Ib qho kev nyuaj tshwm sim ntawm cov ntshav qab zib - ntshav qab zib retinopathy

Mob ntshav qab zib retinopathy yog ib qho kev ua haujlwm ntawm cov plab hnyuv siab raum ntawm lub zeem muag uas tshwm sim los ntawm kev tshwm sim ntawm ntev-ntev hyperglycemia. Lub pathogenesis ntawm cov kab mob no yog ua raws li kev tsis txaus ntseeg ntawm microvasculature (microaneurysms, hemorrhages, exudates, cov nkoj tsim tshiab), uas tshwm sim vim hypoxic tej yam kev mob, uas, nyeg, yog tshwm sim los ntawm lub xeev hyperglycemic. Qhov pib theem ntawm qhov txhab tsis muaj kev tshawb nrhiav tshwj xeeb yog qhov nyuaj rau txheeb xyuas, vim hais tias tsos mob nws tsis ua rau nws tus kheej hnov. Qhov muag pom tsis pom kev (lossis qhov muag tsis pom kev) yog cov cim ntawm tus kab mob uas tau ploj mus deb, uas tsis tuaj yeem tshem tawm.

Txhawm rau zam kom tsis txhob pom kev puas loj, cov neeg muaj ntshav qab zib yuav tsum mus ntsib kws kho qhov muag ib zaug ib xyoos ib zaug thiab ua raws nraim li nws cov lus pom zoo. Yog lawm, tias qhov kev pabcuam tseem ceeb yog ua rau txo cov ntshav qab zib, noj zaub mov thiab ua haujlwm lub cev. Txawm li cas los xij, muaj kev xav tau ntawm cov tshuaj uas cuam tshuam rau lub xeev ntawm cov plab hnyuv siab raum ntawm lub zeem muag. Ib yam ntawm cov tshuaj tiv thaiv yog qhov muag dauv raws li Filatov, uas muaj cov tshuaj lom biologically uas pab tswj kev noj qab haus huv qhov muag.

Kev saib xyuas tshwj xeeb yog them rau qhov kev noj haus ntawm cov vitamins B (lawv tus kws kho mob tuaj yeem sau ntawv rau niam txiv thiab rau kev tswj hwm qhov ncauj), nrog rau C, P thiab E, uas muaj cov khoom muaj kabmob angioprotective. Ua ntu zus, koj yuav tsum tau noj tshuaj uas muaj cov nyhuv dua ntawm lub nkoj ntsa: prodectin, dicinone, thiab lwm yam.

Ib qho kev ntsuas ntau dhau - laser coagulation ntawm tus retina - cov ntsiab lus cuam tshuam rau qhov muag ntawm lub qhov muag, tiv thaiv kev tsim cov ntshav ntau dhau ntawm nws. Cov txheej txheem no qee zaum ua rau muaj kev nyuaj (piv txwv, hemorrhage mus rau hauv lub cev vitreous), uas yuav tsum muaj kev cuam tshuam ntxiv hauv daim ntawv ntawm vitrectomy - tshem tawm ntawm lub cev vitreous thiab hloov nws nrog cov tshuaj tshwj xeeb kom tsis muaj menyuam.

Ib txoj hauv kev tshiab ntawm kev kho tus mob hlwb retinopathy kuj tau tshwm sim - kev txhaj tshuaj tiv thaiv kab mob endothelial vascular growth factor (ranibizumab) rau hauv qhov kab noj hniav ntawm lub qhov muag.

Tus neeg mob, kos cov lus xaus los ntawm cov ntaub ntawv saum toj no, yuav tsum nkag siab tias cov kev kho mob nyuaj no tuaj yeem zam tau yog tias koj ua raws li txoj cai banal ntawm kev noj qab haus huv: tsis txhob noj ntau dhau, noj zaub mov kom zoo, zam tej zaub mov muaj kev phom sij thiab tswj xyuas lub cev kom zoo.

Tus mob retinopathy muaj li cas

Mob ntshav qab zib, cov hlab ntsha ntawm lub retina maj mam hloov pauv. Ua haujlwm dhau sijhawm, cov nqaij mos ntawm lub ntsej muag pom tau txais tsawg dua thiab muaj oxygen. Tus mob retinopathy mob maj mam nthuav dav zuj zus, cov qib theem yog ncaj ncaj rau "kev paub" ntawm tus mob ntshav qab zib. Kuj tseem ceeb yog lub hnub nyoog ntawm tus neeg mob.

Hauv cov neeg muaj hnub nyoog qis dua 30, qhov ntxim nyiam ntawm kev muaj hlwb retinopathy nce mus rau 50% tom qab 10 xyoo txij li pib ntawm tus mob endocrine. Tom qab 20 xyoo mob, qhov txaus ntshai ntawm anomalies hauv kev tsis pom kev yog 75%.

Cov piam thaj maj mam ua kev puas tsuaj rau cov hlab ntsha. Lawv permeability nce mus rau qhov theem txawv. Vim tias qhov no, cov kua ua kua ntawm cov ntshav tuaj yeem nkag mus rau qhov chaw ntawm cov hlab ntsha thiab cov hlab ntsha. Tus retina o, lipid complexes (tawv exudates) tso rau hauv cov ntaub so ntswg, lossis tsuas yog hais lus rog, uas tsis cuam tshuam zoo vim qhov teeb meem hauv metabolic tsis ua haujlwm. Cov kev hloov zoo sib xws yog cov xeeb ceem thaum ntxov ntawm tus mob ntshav qab zib retinopathy. Nws tseem hu ua keeb kwm yav dhau los lossis tsis tshaj tawm, uas yog, tsis nyuaj.

Qhov teeb meem mob

Thaum lub sij hawm dhau los, cov txheej txheem ntawm kev rhuav tshem tau nrov dua. Nyob rau theem ntawm preproliferative hloov pauv, qee feem ntawm qhov tsis nco qab tau txiav tawm tag nrho los ntawm cov ntshav ntshav. Ntawm no paj rwb-zoo li foci pib rau daim ntawv. Lawv qhia tias myocardial retinal ntaub so ntswg. Hauv lwm thaj chaw, mob ntshav hauv zos yuav tshwm sim. Cov xaib uas tsis tawm ntawm lub chaw ua haujlwm dhau los ua qhov muag dig muag.

Proliferative diabetic retinopathy yog suav tias yog qhov theem kawg ntawm kev mob ntshav qab zib. Cov teeb meem ncig ua pa hnyav zuj zus. Cov hlab ntsha tsis sib haum pib loj nyob rau saum npoo ntawm retina. Lawv puav leej yog cov qhov uas los ntshav tas li. Vim tias qhov no, lub cev vitreous kev txom nyem, thiab lub zeem muag kuj maj mam poob.

Neoplasms, los ntshav, thiab lwm yam kev tshwm sim ua rau pom qhov caws pliav nyob rau saum npoo. Cov txheej txheem zoo sib xws no tsis yog ib txwm muaj rau cov khoom no. Cicatricial conglomerates pib cog lus ua tus Retina, ua rau nws ua rau lub cev ploj thiab tsis pom kev.

Cov qauv ntawm pathology

Kev faib tawm ntawm cov ntshav qab zib mob ntshav qab zib muaj kev sib cais ntawm hom mob ntawm cov ntshav qab zib no ua ob hom. Lawv tau hais ua ntej lawm, xav txog lub pathogenesis ntawm tus kab mob. Ntau cov lus qhia hauv qab no.

Retinal Tom Qab Retinopathy
Daim ntawv ntawm cov kab mob pathological no ua rau muaj qhov txawv txav uas tshwm sim hauv Retina, tab sis tsis tuaj yeem pom thaum pib thawj zaug. Daim ntawv no yog xam nrog rau “tus neeg mob ntshav qab zib nrog kev paub”, feem ntau tshwm sim thaum muaj hnub nyoog txaus. Tus kab mob yog pom tus cwj pwm tsis txaus ntseeg qeeb qeeb
Coob tshaj plaws li koob hmoov
Vim tias kev nce ntxiv hauv cov pa oxygen tsis txaus nyob rau hauv cov ntaub so ntswg, tom qab kev tsis taus ntawm retinopathy tuaj yeem txhua lub sijhawm hloov mus rau txoj kev kho kab mob loj. Thaum tiav hluas, muaj kev hloov pauv uas ua rau lub qhov muag pom tsis zoo tshwm sim rau lub hlis. Tom qab retinal detachment ua rau kev ua kom tiav retinal detachment. Nws yog proliferative retinopathy uas suav hais tias yog ib qho ntawm cov kev ua kom pom kev tsis pom kev hauv cov neeg ua haujlwm hluas.
Qib kev txhim kho ntawm tus kab mob

Muaj peb theem ntawm kev rov qab mob hlwb:

Thawj theem. Cov kev hloov pauv uas tsis tshaj tawm tsis tas yuav tsum muaj kev kho mob. Tus neeg mob tau soj ntsuam los ntawm kws kho mob ua ntu zus. Tsis pom kev hloov. Raug rho tawm kis mob txhaws ntawm cov hlab ntsha me ntawm cov retina,
Theem theem ob. Preproliferative retinopathy yog pom los ntawm kev hloov pauv hnyav ntawm pob nyiaj. Cov hlab yog permeable heev, thiab cov hemorrhage tas mus li ua rau lub cev tsis tu ncua ntawm qhov muag pom kev ua haujlwm,
Thib peb theem. Qhov txaus ntshai tshaj plaws thiab cov neeg tawm mus tshaj tawm yog qhov tshwm sim ntawm tus neeg mob tsis saib xyuas zoo rau nws tus kheej kev noj qab haus huv, nrog rau cov kws tsis muaj peev xwm ntawm tus kws kho mob saib xyuas cov ntshav qab zib. Cov hlab ntsha tau txhaws tag nrho, thaj tsam ntawm qhov chaw ntawm retina yog "tuag". Pathological cov hlab ntsha tiv thaiv keeb kwm yav dhau los ntawm kev pom tseeb "kev tshaib plab" ntawm qhov retina loj hlob ntawm qhov tsis zoo. Qhov kawg tshwm sim yog retinal detachment thiab dig muag.

Cov tsos mob ntawm tus mob ntshav qab zib Retinopathy

Tus mob retinopathy yog ib qho kab mob "ntsiag to", cov tsos mob tshwm sim nyob rau theem kawg thaum cov kev hloov pauv tsis ua haujlwm tau. Cov qhia tseeb ntawm tus mob retinopathy muaj xws li:

Yoov thiab me ntsis uas zoo li "ntab" ua ntej koj lub qhov muag. Cov no yog cov ntshav txhaws uas nkag mus rau hauv lub cev vitreous. Thaum tus neeg mob saib ntawm txhua lub teeb ci, lawv cuam tshuam nrog kev pom,
Kev tawm hws zoo nkauj pom tsis pom tseeb. Tus kws kho ntshav qab zib yuav muaj teeb meem nyeem ntawv thaum ua haujlwm nrog cov khoom me me. Nov yog tus tsos mob tseeb qhia tias muaj cov leeg mob thim rov qab,
Daim ntaub npog lub ntsej muag ua ntej lub qhov muag yog lub cim tias mob ntshav tsuas yog tshwm sim.

