Lefu la tsoekere

Karolo ea boraro ea bakuli ba lefu la tsoekere le lefu la tsoekere, le bonahatsoang ke ho se atlehe ha karolo ea makhopho ho metabolism ea carbohydrate, ba na le mathata a lefu lena. Likepe tse kholo le tse nyane li oeloa ke tšenyo e kholo, e bakang tlolo ea lithane tsa mmele oa trophic. Mathata a joalo a bontša letšoao le leholo la matšoao, le bitsoang "diabetesic angiopathy." Ke eng le hore na mochini oa nts'etsopele ea thuto ea methapo ea methapo, o tšohloa joang sehloohong sena.

Lintlha tsa lipalo

Ho latela hore na likepe tse nyane lia ameha kapa li kholo, lefu la tsoekere le na le karohano e latelang.

• microangiopathy - retinopathy, encephalopathy, nephropathy;
• macroangiopathy - tšenyo e lipelong tse tlase le methapong ea mali ea pelo.

Microangiopathy ke boemo bo bonts'a hore ts'ebetso ea methapo ea methapo e etsahala likepeng tse nyane tsa mofuta oa arterial. Diabetesic retinopathy (tlolo ea trophic retina ka lebaka la ho senyeha ha capillary) ha motsoako oa "lefu lena le monate" o hlaha ho 80% ea linyeoe, 5% e lebisang ho lahleheloeng ke pono ka botlalo.

Encephalopathy ea lefu la tsoekere e hlaha khahlano le semelo sa kenyelletso ea ts'ebetso ea methapo ea methapo e fokolang ea bokong. E atile haholo ka mofuta oa lefu le itšetlehileng ka insulin (ho mokuli e mong le e mong oa bobeli).

Macroangiopathy ke boemo bo khetholloang ka ho kenella ha methapo e meholo ea methapo nakong ea ts'enyeho. Tsamaiso ea methapo ea methapo e tlase e na le bothata ba 80% ea linyeoe. Pathology ea methapo ea pelo ha e ea tloaeleha - ho mokuli e mong le e mong oa boraro, leha ho le joalo, sena ha se etse hore ts'ebetso e se kotsi. Kotsi ea lefu e eketseha makhetlo a 'maloa. Lefu la tsoekere la lefu la tsoekere le nkoa e le lefu le bolaeang ka nepo ka lebaka la mafu a khafetsa ka lebaka la nts'etsopele ea mathata a tsoang pelong le methapong ea mali.

Anatomy e tloaelehileng

Lisebelisoa tsa mali li na le marako a entsoeng ka likarolo:

• Ka hare (endothelium) - e amana ka kotloloho le mali. Ka "lefu le monate", lihlahisoa tsa metabolism tsa monosaccharide li bokellana mona.
• Medium - e kenyelletsa likhoele tse 'maloa tse kenyellelitsoeng ho arohaneng ha methapo ea methapo le ho tsamaisa phallo ea mali.
• Kantle - lithane tse hokahantsoeng ka likarolo tsa fiber. E na le ts'ebetso ea ts'ireletso.

Litšobotsi tsa boemo ba likepe tsa motho ea phetseng hantle

Le lefu la tsoekere, endothelium e na le bothata. Ho motho ea phetseng hantle, sekala sa ka hare se hlahisa ntho eo ho thoeng ke boikhathollo, e tlotsang methapo ea mali. Ho batho ba kulang, ntho ena e hlophisitsoe ka tekanyo e nyane, tumello ea lebota la vascular ea eketseha, tsoekere e ngata e kenella kahare.

Tsoekere e halefisa tlhahiso e sebetsang ea glycosaminoglycans, liprotheine, mafura. Sephetho sa ts'ebetso ena ke ho fokotseha ha methapo ea mali ea mokokotlo, e sa senyeheng ea phallo ea mali. Ho theoha ha trophism ea tishu ho lebisa ho tlala ea bona ea oksijene le nts'etsopele e tsoelang pele ea libaka tsa necrotic.

Likepe tse latelang tsa mofuta oa arterial li khetholloa ke caliber:

• Artery - Tšenyo ea bona e tsamaisana le nts'etsopele ea atherosulinosis ho fihlela gangren.
• Arterioles ke likepe tse boholo bo mahareng tse nkang sebaka se bohareng lipakeng tsa methapo le li-capillaries. Li fapana hanyane ka sebopeho ho tsoa methapong ea methapo. Likarolo tsa kahare le tse bohareng li na le libaka tse bulehileng, ka hona, karolo ea mesifa le eona e amana le mali.
• Li-capillaries ke lijana tse tšesaane haholo tsa mofuta oa arterial. Mokhoa oa nts'etsopele ea pathology ho tsona o tsamaisana le ponahalo ea aneurysms kapa sclerosis.

Mochine oa likokoana-hloko tsa lefu la tsoekere

Ts'ebetso ea methapo ea methapo ea methapo le Microangiopathy ho lefu la tsoekere e hlaha methating e latelang:

1. Ponahalo ea hyperglycemia, e khethollang mofuta ofe kapa ofe oa "lefu le monate".
2. Ho kenella ka matla ha tsoekere ho endothelium le ho bokelloa ha sorbitol le fructose moo.
3. Nts'etsopele ea ho eketsa sekhahla sa karolo e kahare ea sekepe, e lebisang ho hoheleng ha mokelikeli, nts'etsopele ea edema le botenya.
4. Ts'ebetso ea ts'ebetso ea thrombosis, e ntseng e fokotsa phallo ea mali haholo.
5. Ho fokotseha ha lumen ea methapo, lisele le linama ha li fumane limatlafatsi tse lekaneng le oksijene.
6. Ho matlafatsa motsoako oa li-capillaries tsa liphio tsa lintho tse hokahanyang le ho thehoa ha sclerosis.
7. Karabelo ea methapo ea mokokotlo ke fragility le hemorrhage.
8. Thrombosis le protrusion ea methapo ea methapo ea methapo.

Sebopeho sa lefu la atherosmithotic ke e 'ngoe ea lipontšo tsa lefu la tsoekere.

Methapo e meholo e marang-rang e na le bothata ba atherosulinosis - ho hlaha ha lipid leboteng la endothelial. Lipids li fumaneha ka lihlopha tse nyane, 'me li hokahantsoe le lintho tse ling tse amanang le eona. Ho feta moo, matlapa a joalo a a tlatsoa ebe a koala methapo ea kutlo.

Setšoantšo sa kliniki sa microangiopathy

Matšoao a angiopathy ea lefu la tsoekere a fapane haholo. Liponahatso li ipapisitse le likepe tseo sepheo sa tsona se fetotsoeng.

Lefu la tsoekere la retinopathy

Retina ke lesela le ka hare la leihlo la mahlo, le nang le tsamaiso e ngata ea phepelo ea mali. Lipontšo tsa kliniki ea lesapo la methapo ea kutlo li hlaha methating e latelang. Bakuli ha ba ikutloe e le mekhahlelo ea mantlha ea nts'etsopele, empa liphetoho li ka ba teng pele tlhahlobong ea mahlo.

Litletlebo tsa bakuli ba nang le retinopathy li hlaha ka tsela e latelang:

• acuity ea pono e fokotsehile;
• mekotla e lefifi e hlaha ka pel'a mahlo;
• khafetsa khafetsa;
• ha u sheba ho tloha ntlheng e 'ngoe ho ea ho e' ngoe, lesira le hlaha ka pel'a mahlo a hau.

Motho ha a khone ho sheba lintho tse nyane, ho hlaka ha setšoantšo ho lahlehile, mela le sebopeho se bonoang li sotha. Haeba hemorrhage e hlahile ka har'a retina, mokuli o tletleba ka ponahalo ea matšoao a libopeho tse fapaneng lebaleng la pono. Pheko ea bohlokoahali ea retinopathy ke nts'etsopele ea lesapo la mokokotlo, le lebisang bofofu.

Matšoao a lefifi le ho fifala ke matšoao a mantlha a ts'oaetso ea "retinal trophic pathology"

Teko ea fundus e lekola boteng ba lipontšo:

• ho fokotseha ha li-arterioles;
• ho ba teng ha li-micaneurysms;
• hemorrhages;
• ho ruruha le ho bokellana ha exudate;
• sinuapy ea li-arterioles.

Nephropathy ea lefu la tsoekere

Liphio li na le li-nephrons tse ngata tse emeloang ke vascular glomerulus, capsule le tubules. Ts'ebetso ea methapo ea methapo e fumaneha hantle ho capillaries ea glomerulus. Joalo ka microangiopathy efe kapa efe, Tšenyo ea liphio ha e na lipontšo tsa kliniki nako e telele.

Bakuli ba qala ho tletleba ka lipontšo tse latelang:

• ho ruruha hoa hoseng tlasa mahlo, a nang le "mofuthu" sebapali;
• keketseho ea khatello;
• bofokoli
• linako tsa ho hlatsa;
• ho otsela
• litlhaselo tse kholisang ka bongata ba ammonia maling.

Encephalopathy ea lefu la tsoekere

Lipontšo tsa pele ke tlhaselo khafetsa ea cephalalgia, bofokoli, ho fokotseha ho matla ha ts'ebetso. Bohloko ba hlooho ha bo imolloe ke meriana. Hamorao, bakuli ba lebala ka lebaka la ho se tsebe ho hopola hantle le ho se khone ho tsepamisa mohopolo oa bona nako e telele.

Cephalgia e hlasela le lefu la tsoekere - lets'oao la pele la ho senya methapo ea kelello

Ntle le moo, ho na le tlolo ea khokahano ea motsamao le taolo, likhakanyo tsa methapo, tsamaiso ea ts'ebetso ea liphetoho tsa sebali sa pono.

Tšenyo ea methapo

Pelo ke setho sa mesifa se sebetsang e le pompo ea ho pompa mali le ho kena ha eona liseleng tsa 'mele le lisele tsa' mele. Pelo e na le methapo e 'meli ea methapo ea kutlo, e atamelaneng le kholo ea lefu la tsoekere ho lefu la tsoekere. Ho hlōla ho tsamaisana le bohloko, arrhythmia le matšoao a ho hloleha ha pelo.

Ramatiki

Ena ke letšoao le hlahelletseng le hlahang mehatong ea pele ea lefu la kelello. Letšoao la bohloko le tšoana le tlhaselo ea angina pectoris: li-compress, khatello, radiates ho lehare, lehetla. Hona ke karabelo ea pelo e haelloang ke oksijene. Tlas'a maemo a joalo, tsoekere e kenella ka matla ho fihlela lactic acid, e halefisang methapo ea kutlo.

Phokotso ea morethetho

Li-socks tsa bongaka tsa lefu la tsoekere

Khahlano le nalane ea ts'enyo ea likepe tse nyane, liphetoho tsa methapo ea methapo li hlaha ka har'a li-fiber tse laolang contractility. Tlolo ea morethetho e ka bonoa liponong tse latelang:

• arrhythmia - likonteraka tsa pelo li lahleheloa ke morethetho oa tsona;
• bradycardia - pelo e etsa likotlo tse ka tlase ho 50 ka motsotso;
• tachycardia - phokotso ea nako e fetang 90 bpm;
• extrasystole - ponahalo ea likonteraka tse eketsehileng tsa pathological.

Ho nyekeloa ke pelo

Mokuli o tletleba ka hore ho thata ho hema, ho bonahala eka o hema hanyane ha a phomola. Case e bitsoang lefu la pelo e hlaha ka lebaka la nts'etsopele ea edema ea pulmonary. Maemong a mangata, tsamaiso ea methapo ea pelo e kopantsoe le li-macro- le microangiopathies tse ling.

Angiopathy ea maoto

Ho senyeha ha lijana tsa mabatooa a tlase ho tsamaisana le matšoao a latelang:

• ho tsitsipana, maikutlo a batang, ponahalo ea "liqhubu" tsa "goose";
• lefu la bohloko
• ho opeloa ke mesifa
• tumellano ea mantsoe lipakeng;
• ulceration khahlano le semelo sa pherekano ea trophic.

Paresthesias le trophic ulcers - lipontšo tsa mafu a potoloha a lipalo tse tlase

Paresthesias e koahela sebaka sa maoto, maoto a maoto. Ts'ebetso e joalo e hlalosoa ke nts'etsopele e tšoanang ea methapo ea mafu a tlhaho ka lebaka la spasm ea methapo.

Lefu la bohloko le hlahella hamorao ha le arabeloa ke leseli la mokokotlo le tlolo ea phepelo ea mali. Claudication ea methapo ke letšoao le ikhethang, le tsamaeang le tlhoko ea mokuli ea emisang ha a ntse a tsamaea ka lebaka la bohloko bo boholo maotong. Litlhaselo tse susumetsang li hlaha bosiu, phomolong, nakong ea motsamao.

Leoto la lefu la tsoekere

E 'ngoe ea lipontšo tsa morao-rao tsa macroangiopathy ea libaka tse tlase. E tšoauoa ka li-pathologies tsa trophic le osteoarticular. Litlama tse tebileng li hlaha maotong a atolohelang lesapong le marong. Sephetho ke deformation e matla, e tsamaeang le li-fractures le dislocations.

Ho hlophisoa ha litokomane tsa bongaka

Ho hlakisa lefu lena litokomaneng tsa lefapha la bongaka, ho sebelisoa mekhoa ea machaba ea khethollo ea machaba. Lefu la tsoekere le lipontšo tsohle tsa lona le kenyelletsoe ka har'a rubric E10-E14. Khatello e tlatselletsoa ke sebopeho sa bone (khoutu ho latela ICD-10):

• nephropathy - .2 kapa N08.3 *;
• retinopathy - .3 kapa H36.0 *;
• peripheral vascular angiopathy - .5 kapa I79.2 *.

Melao-motheo ea Tlhahlobo

Tlhaloso ea psychology ha e etsoe feela ke tlhahlobo ea pono, empa le ka mekhoa ea laboratori:

• boikemisetso ba boemo ba naetrojene (urea, creatinine);
• urinalysis, e lekolang palo ea protheine le glucose e ngata;
• litšobotsi tsa lipid tsa mali (cholesterol, lipoproteins);
• ponahalo ea microglobulin beta 2 moseneng.

Urinalysis ke bohato ba bohlokoa litlhahlobong tsa bongaka.

Ho tsoa ka mekhoa e matla ea tšebeliso:

• ophthalmoscopy - mokhoa oa ho khetholla marang-rang a methapo e sa sebetseng ho iris le ho ithuta maemo a likarolo tsa kantle tsa mohlahlobi oa pono;
• gonioscopy - tekanyetso ea boemo ba kamore e ka ntle ea leihlo;
• tlhatlhobo ea fundus - boikemisetso ba boteng ba aneurysms, exudate, hemorrhage, ho ruruha;
• Optical Tomography
• ECG, Echo KG - tlhahlobo ea mosebetsi oa mesifa ea pelo;
• coronarography - mokhoa oa ho khetholla methapo ea methapo ea pelo tlasa mochini oa X-ray ka ho hlahisa se fapaneng;
• dopplerography ea lijana tsa libaka tse tlase - tekanyetso ea boemo ba methapo ea mali e sebelisang ultrasound;
• arteriography ea libaka tse tlase - qeto ea patency le ho ba teng ha moelelo oa lumen o sebelisa mokhoa o fapaneng;
• Ultrasound ea liphio;
• Renovasography - mokhoa oa radiopaque oa ho lekola boemo ba methapo ea methapo ea methapo;
• Dopplerography ea lijana tsa liphio - ultrasound;
• matla a tlhaho a nyutlelie ea bokong - qeto ea hemorrhages, li-microaneurysms, ho ruruha, makhopho a methapo ea mali.

Motheo oa Therapy

Ntlha ea bohlokoa le e ka sehloohong ea kalafo ke ho lokisoa ha tsoekere 'meleng, hobane e ne e le hyperglycemia e ileng ea baka mathata. Ho sebelisoa lisebelisoa tsa tokiso ea microcirculation.

Ho sebelisoa lihlopha tse latelang tsa meriana:

• Lithethefatsi tse theolelang tsoekere - Metformin, Amaril, Diabeteson.
• Mokhoa oa ho fokotsa cholesterol - Lovasterol, Zokor.
• Fokotsa khatello ea mali - Nifedipine, Lisinopril.
• Lithethefatsi tsa Diuretic - Lasix, Veroshpiron.
• Mekhoa ea ho ntlafatsa microcirculation ea mali - Trental, Rutozid.
• Li-thinner tsa mali - Wobenzym, Aspirin.
• Li-Enzymes le livithamini - ATP, livithamini C, B-letoto, E.

Li-trophic ulc le gangrene li hloka ts'ebetso ea ho buoa.

Lintlha tse ling mabapi le kalafo ea lefu la tsoekere la angiopathy ea likarolo tse tlase li ka fumanoa sengoliloeng sena.

Retinopathy e hloka ts'ebeliso ea laser Photocoagulation, e u lumellang ho emisa ho theoha ha pono ka mashome a lilemo. Ntle le moo, ho hlahisoa liente tsa lihormone le masapo a amanang le ho holofala ha mmele. Lephropathy ea lefu la tsoekere mehatong ea morao e hloka hemodialysis e sa khaotseng - tlhoekiso ea mali.

Katleho ea bakuli e ka ba ntle ha feela ho e-na le boikemisetso ba pele ba ho ba teng ha litlolo, mokhoa o khethiloeng ka nepo oa kalafo le ho latela litlhahiso tsohle tsa litsebi.