SYMPTOMATIC SETJHABELANG MAHALA

SYMPTOMATIC SETJHABELANG MAHALA

Letšoao, kapa la bobeli, khatello ea methapo ea mali (hypertension) ke khatello ea mali, ka mokhoa o amanang le mafu a itseng kapa tšenyo ea litho (kapa lits'ebetso) tse amehang taolong ea khatello ea mali.

Khafetsa ea matšoao a khatello ea methapo ea kutlo ke 5-15% ea bakuli bohle ba nang le khatello ea mali.

Ho na le lihlopha tse 'ne tsa sehlooho tsa SG.

1. Renal (nephrogenic).

3. Hypertension ka lebaka la tšenyo ea pelo le methapo e meholo ea methapo (hemodynamic).

4. Centrogenic (ka lebaka la tšenyo ea tlhaho e amanang le tsamaiso ea methapo).

Motsoako oa maloetse a 'maloa (hangata a mabeli) a ka lebisang ho lefu la khatello ea mali o ka khona, mohlala: lefu la tsoekere la glomerulosclerosis le pyelonephritis e sa foleng, atherosranceotic stenosis ea methapo ea methapo ea methapo le lefu le sa feleng la "pyomerulonephritis", hlahala ea liphio ho mokuli ea nang le lefu la ho hema le methapo ea methapo, Bangoli ba bang ba kenyelletsa khatello e matla ea mali e le lihlopha tse ka sehloohong tsa khatello ea mali. Sehlopha sena se kenyelletsa khatello ea mali, se ntlafalitsoeng ka lebaka la chefo ka lead, thallium, cadmium, jj., Hammoho le lithethefatsi (glucocorticoids, lithibela-pelehi, indomethacin hammoho le ephedrine, jj.).

Ho na le khatello ea mali le polycythemia, mafu a amanang le pulmonary a sa foleng le maemo a mang a sa kenyeng lethathamong.

Lintho tse amanang le khatello ea mali ke mafu a mangata a tsamaeang le nts'etsopele ea khatello ea mali e le sesupo. Ho hlalositsoe maloetse a fetang 70 a tšoanang.

Boloetse ba liphio, methapo ea kutlo le tsamaiso ea urine:

1) fumanoa: senya glomerulonephritis, pyelonephritis e sa foleng, lipakeng tsa lefu le sa feleng, lefu la vasculitis, amyloidosis, lefu la tsoekere le methapo ea methapo ea methapo ea methapo, pyelonephritis boteng ba urolithiasis, li-urorosis.

2) ntho ea tlhaho: hypoplasia, dystopia, tlhekefetso tlhabisong ea methapo ea methapo, hydronephrosis, lefu la liphio tsa polycystic, lipolao tsa methapo ea methapo le tse ling tse mpe tlhabong le boemong ba liphio,

3) khatello ea methapo ea kutlo (vasorenal).

Mathata a tsamaiso ea endocrine:

1) pheochromocytoma le pheochromoblastoma, aldosteroma (aldosteronism ea mantlha, kapa lefu la Conn's), corticosteroma, lefu la eona la Itenko-Cushing le lefu la tsoekere, acromegaly, li fetisa mofuta o nang le chefo.

Mafu a pelo, aorta le lijana tse kholo:

1) sekoli sa pelo se fumanoeng (aortic valve insuffanele, joalo-joalo) le congenital (open ductus arteriosus, jj.),

2) lefu la pelo, le tsamaeang le ho hloleha hoa pelo le ho thibelo e felletseng ea atrioventricular,

3) leseli le amanang le botšehali (coarctation) mme le fumane (arteritis ea aorta le makala a eona, atherosulinosis), liso tsa methapo ea methapo ea methapo ea methapo le methapo ea methapo ea methapo, joalo-joalo.

Maloetse a CNS: lesapo la mokokotlo, encephalitis, khatello ea maikutlo, lesapo la tšebetso la ischemic, jj.

Mokhoa oa ntlafatso ea khatello ea mali maloetseng ohle o na le likarolo tse ikhethang. Li bakoa ke sebopeho le litšobotsi tsa kholo ea lefu le tlasa lefu lena. Kahoo, ho li-renal pathology le liso tsa mokokotlo, ntho e etsang hore re itlhokofale ke renal ischemia, 'me ntho e atisang ho re thusa ho eketsa khatello ea mali ke keketseho ea tšebetso ea baetsi ba khatello le ho fokotseha hoa ts'ebetso ea mahlahana a hlaselang a renal.

Ho mafu a endocrine, ho thehwa ha lihomone tse itseng qalong ke sesosa se tobileng sa keketseho ea khatello ea mali. Mofuta oa li-hormone tsa hyperproducible - aldosterone kapa mineralocorticoid e 'ngoe, li-catecholamines, STH, ACTH le glucocorticoids - ho latela mofuta oa endocrine pathology.

Ka liso tsa tlhaho tsa tsamaiso ea methapo e bohareng, maemo a thehiloe bakeng sa ischemia ea litsi tse laolang khatello ea mali le khatello ea methapo ea methapo ea methapo ea mali, e sa bakoang ke tšebetso (joalo ka khatello ea mali), empa ka liphetoho tsa manyolo.

Ho hemodynamic hypertension e bakiloeng ke tšenyo ea pelo le methapo e meholo ea methapo, methati ea ho eketsa khatello ea mali ha e bonahale e tšoana, 'me e khethiloe ke mofuta oa lesapo. Li amanang:

1) ka tlolo ea ts'ebetso ea libaka tse sithabetsang (sinocarotid zone), ho fokotseha ha maemo a phahameng a arortic arch (e nang le atherosclerosis ea arch),

2) phallo ea mali e pharalletseng kaholimo ho sebaka sa "aorta" (le maiketsetso a eona), ka kenyelletso e tsoetseng pele ea mochine oa renal-ischemic renopressor,

3) le vasoconstriction ho arabela ho fokotseha ha tlhahiso ea pelo, keketseho ea mali a potoloha, hyperaldosteronism ea sekhahla le keketseho ea pono ea mali (ka pelo e sa sebetseng),

4) ka keketseho le ho potlakisa ha systolic ejection ea mali ho aorta (aortic valve insufficiency) ka keketseho ea phallo ea mali ho ea pelong (arteriovenous fistula) kapa keketseho ea nako ea diastole (block atrioventricular block).

Liponahatso tsa kliniki ho khatello ea mali maemong a mangata li na le matšoao ka lebaka la keketseho ea khatello ea mali le matšoao a lefu lena le tlase.

Keketseho ea khatello ea mali e ka hlalosoa ke ho opeloa ke hlooho, ho tsekela, ho fofa hoa "lintsintsi" ka pel'a mahlo, lerata le ho lla litsebeng, bohloko bo fapaneng sebakeng sa pelo le maikutlo a mang a amanang le ona. E fumanoe nakong ea tlhahlobo ea 'mele, hypertrophy ea ventricle e ka lehlakoreng le letšehali, molumo oa II oa matla holim'a aorta ke litholoana tsa khatello e tsitsitseng ea mali. Ho supa liphetoho tse hlahang ka lijaneng tsa fundus. X-ray le electrocardiographly li bona matšoao a hypertrophy ea ventricular ea letsoho le letšehali.

Matšoao a lefu le tlase:

1) e ka phatlalatsoa, maemong a joalo, mofuta oa SG o thehiloe motheong oa matšoao a atolositsoeng a kliniki ea lefu le lumellanang,

2) e kanna ea ba sieo, lefu lena le bontšoa feela ke keketseho ea khatello ea mali, maemong ana, litlhahiso mabapi le mofuta oa letšoao la khatello ea mali li hlaha ha:

a) nts'etsopele ea khatello ea mali ho batho ba bacha le ba baholo ho feta lilemo tse 50-5,

b) nts'etsopele e matla le ho tiisa khatello ea methapo ea mali kapele ka bongata,

c) Asymptomatic thupelo ea khatello ea mali,

g) Ho hanyetsa kalafo ea antihypertensive,

e) boemo bo bobe ba nako ea khatello ea mali.

Tekanyo ea khatello ea methapo ea methapo e bakoa ke liso tsa tlhaho.

Litletlebo tse tloaelehileng tsa keketseho ea paroxysmal khatello ea mali, e tsamaeang le hlooho e bohloko ea hlooho, ho tsekela le lipontšo tse fapaneng tsa limela, ka linako tse ling epileptiform syndrome. Nalane ea likotsi, concussion, mohlomong arachnoiditis kapa encephalitis.

Motsoako oa litletlebo tse hlahelletseng o nang le nalane e nepahetseng o etsa hore ho be le tšebeliso ea maikutlo mabapi le tšimoloho ea methapo ea maikutlo.

Nakong ea tlhahlobo ea 'mele, ho bohlokoa ho fumana tlhaiso-leseling e re lumellang ho nahana ka liso tsa tlhaho tsa tsamaiso ea methapo e kholo. Boemong ba pele ba lefu lena, e ka 'na eaba ha ho na lintlha tse joalo. Ka lefu le lelelele la lefu lena, ho a khonahala ho bona litšobotsi tsa boits'oaro, likotsi tse sa bonahaleng tsa methapo le maikutlo, methapo ea methapo e tsoang methapong ea methapo ea kutlo. Ho thata ho etsa tlhahlobo e nepahetseng ho batho ba tsofetseng, ha likarolo tsohle tsa boits'oaro li hlalosoa ke nts'etsopele ea lefu la mokokotlo.

Tlhahisoleseling ea bohlokoa ka ho fetisisa bakeng sa tlhahlobo ea mali e fumanoa nakong ea tlhahlobo ea laboratori le ea lisebelisoa.

Tlhokahalo ea mekhoa e meng ea ho etsa lipatlisiso e hlaha ka liphetoho tse nepahetseng fundus ("li-nipples tse tsitsitseng") le ho fokotsa likarolo tsa pono.

Mosebetsi oa mantlha ke karabo e hlakileng ea potso ea hore na mokuli o na le hlahala bokong kapa che, kaha ke tlhahlobo e tlang ka nako feela e lumellang kalafo ea ho buuoa.

Ntle le X-ray ea lehata (litaba tsa eona tse bohlokoa feela bakeng sa marang-rang a maholo a boko), mokuli o feta ka har'a electroencephalography, rheoencephalography, ho hlahlojoa ha ultrasound le ho lekanya tomography ea lehata.

Hypertension ea Hemodynamic e bakiloeng ke tšenyo ea pelo le lijana tse kholo mme e arotsoe:

1) phallo ea 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 ea kutlo le lefu la ho ruruha ha mali,

2) khatello ea mali ea tikoloho nakong ea coarctation ea aorta,

3) hyperkinetic circulatory syndrome, e nang le arteriovenous fistulas,

4) khatello ea methapo ea pelo ea ischemic ha pelo e hloleha le bofokoli ba mitral.

Ts'oaetso eohle ea hemodynamic e amana ka kotloloho le mafu a pelo le methapo e meholo, e fetola maemo a phallo ea mali, 'me e kenya letsoho ho nyoloha ha khatello ea mali. Melemo ea keketseho kapa kholo ea kholo ea khatello ea mali ea systolic.

Tlhahisoleseling e ka fumanoa ho bakuli

a) nako ea ho hlaha ha keketseho ea khatello ea mali, mofuta oa eona le maikutlo a ikemetseng,

b) liponahatso tse fapaneng tsa atherosulinosis ho batho ba tsofetseng le ho teba ha bona (ho hlaka nako, ho fokotseha ho hoholo ha mohopolo, jj.),

c) mafu a pelo le methapo e meholo, eo keketseho ea khatello ea mali e ka amanang le eona,

g) ponts'etsong ea ho nyekeloa ke pelo,

e) mofuta le katleho ea kalafo ea lithethefatsi.

Ho ba teng ha khatello ea mali khahlano le semelo sa mafu a teng le tsoelo-pele ea ona ka lebaka la ho fokola ha lefu la lefu le tlase hangata ho supa matšoao a lefu la khatello ea mali (hypertension ke sesupo sa lefu le tlasa).

Boithuto bo tla rarolla:

1) boemo ba khatello ea mali, mofuta oa eona,

2) maloetse le maemo a khethang keketseho ea khatello ea mali,

3) matšoao a bakoang ke khatello ea mali.

Ho bakuli ba bangata ba tsofetseng, khatello ea mali ha e ts'oarehe, ho tsoha ho sa hlokahaleng mme marotholi a tšohanyetso a ka etsahala. AH e tšoauoa ka keketseho ea khatello ea systolic ka mokhoa o tloaelehileng, 'me ka linako tse ling e theola diastolic - seo ho thoeng ke atherosselotic hypertension kapa lilemo tse amanang le (sclerotic) ho batho ba tsofetseng (ntle le lipontšo tse hlakileng tsa kliniki ea atherossteosis). Ho hlwaya matšoao a peripheral arterial atherosclerosis (ho fokotsoa ha pulsation methapong ea methapo e tlase, ho e folisa, jj) ho etsa hore ho fumanoe tšoaetso ea methapo ea methapo ea methapo. Ka ho ferekana ha pelo, o ka fumana ho korotla ho matla ha systolic ho aorta, molumo oa lentsoe la II sebakeng sa bobeli sa botšehali ka lehlakoreng le letona, se bontshang atherosclerosis ea aorta (lefu la pelo ea atherosselotic ka linako tse ling le fumanoa). Ho ba le hypstension e seng e ntse e le teng ea methapo ea kutlo le khatello e ntseng e phehella ea khatello ea diastolic ho ka supa nts'etsopele ea atherosulinosis ea methapo ea methapo ea kutlo (systolic murmur holim 'aorta aorta ho navel ha e utluoe hangata).

Ho eketseha ho hoholo ha khatello ea mali matsohong le ho fokotseha ha khatello ea mali maotong ho ka bonoa. Ho kopana ha AH joalo ka ho eketseha ha methapo ea methapo (nakong ea tlhatlhobo le palpation), ho fokolisa masapo a methapo ea methapo e tlase, le ho lieha ha molumo oa methapo methapong ea basali ho lumella motho hore a belaelle likhohlano tsa aortic ka 'nete. Ho korotla ho hoholo hoa systolic ho senoloa botebong ba pelo, ho utluoa ka holim'a 'mila oa thoracic o ka pele le ka morao (sebakeng se hare-hare), lerata le lla ka likepe tse kholo (carotid, subclavian). Setšoantšo se nang le tšobotsi se re lumella ho tseba ka kholiseho hore re ka tsilatsila.

Nakong ea tlhahlobo ea 'mele, matšoao a ho fokola ha valve ea aortic, ho se koalehe ha ductus arteriosus, lipontšo tsa ho se atlehe ha pelo ho ka fumanoa. Maemo ana kaofela a ka lebisa ho khatello ea mali.

Keketseho ea boemo ba cholesterol (hangata alpha-cholesterol), triglycerides, beta-lipoprotein e fumanoeng thutong ea lipid pontso ea mali e bonoa ka atherossteosis. Ha ophthalmoscopy e ka bonoa liphetoho meralong ea "ecular fundus", e nts'etsopele le atherosclerosis ea likepe tsa mokelikeli. Fokotsa ho khohlela ha lijana tsa lipente tse tlase, ka linako tse ling methapo ea carotid le ho fetola sebopeho sa li-curve ho rheogram e tiisa tšenyo ea methapo ea methapo.

Ho bonahala litšobotsi tse nang le tšobotsi ea li-electrocardiographic, radiology le echocardiographic tsa lefu la pelo.

Ho bakuli ba nang le coarctation ea aorta, hangata angiography e etsoa ho hlakisa sebaka le sebaka sa sebaka se amehileng (pele ho ts'ebetso ea bongaka). Haeba ho na le li-contraindication bakeng sa kalafo ea ho buoa, joale tlhahlobo ea 'mele e lekane ho etsa tlhahlobo.

Tekanyo ea khatello ea kelello ke sesosa se atileng haholo sa khatello ea mali (70-80%). Li arotsoe ka hypertension ho mafu a renal parenchyma, renovascular (vasorenal) methapo ea mali le khatello ea mali e amanang le ho senyeha ha urine. Mofuta o mongata oa renal ke mafu a renoparenchymal le vasorenal pathologies.

Setšoantšo sa kliniki ea mafu a mangata a tsamaeang le khatello ea mali ea methapo ea methapo, se ka bonahatsoa ke li-syndromes tse latelang:

1) khatello ea mali le methapo ea methapo ea methapo,

2) khatello ea mali le feberu,

3) khatello ea mali le ho korotla ka methapo ea kutlo,

4) khatello ea mali le hlahala ea ka mpeng,

5) khatello ea mali (monosymptomatic).

Mosebetsi oa ho batla ho tsebahala o kenyeletsa:

1) pokello ea tlhaiso-leseling e mabapi le mafu a fetileng a liphio kapa tsamaiso ea moroto,

2) tlhaiso e hlahelletseng ea litletlebo tse kopaneng ho lefu la renal, moo khatello ea mali e ka sebetsang e le sesupo.

Matšoao a methapo ea methapo ea methapo ea bana (glomerulo- le pyelonephritis, urolithiasis, jj), khokahano ea eona le nts'etsopele ea khatello ea mali, re re lumelle ho theha mohopolo oa tlhahlobo ea tlhahlobo ea methapo.

Ha ho na le anamnesis ea nang le tšobotsi, boteng ba litletlebo tsa phetoho ea 'mala le boholo ba moroto, mathata a lets'ollo, ponahalo ea edema e thusa ho hokahanya keketseho ea khatello ea mali le methapo ea methapo ntle le lipolelo tse hlakileng mabapi le mofuta oa tšenyo ea liphio. Tlhahisoleseling ena e lokela ho fumanoa maemong a latelang a tlhahlobo ea mokuli.

Haeba mokuli a tletleba ka feberu, bohloko manonyeletsong le mpeng, ho eketseha ha khatello ea mali, joale ho ka belaelloa lefu la pelo - lefu leo ho lona liphio e leng karolo e le 'ngoe feela ea litho tse amehang ts'ebetsong.

Motsoako oa khatello e phahameng ea mali le feberu ke tšoaetso ea ts'oaetso ea pampitšana ea urine (litletlebo tsa mathata a lets'ollo), hape e hlaha le maqeba a liphio.

Maemong a mang, o ka fumana tlhahisoleseling e bontšang keketseho ea khatello ea mali. Monyetla oa ho ba teng ha methapo ea methapo ea pelo ea monosymptomatic e lokela ho tsotelloa, ka hona, bohlokoa ba mehato e latelang ea tlhahlobo ea mokuli bo eketseha ho khetholla sesosa sa keketseho ea khatello ea mali.

Ho ba teng ha edema e boletsoeng e nang le nalane e loketseng ho etsa hore tlhahlobo ea peleho ea glomerulonephritis e tšepahale haholoanyane. Ho na le litlhahiso mabapi le amyloidosis.

Nakong ea tlhahlobo ea 'mele ea mokuli, ho korotla ha systolic ka holimo ho mpa ea mpa sebakeng sa methapo ea methapo ea methapo ho ka fumanoa, ka hona ho ka nahanoa hore boemo ba khatello ea methapo ea mmele bo nchafala. Tlhahlobo e ntlafalitsoeng e etsoa ho latela angiography.

Ho sibolloa ha sebopeho sa tumor ho bakuli ba nang le khatello ea mali nakong ea palpation ea mpa ho bontša lefu la liphio, hydronephrosis kapa hypernephroma.

Ho ipapisitsoe le tlhahlobo ea syndromes e khethiloeng, menahano e latelang e ka etsoa mabapi le mafu a tsamaeang le khatello ea mali ea methapo ea kutlo.

Motsoako oa khatello ea mali le methapo ea methapo ea methapo e iponahatsang:

a) glomerulonephritis e sa foleng le e hlobaetsang,

b) sa feleng sa pyelonephritis.

Motsoako oa khatello ea mali le feberu o atile haholo ka:

a) pyelonephritis e sa foleng,

b) lefu la liphio le polycystic le rarahaneng ke pyelonephritis,

c) lihlahala tsa meno,

d) nodular periarteritis.

Motsoako oa khatello ea mali le tumor e nang le pompo ka mpeng ea mpa e bonoa le:

a) lihlahala tsa meno,

Motsoako o kopaneng oa phallo ea mali le lerata holim'a methapo ea methapo ea methapo e tšoauoa ka methapo ea methapo ea kutlo.

Monosymptomatic hypertension ke tšobotsi ea:

a) ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea kutlo (methapo ea methapo e sa tloaelehang ea methapo ea methapo ea methapo ea kutlo le mefuta e meng ea arteritis),

b) tlhekefetso nts'etsopele ea likepe tsa renal le mokhoa oa urine.

Ho netefatsa lefu lena:

a) tlhatlhobo e tlamehang ea bakuli bohle,

b) lithuto tse khethehileng ho latela lipontšo.

Lithuto tsa pontšo li kenyeletsa:

1) quanifying of bacteriuria, tahlehelo ea protheine ka mehla ka moroto,

2) thuto e akaretsang ea ts'ebetso ea liphio,

3) thuto e arohaneng ea tšebetso ea liphio ka bobeli (isotopic renography and scanning, infusion le ho khutlisetsa pepelografia, chromocystoscopy),

4) Ho hlahlojoa ha liphio

5) compression ea bongoana,

6) phapanyetsano ea angiography (aortography le thuto ea phallo ea mali a renal le phallo ea vevagraphy le venography ea renal veins),

7) tlhahlobo ea mali bakeng sa litaba tsa renin le angiotensin.

Matšoao a sena kapa hore boithuto bo eketsehileng bo itšetlehile ka mohopolo oa tlhahlobo ea tlhahlobo le sephetho sa mekhoa ea tlhahlobo.

E se e le litholoana tsa mekhoa ea tlhatlhobo e tlamang (mofuta oa mochine oa ho ruruha, data ea tlhahlobo ea baktheria), ka nako e 'ngoe motho a ka tiisa mohopolo oa glomerulo- kapa pyelonephritis. Leha ho le joalo, bakeng sa tharollo ea ho qetela ea bothata, ho hlokahala lipatlisiso tse eketsehileng.

Lithuto tsena li kenyelletsa tlhahlobo ea moroto ho latela Nechiporenko, setso sa moroto ho latela Gould (ka tlhahlobo ea bacteriuria le tlhaiso), tlhahlobo ea "prednisolone" (e tsosang leukocyturia kamora taolo ea methapo ea methapo ea methapo ea kutlo, "isotopic renography" le "scanning", "chogocystoscopy"). Ntle le moo, infography urology e lokela ho etsoa ntle ho phoso.

Maemong a belaetsang, biopsy ea meno e etsoa bakeng sa tlhahlobo e hlakileng ea lesapo la morao-rao la pyentonephritis kapa glomerulonephritis.

Khafetsa, ts'ebetso ea methapo ea methapo methong e qeta lilemo tse ngata e patiloe 'me e tsamaea le liphetoho tse nyane le tse sa sebetseng hanyane ka har'a moroto. Proteinuria e nyane e fumana boleng ba ho lemoha feela ha e nahanela palo ea protheine ea letsatsi le letsatsi e lahlehileng ka har'a moroto: protheine ea nako e fetang 1 g / ka letsatsi e ka nkoa e le sesupo se sa amaneng sa ho hokahana ha khatello ea mali le tšenyo ea mantlha ea renal. Urology ea "Excretory" e kenyelletsa (kapa e tiisa) ho ba teng ha majoe, tlhekefetso e tsoetseng pele le boemo ba liphio (ka linako tse ling likepe tsa renal), tse ka bakang macro- le micromaturia.

Tabeng ea hematuria, ho khetholla lesapo la meno, ho kenyelletsa "ur" ea lesapo la mokokotlo, lesapo la liphio, tomography e kopantsoeng mme, sethaleng sa ho qetela, ho etsoa phapang pakeng tsa angiography (aorto le patrag).

Tlhahlobo ea tšoaetso ea nephritis ea li-interstitial, hape e bontšitsoeng ke micromaturia, e ka etsoa feela ho latela liphetho tsa biopsy ea meno.

Ho hlahlojoa ha biopsy le liphihlelo tsa nalane ea biopsy qetellong ho ka tiisa ho fumanoa ha lesapo la eona la amyloid.

Tabeng ea mohopolo oa khatello ea maikutlo ea vasorenal, tlhaho ea eona e ka thehoa ho latela phapang ea angiography.

Lithuto tsena - biopsy ea bana le angiography - li etsoa ho ea ka lipontšo tse thata.

Angiography e etsetsoa bakuli ba banyenyane le ba lilemo tse mahareng ba nang le phekolo e matla ea methapo ea methapo le tšebeliso ea lithethefatsi e sa sebetseng (ho fokotseha hanyane ha khatello ea mali ho bonoa feela kamora ts'ebeliso ea litekanyetso tse kholo tsa lithethefatsi tse sebetsang maemong a fapaneng a taolo ea khatello ea mali).

Lintlha tsa Angiography li hlalosoa ka tsela e latelang:

1) stilosis ea methapo e sa kopaneng ea mali, molomo le karolo e bohareng ea mokokotlo oa mokokotlo, hammoho le matšoao a atherosulinosis ea mpa ea mpa (ho se leka-lekane ha contour), ho banna ba lilemong tse bohareng ke tšibollo ea atherosulinosis ea methapo ea kutlo.

2) alternation of stenosis and dilatation of the renal artery artery on the angiogram with localization of stenosis in the third karolo ya yona (mme e seng molomong) ka aorta e sa fetoheng ho basali ba ka tlase ho lilemo tse 40 e bonts'a hyperplasia ea methapo ea methapo ea mokokotlo,

3) Tšenyo e habeli methapong ea methapo ea kutlo ho tloha molomong ho isa karolong ea boraro ea bohareng, li-aortic contours, matšoao a stenosis a makala a mang a mongobo oa thoracic le mpa a na le tšobotsi ea arteritis ea methapo ea kutlo le aorta.

Setšoantšo sa kliniki ea maloetse a mang a endocrine a bang teng ka khatello ea mali se ka hlahisoa ka mokhoa oa li-syndromes tse latelang:

1) khatello ea methapo ea mali le likhathatso tsa adrenal,

2) khatello ea methapo ea mali le bofokoli ba mesifa le ho ntša metsi urinary,

3) khatello ea mali le botena,

4) AH le hlahala ea ka mpeng ea mokokotlong (hangata).

Litletlebo tsa mokuli mabapi le ho ba teng ha litšisinyeho tse matla tsa khatello ea maikutlo, tse tsamaeang le mehopolo ea letlalo, ho thothomela ha mesifa, ho fufuleloa haholo, le ho ruruha ha letlalo, hlooho, bohloko bo ka morao ho sternum, li etsa hore ho khonehe ho bua ka pheochromacetoma. Haeba litletlebo tse kaholimo li hlaha khahlano le semelo sa feberu, tahlehelo ea boima ba mmele (pontšo ea botahoa), e tsamaeang le bohloko ba ka mpeng (metastases ho ea sebakeng se fumanehang sa "lymph node"), monahano oa pheochromoblastoma o kanna oa ba teng.

Ka ntle ho litsietsi, khatello ea mali e ka ba e tloaelehileng kapa e phahameng. Tloaelo ea ho akheha (haholo-holo ha ke tsoha betheng) mokokotlong oa khatello e phahameng ea mali le eona ke tšobotsi ea pheochromocytoma, e tsoelang pele ntle le mathata.

Litletlebo tsa mokuli tsa khatello e phahameng ea mali le ho hlonama ha mesifa, ho fokotseha ha 'mele, ho nyoroa le ho choachoasela haholo, haholo bosiu, ho etsa setšoantšo sa mantlha sa kalafo ea methapo ea mafu a mantlha (hyp's syndrome) le ho supa sesosa sa khatello ea mali e se e le sethaleng sa I sa lipatlisiso. Ho kopantsoe ha matšoao a kaholimo ho feberu le feberu le bohloko ba ka mpeng ho etsa hore motho a nahane ka adrenal adenocarcinoma.

Haeba mokuli a tletleba ka keketseho ea boima ba 'mele bo tsamaisanang le kholo ea khatello ea mali (le botenya ba alimentary, e le molao, phaello ea boima ba mmele e etsahala nako e telele pele ho nts'etsopele ea khatello ea mali), mathata a teng kahare sebakeng sa genital (dysmenorrhea ho basali, ho felisoa ha libido ho banna), joale nahana hore ke lefu la Itsenko-Cushing kapa lefu. Mohopolo o tšehetsoa haeba mokuli a amehile ka lenyora, polyuria, ho hlohlona (ponahatso ea mathata a metabolism ea carbohydrate).

Mekhoa ea tlhahlobo ea 'mele e senola:

a) liphetoho tsamaisong ea pelo le methapo, li ntse li eketseha tlasa khatello ea khatello ea mali,

b) ho hlahella ha mafura 'meleng ka maoto le matsoho a tšesaane,' mala o pinki, makhopho, hypertrichosis, tšobotsi ea lefu lena le lefu la lona la Itsenko-Cushing,

c) bofokoli ba mesifa, ho holofala le ho ruruha, tšupa-nako e nang le lefu la Conn, matšoao a Hvostek le Trousseau, edema ea nako le nako (ka linako tse ling e hlokometsoeng ka aldosteroma),

d) sebopeho se chitja ka mpeng (adrenal gland).

Hoa hlokahala ho etsa tlhahlobo e tsosang: bimanual palpation ea sebaka sa letso ka tsela e fapaneng bakeng sa metsotso e 2-3 ho ka baka koluoa ea catecholamine le pheochromocytoma. Liphetho tse mpe tsa tlhahlobo ena ha li khetholle pheochromocytoma, hobane e kanna ea ba le sebaka se eketsehileng.

Patlo ea tlhahlobo ea mahlale e bohlokoa hobane e u lumella ho:

a) etsa tlhahlobo ea ho qetela,

b) ho tseba hore na hlahala e kae,

c) hlakisa mofuta oa eona,

d) khetholla maqiti a kalafo.

E se e ntse e le nakong ea lithuto tse tlamang, liphetoho tse hlahang li fumaneha: leukocytosis le erythrocytosis maling a potoloho, hyperglycemia le hypokalemia, karabelo ea urine ea alkaline e atileng (ka lebaka la litaba tse phahameng tsa potasiamo), tšobotsi ea hyperaldosteronism ea mantlha. Ka nts'etsopele ea "hypokalemic nephropathy," polyuria, isostenuria, le nocturia li senoloa thutong ea moroto ho latela Zimnitsky.

Mekhoa e meng ea lipatlisiso e eketsehileng ho khetholla kapa ho qhelela lihlahisoa tsa mantlha aldostonism:

1) Phuputso ea tlhahlobo ea potasiamo ea potasiamo le sodium ka mehla moriring ka lipalo tsa motsoako oa Na / K (o nang le lefu la Conn's, o fetang 2),

2) boikemisetso ba litaba tsa potasiamo le sodium ho plasma ea mali pele le kamora ho nka 100 mg ea hypothiazide (ho lemoha ha hypokalemia ho aldosteronism ea mantlha, haeba boleng ba pele bo tloaelehile),

3) qeto ea polokelo ea mali ea alkaline (e boletsoeng alkalosis ho aldosteronism ea mantlha),

4) boikemisetso ba litaba tsa aldosterone ka moroto oa letsatsi le letsatsi (e eketsehile ka aldostonism ea mantlha),

5) boikemisetso ba boemo ba renin ho plasma ea mali (tšebetso e fokolisitsoeng ea renin kahare ho lefu la Conn's).

Bohlokoa bakeng sa ho khetholla mathata ohle a adrenal tumello ke lintlha tse tsoang lithutong tse latelang:

1) retro-pneumoperitoneum e nang le adrenal tomography,

2) Tlhahlobo ea radionuclide ea litšoelesa tsa adrenal,

3) compression ea letsatsi,

4) phlebography e khethollang ea litsoelesa tsa adrenal.

Haholo-holo ho thata ho lemoha pheochromocytoma extrenal localization. Boteng ba setšoantšo sa lefu lena la bokuli le ho ba sieo ha tumello ea adrenal (ho ea ka retro-pneumoperitoneum e nang le tomography), hoa hlokahala ho etsa aortography ea thoracic le ea mpa e lateloang ke tlhahlobo e phethahetseng ea li-aortographs.

Bakeng sa mekhoa e tlatselletsang ea ho hlahloba pheochromocytoma pele o etsa mekhoa e boletsoeng ea sesebelisoa, ho etsoa liteko tse latelang tsa laboratori:

1) boikemisetso ba lits'oants'o tsa moriti oa letsatsi ka letsatsi oa li-catecholamine le vanillylindic acid khahlano le semelo sa tlokotsi (se eketsehile haholo) le kantle ho sona,

2) thuto e arohaneng ea excretion ea adrenaline le norepinephrine (li-tumors tse fumanehang ka har'a li-adrenal gland le lebota la bladder secrete adrenaline le norepinephrine, li-tumors tsa libaka tse ling - feela norepinephrine),

3) histamine (provocative) le liteko tsa regitin (ho emisa) (boteng ba pheochromocytoma positive).

Mekhoa e tlatselletsang ea ho etsa lipatlisiso bakeng sa bokuli bo belaelloang le lefu la eona la Itsenko-Cushing, li hlahisa:

1) boikemisetso mochine oa letsatsi le letsatsi oa litaba tsa 17-ketosteroids le 17-hydroxycorticosteroids,

2) thuto ea 'mino oa sephiri oa secretion ea 17 le 11-hydroxycorticosteroids maling (ho lefu la Itsenko-Cushing, litaba tsa lihormone maling li eketsehile haholo ka nako ea mots'eare)

3) tlhahlobo e qaqileng ea sesepa sa Turkey le sehlophisi sa eona se hlophisitsoeng (ho sibolloa ha pituitary adenoma),

4) mekhoa eohle e hlalositsoeng pele ea ts'ebetso ea ho ithuta ha litšoelesa tsa adrenal bakeng sa ho fumanoa ha corticosteromas.

Tlhahlobo ea lefu la endocrine e fela ka lipatlisiso tsa tlhahlobo ea mafu.

Ho khetholloa ha matšoao a tšoaetso ea mali ho ipapisitse le tlhahlobo e hlakileng le e nepahetseng ea mafu a tsamaeang le keketseho ea khatello ea mali le ho qheleloa ka thoko mefuta e meng ea khatello ea mali.

Matšoao a tšoaetso ea mali e ka ba sesupo sa lefu le ka tlase, 'me a hlaha tlhahlobong: mohlala, khatello ea methapo ea kutlo. Haeba khatello ea mali ke e 'ngoe ea lipontšo tse ngata tsa lefu lena' me ho sa bonahale e le lets'oao la mantlha, ho ka etsahala hore bokuli bo se ke ba boleloa, ka mohlala, ka ho senya tse nang le chefo, bokuli kapa lefu la Itsenko-Cushing.

I. Phekolo ea tlhaho.

Ha khatello ea mali e fumaneha ka lebaka la methapo ea methapo ea methapo ea methapo, ho kopana ha aorta, kapa adrenal adenomas, ho hlaha potso ea ts'ebetso ea bongaka (ho felisa lisosa tsa khatello ea mali). Pele ho tsohle, sena se ama pheochromocytoma, adenomas e hlahisang aldosterone le adrenal adenocarcinomas, corticosteromas, hape, kankere ea renal hypernephroid.

Ka pituitary adenoma, mekhoa ea ho pepeseha ka mafolofolo e sebelisang x-ray le radiotherapy, kalafo ea laser e sebelisoa, maemong a mang ba etsa ts'ebetso.

Phekolo ea lithethefatsi bakeng sa lefu le ka tlas'a lefu lena (periarteritis nodosa, erythremia, ho nyekeloa ke pelo, mafu a ts'ebetso ea moroto, joalo-joalo) e fana ka phello e ntle ho khatello ea mali.

Ha khatello ea mali ke e 'ngoe ea matšoao ...

Kaha mabaka a keketseho ea bobeli ea khatello a mangata, bakeng sa bonolo ba ne ba kopantsoe ka lihlopha. Tlhalo e bonts'a ts'oaetso ea lehae ea lefu lena le lebisang ho khatello ea mali.

Lenonyeletso le tsoang ka matšoao.
Endocrine.
Hypertension ho mafu a pelo le methapo.
Sebopeho sa Neurogenic.
Hypertension ea kalafo.

Tlhahlobo ea litletlebo le matšoao, mekhoa ea lefu lena, e thusa ho belaella mofuta oa bobeli oa khatello ea mali. Kahoo matšoao a khatello ea mali, ho fapana le mantlha, a tsamaea le:

Ho qala ho matla, ha lipalo tsa khatello li phahama ka tšohanyetso le ka potlako,
Phello e tlase ea kalafo e tloaelehileng ea antihypertensive,
Ketsahalo ea tšohanyetso ea keketseho ea butle butle ea khatello ea maikutlo ntle le nako e fetileng,
Ho hlola ha bacha.

Matšoao a mang a sa tobang sethaleng sa tlhahlobo ea pele le lipuisano le mokuli li ka supa sesosa sa lefu lena. Kahoo, ka foromo ea renal, khatello ea "diast" ("tlaase") e phahama ka ho hlaka, mathata a endocrine-metabolic a etsa hore ho be le keketseho e lekanang ea khatello ea systolic le diastolic, 'me ka methapo ea pelo le methapo ea mali, palo ea "holimo" e eketseha haholoholo.

Ka tlase re nahana ka lihlopha tsa mantlha tsa khatello ea mali e thehiloeng ho sesosa sa lefu lena.

Karolo ea mantlha ea mofuta oa khatello ea mali e phahameng

Liphio ke e 'ngoe ea litho tsa sehlooho tse fanang ka khatello e tloaelehileng ea mali. Ho hloloa hoa bona ho baka keketseho ea khatello ea mali, mme ka mora moo ba kenella e le setho sa sepheo ho khatello e matla ea mali. Matšoao a tšoaetso ea methapo ea methapo ea kutlo a amanang le tšenyo ea methapo ea setho (renovascular form) kapa parenchyma (renoparenchymal).

Phaello ea methapo ea kutlo

Mefuta e ntlafalitsoeng ea mokokotlo e bakoa ke ho fokotseha ha palo ea mali e phallang methapong ho ea lipelong, ho arabela sena, mekhoa e reretsoeng ho khutlisa phallo ea mali e kentsoe tšebetsong, renin e ntšoang, e hlahisang keketseho ea matšoao a vascular, spasm, mme ka lebaka leo, keketseho ea matšoao a khatello.

Har'a lisosa tsa khatello ea methapo ea methapo ea kutlo, lefu la atherosclerosis, le fumanoeng ho bakuli ba 3/4, le ho senyeha ha methapo ea kutlo, e etsang karolo ea 25% ea linyeoe tsa lefu lena. Maemong a sa tloaelehang, vasculitis (ho ruruha ka har'a likepe) e bontšoa e le lisosa - mohlala, Goodpasture syndrome, aneurysms ea vascular, compression ea lesea e tsoang ka ntle ke liharo, lesion ea metastatic, jj.

Likarolo tsa lipontšo tsa kliniki tsa khatello ea methapo ea kutlo:

Ho qaleha ha lefu lena, haholo ho banna kamora lilemo tse 50 kapa basali ba ka tlase ho lilemo tse mashome a mararo,
Sekhahla se phahameng sa BP se hanang kalafo,
Likotsi tsa khatello ea maikutlo ha li hlahelle,
Khatello ea diastolic hangata e phahama,
Ho na le matšoao a lefu la liphio.

Renoparenchymal khatello ea mali

Renoparenchymal secondary arterial hypertension e amahanngoa le tšenyo ea parenchyma mme e nkoa e le mofuta o tloaelehileng oa pathology, o ikarabellang bakeng sa ho fihla ho 70% ea khatello eohle e phahameng ea mali. Lisosa li ka kenyelletsa glomerulonephritis, pyelonephritis, tšoaetso ea methapo ea methapo le methapo ea methapo, lefu la tsoekere, le neoplasms ea renal parenchyma.

Sekhahla se phahameng sa renoparenchymal sethaleng se tšoauoa ka khatello e eketsehang e nang le matšoao a "renal" - ho ruruha, puffility ea sefahleho, bohloko bo ka morao mokokotlong, mathata a dysuric, liphetoho tlhahong le boholo ba moroto. Tlokotsi bakeng sa phapang ena ea lefu lena ha e bonahale, haholo khatello ea diastolic e eketseha.

Mefuta ea endocrine ea khatello e phahameng ea mali

Matšoao a endocrine arterial hypertension a bakoa ke ho se leka-lekane ha tšusumetso ea lihormone, tšenyo ea litšoelesa tsa endocrine le tšebelisano e mpe pakeng tsa tsona. Nts'etsopele ea kholo ka ho fetisisa ea lefu lena le lefu la eona la Itenko-Cushing's, tumoch pheocytoma tumor, pituitary pathology e nang le acromegaly, adrenogenital syndrome le maemo a mang.

Ka mathata a endocrine, sebopeho sa lihormone tse ka matlafatsang khatello ea methapo, ho eketsa tlhahiso ea lihormone tsa adrenal, ho baka ho ts'oaroa ha metsi le letsoai 'meleng. Mekhoa ea tšusumetso ea li-hormone e fapana ebile ha e utloisisoe ka botlalo.

Ntle le khatello ea mali, matšoao a liphetoho tsa lihormone a bitsoa hangata tleleniking. - botenya, kholo ea moriri o feteletseng, sebopeho sa striae, polyuria, lenyora, ho hloka thari, joalo-joalo, ho latela lefu la causative.

Neurgenic e nang le matšoao a tšoaetso ea mali

Hypertension ea Neurogenic e amahanngoa le lefu la methapo ea methapo e bohareng. Har'a lisosa tse atisang ho hlaha ke ho ruruha ha bokong le litho tsa eona, likotsi, lits'ebetso tsa molumo li eketsang khatello ea methapo, le diencephalic syndrome.

Hammoho le keketseho ea khatello, ho na le matšoao a ho senyeha ha methapo ea boko, khatello ea methapo ea mali le data ea maqeba hloohong.

Phaello ea mali le lebaka la methapo

Keketseho ea khatello khahlanong le semelo sa methapo ea pelo kapa pelo e bitsoa hemodynamic sekhahla sa khatello ea kelello ea methapo. Tšenyo ea pelo ea atherosclerotic, coarctation, bofokoli bo itseng ba matla, ho nyekeloa ke pelo ho sa feleng, litšitiso tse matla tsa morethetho oa pelo li lebisa ho eona.

Aortic atherosulinosis e nkuoa e le mokhoa o atisang ho hlaha oa batho ba tsofetseng, o etsang hore ho be le keketseho ea khatello ea methapo ea kutlo, ha diastolic e ka sala e le maemong a ts'oanang. Litlamorao tse mpe tsa khatello ea mali e joalo holima phepelo e hloka kalafo e tlamang, ho nahanela ntlha ea bohlasoa.

Mefuta e meng ea khatello e phahameng ea mali

Ntle le mafu a litho tsa kahare le litšoelesa tsa endocrine, keketseho ea khatello e ka bakoa ke ho sebelisa meriana (lihormone, li-antidepressants, lithethefatsi tse thibelang mafu, joalo-joalo), litlamorao tsa joala, ts'ebeliso ea lihlahisoa tse ling (chisi, chokolete, tlhapi e khethiloeng). Karolo e mpe ea khatello ea maikutlo e matla, hammoho le boemo ka mor'a ho buuoa, ea tsebahala.

Liponahatso le mekhoa ea boits'oaro bakeng sa khatello ea mali ea bobeli

Matšoao a khatello ea mali ea bobeli a amana haufi le lefu lena, a ileng a baka keketseho ea matšoao a khatello. Letšoao le ka sehloohong le kopanyang boima bohle ba mafu ana ho nkoa e le keketseho e sa khaotseng ea khatello ea mali, eo ho leng thata ho e phekola. Bakuli ba tletleba ka hlooho e sa khaotseng, lerata la hlooho, bohloko sebakeng sa moea, maikutlo a ho hlonepha le bohloko ba sefubeng, ho fofa hoa "lintsintsi" ka pel'a mahlo. Ka mantsoe a mang, lipontšo tsa khatello ea mali ea bobeli li tšoana hantle le mofuta oa bohlokoa oa pathology.

Matšoao a pathology ea litho tse ling a ekeletsoa khatello e matla. Kahoo ka khatello ea mali a renal edema, liphetoho liphatseng tsa moroto oa hau le mofuta oa tsona, ho ferekanya, feberu, bohloko bo tlase ba morao bo ka etsahala.

Tlhahlobo ea mefuta ea renal e le eona e atileng haholo e kenyelletsa:

Urinalysis (bongata, morethetho oa letsatsi le letsatsi, sebopeho sa ho qhekella, boteng ba likokoana-hloko),
Radioisotope renography,
Phapang ea X-ray, cystography,
Angiography ea liphio
Tlhahlobo ea Ultrasound,
CT, MRI e nang le mefuta e bonolo ea lenane,
A biopsy.

Tekanyo ea khatello ea mali ea endocrineNtle le keketseho ea 'nete ea khatello, e tsamaisana le likotsi tsa kutloelo-bohloko, bofokoli ba litoeba, boima ba' mele, le phetoho ea liresissi. Ka pheochromocytoma, bakuli ba tletleba ka mofufutso, ho thothomela le mala, ho tšoenyeha ka kakaretso, hlooho e bohloko. Haeba hlahala e hlaha ntle le likotsi, tleliniking e na le maemo.

Ho senyeha ha litšoelesa tsa adrenal ho lefu la Cohn ho baka khatello ea mali le bofokoli bo matla, moroto o feteletseng, haholo-holo bosiu, lenyora. Ho kenella ha feberu ho ka bontša ho hlaha 'mala o bohloko oa tšoelesa ea adrenal.

Ho nona ka bongata ho tsamaisana le ho qala ha khatello ea mali, ho fokotseha ha thobalano, lenyora, letlalo le boreleli, matšoao a otlolohileng a mmele (striae), mathata a amanang le metabolism ea carbohydrate a bontša bothata ba lefu la Itsenko-Cushing.

Ho hlahlojoa ha lefu la tsoekere ea bobeli ho kenyeletsa:

Palo e felletseng ea mali (leukocytosis, erythrocytosis),
Boithuto ba metabolism ea carbohydrate (hyperglycemia),
Qeto ea lielektrone tsa mali (potasiamo, sodium),
Teko ea mali le urine bakeng sa li-hormone le metabolite ea tsona ho latela sesosa sa khatello ea mali,
CT, MRI ea tšoelesa ea adrenal, gland.

Hemodynamic sekhahla se phahameng sa mali se amanang le methapo ea pelo le methapo ea mali. Li tšoauoa ka keketseho ea khatello ea bo-systolic haholo. Tsela e sa tsitsang ea lefu lena e atisa ho bonoa ha keketseho ea khatello ea mali e lateloa ke hypotension. Bakuli ba tletleba ka hlooho, bofokoli, ho hloka thabo ka pelong.

Bakeng sa ho fumanwa ha mefuta ea hemodynamic ea khatello ea mali, ho shebahala hohle ha lithuto tsa angiographic, li-ultrasound tsa pelo le methapo ea mali, ECG e sebelisoa, lipid spectrum e tlamehile haeba ho belaelloa atherossteosis. Boitsebiso bo bongata ho bakuli ba joalo bo fanoa ke ho mamela ho tloaelehileng ha methapo ea pelo le mali, e lumellang ho khetholla lerata la tšobotsi holim'a li-methapo tse amehang tsa pelo, li-valve tsa pelo.

Haeba neurogenic matšoao a khatello ea mali a belaelloa etsa tlhahlobo ea methapo e phethahetseng, hlakisa tlhaiso-leseling mabapi le likotsi, ts'ebetso ea boko, ts'ebetso ea boko. Matšoao a khatello ea mali ho bakuli ba joalo a tsamaisana le matšoao a ho hlobaela ka marang-rang, khatello e matla ea methapo (hlooho, ho hlatsa), ho tsitsipana hoa khoneha.

Tlhahlobo e kenyelletsa CT, MRI ea boko, tlhahlobo ea boemo ba methapo ea kutlo, electroencephalography, mohlomong le ultrasound le angiography ea bethe ea methapo ea kelello.

Lisosa tsa ho hlaha

Matšoao a khatello ea mali - khatello e phahameng ea mali e bakoang ke tšenyo ea litho kapa lits'ebetso tsa mmele tse amehang taolong ea khatello ea mali.

Maemong ana, ho phatloha ho kenang methapong ho etsahala ka methapo ea methapo ea methapo kapa ho fokotseha ha methapo ea mali ka lebaka la palo e eketsehang ea li-enzymes tse laolang bophara ba mokokotlo. Mofuta ona oa lefu o bua ka khatello e phahameng ea mali.

Haeba khatello ea mali e fumanoe ka mokhoa ona, litho tsa bohlokoa tsa motho lia ameha: boko, meno, pelo, methapo ea mali, sebete.

Khatello e phahameng ea methapo ea kutlo ke phello ea methapo ea methapo e etsahalang litho tsena, maemong a sa tloaelehang, khatello ea mali e ka ba sesosa sa lefu lena ho litho tsa sepheo.

Ho ipapisitsoe le lipalopalo, khatello ea maikutlo ea bobeli ka mofuta ona o iponahatsa e le 5-15% ea linyeoe tse tlalehiloeng ke lingaka. Ho feta moo, litletlebo tsa batho ba nang le khatello ea maikutlo le methapo ea methapo e batlang e tšoana.

Ho ipapisitsoe le etiology ea lefu lena, ho na le mefuta e ka bang 70 ea litlhahlobo tse bakang keketseho ea khatello ea methapo. Ntlha ena ha se pontšo ea letho, kahoo u lokela ho ea ngakeng eseng ho inahana. Nahana ka ntho e atileng haholo eo ho eona batho ba ntlafatsang khatello ea mali:

Hangata, sekhahla sa methapo ea methapo ea methapo se hlaha ka mokhoa oa a renal, ka lebaka la mafu a litho tsa kahare tsa urine, liphio le methapo ea kutlo. Ts'oaetso tsena li ka tsoaloa hape tsa fumaneha.

Congenital e kenyelletsa: nts'etsopele ea setho se sa tloaelehang, lefu la liphio tsa polycystic, hypoplasia, meno a maiketsetso, hydronephrosis, dystopia.

Tse fumanoeng li kenyelletsa: systemic vasculitis, e kenyelletsa glomerulonephritis, urolithiasis, mafu a oncological a renal, methapo ea methapo ea methapo le methapo ea methapo, lesapo la mokokotlo, lefu la lesapo la mokokotlo, embolism ea methapo ea methapo.

Sebopeho sa endocrine sa khatello ea mali e phahameng se hlaha khahlano le semelo sa methapo ea methapo ea methapo ea kutlo. Thyrotooticosis ,'senenko-Cushing's syndrome, Pheochromocytoma le lefu la Conn ke mohlala o makatsang oa ketsahalo ena.

Thyrotooticosis ke lefu le hlahisoang ke tlolo ea ts'ebetso ea tšoelesa ea qoqotho. Ka nako e ts'oanang, thyroxine (hormone) e kena 'meleng ka bongata. Lefu lena le tšoauoa ka keketseho e sa tloaelehang ea khatello ea methapo, eo boleng ba diastoli bo lulang bo le ka har'a meeli e tloaelehileng, 'me litekanyetso tsa systolic li eketseha haholo.

Pheochromocytoma e boetse e bua ka mofuta oa endocrine oa khatello ea mali mme o hlaha ka lebaka la hlahala ea tšoelesa ea adrenal. Keketseho ea khatello ea methapo ke pontšo ea mantlha ea lefu lena. Ho feta moo, boleng bo ka fapana bakeng sa motho ka mong: ho mokuli a le mong, lula ka har'a meeli e itseng, 'me ho e mong - o baka tlhaselo ea khatello ea mali.

Lefu la Aldosteroma kapa la Conn le hlahella ka lebaka la ho ntšoa ha homone e ngata maling - aldosterone, e bakang sodium e sa tsoeng 'meleng. Enzyme ena e feteletseng e ka ama motho hampe.

Lefu la eona la Itsenko-Cushing hangata le halefisa khatello ea mali ea mantlha ka sebopeho sa endocrine (hoo e batlang e le 80% ea linyeoe). Matšoao a mantlha a lefu lena ke ho se leka-lekane ha sefahleho le maoto le matsoho. Ka nako e ts'oanang, maoto le matsoho a mokuli a lula a sa fetoha, 'me sefahleho se fumana sebopeho se bopehileng joaloka khoeli.

Climax e boetse e khona ho baka khatello ea mali ea methapo ka lebaka la ho fokotseha hoa mesebetsi ea thobalano.

Sebopeho sa neurogenic sa methapo ea methapo ea methapo se bonts'a ho se sebetse hantle ts'ebetsong ea methapo ea kutlo. Lisosa tsa khatello ea methapo ea methapo ea methapo ea kutlo ke kotsi e bohloko ea boko, maemo a ischemic, ho hlaha ha neoplasms, encephalitis bokong. Tabeng ena, ho na le matšoao a mangata a fapaneng, ka hona mofuta ona oa khatello ea mali o ferekanngoa habonolo le lefu la pelo (ntle le tlhahlobo e khethehileng).

Phekolo ea mofuta ona oa khatello ea mali e reretsoe ho khutlisetsa mesebetsi ea boko le ts'ebetso ea litho.

Matšoao a hemodynamic a matšoao a hlaha ka lebaka la tšenyo ea methapo ea pelo le setho ka boeona: ho fokotseha ha tlhaho ea setho sa tlhaho, atherosclerosis, bradycardia, lefu la methapo ea methapo ea pelo, lefu la mokokotlo oa pelo. Khafetsa, lingaka li theha ka mofuta ona oa lefu lena phapang lipontšong tsa khatello ea mali: ke litekanyetso tsa systolic tse ntseng li eketseha.

Matšoao a tšoaetso ea methapo ea kutlo a ka boela a bakoa ke ho kopana ha maloetse a mangata a pelo kapa pelo.

Hangata lingaka li ne li tlaleha matšoao a kalafo ea bongaka ba methapo e hlahang ka lebaka la tšebeliso ea batho ba sebelisang meriana e eketsang litekanyetso tsa tonometer tsa intravascular, e leng lithibela-pelehi, lithethefatsi tse nang le glucocorticoids, indomethacin e kopantsoeng le ephedrine, levothyroxine.

Ho bohlokoa hape ho tseba hore matšoao a khatello ea mali a arotsoe ka nakoana, a lerato, a tsitsitse ebile a le khopo. Maloetse a fapaneng joalo a nang le khatello ea mali a mangata a ipapisitse le sesosa sa ho hlaha ha ona, ho senyeha ha litho tsa 'mele le ho se tsotelle ha lefu lena, ka hona ho khothalletsoa ho ela hloko matšoao a fumanehang ho methapo ea methapo ea methapo, mme o buisane le ngaka ka keketseho e nyane haholo ea khatello (maemong a khutsitseng).

Tlhahisoleseling ka kakaretso

Ho fapana le khatello ea mali e bohlokoa e ikemetseng (ea mantlha), khatello ea methapo ea kutlo ke matšoao a mafu a a bakileng. Hypertension syndrome e tsamaisana le maloetse a fetang 50. Har'a palo e felletseng ea maemo a khatello ea mali, karolo ea lipalo tsa khatello ea methapo ea kutlo e ka bang 10%. Nako ea phallo ea methapo ea methapo ea mali e tšoaeang matšoao e bonts'a matšoao a etsang hore ho khonehe ho ba khetholla ho tsoa ho khatello e phahameng ea mali (hypertension):

Bakuli ba ka tlase ho lilemo tse 20 le tse fetang 60,
Tsoelo-pele ea tšohanyetso ea khatello ea mali le methapo ea mali e sa khaotseng,
Tsela e bohloko, e tsoelang pele ka potlako,
Nts'etsopele ea likoluoa tse utloisang bohloko,
Nalane ea maloetse a lefu la kelello
Karabelo e fokolang ea phekolo e tloaelehileng,
Keketseho ea khatello ea diastoli ho methapo ea methapo ea kutlo.

Tlhomamiso

Ho latela khokahano ea mantlha ea etiology, matšoao a khatello ea methapo ea kutlo a arotsoe ka:

Neurogenic (ka lebaka la mafu le liso tsa tsamaiso ea methapo e bohareng):

Hemodynamic (ka lebaka la tšenyo ea lijana tse kholo le pelo):

Mefuta ea Litekanyetso ha u nka liminerale le glucocorticoids, progesterone le estrogen tse nang le lithibela-pelehi, levothyroxine, letsoai la tšepe tse boima, indomethacin, licorice phofo, jj.

Ho latela boholo le ho phehella ha khatello ea mali, ho teba ha khatello ea methapo ea methapo ea mali, mofuta oa liphetoho tsa fundus, mefuta e 4 ea matšoao a tšoaetso ea methapo ea kutlo a khethollotsoe: nakoana, labile, e tsitsitseng ebile e le mpe.

Hypertension ea nakoana ea methapo ea methapo e bonts'oa ke keketseho e sa tsitsang ea khatello ea mali, ha ho na liphetoho lipontšong tsa fundus, hypertrophy ea ventricular e setseng e sa tsejoe. Ka khatello ea methapo ea methapo ea methapo, khatello e matla le e sa tsitsang ea khatello ea mali e bonoa e sa fokotsehe ka bohona. Hyperrophy e bonolo ea "ventricle" e tlohetsoeng ka thoko le ho fokotsa likepe tsa retina li hlokomeleha.

Stertial arterial hypertension e tšoauoa ka khatello e phehellang le khatello e phahameng ea mali, myocardial hypertrophy, le phetoho ea methapo ea mali ho fundus (angioretinopathy I - II degree). Malignant arterial hypertension e tšoauoa ka khatello e matla ea mali le e tsitsitseng (haholo diastolic> 120-130 mm Hg), ho qala ka tšohanyetso, nts'etsopele e potlakileng, le kotsi ea mathata a methapo a pelo a tsoang pelong, bokong, fundus, a khethang projosis e mpe.

Nephrogenic parenchymal arterial hypertension

Hangata, matšoao a khatello ea methapo ea methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a lefu la mokokotlo le lefu la tsoekere, lefu la sethoathoa le lefu la tsoekere, likotsi le lefuba la liphio, amyloidosis, SLE, tumello.

Mehato ea pele ea maloetse ana hangata e etsahala ntle le khatello ea mali ea methapo. Phekolo ea methapo ea kutlo e ba le tšenyo e matla litoneng kapa lisebelisoa tsa liphio. Litšobotsi tsa khatello ea methapo ea methapo ea kutlo li haholo lilemong tsa banyane tsa bakuli, ho se be teng ha mathata a methapo ea methapo le a manonyeletso, nts'etsopele ea ho se sebetse hantle ha renal, tlhaho e mpe ea thupelo (maemong a sa foleng a pyelonephritis - ka 12,2%, glomerulonephritis e sa foleng - ho 11,5% ea linyeoe).

Boemong ba tlhahlobo ea methapo ea methapo ea kutlo ea parenchymal renal, liprosesa tsa liphio, urinalysis (proteinuria, hematuria, cylindruria, pyuria, hypostenuria - matla a tlase a moroto a fumanoe), qeto ea moeinine le urea maling (azotemia e fumanoe). Ho ithuta tšebetso ea lekunutu ea liphio, isotope renography, urology, le ho eketsoa, angiography, ultrasound ea lijana tsa liphio, MRI le CT ea liphio, le biopsy ea liphio.

Nephrogenic Renovascular (Vasorenal) Arterial Hypertension

Mofuta oa methapo ea kutlo kapa ea methapo ea methapo ea methapo ea methapo ea methapo ea kutlo e fetoha ka lebaka la khatello ea mali e le 'ngoe kapa tse peli tse amanang le phallo ea mali a arterial renalial. Ho 2/3 ea bakuli, sesosa sa ntlafatso ea methapo ea methapo ea methapo ea methapo ke lesapo la mokokotlo la methapo ea methapo ea kutlo. Phekolo ea methapo ea kutlo e eketseha ka ho fokotswa ha lumen ea methapo ea kutlo e nang le 70% kapa ho feta. Khatello ea mali ea Systolic e lula e le kaholimo ho 160 mm Hg, diastolic - ho feta 100 mm Hg

Hypertension ea methapo ea kutlo e bonts'oa ke ho qaleha ka tšohanyetso kapa ho theoha ho matla ha thupelo, ho se tsotelle kalafo ea lithethefatsi, karolo e phahameng ea thupelo e mpe (ho 25% ea bakuli).

Matšoao a tšoaetso ea methapo ea methapo ea methapo ea methapo ea methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a methapo a potlakisa ho tlosa phapang. Ultrasound - matšoao a bosoasoi a asymmetry ea sebopeho le boholo ba liphio tse fetang cm 1.5. Angiography e senola ho potoloha hoa methapo ea methapo ea methapo. Ho hlahlojoa ha li-doplex tsa duplex ea methapo ea methapo ea methapo ho etsa hore motho a bone hore na ho na le phallo ea mali a mantlha a phallo.

Ha ho sa tšoaroe kalafo bakeng sa khatello ea methapo ea methapo ea methapo ea methapo, ho pholoha ha mokuli ea lilemo tse 5 ho ka ba 30%. Lisosa tse atileng haholo tsa lefu ke likotsi tsa methapo ea methapo, infraction ea myocardial, le ho hloleha ho matla ha a methapo. Molemong oa kalafo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo, ho sebelisoa meriana le lithethefatsi ka bobeli: angioplasty, stenting, lits'ebetso tsa setso.

Ka stenosis ea bohlokoa, tšebeliso ea nako e telele ea kalafo ea lithethefatsi ha e na mabaka. Phekolo ea lithethefatsi e fana ka phello e khuts'oane le ea maemo a mang. Phekolo ea mantlha ke ho buuoa kapa ho emisa. Maemong a vasorenal arterial methapo ea methapo, ho kenngoa lesapo la methapo ea methapo ho holisa leseli la methapo ea kutlo le ho thibela ho fokola ha eona, ho kenella ka hare ho karolo ea sekepe ka sekepe, ts'ebetso e ntlafatsang molemong oa methapo ea methapo: resection with anastomosis, prosthetics, andpass vascular anastomoses.

Pheochromocytoma

Pheochromocytoma, hlahala e hlahisang li-hormone e tsoang liseleng tsa chromaffin tsa adrenal medulla, e etsa karolo ea 0,2% ho isa ho 0,4% ea mefuta eohle e tloaelehileng ea khatello ea mali ea methapo. Pheochromocytomas secrete catecholamines: norepinephrine, adrenaline, dopamine. Thupelo ea bona e tsamaea le khatello e matla ea mali, 'me nako le nako ho ba le likotsi tse matla. Ntle le khatello ea mali e nang le pheochromocytomas, ho opeloa ke hlooho haholo, ho fufuleloa ho eketsehileng le palpitations li bonoa.

Pheochromocytoma e fumanoa ha ho fumaneha litaba tsa catecholam ka moroto ka ho etsa liteko tsa tlhahlobo ea meriana (liteko tsa histamine, tyramine, glucagon, clonidine, jj.). Ultrasound, MRI kapa CT ea tšoelesa ea adrenal e lumella hore tumor e be le tikoloho e nepahetseng haholoanyane. Ka ho etsa tlhahlobo ea radioisotope ea litsoelesa tsa adrenal, hoa khonahala ho khetholla ts'ebetso ea li-hormonal tsa pheochromocytoma, ho khetholla marang-rang a adrenal localization, metastases.

Li-Pheochromocytomas li tšoaroa ka mokhoa o ikhethileng, pele ho ts'ebetso ea bongaka, ho lokisoa ha methapo ea methapo ea kutlo le li-blockers tsa í- kapa β-adrenergic.

Aldosteronism ea mantlha

Ho kenella ha methapo ea methapo ea kutlo ho lefu la Conn kapa hyperaldosteronism ea mantlha ho bakoa ke aldosterone e hlahisang adrenal cortical adenoma. Aldosterone e phahamisa phetisetso ea K le Na ions ka liseleng, ho boloka mokelikeli 'meleng le nts'etsopele ea hypokalemia le arterial hypertension.

Hypertension ha e khonehe bakeng sa khalemelo ea bongaka, ho na le litlhaselo tsa myasthenia gravis, letsoalo, paresthesia, lenyora le nictruria. Likotsi tse nang le khatello ea maikutlo li ka etsahala ka nts'etsopele ea ho hloleha ho hlobaetsang ha pelo le methapo (pelo le asthma ea pelo, pulmonary edema), stroke, ho holofala hoa pelo.

Tsebo ea aldostonism ea mantlha e thehiloe boikhethong ba maemo a plasma a aldosterone, electrolyte (potasiamo, chlorine, sodium). Tlalelo e phahameng ea aldosterone maling le phello ea eona e phahameng ka har'a moroto, alkalosis ea metabolic (mali pH - 7.46-7.60), hypokalemia (

Phekolo ea matšoao a khatello ea mali

Phekolo ea khatello e phahameng ea khatello ea kelello e kenyelletsa mokhoa oa motho ka mong ho mokuli ka mong, hobane mofuta oa lithethefatsi tse behiloeng le lits'ebetso li its'etleha ho "psychology" ea mantlha.

Ka coarctation ea aorta, liphoso tse methapo ea kutlo, ho senyeha ha likepe tsa liphio, potso e hlaha mabapi le tlhoko ea tokiso ea ho lokisa liphetoho. Lithapo tsa tšoelesa ea adrenal, pituitary le liphio le tsona li ka tlosoa ha ho buuoa.

Maemong a tšoaetsanoang le a tšoaetsanoang liphihleng, lefu la polycystic, lithethefatsi tse thibelang mafu, ho loants'oa mafu, ho khutlisetsoa metabolism ea metsi a letsoai hoa hlokahala, maemong a matla hemodialysis kapa peraloneal dialysis.

Hypertension ea Intracranial e hloka ho khethoa ha diuretics tse eketsehileng, maemong a mang phekolo ea anticonvulsant e ea hlokahala, mme lits'ebetso tsa volumetric (ho ruruha, hemorrhage) li tlosoa ka mokhoa o phahameng.

Pheko ea kalafo ea antihypertgency e bolela ho khethoa ha lihlopha tse tšoanang tsa lithethefatsi tse sebetsang haeba ho na le khatello ea mali e hlokahalang. E bonts'ang:

Li-inhibitors tsa ACE (enalapril, perindopril),
Beta-blockers (atenolol, metoprolol),
Lithane tsa calcium calcium (li-diltiazem, verapamil, amlodipine),
Diuretics (furosemide, diacarb, veroshpiron),
Li-vasodilators tsa Peripheral (pentoxifylline, sermion).

Ho bohlokoa ho hlokomela hore ha ho na mofuta o le mong oa kalafo bakeng sa khatello ea mali e phahameng ho bakuli bohle, kaha lithethefatsi tse tsoang lethathamong le fuoeng mofuta oa mantlha oa lefu lena li ka tšoaetsanoa ho bakuli ba nang le methapo ea methapo, bokong kapa methapo ea mali. Mohlala, li-inhibitors tsa ACE li ke ke tsa laeloa bakeng sa lefu la methapo ea methapo ea methapo, le li-beta-blocker tse thathamisitsoeng ho batho ba nang le arrhythmias e matla khahlano le bofokoli ba pelo, coarctation ea aortic.

Sebakeng ka seng, kalafo e nepahetseng e khethoa ho ipapisitsoe le lipontšo, pele ho tsohle, tsa patusative pathology, e khethollang matšoao le li-contraindication tsa moriana ka mong. Khetho e etsoa ke boiteko bo kopaneng ba litsebi tsa pelo, lingaka tsa kutlo, lingaka tsa bongaka, lingaka tse buoang.

Sekhahla sa khatello ea methapo ea kutlo ke bothata bo potlakileng ho lingaka tsa maemo a mangata, hobane ha se tšoaetso ea eona feela, empa le boikemisetso ba sesosa ke mokhoa o rarahaneng mme hangata o nka mekhoa e mengata. Mabapi le sena, ho bohlokoa haholo hore mokuli a fumana tumellano le ngaka kapele kamoo ho ka khonehang mme a hlalose ka botlalo matšoao a hae kaofela, mofuta oa nts'etsopele ea methapo, nalane ea bongaka, linyeoe tsa malapa tsa mafu a itseng. Tlhahlobo e nepahetseng ea khatello ea mali ea bobeli ke senotlolo sa kalafo e atlehileng le thibelo ea mathata a eona a kotsi.

Matšoao a khatello ea kelello

Ntle le ho eketsa khatello ea methapo ea mali mokhoeng oa khatello e phahameng ea mali, mokuli o na le matšoao a mang. Litsebi li tlaleha lipontšo tsa kliniki tsa khatello ea methapo ea mali, tse nang le lintlha tse 3: khatello ea mali e eketsehileng (e hlahisoang ke ho hanyetsa kapa matšoao a sa lumellaneng), boemo bo mpefatsang le ho ba teng ha matšoao a amanang le ts'ebetso ea methapo ea methapo e etsahalang ka mekhoa ea hemodynamic, neurogenic, endocrine le renal.

Maemong a mang, ts'ebetso ea methapo ea methapo ea methapo e tsoela pele ka sebopeho sa tlhaho, empa ho hlahisa sesupo se ba supang - lefu la sekhahla la khatello ea mali. Ka hona, motho ha a lokela ho mamela maikutlo a beng ka eena, metsoalle le ho ea kalafong ntle le tlhahlobo ea bongaka e phethahetseng, kapa ho phekola khatello ea mali ka ho khetheha ka litlhare tsa setso.

Lefu la matšoao a tšoaetso ea mali le ka hlahisoa ke matšoao a ka ba teng ka mokhoa o tsitsitseng ka har'a meeli e itseng, kapa a hlaha ka tšohanyetso mme a nyamela. Hypertonic e kanna ea hlokomela maloetse a latelang:

Bohloko sebakeng, molala, litempele, frontbe lobe.
Mathata a nang le moriti oa ho ntša metsi.
Hlooho ea hlooho.
Nausea, e kopantsoeng le ho hlatsa.
Maqhubu.
Tlhokomeliso e mpe kapa memori.
Mokhathala le bofokoli, lethargy.
Ponahalo ea "lintsintsi" ka pel'a mahlo.
Keketseho ea maeto a bosiu ho ea ntloaneng.
Ho se sebetse kapa ho ilela khoeli ka mokhoa o sa tloaelehang.
Mofuta o mongata oa moroto o tsoang 'meleng.
Mokhathala.
Tinnitus.
Ho hloka botsitso kapa bohloko sebakeng sa pelo.
Ho thothomela mmele kapa matsoho.
Kholo ea moriri oa 'mele.
Masapo a Brittle.
Mofoka.
Keketseho ea mocheso oa 'mele o sa bakoang ke lefu le tšoaetsanoang.
Ho kheloha kelello ho tsoa ho psyche (system ea methapo e bohareng), ka mokhoa oa ho hloka thahasello kapa bohlola ba kelello. Li hlaha ka lebaka la phetiso ea khatello ea methapo ea mali ho bakuli.

Ha ho nahanoa hore ts'ebetso ea methapo e bohareng e ba le khatello ea maikutlo e bakoang ke lefu lena, e ka ferekanya motho haholo ha a tšohile, a tšohile, a tšohile, a tšaba lefu.

Matšoao a tlhaho e eketsehileng a kenyelletsa ho otla ha pelo ka potlako, ho fufuleloa ho eketsehileng le pallor ea letlalo ntle le lintlha tse ka amang lipontšo tsena.

Hape hoa bohlokoa ho hlokomela hore matšoao a ka holimo a tšoana le matšoao a khatello ea mali a kenang ka hare. Ntlha ena e boetse e paka hore ho hlokahala tlhahlobo ea bongaka.

Litšobotsi

Ho ipapisitse le lipontšo tsa khatello ea mali, batho ba bangata ba ferekanya khatello e phahameng ea mali le khatello e phahameng ea mali. Phekolo e sa nepahalang ntlheng ena e lebisa litlamorao tse sa lebelloang: khatello ea methapo ea mali, lefu la pelo, ho otloa, lefu la myocardial, le thatafatsang lefu lena mme le lebisa lefung pele ho nako.

Matšoao a khatello ea mali a fapane le a mantlha ka lipontšo tse joalo:

U sebelisa litlhare tsa antihypertensive, khatello ea mali ha e lule e le maemong a tloaelehileng, kapa ka nako e telele e khutlela ho tloaelehileng.
Khafetsa ho hlaseloa ke tšabo.
Likhatello tsa khatello li etsahala ka tšohanyetso, lula ka litekanyetso tse tšoanang kapa u khutlele ho tse tloaelehileng haufinyane.
Boloetse bona bo tsoela pele ka potlako.
E bonoa ho motho ea ka tlase ho lilemo tse 20, kapa ea phetseng lilemo tse fetang 60.

Haeba u na le matšoao le matšoao a lefu le phahameng la khatello ea mali, joale o lokela ho ea ngakeng hang-hang. Ho bohlokoa ho hopola: pele ts'oaetso e fumanoe, ho bonolo haholo ho tlosa sesosa sa khatello ea methapo le ho thibela mathata.

Phekolo ea mofuta oa bobeli oa khatello ea methapo ea methapo e reretsoe ho fokotsa methapo ea methapo ea kutlo. Ka tlhaho, sena se tla khonahala kamora ho felisa sesosa sa ponahalo ea bona - ts'ebetso ea methapo ea mmele 'meleng.

Bakeng sa sena, ho sebelisoa mefuta e 'meli ea phekolo:

Ts'ebetso ea ts'ebetso. Sena se o lumella ho tlosa li-neoplasms tsa litšoelesa tsa endocrine, boko le liphio, likoli tsa pelo tse bakang khatello ea mali. Haeba ho hlokahala, nakong ea ts'ebetso, lithutsoana tsa maiketsetso li kenngoa kahare ho motho, kapa litho tse amehang lia tlosoa.
Pheko ea lithethefatsi ea hlokahala ha, ka mor'a ho buuoa, khatello ea mali e ne e tsoela pele ka lebaka la mathata a sa phekoleheng a li-hormone. Maemong ana, mokuli o lokela ho nka moriana ho fihlela lefung la hae (kamehla).

Bakeng sa kalafo, ho sebelisoa meriana - antagonists e thibelang tlhahiso ea lihormone tse kotsi le ho emisa nts'etsopele ea khatello ea mali: diuretics, sartans, ACE inhibitors, beta-blocker le calcium block blockers, lithethefatsi tse bohareng ba lithethefatsi, alpha-blockers le lithethefatsi tse thibelang li-receptor tsa vascular.
Ka hona, khatello ea mali ea bobeli e bontšoa ke boemo bo rarahaneng ba motho, bo kenyelletsang mafu a methapo ea litho tsa sepheo, ka hona ho ikoetlisa ha ho amohelehe ntlheng ena. Ho khothalletsoa ho etsa tlhahlobo ea selemo le selemo ke ngaka ea lefu la pelo, le haeba matšoao a khatello ea maikutlo a le sieo ka botlalo, hobane motho a ka se ele hloko malaise a bonolo (ngola lengolo la khatello ea mali bakeng sa mokhathala) kapa a se ke a hlokomela ponahalo ea khatello ea mali ka mokhoa oa morao, ho lumella lefu lena hore le eketsehe ka sekhahla le ho khutsufatsa bophelo.

Mehloli e latelang ea tlhahisoleseling e sebelisitsoe ho lokisa lingoliloeng.

Pathogeneis

GB ea hlaha ka lebaka la ts'ebetso ea ts'ebetso ea kelello e tlasa ts'usumetso ea lintlha tsa psychoemotional tse bakang tlolo ea taolo ea cortical le subcortical ea sistimi ea vasomotor le methapo ea li-hormone ea taolo ea khatello ea mali. Litsebi tsa WHO li supa mabaka a 'maloa a kotsi bakeng sa ho ata ha khatello ea methapo ea methapo: lilemo, bong, mokhoa oa bophelo ba ho lula, ho ja sodium chloride, tšebeliso e mpe ea joala, ho ja lijo tse thethefatsang, ho tsuba, lefu la tsoekere, botenya, litekanyetso tse phahameng tsa lithethefatsi tsa atherogenic le triglycerides, lefutso.

Litsebi tsa WHO le IAG li ile tsa arola bakuli ka lihlopha tse kotsing e felletseng ho latela maemo a khatello ea mali le boteng ba: a) lintlha tse behang kotsing, b) Tšenyo ea litho ka lebaka la khatello ea mali, le c) maemo a kopaneng a kliniki.