Izinkimbinkimbi zezinguquko ezenzeka kuma-heterogeneous pathologies zibuthinta kabi ikhwalithi yempilo yesiguli ngasinye.
Umfutho wegazi ophezulu kushukela uba yisizathu esandisa ukuphazamiseka kwe-metabolic.
Ukuqashelwa kwemitholampilo kukhombisile ukuthi ezigulini ezinokushoda okuphelele noma okuhlobene ne-insulin, izikhathi eziningana umfutho wegazi uba yingozi enkulu yokuphazamiseka kwengqondo.
Izimbangela zokwanda kwengcindezi yegazi kwisifo sikashukela esincike ku-insulin
Ngaphandle kwe-insulin, ushukela awunakusetshenziswa izicubu zomzimba, izicubu ze-adipose ne-hepatocytes. Ekuhluphekeni kwesifo sikashukela sohlobo lwe-I, ingxenye yamangqamuzana abhekene nokukhiqizwa kwale hormone iyathinteka.
Amayunithi e-endocrine agcinwe e-pancreas awakwazi ukumboza zonke izidingo ze-insulin. Ngakho-ke, umzimba ufaka ingcosana ethile kuphela eyenziwe futhi yamukelwa ushukela ekudleni.
I-carbohydrate eningi ihlala egazini. Ingxenye kashukela ibopha amaprotheni e-plasma, i-hemoglobin, ingxenye ethile ikhishwa kumchamo.
Okondla izicubu, izicucu zama-reservation, amafutha, ama-amino acid ayaqala ukusetshenziswa. Imikhiqizo yokuqhekeka kokugcina yezakhi ezibalulekile iholela ekushintsheni kokwakheka kwegazi. Ezingeni lezinso, ukufafazwa kwezinto kuyaphazamiseka, imisebe ye-glomerular membensane iyaqina, ukugeleza kwegazi lezinsimbi kuya ngokuba kubi, nokubonakala kwe-nephropathy. Lesi simo siba yindawo yokuguquka yokuxhuma izifo ezi-2 ezinjengesifo sikashukela kanye nomfutho wegazi ophakeme.
Ukwehla kokugeleza kwegazi ezinso kuholela emsebenzini owengeziwe we-renin-angiotensin-aldosterone system (RAAS).
Le nkimbinkimbi inomthelela ekwandeni okuqondile kwethoni ye-arterioles kanye nokwanda kwempendulo yokuvuselela ukuzwela kwe-autonomic.
Kanye nezinguquko ze-morphological, iqhaza elibalulekile ku-pathogenesis yomfutho wegazi ophakeme lidlalwa ngokubambezeleka komzimba we-sodium ngesikhathi sokuhlungwa kwe-plasma izinso ne-hyperglycemia. Ukweqiwa kosawoti noshukela egazini kugcina uketshezi lombhede we-vascular and intracellularvelo, okubuye kuveze umfutho wegazi ngenxa yengxenye yevolumu (hypervolemia).
Khuphuka ekucindezelweni kwegazi ngokuntuleka kwe-hormone engalingani
Ukuthuthukiswa kokuqina komfutho wegazi nohlobo 2 sikashukela kungenxa yesici esisodwa se-metabolic - ukumelana ne-insulin.Umehluko omkhulu ngale nhlanganisela yezimo ukuqalwa okuhlangene kokubonakaliswa kwe-pathological. Kunezimo ezivame ukwenzeka lapho umfutho wegazi ophakeme ube yi-harbinger yesifo sikashukela esingaxhomekeki ku-insulin.
Ngokushoda okulinganiselwe kwe-insulini, kuvela isimo lapho amanyikwe akhiqiza inani laleli hormone elidingekayo ukumboza izidingo. Kodwa-ke, amanye amaseli okuqondiwe alahlekelwa ukuzwela kwawo ekugcineni.
Izinga likashukela wegazi lesiguli liyakhuphuka futhi lizungeze i-insulin mahhala, enezindawo eziningi:
- i-hormone ithinta uhlelo lokuzimela, ithuthukisa umsebenzi wesixhumanisi sokuzwela;
- kwandisa ukubuya kwama-ion sodium ezinso (ukuphinda ubambe kabusha);
- kuholela ekuqineni kwezindonga zama-arterioles ngenxa yokwanda kwamaseli wemisipha abushelelezi.
Izici zokubonakaliswa kwemitholampilo
Ngokuphikisana nesizinda sezimpawu zakudala zesifo sikashukela ngendlela yokuchama kaningi, ukujuluka, ukoma, isiyezi, ikhanda, ukubonakala kwezimpukane namabala phambi kwamehlo kuyaphawulwa.
Isici esihlukile sokuphazamiseka okuhlanganisiwe ukwanda komfutho wegazi ebusuku, ukuthuthukiswa kwe-orthostatic hypotension kanye nokuxhumana okucacile nokusetshenziswa kokudla okunosawoti kakhulu.
Abangewona ama-Dipers kanye nabakhethi basebusuku
Ezigulini ezisebenza ngokusebenza komzimba kohlelo lwe-autonomic, ukuguquguquka kwansuku zonke kwengcindezi yegazi kusosigaba se-10-20%.
Kulokhu, amanani wokucindezela aphezulu aqoshwa phakathi nosuku, kanye nezinga eliphansi - ebusuku.
Kwizazi zesifo sikashukela esine-autonomic polyneuropathy, isenzo sezinzwa zesitho sangasese sowesifazane ngesikhathi sokulala main siyacindezelwa.
Ngakho-ke, akukho ukwehla okujwayelekile kwengcindezi yegazi ebusuku (iziguli aziwona ama-dippers) noma, kunalokho, kukhona ukusabela okuphambene nokwanda kwezinkomba zokucindezela (kwabathathi ukukhanya).
Isifo sikashukela kanye nomfutho wegazi ophezulu
Ukulimazeka kokuxhumeka kohlelo lwezinzwa lwe-autonomic ku-diabetesics kuholela ekuphulweni kwe-innervation odongeni lwe-vascular.
Lapho uvuka embhedeni usuka endaweni eqondile ezigulini ezinesifo sikashukela, ukuncipha okubukhali kwengcindezi yegazi kuyabonakala ngenxa yokuntuleka kwethoni eyanele yama-arterioles ngenxa yokungasebenzi komzimba.
Iziguli zaphawulwa ngalezo zikhathi isiyezi, zimnyama emehlweni, zibuthakathaka kakhulu kuze kufike ekuthuthumela emilenzeni nasekufeni.
Isimo esiyingozi
I-Comorbidity esimweni se-hypertension kanye nesifo sikashukela i-mellitus (DM) ngenkambo engalawulwa ye-pathology ithwala izingozi ezinkulu zokuthuthukisa izingozi zobuchopho.
Ukulimala okuhlukahlukene odongeni lwasemuva, ukwakheka kwegazi okushintshiwe, izicubu hypoxia, kanye nokwehla kokugeleza kwegazi kuholela eqinisweni lokuthi into yobuchopho iphansi kwe-ischemia.
Iziguli zinethuba elingathandeki lokuhlaselwa yisifo sohlangothi kanye nokuphefumula endaweni engaphansi kwe-subarachnoid.
Ukuxilongwa nokwelashwa
Ukuqinisekisa umfutho we-arterial hypertension esigulini esinesifo sikashukela, kudingeka isilinganiso sokucindezela kathathu.Amanani aphakanyayo angaphezu kwe-140/90 mm RT. Ubuciko., Obuqoshwe ngezikhathi ezihlukile, bukuvumela ukuthi uthole ukuxilongwa komfutho wegazi ophakeme.
Ngaphezu kwalokho, ukusungula ushintsho oluyisimanga esigqingweni se-circadian somfutho wegazi, ukuqapha kukaHolter kwenziwa.
Umgomo oyinhloko wokwelashwa ukufeza ukulawula i-pathology. Odokotela bagcina umfutho wegazi ongaphansi kwe-130/80 mm Hg. Ubuciko. Kubalulekile ukubheka ukuthi umzimba wesiguli usetshenziselwa izinguquko ezithile ze-hemodynamic. Ukufinyeleleka okungazelelwe kwamanani okuhlosiwe kuba ukucindezela okukhulu.
Isisekelo sokwelashwa ukudla
Iziguli ziyahlotshaniswa nokusetshenziswa kokudla okunosawoti.
Uma abantu abanempilo kudingeka banciphise okuqukethwe usawoti kuya ku-5 g ngosuku, khona-ke iziguli ezinesifo sikashukela kudingeka zinciphise leli nani izikhathi ezi-2.
Ngakho-ke, kwenqatshelwe ngokuphelele ukufaka ukudla, futhi ekuhleleni okuqondile kokudla okuphezulu kakhulu ukugwema ukusetshenziswa kwale ngxenye yokunambitha.
I-Hypersensitivity to sodium ibanga umngcele kasawoti kwabashukela ku-2,5-3 g ngosuku.
Yonke eminye imenyu kufanele ihambisane nethebula No. 9. Ukudla kuphekwe kuhhavini, kubenziwe, kubilisiwe. Khawulela amafutha futhi, uma kungenzeka, wenqaba ama-carbohydrate alula. Ukudla okuthosiwe, okubhemayo akufakiwe. Ukuphindaphindeka kokudla okunempilo kufika ezikhathini ezi-5-6 ngosuku. Isikole sabanesifo sikashukela sichaza uhlelo lwamayunithi esinkwa, ngokusho isiguli uqobo sihlanganisa indlela esidla ngayo.
Ukuqokwa kwezokwelashwa
Inkinga yokukhetha ukwelashwa kwe-antihypertensive kunoma yisiphi isiguli esinesifo sikashukela siyanda ngokuba khona kwe-pathology eyisisekelo ye-carbohydrate metabolism.
Phakathi kwezidakamizwa ezikhethiwe ekwelapheni umfutho wegazi ophezulu ezigulini ezinesifo sikashukela, kukhethwa le mithi elandelayo:
- kusebenza kakhulu ngemiphumela emincane emincane;
- kungathinti i-carbohydrate-lipid metabolism;
- nge-nephroprotection kanye nomphumela omuhle ku-myocardium.
Ama-angiotensin-aguqula ama-enzyme inhibitors (i-ACE inhibitors) nama-angiotensinogen II receptor antagonists (ARA II) ahlangabezana nezidingo zokusebenza ngempumelelo okuphephile kushukela. Inzuzo ye-ACE inhibitors ingumphumela omuhle kwezicubu zezinso. Imikhawulo yokusetshenziswa kwaleli qembu i-stenosis ehlanganisiwe yomibili imithambo yezinso.
I-ARA II kanye nabamele i-ACE inhibitors babhekwa njengezidakamizwa zemigca yokuqala yokwelapha yezimo ezinesifo sikashukela.
Ukuhlanganiswa kwezinye izidakamizwa nakho kuyasiza ekwelapheni umfutho wegazi ophakeme ezigulini ezinesifo sikashukela. Imithi engabekelwa yethulwe etafuleni:
Amavidiyo ahlobene
Ukubuyekezwa kwemithi ye-hypertension ebekelwe abanesifo sikashukela:
Indaba yokuphatha iziguli nge-pathology ehlanganisiwe nenkambo eyinkimbinkimbi yesifo sikashukela ihlala isebenza isikhathi esingaphezu kwamakhulu ezinkulungwane zeziguli. Indlela kuphela ebanzi yokwelashwa, ukuhambisana kwesiguli, ukudla, ukwenqaba utshwala nogwayi, ukulawulwa kwe-glycemic kanye nokufinyeleleka kwamanani athile egazi wegazi kusiza ukwenza ukuthi ukugula kwesifo kube ngcono kumguli futhi kunciphise ubungozi bezinkinga ezisongela impilo.
