Khatello e phahameng ea mali bakeng sa lefu la tsoekere

Hypertension ke ha khatello ea mali e phahame haholo hoo mehato ea kalafo e ka bang molemo haholo ho mokuli ho feta litla-morao tse mpe. Haeba u na le khatello ea mali ea 140/90 kapa ho feta - ke nako ea ho fola ka botlalo. Hobane khatello ea khatello ea mali e eketsa menyetla ea ho tšoaroa ke lefu la pelo, ho otloa ke lefu la ho nyekeloa ke masapo kapa ho foufala ka makhetlo a 'maloa. Mofuta oa 1 kapa lefu la tsoekere la 2, sekhahla se phahameng sa khatello ea mali se theohela ho 130/85 mmHg. Art. Haeba o na le khatello e phahameng, o lokela ho etsa boiteko bohle ho e fokotsa.

Ka lefu la tsoekere la mofuta oa 1 kapa mofuta oa 2, khatello ea mali e kotsi haholo. Hobane haeba lefu la tsoekere le kopantsoe le khatello e phahameng ea mali, kotsi ea ho bolaoa ke lefu la pelo e eketseha ka makhetlo a 3-5, ho otloa ke makhetlo a 3-4, ho foufala ka makhetlo a 10 - 20, ho hlaphoheloa ke lefu la masapo ka makhetlo a 20-25, ho ba le leqeba la mokokotlo - Makhetlo a 20. Ka nako e ts'oanang, khatello e phahameng ea mali ha e thata hakalo hore e ka tloaeleha, ntle le haeba lefu la hau la menoana le se le le hole haholo.

Lisosa tsa khatello ea mali ho lefu la tsoekere

Ho mofuta oa 1 le lefu la tsoekere la 2, lisosa tsa nts'etsopele ea khatello ea mali ea methapo li ka fapana. Mofuta oa 1 lefu la tsoekere, khatello ea mali ho 80% ea maemo a hlaha ka lebaka la tšenyo ea menoana (lefu la tsoekere). Ho mofuta oa 2 lefu la tsoekere, khatello ea maikutlo hangata e hlaha ho mokuli pejana ho feta mathata a metabolism ea carbohydrate le lefu la tsoekere ka bolona. Hypertension ke e 'ngoe ea likarolo tsa metabolic syndrome, e leng moetapele oa mofuta oa lefu la tsoekere la 2.

Lisosa tsa nts'etsopele ea khatello ea mali ho lefu la tsoekere le khafetsa

Lintlha tse tafoleng. Isolated systolic hypertension ke bothata bo ikhethileng ho bakuli ba tsofetseng. Bala haholoanyane sehloohong se reng "Isolated systolic hypertension in the older" Psychology e 'ngoe ea endocrine - e ka ba pheochromocytoma, hyperaldosteronism ea mantlha, lefu la eona la Itenko-Cushing, kapa lefu le leng le sa tloaelehang.

Phekolo ea methapo ea methapo - e bolelang hore ngaka ha e khone ho tseba sesosa sa keketseho ea khatello ea mali. Haeba khatello ea mali e kopane le botenya, ho ka etsahala, sesosa ke ho se mamelle lijo tsa lik'habohaedreite le boemo bo eketsehileng ba insulin maling. Sena se bitsoa "metabolic syndrome," 'me se arabela hantle kalafong. E kanna ea ba:

• khaello ea magnesium 'meleng;
• khatello ea kelello e sa foleng;
• botaoa le mercury, lead kapa cadmium;
• ho fokotseha ha methapo e kholo ea methapo ka lebaka la atherosclerosis.

Hape hopola hore haeba mokuli a hlile a batla ho phela, moriana o hloka matla :).

Type 1 lefu la tsoekere e phahameng

Ho mofuta oa 1 lefu la tsoekere, sesosa se ka sehloohong le se kotsi haholo sa khatello e eketsehileng ke ho senyeha ha meno, haholo lefu la tsoekere. Khatello ena e hlaha ho 35-40% ea bakuli ba nang le lefu la tsoekere la 1 mme ba tsoa mehatong e 'maloa:

• sethala sa microalbuminuria (limolek'hule tse nyane tsa protheine ea albin li hlaha ka har'a moroto);
• sethala sa "proteinuria" ("liphio filthara" se sebe le ho feta, 'me ho hlaha liprotheine tse kholo ka har'a moroto);
• Boemo ba ho hloleha ho tsitsipano hoa renal.

Ho latela Federal State Institution Endocrinology Research Center (Moscow), hara bakuli ba nang le lefu la tsoekere la 1 ntle le lefu la liphio, khatello ea mali e ama 10%. Ho bakuli ba sethaleng sa microalbuminuria, boleng bona bo nyolohela ho 20%, sethaleng sa proteinuria - 50-70%, sethaleng sa ho hloleha ha renal ho sa feleng - 70-100%. Ha proteni e ngata e pepesitsoe moroto, khatello ea mali e holimo le ho feta - ona ke molao o akaretsang.

