ʻO nā ʻōleʻa o ka maka - retinopathy diabetic: mau hana, mālama, ka mālamaʻike

ʻO ka retinopathy Diabetic kekahi o nā hoʻopiʻi o ka maʻi maʻi, e alakaʻi ana i ka nānāʻana i nāʻike.

No ke aha a pehea e pau ai nā mea āpau, ʻo ka mea e hōʻemi i ka retinopathy maʻi diabetes a he aha ka hoʻomaʻamaʻa o kēia ʻano?

He aha ka retinopathy?

ʻO ka retinopathy he hoʻololi luku i ka loko o nā retinal o nā maka, ma muli o ke kahe o ke koko i loko o ka retina i ʻeha.

Hoʻopilikia kēia kumu i ka dystrophy, a laila make i ka nerve optic, kahi i hala i ka makapō.

ʻO ka huaʻōlelo "retinopathy" e pili ana i nā loli kulekele i ka retina, o nā ʻano etiology like ʻole.

Hiki iā ia:

1. ʻO nā retinopathies mua ʻaʻole i kumu ʻia e nā ʻōiwi;
2. retinopathies kūkaʻi i ala ma muli o nā ala ʻē aʻe.

ʻO ka huli ʻana i nā patula e kū mai ana i ka hope o ke kaʻi o ka maʻi maʻi, ʻo ka hoʻomaopopo ʻana he maʻi koʻikoʻi nui a me ka hoʻopiʻi pinepine ʻana i ka maʻi maʻi maʻi maʻi, e alakaʻi ana i ka nalowale o ka ʻike, a e pili ana i ka ʻano lua o retinopathy.

Ke hoʻomohala nei i ka asymptomatically ma ka manawa mua, aia ma ka 85% o nā mea maʻi me ka maʻi type 1, nona ka "ʻike" ma kēia kūlana ʻoi aku ma mua o 20 mau makahiki.

Ka mīkini hana retinopathy

Na nā maʻi maʻi maʻi me nā ala 2 ʻano, ma ka hapa o nā hihia i ka poʻe waena a me nā poʻe kahiko, me ka diabetes mellitus, kahi lesion concomitant o nā moku kīʻaha.

Aia ka helu ICD-10

Hoʻokaʻawale ʻia ka retinopathy Diabetic ma muli o ka ICD-10 penei:

• ʻano VII "Nā maʻi o ka maka a me ka adnexa (H00-H59)";
• ʻāpana "Nā maʻi o ka choroid a me ka retina (H30-H36)";
• code pathology "H36.0";
• ka maʻi maʻi "Diabetic retinopathy" mai E10 a i E14, pili i ke ʻano o ka maʻi mellitus maʻi, me ka hōʻailona ʻehā ".3"

ʻO nā kumu hanana

ʻO ka retina o ka maka he hui paʻakikī, ʻo ia hoʻi me kahi nui o nā mea taliaina e loaʻa ana ka mālamalama a hoʻohuli ia i loko o kahi ʻano kūloko.

Hoʻopuni ʻia ʻo ia e ka pūnaehana o nā capillaries e hāʻawi i ke koko piha.

Hoʻokumu ka retinopathy diabetes ma muli o:

• o na hihia pili;
• nā maʻi mikina;
• hoʻonui i ke kiʻekiʻe o ka pahuhopu o ka kahakaha hematoretinal (HBG), i kahi ma ke kūlana maʻamau, ʻaʻole i ʻae nā molekula nui e komo i ka retina ma ke kahe o ke kahe. Ma ka maʻi maʻi, pau ka hana ʻino ʻana i ka maʻi, kahi e alakaʻi ai i ke ʻano hana.

Manaʻo nā kauka i ka hui nui loa o ka hopena no ka retinopathy diabetes hele i nā poʻe e hōʻeha nei:

• haʻi maʻi
• nā maʻi māla;
• nā pilikia kaulike lipid;
• momona momona.

