Umfutho wegazi ubonakala ngokumelana nemithambo yegazi ekhipha ngesikhathi sokukhishwa kwegazi enhliziyweni. Kwenzeka i-systolic ne-diastolic, okungukuthi, ngesikhathi sokukhumula nokuzilibazisa komisipha wenhliziyo, ngokulandelana.
Ukwanda okuqhubekayo kwengcindezi yegazi ngaphezulu kwamamilimitha ayi-120/80 we-mercury kubizwa ngokuthi yi-hypertension. Kumele kwehlukaniswe kwe-arterial hypertension, lapho ukwanda kwezibalo zokucindezela kwenzeka kanye, ngokuya ngezimo zemvelo, njengokucindezela, futhi kudlule ngaphandle kokulimaza impilo.
I-Hypertension inamazinga amaningana obunzima:
- I degree lokuqala libonakaliswa ukwanda kwe-episodic kokumelana kwemithambo, okungaba yi-asymptomatic. Ngaphandle kokuphepha okubonakalayo kwaleli banga, kugcwala izingibe eziningi, ikakhulukazi amathuba wokuqhamuka nenkinga ye-hypertgency kanye nokushintshela okusheshayo enkambeni enzima kakhudlwana;
- Ukwanda okuqhubekayo kwengcindezi ye-systolic kusuka ku-160 kuye ku-180 kanye ne-diastolic kusuka kumamilimitha ayi-100 kuya kwayi-110 okubizwa ngokuthi yi-second degree hypertension. Izikhathi zezinkomba ezijwayelekile ziyancishiswa futhi zincishiswe, ngokuhamba kwesikhathi, ngaphandle kokwelashwa okwanele, ukonakala kanye nomonakalo wezitho eziqondiwe ziqala;
- Isilinganiso esibi sibonakaliswa ukwanda kokucindezela kwe-systolic ne-diastolic okungaphezulu kwamamilimitha angama-180 nama-110 wesibalo, ngokulandelana. Izinga lokumelana nemithambo cishe lihlala lincipha ezinombolweni ezibucayi, lisongela ukungena enkingeni ye-hypertensive bese likhubazeka.
I degree lesibili lalesi sifo lidlangile emhlabeni, ngoba liyatholakala kakhulu ngokwezibalo - iziguli ezineziqu zokuqala azimboni udokotela. Umuntu ngamunye kudingeka azazi izimpawu nokwelashwa kwe-hypertension. Ngemuva kwakho konke, imishanguzo ejwayelekile isiza ukumvimbela ukuthi athuthuke aze afike ezingeni lesithathu ngezinkinga.
Imvamisa ungezwa kudokotela ukutholakala kwe-2 hypertension ngengozi ye-3, kodwa abaningi abazi ukuthi kuyini. Lapho wenza ukuxilongwa, amathuba okulimala kwesitho okuhlosiwe ayathathwa, okuyingozi. Ihlukaniswe izigaba ezine:
- Ingozi ingaphansi kwe-15%;
- Izinga lisuka ku-15 laya ku-20%;
- Ukuvama kwengozi akukho ngaphezulu kwama-30%;
- Inani lezinkinga lingaphezu kwama-30%.
Lezi zitho zibandakanya inhliziyo, ubuchopho, imithambo yegazi nezinso.
Umphumela ezithweni ezitholwayo
Ukulimala kwe-vascular kwenzeka ngendlela ye-spasm engapheli, okuholela ekugcwalisweni kwezindonga zayo ngezicubu ezihlangene. Lokhu kwenza udonga lungahambi ngokuqina, kepha lube mnene, olunomthelela ekuthuthukisweni kwama-atherosclerotic plaque kulo.
I-Hypertension ithinta kakhulu ukwakheka okujwayelekile kwezinso, kuphazamise amandla ayo okusebenza. Lokhu kuboniswa ukukhula kwentuthuko engapheli yezinso - ukulahleka komsebenzi we-parenchyma wokususa ubuthi emzimbeni.
Uma i-hypertension ingaphathwa, khona-ke ukwehluleka kwezinso kuzothuthuka futhi ekugcineni isiguli sizodinga ukufakelwa kwezinso noma i-hemodialysis.
Kunezinketho ezintathu zokulimala kwenhliziyo.
