I-Hypertension yisifo. Okuthi emashumini eminyaka amuva nje bathole ukwabiwa kabanzi phakathi kwazo zonke izingxenye zabantu. Lesi sifo, uphawu oluphambili ukwanda okukhulu komfutho wegazi ngenxa yezizathu eziningi.
Umbiko weWorld Health Organisation ubika ukuthi umfutho wegazi ophakeme wenzeka kuwo wonke umuntu ohlala eMhlabeni wesibili.
Ngakho-ke, inkinga yokuxilongwa nokwelashwa kwalesi sifo iyaziswa. Lokhu kusebenza kuwo wonke umuntu, futhi nezimpawu eziphelele zivela kaningi kakhulu kubantu asebekhulile, kepha kunokuthuthuka okudumazayo - umfutho wegazi ophakeme umncane, othinta abantu abangaphansi kweminyaka engama-30 nangaphansi.
Imvamisa abantu kabanaki ukubonakaliswa kwesikhashana kwengcindezi ephezulu baze baqale lesi sifo kuze kube izigaba ezilandela kamuva, ezintathu no-4 ngokulandelana. Yilezi zindawo eziseceleni eziyingozi kakhulu. Kuyini umfutho wegazi we-grade 3 futhi uvelaphi?
Umfutho wegazi ophakeme kanye nomfutho wegazi ophezulu
Igama lesayensi lalesi sifo yi-hypertension ye-arterial, ama-analogues asele ahlukahluka kuphela kanye nomqondo wesikhathi osele. Kungenxa yezinhlobo ezimbili.
I-Hypertension (igama lezokwelapha lingumfutho wegazi ophambili noma obalulekile) ukukhuphuka okuqhubekayo nokuhlala isikhathi eside komfutho wegazi we-genesis engaziwa.
Lokhu kusho ukuthi imbangela yalokhu kuphazamiseka komhlaba ayikaziwa kwisayensi, futhi konke kuncike ekucabangeni kuphela.
Kukholelwa ukuthi ku-genome yomuntu kunezinhlobo ezingaba ngamashumi amabili ezithinta ngandlela thile ukusebenza kohlelo lokulawula umfutho wegazi. Lesi sifo sibalwa ngaphezu kwamaphesenti angama-90 awo wonke amacala. Ukwelashwa ukudambisa izimpawu eziyingozi futhi kuqedwe imiphumela.
Okwesibili, noma okubonisa izimpawu zamandla okuqubuka komzimba, kwenzeka ngezifo kanye nokusebenza kokuphazamiseka kwezinso, i-endocrine gland, i-inferior innervation kanye nokungasebenzi kahle kwesikhungo se-vasomotor se-medulla oblongata, okucindezelayo nokuhlobene nemithi, okubizwa nangokuthi yi-iatrogenic.
Isigaba sokugcina sifaka umfutho wegazi ophakeme obangelwa ukusetshenziswa kwezidakwamizwa yama-hormonal ngesikhathi sokwelashwa ngesikhathi sokuya esikhathini noma sokuvimbela inzalo.
Kuyadingeka ukuphatha umfutho wegazi onjalo ngokomqondo, okungukuthi, ususe imbangela yempande, hhayi ukumane wehlise ingcindezi.
I-Etiology ne-pathogeneis yentuthuko yalesi sifo
Esikhathini sobunjiniyela bezakhi zofuzo, akunzima ukuthola ukuthi ifa liyinto ehamba phambili ebukhoneni bokukhula kwengcindezi. Kungenzeka kakhulu ukuthi uma abazali bakho bekhononda ngokwanda okuqhubekayo kwengcindezi yegazi, khona-ke lesi sifo sizodluliselwa nakuwe.
Okulandelayo ngokubaluleka, kepha hhayi imvamisa, kuyingqayizivele kwabahlali basemadolobheni - imvamisa ephezulu yezimo ezicindezelayo kanye nesantya esiphakeme sempilo. Kufakazelwe ngokwesayensi ukuthi ngokugcwala okukhulu kwe-psychoemotional, amaqoqo ama-neurons aphuma emijikelezweni ejwayelekile ye-neural, okuholela ekwephuleni umthetho wawo wokushintshana. Inzuzo ekuqondisweni kwezikhungo ezisebenzayo ixhumene ngokungalingani nokwenyuka kwengcindezi yegazi.
Izici zobungozi zikhombisa lawo maqembu abantu anethuba elandayo le-hypertension.
Lokhu kufaka phakathi:
- Abantu abadala. Kuyemukelwa ngokuvamile ukuthi wonke umuntu ongaphezu kweminyaka engama-50 uhlushwa umfutho wegazi ophakeme, noma ngabe engezwa zimpawu zakhe zokuqala. Lokhu kungenxa yokwehla kokuqina kwemithambo yegazi, ngenxa yekhono labo lokunxenxa ukumelana namandla ezinkontileka zenhliziyo. Futhi, ngobudala, ingozi ye-atherosulinosis yemikhumbi emikhulu iyakhuphuka, okuholela ekunciphiseni kwe-lumen yabo kanye nokuhamba okubizwa ngokuthi ukuhamba kwegazi (njenge-nozzle yendiza) ngomgodi omncane enkabeni yomgodi owenziwe ngamathafa anamafutha.
- Abesifazane. Ucwaningo lukhombisa ukuthi amantombazane nabesifazane kungenzeka ukuthi bahlushwa umfutho wegazi ophakeme kunamadoda. Isizathu isizinda esinamandla samahomoni, esikhula ngesikhathi sokukhulelwa, bese sinyamalala ngokumangazayo lapho kwenzeka ukuya esikhathini. Ama-estrogens akhiqizwa ama-ovari anciphisa umfutho wegazi, kepha abusa ingxenye kuphela yokuya esikhathini. Lapho ukukhiqizwa kwabo kuyeka nhlobo, abesifazane baqala ukukhathazeka ngezimpawu zomfutho wegazi ophakeme.
- Ukungalingani kwezimbiwa. Kulesi sigaba unganquma ukulutha kokudla okunosawoti omningi, okuthuthukisa ukubuyiselwa kwamanzi kumathumbu e-nephron futhi kube nomthelela ekwandeni kwevolumu yokujikeleza kwegazi, kanye nokuncipha kwe-calcium. It, njenge-ion yenhliziyo enkulu, iyadingeka ekusebenzeni okugcwele kwe-myocardium. Ngaphandle kwalokho, i-arrhythmias ne-ejection ephezulu ye-arterial kungenzeka, okuholela ekwandeni kwengcindezi.
- Utshwala nokubhema. Imikhuba elimazayo ngokwayo iyingozi kakhulu, ilimaza nezigobolondo zangaphakathi nezinwebekayo zemithambo yegazi, yenze amandla abo okwelula nokweneleka ekushayweni ngegagasi lokushaya. Izinkontileka ezihlala zivela emithanjeni yegazi ngenxa yesenzo sika-nicotine kanye nogwayi kuholela ekwephulweni kwe-innervation ne-vascular pathology.
Ngaphezu kwalokho, esinye sezici ngukuthi khona kokukhuluphala nesifo sikashukela. Ukhuluphele kuhlobene ngokungalingani nokungasebenzi komzimba. I-hypertonic enjalo ihola indlela yokuphila engasebenzi, imikhumbi yayo, ngenxa yokuntuleka komthwalo ojwayelekile, ilahlekelwe yisici semisipha yayo futhi ingaphenduli kumthethonqubo wezinzwa we-autonomic neva.
Ngaphezu kwalokho, izinga le-liphero ye-atherogenic lenyuka, elivuza ngokusebenzisa i-endothelium yemithambo yegazi, ebathinta kabi.
Le dystrophy ithuthukiswa kakhulu ku-mellitus yesifo sikashukela, ngoba ngenxa yokungasebenzi kwe-carbohydrate metabolic boiler, amafutha awanawo oxid futhi aphukile, awakwazi ukungenwa futhi ajikeleze egazini.
Izinga le-hypertension ye-arterial kanye nemiphumela engaba khona
Umtholampilo uhlukanisa amakilasi amane asebenzayo we-hypertension, ngalinye linendlela ekhethekile yokuxilongwa, ukwelashwa
Ngaphezu kwalokho, kunamaqembu ayingozi amaningi okuthuthuka kwezinkinga zesifo
Amaqembu anobungozi ancike ebukhona bezici ezithile ezixaka inkambo yesifo.
Ukuhlukaniswa okulandelayo kwe-hypertension ye-arterial ngokuya ngomfutho wegazi ophezulu kungenzeka.
- Ibanga 1 - systolic 140-159 / diastolic 90-99 mm RT. Ubuciko.
- Ibanga 2 - systolic 160-179 / diastolic 100-109 mm RT. Ubuciko.
- Ibanga 3 - systolic 180+ / diastolic 110+ mm RT. Ubuciko.
- Isolated hypstension ye-Isstated - systolic 140+ / diastolic 90.
