Ntau qhov mob txhab rau ntawm cov hlab ntshav tau pom nyob hauv cov neeg mob uas muaj mob ntshav qab zib ntau dua ib xyoo caum, hauv 45-54% ntawm cov neeg mob. Lub luag haujlwm ntawm kev tswj qhov teeb meem ntawm lub cev yog qhov tseem ceeb heev. Qhov system ntawm neurons tswj lub hlwb, palpitations, ua pa, plab zom mov, thiab cov leeg mob. Mob ntshav qab zib polyneuropathy ntawm qhov qis qis (DPN) yog cov kab mob uas pib hauv ko taw thiab kis mus siab dua thiab siab dua.

Lub pathogenetic mechanism ntawm tus kab mob yog qhov nyuaj heev thiab tsis tau to taub tag nrho los ntawm cov kws tshawb fawb. Kev txiav txim tawm ntawm qhov tso zis ntawm lub paj hlwb yog qhov manifold. Txhua hom DPN muaj nws daim duab kuaj mob. Txawm li cas los xij, txhua daim ntawv ntawm cov kev tsis zoo no yog qhov txaus ntshai thiab xav tau kev kho mob rau tus neeg mob, txwv tsis pub muaj teeb meem ntawm txhais ceg tuaj yeem ua rau tus neeg xiam oob qhab Mob ntshav qab zib polyneuropathy raug kho los ntawm kws kho mob raws li G63.2 raws li ICD-10 qhia txog qhov txawv ntawm tus kabmob.

Cov Hom Mob Neuropathy

Txij thaum lub paj hlwb peripheral raug faib ua somatic thiab autonomous (autonomic), ob hom mob ntshav qab zib polyneuropathy tseem hu ua. Thawj ua rau ntau qhov mob tsis kho qhov mob ntawm qhov mob qis qis, qhov thib ob - teeb meem nrog tso zis, mob tsis xwm yeem thiab mob plawv, feem ntau ua rau neeg tuag taus.

Lwm qhov kev faib tawm yog ua raws cov haujlwm ntawm lub paj hlwb, uas tau ua txhaum raws li kev txhim kho ntawm pathology:

hnov mob polyneuropathy cuam tshuam nrog kev hnov mob hauv ob txhais ceg, lossis, hloov pauv, nrog tus cwj pwm tsis hnov mob,
lub cev ua rau lub cev polyneuropathy, uas yog cov leeg nqaij thiab lub peev xwm txav mus los,
sensorimotor polyneuropathy, sib xyaw cov yam ntxwv ntawm ob qho teebmeem no.

Qhov kev tshaj tawm ntawm lub xeem, sib xyaw pathology yog neuropathy ntawm txoj hlab leeg. Tus mob ntshav qab zib nrog rau qhov mob tsuas yog tsis hnov mob hauv qee qhov chaw ntawm ko taw thiab ceg qis. Qhov seem ntawm seem ntawm ob txhais ceg tsis teb rau ib qho txias lossis kub. Tsis tas li ntawd, cov neeg mob tsis muaj peev xwm tswj hwm lawv ko taw. Cov neeg mob tau yuam kom taug kev, tsis txawv txav ntawm lawv ob txhais ceg ("qaib dib" gait).

Ntshav qab zib distal polyneuropathy

Qhov no yog ib qho kab mob uas ua rau tuag ntawm cov hlab ntsha. Tus kab mob coj mus rau qhov ua tiav tag nrho ntawm tactile rhiab thiab ulceration ntawm deb tshaj plaws ntawm lub qis kawg - qhov taw. Ib qho mob rau cov neeg mob ntshav qab zib nrog DPN uas tsis hnov qab yog yam mob uas ua rau tus neeg tsaug zog tsis taus. Ntxiv mus, qee zaum lub xub pwg pib mob. Polyneuropathy hloov zuj zus, thiab qhov no ua rau cov leeg mob hlwb, pob txha deformation, taw ncaj qha, txiav lub qhov muag.

Sab Sij Huam

Nrog rau tus kabmob no, kev mob hnyav ntawm lub sensorimotor haujlwm ntawm txhais ceg tshwm sim. Hauv cov neeg mob ntshav qab zib, tsis tsuas yog txhais ko taw, pob taws, qis ntawm ob txhais ceg yog mob thiab loog, tab sis kuj txhais tes. Peripheral polyneuropathy feem ntau tshwm sim thaum cov kws kho mob sau ntawv yuav muaj cov tshuaj tua kab mob los tiv thaiv nrog kev mob tshwm sim loj: Stavudine, Didanosine, Saquinavir, Zalcitabine. Nws yog ib qho tseem ceeb kom raws sij hawm ntsuas cov kab mob no kom sai li sai tau txiav cov tshuaj.

Hnov polyneuropathy

Cov yam ntxwv tseem ceeb ntawm cov kab mob pathology yog qhov ploj ntawm qhov rhiab ntawm ob txhais ceg, cov neeg kawm ntawv ntawm qhov twg tuaj yeem sib txawv. Los ntawm qhov kev xav me me kom ua tiav loog, nrog kev ua kom yuag thiab deformation ntawm taw.Nyob rau tib lub sijhawm, qhov tsis muaj kev nkag siab paradoxically sib txuas nrog cov kev mob siab muaj zog uas tshwm sim nthawv. Tus kab mob cuam tshuam rau thawj zaug ib ceg, tom qab ntawd feem ntau txav mus rau ob, nce siab dua thiab siab dua, cuam tshuam rau cov ntiv tes thiab txhais tes, lub cev, lub taub hau.

Dysmetabolic

Qhov tshwm sim ntawm ntau yam mob no feem ntau npau taws, ntxiv rau cov ntshav qab zib, kab mob ntawm lub plab, hnyuv, raum, mob siab. Ntau cov hlab ntsha ntawm qhov kawg ntawm cov leeg tuaj yeem cuam tshuam. Kev ua txhaum ntawm lub sciatic, femoral neurons, kev mob siab, mob raum, mob nyuaj nrog txav mus los, lub hauv caug, leeg caj dab ploj mus. Feem ntau lub luj tshib puas lawm, trigeminal, optic leeg. Dysmetabolic polyneuropathy tuaj yeem tshwm sim yam tsis muaj mob.

Vim li cas cov neeg mob ntshav qab zib thiaj li muaj mob neuropathy

Lub ntsiab yog vim cov ntshav qabzib thiab cov ntshav insulin mus ntev. Deterioration ntawm cov xovtooj ntawm tes muaj cov kev cuam tshuam tsis zoo ntawm cov leeg ntu. Ntxiv rau, kev mob ntshav qab zib polyneuropathy ntawm ob txhais ceg tuaj yeem tshwm sim los ntawm:

endocrine mob
mob siab lossis mob raum,
kev nyuaj siab, kev tiv thaiv tsis muaj zog,
kis tau tus mob
haus cawv
lom nrog lom lom
hlav hlav.

Cov yam ntxwv tseem ceeb ntawm tus kabmob ntawm txhua hom:

Cov tsos mob rhiab - qhov mob, ua kom tsis muaj zog lossis kev tsim txom ntawm kev pom ntawm qhov ntsuas kub hloov, kev co.
Cov tsos mob txav - cramps, tshee, nqaij atrophy ntawm nqua.
Cov tsos mob ua tsis muaj mob - edema, hypotension, tachycardia, tso quav tsis xis nyob, impotence.

Kub cev thiab tingling ob txhais ceg

Qhov xav tias zoo li yog qhov kawg nkaus ntawm ob txhais ceg uas kub hnyiab nrog hluav taws pom thaum lub pob hluav taws xob ntawm qhov nqaj ploj mus los ntawm tus nqaj qaum mus rau ko taw raug mob. Kev hlawv ko taw tsis yog kab mob, tab sis yog tsos mob uas nthuav tawm cov mob polyneuropathy hauv ntshav qab zib mellitus. Cov neurons puas lawm tau qhib thiab xa cov cim tsis tseeb rau lub hlwb, txawm hais tias tsuas txhais ceg txhais ceg yog sib zog thiab tsis muaj hluav taws.

Poob ko taw tsis hnov mob

Thaum xub thawj, tus mob ntshav qab zib ntsib kev ua kom tsis muaj zog, loog ntawm txhais taw. Tom qab ntawv cov kev xav no tshwm sim hauv cov ceg, txhais tes. Thaum polyneuropathy ntawm qis qis zuj zus, cov nqaij mob atrophy nce thiab tactile rhiab heev. Ko taw ua dhau los nyuaj los tswj thiab dai. Cov tes yog loog, pib ntawm lub tswv yim ntawm cov ntiv tes. Nrog rau cov txheej txheem ntev pathological, poob ntawm rhiab heev cuam tshuam ib feem ntawm lub pob tw hauv siab thiab plab.

Kev kuaj mob ntawm tus kabmob

Polyneuropathy ntawm qis qis tshaj yog kuaj pom siv cov kev tshawb fawb ntawm tus neeg mob:

kuaj mus kuaj tsis pom kev zoo,
qhov mob pab kho mob rhiab
kev ntsuam xyuas kev co
xeem kub
daim tawv nqaij hlab me me,
electroneuromyography (ENMG), uas tuaj yeem qhia tau seb cov hlab ntsha puas tuaj yeem hla cov leeg nqaij.

Kev kho mob ntawm mob ntshav qab zib polyneuropathy ntawm qis dua

Cov teeb meem no tsis tuaj yeem kho kom zoo, tab sis lawv txoj kev txhim kho tuaj yeem ua rau qeeb. Yuav kho cov leeg ntshav ntawm neuropathy kom tsawg dua? Qhov tseem ceeb yog qhov normalization ntawm qabzib nyob rau hauv cov ntshav. Kev ua kom loog, khau dav, taug kev tsawg, kev da dej txias yuav pab txo qhov mob. Qhov da dej zoo li ua rau kub taws. Nws yog ib qho tsim nyog yuav tsum tau siv cov tshuaj uas nthuav dav cov hlab ntsha hauv lub cev, cuam tshuam kev sib kis ntawm cov hlab ntaws. Kev kho mob polyneuropathy ntawm qhov qis qis ua kom zoo dua thaum siv cov vitamins B. Nws tseem tseem ceeb uas yuav tau kho cov carbohydrate metabolism ntawm cov zaub mov noj.

Tshuaj kho mob nkeeg

Cov khoom muaj nqis rau kev kho mob nyuaj rau cov neeg mob nrog kev paub txog tus mob polyneuropathy ntawm qhov qis qis:

antidepressants Amitriptyline, Imipramine, Duloxetine, thaiv qhov tsis pub rov qab cov tshuaj hormones norepinephrine thiab serotonin,
anticonvulsants Pregabalin, Carbamazepine, Lamotrigine,
analgesics Targin, Tramadol (koob tshuaj yog nruj me ntsis - cov tshuaj!),
Milgamma Vitamin Complex
Berlition (thioctic lossis alpha lipoic acid), uas muaj lub peev xwm los kho cov leeg uas cuam tshuam nrog,
Actovegin, uas ua rau cov ntshav txhim kho cov hlab ntshav hauv lub hlwb,
Isodibut, Olrestatin, Sorbinil, uas tiv thaiv cov hlab ntsha hauv qabzib,
tshuaj tua kab mob - nrog kev hem thawj ntawm kev mob plab.

Tshuaj kho-kho pub dawb

Qhov kev cia siab uas yuav kho nrog kev pab los ntawm kev pab hauv tsev los yog tshuaj kho kom zoo nkauj yog utopia. Nws yog ib qho tsim nyog yuav tau noj tshuaj thiab nquag siv:

kev kho hluav taws xob
hluav taws xob txhawb
hyperbaric oxygenation,
Kev Siv Tshuaj Tua Tsiaj
Zaws
Kev siv dag zog tawm dag zog (kev tawm dag zog lub cev).

Ntshav qab zib mob polyneuropathy (hom mob, cov lus hnov) yog ib qho mob cuam tshuam ntau tshaj plaws ntawm ntshav qab zib. Nyob rau hauv hom II mob ntshav qab zib mellitus, los ntawm lub sijhawm ntawm kev kuaj mob, kev kuaj mob ua rau pom kev puas siab puas ntsws polyneuropathy raug tshawb pom hauv 20-25%, thiab nrog rau cov kabmob muaj ntev dua 10 xyoo, hauv yuav luag 50% ntawm cov neeg mob. Tsis zoo li cov ntshav qab zib ua pauj ntshav qab zib thiab nephropathy, mob ntshav qab zib polyneuropathy yuav nrog cov tsos mob hauv chaw soj ntsuam. Neurologists ntawm Yusupov Tsev Khomob siv cov kev kuaj mob niaj hnub los txheeb xyuas cov duab hluav taws xob tsis sib xws. Rau kev kuaj mob ntawm cov neeg mob siv cov khoom siv tshiab los ntawm cov tuam txhab ua lag luam European thiab Asmeskas.

Kev siv tswv yim tshiab tau siv los kho cov neeg mob. Kev kho mob sib xyaw rau mob ntshav qab zib distal polyneuropathy nyob hauv tsev kho mob Yusupov suav nrog:

tswj ntshav qabzib thiab ntshav qab zib them,
normalization ntawm ntshav siab,
zaub mov noj
tus neeg kawm ntawv txoj kev kawm
kev ua neej pauv.

Cov kws kho mob hlwb tau sau ntawv rau cov neeg mob uas mob ntshav qab zib polyneuropathy siv tau cov tshuaj zoo tshaj plaws nrog kev pom tshwm sim tsawg kawg. Cov kws kho kom rov zoo tuaj kho lub cev tsis ua haujlwm zoo uas siv cov qauv kev tawm dag zog niaj hnub. Cov kws ua zaub ua mov noj npaj cov tais diav ua noj, qhov zoo ntawm tsis txawv ntawm kev ua noj hauv tsev. Cov neeg mob tau txais kev kho mob lub sijhawm lawv nyob hauv pawg ntseeg nrog theem European kev nplij siab.

Cov txheej txheem rau kev txhim kho ntawm distal mob ntshav qab zib mob polyneuropathy

Lub pathogenesis ntawm ntshav qab zib mellitus yog ua raws li cov nyhuv lom ntawm cov ntshav qabzib. Nws tshwm sim vim kev tsim cov tshuaj insulin tsis txaus los yog muaj qhov tsis xws luag hauv qhov kev nqis tes ua lossis kev sib xyaw ua ke. Qhov tshwm sim hnyav ntawm hyperglycemia ua rau kev txhim kho mob ntshav qab zib angiopathy. Cov txheej txheem pathological ntawm cov hlab ntsha me me (microangiopathy) thiab ntawm cov nkoj ntawm nruab nrab thiab loj caliber (macroangiopathy).

Qhov ua kom lom cuam tshuam ntawm cov ntshav qabzib ntau yog paub nyob rau lwm txoj hauv kev, tshwj xeeb los ntawm kev ua kom cov protein glycosylation txheej txheem. Raws li qhov tsis-enzymatic txuas ntawm cov kua roj molecules rau amino pawg ntawm cov protein, cov qauv txheej txheem protein ntawm cov cell thiab cov protein ntawm cov kab mob hauv lub cev puas lawm. Qhov no ua rau muaj kev cuam tshuam ntawm cov metabolism, thauj khoom thiab lwm cov txheej txheem tseem ceeb hauv lub cev.

Nrog lub siab ntawm cov piam thaj hauv cov ntshav, ketoaldehydes ntawm cov dawb radicals pib tsim, oxidative lossis metabolic kev nyuaj siab pib. Lub cev tsoo qhov sib npaug ntawm cov prooxidants thiab cov ntu ntawm cov khoom siv tiv thaiv kab mob antioxidant. Nws yog nrog los ntawm cov insulin deficiency lossis insulin tsis kam ntawm qhov sib txawv.

Qhov tsis muaj kev ua haujlwm ntawm cov antioxidant enzymes hauv ntshav qab zib yog txiav txim siab los ntawm yam caj ces. Ischemia (tso ntshav tsis txaus), hypoxia (oxygen oxygen starvation) thiab nqaij pseudohypoxia, uas tau pom nyob rau hauv cov ntshav qab zib mellitus, yog lwm yam ntxiv. Lawv nce ntxiv ntawm kev tsim cov tshuaj tiv thaiv oxidants hauv ntau yam plab hnyuv siab raum thiab cov ntaub so ntswg.

Cov mob ntshav qab zib yog qhov tshwm sim ntawm qhov txhab dav ntawm cov leeg hlwb thiab lawv cov txheej txheem nyob rau hauv nruab nrab thiab ntu hlab ntsha hauv lub cev. Vim qhov ua txhaum ntawm cov txheej txheem tsim dua tshiab nyob rau hauv cov ntshav qab zib mellitus, muaj kev tuag sai sai ntawm cov neurons tshwm sim.

Txhua feem ntawm cov kab ke paj hlwb raug cuam tshuam:

cov naj npawb ntawm axons nyob rau hauv cov pob tw ntawm cov hlab ntsha peripheral poob qis (nrog qhov kev cia siab ntawm kev tsis xws luag nyob rau hauv qhov tsis txawv ntawm neurons),
cov naj npawb ntawm cov hlwb hauv tus txha nqaj pob txha caj qaum thiab lub ntsej muag zoo dua ntawm tus txha caj qaum tau txo qis
foci ntawm segmental demyelination thiab remyelination tshwm sim,
kev hloov pauv hauv lub hlwb ntawm lub cev kev puas siab puas ntsws ganglia thiab leeg leeg.

Feem ntau, qhov tsis zoo ntawm ob qho myelin thiab axial thooj voos kheej kheej tshwm sim. Cov txheej txheem pathological txuas ntawm qhov distal rau qhov sib thooj. Axonal degeneration ua rau cov leeg mob atrophy thiab kev tsis pom kev hloov hauv myography, nyob rau hauv kev sib piv rau qhov mob dawb paug ntawm qhov muag. Hauv cov cytoplasm thiab axoplasm ntawm Schwann hlwb, cov khoom lag luam xws li amyloid, ceramide, sulfatide, galactocerebroside ntau ntxiv. Muaj cov yam ntxwv hloov ntawm cov hlab ntsha thiab cov ntaub so ntswg sib txuas ntawm cov hlab ntaws:

loj hlob thiab hypertrophy ntawm endothelial hlwb,
thinning thiab ob npaug ntawm lub qab daus membrane ntawm capillaries,
nce nyob rau hauv tus naj npawb ntawm pib capillaries,
ib qho kev txo qis hauv qhov ceev ntawm endoneural capillary txaj nrog muaj ntau ntawm cov aggregates ntawm cov qe ntshav,
nce interfasicular chaw thiab collagen tso.

Cov teeb meem phom sij rau kev txhim kho cov ntshav qab zib mob polyneuropathy muaj xws li lub sijhawm ntawm tus kabmob, qhov neeg mob hyperglycemia, txiv neej poj niam txiv neej, hnub nyoog muaj hnub nyoog, thiab kev loj hlob.

Cov tsos mob ntawm tus mob ntshav qab zib distal polyneuropathy

Mob ntshav qab zib polyneuropathy (daim ntawv (sensorimotor daim ntawv, hom distal) yog ib qho kev mob tshwm sim ntawm cov ntshav qab zib mellitus, uas ntau qhov txhab ntawm qhov hlab ntaws txhawm rau txhim kho. Nws yog qhia los ntawm peripheral tuag tes tuag taw, vegetovascular mob nyob rau hauv lub deb extremities. Qhov cim thawj ntawm tus kabmob yog ua txhaum ntawm txoj haujlwm ntawm cov ntiv tes thiab ntiv taw. Sij hawm dhau los, thaum tsis muaj kev kho mob, nws npog thaj tsam loj dua ntawm caj npab thiab ceg. Ib ntawm cov yam ntxwv ntawm tus mob ntshav qab zib polyneuropathy yog qhov tshwm sim zoo li tsis hnov tsw ntawm txhua qhov nqua.

Cov tsos mob tseem ceeb ntawm tus kabmob muaj:

leeg atrophy, uas pib nyob rau hauv daim ntawv ntawm cov leeg tsis muaj zog, nce zuj zus ntawm kev kub ceev,
tsis txaus nyob rau hauv rhiab heev,
Kev ua haujlwm ntawm qhov kev hnov mob tactile,
nce hauv qhov mob
tas li kev xav ntawm goosebumps ntawm daim tawv nqaij, tingling los ntawm lub cev.

Nyob rau thawj theem ntawm tus kabmob, tus neeg mob tsis hnov mob. Neurologists pom qee yam hloov pauv ntawm cov hlab ntsha ntawm cov khoom siv tshwj xeeb - electroneuromyographs. Nws yog qhov nyuaj rau kev kuaj tus kab mob ntawm cov theem no.

Qhov theem ob ntawm tus kabmob yog pom los ntawm qhov tshwm sim ntawm qhov mob, kub lossis lossis loog ntawm nqaj, thiab qhov hloov pauv ntawm qhov pib ntawm lub rhiab. Hauv theem peb ntawm tus mob ntshav qab zib distal hnov mob polyneuropathy ntawm qhov qis qis, mob rau daim tawv nqaij ntawm taw thiab txhais ceg qis. Lawv yuav luag tsis muaj mob thiab tsim kho hauv 75% ntawm cov neeg mob yog tias tsis kho. Mob qog nqaij hlav hauv 15% ntawm cov neeg mob ua rau muaj kev xav tau ntawm kev txiav tawm ntawm cov ceg ntoo.

Thaum tus neeg mob tau mus pw hauv tsev kho mob neurology, cov kws kho mob hauv Tsev Kho Mob Yusupov kuaj qhov ntsuas kub, qhov mob, qhov nyuaj thiab lub cev muaj zog ntawm qhov mob siab rau qhov kev soj ntsuam txhua yam ntawm kev puas siab puas ntsws neuropathy. Kev ntsuas qhov kub thiab txias yog txiav txim siab txo qis thaum muaj qhov yuam kev los txiav txim siab qhov sov thiab txias ntawm lub ntsuas. Ib qho cim ntawm tsis muaj kev nkag siab yog qhov tsis muaj peev xwm ntawm tus neeg mob los txiav txim siab qhov sib txawv thaum kov lub sov thiab txias sab ntawm lub cuab yeej.Tactile rhiab heev raug soj ntsuam li qub, txo qis (tus neeg mob tsis hnov zoo kov nrog paj rwb) lossis qhaj ntawv (tus neeg mob tsis hnov kov nrog paj rwb lossis txhais tes).

Kev co rhiab heev yog kwv yees los ntawm tus txheej txheem ntawm biotheziometry zoo li qub (txog 9 V), txo qis (ntawm 10 txog 25 V), tsis tuaj kawm ntawv (ntawm 25 V thiab sab saud). Kev ntsuas ntawm qhov mob rhiab yog nqa tawm siv rab koob txhaj tshuaj. Nws raug txiav txim siab txo yog tias tus neeg mob yuam kev hauv kev txiav txim siab qhov ncaj thiab tsis meej ob sab ntawm rab koob lossis qhov rhiab tsis tshua muaj siab yog piv rau cov ceg nqaj kwv yees. Yog tias tus neeg mob tsis hnov kev txhaj tshuaj, lawv hais txog qhov tsis muaj lub siab xav.

Neurophysiologists ntawm Tsev Kho Mob Yusupov txiav txim siab lub xeev ua haujlwm ntawm lub cev muaj zog ntawm cov leeg thiab cov leeg ntawm qhov mob puas siab puas ntsws, qhov ceev ntawm cov mem tes raws lub cev muaj zog ntawm cov hlab sib xyaw, thiab cov txwv ntawm M teb rau ib qho kev mob siab los ntawm cov leeg ua kom muaj mob ntawm kev siv lub tshuab hluav taws xob. Cov kws kho mob kuaj xyuas tus kheej txheeb xyuas cov khoom siv hluav taws xob hauv qab no: impulse conduction velocity (STI) thiab qhov ntau ntawm M-teb. M-teb - tag nrho cov hluav taws xob muaj peev xwm ntawm cov leeg hauv kev teb rau ib qho hluav taws xob tib lub zog ntawm lub cev muaj zog lossis cov hlab ntaws sib xyaw. Qhov ntau ntawm M-teb cuam tshuam qhov sib xws thiab qhov ntau ntawm kev ua kom muaj zog ntawm cov koog ntawm lub cev muaj zog. Kev tuag ntawm ib feem ntawm cov neurons lub cev muaj zog ua rau txo qis ntawm qhov ntau ntawm M-teb.

SPI yog qhov ceev ntawm cov ntawv tshaj tawm ntawm qhov kev txiav txim muaj peev xwm nyob ntawm cov hlab ntsha. Qhov no yog qhov ntsuas tau suav raws li ntsuas qhov latency ntawm ob qho M-teb (rau lub cev muaj zog). SPI muab suav ua txoj hauv kev no qhia txog kev nrawm ntawm kev ua raws cov fiber ntau ua qhov sib luag. Hauv cov neeg mob kev txom nyem los ntawm qhov paub tab paub xav txog ntshav qab zib mob polyneuropathy, nrog kev pab ntawm electroneuromyography, kev ua txhaum ntawm kev ua haujlwm ntawm lub cev muaj zog ntawm cov hlab hluav taws xob, qhov ua txhaum ntawm kub rhiab, qhov qhaj los yog txo hauv qhov mob, kev tshee thiab tactile rhiab heev tau kuaj.

Kev kho mob rau cov ntshav qab zib kom hnov mob distal polyneuropathy

Tsis muaj kev pom zoo thiab kev ntseeg siab rau txoj kev kho mob ntshav qab zib polyneuropathy. Cov kws kho mob hauv tsev kho mob Yusupov them nyiaj tshwj xeeb rau kev tiv thaiv kev pib ntawm tus kabmob thiab kev loj hlob ntawm cov tsos mob. Cov neeg mob uas tau txais kev kho mob hauv chaw kho mob neurology raug soj ntsuam los ntawm tus kws kho keeb endocrinologist. Cov kws kho mob ua tib zoo soj ntsuam cov ntshav ntshav qabzib. Nws yog tswj nyob rau ntawm ib qib ze rau qhov phiaj thiab theem li ntawm glycosylated hemoglobin. Txhawm rau kom muaj qhov zoo tshaj plaws nyob rau hauv lub siab, ob qho tag nrho cov tshuaj insulin thiab ib qho nyuaj ntawm cov tshuaj tiv thaiv kab mob ntshav tau siv.

Cov neeg mob tau pom zoo kom noj zaub mov zoo, qhov tsim nyog ntawm kev ua haujlwm lub cev, uas yuav ua kom lub cev ua haujlwm ntawm lub cev, tswj nws kom zoo. Yog tias muaj kev cuam tshuam trophic rau ntawm daim tawv nqaij, cov neeg kho mob muab kev saib xyuas rau thaj chaw uas raug mob: siv tshuaj pleev rau daws qhov mob lossis ua kom ib ce rhiab ntawm cov ceg tawv.

Alpha lipoic acid thiab npaj muaj benfotiamine yog dav siv rau kev kho mob ntshav qab zib polyneuropathy. Ib txoj hauv kev kho tau zoo tshaj plaws yog kev siv cov tricyclic antidepressants uas thaiv qhov mob. Cov kws kho mob hlwb siv mus rau hauv tus account contraindications rau kev siv cov tshuaj no, pib kho nrog kev siv tshuaj tsawg kawg nkaus, nce ntxiv rau kev pom zoo tshaj plaws. Cov kws kho mob ua tib zoo saib xyuas qhov tshwm sim ntawm kev phiv los ntawm tricyclic antidepressants (qhov ncauj qhuav, tsaug zog, qaug zog), kho qhov ntau thiab hloov pauv tshuaj.

Cov coj kev kho mob uas cuam tshuam rau kev txhim kho cov txheej txheem ntawm cov ntshav qab zib distal piav qhia polyneuropathy ntawm qhov qis qis tshaj yog siv tshuaj tua kab mob antioxidant. Qhov no yog vim qhov tseeb hais tias nyob rau hauv cov ntshav qab zib mellitus cov kev ua ntawm lawv tus kheej lub zog tiv thaiv kab mob tsawg zuj zus, dawb radicals tsim nyob rau hauv dhau heev lawm. Qhov poob qis hauv qhov tshwm sim ntawm oxidative kev nyuaj siab nrog kev qhia ntawm cov tshuaj uas muaj cov antioxidant zoo yog nrog cov kev hloov hauv qab no:

txhim kho ntawm cov ntshav txaus,
kev txo qis hauv lipid peroxidation,
normalization ntawm cov ntsiab lus ntawm endothelial nitrous oxide,
nce hauv cov ntsiab lus ntawm kev tiv thaiv (tiv thaiv) cov protein ntawm kev ntxhov siab thaum tshav kub.

Thawj qhov chaw ntawm cov tshuaj tiv thaiv kab mob yog ua los ntawm α-lipoic lossis thioctic acid, lub ntuj lipophilic antioxidant. Cov tshuaj no txo cov tsos mob neuropathic thiab neuropathic tsis txaus. Cov kws kho mob ntawm lub tsev kho mob neurology pib kho nrog ib chav ntawm qhov tso dej txau (thioctacid, 600 mg rau 200 ml ntawm physiological saline) rau 15 hnub, thiab tom qab ntawd muab tshuaj rau 600 mg ntawm BV thioctacide ntsiav tshuaj rau tus neeg mob, uas nws siv txuas ntxiv.

Txhawm rau yauv mus kho mob kom txaus rau cov ntshav qab zib distal hnov mob polyneuropathy ntawm qhov qis qis, teem sijhawm nrog tus kws kho mob hlwb hauv xov tooj ntawm lub tsev kho mob Yusupov. Cov Kws Tshaj Lij Mob Hauv Tsev Kho Mob Yusupov Hauv Tsev Kho Mob ib leeg xaiv cov tshuaj, ua txoj kev kho cov mob ntshav qab zib ua kom tsis txhob mob, tsom rau kev tiv thaiv kev txiav tawm ntawm qhov qis qis. Kev kho txhua yam kabmob tuaj yeem pab tswj kom tus mob muaj zog thiab txhim kho lub neej ntawm tus neeg mob.

Ua tim khawv

ICD-10 (Kev Sib Koom Tes Thoob Ntiaj Teb ntawm Cov Kab Mob)
Yusupov Tsev Kho Mob
Batueva E.A., Kaygorodova N.B., Karakulova Yu.V. Cov nyhuv ntawm neurotrophic txoj kev kho tsis yog neuropathic mob thiab psycho-vegetative xwm txheej ntawm cov neeg mob ntshav qab zib neuropathy // Lavxias Phau Ntawv Sau Txog Kev Mob. 2011. No. 2. P. 46.
Boyko A.N., Batysheva T.T., Kostenko E.V., Pivovarchik E.M., Ganzhula P.A., Ismailov A.M., Lisinker L.N., Khozova A.A., Otcheskaya O .V., Kamchatnov P.R. Neurodiclovitis: muaj kev siv rau hauv cov neeg mob uas mob nraub qaum // Farmateka. 2010. No. 7. P. 63–68.

* Cov ntaub ntawv ntawm lub xaib yog rau kev qhia xov xwm nkaus xwb. Txhua cov ntaub ntawv thiab cov nqi tso tawm hauv lub vev xaib tsis yog pej xeem kev txiav txim siab, txiav txim siab los ntawm cov kev cai ntawm Kos duab. 437 ntawm Civil Code ntawm Lavxias Federation. Kom paub cov ntaub ntawv raug, tiv toj rau cov neeg ua haujlwm hauv chaw kho mob lossis mus ntsib peb lub tsev kho mob.

Hauv tsab xov xwm no, peb yuav soj ntsuam hauv kev nthuav dav uas pom qhov tshwm sim ntau tshaj plaws ntawm kev mob lig neurological ntawm ntshav qab zib - distal, zoo ib yam, hloov siab lossis cov sensorimotor polyneuropathy .

Cov tsos mob tseem ceeb tshaj plaws ntawm ntshav qab zib neuropathy yog paresthesia, loog loog, chilliness thiab mob nyob rau hauv qis qis kawg, nrog rau tes. Cov tsos mob tsis sib xws ntawm txhua yam kev hnov mob (mob, kub, tactile thiab kev co) nyob rau hauv lub thiaj li hu ua thaj chaw ntawm “thom khwm” thiab “hnab looj tes” Cov. Hauv ntau tus neeg mob, cov kev qhia no yuav ua rau tsis muaj zog. Hauv cov mob hnyav, hmo ntuj nchuav, mob, hnov pob taws ntawm ko taw thiab tes yog tus yam ntxwv. Yog tsis kho, kab mob kev tuag haj yam phem ntxiv.

Qhov tsos mob ntawm tus mob Neuropathy yog txiav txim siab hauv cov ntiv taw, nrog qhov sib thooj ntawm cov txheej txheem, cov cim ntawm qhov tsis hnov yuav tshwm sim hauv cov ntiv tes. Lub distal sab saud tsis tshua muaj kev koom tes ua ntej.

Nrog kev cuam tshuam, tsis sib luag, sensorimotor polyneuropathy, nyias tsis-myelinated (C), tsis muaj zog myelinated (Aσ) thiab tuab myelinated cov leeg (Aα, Aβ) txom nyem. Rau mob neuropathy nrog kev ua kom mob siab dua ntawm cov nqaij nyias nyias yog cov yam ntxwv ploj ntawm qhov mob thiab kub (cua sov thiab txias) rhiab Cov. Thaum cov tshuaj fiber ntau ua rau koom nrog cov txheej txheem, qhov nrawm ntawm cov hlab ntsha tsis tuaj yeem cuam tshuam thiab lub tactile thiab vibration rhiab poob lossis poob, uas nyob rau hauv cov mob loj tuaj yeem ua rau hnov qab tus mob. Tab sis nws yuav tsum raug sau tseg tias cov cim ntawm kev puas tsuaj rau cov nyias nyias cov hlab ntsha tau pom ua ntej tshaj li cov tuab.

Cov tsos mob ntawm tus mob ntshav qab zib neuropathy tau sau tseg ntau dua 40% ntawm cov neeg muaj ntshav qab zib thiab ib nrab ntawm lawv tau mob. Lub sijhawm ntawm qhov pib ntawm qhov mob yog yam ntxwv: thaum so, thaum ua haujlwm dhau, thaum kev ntxhov siab, thiab feem ntau yog thaum tsaus ntuj, thaum taug kev, qhov sib zog ntawm qhov mob tsawg zuj zus, thaum lub sijhawm hloov ntawm txoj haujlwm ntawm lub caj npab tsis muaj qhov cuam tshuam. Mob ntsws mob ntsws mob ntsws mob neuropathy piav raws li kev kuaj mob ib leeg. Nws yog tus cwj pwm tsis nco qab thiab qhov tsis zoo. Nyob rau tib lub sijhawm, lub cev muaj zog cov hlab ntsha tau tshwj tseg, thiab lub zog ua haujlwm tau raug kev txom nyem me ntsis. Ib qho xwm txheej zoo sib xws tau hu ua Ellenberg "tus kab mob ntshav qab zib cachexia." Mob neuropathic syndrome tau sau tseg nrog kev kho mob insulin thiab kev kho mob glycemia, uas Caravati piav qhia "insulin neuritis." Hauv qhov no, cov tsos mob hnov mob ntsig txog kev tsim kho cov hlab.

Cov kev hloov zuj zus ntawm cov mob ntshav qab zib polyneuropathy ua rau kev puas tsuaj rau lub cev muaj zog (lub cev muaj zog) cov fibers - leeg atrophy thiab tsis muaj zog hauv cov distal sab hauv qab Cov. Nrog rau kev koom tes ntawm autonomous cov leeg, cov hws txo, daim tawv nqaij ua kom qhuav thiab nquag mob hyperkeratosis. Qhov hu ua "kev pheej hmoo nres" yog tsim. Lub hauv caug thiab Achilles reflexes txo, cov pob txha tsis zoo ntawm lub cev tshwm sim: tiv thaiv hau ntawm pob txha metatarsal, rauj thiab rab ntiv taw-puab. Cov tawv nqaij muaj xim liab lossis xim liab, feem ntau muaj cov foci zoo ib yam ntawm hyperpigmentation ntawm sab ceg qis thiab sab nraub qaum ntawm lub taw (qhov thiaj li hu ua "pom qis hauv qab ceg"). Ntsia daim hlau tuaj yeem atrophy los yog hloov dua siab tshiab tuab thiab deform, uas txiav txim siab kev loj hlob ntawm onychomycosis. Thaum kawg, osteoarthropathy lossis Charcot txhais ko taw tau tsim (ib qho kev nce ntawm qhov hloov pauv ntawm lub taw, qhov hloov pauv thiab qhov ntev ntawm lub tiaj, nce deformation ntawm pob taws sib koom ua ke), kev hloov pauv ntawm kev teeb tsa ntawm ko taw tuaj yeem yog ib leeg lossis ob tog, thiab kev mob neuropathic edema kuj tseem tuaj yeem tshwm sim. Ib qho tseem ceeb qhia qhov txawv txav yog qhov kev khaws cia ntawm kev nrhav ntshav hauv cov hlab ntsha ntawm ko taw.

Ntev siab nyob rau ntawm cov chaw ntawm pob txha deformities ua rau inflammatory autolysis ntawm cov nqaij hauv qab thiab tsim ntawm neuropathic mob rau sab hauv, ntau dua ntawm thaj tsam ntawm plantar ntawm ko taw thiab hauv qhov chaw sib deev. Cov mob rwj no rau qee lub sijhawm yuav tsis hnov mob vim qhov tsis hnov mob, thiab feem ntau tsuas yog kis tau tus mob thiab cov txheej txheem mob coj los ua xim rau lub qhov txhab tsis zoo. Yog li no paub ntxov ntawm cov tsos mob ntawm tus mob ntshav qab zib polyneuropathy tsis tseem ceeb heev rau kom txo tau qhov kev pheej hmoo ntawm kev mob plab thiab tom qab ntawd kev txiav tu ncua ntawm lub ceg.

Hmoov tsis zoo, nws tsis muaj "tus qauv kub" rau kev kuaj xyuas cov mob neuropathic hauv ntshav qab zib. Hauv 1998, San Antonio tau pom zoo Kev pom zoo ntawm cov txheej txheem kev tswj hwm tus mob ntshav qab zib polyneuropathy leej twg xav kom ua tej yam hauv qab no:

Kev txheeb xyuas qhov tseeb cov tsos mob.
Kev soj ntsuam: morphological thiab biochemical tsom xam.
Kev tshawb nrhiav Electrodiagnostic: txiav txim siab qhov ceev ntawm lub txim siab raws txoj hlab ntsha.
Qhov yuav tau ntsuas qhov tseeb.
Kev ntsuam xyuas tus kheej muaj nuj nqi.

Feem ntau siv los xyuas txog cov ntshav qab zib mob neuropathy Cov tsos mob ntsuas - NSS (Cov Neuropathy Cov tsos mob Score) thiab nplai ntawm cov paib - VAT (Neuropathy Kev Ntshaw Cov Hluav Taws Xob). Txog kev xyaum kho mob, txoj kab ke no tau yoog los ntawm M. Young et al.

qhov hnov ntawm nqaij, loog loog (loog) lossis qhov hnov ntawm “nqeeb nkag khiab” = 2
qaug zog, mob plab los yog mob ib ce = 1
kev faib khoom:
taw = 1
plab hlaub nqaij leeg = 1
lwm yam = 0
nce:
thaum tsaus ntuj = 2
nruab hnub lossis hmo ntuj = 1
nruab hnub = 0
kev xav ntawm kev pw = 1
txo qis:
thaum taug kev = 2
sawv = 1
zaum lossis dag = 0

Tag nrho cov ntsiab lus muab ua rau teev tus nqi:
3-4 - cov tsos mob me,
5-6 - Cov tsos mob me ntsis,
7-9 - cov tsos mob hnyav.

lub hauv caug duav
kev co rhiab
kev hnov mob hauv nruab siab
kub rhiab
reflexes:
cev = 0
ua kom nrov dua = 1
tsis tuaj = 2 ntawm txhua sab
rhiab (tactile) rhiab:
nimno = 0
txo lossis qhaj = 1 ntawm txhua sab

Tag nrho cov ntsiab lus :
3-5 - cim mentsis
6-8 - cov tsos mob me ntsis
9-10 - cov tsos mob hnyav

Yam tsawg kawg nkaus rau kev kuaj mob ntshav qab zib neuropathy raws li NSS thiab VAT yog:

cov phiaj xwm loj tsawv uas muaj lossis tsis muaj tsos mob (VAT = 6-8 + HCC ≥ 0)
cov mob me nrog cov tsos mob me (VAT = 3-5 + HCC = 5-6)

Txhawm rau txiav txim siab qhov hnyav ntawm cov ntaub ntawv tshawb fawb, nws yog qhov tsim nyog cov khoom siv neurological soj ntsuam ntawm lub ntsuas hluav taws xob sensorimotor Cov. Nws suav nrog txoj kev kawm ntawm txhua hom rhiab thiab rov ua pa.

Lub cev ntaj ntsug muaj rhiab soj ntsuam siv 10 g ntawm monofilament (5.07 Semmes-Weinstein). Cov chaw uas nws yog qhov tsim nyog los ua kev tshawb fawb yog qhov ntoo ntawm lub pob zeb distal ntawm lub ntiv taw loj, lub npov ntoo ntawm lub taub hau distal thiab V metatarsal pob txha. Yuav tsum muaj tsawg kawg yog 2 kov ib qho taw tes. Qhov kev co rhiab ua kom pom kev tsis txaus siab yog txiav txim siab siv lub neurological tuning diav rawg lossis biotheziometer. Txoj kev tshawb fawb yog nqa tawm ntawm cov ntsiab lus txheem: lub hauv paus ntawm tus ntiv tes xoo thiab sab hauv pob luj taws. Kev co rhiab heev tsis txo yog tias tus neeg mob nres kom tsis hnov kev vibration thaum tus nqi ntawm tuning fork scale yog 7 UE lossis siab dua. Kev poob qis ntawm qhov pib ntawm qhov kev xav tau ntawm kev tsis txaus siab los ntawm ntau tus kws tshawb fawb tau raug txheeb xyuas raws li qhov tsis txaus siab tshaj plaws ntawm kev ua cim prognostic. Kev nkag siab kub tau txiav txim siab los ntawm kev sib chwv ntawm qhov chaw sov thiab txias rau qhov chaw nyob ze ntawm tus ntiv tes xoo, nraub qaum ntawm taw, sab hauv taw, sab ceg thiab hauv caug. Qhov tsis hnov qhov mob yog kawm siv koob hno lossis cov twj tshwj xeeb (Neuropen, Pin-log). Txhawm rau soj ntsuam lub xeev ntawm lub cev tsav ntawm cov leeg poob siab, Achilles thiab lub hauv caug tsis zoo txiav txim siab siv lub siab lub cev. Txheeb xyuas qhov tsis pom kev mob hlwb, txoj hauv kev pheej yig tshaj plaws hauv kev coj ua niaj hnub yog orthostatic kuaj .

Ua raws li kev kho mob cov pov thawj, cov hauv qab no cov theem ntawm cov distal mob ntshav qab zib (Cov Lus Qhia Thoob Ntiaj Teb rau Kev Kho Mob Sab Nraum Los Ntawm Tus Mob Ntshav Qab Zib Neuropathy, 1995):

0 - tsis mob neuropathy, cov tsos mob thiab cov tsos mob tsis tuaj
1 - tshuaj tiv thaiv mob hlwb asymptomatic
1 A - HCC = 0, txhawm lub hauv caug txhaws
1 B - HCC = 0, txo lub hauv caug tsis kam
2 - cov tsos mob neuropathy mob
2 A - HCC ≥ 1, lub cev hauv caug tsis kam
2 B - HCC ≥ 1, txo kom lub hauv caug tsis txhob pw
3 - cov leeg neuropathy mob hnyav.

Nrog rau cov ntshav qab zib, ib tug neeg muaj ntau cov teeb meem uas cuam tshuam rau txoj haujlwm ntawm cov nruab nrog cev. Lub paj hlwb peripheral feem ntau kuj cuam tshuam - yog tias ib leeg ntawm cov hlab ntsha cov hlab ntsha cuam tshuam, tus kws kho mob kuaj pom tus mob ntshav qab zib neuropathy, thiab yog tias muaj qhov txhab loj, kuaj ntshav qab zib polyneuropathy raug kuaj pom.

Tus kab mob no loj tuaj ntawm cov neeg mob ntshav qab zib nrog thawj thiab hom thib ob ntawm ntshav qab zib mellitus, qhov kev pheej hmoo ntawm tus kab mob yog 15-50 feem pua ntawm cov neeg mob. Feem ntau, ntshav qab zib polyneuropathy raug kuaj yog tias ib tus neeg tau txais kev tiv thaiv vim tsis muaj tshuaj txaus rau lub sijhawm ntev thiab tau nce cov ntshav qabzib ntau ntau.

Peripheral qab haus huv tau muaj kev cuam tshuam los ntawm kev hloov pauv ntawm cov txheej txheem ntawm cov txheej txheem hauv kev zom zaub mov hauv cov ntaub so ntswg. Kev noj qab haus huv cov hlab ntsha hauv cov pa oxygen tshaib plab, qhov kev tsim ntawm nitric oxide txo, uas ua rau cov ntshav khiav tsis zoo thiab cuam tshuam ntawm cov hlab ntsha tsis zoo.

Polyneuropathy. Kev faib tawm, ua rau, pom dav dav daim duab ntawm polyneuropathies.Dysmetabolic thiab paraneoplastic polyneuropathies. Polyneuropathies nrog cov tsis muaj cov vitamins. Guillain-Barré Syndrome

Lub xaib qhia cov ntawv pov thawj rau cov ntaub ntawv xov xwm nkaus xwb. Kev kuaj thiab kho kab mob yuav tsum tau nqa tawm los ntawm kev saib xyuas ntawm tus kws tshaj lij. Txhua yam tshuaj muaj contraindications. Yuav tsum tau kev sab laj tshwj xeeb!

Polyneuropathy yog dab tsi?

Polyneuropathy (polyneuropathy, mob polyneuritis) Yog tus kab mob uas tau pom los ntawm ntau qhov txhab ntawm qhov hlab ntsha peripheral. Cov kab mob kev mob no tau tshwm sim los ntawm cov neeg tuag tes tuag taw, qhov mob rhiab, qhov tsis txaus ntseeg siab-vascular ntshawv siab (mas nyob hauv lub distal extremities).

Mob ntshav qab zib polyneuropathy: Cov tsos mob

Nyob rau theem sib txawv ntawm tus kab mob, cov tsos mob tuaj yeem sib txawv - nrog ib theem ntawm theem, qhov tsos mob tsis tuaj yeem ua tiav. Thawj theem tsis muaj tus yam ntxwv, tab sis tus kws kho mob tuaj yeem kuaj xyuas tus kab mob los ntawm kev kawm npaj cov ntshav kuaj thiab cov txiaj ntsig ntawm kev kuaj mob kuaj pom ntawm thaj chaw ntawm neurophysiological chav.

Thaum kuaj mob zaum ob, mob mob, mob hnyav, mob leeg thiab tsis mob. Hauv daim ntawv mob mob, cov neeg mob ntshav qab zib xav tias kub thiab mob hauv ob txhais ceg, thaum lub sij hawm rhiab heev tsawg pom tias, qhov txiaj ntsig ntawm qhov mob polyneuropathy ntawm qhov qis qis yog kuaj pom. Tshwj xeeb cov tsos mob yuav tshwm sim thaum hmo ntuj.

Thaum daim ntawv mob hnyav tsim, qhov mob hnov pib kis thoob plaws hauv lub cev, qee kis, muaj qhov mob siab pom nyob rau qis qis. Amyotrophy yog nrog cov leeg ua kom tsis muaj zog thiab mob hnyav thaum hmo ntuj. Nrog rau daim ntawv tsis mob, tus neeg tsis hnov mob tag thiab kub hloov.

Tus kws kho mob kuaj pom theem peb ntawm tus kabmob thaum pom cov kev mob loj tshwm sim. Hauv thaj chaw ntawm ob txhais taw, koj tuaj yeem pom ntau qhov mob thiab mob txhab, nws yog qhov ua tau ntawm kev txhim kho ntawm Charcot tus taw, qhov no tus kab mob feem ntau ua rau txiav tes taw.

Txhua qhov ua tau ntawm kev ua kom paub tus kabmob tuaj yeem raug faib ua peb pawg:

Cov tsos mob rhiab nrog rau qhov tsis txaus siab nyob rau hauv daim ntawv ntawm ua kom tiav, txiav, tua, hlawv kev mob. Hauv cov neeg mob ntshav qab zib, qhov mob rwj tsawg los sis, hloov, rhiab ntau ntxiv, caj npab thiab ceg mus loog. Tsis tas li, tus neeg mob yuav tsis hnov kev vibration lossis kub hloov.
Cov tsos mob ntawm cov yam ntxwv ntawm lub cev muaj zog yog nrog kev ua kom tsis muaj zog lossis atrophy ntawm cov leeg nqaij ntawm ob txhais ceg, tsis muaj qhov cuam tshuam, tshee tshee, cramps ntawm caviar cov leeg.
Nrog rau kev mob ntshav qab zib, lub kaw lus siv lub cev tsis muaj tseeb, cuam tshuam los ntawm tachycardia, txo qis ntshav siab, thaum ib tug neeg hloov nws lub cev txoj haujlwm, cem quav, zawv plab, tsis muaj zog, tsis tuaj yeem tawm hws, edema.

Kev kuaj mob thiab kho mob polyneuropathy

Tus kab mob yog kuaj tau raws li cov lus yws ntawm cov ntshav qab zib, cov tsos mob tshwm sim thiab qee yam. Tus kab mob yog ib qho nyuaj heev los kuaj pom, vim tias cov neeg laus yuav pom cov tsos mob zoo sib xws vim muaj kev hloov pauv hnub nyoog.

Xws li qee lub sijhawm cov tsos mob tsis pom nws tus kheej hauv txhua txoj kev, yog li ntawd, nws yog qhov ua tau kom pom qhov kev ua txhaum cai nkaus xwb los ntawm kev xeem tshwj xeeb.

Feem ntau, tus kab mob no tau tshawb pom hauv cov txiv neej laus, tseem muaj kev pheej hmoo ntawm kev mob ntshav qab zib mob ntshav qab zib nrog cov ntshav qab zib mellitus nrog hyperglycemia ntev, muaj kev loj hlob ntawm tus neeg mob, muaj cov mob ntshav qab zib retinopathy thiab nephropathy, txo qis rhiab rau kev tshee, tsis muaj zog ntawm cov leeg ntshav siab.

Yog tias tus neeg muaj qhov cim xeeb ntawm cov kabmob, rau kev kuaj mob, kev tshee tsaws rhiab ntsuas yog siv ntsuas lub hauv siab, qhov siab ntawm qhov nkag siab hloov qhov kub yog txiav txim siab, qhov mob rhiab pom tau los ntawm pricking ob txhais ceg nrog rab koob tshwj xeeb.Xws li kuaj xyuas tactile rhiab heev thiab muaj peev xwm ntawm cov ntshav qab zib kom paub txog qhov chaw ntawm qhov chaw ntawm lub cev.
Yog tias xav tias lub cev muaj zog ua kom muaj tus kab mob, cov leeg mob siab tau soj ntsuam thiab electromyography yog ua, uas muaj nyob rau hauv kev kawm txog kev ua haujlwm bioelectric ntawm cov leeg nqaij.
Nyob rau hauv cov ntaub ntawv ntawm ib daim ntawv autonomous polyneuropathy, lub plawv dhia thaum nqus tau thiab exhalation yog ntsuas, lub plab zom mov thiab urological tus cwj pwm tau soj ntsuam, thiab tus neeg tau nquag ua kom tsis nco qab txog kev mob ntshav siab.

Thaum lub sijhawm kuaj mob, kws kho mob tshawb xyuas seb tus mob ntshav qab zib puas xav kov, mob, kub, txias, kev co thiab siab. Cov cuab yeej siv tau siv rau qhov no, tab sis tus neeg mob, yog tias tsim nyog, tuaj yeem tshawb xyuas qhov rhiab nws tus kheej nrog cov khoom siv sov thiab txias. Cov nqaij hnov mob ua kom zoo tuaj yeem pom cov paj rwb ntaws, uas nqa ntawm daim tawv nqaij.

Yog hais tias tus mob ntshav qab zib qhia tawm cov ntshav qab zib mob ntshav qab zib, kev kho mob yuav tsum tau muaj txhij txhua, txhua qhov laj thawj uas cuam tshuam tus kab mob yuav tsum tau muab tshem tawm. Rau qhov no, nyob rau kev pom zoo ntawm tus kws kho mob mus kawm, ntau yam tshuaj yog kws kho mob uas txo cov tsos mob thiab txo tus neeg mob tus mob.

Txo cov ntshav qab zib, noj cov tshuaj muaj piam thaj.
Yuav kom lub cev ua haujlwm ntawm lub paj hlwb tsis zoo, tus kws kho mob tau sau tshuaj rau cov vitamins B, tshuaj tua kab mob hauv ib qho tshuaj me me, thiab cov kev npaj muaj thioctic acid.
Gabapentin yog qhov tshuaj kho tau zoo rau qaug dab peg, thiab kev siv tshuaj loog thiab tshuaj loog yog qhov tseem ceeb. Kev npaj magnesium yuav pab txo cov leeg mob, cov leeg ua kom cov leeg rov zoo thiab ua pob.
Txhawm rau nce lub zog cov peev txheej ntawm neurons, nws raug nquahu kom noj cov tshuaj Actovegin.
Yog tias tus neeg muaj tachycardia, noj Nebivolol lossis Metoprolol.
Txhawm rau tshem tawm kev ua kom tawv nqaij ntawm daim tawv nqaij, Kapsikam, Apizartron, Finalgon yog siv.

Kev siv dag zog tshwj xeeb, ua kom ib ce zaws, kho tus mob kho, kho kom haum, kho hluav taws xob tuaj yeem kho kab mob los ntawm cov tshuaj tsis yog.

Cov pov thawj pej xeem txoj hauv kev pab tshem tawm cov qhov txhab thiab mob rau ntawm daim tawv nqaij nrog mob ntshav qab zib polyneuropathy, rau qhov no, tshuaj ntsuab infusions, kho cov roj, thiab muaj txiaj ntsig zoo nkauj siv.

Ib qho dej cawv twg yog qhov tshwj xeeb tshaj tawm hauv cov zaub mov kom lub cev muaj zog thiab noj qab nyob zoo.

Kev tiv thaiv kev ntsuas

Nrog kev kuaj mob kom raws sijhawm, kev kho kom zoo, thiab kev tiv thaiv, kev txhim kho kabmob tuaj yeem nres sijhawm. Txog qhov kawg no, nws yog ib qho tseem ceeb rau cov neeg mob ntshav qab zib tsib xyoo tom qab kuaj pom tus kab mob ntshav qab zib mellitus sab laj rau tus kws kho mob thiab kuaj xyuas seb puas muaj los yog tsis muaj ntshav qab zib polyneuropathy hauv menyuam yaus lossis neeg laus. Tom qab ntawd, koj yuav tsum tswj kom dhau txhua xyoo.

