Tsamba la Raynaud la Phenomenon
Zochitika za Raynaud ndi matenda omwe amakhudza mitsempha ya magazi pa zala, zala, makutu, ndi mphuno. Matendawa amadziwika ndi zida zoopsya, zomwe zimatchedwa masospastic, zomwe zimayambitsa mitsempha ya m'magazi (zala ndi zala) kuti zikhale zochepa. Chochitika cha Raynaud chikhoza kuchitika payekha, kapena chikhoza kukhala chachiwiri kuzinthu zina.
Ngakhale kuti zochitika zaposachedwapa zimagwirizana, kafukufuku waposachedwapa amasonyeza kuti vuto la Raynaud lingakhudze anthu 5 kapena 10 peresenti ya anthu ambiri ku United States. Akazi ndi ovuta kuposa amuna kuti akhale ndi matendawa. Zochitika za Raynaud zikuwonekera kukhala zofala kwambiri kwa anthu omwe amakhala m'madera otentha. Komabe, anthu omwe ali ndi matendawa omwe akukhala m'madera oopsa akhoza kukhala ndi zida zambiri pa nyengo yozizira.
Kodi N'chiyani Chimachitika Panthawi ya Chigawenga?
Kwa anthu ambiri, chiwopsezo chimayamba chifukwa chozizira kapena kupsinjika maganizo. Kawirikawiri, zigawenga zimakhudza zala kapena zala koma zingakhudze mphuno, milomo, kapena lobes.
Kuchepetsa Magazi Ochepetsa Magazi ku Zoopsa
Munthu akadziwidwa ndi chimfine, momwe thupi limayankhira ndi kuchepetsa kutaya kwa kutentha komanso kuteteza kutentha kwake. Kuti asunge kutentha kwake, mitsempha ya magazi imene imayendetsa magazi ikupita pakhungu imayendetsa magazi kuchokera m'mitsempha yomwe imakhala pafupi ndi pamwamba kupita ku mitsempha yozama m'thupi.
Kwa anthu omwe ali ndi vuto la Raynaud, kuyankha kwa thupi kumeneku kumawonjezereka ndi kusokonezeka kwadzidzidzi kwa mitsempha yaing'ono yomwe imapereka magazi kwa zala ndi zala. Mitsempha ya zala ndi zala zingagwe. Chotsatira chake, magazi operekera kumapeto amachepa kwambiri, zomwe zimaphatikizapo zomwe zimaphatikizapo kutuluka kwa khungu ndi kusintha kwina.
Kusintha kwa Khungu ndi Mtundu
Katundu akayamba, munthu akhoza kukhala ndi magawo atatu a mtundu wa khungu kusintha (woyera, buluu, ndi wofiira) ndi zala kapena zala. Lamulo la kusintha kwa mtundu silofanana kwa anthu onse, ndipo sikuti aliyense ali ndi mitundu itatu.
- Pallor (whiteness) imachitika chifukwa cha kupopera kwa arterioles ndi kuwonongeka kwa mitsempha ya digito.
- Cyanosis (blueness) ingawoneke chifukwa zala kapena zala zazing'ono sizikupeza magazi okwanira okosijeni.
Zala zala kapena zala zingakhalenso ozizira ndi zofooka. Potsirizira pake, pamene arterioles amaletsa ndi mwazi umabwereranso ku manambala, kuphulika kumachitika. Pamene chiwonongeko chimatha, kupweteka ndi kumenyedwa kungabwereke pa zala ndi zala. Kuukira kungathe kukhala osachepera mphindi imodzi mpaka maola angapo.
Kodi Phenomenon Ya Raynaud Achita Chiyani?
Madokotala amachititsa chidwi cha Raynaud monga gawo loyamba kapena lachiwiri . M'buku lachipatala, "chochitika chachikulu cha Raynaud" chingatchedwenso kuti:
- Matenda a Raynaud
- Idiopathic Raynaud's phenomenon
- matenda akuluakulu a Raynaud
Mawu akuti idiopathic ndi oyambirira onse amatanthauza kuti chifukwa chake sichidziwika.
Phenomenon ya Primary Raynaud
Anthu ambiri omwe ali ndi vuto la Raynaud ali ndi mawonekedwe akuluakulu.
Munthu yemwe ali ndi vuto lalikulu la Raynaud alibe matenda aakulu kapena mavuto okhudza matenda. Amayi ambiri kuposa abambo amakhudzidwa, ndipo pafupifupi 75% amapezeka mwa amayi omwe ali pakati pa zaka 15 ndi 40.
Kafukufuku amasonyeza kuti anthu osachepera 10% omwe amazunzidwa kwa zaka zingapo, popanda kugwiritsidwa ntchito kwa machitidwe ena kapena ziwalo zina, sakhala ndi matenda ena achiwiri kapena amatha kukhala ndi matenda achiwiri.
Phenomenon ya Raynaud yachiwiri
Ngakhale kuti Raynaud wapachilendo kaŵirikaŵiri sali wamba kusiyana ndi njira yoyamba, nthawi zambiri imakhala matenda ovuta komanso ovuta kwambiri. Sekondi imatanthauza kuti odwala ali ndi matenda omwe amachititsa kuti Raynaud awonongeke.
Matenda osakanikirana ndi omwe amachititsa kuti pulogalamu yachiwiri ya Raynaud ichitike. Zina mwa matendawa zimachepetsa magazi kuthamanga ku mawerengero mwa kuchititsa kuti mazenera a magazi aziwombera ndipo ziwiya zowonongeka mosavuta. Chochitika cha Raynaud chikuwonekera kwa odwala omwe ali ndi:
- scleroderma (pafupifupi 85%)
- matenda osokoneza bongo (pafupifupi 85%)
- lupus (systemic lupus erythematosus) (pafupifupi 33%)
Chochitika cha Raynaud chikhoza kuchitikanso kwa odwala omwe ali ndi matenda ena othandizira , kuphatikizapo:
- Sjögren's syndrome
- dermatomyositis
- polymyositis
Zomwe zingayambitse zowonjezereka za Raynaud, kupatulapo matenda ozunguza mafupa, ndi:
- Matenda a carpal
- matenda obisala
- mankhwala ena (monga beta-blockers, ergotamine kukonzekera, ena chemotherapy agents)
- mankhwala omwe amachititsa kuti vasoconstriction (monga mankhwala ena ozizira kwambiri ndi mankhwala osokoneza bongo)
- anthu ali ndi ntchito zina (monga antchito omwe amadziwika ndi vinyl chloride kapena antchito omwe amagwiritsa ntchito zida zogwedeza)
Anthu omwe ali ndi vuto lachidziwitso cha Raynaud nthawi zambiri amakumana ndi mavuto okhudza matenda. Matenda aakulu kwambiri ndi zilonda za khungu kapena ziphuphu m'mapala kapena zala. Zilonda zopweteka komanso zilonda zamphongo zimakhala zofala ndipo zingakhale zovuta kuchiza. Kufooka mu minofu ya mimba kungayambitse kupweteka kapena kuvutika kumeza.
Ngati dokotala akukayikira zovuta za Raynaud, iyeyo amupempha wodwalayo kuti adziwe mbiri yakale ya zamankhwala. Dokotalayo amatha kufufuza wodwalayo kuti athetse mavuto ena azachipatala. Wodwalayo angakhale ndi vuto lomenyana ndi maulendo paulendo pa ofesi, zomwe zimamuthandizira kuti adziwe matenda a Raynaud. Madokotala ambiri amaona kuti n'zosavuta kupeza chitsimikizo cha Raynaud koma zimakhala zovuta kudziwa mtundu wa matendawa.
