I-Diabetesic polyneuropathy kanye nokwelashwa kwayo

I-Diabetesic polyneuropathy (ICD-10 khodi G63.2 * noma i-E10-E14 k. 4) isho ukuba khona kwezimpawu zomonakalo ohlelweni lwezinzwa ezigulini ezinesifo sikashukela i-mellitus, uma ezinye izizathu ze-pathology zingafakwanga. Ukuxilongwa kungenziwa ngisho nalapho kungekho zikhalazo ezivela esigulini, lapho i-lesion inqunywa phakathi nokuhlolwa.

Isifo sikashukela se-polyneuropathy asiqinisekiswa ngesisekelo sophawu olulodwa lomtholampilo. Izincomo zamanje ze-WHO zisikisela ukuthi lesi sifo kufanele siqume ukuba khona kokubonakaliswa okungenani kwesibili kwesibindi ukuze kuqinisekiswe i-pathology yesistimu yezinzwa ngokumelene nesizinda "sesifo esimnandi".

Uma inqubo ivela emithanjeni yezinzwa eyodwa, khona-ke sikhuluma nge-neuropathy. Endabeni yezilonda eziningi, kuba nokukhula kwe-polyneuropathy. Iziguli ezin uhlobo lwe-1 yesifo sikashukela "zithola" ubunzima ku-15-55% wamacala, uhlobo 2 - 17-45%.

Ukuhlukaniswa

Ukwahlukaniswa kwe-polyneuropathy kuyinkimbinkimbi impela, ngoba kuhlanganisa inani lama-syndromes. Abanye ababhali bakhetha ukuhlukanisa i-lesion ngokuya ngokuthi yiziphi izingxenye zesistimu yezinzwa ezibandakanyekayo kule nqubo: amafomu we-peripheral (nerve spinal nerves) namafemu azimele (isigaba sesitshalo).

Okunye ukwahlukanisa okusetshenziswa kakhulu:

• I-polyneuropathy evuselelayo eguqukayo (yesikhashana, evela ngenxa yokugxuma okubukhali kushukela wegazi).
• I-Symmetric solid polyneuropathy: ukulimala kwemicu emibi ye-nerve (distal somatic); ukulimala kwemicu emincane; ozimele wohlobo lesion.
• I-Focal / multifocal polyneuropathy: uhlobo lwe-cranial; uhlobo lokucindezela; uhlobo lwe-proximal; uhlobo lwe-thoracoabdominal; i-limbopathy yomzimba.

Izizathu

Izinga likashukela wegazi eliphakeme lesimo sabanesifo sikashukela liyakwazi ukuthinta isimo semikhumbi emincane, okwenza ukuthuthukiswa kwe-microangiopathy nemithambo emikhulu, kubangele i-macroangiopathy. Izinguquko ezenzeka emikhunjini emikhulu ziyefana nendlela yokwakhiwa kwe-atherosulinosis.

I-Angiopathy yisixhumanisi esikhulu ekwakhiweni kokulimala kwezinzwa kushukela

Ngokuphathelene nama-arterioles nama-capillaries, konke kwenzeka ngendlela ehlukile lapha. I-Hyperglycemia isebenzisa isenzo se-enzyme yamaprotheni kinase-C, esiza ukwandisa ithoni yezindonga zemithambo yegazi, ikhulule ulwelwesi lwayo, futhi ithuthukise ukuqina kwegazi. Odongeni lwangaphakathi lwe-arterioles kanye nama-capillaries, i-glycogen, i-mucoproteins nezinye izinto zesimo se-carbohydrate ziqala ukufakwa.

Imiphumela enobuthi ye-glucose ingahluka. Ijoyina amaprotheni, awenze abe ngama-glycated, obangela ukulimala kwezitho zemisipha nokuphazamiseka kwe-metabolic, ukuthutha nezinye izinqubo ezibalulekile emzimbeni. Iprotheni edume kakhulu ye-glycated yi-HbA1c hemoglobin. Lapho iphakama indices zayo, kutholakala umoya-mpilo owutholwa amaseli omzimba, kuba nezicubu ze-tishu ezikhulayo.

Isifo sikashukela se-polyneuropathy senzeka ngenxa yomonakalo we-endoneural (etholakala kungqimba yezicubu ezixhumekile phakathi kwemicu yezinzwa emgodini wezinzwa). Lokhu kufakazelwa ubudlelwano obufakazelwe phakathi kokuqina kwama-membrane we-vascular kanye nobuningi bemicu emthanjeni. Le nqubo ithwebula ama-neurons nezinqubo zawo, ezifa ngenxa yokuphazamiseka kwe-metabolic emzimbeni we-diabetes.

