Ukuxilongwa kwe-hypertension kwesinye isikhathi kungenziwa ngephutha, isiguli sithatha ukwelashwa isikhathi eside, kepha akulethi umphumela. Iziguli zilahlekelwa ukholo ekwenzeni intuthuko yazo, futhi kancane kancane ziba nezinkinga eziningi eziyingozi.
Cishe i-15% yamacala okwehla kwengcindezi yegazi ahambisana ne-hypertension yezimpawu ezibangelwa yi-pathologies yezitho zangaphakathi ezithintekayo kulawulo lokucindezela.
Lesi simo sitholakala kuma-20% abantu abanesifo sikashukela abane-hypertension enobungozi, baphendule kabi ekwelashweni. Igama lesibili lalesi sifo yi-hypertension yesibili. Odokotela bathi akusona isifo. Cishe izifo ezingama-70 ziyaziwa ezibangela lolu phawu.
Izimbangela nokuhlukaniswa kwe-pathology
Izimpawu zomfutho we-arterial hypertension zivela ngenxa yokusetshenziswa kwezidakamizwa ezithile, ngokwesibonelo, ama-corticosteroids, ama-contracepadors omlomo. Kunezindlela eziningana ze-pathology, zincike kumbangela eyinhloko yokwanda kwengcindezi.
Umfutho wegazi ophakeme (renoparenchymal, renovascular) uyabonakala. Uma izinso zingatholi igazi elanele, ngokwesibonelo, ngokuthuthukiswa kwe-atherosulinosis yomthambo wezinso, izinto ezibangela ukwanda kwengcindezi ziyakhishwa.
Ukwephulwa komthetho kutholwa ngokulethwa kwe-ejenti ehlukile, i-computer tomography, i-ultrasound, izivivinyo zaselebhu. Umfutho wegazi wesibili ungabangelwa yi-hematomas, i-vasoconstriction yokuzalwa, i-malignant noma i-benign neoplasms, kanye nenqubo yokuvuvukala.
Ezinye izizathu zingafaka:
- izinguquko ze-atherosulinotic;
- ukugoqa kwegazi okwendlulayo futhi okunciphise i-lumen ye-vascular yemithambo ye-renal;
- isifo sikashukela se-nephropathy;
- inkambo engapheli ye-pyelonephritis;
- ukulimala
- Isifo sofuba se-Mycobacterium.
Nge-hypocrension ye-endocrine, sikhuluma ngenkomba eyengeziwe ye-aldeosterone, catecholamines, glucocorticosteroids. Kulesi simo, isimo se-pathological sitholwa kusetshenziswa amasu weelebhu, i-angiography, CT, i-ultrasound. I-Endocrine hypertension ibonwa nge-adrenogenital syndrome, i-acromegaly, isifo se-Itsenko-Cushing, hyperthyroidism, neoplasms ekhiqiza i-endothelin.
Olunye uhlobo lomfutho wegazi ophakeme libangelwa izidakamizwa, kuba lapho imithamo yezidakamizwa engahlangene nokujwayelekile kwamazinga wegazi egazi ingabhekwa. Kwenzeka ngokusetshenziswa isikhathi eside kwezindlela zokuvimbela inzalo ngomlomo, izidakamizwa ezingezona ze-steroidal ezilwa nokuvuvukala, ama-cyclosporin, izikhuthazi zomsebenzi wezinzwa.
I-Neurogenic hypertension ihlotshaniswa nezilonda eziphilayo zesistimu yezinzwa ephakathi:
- isifo sohlangothi;
- ukulimala
- isimila sobuchopho;
- ingcindezi ephezulu ye-intracranial;
- acidosis yokuphefumula;
- i-encephalitis;
- i-bulbar poliomyelitis.
Lezi zifo zitholakala ngesikhathi se-CT, i-ultrasound yemithambo yegazi yobuchopho, i-angiography yemithambo yegazi isebenzisa i-Medium ephakathi.
Ngesifo esizalwe kabusha noma esitholwe sohlelo lwezinhliziyo kwisifo sikashukela, i-hemodynamic hypertension kungenzeka. Izimfuneko zokuthuthuka kwenkinga zinganciphisa i-aorta, ukushiyeka kwemisipha yenhliziyo, i-aneurysm, i-erythremia, indawo ephelele ye-atrioventricular block. Ukwephula umthetho kuzobonisa i-electrocardiogram, i-Echo-KG, i-angiography.
Esigulini esinesifo sikashukela, i-hypertension enobuthi futhi ecindezelayo kungenzeka. Esimweni sokuqala sikhuluma ngoshevu wotshwala, ukudla okunamazinga aphezulu okuhola, i-tyramine, i-thallium. Isizathu sesibili kufanele sifunwe ekushaxekeni kwengqondo nokomzwelo, izinkinga zokulimala kokushiswa, ukungenelela okuyinkimbinkimbi kokuhlinzwa. Ngokuvamile, odokotela baxilonga izinzwa, i-neurogenic, i-endocrine ne-hemodynamic secondary hypertension.