ʻO nā kumu maʻi

Aia kekahi mau hiʻohiʻona o ka hoʻonui i ka hiki i ka hoʻomohala ʻana i ka retinopathy:

• ka lōʻihi o ka maʻi diabetes a me ka pae o ka mana o ka glycemic status. ʻOi aku ka lōʻihi o ka maʻi diabetes, ʻo ke kiʻekiʻe loa o nā pilikia;
• ka hoʻihoʻi wikiwiki ʻana i nā helu kaola momona. Hoʻolālā ʻia kēia me ka ikaika insulin i ka poʻe ʻōpio me ka diakena hoʻopiʻi kino ʻole ʻia. A i ʻole me ke ʻano type 2 aia kahi loli mai nā papa kala e hoʻohiolo ai i ka insulin;
• kahi ʻano maʻi maʻi maʻi maʻi. Me ka insulin, ʻoi aku ka kiʻekiʻe o ka retinopathy;
• ke koko kiʻekiʻe;
• ʻōpū o ka ʻōpū-visceral o ka momona;
• nephropathy o ka maʻi maʻi maʻi maʻi;
• predisposition genetic e hoʻopōʻino i nā microvessels i ka maʻi diabetes.

Nā ʻōpū

ʻO ka papa ʻana o retinopathy, he mea i kūpono i kēia manawa, i hāpai ʻia ma ka 1991. He mea maʻalahi a hoʻomaopopo hoʻi, he mea maʻalahi ia e hoʻohana ai. I mea e like ai me nā ʻōlelo o kēia palapala, ʻekolu mau manawa (nā ʻano) o ka retinopathy diabetic.

Nonololapa

Non-proliferative (background). Hoʻohālikelike ʻia e ka ʻike ma nā retina (retina):

• nā microaneurysms (pili ke koko ma luna o nā moku);
• ʻōpala āpau. Ua koho ʻia lākou he mau ʻōpū, poloka a i ʻole nā ​​wahi pōʻeleʻele, me kahi kikowaena i ke kikowaena o ka waihona kālā a i ʻole nā ​​ʻiliʻu nui e moe hohonu ana i loko o ka retina;
• edema retinal i ka mahele macular (waena) a i ʻole nā ​​moku nui;
• ʻōpū me ka exudate. ʻO kēia nā wahi momona a me nā cholesterol i hoʻokumu ʻia ma muli o ke kahe koko. Ke ʻokeʻele a ʻeleʻele paha paha lākou i ʻohi pinepine ʻia i ka waena o ka ʻeke o ka maka. Loaʻa nā palena o nā ʻano like ʻole o nā kūlike.

Hoʻopuka

Maʻa retinopathy diabetes preproliferative.

ʻO ia loa ʻia:

• ke kahe o nā loli e hewa ai i nā veins a me nā microvessels;
• ka ʻike nui ʻana o ka paʻa a i ʻole ka palu paha e like me ka exudate;
• a helu nui o nā ʻāpana hemorrhagic.

ʻO ka nui o nā hōʻike o kēia mau hoʻololi e pili pono ana i ka hoʻolālā ʻana ma hope o nā hana proliferation.

Kumupua

Hōʻike ʻia ka retinopathy proliferative e ka hoʻomanū ʻana o nā ʻano ʻelua.

• vascular;
• daulau.

Kūkulu ʻia nā moku hou ma ka ʻaoʻao o ka pā o ka posterior vitreous. Ma muli o ko lākou hopena ʻole, ʻike pinepine nā hemorrhages. ʻO ka lōʻihi o ka wā, hiki ke wehe ʻia i ka pā.

Proliferative retinopathy

Nā Hoʻomaka

ʻO nā ʻano o nā hōʻailona a me kā lākou koʻikoʻi ke kau nei i ke kahua o ka retinopathy.

ʻO ka holo pinepine ka holomua o kēia pathology.

I ka wā mua, i ka maʻalahi o ka hoʻōla a me ka hana kūpono, ʻaʻohe mea hōʻike like kino.

I ka manawa ʻaʻohe-proliferative, ʻaʻole ʻike ka poʻe me ka maʻi maʻi i nā pilikia ʻike.

Hōʻike ʻia ʻo Retina edema e ka popo o ka "kiʻi", ka mea ma ka heluhelu ʻana a e hōʻohi ai i nā mea liʻiliʻi i ka liʻiliʻi.

Eia kekahi, i ka wā e hele pinepine ai nā hemorrhages retinal, e kamaʻilio pū me nā maʻi maʻi e pili ana i nā hiʻohiʻona o nā wahiʻeleʻele i mua o ka maka, ʻoiai, ma mua o ka manawa, nalowale lākou e lākou iho.

Hoʻopilikia a me ka mālama ʻana

ʻO ka hoʻomohala ʻana o ka retinopathy diabetic pono i koi ʻia nā mea hana kūikawā me ka nui kiʻekiʻe. He pono ka pono:

• hoʻomaopopo i ka pae o ka ʻike maka a me ke ʻano o ke kikowaena o ka retina;
• pili i ke ala o ka perimetry kamepiula (aʻo ʻana i nā ʻano ʻike) e ʻike ai i ke kūlana ma nā ʻāpana peripheral o ka retina;
• e nānā i mua o ka maka kuilima e ʻike i ke ʻano o ka lens a me ka iris;
• hoʻokō i ka gonioscopy;
• hana i ka tonometry (kahi ana i ka paʻila intraocular).

Ke kūpaʻa ka kaomi ma loko o ka maka i nā palena i ʻāpono ʻia, aia nā ʻano haʻawina e kū nei ma luna o ka haumāna, i hoʻihoʻi ʻia ma lalo o ka mana o nā kolo kūikawā.

• Hoʻohana ʻia ka biomicroscopy o ka lens me ka vitreous.
• Hoʻohana nā koho diagnostic electrophysiological i pono e loiloi i ka hana o ka retina a me nā nerve (optic).
• Hoʻohana ʻia ʻo Ophthalmobiomicroscopy, ka mea e pono ai e hoʻoholo i ka hana pono o ke kino vitreous a me ka retina, me ka ʻike ʻana i nā loli i ka retina, me ka manaʻo paʻa o kā lākou kūloko ʻana. Kuhi kēia haʻawina i ke kiʻi kiʻi ʻana i ke kiʻi i hopena ʻia.
• Hoʻohana ʻia kahi ʻōmole ultrasound o ka maka e ʻike i ke ʻano o ke kino o ka vitreous. Hoʻomaopopo kēia i nā kūlana kūikawā i nā hihia hoʻopiʻi nui, i ka wā e paʻakikī ai ka ophthalmoscopy o ka puna o ka ʻike.

Hōʻaia ka hōʻike piha ʻana no ka ʻike ʻana i ke kūlana o nā lālā o ka ʻike, akā ke wānana nō hoʻi i ka pae o ka holomua o ka pathology, a me ka manawa e loiloi i ka manawa kūpono o ka hopena ʻalike. He mea koʻikoʻi kēia no ke koho ʻana i kahi ʻano o hiki ke hiki ke hōʻoki i ka hoʻomaka ʻana o ka makapō.

Hoʻokomo ʻia nā mea lapaʻau no ka retinopathy:

1. ʻOi ka moxibustion laser, e hōʻemi ana i ka puffiness a hōʻemi i ka nui o nā hemorrhages. I nā 80% o nā hihia, hiki ke hoʻōki i ke kaʻina hana a hoʻopau hou i kahi nānā maka ʻike a hiki i ka 12 mau makahiki. Hiki i kēlā kāpae i kēlā me kēia pae, akā maikaʻi loa, ʻo ia nō ka mea i hōʻike ʻia ma ke kekona.
2. Hoʻomaka i nā lālā o ka ʻike o ka lāʻau Ranibizumab. He ʻenehana hou kēia. Hāʻawi ia iā ʻoe e hoʻopau i ka proliferation a hele maikaʻi me ka laser coagulation.
3. ʻO ka hoʻokuʻuʻana Vitreous (vitrectomy). Hoʻohana ʻia kēia ʻano pānaʻi inā komo nā ʻōnaehana vascular hou i komo i ka vitreous, e hōʻeha ai i ka hemorrhage koʻikoʻi. Inā hoʻohana ma mua o ka hana retinal detachment, ʻo 80% o nā maʻi maʻi maʻi e pale ai i ka nalo ʻana.
4. ʻO ka lāʻau lapaʻau. Hoʻōmi ia i ka hoʻoikaika i ka vascular kiko a hoʻopau i nā hemorrhages. ʻAʻole i kau ʻia nā lāʻau kūikawā kūʻē i ka retinopathy. I kēia manawa, hoʻohana nui nā Tranexamic acid a me nā mea hoʻokumu i hoʻokumu ʻia. Akā, ke noʻonoʻo nei nā ala ʻoi loa ka hopena me he mea laʻa.

