Izimbangela, izinhlobo nezindlela zokwelapha isifo sikashukela

Isifo sikashukela sikashukela sibangela ukushoda noma ukungasebenzi kahle emzimbeni we-hormone obizwa ngokuthi yi-antidiuretic (ADH), noma i-vasopressin. Imisebenzi ye-vasopressin ingukulawulwa kwenani lamanzi emzimbeni, ukususwa kwe-sodium egazini kanye nokuncipha kwemithambo yegazi.

Ukwephulwa kokuqamba noma ukusebenza kwehormoni kuholela ekuphazamisekeni komzimba wonke. Isifo sikashukela insipidus (ND) sidinga ukunakekelwa okuphuthumayo kwezokwelapha ukunquma ukwelashwa.

Isibalo esikhulu sezifo sitholakala ezigulini ezineminyaka engama-20-30 ubudala, kodwa futhi senzeka ezinganeni kusukela zisencane. Ukudlanga kwalesi sifo kuncane - abathathu kwabangu-100,000, kepha muva nje sekukhona ukuthambekela kokukhula ngenxa yokwanda kwenani lemisebenzi ebuchosheni. Yini ubungozi balolu hlobo lwesifo sikashukela?

Izinhlobo ze-pathology

Isifo sikashukela insipidus (ND) sihlukaniswa izinhlobo eziningi ezibonisa imbangela yesifo nendawo yenkinga.

Ukushoda kwama-Hormone emzimbeni kungaba ngokuphelele noma isihlobo.

1. Uma i-hypothalamus kukhiqiza inani elanele le-ADH, sikhuluma ngenani eliphelele lokushoda. Uhlobo lwe-hypothalamic-pituitary noma i-neurogenic yalesi sifo iba emzimbeni.
2. Uhlobo lwesibili lwe-ND luhlotshaniswa nokungakwazi kwezinso ukubona i-ADH. I-hormone ekhiqizwa ngamanani anele ayikwazi ukufeza injongo yayo, futhi umchamo ongonakalisiwe ushiya umzimba. I-pathology yalolu hlobo ibizwa nge-renal noma nephrogenic.

Lolu hlobo lokuhlukaniswa luveza indawo yenkinga - izinso noma ubuchopho.

Ifomu le-neurogenic lihlukaniswa ngokwendlela elivela ngayo ezinhlotsheni ezimbili:

1. Izimpawu - ezibangelwa yizinkinga zobuchopho ezitholakele - izinqubo zokuvuvukala, ukungenelela kokuhlinzwa okuhlulekile, ama-neoplasms.
2. I-Idiopathic - imbangela ingukuqagela kofuzo kokuhlanganiswa okungajwayelekile kwe-vasopressin.

Uhlobo lwe-Nephrogenic lwe-patology luhlobo lwemvelo noma lubangelwa yizinkinga zezinso. Ukuvela kwalolu hlobo lwe-ND kungaholela ekusebenziseni isikhathi eside kwezidakamizwa nezifo ezingamahlalakhona zezitho zangasese.

Abesifazane abakhulelwe bangaba nohlobo lwesifo se-gestagenic, kwesinye isikhathi esidlula ngemuva kokubeletha.

Ezinganeni, ngenxa yokungapheleli kohlelo lwe-genitourinary, indlela yokusebenza ye-ND iyisici.

Olunye uhlobo lwesifo yi-psychogenic emvelweni - i-polydipsia eyinhloko, lapho ukoma okungalawulwa kukhula khona ngenxa yokwehla komkhiqizo we-ADH. Kodwa-ke, uma amanzi engangeni emzimbeni, i-pituitary gland normalize ne-vasopressin synthesis iyabuyiselwa.

Ngokwe-ICD 10, ukuhlukaniswa kwalesi sifo kwenzeka emakilasini amabili - uhlobo lwezinso yikhodi N25.1 - lesi sifo sidluliselwa ohlelweni lwezitho zofuzo. Uhlobo lwe-neurogenic lwe-ND lubethelwe esigabeni sezifo ze-endocrine, ikhodi ye-ICD 10 - E23.2.

Izizathu kanye nendlela yokuthuthuka

Ngokwe-ICD 10, izinhlobo ezimbili ze-ND zihlukaniswa ezahlukweni ezihlukile.

I-ADH ikhiqizwa yi-hypothalamus futhi isebenza ukuhlelela ukufakwa okubucayi ku-nephrons yezinso.

Kwephulwa kabusha kwe-reabsorption, umchamo ongagundwanga ukhishwa emzimbeni ngobuningi, ukoma kuvela ngenxa yokulahleka okukhulu komswakama.

I-pathophysiology ihlukanisa izindlela ezimbili zokwenziwa kwesifo sikashukela ngokuya ngendawo yendawo yenkinga emzimbeni:

1. Ifomu le-neurogenic libonakala ngokukhiqizwa okunganele kwe-ADH.
2. I-Renal ND yenzeka ngenxa yokungakwazi kwezinsana zezinso ukuthola nokusebenzisa i-vasopressin etholakele ukuhlunga uketshezi.

I-pathogenesis yezinhlobo ezimbili eziphambili ze-ND ihlukile, noma kunjalo, izimbangela zesehlakalo ziyefana kakhulu. Ukuthuthukiswa kwe-pathology kuholela ekuqageleni kofuzo, kanye nezifo nokulimala ekhanda noma kwizitho zomchamo.

Isifo sikashukela seNephrogenic singadala:

• isifo sezinso;
• ubuthi ngezidakamizwa nezinto ezinobuthi;
• i-pathology ye-tubules yezinso.

Izimbangela zefomu le-neurogenic:

• ukuhlinzwa kobuchopho;
• i-neoplasms enobungozi kanye nama-metastases;
• izifo ezithathelwanayo, zokuvuvukala kanye nemithambo yengqondo.

Izimpawu zesifo

Izinga lokubonakaliswa kwalesi sifo, okungukuthi ubukhulu bezimpawu, kuya ngezici ezimbili:

1. Malingakanani ama-vasopressin akhona emzimbeni, noma awekho nhlobo.
2. Kungakanani ama-nephrons ezinso akwazi ukubona ama-hormone.

Izimpawu zokuqala nezisobala ze-ND ukoma okuhlungu (i-polydipsia) kanye nesifiso sokuchama njalo (i-polyuria).

IPolydipsia iphoqa umuntu ukuthi aphuze amalitha angaphezu kwamathathu amanzi ngosuku. Umthamo womchamo usukela kumalitha amahlanu kuya kwayi-15 ngosuku. Urination nokoma kubamba nobusuku.

Lezi zinto kancane kancane ziba imbangela yolunye uguquko emzimbeni, eziba yizimpawu ezengeziwe zesifo:

• ukusetshenziswa ngokweqile kwamanzi welula isisu, ngokuhamba kwesikhathi, kuyawa;
• kukhona ukunwetshwa kwe-bladder;
• ukujuluka kuyancipha, kwesinye isikhathi okuholela ekwandeni kokushisa komzimba;
• ulwelwesi olomile nolusu, izinwele ziba brittle;
• ukonakala kwendlela yokugaya ukudla, ukuphazamiseka kwesitulo - ukuqunjelwa, ngenxa yalokho, ukuthuthukiswa kwezinqubo zokuvuvukala kulezi zitho zomzimba;
• ukuphazamiseka kwengqondo kuvela ekukhathazekeni okungapheli, kukhula i-neuroses, ukulahleka kwesifiso empilweni, ikhanda, ukukhubazeka kwememori;
• ukungaboni kahle
• ukulahlekelwa uketshezi kuholela ekunciphiseni komfutho wegazi kanye nokwanda kwesilinganiso senhliziyo.

Lezi zimpawu kwezinye izimo zengezwa yi-envesis noma isicanucanu nokuhlanza ngaphandle kwesizathu.

Isici esibonakalayo sokuphazamiseka kwama-hormone ukungasebenzi ngocansi.

With sikashukela insipidus waphawula:

• emadodeni, ukwehla okuqhubekayo kwesifiso sobulili nokungasebenzi kwe-erectile, okubangelwa ukuqina nokulimazeka ezithweni zezitho zofuzo;
• kwabesifazane, ukuphazamiseka kokuya esikhathini okungaholela ekuphuthweni kwesisu ngesikhathi sokukhulelwa noma sokuzala.

Ngenkathi yokwelashwa, iziguli zihlukaniswe ngamaqembu amathathu ngokuya ngesinxephezelo sokuthola isinxephezelo:

• ukoma kuyayeka ukuhlukumeza isiguli, ukuchama kuyinto ejwayelekile - lokhu kuyinxephezelo;
• ngokuncipha - isifiso esengeziwe sokuphuza nokuchama senzeka ngezikhathi ezithile;
• ukubola kubonakaliswa iqiniso lokuthi ukwelashwa akusizi ukunqoba ukoma, isiguli sihlupheka njengakuqala.

Ezinganeni, lesi sifo siholela ekulahlekelweni kwesifiso sokudla, ukuthola isisindo esinganele, ukukhula okuntekenteke nokukhula. Ukudla kuvame ukudala ukugabha, izingane ziqunjelwe, ukulala umbhede. Abazali kudingeka baqaphe ngokucophelela isimo sezingane.

Izimpawu ze-ND ezinsaneni:

• ukunciphisa isisindo esikhundleni sokuthola isisindo;
• ekhala ngaphandle kwezinyembezi;
• ukuchama kaningi, izingxenye zomchamo zikhulu kakhulu;
• ukuphalaza kaninginingi kanye ne-palpitations.

Izindlela zokuxilongwa

Izimpawu zokuqala ze-ND zisobala - ukoma ngokweqile nokuchama kaningi ngisho nasebusuku.

Ukuxilongwa okugcwele kwalesi sifo kufaka phakathi:

• Ukuhlolwa kweZimnitsky;
• ukuzimisela kwevolumu yomchamo nsuku zonke;
• ukuhlolwa kwe-osmolarity yegazi nomchamo;
• ukunqunywa kokuxubana komchamo;
• ukuzimisela kwe-glucose, i-sodium, i-urea, i-potassium egazini;
• I-CT, i-radiography, ubuchopho be-echoencephalography;
• i-radiography, i-ultrasound yezinso.

Ithebula lezimpawu ze-ND ngokwemiphumela yokuhlaziya:

Ukukhuphela ngaphandle ushukela, kuhlolwa igazi nge-glucose esiswini esingenalutho.

Uma i-osmolarity yegazi nomchamo kuyinto evamile, yenza isivivinyo ngaphandle kokamanzi.

Izinhlobo zeral neurogenic zesifo sikashukela zihlukaniswa ngokushintsha kwesisindo somzimba, i-serum sodium ne-osmolarity. Lokhu kuyadingeka njengoba ukwelashwa kuzohluka.

Ukwelashwa kwe-ND

Esimweni lapho bekunokwenzeka khona ukuthola imbangela yesifo sikashukela, balwa nesifo esidabukisayo se-ND. Ukwelashwa okuqhubekayo kwenziwa ngokuya ngohlobo lwesifo.

Uhlobo lwe-Neurogenic

Ukwelashwa kwezidakamizwa kwenziwa ngomchamo ongaphezu kwamalitha ama-4 ngosuku. Uma ivolumu incane, iziguli zibekelwa ukudla okubandakanya ukuqapha ukungena koketshezi.

Iziphakamiso zemitholampilo zinquma uMinirin, obambele i-ADH. Umthamo womuthi ukhethwa ngawodwana futhi awuncike eminyakeni yobudala nesisindo. Isilinganiselo ukuthuthukiswa kwesimo, ukuncipha kokuchama nokoma. Thatha umuthi amahlandla ama-3 ngosuku.

Amalungiselelo e-carbamazepine, chlorpropamide athuthukisa ukwakheka kwe-vasopressin. I-Adiurekrin ifakwa ekhaleni ukuze inciphise ulwelwesi lwama-mucous owomile, inciphise ukuphuma komchamo.

Uhlobo lwangempela

Ukwelashwa kohlobo lwesifo se-nephrogenic, kusetshenziswa ama-diuretics - i-Hypothiazide, Indapamide, Triampur. Ukunxenxa ukulahleka kwe-potassium, i-Asparkam noma iPanangin kunqunyelwe.

Kwesinye isikhathi ukwelashwa kuhambisana nezidakamizwa ezilwa nokuvuvukala. Ukukhethwa kwezimali kuncike ekujuleni kwesimo kanye nobungakanani bomonakalo kuma-tubules womchamo.

Ekwelashweni kwalezi zinhlobo zombili zezifo, kusetshenziswa izidakamizwa ezisiza ekudambiseni isimo esijwayelekile, sithuthukise ukulala, sithule uhlelo lwezinzwa.

Ukudla

Ukudla kuhlose ukunciphisa ukoma futhi kwenze ukulahleka kwezakhi zomzimba ezilahlekile ngomchamo. Iziguli ziyelulekwa ukuthi zinciphise ukudla usawoti kanye noshukela.

Ukudla izikhathi ezingama-5-6 ngosuku kuyanconywa.

Imikhiqizo ewusizo:

• izithelo ezomisiwe - zenzele ukulahleka kwe-potassium;
• ukudla kwasolwandle - okuqukethwe kwe-phosphorus ephezulu;
• imifino emisha nezithelo;
• inyama engafakwanga inyama.

Amafutha abalulekile nama-carbohydrate - zombili izinhlobo zebhotela, amazambane, i-pasta.

Lokhu kufana nokudla okungu-7 no-10.

Isimo sezulu

Ngemithi yesimanje, lesi sifo asikwazi ukwelashwa. Imithi ebekiwe isiza ukugcina ibhalansi yamanzi futhi idambise isimo. Uma kwenzeka kunxeshezelwa, isiguli sihlala sikwazi ukusebenza.

Ukuvimbela i-insipidus yesifo sikashukela kususelwa ekwelashweni okufika ngesikhathi kwezifo nokulimala okungashukumisa ukukhula kwesifo sikashukela. Lokhu kusebenza kuzo zombili izinkinga zobuchopho kanye nama-pathologies wezinso.

Izinto zevidiyo ezimayelana nesifo sikashukela i-insipidus, izimbangela zokuvela kwayo nokwelashwa:

Iziguli ezine-ND zidinga ukuqapha ngokuqinile izidakamizwa futhi zilandele uhlobo lokudla nokuphuza. Lokhu kuzosiza ukuthuthukisa ikhwalithi yempilo futhi kugweme izinkinga ezengeziwe kusuka ezinhlelweni zenhliziyo nezinzwa.