Lapho isimo se-pathological siba ngesinye sezimpawu zesifo, akusona isibonakaliso esiyinhloko, kungahle kungashiwo ekutholweni kwesifo.
Ukwenza isibonelo, lokhu kwenzeka ngesifo noma i-Itsenko-Cushing's syndrome, sisebenzisa ubuthi obunobuthi.
Izimpawu Zokwephulwa
Ngobuningi bamacala okubonakaliswa kwe-hypertension ye-arterial dalili zizenza zizizwe ngokwanda kwengcindezi yegazi. Ezinye izinkomba kuzoba ukubukeka kokukhala nokukhala kwethinitus, ukuqaqamba kwekhanda, isiyezi, isicanucanu nokuhlanza, izimpukane ezivutha amalangabi phambi kwamehlo, ukukhathala okungapheli.
Isimo se-pathological sihambisana nokujuluka ngokweqile, ubuhlungu esifundeni se-occipital, enhliziyweni, ukukhuphuka ngezikhathi ezithile ekushiseni komzimba okujwayelekile, ukunganaki, kanye nokuqina kokuqina.
Ngesikhathi sokuhlolwa okubukwayo, udokotela uzonquma izimpawu ze-hypertrophy yesinxele sobunxele, ukugcizelelwa kwephimbo lesibili ngaphezulu kwe-aorta, izinguquko ezahlukahlukene emithanjeni yegazi ye-ocular fundus.
Isifo esidala ukuba nomfutho we-hypertension wesibili asikaze sihambisane nezimpawu ezicacile. Ezimweni ezinjengalezi, kunzima kakhulu ukusola uhlobo lwezimpawu zomfutho we-arterial hypertension.
Imvamisa kuhlotshaniswa nezinto:
- ukuthuthukiswa okukhulu, ukuqhubekela phambili ngokushesha kwe-hypertension;
- iminyaka emincane noma ngemuva kweminyaka engama-50;
- ukuntuleka kokwelashwa okusebenzayo komfutho wegazi ophakeme.
Imvamisa inqubo ye-pathological esezinso iqhubeka ngaphandle kwezimpawu ezisobala, ihambisana kuphela nokushintshana okubuthakathaka kanye nokuncipha komchamo. I-Proteinuria ithola inani lokuxilonga uma icubungula umthamo wamaprotheni wansuku zonke olahlekile ngomchamo. Amaproteinuria angaphezu kwe-1 g ngosuku athathwa njengophawu lokuthuthuka kwe-arterial hypertension ngomonakalo wezinso oyinhloko.
Ema-diabetes amaningi asebekhulile, umfutho wegazi onamandla awunakunyakaziswa, isikhathi nesikhathi ukungabi namqondo kuphakama futhi kunciphe ekucindezelweni kwegazi kuqala. Umfutho we-arterial hypertension ubonakala ngokwanda kwengcindezi ye-systolic ngezinga elijwayelekile le-diastolic. Lesi simo sibizwa ngokuthi yi-atherosulinotic noma i-hypertension ehlobene nobudala.
Izimpawu ze-peripheral arterial atherossteosis zenza ukuthi kuxilongwe isifo sokuqina kwethambo lomfutho wethambo.
Ngayo, ukudonsa kwemithambo yemithambo engezansi kuyancipha, imilenze ihlala ibanda ukufika ekuthinteni.
Izindlela zokuxilonga ezihlukile
Udokotela angakwazi ukubona izimbangela zokuphazamiseka kwengqondo okuqhamuka emzimbeni ngemuva kokuqoqa umlando wesiguli, kuzodingeka ukuthi kutholakale amacala okulimala, izifo ezedlule, kanye nengqondo yokwandisa umfutho wegazi.
Kuyadingeka ukukala ingcindezi kaninginingi, kwabanesifo sikashukela ekhaya kudingeka bagcine idayari ekhethekile lapho bephatha imininingwane ngezinkomba zokucindezela kwegazi.
Ukuthola izimbangela zokwehla kwengcindezi kubandakanya ukulethwa kohlolo lwelabhorethri: ukuhlolwa kwegazi okujwayelekile nokunamakhemikhali, ukutadisha kwamazinga ama-hormone, i-urinalysis, i-echo-kg, i-electrocardiogram, i-ultrasound yezinso, imithambo yezinso, i-angiography, i-compact tomography.
Ngemuva kokusungula isimo sezempilo, ukuthola imiphumela yokuhlolwa kwelebhu, ezinye izindlela zokuxilonga zingabekelwa isiguli:
- i-electroencephalography;
- i-intravenous urography;
- i-biopsy yezinso;
- rheoencephalography.
Ezinye iziguli zizodinga i-isotopic renography, ukucwaninga kwezinga le-sodium ne-potassium kumchamo, isiko lomchamo ku-Gulda, ukukhetha i-adrenal gland phlebography.