Kahi Waho

I ka manawa e kūkā nei kekahi kanaka me ka pilikia retinopathic i ke kauka a hoʻomaka i ka mālama ʻana i nā hana i ka wā mua, aia kahi manawa kūpono loa e lohi ai i kahi maʻi nānā kino a hiki i ka 15 mau makahiki. Kuhi kēia i ka mālama mau ʻana i nā pae o ka glucose koko ʻaʻole i kiʻekiʻe ma mua o 9 mmol / L.

Ma ke ʻano type diabetes 1, hoʻomohala koke ka ʻike maka ʻole, e like me kona ʻano ʻelua. ʻO ka papa palena ʻo ka retinopathy hoʻi i hiki i ka hoʻolālā ʻana o nā hana maikaʻi.

Kāohi

ʻO ka mea pōʻino, ʻaʻohe mea pale i hiki ke hoʻopau loa i ka hopena o ka retinopathy me ka maʻi maʻi.

ʻO ia ka mea maʻamau, he hoa aloha nui loa o kēia ʻanoʻike.

I mea e ʻike iki ai ka hemahema ʻole a me ka wikiwiki, pono ʻoe e nānā e ka poʻe ophthalmologist i kēlā me kēia manawa.

Ma ka hihia o ka diabetes mellitus e hilinaʻi ʻia (type 1), pono ka nānā ʻana i kahi maka piha ma hope o 5 mau makahiki ma hope o ka loaʻa ʻana o ka maʻi nui. Ma ka maʻi type 2, kahi hōʻike maʻi o ka moku'āina o nā māla o ka hihiʻo i kuhikuhi koke ʻia.

Ke hōʻoia ʻia ka retinopathy, ʻo ka pinepine o nā kipa ʻana i ka ophthalmologist e hoʻoholo ʻia e kona pae:

• Kūlana 1 - 1 manawa i ka hapalua makahiki;
• Hana 2 - 1 manawa i kēlā me kēia hapaha;
• Kūlana 3 - 4 mau manawa i kahi makahiki a i ʻole ke kau ʻana i nā hōʻike.

ʻO nā kumu maʻamau no ka pale ʻana i nā kūlana retinopathic i ka maʻi diabetes.

• ka mālama mauʻana i nā pae o ka glucose koko (ma ka liʻiliʻi o 4 mau manawa i ka lā);
• ke mālama nei i kahi kūlana olakino a ʻaʻole iʻoi aku ka nui o ka honi i ka 9 mmol / l no ka manawa lōʻihi loa;
• hoʻololi i ka manawa i ka dosages insulin;
• ka hoʻokō ʻana i nā ʻōlelo a ke kauka e pili ana i ka papaʻai, a me ke kauoha ʻana i nā inikini insulin a i ʻole ka hoʻoponopono waha ʻana i nā lāʻau lapaʻau e hōʻemi i ke kō;
• Ke pale aku nei i nāʻokoʻa ākea i ka ulu ʻana a me ka hoʻohaʻahaʻa i ka glucose
• ke nānā nei i ke koko;
• ke kipa pinepine i ka endocrinologist;
• ka mālama kino kino.

Hoʻēmi iki i ka hopena o ka detinalment i ka wā retinopathy, ʻaʻole i:

• hāpai a halihali i nā ukana kaumaha (ma luna o 5 kg);
• Kūkaka
• kānalua (no ka laʻana, ka neʻe ʻana i nā lako);
• hana pono i nā neʻe.

ʻO nā wahine hāpai a me kahi kūlana retinopathic i hōʻike ʻia ka hāʻawi caesarean.

ʻO ka retinopathy Diabetic he maʻamau ʻo ia ka mea hiki ʻole ke ʻoluʻolu. I mea e mālama pono ai i ka ʻike maka nui no nā makahiki he mea nui, he mea nui ia e hoʻomaka i kēia pilikia, akā e hoʻomaka i ka hoʻopau koke ʻana i ka wā hiki.

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