Lefu la tsoekere

Ho hlōloa ha likarolo tsa methapo ea methapo e bohareng le e poteletseng khahlanong le semelo sa lefu la tsoekere ho bitsoa lefu la tsoekere la lefu la tsoekere. Sena ke sesupo sa bothata, e leng tšitiso ea ts'ebetso ea methapo eohle ea methapo khahlanong le semelo sa liphetoho tse etsahalang methapong e meholo ea mali. Diabetes neuropathy (ho ea ka ICD-10 - G63.2 *) e hloka tlhahlobo e potlakileng ea boemo le ho beoa ha kalafo e nepahetseng bakeng sa ho khutlisa mesebetsi e lahlehileng le ho ntlafatsa bophelo ba mokuli.

Tlhomamiso

Nakong ea tlhatlhobo, pathology e fumanoa ho mokuli e mong le e mong oa boraro lilemo tse 10-15 kamora ho qala ha lefu la tsoekere. Khetholla neuropathy ea tlhaho e bohareng le e poteletseng. Tšenyo ea kelello le lesapo la mokokotlo ke karolo ea tšebetso ea methapo ea methapo ebile e arotsoe ka maemo a latelang:

• komello e mpe ka morao ea tšenyo ea likarolo tsa tsamaiso ea methapo e bohareng;
• kotsi ea methapo ea pelo e mpe haholo;
• ts'ebetso ea boko e sa senyeheng khahlanong le semelo sa methapo ea methapo;
• neurosis;
• lefu la tsoekere le amanang le lefu la tsoekere;
• myelopathy khahlano le lefu la tsoekere.

Peripheral diabetesic neuropathy le eona e na le karohano e thehiloeng mafapheng a senya:

• kutloelo-bohloko methapo ea kutlo e kenelletseng ts'ebetsong;
• motor - ts'ebetso e mpe ea methapo ea koloi;
• sensorimotor - tšenyo ea methapo ea kutlo le methapo ea kutlo;
• autonomous - neuropathy ea litho tsa ka hare.

Ho ipapisitsoe le likarolo tsa ts'ebetso ea bongaka, mefuta e latelang ea lefu la tsoekere e arohantsoe:

• mofuta oa subclinical - liphetoho tse senotsoeng nakong ea tlhatlhobo feela li bonts'a ho ba teng ha methapo ea mafu, mokuli ha a na litletlebo;
• mofuta oa tliliniki: sebopeho se matla, se tsamaeang le bohloko; mofuta o sa foleng o nang le bohloko; lipontšo tsa kliniki ntle le bohloko.
• mathata (leoto la tsoekere, bofokoli ba mofuta oa neuropathic).

Mokhoa oa nts'etsopele ea pathology

Khahlano le semelo sa lefu la tsoekere, "hyperglycemia" (keketseho ea tsoekere ea mali) e bonoa. Sena se ka bakoa ke ho hloleha ha manyeme ho kopanya insulin e lekaneng (lefu la 1) kapa ho hlaha ka lebaka la ho fokotseha hoa kutloisiso ea lisele le lisele tsa 'mele ho insulin nakong ea tlhahiso ea eona e tloaelehileng (lefu la mofuta oa 2).

Hyperglycemia ke sesosa se ka sehloohong sa nts'etsopele ea mathata a lefu la tsoekere.

Tekanyo e phahameng ea tsoekere e senya mekhoa eohle ea metabolic. Ka vasotine endothelium, sorbitol, liprotheine tse glycosylated, li bokellana. Sena se baka liphetoho tšebetsong e tloaelehileng le sebopeho sa lisele tsa methapo ea kutlo (li-neurons). Ho bolaoa ke tlala ea oksijene le libaka tse nang le phallo e fokolang ea mali li tlatsetsa ho matlafatsong ea khatello ea oksijene. Sephetho ke ho haella ha lintlha tsa neurotrophic le nts'etsopele ea lefu la tsoekere le lefu la tsoekere.

Setšoantšo sa Clinical

Matšoao a neuropathy ea lefu la tsoekere a itšetlehile ka foromo, ho teba, boemo ba tsoelo-pele le nalane ea kalafo e sebelisitsoeng.

Ho ferekana ha Sensomotor

Foromo ena e atile haholo hara batho ba nang le "lefu le monate". Lipontšo tsa thuto e sa foleng:

• bohloko ba tlhaho e fapaneng;
• paresthesia;
• tsebetso
• fokotsa ho fihlela tlhokahalo e felletseng ea liphetoho tsa mocheso le vibration;
• bofokoli ba mesifa;
• cramp tse lipheletsong tse tlase;
• ho haelloa ke maikutlo a tloaelehileng ka ho teneha;
• ponahalo ea li-pathological reflexes.

Ho ferekanya maikutlo ho matla

Sensory diabetesic neuropathy e tsamaisana le litletlebo tse latelang tsa bakuli:

• ho eketseha ha maikutlo a ho fetoha ha liphetoho ho mocheso, ho ama, ho sisinyeha;
• sensitivity disorder ka tsela ea ho se lekane;
• ponahalo ea bohloko ho arabela tšusumetsong ea lintho tseo tlas'a maemo a tloaelehileng li sa utloiseng bohloko;
• li-reflexes li ka lula li le tloaelehileng;
• lefu la bohloko bo boholo.

Bohloko bo ka chesa, ho hlohlona, ​​ho thunya, pele ho tsohle ho hlaha maotong le maotong, moo likepe li fetang teng kaofela.

Bosoha, ho akheha, ho hlonama - lipontšo tsa maoto le matsoho

Ka foromo ea asopmetric neuropathic, soreness e hlaha sebakeng sa pelvic, mokokotlo oa mokokotlo, e theoha ka leoto ho tloha lehlakoreng moo li-neurons li neng li senyehile. Boemo bona bo tsamaisana le ho fokotseha ha palo ea mafura, ho fokotseha ha mesifa ea leoto "bohloko".

O ka ithuta ho eketsehileng ka lefu la tsoekere la lefu la tsoekere le ka liphateng tse tlase ho tsoa sengolong sena.

Sebopeho sa Standalone

Liso tsa lisele tsa methapo ea litho tsa ka hare li tsamaisana le sekhahla se phahameng sa lefu har'a bakuli ba nang le lefu la tsoekere. Mefuta ea khafetsa le ea sebopeho sa pathology e hlalositsoe tafoleng.

Tlhahlobo ea methapo

Phekolo e fanoa feela ka mor'a phapang le tlhahlobo ea mali. Ho hlahlojoa le ho bokelloa ha litletlebo tsa mokuli ho tsamaisana le tlhahlobo ea methapo. Setsebi se hlakisa boemo ba bohloko, tactile, mocheso, serame, kutloelo-bohloko. Karolo ea setsebi sa methapo ea mafu bakeng sa lefu lena e kenyelletsa:

• mala o nang le nale e kentsoeng - ho lekola boemo ba kutloelo-bohloko;
• nemat - e lekola litakatso tsa maikutlo a mokuli;
• monofilament - moelelo oa kutloisiso ea tactile;
• lifereko - ho bonts'a boemo ba kutloelo-bohloko ba vibrate;
• 'mala o nang le brashi - litakatso tsa maikutlo.

Mefuta ea Atypical ea complication e ka hloka biopsy ea mothapo oa namane le serethe sa letlalo ka tlhahlobo e eketsehileng ea nalane.

Teko ea Reflex ke e 'ngoe ea mehato ea tlhahlobo ea methapo

Neurologist e fana ka lithuto tsa electrophysiological. Electromyography e bonts'a mosebetsi oa bioelectric oa lisebelisoa tsa mesifa le phetisetso ea methapo ea methapo. Lintlha tse fumanoeng li etsa hore ho khonehe ho khetholla boemo bo sebetsang ba mokokotlo, bo ikarabellang bakeng sa ho boloka karolo e itseng ea 'mele, ho senola tšenyo dikarolong tsa tsamaiso ea methapo.

Electroneurography ke mokhoa o qhekellang o bonts'a lebelo la phallo ea methapo ea kutlo le methapo ea kutlo ho tloha sebakeng seo ba tsoang tsamaisong ea methapo ea kutlo ho ea methapong ea methapo e teng mesifa le letlalong.

Lintho tse ka re susumetsang - sena ke thuto e bonts'ang mosebetsi oa lisele tsa methapo ea kutlo le lisele tse sebelisang likhothaletso tse fapa-fapaneng (tse bonoang, tse hlalosang mantsoe le tse bohloko).

Mekhoa e meng ea ho etsa lipatlisiso

Ntle le setsebi sa endocrinologist, gastroenterologist, urologist, cardiologist, ophthalmologist, orthopedist li nka karolo tlhatlhobong ea mokuli. Lisebelisoa tsa ho hlahloba mafu

• boikemisetso ba tsoekere ea mali;
• biochemistry ea mali;
• glycosylated hemoglobin;
• boikemisetso ba palo ea insulin;
• C peptide.

Setsebi sa pelo se fana ka tlhahlobo ea Valsalva, Holter ECG, echocardiography, tlhahlobo ea orthostatic. Ngaka ea gastroenterologist e lekola boemo ba sefuba ka mpeng ka ultrasound, endoscopy, x-ray ea mpa, liteko tsa laboratori ho fumana boteng ba Helicobacter pylori.

