ʻO ka maʻi macroangiopathy Diabetic he laulā ākea a me ka atherosclerotic maʻi e ulu ana i loko o nā nui a i ʻole nā artery nui me ke ʻano lōʻihi o nā maʻi ka maʻi type a me ke ʻano 2.
ʻO kēlā ʻano hiʻohiʻona he mau mea wale ia akā ʻo ka pathogenesis, e uhaʻi i ka nānā ʻana o ka maʻi naʻau coronary, a ua loaʻa pinepine kekahi kanaka i ka hypertension arterial, lesi ka manawa o ka peripheral arteri, a me ka neʻe ʻana o ka cerebral.
Hoʻopā i nā maʻi ma o ke alakaʻi ʻana i ka electrocardiograms, echocardiograms, Doppler ultrasound, nā ʻōpū, nā kīʻaha naʻau, nā aʻa o ka wāwae.
Hoʻokomo ʻia ka mālama ʻana i ka mālama ʻana i ke koko, hoʻomaikaʻi ʻana i ke ʻano hana koko, hoʻoponopono ʻana i ka hyperglycemia.
Nā kumu o ka macroangiopathy i ka maʻi diabetes
Ke maʻi nei kahi kanaka i ka maʻi maʻi no ka manawa lōʻihi, nā capillaries liʻiliʻi, nā pā arterial a me nā veins ma lalo o ke kumu o ka nui o ka glucose e hoʻomaka e wāwahi.
A laila aia kahi milo koʻikoʻi, ke ʻano, a i ʻole, i ka wili ʻana kēia o nā moku koko.
No kēia kumu, ke pilikia nei ka kahe a me ka metabolism ma waena o nā ʻiʻo o nā ʻāpana o ke kino, e alakaʻi ana i ka hypoxia a i ʻole ka pōloli o ka ʻekala e hoʻopuni ana, hoʻoliʻi nā kino o nā maʻi maʻi.
- ʻO ka pinepine pinepine, ua hoʻopili ʻia nā moku nui o nā haʻahaʻa haʻahaʻa a me ka puʻuwai, aia kēia ma kahi o ka 70 pakeneka o nā hihia. Loaʻa kēia mau wahi i ke kino i ka ukana nui loa, no laila uaʻike nui ʻia nā moku e ka loli. I ka microangiopathy maʻi maʻi, ua pā pinepine ʻia ka waihona kālā, i ʻike ʻia ʻo ka retinopathy; ʻo kēia mau mea pinepine ka maʻi.
- Hoʻopilikia pinepine ʻia nā maʻi macroangiopathy maʻi i ka cerebral, coronary, renal, peripheral arteries. Hoʻopili ʻia kēia me ka angina pectoris, myocardial infarction, ischemic stroke, ka maʻi diabetesrrene, a me ke ʻano renovascular. Me ka hoʻopōʻino hewa ʻana o nā kīʻaha koko, ʻo ke ʻano o ka hōʻemi ʻana i ka maʻi naʻau coronary a me ka hōʻeha ʻana ka piʻi ʻana ʻekolu.
- Nui nā maʻi maʻi hānai i alakaʻi i ka atherosclerosis o nā moku koko. Hōʻike ʻia ia maʻi like i ka poʻe me ka type 1 a me ke ʻano type diabetes mellitus 15 mau makahiki ma mua ma mua o nā mea maʻi maʻi. Eia kekahi, maʻi kekahi maʻi maʻi ma mua o ka holo ʻana me ka wikiwiki.
- Hoʻopili ka maʻi maʻi i ka membran basement o ka pākahi a me nā pāheo nui, a me nā ʻano pli atherosclerotic ma hope. Ma muli o ke kalala, hōʻike a me ka nekrosis o nā palaki, hana hoʻopiʻi koko i loko o ka'āina, ua kīkī ka lumen o nā moku, ma muli o ke kahe ʻana o ke kahe i loko o ka wahi i hoʻopilikia ʻia.
E like me ke kānāwai, ua pili aku ka macroangiopathy maʻi i ka coronary, cerebral, visceral, peripheral arteri, no laila ke hana nei nā kauka i nā mea āpau e pale ai i kēlā mau loli ma ke kau ʻana i nā kaʻina pale.
ʻO ka loaʻa ʻana o ka pathogenesis me ka hyperglycemia, dyslipidemia, ka pale ʻana i ka insulin, ka momona, ka hypertension arterial, hoʻonui ʻia coagulation, endothelial disfunction, oxidative stress, systemic inflammation nui loa.
Eia nō naʻe, ulu pinepine ka atherosclerosis i nā mea ulaula, ma ke alo o ka hana kūlohelohe, a me ka hoʻohuihui pilikino. Ma ka pilikia he mau kāne ma luna o 45 mau makahiki a ʻo nā wāhine ma luna o 55.
ʻO ke kumu pinepine o ka maʻi e lilo i predisposition hoʻoilina.
ʻO ka angathyathy Diabetic a me kāna ʻano
ʻO ka angathyathy Diabetic he manaʻo hui kahi e hōʻike ai i ka pathogenesis a pili i nā moku koko i pīpī - liʻiliʻi, nunui a me ke ʻano.
Hoʻomaopopo kēia ʻano noʻonoʻo i ka hopena o kahi hoʻopiʻi hope o ka maʻi mellitus, e ulu ana i ka 15 mau makahiki ma hope o ka puka ʻana o ka maʻi.
ʻO ka macroangiopathy diabetik i hele pū ʻia e nā syndromes e like me ka atherosclerosis o nā aorta a me nā coronary arteri, peripheral a i ʻole cerebral arteries.
- I ka wā o ka microangiopathy i loko o ka maʻi mellitus o ka maʻi mellitus, retinopathy, nephropathy, a me ka microangiopathy o ka maʻi o nā hopena haʻahaʻa.
- ʻO kekahi manawa, ke wāwahi ʻia nā kīʻaha koko, e nānā ʻia ana ka angathyathy aoao, i kāna manaʻo pili i ka maʻi micro-macroangiopathy maʻi.
Ma muli o ka microoneopathy diabetes endoneural e hoʻokūkū i nā nipina peripheral, ma kēia ke kumu ke kumu neuropathy diabetes.
ʻO ka macroangiopathy maʻi Diabetic a me kāna mau hōʻailona
Me ka atherosclerosis o ka aorta a me nā coronary arteri, e hōʻeha ai i ka maʻi macroangiopathy o nā haʻahaʻa haʻahaʻa a me nā ʻāpana ʻē aʻe o ke kino, hiki i kahi maʻi maʻi ke hōʻike i ka maʻi naʻau coronary, myocardial infarction, angina pectoris, cardiosclerosis.
Hoʻopilikia ka maʻi naʻau Coronary ma kēia hihia ma kahi ʻano atypical, me ka ʻole o ka ʻeha a me ka arrhythmia. Hōʻeha loa kēia kūlana, no ka mea e hiki ai ke make i ka make coronary wikiwiki.
ʻO ka pathogenesis i nā maʻi maʻi maʻi pinepine ka hoʻopili i nā hoʻopiʻi post-infarction e like me ka aneurysm, arrhythmia, thromboembolism, cardiogenic shock, ka hoʻopiʻi ʻana o ka naʻau. Inā i hōʻike ʻia e nā kauka ke kumu o ka hala ʻana o myocardial infarction is diabetes macroangiopathy, pono e hana ʻia nā mea āpau a i ʻole ka hōʻeuʻeu o ka puʻuwai, no ka mea ua nui loa ka hopena.
- Wahi a nā helu helu, ʻelua maʻi maʻi type a me 2 ke ʻelua mau manawa e make i ka myocardial infarction e like me nā poʻe ʻaʻohe mea i ka maʻi maʻi. Ma kahi o 10 pakeneka o ka maʻi e loaʻa ana i ka atherosclerosis cerebral ma muli o ka macroangiopathy maʻi maʻi.
- Hoʻokomo ʻia ʻo Atherosclerosis i nā maʻi maʻi i ka hoʻomohala ʻana i ka ischemic stroke a i ʻole ischemia cerebral maʻi. Inā loaʻa i ka hypertension arterial ka nui o ka ulu ʻana o ka hoʻoulu ʻana i nā koi he cerebrovascular.
- I ka 10 pakeneka o nā mea maʻi, ua loaʻa ka maʻi atherosclerotic lesi o nā moku peripheral i hōʻike ʻia ma ka ʻano o ka atherosclerosis obliterans. Hoʻopili ʻia ka macroangiopathy Diabetic me ka leʻaleʻa, ke anuanu o nā wāwae, ka claudication intermittent, ka ʻōpū o ka hypostatic o nā hopena.
- Ke ʻike nei ka mea maʻi i ka ʻeha nui i loko o nā māhina o nā poki, nā ʻūhā, nā wāwae haʻahaʻa, e hoʻoikaika ai me kekahi mea hoʻoikaika kino kino. Inā hele ʻole ke kahe o ke koko i ka mamao o ka mamao, alakaʻi kēia i ka ischemia koʻikoʻi, ma ka hopena pinepine ke kumu o ka necrosis o nā ʻāpana o nā wāwae a me nā wāwae haʻahaʻa i ke ʻano o ka gangrene.
- Hiki i ka ʻili a me ke kiko subcutaneous ke necrotic ma luna o lākou iho, me ka hōʻino ʻole hou. Akā, ma ke ʻano he rula, ua kū ʻia ka nekrosis me kahi hala ʻole o ka ʻili - ka puka ʻana o nā kīʻaha, nā ʻīpī, nā mea hōʻeha.
Ke emi ʻole ka holo ʻana o ke koko, hoʻonaninani ka maʻi makroangiopathy i ke ʻano o nā maʻi o ka maʻi trophic maʻi maʻamau me ka maʻi maʻi ma luna o nā wāwae.
He aha ka hoʻomohala ʻana o ka maʻi macroangiopathy maʻi?
ʻO ka Diagnosis e hoʻoholo ai i ka pōʻino o ka moku coronary, cerebral, a me nā moku peripheral.
No ka hoʻoholo ʻana i ke ʻano loiloi i koi ʻia, pono e nīnau aku ka mea maʻi i ke kauka.
Hana ʻia ka hoʻokolohua e kahi endocrinologist, kahi maʻi maʻi maʻi maʻi, he cardiologist, he hōʻea vascular, kahi maʻi hōʻeha maʻi, he neurologist.
Ma ke ʻano 1 a me ke ʻano type type 2, ua ʻōlelo ʻia ke ʻano o nā maʻi like me ʻike e ʻike ai i ka pathogenesis:
- Hana ʻia kahi hōʻike koko biochemical e ʻike i ke kiʻekiʻe o ka glucose, triglycerides, cholesterol, platelets, lipoproteins. Hoʻomaka ʻia kahi hōʻike koikoi koko.
- E ʻike e nānā i ke ʻano o ka cardiovascular e hoʻohana ana i ka electrocardiogram, ka nānā ʻana o kēlā me kēia lā i ke kahe o ke koko, ke nānā ʻana i ke kaumaha, a echocardiogram, ultrasound dopplerography o ka aorta, scintigraphy myocardial myocardial, coronarography, i hoʻohui ʻia i ka tomographic angiography.
- Ua hōʻike ʻia ke kūlana neurological o ka mea maʻi me ka hoʻohana ʻana i ka dopplerography ultrasound o nā moku cerebral, ka ʻike maka duplex a me ka angiography o nā moku cerebral.
- No ka loiloi i ke ʻano o nā moku koko peripheral, ʻike ʻia nā manamana lima me ka hoʻohana ʻana i ka scan scan duplex, dopplerography ultrasound, peripheral arteriography, rheovasography, capillaroscopy, arterial oscillography.
Ke mālama nei i ka microangiopathy maʻi maʻi
ʻO ka mālama ʻia ʻana o ka maʻi i ka maʻi maʻi ma mua i ka hāʻawi ʻana i nā hana e hoʻolōʻihi i ka holomua o ka hoʻopiʻi vascular pōʻino, hiki iā ia ke hoʻoweliweli i ka mea maʻi me ka maʻi a make paha.
Hoʻomaʻamaʻa ʻia nā ulia Trophic o nā ʻoi aʻe a lalo loa i lalo o ka nānā ʻana o kahi mea maʻi maʻi. I kahi hihia o ka pōpilikia vascular nui, e hoʻokō ʻia ana ka lāʻau kūlia kūpono kūpono. Eia kekahi, hiki i ke kauka ke kuhikuhi i ka lāʻau lapaʻau, kahi i ka endarterectomy, kahi kinai o ka cerebrovascular insufficiency, amputation o ka limu i hoʻopili ʻia, inā he gangrene i ka maʻi maʻi.
Ua pili nā kumu kumu o ka maʻi e pili ana i ka hoʻoponopono ʻana o nā syndromes i hoʻopilikia ʻia, ka nui o ka hyperglycemia, dyslipidemia, hypercoagulation, hypertension arterial.
- No ka hoʻopihapiha i ka metabolism o ka hāmeʻe o ka lolo i ka maʻi maʻi, ke kauka nei ke kauka i ka ʻomo a me ka mālama pinepine ʻana i nā pae koko koko. No kēia mea, lawe ka mea maʻi i nā lāʻau lipid-hoʻokuʻu i loko - stins, antioxidants, fibrates. Eia kekahi, pono e ukali i kahi meaʻai lapaʻau kūikawā a me ka palena o ka hoʻohana ʻana i nā meaʻai me kahi momona o nā momona holoholona.
- Aia ka hopena o ka hoʻomohalaʻana i ka hoʻopiʻi thromboembolic, ua hoʻonā ʻia nā lāʻau antiplatelet - acetylsalicylic acid, dipyridamole, pentoxifylline, heparin.
- ʻO ka hui antihypertensive i ka hihia e ʻike ai i ka maʻi macroangiopathy maʻi i ka hoʻokō a mālama i ke kō o ke koko ma ka pae o 130/85 mm RT. ʻAniā. No kēia kumu, lawe ka mea maʻi i nā ACE inhibitors, diuretics. Inā he hōʻeha ʻia kahi kanaka i ka hōʻino iʻa a myocardial, ua hoʻonoho ʻia nā beta-blockers.
Nā hana kūpono
Wahi a nā helu helu, me ka type 1 a me ka type 2 diabetes mellitus, ma muli o nā hoʻopiʻi cardiovascular ma nā maʻi, nā helu make mai 35 a 75 hapa paona. I ka hapalua o kēia mau mea maʻi, hele mai ka make me ka myocardial infarction, ma ka 15 pakeneka o nā hihia ke kumu o ka maʻi isemia cerebral.
No ka hōʻalo ʻana i ka hoʻomohala ʻana o ka macroangiopathy maʻi, pono ia e hana i nā mea pale a pau. Pono ka mea maʻi e nānā pono i ka pae koko koko, ana ʻole i ke kahe o ke koko, hahai i kahi meaʻai, nānā pono i kona momona pono, e hahai i nā ʻōlelo lapaʻau a pau a hāʻawi i nā hana maikaʻi e like me ka mea.
Ma ke wikiō ma kēia ʻatikala, ua kūkākūkā nā ʻano no ka mālama ʻana i ka macroangiopathy maʻi maʻi o nā mea kūloko nui.
