I-angiopathy ephansi yesifo sikashukela mellitus: izimbangela, izimpawu nokwelashwa

Ezinye zezifo ezivame kakhulu zohlelo lwe-musculoskeletal, okuholela ekukhubazekeni kwangaphambi kwabantu abanamandla, yi-angiopathy yesifo sikashukela ephansi.

Lesi simo sihlotshaniswa noshukela wegazi ophakeme, kanye nomonakalo wezinso ne-retina, unesithakazelo esikhulu kososayensi emhlabeni wonke.

Ngokwezibalo, ngasekupheleni kwekhulu lama-21, wonke umuntu wesithathu emhlabeni uzobhekana nenkinga yokumelana ne-insulin, iningi labo lizoba nezinkinga zemithambo yegazi.

Yini le

Isifo sikashukela i-angiopathy singumphumela oyingozi wohlobo 1 no-2 sikashukela. Uma izimpawu zokuqala zezinkinga zinganakwa, khona-ke emva kwesikhashana esithile (umuntu ngamunye ngamunye) ukuphazamiseka kwengqondo okungenakulungiswa kwezicubu ezithambile zamacala aphansi akhula.

Ingi ephansi ye-angiopathy

Izingxenye ezingemuva kwemilenze (izinyawo) zithinteka kakhulu, lapho ukuhamba kwegazi, noma ngaphansi kwezimo ezijwayelekile, kusezingeni eliphansi.

Ukulimala okuncane kuvula umnyango wokutheleleka, ngokumelene nesizinda sokuncipha komzimba okunciphisiwe, inqubo yokulimala iba ivila, ibhubhise. Uma izinyathelo zingathathwanga ngokuhamba kwesikhathi, inqubo idlulela ekulimazeni kwezihlakala, lokho okubizwa ngokuthi "unyawo sikashukela" kuyavela.

Ngokuya ngokwanda kwenqubo, ukwenziwa kwasendaweni kanye nokubuyela esimeni esijabulisayo, odokotela bahlukanisa izindlela ezintathu eziyinhloko zonyawo lwesifo sikashukela:

• i-neuropathic -ukunqotshwa kwemisipha emikhulu nezincane yezinzwa, ukwephula ukuzwela kanye ne-paresthesia kuza phambili;
• neuroischemic - imikhumbi, okokuqala, ihlupheka;
• kuxutshwe - unezimpawu zombili lezi zinhlobo. 

Ngokuya ngefomu, iziguli zinezikhalazo ezihambisanayo ezinquma amaqhinga aphambili ekwelashweni.

Eminyakeni engaba ngu-25, ukuhlukaniswa kweWagner ngonyawo lwesifo sikashukela kuye kwathandwa emhlabeni wonke. Kuchaza ukwanda kwezinqubo ezonakalisayo zezicubu ezithambile:

• isigaba 0. Izinqubo zokuphikisa kuhlelo lokusebenzisa izinyawo, olubonakala kuphela kuma-x-ray;
• isigaba 1. Izilonda zesikhumba ezingekho emthethweni ezingasakazeki kwezicubu ezithambile ezijulile;
• isigaba 2. Isilonda sisakazeka sijule ezingxenyeni ezingaphansi komhlaba, sifinyelela emathanjeni nasemisukeni;
• isigaba 3. I-Osteomyelitis nokwakheka kwamathumba;
• isigaba 4. IGangrene iyakhiwa, indawo ethintekile yonyawo iba mnyama, ushintsho olungenakulungiswa;
• isigaba 5. I-gangrene ejwayelekile, engafinyelela endaweni yamadolo ehlanganisiwe, ukunqunywa okuphuthumayo kwesitho esithintekile kuyadingeka.

Izimbangela zokwenzeka

Amaseli adinga i-insulin ukuze amunce ngokuphelele ushukela.

Ukwanda okungapheli koshukela egazini likashukela kufinyeleleka "ekupompeni" ngokweqile ezicutshini, ngaphandle kokudla okuthe xaxa.

I-vascular endothelium (i-lining of capillaries kanye ne-arterioles) ivele ifake ushukela ngenxa yokuthi lolu hlobo lweseli aludingi i-insulin ukuze lusetshenziswe. Ngemuva kwesikhathi esithile, ukuhlukunyezwa kufinyelela ezingeni lobuthi, kukhula i-osmolar gradient gradient.

Amanzi aqala ukuqongelela ngaphakathi kwe-endotheliocytes, amaseli avuvukala afe. Ngaphezu kwalokho, kuvulwa indlela ye-metabolism yeshukela, okuphumela ekwakhekeni kwe-sorbitol, umkhiqizo owenziwe ngengozi oyingozi kakhulu ngezinto eziphilayo.

Ngokuhamba kwesikhathi, izinqubo zokuhlanganiswa kwe-endothelial kanye nenhlangano ziyaphazamiseka, ama-macroglobular complements (amaprotheni) aqala ukudlula ngokukhululeka odongeni lomthambo owonakele, i-edema yesikhala sezinhliziyo iyakhula.

Uhlelo lwe-lymphatic alukwazi ukubhekana nenani elikhulayo lamanzi ezicutshini, izinyawo ziba sengozini kalula.

Ezimweni ezinjalo, ngisho nokulimala okuncane kungadala ukuvuvukala okukhulu necrosis.

Imvamisa kakhulu, ngesimo se-neuropathic sonyawo lwesifo sikashukela, lapho ukuzwela kobuhlungu kukhubazeka khona, abantu abakuboni ukulimala isikhathi eside, ngaleyo ndlela baphuthelwa ukubonakaliswa kokuqala kwengxaki.

Izimpawu zesifo

Ukuboniswa kwe-angiopathy yesifo sikashukela kungaba nokwenziwa okuhlukile kwasendaweni. Ngakho-ke, iziguli eziningi zivame ukukhala ngokungahambi kahle kokubonakalayo, ubuthakathaka obujwayelekile, ukuphazamiseka emsebenzini wenhliziyo.

I-les lesion syndrome inezimpawu ezilandelayo:

• ukuphazamiseka kwetrophic ezinyaweni: ukucwilisa isikhumba, ukuncipha kwezinwele, ukulunywa;
• i-congestive hyperemia (isikhumba phezu kwendawo ethintekile siba obomvu ngokwemvelo ngesinye isikhathi nge-cyanotic hue);
• kuphazamisa izinhlungu zomlenze ngenkathi uhamba noma uphumule;
• izinhlungu, izinga lokushisa kanye nokuzwela kokudlidliza kuyancishiswa;
• i-pulsation emithanjeni emikhulu yezinyawo iyancipha;
• ifomu lezilonda;
• izinzwane ezimnyama.

Noma yiziphi kulezi zimpawu ezingenhla kufanele zibe uphawu olwesabekayo nesiginali ukubona udokotela.

Ukuxilonga

Indlela yokuqala yokuthola i-angiopathy yesifo sikashukela semikhawulo ephansi ukuhlolwa okugcwele kwezokwelapha. Udokotela uhlaziya izikhalazo zesiguli, aqoqe umlando wezokwelapha onemininingwane, anqume ubude besikhathi kanye nezinga lokulawulwa kwesifo sikashukela.

Ukuqinisekisa ukutholakala kwale sifo, kwenziwa uchungechunge lwezifundo zaselebhu kanye nezinsimbi.

• ukuhlolwa kwegazi okujwayelekile (ukuba khona kokusabela kokuvuvukala ngesimo se-leukocytosis kanye nokwanda kwe-ESR kuwuphawu olubalulekile lwe-progno)
• ukuhlolwa kwegazi kwe-biochemical (ukuhlolwa kwe-renal kanye nesibindi, ushukela, i-glycosylated hemoglobin, iphrofayili ye-lipid);
• urinalysis (ukuzimisela kwenqanaba le-glucosuria);
• I-Ultrasound yemikhumbi yamaphethelo aphansi kumodi ebizwa ngeDoppler. Ucwaningo lukuvumela ukuthi unqume ubungako be-patency yemithambo yegazi nezindawo zezicubu ezingasebenzi;
• i-angiography. Ngemuva kokuphathwa kobuhlakani obudaywe okhethekile, uchungechunge lwama-x-ray emikhawulweni ephansi luyenziwa, izindawo ezinamaphiko okugeleza kwegazi ziyabonakala;
• I-MRI. Indlela yocwaningo efundisayo nebizayo enikeza imininingwane eminingi ewusizo mayelana nokwanda kwezinqubo ze-ischemic, futhi ikuvumela ukuthi unqume inani lokuhlinzwa;
• fundoscopy. Ukufundwa kwemikhumbi ye-fundus kunikeza imininingwane ebalulekile mayelana nokulimala okuhleliwe kombhede wemithambo, kufaka phakathi ubuchopho;
• ECG kanye ne-ECHO-KG. Hlola ukusebenza kwenhliziyo nokusebenza kwenhliziyo, ikakhulukazi uma kuhlelwa ukuthi kuhlinzwe ukuhlinzwa.

Izindlela zokwelapha

Ukudla okukhethiwe kukhethiwe, ama-carbohydrate asheshayo namafutha ezilwane akhawulelwe ngokuphelele.

Ukudla ngokwako akusebenzi, kepha kungesizinda esihle sokwelashwa kwezidakamizwa.

Kubalulekile ukukhetha umuthi ofanele we-insulin noma izidakamizwa zomlomo ze-hypoglycemic. I-cholesterol yegazi iyalawulwa, uma iphakeme, kunqunywe ama-statin.

Uma kukhona izinguquko ze-ulcerative necrotic, udokotela ohlinzayo uxhunyiwe. Izicubu ezi-efile zivulekile, kusetshenziswe okokugqoka kwe-aseptic ngokulungisa nezakhi zokwelapha. I-Gravitational plasmapheresis ingasetshenziswa, kufakazelwa ukuthi le ndlela inganciphisa ukuvuvukala, inciphise izinhlungu.

Izinguquko zamathambo-ze-thorical ziphathwa ngokufaka amandla ezinyawo ngezicucu zamathambo.

Ukuvimbela

Isifo sikashukela sidinga ukulandela le mihlahlandlela:

• ukuqapha okusondele kwamazinga kashukela egazini;
• izivivinyo ezijwayelekile zokuvimbela udokotela ohlinzayo;
• ukuhlolwa kwezinyawo nezicathulo ekugcineni kosuku ngalunye;
• nokwenza kahle komzimba.

Ividiyo elusizo

Ungahlanza kanjani imithambo yegazi yesifo sikashukela:

Kubalulekile ukukhumbula ukuthi i-angiopathy yesifo sikashukela semikhawulo engezansi yisimo esinamandla sokubuyela emuva esigabeni sokuqala sentuthuko. Ukunakekelwa kwempilo okufika ngesikhathi kusiza ukuvimbela ukunqunywa. Ukulawulwa kweshukela kusiza ukuqeda imiphumela enobuthi ye-glucose odongeni lwe-vascular.