Phekolo ea atherosclerosis obliterans ea likarolo tse tlase

Phekolo ea bakuli ba nang le mafu a felisang ke mosebetsi o boima haholo. E ka etsoa motheong oa ho tsoa, ​​empa ho nepahala ha ts'oaetso, qeto ea sethala le boemo ba tšenyo li bohlokoa, molemong oa hore ha se tleliniki e 'ngoe le e' ngoe e nang le maemo a nepahetseng. Ntlheng ena, mohopolo oa ho theha litsi tsa bongaka ba methapo o ile oa kenngoa tšebetsong. Joale setsing se seng le se seng sa setereke le metseng e meholo ea indasteri ho na le lefapha le sebetsanang le sehlopha sena sa bakuli. Ho boetse ho na le potso ea ho khetholla pakeng tsa mafapha ka mofuta oa pathology, i.e. ho theha mafapha a phlebology le arterial pathology.

Ho kopantsoe mekhoa e fetang makholo a tšeletseng bakeng sa kalafo ea bakuli ba nang le mafu a arohanang le a maqhubu. Ho theosa le lilemo tse 30 ho isa ho 40, ho sebelisitsoe lithethefatsi tse makholo tse fapaneng: ho tloha metsing a se nang metsi ho isa maling a se nang sehlopha, ho tloha ho streptocide ho isa corticosteroids le curare. Joale, bo-ramahlale lefatšeng ka bophara ba fihletse qeto ea hore ha ho na setlhare se le seng bakeng sa kalafo ea maloetse a tšoaetsang. Ho latela polyetiology ea lefu lena, kalafo e lokela ho ba e felletseng. Ha ho na mokhoa o le mong oa kalafo o ipolelang hore ke oa pathogenetic o ka bang teng lefatšeng ka bophara, joalo ka ha ho le thata ho hlalosa boemo ba lefu lena ka lebaka lefe kapa lefe. Pele ho tsohle, kalafo e lokela ho rereloa ho felisa litlamorao tse mpe tsa tikoloho (mosebetsi le phomolo, maemo a tloaelehileng a bophelo, ho tsuba, phepo e nepahetseng, ho tlosa khatello ea maikutlo, ho fola, jj.). Ha u fana ka litlhare tsa kalafo ea lithethefatsi, mefuta ea dyslipidemia (ho latela sehlopha sa WHO) e lokela ho tsotelloa.

Ka mofuta oa I, keketseho e nyane ea k'holeseterole e felletseng, keketseho e tšoaeang ho triglycerides, boemo bo tloaelehileng ba cholesterol ea LDL, chylomicron e fetelletseng e bonoa plasma ea mali.

II Mofuta oa mofuta - boemo bo tloaelehileng ba cholesterol e tloaelehileng kapa e phahameng, boemo bo tloaelehileng ba triglycerides, keketseho e tlamang maemong a cholesterol ea LDL.

Type II B - keketseho ea li-triglycerides, k'holeseterole e feteletseng ea LDL le cholesterol ea VLDL.

Mofuta oa III - liphetoho li tšoana le mofuta oa I, ho na le keketseho ea litaba tsa li-cholesterol-lowing steroids (lipakeng tsa methapo ea methapo ea methapo).

Mofuta oa IV - ho ka ba le keketseho e nyane ea k'holeseterole e felletseng, keketseho ea li-triglycerides le cholesterol e fetang ea VLDL.

Mofuta oa V - k'holeseterole e feteletseng ea VLDL le chylomicron.

Joalokaha ho ka bonoa ho data e hlahisitsoeng, li-atherogenic tse ngata ke mefuta ea II A le II B ea dyslipidemia.

Phekolo e khathollang

Phekolo ea Conservative e lokela ho ba e felletseng, e le motho ka mong, ea nako e telele 'me e shebane le lintlha tse fapaneng tsa pathogenesis:

• normalization of lipid metabolism,
• Tsoseletso ea likhothaletso le ntlafatso ea tšebetso ea tsona,
• ho felisoa ha angiospasm,
• normalization ea methapo ea methapo ea methapo le metabolic ho li-tishu,
• ntlafatsoe
• Tsamaiso ea tlhaho ea tlhaho,
• maemo a tloaelehileng a boits'ireletso ba mmele,
• thibelo ea lefu lena le tlase,
• Phekolo ea ho hlasimolla le ea matšoao.

Lithethefatsi tse sebelisitsoeng li ka aroloa ka lihlopha tse latelang:

1. Litokisetso tse ntlafatsang microcirculation hape li na le thepa ea antiplatelet: li-dextrans tse tlase le tse mahareng (reopoliglyukin, reoglyuman, reokhem, reomakrodeks, hemode), pentoxifylline (trental, vasonite, flexital), tiklid, plavica (clopulodexidel) , compliment (xavin, sadamin), theonicol, agapurin, nicotinic acid, enduracin, chimes (Persantine), aspirin (thrombo ace, aspirin Cardio). Trental e laetsoe ho 400-1200 mg ka letsatsi, vasonite - ho 600-1200 mg, tiklid - 250 mg makhetlo a 2 ka letsatsi, ho sesa - 75 mg ka letsatsi. Lithethefatsi tsena li ka fanoa le aspirin. Tekanyetso ea letsatsi le letsatsi ea aspirin ke 100-300 mg, ho latela boemo ba bongaka le tekanyetso ea lithethefatsi tse amanang le antiplatelet. Motsoako oa li-aspirin le ticlide ha o eletse ka lebaka la ho tsoa mali. Sulodexide e tsamaisoa ka mokhoa o ts'oanelang ho 600 LU (2 ml) makhetlo a 2 ka letsatsi matsatsi a 10-24, ebe kahare ka har'a li-capsule tsa 250 LU makhetlo a 2 ka letsatsi matsatsi a 30-70.

2. Lithethefatsi tsa Metabolic (activate reticuloendothelial system le li-oxidative process in tishu): ente 8-10 ml ea salcoseryl kapa actovegin ka saline ea mmele kapa intra-arterial saline kapa 250-500 ml ea tharollo ea Actovegin kahare ka matsatsi a 10-20.

3. Li-vithamine: ascorbic acid e ntlafatsa methapo ea metabolic liseleng, e matlafatsa sesole sa 'mele, vithamine B, e bontšoa bakeng sa mathata a ischemic neuritis le trophic, vithamine B₂ e susumetsa mekhoa ea ho inchafatsa, livithamini B₆ B₁₂ ama metabolism ea phospholipids ea mali, asiti ea nicotinic le lintho tse tsoang ho eona li na le thepa ea antiaggregant le antiatherogenic le ho ntlafatsa li-microcirculation, livithamini A le E ke li-antioxidants tse matla, vithamine F e ts'ehetsa ts'ebetso e tloaelehileng ea litšoelesa tsa endocrine, e ntlafatsa phihlello ea oksijene ho lisele, cholesterol ka har'a methapo ea kutlo.

4. Angioprotectors (activate intravascular lysis le thibela thrombosis, fokotsa boteng ba methapo ea methapo le ho thibela ho emisoa ha lipids ka leboteng la sejana): doxium, vasolastine, parmidin (prodectin, anginin), tanakan, liparoid-200. Parmidin e fuoe Letlapa le le leng la makhetlo a 3-4 ka letsatsi (750-1500 mg) bakeng sa likhoeli tse 6-12. Ho lefu la tsoekere la lefu la tsoekere, ho eletsoa ho fana ka Doxium 0,25 g makhetlo a 3 ka letsatsi kapa 0,5 g makhetlo a 2 ka letsatsi bakeng sa libeke tse 3-4, 'me joale Letlapa le le 1 ka letsatsi le lelelele, ho latela boemo ba kliniki.

5. Lithethefatsi tse theolang anti-atherogenic kapa lipid tse fokotsang: li-statins le li-fibrate. Statins: cholestyramine, leskol (fluvastatin), lipostabil, lipanor, lipostat (pravastatin), lovastatin (mevacor), simvastatin (okuseor, vasilip), choletar. Thepa ea anti-atherogenic e na le litokisetso tsa konofolo (allicor, alisate), carinate, betinate, enduracin e nang le 500 mg ea nicotinic acid (inhibit biosynthesis ea cholesterol le triglycerides). Statins e laola likaroloana tsa lipid, e fokotsa sekhahla sa cholesterol ea LDL, cholesterol VLDL le triglycerides (TG) le ho eketsa cholesterol ea HDL, ho khutlisa ts'ebetso e tloaelehileng ea endothelial, ka ho etsa joalo ho kenya letsoho karabelong e tloaelehileng ea vasomotor ea methapo, ho ba le litlamorao tse khahlanong le ho ruruha ka bobeli ka aseptic le ts'oaetso ea tšoaetso. thibela postoperative thrombocytosis, e leng ponelo-pele ea mathata a bophelo. Fibrate: bezafibrate (besalip), gemfibrozil (gevilon), fenofibrate (lipantil), fenofibrate ea methane (lipantil 200 M), ciprofibrate. Li-figrate li na le phello e boletsoeng e fokotsoang haholo ea lipid ho li-statins ho triglycerides; li khona ho eketsa karolo ea cholesterol ea anti-atherogenic HDL. Lipalo le li-fibrate li sebetsa hantle haholo ho hyperlipidemia ea liphatsa tsa lefutso. Leha ho le joalo, ho khethoa ha lichelete tsena ho hloka hore ngaka e tsebe litaba tse ikhethang tsa lipidology ea kliniki le metheo ea kopantseng ea lithethefatsi. Mohlala, li-statins ha lia lokela ho sebelisoa hammoho le fiber le nicotinic acid, hobane tsamaiso ea tsona e kopaneng e ka baka myositis. Ts'ebeliso ea li-statins tsohle e qala ka tekanyo e tlase e khothalletsoang. Phello ea ho fokotsa lipid e bonahala ka botlalo ka mor'a libeke tse 'ne, ka hona, phetoho ea litekanyetso ha ea lokela ho etsoa pele ho libeke tse 4. Ka ho fokotseha ha k'holeseterole e kaalo ka tlase ho 3.6 mmol / L kapa LDL cholesterol ka tlase ho 1.94 mmol / L, tekanyetso ea statin e ka fokotsoa. Li-statin tsohle li sebelisoa hang ka letsatsi, bosiu ka mor'a ho ja. Methapo ea li-fibrate le mofuta oa ts'ebeliso ea tsona li fapane ho motho e mong le e mong. Khalemelo ea lithethefatsi ea dyslipidemia ea atherogenic e lokela ho etsoa ka nako e telele haholo. Bakeng sa bakuli ba bangata - bophelong bohle.

