Hypertension ke boemo boo khatello ea mali e fetang meeli eohle e tloaelehileng (140/90) mme ka nako e ts'oanang "boits'oaro" ba eona ba "spasmodic" bo tsejoa ka tatellano. Khatello ea lefu la tsoekere e kotsi haholo, hobane menyetla ea ho ba le tšoaetso ea lefu la sethoathoa, ho ba le stroke, leqhubu la makhopho a tlase le mafu a mang le eketseha makhetlo a 'maloa. Ka hona, ho khothalletsoa hore lefu la tsoekere le lule le shebile feela boemo ba tsoekere maling, empa le khatello.
Mabaka a nts'etsopele
Lefu la tsoekere le khatello ea mali ke mafu a atisang ho thusana. Ntle le moo, sesosa se ka sehloohong sa khatello ea mali ho T1DM ke lefu la tsoekere, le tsebahalang ka ho senyeha ha meno le ts'ebetso e sa sebetseng.
Lisosa tsa ho fanyeha khatello ea mali ho lefu lena le tsona e ka ba:
- Patency e senyehileng ea lijana tsa liphio;
- hypstension ea bohlokoa kapa e ka thoko ea methapo;
- mathata a endocrine.
Ha e le mathata a endocrine 'meleng a bakang nts'etsopele ea khatello ea mali ho lefu la tsoekere, a atileng haholo har'a ona ke:
- Itsenko-Cushing's syndrome;
- pheochromocytoma;
- hyperaldosteronism le ba bang.
Ntle le moo, khatello e phahameng ea mali ho T1DM le T2DM e ka bonoa:
- ka ho haella ha 'mele oa ntho e joalo ea lik'hemik'hale joaloka magnesium;
- mathata a kelello a hlahang khahlano le semelo sa khatello ea maikutlo khafetsa, khatello ea kelello, maemo a sithabetsang, jj.;
- ho pepesehela lintho tse nang le chefo (mohlala, mercury, lead kapa cadmium);
- atherosulinosis, e leng ho ferekanyang ho fokolisa methapo e meholo ea methapo.
Khatello ho T1
Joalokaha ho boletsoe kaholimo, sesosa se ka sehloohong sa khatello ea mali ho mofuta oa 1 lefu la tsoekere ke lefu la tsoekere, le khetholloang ke tšenyo ea liphio. Joalokaha lipalo-palo tsa lefats'e li bonts'a, khatello ena e etsahala ho bakuli ba ka bang 40% mme e feta ho eona ka mekhahlelo e 'maloa:
- ea pele e tšoauoa ka ponahalo ea moroto oa likarolo tse nyane tsa protheine ea albin;
- ea bobeli e bonahatsoa ke ts'ebetso ea renal e senyehileng le ponahalo ea moroto oa likarolo tse kholo tsa protheine ea albin;
- ea boraro e tšoauoa ka ho senyeha ho hoholo ha tšebetso ea renal le nts'etsopele ea ho se sebetse hantle ha renal.
Litholoana tsa khatello ea mali
Ha liphio li sebetsa hantle, ho tsoa hoa sodium 'meleng hoa senyeha. E beiloe maling, 'me molemong oa ho e senya, mokelikeli o qala ho bokellana ka har'a lijana. Keketseho ea eona e lebisa khatello e matla marakong a methapo ea mali, e bakang keketseho ea khatello ea mali.
Ho bokellana ha tsoekere e ngata maling ho lebisa ntlheng ea hore mokelikeli o teng ka har'a lijana o eketseha le ho feta. Ena ke karabelo ea tlhaho ea 'mele ea ho itšireletsa' me e etsahala ka sepheo sa ho theola mali, hobane tsoekere le sodium li etsa hore e teteane. Ka lebaka la lits'ebetso tsena tsohle, molumo oa mali o potoloha oa eketseha le khatello ea mali e nyoloha khafetsa.
Sena, se ama haholo ts'ebetso ea liphio, hobane ke bona ba fetisang mali ka bo bona, ha ba le khatello e matla. Keketseho ea phallo ea phallo ea mali e baka keketseho ea khatello kahare ho litho tsa glomeruli, ka lebaka leo li shoa butle butle mme nako le nako ha liphio li qala ho sebetsa le ho feta.
E le molao, litlhare tse latelang li sebelisetsoa ho phekola khatello ea mali tsoekere e nang le lefu la tsoekere:
- meriana e fokotsang tsoekere ea mali;
- Li-inhibitors tsa ACE;
- lithethefatsi tsa diuretic;
- Angiotensin receptor blockers.
Re lokela ho hlokomela hore kalafo e 'ngoe le e' ngoe e behiloe ka mokhoa o le mong mme e latela lintlha tse 'maloa:
- ho teba ha lefu la tsoekere;
- tekanyo ea nts'etsopele ea lefu la tsoekere;
- boteng ba maloetse a mang ho mokuli.