Hypertension le ho senyeha ha liphio li hlaha ka lebaka la hore liphooko ha li na sodium e ngata hantle ka har'a moroto. Sodium e maling e ba kholoanyane 'me mokelikeli oa e haha. Ho ata ha mali a potoloha ho eketsa khatello ea mali. Haeba tsoekere ea glucose e eketseha ka lebaka la lefu la tsoekere maling, e ntšoa metsi a mangata le eona e le hore mali ha a teteane haholo. Kahoo, bophahamo ba mali bo potoloha bo ntse bo eketseha.

Hypertension le lefu la liphio li etsa potoloho e mpe ea kotsi. Mmele o leka ho lefella ts'ebetso e mpe ea liphio, ka hona khatello ea mali e phahama. Eona e eketsa khatello kahare ho glomeruli. Lintho tseo ho thoeng ke tsa ho sefa. Ka lebaka leo, butle-butle glomeruli ea shoa, 'me liphio li sebetsa le ho feta.

Ts'ebetso ena e phethela ka ho se sebetse hantle ha methapo. Ka lehlohonolo, matsatsing a pele a lefu la tsoekere le nephropathy, potoloho e mpe e ka robeha haeba mokuli a phekoloa ka hloko. Ntho ea bohlokoa ke ho theola tsoekere ea mali ho ea ho tloaelehileng. Li-inhibitors tsa ACE, li-angiotensin receptor blockers, le diuretics le tsona lia thusa. U ka bala ho eketsehileng ka bona ka tlase.

Hypertension le mofuta oa 2 lefu la tsoekere

Nako e telele pele nts'etsopele ea lefu la tsoekere la "nnete" la 2 e sebetsa, ts'ebetso ea lefu lena e qala ka ho hanyetsa insulin. Sena se bolela hore kutloisiso ea mesifa ea tšebetso ea insulin e fokotsehile. Ho lefella ho hanyetsa insulin, insulin e ngata e potoloha maling, 'me sena ka bosona se eketsa khatello ea mali.

Ha lilemo li ntse li feta, lumen ea methapo ea mali e saroloha ka lebaka la atherosclerosis, 'me sena e ba "monehelo" o mong kholisong ea khatello ea mali. Ka ho tšoanang, mokuli o na le botenya ka mpeng (ho pota lethekeng). Ho lumeloa hore lithane tsa adipose li ntša lintho maling le ka ho eketsa khatello ea mali.

Motsoako ona kaofela o bitsoa metabolic syndrome. Ho hlahella hore khatello ea mali e eketseha pejana ho lefu la tsoekere la mofuta oa 2. Hangata e fumanoa ho mokuli hang hang ha ho fumanoa hore o na le lefu la tsoekere. Ka lehlohonolo, lijo tse nang le lik'habohaedreite tse tlase li thusa ho laola lefu la tsoekere la 2 le khatello ea mali ka nako e le 'ngoe. U ka bala lintlha tse ka tlase.

Hyperinsulinism ke pokello ea insulin e ngata maling. E etsahala ka lebaka la ho hanyetsa insulin. Haeba makhopho a mantle a tlameha ho hlahisa insulin e ngata, e tla "tepella" haholo. Ha a khaotsa ho phela ka lilemo, tsoekere ea mali e phahama ebe lefu la tsoekere la 2 le hlaha.

Mokhoa oa hyperinsulinism o eketsa khatello ea mali:

• e buella tsamaiso ea methapo e nang le kutloelo-bohloko;
• Liphio li sebelisa sodium e tsoekere le mokelikeli o mongata ho feta ka moroto;
• sodium le calcium li bokellana kahare ho lisele;
• insulin e ngata e thusa ho tiisa mabota a methapo ea mali, e leng ho fokotsang matla a tsona.

Likarolo tsa lipontšo tsa khatello ea mali ho lefu la tsoekere

Ka lefu la tsoekere, morethetho oa tlhaho oa ho feto-fetoha ha maemo ho feto-fetoha ha khatello ea mali oa senyeha. Ka tloaelo, ho motho hoseng le bosiu nakong ea boroko, khatello ea mali e tlase ka 10-20% ho feta nakong ea motšehare. Lefu la tsoekere le lebisa 'neteng ea hore ho bakuli ba bangata ba nang le khatello e matla khatello ea mali ha e fokotsehe. Ho feta moo, hammoho le khatello ea mali le lefu la tsoekere, khatello ea bosiu hangata e phahame ho feta khatello ea motšeare.

Boloetse bona bo nahanoa hore bo bakoa ke lefu la tsoekere la lefu la tsoekere. Tsoekere e phahameng ea mali e ama tsamaiso ea methapo ea kutlo, e laolang bophelo ba 'mele. Ka lebaka leo, bokhoni ba methapo ea mali ho laola molumo oa bona, i.e., ho ts'oara le ho phomola ho latela mojaro, bo ntse bo mpefala.

Qeto ke hore ka kopanelo ea khatello ea mali le lefu la tsoekere, ha ho hlokahale feela litekanyo tsa khatello ea nako e le 'ngoe le tonometer, empa le tlhaiso ea lihora tse 24. E etsoa ho sebelisoa sesebelisoa se ikhethang. Ho latela liphetho tsa boithuto bona, o ka fetola nako ea ho nka le litekanyetso tsa lithethefatsi bakeng sa khatello.

