Polyneuropathy yog ntau qhov txhab ntawm cov hlab ntsha peripheral, uas yog nrog cov tsos mob hnyav xws li tuag tes tuag taw, tsis muaj zog, tsis muaj zog, vegetative-vascular disorders, thiab lwm yam. Hmoov tsis zoo, cov kab mob muaj ntau heev.
daim duab kho mob zoo li cas? Dab tsi provokes tus kab mob? Nws hom yog dab tsi? Kev kuaj mob ua li cas? Dab tsi yog xav tau rau kev kho mob? Lub ncauj lus no tsa ntau cov lus nug, thiab txhua tus yuav tsum tau teb tam sim no.
Kev faib tshuaj kho mob
Ua ntej tshaj plaws, nws yuav tsum raug sau tseg tias tus kab mob hauv nqe lus nug muaj cov ncauj lus kom ntxaws heev. Muaj ntau hom polyneuropathy, lawv txawv hauv etiology, pathomorphology ntawm kev puas tsuaj thiab qhov xwm txheej ntawm chav kawm. Txawm nyob rau hauv kev faib thoob ntiaj teb cov kab mob, tsis yog tag nrho cov npe tau qhia.
Nyob rau hauv lub thoob ntiaj teb classifier ICD-10, polyneuropathy yog nyob rau hauv ib tug par nrog cov kab mob ntawm lub paj hlwb. Raws li kev faib tawm, pawg no suav nrog cov blocks G00-G99, G60-G64 thiab G62. Hauv ICD-10, cov khoom hauv qab no tau tshwj tseg rau polyneuropathy:
- Medicinal -G62.0.
- Alcoholic - G62.1.
- Toxic - G62.2.
- Beam - G62.8.
- No ntxiv specification (NOS) - G62.9.
Tau kawg, cov npe tiag yog ntev dua. Tab sis qhov kev faib tawm hais tias yog tias tsim nyog los txheeb xyuas qhov laj thawj kom raug, cov kws tshaj lij siv cov lej ntxiv ntawm cov laj thawj sab nraud ntawm chav kawm XX.
Axonal polyneuropathy
Nws ua rau, raws li txoj cai, yog cov teeb meem loj ntawm cov txheej txheem metabolic. Ntawm no, ib yam nkaus, muaj qee qhov kev faib tawm. Muaj peb hom:
- mob axonopathy. Feem ntau cuam tshuam nrog kev ua txhaum cai lossis tua tus kheej lom. Tus kab mob pib tawm tsam keeb kwm yav dhau ntawm daim duab ntawm kev qaug cawv hnyav nrog carbon monoxide, organophosphorus tebchaw, arsenic thiab methyl cawv. Nws kav 2-4 hnub, tom qab ob peb lub lis piam nws muaj kev kho.
- Subacute axonopathy. Txoj kev loj hlob ntawm tus kab mob no yuav siv sij hawm ob peb lub lis piam los yog ntau lub hlis. Daim ntawv subacute yog tus yam ntxwv ntawm ntau cov kab mob metabolic thiab lom neuropathies.
- Chronic axonopathy. Nws yuav siv sij hawm rau lub hlis lossis ntau dua los txhim kho. Feem ntau cov teeb meem yog cawv polyneuropathy. Lub ntsiab yog vim li cas, ntawm chav kawm, yog mob cawv intoxication. Nws kuj pom muaj nyob rau hauv ntshav qab zib mellitus, lymphoma, mob qog noj ntshav, cirrhosis, amyloidosis thiab lwm yam kab mob.
Thiab ua ntej tham txog kev kho mob ntawm hom polyneuropathy, nws tsim nyog xav txog nws qhov tshwm sim. Cov hauv qab no feem ntau pom:
- Xav txog qhov loog ntawm qhov chaw qis qis (ko taw thiab me ntsis saum lawv).
- Pab mob hauv plab mog.
- Limb tsis ua haujlwm uas tshwm sim dhau sijhawm, feem ntau qis dua. Qhia los ntawm kev qaug zog thiab tuag tes tuag taw.
- Kev raug mob rau cov hlab ntsha lub luag haujlwm rau flexion thiab txuas ntxiv ntawm ko taw.
- Kev ua txhaum ntawm daim tawv nqaij rhiab hauv thaj tsam ntawm "cov hnab looj tes" thiab "s thom khwm".
- Mental disorders.
- Txhob ua rau ceg tawv kom mob.
- tawm hws ntau dhau.
- Edema ntawm qhov chaw sab nraud, hloov pauv hauv lawv qhov kub thiab txias.
- Kev raug mob rau lub oculomotor thiab optic paj hlwb.
Yog lub cev tseem muaj tshuaj lom, cov tsos mob tseem loj tuaj. Yog nws tsis nres, nws txoj kev noj qab haus huv yuav poob qis heev.
Kev kho mob ntawm axonopathy
Ua ntej, tus kws kho mob tshuaj xyuas thiab xam phaj tus neeg mob. Tom qab ntawd nws raug xa mus rau tus kws kho mob hlwb, uas kuaj xyuas lub periosteal thiab tendon reflexes, nrog rau lawv cov symmetry. Tom qab ntawd tus neeg yuav tsum tau muab nws cov khoom siv biomaterial rau kev tsom xam - qhov no yog qhov tsim nyog los kawm txog qib ntawm uric acid, urea thiab creatinine. Hauv ntshav qab zib, ntshav tseem pub dawb los ntawm cov leeg thiab tus ntiv tes.
Yog tias qhov kev kuaj mob ntawm axonopathy tau lees paub, tus kws kho mob tau sau cov kev kho mob nyuaj uas cuam tshuam rau cov tsos mob thiab ua rau. Nov yog qhov kwv yees txoj kev kho mob:
- Nrog dystrophy thiab cawv polyneuropathy, cov vitamins B raug tshuaj los ua ib feem ntawm kev npaj lossis hauv ampoules.
- Nyob rau hauv flaccid tuag tes tuag taw, kev siv cov inhibitors yog qhiaCov tshuaj cholinesterase. Cov no suav nrog Neuromidin, Kalimin thiab Neostigmin.
- Txhawm rau tshem tawm spastic tuag tes tuag taw, cov leeg nqaij so thiab cov tshuaj tiv thaiv kab mob - Mydocalm, Baclofen, Sirdalud, Tizanidin.
- Rau polyneuropathy tshwm sim los ntawm kev qaug cawv, tshuaj tiv thaiv tshwj xeeb, yuam diuresis, peritoneal dialysis thiab gastric lavage raug sau tseg.
- Yog hais tias hnyav hlau lom, sodium thiosulfate, tetacin-calcium thiab D-penicillamine raug qhia.
- Glucocorticoid cov tshuaj hormones pab tiv nrog autoimmune neuropathies.
- tshuaj zoo li Atropine pab kho organophosphate intoxication.
- Mob ntshav qab zib polyneuropathy yog tshem tawm los ntawm cov tshuaj hypoglycemic. Cov no suav nrog Glibenclamide thiab Metformin. Kuj tseem pab tau cov tshuaj tiv thaiv hypoxants, pab txhawb kev siv cov pa oxygen hauv lub cev. Nrog ntshav qab zib polyneuropathy pab "Actovegin", "Mexidol" thiab "Emoxipin".
Feem ntau, yog tias koj hnov mob ntawm daim tawv nqaij, loog loog, tsis xis nyob thiab tsis hnov qab, koj yuav tsum sab laj nrog kws kho mob. Tsuas yog nws thiaj sau tau kev kho mob txaus.
mob ntshav qab zib polyneuropathy
Yuav tsum qhia txog nws nyias. Vim tias cov kab mob no hauv ntshav qab zib mellitus tsis yog qhov tshwm sim los yog kab mob sib cais, tab sis muaj teeb meem. Qhov ua rau ntawm qhov tshwm sim yog kev puas tsuaj rau lub paj hlwb. Tus kab mob yog tsim nyob rau hauv cov neeg 15-20 xyoo tom qab mob ntshav qab zib tau tshwm sim nws tus kheej. Raws liKev txheeb cais, qhov zaus ntawm kev nce mus rau theem nyuaj yog 40-60%.
Nws yog ib qho tseem ceeb uas yuav tsum nco ntsoov tias cov kab mob no muaj nws qhov kev faib tawm. Nws nthuav tawm peb hom kab mob uas qhia txog ntu puas hauv lub paj hlwb:
- Motor - tshwm sim hauv qhov tsis muaj zog.
- Sensory - kuaj pom yog tias ib tus neeg muaj kev cuam tshuam rau sab nraud stimuli tau zuj zus lawm.
- Sensomotor - ua ke tshwm sim ntawm cov kab mob ntawm ob hom.
Nws tseem tsim nyog nco qab tias tsis hais qhov ua rau polyneuropathy, nws tuaj yeem ua rau amyotrophic, tsis mob, mob ntev thiab mob. Qhov no yog ib qho kev siv zog. Nyob rau hauv cov ntaub ntawv ntawm ib hom kab mob ntshav qab zib, nws tseem cuam tshuam.
Cov tsos mob tuaj yeem teev raws li hauv qab no:
- Nkauj-pob qhov mob.
- Txhim kho rhiab heev.
- Burning.
- Tingling.
- Tshuaj mob txawm tias kov lub teeb.
- tsis khov thaum taug kev.
- Tingling in libs, ua raws li kev xav ntawm kev tuag.
Headaches, convulsions, kiv taub hau, tso zis incontinence, raws plab, pom thiab hais lus cuam tshuam, thiab anorgasmia nyob rau hauv cov poj niam feem ntau ntxiv rau cov tsos mob ntawm tus mob ntshav qab zib sab sauv qaum polyneuropathy.
Kev kho mob ntshav qab zib hom kab mob
Feem ntau, thaum tus kab mob no tshwm sim thiab tshwm sim, tus kws kho mob tau sau cov tshuaj hauv qab no:
- Metabolic tshuaj. B1 muaj txiaj ntsig zoo rau kev sib txuas ntawm acetylcholine, uas ua rau muaj kev sib kis ntawm ib qho fiber ntau mus rau lwm qhov. B6 tiv thaiv cov dawb radicals los ntawm kev sib sau. B12 pab txhim kho cov khoom noj khoom haus ntawm cov paj hlwb thiab rov qab kho cov hlab ntsha peripheral.
- tshuaj tsis yooj yim. Qhov zoo tshaj plaws yog Vitagamma, Milgamma, Kombilipen, Compligam B thiab Neurobion. Raws li txoj cai, txhaj tshuaj yog thawj zaug. Tom qab ntawd, raws li qhov xwm txheej zoo dua, cov ntsiav tshuaj tau muab tshuaj. Feem ntau, kev teem caij yuav kav 3-5 lub lis piam.
- "Actovegin". Cov tshuaj no tsim nyog saib xyuas tshwj xeeb. Nws yog tsim los ntawm cov ntshav nyuj. Pab txhim kho cov ntaub so ntswg noj qab haus huv, rov qab rhiab heev, tshem tawm qhov mob, txhawb kev tsim cov txheej txheem.
- tshuaj mob plawv. Qhov zoo tshaj plaws yog "Vazonite", "Pentoxifylline" thiab "Trental". Cov tshuaj no normalize ntshav txaus thiab nthuav cov hlab ntsha, yog li cuam tshuam rau cov khoom noj khoom haus ntawm peripheral qab haus huv.
Nws tseem ceeb heev uas yuav tau noj tshuaj kho mob. Qhov tsis xis nyob ntawm tus neeg mob ntshav qab zib hom kab mob yog neuropathic hauv qhov xwm txheej. Yog li ntawd, tshuaj tua kab mob thiab tshuaj tua kab mob yooj yim yuav tsis pab. Cov tshuaj muaj txiaj ntsig zoo yog cov tshuaj tiv thaiv kab mob (Finlepsin), tshuaj tiv thaiv kev nyuaj siab (Amitriptyline), opioids (Oxycodone), tshuaj loog (Capsicam), thiab tshuaj tua kab mob (Katadolon).
Y Demyelinating polyneuropathy
Nov yog lub npe ntawm cov kab mob uas tsis tshua muaj tshwm sim uas tshwm sim los ntawm kev puas tsuaj rau cov hlab ntsha peripheral. Cov tsos mob zoo ib yam li cov syndrome. Guillain-Barre. Raws li txoj cai, nrog rau daim ntawv no ntawm polyneuropathy, ob txhais ceg feem ntau cuam tshuam. Nws yog nyob rau hauv qis extremities uas maj mam nce qaug zog yog pom, uas yog lub ntsiab tsos mob ntawm tus kab mob. Cov kev tshwm sim hauv qab no kuj ua rau lawv tus kheej paub:
- Symmetrical distal thiab proximal leeg tsis muaj zog ntev tshaj li ob lub hlis.
- Kev ploj lossis tsis muaj zog ntawm cov leeg pob txha.
- Sensory deficit.
- Ib feem ntawm kev thaiv lub cev muaj zog.
Nws yuav tsum raug sau tseg tias muaj ntau hom demyelinating polyneuropathy. Tau txais motosensory, multifocal motor, distal symmetrical, cais sensory, thiab lwm yam. sawv tawm ntawm lawv.
Kev kuaj mob tiag tiag ntawm "polyneuropathy" yog ua tom qab kev tshawb fawb ntau. Tus kws kho mob tshuaj xyuas tus neeg mob cov hlab ntsha, qhia txog kev nce hauv cov ntsiab lus ntawm cov protein, muaj cov cim histological ntawm remyelination thiab demyelination. Electrophysiological thiab laboratory diagnostic txoj kev, tomography, raws li zoo raws li lub paj hlwb biopsy yog siv.
Kev kho mob demyelinating yam kab mob
Kev kho mob, uas tom qab kuaj pom tus mob polyneuropathy yuav raug txiav txim los ntawm kws kho mob, yuav yog tsom rau thaiv cov txheej txheem kab mob. Tsis tas li ntawd, lub hom phiaj ntawm kev kho mob yog txhawm rau txo qhov mob thiab tiv thaiv ntxiv axonal degeneration.
Tom qab cov txiaj ntsig tshwm sim, kev kho mob yuav tsum tau ua. Qhov no yog tsim nyog los txo qhov zaus ntawm exacerbations thiabtiv thaiv kev kis tus kab mob. Cov txiaj ntsig ntawm kev kho mob tuaj yeem pom nyob rau hauv kev txhim kho ntawm rhiab heev thiab lub cev muaj zog ntawm tus neeg mob. Ib tug neeg raug suav hais tias yuav raug zam txim yog tias lawv tuaj yeem rov ua haujlwm txhua hnub.
Feem ntau, kev kho mob rau hom polyneuropathy no suav nrog:
- Noj corticosteroids. Qhov zoo tshaj plaws yog Prednisolone, Nycomed, Medopred thiab Prednisolone Gemsuccinate.
- Txoj kev ntawm cov tshuaj "Gamunex-S". Nws muaj txiaj ntsig zoo rau kev tiv thaiv kab mob. Cov tshuaj tsis muaj cov tshuaj tua kab mob - nws yog ib qho ntuj immunoglobulin ua los ntawm cov ntshav plasma los ntawm cov neeg noj qab haus huv.
- Plasmapheresis. Cov txheej txheem no suav nrog kev noj ntshav, ntxuav nws ntxiv, thiab tom qab ntawd rov qab mus rau cov hlab ntsha.
- kev tswj hwm hauv cov hlab ntsha ntawm immunoglobulins.
Txoj kev kho no pab tiv thaiv kev puas tsuaj thib ob ntawm axons thiab tiv thaiv kev kis tus kab mob. Raws li kev txheeb cais, nyob rau hauv 60-80% ntawm cov neeg, tus mob no txhim kho txawm tias thaum siv ib qho ntawm cov kev teev tseg.
YInflammatory polyneuropathy
Raws li lub npe no, nws yog ib txwm ua kom nkag siab ntau yam kab mob ntawm cov hlab ntsha, ua rau muaj kev cuam tshuam los ntawm cov tshuaj tiv thaiv kab mob autoimmune. Cov kab mob no yog qhov txaus ntshai vim nws tsis cuam tshuam rau ib leeg, tab sis ob peb lub cev peripheral. Tsis tas li ntawd, qhov txhab feem ntau ua rau lawv cov myelin sheath.
Nws tsis paub meej tias vim li cas hom kab mob no tshwm sim. Ntau tus ntseeg tias nws yog tsim los ntawm cov txheej txheem autoimmune. NtawmKev kuaj mob tuaj yeem kuaj pom cov pob txha ntawm cov hlwb mononuclear, kuaj xyuas macrophage activation thiab muaj cov txheej txheem perivascular. Tus kab mob no fraught tsis tsuas yog nrog kev hnov lus thiab lub cev muaj zog, tab sis kuj nrog kev nthuav dav ntawm qhov chaw subshell ntawm cov hlab ntsha.
Serum neuropathy tsim nyog saib xyuas tshwj xeeb. Nws feem ntau tshwm sim tom qab ib tug neeg tau txhaj tshuaj tiv thaiv kab mob tetanus. 7-10 hnub tom qab txhaj tshuaj, tus kab mob pib tshwm sim nws tus kheej. Cov tsos mob tsis tuaj yeem tsis meej pem nrog txhua yam: ua npaws, mob hauv lub xub pwg nyom, khaus khaus. Cov kev tshwm sim no yog nrog los ntawm loog loog ntawm txhais tes thiab tsis muaj zog ntawm sab sauv ceg. Ntau tus neeg mob tau ntsib atrophy ntawm cov leeg ntawm lub xub pwg nyom thiab cov leeg ntawm caj npab. Feem ntau kuaj mob arthralgia (qhov mob articular ntawm ya dav hlau), poob ntawm rhiab heev hauv cov hlab ntsha axillary. Purulent o ntawm cov qog ntshav qog kuj tuaj yeem tsim.
Raws li ib feem ntawm kev kuaj mob, ua tiav cov ntshav suav, ntshav cov protein electrophoresis, electroneuromyography, nrog rau cov kev tshawb fawb hauv chav kuaj ntawm cov ntshav ntshav. Nws yog tsuas yog tshem tawm los ntawm cov tshuaj xws li Diphenhydramine thiab Prednisolone. Nws tsis yog txwv tsis pub ua lwm txoj kev kho mob ntshav qab zib polyneuropathy. Koj tus kws kho mob kuj tuaj yeem sau tshuaj tiv thaiv kab mob, corticosteroids, thiab plasmapheresis.
YPeripheral polyneuropathy
Tus kab mob no kuj yuav tsum tau qhia nyias. Tus neeg uas raug nws raug kev txom nyem los ntawm kev puas tsuaj rau cov seem ntawm ob sab qaum thiab sab sab.
Tsuas yog saum toj noCov tsos mob, nco ntsoov cov cim hauv qab no:
- hmo ntuj cramps.
- Cov leeg tsis muaj zog ua rau atrophy.
- daim tawv nqaij tawv.
- Fragility thiab fragility ntawm cov ntsia hlau daim hlau.
- Kev ua txhaum ntawm qhov ncauj qhov ncauj.
- Tes tshee.
Kev txhim kho ntawm tus kab mob no tau yooj yim los ntawm kev siv cov tshuaj thim rov qab transcriptase inhibitors. Cov neeg sawv cev nto moo tshaj plaws ntawm pawg tshuaj no yog Zalcitabine, Stavudine thiab Didanosine. Tag nrho cov tshuaj no muaj zog tiv thaiv kab mob HIV. Nws yog ib qho tseem ceeb heev uas tus kws kho mob tshwj xeeb tau txiav txim siab txog qhov muaj tus kab mob polyneuropathy no hauv tus neeg mob thiab tshem tawm cov tshuaj uas ua rau muaj kev loj hlob ntawm tus kab mob no.
Kev kho mob ntawm cov kab mob peripheral
Tus kws kho mob tuaj yeem sau ib yam tshuaj uas tau teev tseg dhau los. Tab sis nyob rau hauv cov ntaub ntawv no, ntxiv rau cov txheej txheem teem caij, nws yog ib qho tsim nyog yuav tau ua raws li cov lus qhia tshwj xeeb. Hauv particular, noj alpha-lipoic acid. Nws yog ib qho endogenous antioxidant, qhov kev txiav txim ntawm uas yog tsom rau khi dawb radicals. Cov kua qaub koom nrog hauv cov txheej txheem metabolic, thiab tseem ua raws li coenzyme Q, uas pab nqus cov tshuaj nrog cov nyhuv antitoxic.
Qhov tseeb, alpha lipoic acid tiv thaiv kev puas tsuaj ntawm cov paj hlwb. Thiab nws yog cov txheej txheem no uas feem ntau ua rau muaj teeb meem. Ntxiv nrog rau cov kua qaub, tus kws kho mob tuaj yeem sau cov tshuaj uas txhim kho cov ntaub so ntswg, kev siv cov piam thaj, thiab tseem muab venotonic, vasodilating thiabdiuretic kev ua. Nws yuav tsum raug sau tseg tias tag nrho cov khoom no ua ke nrog cov tshuaj hu ua "Instenon".
kev kho neeg zoo
Kev kho mob zoo tshaj plaws rau polyneuropathy yog tshuaj. Tab sis kev kho pej xeem kuj tseem yuav pab tau. Lawv tuaj yeem siv los ua kev kho mob ntxiv. Nov yog qee cov zaub mov txawv:
- Cocktail tshem tawm cawv polyneuropathy. Txhawm rau npaj nws, koj yuav tsum tuav cov roj txiv roj (2 tablespoons) nrog nqaij qaib yolk. Tom qab ntawd ntxiv cov kua txiv hmab txiv ntoo tshiab (100 ml) thiab zib ntab (2 tsp). Haus ob teev ua ntej noj mov. Yuav tsum tau noj ob zaug ib hnub.
- Kho rau ntshav qab zib polyneuropathy. Ncuav tws nplooj nplooj (1 tablespoon) thiab fenugreek noob (3 tablespoons) rau hauv ib lub thermos. Ncuav nyob rau hauv ib liter ntawm boiling dej. Cia nws brew rau 2 teev, lim. Haus txhua hnub thaum nqhis dej.
- Tshuaj kho mob polyneuropathy ntawm qis qis. Ncuav ib nrab khob ntawm tws qus rosemary rau hauv 9% vinegar (0.5 l), kaw, co thiab cia nws brew rau 10 hnub. Co lub sijhawm. Tom qab lub sijhawm dhau mus, koj tuaj yeem siv: 1 tbsp. l. lub resulting infusion diluted nyob rau hauv 1 tbsp. l. dej thiab rub cov txiaj ntsig sib xyaw ntawm ob txhais ceg peb zaug ib hnub.
- Kev kho mob thoob ntiaj teb nrog qhiav thiab St. John's wort. Loosely ncuav crushed St. John's wort rau hauv 0.5 liter hub. Ncuav zaub roj rhuab mus rau 60 ° C. Infuse rau 20 hnub nyob rau hauv qhov chaw tsaus. Lim, ntxiv qhuav Ginger paus (1 tablespoon), sib tov. Rojsiv zaws thiab qhwv caj dab ob zaug ib hnub.
- Tshuaj txhawm rau tshem tawm kev hnov mob polyneuropathy. Crushed nplooj ntawm ginkgo biloba (4 tbsp.) Ncuav rau hauv ib lub thermos thiab ncuav ib liter ntawm boiling dej. Cia nws brew rau 3 teev. Tom qab ntawd lim thiab haus dej txhua hnub.
Tsis tas li, nrog polyneuropathy ntawm qhov kawg, koj tuaj yeem noj ntau yam infusions kom tshem tawm cov tshuaj lom hauv lub cev thiab ntxuav lub siab. Muaj ntau cov zaub mov txawv, tab sis ua ntej koj pib noj cov tshuaj uas koj nyiam, koj yuav tsum sab laj nrog koj tus kws kho mob hlwb.
