Atherosclerosis obliterans ọgwụgwọ

Ọgwụgwọ ndị ọrịa na-arịa ọrịa bụ ọrụ siri ike. Enwere ike ịme ya na onye ọrịa, mana izizi nke nchoputa, mkpebi siri ike nke ogbo na ogo mbibi dị mkpa, nke na-abụghị ụlọ ọgwụ ọ bụla nwere ọnọdụ kwesịrị ekwesị. N'akụkụ a, a malitere itinye echiche nke imepụta mpaghara nke ịwa ahụ. Ugbu a na mpaghara mpaghara ọ bụla na nnukwu obodo mepere emepe enwere ngalaba na-emeso ndị ọrịa a. Enwekwara ajụjụ banyere ịmata ọdịiche dị n'etiti ngalaba site na ụdị ọrịa, i.e. eke ngalaba nke phlebology na artery pathology.

A tụpụtala ụzọ ihe karịrị narị isii maka ịgwọ ndị ọrịa nwere ọrịa ọrịa ọria. N'ime afọ 30-40, ejirila ọtụtụ narị ọgwụ dị iche iche: site na mmiri anya mmiri ruo n'ọbara na-abụghị nke otu, site na streptocide ruo corticosteroids na curare. Ugbu a, ndị ọkà mmụta sayensị gburugburu ụwa abịawo na nkwubi okwu na ọ nweghị ọgwụ ọ bụla nwere ike ịgwọ ọrịa ọ bụla. Dabere na polyetiology nke ọrịa, ọgwụgwọ kwesịrị ịbụ usoro zuru ezu. Ọ bụghị otu usoro ọgwụgwọ na-ekwu na ọ bụ pathogenetic nwere ike ịbụ ihe zuru ụwa ọnụ, dịka ọ gaghị ekwe omume ugbu a ịkọwa isi nke ọrịa site n'otu isi ihe. Nke mbu, ekwesiri ileba anya na iwepu ihe ojoo a na-emebi ebe (oru na izu ike, onodu obibi ndu dika ihe oma, anwuru anwuru, nri kwesiri ekwesi, iwepu nkpagbu, oyi, wdg). Mgbe ị na-edepụta usoro ọgwụgwọ ọgwụ, a ga-atụle ụdị dyslipidemia (dabere na nhazi WHO).

Na ụdị I, ntakịrị mmụba nke cholesterol, mmụba dị ịrịba ama na triglycerides, ọkwa nkịtị nke LDL cholesterol, a na-ahụ oke chylomicron na plasma ọbara.

II ụdị - ọkwa nkịtị ma ọ bụ elu nke ngụkọta cholesterol, ọkwa nkịtị nke triglycerides, mmụba amamịghe ọkwa LDL cholesterol.

IIdị II B - mmụba nke triglycerides, oke nke LDL kọlesterol na VLDL cholesterol.

IIIdị III - mgbanwe bụ otu ihe ahụ dị ka ụdị nke I, enwere mmụba na steroid cholesterol-lowering steroids (njuproteins etiti dị n’etiti).

IVdị nke anọ - enwere ike ibukwu ntakịrị cholesterol, mmụba nke triglycerides na ngafe nke cholesterol VLDL.

Vdị V - oke cholesterol VLDL na chylomicron.

Dịka enwere ike ịhụ site na data ewepụtara, ndị kasị atherogenic bụ ụdị II nke dyslipidemia II A na II B.

Ọgwụ nchekwa

Ọgwụ nchekwa iche kwesịrị ịbụ nke zuru oke, otu onye, ogologo oge yana ebumnuche maka ihe dị iche iche:

normalisation nke lipid metabolism,
mkpali nke collaterals na ndozi nke oru ha,
iwepu angiospasm,
normalisation nke neurotrophic na metabolic Filiks na anụ ahụ,
microcirculation dị mma,
usoro nke coagulation system
normalization nke dịghịzi onodu,
mgbochi nke mgbanwe nke ọrịa na-apụ apụ,
mweghachi na ọgwụgwọ ịgwọ ọrịa.

Enwere ike ike ị drugsụ ọgwụ ndị a na-eji eme ihe na ndị a:

1. Nkwadebe nke na - eme ka microcirculation dị elu ma nwee ngwongwo antiplatelet: dextrans dị ala na nke na - ajụ (reopoliglyukin, reoglyuman, reokhem, reomakrodeks, hemodes), pentoxifylline (trental, vasonite, flexital), tiklid, plavica (clopulodexidel) , otuto (xavin, sadamin), theonicol, agapurin, nicotinic acid, enduracin, chimes (persantine), aspirin (thrombo ace, aspirin cardio). Edere Trental na 400-1200 mg kwa ụbọchị, vasonite - na 600-1200 mg, tiklid - 250 mg ugboro abụọ kwa ụbọchị, igwu mmiri - 75 mg kwa ụbọchị. A pụrụ iji ọgwụ aspirin depụta ọgwụ ndị a. Doseụ ọgwụ aspirin kwa ụbọchị bụ 100-300 mg, dabere n'ọnọdụ ọnọdụ ụlọ ọgwụ yana ọnụọgụ ọgwụ ọgwụ anticonlet concomitant. Ngwakọta ọgwụ aspirin na ticlide bụ ihe amamihe dị na ya n'ihi ọbara ọgbụgba enwere ike. A na-achịkwa Sulodexide intramuscularly na 600 LU (2 ml) ugboro abụọ kwa ụbọchị maka ụbọchị 10-24, emesia n'ime capsules nke 250 LU ugboro abụọ kwa ụbọchị maka ụbọchị 30-70.

Drugs drugs drugs ọgwụ nke anabolic (mee ka reticuloendothelial sistemu na usoro oxidative na anụ ahụ): gbanye 8-10 ml nke salcoseryl ma ọ bụ actovegin na saline physiological ma ọ bụ nnu mmiri nwere ma ọ bụ 250-5500 ml nke Actovegin ngwọta intravenously maka ụbọchị 10-20.

3. Vitamin: ascorbic acid na - eme ka metabolic Filiks dị n’arụ ahụ, na - ewusi usoro ahụ ji alụso ọrịa ọgụ, vitamin B, egosipụtara maka ischemic neuritis na ọrịa trophic, vitamin B₂ na-akpali usoro ịmụgharị, vitamin B₆ na B₁₂ emetụta metabolism nke phospholipids ọbara, nicotinic acid na ihe ndị dị na ya nwere antiaggregant na antiatherogenic Njirimara ma melite microcirculation, vitamin A na E bụ antioxidants dị ike, vitamin F na-akwado ọrụ nkịtị nke gland endocrine, na-eme ka ịnweta oxygen na sel, akụkụ na anụ ahụ, na-egbochi itinye cholesterol. na akwara akwara.

4. Angioprotectors (mee ka lisa intravascular lysis ma gbochie thrombosis, belata permeability nke vaskụla mgbidi ma gbochie nkwụnye nke lipids na mgbidi arịa): doxium, vasolastine, parmidin (prodectin, anginin), tanakan, liparoid-200. Edebere Parmidin mbadamba 1 ugboro 3-4 kwa ụbọchị (750-1500 mg) maka ọnwa 6-12. Na angiopathy na-arịa ọrịa mamịrị, ọ dị mma ịkọwa Doxium 0.25 g ugboro atọ n'ụbọchị ma ọ bụ 0,5 g 2 ugboro n'ụbọchị maka izu 3-4, mgbe ahụ, mbadamba 1 kwa ụbọchị ruo ogologo oge, dabere n'ọnọdụ ọnọdụ.

5. ọgwụ mgbochi na-akụda mmụọ ma ọ bụ na-egbusi ike: statins na fibrates. Statins: cholestyramine, leskol (fluvastatin), lipostabil, lipanor, lipostat (pravastatin), lovastatin (mevacor), simvastatin (zokor, vasilip), choletar. A na - enweta ọgwụ anti-atherogenic site na nhazi galik (allicor, alisate), carinate, betinate, enduracin nwere 500 mg nke nicotinic acid (na-egbochi biosynthesis nke cholesterol na triglycerides). Statins na-achịkwa ụmụ irighiri akwara, na -ebelata ọkwa LDL cholesterol, cholesterol VLDL na triglycerides (TG) ma na-abawanye ọkwa nke HDL cholesterol, weghachi ọrụ ngwụsị nkịtị, si otú a na-enye aka na nzaghachi vasomotor nkịtị nke akwara akwara, na-enwe mmetụta mgbochi mkparị na ọnya na ọnya na-efe efe, igbochi thrombocytosis postoperative, nke bu amụma amụma nsogbu nke thrombotic. Fibrates: bezafibrate (besalip), gemfibrozil (gevilon), fenofibrate (lipantil), micronized fenofibrate (lipantil 200 M), ciprofibrate. Fibrates nwere mmetụta dị ala na-akụda nke ukwuu karịa statins na triglycerides; ha na-enwe ike iwelie akụkụ nke cholesterol HDL anti-atherogenic HDL. Statins na fibrates dị mma karịsịa na hyperlipidemia nke mkpụrụ ndụ ihe nketa kpebiri. Agbanyeghị, nhọpụta nke ego ndị a chọrọ ka dọkịta mata ihe dị mkpa gbasara ọgwụ gbasara egbugbere ọnụ ọgwụ na ihe dị mkpa maka ịgwọ ọgwụ. Dịka ọmụmaatụ, ekwesighi iji statins yana fibrates na nicotinic acid, ebe ọ bụ na njikwa nkwonkwo ha nwere ike ibute myositis. Ojiji nke statins na-amalite site na nke kacha nta ka akwadoro. A na-egosipụta ntụlata egbugbere ọnụ nke ọma ka izu anọ anọ na isii gachara, yabụ, ekwesịrị ịme mgbanwe nha ihu tupu oge izu anọ gachara. Site na mbelata cholesterol dị n'okpuru 3.6 mmol / L ma ọ bụ LDL kọlesterol dị n'okpuru 1.94 mmol / L, enwere ike belata dose nke statin. A na-eji statins niile otu ugboro n'ụbọchị, n'abalị mgbe erichara nri. Seszọ fibrates na ọdịdị nke iji ha dị iche maka onye ọ bụla. E kwesịrị imezi ọgwụ ọjọọ nke dyslipidemia atherogenic ruo ogologo oge. Maka ọtụtụ ndị ọrịa - na ndụ niile.

6. Antioxidants na-arụ ọrụ dị mkpa na ọgwụgwọ nke atherosclerosis site na ịhazi lipid peroxidation (LPO). Ndị a gụnyere vitamin A, E, C, dalargin, cytochrome c, preductal, emoxipin, neoton, probucol. Onye na - anọchite anya otu a bụ vitamin E (alfa-tocopherol acetate), na ntinye nke 400-600 mg / ụbọchị, nwere ọgwụgwọ ọgwụgwọ metụtara hypocoagulation, ịba ụba fibrinolysis yana mma akụrụngwa nke ọbara, mgbochi nke usoro oxidation na ịgbalite nke usoro antioxidant. Ka ọ dị ugbu a, a zụlitere nri ndị nwere ọgwụ antioxidant ma webata ya na omume ụlọ ọgwụ: nkwadebe dabere na omega-3-poly-unsaturated faty acids (eikonol, dokanol), nkwadebe nke kale Kale (clamin), agwa mmiri (splat, spirulina), akwukwo nri mmanụ (mmanụ nke viburnum, buckthorn n'oké osimiri).