Esokuqala ngukushintsha kwe-diastole ku-ventricle yangakwesobunxele. Lokhu kusho ukuthi ngemuva kokuxineka okukhulu ku-systole, i-myocardium ayikwazi ukuphumula ngokuphelele. Kulokhu, ukugcwala kwemisipha yenhliziyo ephethe i-oxygen kuyancipha, kukhula ischemia, okungaholela ku-necrosis;
Okwesibili ukwanda nokuqina kodonga lwe-ventricle yangakwesobunxele. Lokhu kuholela ekuguqukeni kwenhliziyo, okudala ukungqinelana ekuxosheni kwegazi embhedeni wemithambo. Lapho lesi sifo siqhubeka, kulapho udonga luqina khona, futhi, ukusebenza kwenhliziyo kuncipha. Izicubu zomzimba azitholi umoya-mpilo owanele, okuholela ekubeni buthakathaka kanye nokuphefumula.
Ukwesithathu - ukwehluleka kwenhliziyo, kukhula ngokusebenza njalo kwenhliziyo okukhulu ezimeni zokuqukethwe komoya ophefumulwayo. Lokhu kubonakaliswa ukuwohloka kokungaphumuli nje kuphela, kepha nokuwohloka kwenhliziyo. Kunzima impela ukwelapha le-pathology, eyinkimbinkimbi kakhulu kunokuqina komfutho wegazi ophezulu. Futhi uma izifo ezihlangana njenge-atherossteosis noma isifo sikashukela zijoyina umfutho wegazi, ukuthuthuka kokuhluleka kwenhliziyo kuzoshesha.
Umfutho wegazi ophakeme ungadala izinkinga. Isiguli singaba nesifo sohlangothi. Kwenzeka hemorrhagic noma ischemic. Kuqala, kuvela umunyu wamakhokho, owenzeka ngenxa yokuqhuma kwemithambo yobuchopho. Lapho kukhula ingcindezi, kukhulu ithuba lokuthuthukisa le nkinga. Ngokushaywa yi-ischemic, izindonga zemikhumbi azidilizi, kepha zincishiswa kakhulu, okuholela ekungeneni komoya okwanele kwezicubu nokufa kwezindawo ezithintekayo zobuchopho.
I-Hypertension nayo ingadala i-encephalopathy - lokhu kuyinkinga enkulu, lapho ukwanda kwengcindezi kubangela ukusebenza kwekhanda kanye nokulimala kwengqondo, kuguqulwe ngokulingene ngokwanele.
Ngaphezu kwalokho, kwenzeka izinguquko engqondweni yethu - ngenxa yokubulawa yindlala isikhathi eside komoya, amangqamuzana obuchopho ayafa, umthamo wobuchopho uya ngokuya uncipha, kube nezimpawu zokuwohloka komqondo kanye nokukhula komqondo kuyakhula.
Ukubonakaliswa okuyinhloko kwehypertension
I-Hypertension ye-degree yesibili inezimpawu ezimbalwa, ekubonakaliseni ukuthi kubalulekile ukubonana nodokotela ukuze uthole izeluleko nokwelashwa.
Isibonelo, ikhanda lekhanda entanyeni nasemathempeleni kubangelwa ukukhula kwe-vasospasm.
Ukuba khona kwama-nerve plexus amaningi kanye nemicu kulezi zindawo kubangela ukuthuthukiswa kwe-Reflex yobuhlungu obukhulu.
Ukuboniswa okulandelayo kungenzeka futhi:
- Ububomvu besikhumba sobuso buchazwa ngokugeleza kwegazi okuqhubekayo emithanjeni, ngenxa yengcindezi eyandayo, ngenxa yalokho ama-capillaries andiswa njalo futhi alahlekelwe ukuqina, akhanyeke esikhunjeni. Kungadala futhi umphumela we-vasculature esikhunjeni sobuso nentamo.
- U-Edema, ikakhulukazi ubuso namajwabu amehlo, ahlotshaniswa nokugcinwa kwamanzi ngumzimba ngenxa yokuphazamiseka kwemithambo, kwenzeka kaningi ekuseni futhi kuyabonakala emahoreni ambalwa ngemuva kokuvuka.
- Ukukhathala okungapheli nokungakhathaleli kubangelwa ischemia engapheli yezicubu, ikakhulukazi ubuchopho nemisipha yamathambo. Ngenxa yokushoda komoya-mpilo, empeleni basebenzela ukugqokwa nokuklebhula, kancane kancane banciphe, okuholela ekubonakaleni kwezimpawu - okokuqala, ukukhathala ngemuva kokulala, ukuncipha kokuqwashisa namandla okusebenza, bese kuba nomuzwa wokukhathala okungapheli.
