Arterial hypertension yog ib yam kab mob uas nrog rau qhov kev nce siab thiab ntev ntev. Kwv yees li 30% ntawm cov neeg laus hauv lub tebchaws raug kev txom nyem los ntawm nws. Ntshav siab yog ib qho ntawm cov kab mob loj tshaj plaws ntawm cov hlab plawv.
Nrog hnub nyoog, kev pheej hmoo ntawm kab mob nce ntxiv. Cov noob caj noob ces tseem ceeb heev, yog vim li cas, yog tias muaj qhov tsis txaus ntseeg, nws yuav tsum tau mus ntsib kws kho mob ib ntus kom thiaj li pib kho tau raws sijhawm.
Ntxhais kab mob
Lub siab ib txwm yog 120/80 mm Hg. Art. Tus nqi no tuaj yeem hloov pauv lossis qis dua los ntawm qee yam. Yog tias qhov kev hloov pauv tshwm sim nyob rau lub sijhawm luv luv, nws txhais tau tias tus neeg muaj kev noj qab haus huv tag nrho. Txwv tsis pub, kev loj hlob ntawm tus kab mob tuaj yeem raug xav tias yog. Nrog rau qhov mob thawj zaug, ICD-10 code rau arterial hypertension yog I10.
Nrog rau qhov nce siab ntxiv, kev hloov pauv tsis zoo tau pom hauv cov kabmob sab hauv. Raws licov ntsuas no yog kev faib cov kab mob no. Raws li ICD-10, cov tsos mob ntshav siab, uas yog, daim ntawv thib ob ntawm tus kab mob, muaj tus lej I15.0.
Ntxiv rau, muaj ib daim ntawv tswj tsis tau, tus cwj pwm los ntawm qhov tsis muaj txiaj ntsig zoo thaum kho. Nws tuaj yeem yog pseudo lossis ntshav siab. Feem ntau tsis muaj qhov tshwm sim zoo vim yog kev siv tshuaj tsis raug lossis lawv cov kev tswj hwm.
Kev faib tawm
Kev nce ntshav siab tshwm sim vim qhov nqaim ntawm lumen ntawm cov hlab ntsha loj, provoked los ntawm kev ntws ntawm cov txheej txheem hormonal thiab cov hlab ntsha. Nrog rau qhov nqaim ntawm lawv cov phab ntsa, kev ua haujlwm ntawm lub plawv nce siab, thiab tus neeg mob pib tsim thawj cov hlab ntshav siab, uas tshwm sim hauv yuav luag 90% ntawm cov neeg mob. Nws ua rau muaj kev puas tsuaj rau ntau yam kabmob thiab lub cev.
Nyob rau hauv cov neeg mob tas, ib hom kab mob thib ob tau pom, uas yog tshwm sim los ntawm lwm yam pathologies. Lawv tuaj yeem muab faib ua:
- renal;
- hemodynamic;
- endocrine;
- Neurogenic.
Yog tias tus kab mob tau ua rau lub raum tsis ua haujlwm, ces raws li ICD, arterial hypertension muaj tus lej I12.0. Tus kab mob no tshwm sim vim hydronephrosis, pyelonephritis, kab mob polycystic raum, mob hluav taws xob.
Cov kab mob endocrine tshwm sim nrog cov qog ua haujlwm hormonally ntawm cov qog adrenal, nrog rau kev puas tsuaj rau cov thyroid caj pas. Hom neurogenic ntawm tus kab mob yog tsim nrog lub hlwb puas, nrog rau kev hloov pauvacid-base balance. Yog hais tias qhov kev ua txhaum cai tau provoked los ntawm kab mob plawv, ces cov cai hauv ICD rau arterial hypertension yog I13.0. Pathology tshwm sim vim aortic valve insufficiency, atherosclerosis, thiab ntau lwm yam kab mob.
