Bronchial hawb pob thiab ntshav qab zib mellitus tshwm sim tawm tsam keeb kwm ntawm kev ua haujlwm tsis ua tiav ntawm lub cev tsis muaj zog. Mob ntshav qab zib mellitus tshwm sim ua tus kabmob autoimmune nrog rau kev tsim cov tshuaj tiv thaiv rau cov kabmob ua rau pancreatic hlwb ntawm nws tus kheej. Hauv cov kab mob ntsws asthma, cog paj ntoos, zaub mov, tsiaj plaub hau, thiab kab mob ua yeeb yam.
Hauv kev tshawb nrhiav ntawm kev sib raug zoo ntawm cov kab mob no, tau pom tias ib puag ncig muaj kev cuam tshuam rau kev loj hlob ntawm ob hom 1 mob ntshav qab zib mellitus thiab kev tiv thaiv kab mob ntsws-mob ntsws asthma. Txoj kev pheej hmoo ntawm hawb pob hauv cov neeg mob ntshav qab zib tau ntau dua li cov neeg tsis muaj cov kabmob autoimmune.
Nws kuj tseem muaj kev pheej hmoo ntawm qhov tsis txaus ntawm cov metabolism ua cov metabolism rau asthmatics uas siv glucocorticosteroids rau kev kho mob. Nrog rau kev sib xyaw ua ke no, kev txhim kho cov ntshav qab zib, raws li kev mob tshwm sim ntawm kev kho mob steroid, tsis tshua muaj cov kab mob pob txha los yog lwm cov kev mob tshwm sim, tab sis tag nrho cov tshuaj steroids thiab beta-receptor stimulates ua rau mob ntshav qab zib uas twb muaj lawm.
Ua rau kev loj hlob thiab cov tsos mob ntshav qab zib
Ib qho ntawm cov ua rau ntshav qab zib, tshwj xeeb yog thawj hom, yog tus mob muaj keeb, muaj ntshav qab zib hauv niam txiv nce qhov kev pheej hmoo ntawm kev loj hlob ntawm tus menyuam ntau dua 40 feem pua.
Rau hom 1 ntshav qab zib mellitus, kuj tseem muaj kev sib txuas nrog kev kis tus kab mob yav dhau los lossis autoimmune. Mob ntshav qab zib tuaj yeem yog ib qho kev cuam tshuam ntawm cov qog ntshav hlav ntshav lossis mob ntshav qab zib.
Kev mob siab ntsws, nrog rau cov kab mob ntawm cov endocrine system - lub qog ua haujlwm lub qog, cov qog ua rau lub qog ua haujlwm lossis lub qog pituitary, ua rau cov tshuaj tsis txaus hauv lub cev thiab ua rau cov ntsiab lus ntawm cov tshuaj tiv thaiv kabmob hauv cov ntshav.
Hom 2 tsis muaj ntshav qab zib hom mob ntshav qab zib feem ntau yuav txhim kho rau cov laj thawj hauv qab no:
- Hauv tib neeg tom qab 45 xyoo
- Nrog rog dhau lawm, tshwj xeeb tshaj yog lub plab rog hom kev rog.
- Atherosclerosis, tiv thaiv ntshav siab thiab dyslipidemia.
- Arterial kub siab.
- Kev noj tshuaj - cov tshuaj hormones, beta-blockers, thiazide diuretics.
Rau kev kuaj mob ntawm hom 1 mob ntshav qab zib mellitus, cov cim nquag raug coj mus rau hauv tus account: nce tsis muaj zog, nce tso zis, tso zis nyob rau yav hmo ntuj, tso zis poob. Ua kom tso zis ntxiv yog teev. Cov neeg mob hnov lub qhov nqhis tas li thiab lub qhov ncauj qhuav, uas tsis ploj mus tom qab haus dej.
Cov hlab ntsha tsis tu ncua, hloov pauv mus ob peb vas, thiab txob taus, nrog rau nkees thiab qaug zog hauv ntshav qab zib mellitus, muaj kev cuam tshuam ntawm cov piam thaj hauv lub hlwb cov hlwb, raws li lub cev nkag siab tshaj plaws rau kev noj zaub mov tsis zoo.
Ib qib nce ntxiv ntawm cov piam thaj hauv cov ntshav ua rau khaus ntawm daim tawv nqaij thiab ua xua ntawm cov qog ua kua, nrog rau cov perineum. Qhov sib ntxiv ntawm cov kab mob fungal nyob rau hauv daim ntawv ntawm candidiasis txhim kho cov tsos mob no.