Ukuqinisekisa ubukhona bamatshe ezinso, ukuthuthukiswa okungajwayelekile kwemithambo ye-renal engadala i-micro- kanye ne-macrohematicsuria. Nge-hematuria, ukuze kungafakwa ama-neoplasms, ngaphezu kwe-urography ye-excretory, iskena sezinso, i-compact tomography, i-patra ephambene, i-aortography ibonisiwe.
Ngokutholwa kwe-nestritis ye-interstitial, ephinde iboniswe yi-micromaturia, kunconywa i-biopsy yezinso. Ucwaningo lusiza ekugcineni ekuqinisekiseni ubukhona bomonakalo we-amyloid organ. Uma udokotela ephakamisa i-vasorenal hypertension, kuqhathaniswa i-angiography ebhaliwe. Zombili izindlela zokuxilonga zisetshenziselwa izinkomba eziqinile.
I-Angiography yenzelwa abanesifo sikashukela abasebancane nabaseminyakeni ephakathi ne-diastolic dalili izimpawu zomfutho wegazi nokusebenza okuphansi kokulashwa kwezidakamizwa.
Izindlela zokwelapha
Ukwelashwa kwe-hypertension ye-arterial hypertension okuhloswe ngayo ukuqeda izimbangela zokwanda kwengcindezi yegazi. Ukwelashwa nokwelashwa kuyenziwa, i-nadnosis yokusebenza ngempumelelo incike ekujuleni kwesifo esikhona.
Ama-diabetesics anqunywe inkambo yezidakamizwa ze-antihypertensive, zikhethwa ngawodwa, ngokusekelwe kuzinkomba zokucindezela, ukuba khona kwe-contraindication ezintweni ezisebenzayo, izimbangela ze-hypertension ye-arterial.
Ngokuqinisekiswa komfutho wegazi wezinso, kukhonjiswa ukuthatha ama-diuretics, ACE inhibitors. Lapho umphumela we-hypotensive ungenzeki, ama-vasodilators aphelele, ama-P-blockers kufanele athathwe. Ngezinkinga zezinso, hemodialysis iyenziwa.
Kumele kuqashelwe ukuthi irejimeni yokwelashwa eyodwa yesifo somfutho wegazi ayikho. Eminye imishanguzo yohlu lwezidakamizwa ezinconyelwe uhlobo oluphambili lwalesi sifo i-contraindified ezimeni zokuphazamiseka kusuka:
- ubuchopho;
- izinso
- imithambo yegazi.
Isibonelo, ama-inhibitors e-ACE anqatshelwe ku-renal artery stenosis ebangelwa ukuqina kwegazi okuvuselela umzimba. AmaBeta-blockers awakwazi ukubekelwa izinhlobo ezinzima ze-arrhythmia, lapho umtholampilo uhambisana nokungahambi kahle kwemisipha yenhliziyo, ukubumbana kwe-aorta.
Ukwelashwa okuhlanganisiwe nokusetshenziswa kwemithi yamaqembu ahlukahlukene kukhonjiswa ngokuqina kwe-diastolic, hypertension ye-arterial yanoma iyiphi i-pathophysiology, hypertension.
Ukufinyeleleka ngokwejwayelekile ithoni yemithambo yegazi yobuchopho, ukuthuthukisa ukulawulwa kwezinqubo zezinzwa, odokotela banquma imithamo emincane ye-caffeine, i-Cordiamine. Izindlela zithathwa ekuseni, lapho umfutho wegazi ususezingeni eliphansi.
Inkambo yokwelashwa ikhethiwe esigulini ngasinye, ukukhetha kwenziwa ngemizamo ehlangene yesazi sezinzwa, i-cardiologist, udokotela ohlinzayo nodokotela we-endocrinologist. Kubalulekile ukucubungula ngokucophelela ukukhethwa komthamo wemithi, lokhu kuyiqiniso ikakhulukazi ezigulini esezikhulile.
Ukwehla okuqinile kwezinkomba zokucindezela kuzodala ukwephulwa kokujikeleza kwe-cerebral, coronary kanye ne-renal.
I-Prognosis, izindlela zokuvimbela izinkinga
Kungenzeka ukubala ekuqothulweni okuphelele kwesibonakaliso se-arterial hypertension ngokuya ngokuqedwa kwesizathu saso. Ukwanda okuhlala isikhathi eside kwengcindezi yegazi kuvusa ukukhula kanye nokuqhubeka kwe-arteriosulinosis, futhi umshini wokucinezela wezinso ubuye ujoyine i-pathogenesis. Kulokhu, kungenzeka ukuthi imeko ivumelaniswe nesimo.
Uma ukululama kungenzeki
Izindlela zokuvimbela umfutho wegazi ophakeme zehlela ekuvinjelweni kwezifo ezingaphansi kwaso. Iphuzu elibalulekile ukwelashwa okufika ngesikhathi kwe-pachelonephritis eyingozi, glomerulonephritis, atherossteosis. Uma kungekho ukwelashwa okwanele, lezi zifo ziba zezamakhompiyutha.
Imininingwane yokuphawulwa kwegazi elinomfutho inikezwe kuvidiyo kule ndatshana.