Kev kuaj mob

Kev kho mob ntawm retinopathy mob ntshav qab zib, ua ntej txhua yam, xav tau kev ntsuas tsim nyog. Txhawm rau kom thim lossis lees paub qhov kev kuaj mob, ntau txoj kev kuaj mob tseem ceeb yuav tsum tau ua:

Txoj kev tshawb no ntawm cov teb pom (perimetry) tso cai rau koj kom muaj kev ntsuam xyuas qhov xwm txheej ntawm tus Retina ntawm cov leeg sab nrauv,
Kev kawm electrophysiological yuav kawm txog cov leeg hlwb ntawm cov retina, nrog rau lub paj optic nws tus kheej,
Ultrasound kev soj ntsuam ntawm lub qhov muag cov ntaub so ntswg,
Ophthalmoscopy (kuaj xyuas nyiaj hauv tsev).

Txhua tus neeg uas kuaj mob ntshav qab zib yuav tsum nco ntsoov tias nws muaj qhov pheej hmoo ntawm txhua yam mob nyav. Kev zam qhov teeb meem tsis pom kev yog ib qho yooj yim dua li pib kho mob ntshav qab zib ua kom rov zoo siab. Txhua tus neeg mob ntshav qab zib raug nquahu kom mus ntsib tus kws kho mob qhov muag tsawg kawg ib zaug txhua 6 lub hlis txhawm rau tiv thaiv kev soj ntsuam. Tus kws kho mob yuav pom tau cov kev hloov uas tsis zoo thiab coj los ntsuas kev tsim nyog.

Kho Cov Mob Ntshav Qab Zib Ib Ce

Raws li kev txheeb cais, nyob rau hauv ntau dua 80% ntawm tag nrho cov mob ntawm ophthalmic teeb meem nyob rau hauv cov neeg mob ntshav qab zib, nws muaj peev xwm tiv thaiv qhov tshwm sim ntawm kev dig muag. Nws yog ib qho tseem ceeb kom nkag siab tias qhov kev pheej hmoo ntawm cov pob txha caj qaum puas cuam tshuam tsis yog cuam tshuam rau tus neeg mob lub hnub nyoog thiab lub sijhawm nws mob xwb. Lub luag haujlwm tseem ceeb yog ua los ntawm kev hloov pauv hauv cov piam thaj hauv ntshav thiab ntshav siab.

Cov neeg mob uas mob hlwb loj yuav tsum mus ntsib chav ua hauj lwm ntawm tus kws phais laser. Tus kws tshaj lij yuav tuaj yeem txheeb xyuas cov teeb meem tseem ceeb hauv lub sijhawm thiab tshem tawm lawv, siv kev tsim kho tshiab hauv kev phais laser.

Ib ntawm txoj kev phais mob ntawm kev kho mob yog laser coagulation (laser cauterization). Xws li kev kho mob rau tus mob ntshav qab zib retinopathy muaj rau txhua pawg neeg mob thiab tso cai rau koj kom tsis txhob los ntshav hauv zos.

Tus yam ntxwv ntawm laser coagulation (cauterization)

Cov txheej txheem yog ua nyob rau ib qho kev tawm tsam sab nraud ntawm lub hauv paus tshuaj loog. Siv cov kab teeb ci tsom rau qhov tsim vascular vascular formations, tus kws phais mob ceev faj txog thaj chaw tsim nyog. Qhov no tso cai rau koj tiv thaiv kev mob ntshav siab rau yav tom ntej thiab kom tsis txhob pom kev tsis pom kev. Lub sijhawm rov qab yog tsawg heev - tsis pub dhau 1 lub lim tiam.

Vitrectomy - lub chaw kawg

Hauv kev muaj qhov mob siab ntawm tus mob, tus neeg mob yog qhia rau kev mob hlwb. Qhov kev cuam tshuam tau txiav txim siab tsuas yog txoj hauv kev tawm ntawm qhov muaj ntau ntawm hemophthalmus (yog tias muaj ntshav ntau ntawm cov nqaij hauv cov nqaij).

Kev yws tshem tawm qhov tawg tsam ntawm lub cev vitreous, ntxuav qhov nyias ntawm lub npoo ntawm retina. Tsis tas li, kev kho mob neoplasms ntawm tus hlwb retinal vasculature tau ua. Tus kws phais neeg mob, yog tias ua tau, rov qab kho qhov ua kom qhov qub qhov zoo ntawm lub retina.

Ntaus Maculopathy
Yog tias retinopathy nrog kev puas tsuaj rau ntu ntu ntawm qhov retina, kev kho tshuaj hauv nruab nrog cev yog qhia. Rau qhov no, txhaj tshuaj intravitreal yog xyaum - cov qauv tshuaj tshwj xeeb yog qhia rau hauv cov ntaub so ntswg, uas tus kws kho mob xaiv.

Kev tiv thaiv kev ntsuas

Ntshav qab zib yog ib tus kab mob uas koj tuaj yeem nyob nrog tab sis tsis kho. Ua raws li tag nrho cov kev cai thiab cov lus pom zoo ntawm tus kws kho mob uas tuaj kawm, koj tuaj yeem nyob ntev thiab lub neej tag nrho yam tsis muaj kev cuam tshuam koj lub neej nrog qhov tsis zoo ntawm tus kab mob. Cov neeg mob yuav tsum saib xyuas lawv cov ntshav qab zib kom qis thiab ntshav ntshav feem ntau. Ib qho tseem ceeb ntxiv yog kev soj ntsuam tiv thaiv ua ntu zus. Kev saib xyuas koj tus kheej kom noj qab haus huv yuav pab kom tsis txhob muaj cov kab mob ntshav qab zib txaus, suav nrog kev mob ntshav qab zib.

Tus mob ntshav qab zib ua dab tsi?

Tus mob retinopathy yog ib qho teeb meem ntshav qab zib tshaj plaws. Hauv cov kab mob no, lub retina ntawm lub qhov muag muaj kev txom nyem, uas yog lub luag haujlwm rau kev hloov ntawm lub teeb ntws mus rau hauv cov hlab ntsha impulses.

