Ntshav qab zib nephropathy yog lub npe rau feem ntau lub raum mob ntshav qab zib. Lo lus no piav qhia txog qhov ntshav qab zib uas qhov tseem ceeb ntawm qhov lim tawm ntawm lub raum (glomeruli thiab tubules), nrog rau cov hlab ntsha uas pub rau lawv.
Kev mob ntshav qab zib yog qhov txaus ntshai vim tias nws tuaj yeem ua rau qhov kawg (qhov xaus) theem ntawm lub raum tsis ua haujlwm. Hauv qhov xwm txheej no, tus neeg mob yuav tsum tau lim ntshav lossis hloov raum.
Mob ntshav qab zib nephropathy yog ib qho ntawm cov kev mob tshwm sim ua rau muaj kev tuag ntxov thiab kev mob nkeeg hauv cov neeg mob. Ntshav qab zib yog nyob deb ntawm qhov ua rau lub raum teeb meem. Tab sis ntawm cov uas muaj kev lim ntshav thiab sawv ntsug hauv kab rau ib lub raum pub rau hloov ntshav, feem ntau muaj ntshav qab zib. Ib qho laj thawj rau qhov no yog qhov nce ntxiv ntawm qhov kev tshwm sim ntawm tus mob ntshav qab zib hom 2.
Cov laj thawj rau kev txhim kho mob ntshav qab zib nephropathy:
- cov ntshav qab zib siab hauv tus neeg mob;
- cov roj (cholesterol) tsis zoo thiab triglycerides hauv cov ntshav;
- ntshav siab (nyeem peb qhov "tus viv ncaus" rau qhov kub siab);
- mob ntshav liab, txawm tias "mob hnyav" (hemoglobin hauv cov ntshav <13.0 g / liter);
- haus luam yeeb (!).
Cov tsos mob ntawm tus mob Ntshav Qab Zib
Mob ntshav qab zib muaj peev xwm ua kev puas tsuaj rau lub raum tau ntev heev, mus txog 20 xyoo, tsis muaj qhov tsis zoo nyob hauv tus neeg mob. Cov tsos mob ntawm tus mob ntshav qab zib nephropathy tshwm sim thaum lub raum tsis ua haujlwm lawm. Yog tias tus neeg mob muaj cov cim qhia ntawm lub raum tsis ua haujlwm, tom qab ntawv qhov no txhais tau tias cov khoom pov tseg metabolic nce hauv cov ntshav. Vim tias lub raum cuam tshuam tsis tuaj yeem tiv nrog lawv lub lim.
Theem ntshav qab zib mob nephropathy. Kev kuaj mob thiab kev kuaj mob
Yuav luag txhua tus neeg mob ntshav qab zib yuav tsum tau kuaj ib xyoos ib zaug txhawm rau soj qab lub raum ua haujlwm. Yog tias tus mob ntshav qab zib ua rau mob nce hlwb, tom qab ntawd nws yog qhov tseem ceeb heev kom kuaj pom nws thaum ntxov, thaum tus neeg mob tseem tsis tau hnov cov tsos mob tshwm sim. Kev kho tus mob ntshav qab zib nephropathy ua ntej pib, kev muaj feem ntau ntawm txoj kev vam meej, uas yog, tus neeg mob yuav muaj peev xwm nyob tsis muaj kev lim ntshav lossis hloov raum.
Xyoo 2000, Ministry of Health ntawm Lavxias Kev Tshawb Fawb pom zoo rau kev faib tawm cov ntshav qab zib mob nephropathy los ntawm theem. Nws suav nrog cov hauv qab no formulations:
- theem microalbuminuria;
- theem proteinuria nrog cov tshuaj tiv thaiv nitrogen-ua haujlwm raum;
- theem ntawm kev mob raum tsis ua haujlwm (kev kho mob rau lim ntshav los yog lub raum hloov ntshav).
Tom qab ntawd, cov kws tshaj lij tau pib siv cov txheej txheem qhia txawv teb chaws ntawm kev mob raum ntawm cov ntshav qab zib. Hauv nws, tsis yog 3, tab sis 5 theem ntawm kev mob ntshav qab zib nephropathy tau txawv. Saib cov theem ntawm kab mob raum kom paub meej ntxiv. Dab tsi theem ntawm ntshav qab zib nephropathy nyob rau hauv tus neeg mob tshwj xeeb yog nyob ntawm nws lub siab txhaws (nws tau piav qhia meej npaum li cas nws tau txiav txim siab). Qhov no yog qhov ntsuas tseem ceeb tshaj plaws uas qhia tau hais tias kev tswj hwm raum zoo li cas.
