Lefu la tsoekere la lefu la tsoekere: tlhahlobo ea mali, kalafo le thibelo

* Ntho e nang le tšusumetso bakeng sa selemo sa 2017 ho latela RSCI

Koranta ena e kenyelelitsoe Lenaneng la likhatiso tsa saense tse hlahlojoang ke lithaka tsa Khomishene e Phahameng ea Boholo.

Bala makasineng e ncha

Neuropathy, e nang le setšoantšo sa tleleniki e nang le tšobotsi, maemong a mangata e bonts'a ho ba teng ha maemo a fapaneng a pathological. Hajoale, ho na le mafu a ka bang 400, e 'ngoe ea lipontšo tsa eona ke tšenyo ea methapo ea kutlo. Bongata ba maloetse ana ha a fumanehe, kahoo ho lingaka tse ngata kalafo ea mantlha e tsamaeang le matšoao a neuropathy ke lefu la tsoekere. E lula ho e 'ngoe ea libaka tsa pele menyetla ea lefu la neuropathy linaheng tse tsoetseng pele (hoo e ka bang 30%). Ho ea ka lithuto tse fapaneng, lefu la tsoekere la polyneuropathy (DPN) le hlaha ho 10-100% ea bakuli ba nang le lefu la tsoekere.

Pathogeneis le sehlopha

Lintho tse latelang li bapala karolo ea bohlokoa ho pathogenesis ea DPN:

1. Microangiopathy (liphetoho tse sebetsang le / kapa sebopeho ho li-capillaries tse ikarabellang bakeng sa microcirculation ea methapo ea methapo).

Mathata a Metaboliki:

Ho kenngwa tshebetsong ha polyol shunt (tsela e 'ngoe ea metabolism ea tsoekere, eo ho eona e fetoloang ho sorbitol (ho sebelisa enzyme aldose reductase) ebe ho fetoha fructose, ho bokellana ha li-metabolites tsena ho lebisa keketseho ea osmolarity ea sebaka sa "interellular".
Ho fokotseha hoa boemo ba myo-inositol, ho lebisang ho fokotseha ha motsoako oa phosphoinositol (karolo ea likarolo tsa lisele tsa methapo ea kutlo), e qetellang e tlatsetsa ho fokotseheng ha metabolism ea matla le tšusumetso ea methapo ea kutlo.
Glycation ea "non-enzymatic and enzymatic glycation" ea liprotheine (glycation ea myelin le tubulin (likarolo tsa methapo ea kutlo) e lebisa ho demyelination le ho senyeha ha tlhahiso ea methapo ea kutlo, glycation ea liprotheine tsa likarolo tse ka tlase tsa "capillaries" li lebisa tšebetsong ea lona le methapo ea methapo methapong ea methapo.
Khatello e eketsehileng ea oxidative (oxidation e eketsehileng ea tsoekere le lipids, ho fokotseha ha ts'ireletso ea antioxidant ho etsa hore ho bokelloe li-radicals tsa mahala tse nang le phello e tobileng ea cytotoxic).
Ntshetsopele ea li-autoimmune complexes (ho ea ka litlaleho tse ling, li-antibodies ho insulin li thibela kholo ea kholo ea methapo, e lebisang ho atrophy ea methapo ea methapo).

Kamano pakeng tsa lintlha tse fapaneng tsa pathogeneis ea DPN e bonts'itsoe Setšoantšong sa 1.

Classified le lipontšo tsa mantlha tsa kliniki tsa DPN

Psal sensory kapa sensorimotor neuropathy

Ka lesapo le hlahelletseng la likhoele tse nyane:

bohloko bo tukang kapa bo tukang,
hyperalgesia
paresthesia
ho lahleheloa ke bohloko kapa maikutlo a mocheso,
ulc maoto
ho haella ha bohloko ba visceral.

Ka tšenyo e kholo ea likhoele tse kholo:

tahlehelo ea kutlo ea vibration
ho felloa ke matla a ho lemoha lintho ka hloko,
areflexia.

Lithethefatsi tsa lithethefatsi

Anuropathy ea bohloko bo boholo

Lefu la ho ruruha le fokolisang khatello ea methapo

O hlohlorisoa ka mokhoa o ferekanyang kelello.
Mathata a Ts'oenyehang.
Asymptomatic hypoglycemia.
Autonomic gastrointestinal neuropathy:
atony ea mala,
atony of gallbladder,
lefu la tsoekere "(" noarrurnal lets'ollo "),
ho sokela
fecal incinuence.
Autonomic neuropathy ea methapo ea pelo le pelo:
ischemia e se nang bohloko
orthostatic hypotension,
morethetho oa pelo
orthostatic tachycardia,
tachycardia ea phomolo,
sekhahla sa pelo se tsitsitseng
Liphetoho mohatleng oa circadian,
fokotsa mamello.
Autonomic neuropathy ea senya.
Autonomic neuropathy ea mokhoa oa ho ikatisa (dysfunction ea erectile, ho khutla hoa kemolo).

Merobo e tsepamisang mohopolo le ea multifocal

Oculomotor nerve (III).
Mofuta oa methapo (Vuction nerve).
Thibela nerve (IV).

Asymmetric proximal letheka le ka tlase la neuropathy

Asymmetric proximal motor neuropathy.
Bohloko bo ka morao, letheka, mangole.
Bofokoli le mokhabiso oa 'mele oa "fluor", "adductor" le "quadriceps", "
Ho lahleheloa ke Reflex ho tloha Quadriceps tendon.
Liphetoho tse fokolang tsa maikutlo.
Ho fokotsa boima ba 'mele.

Bohloko bo fumaneha ka morao, sefubeng, mpeng.
Re fokotse maikutlo kapa khatello ea kelello.

Khatello (moeli):
- leoto le kaholimo: methapo ea methapo kahareng ea carpal,
- leoto le ka tlase: nko ea tibial, methapo ea kutlo.
E sa qhekelloang.

Diagnostics DPN

1. Pokello ea nalane ea bongaka le litletlebo tsa mokuli (lipotso tsa ho fumana matšoao a arohaneng a mefuta e fapaneng ea neuropathy li bontšoa tafoleng ea 1).

2. Tlhahlobo ea methapo (tafole. 2).

Liteko tse hlahisitsoeng litafoleng 1 le 2 li etsa hore ho khonehe ho bonts'a liponahatso tsa PP ea kapele. Bakeng sa tlhahlobo e qaqileng haholoanyane le boits'oaro ba mefuta e meng ea neuropathy, ho etsoa lithuto tse latelang:

2. Electrocardiography (boikemisetso ba phapang ea lebelo la pelo, liteko ka ho hema haholo, Teko ea Valsalva, tlhahlobo ka phetoho maemong a mmele).

3. Tekanyo ea khatello ea mali (sampole e nang le phetoho maemong a mmele).

4. X-ray ea mpeng ka / ntle le phapang.

5. Tlhahlobo ea Ultrasound ea mpa ea mpa.

6. Intravenous urography, cystoscopy, jj.

Phekolo le thibelo ea DPN

Morero oa mantlha oa kalafo le thibelo ea DPN ke ts'ebetso ea taolo ea glycemic. Boithuto bo bongata bo entsoeng lilemong tsa morao tjena bo pakile ka mokhoa o kholisang hore ho fihlella maemo a tsoekere a mali hantle ka nako ea letsatsi le le leng ho thibela nts'etsopele ea lipontšo tsa DPN. Phekolo ea morao-rao le e nang le bokhoni ea neuropathy e ke ke ea sebetsa ntle le puseletso e sa khaotseng ea lefu la tsoekere.

Hoa tsebahala hore ho lefu la tsoekere ho na le khaello ea li-vithamine tse ngata le likarolo tsa trace, leha ho le joalo, bakeng sa kalafo ea DPN, karolo ea bohlokoa ka ho fetisisa e bapaloa ka ho tlosa khaello ea livithamini tsa sehlopha B. Livithamini tsa Neurotropic (sehlopha sa B) ke li-coenzymes tse kenyelletsoeng lits'ebetsong tse fapaneng tsa biochemical, ho ntlafatsa matla a sele ea methapo, le ho thibela ho etsoa ha lihlahisoa tsa qetello. glycation ea liprotheine. Litokisetso tsa livithamini tsena li sebelisitsoe ho phekola DPN ka nako e telele hantle. Leha ho le joalo, tšebeliso e arohaneng ea vithamine ea B e 'ngoe e eketsa liente le litafole tse' maloa kalafong ea bakuli, e leng tšitiso e kholo. Neuromultivitis ea lithethefatsi e qoba ho kenella ha lithethefatsi tse ngata, hobane Letlapa le le leng le koahetsoeng filimi le se le na le:

thiamine hydrochloride (vithamine B1) - 100 mg,
pyridoxine hydrochloride (vithamine B6) - 200 mg,
cyanocobalamin (vithamini B12) - 0,2 mg.

Thiamine (vithamine B1) 'meleng oa motho ka lebaka la ts'ebetso ea phosphorylation e fetoha cocarboxylase, e leng coenzyme e amehang liputsong tse ngata tsa enzyme. Thiamine e bapala karolo ea bohlokoa ho carbohydrate, protheine le mafura metabolism, e kenella ka mafolofolo lits'ebetsong tsa maqhubu a ho thothomela hoa methapo ea kutlo.

Pyridoxine (vithamine B6) e ea hlokahala bakeng sa ts'ebetso e tloaelehileng ea ts'ebetso ea methapo ea methapo e bohareng le e poteletseng. Ka sebopeho sa phosphorylated, ke coenzyme e amehang ho metabolism ea amino acid (decarboxylation, transamination, jj.). E sebetsa joaloka coenzyme ea li-enzyme tsa bohlokoahali tse sebetsang liseleng tsa methapo. E nka karolo ho biosynthesis ea li-neurotransmitters tse ngata, joalo ka dopamine, norepinephrine, adrenaline, histamine le γ-aminobutyric acid.

Cyanocobalamin (vithamine B12) e hlokahala bakeng sa ho thehoa ka mokhoa o tloaelehileng oa mali le erythrocyte, hape e kenella mekhoeng e mengata ea phetoho e netefatsang ts'ebetso ea bohlokoa ea 'mele: phetisong ea lihlopha tsa methyl (le likarolo tse ling tsa khabone e le' ngoe), phetolelong ea li-acid tsa acid, protheine, phapusing ea amino acid, lik'habohaedreite. E na le phello e molemo lits'ebetsong tse teng tsamaisong ea methapo (synthetic of acidic and lipid composition of cerebrosides and phospholipids). Mefuta ea Coenzyme ea cyanocobalamin - methylcobalamin le adenosylcobalamin lia hlokahala bakeng sa ho pheta-pheta ha lisele le kholo.

