Mgbaàmà na ọgwụgwọ nke neuropathy mamịrị

* Ihe metụtara 2017 maka RSCI

A debara akwụkwọ akụkọ ahụ na Ndepụta nke akwụkwọ sayensị nyocharo nke ndị ọgbọ nke kọmeli kacha elu.

Gụọ na nke ọhụrụ

Neuropathy, nke nwere njirimara akparamaagwa nke ọrịa, n'ọtụtụ oge na-egosi ọnụnọ nke ọnọdụ ọrịa dị iche iche. Ugbu a, enwere ihe dị ka ọrịa 400, otu n'ime ngosipụta nke ya bụ emebi emebi akwara. Imirikiti ọrịa ndị a dị ụkọ, yabụ maka ọtụtụ ndị ọrụ ahụike, isi okwu a jikọtara ya na mgbaàmà nke neuropathy bụ ọrịa shuga mellitus (DM). Ọ nwere otu n'ime ebe izizi nke ọrịa neuropathy na mba ndị mepere emepe (ihe dịka 30%). Dabere na ọmụmụ dịgasị iche, polyneuropathy na-arịa ọrịa mamịrị (DPN) na-apụta na 10-100% nke ndị ọrịa nwere ọrịa shuga.

Pathogenesis na nhazi ọkwa

Ihe ndị a na-arụ ọrụ dị mkpa na pathogenesis nke DPN:

1. Microangiopathy (mgbanwe na arụ ọrụ na / ma ọ bụ usoro nhazi na okpu ndị ọrụ maka microcirculation nke eriri akwara).

2. Nsogbu nke metabolic:

• Ime ihe nke polyol shunt (uzo ozo nke glucose metabolism, nke ewegharia ya na sorbitol (site na iji enzyme aldose reductase) wee ruzie fructose, nnabata nke metabolites ndị a na-eduga na mmụba na osmolarity nke oghere intercellular).
• Mbelata ọkwa nke myo-inositol, nke na-eduga n'ịbelata mkpokọta nke phosphoinositol (ihe mejupụtara nke mkpụrụ ndụ akwara), bụ nke na - eme ka mbelata ike metabolism na nsogbu akwara.
• Enweghi enzymatic na enzymatic glycation nke protein (glycation nke myelin na tubulin (ihe owuwu nke akwara) na-eduga na demyelination na nrụgide nke akwara akwara, glycation nke protein nke okpuru ulo nke okpu ala na-eduga n'ọdịda ya na metabolic na akwara akwara).
• Mmụba oxidative na-abawanye (ụba oxidation nke glucose na lipids, mbelata nchebe antioxidant na-eme ka nchịkọta nke radicals na-enwe mmetụta cytotoxic kpọmkwem).
• Mmepe nke ogige autoimmune (dika ụfọdụ akụkọ si kwuo, ọgwụ mgbochi na insulin na - egbochi ihe itolite akwara, nke na - eduga na nbibi nke eriri akwara).

E gosipụtara mmekọrịta dị n'etiti ihe dị iche iche nke pathogenesis nke DPN na eserese 1.

Nkewa na ngosiputa nke ulo ogwu nke DPN

Nnukwu sensọ ma ọ bụ sensorimotor neuropathy

Na ọnya ọnya nke nwere akwara pere mpe:

• na-egbu mgbu ma ọ bụ nkọ mgbu agba,
• hyperalgesia
• paresthesia
• ụfụ nke mgbu ma ọ bụ ọnọdụ uche,
• ọnya ụkwụ,
• enweghi mgbu visceral.

Pred nwere nnukwu mmebi:

• okfu nke inwe mmetụta uche
• ọnwụ nke mmetụta uche
• ntụpọ.

Ọgwụ Neuropathy

Nnukwu mgbu neuropathy

Ọrịa mgbu na-adịghị ala ala demyelinating neuropathy

• Ọkpụkpụ akwara na-emegharị ahụ.
• Ọsụsọ Sweating.
• Asymptomatic hypoglycemia.
• Autismic gastrointestinal neuropathy:
• obi nke afọ,
• inyoghi-inyoghi,
• enteropathy na-arịa ọrịa shuga ("afọ ọsịsa nke ụbụrụ"),
• afọ ntachi
• mgbaka enweghi mgbaka.
• Automatic neuropathy nke usoro akwara obi:
• ischemia na-adịghị ụfụ,
• orthostatic hypotension,
• obi obibia nsogbu
• orthostatic tachycardia,
• tachycardia nke izu ike,
• olu onodu
• circadian mgbanwe,
• mbelata mmega ahụ.
• Autonomic neuropathy nke eriri afo.
• Automatic neuropathy nke usoro ọmụmụ (nrụrụ etacile, ejaculation retrograde).

Nleba anya na otutu neuropathies

• Oculomotor akwara (III).
• Mgbatị akwara (VI).
• Gbochie akwara (IV).

Asymmetric proximal obere ukwu neuropathy

• Asymmetric proximal moto neuropathy.
• Mgbu na azụ, hips, ikpere.
• Adịghị ike na atrophy nke mgbanwe ahụ, ndị na - emegharị aka na uru nke apata ụkwụ.
• Ọnwụ reflex si akwara quadriceps.
• Ntinye obere ihe na-agbanwe.
• Ibu ibu.

• Ahụ mgbu dị na azụ, obi, afọ.
• Ndalata uche ma ọ bụ dysesthesia.

• Mkpakọ (ọwara):
  • Mkpụkpụ aka elu: irighiri akwara na ọwara Carpal,
  • ukwu aka: akwara nke tibial, akwara peroneal.
• Gburugburu.

Nyocha nchọpụta DPN

1. Nchịkọta nke akụkọ banyere ahụike na mkpesa nke onye ọrịa (ajụjụ maka ikpebi akara ngosipụta nke ụdị ọrịa neuropathy dị iche iche ka egosiri na tebụlụ 1).

2. Nnyocha akwara ozi (tebụl. 2).

Ule a gosipụtara na tebụlụ nke 1 na nke abụọ na-eme ka o kwe omume ịchọpụta ngwa ngwa ngosipụta nke DPN nke dị n'akụkụ. Maka nyocha zuru ezu na njirimara nke ụdị neuropathy ndị ọzọ, a na-eme ọmụmụ ndị a:

2. Electrocardiography (mkpebi siri ike mgbanwe mgbanwe mkpụrụ obi, ulere na iku ume miri emi, nnwale Valsalva, nwalee ngbanwe nke onodu ahu).

3. Njibe ọbara mgbali elu (itinye ihe na mgbanwe na ọnọdụ ahụ).

4. X-ray nke afọ na / na-enweghị iche.

5. Nnyocha nke ultrasound nke oghere ime.

6. Urora intravenous, cystoscopy, wdg.

Ọgwụgwọ na mgbochi nke DPN

Ebumnuche bụ isi nke ọgwụgwọ na mgbochi nke DPN bụ njikarịcha nchịkwa glycemic. Ọtụtụ nnyocha emere n’afọ ndị na-adịbeghị anya, ejirila nwapụta n’egosi na mmadụ inweta ogo glucose ọbara dị mma n’ime otu ụbọchị na-egbochi mmepe nke ngosipụta nke DPN. Ọgwụ ịgwọ ọrịa neuropathy kachasị ugbu a na nke ruru eru agaghị enwe isi na-enweghị nkwụghachi ụgwọ maka ọrịa shuga.

A maara na ọrịa shuga enwere ụkọ nke ọtụtụ vitamin na ihe metụtara, n'agbanyeghị ọgwụgwọ maka DPN, a na-arụ ọrụ kachasị mkpa site na iwepu adịghị ike nke vitamin B .. vitamin Neurotropic (otu B) bụ coenzymes na-etinye aka na usoro biochemical dị iche iche, melite ike akwara, ma gbochie guzobe ngwaahịa ngwaahịa. glycation nke ndi na-edozi. Ejirila nhazi nke vitamin ndị a iji lelee DPN ogologo oge. Agbanyeghị, ojiji dị iche iche nke vitamin B ọ bụla na-agbakwunye ntakịrị injections ma ọ bụ mbadamba na ọgwụgwọ ndị ọrịa, nke na-eweta nnọọ nsogbu. Ọgwụ Neuromultivitis na-ezere ị additionalụ ọgwụ nke ọtụtụ ọgwụ, ebe ọ bụ na otu mbadamba, nke ihe nkiri gbara, nwerelarị:

• nitam hydrochloride (vitamin B1) - 100 mg,
• pyridoxine hydrochloride (vitamin B6) - 200 mg,
• cyanocobalamin (vitamin B12) - 0.2 mg.

Thiamine (vitamin B1) n'ime ahụ mmadụ n'ihi usoro phosphorylation ka agbanwere na cocarboxylase, nke bụ coenzyme metụtara n'ọtụtụ mmeghachi omume enzymatic. Thiamine na-arụ ọrụ dị mkpa na carbohydrate, protein na metabolism abụba, na-ekere òkè na usoro nke oke ụjọ ụjọ na synapses.

Pyridoxine (vitamin B6) dị mkpa maka ịrụ ọrụ nkịtị nke sistem na akụkụ akwara. N'ụdị phosphorylated, ọ bụ coenzyme tinyere aka na metabolism nke amino acid (decarboxylation, transamination, wdg). Ọ na - eme dị ka coenzyme nke enzymes kachasị mkpa nke na - arụ ọrụ na akwara anụ ahụ. Na-ekere òkè na biosynthesis nke ọtụtụ neurotransmitters, dịka dopamine, norepinephrine, adrenaline, histamine na γ-aminobutyric acid.

Cyanocobalamin (vitamin B12) dị mkpa maka ịkpụkọ ọbara na maticryryry erythrocyte, ọ na-esonye n'ọtụtụ mmeghachi azụ nke biochemical nke na-ahụ maka ọrụ dị mkpa: na nnyefe nke otu methyl (na iberibe carbon-ndị ọzọ), na njikọ nke nucleic, protein, na mgbanwe nke amino acid, carbohydrates, lipids. Ọ nwere mmetụta bara uru na usoro dị na usoro ụjọ (njikọ nke nucleic acid na mejupụtara nke libido na phospholipids). Codị coenzyme nke cyanocobalamin - methylcobalamin na adenosylcobalamin dị mkpa maka mmeghari mkpụrụ ndụ na uto.

Nnyocha nke steeti usoro ụjọ akwara na-arịa ndị ọrịa nwere ụdị ọrịa shuga 2 gosiri na Neuromultivitis nwere mmetụta dị mma na ntanetị ihu na ịma mma nke ụkwụ, ma belata belata ike nke mgbu mgbu. Nke a na-egosi mbelata ihe ize ndụ nke ịmalite ọnya ụkwụ trophic na mmụba nke ndụ ndị ọrịa nwere DPN distal. Ekwesịrị ịchọpụta na ịdị mma nke ịme usoro ọgwụgwọ na outpatient, ebe ọgwụ ahụ achọghị nchịkwa parenteral.

