Umfutho wegazi ophezulu wesifo sikashukela

I-Hypertension yisimo lapho umfutho wegazi wedlula yonke imikhawulo ejwayelekile (i-140/90) futhi ngasikhathi sinye "isimilo" sayo se-spasmodic siphawulwa ngokuhlelekile. Ingcindezi yesifo sikashukela i-mellitus iyingozi ikakhulukazi, ngoba ubungozi bokuqalwa kwe-myocardial infarction, unhlangothi, i-gangrene yamaphethelo aphansi nezinye izifo zanda kaningana. Ngakho-ke, kunconywa ukuthi umuntu onesifo sikashukela aqaphe njalo hhayi kuphela izinga likashukela egazini, kodwa futhi nengcindezi.

Izizathu zokuthuthuka

Isifo sikashukela kanye nengcindezi yizifo ezivame ukulekelelana. Ngaphezu kwalokho, imbangela enkulu ye-hypertension ku-T1DM yi-nephropathy yesifo sikashukela, ebonakala ngokulimala kwezinso nokusebenza kahle kokuphazamiseka.

Izimbangela zokulengiswa kwengcindezi yegazi kulesi sifo nazo zingaba:

• ukulawulwa kokukhubazeka kwemikhumbi yezinso;
• umfutho we-systolic obalulekile noma ohlukile;
• ukuphazamiseka kwe-endocrine.

Ngokuqondene nokuphazamiseka kwe-endocrine emzimbeni okuvusa ukuthuthukiswa komfutho wegazi ophezulu kushukela, okuvame kakhulu phakathi kwabo yile:

• I-Itsenko-Cushing's syndrome;
• pheochromocytoma;
• hyperaldosteronism nabanye.

Ngaphezu kwalokho, umfutho wegazi ophakeme ku-T1DM naku-T2DM ungabhekwa:

• ngokushoda emzimbeni wezinto zamakhemikhali ezinjenge-magnesium;
• ukuphazamiseka kwengqondo okukhona okuphikisana nesizinda sokucindezelwa kaningi, ukucindezelwa kwengqondo, isimo sokudangala, njll;
• ukuvezwa kwezinto ezinobuthi (isb. i-zebus, lead noma i-cadmium);
• isifo sokuqina kwemithambo yegazi, okuvusa ukunciphisa imithambo emikhulu yemithambo.

Ingcindezi ku-T1

Njengoba kushiwo ngenhla, imbangela enkulu yomfutho wegazi ophezulu ngohlobo 1 sikashukela i-nephropathy yesifo sikashukela, ebonakala ngokulimala kwezinso. Njengoba izibalo zomhlaba zibonisa, le nkinga iba khona cishe ezingamaphesenti ama-40 eziguli futhi idlule kuwo ngezigaba eziningana:

• owokuqala ubonakala ngokubonakala komchamo wezinhlayiya ezincane zamaprotheni e-albhamuin;
• owesibili ubonakaliswa ukungasebenzi kahle kwezinso nokubonakala komchamo wezinhlayiya ezinkulu zamaprotheni e-albhamuin;
• owesithathu ubonakala ngokungahambi kahle komsebenzi wezinso nokuthuthukiswa kokwehluleka kwesihlungu sezinso.

Imiphumela yokuqina kwegazi

Lapho izinso zingasebenzi kahle, ukukhishwa kwe-sodium emzimbeni kuyaphazamiseka. Ifakwa egazini, futhi ukuze iphule, uketshezi luqala ukuqongelela emithanjeni. Ukunyuka kwayo kuholela ekucindezelweni okuqinile ezindongeni zemithambo yegazi, okuvusa ukwanda kwengcindezi yegazi.

Ukugcwala okukhulu kwe-glucose egazini kuholela eqinisweni lokuthi uketshezi emithanjeni luba luningi ngokwengeziwe. Lokhu kusabela okungokwemvelo kokuvikela umzimba futhi kwenzeka ngenhloso yokunciphisa igazi, ngoba ushukela nesodium kuyenza ibe lukhuni. Ngenxa yazo zonke lezi zinqubo, umthamo wegazi elijikelezayo uyanda futhi umfutho wegazi ukhuphuka kaningi.

