Diabetesic retinopathy (ICD-10 khoutu - H36 kapa E10-E14 leq. 3) ke bothata bo sa foleng ba lefu la tsoekere, le bakang ho fokotseha ho hoholo kapa ho felloa ke pono ka botlalo ho bakuli ba lilemo tse sebetsang. Monyetla oa ho holisa boemo bo joalo o ipapisitse le mofuta oa lefu le tlasa lefu lena, kalafo le puseletso.
Lintho tse kotsi
Nts'etsopele ea methapo ea tlhahlobo ea pono e khothalletsoa ke:
- Nako ea lefu lena le tlase. Lefu la tsoekere le lefu la tsoekere ha le hlahe haholo lilemong tsa pele tse 6, esita le nakong ea bokhachane, leha ho le joalo, le fumanoa ho 5% ea linyeoe ho bakuli ba nang le lefu la tsoekere le sa ts'epeng insulin ka nako ea ho kopana le litsebi.
- Ho hloka taolo e nepahetseng tsoekere e maling ho baka ponahalo ea ho bola kapele.
- Nako ea ho ba le ngoana. Ntho ea bohlokoa haholo ke nts'etsopele ea chestosis ea morao (preeclampsia).
- Khatello ea mali e phahameng. Boemo bona bo halefisa tsoelo-pele ea lefu la tsoekere.
- Liphetoho tsa liphio (nephropathy). Bo-rasaense ba pakile hore kalafo ea "renal pathology" hammoho le photocoagulation e ka ntlafatsa boemo ba mokuli.
- Ho nona haholo.
- Mekhoa e mebe.
Sistimi ea nts'etsopele
Lefu la tsoekere ke lefu leo ho lona mefuta eohle ea metabolism e ferekaneng. Pele ho tsohle, likepe tse nang le li-calig tse kholo le tse nyane li utloisoa bohloko ke sena.
Glycemia e phahameng ke eona e hlohlelletsang nts'etsopele ea methapo ea methapo ea kutlo
Pathogenesis ea lefu la tsoekere la retinopathy e thehiloe phetohong ea metabolic maemong ohle, hammoho le keketseho ea mali coagulation, hypoxia le liprotheine tse phahameng tsa glycated. Lipalo tsa bohlokoa tsa "glucose" li lebisa ho se leka-lekaneng, khahlanong le bokapele ba liphetoho tse etsahalang 'meleng, tšobotsi ea khaello ea oksijene ea lisele le lisele. Mehatong ea pele, ho sebetsoa ka mokhoa o qobelloang, empa ka tsoekere ea tsoekere, ho fokotseha ha lebone la likepe ho hlaha ka lebaka la molumo o phahameng oa marako a bona.
Ho thehoa ha liprotheine tsa glycosylated (limolek'hule tsa glucose li kopana le molek'hule ea protheine) e tsamaisana le ho lokolloa ha lihlahisoa tsa ho qetela, palo e phahameng ea tsona e bakang pherekano ho metabolism ea protheine, le ho fifala ha litho tsa 'mele. Khahlano le nalane ea liphetoho tse joalo, ho hlaha metsoako ea liprotheine tsa kantle ho naha, eo 'mele o lekang ho e senya, ho qala karabelo ea "bonding". Phello ke tšenyo ea marako a li-capillaries, boemo ba bona bo phahameng.
Psychology ea mafura a mmele e baka tšusumetso ea bohlokoa ea k'holeseterole, triglycerides le lintho tse ling tse tšoanang tse ka koalang lumen ea likepe tse khutlang. Sena se lebisa ho sepheo se secha sa khaello ea phepo e nepahetseng le microcirculation ea mali.
Refinal hypoxia e bonahatsoa ke ho thehoa ha methapo e ncha ea methapo ea methapo ea methapo (neovascularization) le ponahalo ea li-sterts tsa arteriovenous (li-workarounds bakeng sa mali).
Tlhomamiso
Ho na le palo e kholo ea classified ea retinopathy ho lefu la tsoekere. Sena se amahanngoa le lipontšo tse ngata tsa pathology. E 'ngoe ea tse sebelisoang haholo:
- sethala se sa feteng;
- sethala sa pele;
- sethala se hola.
Bohlokoa! Karohano e joalo ea mathata e tla khetholla ka ho hlaka nako eo kalafo ea laser e hlokahalang.
Liphetoho ho choroid - lipontšo tse ka sehloohong tsa retinopathy le lefu la tsoekere
Sehlopha se latelang:
- retinopathy ea mofuta o bonolo (bokapele);
- maculopathy;
- Prerolopative retinopathy;
- proliferative retinopathy.
Boemo bo sa ntlafatse
The retina ea mohlahlobi oa pono e se e e-na le li-micaneurysms, li-hemorrhage tse nyane tse shebahalang joaloka matheba a lefifi mme lia bonahala ha ho hlahlojoa fundus. Hemorrhages, joalo ka molao, e etsahala bohareng ba choroid ea mahlo ka bobeli kapa tsamaisong e tebileng ea venous. Ka nako e ts'oanang, li-foci tsa ho bokella ka mokhoa oa exudate li hlaha (tsa lehae ka setsing, tse tšoanang le libaka tse tšoeu kapa tse sootho tse se nang meeli e hlakileng) le ho ruruha.
Bohato ba pelepele
Ho hlaha li-anomalies tsa venous system tsa mofuta o fapaneng. Masapo a fetoha, a tšoanang ka sebopeho sa rosary, matheka a hlaha, seemo sa likepe sea fetoha. Membrane ea vascular e koaheloa ke palo e kholo ea liforomo tsa exudative. Ho ruruha ha mmele ho hoholo le ho feta.
Mohato o hlahang
Boemong bona, ho etsoa ha neovascularization (kholo ea methapo ea methapo ea methapo ea mali moo e sa lokelang ho ba teng). Taba ea pele, li hlaha pakeng tsa choroid le membrane ea posterior vitreous, ebe li hola ho ba vitreous ka boyona.
Neovascularization ke e 'ngoe ea lipontšo tsa proliferative retinopathy.
Haeba neovascularization e ama iris, menyetla ea bobeli ea glaucoma e eketseha makhetlo a 'maloa. Ntle le moo, hemorrhage e nkeloa sebaka ke lisele tsa fibrous, tse ka bakang ponahalo ea ho hema hape ka mokokotlong.
Matšoao a lefu la kelello
Ho qala lefu la tsoekere le lefu la tsoekere e ka ba ntho e sa lebelloang kapa ea hlaha ka tsela e latelang.
- fokotseho ea pono e fokotsehileng;
- lesira kapa libaka tse ntšo tse lefifi ka pel'a mahlo - matšoao a hemorrhage;
- ho sitoa ho bona lintho tse nyane;
- libaka tse tšoeu tse phaphametseng - letšoao la edema;
- ho se khotsofale sebakeng sa leihlo.
Ho fokotseha kapa ho lahleheloa ke pono ke matšoao a morao-rao a lefu la tsoekere. Tsoelo-pele ea bona e bontša ho se senyehe ha ts'ebetso. Ho latela lipalo-palo, bofofu bo felletseng bo hlaha ho 2% ea lefu la tsoekere.
Phapang lipakeng tsa pono ea motho ea phetseng hantle le lefu la tsoekere le pathology ea mohlahlobi oa pono
Tse ling liponong
Li-Microaneurysms ke litheko tsa mabota a likepe tse nyane. Tikoloho ea bona ke moeli oa libaka tse se nang mali. Vasodilation mehatong ea pele ke sesupo sa kenyelletso ea mekhoa e tlatsetsang.
Haeba li-microaneurysms li le teng ntle le lipontšo tse ling tsa ts'ebetso ea mohlahlobi, ha li na kotsi, empa li mpa li bontša qalo ea nts'etsopele ea mathata. Leha ho le joalo, ha lefu lena le ntse le tsoela pele, ba ata le ho feta. Phello ea khafetsa ea li-micaneurysms tse karolong e bohareng ea retina ke ponahalo ea ho puffness.
Hemorrhage
Li ka hlaha likarolong tse fapaneng tsa choroid, li na le sebopeho se fapaneng. Haeba likarolo tse tebileng li ameha, hemorrhages ke matheba kapa matheba a oval kapa sebopeho se chitja. Ha e fumaneha ka mokhoa o phahameng haholo, e tšoana le likhoele tse senyehileng.
