Diabetesic polyneuropathy hore tsena ke mekhoa ea sejoale-joale ea kalafo

Lefu la tsoekere la polyneuropathy. E qala ho batho ba nang le lefu la tsoekere. Polyneuropathy e kanna ea ba ponahatso ea pele ea lefu la tsoekere kapa ea hlaha lilemo tse ngata kamora ho qala ha lefu lena. Polyneuropathy syndrome e hlaha hoo e ka bang halofo ea bakuli ba nang le lefu la tsoekere.

Forecast

Mekhoa ea bohlokoa ka ho fetisisa ea nts'etsopele ea neuropathy ke mathata a ischemia le metabolic mothong ka lebaka la hyperglycemia.

Setšoantšo sa Clinical

Ho na le likhetho tse 'maloa tsa kliniki bakeng sa polyneuropathy. Pontšo ea pejana ea polyneuropathy hangata e ka ba ho fokolisa kutloelo-bohloko le maikutlo a Achilles. Lintho tsena li ka ba teng ka lilemo tse ngata. Khetho ea bobeli e bontšoa ke tšenyo e mpe le e totobatsang methapo e ikemetseng: khafetsa ho feta tšehali, saense, ulnar kapa median, hammoho le oculomotor, trigeminal le abducent. Bakuli ba tletleba ka bohloko, pherekano ea maikutlo le parresis ea mesifa e kenyellelitsoeng ke methapo e lumellanang. Khetho ea boraro ke lesela la bohlokoa la methapo e mengata ea methapo e nang le mathata a tebileng le li-paresis, haholo maotong. Hangata bohloko bo eketsoa ke khatello ea 'mele le phomolong. Khafetsa, bolulo ba boikemelo ba marang-rang bo tšoenyeha. Haeba ts'ebetso e ntse e tsoela pele, bohloko bo ntse bo eketseha, bo ba bo sa mamellehe, ho na le liketane tsa letlalo le 'mala o pherese le bosoeu, ho ts'oaroa ha lithane tse tlotsitsoeng. Hangata maemong a joalo, ho hlohlona, ​​ulophts ea trophic le liketsahalo tsa "osteoarthropathy" li etsahala, li tsamaisana le deformation ea maoto.

Nako ea "polyneuropathy" ea lefu la tsoekere hangata e na le tšekamelo e tsoelang pele. Ka linako tse ling e tsamaisana le matšoao a seo ho thoeng ke visceral neuropathy, e leng tlolo ea poloko ea litho tsa ka hare. Haholo-holo khafetsa, hypotension ea orthostatic, lesapo la mokokotlo la neurogenic, ho hloka matla hoa nts'etsopele.

Ho rarahana ho hoholo ke (hangata ho bakuli ba lilemo tse fetang 50) likotsi tse fetisetsang methapo ea mesifa ea leihlo (III, IV le VI), e lebisang ho strabismus, anisocoria, tlolo ea melao ea boitšoaro ea bana ho khantša, bolulo le ho fetoha.

Forecast

Boloetse ba lefu lena ha bo monate, bokuli bo sa foleng, bo tsoela pele butle butle. Liphetoho tse mpe tse ntlafalitsoeng li ke ke tsa khutlisoa. Phekolo ea lithethefatsi e ikemiselitse ho ntlafatsa bophelo le ho thibela tsoelo-pele ea lefu lena. Nakong ea kholo ea lefu lena, bokooa bo lahleha ka mokhoa o tsitsitseng.

Polyneuropathy ea lefu la tsoekere ke eng

Sebopeho sa tsamaiso ea methapo e poteletseng ho batho se kenyeletsa mafapha a mabeli.

• Somatic eu lumella ho laola ts'ebetso ea 'mele oa hau ka hloko.
• Bahlahisi ba Vegetative ba hlokomela mesebetsi e ikemetseng ea litho tsa ka hare le litsamaiso.

Lefu le hlaha joang ho lefu la tsoekere

Polyneuropathy e na le litokisetso tsohle ho ama mafapha ana ka bobeli.

Ka lebaka la lefu la tsoekere, methapo ea methapo ea litho tsa ka hare ho motho e senyeha haholo, e kenyeletsa nts'etsopele ea lefu lena.

Ho tloha ntlheng ea pono ea litlhaloso tsa mohopolo ona, re ka re ke mofuta oa neuropathy moo ts'ebetso e tloaelehileng ea methapo ea kutlo le motor e thibetsoeng.

Ho etsahalang ka methapo ea kutlo ea methapo

• Li-nerve tsa kutlo li na le boikarabello ba ho tsamaisa ts'oaetso ho tloha tikolohong e kantle ho ts'ebetso ea rona ea methapo ea kutlo (ke hore, ho ea bokong le mokokotlong). Ba laola maikutlo a ho amang, bohloko, serame kapa mofuthu.
• Maemong ana, methapo ea koloi e ikarabella ho arabeleng maikutlo a bona. Mohlala, ka mokokotlo oa mesifa e lumellanang e fanang ka ho sisinyeha ha matsoho le maoto.

Matšoao a lefu lena

Haeba u ithuta mohopolo oa lefu la tsoekere la polyneuropathy, hore na ke eng le hore na o ikutloa joang 'meleng, o tla hlokomela, pele ho tsohle, o boletse bohloko maotong le matsohong. Ho feta moo, ke motho ka mong mme o fapana ho batho ba nang le lefu la tsoekere.

Matšoao a tloaelehileng a neuropathy ea sensor ke:

• Ho tsitsipana kapa ho felloa ke matla a maikutlo, hangata matsohong le maotong.
• Motho o na le maikutlo a ikhethang a "liatlana le lisokisi".
• Hypnothesia,
• Bohloko
• Ho na le boholo bo fapaneng ba bohloko bo nang le methapo ea kutlo. E ka ba bomalimabe feela ha batho ba utloa bohloko bo otlang kapa ba bohloko bo boholo.
• Ka linako tse ling, hyperalgesia ho tšusumetso efe kapa efe e tenang. Boemo bona bo boetse bo bitsoa allodynia.

Tlhaho ea bohloko le polyneuropathy

Joalo ka boholo ba bohloko, tlhaho ea eona e ka fapana haholo. Matšoao a mang a bohloko a utloa eka a tuka, a mang a opa habohloko, liponong tse ling a tebile haholo ebile a hloekile.

Boloetse bo tsebahalang ba maikutlo bo ka hlalosoa ka tsela e latelang:

• Boikutlo ba ho tsamaea ka k'hothone
• Maikutlo a fosahetseng a sebaka se thata
• Ho thata ho fetola maqephe a koranta,
• Mathata a ho lemoha lichelete tsa tšepe ntle le ho li sheba.
• Haeba motho a utloa hore mocheso o teng o lula o phahamisitsoe, sena se ka lebisa ho cheleng ho tebileng letlalong.

Motor neuropathy

Motor neuropathy hangata e bonahala ka sebopeho sa bofokoli ba mesifa maotong. Methapo e ka senyeha, e amang hampe:

• Mesifa ea proximal. Li fumaneha haufi le 'mele - sebaka sa letheka le matsoho,
• Mesifa e ka hare. Tsena ke liphiri, li hole haholo le 'mele, mohlala, maoto.

Motho ea fumanoang a na le polyneuropathy o ikutloa joang?

• Ka lebaka la tšenyo ea lisele tsa mesifa ho batho, tsamaiso ea methapo ka kakaretso e senyehile.
• Ka lebaka leo, ho etsa lintho tse thata tse kang ho bula mamati ka mamati ho ka ba thata.
• Matšoao a pele a ho senyeha ha methapo ea kutlo e fanang ka mesifa ea leoto le ka tlase a hlaha sebakeng sa leoto.
• Ebe ho ka ba le mathata ha u hloella kapa u theoha litepisi, ho le thata ho tsoa betheng kapa sofa, ho oela ka lebaka la bofokoli bo boholo le mesifa ea mesifa.
• Ka lebaka la lefu lena le ntseng le tsoela pele ho ata, motho o ikutloa a "lemetse" kapa "hamore e otla menoaneng ea hae."

Lisosa le Lintho Tse Kotsi

Ho fihla joale, mochine o nepahetseng oa ho ata ha lefu la tsoekere ha o e-so fumanoe, empa hoa tsebahala hore ho na le mabaka a mangata a sena. Maemong a mang, mokuli ka boeena a ka baka mabaka a tlatsetsang kholong ea hae.

Ho senyeha ha methapo ea methapo ho ka etsahala haholo ka:

• lefu la tsoekere le sa foleng, le tšoarelang lilemo tse ngata (le maemo a phahameng a HbA1c),
• mafura a sa tloaelehang a 'mele
• khatello ea mali
• ho tsuba
• ho pepesehela lithethefatsi tse chefo joalo ka joala.
• mojaro oa liphatsa tsa lefutso
• liphetoho tse amanang le lilemo

Tlhahlobo ea lefu lena

Ntho ea bohlokoa ka ho fetisisa ea mehato ea ho hlahloba hore na ho felisoa lefu lena le lefu la tsoekere hangata e thusa ho thibela tlhahlobo e nepahetseng ea bophelo le nalane ea bongaka.

Lirapa tsa lipotso tsa bongaka tse etselitsoeng merero e joalo li se li sebelisoa sebakeng sena.

Mokhoa oa ho sebelisa

Bakeng sa sena, ho sebelisoa likhoele tsa monofilament le lehlaka.

Ba pele ba u lumella ho lekola hore na u ikutloa joang tlas'a lefatše ka tlas'a maoto a hau, 'me ea bobeli - bokhoni ba lisebelisoa tsa hau tse ncha.

Lisebelisoa tse ling li boetse li sebelisetsoa ho hakanya (ka hona sepheo se eketsehileng) ts'ebetso ea ho sisinyeha ha mocheso, mocheso, khanya le khanya.

Bakeng sa ts'oaetso ea lefu la tsoekere la polyneuropathy maemong a mangata, ho khothalletsoa ho etsa tlhahlobo ea liteko tse thusang.

Liteko tsa Botsoa

• Tlhahlobo ea pele ke pokello ea glycosylated hemoglobin HbA1c, e leng sesupo sa taolo ea lefu la tsoekere. Ho netefalitsoe ka lebaka la lithuto hore boemo ba eona bo phahame haholo hangata ho ba nang le lefu la polyneuropathy.
• Bakeng sa liteko tse hlakileng tsa tlhahlobo ea tlhahlobo, ho sebelisoa tlhahlobo ea electromyographic (EMG) le nerve conduction velocity velocity (NCV). Mehato ena eu lumella hore u tsebe moo lefu le amanang le methapo e amanang le lona le hore na lefu lena le hokae.
• Boithuto ba skrini - imaging ea imagonance imaging le diagnostics ea khomphutha li sebelisetsoa ho khetholla lisosa tse ling tsa tšenyo ea pheletso ea methapo, haholo-holo mekhoa ea neoplastic.

Pele o lemoha lefu la tsoekere la polyneuropathy - ke lefu la mofuta ofe, lisosa tse ling tsa neuropathy li lokela ho qheleloa ka thoko. Ho hakanngoa hore maemong a 10-26%, tšenyo ea methapo ho batho ba nang le lefu la tsoekere e na le motheo o fapaneng. Ka hona, pele, mabaka a bohlokoa a kang:

• anemia e kotsi,
• Chefo ea vithamine B6
• tlhekefetso ea joala
• uremia
• hepatitis
• paraneoplastic syndromes (mafu a amanang le mofetše),
• syphilis
• HIV / AIDS
• litla-morao ka tšebeliso ea meriana e itseng (jk. chemotherapy, isoniazid),
• mafu a lesapo la mokokotlo.

Ho bohlokoa haholo ho khona ho tseba matšoao a lefu la lefu la tsoekere la polyneuropathy, eo hangata e u lumellang hore u nke mehato e nepahetseng ka nako ho fokotsa liso.

Phekolo le thibelo ea lefu la tsoekere la polyneuropathy

Ka bomalimabe, kalafo e loketseng ea pharmacological ha e so fanoe. Leha ho le joalo, taolo ea maemo a tsoekere ea mali, takatso ea ho netefatsa hore HbA1 e bolokoa maemong a khothalletsoang, ho ba sieo ha mafura a sa hlokahaleng ho tla tlosa matšoao a mang a polyneuropathy.

Bakuli ba bangata ba bolela hore ho boloka maemo a tsoekere ka har'a meeli e tloaelehileng ho batla ho felisa bohloko. Habohlokoa le ho feta, e thibela nts'etsopele ea lefu lena.

Litokisetso tsa lefu la tsoekere la polyneuropathy

Haeba letšoao le hlahelletseng la bokuli bona ke bohloko, ho kenyelletsa le lithethefatsi tse thusang le tse khothatsang, tse kenyeletsang li-antidepressants le anticonvulsants.

Tsena li kenyeletsa:

• pregabalin, Absenor, Depakin, Valprolek, gabapentin (Symleptic, Neuran, Gabagamm, Neurontin).
• Ntle le hore sephetho ha se sebetse, ngaka e ka fana ka ho fana ka dextromethorphan, tramadol, oxycodone kapa morphine. Ntle le moo, ho ka khothaletsoa tšebeliso ea li-capsaicin le litokisetso tsa lidocaine.
• Lilemong tsa morao tjena, phello e ntle ea amitriptyline, venlafaxine le duloxetine e boetse e bonoa kalafong ea bohloko bo tsamaeang le lefu la tsoekere la polyneuropathy.
• Maemong a mang, lithethefatsi tsa antioxidant li ka khothaletsoa ka nako e itseng. Haholo-holo, li-alpha lipoic acid. Pheko ena hangata e fanoa ke litsebi tsa lefu la tsoekere e le ente e kenang. Khafetsa tšebeliso ea eona hangata hangata e na le libeke tse peli kapa tse tharo. Pheko e tsoela pele ka meriana ea molomo (Thiogamm 600, Thiogamm Turbo-Set).

Bohlokoa! Ha ho na joalo, u se ke ua qala ho iphekola ka lithethefatsi tsena.

Ho ikoetlisa le papali

Keketso ea bohlokoa kalafong ea meriana, haholo ha ho fokola mesifa, ke ea 'mele. Physiotherapist e khetha lenaneo le le leng ho latela bokhoni ba e 'ngoe le e' ngoe, e lumelle mesifa hore e sebetse halelele kamoo ho ka khonehang. Ntle le boikoetliso bo tloaelehileng, mehato ea ho laolla, joalo ka lits'ebetso tsa metsi, le eona e sebelisoa.

Mekhoa ea thibelo

Maemong a mang, ho ba bonolo ho fana ka tšoaetso ea mafu a tebileng ho feta ho a phekola ho ea pele. Ka hona, ho lokela ho lebisoa tlhokomelo e khethehileng mehatong e fapaneng ea thibelo e reretsoeng ho fokotsa menyetla ea ho ata ha matšoao a lefu lena le tšenyo ea litho tse ngata le tse ling.

Mekhoa e ka sehloohong ea ho loantša polyneuropathy e kenyeletsa:

• tlhaiso e nepahetseng le e sa khaotseng ea maemo a tsoekere, ho nka glycemic e tloaelehileng le hemoglobin e glycated,
• kalafo e potlakileng haholo ea mafu a kopaneng, a joalo ka khatello ea mali,
• ho ikoetlisa khafetsa, ka tekano,
• ho khaotsa ho tsuba le ho fokotsa tahi.
• Lijo tse nang le phepo e ntle tse fanang ka matšoao a nepahetseng a mafura,
• ho boloka boima ba 'mele bo le maemong a matle,
• litlhahlobo khafetsa le ho buisana le ngaka ea hau.

Phekolo ea sejoale-joale e ntse e ithuta ka botebo mohopolo oa lefu la tsoekere le lefu la tsoekere, e leng bothata ba bohlokoa bo ikhethang bo tsebahalang lefatšeng ka bophara. Haufinyane, nts'etsopele le mahlale a morao-rao a hlahisitsoe a ikemiselitse ho fokotsa matšoao a bohloko le ho thibela litlamorao tse mpe tse ka bang teng. Leha ho le joalo, bakuli ka bobona ba nang le bothata ba tšenyo ea metabolic joalo ka lefu la tsoekere ba lokela ho ba hlokolosi haholoanyane ka boemo ba bona. Ka bokhutšoanyane, leha e ka bonahala e se letho la lits'oaetso tsa methapo, hoa hlokahala ho batla thuso ea bongaka.