Boikoetliso bo bontša hore bakuli ba nang le lefu la tsoekere la mofuta oa 1 le mofuta oa 2 hangata ba tsotella letsoai haholo ho feta bakuli ba se nang lefu la tsoekere. Sena se bolela hore ho fokotsa letsoai lijong ho ka ba le phello e matla ea pholiso. Ho lefu la tsoekere, ho phekola khatello e phahameng ea mali, leka ho ja letsoai le tlase 'me ka mor'a khoeli, hlahloba se etsahalang.

Khatello e phahameng ea mali ho lefu la tsoekere hangata e thatafalloa ke hypotension ea orthostatic. Sena se bolela hore khatello ea mali ea mokuli e fokotseha haholo ha o tloha sebakeng sa ho bua leshano ho ea boemong ba ho ema kapa ho lula. Orthostatic hypotension e iponahatsa ka mor'a ho phahama ho tsitsitseng ha meno, ho fifala mahlong kapa esita le ho akheha.

Jwalo ka tlolo ya morethetho wa circadian wa khatello ya madi, bothata bona bo hlaha ka lebaka la ntshetsopele ya lefu la tsoekere le lefu la tsoekere. Butle-butle tsamaiso ea methapo e lahleheloa ke matla a ho laola molumo oa methapo. Ha motho a phahama ka potlako, moroalo o phahama hanghang. Empa 'mele ha o na nako ea ho eketsa phallo ea mali ka har'a methapo, mme ka lebaka lena, bophelo bo botle bo mpefala.

Orthostatic hypotension e thatafatsa ho hlahlojoa le kalafo ea khatello e phahameng ea mali. Ho lekanya khatello ea mali ho lefu la tsoekere ho hlokahala maemong a mabeli - ho ema le ho robala. Haeba mokuli a e-na le bothata bona, o lokela ho tsoha nako le nako, "ho ea ka bophelo ba hae bo botle".

Lijo tse amanang le lefu la tsoekere

Sebaka sa rona sa marang-rang se thehiloe ho khothaletsa lijo tse nang le lik'habohaedreite tse tlase tsa mofuta oa 1 le lefu la tsoekere la 2. Hobane ho ja lik'habohaedreite tse tlase ke tsela e molemohali ea ho theola le ho boloka tsoekere ea hau ea mali. Tlhokahalo ea hau ea insulin e tla fokotseha, mme sena se tla thusa ho ntlafatsa sephetho sa hau sa kalafo ea khatello ea mali. Hobane ha insulin e potoloha maling, e eketsa khatello ea mali haholo. Re se re buile ka mochine ona ka botlalo.

Re khothaletsa lingoloa tsa hau tsa tlhokomelo:

• Insulin le lik'habohaedreite: 'nete eo u lokelang ho e tseba.
• Mokhoa o motle oa ho theola tsoekere ea mali le ho o boloka o tloaelehile.

Lijo tse nang le lik'habohaedreite tse tlase tse nang le lefu la tsoekere li loketse feela haeba o e-so qalelle ho hloleha ha meno. Mokhoa ona oa ho ja o sireletsehile ka botlalo mme o na le thuso nakong ea sethala sa microalbuminuria. Hobane ha tsoekere ea mali e theohela boemong bo tloaelehileng, liphio li qala ho sebetsa ka tsela e tloaelehileng, 'me litaba tsa albin ka har'a moroto li khutlela ho tse tloaelehileng. Haeba u na le karolo ea proteinuria - ela hloko, etela ngaka ea hau. Ithute hape le "Diabetes Kidney Diet".

Lefu la tsoekere le lokela ho imoloha ho isa kae?

Bakuli ba nang le khatello ea mali e matla le lefu la tsoekere ke bakuli ba nang le kotsi e phahameng kapa e phahameng haholo ea mathata a pelo le methapo. Ho khothalletsoa hore ba theole khatello ea mali ho 140/90 mm RT. Art. libekeng tse 4 tse qalang, haeba ba mamella tšebeliso ea lithethefatsi tse behiloeng hantle. Libekeng tse latelang, o ka leka ho theola khatello ho fihlela e ka ba 130/80.

Ntho ea bohlokoa ke hore na mokuli o mamella joang kalafo ea lithethefatsi le litholoana tsa eona? Haeba e le mpe, khatello ea mali e tlase e lokela ho ba butle butle, maemong a mangata. Karolong e 'ngoe le e' ngoe ea methapo ena - ka 10-15% ea boemo ba pele, nakong ea libeke tse 2,2. Ha mokuli a ikamahanya le maemo, eketsa litekanyetso kapa eketsa palo ea meriana.

Haeba o fokotsa khatello ea mali ka methati, joale sena se qoba likarolo tsa hypotension 'me ka hona, o fokotsa kotsi ea infyo ea myocardial kapa stroke. Moeli o tlase oa monyako oa khatello e tloaelehileng ea mali ke 110-115 / 70-75 mm RT. Art.

