Ntshav qab zib nephropathy yog dab tsi thiab nws muaj li cas?

Ntshav Qab Zib Nepropathy- yog dab tsi? Qhov no yog qhov kab mob phom sij uas tsim nrog nrog hom 1 thiab hom 2 mob ntshav qab zib mellitus, ua rau muaj kev puas tsuaj rau cov hlab ntshav ntawm lub raum, txo qis rau lawv lub peev xwm lim thiab tshwm sim ntawm raum tsis ua haujlwm.

Xws li lub pathology feem ntau dhau los ua qhov tsis taus thiab feem ntau ua rau tuag taus.

Pathogenesis ntawm Nifaisropathy

Ntshav qab zib nephropathy muaj ICD code ntawm 10 E10.2-E14.2 - cov qhov txhab mob ntshav qab zib hauv cov ntshav qab zib mellitus. Pathology yog pom los ntawm kev hloov pauv ntawm cov hlab ntsha mus rau lub plawv thiab lub ntsej muag glomerular muaj nuj nqi (txoj hlab ntuag).

Kev loj hlob ntawm cov nephropathy tshwm sim tawm tsam ntawm keeb kwm ntawm kev ua txhaum ntawm cov metabolism hauv cov metabolism thiab cov tsos ntawm hyperglycemia.

Nws muaj ntau lub tswv yim sib txawv ntawm pathogenesis ntawm tus kab mob:

1. Kev ntsuas cov ntsiab lusCov. Feem ntau ntawm kev nce ntxiv hauv cov ntshav piam thaj ua rau muaj kev ua tsis zoo ntawm cov txheej txheem biochemical. Cov dej-electrolyte tshuav kev hloov pauv, kev coj ua ntawm cov pa oxygen poob qis, kev sib pauv ntawm cov roj ntsha pauv, cov ntsiab lus ntawm cov roj ntsha glycated nce, lub raum yog tshuaj lom thiab cov txheej txheem ntawm cov kua nplaum cuam tshuam. Raws li kev tshawb fawb hauv keeb kwm, qhov tshwm sim ntawm hemodynamic thiab metabolic cuam tshuam provokes qhov tshwm sim ntawm nephropathy vim muaj caj ces.
2. Hemodynamic txoj kev xavCov. Raws li qhov kev tshawb xav no, qhov ua rau mob nephropathy yog ib qho kev nce siab ntxiv hauv cov ntshav siab, uas ua rau kev mob ntshav siab ntawm txoj hlab ntaws thiab ua rau cov ntshav tsis zoo rau lub raum. Tom qab, qhov kev hloov pauv tseem ceeb ntawm cov qauv ntawm cov loops tshwm sim, uas tau tshwm sim hauv kev ceev thiab tsim cov zis nrog cov ntsiab lus ntawm cov protein ntau dhau los, thiab tom qab ntawd muaj peev xwm lim qis thiab glomerulosclerosis kev loj hlob (hloov ntawm cov nqaij mos glomerular los ntawm cov qe sib txuas). Raws li qhov tshwm sim, lub raum tsis ua haujlwm tshwm sim.

Qhov feem ntau muaj kev pheej hmoo ntawm ntshav qab zib nephropathy yog cov neeg mob ntshav qab zib nrog qhov tseem ceeb ntawm cov yam xws li:

1. Tub los ntxhais. Hauv cov txiv neej, nephropathy pom muaj ntau tus mob.
2. Hom ntshav qab zib. Tus mob ntshav qab zib hom 1 yog cov yuav raug pathology.
3. Lub sijhawm tiv thaiv ntawm tus kabmob. Yeej, qhov davhlau ya nyob twg theem ntawm raum puas tsuaj tom qab 15 xyoo ntawm ntshav qab zib.
4. Tawg siab
5. Noj tshuaj uas muaj qhov tsis ntxim rau lub raum.
6. Kev kis mob ntawm genitourinary system.
7. Kev cuam tshuam ntawm lipid metabolism.
8. Kev siv dej cawv thiab luam yeeb.
9. Rog dhau.
10. Feem ntau ntawm cov piam thaj ntxiv nrog lub sijhawm ntev uas tsis muaj qhov ntsuas tau kho.

Cov tsos mob ntawm qib sib txawv

Tus kab mob feem ntau loj hlob rau lub sijhawm ntev thiab yog asymptomatic thaum ntxov.

Qhov no ua rau muaj kev nyuaj siab rau kev kuaj mob thiab kev kho mob, vim tias cov neeg mob feem ntau nrhiav kev pab twb tau thaum lub sijhawm ua haujlwm dhau los lossis theem kawg, thaum nws tsis muaj peev xwm pab tau lawv.

