Chilichonse Chimene Muyenera Kudziwa Zokhudza Cardiorenal Syndrome

Chiwalo ichi chikhoza kugogoda ziwalo ziwiri zofunika panthaŵi yomweyo

Monga momwe dzina limasonyezera, "cardio" (yokhudza mtima), ndi "renal" (zokhudzana ndi impso) ndi chipatala chodziwika pomwe kuchepa kwa mtima kumapangitsa kuchepa kwa ntchito ya impso (kapena mosiyana). Choncho, dzina la matenda kwenikweni limasonyeza kuyanjana koopsa pakati pa ziwalo ziwiri zofunika.

Kupititsa patsogolo; kuyanjana ndi njira ziwiri.

Choncho, si mtima wokha umene umatha kugwedeza impso pansi pake. Ndipotu, matenda a impso, onsewa (nthawi yayitali, nthawi zonse mwadzidzidzi) kapena matenda aakulu (omwe amakhalapo kwa nthawi yayitali, omwe amachedwa kuchepa) angayambitse mavuto ndi mtima. Pomaliza, bungwe lachiwiri (monga matenda a shuga) likhoza kuvulaza impso ndi mtima, zomwe zimayambitsa vuto la ziwalo zonse.

Matenda a Cardiorenal angayambe pa zochitika zovuta pomwe mtima wowonongeka mwadzidzidzi (mwachitsanzo, matenda a mtima omwe amachititsa kuti mtima ukhale wolephera) amavuta impso. Komabe, izi sizingakhale choncho nthawi zonse kuyambira nthawi yayitali matenda osadwala mtima (CHF) amatha kuchepetsa kupitirirabe kwa ntchito ya impso. Mofananamo, odwala omwe ali ndi matenda aakulu a impso (CKD) ali pachiopsezo chachikulu cha matenda a mtima.

Malingana ndi momwe kugwirizanirana kumeneku kuli kukhazikitsidwa ndikukula, matenda a cardiorenal amagawidwa m'magulu angapo, zomwe zili zosawerengeka pa nkhaniyi.

Komabe, ndikuyesera kupereka mwachidule zinthu zofunikira zomwe munthu wamba angafunikire kudziwa zokhudza odwala matenda a cardiorenal.

Chifukwa Chake Muyenera Kudziwa Zokhudza Cardiorenal Syndrome: The Implications

Tikukhala mu nthawi ya matenda osokonezeka mtima. Anthu opitirira 700,000 a ku America amavutika ndi matenda a mtima chaka chilichonse, ndipo anthu opitirira 600,000 amafa ndi matenda a mtima chaka chilichonse.

Imodzi mwa zovuta za izi ndi zokhumudwitsa mtima. Ngati kulephera kwa chiwalo chimodzi kumagwirizanitsa ntchito yachiwiri, zimapweteka kwambiri wodwalayo. Mwachitsanzo, kuwonjezeka kwa msinkhu wa serum creatinine ndi 0.5 mg / dL yokha ndikumayenderana ndi 15 peresenti yowonjezera chiopsezo cha imfa (pamayendedwe a cardiorenal syndrome).

Chifukwa cha izi, matenda a cardiorenal ndi malo a kufufuza mwamphamvu. Si chinthu chodabwitsa mwa njira iliyonse. Patsiku lachitatu lachipatala, anthu oposa 60 peresenti (omwe amavomerezedwa kuti athetse vuto la mtima wa mtima) akhoza kudwala matenda a impso osiyanasiyana, ndipo amapezeka ndi matenda a cardiorenal.

Kodi Zinthu Zowopsa Ndi Ziti?

Mwachiwonekere, sikuti aliyense amene ali ndi matenda a mtima kapena impso adzachotsa vuto ndi chiwalo china. Komabe, odwala ena akhoza kukhala chiopsezo chachikulu kuposa ena. Odwala omwe ali ndi zotsatirazi amaonedwa kuti ndi oopsa:

• Kuthamanga kwa magazi
• Matenda a shuga
• Akulu achikulire
• Mbiri yomwe ilipo kale ya matenda a mtima kapena matenda a impso

Kodi Cardiorenal Syndrome Yakula Bwanji?

Matenda a Cardiorenal ayamba ndi kuyesa kwa thupi lathu kuti tisasokonezeke. Ngakhale kuti kuyesera kumeneku kungakhale kopindulitsa panthaŵi yochepa, pamapeto pake, kusintha kumeneku kumakhala kosavuta ndipo kumayambitsa kuphulika kwa thupi.

Chiwombankhanga chomwe chimayambitsa matenda a cardiorenal chikhoza kuyamba ndi kusintha mwa zotsatirazi:

1. Pa zifukwa zingapo (matenda a mtima ndi amodzi omwe amachititsa), wodwala angapangitse kuchepa kwa mphamvu ya mtima kupopera magazi okwanira, chinthu chomwe timachitcha kuti mtima wosagonjetsedwa kapena CHF.
2. Kuchepetsa m'mitima ya mtima (yomwe imatchedwanso "kuchuluka kwa mtima") kumachepetsa kuchepetsa kukhuta kwa mitsempha ya mitsempha (mitsempha). Ife madokotala timatcha izi "kuchepa kwabwino kwa magazi opatsirana".
3. Pamene sitepe iwiri ikuipiraipira, thupi lathu limayesa kulipira. Njira zomwe tonse takhala nazo monga gawo la chisinthiko zimayambira. Chinthu chimodzi choyamba chomwe chimapita mu nthawi yambiri ndi dongosolo la mitsempha, makamaka chinachake chomwe chimatchedwa "chifundo cha misonkho" (SNS). Ichi ndi gawo la mchitidwe womwewo wogwirizanitsidwa ndi otchedwa kuthawa kapena yankho la nkhondo. Ntchito yowonjezereka ya mitsempha yokhudzidwa idzapangitsa mitsempha kuyesa kukweza magazi ndi kusunga perfusion.

1. Impso zimalowa mkati mwa kuwonjezera ntchito ya chinachake chomwe chimatchedwa "renin-angiotensin-aldosterone system" (RAAS). Cholinga cha dongosolo lino ndikuwonjezera kupsyinjika ndi kuchuluka kwa magazi mu kayendedwe kake. Zimatero ndi njira zing'onozing'ono (kuphatikizapo kuthandizira ndondomeko yamanjenje yokhudzidwa pamwambapa), komanso kusunga madzi ndi mchere mu impso.
2. Nsonga yathu yamatenda imayamba kutulutsa ADH (kapena hormone ya anti-diuretic), yomwe imayambitsanso kusunga madzi kuchokera mu impso.

Mafotokozedwe atsatanetsatane a chikhalidwe chilichonse sichikupezeka pa nkhaniyi. Ndiyenera kugogomezera kuti ndondomekozi zapamwamba sizikuyenda mofananamo, koma zimakhala zofanana. Ndipo potsiriza, izi siziri mndandanda wambiri.

Mtsuko chifukwa cha njira zowonjezerapozi ndikuti mchere wambiri ndi madzi zimayamba kusungidwa m'thupi, kuti chiwerengero chonse cha madzi amadzimadzi chikwere. Izi, mwazinthu zina, zidzakulitsa kukula kwa mtima kwa nthawi ndithu (kusintha kotchedwa "cardiomegaly"). Momwemo, pamene minofu ya mtima imatambasulidwa, zotsatira za mtima ziyenera kuwonjezeka. Izi zimagwira ntchito mwachindunji. Kupitirira apo, mtima wopereka sudzawonjezeka ngakhale kuwonjezeka kutambasuka / kukula komwe kumatsatira kupindula kosalekeza m'magazi. Chodabwitsa ichi chikuwonetsedwera bwino mu mabuku a zamankhwala monga chinachake chotchedwa " Frank-Starling curve ".

Choncho, wodwalayo amakhala ndi mtima wochuluka, kuchepa mtima kwa thupi, komanso madzimadzi ambiri m'thupi (makhadiakulu a CHF). Kusungunuka kwa madzi kumayambitsa zizindikiro kuphatikizapo kupuma pang'ono, kutupa kapena edema, ndi zina zotero.

Nanga zonsezi zimavulaza bwanji impso? Chabwino, njira zomwe zili pamwambazi zikuchitanso zotsatirazi:

• Kuchepetsa magazi a impso, chinachake chotchedwa "renal vasoconstriction".
• Kutuluka kwa madzi m'thupi mwa wodwala wodwalayo kumawonjezera kupanikizika mkati mwa impso mitsempha.
• Pomalizira pake, kupanikizika mkati mwa mimba kumatha kupita, chinachake chotchedwa "intra-m'mimba hypertension".

Zosintha zonsezi zimagwirizana pamodzi kuti zichepetse impso 'magazi (perfusion) zomwe zimayambitsa matenda opweteka kwambiri a impso. Tsatanetsatane wa mawuwa mwachiyembekezo imakupatsani inu lingaliro la momwe mtima wosautsika umayendetsera impso nawo.

Ichi ndi chimodzi mwa njira zomwe cardiorenal syndrome ikhoza kukhalira. Choyamba chimakhala impso mmalo mwake, kumene impso zopanda mphamvu (matenda aakulu a impso, mwachitsanzo) zimapangitsa madzi ochulukirapo kuti amange thupi (osati zachilendo kwa odwala ali ndi matenda a impso). Madzi oterewa amakhoza kuwonjezera mtima ndikupangitsa kuti pang'onopang'ono alephere.

Kodi Cardiorenal Syndrome Amadziwika Bwanji?

Kudandaula kwachipatala ndi dokotala wodabwitsa nthawi zambiri kumabweretsa chidziwitso chodzidzimutsa. Komabe, mayesero omwe amachititsa kuti aone kuti impso ndi mtima zimagwira ntchito, zingakhale zothandiza, ngakhale kuti sizingatheke. Mayesero awa ndi awa:

• Kwa impso: Mayeso a magazi a creatinine / GFR ndi mayeso a mkodzo chifukwa cha magazi, mapuloteni, ndi zina. Mbali ya sodium mu mkodzo ikhoza kukhala yothandiza (koma iyenera kutanthauzira mosamala kwa odwala odwala diuretics). Mayesero ojambula ngati ultrasound amachitanso chimodzimodzi.
• Kwa mtima: Kuyezetsa magazi kwa troponin, BNP, etc. Zofufuza zina monga EKG, echocardiogram, ndi zina zotero.

Wodwala wodwalayo angakhale ndi mbiri ya matenda a mtima ndi kuwonongeka kwaposachedwa (CHF), pamodzi ndi zizindikiro zapamwamba za ntchito yowopsya.

Kuchiza kwa Cardiorenal Syndrome

Monga tafotokozera pamwambapa, kasamalidwe ka matenda a cardiorenal ndi malo ogwira ntchito kafukufuku pa zifukwa zomveka. Odwala omwe ali ndi matenda a cardiorenal kawirikawiri amagwira ntchito kuchipatala komanso kuwonjezeka kwa matenda komanso kuopsa kwa imfa. Choncho, mankhwala othandiza ndi ofunikira. Nazi njira zina:

1. Popeza kutayika kwa matenda a cardiorenal kumayambitsidwa ndi mtima wosayenerera womwe umayambitsa mankhwala ochulukirapo, omwe amalinganiza kuchotsa madzi ambiri m'thupi. Mwinamwake mwamvapo za otchedwa "mapiritsi a madzi" (makamaka otchedwa "loop diuretics", chitsanzo chofala ndi furosemide, kapena Lasix). Ngati wodwalayo akudwala mokwanira kuti apeze chipatala, amagwiritsidwa ntchito ndi jekeseni wa mankhwala opatsirana pogwiritsa ntchito mankhwala. Ngati majekeseni a mankhwalawa samagwira ntchito, phokoso lopitirira limafunika.
2. Komabe, chithandizo sichinali cholondola. Malamulo ena omwe amachititsa kuti dokotala awonongeke nthawi zina amachititsa kuti dokotala "asamalire njira" ndi kuchotsa madzimadzi, ndikupangitsa kuti serum creatinine ifike pamwamba (yomwe imatanthawuzira ku ntchito yambiri ya impso). Izi zikhoza kuchitika kuchokera ku kugwa kwa impso kusakaniza magazi. Choncho, diuretic dosing imafunika kuti ikhale yoyenera pakati pa kusiya wodwala "wouma kwambiri" ndi "mvula kwambiri."
3. Pomaliza, kumbukirani kuti mphamvu ya dioptic yokhazikika imadalira impso 'ntchito ndi kuthetsa madzi ochulukirapo. Chifukwa chake, impso zingathe kukhala mgwirizano wofooka mu unyolo. Izi zili choncho, mosasamala kanthu kuti mphamvu ya diuretic imakhala yamphamvu bwanji, ngati impso sizigwira ntchito bwino, palibe madzimadzi angachotsedwe m'thupi ngakhale kuti amayesetsa kuchita zachiwawa.
4. Pazimenezi, njira zochiritsira zowonjezereka kuti mutenge madzi monga aqua pheresis kapena dialysis angafunike. Njira zochiritsira izi ndizovuta ndi umboni mpaka pano zakhala zotsutsana. Kotero, palibe njira iliyonse yoyamba ya mankhwala a chikhalidwe ichi.
5. Palinso mankhwala ena omwe amayesedwa kawirikawiri (ngakhale kuti sizinali zoyenera kutsatiridwa mzere woyamba) ndipo izi zimaphatikizapo zomwe zimatchedwa inotropes (zomwe zimapangitsa mphamvu ya kupopera mtima), mankhwala otsekemera a abambo, komanso mankhwala oyesera kuti azisamalira matenda a cardiorenal. tolvaptan.