Ukusuka kulolu hlaka kusobala ukuthi okuyingozi kakhulu i-degree yesi-3, enengcindezi ephezulu kakhulu, inkinga ye-pre-hypertensive. Leli degree linqunywa ngokulinganisa okujwayelekile kwengcindezelo ngokuya ngendlela yeKorotkov, kepha ayiphathi izinkomba zomtholampilo. Ukubonisa ushintsho ezithweni ezithinta kakhulu ukwanda kwengcindezi yegazi (izitho ezibizwa ngokuthi izisulu) nemiphumela engenzeka, kwahlukaniswa ngezigaba ngezigaba. Lezi zitho zibandakanya ubuchopho, isibindi, izinso, amaphaphu. Izimpawu eziyinhloko ukuvuvukala komzimba ku-organ parenchyma ngokwephula okulandelayo komsebenzi wayo kanye nokuthuthukiswa kokungapheleli.
Isigaba 1 - izinguquko kwezitho ezihlosiwe azitholakali. Umphumela we-hypertension enjalo ukubuyiselwa kwesiguli ngendlela efanele yokwelashwa.
Isigaba 2 - uma okungenani kuthinteka isitho esisodwa, isiguli sikulesi sigaba salesi sifo. Kulesi sigaba, kuyadingeka ukwenza uhlolo lwendawo ethintekile bese uthintana nochwepheshe. I-ECG, i-echocardiography, ukuhlolwa kwamehlo kwe-retinopathy lapho kuhlolwa i-fundus (uphawu olufundisayo nolutholakala kalula okwamanje), ukuhlolwa kwegazi okujwayelekile nokwenziwe ngamakhemikhali, i-urinalysis.
Isigaba 3 - isimo esisemngceleni ekuqaleni kwenhlupho yegazi. Kuboniswa ukuba khona kwezilonda eziningi nezinwebekayo zesitho esingaphezulu kwelilodwa. Kungaba: i-hemorrhagic kanye ne-ischemic stroke ngenxa ye-angiopathy yemithambo yegazi, i-encephalopathy yemisuka ehlukahlukene, isifo se-coronary artery (isifo senhliziyo esine-coronary) ngokubonakaliswa kwe-angina pectoris (isifuba esibuhlungu engalweni yangakwesokunxele, entanyeni, emhlathini), ukufakwa kwe-myocardial ngezinguquko ezilandela i-necrotic ne-toxic - I-Dressler's syndrome, i-reperfusion syndrome kanye ne-cardiogenic shock. Lokhu kuzolandelwa ngumonakalo wokuvinjwa kwe-renal, ngenxa yokuthi i-proteinuria izokwenzeka, izinqubo zokuhlunga nokubuyiselwa kwe-plasma yegazi ku-nephron zizokhula kakhulu, kanye nokwehluleka kokuqina kwe-renal. Imikhumbi emikhulu izothinteka kulokhu okulandelayo, okuzobonakala njenge-auric aneurysm, isifo sokuqina kwemithambo yegazi, kanye nomonakalo emithanjeni ye-coronary. I-retina izwela kakhulu umfutho wegazi ophakeme, obonakaliswa ngomonakalo we-opic nerve kanye ne-intraocular hemorrhage. Lesi sigaba sidinga izindlela ezinqumayo zokunxephezela izinqubo ezilimazayo nezidakamizwa.
Isigaba 4 - izwe elibulalayo, okuthi, ngokuqhubeka isikhathi esingaphezu kwesonto, liholele ekukhubazekeni okungaguquki.
Ngaphezu kwalokho, kunamaqembu ayingozi amaningi okuthuthuka kwezinkinga:
- eyokuqala - ngesikhathi sokuhlolwa, akukho zinkinga, futhi amathuba okuthuthuka kwabo iminyaka engaphezu kwe-10 afinyelela ku-15%;
- okwesibili - kunezici ezintathu, futhi ubungozi bezinkinga abudluli kuma-20%;
- elesithathu - kuvezwa izici ezingaphezu kwezintathu, ubungozi bokuxinaniswa cishe buyi-30%
- okwesine - kutholakala ukulimala okukhulu kwezitho nezinhlelo, ingozi yokuhlaselwa yisifo senhliziyo nokushaywa unhlangothi ingaphezu kwama-30%.
Ngokusekelwe kokushiwo ngenhla, kuyacaca ukuthi imuphi umfutho wegazi ophakeme wesigaba 3 ungobungozi 4. Ngamazwi alula, lesi sifo siyabulala.
Ukwelashwa kwe-Hypertension
I-Arterial hypertension grade 3 ingozi 4 idinga ukunakekelwa okuphuthumayo futhi akubekezeleli ukubambezeleka. Izinkinga yilezi ezingathandeki kakhulu - ukushaya kwenhliziyo, unhlangothi, ukwehluleka kwezinso.
Ukuze ungalindi isikhathi se-hypertgency, udinga ukubiza i-ambulensi ngokushesha lapho kunezimpawu ezinkulu ezishaqisayo - umfutho we-systolic ngaphezulu kwezingu-170, ikhanda elichithekile, ikhanda lokucanuzelelwa kwenhliziyo ngenxa yengcindezelo enkulu ye-intracranial (ngemuva kokuhlanzwa nge-nausea enjalo, isimo asincishisi), i-tinnitus ngenxa yokuphuma kwegazi okwandayo, izinhlungu ezivuthayo ngemuva kwe-sternum, ubuthakathaka emilenzeni nokuqina kwawo.
Mhlawumbe umuzwa wokuthi "ama-goosebumps" ngaphansi kwesikhumba, ukuwohloka okuqhubekayo kwinkumbulo kanye nokwehla kwamakhono obuhlakani, umbono ongenamandla.
Kulesi simo, ukusebenza ngokomzimba, ukunyakaza okungazelelwe kufakwe umthetho, iziguli zenqatshelwe ngokuphelele ukwenza imisebenzi, zizale, zishayele imoto.
Izincomo zochwepheshe ukuthi basebenzise izidakamizwa ezinhlobonhlobo, ngayinye izothinta ingxenye yayo yeketheni ye-pathogenesis.
Ukulungiselela kweqembu eliyinhloko, okusetshenziselwa ikakhulukazi umfutho wegazi ophezulu:
- I-Loop diuretics yizinto ezivimba i-Na + K + Cl -anscorter engxenyeni enyukayo yeHenle nephron loop, ekwehlisa ukuphindisela uketshezi, amanzi awabuyeli egazini, kepha akhululwa ngokuqinile emzimbeni. Umthamo wegazi elijikelezayo uyancipha, futhi ngalo umfutho wegazi. Izimali ezinjalo zifaka iFurosemide (aka Lasix), Indapamide (eyaziwa nangokuthi yi-Indap noma i-Arifon), iHydrochlorothiazide. Zisetshenziswa kaningi, ngoba azibizi kakhulu uma ziqhathaniswa nama-analogues.
- Ama-blocker e-Beta. Yehlisa ukuzithoba kwenhliziyo kukhuphuke nge-grade 3 hypertension, kuvimbe ama-adrenergic synapses we-myocardium. Imithi yaleli qembu ibandakanya i-Anaprilin (Propranolol), Atenolol (Atebene), Cordanum, Metoprolol (kunezindlela zeSpesicor, Corvitol neBetalok), Nebivalol. Kuyadingeka ukusebenzisa lezi zidakamizwa ngokucacileyo ngokwemiyalo, ngoba ithebulethi eyengeziwe ye-blocker ingaholela ekungenisweni kokulimazeka kanye ne-automatism kanye ne-arrhythmias.
- Angiotensin-converting enzyme inhibitors. I-Angiotensin yandisa kakhulu umfutho wegazi, futhi uma uphazamisa ukukhiqizwa kwayo ngokwezinga le-angiotensinogen yezicubu, ungasusa ngokushesha nangokuphumelelayo izimpawu zobuningi be-grade 3, ngisho nengozi ka-4. Abamele abaziwayo kakhulu baleli qembu yiCaptopril (Kapoten), Kaptopress, Enap (Renitek), Lisinopril. Ukuvinjwa kwama-receptors angiotensin ngqo neLosartan kungenzeka.
- Abamelene neCalcium - I-Nifedipine ne-Amlodipine - banciphisa amandla enhliziyo kanye nomthamo wokuphuma kwegazi okweqile, ngaleyo ndlela kwehlise umfutho wegazi.
Kungenzeka ukuvikela umfutho wegazi ophakeme kanye nomfutho wegazi ophakeme ekhaya. Isisekelo sendlela yokudla okuqinile njengendlela eyinhloko yempembelelo yokwelapha, ikakhulukazi ukusetshenziswa kwetafula elinosawoti No. 10 ngokusho kukaPevzner.
Kubandakanya isinkwa sikakolweni, inyama enamafutha amancane, amasaladi aqukethe i-fiber amaningi, amaqanda abilisiwe, iziphuzo zobisi olunoshukela, amasobho. Qiniseka ukuthi ubeka umkhawulo wokudla usawoti ukufika ku-6 g ngosuku. Izindlela ezihlukile ziyi-sedative - i-valerian, i-mamawort, i-pepper mint, i-hawthorn.
Isigaba 3 somfutho wegazi ophakeme sichazwe kuvidiyo kule ndatshana.
