Izimpawu zobunzima be-hypertensive kanye nosizo lokuqala

I-Hypertension ngesinye sezifo ezivame kakhulu, eRussia kuthinta cishe ama-40% abantu abadala, futhi isibalo seziguli siyakhuphuka minyaka yonke. Ukuxakaniseka okunamandla kwalesi sifo, ubunzima obukhulu be-hypertensive, kwenzeka okungenani ngonyaka ngonyaka ka-1-7% weziguli ezinesifo somfutho wegazi. Kuhambisana nokukhuphuka okuqinile kwengcindezi yezinombolo ezingeyona uphawu lwesiguli esithile.

Kungani inhlekelele iyingozi? Uma iqhubeka ngendlela enzima, iziguli zinezimpawu zokulimala kobuchopho noma ukungasebenzi kahle kwenhliziyo. Inkinga engazange imiswe ngesikhathi igcwele imiphumela eminingi yezitho zomzimba, kwesinye isikhathi ezingahambelani nokuphila. Sizokutshela ukuthi ungasiphatha kanjani isifo se-hypertensive, ungasibuyisela kanjani ngokushesha impilo ngemuva kwaso.

Yini ubunzima be-hypertensive

Namuhla kunokhetho olukhulu lwezidakamizwa ezingabizi ezisiza ukugcina ingcindezi ilawulwa. Ngokudla kwabo okungapheli, ubungozi bokuthola ubunzima be-hypertensive lincane. Ngeshwa, akuyena wonke umuntu osebenzisa izimpumelelo zomuthi: I-19% leziguli ezinesifo somfutho wegazi ophezulu abazi ngesifo sabo, abanye baphuza izidakamizwa ngokunganaki noma ngethamo eliphansi kunalokho okudingekayo, ngakho-ke ingcindezi yabo ivame ukwanda. Zingama-27% kuphela iziguli ezilashelwa ngempumelelo futhi eziyalwa. Incomo yabodokotela yokuhlola njalo ingcindezi nayo ayihlonishwa. Ngokusho kocwaningo, balandelwa kuphela yi-39% yeziguli. Lapho isimo sesiya ngokuba sibi, ama-40% alinganise ingcindezi, ama-21% eziguli ezinomfutho wegazi ophakeme akasilawuli nhlobo lesi sifo.

Inkinga ye-Hypertgency ingumphumela oqondile wesimo sokungabekezeleli empilweni yomuntu. Imvamisa inhlupheko ibhekwa njengokwanda kokuncipha, i-diastolic, ingcindezi ukuya ku-120 noma ngaphezulu. Leli zinga okunzima ukulibekezelela umzimba, lihambisana nezimpawu ezicacile nokuwohloka okubukhali enhlalakahleni. Inkinga yehypertensive ishaya izitho ezivame ukubizwa ngokuthi izisulu ze-hypertension: ubuchopho, inhliziyo, i-retina, izinso, ngakho-ke bazama ukuwuyeka ngokushesha. Ngabe inkinga ihlala isikhathi esingakanani? Ngokulashwa okufika ngesikhathi - ukusuka engxenyeni yehora kuya emahoreni ambalwa, uma kungalashwa, isimo siphikelela isikhathi eside, kuvame ukuholela ekulimazekeni kwezitho eziningi nokufa. Ngaphambi kokuqalwa kwezidakamizwa ezisebenzayo zengcindezelo, isikhathi sempilo se-hypertension ngemuva kwenkinga yokuqala asizange sidlule iminyaka emi-2.

Izizathu zokukhula kwe-HA

Imbangela yanoma yisiphi isiphithiphithi se-hypertensive ukwephula ukusebenza kohlelo lokugcina ingcindezi emikhunjini. Ngokuqina komfutho wegazi isikhathi eside, lolu hlelo lusebenza ngaphansi kwezimo zomthwalo owengeziwe. Uma kungekho ukwelashwa noma kungahambi, umthwalo uyanda kaningi. Ngezigaba ezi-2 zomfutho wegazi ophakeme (ingcindezi esuka ku-160/1100), ukuphuma kwegazi kuya ezithweni kuyanda. Ukuqinisekisa ukuphuma okufika ngesikhathi, ithoni enhle yemithambo iyadingeka, kepha ezimweni zokuqina komfutho wegazi isikhathi eside, umzimba wakhe awukwazi ukunikela.