Ho na le lihlopha tsa bakuli ba nang le lefu la tsoekere ba theolang khatello ea mali "holimo" ho 140 mmHg. Art. mme e tlase e ka ba thata haholo. Lenane la bona le kenyeletsa:

• bakuli ba seng ba e-na le litho tsa bona tse tobileng, haholo-holo liphio;
• bakuli ba nang le mathata a pelo;
• batho ba tsofetseng, ka lebaka la ts'enyo ea methapo e amanang le botsofali ho atherosclerosis.

Lipilisi tsa khatello ea lefu la tsoekere

Ho ka ba thata ho khetha lipilisi tsa khatello ea mali ho mokuli ea nang le lefu la tsoekere. Hobane metabolism ea carbohydrate e senyehileng e beha lithibelo ts'ebelisong ea lithethefatsi tse ngata, ho kenyelletsa le khatello ea mali. Ha a khetha moriana, ngaka e nahana ka hore na mokuli o laola lefu la hae la lefu la tsoekere le hore na ke mafu afe a kopaneng, ntle le khatello ea mali.

Lipilisi tse ntle tsa khatello ea tsoekere li lokela ho ba le thepa e latelang:

• fokotsa haholo khatello ea mali, 'me ka nako e ts'oanang ho fokotsa litla-morao;
• se ke oa mpefatsa taolo ea tsoekere ea mali, u se ke ua eketsa cholesterol e “mpe” le triglycerides;
• Sireletsa pelo le liphio ho tsoa kotsi e bakoang ke lefu la tsoekere le khatello e phahameng ea mali.

Hajoale ho na le lihlopha tse 8 tsa lithethefatsi bakeng sa khatello ea mali, tseo tse 5 tsa tsona e leng tsona tse ka sehloohong tse 3 tse ling. Matlapa, e leng a lihlopha tse eketsehileng, a laetsoe e le molao, e le karolo ea kalafo e kopaneng.

Lihlooho tsa khatello ea khatello

Ka tlase re fana ka likhothaletso bakeng sa taolo ea lithethefatsi tsena ho bakuli ba nang le lefu la khatello ea mali eo ho lona ho rarahaneng mofuta oa lefu la tsoekere la mofuta oa 2 kapa mofuta oa 2.

Diuretics (diuretics) tsa khatello

Tlhophiso ea diuretics

Tlhahisoleseling e qaqileng ka lithethefatsi tsena tsohle tsa diuretic e ka fumanoa mona. Joale, a re tšohleng hore na diuretics li tšoara khatello ea mali ho tsoekere joang.

Phekolo ea methapo ho bakuli ba nang le lefu la tsoekere hangata e ba teng ka lebaka la hore palo ea mali a potoloha e ea eketseha. Hape, batho ba nang le lefu la tsoekere ba khetholloa ke ho eketseha ha letsoai le letsoai. Tabeng ena, li-diuretics hangata li laeloa ho phekola khatello e phahameng ea mali ho lefu la tsoekere. Bakeng sa bakuli ba bangata, lithethefatsi tsa diuretic li thusa hantle.

Lingaka li thabela diuretics tsa thiazide hobane lithethefatsi tsena li fokotsa kotsi ea ho tšoaroa ke pelo le ho otloa ke bakuli ba nang le khatello ea mali ka 15-25%. Ho kenyelletsa ba nang le lefu la tsoekere la mofuta oa 2. Ho lumeloa hore ka tekanyetso e nyane (e lekanang le hydrochlorothiazide <25 mg ka letsatsi) ha ba nyenyefatse taolo ea tsoekere ea mali ebile ha ba eketse cholesterol e "mpe".

Liuretics tsa Thiazide le thiazide li tšoaetsanoa ho bakuli ba nang le bothata bo sa foleng ba a reisosis. Liopture tsa Loop, ka lehlakoreng le leng, li sebetsa hantle ho hloleha ha rems. Li khethoa haeba khatello ea mali e kopantsoe le edema. Empa ha ho na bopaki ba hore ba sireletsa liphio kapa pelo. Potrate-sparing le osmotic diuretics tsa lefu la tsoekere ha e sebelisoe ho hang.

Ka khatello ea mali e kopantsoeng le lefu la tsoekere, litekanyetso tse nyane tsa thiazide diuretics hangata li fanoa hammoho le ACE inhibitors kapa beta-blockers. Hobane diuretics feela, ntle le lithethefatsi tse ling, ha e sebetse ka ho lekaneng maemong a joalo.

Beta blockers

Meriana e tsoang sehlopheng sa beta-blocker ke:

• ea khethang le e seng khetho;
• lipophilic le hydrophilic;
• le ts'ebetso ea ntle le kutloelo-bohloko.

Tsena tsohle ke thepa ea bohlokoa, 'me ho bohlokoa hore mokuli a qete metsotso e leshome le metso e mehlano ho li utloisisa. Ka nako e tšoanang ithute ka li-contraindication le litlamorao tsa beta-blockers. Kamora moo, o ka utloisisa hore na hobaneng ngaka e laetse sena kapa sethethefatsi seo.

Beta-blockers li tlameha ho fuoa mokuli ea nang le lefu la tsoekere haeba a ka fumanoa a e-na le ho tsoa lenaneng le latelang:

• lefu la pelo;
• ho nyekeloa ke pelo;
• nako e mpe haholo ea kamora lefutso - bakeng sa thibelo ea infarction ea myocardial e sa khaotseng.