Kev txheeb xyuas qhov tseeb cov tsos mob.
Kev soj ntsuam: morphological thiab biochemical tsom xam.
Kev tshawb nrhiav Electrodiagnostic: txiav txim siab qhov ceev ntawm lub txim siab raws txoj hlab ntsha.
Qhov yuav tau ntsuas qhov tseeb.
Kev ntsuam xyuas tus kheej muaj nuj nqi.

qhov hnov ntawm nqaij, loog loog (loog) lossis qhov hnov ntawm “nqeeb nkag khiab” = 2
qaug zog, mob plab los yog mob ib ce = 1
kev faib khoom:
taw = 1
plab hlaub nqaij leeg = 1
lwm yam = 0
nce:
thaum tsaus ntuj = 2
nruab hnub lossis hmo ntuj = 1
nruab hnub = 0
kev xav ntawm kev pw = 1
txo qis:
thaum taug kev = 2
sawv = 1
zaum lossis dag = 0

Tag nrho cov ntsiab lus muab ua rau teev tus nqi:
3-4 - cov tsos mob me,
5-6 - Cov tsos mob me ntsis,
7-9 - cov tsos mob hnyav.

lub hauv caug duav
kev co rhiab
kev hnov mob hauv nruab siab
kub rhiab
reflexes:
cev = 0
ua kom nrov dua = 1
tsis tuaj = 2 ntawm txhua sab
rhiab (tactile) rhiab:
nimno = 0
txo lossis qhaj = 1 ntawm txhua sab

Tag nrho cov ntsiab lus :
3-5 - cim mentsis
6-8 - cov tsos mob me ntsis
9-10 - cov tsos mob hnyav

Yam tsawg kawg nkaus rau kev kuaj mob ntshav qab zib neuropathy raws li NSS thiab VAT yog:

cov phiaj xwm loj tsawv uas muaj lossis tsis muaj tsos mob (VAT = 6-8 + HCC ≥ 0)
cov mob me nrog cov tsos mob me (VAT = 3-5 + HCC = 5-6)

0 - tsis mob neuropathy, cov tsos mob thiab cov tsos mob tsis tuaj
1 - tshuaj tiv thaiv mob hlwb asymptomatic
1 A - HCC = 0, txhawm lub hauv caug txhaws
1 B - HCC = 0, txo lub hauv caug tsis kam
2 - cov tsos mob neuropathy mob
2 A - HCC ≥ 1, lub cev hauv caug tsis kam
2 B - HCC ≥ 1, txo kom lub hauv caug tsis txhob pw
3 - cov leeg neuropathy mob hnyav.

Polyneuropathy - Qhov no yog qhov mob nyav heev, uas yog qhov yeej ntawm qhov tseem ceeb ntawm cov leeg hlwb, lub hauv paus ntawm uas yog trophic kev ntxhov siab, qhov tsis haum siab, kev noj qab haus huv-vascular dysfunctions, flaccid tuag tes tuag taw, feem ntau pom nyob hauv ntu distal ntawm nqua. Tus kab mob no feem ntau yog cais raws li qhov xwm txheej etiological, pathomorphology ntawm lub pathological tsom thiab qhov xwm ntawm cov chav kawm.

Cib lim polyneuropathy yog suav tias yog hom kab mob sib kis, feem ntau cuam tshuam rau cov ntu sib txawv nrog cov maj mam koom nrog ntawm cov ntu.

Cov tsos mob polyneuropathy

Tus kab mob nyob rau hauv kev txiav txim siab polyneuropathy ntawm qaum thiab qis kawg pib nrog cov leeg tsis muaj zog, thiab hauv thawj zaug tig, hauv thaj chaw distal ntawm ob txhais ceg thiab caj npab. Qhov no yog vim kev puas tsuaj rau cov hlab ntuag. Nrog rau tus kabmob no, ua ntej txhua yam, cov teeb meem cuam tshuam ntawm cov ceg tawv muaj qhov cuam tshuam vim tias tsis muaj kev tiv thaiv txaus rau ntu ntawm cov ntu ntu (piv txwv li, ntshav-teeb meem nyob hauv lub hlwb).

Cov cim ntawm qhov piav qhia pathology taw qhia thaj tsam ntawm ko taw thiab kis maj maj zuj zus mus ntawm ceg. Ua raws li cov ntawv ntawm cov kab mob ntawm cov hlab ntaws uas raug rhuav tshem kom ntau dua, txhua hom polyneuropathy tau muab faib ua plaub pawg me.

Vim tias qhov yeej, feem ntau ntawm kev ua haujlwm ntev ntawm neurons, cov neeg mob muaj qhov zoo lossis tsis zoo rau tus mob. Thawj - yog tus cwj pwm los ntawm tus tsis muaj nuj nqi lossis qhov nws txo qis, cov tsos mob zoo yog cov kev mob tshwm sim uas tsis tau pom yav tas los.

Nyob rau hauv thawj zaug tig, hauv cov neeg mob tus kab mob hauv cov lus nug manifests nws tus kheej nrog ntau yam ntawm paresthesias, xws li hlawv, tingling, nkag mus rau ants, loog. Tom qab ntawd cov duab hauv tsev kho mob yog qhov nyuaj ntawm algias ntawm ntau yam kev sib zog, thiab qhov ntxim nyiam ntawm qhov muaj zog mob stimuli yog kho kom zoo. Raws li cov tsos mob nce ntxiv, cov neeg mob rhiab dhau rau kov yooj yim. Tom qab ntawd, lawv tau ua rau pom kev xav ntawm atoryia, qhia hauv kev tshee tshee ntawm cov tsuj taw, tshwj xeeb nrog lub qhov muag kaw, thiab tsis hnov lus ntawm kev txav. Cov tsos mob tsis zoo ntawm polyneuropathy muaj xws li txo qis ntawm cov neeg mob ntawm cov chaw ntawm kev puas tsuaj rau cov hlab ntaws.

Nyob rau hauv cov ntaub ntawv ntawm axonal puas rau neurons, lub zog ntawm polyneuropathy ntawm lub sab sauv thiab qis dua yog qhov tseeb, hauv thawj zaug tig, los ntawm cov leeg nqaij thiab muaj nyob hauv qhov tsis muaj zog ntawm txhais ceg thiab caj npab. Cov tsos mob piav tau nce mus rau kev tuag tes tuag taw thiab paresis. Kuj tsis tshua pom, qhov xwm txheej tuaj yeem pom, pom los ntawm qhov tsis xis nyob hauv cov ceg, tshwm sim thaum so thiab yuam kom tib neeg ua qhov txav ntawm qhov yooj yim ("tsis muaj ceg qis dua"). Ntxiv rau, kev ua kom txaus siab thiab qaug dab peg yuav tshwm sim.

Kev noj tshuaj tsis muaj zog tau muab faib ua trophic cuam tshuam thiab mob vascular. Thawj suav nrog cov tsos ntawm pigmentation thiab tev tawv nqaij, qhov zoo li pom ntawm qhov kawg ntawm cov kab nrib pleb thiab mob txhab. Cov leeg ntshav tsis xws luag suav nrog qhov txias ntawm qhov txias ntawm ntu tawg, fading ntawm daim tawv nqaij (lub npe hu ua "marble pallor").

Cov zaub mov-trophic cov tsos mob kuj muaj xws li kev hloov pauv hauv tus qauv ntawm derivatives ntawm dermis (plaub hau thiab rau tes). Vim tias qhov tseeb ntawm qis qis dua tuaj yeem tiv taus ntau lub nra, polyneuropathy ntawm ob txhais ceg yog kuaj pom ntau ntau dua li tes.

Polyneuropathy ntawm qis qis dua

Tus kab mob nyob rau hauv kev txiav txim siab polyneuropathy ntawm qhov xaus yog qhov kev puas tsuaj ntawm cov hlab hlwb, ua rau lub cev tsis ua haujlwm ntawm kev ua haujlwm ntawm lub nruab nrog cev. Qhov kev mob no yog pom los ntawm qhov txo qis hauv lub cev muaj zog, txo qis ntawm qhov rhiab, nyob ntawm qhov chaw ntawm lub ntsiab lus pathological, txhua qhov ntawm nqaj, mob leeg. Nrog rau tus kab mob hauv cov lus nug, tus neeg mob lub cev pob txha uas txhawb nqa cov taw yog puas. Raws li qhov tshwm sim ntawm kev teeb tsa kev puas tsuaj rau cov hlab ntsha ntawm lub cev, qhov rhiab ntawm cov ceg tau ploj, uas cuam tshuam rau tus neeg lub peev xwm txav ntawm nws tus kheej.

Kev kho mob polyneuropathy ntawm qhov qis qis, raws li txoj cai, yog qhov mob nyhav thiab ntev, txij li feem ntau cov kab mob no muaj tus cwj pwm kev vam meej thiab muaj kev loj hlob mus rau hauv cov mob ntev.

Txhawm rau txiav txim siab qhov ua rau cuam tshuam kev txhim kho ntawm tus kabmob piav qhia, hauv thawj qhov chaw, koj yuav tsum nrog cov cuab yeej ntawm cov leeg hlwb, tshwj xeeb nws thaj chaw cais - cov kab ke.Nws yog ua raws cov txheej txheem ntev ntawm cov hlab ntaws, txoj haujlwm ua haujlwm uas yog xa cov cim, uas ua kom lub cev muaj zog ntawm kev ua haujlwm ntawm lub cev thiab lub zog. Lub cev ntawm cov neurons no nyob hauv nuclei ntawm lub hlwb thiab tus txha caj qaum, yog li tsim kev sib txuas zoo. Los ntawm kev pom ntawm lub tswv yim, ntu ntu ntu ntawm lub paj hlwb txuas ntawm cov sib txuas "cov coj" uas txuas cov hlab ntsha chaw nrog receptors thiab cov plab hnyuv siab raum ua haujlwm.

Thaum polyneuropathy tshwm sim, ib qho sib cais ntawm cov cuab yeej hluav taws xob txuas nrog cuam tshuam. Yog li, kev nthuav qhia pom ntawm tus kab mob raug pom hauv qee thaj chaw. Xam tias muaj pathology rau ntawm nqua tes ua rau nws tus kheej symmetrically.

Nws yuav tsum raug sau tseg tias cov kab mob pathology tau txheeb xyuas muaj ntau ntau yam, uas tau faib raws li kev ua haujlwm ntawm cov hlab ntsha hauv kev puas tsuaj. Yog li, piv txwv, yog tias cov neurons lub luag haujlwm rau kev txav mus los, cuam tshuam lub peev xwm txav mus los yuav ploj lossis nyuaj. Xws li polyneuropathy yog hu ua lub cev muaj zog.

Nrog rau daim ntawv txiav txim siab ntawm qhov tsis meej nyob rau hauv nqe lus nug, cov hlab ntsha cov hlab ntsha cuam tshuam, ua rau rhiab, uas muaj kev txom nyem heev thaum pawg ntawm neurons puas.

Kev tsis txaus ntseeg ntawm lub zog ntawm lub zog tswj hwm tus kheej muaj tshwm sim nrog kev puas tsuaj rau autonomic cov leeg (hypothermia, atony).

Yog li, cov yam tseem ceeb hauv qab no uas ua rau kev loj hlob ntawm tus kab mob no tau txawv: kev mob metabolic (cuam tshuam nrog cov teeb meem hauv lub cev), autoimmune, roj ntsha, alimentary (tshwm sim los ntawm kev noj zaub mov tsis zoo), lom thiab kis-lom.

Ob daim ntawv ntawm cov kab mob piav qhia tau txawv tshwj xeeb nyob ntawm qhov chaw ntawm qhov chaw muaj kiav txhab: demyelinating thiab axonal. Thaum xub thawj - myelin cuam tshuam - ib yam khoom uas tsim cov hlab ntsha ntawm lub cev, muaj cov duab axonal, lub tog raj kheej axial puas lawm.

Daim ntawv axonal ntawm polyneuropathy ntawm ob txhais ceg yog pom hauv txhua yam kabmob. Qhov txawv yog qhov nthuav dav ntawm hom kev ua txhaum, piv txwv li, tej zaum yuav muaj qhov teeb meem ntawm lub cev muaj zog los sis txo qis ntawm rhiab. Daim ntawv no tshwm sim vim yog cov zaub mov tsis txaus, ua rau lub cev sib xyaw ua ke nrog cov kab mob organophosphorus, cov hmoov txhuas, cov ntsev muaj mercury, cov kua qaub, nrog rau cov cawv cawv.

Plaub daim ntawv no tau muab qhov txawv txav, nyob ntawm qhov kev kawm ntawm qhov kev kawm: ib chav ntev thiab rov ua dua qub, mob siab thiab subacute.

Cov mob hnyav ntawm axonal polyneuropathy feem ntau muaj kev txhim kho hauv 2-4 hnub. Ntau zaus nws npau taws los ntawm kev lom neeg tua tus kheej lossis lub txim txhaum loj, feem ntau qaug dej qaug cawv vim kis tau los ntawm arsenic, carbon monoxide, txhuas, kua ntsev mercury, cawv methyl cawv. Daim ntawv mob hnyav tuaj yeem siv sijhawm ntau dua kaum hnub.

Cov tsos mob ntawm daim ntawv subacute ntawm polyneuropathy nce ntxiv hauv ob peb lub lis piam. Daim ntawv no feem ntau tshwm sim nrog kev cuam tshuam ntawm metabolic lossis vim yog toxicosis. Feem ntau, txoj kev rov qab los maj mam tuaj yeem siv ntau lub hli.

Daim ntawv uas nquag muaj ntau zuj zus nyob rau ncua sijhawm txuas ntxiv ntawm rau lub hlis lossis ntau dua. Tus kab mob feem ntau tshwm sim los ntawm kev quav dej quav cawv, mob ntshav qab zib, lymphoma, kab mob ntshav, tsis muaj cov vitamins thiamine (B1) lossis cyanocobalamin (B12).

Ntawm cov kab mob axonal polyneuropathies, cov tshuaj tiv thaiv cawv ntau yog paub ntau dhau los, tshwm sim los ntawm kev haus dej haus cawv thiab haus dej cawv ntau dhau. Lub luag haujlwm tseem ceeb rau kev tshwm sim ntawm pathology nyob rau hauv kev txiav txim siab tsis yog ua los ntawm cov "haus dej" ntau dhau ntawm cawv, tab sis kuj los ntawm qhov zoo ntawm cov khoom nws tus kheej, vim tias ntau yam dej cawv muaj ntau yam tshuaj lom rau lub cev.

Lub hauv paus tseem ceeb uas ua rau cov neeg haus cawv haus cawv lub cev yog qhov tsis zoo ntawm co toxins, uas muaj ntau ntawm cawv, ntawm cov txheej txheem ntawm cov hlab ntsha, uas ua rau lub cev tsis haum lub cev. Feem ntau, pathology hauv nqe lus nug yog tus cwj pwm los ntawm subacute chav kawm. Thaum pib, nyob rau hauv cov xim sib faib ntawm qhov qis qis, qhov hnov ntawm nqaij tawv sawv, thiab hauv cov leeg nqaij nyuj - mob hnyav. Nrog rau nce siab, cov algias hauv cov leeg yuav pom ntau ntxiv.

Ntawm cov theem tom ntej ntawm kev txhim kho ntawm tus kabmob, kev ua haujlwm ntawm feem ntau qis qis tshaj yog pom, uas yog qhia los ntawm kev qaug zog, feem ntau txawm tias tuag tes tuag taw. Cov hlab ntsha ua rau flexion-ncua ntxiv ntawm ko taw yog feem ntau puas. Tsis tas li ntawd, qhov kev nkag siab ntawm cov khaubncaws sab nraud povtseg ntawm cov tawv nqaij hauv thaj chaw ntawm txhais tes los ntawm hom "hnab looj tes" thiab ko taw los ntawm hom "thom khwm" yog qhov tsis taus.

Qee qhov xwm txheej, qhov mob no yuav ua rau mob hnyav. Qhov no feem ntau yog vim overcooling.

Ntxiv rau cov kev kho mob saum toj no, lwm cov kab mob pathological kuj tseem muaj, xws li muaj qhov hloov xim tseem ceeb ntawm cov tawv nqaij ntawm ob txhais ceg thiab qhov kub ntawm qhov mob siab, o ntawm qhov tsis sib luag ntawm ob txhais ceg (tsawg dua caj npab), tawm hws ntau. Tus kab mob hauv nqe lus nug qee zaum tuaj yeem cuam tshuam cov cranial qab haus huv, hu ua oculomotor thiab optic qab haus huv.

Cov piav qhia tsis meej muaj feem ntau pom thiab nce ntau ntau lub lis piam / hli. Tus kab mob no tuaj yeem mob mus txog ntau xyoo. Nrog kev txiav tseg ntawm kev haus cawv, tus kab mob tuaj yeem kov yeej.

Daim ntawv demyelinating polyneuropathy pom tias yog tus kab mob hnyav, nrog rau mob o ntawm cov cag ntawm cov hlab ntsha thiab maj mam muaj kev puas tsuaj rau lawv cov myelin sheath.

Daim ntawv txiav txim siab ntawm tus kabmob yog tus tsawg. Ntau zaus, cov txiv neej laus tau muaj mob vim muaj tus kabmob no, txawm hais tias nws tuaj yeem tshwm sim hauv ib nrab tsis muaj zog thiab menyuam yaus. Demyelinating polyneuropathy feem ntau tshwm sim los ntawm cov leeg tsis muaj zog hauv qhov chaw tsis sib luag thiab thaj chaw ntawm lub nqaj, vim kev puas tsuaj rau cov hlab cag.

Hmoov tsis zoo, tus txheej txheem ntawm kev txhim kho thiab tus neeg muaj txiaj ntsig ntawm tus qauv txiav txim siab ntawm tus kabmob tsis paub qhov tseeb, txawm li cas los xij, ntau cov kev tshawb fawb tau qhia qhov kev ua haujlwm autoimmune polyyuropathy. Rau qee qhov laj thawj, lub cev tiv thaiv kab mob pib xav txog nws lub hlwb txawv teb chaws, vim tias nws yog txoj cai los tsim cov tshuaj tiv thaiv tshwj xeeb. Nrog rau daim ntawv no ntawm pathology, antigens tawm tsam cov hlwb ntawm cov hlab ntsha hauv lub hauv paus, ua rau kev puas tsuaj ntawm lawv lub membrane (myelin), yog li ua rau muaj kev cuam tshuam kev txhim kho. Raws li qhov kev tawm tsam no, cov hlab ntsha hauv paus poob lawv cov haujlwm tseem ceeb, uas ua rau muaj kev cuam tshuam nyob rau sab hauv ntawm cov plab hnyuv siab raum thiab cov leeg.

Txij li nws feem ntau lees txais tias keeb kwm ntawm ib tus kab mob autoimmune cuam tshuam nrog kev muaj keeb, caj ces hauv qhov tshwm sim ntawm demyelinating polyneuropathy tsis tuaj yeem txiav tawm. Tsis tas li ntawd, muaj cov xwm txheej uas tuaj yeem hloov qhov kev ua haujlwm ntawm lub cev. Cov xwm txheej los yog lwm yam muaj xws li kev cuam tshuam ntawm metabolic thiab hormonal, ua kom lub cev hnyav, ua mob rau lub cev, kev ntxhov siab, txhaj tshuaj tiv thaiv, raug mob, cuam tshuam rau kev ntxhov siab, mob hnyav thiab phais mob.

Yog li, kev kho mob polyneuropathy ntawm qhov qis hauv nruab nrab yog sawv cev los ntawm ntau cov nta uas yuav tsum raug coj los rau hauv, vim hais tias qhov kev ua txhaum hauv cov lus nug tsis tshwm sim nws tus kheej. Yog li no, thaum kuaj pom thawj qhov kev tshwm sim thiab cov tsos mob ntawm tus mob, nws yog ib qho tsim nyog yuav tsum tsim kom muaj tus mob etiological tam sim ntawd, txij li kev kho mob, piv txwv li, mob ntshav qab zib polyneuropathy txawv ntawm kev kho ntawm lub pathology uas tsim los ntawm kev haus dej cawv.

Polyneuropathy ntawm nqua saum

Qhov kev ua txhaum no tshwm sim vim yog kev puas tsuaj rau lub paj hlwb thiab ua rau tuag tes tuag taw ntawm sab qaum. Nrog rau qhov mob no, ua kom pom qhov kev puas tsuaj rau cov hlab ntsha ntawm qhov txawv txav feem ntau tau sau tseg.

Cov tsos mob ntawm polyneuropathy ntawm txhais tes yog yuav luag ib txwm hnav. Cov neeg mob muaj kev tawm hws ntau ntxiv, ua txhaum ntawm qhov mob rhiab, thermoregulation, khoom noj ntawm daim tawv nqaij, qhov hloov pauv ntawm tactile rhiab heev, paresthesias tshwm sim nyob rau hauv daim ntawv ntawm "goose bumps". Qhov kab mob pathology no yog tsim los ntawm peb hom kev kawm, uas yog mob ntev, mob hnyav thiab subacute.

Polyneuropathy ntawm lub sab sauv yog qhov tseeb feem ntau los ntawm kev tsis muaj zog ntawm txhais tes, ntau yam algias, uas tab tom kub hnyiab lossis tawg hauv cov ntsiab lus, o, txhaws qee zaum tuaj yeem hnov. Nrog rau cov kab mob no, kev nyuaj siab rhiab vim tsis hnov tsw, vim tias cov neeg mob feem ntau ntsib teeb meem hauv kev ua tiav ntawm kev pib thaum ub. Qee lub sij hawm cov tib neeg kev txom nyem los ntawm polyneuropathy kev txo qis rhiab hauv lawv txhais tes.

Ua rau mob polyneuropathy ntawm txhais tes, feem ntau, ntau yam dej cawv, piv txwv li, vim yog haus cawv, tshuaj lom neeg, zaub mov lwj. Tsis tas li, qhov tshwm sim ntawm tus kab mob hauv cov lus nug tuaj yeem ua rau: vitamin tsis muaj peev xwm, kev sib kis (kab mob los yog kab mob etiology), collagenoses, mob siab, lub raum tsis ua haujlwm, mob qog lossis autoimmune txheej txheem, pancreatic thiab endocrine pathologies. Feem ntau, cov kab mob no tshwm sim los ntawm cov ntshav qab zib.

Cov kab mob piav tau muaj peev xwm tshwm sim rau txhua tus neeg mob nyob rau hauv kev sib txawv.

Los ntawm pathogenesis, polyneuropathy ntawm lub sab saud tuaj yeem muab faib ua axonal thiab demyelinating, raws li kev soj ntsuam kev ua haujlwm, kev xav, kev hnov, thiab lub cev muaj zog. Nyob rau hauv nws daim ntawv dawb huv, nws yog qhov nyuaj ua kom tau raws li cov npe ntawm ntau yam mob no, ntau zaus cov kab mob ua ke cov tsos mob ntawm ntau yam kev hloov.

Kev kho mob Polyneuropathy

Niaj hnub no, cov hau kev ntawm kev kho mob ntawm tus kab mob nyob rau hauv nqe lus nug yog theej tsawg. Yog li no, los txog niaj hnub no, kev kho mob polyneuropathies ntawm ntau hom ntawv tseem yog ib qho teeb meem loj. Qib ntawm kev paub ntawm cov kws kho mob niaj hnub hauv thaj tsam ntawm cov kab mob pathogenetic thiab cov kev ua haujlwm etiological ntawm hom kab mob no tau txiav txim siab qhov tsim nyog ntawm kev sib txawv ob thaj chaw ntawm kev kho mob, uas yog txoj kev tsis sib xws thiab cov kev sib txawv.

Kev sib txawv ntawm cov txheej txheem los kho cov lus qhia hais tias muaj kev tiv thaiv kab mob ua rau muaj kev tiv thaiv kab mob (yam li nephropathy, ntshav qab zib), nrog cov kab mob ntawm cov plab zom mov los ntawm malabsorption, xav tau kev tswj hwm kev noj tshuaj ntau ntawm cov vitamins B1 (thiamine) thiab B12 (cyanocobalamin).

Yog li, piv txwv li, kho cov kab mob ntshav qab zib polyneuropathy thiab lawv cov kev xaiv yog vim kev saib xyuas ntawm qee qib glycemic. Kev kho mob polyneuropathy tiv thaiv ntshav qab zib yuav tsum ua ntu zus. Nyob rau thawj theem, lub cev nyhav thiab kev noj haus yuav tsum tau kho, ib ce tshwj xeeb lub cev yuav tsum tau tsim, thiab ua raws li cov ntsuas ntshav siab nrog tus qauv yuav tsum tau saib xyuas. Cov txheej txheem ntawm txoj kev kho nrog kev siv cov neurotropic vitamins thiab txhaj tshuaj ntawm alpha-lipoic acid nyob rau hauv cov koob tshuaj loj.

Undifferentiated txoj kev kho tau yog sawv cev los ntawm glucocorticoids, immunosuppressive tshuaj thiab plasmapheresis.

Polyneuropathy kev kho mob tshuaj yuav tsum tau muab sau ua ke. Qhov tshwj xeeb ntawm kev xaiv ntawm kev kho kom zoo rau cov kab mob pathology raws li kev txiav txim siab ib txwm nyob ntawm tus neeg etiological uas tau ua rau tus kab mob thiab ua rau nws cov chav kawm. Piv txwv li, cov tsos mob ntawm tus mob polyneuropathy uas ua los ntawm ib qho pyridoxine ntau ntau (vitamin B6) ploj mus yam tsis muaj ib txoj lw tom qab normalizing nws qib.

Polyneuropathy tshwm sim los ntawm cov txheej txheem mob qog noj ntshav tau kho los ntawm kev phais mob - tshem tawm ntawm neoplasm, uas muab tso siab rau qhov kawg ntawm cov leeg. Yog hais tias tus kab mob sawv los tiv thaiv hypothyroidism, ces siv tshuaj kho hormone.

Kev kho mob ntawm cov tshuaj lom polyneuropathy, hauv thawj qhov chaw, koom nrog kev ntsuas detoxification, tom qab uas cov tshuaj raug kho los kho tus kab mob nws tus kheej.

Yog tias nws tsis tuaj yeem txheeb xyuas lossis tshem tawm cov laj thawj uas ua rau kev txhim kho ntawm tus kabmob piav qhia, lub hom phiaj tseem ceeb ntawm kev kho mob cuam tshuam nrog kev tshem tawm kev mob thiab tshem tawm ntawm cov leeg tsis muaj zog.

Hauv cov rooj plaub no, cov txheej txheem ntawm kev siv lub cev ua haujlwm thiab kev teem sijhawm ntawm ntau cov tshuaj tsom rau kev tshem tawm lossis txo cov mob los ntawm kev puas tsuaj rau cov hlab ntaws siv. Ib qho ntxiv, txoj kev siv lub cev siv dag zog yog siv ncaj qha rau txhua theem ntawm kev kho kom rov zoo.

Nrog kev pab los ntawm cov tshuaj tiv thaiv analgesic lossis cov tshuaj tsis-steroidal los tiv thaiv cov tshuaj, nws yog qhov nyuaj heev kom swb ntawm Algia. Yog li, kev coj ua los ntawm kev ua kom zoo tshuaj loog hauv zos, cov tshuaj tiv thaiv kab mob thiab tshuaj tua kab mob rau kev daws qhov mob ntawm qhov mob ntau dua li kev coj ua.

Qhov ua tau zoo ntawm kev siv tshuaj tiv thaiv yog nyob hauv lawv lub peev xwm los ua kom muaj kev ua haujlwm ntawm cov txheej txheem noradrenergic. Qhov kev xaiv ntawm cov tshuaj hauv cov pab pawg no yog tsim los ntawm tus kheej, vim tias cov tshuaj tiv thaiv kev ntxhov siab feem ntau ua rau lub hlwb tsis zoo.

