Isifo sikashukela sibizwa nangokuthi isifo sikashukela i-insipidus ngendlela ehlukile - lokhu kuyisimo se-pathological esibonakala ukwephulwa kokubuyiselwa kwamanzi okusobala ezinso, ngenxa yalokho, umchamo awungeni inqubo yokuhlushwa futhi uthululwa ngevolumu enkulu kakhulu ngendlela ehlanjululwe. Konke lokhu kuhambisana nomuzwa ohlala womile esigulini, okukhombisa ukulahleka kwamamanzi amaningi emzimbeni. Uma lezi zindleko zinganikezwa isinxephezelo sangaphandle, khona-ke ukuphuma komzimba kwenzeka.
Ukuvela kwesifo sikashukela i-insipidus kuhlotshaniswa nokukhiqizwa okunganele kwe-vasopressin. Leli yihomoni ye-hypothalamus enezenzo ze-antidiuretic. Ukuzwela kwezicubu zezinso ezinomphumela wazo kungancishiswa futhi.
Lesi sifo siyindlela ye-endocrine engavamile, ukuthuthukiswa kwayo okuyi-20% yamacala kungenxa yezinkinga ngemuva kokuhlinzwa okuhlinzwa ebuchosheni.
Izibalo zezokwelapha zikhomba ukuthi i-ND ayihlobene nobudala noma ubulili bomuntu, kepha imvamisa iqoshwa ezigulini ezineminyaka engama-20 kuye kwengama-40.
Izinhlobo zesifo sikashukela insipidus
Kunezinhlobo ezimbili zalesi sifo, kuya ngezinga lapho ukwephulwa kwabonwa khona:
I-Hypothalamic noma isifo sikashukela esimaphakathi - kungumphumela wokuphulwa kokuqalwa noma ukukhishwa kwe-hormone ye-antidiuretic egazini. Yena-ke, unezindlela ezimbili ezingaphansi:
- Isifo sikashukela se-idiopathic - esihambisana ne-pathology eyindlalifa, lapho kukhiqizwa khona ama-hormone angama-antidiuretic ngamanani amancane;
- isifo sikashukela esinezimpawu - kungahle kube ngumphumela wezinye izifo, ezinjenge-neoplasms ebuchosheni, izinqubo zokutheleleka kokutheleleka kwamalunga noma ukulimala.
I-Renal noma nephrogenic ND - ehambisana nokuncipha kokuzwela kwezicubu zezinso emiphumeleni ye-vasopressin. Lolu hlobo lwesifo luvame kakhulu. Imbangela ye-pathology iba ngukuphansi kwesakhiwo se-nephrons, noma ukumelana kwama-renal receptors ku-vasopressin. Isifo sikashukela se-renal singabandala, futhi singenzeka ngenxa yomonakalo kumaseli wezinso ngaphansi kwethonya lemithi.
Futhi, abanye ababhali bahlukanisile ngokwehlukana kwe-gestagenic ND yabesifazane abakhulelwe, okuthi ikhule ngomsebenzi owengeziwe we-placental enzyme obhubhisa i-vasopressin.
Izingane ezincane zingaba nesifo sikashukela esisebenzayo ngenxa yokuthi inqubo yokuchama komchamo yizinso ayiqali. Futhi, ezigulini, i-iatrogenic sikashukela i-insipidus kwesinye isikhathi inqunywa ngokumelene nesizinda sokusebenzisa izidakamizwa ze-diuretic.
I-Endocrinologists ikholelwa ukuthi i-polydipsia eyinhloko indlela yokuthola isifo sikashukela. Kwenzeka ngezinsolo zesikhungo somile esise-hypothalamus, futhi kubonakale njengomuzwa we-pathological wokoma, kanye ne-neurosis, i-schizophrenia ne-psychosis, njengesifiso esiphoqayo sokuphuza.
Kulesi simo, i-vasopressin yokwakheka komzimba iyacindezelwa ngenxa yokwanda kwethamo lamanzi aqediwe, kanye nezimpawu zomtholampilo zesifo sikashukela esivela phambili.