Zolinga Zowonongeka kwa Phenomenon ya Raynaud
Madokotala amagwiritsa ntchito njira zina zowunikira kuti apeze chochitika cha pulayimale kapena chachiwiri cha Raynaud.
Zolinga: Phenomenon ya Primary Raynaud
Zomwe zimagwiritsidwa ntchito pozindikira kuti zochitika zapadera za raynaud zikuphatikizapo:
- Zochitika zapadera zapadera (zoyera) kapena za cyanosis (blueness) (Dziwani: madokotala ena akuphatikizirapo chifukwa china chokhalapo kwa zidazi kwa zaka zosachepera 2)
- Ndondomeko yachizolowezi ya capillary yamphongo
- Mayeso oletsa antitinuclear anti-antibody (ANA)
- Mlingo wodetsedwa wa erythrocyte sedimentation (ESR)
- Kulibe zikopa kapena zilonda za khungu, kapena chimfine (imfa ya minofu) pa zala kapena zala
Zolinga: Phenomenon yachiwiri ya Raynaud
Zomwe zimagwiritsidwa ntchito pozindikira kuti chochitika chachiwiri cha raynaud ndi:
- Zochitika zapadera zapadera zosautsa (kuwala) ndi cyanosis (blueness)
- Ndondomeko yosawerengeka ya capillary
- Mayendedwe abwino a antitinuclear antibody (ANA)
- Mlingo wosakanizika wa erythrocyte sedimentation (ESR)
- Kukhalapo kwa zilonda za pitting kapena zilonda za khungu, kapena zowonongeka m'mapala kapena zala
Mayesero Odziwa Kuzindikira kwa Phenomenon ya Raynaud
Madokotala angapangidwe kafukufuku angapo kuti adziwe kuti Raynaud akudziwunikira.
Chophimba pamutu
Zojambulajambula zojambula pamadzi (kuphunzira ma capillaries pansi pa microscope) zingathandize dokotala kusiyanitsa pakati pa chochitika cha pulayimale ndi chachiwiri cha Raynaud.
Pakati pa mayesowa, dokotala amaika dontho la mafuta pa zikhomo za wodwalayo, khungu pamunsi pa chikhomo. Dokotala amatha kuyang'ana zojambulazo pamsana ndi microscope pofuna kuyang'ana zosavuta za mitsempha yaing'ono yamagazi yotchedwa capillaries. Ngati ma capillaries akukulitsidwa kapena opunduka, wodwalayo akhoza kukhala ndi matenda oopsa.
Dokotala akhoza kuitanitsa mayeso awiri a magazi, mayeso a antitinuclear antia (ANA) ndi mlingo wa erythrocyte sedimentation (ESR).
Mayeso a Antiinuclear Antibody (ANA)
Mayeso a antitinuclear antibody (ANA) amatsimikizira ngati thupi limapanga mapuloteni apadera (antibodies) omwe amapezeka mwa anthu omwe ali ndi matenda a minofu kapena zovuta zina. Odwala omwe ali ndi matenda opatsirana pogonana kapena zovuta zina, amapanga tizilombo toyambitsa matenda kumtundu wa maselo a thupi. Mankhwalawa amatchedwa antitinuclear antibodies ndipo amayesedwa mwa kuyika seramu ya magazi m'magetsi a microscope omwe ali ndi maselo omwe ali ndi nthenda yooneka. Dothi lokhala ndi tizilombo tomwe timatulutsa timadzi timene timakhala ndi tizilombo toyambitsa matenda. Pansi pa microscope ma antibodies osalimba angawonekere kumbali.
Mlingo wa Erythrocyte Sedimentation Rate (ESR)
Mlingo wa erythrocyte sedimentation (ESR) ndi kuyezetsa kuyerekezera kwa kutupa.
Mayeso a erythrocyte sedimentation (ESR) ndiyeso la kutupa thupi ndipo amayesa momwe maselo ofiira amagazi amatha kukhalira mwazi osaloledwa mwa kuyeza mlingo umene maselo ofiira a m'magazi amagwera pansi pa chubu pa nthawi. Kuwonjezeka kwa kuchepa kwa sedimentation kumagwirizana ndi kuchuluka kwa kutukumula kosadziwika bwino m'thupi. Nthawi zambiri amatchedwa "sedrate" mwachidule.
Mayeso Okhudzidwa ndi Kuda Kwambiri
Kuyezetsa kozizira ndi njira ina imene dokotala angagwiritse ntchito kuti azindikire zochitika za Raynaud. Chiyeso chozizira chozizira chimayeza kutentha kwa chala chirichonse mutatha kumizidwa mu kusamba madzi.
Masensa otentha amamatiridwa ndi zala zanu ndipo kutentha kumalembedwa mpaka kutentha kwanu kwachindunji kukufanana mofanana ndi poyamba kunali kuikidwa mu madzi osambira.
Kodi Ndifukufuku Wotani Wophunzitsidwa Kuti Athandize Anthu Amene Ali ndi Phenomenon ya Raynaud?
Ochita kafukufuku akuphunzira njira zowunikira kuti azindikire zomwe Raynaud anachita komanso kuti adziŵe momwe amachitira ndi matenda ena. Iwo akuwonanso kugwiritsa ntchito mankhwala atsopano kuti azitha kuyendetsa magazi m'mayesero a Raynaud. Ofufuza a scleroderma ndi matenda ena okhudzana ndi minofu akufufuzanso zochitika za Raynaud zokhudzana ndi matendawa.
Zolinga za mankhwala ndi kuchepetsa chiwerengero ndi kuopsa kwa zida ndi kuteteza kuwonongeka kwa minofu ndi kuwonongeka kwa zala ndi zala. Madokotala ambiri ndi ochiritsira pochiza odwala ndi zochitika zoyambirira ndi zachiwiri za Raynaud; ndiko kuti, amalimbikitsa osalandira mankhwala osokoneza bongo komanso njira zothandizira.
Madokotala angapereke mankhwala kwa odwala ena, kawirikawiri omwe ali ndi vuto lachiwiri la Raynaud.
Kuonjezera apo, odwala amachiritsidwa ndi matenda aliwonse omwe amachititsa kuti Raynaud apitirize.
Mankhwala Osokoneza Bongo ndi Njira Zothandizira Modzikonda
Mankhwala amodzi ochepetsa mankhwala osokoneza bongo komanso njira zodzithandizira kungachepetse kuopsa kwa kuukira kwa Raynaud komanso kulimbikitsa moyo wabwino.
Chitanipo Ntchito Pa Chigamulo:
Kuukira sikuyenera kunyalanyazidwa. Kutalika kwake ndi kuuma kwake kungachepetsere ndi zosavuta zochepa. Choyamba ndi chofunika kwambiri ndikutentha manja ndi mapazi. M'nyengo yozizira, anthu ayenera kupita m'nyumba. Kuthamanga madzi otentha pa zala kapena zala kapena kuwaika mu mbale ya madzi ofunda kudzawawotha. Kupeza nthawi yopuma kumathandizanso kuthetsa chiwonongeko. Ngati vuto limayambitsa chiwonongeko, munthu akhoza kuthana ndi vutoli pochotsa vutoli ndikukhala chete. Anthu omwe amaphunzitsidwa ndi biofeedback akhoza kugwiritsa ntchito njirayi komanso kutentha manja ndi mapazi m'madzi kuti athetse kuchepa.
Khalani Wotentha:
Ndikofunika kuti zisamakhale zotenthetsa komanso kuti zisamawotchedwe mbali iliyonse ya thupi. Mvula yozizira, anthu omwe ali ndi vuto la Raynaud ayenera kusamala kwambiri kavalidwe.