Alfa lipoic acid bụ coenzyme nke isi enzymes nke okirikiri nke Krebs, nke na-enye gị ohere iweghachi ike nke akwara, yana antioxidant (dị ka onye na-ahụ maka oxidizing eke), nke na-eme ka o kwe omume igbochi mmebi ọzọ nke ihe akwara ma chebe akwara anụ ahụ na radicals n'efu. Na mbu, nke izu 2-4. (opekata mpe - 15, optimally - 20) ka etinyere acid α-lipoic acid ka ọ bụrụ ntinye iv drip infusion nke 600 mg / ụbọchị. Mgbe nke ahụ gasịrị, ha na-agbanye were mbadamba nwere 600 mg nke α-lipoic acid, 1 mbadamba / ụbọchị maka ọnwa 1.5-2.

Maka ọgwụgwọ nke ụdị DPN na-egbu mgbu, nyocha dị mfe, ọgwụ mgbochi mkpali (acetylsalicylic acid, paracetamol) ka etinyere na ọgwụ ndị a dị n'elu. N'ime ha, ọ bara uru ịkọwa ọgwụ Neurodiclovit, nke nwere vitamin Diclofenac na B (B1, B6, B12), nke nwere ọgwụ analgesic, anti-inflammatory and antipyretic.

Ojiji nke otu ọgwụ ọgwụ dị ka ọgwụ tricyclic antidepressants (amitriptyline 25-50 - 100 mg n'abalị), n'ihupentin (ọgwụ mbụ - 300 mg, mmụba site na 300 mg kwa ụbọchị 1-3, oke kachasị - 3600 mg), pregabalin (ọgwụ mmalite) ka egosiri. - 150 mg, mụbaa na 300 mg n'ime ụbọchị 3-7, oke kachasị - 600 mg (kewara 2-3 usoro)), duloxetine (ọgwụ mbụ - 60 mg 1 r / ụbọchị, mgbe ụfọdụ mụbaa 60 mg 2 r. / ụbọchị, oke kachasị bụ 120 mg).

A na-eji ọgwụgwọ gastrointestinal neuropathy eme ihe:

• na atony nke afọ: cisapride (5-40 mg 2-4 p. / ụbọchị 15 nkeji tupu nri), metoclopramide (5-10 mg 3-4 p / ụbọchị), domperidone (10 mg 3 p / ụbọchị),
• ya na enteropathy (afọ ọsịsa): loperamide (nke mbụ bụ 2 mg, mgbe ahụ, 2-12 mg / ụbọchị ruo ugboro stool nke 1-2 p / ụbọchị, mana ọ bụghị karịa 6 mg maka kilogram 20 niile nke ndị ọrịa na otu ụbọchị).

Maka ọgwụgwọ autonomic neuropathy nke sistem obi (izu ike tachycardia), io-blockers, cardioselective β-blockers, ndị na-egbochi calcium Channel (dịka verapamil, Diltiazem Lannacher).

Maka ọgwụgwọ nke nrụrụ erectile, a na-eji ụdị 5 phosphodiesterase inhibitors (ọ bụrụ na enweghi contraindications), nchịkwa intracavernous nke alprostadil, prosthetics, ndụmọdụ gbasara mmụọ.

Maka mgbochi n'ozuzu nke hypovitaminosis na nsogbu, ndị ọrịa na-arịa ọrịa shuga ka a na-akwado usoro multivitamin. N'okwu a, nchịkwa nke vitamin B na usoro ọgwụgwọ ọgwụgwọ (Neuromultivitis) dịkwa irè.

1. Greene D.A., Feldman E.L., Stevens M.J. et al. Ọrịa mamịrị na-arịa ọrịa mamịrị. Na: Diabetes Mellitus, Porte D., Sherwin R., Rifkin H. (Eds). Appleton & Lange, East Norwalk, CT, 1995.
2. Dyck P.J., Litchy W.J., Lehman K.A. et al. Ihe dị iche iche na - emetụta mmetụta njedebe nke neuropathic: Ọmụmụ ihe omumu nke Rochester Diabetic Neuropathy nke Isi Okwu // Neurology. 1995. Vol. 45.P. 1115.
3. Kempler R. (ed.). Neuropathies. Pathomechanizm, ngosipụta nke ụlọ ọgwụ, nyocha, ọgwụgwọ. N'oge opupu ihe ubi, 2002.
4. Kpesa na Aro nke San Antonio Conference na Diabetic Neuropathy // Ọria mamịrị. 1988. Vol. 37.P. 1000.
5. Njikọ Ọrịa shuga America. Ọgwụ omume na-atụ aro 1995. neuropathy mamịrị. Ejiri usoro Standortized na neuropathy mamịrị // Nlekọta Ọrịa shuga. 1995. Vol. 18. R. 53–82.
6. Tokmakova A.Yu., Antsiferov M.B. Ohere nke iji neuromultivitis na usoro mgbagwoju anya nke polyneuropathy na ndị ọrịa nwere ọrịa mellitus // Ọrịa shuga mellitus. 2001.Vol 2. C. 33-35.
7. Gurevich K.G. Neuromultivitis: iji na usoro ọgwụgwọ ọgbara ọhụrụ // Farmateka. 2004.Vol 87. Nke 9/10.
8. Ntuziaka maka iji ọgwụ ọgwụ Neuromultivit. Na nkọwa zuru ezu banyere ọgwụ. Medi.Ru. 2014.