6. Li-antioxidants li bapala karolo ea bohlokoa kalafong ea atherosulinosis ka ho laola lipid peroxidation (LPO). Tsena li kenyelletsa livithamini A, E, C, dalargin, cytochrome c, preductal, emoxipin, neoton, probucol. Moemeli ea atileng haholo oa sehlopha sena ke vithamine E (alpha-tocopherol acetate), ka tekanyetso ea 400-600 mg / ka letsatsi, e nang le phello ea kalafo e amanang le hypocoagulation, fiberrinolysis e eketsehileng le thepa e ntlafalitsoeng ea mali, thibelo ea lits'ebetso tsa oxidation le ts'ebetso ea sistimi ea antioxidant. Hajoale, ho tlatsitsoe li-supplement tsa lijo tse nang le thepa ea antioxidant le ho kenngoa ts'ebetsong ea bongaka: litokisetso tse thehiloeng ho omega-3-poly-unsaturated fatty acids (eikonol, dokanol), litokisetso tsa leoatle kale (clamin), seaweed (splat, spirulina), meroho oli (oli ea viburnum, leoatle buckthorn).

7. Antispasmodics (papaverine, no-shpa, nikoshpan) e ka laeloa bakeng sa methati ea I le II ea lefu lena, ha lefu la arterial spasm le hlaha.

8. Li-anticoagulants tse tobileng le tse sa tobang li behiloe ho latela matšoao a nang le khatello e matla ea maikutlo.

9. Sehlopheng se arohaneng ho kenyelletsa vazaprostan (prostaglandin E,). Setlhare se na le thepa ea antiplatelet, se ntlafatsa phallo ea mali ka ho holisa methapo ea mali, se kenya tšebetsong fibrinolysis, se ntlafatsa methapo e mengata, se khutlisetsa metabolism e tloaelehileng linthong tsa ischemic, se thibela ts'ebetso ea li-neutrophils, ka ho etsa joalo se thibela litlamorao tsa tšenyo ea lisele, se na le phello ea antisrance. Vazaprostan e bonts'oa mefuta e matla ea liso tse senyehang tsa methapo ea maoto le matsoho. E fanoa ka mokhoa o kenang kahare kapa kahare ho litekanyetso tsa 20-60 μg ka hara lethopo la 100-200 ml ea tharollo ea 0,9% NaCl letsatsi le leng le le leng kapa ka letsatsi le leng le le leng. Nako ea kenyelletso ke lihora tse 2-3. Nako ea thupelo ke libeke tse 2,2. Moriana o tšoauoa ka keketseho ea phello ea kalafo, e ka tsoelapele beke e le 'ngoe ho isa ho tse peli kamora ho hlakoloa ha eona. Litlamorao li ka latsoa selemo ho pota.

Bohlokoa ke khetho ea lithethefatsi ka bomong le ts'ebeliso ea tsona ea ts'ebetso ka tlhahlobo ea katleho ea moriana o itseng. Mohlala kalafo ea kalafo ea kalafo ea kalafo: prodectin + trental, prodectin + ticlide, prodectin + plavica, prodectin + aspirin, plavica + aspirin, vasonite + prodectin, trental + aspirin, sulodexide, jj. le tlatsetso maemong ohle a lithethefatsi tse khahlanong le atherogenic. Ho bohlokoa ho fetola litlhare tsena kapa tse ling tsa lithethefatsi ka mor'a likhoeli tse ling le tse ling tse tharo. Mehatong ea morao le sepetlele, ho sebelisitsoe mokhoa o latelang: ho sebelisoa ka mokhoa o latelang marang-rang a tsoang ka makhetlo a 400 ml + trental 5-10 ml + nicotinic acid 4-6 ml kapa ka ho latellana 4-6 ml, solcoseryl kapa actovegin 10 ml ka 200 ml ea saline, ho bakeng sa matsatsi a 10-15 kapa ho feta. Lipheko tsohle tse kaholimo li tlatselletsa matšoao a kalafo. Phekolo ea kalafo le kalafo ea mafu a kopaneng e ea tlama ebile ha e khone ho buisanoa.

Barotherapy (hyperbaric oxygenation - HBO) e ntlafatsa maemo a phepelo ea oksijene liseleng ka ho theha moea o mongata oa khatello ea oksijene liseleng le ho eketsa palo ea oksijene e fetang lithong ka motsotso. Monyetla oa mantlha oa ho isa palo e hlokahalang ea oksijene liseleng ka phallo e khutsitseng ea phallo ea mali e etsa HBO tsela ea pathogenetic le e nepahetseng haholo ntoeng e khahlanong le hypoxia ea tikoloho. Phello e latela boemo ba hemodynamics bohareng. Letšoao la ntlafatso phepelong ea oksijene ea li-tishu kamora thupelo ea HBO ke keketseho ea likarolo tsa phallo ea mali e bohareng le ea potoloho (V.I. Pakhomov, 1985). Ka tlhahiso ea pelo e tlase, ho sa tsotelehe liphetoho phallo ea mali ea tikoloho, ho tsamaisoa ha oksijene ha ho na katleho. Ha ke a ka ka fumana sesepa se pharalletseng ho sebelisoa lisebelisoa tsa Kravchenko le Shpilt.

Mokhoa oa ultraviolet nosetso oa mali (UV) o atile, o qaliloe ke ngaka e buoang ea Czech Gavlicek ka 1934, o ile ao sebelisetsa peritonitis. Mokhoa oa likokoana-hloko oa mahlaseli a UV o lutse ka ho iphetola ha motho ea lulang a phela maemong a mahlaseli a letsatsi. Kameho e ntle ea UFO ho feliseng mafu a methapo ea methapo e ile ea theoa ka 1936 ke Kulenkampf. UFO ho latela mokhoa oa setso oa Knott e etsoa ka tsela e latelang: 3 ml ea mali ka kilo e le 'ngoe ea boima ba' mele oa mokuli e nkuoa mothapong. Mali a fetisoa ka har'a lisebelisoa tse nang le mohloli oa lebone la UV-mercury-quartz le wavelength ea 200-400 nm. Qeta likarolo tse 5-7 ka nako ea matsatsi a 2-6. Mali a UFO a na le bactericidal, immunocorilinging le e susumetsang ea tsamaiso ea potoloho ea mali.

Mokhoa oa Wisner o ka tsela e latelang: 45 ml ea mali e nkuoa mothapong, e kopantsoe le 5 ml ea tharollo e metsi ea citrate ka quartz cuvette mme e tšeletsoe metsotso e 5 ka lebone la HN 4-6 UV ka leqhubu la 254 nm mme mali a boetse a tšeloa mothapong oa mokuli.

Ho na le mokhoa oa seo ho thoeng ke hemato native oskidant therapy - GOT (Verlif). Ha e tsamaellana le ho hasana ha mali le lebone la xenon le wavelength ea 300 nm, e matlafalitsoe ke oksijene. Ho fihlela sena, oksijene e kentsoe: 300 cm 3 ho 1 min ho kena valk ea mali. Thupelo e behiloe lits'ebetso tsa 8-12.

Gavlicek (1934) o hlalositse phello ea radiation ea ultraviolet ketsahalo ea metabolites, eo, ha e khutletse 'meleng, e etsang joalo ka lithethefatsi. Acidosis ea fokotseha, li-microcirculation lia ntlafala, home -asis ea electrolyte ea metsi e tloaelehile.

Ts'ebeliso e atileng haholo kalafong ea bakuli e amohetse mokhoa oa ho ntša maikutlo. Pula-maliboho ea ho hlahisoa ha mokhoa ona ka 1970 e ne e le setsebi sa thuto ea bongaka saense ea bongaka Yu.M. Lopukhin. Ho fapana le hemodialysis, moo ho tlosoang feela lintho tse qhibilihang ka metsing, hemosorption e ka tlosa chefo efe kapa efe, kaha ho na le ho kopana ka kotloloho le mali le sorbent.

Yu.M. Lopukhin ka 1977 o khothalelitse ho kenngoa ha hemosorption ho phekolo e rarahaneng ea atherosulinosis ka sepheo sa ho li-decholesterolization. Tlokotsi ea lipid homeostasis e etsahala tlasa ts'usumetso e nang le chefo ea xenobiotic - lintho tse arohaneng le 'mele tse lematsang tsamaiso ea oxidative ea sebete. Ho bokellana ha li-xenobiotic ho hlaha botsofaling, ka botenya, ho ba tsubang haholo. Ho sa tsotelehe hore na hypercholesterolemia le hyperbeta-lipoproteinemia ke tsona lisosa tsa atherosclerosis ho latela khopolo ea N.N. Anichkova kapa ka lebaka la peroxidation ea lipid peroxidation, dyslipoproteinemia e nang le atherosclerosis e etsahala. Hemosorption e e tsamaellana, e fokotsa se ka har'a li-atherogenic lipoprotein tsa low (LDL) le letsoalo le tlase haholo (VLDL).

Hemosorption e meraro e tlosa cholesterol leboteng la methapo ea mali ka 30% (Yu.M. Lopukhin, Yu.V. Belousov, S.S. Markin), 'me ka nako e itseng ho khutla ha ts'ebetso ea atherosseloticotic ho fokotseha, "membrane microviscosity e fokotseha" bokhoni ba lisele tse khubelu tsa mali, bo ntlafatsa microcirculation.

Nakong ea ischemia e mahlonoko, bongata bo boholo ba chefo ea ischemic ea ischemic, lintho tse kang histamine, lihlahisoa tsa metabolism e khelohileng ea mmele le cell necrobiosis li bokellana 'meleng. Hemosorption eu lumella ho tlosa albinotoxin, lipazotoxin 'meleng mme e bapala karolo ea kalafo ea immunocorrective. Hemosorption e ngoe e nang le SKN-4M sorbent e fokotsa litaba tsa li-immunoglobulins G ka 30%, sehlopha sa A ka 20% le sehlopha M ka 10%, li-immunocomplexes (CECs) tse potolohang li fokotsehile ka 40%.

Ho latela S.G. Osipova le V.N. Titova (1982), o senotse hore ka tšenyo ea atherosselotic ho likepe tse pheletsong e tlase, boits'ireletso bo sitisitse. Ka nako e ts'oanang, lisele tsa immunocompetent - T-suppressors, tse nang le B-cell activation le tlhahiso e ngata ea li-immunoglobulins li hatelloa, e lebisang ts'enyetsong e eketsehileng ho vasotine endothelium.

Mathata (ho latela E.A. Luzhnikov, 1984) a bonoa ho bakuli ba 30-40%.Tsena li kenyelletsa: ho sithabela maikutlong a lisele tsa mali, boloi hammoho le chefo ea oksijene le liprotheine tsa bohlokoa tsa 'mele le likarolo tsa mohlala. Nakong ea ts'ebetso, hypotension, chills, thrombosis ea sistimi, embolism e nang le likaroloana tsa mashala e ea khonahala (likaroloana tse 33 ka boholo li fumaneha matšoafong, lephong, liphio, bokong). Li-sorbents tse ntle ka ho fetisisa ke mashala a granular le microfilm. Palo e felletseng ea lisele tse khubelu tsa mali ea fokotseha, empa sebopeho sa tsona sa boleng se fetoha se felletseng. Hypoxemia ea hlaha, ka hona, oksijene e etsoa le ho feta nakong ea hemoperfusion. Ho sebelisa oksijene ea lik'hemik'hale le hona hoa etsoa. Hoa tsebahala hore tharollo ea 3% ea hydrogen peroxide e na le 100 cm 3 ea oksijene, hona ho lekane ho tlatsa ligrata tse fetang 1.5 tsa mali a venous. E.F. Abuhba (1983) o hlahisitse tharollo ea 0.24% ea H₂Oho₂ (250-500 ml) lekareng la artery ea aracic mme a fumana phello e ntle ea oksijene.