Kunamazinga athile obunzima besifo sikashukela ngaphandle kokulungiswa kwezidakamizwa:
- imnene - ibonakala ngokukhishwa komchamo nsuku zonke ngevolumu yamalitha ayi-6 kuye kwayi-8;
- i-degree ephakathi nendawo - umthamo womchamo wansuku zonke owenziwe kuhlu usukela kumalitha ayisishiyagalombili kuya kwabane;
- ubukhulu obukhulu - kunokukhipha okungaphezulu kwamalitha ayi-14 omchamo ngosuku.
Kulezo zimo lapho izidakamizwa ziphuzwa ukulungisa lesi sifo, inkambo yaso iqukethe izigaba ezintathu:
- Isigaba sokunxephezela, lapho kungekho khona umuzwa wokoma, futhi umthamo womchamo wansuku zonke awukhuphuki.
- Isigaba sokuncanyana - kukhona i-polyuria kanye nokonakala ngezikhathi ezithile.
- Isigaba sokuwohloka - i-polyuria yenzeka ngisho nangesikhathi sokwelashwa, futhi umuzwa wokoma uhlala ukhona.
Izimbangela kanye nendlela yokukhula kwesifo sikashukela
Isifo sikashukela sohlobo oluphakathi sivela ngenxa yezakhi zofuzo ezihlobene nokuzala kwengqondo. I-insipidus yesifo sikashukela etholakele iba neoplasms yobuchopho noma ngama-metastases abangelwa ukuvela kwezimila zezinye izicubu.
Futhi, lolu hlobo lwesifo lungavela ngemuva kokutheleleka kwangaphambili kobuchopho noma ukulimala kwalo. Ngaphezu kwalokho, isifo sikashukela esinjalo singadala i-ischemia ne-hypoxia yezicubu zobuchopho ekuphazamisekeni kwemithambo yegazi.
Uhlobo lwe-idiopathic lwesifo sikashukela lungumphumela wokuvela okuzenzakalelayo kwama-antibodies kumaseli akhipha ama-antidiuretic hormone, kuyilapho kungekho monakalo we-organic we-hypothalamus.
I-Nephrogenic sikashukela insipidus nayo ingatholakala noma izalwe kabusha. Amafomu atholakalayo avela nge-renal amyloidosis, ukwehluleka okungapheli kwezinso, ukungasebenzi kahle kwe-potassium ne-calcium metabolism, enobuthi ngezidakamizwa eziqukethe i-lithium. I-Congenital pathology ihlotshaniswa ne-Tungsten syndrome kanye nezinkinga zofuzo kuma-receptors abopha i-vasopressin.
Izimpawu zesifo sikashukela insipidus
Izimpawu ezibonakala kakhulu zesifo sikashukela i-insipidus yi-polyuria (umchamo udalulwa ngobuningi obedlula okujwayelekile kwansuku zonke) ne-polydipsia (ukuphuza inani elikhulu lamanzi). Ngosuku, ukuphuma komchamo ezigulini kungasukela kumalitha amane kuya kwamashumi amathathu, okunqunywa usizi lwalesi sifo.
Kulesi simo, umchamo awugcini lapho, ubonakala njengabantu abaphansi kakhulu futhi cishe awekho usawoti nezinye izinto ezihlanganisiwe ezitholakala kuwo. Ngenxa yesifiso esiqhubekayo sokuphuza amanzi, iziguli ezinesifo sikashukela zisebenzisa amanzi amaningi kakhulu. Umthamo wamanzi okuphuza ungafinyelela kumalitha ayishumi nesishiyagalombili ngosuku.
Izimpawu zihambisana nokuphazamiseka kokulala, ukukhathala okwandayo, i-neurosis, ukungalingani ngokomzwelo.
