I kēia manawa, hiki i kahi mea lapaʻau i kekahi lāʻau lapaʻau ke hāʻawi i nā penikala like ʻole no ke kaomi ʻana no ka maʻi type 2, ka nui o kahi papa inoa.
"ʻO nā maʻi momona" me ka mālama maikaʻi ʻole e alakaʻi i nā hoʻopiʻi he nui, ʻo kekahi o ka mea e weliweli loa he hypertension. Hōʻʻano ia e ka hoʻonui nui ʻana i ke kahe o ke koko (BP).
ʻO ka maʻi mellitus a me ke kaumaha i loko o ka paʻakikī ka hoʻonui i ka hopena o ka neʻe, ischemia, uremia, gangrene o nā haʻahaʻa haʻahaʻa a i ʻole ka ʻike. No laila, he mea nui e ʻike pehea e hana ai i ke koko kiʻekiʻe o ka maʻi diabetes mellitus i mea e pale ai i ka hoʻomohala ʻana o nā ʻōkuhi makemake ʻole.
Nā kumu o ke Hypertension
Manaʻo wau he aha ka ʻemi i ka maʻi diabetes i ʻae ʻia? Ma hope o nā mea a pau, i ka poʻe olakino pono ʻia ʻo 120/80.
ʻO ke kaomi ʻana no ka maʻi maʻi hānai, ʻaʻole eʻoi aku ma mua o ka paepae kiʻekiʻe o ka 130/85. Inā makemake ʻole kēia kuhi, ua wikiwiki e ʻimi i ke kōkua mai kahi loea.
He aha nā kumu o ka piʻi nui o ke koko i ka maʻi maʻi maʻi? ʻAe, he nui o lākou o lākou. ʻO ka hoʻonuiʻana i ke kaomi kino i ka maʻi type 1 i ka 80% o nā hihia ma muli o nā palaka olakino.
I ka lua o nā maʻi o ka maʻi, ke ʻano o ka hypertension, ʻo ia hoʻi, he ulu mau i ka neʻe ʻana o ke koko, kū pinepine ma mua o nā hana hōʻino.
Aia ma muli o ke ʻano o ka hypertension ʻokoʻa, he ʻano ʻokoʻa. Aia ma lalo aʻe nā ʻano kumu nui a me nā kumu o ka hoʻomohala ʻana i ka pathology:
- Pono, ka mea i kapa ʻia ʻo hypertension, aia ma 90-95% o nā hihia me ke koko kiʻekiʻe.
- ʻO ka systola isolated, ka hopena mai ka emi ʻana o ka elasticity o nā paia vascular, a me ka holoʻana o ka neurohormonal.
- ʻO Renal (nephrogenic), nā kumu nui e pili pū ana i ka hana o ke ʻano paena. ʻO kēia ka nephropathy diabetes, polycystic, pyelonephritis, a me ka glomerulonephritis
- Endocrine, ulu pinepine. Eia nō naʻe, ʻo nā kumu nui o ka maʻi ʻo ka maʻi Cush, pheochromocytoma, a me ka hyperaldosteronism mua.
Hiki i ka hoʻomohala ʻana o ka maʻi hypertension ma ke ʻano maʻi type 2 e nā kumu ʻē aʻe. No ka laʻana, i nā wahine e lawe ana i nā contraceptives hormonal, piʻi nui ka hopena o ka hypertension i nā manawa. Eia kekahi, ʻo ka wā o ka mea maʻi me ka maʻi mellitus e loaʻa hoʻi i ka maʻi hypertension, inā he ʻelemakule, loaʻa iā ia nā pilikia me ka momona a he mea nui paha ke ʻano o ka hili ʻana.
I kekahi manawa ke hiki mai ka ulu o ka hypertension ma ke ʻano o ka nele o ka magnesium, i ka hoʻonā a me kekahi mau mea, ke hōʻoki ʻia i ka palaki nui, a me nā kūlana paʻakikī.
ʻO nā kumu o nā maʻi, e like me kā mākou e ʻike nei, he nui. No laila, me ka diabetes mellitus, he mea nui ia e hoʻokō pono i nā kānāwai kumu no ka hoʻomaʻamaʻa ʻana o ka holomua, me ka meaʻai kūikawā, ʻakena, nā lāʻau lapaʻau (Metformin, etc.) a me ka nānā pinepine ʻana i ke kiʻekiʻe o ka glycemia.
Nā hiʻohiʻona o ka papa o ka hypertension
I ke ʻano type diabetes 1, hoʻoli pinepine ka piʻi ʻana e ka maʻi diffunction. Hele ia i kekahi mau 'āina - microalbuminuria, proteinuria a me ka nele kūlohelohe.
