MOB NTSHAV QAB ZIB THIAB CEG MOB LWM YAM. MOB NTSHAV QAB ZIB TAW MOB - KHO

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Mob ntshav qab zib feem ntau ua rau muaj teeb meem rau ob txhais ceg. Ko taw cov teeb meem thoob plaws lub neej tshwm sim hauv 25-35% ntawm txhua tus neeg mob ntshav qab zib. Thiab cov neeg laus dua, qhov ntau dua qhov yuav tshwm sim ntawm lawv qhov tshwm sim. Kab mob ntawm ob txhais ceg nrog ntshav qab zib coj teeb meem ntau rau cov neeg mob thiab kws kho mob. Ceg mob nrog ntshav qab zib - hmoov tsis zoo, ib qho kev daws teeb meem yooj yim no tseem tsis tau muaj. Yuav tau ua kuv qhov zoo tshaj plaws los kho mob. Thiab koj yuav tsum tau kho tsuas yog nrog tus kws kho mob tshaj lij, thiab tsis muaj qhov xwm txheej "tshuaj ntsuab". Hauv tsab xov xwm no, koj yuav kawm yuav ua li cas. Cov hom phiaj kho:

Pab txo qhov mob ntawm ob txhais ceg, thiab zoo dua - tshem tawm tag nrho ntawm lawv;
Txuag lub peev xwm txav "ntawm koj tus kheej."

Yog tias koj tsis them sai sai rau kev tiv thaiv thiab kev kho mob ntawm kev mob ntshav qab zib ntawm ob txhais ceg, tus neeg mob yuav plam ntiv taw lossis ko taw nkaus.

Tam sim no tus neeg mob ob txhais ceg tsis raug mob, vim hais tias kev ua haujlwm kom nthuav tawm cov lumen hauv cov hlab ntsha txhim kho cov ntshav txaus hauv lawv, thiab cov ntaub so ntswg ntawm ob txhais ceg nres xa cov cim mob.

Nrog ntshav qab zib, ob txhais ceg mob, vim tias atherosclerosis tawm dhau nqaim ib lumen hauv cov hlab ntshav. Cov leeg caj ceg tsis tau txais ntshav txaus, "ua tsis taus pa" thiab yog li xa cov cim qhia mob. Kev ua haujlwm los kho cov ntshav ntws hauv cov hlab ntsha ntawm qhov qis qis tuaj yeem daws qhov mob thiab txhim kho lub neej muaj ntshav qab zib.

Muaj ob qho xwm txheej tseem ceeb rau cov teeb meem ceg nrog ntshav qab zib:

Mob ntshav qab zib kom ntshav qab zib muaj feem xyuam rau cov hlab ntsha cov leeg, thiab lawv tsum tsis muaj lub zog hloov pauv. Qhov no hu ua mob ntshav qab zib neuropathy, thiab vim tias nws, ob txhais ceg poob lawv qhov kev nkag siab.
Cov hlab ntshav uas pub txhais ceg txhaws vim yog atherosclerosis lossis kev tsim ua kom muaj ntshav txhaws (ntshav txhaws). Ischemia kev tsim tawm - cov pa oxygen tshaib plab ntawm cov ntaub so ntswg. Hauv qhov no, ob txhais ceg feem ntau raug mob.

Ntshav qab zib mob ko taw

Kev puas tsuaj rau cov hlab ntshav vim cov ntshav tawm suab yog hu ua ntshav qabzib neuropathy. Qhov kev mob ntshav qab zib no ua rau qhov tseeb tias tus neeg mob tsis muaj peev xwm kov nws txhais ceg, mob, siab, kub thiab txias. Tam sim no yog tias nws mob nws sab ceg, nws yuav tsis hnov nws lub siab. Cov neeg mob ntshav qab zib feem ntau hauv qhov xwm txheej no muaj mob rau ntawm txhais ceg thiab txhais taw ntawm tus taw, uas kho tau ntev thiab nyuaj.

Yog tias qhov rhiab ntawm txhais ceg tsis muaj zog, tom qab ntawd cov qhov txhab thiab mob txhab tsis ua rau mob. Txawm hais tias muaj kev puas ntsoog los yog txhuam pob txha ntawm pob txha, ces nws yuav tsis tshua mob. Qhov no yog hu ua tus mob ko taw mob ko taw. Txij li thaum cov neeg mob tsis hnov mob, ntau yam ntawm lawv tub nkeeg heev ua raws li kws kho mob pom zoo. Raws li qhov tshwm sim, cov kab mob ua rau ntau ntxiv hauv cov qhov txhab, thiab vim yog mob caj dab, ceg ntau zaus yuav tsum tau txiav tu.

