Ntshav siab ntshav qab zib kom ntshav qab zib

Kev siab yog thaum ntshav siab nce siab tias cov kev kho mob yuav muaj txiaj ntsig ntau rau tus neeg mob dua li cov kev mob tshwm sim. Yog tias koj muaj ntshav siab txog 140/90 lossis siab dua - nws yog lub sijhawm los kho kom zoo. Vim tias tawg yuav ua rau muaj kev pheej hmoo ntawm lub plawv nres, mob hlab ntsha tawg, lub raum tsis ua haujlwm, lossis dig muag ob peb zaug. Ntawm hom 1 lossis ntshav qab zib hom 2, ntshav siab tshaj plaws yuav pib nce mus rau 130/85 mmHg. Kos duab. Yog tias koj muaj qhov siab tshaj, koj yuav tsum ua txhua yam kom txo nws.

Nrog hom 1 lossis ntshav qab zib hom 2, ntshav siab yog qhov phom sij tshwj xeeb. Vim tias yog tias ntshav qab zib ua ke nrog ntshav siab, qhov kev pheej hmoo ntawm lub plawv tuag nce siab li 3-5 zaug, mob stroke 3-4 zaug, qhov muag tsis pom los ntawm 10-20 zaug, lub raum tsis ua haujlwm los ntawm 20-25 zaug, mob caj pas thiab txhais ceg txhaws tawm - 20 zaug. Nyob rau tib lub sijhawm, ntshav siab tsis yog qhov nyuaj rau qhov ib txwm ua, tshwj tsis yog koj lub raum tau dhau mus.

Ua rau Cov Ntshav Qab Zib Mob Ntshav Qab Zib

Ntawm hom 1 thiab ntshav qab zib hom 2, cov laj thawj ntawm kev txhim kho ntawm txoj kev mob ntshav siab tuaj yeem sib txawv. Hauv hom 1 mob ntshav qab zib mellitus, kub siab nyob rau hauv 80% ntawm cov neeg mob tshwm sim vim yog lub raum puas (mob ntshav qab zib nephropathy). Hauv hom 2 Ntshav Qab Zib, ntshav siab feem ntau yog txhim kho hauv tus neeg mob ntau dua li kev noj haus ua ntej tshaj li cov carbohydrate metabolism cuam tshuam thiab ntshav qab zib nws tus kheej. Tawg yog ib yam ntawm cov metabolic syndrome, uas yog tus precursor rau yam 2 mob ntshav qab zib.

Cov tshwm sim ntawm kev txhim kho tawg hauv ntshav qab zib thiab lawv cov zaus

Sau ntawv rau qhov rooj. Cais tawm systolic cov ntshav siab yog qhov teeb meem tshwj xeeb hauv cov neeg laus. Nyeem ntxiv hauv kab lus “Tus kheej systolic tawg rau cov neeg laus.” Lwm qhov endocrine pathology - nws yuav yog pheochromocytoma, thawj tus kabmob hyperaldosteronism, Itsenko-Cushing's syndrome, lossis lwm yam mob uas tsis tshua muaj mob.

Qhov tseem ceeb ntawm kev kub siab - txhais tau tias tus kws kho mob tsis tuaj yeem tsim qhov ua rau muaj qhov nce ntxiv hauv cov ntshav siab. Yog tias kub siab ua ke nrog kev rog dhau, tom qab ntawd, feem ntau yuav ua rau, cov zaub mov tsis txaus siab rau cov zaub mov carbohydrates thiab nce qib hauv cov tshuaj insulin hauv cov ntshav. Qhov no hu ua "kev mob ua pa", thiab nws teb tau zoo rau kev kho mob. Nws kuj yuav yog:

• magnesium tsis muaj zog hauv lub cev;
• kev nyuaj siab mob ntsws ntev;
• qaug cawv nrog mercury, txhuas lossis cadmium;
• nqaim ntawm cov leeg loj vim yog atherosclerosis.

Thiab nco ntsoov tias yog tias tus neeg mob xav nyob, ces tshuaj yeej tsis muaj zog :).

Yam 1 ntshav qab zib ntshav siab

Ntawm hom 1 mob ntshav qab zib mellitus, qhov tseem ceeb thiab txaus ntshai ua rau muaj kev nyuaj siab ntxiv yog mob raum, tshwj xeeb, mob ntshav qab zib nephropathy. Qhov kev mob tshwm sim no hauv 35-40% ntawm cov neeg mob ntshav qab zib hom 1 thiab mus los ntawm ntau theem:

• theem ntawm microalbuminuria (cov roj me me ntawm cov proteinin tshwm sim hauv cov zis);
• theem ntawm proteinuria (lub raum lim tsis zoo, thiab cov protein ntau tshwm sim hauv cov zis);
• theem ntawm kev mob raum tsis ua hauj lwm.

Raws li Tsoomfwv Meskas Lub Chaw Haujlwm Kev Tshawb Fawb Kev Tshawb Nrhiav Kev Tshawb Fawb (Moscow), ntawm cov neeg mob uas muaj ntshav qab zib hom 1 tsis muaj mob raum, ntshav siab cuam tshuam 10%. Hauv cov neeg mob nyob rau theem ntawm microalbuminuria, tus nqi no nce mus rau 20%, nyob rau theem ntawm proteinuria - 50-70%, nyob rau theem ntawm kev mob raum tsis ua tiav - 70-100%. Cov protein ntau ntau nyob hauv cov zis, qhov siab dua ntawm tus neeg mob cov ntshav - qhov no yog ib qho kev cai thoob plaws.