- Ukushiswa kwezimpukane phambi kwamehlo, kumnyama emehlweni ngemuva kokuzivocavoca ngokomzimba - lezi zimpawu zidalwa yi-hypoxia ye-opic nerve kanye nokunciphisa imithambo ye-retina. Ngenxa yokushoda kwe-hemoglobin ye-oxygenated, i-retina ebucayi iqala uku-atrophy, kungenzeka kakhulu lokhu kwenzeka ngokwanda okukhulu kwengcindezi, ngokwesibonelo, ngengcindezi. Uma le nqubo ingalawulwa, kungenzeka kugqamuke ukugqama nobumpumputhe.
- I-Tachycardia, noma ukwanda kwenhliziyo, kwenzeka ngokuxhamazela lapho kukhuphuka ingcindezi. Lokhu kungenxa yokucasulwa kwama-receptors enhliziyo, angenawo umoya-mpilo, ukusabela kwe-chain kuyenziwa. Ihlose ekwandiseni ukuhamba kwegazi okuhamba kahle kokulethwa kwezidakamizwa okungcono. Lokhu kwenziwa ngokwandisa ukuthengiswa kwe-myocardium, ezwa umuzwa ongathandeki ngemuva kwe-sternum.
- Izinkinga ngememori nokuhlushwa kungenxa yokuthi izicubu zobuchopho zingaphansi kwengcindezi engapheli ngenxa ye-ischemia, ukuxhumana kwe-neural kuyaphuka futhi imisebenzi yokuqonda iyahlupheka.
- I-Tinnitus lapho ukhuphuka izitebhisi kanye nesinyathelo esisheshayo kungenxa yokungasebenzi kahle kwensiza ye-vestibular ngenxa yokuphefumula okunganele kwe-oxygenation. Izinzwa zezinwele ezibucayi, kunomzwa womsindo ekhanda. Kamuva, kungaba yinkimbinkimbi ngokuba nesiyezi kwesinye isikhathi, ukulahleka kwengqondo nokukhumbula.
- Ukuqunjelwa kanye nokusebenza komoya ngokomzwelo kuvela ngenxa yempilo engeyinhle, imvamisa ngokuyeka ukwelashwa komfutho wegazi ophakeme.
Ngaphezu kwalokho, kubhekwa umjovo wemikhumbi egxekayo - ukuqhekeka okuncane kakhulu ngenxa yokuqothuka kodonga lwe-vascular.
Ukwelashwa okuyisisekelo komfutho wegazi ophakeme
Lapho usebenzisa ukwelashwa, indlela edidiyelwe kufanele isetshenziswe.
Okwelashwa, udokotela ohambelayo uncoma ukusetshenziswa kwezidakamizwa eziningana ezinomphumela ohlukile emzimbeni.
Lezi izidakamizwa zamaqembu ahlukene azothinta izinqubo ezihlukene emzimbeni. Ngokuvumelana nalokho, phatha umzimba ngokubuka okuhlukile.
Amaqembu alandelayo wezidakamizwa asetshenziswa: izidakamizwa ze-antihypertensive zokwenza izibalo zencindezi zibe ngompetha kanye nethonya imbangela eyinhloko yesifo; ama-diuretics ukususa uketshezi olwedlulele kwezicubu; izindlela zokunciphisa usizi lwegazi ukulungiselela ukuhamba kwegazi ngemithambo encishisiwe; izidakamizwa ezokwehlisa i-cholesterol zokuvimbela i-atherossteosis; amalungiselelo okulungiswa koshukela wegazi, uma phakathi kwezifo ezihlangana kukhona uhlobo 2 lwesifo sikashukela / uhlobo 1 sikashukela.
Izidakamizwa ze-antihypertensive zifaka:
- AmaBeta-blockers anciphisa ukushaya kwenhliziyo. Ngenxa yalokhu, ukuphuma kwenhliziyo kuncipha futhi ingcindezi iyancipha. Bangomunye wamaqembu akudala; baba ngabokuqala ekwelashweni kwezifo zenhliziyo nezemithambo. Umphumela oyingozi oyingozi ukuthuthukiswa kwe-bronchospasm, ukukhwehlela okukhohlisayo kanye nokuphefumula, ngakho-ke, kubalulekile ukuthi ucabangele udokotela maqondana neziguli ezinesifo esingelapheki se-pulmonary isifo, isifuba somoya noma isifo sofuba. Leli qembu lifaka amaphilisi anjengeMetoprolol, iSotalol, iLabetalol kanye nezimpawu zawo.
- Ama-inhibitors e-ACE - isenzo sabo ukuvimba i-enzyme eguqula i-angiotensin, futhi sinciphise inani le-angiotensin elizonamathisela kuma-receptors emithambo futhi lenyuse ukumelana nemisipha. Banikeza ukwelashwa okusebenzayo esigabeni sokukhula kokungaphumeleli kwezinhliziyo ezingapheli, bavikela izicubu zenhliziyo kusuka ku-necrotizing. Akunconyelwe ukuthi kusetshenziswe ezigulini zokwehluleka kwe-renal nasezigulini ezikwi-hemodialysis, ngoba izinto ezisebenzayo zivezwa yizinso nabesifazane abakhulelwe, ngenxa yengozi ye-gestosis.
- Ama-calcium antagonists anciphisa umphumela we-ion kuma-receptors emithambo. Ngokuvamile kusetshenziswa njengendlela yokuvimbela. Ngokungafani ne-beta-blockers, ayinamphumela ohlelweni lokuphefumula, ngakho-ke, asetshenziswa ngenkuthalo ezigulini ezinokuvinjezelwa i-bronchial futhi aba nokubuyekezwa okuhle. Leli qembu lifaka iNifedipine noDiltiazem.
Ngaphezu kwalokho, kusetshenziswa ama-alpha-blockers. Babekelwe iziguli ezinezifo ezifanayo, ezinjengesifo sikashukela, i-adrenal hypertrophy syndrome kanye ne-pheochromocytoma. Bangakwazi ukwehlisa ngokumangalisayo ingcindezi, ngakho-ke kufanelekile ukubheka umthamo obekwe udokotela. I-Doxazosin ingekaleli qembu.
Imithi eyengeziwe ye-Hypertension Therapy
Ngokuhambisana nezidakamizwa ze-antihypertensive, kusetshenziswa ama-diuretics. Zibangela ukwanda kwe-excretion koketshezi oluvela kumaseli ngokwandisa inani lomchamo. Zingahluka emandleni wethonya, ngakho-ke ukukhetha izidakamizwa kuyinto eyodwa. Amandla amakhulu yi-loop diuretics. Azisusi nje kuphela amanzi, kodwa futhi ne-potassium, chlorine ne-sodium ion, ezigulini ezinokwehluleka kwenhliziyo zizodala ukukhula kwenhliziyo. Lokhu kufaka phakathi i-furosemide.
I-Thiazide diuretics, ekhipha amanzi ku-nephron loop kanye nama-ion e-potassium, ishiye i-sodium ne-chlorine ku-fluid ye-interellular, kuthathwa njengobuthakathaka kancane ekusebenzeni. Umuthi oyinhloko kuleli qembu yi-hydrochlorothiazide.
Izidakamizwa ezichitha i-Potassium azisebenzi kakhulu, kepha zithathwa njengezonga isikhathi eside uma ziqhathaniswa nezinye. Ummeleli waleli qembu yi-Spironolactone.
Ngokuhambisana nalokhu kwelashwa, ama-statin anqunyelwe ukuthi anciphise i-cholesterol futhi avimbele ukuthuthukiswa kwe-atherosclerosis, kanye nezidakamizwa ezinciphisa ushukela zabanesifo sikashukela.
Ngokungeziwe ekwelashweni okuyinhloko, odokotela batusa ukulandela indlela yokuphila enempilo, bandise inani lezithelo nemifino ekudleni, uma kungenzeka, banikeze okungenani imizuzu engamashumi amathathu umsebenzi wokuzivocavoca futhi bakhiphe ukubhema nokuphuza utshwala. Uma unamathela kulokhu, khona-ke ubungozi bezinkinga buncishiswa ngama-20%, okunomthelela esikhathini eside sokuphila. Ukuzelapha akusizi ngalutho, ngoba izidakamizwa eziningi zine-contraindication futhi zingabekwa uchwepheshe ofanelekayo kuphela, ngaphandle kokuthi imiyalo yokusebenzisa umuthi ingalandwa. Lokhu kugcwele impilo ekhubazekile.
Imininingwane nge-grade 2 hypertension inikezwe kuvidiyo ekulesi sihloko.