Kev siv cov tshuaj tiv thaiv anticonvulsants tsuas yog txiav txim siab los ntawm lawv lub peev xwm los tiv thaiv kev puas hlwb cov pa tawm los ntawm cov hlab ntsha cuam tshuam.

RCHR (Chaw Pabcuam Sawv Cev Rau Kev Noj Qab Haus Huv ntawm Ministry of Health of the Republic of Kazakhstan)
Version: Kev soj ntsuam raws tu qauv ntawm Ministry of Health of the Republic of Kazakhstan - 2017

Tus mob ntshav qab zib mob hlwb (E10-E14 + NROG TUS NEEG SAIB XYUAS QHOV TSEEB. 4)

Cov lus qhia luv luv

Pom zoo
Cov Sawv Cev Koom Tes rau Cov Kev Pab Kho Mob Zoo
Ministry of Health Cov koom pheej ntawm Kazakhstan
kos rau lub Kaum Ib Hlis 28, 2017
Nqe Lus Cog Tseg No. 33

Mob neuropathy mob ntshav qab zib - Cov hlab ntsha puas tsuaj vim cov ntshav qab zib, mob hauv tsev kho mob lossis pom meej, nyob hauv qhov tsis muaj lwm txoj kev xav (WHO). Cov kev kawm ntau tshaj thiab cov hom mob ntshav qab zib neuropathy yog distal symmetric polyneuropathy. DSPN - qhov tshwm sim ntawm cov tsos mob ntawm distal peripheral hlab ntsha ua haujlwm hauv cov neeg mob ntshav qab zib mellitus tom qab tsis suav lwm yam ua rau.

Cov txheej txheem kev txhim kho / kho dua hnub : 2017 xyoo.

Cov tsiaj ntawv luv siv nyob rau hauv cov txheej txheem:

GPP	Kev Taw Qhia Zoo
LEEJ TWG	Lub Koom Haum Noj Qab Haus Huv Ntiaj Teb
KOJ tus kheej	pom duab sib piv
DAN	zawv plab hlab ntsha autonomic neuropathy
DMN	mob ntshav qab zib mononeuropathy
DN	mob ntshav qab zib polyneuropathy
DPN	mob ntshav qab zib polyneuropathy
DSPN	ntshav qab zib sensorimotor polyneuropathy
ICD 10	thoob ntiaj teb kev faib cov kab mob ntawm 10 kho dua
NA	cov leeg hlab hlwb
RCT	kev tshawb nrhiav sim tshuaj
SD Kuv	yam kuv mob ntshav qab zib
SD 2	ntshav qab zib hom II
ENMG	Electroneuromyography

Cov siv raws tu qauv : cov kws kho paj hlwb, tus kws kho txoj sia, tus kws kho mob zaws.

Qib pov thawj:
Kem 1 - qhov ntsuas ntawm qib ntawm cov pov thawj

A	Kev ntsuas cov zaub mov muaj txiaj ntsig zoo, kev tshuaj xyuas cov txiaj ntsig ntawm RCTs lossis RCTs loj uas muaj qhov tshwm sim tsawg heev (++) ntawm kev ua haujlwm tsis tiav, cov txiaj ntsig ntawm qhov twg tuaj yeem sib kis tau rau cov pej xeem.
Hauv	Kev ua tau zoo (++) kev sib koom ua ke lossis kev soj ntsuam cov ntaub ntawv lossis cov kev soj ntsuam zoo (++) pawg neeg sib koom tes lossis kev soj ntsuam cov ntaub ntawv muaj kev pheej hmoo ntawm cov kev ua haujlwm tsis zoo lossis RCTs nrog qhov tsis tshua muaj (+) kev pheej hmoo ntawm cov kab ke kev ua yuam kev, cov txiaj ntsig ntawm qhov tuaj yeem tshaj tawm rau cov neeg nyob Cov.
Nrog	Ib pab pawg los yog rooj plaub tswj kev tshawb fawb lossis kev kawm tswj xyuas uas tsis muaj kev tshawb fawb tsis muaj kev cuam tshuam nrog qhov kev pheej hmoo tsawg kawg (+). Cov txiaj ntsig ntawm qhov uas tuaj yeem muab faib rau cov pej xeem sib xws lossis RCTs nrog qhov muaj tsawg heev lossis pheej hmoo ntawm cov kev ua yuam kev (++ lossis +), cov txiaj ntsig uas tsis tuaj yeem faib ncaj qha rau cov pej xeem sib xws.
D	Cov lus piav qhia ib qho xwm txheej ntawm cov xwm txheej lossis kev tshawb nrhiav tsis tau tswj hwm lossis cov kws tshaj lij lub tswv yim.
GRP	Cov kev kho mob zoo.

Kev kuaj mob sib txawv

Kev kuaj mob sib txawvthiab cov laj thawj rau kev tshawb fawb ntxiv
DSPN yog kev zam kev zam. Qhov muaj ntshav qab zib mellitus thiab cov tsos mob ntawm polyneuropathy tsis tau txhais tau tias yog qhov muaj ntshav qab zib mob polyneuropathy. Ib qhov kev kuaj mob meej meej kom pom tseeb qhov kev kuaj mob txawv txav.

Rooj 3 - Kev kuaj mob txawv ntawm DSPN

Kev kuaj mob	Qhov meej pem ntawm kev kuaj mob txawv	Kev Ntsuam Xyuas	Kev kuaj mob cais tawm cov qauv
Quav Cawv Mon	Kev kuaj ntshav biochemical. Ultrasound	Cov ntaub ntawv anamnestic. Muaj cov cawv dej cawv ua rau lub siab, lwm qhov kev paub ntawm NS: haus dej cawv encephalopathy, cawv myelopathy, cawv polyradiculoneuropathy
PN hauv cov kab mob autoimmune	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Kev kuaj ntshav kuaj ntshav.	Keeb kwm ntawm cov kab mob autoimmune. Cov chaw khomob thiab kuaj pom ntawm cov kabmob no.
PN nrog cov vitamin B12 tsis txaus	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Kev txiav txim siab txog qib B12 hauv cov ntshav.	Tsawg cov dej ntshiab vitamin B12 siab. Kab tias muaj kev sib xyaw nrog macrocytic megaloblastic anemia.
PN hauv lwm qhov kev cuam tshuam ntawm metabolic (hypothyroidism, hyperthyroidism, rog)	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Kuaj ntshav rau cov thyroid hormones. Cov thyroid ultrasound	Cov ntaub ntawv anamnestic. Cov chaw soj ntsuam, kuaj thiab ua paib ntawm cov kabmob no.
Paraneoplastic syndromes	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Raws li cov kab mob ntawm KP oncological.	Cov ntaub ntawv anamnestic. Cov txiaj ntsig ntawm cov kev tshawb fawb seev qhia txog qhov muaj cov txheej txheem oncological.
Inflammatory demyelinating PN (Tom qab txhaj tshuaj tiv thaiv, tom qab kis mob hnyav)	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	ENMG. Kev txheeb xyuas CSF. Txaij n.suralis	Cov ntaub ntawv anamnestic. Cov ntaub ntawv tshwj xeeb ntawm ENMG. Kev kuaj ntshav ntawm cov protein hauv cerebrospinal kua. Cov Hloov Hloov Tshwj Xeeb rau n.suralis Biopsy
Qub txeeg qub teg Mon	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Tshawb nrhiav hauv lub chaw soj nstuam keeb molecular. ENMG	Cov ntaub ntawv anamnestic. Keeb kwm tsev neeg. Cov chaw kho mob thiab kuaj pom ntawm ib hom kab mob tshwj xeeb.
PN thaum lub sij hawm ua tsis tau zoo (txhuas, arsenic, phosphorus, thiab lwm yam)	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Ntshav thiab zis rau tshuaj lom mob.	Cov ntaub ntawv anamnestic. Cov chaw kho mob thiab kuaj pom ntawm ib qho intoxication.
PN kev phiv rau cov kab mob ua ke (mob siab tsis ua hauj lwm, mob raum tsis ua hauj lwm)	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Kev kuaj ntshav thiab cov zis biochemical. Ultrasound thiab / lossis MRI ntawm OBP thiab lub raum	Cov ntaub ntawv anamnestic. Cov chaw kho mob, kuaj thiab cov paib ntawm daim siab ua rau lub siab mob raum lossis lub raum tsis ua haujlwm.
PN rau kev kis mob (mob syphilis, mob ruas, HIV, brucellosis, herpes, diphtheria, thiab lwm yam)	Cov cim ntawm polyneuropathy uas tsis haum rau hauv lub moj khaum ntawm DPNP *	Kuaj ntshav (ELISA, PCR, thiab lwm yam) rau ntawm qee qhov muaj mob.	Cov ntaub ntawv anamnestic. Chaw kuaj mob thiab kuaj pom ntawm ib qho kab mob

* asymmetric / feem ntau lub cev muaj zog / laus hauv ceg nqaum / thaj chaw loj zuj zus polyneuropathy

Tau txais kev kho mob hauv Kaus Lim Kauslim, Ixayees, Lub Tebchaws Yelemees, Asmeskas

Tau txais tswv yim kho mob

Kev saib xyuas tus kheej, koj tuaj yeem ua rau tsis zoo uas tsis zoo rau koj lub cev.
Cov ntaub ntawv muaj nyob hauv MedElement lub vev xaib tsis tuaj yeem hloov thiab tsis txhob hloov tus kws kho mob kev sib tham tim ntsej tim muag. Nco ntsoov hu rau chaw kho mob yog tias koj muaj kab mob lossis tsos mob uas cuam tshuam koj.
Kev xaiv cov tshuaj thiab lawv qhov ntau npaum li cas yuav tsum tau pom zoo nrog tus kws tshwj xeeb. Tsuas yog tus kws kho mob tuaj yeem sau tshuaj rau qhov xav tau thiab nws qhov ntau npaum li cas, suav nrog tus kabmob thiab qhov mob ntawm tus neeg mob lub cev.
MedElement lub vev xaib yog cov ntaub ntawv siv tsuas yog siv xwb. Cov ntaub ntawv tshaj tawm hauv lub xaib no yuav tsum tsis txhob siv txoj kev hloov pauv tus kws kho mob lub siab xav.
Cov neeg kho kho ntawm MedElement tsis muaj lub luag haujlwm rau kev puas tsuaj rau kev noj qab haus huv lossis cov khoom raug mob los ntawm kev siv lub xaib no.

Ib pawg neeg tsis sib luag ntawm cov kabmob muaj cov kab mob rau hauv cov leeg txoj hlab ntsha leeg. Polyneuropathies tau muab faib ua thawj txoj kab axonal thiab thawj qhov sib txawv. Tsis hais seb hom mob polyneuropathy zoo li cas, nws cov duab hauv chaw soj ntsuam yog pom los ntawm kev txhim kho ntawm cov leeg tsis muaj zog thiab atrophy, cov leeg tsis paub qab hau, ntau qhov kev cuam tshuam ntawm lub cev (paresthesias, hypo- thiab hyperesthesia) uas tshwm sim hauv qhov kev tsis sib luag, thiab kev mob ntawm lub cev. Ib qho tseem ceeb rau kev kuaj mob hauv kev paub mob polyneuropathy yog txhawm rau txiav txim qhov ua rau nws tshwm sim. Txoj kev kho mob polyneuropathy yog mob, yam haujlwm tseem ceeb yog tshem tawm qhov laj thawj.

Cov ntaub ntawv dav dav

Ib pawg neeg tsis sib luag ntawm cov kabmob muaj cov kab mob rau hauv cov leeg txoj hlab ntsha leeg. Polyneuropathies tau muab faib ua thawj txoj kab axonal thiab thawj qhov sib txawv. Tsis hais seb hom mob polyneuropathy zoo li cas, nws cov duab hauv chaw soj ntsuam yog pom los ntawm kev txhim kho ntawm cov leeg tsis muaj zog thiab atrophy, cov leeg tsis paub qab hau, ntau qhov kev cuam tshuam ntawm lub cev (paresthesias, hypo- thiab hyperesthesia) uas tshwm sim hauv qhov kev tsis sib luag, thiab kev mob ntawm lub cev. Ib qho tseem ceeb rau kev kuaj mob hauv kev paub mob polyneuropathy yog txhawm rau txiav txim qhov ua rau nws tshwm sim. Txoj kev kho mob polyneuropathy yog mob, txoj haujlwm tseem ceeb yog tshem tawm cov kev ua kom muaj mob lossis kev them nyiaj rau tus mob.

Etiology thiab pathogenesis ntawm polyneuropathies

Tsis hais txog ntawm qhov xwm txheej etiological nyob rau hauv polyneuropathies, ob hom pathological cov txheej txheem raug nthuav tawm - axon kev puas tsuaj thiab cov hlab fiber demyelination. Nrog cov axonal mob ntawm lesion, secondary demyelination tshwm sim, nrog lub qhov txhab mob tawv ncauj, qhov axonal tiv thaiv rov ua haujlwm. Feem ntau cov axonal yog cov feem ntau ntawm cov tshuaj lom polyneuropathies, hom axonal ntawm GBS, thiab hom II NMSN. Thawj qhov kev siv tshuaj tua kab mob siab muaj xws li GBS, HVDP, paraproteinemic polyneuropathies, hom I NSC.

Nrog cov kab mob axonal polyneuropathies, kev ua haujlwm thauj ntawm lub axial lub tog raj kheej yog feem ntau cuam tshuam los ntawm cov axoplasmic tam sim no, uas nqa lub xov tooj ntawm cov khoom siv roj ntsha tsim nyog rau kev ua haujlwm ntawm cov leeg thiab cov leeg nqaij hauv qhov kev taw qhia los ntawm lub cev muaj zog mus rau cov leeg thiab rov ua dua. Cov hlab ntsha uas muaj cov ceg ntev tshaj plaws yog qhov kev koom tes nrog ua. Kev hloov pauv ntawm kev ua haujlwm ntawm lub qog ntawm lub axon thiab txoj kev thauj khoom axonal ua rau qhov zoo li ntawm qhov tsis lees paub qhov kev hloov ntawm cov leeg.Qhov uas tsis pub cov leeg nqaij ua rau lub zog nthuav dav hauv lub davhlau ya nyob twg thiab tom qab ntawd cov khoom sib txuas ua ke, qhov kev loj hlob ntawm cov tshiab thiab rov ua dua ntawm cov leeg nqaij, uas ua rau muaj kev hloov ntawm cov qauv ntawm DE.

Nrog demyelination, ib qho kev ua txhaum ntawm saltatory conduction ntawm lub paj impulse tshwm sim, vim tias qhov kev ceev ntawm kev sib dhos raws cov hlab ntsha poob qis. Demyelinating cov hlab ntuag ua rau lub cev raug mob los ntawm kev nthuav dav ntawm cov leeg tsis muaj zog, thaum ntxov poob ntawm cov leeg tsis muaj kev txhim kho ntawm cov leeg atrophy. Lub xub ntiag ntawm atrophy qhia tias ib qho khoom ntxiv axonal. Demyelination ntawm cov hlab ntsha tuaj yeem tshwm sim los ntawm kev tiv thaiv autoimmune nrog kev tsim cov tshuaj tiv thaiv rau ntau yam ntawm cov peripheral myelin protein, kev mob caj ces, cuam tshuam nrog exotoxins. Kev puas tsuaj rau cov axon ntawm ib qho hlab ntsha vim yog kis tau cov hlab ntsha ntawm exogenous lossis endogenous co toxins, caj hlav yam.

Kev faib tawm Polyneuropathies

Txog rau hnub no, feem ntau lees paub kev faib tawm ntawm polyneuropathies tsis muaj. Raws li cov kab mob pathogenetic ntawm polyneuropathy, lawv muab faib ua axonal (feem ntau ua rau lub tog raj axial) thiab demyelinating (pathology ntawm myelin). Los ntawm cov xwm hauv daim duab soj ntsuam, lub cev muaj zog, qhov paub tab thiab tus kheej ntawm cov tshuaj polyneuropathies tshwj xeeb. Txawm li cas los xij, hauv nws daim ntawv dawb huv, cov foos no tau pom muaj tsawg kawg, ntau zaus lawv qhia tawm qhov sib txuas ntawm ob lossis peb hom hlab ntsha hauv lub cev (lub cev muaj zog-hnov, hnov tsis tshua xav-lwm tus).

Raws li cov kev coj ua (etiological factor, polyneuropathies) tau muab faib ua cov mob muaj keeb (, Russi-Levy syndrome, Degerin-Sott syndrome, Refsum tus kab mob, thiab lwm yam), cov kab mob autoimmune (Miller-Flasher syndrome, axonal hom GBS, paraproteinemic polyneuropathies, paraneoplastic neuropathies, thiab lwm yam). polyneuropathy, uremic polyneuropathy, hepatic polyneuropathy, thiab lwm yam), alimentary, lom thiab kis-lom.

Cov duab saib mob rau cov mob polyneuropathy

Cov duab saib xyuas cov mob polyneuropathy, raws li txoj cai, sib txuas ua ke ntawm cov cim ntawm kev puas tsuaj rau lub cev muaj zog, cov nqaij mos thiab cov leeg. Nyob ntawm seb qhov kev sib koom tes ntawm cov fibers ntawm ntau hom nyob rau hauv lub neurological xwm txheej, lub cev muaj zog, qhov hnov ntxhiab los yog lub zog cim yuav tuaj yeem dhau. Kev puas tsuaj rau lub cev muaj zog ua rau muaj kev txhim kho cov pa txhaws txhaws; rau feem ntau polyneuropathies, qhov mob txhab ntawm sab qaum thiab sab saud nrog kev faib tawm ntawm cov leeg tsis muaj zog yog qhov qub, nrog cov leeg txhab axon ntev, mob nqaij leeg. Axonal thiab hereditary polyneuropathies yog qhov txawv txav ntawm cov leeg tsis muaj zog (feem ntau nyob hauv qis qis), uas yog tshaj tawm nyob rau hauv extensor leeg ntau dua li hauv cov leeg flexor. Nrog rau kev ua kom tsis muaj zog ntawm cov leeg mob cov leeg, cov ncauj lus tshiab tshwm sim (tus thiaj li hu ua "qaib dib gait").

Txais demyelinating polyneuropathies tuaj yeem tshwm li qhov tsis sib thooj ntawm cov leeg tsis muaj zog. Hauv cov xwm txheej loj, cov qhov txhab ntawm CN thiab cov leeg ua pa tuaj yeem pom, uas feem ntau pom nrog Guillain-Barré syndrome (GBS). Polyneuropathies yog tus cwj pwm los ntawm qhov tsis sib thooj ntawm cov leeg tsis muaj zog thiab atrophy. Cov tsos mob asymmetric yog cov yam ntxwv ntawm ntau lub mononeuropathies: multifocal lub cev muaj zog neuropathy, multifocal sensorimotor neuropathy Sumner-Lewis. Tendon thiab periosteal reflexes nrog polyneuropathy feem ntau txo los yog poob tawm, ua ntej txhua yam, Achilles leeg leeg tsis kam, nrog kev txhim kho ntxiv ntawm cov txheej txheem - lub hauv caug thiab carporadial, cov leeg rov qab los ntawm biceps thiab triceps ntawm lub xub pwg leeg tuaj yeem nyob twj ywm rau lub sijhawm ntev.

Cov teeb meem tsis hnov tsw hauv polyneuropathy kuj tseem sib xws, kuj tshwm sim thawj thaj tsam hauv thaj chaw ib puag ncig (xws li “hnab looj tes” thiab “thom khwm”) thiab kis sib kis.Hauv kev tshwm sim ntawm polyneuropathy, cov tsos mob zoo li tus neeg muaj lub ntsej muag (paresthesia, dysesthesia, hyperesthesia) feem ntau pom, tab sis nrog kev txhim kho ntxiv ntawm cov txheej txheem, cov tsos mob ntawm voos tau hloov los ntawm cov tsos mob ntawm prolapse (hypesthesia). Kev puas tsuaj rau cov pob zeb myelinated tuab ua rau ua rau cov leeg tsis muaj qhov sib sib zog nqus thiab lub cev tsis txaus, ua kev puas tsuaj rau cov myelinated nyias ua rau muaj kev ua txhaum ntawm qhov mob thiab kub ntawm daim tawv nqaij.

Kev ua txhaum ntawm lub zog ntawm lub zog tshwj xeeb tshaj plaws yog tshaj tawm nrog axonal polyneuropathies, vim tias autonomic fibers tsis-myelinated. Cov tsos mob ntawm prolapse feem ntau pom: kev puas tsuaj rau cov hlab ntsha ua haujlwm uas ua rau lub qhov txha nqaj qaum yog pom los ntawm daim tawv nqaij qhuav, cuam tshuam kev cai ntawm lub suab vascular, kev puas tsuaj rau visceral vegetative fibers ua rau disautonomia (tachycardia, orthostatic hypotension, ua haujlwm tsis zoo erectile, cuam tshuam ntawm lub tsev thiab cov kev sib txuas lus).

Amyloid transthyretin polyneuropathy

... vim tias tsis muaj kev paub txog ntawm cov kws kho mob, lub sijhawm txij li pib ntawm cov tsos mob mus rau kev kuaj mob yuav dhau 3 xyoos.

Lub ntsiab lus "amyloidosis" sib sau ua ke cov kab mob uas muaj kev tso tawm ntawm ib qho tshwj xeeb insoluble amyloid fibrillar protein (amyloid fibrils - tshwj xeeb cov qauv protein nrog lub taub ntawm 5-10 nm thiab qhov ntev mus txog 800 nm, suav nrog 2 lossis ntau cov kab sib luag multidirectional filaments tsim ib qho kev sib tshooj ua ke-beta-folded) Cov. Cov yam ntxwv thiab tshuaj lom neeg ntawm amyloid yog txiav txim siab los ntawm cov khoom tseem ceeb ua ntej, cov ntsiab lus uas nyob hauv fibril nce mus txog 80% thiab yog lub cim tshwj xeeb rau txhua hom amyloidosis (ntau dua 30 cov protein tshwj xeeb uas muaj peev xwm tsim amyloid fibrils paub).

Ua ntej nyeem ntxiv cov khoom tsim tawm hauv qab no, Kuv pom zoo kom nyeem cov ncej: Mob Amyloidosis (ntawm laesus-de-liro.livejournal.com) nyeem

Transthyretin amyloidosis (ATTR) yog cov kab mob hauv lub cev uas muaj cov cim tso rau ntawm amyloid, tus txheej txheem ua ntej uas yog transthyretin (TTR), cov protein koom nrog kev thauj cov thyroid hormone thyroxine thiab retinol, thiab tseem ua lub luag haujlwm tseem ceeb hauv kev tsim kho cov hlab ntsha. Mus txog 95% ntawm TTR yog tsim tawm hauv lub siab, qhov seem 5% yog tsim los ntawm cov leeg ntshav ntawm lub ventricles ntawm lub hlwb thiab xim epithelium ntawm retina (hauv plasma, TTR circulates ntawm qhov siab ntawm 20-40 mg / dl L. Obici li al., 2005).

ATTR suav nrog qhov tsis tshua muaj senile systemic amyloidosis (hom tsiaj amyloidosis - ATTRwt), uas tshwm sim vim cov hnub nyoog hloov hauv cov qauv ntawm cov caj ces qub TTR (hom kabmob ntawm senile amyloidosis yog lub plawv, hlab ntsha hlab ntsha thiab aorta), nrog rau kev hloov caj dab ATTRm amyloidosis (saib ntxiv), tshwm sim los ntawm kev hloov pauv ntawm TTR gene (encoding TTR synthesis), suav nrog 4 exons thiab nyob ntawm caj npab ntev ntawm chromosome 18. Txog hnub no, ntau tshaj 120 hloov ntawm TTR noob tau piav qhia. Feem ntau TTR noob hloov pauv kom ua rau kev loj hlob ntawm ATTR yog kev hloov pauv ntawm methionine nrog valine ntawm txoj haujlwm 30 (ATTR Val30Met). Ib qho tsis tshua muaj neeg paub txog TTR hloov pauv noob yog qhov hloov ntawm cysteine nrog tyrosine ntawm txoj haujlwm 114 (Tyr114Cys).

Transthyretin yog homotetramer, txhua qhov haujlwm me me uas muaj 127 amino acid seem thiab muaj cov qauv beta. Raws li kev hloov pauv ntawm TTR cov noob, kev hloov pauv ntawm cov protein tshwm sim, uas ua rau thermodynamic tsis khov ntawm tetramer thiab lwj mus rau hauv monomers. Protein monomers, nyeg hloov pauv mus rau hauv pathological oligomers uas tsim ib qho amyloid, uas muaj qhov cuam tshuam ncaj qha rau cov ntaub so ntswg los ntawm kev zom, thiab tseem ua rau vascular obliteration thiab, vim li ntawd, rau ischemia. Ntawm qhov tod tes, kev tshawb fawb qhia tias nws tsis yog amyloid fibrils, namely molecular hnyav transthyretin oligomers uas ua rau muaj kev tiv thaiv kab mob calcium uas muaj kev tiv thaiv, ua rau muaj kev tuag ntawm tes.

Tus mob raws roj ntsha ATTR tuaj yeem tshwm sim hauv peb hom kab mob: 2.1 transthyretin tsev neeg amyloid polyneuropathy (txuas ntxiv - TTR-SAP), 2.2 transthyretin tsev neeg amyloid cardiopathy thiab 2.3 transthyretin tsev neeg leptomeningeal amyloidosis.Thov nco tseg: TTP-SAP yog cov hom muaj ntau hom kabmob muaj keeb amyloidosis nrog lub cim autosomal hom ncaus.

TTP-SAP yog ib qho muaj kev tawm tsam, muaj kev xiam oob khab, ua rau mob tuag tes tuag taw neurodegenerative raws li amyloid deposition (ATTR) hauv epineuria, perineuria, endoneuria thiab cov hlab ntsha, uas ua rau axonal degeneration ntawm somatic thiab autonomic qab haus huv. Yog tias tsis kho, TTP-SAP yuav tuag taus tom qab 7-12 xyoo txij li hnub pib mob. Qhov ntau ntawm TTR-SAP nyob hauv Europe thiab Asmeskas yog kwv yees li 1 tauj 100 txhiab tus neeg. Cov neeg mob loj tshaj plaws tau tshawb pom hauv cov teb chaws muaj thoob ntau xws li Nyiv, Portugal, Brazil thiab Sweden, uas txawv ntawm 0.9 - 204 rau 1 lab tus tib neeg, nce mus txog 3.8 - 1631 rau 1 lab hauv ib cheeb tsam.

TTP-SAP yog tus cwj pwm mob los ntawm chaw kho mob heterogeneity (vim muaj coob tus muaj TTR hloov tau). Raws li qhia saum toj no, kev hloov pauv Val30Met feem ntau cuam tshuam nrog TTP-SAP, thiab nws cov kev sim kho mob yog qhov tau kawm ntau tshaj plaws. Tus kab mob no tuaj yeem loj hlob nyob nruab nrab ntawm 20 txog 70 xyoo. Lub hauv paus ntawm cov duab saib mob yog qhov ua tau zoo sensorimotor thiab autonomic polyneuropathy, txhim kho los ntawm qhov tsis sib luag mus rau qhov tsis thooj rau cov leeg, pib txij ko taw, maj mam kis mus rau sab ceg qis thiab caj npab.

Ua ntej, nyias lub cev tsis muaj zog myelinated cov hlab ntsha muaj qhov cuam tshuam, uas ua rau mob thiab qhov kub tsis txaus, uas ua rau cov neeg mob ua rau muaj mob ntawm lub taw, neuropathic mob mob thaum pib ua rau TTP-SAP - kev kub ntxhov thiab kub hnyiab ntawm qhov mob tshwm sim nyob rau hauv daim ntawv ntawm txias allodynia vim kev puas tsuaj thiab rhiab ntawm cov nqaij mos nyias nyias raws li lub cev tsis muaj zog myelinated cov nqaij ntshiv tuag, hlawv kev mob dhau los ua tsis tau hais, tom qab kev ua rau qhov kev hnov mob yog hloov los ntawm paroxysms ntawm qhov mob. thiab nyob rau hauv daim ntawv ntawm "dhau lub tshuab hluav taws xob tam sim no" thiab cov tshuab hluav taws xob txhua yam uas tau los ntawm kev nruab nrab ntawm qhov hluav taws xob).

