Khafetsa ka lefu la tsoekere, khatello ea mali e phahama, e senyang tsamaiso ea methapo ea pelo, e lematsang liphio le litho tse ling tsa ka hare. Ho mofuta oa 1 lefu la tsoekere, khatello ea mali e hlaha ka lebaka la methapo ea meno. Haeba motho a e-na le mofuta oa 2, joale nts'etsopele ea lefu la Itenko-Cushing's, pheochromocytoma, e etsa hore khatello e eketsehe. Ho bakuli ba joalo, khatello ea maikutlo e lebisa ho nts'etsopele ea methapo e lebisang lefung, ka hona ngaka e beha matlapa a antihypertensive. Lihlopha tse ka sehloohong tsa lithethefatsi li kenyelletsa: diuretics, ACE inhibitors, beta-blockers, BKK, ARB.
Diuretics
Li-diuretics ke diuretics tse nooang hammoho le meriana e meng. E ama tšebetso ea liphio le ho potlakisa ho ntšoa ha moroto 'meleng. Ho lefu la tsoekere, diuretics li ka fokotsa matšoao a khatello ea mali le ho tlosa ho ruruha.
Lithethefatsi tsa diuretic ke tsa mefuta e latelang:
- Loop - thusa ho potlakisa khatello ea khatello. Furosemide e nkoa e le sethethefatsi se tloaelehileng ka ho fetisisa.
- Thiazide - eketsa bongata ba tsoekere, cholesterol le triglycerides. Tsena ke chlortalidone, clopamide, indapamide.
- Osmotic - tlosa mokelikeli o mongata linthong tse ntle ka lebaka la phokotso ea khatello ea mali. E sebetsang ka ho fetisisa: Potasium acetate, Mannitol.
Bakuli ba bangata ba nang le khatello e phahameng ea mali ba fuoe diuretics ea thiazide, e lokelang ho nkuoa nako e telele. Empa li ka lebisa tahlelong e kholo ea sodium. Ho nka meriana ena, bakuli ba lokela ho ja litholoana le meroho e mecha, ho lefella ho lahleheloa ke magnesium, potasiamo le sodium. Nakong ea kalafo, tsoekere ea mali e lokela ho hlahlojoa, e eketsa palo ea diuretic, haeba ho hlokahala.
Haeba mokuli ea nang le lefu la tsoekere la mofuta oa 2 a hlaha a ruruha maoto ka lebaka la khatello e phahameng, ngaka e beha Indapamide kapa Arifon. Lithethefatsi tsena ka bobeli ha li ame metabolism ea carbohydrate. Li-diuretics tse ling ha li sebelisoe hangata haholo.
Li-inhibitors tsa ACE
E bohlokoa haholo bakeng sa lefu la tsoekere, le tsamaeang le khatello ea mali ea methapo, li-inhibitors tsa ACE. Lithethefatsi tse joalo li thibela tlhahiso ea enzyme e ikarabellang bakeng sa tlhahiso ea ntho e lebisang ho tsitsitseng ha methapo ea mali ea boko, hape e kenya letsoho ho hlahisoeng ha aldosterone e ngata, e qhekellang sodium le metsi lithong tsa mmele. Ka lebaka la ts'ebeliso ea li-inhibitors tsa ACE, methapo ea mali e hlapolloang le mokelikeli o mongata o tlosoa 'meleng, e lebisang ho fokotseha ha khatello.
Lithethefatsi tse joalo li na le phello e boletsoeng, e phehellang esita le ka ho fokotseha ha khatello ka potlako. Ntle le moo, li na le phello e molemo maboteng a methapo ea mali, li thibela ho thehoa ha liathomo tsa atherosselotic, hape li na le phello ea pelo, e sirelletsang khahlanong le ho hlaseloa ke pelo le stroke. Li-inhibitors tsa ACE ha li sitise metabolism ea mafura le lik'habohaedreite hape li eketsa kutloisiso ea lithane ho insulin.
