Stroke tuaj yeem tiv thaiv tau yog tias koj paub lub hauv paus ntawm nws qhov tshwm sim, muaj feem cuam tshuam, txoj hauv kev los daws qhov ua rau. Kwv yees li 80% ntawm ischemic strokes yog vim kev puas tsuaj rau cov hlab ntsha carotid lossis vertebral hlab ntsha.
Brief Anatomy
Lub nkoj loj tshaj plaws hauv lub cev yog aorta. Nws tshwm sim los ntawm sab laug ventricle ntawm lub plawv, tom qab ntawd tsim ib qho arc thiab nqis vertically down, muab cov ceg rau hauv nruab nrog cev ntawm txoj kev. Cov nkoj uas pub rau sab saud thiab lub hlwb tawm ntawm lub arc. Cov no yog cov hlab ntsha brachiocephalic (los ntawm Latin, lub xub pwg nyom taub hau).
Ua ntej, muaj cov nkoj nyob ntawm sab laug. Cov no suav nrog cov hlab ntsha subclavian, uas muab rau sab sauv sab saud, thiab cov hlab ntsha carotid, uas nce vertically rau lub taub hau. Lawv tau ua raws li lub cev brachiocephalic, nws muab faib ua cov hlab ntsha sab xis: ntau carotid thiab subclavian.
Cov hlab ntsha subclavian, raws li lawv cov chav kawm, muab cov ceg ntoo uas dhau los ntawm cov txheej txheem hla ntawm lub ncauj tsev menyuam.vertebrae thiab mus rau lub taub hau. Feem ntau pw tsaug zog yog muab faib ua sab hauv thiab sab nraud. Txhua tus ntawm lawv ua nws txoj haujlwm. Lub puab tsaig txhawb lub hlwb, thiab sab nraud txhawb nqa cov nqaij mos ntawm lub taub hau. Ntawm lub hauv paus ntawm lub paj hlwb, cov hlab ntsha hauv carotid koom nrog cov vertebrates los ua lub voj voog ntawm Willis. Nws lub luag haujlwm tseem ceeb hauv qhov nws rov faib cov ntshav ntws thaum lub nkoj puas.
Kev txhais ntawm atherosclerosis
Yog vim li cas rau qhov txo qis hauv cov ntshav mus rau lub hlwb, feem ntau, yog atherosclerosis ntawm cov hlab ntsha brachiocephalic. Qhov no yog kab mob ntev uas cov hlab ntsha ntawm phab ntsa thickens, thiab atherosclerotic formations (plaques) rau nws. Qhov tshwm sim ntawm cov txheej txheem no yog qhov txo qis hauv lumen, cuam tshuam ntawm cov ntshav khiav thiab tsis muaj ntshav txaus.
Atherosclerotically hloov pauv cov hlab ntsha brachiocephalic tsim muaj kev pheej hmoo siab ntawm cov hlab ntsha ntawm kev tsim cov hlab ntsha tawg, CCI (kev mob cerebrovascular insufficiency), mob stroke.
Nyob rau xyoo tas los no, qhov xwm txheej ntawm cov mob stroke tau nce hauv Russia, thiab qhov no yog ntau dua 400 txhiab tus neeg nyob rau ib xyoos. Kwv yees li 70-85% ntawm lawv yog ischemic, uas yog, cuam tshuam nrog kev txo qis hauv cov ntshav vim qhov nqaim ntawm lub qhov ncauj ntawm lub nkoj lossis nws qhov txhaws. Kwv yees li 80% ntawm cov hlab ntsha (ischemic) yog vim atherosclerosis ntawm vertebral lossis carotid hlab ntsha.
Risk factors
Muaj ntau yam kev pheej hmoo uas tuaj yeem ua rau muaj kev txhim kho pathology. Cov no suav nrog:
- Hnub nyoog (poj niam, nrogthaum ntxov menopause los yog tshaj 55, txiv neej tshaj 45).
- Yog cov txheeb ze, cov niam txiv muaj keeb kwm mob hlab ntsha tawg, lub plawv nres, pib ntxov ntxov ntawm cov hlab ntsha.
- Smoking.
- Hypertension.
- Tag nrho cov roj (TC) ntau dua 5 mmol ib liter lossis tsawg-density lipoprotein (CHLDL) ntau dua lossis sib npaug li 3 mmol / L.
- Triglycerides (TG) ntau dua 2 mmol / l, high-density lipoproteins (HDL-C) tsawg dua 1 mmol / l.
- Mob ntshav qab zib mellitus, ntshav qabzib ntau dua 7 mmol / l ntawm lub plab khoob.
- plab plab yog thaum lub duav ncig dav dua 102 cm rau txiv neej thiab 88 cm rau poj niam.
YKev kuaj mob atherosclerosis
Tag nrho cov roj cholesterol yuav tsum yog ib txwm:
- general - tsawg dua 5 mmol / liter;
- HDL cholesterol - ntau dua lossis sib npaug rau 1 mmol / L;
- TG - tsawg dua 1.7 mmol / l.
LDL cholesterol - qis dua 3 mmol / l;
Txawm tias tsis muaj cov tsos mob ntawm HNMK, tab sis muaj ob lossis ntau qhov kev pheej hmoo, nws yuav tsum raug kuaj xyuas kom tsis suav nrog atherosclerosis. Kev kuaj mob txhua xyoo suav nrog kev kawm txog tag nrho cov roj (cholesterol) nrog kev nce qib ntawm nws qib siab dua 5 mmol / l, yuav tsum tau ua tiav kev soj ntsuam txuas ntxiv (lipidogram). Qhov no yuav ua rau koj paub txog qib lipoproteins thiab triglycerides. Yog tias qhov lipid profile tsis ua raws li tus qauv, lossis muaj kev tsis txaus siab txog kev noj qab haus huv, nws yuav tsum tau kawm ntxiv txog cov hlab ntsha brachiocephalic.
Nrog cov kab mob atherosclerotic ntawm cov hlab ntsha brachiocephalic thiab tshwm sim ntawm CNMC, tej zaum yuav muaj cov tsos mob hauv qab no:
- Asymptomatic daim ntawv, thaum cov hlab ntsha raug cuam tshuam, tab sis tus neeg mob tsis muaj kev tsis txaus siab,yam ntxwv ntawm txo lub hlwb lub zog. Thaum kuaj ntxiv, cov hlab ntsha brachiocephalic muaj qhov txo qis ntawm qhov sib txawv.
- Kev mob MC Transient, tseem hu ua kev tawm tsam ischemic lossis TIA, thaum pom cov tsos mob tshwm sim pom tseeb (paresis, tuag tes tuag taw, tsis hais lus, lub ntsej muag asymmetry), tab sis qhov no kav tsis ntev tshaj ib hnub.
- Lub paj hlwb tsis ua haujlwm (dyscirculatory encephalopathy DEP), uas tuaj yeem ua rau mob taub hau, qaug zog, kiv taub hau, nce kev xav, pw tsaug zog, nco, thiab lwm yam.
- Ischemic stroke. Nws cov tsos mob ntawm lub paj hlwb nyob ntawm seb lub nkoj twg raug thaiv thiab qhov thaiv tau ntev npaum li cas.
Duplex scanning ntawm brachiocephalic hlab ntsha
Txoj kev tshawb fawb tseem ceeb yog ultrasound xim duplex scanning (USDS).
Feem ntau tau ua nyob rau theem pib ntawm kev tshawb fawb. Nws tso cai rau koj kom paub:
- Yog cov nkoj patent.
- Puas muaj kev tsim sab hauv (atherosclerotic plaques lossis ntshav txhaws), thiab yog tias muaj, lawv thaiv lub nkoj ntau npaum li cas. Plaque loj hlob tuaj yeem nkag mus tob rau hauv lub nkoj - stenosing atherosclerosis, los yog raws li lub nkoj - tsis-stenosing (los yog maj mam stenosing).
- Tus qauv ntawm phab ntsa vascular.
- Puas muaj anomaly anomaly.
- ntshav ntws.
Nrog stenosis siab dua 50%, duplex scanning ntawm cov hlab ntsha brachiocephalic, yuav tsum tau ua txhua xyoo rau kev tswjtom qab cov quav hniav.
Tactics ntawm kev tswj cov neeg mob nrog atherosclerosis ntawm brachiocephalic hlab ntsha
Cov neeg mob cov tsos mob (ntau dua 60% stenosis) tau kho nrog kev phais.
Rau cov neeg mob asymptomatic (tsis muaj tsos mob) nrog ob lossis ntau qhov sib txawv, kev kho tshuaj yog qhov kev xaiv zoo tshaj plaws. K Cov kev kho mob phais muaj xws li:
- Carotid endarterectomy (CEAE), carotid bypass, hloov cov hlab ntsha hauv carotid.
- Carotid angioplasty nrog stenting (CAPS), stenting ntawm subclavian, vertebral artery.
Kev ua haujlwm zoo li cas, thiab seb nws yuav tsum tau ua li cas, yog txiav txim siab los ntawm cov kws kho plawv thiab cov kws phais plawv, nyob ntawm lub hnub nyoog, qib ntawm vascular stenosis, concomitant pathology, thiab lwm yam. Ntawd yog, tom qab ntsuas tag nrho cov kev pheej hmoo. Kev txiav txim siab ua haujlwm yog ua nruj me ntsis raws li cov lus qhia, raws li lub teb chaws cov lus qhia rau kev tswj cov neeg mob vascular pathology.
Yog tias kev kho phais tsis qhia rau tus neeg mob, tus kws kho mob muab cov lus pom zoo rau kev hloov pauv txoj kev ua neej. Txhua qhov kev pheej hmoo yuav tsum raug tshem tawm:
- ntsuas ntshav siab thiab ntshav qabzib qib;
- kho comorbidities;
- txiav luam yeeb thiab tso cawv;
- ua raws li kev noj haus uas txwv tsis pub tsiaj rog thiab carbohydrates;
- xyuam xim rau lub cev ua si, taug kev txhua hnub, ua haujlwm thaum sawv ntxov;
- noj statins(Cov tshuaj ntawm pab pawg no yuav raug xaiv los ntawm tus kws kho mob lossis kws kho plawv).
Ua tiav tag nrho cov lus pom zoo ntawm tus kws kho mob tuaj koom, koj tuaj yeem zam kev phais.