Ib qho ntxiv, cov neeg mob ntshav qab zib yws yws ntawm khaus lossis khaus ntawm tus taw thiab txhais tes, tawv nqaij ua pob, txhaws ntsej muag, mob lub plawv, thiab hloov tawm ntawm cov ntshav siab.
Yog hais tias cov tsos mob muaj tshwm sim tsis tseg thiab ploj mus, tom qab ntawd kev kuaj mob tuaj yeem tshwm sim lig - thaum lub caij txhim kho cov teeb meem (ketoacidosis).
Hauv cov neeg mob uas muaj ntshav qab zib ntau, xeev siab, ntuav thiab mob plab nce ntxiv, qhov tsis hnov ntxhiab ntawm acetone tshwm nyob rau hauv cov pa uas ua pa tawm, qhov ketoacidosis muaj mob hnyav, kev nco qab yog qhov tsis muaj zog, tus neeg mob poob rau hauv lub cev tsis nco qab, nrog rau kev tawm tsam thiab lub cev qhuav dej.
Txhawm rau kom paub tseeb tias kev kuaj ntshav qab zib, kev kuaj ntshav ceev ceev yog qhov ua - nrog ntshav qab zib, ntshav qabzib siab dua li 6.1 mmol / l, thaum siv cov ntshav qabzib kam kuaj 2 teev tom qab kev tawm dag zog, nws ntau dua 7.8 mmol / l. Ntxiv rau qhov no, cov tshuaj tiv thaiv tshwj xeeb, glycated hemoglobin, raug sim.
Cov xwm txheej thiab tsos mob ntawm tus mob ntsws asthma
Bronchial hawb pob tshwm sim nrog spasm ntawm txoj hlab ua pa nyob rau hauv tus ntawm yam tshwj xeeb. Nws muaj keeb caj ces hauv kev txhim kho hauv daim ntawv ntawm qhov muaj keeb muaj keeb rau kev tsis haum.
Nws tuaj yeem tsim kev npau taws los ntawm kev haus luam yeeb, muaj kev nkag siab zoo ntawm lub bronchi rau cov pa paug los ntawm cov plua plav, cov pa roj thiab cov pa luam yeeb tsim tawm. Mob hawb pob feem ntau tshwm sim tom qab kis kab mob los yog kab mob, txo lub cev, mob nyhav lub cev, thiab raug mob hauv siab.
Cov tsos mob tshwm sim ntawm tus mob hawb pob yog hnoos nrog mob hawb pob, ua tsis taus pa, tus cwj pwm whistling thiab hawb pob hauv lub ntsws.
Rau mob ntsws asthma, cov cim tseem ceeb yog:
- Kev mob rau tsev neeg (mob hawb pob, mob pob txuv atopic dermatitis, quav nyab kub taub hau, rhinitis).
- Qhov tshwm sim ntawm kev ua xua tom qab sib cuag nrog cov nroj tsuag lossis tsiaj txhu, nrog cov kab mob ua pa.
- Kev hnoos thiab hawb pob ua rau muaj zog hmo ntuj, tom qab kev tawm dag zog lub cev, hloov huab cua.
Bronchial hawb pob hauv ntshav qab zib tshwm sim ntau nrog thawj, hom tshuaj insulin. Tsis muaj kev cuam tshuam los ntawm hom 2 mob ntshav qab zib thiab qhov tshwm sim ntawm hawb pob.
Steroid-tiv taus mob hawb pob thiab ntshav qab zib
Hauv cov neeg mob hawb pob uas muaj mob ntshav qab zib steroid, chav kawm hawb pob yog feem ntau mob hnyav, uas yog qhov laj thawj ntawm kev teem caij cov tshuaj steroids. Lawv siv nyob rau hauv cov koob tshuaj siab los yog lub sijhawm ntev ntev ua rau cov rog. Tshaj lub cev nyhav dhau los tuaj yeem ua rau apnea thaum hmo ntuj lossis nyuaj rau hnoos. Kev pham muaj peev xwm ua rau cov tsos mob ntshav qab zib ntau dua.
Hauv cov neeg mob feem ntau uas mob ntsws asthma, lawv tswj kom txo cov qaug dab peg los ntawm kev nqus cov pa glucocorticosteroids. Hauv qee tus neeg mob, qhov no tsis muab cov nyhuv xav ua rau qhov kev nthuav dav ntawm lub ntsws, txawm tias thaum siv cov tshuaj steroids sab hauv lossis raws li kev txhaj tshuaj.
Cov neeg mob zoo li no yog suav tias yog tshuaj tiv thaiv steroid. Steroid tsis kam yog qhov tseeb yog tias qhov kev quab yuam ua kom hnyav hauv 1 s (raws li ntsuas los ntawm spirometry) - FEV 1 tsis nce ntau dua los ntawm ntau dua 15% los ntawm kev nqus ntawm ib tus betamimetic tom qab noj 40 mg ntawm prednisolone ib hnub rau ib lub lim tiam.
Rau kev kuaj mob ntawm tus mob steroid-resistant hawb pob, kev sim hauv qab no yog yuav tsum tau ua:
- Kawm txog lub ntsws muaj nuj nqi thiab Tiffno qhov ntsuas.
- Teeb lub cim ntawm bronchial nthuav qhia tom qab 200 mcg ntawm salbutamol.
- Ua ib qho tshuaj ntsuam histamine.
- Nrog mob bronchoscopy, tshuaj xyuas qib ntawm eosinophils, cytology thiab kuaj me ntawm bronchi.
- Tom qab 2 lub lim piam ntawm kev noj tshuaj Prednisolone, rov ua cov kev kuaj mob.
Qhov sib txawv ntawm cov chav kawm txog mob ntsws asthma yog tus cwj pwm los ntawm kev tawm tsam ntau thiab mob hnyav uas yuav tsum tau mus pw hauv tsev kho mob, suav nrog cov chaw tu mob hnyav, qhov txo lub neej zoo.
Yog li, ntxiv rau kev nqus tau cov tshuaj steroids, cov neeg mob zoo li no tseem siv los ntawm qhov ncauj lossis los ntawm kev txhaj tshuaj. Cov kev kho mob zoo li no ua rau Itenko-Cushing's syndrome thiab steroid ntshav qab zib. Ntau zaus, cov poj niam hnub nyoog 18 txog 30 xyoo muaj mob.
Cov yam ntxwv ntawm kev kho mob hawb pob mob ntshav qab zib
Cov teeb meem tseem ceeb ntawm kev kho tus mob ntsws asthma hauv cov ntshav qab zib yog kev siv cov tshuaj nqus, vim tias beta-receptor stimulants nyob rau hauv bronchi thiab mauj tshuaj corticosteroids nce ntshav qab zib.
Glucocorticosteroids ua rau kom cov glycogen thiab kev tsim cov piam thaj nyob rau hauv daim siab, betamimetics txo qis rhiab rau insulin. Salbutamol, ntxiv rau ua rau cov ntshav qabzib ntau dua, muaj kev pheej hmoo rau cov teeb meem zoo li ntshav qab zib ketoacidosis. Kev kho mob Terbutaline nce qib suab thaj los ntawm kev ua kom muaj zog ntawm cov glucagon, uas yog insulin antagonist.
Cov neeg mob noj beta cov tshuaj tiv thaiv kab mob vim tias nqus tau cov tshuaj tiv thaiv ntshav qog tsawg dua li siv cov tshuaj steroid. Nws yooj yim dua rau lawv los tswj cov ntshav qab zib kom nyob ruaj.
Kev kho thiab tiv thaiv mob hawb pob thiab mob ntshav qab zib yog ua raws cov qauv hauv qab no:
- Kev soj ntsuam los ntawm tus kws kuaj mob endocrinologist thiab kws kho ntsws, tus mob kev phiv tshuaj.
- Cov khoom noj kom zoo thiab tiv thaiv kev rog.
- Tswj lub cev ua si.
- Kev tswj nruj ntawm cov ntshav qab zib thaum siv cov tshuaj steroids.
Rau cov neeg mob uas muaj mob hawb pob bronchial, ua tiav kev haus luam yeeb yog qhov tsim nyog, vim tias qhov txiaj ntsig no ua rau muaj kev tawm tsam ntau zaus thiab ua rau muaj kev ua txhaum ntawm cov ntshav ncig, vasospasm. Hauv cov ntshav qab zib mellitus, nyob rau hauv cov xwm txheej ntawm angiopathy, haus luam yeeb nce qhov kev pheej hmoo ntawm kev mob ntshav qab zib neuropathy, mob plawv, rhuav tshem ntawm glomeruli ntawm lub raum thiab lub raum tsis ua haujlwm.
Txog kev teem caij glucocorticosteroids hauv ntsiav tshuaj nrog rau kev kawm ua ke ntawm tus mob ntshav qab zib mellitus thiab bronchial hawb pob, yuav tsum muaj kev ntsuas nruj heev. Cov no suav nrog kev mob hawb pob ntau zaus thiab tsis tuaj yeem tswj hwm, tsis muaj kev cuam tshuam los ntawm kev siv tshuaj steroids los ntawm kev nqus pa.
Rau cov neeg mob uas twb tau sau cov tshuaj glucocorticoid npaj rau hauv cov ntsiav tshuaj lossis xav tau kom muaj cov tshuaj hormones ntau heev, Prednisolone qhia rau tsis pub dhau kaum hnub. Kev suav ntawm qhov koob tshuaj yog nqa tawm hauv ib phaus ntawm lub cev qhov hnyav hauv ib hnub, tsis pub ntau tshaj 1-2 mg ib kg.
Qhov laj thawj ntawm feem ntau rau kev txhim kho cov ntshav qab zib steroid thiab cov teeb meem ntawm tus kab mob uas twb muaj lawm yog kev teem caij cov tshuaj steroid uas tuaj yeem tsim lub depot hauv lub cev. Cov tshuaj no txwv cov kev ua haujlwm ntawm cov qog adrenal thiab lawv tsis tuaj yeem raug sau cia hauv ib ntus. Cov tshuaj no suav nrog: Dexamethasone, Polcortolone thiab Kenalog.
Cov txiaj ntsig ntawm kev siv hawb pob thiab mob ntshav qab zib yog:
- Txoj kev haus tshuaj nyab xeeb tshaj plaws uas muaj cov tshuaj steroids yog Budesonide. Nws tuaj yeem siv rau hauv menyuam yaus thiab neeg laus, nrog rau cov lus hais tseg rau cov poj niam cev xeeb tub.
- Pulmicort nyob rau hauv daim ntawv ntawm cov tshuaj tua kab mob tuaj yeem siv los ntawm 1 xyoos, siv ntev, uas tso cai rau koj tsis kam Prednisolone ntsiav tshuaj. Cov hmoov qhuav qhuav hauv lub tshuab raj txiav tu yog tsim tawm txij li 6 xyoo.
- Kev kho nrog fluticasone propionate hauv lub nebulas tuaj yeem siv hom kev kho mob monotherapy thiab tsis tas yuav ntxiv cov tshuaj ntawm cov tshuaj systemic.
Thaum kawm txog cawv ntawm ultraviolet sab kev tiv thaiv kev txhim kho ntawm cov kab mob nrog lub cev tsis muaj zog tiv thaiv kab mob, nws tau pom tias kev tsim cov vitamin D hauv daim tawv nqaij txo cov ntshav qab zib. Yog li, cov menyuam yaus hnub nyoog qis dua ib xyoos uas tau noj cov tshuaj vitamin A rau kev tiv thaiv rickets tsis tshua muaj kev kuaj mob ntshav qab zib.
Vitamin D tau qhia rau txhua tus neeg mob uas noj tshuaj prednisolone los tiv thaiv txha, uas feem ntau yog kev phiv los ntawm tshuaj steroids.
Txhawm rau tiv thaiv cov kev mob ntshav qab zib hauv kev kho mob hawb pob, cov neeg mob tau qhia kom ua raws li kev noj zaub mov nrog kev txwv tsis pub muaj carbohydrates thiab zaub mov yooj yim uas tuaj yeem ua rau muaj kev tsis haum.
Kev tshuaj xyuas tas li ntawm theem ntawm cov metabolism hauv cov metabolism thiab cov kev hloov kho koob tshuaj thaum kho mob glucocorticoids yog qhov tsim nyog. Nws yog qhov zoo dua los siv cov pa tshuaj ntawm txoj kev tswj hwm, thiab yog tias tsim nyog, nqa tawm kev kho mob nrog prednisolone hauv cov chav kawm luv. Yuav kom nce qib ntawm kev ua haujlwm hauv lub cev, kev tawm dag zog lub cev thiab kev tawm dag zog ua pa rau ntshav qab zib tau pom zoo. Daim vis dis aus hauv tsab xov xwm no yuav piav qhia tias vim li cas hawb pob thiaj li txaus ntshai rau ntshav qab zib.