7. Enwere ike ịtụ ọgwụ antispasmodics (papaverine, no-shpa, nikoshpan) maka ọkwa nke m na II nke ọrịa ahụ, mgbe akwara arterial mere.

8. Edebere ọgwụ anticoagulants ozugbo na nke na-apụtaghị aka dịka akara ngosi dị na hypercoagulation siri ike.

9. N'ime otu dị iche iche kwesịrị ịgụnye vazaprostan (prostaglandin E,). Ọgwụ ahụ nwere ngwongwo antiplatelet, na-eme ka ọbara na-agbasawanye site na ịgbasa arịa ọbara, na-eme ka fibrinolysis, na-eme ka microcirculation dịghachi mma, na-eweghachi metabolism nkịtị na nsị ischemic, na-egbochi mmegharị nke neutrophils, si otú ahụ na-egbochi mmetụta nke mbibi anụ ahụ, nwere mmetụta antisclerotic. E gosipụtara Vazaprostan maka ụdị nnukwu nhichapụ ọnya akwara ndị aka na ụkwụ. A na-edozi ya n'ụzọ intraveneri ma ọ bụ intraarterially site na iji 20-60 μg na dilution nke 100-200 ml nke NCl 0.9% kwa ụbọchị. Oge iwebata bụ awa 2-3. Ogologo ihe ọmụmụ a bụ izu nke anọ. Ejiri ọgwụ gosipụtara mmụba nke ọgwụgwọ ọgwụgwọ, nke nwere ike ịga n'ihu otu izu ma ọ bụ izu abụọ ka akagbuo ya. Enwere ike depụtara nsonaazụ ahụ n'afọ niile.

Ihe dị mkpa bụ nhọrọ otu ọgwụ na otu esi eme ya na nyocha nke arụmọrụ otu ọgwụ. Usoro ọgwụgwọ outpatient ihe atụ: prodectin + trental, prodectin + ticlide, prodectin + plavica, prodectin + aspirin, plavica + aspirin, vasonite + prodectin, trental + aspirin, sulodexide, wdg. na mgbakwunye na okwu ikpe niile nke ọgwụ mgbochi atherogenic. Ọ dị mma ịtụgharị ọgwụ ndị a ma ọ bụ ndị ọzọ ọgwụ ọ bụla ruo ọnwa 2-3 ọ bụla. N'ime usoro nke ikpeazu na ọnọdụ ụlọ ọgwụ, a na-eji atụmatụ dị ka usoro a: intravenously drip reopoliglyukin 400 ml + trental 5-10 ml + nicotinic acid 4-6 ml ma ọ bụ nnabata 4-6 ml, solcoseryl ma ọ bụ actovegin 10 ml kwa 200 ml nke saline, maka 10-15 ụbọchị ma ọ bụ karịa. Drugs drugsụ ọgwụ niile dị n'elu na-egosi njirimara ọgwụgwọ. Symgwọ ọrịa Symptomatic na ọgwụgwọ nke ọnya na-efe efe bụ iwu na ọ bụghị mkparịta ụka.

Barotherapy (hyperbaric oxygenation - HBO) na-eme ka ọnọdụ oxygen dị na anụ ahụ dịkwuo elu site na imeju ogo mgbakasị oxygen na anụ ahụ na ịba ụba nke oxygen na-agafe n’akpụ anụ ahụ kwa nkeji. Ihe puru ime iji nyefee akwara oxygen nke anụ ahụ na - enweta ọbara ọgbụgba dị mkpụmkpụ na - eme ka HBO bụrụ usoro pathogenetic na ụzọ kachasị mma n'ọgụ megide hypoxia anụ ahụ mpaghara. Nsonaazụ dabere na steeti Central hemodynamics. Ihe ngosiputa banyere oganihu n’enye oxygen n’arụ mgbe ha gbasịrị HBO bụ mmụba na pịmbariti n’agbata ọbara na mpaghara (V.I. Pakhomov, 1985). Site na nrụpụta obi ala dị ala, n'agbanyeghị mgbanwe mgbanwe n'ọbara mpaghara, nnyefe oxygen adịchaghị arụ ọrụ. Ahụghị m ịhịa aka n'ahụ zuru oke site na iji ngwa Kravchenko na Shpilt.

Ofzọ nke ultraviolet irradiation nke ọbara (UV) zuru ebe nile, nke onye Czech ịwa ahụ Gavlicek butere na 1934, o jiri ya maka peritonitis. Usoro ndu nke ụzarị UV sitere na mgbanwe nke mmadụ nke birila na mgbe ọ bụla. Mmetụta ziri ezi nke UFO na ikpochapụ ọrịa nke akwara ozi bu ụzọ guzobe na 1936 site Kulenkampf. A na-eme UFO dịka usoro Knott ọdịnala si dị: a na-ewere 3 ml ọbara kwa 1 n'arọ nke ogo ahụ onye ọrịa site na akwara. Ọbara na-enweta site na isi iyi nke oriọna UV-Mercury-quartz nke na-efegharị efegharị nke 200-400 nm. Wepụta oge nkeji isii na anọ ka ọ ga-eme ihe dị ka ụbọchị 2-6. UFO ọbara nwere nje na - akpata ọgwụ mgbochi na - akpali akpali ma na - akpali akpali.

Wiszọ Wisner bụ dị ka ndị a: a na-ewere ọbara dị milimita 45 n'ime akwara, a na-agwakọta ya na ml 5 ml nke citrate na quartz cuvette na irradiated maka minit 5 na oriọna HN 4-6 UV na-efegharị efegharị nke 254 nm ma na-abanyeghachi ọbara n'ọbara.

Enwere usoro nke a na-akpọ ọgwụ oskidant hematogenous - GOT (Verlif). Yiri nke irigraation nke ọbara nke nwere oriọna xenon nke na-efegharị efegharị nke nm 300, ikuku oxygen. Iji mezuo nke a, oxygen ezighi ezi: 300 cm 3 n'ime 1 min n'ime vial ọbara. Edere usoro ahụ 8-12.

Gavlicek (1934) kọwara mmetụta nke radieshon radieshon site na ihe omume metabolites, nke, mgbe a laghachiri n'ahụ ahụ, na-eme ka ọgwụ. Acidosis na-agbadata, microcirculation na-eme ka ọ dị mma, homeostasis mmiri-electrolyte.

Ojiji zuru oke n'ọgwụgwọ ndị ọrịa natara usoro nke iji kwụsị. Onye ọsụ ụzọ nke iwebata usoro a na 1970 bụ agụmakwụkwọ nke Ọka na Ahụike Sciences Yu.M. Lopukhin. N'adịghị ka usoro akụrụngwa, ebe a na-ewepụ naanị ihe mmiri na-agbanye mmiri, hemosorption nwere ike wepu nsị ọ bụla, ebe ọ bụ na ọnụnọ dị kpọmkwem na ọbara.

Yu.M. Lopukhin na 1977 kwupụtara iwebata hemosorption na usoro ọgwụgwọ nke atherosclerosis na ebumnuche nke decholesterolization. Mmebi nke lipid homeostasis pụtara n'okpuru nsị na-egbu egbu nke xenobiotics - ihe dị iche iche nye anụ ahụ na-emebi sistem umeji umeji. Nchịkọta nke xenobiotics na eme na agadi, na-ebu oke ibu, na ndị na-ese anwụrụ ọkụ. N'agbanyeghị ma hypercholesterolemia na hyperbeta-lipoproteinemia bụ ihe na-akpata atherosclerosis dị ka tiori nke N.N. Anichkova ma ọ bụ n'ihi nsị nke peroxidation nke lipid peroxidation, dyslipoproteinemia na atherosclerosis na-ewere ọnọdụ. Hemosorption megharia ya, na -ebelata ọdịnaya nke liheprotiins atherogenic dị ala (LDL) yana njupụta dị ala (VLDL).

Atọ hemosorption okpukpu atọ na-ewepụ cholesterol na mgbidi arịa ọbara site na 30% (Yu.M. Lopukhin, Yu.V. Belousov, S.S. Markin), na maka oge ụfọdụ iweghasị usoro atherosclerotic na-enweta, membrane microviscosity na-ebelata, mgbanwe ion mgbanwe na-eme ka ọ dị mma, nzacha nzacha na-abawanye ụba, nzacha ọnụego na-abawanye ụba, nzacha ọnụego na-abawanye ụba, nzacha ọnụego na-abawanye, na-achọpụta ọnụego na-abawanye, ike nke mkpụrụ ndụ ọbara uhie, na - eme ka microcirculation dịkwuo mma.

N'ime oge ischemia dị oke egwu, oke ụba nke toxins na-egbu egbu, ihe ndị dị na akụkọ ihe mere eme, ngwaahịa nke metabolism anụ ahụ na-aba ụba na cellular necrobiosis na-agbakọ n'ime ahụ. Hemosorption na-enye gị ohere iwepu albuminotoxin, lipazotoxin n'ahụ ma na-arụ ọrụ nke ọgwụgwọ immunocorrective. Sing hemosorption with SKN-4M sorbent belata ọdịnaya nke immunoglobulins G site na 30%, klas A site na 20% na klaasị M site na 10%, na-ebelata immunocomplexes (CEC) na-ebelata 40%.

Dabere na S.G. Osipova na V.N. Titova (1982) kpughere na ya na mmebi nke atherosclerotic na arịa nke mpaghara ala, ọgụ nwere mgbochi. N'otu oge ahụ, mkpụrụ ndụ immunocompetent - T-suppressors, na-arụ ọrụ B-cell na oke mmachi immunoglobulins, na-eduga na mmebi ndị ọzọ na vaskụla endothelium.

A na - ahụta mgbako (dika E.A. Luzhnikov, 1984) si gosipụta na 30-40% nke ndị ọrịa.Ihe ndị a gụnyere: trauma na sel ọbara, ime anwansi yana toxins oxygen yana protein dị mkpa na akụkụ ahụ. Mgbe ị na-arụ ọrụ, hypotension, akpata oyi, thrombosis nke usoro ahụ, embolism ya na ụmụ irighiri ihe ga - ekwe omume (a na - ahụ irighiri akwara 3-33 na nha, akpa ume, akụrụ, ụbụrụ). Ihe mgbaasị kachasị mma bụ icheku akwa na microfilm. Ọnụ ọgụgụ sel ọbara ọbara uhie na-agbadata, mana njikọ ha ruru eru na-ezu oke. Hypoxemia na-etolite, ya mere, a na - eme oxygenation ozo n’oge obara ya. A na-arụkwa ikuku oxygen. A maara na ihe 3% nke hydrogen peroxide nwere 100 cm 3 nke oxygen, nke a zuru iji zuru ezu karịa 1.5 lita nke venous ọbara. E.F. Abuhba (1983) gosipụtara usoro 0.24% nke H₂Ewoo₂ (250-500 ml) na ngalaba iliac artery ma nata ezigbo oxygenating.

Enwere ọrụ na-achịkọta ahụmịhe nke ihe nnabata na ọgwụgwọ nke ikpochapụ ọrịa nke mpaghara ala. Maka enterosorption eji:

carbons akpọghị akpọ (IGI, SKT, AUV),
akọwapụtara ion mgbanwe mgbanwe,
ụdị anwansi ndị a kapịrị ọnụ nke dabere na glycosides na-eso usoro ịkpa oke yana cholesterol na-agwụ ike.
Abali abuo rue ato nke enterosorption zuru oke n ’otu mkpom hemosorption. Mgbe enterosorption enwetara:
ntụgharị nke ihe ndị na-egbu egbu site na ọbara banye eriri afọ ya na itinyekwu aka na mgbaasị ahụ,
na-asachapụ ihe ọ digụ juụ nke mkpụrụ nke eriri afọ, na-eburu ọnụọgụ nke nsị,
mgbanwe mgbanwe egbugbere ọnụ na amino acid nke ọdịnaya eriri afọ,
mwepụ ihe ndị na - egbu egbu guzobere na eriri afọ n’onwe ya, nke na - ebelata ibu n’elu imeju.

Ọgwụ ịwa ahụ

Enwere ike ikewa ụzọ ịwa ahụ ụzọ abụọ: 1) ịwa ahụ na sistemụ akwara, 2) ịwa ahụ na arịa.

Claude Bernard (Claude Bernard, 1851) chọpụtara ihe vasoconstrictor nke usoro ọmịiko na ọmịiko na mpaghara ọbara. Mgbe ahụ M. Zhabuley (M. Jaboulay, 1898) kọrọ banyere ọgwụgwọ na-aga nke ọma nke ọnya ụkwụ na ụkwụ site na nbipụta nke obi ọmịiko nke arịa ahụ. Na 1924, J. Diez zụpụtara usoro maka nkwado ọmịiko nke lumbar site na mgbasapu ganglia site na lumbar nke abụọ ruo n'ọkwa agba nke atọ. N'ime ọtụtụ ndị ọrịa, enwetara ezigbo nsonaazụ: vasodilation na mmụba na usoro ọgwụgwọ ọrịa. Na Russia, a rụrụ lumbar mbụ ime mmụọ ahụ na 1926 site na P.A. Herzen. Wa ahụ nwere ihe ngosi siri ike, dịka paresis nke arịa ọbara nwere ike ibute ọrịa trophic ma mee ka ọnọdụ onye ọrịa ahụ ka njọ.

a) ngụkọta - yiri nke ogwe ndị ahụ na-agbụ nke nwere olu ọmịiko n'ogo ogologo,

b) akwara - yiri nke eriri n’etiti ganglia abụọ nwere ọmịiko,

c) ganglioectomy - iwepu ganglion nwere ọmịiko.

Site na ọmịiko, enwere ike nweta ezumike ma ọ bụrụ na esite na sentimita na - esite na ọnya ma na - ebute ọfụma na akwara azụ na ụbụrụ, yana ihe centrifugal na - akpata ma ọ bụ kwalite trophic, humudani na nsogbu ọgbụgba na mpaghara ọnya ọnya. Na -eme ka akwara vaskụla, ọmịiko na-eme ka mgbakwunye nke collateral dịkwuo elu. Mgbe ọmịiko gachara, ọnụọgụ nke mkpụrụ ndụ ndị a na-ahụ anya na-abawanye nke ukwuu. Site na ihe mgbaàmà mgbu, na pathogenesis nke mmetụta ọkụ na-ezughị ezu site na lesion na-elekwasị anya dị mkpa, yana ischemia anọghị, mmetụta ọgwụgwọ nke ọmịiko anaghị adịte aka. Site na mmebi nke arịa nke akụkụ ala, ọkachasị nke abụọ na nke atọ ana-ewepụ lumbar ganglia. Tupu ịwa ahụ, a na-atụ aro ka iji nnwale novocaine nke ndị ganglia nwere ọmịiko nke emere atụmatụ iwepụ ya.

B.V. Ognev (1956), na ndabere nke data siteregenesis, kwenyere na ntinye obi ọmịiko nke akụkụ ala aka ekpe site na ogwe aka ekpe, n'ihi ya iwepu oghere atọ nke ọmịiko ọmịiko zuru ezu. Ọtụtụ ndị dọkịta anaghị agbaso iwu a ma rụọ ịwa ahụ n'akụkụ arịa ndị emetụtara. Ekwesịrị ịmaliteghachi echiche nke ime ọmịiko ka ọ dịkarịa ala na-ezighi ezi. Ọ bụ n'ọkwa mmalite nke ike ọkọnọ nke ọkọnọ ọbara na ọmịiko na-enye nsonaazụ ozugbo na ogologo oge.

Egosipụta ọrịa Lumbar maka ndị ọrịa nwere ụdị mbibi akwara dị anya, mgbe ịwa ahụ na arịa agaghị adị ma ọ bụ bụrụ nke anabataghị site na ụdị oria na-efe efe. Na ọnụnọ nke mgbanwe ọrịa akwara akwara, a ga-ejikọ ya na ọmịiko ka ọ jikọtara ya na ọgwụ mkparị na mgbatị akụ na ụba. Sympatectomy bụ ihe bara uru maka ịwa ahụ na-emegharị ahụ. Mbelata nguzogide nsogbu na mmụba nke ọbara n'ihi mwepụ arteriospasm bụ mgbochi nke retrombosis na akwara azụ. Site na retrombiosis, ọrịa akwara lumbar na-eme ka ischemia na-arịwanye elu ma na-eme ka ohere nke ịnọgide na-akwụ ụgwọ ọbara na-akwụghachi.

Enwere ike ịkọwa nsonaazụ na-enweghị afọ ojuju site na ọmịiko site na njirimara akụkụ nke sistemụ ọmịiko, ọdịdị nke ọrịa ahụ, nbibi nke nnukwu arịa na mgbanwe ndị a na-apụghị ịgbagha agbagha na ọkwa nke microcirculation.

Site na ọmịiko, nsogbu ndị na-esonụ nwere ike ime:

ọbara (0,5%) na-agba ọbara
embolism na akwara nke ala ala nke nwere atherosclerotic plaques si aorta (0,5%),
neuralgia, ọrịa gosipụtara site n'ihe mgbu n'akụkụ akwara ikpere ụkwụ (10%), nke na-apụ n'anya mgbe ọnwa 1-6 gachara.
Ọrịa ejaculation mgbe agabighara ndị mmadụ (0.05%),
ọnwụ (ihe erughị 1%, dị ka A.N. Filatov si kwuo - ruru 6%). Emere ka ọrụ ahụ dị mfe n'ihi iwebata usoro endoscopic.

R. Lerish choro ka iwepu ihe akwara nke akwara nke anakpo aru nwanyi, wepu adventitia ma si otua na emetuta ubara nke akwara nke ihe nile di. Nkwụ (Palma) rụpụtara ntọhapụ nke akwara akwara si na ngbanye anụ ahụ na anụ ahụ gbara gburugburu na Hunter Canal.

A na-arụ ọrụ ndị a

ndo ndo (Szyfebbain, Olzewski, 1966). Ebumnuche nke arụmọrụ ahụ mejupụtara na nchikota nke ngalaba ngalaba nke akwara sciatic na-aga akwara nke nwa aka na aka ha, nke na - enyere aka gbanyụọ ọrụ nke akwara n'oge ị na - eje ije, si otú a belata ikike oxygen ha,
Arụ ọrụ na akwara azụ (A.G. Molotkov, 1928 na 1937, wdg).

Adrenal gland ịwa ahụ na V.A. chọrọ ma rụọ ya. Oppel (1921). Mkparịta ụka banyere ọfụma nke ịwa ahụ adrenal gland na ndị ọrịa nwere ọrịa ọria nọ na-aga kemgbe ihe karịrị afọ 70.

A na-etinye nlebara anya dị ukwuu n'ọgwụgwọ ụdị ndị ọrịa a ka ọgwụ ike dị ogologo na ọgwụ ọgụ na njikọta dị iche iche. A na-ewebata ngwakọta: saline, reopoliglukin, heparin, trental, nicotinic acid, ATP, ngwọta novocaine, ọgwụ mgbu, ọgwụ nje. Ugbu a, maka infusomats intravenous intraarterial intraarterial, a na-eji infusomats. Maka nchịkwa ọtụtụ ụbọchị nke ọgwụ, a na-eme mkpọchi akwara dị ala ma ọ bụ otu n'ime alaka akwara dị na akwara.

A tụpụtala ụzọ ndị ọzọ maka ịgwọ ọrịa ischemia dị ala:

ntuzigharị akwara kpọmkwem (S. Shionga et al., 1973),
nka nka site na akwara artistio-bone fistulas (R.H. Vetto, 1965),
ntụgharị microvascular nke oke mmanu (Sh.D. Manrua, 1985),

,Zọ ndị a, emebere iji kwalite mgbasa ụkọ, enweghị ike iwepụta iwe ngwa ngwa nke ihe ọghọm a enweghị ike iji ya na ogbo nke ụkọ akwara.

Emeela mgbalị iji mepụta aka ụkwụ ischemic site na sistem a na-eme site na itinye fistula arteriovenous fọdula na apata ụkwụ (San Martin, 1902, M. Jaboulay, 1903). Nke a mechara ọtụtụ bidoro chọọ ụzọ ndị ọzọ. N’afọ 1977 A.G. Shell (A.G. Shell) jiri shọọtụ azụ nke ukwu ụkwụ ya. Onye ode akwukwo ritere ihe oma ruru iri ise n’acho ischemia di nkpa. B.L. webatara arụmọrụ yiri ya. Gambarin (1987), A.V. Pokrovsky na A.G. Horovets (1988).

A na-ekpebi ihe ngosipụta maka arụmọrụ mgbakwunye na-adabere n'ịdị oke aka ischemia, ọnọdụ mpaghara ọrụ, yana ogo ihe eji arụ ọrụ a. A na-enyocha ọnọdụ mpaghara dabere na data aortoarteriography. Ọnọdụ kachasị mma maka ịwa ahụ bụ ịnọgide na-echekwa ihe ndina dị anya. Ahụmahụ na-ahụike na-eme ka anyị kwenye na enweghi ike ịrụ ọrụ ọ bụla maka ọrịa a, mana ọ ga-eduzi ụzọ ndị mmadụ họọrọ ka esi rụọ ọrụ ahụ. A na-ekpebi ihe eji eme ka usoro nwughari mmadụ dabere na ụdị mgbapụta, afọ na ọnọdụ onye ọrịa, ọnụnọ nke ihe ndị dị ize ndụ maka ịwa ahụ na ọrịa izizi. Ihe na - egbochi ihe ngosipụta maka ọgwụgwọ ịwa ahụ ma na - ebute ịba ụba nke ịwa ahụ bụ: ọrịa obi na - adịghị ala ala, ọrịa ụbụrụ na - akpata oke ume, ọbara mgbali elu, akwara afọ na akwara afọ, ọnya afọ na duodenal ọnya, deellensated diabetes mellitus, usoro oncological, na afọ senile. Site n'ihe egwu dị ukwuu nke belata aka na ụkwụ ukwu, enwere ụfọdụ ihe ọghọm nke ịnwa ịwa ahụ na-ekwughachi, ebe ọ bụ na n'agbanyeghị mgbatị dị elu, ọnụ ọgụgụ ndị nwụrụ afọ 60 bụ 21-28% ma ọ bụ karịa.

Maka arụ nrụpụta, ụdị sọks dị iche iche, nke a kpọtụrụ aha n'elu, na eji autogenes. Aredị nnabata ndị ọzọ anaghị ejikarị eme ihe.

Ejiri ụdị endarterectomies dị iche iche (nke mepere emepe, nke mepere emepe, nke nwere carbodissection, ultrasound) na-eji ya eme ihe dị ka nnwere onwe na-eme maka mmachi na mgbapu mmachi, yana mgbakwunye dị mkpa maka ịgbachi ma ọ bụ prosthetics. Ọtụtụ ndị na-awa ahụ na-eche na o kwesịrị ekwesị ijikọta usoro ịwa ahụ na lumbar sympathectomy.

Na ọrịa Leriche, nnweta nke aorta bụ laparotomy median ma ọ bụ ngalaba n'akụkụ Rob (C.G. Rob). Akụkụ Rob na-amalite site na ọgịrịga XII wee ruo etiti etiti 3-4 cm n'okpuru otube ahụ, ebe akụkụ ikiri ụkwụ ahụ nwere akụkụ ma ọ bụ na-agbagha kpamkpam, akwara mgbidi ahụ na-ewepụ ma ọ bụ kewapụ ya na peritoneum, na peritoneum na-ewepụta ma wepụ ya na eriri afọ ya. Maka nhọrọ ọnụọgụ iliac akwara nke akụkụ nke ọzọ, enwere ike ịgbatị mbepụ ya site na nchikota nke akwara ime nwa ọzọ. Nnweta a adịkarịghị njọ, ọ naghị akpata paresis, ọ na-enye mmadụ ohere ịmalite ọrụ ngwa ngwa mgbe a wasịrị ya ahụ. Nweta oghere akwara dị si aga na mpaghara ndọtị n’akwara azụ na akwara inguinal. Akụkụ nke mgbago dị elu bụ 1-2 cm karịa n'usoro inguinal. Ọ bụ ihe amamihe dị na ya ịhapụ nchapu nke ọbara n’etiti (na etiti) na-enweghị ịgabiga ha.

Site na nnabata dị elu nke eriri afọ yana mmebi nke akụkụ akụrụ ma ọ bụ visceral, a na-eji thoracophrenolumbotomy.

Mgbe ọ bụla naanị mọzụlụ iliac dị, a na-eji ịwa ahụ ma ọ bụ endarterectomi. Imirikiti arụmọrụ nke ngalaba aortic femasin na-akwụsị na ntinye nke akwara dị elu nke anụ ahụ n'ime ọbara. Na 4-10% nke ndị ọrịa, ọbara ọgbụgba na-agbapụta site na akwara dị omimi akwara anaghị akwụ ụgwọ maka ischemia ụkwụ, n'ụdị ndị a, egosiputara ịmaliteghachi nke akụkụ ahụ nke feminin-popliteal. Iji weghachi ọbara ọbara na mpaghara feminin-popliteal, a na-ejikarị autovein arụ ọrụ. Emegharia ihe nlere na akuko nke feminin-popliteal maka 60-70% nke ụdị ọrụ niile dị na akwara akwara ugwu (Nielubowicz, 1974). Maka ịnweta akụkụ dị warara nke akwara popliteal na mpaghara mbipụta ya (trifurcation), a na-ejikarị ntanetị (oghere tibial dịka M. Conghon, 1958). Iji kpughee mpaghara etiti ma ọ bụ akwara niile, a ga-atụnye mbịaru ihu na oghere nke akwara aka pes ansevinus (ọsịsọ) na isi medial m.gastrocnemius (A.M. Imperato, 1974).

Nweta ojiji nke profundoplasty. N'ọtụtụ ndị ọrịa nwere nsogbu mebiri emebi n'ụkwụ ụkwụ, iwughari akwara dị omimi bụ naanị ihe nwere ike ichebe aka na ụkwụ. Enwere ike rụọ ọrụ ahụ n'okpuru izizi mpaghara ma ọ bụ n'okpuru usoro izizi nke epidural. Profundoplasty na-ebelata ogo ischemia, mana anaghị ewepu nkọwa zuru oke. Improkwalite mgbasa mgbasa ọbara zuru ezu iji gwọọ ọnya trophic ọnya na ọnya mgbe etiwapụrụ akụ na ụba. Ntughari nke akwara di omimi nke ukwu ahu ana - eme ka odi nziwanye nke mgbasa nke obara na 65-85% nke ndi oria (J. Vollmar et al., 1966, A.A. Shalimov, N.F. Dryuk, 1979).

N'ime ndị ọrịa nke afọ akwara nwere ọrịa na-efe efe, a na-ejikọta arụmọrụ akwara aorta na iliac na nnukwu ihe ize ndụ na oke ọnwụ. N'ime ìgwè ndị ọrịa a, enwere ike iji mmachi ime ihe nke ime mmụọ na - agafe agafe. Ihe egwu kachasị nke shunt thrombosis pụtara na ọnwa isii mbụ wee rute 28%.

Ka afọ 5-7 gachara, ikike ịgbatị onwe ya nke mpaghara feminin-popliteal na-aga n'ihu na 60-65%, na mgbe endarterectomy gasịrị, ikikere nke akwara dị na 23% nke ndị ọrịa. E nwere ihe akaebe na mgbe afọ ise gasịrị, a na-ahụzi ihe eji emezi nke anụ ahụ na-eme ka mmadụ megharịa ahụ na 73% nke ikpere, yana prosthesis na-arụ ọrụ n'ime 35% nke ndị ọrịa (D.C. Brewstev, 1982).

Ihe omumu ohuru n’ime mmepe nke ogwugwo akwara nke nkwuputa akpo nke nkwonkwo nkwonkwo ogwu bu ihe eji eme ihe eji eme ihe. Ihe mgbagwoju anya nke oru dika akwara akwara nwere ogwara 1.5-3 mm, nsogbu na oge nbiwanye aka n’ahu ma o buru oge atughari ya, oke onodu ojoo nke mbido na ngwucha n’ile nke thrombosis na iwere bu ihe ebum n’uche n’ile anya otutu ndi ogwugwo na aru oru di otua ka egosiputara na okwu banyere ischemia nke ukwu aka, ya na egwu nke belata. A na-akpọ ụdị ọrụ a "arụmọrụ maka mmachi ụkwụ". Agbanyeghị oge, arụmọrụ ndị a abụghị nsogbu. Ọnwụ mgbe a na - amụkarị ọbara dị obere - site na 1 ruo 4%, ebe m bepụ ukwu nke aka ya ruru 20-30%. Ihe dị mkpa iji chọpụta ihe ngosipụta maka ọgwụgwọ ịwa ahụ abụghị ihe ndị dị ize ndụ, mana ọnọdụ mpaghara ọrụ, i.e. na-ejide ikike nke opekata mpe n’ime akwara atọ naịba na ọnọdụ afọ ojuju maka ọbara na-aga site na akwara iliac na femoral art.

N'afọ ndị na-adịbeghị anya, site na iji atherosclerotic stenosis nke akwara ndị bụ isi, usoro nke endovascular dilatation na stenting abụrụla ebe nile. N'afọ 1964, na nke mbụ, a kọwara ụzọ “ọgwụgwọ ogwugwo” nke ileo-feminin ngalaba mgbaasị site na iji ndị na - ekupụ catheter (Ch. Dotter na M. Yudkins). A na-akpọ usoro a "transluminal dilatation", "transluminal angioplasty", plastic endovascular, wdg. N'afọ 1971, E. Zeitler (E. Zeitler) tụrụ aro iwepụ nhụsianya mgbu site na iji catgater Fogarty. N’afọ 1974

A. Gruntzig na X. Hopt (A. Gruntzig na N.Hopt) choputara catheter balloon okpukpu abụọ, nke mere ka o nwee ike mee ka ọrụ a dị mfe ma rụọ angioplasty n'ihe fọrọ nke nta ka ọ bụrụ ọdọ mmiri ọ bụla na - enwe obere nsogbu. Ugbu a, enwetala ahụmịhe bara ụba na angioplasty nke ọnya ọnya akwara. N'ihi ihe balloon angioplasty, dayameta nke akwara na-abawanye n'ihi ihe mgbapụta nke ihe atheromatous na-enweghị ịgbanwe ọkpụrụkpụ nke mgbidi akwara ozi. Iji gbochie spasm nke akwara akpọrọ na ichebe ogologo oge nke lumen ya, etinyere nitinol stent n'ime akwara. A na - arụ ọrụ akpọrọ endovascular prosthetics. A na-ahụ nsonaazụ kachasị mma na ngalaba stenosis nwere ogologo na-erughị 10 cm na ngalaba aorto-iliac na femoral-popliteal, na-enweghị calcification nke mgbidi akwara, n'agbanyeghị ọkwa nke ọrịa ahụ. Nnyocha nke nsonaazụ ogologo oge gosiri na usoro a enweghị ike ịsọ mpi na arụgharị akwara ozi, mana n'ụfọdụ ụzọ, ọ na-akwado ha nke ọma.

N'ime afọ iri gara aga, ọrụ apụtala na mmepe na mmejuputa ya na omume ụlọọgwụ nke ihe ịwa ahụ na-eme ọfụma n'ọkpụkpụ ala - osteotrepanation na osteoperforation (F.N. Zusmanovich, 1996, P.O. Kazanchan, 1997, A.V.) Ihe nlere, 1998). Ezubere arụmọrụ ahụ (ROT) iji mee ka ọbara gbagoro, mee ka ekpughere ma rụọ ọrụ nke ntụpọ ahụ, gosipụtara ya maka ndị ọrịa nwere nnukwu mbibi akwara, mgbe enweghị ike ịwa ahụ arụmọrụ. A na-arụ ọrụ ahụ n'okpuru mgbatị mpaghara ma ọ bụ epidural. A na-etinye oghere n'ime oghere nwere mmachi nke 3-5 mm na ọnụọgụ 8-12 ma ọ bụ karịa n'apata ụkwụ, ala ala na ụkwụ na isi ihe dị egwu. Enwetara nsonaazụ kachasị mma na ndị ọrịa nwere ọkwa II B na ọrịa III.

