv thaiv insulin thiab ua kom cov rog rog tawg. Cov tshuaj uas nrov tshaj plaws yog Physiotens, Albarel.

Alpha blockers

Kev txo qis ntshav siab, txhim kho cov metabolism hauv cov carbohydrates thiab cov rog. Tab sis lawv muaj cov cuab yeej tsis zoo tseem ceeb - lawv ua rau poob siab thaum lub zog poob (tsaus muag, lub cev tsis muaj zog). Yog li ntawd, muaj ntshav qab zib, nws tsis xav siv lawv. Nws yog qhov phom sij tshwj xeeb tshaj yog tom qab 55 xyoos, nyob rau ntawm qhov muaj mob neuropathy. Kardura thiab Setegis feem ntau pom zoo nrog concomitant o qhov loj ntawm lub qog prostate.

Kev noj zaub mov zoo li cas ua rau cov ntshav siab

Yog tias tus neeg mob ntshav qab zib pom tias muaj qhov hnyav nce me (txog li 145-150 / 85-90 mm Hg) thawj zaug, tom qab ntawd rau lub hlis muaj qhov hnyav tsawg hauv lub cev thiab txwv ntsev rau hauv kev noj haus kom 3 g ib hnub tuaj yeem pom zoo. Qhov no yog vim qhov tseeb hais tias feem ntau kub siab muaj ntsev kev tiv thaiv. Yog tias ib tug neeg mob uas muaj ntshav qab zib hom 2 tswj hwm qhov hnyav los ntawm 5% los ntawm daim tseem, ces nws muaj:

25% txo kev phom sij ntawm cov mob ua rau neeg tuag taus,
lub ntsuas qhov siab yuav qis los ntawm qhov nruab nrab ntawm 10 units,
ntshav qab zib yuav txo los ntawm 35-45% thiab glycated hemoglobin los ntawm 15%,
lipid profile normalizes.

Cov kev cai tswj hwm kev noj haus rau kev kub siab thiab ntshav qab zib

Ntawm hom 1 Ntshav qab zib, mob ntshav siab tshwm sim nrog nephropathy. Yog li ntawd, nws yog ib qho tseem ceeb kom hloov mus ua noj ua haus yam tsis muaj ntsev, thiab 2-3 g tau muab rau tus neeg mob hauv nws txhais caj npab rau salting. Pom zoo kom suav nrog hauv cov ntawv qhia zaub mov:

zaub roj, zaub xam lav,
cov neeg tsis noj nqaij ua ntej kawm
nqaij siav, lub hau yuav tsum muab hliv. Tsuas yog cov rog uas tsis muaj roj ntau tau pub,
ncu lossis hau ntses, nqaij ntses thiab nqaij npuas ua nqaij,
cov rog hauv tsev cheese, cov dej haus muaj lactic,
hau zaub, khaub noom,
buckwheat thiab oatmeal
unsweetened txiv hmab txiv ntoo thiab berries.

Cov khoom noj yuav tsum tsis txhob nyob hauv koos poom, tshij, nqaij nqaij uas haus luam yeeb, hnyuv ntxwm, cov txuj lom kub, ua kom sib xyaw.

Nrog rau kev rog thiab kub siab, kev noj zaub mov kom muaj calorie tsawg. Cov khoom noj carbohydrate yog qhov tseem ceeb uas xaiv nrog qis glycemic index. Tseem ceeb tshiab thiab hau cov zaub mov tsis muaj hmoov nplej - zaub qhwv, cucumbers, zucchini, txiv lws suav, lws, zaub xam lav ntsuab. Npaum li cas ntawm cov khob cij thiab cereal tsawg. Cereals thiab legumes tsuas yog siv rau kua zaub.

Nyob rau hauv txoj kev txwv nruj:

qab zib, khoom qab zib,
cov kua txob npaj, kua txiv, kua qab zib,
vas nthiv zaub mov seasoning
cawv
cov rog ua nqaij, nqaij ntses,
pickles, haus, marinades,
mashed qos yaj ywm los sis kua zaub,
nplej zom, nplej dawb, cov kwv tij, bulgur,
hau carrots thiab beets,
qab zib txiv hmab txiv ntoo
cream, tsev cheese los ntawm 5% rog.

Cov khoom noj ceev ceev

Tus neeg mob txoj kev ua neej

Yog tias ua ntej, kev txwv siab tshaj ntawm tus qauv tau txiav txim siab 140/90 hli RT. Kev Ua Yeeb Yam., Tom qab ntawd xyoo 2017, Asmeskas Lub Koom Haum Hauv Lub Siab tau xav tias ntaus nqi nruab nrab ntawm 130/80 txog 140/90 mus rau thawj qhov kev mob ntshav siab. Rau cov neeg mob ntshav qab zib, txawm tias ua ntej ntawd, qib 130/80 tsis pom zoo kom ua dhau. Ntev mus, tej zaum qhov txheej txheem no yuav poob qis.

Cov kev hloov pauv no yog tshwm sim los ntawm qhov tau ua pov thawj: nrog systolic siab ntawm 120 thiab 130 mm Hg. Kos duab. kev pheej hmoo ntawm cov teeb meem vascular yog qhov tsawg dua. Yog li, nws tau pom zoo tias txawm tias cov neeg mob uas lawv lub siab nyob ze rau ib txwm hloov pauv hauv lawv lub neej. Tshaj li ntawm 130/80 hli RT. Kos duab. Cov cai no mas yuav tsum nruj:

ua tiav kev haus luam yeeb thiab haus cawv,
kev cais tawm ntawm cov zaub mov muaj roj, tshwj xeeb tshaj yog cov uas muaj cov roj (cov rog, cov nqaij ntshiv, cov khoom tiav ib nrab), khoom qab zib thiab khoom qab zib, cov lus ntsev ntau dua 3-5 g,
kev tawm dag zog lub cev txhua hnub ntawm tsawg kawg ib nrab ib teev,
ntsuam xyuas ntshav siab,
kev siv cov tshuaj los kho ntshav siab,
ua raws li tsoomfwv nruab hnub, tsis kam ua haujlwm hmo ntuj,
mastering cov tswv yim ntawm kev so nyob rau hauv kev ntxhov siab (ua pa qoj ib ce, yoga, xav, taug kev hauv qhov xwm, suab paj nruag twj ywm, aromatherapy), acupressure (sab hauv kawg ntawm cov plaub muag, qhov chaw ntawm qhov mob siab tshaj plaws nyob rau hauv occiput, nruab nrab ntawm cov yas).

Thiab ntawm no yog ntau txog yam mob ntshav qab zib hom ntshav qab zib.

Mob ntshav qab zib thiab kub siab ua kom sib txuam. Ntawm hom 1 ntshav qab zib, nephropathy yog qhov ua rau muaj ntshav siab, thiab hauv ntshav qab zib hom 2, kev rog rog thiab insulin tsis kam yog qhov ua rau. Txoj kev ua kom paub ntau yam tsis yog qhov tshwj xeeb, yog li nws tseem ceeb uas yuav tsum ntsuas ntsuas ntsuas. ACE inhibitors thiab cov tshuaj angiotensin 2 receptor antagonists, kev sib txuam ua ke tau zoo tshaj plaws rau lawv txo cov ntshav qab zib.

Nws kuj tseem pom zoo kom hloov pauv kev noj zaub mov, txo qhov hnyav thiab tawm tsis zoo.

Cov qauv ntawm kub siab

Kev nce siab hauv lub txaj viav vias hauv cov xwm txheej ntawm cov ntshav qab zib tau txhais tias systolic ntshav siab ≥ 140 mmHg. thiab diastolic ntshav siab ≥ 90 mmHg Muaj ob hom mob ntshav siab (BP) hauv ntshav qab zib:

Raug rho tawm ntawm cov ntshav siab ntawm keeb kwm ntawm ntshav qab zib,
Ntshav siab vim ntshav qab zib nephropathy,

Mob ntshav qab zib yog ib qho tseem ceeb ntawm microvascular cov teeb meem mob ntshav qab zib mellitus thiab yog lub hauv paus ua rau mob raum tsis ua haujlwm nyob hauv Western ntiaj teb. Raws li yog lub ntsiab lus tseem ceeb ntawm kev coj tus kheej thiab kev tuag hauv cov neeg mob uas muaj yam 1 thiab ntshav qab zib hom 2. Feem ntau, ntshav qab zib hom 1 yog pom los ntawm kev kub siab vim kev loj hlob ntawm cov kab mob pathology hauv cov hlab ntsha ntawm lub raum. Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, ntshav nce siab feem ntau muaj ua ntej cov thawj coj ntawm cov kab mob pathological hauv lub raum. Hauv ib txoj kev tshawb nrhiav, 70% ntawm cov neeg mob uas nyuam qhuav nrhiav mob hom 2 mob ntshav qab zib mellitus twb tau tawg.