Ukuze kube nenkinga ye-hypertensive kuleli lizwe, ngisho nokwanda okuncane komthwalo emikhunjini kwanele.

Izizathu zingaba:

• ukucindezelwa, noma yikuphi injabulo futhi injabulo yenjabulo;
• ushintsho ekucindezelweni komkhathi;
• ukusetshenziswa kabi kokudla okunosawoti;
• ukuphuza ngokweqile uketshezi;
• ukuphuza utshwala;
• noma yimuphi umsebenzi womzimba;
• ukweqa amaphilisi okucindezela, ukukhanselwa okungagunyaziwe;
• ukuqina kwesibindi;
• ukuzila ukudla;
• umsebenzi wezinso ongonakalisiwe;
• ukuphazamiseka kwe-hormonal;
• kwabesifazane - ukuya esikhathini;
• ubambe umoya wakho ephusheni (i-apnea);
• usizi
• ukungenelela kokuhlinzwa;
• i-prostate adenoma yokugcinwa komchamo emadodeni.

Isizathu se-70% yezinkinga ezinkulu ze-hypertensive ukunwa kwezidakamizwa okungakafiki isikhathi. Kulesi simo, ukwanda kwengcindezi kungavusa noma ikuphi ukuqaphela. 10% wezinkinga zenzeka nge-renovascular hypertension. Kwenzeka lapho ubuciko bethambo lomthambo luphazamiseka ngenxa ye-atherosclerosis, i-trauma kanye ne-tumor. Imbangela ye-10% elandelayo yezinkinga yi-nephropathy yesifo sikashukela. Endaweni yesine yesifo sohlelo lwezinzwa, bavusa cishe i-6% yengcindezi yokuqunjelwa. Cishe ama-3% ezinkinga ezenzeka ezigulini ezine-pheochromocytoma. Ezinye izimbangela zezinkinga azikho ngaphezu kwe-1% yamacala.

Ngenhlupho ye-hypertensive, ukulawulwa kwephimbo le-vascular kuyaphazamiseka, ithonya lohlelo lwezinzwa lwe-autonomic ekuhambeni kwegazi landa, futhi ukuphuma kwenhliziyo kuyanda. Ngaphansi kwezimo zokuphazamiseka, umzimba uyakwazi ukuphendula ngokungafanele, ukuphendula okuphoqelekile kokunyuka kwengcindezi kungaba ngokungakwanele futhi okuthe xaxa.

Ukuhlukaniswa kwe-WHO kwesifo se-hypertensive

Umqondo "wenhlekelele" ekuhlukanisweni kwe-WHO ulahlekile. Ukwanda kwengcindezi ye-diastolic ngenhla kwe-120 kuhlukaniswa njengomfutho wegazi ophakeme noma ophikelelayo. Ukwahlukana phakathi kwale mikhakha kwenziwa ngokuya ngomonakalo wezitho zomzimba:

E-Russia, lokhu kuhlukaniswa kuyahambelana nokwahlukana okulandelayo kwezinkinga ezinkulu zegazi:

1. Inkinga Ye-Hypertensive Engasebenziseki kalula - Isizathu esiyinhloko sokubiza eziphuthumayo zenhliziyo. Iqembu lama-ambulensi linganciphisa ngempumelelo ingcindezi. Ukulaliswa esibhedlela akudingeki ngaso sonke isikhathi. Uma inkinga iqala ukwenzeka okokuqala noma iphindwa okwesibili ngosuku, ukucindezela kwehla kancane noma kunokungabaza ngokungabikho kwemiphumela eyingozi, isiguli sinconywa ukwelashwa okungelapheki. Ikhodi ye-ICD 10, enikezwe lesi sifo: I10 uma umfutho wegazi ophakeme ungowokuqala, u-I15 uma ubangelwa ezinye izifo.
2. Inkinga ye-hypertensive eyinkimbinkimbi - kudinga ukulethwa kwesiguli ngokushesha esikhungweni sokunakekelwa okuqinile komnyango wezokwelapha noma wezinhliziyo, futhi uma kwenzeka kunesifo sohlangothi esitholakele, esikhungweni sokunakekelwa esibucayi se-neurology. Lesi simo sifakiwe kufakwa kulitshe elonakalisiwe: I11 - inhliziyo, I12 - izinso, H35 - retina, I60-69 - ubuchopho.

I-ambulensi ayihlali ichaza ubunzima benkinga ye-hypertensive. Uma odokotela bengaqiniseki ngokutholwa futhi begcizelela ukulaliswa esibhedlela, kungcono ukuvumelana nabo, noma ngabe ingcindezi isiqalile ukwehla, nempilo yathuthuka.

Izimpawu nezimpawu zokuqala

Uphawu oluphambili lwenhlekelele ingcindezi eyandayo. Izinga elemukelwa ngokuvamile lokucindezela okuphansi okukhulu kune-120 linemibandela, ngoba ngamunye wethu unezinkomba zakhe ezinhle. Zincike eminyakeni yobudala, isisindo, izifo ezihlangene. Inkinga ibhekwa njengokwanda kwengcindezi engaphezulu kuka-40% yokuhle.

Isifo se-Hypertensive sivame ukubizwa ngokuthi yisimo esihambisana nezimpawu ezinzima:

1. Ubuhlungu bekhanda. Imvamisa itholakala ngemuva kwekhanda noma ihlanganisa ikhanda njengengubo. Lesi sibonakaliso sanda ngokushintsha kwesimo somzimba, ikhanda liphenduke.
2. Ebambe ongezansi emathempelini, umuzwa wokujaha kwegazi ekhanda.
3. Ubuhlungu emehlweni, umuzwa wokucindezela kubo. Izimpawu zingase zingaboni kahle (izinto ezingaphambi kwamehlo zibonakala kangcono kunokuvela ohlangothini), izimpukane, amabala anemibala noma imbuthano phambi kwamehlo.
4. Ukubonakala kwe-edema, imvamisa ubuso.
5. Kunezimpawu zokusebenzisa uhlelo lwezinzwa: ukuyaluza, ulaka, ukukhathazeka okukhulu.
6. Ikhanda lingaba nesiyezi kakhulu, kufinyelela ekungakwazi ukuhamba ngokuzimela. Lolu phawu lubizwa kakhulu ezigulini ezinenkinga yokuqala yegazi.
7. Ubuthakathaka obukhali, ukozela kungenzeka, ezimweni ezinzima - ukudideka.
8. I-Pallor yesikhumba noma, ngakolunye uhlangothi, ubuso obomvu namabala entanyeni, kwandise ukujuluka.
9. Izimpawu zemiphumela yenkinga ye-hypertensive ebuchosheni, isicanucanu, ukugabha kokudla, kanye nokuqunjelwa.
10. Ukuntuleka kokujikeleza kwe-cerebral kungabonakala ngezimpawu ze-neurological: ukuthuthumela, ukuhlangana okulimazayo, ukungakwazi ukugxila.
11. Ngezinkinga zenhliziyo, ukufupheka komzimba ngisho nokwanela, ubuhlungu besifuba bungenzeka.
12. Ngokuqhuma kwe-aortic, izimpawu zingubuhlungu obukhali obukhulu, buthamba.

Izimpawu ezivame kakhulu zenkinga ye-hypertensive (> 80% yeziguli) zithathwa njengezintathu: izinhlungu emuva kwekhanda - isicanucanu - isiyezi.

Ungalunikeza kanjani usizo lokuqala ku-Code Code

Ungakwenza ngaphandle kosizo lwezokwelashwa uma usujwayele lesi simo futhi kufanele usiyeke kaninginingi. Uma inkinga ye-hypertensive ivela okokuqala, izimpawu zihlukile noma ingcindezi iphakeme kunesikhathi esedlule, kuphephile ukubiza u-03.

I-algorithm yezenzo zosizo lokuqala ngenkathi ulinde udokotela ilula:

1. Beka noma uhlalise kahle isiguli ukuze ikhanda lipulatifomu ephakanyisiwe. Isiguli sinqatshelwe kunoma yimuphi umthwalo, ngisho nokukhuphuka izitebhisi. Uma inkinga iqala emgwaqweni, kungcono ulinde udokotela ebhentshini noma esitolo esiseduze.
2. Zama ukumhlalisa phansi, uma kungenzeka, ususe izingane nabantu ongabazi emagcekeni.
3. Uma ulahlekelwa ukwazi, beka isiguli eceleni kwakhe.
4. Vula iwindi egumbini ukuze uvumele umoya ukuba ugeleze.
5. Linganisa ukucindezela kwesiguli nokushaya kwenhliziyo. Izilinganiso kufanele zithathwe njalo ngekota yehora kuze kufike lapho odokotela befika.
6. Uma ikhanda lakho libuhlungu kabi, beka udaka lwesinaphi ngemuva kwentamo, ngezansi kwekhanda ngemuva.
7. Fudumeza izinyawo zakho. Zingahliselwa imizuzu engama-20 kubheseni olunamanzi ashisayo.

Kungenzeka ukuthi udambise ubunzima be-hypertensive ekhaya ngosizo lwemithi yezingcindezi zesenzo esifushane (esisheshayo). Lezi zidakamizwa zivame ukunqunyelwa yi-Therapist kanye namaphilisi ezijwayelekile ze-antihypertensive futhi zixwayisa ukuthi kufanele zithathwe kuphela njengendawo yokugcina, ngokucindezela okukhulu kakhulu.

Ungayinqanda kanjani le nkinga: i-nifedipine ibhekwa njenge isidakamizwa esisebenza kahle nesiphephe kakhulu sosizo lokuqala. Ithebhulethi elilodwa noma amabili (10-20 mg we-nifedipine) abekwa ngaphansi kolimi. Ngale ndlela yokuphatha, umuthi unikeza ukwehla kwengcindezi ezigulini eziningi ezinesifo somzimba esinama-HA ngendlela elula ngaphakathi kwemizuzu engama-5-30. Isikhathi somphumela sifinyelela emahoreni angama-5, kulokhu sekwanele ukuqala noma ukuqala kabusha ukwelashwa okujwayelekile ngezidakamizwa ezisebenza isikhathi eside. Uma umuthi ungasebenzi ngaphakathi kwengxenye yehora, ungaphuza elinye iphilisi.

Izidakamizwa ezinde ezine-nifedipine (ukubuyisa, ukuguqulwa noma ukukhishwa okulawulwayo) akufanele zidakwe ngesikhathi senhlekelele, ngoba ukusebenza kwazo kubambezelekile. I-Kordafen, Fenigidin, Kordafleks (kodwa hhayi i-Kordafleks RD!), Izinkampani zezokwelapha i-Nifedipine zaseValenta, Ozone ne-Obolenskoye zizokwenza.

Umphumela we-nifedipine uvezwa kakhulu ekucindezelweni okuphezulu kakhulu kunokukhula okuncane, ezigulini ezinamandla kakhulu we-hypertensive unamandla kunasebancane. Ukuxhumana kokuthathwa kokuthatha i-nifedipine kuyizimpawu zokulimala kobuchopho kanye nenhliziyo.

Uma ingekho i-nifedipine noma i-contraindication, i-captopril ku-23-50 mg ithathwa njengesiphuthumayo uma kwenzeka nge-HC. Ithebhulethi kufanele ifakwe ngaphansi kolimi, khona-ke izoqala ukwehlisa ingcindezi ngemuva kwemizuzu eyi-10, futhi ubude besikhathi sokusebenza buzoba yihora eli-1.

Njengoba usunikeze usizo lokuqala, lungela ukuphendula imibuzo:

• ukuthi ngabe ingcindezi inyuke phambilini;
• kuliphi izinga;
• ukuthi izikhalazo manje ziyehluka yini kulezo ezazikhona ngesikhathi senhlekelele eyedlule;
• ukucindezela kuqhamuke nini futhi kanjani;
• yiziphi izidakamizwa eziphuzwa yisiguli;
• ukuthi ngabe ngabe kukhona amaphilisi aphuthelwe ngaphambi kokuqala kwenkinga;
• yini amaphilisi isiguli awaphuza ngenkathi elinde udokotela.

Ukwelashwa kwesifo esibuthakathaka

Izinkinga ezingelula, zivame ukuqedwa ngamaphilisi. Ngaphezu kwe-nifedipine ne-capopril, i-carvedilol, i-amlodipine, i-furosemide ijwayele ukusetshenziswa. Ukwelashwa kwenhlekelele kuqala ngesidakamizwa esisodwa, esijwayele ukwenzeka. Ukwehla okukhulu kwengcindezi kungaba yingozi, ngakho-ke emahoreni amabili okuqala udinga ukufezekisa ukwehla kwawo ngo-25%. Kungcono ukufinyelela ezingeni lokucindezela okuqondiwe ezinsukwini eziyi-1-2.

Ungayinqanda kanjani inkinga eyinkimbinkimbi kuya ngezitho ezithintekile kanye nobungako bokulimala kwazo. Imithi iphathwa ngokuhlinzwa. Izincomo zomtholampilo zifaka kuphela lezo ezinokufakazelwa kokusebenza okuhle: i-sodium nitroprusside, nitroglycerin, enalaprilat, furosemide, metoprolol, esmolol, urapidil, clonidine. Emahoreni amabili okuqala, ingcindezi kufanele inciphe ngo-15-25%, emahoreni ayi-6 alandelayo - ifinyelela ezingeni le-160/1100. Akunakwenzeka ukwehlisa ngokushesha ingcindezi ibe eyejwayelekile nge-GC eyinkimbinkimbi, ngoba ukunikezwa kwegazi ezithweni kungonakala.

Inkinga ngemuva kotshwala bususwa ikakhulukazi ngabakwa-beta-blockers kanye ne-ACE inhibitors. Ukusetshenziswa kwama-vasodilators, ama-diuretics ne-clonidine kuyagwenywa, ngoba kwandisa ukudakwa futhi kungabangela i-tachycardia.

Ukuvuselela kanye nokulungiswa kabusha

Ngemuva kokuhlupheka kakhulu, iziguli eziningi ziphawula ukwehla kwenhlala-kahle. Ubuhlungu bekhanda, isiyezi, ukunganaki kungaqhubeka isikhathi eside. Ukulungiswa kwekhaya akwenzeki njalo. Ukubuyela empilweni ejwayelekile, ungadinga usizo lukadokotela wezenhliziyo, owelaphi, futhi kwesinye isikhathi udokotela wengqondo.

Indlela yokuziphatha ngemuva kokuhlaselwa:

1. Okokuqala, qinisekisa ukuthi uzothola usizo masisha uma kwenzeka kuba nenhlekelele yesibili: njalo phatha ifoni ekhokhisiwe, uhambe ne-escort amabanga amade, futhi wenqabe ukushayela isikhashana. Khumbula imithetho yokunqanda ubunzima, uphathe nemithi esebenza ngokushesha.
2. Isinyathelo sokuqala sokushintsha lesi simo ukukhethwa kwamaphilisi wokucindezela, azodinga ukuthatha njalo. Ngemuva kwenhlupheko, amalungiselelo ayinkimbinkimbi avame ukubekwa, aqukethe izinto ezimbili, ezingatheni izinto ezintathu ezisebenzayo. Bakhethwa bebheka izifo ezikhona, ngakho-ke kwesinye isikhathi kungadingeka ukuthi bahlolwe. Ukuze amaphilisi aqale ukusebenza ngokugcwele, kuzothatha okungenani inyanga eyi-1. Ngalesi sikhathi, ingcindezi ingaba ngaphezulu kokwejwayelekile.
3. Gwema noma imuphi umthwalo womsebenzi okungenani isonto, noma inempilo egculisayo, unganikezeli ikhefu lokugula, ungayi emsebenzini.
4. Khipha utshwala, ikofi elinamandla netiye. Khawulela usawoti.
5. Nikeza umzimba wakho uketshezi. Qinisekisa ukuthi imvamisa ikhishwa emzimbeni futhi ayicasuli i-edema. I-GP yakho ingancoma i-teuretic tee.
6. Ukwelashwa kwekhanda kuwuphawu, kuqukethe ekuthatheni ama-antispasmodics noma ama-analgesics, anqunywe ngumelaphi.
7. Umphumela ovela njalo wenhlupheko, njengokufikelwa isiyezi, ungancishiswa ngendlela elula: inhale ngekhala, ubambe umoya wakho, ukhiphe ngomlomo, uphinde uphinde kaningana.
8. Ngemuva kwenhlupho ye-hypertensive, isimo esidangele singaphikelela isikhathi eside. Ukubuyisa umzimba ngokushesha, udinga ukuqinisekisa ukuthula okukhulu ngokwakho, gxila empilweni yakho, uzibekele isikhathi sokuphumula nokuzilibazisa. Uma ukudangala nokukhathazeka kungahambi, ungalunaki usizo lomelaphi.

Izinkinga ze-GC

Izinkinga eziningi ezinomfutho wegazi aziholeli ekulimaleni kwesitho. Kakade amasonto ambalwa emva kwabo, iziguli zingaphila impilo ejwayelekile. Kodwa-ke, ngaphandle kokulawulwa kwengcindezi yezokwelapha, ukuhlasela okulandelayo kumane kuyindaba yesikhathi. Futhi akunasiqinisekiso sokuthi nayo izobanjwa ngendlela emnene, ngaphandle kwezinkinga. Lapho umzimba uthatha isikhathi eside ngokweqile ngesimo sengcindezelo ephezulu, kukhulu ubungozi benkinga enkulu.

Uyini ubungozi besifo se-hypertensive ngendlela eyinkimbinkimbi:

• i-cerebral hemorrhage, ukwephulwa kwesikhashana kokuhlinzekelwa kwegazi ebuchosheni kwenzeka ngamaphesenti angama-29;
• isilinganiso se-encephalopathy - 16%;
• ukushaya kwenhliziyo - 12%;
• ukungapheleli kwe-coronary - 15%;
• i-pulmonary edema - 23%;
• eminye imiphumela, kufaka phakathi ukulahleka kombono ngenxa ye-retinopathy eyingozi, ibonwa ku-6% weziguli.

Ungakuvimbela kanjani ukuhlaselwa kwesibili

Indlela ephumelela kunazo zonke yokuvimbela ukuphindeka kwezinkinga zokwelapha yempilo yansuku zonke, ngaphandle kwamaphilisi alahlekile. Ukuqinisekisa ukuthi amaphilisi ayasebenza, ukukala ingcindezi kabili ngosuku. Yenza lokhu ngesimo esizolile, usesimweni sokuhlala, bhala umphumela kanye nosuku encwadini yokubhalela. Uma izinga lokucindezela liqala ukwedlula i-140/90, noma igxuma livela phakathi nosuku, ebelungekho lapho ngaphambili, udinga ukulungiswa kokwelashwa. Bona udokotela. Uyokwenyusa umthamo womuthi, noma anikeze entsha, esebenzayo kakhudlwana.

Ungathonya ukucindezela hhayi ngamathebulethi kuphela. Uma uxhuma izindlela ezingezona ezokwelapha, ubungozi besikhathi sokuphindaphindwa kwegazi eliphezulu buzokwehla kakhulu. Njengomthetho, iziguli ezinomfutho wegazi ophakeme zelulekwa ukuba zinamathele ekudleni, zehlise isisindo esivamile (zifinyelele kwi-BMI engaphansi kwama-25), zinikeze i-nicotine notshwala, futhi zikhuphule umsebenzi. Izinga lomsebenzi womzimba linqunywa udokotela. Kungase kudingeke ukuthi uye ohlolweni olwengeziwe ukuze uthole imvume yokuzethemba empilweni yenhliziyo. Ukudla kufaka inani elikhulu lemifino namakhambi, okusanhlamvu okuhlanganisiwe, ukukhawulelwa usawoti (ngosuku <5 g), amafutha wezilwane, ukufakwa kwamafutha we-trans.