Imvamisa, amaphilisi okucindezela ohlobo 2 lwesifo sikashukela atholakala ezigulini ezinokuxilongwa okutholwe njalo njengezidakamizwa ze-antipyretic.
Lokhu kungenxa yokuthi inqubo ye-pathological ayikhonjiswa ngokungekuhle kuphela ekusebenzeni okujwayelekile kwamanyikwe, kepha futhi ifaka izingqinamba ezahlukahlukene ezivela kwezinye izinhlelo nezitho zomzimba womuntu.
Ukuthuthukiswa kwesifo sikashukela i-mellitus kuyingozi hhayi kuphela ngezibonakaliso eziphambili nezimpawu ze-pathology, kodwa futhi ngengozi ekhulayo yokubonakaliswa kwemiphumela emibi, ukuphazamiseka kokusebenza okujwayelekile kwezitho eziningi zangaphakathi nezinhlelo zomzimba.
Okokuqala, ngohlobo lwe-2 mellitus yesifo sikashukela, ukusebenza kohlelo lokuphatheka kwenhliziyo nokujikeleza kwegazi kuqala ukuwohloka. Njengomthetho, umphumela wokuphulwa okunjalo yile:
- kunokuwohloka ekunikezelweni kwegazi emzimbeni wonke;
- ubungozi bokushaywa unhlangothi noma i-myocardial infarction buyanda;
- ukwanda kwengcindezi yegazi;
- isifo sokuqina kwemithambo yegazi, ukuvela kweziqalo zegazi ngenxa yokuqhuma kwemithambo yegazi nemithambo yegazi.
Ngaphandle
Ngaphezu kwalokho, imiphumela emibi engahle ivele phakathi kokuqhubeka kwesifo sikashukela ifaka:
Ukulahleka okuphelele noma okuyingxenye kwe-acuity ebonakalayo, njengoba ukubhujiswa kwe-retina kwenzeka ngenxa kashukela wegazi ophezulu. Ukuthuthukiswa kwe-neuropathy yesifo sikashukela, esizibonakalisa ngesimo sobuhlungu obukhulu emaphethelweni aphansi.
Ukusebenza okungasebenzi kahle kwezinso nezinso. Yehlise ukungazetheki.
Izifo ezahlukahlukene zesimiso sezinzwa. Imvamisa, imizwa yezinsimbi eziphelele iyathinteka, okuholela ekuxineni nasekulahlekelweni kokuzwa kwemikhawulo. Ukuphazamiseka kwendlela yokuhamba kwamathumbu emathunjini. Ukuthuthukiswa kwezifo ezahlukahlukene zesikhumba.
Kungakho kubaluleke kakhulu ukuthola lesi sifo ngendlela esifike ngesikhathi bese uqala ukwelashwa okuyinkimbinkimbi.
Ukwanda kwengcindezi yegazi ku-mellitus engavikeleki nge-insulin
Isifo sikashukela kanye nokuphazamiseka kwesifo sikashukela, okukhonjiswa ngesimo somfutho wegazi ophakeme njalo, yimibono emibili exhumeke ngokungalingani. Kumele kuqashelwe ukuthi i-hypertension ingaba enye yezimbangela zokuvela kwe-pathology futhi ikhule ngemuva kokusungulwa kwesifo sikashukela.
Kodwa-ke, zombili lezi zifo zinomthelela omubi ekusebenzeni komzimba, ezingabonakala ngesimo se:
- ukulimala kwemithambo yobuchopho;
- Izinkinga ngokusebenza okujwayelekile kwenhliziyo;
- umthelela omubi ngesimo semikhumbi yamehlo;
- umsebenzi wezinso ongonakalisiwe.
Imvamisa, umfutho wegazi ophezulu ku-mellitus yesifo sikashukela ubangela ama-pathologies alandelayo:
- I-Myocardial infarction kanye nesifo sohlangothi.
- Ischemia yenhliziyo.
- Ukuphazamiseka kancane kancane kokujikeleza kwe-cerebral kwenzeka.
- Ukuthuthukiswa kokuhluleka kwe-renal kohlobo lwesifo esibulalayo.
Ukuqala kwenqubo engemihle njengokuthi i-mellitus yesifo sikashukela ihlala iqala ngokuboniswa kokumelana ne-insulin, okuzibonakalisa ngesimo sokulahlekelwa okuyingxenye kokuzwela kwezicubu kwi-hormone ekhiqizwa yi-insulin. Umzimba, ukuze unxephezele ukuncipha okunjalo kokuzwela, uqala ukukhiqiza inani elikhulu kakhulu le-insulin, elikhulisa umfutho wegazi futhi liholele ekuthuthukiseni umfutho wegazi ophakeme.
Ehlelweni lokubonakaliswa kwesifo sikashukela i-mellitus, i-lumen yemithambo yegazi (ngenxa ye-atherosulinosis) iyaqina kancane kancane, okubuye kwandise ukuthuthukiswa kokuqina komfutho wegazi.
Ngaphezu kwalokho, ukuba khona kokukhuluphala esiswini kuwuphawu lwabanesifo sikashukela, esandisa umthwalo ohlelweni lwenhliziyo, okwandisa umfutho wegazi. Ngakho-ke, zonke izinqubo ezenzeka emzimbeni zixhunyaniswe ngokungenasimilo. Futhi ukwehluleka emsebenzini wesitho esisodwa kuholela ekwephulekeni kokusebenza kwabanye.
Kumele kuqashelwe ukuthi kumuntu ophilile, umfutho wegazi ngesikhathi sokulala futhi ngokushesha ngemuva kokuvuka uphansi kancane kunokujwayelekile osunguliwe. Ukuthuthukiswa kwesifo sikashukela kuholela ekutheni ingcindezi ayinciphi ebusuku, futhi kwezinye izimo, ingakhuphuka.
Kungakho ukwelashwa okusetshenziselwa isifo sikashukela sohlobo 2 kuvame ukubandakanya imithi yengcindezi.
Ungenza kanjani ukukhetha okuhle?
Yimaphi amaphilisi engingawaphuza ukwelapha umfutho we-hypertension ku-mellitus yesifo sikashukela ukuze singavumeli ukubonakaliswa kokungaphenduki okuhle? Kuyadingeka ukuthatha imishanguzo kuphela njengoba kuchazwe udokotela oholayo, ongalikhulisi izinga le-glucose egazini.
Kuze kube manje, imakethe ye-pharmacological inikeza ukukhethwa okubanzi kwemithi ehlukahlukene enomphumela we-antihypertensive. Kodwa-ke, iningi labo alinqatshelwe ukuthatha ubukhona besifo sikashukela.
Lapho ukhetha umuthi wokucindezela isifo sikashukela, kufanele kubhekwe lezi zinto ezilandelayo:
- Umphumela wesidakamizwa ezinqubweni ze-lipid ne-carbohydrate metabolic emzimbeni. Umuthi kufanele ukhethwe ukuze umphumela wawo ungathathi hlangothi noma uthuthukise imetabolism yamafutha nama-carbohydrate.
- Ithebhulethi yomfutho wegazi ophakeme akufanele ibe nokuphikisana lapho kunezinkinga ngokusebenza kwezinso noma isibindi.
- Kungcono ukukhetha umuthi wokucindezela ushukela onemiphumela ye-organoprotective. Izidakamizwa ezinjalo zinomthelela ekwenzeni ngcono ukusebenza kwezitho ezilimele.
Imithi yokuthola umfutho wegazi ophakeme wesizukulwane esidala sikashukela ayinconywa. Izidakamizwa ezinjengalezi eziphakathi nendawo zinokuphikisana kwazo nesifo sikashukela.
Abantu abanesifo sikashukela kanye nomfutho wegazi ophakeme banengozi eyandayo yokuqhamuka nezinkinga zenhliziyo. Kungakho, ukwelashwa okwelashwa kufanele kuhloswe ukuthi kwehle kancane kancane ekucindezelweni kwegazi - ngenyanga yokuqala kuya ku-140/90 mm. Hg. Ubuciko. Endabeni yokubekezelela okuhle kwezidakamizwa. Ukwelashwa okuqhubekayo kufaka ukwehla kuya ku-130/80.
Isici esiyinhloko ukuthi isiguli sidlulisela kanjani imishanguzo abayiphuzayo. Uma kunobungozi bezinkinga noma izinga lokubekezelela amathebulethi lingafiki amazinga aphakeme, kunengqondo ukuthi kancane kancane futhi kancane kancane ukunciphisa umfutho wegazi.
Udokotela ohambelayo kufanele alawule ngokuphelele inqubo eqhubekayo. Kungcono uma ingcindezi yehla ngamaphesenti ayishumi ngenyanga isiguli sizizwa kahle.
Njengomthetho, ukwelashwa kuthatha cishe amasonto amathathu kuya amane, emva kwalokho kunokulungiswa kwemithamo emisiwe.
Amaqembu izidakamizwa wehypertension?
Kuze kube manje, kunamaqembu aphambili ezidakamizwa asiza ukulwa nomfutho wegazi ophakeme:
- izidakamizwa eziphakathi nendawo;
- i-alpha ne-beta blockers;
- abamelene ne-calcium;
- Ama-inhibitors e-ACE (i-ACE inhibitors);
- ama-angiotesin receptor antagonists amabili;
- izidakamizwa ze-diuretic;
- izidakamizwa ze-diuretic.
Izidakamizwa ezivimbela i-beta zivame ukubekwa udokotela ovele ekhona lapho kunezifo ezenzeka ngendlela ye-arrhythmias noma isifo senhliziyo. Umehluko omkhulu phakathi kwezidakamizwa ezinjalo phakathi kwazo yizimpawu ezilandelayo:
- Ukukhetha.
- I-Lipophilicity.
- I-Hydrophilicity.
- Amandla okunciphisa imithambo yegazi.
Izidakamizwa ze-Alfablocator zehlisa kahle umfutho wegazi ophakeme, ngaphezu kwalokho, zinomphumela onenzuzo kuma-metabolism we-car kanye ne-carbohydrate, futhi zandisa ukuzwela kwezicubu kwe-insulin. Kodwa-ke, ngaphandle kwazo zonke izinhlobo zezinzuzo, kufanele zisetshenziswe ngokucophelela okukhulu. Imithi enjalo ingadala i-orthostatic hypotension (ukwehla okukhulu kwengcindezi), ukuvuvukala kwezicubu, ne-tachycardia. Ngaphezu kwalokho, ukuphikisana kokusetshenziswa kwabo kufaka phakathi abantu abanokuhluleka kwenhliziyo.
Abaphikisi beCalcium ziyizidakamizwa ezisebenza kakhulu, kepha ukuphatha kwabo isikhathi eside kungaholela ekwehlelweni kokukhiqizwa kwe-insulin kwe-pancreatic. Lapho nje ukuhoxiswa kwesidakamizwa esinjalo kwenzeka, umzimba uqala ukusebenza ngamandla afanayo. Izici ezinhle zamathebhulethi yilezi:
- kwehlise izinga lomfutho wegazi ngisho nokusetshenziswa komuthi ngemithamo emincane;
- ubungozi bokuhlakulela i-mellitus engavikelekile nge-insulin ayikhuphuki.
Abaphikisi beCalcium bangabonakala kancane noma isikhathi eside. Ngokuya ngezinhlobonhlobo zomuthi, izakhiwo zawo zokwelapha kanye nokuthi kungenzeka kwemiphumela emibi kubonisiwe. Imvamisa, imishanguzo enjalo ibekelwe iziguli ukuvimbela ukunqotshwa unhlangothi, ngezinga eliphakeme lomfutho wegazi ophezulu.
Ama-inhibitors e-ACE ukukhetha okungcono kakhulu okwehlisa umfutho wegazi kwabashukela. Bawuthinta kahle umsebenzi wesistimu yenhliziyo, umetabolism, kanye nokusebenza kwezinso nesibindi.
Imithi eqenjini le-ACE inhibitors kufanele ichazwe kuphela ngudokotela oholayo, ngoba inezindlela eziningi zokuphambana okufanele zisetshenziswe.
Kwenqatshelwe ukusebenzisa amadivaysi ezokwelapha kulabo abaphethwe i-pulmonary pathologies ene-asthma ye-bronchial. Amaphilisi angadala ukuvela ukukhwehlela owomile neminye imiphumela emibi.
Ngeke isetshenziswe lapho kukhona ukwehluleka kwezinso, ngaphambi kokusebenzisa umuthi, kuyadingeka ukubheka umfutho wegazi, i-creatinine ne-potassium egazini.
Imithi yaleli qembu, njengomthetho, ayinqunyelwe abantu asebekhulile abane-atherosclerosis, ngoba kungenzeka i-renal artery stenosis.
Imithi ye-diuretic imvamisa ichazwa ngokuhlanganiswa kwezidakamizwa nezidakamizwa zeqembu le-ACE inhibitor. Amandla amakhulu wezibhebhe ze-diuretic yilezi:
- Ithonya elithambile emzimbeni.
- Ungathinti izinga likashukela nama-lipid egazini.
- Ungaphazamisi ukusebenza kwesibindi nezinso.
Inketho enhle kakhulu yokusetshenziswa kwama-diuretics angaba yi-Indapamide ne-Arefon Retard.
Sibutsetelo Amathebhulethi
Izidakamizwa eziphambili ezingakhethi eqenjini le-betablocker ngamacwecwe e-Anaprilin neNadodol, anomthelela oqondile kuma-receptors akhiwe kumanyikwe. Njengomphumela wokuvezwa kwabo, ukukhiqizwa kwe-insulin ye-hormone kuvinjelwe. Izidakamizwa ze-antihypertensive zesifo sikashukela zingcono ukukhetha uhlobo olukhethayo. Lokhu, okokuqala, i-Atenolol, iBisoprolol, amalungiselelo weMetoprolol. Izidakamizwa ezinjalo zinomphumela omuhle emsebenzini wenhliziyo.
Ama-betablockers we-Lipophilic avezwa emakethe yezokwelapha enama-ejenti abekwe etafuleni njengeMetoprolol nePindolol. Isici sabo esihlukanisa ukuthi basuswa ngokuphelele emzimbeni ngesibindi. Kungakho, ngokuthuthukiswa kwesifo sikashukela i-mellitus, izidakamizwa ezinjalo zibekelwa kakhulu, ukuze zingabangeli ukulimala okukhulu kokusebenza kwesitho.
I-Atenolol neNadolol bayingxenye yeqembu lezidakamizwa ezivimbela i-beta-encibilikayo amanzi. Izidakamizwa ezinjalo zinomphumela wesikhathi eside ngemuva kokuphathwa, futhi futhi azinamphumela omubi ekusebenzeni kwesibindi nezinso.
Ama-betablockers avela ku-vasodilating effect abe nomphumela omuhle ekunciphiseni i-syndrome yokumelana ne-insulin, okwandisa ukuzwela kwezicubu ukungena kwe-insulin. Ngaphezu kwalokho, phakathi kwezakhiwo zabo ezinhle kungabikwa ukuthi kunomthelela omuhle ekuvumelaneni kwe-lipid namafutha metabolism. Lapho uthatha amalungiselelo anjalo wethebhulethi, kuyadingeka ukufunda ngokucophelela uhlu lokuphendula okungaba khona, ngoba uhlu lwabo lukhulu impela. Abamele abaphambili balesi sigaba sezidakamizwa yiNebivolol neCardiovolol.
Ezidakamizweni zeqembu, abamelene ne-calcium antagonists, iziguli ezinokuxilongwa kwesifo sikashukela kufanele zithathe i-dihydropyridine esebenza isikhathi eside. Izidakamizwa ezinjalo zinomphumela onenzuzo ekusebenzeni kwezinso. Abamele babo abaphambili nguVerapamil noDiltiazem.
Ama-inhibitors e-ACE avame ukubekelwa ukuthuthukiswa kwesifo sikashukela ukwehlisa umfutho wegazi. Zisusa izimpawu zokuqina komfutho wegazi, zinciphise umthwalo enhliziyweni, futhi zivimbele ukuthuthukiswa kwe-inhliziyo pathologies. Izidakamizwa eziphambili kuleli qembu yiCaptopril, uRamipril noFosinopril.
Ama-Angiotesin 2 receptor antagonists ayiqembu elisha lezidakamizwa elinamathuba aphansi wemiphumela emibi. Amathebhulethi anjalo athengiswa ngaphansi kwamagama alandelayo:
- I-Losartan;
- I-Telmisartan;
- IValsartan.
Izinzuzo zezidakamizwa ze-angiotesin receptor antagonist ziyingozi encishisiwe yokushaywa unhlangothi nokuhlaselwa yisifo senhliziyo, umthelela omuhle ezinso, kanye nezehlo eziphansi zokuphendula okungalungile.
Yimaphi amaphilisi okungcono ukuwagwema phambi kwesifo sikashukela?
Ngaphandle kokukhethwa okukhulu kwezidakamizwa ezahlukahlukene ezingangehlisa umfutho wegazi ophakeme, kufanele kukhunjulwe ukuthi akuzona zonke izidakamizwa ezingalungela abantu abanesifo sikashukela.
Kwenqatshelwe ukuthatha imishanguzo ye-thiazide diuretic (Hypothiazide, Chlortiazide, Xipamide), ngoba banegalelo ekwandeni koshukela wegazi kanye nokwanda kwe-cholesterol embi. Ngaphezu kwalokho, amaphilisi anjalo awuthinta kabi umsebenzi wezinso, okuyingozi enkulu kubantu abahlulekile izinso. I-Osmotic diuretics yohlobo 2 nohlobo 1 sikashukela ingaholela esimweni se-hyperosmolar coma in diabetesics.
Izidakamizwa ze-antihypertensive ezivela eqenjini labaphikisi be-calcium azinconywa ukuba zithathwe uma umuthi ungokwe-dihydropyrid efushane. Amaphilisi anjalo, ngisho nasemithanjeni emincane, ayandisa kakhulu ingozi yokufa kwenhliziyo futhi athathwe ezigulini ezinesifo sikashukela lapho kunesifo senhliziyo nesifo senhliziyo. Ummeleli oyinhloko walolu hlobo lwesidakamizwa yiNifedipine.
I-Atenolol, isidakamizwa esivela eqenjini lama-beta-blockers, singavusa ukugxuma kushukela egazini futhi kuholele ku-hypo- noma hyperglycemia. Ngaphezu kwalokho, umuthi onjalo unciphisa ukuzwela kwezicubu kwi-insulin ekhiqizwa ama-pancreas.
Yimaphi amaphilisi angaphuzwa ngomfutho wegazi ophezulu wesifo sikashukela azotshela ividiyo ekulesi sihloko.