Ua rau muaj ntshav siab ntshav qab zib

Hauv ntiaj teb, kwv yees li 970 plhom leej neeg mob ntshav siab. LEEJ TWG suav tias kev kub siab yog ib qho tseem ceeb tshaj plaws ua kom neeg tuag ntxov hauv ntiaj teb, thiab cov teeb meem no tau kis mus. Hauv xyoo 2025, tau kwv yees tias yuav muaj 1.56 txhiab tus neeg nyob nrog cov ntshav siab. Tawg nce qib vim yog cov hauv paus ntsiab lus uas nthuav tawm ntawm nws tus kheej lossis ua ke:

Lub siab ua haujlwm nrog lub zog ntau dua, tso ntshav ntawm cov hlab ntsha.
Hlab ntsha (hlab ntsha) spasmodic lossis txhaws nrog cov leeg atherosclerotic plaques tiv taus ntshav kev.

Muaj ntshav qabzib thiab ntshav siab ntau dhau los muaj cov kab mob pathogenesis, xws li cov leeg hlwb muaj hlwb, renin-angiotensin-aldosterone system. Cov kev no sib cuam tshuam thiab muaj kev cuam tshuam rau ib leeg thiab tsim lub voj voog muaj txiaj ntsig. Kev siab thiab ntshav qab zib yog qhov kawg ntawm kev mob tshwm sim ntawm metabolic. Yog li ntawd, lawv tuaj yeem tsim kho ib leeg tom qab rau tib tus neeg lossis nyias muaj nyias ntawm ib leeg.

Txoj Kev Pheej Hmoo Raug Mob thiab Cov tsos mob

Raws li American Diabetes Association, muaj 2 qho kev sib xyaws cov kab mob tshwj xeeb tshaj yog cov neeg tuag taus thiab ua rau muaj kev pheej hmoo ntawm lub plawv lossis hlab ntsha tawg. Ntshav qab zib Hom 2 thiab ntshav siab tseem yuav ua rau muaj feem ua rau muaj kev puas tsuaj rau lwm qhov plab hnyuv siab raum thiab lub nruab zog, xws li kev puas tsuaj rau cov hlab ntsha ntawm lub raum nephron thiab retinopathy (pathology ntawm lub nkoj ntawm lub qhov muag). 2.6% ntawm qhov muag tsis pom kev tshwm sim hauv kev kho mob ntshav qab zib. Tsis tswj tus mob ntshav qab zib tsis yog kab mob kev noj qab haus huv nkaus xwb uas ua rau muaj kev pheej hmoo mob ntshav siab. Qhov pheej hmoo ntawm cov leeg mob necrosis los yog mob ntshav nce siab yog nce nrawm dua yog tias muaj ntau dua ib qho ntawm cov kev pheej hmoo hauv qab no:

kev ntxhov siab
noj cov rog hauv cov rog, ntsev,
kev ua neej nyob sedentary, adynamia,
hnub nyoog siab heev
rog dhau
haus luam yeeb
haus cawv
kab mob ntev.

Kev ntsuas ntshav siab yog qhov xav tau tsis tu ncua.

Raws li txoj cai, kub siab tsis muaj cov tsos mob tshwj xeeb thiab yog nrog mob taub hau, kiv taub hau, thiab o. Yog li ntawv koj thiaj yuav tau kuaj xyuas koj cov ntshav siab tsis tu ncua. Tus kws kho mob yuav ntsuas nws txhua qhov kev mus ntsib, thiab tseem pom zoo kom kuaj xyuas nws hauv tsev txhua hnub. Feem ntau cov tsos mob ntawm tus mob ntshav qab zib yog:

nquag tso zis
mob siab rau nqhis dej thiab muaj kev tshaib plab
ua rau koj qhov hnyav nce lossis poob phaus sai,
txiv neej deev kawg,
loog thiab tingling hauv caj npab thiab ceg.

Rov qab rau cov lus txheej txheem

Yuav ua li cas thiaj txo tau lub siab?

Hauv thaj muaj cov piam thaj hauv siab, nws raug nquahu kom ua kom ntshav siab li 140/90 hli Hg. Kos duab. thiab hauv qab. Yog tias cov lej siab yog siab dua, kev kho mob nrog tshuaj tiv thaiv kab mob yuav tsum tau pib. Tsis tas li, teeb meem nrog lub raum, qhov muag lossis muaj qhov pom ntawm cov hlab ntsws yav dhau los yog qhov qhia tau ncaj qha rau kev kho. Qhov kev xaiv ntawm cov tshuaj yog xaiv ib tus zuj zus los ntawm tus kws kho mob mus kawm nyob ntawm lub hnub nyoog, cov kab mob mus ntev, ntawm chav kawm ntawm tus kab mob, tiv taus cov tshuaj.

Tshuaj rau kev kho mob nrog txoj kev kawm tib lub sijhawm

Kev kho mob ntshav siab hauv ntshav qab zib yuav tsum muaj txhij txhua. Cov tshuaj tiv thaiv kab mob thawj zaug suav nrog 5 pawg. Thawj cov tshuaj uas feem ntau siv rau cov mob ntshav qab zib concomitant yog ib cov tshuaj los ntawm pawg ntawm angiotensin hloov mus rau enzyme inhibitors (ACE inhibitors)Cov. Nrog kev tsis txaus ntseeg rau ACE inhibitors, ib pawg ntawm angiotensin 2 receptor blockers (sartans) yog kws kho. Ntxiv nrog rau qhov kev mob siab (txo qis qis), cov tshuaj no tuaj yeem tiv thaiv lossis maj mam ua kev puas tsuaj rau cov hlab ntsha ntawm lub raum thiab retina hauv cov neeg muaj ntshav qab zib. Ib qho tshuaj ACE inhibitor yuav tsum tsis txhob nrog cov tshuaj angiotensin 2 receptor antagonist hauv kev kho. Txhawm rau txhim kho cov nyhuv ntawm cov tshuaj antihypertensive, diuretics ntxiv rau kev kho mob, tab sis tsuas yog nrog kev pom zoo ntawm cov kws kho mob koom nrog.

Kev noj haus raws li ib txoj kev ntawm lub neej

Qhov tseem ceeb hauv kev noj zaub mov noj qab zib thiab ntshav siab yog qhov muab xam los ntawm cov khoom noj carbohydrates, kev noj cov piam thaj tsawg, thiab kev noj ntsev ntau ntau hauv cov zaub mov. Cov lus qhia no yuav pab ua raws li cov cai no:

Cov ntsev tsawg txhais tau tias ntau dua cov txuj lom.
Ib lub phaj ntim khoom noj zoo li lub moos. Ib nrab ntawm lub phaj yog tsim los ntawm zaub thiab txiv hmab txiv ntoo, ib quarter yog zaub mov muaj protein ntau thiab qhov seem yog carbohydrates (tseem muaj nplej).
Txwv koj kev noj haus caffeine. Nws nce ntshav siab thiab nce cov roj cholesterol.
Noj cov khoom uas muaj vitamins, minerals, thiab fiber ntau ntau.
Hais tsis txhob haus cawv. Npias, cawv, thiab qhov ntau ntawm smoothies muaj suab thaj, uas tuaj yeem ua rau nce ntshav ntxiv hauv cov ntshav. Cawv kuj pab txhawb kev qab los noj mov thiab ua rau lub cev yuag dhau.
Cov zaub mov ua noj hauv qhov cub lossis ua noj. Tsis kam rau cov zaub mov kib.
Tshem tawm cov rog "tsis zoo".

Rov qab rau cov lus txheej txheem

Kev tiv thaiv kub siab thiab ntshav qab zib

Txoj kev ua neej zoo tshaj plaws tseem yog qhov tseem ceeb hauv kev tiv thaiv thiab kho ntshav qab zib thiab kub siab. Kev siv lub cev zoo tshaj plaws txog 30 feeb txhua hnub, kev noj zaub mov zoo rau lub cev, tswj ntshav siab, ntshav qabzib thiab ntshav lipids, tsis ua haujlwm tsis zoo - yuav txo qhov pheej hmoo ua kom ntshav nce siab nyob rau hauv muaj ntshav qab zib.

Kev soj qab xyuas cov piam thaj hauv cov ntshav txo qis kev pheej hmoo ntawm kev mob plawv los ntawm 42% thiab kev pheej hmoo ntawm lub plawv nres, mob stroke, lossis tuag los ntawm kab mob plawv los ntawm 57%. Kev tswj cov lipids hauv cov ntshav txo cov kev cuam tshuam ntawm cov kab mob plawv los ntawm 20-50%. Kev hnyav dua thiab kev txij nkawm, nrog rau kev tswj lub neej noj qab haus huv yuav tsis yog txhim kho cov ntshav qab zib xwb, tab sis kuj txhim kho kev noj qab haus huv.