Ezinganeni, izimpawu zesifo sikashukela i-insipidus zivame ukuhlotshaniswa ne-bedwetting, futhi kamuva ukubuyiselwa emuva ukukhula kanye nentuthuko yezocansi kuyo. Ngokuhamba kwesikhathi, ushintsho oluhlelekile kwizitho zohlelo lomchamo luqala, ngenxa yalokho i-pelvis ye-renal, i-bladder kanye ne-ureters iyanda.
Ngenxa yokuthi uketshezi luphuzwa ngobuningi, izinkinga ngesisu ziyaqala, izindonga zalo nezicubu ezizungezile zilula kakhulu, ngenxa yalokho, isisu siyawa, izindunduma ze-bile ziyaphazamiseka, futhi konke lokhu kuholela ekuguleni okungahambi kahle kwamathumbu.
Ezigulini ezinesifo sikashukela i-insipidus, ukutholakala komile kwezikhumba nezikhumba kuyatholakala, zikhononda ngokwehla kwesifiso sokudla kanye nesisindo, ikhanda, kanye nokwehla komfutho wegazi.
Kwabesifazane abanalesi sifo, izimpawu ezilandelayo - umjikelezo wokuya esikhathini uyaphulwa, emadodeni kukhona ukwephulwa komsebenzi wobulili. Kuhle ukuhlukanisa zonke lezi zibonakaliso kusuka kunoma yiziphi izimpawu zesifo sikashukela mellitus.
Isifo sikashukela i-insipidus siyingozi ngoba singadala ukomisa, futhi ngenxa yalokho, ukuthuthuka kokuphazamiseka okuqhubekayo emkhakheni we-neurology. Ukuxazulula okunjalo kuba khona uma uketshezi olulahlekile ngomchamo lungakhokhelwa ngenani elifanele kusuka ngaphandle.
Izindlela zokuhlonza isifo sikashukela
Akunzima ukuthola inkambo yesifo ejwayelekile, izimpawu ziyabizwa. Udokotela uthembele kwizikhalazo zokoma njalo nomthamo wansuku zonke womchamo ongaphezu kwamalitha amathathu. Ezifundweni zaselaborathic, i-hyperosmolarity ye-plasma yegazi kanye nenqwaba ekhuphukayo yama-sodium ne-calcium ion kunqunywa ngezinga eliphansi le-potasium. Lapho sihlaziya umchamo, i-hyperosmolarity yayo kanye nokwehla kwabantu kuyavela.
Esigabeni sokuqala sokuxilongwa, iqiniso le-polyuria kanye nenani eliphansi lokuxineka komchamo kuyaqinisekiswa, izimpawu ziyasiza kulokhu. Kwi-insipidus yesifo sikashukela, njengomthetho, ubukhulu be-umchamo bungaphansi kwe-1005 g / ilitha, futhi umthamo wayo ungaphezu kwama-40 ml nge-1 kg yesisindo somzimba.
Uma esigabeni sokuqala kusethwa lezo zinhlaka, khona-ke ziqhubekela esigabeni sesibili sokuxilongwa, lapho kwenziwa khona isivivinyo esomile.
Uhlobo olusezingeni lwesampula ngokusho kukaRoberton ukwenqaba ngokuphelele uketshezi futhi kungcono ukwenqatshwa kokudla emahoreni ayisishiyagalombili okuqala ocwaningo. Ngaphambi kokudla kanye noketshezi kulinganiselwe, ukuvela komchamo negazi, ukugcwala kwama-sodium ion egazini, umthamo womchamo obanzi, umfutho wegazi nesisindo somzimba wesiguli kunqunywa. Lapho ukulethwa kokudla namanzi kumisiwe, le sethi yokuhlolwa iphindwa njalo emahoreni ayi-1.5 kuye kwayi-2, kuye ngenhlala kahle yesiguli.
Uma phakathi nocwaningo isisindo somzimba sesiguli sehle ngo-3 - 5% wangempela, khona-ke amasampula ayamiswa. Futhi, ukucutshungulwa kuqediwe uma isimo sesiguli siba sibi, ukuphuma kwegazi osmolality kanye ne-sodium level kukhuphuka, kanti umchamo wesibeletho ungaphezulu kuka-300 mOsm / lit.
Uma isiguli sisesimweni esizinzile, ukuhlolwa okunjalo kungenziwa ngaphandle kwesizathu, kuyilapho kwenqatshelwe ukuphuza isikhathi esiningi ngangokunokwenzeka. Uma, ngomkhawulo wethamo lamanzi, isampula somchamo esiphumela sizoba nokuvela kwe-650 mOsm / ilitha, khona-ke ukutholakala kwesifo sikashukela i-insipidus kufanele kungabandakanywa.
Ukuhlolwa kokudla okuomile ezigulini ezinalesi sifo akubangeli ukwanda okukhulu kwe-osmolality yomchamo kanye nokwanda kokuqukethwe kwezinto ezihlukahlukene kuso. Ngesikhathi sokutadisha, iziguli zikhononda nge-nausea nokuhlanza, ikhanda, ukuyaluza, ukwehluleka. Lezi zimpawu zenzeka ngenxa yokuphelelwa ngamanzi emzimbeni ngenxa yokulahleka okukhulu kukamanzi. Futhi, kwezinye izimo, ukwanda kokushisa komzimba kungabonakala.
Ukwelashwa kwesifo sikashukela insipidus
Ngemuva kokuqinisekisa ukutholwa nokuthola uhlobo lwe-insipidus yesifo sikashukela, kunikezwa ukwelashwa ukuqeda imbangela eyayibangele - isimila sisuswa, isifo esiyisisekelo siyelashwa, futhi imiphumela yokulimala kobuchopho iyaqedwa.
Ukunxephezela inani elifunekayo le-hormone ye-antidiuretic yazo zonke izinhlobo zesifo, kunqunywe i-desmopressin (i-analogue yokwenziwa ye-hormone). Kusetshenziswa ngokufakwa emgodleni wamakhala.
Esikhathini sikashukela esimaphakathi, i-insipidus, chlorpropamide, carbamazepine neminye imithi esetshenziselwa ukwenza ukwakhiwa kwe-vasopressin.
Ingxenye ebalulekile yezindlela zokwelapha ukulengiswa kwe-water-salt salt, okubandakanya ukugcina izisombululo zikasawoti eziningi ngendlela ye-infusions. Ukuze unciphise ukuphuma komchamo emzimbeni, kunqunywa i-hypothiazide.
Ngokuthola i-insipidus yesifo sikashukela, kubalulekile ukulandela ukudla okubandakanya ukudla okuqukethe okungenani amaprotheni amaningi kanye nenani lama-carbohydrate namafutha. Lokhu kuzonciphisa umthwalo ezinso. Iziguli zelulekwa ukuthi zidle ukudla kaningi nangezingxenye ezincane. Ukudla kufanele kube nenani elikhulu lezithelo nemifino. Ngokuphuza, kungcono ukusebenzisa hhayi amanzi, kepha ama-compotes ahlukahlukene, ama-jusi noma iziphuzo zezithelo.
I-IDiopathic sikashukela i-insipidus ayibeki engcupheni empilweni yesiguli, kepha ukululama okugcwele akuvamile kakhulu. Izinhlobo ze-Iatrogenic kanye nokuthinta kwesifo sikashukela, kunalokho, zivame ukwelapheka ngokuphelele futhi zithambile emvelweni.
I-insipidus yesifo sikashukela esikhulelwe inyamalala ngokuphelele ngemuva kokubeletha (ngempatho efanele), kanye nesifo sikashukela se-iatrogenic ngemuva kokuhoxiswa kwemithi ebangela lokho.
Odokotela kufanele banikeze amakhambi afanele esikhundleni sokwelapha ukuze iziguli zihlale zikwazi ukusebenza futhi ziphile impilo ejwayelekile. Uhlobo olungathandeki kakhulu lwesifo sikashukela i-insipidus ngokwemigomo ye-prognosis yi-nephrogenic sikashukela insipidus ebuntwaneni.