Ho na le mesebetsi e akaretsang ka boiphihlelo ba enterosorption ka kalafo ea ho felisoa ha mafu a lipalo tse tlase. Bakeng sa enterosorption e sebelisitsoeng:

• li-carbons tse sa ikhethang (IGI, SKT, AUV),
• Sekhahla sa phapanyetsano ea ion,
• li-sorbents tse ikhethileng tse amanang le glycosides sequestrating exo native and endo native cholesterol.
• Matsatsi a mabeli ho isa ho a mararo a enterosorption a lekane ka katleho ho karolo e le 'ngoe ea hemosorption. Ha enterosorption e fumanoa:
• pharalla ha lintho tse chefo ho tloha maling ho ea ka popelong ka tlamo e tsoelang pele ho sorhuth,
• Ho hloekisa lisosa tsa tšilo ea lijo ka mpeng, tse nang le chefo e ngata.
• phetoho liponeng tsa lipid le amino acid ea likarolo tsa ka mpeng,
• ho tlosoa hoa lintho tse chefo tse entsoeng ka mpeng ka boeona, e fokotsang mojaro ho sebete.

Phekolo ea kalafo

Mekhoa ea ho buoa e ka aroloa ka lihlopha tse peli: 1) ts'ebetso ea ts'ebetso ea ts'ebetso ea methapo, 2) ts'ebetso ea methapo ea methapo.

Matla a vasoconstrictor a methapo e nang le kutloelo-bohloko ea phallo ea mali a potoloha a fumanoe ke Claude Bernard (Claude Bernard, 1851). Eaba M. Zhabuley (M. Jaboulay, 1898) a tlaleha ka kalafo e atlehileng ea ho ruruha ha liso tsa leoto ka ho phomola hoa kutloelo-bohloko ea ho boloka sekepe. Ka 1924, J. Diez o ile a qapa mokhoa oa kutloelo-bohloko ea lumbar ka ho qolla ganglia ho tloha lumbar ea bobeli ho ea sebakeng sa boraro sa thoral. Ho bakuli ba bangata, ho ile ha fumanoa phello e ntle: vasodilation le ntlafatso lithutong tsa bongaka tsa lefu lena. Naheng ea Russia, kutloelo-bohloko ea pele ea lumbar e ile ea etsoa ka 1926 ke P.A. Herzen. Ts'ebetso ena e na le matšoao a hlakileng, hobane li-paresis tsa methapo ea mali li ka baka moferefere mme tsa mpefatsa boemo ba mokuli.

a) kakaretso - boholo ba kutu ea moeli o nang le methapo ea kutloelo-bohloko e fetang bolelele bo boholo,

b) truncular - moeli oa moeli o pakeng tsa ganglia tse peli tse nang le kutloelo-bohloko,

c) ganglioectomy - ho tlosoa ha sehlopha sa kutloelo-bohloko.

Ka kutloelo-bohloko, ho khaola ho ka fihlelleha ka litšusumetso tsa "centripetal" tse tsoang lesion le ho baka ts'oarelo e sa khaotseng mokokotlong oa mokokotlo le bokong, le litšusumetso tsa centrifugal tse bakang kapa ho ntlafatsa mafu a trophic, humoral le vasomotor sebakeng sa lesion. Ho khutsisa spasm ea vascular, kutloelo-bohloko e eketsa haholo ts'ebetso ea likhalase. Kamora ho utloela bohloko, palo ea li-capillaries tse hlahang e eketseha haholo. Ka matšoao a bohloko, ho pathogenesis eo tšusumetso e sa lekanyetsoang ea tšusumetso e tsoang ho lesion e bohlokoa, mme ischemia e le sieo, phello ea kalafo ea kutloelo-bohloko ha e fetohe khafetsa. Ka tšenyo ea lijana tsa libaka tse tlase, haholo-holo sehlopha sa bobeli le sa boraro sa lumbar se tlosoa. Pele ho buuoa, ho khothalletsoa ho etsa liteko ka novocaine blockade ea li-ganglia tse nang le kutloelo-bohloko tse reretsoeng ho tlosoa.

B.V. Ognev (1956), motheong oa data ea inclusionsis, o ne a lumela hore ts'ehetso ea kutloelo-bohloko ea libaka tse tlase e tsamaisoa ke moqomo oa moeli o setseng, ka hona ho tlosa noutu ea kutloelo-bohloko ea boraro ea kutlo e lekane. Lingaka tse ngata ha li latele molao ona ebile li etsa opereishene lehlakoreng la likepe tse amehileng. Khopolo ea hore kutloelo-bohloko e lokela ho fetoloa e se e fosahetse. Ke maemong a qalang ka ho haella ha phepelo ea mali moo kutloelo-bohloko e fanang ka litholoana tse ntle tsa kapele le tsa nako e telele.

Kutlwelo-bohloko ea Lumbar e bontšoa ho bakuli ba nang le mofuta o mong oa ho senyeha ha litheko, ha ts'ebetso e ntlafalitsoeng likepeng e sa fumanehe kapa e sa mamellehe ke mofuta oa mafu a kopaneng. Ha ho na le liphetoho tsa ulcerative necrotic, ho hlokahala hore kutloelo-bohloko e kopane le infusions ea lithethefatsi tsa nako e telele le litheko tsa moruo. Sympatectomy ke tlatsetso ea bohlokoa ho tsa bongaka tse ntlafatsang. Ho fokotseha ha khatello ea ho potoloha le ho phahama ha phallo ea mali ka lebaka la ho tlosoa ha arteriospasm ke thibelo ea ho khutla hoa methapo ea methapo. Ka ho khutlisetsoa morao, kutloelo-bohloko ea lumbar e etsa hore ischemia e hlobaetsang e se ke ea boleloa haholo 'me e eketsa menyetla ea ho boloka matšeliso a potoloha.

Liphetho tse sa khotsofatseng tse nang le kutloelo-bohloko li ka hlalosoa ke likarolo tsa sebopeho sa ts'ebetso ea kutloelo-bohloko ea kutloelo-bohloko, sebopeho sa lefu lena, ho ata ha tšenyo ea likepe tse kholo le liphetoho tse ke keng tsa fetoleloa boemong ba microcirculation.

Ka kutloelo-bohloko, mathata a latelang a ka hlaha:

• Ho tsoa mali ho tsoa methapong le methapong (0.5%),
• embolism ka har'a methapo ea methapo e tlase le methapo ea methapo ea methapo ea methapo (0.5%),
• neuralgia, e pepesitsoeng ke bohloko ka kotloloho holim'a letheba la anterolateral (10%), e nyamelang kamora likhoeli tse 1-6.
• mathata a ho imoloha ka mor'a kutloelo-bohloko e habeli (0,05%),
• lefu la batho (ba ka tlase ho 1%, ho latela A.N. Filatov - ho fihla ho 6%). Ts'ebetso e ile ea nolofatsoa ka lebaka la kenyelletso ea mokhoa oa endoscopic.

R. Lerish o khothalelitse ho etsa desympathization ea li-artery tsa basali tse tloaelehileng, a tlosa bahanyetsi ka tsela eo e amang molumo oa methapo ea methapo ea methapo. Palema (Palma) e hlahisitse tokollo ea methapo ea methapo ea basali ho tsoa methapong le lithong tse haufi le Hunter Canal.

Ts'ebetso tse latelang li etsoa ho methapo ea kutlo:

• Shin denervation (Szyfebbain, Olzewski, 1966). Bohlokoa ba ts'ebetso bo na le lipakeng tsa makala a makoloi a methapo ea kutlo ea mokokotlo e ea sebakeng se le seng le mesifa ea namane, e thusang ho tima tšebetso ea karolo ea mesifa nakong ea ho tsamaea, ka tsela eo e fokotsa tlhokeho ea oksijene.
• ts'ebetso ho methapo ea kutlo ea mokokotlo (A.G. Molotkov, 1928 le 1937, jj.).

Ho buuoa ka Adrenal gland ho ile ha etsoa tlhahiso le ho etsoa ke V.A. Mohanyetsi (1921). Ho se ho fetile lilemo tse fetang tse 70 lipuisano tse mabapi le boeletsi ba ho sebelisa ngaka ea adrenal gland ho bakuli ba nang le maloetse a fetofetogang li ntse li tsoela pele ka lilemo tse fetang 70.

Ho lebisoa tlhokomelo e matla kalafong ea sehlopha sena sa bakuli ho fanoa ka litlatsetso tsa nako e telele tsa kahare tsa lithethefatsi tse fapaneng. Motsoako o hlahisoa: saline, reopoliglukin, heparin, trental, nicotinic acid, ATP, tharollo ea novocaine, li-painkillers, lithibela-mafu. Hajoale, bakeng sa infravenous le intraarterial infusions, ho sebelisoa infusomats. Bakeng sa tsamaiso ea lithethefatsi ea matsatsi a mangata, ho etsoa ha methapo e meng e ka tlase ea epigastric kapa e 'ngoe ea makala a mokokotlo oa basali e etsoa.

Mekhoa e meng ea ho phekola ischemia ea maoto le matsoho e boletsoe:

• ho hlasolla mesifa ka kotlolloho (S. Shionga et al., 1973),
• arterialization ea sistimi ea capillary e sebelisang arterio-bone fistulas (R.H. Vetto, 1965),
• transplantation e kholo ea omentum e kholo (Sh.D. Manrua, 1985),

Mekhoa ena, e etselitsoeng ho ntlafatsa ho potoloha ha 'mele, ha e khone ho fihlella kapele liketsahalo tsa ischemic mme e ka se sebelisoe mohatong oa IV oa mathata a sa feleng a ho kula.

Ho entsoe boiteko ba ho kopanya setho sa ischemic ka har'a venous system ka ho sebelisa fistula e arolang ka serope (San Martin, 1902, M. Jaboulay, 1903). Kamora moo, ba bangata ba ile ba qala ho batla litsela tse ling. Ka 1977 A.G. Shell (A.G. Shell) o ne a sebelisa mokokotlo oa mokokotlo o ka morao oa leoto. Sengoli se fihletse liphetho tse ntle tsa 50% ho ischemia e bohloko. Ts'ebetso e ts'oanang e ile ea hlahisoa ke B.L. Gambarin (1987), A.V. Pokrovsky le A.G. Horovets (1988).