Cov qauv ntawm tus kabmob

Kev txhawb siab ntxiv cov piam thaj hauv ntshav qab zib ua rau muaj kev puas tsuaj sab hauv ntawm lub txaj viav vias. Qhov no ua txhaum kev tsim cov vasodilating tshuaj nyob rau hauv nws, txo kev ywj pheej ntawm cov hlab ntsha thiab ua rau kev txhim kho tawg.

Nrog kev puas tsuaj rau cov hlab ntsha ntawm lub raum, uas yog yam ntxwv ntawm ntshav qab zib, ntshav qab zib nephropathy tshwm sim. Lub raum pib zais ntau lub vasoconstrictor tshuaj uas ua rau mob ntshav khov ntawm cov ntshav khov.

Kev nce siab uas cuam tshuam nrog qhov tseem ceeb (thawj) kev kub siab yog pom hauv 80% ntawm cov neeg mob. Qhov seem 20% raug kev txom nyem los ntawm kev cuam tshuam ntawm kev kub siab theem nrab. Hauv qhov feem me me ntawm cov neeg mob, qhov kev nce siab ntau ntxiv yog tshwm sim los ntawm txoj kev nqaim ntawm cov hlab ntsha hauv lub raum, pyelonephritis, glomerulonephritis.

Thib ob cov ntshav siab ntsig txog ntshav qab zib nephropathy feem ntau tshwm sim tawm tsam ntawm keeb kwm hom ntshav qab zib hom I. Daim ntawv no ntawm tus kab mob loj hlob nyob rau hauv cov tub ntxhais hluas thiab yog nrog kev puas tsuaj sai rau lub raum cov ntaub so ntswg. 10 xyoo tom qab thawj zaug ntawm tus kab mob pathology, ib nrab ntawm cov neeg mob nce siab.

Vim li cas ntshav qab zib tawg yog txaus ntshai tshaj

Kev sib xyaw ua ke ntawm ntshav siab thiab ntshav qab zib hom 2 ua rau muaj kev pheej hmoo mob stroke thiab lub plawv nres. Qhov ntxim nyiam ntawm lub raum tsis ua haujlwm nce. Muaj kev puas tsuaj rau cov hlab ntsha hauv pob nyiaj tuaj yeem ua rau dig muag.

Retinopathy nrog ntshav txhaws thiab ntshav qab zib nce sai thiab tuaj yeem ua rau dig muag

Kev kub siab ceev nrawm rau qhov pib ntawm lub hnub nyoog ntsig txog kev puas hlwb, xws li Alzheimer tus kab mob thiab dementia (senile dementia).

Qhov phom sij ntawm kev sib xyaw ntawm ob hom kab mob no yog qhov tshwj xeeb tshaj yog nyob rau ntawm qhov muaj lwm yam kev pheej hmoo:

mob ntawm myocardial infarction ntawm cov txheeb ze ze,
kev ntxhov siab
cov zaub mov muaj rog thiab ntsev,
vim tsis muaj kev tawm dag zog
hnub nyoog siab heev
thawj
haus luam yeeb
tsis muaj poov tshuaj lossis vitamin D,
quav cawv
concomitant raum mob, pw tsis tsaug zog apnea.

Lub hom phiaj kho mob tseem ceeb

Kub siab thiab ntshav qab zib ua rau cov nyom ib leeg. Qhov tshwm sim ntawm cov kab mob pathology nrog cov nce kev pheej hmoo ntawm cov teeb meem (lub plawv nres, mob hlab ntsha tawg, plawv nres) thiab lub raum tsis ua haujlwm.

Kev kho kab mob ntshav siab hauv ntshav qab zib mellitus muaj lub hom phiaj tseem ceeb hauv qab no:

txo cov teeb meem phom sij los ntawm lub siab thiab cov hlab ntshav,
txo kev tuag ntawm cov teeb meem no,
tiv thaiv raum tsis ua hauj lwm,
txhim kho lub neej zoo ntawm tus neeg mob,
tswj cov ntshav qabzib feem ntau (muaj kev cuam tshuam txog kev zom zaub mov carbohydrate).

Xaiv cov tshuaj

Kev kho mob ntshav siab hauv ntshav qab zib mellitus yuav tsum pib nrog angiotensin-hloov enzyme inhibitors (ACE inhibitors). Lawv cov txiaj ntsig tau raug pov thawj los ntawm kev tshawb fawb thoob ntiaj teb.

Nrog tsis muaj txiaj ntsig ntawm ACE inhibitors, calcium antagonists (amlodipine, felodipine) ntxiv rau kev kho. Qhov kev sib xyaw no tiv thaiv lub siab los ntawm cov teeb meem tshwm sim ntawm cov piam thaj ntau dhau.

Yog tias tsim nyog, ACE inhibitors tuaj yeem ua ke nrog diuretics. Xum yuav tsum tau muab rau indapamide, raws li cov tshuaj feem ntau ntawm txhua yam tshuaj diuretics.

Yog tias kev mob ntshav siab hauv cov neeg mob ntshav qab zib mellitus koom ua ke nrog cov kab mob hauv lub plawv (angina pectoris, mob plawv nres), beta-blockers yuav tsum tau ntxiv rau kev kho mob. Koj yuav tsum xaiv cov uas tsis cuam tshuam rau cov khoom noj metabolism. Cov tshuaj no suav nrog cardioselective beta-blockers, tshwj xeeb, bisoprolol, carvedilol, nebivolol. Cov tshuaj no yuav tsum tau siv los tiv thaiv lub plawv nres thiab tuag sai sai.

Cov pawg tseem ceeb ntawm cov tshuaj siv hauv kev kho mob ntawm cov neeg mob ntshav thiab ntshav qab zib	Cov Npe Tshuaj
ACE inhibitors	Enalapril, Lisinopril, Ramipril, Fosinopril
Diuretics (tshuaj tiv thaiv kab mob)	Indapamide, Arifon
Cov calcium antagonists (calcium channel blockers)	Amlodipine, Felodipine
Beta blockers	Bisopralol, Carvedilol, Nebivolol
Angiotensin-11 receptor blockers	Valsartan

Kev xaiv tshuaj yog nyob ntawm nws cov nyhuv ua rau lub raum tsis ua haujlwm. Nws tau raug pov thawj tias ACE inhibitors thiab indapamide txo qis excretion ntawm protein ntau hauv cov zis thiab yog li tiv thaiv txoj kev txhim kho ntawm lub raum tsis ua haujlwm, thiab calcium antagonists (verapamil thiab diltiazem) muaj tib lub txiaj ntsig. Cov tshuaj no tseem tuaj yeem siv rau hauv kev kho mob ntshav siab ntawm ntshav qab zib. Thaum tsis pom zoo rau ACE inhibitors, angiotensin II receptor blockers - sartans (valsartan) yog tus kws kho mob tau sau tseg.

Cov nyhuv ntawm cov tshuaj nyob rau ntawm lub dav dav

Qee qhov tshuaj tiv thaiv kab mob siab ua rau muaj kev cuam tshuam txog cov metabolism hauv cov metabolism, yog li lawv tsis pom zoo siv rau hauv ntshav qab zib. Qhov no siv rau thiazide diuretics thiab beta-blockers.

Kev siv ntau tshaj plaws thiazide diuretic yog hypothiazide. Nws tuaj yeem ua rau nce ntxiv ntawm kev yoo ntshav cov piam thaj thiab ib qho kev hnyav ntawm glycosylated hemoglobin. Tawm tsam keeb kwm ntawm nws qhov kev nqus, kev tso kua nplaum (thev taus) zuj zus. Cov kab mob raug paub thaum tsis muaj ketonemic hyperosmolar coma tsim thaum lub sijhawm tswj hwm hypothiazide. Qhov no yog vim yog kev tsuj tawm ntawm insulin secretion thiab qhov txo qis hauv rhiab ntawm cov nqaij mos rau cov tshuaj no.

Cov kev mob tsis zoo rau cov ntshav qab zib thiab beta-blockers. Cov tshuaj no:

inhibit zus ntawm insulin,
nce nqaij tiv thaiv (insulin kuj),
inhibit qhov nqus ntawm qab zib los ntawm lub hlwb,
nce zais kev zais ntawm kev loj hlob hormone - ib qho insulin antagonist.

Raws li qhov tshwm sim, kev yoo mov ntxiv nce tom qab noj mov. Cov neeg muaj mob ntawm cov mob ntshav qab zib tsis xeev tau tshwm sim.

Beta blockers npog cov tsos mob ntawm kev tsis muaj cov piam thaj hauv cov ntshav, ua rau nws nyuaj rau kev kuaj ntshav qog ntshav qab zib. Lawv kuj inhibit thaum muaj xwm ceev tso tawm cov carbohydrates los ntawm lub siab, piv txwv li, thaum lub cev tawm mus. Qhov no ua rau ntau txoj kev txhim kho hypoglycemic.

Cov kev tshawb fawb pom tau tias txawm tias cov tib neeg muaj ntshav qabzib feem ntau nrog kev kho mob ntev nrog thiazides thiab beta-blockers, qhov kev pheej hmoo ntawm kev tsim muaj ntshav qab zib muaj ntau dua nrog kev kho nrog ACE inhibitors.

Kev tiv thaiv kab mob ntshav siab hauv ntshav qab zib

Txhawm rau zam kom tsis txhob mob hnyav ntawm cov kab mob no, tus neeg mob yuav tsum txo qis qhov ntsev ntawm lub rooj noj mov thiab nce kev ua haujlwm. Taug kev yog pom zoo rau 20 mus rau 30 feeb hauv ib hnub, lossis ib qho kev ua si sab nraud rau 90 feeb hauv ib lub lis piam. Nws raug nquahu kom tso lub elevator thiab siv lub tsheb uas koj tuaj yeem taug kev.

Nws yog ib qho tseem ceeb kom ua raws li cov zaub mov tsis muaj calorie ntau, ib qho kev txwv hauv kev noj cov ntsev, qab zib, nqaij thiab cov rog muaj roj. Cov kev ntsuas no yog tsom rau kev kho rog. Kev rog dhau hwv yog qhov tseem ceeb rau qhov pib thiab mob ntshav qab zib. Kev ua kom lub cev hnyav hloov kho qhov nqus ntawm cov piam thaj los ntawm cov ntaub so ntswg thiab ua rau txo qis ntshav siab.

Cov lus qhia noj haus zoo rau cov neeg mob ntshav siab thiab ntshav qab zib:

noj txiv hmab txiv ntoo thiab zaub ntau
haus cov zaub mov tsis muaj roj tsawg,
tsis txhob noj qab ntsev thiab kib ntau, feem ntau siv ua noj lossis ci,
noj cov mov ci ci tag nrho, cov txhuv xim av, cov nplej zom tsuas yog los ntawm durum nplej,
txo cov khoom noj kom tsawg,
nco ntsoov noj tshais.

Feem ntau cov neeg muaj ntshav qab zib tau "ua npog" qhov kub siab, uas tsis pom qhov ntsuas nrog tsawg, tab sis muaj cov cuam tshuam tsis zoo rau lub xeev cov hlab ntsha. Yog li, txhua tus neeg mob ntshav qab zib yuav tsum ua qhov kev soj ntsuam ntshav siab txhua hnub. Kev siv tshuaj yeeb yuav tsum tau pib nrog ib tus me ntsis ntawm cov lej ntawm ib txwm.

Mob ntshav qab zib mellitus feem ntau cuam tshuam los ntawm kev mob ntshav siab lossis mob ntshav thib ob. Kev sib xyaw ntawm ob hom kabmob no ua rau muaj kev pheej hmoo mob ntxiv los ntawm lub siab, ob lub raum, ob lub qhov muag, lub hlwb thiab lwm yam kabmob. Txhawm rau zam qhov no, nws yog qhov yuav tsum tau soj ntsuam hom kev ua si, khoom noj khoom haus, kuaj xyuas raws sijhawm thiab noj tshuaj uas koj tus kws kho mob sau.

Nws yog qhov tsim nyog yuav tsum noj cov vitamins rau kub siab, vim nws muaj pov thawj tias lawv txo cov ntshav siab. Qhov twg tsim nyog haus? Yuav magnesium B6 thiab nws cov analogues pab?

Sartans thiab kev npaj muaj nrog lawv yog cov kws kho mob, yog tias tsim nyog, txo qis siab. Muaj tshwj xeeb kev faib tawm cov tshuaj, thiab lawv kuj tseem muab faib ua pawg. Koj tuaj yeem xaiv qhov sib koom ua ke lossis tshiab tiam tshiab nyob ntawm cov teeb meem.

Tsis yog li txaus ntshai rau cov neeg noj qab haus huv, arrhythmia muaj ntshav qab zib tuaj yeem yog qhov kev hem thawj rau cov neeg mob. Nws yog qhov xwm txheej tshwj xeeb tshaj yog rau cov ntshav qab zib hom 2, vim nws tuaj yeem dhau los ua rau mob stroke thiab lub plawv nres.

Tib lub sijhawm, ntshav qab zib thiab angina pectoris ua rau muaj kev hem thawj loj rau kev noj qab haus huv. Yuav kho tus mob angina pectoris li cas nrog ntshav qab zib hom 2? Lub plawv ntxhov ntxhov tuaj yeem pom li cas?

Kev noj zaub mov kom zoo rau lub plawv mob rau lub plawv yuav pab ua kom muaj kev nyob tus li qub. Kev noj qab haus huv thiab khoom noj muaj txiaj ntsig rau angina pectoris thiab mob plawv ischemia yuav pab txhawb lub cev.

Arterial hypertension hauv lub hnub nyoog laus tuaj yeem cuam tshuam tus qauv ntawm kev ua neej. Muaj ob peb txoj hauv kev los daws nws.

Yuav luag tsis muaj leej twg tswj kom tsis txhob muaj cov mob atherosclerosis hauv ntshav qab zib. Ob txoj kab kev sib deev no muaj qhov sib ze, vim tias cov piam thaj ntau ntxiv cuam tshuam rau cov hlab ntsha, ua rau kev txhim kho ntawm obliterating atherosclerosis ntawm qis qis hauv cov neeg mob. Kev kho mob yuav siv qhov khoom noj nrog.

Tus mob ntshav qab zib yog cov muaj feem yuav ua mob plawv. Myocardial infarction hauv ntshav qab zib tuaj yeem ua rau tuag taus. Tus mob plawv sai sai. Nrog hom 2, kev hem thawj yog dua. Yuav kho tus mob li cas? Dab tsi yog nws cov nta? Yam khoom noj dab tsi uas xav tau?

Yog tias kev txheeb xyuas tus mob exertional angina tau tsim, kev kho yuav raug coj ua lub hauv paus rau qhov pib ntawm kev txhim kho ntawm qhov teeb meem, piv txwv li, kab mob plawv. Cov tshuaj noj kom ruaj khov angina pectoris tshwm sim hauv tsev kho mob.

Pathogenesis ntawm kev kub siab hauv hom 1 mob ntshav qab zib

Hom ntshav qab zib hom 1, lub keebkwm ntawm cov ntshav siab yog 80-90% txuam nrog kev txhim kho ntawm DN. Nws tau pom nyob rau hauv 35-40% ntawm cov neeg mob uas muaj ntshav qab zib hom 1 thiab dhau los ntawm ntau theem: theem ntawm MAU, theem ntawm PU thiab theem ntawm kev mob raum tsis ua haujlwm. Kev nce ntshav siab (> 130/80 hli Hg) raug kuaj pom ntawm 20% ntawm cov neeg mob MAU, hauv 70% nyob rau theem ntawm PU thiab hauv 95-100% nyob rau theem ntawm kev mob raum tsis ua haujlwm. Hauv peb qhov kev tshawb fawb, qhov kev sib txheeb ze siab tau pom nyob nruab nrab ntawm cov qib protein ntau hauv cov zis thiab cov ntshav siab ntawm kev nce ntshav. Txoj kev sib txuam coefficient ntawm cov ntshav siab nrog MAU yog 0.62 (p 160/95 hli RT. Daim duab.),
- 63% ntawm cov tib neeg uas muaj hyperuricemia (ntshav uric acid cov ntsiab lus> 416 μmol / L hauv cov txiv neej thiab> 387 μmol / L hauv cov poj niam),
- 84% ntawm cov tib neeg mob hypertriglyceridemia (TG> 2.85 mmol / L),
- 88% ntawm cov neeg muaj cov roj HDL tsawg (7.8 mmol / L thiab 2 teev tom qab kev thauj khoom qab zib> 11.1 mmol / L).

Nrog kev sib xyaw ntawm hom 2 mob ntshav qab zib (lossis NTG) nrog dyslipidemia, hyperuricemia thiab kub siab, i.e., nrog cov khoom tseem ceeb ntawm cov khoom noj hauv lub cev, qhov kuaj tau ntawm IR yog 95%. Qhov no qhia tau tias, qhov tseeb, kev coj ua ntawm kev txhim kho metabolic syndrome yog IR.