Hōʻike nā haʻawina he nui nā maʻi āpau me ka maʻi āpau o ka maʻi 1, ʻaʻole wale ka 10% o ka maʻi i ka maʻi ʻana. No ka mea, ʻaʻole hiki i nā keiki ke hoʻopiha i ka sodium, ulu ka hypertension i ka maʻi diabetes. Ka lōʻihi o ka manawa, hiki ke hoʻonui ʻia ka ʻike o ka sodium i loko o ke koko, a me ia me ka hōʻuluʻulu ʻana o ka wai. ʻO ke koko koko nui e alakaʻi i ka hoʻonui ʻana i ke koko.
ʻO ka nephropathy Diabetic a me ke hypertension kahi pōʻaiʻē. Hoʻokomo ʻia ka hana palupalu e ka māhuahua o ke koko. Ke hoʻopiʻi nei ka hope i ka paʻakikī intracubular, ka mea e alakaʻi ai i ka luku mauʻana i nā mea kānana.
Hypertension a me ke ʻano maʻi diabetes 2 hoʻokaʻawale ma mua o ka puka ʻana o kāna mau hōʻailona koʻikoʻi. Hoʻomaka ia me ke ʻano o ka nalo ʻana o ka hopena o nā kaʻe o ka ʻiʻo i ka hoʻohiolo ʻana i ke kō. E hoʻopaʻi i ka paleʻana i ka insulin, hoʻomaka ka hōʻuluʻulu ma loko o ke koko, e hoʻonui ana i ke koko o ka maʻi diabetes. ʻO kēia hiʻohiʻona ma mua o ka manawa e alakaʻi i kahi pōkole o ka lumen o nā moku koko ma muli o nā hopena maikaʻi ʻole o ka atherosclerosis.
ʻO kahi hiʻohiʻona o ka hana maʻamau i loko o ka diabetes-mellitus-non-diabetes mellitus ʻo ka ʻōpū o ka ʻōpū o kaʻōpū (hōʻiliʻili o ka momona i ka ʻōpū). Me ka hoʻohaʻaka ʻana o nā momona, hoʻokuʻu ʻia nā mea kanu, e hoʻonui aʻe ana i ke kaomi. Hoʻokumu ka hana ʻo Renal i ka wā lōʻihi, akā hiki ke pale ʻia inā mālama pono ʻia ka mālama ʻana.
ʻO ka hoʻonui pinepine ʻana o ka insulin (hyperinsulinism) e hoʻopiʻi ana i ke kiʻekiʻe o ka maʻi diabetes. Hiki i ka Hyperinsulinism ke hāpai iā ia, no ka mea:
- ʻO ka sodium a me nā wai wai ʻaʻole i pau loa i ka hana ʻia e nā keiki;
- hoʻōla ʻia ka ʻōnaehana hoʻonāukiuki;
- ʻākoakoa ka hōʻiliʻili o loko o ka calcium a me ka sodium;
- ke emi nei ka elasticity o nā moku koko.
I mea e pale ai i ka hypertension, pono e pono ke kau ʻia ka nui o ke kō me ke koko.
ʻO ka paila ka 5.5 mmol / L, pono ʻoe e hoʻoikaika no ia.
Hanaʻai me ka ACE inhibitors a me ARB
I ka ʻike ʻana i ka ʻike e pili ana i ke piʻi ʻana o ke koko i ka mellitus maʻi diabetes, hiki iā mākou ke hoʻomau i ka nīnau pehea e hōʻemi ai ia a ʻo ia nā peni no nā hypertension e ʻae ʻia e hoʻohana.
E hoʻomaka me ka mea, ke noho nei mākou i ka kikoʻī hou aku i ka ACE inhibitors, no ka mea he hui ʻano nui kēia o nā lāʻau lapaʻau i hiki ke hoʻohaʻahaʻa i ke koko.
Pono e hoʻomaopopo koke ʻia e pono ke kāpae ʻia ka lāʻau lapaʻau inā inā nā mea maʻi me ka maʻi maʻi i hoʻomohala i ka stenosis hoʻokahi o ka lāʻau ʻōiwi a i ʻole ka bilateral stenosis.
Hoʻomaʻa ʻia ka mālama ʻana o ka maʻi hypertension ma ka type 2 diabetes mellitus me nā mea paʻa o ka ACE.
- Ke ala ʻo Creatinine i kahi mea ma mua o 30% ma hope o 7 mau lā o ka mālama ʻana me kēia lāʻau lapaʻau.
- Loaʻa ka Hyperkalemia i kahi o ka potassium pākeka ma lalo o 6 mmol / L.
- ʻO ka wā hānau a keiki a ʻōpiopio paha.
Hiki ke kūʻai ʻia ke Cewareril, Kapoten, Perindopril, a pēlā aku i ka lāʻau lapaʻau. No laila, ke pale ʻia ke koko kiʻekiʻe i ka maʻi diabetes me ka hoʻohana ʻana i nā mea paʻa o ACE. Akā ma mua o ka lawe ʻana iā lākou, pono ʻoe e nīnau i ke kauka.
No ka type 2 diabetes mellitus, pili i ka mālama ʻana i ka lawe ʻana i nā mea hoʻoweliweli o ka ʻĀina ʻōpehu (ARB) a i ʻole sartans e hoʻohaʻahaʻa i ke koko. Pono e hoʻomaopopo aku ʻaʻole o ARB e hoʻopilikia i nā loina metabolic i loko o kekahi mea, e hoʻonui ana i ka hiki ke hana o nā ʻano hanana a me ka hoʻopuka o ka hānō i ka maʻi pāʻai me ke kō koko kiʻekiʻe.
ʻO kēlā mau lāʻau no ke kiʻekiʻe o ke koko ma ka maʻi diabetes e maʻalahi maʻalahi e ka mea maʻi he nui. No laila, hiki iā ʻoe ke koho i nā lāʻau lapaʻau e hiki mai ana no ka hypertension - Valsartan, Azilsartan, Candesartan, etc.
Hoʻohālikelike ʻia me nā mea ACE inhibitors, ʻoi aku ka nui o nā hopena sartans, a hiki ke mālama ʻia ka hopena therapeutic ma hope o ʻelua pule.
Ua hōʻike ʻia nā haʻawina ʻo ia lāʻau lapaʻau no ka hypertension e hoʻohaʻahaʻa i ka excretion protein i ka urine.
ʻO ka hoʻohana ʻana o ka diuretics a me nā antagonist calcium
He aha nā lāʻau lapaʻau e hiki ke hoʻohana i ka wā o ka paʻakai o ka paʻakai i loko o ke kino o ke kanaka? No kēia, lawa ka diuretics a diuretics paha.
Ke koho nei i nā piliona o ke koko, pono e noʻonoʻo ʻia nā mea he nui.
No laila, me ka hoʻoulu ʻana o ka kidney mai ke koʻikoʻi, ʻoi aku ka maikaʻi o ka inu ʻana i ka "diuretics" loop.
Ma ka maʻi mellitus o ka ʻano lua, ʻaʻole kaukaʻi nā kauka i ka hoʻohana ʻana o nā diuretics o nā ʻano ʻehā penei:
- osmotic (mannitol), no ka mea hiki iā lākou ke hoʻokō i kahi moku'āina o ka maikaʻi comers hypersmolar;
- thiazide (Xipamide, Hypothiazide), ʻoiai nā lāʻau lapaʻau me ka nui o ke kō no ka nui o ka hypertension;
- carbonac anhydrase inhibitors (Diacarb) - nā lāʻau lapaʻau ʻaʻole i hōʻike i ka hopena hypotensive kūpono, ʻaʻole i lawa ka maikaʻi o kā lākou hoʻohana.
ʻO nā lāʻau maʻi maʻi ʻoi aku ka hopena e pili ana i nā diuretics loop. I loko o kahi kalekaʻai, hiki iā ʻoe ke kūʻai iā Bufenox a i Furosemide. Hiki i nā kumukūʻai o nā lāʻau lapaʻau e hōʻoluʻolu i ke kaomi inā hoʻohālikelike iā lākou ma ka pūnaewele.
Eia kekahi o nā loiloi maikaʻi mai Anna (55 makahiki): "Ua hoʻomanawanui wau i ka maʻi type 2 no nā makahiki he 8. I nā makahiki i hala iho nei, ua hoʻomaka ka pilikia i ke kaumaha. Ua mālama ʻia au me Diakarb, akā, ʻaʻole i kōkua ka lāʻau lapaʻau. Akā, inu au iā Bufenoks a hoʻomaka ka manaʻo nui. hiki i kekahi lāʻau lapaʻau hou aku me ka wikiwiki e hoʻohaʻahaʻa i ke kaumaha, akā hauʻoli wau i kēia lāʻau lapaʻau. "
Hoʻoholo ʻia nā Dosages ma ke kumuhana pilikino e ka hoa hana. Ke koho nei i nā lāʻau lapaʻau e hōʻemi i ke koko, e pono nā mea e pono ai:
- Ke lawe nei iā Nifedipine (hana liʻiliʻi), hiki i ka nui o ke ʻano maʻi cardiovascular ke piʻi.
- Hoʻomaʻamaʻa ʻia ka antagonis kalakal no ka pale ʻana o ka hōʻeha a me ka puʻuwai puʻuwai i ka maʻi maʻi.
- ʻAʻole palekana ʻo Felodipine (hana lōʻihi) akā naʻe ʻaʻole ia e like me ka pale ʻana o ACE. No ka hōʻemi ʻana i ka hoʻemi maikaʻi ʻana, pono ia e hoʻohui me nā ʻano ʻē aʻe.
- ʻOi aku ka maikaʻi o Neghydropelins (Diltiazem a me Verapamil) no ka maʻi maʻi, e ʻoluʻolu lākou i ka hana o nā kuhi.
ʻO nā antagonis kaleta he mau papa kūpono no ke koko kiʻekiʻe, ʻoiai me ka hoʻohana lōʻihi e hiki iā lākou ke pale i ka hana o ka insulin.
Inā hōʻea ʻoe i ka lawe ʻana i nā mea lapaʻau no ka hypertension i ka maʻi diabetes, a laila e piʻi hou ka hana o ka pancreas.
ʻO ka hoʻohana ʻana o nā alpha a me nā mea pani beta
ʻO nā Alpha-blockers e like me Terazosin a i Prazosin, ʻaʻole i like me ka beta-blockers no ka maʻi maʻi, hoʻomaikaʻi i ka hoʻoliʻiliʻi a me ka lipid metabolism, me ka hoʻonui ʻana i ka hoʻoneʻe ʻana o nā kiko o ka iwi i ka hoʻohiolo ʻana i ka hilo.
ʻOiai ke pōmaikaʻi o nā pono āpau, hiki i kēia mau lāʻau no ke kaomi ʻana i ka maʻi maʻi i ka hopena o ka hopena - ka huehue, ka tachycardia hoʻomau a me ka hypotension orthostatic (hoʻohaʻahaʻa i ke koko). ʻAʻole inu ka pōʻai i kahi hihia me ka nele o ka naʻau.
Me ka hoʻohana ʻana o nā beta-blockers, maʻi hānai a me nā puʻuwai cardiac e hiki ke hoʻokele. Ke koho nei i nā papa e inu ai, pono e noʻonoʻo pono i ka selectivity, hydrophilicity, vasodilating hopena a me ka lipophilicity o nā lāʻau lapaʻau no ka maʻi hypertension ma ka diabetes mellitus.
Hiki iā ʻoe ke inu i nā beta-blocker koho no ka maʻi maʻi maʻi, ʻoiai lākou e hoʻomaikaʻi ai i ka hana o ke ʻōnaehana cardiovascular a, ʻaʻole like me nā poʻe maʻamau, ʻaʻole i hoʻokaʻawale i ka hana ʻana o ka insulin.
Eia kekahi, me ka manaʻo nui o ka maʻi a me ka maʻi diabetes, aʻo nā kauka he nui i ka lawe ʻana i nā lāʻau make vasodilator, no ka mea e hoʻopilikia maikaʻi ana lākou i ka metabolism o nā pakano a me nā momona, hoʻonui i ka naʻau o ka hormone hypoglycemic. Eia naʻe, hiki ke lawe ʻia kēia mau penikala ma lalo o ka mālama koʻikoʻi o kahi kauka, no ka mea he papa nui o nā contraindications.
ʻO ka komo ʻana o ka beta-block-soluble a me ka wai-hoʻokahe wai ʻole e hoʻopukapuka maʻamau i ka maʻi maʻamau, e pili ana i ka ʻāʻī a me ke kūlana psychoemosi.
E pale i ke ʻano o ke ʻano o ka lāʻau lapaʻau, hiki nō hoʻi ke mālama i ka maʻi hypertension me nā kūpaʻa o nā kānaka. ʻO nā huahana lapaʻau kaulana loa nā ʻenehana popula, nā hua flax a me ke kāleka. Aia ma nā ʻano like ʻole e hoʻomākaukau ai iā lākou - nā ʻāpana, decoctions, a me nā mea hoʻonaninani no nā maʻi maʻi maʻi lapaʻau e pono ke mālama ʻia, ʻaʻole pono ia e ʻōlelo aku i kahi loea ma mua.
ʻAʻole i hōʻemi iki ka mea hoʻemi i ka hoʻohaʻahaʻa haʻahaʻa i ka maʻi mellitus (hypotension), no ka mea ke kahe ana o ke koko i ka hopena o ka make. I kekahi hihia, pono e nānā i ka kaomi i ke kāʻei maʻi type 2.
ʻO ka maʻi diabetes a me ke koko koko kiʻekiʻe he mau kumuhana pili. No laila, i mea e pale ai i ka ulu ʻana o nā hopena koʻikoʻi, pono ia e lawe i nā paʻi pali no ka maʻi mellitus, a me ka mālama pono ʻana i nā meaʻai kūpono, e hana i nā hana o waho a hoʻohana i nā hoʻoponopono pilikino ma hope o ka kūkā ʻana me ke kauka.
He aha nā peni no ka hypertension hiki i nā maʻi maʻi maʻi haʻi i ka loea i ka wikiō ma kēia ʻatikala.