Matšoao a ts'ebetso ea ho hlaphoheloa a khethoa ho latela boima ba ischemia ea maoto, maemo a sebaka a ts'ebetso, le tekanyo ea kotsi ea ts'ebetso. Maemo a lehae a hlahlojoa ho ipapisitsoe le data ea aortoarteriography. Boemo bo nepahetseng bakeng sa ts'ebetso ke ho boloka moalo oa bethe ea distal. Boiphihlelo ba tsa bongaka bo re kholisa hore ha ho na ts'ebetso ea lefats'e bakeng sa lefu lena, empa e lokela ho tataisoa ke maqheka a khetho ea motho ka mong ea mokhoa oa ts'ebetso. Matšoao a ts'ebeliso ea mekhoa ea ho aha bocha a ikhethile ho latela sebopeho le boemo ba mokuli, lilemo le boemo ba mokuli, ho ba teng ha lintlha tsa kotsi bakeng sa ts'ebetso ea ho buoa le lefu la ho opa hlooho. Mabaka a sitisang matšoao a kalafo ea ho buoa le a bakang kotsi e kholo ea ho buoa ke: lefu le sa foleng la pelo, ho se lekane ha methapo ea mali, khatello ea mali, ho fokola ha pelo le masapo, lesapo la mokokotlo le lefu la mokokotlo, lefu la mellitus le lefu la tsoekere. Ka tšokelo ea 'nete ea ho khaoloa leoto le phahameng, boemo bo itseng ba menyetla ea ho leka ho buuoa bocha bo a amoheleha, kaha leha a ka khaoloa likoto tse phahameng, lefu la bakuli ba lilemo tse ka tlase ho 60 ke 21-28% kapa ho feta.

Bakeng sa ts'ebetso e ntlafatsang, ho sebelisoa li-prostheses tse fapaneng tsa maiketsetso, tse boletsoeng ka holimo, le autogene. Mefuta e meng ea li-transplant ha e sa sebelisoe seoelo.

Mefuta e fapa-fapaneng ea endarterectomies (e bulehileng, e bulehileng, eversion, e nang le khase ea carbodis Assembly, ultrasound) e sebelisoa ka bobeli e le lipuisano tse ikemetseng bakeng sa stenosis le occlusion, hape e le tlatsetso e hlokahalang ho shunting kapa prosthetics. Lingaka tse ngata li nka hore ho loketse ho kopanya ts'ebetso e ntlafatsang le kutloelo-bohloko ea lumbar.

Ho Leriche syndrome, ho fihlella aorta ke median laparotomy kapa karolo e tsamaeang le Rob (C.G. Rob). Karolo ea Rob e qala ho tloha mothapo oa XII 'me e fetela ho bohareng ba bolelele ba 3-4 cm ka tlase ho mokhubu, ha mesifa ea "rectus abdominis" e le karolo e itseng kapa e arohana ka ho phethahala, mesifa ea lebota la anterolateral e arotsoe kapa e arohantsoe le peritoneum,' me e tsoa ka har'a mpa. Bakeng sa khetho e pharaletseng ea methapo ea iac ea lehlakoreng le lehlakoreng le fapaneng, ho ts'oaroa ho ka atolosoa ka phallo ea mosifa o mong oa rectus abdominis. Ho fihlella hona ha ho sithabetse, hoo e batlang e sa bakise mala, ho fana ka monyetla oa ho qala ts'ebetso ea mokuli kapele ka mor'a ho buuoa. Ho fihlella methapo ea methapo ea basali ke ka phello ea morao e emeng ka tlase ho liginal ea inguinal. Karolo e ka holimo ea sehiloeng ke cm cm ka holim'a 'mele oa inguinal. Ho khothalletsoa hore u lahle li-lymph node ka tsela e bohareng (bohareng) ntle le ho li tšela.

Ka occlusion e phahameng ea mpa ea mpa ea mpa hammoho le tšenyo makaleng a renal kapa visceral, thoracophrenolumbotomy e sebelisoa.

Ha feela methapo ea methapo ea letsohoe e khelositsoe, ho sebelisoa opereishene ea kapele-pele kapa endarterectomy. Ts'ebetso e mengata e fetang kapele ea karolo ea basali ea aortic e fela ka ho kenella ka mokokotlong o matla oa basali hore o kene maling. Ho 4-10% ea bakuli, phallo ea mali e kopaneng mokokotlong o motšehali oa botšehali ha e lefelle ischemia ea maoto, maemong a joalo ho ahelloa ka karolo ea botšehali le popliteal. Ho khutlisetsa phallo ea mali karolong ea botšehali, popovein e sebelisoa hangata. Ts'ebetso e ntlafatsang ho ak'haonte ea popi ea popi-popliteal bakeng sa 60-70% ea mefuta eohle ea ts'ebetso ho methapo ea methapo (Nielubowicz, 1974). Bakeng sa ho fihlella karolong e ka thōko ea mokelikeli oa popliteal le sebakeng sa makala a sona (trifurcation), hangata ho sebelisoa hangata ho amang maikutlo (medial tibial ho latela M. Conghon, 1958). Ho pepesa karolo e bohareng kapa methapo eohle ea popliteal, ho ts'oaroa hoa maikutlo le tsela ea methapo ea methapo ea kutlo (tendon pes ansevinus (goose paws) le hlooho ea medial m.gastrocnemius (A.M. Imperato, 1974).

E sebelisitse profundoplasty e pharalletseng. Ho bakuli ba bangata ba nang le tšilafalo e mpe methapong ea leoto, ho nchafatsa methapo e meholo ea botšehali ke eona feela karolo e ka pholosang setho sa letsoho ho khaoloa. Ts'ebetso e ka etsoa tlhatlhobong ea lehae kapa ka tlholeho ea lefu la ho bola. Profundoplasty e fokotsa botebo ba ischemia, empa ha e felise ho hlaka ho buoang ka nako eohle. Ho ntlafatsa phallo ea mali ho lekane ho folisa liso tsa kahare le maqeba ka mora ho khaoloa ha moruo. Ho nchafatsoa hoa mokokotlo o tebileng oa basali ho ischemia e matla ho fana ka ntlafatso e tobileng ea phallo ea mali le maoto le matsoho ka 65-85% ea bakuli (J. Vollmar et al., 1966, A.A. Shalimov, N.F. Dryuk, 1979).

Ho bakuli ba lilemo tsa senile ba nang le mafu a matla a kopaneng, ts'ebetso e otlolohileng methapong ea aorta le li-vaac li amahanngoa le kotsi e kholo le lefu le phahameng. Sehlopheng sena sa bakuli, ho sebelisoa grafting ea femal-femoral suprapubic le axillary-femoral bypass. Kotsi e kholo ea shunt thrombosis e hlaha likhoeling tsa pele tse tšeletseng mme e fihla ho 28%.

Kamora lilemo tse 5-7, boemo ba mokokotlo oa mokokotlo oa basali bo ntse bo phehella ka 60-65%, mme kamora ho emisoa ke semolao sa methapo ho mokokotlo oa 23 ho bakuli. Ho na le bopaki ba hore kamora lilemo tse 5, ts'ebetso ea "femoral-popliteal shunt" e ileng ea etsahala e ile ea feta maemong a 73%, mme lefu la maiketsetso ho 35% ea bakuli (D.C. Brewstev, 1982).

Mohato o mocha oa ntlafatso ea tšebetso e nchafatsang ea methapo ea mokokotlo ea popliteal e ne e le ts'ebeliso ea lingaka tse ntlafatsang li sebelisa mekhoa ea microsuction. Ho rarahana ha ts'ebetso ho methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo le methapo ea methapo ea methapo. linyeoe tsa leoto le matla ischemia, ka tšokelo ea ho khaoloa. Ts'ebetso tse joalo li bitsoa "lits'ebetso tsa maoto le matsoho". Leha nako e le teng, tšebetso ena ha e bohloko. Lefu la ts'ebetso ea postoperative le batla le le tlase - ho tloha ho 1 ho isa ho 4%, ha litetso tse phahameng tsa leoto le fihla ho 20-30%. Nako ea qeto ea ho fumana matšoao a kalafo ea ts'ebetso ea ho buoa hangata ha se mabaka a kotsi, empa maemo a ts'ebetso ea lehae, i.e. ho boloka patency ea bonyane e le 'ngoe ea methapo e meraro ea methapo ea kutlo le maemo a khotsofatsang bakeng sa phallo ea mali ka methapo ea methapo ea basali.

Lilemong tsa morao tjena, ka atherosselotic stenosis ea methapo e meholo ea methapo, mokhoa oa ho fokotseha ha methapo ea kutlo le khatello ea maikutlo o se o atile. Ka 1964, ka lekhetlo la pele, ho ile ha hlalosoa lekhetlo la pele ho hlalosoa mokhoa oa ho se "buuoe" ntle le ts'ebetso ea setho sa botšehali o sebelisa li-catheter exters (Ch. Dotter le M. Yudkins). Mokhoa ona o bitsoa "translateuminal dilatation", "translateuminal angioplasty", polasetiki ea endovascular, jj. Ka 1971, E. Zeitler (E. Zeitler) o ile a etsa tlhahiso ea ho felisa marang-rang a bolaeang meno a sebelisang catheter ea Fogarty. Ka 1974

A. Gruntzig le X. Hopt (A. Gruntzig le N.Hopt) e buelletse catheter e habeli ea lumenon e habeli, e ileng ea nolofalletsa ho "nolofatsa" ts'ebetso ena le ho etsa angioplasty hoo e batlang e le liporong tsohle tsa methapo e nang le liperesente tse fokolang. Hona joale, ho fumanoe boiphihlelo bo pharaletseng ka angioplasty ea li-stenotic lesion of artery. Ka lebaka la balloon angioplasty, bophara ba methapo ea methapo bo eketseha ka lebaka la ho abjoa ha thepa ea atheromatous ntle le ho fetola botenya ba lerako la arterial. Ho thibela spasm ea mokelikeli o hlapolotsoeng le tšireletso ea nako e telele ea lumen, stent ea nitinol e kenngoa methapong. E etsa tse bitsoang li-endovascular prosthetics. Liphetho tse ntle ka ho fetisisa li bonoa ka karolo ea "stenosis" e nang le bolelele bo seng bo fetang 10 cm kahare ho likarolo tsa aorto-iliac le tsa basali, ntle le ts'oaetso ea mabota a artery, ho sa tsotelehe sethala sa lefu lena. Boithuto ba liphetho tsa nako e telele bo bontšitse hore mokhoa ona o ke ke oa qothisana lehlokoa le ts'ebetso ea methapo, empa maemong a mang e e tlatselletsa hantle.

Lilemong tse 10 tse fetileng, mosebetsi o hlahile hodima nts'etsopele le ho kenya tšebetsong ts'ebetso ea bongaka ea ts'ebetso ea bongaka e kenelletseng masapong a masapo a tlase - osteotrepanation and osteoperforation (F.N. Zusmanovich, 1996, P.O. Kazanchan, 1997, A.V. . Mehlala, 1998). Ts'ebetso e ntlafalitsoeng ea osteotrepanation (ROT) e etselitsoe ho qobella phallo ea mali a masapo, e senola le ho ntlafatsa ts'ebetso ea lipallo tsa motlakase, mesifa le letlalo mme e bontšoa ho bakuli ba nang le mathata a amanang le mathata a amanang le bohloko ba methapo, leha ho ka etsoa opereishene e nchafatsang. Ts'ebetso e etsoa tlas'a anesthesia ea lehae kapa ea lefu la boloi. Ho sebelisoa masoba a bophahamo ba limilimithara tse bophara ba 3-5 mm ka bophara ba 8-12 kapa ho feta moo ho kenngoeng leotong, leotong le ka tlase le leoto libakeng tse sebetsang. Liphetho tse ntle li fumanoe ho bakuli ba nang le lefu la II B le lefu la sethala sa III.