Tom qab ntawd, twb tau ua kom cov leeg myelinated cov cov hlab ntaws ua ke, cov kev mob lub cev, paresis tshwm sim, thiab qhov sib sib zog nqus tsis hnov tsw thiab mob ataxia. Nyob rau tib lub sijhawm, cov leeg ntawm cov leeg (tsis tuaj yeem) lub paj hlwb tau cuam tshuam - cov neeg mob txhim kho peripheral autonomic tsis txaus - ua rau lub cev poob phaus, orthostatic hypotension, pelvic cuam tshuam (neurogenic zais zis), impotence, mob plab-plab hnyuv plab - raws plab, ua raws li quav tawv.

Polyneuropathy yog qhov hloov zuj zus ntawm qhov ua rau lub cev tsis taus, hauv cov neeg mob taug kev yog qhov tsis taus thiab maj mam dhau los ua tsis tau, lub rooj zaum muaj log rau kev txav mus los, cov neeg mob tau tos kev pab sab nraud. 4 theem (0 - 3) ntawm TTR-SAP yog qhov sib txawv, nyob ntawm kev khaws cia ntawm tus neeg mob txoj kev ua haujlwm:

Nrog TTR-SAP, kev tsim kho ntawm ntau qhov kev puas hlwb neuropathy (suav nrog rau hauv daim ntawv ntawm ob tog carpal tunnel syndrome) yog ua tau vim kev tso tawm ntawm amyloid nyob rau hauv cov khoom siv ligamentous nrog tom qab txuas ntawm cov hlab ntsha leeg.

Cov cim qhia ntawm neuropathy yeej hla thoob plaws thaum kawg ntawm tus kab mob. Txawm li cas los xij, TTR-SAP tseem ua rau lub plawv puas tsuaj (tswj kev mob plawv, mob suab paj hlwb tsis sib xws), lub raum (proteinuria ua raws li kev txhim kho lub raum tsis ua haujlwm), qhov muag (kab mob txuas ntxiv ntawm lub ntsej muag, vitreous opacification hauv Sweden; cov mob txhab rau ntawm lub qhov txhab ntawm lub qhov txhab thaum pib piav qhia) (qaug dab peg qaug dab peg, ischemic lossis hemorrhagic strokes, teeb meem txawj ntse). Kev tuag tshwm sim los ntawm kev mob plawv (lub plawv tsis ua haujlwm, ua pa txawv txav), cachexia, lub cim xeeb tsis ua haujlwm, thiab kev kis mob thib ob.

Kev sib hloov "tsis yog Val30Met" tsawg dua kawm txog hauv kev sib txuas nrog kev tsis tshua muaj tshwm sim, sib txawv hauv cov duab hauv chaw kuaj mob. Ntau zaus tom qab pib ntawm tus kab mob tau pom (tom qab 50 xyoo), tes - carpal (carpal) ligaments yuav cuam tshuam thaum xub thawj (ob leeg carpal tunnel syndrome tsim, ceeb toom: thawj qhov kev mob tshwm sim ntawm TTP-SAP hauv cov neeg mob li ntawd yuav yog mob carpal tunnel syndrome), tus kab mob yuav sawv cev tsuas yog los ntawm autonomic polyneuropathy, thawj kev puas tsuaj rau lub siab lossis lub qhov muag.

Kev kuaj mob ntawm TTR-SAP tseem yog ib txoj haujlwm nyuaj, tshwj xeeb tshaj yog rau thaj chaw tsis muaj, qhov twg feem ntau tsis muaj keeb kwm tsev neeg muaj tus kab mob thiab nyob ntawm cov tsos mob tseem ceeb (neurological, mob plawv, ophthalmology), cov neeg mob tig mus rau ntau tus kws kho mob tshwj xeeb. Vim tias tsis muaj kev paub txog ntawm cov kws kho mob, lub sijhawm txij li pib ntawm cov tsos mob mus rau kev kuaj mob tuaj yeem dhau peb xyoos. Ib qho xwm txheej zoo dua nyob rau hauv cov nqe lus ntawm kev kuaj mob raws sij hawm thiab kev kho mob yog tus yam ntxwv ntawm cov teb chaws uas pheej hmoo.

Xyuam xim! TTR-SAP yuav tsum ntseeg yog tias tus neeg mob muaj lub zog txaus sensorimotor axonal polyneuropathy hauv kev sib xyaw nrog cov kabmob tsis haum (tshuaj hnyav dua, mob plab thiab lub plab zom mov, mob ntshav siab) thiab qhov tsis muaj lwm yam uas qhia txog polyneuropathy.

Cov hau kev seev suab uas siv los tawm tsam peripheral hlab ntsha puas tsuaj suav nrog electroneuromyography (ENMG), kev tshuaj xyuas seb muaj ntau npaum li cas, thiab tshawb xyuas qhov tseeb ntawm cov kev xav ua kom lub cev puas tsuaj. Txawv tebchaws, MR neurography ua tau zoo, nrog rau sudoscan, ib txoj kev nrawm thiab tsis siv rau kev txheeb xyuas lub xeev ntawm cov hlab ntsha nyias nyias, uas tso cai rau koj los ntsuas lub electrochemical conductivity ntawm daim tawv nqaij, uas poob thaum lub sab hauv ntawm qhov hws caj pas cuam tshuam.

Lwm yam kabmob uas muaj mob los ntawm ATTR kuj raug tshuaj xyuas: lub siab (ECG, Holter ECG xyuas, Echocardiography), qhov muag (kuaj qhov muag), lub raum (urinalysis, ultrasound). Yog tias pom lub sensorimotor thiab autonomic progressive polyneuropathy, nws txoj kev sib raug zoo nrog ATTR yuav tsum paub tseeb. Amyloid tso tawm muaj peev xwm nrhiav pom hauv qhov nqaij me me ntawm cov hlab ntsha plab hlaub, cov caj pas muaj qaub ncaug, cov qog adipose plab, thiab lub plab qhov quav. Tso me me mus kuaj cov xim liab liab kom tshawb pom amyloid tso nyiaj uas tsim lub teeb ntsuab ntsuab ci rau qhov pom kev kaj. Ib qho kev kawm tshuaj immunohistochemical yuav tsum tsim kom muaj cov amyloid kab mob sib xyaw ua ntej. Thov nco ntsoov: qhov tsis muaj amyloid ntau hauv cov nqaij mos ua kom tsis muaj qhov kuaj pom ntawm TTP-SAP, hauv qhov no, kev kawm morphological yuav tsum nqa los ntawm cov kws kho mob muaj kev paub txog, nws yuav tsum kawm 2 - 3 cov nqaij sib txawv ntawm cov nqaij mos, thiab txoj kev tshawb fawb caj ces kuj yuav tsum tau. Cov tsev neeg uas muaj TTR hloov dua tshiab paub tseeb tias muaj kev hloov pauv tshwj xeeb; hauv kev kis tsis tau, ua tiav ntawm tag nrho cov noob TTR yog kev pom zoo (ceeb toom: kev tshuaj ntsuam genetic sim rau TTR-SAP raug pom zoo rau txhua tus neeg mob uas muaj kev sib luag nrog cov qog ntshav nrog ua cov nqaij mos).

nyeem kuj ncej: Cov tshuaj fiber ntau hauv lub cev (ntawm laesus-de-liro.livejournal.com) nyeem

Kev kho mob ntawm TTP-SAP ua tau zoo nyob rau theem I ntawm tus kab mob, thaum nws muaj peev xwm ua kom qeeb ntawm kev nce qib ntawm polyneuropathy thiab nce tus neeg mob txoj sia .. Xyoo 1990, tsuas kho TTP-SAP yog orthotopic daim siab hloov chaw, pab txhawb 20-xyoo kev muaj sia nyob hauv patients1 / 2 cov neeg mob .. Kev ua haujlwm tau zoo dua yog muaj keeb kwm luv luv ntawm tus kabmob, hnub nyoog menyuam yaus tus neeg mob, muaj lub siab hloov Val30Met, thiab tsis muaj lub siab tsis ua haujlwm siab.Los ntawm kev tshem tawm cov khoom tseem ceeb ntawm mutant transthyretin hauv daim siab, hloov pauv daim siab, txawm li cas los xij, tsis tiv thaiv amyloid deposition nyob rau hauv lub siab nqaij, vitreous lub cev, thiab lub hauv nruab nrab cov hlab ntsha. Yog hais tias tus neeg mob tau mob concomitant heev lub plawv los yog lub raum tsis ua haujlwm, kev sib koom ua ke hloov qee zaus ua - mob siab thiab mob plawv, lub siab thiab lub raum.

Xyoo tsis ntev los no, cov kev muaj peev xwm ntawm kev txuag kho cov kab mob kho thaum ntxov ntawm TTP-SAP tau tshwm sim. Tafamidis (kev npaj Vindakel), pom zoo siv rau hauv Tebchaws Europe thiab Russia thaum thawj theem ntawm TTP-SAP, pab ua kom lub cev ruaj khov ntawm cov kua roj (transthyretin molecule), tiv thaiv nws qhov kev tawg rau amyloidogenic monomers. Qhov uas tsis yog-steroidal anti-inflammatory tshuaj diflunisal muaj cov nyhuv zoo sib xws, tab sis nws txoj kev siv tsuas yog muaj kev phiv los ntawm kev mob tshwm sim hnyav los ntawm txoj hnyuv plab. Ntxiv nrog rau kev kho mob pathogenetic, kev kho mob ntsig txog kev siv yog - txhais tau tias siv ceev xwm txheej mob neuropathic mob, tshuaj tiv thaiv kab mob, kev kho mob orthostatic hypotension, lub plawv tsis ua hauj lwm, kev cog tshuaj kho lub cev tsis haum thaum lub cev tsis tuaj yeem ua rau lub cev tsis tuaj yeem, vitrectomy thaum muaj kev puas tsuaj rau lub cev vitreous. Yog hais tias kev kho kom tsis muaj txiaj ntsig thiab tus kab mob hloov zuj zus ntxiv, kev hloov pauv ntawm daim siab yog ua tiav, thiab, yog tias tsim nyog, lub siab hloov pauv.

Nyeem ntxiv txog TTR-SAP thiab ATTR hauv cov hauv qab no.:

tsab xov xwm “Cov xwm txheej transthyretin tsev neeg amyloid polyneuropathy: kev kuaj mob tshawb nrhiav” Smirnov AP, Serdyuk AV, Kovrazhkina EA, FSBEI HE “RNIMU im. N.I. Pirogova ”(Consilium Medicum Magazine No. 9, 2018) nyeem,

tsab xov xwm "Transthyretin amyloid polyneuropathy: pathogenesis, chaw kuaj mob, kho mob" "O.E. Zinoviev, E.I. Safiulina, Tsoom Fwv Teb Chaws Lub Tsev Haujlwm Saib Xyuas Kev Kawm Qib Siab ntawm Kev Kawm Ntawv Qib Siab "Thawj Tshawb Xyuas Kev Kawm Hauv Lub Xeev Moscow Hauv Tsev Kawm Ntawv lub npe tom qab I.M. Sechenov Ministry of Health ntawm Lavxias Federation ("Tswj kev mob" magazine No. 4, 2017) nyeem,

tshuaj xyuas cov ntaub ntawv txog tus kabmob thiab kuaj mob “Transthyretin tsev neeg amyloid polyneuropathy (TTR-SAP)” Pfizer Innovation LLC, Moscow (www.pfizerprofi.ru), 12/08/2016 nyeem,

tsab xov xwm “Familial amyloid polyneuropathy TTR Cys 114 hauv cov kwv tij monozygotic ntxaib (chaw kuaj mob)” M.O. Kovalchuk, I.A. Strokov, Utrecht University Medical Center, Tebchaws Netherlands, Utrecht, Tsoomfwv Lub Xeev Lub Tsev Haujlwm Saib Xyuas Kev Kawm Qib Siab ntawm Kev Kawm Qib Siab Thawj Hauv Lub Xeev Moscow Lub Tsev Kawm Ntawv Kho Mob I.M. Sechenova Ministry of Health ntawm Lavxias Federation, Moscow (phau ntawv xov xwm "Cov Kab Mob Hlwb Neuromuscular" No. 1, 2017) nyeem,

tsab xov xwm “Transthyretin amyloidosis: qhov teeb meem tam sim no” I.A. Dyudina, Lub Txiaj Ntsim Hauv Lub Xeev "NSC" Lub koom haum ntawm Cardiology npe tom qab Neeg ntxhoo. N.D. Strazhesko "NAMS ntawm Ukraine", Kiev (phau ntawv xov xwm "Lub plawv tsis muaj zog thiab comorbidity", No. 1, 2017) nyeem,

tsab xov xwm “Ib qhov xwm txheej kuaj mob ntawm transthyretin amyloidosis nrog kev ncua sij hawm los kuaj xyuas tus mob hauv tus neeg mob kuaj mob” E.S. Naumova, S.S. Nikitin, T.A. Adyan, 3, D.S. Druzhinin, V.A. Warsaw, Chaw Kho Mob "Tshawb Pom Neurology", Moscow, Tsoom Fwv Teb Chaws Kev Siv Nyiaj Txiag Tshawb Nrhiav "Kev Tshawb Fawb Txog Kev Tshawb Fawb", Moscow, Tsoom Fwv Teb Chaws Kev Siv Nyiaj Txiag Tshawb Nrhiav Cov Tsev Kawm Qib Siab "Lavxias National Tshawb Fawb Kev Kho Mob University muaj npe tom qab N.I. Pirogov ”, Ministry of Health ntawm Lavxias Federation, Moscow, FSBEI HE" Yaroslavl State Medical University "Ministry of Health ntawm Lavxias Federation, Yaroslavl, FSAEI HE First Moscow State Medical University I.M. Sechenova Ministry of Health ntawm Lavxias Federation, Moscow (phau ntawv xov xwm "Cov Kab Mob Neuromuscular" No. 1, 2018) nyeem,

tsab xov xwm "Amyloid neuropathy nyob rau hauv tus neeg mob nrog transthyretin tsev neeg amyloidosis" Zinovieva OE, Umari DA, Solokha OA, Yakhno NN, GBOU VPO "Thawj MGMU muaj npe tom qab I.M. Sechenov ", Lub tsev kho mob ntawm Cov Kab Mob Hlwb muaj npe tom qab A.Ya. Kozhevnikova, Lub Chaw Haujlwm Tshawb Fawb Kev Tshawb Fawb, Lub Chaw Tshawb Fawb, Moscow (Cov Xov Xwm Neurological, No. 5, 2016) nyeem,

tsab xov xwm "Kev puas tsuaj rau cov leeg ntu paj hlwb hauv cov kab ke amyloidosis" Safiulina E.I., Zinovieva O.E., Rameev V.V., Kozlovskaya-Lysenko L.V., FGAOU VO "Thawj Moscow State Medical University muaj npe tom qab I.M. Sechenova "Ministry of Health ntawm Lavxias Federation, Moscow (phau ntawv sau xov xwm" Neurology, Neuropsychiatry, Psychosomatics "No. 3, 2018) nyeem

Kev kuaj mob ntawm cov mob polyneuropathies

Yog hais tias maj mam hloov zuj zuj sensorimotor polyneuropathy, uas ua kom pom tseeb los ntawm cov leeg mob ua kom pom tseeb, nws yog qhov yuav tsum tau hais meej txog keeb kwm keeb kwm, tshwj xeeb tshaj yog muaj kev qaug zog thiab tsis muaj zog ntawm cov leeg ceg, kev hloov pauv, thiab deformation ntawm lub taw (nce siab). Nrog rau kev txhim kho ntawm qhov tsis muaj qhov sib npaug ntawm qhov txuas ntawm tes, nws yog ib qho tsim nyog yuav tsum tsis suav cov hlau lead. Raws li txoj cai, tshuaj lom polyneuropathies yog tus yam ntxwv, ntxiv rau cov tsos mob ntawm lub cev, los ntawm kev ua kom tsis muaj zog, ntxiv zog rau qhov tsis txaus, thiab tsis tshua muaj qhov tsis txaus siab nyob hauv plab. Ib qho ntxiv, nws yog qhov tsim nyog kom pom qhov tshuaj uas tus neeg mob coj / siv sij hawm txhawm rau txhawm rau tshem tawm cov tshuaj polyneuropathy.

Kev maj mam zuj zus kev txhim kho cov asymmetric leeg tsis muaj zog yog qhov kev kuaj mob ntawm cov kabmob muaj ntau yam ua rau lub cev tsis muaj zog. Mob ntshav qab zib polyneuropathy yog yam ua rau maj mam dhau zuj zus lawm qhov qis ntawm caj pas qis, ua ke nrog qhov kev hnov mob khaus thiab lwm yam tshwm sim ntawm taw. Cov mob polyneuropathy siab heev tshwm sim, raws li txoj cai, tawm tsam keeb kwm ntawm mob raum ntev (CRF). Nrog rau kev nthuav dav ntawm kev hnov mob-cov khoom noj khoom haus polyneuropathy, muaj tus yam ntxwv los ntawm kev kub hnyiab, dysesthesia, tawm ntawm qhov txo lub cev hnyav, nws yog qhov tsim nyog kom tshem tawm amyloid polyneuropathy.

Rau cov roj ntsha polyneuropathies, thawj qhov tsis muaj zog ntawm lub zog extensor ntawm tus taw, tus taw ntaiv, qhaj tsis tiav ntawm Achilles tendon reflexes, qhov siab ntawm ko taw yog yam ntxwv. Ntawm cov theem tom qab ntawm tus kab mob, tsis muaj lub hauv caug thiab lub cev nqaij hlav ntawm lub pob txha caj qaum, mob caj dab ntawm cov leeg ntawm txhais taw thiab ceg. Kev mob nqaij ua rau qhov pom ntawm sab hauv ntawm tus tib neeg cov leeg ntshav, uas tsis hnov lub ntsej muag cuam tshuam, yog tus yam ntxwv ntawm ntau lub cev ntsig txog lub cev. Feem ntau, ua kev puas tsuaj rau cov kev sib tshuam sab saud.

Kev hnov mob polyneuropathies yog qhov txawv txav ntawm kev faib tawm hypesthesia. Hauv cov theem pib ntawm tus kab mob, hyperesthesia yog ua tau. Sensomotor axonal neuropathies yog tus cwj pwm los ntawm distal hypesthesia thiab distal leeg tsis muaj zog. Hauv autonomic polyneuropathies, ob qho tib si prolapse thiab voos ntawm autonomic cov leeg paj yog tau. Rau kev kho mob polyneuropathy kev nyuaj siab, hyperhidrosis, lub cev tsis muaj zog ntawm lub cev yog qhov ib txwm muaj, rau kev mob ntshav qab zib polyneuropathy, ntawm qhov tsis sib xws, daim tawv nqaij qhuav, cuam tshuam kev cuam tshuam ntawm lub plab hnyuv siab raum.

Txoj kev kawm txog cov tshuaj tiv thaiv rau GM1 ganglycosides raug pom zoo rau cov neeg mob uas lub cev muaj zog neuropathies. High titers (ntau dua 1: 6400) tshwj xeeb rau lub cev muaj zog multifocal neuropathy. Cov tshuaj tiv thaiv qis (1: 400-1: 800) muaj peev xwm ua tau nrog mob ntsig txog mob ntsws mob txhaws mob hlwb (HVDP), Guillain-Barré syndrome thiab lwm cov leeg mob hlwb. Nws yuav tsum nco ntsoov tias nce titer ntawm cov tshuaj tiv thaiv rau GM1-gangglycosides raug kuaj pom hauv 5% ntawm cov neeg noj qab haus huv (tshwj xeeb yog cov neeg laus). Cov tshuaj tua kab mob rau myelin-txuam nrog glycoprotein raug tshawb pom hauv 50% ntawm cov neeg mob kuaj mob paraproteinemic polyneuropathy thiab, qee qhov xwm txheej, lwm cov leeg lub cev tsis muaj zog.

Yog tias polyneuropathies xav tias cuam tshuam nrog intoxication nrog cov hmoov txhuas, txhuas, thiab mercury, kuaj ntshav thiab tso zis rau cov hlau hnyav tau ua. Nws yog ua tau los ua cov kev ntsuas keeb kwm molecular ntawm txhua cov qauv ntawm IMSS I, IVA, IVB yam. Ua cov koob electromyography nrog polyneuropathies tso cai rau koj los txheeb xyuas cov cim ntawm qhov qhia tam sim no-rov ua haujlwm. Ua ntej tshaj plaws, nws yog qhov yuav tsum tau kuaj xyuas qhov txawv txav ntawm cov leeg ntawm sab saud thiab sab qis, thiab, yog tias tsim nyog, cov leeg ze. Ib txoj hlab ntshav ntawm lub cev tsuas yog tsim nyog yog tias muaj kev ua haujlwm ntawm amyloid polyneuropathy (kuaj pom ntawm amyloid tso nyiaj).

Kev kho mob polyneuropathies

Nrog polyneuropathies kev muaj keeb, kev kho yog mob.Hauv autoimmune polyneuropathies, lub hom phiaj ntawm kev kho mob yog kom ua tiav kev zam txim. Hauv cov mob ntshav qab zib, haus dej cawv, uremic thiab lwm yam kev mob siab ntsig txog kev txhaj tshuaj tiv thaiv kab mob, kev kho mob yog txo qis mus rau qhov hnyav ntawm cov tsos mob thiab qhov ua kom qeeb qeeb. Ib qho tseem ceeb ntawm kev siv tshuaj tsis yog tshuaj yog kev tawm dag zog ua lub zog tswj lub cev nqaij daim tawv thiab tiv thaiv kev cog lus. Nyob rau hauv cov ntaub ntawv ntawm kev loj hlob ntawm kev ua pa tsis haum nrog diphtheria polyneuropathy, tshuab cua tshuab pa yuav tsum tau. Kev siv tshuaj kho tau cov mob muaj keeb polyneuropathies tsis muaj nyob. Kev npaj tshuaj vitamin thiab cov tshuaj tiv thaiv neurotrophic yog siv los kho kev kho mob. Txawm li cas los xij, lawv cov kev ua tau zoo tseem tsis tau pom tseeb.

Txog kev kho mob ntawm porphyria polyneuropathy, qabzib yog tshuaj, uas feem ntau ua rau kev txhim kho ntawm tus neeg mob, nrog rau cov tshuaj pleev xim thiab lwm cov tshuaj mob. Kev siv tshuaj kho mob ntawm tus mob vwm demyelinating polyneuropathy suav nrog kev coj ua, kev siv ntawm tib neeg immunoglobulin lossis prednisolone. Qee qhov xwm txheej, cov tshuaj tiv thaiv ntawm immunoglobulin kuj tsis txaus, yog li, yog tias tsis muaj contraindications, kev kho yuav tsum pib tam sim ntawd nrog glucocorticosteroids. Kev txhim kho tshwm sim tshwm sim, feem ntau tom qab 25-30 hnub, tom qab ob lub hlis, koj tuaj yeem pib maj mam txo qhov koob rau ib txoj kev tswj xyuas. Nrog rau qhov txo qis dua ntawm glucocorticosteroids, EMG kev tswj hwm yog qhov tsim nyog. Raws li txoj cai, prednisolone tuaj yeem raug tshem tawm kom tiav tsis pub dhau 10-12 lub hlis, yog tias tsim nyog, koj tuaj yeem "pov hwm" nrog azathioprine (tsis hais cyclosporine lossis mycophenolate mofetil).

Kev kho mob ntshav qab zib polyneuropathy yog ua tiav nrog tus kws kho mob endocrinologist, nws lub hom phiaj tseem ceeb yog tswj cov ntshav qab zib kom nyob qis. Txog kev daws qhov mob, tricyclic cov tshuaj tiv thaiv kab mob tau siv, zoo li pregabalin, gabapentin, lamotrigine, carbamazepine. Feem ntau, thioctic acid npaj thiab cov vitamins B yog siv. Ntawm cov tshuaj, cov vitamins B tau siv, nrog mob hnyav - tricyclic antidepressants, pregabalin.

Lub ntsiab kev kho mob rau hauv kev kho mob ntawm cov tshuaj lom polyneuropathy yog kom tsis txhob kov nrog cov tshuaj lom neeg. Nrog koob tshuaj tiv thaiv polyneuropathies koob tshuaj, nws yog qhov tsim nyog los kho cov koob tshuaj ntawm cov tshuaj sib haum. Nrog kev paub tseeb tus mob diphtheria, kev tswj hwm ntawm antitoxic cov ntshav txo qis qhov muaj feem yuav ua rau muaj kab mob diphtheria polyneuropathy. Tsawg tsawg zaus, kev phais mob yuav tsim nyog vim qhov kev txhim kho ntawm kev cog lus thiab deformity ntawm ob txhais taw. Txawm li cas los xij, nws yuav tsum nco ntsoov tias lub caij nyoog tsis tuaj yeem tom qab kev phais mob tuaj yeem cuam tshuam rau lub cev muaj zog.

Kev ntsuas rau tus mob polyneuropathy

Nrog mob inflammatory demyelinating polyradiculoneuropathy, qhov tshwm sim rau lub neej yog qhov muaj txiaj ntsig zoo. Kev tuag yog tsawg heev, txawm li cas los xij, kev ua kom tiav rov qab muaj tsawg heev. Txog li 90% ntawm cov neeg mob uas siv cov tshuaj tiv thaiv kho kom ua tiav tau lossis siv tsis tau tag nrho. Nyob rau tib lub sijhawm, tus kab mob yog nquag dhau los ua kev puas tsuaj, kev siv tshuaj tiv thaiv kev kho mob tuaj yeem saib xyuas nws cov kev mob tshwm sim, uas ua rau muaj kev cuam tshuam ntau yam.

Nrog rau kev tiv thaiv kab mob polyneuropathies, nws tsis tshua muaj los ua kom tau kev txhim kho, vim tias tus kab mob maj mam hloov zuj zus. Txawm li cas los xij, cov neeg mob, raws li txoj cai, hloov kho lawv tus mob thiab, feem ntau, txog thaum kawg tus mob tus kab mob muaj peev xwm saib xyuas tus kheej.Nrog rau cov mob ntshav qab zib polyneuropathy, qhov pom tias muaj txiaj ntsig rau lub neej yog muaj kev txaus siab, muab kev kho mob sijhawm thiab tswj kev ceev ntawm glycemia. Tsuas yog tom qab kis ntawm tus kab mob yog qhov mob hais qhia qhov mob uas muaj peev xwm cuam tshuam loj dua tus neeg mob lub neej.

Kev kuaj mob rau lub neej nrog rau kev mob caj dab (polyneuropathy) uremic yog nyob ntawm qhov mob ntawm lub raum tsis ua hauj lwm zoo. Txoj kev pabcuam hemodialysis lossis lub raum hloov pauv tuaj yeem ua rau kom tiav lossis yuav luag tiav qhov ua haujlwm ntawm uremic polyneuropathy.

Kab lus no kuj muaj nyob hauv cov lus hauv qab no: lus Thaib

Cov chaw kab mob hauv tus kab mob

Hauv txhua kis, chav kawm ntawm dysmetabolic polyneuropathy tej zaum yuav txawv. Yog hais tias tus kab mob kev loj hlob thaum ntxov txaus thiab raug pom los ntawm kev txo qis ntawm kev tsis txaus siab, ces poob ntawm hauv caug thiab Achilles reflexes tuaj yeem pom.