Lub luag haujlwm ntawm IR hauv kev txhim kho hom 2 mob ntshav qab zib

Peripheral ntaub so ntswg IR underlies qhov kev loj hlob ntawm cov ntshav qab zib hom 2. Ntawm qhov tseem ceeb tshaj plaws hauv tsev kho mob yog qhov poob ntawm insulin rhiab heev hauv cov leeg nqaij, adipose thiab daim siab.IR ntawm cov leeg nqaij yog qhia nyob rau hauv ib qho kev txo qis ntawm cov ntshav qabzib los ntawm cov ntshav mus rau myocytes thiab nws siv nyob rau hauv cov leeg nqaij, adipose cov ntaub so ntswg - nyob rau hauv kev tawm tsam cov antilipolytic nyhuv ntawm cov tshuaj insulin, uas ua rau kev sib txuam ntawm cov roj dawb (FFA) thiab glycerol. FFAs nkag mus rau lub siab, qhov chaw uas lawv tau los ua lub hauv paus tseem ceeb ntawm kev tsim cov atherogenic lipoproteins ntawm qhov ntom ntom heev (VLDL). Cov qog nqaij hlav IR yog tus cwj pwm los ntawm txo cov glycogen synthesis thiab ua kom cov zom ntawm glycogen mus rau cov kua nplaum (glycogenolysis) thiab de novo qabzib cov lus los ntawm cov amino acids, lactate, pyruvate, glycerol (gluconeogenesis), vim li ntawd cov piam thaj hauv lub siab nkag rau cov ntshav. Cov txheej txheem no hauv lub siab ua haujlwm vim yog qhov tsis muaj lawv qhov kev cais los ntawm cov tshuaj insulin.

Peripheral ntaub so ntswg IR ua ntej qhov kev loj hlob ntawm hom 2 mob ntshav qab zib thiab tuaj yeem tshawb pom nyob rau hauv tsev neeg kiag ntawm cov neeg mob uas muaj ntshav qab zib hom 2 tsis muaj carbohydrate metabolism cuam tshuam. Tau ntev, IR tau them nyiaj los ntawm cov tshuaj insulin ntau dhau los ntawm kev mob hlwb (pancreatic β-cells (hyperinsulinemia), uas txhawb nqa cov metabolism hauv cov pluas (metabolism). Hyperinsulinemia yog sib npaug nrog cov cim ntawm IR thiab suav hais tias yog lub zog ntawm cov ntshav qab zib hom 2. Tom qab ntawd, nrog kev nce qib hauv IR, cells-hlwb nres tiv thaiv nrog cov ntshav qabzib ntau ntxiv, uas ua rau txo qis ntawm insulin secretory peev xwm thiab kev soj ntsuam mob ntshav qab zib. Ua ntej txhua, theem 1 ntawm insulin secretion (nrawm) tiv thaiv kev teb rau cov zaub mov thauj khoom, theem thib 2 (theem ntawm theem insal secretion zais cia) kuj pib poob qis.

Cov kev tsim kho hyperglycemia ntxiv txhim kho peripheral ntaub so ntswg IR thiab tswj cov tshuaj insulin-secretory muaj nuj nqi ntawm β-hlwb. Tus txheej txheem no yog hu ua piam thaj.

Nws ntseeg tias qhov xwm txheej ntawm IR muaj keeb caj ces, ruaj khov thaum hloov zuj zus. Raws li kev xav ntawm ib qho "qauv siv nyiaj txiag" ua ntej los ntawm V. Neel xyoo 1962, IR yog qhov hloov kho rau txoj kev muaj sia nyob hauv cov xwm txheej tsis zoo, thaum lub sijhawm muaj ntau nplua mias hloov nrog lub sij hawm ntawm kev tshaib plab. Qhov kuaj pom ntawm IR paub tseeb qhov kev txuam nrog lub zog hauv daim ntawv khaws nyiaj ntawm cov rog, qhov tshwj tseg ntawm uas tau txaus los ua kom muaj kev tshaib nqhis. Hauv qhov kev xaiv ntawm ntuj, cov noob uas muab IR thiab lub zog cia tau hloov kho raws li qhov tsim nyog tshaj plaws. Qhov kwv yees tau ua pov thawj nyob hauv kev sim rau cov nas uas tau ua rau lub hnub tshaib plab ntev heev. Tsuas yog cov nas ciaj sia uas tau tso tawm cov IR-txhob kaw. Nyob rau hauv cov xwm txheej niaj hnub, hauv cov tebchaws uas muaj lub neej zoo, ua rau tsis muaj peev xwm thiab zaub mov tsis zoo, cov txheej txheem ntawm IR tau khaws cia hauv kev tshuaj ntsuam keeb mus txuas ntxiv "ua haujlwm" ntawm lub zog cia, uas ua rau lub plab rog, rog ntshav qab zib, ntshav siab thiab, thaum kawg, hom 2 mob ntshav qab zib.

Txog rau hnub tim, cov pov thawj txaus tau tsim los qhia tias IR thiab nws cov kab mob hyperinsulinemia yog qhov muaj feem yuav ua rau nce atherogenesis thiab tuag ntau los ntawm kab mob plawv. Kev tshawb nrhiav IRAS ntau ntau (Kev Tshawb Nrhiav Tshuaj Ntshav Tiv Thaiv Kev Ntsuas Kab Mob Kev Noj Qab Haus Huv) tau ua tiav, tsis ntev los no tau ua tiav, uas yog txhawm rau ntsuas qhov sib txheeb ntawm IR (txiav txim los ntawm kev kuaj ntshav qabzib siab) thiab kev pheej hmoo mob plawv hauv cov neeg ntawm cov tib neeg tsis muaj ntshav qab zib thiab cov neeg mob ntshav qab zib hom 2. Raws li lub cim ntawm atherosclerotic lesion. cov hlab ntsuas lub pob ntsa tuab ntawm cov carotid leeg. Txoj kev tshawb no tau qhia meej txog kev sib raug zoo ntawm qib IR txog kev mob ntshav siab thiab mob hnyav ntawm lub plab rog, atherogenicity ntawm cov ntshav lipid spectrum, kev ua kom muaj qhov coagulation system, thiab phab ntsa tuab ntawm cov carotid leeg nyob rau hauv ob leeg tib neeg tsis muaj ntshav qab zib thiab cov neeg mob ntshav qab zib hom 2 ntawm phab ntsa tuab rau txhua qhov ntawm IR carotid leeg nce ntxiv los ntawm 30 microns.

Muaj ntau qhov kev sim ua pov thawj tias hyperinsulinemia yog qhov kev pheej hmoo ntawm kev mob ntshav siab rau cov neeg tsis muaj ntshav qab zib hom 2: kev tshawb pom yav tom ntej ntawm Paris (txog 7000 tshuaj), Busselton (ntau tshaj li 1000 tus neeg kuaj) thiab Helsinki Policemen (982 tshuaj ntsuam) (meta-tsom xam los ntawm B. Balkau et al. ) Xyoo tsis ntev los no, kev sib piv tau zoo sib xws tau pom muaj hauv cov neeg mob ntshav qab zib hom 2. Nws muaj cov pov thawj sim rau cov ntaub ntawv no. Kev ua haujlwm ntawm R. Stout qhia tias insulin muaj cov atherogenic cuam tshuam ncaj qha rau cov phab ntsa ntawm cov hlab ntsha, ua rau muaj kev tawm tsam thiab tsiv teb tsaws ntawm cov leeg nqaij mos, ua kom cov lipids hauv lawv, nthuav tawm ntawm fibroblasts, kev ua kom cov ntshav coagulation system, thiab txo qis hauv cov haujlwm fibrinolysis.

Yog li, IR thiab hyperinsulinemia ua rau muaj txiaj ntsig zoo rau kev nce qib ntawm atherosclerosis ntawm ob tus tib neeg predisposed rau kev txhim kho ntshav qab zib thiab hauv cov neeg mob uas muaj ntshav qab zib hom 2.

Lub luag haujlwm ntawm IR hauv kev txhim kho kub siab

Cov kev sib raug zoo ntawm hyperinsulinemia (tus cim ntawm IR) thiab qhov tseem ceeb ntawm kev kub siab yog li muaj zog uas muaj qhov siab ntawm cov ntshav plasma insulin hauv tus neeg mob, nws muaj peev xwm twv tau txoj kev loj hlob ntawm cov ntshav siab hauv lub sijhawm luv. Ntxiv mus, txoj kev sib raug zoo no tuaj yeem dhau hauv ob cov neeg mob rog thiab cov neeg uas lub cev nyhav.

Muaj ntau ntau cov qauv uas tau piav qhia txog kev nce ntshav siab nyob rau hauv hyperinsulinemia. Cov tshuaj insulin ua kom muaj kev ua haujlwm ntawm cov leeg hlwb, nce qhov rov ua kom rov qab ntawm Na thiab cov kua dej hauv cov hlab ntsha rov qab, ntau zuj zus ntawm Na thiab Ca, insulin ua rau lub zog ua kom muaj qhov ua kom loj ntxiv ntawm cov leeg nqaij hauv cov leeg nqaij, uas ua rau kom txoj hlab ntaws tuab.

