I-Stenosis isho ukunciphisa. I-Renal artery stenosis iwukunciphisa okukhulu kwe-lumen yemithambo yegazi ekondla izinso ngenxa yokuqothula kwamapherothi abo e-atherosranceotic. Ezigulini esezikhulile ezinesifo sikashukela sohlobo 2, lokhu kungenye yezimbangela ezivamile zokuhluleka kwe-renal. I-Renal artery stenosis nayo ibangela umfutho wegazi ophakeme, ongazwisiseki.
Umthamo wegazi okungenzeka ukuthi imithambo ye-renal idlule kuwo uqobo, ngokweqile, uhlinzeka ngokuhlinzekwa kwezitho nge-oxygen. Ngakho-ke, i-renal artery stenosis ingakhula isikhathi eside ngaphandle kwezimpawu. Izikhalazo ezigulini zivela, njengomthetho, sekuvele lapho i-vasency patency iphazamiseka ngo-70-80%.
Ubani osengozini ye-renal artery stenosis
Ezigulini ezinomdlavuza wesifo sikashukela sohlobo 2, i-renal artery stenosis ivame kakhulu. Ngoba baqala ukuba nesifo se-metabolic, bese ushukela wegazi labo uphakama ngokuqina. Lokhu kuphazamiseka kwe-metabolic kubangela i-atherossteosis, i.e., ukuqhekeka kwemikhumbi emikhulu emikhulu enikezela inhliziyo nengqondo. Ngasikhathi sinye, i-lumen emithanjeni ekhipha izinso ibunile.
E-USA, ukusinda kweziguli ezine-renal artery stenosis kwafundwa iminyaka engu-7. Kwavela ukuthi iziguli ezinje zinengozi enkulu yenhlekelele yenhliziyo. Kuphindwe izikhathi ezi-2 kunengozi yokwehluleka kwezinso. Ngaphezu kwalokho, ukubuyiselwa kokuhlinzwa kwe-patal vasency patency akukunciphisi amathuba okufa kokuhlaselwa yisifo senhliziyo noma unhlangothi.
I-Renal artery stenosis ingaba yi-unilateral (monolateral) noma i-bilateral (bilateral). Bilateral - kulapho kuthinteka khona imithambo yegazi eyondla izinso zombili. Olunye uhlangothi - lapho i-patency emthanjeni owodwa wezinzwa iphazamiseka, kanti kolunye kuseyinto ejwayelekile. Amagatsha wemithambo ye-renal angathinteka futhi, kepha izitsha ezinkulu azikho.
I-atherossteotic stenosis yemithambo ye-renal iholela ku-ischemia (ukunganele kwegazi) yezinso. Lapho izinso 'zilamba' futhi 'zivuma,' ukusebenza kwazo kuyawohloka. Ngasikhathi sinye, ubungozi bokwehluleka kwezinso bukhuphuka, ikakhulukazi ngokuhlanganiswa nephropathy yesifo sikashukela.
Izimpawu Nokuxilongwa
Izici zobungozi ze-renal stenosis ye-renal ziyefana ne-atherosclerosis "evamile". Sizibhala:
- umfutho wegazi ophakeme;
- ukukhuluphala;
- ubulili besilisa;
- amazinga aphakeme e-fibrinogen egazini;
- ubudala
- ukubhema
- cholesterol ampofu namafutha egazi;
- isifo sikashukela mellitus.
Kuyabonakala ukuthi iningi lalezi zinto eziyingozi lingalungiswa uma onesifo sikashukela ebandakanyeka empilweni yakhe esemncane noma esemncane. Uma i-stenosis yomunye wemithambo ye-renal iba khona, khona-ke amathuba okuthi kwesibili nawo ahlupheke.
Udokotela angasola i-renal stenosis esigulini esinesifo sikashukela phambi kwezimpawu ezilandelayo nemininingwane yenhloso:
- iminyaka yesiguli idlula iminyaka engama-50;
- ukwehluleka kwe-reso kuyaqhubeka, ngasikhathi sinye, i-proteinuria <1 g / usuku kanye nezinguquko zokuzitika kokuchama kuncane;
- umfutho wegazi omkhulu kakhulu - umfutho wegazi wanda kakhulu, futhi akunakwenzeka ukuba wehlise ngemithi;
- ukuba khona kwe-vascular pathology (isifo senhliziyo esi-coronary, ukuqhuma kwemikhumbi emikhulu, umsindo ngokulandelana kwemithambo yezinzwa);
- ekwelapheni i-ACE inhibitors - i-creatinine eyandayo;
- isiguli sibhema isikhathi eside;
- lapho ihlolwa ngudokotela wezifo zamehlo - isithombe esibonakalayo kwi-retina ye-Hollenhorst plaque.
Ngokuthola lesi sifo, izindlela ezahlukahlukene zokucwaninga zingasetshenziswa ezinikeza isithombe esibonakalayo sesimo semithambo yegazi. Uhlu lwabo lubandakanya:
- Ukuskena kwe-Ultrasound duplex (ultrasound) kwemithambo yezinso;
- I-angiography ekhethiwe
- I-Magnetic resonance angiography;
- I-computer tomography (CT);
- I-Positron emission tomography (PET);
- I-Captopril scintigraphy.
