Nqaim ntawm lumen hauv cov hlab ntsha ntawm lub hlwb lossis lawv qhov txhaws tag ua rau qhov tseeb tias cov ntshav khiav tsis muaj zog, hypoxia teeb tsa, ua rau muaj kev cuam tshuam ntawm cov ntshav ncig. Cov kab mob ischemic hlwb tsim, uas yuav tsum tau kuaj xyuas, kho sai txaus. Yog tias tsis muaj kev ntsuas, ces cov kab mob pathology yooj yim dhau mus ntev. Raws li qhov tshwm sim, tus neeg mob muaj qhov hnyav ntawm kev ua haujlwm tsis zoo, uas ua rau kev kho mob tsis zoo, tag nrho vim tias hypoxia ua rau cov nqaij mos necrosis.
Ischemia lossis kab mob coronary ntawm lub hlwb yog ib yam kab mob nrog rau cov pa oxygen tsis txaus rau lub hlwb, hauv cov ntsiab lus nkag siab ntau dua, oxygen tshaib plab tshwm sim. Thiab tib neeg lub hlwb feem ntau ntawm tag nrho cov xav tau ib qho khoom noj tas li ntawm oxygen. Txawm hais tias qhov tseeb tias nws ua tsis tau ntau tshaj 4% ntawm tag nrho lub cev qhov hnyav, nws tuaj yeem dhau los ntawm ib feem tsib ntawm tag nrho cov ntshav hauv tib neeg lub cev.
Tus neeg twg muaj kev pheej hmoo?
Cov kws kho mob xa mus rau cov pab pawg muaj kev pheej hmoo siab:
- neeg laus;
- tus neeg muaj mob vascular thiab plawv pathologies;
- mob ntshav qab zib;
- kev quav cawv thiab haus luam yeeb;
- ua haujlwm hauv kev lag luam phom sij;
- ntau zaus hauv kev ntxhov siab.
Tab sis pawg tseem ceeb ntawm kev pheej hmoo yog cov neeg laus, txawm hais tias niaj hnub no cov npe hnub nyoog pawg ntawm cov neeg mob ischemic hlwb tau nthuav dav. Cov menyuam yaus thiab cov laus muaj mob, cov menyuam muaj mob ntawm cov menyuam yug tshiab tau nce.
Dab tsi ua rau ischemia?
Qhov laj thawj tseem ceeb ntawm ischemia yog qhov txhaws ntawm cov hlab ntsha hauv lub hlwb, los ntawm cov pa oxygen nkag mus rau txhua lub cell. Lub hlwb tsis tau txais qhov tsim nyog ntawm cov pa oxygen, yog li nws tsis tuaj yeem ua haujlwm tag nrho. Kev txhaws ntawm cov hlab ntsha tshwm sim rau ntau yam:
- ua txhaum lub plawv cov leeg, uas ua rau arrhythmias thiab mob ntev;
- txo cov ntshav ntws hauv lub hlwb vim kev puas tsuaj rau cov hlab ntsha los ntawm atherosclerosis;
- mob ntshav siab, ua rau muaj kev cuam tshuam hauv cov hlab ntsha ntawm lub hlwb thiab cuam tshuam ntawm venous outflow;
- mob ntshav qab zib thiab muaj pes tsawg leeg ntawm insulin hauv cov hlab ntsha;
- amyloidosis, tshwm sim feem ntau hauv cov neeg laus;
- pathologies cuam tshuam rau cov hlab ntsha, txo cov pa oxygen thiab ua rau tsimntshav txhaws.
Yog tias muaj cov hlab ntsha ntawm lub hlwb, ces cov kab mob xws li atherosclerosis thiab ntshav siab tuaj yeem ua rau tus mob no. Atherosclerosis ua rau lub fact tias cov roj deposits loj hlob nyob rau hauv cov phab ntsa ntawm cov hlab ntsha, uas ua rau cov blockage, uas txhais tau hais tias yog hais tias tsis ntsuas, cov tsos mob ntawm tus kab mob coronary hlwb yuav tshwm sim sai sai no. Feem ntau, nws sai sai ua mob ntev, vim vasoconstriction yog ib qho txheej txheem maj mam. Tus kab mob no tshwm sim tam sim ntawd thiab yog vim muaj ntshav txhaws.
Atherosclerosis thiab thrombosis yog qhov ua rau txaus ntshai tshaj plaws ua rau mob hlwb ischemia thiab tuag rau txhua tus neeg mob thib peb. Daim ntawv mob hnyav tuaj yeem tshwm sim los ntawm kev txhim kho ntawm cov xwm txheej zoo li no:
- bradycardia;
- ntshav qab zib;
- tshuaj lom nrog cov pa phem;
- obesity;
- siv tshuaj.
Tus kab mob no tshwm sim hauv yuav luag txhua pawg ntawm tib neeg, txij li cov menyuam yug tshiab mus rau cov neeg laus. Tab sis qhov txaus ntshai tshaj plaws ntawm cov kab mob coronary hlwb hauv cov menyuam yug tshiab yog suav tias yog. Tus kab mob no suav hais tias yog tus kab mob txaus ntshai tshaj plaws, yog li nws tseem ceeb heev kom nrhiav kev pab tsim nyog ntawm thawj cov tsos mob. Yuav ua li cas tsis nco thawj cov cim?
Ischemia cov tsos mob
Muaj ntau yam tsos mob ntawm tus kab mob coronary hlwb:
- Kev ua haujlwm tsis zoo ntawm lub paj hlwb, uas tshwm sim nws tus kheej hauv kev hais lus tsis meej lossis teeb meem tsis pom kev.
- Nyob.
- Tsis muaj zog hauv txhua yamtele.
- Zoo siab.
- Txo kev ua haujlwm.
- Short-term nco poob.
- Nyob zoo ib tsoom phooj ywg.
- Insomnia.
- Headache.
- dhia ntshav siab.
- ua pa tsis ua haujlwm.
- kiv taub hau.
- Poob tsis nco qab.
- Nyob hauv ob txhais tes thiab ko taw.
- Xav txias hauv libs.
Yog tias koj tsis ua txhua yam kev ntsuas thiab tsis pib kho raws sijhawm, cov tsos mob ntawm tus kab mob hauv lub hlwb tsuas tuaj yeem nce ntxiv. Cov kws kho mob faib tus kab mob mus rau peb theem tseem ceeb lossis qib. Qee tus kws tshaj lij kuj tseem hais txog qhov thib plaub.
Qee zaum nws nyuaj heev rau kev txiav txim siab cov tsos mob ntawm tus mob hauv cov menyuam yug tshiab, vim tias lawv tus kheej tsis tuaj yeem qhia txog lawv tus mob. Yog li ntawd, cov niam txiv yuav tsum tau xyuam xim rau tej yam tshwm sim:
hyperexcitability: tus menyuam tas li shudders, muaj kev tshee ntawm qee qhov ntawm lub cev, pw tsis tsaug zog, quaj vim tsis meej;
- kev nyuaj siab ntawm lub paj hlwb: lethargy, qaug zog nqus thiab nqos reflexes, strabismus, lub ntsej muag asymmetry;
- nce taub hau loj;
- siab intracranial siab;
- tsis nco qab;
xav
Yog tias tus menyuam muaj yam tsawg kawg ib qho ntawm cov tsos mob tau piav qhia, ces koj yuav tsum tau mus nrhiav kev pab tswv yim tam sim.
Degrees of coronary disease
kab mob ischemic hlwb raug cais los ntawm qib, thiab tsuas muaj peb ntawm lawv, txawm tias lawv hais tias muaj plaub. Qib 3 yog suav tias yog qhov nyuaj tshaj plaws.
Thawj qib yog tus cwj pwm los ntawm kev mob me ntsis ntawm kev mloog thiab kev txawj ntse. Ntau zaus, cov neeg mob tiv nrog cov hauj lwm nyuaj yam tsis muaj teeb meem, tab sis nws yuav siv sij hawm ntau heev. Tsis muaj teeb meem kev sib koom tes, tsis muaj kev txwv hauv lub neej, tab sis cov cim me me twb tshwm sim:
- shuffling gait;
- mob thiab mob ntawm tes tom qab kev tawm dag zog;
- ntshai;
- tsis muaj zog.
Ischemic mob hlwb ntawm 2nd degree manifests nws tus kheej hauv daim ntawv uas tus neeg mob tsis muaj peev xwm tswj tau nws qhov kev ua. Thaum ua haujlwm qee yam, nws xav tau kev pab sab nraud, uas cuam tshuam tsis zoo rau nws cov haujlwm tshaj lij. Tus neeg mob kuj tuaj yeem poob qee qhov kev txawj ntse uas twb muaj lawm, muaj qhov tsis zoo.
Ischemia qib 3 tshwm sim nws tus kheej li kev puas siab puas ntsws loj hauv daim ntawv ntawm tus kab mob Parkinson, urinary incontinence thiab teeb meem loj nrog kev sib koom tes.
Tus neeg mob yuav poob peev xwm ntawm nws tus kheej taug kev hauv qhov chaw, nws ob txhais ceg tsis mloog. Muaj teeb meem nrog kev hais lus, kev nco raug kev txom nyem, kev xav cuam tshuam. Yog tias tsis muaj kev ntsuas, ces qhov tshwm sim ntawm theem 3 ischemic mob hlwb poob siab: ua tiav kev puas tsuaj ntawm tus cwj pwm, mob stroke thiab cerebral hemorrhage.
Type of ischemia
Txog hom kab mob, muaj ob ntawm lawv: mob thiabmob.
Daim ntawv mob hnyav yog qhov tshwm sim tam sim ntawd thiab lub sijhawm luv luv ntawm chav kawm. Yog tias cov ntshav ntws tawm sai sai, qhov mob ischemia tshwm sim. Cov tsos mob tshwm sim tam sim ntawd, los ntawm qhov twg ntawm lub hlwb tsis tau txais cov pa oxygen, cov tsos mob sib xws kuj tshwm sim. Daim ntawv mob hnyav tuaj yeem ua rau cov leeg tsis muaj zog, dig muag, thiab kiv taub hau.
Tus kab mob ischemic mob hlwb yog tshwm sim los ntawm qhov tsis muaj oxygen nyob rau hauv lub hlwb ntev. Daim ntawv no tsis muaj qhov mob tshwm sim uas yog tus yam ntxwv ntawm mob hnyav. Thaum lub sij hawm ntev, feem ntau cov hlab ntsha raug cuam tshuam. Nws tuaj yeem tshwm sim los ntawm qhov tshwm sim ntawm daim ntawv mob hnyav, yog li nws yog ib qho tseem ceeb uas yuav tau pib kho raws sijhawm. Yog tias koj xaiv cov tshuaj siv tau zoo thiab ua tiav cov chav kawm, ces qhov kev cia siab yog qhov zoo.
Diagnosis
kab mob ischemic hlwb tuaj yeem lees paub tom qab sau cov ntaub ntawv tiav ntawm tus neeg mob cov kab mob uas twb muaj lawm, kuaj tus kws kho mob thiab ua cov kev tshawb fawb ntxiv:
- Thaum ophthalmoscopy, lub xeev ntawm lub paj hlwb tuaj yeem ntsuas intracranial siab thiab qib ntawm cov hlab ntsha.
- Ultrasound ntawm lub caj dab cov hlab ntsha tso cai rau koj los txiav txim siab qhov ceev ntawm cov ntshav khiav, nrhiav kev cuam tshuam rau kev tso ntshav dawb los ntawm cov hlab ntsha carotid thiab vertebral.
- Kev ntsuam xyuas cov ntshav ntws hauv cov hlab ntsha tseem ceeb ntawm lub hlwb pab kom tau txais cov ntaub ntawv ntxiv.
- Angiography ntawm cerebral hlab ntsha yog suav tias yog cov txheej txheem qhia ntau tshaj plaws uas pab txiav txim siab seb puas muaj qhov tsis txaus ntseeg ntawmatherosclerosis lossis ntshav txhaws.
ECG, ECHO, X-ray ntawm lub ncauj tsev menyuam hauv qee kis pab txheeb xyuas qhov ua rau muaj tus kabmob
Tsuas yog tom qab qhov laj thawj tseeb, raws li kev tshawb fawb thiab cov tsos mob, yog kev kho mob ntawm cov kab mob hauv lub hlwb zoo dua.
Txoj Kev Kho Mob
Lub hom phiaj tseem ceeb ntawm kev kho mob ischemia ntev yog txhawm rau txhim kho cov txheej txheem kev puas tsuaj ntawm ischemia sai li sai tau, nrog rau kom tsis txhob muaj kev loj hlob, ua kom cov txheej txheem sanogenetic them nyiaj. Nws yog ib qho tsim nyog yuav tsum tau ua kev tiv thaiv kom tsis txhob mob stroke, nrog rau kev kho mob rau cov txheej txheem somatic.
Daim ntawv mob tsis tau hais txog kev mus pw hauv tsev kho mob sai, tshwj tsis yog nws nyuaj los ntawm kev muaj mob stroke lossis mob hnyav. Yog tias tus neeg mob muaj kev paub tsis meej, ces tshem nws tawm ntawm nws qhov chaw ib puag ncig tuaj yeem ua rau tus kab mob hnyav dua. Kev kho mob ntawm ischemic hlwb yog ua los ntawm kws kho mob hlwb.
Tshuaj kho mob muab ob qho kev qhia:
- normalization ntawm cov ntshav ntws hauv cov ntaub so ntswg hauv hlwb los ntawm kev cuam tshuam ntau theem ntawm lub plawv thiab cov hlab ntsha;
- effect ntawm platelet link.
Vim li ntawd, cov ntshav hauv lub hlwb rov zoo li qub.
Txoj kev kho mob ntshav siab pab tswj cov ntshav siab txaus thiab pab tiv thaiv thiab txhim kho cov kab mob ntev. Yog hais tias tus kws kho mob sau tshuaj antihypertensive, ces txhua leej txhua tus yuav tsum tauua tau txoj hauv kev kom tsis txhob muaj kev kub ntxhov sai sai, raws li kev txhim kho ntawm tus kab mob txiav txim siab cov txheej txheem ntawm kev tswj hwm cov ntshav ntws hauv lub hlwb.
Ntawm cov tshuaj tiv thaiv kab mob siab, cov kws tshaj lij nyiam ob pawg:
- angiotensin enzyme inhibitors;
- angiotensin II receptor antagonists.
Ob hom maj mam thiab maj mam nthuav cov lumen ntawm cov hlab ntsha, muab cov nyhuv antihypertensive, txhim khu kev tiv thaiv kab mob uas raug kev txom nyem los ntawm arterial hypertension.
Qhov kev ua tau zoo ntawm cov tshuaj no yuav nce ntxiv yog tias lawv ntxiv nrog rau lwm cov tshuaj tiv thaiv ntshav siab, xws li Indapamide thiab Hydrochlorothiazide.
Nyob rau hauv cov neeg mob uas muaj atherosclerotic plaques nyob rau hauv cov hlab ntsha ntawm lub paj hlwb thiab dyslipidemia, tsis yog tsuas yog ib tug nruj kev noj haus, tsis suav tag nrho cov tsiaj rog los ntawm cov zaub mov. Nws yuav raug pom zoo kom txo qis cov tshuaj lipid rau kev noj: Statins, Simvastatin, Atorvastatin. Lawv tsis tsuas yog cov txiaj ntsig tseem ceeb ntawm lub cev, tab sis kuj tseem pab txhim kho endothelial muaj nuj nqi, txo cov ntshav viscosity, thiab tseem muaj cov nyhuv antioxidant.
Rau daim ntawv mob ntev ntawm cov kab mob plawv ntawm lub paj hlwb, qhov nce hauv platelet-vascular txuas ntawm hemostasis yog yam ntxwv, vim li no nws tau pom zoo kom tus neeg mob tau txais tshuaj antiplatelet, xws li acetylsalicylic acid. Raws li kev txiav txim siab ntawm tus kws kho mob, tus neeg mob kuj tseem yuav tau txais lwm cov tshuaj antiplatelet, xws li Clopidogrel, Dipyridamole.
Kho cov kab mob coronary artery ntawm lub paj hlwb tuaj yeem ua tiav nrog cov tshuaj ua ke. Xav tias muaj ntau yam txheej txheem uas cuam tshuam rau daim ntawv ntev, tom qab ntawd ntxiv rau cov tshuaj yooj yim tau piav qhia, tus kws kho mob tuaj yeem pom zoo cov tshuaj rau tus neeg mob uas txhim kho cov ntshav muaj pes tsawg leeg, venous outflow, thiab microcirculation. Lawv kuj tuaj yeem muaj angioprotective thiab neurotrophic zog. Tus kws kho mob yuav sau ntawv:
- "Vinpocetine" - los ntawm 150 txog 300 mg ib hnub;
- Ginkgo biloba nplooj extract;
- "Cinnarizine" 75 mg + "Piracetam" 1.2 g;
- "Piracetam" 1.2 g ua ke nrog 15 mg "Vinpocetine";
- "Nicergoline" txog 30 mg ib hnub;
- "Pentoxifylline" 300 mg ib hnub.
Txhua yam tshuaj saum toj no raug pom zoo kom coj mus kawm, tsis pub ntau tshaj ob zaug hauv ib xyoos nrog so ntawm ob mus rau peb lub hlis.
Yog tias cov tsos mob ntawm tus kab mob ischemic cerebrovascular hnyav, tus neeg mob yuav raug pom zoo phais. Nws yog feem ntau qhia rau cov neeg mob uas nquag tsim ib qho teeb meem occlusive-stenosing ntawm cov hlab ntsha loj ntawm lub taub hau. Nyob rau hauv tas li ntawd, ib tug reconstructive lag luam yog ua nyob rau hauv cov hlab ntsha - carotid endarterectomy, stenting ntawm carotid hlab ntsha.
Kev kho mob ntawm cov neeg mob uas muaj daim ntawv mob ntev yuav tsum tau ua raws li kev saib xyuas nruj ntawm tus kws kho mob tuaj koom, leej twg tuaj yeem, yog tias tsim nyog, khokev kho mob.
ntsuas kev tiv thaiv
Kev kho mob tsis tuaj yeem tiv nrog cov mob ntev ntawm cov kab mob hauv lub hlwb, tus neeg mob qhov kev tsis taus yog lav. Ib tug neeg tsis tuaj yeem coj txoj kev ua neej zoo, koom nrog tib hom kev ua ub no. Txhawm rau kom tsis txhob coj koj tus kheej mus rau lub xeev nyuaj thiab muaj peev xwm ua neej nyob, nws yuav tsum tau ua txhua yam kev tiv thaiv ua ntej:
- Ua ntej tshaj, cov neeg laus yuav tsum saib xyuas lawv txoj kev noj qab haus huv. Lawv yuav tsum nco ntsoov suav nrog kev tawm dag zog lub cev hauv lawv txoj haujlwm niaj hnub, siv hom kev tawm dag zog lub cev - los ntawm kev kho lub cev mus rau kev ua kis las. Loads yuav pab normalize ntshav ncig, ua kom cov txheej txheem metabolic hauv lub cev. Lawv kuj tiv thaiv kev tso cov roj cholesterol thiab thrombosis.
- Lub hnub nyoog ntawm tus neeg mob tom qab 40 xyoo yog lub hauv paus rau kev xeem txhua xyoo los ntawm kws kho mob.
- Yog tus kws kho mob pom zoo kom tiv thaiv kev kho mob, ces yuav tsum tau ua, vim qhov tseem ceeb yog tiv thaiv kab mob, thiab tom qab ntawd kho nws nyuaj heev. Cov kev kho mob zoo li no suav nrog kev noj tshuaj anticoagulants. Txoj kev daws teeb meem zoo yuav yog siv cov tshuaj ib txwm siv.
Tus kws kho mob tshwj xeeb tuaj yeem pom zoo rau chav kho mob hirudotherapy. Qhov tseem ceeb yog muab rau kev tiv thaiv theem nrab, uas suav nrog kev kho mob ntawm cov hlab plawv, cov hlab ntsha thiab kub siab.
khoom noj khoom haus
Pab zoo hauv kev tiv thaiv kev noj zaub mov zoo, uas suav tias yog ib feem tseem ceeb ntawm kev kho mobischemic kab mob ntawm cerebral cortex. Kev noj zaub mov raug xaiv tus kheej rau txhua tus neeg mob. Nws lub luag haujlwm tseem ceeb yog txo cov ntshav qab zib thiab cov roj cholesterol. Nws tuaj yeem muaj ntau yam kev xaiv rau kev kho cov khoom noj khoom haus, vim nws yog ib qho tseem ceeb uas yuav tsum tau coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob. Txhawm rau tsim ib qho kev pab cuam khoom noj khoom haus tshwj xeeb rau tus neeg mob, cov kws qhia noj zaub mov ua raws li cov hauv qab no:
- noj tsawg kawg 5-6 zaug hauv ib hnub;
- feem yuav tsum me me;
- txo qis ntsev kom tsawg;
- Cov roj ntawm tsiaj keeb kwm yuav tsum khaws cia kom tsawg, piv txwv li, nqaij npuas tuaj yeem hloov tau yooj yim nrog luav lossis nqaij qaib;
- carbohydrates hauv lub cev yuav tsum tuaj nrog zaub thiab txiv hmab txiv ntoo;
- tsis suav tag nrho los ntawm kev noj zaub mov ci, qab zib thiab khoom qab zib;
- koj tsis tuaj yeem haus ntau dua 300 mg ntawm carbohydrates ib hnub.
Huab cua
Yog tias koj mus txog kev kho mob ntawm cov kab mob hauv lub hlwb thiab mob hlab ntsha tawg hauv txoj kev nyuaj, koj tuaj yeem tsis tsuas yog them nyiaj rau kev ua txhaum ntawm kev ua haujlwm ntawm lub paj hlwb thiab kab mob cerebrovascular, tab sis kuj tiv thaiv kev txhim kho ntawm ntau yam teeb meem. Kev saib xyuas tsis tu ncua los ntawm tus kws kho mob thiab kev ntsuas kho raws sijhawm cog lus tias yuav muaj kev pom zoo rau tus neeg.
Yog tias kev kho mob raws sijhawm ntawm cov kab mob sib xws xws li arrhythmia, kub siab, cardiomyopathy, ntshav qab zib mellitus tsis tau pib, qhov no tuaj yeem ua rau muaj teeb meem vestibular, kev loj hlob ntawm microstrokes, cerebral edema thiab tuag ntawm paj hlwb. Hauv qhov no, qhov kev cia siab yuav poob siab. puvKev kho tsis tuaj yeem xav tau, kev tsis taus tau teeb tsa, lossis tus neeg mob raug hem tias yuav tuag. Saib xyuas koj txoj kev noj qab haus huv, tsis txhob noj tshuaj rau tus kheej, mus ntsib kws kho mob thaum thawj cov tsos mob tshwm sim. Nov yog tib txoj hauv kev los tiv thaiv koj tus kheej kom tsis txhob muaj mob hnyav.