ECG - e 'ngoe ea mekhoa ea ho ithuta tšenyo ea tšenyo ea letsoalo ea mofuta o ikemetseng

Tlhahlobo ea boemo bo sebetsang ba methapo ea methapo ea kutlo e thehiloe ho urinalysis, ultrasound, cystoscopy, urravenous urography, le electromyography ea tsamaiso ea mesifa ea senya.

Phekolo

Lefu la tsoekere le lefu la tsoekere, kalafo eo e lokelang ho qala ka ho lokisoa ha tsoekere ea mali, e hloka phekolo e felletseng. Ho etsa sena, sebelisa liente tsa insulin (tsa lefu la tsoekere la 1) kapa lithethefatsi tse theolelang tsoekere (bakeng sa lefu la mofuta oa 2). Tlhokahalo ke taolo ea tsoekere maemong a boima ka mekhoa ea laboratori le mokhoa oa ho itaola.

Phekolo ea mathata e tsamaisana le ho lokisa lijo, ho ikoetlisa 'meleng le ho phomola, ho fokotsa boima ba' mele ba mmele, ho theha maemo a ho boloka khatello maemong a tloaelehileng.

Boikoetliso ba lefu la tsoekere

Lithethefatsi tse theolelang tsoekere tse sebelisoang ho lokisa likhahla tsa tsoekere:

• Metformin
• Maninil
• Victoza
• Januvius
• Lefu la tsoekere
• Novonorm.

Litokisetso tsa Thioctic acid

Mekhoa ea kalafo e tloaelehileng ea lipid metabolism, laola cholesterol. Mekhoa e ntlafatsa ts'ebetso ea sebete, e fokotsa litlamorao. Baemeli ba sehlopha:

• Berlition,
• Tiogamma
• Liopthioxone
• Lipoic acid.

Li-antidepressants

Lithethefatsi tsena li sebelisetsoa ho emisa letšoao la bohloko le ileng la hlaha khahlano le semelo sa neuropathy. Etsa kopo amitriptyline, imipramine, nortriptyline. Lipheko tsa pele tse peli ha li na chefo ebile li baka litla-morao tse fokolang. Ho felisoa ha bohloko ho hlaha pejana ho feta ha ts'ebetso ea antidepressant e hlaha.

Amitriptyline ke antidepressant e sebetsang e nang le chefo e fokolang 'meleng.

Batho ba baholo le ba nang le bothata ba encephalopathy, neurosis, maemo a bonoang ba lokela ho sebelisa lithethefatsi tlasa taolo e haufi ea litsebi kapa beng ka motho. Phekolo e sa lekaneng e ka bolaea.

Li-analgesics le lithibela-mafu

E boetse e sebelisoa ho kokobetsa bohloko. Likopo tse sebelisang anesthetics ea lehae (Lidocaine, Novocaine) li sebelisoa. Ha ho bapisoa le li-antidepressants, phello ea tsona ea analgesic e fokola, empa e sebelisoa ho ikoetlisa. Ntlafatso ea boemo ba mokuli e etsahala kamora metsotso e 10-25.

Li-analgesics ka sebopeho sa Analginum, Paracetamol ha li na thuso, leha ho le joalo, linyeoe tsa ho se be le motheo oa tsona li tsejoa.

Li-vithamini tsa B-Series

Litokisetso tsa vithamini li sebelisoa ho tsamaisa ts'ebetso ea methapo, ho fetisetsa litšusumetso. Pyridoxine e ratoang (B₆), thiamine (B₁) le cyanocobalamin (B₁₂) Sekema sa kopo se khethoa ke setsebi ka bonngoe.

Li-anticonvulsants

Carbamazepine, Finitoin ke baemeli ba sebetsang ba sehlopha, ba hloka ho khethoa ka hloko bakeng sa litekanyetso ka lebaka la litlamorao tse ka bang teng. Qala ho nka ka litekanyetso tse nyane, butle-butle u tlise kalafo e hlokahalang. Ts'ebetso ena ha e hloke esita le matsatsi a 'maloa, empa libeke tse 3-4.

Phekolo tse ling

Phekolo ea lefu la tsoekere la lefu la tsoekere e sebelisa mekhoa e latelang e seng ea lithethefatsi:

• ts'ebeliso ea laser;
• ho thothomela ha methapo e meholo;
• magnetotherapy;
• acupuncture;
• tšusumetso ea motlakase oa transcutaneous.

Boikemisetso ka nako ea nts'etsopele ea pathology le thuso ea litsebi tse tšoanelehang haholo li tla thusa ho boloka bophelo bo botle ba mokuli ka tekanyo e phahameng le ho qoba mathata a tebileng.