Qhov subclinical no ntawm polyneuropathy tsis ua rau mob, tab sis muaj kev txhim kho mus ntau xyoo hauv uake.

Mob ntshav qab zib polyneuropathy tuaj yeem ua tus subacute lossis txawm tias mob hnyav. Hauv qhov no, kev puas tsuaj rau qee ntu ntawm cov leeg paj ntoo tshwm sim. Raws li txoj cai, cov leeg puas tsuaj tshwm sim:

Cov teeb meem no tuaj yeem nrog nws cov paresis ntawm cov pawg hauv cov leeg mob, qhov mob thiab rhiab. Yog tias tus poj niam lub paj hlwb raug cuam tshuam, tom qab ntawd poob ntawm lub hauv caug tsis txhob poob siab.

Tsis tas li ntawd, kev puas tsuaj rau lub cranial qab haus huv (kev rho tawm, trigeminal, oculomotor) tau sau tseg.

Muaj hom thib peb ntawm hom kev kawm ntawm tus mob ntshav qab zib polyneuropathy. Nws yog tus cwj pwm los ntawm kev puas tsuaj rau qee cov leeg ntawm nqaj thiab kev txhim kho ntawm cov kev xav thiab lub cev muaj zog (tshwj xeeb tshaj yog qis qis)

Tendon reflexes muaj peev xwm ua kom ploj, thiab nyob rau palpation mob ntawm cov hlab ntaws ntawm ib qho kev xav.

Nrog rau polyneuropathy, kev noj haus thiab trophic mob tsis txaus ntseeg. Cov teeb meem ntawm kev tso zis thiab tom qab hypotension tsim.

Yuav kho li cas?

Ua ntej tshaj plaws, nws yog ib qho tsim nyog yuav tau kho cov metabolism hauv kev ua kom yuag nrog kev pab los ntawm cov tshuaj insulin thiab kev noj zaub mov tshwj xeeb. Tus kws kho mob yuav pom zoo:

tshuaj mob taub hau
B vitamins,
finlepsin,
laib kev loj leeb (gangleron),
espa lipon (berlition).

Yuav ua raws li lub sijhawm ntsuas ntawm kev ntsuas uas siv los daws tus mob neuropathy.

Polyneuropathy nrog mob tag nrho

Yog hais tias tus neeg mob muaj mob lupus erythematosus, uas cuam tshuam rau daim tawv nqaij, ob lub raum thiab pob qij txha, ces polyneuropathy yog tus cwj pwm los ntawm kev txhim kho tuag tes tuag taw los yog paresis ntawm cov leeg nqaij sib thooj, poob ntawm qee cov leeg caj dab tsis kam. Tseem ceeb tshaj qhov txo qis mob ua kom qhov mob tseem muaj feem.

Muaj qee kis, cov cim qhia ntawm polyneuropathy tuaj yeem ua rau pom thawj zaug ntawm kev txhim kho ntawm lub hauv paus mob. Cov tshuaj paub cov ntawv uas muaj kev puas tsuaj rau ntau txoj hlab ntshav ntawm caj npab thiab ceg.

Hauv qhov no, peb yuav tham txog mononeuropathy. Hauv kev mob rheumatoid mob caj dab, mob polyneuropathy kuj tseem pom. Thaum pib, nws yuav tshwm sim nws tus kheej raws li qhov mob rhiab, thiab tom qab ntawd es tsis zoo sensorimotor neuropathy.

Yog tias pom tus mob periarteritis nodosa, tshwm sim rau cov leeg hlwb thiab leeg txha caj qaum. Cov kev ua txhaum zoo sib xws yuav cuam tshuam nrog kev mob hnyav:

nroj tsuag
lub cev muaj zog,
rhiab tsawv.

Daim ntawv txiav txim siab ntawm neuropathy feem ntau yog nrog cov tsos mob ntawm tus mob angiopathy nyob rau lwm qhov plab hnyuv siab raum thiab lub nruab.

Cov roj ntsha tiv thaiv kab mob

Ua ntej tshaj plaws, nws yog polyneuropathy, uas tshwm sim nrog porphyria (kev mob caj ces enzyme cuam tshuam). Cov tsos mob tseem ceeb ntawm tus kab mob no yog:

mob hauv plab hauv plab,
nce ntshav siab
kev puas tsuaj rau lub nruab nrab hauv lub paj hlwb,
zis ntau lawm nrog cov yam ntxwv tsaus xim.

Porphyric polyneuropathy yuav tshwm sim vim lub paj hlwb txoj kev mob tshwm sim. Hauv qhov xwm txheej no, qhov mob, leeg tsis muaj zog, nqaij pob txha caj qaum (sab sauv thiab qis dua) tshwm sim. Lub cev muaj zog tuaj yeem nce zuj zus, nce mus rau qhov txhawm rau txhawm chim lossis paresis.

Nrog rau qhov mob no, tus neeg mob yuav xav tias:

mob ntawm cov hlab ntaws cev,
poob ntawm txhua hom rhiab.

Txheeb xyuas kom paub tseeb, tus kws kho mob yuav coj mus rau hauv tag nrho cov tsos mob ntawm cov kab mob metabolism hauv porphyrin. Txhawm rau kom tshem tawm cov mob, tus kws kho mob pom zoo rau cov leeg thiab qhov ncauj ntawm cov kua nplaum hauv qhov ntau thiab tsawg txog 400 mg (kev kho mob tib yam yog qhia rau lwm hom mob polyneuropathy).

Amyloid polyneuropathy

Ib hom amyloid ntawm polyneuropathy kev loj hlob hauv cov neeg mob uas muaj keeb kwm ntawm cov mob muaj keeb amyloidosis. Nws cov ntawv tseem ceeb hauv kev soj ntsuam yog:

cov quav tsis zoo (cem quav thiab raws plab),
hnyuv mob mob
lub plawv tsis ua hauj lwm
macroglossia (kev nce hauv qhov loj ntawm tus nplaig).

Nrog rau qhov mob no, kev hnov mob tsis zoo los cuam tshuam predominate, piv txwv li, mob ntawm nqua, poob ntawm qhov mob thiab qhov kub rhiab. Ntawm cov theem tom qab, paresis kuj koom nrog qhov tsis zoo.

Raws li kev kho mob txaus, thaum lub caij nws tsis muaj nws.

Lub cev ntaj ntsug-lub cev muaj zog polyneuropathy

Muaj ntshav qab zib, cov hlab ntaws ntev yog feem ntau cuam tshuam. Mob ntshav qab zib polyneuropathy pom muaj 40% ntawm cov neeg mob ntshav qab zib. Qhov hom mob zoo li no tau qhia los ntawm qhov tsis paub ntawm lub siab ntawm lub siab, qhov hloov pauv ntawm qhov kub thiab txias, qhov mob, vibration thiab qhov chaw txheeb ze rau lwm yam khoom.

Hnov polyneuropathy yog qhov txaus ntshai vim tias tus mob ntshav qab zib tuaj yeem hnov tsis hnov mob thiab tsis kub.

Cov nqaij mob tshwm sim qis rau ntawm qhov qis, txhaws ntawm txhais ceg fester. Kev mob hnyav rau kev sib koom tes thiab pob txha caj dab tsis raug tswj hwm.

Sensomotor polyneuropathy tuaj yeem tshwm sim los ntawm cov tsos mob nquag, piv txwv li, txaus qhov muaj zog ntawm ob txhais ceg, uas tshwj xeeb tshaj yog nyob rau hmo ntuj.

Raws li tus kabmob loj hlob tuaj, kev cuam tshuam hauv kev ua haujlwm ntawm cov leeg mus ntawm lub cev yuav saib xyuas. Thaum zoo li no:

pob txha deformation
mob leeg
ntev li ntawm dryness ntawm daim tawv nqaij,
cov tsos ntawm lub hnub nyoog me ntsis,
tawv nqaij plhu liab
hws caj dab kawg ua.

Cov tsos mob tshwj xeeb tshaj plaws ntawm distal polyneuropathy hauv ntshav qab zib yuav mob rwj uas tshwm sim nruab nrab ntawm cov ntiv taw thiab ntiv taw. Cov qhov txhab txhab tsis muaj peev xwm ua rau muaj qhov tsis xis nyob vim tias tsis hnov mob. Hauv cov xwm txheej siab, peb yuav tham txog kev txiav tes taw.

Autonomic polyneuropathy mob ntshav qab zib

Hauv qhov muaj qhov txhab ntawm cov leeg ntshav ntawm lub paj hlwb tiv thaiv keeb kwm ntawm cov chav kawm mob ntshav qab zib, tus neeg mob yuav xav tias:

tsaus nti nti hauv qhov muag
tsaus muag thaum sawv ntsug,
kiv taub hau.

Daim ntawv ntawm polyneuropathy no yuav nrog kev ua haujlwm tsis zoo hauv kev ua haujlwm ntawm lub plab zom mov, uas tau tshwm sim los ntawm kev qeeb hauv kev noj zaub mov. Vim tias qhov no, nws yog qhov kev ua tsis yooj yim los tswj lub siab ntawm cov piam thaj hauv cov ntshav ntawm cov ntshav qab zib.

Qhov ua kom muaj kev tuag sai sai yuav yog qhov ua txhaum ntawm lub plawv dhia hauv cov ntshav qab zib mob ntshav qab zib.

Cov neeg uas raug kev txom nyem los ntawm tus mob no yuav hnov teeb meem los ntawm cov kab mob genitourinary - kev tso zis tsis txaus ntseeg tshwm sim. Lub zais zis yuav plam nws lub peev xwm los ua qhov khoob kiag, uas yog qhov tsim nyog rau kev txhim kho ntawm tus mob sib kis. Erectile kawg ua haujlwm hauv autonomic polyneuropathy yuav tau sau tseg rau cov txiv neej, thiab dyspareunia hauv poj niam (tsis muaj peev xwm ua tiav orgasm).

Cov ntawv ntawm polyneuropathies

Polyneuropathies tuaj yeem muab cais los ntawm keeb kwm (etiology)), thiab qhov chaw kuaj mob.

Polyneuropathies los ntawm cov duab hauv qhov chaw kuaj mob yuav yog cov hauv qab no:

lub cev muaj zog polyneuropathies (kev puas tsuaj rau lub cev fiber ntau, kev txhim kho cov leeg tsis muaj zog, ua tuag tes tuag taw, paresis),
piav thoob hlo polyneuropathies (cov yam ntxwv ntawm kev puas tsuaj rau cov fibers yooj yim, loog, hlawv thiab mob),
autonomic polyneuropathies (paub txogua txhaum lub luag haujlwm ntawm cov khoom nruab nrog sab hauv, kev puas tsuaj rau cov hlab ntsha uas tswj cov kev ua haujlwm ntawm cov nruab nrog cev),
lub cev muaj zog-hnov qab polyneuropathies (kev puas tsuaj rau lub cev muaj zog thiab cov pob hluav taws xob yog qhov yam ntxwv).

Raws li lub ntsiab ntawm lub ntsiab lus tseem ceeb ntawm polyneuropathy tuaj yeem faib ua:

axonal (thawj lub qhov txhab ntawm axon - lub txheej txheem ntev ntev ntawm txoj hlab ntaws),
demyelinating (myelin pathology - cov hlab ntshav tso zis).

Los ntawm keeb kwm (etiology) tuaj yeem faib ua polyneuropathy rau hauv:

autoimmune (Miller-Fisher mob, kev mob tawm tsam polyneuropathy, paraneoplastic polyneuropathies, mob txhaws mob axonal mob polyneuropathy, Sumner-Lewis syndrome),
caj ces (cov leeg muaj lub cev tsis muaj zog-tso siab rau hom I, tus mob Rus-Levy syndrome, lub cev muaj zog ntawm lub cev-mob hlwb neuropathy ntawm hom II, kab mob rau lub cev muaj zog-hnov mob neuropathy ntawm hom III, mob lub cev muaj zog-txoj kev xav ntawm neuropathy ntawm hom IV, mob neuropathy nrog txoj kev xav mus rau tuag tes tuag taw los ntawm kev zaws, kab mob hauv lub cev),
metabolic (mob ntshav qab zib polyneuropathy, mob ntshav qab zib polyneuropathy, mob polyneuropathy mob ntshav siab, mob polyneuropathy hauv cov kab mob endocrine, polyneuropathy hauv thawj cov kab mob amyloidosis),
alimentary (nrog lub cev tsis muaj cov vitamins B1, B6, B12, E),
lom (dej cawv polyneuropathy, tshuaj tiv thaiv polyneuropathies, polyneuropathies thaum muaj tshuaj lom nrog cov hlau nyhav, cov kuab tshuaj organic thiab lwm yam tshuaj lom),
polyneuropathies hauv cov kab ke uas muaj kabmob (mauj lupus erythematosus, scleroderma, mob rheumatoid, mob sarcoidosis, mob vasculitis, Sjogren's syndrome),
lom lom (diphtheria, tom qab mob khaub thuas, qhua pias, mob qog, kis mob mononucleosis, txhaj tshuaj tiv thaiv tom qab, nrog zuam tus mob borreliosis, mob HIV, nrog mob ruas).

Chav kawm ntawm tus kab mob ntawm polyneuropathy tuaj yeem yog:

ntse (cov tsos mob tshwm sim li ntawm ob peb hnub lossis ob peb lim tiam),
subacute (cov tsos mob nce nyob rau hauv ob peb lub lis piam, tab sis tsis ntau tshaj ob hlis),
mob nyhav (cov tsos mob tshwm sim ntau lub hlis lossis xyoo).

ICD-10 polyneuropathy

Raws li kev faib tawm thoob ntiaj teb ntawm cov kab mob ntawm kaum kev kho (ICD-10) polyneuropathy nkag los ntawm cipher G60 - G64. Cov chav kawm no muaj cov npe ntawm polyneuropathies thiab lwm qhov chaw mob ntawm cov leeg ntu paj hlwb. Hom ntawm cov kabmob no tau piav qhia ntxiv los ntawm ib daim duab ntxiv, piv txwv li, haus dej cawv polyneuropathy - G62.1.

ICD-10 polyneuropathy coding

Kab mob lub cev muaj zog thiab kev hnov mob neuropathy (Kab mob hauv Charcot-Marie-Tooth, Degerin-Sott kab mob, kab mob rau lub cev tsis muaj zog ntawm cov tshuaj I-IV, mob hlwb tsis zoo ntawm cov menyuam yaus, mob ntshav qab zib-Levy, mob leeg ntshav nrog ib leeg.)

Neuropathy sib xyaw ua ke nrog kev tiv thaiv raws roj ntsha ataxia

Idiopathic hnyav mob neuropathy

Lwm yam mob muaj keeb thiab idiopathic neuropathies (Tus kab mob Morvan, Cov mob Nelaton syndrome, hnov mob neuropathy)

Tsis paub meej txog tus mob muaj keeb thiab idiopathic neuropathy

Guillain-Barré Syndrome (Kev mob Guillain-Barré Syndrome)Miller-Fisher mob, mob hnyav tom qab kis / kev kis mob rau tus mob polyneuritis)

Lwm cov tshuaj tiv thaiv polyneuropathies

Tsis pom tseeb mob polyneuropathy mob

Polyneuropathy mob los ntawm lwm cov tshuaj lom

Lwm cov polyneuropathies sau tseg

Polyneuropathy hauv kev kis kab mob thiab cov cab uas raug cais rau lwm qhov (polyneuropathy mob diphtheria, mob mononucleosis, mob ruas, mob syphilis, mob ntsws, mob qog, mob Lyme)

Polyneuropathy hauv neoplasms

Polyneuropathy nyob rau hauv lwm yam kab mob endocrine thiab teeb meem hauv lub cev hauv metabolism

Polyneuropathy nrog kev noj haus tsis zoo

Polyneuropathy nrog cov qhov txhab mob ntawm cov nqaij mob sib txuas

Polyneuropathy nrog lwm cov leeg nqaij pob txha

Polyneuropathy rau lwm cov kab mob uas tau faib rau lwm qhov (uremic neuropathy)

Lwm qhov kev cuam tshuam ntawm cov leeg ntu paj ntaub

Chaw saib duab dav dav ntawm polyneuropathies

Raws li tau hais ua ntej, polyneuropathies tuaj yeem tshwm sim lub cev muaj zog (lub cev muaj zog), rhiab (rhiab) thiab cov tsos mob ua ke uas yuav tshwm sim nrog kev puas tsuaj rau cov khoom sib txuam ntawm cov leeg.

Qhov kev yws tseem ceeb ntawm cov neeg mob polyneuropathy yog qhov mob. Los ntawm nws cov xwm, nws tuaj yeem sib txawv, tab sis ntau tshaj plaws yog qhov mob tas mus li lossis khaus khaus lossis mob ib qho lossis mob sib khuav. Qhov xwm ntawm qhov mob hauv polyneuropathy nyob ntawm qhov hnyav ntawm cov txheej txheem pathological, hom thiab caliber ntawm cov cuam tshuam txog cov fibers. Feem ntau, qhov mob nrog polyneuropathies pib nrog qhov sib txawv tshaj plaws (nyob deb) cov chaw haujlwm, uas yog los ntawm plantar saum npoo ntawm taw.

Nrog rau polyneuropathies, koj tuaj yeem ua tau raws li qhov thiaj li hu ua mob tsis tswm ceg ceg. Cov tsos mob no yog ib yam mob uas yog qhov tsis txaus siab nyob rau hauv qis qis uas tshwm sim thaum so (ntau dua nyob rau yav tsaus ntuj thiab thaum hmo ntuj) thiab yuam tus neeg mob taw kev ua kom yooj yim lawv thiab feem ntau ua rau pw tsaug zog. Cov chaw kuaj mob nthuav qhia txog cov ceg tsis tswm zoo tuaj yeem yog qhov xav tias khaus khaus, khawb, nti, tawg lossis tsoo. Qee lub sij hawm yuav muaj qhov hnov zoo li nce toj ntawm cov caj pas, lub npub lossis txiav mob, uas feem ntau tuaj yeem tshwm sim hauv tus taw lossis hauv qhov tob ntawm ob txhais ceg.

Lub cev muaj zog ntawm polyneuropathy muaj xws li cov hauv qab no:

leeg tsis muaj zog (feem ntau tetraparesis lossis qis dua paraparesis),
mob hypotension (txo quag ntawm cov leeg nruj lossis tsis kam mus rau kev txav),
atrophy (depletion lossis ploj qhov tseem ceeb) cov leeg
tshee hnyo (tshee),
cov hlwb (lub xeev los ntawm qhov tsis sib haum lossis cov leeg pob txha),
kev ua yeeb yam (kev tswj tsis tau lub cev cia hauv plab mus ntev uas pom los ntawm daim tawv nqaij),
mob leeg.

Feem ntau, kev noj cov zaub mov tsis zoo uas muaj kev puas tsuaj rau cov leeg hlwb tsis txaus los ntawm kws kho mob mus kawm thiab tsis raug lees paub tias yog ib qho ntawm cov tsos mob polyneuropathy. Hauv cov neeg mob uas muaj kev puas tsuaj rau cov nqaij tsis muaj plab, muaj kev ua kom pom kev tsis ua haujlwm ntawm lub hlab plawv, lub plab zom mov, ua kom lub zog tsis zoo, tso zis tsis zoo, tawm pob ntawm lub cev, thiab tawm hws.

Lub ntsiab kev soj ntsuam cov tsos mob ntawm tus kheej neuropathy yog:

Orthostatic hypotension (los ntshavtxo nyob rau hauv cov ntshav siab raws li kev hloov ntawm lub cev txoj haujlwm los ntawm kab rov tav mus rau ntsug),
lub siab ua ntxhov,
ua txhaum ntawm lub zog hloov pauv txhua hnub hauv ntshav siab,
postural tachycardia (qhov nce hauv lub plawv dhia thaum sawv thiab qhov txo qis hauv rov qab mus rau qhov chaw rov tav),
latent myocardial ischemia (myocardial kev puas tsuaj raws li kev txo qis lossis poob ntawm cov ntshav txaus rau cov leeg plawv),
nce kev pheej hmoo ntawm kev tuag sai,
txoj hlab pas thiab plab zom mov,
plab hnyuv kawg (cem quav lossis raws plab),
kev puas tsuaj rau lub zais zis (stagnation ntawm bile, cholecystitis, mob pob zeb),
ua txhaum ntawm tso zis (nyuaj ua rau zais zis, ua kom lub tso zis tawm kom zoo, hloov cov zaus tso zis, tso zis),
erectile kawg (qhov tsis yooj yim ntawm qhov tshwm sim lossis kev saib xyuas ntawm ib qho erection, retrograde ejaculation),
tawm hws cuam tshuam
ua txhaum ntawm lub qhov tob ntawm cov tub ntxhais kawm.

Yuav luag txhua qhov polyneuropathies yog qhov pom los ntawm qhov muaj feem cuam tshuam ntawm qhov txawv txav sab nraud thiab nce mus rau sab nraud ntawm cov tsos mob, uas yog txhais ceg tau koom tes ua ntej tshaj ntawm txhais tes. Tag nrho cov no nyob ntawm qhov ntev ntawm cov fibers uas tau koom nrog hauv cov txheej txheem pathological.

Hauv qee qhov polyneuropathies, ntxiv rau lub pob txha caj qaum, qee qhov kev mob cranial yuav muaj kev cuam tshuam, uas yuav muaj cov nqi kuaj mob hauv qhov mob no.

Kev Kho Mob Guillain-Barré Syndrome

Kev kho mob rau Guillain-Barré syndrome yog kev kho mob. Tsis tas li, nws yuav tsum raug sau tseg tias txawm hais tias muaj kev mob nyhav tsawg kawg, muaj lub hauv paus rau tsev kho mob sai ntawm tus neeg mob. Cov neeg mob nrog Guillain-Barré syndrome yuav raug coj mus pw hauv tsev kho mob ntawm chav saib xyuas mob hnyav.

Rau kev kho cov tsos mob nrog rau kev nce ntxiv hauv cov ntshav siab, nifedipine yog tshuaj rau tus neeg mob (10 - 20 mg rau hauv qab tus nplaig) Propranolol yog siv los txo tachycardia (thawj koob tshuaj 20 mg 3 zaug hauv ib hnub, thiab tom qab ntawd cov koob tshuaj tau nce zuj zus mus rau 80 - 120 mg rau 2 rau 3 koob tshuaj nyob rau hauv kev tswj ntshav siab, lub plawv dhia thiab ECG) Hauv bradycardia, tus neeg mob nrog Guillain-Barré Syndrome tau qhia tshuaj atropine ua ke (0.5 - 1 mg nyob rau hauv kev tswj hwm ntawm ECG thiab ntshav siab, thiab yog tias tsim nyog, cov lus qhia rov ua dua tom qab 3 - 5 feeb) Txhawm rau txo qis qhov mob, tshuaj loog, tshuaj tsis haum tshuaj tsis haum tshuaj, xws li ketorolac (qhov ncauj ib zaug hauv ib koob ntawm 10 mg lossis rov ua dua, nyob ntawm qhov mob hnyav ntawm tus mob huam, 10 mg txog 4 zaug hauv ib hnub), diclofenac (intramuscularly, ib koob tshuaj tsuas yog 75 mg, thiab qhov siab tshaj plaws ib hnub yog 150 mg) Ibuprofen (1 mus rau 2 ntsiav tshuaj 3 lossis 4 zaug hauv ib hnub, tab sis tsis ntau tshaj 6 ntsiav tshuaj hauv ib hnub).

Cov yam ntxwv ntawm tus kab mob thiab nws ntau yam

Txhais los ntawm Greek polyneuropathy txhais tau tias "kev txom nyem ntawm ntau lub hlab ntsha." Qhov ua rau ntawm cov kab mob pathology yog ntau yam - yuav luag txhua qhov cuam tshuam uas tsawg kawg ib zaug muaj qhov tsis zoo ntawm qhov tsis xws luag hlab ntsha tuaj yeem ua rau mob polyneuropathy.

Txij li qhov tseem ceeb ntawm lub cev yog nyob ntawm kev xa cov lus txib mus rau lub hlwb los ntawm qhov kawg ntawm cov hlab ntsha, nrog rau txoj kev txhim kho polyneuropathy, qhov kev ua txhaum ntawm kev xav thiab lub cev muaj zog ua haujlwm ntawm nqaj tau tshwm sim.

Tseem Ceeb! Polyneuropathy ntawm qis qis dua yog qhov ntau dua, vim hais tias ob txhais ceg muaj lub nra hnyav dua lub cev sab saud.

Nrog rau polyneuropathy, feem ntau cov leeg me me cuam tshuam, vim lawv cov myelin sheath yog cov tawv nyias, thiab cov khoom tsis zoo yog yooj yim rau kev nkag mus rau hauv cov hlab ntsha. Yog li ntawd, polyneuropathy ntawm qaum thiab qis kawg feem ntau tshwm sim - kev puas tsuaj rau taw thiab tes.

Feem ntau, thaum txiav txim kev kuaj mob, tus neeg mob tsis yog sau lo lus “polyneuropathy ntawm ob txhais ceg lossis caj npab” xwb, lawv paub tseeb ntxiv qee cov lus txhais uas nyob ntawm hom mob. Kev faib tawm thoob ntiaj teb muaj ntau yam kab mob suav nrog ntau yam kab mob polyneuropathy (ICD code - G60-G64), uas sib txawv ntawm qhov chaw, qib thiab thaj chaw ntawm lub qhov txhab, rau cov laj thawj tshwm sim.

Los ntawm degree thiab thaj tsam ntawm kev puas tsuaj

Cov hlab ntsha tuaj yeem muab faib ua ntau hom - lub cev muaj zog, lub zog, lub cev. Nyob ntawm seb qhov kev mob tso zis ntau ntxiv, polyneuropathy tseem muab cais:

Lub cev muaj zog (lub cev muaj zog). Qhov xwm txheej ib txwm ntawm cov leeg ua rau tsis zoo, uas ua rau lawv tsis ua haujlwm: cov leeg tsis muaj zog, cramps, atrophy thiab leeg mob hypotrophy tshwm sim.Cov tsos mob kis tau txij li hauv qab mus rau hauv thiab tuaj yeem ua rau tag nrho cov kev txav tsis ua tiav.

Nroj Tsuag. Lub zog ntawm lub cev hluav taws xob muaj qhov cuam tshuam, uas nyob ntawm lub xeev ntawm kev ua haujlwm nruab nrog. Muaj qhov nce hauv kev tawm hws, teeb meem nrog tso zis, ib qho nyiam rau, cov tawv nqaij qhuav tshwm.
Hnov polyneuropathy. Cov kev mob siab tshwm sim: qhov hnov ntawm qoj ib ce, kub taub hau, loog, "nkag hauv tob," qhov hnov thiab mob siab txawm tias tau chwv ntawm tus ceg pov.
Sensomotor polyneuropathy. Nws ua ke cov tsos mob ntawm kev puas tsuaj rau hnov thiab cov leeg.
Sib xyaw. Nrog rau cov cim qhia ntawm txhua yam kev cuam tshuam.

Hauv nws daim ntawv dawb huv, cov foos no tuaj yeem pom tsis tshua pom, feem ntau hnov thoob-kev noj, lub cev muaj zog-hnov thiab lwm hom sib xyaw ua ke yog kuaj mob.

Los ntawm hom txheej txheem pathological

Polyneuropathy cuam tshuam rau cov hlab ntsha cov hlab ntsha, uas muaj cov axons thiab myelin sheaths. Ua raws li lesion, lawv cais:

Axonal polyneuropathy - tshwm sim thaum lub axon raug puas tsuaj nyob rau hauv ntau yam kev mob tshwm sim: nrog rau kev qaug cawv nrog arsenic, hmoov txhuas, mercury, cawv,
Demyelinating polyneuropathy - tshwm sim nrog demyelination ntawm cov hlab ntaws, tus kab mob loj hlob sai, feem ntau lub cev muaj zog thiab cov ntsaws siab yog cuam tshuam.