Boithuto ba boemo ba methapo ea methapo ea kutlo ho bakuli ba nang le lefu la tsoekere la mofuta oa 2 bo bontšitse hore Neuromultivitis e na le phello e ntle boikhatellong ba kutlo ba maoto le maqhubu, hape e fokotsa haholo botebo ba letšoao la bohloko. Sena se bontša ho fokotseha hoa menyetla ea ho ba le liso tsa maoto a trophic le keketseho ea boleng ba bophelo ba bakuli ba nang le distal DPN. Hape ho lokela ho hlokomeloe bonolo ba ho tsamaisa mofuta oa kalafo motheong oa kantle, hobane setlhare ha se hloke tsamaiso ea batsoali.

Alpha lipoic acid ke coenzyme ea li-enzyme tsa bohlokoa tsa potoloho ea Krebs, eu lumellang ho khutlisetsa tekanyo ea matla ea methapo ea methapo, hammoho le antioxidant (e le moemeli oa tlhaho oa oxidizing), e etsang hore ho khonehe ho thibela tšenyo e eketsehileng mehahong ea methapo le ho sireletsa lithane tsa methapo ho tsoa ho li-radicals tsa mahala. Pele, bakeng sa libeke tse 2-5. (Bonyane thupelo - 15, ka nepo - 20) α-lipoic acid e beoa joalo ka ts'ebetso ea letsatsi le letsatsi ea iv drip ea 600 mg / ka letsatsi. Kamora moo, ba fetohela matlapeng a nang le 600 mg ea α-lipoic acid, Letlapa le le 1 / khoeli bakeng sa likhoeli tse 1.5-2.

Bakeng sa kalafo ea mofuta o utloisang bohloko oa DPN, li-analgesics tse bonolo, lithethefatsi tse seng khahlanong le ts'oaetso (acetylsalicylic acid, paracetamol) li ka eketsoa ho lithethefatsi tse kaholimo. Har'a bona, ho bohlokoa ho hlokomela motsoako oa lithethefatsi Neurodiclovit, o nang le livithamini tsa diclofenac le B (B1, B6, B12), e nang le phello e boletsoeng ea hore li-analgesic, anti-inflammatory le antipyretic.

Ts'ebeliso ea lihlopha tse joalo tsa lithethefatsi joalo ka li-antidepressants tsa li-tricyclic (amitriptyline 25-50-100 mg bosiu), gabapentin (lethal dose la pele - 300 mg, keketseho ka 300 mg ka matsatsi a 1-3, tekanyetso e kholo - 3600 mg), pregabalin (tekanyetso ea pele) e bonts'oa - 150 mg, keketseho ho 300 mg ka matsatsi a 3-7, lethal dose e kholo - 600 mg (e arotsoe ka litekanyetso tse 2-3), duloxetine (lethal dose la pele - 60 mg 1 r. / Letsatsi, ka linako tse ling le nyolohela ho 60 mg 2 r. / letsatsi, tekanyo e phahameng ke 120 mg).

Bakeng sa kalafo ea neuronomic ea matsoele ea matsoele e sebelisoa:

ka atony ea ka mpeng: cisapride (5- 40 mg 2 - 4 leq. / letsatsi metsotso e 15 pele ho lijo), metoclopramide (5 - 10 mg, 3 - 4 p. / letsatsi), domperidone (10 mg 3 leq. / letsatsi),
ka enteropathy (lets'ollo): loperamide (lethal dose la pele ke 2 mg, ebe 2 - 2 mg / letsatsi ho ea ho maqhubu a 1ml. / ka letsatsi, empa eseng ho feta 6 mg bakeng sa boima ba mokuli ka mong ka makhetlo a 20).

Bakeng sa kalafo ea "neuronomicuropathy" ea pelo le methapo ea pelo (resta tachycardia), li-blockers tsa pelo, li-blockers tsa calcium calcium (jk. Verapamil, Diltiazem Lannacher) li sebelisoa.

Bakeng sa phekolo ea ho senyeha ha erectile dysfunction, mofuta oa 5 phosphodiesterase inhibitors (haeba ho se na li-contraindication), tsamaiso e bohlale ea alprostadil, prosthetics, tlhabollo ea kelello e sebelisoa.

Bakeng sa thibelo e akaretsang ea hypovitaminosis le mathata, bakuli ba nang le lefu la tsoekere ba boletsoe litokisetso tsa multivitamin. Tabeng ena, tsamaiso ea li-vithamine tsa B ho litekanyetso tsa kalafo (Neuromultivitis) le eona e ea sebetsa.

Greene D.A., Feldman E.L., Stevens M.J. et al. Lefu la tsoekere. Ka: Lefu la tsoekere Mellitus, Porte D., Sherwin R., Rifkin H. (Eds). Appleton & Lange, East Norwalk, CT, 1995.
Dyck P.J., Litchy W.J., Lehman K.A. et al. Mekhoa e fapaneng e susumetsang li-endopathic endpoints: Tlhahlobo ea Rochester Diabetesic Neuropathy ea lihlooho tse phetseng hantle tsa bophelo bo botle // Neurology. 1995. Moq. 45.P. 1115.
Kempler R. (ed.). Neuropathies. Pathomechanizm, tlhahiso ea bongaka, tlhahlobo ea bongaka, kalafo. Springer, 2002.
Tlaleha le Litlhahiso tsa Seboka sa San Antonio mabapi le lefu la tsoekere la lefu la tsoekere / lefu la tsoekere. 1988. Moq. 37.P. 1000.
Mokhatlo oa Amerika oa lefu la tsoekere. Litlhahiso tsa litlatsetso tsa tleliniki 1995. Lero la tsoekere. Mehato e emeng ho lefu la tsoekere le lefu la tsoekere. 1995. Moq. 18. R. 53-82.
Tokmakova A.Yu., Antsiferov M.B. Monyetla oa ho sebelisa neuromultivitis kalafong e rarahaneng ea polyneuropathy ho bakuli ba nang le lefu la tsoekere mellitus // lefu la tsoekere. 2001.Vol .. 2. C. 33-35.
Gurevich K.G. Neuromultivitis: sebelisa ts'ebetsong ea bongaka ea sejoale-joale kalafong ea bophelo ba bongaka .. 2004.Vol. 87. Che. 9/10.
Litaelo bakeng sa ts'ebeliso ea bongaka ea Neuromultivit. Lintlha ka botlalo mabapi le meriana. Medi.Ru. 2014.

Ke basebelisi feela ba ngolisitsoeng

Matšoao a lefu la tsoekere

Matšoao a tsoang lipheletsong (matsoho, maoto):
- maikutlo a bonoang
- botenya ba maoto le matsoho
- serame sa maoto le matsoho
- bofokoli ba mesifa
- syndrome ea maoto a sa phomoleng - bohloko ba bosiu maotong bo kopaneng le hypersensitivity: esita le ho ama kobo ho baka bohloko ho bakuli,
- ho fokotseha ha bohloko, mocheso, kutloelo-bohloko ea maemo a phahameng (bokhoni ba ho khetholla pakeng tsa ho bata le ho chesa, ho ama, bohloko bo fokotseha),
- fokotseha ha tendon reflexes (karabelo ho teneha (mohlala, ho theola tendon ka hamore ea methapo),
- tlolo ea tumellano ea motsamao le botsitso (maoto a fetoha "cottony"),
- microtrauma ea maoto le matsoho e lebisa tšebetsong ea tšehetso,
- ho ruruha ha maoto.
Matšoao a litho tsa ka hare:
- pelo lippitations,
- ho fokotseha ha khatello ea methapo ea mali (arterial (madi)) ha o tloha ho o mong ho isa mothong (mohlala, ho tloha betheng),
- ho akheha ho ka etsahala
- ka lebaka la ts'ebetso e sitisang methapo ea methapo ho lefu la tsoekere, mefuta e sa utloiseng bohloko ea myocardial infarction hangata e fumanoa (lefu la karolo ea mesifa ea pelo),
- ho nyekeloa
- bohloko ka mpeng,
- bothata ba ho koenya lijo,
- lets'ollo (lets'ollo) kapa ho sokela,
- Tlolo ea litšoelesa tsa mofufutso: ho haelloa ke mofufutso, ho fufuleloa ho feteletseng nakong ea lijo,
- ho hloka urination,
- erectile dysfunction,
- ho bakuli, matla a ho ikutloa a hypoglycemia a fokotseha (serethe se tlase sa tsoekere 'meleng, seo ka tloaelo se iponahatsang e le maikutlo a tlala, tšabo, thabo ea mokuli, mofufutso o eketsehileng).

Sensory - tšenyo ea methapo e ikarabellang bakeng sa maikutlo (tactile, bohloko, mocheso, vibrate). Bakuli ba na le bokhoni bo fokotsehileng ba ho khetholla pakeng tsa ho bata le ho chesa, ho ama, ho utloa bohloko le ho bona litlamorao.
Motlakase - Tšenyo ea methapo e ikarabellang bakeng sa motsamao. Bofokoli ba mesifa, ho fokotseha hoa maikutlo a tendon (karabelo ho motho ea halefileng) ho hlokomeloa.
Boemo (limela) - Tšenyo ea methapo e ikarabellang bakeng sa mosebetsi oa litho tsa ka hare.
- Sebopeho sa pelo - se amanang le tšenyo ea methapo e laolang tsamaiso ea methapo ea pelo:
  - pelo lippitations,
  - ho fokotseha ha khatello ea methapo ea mali (arterial (madi)) ha o tloha ho o mong ho isa mothong (mohlala, ho tloha betheng),
  - ho akheha ho ka etsahala
  - ka lebaka la ts'ebetso e sitisang methapo ea methapo ho lefu la tsoekere, mefuta e sa utloiseng bohloko ea myocardial infarction (lefu la karolo ea mesifa ea pelo) hangata e fumanoa.
- Sebopeho sa ka mpeng - se amanang le tšenyo ea methapo e laolang tsamaiso ea mokokotlo:
  - ho nyekeloa
  - bohloko ka mpeng,
  - bothata ba ho koenya lijo,
  - lets'ollo (lets'ollo) kapa ho sokela.
- Sebopeho sa urogenital - se amanang le tšenyo ea methapo e laolang tsamaiso ea genitourinary:
  - ho hloka urination,
  - ho banna le bashanyana - tlolo ea tlholeho.
- Matla a ho hloka matla a ho lemoha hypoglycemia (glucose e tlase 'meleng). Hangata e bonahatsoa ke moea oa tlala, tšabo, ho ferekana ha mamello, le mofufutso o eketsehileng. Bakuli ba nang le lefu la tsoekere ha ba utloe matšoao ana.

Ngaka endocrinologist e tla thusa kalafong ea lefu lena

Ts'oaetso

Ho hlahlojoa ha litletlebo tsa mafu:
- maikutlo a bonoang
- botenya ba maoto le matsoho
- serame sa maoto le matsoho
- bofokoli ba mesifa
- syndrome ea maoto a sa phomoleng - bohloko ba bosiu maotong bo kopaneng le hypersensitivity: esita le ho ama kobo ho baka bohloko ho bakuli,
- tlolo ea tumellano ea motsamao le botsitso (maoto a fetoha "cottony"),
- microtrauma ea maoto le matsoho e lebisa tšebetsong ea tšehetso,
- ho ruruha ha maoto
- pelo lippitations,
- ho fokotseha ha khatello ea methapo ea mali (arterial (madi)) ha o tloha ho o mong ho isa mothong (mohlala, ho tloha betheng),
- ho akheha
- bohloko ka mpeng,
- bothata ba ho koenya lijo,
- lets'ollo (lets'ollo) kapa ho sokela,
- Tlolo ea litšoelesa tsa mofufutso: ho haelloa ke mofufutso, ho fufuleloa ho feteletseng nakong ea lijo,
- ho hloka matla a ho ntša metsi.
Tlhahlobo ea nalane ea bongaka (nalane ea nts'etsopele ea lefu lena: potso ea hore na lefu le qalile le nts'etsopele joang, lefu la tsoekere le qalile ho tloha neng.
Tlhahlobo e akaretsang (tekanyo ea khatello ea mali, ho hlahloba letlalo, ho mamela pelo ka phonendoscope, palpation ea mpa).
Tlhaloso ea Boikutlo:
- e boreleli - ka thuso ea fereko e katiloeng, e amang maoto le matsoho.
- bohloko - ka ho opeloa ke nale ea tsitsipano,
- mocheso - ho ama ka ho sa feleng lintho tse batang le tse chesang letlalong,
- tactile - ka ho ama letlalo.
Boithuto ba tendon reflexes (karabelo ho teneha) - bo ikemiselitsoe ka ho penya hamore ea methapo methapong.
Electroneuromyography ke mokhoa oa ho etsa lipatlisiso o thehiloeng ho ho ngola bokaholimo ho tsoa methapo le mesifa. Eu lumella hore u tsebe ho fumana tsamaiso ea methapo methapong ea pele.
Bakeng sa tlhahlobo ea tšenyo ea tsamaiso ea pelo le methapo:
- tekanyo ea letsatsi le letsatsi ea khatello ea mali,
- ECG (electrocardiography),
- Tlhahlobo ea Holter ECG (nakong ea letsatsi).
Bakeng sa tlhahlobo ea tšenyo e bakoang ke tšubuhlellano ea ka mpeng:
- Ultrasound ea mpa
- gastrointestinal radiography,
- FGDS (fibrogastroduodenoscopy) ke mokhoa oa ho etsa lipatlisiso o u lumellang ho hlahloba karolo ea ka mpeng ho tsoa kahare o sebelisa sesebelisoa se khethehileng (endoscope) se kentsoeng ka har'a pampitšana ea gastrointestinal.
Ultrasound ea lesapo la senya - ka tšenyo ea karolo ea hau ea urogenital.
Taolo e matla ea boemo ba tsoekere ea mali (tekanyo ea boemo ba tsoekere nakong ea motšehare).
Kopano ea ngaka ea methapo ea kutlo le eona e ka etsahala.

Kalafo ea lefu la tsoekere la lefu la tsoekere

Phekolo ea lefu la tsoekere mellitus (lefu le bonahatsoang ke boemo bo eketsehileng ba tsoekere maling).
Lijo tse nang le thibelo ea letsoai, protheine, lik'habohaedreite.
Lithethefatsi tsa Neurotropic (ho ntlafatsa phepo e nepahetseng ea tsamaiso ea methapo).
Li-vithamine tsa sehlopha sa B.
Phekolo ea matšoao (lithethefatsi ho eketsa khatello ea methapo ea mali (mali) ha e fokotseha, meriana ea bohloko bakeng sa bohloko liphateng.

Mathata le litlamorao

Sebopeho se se nang bohloko sa infraction ea myocardial (lefu la karolo ea mesifa ea pelo) - ka lebaka la ts'enyo ea methapo, bakuli ha ba utloe bohloko, infraction ea myocardial e lula e sa fumanoe nako e telele.
Ulcerative lesion ea libaka tse feteletseng (ponahalo ea bofokoli ba nako e telele bo sa phekoleng letlalo).
Leoto la lefu la tsoekere - tšenyo e mpe methapong, methapong ea mali, liseleng tse bobebe le lisebelisoa tsa leoto, e lebisang lefung la mesifa, lits'ebetso tsa pelepele tse hlokang ho pongoa leoto.

Thibelo ea lefu la lefu la tsoekere

Phekolo e lekaneng le e nakong ea lefu la tsoekere mellitus (lefu le bonahatsoang ke boemo bo eketsehileng ba tsoekere maling).
Bakuli ba nang le lefu la tsoekere ba hloka ho hlahlojoa selemo le selemo sa boemo ba tsamaiso ea methapo:
- Matla a ho thothomela - o sebelisa fereko ea ho sotha, e amang maoto le matsoho.
- maikutlo a bohloko - ka ho luma ka nale ea methapo,
- maikutlo a mocheso - ho ama ka ho sa feleng lintho tse batang le tse chesang letlalong,
- maikutlo a bonojo - ka ho ama letlalo,
- boithuto ba tendon reflexes (karabelo ho teneha) - e ikemiselitsoe ka ho otla hamore ea methapo methapong,
- electroneuromyography ke mokhoa oa ho etsa lipatlisiso o thehiloeng ho ho ngola bokaholimo ho tsoa methapo le mesifa. Eu lumella hore u tsebe ho fumana tsamaiso ea methapo methapong ea pele.

TLHOKOMELISO PUSELETSO

Ho buisana le ngaka hoa hlokahala

Endocrinology - Dedov I.I., Melnichenko G. A, Fadeev V.F., - GEOTAR - Media, 2007
Algorithms bakeng sa tlhokomelo e khethehileng ea bongaka bakeng sa bakuli ba nang le lefu la tsoekere la mellitus, 2012

Nts'etsopele ea lefu la tsoekere

Ho utloisisa likarolo tsa lefu la tsoekere le lefu la tsoekere, hore na ke eng, lisosa le matšoao a sebopeho, hoa hlokahala ho utloisisa mochini oa nts'etsopele ea lefu lena. Pathology e etsahala khahlanong le semelo sa lefu la tsoekere mellitus, le bakang khaello ea metabolic le tšenyo methapong e nyane ea mali, e amang boemo ba lisele tsa methapo ea kutlo bokong. Lisele tsa boko lia ruruha 'me sena se lebisa ho kenelletseng ha tšusumetso ea mokokotlo. Ka mantsoe a mang, kelello e lahleheloa ke bokhoni ba ho fetisetsa lipontšo likarolong tse ling tsa 'mele.

Ka lebaka la mathata a metabolism le phallo ea mali, lits'ebetso tsa oxidative lia matlafala, tse lebisang lefung la butle-butle la lisele tse fumanang limatlafatsi tse sa lekaneng.

Lefu la lefu la tsoekere le methating ea pele ea nts'etsopele le tšoauoa ka tšenyo ea methapo e ikarabellang phetisong ea lits'itiso lipheletsong tse holimo le tse tlase.

Ka lebaka lena, maikutlo a maoto le matsoho a fokotsehile, 'me letlalo le lemala habonolo, ka lebaka leo maqeba a hlahang hangata.

Ho lefu la tsoekere le ka tlase le amanang le lefu la tsoekere, ka karolelano, 78% ea bakuli e ba le li-ulcic tsa nako e telele. Lefu lena ka bolona le hlaha ho 60-90% ea linyeoe tsa lefu la tsoekere lilemong tse 5-15 tsa pele. Ho feta moo, neuropathy e etsahala ho batho ba nang le mefuta e 'meli ea methapo ea methapo.

Mefuta ea lefu lena

Ka peripheral neuropathy ea likarolo tse tlase, setšoantšo sa kliniki se fapane. Sena se hlalosoa ke taba ea hore ho fokotseha ha tsoekere ea mali ho baka tšenyo methating e fapaneng ea methapo. Motheong oa karolo ena, lefutso la lefu lena le aha.

Mefuta e latelang ea lefu lena ea khetholoha:

bohareng
sensorimotor,
autonomous (ho hohlisa),
proximal
tsepamiso.

Ka mofuta oa methapo ea methapo, mafu a amanang le mosebetsi oa boko a hlaha. Boloetse bona bo baka ts'oarano ea khatello ea kelello, ho akheha ha kelello, ho se sebetse hantle ha litho tsa tsamaiso ea urine le mala.

Sensomotor neuropathy e tšoauoa ka ho fokotseha ha methapo ea kutlo ea maoto le tšubuhlellano ea mokhathala. Ho bakuli ba nang le ts'oaetso ena, ho ts'oaroa ha nakoana hoa tsebahala. Ha e le hantle, psychology e ama leoto le le leng, mme matla a matšoao a kakaretso a eketseha mantsiboea. Nakong ea lefu le emeng, maoto a koetehile ka botlalo (mokuli o khaotsa ho utloa bohloko). Ka lebaka la ho fokotsoa hoa matla, ho hlaha liso.

Sensory neuropathy, ho fapana le sensorimotor neuropathy, e baka feela ho fokotseha hoa kutlo. Coordination e ntse e tšoana. Ka motor neuropathy, ka hona, ts'ebetso ea motor e senyehile. Mokuli ea nang le bothata bona o thatafalloa ke ho sisinyeha, ho bua, ho ja lijo.

Mofuta o ikemetseng oa lefu lena o hlaha ka tšenyo ea likhoele tsa tsamaiso ea methapo ea kutlo. Ka lebaka lena, mosebetsi oa litho ka bomong oa senyeha.

Haholo-holo, ka ho hlola tsamaiso ea bobuelli, phallo ea oksijene 'meleng e ea fokotseha, ho kenngoa ha limatlafatsi tse ngata ho mpefala,' me ho se sebetse hantle ha mathe le lesapo la senya. Mofuta ona oa lefu o tsosa mofere-fere o fapaneng oa bongaka.

Mofuta oa proximal ea pathology o fumaneha moo. Mokuli ea nang le foromo ena o tšoenngoa ke bohloko bo kopaneng ba mokokotlo. Ha ts'ebetso ea methapo ea methapo e ntse e tsoela pele, methapo ea methapo ea kutlo e senyeha haholo, e lebisang ho mesifa ea mesifa. Maemong a tsoetseng pele, mokuli o lahleheloa ke matla a ho sisinyeha.

Ka foromo e shebileng, likhoele tsa methapo ea motho ka mong lia ameha. Mofuta ona oa lefu o tšoauoa ka ho qala ka tšohanyetso. Ho latela sebopeho sa methapo ea methapo ea kutlo le mesebetsi eo ba ikarabellang ho eona, mokuli o na le maikutlo a bohloko le ho holofala ha likarolo tsa 'mele (boholo ba halofo ea sefahleho). Nako ea sebopeho se sekametseng ho thata ho e tseba esale pele.

Lisosa tsa neuropathy ho lefu la tsoekere

Lebaka le ka sehloohong la nts'etsopele ea lefu la tsoekere ke phetoho ea khatello ea tsoekere maling. Boemo bona ha se kamehla bo bakoang ke ho se latele melao ea kalafo e tlasa lefu lena le tlase. Mabaka a latelang a ka baka ts'abo ea methapo:

liphetoho tsa tlhaho 'meleng tse etsahalang ha motho a ntse a hola
ho nona haholo
keketseho e kholo le e phehellang ea khatello ea mali,
keketseho e matla ea maemo a tsoekere,
hyperlipidemia (lipid tse eketsehileng)
ho tsuba
tšenyo e bakoang ke likhoele tsa methapo,
lefutso le futsitsoeng ho mafu a itseng.

Sehlopha sa kotsi bakeng sa nts'etsopele ea methapo ea mafu se kenyelletsa batho ba fumanoeng ba e-na le lefu la tsoekere nako e telele. Ha motho a se a le moholo, matšoao a bona a ba a eketsehileng le ho ba thata le ho feta ho laola boemo ba tsoekere.

Autonomous diabetesic neuropathy e nkoa e le kotsi ka ho fetisisa. Mofuta ona oa pathology o ka baka lefu la mokuli ka lebaka la ho tšoaroa ke pelo.

Matšoao a tloaelehileng a lefu la tsoekere

Nako ea neuropathy ho lefu la tsoekere e tšoauoa ka matšoao a fapaneng. Sebopeho se ka sehloohong sa lefu lena le iponahatsa ka potlako, kaha boko bo ferekane.

Ho qaleha ha matšoao a lefu la tsoekere ha motho a senya tikoloho ea mpa ho bonahala likhoeli tse 'maloa kamora ho qala ha ts'ebetso ea methapo. Taba ena e hlalosoa ke 'nete ea hore qalong methapo ea methapo e phetseng hantle e sebetsa joaloka e senyehileng.

Haeba ho ka hlaha mofuta oa maikutlo oa lefu la tsoekere, matšoao a tlatselletsoa ke ketsahalo e latelang ea kliniki:

Hypnothesia (hypersensitivity ho irritants tse fapaneng). Boemo bona bo khetholloa ke ponahalo ea khafetsa ea "li-goose bumps", maikutlo a tukang kapa a hohelang, le bohloko bo boholo (bo tsitsitseng).
Karabelo e sa tloaelehang ho ba khopisang. Motho o utloa bohloko bo boholo ka ho ama hanyane. Ntle le moo, khafetsa ha u arabela ts'usumetso, ka nako e ts'oanang ho na le maikutlo a mangata (tatso molomong, maikutlo a monko, tinnitus).
Ho fokotseha kapa ho felloa ke matla ha maikutlo. Ho ba le lipalo tse nang le lefu la tsoekere ho nkoa e le phepelo e atileng haholo ea lefu lena.

Ka mofuta oa lefu lena le lefu lena, ho boletsoe liketsahalo tse latelang:

e sa tsitsang Gait
khokahano e senyehileng ea metsamao,
Ho ruruha ha manonyeletso, ka lebaka la hore ho fokotseha ho fokotsoang,
bofokoli ba mesifa, bo bonahatsoang ka mokhoa oa ho fokotseha ha matla maotong le matsohong.

Autonomic neuropathy ho lefu la tsoekere e tšoauoa ka matšoao a atileng haholo:

Ho se sebetse hantle ka mpeng. Ka tlolo e joalo, mokuli o thatafalloa ke ho metsa, ho hlatsa khafetsa ka lebaka la spasms ea ka mpeng, ho akheha ho sa foleng kapa letšollo le matla, ho luma le ho otla ha pelo.
Ho se sebetse hantle ha litho tsa kahare. Ho hloka matla ho hlaha ka lebaka la microcirculation e sa lekaneng ea mali, mme tlolo ea tlhahiso ea methapo e baka ho fokotseha hoa molumo oa mesifa ea senya. E latelang e lebisa ho fokotsa ho ropoha le ho phahamisa ho hokahana ha microflora ea baktheria.
Ho senyeha ha mesifa ea pelo. Boemo bona bo tsamaea le tachycardia kapa arrhythmia. Ha o tsamaisa mmele ho tloha o otlolohile ho isa ho oaka ka lebaka la ho se sebetse hantle pelong, khatello ea mali e theoha haholo. Ho feta moo, tlolo ena e baka tsitsipano ea maikutlo a pelo. Le ha a e-na le lefu la pelo, mokuli ha a utloe bohloko.

Mokhahlelong oa pele oa nts'etsopele ea neuronomic e ikemetseng, ho ruruha ho ka eketseha. Letšoao lena le bitsoa haholo meleng e kaholimo bosiu. Ha ts'ebetso ea ts'ebetso ea methapo ea methapo e ntse e eketseha, sekhahla sa li-capillaries se etsahala, ka lebaka leo tlhahiso ea mofufutso e fokotsehang. Sena se etsa hore letlalo le ome. Kamora moo, matheba a lilemo a hlaha sefahlehong le likarolong tse ling tsa 'mele. 'Me maemong a matla, vasospasm e baka likotsi tsa letlalo khafetsa.

Hape, ka mofuta o ikemetseng oa lefu lena, tšenyo ea methapo ea kutlo e ka etsahala, hobane pono e mpefala.

Matšoao ana a thusa ho tseba mokhoa oa ho phekola lefu la tsoekere le lefu la tsoekere. Matšoao ana a bonts'a khakanyo ea lehae ea methapo ea methapo.

Litokisetso tsa kalafo ea lefu la tsoekere le lefu la tsoekere

Ka lefu la tsoekere le lefu la tsoekere, kalafo e rarahane, e beoa ke ngaka ho latela lisosa, matšoao, nalane ea bongaka ebile e kenyelletsa ho tsamaisoa ha lithethefatsi tsa lihlopha tse fapaneng.

Motheo oa phekolo ke lithethefatsi tse thatafatsang maemo a tsoekere ea mali:

meriana e eketsang mofuta oa insulin (Nateglinide, Repaglinide, Glimepiride, Gliclazide),
Lithethefatsi tse eketsang kutloisiso ea litho tsa linama ho insulin (Ciglitazone, Englitazone, Fenformin),
li-agents tse fokotsang sekhahla sa ho monya mala (Miglitol, Acarbose).

Ho hatella bohloko le ho khutlisa methapo ea methapo ea kutlo, ho laetsoe tse latelang:

Litokisetso tsa alpha-lipoic acid (Thiogamma, Tieolepta). Meriana e fokotsa khatello ea "glucose" maling le ho tloaela metabolism.
Neurotropes (livithamini tsa B). Hatella ts'ebetso ea ho ruruha e amang lisele tsa methapo.
Lithethefatsi tse seng khahlanong le ho ruruha (Nimesulide, Indomethacin). Emisa bohloko ka ho hatella ho ruruha.
Li-antidepressants tsa Tricyclic (Amitriptyline). E fokotsa lebelo la litšusumetso tse ikarabellang phetisong ea bohloko.
Li-anticonvulsants ("Pregabalin", "Gabapentin"). Thibela ho fokola ha mesifa ea mokokotlo.
Li-opioid tsa maiketsetso (Zaldiar, Oxecodone). Li na le phello ea mocheso le li-receptor tsa bohloko.
Mekhoa ea litlhare ea antiarrhythmic ("Mexico"). Li sebelisoa bakeng sa tšenyo ea mesifa ea pelo.
Li-anesthetics (li-plasters, li-gels, litlolo). Tlosa bohloko maotong le matsoho.

Phekolo ea lefu la tsoekere la lefu la tsoekere e etsoa ka katleho ka thuso ea lijo tse nang le nama e fokolang ea carb, e tlatselletsoang ke ho ja li-vithic acid le livithamini tsa B maemong a maholo.

Phekolo ka litlhare tsa setso

Lefu la tsoekere la lefu la tsoekere le emisitsoe hantle ka thuso ea meriana ea setso. Tšebeliso ea mekhoa e hlalositsoeng ka tlase e tlameha ho lumellanoa le ngaka. Ha ho phekoloa lefu la tsoekere la neuropathy ho sebelisoa:

Blue (putsoa) letsopa. E sebelisoa e le compress. Ho lokisa moriana, o hloka ho hlapela letsopa le 100 g ho mmuso oa mosy. Sesebelisoa se sebelisoa sebakeng sa bothata le ho tsofala ho fihlela se tiisitsoe ka botlalo.
Oli ea camphor. E sebelisoa ho silila sebaka se amehileng. Ts'ebetso e etsoa nakong ea metsotso e 15.
Ts'oaetso ea lipalesa tsa calendula. Ho tla nka 2 tbsp. motsoako oa mohloli le 400 ml ea metsi a belang. Sesebelisoa se kenngoa lihora tse peli, ka mor'a moo se nkuoa motšehare ka 100 ml. Ho kenngoa ho lokela ho jeoa ho fihlela likhoeli tse peli.
Lemon.Pele e lokela ho thuloa hantle, ebe e kenngoa maotong ebe e tlangoa. Ts'ebetso e lokela ho etsoa pele ho robala libeke tse peli.

Broth Eleutherococcus. E tla nka 1 tbsp. motso o omileng le 300 ml ea metsi a belang. Lithako li tsoakiloe ebe li qoelisoa ka bateng ea metsi ka metsotso e 15. Ebe ho eketsoa 1 tsp ho motsoako o hlahang. mahe a linotsi le 2 tbsp lero la lemone. Ho nooa ho khothalletsoa letsatsi lohle.

Neuropathy ea likarolo tse tlase tsa lefu la tsoekere e ke ke ea phekoloa feela ka thuso ea meriana ea setso. Meriana ena e kaholimo e fokotsa boemo ba mokuli ebile e ntlafatsa likhoele tsa methapo ea kutlo.

Phatlalatso le Thibelo

Lefu la tsoekere la neuropathy la maemo a tlase le lefu la tsoekere le fana ka mathata a mangata. Tsoelo-pele ea lefu lena e ikemiselitsoe ho latela ho se tsotelle ha molato le ts'ebetso ea lehae ea methapo. Ha ho se na kalafo e lekaneng, infarction ea myocardial e se nang bohloko, ho holofala leoto le ts'oso ea ho khaoloa li khonahala.

Thibelo ea lefu la tsoekere e fana ka ho khomarela lijo tse khethehileng tse reretsoeng lefu la tsoekere, ho hlahloba tsoekere ea mali le khatello ea mali kamehla le ho lahla mekhoa e mebe.

Ka lefu le joalo, ho bohlokoa ho buisana le ngaka ka nako haeba ho na le matšoao a ho fokotseha maemong a akaretsang.