Tawv ntshav nrog rau kev puas tsuaj rau lub raum pib vim qhov tseeb tias lub raum tsis ua kua ntsev hauv cov zis. Sodium hauv cov ntshav yuav loj dua thiab kua tsim los txhawm rau txhawm rau nws. Ntev dhau heev ntawm lub voj voog ncig ua rau cov ntshav nce ntxiv ntshav siab. Yog tias cov piam thaj hauv ntshav nce ntxiv vim yog cov ntshav qab zib hauv cov ntshav, tom qab ntawd nws nqus cov kua dej ntau nrog nws kom cov ntshav tsis tuab dhau. Yog li, qhov ntim ntawm cov ntshav ncig yog tseem nce.

Tawg ntshav thiab raum mob ua lub voj voog txaus ntshai heev. Lub cev tab tom sim them nyiaj rau cov haujlwm tsis zoo ntawm lub raum, thiab yog li ntawd cov ntshav siab nce siab. Nws, nyeg, nce siab ntxiv hauv glomeruli. Yog li ntawd, hu ua lim tawm cov khoom hauv ob lub raum. Raws li qhov txiaj ntsig, lub glomeruli maj mam tuag, thiab lub raum ua haujlwm zuj zus.

Txoj kev no xaus nrog lub raum tsis ua haujlwm. Hmoov zoo, thaum ntxov ntawm tus mob ntshav qab zib nephropathy, lub voj voog ntawm kev tuaj yeem tuaj yeem tsoo tau yog tias tus neeg mob tau ua tib zoo kho. Qhov loj tshaj plaws yog kom ntshav qab zib kom qis dua qub. ACE inhibitors, angiotensin receptor blockers, thiab tshuaj diuretics kuj pab tau. Koj tuaj yeem nyeem ntxiv txog lawv hauv qab no.

Kub siab thiab hom 2 mob ntshav qab zib

Ntev ua ntej txoj kev loj hlob ntawm tus mob ntshav qab zib "tiag" 2, cov kab mob pib nrog insulin tsis kam. Qhov no txhais tau hais tias qhov rhiab ntawm cov ntaub so ntswg mus rau kev ua ntawm insulin yog txo. Txhawm rau them nyiaj rau cov tshuaj tiv thaiv insulin, ntau cov insulin ntau dhau hauv cov ntshav, thiab qhov no hauv nws tus kheej nce ntshav siab.

Tau ntau xyoo dhau los, cov lumen ntawm cov hlab ntsha nqaim vim yog atherosclerosis, thiab qhov no dhau los ua lwm qhov "tseem ceeb" rau kev txhim kho tawg. Hauv tib lub sijhawm, tus neeg mob tau mob plab rog (ncig ntawm lub duav). Nws ntseeg tau tias daim ntaub adipose tso tawm cov tshuaj rau hauv cov ntshav uas ntxiv cov ntshav siab ntxiv.

Tag nrho cov txheej txheem no hu ua kev mob metabolic. Nws hloov tawm tias kev mob ntshav siab sai sai ua ntej muaj ntshav qab zib hom 2 ntau dua. Nws feem ntau pom nyob rau hauv tus neeg mob tam sim ntawd thaum lawv kuaj pom tias mob ntshav qab zib. Hmoov zoo, cov zaub mov muaj protein tsawg yuav pab tswj hom 2 ntshav qab zib thiab ntshav siab tib lub sijhawm. Koj tuaj yeem nyeem cov ncauj lus hauv qab no.

Hyperinsulinism yog kev nce siab ntawm cov tshuaj insulin hauv cov ntshav. Nws tshwm sim hauv kev teb rau insulin tsis kam. Yog tias tus txiav yuav tsum tsim muaj cov tshuaj insulin ntau dhau, ces nws siv zog “hnyav tawm”. Thaum nws tsum tsis tu thaum lub xyoo, cov ntshav qab zib kom nce thiab hom ntshav qab zib hom 2 tshwm sim.

Yuav ua li cas hyperinsulinism nce ntshav siab:

• qhib kev ua rau cov leeg hlwb tu siab;
• ob lub raum ua haujlwm tawm cov kua ntsev thiab kua dej hauv cov zis;
• sodium thiab calcium ntxiv hauv cov hlwb;
• kev tshaj tawm insulin pab ua kom tuab cov phab ntsa ntawm cov hlab ntshav, uas txo lawv lub cev.

Nta ntawm kev tshwm sim ntawm kev mob ntshav siab hauv ntshav qab zib

Nrog ntshav qab zib, lub ntuj diurnal atherosclerosis ntawm fluctuations nyob rau hauv cov ntshav siab yog cuam tshuam. Feem ntau, hauv ib tus neeg thaum sawv ntxov thiab tsaus ntuj thaum pw tsaug zog, ntshav siab yog 10-20% qis dua thaum nruab hnub. Mob ntshav qab zib ua rau lub fact tias nyob rau hauv ntau cov neeg mob ntshav siab lub zog thaum hmo ntuj tsis poob. Ntxiv mus, nrog kev sib xyaw ua ke ntawm ntshav siab thiab ntshav qab zib, hmo ntuj feem ntau siab dua nruab hnub.

Qhov kev tsis zoo no yog xav tias yog vim mob ntshav qab zib neuropathy. Kev nce ntshav qab zib muaj feem xyuam nrog autonomic lub paj hlwb, uas tswj lub neej ntawm lub cev. Raws li qhov tshwm sim, lub peev xwm ntawm cov hlab ntshav tswj tau lawv lub suab, i.e., kom nqaim thiab so raws li lub nra, muaj teeb meem zuj zus tuaj.

Qhov xaus yog tias nrog kev sib xyaw ntawm kev kub siab thiab ntshav qab zib, tsis tsuas ntsuas ntsuas ib zaug nrog lub tonometer yog qhov tsim nyog, tab sis kuj tseem kuaj xyuas 24 teev nyob rau txhua hnub. Nws yog nqa tawm siv cov khoom tshwj xeeb. Raws li cov txiaj ntsig ntawm txoj kev kawm no, koj tuaj yeem kho lub sijhawm noj thiab ntau npaum li cas ntawm cov tshuaj rau siab.

Kev xyaum qhia tau hais tias cov neeg mob ntshav qab zib hom 1 thiab ntshav qab zib 2 feem ntau yog cov ntsev ntau tshaj cov neeg mob ntshav qab zib uas tsis muaj ntshav qab zib. Qhov no txhais tau tias kev txwv txiav ntsev rau hauv cov khoom noj muaj peev xwm muaj qhov ua tau zoo kho mob. Ntawm cov ntshav qab zib, txhawm rau kho ntshav siab, sim noj ntsev tsawg dua thiab tom qab ib hlis, soj ntsuam seb yuav tshwm sim dabtsi.

Ntshav siab hauv ntshav qab zib feem ntau yog cuam tshuam los ntawm orthostatic hypotension. Qhov no txhais tau hais tias tus neeg mob cov ntshav siab poob qis thaum tsiv los ntawm txoj hauj lwm dag mus rau txoj haujlwm sawv lossis zaum. Orthostatic hypotension qhia qhov tseeb nws tus kheej tom qab kev nce siab hauv kiv taub hau, tsaus nti hauv qhov muag lossis tsaus muag.

Ib yam li kev ua txhaum ntawm lub circadian atherosclerosis ntawm ntshav siab, qhov teeb meem no tshwm sim vim yog txoj kev loj hlob ntawm cov ntshav qab zib neuropathy. Cov leeg hlwb maj mam poob nws lub peev xwm los tswj cov leeg ntshav. Thaum ib tus neeg twg ris sai sai, lub nra yuav nce tam sim ntawd. Tab sis lub cev tsis muaj sij hawm los ua kom cov ntshav ntws los ntawm cov hlab ntsha, thiab vim qhov no, kev noj qab haus huv tau ua kom tsis zoo.

Orthostatic hypotension ua rau kev kuaj ntshav thiab kho ntshav siab. Kev ntsuas ntshav siab hauv ntshav qab zib yog qhov tsim nyog nyob hauv ob txoj haujlwm - sawv ntsug thiab pw. Yog tias tus neeg mob muaj qhov mob no, ces nws yuav tsum sawv txhua zaus, "raws nws txoj kev noj qab haus huv".

Ntshav Qab Zib Ntshav Qab Zib Noj Zoo

Peb lub vev xaib raug tsim los txhawb kev noj zaub mov kom tsis rog rog rau hom 1 thiab ntshav qab zib hom 2. Vim tias kev noj zaub mov carbohydrates tsawg yog qhov zoo tshaj rau txo qis thiab tswj koj cov ntshav qab zib. Koj qhov yuav tsum tau insulin tsawg dua, thiab qhov no yuav pab txhim kho koj cov txiaj ntsig kho kev mob ntshav siab. Vim tias cov insulin ntau dua hauv cov ntshav, cov ntshav siab ntau dua. Peb twb tau sib tham txog cov txheej txheem no hauv kev nthuav dav saum toj no.

Peb pom zoo rau koj cov lus xim:

• Insulin thiab carbohydrates: qhov tseeb koj yuav tsum paub.
• Txoj kev zoo tshaj plaws los txo cov ntshav qab zib thiab ua kom nws nyob li qub.

Kev noj zaub mov kom tsis qab ntsev rau cov ntshav qab zib tsuas yog haum yog tias koj tseem tsis tau tsim lub raum tsis ua haujlwm. Hom noj mov no muaj kev nyab xeeb thiab tau txais txiaj ntsig nyob rau theem microalbuminuria. Vim tias thaum cov ntshav qab zib cov ntshav poob qis rau li qub, ob lub raum pib ua haujlwm zoo li qub, thiab cov ntsiab lus albumin hauv cov zis yuav rov qab zoo li qub. Yog tias koj muaj theem ntawm proteinuria - ceev faj, tham nrog koj tus kws kho mob. Kuj tseem kawm txog tus mob ntshav qab zib lub raum noj.

Kuaj ntshav qab zib kom mus txog qib twg?

Cov neeg mob ntshav siab mob ntshav qab zib mellitus yog cov neeg mob lub siab los yog muaj feem yuav muaj kab mob plawv heev dua. Lawv raug nquahu kom txo cov ntshav siab rau 140/90 hli RT. Kos duab. hauv thawj 4 lub lis piam, yog tias lawv ua siab ntev rau kev siv cov tshuaj zoo. Hauv ob peb lub lim tiam tom qab no, koj tuaj yeem sim txo qis dua mus rau 130/80.

Qhov loj tshaj plaws yog yuav ua li cas tus neeg mob mob siab rau kev siv tshuaj thiab nws cov txiaj ntsig? Yog tias nws tsis zoo, tom qab ntawv txo ntshav siab yuav tsum muaj qeeb dua, nyob hauv ntau theem. Nyob rau txhua qib ntawm cov theem no - los ntawm 10-15% ntawm thawj theem, tsis pub dhau 2-4 lub lis piam. Thaum tus neeg mob hloov kho, nce tshuaj lossis nce qhov ntau npaum li cas ntawm kev noj tshuaj.

Yog tias koj txo cov ntshav siab hauv theem, tom qab ntawd qhov no zam kev ntu kev npau taws thiab yog li txo qis myocardial infarction lossis mob stroke. Qhov qis qis ntawm qhov pib ntawm kev ntsuas ntshav ib txwm yog 110-115 / 70-75 mm RT. Kos duab.

Muaj ntau pab pawg ntawm cov neeg mob ntshav qab zib uas txo lawv cov ntshav siab "siab dua" mus txog 140 mmHg. Kos duab. thiab qis kuj yuav nyuaj heev. Lawv daim ntawv muaj xws li:

• cov neeg mob uas twb muaj cov hom phiaj ua haujlwm, tshwj xeeb tshaj yog lub raum;
• cov neeg mob nrog cov mob plawv;
• cov neeg laus, vim tias muaj hnub nyoog ntsig txog vascular puas tsuaj rau atherosclerosis.

Ntshav qab zib siab Ntsiav tshuaj

Nws yog ib qho nyuaj rau koj xaiv cov tshuaj noj ntshav rau cov neeg mob ntshav qab zib. Vim tias cov roj ntsha tsis ua rau cov metabolism hauv lub cev ua rau cov kev txwv tsis pub siv ntau yam tshuaj, suav nrog rau kev kub siab. Thaum xaiv cov tshuaj, tus kws kho mob yuav siv sij hawm los xyuas seb tus neeg mob tswj nws cov ntshav qab zib li cas thiab cov kab mob sib kis li cas ntxiv rau kev mob ntshav siab, twb tau tsim kho lawm.

Tshuaj zoo ntshav qab zib yuav tsum muaj cov khoom nram qab no:

• txo cov ntshav siab, thiab tib lub sijhawm txo cov kev mob tshwm sim;
• tsis txhob ua kom cov ntshav qab zib tsis txaus, tsis txhob nce qib ntawm cov "phem" cov roj (cholesterol) thiab triglycerides;
• tiv thaiv lub siab thiab lub raum los ntawm kev raug mob uas mob ntshav qab zib thiab ntshav siab ua rau.

Tam sim no, muaj 8 pab pawg ntawm cov tshuaj rau kub siab, ntawm cov 5 uas yog qhov tseem ceeb thiab 3 ntxiv. Cov ntsiav tshuaj, uas zwm rau ntawm cov pab pawg ntxiv, tau sau tseg, raws li txoj cai, ua ib feem ntawm kev sib xyaw ua ke.

Siab Pab Pawg Tshuaj

Hauv qab no peb muab lus pom zoo rau kev tswj hwm cov tshuaj no rau cov neeg mob ntshav siab uas nws nyuaj los ntawm hom 1 lossis ntshav qab zib hom 2.

Diuretics (diuretics) rau kev nyuaj siab

Kev faib tawm ntawm diuretics

Cov ncauj lus kom ntxaws txog tag nrho cov tshuaj diuretic tuaj yeem pom ntawm no. Tam sim no cia peb tham txog yuav ua li cas cov tshuaj diuretics kho ntshav siab hauv ntshav qab zib.

Tawg hauv cov neeg mob ntshav qab zib feem ntau muaj qhov tseeb vim tias qhov ntim ntawm cov ntshav ncig ua si ntau dua. Tsis tas li, cov mob ntshav qab zib tau ua qhov txawv txav los ntawm qhov muaj zog ntxiv rau ntsev. Hauv kev hais txog qhov no, cov tshuaj tso ntshav kho ntshav qab zib feem ntau tau kho mob ntshav siab hauv ntshav qab zib. Thiab rau ntau tus neeg mob, cov tshuaj diuretic pab tau zoo.

Cov kws kho mob txaus siab rau thiazide diuretics vim tias cov tshuaj no txo ​​cov kev pheej hmoo ntawm lub plawv nres thiab mob hlab ntsha tawg hauv cov neeg mob ntshav siab txog li 15-25%. Xws li cov neeg muaj ntshav qab zib hom 2. Nws ntseeg tau hais tias nyob rau hauv cov koob tshuaj me me (sib npaug ntawm hydrochlorothiazide <25 mg ib hnub twg) lawv tsis cuam tshuam tswj ntshav qab zib thiab tsis nce cov roj "phem".

Thiazide thiab thiazide-zoo li cov diuretics yog contraindicated hauv cov neeg mob uas mob raum tsis ua haujlwm. Ntxees diuretics, nyob rau hauv sib piv, yog zoo nyob rau hauv lub raum tsis ua hauj lwm. Lawv tau xaj yog tias kub siab ua ke nrog edema. Tab sis tsis muaj pov thawj qhia tias lawv tiv thaiv lub raum lossis lub plawv. Potassium-sparing thiab osmotic diuretics rau ntshav qab zib tsis siv txhua.

Nrog rau kev kub siab hauv kev sib xyaw nrog cov ntshav qab zib, cov tshuaj thiazide diuretics me me feem ntau yog ua ke nrog ACE inhibitors lossis beta-blockers. Vim tias diuretics ib leeg, tsis muaj lwm yam tshuaj, tsis muaj txiaj ntsig zoo nyob rau hauv cov xwm txheej zoo li no.

Beta blockers

Cov tshuaj los ntawm pawg beta-blocker yog:

• xaiv thiab tsis xaiv;
• lipophilic thiab hydrophilic;
• nrog thiab tsis muaj kev ua si sympathomimetic.

Tag nrho cov no yog cov khoom tseem ceeb, thiab nws raug nquahu kom tus neeg mob siv sijhawm li 10-15 feeb kom nkag siab lawv. Thiab tib lub sij hawm kawm paub txog contraindications thiab phiv ntawm beta-blockers. Tom qab ntawd, koj tuaj yeem nkag siab tias yog vim li cas tus kws kho mob tau sau daim ntawv yuav tshuaj lossis yam tshuaj no.

Beta-blockers yuav tsum raug tshuaj rau tus neeg mob ntshav qab zib yog tias nws kuaj pom qee yam los ntawm cov npe hauv qab no:

• kev mob plawv hauv lub plawv;
• lub plawv tsis ua hauj lwm;
• lub sij hawm mob post-infarction - rau kev tiv thaiv ntawm rov qab myocardial infarction.

Hauv txhua qhov xwm txheej no, beta-blockers txo qis txoj kev pheej hmoo ntawm kev tuag los ntawm cov kab mob plawv thiab lwm yam.

Tib lub sijhawm, beta-blockers tuaj yeem npog cov tsos mob ntawm kev yuav mob ntshav qab zib, thiab ua rau nws nyuaj rau tawm ntawm lub xeev hypoglycemic. Yog li, yog tias tus mob ntshav qab zib ua rau nws tsis nco qab txog lub qog ntshav qab zib, ces cov tshuaj no tuaj yeem muab tshuaj nrog kev ceev faj ntxiv.

Xaiv beta-blockers muaj qhov tsawg tshaj plaws tsis zoo cuam tshuam ntawm cov metabolism hauv ntshav qab zib. Qhov no txhais tau tias yog tias, raws li qhov ntsuas, tus neeg mob yuav tsum noj beta-blockers, ces siv tshuaj cardioselective yuav tsum tau siv. Beta blockers nrog vasodilator kev ua si - nebivolol (Nebilet) thiab carvedilol (Coriol) - tuaj yeem txhim kho cov metabolism hauv carbohydrates thiab cov rog. Lawv nce cov ntaub so ntswg rhiab rau insulin.

Lus khaws xav Carvedilol tsis yog xaiv cov beta-blocker, tab sis nws yog ib qho ntawm cov tshuaj niaj hnub uas siv dav, ua haujlwm zoo thiab, tej zaum, tsis ua kom cov metabolism hauv ntshav qab zib.

Cov niaj hnub beta-blockers, ntau dua li cov tshuaj dhau los, raug pom zoo los muab kev nyiam ua rau kev kho mob rau cov neeg mob ntshav qab zib, nrog rau cov neeg mob uas muaj feem yuav muaj ntshav qab zib hom 2. Hauv kev sib piv, tsis xaiv cov beta-blockers uas tsis muaj vasodilator kev ua si (propranolol) nce qhov kev pheej hmoo ntawm hom ntshav qab zib hom 2.

Lawv txhim kho cov tshuaj insulin nyob rau hauv cov ntaub so ntswg ib feem, thiab tseem nce qib roj "phem" thiab triglycerides (rog) hauv cov ntshav. Yog li, lawv tsis pom zoo rau cov neeg mob ntshav qab zib lossis nrog muaj kev pheej hmoo ntau dua ntawm kev mob ntshav qab zib hom 2.

Calcium Channel Blockers (Cov Hluav Taws Xob calcium Antagonists)

Kev faib tawm ntawm calcium channel blockers

Calcium antagonists yog cov tshuaj rau kub siab, uas feem ntau muaj thoob ntiaj teb. Nyob rau tib lub sijhawm, ntau thiab ntau tus kws kho mob thiab cov neeg mob "ntawm lawv tus kheej daim tawv nqaij" tau ntseeg tias cov ntsiav tshuaj magnesium muaj tib yam li calcium calcium blockers. Piv txwv li, qhov no tau sau rau hauv phau ntawv Reverse Heart Disease Now (2008) los ntawm kws kho mob Asmeskas kws kho mob Stephen T. Sinatra thiab James C. Roberts.

Magnesium deficiency ua rau cov metabolism hauv calcium tsis txaus, thiab qhov no yog qhov ua rau kub siab tshaj. Cov tshuaj los ntawm pab pawg calcium antagonist feem ntau ua rau cem quav, mob taub hau, yaug tawm thiab o ntawm taw. Magnesium npaj, los ntawm qhov tsis sib xws, tsis muaj kev tsis zoo lub neej tshwm sim. Lawv tsis tsuas yog kho kho ntshav siab, tab sis kuj tseem txhawb cov leeg ntshav qab haus huv, txhim kho lub plab ua haujlwm, thiab pab txhawb kev muaj mob ua kom tsis taus mob hauv poj niam.

Koj tuaj yeem nug cov tsev muag tshuaj rau cov tshuaj uas muaj cov tshuaj magnesium. Koj tuaj yeem kawm paub ntau ntxiv txog kev npaj magnesium rau kev kho mob ntshav siab ntawm no. Tshuaj ntxiv Magnesium muaj kev nyab xeeb tag nrho, tshwj tsis yog thaum tus neeg mob tau mob raum. Yog tias koj muaj tus kab mob ntshav qab zib nyob rau theem ntawm lub raum tsis ua haujlwm, sab laj koj tus kws kho mob yog tias nws tsim nyog noj tshuaj magnesium.

Cov calcium calcium blockers hauv kev kho mob hauv nruab nrab tsis cuam tshuam rau cov metabolism ntawm cov carbohydrates thiab cov rog. Yog li, lawv tsis nce txoj kev pheej hmoo ntawm kev tsim cov ntshav qab zib hom 2. Tib lub sijhawm, luv-yeeb yaj kiab dihydropyridines nyob rau hauv nruab nrab thiab siab siab ntxiv ua rau muaj kev pheej hmoo tuag rau cov neeg mob los ntawm kev mob plawv thiab lwm yam.

Calcium antagonists yuav tsum tsis txhob raug rau cov neeg mob ntshav qab zib uas muaj mob plawv, tshwj xeeb yog cov xwm txheej hauv qab no:

• tsis khov ntawm angina pectoris;
• lub sij hawm mob ntawm myocardial infarction;
• lub plawv tsis ua hauj lwm.

Kev siv lub cev ntev dihydropyridines pom tau tias muaj kev nyab xeeb rau cov neeg mob ntshav qab zib uas muaj kab mob hauv lub plawv. Tab sis hauv kev tiv thaiv ntawm myocardial infarction thiab lub plawv tsis ua haujlwm, lawv tau qis dua ACE inhibitors. Yog li no, lawv raug pom zoo kom siv cov tshuaj ACE inhibitors lossis beta blockers.

Rau cov neeg mob laus uas muaj cov kab mob ntshav siab (systolic hypertension), calcium antagonists raug suav tias yog cov tshuaj thib ib rau kev tiv thaiv mob stroke. Tshwj xeeb cov neeg mob ntshav qab zib hom 2. Qhov no siv rau ob qho dihydropyridines thiab tsis-dihydropyridines.

Verapamil thiab diltiazem tau muaj pov thawj los tiv thaiv lub raum. Yog li, nws yog cov calcium calcium blockers uas tau sau tseg rau cov neeg mob ntshav qab zib nephropathy. Calcium antagonists los ntawm cov pab pawg dihydropyridine tsis muaj cov nyhuv nephroprotective. Yog li, lawv tuaj yeem tsuas yog siv ua ke nrog ACE inhibitors lossis angiotensin-II receptor blockers.

ACE inhibitors

ACE inhibitors yog pawg tseem ceeb heev rau kev siv tshuaj kho mob ntshav siab ntshav qab zib, tshwj xeeb yog tias lub raum ua mob lub siab. Ntawm no koj tuaj yeem nrhiav cov ncauj lus kom ntxaws txog ACE inhibitors.

Thov nco ntsoov tias yog tias ib tus neeg mob tsim muaj ob leeg lub raum mob ntshav siab los yog lub raum artery stenosis, ces ACE cov tshuaj tiv thaiv yuav tsum tau tshem tawm. Tib yam mus rau angiotensin-II receptor blockers, uas peb yuav tham txog hauv qab no.

Lwm yam contraindications rau siv ACE inhibitors:

• hyperkalemia (kev theem ntawm cov poov tshuaj hauv cov ntshav)> 6 mmol / l;
• ib qho kev nce hauv cov ntshav creatinine los ntawm ntau dua 30% los ntawm thawj theem nyob rau hauv 1 lub lis piam tom qab pib kev kho mob (muab tes hauv qhov tsom xam - xyuas!);
• cev xeeb tub thiab lub sijhawm pub mis.

Txog kev kho mob lub plawv tsis ua haujlwm ntawm txhua qhov mob hnyav, ACE inhibitors yog thawj cov tshuaj ntawm kev xaiv, suav nrog cov neeg mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2. Cov tshuaj no ua rau muaj kev cuam tshuam ntawm cov nqaij mos rau insulin thiab yog li muaj cov txiaj ntsig ntawm kev txhim kho ntshav qab zib hom 2. Lawv tsis ua kom tsis zoo rau kev tswj cov ntshav qab zib, tsis txhob nce cov "cholesterol" phem.

ACE inhibitors yog qhov # 1 tshuaj rau kev kho mob ntshav qab zib nephropathy. Cov neeg mob ntshav qab zib hom 1 thiab ntshav 2 yog tshuaj ACE inhibitors kom sai li sai tau thaum kev kuaj pom microalbuminuria lossis proteinuria, txawm hais tias ntshav siab tseem nyob li qub. Vim tias lawv tiv thaiv ob lub raum thiab ncua kev txhim kho ntawm lub raum tsis ua haujlwm yav tom ntej.

Yog tias tus neeg mob noj tshuaj ACE inhibitors, tom qab ntawd nws tau hais qhia kom txwv ntsev kom tsawg dua 3 grams nyob rau ib hnub. Qhov no txhais tau tias koj yuav tsum ua zaub mov noj yam tsis muaj ntsev hlo li. Vim tias nws yog ntxiv rau cov khoom tiav thiab cov khoom lag luam tiav. Qhov no yog ntau tshaj li txaus yog tias koj tsis muaj sodium ib yam hauv lub cev.

Thaum kho nrog ACE inhibitors, ntsuas ntshav siab yuav tsum tau ntsuas tas li, thiab ntsuas cov ntshav creatinine thiab poov tshuaj yuav tsum tau saib xyuas. Cov neeg laus uas mob atherosclerosis feem ntau yuav tsum raug kuaj rau ob leeg mob raum leeg mob ua ntej cov tshuaj ACE inhibitors.

Angiotensin-II receptor blockers (angiotensin receptor antagonists)

Koj tuaj yeem pom cov ntaub ntawv ntxaws ntsig txog cov tshuaj tshiab no ntawm no. Txhawm rau kho ntshav siab thiab raum teeb meem nyob rau hauv cov ntshav qab zib, angiotensin-II receptor blockers yog cov tshuaj yog tias tus neeg mob tsim hnoos qhuav los ntawm ACE inhibitors. Qhov teeb meem no tshwm sim hauv kwv yees li 20% ntawm cov neeg mob.

Angiotensin-II receptor blockers yog kim dua ACE inhibitors, tab sis lawv tsis ua rau hnoos qhuav. Txhua yam sau nyob rau hauv cov tshooj lus saum toj no hauv tshooj ntawm ACE inhibitors siv rau cov tshuaj angiotensin receptor blockers. Cov txheej txheem sib txuas yog qhov qub, thiab kev ntsuas tib yam yuav tsum tau coj thaum noj cov tshuaj no.

Nws yog ib qho tseem ceeb kom paub tias angiotensin-II receptor blockers txo sab laug ventricular hypertrophy zoo dua li ACE inhibitors. Cov neeg mob zam rau lawv zoo dua li lwm cov tshuaj rau ntshav siab. Lawv tsis muaj kev mob tshwm sim ntau dua li siv cov placebo.

Rasilez - ib qho ncaj qha inhibitor ntawm renin

Nov yog tshuaj tshiab. Nws tau tsim tom qab li ntawm ACE inhibitors thiab angiotensin receptor blockers. Rasilez tau sau npe hauv tebchaws Russia
thaum lub 7 hli 2008. Cov txiaj ntsig ntawm kev tshawb nrhiav ntev ntev ntawm nws cov txiaj ntsig tseem xav tau.

Rasilez - ib qho ncaj qha inhibitor ntawm renin

Rasilez yog tshuaj ua ke nrog ACE inhibitors lossis angiotensin-II receptor blockers. Xws cov tshuaj sib xyaw ua ke muaj txiaj ntsig zoo rau kev tiv thaiv lub plawv thiab ob lub raum. Rasilez txhim kho cov roj hauv cov ntshav thiab ua rau cov nqaij hauv lub cev tsis txaus siab rau cov tshuaj insulin.

Alpha blockers

Rau kev kho mob ntev ntev ntawm txoj kev hloov kho ntawm txoj kev mob ntshav nce qib, xaiv alpha-1-blockers yog siv. Cov tshuaj hauv pawg no suav nrog:

• prazosin
• doxazosin
• terazosin

Pharmacokinetics ntawm kev xaiv alpha-1-blockers

Phiv los ntawm alpha-blockers:

• orthostatic hypotension, nce txog tsaus muag;
• o ntawm ceg;
• ntsoos ntsoos Mob (ntshav siab jumps "rov qab");
• mob siab tachycardia.

Qee qhov kev tshawb fawb pom tau tias alpha-blockers nce siab ntxiv rau qhov kev pheej hmoo ntawm lub plawv. Txij thaum ntawd los, cov tshuaj no tseem tsis tau nrov heev, tsuas yog qee qhov xwm txheej. Lawv raug kho ua ke nrog lwm cov tshuaj rau kev kub siab, yog tias tus neeg mob muaj benign prostatic hyperplasia.

Ntawm cov ntshav qab zib, nws yog qhov tseem ceeb uas lawv muaj txiaj ntsig zoo ntawm kev zom zaub mov. Alpha-adrenergic blockers qis dua cov ntshav qab zib, ua kom cov nqaij mos rhiab rau insulin, thiab txhim kho cov roj cholesterol thiab triglycerides.

Tib lub sijhawm, lub plawv tsis ua haujlwm yog qhov tsis sib xws rau lawv siv. Yog tias tus neeg mob tau mob lub cev neonpathy nrog orthostatic hypotension, ces cov tshuaj alpha-adrenergic blockers tsis tuaj yeem nqa tshuaj.

Yam tshuaj twg los xaiv rau kev kho mob ntshav siab hauv ntshav qab zib?

Xyoo tsis ntev los no, ntau thiab ntau tus kws kho mob tau mob siab ntseeg tias nws zoo dua yog tias tsis sau ib qho, tab sis tam sim ntawd 2-3 cov tshuaj los kho ntshav siab. Vim tias cov neeg mob feem ntau muaj ntau lub zog ntawm kev loj hlob ntawm tib lub sijhawm, thiab ib qho tshuaj tsis tuaj yeem cuam tshuam rau txhua tus ua. Vim tias cov tshuaj siab tau muab faib ua pab pawg, lawv coj tus cwj pwm sib txawv.

Ib qho tshuaj kho mob tuaj yeem txo qhov siab mus rau qhov ib txwm tsis ntau tshaj 50% ntawm cov neeg mob, thiab txawm hais tias kub siab thaum pib muaj ntsis. Tib lub sijhawm, kev sib xyaw ua ke pub koj siv cov tshuaj me dua, thiab tseem tuaj yeem ua tiav zoo dua. Tsis tas li ntawd, qee cov ntsiav tshuaj ua kom tsis muaj zog lossis tshem tawm cov kev mob tshwm sim ntawm ib leeg.

Kev kub siab tsis txaus ntshai rau nws tus kheej, tab sis cov teeb meem uas nws ua. Lawv cov npe suav nrog: mob plawv, mob stroke, lub raum tsis ua haujlwm, dig muag. Yog tias ntshav siab ua ke nrog ntshav qab zib, tom qab ntawv qhov kev pheej hmoo ntawm cov kev mob tshwm sim ntau zaus. Tus kws kho mob ntsuas qhov kev pheej hmoo no rau tus neeg mob tshwj xeeb thiab tom qab ntawd txiav txim siab yuav pib kho nrog ib ntsiav tshuaj lossis siv cov tshuaj sib xyaw tam sim ntawd.

Cov lus piav qhia rau daim duab: HELL - ntshav siab.

Lub Lavxias Association of Endocrinologist pom zoo rau kev kho mob hauv qab no los kho mob ntshav qab zib hauv kev mob ntshav qab zib. Ua ntej tshaj plaws, ib qho tshuaj angiotensin receptor blocker lossis ACE inhibitor yog tshuaj. Vim tias cov tshuaj los ntawm cov pab pawg no tiv thaiv lub raum thiab lub plawv zoo dua li lwm cov tshuaj.

Yog tias monotherapy nrog ACE inhibitor lossis angiotensin receptor blocker tsis pab txhawm rau txo cov ntshav siab txaus, nws raug nquahu kom ntxiv cov diuretic. Twg diuretic los xaiv nyob ntawm kev khaws cia ntawm lub raum ua haujlwm hauv tus neeg mob. Yog tias tsis muaj mob raum tsis ua haujlwm, thiazide diuretics tuaj yeem siv. Cov tshuaj Indapamide (Arifon) yog suav tias yog ib qho tshuaj lom zoo tshaj plaws tshuaj los kho tus mob ntshav siab. Yog tias lub raum tsis ua haujlwm twb tau tsim, lub voj tshuaj diuretics raug kho.

Cov lus piav qhia rau daim duab:

• HELL - ntshav siab;
• GFR - tus nqi ntawm glomerular pom ntawm lub raum, kom paub cov ntsiab lus ntxiv pom "Dab tsi yuav tsum tau ua los ntsuas koj lub raum";
• CRF - mob raum tsis ua haujlwm;
• BKK-DHP - dihydropyridine calcium channel blocker;
• BKK-NDGP - tsis-dihydropyridine calcium channel blocker;
• BB - beta blocker;
• ACE inhibitor - ACE inhibitor;
• ARA yog tshuaj tua kab mob angiotensin receptor antagonist (angiotensin-II receptor blocker).

Nws raug nquahu kom siv tshuaj uas muaj 2-3 yam tshuaj nyob hauv ib ntsiav tshuaj. Vim tias cov tshuaj me dua, cov neeg mob ntau txaus siab nqa lawv.

Daim ntawv luv luv ntawm cov tshuaj suav ua ke rau kev kub siab:

• Korenitec = enalapril (renitec) + hydrochlorothiazide;
• foside = fosinopril (monopril) + hydrochlorothiazide;
• co-diroton = lisinopril (diroton) + hydrochlorothiazide;
• gizaar = losartan (cozaar) + hydrochlorothiazide;
• noliprel = perindopril (prestarium) + thiazide-zoo li diuretic indapamide retard.

ACE inhibitors thiab calcium channel blockers ntseeg tau kom pab txhawb ntxiv ib leeg muaj peev xwm tiv thaiv lub plawv thiab raum. Yog li, cov tshuaj sib xyaw ua ke hauv qab no feem ntau sau tseg:

• tarka = trandolapril (hopten) + verapamil;
• prestanz = perindopril + amlodipine;
• txoj kab nruab nrab = lisinopril + amlodipine;
• exforge = valsartan + amlodipine.

Peb qhia ceeb toom rau cov neeg mob: tsis txhob sau ntawv rau koj tus kheej cov tshuaj rau kev kub siab. Koj tuaj yeem mob hnyav rau cov kev mob tshwm sim, txawm tias tuag. Nrhiav kws kho mob uas tsim nyog thiab tiv tauj nws. Txhua xyoo, tus kws kho mob soj ntsuam ntau pua tus neeg mob ntshav siab, thiab vim li ntawd nws tau tsim cov kev coj ua, cov tshuaj ua haujlwm thiab cov twg zoo dua.

Kev kub siab thiab ntshav qab zib: cov lus xaus

Peb cia siab tias koj pom cov ntawv no yuav pab tau rau cov ntshav siab mob ntshav qab zib. Ntshav siab ntshav qab zib yog ib qho teeb meem loj rau cov kws kho mob thiab cov neeg mob lawv tus kheej. Cov khoom siv uas tau hais ntawm no yog txhua yam. Hauv tsab xov xwm “Ua rau Cov Kev Ntshav Ntseg thiab Yuav Tsum Li Cas. Kev ntsuam xyuas mob ntshav siab ”koj tuaj yeem tshawb nrhiav qhov kev qhia paub yam twg uas koj xav tau kom ua tiav rau txoj kev kho kom zoo.

Tom qab nyeem peb cov ntaub ntawv, cov neeg mob yuav tuaj yeem nkag siab zoo dua qub ntawm kab mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2 kom thiaj li ua raws li cov tswv yim kho tau zoo thiab txuas ntxiv rau lawv lub neej thiab kev muaj peev xwm. Cov ntaub ntawv hais txog cov tshuaj siab yog qhov kev teeb tsa zoo thiab yuav pab kom yooj yim "cov ntawv dag" rau cov kws kho mob.

Peb xav hais qhia ib zaug ntxiv tias kev noj zaub mov kom tsis muaj carbohydrate yog ib qho txiaj ntsig zoo los txo cov ntshav qab zib hauv ntshav qab zib, nrog rau cov ntshav siab li qub. Nws yog ib qho txiaj ntsig kom ua raws li kev noj haus no rau cov neeg mob ntshav qab zib tsis yog ntawm tus kabmob thib 2, tabsis txawm tias yam 1, tshwj tsis yog muaj mob raum.

Ua raws li peb cov ntshav qab zib hom 2 lossis phiaj xwm ntshav qab zib hom 1. Yog tias koj txwv tsis pub cov khoom noj carbohydrates hauv koj qhov kev noj haus, nws yuav ua rau kom koj tuaj yeem nqa koj cov ntshav siab rov qab zoo li qub. Vim tias cov tshuaj insulin tsawg tsawg hauv cov ntshav, yuav ua kom yooj yim dua.