Nako ea ts'ebetso

Mosebetsi o ka sehloohong oa nako ea pele ea ts'ebetso ke ho thibela thrombosis, ho tsoa mali le ho matlafatsa leqeba. Ho boloka litekanyetso tse phahameng tsa hemodynamics tse akaretsang le tse bohareng ke boemo ba bohlokoa bakeng sa thibelo ea thrombosis. Le haeba ho theoha ha nakoana khatello ea mali nakong ena ho ka lebisa ho arterial thrombosis. Bakeng sa thibelo ea khatello ea khatello e bohlokoa:

• Ngoliso le ho phetisa metsi le mali a lahlehang nakong ea ts'ebetso,
• khalemelo e nakong le e lekaneng ea metabolic acidosis, haholo-holo ka mor'a ho kenyelletsoa ha leoto la ischemic maling.

Phepelo e felletseng ea mokelikeli e lokela ho ba 10-15% e phahameng ho feta tahlehelo ea eona (ntle le mali). Hoa hlokahala ho hlokomela le ho boloka ts'ebetso ea maiketsetso (taolo ea diuresis, ho hlahisoa ha li-dextrans tsa boima ba limolek'hule, aminophylline), ho lokisa likhathatso tsa tekanyetso ea acid-base (ASC), tekanyo ea metsi le letsoai le metabolic acid.

Potso ea ts'ebeliso ea li-anticoagulants e qetoa ka bomong, ho latela likarolo tsa ts'ebetso ea bongaka e nchafatsang. Ho ntlafatsa tšollo ea mali ea tikoloho, microcirculation le thibelo ea mathata a thrombotic, li-antiplatelet agents li laetsoe: reopoliglyukin, compliment, trental, fluvide, ticlide, joalo-joalo ts'ebeliso ea lithibela-mafu le kalafo ea matšoao li ka ntle ho pelaelo. E le ho thibela li-paresis tsa ka mpeng ka mor'a ho kenella methapong ea aorta le li-arac matsatsing a pele a 2-3, ho khothalletsoa phepo e nepahetseng ea botsoali.

Har'a mathata a nakong ea ts'ebetso ea hang-hang, ho bonoa: ho tsoa mali - 12%, thrombosis - 7-10%, ts'oaetso ea maqeba a postoperative - 1-3% (Liekwey, 1977). Ka tšebetso ea maiketsetso a sebaka sa basali sa aortic, lefu le fihla ho 33-37%, likotsi - 14-23% (A.A. Shalimov, N.F. Dryuk, 1979).

Liphetoho tse bonoang nakong ea ts'ebetso e ntlafatsang (H.G. VeeY, 1973) li ka aroloa:

• tšenyo ea litho tsa ka mpeng, e ka tlaase le e tsoang methapong,
• tšenyo ea lijana nakong ea ho theha kotopo bakeng sa bohlola,
• Proposis ea maiketsetso nakong ea ho ts'oaroa ha mongobo,
• embolism
• Ho tsoa mali ka lebaka la ho fokola hoa mmele,
• mathata a methapo ea kutlo (ho se sebetse hantle ha litho tsa pelvic ka lebaka la ischemia ea lesapo la mokokotlo).

2. Mathata a mantlha a ts'ebetsong:

• ho tsoa mali
• ho se sebetse hantle ha renal (oliguria ea nakoana nakong ea lihora tse 48),
• thrombosis ea methapo ea mali le methapo ea mali,
• intestinal paresis,
• ischemia ea intestinal le necrosis ka lebaka la ho lemala le mesenteric thrombosis,
• lymphorrhea le phepelo ea maqeba a postoperative.

3. Kamora mathata a ts'ebelisano ka mora nako:

• thrombosis ea lijana le ho ruruha ka lebaka la lefu le atang (atherosulinosis),
• li-aneurysms tsa bohata tsa anastomoses (ts'oaetso e khaohileng kapa ho se sebetse hantle ha likhoele tsa maiketsetso),
• aortic intestinal fistulas
• ts'oaetso ea lefu la matsoele
• ho hloka matla.

Ho thibela mathata a purulent ho bohlokoa. Mathata a morao-rao ka mor'a ts'ebetso e ntlafatsang a fumanoa ho 3-20% ka sekhahla sa lefu la 25-75%. Keketseho ea palo ea ts'ehetso ea postoperative e amanang le:

• kenyelletso ea lits'ebetso tse ncha tse rarahaneng le tse jang nako,
• lilemo tsa bakuli
• mafu a tšoaetsanoang a matla (mohlala, lefu la tsoekere),
• anemia, hypoproteinemia, khaello ea livithamini,
• phetsiso
• kalafo ea nakong e fetileng ea hormone
• Ho haella (ho se lekane) ho hula ha maqeba,
• tlamo ea khatello ka liphahlo tse sa tloaelehang, ho khahloa haholo ke lithibela-mafu le ho hlaha ha mefuta e hanyetsanang ea likokoana-hloko.
• keketseho ea koloi ea staphylococcal ho basebetsi le bakuli,
• ho fokolisa tlhokomelo ea lingaka ho melao ea khale ea asepsis le antiseptics. G.V. Lord (G.W. Lord, 1977) o arola phetisetso ea li-prostheses ho latela botebo ba ts'oaetso:
  • I degree - lesion letlalo,
  • Bophahamo ba II - tšenyo letlalong le linthong tse ka tlasana
  • Bophahamo ba III - Tšenyo sebakeng sa ho kenella ha makhopho.

1. Mehato ea thibelo: ho felisoa ha maqeba le liso tsa trophic, kalafo ea phokolo ea mali, tlhoekiso ea kelello ea ts'oaetso, bohloeki ba seteraeke sa matsatsi a 2-3 pele ho ts'ebetso ea bongaka.

2. Ho sebelisana: kalafo e phethahetseng ea letlalo, hemostasis ea mokhoa, phetoho ea liatlana maemong a mantlha a ts'ebetso, drainage ea maqeba.

3. Nakong ea ts'ebetso: ho khutlisetsa tahlehelo ea mali, lithibela-mafu tse pharalletseng bakeng sa matsatsi a 7-10, kalafo e loketseng ea infusion.

Ka ho fokotseha le ho pepeseha ha lefu lena, ho hlokahala hore ho hlatsuoe ka mafolofolo, ho lokisa leqeba le ho le koala le ho rala ka boqhetseke ba letlalo. Haeba kalafo e sa atlehe, ho na le tsela e tlileng pele e tlosoang ka lefu lena. Ho kenella ka sebete le ho nahannoeng hantle ho molemo ho feta mehato e lihlong, e sa nahaneleng le e senang thuso. Tabeng ea ts'ebeliso ea lithibela-mafu kapele, motho o lokela ho shebana le ho bona ts'ebetso e kenang, ts'ebetso ea liso tsa trophic le allotransplantation. Ho kenya letsoho ha bakuli ho latela boemo ba bona ka kakaretso le palo ea ts'ebetso ea ho buuoa. Ho tsamaea hangata ho lumelloa ka letsatsi la 3-5, leha ho le joalo, makasine ena e khethoa ka bomong boemong bo bong le bo bong.

Kamora ts'ebetso leha e le efe e ntlafatsang, bakuli ba lokela ho nka tekanyetso ea prophylactic ea antiplatelet le anti-atherogenic, ba sebelisoe ka mokhoa o hlophisehileng oa kalafo, 'me ba be tlas'a taolo ea kamehla ke Angiosurgeon.

Kahoo, hajoale ho na le boiphihlelo bo bongata bo fumanoeng mabapi le tlhahlobo le kalafo ea maloetse a arohanyang a methapo ea kutlo, e etsang hore maemong ka leng ho etsa tlhahlobo e nepahetseng le ho khetha mokhoa o nepahetseng oa kalafo.

Lipuo tse khethiloeng mabapi le angiology. E.P. Kohan, I.K. Zavarina

Atherossteosis obliterans ea lintho tse feteletseng: matšoao le kalafo

Ho senya atherosulinosis ea libaka tse tlase tse tlase ho tsamaisana le mafu a sa foleng, a atisang ho ama batho ba lilemo tse fetang 40. Ka ho fokotsoa hanyane ka hanyane ha lijana tsa maoto, matšoao a hypoxia a hlaha - ho ba le maoto le matsoho, ho felloa ke matla, ho opeloa ke mesifa ha ho tsamaea.

Ho thibela khafetsa ho ka thibela nts'etsopele ea mathata a amanang le ho ruruha, empa bakuli ba bangata ba na le maemo a kotsi:

• Ho Nona Haholo
• Keketseho ea mafura a mangata,
• Tlolo ea phepelo ea mali libakeng tse tlase ka lebaka la methapo ea varicose.

Atherosclerosis obliterans ea methapo e ka tlase ea maoto le matsoho

Liphetoho tsa ischemic mokokotlong oa botšehali ha li etsahale feela ka lipalo tsa atherosselotic. Pathology ea litho tsa pelvic, tsamaiso ea ho ikatisa, methapo ea varicose e tsamaea le khaello ea phepo e nepahetseng, oxygenation ea lebota la sekepe. Ho thibela vasheria atherosulinosis, ho hlokahala kalafo ea nako e tlang ea mathata a ho ikatisa.

Khafetsa e phahameng ea liplatelete ka hara mokokotlo oa basali ke ka lebaka la ho ba teng ha bifurcation ka aorta haufi le sekepe sena, sebaka sa karohano ho likutu tse peli. Sebakeng sena, ho na le mothapo o mongata oa mali nakong ea ho sisinyeha, e leng ho eketsang monyetla oa ho tepella le leboteng. Taba ea pele, ho bokelloa hoa mafura ho aorta, ebe ho oela ka tlase.

Claudication e kenelletseng ho lefu la methapo ea methapo ea methapo

Letšoao le tsebahalang haholo la setho sa maoto le matsoho ke ho etsa lintho ka nakoana. Pathology e lebisa ponahalong ea bohloko, letsoalo la maoto le matsoho. Ho imeloa ha mesifa ea mesifa ho lebisa ho bohloko ba butle butle.

Ka lefu la kelello, motho o na le matšoao a lefu la kelello. Boemo bo khetholloa ke ho se khotsofale, bohloko.

Ka claudication ea nako le nako, matšoao a "pathological" a hlaha leqeng le le leng. Butle-butle, nosology e fumana ho lumellana, e tsamaeang le lipontšo tsa bophatlalatsi bo kopaneng ba linaha tse peli. Ha o tsamaea, bohloko ba mesifa bo hlaha mokokotlong oa namane, pele ka lehlakoreng le leng ebe ka bobeli.

Botebo ba boemo bo khethoa ke sebaka seo motho a tsamaeang ho sona pele a qala ho utloa bohloko. Maemong a tebileng, bohloko bo bonahala bo sa tloha feela ha o ntse o potoloha sebaka sa sebaka se sa feteng 10 metres.