Lithethefatsi tse joalo li laetsoe ka hloko mabapi le ho se sebetse hantle ha renal ba lieha ho felisoa ha potasiamo ho tsoa 'meleng. Ka linako tse ling, khahlano le semelo sa bona, litla-morao li hlaha ka mokhoa oa khohlela e matla, e hlokang ho khaotsa ts'ebeliso ea lithethefatsi. Li-contraindicated nakong ea bokhachane, letsoele, pelo ea methapo ea methapo.
Lithethefatsi tse sebetsang ka ho fetisisa:
- Enalapril, Attoril, Burlipril, Enap.
- Quinapril, Quinafar, Accupro.
- Lisinopril, Vitopril, Diroton, Zonixem.
Beta blockers
Beta-blockers ba laetsoe lefu la tsoekere le khatello e phahameng ea mali, ha boemo bona bo thatafatsoa ke ho se sebetse ha pelo, angina pectoris le tachycardia. Hangata, ngaka e khetha sehlopha sa methapo ea pelo e se nang litlamorao tse mpe ho metabolism ea lefu la tsoekere.
Tsena li kenyeletsa:
- Atenolol, Atenol, Atenobene.
- Metoprolol, Corvitol, Emzok.
- Bisoprolol, Concor, Coronal, Bicard, Bidop.
Empa lithethefatsi tse joalo li ka eketsa bongata ba tsoekere le cholesterol 'meleng le ho eketsa ho hanyetsoa ha insulin.
Li-blocker tsa Beta tse kang Nebilet, Coriol, Atram, li na le matla a tlatselletsang a vasodilating. Lipilisi tsena tsa khatello ea lefu la tsoekere li theola khatello ea "insulin" 'me li na le phello e molemo ho metabolism ea lipid le carbohydrate.
BKK (bahanyetsi ba calcium)
Li-blockers tsa calcium calcium li atisa ho fuoa khatello, hobane ha li ame metabolism ea lipid le carbohydrate. Li sebelisoa ha mokuli a boetse a e-na le ischemia le angina pectoris. Pele ho tsohle, lithethefatsi tse joalo li laeloa batho ba tsofetseng.
Khetho e fuoa meriana e nang le phello e telele, e lokelang ho nooa nako e le ngoe ka letsatsi:
- Lercanidipine.
- Felodipine.
- Nifedipine.
- Amlodipine.
Amlodipine e na le phello e telele.
Likhohlano tsa khalsiamo li lebisa ho nts'etsopele ea litla-morao tse kang ho ruruha le sekhahla sa pelo, seo hangata se lebisang ho hlakoleng ha bona. Motsoako o le mong feela o se nang litlamorao tse mpe ke Lerkamen.
ARB (lingiotensin receptor antagonists)
Angiotensin II receptor blockers e sebetsa hantle ho phekoleng khatello ea mali ea methapo e tsamaeang le lefu la tsoekere. Li na le thepa e latelang:
- fokotsa ho hanyetsa insulin;
- ba le phello ea nephroprotective;
- fokotsa hypertrophy ea ventricle ea pelo e setseng;
- u se ke oa ama mekhoa ea metabolic;
- mamelleha hantle mme o na le litla-morao tse fokolang.
Ts'ebetso ea lithethefatsi e hola hanyane ka hanyane mme e fihlela botebo ba eona libeke tse 2-3 kamora ho qala taolo.
Lithethefatsi tse sebetsang ka ho fetisisa:
- Sartokad, Diosar, Vasar.
- Limakasine, Adible, Candecor.
- Closart, Lorista, Cozaar, Lozap.
Li-blocker tsa Alpha
U sebelisa li-alpha-blockers, mosebetsi oa li-receptor tsa α-adrenergic tse fumanehang liseleng tse ngata le litho li koetsoe. Lithethefatsi tse joalo lia khetha ebile ha li ikhethe. Bakeng sa kalafo ea khatello ea mali maling a lefu la tsoekere, ho sebelisoa li-alpha-blockers tse sebelisoang feela 'me li sebelisitsoe feela ho kopantseng kalafo.
Tsena li kenyeletsa:
- Terazosin.
- Doxazosin.
- Prazosin.
Lithethefatsi tse joalo li fokotsa khatello ea "glucose" le "lipids" hammoho le ho hanyetsa insulin. Ka lebaka la li-alpha-blockers, khatello e fokotseha hantle, ntle le ho baka kholo e matla ea sekhahla sa pelo. Empa meriana e joalo e lokela ho nkoa ka hloko ka neuropathy e matla, e khethiloeng ke lerotholi la khatello ea orthostatic. Li boetse li loantsoe ke mafu a pelo.
Terazosin e fokotsa khatello ea "glucose" le lipids.
Rasilez (renin inhibitor e tobileng)
Ena ke setlhare se secha se fokotsang khatello ea mali ka botlalo letsatsi lohle. Kamora libeke tse peli tsa ho ja khafetsa, karabelo e matlafatsang le ho khutlisetsa litekanyetso tse tloaelehileng tsa hemodynamic li bonoa.
Rasilez e sebelisoa hammoho le kalafo ea ho kopanya le angiotensin ii receptor blockers kapa li-inhibitors tsa ACE. Ka lebaka la motsoako ona, liphio le pelo li sirelelitsoe ka nepo. Setlhare sena se thusa ho ntlafatsa k'holeseterole maling le ho matlafatsa kutloisiso ea linama ho insulin.
Ke lipilisi life tseo ho leng molemo ho li ila pele ho lefu la tsoekere?
Leha e le hore ho na le palo e kholo ea lithethefatsi tse fokotsang khatello ea mali e phahameng, ha se lithethefatsi tsohle tse loketseng batho ba nang le lefu la tsoekere. Meriana e latelang e thibetsoe - Xipamide, Hydrochlorothiazide, Hypothiazide. Tsena ke li-diuretics tse eketsang tsoekere ea mali le ho eketsa bongata ba cholesterol e mpe. Ntle le moo, meriana e joalo e ama ts'ebetso ea liphio hantle, e leng kotsi haholo bathong ba nang le bothata ba ho hloleha ha meno.
Ts'ebeliso ea lithethefatsi tse felisang kalafo joaloka li-calcium antagonists tse amanang le dihydropyridines tse nkang nakoana ha e khothalletsoe khatello e phahameng ea mali le lefu la tsoekere. Leha e le ka tekanyetso e nyane, ba eketsa haholo menyetla ea ho ba le lefu la pelo 'me ba tšoaelitsoe ke lefu la pelo. Tsena li kenyelletsa lithethefatsi Nifedipine.
Atenolol, eo e leng ea sehlopha sa beta-blockers, e thibetsoe, hobane e kenya letsoho ho tloleng ho matla tsoekere ea mali le kholo ea kholo ea "hypo-" le hyperglycemia. Ntle le moo, moriana o joalo o fokotsa kutloisiso ea lisele ho insulin, e hlahisoang ke manyeme.
Ho eketsa khatello ea mali ho lefu la tsoekere?
Khatello e tlase ea mali ea mofuta oa 2 lefu la tsoekere hangata e hlaha ho basali. Maemong ana, ho na le tlolo ea ho potoloha ha lisele, 'me lisele li emisa ho fumana limatlafatsi tse hlokahalang. Haeba boemo bona bo sa phekoloe, joale sena se lebisa ho nts'etsopele ea mathata a pelo le pelo. Ntle le moo, litla-morao tse bohloko tse kang:
- lefu la tsoekere;
- thrombosis
- lefu la linama lintlheng tse tlase;
- liso tsa lefu la tsoekere.
