Kev kho mob ntawm daim ntawv mob mob ntshav qab zib polyneuropathy

Mob ntshav qab zib distal symmetric sensory-lub cev muaj zog polyneuropathy (DPN) yog cov muaj tus kabmob ntshav qab zib feem ntau, uas tau tshawb pom ntau dua 50% ntawm cov neeg mob uas muaj yam 1 thiab hom 2 mob ntshav qab zib mellitus. DPN yog qhov thib ob tshaj rau cov mob neuropathic (NI). Kev nthuav dav ntawm DPN sib txawv raws li kev kuaj mob siv. Zaus tus mob neuropathy kuaj raws li kev mob tshwm sim yog li 25%, thiab thaum ua qhov kev tshawb nrhiav electroneuromyographic, nws yog 100% hauv cov neeg mob ntshav qab zib.

Kev kuaj mob ntawm DPN yog ua raws li keeb kwm kev khaws cia, kev soj ntsuam cov leeg puas hlwb, tshuaj ntsuam electrophysiological. Cov tsos mob tshwm sim yog qhov hnov ntawm "qog caj dab", hlawv, mob rau ntawm ceg thiab taw, mob leeg hmo. Kev soj ntsuam neurological qhia txog kev ua kom tsis muaj zog ntawm Achilles reflexes, qhov tsis hnov qhov muag ntawm cov thom khwm "thom khwm" thiab "hnab looj tes", qhov txo qis ntawm qhov tseem ceeb ntawm qhov tsis hnov qab. Nrog rau kev kho mob tsis raws cai thiab kev kho mob tsis ua hauj lwm, muaj teeb meem ntawm DPN xws li mob ko taw, uas tuaj yeem ua rau tus mob necrosis, mob caj pas (mob ntshav taw) thiab ua rau txiav tes taw. Cov neeg mob ntshav qab zib yuav tsum muaj txoj kev soj ntsuam neurological thiab kuaj mob txhua xyoo ntawm ko taw.

Nws feem ntau pom tau tias qhov tseem ceeb ntawm kev txhim kho ntawm DPN yog qib nce ntawm cov piam thaj. Raws li, tsuas yog txoj kev kho mob pom zoo uas tuaj yeem ua rau qeeb qeeb thiab txawm tias qee qhov thim rov qab hloov zuj zus ntawm DPN yog qhov kev tswj hwm zoo ntawm glycemia hauv cov neeg mob ntshav qab zib insulin-tiv thaiv. Hauv cov neeg mob uas mob ntshav qab zib ntau npaum li cas (3 los yog ntau dua qhov kev txhaj tshuaj insulin ib hnub lossis txuas ntxiv subcutaneous insulin infusion siv insulin dispenser (qib HbA)_1c nyob rau hauv thaj tsam ntawm 6.5-7.5)), qhov tseem ceeb txo qis hauv kev pheej hmoo ntawm kev tsim mob microvascular thiab cov mob neuropathy tau pom. Kev kho mob hnyav nrog sulfonylureas hauv cov neeg mob uas tsis yog yam tshuaj insulin-ntshav qab zib kuj ua rau txo qis thiab nce ntawm neuropathy. Txawm li cas los xij, tsuas yog kev ua tiav ntawm normoglycemia tsis muaj peev xwm tshem tawm qhov chaw kho mob ntawm DPN sai sai. Hauv qhov no, ntxiv cov kab mob pathogenetic thiab tsos mob yuav tsum kho, tshwj xeeb tshaj yog rau kev daws qhov mob.

Alpha-lipoic (thioctic) acid (Espa-lipon, Thioctacid, Thiogamma, Tiolept) belongs rau cov kab mob kev npaj tos. Cov tshuaj no yog cov txheej txheem kub rau kev kho mob ntawm DPN. Alpha Lipoic Acid yog ib qho muaj zog antioxidant lipophilic. Thioctic acid, uas nyob hauv cov hlab ntsha hauv cov hlab ntsha, txo cov ntsiab lus ntawm cov dawb radicals, nce endoneural ntshav txaus, normalizes cov ntsiab lus ntawm TSIS, cov neeg tswj hwm ntawm kev so ntawm lub vascular phab ntsa (yog tias muaj ntau ntawm nws, zoo li hauv ntshav qab zib, nws pib ua haujlwm zoo li dawb radical), txhim kho endothelial muaj nuj nqi, txo cov theem ntawm cov roj cholesterol, nce qib ntawm antiatherogenic feem ntawm lub siab ceev lipoproteins. Ntau cov kev tshawb fawb tau pom tias kev siv alpha-lipoic acid ntawm kev noj tshuaj ntawm 600 mg / hnub iv lossis qhov ncauj rau peb lub lis piam mus rau rau lub hlis txo cov tsos mob tseem ceeb ntawm DPN nyob rau hauv cov chaw kho mob tseem ceeb, suav nrog kev mob, mob caj dab thiab loog 7, 8. Zoo tshaj plaws nws yog suav tias yog kev teem sijhawm thaum pib ntawm kev kho mob tawm dej txau ntawm alpha-lipoic acid (600 mg rau 200 ml ntawm dej qab ntsev) rau 3 lub lis piam (15 poob), tom qab ntawd 600 mg ntawm cov tshuaj hauv daim ntawv ntawm cov ntsiav tshuaj (ib zaug ib hnub 30-40 feeb ua ntej noj mov ) hauv 1-2 lub hlis.

Kev npaj uas txhim kho cov metabolism hauv cov teeb meem kev puas siab puas ntsws suav nrog B vitamins, vim yog lawv cov khoom neurotropic. Vitamin B₁ koom rau hauv cov tshuaj hluavtaws ntawm acetylcholine, thiab B₆ - hauv qhov kev sib txuas ntawm cov neurotransmitters, kis tau ntawm kev zam. Vitamin B₁₂ txhim kho cov hlab ntshav trophic peripheral. Qhov ua tau zoo ntawm cov tshuaj Milgamma dragee hauv kev kho mob nyuaj ntawm DPN tau pom. Nws muaj 100 mg ntawm benfotiamine thiab 100 mg ntawm pyridoxine. Cov tshuaj raug xaj ib ntsiav tshuaj 2-3 zaug hauv ib hnub rau 3-5 lub lis piam. Nws yog ib qho tseem ceeb tias Milgamma muaj benfotiamine, lipid solubility ntawm uas yog qhov laj thawj kom ua tiav lub siab ntawm thiamine hauv cov ntshav thiab cov ntaub so ntswg.

Cov ntaub ntawv hais txog qhov ua tau zoo thiab muaj kev nyab xeeb profile tso cai rau peb xav txog alpha-lipoic acid thiab benfotiamine ua thawj cov tshuaj rau kab mob kev kho mob rau kev kho mob ntshav qab zib polyneuropathy.

Hauv ob lub multicenter, cov kev tshawb fawb tshuaj placebo ntawm 1335 tus neeg mob nrog DPN, nws tau pom tias noj acetyl-L-carnitine ntawm koob tshuaj 1000 mg 3 zaug hauv ib hnub rau 6 thiab 12 lub hlis txo cov tsos mob ntawm DPN.

Cov kev taw qhia ntawm txoj kev kho pathogenetic yog qhov tseem ceeb tshaj plaws thiab txiav txim siab qhov kwv yees loj. Txawm li cas los xij, kev kho mob yog nqa tawm hauv cov kev kawm ntev thiab tsis yog ib txwm nrog los ntawm kev kho mob sai, pom tseeb hauv kev kho mob. Tib lub sijhawm, txawm hais tias muaj DPN tsawg, qhov mob hnyav tuaj yeem tshwm sim, ua rau pw tsaug zog, kev nyuaj siab, ntxhov siab thiab kev tsis raug. Yog vim li ntawd, nyob rau hauv nrog rau kev kho mob pathogenetic, nws yog ib qho tseem ceeb tshaj plaws rau kev coj ua raws sijhawm ntawm kev kho mob NB.

Kuv xav hais txog tam sim ntawd cov tshuaj loog uas yooj yim thiab tsis siv tshuaj tiv thaiv kab mob hauv kev kho mob nrog DPN tsis pom zoo vim tias lawv tsis muaj peev xwm. Hmoov tsis zoo, hauv ntiaj teb ntau dua 60% ntawm cov neeg mob NB tseem tau txais cov tshuaj no, uas tsis tsim nyog thiab txaus ntshai rau kev siv lub sijhawm ntev (mob mob plab hnyuv (GIT), mob siab thiab ntshav). Cov pawg tseem ceeb ntawm cov tshuaj rau kev kho mob ntawm NB nrog DPN yog: tshuaj tiv thaiv kab mob siab, tshuaj tua kab mob, opioids, antiarrhythmic tshuaj, tshuaj hauv zos.

Tricyclic antidepressants (TCAs) yog ib qho tshuaj thawj zaug uas tau txais txiaj ntsig zoo los kho cov neeg mob NB. Txawm li cas los xij, tsuas yog ib qho TCA tau tso npe hauv Lavxias - amitriptyline, uas yog siv los kho NB (postherpetic neuralgia, DPN). Nws ntseeg tau tias qhov ua haujlwm tsis tseem ceeb ntawm TCAs cuam tshuam nrog lawv qhov kev txwv tsis pub rov ua dua ntawm serotonin thiab norepinephrine, uas ua rau muaj kev nce ntxiv hauv cov haujlwm qis ntawm noradrenergic thiab serotonergic systems, uas inhibit cov kev coj ua ntawm kev mob siab ua raws nociceptive txoj hauv kev hauv nruab nrab lub paj hlwb.

Ntxiv rau kev thaiv qhov rov ua dua ntawm serotonin thiab norepinephrine, TCAs block alpha₁adrenergic, N₁-histamine, M-cholinergic receptors, uas ua rau ntau tus contraindications thiab phiv uas txwv lawv siv. Cov kev mob tshwm sim suav nrog pom lub qhov muag, lub qhov ncauj qhuav, mob tachycardia, cem quav, tso zis cia, tsis meej pem thiab / lossis nco kev puas tsuaj (tshuaj tiv thaiv kab mob), ua kom tsaug zog, tsaug zog, nce phaus (H1-histamine teebmeem), orthostatic hypotension, kiv taub hau, tachycardia (alpha₁adrenergic cuam tshuam). TCAs yog contraindicated rau hauv cov neeg mob uas muaj mob hnyav thiab subocute myocardial infarction, nrog kev ua kom lub ntsej muag tsis sib luag, nrog lub kaum sab xis kaw lub ntsej muag, noj monoamine oxidase inhibitors (MAOIs). Cov tshuaj no yuav tsum tau siv nrog ceev faj hauv cov neeg mob uas muaj mob plawv (CHD), arrhythmia, mob ntshav siab, tom qab mob hlab ntsha tawg, ntxiv rau kev tso zis tsis tuaj yeem lossis ua kom tsis muaj zog. Qhov xwm txheej no ua rau muaj kev txwv ntau ntawm TCAs hauv kev kho mob dav dav.

Kev ua tau zoo ntawm TCA (amitriptyline, desipramine, clomipramine, imipramine) hauv kev kho mob qhov mob DPN tau pom nyob rau ntau qhov kev sim, xaiv cov tshuaj placebo. Cov tshuaj feem ntau ntawm cov pab pawg no tau siv los kho mob polyneuropathies yog amitriptyline thiab imipramine. Qhov feem ntau siv amitriptyline. Thawj qhov tshuaj thawj zaug yog 10-12.5 mg thaum tsaus ntuj, tom qab ntawd qhov tshuaj txhaj tau nce ntxiv los ntawm 10-25 mg txhua 7 hnub kom txog thaum cov nyhuv tiav (ntau kawg yog 150 mg / hnub). Qhov tshuaj txhua hnub yog noj ib zaug thaum tsaus ntuj lossis tsoo rau hauv 2-3 koob. Nrog concomitant kev nyuaj siab, qhov ntau dua ntawm cov tshuaj feem ntau yuav tsum tau ua. Nrog kev tsis haum rau amitriptyline, lwm yam TCAs yuav raug kho, piv txwv li, imipramine lossis clomipramine. Kev kho sim tshuaj tiv thaiv kab mob siab yuav tsum nyob ntev li 6-8 lub lis piam, thaum tus neeg mob yuav tsum tau txhaj ntau tshaj plaws kom tsawg kawg li 1-2 lub lis piam. Txawm hais tias amitriptyline ua tau zoo nyob rau hauv kwv yees li 70% ntawm cov neeg mob NB, kev mob tshwm sim hnyav txwv kev siv. Ua ntej yuav teem caij los ntawm TCA, yuav tsum muaj ECG ua ntej, tshwj xeeb yog cov neeg laus dua 40 xyoo.

Yog tias TCA ua tsis tau zoo, tetracyclic antidepressants (xws li maprotiline, 25–100 mg / hnub) lossis xaiv serotonin thiab norepinephrine reuptake inhibitors (SSRIs) (venlafaxine, 150-225 mg / hnub, lossis duloxetine, 60–20 mg / hnub tuaj yeem siv) ) Qhov ua tau zoo ntawm venlafaxine tau rov ua pov thawj hauv kev tshawb fawb nrog cov neeg mob DPN 17, 18, thaum nws tsis muaj qhov "postynaptic effect yam ntxwv ntawm TCAs (kev ua haujlwm ntawm M-cholinergic receptors, alpha-adrenergic thiab histamine receptors). Qhov no ua rau cov tshuaj muaj kev nyab xeeb ntau dua li TCAs. Qhov pib ntawm kev siv analgesic tau sau tseg twb tau nyob hauv ob lub lim tiam ntawm kev kho mob.

Yog li, venlafaxine yog ib qho tshuaj tiv thaiv zoo, muaj kev nyab xeeb thiab zoo-txais tshuaj rau hauv kev kho mob ntawm DPN. Peb tus neeg ua haujlwm ntau qhov, xaiv, ob-dig muag, cov tshuaj placebo tswj tau ntev ntev los ntawm 12 mus rau 13 lub lis piam pom tias qhov zoo tshaj ntawm duloxetine ntawm ib koob li 60 txog 120 mg / hnub hauv cov neeg mob uas mob DPN. Raws li kev soj ntsuam, qhov txo qis 50% hauv kev siv tshuaj mob thaum kho nrog duloxetine (tsis hais lub koob tshuaj siv) pom nyob rau hauv 41% ntawm cov neeg mob, piv nrog 24% ntawm cov neeg mob noj cov placebo.

Xaiv serotonin reuptake inhibitors (SSRIs) (fluoxetine, paroxetine, sertraline, citalopram, escitalopram) ua rau muaj kev mob tshwm sim tsawg dua, tab sis muaj cov nyhuv tsis tseem ceeb, uas yuav piav qhia los ntawm qhov tsis muaj qhov cuam tshuam ncaj qha rau ntawm kis noradrenergic. Lawv qhia feem ntau hauv qhov xwm txheej qhov mob qhov cuam tshuam nrog kev nyuaj siab, thiab tus neeg mob tsis kam lees ua lwm yam tshuaj tiv thaiv kev ntxhov siab.

Txij li thaum NB feem ntau nrog kev nyuaj siab, kev xaiv ntawm cov tshuaj uas cuam tshuam rau lub xeev psychopathological no thiab muaj cov ntaub ntawv muaj kev nyab xeeb zoo yog qhov cuam tshuam. Ib qho ntawm cov tshuaj no yog pipofesin (Azafen). Cov tshuaj tiv thaiv kev ntxhov siab yog ua raws li kev cais tawm ntawm kev cais tawm ntawm serotonin thiab norepinephrine reuptake, uas ua rau muaj kev nce ntxiv hauv lawv cov kev xav hauv nruab nrab lub paj hlwb. Cov tshuaj tsis muaj lub zog cardiotoxic. Vim tias tsis muaj qhov tshuaj tiv thaiv anticholinergic, Azafen tuaj yeem raug kho rau cov neeg mob lub ntsej muag thiab lwm yam kabmob uas kev siv tshuaj tiv thaiv nrog kev ua haujlwm anticholinergic, suav nrog imipramine thiab amitriptyline, yog contraindicated. Qhov tsis muaj cov kev mob tshwm sim tuaj yeem tso cai rau koj kom muab tshuaj rau cov neeg mob somatic thiab cov neeg laus, tshwj xeeb hauv kev kho mob tawm.

Ntawm cov anticonvulsants siv nyob rau hauv kev kho mob ntawm DPN, qhov ua tau zoo tshaj plaws yog gabapentin (Neurontin) thiab pregabalin (Lyric) 22, 23. Lub tshuab kev ua ntawm gabapentin thiab pregabalin, pom tseeb, yog raws li lub peev xwm los khi rau alpha-2-delta subunits ntawm voltage-dependent calcium channels. peripheral piav thoob hlo neurons. Qhov no ua rau muaj kev txo qis hauv kev nkag mus ntawm calcium rau hauv presynaptic neuron, uas ua rau muaj qhov txo qis hauv kev tso tawm ntawm cov kev kho mob tseem ceeb (glutamate, norepinephrine thiab tshuaj P) los ntawm overexcited neuron, uas nrog nrog txo qhov mob hauv qab. Ob qho tshuaj muaj peev xwm tiv taus zoo thiab nce siab pom tau twb dhau ntawm 1 lub lim tiam ntawm kev kho mob. Feem ntau cov kev mob tshwm sim yog kiv taub hau thiab tsaug zog. Thawj koob tshuaj gabapentin yog 100-300 mg thaum tsaus ntuj. Tom qab ntawd cov koob tshuaj txhua hnub yog maj nce txhua 3-5 hnub los ntawm 100-300 mg, hloov mus rau ib koob tshuaj thib peb zaug.

Qhov nruab nrab cov txiaj ntsig zoo yog 1800 mg / hnub (600 mg 3 zaug hauv ib hnub), qhov ntau tshaj - 3600 mg / hnub. Nws yuav siv li 2 mus rau 8 lub lim tiam kom tau ib feem ntawm koob tshuaj gabapentin. Ua ntej txiav txim siab tias qhov tshuaj tsis muaj txiaj ntsig, nws qhov siab tshaj plaws yuav tsum tau noj rau 1-2 lub lis piam. Hais txog qhov ua tau zoo thiab kev nyab xeeb, pregabalin kwv yees sib raug rau gabapentin, tab sis tsis zoo li gabapentin nws muaj linear pharmacokinetics, uas ua kom paub tseeb txog kev hloov pauv ntawm cov tshuaj nyob hauv ntshav ntshav nrog kev hloov pauv ntawm koob tshuaj. Qhov ntau ntawm cov tshuaj txhua hnub ntawm preagabalin yog 150-600 mg / hnub hauv 2 faib ua ob zaug.

Hauv kev kho mob ntawm DPN mob, qhov pib noj tshuaj tuaj yeem yog 150 mg / hnub. Raws li cov txiaj ntsig thiab kev ua siab ntev, cov koob tshuaj tuaj yeem raug nce ntxiv rau 300 mg / hnub tom qab 3-7 hnub. Yog tias tsim nyog, koj tuaj yeem nce lub koob ntau dua (600 mg / hnub) tom qab sib nrug 7-hnub. Raws li cov kev paub dhau los ntawm kev siv tshuaj, yog tias tsim nyog, tsum tsis txhob noj nws yog qhov pom zoo kom txo cov tshuaj kom tsawg dua hauv lub lim tiam. Pregabalin nrawm dua rau hauv cov ntshav thiab muaj lub siab dua (90%) piv nrog gabapentin (33 (66%). Raws li qhov tshwm sim, cov tshuaj muaj txiaj ntsig zoo nyob rau hauv cov koob tshuaj tsawg dua thiab muaj qhov tsawg zaus thiab qhov mob ntawm cov kev mob tshwm sim, tshwj xeeb tshaj yog kev ua kom tsaug zog 22, 23.

Kev siv cov tshuaj opioids rau kev kho cov mob syndromes yog ua tau tsuas yog thaum tsis muaj cov nyhuv ntawm lwm yam tshuaj. Ntawm cov tshuaj opioids, oxygencodone ntawm koob tshuaj 37-60 mg / hnub thiab tramadol (tshuaj uas muaj qhov cuam tshuam tsawg rau opioid ors receptors thiab tib lub sijhawm ib qho inhibitor ntawm serotonin thiab norepinephrine reuptake) tau pom tias muaj txiaj ntsig zoo tshaj plaws hauv kev kho mob DPN. Kev kho nrog tramadol pib nrog ib koob tshuaj 50 mg thaum hmo ntuj (lossis 25 mg 2 zaug hauv ib hnub), tom qab 5-7 hnub, qhov tshuaj tau nce ntxiv rau 100 mg / hnub. Yog tias tsim nyog, nce qhov koob tshuaj rau 100 mg 2–4 zaug ib hnub. Kev sim kho nrog tramadol yuav tsum nyob ntev li 4 lub lis piam. Cov tshuaj opioids raug rau lawv lub cev ua kom loog, tab sis cov tshuaj ntawm cov hauv chav kawm no ua rau muaj kev tawm tsam thiab muaj kev phom sij hauv lub cev.

Kev sib xyaw ntawm tramadol nrog paracetamol (Zaldiar) tso cai rau koj kom txo qis ntawm tramadol thiab yog li kev pheej hmoo ntawm kev phiv, tsis muaj kev pab cuam rau cov nyhuv analgesic. Nrog kev sib xyaw ntawm ob cov tshuaj nrog cov sib txawv sib txawv ntawm kev ua (lub tshuab muaj cov nyhuv analgesic ntawm paracetamol tej zaum yuav cuam tshuam nrog kev cuam tshuam ntawm lub zog hluav taws xob nruab nrab ntawm prostaglandins, tej zaum vim yog inhibition ntawm COX-3), cov nyhuv synergism tshwm sim. Kev siv tshuaj loog kom zoo thaum noj tshuaj ntau ntxiv yog pom 1.5-3 zaug ntau dua li thaum siv txhua yam ntawm cov sib txuas hauv cov koob tshuaj uas tsim nyog.

Tsis tas li ntawd, paracetamol thiab tramadol yog tus cwj pwm los ntawm cov tshuaj pharmacokinetic zoo li qub, vim tias cov tshuaj sai sai pib ua - tom qab 15-20 feeb (vim paracetamol) thiab rau lub sijhawm ntev txhawb cov nyhuv analgesic (vim tramadol). Zaldiar muaj tsawg kawg nkaus ntawm tramadol (ib ntsiav tshuaj muaj 37.5 mg ntawm tramadol thiab 325 mg ntawm paracetamol), yog li cov kev mob tshwm sim thaum siv nws tsawg dua li thaum siv tramadol. Lub hom phiaj ntawm cov tshuaj tsis tas yuav tsum tau dhau feem ntau koob tshuaj, kev kho mob tuaj yeem pib nrog koob tshuaj 1-2 ntsiav tshuaj hauv ib hnub, hauv koob tom ntej tuaj yeem nce ntxiv rau 4 ntsiav tshuaj hauv ib hnub.

Mexiletine, ib qho tshuaj tiv thaiv kab mob hauv qhov ncauj, kuj yog tshuaj loog. Nws ntseeg tau tias mexiletine thaiv sodium raws, yog li ua kom lub cev puas ntawm cov neurons thiab thaiv qhov kev sib kis ntawm qhov mob siab. Kev ntsuam xyuas rau kev siv mexiletine hauv NB muab cov txiaj ntsig tsis sib haum. Muaj qee kis, mexiletine txo qis kev mob, tshwj xeeb tshaj yog siv thaum siv tshuaj ntau. Txawm li cas los xij, cov kev mob tshwm sim feem ntau tshwm sim, tshwj xeeb los ntawm kev mob plab hnyuv. Cov tshuaj yuav tsum tau siv nrog ceev faj yog tias muaj keeb kwm ntawm lub plawv pathology lossis yog tias muaj kev txawv txav hauv lub sijhawm tshawb fawb txog ECG.

Hauv ntau qhov kev tshawb fawb, nws tau qhia tias kev siv tshuaj loog hauv zos (cream, gels thiab thaj (Versatis) nrog 5% cov ntsiab lus ntawm lidocaine lossis kev npaj raws li kev rho tawm ntawm kua txob kub - capsaicin) muaj txiaj ntsig zoo rau kev kho mob daim ntawv ntawm DPN 27, 28. Cov nyhuv ntawm lidocaine yog ua raws li thaiv qhov kev thauj mus los ntawm sodium ions los ntawm daim nyias nyias ntawm peripheral neurons, vim qhov kev cuam tshuam ntawm cov cell membrane yog qhov ruaj khov, kev sib kis ntawm qhov muaj peev xwm ua kom qeeb, thiab yog li ntawd, qhov mob txo qis. Ntawm qhov tshwm sim, qhov tawv nqaij hauv zos ntawm thaj tsam ntawm daim ntawv thov tuaj yeem pom, uas feem ntau ploj me ntsis thiab sai sai. Qhov kev ua ntawm capsaicin kev npaj yog ua raws li kev ua kom tiav ntawm cov tshuaj P hauv qhov kawg ntawm cov pa roj carbon fiber. Hlawv, liab, thiab khaus ntawm qhov chaw ntawm daim ntawv thov yog cov kev mob tshwm sim feem ntau, thiab mob yog feem ntau sau tseg thaum cov tshuaj ua ntej thov.

Txawm li cas los xij, tsis muaj tshuaj dab tsi tuaj yeem suav hais tias yog cov tshuaj nkaus xwb rau kev kho mob ntawm kev hnov mob hauv DPN. Muaj ntau zaus uas kev siv ntawm cov nyiaj hais los saum toj no tsis tau txais txiaj ntsig txaus thiab muaj qhov xav tau ntawm kev sib txuam nrog cov tshuaj. Yog li, txawm hais tias cov tshuaj noj ntau npaum li cas los ntawm tus neeg mob tib lub sijhawm cov kev cai ib txwm yuav tsum tau sim txwv, feem ntau, NB nrog DPN tuaj yeem tswj tau txaus nkaus xwb nrog ob hom tshuaj los yog ntau dua. Nws yog qhov tsis ncaj ncees tam sim ntawd los mus muab ntau yam tshuaj: thaum xub thawj ib qho tshuaj yuav tsum tau sim, thiab tsuas yog tom qab ua kom paub tseeb tias nyob rau hauv cov koob tshuaj zam los ntawm tus neeg mob no nws tsuas muaj ib feem, tus neeg sawv cev txuas ntxiv yuav tsum txuas rau nws, uas, raws li txoj cai, muaj qhov sib txawv ntawm kev ua.

Hauv kev xyaum ua haujlwm, kev siv tshuaj tiv thaiv kab mob nrog anticonvulsant feem ntau ua ke, ib qho tshuaj tiv thaiv nrog tramadol lossis Zaldiar. Nws raug nquahu kom tsis txhob muaj kev sib xyaw ua ke ntawm tramadol (tshwj xeeb tshaj yog txhaj ntau) nrog MAOI, SSRIs thiab SSRIs, vim tias qhov sib txuam no tuaj yeem ua rau serotonin syndrome. Nrog kev ceev faj, tramadol yuav tsum tau muab sau ua ke nrog tricyclic antidepressants (muab kev pheej hmoo ntawm serotonin syndrome).

Kev tsis siv tshuaj rau kev kho mob DPN suav nrog kev kho mob hlwb, kev kho lub cev, kev tiv thaiv kabmob, hyperbaric oxygenation (1.2–2 atm.), Kev Kho Mob, Kev Kho Mob, Kev Kho Mob, Electrophoresis, diadynamic currents, cov leeg nqaij hluav taws xob, kev kho hluav taws xob, kev kho lub cev hluav taws xob, kev kho mob. Ib qho kev sib txuam nrog lawv txoj kev siv yog qhov mob hnyav ntawm tus neeg mob vim yog somatic pathology thiab / lossis hnyav kho tsis tau ntawm metabolism. Ib tus lej ntawm cov kws sau ntawv tau qhia qhov ua tau zoo ntawm kev siv hluav taws xob tsa kho tus txha caj qaum siv los kho tus mob ntshav qab zib mob neuropathy. Raws li txoj cai, qhov cog cov tshuaj ntawm stimulants ua rau cov neeg mob uas muaj mob syndromes refractory mus tshuaj kho.

Hauv kev xaus, nws yuav tsum raug sau tseg tias kev kho mob ntawm txhua tus neeg mob yuav tsum yog tus kheej, coj mus rau hauv qhov chaw kuaj mob, nrog rau muaj cov kab mob comorbid (ntxhov siab, kev nyuaj siab, kab mob ntawm cov kabmob hauv nruab nrog, thiab lwm yam). Thaum xaiv cov tshuaj, ntxiv rau cov tshuaj loog ncaj qha, lwm cov txiaj ntsig zoo ntawm cov tshuaj xaiv (txo kev ntxhov siab, kev ntxhov siab, txhim kho pw tsaug zog thiab mus ob peb vas), nrog rau nws lub siab thiab qhov ua rau muaj teeb meem loj, yuav tsum tau muab rau hauv.

Tus naj npawb ntawm cov kws sau ntawv pom zoo thawj zaug tshuaj nyob rau hauv kev kho mob ntawm cov ntaub ntawv mob polyneuropathies TCAs thiab gabapentin lossis pregabalin. Cov tshuaj thib ob suav nrog SSRIs - venlafaxine thiab duloxetine. Lawv tsis tshua muaj txiaj ntsig, tab sis muaj kev nyab xeeb dua, muaj tsawg dua qhov contraindications dua li TCAs, thiab yuav tsum yog txoj hauv kev kho mob rau cov neeg mob mob plawv. Thib peb cov tshuaj suav nrog opioids. Cov tshuaj siv nrog cov nyhuv tsis muaj zog suav nrog capsaicin, mexiletine, oxcarbazepine, SSRIs, topiomat, memantine, mianserin.

Ntaub Ntawv

Strokov I. A., Strokov K. I., Akhmedzhanova L. L., Albekova J. S. Thioctacid kho mob ntshav qab zib polyneuropathy // Cov neeg mob uas nyuaj. Khaws. 2008. No. 12. P. 19–23.
Galieva O. R., Janashia P. Kh., Mirina E. Yu. Kev kho mob ntawm neuropathic neuropathy // International Neurological Journal. 2008. No. 1. S. 77–81.
Koom Haum Asmeskas Mob Ntshav Qab Zib. Kev tiv thaiv mob ko taw nyob hauv cov neeg muaj ntshav qab zib // Kho Ntshav Qab Zib. Xyoo 2002. No. 25 (Tus Neeg Sau 1). P. 69–70.
Feldman E. L., Russell J. W., Sullewan K. A., Golovoy D. Txoj kev xav tshiab rau txoj kev mob ntshav qab zib neuropathy // Curr. Lub tswv yim. Neurol. Xyoo 1999. Vol. 12, No. 5. P. 553-563.
Retinopathy thiab nephropathy nyob rau hauv cov neeg mob uas mob ntshav qab zib hom 1 plaub xyoos tom qab sim kev kho kom zoo. Kuaj Mob Ntshav Qab Zib thiab Lwm Yam Teeb Meem Ua / Ep>S. A. Gordeev *, MD
L. G. Turbina **, Kws Kho Mob Kev Tshawb Fawb ntawm Kev Tshawb Fawb, kws kho mob
A. A. Zusman **, neeg sib tw ntawm kev kho mob sciences

*Thawj MGMU lawv. I. M. Sechenova, ** MONICA xwb. M.F. Vladimirsky, Moscow

Cov tsos mob thiab hom mob ntshav qab zib mob hlwb

Cov kev pom ntawm tus kab mob yog qhov ntev heev.

Thaum xub thawj, mob ntshav qab zib mob neuropathy mob sib khuav xwb, tab sis tom qab ib pliag, cov teeb meem hnyav heev.

Mob neuropathy mob ntshav qab zib muaj cov tsos mob li nram no:

leeg tsis muaj zog
tus mob ntshav siab heev
kiv taub hau
mob ib ce me me
loog thiab tingling ntawm nqua,
muaj teeb meem nqos khoom noj,
txo qis libido
muaj teeb meem nrog txoj hnyuv zom zaub mov, mob plab hnyuv ntau zaus,
ua txhaum ntawm lub qhov muag txav,
mob ib ce
quav thiab zis tsis tu ncua,
ib tug ntau npaum li cas ntawm hws los yog tsis muaj nws,
txo qis hauv qhov kub thiab txias, mob thiab tactile rhiab,
tsis muaj kev sib koom ua ke ntawm txav.

Kev mob ntshav qab zib muaj feem xyuam rau cov hlab ntsha pob txha, tab sis cov qib ntawm kev phom sij tuaj yeem sib txawv. Hom kev mob cuam tshuam yog nyob ntawm seb cov fibers twg cuam tshuam ntau tshaj. Thaum nws los txog rau lub paj hlwb ntawm lub hlwb, kev faib tawm hu ua qhov kev ua txhaum central neuropathy. Yog tias lwm yam plexuses thiab cov hlab ntsha cuam tshuam, qhov no yog distal lossis ntshav qab zib peripheral neuropathy.

Thaum lub siab ntawm lub cev muaj zog yuav ntxhov, tus neeg tsis tuaj yeem noj, taug kev thiab tham, nrog cov leeg puav leej muaj lub siab xav, ua rau lub siab ntsws. Nrog kev puas tsuaj rau cov hlab ntsha xov xwm, cov leeg hlwb muaj peev xwm tshwm sim. Hauv cov xwm txheej no, ib tus yam ntxwv ntawm tus yam ntxwv yog lub cev tsis ua hauj lwm ntawm ntau yam kabmob ntawm ib zaug, suav nrog lub siab.

Autonomic Neuropathy Mob:

kev ua pa
urogenital
hlab plawv
lub plab zom mov
nkoj cav.

Feem ntau:

rhiab
neeg sim
lawv yuav nyob tsis tau
focal neuropathy.

Nrog central neuropathy yog cov yam ntxwv:

cov mob migraines thiab kiv taub hau,
tsis nco qab zoo, mloog tsis meej, mloog zoo.

Tus neeg nquag raug mob tsaus muag, thiab nquag mus tso quav.

Nrog lub sensorimotor neuropathy, qhov kev cuam tshuam poob qis, tib neeg cov leeg tsis muaj zog, thiab kev sib koom tes yog qhov tsis tau. Raws li txoj cai, kev tsis sib haum xeeb ntawm caj npab lossis txhais ceg txhawm rau thaum yav tsaus ntuj. Nyob rau theem ua tiav, ib tus neeg tsis hnov zoo li tsis xis nyob tus cwj pwm ntawm taw ntawm cov ntse los yog nrog lwm yam kev puas tsuaj.

Cov tsos mob ntawm tus mob ntshav qab zib neuropathy kuj suav nrog kev ua tsis tiav ntawm kev hnov mob lub sijhawm. Yog li, mob rwj thiab deformities ntawm taw thiab taw tshwm sim.

Autonomous neuropathy mob ntshav qab zib tshwm sim vim yog kev ua haujlwm tsis zoo ntawm lub zog ntawm lub cev. Cov pa oxygen tsawg dua, cov khoom noj khoom haus tsis zom txaus, uas ua rau cuam tshuam kev ua haujlwm:

txoj hnyuv
lub zais zis
lub plawv thiab lwm yam kabmob.

Feem ntau muaj teeb meem nrog kev sib deev muaj siab thiab cov hws zais cia. Nrog rau cov mob hlwb genitourinary neuropathy, ib tus neeg yuav ntxhov siab vim los ntawm cov zis nyob hauv lub zais zis. Qee qhov xwm txheej, cov zis ntws los rau hauv tee tom qab kev ua ntawm tso zis, impotence kuj tseem pom.

Urodynamic kev puas tsuaj qhia tawm - qeeb hauv cov zis txaus. Lub sijhawm ntawm tso zis tseem nce thiab qhov pib ntawm reflex mus rau qhov tso zis nce. Lub zais zis tso zis obsessively teeb liab yuav tsum tau tso zis. Txhua yam no cuam tshuam cov kev ua neej ib txwm muaj.

Qhov mob sib thooj ntawm qhov tsis thooj yog xav txog qhov mob ntawm lub pob tw thiab lub duav, thiab lub ntsag pob qij txha kuj tseem cuam tshuam. Ib tug neeg pib pom tias nws cov leeg tsis mloog lus, thiab lawv lub sij hawm atrophy.

Focal neuropathy feem ntau tshwm sim dheev thiab cuam tshuam rau ib leeg tus leeg ntawm pob tw, ceg lossis taub hau. Tus neeg muaj ob lub zeem muag, qhov mob hauv ib cheeb tsam hauv lub cev tshwm, tuag tes tuag taw ntawm ib nrab ntawm lub ntsej muag yuav tshwm sim. Mob ntshav qab zib neuropathy yog ib qho mob uas tsis tau paub txog, kev paub tshwm sim uas feem ntau tsis paub txog.

Ntshav qab zib optic neuropathy yog ib qho kab mob uas tuaj yeem ua rau tsis pom kev ib ntus lossis mus tas li. Neuropathy ntawm qhov qis qis yog qhov nyuaj ntawm ntau qhov mob, uas tau sib koom ua ke los ntawm qhov muaj teeb meem ntawm cov hlab ntsha tsis sib haum ntawm ob txhais ceg.

Cov Neeg Mob Ntshav Qab Zib Neuropathy

Pathology tshwm sim qeeb, tiv thaiv keeb kwm ntawm lub caij nyoog ntev ntawm hom 1 lossis hom 2 ntshav qab zib. Cov kws kho mob tau hais tias tus kab mob tuaj yeem tshwm sim nws tus kheej li 15-20 xyoo tom qab kuaj ntshav qab zib.

Raws li txoj cai, qhov no tshwm sim nrog kev kho mob tsis txaus thiab tsis ua raws li tus kws kho mob pom zoo ntawm kev ua neej zoo. Qhov laj thawj tseem ceeb ntawm cov tsos mob ntawm tus kab mob pathology yog qhov tshwm sim ntau dhau ntawm cov ntshav qabzib hauv lub cev, thaum cov txheej txheem ploj, uas ua rau muaj kev cuam tshuam ntawm kev ua haujlwm ntawm cov nruab nrog sab hauv, nrog rau lub paj hlwb.

Tsom fiber saturates txog hlab ntshav, thiab nyob rau hauv qhov tsis zoo ntawm qab zib, khoom noj khoom haus muaj kev ntxhov siab thiab oxygen tshaib plab pib. Yog li, thawj cov tsos mob tshwm sim ntawm tus kabmob.

Yog tias kev noj zaub mov ntawm tus neeg mob ntshav qab zib yog noo nrog cov kab kawm thiab cov vitamins, tom qab ntawd vim muaj teeb meem nrog cov txheej txheem hauv metabolic, cov hlab ntsha tseem tuaj yeem tau cov tshuaj no rau lawv lub neej.

Nrog rau kev kho mob tsis tu ncua ntawm tus mob ntshav qab zib neuropathy, muaj txoj hmoo nres kev mob thiab tiv thaiv ntau yam phom sij. Tab sis tsuas yog kws kho mob paub txog kev kho mob pathology. Kev coj tus kheej yog txwv tsis pub ua.

Yog tias kev kho mob tsis nqa tawm tag nrho, thiab tsis muaj txoj hauv kev tiv thaiv, ces txoj kev mob thim rov qab tuaj yog ib daim ntawv hnyav dua.

lub sijhawm ua ntshav qab zib
tas li cov piam thaj
nce lipid ntau ntau
o ntawm cov leeg poob siab
cwj pwm tsis zoo.

Cov kev paub txog algorithm ntawm tus kabmob: ntshav qabzib pib ua kom lub nkoj me me uas pub cov hlab ntsha khiav haujlwm. Lub capillaries poob patency, thiab cov leeg tau pib "ua tsis taus pa" los ntawm cov pa oxygen, vim tias cov hlab ntsha poob nws txoj haujlwm.

Tib lub sijhawm, qab zib tsis zoo cuam tshuam rau cov protein thiab lawv pib ua lawv txoj haujlwm tsis raug, rhuav lub sijhawm thiab khib nyiab ua tshuaj lom rau lub cev.

Kev kuaj mob

Tus kabmob muaj ntau hom tsiaj uas muaj cov yam ntxwv tshwm sim. Thaum lub sijhawm kuaj pom, tus kws kho mob kuaj xyuas tus taw, pob qij txha thiab xib teg, lub cev deformation uas qhia tau tias mob neuropathy. Nws yog txiav txim siab seb puas muaj dryness, liab, lossis lwm yam cim ntawm tus kabmob ntawm daim tawv nqaij.

Kev kuaj lub hom phiaj ntawm ib tug neeg qhia kev qaug, nrog rau lwm qhov tseem ceeb ntawm tus kab mob. Ntshav qab zib cachexia yog ib qho kab ke huab cua ntawm pathology, thaum ib tus neeg tau ua tsis tiav cov roj subcutaneous thiab tso nyiaj hauv thaj chaw mob plab.

Tom qab kuaj xyuas cov nqaj qis thiab sab nraud, kev kawm ntawm kev hnov lub suab nrov nrov ntawd yog siv lub tshuab tshwj xeeb. Txoj kev tshawb no yuav tsum ua ntawm peb zaug.

Txhawm rau txiav txim siab ntawm hom mob, thiab txiav txim siab txoj kev kho mob, qee qhov kev kuaj mob xav tau uas tuaj yeem txiav txim siab pathology. Qhov rhiab heev tau qhia tawm:

Tsis tas li ntawd, kev kuaj mob tawm tsam nrog rau kev ntsuas qhov theem ntawm reflexes.

Muaj ntau cov chav kawm yog cov yam ntxwv ntawm tus mob neuropathy, yog li feem ntau muaj kev txiav txim siab los ua qhov kev ua tiav ntawm kev kuaj mob tus txheej txheem.

Tus kab mob tsuas yog tuaj yeem kho kom ncav sijhawm nrog txoj kev xaiv tshuaj.

Kuj tseem muaj qhov sib txawv hauv kev kho mob rau thawj hom mob ntshav qab zib thawj hom thib ob.

Cov yam ntxwv khomob

Mob ntshav qab zib neuropathy, lub pathogenesis ntawm cov uas paub, xav tau kev kho mob.

Kev kho mob ntshav qab zib neuropathy yog raws li peb qho. Nws yog ib qho tsim nyog yuav tau txo qis cov concentration ntawm cov piam thaj hauv cov ntshav, txo tib neeg kev mob, txo qhov mob thiab rov kho cov leeg ntshav tsis zoo.

Yog tias tus neeg muaj ntshav qab zib mob neuropathy, ces kev kho pib nrog kev kho ntawm cov piam thaj hauv cov ntshav. Lub luag haujlwm tseem ceeb yog coj li qub rau qab zib thiab tswj nws kom raug. Hauv cov xwm txheej no, cov neeg sawv cev uas txo qis qab zib hauv tib neeg lub cev raug pom zoo.

Ntsiav tshuaj yuav txo cov ntshav qabzib hauv ntau pawg. Thawj qeb suav nrog cov tshuaj uas ua rau cov tshuaj insulin ntau ntxiv hauv lub cev.

Cov pab pawg thib ob suav nrog cov tshuaj uas ua rau muaj kev cuam tshuam ntau dua ntawm cov nqaij mos - Metformin 500. Hauv pab pawg thib peb, cov ntsiav tshuaj uas thaiv qee qhov kev nqus ntawm kev zom zaub mov nyob hauv cov hnyuv, peb tab tom hais txog Miglitol.

Nrog rau qhov chiv keeb no, tus kws kho mob xaiv cov tshuaj nruj me ntsis ntawm tus kheej. Cov koob tshuaj thiab ntau zaus ntawm kev muab tshuaj rau cov ntshav qab zib hom 1 tuaj yeem sib txawv.

Thaum nws ua tau kom tswj tau theem ntawm cov piam thaj hauv tus neeg mob cov ntshav, tseem tuaj yeem ua rau lub hlwb tsis nco qab. Cov tsos mob yuav tsum tau muab tshem tawm nrog cov tshuaj qhwv taub hau. Kev qhia pom tseeb tias qhov kev hloov pauv rov qab ua tau. Mob neuropathy mob ntshav qab zib, uas kho tau raws sijhawm, tuaj yeem kho thiab cov leeg ntshawb rov qab los.

Ntau yam tshuaj siv los txhim kho cov hlab ntsha ua haujlwm thiab analgesia. Ua ntej tshaj plaws, nws tsim nyog pom tias Tiolept tswj cov txheej txheem hauv lub cev zom zaub mov, tiv thaiv cov leeg hlwb los ntawm kev ua ntawm cov dawb radicals thiab cov tshuaj lom.

Cocarnit yog cov complex ntawm cov vitamins thiab tshuaj uas cuam tshuam rau tib neeg cov metabolism. Cov tshuaj hauv qhov muaj pes tsawg leeg ua kom tiav zoo rau qhov mob thiab ua kom pom qhov nyhuv neurometabolic. Cov tshuaj no tau muab ntau lub ampoules ib hnub rau ua intramuscularly. Lub sijhawm kho yog nyob ntawm cov xwm txheej kev khomob tshwj xeeb.

Nimesulide relieves o ntawm lub qab haus huv, thiab tseem yuav txo qhov mob. Mexiletine thaiv cov sodium sodium, yog li ntawd, kev xa xov ntawm qhov mob siab cuam tshuam thiab lub plawv dhia li qub.

Nrog kev mob ntshav qab zib neuropathy, cov tshuaj yuav tsum ua kom tiav cov tshuaj tsim nyog. Cov ntawv ua rau mob ntshav qab zib mob neuropathy yuav tsum siv tshuaj loog, siv tshuaj tiv thaiv kab mob los sib xyaw ua ke.

Nws yog qhov tsim nyog los kho nqaj qis neuropathy nrog cov kev kawm ntawm vasoactive tshuaj:

Pentoxifylline
Instenon
Nicotinic acid
Lub lauj kaub.

Cov tshuaj tiv thaiv kab mob hauv qab no yog siv:

Kev tiv thaiv ua

Thaum neuropathy twb muaj nyob rau tam sim no, nws yog ib qho tseem ceeb rau txoj kev noj tshuaj kom zoo. Tab sis los tiv thaiv qhov no los ntawm tshwm sim, txoj kev tshaj tawm yuav tsum tau siv. Ua ntej tshaj plaws, koj yuav tsum tswj hwm qhov siab, txij li kev kub siab tuaj yeem ua rau npau taws ntawm cov hlab ntsha, uas tseem ua rau kev tshaib plab ntawm cov hlab ntaws.

Nrog exacerbations, koj yuav tsum nruj me ntsis rau cov khoom noj kom tswj lub cev qhov hnyav. Kev pham muaj kev cuam tshuam tsis zoo rau lub xeev ntawm cov leeg. Nws yog ib qho tseem ceeb kom tshem tawm cov kev coj ua tsis zoo, txij li haus dej cawv thiab nicotine ua rau cov leeg xaim xaus.

Nws yog ib qho tsim nyog los ua kev ua kis las thiab ua lub neej muaj sia, qhov no ib txwm ua rau cov txheej txheem metabolic thiab nce qib ntawm kev tiv thaiv. Mob ntshav qab zib, koj tsis tas yuav tsum taug kev ua ko taw taug kev kom tiv thaiv kev puas tsuaj rau ntawm daim tawv. Ib txhais ceg uas puas lawm yuav tsum tau kho tam sim ntawd nrog cov sib txuas tshwj xeeb, nws tuaj yeem pleev pleev lossis pleev.

Nrog rau hom ntshav qab zib hom 2, cov kws kho mob qhia koj ua ntu zus ib ce tshwj xeeb. Nws yog ib qho tsim nyog los tswj lub cev kom ntshav khiav hauv ob txhais ceg thiab tiv thaiv qhov pom ntawm atherosclerosis. Koj yuav tsum xaiv cov khau yooj yim thiab tsim nyog ua los ntawm cov tawv tsiaj. Koj tus kws kho mob kuj tseem tuaj yeem sau cov khau orthopedic rau cov neeg mob ntshav qab zib.

Cov ntaub ntawv hais txog neuropathy tau muab nyob hauv cov yeeb yaj kiab hauv tsab xov xwm no.

Cov kws kho mob cov lus

Kev ntsuas tseem ceeb rau kev tiv thaiv thiab kho kab mob ntshav qab zib neuropathy yog qhov ua tiav thiab tswj cov hom phiaj glycemic.

Cov lus pom zoo rau kev kho kab mob ntshav qab zib rau cov ntshav qab zib neuropathy (benfotiamine, aldolazoreductase inhibitors, thioctic acid, kev loj hlob ntawm cov hlab ntsha, aminoguanidine, protein kinase C inhibitor) tab tom muaj kev loj hlob. Qee qhov xwm txheej, cov tshuaj no daws cov mob neuropathic. Kev kho mob ntawm diffuse thiab focal neuropathies feem ntau yog cov tsos mob.

Thioctic acid - tso ntshav tawm (li 30 feeb), 600 mg hauv 100-250 ml ntawm 0.9% sodium chloride tov 1 zaug hauv ib hnub, 10-12 hno, tom qab ntawd sab hauv, 600-1800 mg / hnub, hauv 1-3 nkag, 2-3 lub hlis.

Benfotiamine - sab hauv 150 mg, 3 zaug hauv ib hnub, 4-6 lub lis piam.

Kev muab tshuaj kho pab thiab tiv thaiv xim

Rau qhov mob, ntxiv rau NSAIDs, siv tshuaj loog hauv zos yog siv:

Diclofenac hais lus, 50 mg 2 zaug hauv ib hnub, ncua sijhawm kho yog txiav txim siab ib leeg lossis
Ibuprofen hauv 600 mg 4 zaug hauv ib hnub, kev kho mob ntev yog txiav txim siab ib tus lossis
Ketoprofen hauv 50 mg 3 zaug hauv ib hnub, sijhawm kho yog txiav txim siab ib leeg.
Lidocaine 5% gel, ntsiab lus thov nrog txheej nyias ntawm daim tawv nqaij txog 3-4 zaug hauv ib hnub, kev ncua sijhawm ntawm kev kho yog txiav txim siab tus kheej lossis
Capsaicin, 0.075% tshuaj pleev / cream, pleev tau saum txheej nrog nyias txheej ntawm daim tawv nqaij txog 3-4 zaug hauv ib hnub, sijhawm ntev ntawm kev kho yog txiav txim siab ntawm tus kheej.

, , , , , ,

Antidepressant thiab anticonvulsant kev kho mob

Yog tias NSAIDs tsis muaj txiaj ntsig, tshuaj tiv thaiv kev ntxhov siab (tricyclic thiab tetracyclic, xaiv serotonin reuptake inhibitors) tuaj yeem muaj cov teebmeem analgesic:

Amitriptyline sab hauv 25-100 mg ib hnub ib zaug (thaum tsaus ntuj), lub sijhawm ntawm kev kho yog txiav txim siab ib tus zuj zus.
Maprotiline ntawm qhov ncauj 25-50 mg 1-3 zaug hauv ib hnub (tab sis tsis ntau tshaj 150 mg / hnub), qhov ntev ntawm kev kho yog txiav txim siab ntawm tus kheej lossis
Fluoxetine ntawm qhov ncauj 20 mg 1-3 zaug hauv ib hnub (pib koob 20 mg / hnub, nce koob tshuaj 20 mg / hnub rau 1 lub lis piam), lub sijhawm kho yog txiav txim siab ib leeg lossis
Citalopram qhov ncauj 20-60 mg ib hnub ib zaug, qhov ntev ntawm kev kho yog txiav txim siab ib tus zuj zus.

Nws kuj tseem ua tau siv cov tshuaj anticonvulsant:

Gabapentin qhov ncauj 300-1200 mg 3 zaug hauv ib hnub, kev kho kom ntev yog txiav txim siab tus kheej lossis
Qhov ncauj carbamazepine 200-600 mg 2-3 zaug hauv ib hnub (qhov siab tshaj plaws 1200 mg / hnub), qhov ntev ntawm kev kho yog txiav txim siab ntawm tus kheej.

Lwm yam kev kho mob

Rau kev kho tus mob ntshav qab zib mob ntshav qab zib neuropathy, tsis siv tshuaj thiab yeeb tshuaj kho.

Nrog autonomic neuropathy ntawm lub plab zom mov, cov zaub mov raug pom zoo hauv qee qhov me me; yog tias muaj qhov txaus ntshai ntawm kev txhim kho tom qab ntshav qab zib, nws raug nquahu kom haus cov dej qab zib ua ntej noj mov. Siv cov tshuaj uas normalize lub motility ntawm lub plab zom mov, nrog atony ntawm lub plab, tshuaj tua kab mob yog ntxiv ntxiv:

Domperidop sab hauv 10 mg 3 zaug hauv ib hnub, kev kho mob ntev yog txiav txim siab ib leeg lossis
Metoclopramide sab hauv 5-10 mg 3-4 zaug hauv ib hnub, kev kho kom ntev yog txiav txim siab nws tus kheej.
Erythromycin sab hauv 0.25-4 zaug hauv ib hnub, 7-10 hnub.

Rau mob raws plab nrog kev mob ntshav qab zib enteropathy, tshuaj tua kab mob ntau yam thiab tshuaj uas thaiv txoj hnyuv plab siv:

Doxycycline qhov ncauj 0.1-0.2 g ib hnub ib zaug, rau 2-3 hnub txhua lub hlis (thaum tsis muaj dysbiosis).
Loperamide sab hauv 2 mg, tom qab ntawd 2-12 mg / hnub rau tso quav ntau zaus 1-2 zaug hauv ib hnub, tab sis tsis ntau tshaj 6 mg / 20 kg ntawm tus neeg mob lub cev qhov hnyav ib hnub.

Nrog rau kev mob ntshav qab zib mob neuropathy ntawm cov hlab plawv nrog orthostatic hypotension, haus dej haus hnyav, da dej tsis sib thooj, hnav cov ntsiab lus elastic yog qhov pom zoo, nws raug nquahu kom nce me ntsis ntawm kev noj ntsev. Tus neeg mob yuav tsum tau sawv ntawm txaj thiab muab cov quav maj mam tso. Yog tias qhov kev ntsuas tsis ua tiav, kev npaj mineralocorticoid yog:

Fludrocortisone sab hauv 0.1-0.4 1 lub sijhawm hauv ib hnub, sijhawm ntev ntawm kev kho yog txiav txim siab ntawm tus kheej.

Nrog kev ntxhov siab ntawm lub plawv txawv

Mexiletine sab hauv 400 mg, tom qab ntawd 200 mg txhua 8 teev, tom qab cov nyhuv tiav, 200 mg 3-4 zaug hauv ib hnub, sijhawm ntev ntawm kev kho yog txiav txim siab ntawm tus kheej.

Thaum kws kho mob muab tshuaj tua kab mob ua kom tsaug zog, nws yog ib qho tsim nyog los kho tus neeg mob ua ke nrog tus kws kho plawv.

Hauv kev txhim kho ntshav qab zib mob neuropathy uas ua rau lub zais zis tsis ua haujlwm, coj mus siv catheterization, cov tshuaj uas normalize detrusor muaj nuj nqi <лечение проводят="" совместно="" с="">

Nrog rau kev ua kom tiav erectile, nws yog qhov ua tau siv alprostadil raws li tus qauv ntsuas (thaum tsis muaj contraindications).

Yuam kev uas tsis raug cai thiab kev teem sijhawm tsis raws cai

Thaum sau tshuaj rau NSAIDs, nws yog qhov yuav tsum tau nco ntsoov txog lawv cov txiaj ntsig nephrotoxic, thaum tsis muaj qhov ua kom loog tsis tas yuav nce qhov ntau ntawm cov tshuaj, tab sis kev txheeb xyuas cov laj thawj rau qhov tsis muaj txiaj ntsig ntawm NSAIDs.

Peb lub teb chaws muaj kev coj noj coj ua ntawm kev siv tshuaj pab kho mob ntshav qab zib <водорастворимых витаминов="" группы="" в,="" антиоксидантов,="" препаратов="" магния="" и="">

Txawm li cas los xij, cov ntaub ntawv los ntawm kev tshawb fawb thoob ntiaj teb loj loj hais txog qhov ua tau zoo ntawm cov tshuaj no tsis muaj txhij txhua, thiab, raws li cov kws tshaj lij, kev tshawb fawb ntxiv thoob ntiaj teb xav tau ntawm qhov teeb meem no. Nws tseem yuav tsum nco ntsoov tias tsis muaj ib qhov txuas dab tsi tuaj yeem hloov cov nyiaj them zoo rau ntshav qab zib.

, ,

Ntshav qab zib mob neuropathy mob ntxiv qhov pom kev ntawm cov neeg mob ntshav qab zib. Qhov no yog qhov tseeb tshwj xeeb tshaj yog rau kev mob ntshav qab zib mob ntshav qab zib (neuropathy mob ntshav qab zib) ua rau muaj kev puas tsuaj ntawm lub plawv sab hauv ntawm txoj hlab plawv tuaj yeem ua rau muaj kev pheej hmoo ntawm ventricular arrhythmias (suav nrog ventricular tachycardia thiab ventricular fibrillation) los ntawm 4 zaug, ntsig txog, tuag tam sim ntawd.

Kev them nyiaj ntawm ntshav qab zib mellitus - kev siv tshuaj insulin ntau dua, kev kawm txog tus neeg mob thiab tswj cov nyiaj tau zoo rau cov khoom noj uas ua rau cov pluas mov carbohydrate - txo cov kev pheej hmoo ntawm kev txhim kho cov chaw kho mob thiab kho mob electrophysiological ntawm peripheral neuropathy los ntawm 50-56%. Nws tseem muaj pov thawj ntxiv tias tswj kev noj qab haus huv cov ntshav nruab nrog ntshav qab zib, tswj ntshav siab, ntshav siab ua ke nrog kev siv tshuaj tua kabmob (angiotensin-converting enzyme inhibitors) txo cov kev pheej hmoo ntawm kev tsim kabmob ntshav qab zib mob neuropathy los ntawm 3 zaug.

, ,

Cov kua nplaum nyeem li ib txwm

Qhov teeb meem tseem ceeb ntawm cov ntshav qab zib yog kev nce ntxiv hauv cov ntshav qabzib. Vim tias qhov no, tag nrho lwm yam kev mob tshwm sim, thiab ntshav qab zib neuropathy tsis muaj kev zam. Yog hais tias cov concentration ntawm cov piam thaj hauv cov ntshav tau tswj xyuas hauv qhov txwv, tom qab ntawd tsis muaj teeb meem ntshav qab zib yuav tshwm sim. Yuav kom ua tiav qhov no, cov tshuaj tsim nyog raug siv rau ntau yam mob ntshav qab zib. Yog li, nrog hom 1 mob ntshav qab zib mellitus, qhov no yog kev kho mob insulin, thiab nrog hom 2 mob ntshav qab zib mellitus - cov tshuaj qab zib-txo qis (sulfonylureas, biguanides, meglitinides, alpha-glucosidase inhibitors, thiab lwm tus). Qee zaum nrog mob ntshav qab zib hom 2, tshuaj insulin kuj tseem siv tau.

Kev tsis tu ncua ntawm cov piam thaj hauv ntshav yuav pab nres kev txhim kho ntshav qab zib neuropathy, tab sis tsis coj mus rau ploj ntawm cov tsos mob uas twb muaj lawm. Qee zaum, txawm tias tom qab nce mus txog qib qabzib ib txwm dhau los, tom qab ib ntus, cov tsos mob ntawm tus mob ntshav qab zib nce ntxiv. Qhov no yog vim qhov tseeb tias nyob rau hauv cov hlab ntsha cov hlab ntsha nrog cov piam thaj li qub, cov txheej txheem rov qab pib. Qhov xwm txheej no tsuas yog ib ntus, tom qab ob peb lub lis piam lossis lub hlis cov tsos mob ploj mus. Tus neeg mob xav kom nkag siab tias qhov no yog kev hloov pauv tsis zoo hauv kev noj qab haus huv, uas yuav hloov los ntawm kev hloov pauv hauv kev noj qab haus huv zoo, thiab muaj lub siab ntev.

Txhawm rau kom cov hlab ntsha ua kom rov zoo, nws yog qhov tsim nyog siv lwm pab pawg ntawm cov tshuaj - tshuaj tiv thaiv kab mob antioxidant thiab cov tshuaj neurotrophic.

Antioxidants thiab neurotrophic tshuaj

Cov tshuaj no ua rau muaj kev thim rov qab ntawm cov kev hloov pauv hauv cov leeg hauv cov hlab ntsha uas tau tshwm sim thaum muaj ntshav qab zib mellitus. Puv rov qab yog ua tau nrog rau kev kuaj pom tsis meej. Qhov no txhais tau hais tias yog tias tus mob ntshav qab zib tsis tau kho nws lub sij hawm ntev, tom qab ntawv puv nkaus yuav tsis yooj yim sua.

Muaj ntau cov tshuaj antioxidant, zoo li cov tshuaj neurotrophic. Txawm li cas los xij, tsuas yog qee tus yog qhov tsim nyog rau kev kho mob ntshav qab zib neuropathy. Peb yuav tsom mus rau cov uas muaj txiaj ntsig zoo hauv tus kab mob no tau raug pov thawj pom zoo los ntawm cov tshuaj.

Tej zaum cov tshuaj antioxidant tseem ceeb tshaj plaws rau cov ntshav qab zib neuropathy yog thioctic acid (alpha lipoic). Nws yog tsim los ntawm ntau cov chaw lag luam kws nyob hauv cov npe xws li Berlition, Espa-lipon, Tiogamma, Thioctacid, Oktolipen, Neuroleepone. Txhua yam tshuaj txhua qhov zoo sib xws thaum sib koom ua ke sib txawv thiab sib txawv tsuas yog pab txhawb ntxiv thiab tus nqi.

Thioctic acid pab txhim kho cov khoom noj khoom haus ntawm cov hlab ntaws, rov qab ntshav ncig ncig cov hlab ntsha, thiab tiv thaiv kev tsim cov dawb radicals uas rhuav tshem cov hlab ntsha. Cov nyhuv yog muab tsuas yog los ntawm chav kawm ntawm kev siv yeeb tshuaj. Tus txheej txheem txheem txhais tau tias thaum thawj zaug nqus dej txau rau 10-20 hnub, 600 mg ntawm cov tshuaj, tom qab ntawd hloov mus rau cov ntsiav tshuaj. Hauv daim ntawv ntawm cov ntsiav tshuaj, nws yog ib qho tsim nyog yuav tau txuas ntxiv noj thioctic acid rau lwm 2-4 lub hlis (cov tshuaj yog npaum li cas ntawm 600 mg ib nrab teev ua ntej noj mov).

Lub sijhawm tag nrho ntawm cov chav kawm ntawm kev kho yog txiav txim siab ntawm tus kheej, coj mus rau hauv tus account qhov hnyav ntawm cov tsos mob ntawm tus mob ntshav qab zib neuropathy. Lwm txoj kev cai kho mob tau raug sim tam sim no uas siv ntau dua koob tshuaj (1800 mg ib hnub). Thioctic acid, ntxiv rau cov nyhuv antioxidant, tsis ncaj qha txo qhov mob hnyav hauv cov mob ntshav qab zib neuropathy, yog li txhim kho lub neej muaj txiaj ntsig.

Ntawm cov tshuaj neurotrophic, lub luag haujlwm ntawm cov vitamins B (B1, B6, B12) yuav tsum tau sau tseg. Lawv tso cai rau cov hlab ntsha ua kom rov zoo (ob qhov tseem ceeb ntawm nws tus kheej thiab nws lub hnab tawv), txo qhov kev sib zog ntawm qhov mob, txhim kho kom zoo ntawm kev coj mus tsuj, thiaj li tshem tawm cov kev hnov mob thiab lub cev muaj zog. Muaj qee qhov nta ntawm kev siv ntawm pawg tshuaj no. Nws muaj pov thawj tias, piv txwv li, vitamin B1 yuav tsum muaj daim foos roj-cov tshuaj lom (benfotiamine) txhawm rau txhawm rau nkag mus rau hauv cov hlab ntsha hauv qhov tsis txaus. Ib qho ntxiv, cov vitamins B rau ntshav qab zib mob neuropathy yuav tsum tau siv nyob rau hauv cov koob tshuaj zoo txaus. Lawv kuj tseem siv hauv cov chav kawm.

Rau kev yooj yim ntawm kev siv, ib txoj hauv kev ntawm cov vitamins B muaj nyob rau tam sim ntawd hauv daim ntawv ntawm ib ntsiav tshuaj (dragee). Qhov no, piv txwv li, Milgamma, Kombilipen, Vitagamma, Compligam V. Milgamma raug xaj 1 ntsiav tshuaj 3 zaug hauv ib hnub rau 2-4 lub lis piam, thiab tom qab ntawd 1 ntsiav tshuaj 1-2 zaug hauv ib hnub rau ob peb lub lis piam. Nrog rau daim ntawv foos mob ntshav qab zib neuropathy, kev kho mob tuaj yeem pib nrog cov ntawv txhaj nrog kev hloov pauv tom qab rau cov tshuaj ntsiav.

Pab pawg vitamins B yuav tsum xyuam xim, vim tias thaum siv ntau dua, lawv tuaj yeem ua rau muaj kev tsis haum. Hauv cov xwm txheej zoo li no, lawv txoj kev siv yuav tsum tau tso tseg (yog tias nws muaj kev ntseeg siab uas cov vitamin B ua rau tsis nkag siab, tom qab ntawd tsuas yog nws tau thim tawm, tawm hauv lwm tus).

Lwm cov tshuaj nrog cov nyhuv neurotrophic yog Actovegin. Nws pib siv nyob rau hauv daim ntawv ntawm txoj kev txhaj tshuaj ntawm 5-10 ml rau 2-3 lub lis piam, thiab tom qab ntawd txuas ntxiv raug coj los ua tus cab (ib ntsiav tshuaj 3 zaug hauv ib hnub txog li 2 hlis). Actovegin tuaj yeem siv ib txhij nrog thioctic acid thiab pab pawg B vitamins.

Raws li cov tshuaj neurotrophic, Pentoxifylline (Vasonite, Trental) tuaj yeem hais txog. Qhov no yog qhov tshuaj uas txhim kho microcirculation, uas yog, ntshav ntws hauv cheeb tsam ntawm cov hlab ntsha. Indirectly, vim txhim kho cov ntshav txaus, Pentoxifylline pab kho cov hlab ntsha cov hlab ntsha, uas yog vim li cas nws tau siv rau hauv kev kho mob ntshav qab zib neuropathy. Kev npaj ntawm 5 ml yog muab rau cov tshuaj ua kom ncaj, diluted nyob rau hauv physiological saline daws ntawm sodium chloride, rau 10 hnub, thiab tom qab ntawd txuas ntxiv kev kho nrog daim ntawv ntsiav tshuaj (200 mg 3 zaug hauv ib hnub). Lub chav kawm ntawm kev kho mob yog 1 hlis.

Qhov teeb meem ntawm qhov mob nyem nyob hauv ntshav qab zib neuropathy

Kev hnov mob hauv cov mob ntshav qab zib neuropathy yog ib qho teeb meem tseem ceeb uas cuam tshuam cov neeg mob lub neej twb nyuaj. Qhov yog tias qhov mob ua kom tus mob yog mob (feem ntau yog hlawv, ci) thiab tsis poob thaum noj cov tshuaj pleev xim (tus lej ntawm analgin thiab cov tshuaj zoo sib xws). Thaum tsaus ntuj, qhov mob hnyav ntxiv, cuam tshuam nrog kev so kom zoo, uas ua pa tawm rau cov neeg mob.

Ntau pawg tshuaj tau siv los tawm tsam mob hauv cov leeg ntshav qab zib neuropathy. Qee qhov ntawm lawv tau siv rau lub sijhawm ntev (tricyclic antidepressants), lwm tus - tsuas yog xyoo kaum xyoo dhau los. Nyob rau hauv xyoo tas los no, qhov tseem ceeb tau siv rau cov tshuaj tshiab tshiab - Gabapentine thiab Pregabalin. Txawm li cas los xij, lawv cov nqi siab dhau los ua qhov laj thawj uas yav dhau los siv yeeb tshuaj tsis poob lawv qhov tseeb.

Yog li, txhawm rau tawm tsam mob hauv cov ntshav qab zib neuropathy tuaj yeem siv:

tshuaj tiv thaiv kab mob
anticonvulsants (anticonvulsants), thiab
tshuaj lom neeg thiab tshuaj loog hauv zos,
cov tshuaj tiv thaiv kab mob
Cov tshuaj yeeb dej cawv (opioids).

Tshuaj tiv thaiv kab mob siab - qhov no yog qhov qub tshaj plaws (xa mus rau kev paub ntawm kev siv) tshuaj ntsuab txoj kev los ntawm kev sib txuas cov mob hauv ntshav qab zib mellitus. Amitriptyline feem ntau yog siv. Qhov tsim nyog koob tshuaj yog xaiv maj mam raws li kev nce zuj zus. Pib nrog 12,5 mg ib hnub ib zaug, maj mam nce koob tshuaj 12,5 mg. Qhov koob tshuaj txhua hnub tuaj yeem ncav cuag li 150 mg, nws muab faib ua ntau zaug.

Cov tshuaj no muaj qee qhov kev mob tshwm sim, uas feem ntau dhau los ua qhov laj thawj ntawm kev siv tsis tau. Ntawm lwm cov tshuaj tiv thaiv kev ntxhov siab, xaiv serotonin thiab norepinephrine reuptake inhibitors (Duloxetine, Venlafaxine, Sertraline, thiab lwm yam) tuaj yeem txiav txim siab tau. Lawv muaj cov kev mob tshwm sim me ntsis, tab sis tus nqi yog ib qho kev txiav txim ntawm qhov ntau dua.Rau qhov ua kom daws teebmeem tsis zoo, cov tshuaj tiv thaiv kev ntxhov siab yuav tsum tau siv ntev (tsawg kawg ib hlis, thiab feem ntau ntev dua).

Cov tshuaj Anticonvulsants kuj tau siv los ua cov tshuaj pleev xim rau mob ntshav qab zib neropathy rau qee lub sijhawm. Thawj heev ntawm pawg no tau pib siv carbamazepine (Finlepsin). Txawm li cas los xij, cov tshuaj no muaj cov nyhuv sedative. Cias rau, nrog nws siv, cov neeg mob tsaug zog tsaug zog, qaug zog, xav nruj me ntsis. Lawm, tsis muaj leej twg nyiam qhov tshwm sim no. Yog vim li cas thiaj li tsis ntev los no cov anticonvulsants tseem tabtom sim tsis txhob muab tshuaj rau.

Cov tshuaj anticonvulsants tam sim no tsis muaj kev mob tshwm sim. Ntawm lawv, Gabapentin thiab Pregabalin feem ntau siv. Gabapentin (Gabagamma, Neurontin) yuav tsum muaj feem ntau koob tshuaj. Qhov no txhais li cas? Kev suav nrog ua tiav qhov ua tiav tiav ntawm qhov xav tau ntawm cov tshuaj. Nyob rau thawj hnub ntawm kev nkag, tus neeg mob yuav siv sijhawm 300 mg thaum tsaus ntuj, hnub thib ob - 300 mg thaum sawv ntxov thiab yav tsaus ntuj, nyob rau hnub peb - 300 mg 3 zaug ib hnub. Thiab yog li ntawm qhov nce zuj zus, qhov kev xav tau analgesic koob yog ua tiav (lawv tau coj los ntawm tus neeg mob txoj kev xav). Feem ntau txaus 1800 mg ib hnub. Ntawm cov tshuaj no lawv tso tseg thiab coj mus ib ntus.

Pregabalin (Lyric) tsis xav tau koob feem kaum. Nws raug muab tshuaj 75-150 mg 2 zaug ib hnub. Lub sijhawm sijhawm siv txawv nyob ntawm qhov mob hnyav ntawm tus mob hauv ib tus neeg mob, txawm li cas los xij, nws tseem tsis tuaj yeem siv cov tshuaj no tas li.

Cov tshuaj loog hauv zos tau ua pov thawj lawv tus kheej hauv qhov mob. Feem ntau lawv siv nyob rau hauv daim ntawv ntawm cream, tshuaj pleev thiab txawm tias plasters (piv txwv li, Versatis thaj muaj 5% lidocaine). Cov ntawv lo ntsiab muag cia koj ua kom cov khaub ncaws huv, lo rau 12 teev, nws yooj yim heev rau cov tib neeg ua lub neej nquag.

Npaj nrog lub hauv zos ua tsis xis nyob tsis haum rau txhua tus neeg mob ntshav qab zib neuropathy. Qhov tseeb yog tias lawv cov kev ua ntawm kev ua raws li kev ua haujlwm ntawm kev mob siab, uas yog, tom qab lawv daim ntawv thov, qhov mob ua ntej pib mob zuj zus ntxiv, thiab tsuas yog tom qab ntawd pib kho mob pib. Tab sis lub sijhawm no, thaum qhov mob hnyav ntxiv, tuaj yeem sib txawv. Tsis muaj leej twg tuaj yeem kwv yees tau tias yuav ntev li cas. Yuav ua li cas tus neeg mob hloov mus rau cov pab pawg ntawm cov tshuaj no tuaj yeem tsim tau tsuas yog sim siv cov tshuaj zoo sib xws. Cov no suav nrog tshuaj pleev xws li Capsaicin, Capsicam, Finalgon, Viprosal, Apizartron.

Antiarrhythmic cov tshuaj tsis yog cov tshuaj feem ntau rau hauv kev sib ntaus tawm tsam kev mob hauv kev mob ntshav qab zib neuropathy. Ntawm lawv, nws yog kev coj noj coj ua kom siv cov lidocaine (hauv daim ntawv ntawm qhov mob sai sai sai li ntawm koob tshuaj 5 mg rau ib phaus ntawm lub cev hnyav) thiab mexiletine (hauv daim ntawv ntawm cov ntsiav tshuaj hauv ib hnub ntawm 450-600 mg). Qhov txwv ntawm lawv txoj kev siv yog cuam tshuam nrog lawv cov txiaj ntsig ntawm lub plawv dhia.

Cov tshuaj yeeb dej cawv yog qhov txuas kawg hauv kev kho qhov mob ntawm mob ntshav qab zib neuropathy. Lawv, ntawm chav kawm, zoo heev, tab sis ntxiv nrog siv ntev. Yog vim li cas lawv thiaj li mus rau qhov kawg, thaum muaj lwm txoj kev tsis muaj nuj nqis. Qhov tshwj xeeb tshaj plaws ntawm pawg tshuaj no yog oxycodone thiab tramadol. Muaj kev sib xyaw ntawm Tramadol nrog cov tshuaj paracetamol (Zaldiar), uas tso cai rau koj siv cov tshuaj me dua li qub nrog lub zog ntawm cov nyhuv analgesic. Ib txwm ua, opioids tsuas yog kho los ntawm kws kho mob (cov tshuaj tshwj xeeb yog kho).

Hauv kev ncaj ncees, nws tsim nyog hais tias, hmoov tsis zoo, nws tsis yog ib txwm ua tau los pab tus neeg mob ntshav qab zib neuropathy ua kom tiav qhov mob. Qee lub sij hawm lawv yog cov tawv ncauj heev thiab zoo rau kev kho tsuas yog nrog kev teem sij hawm ntawm ob, lossis txawm tias peb cov tshuaj. Tias yog vim li cas kev tshawb fawb rau cov tshuaj kho mob kom zoo txuas ntxiv rau lub sijhawm tam sim no.

Kev siv tshuaj kho ntshav qab zib rau cov ntshav qab zib yog feem ntau ua ke nrog cov txheej txheem kho lub cev. Lub spectrum yog qhov dav heev thiab muaj ntau haiv neeg, zoo li cov tsos mob ntawm tus mob ntshav qab zib neuropathy lawv tus kheej. Yuav luag txhua tus txheej txheem ntawm lub cev kho mob tuaj yeem siv rau hauv kev kho mob ntawm tus kabmob no. Feem ntau siv rau kev kho mob magnetotherapy, acupuncture, electrophoresis, kev siv hluav taws xob.

Lwm txoj hauv kev ntawm kev kho mob

Nrog rau txoj kev kho mob ib txwm, cov neeg mob feem ntau siv cov tshuaj ntsuab. Yuav ua li cas cov neeg kho mob tsis pom zoo! Qee qhov kev pom zoo no ua rau muaj lub luag haujlwm. Feem ntau ntawm cov qauv ib txwm tuaj yeem ua ke nrog kev kho mob ib txwm muaj (thawj zaug, ntawm chav kawm, tom qab sab laj nrog kws kho mob).

Cov kev daws teeb meem uas neeg nyiam tshaj plaws rau kev tawm tsam kev mob ntshav qab zib neuropathy yog qhov Txoj kev lis ntshav ntawm calendula, nettle, chamomile paj, decoctions ntawm eleutherococcus, Bay nplooj, tinctures ntawm rosemary thiab ledum, txiv qaub tev, ntsuab thiab xiav av nplaum. Ib yam siv hauv sab hauv, ib yam dab tsi hauv zos hauv cov ntawv pleev tshuaj thiab compresses. Yog lawm, cov nyhuv ntawm cov kev kho mob, nrog rau kev ua ib txwm, tsis yog pom tam sim ntawd. Txawm li cas los xij, hauv kev tawm tsam tus mob ntshav qab zib neuropathy, xws li hauv kev ua rog, txhua yam txhais tau tias zoo.

Yog li, kev kho tus mob ntshav qab zib neuropathy yog ib txoj haujlwm nyuaj. Ua ntej, txhawm rau kom muaj tsawg kawg qee qhov kev txhim kho hauv tus mob, yuav tsum muaj kev kho mob tsawg kawg yog ob peb hlis. Thib ob, nws tsis yog qhov zoo tas li thaum thawj zaug sim nrhiav qhov tshuaj kho mob uas tsim nyog rau tus neeg mob muab. Thib peb, kev kho cov ntshav qabzib hauv nws tus kheej kom tiv thaiv kev mob ntxiv ntawm neuropathy yog qhov nyuaj heev. Tab sis txawm hais tias tag nrho cov kev nyuaj, kev tawm tsam tiv thaiv ntshav qab zib neuropathy yuav tsum tau ua kom tas li txhawm rau txhawm rau tiv thaiv kab mob ntshav qab zib hnyav ntxiv.

Tus kws kho mob twg yuav hu rau

Tus neeg uas muaj ntshav qab zib yuav tsum rau npe nrog tus kws kho mob endocrinologist. Nws yog ib qho tsim nyog yuav tsum qhia rau tus kws kho mob kom raws sijhawm txog qhov tsos pom ntawm qhov mob ntawm qhov mob siab, tsis hnov mob, mob tsis muaj zog thiab lwm cov tsos mob tshiab rau tus neeg mob. Hauv qhov no, tus kws kho keeb (endocrinologist) yuav tsum npaj kev kho tus mob neuropathy. Kws kho mob sab laj (kws kho mob sab laj) xav tau. Kev siv dag zog hauv lub cev yog feem ntau qhia.

Thawj channel, qhov kev pab cuam "Nyob Nyab Xeeb" nrog Elena Malysheva, hauv seem "Hais Txog Tshuaj", tham txog tus mob ntshav qab zib neuropathy (los ntawm 32:10):

Cov ntawv kho mob hais txog cov txheej txheem ntawm kev loj hlob ntawm tus mob neuropathy hauv ntshav qab zib: