Ngezifo eziningi ezilimaza imikhumbi, izitsha ze-retina nazo ziyahlupheka. Izinguquko ezishiwo kakhulu emithanjeni yegazi, ezivame ukuholela ekulimazelweni okubukwayo nokungaboni, zibangela isifo sikashukela. Lolu shintsho emithanjeni nasemithanjeni lubizwa ngokuthi yi-diabetesic retinal angiopathy. Lezi zinguquko zivame ukubonwa emehlweni womabili.
I-retina angiopathy iyodwa ayisona isifo, kodwa ikhuluma kuphela ngoshintsho lokuqala emithanjeni yegazi ethintwa yisifo sikashukela. Lolu shintsho lubizwa ngokuthi yi-microangiopathy; Inkambo ende yesifo sikashukela, ikakhulukazi esesimweni esinamandla, esibolile, iholela ekuthuthukisweni kwama-macroangiopathies, lapho kuphelela khona okomhlaba, inhliziyo, ubuchopho kanye namehlo.
Ukushintshwa kwe-pathological kunekhodi ngokuya nge-ICD-10 - H35.0 (i-back retinal angiopathy).
Indlela yokuthuthukiswa kwe-angiopathy ye-retinal
Ushukela wegazi ophakeme ubangela ukubhujiswa kancane kancane kwezindonga zemithambo yegazi, kuqala ngamabhilidi amancane kakhulu. Esizeni se-endothelium eyonakele, kuvela ama-thrombi, bese kuba nama-cholesterol plaque.
Ngokuhamba kwesikhathi, ukuphuma kwegazi kuma-capillaries amancane kuyaphela ngokuphelele, izindonga zama-venules kanye nama-arterioles ziba zidedele futhi zivunyelwe, okokuqala ngenxa ye-plasma yegazi, bese kulandela izinto ezakhiwe. Ukuphuma kombhede we-vascular, ingxenye ye-liquid yegazi ibangela i-edema ye-retina, "cottony" foci avele. Esimweni sokuphuma kwegazi, kuphuma i-hemorrhages kusuka esikhwameni kusuka kokuncane kuya kokuncane, kuya kokuningana okuthatha ingxenye enkulu yomzimba omkhulu. Lesi sigaba sezinguquko emikhunjini ye-retinal sibizwa ngokuthi i-non-proliferative diabetesic retinopathy (DRP).
Ushintsho olwengeziwe luholela ekuthuthukisweni kwemikhumbi emisha eyakhiwe, ngomonakalo ikakhulukazi endaweni ye-macular, ukubhujiswa komzimba onamandla kanye nokugcwala kwamalensi. Lesi sigaba salesi sifo sibizwa ngokuthi i-proliferative DRP.
Izimpawu nokubonakaliswa kwalesi sifo
Isikhathi eside, i-angiopathy ye-retinal i-asymptomatic. Ngesinye isikhathi, ngokwanda ushukela wegazi noma ngokwenyuka kwengcindezi yegazi, ukuthikamezeka okwesikhashana kokubonakalayo, umbono ophindwe kabili, kuvela “inkungu,” okunyamalala lapho izinto ezenze ukuthi zinyamalale.
Ngokuthuthuka kwe-DRP engahambisani nezimpawu, izimpawu nazo zivame ukungabikho.
Ingxenye kuphela yeziguli enezikhalazo ezilandelayo:
- umbono onsundu, "inkungu" emehlweni;
- izimpukane, amakhwela, ama-opacity ezintantayo emehlweni;
- ukubukeka kunciphisa amasimu wombono.
I-DrP eyandayo ithinta kakhulu imithambo yegazi ne-retina.
Kulesi sigaba senguquko, kuhlale kunezikhalazo:
- ukwehla okukhulu kombono akunakukwazi ukulungiswa;
- opacities iba kakhulu, ehambisana nokubhujiswa komzimba we-vitreous kanye nokuthuthukiswa kwekhathazagu yesifo sikashukela.
Ukuxilongwa kwe-pathology
Ubunzima bokuhlolwa kwesifo sikashukela kufaka phakathi ukuhlolwa kwaminyaka yonke ngudokotela wezifo zamehlo. Ngokushintshwa kwamehlo osekuvele kwaziwe, ukuhlolwa kwenziwa kanye njalo ezinyangeni eziyisithupha.
Ukuxilongwa kwe-angiopathy nolunye ushintsho lwamehlo olubangelwa yisifo sikashukela ezimweni eziningi akubangeli ubunzima. Ukuhlolwa kuqala ngesheke le-visual acuity ne-tonometry.
Ngemuva kwalokho, amaconsi angu-1-2 e-mydriacil, umuthi okhethekile oxolisa umfundi, afakwa kwi-sac conjunctival. Ngemuva kwemizuzu eyi-10- 10, lapho umfundi ekhula, ukuhlolwa kwenziwa kwisibani se-slit kusetshenziswa amalensi we-dioptric kakhulu. Kungenxa ye-biomicroscopy ezimweni ze-mydriasis lapho kutholwa khona izinguquko eziningi ku-retina nemikhumbi yayo, ama-hemorrhages, kanye ne-edema.
Umbhede ongafani nawo ubuye ube nezinguquko - izindonga zama-arterioles ziba mncanyana, ubala be-lumen buyancipha. Phezu kwemikhumbi kuvame ukuvela umucu wombala omhlophe - ukubonwa kwama-lymphocyte namaseli egazi we-plasma. Esigabeni sokuqala, izinguquko ezinjalo zivame ukwenzeka engxenyeni ye-fundus, futhi zingaphuthelwa uma zibukwa kumfundi omncane.
Akukho ukuthembela okuqondile kwesigaba salesi sifo ezingeni likashukela wegazi kanye nesikhathi sikashukela. Ezinye iziguli ezinesifo sikashukela sohlobo lwe-Type 1 sikashukela isikhathi esingaphezu kweminyaka engama-20, futhi ezinoshukela ojwayelekile esifundeni se-10-12 mmol / l, azizange zisho izinkinga. Futhi, kunalokho, ezigulini ezinama-glucose aphansi ama-7-8 mmol / L kanye "nesipiliyoni" sesi sifo seminyaka engu-2-3 kungaba nezinkinga ezinkulu.
Imitholampilo eminingi ekhethekile yezokwelapha yenza ubuciko bokubhala kwesikhwama ukuze kubhekwe namandla alesi sifo.
Uma usola ukuthuthukiswa kwe-edema ye-macular edema, i-retina disachment, noma i-neovascularization, kunconywa i-optical coherence tomography (OCT).
Le ndlela yokuhlola ikuvumela ukuthi ubone i-retina esilinganisweni, okwakungakwazi ukwenza ngaso leso sikhathi futhi kube nzima ukuxilonga, futhi sinqume namaqhinga okwelashwa.
Enye indlela efundisayo yokuhlola i-fluorescence angiography ye-retina, ekuvumela ukuthi ukhombise ngokunembile indawo yokujuluka kwegazi emithanjeni yegazi. Le ndlela iyanconywa ngemuva kokuhlanganiswa kwe-laser ye-retina, kanye nokuba khona kwe-SNM.
Ukwelashwa Sikashukela
I-angiopathy yesifo sikashukela ayidingi ukwelashwa okukhethekile. Isiguli sinconywa ukuba silandele ukudla okuyisipesheli, siqaphe ushukela wegazi nomfutho wegazi, i-glycated hemoglobin. Ukwelashwa kumele kuqale ngokwakhiwa kwezinkinga.
Okulondolozayo
Iningi lezamehlo, lapho libona i-angiopathy noma i-DRP engeyona eyokwanda, nikeza amathonsi esu ka-Taufon ne-Emoxipin. Le mishanguzo igelezela kuwo womabili amehlo ngezinsuku ezingama-30, imvamisa ephindwe kathathu ngosuku.
Lapho kukhona i-glaucoma, evame ukwenzeka ngesifo sikashukela sikashukela, ukwelashwa kwe-antihypertensive kuyadingeka.
Uma i-edema yesifo sikashukela sitholakele, kutholakala izidakamizwa ezingezona ze-steroidal - INevanak 1 yehla amahlandla ama-3 ngosuku ngenyanga.
I-Laser coagulation
Ukwelashwa ngokuhlinzwa kokutholwa kwesifo sikashukela se-retinal angiopathy akuboniswa. Lapho udokotela wezifo zamehlo ekhomba ukugeleza kwemithambo emithanjeni nasendaweni yama-macular, kuqhutshekiswa nge-laser retinal coagulation.
I-laser cauterize i-retinal ruptures yemisipha ukuvikela ukopha okuthe xaxa. Imvamisa lokhu kudalwa kwenziwa kabili, kanti ama-laser coagulates amboza yonke indawo ye-retina.