Khatello ho T2
Mofuta oa 2 oa lefu la tsoekere o hlaha butle butle. 'Me methating ea pele ea nts'etsopele ea eona, ha ho na le ho fokotseha ha kutloisiso ea lithane ho insulin, hangata bakuli ba na le khatello e phahameng ea mali. Lebaka la sena ke ho na le insulin e ngata maling, eo ka boeona e qholotsang ho hlaha ha khatello e phahameng ea mali.
Liphetoho tsa metabolic syndrome
Ka T2DM ea nako e telele, methapo ea methapo ea methapo, e bakoang ke nts'etsopele ea lefu le joalo le atherosclerosis. Tumellanong le sena, ka mpeng ho na le lisele tse mafura tse ngata li kenyang mali, ka tsela eo li eketsa ho potoloha ha tsona le khatello ea mali e ntseng e eketseha.
Ts'ebetso tsena kaofela tse etsahalang 'meleng ka moriana li bitsoa metabolic syndrome. 'Me ho etsahala hore tsoelo-pele ea khatello ea mali maemong ana e qala pejana ho feta mofuta oa' nete oa lefu la tsoekere le hlahang.
Tekanyo e ntseng e eketseha ea insulin maling e boetse e na le lebitso la eona la semmuso - hyperinsulinism, e etsahalang ka lebaka la ho hanyetsa insulin. Ha manyeme, a kenelletseng ho hlahiseng insulin, a qala ho sebetsa ka mafolofolo, kapele "o tepella" mme o khaotsa ho sebetsana le mesebetsi ea hae, e qholotsang kholo ea lefu la tsoekere la mofuta oa 2.
Ha hyperinsulinism e etsahala mmeleng, ho latela tse latelang:
- CNS e nyakaletse;
- katleho ea liphio ea fokotseha, e lebisang ho bokellweng ha sodium 'meleng;
- insulin e ngata maling e tebisa methapo ea methapo ea mali le ho fokotsa matla a eona.
Taolo ea tsoekere ea mali eu lumella ho laola khatello ea maliTs'ebetso tsena kaofela li baka keketseho ea khatello ea mali le ho fokola hoa bophelo ka kakaretso. Leha ho le joalo, ntlheng ena, haeba mokuli a etela ngaka hang-hang 'me a qala ho fumana kalafo, tsoelo-pele ea khatello ea mali le lefu la tsoekere la 2 e ka thibeloa. Ho feta moo, ho bonolo haholo ho e etsa ho feta ka SD1. Latela lijo tse nang le carb e tlaase ebe u nka lipilisi tsa diuretic.
Likarolo tsa khatello e phahameng ea mali ho lefu la tsoekere
Ho motho ea phetseng hantle, ho fokotseha ha khatello ea mali ho hlaha feela hoseng le ka mantsiboea lihora. Le lefu la tsoekere, le tlola letsatsi lohle. Ho feta moo, bosiu ho batho ba lefu la tsoekere, khatello e eketseha haholo ho feta hoseng.
Joalokaha bo-ramahlale ba bontša, ketsahalo ena e etsahala ka lebaka la nts'etsopele ea lefu la tsoekere le lefu la tsoekere. Sena se bakoa ke taba ea hore tekanyo e phahameng ea tsoekere maling e ama hampe mosebetsi oa tsamaiso ea methapo ea kutlo, e laolang tšebetso ea bohlokoa ea 'mele. Ka lebaka la sena, molumo oa mokokotlo o fokotseha mme ho latela mejaro, ba qala ho thella kapa ba phomola.
Mme ka ho akaretsa, ho lokela ho hopoloa hore haeba lefu la tsoekere le kopantsoe le khatello ea mali, khatello ea mali ha ea lokela ho lekanngoa makhetlo a 1-2 ka letsatsi, empa ho pholletsa le letsatsi, ka linako tse itseng. U ka sebelisa ho shebella, e etsoang likarolo tsa boemelong ba sebelisa lisebelisoa tse ikhethang.
Lefu la tsoekere le khatello ea mali hangata le tsamaisoa ke li-pathologies tse ling tse hlokang kalafo e arohaneng.Ntle le khatello ea mali, ba tsoekere hangata ba ba le hypotension ea orthostatic, e khetholloang ka ho fokotseha ho matla ha khatello ea mali. Sena se etsahala haholo ha mokuli a fetola boemo ba hae (mohlala, ho tloha ho lula setulong ho ea ho se emeng). Boemo bona bo iponahatsa ka ho tsekela, "li-goosebumps" ka pel'a mahlo, ponahalo ea mekoloko e lefifi ka tlasa mahlo, ea akheha.
Orthostatic hypotension le eona e hlaha khahlano le semelo sa nts'etsopele ea lefu la tsoekere le tahlehelo ea matla a ho laola molumo oa methapo. Linakong tseo ha motho a phahama haholo, moroalo 'meleng oa hae oa phahama, ka lebaka leo, ha a na nako ea ho eketsa phallo ea mali, e bonahatsoang ke phokotso ea khatello ea mali.
Tloaelo ea khatello ea mali ho lefu la tsoekere
Ho fokotsa khatello ea mali, lingaka li fana ka meriana e khethehileng. Empa u hloka ho li nka ka hloko haholo. Taba ke hore ho fokotseha ho hoholo ha khatello ea mali ho ka mpefatsa boemo ba mokuli, bo tla ama boemo ba pelo le methapo e mpe.
