Diabetesic polyneuropathy (ICD-10 khoutu G63.2 * kapa E10-E14 leq. 4) e bua ka ho ba teng ha matšoao a tšenyo tsamaisong ea methapo ho bakuli ba nang le lefu la tsoekere, haeba mabaka a mang a lefu la methapo a sa behelletsoe ka thoko. Ts'oaetso e ka etsoa leha ho se na litletlebo tse tsoang ho mokuli, ha lesion le khethoa nakong ea tlhahlobo.
Diabetesic polyneuropathy ha e tiisoe motheong oa letšoao le le leng la kliniki. Litlhahiso tsa hona joale tsa WHO li bontša hore tlhahlobo ea mafu e lokela ho khetholla boteng ba lipontšo tse peli tsa lesion e le ho netefatsa lefu la methapo ea methapo khahlanong le semolao sa "lefu le monate".
Haeba ts'ebetso e etsahala methapong ea methapo ka bomong, joale re bua ka neuropathy. Tabeng ea maqeba a mangata, polyneuropathy e ba teng. Bakuli ba nang le lefu la tsoekere la mofuta oa 1 "ba amohela" mokokotlo maemong a 15-55%, mofuta oa 2 - 17-45%.
Tlhomamiso
Karohano ea polyneuropathy e rarahane haholo, hobane e kopanya li-syndromes tse 'maloa. Bangoli ba bang ba khetha ho khetholla leseli ho latela hore na likarolo tsa ts'ebetso ea methapo li kenella ts'ebetsong efe: liforomo tsa methapo ea kutlo (lesapo la mokokotlo) le liforomo tse ikemetseng.
Sehlopha se seng se sebelisoang khafetsa:
- Polyneuropathy e potlakileng (ea nakoana, e hlahang ka lebaka la ho tlōla hoa tsoekere maling).
- Symmetric solidne polyneuropathy: tšenyo ea methapo ea methapo e meholo (distal somatic); tšenyo ea likhoele tse tšesaane; autionous mofuta lesion.
- Focal / multifocal polyneuropathy: mofuta oa cranial; mofuta oa compression; mofuta oa proximal; mofuta oa thoracoabdominal; maoto le matsoho.
Mabaka
Boemo bo phahameng ba tsoekere ea mali ho batho ba nang le lefu la tsoekere bo khona ho ama boemo ba likepe tse nyane haholo, bo hlahise nts'etsopele ea microangiopathy le methapo e meholo, e bakang macroangiopathy. Liphetoho tse etsahalang ka har'a likepe tse kholo li ts'oana le mochini oa sebopeho sa atherosclerosis.
Angiopathy ke sehokelo sa mantlha kholisong ea tšenyo ea methapo ea lefu la tsoekere
Mabapi le li-arterioles le li-capillaries, tsohle li etsahala ka tsela e fapaneng mona. Hyperglycemia e etsa hore tšebetso ea protheine ea kinase-C e sebetse, e thusang ho phahamisa molumo oa marako a methapo ea mali, e nolofatsang membrane ea bona, 'me e ntlafatsa tšilafalo ea mali. Leboteng le ka hare la li-arterioles le li-capillaries, glycogen, mucoprotein le lintho tse ling tsa tlhaho ea carbohydrate li qala ho beoa.
Litlamorao tsa chefo ea tsoekere e kanna ea fapana. E ikopanya le liprotheine, e li etsa li-glycated, tse bakang tšenyo ea metsoako ea methapo le tšilafalo ea metabolic, tsamaiso le lits'ebetso tse ling tsa bohlokoa 'meleng. Protheine e tsebahalang ka ho fetisisa glycated ke HbA1c hemoglobin. Ha thepa ea eona e phahama le ho feta, e fumana oksijene e fokolang eo lisele tsa 'mele e e fumanang.
Diabetesic polyneuropathy e etsahala ka lebaka la tšenyo ea endoneural (e fumanehang ka har'a metsoako ea methapo pakeng tsa methapo ea methapo e ka har'a mokokotlo oa methapo). Sena se netefatsoa ke kamano e netefalitsoeng pakeng tsa botenya ba methapo ea methapo le methapo ea methapo methapoong. Ts'ebetso e hapa li-neuron le lits'ebetso tsa tsona, tse shoang ka lebaka la mathata a metabolic 'meleng oa batho ba lefu la tsoekere.
