Isifo sikashukela i-macroangiopathy ingukuphazamiseka okujwayelekile nokwenzeka emithanjeni emaphakathi noma enkulu enenkambo ende yohlobo 1 nohlobo 2 lwesifo sikashukela.
Isimo esinjalo asiyonto ngaphandle kwe-pathogeneis, sibangela ukuvela kwesifo senhliziyo, futhi umuntu uvame ukuba nomfutho wegazi ophakeme, izilonda ezihambelana nemithambo yethambo, futhi ukujikeleza kwengqondo kuyaphazamiseka.
Xilonga lesi sifo ngokwenza ama-electrocardiogram, ama-echocardiogram, iDoppler ultrasound, izinso, imithambo yobuchopho, imithambo yemithambo yegazi kuyahlolwa.
Ukwelashwa kuqukethe ukulawula umfutho wegazi, ukuthuthukisa ukwakheka kwegazi, ukulungisa i-hyperglycemia.
Izimbangela ze-macroangiopathy kushukela
Lapho umuntu egula isifo sikashukela isikhathi eside, ama-capillaries amancane, izindonga kanye nemithambo ye-arterial ngaphansi kwethonya lesilinganiso seglucose eqala ukuwohloka.
Ngakho-ke kukhona ukuncipha okuqinile, ukuguqulwa, noma, ngakolunye uhlangothi, lokhu kuqina kwemithambo yegazi.
Ngalesi sizathu, ukugeleza kwegazi nokudla emzimbeni phakathi kwezicubu zezitho zangaphakathi kuyaphazamiseka, okuholela ekutheni i-hypoxia noma indlala ye-oxygen yezicubu ezizungezile, kulimale izitho eziningi zesifo sikashukela.
- Imvamisa, imithambo emikhulu yamaphethelo aphansi nenhliziyo iyathinteka, lokhu kwenzeka ngamaphesenti angama-70 amacala. Lezi zingxenye zomzimba zithola umthwalo omkhulu kunayo yonke, ngakho-ke, izikebhe zithinteka kakhulu ngokushintshwa. Kwi-Microangiopathy yesifo sikashukela, i-fundus ivame ukuthinteka, okutholakala njenge-retinopathy; lokhu kuyizimo ezivame ukwenzeka.
- Imvamisa yesifo sikashukela esithinta isifo sikashukela sithinta ukuqubuka kwamalungu omzimba, i-coronary, renal, imithambo yegazi. Lokhu kuhambisana ne-angina pectoris, infarction myocardial, stroke ischemic, gangren sikashukela kanye ne-renovascular hypertension. Ngokulimala okungafani nemithambo yegazi, ingozi yokuba nesifo senhliziyo nokushayeka kwenhliziyo ikhuphuka kathathu.
- Ukuphazamiseka okuningi kwesifo sikashukela kuholela ekutholakaleni kwemizwa kwemithambo yegazi. Isifo esinjalo sitholakala kubantu abanohlobo 1 nohlobo 2 lwesifo sikashukela eminyakeni eyi-15 ngaphambili kuneziguli ezinempilo. Isifo sikashukela singathuthuka ngokushesha okukhulu.
- Lesi sifo siqokomisa izingqimba ezingaphansi zemithambo ephakathi nendawo enkulu, lapho ama-atherosclerotic plaque akha khona kamuva. Ngenxa yokubala, ukubonakaliswa kanye necrosis yama-plaque, izingqimba zegazi zakha endaweni, ukukhanyiselwa kwemithambo kuvala, ngenxa yalokho, ukuhamba kwegazi endaweni ethintekile kuyaphazamiseka kwisifo sikashukela.
Njengomthetho, i-macroangiopathy yesifo sikashukela ithinta imithambo ye-coronary, cerebral, visceral, ne-peripheral, ngakho odokotela benza konke ukuvikela ushintsho olunjalo ngokusebenzisa izindlela zokuthibela.
Ingozi ye-pathogenesis ene-hyperglycemia, i-dyslipidemia, ukumelana ne-insulin, ukukhuluphala, umfutho we-arterial, ukukhuphuka kwegazi, ukungasebenzi komzimba, ukucindezela kwe-oxidative, ukuvuvukala okuhleliwe kuphezulu kakhulu.
Futhi, i-atherossteosis ivame ukwenzeka kubantu ababhemayo, lapho kukhona ukungasebenzi ngokomzimba, kanye nokudakwa okuchwephesha. Engcupheni kukhona amadoda angaphezu kweminyaka engama-45 futhi abesifazane baneminyaka engaphezu kuka-55.
Imvamisa imbangela yalesi sifo iba yinto eyindlalifa eyindlalifa.
I-angiopathy yesifo sikashukela kanye nezinhlobo zayo
I-angiopathy yesifo sikashukela ngumqondo wokuhlangana omelela i-pathogeneis futhi kubandakanya imithambo yegazi engenawo amandla - emincane, enkulu nephakathi.
Lesi simo sibhekwa njengomphumela wokuphindaphindana kwesikhathi nesifo sikashukela, esiqala cishe eminyakeni eyi-15 ngemuva kokuvela kwalesi sifo.
I-macroangiopathy yesifo sikashukela ihambisana nama-syndromes anjenge-atherosclerosis ye-aorta kanye nemithambo ye-coronary artery, i-aripheral or cerebral artery.
- Ngesikhathi se-microangiopathy ku-mellitus yesifo sikashukela, i-retinopathy, i-nephropathy, kanye ne-Microangiopathy yesifo sikashukela emaphethelweni aphansi kuyabonakala.
- Kwesinye isikhathi, lapho imithambo yegazi yonakaliswa, kutholakala i-angiopathy yendawo yonke, umqondo wayo ubandakanya isifo sikashukela se-micro-macroangiopathy.
I-Endoneural diabetesic microangiopathy idala ukwephula izinzwa zepherishi, lokhu kubuye kubangele isifo sikashukela se-neuropathy.
I-macroangiopathy yesifo sikashukela nezimpawu zayo
Nge-atherosclerosis ye-aorta kanye nemithambo ye-coronary, ebangela i-macroangiopathy yesifo sikashukela ngamaphethelo aphansi nezinye izingxenye zomzimba, isifo sikashukela singathola isifo senhliziyo, i-myocardial infarction, i-angina pectoris, isifo senhliziyo.
Isifo senhliziyo esikulesi simo siqhubeka ngendlela ye-atypical, ngaphandle kobuhlungu futhi sihambisana ne-arrhythmia. Lesi simo siyingozi kakhulu, ngoba singadala ukufa kwe-coronary kungazelelwe.
I-Pathogenesis ku-diabetesics ifaka phakathi izinkinga ezifana ne-aneurysm, arrhythmia, thromboembolism, ukushaqeka kwe-cardiogenic, ukuhluleka kwenhliziyo. Uma odokotela beveze ukuthi imbangela yokudalwa yi-myocardial infarction yi-macroangiopathy yesifo sikashukela, konke kumele kwenziwe ukuze ukuhlaselwa yinhliziyo kungaphindi, ngoba ingozi iphezulu kakhulu.
- Ngokwezibalo, uhlobo loku-1 no-2 sikashukela kungenzeka kabili ukuthi kufe ngokuqothuka kwe-myocardial njengabantu abangenaso isifo sikashukela. Cishe amaphesenti ayi-10 eziguli ahlushwa yi-cyperal artery atherossteosis ngenxa yesifo sikashukela sikashukela.
- I-atherossteosis in diabetesics izenza izizwe ngokwakhiwa kwesiteki se-ischemic noma i-ischemia yesibeletho esingamahlalakhona. Uma isiguli sine-hypertension ye-arterial, ingozi yokuba nezinkinga ze-cerebrovascular yanda kathathu.
- Kumaphesenti ayi-10 eziguli, kutholakala izilonda ezithatha imithambo yegazi ezitholakala emithanjeni yethambo. I-macroangiopathy yesifo sikashukela ihambisana nokubindeka, ukubanda kwezinyawo, ukukhumuzelana ngezikhathi ezithile, ukuvuvukala kwe-hypostatic yemikhawulo.
- Isiguli sizwa ubuhlungu obukhulu ezicutshini zemisipha yamathanga, amathanga, umlenze ophansi, oqina ngokuzivocavoca ngokomzimba. Uma ukuhamba kwegazi emaphethelweni e-distal kuphazamiseka kakhulu, lokhu kuholela ku-ischemia ebucayi, ethi ekugcineni ivame ukubangela i-necrosis yezicubu zezinyawo nomlenze ophansi ngendlela ye-gangrene.
- Isikhumba nezicubu ezithambile zingazitholela zona ngokwazo, ngaphandle kokulimala okwengeziwe. Kodwa, njengomthetho, i-necrosis yenzeka ngokuphulwa kwesikhumba okwedlule - ukubonakala kokuqhekeka, izilonda zokukhunta, amanxeba.
Lapho ukuphazamiseka kokugeleza kwegazi kungakhulunywa kahle, i-macroangiopathy yesifo sikashukela ibangela ukuvela kwezilonda ezingapheli zesifo sikashukela emilenzeni.
Itholakala kanjani isifo sikashukela i-macroangiopathy?
Ukuxilonga ukuthola ukuthi imithambo ye-coronary, i-cerebral kanye ne-peripheral ithinteka kabi kangakanani.
Ukunquma indlela yokuhlola edingekayo, isiguli kufanele sibonane nodokotela.
Ukuhlolwa kwenziwa ngu-endocrinologist, udokotela wesifo sikashukela, udokotela wezinhliziyo, udokotela ohlinzeka ngemithambo, udokotela ohlinza inhliziyo, udokotela wezinzwa.
Kuhlobo 1 nesifo sikashukela sohlobo 2, izinhlobo ezilandelayo zokuxilonga zibekelwa ukuthola i-pathogeneis:
- Ukuhlolwa kwegazi kwe-biochemical kwenziwa ukuthola izinga le-glucose, triglycerides, cholesterol, amaplatelet, lipoproteins. Ukuhlolwa kwegazi kwegazi kuyenziwa futhi.
- Qiniseka ukuthi uhlola uhlelo lwezinhliziyo usebenzisa i-electrocardiogram, ukubhekelwa nsuku zonke kwengcindezi yegazi, ukuhlolwa kwengcindezi, i-echocardiogram, i-dopplerography ye-ultrasound ye-aorta, i-myocardial perfusion scintigraphy, i-coronarography, i-computer ye-tomographic angiography.
- Isimo se-neurological sesiguli sicacisiwe kusetshenziswa i-dopplerography ye-ultrasound yemikhumbi eqoqodayo, ukuskena okuphindwe kabili kanye ne-angiography yemikhumbi yokuqwasha nakho kuyenziwa.
- Ukuhlola isimo semithambo yegazi yangaphakathi, izitho zomzimba ziyahlolwa kusetshenziswa ukuskena okuphindwe kabili, i-dopplerography ye-ultrasound, i-peripheral arteriography, i-rheovasography, capillaroscopy, arcial oscillography.
Ukwelashwa kwe-Microangiopathy yesifo sikashukela
Ukwelashwa kwalesi sifo kubantu abanesifo sikashukela ngokuyinhloko kuqukethe ukuhlinzeka ngezindlela zokunciphisa intuthuko yesifo esiyingozi semithambo, engasongela isiguli ngokukhubazeka noma nokufa imbala.
Izilonda ze-Trophic zezinga eliphezulu nelingezansi ziphathwa ngaphansi kokubhekwa ngudokotela ohlinzayo. Uma kwenzeka inhlekelele ebanga kakhulu yemithambo yegazi, kuthathwa ukwelashwa okunamandla okuningana. Futhi, udokotela angakwazi ukuqondisa ukwelashwa okuhlinzwa, okubandakanya i-endarterectomy, ukuqedwa kokungasebenzi kahle kwe-cerebrovascular, kuchekwa kwengalo kanye nomzimba othintekile, uma sekuvele kubi kakhulu isifo sikashukela.
Izimiso eziyisisekelo zokwelapha zihambisana nokulungiswa kwama-syndromes ayingozi, kubandakanya i-hyperglycemia, i-dyslipidemia, i-hypercoagulation, i-arterial hypertension.
- Ukunxephezela i-carbohydrate metabolism in diabetesics, udokotela unquma ukwelashwa kwe-insulin nokuhlolwa okujwayelekile kwamazinga kashukela wegazi. Kulokhu, isiguli sithatha izidakamizwa ezokwehlisa i-lipid - ama-statin, ama-antioxidants, i-fibrate. Ngaphezu kwalokho, kuyadingeka ukulandela indlela ekhethekile yokudla kanye nemikhawulo yokusetshenziswa kokudla okunokuqukethwe okuphezulu kwamafutha ezilwane.
- Lapho kunobungozi bokuhlakulela izinkinga ze-thromboembolic, izidakamizwa ze-antiplatelet zinqunyelwe - i-acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
- Ukwelashwa kwe-antihypertensive uma kwenzeka kutholakala i-macroangiopathy yesifo sikashukela kufinyelela futhi kulondolozwe umfutho wegazi ezingeni le-130/85 mm RT. Ubuciko. Ngale njongo, isiguli sithatha i-ACE inhibitors, ama-diuretics. Uma umuntu eye waphathwa kabi yi-myocardial infarction, kunqunywa ama-beta-blockers.
Izindlela zokuvimbela
Ngokwezibalo, ngohlobo 1 nohlobo 2 lwesifo sikashukela, ngenxa yezinkinga zenhliziyo ezigulini, amanani okufa asukela kumaphesenti angama-35 kuya kwangama-75. Engxenyeni yalezi ziguli, ukufa kwenzeka nge-myocardial infaration, ngamaphesenti ayi-15 amacala abangelwa yi-ischemia acute.
Ukugwema ukuthuthukiswa kwe-macroangiopathy yesifo sikashukela, kubalulekile ukuthatha zonke izindlela zokuthibela. Isiguli kufanele siqaphe njalo amazinga kashukela wegazi, sikala umfutho wegazi, silandele indlela esidla ngayo, siqaphe isisindo sayo, silandele zonke izincomo zezokwelapha futhi siyeke imikhuba emibi ngangokunokwenzeka.
Kwividiyo ekulesi sihloko, kuxoxwa ngezindlela zokwelapha i-macroangiopathy yesifo sikashukela semikhawulo.
