I-atherosulinosis yemikhumbi yamaphethelo aphansi yisifo esingapheli esibonakaliswa ukwakheka kwamachaphaza e-cholesterol ebusweni bangaphakathi be-membrane yemithambo enikeza imilenze ephansi
Ikhula ikakhulu ebudaleni (iminyaka engama-60-75), futhi iholela ekuwohlokeni kwezicubu ezithambile ze-trophic.
Izimbangela ze-atherosclerosis zamaphethelo aphansi
Ekujuleni kwemithambo yegazi ngenxa ye-hypercholesterolemia yesikhathi eside kanye nezinye izici, kudalwa imali yemisipha yabantu abaningi nezicubu ezihlangene.
Ngokuya ngosayizi nokwakheka kwe-cholesterol plaque, ukwephulwa kwengqondo yomkhumbi kanye nokwehla kwezicubu ezithambile ze-trophic ngenxa yokwanda kwe-ischemia.
Ngokuhamba kwesikhathi, ama-plaque ayaxaka, izinga lokuncipha kwe-artery landa.
Ngaphezu kokunciphisa ubukhulu be-artery ethintekile, ukubonakaliswa okulandelayo kwesifo kuyahlukaniswa: i-stenosis, noma ukuncipha okungaphelele kwe-lumen; i-occlusion (ukuqedwa ngokuphelele kwemithambo yegazi), noma ukuqeda i-atherosulinosis.
Izimbangela eziphambili ze-atherosulinosis yemikhawulo ephansi:
- Izifo ezihambisana nohlelo lwezinhliziyo (isifo senhliziyo, umfutho wegazi ophakeme).
- Ukuthambekela kokuzizwa kwe-hyperlipidemia kanye ne-atherosclerosis (dyslipidemia), i-hyperfibrinemia, i-monocytosis, i-Homocysteinemia.
- Imikhuba emibi - ukuphuza ngokweqile nokubhema.
- Ukwephulwa kokudla - ukudla amanani amaningi wezilwane nama-protein, ukudla okune-cholesterol, ukunganaki kokudla kwezitshalo.
- Izifo ze-Endocrine, ezinjengohlobo 2 sikashukela i-mellitus, i-hypothyroidism (ukukhiqizwa okunganele kwama-hormone e-thyroid), isifo se-metabolic, ukukhuluphala, isifo sika-Itsenko-Cushing. Ukukhulupha ngokweqile kanye nokukhulupha ngokweqile kwakha umthwalo owengeziwe emilenzeni ephansi.
- Ukwanda kokuzivocavoca komzimba nakho kudala ukwanda kwengcindezi emithanjeni yemithambo yegazi.
- Ukungasebenzi kahle komzimba - kuvusa ukwephulwa kwe-hemodynamics ne-tischem ischemia.
- I-pathology ehambisanayo - ama-varicose veins, i-macroangiopathy yesifo sikashukela noma i-microangiopathy.
- I-Pathology yezitho zomzimba we-pelvic, okungukuthi i-thrombosis kanye ne-thromboembolism yemithambo ye-pelvis.
- Ukuphazamiseka kweHormonal nokukhiqizwa okunganele kwe-estrogen ngenxa yokunqamuka kokuya esikhathini nakho kuholela ekwandeni kwe-cholesterol nezingxenyana zayo.
- Ukulimala ne-frostbite yemikhawulo - kuholele ekuguqukeni kwe-anatomical ekwakhekeni kwezicubu ezithambile nezithambo.
- Izimo ezicindezelayo ne-hypothermia.
Imbangela yokwanda kwalesi sifo kungaba izinguquko ezihlobene nobudala (kubantu asebekhulile, ukuqina kwemithambo kwehle, futhi ngisho nokufakwa okuncane kwe-cholesterol kungalimaza kakhulu ukuhamba kwegazi),
Ubulili bubamba iqhaza ekuthuthukiseni lesi sifo.
Imvamisa, i-atherosclerosis iba ngamadoda, ngoba kubantu besifazane ama-hormone ocansi anethonya lokuzivikela odongeni lwemithambo yegazi,
Ukusungulwa kwendawo ethintekile
Ukutholwa kwendawo ethintekile ngezinga elikhulu kuthinta izinga lokuqhubeka kwezifo kanye nobunzima bemiphumela.
Ukuthuthukiswa kwalesi sifo kungenzeka ezindaweni ezahlukahlukene zamaphethelo aphansi.
Ngokuya ngendawo, izinhlobo ezahlukahlukene ze-pathology ziyahlukaniswa.
Lezi zinhlobo ze-atherosclerosis zamaphethelo aphansi ziyahlukaniswa:
- i-atherosclerosis yengxenye ye-aorto-iliac;
- ukunqotshwa kwesiza se-femal-popliteal;
- i-pathology eyenziwe yasendaweni engxenyeni ye-popliteal-tibial.
- i-occlusion yesifunda somlenze;
- ukulimala kwemithambo ye-multilevel.
Futhi, kuye ngezinga lokuncipha kwe-lumen yomkhumbi, i-atherosulinosis yemithambo yomlenze ophansi ihlukaniswe ihlukane, ngokuhlangana kwe-lumen okungaphezulu kwama-50%, futhi hhayi ukwahlukanisa, ngokuncipha okuncane.
Izimpawu zesici kanye nezigaba ze-pathology
Lesi sifo singabonakala ngezimpawu ezahlukahlukene.
Izimpawu zesifo zincike ebangeni lokuthuthuka, isiza kanye nenani lokulimala kwemithambo.
Izikhalazo zokuqala kungaba ukukhathala kwemilenze lapho uhamba, ubuhlungu besikhathi esithile emisipha, ukupholisa kwezinyawo.
Ngokuhamba kwesikhathi, kuvela ezinye izimpawu:
- Ukwehla kwezinga lokushisa nokuzwela kobuhlungu besikhumba semilenze nezinyawo, ukushuba kwawo.
- Ukuphazamiseka kwethrophic - ukuqina kwesikhumba noma ukugqama kwesikhumba, ukuncipha kwalo, ukoma, ukulahlekelwa izinwele, ukukhipha noma ukuqina kwamazipho. Nge-ischemia ebalulekile futhi ehlala isikhathi eside, izilonda ze-trophic kanye ne-gangrene grow.
- Ukusebenza kahle ngaphakathi kwezicubu zezinzwa kukhubazekile, okungaholela ekunciphiseni umlenze, imvamisa ebusuku.
- I-Pain syndrome ivela - kusuka emseni kuya kokhona ngisho nasekuphumuleni. Njengomthetho, ubuhlungu banda ngesikhathi sokuhamba.
Isibonakaliso se-pathognomonic ye-atherosulinosis obliterans yemikhawulo engezansi ukugcotshwa ngezikhathi ezithile.
Ngokuya kokungasebenzi kahle, kuhlukaniswa izigaba eziningana zokulimala kwemilenze, umbandela oyinhloko ibanga lokuhamba kobuhlungu.
Esigabeni sokuqala, isiguli singahamba amakhilomitha angaphezu kwelilodwa ngokuqhubekayo, izinhlungu zenzeka ngokuzikhandla okukhulu ngokomzimba.
Isigaba sesibili u- “A” sibonisa ngokubonakala kobuhlungu lapho uhamba ibanga lamamitha angama-250 ukuya kwekhilomitha elilodwa, i-"B" yesibili - ukusuka kumamitha angama-50 kuye kwangama-250.
Isigaba sesithathu - i-ischemia ebucayi - sibonisa ukuncishiswa ebangeni lokuhamba kobuhlungu obungaphansi kwamamitha angama-50, ukubonakala kwezimpawu ezengeziwe, izinhlungu ziphikelela ngisho nasekuphumuleni.
Isigaba sesine sihlanganisa izimpawu zokuphazamiseka kwesithathu futhi kube nokungezelelekile kwe-trophic, kuze kufike ku-gangrene yemikhawulo.
Izindlela eziyisisekelo zokuxilonga
Ukuxilongwa kwalesi sifo kususelwa kwizikhalazo zesiguli, idatha emlandweni wezokwelapha (lapho kuqala ukubonakala izimpawu, isimo sazo, ubude besikhathi, imvamisa yokwenzeka, ingabe isiguli sihlobanisa lesi sifo nezinye izinto - ukuqaqanjelwa, i-hypothermia), umlando wezokwelapha (izifo zangaphambilini, ukuthambekela komndeni we-hypertension, i-angina pectoris, ukuba khona kwe-atherosulinosis yendawo ehlukile).
Futhi, ukwenza ukuxilongwa, imininingwane yokuhlolwa kwenhloso ibalulekile, okungukuthi, isimo sesikhumba nokufakelwa, izicubu ezithambile nemisipha yemilenze, ukudonsa kwemithambo ye-distal yomlenze nonyawo. Baphinde basebenzise izivivinyo zokuxilonga ngomthwalo, ngokwesibonelo lokhu: ukusuka endaweni othambekele kuyo, isiguli kudingeka siphakamise imilenze yaso ngama-degree angama-45 futhi siyibambe isikhashana. I-Pro atherossteosis ikhombisa ukuqala ngokushesha kokukhathala, ukuqina kwemilenze.