Lintho tse hohelang
Lintho tse latelang li kenya letsoho kholisong ea polyneuropathy ho lefu la tsoekere:
- tlhekefetso ea ho itlhokomela tsoekere ea mali;
- nako e telele ea lefu le ka tlase;
- khatello ea mali e phahameng;
- kholo e phahameng;
- botsofali;
- ho ba teng ha mekhoa e mebe (ho tsuba, ho noa joala);
- dyslipidemia;
- phatsa ea tlhaho.
Likarolo tsa ts'ebetso ea pathological ka liso tse ngata tsa methapo ea methapo
Mehato
Ho latela botebo ba liponahatso, methati e latelang ea tšenyo e khetholloa, motheong oo kalafo e hlokahalang bakeng sa polyneuropathy e ikemiselitseng:
Lefu la Angiopathies- 0 - ha ho na data ea pono;
- 1 - asymptomatic nete ea hore complication;
- 1a - ha ho na litletlebo tse tsoang ho mokuli, empa liphetoho tsa pathological li kanna tsa ikemisetsa ho sebelisa liteko tsa tlhahlobo ea mali;
- 1b - ha ho litletlebo, liphetoho li ka khethoa eseng feela ka liteko tse ikhethang, empa hape le tlhahlobo ea methapo;
- 2 - sethala sa lipontšo tsa kliniki;
- 2a - matšoao a lesion a bontšoa hammoho le liteko tse ntle tsa tlhahlobo;
- 2b - mohato oa 2a + bofokoli ba maoto a ka morao a maoto;
- 3 - polyneuropathy e rarahaneng ke bokooa.
Matšoao
Matšoao a polyneuropathy ea lefu la tsoekere a itšetlehile ka ho toba sethaleng le sebopeho sa nts'etsopele ea ona, hammoho le kalafo e sebelisitsoeng.
Mathata a Boholo
Tšoaetso ea tšobotsi ea methapo ea kutlo. Li ka khethoa feela ka liteko tsa tlhahlobo ea bongaka (fomu ea subclinical) kapa ho ba litletlebo tsa mokuli (mofuta oa bongaka). Bakuli ba utloa bohloko. Bohloko e ka ba ho chesa, ho baka, ho thunya, ho tena. Ponahalo ea eona e ka ts'oaroa le ke lintho tse sa bakeng ts'oarelo ho batho ba phetseng hantle.
Mokuli a ka tletleba ka botšehali, maikutlo a kang a ho hlasimoloha, ho chesoa ke maikutlo, ho angoa ka matla ke litlamorao tsa ho bata, mocheso le vibrate. Boikhutso ba 'mele bo phehella,' me bo ka 'na ba se be teng.
Ha e le molao, liphapang tse tebileng ke tse tšoanang. Ka ponahalo ea asymmetric pathology, lefu la bohloko le qala ho tsoa sebakeng sa pelvic mme le theohe lethekeng. Sena se tsamaisana le ho fokotseha ha palo ea leoto le amehang, tlolo ea boholo ba lona mabapi le 'mele kaofela.
Ho senyeha ha maikutlo a bohloko ke e 'ngoe ea matšoao a khanyang a polyneuropathy
Psychology e kopaneng
Nts'etsopele ea sensory-motor polyneuropathy maemong a mangata e na le thuto e sa foleng. Litsebi tsa lefu la tsoekere li tletleba ka lipontšo tse latelang:
- ho ikutloa eka ha u tsebe letho;
- bohloko ba tlhaho e fapaneng;
- tlolo ea kutlo ea kutlo ho fihlela ho se be teng ka botlalo;
- bofokoli ba mesifa;
- ho haella ha 'mele le ponahalo ea li-pathological reflexes;
- manonyeletso a bosiu a lipheletso tse tlase le tse holimo;
- ho hloka botsitso ha o tsamaea.
Khatello e etsahalang khafetsa ea ts'ebetso e sa foleng hammoho le tšenyo ea mochini ke leoto la tsoekere - boemo bo teng moo lesion e nkang likarolo tsohle, ho kenyeletsoa lefufuru le likarolo tsa masapo. Liphetho - phetoho le pherekano e mpe.
Hlolang ka ntle ho tšenyo ea nako
Lisele tsa methapo tse fumanehang libakeng tsa kahare le tsona lia ameha. Matšoao a itšetleha ka hore na setho kapa tsamaiso efe e amehile. Pathology ea pelo le methapo ea mali e bonahatsoa ke khatello ea methapo ea methapo ea methapo, edema ea pulmonary, sensitivity sensational sensation. Bakuli ba tletleba ka pherekano ea morethetho oa pelo, khatello e phahameng ea mali, ho hema ka thata, khohlela. Ho haella kalafo ka nako ho ka bolaea.
Ho tšoenyeha ka morethetho oa pelo - letšoao le ka 'nang la hlaha la mofuta oa mofuta oa boikemelo
Tšenyo ea mali ka mpeng e bonahatsoa ke parresis, ho fokotseha ha lentsoe la mafapha a hae, tlolo ea microflora e tloaelehileng le lefu la Reflux. Bakuli ba na le mathata a ho hlatsa, ho otla ha pelo, lets'ollo, ho theola boima ba 'mele, bohloko.
Genitourinary polyneuropathy e tsamaisana le atony ea lesapo la mokokotlo, mokokotlo o ka morao oa moroto, ts'ebetso ea thobalano e senyehileng, ts'oaetso ea bobeli e ka etsahala. Bohloko bo hlaha mokokotlong o ka tlase le ka holimo ho "pubis", ho ntša metsi khafetsa, ho tsamaea le bohloko le ho chesa, mocheso oa 'mele oa phahama, ho tsoa methapong ea methapo ho tsoa ka hara botshehadi mme urethra e hlaha.
Mathata a mang:
- tlolo ea mekhoa ea ho fufuleloa (ho eketseha kapa ho fokotsoe haholo ho fihlela ho se sebetse hantle hoa litšoelesa tsa mofufutso);
- methapo ea kutlo ea lipono (pudi e fokotseha ka bophara, "" acuity visual "e fokotseha ka sekhahla, haholoholo mantsiboea);
- polyneuropathy ea tšoelesa ea adrenal ha e na lipontšo tsa matšoao.
Ts'oaetso
Pele a fana ka kalafo ea lefu la tsoekere la polyneuropathy ea likarolo tse tlase, mokuli ha a hlahlojoe feela bakeng sa neurology, empa hape le setsebi sa endocrinologist ho hlakisa boemo ba puseletso bakeng sa lefu lena le tlase.
Setsebi se hlakisa boemo ba mefuta e fapaneng ea maikutlo (mocheso, vibration, tactile, bohloko). Bakeng sa sena, boea ba k'hothone, li-monofilaments, malots ka brashe le nale, qetellong ho sebelisoa lifereko. Maemong a ikhethang, thepa e nkuoa ke biopsy bakeng sa nalane e tsoelang pele. Tlhahlobo ea Neurological e boetse e kenyelletsa mekhoa e latelang:
- Lintho tse nang le ts'oaetso - likhoele tsa methapo lia hlohlelletsoa, likarabo tsa tsona li tlalehiloeng ke sesebelisoa se ikhethileng.
- Electroneurography ke mokhoa oa tlhahlobo oo ka oona lebelo la ts'ebetso ea methapo ea kutlo e tsoang mafapheng a tsamaiso ea methapo e kholo ho ea ho li-receptors li ikemiselitseng.
- Electromyography ke tlhahlobo e hlakisang boemo ba phetisetso ea lisele tse tsoang liphatseng tsa methapo ea kutlo ho lisebelisoa tsa mesifa.
Ho Khetholloa ha Pulse - Mokhoa oa Bohlokoa oa ho Lekola
Mekhoa ea ho hlahloba mafu ka laboratori e tlama: ho hlakisa boemo ba glycemia, tlhahlobo ea biochemical, matšoao a C-peptide le hemoglobin ea glycated. Tabeng ea ts'ebetso e belaetsang ea ho ba le ts'oaetso, mokuli o fuoa ECG, echocardiography, ultrasound ea pelo, dopplerografia ea likepe, ultrasound ea seterata sa gastrointestinal, endoscopy, x-ray.
Boemo ba ts'ebetso ea moroto bo ka khethoa ke tlhahlobo ea moroto ea letsatsi le letsatsi, tlhahlobo ho latela Zimnitsky le Nechiporenko, hape le nakong ea ultrasound, cystography, cystoscopy le electromyography.
Litšobotsi tsa kalafo
Bakeng sa kalafo ea lefu la tsoekere la polyneuropathy, ntho ea bohlokoa ke tokiso ea tsoekere ea mali. Sena se etsoa ke endocrinologist, ea ntseng a hlahloba mofuta oa kalafo ea insulin le tšebeliso ea lithethefatsi tse theolelang tsoekere. Haeba ho hlokahala, chelete e nkeloa sebaka ke e sebetsang haholoanyane kapa ho fanoa ka litlatsetso tse ling.
Khalemelo ea lijo e ea etsoa, ho khethoa mokhoa o hlokahalang oa ho ikoetlisa. Ngaka e fana ka likeletso mabapi le mokhoa oa ho boloka khatello ea mali le boima ba 'mele ka har'a meeli e amohelehang.
Lihlopha tse latelang tsa meriana li fanoe:
- Liphetho tsa alpha lipoic acid ke lithethefatsi tsa khetho. Ba khona ho tlosa k'holeseterole e feteletseng, ba emise litlamorao tse chefo tsa mabaka a kantle ho sebete le methapo ea mali. Baemeli - Berlition, Lipoic acid, Thiogamm. Nako ea kalafo ke bonyane likhoeli tse peli.
- Li-vithamine tsa B - li ntlafatsa ts'ebetso ea methapo e bohareng le e poteletseng ea methapo, li kenya letsoho ho fetisetsano ea phetisetso ea methapo ea methapo (Pyridoxine, Cyanocobalamin, Thiamine).
- Li-antidepressants - li sebelisetsoa ho fokotsa lipontšo tse bohloko (amitriptyline, nortriptyline). Li fanoa ka tekanyetso e nyane, butle-butle li fihlela phello e hlokahalang ea kalafo.
- Li-inhibitors tsa Aldose reductase - likarolo tse ntle tsa kalafo ka sehlopha sena li bontšitsoe, empa ha lia ka tsa hlakisa tšepo eohle e behiloeng ho bona. E sebelisoa ka monahano oa ngaka e eang teng (Olrestatin, Izodibut, Tolrestat).
- Li-anesthetics tsa lehae - li sebelisetsoa ho emisa ho soreness ka mokhoa oa lits'ebetso. Matla a hlaha kamora metsotso e 10- 10.
- Li-anticonvulsants - Carbamazepine, Finitoin. Sehlopha sena se hloka khetho e hlokoang ea litekanyetso. Qala ka litekanyetso tse nyane, o eketseha ho feta libeke tse 'maloa.
Liphetho tsa alpha-lipoic (thioctic) acid - lithethefatsi ho etsa hore boemo ba methapo ea mali bo fetohe le ho tlosa mehopolo e sa thabiseng ka ts'abo ea lefu la tsoekere tsamaisong ea methapo.
Litlhare tsa setso
Hoa khoneha ho phekola lefu la tsoekere polyneuropathy eseng feela ka meriana ea setso, empa le ka mekhoa e fapaneng le infusions e lokiselitsoeng lapeng.
Recipe nomoro ea 1
Jala lithupa tse lokiselitsoeng esale pele. Mokuli o lokela ho ba hloibila bonyane metsotso e 7-10 ka letsatsi.
Recipe nomoro ea 2
Metso e sithabetseng ea burdock le makhasi a blueberry li kopane. 3 tbsp motsoako o hlahisoang o tšeloa ka litha e le nngwe tsa metsi a belang mme o ts'oaroa bonyane lihora tse 8. Ebe u chesa 'me u tepelletse lihora tse ling tse 3. Kamora hore moroo o folile, e tlameha ho hloekisoa. - Noa metsi a mangata nakong ea letsatsi.
Recipe nomoro ea 3
Khalase ea oats e tšeloa ka litara e le 1 ea metsi a belang. Tsitlella lihora tse 10, ka nako eo o hloka ho pheha motsoako ona bonyane metsotso e 40. Tlosa setofo mme o romelle sebakeng se futhumetseng. Kamora hore e hloekisoe le ho nooa ka khalase halofo ea hora pele ho lijo tsohle.
Ho tlameha ho hopoloa hore ho ke ke ha khoneha ho tlosa polyneuropathy ka litlhare tsa setso ntle le meriana ea setso le taolo ea tsoekere ea mali. Empa phello e kopaneng ea lintlha tsena e ka lebisa pheletsong e ntle ea pathology.