Ho ipapisitsoe le bohloko ba lehae, ho arohana ho arotsoe ka likarolo tse 3:

Ka sehlopha se phahameng, lefu la bohloko le hlahisoa ka ho khetheha mesifa ea gluteal. Nosology e atisa ho kopantsoe le lefu la Lerish (le nang le "plaque bifurcation").

Li-lameness tse tlase li tšoauoa ka bohloko ba namane. E etsahala ka ho tsepamisa mohopolo ha karolo ea boraro e ka tlase ea serope, e kopaneng.

Ho lemoha ho ikhetholla ha lintho nako le nako ho bonolo. Ntle le litletlebo tsa mokuli tsa bohloko mesifa ea namane ha a ntse a tsamaea, ho na le phallo ea ho ba sieo ha pente sebakeng sa sekepe se amehang - li-engac le femar artery, le lijana tsa leoto le tlase.

Tsela e matla e tsamaisana le tlolo ea mesifa ea trophic, e bonahatsoang ke ho fokotseha ha palo ea bona, cyanosis ea letlalo, cyanosis ea menoana. Leoto le amehang le bata ho ama.

Tšenyo ea Ischemic likarolong tse tlase e tsamaea le tšenyo ea methapo ea methapo, ho ruruha ha leoto, leoto. Ho Psychology, bakuli ba na le boemo ba 'mele bo qobelloang - ba boloka maoto a le mathateng.

Tlhokomelo ea atherosulinosis e senyehang:

1. Ho utloa bohloko ha o tsamaea sebaka se fetang kilometer. Ho na le bohloko feela ka ho ikoetlisa ka matla. Maeto a malelele ha a khothalletsoe ka lebaka la ischemia e matla ea leoto,
2. Mothati oa 1 o tšoauoa ka ponahalo ea likhakanyo tsa nakoana nakong ea ha a tloha ho limithara tse 250 ho isa ho kilometer e le ngoe ka nako ea nako. Litoropong tsa sejoale-joale, maemo a joalo ha a bopehe hangata, ka hona, motho ha a utloe a sa thaba. Batho ba libakeng tsa mahaeng ba kotsing e kholo ea ho tšoaroa ke lefu la ho nyefola,
3. Mothati oa 2 o tšoauoa ka bohloko ha o tsamaea limithara tse fetang 50. Boemo bo isa ho qobelloeng ha leshano kapa boemo bo lutseng ba motho ha a tsamaea,
4. Mothati oa 3 - ischemia e bohlokoa, e nts'etsopele ka ho fokotseha hoa methapo ea maoto. Pathology e tšoauoa ka bohloko ha o tsamaea maeto a makgutshwane. Boemo bo khetholloa ke ho holofala le ho holofala. Ho khathatsoa ke boroko ho bakoa ke bohloko bosiu,
5. Mothati oa 4 oa mathata a trophic a bonahatsoa ke ho thehoa ha necrotic foci, e leng tlolo ea molao ea phatlalatso ea phepelo ea mali ka nts'etsopele ea morao ea gangrene ea liphula tse tlase.

Ka nts'etsopele ea mathata a occlusal-stenotic, ho na le ho felisoa hoa karolo ea aorto-iliac, tšenyo sebakeng sa popliteal-tibial. Ka psychology, morphologists ba hlokomela seo ho thoeng ke "tšenyo e mengata ea lipalesa tsa methapo." Bophelong bohle ba ntho e ithutoang, li-cholesterol tse netefalitsoeng li bonoa.

Ho ata ha atherosclerosis obliterans ho arotsoe ka mekhahlelo:

• Ho arohana ho karolo - sekoto se le seng feela se oelang setsing sa microcirculation,
• Tloaelo e tloaelehileng (sehlopha sa 2) - lesapo la mokokotlo o matla oa basali,
• Ho thibela marapo a popliteal le a basali ka mokhoa o senyehileng oa sebaka se ikhethileng,
• Ho blockage ho felletseng ha li-microcirculation ka har'a methapo ea popliteal le ea basali - 4 degree. Ka pathology, phepelo ea mali tsamaisong ea methapo e meholo ea basali e bolokiloe,
• Tšenyo ea methapo e tebileng ea basali ka tšenyo tikolohong ea basali. Kereiti ea 5 e khetholloa ke hypoxia e matla ea liphula tse tlase le necrosis, trophic gangrene ulcers. Boemo bo tebileng ba mokuli ea leshano bo thata ho bo rarolla, ka hona kalafo e bontša feela.

Mefuta ea lesapo la "occlusal stenotic" ho atherosulinosis e hlahisoa ke mefuta e meraro:

1. Tšenyo e lebisang karolong e ka thoko ea methapo ea methapo ea methapo ea mali ka popelong, moo mali a pholohang leoto le tlase a bolokiloe.
2. Vascular occlusion ea leoto le ka tlase. Patency ho tibia le popliteal artery e bolokiloe,
3. Sebopeho sa lisebelisoa tsohle tsa serope le leoto le tlase ka ho boloka likarolo makaleng a arohaneng a methapo ea methapo.

Matšoao a ho felisoa ha atherosclerosis ea lijana tsa lipheo tse tlase

Matšoao a ho felisoa ha lipallo tse tlase a atisoa ka bongata. Ka lipontšo tsohle ho tloha sebakeng sa pele, claudication ea nakoana, e tšoaeang lefu la methapo.

Matšoao 'ohle a ho senyeha ha methapo ea methapo methapong ea maoto a arotsoe habonolo hore e be a pele le morao. Matšoao a pele a ho bea mafura ka har'a lijana tsa maoto le matsoho:

• Hypersensitivity ketso ea sefuba. Lipelaetso tsa ho hahaba, bocha, ho chesa, ho hlohlona, ​​bohloko bo namaneng,
• Lefu la Lerish le tsamaisana le bohloko mesifaaneng e boreleli, sebaka se ka morao se nang le letheba le fumanehang karolong ea aortic-iliac,
• Atrophy ea mafura a tlotsitsoeng, mesifa ea mesifa,
• Ho kuta moriri leoto le serope,
• Hyperkeratosis ea lipekere,
• Ho nyekeloa ha lipoleiti,
• Londa tse sa foleng tsa trophic,
• Ho thehwa ha poone molemong oa tšenyo ea letlalo.

Ho senyeha ha atherosclerosis ho tšoauoa ka litšitiso tse matla le phetoho ea maoto a trophic ho fihlela gangren.

Ho 45% ea bakuli, bohloko bo thehoa ka lebaka la ho ts'oaroa khafetsa kamora ho hlakoloa ha kalafo e sebetsang ka phetoho ea ts'ebetso ea ts'ebetso ea thibelo. Pheko ea nako le nako ea maikutlo e khothaletsoa batho ba nang le khafetsa khafetsa.

Ts'oaetso

Haeba matšoao a ka holimo a bonoa, mokuli o lokela ho batla boeletsi ba angiosurgeon, eo ka mor'a ho hlahloba mokuli a tla mo fa tlhahlobo ea tlhahlobo. Ho fumana ts'oaetso ea lefu lena, ho ka ngolisoa mefuta e latelang ea liteko tsa laboratori le tsa lisebelisoa:

• Teko ea mali bakeng sa sebopeho sa lipids, mokokotlo oa fibrinogen, tsoekere,
• hlahlobisisa ho bona hore na ho tsoa mali neng,
• Ultrasound ea likepe tse nang le dopplerography,
• angiography le moemeli ea fapaneng,
• rheovasography
• MRI
• CT e sebetsana le moemeli ea fapaneng.

Kamora ho tseba sethala sa lefu lena, mokuli o fuoa kalafo e felletseng.

Maano a ho phekola atherosclerosis obliterans ea likepe tse lipheletsong tse tlase a ipapisitse le sethala sa nts'etsopele ea ts'ebetso ea methapo mme a ka kenyelletsa mekhoa ea ho boloka kapa ho buuoa.

Qalong ea kalafo, mabaka a tlatsetsang ho ateng ha lefu lena a felisoa:

1. Khalemelo ea boima ba 'mele.
2. Ho tlohela ho tsuba le mekhoa e meng e mebe.
3. Ntoa khahlanong le ho se sebetse 'meleng.
4. Ho hana ho ja lijo tse nang le cholesterol e ngata le mafura a liphoofolo (Lijo No. 10).
5. Taolo ea khatello ea mali le ho felisoa ha khatello ea mali.
6. Fokotsa boemo ba cholesterol e "mpe".
7. Ho shebella khafetsa maemo a tsoekere ho lefu la tsoekere.

Bakuli ba methating e qalang ea lefu lena ba ka khothaletsoa ho sebelisa meriana e joalo:

• Lithethefatsi tsa ho fokotsa cholesterol - Lovastatin, Quantalan, Mevacor, Cholestyramine, Zokor, Cholestid,
• Lithethefatsi tsa ho fokotsa triglycerides - clofibrate, bezafibrat,
• litokisetso tsa ho tsitsisa microcirculation le ho thibela thrombosis - Cilostazol, Pentoxifylline, Clopidogrel, Aspirin, Warfarin, Heparin,
• Lithethefatsi tsa ho theola khatello ea mali - Atenolol, Betalok ZOK, Nebilet,
• Lithethefatsi tsa ho ntlafatsa trophism ea lisele - Nikotinic acid, Nikoshpan, livithamini tsa B,
• li-multivitamin complexes.

Mekhoa ea physiotherapeutic (microcurrents, laser therapy), balneotherapy le hyperbaric oxygenation e ka fuoa kalafo bakeng sa kalafo ea li-arteriosulinosis obliterans tsa likarolo tse tlase.

Matšoao a ho buuoa a ka kenyelletsa:

• matšoao a boloi
• bohloko bo boholo ba ho phomola,
• thrombosis
• khatelo-pele e potlakileng kapa mohato oa boraro-IV oa atherosulinosis.

Mehatong ea pele ea lefu lena, mokuli a ka buuoa ka makhetlo a hlaselang:

• balloon angioplasty - catheter e ikhethileng e nang le balune e kenngoa ka har'a mokoallo ka lesoba la moea, ha moea o kenngoa ka balune, mabota a artery a otlolohile.
• cryoplasty - mokhoa ona oa ho qhekella o tšoana le balloon angioplasty, empa keketseho ea artery e etsoa ho sebelisoa li-coolants, tse ke keng tsa atolosa feela lumen ea sekepe, empa hape ea senya li-deposits tsa atherosranceotic.
• stenting - masenke a khethehileng a kenngoa ka leseli la mokokotlo, o nang le litokisetso tse fapa-fapaneng tsa timetso ea li-sclerotic plaque.

Ha o etsa ts'ebetso e joalo e sa rateheng, angiography e sebelisoa ho laola mekhoa e entsoeng. Lits'oaetso tsena li ka etsoa lipetleleng tse ikhethang. Kamora ts'ebetso, mokuli o tlas'a tlhokomelo ea bongaka bakeng sa letsatsi, a ka khutlela hae ka le hlahlamang.

Ka ho fokotseha ho hoholo hoa lumen ea artery bakeng sa kalafo ea opereishene, ho sebelisoa mekhoa e joalo e bulehileng:

• ho sisinyeha - nakong ea ts'ebetso, sekepe sa maiketsetso se bōpiloe ka thepa ea maiketsetso kapa likarolo tsa methapo e meng e nkuoeng ho mokuli,
• endarterectomy - nakong ea ts'ebetso, sebaka sa mokelikeli se anngoeng ke letsopa la atherosselotic se tlosoa.