Ukwelapha ngokuhlinzwa kubhekiselwa kumacala alandelayo:
- lapho kuvela ulwelwesi lwe-subretinal neovascular membrane (SNM) esifundeni se-macular. Le nkinga iholela ekujuleni kwenhliziyo, esisongela ukulahleka kombono okungaphendukiyo;
- ngokubhujiswa komzimba we-vitreous onengozi enkulu yokuhlakulela i-traction detachment ye-traction, i-vitrectomy yenziwa.
Ukudla lesi sifo
Kunezidingo eziningi zokudla okunempilo kohlobo I no-Type 2 sikashukela. Lezi zidingo kufanele zihlangatshezwe kungakhathalekile ukuthi kukhona noma ukungatholakali kwezinkinga.
Kunconywa ukudla ukudla okulandelayo, okungeke kukhuphule izinga likashukela, futhi ngenxa yalokho kungadliwa unomphela:
- imifino: ukhukhamba, utamatisi, zonke izinhlobo iklabishi, pepper, zucchini, isitshalo seqanda, isithombo, isithombo;
- amakhowe amasha futhi aqokiwe;
- imifino, isipinashi, isigaxa;
- itiye nekhofi ngaphandle koshukela no-ukhilimu;
- amanzi amaminerali.
Iqembu lesibili lifaka imikhiqizo okumele ukusetshenziswa kwayo kukhawulwe ngomkhawulo "wehlukaniswe ngababili":
- inyama ebondayo: inkukhu, iturkey, inyama yenkomo;
- izinhlobo zezinhlanzi ezinamafutha amancane: i-cod, pollock, zander, hake.
- umvimba ophekwe ngaphandle kwamafutha.
- ubisi olunokuqukethwe kwamafutha amancane i-1.5-2%.
- ushizi wekotishi onamafutha amancane;
- amazambane
- i-legumes - uphizi, ubhontshisi, udali;
- imikhiqizo yesinkwa neyokubhaka;
- I-pasta
- amaqanda.
Kunconywe ukuthi imikhiqizo elandelayo ingafakwa ngokuphelele:
- uwoyela wesilwane nowemifino;
- isinqe, imajarini nemayonnaise;
- ukhilimu, ushizi kanye namafutha e-cottage shizi;
- inyama enamafutha: ingulube newundlu, idada, ihansi;
- izinhlobo zezinhlanzi ezinamafutha: i-trout, i-salmon, i-herring, i-chum salmon;
- amantongomane nembewu;
- ushukela, uju, ujamu, amakhukhi, ujamu, ushokoledi, u-ayisikhilimu, iziphuzo ezimnandi;
- iziphuzo eziqukethe utshwala;
- amagilebhisi, ubhanana, ama-Persimmons, izinsuku, amakhiwane.
Izici ze-angiopathy ezinganeni
Ebuntwaneni, isifo sikashukela sikhula ngenxa yokusebenza kwe-pancreatic cell okwanele.
Ukuthuthukiswa kwezinkinga zamehlo ezinesifo sikashukela ezinganeni, kanye nokuhlolwa kwazo, kunezici ezithile:
- ngenxa yobuthakathaka bemithambo obuthakathaka, izingane zibonakaliswa ukubonakaliswa okusheshayo kwezinkinga - i-DRP eyandayo, ukubukeka kwamehlo kwesifo sikashukela, ukubanjwa komzimba, i-glaucoma yesibili;
- Izingane zasenkulisa zingahle zingakhombisi noma yiziphi izikhalazo, noma ngabe zinamehlo amancane kakhulu;
- Ukuhlolwa kwezingane ezincane ngudokotela wamehlo kuveza nobunzima obuthile;
- izingane azikwazi ukuqapha ngokuzimela ukudla, imijovo ye-insulin ejwayelekile, futhi ihlole namazinga kashukela egazini, nayo ebeka engcupheni enkulu.
Izinto zevidiyo ezimayelana nokuxilongwa kanye nokwelashwa kwe-pathologies ye-retina:
Izindlela zokuvimbela okuhloswe ngazo ukuvimbela ukuthuthukiswa kwe-angiopathy yesifo sikashukela nezinye izinkinga zamehlo zibandakanya:
- ukudla okuqinile;
- ukudla njalo nangendlela efanele izidakamizwa ze-insulin nezokwehlisa ushukela;
- Ukulawulwa kwamazinga kashukela, i-hemoglobin ye-glycated kanye nomfutho wegazi;
- ukuvakashela njalo i-endocrinologist kanye ne-ophthalmologist.