Kub siab yog dab tsi?

Hauv cov tshuaj, tus kab mob no tau txhais tias yog nce siab ntxiv ntawm ntshav tawm ntawm 140/90 hli Hg. Kos duab. thiab. Qhov tseem ceeb tawg yog li 90-95% ntawm cov neeg mob. Nws zoo li tus kabmob ywj siab thiab yog tus yam ntxwv muaj ntshav qab zib hom 2. Kev mob ntshav siab nyob rau hauv 70-80% ntawm cov neeg mob ua ntej cov kab mob no, thiab tsuas yog 30% ntawm cov neeg mob tshwm sim tom qab mob raum. Nws muaj theem ob tawg (mob). Nws muaj mob ntshav qab zib hom 1.

Ua rau muaj ntshav siab txaus rau ntshav qab zib

Cov laj thawj ntawm kev loj hlob ntawm kev tawg yog txiav txim siab nyob ntawm hom mob ntshav qab zib mellitus. Nyob rau hauv hom 1, 80% ntawm cov xwm txheej ntawm txoj hlab ntaws hloov zuj zus vim kev mob ntshav qab zib nephropathy, i.e. vim mob raum puas. Xws li hom ntshav qab zib hom 2, lub siab nce siab txawm tias ua ntej nws tshwm sim. Nws ua ntej ntawm tus kab mob loj no, ua ib feem ntawm cov mob metabolic.

Qhov sib txawv ntawm hom 1 mob ntshav qab zib mellitus (DM 1) yog tus neeg mob tas li xav tau kev txhaj tshuaj ntawm cov tshuaj insulin - cov tshuaj uas pab cov piam thaj nkag mus rau hauv lub hlwb, uas ua kom lawv cov haujlwm tseem ceeb. Nws ceases tau tsim hauv lub cev nws tus kheej. Qhov ua rau feem ntau ntawm tus mob no yog kev tuag ntau dua 90% ntawm cov leeg hlwb. Ntshav qab zib hom no yog insulin-tau txiaj ntsig, tau txais txiaj ntsig, thiab tsis kis nyob rau hauv lub neej. Ntawm cov ua rau mob ntshav liab nrog nws, hauv qab no yog sau tseg:

pathology ntawm endocrine system - 1-3%,
raug rho tawm systolic kub siab - 5-10%,
tawg siab - 10%,
mob ntshav qab zib nephropathy thiab lwm yam mob raum - 80%.

Kuj tseem muaj insulin-ywj pheej hom ntshav qab zib (ntshav qab zib hom 2). Nws tshwm sim rau cov neeg laus tom qab 40 xyoo, tab sis qee zaum pom hauv cov menyuam yaus. Qhov ua kom muaj tus kab mob yog qhov tsis txaus tsim cov tshuaj insulin los ntawm cov txiav tsis ua kab mob. Raws li qhov tshwm sim, cov txheej txheem metabolic tsis tuaj yeem ua raws li ib txwm muaj. T2DM tau txais thaum lub neej. Nws yog qhov tshwj xeeb tshaj yog rau cov neeg mob rog rog lossis rog dhau.

Tawg tiv thaiv keeb kwm ntawm tus mob ntshav qab zib hom no tshwm sim ntawm:

pathology ntawm endocrine system - 1-3%,
lub raum hlab patency tsis meej - 5-10%,
ntshav qab zib nephropathy - 15-20%,
raug rho tawm systolic tawg - 40-45%,
qhov tseem ceeb kub siab (thawj hom) - 30-35%.

Npaum li cas thiaj pom ntshav muaj ntshav qab zib

Nrog txhua yam ntshav qab zib, cov hlab ntsha loj thiab cov hlab ntsha me me hauv tib neeg lub cev tau cuam tshuam. Vim tias qhov txo qis hauv lawv qhov elasticity, lub siab poob pib. Hauv feem ntau cov neeg mob ntshav qab zib, mob ntshav hlwb tau ntxhov vim tias muaj ntshav siab. Kev kho mob ntshav siab hauv ntshav qab zib yog nyob ntawm nws qhov pom. Nrog tus mob ntshav qab zib hom 1, nws muaj kev cuam tshuam nrog kev mob ntshav qab zib, uas cuam tshuam rau cov hlab ntshav ntawm cov leeg hlwb thiab tus qauv ntawm lub raum, ua rau:

Cov tsos hauv cov zis ntawm albumin yog microalbuminuria. Ua raws li cov tsos mob thaum ntxov ntawm ntshav siab.
Kev Proteinuria Sawv cev rau qhov txo qis hauv kev ua haujlwm ntawm lub raum. Qhov tshwm sim yog qhov pom ntawm tag nrho cov protein nyob hauv cov zis. Nrog cov proteinuria, qhov kev pheej hmoo ntawm kev tsim kev kub siab nce mus txog 70%.
Mob raum tsis ua hauj lwm. Nyob rau qib no, ua tiav raum ua haujlwm raug pom, uas yog 100% lees paub txog kev txhim kho kev mob ntshav siab.

Ntshav qab zib Hom 2 feem ntau pib tawm tsam keeb kwm ntawm kev rog dhau. Yog hais tias tus kab mob ua ke nrog kub siab, tom qab ntawd nws tshwm sim cuam tshuam nrog kev tsis txaus siab rau cov zaub mov carbohydrates lossis cov ntshav siab nyob hauv ntshav. Nws precedes tsis hnov qab zib nyob rau hauv lub cev. Tus mob no yog hu ua "metabolic syndrome." Kev kho ntawm insulin tsis kam yog nqa tawm uas siv cov khoom noj khoom haus carbohydrate tsawg.

Yuav kho kab mob ntshav siab li cas hauv ntshav qab zib

Cov kev kho mob tshwj xeeb yog xaiv rau cov neeg mob uas muaj cov kabmob no. Lawv yuav tsum ua kom ntshav nce siab, txwv tsis pub, raws li kws kho plawv, kev pheej hmoo ntawm kev txhim kho cov hlab plawv muaj teeb meem loj: kev tiv thaiv mob plawv (CHD), lub plawv tsis ua haujlwm, thiab mob hlab ntsha tawg. Ib qho kev txaus ntshai txaus ntshai yog tawg. Cov kev kho mob yog yam. Nws suav nrog:

Tsawg cov zaub mov carb. Txhawm rau kom tsis txhob muaj qhov hloov pauv ntawm cov ntshav siab, nws yog ib qho tsim nyog yuav tau ua kom qis cov ntsiab lus ntawm lipoproteins tsawg thiab qabzib hauv cov zaub mov noj.
Cov tshuaj rau cov ntshav qab zib muaj ntau yam sib txawv ntawm cov tshuaj uas ua rau qee cov txheej txheem los txo cov ntshav siab.
Folk kev. Lawv rov qab ua kom cov metabolism hauv lub zog tsis zoo, yog li txo lub siab. Ua ntej siv lwm cov tshuaj, nws yog qhov yuav tsum tau sab laj nrog cov kws kho mob endocrinologist kom xaiv ib qho los xaiv cov tshuaj noj muaj txiaj ntsig lossis cov zaub mov txawv.

Tsawg cov zaub mov carb

Ib txoj hauv kev los ua kom cov ntshav qab zib thiab ntshav qab zib qis yog noj cov zaub mov muaj carb tsawg. Txhua yam khoom noj uas siv yuav tsum yog maj ua kom siav. Ua li no, siv ua noj, ci, ncu thiab cub. Cov kev kho mob zoo li no tsis ua rau phab ntsa ntawm cov hlab ntsha, uas txo qis kev pheej hmoo ntawm kev mob ntshav siab.

Kev noj zaub mov kom noj txhua hnub yuav tsum muaj cov vitamins thiab minerals uas pab txhim kho cov ntshav hauv cov kabmob. Thaum kos duab los ntawm cov ntawv qhia zaub mov, koj yuav tsum siv cov npe uas tau tso cai thiab txwv tsis pub cov khoom lag luam. Thawj qeb yog:

nqaij nruab deg
txiv ntoo jelly
khoom noj siv mis nyuj,
tshuaj ntsuab tshuaj ntsuab
marmalade
wholemeal qhob cij,
qe
tawv nqaij thiab ntses,
zaub broth
zaub ntsuab
txiv hmab txiv ntoo qhuav
zaub.

Kev siv cov khoom no maj mam tso qhov qib ntshav siab. Kev noj zaub mov zoo rau cov ntshav qab zib hom 2 nrog ntshav siab txo cov naj npawb ntawm cov tshuaj tiv thaiv antihypertensive. Nws tsis txaus kom xam cov khoom noj zoo hauv koj cov zaub mov noj. Nws tseem yog qhov yuav tsum tau tso tseg ntau cov khoom:

ntsim ntsim hom cheese
marinades
cawv
bakery khoom
dej qab zib
rog hnyuv ntxwm
haus dej kas fes thiab hauv dej qab zib,
rog nqaij thiab ntses,
pickles
hnyuv ntxwm, noj nqaij.