Mob peripheral leeg mob ntshav qab zib

Yog tias txoj hlab ntaws ntawm txoj hlab ntshav ntog, ces cov nqaij ntawm ob txhais ceg pib “tshaib plab” thiab xa cov cim qhia mob. Qhov mob yuav tshwm sim thaum so lossis tsuas yog thaum taug kev. Hauv kev paub, yog tias koj ob txhais ceg mob ntshav qab zib muaj ntshav qab zib yog qhov zoo. Vim hais tias qhov mob ntawm txhais ceg txhawb cov neeg mob ntshav qab zib kom ntsib kws kho mob thiab kho nrog tag nrho nws lub zog. Hauv tsab xov xwm niaj hnub no, peb yuav xav txog qhov xwm txheej zoo li no.

Cov teeb meem nrog cov hlab ntshav uas pub ob txhais ceg hu ua "kab mob txha caj qaum". Peripheral - txhais tau deb ntawm qhov chaw. Yog hais tias lub lumen hauv cov hlab ntsha tau nqaim, tom qab ntawd feem ntau muaj ntshav qab zib, sib quas ntus claudication tshwm sim. Qhov no txhais tau hais tias vim yog mob hnyav hauv txhais ceg, tus neeg mob yuav tsum tau taug kev qeeb lossis tsum.

Yog tias tus kab mob peripheral artery muaj nrog tus mob ntshav qab zib neuropathy, tom qab ntawd qhov mob yuav mob me lossis tsis tuaj kiag li. Kev sib xyaw ua ke ntawm vascular txhaws thiab poob ntawm qhov mob rhiab ua rau muaj qhov ua tau ntau ntxiv tias tus mob ntshav qab zib yuav tau txiav ib qho lossis ob sab ceg. Vim tias cov nqaij ntawm ob txhais ceg txuas mus ntxiv vim yog "tshaib plab," txawm hais tias tus neeg mob tsis hnov mob.

Yuav ua li cas kev ntsuam xyuas yog tias koj ob txhais ceg mob ntshav qab zib

Nws yog ib qho tsim nyog yuav tsum ua tib zoo tshuaj xyuas koj ob txhais ceg thiab ko taw txhua hnub, tshwj xeeb tshaj yog thaum muaj hnub nyoog laus. Yog tias cov ntshav ntws los ntawm cov hlab ntsha tau cuam tshuam, tom qab ntawd koj tuaj yeem pom cov cim ntxov ntawm qhov no. Cov tsos mob ntawm ib tug thaum ntxov ntawm tus kab mob peripheral leeg:

daim tawv nqaij ntawm ob txhais ceg yuav qhuav;
tej zaum nws yuav pib tev tawm, ua ke nrog ib qho khaus;
pigmentation lossis depigmentation yuav tshwm sim rau daim tawv nqaij;
nyob rau hauv cov txiv neej, cov plaub hau ntawm sab ceg qis tig grey thiab ntog tawm;
daim tawv nqaij yuav dhau los ua daj ntseg tas li thiab txias rau qhov kov;
los yog hloov ua lwm yam, nws tuaj yeem ua kom sov siab thiab tau cov xim cyanotic.

Tus kws kho mob uas paub dhau los tuaj yeem tshawb xyuas los ntawm kov yam twg mem tes ntawm tus neeg mob muaj nyob rau ntawm cov hlab ntsha uas pub cov nqaij ntawm ob txhais ceg. Qhov no suav hais tias yog qhov yooj yim thiab pheej yig tshaj plaws rau kev kuaj kab mob hauv lub cev. Nyob rau tib lub sijhawm, kev ntoj ncig ntawm cov leeg nres lossis thim rov qab tsuas yog thaum nws lumen nqaim los ntawm 90% lossis ntau dua. Nws yog lig dhau lawm los mus tiv thaiv cov ntaub so ntswg “tshaib plab”.

Yog li, lawv siv cov ntaub ntawv tshawb fawb tob dua siv cov khoom siv kho mob niaj hnub no. Xam qhov piv ntawm systolic ("sab sau") siab hauv cov hlab ntsha ntawm txhais ceg qis thiab ceg leeg. Qhov no yog hu ua ankle-brachial index (LPI). Yog tias nws nyob ntawm thaj tsam 0.9-1.2, tom qab ntawd cov ntshav ntws hauv ob txhais ceg yog suav tias yog ib txwm. Kev ntsuas ntshav tes ntiv tes siab yog qhov ntsuas tau.

Pob luj taws-ntu qhia cov lus tsis tseeb yog tias cov hlab ntsha cuam tshuam los ntawm Menkeberg's atherosclerosis, uas yog, lawv tau them nrog "calcareous" teev ntawm sab hauv. Hauv cov neeg laus cov neeg mob, qhov no tshwm sim ntau zaus. Yog li ntawd, cov hau kev xav tau uas muab cov txiaj ntsig tau raug dua thiab ruaj khov. Qhov no tseem ceeb tshwj xeeb tshaj yog thaum kev phais mob tau raug daws tau los kho kom rov zoo vascular patency kom ob txhais ceg tsis raug mob.

Transcutaneous Oximetry

Transcutaneous oximetry yog ib txoj kev tsis muaj mob uas tso cai rau koj soj ntsuam seb cov ntaub so ntswg zoo li cas nrog oxygen. Transcutaneous txhais tau tias “hla ntawm daim tawv nqaij.” Lub ntsuas tshwj xeeb yog siv rau daim tawv nqaij, uas ua rau ntsuas.

Qhov tseeb ntawm qhov kev xeem ntawv nyob ntawm ntau yam:

lub xeev ntawm lub ntsws ntsws ntawm cov neeg mob;
ntshav ntshav hemoglobin theem thiab mob zis;
cov pa oxygen hauv huab cua;
lub thickness ntawm daim tawv nqaij uas lub ntsuas phoo thov;
o lossis o rau thaj tsam ntsuas.

Yog tias tus nqi tau tau yog qis dua 30 hli RT. Daim duab., Tom qab ntawd qhov tseem ceeb ischemia (oxygen starvation) ntawm ob txhais ceg tau kuaj pom. Qhov tseeb ntawm cov qauv ntawm transcutaneous oximetry tsis siab. Tab sis nws tseem siv, vim tias nws pom tau tias yog xov xwm ntau thiab tsis tsim teeb meem rau cov neeg mob.

Ultrasound ntawm cov hlab ntsha muab ntshav rau ob txhais ceg

Kev kuaj ntshav khov (cov duab hluav taws xob) ntawm cov hlab ntsha ntawm cov leeg ntshav qis - siv los ntsuas lub xeev cov ntshav ua ntej thiab tom qab ua tiav kev phais ntawm cov hlab ntsha. Txoj kev no ua rau muaj kev pheej hmoo ntau ntxiv uas nws muaj peev xwm nyob rau hauv lub sijhawm los tshawb nrhiav kev cuam tshuam ntawm cov leeg los ntawm txoj hlab pas lossis rov ua kom qis ntawm lumen hauv cov hlab ntsha tom qab kev phais mob (rov qab kho dua).

Ultrasound ntawm cov hlab ntshav tso cai rau koj los kawm txog thaj chaw muaj teeb meem, uas yog ntu uas "tau muab tua" los ntawm cov hlab ntshav vim qhov tshwm sim ntawm kev loj hlob ntawm tus kab mob. Siv cov txheej txheem no, koj tuaj yeem ua tib zoo xav txog cov xwm txheej ntawm cov hlab ntsha thiab npaj ua ntej kev ua haujlwm kom rov qab tau lawv lub luag haujlwm.

Rov qab los ntawm tus neeg mob uas muaj ntshav qab zib hom 2, nws cov teeb meem ceg ploj tom qab cov ntshav qab zib cov ntshav nce qib ...
Luam tawm los ntawm Sergey Kushchenko Lub Kaum Ob Hlis 9, 2015

Xoo hluav taws xob xoo hluav taws xob sib txawv angiography

Xoo hluav taws xob xoo hluav taws xob xoo hluav taws xob yog kev soj ntsuam uas tus neeg sawv cev sib piv txhaj rau hauv cov hlab ntshav, thiab tom qab ntawd cov hlab ntsha yog "translucent" nrog xoo hluav taws xob. Angiography txhais tau tias "kev soj ntsuam vascular". Nov yog hom kev qhia tshaj plaws. Tab sis nws tsis kaj siab rau tus neeg mob, thiab tseem ceeb tshaj - tus neeg sawv cev tsis sib xws tuaj yeem ua kom lub raum puas. Yog li, nws raug nquahu kom siv nws tsuas yog thaum qhov teeb meem ntawm kev ua haujlwm phais los rov qab vascular patency yog txiav txim siab.

Qib mob ntshav qab zib muaj teeb meem ntawm ob txhais ceg

Muaj 3 qib peripheral ntshav ntws cuam tshuam hauv cov neeg mob ntshav qab zib mellitus.

Qib 1 - tsis muaj cov tsos mob thiab cov tsos mob ntawm tus kab mob txog hlab ntsha hauv ob txhais ceg:

arterial yeej paub ntsoov;
pob taws-brachial Performance index 0.9-1.2;
ntiv tes-lub xub pwg Performance index> 0.6;
transcutaneous oximetry tus nqi> 60 mmHg. Kos duab.

Theem thib 2 - muaj cov tsos mob lossis cov paib, tab sis tseem tshuav tsis txaus oxygen tshaib plab ntawm cov ntaub so ntswg:

sib quas zaws claudication (mob duav);
pob taws-brachial Performance index <0.9, nrog systolic siab hauv cov hlab ntsha ntawm sab ceg qis dua 50 hli RT. st .;
ntiv tes-lub xub pwg Performance index ntawm 30 hli RT. st .;
transcutaneous oximetry 30-60 hli RT. Kos duab.

Qib 3 - tseem ceeb oxygen tshaib plab ntawm cov nqaij (ischemia):

systolic siab hauv cov hlab ntsha ntawm sab ceg qis <50 hli RT. Kos duab. lossis
ntiv tes artery siab <30 mmHg. st .;
transcutaneous oximetry <30 hli Hg. Kos duab.

Yuav kho dab tsi yog tias mob ceg cov ntshav qab zib

Yog tias koj ob txhais ceg mob ntshav qab zib, tom qab ntawv kho yog 3 qhov qhia tias:

nthuav tawm rau yam tseem ceeb uas txhawb kev txhim kho atherosclerosis, suav nrog hauv cov hlab ntsha ntawm ob txhais ceg;
ua tib zoo siv cov lus pom zoo rau kev tiv thaiv thiab kho mob ntawm cov teeb meem ceg, uas tau tham hauv cov ncauj lus kom ntxaws hauv tsab xov xwm "Cov mob ntshav qab zib ko taw";
daws ntawm qhov teeb meem ntawm kev phais neeg txhawm rau kho ntshav kev hauv cov hlab ntsha

Txog thaum nyuam qhuav, nyob rau theem ntawm kev sib quas ntus, cov neeg mob tau raug tshuaj pentoxifylline. Tab sis kev tshawb fawb pom tau tias tsis muaj txiaj ntsig zoo rau cov neeg mob ntshav qab zib uas muaj kab mob txhaws.

Nrog rau cov teeb meem ntshav qab zib ntawm ob txhais ceg, phais kom rov qab los ntshav hauv cov hlab ntsha tuaj yeem tau txais txiaj ntsig zoo. Cov kws kho mob txiav txim siab rau lo lus nug ntawm nws txoj kev coj ua nrog txhua tus neeg mob, coj mus rau hauv nws tus kheej qhov kev pheej hmoo rau kev phais mob.

Cov neeg mob uas mob ceg mob ntshav qab zib, raws li txoj cai, tau tshaj tawm cov kev cuam tshuam ntawm cov metabolism carbohydrate (ntshav qab zib hauv ntshav siab heev), ko taw mob ntshav qab zib, nrog rau kev tshwm sim ntawm lwm cov kev mob ntshav qab zib. Txhawm rau pab lawv tiag tiag, koj yuav tsum koom nrog ib pab kws tshaj lij hauv kev kho mob.

Kev kho mob ntawm tus tsos mob ntawm tus mob ntshav qab zib taw yog ua los ntawm tus kws kho tshwj xeeb (yuav tsum tsis txhob muaj teeb meem nrog tus kws kho mob hlwb). Ua ntej, kev phais mob ntawm kev mob ntawm ko taw tej zaum yuav tsim nyog txhawm rau tiv thaiv kev txhawm chim, thiab tsuas yog tom qab ntawd - kho kom rov qab lees paub txog cov hlab ntshav.

Mob ntshav qab zib thiab mob ceg yam: nrhiav tau

Peb vam tias tsab xov xwm no tau piav qhia rau koj kom meej yuav ua li cas yog tias koj ob txhais ceg mob ntshav qab zib. Nws yog ib qho tsim nyog yuav tsum hloov mus rau lub neej noj qab haus huv nyob rau hauv thiaj li yuav ua kom cov ntshav qab zib thiab nres kev txhim kho atherosclerosis. Nrog kws kho mob, koj yuav muaj peev xwm txiav txim siab txog kev phais mob uas yuav ua kom rov qab tau qhov ywj pheej ntawm cov hlab ntsha ntawm ob txhais ceg. Koj kuj yuav tsum tau tshuaj ntsuam xyuas lwm yam kev mob ntshav qab zib thiab kho lawv.

Thov tsis txhob sim "muffle" qhov mob los ntawm lam ua lam nrog kev pab los ntawm ib co ntsiav tshuaj. Cov kev mob tshwm sim tuaj yeem cuam tshuam koj qhov mob thiab lub neej ntev dua. Sab laj tus kws kho mob tsim nyog. Ntawm cov ntshav qab zib, nws yog ib qho tseem ceeb kom ua tib zoo tswj kev tu cev ko taw txhawm rau txhawm rau ua kom muaj peev xwm txav "ntawm koj tus kheej."

Nyeem kuj cov lus: