Enye yezimpawu eziholela lapho ushukela kungasolwa khona ukoma okungapheli kanye nokuchama ngokweqile, okungafinyelela kumalitha ama-5 no-10 ngosuku.
Izimpawu ezifanayo ziphawulwa nge -abetes insipidus, noma isifo sikashukela insipidus. Lesi sifo esinqabile sihlotshaniswa nokuntuleka kwe-antidiuretic hormone vasopressin.
IVasopressin ingahle ihlanganiswe ngamanani ancishisiwe, noma ama-receptors ezinso ayeke ukuphendula kuwo. Futhi, i-insipidus yesifo sikashukela ingakhula ezinganeni ezingaphansi konyaka owodwa ubudala, kuma-trimesters wesibili noma wokugcina wokukhulelwa, lapho uthatha imishanguzo. Amafomu wokugcina, ngokungafani naphakathi nendawo kanye ne-renal, ane-prognosis evumayo nenkambo emnene.
Ukuthuthukiswa kwesifo sikashukela insipidus: izimbangela kanye nomshini
Ukuze i-liquid ibuyele egazini ivela kumchamo oyinhloko, i-vasopressin iyadingeka. Leli kuphela i-hormone emzimbeni womuntu elingenza umsebenzi onjalo. Uma kungasebenzi, khona-ke kuzoba nokukhubazeka okungathi sína kwe-metabolic - sikashukela insipidus.
IVasopressin ikhiqizwa kuma-neurons e-hypothalamus - ku-nucleus ye-supraoptic. Ngemuva kwalokho, ngezinqubo zama-neurons, ungena emgodini we-pituitary, lapho uqongelela khona bese uthululwa egazini. Isiginali sokukhishwa kwayo ukwanda kwe-osmolarity (okuhlushwa) ye-plasma kanye nokwehla kwenani lokujikeleza kwegazi.
I-Osmolarity ikhombisa ukugcotshwa kwawo wonke usawoti oncibilikile. Imvamisa, isukela ku-280 iye kuma-300 mOsm / l. Kulokhu, umzimba usebenza ezimweni zomzimba. Uma luphakama, khona-ke ama-receptors ku-hypothalamus, isibindi nasodongeni 3 lwe-ventricle yobuchopho adlulisela amasayense ngesidingo sokugcina uketshezi, aluthathe kumchamo.
I-pituitary gland ithola izibonakaliso ezifanayo ezivela kuma-disc receptors e-atria kanye nemithambo ngaphakathi kwesifuba uma umthamo wegazi elijikelezayo lingaphansi kwesijwayelekile. Ukugcina ivolumu ejwayelekile kukuvumela ukuthi unikeze izicubu ngezakhi kanye ne-oxygen. Ukwehla kwethamo legazi, umfutho wegazi wehla kanye ne-microcirculation kuvinjelwe.
Ukuqeda imiphumela yokushoda koketshezi nosawoti ngokweqile, kukhululwa i-vasopressin. Ukwanda kwezinga le-hormone ye-antidiuretic kwenzeka ngenxa yezizathu ezilandelayo: ukushaqeka kobuhlungu ngesikhathi sokuhlukumezeka, ukulahleka kwegazi, ukuphuma komzimba, i-psychosis.
Isenzo se-vasopressin senzeka kulezi zindawo ezilandelayo:
- Ukuchama kuyancipha.
- Amanzi avela kumchamo angena egazini, andisa umthamo wawo.
- I-plasma osmolarity iyancipha, kufaka phakathi i-sodium ne-chlorine.
- Ithoni yemisipha ebushelelezi iyanda, ikakhulukazi ohlelweni lokugaya ukudla, imithambo yegazi.
- Ingcindezi emithanjeni iyanda, baba nezwela kakhulu kuma-adrenaline ne-norepinephrine.
- Ukopha kuyema.
Ngaphezu kwalokho, i-vasopressin inomphumela ekuziphatheni komuntu, ngokwengxenye enquma indlela yokuziphatha komphakathi, ukusabela okunobudlova nokwakha uthando lwezingane zobaba.
Uma i-hormone iyeka ukungena egazini noma umuzwa ulahlekile, khona-ke kukhula isifo sikashukela.
Izinhlobo zesifo sikashukela insipidus
Isifo sikashukela esimaphakathi sikashukela siba nokulimala nokulimala kobuchopho, kanye nokwephulwa kokuhlinzekwa kwegazi ku-hypothalamus noma i-pituitary gland. Imvamisa, ukuqala kwesifo kuhlotshaniswa neuroinfection.
Ukwelashwa kokuhlinzwa kwe-adenoma ye-pituitary noma i-radiation ngesikhathi sokwelashwa kungadala izimpawu zesifo sikashukela. I-Tungsten genetic syndrome ihambisana nokukhiqizwa okunganele kwe-vasopressin, ekhuthaza ukuvela kwalesi sifo.
Ngobunzima bokuthola imbangela, obonwa engxenyeni ebalulekile yazo zonke iziguli ezinefomu eliphakathi lesifo sikashukela insipidus, lokhu kuhluka kwesifo kubizwa ngokuthi yi-idiopathic.
Ngefomu le-renal, ama-vasopressin receptors awaphenduli ebukhoneni bawo esegazini. Lokhu kungenzeka ngenxa yezizathu ezinjalo:
- Ukungasebenzi kahle kwe-Congenital of receptors.
- Ukwehluleka kwangempela
- Ukwephulwa kokwakhiwa kwe-ionic ye-plasma.
- Ukuthatha umuthi we-lithium.
- I-nephropathy yesifo sikashukela ezigabeni ezithuthukile.
Isifo sikashukela i-insipidus kwabesifazane abakhulelwe sithathwa ngokuthi siyisikhashana (sidlula), sihambisana neqiniso lokuthi ama-enzyme akhiqizwa yi-placenta abhubhisa i-vasopressin. Ngemuva kokuzalwa, i-insertidus yesifo sikashukela inyamalala.
I-insipidus yesikhashana yesifo sikashukela ibuye ithinte izingane zonyaka wokuqala wokuphila, ohambisana nokwakhiwa kwe-pituitary kanye ne-hypothalamus.
Ubukhulu benkambo yesifo kanye nezinga lokuphazamiseka komzimba wamakhemikhali we-electrolyte kuya ngezinga lokuphelelwa ngumzimba emzimbeni. Kunezindlela ezinje zesifo sikashukela:
- Kakhulu - ukuchama kusuka kumalitha ayi-14 ngosuku.
- I-diuresis evamile isukela kumalitha ayi-8 kuye kwayi-14 ngosuku.
- imnene - iziguli zibeka amalitha ayi-8 ngosuku.
- Ngokulahleka okungaphansi kwamalitha ama-4 nsuku zonke - okuyingxenye (ngokwengxenye) yesifo sikashukela.
Isifo sikashukela esijwayelekile ezinganeni nabesifazane abakhulelwe bavame ukuvela ngendlela emnene. Lapho uthatha imishanguzo (iatrogenic) - ngokulinganisela. Ngamafomu aphakathi nawezinso, inkambo ebi kakhulu yesifo sikashukela iyaphawulwa.
Isifo sikashukela sithathwa njengesifo esingajwayelekile. Kepha muva nje, kukhule ukukhula okuzinzile kwamafomu aphakathi maqondana nokwanda kokulimala kwe-craniocerebral kanye nokungenelela kokuhlinzwa kwezifo zobuchopho.
Ngokuvamile, i-insipidus yesifo sikashukela nezimpawu zayo kutholakala emadodeni aneminyaka eyi-10 kuye kwengama-30.
Ukuxilongwa kwesifo sikashukela insipidus
Izimpawu zesifo sikashukela i-insipidus zihambisana nenani elikhulu lomchamo obunjiwe kanye nokukhula komzimba. Ngaphezu kwalokho, kunokungalingani kuma-electrolyte egazini nokwehla komfutho wegazi.
Ubulukhuni bunqunywa ubukhali balesi sifo nembangela yokwenzeka kwalo. Isikhalazo esiyinhloko seziguli, njengasoshukela i-mellitus, ukoma kakhulu, umlomo owomile njalo, isikhumba esomile, nesikhumba samanzi kanye nolwelwesi lwama-mucous, kanye nokuchama okuvamile.
Iziguli zingaphuza ngaphezu kwamalitha ayi-6 koketshezi ngosuku futhi umthamo womchamo obanzi udlulela kumalitha ayi-10 - 20. Kukhuphuke kakhulu ebusuku kusihlwa.
Izimpawu ezejwayelekile zesifo sikashukela yilezi:
- Ukukhathala, ukungabi namandla.
- Ukuqwasha noma ukwanda kokuqina.
- Kwehliswe isisulu.
- Ukuqunjelwa okuqhubekayo.
- Isisindo esiswini ngemuva kokudla, i-belching.
- Isicanucanu nokuhlanza.
- Umkhuhlane.
Ngasohlangothini lohlelo lwezinhliziyo, kutholakala inkimbinkimbi yesibonakaliso somqondo wemithambo - ukwehla kwengcindezi yegazi, ukushaya ngamandla kwenhliziyo, ukuphazamiseka emsebenzini wenhliziyo. Isisindo somzimba sehla, ukuqubuka komchamo kukhula ezinganeni ngemuva kweminyaka engu-4 ubudala, iziguli zikhathazekile ngokulunywa okuqhubekayo kwesikhumba.
Izimpawu ze-Neurological zikhula ngenxa yokulahleka kwama-electrolyte emchameni - ikhanda, ukugoba noma ukusonteka kwemisipha, ukuqina kwezinzwane nezinye izingxenye zomzimba. I-insipidus yesifo sikashukela sowesilisa inokubonakaliswa okujwayelekile njengokuncipha kwe-drive drive yocansi kanye nokuthuthukiswa kokungasebenzi kahle kwe-erectile.
Ukuqinisekisa ukutholakala kwesifo sikashukela i-insipidus, ukuxilongwa kwelabhoratri kanye nokuhlolwa okukhethekile kwenziwa ukuze kucaciswe umsuka wesifo sikashukela. Ukuxilongwa okuhlukile kwe-renal kanye namafomu aphambili alesi sifo kuyenziwa, futhi isifo sikashukela asifakwa ngaphandle.
Esigabeni sokuqala, kuhlolwa umthamo womchamo, ukuqina kwawo kanye nokuqina komzimba. Kwi-insipidus yesifo sikashukela, amanani alandelayo ayimpawu:
- Kuwo wonke amakhilogremu esisindo somzimba ngosuku, angaphezu kuka-40 ml womchamo uyachithwa.
- Ukwehla kobukhulu bomchamo obungaphansi kwe-1005 g / l
- Umchamo osmolality ongaphansi kwama-300 mOsm / kg
Ngendlela ye-renal yesifo sikashukela i-insipidus, kuboniswa lezi zimpawu ezilandelayo: i-hypercalcemia, i-hyperkalemia, ukwanda kwe-creatinine egazini, izimpawu zokuhluleka kwe-renal noma ukutheleleka emgodini we-urinary. Ku-nephropathy yesifo sikashukela, inkomba yokuxilonga ukwanda koshukela wegazi.
Lapho wenza isivivinyo ngokudla okomile, izimpawu zokuphelelwa ngamandla emzimbeni kanye nokunciphisa umzimba zisheshe zanda ezigulini. Ifomu eliphakathi lesifo sikashukela i-insipidus lisuswa ngokushesha ngokuhlolwa kwe-desmopressin.
Qiniseka, uma kutholakala ukuthi isifo asixilongile, yenza ucwaningo lobuchopho, kanye nesifundo sofuzo.
Ukwelashwa kwesifo sikashukela i-insipidus
Ukukhetha kwamaqhinga wokwelapha isifo sikashukela kuya ngesimo sesifo. Ukwelashwa kwefomu eliphakathi ngenxa yomonakalo we-hypothalamus noma i-pituitary gland, kusetshenziswa i-vasopressin analog synthetically synthetically.
Umuthi osuselwa ku-desmopressin uyatholakala ngesimo samathebulethi noma ngesifutho samakhala. Amagama okuhweba: IVasomirin, iMinirin, i-Presinex neNativa. Ikhuthaza ukumunwa kwamanzi okuphindayo. Ngakho-ke, lapho uyisebenzisa, udinga ukuphuza kuphela nomuzwa wokoma, ukuze ungabangeli ukudakwa kwamanzi.
Uma kwenzeka kwe-desmopressin ngokweqile noma ukusetshenziswa kwamamanzi amaningi ngesikhathi sokusebenzisa kwayo, lokhu okulandelayo kungenzeka:
- Umfutho wegazi ophakeme.
- Ukuthuthukiswa kwe-edema yezicubu.
- Yehlisa ukugcwala kwe-sodium esegazini.
- Ukungazi kahle.
Umthamo ukhethiwe ngamunye kusuka ku-10 kuye ku-40 mcg ngosuku. Ingathathwa kanye noma ihlukaniswe ngemithamo emibili. Imvamisa umuthi ubekezelelwa kahle, kepha imiphumela emibi kungenzeka ngesimo sekhanda nesiyezi, izinhlungu emathunjini, isicanucanu kanye nokwenyuka okulinganiselayo komfutho wegazi.
Lapho usebenzisa i-desmopressin isifutho noma amaconsi, udinga ukukhumbula ukuthi ngekhala eligijimayo ngenxa yokuvuvukala kolwelwesi lwama-mucous, ukumunca umuthi kwehlisa ijubane, ngakho ezimeni ezinjalo kungadonswa ngaphansi kolimi.
Ngendlela esezingeni eliphakathi nesifo sikashukela i-insipidus, amalungiselelo asuselwa ku-carbamazepine (Finlepsin, Zeptol) ne-chloropropamide asetshenziselwa ukukhuthaza ukwenziwa kwe-vasopressin.
I-Nephrogenicabetes insipidus ihlotshaniswa nokuntuleka kwekhono lezinso ukuphendula i-vasopressin, engahle yanele egazini. Kodwa-ke, lapho wenza isivivinyo nge-desmopressin, ukusabela kukho akwenzeki.
Ukwelashwa kwaleli fomu, izidakamizwa ze-thiazide diuretics nezidakamizwa ezingezona ze-steroidal ezilwa nokuvuvukala - Indomethacin, Nimesulide, Voltaren ziyasetshenziswa. Ekudleni, inani likasawoti lilinganiselwe.
I-insipidus yesifo sikashukela se-Gestational ilashwa ngamalungiselelo we-desmopressin, ukwelashwa kwenziwa kuphela ngesikhathi sokukhulelwa, ngemuva kokubeletha asikho isidingo sokwelashwa okunjalo.
Ngohlobo lwesifo sikashukela esithambile noma ngesimo esinqunyiwe, ukwelashwa okungezona izidakamizwa kungasetshenziswa ngohlobo lwerejimeni elanele lokuphuza ukuvikela ukuphuma komzimba.
Ukudla kwesifo sikashukela i-insipidus kumiselwe ukunciphisa umthwalo ezinso. Izimiso zalo eziyisisekelo:
- Imikhawulo yamaprotheni, ikakhulukazi inyama.
- Inani elanele lamafutha kanye nama-carbohydrate.
- Ukudla okuvame ukuvela.
- Ukufaka imifino nezithelo ezintsha.
- Ukuqeda ukoma kwakho, sebenzisa iziphuzo zezithelo, amajusi noma ama-compotes.
Ukuhlola ukusebenza kahle kokulashwa kuhlolwa inhlala-kahle yeziguli kanye nokwehla kwenani lomchamo osuswe.
Ngokunxeshezelwa okugcwele, izimpawu zesifo sikashukela i-insipidus ziyanyamalala. I-insipidus yesifo sikashukela ekhokhelwe ihambisana nokoma okulinganiselayo nokuchama okwandayo. Ngenkambo ebolile, izimpawu azishintshi ngaphansi kwethonya lokwelashwa.
Ukwelashwa okunzima kakhulu yi-insulin yesifo sikashukela sezinso ezinganeni, futhi kuvame ukuba nokuhluleka okukhulu kwezinso, kudinga i-hemodialysis kanye nokufakelwa kwezinso. Uhlobo lwe-idiopathic lwesifo sikashukela i-insipidus aluvamile ukusongela impilo, kepha amacala okuthola ukwelashwa okuphelele ayivelakancane.
Ngefomu eliphakathi lesifo sikashukela i-insipidus, ukwelashwa okuyikhono okuvumelekile kuvumela iziguli ukuba zilondoloze amandla abo okusebenza nomsebenzi wezenhlalo. Isifo sikashukela sokutholwa komzimba, kanye namacala ahlobene nemithi kanye nokugula ezinganeni ngonyaka wabo wokuqala wokuphila, zivame ukuphela ekululameni. Ividiyo ekulesi sihloko iphakamisa isihloko sengculaza insipidus.