Lokhu-ke, kuthinta kakhulu ukusebenza kwezinso, ngoba yibona abadlula igazi ngokwabo, ngenkathi behlangabezana nengcindezi enkulu. Ukwanda kokujikeleza kwegazi kushukumisa ukwanda kwengcindezi ngaphakathi kwe-glomeruli yesitho, ngenxa yalokho bafa kancane kancane futhi isikhathi ngasinye lapho izinso ziqala ukusebenza zimbi kakhulu.

Njengomthetho, le mithi elandelayo isetshenziswa ekwelapheni umfutho wegazi ophezulu kushukela onesifo sikashukela:

• imithi esehlisa ushukela wegazi;
• Ama-inhibitors e-ACE;
• izidakamizwa ze-diuretic;
• ama-angiotensin receptor blockers.

Kumele kuqashelwe ukuthi ukwelashwa esimweni ngasinye kunqunywe ngokuhlukile futhi kuncike ezicini eziningana:

• ubunzima besifo sikashukela;
• izinga lokuthuthukiswa kwe-nephropathy yesifo sikashukela;
• ukuba khona kwezinye izifo esigulini.

Ingcindezi ku-T2

Uhlobo 2 sikashukela lukhula kancane. Futhi ezigabeni zokuqala zokukhula kwayo, lapho kuncipha kokuzwela kwezicubu kwe-insulin, iziguli zivame ukuba nomfutho wegazi ophakeme. Isizathu salokhu ukuhlukunyezwa okuphezulu kwe-insulin egazini, okuthi kuyo ngokwayo kuthuthukise ukwenzeka komfutho wegazi ophakeme.

Izinkinga ze-metabolic syndrome

Ngenkambo ende ye-T2DM, i-vascular lumen narrows, ebangelwa ukuvela kwesifo esinjengalesi njenge-atherosclerosis. Ngokuhambisana nalokhu, esiswini kukhona ukunqwabelana kwamaseli wamafutha nawo afihla igazi, ngaleyo ndlela andise ukujikeleza kwawo futhi anda nomfutho wegazi.

Zonke lezi zinqubo ezenzeka emzimbeni kwezokwelapha zibizwa ngokuthi yi-metabolic syndrome. Futhi kuvela ukuthi ukuthuthukiswa komfutho we-hypertension kuleli cala kuqala kakhulu ngaphambi kokuba uhlobo lwe-2 yesifo sikashukela luvele.

Izinga elikhulayo le-insulin egazini libuye libe negama lalo elisemthethweni - i-hyperinsulinism, elenzeka ngenxa yokumelana ne-insulin. Lapho ama-pancreas, obandakanyeka ekwenziweni kwe-insulin, eqala ukusebenza ngenkuthalo, ngokushesha "ayakhathala" futhi ayeke ukubhekana nemisebenzi yakhe, okucasulayo ukukhula kwesifo sikashukela sohlobo 2.

Lapho i-hyperinsulinism ivela emzimbeni, kwenzeka okulandelayo:

• I-CNS ijabule;
• ukusebenza kwezinso kunciphisa, okuholela ekuqokeleleni kwe-sodium emzimbeni;
• okweqile kwe-insulin egazini kukhulisa izindonga zemithambo yegazi futhi kunciphise ukuqina kwawo.

Ukulawulwa kweshukela egazini kukuvumela ukuthi ulawule umfutho wegazi

Zonke lezi zinqubo zivusa ukwanda kwengcindezi yegazi kanye nokuwohloka okujwayelekile kwezempilo. Kodwa-ke, kuleli cala, uma isiguli sithintana nodokotela ngokushesha futhi siqala ukuthola ukwelashwa, ukuqina komfutho wegazi ophezulu nohlobo 2 sikashukela kungavinjelwa. Ngaphezu kwalokho, kulula kakhulu ukwenza ukwedlula nge-SD1. Mane ulandele ukudla okune-carb ephansi futhi uthathe amaphilisi e-diuretic.

Izici zomfutho wegazi ophezulu kushukela

Kumuntu ophile kahle, ukwehla komfutho wegazi kwenzeka kuphela ekuseni nakusihlwa kusihlwa. Isifo sikashukela, sigxuma usuku lonke. Ngaphezu kwalokho, ebusuku kubashukela, ingcindezi ikhuphuka kakhulu kunasekuseni.

Njengoba ososayensi besikisela, le nto yenzeka ngenxa yokuqalwa kwesifo sokuqina kwesifo sikashukela. Lokhu kungenxa yokuthi izinga eliphakeme le-glucose egazini liwuthinta kabi umsebenzi wohlelo lwezinzwa oluzimele, olulawula umsebenzi obalulekile womzimba. Ngenxa yalokhu, ithoni ye-vascular iyancipha futhi ngokuya ngemithwalo, baqala ukuncipha noma baphumule.

Futhi ukufingqa, kufanele kuphawulwe ukuthi uma isifo sikashukela sihlanganiswa nomfutho wegazi ophakeme, umfutho wegazi akufanele ulinganiswe izikhathi ezi-1-2 ngosuku, kepha usuku lonke, ngezikhathi ezithile. Ungasebenzisa futhi ukuqapha, okwenziwa amayunithi wokuma usebenzisa amadivaysi akhethekile.

Isifo sikashukela kanye ne-hypertension kuvame ukuhambisana namanye ama-pathologies adinga ukwelashwa okuhlukile.

Ngaphezu komfutho wegazi ophakeme, abanesifo sikashukela bavame ukuba ne-orthostatic hypotension, ebonakala ngokwehla okukhulu komfutho wegazi. Lokhu kwenzeka ikakhulukazi lapho isiguli siguqula isikhundla sayo (ngokwesibonelo, sisuka endaweni yokuhlala siye kwesinye). Lesi simo sizibonakalisa ngesiyezi, "ama-goosebumps" phambi kwamehlo, ukubonakala kwemibuthano emnyama ngaphansi kwamehlo, ifoka.

I-Orthostatic hypotension nayo yenzeka iphikisana nesizinda sokukhula kwesifo sikashukela kanye nokulahleka kwekhono lokulawula ithoni ye-vascular. Kulezo zikhathi lapho umuntu esukuma kakhulu, umthwalo osenyameni wakhe uphakama ngokushesha, ngenxa yalokho asinaso isikhathi sokwanda kokugeleza kwegazi, okukhombisa ukuncipha komfutho wegazi.

Isimo somfutho wegazi kushukela

Ukunciphisa umfutho wegazi, odokotela banquma imishanguzo ekhethekile. Kepha udinga ukubathatha ngokucophelela. Into ekhona ukuthi ukwehla kakhulu kwengcindezi yegazi kungasenza sibe sibi kakhulu isimo sesiguli, esizosithinta kabi isimo sohlelo lwezinhliziyo.

Ngabe isifo sikashukela esingu-2 singalashwa?

Ngakho-ke, ukwelashwa kwe-hypertension kufanele kwenzeke kancane kancane. Ekuqaleni, udinga ukuzibekela umgomo, wehlise umfutho wegazi ufike ku-140/90 mm RT. Ubuciko. Lokhu kumele kwenzeke emavikini amane okuqala okwelashwa. Uma isiguli sizizwa kahle futhi singenayo imiphumela emibi evela ekwelashweni kwezidakamizwa, khona-ke imithamo ephezulu kakhulu yezidakamizwa isetshenziselwa ukunciphisa umfutho wegazi ukuya ku-130/80 mm Hg. Ubuciko.

Uma, lapho elashwa, isiguli siwohloka enhlalakahleni, ukwehla kwengcindezi yegazi kufanele kwenzeke kancane kancane. Uma ukuthatha amakhambi kuvusa ukuthuthukiswa kwe-hypotension, ama-ejenti asetshenziswa angakhuphula umfutho wegazi. Kepha kufanele futhi zisetshenziswe ngokucophelela nangendlela eqinile ebekwe udokotela.