Ntxiv rau, tej zaum yuav muaj lwm yam kab mob uas tshwm sim nrog kev mob toxicosis lig thaum cev xeeb tub, lom nrog tshuaj lom, mob qog noj ntshav, noj tshuaj ntau dhau. Raws li qhov xwm txheej ntawm chav kawm, arterial hypertension tuaj yeem yog:
- transient;
- stable;
- labile;
- crisis;
- malignant.
Hom kev phom sij tshaj plaws yog qhov tsis zoo, vim tias lub siab nce mus rau qib siab, thiab tus kab mob mus sai heev. Daim ntawv no tuaj yeem ua rau muaj teeb meem txaus ntshai heev thiab txawm tias tus neeg mob tuag.
theem ntawm cov kab mob
Cov kws kho mob tshwj xeeb txheeb xyuas ntau qib ntawm arterial hypertension, sib txawv ntawm qhov kev loj hlob thiab cov yam ntxwv ntawm chav kawm. Theem 1 yog suav tias yog qhov yooj yim tshaj plaws, tus cwj pwm los ntawm kev nce siab me ntsis. Nws theem thaum nruab hnub tuaj yeem tsis ruaj khov, tab sis tom qab so, qhov ntsuas no pib maj mam ruaj khov.
Nws tsim nyog sau cia tias tus neeg mob tsis muaj teeb meem kev noj qab haus huv txhua. Qee zaum, cov tsos mob hauv qab no yuav tshwm sim:
- mob taub hau;
- pw tsis tsaug zog;
- suab nrov hauv taub hau;
- txo qis hauv kev puas siab puas ntsws.
Qee zaum yuav kiv taub hau thiab los ntshav. Lub raum tsis ua haujlwm tsis raug, thiab cov nyiaj siv tau zoo tsis hloov pauv.
Nrog 2 degrees ntawm arterial hypertension, muaj qhov nce siab tsis tu ncua, uas tuaj yeem sib txawv ntawm 180-200 mm Hg. Art. Cov neeg mob feem ntau yws txog mob taub hau, kiv taub hau, mob hauv siab. Cov theem no yog tus cwj pwm los ntawm hypertensive crises. Qhov no qhia txog kev puas tsuaj rau hauv nruab nrog cev.
Rau ib feem ntawm lub paj hlwb, muaj qhov tshwm sim ntawm vascular insufficiency, cerebral ischemia, thiab tuaj yeem mob stroke. Ntawm lub fundus, muaj cov cim qhia ntawm compression ntawm cov leeg. Lub raum ntshav ntws tau txo qis heev, txawm hais tias tsis muaj qhov txawv txav hauv kev tshuaj ntsuam.
Nrog cov hlab ntshav siab ntawm qib 3, muaj qhov tshwm sim tsis tu ncua ntawm cov hlab ntsha, nyob ntawm qhov nce siab, uas tuaj yeem nyob ruaj khov rau lub sijhawm ntev. Daim duab kho mob yog txiav txim los ntawm qhov mob:
- hlwb;
- siab;
- fundus;
- kidney.
Qee tus neeg mob qib 3 arterial hypertension, txawm tias qhov nce siab, tsis muaj teeb meem vascular ntau xyoo.
Kev tshwm sim
Kev ntsuas qib ntawm kev pheej hmoo ntawm kev mob ntshav siab, nws yog ib qho tsim nyog yuav tsum coj mus rau hauv tus account vim li cas qhov kev ua txhaum cai no tshwm sim. Vasoconstriction yog suav tias yog qhov tseem ceeb hauv kev nce siab. Cov ntshav ntws tawm lub siab tseem ceeb ntawm lawv cov phab ntsa. Ntawm cov laj thawj tseem ceeb ntawm kev nce siab, nws yog ib qho tsim nyog los qhia txog qhov muaj nyob ntawmatherosclerosis. Tus kab mob no nws thiaj li ua rau muaj cov tsos mob ntawm arterial hypertension.
Raws li kev cuam tshuam ntawm atherosclerosis, cov phab ntsa ntawm cov hlab ntsha pib thicken, thiab cov hlab ntsha poob lawv cov qub elasticity. Tsis tas li ntawd, lawv tau them nrog atherosclerotic plaques los ntawm sab hauv. Qhov no ua rau muaj kev hem thawj rau lub neej, vim nws ua rau muaj kev pheej hmoo ntawm plawv nres lossis mob stroke.
Ntawm cov laj thawj tseem ceeb uas ua rau muaj kev loj hlob ntawm arterial hypertension, nws yog ib qho tsim nyog los qhia txog:
- hnyav dhau;
- tus cwj pwm phem;
- noj ntsev ntau ntau.
Paub meej tias dab tsi ua rau tus kab mob no, koj tuaj yeem tiv thaiv kev pheej hmoo ntawm nws txoj kev loj hlob. Tsis tas li ntawd, cov neeg uas muaj kev pheej hmoo siab rau ntshav siab yuav tsum tau mus kuaj xyuas ib ntus nrog kws kho mob thiab ua raws li nws cov lus pom zoo.
Cov tsos mob tseem ceeb
Thaum cov ntshav siab tshwm sim, cov tsos mob ntawm cov tshuaj yuav tsis raug soj ntsuam ntev, yog li yog tias koj tsis siv lub tonometer, koj yuav tsis paub txog qhov muaj teeb meem, uas cuam tshuam nrog kev kho raws sijhawm. Cov tsos mob tseem ceeb tshaj plaws yuav yog ntshav siab tsis tu ncua. Txawm li cas los xij, tsis yog peb txhua tus tswj nws qib. Tias yog vim li cas koj yuav tsum tau xyuam xim rau cov tsos mob xws li:
- mob taub hau;
- mob siab;
- tinnitus;
- lub plawv dhia;
- pom qhov tsis pom kev;
- kev puas tsuaj;
- ua tsis taus pa;
- puffinessko taw.
mob taub hau feem ntau nyob hauv cov tuam tsev, sab nraub qaum lossis thaj tsam parietal. Kev tsis xis nyob yuav tshwm sim thaum hmo ntuj lossis tam sim ntawd tom qab sawv. Raws li txoj cai, qhov mob nce nrog lub cev thiab lub hlwb kev ntxhov siab.
Thaum thawj cov tsos mob ntawm tus kab mob tshwm sim, koj yuav tsum tau mus ntsib kws kho mob tam sim ntawd kom paub meej qhov kev kuaj mob, vim qhov no yuav ua rau nws muaj peev xwm kuaj tau thiab sau tshuaj kho raws sijhawm kom tsis txhob muaj kev loj hlob ntawm tus kab mob. ib tug hypertensive ntsoog.
Diagnostics
Thaum lub siab nce siab, koj yuav tsum sab laj nrog kws kho mob tam sim ntawd. Thaum pib, kev kuaj mob yog kev kawm txog keeb kwm ntawm cov kab mob, nrog rau cov tsos mob uas twb muaj lawm.
Ntxiv rau, chav kuaj thiab ntsuas ntsuas xws li:
- kuaj ntshav thiab zis;
- electrocardiogram;
- kev tshawb fawb biochemical;
- ultrasound.
Nws tseem ceeb heev rau kev tswj ntshav siab los ntawm kev siv cov cuab yeej tshwj xeeb - tonometer. Tus neeg mob yuav tsum tau txais nws thiaj li muaj peev xwm teb tau raws sijhawm rau cov kev hloov tsis zoo hauv lub cev. Yuav tsum tau kuaj lub cev, uas suav nrog kuaj tus neeg mob nrog lub stethoscope. Nws pab txiav txim siab qhov muaj lub plawv yws thiab ntau lwm yam kev hloov pauv hauv lub cev.
Kom tau txais cov ntaub ntawv tiav txog lub xeev ntawm cov phab ntsa ntawm cov hlab ntsha,Koj yuav tsum tau mus rau arteriography, uas yog ib qho kev kuaj x-ray. Tsis tas li ntawd, kev kuaj ultrasound ntawm cov ntshav ntws ntawm cov hlab ntsha yog ua tiav.
Kev kho mob
Kev kho mob ntshav siab yuav tsum tau ua tiav, nrog rau ua raws li cov lus pom zoo ntawm tus kws kho mob, kom tsis txhob ua rau muaj kev noj qab haus huv tsis zoo. Thaum ua kev kho mob, nws yog ib qho tsim nyog yuav tsum tau tshem tawm cov kev pheej hmoo xws li:
- haus luam yeeb thiab haus cawv;
- hnyav dhau;
- kev ua neej nyob.
Tsis tas li ntawd, nws yog ib qho tseem ceeb kom normalize qib lipids hauv cov ntshav. Qhov no tuaj yeem ua tiav los ntawm kev kho tshuaj lossis los ntawm kev noj zaub mov kom raug. Kev noj zaub mov rau ntshav siab txhais tau hais tias txo qis ntawm cov ntsev noj, nrog rau kev qhia txog seaweed, qos yaj ywm, legumes rau hauv kev noj haus ib txwm.
Kev kho tshuaj yuav tsum tau siv yog tias ntshav siab nyob ntawm 140 lossis ntau dua rau lub sijhawm ntev txawm hais tias kev ua neej hloov pauv. Thaum arterial hypertension tshwm sim, cov lus pom zoo kho mob yuav tsum tau ua raws nruj heev. Tus neeg mob tau kho los ntawm kws kho plawv. Yog tias daim ntawv thib ob tau txheeb pom, tus neeg mob raug xa mus rau kws kho mob nephrologist lossis endocrinologist.
Ntxiv rau, nws raug nquahu kom kuaj xyuas ntxiv los ntawm kws kho mob hlwb thiab tus kws kho qhov muag txhawm rau txiav txim siab qhov xwm txheej ntawm cov kabmob sab hauv. Ua raws li cov lus qhia yooj yim ua rau muaj txiaj ntsig zoo.
Tshuajkev kho mob
Tshuaj kho mob arterial hypertension muaj nyob rau hauv kev siv tshuaj xws li:
- tshuaj tiv thaiv hypertensive;
- Ydiuretics;
- blockers;
- ACE inhibitors;
- calcium antagonists.
Kev kho yuav tsum pib nrog kev qhia txog qhov tsawg kawg nkaus ntawm cov tshuaj tiv thaiv kab mob siab thiab nce ntxiv yog tias tsis muaj qhov xav tau. Txhawm rau tiv thaiv kev pheej hmoo ntawm cov teeb meem, cov tshuaj yuav tsum tau noj thoob plaws lub neej, vim tias lawv yuav tso cai rau koj los ua kom lub siab zoo. Thaum xaiv cov tshuaj, qhov kev nyiam yuav tsum tau muab rau cov tshuaj ua haujlwm ntev, vim qhov no yuav tso cai rau kev teeb tsa ib zaug xwb thaum sawv ntxov.
Pib kho cov tsos mob ntawm arterial hypertension nrog monotherapy thiab maj mam txav mus rau kev sib xyaw ntawm cov tshuaj los ntawm ntau pawg. Rau cov neeg laus, calcium channel blockers yuav tsum tau siv thawj zaug. Nws yog qhov tsis xav tau tias lawv muaj cov khoom siv uas hloov cov metabolism ntawm insulin thiab piam thaj. Lub hom phiaj tseem ceeb ntawm kev kho yog tiv thaiv kev tuag ntawm cov neeg mob.
Diuretics muaj txiaj ntsig zoo rau cov leeg hauv lub plawv thiab tau txais txiaj ntsig zoo los ntawm cov neeg mob feem ntau. Lawv siv los kho cov ntshav siab tsuas yog thaum tsis muaj gout thiab ntshav qab zib. Diuretics feem ntau tau sau nrog rau lwm cov tshuaj ntshav siab.
Adrenergic blockers muaj txiaj ntsig zoo rau cov ntshav muaj pes tsawg leeg. Lawv tsis yog kiag lihloov cov piam thaj, txo cov ntshav siab yam tsis tau nce lub plawv dhia. Nws yog ib nqi sau cia hais tias thaum xub thawj siv cov tshuaj no, tej zaum yuav muaj ib co deterioration nyob rau hauv kev noj qab nyob zoo, thiab ib tug neeg tej zaum yuav txawm tsis nco qab. Txhawm rau zam qhov no, koj yuav tsum ua raws qee cov cai. Diuretics yuav tsum tau txiav tawm ua ntej noj cov tshuaj no, thiab thawj koob tshuaj yuav tsum yog thaum yav tsaus ntuj.
ACE inhibitors thaiv kev tsim cov tshuaj hormones uas ua rau vasoconstriction. Vim lawv cov kev cuam tshuam rau tus neeg mob lub cev, qhov txo qis hauv siab tau pom. Tsis tas li ntawd, lawv siv txo qhov kev pheej hmoo ntawm kev txhim kho nephropathy hauv ntshav qab zib. Nws yog ib nqi sau cia hais tias lawv siv yog qhia feem ntau rau lub plawv tsis ua hauj lwm.
Hormone antagonists raug tshuaj yog tias vim qee qhov kev siv cov tshuaj inhibitors yog contraindicated. Nyob rau hauv kev kho mob ntawm arterial hypertension, soj ntsuam cov lus pom zoo yuav tsum tau ua raws li nruj me ntsis, vim hais tias txoj kev vam meej ntawm kev rov qab los feem ntau nyob ntawm qhov no. Tus kws kho mob yuav sau ib los yog ntau yam tshuaj rau kev kho mob.
Txawm tias tom qab ua kom lub siab zoo li qub, kev kho mob yuav tsum tsis txhob nres yam tsis tau sab laj nrog kws kho mob, vim qhov no tuaj yeem ua rau muaj kev kub ntxhov siab.
Non-pharmaceuticals
Thaum cov ntshav siab tshwm sim, tus kws kho mob cov lus pom zoo yuav tsum ua raws li nruj me ntsis, vim tias kev noj tshuaj rau tus kheej tuaj yeem ua rau muaj teeb meem ntau yam. Txoj kev tsis siv tshuaj ntawm kev kho mob yog siv dav, uas zoo sib xyaw nrog ntau yam tshuajtshuaj.
Nco ntsoov tso kev haus luam yeeb, vim nws muaj kev cuam tshuam tsis zoo rau lub xeev ntawm cov hlab plawv. Tsis tas li ntawd, nws yog ib qho tseem ceeb los saib xyuas koj qhov hnyav, vim tias qhov poob phaus muaj txiaj ntsig zoo ntawm kev txo cov ntshav siab thiab pab tshem tawm cov teeb meem tseem ceeb rau kev tsim cov kab mob.
Nws tsim nyog nce kev noj cov txiv hmab txiv ntoo thiab zaub uas muaj cov poov tshuaj thiab magnesium, nrog rau kev txwv cov tsiaj rog hauv koj cov zaub mov. Nco ntsoov sim kom tsis txhob muaj kev ntxhov siab, mob hlwb thiab lub cev. Cov kws kho mob pom zoo kom ua kom lub cev muaj zog. Piv txwv li, taug kev nrawm thiab ua luam dej yuav pab tau. Nws yog ib qho tsim nyog sau cia tias qee hom kev thauj khoom, ntawm qhov tsis sib xws, ua rau muaj kev nce siab hauv qib siab.
Txoj kev tshwm sim ntawm tus kab mob
Nws yog qhov tsim nyog kom nkag siab meej tias qhov kev pheej hmoo ntawm arterial hypertension tuaj yeem ua li cas. Nrog rau lub sij hawm nce siab, cov phab ntsa ntawm cov hlab ntsha thicken ho thiab poob lawv lub peev xwm los so. Yog li ntawd, cov txheej txheem ntawm saturation ntawm cov ntaub so ntswg thiab lub cev nrog cov pa oxygen cuam tshuam, uas ua rau txo qis hauv lawv cov haujlwm. Ntawm cov kev pheej hmoo tseem ceeb ntawm kev kub siab yog cov hauv qab no:
- kev kub ntxhov siab;
- stroke;
- mob plawv;
- angina;
- lub plawv tsis ua hauj lwm;
- kab mob ischemic;
- raum tsis ua haujlwm;
- kev pom kev tsis pom kev.
Ntawm cov kev pheej hmoo feem ntau ntawm cov kab mob, ib tus tuaj yeem tawm qhov tshwm sim ntawm qhov kub ntxhov. Nws tuaj yeem pom ntawmkuj txaus siab rau tus neeg mob. Qhov no yog ib qho ntawm feem ntau txaus ntshai ntawm arterial hypertension ntawm 2nd degree. Nws tuaj yeem provoked los ntawm psychophysical kev nyuaj siab ntawm tus neeg mob. Nws loj hlob sai heev, thiab tib lub sijhawm nws tau pom:
- siab surge;
- mob taub hau;
- nausea;
- arrhythmia lossis tachycardia.
Qhov kev pheej hmoo ntawm qib 3 mob ntshav siab yog qhov tshwm sim ntawm myocardial infarction. Qhov teeb meem no tshwm sim rau ob peb feeb thiab tuaj yeem ua rau tus neeg mob tuag. Cov tsos mob tseem ceeb yog qhov mob ntev heev.
Hypertensive crisis
Hypertensive ntsoog yog ib qho mob uas yuav tsum tau saib xyuas sai. Nws implies ib tug ntse nce nyob rau hauv siab mus rau siab heev. Nyob rau hauv rooj plaub no, muaj kev ua txhaum ntawm cov ntshav muab rau hauv lub cev, nrog rau cov tseem ceeb. Nws tshwm sim thaum lub cev raug rau yam tsis zoo.
Hypertensive ntsoog yog qhov txaus ntshai heev vim nws tsis tuaj yeem twv ua ntej. Thaum tsis muaj kev pab raws sij hawm, qhov tshwm sim tuag tau tshwm sim. Txhawm rau muab kev saib xyuas xwm txheej ceev, tus neeg mob yuav tsum tau coj mus rau tsev kho mob sai, qhov twg nws lub siab yuav raug txo los ntawm kev siv tshuaj tshwj xeeb.
Kev cuam tshuam ntawm lub cev hauv nruab nrog
Arterial hypertension yog qhov mob hnyav heev, vim qhov nce siab tas li ua rau muaj kev puas tsuaj rau ntau lub cev thiab lub cev. Tshwj xeeb, cov no suav nrog:
- hlwb;
- siab;
- viav;
- kidneys.
Cov tsos mob ntawm tus kab mob no feem ntau nyob ntawm seb lub cev twg raug cuam tshuam rau thawj qhov chaw. Pathological hloov nyob rau hauv cov hlab ntsha kev txhawj xeeb, ua ntej ntawm tag nrho cov, lawv cov phab ntsa, raws li lawv thickening, nqaim ntawm lub lumen thiab kev puas tsuaj los ntawm plasma proteins tshwm sim. Qhov no ua rau muaj kev cuam tshuam ntawm kev ua haujlwm ntawm cov hlab ntsha thiab hypoxia ntawm lub cev.
Hloov pauv hauv plawv cov leeg pib nrog myocardial hypertrophy. Tom qab ntawd, lub plawv tsis ua hauj lwm tshwm sim thiab kev pheej hmoo ntawm kev tuag sai sai. Hauv lub raum, cov txheej txheem tseem ceeb yog inhibited thaum pib. Tom qab ntawd degenerative thiab cov qauv hloov pauv tshwm sim hauv lub raum cov hlab ntsha, thiab lub raum atrophy tshwm sim.
Kev hloov pauv tib yam tshwm sim hauv lub hlwb xws li hauv cov hlab ntsha ntawm ob lub raum. Qhov no ua rau encephalopathy, hemorrhagic stroke, thiab ischemia.
Hypertension ua rau ntshav siab thiab nce kev ntxhov siab ntawm lub plawv. Qhov no provokes thickening ntawm myocardium thiab kev loj hlob ntawm lub plawv tsis ua hauj lwm.