Kev puas tsuaj pib ntawm theem ntawm cov hlab ntsha me, capillaries, muab cov retina nrog cov as-ham, vim tias cov hlwb photosensitive tuag "los ntawm kev tshaib plab".

Tus mob retinopathy mob ntshav qab zib tuaj yeem tshwm sim muaj ob hom ntshav qab zib 1 thiab ntshav qab zib hom 2.

Cov txheej txheem rau kev txhim kho kev mob ntshav qab zib

Cov tsos mob ntawm tus mob ntshav qab zib retinopathy yog tshwm sim los ntawm kev hloov pauv ntawm phab ntsa ntawm tus leeg ntawm retina, uas yog, cov ntshav me me uas nqa ntshav mus rau qhov retina.

Hauv kev, nws tshwm sim:

Cell poob: i.e. vascular endothelial hlwb thiab cov qe ntshav uas nyob ib puag ncig endothelial.
Thickening ntawm lub capillaries: daim nyias nyias hauv qab ntawm capillaries, uas ua rau txoj kev nqaim ntawm cov leeg thiab lim ntshav txaus.
Kev hloov pauv ntawm kev sib txuas ntawm cov cell: poob lossis rhuav pov tseg ntawm cov hlwb endothelial ua rau lub cev tsis muaj zog ntawm cov vascular phab ntsa nrog tsim tom qab ntawm edema nyob rau theem ntawm tus retina.

Yam muaj feem thiab cov teeb meem ntawm cov mob ntshav qab zib retinopathy

Txhua tus neeg mob ntshav qab zib khiav txoj kev pheej hmoo ntawm tus mob retinopathy. Txawm li cas los xij, muaj qee yam kev pheej hmoo uas ua rau muaj feem ntau ntawm cov kab mob no.

Ntawm cov kev pheej hmoo peb muaj:

Lub sijhawm muaj tus mob ntshav qab zib: nws tau kwv yees tias hauv kev kuaj ntshav qab zib hauv ib tus neeg muaj hnub nyoog 30 xyoo, tom qab tsib xyoos, nws muaj 20% kev pheej hmoo ntawm kev mob hlwb, tom qab kaum xyoo qhov tshwm sim no nce mus txog 40-50%, thiab tom qab 15 - ntau dua 90%. Yog li, ntev lub sijhawm ntawm cov kabmob, ntau qhov kev pheej hmoo ntawm kev txhim kho retinopathy.
Mob ntshav qab zib tsis zoo: qhov no txhais tau hais tias feem ntau cov suab thaj feem ntau mus txog qhov muaj nuj nqis. Qhov no tshwm sim thaum tus neeg mob tsis siv tshuaj kho txaus lossis tsis xav hloov nws txoj kev ua neej.
Muaj lwm cov kev pheej hmoo: muaj kev sib txig sib luag ntawm kev pheej hmoo xws li haus luam yeeb, cawv, ntshav siab thiab noj cov zaub mov muaj roj ntau ntxiv ua rau muaj qhov mob ntshav qab zib rov qab, vim tias cov ntsiab lus no ua kev puas tsuaj rau phab ntsa ntawm cov hlab ntsha.

Cov theem ntawm retinopathy: proliferative thiab tsis-loj hlob

Mob ntshav qab zib retinopathy tuaj yeem muab faib ua theem ntawm kev vam meej, uas mus ko taw mus ko taw nrog qhov nce ntawm qhov mob hnyav ntawm cov kab mob pathology.

Nws muaj ob qib loj:

Nonproliferative retinopathy: tseem hu ua daim ntawv yooj yim thiab tsis hnyav ntawm kev rov ua haujlwm. Nws yog tus cwj pwm los ntawm kev tsim cov microaneurysms, uas yog, nthuav dav ntawm cov phab ntsa ntawm cov hlab ntsha, uas ua rau lawv txoj kev qaug zog thiab kev tsim cov ntshav tawm ntawm cov qib ntawm retina thiab macular edema.

Kev nthuav tawm kuj tseem tshwm sim, yog li ntawd daim ntawv no hu ua exudative, tshwm sim los ntawm cov dej ntws tawm hauv cov hlab vim qhov ua haujlwm tsis ua haujlwm nyob hauv phab ntsa. Xws li exudate nyob rau thawj theem yog ib hom tsis yeem, uas yog, nws muaj cov rog thiab cov nqaijrog, xws li fibrin.

Proliferative retinopathy: qhov no yog qib siab thiab hnyav tshaj plaws, uas yog tus cwj pwm pom los ntawm cov ntshav ntxiv ntxiv uas tsim los thaiv qhov tsis zoo.

Lub exudate nyob rau theem no muaj qee yam me, zoo li ntawm cov paj rwb ntaub, thiab tsim thaum lub sij hawm ischemia nyob rau ntau qhov chaw ntawm cov retinal fibers thiab kev txuam nrog ntawm cov khoom siv endoplasmic ntws los ntawm cov endothelium uas puas lawm.

Cov hlab ntsha tshiab, uas tau tsim rau cov ntshav txaus rau thaj chaw ntawm ischemia, muaj cov phab ntsa uas tsis yooj yim thiab tawg yooj yim, uas ua rau cov ntshav muaj ntshav ntau. Tsis tas li, caws pliav cov ntaub ntawv ntawm lub retina vim yog qhov tawg tas li ntawm cov hlab ntsha, qhov no tuaj yeem txiav txim siab retinal wrinkling thiab nws cov cuam tshuam.

Tshuaj kho mob ntshav qab zib

Ntawm cov tshuaj kho mob tshiab tau siv los kho tus mob ntshav qab zib retinopathy, txhaj tshuaj rau intravitreal yuav tsum raug sau tseg. Nrog rau txoj kev kho no, cov tshuaj tau txhaj rau hauv qhov chaw vitreous nrog rab koob, uas txo cov kev tsim cov hlab ntsha tshiab.

Ntawm cov tshuaj feem ntau siv:

Cov tshuaj tiv thaiv VEGF: Avastin thiab Lucentis yog koom nrog pawg no.
Corticosteroids: triamcinolone thiab dexamethasone. Lawv siv vim yog lawv lub zog muaj kev tiv thaiv zoo, uas txo kev tsim ntawm edema.

Txhawm rau txhim kho qhov muag, koj tuaj yeem siv tsom iav thiab lo ntsiab muag uas lim pom lub teeb thiab txhim kho teeb pom kev zoo.

Kev faib tawm

Nyob ntawm theem ntawm tus kab mob, qhov xwm txheej ntawm cov kev hloov pauv ntawm cov hlab ntsha, nrog rau cov ntaub so ntswg ntawm lub qhov muag, cov kab ke hauv qab no tau saws:

uas tsis yog-cov xwm txheej mob ntshav qab zib,
preproliferative mob ntshav qab zib retinopathy,
proliferative mob ntshav qab zib retinopathy.

Kev tsim kho tshuab

Lub hauv paus tseem ceeb ntawm lub zog rau kev ua haujlwm ntawm lub cev tag nrho yog nyob hauv qab. Nyob hauv kev cuam tshuam ntawm cov tshuaj insulin, qhov ntawm lub cev ntawm cov txiav ua qab zib, piam thaj rau hauv lub hlwb qhov chaw uas nws tab tom ua. Hauv cov ntshav qab zib mellitus, rau qee qhov laj thawj, kev ua txhaum ntawm cov tshuaj insulin secretion tshwm sim. Cov piam thaj tsis ua haujlwm ntxiv nyob rau hauv cov ntshav, vim qhov kev zom zaub mov hauv lub cev tau cuam tshuam. Nws ua rau txhaws, ua kev puas tsuaj rau cov hlab ntsha ntawm ntau yam kabmob, nrog rau cov kabmob ntawm cov tsis pom kev. Yog tias kho qhov nce ntxiv ntawm cov piam thaj hauv cov neeg mob ntshav qab zib mellitus tsis tau pib hauv lub sijhawm, tom qab ntawd tus kab mob ntshav qab zib pib tsim.

Ua rau

Qhov tseem ceeb ntawm tus kab mob pathology yog nce ntshav qab zib ntxiv (qabzib) ntev mus.

Nquag, cov ntshav qab zib cov ntshav yuav tsum tsis txhob nce siab tshaj 5.5 mmol / L ntawm lub plab khoob thiab 8.9 mmol / L tom qab noj mov.

Tsis tas li ntawd, muaj cov yam tsis pom qab hauv cov neeg mob ntshav qab zib cuam tshuam qhov tshwm sim ntawm retinopathy. Lawv tuaj yeem tsis tsuas yog ua rau kev tsim ntawm kev cuam tshuam li no xwb, tab sis kuj tseem ceev nws cov chav kawm.

ntxiv ntshav qab zib
kub siab lub cev (mob ntshav nce siab),
cev xeeb tub
ntau yam pathologies thiab kab mob ntawm lub raum,
thawj
haus luam yeeb
cawv
muaj hnub nyoog txog kev hloov pauv ntawm cov hlab plawv,
txhob kaw txiav txim siab qhov kev txwv.

Kho kev noj haus

Cov neeg muaj tus kabmob no yuav tsum ua raws li kev noj haus kom zoo, uas yog ib txoj hauv kev tseem ceeb ntawm kev siv tshuaj kho txoj siv tau.

Los ntawm cov khoom noj tsis suav:

qab zib, hloov nws nrog hloov chaw (xylitol, sorbitol),
ncuav thiab ncuav puff pastry,
hwm thiab thawj khob cij,
rog nqaij ntses, ntses,
cov khoom qab zib thiab curd qab zib, qab zib,
muab nqaij noj
nplej zom, semolina, mov,
kua txiv muaj roj zoo nkauj, kua zaub siav nrog mis nyuj, mov,
cov khoom ua kua kub, cov kua txob, cov txuj lom,
cov dej qab zib thiab dej tsis qab ntsev, kua txiv, nrog rau txiv hmap,
zib ntab, ice cream, jam

grey, rye zoo tshaj plaws, nrog rau mov ci,
Cov muaj roj tsawg nqaij, nqaij qaib, ntses - hau thiab cov ntses aspic,
buckwheat, oat, lossis pearl barley (vim muaj kev txwv khob cij),
ib hnub koj yuav tsum noj tsis ntau tshaj li ob lub qe muag muag lossis ib qho nqaij to,
cheese, qaub cream nkaus xwb hauv qhov tsawg,
txiv hmab txiv ntoo, xws li cranberries, blackcurrants lossis txiv hmab txiv ntoo stewed, txiv qab zib tsis qab, tab sis tsis ntau tshaj 200 grams tauj ib hnub,
txiv lws suav thiab lwm cov kua txiv uas tsis qab zib thiab kua txiv.
kas fes xav tau hloov nrog chicory.

Ntawm qhov tseem ceeb tshwj xeeb yog phytodiet. Hauv cov neeg mob ntshav qab zib mellitus, kev ua rau acidification tshwm sim hauv lub cev, uas yog vim li cas cov zaub siv nrog cov nyhuv alkalizing yog qhov pom zoo:

Haus birch SAP hauv ib nrab ib khob txog peb zaug hauv ib hnub, kaum tsib feeb ua ntej noj mov.

Tshuaj kho mob nkeeg

Hauv tshuaj kho, qhov chaw loj yog nyob ntawm:

ntshav cov ntshav cov roj ua kom tsawg
anabolic tshuaj yuam
tshuaj tiv thaiv kab mob
cov vitamins
angioprotectors
txhaj tshuaj tiv thaiv kab mob
tshuaj tua kab mob biogenic,
cov enzymes
desensitizing cov tshuaj
coenzymes thiab lwm tus.
Cov tshuaj tiv thaiv mob siab Hypocholesterolemic:
tribusponin
miscleron.

Cov tshuaj no raug pom zoo rau kev siv rau kev mob ntshav qab zib retinopathy, uas tshwm sim rau kev sib xyaw nrog kev mob atherosclerosis.

Angioprotectors:
mob caj pas
Parmidin
Doxium
Dicinone "lossis" Etamsylate,
trental
pentoxifylline.
Rau kev kho mob ntawm preproliferative theem ntawm pathology, cov tshuaj "Phosphaden" yog siv, uas txhim kho qhov muag hemodynamics, cov xwm txheej dav dav ntawm pob txha thiab stimulates cov txheej txheem metabolic.
Kev siv tshuaj tiv thaiv kab mob hauv cov theem thaum ntxov ntawm tus kabmob yog ua tiav los ntawm kev siv cov tshuaj Levomezil, thiab kev txhaj tshuaj Tactivin thiab Prodigiosan.
Cov vitamins ntawm pab pawg B, C, E, R.
Rov qab thiab txhim kho metabolism hauv qhov muag nqaij: npaj "Taufon", "Emoksipin".
Kev tswj hwm ntawm cov enzyme npaj "Lidaza", "Gemaza" yog siv nyob rau hauv muaj cov lus tawm los ntshav.

Yuav kom ua tiav cov txiaj ntsig siab hauv kev kho mob, koj tuaj yeem siv cov Sidorenko Tsom iav, cov khoom siv thev naus laus zis uas yooj yim rau kev siv hauv tsev, thiab txhim kho cov ntshav ncig.

Hmoov tsis zoo, kev kho tshuaj muaj peev xwm tsuas ua tau zoo thaum nyuam qhuav pib ntawm hom retinopathy no. Hauv cov sijhawm tom qab ntawm nws txoj kev loj hlob, kev kho cov tshuaj laser yog siv.

Laser coagulation tso cai rau koj kom txo qis qis lossis txawm tias nres qhov loj hlob ntawm cov nkoj tsim tshiab, ntxiv dag zog rau lawv cov phab ntsa thiab txo qis permeability. Qhov tshwm sim ntawm retinal tsis lees paub yog txo.

Nrog rau daim ntawv qib siab ntawm cov ntshav qab zib ua kom muaj ntshav qab zib, kev phais mob yuav tsum - vitrectomy.

Kev cais tawm ntawm cov teeb meem kev pheej hmoo: ua kom lub cev nyhav, kho kev kub siab, tsis kam haus cawv thiab haus luam yeeb pab rov qab cov teeb meem hauv lub cev, ua kom tshwm sim ntawm kev kho.

Retinopathy yog dab tsi?

Lub pathogenesis ntawm txoj kev loj hlob ntawm xws li mob hnyav yog kev ntseeg siab heev thiab multifaceted.

Cov hauv qab no ua lub luag haujlwm tseem ceeb hauv kev tsim kho ntawm kev pom kev tsis zoo:

Microangiopathy. Ntev hyperglycemia provokes sclerosis ntawm cov hlab ntsha thiab venules, raws li ib qho kev tshwm sim ntawm uas lawv sclerosis tshwm sim thiab cov ntshav ncig hauv qhov pom kev tsom xam cov kev mob tshwm sim. Retina tsis tau txais ntshav txaus. Lub cev tsim kho lub cev ua kom cov kua dej ntws mus ntau ntxiv, uas ua rau lub microvessels puas tsuaj thiab ua rau lawv raug mob.
Ntxiv nkag mus ntawm cov hlab ntsha capillary. Hauv qhov no, muaj ntau yam tshuaj uas tsis tuaj yeem nkag mus rau hauv lub qhov muag ua ntej yuav thauj mus rau qhov ntawd. Qhov no kuj siv rau cov co toxins nrog lwm cov tebchaw tsis tseem ceeb.
Kev puas tsuaj mus tas li rau cov qauv ntawm cov ntshav ua rau lub zog neovascularization txheej txheem - kev tsim cov hlab ntsha tshiab. Lawv muaj zog ntau dua li ib txwm, yog li ntawd, ntu kev mob ntshav qis los ua ntau zaus.

Thaum kawg, nyob rau qhov tsis muaj kev kho mob txaus tsim nyog, retinopathy nyob rau hauv cov ntshav qab zib hloov zuj zus mus ua tiav kev tsis pom kev.

Mob ntshav qab zib retinopathy

Tus mob retinopathy yog ib qho qhia ntxov rau tus mob ntshav qab zib mellitus, ob hom insulin thiab tsis-insulin-kev vam khom. Hauv ophthalmology, mob ntshav qab zib retinopathy ua rau pom kev tsis pom kev hauv cov neeg mob ntshav qab zib hauv 80-90% ntawm cov neeg mob. Hauv cov neeg muaj ntshav qab zib, qhov muag tsis pom kev yuav muaj 25 zaus ntau dua li lwm tus neeg sawv cev ntawm cov pej xeem. Nrog rau tus mob ntshav qab zib retinopathy, cov neeg mob ntshav qab zib tau muaj kev pheej hmoo mob ntshav siab, mob ntshav qab zib nephropathy thiab mob polyneuropathy, cataracts, glaucoma, occlusion ntawm lub hauv nruab nrab lub paj hlwb thiab lub paj hlwb hlab plawv, mob ko taw ko taw thiab mob caj dab ntawm lub siab. Yog li, kev kho mob ntshav qab zib yuav tsum muaj kev ua ntau yam, nrog rau kev koom tes ntawm cov kws tshwj xeeb los ntawm endocrinologist (kws kho mob ntshav qab zib), ophthalmologist, kws kho plawv, kws kho pob ntseg.

