I-NEUROPATHY YESIFO SIKASHUKELA KU-MELLITUS YESIFO SIKASHUKELA: IZIMPAWU NOKWELASHWA

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Ukwehlulwa kwezakhi zesistimu yezinzwa ephakathi nendawo. Lokhu kuyinkimbinkimbi yesibonakaliso, okuwukuphazamiseka kwesimo esisebenzayo sayo yonke imicu yezinzwa ngokumelene nesizinda sezinguquko ezenzeka emithanjeni yegazi emincane. I-neuropathy yesifo sikashukela (ngokusho kwe-ICD-10 - G63.2 *) idinga ukuhlolwa okusheshayo kwesimo nokuqokwa kokwelashwa okufanele ukuze kubuyiswe imisebenzi elahlekile futhi kuthuthukiswe impilo yempilo yesiguli.

Ukuhlukaniswa

Ngesikhathi sokuhlolwa, i-pathology iyatholakala kuzo zonke iziguli zesithathu eminyakeni eyi-10-15 ngemuva kokuqala kwesifo sikashukela. Ukwahlukanisa i-neuropathy yemvelo ephakathi nethintekile. Ukulimala kobuchopho kanye nentambo yomgogodla kungokwenqubo ye-pathological ephakathi nendawo futhi kuhlukaniswe ngale mibandela elandelayo:

ukuqubuka komzimba okuphezulu ngemuva kokulimazeka kwezakhi zohlelo lwezinzwa oluphakathi;
ingozi ye-cerebrovascular eyingozi;
ukungasebenzi kahle kobuchopho ngokumelene nesizinda se-pathology yezinso;
i-neurosis;
isifo sokuqina kwesifo sikashukela;
i-myelopathy ngokumelene nesifo sikashukela.

I-peripheral diabetesic neuropathy nayo inesigaba esekwe eminyangweni yomonakalo:

izinzwa ezibucayi - ezibucayi ziyabandakanyeka kule nqubo;
ukusebenza kwemoto - ukungasebenzi kahle kwezinzwa zemoto;
i-sensorimotor - ukulimala kwemizwa nezinzwa zemizwa;
ezizimele - i-neuropathy yezitho zangaphakathi.

Ngokusekelwe ezicini zenqubo yomtholampilo, lezi zinhlobo ezilandelayo zesifo sikashukela se-diabetes zihlukaniswa:

uhlobo olungasasebenzi - izinguquko ezembulwe ngesikhathi sokuhlolwa kuphela ezibonisa ukuba khona kwe-pathology, isiguli asinazikhalazo;
Uhlobo lomtholampilo: ifomu eliyingozi, elihambisana nobuhlungu; ifomu elingamahlalakhona ngobuhlungu; ukubonakaliswa komtholampilo ngaphandle kobuhlungu.
izinkinga (isifo sikashukela, ukuwohloka kohlobo lwe-neuropathic).

Indlela yokuthuthukiswa kwe-pathology

Ngokuphikisana nesizinda sikashukela i-mellitus, i-hyperglycemia ejwayelekile (ukwenyuka kweglucose yegazi) kuyabonakala. Lokhu kungahle kube ngenxa yokwehluleka kwama-pancreas ukuhlanganisa i-insulin eyanele (uhlobo lwe-1 isifo) noma ivele ngenxa yokuncipha kokuzwela kwamangqamuzana nezicubu ukungena kwe-insulin ngesikhathi sokukhiqizwa kwayo okuvamile (uhlobo 2 lwesifo).

I-Hyperglycemia iyimbangela eyinhloko yokwanda kwezinkinga zesifo sikashukela.

Amazinga kashukela aphezulu aphazamisa zonke izinqubo ze-metabolic. Kwi-vasotine endothelium, i-sorbitol, amaprotheni e-glycosylated, aqongelela. Lokhu kudala ushintsho ekusebenzeni okujwayelekile nokwakheka kwamangqamuzana ezinzwa (ama-neurons). Indlala ye-oksijini kanye nezindawo ezinokunganele kwegazi zinezela ekuthuthukiseni ukucindezelwa kwe-oxidative. Umphumela uwukuntuleka kwezimpawu ze-neurotrophic kanye nokukhula kwe-neuropathy yesifo sikashukela.

Izithombe zemitholampilo

Izimpawu ze-neuropathy yesifo sikashukela zincike kwifomu, ubukhulu, isilinganiso sokuthuthuka nomlando wokwelashwa osetshenzisiwe.

Ukuphazamiseka kweSensomotor

Leli fomu livame kakhulu kubantu abaphethwe “isifo esimnandi”. Ukuboniswa kwenkambo engapheli:

izinhlungu zemvelo ehlukile;
i-paresthesia;
ukukhubazeka
ukunciphisa kufinyelele ekuntuleni okuphelele kokuzwela ekushintsheni kwezinga lokushisa nokudlidliza;
ubuthakathaka bemisipha;
imiphetho yemikhawulo ephansi;
ukuntuleka kokuqonda okujwayelekile ngokucasuka;
ukubonakala kokuqagela kwe-pathological.

Izimpawu zenzeka hhayi ngokusebenza ngokomzimba noma ngemoto kuphela, kepha futhi nasebusuku, ukuphumula. Izinkinga ezihlala zivela enkambweni engapheli yokulimala kwe-sensorimotor neuronal inyawo lukaCharcot. Lesi ngesinye sezimpawu zonyawo lwesifo sikashukela, esihambisana nokushintshwa kwezakhi zethambo-tendon ngokufakwa kwe-fractures and dislocations.

Ukuphazamiseka kwemizwa okunamandla

I-Sensory diabetesic neuropathy ihambisana nezikhalazo ezilandelayo zeziguli:

ukukhuphuka kokuzwela kokungabonakali kokushintsha kwezinga lokushisa, ukuthinta, ukudlidliza;
ukuphazamiseka kobuzwela ngesimo sokuqonda okunganele;
ukubonakala kobuhlungu ekuphenduleni umthelela walezo zici ukuthi ngaphansi kwezimo ezijwayelekile azibangeli buhlungu;
ikhaliphe ingahlala ijwayelekile;
isifo sobuhlungu obukhulu.

Ubuhlungu bungavutha, ukudonsa, ukudubula, okokuqala kuvela ezinyaweni nasemilenzeni, lapho imikhumbi ihlangana khona kakhulu.

Ukwehla, ukudinwa, ukuqaqamba - ukubonakaliswa kwethambo lomzimba

Ngefomu le-asopmetic le-neuropathic, ukuqina kwesisu kubonakala endaweni ye-pelvic, ukuhlangana kwe-hip, kwehlela phansi emlenzeni kusuka ohlangothini lapho kulimale khona ama-neurons. Lesi simo sihambisana nokuncipha kwenani lamafutha, ukwehla kwesisindo semisipha yomlenze "obuhlungu".

Ungafunda kabanzi nge-neuropathy yesifo sikashukela semikhawulo ephansi kusuka kule ndatshana.

Ifomu leStrone

Izilonda zamaseli ezinzwa zezitho zangaphakathi zihambisana nezinga lokufa eliphakeme phakathi kweziguli ezinesifo sikashukela i-mellitus. Izinhlobo ezivame kakhulu nezinobuntu be-pathology zichazwe etafuleni.

Ama-Organs nezinhlelo	Izimpawu	Umtholampilo
Inhliziyo, imikhumbi	I-Cardiac denervation syndrome, i-orthostatic hypotension, ukuzwela okuphazamisekile emsebenzini womzimba, i-edema ye-pulmonary edema	Ukuphazamiseka kwesigqi senhliziyo (i-tachycardia, i-arrhythmia), umfutho wegazi ophakeme, ushintsho lwe-ECG, ukukhwehlela "kwenhliziyo", ukushesha komoya, ukufa ngokuzumayo
Amapheshana wesisu	I-Gastroparesis, i-atony yamathumbu, i-dysbiosis, i-pancreatitis, isifo se-Reflux, izinhlungu	Isicanucanu, ukuhlanza, ubuhlungu besisu, ukuqhakaza, ukushisa kwenhliziyo, ukwehla okukhulu kwesisindo somzimba, uhudo
Isistimu ye-genitourinary	I-Atony, i-Reflux, ukutheleleka, ukungasebenzi kahle kwe-erectile	Ubuhlungu ngaphezulu kwe-pubis, ukwephulwa kwenqubo yokuchama, ukuphuma kwe-pathological kusuka kwi-urethra kanye ne-vagina, ubuhlungu emhlane ongezansi, i-hyperthermia
Uhlelo lokuxolisa	Anhidrosis, hypohidrosis, hyperhidrosis	Ukungabi khona, ukwehla noma ukukhulisa umjuluko ngesikhathi sokudla kanye nokuzivocavoca umzimba
Uhlelo lokubumbana kwabafundi	Ukulimazeka kokubonakalayo	Ukunciphiswa kububanzi babafundi, ukusabela okuthe chu ezishintsheni ekufikeni kwamagagasi okukhanya, i-pathology of ukubona kokuhlwa
Izindlala ze-Adrenal	Ukuntuleka kokwethulwa kwemitholampilo

Ukuxilongwa kwe-Neurological

Ukwelashwa kunqunywa kuphela ngemuva kokwehlukanisa nokuxilonga. Ukuhlolwa nokuqoqwa kwezikhalazo zesiguli kuhambisana nokuhlolwa kwengqondo. Uchwepheshe ucacisa isimo sobuhlungu, ukuthambisa, ukushisa, ukubanda, ukuzwela kokudlidliza. Iqoqo le-neurologist lokuxilongwa lifaka:

i-malleus enenalithi eyakhelwe ngaphakathi - ukuhlola isimo sokuzwela kobuhlungu;
IV - ihlaziya imizwa yokuthula kwesiguli;
i-monofilament - incazelo yokuzwela nge-tactile;
ukugeleza kwemfoloko - bonisa izinga lokuzwela kokudlidliza;
i-malleus ene-brashi - imizwa ye-tactile.

Izinhlobo zezinkinga zokuxakeka zingadinga i-biopsy yezinzwa zamathole nesikhumba somzimba ngokuhlolwa okwengeziwe komlando.

Ukuhlolwa kwe-Reflex kungenye yezigaba zokuxilongwa kwe-neurological

Isazi sezinzwa sinquma izifundo ze-electrophysiological. I-Electromyography ikhombisa umsebenzi we-bioelectric wokusebenza kwemisipha nokudluliselwa kwe-neuromuscular of impulses. Imininingwane etholakele yenza sikwazi ukubona isimo sezinzwa esisebenzayo, esibhekele ukwenziwa kwengxenye ethile yomzimba, ukwembula umonakalo ezingxenyeni eziyingxenye zesistimu yezinzwa.

I-Electroneurography iyinhlangano ekhombisa ukuthi ijubane lokudlula kwethambo lezinzwa ngokuhambisana nemicu yethrafikhi evela endaweni lapho ikhipha khona uhlelo lwangaphakathi lwezinzwa iye kuma-nerve receptors akhiwe kwimisipha nesikhumba.

Amandla afakiwe - lolu cwaningo olukhombisa umsebenzi we-bioelectric wamaseli wezinzwa nezicubu besebenzisa izishukumisi ezahlukahlukene (ezibukwayo, ezinamazwi, ezithinta).

Ezinye izindlela zokucwaninga

Ngaphezu kwe-endocrinologist, udokotela wezifo zesisu, uchwepheshe wezifo zenhliziyo, udokotela wezifo zamehlo ubamba iqhaza ekuhlolweni kwesiguli. Kwabelwa izifo zokuxilonga elabhorethri:

ukuzimisela kashukela wegazi;
i-biochemistry yegazi;
i-glycosylated hemoglobin;
ukunqunywa kwenani le-insulin;
I-peptide.

Kubalulekile! Ochwepheshe bahlola ukugeleza kwemithambo emikhulu yengozi, balinganise umfutho wegazi, bahlole imilenze yezilonda, ukungasebenzi kahle, nezinye izibonakaliso zezilonda ezihlotshayo.

Udokotela wezinhliziyo unikeza ukuhlolwa kweValsalva, iHolter ECG, i-echocardiography, ukuhlolwa kwamathambo. Udokotela osesiswini uhlola isimo sepheshana esiswini nge-ultrasound, endoscopy, x-ray yesisu, ukuhlolwa kwelabhoratri ukuthola ukuthi ukhona yini uHelicobacter pylori.

I-ECG - enye yezindlela zokutadisha ukulimala kokufakwa ngaphakathi kwezinzwa zohlobo lokuzimela

Ukuhlolwa kwesimo esisebenzayo sohlelo lwe-urinary kususelwa ekuhlaziyeni komchamo, i-ultrasound, i-cystoscopy, i-urravenous urography, i-electromyography yamathuluzi wemisipha yesinye.

Ukwelashwa

I-neuropathy yesifo sikashukela, ukwelashwa okufanele kuqale ngokulungiswa kweglucose yegazi, kudinga ukwelashwa ngezigaba. Ukuze wenze lokhu, sebenzisa imijovo ye-insulin (yohlobo 1 sikashukela) noma izidakamizwa ezinciphisa ushukela (isifo sohlobo 2). Isidingo kukulawula ushukela ku-dynamics ngezindlela zaselebhu kanye nendlela yokuzithiba.

Ukwelashwa kwezinkinga kuhambisana nokulungiswa kokudla, ukusebenza komzimba nokuphumula, ukunciphisa isisindo somzimba we-pathological, ukudala izimo zokugcina ingcindezi ezingeni elijwayelekile.

Gymnastics yesifo sikashukela

Izidakamizwa ezokwehlisa ushukela ezisetshenziselwa ukulungisa amazinga kashukela:

I-Metformin
Maninil
Victoza
UJanuvius
Isifo sikashukela
I-Novonorm.

Ukulungiswa kwe-Thioctic acid

Imithi yenza ngokwejwayelekile i-lipid metabolism, ilawule i-cholesterol. Kusho ukuthuthukisa ukusebenza kwesibindi, ukunciphisa imiphumela enobuthi. Abamele iqembu:

I-Berlition,
I-Tiogamm
I-Liopthioxone
I-Lipoic acid.

Abacindezeli

Le mishanguzo isetshenziselwa ukumisa i-pain syndrome eyaqhamuka ngemuva kwesizinda se-neuropathy. Faka isicelo se-amitriptyline, imipramine, i-nortriptyline. Izindlela zokwelapha ezimbili zokuqala zinobuthi obuncane futhi zibangela imiphumela emibi emincane. Ukuqedwa kobuhlungu kuvela kancane ngaphambi kokuba umphumela we-antidepressant ube khona.

I-Amitriptyline iyi-antidepressant ephumelelayo enobuthi obuncane emzimbeni.

Abantu asebekhulile nalabo abahlushwa i-encephalopathy, i-neurosis, izimo ezihlolayo kufanele baphuze izidakamizwa ngaphansi kokuqashwa okuphezulu kongcweti noma izihlobo. Umuthi onganele ungabulala.

Ama-analgesics nama-anesthetics

Ibuye isetshenziselwe ukudambisa izinhlungu. Izicelo ezenziwe nge-anesthetics yendawo (Lidocaine, Novocaine) ziyasetshenziswa. Uma kuqhathaniswa nama-antidepressants, ukusebenza kwawo kwe-analgesic kuncane, kepha kusetshenziselwa ukuzilolonga. Ukwenza ngcono isimo sesiguli kwenzeka ngemuva kwemizuzu eyi-10-15.

Ama-analgesics ngesimo se-Analginum, Paracetamol awaphumeleli, noma kunjalo, amacala okuqokwa kwawo angenasisekelo ayaziwa.

Amavithamini we-B-Series

Amalungiselelo e-Vitamin asetshenziselwa ukwenza uhlelo lwezinzwa lube ngokwejwayelekile IPyridoxine iyathandwa (B₆), thiamine (B₁) ne-cyanocobalamin (B₁₂) Isikimu sokukhethwa kukhethwe uchwepheshe ngamunye.

Ama-anticonvulsants

I-Carbamazepine, i-Finitoin bangabameleli abaphumelelayo baleli qembu, abadinga ukukhethwa ngokucophelela komthamo ngenxa yemiphumela emibi engaba khona. Qala ukuthatha imithamo emincane, kancane kancane ulethe ekwelashweni okudingekayo. Le nqubo ayidingi ngisho nezinsuku ezimbalwa, kodwa amasonto angama-3-4.

Ezinye izindlela zokwelapha

Ukwelashwa kwe-neuropathy yesifo sikashukela kusebenzisa kakhulu izindlela ezingezona izidakamizwa:

isicelo se-laser;
ukubola kwezinzwa ezinkulu;
i-magnetotherapy;
i-acupuncture;
ukuvusa kagesi okushintshayo.

Ukuzimisela ngesikhathi ukuthuthukiswa kwe-pathology kanye nosizo lwabachwepheshe abaqeqeshiwe kuzosiza ekugcineni impilo yesiguli ezingeni eliphakeme futhi igweme izinkinga ezinkulu.

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