Polyneuropathy ea lefu la tsoekere e bontšoa le ho phekoloa joang?

Polyneuropathy ea likarolo tse tlase ke motsoako o tloaelehileng oa lefu la tsoekere. Lesion ena e ama methapo ea kutlo e hole haholo le boko mme e ka tsamaisana le bohloko, ho se tsamaee hantle, ho fokotsa boleng ba bophelo ba mokuli.

Le lefu la tsoekere la polyneuropathy ea likarolo tse tlase e kae

Diabetesic polyneuropathy ea likarolo tse tlase tse tlase e tšoauoa ka tšenyo ea likhoele tse 'maloa tsa methapo tse ikarabellang bakeng sa ts'ebetso ea koloi le leqhubu la eona - bohloko, mocheso, tactile (tactile).

Synonyms: lefu la tsoekere la limela tse nang le tsoekere tse maemong a tlase, lefu la tsoekere la mofuta oa polyneuropathy, distal symmetric sensorimotor polyneuropathy.

Pathology e qala ka ho halefisoa ke methapo ea methapo, ha nako e ntse e tsamaea, lefu la bona le etsahala. Ka lebaka leo, pono ea matšoao a bokong le mokokotlo e khathatseha maotong, 'me ha tšosoa letlalo le mesifa. Liphetoho tsena li ka tsamaisana le bohloko, phetoho ea gait.

Ho lefu la tsoekere le polyneuropathy ea likarolo tse tlase, ho senyeha ha mesifa ea methapo

Matšoao a etsang hore ho be le monyetla oa ho beha mokuli kotsing ea ho ba le lefu la tsoekere la tsoekere:

• nako ea lefu la tsoekere e feta lilemo tse hlano,
• retinal capillary mathata a
• botenya
• khatello ea mali
• lefu la pelo
• bokapele ba lefutso
• paramethara ea laboratori: lipids tse ngata (cholesterol, lipoprotein) ea mali le albin ea moroto.

Mofuta oa lefu la tsoekere ha o ame tlokotsi ea autonomic polyneuritis.

Lisosa le mabaka a kotsi

Ha boemo bo phahameng ba tsoekere bo ntse bo le maling, ho ka ba bonolo le ho feta hore nts'etsopele ea polymenturopathy ea lefu la tsoekere e mpe le ho feta. Mehato ea nts'etsopele ea lefu lena ha e so hlakisoe, leha ho le joalo, ho nahanoa hore lefu la methapo ea methapo le amana haufi le ts'ebetso ea methapo ea methapo e bakoang ke tlolo ea ts'ebeliso ea glucose e tloaelehileng ke lisele tsa 'mele.

Kahoo, lebaka le ka sehloohong la nts'etsopele ea distal polyneuritis ke lefu la tsoekere, 'me lebaka le ka sehloohong ke ho eketseha ha tsoekere ea mali (hyperglycemia).

Mabaka a mang a kotsi a kenyelletsa ho tsuba.

Matšoao a lefu la tsoekere la polyneuritis ea tsoekere

Karolong ea pele (subclinical), lefu lena ha le khathatse mokuli. Ka nako e ts'oanang, tlhahlobo ea methapo e senola matšoao a latelang:

• tlolo ea kutloelo-bohloko ea letlalo la leoto,
• fokotsehile maikutlo a tebileng a tebileng.

Ha lefu le ntse le tsoela pele, karolo ea bongaka (e tsamaeang le lipontšo tsa kantle) e etsahala.

Matšoao a mantlha:

• fokotseha ha mocheso oa letlalo la leoto,
• sensor of "goosebumps", tinging,
• hypnothesia (hypersensitivity to light touch),
• cramps
• bohloko ba tlhaho e fapaneng le matla.

Bakeng sa bakuli ba nang le lefu la tsoekere la lefu la tsoekere, ho ba le karabelo e makatsang hangata - ho ka lehlakoreng le leng, ho hloka kutloelo-hloko ha litšusumetso tsa kantle, ka lehlakoreng le leng, bohloko bo sa amaneng le tsusumetso ea kantle.

Matšoao a polyneuropathy ea lefu la tsoekere, e le molao, a qala ho bonahala ha feela ts'ebetso ea methapo ea methapo e lebisitse liphetoho tse ke keng tsa fetoloa

Tšenyo e 'ngoe methapong ea methapo e tsamaisana le matšoao a latelang:

• ho omella le mokhathala oa letlalo la leoto,
• atrophy ea mesifa
• maikutlo a "li-socks" maotong,
• ho nolofatsa methapo ea maoto, sebopeho sa "lesapo" sebakeng se kopaneng sa monoana,
• ho hloka botsitso,
• paresis ea leoto,
• maikutlo a "liatlana" matsohong.

Ho lefu la tsoekere la polyneuritis, maoto ka bobeli a tloaetse ho ameha tšebetsong ea methapo.

50-80% ea bakuli ba na le mofuta oa lefu lena le se nang bohloko (asymptomatic). Maemong a joalo, lesion e ka fumanoa maemong a mathata - ka ponahalo ea liso tsa trophic.

Tsebiso le tlhahlobo ea tlhahlobo

Bakeng sa ts'oaetso ea lefu la polyonomia ea cyturia, tlhahlobo ea methapo e sebelisoa ka lisebelisoa tse latelang:

• monofilament - ho lekola litakatso tsa maikutlo,
• tunk fereko - bakeng sa ho lekola kutloisiso ea vibration,
• "Malebela a Neuro" (naletso ea methapo) - bakeng sa ho lekola kutloisiso ea bohloko,
• "Type-term" - bakeng sa ho lekola maikutlo a mocheso,
• malleus - ho lekola tendon Reflex.

Ntle le moo, liteko tsa laboratori tsa mali le urine li etsoa ho lekola lintlha tse ka bang kotsing.

Diabetesic distal polyneuropathy e hlile e khetholoha ho polyneuropathy e bakoang ke mabaka a mang:

• bokhoba ba joala
• tšoaetso
• lefu la qoqotho
• khaello ea vithamine
• mafu a oncological
• chefo
• autoimmune pathologies.

Disal polyneuropathy e hlahileng ka morao ho lefu la tsoekere ha se kamehla e bang litholoana tsa sona.

Litataiso tse kholo tsa kalafo bakeng sa lefu la tsoekere la lefu la tsoekere:

• pathogenetic - tsosoloso ea ts'ebetso ea methapo ea methapo,
• matšoao - kenyelletso ea lipontšo tsa pathology.

Phekolo e joalo ha e felise sesosa sa lefu lena, empa e liehisa tsoelo-pele ea eona, e fokotsa monyetla oa mathata, e ntlafatsa boemo ba mokuli le ba maikutlo.

Phekolo ea lefu la tsoekere la distal polyneuropathy ke mokhoa o hlokisang takatso, o kenyeletsang:

• phekolo ea lithethefatsi
• physiotherapy le physiotherapy
• kalafo ya ho ja
• moriana oa litlama.

Phekolo e phethahetseng (ho kenyeletsa le mefuta e 'maloa) e fana ka litholoana tse ntle.

Ha ho na mofuta oa kalafo o lokelang ho sebelisoa ntle le tumello ea ngaka: lithethefatsi tse ngata li hloka khetho e hlokoang ea litekanyetso le tlhahlobo ea tšebelisano, 'me lisebelisoa le mekhoa e mengata li hlekefelitsoe ho mafu a kopaneng.

Phekolo ea lithethefatsi

Ho khutlisetsa tšebetso ea methapo ea methapo (ho ntlafatsa tšebetso ea bona - ho fetisa lipontšo tsa tsamaiso ea methapo e kholo), kenya kopo:

• Litokisetso tse nang le livithamini tsa sehlopha sa B (Milgamma) kapa mofuta o qhibilihang oa vithamine B feela₁ (Benfotiamine)
• α-lipoic acid (Thiogamma, Thioctacid).

Pathogenetic ea kalafo e etsoa lithutong tse telele, phello ea eona ha e bonahale hanghang.

Ho felisa bohloko le mathata a amanang le ho robala, ho tšoenyeha, khatello ea maikutlo, ho fanoa ka litlhare tse latelang:

• antidepressants (amitriptyline, desipramine, paroxetine),
• anticonvulsants (gabapentin, carbamazepine),
• antiarrhythmic (mexiletine),
• li-painkillers le liente (Tramadol), hammoho le li-gels le litlolo (Capsaicin).

Lithethefatsi tse seng khahlanong le ho ruruha (Ibuprofen) li ka laeloa lithutong tse khutšoane, hobane tšebeliso ea tsona ea nako e telele e amahanngoa le kotsi e kholo ea ho senyeha ha mucosa ea gastric.

Boikoetliso ba 'mele, ho silila, ho ikoetlisa

Boikoetliso ba 'mele, ho silila le ho ikoetlisa ho thusa ho kokobetsa bohloko le ho fepa litho tsa mesifa le mesifa, ho thibela mesifa ea mesifa le ho ntlafatsa moralo oa methapo.

• magnetotherapy
• phonophoresis,
• electrophoresis
• pholiso ea seretse.

Ho silila ho sebelisoa ka mokhoa oa khale le oa ho hlohlona.

Boikoetliso ba 'mele ke ho khumama letsatsi le leng le le leng, ho otlolla maoto ka matsoho, ho toloka le ho otlolla menoana ea hau, ho potoloha leqaqailana le kopaneng lifofaneng tse fapaneng.

Likarolo tsa lijo

Ho khothalletsoa ho ntlafatsa lijo le li-macronutrients le livithamini tse kenyang letsoho ntlafatso ea phepelo ea methapo - potasiamo, magnesium, livithamini tsa B.

• linaoa, lierekisi, lensisi,
• li-buckwheat groats
• lipeo, linate,
• matlakala
• tamati, likomkomere, parsley,
• lijo tsa leoatleng.

Haeba ho se na tšenyo e tšoanang ea liphio, liprotheine tsa liphoofolo (nama, likhoho, tlhapi) ha lia lokela ho lekanyetsoa: khaello ea tsona e mpefatsa ts'ebetso ea mesifa ea methapo.

Phekolo ea kalafo le mathata a ka bang teng

Senotlolo sa kalafo e atlehileng ea lefu la tsoekere la distal polyneuropathy ke ho felisoa ha sesosa se ka sehloohong sa ho felisoa ha methapo ea methapo: tloaelehileng le ho tiisa tsoekere ea mali (glycemia). Ntle le ho etsa sena, katleho ea kalafo e reretsoeng ho khutlisetsa ts'ebetso ea methapo e nyane haholo.

E fanoe ka tlhokomelo ea nako e telele ea tsoekere ea mali ka tekanyo e itseng, kalafo ea polyneuropathy e fana ka phello e ntle, haholo haeba e qalile ka nako e loketseng. Mehatong ea pele ea lefu lena, liphetoho tsa methapo methapong ea methapo li fetoha ka botlalo.

Ka linako tse ling ho tšoarela ho ke ke ha khoneha esita le ka ho thatafala ha glycemia. Bakuli ba joalo, hammoho le bao ka mabaka a itseng ba sa kang ba fumana kalafo e rarahaneng, hangata ba ba le mathata a tebileng:

• lefu la tsoekere
• Leoto la Charcot.

Maemo ana a atisa ho thatafatsoa ke gangrene, e kenyang ho poma leoto.

Diabetesic polyneuropathy ea maemo a tlase a tlase ha ho se na kalafo hangata e thatafatsoa ke lefu la kelello le tšoanang le leoto la Charcot

Thibelo

Liketsahalo tse thibelang nts'etsopele ea "diabetesic autonomic polyneuritis:"

• taolo e nepahetseng ea tsoekere ea mali,
• ho khetholoha ho tsuba,
• taolo ea boima ba 'mele.

Ntho ea bohlokoa ka ho tšoanang ke ho kopanya mosebetsi le ho phomola ka mokhoa o leka-lekaneng - ntho e fokolisitsoeng ke ho se robale hantle, mokhathala, khatello ea maikutlo, ho thata haholo ho hanela lefu lena.

Phekolo e bohloko ea lefu la tsoekere le kalafo ea eona - video

Lefu la tsoekere la polyneuropathy la maemo a tlase ke khatello e mpe ea methapo ea lefu la tsoekere, le tsamaeang le ho senyeha ha bophelo ba mokuli mme hangata ho lebisa ho holofetseng. Ho lemoha kapele le kalafo e rarahaneng ea methapo ea methapo ho ka liehisa ho timetsoa ha lisele tsa methapo, mme maemong a mang ba fumana tšoarelo e tsitsitseng.

Sisteme ea Tšenyo

Diabetesic polyneuropathy ke eng? Khokahano e hokahanyang pakeng tsa litho tse fapaneng le bokong ke methapo ea kutlo. Sebopeho sena se kenyelletsa tsamaiso ea methapo e bohareng (bokong le lesapo la mokokotlo), tsamaiso ea methapo ea kutlo le peripheral. Karolo e poteletseng e na le likhoele tsa methapo tse eang lipheletsong, kutu le hloohong. Le eena o kenyelletsa likarolo tse peli: ea limela le ea somatic. Ea pele e ikarabella bakeng sa mosebetsi oa litho tsa ka hare, ea bobeli ke ea ho laola 'mele. Ka DP, likarolo tsena ka bobeli lia ameha. Ka hona, tleliniki e na le bohloko bo boholo mme e ka beha bophelo ba motho kotsing.

Tsoekere e phahamisitsoeng ea mali e senya marako a methapo ea mali, 'me likhoele tsa methapo li ke ke tsa fumana phepo e lekaneng le oksijene ka lebaka la ho se sebetse ho potoloha ha mali. Ka hona, metabolism e tšoenyeha mona, ischemia e etsahala, mme sena ha se etsahale hanghang. Ka lebaka leo, ts'ebetso ea li-pulses e liehisoa kapa e emisoa ka botlalo. Haeba tšenyo ea methapo ea methapo e ile ea fumanoa kapele, joale methapo e ka tsosolosoa ka botlalo.

Hangata polyneuropathy e ama matsoho, empa matsoho le maoto a tlase hangata a utloa bohloko.

Sesosa ke, ehlile, hyperglycemia, le lisosa tsa kotsi ke tse latelang:

• botsofali
• boiphihlelo ba khatello ea mali,
• ho tsuba
• atherosulinosis
• nephropathy
• lefu la tsoekere.

Tlhophiso ea polyneuropathy ho lefu la tsoekere

Karohano e bonts'a hore na mafapha afe a methapo ea methapo a kentseng letsoho ts'ebetsong - ho ikemela le ho hlophisoa ka kakaretso. Maemong a morao-rao, likhoele tsa methapo ea kutlo le tsa methapo lia ameha. Sensitive - e tšesaane ebile e boreleli ka di-diameter tse fapaneng. Li sebeletsa ho fetisa litšusumetso ho tsoa bokhabaneng ho isa bokong. Motor - isa taelo ea boko libakeng tse fapaneng tsa 'mele. Mohlala, motho o ne a ama sebaka se chesang, masela a hlokolosi hanghang, ka makholo a makholo a motsotsoana, a fetisetsa tlhahisoleseling ka sena bokong. Mme ebe sehlopha se fetela likhoele tsa motor ho tlosa letsoho. Ha u bone le hore na sena se etsahala kapele hakae, 'me ha u na nako ea ho chesoa. Mefuta ea polyneuropathy e akaretsang ke ea mefuta e latelang:

• sensory - matla a mocheso a lahlehile,
• motor - methapo ea koloi e amehile mme bofokoli ba mesifa bo hlaha,
• sensorimotor - motsoako oa tse fetileng.

Lipontšo tsa matšoao

Matšoao a pele le matšoao a lefu la tsoekere la polyneuropathy sethaleng se ntseng se hola ke goosebumps le bohloko ba leoto, hammoho le ho akheha. Bohloko bo hlaha phomolong mme bo nyoloha ho tloha menoaneng ho ea maotong. Hamorao, maikutlo a sa thabiseng a qala ho thatafala bosiu mme a tšoauoa a chesa maotong. Mocheso le maikutlo a bohloko a qala ho fokotseha. Bakeng sa matšoao a hamorao, hlokomela:

• bohloko ba ho phomola le ho sebetsa ho feta tekano, bo ikemetseng
• ho hloka boroko ka lebaka la bohloko, ho eketseha nakong ea khatello ea maikutlo le ho fokotseha nakong ea ho tsamaea,
• mesifa ea maoto e qala ho ema, menoana le maoto a fokola,
• maoto a fetoha a pinki kapa a bofubelu, ho ka hlaha matheba a lefifi ho 'ona.

Manala a menoaneng a holile: a ba motenya ka tsela e sa tloaelehang kapa e mosesane. Boemong ba ho qetela, sebopeho sa leoto le sona sea fetoha: e hola ka nqane, ho hlaha maoto, lehare le kopaneng le fetoha - hona ke lefutso. Tabeng ena, pulse e ka leoto e lula e bolokiloe. Ha ho hlahlojoa ke setsebi sa methapo ea kutlo, ho fumanoa lingaka tsa methapo ea methapo ea methapo ea methapo. Taba ea pele, likhoele tse telele haholo tse tebileng tse eang matsohong le maotong lia ameha. Tsena tsa morao li ameha ka pel'a matsoho. Sena ke seo se bitsoang - "socks-gloves" syndrome.

Ka ho felisoa ha methapo ea methapo e meholo, letlalo le utloa bohloko haholo, esita le ho tloha ha le ama habonolo ho na le bohloko bo bohale (allodynia).

Empa ka nako e ts'oanang, menoana ea maoto le matsoho e felloa ke matla. Matšoao ana a bitsoa a khothatsang, a bontsa tšimoloho ea ts'ebetso. Ebe likhoele tsa methapo e nyane le tsona lia ameha, athe matla a mocheso a nyamela, mme maikutlo a ho tepella le a tukang maotong a etsahala. Ho opeloa ke leoto le ho akheha ka hlooho ke ntho e mpe haholo bosiu. Matsoho a lula a chamele, maoto a ruruha. Letlalo le omella haholo 'me le lula le koloba kapa le lula le le metsi kamehla. Li-ulcers, maqeba le callosa hangata li hlaha maotong. Ka lebaka la tšenyo ea likhoele tsa motor, mesifa ea fokola 'me atrophy, menoana le maoto lia holofala.

Kamora nako, ho fokola ka botlalo ha mesifa le ho fokotseha hoa maikutlo a tendon. Lipontšo tsohle tse hlalositsoeng ke khatelo-pele feela. Ho sena ho eketsoa visceral neuropathy, e tsamaeang le ho se sebetse hantle ha litho tsa ka hare. Mohlala, hypotension ea orthostatic e ka hlaha ha methapo e sa khone ho boloka sekhahla se tloaelehileng sa khatello ea mali, ho na le mathata a amanang le lesapo la mokokotlo ka mokhoa oa ho ruruha ha methapo, ho hloka matla le ho hlohlona ho ka hlahang ho basali, 'me ho tepella ho ka hlaha.

Manonyeletso a fetisang matšoao ho mesifa ea fundus a amehile, haholoholo ho batho ba baholo. Ebe likatse, ho ntšetsapele ansocoria, bolulo bo ea ferekana, jj. Matšoao a fosahetseng a hlaha: maoto le matsoho a tšoana le ho akheha, ho ka ba thata ho tsamaisa matsoho le maoto ntle le ho utloa bohloko, ho tsitsipana le ho tsikinyeha hoa fetoha. Lesela ha le sa tsitsa, motho o lula a le mothating oa ho oa, hobane ha a utloe eka oa tsoella, joalo ka ha a tsamaea ka k'hothone. Sena se bonts'a ho ke keng ha fetoloa ha liphetoho.

DP e tsamaisana le ho sgging le ho sgging ha mesifa ea sefahleho, lintja, ho koenya hoa khathatseha, ho ba le letsoele le hlaha.

Liphetoho tsa puo: ho felisoa ha mantsoe ho metsitsoe, motho a ke ke a bitsa mantsoe ka mantsoe a fetang a 3.Ka mantsoe a mang, mesifa efe kapa efe e qala ho fokola butle mme ts'ebetso ena e tloha bokong ho ea bokong.

Ka lefu la tsoekere la polyneuropathy, matšoao a feta methating e mengata ea kholo:

1. Subclinical - motho ha a na litletlebo, empa setsebi sa methapo ea kutlo se ka bona ho fokotseha ha bohloko, mocheso le kutloelo-bohloko ea vibrate, e mpefatsa boemo ba kelello ba Achilles.
2. Tleliniki - e ka ba bohloko, ha e utloise bohloko, amyotrophic. Ka sebopeho sa pele, ts'ebetso ea methapo ea botšehali, ulnar, trigeminal, sciatic and optic ha e na bohloko le bohloko ba 'mele le allodynia e hlaha. Boemo bo se nang bohloko - matšoao a fosahetseng a boletsoeng ka holimo. Motho ha a utloe lieta li tletse, metsi a chesang, likotsi. Tšenyo e etsahala, empa mokuli ha a utloe. Li-ulc maotong li hlaha ho 75% ea linyeoe.

Liphello tsa lefu lena

Polyneuropathy ho lefu la tsoekere mellitus ka boeona e ka baka mathata. Ka ho lahleheloa ke maikutlo maotong, motho ha a utloe ho cha, ho khaola, poone, ho ruruha. E fela ka ho khaoloa. Ka ho felisoa ha likhoele tse bobebe tse tebileng, ho na le bohloko bo sa feleng: ho thunya, ho tsikitlanya, ho tsubella, ho hlaka kapa ho fifala. Maoto a utloa bohloko bosiu, phomolong. Ka tloaelo ea tsoekere, bomalimabe boa nyamela, empa matšoao ohle a sala a le teng.

Ho hobe le ho feta botebong ba boemo ke ha tsoekere e le holimo mme ho se na bohloko.

Bokhachane, botšehali bo lula bo hlokomeleha. Phetoho ea leoto e kaholimo e bitsoa lefu la tsoekere. Khopolo ena e kopanetsoeng e kenyelletsa, ho tlatselletsa ho matšoao a hlalositsoeng, ho ba teng ha ulcers, process tsa purulent-necrotic, lesapo la methapo ea methapo. Phepelo ena ea DP hangata e hlaha le lefu la tsoekere la mofuta oa 2 - makhetlo a ka bang 10. Ka leoto la lefu la tsoekere, ho hlaha mathata a fokolang a leoto:

• letheka le kenang, le fifatsa letheka ka lebaka la hemorrhage e nyane e tsoang lieta tse thata,
• fungus ea lefu (onychomycosis) le letlalo la leoto,
• poone le poone,
• makhopho le letlalo le omeletseng la li-heel - hyperkeratosis.

Ponahalo ea leoto ea fetoha: e boreleli ka lebaka la maoto a bataletseng, ho ruruha, lesapo la monoana le ea eketseha, menoana e fetoha hamore, e sothehile, e inamele kahare.

Tlhahlobo ea lefu lena

Le ha mokuli a sa hlahise litletlebo tsa DP, sena ha se bolele hore ha se eo. Bakeng sa ts'oaetso, ho etsoa mekhoa e khethehileng ea electroneuromyography le tlhahlobo ea sensory ea bongata.

Electroneuromyography - boikemisetso ba matla a motlakase a mesifa ea maoto, boithuto ba li-impulses ka methapo ea methapo ea kutlo. Mokhoa ona o nkuoa e le o rutang, o khethang libaka tsa marang-rang le botebo ba tšenyo ea ts'ebetso ea methapo ea kutlo. Ho tšoenyeha ha maikutlo ho aparela makoloi.

Ntle le moo, ho sebelisoa mokhoa oa ho etsa lintho tse nang le bokhoni: ho lekola karabelo ea boko ho halefisoa ha fiber ea methapo.

Ngaka e hlahloba mokuli, e ela hloko ponahalo ea mekhahlelo e tlase, ho phahama ha methapo ea maoto, khatello ea mali matsohong le maotong, ECG le ultrasound ea pelo. Boikemisetso ba k'holeseterole le lipoprotein boa tlameha. Tsoekere ea mali le maemo a insulin a ikemiselitse. Setsebi sa kelello se hlahloba methapo ea methapo ka methapo ea bongaka, tactile (ho sebelisa monofilament - sesebelisoa se nang le mohala o teteaneng oa ho ts'oasa litlhapi, seo ngaka e se hatellang letlalong la mokuli) le maikutlo a mocheso, ho sisinyeha - ho hlahlojoa ka fereko ea tuning (e lokela ho ba joalo ka maoto ka bobeli). PNP e lekiloeng le botsitso ba mokuli maemong a Romberg. Mokhoa o mong ha o fumanoe.

Ka lebaka leo, haeba mokuli a e-na le lefu la tsoekere, hypervolemia ea nako e telele ka lebaka la hyperglycemia, matšoao a distal symmetric sensorimotor DP ea liphihlelo tse tlase, le ho se be teng ha methapo e meng ea methapo ea kutlo, sena se lumella tlhahlobo ea lefu la tsoekere la lefu la tsoekere.

Phekolo ea polyneuropathy ho lefu la tsoekere

Phekolo e reretsoe ho fokotsa tsoekere ea mali hore e be e tloaelehileng kapa e haufi le eona ka moo ho ka khonehang, ho khutlisetsa metabolism ea protheine le mafura. Bakuli ba lokela ho abeloa lijo tse fokolang tsa carb, 'me ka T2DM, ho ikoetlisa. Phekolo ea insulin, lithethefatsi tsa antidiabetes, le antioxidants li laetsoe.

Phekolo ea polyneuropathy ho tsoekere ea mellitus e kenyelletsa ho tlosa bohloko, ho ntlafatsa li-microcirculation, ho khutlisetsa mokhoa oa phepelo le phepo ea methapo ea methapo, ho ba tlatsa ka oksijene, jj.

Ho hlakola bohloko ho lefu la tsoekere la polyneuropathy

Ho khutlisetsa bohloko le ho nyamela ka ho felletseng ha lefu lena ho fumanoa ka ho etsa hore tsoekere e khutsitseng ea mali. Ho fokotsa bohloko ba ho thunya le ho chesa, ho sebelisoa lithethefatsi tse sebelisang anticonvulsants le antiarrhythmic. Hoa hlokomeleha hore tsa pele li na le litla-morao tse ling. Setlolo sa Capsaicin hangata se laetsoe, empa hangata ha se lumelloe hantle, hobane se baka maikutlo a matla a tukang. Ointments Finalgon, Apizartron le tsona lia sebelisoa. Matšoao a methapo ea kutlo a ntlafalitsoe hantle ke lipoic acid.

Phekolo ea lefu la tsoekere la polyneuropathy ea likarolo tse tlase ha e felle ntle le ts'ebeliso ea thioctic acid.

E emisa ho bokelloa ha tsoekere linthong tsa methapo, e kenya li-enzyme liseleng, tse thusang ho khutlisetsa methapo e senyehileng. Har'a mekhoa ea mantlha ea kalafo e ka tsejoa:

1. Thioctacid BV, Dialipon, Espa-Lipon, Berlition - kajeno ke lithethefatsi tse ka sehloohong bakeng sa kalafo ea DP, nako ea tsamaiso ea bona bonyane likhoeli tse 3.
2. Ho fuoa li-vithamine tsa B - li thibela litlamorao tsa chefo e hlahileng ketsong ea tsoekere ho lisele tsa methapo, mme e khutlisetsa phetiso ea lits'usumetso ho lits'ebetso tsa methapo. Nka sethethefatsi Milgamma Compositum bakeng sa likhoeli tse 1.5.
3. Ho ntlafatsa li-microcirculation tsa mali, Neurostabil, Actovegin, Trental, Ginkgo biloba, Tanakan li laetsoe nako ea likhoeli tse 3. Ka maqhubu a maoto, ho sebelisoa litokisetso tsa magnesium.
4. Matla a lipoic acid ho DP: a nka karolo phapanyetsanong ea tsoekere le lipids mme ha a lumelle cholesterol hore e be teng, ke cytoprotector, e tsitsitseng membrane ea lisele mme e eketsa ts'ebetso ea bona ea antioxidant, e na le anti-inflammatory le analgesic.

O ka alafa ntle le kalafo. Bakeng sa mekhoa eo e seng ea lithethefatsi e ka bitsoa li-gymnastics bakeng sa maoto, ho silila le physiotherapy. Haeba o fumana sekoli se itseng maotong 'me u nka qeto ea ho se lokisa, u ke ke ua sebelisa li-tanning hobane li lieha ho folisa (iodine, greenback, joala, potasiamo permanganate). U ka kenya furatsilin, chlorhexidine, dioxidine. U ke ke ua sebelisa chisi hobane e khomarela leqeba. Ka kakaretso, ts'ebetso e sebetsa hantle ho setsebi.

Ha ho e-na le mathata a potoloha ka har'a lijana tsa maoto, ts'ebetso ea ho sisinyeha kapa balloon angioplasty ea etsoa.

Maemong a tsoetseng pele, polyneuropathy e tlameha ho phekoloa ka thuso ea lingaka: ts'ebetsong ea ho ruruha, lefu la ho ruruha, li-abscesses, phlegmon, necondolaomy, ho khaoloa le ho etsoa hape ka moruo ho etsoa (ka 15-20% ea linyeoe). Extracorporeal shock wave therapy ke mokhoa o mocha oa kalafo. E ka bitsoa pheko e nang le mabaka a ho hola, kalafo ea lisele tsa stem, mokhoa oa jet ea plasma, mokhoa oa biomechanical.

Ntle le kalafo e ka sehloohong, ho kgothaletswa:

1. Phekolo ea boikoetliso ke mokhoa oo eseng lithethefatsi. Ho ikoetlisa ho etsoa bakeng sa metsotso e 10, letsatsi le leng le le leng (ho feto-fetoha ka leoto la menoana, maoto a chitja serethe le menoana, leqaqaqaqaqaqajang, ho beha serethe le menoana fatše, tsela le ha e ntse e bilikisoa.) Sena se boloka molumo oa mesifa.
2. Magnetotherapy - e ntlafatsa microcirculation liseleng, e fokotsa ho ruruha, e tsosa khapo ea methapo e senyehileng hape e imolla bohloko. Acupuncture e boetse e sebelisetsoa ho ntlafatsa phallo ea mali le ho fokotsa tsoekere ea mali.
3. Hyperbaric oxygenation - ho pepesehela 'mele tlas'a khatello e phahameng ea oksijene. Maemong ana, mali a tletse ka oksijene 'me lisele tsa eona li fetoha insulin.
4. Vazaprostan - e sireletsa methapo ea mali methapong ea mali, e atolosa methapo ea mali le ho thibela ho hlahisoa ha cholesterol marakong a bona.

Mabapi le li-compress le litlolo, hoa bohlokoa ho hlokomela hore ha li tšoanele li-ulcers le li-abscesses maotong le maotong ka lefu la lefu la tsoekere. Litlolo li etsa hore ho be thata ho tšolla lintho tse tsoang leqebeng, hape li ka fetoha setsi bakeng sa likokoana-hloko, kahoo kajeno ba sebelisa lipompo ka tšebetso e eketsehileng ea monko (ba antimicrobial) kapa ba sebelisa liponche tsa collagen ho tlatsa maqeba.

Phekolo ka litlhare tsa setso

Ka lefu la tsoekere la polyneuropathy, kalafo e ka etsoa ka litlhare tsa setso, meriana ea litlama. Empa pheko efe kapa efe e joalo e tlameha ho lumellanoa le ngaka. Ho fokotsa tsoekere maling

• infusion ea makhasi a laurel le lipeo tsa fenugreek,
• inflores,
• motsoako oa litlama: Motso oa burdock, khoele, li-cones tsa hop le li-buds tsa birch,
• ho matlafatsa methapo ea methapo ka limatlafatsi - e jele ea kefir, parsley le peo ea soneblomo,
• bakeng sa ho silila le marapo a 'mele a sebelisa oli e tsoang ho setoto le ginger ea St.
• tin rub rubing ea rosemary ka asene e tšeloa mehatong.

Lisosa le Lintho Tse Kotsi

Sesosa sa hang-hang sa lefu la tsoekere ke polyphara e sa feleng ea tsoekere e maling e bang teng ka lebaka la lefu la tsoekere ka lebaka la tlhahiso e tlase ea insulin. Ka nako e ts'oanang, ts'ebetso ea ts'enyo ea methapo ea methapo maemong ana e sebetsa haholo mme e bakoa ke lits'ebetso tse 'maloa tsa pathological. Karolo e etelletseng pele e bapaloa ke lintlha tse 'maloa.

1. Mathata a methapo ka har'a lithane tsa methapo. Khaello ea insulin e lebisa ntlheng ea hore tsoekere e tsoang maling ha e kene ka liseleng, e bonahatsoang ke hyperglycemia. Ka nako e ts'oanang, carbohydrate ena ke eona e ka sehloohong le hoo e batlang e le mohloli o le mong feela oa matla bakeng sa lithane tsa methapo. Ho haella ha matla ho lebisa ho fokotsoeng ha fiber le nts'etsopele ea lefu la tsoekere la polyneuropathy.
2. Mathata a akaretsang a metabolic . Ka lebaka la ho haella ha tsoekere maling, methapo ea methapo ea methapo e kenyellelitsoe ho lefella khaello ea matla. Sena se lebisa sebopeho sa 'mele oa ketone (sehlahisoa se qhekellang mafura) le lintho tse ling tse chefo tse ka lematsang lithane tsa methapo.
3. Mathata a Ischemic. Ho lefu la tsoekere mellitus, nts'etsopele ea "angiopathies" (leseli lesapo la mokokotlo) e amanang le ts'ebetso ea methapo ea methapo mohaleng oa methapo e na le tšobotsi. Sena se fokotsa phepelo ea mali ho lisele le liseleng, haholo-holo boemong ba microcirculatory. Ho potoloha ha mali ka bongata ho mpefatsa boemo ba khaello ea matla litsing tsa methapo ea kutlo le ho potlakisa ho fokola ha tsona.

Monyetla oa ho ba le lefu la tsoekere la polyneuropathy o phahame ho bakuli ba nang le lefu la tsoekere, hangata ho roba lijo le ho sebelisa lithethefatsi tsa hypoglycemic. Maemong a mang, mathata a methapo ea kutlo e ka ba lets'oao la pele la tlhahiso e sa lekaneng ea insulin, empa hangata lefu la neuropathy le hlaha lilemo tse ngata kamora tsoelo-pele ea lefu la tsoekere. Liphetoho tsa methapo tsamaisong ea methapo li ke ke tsa fetoloa.

Mefuta ea lefu lena

Diabetesic polyneuropathy e tšoauoa ka mefuta e fapaneng ea tleliniki, ho latela hore na ke methapo efe ea sehlopha eo e amehang ho isa tekanyong e kholo. Ho na le puisano e itseng mabapi le tlhahlobo sechabeng sa mahlale.

Ka nts'etsopele ea tšenyo ea methapo, liphetoho tsa pathological hangata li ke ke tsa fetoloa, ka hona ho bohlokoa ho thibela boemo ba boemo.

Ho latela bafuputsi ba bang, polyneuropathy ea 'nete ea lefu la tsoekere e lokela ho nkoa e le mofuta o le mong feela oa tšenyo tsamaisong ea methapo ho lefu la tsoekere mellitus - distal symmetric sensorimotor neuropathy. Ho latela pono ena, boemo bo na le mefuta e latelang ea tlhahlobo ea bongaka:

• tlolo ea maikutlo a vibration le maikutlo a tendon ea motho ka mong (mohlala, Achilles). Ona ke a mofuta o bobebe, ha lilemo li ntse li tsoela pele ntle le ho bonahala tsoelo-pele e ntle.
• tšenyo ea methapo e le 'ngoe, ho ba le sebopeho se matla kapa se bohlasoa. Hangata e ama methapo ea methapo ea maoto le matsoho (liso, botšehali, methapo ea kutlo) le hlooho (sefahleho, methapo ea kutlo, oculomotor),
• ho ruruha le ho fokola ha methapo ea lipheo tse tlase, tse amang ho baballa ha lefatše. E tšoauoa ka bohloko ba bohlokoa 'me hangata e thatafalloa ke liso tsa maoto le maoto a sephara.

Taba e 'ngoe ke hore mefuta eohle ea tšenyo ea methapo ea kutlo e amanang le lefu la tsoekere e bitsoa lefu la tsoekere. Tabeng ena, symmetric sensorimotor neuropathy le autonomic neuropathy li khetholloa ho eona. Ho qetela ho kenyelletsa popillary, gastrointestinal, popae, mefuta ea pelo - ho latela hore na ke sistimi efe kapa efe e anngoeng haholo ke lefu la kelello. Ka thoko, lefu la tsoekere la neuropathic cachexia lea khetholoha - e leng lefu le matla le kenyelletsang sensorimotor le neuronomic ea autonomic hammoho le phokotso e kholo ea boima ba 'mele.

Methati ea lefu lena

Ha hona joale ha ho na mekhoa e hlalositsoeng ka ho hlaka bakeng sa methati ea lefu la tsoekere ea polyneuropathy. Leha ho le joalo, psychology e na le semelo se boletsoeng esale pele, tekanyo ea ho eketseha ha matšoao ho latela tekanyo ea hyperglycemia, mofuta oa neuropathy, mokhoa oa bophelo oa mokuli. Ka kakaretso, lefu lena le ka aroloa ka mekhahlelo:

1. Lipontšo tsa Nuropecific neurogenic. Tsena li kenyelletsa ho senyeha ha maikutlo, maikutlo a "marang-rang" letlalong, maemong a mang - ho hlonama ha methapo ea methapo ea kutlo le sebakeng sa bolulo ba bona. Boemo bona bo ka phehella ka lilemo tse ngata mme ba se ke ba ea ka mefuta e mebe ho feta.
2. Ho senyeha ha koloi. Li hlaha ha likhoele tsa motor li kenella ts'ebetsong ea pathological, ho kenyelletsa le tsamaiso ea methapo ea kutlo. Ho sisinyeha ha mesifa, paresis e ka nts'etsopele, mme ka seoelo haholo - makhopho. Ha methapo ea kutlo ea tsamaiso ea methapo ea kutlo e ameha, ho tsitsinyeha ha bolulo, ho hlohlona ha bana, ho fufuleloa, le ts'ebetso ea methapo ea pelo le tsamaiso ea tšilo ea lijo li etsahala.
3. Bofokoli ba trophic. Litlamorao tse mpe ka ho fetisisa tsa lefu la tsoekere la polyneuropathy li hlaha ka lebaka la ho kopana ha methapo ea kutlo ea mafu le bolulo bo bobebe. E ka ba li-ulcers tsa lehae (tsa trophic ulcers, gangrene ea maoto), le kakaretso ka tlhaho (neuropathic cachexia).

Sephetho se seng se tloaelehileng sa lefu la tsoekere la polyneuropathy ke ho hloloa hoa lipara tsa 3 le 4 tsa methapo ea kutlo e ikarabellang bakeng sa ho sisinyeha ha mahlo. Sena se tsamaisana le ho senyeha ho hoholo ponong ka lebaka la ts'ebetso ea ts'ebetso ea bolulo, ho fetoha, likhakanyo tsa bana, nts'etsopele ea anisocoria le strabismus. Hangata, setšoantšo sena se hlaha ho bakuli ba nang le lefu la tsoekere ba kaholimo ho lilemo tse 50, ba qetileng nako e telele ba tšoeroe ke matšoao a mang a neuropathy.

Diabetesic polyneuropathy e tšoauoa ka lipontšo tse ngata tse fapaneng, setšoantšo sa kliniki se itšetlehile ka sebopeho sa pathology, tekanyo ea tsoelo-pele ea sona, le mofuta oa methapo ea methapo (motor, sensory, autonomic) tse ileng tsa ameha haholo. Hangata khafetsa, mathata a kutloelo-bohloko (haholo mocheso le vibrate) a hlaha pele. Hamorao, mathata a motor (bofokoli ba mesifa ea maoto le matsoho) a ka li kopanya. Haeba methapo ea leihlo la mahlo e ne e amehile, ho ba le anisocoria le strabismus.

Lefu lena le sa foleng ka tlhaho ea lona, ​​lipontšo tsa lona li eketseha butle butle ka lilemo tse ngata, boemo ba nts'etsopele bo ipapisitse le ho lekana ha kalafo ea lefu la tsoekere le ho boloka maemo a tsoekere a mali a tloaelehileng.

Lefu la tsoekere le lefu la tsoekere hangata le tsamaisana le mathata a ho potoloha ha limela, haholo lintlheng tse tlase. Pele, mocheso oa letlalo la maoto le maoto a tlase oa fokotseha, ho sitisoa ha letlalo hoa khoneha - ho peeling, keratinization. Likotsi le likotsi tsa maoto li fola nako e telele le ka thata.Ha Psychology e ntse e tsoela pele, bohloko bo boholo maotong bo ba teng (ka nako ea ho phomola le nakong ea boikoetliso), ho hlaha liso tsa kahare. Ha nako e ntse e tsamaea, ho ba le necrosis ea likarolo tse fapaneng tsa maoto hangata e fetoha, 'me joale e fetoha gangrene.

Ho ka ba le mathata le litlamorao

Ho eketseha ha lefu la tsoekere la polyneuropathy ho ka baka bofokoli ba mesifa le mesifa, bo sitisang motsamao. Ho senyeha ha methapo ea kutlo ho baka ho holofala sefahlehong le litšitiso tsa pono. Mathata a potolohileng a tsamaeang le polyneuropathy ea lipheletso hangata a thatafatsoa ke liso tsa trophic le gangrene, e leng sesupo sa ho khaola maoto.

Monyetla oa ho ba le lefu la tsoekere la polyneuropathy o phahame ho bakuli ba nang le lefu la tsoekere, hangata ho roba lijo le ho sebelisa lithethefatsi tsa hypoglycemic.

Ntho e boima ka ho fetisisa ea lefu la tsoekere la polyneuropathy ke neuropathic cachexia, e tsamaeang le boima ba 'mele, mathata a sensorimotor le methapo e mengata ea litho tsa ka hare.

Bo-ramatiki ha bo na maemo a matle, hobane mathata a seng a le teng ha a fetohe. Leha ho le joalo, ho fumanwa ha pathology ka nako hammoho le kalafo e nepahetseng e khethiloeng ho ka fokolisa tsoelo-pele ea eona haholo.

Video ea YouTube e mabapi le sehlooho sa sengoloa:

Diabetesic polyneuropathy (polyneuropathy) ke lesapo la tsamaiso ea methapo ea kutlo, e leng letšoao (complication) la lefu la tsoekere.

Tlhahisoleseling ka kakaretso

Tsamaiso ea methapo ea kutlo e nang le methapo, mokokotlo le methapo e meng ea kutlo. Mosebetsi oa eona o ka sehloohong ke ho hokahanya tsamaiso ea methapo e bohareng le litho tsa 'mele. Sistimi ea peripheral e arotsoe ka somatic and autonomic (autonomous, visceral). Ea somatic e na le boikarabello ba ho sisinyeha ha mesifa, 'me ea limela e laoloa ke lits'ebetso tsa bohlokoa - ho phefumoloha, ho otla ha pelo, synthesis ea hormone joalo-joalo.

Diabetes polyneuropathy e ama lihokela tsena ka bobeli. E hlaha ho 75% ea batho ba nang le lefu la tsoekere (ho sa tsotelehe mofuta oa eona). E le molao, lipontšo tsa pele tsa lefu lena la mafu li etsa hore li ikutloe li le lilemo li 15-25 kamora ho qala ha lefu lena.

Lefu la tsoekere le tsoekere le hlaha ka lebaka la keketseho e tsoelang pele ea tsoekere ea mali. Ho na le mekhoa ea bohlokoa ea ntlafatso ea eona:

• Ka lebaka la khatello ea bohlokoa ea tsoekere, li-capillaries tse potileng methapo ea methapo li senyehile. Phallo ea mali e mpefala, 'me methapo e fumana oksijene e lekaneng, livithamini le liminerale. Ts'ebetso ea phetisetso ea pulse e ea theoha kapa ea emisa ka botlalo.

1. Glucose e hokahane ka mafolofolo le liprotheine, ho kenyelletsa le tseo e leng karolo ea methapo ea kutlo. Ka lebaka leo, ts'ebetso ea bona e sa sebetse, 'me lihlahisoa tse nang le chefo ea glycation lia bokellana' meleng.

Diabetesic polyneuropathy e ka tsamaisana le likala tse fapaneng tsa tšenyo tsamaisong ea methapo ea kutlo. Ho latela sena, mefuta le libato tsa eona tse 'maloa li khethollotsoe, e' ngoe le e 'ngoe ea eona e na le litšobotsi tsa eona.

• Subclinical. Mokuli ha a ikutloe a sa phutholoha, empa nakong ea tlhahlobo, setsebi sa methapo ea kutlo se bona ho fokotseha ha kutloelo-bohloko ea bohloko, ho thothomela, mocheso, le ho hlohlona ha Achilles.
• Tleliniki. E ka iponahatsa ka mefuta e 'maloa - bohloko, ha bo utloe bohloko, amyotrophic.
• Mathata

Matšoao a polyneuropathy e bohloko ea lefu la tsoekere, moo mosebetsi oa methapo ea setho sa botšehali, ulnar, sciatic, trigeminal, abducent and optic nerve:

• ho opeloa ke 'mele hohle, ho re hopotsa mathata a dagger kapa a motlakase oa motlakase,
• tlolo ea kutlo ea kutlo
• ho honotha le matsoho
• allodynia - bohloko bo boholo ka ho ama hanyane.

Ka mokhoa o se nang bohloko, lefu la tsoekere la polyneuropathy la maemo a tlase le hlaha (sensory neuropathy). Ha e ama methapo ea kutlo e eang maotong. Matšoao a hae:

• boteng le maoto
• ho hohlana
• ho hloka botsitso ha o ntse o tsamaea.

Ka tsoelo-pele ea matšoao a lefu la tsoekere la polyneuropathy ea maemo a tlase, kutloelo-bohloko e lahlehile ka botlalo: mokuli ha a utloe ho tiea ha lieta le metsi a chesang ka kamoreng ea ho hlapela, ha a lemohe likotsi le tse ling.

Mofuta oa amyotrophic o tšoauoa ka lesion la bohlokoa la methapo ea methapo. E tsamaea le bohloko, ho tepella maotong le bofokoli ba mesifa.

Khetho e thata ka ho fetisisa ke lefu la tsoekere la polyneuropathy, le amang tsamaiso ea methapo ea kutlo le ea maiketsetso. Matšoao a ho se sebetse hantle ha litho tsa ka hare a kenyelletsoa matšoao a maikutlo le bohloko, ho kenyeletsa:

• gastroparesis (tsoelo-pele ea lijo tse ntseng li mpefala), lets'ollo, lets'ollo,
• ho tsekela, ho akheha,
• lebelo la pelo le liehang
• tahlehelo ea taolo ea bladder (ho se lekane, ho hloka letho ka botlalo),
• erectile dysfunction ho banna, anorgasmia ho basali,
• ho sitoa ho bua, ho koenya ka thata, joalo-joalo.

Litlamorao tsa lefu la tsoekere le polyneuropathy ntle le kalafo:

• liso tsa leoto tse sa foliseng (ho 70-75% ea bakuli),
• phetoho ea maoto,
• tšenyo ea methapo ea kutlo, e baka strabismus mme,
• ponahalo ea libaka tsa lithane tse kentsoeng litlolo, tse lebisang ho khaoloang maoto le matsoho.

Lintho tse hohelang

Lintho tse latelang li kenya letsoho kholisong ea polyneuropathy ho lefu la tsoekere:

• tlhekefetso ea ho itlhokomela tsoekere ea mali,
• nako e telele ea lefu le tlasa
• khatello e phahameng ea mali
• kholo e phahameng
• botsofali
• boteng ba mekhoa e mebe (ho tsuba, ho nwa joala),
• dyslipidemia,
• phatsa ea tlhaho.

Likarolo tsa ts'ebetso ea pathological ka liso tse ngata tsa methapo ea methapo

Ho latela botebo ba liponahatso, methati e latelang ea tšenyo e khetholloa, motheong oo kalafo e hlokahalang bakeng sa polyneuropathy e ikemiselitseng:

• 0 - ha ho na data ea pono
• 1 - tsela ea li-complication,
• 1a - ha ho na litletlebo tse tsoang ho mokuli, empa liphetoho tsa pathological li kanna tsa ikemisetsa ho sebelisa liteko tsa tlhahlobo ea mali,
• 1b - ha ho na litletlebo, liphetoho li ka khethoa eseng feela ka liteko tse ikhethang, empa hape le tlhahlobo ea methapo,
• 2 - sethala sa lipontšo tsa bongaka,
• 2a - matšoao a lesion a hlaha hammoho le liteko tse ntle tsa tlhahlobo ea mafu,
• 2b - mohato oa 2a + bofokoli ba maoto a morao a maoto,
• 3 - polyneuropathy e rarahaneng ke bokooa.

Matšoao a polyneuropathy ea lefu la tsoekere a itšetlehile ka ho toba sethaleng le sebopeho sa nts'etsopele ea ona, hammoho le kalafo e sebelisitsoeng.

Mathata a Boholo

Tšoaetso ea tšobotsi ea methapo ea kutlo. Li ka khethoa feela ka liteko tsa tlhahlobo ea mafu (subclinical form) kapa e be litletlebo tsa bakuli (foromo ea bongaka). Bakuli ba utloa bohloko. Bohloko e ka ba ho chesa, ho baka, ho thunya, ho tena. Ponahalo ea eona e ka ts'oaroa le ke lintho tse sa bakeng pherekano ho batho ba phetseng hantle.

Bohlokoa! Diabetesic polyneuropathy ea libaka tse tlase tse tlase e tšoauoa ka lipontšo tse ts'oanang ho tloha lehlakoreng la maoto le maoto a tlase, kaha moo likepe tsa endoneural li utloa bohloko sebakeng sa pele.

Mokuli a ka tletleba ka lefu la botšehali, ho utloahala eka ke lits'oants'o, maikutlo a tukang, hypersensitivity ho litlamorao tsa ho bata, mocheso, vibrate. Boikhutso ba 'mele bo phehella,' me bo ka 'na ba se be teng.

Ha e le molao, liphapang tse tebileng ke tse tšoanang. Ka ponahalo ea asymmetric pathology, bohloko ba kutlo bo qala ho tloha sebakeng sa pelvic mme bo theoha serope. Sena se tsamaisana le ho fokotseha ha palo ea leoto le amehang, tlolo ea boholo ba lona mabapi le 'mele kaofela.

Ho senyeha ha maikutlo a bohloko ke e 'ngoe ea matšoao a khanyang a polyneuropathy

Psychology e kopaneng

Nts'etsopele ea sensory-motor polyneuropathy maemong a mangata e na le thuto e sa foleng. Litsebi tsa lefu la tsoekere li tletleba ka lipontšo tse latelang:

• tsebetso
• bohloko ba tlhaho e fapaneng
• tlolo ea kutlo ea kutloisiso ho fihlela ho se be teng ka botlalo,
• bofokoli ba mesifa
• ho haella ha 'mele le ponahalo ea lintho tse senang kelello.
• bosiu maratsoana a lipheletso tse tlase le tse holimo,
• ho hloka botsitso ha o tsamaea.

Khafetsa khafetsa ea mekhoa e sa foleng e kopaneng le tšenyo ea mochini ke leoto la tsoekere - boemo ba methapo eo lesion e nkang likarolo tsohle ho kenyeletsoa lefufuru le likarolo tsa masapo. Liphetho - phetoho le pherekano e mpe.

Taba ea bohlokoa ke phapang ea mofuta oa tsoekere ea sensorimotor le joala ba joala ba joala.

Hlolang ka ntle ho tšenyo ea nako

Lisele tsa methapo tse fumanehang libakeng tsa kahare le tsona lia ameha. Matšoao a itšetleha ka hore na setho kapa tsamaiso efe e amehile. Pathology ea pelo le methapo ea mali e bonahatsoa ke khatello ea methapo ea methapo ea methapo, edema ea pulmonary, matla a sitisang mesebetsi ea 'mele. Bakuli ba tletleba ka pherekano ea morethetho oa pelo, khatello e phahameng ea mali, ho hema ka thata, khohlela. Ho haella kalafo ka nako ho ka bolaea.

Ho tšoenyeha ka morethetho oa pelo - letšoao le ka 'nang la hlaha la mofuta oa mofuta oa boikemelo

Tšenyo ea mali ka mpeng e bonahatsoa ke parresis, ho fokotseha ha lentsoe la mafapha a hae, tlolo ea microflora e tloaelehileng le lefu la Reflux. Bakuli ba na le mathata a ho hlatsa, ho otla ha pelo, lets'ollo, ho theola boima ba 'mele, bohloko.

Genitourinary polyneuropathy e tsamaisana le atony ea lesapo la mokokotlo, mokokotlo o ka morao oa moroto, ts'ebetso ea thobalano e senyehileng, ts'oaetso ea bobeli e ka khangoa. Bohloko bo hlaha mokokotlong o ka tlase le kaholimo ho "pubis", ho ntša metsi khafetsa, ho tsamaea le bohloko le ho chesa, mocheso oa 'mele oa phahama, ho tsoa methapong ea methapo ea mmele ho tsoa ka hara botshehadi mme o hlaha.

• tlolo ea mekhoa ea ho fufuleloa (ho eketseha kapa ho fokotsoe haholo ho fihlela ho se sebetse hantle hoa litšoelesa tsa mofufutso)
• Psology ea mohlahlobi oa pono (seithuti se fokotseha ka bophara, "" acuity visual "e fokotseha ka sekhahla, haholoholo mantsiboea),
• adrenal polyneuropathy ha e na lipontšo tsa matšoao.

Litšobotsi tsa kalafo

Bakeng sa kalafo ea lefu la tsoekere la polyneuropathy, ntho ea bohlokoa ke tokiso ea tsoekere ea mali. Sena se etsoa ke setsebi sa endocrinologist, se ntseng se lekola li-regimens tsa kalafo ea insulin le tšebeliso ea lithethefatsi tse theolelang tsoekere. Haeba ho hlokahala, chelete e nkeloa sebaka ke e sebetsang haholoanyane kapa ho fanoa ka litlatsetso tse ling.

Khalemelo ea lijo e ea etsoa, ​​mokhoa oa ts'ebetso o hlokahalang oa khethoa. Ngaka e fana ka likeletso mabapi le mokhoa oa ho boloka khatello ea mali le boima ba 'mele ka har'a meeli e amohelehang.

Lihlopha tse latelang tsa meriana li fanoe:

1. Liphetho tsa alpha lipoic acid ke lithethefatsi tsa khetho. Ba khona ho tlosa k'holeseterole e feteletseng, ba emise litlamorao tsa chefo ea mabaka a kantle ho sebete le methapo ea mali. Baemeli - Berlition, Lipoic acid, Thiogamm. Nako ea kalafo ke bonyane likhoeli tse peli.
2. Li-vithamine tsa B - li ntlafatsa ts'ebetso ea methapo e bohareng le e poteletseng ea methapo, li kenya letsoho ho fetiseng maikutlo hoa phetisetso ea methapo ea methapo (Pyridoxine, Cyanocobalamin, Thiamine).
3. Li-antidepressants - li sebelisetsoa ho fokotsa lipontšo tse bohloko (amitriptyline, nortriptyline). E fanoe ka tekanyetso e nyane, butle-butle e fihlella kalafo e hlokahalang.
4. Li-inhibitors tsa Aldose reductase - likarolo tse ntle tsa kalafo ka sehlopha sena li bontšitsoe, empa ha lia ka tsa hlakisa tšepo eohle e behiloeng ho bona. E sebelisoa ka monahano oa ngaka e eang teng (Olrestatin, Izodibut, Tolrestat).
5. Li-anesthetics tsa lehae - li sebelisetsoa ho imolla bohloko ba mofuta oa lits'ebetso. Matla a hlaha kamora metsotso e 10- 10.
6. Li-anticonvulsants - Carbamazepine, Finitoin. Sehlopha sena se hloka khetho e hlokoang ea litekanyetso. Qala ka litekanyetso tse nyane, o eketseha ho feta libeke tse 'maloa.