Cov Neeg Ua thiab Teeb Meem Qhov Tseeb

Lub tshuab kev txhim kho ntawm cov ntshav qab zib retinopathy yog cuam tshuam nrog kev puas tsuaj rau cov hlab ntsha hlwb (cov hlab ntsha ntawm cov leeg ntshav): lawv cov permeability nce ntxiv, occlusion ntawm capillaries, cov tsos ntawm cov nkoj tsim tshiab thiab kev txhim kho ntawm kev nthuav dav (caws pliav) cov ntaub so ntswg.

Feem ntau ntawm cov neeg mob uas muaj lub sijhawm ntev ntev ntawm mob ntshav qab zib mellitus muaj qee yam lossis lwm yam cim kev puas tsuaj rau pob txha. Nrog lub sijhawm ntev li ntshav qab zib txog 2 xyoo, mob ntshav qab zib retinopathy raug kuaj pom mus rau ib qib lossis lwm qhov hauv 15% ntawm cov neeg mob, nce txog 5 xyoo - hauv 28% ntawm cov neeg mob, txog 10-15 xyoo - hauv 44-50%, txog 20-30 xyoo - hauv 90-100%.

Cov kev pheej hmoo tseem ceeb cuam tshuam rau ntau zaus thiab kev hloov pauv ntawm tus mob ntshav qab zib retinopathy muaj xws li lub sijhawm mob ntshav qab zib, hyperglycemia, kub siab, mob raum tsis ua haujlwm, dyslipidemia, metabolic syndrome, thiab kev rog. Txoj kev txhim kho thiab kev loj hlob ntawm tus mob retinopathy tuaj yeem pab ua tiav nkauj tiav nraug, cev xeeb tub, caj ces tsis muaj zog, thiab haus luam yeeb.

Muab cov kev hloov pauv zuj zus nyob rau hauv cov kev khwv nyiaj, uas tsis yog neeg tawm tsam, kev npaj ua ntej thiab kev mob ntshav qab zib muaj peev xwm sib txawv tau tshwm sim.

Txhawb siab, tswj cov ntshav qab zib tsis zoo yuav ua rau kev puas tsuaj rau cov hlab ntshav ntawm ntau yam plab hnyuv siab raum, suav nrog tus retina. Hauv qhov tsis nce qib ntawm kev mob ntshav qab zib retinopathy, cov phab ntsa ntawm cov hlab ntsha retinal ua permeable thiab nkig, uas ua rau taw tes rau hemorrhages, kev tsim cov microaneurysms - lub zos saccular dilatation ntawm cov hlab ntsha. Kev tso dej ua kua ntawm cov ntshav seeps los ntawm phab ntsa semipermeable los ntawm cov hlab ntsha mus rau ntawm qhov retina, ua rau kom cov leeg o tuaj. Xws li kev koom tes hauv cov txheej txheem ntawm nruab nrab ntawm thaj av ntawm cov retina, macular edema nthuav dav, uas tuaj yeem ua rau tsis pom kev zoo.

Hauv lub sijhawm npaj ua ntej, nce qib ntawm lub pob txha caj qaum ischemia tsim vim muaj occlusion ntawm txoj hlab ntsha, ntshav tawm hauv lub plawv, mob ntshav tsis txaus.

Preproliferative diabetic retinopathy ua ntej qib proliferative, uas tau txheeb xyuas hauv 5-10% ntawm cov neeg mob ntshav qab zib mellitus. Muaj feem xyuam nrog hauv kev txhim kho cov kabmob ntshav qab zib muaj sia nyob ntau dua li cov kabmob myopia, muaj mob ntawm cov hlab ntsha carotid, posterior vitreous detachment, optic atrophy. Nyob rau theem no, vim tias cov pa oxygen tsis paub dhau los ntawm qhov retina, cov hlab ntsha tshiab pib tsim nyob rau hauv nws kom tswj kev nqus pa kom txaus. Cov txheej txheem ntawm neovascularization ntawm retina ua rau rov ua dua preretinal thiab retrovitreal hemorrhages.

Feem ntau, mob ntshav liab me hauv cov khaubncaws sab hauv retina thiab vitreous lub cev daws teeb meem ntawm nws tus kheej. Txawm li cas los xij, nrog cov ntshav tawm hauv lub qhov muag kab mob hauv lub cev (hemophthalmus), cov kab mob tsis muaj zog nyob rau hauv lub cev vitreous tshwm sim, yam ntxwv ntawm fibrovascular fusion thiab caws pliav, uas thaum kawg ua rau tractional retinal detachment. Thaum txhaws qhov tawm ntawm cov kab mob HPV, kev txhim kho ntawm lub cev nqaij daim tawv neau leeg.

Kev Kho Mob Retinopathy Mob Ntshav Qab Zib

Nrog rau cov qauv dav dav ntawm kev kho mob retinopathies, kev kho mob suav nrog kev kho cov teeb meem metabolism, txhim kho kev tswj kom zoo dua qib ntawm glycemia, ntshav siab, lipid metabolism. Yog li no, nyob rau theem no, txoj kev kho mob tseem ceeb yog kho los ntawm tus kws kho mob endocrinologist-diabetologist thiab tus kws kho plawv.

Ua tib zoo saib xyuas txog qib glycemia thiab glucosuria, kev xaiv cov tshuaj insulin txaus rau kev mob ntshav qab zib mellitus yog nqa tawm, angioprotectors, tshuaj tiv thaiv kab mob siab, tshuaj tiv thaiv kab mob, thiab lwm yam.

Cov neeg mob uas mob ntshav qab zib ua kom rov ua hauj lwm zoo yog qhia tau rau laser retinal coagulation. Laser coagulation tso cai rau koj los txwv cov txheej txheem ntawm neovascularization, kom ua tiav obliteration ntawm cov hlab ntshav nrog nce siab thiab permeability, los tiv thaiv kev pheej hmoo ntawm retinal detachment.