Maemong ana kaofela, beta-blockers e fokotsa haholo kotsi ea lefu la lefu la pelo le lisosa tse ling.

Ka nako e ts'oanang, beta-blockers e ka pata matšoao a ho ba le hypoglycemia e matla, hape ea etsa hore ho be thata ho tsoa seterekeng sa hypoglycemic. Ka hona, haeba motho ea nang le lefu la tsoekere a sitisitse tlhokomeliso ea hypoglycemia, lithethefatsi tsena li ka fuoa feela ka hloko e matla.

Bakhethoa ba beta-block ba na le litlamorao tse mpe ho metabolism ho lefu la tsoekere. Sena se bolela hore, ho ea ka lipontšo, mokuli o hloka ho nka li-beta-blockers, joale lithethefatsi tsa pelo li lokela ho sebelisoa. Li-blocker tsa Beta tse nang le mosebetsi oa vasodilator - nebivolol (Nebilet) le carvedilol (Coriol) - li ka ntlafatsa metabolism ea lik'habohaedreite le mafura. Ba eketsa kutloisiso ea lithane ho insulin.

Hlokomela Carvedilol ha se beta-blocker e khethang, empa ke e 'ngoe ea lithethefatsi tsa sejoale-joale tse sebelisoang haholo, tse sebetsang hantle mme, mohlomong, ha se mpefatse metabolism ho lefu la tsoekere.

Ba-beta-blockers ba mehleng ena, ho fapana le lithethefatsi tsa moloko o fetileng, ba khothaletsoa ho fana ka khetho ho kalafo ea bakuli ba nang le lefu la tsoekere, hammoho le bakuli ba kotsing ea ho ba le lefu la tsoekere la mofuta oa 2. Ka lehlakoreng le leng, li-beta-blockers tse se nang khetho tse se nang tšebetso ea vasodilator (propranolol) li eketsa kotsi ea lefu la tsoekere la mofuta oa 2.

Ba matlafatsa ho hanyetsoa ha insulin liseleng tsa paripheral, hape ba eketsa boemo ba cholesterol e mpe “le e mpe” maling. Ka hona, ha e khothalletsoe bakuli ba nang le lefu la tsoekere kapa ba nang le monyetla oa ho ba le lefu la tsoekere la mofuta oa 2.

Li-blocker tsa li-calcium calcium (li-antagonists tsa calcium)

Tlhophiso ea liteishene tsa calcium calcium blockers

Lithane tsa khalsiamo ke lithethefatsi bakeng sa khatello ea mali, tse atisang ho laoloa lefatšeng ka bophara. Ka nako e ts'oanang, lingaka le bakuli ba eketsehileng "ka letlalo la bona" ​​ba kholoa hore matlapa a magnesium a na le phello e ts'oanang le ea li-calcium channel blockers. Mohlala, sena se ngotsoe bukeng ea Reverse Heart Illase Now (2008) ke lingaka tsa Amerika Stephen T. Sinatra le James C. Roberts.

Khaello ea Magnesium e senya metabolism ea calcium, mme hona ke sesosa se tloaelehileng sa khatello ea mali. Motsoako o tsoang ho sehlopha sa khalsiamo ea calcium hangata o baka ho ruruha, ho opeloa ke hlooho, ho sohloka le ho ruruha ha maoto. Litokisetso tsa Magnesium, ka lehlakoreng le leng, ha li na litlamorao tse mpe. Ha li phekole khatello ea khatello ea mali feela, empa li thoba le methapo ea kutlo, li ntlafatsa ts'ebetso ea matsoele le ho tsamaisa lefu la pele ho basali.

O ka kopa k'hemiste bakeng sa lipilisi tse nang le magnesium. O ka ithuta ho eketsehileng ka litokisetso tsa magnesium bakeng sa kalafo ea khatello ea mali mona. Lintho tse tlatselletsang Magnesium li sireletsehile ka botlalo, ntle le ha mokuli a e-na le mathata a maholo a liphio. Haeba o na le lefu la tsoekere lephropathy mothating oa ho hloleha ho phekoloa ke lefu la masapo, etela ngaka ea hau haeba ho loketse ho nka magnesium.

Li-blocker tsa calcium calcium tse fumanehang litekanyetso tse ngata tsa kalafo ha li ame metabolism ea lik'habohaedreite le mafura. Ka hona, ha li eketse kotsi ea ho ba le lefu la tsoekere la mofuta oa 2. Ka nako e ts'oanang, li-dihydropyridine tse sebetsang ka nako e khutšoane le tekanyetso e phahameng li eketsa kotsi ea lefu bakeng sa bakuli ba tsoang ho pelo le lisosa tse ling.

Lithane tsa khalsiamo ha lia lokela ho fuoa bakuli ba nang le lefu la tsoekere ba nang le lefu la pelo, haholo maemong a latelang:

• angina pectoris;
• nako e mpe ea infarction ea myocardial;
• ho nyekeloa ke pelo.

Li-dihydropyridine tse sebetsang ka nako e telele li nkuoa li sireletsehile ho bakuli ba nang le lefu la tsoekere le lefu la pelo le kopaneng. Empa ts'ebetsong ea ts'oaetso ea myocardial infarction le ho nyekeloa ke pelo, li tlaasana le li-inhibitors tsa ACE. Ka hona, ba khothalletsoa hore ba sebelisoe hammoho le li-inhibitors tsa ACE kapa beta.

Bakeng sa bakuli ba tsofetseng ba nang le methapo ea methapo ea kutlo, bahanyetsi ba calcium ba nkoa e le lithethefatsi tsa mola oa pele bakeng sa ts'ireletso ea stroke. Haholo-holo ho bakuli ba nang le lefu la tsoekere la mofuta oa 2. Sena se sebetsa ho li-dihydropyridine le tseo e seng dihydropyridine.

Verapamil le diltiazem li netefalitsoe ho sireletsa liphio. Ka hona, ke li-blockers tsena tsa calcium calcium tse ngoletsoeng bakuli ba nang le lefu la tsoekere. Li-antagonists tsa calcium tse tsoang sehlopheng sa dihydropyridine ha li na phello ea nephroprotective. Ka hona, li ka sebelisoa feela hammoho le ACE inhibitors kapa li-blockers tsa angiotensin-II receptor.

Li-inhibitors tsa ACE

Li-inhibitors tsa ACE ke sehlopha sa bohlokoa haholo sa lithethefatsi bakeng sa ho phekola khatello e phahameng ea mali ho lefu la tsoekere, haholo ha bothata ba meno bo hlaha. Mona o ka fumana leseli le qaqileng mabapi le li-inhibitors tsa ACE.

Ka kopo hlokomela hore haeba mokuli a ka ba le methapo ea methapo ea methapo kapa methapo e le 'ngoe ea methapo ea methapo, ho hlokahala hore thibelo ea ACE e hlakoloe. E tšoanang e ea li-blockers tsa angiotensin-II, tseo re tla li tšohla ka tlase.

Lintho tse ling tse khahlanong le tšebeliso ea li-inhibitors tsa ACE:

• hyperkalemia (maemo a phahameng a potasiamo maling)> 6 mmol / l;
• keketseho ea serum creatinine ka ho feta 30% ho tloha boemong ba pele nakong ea beke ea 1 kamora ho qala kalafo (fetisa tlhahlobo - lekola!);
• boimana le nako ea ho anyesa.

Bakeng sa kalafo ea ho hloleha ha pelo ha ho teba ha letho, li-inhibitors tsa ACE ke lithethefatsi tsa mola oa pele, ho kenyeletsoa le ho bakuli ba lefu la tsoekere la mofuta oa 2. Lithethefatsi tsena li matlafatsa kutloisiso ea lisele tsa mmele ho insulin mme ka hona li na le phello ea prophylactic kholisong ea lefu la tsoekere la mofuta oa 2. Ha li mpefatse taolo ea tsoekere ea mali, ha li eketse cholesterol e "mpe".

Li-inhibitors tsa ACE ke setheo sa # 1 sa ho alafa lefu la tsoekere. Bakuli ba mofuta oa 1 le ba 2 ba lefu la tsoekere ba fuoa li-inhibitors tsa ACE hang ha liteko li bontša microalbuminuria kapa proteinuria, leha khatello ea mali e lula e le ntho e tloaelehileng. Hobane li sireletsa liphio le ho liehisa nts'etsopele ea ho se sebetse hantle ha renal nakong e tlang.

Haeba mokuli a sebelisa li-inhibitors tsa ACE, joale o eletsoa ka matla hore a fokotse tšebeliso ea letsoai le eseng ho feta ligrama tse 3 ka letsatsi. Sena se bolela hore o hloka ho pheha lijo ntle le letsoai ho hang. Hobane e se e kenyellelitsoe lihlahisoa tse felileng le lihlahisoa tse felileng. Sena se feta molemong oa hore u se ke ua ba le khaello ea sodium 'meleng.

Nakong ea kalafo le li-inhibitors tsa ACE, khatello ea mali e lokela ho lekanngoa khafetsa, 'me serum creatinine le potasiamo e lokela ho lekoloa. Bakuli ba tsofetseng ba nang le atherosclerosis e akaretsang ba lokela ho hlahlojoa bakeng sa methapo e meng ea methapo ea methapo ea methapo pele ba fana ka li-inhibitors tsa ACE.

Angiotensin-II receptor blockers (lingiotensin receptor antagonists)

U ka fumana leseli le qaqileng ka lithethefatsi tsena tse ncha mona. Ho phekola khatello e phahameng ea mali le mathata a liphio ho lefu la tsoekere, li-blockers tsa li-angiotensin-II li laetsoa haeba mokuli a baka khohlela e omileng e tsoang ho li-inhibitors tsa ACE. Bothata bona bo hlaha ho bakuli ba ka bang 20%.

Angiotensin-II receptor blockers li theko e phahameng haholo ho feta li-inhibitors tsa ACE, empa ha li bake ho khohlela ho omileng. Ntho e ngoe le e ngoe e ngotsoeng ho sengoloa sena ka holimo karolong ea li-inhibitors tsa ACE e sebetsa ho li-blockers tsa angiotensin receptor. Li-contraindication li tšoana, 'me liteko tse tšoanang li lokela ho nkuoa ha u ntse u sebelisa meriana ena.