Ntle le ts'ebetso e joalo e ntlafatsang, ho ka sebelisoa mekhoa e meng e thusang ea ho buoa:

• revascularizing osteotomy - kholo ea methapo e mecha ea mali e susumetsoa ke tšenyo ea masapo,
• kutloelo-bohloko - tšubuhlellano ea methapo ea kutlo e etsang hore methapo ea methapo e sebetse hantle, 'me e etsoa ka mokhoa oa ho phatloha ha methapo ea methapo ea methapo.

Ka ho theha liso tsa kahare tse se nang pholiso ea masapo a maholo kapa tse nang le matšoao a setho sa lesapo la mokokotlo, ho buoa ka polasetiki ho ka etsoa ka lipalo tse phetseng hantle tsa letlalo kamora ho tlosoa ha likarolo tse mpe kapa ho pongoa karolo ea leoto le ka tlase.

Boprofeta esale pele bakeng sa kalafo ea ho senyeha ha atherosulinosis ea likepe tse lipheletsong tse tlase bo loketseng kalafo ea pele ea mokuli ke angiosurgeon. Kamora lilemo tse 10 nts'etsopele ea pathology ena, nts'etsopele ea thrombosis kapa gangrene e bonoa ho 8% ea bakuli.

Thibelo

Ho thibela nts'etsopele ea atherosulinosis ea methapo ea methapo e tlase, ho ka nkuoa mehato e latelang:

1. Phekolo ea nako le nako ea maloetse a sa foleng.
2. Tlhahlobo e tsoelang pele ea bongaka ea bophelo bo botle kamora lilemo tse 50.
3. Ho hana mekhoa e mebe.
4. Phepo e nepahetseng.
5. Ntoa khahlanong le ho se sebetse 'meleng.
6. Phallo ea maemo a sithabetsang.
7. Ho loantša boima ba 'mele.

Sena ke eng

Atherosclerosis obliterans ke mofuta oa atherosulinosis. Ka lefu lena, li-cholesterol plaque li thea maboteng a methapo ea kutlo, li senya phallo e tloaelehileng ea mali, li baka vasoconstriction (stenosis) kapa blockage e felletseng, e bitsoang occlusion kapa ho senyeha, kahoo ba bua ka liso tsa occlusal-stenotic tsa methapo ea maoto.

Ho latela lipalo-palo, tokelo ea ho ba teng ha mafu a kelello ke ea banna ba baholo ho feta lilemo tse 40. Ho arohana ha atherosulinosis ea lipheo tse tlase ho etsahala ho 10% ea palo eohle ea Lefatše, mme palo ena e lula e eketseha.

Lisosa tsa ho hlaha

Sesosa se ka sehloohong sa atherosclerosis ke ho tsuba. Nikotine e tšetsoeng koae e baka methapo ea methapo, ka hona e thibela mali ho tsamaea ka har'a methapo le ho eketsa kotsi ea likhahla tsa mali ho tsona.

Lintho tse ling tse bakang atherosulinosis ea methapo ea methapo e tlase le ho lebisa ho qaleheng hoa lefu le lefu le matla:

• cholesterol e phahameng e sebelisoang khafetsa lijo tse nang le mafura a liphoofolo,
• khatello e phahameng ea mali
• ho nona haholo
• bokapele ba lefutso
• lefu la tsoekere
• ho se ikoetlise ka ho lekaneng
• khatello ea maikutlo khafetsa.

Pholile ea frostbite kapa ea nako e telele ea maoto, e fetisitsoeng a le monyane oa serame, le eona e ka ba kotsi.

Sistimi ea nts'etsopele

Hangata, atherosulinosis ea lijana tsa bophahamo bo tlase e iponahatsa botsofaling mme e bakoa ke metabolism ea lipoprotein e sa bonahaleng. Mokhoa oa ntlafatso o feta methating e latelang.

1. K'holeseterole le li-triglycerides tse kenang 'meleng (tse kenngoeng leboteng) li tšoaroa ke liprotheine tse khethehileng - liprotheine - li-chylomicrons ebe li fetisetsoa maling.
2. Sebete se sebetsana le lintho tse hlahang 'me se kopanya likarolo tse khethehileng tsa mafura - VLDL (cholesterol e tlase haholo).
3. Maling, lipoproteidlipase enzyme e sebetsa ho limolek'hule tsa VLDL. Boemong ba pele ba karabelo ea lik'hemik'hale, VLDLP e fetela lipoprotein tse mahareng (kapa STLPs), 'me mohato oa bobeli oa karabelo, VLDLP e fetoha LDLA (cholesterol e tlase). LDL ke k'holeseterole e "mpe" 'me ke eona e atherogenic (ka mantsoe a mang, e ka bakang atherosclerosis).
4. Likaroloana tse nang le mafura li kena sebeteng bakeng sa tšebetso e eketsehileng. Mona, k'holeseterole e nang le "high-density cholesterol" (HDL) e thehoa ho tsoa lipoproteins (LDL le HDL), e nang le litlamorao tse fapaneng mme e khona ho hloekisa mabota a methapo ea mali ho tsoa mekhahlelong ea cholesterol. Ena ke seo ho thoeng ke k'holeseterole e “ntle”. Karolo ea joala e nang le mafura e kenngoa ka har'a metsoako ea metso ea lijo, e hlokahalang bakeng sa ts'ebetso e tloaelehileng ea lijo, 'me e romeloa mala.
5. Mothating ona, lisele tsa hepatic li ka hloleha (liphatsa tsa lefutso kapa ka lebaka la botsofe), ka lebaka la hore ha HDL e le teng, likaroloana tsa mafura a fokolang li tla lula li sa fetohe ebe li kena maling.

Ha ho na tlase, 'me mohlomong le agrogenic e ngata, e fetotsoe kapa e fetotsoe ka lipoprotein. Mohlala, oxidised ka ho pepesetsoa H2O2 (hydrogen peroxide).

1. Likarolo tse tlase tsa mafura a manyane (LDL) a lula marakong a methapo ea methapo e tlaase. Ho ba teng ha nako e telele linthong tse tsoang ka ntle ho lumen ea methapo ea mali ho kenya letsoho ho ruruheng. Leha ho le joalo, li-macrophages kapa leukocytes ha li khone ho sebetsana le likaroloana tsa cholesterol. Haeba ts'ebetso ena e ts'oaroa, ho theoa litheko tsa joala bo nang le mafura - liphooko. Li-amana tsena li na le letsoalo le phahameng haholo ebile li kena-kenana le phallo e tloaelehileng ea mali.
2. Ho kenyellelitsoe methapo ea "cholesterol" e mpe, 'me mali a ba teng nakong ea likotsi kapa ho senyeha ha sephutsoana. Ho ts'oana ha mali ho na le matla a tlatsetsang ho eona a makatsang le methapo ea methapo e koalehang le ho feta.
3. Butle-butle, karoloana ea k'holeseterole e kopantsoe le ho chesoa ha mali e tsoakana hantle, ka lebaka la letsoai la calcium. Mabota a methapo ea methapo a lahleheloa ke ho atoloha ho tloaelehileng ebe a fetoha brittle, e leng se bakang ho phatloha. Ntle le ntho e ngoe le e ngoe, ischemia e phehellang le necrosis ea lisele tse haufi li thehoa ka lebaka la hypoxia le khaello ea limatlafatsi.

Nakong ea phello ea atherosulinosis ea lipalo tse tlase, methati e latelang e khethollotsoe:

1. Mothati oa pele (liponahatso tsa pele tsa lefu la sethoathoa) - maikutlo a hoosebumps, letlalo le koahelang letlalo, maikutlo a batang a ho bata, ho fufuleloa ho feteletseng, mokhathala o potlakileng ha o tsamaea,
2. II A sethala (lipakeng tsa nakoana) - maikutlo a ho tepella le ho satalla mesifa ea namane, ho hatella bohloko ha o leka ho tsamaea ka 200 m,
3. Boemo ba II B - bohloko le maikutlo a ho satalla ha li u lumelle ho ea 200 m,
4. Mothati oa III - bohloko bo ikhethileng mesifa ea namane bo tebile haholo mme bo bonahala le ha o phomola,
5. Mohato oa IV - holim'a leoto ho na le matšoao a ho hloka taolo, liso tse telele tse sa foliseng le matšoao a bohloka.

Mehatong e tsoetseng pele ea atherosclerosis ea likarolo tse tlase, nts'etsopele ea gangrene hangata e lebisa ho lahleheloa ke leoto ka botlalo kapa ka mokhoa o itseng. Ho haella ha tlhokomelo ea bongaka e lekaneng maemong a joalo ho ka lebisa lefung la mokuli.

Ho ata ha atherosclerosis obliterans ho arotsoe ka mekhahlelo:

1. Ho arohana ho karolo - sekoto se le seng feela se oelang setsing sa microcirculation,
2. Tloaelo e tloaelehileng (sehlopha sa 2) - lesapo la mokokotlo o matla oa basali,
3. Ho thibela marapo a popliteal le a basali ka mokhoa o senyehileng oa sebaka se ikhethileng,
4. Ho blockage ho felletseng ha li-microcirculation ka har'a methapo ea popliteal le ea basali - 4 degree. Ka pathology, phepelo ea mali tsamaisong ea methapo e meholo ea basali e bolokiloe,
5. Tšenyo ea methapo e tebileng ea basali ka tšenyo tikolohong ea basali. Kereiti ea 5 e khetholloa ke hypoxia e matla ea liphula tse tlase le necrosis, trophic gangrene ulcers. Boemo bo tebileng ba mokuli ea leshano bo thata ho bo rarolla, ka hona kalafo e bontša feela.

Mefuta ea lesapo la "occlusal stenotic" ho atherosulinosis e hlahisoa ke mefuta e meraro:

1. Tšenyo e lebisang karolong e ka thoko ea methapo ea methapo ea methapo ea mali ka popelong, moo mali a pholohang leoto le tlase a bolokiloe.
2. Vascular occlusion ea leoto le ka tlase. Patency ho tibia le popliteal artery e bolokiloe,
3. Sebopeho sa lisebelisoa tsohle tsa serope le leoto le tlase ka ho boloka likarolo makaleng a arohaneng a methapo ea methapo.

Matšoao a OASNK mekhatlong ea pele, e le molao, a boreleli kapa ha a eo ho hang. Ka hona, lefu lena le nkoa le le kotsi ebile le sa lebelloa. Ke tšenyo ea methapo e atang ho hola butle, 'me ho teba ha matšoao a kliniki ho tla ipapisa le sethala sa lefu lena.

Matšoao a pele a ho felisoa ha atherosulinosis ea likarolo tse tlase (mokhatlong oa bobeli oa lefu lena):

• maoto a qala ho bata kamehla
• maoto a lula a akheha
• ho ruruha ha maoto ho etsahala
• haeba lefu le ama leoto le le leng, le lula le bata ho feta le phetseng hantle.
• bohloko maotong ka mor'a ho tsamaea nako e telele.