Siv tshuaj kho

Ib hom tshuaj tshwj xeeb rau kev mob ntshav siab hauv ntshav qab zib mellitus yog xaiv nrog kev ceev faj, vim tias rau ntau yam tshuaj siv tus kab mob no yog kev sib kis. Lub ntsiab ntawm cov tshuaj yog raws li nram no:

lub peev xwm los txo cov ntshav siab uas tsawg kawg ntawm kev phiv,
tsis muaj kev cuam tshuam rau cov piam thaj hauv cov ntshav, theem ntawm cov "kev phem" cov roj (cholesterol) thiab triglycerides,
muaj cov txiaj ntsig zoo ntawm kev tiv thaiv ob lub raum thiab lub plawv los ntawm kev sib xyaw ua ke tiv thaiv ntshav qab zib thiab kub siab.

Niaj hnub no, ntau pab pawg ntawm cov tshuaj tau txawv. Lawv tau muab faib ua ob pawg: loj thiab pabcuam. Cov tshuaj ntxiv yog siv thaum kws kho mob muab sib ntxiv rau tus neeg mob. Qhov muaj pes tsawg leeg ntawm cov tshuaj pab pawg tau siv yog qhia hauv qab rooj:

Angiotensin II receptor blockers

Cov tshuaj tiv thaiv (diuretics)

Cov calcium antagonists (calcium channel blockers)

Imidazoline receptor agonists (tshuaj uas muaj cov nyhuv hauv nruab nrab)

Rasilez - ib qho ncaj qha inhibitor ntawm renin

Lwm txoj hauv kev ntawm kev kho mob

Lwm txoj kev siv tshuaj kho mob muaj qhov ua tsis zoo rau lub cev, pab txo qis phiv thiab kho cov tshuaj sai. Tsis txhob cia siab rau cov kev kho mob pej xeem, thiab ua ntej siv lawv, koj yuav tsum sab laj nrog koj tus kws kho mob. Ntawm cov zaub mov noj zoo tiv thaiv cov ntshav siab, cov hauv qab no sawv:

Suav sau 1. Npaj 25 g ntawm motherwort tshuaj ntsuab, 20 g ntawm dill noob, 25 g ntawm hawthorn paj. Sib tov cov khoom xyaw thiab zom nrog kas fes grinder. Nqa 500 ml ntawm dej npau rau lub npe ntawm cov tshuaj ntsuab. Qhov sib tov yog simmering rau txog 15 feeb tshaj tsawg tshav kub. Lim los ntawm cheesecloth ua ntej siv. Siv tsis pub ntau tshaj 4 khob ib hnub rau 4 hnub.
Suav sau 2. Rau 1 liter ntawm dej npau npau, noj 30 g ntawm currant nplooj, 20 g ntawm oregano thiab chamomile paj, 15 g ntawm hauv marsh. Qhov sib tov yog simmered tshaj li tsawg cua sov rau 10-15 feeb. Siv ib nrab ib teev ua ntej noj mov 3 zaug hauv ib hnub.
Txog 100 g ntawm hawthorn berries brew nrog dej npau npau, ua noj lawv ntawm qhov kub tsawg li txog ib quarter ntawm ib teev. Tom ntej no, cia cov kua rau txias txias ntawm chav sov. Lim los ntawm cheesecloth ua ntej siv. Haus ib lub decoction tsis txhob siv cov tshuaj yej tas li txhua hnub.

Cov tshuaj antihypertensive

Cov kev coj hauv kev kho mob ntshav siab hauv ntshav qab zib yog noj tshuaj tiv thaiv kabmob. Nws muaj ntau yam sib txawv ntawm cov nyiaj ntawd. Lawv qhov sib txawv nyob ntawm cov txheej txheem ntawm kev txiav txim. Tus kws kho mob yuav sau ntawv rau ib hom tshuaj, i.e. tshuaj mob hlwb. Ntau zaus, kev kho mob siv nyob rau hauv hom kev sib xyaw - nrog qee yam lossis ob peb hom tshuaj ntawm ib zaug. Qhov no pab txo qis cov tshuaj ntawm cov khoom xyaw nquag thiab txo cov tshuaj phiv ntau. Ob peb ntsiav tshuaj cuam tshuam rau cov kev sib txawv ntawm cov ntshav siab.

Beta blockers

Cov no yog tshuaj txo tus plawv-txo. Nrog rau kev kub siab, lawv raug kho nyob rau hauv cov ntaub ntawv ntawm tas mus li atrial fibrillation, tachycardia, tom qab lub plawv nres, angina pectoris thiab mob plawv tsis ua haujlwm. Qhov ua haujlwm ntawm cov tshuaj no yog los thaiv beta-adrenergic receptors nyob rau hauv ntau yam plab hnyuv siab raum, suav nrog lub siab thiab cov hlab ntsha.

Ib qhov tshwm sim ntawm txhua qhov beta-blockers yog qhov ntsej muag ua kom tshwm sim ntawm cov ntshav qog ntshav qab zib. Txoj kev tawm ntawm lub xeev no qeeb qeeb. Vim li no, beta-blockers yog contraindicated rau hauv cov neeg mob uas xav tias qhov pib ntawm cov cim qhia ntawm hypoglycemia. Txhua qhov tshuaj tawm ntawm beta-blockers xaus rau "-ol". Muaj ntau ntau pab pawg ntawm cov tshuaj no: lipophilic thiab hydrophilic, tsis muaj kev ua sab hauv nrog sympathomimetic lossis nrog nws. Raws li kev faib tawm loj, beta-blockers yog:

Tsis-xaiv. Lawv thaiv beta1 thiab beta2 receptors, txhim kho insulin tsis kam. Anaprilin tshuaj nrog propranolol hauv cov muaj pes tsawg leeg tso tawm ntawm no.
Xaiv. Kev thaiv cov beta2 receptors ua rau cov kev xav tsis zoo, xws li bronchospasm, ua rau mob ntsws asthma, vasospasm. Vim li no, xaiv beta blockers tau tsim. Lawv raug hu ua cardioselective thiab block tsuas yog beta1 receptors. Cov tshuaj yeeb dej caw bisoprolol (Concor), metoprolol, atenolol, betaxolol (Lokren) tau tso tawm ntawm no. Lawv kuj txhim kho insulin tsis kam.
Beta-blockers nrog cov nyhuv vasodilating. Cov no yog cov tshuaj tshiab dua thiab muaj kev nyab xeeb dua rau cov ntshav siab mob ntshav qab zib.Lawv raug pom los ntawm cov kev mob tshwm sim tsawg dua, muaj cov txiaj ntsig zoo ntawm cov carbohydrate thiab lipid profile, thiab txo cov tshuaj insulin tsis kam. Cov tshuaj uas tsim nyog tshaj plaws rau cov ntshav qab zib hauv cov pab pawg no yog Dilatrend (carvedilol) thiab Nebilet (nebivolol).

Cov calcium calcium blockers

Txog rau luv luv, cov tshuaj no raug xa mus ua LBC. Lawv thaiv cov kab qeeb hauv cov hlab ntsha thiab cov leeg plawv, uas qhib hauv qab ntawm norepinephrine thiab adrenaline. Raws li qhov tshwm sim, cov calcium tsawg yog muab rau hauv cov plab hnyuv siab raum, ib qhov microelement uas ua kom muaj ntau cov txheej txheem hauv kev ua haujlwm hauv cov leeg hlwb. Qhov no ua rau vasodilation, uas ua rau muaj pes tsawg tus neeg mob plab.

Calcium antagonists qee zaum ua rau mob taub hau, yaug, tawm pob, thiab cem quav. Vim li no, lawv raug hloov nrog cov tshuaj magnesium npaj. Lawv tsis tsuas yog txo qis siab, tab sis kuj txhim kho plab hnyuv muaj nuj nqi, ntxias cov leeg ntshaus. Nrog mob ntshav qab zib nephropathy, koj yuav tsum xub tham koj tus kws kho mob. Hom LBC raug faib nyob ntawm seb cov chaw twg thaiv:

Verapamil pab pawg. Cov tshuaj no cuam tshuam rau cov leeg nqaij ntawm cov hlab ntsha thiab lub plawv. Qhov no suav nrog cov tshuaj los ntawm cov pab pawg ntawm tsis-dihydropyridines: phenylalkylamines (Verapamil), benzothiazepines (Dilziatem). Lawv raug txwv tsis pub siv ua ke nrog cov beta-blockers vim tias qhov phom sij ntawm lub suab tsis sib xws. Cov txiaj ntsig yuav ua tau atrioventricular block thiab lub plawv raug ntes. Verapamil thiab Dilziatem yog qhov kev xaiv zoo rau beta blockers thaum lawv tau contraindicated tab sis tsim nyog.
Cov pab pawg nifedipine thiab dihydropyridine BBK (kawg nrog "-dipin"). Cov tshuaj yeeb yaj kiab no tsis cuam tshuam rau kev ua haujlwm ntawm lub siab, yog li lawv raug tso cai ua ke nrog beta-blockers. Lawv qhov rho tawm yog qhov nce siab hauv lub plawv, dua li lub siab sim tswj lub siab thaum nws txo qis. Ntxiv rau, txhua qhov BBK tsis muaj cov kev ua nephroprotective. Cov kev siv sib txuam kom siv yog hyperglycemia thiab tsis khov ntawm lub pob taws. Hauv pawg no, ntau qhov subtypes siv yeeb siv tshuaj ntawm dihydropyridine pawg yog qhov txawv:
- nifedipine - Corinfar, Corinfar Retard,
- felodipine - Adalat SL, nimodipine (Nimotop),
- lercanidipine (Lerkamen), lacidipine (Sakur), amlodipine (Norvask), nicardipine (Barizin), isradipine (Lomir), nitrendipine (Bypress).

Hauv cov neeg mob ntshav qab zib, muaj qhov nce siab ntxiv rau ntsev thiab nce ntxiv ntawm cov roj ntsha mus rau hauv lub cev. Raws li qhov tshwm sim, ntshav siab nce siab. Txhawm rau txo nws, siv tshuaj diuretics (tshuaj tso zis tso zis). Lawv tshem tawm cov kua dej ntau dhau thiab ntsev tawm hauv lub cev, txo qhov ntim ntawm cov ntshav ncig, uas pab txo qis systolic thiab diastolic.

Tawm tsam cov keeb kwm ntawm ntshav qab zib, diuretics feem ntau ua ke nrog beta-blockers lossis ACE inhibitors, txij li nyob rau hauv cov qauv ntawm cov tshuaj tua kab mob lawv qhia lawv qhov tsis muaj txiaj ntsig. Muaj ntau ntau pawg ntawm diuretics:

Lub npe ntawm cov pab pawg ntawm diuretics

Yog tias tsim nyog, vasodilation, txhawm rau txhim kho cov metabolism. Pom zoo rau gout, mob ntshav qab zib thiab hnub nyoog laus.

Torasemide, Furosemide, Ethacrine Acid

Nrog lub raum tsis ua haujlwm. Siv nrog ceev faj nrog glucophage thiab lwm yam tshuaj rau ntshav qab zib vim qhov pheej hmoo ntawm kev tsim cov tsos mob ntawm cov kab mob lactic acidosis.

Triamteren, Amiloride, Spironolactone

Thaum cov ntshav qab zib tsis tau thov.

DM yog qhov tsis sib haum rau kev siv cov tshuaj diuretics no, vim tias lawv muaj peev xwm tob tob acidosis.

ACE inhibitors

Kev kho mob ntshav siab hauv ntshav qab zib tsis ua tiav yog tsis muaj angiotensin-hloov enzyme inhibitors, tshwj xeeb tshaj yog nyob rau ntawm muaj mob lub raum. Cov kev txwv tsis pub siv rau lawv siv yog cev xeeb tub, hyperkalemia thiab nce siab cov ntshav creatinine. Hauv cov neeg mob uas muaj hom 1 thiab ntshav qab zib hom 2, ACE inhibitors yog thawj cov tshuaj. Lawv raug kho rau proteinuria thiab microalbuminuria.

Kev nqis tes ntawm cov tshuaj yog txhawm rau txhim kho qhov rhiab ntawm cov nqaij mos rau insulin. Qhov no muab kev tiv thaiv ntawm cov ntshav qab zib hom 2. ACE inhibitors dilate cov hlab ntshav, thiab sodium thiab dej, vim lawv, txuas mus ntxiv rau hauv cov ntaub so ntswg. Tag nrho cov no ua rau qhov txo qis siab. Cov npe ntawm ACE inhibitors xaus rau "-pril." Txhua yam tshuaj tau muab faib rau cov pawg hauv qab no:

Sulfhydryl. Cov no suav nrog benazepril (Potenzin), captopril (Kapoten), zofenopril (Zokardis).
Carboxyl. Muaj xws li perindopril (Prestarium, Noliprel), ramipril (Amprilan), enalapril (Berlipril).
Phosphinyl. Hauv cov pab pawg no, Fosicard thiab Fosinopril sawv.

Cov tshuaj tiv thaiv

Yog tias tus neeg mob tau txais kev kho mob sib xyaw, tom qab ntawd ntxiv rau cov tshuaj tseem ceeb, cov tshuaj tiv thaiv kab mob yog siv. Lawv tau siv nrog ceev faj vim qhov ua tau phiv. Qhov qhia tau rau kev teem caij ntawm cov neeg ua haujlwm pabcuam yog qhov ua tsis tau ntawm kev kho mob nrog cov tshuaj hauv paus. Piv txwv, los ntawm cov neeg mob ACE inhibitors, hnoos qhuav tshwm sim hauv qee cov neeg mob. Hauv cov xwm txheej zoo li no, ib tus kws kho mob uas tsim nyog hloov mus rau tus neeg mob mus rau kev kho mob ntawm angiotensin receptor antagonists. Txhua kis tau raug txiav txim siab ntawm tus kheej nyob ntawm tus mob ntawm tus neeg mob.

Direct renin inhibitor

Resiles yog qhov ncaj qha renin inhibitor nrog kev tshaj tawm. Qhov kev ua ntawm cov tshuaj yog txhawm rau txhaws cov txheej txheem ntawm kev hloov pauv ntawm angiotensin los ntawm daim ntawv I rau II. Qhov tshuaj no txwv cov hlab ntsha thiab ua rau cov qog adrenal ua cov tshuaj hormone aldosterone. Cov ntshav siab poob qis tom qab siv ntev ntawm cov resiles. Qhov zoo ntawm cov tshuaj yog tias nws cov hauj lwm zoo tsis yog nyob ntawm qhov hnyav lossis hnub nyoog ntawm tus neeg mob.

Qhov tsis zoo suav nrog qhov tsis muaj peev xwm siv tau thaum cev xeeb tub lossis nws cov phiaj xwm yav tom ntej. Ntawm cov kev mob tshwm sim tom qab noj cov Resiles yog:

anemia
zawv plab
hnoos qhuav
daim tawv nqaij ua pob,
ntxiv theem ntawm poov tshuaj nyob rau hauv cov ntshav.

Nws yog tsim nyog teev cia hais tias kev tshawb fawb ntev ntawm Rasilez tseem tsis tau ua tiav. Vim li no, cov kws kho mob tsuas hais qhia tias cov tshuaj muaj cov txiaj ntsig ntawm kev tiv thaiv ob lub raum. Rasilez feem ntau ua ke nrog angiotensin II receptor blockers thiab ACE inhibitors. Tawm tsam keeb kwm yav dhau los ntawm lawv cov kev nkag, cov tshuaj tsub kom rhiab ntawm cov ntaub so ntswg mus rau insulin thiab txhim kho cov ntshav suav. Rasilez yog contraindicated nyob rau hauv:

Renovascular tawg
cov me nyuam tsis tau muaj 18 xyoo,
tsis tu ncua hemodialysis
cov tsos mob nephrotic
muaj lub cev tsis haum rau lub tshuaj,
mob siab ua rau daim siab.

Imidazoline receptor agonists

Qhov no yog lub npe rau centrally ua yeeb tshuaj. Lawv cuam tshuam rau lub hlwb receptors. Qhov kev ua ntawm agonists yog ua rau txoj haujlwm tsis muaj zog ntawm kev cia siab ntawm lub hlwb. Qhov tshwm sim yog qhov txo qis plawv thiab qhov siab. Piv txwv ntawm imidazoline receptor agonists yog:

rilmenidine - Albarel,
moxonidine - Kev tawm dag zog.

Qhov tsis zoo ntawm cov tshuaj yog tias lawv cov txiaj ntsig ntawm kev tawg yog pov thawj hauv 50% ntawm tus neeg mob xwb. Ntxiv rau, lawv muaj ntau cov kev mob tshwm sim, xws li:

Qhov zoo ntawm txoj kev kho nrog cov tshuaj no yog qhov tsis tuaj ntawm kev tshem tawm thiab kev mob siab rau mob siab. Lawv yog thawj qhov raug xaj rau cov neeg nyob rau lub hnub nyoog laus, tshwj xeeb nrog cov kab mob concomitant pathology, suav nrog ntshav qab zib. Imidazoline receptor agonists yog contraindicated hauv: