ntshav siab yog ib qho teeb meem tshwm sim heev. Tshwj xeeb tshaj yog cov neeg laus thiab cov neeg laus nruab nrab. Yuav muaj ntau yam ua rau mob ntshav siab. Ntawm lawv yog kab mob plawv, kab mob raum, kab mob endocrine. Raws li koj paub, ntshav siab tuaj yeem ua rau mob stroke thiab plawv nres. Yuav kom nkag siab txog yuav ua li cas nrog cov tsos mob no, nws yog ib qho tsim nyog los tsim qhov ua rau. Qee zaum, ntshav siab tshwm sim tawm tsam keeb kwm ntawm pathology xws li lub raum hlab ntsha stenosis. Kev kho tus kab mob no yuav tsum tau pib sai li sai tau. Tom qab tag nrho, arterial stenosis tuaj yeem ua rau tsis yog tsuas yog nce ntshav siab xwb, tab sis kuj ua rau lwm yam teeb meem loj. Pathology tshwm sim hauv cov txiv neej thiab poj niam. Qee zaum, tus kab mob yog congenital. Ntau zaus nws tshwm sim tawm tsam keeb kwm ntawm vascular mob.
Nyeem ntxiv txog lub raum hlab ntsha stenosis
Stenosis ntawm lub raum cov hlab ntsha yog qhov nqaim ntawm lumen ntawm lub nkoj vim muaj ntau yam kab mob. Tus kab mob no yog cais raws li ib tug nephropathic pathology. Lub raum cov hlab ntsha yog cov hlab ntsha loj uas muab cov ntshav rau cov ntaub so ntswglub cev. Nrog stenosis, lawv noticeably txo nyob rau hauv txoj kab uas hla. Yog li ntawd, cov txheej txheem ntawm cov ntshav mus rau lub raum yog cuam tshuam. Cov kab mob no ua rau muaj kev cuam tshuam loj xws li mob ntshav siab, CRF. Muaj 2 lub tswv yim rau kev txhim kho stenosis. Ntawm lawv:
- Atherosclerotic variant. Nws yog pom nyob rau hauv feem ntau ntawm cov neeg mob raug kev txom nyem los ntawm no pathology. Ib qho zoo sib xws rau kev txhim kho ntawm stenosis muaj nyob rau hauv maj mam txhaws ntawm lumen ntawm lub nkoj los ntawm cov cholesterol plaques. Kev mob vascular occlusion feem ntau pom nyob rau hauv cov neeg laus.
- Fibromuscular dysplasia. Qhov no variant ntawm kev loj hlob ntawm pathology yog tsawg dua. Nws tuaj yeem tshwm sim hauv cov poj niam hnub nyoog nruab nrab thiab cov ntxhais hluas. Cov leeg nqaij dysplasia yog ib qho kev yug me nyuam.
Tsuas yog tom qab kev tshuaj ntsuam xyuas tuaj yeem kuaj xyuas "lub raum hlab ntsha stenosis" raug tsim. ICD yog ib qho kev faib tawm ntawm pathologies siv thoob plaws ntiaj teb. Nws suav nrog ntau yam kab mob, txhua tus muaj cov cai tshwj xeeb. Lub raum hlab ntsha stenosis yog encoded nyob rau hauv 2 txoj kev, nyob ntawm seb qhov ua rau nws tshwm sim. Ib qho kev xaiv yog code I15.0, uas txhais tau tias "renovascular hypertension." Lwm tus lej ICD yog Q27.1. Nws sawv cev rau "congenital renal artery stenosis". Ob qho xwm txheej yuav tsum tau kho los ntawm kws kho mob urologist lossis tus kws phais mob vascular.
Lub raum hlab ntsha stenosis: ua rau pathology
Nov ntawm lumen ntawm cov hlab ntsha peripheral yog hu ua pathology ntawm vascular system. Muab faibntau yam ua rau stenosis. Feem ntau ntawm cov no yog atherosclerosis. Raws li koj paub, feem ntau nws tau pom nyob rau hauv cov neeg uas rog dhau, ua rau kev ua neej nyob tsis muaj zog lossis mob ntshav qab zib. Atherosclerosis tuaj yeem tsim nyob rau lub sijhawm ntev. Txawm li cas los xij, nws tsis tshua kuaj pom ua ntej cov tsos mob ntawm cov hlab ntsha txhaws tshwm sim. Lwm yam ua rau stenosis muaj xws li:
- Fibromuscular dysplasia. Lo lus no yog hais txog qhov tsis zoo ntawm caj ces, uas ua rau tsis muaj cov leeg nqaij hauv cov hlab ntsha ntawm phab ntsa. Pathology tau pom nyob rau hauv cov poj niam ntawm txhua lub hnub nyoog.
- Aneurysm ntawm cov hlab ntsha ntawm ob lub raum.
- Tumours ntawm peripheral hlab ntsha.
- Congenital thiab kis tau vasculitis.
- Kev sib xyaw ntawm lub raum cov hlab ntsha los ntawm neoplasms los ntawm cov ntaub so ntswg ntawm cov khoom nruab nrog cev.
Cov laj thawj uas tsis tshua muaj. Yog li, lawv qhov kev kuaj mob tsuas yog pib tom qab kev cais tawm ntawm atherosclerosis.
Mechanism of development of hypertension
Cov tsos mob tseem ceeb ntawm lub raum hlab ntsha stenosis yog qhov nce ntshav siab. Yog li ntawd, nrog rau qhov kev kuaj mob no, kev kuaj mob raum yog tsim nyog. Lub raum artery stenosis thiab arterial hypertension cuam tshuam li cas? 2 lub tswv yim koom nrog hauv kev nce ntshav siab:
- Ua kom cov renin-angiotensin system. Raws li kev cuam tshuam ntawm cov tshuaj lom neeg, kev nqaim ntawm arterioles tsim. Yog li ntawd, peripheral vascular kuj nce. Yog li ntawd, ntshavlub siab nyob rau hauv cov hlab ntsha nce.
- Aldosterone ua. Cov tshuaj no yog tsim nyob rau hauv lub adrenal cortex. Nquag, nws yog tas li tam sim no nyob rau hauv lub cev. Txawm li cas los xij, nrog arterial stenosis, nws cov khoom tsim tau zoo dua qub. Vim muaj ntau tshaj aldosterone, kua thiab sodium ions nyob rau hauv lub cev. Qhov no, nyob rau hauv lem, kuj ua rau kom ntshav siab.
Raws li qhov tshwm sim ntawm kev kub siab ntev, kev hloov pauv tshwm sim hauv cov hlab plawv. Sab laug ventricle maj hypertrophies thiab stretches. Nov yog lwm qhov ua rau mob ntshav siab.
Lub raum hlab ntsha stenosis: cov tsos mob ntawm tus kab mob
Ntxoov cov hlab ntsha ntawm lub raum muaj ntau yam tshwm sim. Cov tsos mob ntawm stenosis tsis tshwm sim tam sim ntawd, tab sis tsuas yog nrog mob hnyav heev. Txawm li cas los xij, kev saib xyuas kev kho mob tsis yog ib txwm ua tau zoo. Ntxiv nrog rau cov kab mob vascular, arterial stenosis ua rau ischemic hloov hauv lub raum. Raws li qhov tshwm sim, kev pom thiab kev ua haujlwm siab ntawm lub cev raug kev txom nyem. Muab qhov no, 2 qhov chaw kho mob tuaj yeem paub qhov txawv uas tshwm sim nrog stenosis. Thawj yog arterial hypertension. Qhov no syndrome yog yus muaj los ntawm ib tug xov tooj ntawm kev kho mob tshwm sim. Ntawm lawv:
- Npaj ntshav siab. Nws tuaj yeem yog episodic lossis mus tas li. Qhov tseem ceeb tshwj xeeb rau kev kuaj mob yog nce ntshav siab diastolic (ntau dua 100 mm Hg).
- Tshuaj ntsuab.
- kiv taub hau.
- Ntaus uas tsis muaj dab tsi ua nrog noj.
- Flashing"flies" ua ntej qhov muag.
- mob taub hau hauv cov tuam tsev, hauv pliaj.
- Nyob zoo ib tsoom phooj ywg.
Qhov thib ob kho mob syndrome yog ischemic nephropathy. Vim lub raum tsis ua hauj lwm cov ntshav khiav, "kev noj haus" ntawm lub cev nres. Ob sab stenosis ntawm lub raum cov hlab ntsha yog qhov txaus ntshai tshwj xeeb. Ntshav siab yog ib yam mob uas tuaj yeem tswj tau ib feem nrog tshuaj. Hmoov tsis zoo, lub cev hnyav ischemia tsis tuaj yeem kho nrog tshuaj. Cov tsos mob ntawm "oxygen starvation" ntawm lub raum yuav tsum muaj xws li: mob hauv cheeb tsam lumbar, hloov tso zis. Feem ntau muaj qhov txo qis ntawm cov kua dej tso tawm, qhov dav dav tsis muaj zog. Ib qho kev sib xyaw ntawm cov ntshav, cov pos huab tuaj yeem tshwm sim hauv cov zis.
Diagnosis
Tsuas yog tom qab kuaj pom tau tias "lub raum hlab ntsha stenosis" ua tau. Kev kuaj mob ntawm pathology suav nrog kev sau cov lus tsis txaus siab thiab anamnesis ntawm tus kab mob, kuaj hauv chav kuaj thiab ntsuas cov txheej txheem. Feem ntau, cov tsos mob ua ntej yog arterial hypertension, uas tsis zoo rau kev kho mob ntshav siab. Tsis tas li, cov neeg mob tuaj yeem yws yws ntawm qhov tsis xis nyob hauv lub nraub qaum (ntawm ib sab lossis ob sab), kev hloov pauv ntawm qhov tso zis. Cov phiaj xwm kev xeem suav nrog:
- CBC thiab urinalysis.
- ECG.
- kuaj ntshav biochemical. Tus kab mob tuaj yeem xav tias muaj kev nce qib ntawm creatinine thiab urea.
- Ultrasound ntawm lub raum.
- Cov qauv tshwj xeeb: urinalysis raws li Nechiporenko, Zimnitsky.
- X-ray sib piv kev kawm ntawm cov hlab ntsha -renography.
- Dopplerography ntawm lub raum cov hlab ntsha.
- Angiography.
- CT thiab MRI.
Differential Diagnosis
Muab hais tias qhov mob hnyav yog qhov ua rau, lub raum hlab ntsha stenosis txawv ntawm lub plawv pathologies, aortic atherosclerosis. Tsis tas li, cov tsos mob yuav zoo ib yam li Cushing's disease thiab pheochromocytoma.
Yog tias cov tsos mob ntawm ischemic nephropathy yeej, ces stenosis txawv ntawm cov kab mob ntawm lub raum. Cov no suav nrog pyelo- thiab glomerulonephritis. Tsis tas li ntawd, cov tsos mob zoo sib xws tuaj yeem pom muaj teeb meem ntawm ntshav qab zib.
Kev kho mob rau lub raum hlab ntsha stenosis
Kev kho mob raum cov hlab ntsha stenosis pib nrog kev saib xyuas. Nrog ntshav siab tshwm sim los ntawm kev nqaim ntawm lub raum hlab ntsha, kev sib xyaw ntawm ntau yam tshuaj yog tsim nyog. Angiotensin-hloov enzyme inhibitors yog nyiam. Tab sis cov tshuaj no tsis pom zoo rau qhov mob hnyav atherosclerotic vascular txhab. Kev sib xyaw ua ke yog tsim los ntawm cov tshuaj hauv qab no:
- Beta blockers. Cov no suav nrog tshuaj Metoprolol, Coronal, Bisoprolol.
- Zoo diuretics. Cov tshuaj uas xaiv yog cov tshuaj Furosemide.
- Calcium channel blockers. Ntawm lawv yog cov tshuaj "Verapamil", "Diltiazem"
Ntxiv rau, tus neeg mob yuav tsum noj cov tshuaj tsim nyog los kho cov kab mob hauv qab (atherosclerosis, ntshav qab zib mellitus).
Kev kho mob stenosis
Hmoov tsis zoo, feem ntau, kev kho mob ntshav siab tsis zoo. Tsis tas li ntawd, txo cov ntshav siab tsuas yog exacerbates ischemic nephropathy. Yog li ntawd, nws yog ib qho tsim nyog yuav tau mus rau kev cuam tshuam kev phais. Nyob ntawm qhov kev puas tsuaj, xaiv txoj kev kho mob phais. Feem ntau, stenting ntawm cov hlab ntsha muab lub raum yog ua. Yog hais tias tag nrho cov lumen ntawm lub nkoj yog obturated nyob rau hauv ib tug deb deb, shunting yog ua - hloov ib feem ntawm lub nkoj nrog ib tug graft. Thaum cov ntaub so ntswg tuag, nephrectomy tau ua.
Kev kuaj mob tom qab phais kho mob stenosis
Txawm hais tias sab twg qhov mob yog (stenosis ntawm lub raum sab laug lossis sab xis), qhov kev tshwm sim tom qab phais yog nyob ntawm kev ua raws li tus kws kho mob cov lus pom zoo thiab tus neeg mob somatic. Feem ntau, kev kho phais tuaj yeem ua tiav qhov txiaj ntsig zoo. Tom qab ob peb lub hlis, 60-70% ntawm cov neeg mob normalize ntshav siab.
Cov teeb meem ntawm lub raum stenosis
Hmoov tsis zoo, lub raum hlab ntsha stenosis tsuas yog kuaj tau nyob rau theem kawg ntawm kev loj hlob. Yog li ntawd, nws tsis tuaj yeem tsis quav ntsej cov lus pom zoo ntawm tus kws kho mob. Tom qab tag nrho, tsis muaj kev kho kom raug, cov teeb meem txaus ntshai tuaj yeem tshwm sim. Ntawm lawv yog myocardial infarction thiab mob stroke tiv thaiv keeb kwm yav dhau ntawm kev kub ntxhov siab, mob raum tsis ua haujlwm thiab mob ntev. Yog tias kev phais tsis ua raws sijhawm, tus neeg mob yuav poob lub cev.
Kev Tiv Thaiv
Kev ntsuas tiv thaiv suav nrog kev soj ntsuam tas li ntawm cov ntshav siab thaum muaj kev tsis txaus siab ntawmkiv taub hau thiab tinnitus, txiav luam yeeb thiab haus cawv. Txhawm rau kom tsis txhob muaj kev loj hlob ntawm atherosclerosis, nws yog ib qho tsim nyog yuav tsum ua raws li kev noj zaub mov tshwj xeeb hypocholesterol, ua lub neej nquag. Qee tus neeg mob yuav tsum tau noj tshuaj tshwj xeeb hu ua statins.
