Polyneuropathy na ciwon sukari (ICD-10 code G63.2 * ko E10-E14 shafi 4) yana nufin kasancewar alamun lalacewar tsarin mai juyayi a cikin marasa lafiya tare da masu ciwon sukari na mellitus, idan an cire sauran abubuwan da ke tattare da cutar. Za'a iya gano cutar koda cikin rashin gunaguni daga mai haƙuri, lokacin da aka ƙayyade rauni a lokacin binciken.
Ba'a tabbatar da cutar ciwon sikari ta dalilin alamar guda na asibiti ba. Shawarwarin WHO na yanzu suna ba da shawara cewa bincike yakamata a ƙayyade kasancewar alamomi guda biyu na cutar don ya tabbatar da cututtukan cututtukan ƙwayar jijiyoyin cutar da asalin wani "cuta mai daɗi".
Idan tsari ya gudana a cikin ƙwayoyin jijiya na mutum, to muna magana ne game da neuropathy. Game da cututtukan rauni da yawa, polyneuropathy ke haɓaka. Marasa lafiya tare da nau'in 1 mellitus na sukari "suna" rikitarwa a cikin 15-55% na lokuta, nau'in 2 - 17-45%.
Rarrabawa
Rashin polyneuropathy yana da rikitarwa, saboda yana haɗuwa da yawancin syndromes. Wasu marubutan sun fi son rarrabuwa da cutar ta la whichakari da ɓangaren ɓangaren tsarin juyayi da ke cikin aikin: tsinkaye (jijiyoyin jijiyoyi) da kuma sassan (sassan ciyawar).
Wata rarraba da aka saba amfani dasu:
- Juyawar cututtukan cututtukan ƙwayar cuta (ta wucin gadi, yana tasowa daga tsalle-tsalle a cikin sukari na jini).
- Polyneuropathy na Symmetric: lalacewar ƙwayar jijiya mai ƙyalli (distal somatic); lalacewar fibers na bakin ciki; Nau'in mai cutar kansa.
- Polyneuropathy na focal / multifocal: nau'in cranial; nau'in matsawa; nau'in proximal; nau'in thoracoabdominal; jijiyoyin mahaifa.
Dalilai
Babban halayyar matakin sukari na halayyar masu ciwon sukari yana da ikon ya haifar da yanayin cutar ƙananan jijiyoyin ruwa, haifar da haɓakar microangiopathy, da manyan jijiyoyin jini, suna haifar da macroangiopathy. Canje-canje da ke faruwa a cikin manyan tasoshin suna kama da tsarin aikin samuwar atherosclerosis.
Angiopathy shine babbar hanyar haɗi a cikin haɓakar lalata jijiya a cikin ciwon sukari
Game da arterioles da capillaries, komai yana faruwa daban. Hyperglycemia yana aiki da sinadarin kinase-C enzyme, wanda ke taimakawa haɓaka sautin ganuwar tasoshin jijiyoyin jini, yi kauri a cikin jikinsu, da inganta haɓakar jini. A bangon ciki na arterioles da capillaries, glycogen, mucoproteins da sauran abubuwa na yanayin carbohydrate sun fara sanya su.
Sakamakon mai guba na glucose na iya zama daban. Yana haɗuwa da sunadarai, yana sa su zama glycated, wanda ke haifar da lalacewar membranes na jijiyoyin bugun gini da rushewar rayuwa, sufuri da sauran mahimman ayyukan jiki. Mafi shahararren furotin glycated shine HbA1c haemoglobin. A mafi girma a cikin fihirisa, da ƙasa da oxygen oxygen Kwayoyin jiki samu, hypoxia nama tasowa.
Polyneuropathy na ciwon sukari na faruwa ne sakamakon lalacewar mahaifa (wanda yake a cikin haɗin nama tsakanin jijiyoyin jijiyoyin a cikin jijiyar jijiya). An tabbatar da wannan ta hanyar ingantacciyar dangantakar dake tsakanin kauri daga membranes na jijiyoyin bugun jini da kuma yawan zaruruwa a cikin jijiya. Tsarin yana ɗaukar neurons da kuma hanyoyin su, wanda ke mutuwa saboda raunin ƙwayar cuta a cikin jikin masu ciwon sukari.
Abubuwanda ke haifar da tashin hankali
Abubuwan da suka biyo baya suna ba da gudummawa ga ci gaban polyneuropathy a cikin ciwon sukari mellitus:
- take hakkin kai-da-ido da sukari na jini;
- tsawon lokaci na cututtukan da ke tattare da cutar;
- hawan jini;
- babban girma;
- tsufa;
- kasancewar halaye marasa kyau (shan sigari, shan giya);
- dyslipidemia;
- kwayoyin halittar jini.
Siffofin tsarin ilimin halayyar cuta tare da raunuka da yawa na ƙwayoyin jijiya
Matsayi
Ya danganta da tsananin bayyanar, ana rarrabe matakan lalacewa masu zuwa, wanda akan ƙaddara maganin da ake buƙata na polyneuropathy:
Ciwon sukari Angiopathies- 0 - babu bayanan gani;
- 1 - asymptomatic hanya na rikitarwa;
- 1a - babu korafi daga mai haƙuri, amma canje-canje na cututtukan cuta za a iya tantance su ta amfani da gwaje-gwaje na gwaji;
- 1b - babu gunaguni, canje-canje za a iya ƙaddara ba kawai ta takamaiman gwaje-gwaje ba, har ma ta hanyar gwajin ƙwaƙwalwa;
- 2 - matakin bayyanuwar asibiti;
- 2a - alamun bayyanar cututtukan fata yana bayyana tare da gwaje gwaje masu inganci;
- 2b - mataki na 2a + rauni na raƙuman baya na ƙafa;
- 3 - polyneuropathy rikitarwa tawaya.
Kwayar cutar
Kwayar cututtukan cututtukan cututtukan cututtukan ƙwayar cuta ta kai tsaye sun dogara da mataki da nau'i na ci gabanta, da kuma maganin da ake amfani da shi.
Rashin damuwa
Bayyanar alamun halayyar ƙwayar ƙwayar cuta. Ana iya tantance su ta hanyar gwaje-gwajen gwaji kawai (tsari na gaba) ko zama gunaguni na haƙuri (nau'i na asibiti). Marasa lafiya suna fama da ciwo. Zafin na iya zama mai ƙonewa, yin burodi, harbi, jefawa. Bayyanuwarsa na iya haifar da koda wadancan dalilai waɗanda basa haifar da rashin jin daɗi a cikin mutane masu lafiya.
Marasa lafiya na iya yin gunaguni na numbness, jin kamar dai goosebumps, ƙonewa mai ƙonewa, rashin jin daɗin cutar sanyi, zafi, rawar jiki. Ragewar jiki yana ci gaba, kuma masu ilimin na iya zama babu su.
A matsayinka na mai mulkin, rikice rikice masu hankali ne. Tare da bayyanar cututtukan asymmetric, raunin raunin yana farawa daga yankin pelvic kuma yana sauka hip. Wannan yana tattare da raguwar limarfin reshe wanda abun ya shafa, keta alfarma gwargwado dangane da sauran sassan jiki.
Rage damuwa na jin zafi shine ɗayan alamun bayyanar cututtuka na polyneuropathy
Daidaita ilimin cuta
Haɓaka polyneuropathy na firikwensin a cikin mafi yawan lokuta yana da hanya mai rauni. Masu ciwon sukari suna korafi game da wadannan bayyanar:
- jin numbness;
- zafin wani yanayi na daban;
- take hakkin hankali har zuwa cikakkiyar rashi;
- rauni na tsoka;
- karancin ilimin halittar jiki da kuma bayyanar cututtuka masu iya canzawa;
- daren katsewa na ƙananan gwiwa da na babba;
- rashin kwanciyar hankali yayin tafiya.
Wani rikitarwa na yau da kullun na tafiyar matakai tare da lalacewa na inji shine ƙafar mai ciwon sukari - yanayin yanayin cututtukan ciki wanda rauni ya kama dukkan bangarori, gami da gurneti da abubuwan kashi. Sakamakon - nakasawa da damuwa damuwa.
Kasancewar waje
Hakanan za'a iya shafa ƙwayoyin jijiya waɗanda ke cikin gabobin ciki. Kwayar cutar ta dogara da wane ɓangare ko tsarin ya shafi. Pathology na zuciya da jijiyoyin jini yana bayyana ta hauhawar jini na orthostatic, huhun ciki, ƙarancin aiki game da aiki. Marasa lafiya yi korafi na zuciya tashin hankali, kara karfin jini, gazawar numfashi, tari. Rashin magani na lokaci na iya zama da m.
Rikicin bugun zuciya - wata alama mai yiwuwar cutar sankarau ta wani nau'in mulkin mallaka
Lalacewa ga ƙwayar gastrointestinal yana bayyana ta paresis, raguwa cikin sautin sassan sassanta, take hakkin microflora na al'ada, da cutar reflux. Marasa lafiya suna fama da matsanancin amai, tashin zuciya, zawo, yawan asara, zafi.
Kwayar cutar ta ƙwayar cuta yana haɗuwa tare da atony na mafitsara, juyewar fitsari fitsari, rashin aikin jima'i, lalacewar sakandare yana yiwuwa. Cutar jiki ta bayyana a cikin ƙananan baya da kuma a bayan fitsarin, urination ya zama sau da yawa, tare da ciwo da ƙonewa, zazzabi jiki ya tashi, zubar jijiyoyin jiki daga farji da urethra ya bayyana.
Sauran raunuka:
- take hakkin gumi (wanda aka haɓaka ko aka rage har zuwa cikakken rashin wadatar gland)
- Pathology na gani na nazari (ɗalibi yana raguwa a diamita, ƙarancin gani na gani yana raguwa sosai, musamman a yamma);
- polyneuropathy na adrenal gland shine yake ba shi da alamun bayyanar cututtuka.
Binciko
Kafin rubuta magani don cututtukan ciwon sukari na ƙananan ƙarshen, ana bincika mai haƙuri ba kawai don neurology ba, har ma da endocrinologist don bayyana matakin diyya game da cutar.
Kwararrun ya fayyace matakin nau'ikan nau'ikan ji na jika (zazzabi, rawar jiki, kasala, jin zafi). Don wannan, ulu ulu, monofilaments, mallets tare da buroshi da allura a ƙarshen, ana amfani da tawul ɗin toya. A cikin lokuta na musamman, wani abu ya ɗauke ta hanyar biopsy don ƙarin ilimin tarihin. Binciken ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa shima ya haɗa da hanyoyi masu zuwa:
- Abubuwan da ba a bayyana ba - ƙwayoyin jijiya suna yin motsawa, abubuwan da aka amsa wanda aka rubuta su ta kayan aiki na musamman.
- Electroneurography hanya ce ta bincike wacce ta ƙaddara saurin yaduwar jijiyar jijiya daga sassan ɓangaren tsarin juyayi zuwa masu karɓa.
- Electromyography bincike ne wanda ke bayyana yanayin watsa abubuwan motsa jiki daga sel jijiyoyi zuwa cikin jijiyar tsoka.
Bayyanar daskarewa ta Pulse - Hanyar Magance Mahimmanci
Hanyoyin bincike na dakin gwaje-gwaje na tilas ne: fayyace matakin glycemia, nazarin halittu, alamu na C-peptide da glycated haemoglobin. Idan kuma ana zargin an lalata lalacewar mai mulkin, an tsara mai haƙuri ECG, echocardiography, duban dan tayi na zuciya, dopplerography of the jiragen, duban dan tayi na jijiyoyin ciki, endoscopy, x-ray.
Za'a iya tantance yanayin tsarin urinary ta hanyar nazarin fitsari yau da kullun, bincike bisa ga Zimnitsky da Nechiporenko, kazalika a lokacin duban dan tayi, cystography, cystoscopy da electromyography.
Siffofin jiyya
Don lura da ciwon sukari wanda ke da ciwon sukari, wanda ake bukata shine gyaran sukari na jini. Anyi wannan ne ta hanyar endocrinologist, wanda ke yin bita game da maganin insulin da kuma amfani da magunguna masu rage sukari. Idan ya cancanta, ana maye gurbin kudaden ta hanyar ingantattun masu amfani ko kuma an tsara ƙarin magunguna.
Ana aiwatar da gyaran abinci, ana zaɓi yanayin aikin tilas. Likita ya ba da shawara kan yadda za a kula da karfin jini da nauyin jiki a cikin iyakokin da aka yarda.
An tsara rukuni na magungunan masu zuwa:
- Abubuwan da keɓaɓɓe na alpha lipoic acid sune magungunan zaɓaɓɓu. Suna iya cire ƙwayar cholesterol, dakatar da illa mai guba na abubuwan da ke waje akan hanta da jijiyoyin jini. Wakilai - Berlition, acid na Lipoic, Thiogamma. Aikin magani akalla watanni 2 ne.
- Bitamin B - haɓaka aiki na tsakiya da na gefe mai juyayi, suna ba da gudummawa ga daidaituwa na watsa abubuwan motsa jini (Pyridoxine, Cyanocobalamin, Thiamine).
- Antidepressants - ana amfani dasu don rage bayyanar cututtuka masu raɗaɗi (amitriptyline, northriptyline). An wajabta su a cikin ƙananan allurai, sannu a hankali suna samun sakamako mai mahimmanci na warkewa.
- Aldose reductase inhibitors - ingantattun fannoni a cikin aikin likita ta hanyar wannan rukuni an nuna su, amma ba su tabbatar da duk fatan da aka sanya masu ba. Amfani da shi akan shawarar malamin halartar (Olrestatin, Izodibut, Tolrestat).
- Magungunan cikin gida - ana amfani da su don dakatar da tashin hankali a cikin aikace-aikace. Tasirin yana bayyana bayan minti 10-15.
- Anticonvulsants - Carbamazepine, Finitoin. Wannan rukunin yana buƙatar zaɓi mai mahimmanci na sashi. Fara da ƙananan allurai, yana ƙaruwa sama da makonni.
Abubuwan alfa-lipoic (thioctic) acid - magunguna don daidaita yanayin tasoshin jini da kawar da abubuwan jin daɗi mara kyau a cikin lalacewar ciwon sukari ga tsarin juyayi
Magungunan magungunan gargajiya
Zai yuwu mu kula da ciwon sikari ba kawai tare da maganin gargajiya ba, har ma da hanyoyi masu yawa da infusions da aka shirya a gida.
Yawan cin abinci 1
Yada pre-shirye stalks na nettles. Yakamata mai haƙuri ya sauƙaƙa a kansu na aƙalla minti 7-10 a rana.
Girke-girke mai lamba 2
Tushen ɓullar burdock Tushen ganye da ganyen blueberry sun haɗu. 3 tbsp an cakuda cakuda da aka zub da lita na ruwan zãfi kuma nace aƙalla awanni 8. Bayan haka sai a kunna wuta a daddaure na tsawon awanni 3. Bayan broth ya sanyaya, dole ne a tace shi. Sha adadin ruwan da aka karɓa lokacin rana.
Yawan cin abinci 3
Gilashin hatsi tana zuba tare da 1 lita na ruwan zãfi. Nace don awanni 10, sannan kuna buƙatar tafasa cakuda na akalla minti 40. Cire daga murhun kuma aika zuwa wurin dumi. Bayan tace kuma a ɗauka a cikin gilashi na rabin sa'a kafin kowane abinci.
Dole ne a tuna cewa ba shi yiwuwa a rabu da polyneuropathy tare da magungunan jama'a ba tare da maganin gargajiya ba da kuma sarrafa sukari na jini. Amma hada sakamakon wadannan abubuwan na iya haifar da sakamako mai kyau na cutar.