Litšebeliso tsa alpha-lipoic (thioctic) acid - lithethefatsi ho etsa hore boemo ba methapo ea mali bo fetohe le ho tlosa mehopolo e sa thabiseng ka tšenyo ea lefu la tsoekere tsamaisong ea methapo.

Litlhare tsa setso

Hoa khoneha ho phekola lefu la tsoekere polyneuropathy eseng feela ka meriana ea setso, empa le ka mekhoa e fapaneng le infusions e lokiselitsoeng lapeng.

Jala lithupa tse lokiselitsoeng esale pele. Mokuli o lokela ho ba hloibila bonyane metsotso e 7-10 ka letsatsi.

Metso e sithabetseng ea burdock le makhasi a blueberry li kopane. 3 tbsp motsoako o hlahisoang o tšeloa ka litha e le nngwe tsa metsi a belang mme o ts'oaroa bonyane lihora tse 8. Ebe u chesa 'me u tepelletse lihora tse ling tse 3. Kamora hore moroo o folile, e tlameha ho hloekisoa. - Noa metsi a mangata nakong ea letsatsi.

Khalase ea oats e tšeloa ka litara e le 1 ea metsi a belang. Tsitlella lihora tse 10, ka nako eo o hloka ho pheha motsoako ona bonyane metsotso e 40. Tlosa setofo mme o romelle sebakeng se futhumetseng. Kamora hore e hloekisoe le ho nooa ka khalase halofo ea hora pele ho lijo tsohle.

Ho tlameha ho hopoloa hore ho ke ke ha khoneha ho tlosa polyneuropathy ka litlhare tsa setso ntle le meriana ea setso le taolo ea tsoekere ea mali. Empa phello e kopaneng ea lintlha tsena e ka lebisa pheletsong e ntle ea pathology.

Lefu la tsoekere ke lefu le tebileng la 'mele, le tsamaeang le tšenyo ea likarolo tsa tsamaiso ea methapo ea kutlo. Boloetse bona ke bothata ba lefu la tsoekere, matšoao a lona a pele a hlahang lilemo tse 'maloa ka mor'a ho fumanoa ke lefu la tsoekere. E tsoela pele butle butle, qalong ho ba le likarolo tse ling tsa tsamaiso ea methapo li kenella ts'ebetsong ea methapo.

Polyneuropathy e fumanoa ho 70% ea bakuli ba nang le lefu la tsoekere mme, e le molao, e se e le boemong bo joalo ha phekolo hangata e sa kopane. Phekolo e sa reroang e lebisa ponahalong ea bohloko bo boholo, ts'ebetso e lahlehile. Ho na le kotsi ea lefu. Nahana ka mokhoa oa ho phekola polyneuropathy ho lefu la tsoekere.

Lisosa, pathogenesis ea polyneuropathy

Lebaka le ka sehloohong le tsosang mochine oa neuropathy ke khatello e eketsehileng ea tsoekere maling. Sephetho ke keketseho ea matla a lits'ebetso tsa oxidative. Li-radicals tsa mahala li bokella 'meleng, tse amang hampe neurons, li sitisa mesebetsi ea tsona.

Tsoekere e ngata e baka ts'ebetso ea ts'ebetso ea autoimmune e senyang lithane tsa methapo. Ho bokellana ha tsoekere ho baka tsitsinyeho ho osmolarity ea sebaka se kahare, methapo ea kutlo e ruruhileng, tsamaiso ea methapo e pakeng tsa lisele e ferekane. Kholo ea lisele tsa fiber tsa methapo e ea fokola. Hyperglycemia ea kamehla e fokotsa bongata ba matla a metabolism, tšusumetso ea conduction e mpefala le ho feta. Qetellong ea lisele tsa methapo ea kutlo li na le hypoxia (tlala ea oksijene).

Lintho tse hlahisang nts'etsopele ea neuropathy:

• Nako e telele ea lefu la tsoekere,
• Boloetse
• Boteng ba mekhoa e mebe,
• Ho kenella ka har'a metsoako ea lik'hemik'hale, lithethefatsi.

Pathology e ka hlaha khahlano le semelo sa mafu a systemic:

Kotsi ea polyneuropathy e eketseha ho batho ba lefu la tsoekere le khatello ea methapo ea methapo, botenya, hyperlipidemia.

Moriana oa litlama

Ntle le mehato ea kalafo e boletsoeng ke ngaka, o ka phekoloa ka meriana ea setso. Moriana oa litlama o tla thusa ho fokotsa bongata ba matšoao.

Tloaetsa maemo a tsoekere a sebelisa decoction, e kenyeletsang:

• Peppermint - 30 g
• Poone stigmas - 60 g,
• Galega (poli) - 100 g,
• Bean Sash - 100 g.

Tšela tafole ea 6. l Bokella litara e le 1 ea metsi a belang ebe o beha mocheso o tlase metsotso e 5. Pele o sebelisa, sefa moea le ka pele ho lijo. Sekhahla se le seng ke 100 ml.

Ho fa li-neurons ka limatlafatsi, nka motsotsoana oa Vitamin letsatsi le letsatsi. O tla hloka:

• Kefir - 1 tbsp.,
• Peo ea soneblomo - tafoleng e 2. l.,
• Parsley - ho latsoa.

Ebola ebe u khaola lipeo tsa sonobolone, eketsa ho kefir. Kenya meroho le kopanya. - Noa lino tse 1 ka nako ea halofo ea hora pele ho lijo tsa hoseng (ka mpeng e se nang letho).

Clove (senoko) se na le phello e ntle ea antioxidant. Ho lokisa tlhahiso eo o tla e hloka:

Lefu la tsoekere ke mofuta o mong oa mathata a tsamaeang le lefu la tsoekere. Boemo bona bo hlaha ka lebaka la tšenyo ea lisele tsa mmele oa hau ka li-pathological agents tse hlahisoang ka ho tlola metabolism ea carbohydrate.

Lipalo-palo mabapi le lefu la tsoekere le bontša hore ponahalo ea mathata hangata e hlaha kamora lilemo tse 15 ho tloha qalong ea ts'ebetso ea methapo. Kamora hore lefu le hlahe, ho lokela ho feta nako e telele, hobane lefu la tsoekere le tsoela pele butle.

Ho ata ha lefu la tsoekere la polyneuropathy ho bakuli ke hoo e ka bang 50-60%. Ho rarahana ho bonahala ka mefuta ea lefu la tsoekere la pele le la bobeli. Phekolo ea lefu lena e khothaletsoa litsing tse khethehileng tsa bongaka, nomoro ea mohala le aterese ea tsona e ka fumanehang webosaeteng.

Ts'oaetso ea lefu la tsoekere la polyneuropathy e kenyelelitsoe ho sehlopha sa machaba sa maloetse - ICD. Boloetse bona tsamaisong bo fuoa khoutu ea G63.2.

Tsamaiso ea methapo ea motho e entsoe ka karolo e bohareng, e emeloang ke bokong le lesapo la mokokotlo, hammoho le methapo ea methapo e tsoang ho bona, e bōpang tsamaiso ea methapo ea kutlo. E kenyelletsa mefuta e 'meli ea sehlooho ea methapo:

Mechini e nang le methapo ea kutlo e ikarabellang bakeng sa ho boloka mesifa ea mesifa. Mefuta ena ea anatomical e fana ka motsamao oa batho oa mahala, o se nang qobello.

Tsamaiso ea boits'oaro e fana ka likutu tse ngata tsa methapo tse tsamaeang le litho tsohle tsa ka hare. E laola ts'ebetso ea lits'ebetso tse latelang:

1. Phekolo ea lijo
2. Lithapo tsa mali
3. Sistimi ea khalemelo
4. Tšepe ea urinary, jj.

Tsamaiso ea methapo ea kutlo e sebetsa ka bolokolohi, ke hore, ha e mamele litakatso tsa motho tsa bohanyetsi.

Diabetesic polyneuropathy e atoloha ho methapo eohle ea kutlo e leng karolo ea litsamaiso tse ikemetseng le tse sa sebetseng hantle. Matšoao a tlang ho hlaha ho motho a itšetleha ka hore na a senyehile hokae.

Ha ho na le litšitiso tsa methapo ea mokokotlo, tšebetso ea mesifa ea marapo ea fokotseha. Ka ntle, sena se bonahala ka bohloko bo boholo maotong le libakeng tse ling moo mesifa e mengata e leng teng (khatello ea mpa, mokokotlo).

Ho senyeha ha methapo e etsang tsamaiso ea methapo ea kutlo ho lebisa ho sitiseng litho tsa ka hare. Ts'ebetso ena e kotsi haholo bakeng sa 'mele oa motho, kaha e lebisa ho kholo ea ho se sebetse hantle ha litho le litsamaiso tsa' mele.

Phetoho ea ts'ebetsong ea ts'ebetso ea methapo ho lefu la tsoekere e bakoa ke ho eketseha ha tsoekere ea mali. Ka boemo ba tsoekere bo phahameng kamehla, metabolism ho li-tishu le lisele e ea khathatsoa. Glucose e tlohela phallo ea mali mme e lula mekhoeng e fapaneng ea anatomical, ho kenyelletsa le tsamaiso ea methapo.

Tšenyo ea methapo ea kutlo e baka tšenyo ea bolulo ea litho tse fapaneng. Ho bohlokoa haholo ho nts'etsopele ea methapo ea methapo ea methapo ke ntlha e 'ngoe - tlala ea oksijene (hypoxia). Khahlanong le metabolism e akaretsang ea motho ea nang le lefu la tsoekere, lebelo la ho tsamaisoa ha mali ka har'a lijana le ea fokotseha. Ka lebaka la sena, methapo ea methapo ha e fuoe oksijene e lekaneng, e lebisang ho fokotseheng ha tšebetso ea bona.

Setšoantšo sa kliniki ea lefu lena

Matšoao a polyneuropathy maemong a mangata a atoloha le lipheletsong tse tlase. Maemong a sa tloaelehang, liphetoho tsa pathological li hlaha methapong ea matsoho.

Ho latela sethala sa ntlafatso ea ts'ebetso le ho teba ha matšoao a kliniki, mehato ea mantlha ea lefu la tsoekere e fapana. Tsena li kenyeletsa:

1. Mohato oa pele
2. Mohato oa bongaka
3. Boemo ba mathata.

Mokhahlelo oa liphetoho tse tlang pele ho nako o bonahala ka ho se be le litletlebo tse felletseng ho motho ea kulang. Matšoao a pele a ho senyeha ha lisele tsa methapo a hlaha - kutloelo-bohloko maotong le ea fokotseha. Pele ho tsohle, pono ea vibrate, liphetoho tsa mocheso le bohloko lia khathatseha.

Boemong ba matšoao a bokuli, mokuli o ba le setšoantšo se boletsoeng sa bokuli. Ho hlaha lefu le matla la bohloko, le ka fumanehang karolong efe kapa efe ea 'mele. Botebo ba bohloko bo fapana ho tloha ho bonolo ho isa ho bo matla, bo kopantsoeng le ho fokotseha ha kutloelo-bohloko. Matšoao a mang a lefu lena a kenyelletsa:

1. Bolo ba maoto le matsoho
2. Ho lahleheloa ke maikutlo haholo,
3. Bohloko bo boholo bosiu bo ka tlohang sebakeng se seng ho ea ho se seng,
4. Ho utloa maikutlo
5. Letlalo le tukang.

Ka thoko, ho loketse ho bua ka mefuta e ikhethang ea lefu la tsoekere. Setšoantšo sa tliliniki sa sebopeho se se nang bohloko se bonahatsoa ke matšoao a methapo - maoto le methapo ea kutlo. Amyotrophic polyneuropathy, ntle le tahlehelo ea kutlo, e tšoauoa ka ponahalo ea bofokoli ba mesifa le ho fokotseha ho lekanang hoa ts'ebetso ea makoloi a motho.

Nako ea lefu lena e ka tsamaisana le ponahatso ea matšoao a sa khetholloeng ka kakaretso. Tsena li kenyeletsa:

1. Ho opeloa ke hlooho
2. Maqhubu
3. Tsietsing
4. Fokotsa matla a kutlo
5. Letšollo le ho nyekeloa ke pelo
6. Urinary incinuence
7. Kutlo e sa utloeng hantle le pono,
8. Basali ba na le khatello ea maikutlo,
9. Tlolo ea mosebetsi oa puo.

Mohato o latelang oa ho hola ha lefu lena ke mohato oa mathata. Ka tsoelo-pele ea lefu la tsoekere la polyneuropathy, ho ba le litlamorao tse mpe tsa tšenyo ea methapo. Mothating ona, mokuli o na le letšoao la "matšoao a fosahetseng" a lefu lena, a kenyeletsang:

1. Bokhoni
2. Ho boima ba maoto le matsoho,
3. Ho tiea ha o tsamaea, o tsamaea le bohloko bo boholo,
4. "Lefu" la letlalo.

Ho hlaha hoa matšoao ana ho bonts'a kholo e sa thabiseng ea mokuli. Kamora nako, liso tsa trophic li qala ho ba teng le mahetleng a mokuli, li senya boteng ba letlalo.

Ha tsoelo-pele ea ts'ebetso e ntse e tsoela pele, matšoao a ea mpefala, a ka lebisang ho tlolo ea ts'ebetso ea likarolo tse tlase. Mokhoa oa ho se tsotelle o beha bophelo ba mokuli kotsing, ka hona, sethaleng sa ho qetela, mokuli a ka hloka ho khaoloa leoto le amehileng.

Phekolo ea mafu

Bakeng sa kalafo ea lefu la tsoekere la polyneuropathy, ho sebelisoa kalafo e akaretsang ea lithethefatsi, e ikemiselitseng ho emisa tšusumetso ea lintho tse khothalletsang kholo ea lefu lena.

Karolo ea bohlokoa kalafong ea lefu lena ke ho pepeseha hoa glucose maling. Kaha polyneuropathy ke motsoako oa lefu la tsoekere, mohato oa pele o lebisang ho hlaphoheloeng ha mokuli ke ho etsa hore lefu le fole. Mokuli o lokela ho buisana le setsebi sa endocrinologist se tla khetha tekanyetso e ntle ea insulin. Sena se tla potlakisa boemo ba tsoekere ka har'a serame sa mali sa mokuli.

Phekolo ea lefu la tsoekere la polyneuropathy e kenyelletsa tšebeliso ea lithethefatsi tse thatafatsang methapo ea kutlo ea mokuli. Ngaka e fana ka litlhare tse latelang:

1. Vitamin complexes, haholo-holo li-vithamine tsa B, e khutlisetsa tšebetso ea tšebetso ea methapo ea methapo,
2. Litokisetso tsa li-antioxidant (livithamini tsa lihlopha tsa C le E),
3. Li-inhibitory agents
4. Actovegin,
5. Li-antibiotic moo ho nang le mafu a tšoaetsanoang a tšoaetsanoang,
6. Bakuli ba hlasimollang matšoao a bohloko.

Ka tšebeliso ea kamehla ea lithethefatsi e kentsoeng mohahong oa lithethefatsi, boemo ba mokuli bo ntlafala ka potlako, ho teba ha matšoao ho fokotseha. Ho fihlella phello e potlakileng, ho khothalletsoa ho kopanya lichelete tse thathamisitsoeng le e mong, kaha sena se tla ama lintlha tse 'maloa tsa pathological tse bakang kholo ea lefu lena. Ka lebaka la sena, kalafo e tla sebetsa haholoanyane.

Ho bohlokoa haholo phodisong le phepong ea mokuli kamora lefu la tsoekere ke mekhoa ea kalafo e seng ea lithethefatsi. Mekhoa e latelang e fuoe mokuli:

1. Phekolo ea mmele
2. Phekolo ea maqeba a letlalo le bofokoli holima libaka tse nang le li-antiseptics ho thibela ts'oaetso e tšoanang,
3. Tšebeliso ea li-insoles tsa orthopedic tse khethehileng,
4. Ho silila ka leoto le tlase
5. Ho futhumatsa libaka tse tlase ka likausi tse futhumetseng (ho thibetsoe ho sebelisa lipitsa tse futhumatsang le libate tse chesang bakeng sa merero ena),
6. Boikoetliso ba 'mele ho khutlisetsa tšebetso ea mesifa.

Boikoetliso ba 'mele bo nang le lefu la tsoekere la polyneuropathy ea likarolo tse tlase bo kenyelletsa boikoetliso bo tloaelehileng, bo ka etsoang setulong.

Ha u fola bolwetse, ho ka sebelisoa mekhoa ea meriana ea setso. Tsena li kenyeletsa:

1. Matsatsi
2. Clay
3. Li-decoctions tsa litlama (calendula, motso oa burdock),
4. Mahe a linotsi
5. Lebese la pōli
6. Nutmeg
7. Mummy.

Mekhoa e meng e ke ke ea sebelisoa ho fapana le lithethefatsi, kaha sena se ka lebisa ho mathata a lefu lena. Latela litlhahiso tsa ngaka. Mokhoa o mong oa phekolo o ka sebelisoa ho kokobetsa matšoao a lefu lena.

Phatlalatso le Thibelo

Tsoelo-pele ea motho ea nang le lefu la tsoekere la polyneuropathy ea liphihlelo li ipapisitse le hore na mochine ona o fumanoe o le sethaleng sefe. Haeba lefu lena le fumanoa le le maemong a mantlha, joale ho ka fola mokuli ka botlalo. Haeba mohato o tsoetseng pele oa pathology o nang le mathata a tebileng o fumanoe, phallo ea morao-rao ha e ntle.

Ho thibela lefu lena ho bapala karolo e kholo ho bakuli ba nang le lefu la tsoekere. Ba tlameha ho latela ka hloko litlhahiso tsa ngaka e eang teng, ho ja hantle, ho sebelisa meriana ka nako. Ho bohlokoa ho phela bophelo bo phetseng hantle, tlohela mekhoa e mebe le ho laola boima ba 'mele oa hau.

Kahoo, lefu la tsoekere la polyneuropathy ea lintho tse feteletseng ke bothata bo boholo ba lefu la tsoekere. Haeba u belaella lefu lena, u lokela ho fumana nomoro ea mohala le aterese ea ngaka ea boemo bo phahameng e le hore u tsebe ho kopana le eena.

Re leka ho fana ka tlhaiso-leseling e nepahetseng le e sebetsang bakeng sa hau le bophelo ba hau. Lisebelisoa tse leqepheng lena li etselitsoe tlhahisoleseling mme li etselitsoe merero ea thuto. Baeti ba webosaete ha baa lokela ho li sebelisa e le likhothaletso tsa bongaka. Ho khetholla tlhahlobo ea lefutso le khetho ea mekhoa ea kalafo e lula e le tokelo e khethehileng ea ngaka ea hau! Ha re na boikarabello bakeng sa litlamorao tse mpe tse bakoang ke tšebeliso ea tlhaiso-leseling e hatisitsoeng webosaeteng