Na lefu la tsoekere la mofuta oa 2 le ka phekoloa?Ka hona, kalafo ea khatello ea mali e lokela ho etsahala butle butle. Qalong, ho hlokahala hore u ipehele sepheo, u fokotse khatello ea mali ho 140/90 mm RT. Art. Sena se lokela ho etsahala nakong ea libeke tse 4 tsa kalafo. Haeba mokuli a ikutloa hantle 'me a se na litla-morao tse tsoang ho kalafo ea lithethefatsi, joale litekanyetso tse phahameng ka ho fetisisa tsa lithethefatsi li sebelisoa ho fokotsa khatello ea mali ho isa ho 130/80 mm Hg. Art.
Haeba, ha a le kalafong ea bongaka, mokuli o mpefala 'meleng, ho fokotseha ha khatello ea mali ho lokela ho etsahala butle butle. Haeba ho sebelisa meriana ho qholotsa nts'etsopele ea hypotension, ho sebelisoa li-agents tse ka eketsang khatello ea mali. Empa li boetse li lokela ho sebelisoa ka hloko le ka mokhoa o tiileng o boletsoeng ke ngaka.
Phekolo ea khatello ea mali ho lefu la tsoekere
Ke moriana ofe oo u lokelang ho o sebelisa ho theola khatello ea mali ho lefu la tsoekere, ke ngaka feela e etsang qeto. Joaloka kalafo ea kalafo, lithethefatsi tsa litlamorao tse fapaneng li ka sebelisoa.
Metheo ea mantlha ea kalafo ea khatello ea mali ho lefu la tsoekere
Diuretics
Har'a litlhare tse sebelisoang ho phekola khatello ea mali, tse atileng haholo ke:
- Furosemide;
- Mannitol;
- Amiloride;
- Torasemide;
- Diacarb.
Tabeng ena, diuretics e fana ka phello e ntle haholo ea kalafo. E fana ka ho tlosoa ha metsi a mangata 'meleng, ka tsela eo a fokotsa bongata ba phallo ea mali le khatello leboteng la methapo ea mali.
Beta blockers
Litsebi tsa lefu la tsoekere li laeloa maemong ao mokuli a nang le ona:
- lefu la pelo;
- nako ea kamora ho chechisa;
- stroke.
Ka maemo ana ohle, khatello e phahameng ea mali e ka etsa hore motho a qale ho shoa ka tšohanyetso. Ketso ea beta-blockers e etselitsoe ho holisa methapo ea mali le ho matlafatsa kutloisiso ea lisele tsa mmele ho insulin. Ka lebaka la sena, litla-morao tse peli tsa kalafo li fihlelloa hang-hang - ho tloaeleha ha khatello ea mali le boemo ba tsoekere ea mali.
Ho nka lithibelo tsa beta ho fokotsa kotsi ea ho tšoaroa ke lefu la stroke le myocardialHo fihla joale, li-beta-blockers tse latelang li sebelisoa haholo e le kalafo bakeng sa khatello ea mali ho lefu la tsoekere:
- Tekete eo eseng ea hae;
- Coriol.
- Carvedilol.
Ho ke ho hlokomeloe hore ho na le ba-beta-blockers 'marakeng oa meriana o se nang phello ea vasodilating. Ho thibetsoe ka thata ho ba nka ka lefu la tsoekere, ha ba ntse ba eketsa ho hanyetsa ha insulin, 'me hape ba baka keketseho ea cholesterol "e mpe" maling, e lebisang ho hola ha lefu lena le tlasa mathata a mang a tebileng.
Lithala tsa calcium calcium
Tsena li kenyelletsa lithethefatsi tse latelang:
- Amlodipine;
- Nifedipine;
- Lacidipine;
- Verapamil;
- Isredipine.
Lithethefatsi tsena li na le phello e molemo ho potoloha ha mali le ho fana ka tšireletso e tšepahalang lipelong, ka hona, hangata li fuoe bakuli ba nang le lefu la tsoekere le lefu la tsoekere. Li-blockers tsa calcium calcium ha li na sephetho se sebetsang ebile li ka sebelisoa hammoho le li-inhibitors tsa ACE le li-angiotensin-II receptor blockers.
Lithethefatsi tse ling bakeng sa kalafo ea khatello ea mali ho tsoekere
Joalo ka kalafo ea kalafo e ka sebelisoa hape:
- Li-inhibitors tsa ACE;
- angiotensin-II li-receptor blockers;
- alpha adrenergic blockers.
Ho feta moo, kamohelo ea bona e tlameha ho sebelisoa hammoho le sejo se phekolang, se sa kenyelletseng lijong tse nang le letsoai, tse halikiloeng, tse tsutsitsoeng, tse mafura, phofo le lijana tse monate. Haeba motho a latela litlhahiso tsohle tsa ngaka ka tieo, o tla khona ho hlola kapele khatello ea mali le ho boloka tsoelo-pele ea lefu la tsoekere e le taolong ea hae.