"E tiileng" exudate
Ke pokello ea lipids le lihlahisoa tsa tsona tsa ho senyeha. Li na le tint e 'mala o mosehla le sebopeho se hlakileng. "Solid" exudates li libakeng tse katoloso ea li-capillaries le haufi le moeli oa puffness. Li-depositi tse joalo karolong e bohareng ea choroid li lebisa ho fokotseha ho matla ha pono ea mahlo.
Maqhubu a Laetsoeng
Ke likarolo tse nyane tsa ischemia (necrosis) ea methapo ea methapo e hlahang ka lebaka la corlusion ea capillary. "Ba bonolo" exudates ba shebahala ka mokhoa oa libaka tse tšoeu tse se nang meeli e hlakileng.
Letsoalo la lefu la tsoekere
E 'ngoe ea lipontšo tsa angioretinopathy, e khethiloeng ke liso tsa macula.
Letsoalo la "abetes "la" lefu la tsoekere "le hlaha ka lebaka la khaello ea" capillaries "le" micocclusion "ea bona ea pele. Lintlha tsa hajoale li totobatsa ho haella ha karohano e amoheloang ka kakaretso ea lesapo la macular, empa bangoli ba bangata ba khetha ho e arola ka mokhoa o makatsang le oa ischemic, o itšetlehileng ka ho ata ha lipontšo tsa lehae.
Edematous maculopathy e ka ba:
Phekolo ea polyneuropathy ho lefu la tsoekere- ea lehae (e lekanyelitsoeng) - tlhahlobo e bonts'a ho ba teng ha sebaka se le seng kapa ho feta tsa compaction bohareng ba retina;
- ferekanya - edema ea bohlokoa e hlaha, e se nang meeli e hlakileng, hammoho le sebopeho sa li-cysts tse nyane.
Ischemic maculopathy e na le litholoana tse mpe ka ho fetisisa mabapi le mosebetsi oa mohlahlobi oa pono le pono ea mahlo. Ho thata haholo ho e khetholla ha ho hlahlojoa fundus. Optometrists, joalo ka molao, nahana ka nts'etsopele ea mofuta ona oa pathology ka mismatch pakeng tsa acuity ea pono e tlase le liphetoho tse fokolang tsa pono. Bakeng sa ts'oaetso, ho sebelisoa fluorescence angiography.
Boloetse
Ophthalmologist e hlahloba lefu la tsoekere khafetsa:
- kamora lilemo tse 5 ho tloha qalong ea "lefu le monate" le khethiloeng ka lefu la tsoekere la 1;
- ha u qala ho ikopanya le endocrinologist ka lefu la mofuta oa 2;
- 1 nako ka selemo ntle le boteng ba retinopathy;
- ka mor'a likhoeli tse ling le tse ling tse 6 ho fumanoe hore o na le retinopathy e seng prolifaative;
- sethala sa pele - hang hang ka likhoeli tse 3-4;
- "proliferative retinopathy" nalaneng ea bongaka - hang ka likhoeli tse ling le tse ling tse 2-3.
Ophthalmologist - mothusi oa sehlooho kalafong le thibelong ea methapo
Mekhoa ea ho khetholla e sebelisitsoeng:
- Boikemisetso ba masimo a tloaelehileng a retinal - bo etsoa ho sebelisoa lifoto tsa stereoscopic. Mokhoa o khetholloa ke maikutlo a phahameng, ts'ebetso ea lifoto e potlakileng. Patlisiso e theko e boima.
- Direct ophthalmoscopy - ngaka e fana ka khanya ea leihlo la mokuli, eu lumellang ho hlahloba boemo ba fundus.
- Biomicroophthalmoscopy - lilense tsa ho ikopanya tsa ashera li sebelisetsoa ho etsa lipatlisiso.
- Fluorescence angiography - ntho e khethehileng e kenngoa maling a sehlooho, e khonang ho phatsima ha e bona khanya. Eu lumella hore u lekole boemo ba microcirculation, ho tsebahala ha methapo ea mali, ho ba teng ha ischemia, hemorrhage.
- Optical khokahano ea palera - eu lumella ho lekola boemo ba ho ruruha.