Ukwelashwa kwe-hypertension kushukela

Yisiphi isidakamizwa okufanele usithathe ukwehlisa umfutho wegazi kushukela, kuphela udokotela onqumayo. Njengokwelashwa okwelapha, izidakamizwa zemiphumela ehlukahlukene zingasetshenziswa.

Izimiso eziyisisekelo zokwelashwa kwe-hypertension kushukela

Ama-diuretics

Phakathi kwezidakamizwa ze-diuretic ezisetshenziselwa ukwelapha isifo segazi, ezivame kakhulu yilezi:

• Furosemide;
• IMannitol;
• I-Amiloride;
• Torasemide;
• I-Diacarb.

Kulokhu, ama-diuretics anikeza umphumela omuhle kakhulu wokwelapha. Banikeza ukususwa koketshezi oluqhamuka emzimbeni, ngaleyo ndlela banciphise inani lokujikeleza kwegazi nengcindezi ezindongeni zemithambo yegazi.

Ama-blocker e-Beta

Abanesifo sikashukela banqunywa ezimweni lapho isiguli sinakho:

• isifo senhliziyo;
• isikhathi sokwengezelela;
• isifo sohlangothi.

Ngazo zonke lezi zimo, umfutho wegazi ophakeme ungadala ukuqala kokufa ngokuzumayo. Isenzo sabakwa-beta-blockers sihlose ukwandisa imithambo yegazi nokwandisa ukuzwela kwezicubu ukungena kwe-insulin. Njengomphumela walokhu, imiphumela emibili yokwelapha itholakala ngasikhathi sinye - ukujwayelekile kwengcindezi yegazi kanye neleveli yeglucose.

Ukuthatha i-beta blockers kunciphisa ingozi yokushaywa yi-stroke kanye ne-myocardial infarction

Kuze kube manje, laba balandelayo-beta-blockers bavame ukusetshenziswa njengendlela yokwelapha i-hypertension kushukela:

• Ithuba elingelona ithikithi;
• ICoriol.
• I-Carvedilol.

Kufanele kuqashelwe ukuthi kukhona nama-beta-blocker emakethe yemithi angenawo umphumela we-vasodilating. Kwenqatshelwe ngokuphelele ukubathatha ngesifo sikashukela, njengoba bekhulisa ukumelana kwe-insulin kwezicubu zomzimba, futhi futhi kubangela ukwanda kwezinga le-cholesterol "embi" egazini, okuholela ekuqhubekeni kwesifo esiyimbangela kanye nezinye izinkinga ezinkulu.

I-calcium calcium blockers

Lokhu kufaka phakathi izidakamizwa ezilandelayo:

• I-Amlodipine;
• INifedipine;
• ILacidipine;
• UVerapamil;
• Isredipine.

Le mishanguzo inomphumela onenzuzo ekusakazweni kwegazi futhi ihlinzeka ngokuvikelwa okunokwethenjelwa ezinso, ngakho-ke imvamisa ibekelwa iziguli ezine-nephropathy yesifo sikashukela. Amabhulokhi wesiteshi se-calcium ayinamphumela we-nephroprotective futhi angasetshenziswa ngokuhlanganiswa ne-ACE inhibitors ne-angiotensin-II receptor blockers.

Ezinye izidakamizwa zokwelapha i-hypertension kushukela

Njengoba ukwelashwa okwelashwa nakho kungasetshenziswa:

• Ama-inhibitors e-ACE;
• ama-angiotensin-II receptor blockers;
• alpha adrenergic blockers.

Ngaphezu kwalokho, ukwamukela kwabo kumele kusetshenziswe kuhlanganiswe nokudla okwelaphayo, okungafaki ekudleni okunosawoti, okuthosiwe, okubhemayo, okunamafutha, ufulawa nezitsha ezimnandi. Uma umuntu elandela ngokuqinile zonke izincomo zikadokotela, uzokwazi ukunqoba ngokushesha i-hypertension futhi agcine ukuthuthukiswa kwesifo sikashukela kungaphansi kwakhe.