Nyob rau theem ntawm kev kuaj mob ntshav qab zib nephropathy, nws yog ib qho tseem ceeb rau kws kho mob kom nkag siab yog tias lub raum puas yog mob ntshav qab zib lossis lwm yam ua. Ib qho kev kuaj mob ntshav qab zib nephropathy nrog lwm cov kab mob hauv lub raum yuav tsum tau ua:
- mob ntsws pyelonephritis (mob sib kis ntawm lub raum);
- raum tuberculosis;
- glomerulonephritis mob thiab mob ntev.
Cov tsos mob ntawm tus mob pyelonephritis:
- cov tsos mob ntawm intoxication (qaug zog, nqhis dej, xeev siab, ntuav, mob taub hau);
- mob hauv qab qis thiab plab hauv sab ntawm lub raum cuam tshuam;
- nce ntshav siab;
- hauv ⅓ cov neeg mob - ceev ceev, mob tso zis;
- kev ntsuam xyuas qhia pom muaj cov qe ntshav dawb thiab kab mob hauv cov zis;
- yam ntxwv duab nrog ultrasound ntawm lub raum.
Nta ntawm lub raum tuberculosis:
- hauv cov zis - leukocytes thiab mycobacterium tuberculosis;
- nrog excretory urography (xoo hluav taws xob ntawm ob lub raum nrog kev tso ntshav ntawm qhov nruab nrab nruab nrab) - ib qho duab tshwj xeeb.
Kev noj haus rau raum mob ntshav qab zib
Feem ntau cov mob ntshav qab zib muaj teeb meem, kev noj ntsev ntau ntxiv yuav pab txo ntshav siab, txo qhov o, thiab qeeb ntawm kev mob ntshav qab zib nephropathy. Yog tias koj li ntshav siab yog qhov qub, ces noj tsis ntau tshaj 5-6 grams ntsev hauv ib hnub. Yog tias koj twb tau tawg lawm, ces txwv koj kev noj ntsev kom tsawg li 2-3 gram ib hnub twg.
Tam sim no qhov tseem ceeb tshaj plaws. Cov tshuaj kho mob pom zoo kom noj zaub mov "sib npaug" rau cov ntshav qab zib, thiab tseem qis dua cov protein rau cov ntshav qab zib mob nephropathy. Peb xav tias koj xav txog kev siv zaub mov muaj protein ntau kom koj cov ntshav qab zib kom qis. Qhov no tuaj yeem ua tiav ntawm glomerular pom kev ntsuas siab tshaj 40-60 ml / min / 1.73 m2. Hauv tsab xov xwm “Kev noj zaub mov rau raum muaj ntshav qab zib,” cov ncauj lus tseem ceeb no tau piav qhia txhua yam.
Ntshav Qab Zib Kho Tus Neeg Mob Ntshav Qab Zib
Txoj kev tseem ceeb ntawm kev tiv thaiv thiab kho tus mob ntshav qab zib yog ua kom cov ntshav qab zib qis, thiab tom qab ntawd tswj nws kom nyob ze rau cov tib neeg noj qab haus huv. Saum toj no, koj tau kawm yuav ua li cas ua li no nrog kev noj haus tsawg-carb. Yog tias tus neeg mob cov ntshav cov ntshav hauv cov ntshav muaj ntshav nce siab lossis txhua lub sijhawm nyob ntawm qhov siab mus rau ntshav qis, ces txhua lwm yam haujlwm yuav tsis tshua muaj siv.
Cov tshuaj kho rau cov mob ntshav qab zib nephropathy
Rau kev tswj hwm ntawm txoj hlab ntshav txhaws, ntxiv rau intracranial kub siab hauv lub raum, ntshav qab zib yog feem ntau siv tshuaj - ACE inhibitors. Cov tshuaj no tsis tsuas yog txo cov ntshav siab xwb, tab sis kuj tiv thaiv lub raum thiab lub plawv. Lawv siv txo txoj kev pheej hmoo ntawm lub davhlau ya nyob twg tsis ua hauj lwm. Tej zaum, ACE cov tshuaj thaiv ntev ua haujlwm zoo dua li cov captopril, uas yuav tsum tau noj 3-4 zaug hauv ib hnub.
Yog tias tus neeg mob tau txhim kho hnoos qhuav los ntawm kev noj tshuaj los ntawm pab pawg ntawm ACE inhibitors, tom qab ntawd cov tshuaj yuav hloov nrog cov tshuaj angiotensin-II receptor blocker. Cov tshuaj hauv pawg no muaj nqi ntau dua li ACE inhibitors, tab sis ntau ntau kuj yuav tsis ua kev phiv. Lawv tiv thaiv ob lub raum thiab lub plawv nrog txog kev ua haujlwm zoo ib yam.
Lub hom phiaj ntawm cov ntshav siab rau cov neeg mob ntshav qab zib yog 130/80 thiab qis dua. Feem ntau, hauv cov neeg mob uas muaj ntshav qab zib hom 2, nws tsuas tuaj yeem ua tiav siv txoj kev siv tshuaj ua ke. Nws tuaj yeem muaj ACE inhibitor thiab cov tshuaj "los ntawm cov siab" ntawm lwm pab pawg: diuretics, beta-blockers, calcium antagonists. ACE inhibitors thiab angiotensin receptor blockers ua ke tsis pom zoo. Koj tuaj yeem nyeem txog cov tshuaj sib xyaw rau kev kub siab, uas tau pom zoo siv rau cov ntshav qab zib, ntawm no. Kev txiav txim siab zaum kawg, uas ntsiav tshuaj yuav tshuaj, yog ua los ntawm kws kho mob nkaus xwb.
Cov raum muaj teeb meem li cas rau kev saib xyuas ntshav qab zib
Yog tias tus neeg mob kuaj tau mob ntshav qab zib nephropathy, ces cov hau kev ntawm kev kho mob ntshav qab zib tau pauv hloov ntau. Vim tias ntau yam tshuaj yuav tsum tau ua kom ncua tseg lossis lawv cov tshuaj ntau npaum li cas. Yog hais tias tus glomerular pom npaum li cas txo, ces ntau npaum li cas ntawm cov kua dej yuav tsum tau txo, vim tias lub raum tsis muaj zog ua rau nws muaj ntau qeeb dua.
Thov nco ntsoov tias cov tshuaj nrov rau hom 2 mob ntshav qab zib metformin (siofor, glucophage) tuaj yeem siv tsuas yog ntawm glomerular pom kev siab dua 60 ml / min / 1.73 m2. Yog tias tus neeg mob lub raum ua haujlwm tsis muaj zog, ces qhov kev pheej hmoo ntawm mob lactic acidosis yog qhov kev phom sij txaus ntshai. Hauv cov xwm txheej zoo li no, metformin thim tawm.
Yog tias tus neeg mob tshuaj ntsuam pom tias tsis muaj ntshav txaus, ces nws yuav tsum tau kho, thiab qhov no yuav qeeb rau kev txhim kho cov ntshav qab zib ua kom tsis muaj mob nephropathy. Tus neeg mob yog tshuaj kho mob uas tsim kho erythropoiesis, i.e., kev tsim cov qe ntshav liab hauv cov pob txha pob txha. Qhov no tsis tsuas yog txo qis kev pheej hmoo ntawm lub raum tsis ua hauj lwm, tab sis kuj tseem txhim kho lub neej zoo. Yog hais tias tus mob ntshav qab zib tseem tsis tau ua rau kev lim ntshav, cov tshuaj hlau ntxiv kuj tseem yuav raug kho.
Yog hais tias prophylactic kho mob ntshav qab zib nephropathy tsis pab, ces lub raum tsis ua haujlwm. Hauv qhov xwm txheej no, tus neeg mob yuav tsum tau lim ntshav, thiab yog tias ua tau, tom qab ntawd hloov lub raum. Peb nyias muaj nyias ib tsab xov xwm hais txog kev hloov raum, thiab peb yuav tham me ntsis txog hemodialysis thiab peritoneal lim ntshav hauv qab no.
Hemodialysis thiab peritoneal lim ntshav
Thaum lub sij hawm tus txheej txheem hemodialysis, tus kav raj tso rau ntawm tus neeg mob txoj hlab ntshav. Nws txuas nrog cov lim dej sab nraud uas lim cov ntshav ua kom lub raum tsis huv. Tom qab ua kom huv, cov ntshav yuav muab xa rov qab mus rau tus neeg mob cov ntshav. Hemodialysis tsuas tuaj yeem ua nyob hauv tsev kho mob chaw. Nws tuaj yeem ua rau poob hauv ntshav siab lossis mob kis.
Peritoneal lim ntshav yog thaum lub raj tsis tso rau ntawm cov leeg ntshav, tab sis mus rau hauv lub plab plab. Tom qab ntawd cov kua dej loj tau pub rau hauv nws los ntawm kev nrog qhov. Qhov no yog kua tshwj xeeb uas thim cov pov tseg. Lawv raug tshem tawm raws li cov kua dej tawm los ntawm kab noj hniav. Peritoneal lim ntshav yuav tsum ua txhua hnub. Nws muaj kev pheej hmoo kis tus kab mob rau ntawm qhov chaw uas cov raj nkag mus rau hauv lub plab hauv plab.
Ntawm cov ntshav qab zib mellitus, kua dej tawm, cuam tshuam kev cuam tshuam ntawm nitrogen thiab electrolyte tshuav kev loj hlob ntawm cov qib siab txhaws txhaws. Qhov no txhais tau tias cov neeg mob ntshav qab zib yuav tsum hloov mus rau txoj kev lim ntshav thaum ntxov dua li cov neeg mob uas muaj lwm txoj hlab ntsws. Qhov kev xaiv ntawm txoj kev lim ntshav nyob ntawm tus nyiam ntawm tus kws kho mob, tab sis rau cov neeg mob nws tsis muaj qhov sib txawv.
Thaum twg thiaj pib kho mob raum (hloov ntshav los yog lub raum hloov chaw) rau cov neeg mob ntshav qab zib mellitus:
- Tus nqi hlaws ntim glomerular <15 ml / min / 1.73 m2;
- Kom siab ntau ntau ntawm cov potassium nyob hauv cov ntshav (> 6.5 mmol / L), uas tsis tuaj yeem txo los ntawm kev txuag txoj hauv kev;
- Kev ceev cov kua dej kom tsis txhob mob hauv lub cev nrog txoj kev pheej hmoo ntawm mob ntsws ntsws;
- Cov tsos mob tshwm sim ntawm cov protein-lub zog tsis zoo.
Lub hom phiaj rau kev kuaj ntshav hauv cov neeg mob ntshav qab zib uas kho ntshav qab zib:
- Glycated hemoglobin - tsawg dua 8%;
- Cov ntshav hemoglobin - 110-120 g / l;
- Parathyroid hormone - 150-300 pg / ml;
- Cov tshuaj phosphorus - 1.13-1.78 mmol / L;
- Tag nrho cov calcium - 2.10-2.37 mmol / l;
- Cov khoom lag luam Ca × P = Tsawg dua 4.44 mmol2 / l2.
Yog tias lub raum ua kom muaj ntshav qab zib rau cov neeg mob ntshav qab zib, cov tshuaj erythropoiesis cov tshuaj tiv thaiv kab mob (epoetin alpha, epoetin beta, methoxypolyethylene glycol epoetin beta, epoetin omega, darbepoetin alpha), ib yam li tshuaj muaj hlau lossis txhaj tshuaj. Lawv sim tswj kom ntshav siab qis dua 140/90 hli Hg. Art., ACE inhibitors thiab angiotensin-II receptor blockers tseem tshuav cov tshuaj ntawm kev xaiv rau kev kho mob ntshav siab. Nyeem kab lus “Ntshav siab Hom 1 thiab Hom 2 Ntshav Qab Zib” kom ntxaws.
Hemodialysis lossis peritoneal lim ntshav yuav tsum raug suav tias tsuas yog ib qib kev npaj tam sim no rau kev hloov raum. Tom qab lub raum ua tiav rau lub sij hawm hloov ntshav hloov tsis ua haujlwm, tus neeg mob kho tsis tuaj yeem mob raum. Ntshav qab zib nephropathy hloov kho, tus neeg mob txoj sia muaj sia zuj zus.
Thaum npaj lub raum hloov raum rau cov ntshav qab zib, cov kws kho mob tau sim los soj ntsuam seb yuav ua li cas tus neeg mob yuav muaj mob plawv (mob plawv lossis mob hlab ntsha tawg) thaum lossis tom qab phais tas. Rau qhov no, tus neeg mob yauv mus kuaj mob ntau yam, suav nrog ib qho ECG nrog lub nra.
Feem ntau cov txiaj ntsig ntawm kev soj ntsuam no qhia tau tias cov hlab ntsha uas pub rau lub plawv thiab / lossis lub hlwb tau cuam tshuam ntau heev los ntawm atherosclerosis. Saib cov lus “Rawv raum mob ntshav liab” kom paub cov ntsiab lus. Hauv qhov no, ua ntej lub raum hloov chaw, nws raug pom zoo kom phais neeg rov qab kho qhov qub txeeg qub teg ntawm cov hlab ntsha no.
