Stenosis txhais tau tias nqaim. Cov hlab ntsha raum yog ib qhov tseem ceeb ntawm cov lumen ntawm cov hlab ntshav uas pub lub raum vim txhaws ntawm lawv cov atherosclerotic plaques. Hauv cov neeg mob laus neeg mob ntshav qab zib hom 2, qhov no yog ib qho ua rau lub raum tsis ua haujlwm. Cov leeg ntshav hlab ntsha kuj ua rau mob ntshav siab heev, uas yog xyaum ua tsis tau raws cai.
Qhov ntim ntawm cov ntshav uas lub raum ua tau hla nws tus kheej, dhau mus, muab cov khoom tsim nyog ntawm cov kabmob nrog cov pa. Yog li ntawd, raum cov leeg mob raum tuaj yeem pib ntev ntev yam tsis muaj tsos mob dab tsi. Kev yws yws hauv cov neeg mob tshwm sim, raws li txoj cai, twb yog thaum muaj kev cuam tshuam ntawm cov leeg ntshav yog 70-80%.
Leej twg yuav muaj teeb meem rau lub raum leeg ntshav hlab ntsha
Hauv cov neeg mob uas muaj hom 2 mob ntshav qab zib mellitus, mob ntshav hlab plawv yog qhov tshwj xeeb tshaj. Vim tias lawv thawj zaug tau tsim cov kev mob metabolic, thiab tom qab ntawd lawv cov piam thaj hauv ntshav tseem nyob kom nce ntxiv. Cov teeb meem ntawm cov khoom noj hauv lub cev ua rau atherosclerosis, i.e., txhaws ntawm cov hlab ntsha loj muab lub plawv thiab lub hlwb. Nyob rau tib lub sijhawm, lumen hauv cov hlab ntshav pub rau lub raum kom mus txog.
Nyob rau tebchaws Asmeskas, kev muaj sia nyob ntawm cov neeg mob raum leeg mob hlwb raum tau kawm txog 7 xyoo. Nws muab tawm tias cov neeg mob li no muaj kev pheej hmoo loj heev ntawm kev mob plawv. Nws yog kwv yees li 2 npaug ntau dua qhov kev pheej hmoo ntawm lub raum tsis ua hauj lwm. Ntxiv mus, kev phais mob rov qab los ntawm kev kho plawv raum tsis txo qis txoj kev pheej hmoo ntawm kev tuag los ntawm kev mob plawv lossis mob stroke.
Cov leeg txoj hlab leeg tuaj yeem yog qhov tsis tuaj yeem (monolateral) lossis ob sab sib luag (ob tog). Ob tog - qhov no yog thaum cov hlab ntsha uas pub ob lub raum cuam tshuam. Ib leeg - thaum txoj kev hlub tshua hauv ib lub raum leeg yog qhov chaw tsis taus, thiab lwm qhov nws tseem yog qhov qub. Cov ceg ntawm cov hlab ntsha hauv plab kuj tuaj yeem cuam tshuam, tab sis cov hlab ntsha kuj tsis yog.
Atherosclerotic stenosis ntawm cov hlab ntsha hauv lub raum ua rau mob ischemia (ntshav tsis txaus) ntawm lub raum. Thaum lub raum “tshaib plab” thiab “ua tsis taus pa”, lawv txoj kev ua haujlwm zuj zus. Nyob rau tib lub sijhawm, txoj kev pheej hmoo ntawm lub raum tsis ua haujlwm nce, tshwj xeeb tshaj yog ua ke nrog cov ntshav qab zib nephropathy.
Cov tsos mob thiab kuaj mob
Kev pheej hmoo rau lub raum leeg ntshav hlab plawv yog tib yam li rau "atherosclerosis" zoo tib yam. Peb sau lawv:
- ntshav siab;
- thawj;
- txiv neej tub poj niam;
- txhawb ntau ntau ntawm cov fibrinogen hauv cov ntshav;
- hnub nyoog siab heev;
- haus luam yeeb
- cov roj (cholesterol) tsis zoo thiab cov rog ntshav;
- mob ntshav qab zib mellitus.
Nws tuaj yeem pom tias feem ntau ntawm cov kev pheej hmoo no tuaj yeem kho tau yog tias tus mob ntshav qab zib tau koom nrog nws kev noj qab haus huv thaum tseem hluas lossis nruab nrab hnub nyoog. Yog hais tias stenosis ntawm ib qho ntawm cov hlab ntsha txoj hlab ntsha tawg zuj zus, ces txoj kev ntxim nyiam yuav nce ntxiv tias zaum ob yuav raug kev txom nyem.
Tus kws kho mob yuav xav tias cov mob raum mob ntshav liab rau cov neeg mob ntshav qab zib mellitus thaum cov tsos mob hauv qab no thiab cov ntaub ntawv tsis raug:
- tus neeg mob lub hnub nyoog siab dua 50 xyoo;
- lub raum tsis ua hauj lwm hnyav zuj zus, tib lub sijhawm, proteinuria <1 g / hnub thiab kev hloov pauv ntawm cov zis muaj tsawg;
- kev mob ntshav hauv cov ntshav ntau - ntshav siab yog qhov nce ntxiv, thiab nws tsis tuaj yeem txo nws nrog cov tshuaj;
- muaj cov kab mob vascular pathology (kev mob plawv hauv lub plawv, txhaws cov hlab ntsha loj, suab nrov hauv cov kwv yees ntawm cov hlab plawv hlab ntsha);
- hauv kev kho ntawm ACE inhibitors - nce creatinine;
- tus neeg mob haus luam yeeb ntev;
- thaum kuaj xyuas los ntawm tus kws kho qhov muag - tus cwj pwm duab ntawm lub retina ntawm Hollenhorst cov quav hniav.
Rau kev kuaj mob, ntau txoj kev tshawb fawb tuaj yeem siv uas muab cov duab pom ntawm qhov mob ntawm lub raum cov hlab ntsha. Lawv daim ntawv muaj xws li:
- Ultrasound duplex scanning (ultrasound) ntawm cov hlab ntsha hlaus;
- Xaiv cov ntawv sau keeb kwm
- Magnetic resonance angiography;
- Tham tomography (CT);
- Positron emission tomography (PET);
- Captopril scintigraphy.
Qee qhov ntawm cov qauv no xav tau kev qhia ntawm cov neeg sawv cev sib luag rau hauv cov hlab ntshav, uas tuaj yeem muaj cov nyhuv nephrotoxic, i.e., ua kom lub raum puas tsuaj. Tus kws kho mob tau sau ntawv rau lawv yog tias muaj txiaj ntsig zoo ntawm kev qhia qhov kev kuaj mob ntau tshaj qhov txaus ntshai. Qhov no muaj tseeb tshwj xeeb tshaj yog thaum muaj kev npaj phais mob los npaj kho lub ntsej muag ntawm lub raum.
Kev kho mob raum leeg ntshav hlab ntsha
Txoj kev kho kom zoo ntawm cov hlab ntsha ua rau mob raum yuav tsum muaj kev nruam, kev siv zog los nres kev txhim kho ntawm cov txheej txheem atherosclerotic Lub luag haujlwm tseem ceeb rau lawv nyob ntawm tus neeg mob nws tus kheej thiab nws tsev neeg. Cov npe ntawm cov haujlwm tsim nyog suav nrog:
- txiav luam yeeb;
- normalization ntawm ntshav cov piam thaj;
- txo qis ntshav siab rau qhov qub;
- nyob rau hauv cov ntaub ntawv ntawm lub cev hnyav - poob ceeb thawj;
- cov tshuaj ntawm cov tshuaj - anticoagulants;
- noj tshuaj los ntawm chav kawm ntawm statins los txhim kho cov roj cholesterol thiab triglycerides hauv cov ntshav.
Peb pom zoo kom noj cov zaub mov muaj protein ntau rau hom 1 thiab ntshav qab zib hom 2. Nov yog txoj hauv kev zoo tshaj plaws los txo koj cov ntshav qab zib kom nyob rau li qub thiab yog li tiv thaiv koj ob lub raum los ntawm ntshav qab zib. Kev noj zaub mov kom tsis txhob rog rog tsis tsuas txo qis qab zib, tab sis kuj tseem ceeb triglycerides, "ntshav" thiab "roj" ntshav rog. Yog li, nws yog qhov cuab yeej muaj zog kom txo cov mob atherosclerosis, suav nrog kev txwv tsis pub mob raum leeg. Tsis zoo li cov tshuaj statin, kev noj zaub mov noj tsis muaj kev phom sij tshwm sim. Seem ntawm peb cov raum noj ntshav qab zib yog qhov tseem ceeb rau koj.
Lub raum leeg ntshav hlab ntsha thiab Cov Tshuaj Noj
Txog cov ntshav qab zib muaj teeb meem, cov neeg mob feem ntau tau siv tshuaj los ntawm cov pawg ntawm ACE inhibitors lossis angiotensin-II receptor blockers (ARBs). Yog tias tus neeg mob tau kho cov pob txha tsis muaj ntshav liab tsis zoo, tom qab ntawd nws raug nquahu kom noj cov tshuaj ntxiv. Thiab yog tias stenosis ntawm lub raum ntshaus yog ob sab sib luag, ACE thiab ARB inhibitors yuav tsum tau muab tshem tawm. Vim tias lawv tuaj yeem pab txhawb ntxiv rau kev tsis ua haujlwm ntawm lub raum.
Cov tshuaj los ntawm chav kawm ntawm cov statins txo qis qib "phem" cov rog hauv cov ntshav. Qhov no feem ntau tso cai rau koj nyob ruaj khov atherosclerotic plaques hauv cov hlab ntsha raum thiab tiv thaiv lawv cov kev nruam ntej. Nrog atherosclerotic txhab ntawm lub raum hlab ntsha, cov neeg mob feem ntau yog tshuaj aspirin. Tib lub sijhawm, kev tsim nyog thiab kev nyab xeeb ntawm nws siv nyob rau hauv ib qhov xwm txheej tseem tsis tau muaj pov thawj txaus thiab yuav tsum muaj kev kawm ntxiv. Tib yam mus rau qhov tsis tshua muaj molecular hnyav heparins thiab glycoprotein receptor blockers.
Cov lus qhia rau kev phais mob mob raum leeg ntshav liab (American Heart Association, 2005):
- Hemodynamically tseem ceeb ob tog raum leeg ntshav hlab ntsha;
- Artery stenosis ntawm ib lub raum ua haujlwm;
- Cov unilateral los yog ob tog hemodynamically tseem ceeb lub raum leeg ntshav hlab ntsha, uas ua rau tsis tuaj yeem tswj ntshav siab;
- Mob raum tsis ua hauj lwm nrog unen stenosis;
- Rov ua dua ntawm cov neeg mob ntsws txhaws nrog hemodynamically tseem ceeb stenosis;
- Tsis khov tsis khov angina pectoris nrog hemodynamically tseem ceeb stenosis.
Lus khaws xav Hemodynamics yog kev txav ntshav ntawm cov hlab ntsha. Hemodynamically tseem ceeb hlab ntsha stenosis - ib qho uas ua rau cov ntshav khiav tsis ncaj. Yog tias cov ntshav txaus rau lub raum tseem muaj txaus, txawm tias muaj ntshav khov ntawm lub raum, tab sis txoj kev pheej hmoo ntawm kev phais mob yuav dhau nws cov txiaj ntsig yuav muaj.