Ho bohlokoa ho tseba hore li-angiotensin-II li-receptor blockers li fokotsa li-hypricrophy tse tsoang ka letsohong le letle ho feta li-inhibitors tsa ACE. Bakuli ba li mamella hantle ho feta lithethefatsi tse ling bakeng sa khatello e phahameng ea mali. Ha li na litlamorao tse ngata ho feta placebo.

Rasilez - inhibitor e tobileng ea renin

Ena ke sethethefatsi se secha. E ntlafalitsoe hamorao ho feta li-inhibitors tsa ACE le li-angiotensin receptor blockers. Rasilez o ne a ngolisitsoe ka molao Russia
ka Phupu 2008. Liphetho tsa lithuto tsa nako e telele tsa ho sebetsa ha tsona li sa lebelloa.

Rasilez - inhibitor e tobileng ea renin

Rasilez e laetsoe hammoho le ACE inhibitors kapa li-blockers tsa angiotensin-II receptor. Motsoako o joalo oa lithethefatsi o na le tšusumetso ho sirelletso ea pelo le liphio. Rasilez e ntlafatsa cholesterol ea mali mme e eketsa kutloisiso ea lithane ho insulin.

Li-blocker tsa Alpha

Bakeng sa kalafo ea nako e telele ea khatello ea methapo ea kutlo, ho sebelisoa li-alpha-1-blockers tse khethiloeng. Lithethefatsi tse sehlopha sena li kenyeletsa:

• prazosin
• doxazosin
• terazosin

Pharmacokinetics ea li-alpha-1-blocker tse khethiloeng

Litla-morao tsa li-alpha-blockers:

• orthostatic hypotension, ho fihlela ho akheha;
• ho ruruha ha maoto;
• khatello ea ho khaotsa (khatello ea mali e theoha ka matla "ho hlaba");
• ho phehella tachycardia.

Boithuto bo bong bo bontšitse hore li-alpha-blocker li eketsa menyetla ea ho nyekeloa ke pelo. Ho tloha ka nako eo, meriana ena ha ea ka ea ratoa haholo, ntle le maemong a mang. Li ngotsoe hammoho le lithethefatsi tse ling bakeng sa khatello ea mali, haeba mokuli a e-na le benign Prostatic hyperplasia.

Ho lefu la tsoekere, ho bohlokoa hore li be le phello e molemo ho metabolism. Al-adrenergic blockers tsoekere e khutsitseng ea mali, eketsa kutloisiso ea lithane ho insulin, le ho ntlafatsa cholesterol le triglycerides.

Ka nako e ts'oanang, ho nyekeloa ke pelo ke sesupo sa tšebeliso ea bona. Haeba mokuli a e-na le autonomic neuropathy le orthostatic hypotension, li-block tsa alpha-adrenergic li ke ke tsa laeloa.

Ke lipilisi life tseo u lokelang ho li khetha bakeng sa kalafo ea khatello ea mali ho lefu la tsoekere?

Lilemong tsa morao tjena, lingaka tse eketsehileng li ikemiselitse ho lumela hore ho molemo ho fana ka lingoloa, empa hang-hang lithethefatsi tse 2-3 ho phekola khatello e phahameng ea mali. Hobane bakuli ba na le mekhoa e mengata ea ho ntlafatsa khatello ea mali ka nako e le 'ngoe,' me moriana o le mong o ke ke oa ama lisosa tsohle. Hobane lipilisi tsa khatello li arotsoe ka lihlopha, li sebetsa ka tsela e fapaneng.

Moriana o le mong o ka fokotsa khatello ea maemo ho tloaelehileng ho bakuli ba sa feteng 50%, mme le haeba khatello ea khatello ea mali qalong e ne e le lekana. Ka nako e ts'oanang, kalafo ea ho kopanya e u lumella ho sebelisa litekanyetso tse nyane tsa lithethefatsi, 'me u ntse u fumana litholoana tse ntle. Ntle le moo, matlapa a mang a fokolisa kapa a felise ka botlalo litla-morao tsa e mong.

Phaello ea mali ha e kotsi ka boeona, empa mathata a e bakang. Lethathamo la bona le kenyeletsa: ho nyekeloa ke pelo, ho otloa, ho se sebetse hantle ha masapo, bofofu. Haeba khatello e phahameng ea mali e kopantsoe le lefu la tsoekere, menyetla ea mathata e eketseha makhetlo a 'maloa. Ngaka e hlahloba kotsi ena bakeng sa mokuli ea itseng ebe e etsa qeto ea hore na e qala kalafo ka pilisi e le 'ngoe kapa e sebelise motsoako oa litlhare hanghang.

Litlhaloso tsa palo ena: HELL - khatello ea mali.

Mokhatlo oa Russia oa Endocrinologists o khothaletsa mokhoa o latelang oa kalafo bakeng sa khatello e phahameng ea mali ho lefu la tsoekere. Pele ho tsohle, ho fanoa ka angiotensin receptor blocker kapa inhibitor ea ACE. Hobane lithethefatsi tse tsoang lihlopheng tsena li sireletsa liphio le pelo hantle ho feta lithethefatsi tse ling.