Ezinye zalezi zindlela zidinga ukuthi kungeniswe ama-ejenti agxile emgudwini wegazi, ongaba nomphumela we-nephrotoxic, okungukuthi, olimaza izinso. Udokotela ubanikeza uma inzuzo engaba khona yokucacisa ukutholakala kwegciwane idlula ingozi engaba khona. Lokhu kuyiqiniso ikakhulukazi ezimweni lapho kuhlinzwe ukuhlinzwa kokuhlinzwa ukuze kubuyiswe amandla emithambo yegazi.
Ukwelashwa kwe-renal artery stenosis
Ukwelashwa okuphumelelayo kwe-renal stenosis ye-renal kudinga imizamo eqhubekayo, ebanzi yokumisa ukuthuthukiswa kwenqubo ye-atherosclerotic. Isibopho esikhulu sazo sikhona nesiguli uqobo kanye namalungu omndeni wakhe. Uhlu lwemisebenzi edingekayo ifaka:
- ukuyeka ukubhema;
- ukujwayelekile kwamazinga kashukela egazini;
- ukwehlisa umfutho wegazi kube okwejwayelekile;
- uma kwenzeka kwesisindo somzimba ngokweqile - ukunciphisa umzimba;
- ukunikezwa kwezidakamizwa - ama-anticoagulants;
- ukuthatha izidakamizwa ezivela ekilasini lama-statins ukuthuthukisa i-cholesterol ne-triglycerides egazini.
Sincoma ukuthi kudliwe i-carbohydrate ephansi yohlobo 1 nohlobo 2 sikashukela. Le yindlela enhle yokwehlisa ushukela wegazi lakho ibe evamile bese uvikela izinso zakho kushukela. Ukudla kwe-carbohydrate ephansi akugcini nje ukwehlisa ushukela, kepha futhi kuvamisa ama-triglycerides, “amahle” kanye “nokubi” cholesterol yegazi. Ngakho-ke, iyithuluzi elinamandla lokunciphisa i-atherossteosis, kufaka phakathi ukuvimbela i-renal artery stenosis. Ngokungafani nezidakamizwa ze-statin, ukwelashwa okudla akunayo imiphumela emibi eyingozi. Isigaba sokudla kwezinso zethu sikashukela sibaluleke kakhulu kuwe.
I-Renal Artery Stenosis neMedical
Ngezinkinga zezinso ezinesifo sikashukela, iziguli zivame ukubekwa izidakamizwa ezivela emaqenjini e-ACE inhibitors noma ama-angiotensin-II receptor blockers (ama-ARB). Uma isiguli sine-unilateral renal stenosis ke kuyanconywa ukuthi siqhubeke nokuthatha umuthi. Futhi uma i-stenosis yemithambo ye-renal isimbili, i-ACE ne-ARB inhibitors kudingeka ukuthi ikhanseliwe. Ngoba zingasiza ekulimazeni ekuqhubekeni komsebenzi wezinso.
Imithi evela esigabeni sama-statins yehlisa izinga le-cholesterol "embi" egazini. Lokhu kuvame ukuvumela ukuthi uzinzise ama-atherosselotic plaque emithanjeni yezinso futhi uvikele ukuqhubeka kwawo. Ngezilonda ze-atherosulinotic zemithambo ye-renal, iziguli zivame ukunikezwa i-aspirin. Ngasikhathi sinye, ukuphepha nokuphepha kokusetshenziswa kwayo esimweni esinjalo akukaze kufakazelwe futhi kudinga ukuqhubeka nokufundwa. Kuhamba okufanayo kuma-heparin aphansi wesisindo nama-glycoprotein receptor blockers.
Izinkomba zokwelashwa okuhlinzwa kwe-renal artery stenosis (American Heart Association, 2005):
- I-hemodynamically ebalulekile yangaphakathi kwamazinyo we-artery stenosis;
- I-Artery stenosis yezinso esisodwa esisebenzayo;
- I-unilateral noma i-bilodyal hemodynamically renal artery stenosis, okwaholela ekutheni kube nomfutho wegazi ongalawulwa;
- Ukwehluleka okungapheli kwezinso nge-unenaral stenosis;
- Amacala aphindaphindiwe we-pulmonary edema nge-hemodynamically stenosis ebalulekile;
- I-angina pectoris engakwazi ukuqina nge-stenosis ebalulekile ye-hemodynamically.
Qaphela IHemodynamics ukuhamba kwegazi emithanjeni. I-stemosis yomkhumbi obalulekile we-hememnamically - lowo okhulisa ukuhamba kwegazi ngempela. Uma ukunikezwa kwegazi ezinso kuhlala kuhlala kwanele naphezu kwe-stenosis yemithambo yezinso, khona-ke ingozi yokwelashwa kokuhlinzwa ingadlula inzuzo yayo engaba khona.