Kev phais kab mob Retina rau cov ntshav qab zib retinopathy siv ntau txoj hauv kev. Teeb meem laser coagulation ntawm tus retina cuam tshuam nrog cov ntawv thov ntawm paramacular coagulates ntawm hom "ntoo", nyob rau ntau kab, thiab yog qhia rau qhov tsis tshwm sim ntawm retinopathy nrog macular edema. Focal laser coagulation yog siv los ua kev ceev faj me me ntawm cov kab mob hlwb, ua kom tiav, thiab cov ntshav tawm me me thaum lub sijhawm angiography. Nyob rau hauv cov txheej txheem ntawm panretinal laser coagulation, coagulates yog thov thoob plaws lub retina, tsuas yog thaj chaw macular, txoj kev no tsuas yog siv ntawm theem preproliferative los tiv thaiv nws cov kev nruam ntej.

Nrog opacification ntawm cov kho qhov muag tawm ntawm lub qhov muag, ib qho kev xaiv rau laser coagulation yog transscleral cryoretinopexy, raws li kev rhuav tshem txias ntawm pathological seem ntawm retina.

Nyob rau hauv cov ntaub ntawv ntawm loj proliferative diabetic retinopathy nyuaj los ntawm hemophthalmus, macular traction lossis retinal detachment, vitrectomy yog nyob rau, thaum lub sijhawm ntawd cov ntshav, lub cev vitreous nws tus kheej raug tshem tawm, qhov nqaij sib txuas strands raug txiav, hlab ntsha hlab ntshav hlawv.

Theem Kab Mob Ntshav Qab Zib Retinopathy

Tus mob retinopathy uas mob ntshav qab zib muaj ntau theem. Cov theem pib ntawm retinopathy hu ua tsis-loj hlob, thiab yog tus yam ntxwv ntawm microaneurysms uas nthuav cov hlab ntsha, pom cov ntshav tawm hauv qhov muag nyob rau hauv daim ntawv ntawm cov tsaus nti nti lossis cov kab txaij, cov tsos ntawm ischemic retinal aav, retinal edema hauv thaj chaw macular, nrog rau kev nce ntxiv permeability thiab fragility ntawm cov hlab ntsa. Hauv qhov no, dhau los ntawm cov hlab ntsha hauv qab, cov kua ua kua ntawm cov ntshav nkag rau qhov retina, uas ua rau tsim muaj cov edema. Thiab yog tias qhov nruab nrab ntawm qhov retina koom nrog hauv cov txheej txheem no, tom qab ntawd txoj cai ntawm kev pom txo qis.

Nws yuav tsum raug sau tseg tias hom mob ntshav qab zib no tuaj yeem tshwm sim rau txhua theem ntawm tus kab mob, thiab sawv cev rau theem pib ntawm kev mob hlwb. Yog tias nws tsis kho, tom qab ntawd hloov mus rau theem ob ntawm tus kab mob tshwm sim.

Qhov theem ob ntawm retinopathy yog proliferative, uas yog nrog cov ntshav ncig hauv retina, uas ua rau lub cev tsis muaj pa oxygen hauv retina (oxygen starvation, ischemia). Txhawm rau rov qab cov pa oxygen ntau ntxiv, lub cev tsim cov hlab ntshav tshiab (txoj kev no hu ua neovascularization). Cov hlab ntsha tsim tshiab raug puas ntsoog thiab pib los ntshav, los ntawm qhov uas cov ntshav nkag mus rau hauv Vitreous lom zem, cov txheej txheej ntawm retina. Raws li qhov no, ntab opacities tshwm sim hauv lub qhov muag tiv thaiv keeb kwm ntawm qhov tsis pom kev zoo.

Hauv cov theem thaum ntxov ntawm retinopathy nrog txuas ntxiv ntawm cov hlab ntsha tshiab thiab caws pliav, nws tuaj yeem ua rau cov pob txha mos thiab ua rau lub ntsej muag txhaws.

Qhov laj thawj tseem ceeb ntawm kev loj hlob ntawm tus mob ntshav qab zib retinopathy yog qhov tshuaj insulin tsis txaus, uas ua rau kom muaj kev sib txuam ntawm fructose thiab sorbitol, uas ua rau muaj kev nce siab, ua kom tuab ntawm phab ntsa ntawm cov hlab ntsha thiab nqaim lawv cov khoob.

Kev Tiv Thaiv Retinopathy Mob Ntshav Qab Zib

Kev tiv thaiv ntawm retinopathy yog tswj cov ntshav qab zib kom zoo nyob rau hauv cov ntshav qab zib, kev them nyiaj rau kev noj qab haus huv rau cov metabolism, tswj ntshav siab, kho cov lipid metabolism. Qhov no tso cai rau koj kom txo kev muaj mob rau lub qhov muag.

Kev noj haus kom zoo thiab kev tawm dag zog kom lub cev muaj txiaj ntsig zoo cuam tshuam rau cov xwm txheej ntawm cov neeg mob ntshav qab zib. Nws tseem yog ib qho tseem ceeb uas yuav tsum tau mus kuaj mob tsis tu ncua los ntawm kws kho qhov muag. Kev tiv thaiv raws sijhawm ntawm tus mob ntshav qab zib retinopathy thiab qhov muag puas tsuaj hauv ntshav qab zib yog qhov tseem ceeb heev. Txij li nyob rau theem tom qab ntawm tus kab mob, kev kho mob tsis muaj txiaj ntsig.Txawm li cas los xij, vim qhov tseeb tias nyob rau theem pib ntawm retinopathy, kev tsis txaus ntseeg tsis pom, cov neeg mob nrhiav kev pab thaum muaj cov ntshav tawm thiab cov kev hloov pauv hauv nruab nrab ntawm thaj chaw ntawm retina twb tshwm sim lawm.