Hauv nws daim ntawv dawb huv, cov hom tsis muaj nyob ntev: nrog kev puas tsuaj axon, qhov kev cuam tshuam demyenilizing maj mam koom nrog, thiab nrog demyelination, hom axonal.

Nyob ntawm qhov chaw hauv zos, distal polyneuropathy thiab qhov sib thooj tau ntsib: nrog rau qhov tsis sib luag, ua ntej txhua yam, ceg nyob hauv qab yog cuam tshuam, nrog qhov sib thooj, qhov feem ntawm cov nqua uas nyob saum toj no.

Ua rau

Txhawm rau kev kho mob polyneuropathy kom muab cov txiaj ntsig, nws yog qhov yuav tsum tau txheeb xyuas qhov laj thawj uas ua rau nws.

Vim li cas polyneuropathy ntawm nqua thiab txhais ceg tshwm sim:

Uas Ntshav Qab Zib Cov. Kev swb ntawm cov hlab ntsha me, uas yog ib qho kev cuam tshuam, tshwm sim hauv cov neeg mob feem ntau uas raug tus kab mob no. Yog li, nws yog thawj hauv cov npe ntawm qhov ua rau mob polyneuropathy. Ib qho kev mob tshwm sim zoo sib xws feem ntau tshwm sim hauv cov neeg uas muaj ntshav qab zib ntev mus ntev (5-10 xyoo).
Daim foos lom. Nws tshwm sim thaum cov tshuaj alien rau tib neeg lub cev nkag rau hauv cov ntshav: arsenic, lead, methanol, mercury thiab lwm yam tshuaj lom neeg. Qee zaum cov tshuaj lom polyneuropathy tuaj yeem tshwm sim nrog kev siv tshuaj ntev, tab sis haus dej cawv polyneuropathy yog qhov tshwm sim ntau tshaj plaws. Daim ntawv foos cawv tshwm sim muaj kwv yees li 2-3% ntawm cov neeg mob kev quav dej caw, thiab muaj ntau zaus tshwm sim nyob hauv ob qho chaw tom qab mob ntshav qab zib daim ntawv ntawm tus kab mob.
Tsis muaj cov vitamins B Cov. Qee hom B vitamins (B12, B1, B6) muaj cov neurotropic zoo, muaj kev cuam tshuam zoo rau cov hlab ntsha leeg thiab lub paj hlwb nruab nrab. Yog li ntawd, lawv qhov tsis muaj peev xwm ua rau pom kev mob qog mob leeg.
Dysmetabolic hom. Tus kab mob no tshwm sim vim muaj kev cuam tshuam ntawm kev ua haujlwm ntawm cov ntaub so ntswg uas tau tshwm sim los ntawm kev siv cov khoom uas tsim tawm hauv lub cev tom qab qee yam kab mob.
Raug mob. Raws li kev raug mob, kev siv tshuab ua kom puas rau cov hlab ntsha tuaj yeem tshwm sim, uas ua rau txoj kev txhim kho neuropathy ntawm cov lus sab saud thiab sab qis.

Ua tib zoo mloog! Polyneuropathy feem ntau tshwm sim los ntawm cov kab mob hauv lub cev tsim cov tshuaj phem uas cuam tshuam rau cov hlab ntsha tsis zoo.

Thawj hom ntawm cov kabmob muaj xws li cov mob caj ces polyneuropathy thiab daim ntawv ideopathic (Guillain-Barré syndrome). Lub etiology ntawm cov ntawv no tsis tau txhais tag nrho, uas ua rau kev kho mob ntawm qee yam nyuaj.

Cov ntaub ntawv thib ob ntawm polyneuropathy ntawm qhov ncauj sab sauv thiab sab saud suav nrog cov hom uas tshwm sim los ntawm cov kab mob kis, kev mob plab zom mov, lom, kab mob ntawm lub raum thiab mob siab, kev ua haujlwm ntawm cov qog endocrine, thiab cov qog ntawm ntau yam.

Cov tsos mob thiab kev loj hlob ntawm tus kab mob

Polyneuropathy muaj lub ntsej muag luag saib tsis taus tus yam ntxwv. Cov tsos mob tseem ceeb ntawm tus kab mob tuaj yeem suav hais tias yog qhov kev ntsuas ntawm qhov yeej ntawm qhov qis dua thiab sab saud, vim hais tias pathological yam circulate los ntawm cov ntshav.

Feem ntau cov tsos mob ntawm tus kab mob:

Kev mob ntawm ntau qhov, muaj tus mob neuropathic ("hlawv") Hawj txawm.
Hloov ntiv tes.
Cov tsos ntawm cov leeg sib tw uas tshwm sim tsis kam.
Kev ua txhaum ntawm kev nkag siab (mob, nruj, kub). Nrog rau kev txhim kho cov kabmob, tus neeg mob yuav tsis xav tias muaj lub pob zeb nyob hauv khau, qhov chaw kub thiab lwm yam ua rau mob.
Kev tsis muaj zog ntawm cov leeg nqaij, qhov nyuaj hauv qhov txav nrog qhov loj dav.
O ntawm qhov qis qis,
Ib nrab loog ntawm ob txhais ceg.

Cov tsos mob tsis zoo ntawm cov kab mob suav nrog cov tsos ntawm lub siab ntawm chilliness, tsis muaj zog ntawm cov ntiv tes, mob ntshav tawm (lim ntawm cov xim ntawm cov ceg tawv, tsis zoo ntawm qhov txhab, thiab lwm yam), kub xaim.

Mob ntshav qab zib polyneuropathy ntawm qhov qis qis ua rau pom cov duab hauv qab no:

Cov tsos ntawm excruciating, mob hnyav nyob rau hauv ob txhais ceg thiab taw, uas ua rau muaj zog ntawm sov:
Muaj tsis muaj zog hauv tus taw,
Cov phiajcim muaj ntau zuj zus
Qhov mob pib maj mam nce ntxiv, thaum khaus tshwm thiab cov xim ntawm daim tawv nqaij hloov (tsaus xim doog, yuav luag dub),
Tsim.

Cawv polyneuropathy nthuav dav zuj zus, nws cov tsos mob tshwm sim vim yog cov tshuaj lom cawv los ntawm ethanol nyob rau hauv nruab nrab lub paj hlwb thiab cov teeb meem hauv lub cev tsis ua haujlwm:

Ua ntej, kev mob ntawm thaj chaw plab hlaub tshwm sim, uas sib zog nrog nias
Muaj kev qaug zog, tuag tes tuag taw tshwm sim, ob qho tib si ntawm sab qaum thiab sab ceg qis,
Atrophy ntawm cov leeg nqaij tshwm sim
Thawj qhov kev ntxhov siab uas tsis hnov pom tshwm tuaj (uas yog cov thom khwm thiab hnab looj tes),
Muaj kev tawm hws ntau ntxiv, o ntawm lub ntsej muag distal, qhov hloov pauv ntawm daim tawv nqaij.

Polyneuropathy tuaj yeem tshwm sim vim kev haus cawv ntau dhau, vim qhov kev txiav txim siab ntawm lub hauv nruab nrab yog lom los ntawm ethanol.

Polyneuropathy tsis tshwm sim tas mus li: muaj mob tshwm sim, cov tsos mob tuaj yeem tshwm sim hauv ib lub lis piam, nrog hom subacute - tshwm sim ntau ntxiv tuaj txog ib hlis, nrog daim ntawv ntev - cov kab mob tuaj yeem txhim kho rau xyoo.

Cov hau kev kho

Ua ntej txoj kev kho mob ncaj qha rau polyneuropathy, nws qhov kev kuaj mob yog nqa tawm, uas cov kev ua kom pom tus kabmob, thiab nws cov kev mob tshwm sim, thiaj li yuav cheb cov pathologies uas tau tshwm sim los ntawm cov cim zoo sib xws.

Yuav kuaj li cas thiaj paub:

Kev tsis txaus siab ntawm tus neeg mob tau ntsuas.
Lub sijhawm tau teeb tsa thaum tsim thawj cov tsos mob tshwm sim.
Nws hloov tawm seb tus neeg mob cov haujlwm puas cuam tshuam nrog kev siv tshuaj.
Nws yog txiav txim siab seb tus neeg mob puas haus cawv tau.
Tsim los ntawm cov muaj keeb yam muaj keeb.
Yuav kuaj ntshav ntxiv.
Cov leeg leeg tau xaj.
Electroneimography tau ua.
Qee qhov kev kuaj mob yog nyob ntawm qee kis, ntawm tus kws kho mob.

Txij li thaum polyneuropathy tsis yog ib tus kab mob ywj pheej, nws txoj kev kho mob tseem ceeb yuav tau coj los txiav tawm yam tseem ceeb uas ua rau pib muaj mob. Txawm li cas los xij, kev kho mob yuav tsum tau ua kom nkag siab, thiaj li yuav tshem tawm cov kev mob tsis zoo ntawm polyneuropathy tib lub sijhawm ua kev kho mob tseem ceeb.

Kev ua si ntawm lub cev

Kev tawm dag zog lub cev ua lub luag haujlwm tseem ceeb hauv kev kho mob polyneuropathy, tshwj xeeb tshaj yog tias tus kabmob muaj cov keeb kwm muaj keeb lossis mob ntev.

Cov txheej txheem hauv qab no yog nqa tawm:

Raug rau cov nqaj paj hlwb ntawm lub cev sib nqus,
Zaws Kho
Electrophoresis

Zaws nrog polyneuropathy pab ntxiv dag zog rau cov leeg, txhim kho thiab txhawb lawv cov kev ua haujlwm. Vim tias qhov no, lub zog ua haujlwm rov qab sai dua, qhov kev pheej hmoo ntawm cov leeg atrophy yog txo qis. Txawm li cas los xij, nws yuav tsum tau qhia rau hauv lub siab tias nyob rau hauv cov ntaub ntawv mob ceev, zaws yuav tsum tsis txhob ua.

Ua tib zoo mloog! Thaum muaj tshuaj lom, thiab tshwj xeeb tshaj yog haus dej cawv polyneuropathy, cov txheej txheem kho mob tsuas yog ua tiav tom qab kev ua kom huv ntawm cov ntshav tsim nyob rau hauv chaw mob.

Kev tawm dag zog ib ce tawm dag zog tuaj yeem nqa tawm, ob leeg ntawm nws tus kheej hauv tsev, thiab nyob rau hauv kev qhia ntawm kws kho mob. Lawv pab tsim kho cov leeg ua haujlwm, uas tso cai rau koj qee los yog tag nrho rov qab ua haujlwm tau zoo ntawm nqaj.

Teeb meem thiab kev kuaj ntshav

Yog tias koj tsis nrhiav kev kho mob kom ncav sijhawm, ces tus kab mob tuaj yeem ua rau muaj kev phom sij hnyav.

Ua ntej tshaj plaws, polyneuropathy tuaj yeem hloov kho mus rau hauv daim ntawv ntev, uas tsis kho kiag li. Ua haujlwm dhau sijhawm, ib tus neeg ua rau tag nrho tsis zoo siab hnov lawv nqua, thiab cov leeg nqaij los ntawm cov qauv uas ib tus neeg tuaj yeem ua kev tsis taus, vim tias ua tsis tiav nws lub peev xwm txav tau.

Tseem Ceeb! Nws muaj peev xwm ua kom tiav kiag rau kev kho mob polyneuropathy nrog xws li hom kab mob xws li kis, cawv, thiab lom. Nrog rau daim ntawv ntshav qab zib, nws tsuas yog ua tau kom qee qhov txo cov tsos mob ntawm tus kab mob.

Hauv cov ntawv hnyav ntawm cov kabmob nrog kev ua haujlwm tsis zoo ntawm cov hlab ntshav uas yog lub luag haujlwm rau kev ua haujlwm hauv lub plawv, muaj zog tuaj yeem tshwm sim, uas tuaj yeem ua rau tuag taus.

Hauv daim ntawv uas muaj cov ntshav qab zib, kev kis mob theem ob, qhov mob tsis haum rau lub cev, cov qhov txhab ua tsis zoo yog qhov ua tau.

Nrog cov kev kho mob txaus tsim nyog pib hauv lub sijhawm, kev ntsuas ntawm tus kabmob yog qhov muaj txiaj ntsig zoo, tab sis tseem tseem muaj tus kabmob zoo los tiv thaiv dua li kho nws ntev, kev txom nyem los ntawm cov tsos mob tsis zoo.

Nws tsis tuaj yeem tiv thaiv polyneuropathy, tab sis cov kev pheej hmoo rau nws txoj kev txhim kho tuaj yeem txo qis: tso dej cawv, kho cov kis mob thiab cov kab mob kis tau raws sijhawm, saib xyuas qhov zoo ntawm cov khoom siv, txwv kev sib cuag nrog tshuaj lom cov tshuaj lom.

Polyneuropathy yog ib hom mob uas cuam tshuam rau ntau qhov ntawm cov hlab ntsha hauv tib neeg lub cev. Tus kab mob muaj ntau yam ua rau. Qhov tseeb ua rau muaj qhov pib ntawm tus kab mob, feem ntau ua rau txoj hlab ntaws ua pa, thiab tsuas yog tom qab ntawd ua rau cuam tshuam ntawm lawv txoj haujlwm. Cov yam ntxwv ntawm tus kab mob yog cov leeg tsis muaj zog thiab mob hauv thaj tsam cuam tshuam ntawm lub cev.

Tus kab mob yog pom los ntawm kev tuag tes tuag taw, qhov cuam tshuam tsis haum rau kev kov kov, ntau yam kev tsis sib haum xeeb hauv kev ua haujlwm ntawm lub siab thiab qis ntawm tib neeg lub cev. Cov cim ntawm tus kabmob thiab qhov siv ntawm lawv qhov tshwm sim nyob ntawm daim foos thiab hom ntawm tus kabmob. Polyneuropathy feem ntau ua rau ntau qhov kev txom nyem rau cov neeg mob, kev kho mob yog qhov ntev. Cov chav kawm ntawm tus kab mob yog kev loj hlob thiab cov txheej txheem tuaj yeem tau chronized. Feem ntau, tus kab mob no tshwm sim hauv qhov qis ntawm lub cev.

Polyneuropathy tuaj yeem tshwm sim nyob rau hauv daim ntawv qeeb, thiab tseem muaj kev tsim hluav taws xob-ceev ceev.

Qhov ua rau mob polyneuropathy muaj ntau yam. Qhov tseem ceeb suav nrog:

lom nrog dej cawv, roj, arsenic (lom tshuaj lom),
cov kab mob mus ntev (,),
systemic pathologies ntawm lub cev,
lub caij nyoog siv qee pawg ntawm cov kws tshuaj,
quav cawv
Kev tiv thaiv kev ua txhaum
yam muaj keeb muaj caj
teeb meem ntawm metabolic

Pathology tej zaum yuav yog qhov:

mob. Hauv qhov no, muaj qhov mob hnyav ntawm cov hlab ntaws,
lom. Nws muaj kev vam meej vim kev haus cov tshuaj lom ntau,
ua xua
kev poob plig.

Tam sim no, hom feem ntau yog hom mob ntshav qab zib polyneuropathy. Nws yog tsim nyog sau cia tias polyneuropathy yog txoj kev mob nyav heev, uas yuav tsum muaj kev kho mob raws sij hawm thiab kev kho mob txaus. Yog tias nws tsis muaj nyob, tom qab ntawd qhov tshwm sim ntawm tus kabmob tuaj yeem ua rau mob leeg nqaij thiab nqaij. Qhov phom sij txaus ntshai tshaj plaws yog tuag tes tuag taw ntawm txhais ceg lossis caj npab, thiab tom qab ua pa nqaij leeg.

Ntau yam

Los ntawm kev siv tshuab ntawm kev puas tsuaj, tus kabmob raug faib ua hom:

demyelinating polyneuropathy. Kev txhim kho ntawm tus kabmob yog cuam tshuam nrog kev tawg ntawm cov protein nyob hauv lub cev, uas ua rau cov hlab ntsha hauv lub luag haujlwm thiab yog lub luag haujlwm rau qhov kev kub ceev ntawm conduction ntawm pulses los ntawm lawv,
axonal. Hom no yog cuam tshuam nrog kev ua txhaum nyob rau hauv kev ua haujlwm ntawm lub paj hlau. Hom no yog nrog los ntawm kev kho mob hnyav thiab rov qab ntev,
neuropathic. Nrog nws, kev puas tsuaj rau lub cev ntawm cov hlab hlwb ncaj qha yog pom,
mob caj dab thiab mob ntshav qab zib polyneuropathy,
polyneuropathy ntawm qhov qis qis,
cawv polyneuropathy.

Raws li lub primacy ntawm hlab ntsha puas, polyneuropathy yog:

rhiab. Nws ua tau nws tus kheej hauv daim ntawv ntawm loog lossis mob,
lub cev muaj zog. Lub cev muaj zog yog cuam tshuam, uas nrog nws cov lus tsis muaj zog hauv cov leeg,
piav thoob hlo-tsav. Cov yam ntxwv ntawm lub qhov txhab yog qhov txo qis ntawm qhov rhiab heev thiab kev ua lub cev ntawm cov leeg,
nroj tsuag. Muaj kev ua txhaum nyob hauv kev ua haujlwm ntawm cov khoom nruab nrog sab hauv vim yog o ntawm cov hlab ntshav hlab ntsha,
sib xyaw. Nrog rau txhua qhov nta ntawm cov hom saum toj no,
polyneuropathy ntawm qis qis dua.

Nyob ntawm qhov ua kom muaj kev txhim kho, polyneuropathy tuaj yeem yog:

idiopathic. Qhov tshwm sim tau cuam tshuam nrog kev cuam tshuam hauv lub cev tsis muaj zog,
roj ntsha. Dhau ib tiam mus rau lwm tiam,
dysmetabolic. Kev nce qib vim qhov teeb meem ntawm cov khoom noj hauv lub cev,
lom polyneuropathy tsim tawm los ntawm cov khoom lom nkag mus rau hauv lub cev,
postinfectious. Nws tshwm sim nrog cov txheej txheem sib kis hauv lub cev,
paraneoplastic. Kev loj hlob mus nrog cov mob oncological,
nrog cov kabmob ntawm lub cev, txhim kho ua ib feem ntawm tus kabmob,
cawv polyneuropathy.

Ntawm qhov kev kawm:

ntsim ntsim. Lub sijhawm loj hlob yog los ntawm ob txog plaub hnub. Cov kev kho mob kav ob peb lub lis piam,
subacute. Tsim nyob rau hauv ob peb lub lis piam, kev kho mob siv sijhawm ntau lub hlis,
mob ntev Nws nce zuj zus txij li rau lub hlis lossis tshaj saud, muaj lub sijhawm kho mob rau txhua tus neeg.

Tsis hais hom mob twg uas ib tus neeg muaj, txawm nws yog dej cawv lossis ntshav qab zib, mob caj ces lossis mob polyneuropathy lossis mob ua paug, cov tsos mob feem ntau muaj cov tsos mob zoo ib yam.

Ntau yam ua rau tus kabmob kis, feem ntau cuam tshuam rau cov hlab ntsha, thiab tom qab ntawd ua rau cuam tshuam ntawm lawv txoj haujlwm. Cov tsos mob tseem ceeb ntawm tus kabmob yog:

tsis muaj zog hauv cov leeg ntawm caj npab thiab ceg,
ua pa tsis ua hauj lwm
txo nyob rau hauv reflexes thiab rhiab, mus txog rau lawv ua tiav qhaj ntawv,
lub caij nyoog txaus ntawm "goosebumps" thoob plaws daim tawv nqaij,
nce hws
tshee hnyo lossis cramps,
o ntawm caj npab thiab txhais ceg,
lub plawv dhia
tshee gait thiab kiv taub hau,
cem quav.

Kev Tiv Thaiv

Kev tiv thaiv kev ntsuas ntawm polyneuropathy yog tsom kom tshem tawm cov laj thawj uas cuam tshuam rau cov hlab ntsha cov leeg. Cov hau kev tiv thaiv:

ua tsis tiav cov dej cawv,
yog tias kev ua haujlwm nrog tshuaj, nqa tawm nws tsuas yog hauv cov khaub ncaws tiv thaiv,
saib xyuas cov zaub mov zoo noj,
tsis txhob noj tshuaj yam tsis muaj kws kho mob sau,
kho cov kab mob ntawm txhua qhov thiab tsis yooj yim,
suav cov vitamins hauv koj cov zaub mov noj,
ua kev tawm dag zog lub cev
lossi soj ntsuam koj cov ntshav qab zib
tsis tu ncua mus rau qhov kho cov mob kho qhov mob.

Puas yog txhua yam muaj tseeb hauv kab lus los ntawm kev kho mob taw tes?

Tsuas yog teb yog tias koj tau muaj kev paub txog kev khomob.

Cov kab mob nrog cov tsos mob zoo sib xws:

Guillain-Barré syndrome yog ib pawg ntawm cov kab mob autoimmune uas yog tus cwj pwm los ntawm kev mob ceev ceev. Lub sijhawm ntawm kev loj hlob sai yog kwv yees li ib hlis. Hauv cov tshuaj, qhov kev puas tsuaj no muaj ntau lub npe - Landry tuag tes tuag taw los yog mob hnyav idiopathic polyneuritis. Cov tsos mob tseem ceeb yog cov leeg tsis muaj zog thiab lub cev tsis rov qab los uas tshwm sim tawm tsam ntawm keeb kwm yav dhau los ua rau kev puas tsuaj rau cov leeg ntshav (vim los ntawm cov txheej txheem autoimmune). Qhov no txhais tau hais tias tib neeg lub cev lees txais nws tus kheej cov ntaub so ntswg li txawv teb chaws, thiab lub cev tiv thaiv kab mob ua rau cov tshuaj tiv thaiv tawm tsam cov hlab ntsha cuam tshuam.

Distal polyneuropathy ntawm qis qis dua Nws ua ke ntau yam kabmob uas tshwm sim rau ntau yam, nyob rau hauv uas ib txwm ua haujlwm ntawm cov ntu hluav taws xob tsis zoo.

Feem ntau, kab mob pathology cuam tshuam rau cov nqua, kev ua haujlwm tsis zoo rau cov nqaij ntshiv, cov ntshav kev, txo qhov mob rhiab. Qhov tshwm sim ntawm polyneuropathy yog qhov txaus ntshai vim tias lawv tuaj yeem ua rau qee qhov lossis tag nrho ntawm qhov rhiab ntawm caj npab thiab txhais ceg lossis ua tiav immobilization ntawm cov tawg.

Tus kab mob no nthuav dav rau ntau yam, muaj ntau yam cuam tshuam rau tib neeg lub siab tuaj yeem ua rau mob polyneuropathy. Txij li thaum ua tiav ntawm lub cev yog txiav txim siab los ntawm qhov zoo ntawm kev sib kis ntawm txoj kev xa mus los ntawm cov hlab ntsha mus rau lub hlwb, nrog cov tsos ntawm xws li pathology, kev tsis zoo ntawm lub cev muaj zog thiab qhov rhiab ntawm cov ceg tawv tshwm sim.

Polyneuropathy ntawm qis qis dua thiaj li kuaj tau ntau dua, txij li qhov kev xav tau zoo tso rau ntawm txhais ceg hauv qhov sib piv nrog cov ntu sab saud. Pathology feem ntau cuam tshuam rau cov leeg me me, vim tias lawv muaj myelin tsawg heev, thiab cov teeb meem kab mob tsis zoo tsis tas yuav nkag mus rau cov hlab ntsha. Yog li, polyneuropathy ntawm txhais tes thiab taw, puas rau ntawm tes thiab taw feem ntau tshwm sim.

Feem ntau thaum lub sij hawm kuaj mob, cov kws kho mob qhia qhov tseeb txhais ntawm tus kab mob, vim muaj ntau yam ntawm pathologies. Muaj ntau hom polyneuropathy uas sib txawv ntawm qhov chaw, thaj tsam ntawm thaj chaw puas, thiab qhov teeb meem cuam tshuam.

Lub cev muaj zog tsis sib haum xeeb tshwm sim thaum lub xeev cov leeg mob siab dua, lawv txoj haujlwm tsis ua haujlwm, ua haujlwm tsis muaj zog, pov hwm lub xeev, tawv nqaij, thiab tsis tuaj yeem tshwm sim. Cov paib kis tau los ntawm thoob plaws qis dua, ua rau cuam tshuam tsis zoo hauv kev ua kom lub cev muaj zog:

Nroj Tsuag Cov. Ua rau kev puas tsuaj rau cov hlab ntsha xov xwm, ua rau muaj mob ntawm cov nruab nrog cev. Kev tawm hws, cuam tshuam ntawm lub plab ua haujlwm, cem quav, dryness yog aggravated.
Hnov polyneuropathy , txo qhov mob rhiab, tingling, hlawv, loog, muaj qhov zoo ntawm goosebumps, tingling, mob me nrog kev sib chwv tsawg heev.
Sensorimotor polyneuropathy Cov. Ua ke cov cim ntawm kev puas tsuaj rau cov qhov hnov ntawm lub cev thiab lub cev.
Ua ke. Tso cai rau koj siv txhua yam kev tsis zoo.

Hauv nws daim ntawv dawb huv, cov ntawv zoo li no tsis tshua muaj tshwm sim, feem ntau hnov tsis tshua pom-ntau thiab lwm hom kev sib xyaw ua ke.

Symptomatology

Thaum pom cov kab mob, txoj haujlwm ntawm lub cev muaj zog thiab cov pob hluav taws xob tsis zoo. Hauv qhov no, muaj cov cim ntawm polyneuropathy ntawm ob txhais ceg:

Looj ceeb.
Puffiness.
Mob
Ntxim.
Ua rau tsis muaj zog ntawm cov leeg nqaij.
Tsawg rhiab heev.

Kev kho nta

Kev kho rau polyneuropathy ntawm qhov qis qis hauv qhov sib txawv ntawm nws cov yam ntxwv, piv txwv li, daim ntawv qhia txog ntshav qab zib tsis tau muab tshem tawm los ntawm kev tsis lees paub txog dej cawv. Xws li cov pathologies tsis tsim kho lawv tus kheej. Ntawm thawj cov tsos mob tshwm sim, kev txiav txim siab ntawm qhov ua kom muaj kev cuam tshuam yog qhov yuav tsum tau ua.

Tom qab ntawd, nws thiaj li muaj peev xwm txiav txim siab txog qhov sib cuam tshuam.Txoj kev kho mob polyneuropathy yuav tsum muaj kev qhia dav dav thiab tsom mus rau tshem tawm lub hauv paus ntawm lub pathology no. Yog li, lwm txoj kev xaiv yuav tsis tsim cov txiaj ntsig yam xav tau.

Ua ntej txoj kev kho, qhov kev kuaj mob raug ua rau hauv cov kab mob pathology tau kuaj pom thiab nws cov laj thawj tau txiav txim siab kom thiaj li tshem tawm txoj kev loj hlob ntawm cov kab mob uas pom los ntawm cov tsos mob zoo sib xws.

Methylprednisolone yog siv rau txoj kev tsim kho nyuaj ntawm pathology.
Tramadol yog siv rau qhov mob tsis taus.
Flowerpot txhawb cov ntshav hauv thaj chaw puas.
Vitamin B.
Cov tshuaj uas pab ua kom saturate hlwb nrog micronutrients.

Zaws
Raug rau cov teb chaw sib nqus.
Kev kho kab mob hauv lub nruab nrog.
Kev saib xyuas sab hauv cov plab hnyuv siab raum.

Thaum pom cov co toxins hauv lub cev, koj yuav tsum ntxuav cov ntshav. Cov kws kho mob feem ntau hais txog ntau qhov kev tawm dag zog tawm dag zog.

