Tsarin ciwon sukari (lambar ICD-10 - H36 ko E10-E14 p .3) cuta ce mai saurin kamuwa da cutar sankara, wanda ke haifar da raguwa sosai ko kuma asarar hangen nesa a tsakanin marasa lafiya na shekarun aiki. Yiwuwar samun irin wannan yanayin ya dogara da nau'in cutar, cututtukan jiyya da biyan diyya.
Abubuwan haɗari
Ci gaban Pathology na nazarin mai gani an inganta shi ta:
- Tsawon lokacin da cutar ta fara. Rashin ƙwaƙwalwar ciwon sukari da wuya ya faru a cikin shekaru 6-7 na farko, daidai da lokacin balaga, duk da haka, an gano shi a cikin 5% na lokuta a cikin marasa lafiya waɗanda ba su da insulin-da ke fama da ciwon sukari a lokacin tuntuɓar kwararru.
- Rashin kulawar da ta dace a kan sukari na jini yana haifar da bayyanar ƙin farko.
- Lokacin haihuwar yaro. Musamman mahimmancin shine haɓakar marigayi gestosis (preeclampsia).
- Hawan jini. Wannan yanayin yana tsokani cigaban ciwon sukari.
- Matsalolin da kodan (nephropathy). Masana kimiyya sun tabbatar da cewa lura da cututtukan cututtukan koda da hade tare da photocoagulation na iya inganta yanayin haƙuri.
- Yawan kiba.
- Mummunan halaye.
Kayan aikin ci gaba
Ciwon sukari mellitus cuta ce wanda kowane nau'in metabolism ke rikitar da shi. Da farko dai, jiragen ruwa manya da kanana suna fama da hakan.
Babban glycemia shine ke haifar da ci gaban ilimin halittu na masu binciken gani
A pathogenesis na ciwon sukari retinopathy dogara ne akan canje-canje na rayuwa a kowane matakan, kazalika da karuwa a cikin coagulation na jini, hypoxia da sunadaran glycated. Alkaluman glucose masu mahimmanci suna haifar da rashin daidaituwa, a bango wanda canje-canje ke faruwa a cikin jiki, halayyar rashi oxygen din kyallen takarda da sel. A farkon matakan, ana kunna hanyoyin biyan diyya, amma tare da ci gaba da ciwon sukari, raguwa a cikin bututun jiragen ruwa yana bayyana saboda girman sautin ganuwar su.
Samuwar sunadaran glycosylated (kwayoyin glucose hade da sunadarin sunadarin sunadarai) yana tare da kwantar da abubuwan karshen, manyan lambobi wadanda suke tsokanar hargitsi a cikin sunadarai, da kuma membranes na sel. A kan asalin waɗannan canje-canjen, samuwar ƙwayoyin furotin na ƙasashen waje na faruwa, wanda jiki ke ƙoƙarin lalata, yana farawa da halayen "haɗin gwiwa". Sakamakon shine lalacewar ganuwar capillaries, babban ƙarfin su.
Ilimin halittar metabolism na mai mai haifar da babban aiki na tasirin cholesterol, triglycerides da sauran abubuwa makamantan wannan wadanda zasu iya rufe bakin jijiyar jiragen ruwa. Wannan yana haifar da sabon yanayin rashin abinci mai gina jiki da ƙwanƙwasa jini.
Hypoxia na ciki ya bayyana ne ta hanyar samuwar sabbin hanyoyin cututtukan jijiyoyin jini (neovascularization) da kuma bayyanar shuntar arteriovenous (workarounds for blood).
Rarrabawa
Akwai mahimman adadin litattafan retinopathy a cikin ciwon sukari. Wannan yana da alaƙa da yawancin bayyanar cututtuka. Daya daga cikin yadu amfani:
- matakin rashin cigaba;
- matakin farko;
- matakan fadadawa.
Mahimmanci! Irin wannan rabuwa da rikice-rikice zai bayyana a fili lokacin da ake buƙatar laser.
Canje-canje a cikin choroid - babban alamun bayyanar cututtukan fata tare da ciwon sukari
Rarrabawa na gaba:
- retinopathy na nau'in mai sauƙi (baya);
- maculopathy;
- maganin rashin lafiyan cuta;
- yaduwar cututtukan fata.
Matattarar rashin cigaba
Tsarin retina na mai duban gani tuni yana da microaneurysms, ƙananan bashin da ke kama da ɗigon duhu kuma ana iya ganin su lokacin nazarin harajin. Zazzabin cizon sauro, a matsayinka na mai mulki, yakan faru ne a tsakiyar choroid na idanun biyu ko a cikin tsarin jijiyoyin ciki. A lokaci guda, abubuwan da ke tattare da fashewar abubuwa sun bayyana (an sanya shi a tsakiya, mai kama da farar fata ko rawaya masu launin shuɗi waɗanda ba su da iyakoki bayyananne) da kumburi.
Mataki na rigakafi
Abubuwan da ke haifar da ɓacin rai na tsarin halitta daban ne. Jijiyoyin sun zama hade, kama da tsari zuwa ga rosary, madaukai sun bayyana, kifin jirgi ya canza. A vascular membrane an rufe shi da yawa yawan exudative formations. Hemorrhages zama mafi yawa.
Matsalar fadadawa
A wannan matakin, samunwar neovascularization yana faruwa (cututtukan cututtukan jijiyoyin jini a inda bai kamata su kasance ba). Da farko, sun bayyana a tsakanin ƙwayar choroid da membrane na vitreous, sannan kuma su girma cikin vitreous kanta.
Neovascularization yana daya daga cikin alamun bayyanar cututtukan fata.
Idan neovascularization yana shafar iris, haɗarin glaucoma na biyu yana ƙaruwa sau da yawa. Bugu da kari, an maye gurbin basur da zazzabi mai zazzabi, wanda zai tsokani bayyanar rashin aikin retinal.
Cutar cutar sankara
Maganin retinopathy na farko na iya zama asymptomatic ko bayyana kamar haka:
- rage ƙarancin gani;
- mayafi ko iyo lemo mai duhu a gaban idanun - alamun zubar jini;
- rashin iya ganin kananan abubuwa;
- farin yankuna masu iyo - alama ce ta edema;
- rashin jin daɗi a cikin yankin ido.
Rage raguwa ko asarar hangen nesa sune alamu na ƙarshen cututtukan cututtukan masu ciwon sukari. Haɓakarsu yana nuna rashin sauya tsarin aikin. A cewar kididdigar, cikakken makanta yana faruwa a cikin 2% na masu ciwon sukari.
Bambanci tsakanin hangen nesa na mutum mai lafiya da mai ciwon sukari tare da ilimin cututtukan mahaifa na gani
Onari akan bayyanannun
Microaneurysms diaries ne na ganuwar ƙananan jirgin ruwa. Kasancewar su shine iyakar waɗancan yankuna waɗanda basu da wadataccen jini. Vasodilation a cikin farkon farkon alama alama ce ta haɗuwa da hanyoyin ramuwa.
Idan microaneurysms suna tare ba tare da wasu alamun bayyananiyar binciken na nazari ba, ba sa ɗaukar hatsari, amma a nuna kawai farkon ci gaban rikice-rikice. Koyaya, idan cutar ta ci gaba, yayin da ake ci gaba da karuwa. Sakamakon akai-akai na microaneurysms a cikin sashin tsakiya na retina shine bayyanar pu puffiness.
Ciwon ciki
Zasu iya bayyana a cikin yadudduka daban-daban na choroid, suna da nau'i daban. Idan ana shafar yadudduka masu zurfi, bashin dige ne ko digo na oval ko siffar zagaye. Lokacin da mafi yawan yankuna keɓaɓɓu, suna kama layin laushi.
"M" exudate
Yana tara tarin lipids da kayayyakin lalacewarsu. Suna da launin rawaya mai haske da kuma bayyananniyar siffar. Exudates na "M" suna cikin bangarorin fadada abubuwa da kuma iyakar puffiness. Irin wannan adibas a cikin tsakiyar tsakiyar choroid yana haifar da raguwa mai yawa a cikin gani na gani.
Kwalliya mai laushi
Su ƙananan yankuna ischemia (necrosis) na ƙwayoyin jijiya waɗanda ke tashi saboda ruɗar ƙwaƙwalwar ƙwaƙwalwa. '' Taushi '' exudates suna kama da fararen bangarorin da ba su da tsayayyun sarari.
Ciwon mara maculopathy
Ofaya daga cikin bayyanar cututtuka na angioretinopathy, wanda ke dauke da raunuka na macula.
Cutar sankarar maculopathy na faruwa ne saboda karuwar ƙwayoyin motsi da ƙwaƙwalwar ƙwayoyin cuta da farkon farawar su. Bayanai na yanzu suna nanata rashin daidaiton al'adun maza da yawa, amma yawancin marubutan sun gwammace su rarrabe shi zuwa edematous da ischemic, wanda ya danganta da bayyanar bayyanar cikin gida.
Edematous maculopathy na iya zama:
Jiyya na polyneuropathy a cikin ciwon sukari- na gida (iyakantacce) - jarrabawa yana nuna kasancewar yanki daya ko fiye na aiwatarwa a tsakiyar frinin;
- yaxuwa - muhimmin edema ya bayyana, wanda ba shi da iyakoki bayyananne, a hade tare da samuwar ƙananan cysts.
Ischemic maculopathy yana da mummunan sakamako dangane da aikin mai nazarin gani da ƙwarewar gani. Yana da matukar wuya a rarrabe yayin nazarin harajin. Optometrists, a matsayin mai mulkin, yi tunani game da haɓaka wannan nau'in cutar tare da rashin daidaituwa tsakanin ƙarancin gani na gani da ƙananan canje-canje na gani. Don bincike, ana amfani da angiography mai kyalli.
Ciwon ciki
Likitocin dabbobi suna nazarin masu ciwon sukari tare da wani sanadin:
- bayan shekaru 5 daga farawa da gano "cutar mai daɗi" tare da nau'in ciwon sukari na 1;
- lokacin da kuka fara hulɗa da endocrinologist tare da nau'in cuta 2;
- Lokaci 1 a cikin shekara guda ba tare da kasancewar maganin cutar ta ido ba;
- kowane watanni 6 tare da bayyanar cututtuka na maganin cututtukan fata marasa ƙwaƙwalwa;
- matakin karin haske - sau daya a kowane watanni 3-4;
- "proliferative retinopathy" a cikin tarihin likita - sau ɗaya kowace watanni 2-3.
Ophthalmologist - babban mataimaki a jiyya da rigakafin cutar sankara
Hanyoyin bincike da aka yi amfani da su:
- Eterayyade wuraren daidaitattun filayen baya - ana aiwatar da su ta amfani da ɗaukar hoto na stereoscopic. Hanyar tana bayyanuwa da azanci mai ƙarfi, sarrafa hoto da sauri. Bincike yana da tsada.
- Kai tsaye ophthalmoscopy - likitan ya ba da haske na haske a cikin idon mai haƙuri, wanda ya ba ka damar bincika yanayin asusun.
- Biomicroophthalmoscopy - Ana amfani da ruwan tabarau na hulɗa da juna don bincike.
- Fuskarwar iska mai ban sha'awa - wani abu ne na musamman da aka shigar dashi cikin magudanar jini, wanda zai iya bada haske yayin fuskantar haske. Yana ba ku damar tantance yanayin microcirculation, ƙaddamar da tasoshin jini, kasancewar ischemia, basur.
- Ilimin walwala na ɗalibi na gani - yana ba ku damar tantance yanayin kumburi.
- Ilimin halin dan adam - amfani da hanyar tantance da yawa da kuma karancewar abubuwan da ke tattare da cutar a cikin ido.
- EFI hadaddun yara ne wanda ya haɗa da karatu da yawa. Sun ba mu damar bayyana matakan bioelectrogenesis na yadudduka na choroid na mai nazarin gani.
Ka'idojin jiyya
Da farko dai, yana da muhimmanci a daidaita alamu na glucose na jini sannan kuma a sami biyan diyya game da cutar. Yana da kyau cewa ƙididdigar jinin azumi ya wuce 6 mmol / l, kuma matakan haemoglobin na glycated sun haɗu da 6.5%.
Hakanan, rashi hauhawar jini ana ɗauka mahimman mahimmanci. Babban maƙasudin masu ciwon sukari shine cutar hawan jini wanda ba ta wuce sama da 140/90 mm Hg. Don daidaita lambobi, ana amfani da rukunin magungunan masu zuwa:
- ACE inhibitors - Captopril, Lisinopril.
- Antagonists na Calcium - Verapamil, Tiapamil.
- Diuretics - Dichlothiazide, Furosemide.
Manuniya na BP na yau da kullun - hanyar haɗi a cikin rigakafin cututtukan fata
Gyara cholesterol
Magungunan da aka yi amfani da su don wannan dalili sun ba da damar rama ga masu ciwon sukari da kuma rage haɓakawa da ci gaban rikice-rikice. Yi amfani da kuɗi daga ƙungiyar statins (Lovastatin, Fluvastatin) da fibrates (Fenofibrate, Bezafibrat).
Inganta rheology jini da jijiyoyin jini bango
Maganin ciwon sukari yana tare da haɓaka adhesion platelet. Wannan ya bayyana bukatar yin nadin wadannan kudade:
- Acetylsalicylic acid;
- Heparin;
- Sulodexide;
- Ticlopidine;
- Pentoxifylline.
Don daidaita sautin bango na jijiyoyin bugun gini, an tsara Vitamin C, Rutozid, Pirikarbat, Etamzilat.
Antioxidants da haɓaka haɓakar metabolism
Yin amfani da bitamin E, methylethylpyridinol, Ginkgo biloba cirewa a cikin recentan kwanannan yana yaɗu. Magungunan suna da sakamako na antioxidant, suna ɗaure da cire tsattsauran ra'ayi daga jiki.
Yana nufin haɓaka tafiyar matakai na rayuwa a cikin retina (wanda aka gudanar da shi, da bakin magana da kuma na yau da kullun):
- Dihydroergocriptine;
- Inosine;
- bushe ruwan 'ya'yan itace blueberry;
- ruwan 'ya'yan itace blueberry tare da beta-carotene.
Coagulation Laser
Ana amfani da wannan hanyar ɗayan mafi inganci a cikin maganin cututtukan fata na masu ciwon sukari. Manufar sa ita ce:
- rufe wuraren ischemic;
- hanawa da samuwar sabbin jirage;
- rufewa na jijiyoyin bugun zuciya na wadancan abubuwan da suka karu a jikin bangon;
- da samuwar adhesions, da rage yiwuwar warewa.
Laser retagu coagulation - ingantacciyar hanyar dakatar da ci gaba da cutar
Coagulation ana yin sa ne ta hanyar amfani da hasken rana (argon, solid-state or diode (infrared) laser. Akwai hanyoyi da yawa na coagulation na laser, wanda ya bambanta da juna a cikin manufar aiwatar, alamomi, dabaru.
Coagulation na farji
Amfani da shi a cikin lura da ƙwayoyin cuta na ƙwayar cuta da kuma ɗaukar hoto na farfadowa na cututtuka daban-daban. Ana amfani da coagulates a duk yankin na choroid, sai dai corpus luteum, don hana ko rage bayyanar sabbin jiragen ruwa. Wannan yana ba mu damar haɓaka trophism na waɗancan wuraren na retina waɗanda har yanzu basu shafi tsarin ilimin halittu ba.
Kafin yin amfani da shi, mai haƙuri ya kamata ya saba da gaskiyar cewa ba a aiwatar da hanyar da niyyar dawo da jijiyar gani ba, amma don hana ci gaban faduwarta.
Maganin antiangiogenic
Hanyar da aka shigar da kwayoyi kai tsaye a cikin vitreous. Don hana hanawar neovascularization, ana amfani da hanawar angiogenesis. Sakamakon haka ma raguwa ne na edema a yankin corpus luteum.
Ba a amfani da hanyar azaman tsari na daban. Ana daukar magani na antiangiogenic wani bangare ne na hadaddun farji kuma ana hade shi da coagulation laser ko tiyata.
Kwakwalwa
Shigowar tiyata ya zama dole don hana ci gaban tsarin cututtukan, kamar yadda kuma don daidaita yanayin mai haƙuri idan akwai rikitarwa. Ba a yin maganin ƙwayoyin cuta a cikin waɗannan halaye masu zuwa:
- rubeosis na iris;
- sakandare neovascular glaucoma;
- optic atrophy;
- ilimin cututtukan mahaifa;
- tashoshin tashoshi masu yawa;
- lalata kwayar cutar sankarau da sauran cututtukan tsari.
A cewar likitocin kwantar da hankali, kwantar da hankali na ayyukan mai nazarin gani bayan tiyata ya faru a cikin 45% na lokuta, yayin da a cikin marasa lafiya waɗanda ba su bi shawarar likitoci ba, kawai 14%.
Magungunan magungunan gargajiya
Jiyya tare da magungunan jama'a yana ba kawai damar kula da ayyukan kayan aikin gani ba, har ma don adana sukari na jini a cikin iyakokin da aka yarda. Ingancin amfanin amfani da nettle. Fresh ganye ne crushed, samun ruwan 'ya'yan itace. Wajibi ne a sha uku bisa uku na gilashi sau uku a rana. Nettle ganye za a iya ƙara salads, darussan farko.
Nettle ruwan 'ya'yan itace - ɗakunan ajiya na abubuwa masu amfani ba kawai ga marasa lafiya ba, har ma ga mutane masu lafiya
Irin wannan sakamako yana da ruwan 'ya'yan itace na ganye na Aloe. Kafin cire ruwan warkarwa, ana sanya ganye a cikin firiji don awanni da yawa. Sannan an murƙushe su, an samo ruwan 'ya'yan itace, an dafa shi ba fiye da minti 3-4. Amfani 1 tsp. sau uku a rana, da daddare zaku iya nutsuwa a idanun (2 saukad da kowace).
Zaka iya amfani da jiko na blueberries (sha a cikin kananan rabo a ko'ina cikin yini), ruwan 'ya'yan itace na lingonberry, kayan ado na shirye-shiryen ganye.
Matakan hanyoyin kariya
Muhimmin mahimmanci shine kiyayewa da alamun da aka yarda da sukari na jini, hawan jini, nauyin jikin mutum. Wannan yana ba ku damar gujewa ko jinkirta ci gaban ba wai kawai maganin cututtukan fata ba, har ma da sauran rikice-rikice masu rikice-rikice na ciwon sukari mellitus.
Yin rigakafin kamar haka:
- bijiro da tsarin karancin carbohydrate;
- cikakken aiki na jiki;
- bincike na yau da kullun tare da likitan likitan ido;
- lokacin lura da cutar da kuma farkon matakan rikice-rikice.
Abun takaici, abu ne mai wuya a magance cuta, musamman ma a matakai na gaba, kuma zai yuwu a hana ci gaban sa, a kiyaye ayyukan gani kuma a daina ci gaba. Babban abu shine bin shawarwari da shawarwarin kwararru kuma yana da mahimmanci game da cutar da ke gudana.