- Echography - sebelisa mokhoa o khethollang letsoalo le ho hlaseloa ha lintho tsa methapo kahare ho leihlo.
- EFI ke rarahaneng e kenyeletsang lithuto tse 'maloa. Li re lumella ho hlakisa lits'ebetso tsa bioelectrogenesis ea likarolo tsa choroid ea mohlahlobi oa pono.
Melao-motheo ea kalafo
Pele ho tsohle, ho bohlokoa ho ntlafatsa matšoao a tsoekere ea mali le ho fihlela boemo ba puseletso bakeng sa lefu le ka tlase. Ho bohlokoa hore mali a potlakileng a mali a se ke a phahama ho feta 6 mmol / L, mme boemo ba hemoglobin ea glycated bo fihla ho 6,5%.
Hape, ho ba sieo ha khatello ea mali ho nkoa e le ntlha ea bohlokoa. Morero o ka sehloohong oa batho ba nang le lefu la tsoekere ke khatello ea mali e seng holimo ho 140/90 mm Hg. Ho etsa hore lipalo li fetohe, ho sebelisoa lihlopha tse latelang tsa lithethefatsi:
- Li-inhibitors tsa ACE - Captopril, Lisinopril.
- Li-antagonists tsa Calcium - Verapamil, Tiapamil.
- Diuretics - Dichlothiazide, Furosemide.
Matšoao a tloaelehileng a BP - khokahano ho thibela retinopathy
Khalemelo ea Cholesterol
Lithethefatsi tse sebelisoang molemong ona li etsa hore ho be le tefo ea tsoekere ea lefu la tsoekere le ho liehisa nts'etsopele le tsoelo-pele ea mathata. Sebelisa chelete e tsoang sehlopheng sa li-statins (Lovastatin, Fluvastatin) le li-fibrate (Fenofibrate, Bezafibrat).
Ho ntlafatsa rheology ea mali le boemo ba mokokotlo oa methapo
Lefu la tsoekere la retinopathy le tsamaisana le keketseho ea khokahano ea liplatelete. Sena se hlalosa tlhokeho ea ho khethoa ha lichelete tse latelang:
- Acetylsalicylic acid;
- Heparin;
- Sulodexide;
- Ticlopidine;
- Pentoxifylline.
E le ho lokisa molumo oa lerako la methapo, ho ngotsoe vithamine C, Rutozid, Pirikarbat, Etamzilat.
Li-antioxidants le ntlafatso ea metabolic
Ts'ebeliso ea vithamine E, methylethylpyridinol, Ginkgo biloba, e sa tsoa phatlalatsoa, e atile. Lithethefatsi li na le phello ea antioxidant, e tlama le ho tlosa li-radicals tsa mahala 'meleng.
Mekhoa e ntlafatsang ts'ebetso ea metabolism kahare ho "retina" (e tsamaisoang ka botsoali, ka molomo le ka periocularly):
- Dihydroergocriptine;
- Inosine;
- nko ea litholoana e ommeng ea blueberry;
- monokotšoai oa litholoana tsa blueberry ka beta-carotene.
Laser coagulation
Mokhoa ona o nkuoa e le o sebetsang ka ho fetisisa kalafo ea lefu la tsoekere. Morero oa ona ke:
- ho koaloa ha libaka tsa ischemic;
- khatello ea ho thehoa ha likepe tse ncha tsa pathological;
- Ho koaloa ha mesifa ea lesapo la mokokotlo oa li-capillaries tseo li eketsang matla a marako;
- sebopeho sa adhesions, fokotsa monyetla oa ho detachment.
Laser retinal coagulation - mokhoa o sebetsang oa ho emisa tsoelo-pele ea lefu lena
Coagulation e etsoa ke laser, solid-state kapa diode (infrared) laser. Ho na le mekhoa e mengata ea laser coagulation, e fapaneng le e 'ngoe ka sepheo sa ho etsa, lipontšo, maano.
Panretinal coagulation
E sebelisoa ho kalafo ea prrolifative le proliferative retinopathy ea li-etiologies tse fapaneng. Li-coagulates li sebelisoa sebakeng sohle sa choroid, ntle le corpus luteum, ho thibela kapa ho fokotsa ponahalo ea likepe tse ncha. Sena se re lumella ho ntlafatsa trophism ea libaka tseo tsa retina tse sa kang tsa angoa ke ts'ebetso ea methapo.
Pele ho thetso, mokuli o lokela ho tloaelana le taba ea hore ts'ebetso ha e etsoe ka sepheo sa ho khutlisa pono ea acuity, empa e le ho thibela tsoelo-pele ea ho theoha ha eona.
Phekolo ea antiangiogenic
Mokhoa oo lithethefatsi li kenang ka kotlolloho ka ho toba ho vitreous. Bakeng sa ho thibela neovascularization, li-blockers tsa angiogene li sebelisoa. Sephetho hape ke ho fokotseha ha edema sebakeng sa corpus luteum.
Mokhoa ha o sebelisoe joalo ka mokhoa o ikhethileng. Phekolo ea antiangiogenic e nkoa e le karolo ea kalafo e rarahaneng 'me e kopantsoe le laser coagulation kapa opereishene.
Vitondola
Ts'ebetso ea ts'ebetso ea opereishene e hlokahala ho thibela tsoelo-pele ea ts'ebetso ea methapo ea methapo, hammoho le ho lokisa boemo ba mokuli haeba ho na le mathata. Vitrectomy ha e etsoe maemong a latelang:
- rubeosis ea iris;
- glaucoma ea bobeli;
- atrophy ea optic;
- corneal pathology;
- sethala sa ho bola;
- ho buseletsoa ha lefu la tsoekere le maloetse a mang a tsamaiso.
Ho latela litsebi tsa mahlo, ho tiisa ts'ebetso ea ts'ebetso ea mohlahlobi oa pono ka mor'a ho buuoa ho etsahala ho 45% ea linyeoe, ha har'a bakuli ba sa latelang likeletso tsa lingaka, ke 14% feela.
Litlhare tsa setso
Phekolo ka kalafo ea setso ha e lumelle feela ho boloka ts'ebetso ea lisebelisoa tsa bonono, empa hape le ho boloka tsoekere ea mali ka har'a meeli e amohelehang. Ho sebelisa hantle ho bonts'a nettle. Makhasi a hloekileng a sithabetse, a fumana lero. Hoa hlokahala hore o noe karolo ea boraro ea khalase makhetlo a mararo ka letsatsi. Makhasi a nettle a ka eketsoa ho li-salads, lithuto tsa pele.
Lero la Nettle - ntlo ea polokelo ea lintho tse nang le thuso eseng bakeng sa bakuli feela, empa le bakeng sa batho ba phetseng hantle
Phello e tšoanang e na le lero la makhasi a lekhala. Pele o ntša mokelikeli oa pholiso, makhasi a beoa sehatsetsing lihora tse 'maloa. Ebe e sithabetsoa, lero le fumanoa, e phehiloe nako e sa feteng metsotso e 3-4. Sebelisa 1 tsp. hararo ka letsatsi, bosiu o ka rotha ka mahlong (2 a oela ka leng).
U ka sebelisa infusion ea li-blueberries (lino tse nang le likaroloana tse nyane letsatsi lohle), lero la lingonberry, li-decoctions tsa litokisetso tsa litlama.
Mehato ea thibelo
Ntlha ea bohlokoa ke ho boloka matšoao a amohelehang a tsoekere ea mali, khatello ea mali, boima ba 'mele. Sena se o lumella ho qoba kapa ho liehisa nts'etsopele ea "retinopathy" feela, empa le mathata a mang a hlobaetsang le a sa foleng a lefu la tsoekere.
Thibelo e tjena:
- ho khomarela lijo tse nang le lik'habohaedreite tse tlase;
- ho ikoetlisa ka ho lekaneng;
- ho hlahloba khafetsa le setsebi sa mahlo;
- kalafo e nakong ka nako ea lefu le tlasa mehato ea pele ea mathata.
Ka bomalimabe, ho ke ke ha khoneha ho phekola bothata, haholoholo matsatsing a morao, mme ho a khonahala ho thibela nts'etsopele ea eona, boloka mesebetsi ea pono le ho emisa tsoelo-pele. Ntho ea bohlokoa ke ho latela likeletso le litlhahiso tsa litsebi mme li tebile ka lefu lena le tlase.
