Lub yeej ntawm cov ntsiab ntawm lub hauv nruab nrab thiab peripheral lub paj hlwb tiv thaiv keeb kwm ntawm ntshav qab zib yog hu ua ntshav qab zib mob neuropathy. Qhov no yog cov tsos mob nyuaj, uas yog kev tsis sib haum xeeb ntawm lub xeev ua haujlwm ntawm txhua txoj hlab ntaws tiv thaiv cov keeb kwm yav dhau los ntawm kev hloov pauv uas tshwm sim me me-caliber cov hlab ntsha. Mob neuropathy mob ntshav qab zib (raws li ICD-10 - G63.2 *) yuav tsum muaj kev soj ntsuam sai ntawm qhov mob thiab kev teem sij hawm kho mob kom zoo thiaj li rov qab ua haujlwm ploj thiab txhim kho tus neeg mob lub neej zoo.
Kev faib tawm
Thaum kuaj, kab mob raug pom hauv txhua tus neeg mob thib peb 10-15 xyoo tom qab pib mob ntshav qab zib. Qhia qhov txawv ntawm neuropathy ntawm qhov nruab nrab thiab ntu ntu. Kev puas tsuaj rau lub hlwb thiab pob txha caj qaum yog koom nrog txoj hauv kev thiab kab mob no tau muab faib ua tej yam hauv qab no:
- mob tsis zoo nyob rau tom qab ntawm kev puas tsuaj rau cov kev teeb tsa ntawm nruab nrab lub paj hlwb;
- mob kev nrawm nrog cerebrovascular;
- cuam tshuam ntawm lub hlwb kev ua haujlwm tiv thaiv keeb kwm ntawm lub raum pathology;
- cov leeg mob hlwb;
- cov kab mob encephalopathy mob ntshav qab zib;
- myelopathy tiv thaiv ntshav qab zib.
Tus kws mob ntshav qab zib mob paj hlwb tseem muaj faib nyob rau chaw haujlwm:
- rhiab - rhiab cov leeg puav leej koom nrog hauv cov txheej txheem;
- lub cev muaj zog - ua tsis tau zoo ntawm lub cev muaj zog;
- sensorimotor - kev puas tsuaj rau lub cev muaj zog thiab kev hnov ntawm cov leeg hlwb;
- autonomous - neuropathy ntawm plab hnyuv siab raum.
Raws li cov yam ntxwv ntawm cov kev kuaj mob, cov kab mob ntshav qab zib hauv qab no tau txawv:
- subclinical type - tsuas yog pauv hloov lub sijhawm kuaj xyuas pom muaj tus kab mob pathology, tus neeg mob tsis muaj kev tsis txaus siab;
- saib mob hom: cov mob hnyav, nrog mob; daim ntawv ntev nrog mob; soj ntsuam cov tsos mob tsis muaj mob.
- cov nyom (mob ntshav taw, cov mob neuropathic deformities).
Tus txheej txheem ntawm kev txhim kho pathology
Tawm tsam keeb kwm ntawm ntshav qab zib mellitus, nquag hyperglycemia (ib qho kev nce ntxiv hauv cov ntshav qab zib) tau pom. Qhov no tuaj yeem vim qhov tsis ua tiav ntawm lub cev ua kom lub zog ua kom tsis txhob muaj cov tshuaj insulin txaus (yam kab mob 1) lossis tshwm sim los ntawm qhov kev cuam tshuam qis ntawm cov hlwb thiab cov nqaij ntawm lub cev mus rau insulin thaum nws ua haujlwm txawv (hom 2).
Hyperglycemia yog qhov ua rau kev loj hlob ntawm cov ntshav qab zib muaj teeb meem.
Cov piam thaj ntau yog cuam tshuam rau tag nrho cov txheej txheem metabolic. Ntawm cov leeg endothelium, sorbitol, glycosylated proteins, ntau ntxiv. Qhov no ua rau muaj kev hloov pauv ntawm cov kev ua haujlwm ib txwm thiab cov qauv ntawm cov hlab hlwb (neurons). Oxygen kev tshaib plab thiab cov cheeb tsam uas tsis muaj ntshav txaus pab ntxiv rau kev txhim kho oxidative kev nyuaj siab. Qhov tshwm sim yog qhov tsis muaj neurotrophic yam thiab kev txhim kho mob ntshav qab zib neuropathy.