Naanị maka ndị ọrụ edebanyere aha

Ihe mgbaàmà nke neuropathy mamịrị

• Ọrịa sitere na nsọtụ (ogwe aka, ụkwụ):
  • mmetụta na-achọsi ike
  • ọnya aka
  • itu ukwu nke aka
  • ike adighi ike
  • ọrịa mgbu na - enweghị nsogbu - mgbu mgbu abalị n'ụkwụ ya na enweghị nchekwube: ọbụna imetụ blanket ahụ na - eme ka ndị ọrịa nwee ihe mgbu,
  • ibelata mgbu, ọnụọgụ ọkụ, ịdị na-adọrọ uche na nsọtụ (ikike ịmata ọdịiche dị n’etiti oyi na okpomoku, mmetụ, ihe mgbu belata),
  • mbelata ihe na-eme ka akaị na -akasị (ime ka iwe wee iwe (dịka ọmụmaatụ, ịkụ aka akwara na mpaghara akwara ozi)),
  • imebi nhazi nke mmeghari na nguzosi ike (ukwu aburu “cottony”),
  • microtrauma nke aka na aka na - eduga n'ịrụ ọrụ,
  • ọzịza nke ụkwụ.
• Mgbaàmà nke akụkụ nke ime:
  • obi palp,
  • mbelata ọbara mgbali elu (ọbara) mgbe ị na –ebugharị na vetikal gaa vetikal (dịka ọmụmaatụ, ibili ọtọ akwa),
  • ike kwere omume
  • n'ihi nsogbu nke akwara ozi na ọrịa shuga mellitus, a na-ahụkarị ụdị infarction na-egbu mgbu (ọnwụ nke akụkụ akwara obi).
  • ọgbụgbọ
  • mgbu afọ,
  • nri ilo nri,
  • afọ ọsịsa (afọ ọsịsa) ma ọ bụ afọ ntachi,
  • imebi nke ọsụsọ: ọsụsọ, ,ụbiga mmanya ókè n'oge nri,
  • enweghị agụụ ịga urin,
  • mmebi emebi emebi,
  • n’ebe ndị ọrịa nọ, ikike inwe mmetụta hypoglycemia na-ebelata (obere glucose dị n’ime ahụ, nke na-egosipụta onwe ya n’onwe ya dịka mmetụta agụụ, ụjọ, mkpali ndị ọrịa, ịsụsọ nke ukwuu).

• Ihe mmetụta - mmerụ ahụ irighiri akwara ndị a rụpụtara maka inwe uche (tactile, mgbu, okpomọkụ, amaja). Ndị ọrịa nwere ikike dị ntakịrị iji mata ọdịiche dị n’etiti oyi na okpomoku, mmetụ aka, ihe mgbu, na mmetụta ịma jijiji.
• Ọgbọ - mbibi akwara ndị dị na mmegharị. Achọpụtara ike ọgwụgwụ, mbelata ihe na - emegharị ahụ (nzaghachi ihe iwe).
• Standalone (ahịhịa) - mmebi nke irighiri akwara ndị dị maka ọrụ nke anụ ahụ.
  • Ọkpụkpụ obi - metụtara mbibi akwara ndị na-edozi sistem:
    • obi palp,
    • mbelata ọbara mgbali elu (ọbara) mgbe ị na –ebugharị na vetikal gaa vetikal (dịka ọmụmaatụ, ibili ọtọ akwa),
    • ike kwere omume
    • n'ihi nsogbu nke akwara ozi na ọrịa shuga mellitus, a na-ahụkarị ụdị mgbu na-adịghị ala ala (ọnwụ nke akụkụ akwara obi).
  • Gtọ eriri afọ - metụtara mbibi akwara ndị na-edozi eriri afọ:
    • ọgbụgbọ
    • mgbu afọ,
    • nri ilo nri,
    • afọ ọsịsa (afọ ọsịsa) ma ọ bụ afọ ntachi.
  • Udị urogenital - metụtara mmebi nke irighiri akwara ndị na-edozi sistem:
    • enweghị agụụ ịga urin,
    • n'ime ụmụ nwoke na ụmụ nwoke - imebi mkpọmkpọ ebe.
  • Ikike arụ ọrụ iji mata hypoglycemia (glucose dị ala n’ahụ). Nọmalị gosipụtara site na mmetụta nke agụụ, egwu, mkparị ndidi, ịsụsọ. Ndị ọrịa nwere neuropathy mamịrị anaghị enwe mgbaàmà ndị a.

Dọkịta endocrinologist ga - enyere aka n'ịgwọ ọrịa ahụ

Diagnostics

• Nchoputa nke mkpesa oria:
  • mmetụta na-achọsi ike
  • ọnya aka
  • itu ukwu nke aka
  • ike adighi ike
  • ọrịa mgbu na - enweghị nsogbu - mgbu mgbu abalị n'ụkwụ ya na enweghị nchekwube: ọbụna imetụ blanket ahụ na - eme ka ndị ọrịa nwee ihe mgbu,
  • imebi nhazi nke mmeghari na nguzosi ike (ukwu aburu “cottony”),
  • microtrauma nke aka na aka na - eduga n'ịrụ ọrụ,
  • ọzịza nke ụkwụ
  • obi palp,
  • mbelata ọbara mgbali elu (ọbara) mgbe ị na –ebugharị na vetikal gaa vetikal (dịka ọmụmaatụ, ibili ọtọ akwa),
  • ịkụda mmụọ
  • mgbu afọ,
  • nri ilo nri,
  • afọ ọsịsa (afọ ọsịsa) ma ọ bụ afọ ntachi,
  • imebi nke ọsụsọ: ọsụsọ, ,ụbiga mmanya ókè n'oge nri,
  • enweghi agu urin.
• Nyocha gbasara akụkọ gbasara ahụike (akụkọ mmepe) nke ọrịa: ajụjụ gbasara etu ọrịa bidoro ma mekwaa, afọ ole ka ọrịa shuga bidoro.
• Nnyocha zuru ezu (ntụle ọbara mgbali, nyocha nke anụ ahụ, iji ntị na -ege ntị na obi na mkpịsị ahụ, palpation nke afọ).
• Nkọwapụta mmetụta:
  • site n'enyemaka nke ndụdụ, nke na-emetụ aka na ụkwụ,
  • mgbu - site na iji mkpa agịga na-egbu egbu,
  • okpomoku - ihe na - agbanwe agbanwe nke oyi na ihe na - ekpo ọkụ na anụ ahụ,
  • tactile - site na imetụ anụ ahụ aka.
• Ọmụmụ ihe gbasara akwara na-atụgharị uche (nzaghachi maka iwe ahụ) - ekpebiri ya site na ịmịgharịa hamaị na akwara.
• Electroneuromyography bụ usoro nyocha dabere na ndekọ ndekọ ike site na irighiri akwara na akwara. Na-enye gị ohere ịchọpụta ọrịa nke usoro ụjọ ahụ n’oge mmalite.
• Maka nyocha nke mmebi nke akwara obi:
  • ubochi obara obara,
  • ECG (electrocardiography),
  • Nyochaa Holter ECG (n'ehihie).
• Maka nyocha nke mmebi ahụ eriri afọ:
  • Ultrasound nke afọ
  • eriri afọ,
  • FGDS (fibrogastroduodenoscopy) bụ usoro nyocha nke na-enye gị ohere inyocha eriri afọ site n'ime site na iji ngwaọrụ pụrụ iche (endoscope) etinyere na eriri afọ.
• Ultrasound nke eriri afo - ya na mbibi urogenital sphere.
• Njikwa ike nke ogo glucose ọbara (ịkwa ọkwa glucose ụbọchị n’ụbọchị).
• Inwe mkparịta ụka banyere akwara ozi na-ekwekwa omume.

Ọrịa mamịrị Ọrịa Neuropathy

• Ofgwọ ọrịa shuga mellitus (ọrịa gosipụtara n'ọtụtụ glucose n'ọbara).
• Nri nwere mmachi nnu, protein, carbohydrates.
• Ọgwụ Neurotropic (na-eme ka nri ahụike nke sistemụ ahụ ike) dịkwuo mma.
• Vitamin nke otu B.
• Usoro ọgwụgwọ Symptomatic (ọgwụ iji mee ka nrụgide akwara (ọbara) dịkwuo elu mgbe ọ na-agbada, ọgwụ mgbu maka ihe mgbu na ogwe aka).

Nsogbu na nsonaazụ ya

• Lessdị enweghi mgbu nke myocardial infarction (ọnwụ nke akụkụ akwara obi) - n'ihi mmerụ akwara, ndị ọrịa anaghị enwe ihe mgbu, adịghị ahụkarị myocardial infarction ogologo oge.
• Ọria nwanyị nke dị nsọ (ọdịdị nke anụ arụ na - adịghị agwọ ọrịa ogologo oge).
• Ọrịa mamịrị - mmerụ ahụ dị akwara, arịa ọbara, anụ ahụ dị nro na ngwa ọkpụkpụ nke ụkwụ ahụ, na-eduga na ọnwụ anụ ahụ, usoro purulent-putrefactive na-achọ mgbatị nke aka.

Ọrịa Neuropathy Ọrịa mamịrị

• Ọgwụ zuru oke na oge ọgwụgwọ maka ọrịa shuga mellitus (ọrịa gosipụtara n'ọtụtụ glucose n'ọbara).
• Ndị ọrịa na-arịa ọrịa shuga chọrọ nleba anya kwa afọ maka ọnọdụ nke sistem ụjọ:
  • jiri ụda olu na - emegharị anya, nke na - emetụ aka na ụkwụ,
  • ihe mgbu mgbu - site na iji agịga na - egbu egbu,
  • Mmetụta ọnọdụ ọkụ - mmetụ nke ihe oyi na ihe na - ekpo ọkụ na anụ ahụ,
  • uche akpachapụ anya - site na imetụ anụ ahụ aka,
  • Ọmụmụ ihe na - eme ka akwara ike ahụ (na - emeghachi iwe iwe) - a na - ekpebisi ike site na ịmegharị otu akwara ozi na akwara,
  • electroneuromyography bụ usoro nyocha dabere na ndekọ ndekọ ike site na irighiri akwara na akwara. Na-enye gị ohere ịchọpụta ọrịa nke usoro ụjọ ahụ n’oge mmalite.

AKR RERF EGO

Isoro dọkịta na-achọ

Endocrinology - Dedov I.I., Melnichenko G. A, Fadeev V.F., - GEOTAR - Media, 2007
Algorithms maka nlekọta ahụike pụrụ iche maka ndị ọrịa nwere ọrịa mellitus, 2012

Mmepe nke neuropathy mamịrị

Iji ghọta atụmatụ nke ọrịa mamịrị, nke ọ bụ, ihe kpatara ya na njiri mara ya, ọ dị mkpa ịghọta usoro mmepe nke ọrịa ahụ. Ọrịa ụbụrụ na - eme n ’usoro mmalite nke ọrịa shuga mellitus, nke na - akpata nsogbu nke metabolic na mmebi na obere arịa ọbara, nke na - emetụta steeti mkpụrụ ndụ akwara na ụbụrụ. Ọkpụkpụ ụbụrụ na-aza ma nke a na-eduga n'ọkpụkpụ mmetụta uche. Nke ahụ bụ, ụbụrụ na-efunahụ ikike nke ibugharị akara ya na akụkụ akụkụ ụfọdụ nke ahụ.

N'ihi nsogbu metabolism na mgbasa ọbara, usoro oxidative na-abawanye, na-eduga ọnwụ nke anụ ahụ na-enweta ihe na-ezighi ezi.

A na-enwe ọrịa mamịrị na-arịa ọrịa shuga n'oge mbido mmepe site na mmebi nke akwara ndị dị na ntinye nke mkpali gaa na elu na nke ala.

N'ihi nke a, a na-ebelata ezi uche nke ụkwụ na nkwụ, anụ na-emerụkwa ahụ mfe, n’ihi nke ọnya na-enwekarị.

Na neuropathy nke aka na-arịa ọrịa shuga, na nkezi, 78% ndị ọrịa na-azụlite trophic, ọnya na-agwọ ogologo oge. Ọrịa ahụ na-etolite na 60-90% nke ọrịa shuga n'ime afọ 5-15 mbụ. Ọzọkwa, neuropathy na-apụta na ndị mmadụ nwere ụdị ọrịa metụtara nsogbu ahụ.

Ofdị ọrịa ahụ

Site na akwara neuropilaị nke akụkụ ala, foto onyonyo a dịgasị iche iche. A kọwara nke a site n'eziokwu ahụ bụ na mbelata ọbara shuga na-akpalite mbibi akwara dị iche iche. Dabere na njirimara a, a na-ewu nhazi nke ọrịa.

Ndi iche ụdị oria a ka amara:

• etiti
• sensorimotor,
• kwurula (ahịhịa),
• proximal
• lekọtara.

N'iburu udiri akuko nke udiri akwara, nsogbu ndi ozo na aru oru a na-eme. Ọrịa a kpalitere mmebi nke ịta ahụhụ, nsụhọ mmụọ, ọnya mkpụrụ ndụ nke urinary na eriri afọ.

Ihe akwara Sensomotor neuropathy bụ mbelata uche na aka na njikọta mmeghari. N’ime ndị ọrịa nwere nsogbu a, a na-ama ọkwa dị mkpirikpi. N'ụzọ bụ isi, pathology na-emetụta otu aka, na ike nke izugbe symptomatology na-abawanye na mgbede. N'oge ọrịa a, ụkwụ na-apụ n'anya kpamkpam (onye ọrịa ahụ akwụsị inwe obi mgbu). N'ihi nrụrụ aka adịghị ike, ọnya na-apụta.

Sensory neuropathy, na ọdịiche na sensorimotor neuropathy, na-akpalite naanị mbelata uche. Nchikota ka bu otu ihe. N'ihe banyere neuropathy moto, yabụ, arụmọrụ moto adịghị mma. Onye nwere nsogbu a na - enwe nsogbu na mmegharị, ikwu okwu, iri nri.

Autdị ọrịa ahụ kwụ ọtọ na-apụta na mbibi nke akwara nke sistemu akwara. N'ihi nke a, arụ ọrụ nke otu akụkụ na-akụghasị.

Nke kachasị, site na mmeri nke sistemụ autonomic, ikuku oxygen na-abanye n'ime ahụ na-ebelata, njigide nri na-akawanye njọ, ọnya afọ na akwara na-apụta. Formdị ọrịa a na-akpalite ihe dị iche iche dị egwu na-adakarị.

Prodị ụdị ọrịa nje proximal dị. Onye ọrịa nwere ụdị a na-enye nsogbu site na mgbu na nkwonkwo ụkwụ. Ka usoro a na - aga n'ihu, akụrụngwa akwara akwara na-akawanye njọ, nke na-eduga n'ọkpụkpụ akwara. N'okwu ndị dị elu, onye ọrịa na-efunahụ ikike ịkwaga.

Site n'ụdị nlezianya, a na-emetụta eriri akwara ndị mmadụ n'otu n'otu. Ejiri ụdị ọrịa a na mberede. Dabere n'otu esi etinye eriri akwara ozi yana ọrụ ndị ha na-eme, onye ọrịa nwere mmetụta na-egbu mgbu na ahịrị akụkụ nke ahụ (ọkachasị na ọkara ihu). Ofzọ nke folọtọ siri ike ịkọ.

Ihe kpatara neuropathy na ọrịa shuga

Isi ihe kpatara mmepe nke neuropathy mamịrị bụ mgbanwe na mkpokọta glucose (sugar) n'ọbara. Ọnọdụ a anaghị abụkarị n'ihi nrube isi na iwu nke ọgwụgwọ ọrịa na-akpata ọrịa. Ihe ndi a nwere ike ịkpasu neuropathy:

• mgbanwe ndị sitere na anụ ahụ na-eme mgbe mmadụ toro,
• ibu oke ibu
• mmụba dị elu ma na-adịgide adịgide
• mmụba dị elu nke shuga,
• hyperlipidemia (mmerụ nke lipid),
• ise siga
• mmebi nke akwara ozi,
• ọrịa sitere na ya ketara eketa na ọrịa ụfọdụ.

Ndị otu nọ n'ihe ize ndụ maka mmepe nke ọrịa gụnyere ndị mmadụ butere ọrịa shuga ogologo oge. Ka ị na-emekwu okenye, ihe mgbaàmà ọ na-akawanye njọ ma na-esikwu ike ịchịkwa ọkwa shuga.

A na-ewere neuropathy na-arịa onwe ya dị ka ihe kasị dị ize ndụ. Ofdị usoro ọgwụgwọ a nwere ike ibute ọnwụ onye ọrịa n'ihi njide obi.

Ihe mgbaàmà ndị a na-ahụkarị nke neuropathy mamịrị

Ejiri ụdị ọrịa neuropathy na-arịa ọrịa shuga n'ọtụtụ mgbaàmà. Centraldị oria ahụ na - egosipụta onwe ya ngwa ngwa, ebe ọ bụ na ụbụrụ na - ama jijiji.

A na-ahụ mmalite nke ihe mgbaàmà nke ọrịa mamịrị na-arịa ọrịa shuga n'ihe metụtara mbibi mpaghara mpaghara, ọtụtụ ọnwa ka amalitela usoro ahụ. A kọwapụtara eziokwu a site na eziokwu na mbụ usoro ahụ akwara na-arụ ọrụ dịka ndị mebiri emebi.

N'ọnọdụ ebe enwere ụdị ọrịre nke ọrịa mamịrị na-arịa ọrịa shuga, ihe mgbaàmà ndị a na-esote na-esote usoro ịtụle:

1. Hyperesthesia (hyperensitivity na -akasị iwe dị iche iche). Ejiri ọnọdụ a mgbe ọ bụla nke “ọgazị bumps”, mmetụ ọkụ na-anyụ anyụ, na oke obi (dagger).
2. Mmeghachi omume na-adịghị mma maka ndị na-akpasu iwe. Mmadu na-enwe oke ihe mgbu na-emetụ ya aka. Na mgbakwunye, ọtụtụ mgbe na nzaghachi nke mkpali, n'otu oge ahụ enwere ọtụtụ sensations (uto n'ọnụ, mmetụta nke isi, tinnitus).
3. Mbelata ma ọ bụ izu oke nke inwe uche. A na-ahụta afọ ole ndị bu ọrịa shuga bụ nsogbu kachasị emetụta ọrịa a.

Site n'ụdị ọrịa nke ọrịa ahụ, a hụrụ ihe ndị na-esonụ:

• uru a na-ejighị n'aka
• nhazi nke mmeghari,
• ọzịza nke nkwonkwo, n'ihi nke a na-ebelata agagharị,
• ike ahu, gosiputara n’ụdị mbelata ike na ụkwụ na aka.

A na-eji ọrịa kansa akwara na-arịa ọrịa kansa akwara na-egosi ụdị mgbaàmà a na-ahụkarị:

1. Ọkpụkpụ nri. Site na mpụ dị otú ahụ, ọ na-esiri onye ọrịa ike ilo mmiri, ị na-agbọ agbọ ugboro ugboro n'ihi afọ nke afọ, afọ ntachi ma ọ bụ nnukwu afọ ọsịsa, ikechi na obi mgbu.
2. Ọkpụkpụ akụkụ ahụ aka pelvic. Enweghị ike na - ebilite n'ihi microcirculation ọbara ezughi ezu, ma imebi akwara ozi na - eme ka mbelata ụda olu nke eriri. Nke ikpeazụ na-eduga ná mbelata urination ma na-akwalite mgbakwunye nke microflora nje.
3. Ọkpụkpụ akwara obi. Ọnọdụ a jikọtara ya na tachycardia ma ọ bụ arrhythmia. Mgbe ị na-emegharị ahụ site na usoro kwụ ọtọ na vetikal n'ihi nsị obi, ọbara mgbali na-ada nke ọma. Ọzọkwa, imebi iwu a na-ebute mbelata obi. N'agbanyeghị nkụchi obi, onye ọrịa anaghị enwe ihe mgbu.

Na nmalite mmalite nke mmepe nke akwara obi, ọsụsọ nwere ike ịba ụba. Ihe nrịba ama a na-ekwupụta n’elu anụ ahụ n’abalị. Ka usoro ahụ na - eto, a na - eme nnukwu mmachi nke anọkpụsị, n'ihi ihe ndị ọsụsọ na - ebelata. Nke a na - eme ka akpọnwụ akpọnwụọ. Nke ọzọ, ntụpọ afọ na-apụta n'ihu na akụkụ ndị ọzọ nke ahụ. Na ikpe ndị siri ike, vasospasm na-akpata mmerụ anụ ahụ ugboro ugboro.

Ọzọkwa, site n'ụdị ọrịa a na-akpaghị aka, ọ ga-ekwe omume imebi akwara optic, n'ihi ọhụụ na-akawanye njọ.

Ihe mgbaàmà ndị a na-enyere aka ikpebi otu esi agwọ ọrịa neuropathy mamịrị. Ihe ịrịba ama ndị a na-egosi nsonaazụ nke usoro pathological.

Nkwadebe maka ọgwụgwọ neuropathy mamịrị

Na-arịa neuropathy mamịrị, ọgwụgwọ ahụ dị mgbagwoju anya, nke dọkịta doziri ya dabere na-akpata, mgbaàmà, akụkọ ahụike yana metụtara nchịkwa ọgwụ nke otu dị iche iche.

Ntọala nke usoro ọgwụgwọ bụ ọgwụ ndị na-eme ka ọkwa glucose ọbara dị ala.

• ọgwụ na-eme ka njikọ insulin dịkwuo elu (Nateglinide, Repaglinide, Glimepiride, Gliclazide),
• ọgwụ na - eme ka mkpụrụ ndụ dịkwuo elu na insulin (Ciglitazone, Englitazone, Fenformin),
• ndị nnọchi anya na -ebelata ogo mgbali afọ (Miglitol, Acarbose).

Echichara ihe mgbu na iweghachite ụzọ akwara akwara, a na-enye ihe ndị a:

1. Nkwadebe nke Alfa-lipoic acid (Thiogamma, Tieolepta). Ọgwụ na -ebelata mkpụkọ gluu n'ọbara ma mezie metabolism.
2. Neurotropes (vitamin B). Kpochapụ usoro mkpali na-emetụta akwara anụ ahụ.
3. Ọgwụ antisteroidal anti-inflammatory ọgwụ (Nimesulide, Indomethacin). Kwụsị ihe mgbu site na ịkwụsịlata mbufụt.
4. Tricyclic antidepressants (Amitriptyline). Na-ebelata ọsọ nke ihe mkpali sitere na nnyefe ihe mgbu.
5. Anticonvulsants ("Pregabalin", "Gabapentin"). Na-egbochi mwepu mgbu ahụ.
6. Opioids Sịntetik (Zaldiar, Oxycodone). Ha na-enwe mmetụta na igwe na-anabata ya ma na-anabata ndị na-egbu mgbu.
7. Ọgwụ antiarrhythmic ("Mexicoiletin"). A na-eji ha maka imebi akwara obi.
8. Anesthetics (akwa, piels, mmanụ). Wepụ ihe mgbu n'ụkwụ.

Site n'enyemaka nke nri nwere obere carb, a na-eme ọgwụgwọ nke ọrịa obi na-arịa ọrịa shuga, nke a na-emeju site na ị theụ ọgwụ lipoic acid na B na nnukwu usoro.

Ọgwụ ọgwụgwọ na ọgwụ ndiife

Ọrịa neuropathy na-arịa ọrịa shuga kwụsịrị nke ọma site na enyemaka nke ọgwụ ọdịnala. Ekwesiri iji ọgwụ a kọwara n'okpuru ebe a na dọkịta. Na ọgwụgwọ nke ọrịa mamịrị neuropathy na-eji:

1. Clayrọ na-acha odo odo. A na-eji ya dịka mkpakọ. Iji kwadebe ọgwụ ahụ, ịkwesịrị ịgbanye ụrọ nke 100 g ka ọ bụrụ ala. A na-etinyere ngwaọrụ ahụ na mpaghara nsogbu ahụ wee dị ruo mgbe etinyere kpamkpam.
2. Mmanụ camphor. A na-eji ịhịa ya aka n'akụkụ ebe emetụtara. A na-eme usoro ahụ n'ime nkeji iri na ise.
3. Ntutu nke ifuru calendula. Ọ ga-ewe 2 tbsp. ihe eji eme ihe na 400 ml nke mmiri esi. A na-enye ngwá ọrụ ahụ awa abụọ, mgbe nke ahụ gasịrị, a na-ewere ya n'ehihie na 100 ml. A ga-emebi infusion ruo ọnwa abụọ.
4. Mkpụrụ lemon.Ọ ga-ebu ụzọ ghakpaa ya nke ọma, ma tinye ya n'ụkwụ ma kechie ya. Ekwesịrị ịme usoro ahụ tupu alakpu ụra ruo izu abụọ.

Broth Eleutherococcus. Ọ ga-ewe 1 tbsp. mgbọrọgwụ akọrọ na 300 ml nke esi mmiri. Agwakọta ihe ndị ahụ ma kpochapu ya n'ime mmiri mmiri 15 nkeji. Mgbe ahụ 1 tsp agbakwunye na ihe mepụtara. mmanụ a honeyụ na 2 tbsp ihe ọ juiceụ lemonụ lemon. A na-atụ aro ịrinụ mmanya ogologo ụbọchị.

Agaghị agwọ ọrịa ọwụwa akwara na-arịa ọrịa shuga naanị site na enyemaka nke ọgwụ ọdịnala. Ọgwụ ndị a dị n'elu na-ebelata ọnọdụ onye ọrịa ma melite arụ ọrụ nke eriri akwara.

Amụma na Mgbochi Ya

Ọrịa mamịrị na-arịa ụkwara ume ọkụ nke mpaghara ala ala na-arịa ọrịa shuga na-enye ọtụtụ nsogbu. A na-ekpebi prognosis maka ọrịa a dabere na nleghara anya nke ikpe ahụ na ịkọwapụta usoro nje. Na-enweghị ọgwụgwọ zuru oke, ịda mba na mpụta ụfụ na-enweghị mgbu, nrụrụ ụkwụ, na ụjọ nke mbepụ.

Mgbochi nke ọrịa mamịrị na-arịa ọrịa shuga na-eme ka a na-agbaso nri pụrụ iche edepụtara maka ọrịa shuga, nyochaa shuga ọbara na ọbara mgbali mgbe niile, na ịjụ omume ọjọọ.

Site n'ọrịa dị otú ahụ, ọ dị mkpa ịgakwuru dọkịta n'oge ọ bụla ma ọ bụrụ na e nwere ihe ịrịba ama nke njọ na ọnọdụ izugbe.