Tshuaj Kho Mob

Cov tshuaj yog kws kho mob coj mus rau hauv tus account ntau yam ntawm pathology thiab theem ntawm kev txhim kho polyneuropathy thiab nws cov tsos mob:

Vitamin complexes. Qhov Xaiv yog muab rau cov vitamins ntawm pab pawg Ua ke nrog lwm cov minerals. Cov kev kho mob Vitamin khov kho lub peev xwm ntawm cov hlab ntsha los kho lawv cov txheej txheem yam ntxwv, txhawb kev tiv thaiv antioxidant.
Pob Taum Pleev. Txhawm rau tshem tawm qhov mob, analgesics lossis non-steroidal anti-inflammatory tshuaj yog kws kho. Tsawg tsawg zaus, cov neeg mob raug xaj morphine lossis codeine.
Kev siv tshuaj tua kabmob thiab siv tshuaj tiv thaiv kab mob. Cov txheej txheem ntawm kev kho mob yog txiav txim los ntawm tus kws tshaj lij, suav txog qhov nce thiab txo qis hauv kev noj tshuaj. Kev kho tshuaj hormones yog ntxiv nrog immunoglobulins. Cov txheej txheem zoo li no tau ua nyob hauv tsev kho mob.
Cov tshuaj uas pab txhawb kev ntshav hauv cov hlab ntaws.
Cov tshuaj uas pab xa cov txiaj ntsig zoo rau cov ntaub so ntswg.

Thaum tshem tawm cov mob polyneuropathy, koj yuav tsum nkag siab tias kev tshem tawm cov kab mob pathology nrog kev pab ntawm cov tshuaj yuav tsis ua haujlwm. Kev noj haus yog qhov tseem ceeb, kev kho kom rov zoo thiab saib xyuas cov neeg mob los ntawm lwm tus neeg kuj txhais tau ntau.

Muaj teeb meem tshwm sim

Nws yog qhov tsis tsim nyog pib kis kab mob thiab ua rau muaj teeb meem. Txwv tsis pub, ib daim ntawv ua mob ntev thiab ntau qhov nyuaj yuav tsim. Yog hais tias ib tug neeg tsis tuaj yeem kho tus mob rov qab los ntawm tus kab mob no, nws ob txhais ceg yuav laim tag nrho. Yog li ntawd, tus neeg mob yuav tsis tuaj yeem txav mus los txhua zaus.

Yog tias txoj kev kho mob tau pib raws sijhawm, kev soj ntsuam ntawm tus kabmob no yuav pom tau qhov zoo. Tsuas yog muaj daim ntawv ntev dua tuaj yeem muaj teeb meem. Nws yuav ua haujlwm tsis tiav, tab sis muaj cov hau kev los txo qhov hnyav ntawm nws txoj kev loj hlob.

Hnov polyneuropathy yog ib qho mob uas yog cov tsos mob tshwm sim los ntawm qhov yeej ntawm neurons uas yog lub luag haujlwm rau lub cev muaj zog, vim tias cov haujlwm ntawm lub cev muaj zog tuaj yeem ua rau muaj kev cuam tshuam loj. Tus kab mob txaus ntshai no muaj ntau rau cov neeg mob ntshav qab zib. Ib yam li lwm yam polyneuropathies, ib qho kev txiav txim siab hauv kev xaiv ntawm kev kho thiab nws cov txiaj ntsig tom ntej yog kev kuaj pom lub sijhawm.

Hnov mob polyneuropathy tuaj yeem tshwm sim vim muaj ntau yam, suav nrog kev sib txuas nrog cov txheej txheem phom sij, ua rau lub cev qaug cawv, kab mob sib kis thiab kab mob kis, thaum kis mob hnyav tshaj plaws yog thaum tus kab mob no tau txais los yog tau los vim muaj qhov tshwj xeeb ntawm kev tshuaj ntsuam.

Cov tsos mob tseem ceeb ntawm qhov phom sij ua pa hluav taws xob yog qhov tsis hnov, qhov mob tsis hnov tsw, txhawm rau thiab khaus, qhov hnov ntawm lub suab nrov nyob hauv nqua, thiab tus neeg mob pib paub txog qhov kub thiab txias, thiab qhov kub qis dua tuaj. Nrog rau qhov mob siab polyneuropathy, cov tsos mob tsis zoo ntawm lub siab ntxhov siab, zoo nkaus li "hnab looj tes" thiab "thom khwm", thiab ua txhaum ntawm qhov rhiab ntawm lub plab qis dua kuj tseem muaj peev xwm ua tau.

Nyob ntawm seb hom neurons puas zoo li cas, peb lub ntsiab lus tseem ceeb ntawm kev hnov mob polyneuropathy tuaj yeem sib txawv: hyperalgesic daim ntawv, atactic daim ntawv thiab daim foos sib xyaw. Nrog rau daim ntawv atactic ntawm tus kabmob, cov tsos mob xws li kev sib koom tes ntawm kev txav mus los, kev sib daj sib deev, loog, tsis khov (tshwj xeeb nrog kaw lub qhov muag) yog sau tseg. Nqaij ua kom lub zog feem ntau tsis hloov, txawm li cas los xij, thaum kuaj xyuas los ntawm kws kho mob thiab tshawb xyuas lub zog muaj feem nrog poob ntawm qhov tob tob tob, nws tuaj yeem txo qis.

Daim ntawv hyperalgesic cuam tshuam rau cov tsos mob xws li mob suab tsis haum, mob (feem ntau hlawv lossis tua), txo qhov mob rhiab, tsis hnov mob kub. Cov ntawv sib xyaw ua ke uas hnov mob polyneuropathy muaj xws li cov tsos mob ntawm cov ntawv hais los ntawm tus kab mob.

Nrog kev hnov mob polyneuropathy, cov tsos mob tseem ceeb feem ntau asymmetric, tshwj xeeb tshaj yog thaum pib ntawm tus mob. Yog li, piv txwv li, tus kab mob no tuaj yeem pib ntawm ib txhais ceg, thaum thib ob yuav noj qab haus huv tag nrho lub sijhawm ntev, txawm li cas los xij, thaum tus kab mob loj tuaj, cov tsos mob tshwm sim ntau dua qub. Feem ntau thaum pib ntawm tus kabmob, tsis tsuas yog txhais ceg raug cuam tshuam, tab sis kuj rau nqua sab sauv, thiab qee zaum txawm tias pob tw thiab ntsej muag. Cov tsos mob tuaj yeem tshwm sim hauv ob peb hnub, thiab 1 - 2 hlis.

Tau mus txog ib qho taw tes, yog li yuav hais lus, ntawm qhov siab tshaj plaws, ntau tus tsos mob feem ntau nyob ruaj khov rau ib lub sijhawm ntev. Nws feem ntau tshwm sim tias cov tsos mob poob qis, tab sis ntau zaus, tshwj xeeb tshaj yog nrog cov kab mob monophasic ntawm tus kab mob, lawv nyob twj ywm rau tib theem, uas feem ntau yog siab heev, lossis txuas ntxiv nce ntxiv. Tsis zoo li Guillain-Barré syndrome, hnov mob polyneuropathy yog qhov txawv txav ntawm kev ua haujlwm.

Kev hnov mob rau lub cev tuaj yeem yog los ntawm mob ntsws me mus txog qhov tshuaj loog tob tshaj plaws nrog mob caj pas thiab mob txhab. Nrog rau tus kab mob no, poj niam caj dab thiab tshwm sim tsis hnov mob feem ntau pom. Nyob rau lub sijhawm tam sim no, cov lus piav qhia tag nrho rau cov kabmob tshwj xeeb no, uas sib txuas ua ke qhov tsis muaj qhov rhiab heev ntawm kev hnov mob thiab mob hnyav heev, tseem tsis tau pom.

Kev kuaj mob ntawm qhov paub txog tus mob polyneuropathy yuav tsum muaj qhov ua paug nrog kev ceev faj txog lwm yam kab mob, cov khoom noj muaj txiaj ntsig, cov npe tshuaj uas tus neeg mob tau siv, cov lus piav qhia txog kev muaj mob, kev kis mob yav dhau los uas tuaj yeem cuam tshuam kev txhim kho polyneuropathy, kev txheeb xyuas ntawm tus neeg mob lub chaw ua haujlwm, thiab qhov tseeb ntawm kev sib cuag nrog tshuaj lom , ENMG cov txiaj ntsig, nrog rau cov kev sib tw tshwj xeeb rau ntawm daim tawv nqaij ua kom sib deev, thiab lwm yam.

Txog rau hnub, txoj kev kho mob ntawm cov paub tab polyneuropathy yog kev tsim txom. Hauv kev kho, corticosteroids, cytostatics, plasmapheresis thiab immunoglobulin feem ntau siv, txawm li cas los xij, ntau zaus, kev sim ua tsis tiav. Tawm tsam keeb kwm ntawm kev siv tshuaj tiv thaiv kab mob, ib nrab regression ntawm cov tsos mob thiab kev nyob ruaj khov ntawm tus mob tau pom, tab sis vim li cas rau cov txiaj ntsig no tsis tau to taub tag nrho, txawm li cas los xij, nyob rau qee kis, kev kho kom raws sijhawm ua lub luag haujlwm tseem ceeb.

Raws li txhua yam ntawm polyneuropathies, kev kuaj mob raws sijhawm thiab pib kho yuav pab, yog tias tsis rov ua haujlwm, tom qab ntawd tswj tus neeg mob tus mob. Tus neeg muaj mob polyneuropathy, yog tias tus kab mob tsis pom thaum ntxov, tom qab ntawd, tom qab ib qho tseem ceeb ntawm cov neurons tau tuag, nws tsis tuaj yeem nqa tawm cov kev rov qab tseem ceeb, txawm li cas los xij, ib qho tuaj yeem cia siab nres qhov kev vam meej ntawm tus kab mob thiab tswj tus neeg mob lub zog.

Cov kab mob ntawm cov hlab ntsha tsom mus rau cov tsos mob neurological.Ib tug neeg yuav muaj kev mob cog lus (sib tsub sib txuam), co tes, lub paresis (ua kom tsis muaj zog) thiab tuag tes tuag taw ntawm cov leeg nqaij, poob qis lossis sib zog, nrog rau cov cim ntawm daim tawv nqaij. Qhov kawg taw tes suav nrog qhov kev hnov ntawm khiav goosebumps, loog thiab tingling ntawm qee qhov ntawm lub cev.

Cov tsos mob tau tshwm sim feem ntau nyob rau ntawm qhov chaw nyob sab hauv ntawm qhov hlab ntsha cuam tshuam, piv txwv li, thaum ceg ntsej muag raug puas ntsoog, tag nrho lub ntsej muag raug kev txom nyem. Qee zaum cov laj thawj tau muab zais rau hauv cov txheej txheem pathological uas tau tshwm sim hauv tus txha caj qaum thiab lub hlwb. Nyias, nws yog qhov yuav tsum tau hais txog cov kab mob xws li polyneuropathy (polyneuropathy). Nws sawv cev rau kev puas tsuaj rau ntau txoj hlab ntshav hauv ib zaug, feem ntau los ntawm lwm yam sab nraud. Lwm qhov laj thawj, xws li kis mob lossis ntshav qab zib, uas yog qhov tseem ceeb kom paub ua ntej kev kho mob, tuaj yeem ua ntej ua haujlwm no.

Nrog rau ntau txoj hlab ntaws, cov kws kho mob feem ntau kuaj mob polyneuropathy, tab sis qee tus neeg paub tias nws yog dab tsi. Lub qhov txhab muaj nyob hauv thaj chaw nruab nrab ntawm lub hauv nruab nrab cov hlab ntsha thiab feem ntau sab nraud, uas ntev heev cuam tshuam lawv cov haujlwm, ua ntej cov txheej txheem no.

Cov tshuaj lom neeg mob hlwb yog qhov tseem ceeb ntawm ntau qhov txhab. Rau nws, qhov tau ua dhau los kuj yuav yog cov kab mob uas lom rau tib neeg. Ntawm lawv, kev cuam tshuam ntawm endocrine, piv txwv li, ntshav qab zib mellitus, tuaj yeem sib txawv. Distal polyneuropathy yog cov yam ntxwv ntawm tus kab mob no thiab nws tshwm sim ntau dua ib nrab ntawm cov mob. Xws li tus txheej txheem tshwm vim yog lub sijhawm ntev raug rau cov ntshav qab zib ntau. Hauv cov tshuaj, hom pathology no hu ua dysmetabolic polyneuropathy vim muaj cov yam ntxwv tsis zoo hauv cov metabolism.

Kev mob hlwb neuropathy tuaj yeem tshwm sim tsis tsuas yog vim tias cov ntshav qab zib ntau ntau, tab sis kuj yog vim muaj lwm cov tshuaj uas rhuav tshem cov hlab ntsha.

Piv txwv li, ib qho tshuaj yeeb yuav tsis tuaj yeem sab hauv lub cev, tab sis tas li nkag mus nws los ntawm sab nraud. Yeej, cawv yog cov taug thiab hom mob no hu ua cawv cawv polyneuropathy ntawm qhov qis qis. Raws li tus kab mob pathology loj hlob tuaj, tus neeg mob txhais tes tau maj mam hloov. Tus kabmob tseem yog ib feem ntawm pawg neeg ntawm dysmetabolic tsis ua haujlwm thiab npog feem ntau ntawm kev hnov mob lub cev.

Malignant oncological kab mob tsis yog qhov tsis tshua muaj nyob hauv neuropathy. Lawv lom tshuaj rau tag nrho lub cev thiab tshem ntawm lawv yog qhov nyuaj heev, yog li kev kwv yees rau kev rov qab los feem ntau yog qhov tsis zoo. Neoplasms yog nyob nrog hom paraneoplastic ntawm tus kab mob.

Hauv qee qhov tsawg, muaj kev kis mob, xws li kabmob qog ntshav bacillus, ua rau tus kabmob loj tuaj. Nws cov khoom pov tseg tsim kev puas tsuaj rau cov hlab ntsha thiab pib maj mam poob. Tus kab mob ntawm daim ntawv no belongs rau kis thiab muaj tshuaj lom tib lub sijhawm.

Polyneuropathy ua rau tsis yog tas li ua rau muaj kev phiv tshuaj lom rau ntau yam. Tus kab mob qee zaum tshwm sim vim kev tiv thaiv kab mob hauv lub cev, hauv cov tshuaj tiv thaiv tua cov myelin sheath ntawm cov hlab ntsha hlwb. Hom kab mob no hu ua demyelinating thiab belongs rau cov pab pawg ntawm autoimmune pathological cov txheej txheem. Feem ntau hom mob neuropathy muaj qhov caj ces ntawm kev txhim kho, thiab cov kab mob muaj hnub nyoog motosensory pathology manifests nws tus kheej hauv daim ntawv ntawm kev puas tsuaj rau lub cev muaj zog.

Cov hom mob ailment

Polyneuropathy ntawm sab sauv thiab qis dua yog ua kom pom tseeb hauv cov qauv ntawm cov tsos mob neurological thiab qhov sib txawv ntawm nws qhov tshwm sim nyob ntawm daim ntawv ntawm tus kab mob thiab hom kev puas tsuaj.

Los ntawm hom kev puas tsuaj rau cov hlab ntsha xov, lub pathology yog ntawm cov nram qab no:

Demyelinating polyneuropathy (mob axonically demyelinating). Cov txheej txheem pathological no yog kev rhuav tshem ntawm myelin sheath ntawm cov txheej txheem (axons) los ntawm neurons,
Axonal polyneuropathy. Nws tshwm sim vim malfunctions nyob rau hauv axons,
Neuropathic polyneuropathy. Xws li tus kab mob pathology tshwm vim yog kev puas tsuaj rau lub cev ntawm lub hlwb ntawm cev (paj hlwb).

Pathology muaj peev xwm raug faib ua qee yam kev kis, uas yog:

Hnov polyneuropathy. Nws cov tsos mob suav nrog kev ua txhaum ntawm kev nkag siab ntawm qhov kawg ntawm lub paj hlwb, piv txwv li, qhov kev xav ntawm qhov mob, hlawv thiab loog,
Lub cev muaj zog polyneuropathy. Kev cai ua kom puas rau ib leeg. Qhov no tshwm sim hauv cov qauv ntawm qhov tsis muaj zog, atrophy, tuag tes tuag taw, thiab lwm yam.
Sensomotor polyneuropathy. Nyob rau hom kev puas tsuaj no, qhov piav tau zoo thiab lub cev muaj zog yog cov sib txuam,
Autonomic polyneuropathy. Ua tsis tiav qhov teeb meem no tshwm sim hauv lub hlwb tsis muaj zog, uas yog lub luag haujlwm rau kev ua haujlwm ntawm cov nruab nrog sab hauv. Cov paj ntoo no tseem yog lub luag haujlwm rau lwm cov kab ke uas ib tug neeg tsis tuaj yeem tswj tau, xws li, lub plawv dhia, salivation, hws, thiab lwm yam,
Mixed view. Nws suav nrog ntau cov cim ntawm kev ua txhaum tus cwj pwm ntawm txhua pab pawg.

Raws li qhov xwm txheej etiological, tus kabmob tau muab faib rau cov pawg hauv qab no:

Idiopathic form (polyneuropathy uas tsis paub keeb kwm). Nws tsis muaj lub laj thawj tshwj xeeb rau qhov no, tab sis lub ntsiab version ntawm txoj kev loj hlob tau suav tias yog kev ua kom tsis muaj zog,
Txais daim ntawv. Cov kab mob no kis tau los ntawm niam txiv,
Daim ntawv ntawm Dysmetabolic. Nws tshwm sim vim kev cuam tshuam hauv cov metabolism,
Daim foos lom. Kev txhim kho ntawm hom no yog vim muaj cov nyhuv ntawm co toxins rau ntawm lub cev,
Postinfectious daim ntawv no. Hom kab mob polyneuropathy zoo li no tshwm sim vim yog kis mob uas tau cuam tshuam rau lub cev feem ntau, xws li kev kis mob HIV lossis mob qas ntshav,
Paraneoplastic daim ntawv. Nws tshwm nyob rau tom qab ntawm kev mob qog noj ntshav ntawm lub siab phem,
Cov kab mob uas tag nrho. Hom polyneuropathy no yog ib feem ntawm lwm qhov txheej txheem pathological uas tau tshwm sim hauv cov nqaij sib txuas, piv txwv li, scleroderma (tsis ua hauj lwm hauv kev tsim cov collagen).

Polyneuropathy mas cuam tshuam ntau rau txhais ceg thiab caj npab ntawm ib tug neeg, ntau dua, qhov txhais taw thiab txhais tes. Qhov no tshwm sim vim qhov tseeb tias feem ntau cov leeg me me puas ntsoog, txij li co toxins feem ntau yooj yim rhuav tshem. Qee zaum cov tsos mob polyneuritic tshwm sim thiab tib cov tsos mob ntawm ntu sab sauv thiab sab saud yog cov yam ntxwv ntawm nws. Feem ntau, kev puas tsuaj tshwm sim zoo ib yam, vim yog cov co toxins kis tau los ntawm cov hlab ntshav.

Nrog rau polyneuropathy, cov tsos mob ntawm txoj hlab ntaws txav tau yog li hauv qab no:

Hnov qhov mob sib txawv ntawm qhov sib txawv ntawm ua qauv nrog lub keeb ntawm kev hlawv,
Tremor (tshee) nyob rau hauv qis dua thiab sab saud, manifested tsuas yog nyob rau hauv cov ntiv tes,
Kev tswj tsis tau zoo, uas yog cov leeg nqaj,
Hnov qhov tsis haum, uas suav nrog qhov tsis pom ntawm qhov kub thiab txias, qhov mob, thiab tseem kov (ua kom loog) tsis zoo. Ntawm cov ntshav qab zib, cov neeg mob yuav tsis txawm pom tias iav los yog peb lub pob zeb nkag mus rau hauv khau nrog polyneuropathy ntawm ko taw,
Paresis (tsis muaj zog) ntawm cov leeg, vim nws ua rau nws tus kheej nyuaj rau taug kev kev deb thiab ua txoj haujlwm txhua hnub. Cov tsos mob no feem ntau ua ke nrog cov leeg nqaij qes thiab tsis muaj zog hauv tus neeg mob, thiab feem ntau tshwm sim nrog polyneuropathy ntawm qhov qis qis.

Qhov txaus ntshai yog qhov pib ntawm tus kab mob thiab ntawm lawv cov tsos mob hauv qab no tuaj yeem paub qhov txawv:

Kub jumps
Ua haujlwm hnyav ntawm qog sebaceous,
Tawv nqaij daj
Kev voj voog tsis ua haujlwm
Arrhythmia ntawm lub plawv.

Nrog polyneuropathy ntawm qis qis, cov tsos mob feem ntau hais meej feem ntau yog li no:

Txo hauv cov neeg mob siab
Nqaij paresis
Txo Achilles reflexes,
Hloov pauv ntawm Trophic.

Polyneuropathy ntawm lub sab saud ua tau nws tus kheej hauv kev siv tib txoj kev, tab sis daim tawv xim yuav ua tsis taus thiab cov tshee tshee muaj zog dua. Txawm li cas los xij, tus kab mob no tsis tshwm sim ntau lub xyoo.Qee qhov xwm txheej, nws tshwm sim nws tus kheej tom qab 2-3 teev, piv txwv li, tom qab kis tau lossis raug lom ntau nrog cov tshuaj lom neeg.

Hauv qee qhov tsis tshua muaj tshwm sim, vim muaj qhov tseem ceeb vim tsis muaj cov vitamin B12 tshwm sim. Nws yog cov yam ntxwv ntawm kev puas tsuaj rau cov pos qaum ntawm tus txha caj qaum. Lawv muaj cov ceg ntawm cov leeg ua lub luag haujlwm rau kev pom ntawm cov pob qij txha thiab cov leeg. Xws li cov txheej txheem pathological nws muaj nws tus kheej, vim hais tias nrog ataxia ib tug neeg tsis tuaj yeem txav mus rau hauv qhov tsaus ntuj, vim nws tsis nkag siab qhov twg nws txhais ceg thiab caj npab nyob. Txawm li cas los xij, nrog lub teeb pom kev zoo, qhov teeb meem ploj mus ntawm nws tus kheej thiab tus neeg mob tsis xav tias muaj kev hloov pauv.

Nrog autonomic polyneuropathy, ib tus neeg tuaj yeem cia li tuag sai sai los ntawm lub plawv dhia, uas tshwm sim vim yog mob hnyav tsis xws luag lossis cuam tshuam dab tsi hauv kev ua pa ua pa. Daim ntawv ntawm pathology hais txog kev mob plawv ntawm polyneuropathy.

Tshuaj kho mob nkeeg

Kev kho mob polyneuropathy yog kom yauv tau txais kev kho mob ntev ntev. Nws lub sijhawm feem ntau nyob ntawm qhov kev puas tsuaj thiab lawv qhov ua rau, vim nws yog qhov yuav tsum tau rov qab ua txoj hlab ntsha hauv txoj hauv kev tshiab, thiab nws nyuaj heev kom ua qhov no. Tias yog vim li cas polyneuropathy yog hais txog cov organic qhov txhab ntawm cov hlab ntsha tsis zoo, thiab tsis yog rau qhov ua haujlwm zoo.

Ua ntej koj yuav tsum txiav txim siab ua kom muaj mob thiab tshem tawm nws. Koj tuaj yeem nkag siab yuav ua li cas kho mob polyneuropathy nrog piv txwv ntawm cov ntshav qab zib. Lawv yuav tsum kuaj xyuas lawv cov ntshav qab zib kom zoo dua kom nws ib txwm nyob li qub. Yog nws haus cawv, ces lawv yuav tsum txiav cawv rau nws. Txwv tsis pub, tshuaj yuav tsis pab rau thawj lossis pawg thib ob. Nrog oncological kab mob, ua ntej kev kho mob ntawm pathology, nws yog ib qhov tsim nyog los tshem tawm cov leeg ntshav uas tau tshwm sim hauv lub cev.

Nrog polyneuropathy, kev kho mob yog nqa tawm nrog kev pab ntawm cov tshuaj no:

Vitamin complexes, piv txwv li, Milgamma,
Berlition-yam tshuaj tua kab mob,
Cov tshuaj uas muaj cov nyhuv hauv lub cev kom paub xav ua kom cov microcirculation zoo li Trental,
Kev ua kom loog zoo li kev siv tshuaj pleev tshuaj pleev ib ce Versatis.

Kev siv tshuaj pleev thiab ntsiav tshuaj hauv kev kho mob polyneuropathy yog qhov pom zoo ua ke nrog kev noj zaub mov kom zoo. Koj yuav tsum ntxiv zaub thiab txiv hmab txiv ntoo ntau rau koj cov zaub mov thiab, yog tias ua tau, tsis kam yws, haus luam yeeb thiab zaub mov kaus poom. Nws raug nquahu los ua zaub mov noj lossis ncu nws.

Kev siv dag zog hauv lub cev tuaj yeem kho cov txheej txheem kho kom zoo thiab cov txheej txheem hauv qab no feem ntau siv:

Dibazole thiab thiamine-based electropharis,
Kev kho mob ntawv nyiaj (qhwv ob leeg),
Kho da dej
Kev Siv Tshuaj Tua Tsiaj

Ntawm qhov txiaj ntsig tshwj xeeb yog zaws rau polyneuropathy. Nws yuav tsum tau ua los ntawm cov kws tshaj lij muaj txiaj ntsig, yog li kom tsis txhob ntxiv qhov kev kawm ntawm tus kab mob.

Kev kho mob polyneuropathy ntawm qhov qis qis hauv feem ntau tsis yog siv tshuaj xwb, tab sis kuj yog siv hauv kev tawm dag zog. Nws tso cai rau koj los tswj cov leeg nqaij thiab txhim kho kev mob ntawm tus neeg mob. Kev tawm dag zog lub cev (LFK) yuav tsum yog kws kho nyob ntawm lub xeev ntawm tus neeg, vim hais tias feem ntau muaj ntau lub cev ntau dhau tsis pom zoo.

Feem ntau, kev xav rau polyneuropathy tsis yog kev nplij siab. Tus kab mob yog qhov nyuaj los kho thiab nyhav rau kev nce qib. Sij hawm dhau mus, tus neeg tuaj yeem ua rau tsis taus thiab txawm tias tas sim neej vim yog kev ua tsis zoo hauv lub siab. Qee hom mob tsis muaj kev kho txhua lub sijhawm, piv txwv, tshwm sim los ntawm autoimmune tsis ua haujlwm. Yog hais tias nws los txog kev haus cawv cawv lossis ntshav qab zib, qhov pom tau hais tias yog feem ntau muaj txiaj ntsig, tab sis tau muab rau tus neeg mob ib txwm noj cov suab thaj thiab tsis kam haus cawv.

Polyneuropathy yog qhov kev puas tsuaj rau cov hlab ntaws ntau heev thiab nws yuav tsum tau kho thaum thawj cov tsos mob tshwm sim, txwv tsis pub lub pathology yuav vam meej. Xws li kev nthuav dav ntawm cov xwm txheej feem ntau ua rau muaj kev tsis taus thiab kev tuag.

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			*Polyneuropathy, rau cov kab mob cais lwm qhov*
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Poob ko taw tsis hnov ​​mob

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Kev kho mob rau cov ntshav qab zib kom hnov ​​mob distal polyneuropathy

Ua tim khawv

Polyneuropathy. Kev faib tawm, ua rau, pom dav dav daim duab ntawm polyneuropathies.Dysmetabolic thiab paraneoplastic polyneuropathies. Polyneuropathies nrog cov tsis muaj cov vitamins. Guillain-Barré Syndrome

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Yuav kho li cas?

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