Izici ezivusa inkanuko

Izici ezilandelayo zinomthelela ekuthuthukisweni kwe-polyneuropathy ku-mellitus yesifo sikashukela:

• ukwephulwa kokuziqapha ushukela wegazi;
• isikhathi eside sesifo esingaphansi;
• umfutho wegazi ophakeme;
• ukukhula okuphezulu;
• ubudala
• ukuba khona kwemikhuba emibi (ukubhema, ukuphuza utshwala);
• dyslipidemia;
• isakhi sofuzo.

Izici zenqubo ye-pathological enezilonda eziningi zemicu yezinzwa

Izigaba

Ngokuya kobukhulu bokubonakaliswa, lezi zigaba ezilandelayo zomonakalo ziyahlukaniswa, ngesisekelo lapho ukwelashwa okudingekayo kwe-polyneuropathy kunqunywa:

Isifo Angiopathies yesifo sikashukela

• 0 - akukho datha ebonakalayo;
• 1 - inkambo ye-asymptomatic ye-complication;
• I-1a - azikho izikhalazo ezivela esigulini, kepha ushintsho lwe-pathological selungavele lunqunywe kusetshenziswa izivivinyo zokuxilonga;
• I-1b - azikho izikhalazo, izinguquko zinganqunywa hhayi ngezivivinyo ezithile, kepha futhi nangokuhlolwa kwe-neurological;
• 2 - isigaba sokubonakaliswa kwemitholampilo;
• I-2a - izimpawu zesilonda zibonakaliswa ndawonye nokuhlolwa okuhle kokuxilongwa;
• I-2b - isigaba 2a + ubuthakathaka be-flexors engemuva yezinyawo;
• I-3 - i-polyneuropathy eyinkimbinkimbi ngokukhubazeka.

Izimpawu

Izimpawu ze-polyneuropathy zesifo sikashukela zincike ngqo esiteji nasefomini lokukhula kwalo, kanye nokwelashwa okusetshenziswayo.

Ukuphazamiseka Okuzwakalayo

Ukubonakaliswa kwesici se-sensory pathology. Zinganqunywa kuphela ngokuhlolwa kwezifo zokuxilonga (ifomu elingasekelwa) noma zibe izikhalazo zesiguli (ifomu lomtholampilo). Iziguli zinobuhlungu. Ubuhlungu bungashiswa, ukubhaka, ukudubula, ukugwaza. Ukuvela kwayo kungadalwa ngisho nayilezi zinto ezingadali ukujabha kubantu abaphilile.

Isiguli singakhalaza ngokuxineka, umuzwa kungathi ngama-goosebumps, umuzwa ovuthayo, ukuzwela okwengeziwe kwemiphumela yokubanda, ukushisa, nokudlidliza. Izikhombisi zemizimba ziphikelela, kanti ezokugula kungenzeka zingabikho.

Njengomthetho, ukuphazamiseka okubucayi kuyizimpawu. Ngokuvela kwe-asymmetric pathology, isifo sezinhlungu siqala esifundeni se-pelvic futhi sehle okhalweni. Lokhu kuhambisana nokuncipha kwenani lesilungu esithintekile, ukwephulwa kokulingana kwalo maqondana nalo lonke umzimba.

Ukuphazamiseka kokuzwa kobuhlungu kungenye yezimpawu ezikhanyayo ze-polyneuropathy

I-pathology ehlanganisiwe

Ukuthuthukiswa kwe-sensory-motor polyneuropathy ezimeni eziningi kunenkambo engapheli. Isifo sikashukela sikhononda ngalokhu kuboniswa okulandelayo:

• umuzwa wokuqina;
• Ubuhlungu besimo esehlukile;
• ukwephula ukuzwela kuze kufike kokungabikho ngokuphelele;
• ubuthakathaka bemisipha;
• ukuntuleka kokuzivocavoca komzimba kanye nokuvela kokukhalipha kwengqondo;
• ukugoba ebusuku emikhawulweni ephansi nangaphezulu;
• ukuntuleka kokuqina lapho uhamba.

Ukuphindaphindeka kwengqondo kwezinqubo ezingamahlalakhona ezihambisana nomonakalo womshini kuyinto yonyawo lwesifo sikashukela - isimo sendawo lapho lesion ithwebula zonke izinhlaka, kufaka phakathi i-cartilage ne-bone element. Umphumela - ukuguqulwa nokuphazamiseka kwe-gait.

Ukwehlula okungaxhunyiwe ku-inthanethi

Amangqamuzana ezinzwa akhiwe ngaphakathi ezithweni zangaphakathi nawo angathinteka. Izimpawu zincike ekutheni yiliphi ithimba noma uhlelo oluthintekayo. I-Pathology yenhliziyo nemithambo yegazi ibonakaliswa yi-orthostatic hypertension, i-pulmonary edema, uzwela olungasebenzi kahle ngokomzimba. Iziguli zikhononda ngokuphazamiseka kwesigqi senhliziyo, ukukhuphuka kwengcindezi yegazi, ukushesha komoya, ukukhwehlela. Ukuntuleka kokwelashwa okufika ngesikhathi kungabulala.

Ukuphazamiseka kwesigqi senhliziyo - uphawu olungaba khona lwe-pathology yohlobo lokuzimela

Ukulimala kwipheshana lesisu kubonakaliswa yi-paresis, ukwehla kwezwi leminyango yalo, ukwephulwa kwe-microflora ejwayelekile, kanye nesifo se-Reflux. Iziguli zinenkinga yokuhlanza, ukushaya kwenhliziyo, isifo sohudo, ukwehla kwesisindo, nobuhlungu.

I-genitourinary polyneuropathy ihambisana ne-atony yesinye, ukubuyela emuva komchamo, ukubuyela ocansini okungasebenzi kahle, izifo zesibili kungenzeka. Ubuhlungu bubonakala emhlane ongemuva nangaphezulu kwe-pubis, ukuchama kuyavama, kuhambisane nobuhlungu nokushiswa, kuphakama izinga lokushisa lomzimba, ukuphuma komzimba kusuka esithweni sangasese sowesifazane futhi i-urethra ivele.

Ezinye izilonda:

• ukwephulwa kwezinqubo zokujuluka (ukukhuphuka noma ukuncishiswa kakhulu kuze kube ukungabikho okuphelele kwezithukuthuku);
• i-pathology ye-analyzer ebonakalayo (umfundi ancipha ngamasentimitha, ama-acuity ezibonakalayo ancipha kakhulu, ikakhulukazi kusihlwa);
• i-polyneuropathy ye-adrenal gland ayinazimpawu ezibonakalayo.

Ukuxilonga

Ngaphambi kokunquma ukwelashwa kwe-polyneuropathy yesifo sikashukela emaphethelweni aphansi, isiguli asihloliwa i-neurology kuphela, kodwa futhi nesazi se-endocrinologist ukucacisa izinga lesinxephezelo ngalesi sifo esiyimbangela.

Uchwepheshe ucacisa ngezinga lezinhlobo ezahlukahlukene zokuzwela (izinga lokushisa, vibration, tactile, pain). Kulokhu, uvolo wekotini, ama-monofilaments, amabele ngebhulashi nenaliti ekugcineni, kusetshenziswa imfoloko. Ezimweni ezikhethekile, impahla ithathwa yi-biopsy ukuze kuqhubeke umlando. Ukuhlolwa kwe-Neurological kuhlanganisa nezindlela ezilandelayo:

• Amandla afakiwe - Imicu yezinzwa yenziwa ukukhuthaza, izimpendulo ezirekhodwe yinsiza ekhethekile.
• I-Electroneurography yindlela yokuxilonga lapho kunqunywa khona ijubane lokusakazwa kwezifiso zemithambo yeminyango evela eminyangweni yohlelo lwezinzwa oluyinhloko ukuya kuma-receptors.
• I-Electromyography ukuhlolwa okucacisa isimo sokudluliselwa kwezifiso kusuka kumaseli wezinzwa kuya kwizixhobo zemisipha.

Ukutholwa Kokudluliselwa Kwegulasi - Indlela Ebalulekile Yokuxilonga

Izindlela zokuxilongwa kwelabhorethri ziyimpoqo: ukucacisa izinga le-glycemia, ukuhlaziywa kwe-biochemical, izinkomba ze-C-peptide kanye ne-glycated hemoglobin. Uma kunokusolwa kwesilonda esizimele, isiguli sinqunywe i-ECG, i-echocardiography, i-ultrasound yenhliziyo, i-dopplerography yemikhumbi, i-ultrasound yamapheshana emathunjini, i-endoscopy, i-x-ray.

Isimo sohlelo lomchamo sinqunywa ngokuhlaziywa umchamo nsuku zonke, ukuhlaziya ngokuya nge-Zimnitsky kanye neNechiporenko, kanye nangesikhathi se-ultrasound, i-cystography, i-cystoscopy ne-electromyography.

Izici zokwelapha

Ukwelashwa kwe-polyneuropathy yesifo sikashukela, imfuneko yokulungisa ushukela wegazi. Lokhu kwenziwa yi-endocrinologist, ebukeza kabusha irejimeni yokwelashwa kwe-insulin nokusetshenziswa kwezidakamizwa ezinciphisa ushukela. Uma kunesidingo, imali ithathelwa indawo yilabo abaphumelela ngokwengeziwe noma kunikezwa eminye imithi.

Ukulungiswa kokudla kwenziwa, imodi edingekayo yokusebenza komzimba iyakhethwa. Udokotela unikeza isiyalo sendlela yokugcina umfutho wegazi kanye nesisindo somzimba ngaphakathi kwemingcele eyamukelekayo.

Amaqembu alandelayo emithi anqunyelwe:

1. Ama-derivatives we-alpha lipoic acid izidakamizwa zokuzikhethela. Bayakwazi ukususa i-cholesterol eyeqile, bayeke imiphumela enobuthi yezinto zangaphandle esibindini nasemithanjeni yegazi. Abamele - I-Berlition, i-Lipoic acid, iT Thiogamm. Inkambo yokwelashwa okungenani izinyanga ezimbili.
2. Amavithamini we-B - athuthukisa ukusebenza kwesistimu yezinzwa ephakathi nethintekayo, aba nomthelela ekuguquguqukeni kokudluliselwa kwemizwa ye-neuromuscular impulses (Pyridoxine, Cyanocobalamin, Thiamine).
3. Ama-antidepressants - asetshenziselwa ukunciphisa ukubonakaliswa kobuhlungu (amitriptyline, nortriptyline). Zinqunyelwe kumthamo omncane, kancane kancane zifinyelela umphumela wokwelapha odingekayo.
4. I-Aldose reductase inhibitors - izici ezinhle zokwelapha ngaleli qembu zaboniswa, kepha azizange zithethelele wonke amathemba abekwe phezu kwawo. Kusetshenziswe ngokokubona kukadokotela ohambelayo (Olrestatin, Izodibut, Tolrestat).
5. Ama-anesthetics endawo - asetshenziselwa ukumisa ubuhlungu ngendlela yezicelo. Umphumela uvela ngemuva kwemizuzu engu-10-15.
6. Ama-Anticonvulsants - Carbamazepine, Finitoin. Leli qembu lidinga ukukhetha ngokucophelela umthamo. Qala ngemithamo emincane, ukhule ngaphezu kwamasonto ambalwa.

Okususelwa ku-alpha-lipoic (thioctic) acid - izidakamizwa ukwenza isimo sejwayelekile semithambo yegazi futhi sisuse ukungahambi kahle kokulimala kwesifo sikashukela ohlelweni lwezinzwa

Amakhambi esintu

Kungenzeka ukwelapha isifo sikashukela i-polyneuropathy hhayi kuphela ngemithi yendabuko, kodwa futhi nangezindlela ezahlukahlukene kanye ne-infusions elungiselelwe ekhaya.

Inombolo yeresiphi

Hlakazisa ukhipha izingqinamba ezilungiselelwe ngaphambili. Isiguli kufanele sinqamule kubo okungenani imizuzu engama-7-10 ngosuku.

Inombolo yeresiphi 2

Izimpande ezichotshoziwe ze-burdock kanye namaqabunga aluhlaza okwesibhakabhaka zixubile. 3 tbsp ingxube ephumayo ithululelwa ilitha lamanzi abilayo futhi kugcizelelwa okungenani amahora angama-8. Ngemuva kwalokho faka umlilo bese ukhathele amanye amahora amathathu. Ngemuva kokuthi umhluzi usupholile, kufanele uhlungwe. Phuza inani lamanzi atholakala phakathi nosuku.

Inombolo yeresiphi 3

Ingilazi yama-oats ithululelwa nge-1 litre lamanzi abilayo. Faka amahora ayi-10, khona-ke kuzodingeka ubilise le ngxube okungenani imizuzu engama-40. Susa esitofini bese uthumela endaweni efudumele. Ngemuva kokuhlunga futhi uthathe engilazini isigamu sehora ngaphambi kokudla ngakunye.

Kumele kukhunjulwe ukuthi akunakwenzeka ukususa i-polyneuropathy ngemithi yesintu ngaphandle kwemithi yendabuko nokulawula ushukela wegazi. Kepha umphumela ohlangene walezi zinto ungaholela emphumeleni omuhle we-pathology.