Oge nkaa

Ọrụ bụ isi n'oge oge ọ gbasasịrị bụ mgbochi nke thrombosis, ọbara ọgbụgba na ịkwụsị ọnya ahụ. Intanọgide na-enwe hemodynamics dị elu n'ogo na etiti bụ ọnọdụ dị mkpa maka igbochi thrombosis. Ọdịda ọbara ọgbụgba dị mkpụmkpụ n'oge a nwere ike ibute ọria ọbara. Maka mgbochi nrụgide nke nrụgide dị mkpa:

ndebanye aha na itinyeghachi mmiri na ọbara furu efu n’oge ịwa ahụ,
n'oge kwesịrị ekwesị na mgbazi nke metabolic acidosis, ọkachasị mgbe ntinye nke aka ischemic dị n'ọbara.

Ntughari mmiri zuru ezu kwesiri ibu ihe di okpukpo 10-15% karie mfu ya (ewezuga obara). Ọ dị mkpa iji lelee ma lekwaa ọrụ ahụ akụrụ (njikwa nke diuresis, iwebata obere dextrans molecule, aminophylline), iji dozie ọgba aghara nke acid-base balance (ASC), nguzozi-nnu mmiri na metabolic acidosis.

A na-ekpebi ajụjụ nke iji ọgwụ anticoagulants n'otu oge, dabere na njiri mara nke ịwa ahụ. Iji mee ka mgbasa ọbara mpaghara, microcirculation na igbochi nsogbu nke thrombotic, a na-enye ndị nnọchi anya antiplatelet: reopoliglyukin, compliment, trental, fluvide, ticlide, wdg. Iji ọgwụ mgbochi na ọgwụgwọ Symptomatic karịrị obi abụọ. Iji gbochie paresis eriri afọ mgbe etinyechara ya na aorta na iliac akwara ụbọchị mbụ 2-3, a na-atụ aro nri nri parenteral.

N'ime nsogbu nke oge ịmụ nwa ozugbo, enwere nlebara anya: ọbara ọgbụgba - 12%, thrombosis - 7-10%, ọrịa nke ọnya postoatory - 1-3% (Liekwey, 1977). Site na mgbachi nke prosthesis nke mpaghara aortic femoral, ọnwụ na-eru 33-37%, mbepụ - 14-23% (A.A. Shalimov, N.F. Dryuk, 1979).

Enwere ike ekewa mpikota onu ndi a huru n’oge oru mmeghari (H.G. VeeY, 1973):

imebi akụkụ ahụ nke apịtị, afọ olulu na iliac veins, ureter,
mmebi nke arịa ndị ahụ n'oge etolite ọwara maka prosthesis,
thrombosis na - agba ume n'oge ị na - achọ ọgwụ,
embolism
ọbara ọgbụgba n'ihi ọrịa hemostasis adịghị mma,
nsogbu akwara ozi (nsonaazụ akụkụ ahụ nke pelvic n'ihi ischemia ọkpụkpụ azụ).

2. Nsogbu izizi banyere mmalite:

ọbara ọgbụgba
Nsogbu gbasara akụrụngwa (nwa obere oge n'ime 48 awa),
thrombosis nke prosthesis na arịa ọbara,
paresis eriri afọ,
ischemia na nsị nke anụ ahụ n'ihi mmerụ ahụ na thrombosis nke mesenteric,
lymphorrhea na igbachi ọnya postoperative.

3. Mbubreyo nka diri nsogbu:

ọbara nke arịa na prosthesis n'ihi nrịba nke ọrịa (atherosclerosis),
ụgha nke anastomoses (ọrịa dormant ma ọ bụ njupụta nke eriri oku),
fistulas nke eriri afo
ọrịa prosthesis
enweghi ike.

Mgbochi nke nsogbu purulent dị mkpa. A na - ahụta nsogbu dịkarịsịrị njọ ma ọ bụrụ na arụzigharị ihe dị na 3-20% yana ọnụ ọgụgụ ndị nwụrụ n'ime 25-75%. Ejikọtara ọnụ ọgụgụ nke ịrịọ postoperative na:

iwebata ọrụ ọhụrụ dị mgbagwoju anya na-ewe oge,
afọ nke ndị ọrịa
oke ọrịa concomitant (dịka ọmụmaatụ, ọrịa shuga mellitus),
anaemia, hypoproteinemia, ụkọ vitamin
hypercoagulation
ọgwụgwọ ịla ahụ na mbụ
mmebi nke ọnya na-adighi nma (ezughi oke)
bandeeji nrụgide nwere uwe na-adịghị ahụkebe, na-adọrọ mmasị dị ukwuu na ọgwụ nje na ntopute nke ụdị microorganisms na-eguzogide,
mmụba n'ụgbọ ịnyịnya staphylococcal na ndị ọrụ na ndị ọrịa,
na-eme ka nlebara anya nke ndị dọkịta na-eleda iwu nchịkwa asepsis na antiseptics oge gboo. G.V. Chineke (G.W. Onyenwe anyị, 1977) na-ekewapụta nnabata nke ndị na-akwa iko na-erite site na ịdị omimi nke ọrịa:
- M digiri - ọnya anụ ahụ,
- Uzo abuo - imebi akpukpo aru na okpukpu ala
- Ogo III - mmebi nke mpaghara itinye akụkụ nke prosthesis.

A na - ahọpụta ụzọ mgbochi atọ

1. Usoro mgbochi: mkpocha ọnya na ọnya trophic, ọgwụgwọ nke anaemia, idebe afọ nke ọrịa, idebe akwara afọ 2-3 ụbọchị ịwa ahụ.

2. Intraoperative: ọgwụgwọ anụ ahụ zuru oke, hemostasis na-ahụ maka ya, mgbanwe nke uwe aka na mmalite nke ọrụ ahụ, mmerụ ahụ ọnya.

3. N'ime oge ọmụmụ: mwepu ọbara ọgbụgba, ọgwụ mgbochi oke maka ụbọchị 7-10, ọgwụ infusion zuru oke.

Site na nnabata ya, ọ dị mkpa iji aka ya gbapuo mmiri, rụkwaa ọnya ma mechie ya na akụkụ ahụ. Ọ bụrụ na ọgwụgwọ agaghị nke ọma, uzo uzo na mwepu nke prosthesis kwesịrị ịrụ. Boldwa ahụ siri ike ma jiri nlezianya chepụta nke ọma dị mma karịa ọkara ihe ihere, enweghị uche na enweghị enyemaka. N'ihe banyere iji ọgwụ mgbochi ọgwụ n'oge mbụ, mmadụ kwesịrị ilekwasị anya na ịkpa arụ ahụ, ọnụnọ nke ọnya trophic na allotransplantation. Mgbalị ndị ọrịa na-eme bụ dabere n'ọnọdụ ha n'ogo yana olu nke ịwa ahụ. Anabatakarị ije ije n’ụbọchị nke 3-5, otu o sila dị, edepụtara okwu a n’otu n’otu n’otu.

Mgbe ọ bụla emegharịgharị ahụ, ndị ọrịa kwesịrị ị takeụ ọgwụ protinlactic mgbe niile na ọgwụ mgbochi atherogenic, na-enyocha usoro nchekwa zuru oke, ma bụrụ ndị a na-atụle mgbe niile.

Ya mere, ka ọ dị ugbu a, achịkọtala ahụmịhe dị ukwuu na nchoputa na ọgwụgwọ nke ikpochapụ ọrịa na akwara, nke na-eme ka o kwe omume n'ọnọdụ nke ọ bụla ịme nyocha nke ziri ezi ma họrọ usoro ọgwụgwọ kachasị mma.

Okwu ahọpụtara na angiology. E.P. Kohan, I.K. Zavarina

Atherosclerosis obliterans nke akụkụ: akara na ọgwụgwọ

Ibepu atherosclerosis nke ala ahụ yana nkwarụ na-adịghị ala ala, bụ nke na-emetụtakarị ndị gbara afọ 40. Site n’inwe ntakịrị mkpụmkpụ nke arịa ụkwụ, akara nke hypoxia na - apụta - mmerụ ahụ n'ụkwụ, mwepu nke uche, mmetụ olu mgbe ị na-eje ije.

Preventionga n’ihu nwere ike igbochi mmepe nke ọrịa akwara akwara, mana ọtụtụ ndị ọrịa nwere ihe ọghọm:

Ibu ibu
Fatba ụba abụba,
Mmebi nke ọbara ọgbụgba na mpaghara ala n'ihi varicose veins.

Atherosclerosis obliterans nke ukwu aka akwara

Mgbanwe Ischemic na akwara metụtara ụkwụ anaghị apụta naanị na ngwugwu atherosclerotic. Ọrịa ụbụrụ nke akụkụ ahụ, akụkụ ọmụmụ, akwara varicose tinyere nri na-edozi ahụ, oxygenation nke arịa ahụ. Iji gbochie atherosclerosis vaskụla, a na-achọ ọgwụgwọ n'oge maka nsogbu ọmụmụ.

Ogologo oke paịlị na akwara anụ ahụ bụ n'ihi ọnụnọ nke bifurcation na aorta n'akụkụ arịa a - ebe nkewa n'ime ụzọ abụọ. Na mpaghara a, enwere vortex ọbara n'oge mmegharị, na-eme ka ohere nke trauma na mgbidi daa. Nke mbu, mkpokoro ahihia na-eme na aorta, wee daa n'okpuru.

Ngwurugwu dị n'etiti nke atherosclerosis nke akwara anụ ahụ

Ihe nrịba ama a na-ahụkarị ischemia bụ ịkọ nkọ. Ọrịa ụbụrụ na - eduga n'ọdịdị mgbu, ọnya aka. Mkpakọ nke akwara akwara na-eduga n'iwe nwayọ nwayọ nwayọ.

Site na oria ogwu, mmadu nwere oria ojoo. Ejiri ọnọdụ ahụ bụ ahụ erughị ala, mgbu.

Site na mkparịta ụka na-abaghị uru, mgbaàmà nke ọrịa na-apụta n'otu aka. Nke nta nke nta, nosology na-enweta Symmetry, nke na-esite na ngosipụta nke nkọwa dị n'etiti abụọ na-agakọ. Mgbe ị na-eje ije, mgbu akwara na-apụta na akwara nke nwa ehi, nke mbụ n'otu akụkụ, emesia na nke abụọ.

A na-ekpebi ịdị njọ nke ọnọdụ ahụ site na anya mmadụ na-eje tupu mmalite nke ihe mgbu. N'ọnọdụ dị oke njọ, ihe mgbu ahụ na-apụta oge karịa mgbe ị na-agagharị na mbara ala ahụ karịa mita 10.

Dabere n’etu ebe ihe mgbu si dị, a na-ekewa ihe n ’ime ihe dị iche iche ụzọ atọ:

Site na otu ụdị dị elu, a na-ahụ nsogbu mgbu ahụ kpọmkwem na akwara gluteal. A na-ejikọkarị Nosology na ọrịa Lerish (yana ihe ncheta na mpaghara aortic bifurcation).

Ihe eji mara nwa obere ihe bu ihe mgbu. Ọ na - eme ya site na atherosclerotic na - elekwasị anya na ntule nke ukwu atọ nke apata ụkwụ, nkwonkwo ikpere.

Agnochọpụta nkọwapụta ngwa ngwa dị mfe. Na mgbakwunye na mkpesa nke onye ọrịa na-enwe ihe mgbu na akwara azụ nwa mgbe ị na-eje ije, enwere palpation nke enweghị isi akwara na ọnọdụ nke arịa ahụ metụtara - iliac na akwara akwara akwara, na arịa nke ụkwụ ala.

Ihe jọrọ njọ bụ ihe na - emebi akwara trophic, nke gosipụtara site na mbelata nke olu ha, cyanosis nke anụ ahụ, cyanosis nke mkpịsị ụkwụ ya. Aka a emetụtara bụ ihe aka metụrụ emetụ.

Ọ na - esoro mmebi ahụ na - emebi ụkwụ, ụkwụ, ụkwụ. Na akwukwo ogwu, ndi oria nwere ikike ha noro - ha na edobe ukwu ha n’onu.

Nkewa nke ikpochapu atherosclerosis:

Mgbu mgbe ị na-ebugharị ihe karịrị 1 kilomita. Enwere ihe mgbu naanị na mgbatị ahụ siri ike. A naghị atụ aro ka anya dị anya n'ihi ụkwụ ụkwụ ischemia siri ike,
A na-eji ọkwa nke 1 mara mpụta nke esemokwu na-enweghị oge mgbe ị na-aga site na mita 250 ruo 1 kilomita n'ogologo. N’obodo ọgbara ọhụrụ, ọnọdụ ndị dị otú a adịkarịghị emepụta, ya mere mmadụ anaghị enwe ahụ erughị ala. Ndị nọ n’ime ime obodo yikarịrị ị ga-arịa ọrịa atherosclerosis,
A na-egosipụta mgbu nke 2 mgbe ọ na-aga ije ihe karịrị 50 mita. Ọnọdụ ahụ na-eduga n'ịgha ụgha ma ọ bụ ịnọdụ ala mmadụ mgbe ọ na-eje ije,
Ọkwa 3 - ischemia dị oke egwu, na-etolite na akpọchi akwara nke ụkwụ. A na - eji ihe mgbu mara ihe mgbe ọ na - agagharị n’ebe dị anya. Ejiri ọnọdụ ahụ na nkwarụ na nkwarụ. Na-akpata nsogbu ụra n’abalị,
A na-egosipụta ọkwa nke 4 nke ọrịa trophic site na nguzobe nke necrotic foci, nkwuputa nke nnweta ọbara na mmụba na-esote ngụkọta nke mpaghara ala.

Site na mmepe nke nsogbu anwansi-stenotic, enwere mkpochapụ nke ngalaba aorto-iliac, mmebi mpaghara mpaghara popliteal-tibial. Site na usoro ogwu, ndi mmadu na - acho ihe a na - akpo "mbibi otutu akwara ndi mmadu mere." N’ime ihe nile dị omimi ahụ, a na-ahụta palesterol palestarol.

A na - ekewa ihe mgbochi nke atherosclerosis na nkebi:

Kpochapu akụkụ nke akụkụ - nanị otu akụkụ aka ya na-ada site na saịtị microcirculation,
Occchụkarị mmụọ (klas nke abụọ) - ngọngọ nke akwara ozi nke anụ ahụ,
Igbochi akwara popliteal na akwara ya na ikike mmerụ ahụ mpaghara mpaghara bifurcation,
Ihe mgbochi zuru oke nke microcirculation na akwara popliteal na femoral - 4 ogo. Site na usoro ogwu, a na-echekwa obara nye usoro nke akwara di omimi.
Mbibi nke akwara anụ ahụ miri emi nke mebiri mpaghara mpaghara feminin-popliteal. Emezu akara aji ise na hypoxia nke akụkụ ala ala na necrosis, trophic gangrene ọnya. Ọnọdụ siri ike nke onye ọrịa na-agha ụgha siri ike idozi, yabụ ọgwụgwọ a na-egosi na ọ ga-ala ala.

3zọ ọnya ọnya na-arịa ọrịa atherosclerosis na-anọchi anya ụdị atọ:

Mmebi akụkụ ahụ ọgịrịga ahụ na nke akụkụ ahụ, nke a na-echekwa obara ọbara n'okpuru ukwu ala,
Mwepu akwara nke ukwu. Chekwaara ọgọdọ na tibia na akwara ozi,
Mkpokọta arịa niile dị n’apata ụkwụ na nke ala, na-ejidekwa ikikere ya na akwara dị iche iche.

Ihe mgbaàmà nke ikpochapụ atherosclerosis nke arịa nke ala akụkụ ahụ

Ọrịa ọgbụgba nke mkpụcha nke ala na - adị n'ọtụtụ ebe. Na ngosipụta niile na mbido, ịkọwapụta ihe dị iche iche, nke bụ akara akara ọnya.

A na - ekewa ihe mgbaàmà niile nke mbibi atherosclerotic na arịa nke ụkwụ ụkwụ na mbido na ọdụ. Ihe ịrịba ama nke mmalite nke abụba na arịa nke aka ya:

Ejighị mmụọ rụọ ọrụ nke oyi. Mkpesa nke mkpọda, ntu oyi, ọkụ, itching, mgbu nwa ehi,
Ọrịa Lerish na-eso mgbu mgbu gluteal, mpaghara azụ yana ịkọwa ihe ncheta na mpaghara aortic-iliac,
Atrophy nke abụba dị n'okpuru, akwara anụ ahụ,
Isi ntutu na apata ụkwụ,
Hyperkeratosis nke mbọ,
Lamin nke efere ahụ,
Ọrịa ọnya na-enweghị ọgwụgwọ,
Guzobe ahizi na aru nke akpukpo aru.

Ihe eji amata ihe mmebi nke anherosclerosis bu ihe mgbochi siri ike nke nwere mgbanwe ogwugwo ukwu rue ukwu.

Na 45% nke ndị ọrịa, ihe mgbu na-etolite n'ihi nsogbu ọdịdọ mgbe ọwachara ọgwụgwọ zuru oke na ntughari na usoro mgbochi. A na-atụ aro ịgwọ ọrịa inpatient oge maka ndị nwere nlọghachị ugboro ugboro.

Ọrịa nyocha

Ọ bụrụ na achọpụtara ihe mgbaàmà ndị dị n'elu, onye ọrịa ahụ kwesịrị ịchọ ndụmọdụ nke angiosurgeon, onye ga-enyocha onye ọrịa ahụ ga-edenye ya usoro nyocha. Iji gwaa ọrịa a, enwere ike ịkọwa ụdị ụlọ nyocha na akụrụngwa ndị a:

nyocha ọbara maka usoro nke lipids, ịta nke fibrinogen, glucose,
nyocha iji chọpụta oge ọgbụgba ọbara dị,
Ultrasound nke arịa nwere dopplerography,
angiography na ndi ozo di iche,
rheovasography
MRI
CT scan na iche iche.

Mgbe ịchọpụtachara usoro ọrịa ahụ, a na-enye onye ọrịa ahụ ọgwụgwọ zuru oke.

Ofzọ nke ịgwọ ọrịa atherosclerosis obreranse nke arịa nke ala akụkụ ahụ gbadoro ụkwụ na nzụlite nke usoro pathological na ọ nwere ike ịgụnye nchedo ma ọ bụ usoro ịwa ahụ.

Na nmalite ọgwụgwọ, a na - ewepụ ihe ndị na - eme ka ọrịa a na - aga n'ihu.

Ighazi ibu.
Kwụsị ise anwụrụ na àgwà ọjọọ ndị ọzọ.
Ọgụ megide arụ ọrụ.
Usjụ iri ihe oriri nke nwere kọlestrọl dị elu na abụba anụmanụ (nri Nke 10).
Njikwa ọbara mgbali na mkpochapu ọbara mgbali elu.
Mbelata ọkwa nke cholesterol "ọjọọ".
Na-aga n'ihu na-elele ọkwa shuga n'ọrịa shuga.

Enwere ike ịkwado ndị ọrịa nwere usoro izizi nke ọrịa ahụ iji suchụ ọgwụ ndị a:

ọgwụ maka iweda cholesterol - Lovastatin, Quantalan, Mevacor, Cholestyramine, Zokor, Cholestid,
ọgwụ iji belata triglycerides - clofibrate, bezafibrat,
nkwadebe maka imezi microcirculation na igbochi thrombosis - Cilostazol, Pentoxifylline, Clopidogrel, Aspirin, Warfarin, Heparin,
ọgwụ maka iweda ọbara mgbali elu - Atenolol, Betalok ZOK, Nebilet,
ọgwụ iji melite trophism anụ ahụ - Nicotinic acid, Nikoshpan, vitamin B,
multivitamin ogige.

Usoro physiotherapeutic (microcurrents, laser therapy), balneotherapy na hyperbaric oxygenation nwere ike ịkọwa maka ọgwụgwọ nke arteriosclerosis obliterans nke mpaghara ala.

Ihe ngosi maka ogwugwo nwere ike ghaa:

ihe ịrịba ama nke gangrene
obi mgbu na ezumike,
thrombosis
ngwangwa ngwangwa ma ọ bụ ọkwa III-IV nke atherosclerosis.

Na mbido ọrịa ahụ, onye ọrịa nwere ike ịwa ahụ nwa oge:

balloon angioplasty - a na-etinye catheter pụrụ iche nke nwere balloon n'ime akwara ozi site na mgbapụta, mgbe a na-agbanye ikuku n'ime balloon, mgbidi nke akwara kwụ ọtọ,
cryoplasty - mgbatị a yiri balloon angioplasty, mana mgbasawanye nke akwara a na-eme site na iji refrigerant, nke na-enweghị ike ịgbasa lumen nke arịa ahụ, ma mebie nkwakọba atherosclerotic,
stenting - a na-ewebata akwa pụrụ iche na lumen akwara, nke nwere nkwadebe dị iche iche maka mbibi nke sclerotic plaques.

Mgbe ị na-arụ ọrụ ndị a na-eyi egwu obere oge, a na-eji angiography na-achịkwa usoro a na-eme. Enwere ike ịme ihe ndị a na ụlọ ọgwụ pụrụ iche. Mgbe ọ gbasịrị ahụ, onye ọrịa ahụ na-elekọta ahụike maka otu ụbọchị, ọ nwere ike ị laa n'ụlọ na-esote ụbọchị.

Site na mbelata nke akwara siri ike maka ọgwụgwọ ịwa ahụ, a na-eji ụzọ emeghe ndị a:

na - agbachi - mgbe a na - arụ ọrụ, a na - emepụta ihe eji eme ihe site na ihe ndị siri ike ma ọ bụ na akụkụ nke akwara ndị ọzọ na - esite n'aka onye ọrịa,
endarterectomy - n'oge arụ ọrụ ahụ, a na-ewepụ mpaghara nke akwara ozi ahụ na-emetụta atherosclerotic.

Na mgbakwunye na arụmọrụ nwughari dị otú ahụ, enwere ike iji usoro ịwa ahụ ọzọ inye aka:

imeghari osteotomi - mmerụ nke ọkpụkpụ na-akpali uto nke obere arịa ọbara ọhụrụ.
nnabata - ụzọ mbata nke akwara ozi na - akpasu mkpasu iwe banyere akwara ndị ahụ, ana - ebu ụzọ mechie ọnya nke akwara ndị ọzọ.

Site na imepụta nnukwu ọnya na - adịghị agwọ ọnya ma ọ bụ jiri akara nke gangrene, a nwere ike ịwa ahụ plastic na njiri akpụkpọ ahụ dị mma mgbe mwepụ nke mpaghara necrotic ma ọ bụ mgbatị nke akụkụ nke aka.

Amụma maka ọgwụgwọ nke ikpochasị atherosclerosis nke arịa nke ala akụkụ ahụ dị mma site na ọgwụgwọ mbụ site na onye ọrịa site na angiosurgeon. N'ime afọ iri nke mmepe nke usoro a, a na-ahụ mmepe mmepe nke thrombosis ma ọ bụ gangrene na 8% nke ndị ọrịa.

Mgbochi

Iji gbochie mmepe nke atherosclerosis nke akwara akwara nke ala ala, enwere ike ịme usoro ndị a:

Treatmentgba oge n'oge nke ọrịa na-adịghị ala ala.
Na-aga n'ihu nyocha ahụike nke ahụike mgbe afọ 50 gachara.
Jụ omume ọjọọ.
Ezigbo ihe oriri.
Ọgụ megide arụ ọrụ.
Ewepu ọnọdụ nrụgide.
Na-alụ ọgụ maka oke ibu.

Gịnị bụ ihe a

Atherosclerosis obliterans bụ otu ụdị nke atherosclerosis. Site na ọrịa a, cholesterol plaques etolite na mgbidi akwara ndị ahụ, ha na-akpaghasị usoro ọbara na - adịkarị, na - akpata vasoconstriction (stenosis) ma ọ bụ mgbochi zuru oke ya, nke a na - akpọ mgbapụ ma ọ bụ ikpochapụ ya, yabụ ha na - ekwu okwu banyere ọrịa ọnya ụkwụ.

Dabere na ọnụ ọgụgụ, prerogrant nke ọnụnọ nke ọrịa bụ nke ụmụ nwoke karịrị afọ 40. Ibepu atherosclerosis nke ala ala akụkụ 10% nke ọnụọgụ ụwa niile, ọnụ ọgụgụ a na-eto kwa mgbe.

Ihe na-eme

Isi ihe kpatara atherosclerosis bụ ise siga. Nicotine dị na ụtaba na-akpata akwara umeji, si otú ahụ na-egbochi ọbara ịgafe arịa ndị ahụ na-amụba ohere nke ịmịkọrọ ọbara n'ime ha.

Ihe ndị ọzọ na-akpalite atherosclerosis nke akwara akwara nke ala ala ma na-eduga na mbido mbụ na nnukwu ọrịa ahụ:

cholesterol dị elu na oriri ugboro ugboro nke ihe oriri nwere abụba anụmanụ.
ọbara mgbali elu
ibu oke ibu
ma ihe a ketara eketa
ọrịa shuga mellitus
enweghi mmega zuru oke,
oge nrụgide.

Nzuzo ma ọ bụ iji mee ka ụkwụ ghara ịdị ogologo, na-ebugharị n'oge ọ dị obere site na ntu oyi, nwekwara ike ibute ihe egwu.

Usoro mmepe

Ọtụtụ mgbe, atherosclerosis nke arịa nke ala nsọ ahụ na-egosipụta onwe ya na agadi yana ọ bụ metabolism lipoprotein na-akpata ahụ. Usoro mmepe ahụ na-agafe usoro ndị a.

A na-ejide cholesterol na triglycerides nke na-abanye n'ime ahụ (nke na-abanye n'ime mgbidi eriri afọ) site na protein protein na-edozi - chylomicron na - ebuga ya n'ọbara.
Imeju na - emegharị ihe ndị mepụtara ma na - ekekọta ihe pụrụ iche nwere - VLDL (cholesterol dị ala).
N'ime ọbara, enzyme lipoproteidlipase na-arụ ọrụ na ụmụ irighiri ọgwụ VLDL. Na ọkwa mbụ nke mmeghachi ahụ na kemịkal, VLDLP gafere lipoproteins njupụta (ma ọ bụ STLPs), na mgbe ahụ na ọkwa nke abụọ nke mmeghachi omume, VLDLP na-agbanwe ghọọ LDLA (cholesterol dị ala). LDL bụ cholesterol a na-akpọ “jọrọ njọ” ọ bụ na ọ bụ karịa atherogenic (ya bụ, ọ nwere ike ịkpasu atherosclerosis).
Akụkụ abụba dị iche iche na-abanye na imeju maka inwekwu nhazi N'ebe a, a na-emepụta cholesterol dị elu (HDL) site na lipoproteins (LDL na HDL), nke nwere mmetụta dị iche ma nwee ike ịsacha mgbidi nke arịa ọbara site na akwa kọlesterol. Nke a bụ cholesterol a na-akpọ “mma”. A na-edozi akụkụ nke mmanya na-egbu egbu n'ime nri bile acid, nke dị mkpa maka nhazi nri, yana ezigara eriri afọ.
N'oge a, mkpụrụ ndụ ịba ọcha n'anya nwere ike ịda (na mkpụrụ ndụ ihe nketa ma ọ bụ n'ihi ịka nká), n'ihi nke, n'ọnọdụ nke HDL, mmepụta nke ụmụ irighiri abụba dị ala ga-anọgide na-agbanweghi ma banye n'ọbara.

Ọ dịghị ihe ọzọ, na ikekwe karịa atherogenic, na-emegharị ma ọ bụ na-agbanwe agbanwe lipoproteins. Dịka ọmụmaatụ, oxidized site na ikpughe H2O2 (hydrogen peroxide).

Mpekere abụba dị ala (LDL) kwụsịrị na mgbidi akwara ndị dị na mpaghara ala. Ogologo ọnụnọ nke ihe ndị si mba ọzọ na lumen arịa ọbara na-eme ka mbufụt. Agbanyeghị, macrophages na leukocytes enweghị ike ịnagide irighiri cholesterol. Ọ bụrụ na usoro a amalite, a na -ebe akwa nke mmanya na - egbu egbu - plaques -. Ihe nkwụnye ego ndị a nwere nnukwu njupụta ma na-egbochi oke ọbara.
A na - egota cholesterol nke “jọrọ njọ”, ma na - eme mkpọchi ọbara n'oge ruptures ma ọ bụ mbibi nke Capsule. Ọkpụkpụ ọbara na-arụpụta ihe na-emetụta mmụọ.
Nke nta nke nta, irighiri cholesterol yana mkpokọta ọbara na - ewere ọnọdụ kwụ ọtọ, n'ihi ntinye nnu nnu. Mgbidi nke akwara ndị ahụ na-efukarị ike ha, ma na-emebi emebi, na-ebute mkpọmkpọ ebe. Na mgbakwunye na ihe niile, ischemia na necrosis nke anụ ahụ dị nso na-etolite n'ihi hypoxia na enweghị nri.

N'oge ikpochasị atherosclerosis nke ala nke ala, a na-amata ọkwa ndị a:

Okpomoku nke mbu (ekpughere ihe mbu nke stenosis) - mmetụta nke goosebumps, blanching nke anụ ahụ, mmetụta nke ịba na oyi, oke ịsụsọ, ike ọgwụgwụ ngwa ngwa mgbe ị na-eje ije,
II A ogbo (esighi ike nghọta) - mmetụta nke ike ọgwụgwụ na isi ike na akwara nwa ehi, mpịkọ mgbu mgbe na-achọ ije ije ihe 200 m,
Uzo II B - ihe mgbu na mmetụta nke isi ike anaghị ekwe gị ịga 200 m,
Nkeji III - ihe mgbu na akwara nke nwa ehi na - akawanye ike ma na - apụta ọbụna mgbe izu ike,
Afọ III - n’elu ụkwụ nwere ihe ịrịba ama nke ọgba aghara, ọnya na - adịghị agwọ ọrịa ogologo oge na ihe ịrịba ama nke gangrene.

N'oge ọkwa dị elu nke atherosclerosis nke ala akụkụ ala, mmepe nke gangrene na-edugakarị na njedebe nke aka aka. Enweghị nlekọta ịwa ahụ zuru oke n'ọnọdụ ndị dị otú a nwere ike ibute ọnwụ nke onye ọrịa.

A na - ekewa ihe mgbochi nke atherosclerosis na nkebi:

Kpochapu akụkụ nke akụkụ - nanị otu akụkụ aka ya na-ada site na saịtị microcirculation,
Occchụkarị mmụọ (klas nke abụọ) - ngọngọ nke akwara ozi nke anụ ahụ,
Igbochi akwara popliteal na akwara ya na ikike mmerụ ahụ mpaghara mpaghara bifurcation,
Ihe mgbochi zuru oke nke microcirculation na akwara popliteal na femoral - 4 ogo. Site na usoro ogwu, a na-echekwa obara nye usoro nke akwara di omimi.
Mbibi nke akwara anụ ahụ miri emi nke mebiri mpaghara mpaghara feminin-popliteal. Emezu akara aji ise na hypoxia nke akụkụ ala ala na necrosis, trophic gangrene ọnya. Ọnọdụ siri ike nke onye ọrịa na-agha ụgha siri ike idozi, yabụ ọgwụgwọ a na-egosi na ọ ga-ala ala.

3zọ ọnya ọnya na-arịa ọrịa atherosclerosis na-anọchi anya ụdị atọ:

Mmebi akụkụ ahụ ọgịrịga ahụ na nke akụkụ ahụ, nke a na-echekwa obara ọbara n'okpuru ukwu ala,
Mwepu akwara nke ukwu. Chekwaara ọgọdọ na tibia na akwara ozi,
Mkpokọta arịa niile dị n’apata ụkwụ na nke ala, na-ejidekwa ikikere ya na akwara dị iche iche.

Mgbaàmà nke OASNK na mbido mbụ, dịka iwu, bụ ịfelata ma ọ bụ abiaghi kpamkpam. Ya mere, a na-ahụta ọrịa ahụ dịka nke enweghị atụ. Ọ bụ mbibi a na akwara ndị a na - etolite nwayọ, ogo ogo ihe mgbaàmà na - emetụta ogo mmepe nke ọrịa ahụ.

Ihe ịrịba ama nke mbụ nke imebi atherosclerosis nke ala nsọ (nke abụọ nke ọrịa ahụ):

ụkwụ na-amalite ifriizi oge niile
ụkwụ na-apụtakarị ọnụ
ọzịza nke ụkwụ na-apụta
ọ bụrụ na ọrịa a na-emetụta otu ụkwụ, ọ na-ajụkarị oyi karịa nke ahụ siri ike,
mgbu na ụkwụ mgbe ogologo ije gachara.

Ihe ngosi ndia putara na ogbo nke abuo. N'oge a nke mmepe nke atherosclerosis, mmadụ nwere ike ịga ije mita 1000-1500 na-enweghị ihe mgbu.

Ndị mmadụ anaghị agbakwunye mkpa ọ dị na mgbaàmà ndị dị ka mmịkọ, ọnụọgụ oge, ihe mgbu mgbe ị na-eje ije ogologo ụzọ. Ma n'efu! E kwuwerị, ịmalite ọgwụgwọ na ọkwa nke abụọ nke pathology, ị nwere ike igbochi nsogbu 100%.

Mgbaàmà nke na-egosi na ọkwa atọ:

mbọ na-eto nwayọ karịa ka ọ dị na mbụ
ụkwụ na-amalite ịda
mgbu nwere ike ịdapụta na mberede ehihie na abalị,
Mgbu na-apụta mgbe ijechara obere ije (250-100 m).

Ọ bụrụ na mmadụ nwere ogwe ụkwụ 4 na - ekpochapụ atherosclerosis nke ụkwụ, ọ nweghị ike ịga ije mita 50 na-enweghị ihe mgbu. Maka ndị ọrịa dị otú ahụ, ọbụlagodi njem ịzụ ahịa na-aghọ ọrụ dị egwu, mgbe ụfọdụ ọ na-apụ apụ naanị na yad, ka ịrịgo na steepụ gbagoro agbada na-ata ahụhụ. Ọtụtụ mgbe, ndị ọrịa nwere oria 4 nwere ike ịgagharị n'ụlọ naanị. Ka nsogbu na-etolite, ha anaghị ebilite ma ọlị.

N'oge a, ọgwụgwọ ọrịa na-ehichapụ ọrịa atherosclerosis nke ala ahụ na-abụkarị ihe na-enweghị ike, ọ nwere ike iwepụ mgbaàmà maka obere oge ma gbochie nsogbu ndị ọzọ, dị ka:

Ọkpụkpụ na-achaji akpụkpọ ahụ n'ụkwụ,
ọnya afọ
gangrene (site na nsogbu a, igbatị ụkwụ nke aka adịghị mkpa).

Akụkụ nke usoro ahụ

Ihe mgbaàmà niile nke ọrịa ahụ ji nwayọọ nwayọọ na-eto, ma n'ọnọdụ ndị obere, ikpochapụ atherosclerosis nke arịa nke ala nsọ ahụ na-egosipụta onwe ya n'ụdị thrombosis akwara. Mgbe ahụ, na ebe akwara akwara ọbara, thrombus na - apụta, nke na - emechi oghere akwara ngwa ngwa. Ọrịa yiri ya maka ọrịa ahụ na - etoliteghi na mberede, ọ na - enwe mmetụta dị njọ na ọdịmma, anụ ahụ nke ụkwụ tụgharịrị achagharị, ọ na - ajụ oyi. N'okwu a, ịrịọ arịrịọ ngwa ngwa (na-agụta oge ihe omume na -agaghị agbagide - awa ole na ole) nye dọkịta na-awa ahụ na-enye gị ohere ịchebe ụkwụ mmadụ.

Site na ọrịa concomitant - ọrịa shuga, ụzọ ikpochapụ atherosclerosis nwere njirimara nke ya. Akụkọ ihe mere eme nke ụdị ọrịa a adịkarịghị, ebe ọrịa ahụ na-amalite ngwa ngwa (site na ọtụtụ awa ruo ọtụtụ ụbọchị) nke na obere oge ọ na-eduga na necrosis ma ọ bụ gangrene na mpaghara nke mpaghara ala. Ọ bụ ihe nwute, ndị dọkịta na-enwekarị ụdị ọnọdụ a na - agbapụ ụkwụ - nke a bụ naanị ihe nwere ike ịchebe ndụ mmadụ.

Ozi izugbe

Atherosclerosis obliterans - ọrịa na-adịghị ala ala nke mpaghara akwara, nke akwara site na ọnya mmụọ ha na-akpata ma na-akpata ischemia nke akụkụ ala. Na cardiology na akwara obi, atherosclerosis obliterans ka a na-ewere ụdị ọgwụgwọ ọrịa atherosclerosis (nke atọ a na-ebutekarị ọrịa akwara na akwara nke ọrịa ụkwara ume ọkụ). Ibepu atherosclerosis nke ala ikpere ala na-apụta na 3-5% nke ikpe, ọkachasị ụmụ nwoke gbara afọ 40. Ọrịa ọgbụgba a na-eme n'oge gboo na-emetụta nnukwu arịa (aorta, iliac arteries) ma ọ bụ nnukwu akwara (popliteal, tibial, femoral). Site na atherosclerosis obliterans nke akwara akwara nke elu akuku, a na-emetuta okpo mmiri nke subclavian artery.

Ihe na-eme ka ahụ gharazie isi ike

Ibepu atherosclerosis bụ ngosipụta nke systemhe atherosclerosis, ya mere ihe omume ya jikọtara ọnụ na otu etioloji na usoro nje nke na - ebute usoro atherosclerotic na mpaghara ọ bụla ọzọ.

Dabere na echiche nke oge a, dyslipidemia na-akwalite mmebi vaskụla na-akpata, mgbanwe nke steeti mgbidi vaskụla, arụ ọrụ nke ngwa onye na-anabata ihe na ihe kpatara mkpụrụ ndụ ihe nketa (mkpụrụ ndụ ihe nketa). Mgbanwe ndị bụ isi pathologies na ikpochapu atherosclerosis na-emetụta intima nke akwara. Na gburugburu ezi nke lipoidosis, anụ ahụ na-ejikọta ya na tozu oke, nke a na -eme ka e nwee iberibe iberibe paịlị, iberibe platelet na mkpo fibrin.

Site na nsogbu ndị metụtara ọbara na necrosis plasta, a na -eme oghere ndị jupụtara na anụ ahụ detritus na oke atheromatous. Nke ikpeazụ, itufu akwara akwara, nwere ike banye n'ọbara ọbara, na-eme ka akwara ike ọkpụkpụ aka.Tụkwasị salts nke nnu n'ime klọb ndị a gbanyere mkpọrọgwụ na-eme ka arịa ndị ahụ kwụsị, na-eduga ha na mgbochi. Stenosis akwara nke ihe karịrị 70% nke dayameta nkịtị na-eduga n'ịgbanwe ọdịdị na ọsọ nke ọbara na-agba.

Ihe ndị na-ebute ihe na-eme mkpochapụ atherosclerosis bụ ị smokingụ sịga, ị alcoholụ mmanya, cholesterol ọbara mgbali elu, ịkọ ọdịnihu, enweghị mmega ahụ, oke akwara oke, menopause. Atherosclerosis obliterans mgbe mepere megide ndabere nke ọrịa concomitant - ọbara mgbali ọbara, ọrịa shuga mellitus (ọrịa shuga macroangiopathy), oke ibu, hypothyroidism, ụkwara nta, rheumatism. Ihe mpaghara na-enye aka na ọnya ọgbụgba akwara na-emetụta ọnya afọ gara aga, ọnya ụkwụ. N'ihe fọrọ nke nta ka ọ bụrụ ndị ọrịa niile nwere ọrịa mebiri emebi, a na-achọpụta atherosclerosis nke arịa nke obi na ụbụrụ.

Nkewa nke ikpochapu atherosclerosis

N'oge ikpochasị atherosclerosis nke ala nke obere, a na-ahụ ọkwa 4:

1 - ije ije na-enweghi mgbu ọ bụla ga - ekwe omume na anya karịa 1000 m. Mgbu na - aputa naanị mgbatị ahụ siri ike.
2a - ije ije na-enweghị mgbu na anya nke 250-1000 m.
2b - ije ije na-enweghị mgbu na anya nke 50-250 m.
3 - ogbo nke ischemia di nkpa. Ogologo ije ije na-enweghị mgbu erughị 50. Ihe mgbu na-apụtakwa na izu ike na abalị.
4 - ogbo nke nsogbu trophic. Na mpaghara akụkụ aka na mkpịsị aka, enwere mpaghara necrosis, nke ga-eme n'ọdịnihu nwere ike ibute ọgbụgba ụkwụ.

N'iburu n'uche ntụgharị nke usoro mgbaasị-stenotic, enwere ike ịmata ihe ndị a: atherosclerosis obliterans nke ngalaba aorto-iliac, akụkụ nke feminin-popliteal, popliteal-tibial mebiri, mbibi akwara ọtụtụ. Site na ọnya ọnya ahụ, a na-ahụ ihe dị iche iche na - eme ka mmadụ dị iche iche na - apụ apụ na iche.

Ihe njuputa akwara nke atherosclerosis nke akwara nwanyi na popliteal arteries na-egosi ihe di iche gbasara oria akwara nke anwansi:

M - amachiri anya (nkewa)
II - ọnya na-ahụkarị na akwara akwara,
III - nnabata nile nke akwara ikpuchi isi na akwara ozi, mpaghara mpaghara mmerụ ahụ nke akwara popliteal bụ ihe a na-agaghị ahụ anya,
IV - kagbuo akwara ikpehe nke elu anụ ahụ na akwara ozi, mkpochapu ọnya ọgbụgba nke popliteal artial nke nnukwu feminin artery adịghị emebi emebi,
V - mgbazigharị nke ọnụnọ nke anụ ahụ na –esi ike ya.

A na - anọchi anya ụdị mkpụrụ ọnya nke metụtara mgbaasị nke mpaghara popliteal-tibial na mkpochasị atherosclerosis site na ụdị III:

M - igbachapụ akwara popliteal artal akụkụ nke artaliibi na nkebial na ngalaba nke mbụ, echekwara 1, 2 ma ọ bụ atọ akwara ụkwụ,
Nke abụọ - mkpocha akwara dị n'okpuru nke ala, akụkụ nke popliteal na akwara ịwa ahụ ga-agafe agafe,
III - igbachapu nke popliteal na nkebial arteries, akụkụ nke onwe ya na akwara nke ukwu ala na ụkwụ nwere ike ịgafe.

Amụma na mgbochi nke ikpochapụ atherosclerosis

Atherosclerosis obliterans bụ ajọ ọrịa nke nwere ọnọdụ nke atọ na ntọala nke ọnwụ site na ọrịa obi. Site na ikpochapu atherosclerosis, enwere nnukwu ihe omuma nke imegharia gangrene, na-acho ukwu aka ya. Prognosis nke imebi ọrịa ahụ na-ekpebisi ike na ọnụnọ nke ụdị ndị ọzọ nke atherosclerosis - ọrịa ụbụrụ, akwara ozi. Ofzọ ikpochapụ atherosclerosis, dịka iwu, adịghị mma n'ime ndị nwere ọrịa shuga.

Ihe mgbochi izugbe gụnyere mkpochapu ihe ndị dị ize ndụ maka atherosclerosis (hypercholesterolemia, oke ibu, ị smokingụ sịga, arụghị ọrụ nke anụ ahụ, wdg). Ọ dị ezigbo mkpa iji gbochie mmerụ ahụ ụkwụ, ịdị ọcha na nlekọta mgbochi ụkwụ, na-eyi akpụkpọ ụkwụ dị mma. Usoro ọmụmụ nke usoro ọgwụgwọ na-egbochi mkpochapụ atherosclerosis, yana ịwa ahụ na-eweghachi oge, na-enye gị ohere ịchekwa ụkwụ na akawanye mma na ndụ ndị ọrịa.