Liponahatso tsena li hlaha mohatong oa bobeli. Mothating ona oa nts'etsopele ea atherosulinosis, motho a ka tsamaea limithara tse 1000-1500 ntle le bohloko.

Hangata, batho ha ba nke bohlokoa ba matšoao a kang ho bata, ho tsitsipana ha linako, bohloko ha u tsamaea maeto a malelele. Empa ha ho na thuso! Ntle le moo, ho qala kalafo mohatong oa bobeli oa pathology, o ka thibela 100% mathata.

Matšoao a hlahang mehatong e 3:

• lipekere li hola butle ho feta pele
• maoto a qala ho akheha
• bohloko bo ka hlaha hanghang mots'eare le bosiu,
• bohloko bo hlaha kamora ho tsamaea libaka tse khutšoane (250- 900 m).

Ha motho a e-na le methapo ea 4 e senyehang ea lefu la maoto, a ke ke a tsamaea limithara tse 50 ntle le ho utloa bohloko. Bakeng sa bakuli ba joalo, esita le leeto la mabenkele e ba mosebetsi o boima, 'me ka linako tse ling e ea feela ka jareteng, ha ho nyoloha ka litepisi ho fetoha tlhokofatso. Hangata, bakuli ba nang le lefu la 4 ba ka potoloha ntlo. Ha mathata a ntse a eketseha, ha a sa tsoha ho hang.

Mothating ona, kalafo ea lefu le felisang atherosulinosis ea likarolo tse tlase hangata e hloka matla, e ka imolla matšoao nakoana le ho thibela mathata a mang, a kang:

• ho fifatsa letlalo ka maoto,
• liso
• gangrene (ka bothata bona, ho pongoa leoto hoa hlokahala).

Likarolo tsa thupelo

Matšoao ohle a lefu lena a hlaha butle-butle, empa maemong a sa tloaelehang, ho senyeha ha atherosulinosis ea likepe tsa likarolo tse tlase ho iponahatsa ka tsela ea arterial thrombosis. Joale, sebakeng sa artery stenosis, ho hlaha thrombus, e koalang hanghang le ka tieo lesapo la mokokotlo. Psychology e tšoanang le ena ea mokuli e ba teng ka tšohanyetso, o ikutloa a ts'oha haholo ha a phela hantle, letlalo la leoto le fetoha le boreleli, 'me lea bata. Maemong ana, boipiletso bo potlakileng (ho bala nako ea liketsahalo tse ke keng tsa fetoloa - ka lihora tse ngata) ho ngaka e buoang methapo eu lumella ho boloka leoto la motho.

Ka lefu le kopaneng - lefu la tsoekere, mokhoa oa ho felisoa ha atherosclerosis o na le litšobotsi tsa oona. Nalane ea li-pathologies tse joalo ha e fumanehe seoelo, ha lefu lena le hlaha ka potlako haholo (ho tloha lihora tse 'maloa ho isa matsatsing a' maloa) hoo ka nako e khuts'oane le isang ho necrosis kapa gangrene seterekeng sa libaka tse tlase. Ka bomalimabe, lingaka hangata maemong a joalo li sebelisa ho khaoloa leoto - ke eona feela ntho e ka pholosang bophelo ba motho.

Tlhahisoleseling ka kakaretso

Atherosclerosis obliterans - lefu le sa foleng la methapo ea methapo ea kutlo, le khetholloang ka lesapo la moea le ho baka ischemia ea liphula tse tlase. Ka lefu la pelo le methapo ea methapo, atherosclerosis obliterans e nkuoa e le mofuta o hlahelletseng oa tleliniki ea atherosulinosis (e leng ea boraro e atileng haholo kamora lefu la methapo ea methapo ea mokokotlo le ischemia e sa foleng). Ho senyeha ha atherosulinosis ea liphello tse tlase ho etsahala ka makhetlo a 3-5%, haholoholo ho banna ba baholo ho feta lilemo tse 40. Lesloplous-stenotic lesion hangata e ama likepe tse kholo (aorta, artery artery) kapa methapo e meholo e bohareng (popliteal, tibial, femoral). Ka atherosclerosis obliterans ea methapo ea methapo e holimo, hangata methapo ea methapo e sa ameheng.

Lisosa tsa atherosulinosis e felisang

Ho arohana le atherosulinosis ke sesupo sa systemic atherosulinosis, ka hona, ho ba teng ha eona ho amana le ts'ebetso e ts'oanang ea etiological le pathogenetic e bakang lits'ebetso tsa atherosselotic tsa lehae le leng.

Ho latela mohopolo oa sejoale-joale, tšenyo ea methapo ea methapo e khothalletsoa ke dyslipidemia, phetoho seterekeng sa methapo ea methapo, ts'ebetso e senyehileng ea lisebelisoa tsa receptor, le lebaka la lefutso. Liphetoho tse ka sehloohong tsa methapo ea methapo ea methapo e fokolisang methapo ea methapo li ama ho fokola ha methapo ea methapo. Ho pota-potiloe ke poleloana ea lipoidosis, mesifa e sebetsang ea hola ea hola le ho hola, e tsamaellanang le ho etsoa hoa lipopae tse nang le masapo, ho raloa liplatelete le li-fibrin clots ho tsona.

Ka mathata a ho potoloha le ho potoloha ha methapo, methapo ea methapo e tlatsitsoe ka lesapo la mokokotlo le maselese a atheromatous. Qetellong, e kenella ka har'a leseli la methapo ea methapo, e ka kena maling a tsoang hare, ea baka methapo ea methapo.Ho hlahisoa ha letsoai la khalsiamo liphoofolong tse fetotsoeng tse phetheselang ho tlatsa lesapo le senyehileng la likepe, e leng se lebisang bothateng ba tsona. Arterial stenosis e fetang 70% ea bophara bo tloaelehileng e lebisa phetohong ea tlhaho le lebelo la phallo ea mali.

Lintlha tse rerileng ho hlaha ha atherosclerosis e felisang ho tsuba, ho tsuba, joala bo phahameng, k'holeseterole e phahameng, lefutso, lefu la ho ikoetlisa ka matla a pelo, ho imeloa ke methapo, ho khaotsa ho ilela khoeli. Atherossteosis obliterans hangata e hlaha khahlano le semelo sa maloetse a kopaneng - khatello ea methapo, lefu la tsoekere, lefu la tsoekere, lefu la ho fokola ha masapo, hypothyroidism, lefuba, rheumatism. Lintho tse sebelisoang sebakeng sa heno tse tlatsetsang ho lesapo le holofatsang la methapo ea methapo li kenyelletsa serame sa nakong e fetileng tsa leqhoa, leqeba la leoto. Hoo e batlang e le bakuli bohle ba nang le atherosulinosis obliterans, atherosclerosis ea lijana tsa pelo le bokong ba bonoa.

Tlhotlhomiso ea atherosulinosis e senyehang

Nakong ea ho felisoa ha atherosulinosis ea liphihlelo tse tlase, mekhahlelo e mene e khetholisitsoe:

• 1 - Ho tsamaea ntle le bohloko ho ka khoneha ka sebaka se fetang limithara tse 1000. Bohloko bo hlaha feela ka ho ikoetlisa ka matla.
• 2a - ho se utloise bohloko ho sa tsamae letho ka 250-1000 m.
• 2b - ho se utloise bohloko ho sa tsamae letho ka 50-250 m.
• 3 - sethala sa ischemia ea bohlokoa. Sebaka sa ho tsamaea se se nang bohloko ha se tlase ho limithara tse 50. Bohloko bo boetse bo etsahala nakong ea ho phomola le bosiu.
• 4 - sethala sa mathata a trophic. Libakeng tsa calcaneal le menoaneng ho na le libaka tsa necrosis, tseo nakong e tlang li ka bakang litho tsa mpa.

Ha ho fanoa ka tlhahiso ea lehae ea ts'ebetso ea occlusal-stenotic, ho ka khetholoha tse latelang: atherosulinosis obliterans ea karolo ea aorto-iliac, karolo ea basali-popliteal, karolo ea popliteal-tibial, tšenyo ea methapo ea methapo. Ka mofuta oa lesion, stenosis le occlusion lia khetholoha.

Ho ata ha atherosmithosis obliterans ea methapo ea botšehali le ea popliteal ho khetholla mefuta ea V ea liso tsa maiketsetso tse amanang le maikutlo:

• I - - limited - seoplane
• II - lesse le tloaelehileng la mokokotlo o matla oa basali,
• III - tloaelo e pharalletseng ea methapo e meholohali ea basali le ea popliteal, sebaka sa trifurcation ea mothapo o mongata oa popelo se khona ho feta,
• IV - ho felisoa ka botlalo hoa sebopeho se phahamenghali sa botšehali le botšehali, ho felisoa ha sehokelo sa methapo e sabaletseng ea popliteal, patency ea methapo e tebileng ea basali ha e senyehe.
• V - lesapo le phatsimang la setho sa botšehali le sebopeho se matla sa botšehali.

Likhetho bakeng sa lesapo la popliteal-tibial la karolo ea popliteal-tibial ho atherosclerosis e felisang li emeloa ke mefuta ea III:

• - Ho senyeha ha methapo ea pelo ea popliteal karolong e ka thoko ea methapo le methapo ea methapo likarolong tsa pele, patency ea methapo ea leoto e 1, kapa e 3 e bolokiloe,
• II - ho senyeha ha methapo ea leoto le ka tlase, karolo e arolang ea methapo ea methapo ea popliteal le tibial e khona ho feta,
• III - ho felisoa ha methapo ea methapo ea popliteal le tibial, likarolo tsa motho ka mong tsa methapo ea leoto le leoto le tlase lia feta.

Phatlalatso le thibelo ea ho senyeha ha atherosclerosis

Atherosclerosis obliterans ke lefu le kotsi le nkang sebaka sa 3 ho sebopeho sa lefu le tsoang ho lefu la pelo. Ka lefu la ho senyeha ha litho tsa kahare, ho na le kotsi e kholo ea ho tšoaroa ke lefu la ho ruruha, le hlokang ho khaoloa leoto le phahameng. Tsoelo-pele ea lefu le felisang maemo a liphihlelo li ikemiselitsoe haholo ke ho ba teng ha mefuta e meng ea atherosmithosis - cheri, coronary. Mokhoa oa ho felisa atherosclerosis, joalo ka molao, ha o monate ho batho ba nang le lefu la tsoekere.

Mehato e akaretsang ea thibelo e kenyelletsa ho felisoa hoa mabaka a kotsi bakeng sa atherosclerosis (hypercholesterolemia, botenya, ho tsuba, ho se ikoetlise 'meleng, jj.). Ho bohlokoa haholo ho thibela likotsi tsa maoto, tlhokomelo ea bohloeki le thibelo ea maoto, le ho roala lieta tse hantle. Lithuto tse hlophisehileng tsa kalafo e bolokang ho felisoa ha atherosulinosis, hammoho le ts'ebetso e ntlafatsang ea nako e tlang, e ka boloka leoto mme ea ntlafatsa haholo boleng ba bophelo ba bakuli.