Soj ntsuam duab
Cov tsos mob ntawm tus mob ntshav qab zib neuropathy nyob ntawm daim ntawv, mob heev, tus lej ntawm kev nce qib thiab keeb kwm ntawm kev kho tau siv.
Sensomotor muaj kev ntxhov siab
Daim foos no yog cov neeg ib txwm muaj los ntawm ib tus kab mob "qab zib". Qhia ntawm lub chav kawm:
- mob ntawm qhov sib txawv;
- paresthesia;
- loog
- txo kom txog thaum ua tiav qhov tsis muaj kev nkag siab txog qhov hloov kub thiab vibration;
- leeg tsis muaj zog;
- cramps ntawm qis qis kawg;
- tsis muaj reflexes coj nrog lub voos;
- cov tsos ntawm pathological reflexes.
Kev ntxhov siab hnov mob tsis huv
Kev hnov mob ntshav qab zib mob ib ce nrog cov lus hauv qab no ntawm cov neeg mob:
- nce tactile rhiab heev rau kev hloov pauv ntawm kub, kov, vibration;
- rhiab qhov tsis meej nyob rau hauv daim ntawv ntawm qhov kev xav tsis txaus;
- cov tsos ntawm kev hnov mob hauv kev teb rau kev cuam tshuam ntawm cov yam ntawd uas nyob rau hauv ib txwm mob tsis ua rau mob;
- reflexes yuav nyob li qub;
- cov tsos mob hnyav heev.
Qhov mob tuaj yeem kub hnyiab, mob ntshav, tua, ua ntej txhua yam tshwm hauv ko taw thiab txhais ceg, qhov twg cov hlab ntsha hloov pauv feem ntau ntawm txhua qhov.
Loog, tingling, mob - tshwm sim ntawm nqua neuropathy
Nrog rau daim ntawv asymmetric neuropathic, mob mob rau thaj tsam ntawm lub plab hu ua pob qij txha, pob qij txha, nqis los ntawm txhais ceg los ntawm sab qhov chaw uas cov hlab hlwb puas ntsoog. Tus mob no yog nrog los ntawm cov rog tsawg zuj zus, qhov txo qis ntawm cov leeg ntawm caj pas "mob".
Koj tuaj yeem kawm paub ntau ntxiv txog tus mob ntshav qab zib neuropathy ntawm qhov qis qis hauv qhov tsab xov xwm no.
Kiag Npog daim ntawv
Txhab ntawm cov hlab ntsha hauv nruab nrog sab hauv nrog cov chaw tuag nrog cov neeg mob ntshav qab zib mellitus. Daim ntawv nquag thiab cov yam ntxwv ntawm tus kab mob pathology tau piav qhia hauv lub rooj.
| Organs thiab tshuab | Neej Neeg | Cov chaw kho mob |
| Lub plawv, cov hlab ntsha | Mob raum tsis ua hauj lwm, orthostatic hypotension, tsis hnov mob rau lub cev ua si, mob ntsws ntsws | Lub plawv atherosclerosis disturbances (tachycardia, arrhythmia), ntshav siab ntxiv, ECG hloov, "plawv" hnoos, txog siav, ua pa tuag tam sim ntawd |
| Kev kho mob txoj hnyuv | Gastroparesis, mob hnyuv atony, dysbiosis, pancreatitis, tus mob reflux, mob | Xeev siab, ntuav, mob plab, tsam plab, kub siab, kub siab poob rau lub cev hnyav, raws plab |
| Lub Hauv Paus Nruab Nrab | Atony, reflux, tus kab mob, erectile kawg | Kev hnov mob hla ntawm qhov pubis, ua txhaum ntawm txoj kev tso zis, txoj kev mob tso tawm los ntawm txoj hlab zis thiab lub paum, qhov mob nyob hauv qis dua rov qab, hyperthermia |
| Excretory system | Anhidrosis, hypohidrosis, hyperhidrosis | Qhaj ntawv, poob qis lossis nce tawm hws thaum noj mov thiab ua si lub cev |
| Pupillary constriction system | Pom kev tsis pom kev | Txo txoj kab uas hla ntawm cov tub ntxhais kawm, qhov maj mam tshwm sim rau kev hloov pauv ntawm cov sij hawm tuaj txog ntawm lub teeb ci, pathology ntawm twilight pom kev |
| Adrenal qog | Tsis muaj qhov chaw muab tshuaj | |
Kev kuaj mob neurological
Txoj kev kho yog tsuas yog tom qab sib txawv thiab kuaj pom. Kev tshuaj xyuas thiab sau ntawm cov neeg yws cov neeg mob tsis txaus siab nrog txoj kev soj ntsuam neurological. Tus kws tshaj lij qhia meej meej lub xeev ntawm kev mob, nruj, cua sov, txias, kev co rhiab. Ib co ntawm cov neurologist rau kev kuaj mob suav nrog:
- malleus nrog cov koob tsim - txhawm rau ntsuas lub xeev ntawm qhov mob rhiab;
- vatu - ntsuas qhov tsis hnov ntawm tus neeg mob;
- monofilament - lub ntsiab lus ntawm tactile rhiab heev;
- tuning tib rab diav rawg - qhia txog qib kev vibration uas ua tau;
- malleus nrog txhuam txhuam - tactile ncus.
Atypical cov ntaub ntawv ntawm cov kev tsis txaus yuav xav tau kuaj me me ntawm lub plab hlaub hlab ntsha thiab nqaij tawv nqaij txuas ntxiv nrog kev txheeb xyuas keeb kwm yav dhau los.
Kev ntsuam xyuas Reflex yog ib qho ntawm cov qib mob ntawm txoj kev mob neurological
Neurologist muab tshuaj rau kev tshawb fawb electrophysiological. Electromyography qhia tau qhov kev xaiv xyoob ntoo ntawm lub tshuab ua kom mob thiab neuromuscular kis ntawm impulses. Cov ntaub ntawv tau ua rau nws tuaj yeem txiav txim siab ua haujlwm ntawm lub xeev ntawm txoj hlab ntsha, uas yog lub luag haujlwm rau lub qhov tob ntawm qee qhov ntawm lub cev, txhawm rau qhia kev puas tsuaj rau cov ntu ntu ntawm cov leeg hlwb.
Electroneurography yog ib qho kev ntxias uas qhia txog qhov nrawm ntawm qhov kev mob ntawm cov hlab ntsha raws lub cev thiab cov leeg ntawm qhov chaw lawv tawm ntawm lub hauv nruab nrab cov hlab ntsha mus rau cov leeg kho mob uas nyob hauv cov leeg thiab tawv nqaij.
Raug tshem tawm lub peev xwm - qhov no yog kev kawm qhia qhia txog kev xaiv xyoob ntoo ntawm cov hlab ntsha ntawm cov hlab ntsha thiab cov ntaub so ntswg uas siv ntau cov kev txhawb nqa (pom, hnov, hnov).
Lwm txoj kev tshawb nrhiav
Ntxiv nrog rau tus kws kho endocrinologist, tus kws kho mob plab, urologist, kws kho plawv, kws kho pob txha, pob ntseg nrog koom nrog kev tshuaj xyuas ntawm tus neeg mob. Kuaj hauv chav kuaj mob tau muab:
- kev txiav txim siab ntawm cov ntshav qab zib;
- ntshav biochemistry;
- glycosylated hemoglobin;
- kev txiav txim siab ntawm tus nqi ntawm cov tshuaj insulin;
- C peptide.
Tus kws kho plawv tawm kev kuaj Valsalva, Holter ECG, echocardiography, kev ntsuas orthostatic. Tus kws kho mob soj ntsuam cov kev mob ntawm txoj hnyuv nrog ultrasound, endoscopy, xoo hluav taws xob soj ntsuam lub plab, kuaj kev kuaj kom paub txiav txim siab ntawm Helicobacter pylori.
ECG - ib txoj hauv kev rau kev kawm qhov kev puas tsuaj rau qhov kev poob siab ntawm txoj kev xav ntawm sab nrauv ntawm hom kev xaiv kheej
Kev ntsuas ntawm lub cev ua haujlwm ntawm txoj hlab zis yog raws li urinalysis, ultrasound, cystoscopy, mob leeg, thiab electromyography ntawm cov leeg txheej txheem ntawm lub zais zis.
Kev Kho Mob
Mob neuropathy mob ntshav qab zib, kev kho mob uas yuav tsum tau pib kho ntawm cov ntshav cov piam thaj, yuav tsum tau kho phased. Txhawm rau ua qhov no, siv cov insulin txhaj tshuaj (rau ntshav qab zib hom 1) lossis siv tshuaj txo cov ntshav qab zib (rau hom 2). Ib qho yuav tsum tau ua ua ntej yog kev tswj suab thaj hauv kev ua haujlwm los ntawm kev sim thiab hom kev tswj tus kheej.
Kev kho mob ntawm kev mob yog nrog kev txhim kho kev noj zaub mov zoo, kev ua kom lub cev thiab so kom txaus, txo cov ntshav hauv lub cev pathological, tsim cov xwm txheej rau kev tswj kom lub siab nyob rau theem li qub.
Gymnastics rau ntshav qab zibCov tshuaj uas muaj piam thaj siv los kho cov piam thaj hauv qab:
- Metformin
- Maninil
- Lub Neej
- Januvius
- Lawj xeeb
- Novonorm.
Thioctic acid npaj
Cov tshuaj noj normalize lipid metabolism, tswj cov cholesterol. Txhais tau tias txhim kho daim siab ua haujlwm, txo qaug tshuaj lom. Cov neeg sawv cev ntawm cov pab pawg:
- Berlition,
- Tiogamma
- Liopthioxone
- Lipoic acid.
Cov tshuaj tiv thaiv kab mob
Cov tshuaj no yog siv los txiav qhov mob syndrome uas tshwm sim rau keeb kwm ntawm neuropathy. Thov amitriptyline, imipramine, nortriptyline. Thawj ob txoj kev hais daws tsis tshua muaj tshuaj lom thiab ua rau muaj kev phiv ntau. Kev tshem tawm ntawm qhov mob tshwm sim me ntsis ua ntej tshaj li cov tshuaj tiv thaiv kab mob siab hlob.
Amitriptyline yog cov tshuaj tiv thaiv kab mob muaj txiaj ntsig zoo nrog kev mob lom tsawg tshaj plaws rau lub cev.
Cov neeg laus thiab cov uas muaj mob encephalopathy, mob neurosis, muaj qhov tsis paub qab hau yuav tsum siv tshuaj nyob rau hauv kev saib xyuas ntawm cov kws tshwj xeeb lossis cov neeg txheeb ze. Noj tshuaj tsis txaus yuav ua tau neeg tuag taus.
Tshuaj loog thiab tshuaj loog
Kuj tseem siv los daws qhov mob. Cov ntawv thov nrog cov tshuaj loog hauv zos (Lidocaine, Novocaine) yog siv. Piv nrog tshuaj tiv thaiv kab mob siab, lawv cov nyhuv analgesic tsawg dua, tab sis siv rau hauv kev coj ua. Kev txhim kho ntawm tus neeg mob tshwm sim tom qab 10-15 feeb.
Analgesics nyob rau hauv daim ntawv ntawm Analginum, Paracetamol yog qhov ua haujlwm tsis muaj txiaj ntsig, txawm li cas los xij, cov xwm txheej ntawm lawv qhov tsis muaj qhov teem sij hawm tsis tau paub.
B-Series Vitamins
Kev npaj Vitamin yog siv rau kev ua haujlwm ntawm cov leeg poob qis, xa cov impulses. Pyridoxine yog qhov zoo dua (B6), thiamine (B1) thiab cyanocobalamin (B12) Cov txheej txheem daim ntawv thov raug xaiv los ntawm tus kws tshaj lij tshwj xeeb.
Anticonvulsants
Carbamazepine, Finitoin yog cov neeg sawv cev ntawm pab pawg, xav tau kev xaiv ua tib zoo tshuaj vim muaj kev phiv. Pib noj nrog cov tshuaj me me, maj mam nqa mus rau qhov tsim nyog kho. Tus txheej txheem no tsis xav tau txawm tias ntau hnub, tab sis 3-4 lub lis piam.
Lwm yam kev kho mob
Kev kho mob ntshav qab zib neuropathy dav siv cov hauv qab no tsis siv tshuaj:
- daim ntawv thov laser;
- decompression ntawm cov hlab ntsha loj;
- kev kho mob magnetotherapy;
- acupuncture;
- transcutaneous hluav taws xob stimulation.
Kev txiav txim siab kom raws sij hawm ntawm kev txhim kho pathology thiab kev pab ntawm cov kws tshaj lij yuav pab tswj cov neeg mob kom nyob rau theem siab thiab zam kom tsis txhob muaj teeb meem loj.