Hypotension a lefu la tsoekere e hlaha ka lebaka la:
- ho hloka boroko
- mafu a ka mpeng;
- ho haella ha livithamini le liminerale 'meleng;
- khatello ea maikutlo
- lefu la pelo
- kalafo ea lithethefatsi ea nako e telele;
- mafu a tsamaiso ea methapo.
Bakuli ba eketsehile mofufutso, ho otsela ho feteletseng, maikutlo a ho ba le mathata, tlhaselo ea ho tšoha e hlaha, bofokoli le ho otsela li etsahala. Ho eketsa khatello ea lefu la tsoekere, ho fanoa ka litlhare tse khethehileng. Lithethefatsi tse ntle ka ho fetisisa ke Eleutherococcus le Leuzea. Li nooa matsatsi a 7, kamora moo li phomola khoeli e le 'ngoe.
Ka hypotension, litlhare tsa kalafo lia thusa. U ka kopanya tee e tala e nang le asiti le ascorbic acid. Ho kenella ka katleho ea khabone ea mmutla. Ho etsa sena, tšela 20 g ea semela se omileng ka khalase ea metsi a belang ebe u tsitlella lihora tse 3. Ho kenngoa ho hloekisoa ebile ho nkoa makhetlo a mararo ka letsatsi. Libate tse nang le oli e nkhang hamonate li boetse li thusa ho eketsa khatello. Bakeng sa sena, li-clove, bergamot, lemone, lamunu, eucalyptus li loketse.
U ka khetha lipilisi tsa mofuta o itseng oa kliniki?
Lingaka li khothaletsa ho sebelisa lithethefatsi tse 'maloa tsa lihlopha tse fapaneng ka nako e le' ngoe. Sena se thusa kalafo e sebetsang haholoanyane bakeng sa khatello ea mali ho lefu la tsoekere. Ha ho kopantsoe kalafo, ho sebelisoa litekanyetso tse nyane tsa lithethefatsi, 'me lithethefatsi tse ngata li ka emisa litlamorao. Morero oa kalafo o khethoa ke ngaka ho thibela kotsi ea ho otloa ke pelo le stroke.
Ka kotsi e nyane, monotherapy ea tekanyetso e tlase e etsoa. Haeba ho sa khonehe ho fokotsa khatello ho lipalo tse nepahetseng, ngaka e beha moriana o mong, 'me haeba o sa sebetse, motsoako oa lithethefatsi tse' maloa tsa lihlopha tse fapaneng.
Kotsi e kholo ea ho senyeha ha methapo ea pelo le pelo, kalafo e nang le lithethefatsi tse 2 ka litekanyetso tse tlase ea hlokahala. Haeba kalafo e joalo e sa ka ea sebetsa, joale ngaka e beha moriana oa boraro ka tekanyetso e tlase kapa e fana ka litlhare ka bobeli ka tekanyetso e kholo. Haeba ho sena sephetho, ho sebelisoa kalafo ea kalafo ea lithethefatsi tse 3 ka tekanyetso e phahameng ka ho fetisisa.
Algorithm bakeng sa ho khetha lithethefatsi khatello ea lefu la tsoekere (ka methati):
- Keketseho ea mantlha ea khatello ea mali - fana ka li-ARB kapa li-inhibitors tsa ACE.
- Khatello ea mali e eketsehile, empa ha ho na protheine ho moroto - eketsa diuretics, BKK.
- Khatello ea mali e phahame ho feta e tloaelehileng, protheine e nyane e fumanoa moriring - li-thiazide le BKK ea nako e telele lia eketsoa.
- Khatello e phahameng ea mali hammoho le ho hloleha hoa renal - eketsa BKK le loopture ea looptitis.
Pele a etsa moriana oa kalafo, ngaka e hlahloba liphetho tsa lithuto tsa maiketsetso le tsa laboratori. U ka se ipehele lithethefatsi khatello ea lefu la tsoekere, hobane tse ngata tsa tsona li lebisa ho mathata a maholo le lefu.