Haeba monotherapy e nang le ACE inhibitor kapa angiotensin receptor blocker e sa thusa ho theola khatello ea mali e lekaneng, ho kgothaletswa ho eketsa diuretic. E leng diuretic eo u lokelang ho e khetha e latela poloko ea ts'ebetso ea liphio ho mokuli. Haeba ho na le bothata bo sa foleng ba ho phekola renal, thiazide diuretics e ka sebelisoa. Lithethefatsi Indapamide (Arifon) e nkoa e le e 'ngoe ea diuretics tse sireletsehileng haholo bakeng sa kalafo ea khatello ea mali. Haeba ho se sebetse hantle ha renal ho se ho qalile, ho fanoa ka loopture ea loopt.

Litlhaloso tsa palo ena:

• HELL - khatello ea mali;
• GFR - sekhahla sa ho hlohlona ha liphio, ho fumana lintlha tse eketsehileng bona "Ho hlokahala hore ho etsoe liteko life ho hlahloba liphio tsa hau";
• CRF - ho hloleha ho phekola ha renal;
• BKK-DHP - dihydropyridine calcium Channel blocker;
• BKK-NDGP - blockbine e se nang dihydropyridine calcium blocker;
• BB - beta blocker;
• ACE inhibitor - ACE inhibitor;
• ARA ke angiotensin receptor antagonist (angiotensin-II receptor blocker).

Ho bohlokoa ho fana ka lithethefatsi tse nang le lintho tse 2-3 tse sebetsang tse teng ka har'a letheba le le leng. Hobane lipilisi tse nyane ha li fokola, balateli ba tsona ba li noa ka ho rata.

Lethathamo le le khuts'oane la litlhare tse kopaneng bakeng sa khatello ea mali:

• Korenitec = enalapril (renitec) + hydrochlorothiazide;
• foside = fosinopril (monopril) + hydrochlorothiazide;
• co-diroton = lisinopril (diroton) + hydrochlorothiazide;
• lehar = losartan (cozaar) + hydrochlorothiazide;
• noliprel = perindopril (prestarium) + thiazide-like diuretic indapamide retard.

Ho lumeloa hore li-inhibitors tsa ACE le calcium blockers li ntlafatsa bokhoni ba e mong le e mong ba ho sireletsa pelo le liphio. Ka hona, meriana e latelang e kopaneng hangata e fanoa:

• tarka = trandolapril (hopten) + verapamil;
• prestanz = perindopril + amlodipine;
• equator = lisinopril + amlodipine;
• exforge = valsartan + amlodipine.

Re lemosa bakuli haholo: o se ke oa ipeha moriana oa khatello ea mali. O ka ameha hampe ka litla-morao, esita le lefu. Fumana ngaka e tšoanelehang 'me u ikopanye le eena. Selemo se seng le se seng, ngaka e hlokomela bakuli ba makholo ba nang le khatello ea mali, ka hona o bokelletse boiphihlelo bo sebetsang, hore na lithethefatsi li sebetsa joang le hore na ke life tse sebetsang hantle.

Phekolo ea mali le lefu la tsoekere: liqeto

Rea tšepa hore u tla fumana sengoloa sena se thusa mabapi le phallo ea mali ho lefu la tsoekere. Khatello e phahameng ea mali bakeng sa lefu la tsoekere ke bothata bo boholo ho lingaka le ho bakuli ka bobona. Lintho tse hlahisoang mona li bohlokoa ka ho fetesisa. Sehloohong se reng, "Lisosa tsa khatello ea mali le mokhoa oa ho li felisa. Liteko tsa khatello ea mali "u ka tseba ka ho hlaka hore na u hloka ho sebelisa liteko life bakeng sa kalafo e sebetsang.

Kamora ho bala lisebelisoa tsa rona, bakuli ba tla khona ho utloisisa hamolemo khatello ea mali ka mofuta oa 1 le mofuta oa 2 lefu la tsoekere ho latela mokhoa o sebetsang oa kalafo le ho lelefatsa bophelo ba bona le matla a molao. Tlhahisoleseling ka lipilisi tsa khatello e hlophisitsoe hantle 'me e tla sebetsa e le "pampiri e qhekellang" e loketseng lingaka.

Re batla hape ho hatisa hore mokhoa oa ho ja lijo tse nang le lik'habohaedreite ke sesebelisoa se sebetsang sa ho theola tsoekere ea mali ho tsoekere, hammoho le ho fokotsa khatello ea mali. Ho bohlokoa ho latela lijo tsena ho bakuli ba nang le lefu la tsoekere eseng la mofuta oa bobeli feela, empa le mofuta oa 1, ntle le haeba ho na le mathata a maholo a liphio.

Latela lenaneo la rona la lefu la tsoekere la mofuta oa 2 kapa mofuta oa 1 lefu la tsoekere. Haeba u fokotsa lik'habohaedreite lijong tsa hau, ho eketsa monyetla oa hore u khutlise khatello ea mali ea hau ho tloaelehileng. Hobane insulin e fokolang e potoloha maling, ho ba bonolo ho e etsa.