Yog li, ntshav qab zib nephropathy txiav txim siab ua qhov phom sij txaus ntshai tshaj plaws ntawm ntshav qab zib, uas yog xaus rau qhov tuag.

Yav tom ntej, cov cim qhia lawv tus kheej nyob ntawm txoj kev loj hlob ntawm pathology.

Muaj kev faib tawm yog qeb:

1. Asymptomatic theem - cov tsos mob hauv kev kuaj mob yog qhaj ntawv, tab sis hauv kev tshawb fawb tso zis ib qho kev nce siab ntawm glomerular pom yog qhov pom tau, thiab lub raum ntshav nce ntxiv. Qhov ntsuas qhov cim ntawm microalbumin tsawg dua 30 mg / hnub.
2. Cov theem ntawm kev hloov cov qauv pib hauv ob peb xyoos los ntawm cov tsos ntawm endocrine cuam tshuam. Tus nqi glomerular pom thiab qhov siab ntawm microalbumin tsis hloov, tab sis muaj qhov tuab ntawm phab ntsa capillary thiab qhov nce ntxiv ntawm qhov chaw intercellular.
3. Qhov prenephrotic theem tau tshwm sim tom qab 5-6 xyoo txij li pib muaj ntshav qab zib. Kev yws ntawm cov neeg mob tsis tuaj. Qee zaum, tom qab ua haujlwm ntawm lub cev, lub zog siab tau sau tseg. Qhov muab cov ntshav thiab cov lim pom tsis txawv, tab sis theem ntawm microalbumin nce ntawm 30 mus rau 300 mg / hnub.
4. Tom qab 15 lub xyoos dhau los ntawm kev mob, theem pib mob pib. Ua ntu zus, cov ntshav tshwm hauv tus neeg tso zis, muaj protein ntau dua 300 mg / hnub tshawb pom tsis tu ncua. Nquag ntshav siab ntshav siab uas tsis paub kho. Cov ntshav ntws hauv cov hlab ntsha ntawm lub raum thiab glomerular pom kev lag luam tsawg dua. Urea thiab creatinine nyob rau hauv cov ntshav me ntsis dhau qhov tso cai pom zoo. Kev o ntawm lub ntsej muag thiab lub cev tau tshwm sim. Muaj kev ua ntxiv ntawm ESR thiab cov cholesterol, thiab hemoglobin tsawg dua.
5. Terminal theem (nephrosclerosis). Kev ua haujlwm ntawm kev lim dej thiab lub raum concentration poob qis. Cov concentration ntawm urea thiab creatinine hauv cov ntshav tau loj hlob sai, thiab cov protein ntau tau tsawg zuj zus lawm. Cylindruria thiab muaj cov ntshav nyob rau hauv cov zis thiab cov protein ntau tau pom. Hemoglobin ntog catastrophically. Kev nthuav tawm ntawm insulin los ntawm ob lub raum tsis ua haujlwm thiab tsis muaj suab thaj hauv lub urinalysis. Tus mob ntshav qab zib yws cov kev mob siab thiab pheej o hnyav ntxiv. Cov piam thaj hauv qab zib poob qis thiab qhov xav tau rau insulin ploj mus. Cov tsos mob ntawm uremia thiab dyspeptic mob huam yuaj, intoxication ntawm lub cev tshwm sim thiab tag nrho cov mob raum tsis ua hauj lwm tas.

Kev kuaj mob pathology

Kev kuaj mob ntawm nephropathy thaum pib ntawm txoj kev loj hlob yog nqa tawm siv:

• soj ntsuam ntshav;
• kuaj ntshav rau biochemistry;
• kev kuaj mob thiab tshuaj biochemical ntawm kev tso zis;
• Ultrasound ntawm cov hlab ntsha hlaus;
• kuaj ntawm Zimnitsky thiab Reberg.

Lub ntsiab tseem ceeb rau cov xim uas tau kos yog cov ntsiab lus ntawm microalbumin thiab creatinine hauv qhov urinalysis. Yog hais tias muaj qhov nce siab hauv microalbumin, nrog qhov yuav tau txais ntawm 30 mg / hnub, tom qab ntawd kev kuaj mob ntawm cov mob nephropathy tau lees paub.

Hauv cov theem tom qab, kev kuaj mob yog txiav txim siab ntawm lub hauv paus ntawm cov ntsuas no:

• cov tsos pom hauv kev tso zis ntawm cov protein ntau tshaj (ntau dua 300 mg / hnub);
• qhov txo qis hauv cov ntshav protein;
• cov ntshav siab ntawm urea thiab creatinine;
• tus nqi qis glomerular pom (hauv qab 30 ml / min.);
• nce siab;
• txo qis hauv hemoglobin thiab calcium;
• cov tsos ntawm kev o ntawm lub ntsej muag thiab lub cev;
• kev pom ntawm acidosis thiab hyperlipidimia yog cai.

Ua ntej ua ib qho kev kuaj mob, qhov ntsuas mob sib piv tau ua nrog lwm cov pathologies:

1. Mob pyelonephritis Mob. Ntawm qhov tseem ceeb yog qhov tshwm sim ntawm urography, ultrasound thiab cov cim ntawm bacteriuria thiab leukocyturia.
2. Tus mob glomerulonephritis ntev thiab mob.
3. Tuberculosis ntawm lub raum. Txaus siab nyob rau hauv cov zis ntsuas ntawm lub xub ntiag ntawm mycobacteria thiab cog kev loj hlob.

Rau qhov no, ultrasound, tshuaj ntsuam ntawm urinary microflora, raum urography yog siv.

Yuav siv ib lub raum los siv hauv cov kis no:

• cov kab mob proteinuria thaum ntxov thiab sai sai;
• pheej hematuria;
• tsim cov mob nephrotic syndrome.

Kho kab mob

Lub hom phiaj tseem ceeb ntawm kev siv tshuaj kho mob yog txhawm rau tiv thaiv qhov tshwm sim ntawm lub raum tsis ua hauj lwm thiab kev tiv thaiv lub plawv pathologies (mob hlab ntsha tawg, plawv nres, mob plawv).

Cov theem pib ntawm txoj kev loj hlob ntawm cov ntshav qab zib nephropathy yuav tsum tau nrog cov sij hawm teem tseg ntawm ACE inhibitors rau prophylactic lub hom phiaj thiab tswj cov piam thaj cov ntsiab lus nrog kev kho tom qab.

Kev kho mob ua ntej-nephrotic theem muaj:

1. Kev noj haus tsis tu ncua nrog cov txo protein ntau.
2. Lub siab ruaj khov. Siv yeeb tshuaj xws li enalapril, losartan, ramipril. Cov koob tshuaj yuav tsum tsis txhob ua rau kev mob ntshav siab.
3. Rov qab los ntawm cov ntxhia tsis muaj peev xwm thiab cov khoom siv roj ntsha tsis zoo ntawm cov rog, protein thiab carbohydrates.

Qeb theem nephrotic yog kho nrog kev noj zaub mov noj rau lub cev. Kev noj zaub mov nrog kev noj zaub mov kom tsawg ntawm cov tsiaj rog thiab cov tsiaj ntawm cov tsiaj rog yog kho tau. Kev cais tawm ntawm cov khoom noj muaj ntsev thiab cov zaub mov ntau nyob hauv cov potassium thiab phosphorus yog qhia.

Nws raug nquahu kom noj cov tshuaj uas txo cov ntshav siab thiab qhov kev noj haus hauv qib siab hauv cov ntshav thiab nws cov lipid spectrum (folic thiab nicotinic acid, statins). Nyob rau theem no, feem ntau hypoglycemia tau tshwm sim, uas qhia txog qhov ntxim nyiam ntawm kev tsis kam siv tshuaj insulin.

Kev kho ntawm qhov kawg, davhlau ya nyob twg nyob ntawm kev tswj cov haujlwm tseem ceeb ntawm lub cev:

• nce nyob rau hauv hemoglobin - Ferropleks, Fenyuls yog siv;
• noj tshuaj diuretics los daws qhov mob edema - Hypothiazide, Furosemide;
• cov ntshav qab zib cov ntshav tau hloov kho;
• tshem tawm cov intoxication ntawm lub cev;
• cov kev hloov hauv cov pob txha caj qaum yog tiv thaiv los ntawm kev noj cov tshuaj vitamin D3;
• sorbents yog tshuaj.

Hauv theem kawg, lo lus nug ntawm kev siv perineal dialysis, hemodialysis, thiab nrhiav kom tau lub raum rau kev hloov ntshav tau nce ceev.

Kev twv ua ntej thiab Kev Tiv Thaiv

Kev tu ncua sijhawm pib tuaj yeem tshem tawm qhov kev pom ntawm microalbuminuria. Nws muaj peev xwm tiv thaiv tau qhov tshwm sim ntawm kev mob raum tsis zoo txawm tias lub sijhawm loj hlob ntawm cov proteinuria.

Kev kho mob qeeb mus txog 10 xyoo ua rau lub raum tsis ua haujlwm ib nrab ntawm cov ntshav qab zib hom 1 thiab hauv txhua tus neeg mob 10 tus mob ntshav qab zib hom 2.

Yog hais tias lub davhlau ya nyob twg lig pib tshwm sim thiab lub raum tsis ua tiav, ces tus txheej txheem no tsis tuaj yeem hloov kho tau thiab kev hloov raum sai sai lossis kho mob hlwb yog qhov tsim nyog los cawm tus neeg mob lub neej.

Raws li kev txheeb cais, txhua txhua 15 tus neeg mob, kuaj mob hom 1 mob ntshav qab zib mellitus thiab tsis muaj hnub nyoog qis dua 50 xyoo, tuag ntawm tus mob ntshav qab zib nephropathy.

Cov cai hauv qab no yuav tsum tau ua raws:

1. Yuav tsum tau soj ntsuam txhua hnub ntau ntawm cov ntshav qab zib. Ntsuas cov piam thaj hauv qib ua ntej thiab tom qab noj mov.
2. Ua raws li kev noj haus, zam kev dhia rau hauv cov piam thaj. Cov zaub mov yuav tsum muaj cov rog thiab cov zaub mov kom tsawg kawg. Koj yuav tsum tsis kam qab zib. Ntev sib nrug ntawm cov pluas noj thiab ua noj ntau dhau kuj yuav tsum cais tawm.
3. Thaum cov tsos mob ntawm tus mob nephropathy tshwm sim, nws yog ib qho tsim nyog yuav tsum txo qis ntawm tsiaj cov nqaijrog, cov rog thiab tsis suav cov ntsev kom tsawg.
4. Thaum hloov pauv qhov ntsuas tseem ceeb, kev ntsuas kho yuav tsum ua. Qhov ntau npaum ntawm cov tshuaj insulin yuav tsum yog tus kws kho mob tshwj xeeb.
5. Zam kev coj ua tsis zoo. Cov dej cawv pab kom cov ntsiab lus qab zib, thaum nicotine txwv cov hlab ntsha thiab cuam tshuam txog ntshav kev ntshav.
6. Tswj lub cev hnyav. Cov phaus ntxiv yog ib qho ua rau cov piam thaj hloov. Ntxiv rau, kev muab ntshav mus rau cov nruab nrog cev yog cuam tshuam los ntawm qhov hnyav dhau thiab cov kab mob ntawm cov hlab plawv cov ntshav tau tshwm sim.
7. Tswj dej kom sib npaug los ntawm haus dej kom ntau. Tsawg kawg 1,5 litres cov dej yuav tsum haus txhua hnub.
8. Txhim kho cov ntshav ntxiv rau cov nruab nrog cev nrog kev tawm dag zog lub cev. Taug kev thiab ua si kis las li qub lub plawv, txaus ntshav nrog oxygen thiab ua kom lub cev tiv thaiv cov kev cuam tshuam.
9. Zam kev mob txeeb zig. Hypothermia, kev tu cev tsis txaus thiab kev tiv thaiv tsis pw ua ke ua rau mob raum.
10. Tsis txhob muab tshuaj rau tus kheej. Kev noj tshuaj yuav tsum yog nyob tom qab kev sib pom zoo nrog kws kho mob. Cov kev qhia ntawm cov tshuaj ib txwm siv yuav tsum tsis txhob hloov cov tshuaj ntawm kws kho mob, tab sis tsuas yog siv tau los ua cov nyob sib ze.
11. Saib xyuas ntshav siab. Qhov ntsuas yuav tsum tsis pub dhau 130/85.
12. Tsis hais txog qhov ntsuas siab, ACE inhibitors yuav tsum tau kho.

Cov khoom siv ua vis dis aus txog kev mob raum ntshav qab zib:

Cov kev tiv thaiv yuav tsum tau pib tam sim ntawd tom qab paub tseeb tias kuaj ntshav qab zib. Tus kws kho mob yuav tsum tau mus ntsib tomqab 5 xyoos txij li pib muaj tus kabmob ob zaug ib xyoos rau cov neeg mob ntshav qab zib hom 1 thiab ntshav qab zib hom 2 txhua xyoo.

Thaum mus ntsib kws kho mob, tso zis yuav tsum muab tshuaj rau tso zis, urea, thiab creatinine. Ntawm thawj cov kev hloov pauv hauv qhov ntsuas, tus kws kho mob yuav tshaj tawm txoj kev kho kom tsim nyog.

Qhia tus kws kho mob txog thawj cov tsos mob uas txaus ntshai nyob rau hauv daim ntawv ntawm kev ntxhov siab pw tsaug zog thiab qab los noj mov, qhov tshwm sim ntawm xeev siab thiab tsis muaj zog, yog tias ua pa luv tshwm sim lossis o tau pom hauv qab lub qhov muag thiab nqua.

Txhua yam no yuav ua rau pom qhov kev loj hlob ntawm cov ntshav qab zib nephropathy thaum pib ntawm txoj kev loj hlob thiab pib kho mob kom raws sijhawm.