Ezindlela ezengeziwe zokuxilonga, kusetshenziswa izindlela ezijwayelekile zokwelapha - ukubalwa kwegazi okujwayelekile, i-urinalysis ejwayelekile, i-glucose yegazi (ukukhipha i-angiopathy yesifo sikashukela), i-biochemistry yegazi ngokunqunywa kwe-cholesterol ephelele (evame ukufika ku-5.5 mmol ilitha ngalinye), i-lipoproteins ephansi (i-atherogenic), i-lipoproteins ubukhulu bokuphakama (ingxenyeni ye-anti-atherogenic), izifundo zamahomoni - amazinga ama-hormone egilo, ama-hormone ocansi.
Izindlela zensimbi ziyasetshenziswa - auscultation of imithambo, isilinganiso sokucindezela ngokuqonda kwenkomba ye-ankle-brachial, i-angiography, i-magnetic resonance angiography, i-multispiral computed angiography, i-arip ye-peripheral, ukuskena okuphindwe kabili (i-US) yemithambo.
Ukwelashwa kuncike ekujuleni kwesimo, ekutholakaleni kwesilonda, umthamo waso, isigaba sesifo, futhi siqukethe ukuguqulwa kwendlela yokuphila, imiphumela yezidakamizwa kanye nokwelashwa kokuhlinzwa.
Ukulungiswa kwendlela yokuphila ne-atherosulinosis yemikhawulo ephansi
Isinyathelo sokuqala ekwelashweni kwe-atherosclerosis kuqala ngokushesha ngemuva kokuxilongwa futhi siqukethe ukulungiswa kwendlela yokuphila.
Lokhu kufaka phakathi ukudla noma ukondleka kwezokwelapha, ukwenqaba imikhuba emibi, ukulawulwa kokuzivocavoca umzimba.
Ukudla okunempilo noma okokwelashwa kuyisinyathelo sokuqala ekwelapheni kwazo cishe zonke izifo zenhliziyo, ngoba inani le-cholesterol embi egazini kanye nomfutho wegazi kuncike ekudleni komuntu.
Odokotela batusa ukubambelela ekudleni okulwa ne-atherogenic ngaphandle kwamafutha ezilwane namaphrotheni, ukudla okune-cholesterol eningi - isaladi, udoti, amaqanda enkukhu, amasoseji. Imithombo ye-fiber kufanele ifake kuqala ekudleni - imifino eluhlaza (amasaladi, iklabishi, i-zucchini, i-broccoli), izithelo, okusanhlamvu kanye nama-legumes (njengemithombo yama-carbohydrate ayinkimbinkimbi namaprotheni emifino), amantongomane (njengemithombo yamafutha anempilo).
Njengomthombo wamaprotheni, izinkukhu (inkukhu, idada, izigwaca), inhlanzi (izinhlobo ezinamafutha aphansi), nezinsimbi ziyamukeleka. Kubalulekile ukuqaphela umbuso wokuphuza - ama-millilitha angama-30 kuye kwangama-50 we-ode elingagcwele ikhabhoni ngekhilogremu yesisindo somzimba, amanzi amnandi anekhabhoni kufanele aqedwe ngokuphelele. Udinga futhi ukulahla ngokuphelele ukudla okusheshayo, ukudla okulula, ukubhema, ukudla okuthosiwe okujulile, izitsha ezihlotshisiwe nezithosiwe.
Okubaluleke kakhulu ukwenqatshwa kwemikhuba emibi - ukusebenzisa kabi utshwala, ukubhema.
Ukuzivocavoca umzimba ezigabeni zokuqala zesifo kungathinta kahle inkambo yesifo. Ungaqala ngokuhamba nsuku zonke imizuzu engama-30-60, ukugijima, ukuzivocavoca esiteshini samabhayisekili, ukubhukuda. Kuyelulekwa ukwenyusa kancane kancane umthwalo ngokuhamba kwesikhathi, kucatshangelwa izimpawu zesifo, izinga lokuvinjwa kokunyakaza.
Ukunakekelwa kwezinyawo kubalulekile futhi ezigulini - ukuhlanza nsuku zonke, i-pedicure efanele, ukwelashwa kwamanxeba nokunye ukulimala ngama-antiseptic agents.
Ukusetshenziswa kwezokwelapha
Isinyathelo esilandelayo ekwelashweni ukulungiswa kwezokwelapha kwezimpawu ezivela esigulini. Ngokushesha lapho uqala ukwelashwa, izinkinga eziningi ze-atherosulinosis ongakuvimbela futhi umncane umonakalo owenziwe emalungeni.
Izidakamizwa zokuqala ekwelapheni nasekuvimbeleni i-atherosulinosis yanoma yikuphi ukwenziwa kwasendaweni ngama-statins - Atorvastatin, Lovastatin, Rosuvastatin. Zithinta umzimba we-cholesterol kanye nokubopha kwayo isibindi, kunciphisa inani layo egazini. Futhi, ukunciphisa inani lama-lipoprotein egazini kuvumela i-fibrate, i-nicotinic acid, i-probucol.
Sebenzisa ama-antiplatelet agents - i-Aspirin, i-Cardiomagnyl, iMagnikor, i-Thrombo-Ass, le mishanguzo ithinta ukwenziwa kwezixuku ze-atheromatous nokuhlangana kweplatelet ezindaweni ezilimele ze-endothelium. Uma kungabikho ama-contraindication (isilonda se-peptic sesisu noma isilonda se-duodenal, isifo segazi, ukungabekezelelani), ukuthathwa isikhathi eside kwe-Aspirin okunconyiwe kungama-milligram angama-75 kuya kwayi-100 ngosuku ukuvimbela izinkinga ezingama-thrombotic.
Lapho kukhona izinkinga ze-thrombotic ku-anamnesis nezifo ezihambisanayo zohlelo lwegazi ngokuthambekela kwe-hypercoagulation, kuyalulekwa ukusebenzisa ama-anticoagulants - Warfarin, Heparin, Fraxiparin.
Indlela yokwelashwa ifaka izidakamizwa ze-vasodilator - antispasmodics No-spa, Drotaverin, Papaverine, izidakamizwa ezi-Vasooprostan, Trental, Agapurin.
Ukunciphisa izimpawu nokunciphisa izinhlungu, i-Pentoxifylline, i-Cilostazole iyasetshenziswa; ukwenza ngcono i-trophism kwezicubu ezithambile ezithintekile - iZincteral.
Ukwelashwa kwendawo kukhonjiswa ukuthuthukiswa kwezinkinga ezithathelwanayo kanye nezilonda ezindexayo; kusetshenziswa i-Oflokain, iLevomekol, nokugcotshwa kweDelaskin.
Ngaphezu kwalokho, kusetshenziswa ama-vitamin complexes, ukwelashwa kwe-physiotherapy - i-electrophoresis ene-novocaine noma i-lidocaine, i-darsonvalization.
Kuphoqelekile ukuphatha hhayi i-atherosclerosis kuphela, kepha nezifo ezihlanganyelayo (umfutho wegazi ophakeme, i-angina pectoris, isifo sikashukela) kanye nezinkinga.
Izindlela Zokuhlinzwa
Ukukhethwa nokusetshenziswa kwendlela yokwelashwa okuhlinzwa kwenziwa ngudokotela, kucatshangelwa inani elikhulu lezinto.
Ukwelashwa ngokuhlinzwa kuyadingeka uma kugula kakhulu, kumelana nokwelashwa kwezidakamizwa noma kungakubekezeleli.
Umthamo wokungenelela kokuhlinzwa kuya ngesihloko se-lesion, ubungako besifiso somkhumbi, ukuba khona kwezilonda eziseduze kwesikhumba nezicubu ezithambile, kanye nezinkinga ze-atherossteosis.
Kunezinhlobo ezinjalo zokusebenza:
- Ukuhlinzwa kweBypass kungukungenelela okungahlaseli kangako, umongo wayo ukwakha enye indlela yokugeleza kwegazi ngokudlula endaweni ethintekile bese ubuyisela izicubu zomzimba ngale ndlela.
- I-Stenting ukufakwa kweshubhu elenziwe ngezinto zokwenziwa emgodini womkhumbi, ovimba i-lumen ekunciphiseni.
- I-balloon angioplasty - ukunwebeka kwe-lumen yemithambo ngebhaluni.
- I-Endarteriectomy - ukususwa kwe-artery ethintekile kanye nezinsizwa ezinama-atheromatous, kanye nezinye izinhlungu zokuqubuka.
- I-Autodermoplasty - indlela yokwelashwa yezilonda eziyizidudla, iqukethe ukufaka isikhumba esithintekile esikhunjeni sesiguli uqobo, esithathwe kwezinye izingosi.
- Ngokuthuthukiswa kwezinkinga, ezifana ne-gangrene, ukunqunywa kwezindawo ezingama-necrotic kanye nezitho zomzimba wokufakelwa insimbi kuyasetshenziswa.
Ukuvimbela i-atherosclerosis kufanele kube okuphelele futhi okuqhubekayo, kufaka phakathi ukuqapha umfutho wegazi, ukuqapha iphrofayili ye-lipid yegazi, ukubonisana nodokotela ohlinza inhliziyo kanye nodokotela ohlinza ngemithambo uma kudingeka.
Ukuthi ulapha kanjani i-atherosclerosis yemilenze kuchazwe kule vidiyo kulesi sihloko.