- Pali zinthu zingapo zovala zovala, masokiti, zipewa, ndi magolovesi kapena mittens.
- Chipewa ndi chofunikira chifukwa kutentha kwa thupi kumatayika kupyolera mu khungu.
- Mapazi ayenera kukhala owuma ndi ofunda.
- Anthu ena amaona kuti ndi bwino kuvala mitsuko ndi masokosi kuti azigona m'nyengo yozizira.
- Zotentha zamakina, monga zikopa zazing'ono zomwe zimatha kuikidwa m'matumba, mitsuko, nsapato, kapena nsapato, zingapereke chitetezo chowonjezereka panthawi yaitali kunja.
Anthu omwe ali ndi vuto la Raynaud ayeneranso kuzindikira kuti kutentha kwa mpweya kungayambitse ziwonongeko. Kutsegula mpweya wabwino kapena kuvala sweti kungathandize kupewa ziwonongeko. Anthu ena amaonanso kuti n'kothandiza kugwiritsa ntchito magalasi osamwa ndi kusunga magolovesi musanayambe kudya zakudya zozizira kapena zafriji.
Kusiya Kusuta:
Nicotine mu ndudu imayambitsa kutentha kwa khungu, zomwe zingayambitse kuwukira.
Kupanikizika Kwambiri:
Kusamalira kupanikizika n'kofunika. Kupsinjika maganizo ndi kusokonezeka maganizo kungayambitse kuukira, makamaka kwa anthu omwe ali ndi vuto lalikulu la Raynaud, kuphunzira kuzindikira ndi kupeŵa zovuta zomwe zingathandize kuchepetsa chiwerengero cha zigawenga. Anthu ambiri apeza kuti kumasuka kapena kuphunzitsidwa kwa biofeedback kungathandize kuchepetsa chiwerengero ndi kuopsa kwa zigawenga. Maphunziro a Biofeedback amaphunzitsa anthu kubweretsa kutentha kwala zawo mwadzidzidzi.
Kuchita masewera olimbitsa thupi:
Madokotala ambiri amalimbikitsa odwala omwe ali ndi vuto la Raynaud, makamaka mawonekedwe oyambirira, kuti azichita masewero olimbitsa thupi.
Anthu ambiri amapeza zochitikazo:
- amalimbikitsa moyo wabwino
- kumawonjezera mphamvu
- kumathandiza kuchepetsa kulemera
- amalimbikitsa kugona mokwanira
Nthawi zonse muziyankhula ndi dokotala musanayambe pulogalamu yochita masewera olimbitsa thupi. Anthu omwe ali ndi vuto lachiwiri la Raynaud ayenera kulankhulana ndi madokotala awo asanatuluke kunja kwa nyengo yozizira.
- Zakudya / Kuchita Zochita
Onani Dokotala Wanu:
Anthu omwe ali ndi vuto la Raynaud ayenera kuwona madokotala awo ngati ali ndi nkhawa kapena akuwopsya pozunza kapena ngati ali ndi mafunso okhudza kusamalira okha. Nthawi zonse ayenera kuwona madokotala awo ngati zigawenga zimachitika kumbali imodzi ya thupi (dzanja limodzi kapena phazi limodzi) ndipo nthawi iliyonse kuukira kumabweretsa zilonda kapena zilonda pa zala kapena zala.
Kuchiza Ndi Mankhwala
Anthu omwe ali ndi vuto lachiwiri la Raynaud ali oposa omwe ali ndi njira yoyenera kuti adziritsidwe ndi mankhwala.
Madokotala ambiri amakhulupirira kuti mankhwala ogwira ntchito kwambiri ndi otetezeka kwambiri ndi njira zothandizira kashiamu, zomwe zimachititsa kuti minofu ikhale yophweka komanso imachepetsa mitsempha yaing'ono yamagazi. Mankhwalawa amachepetsa kuchuluka kwa chiwopsezo ndi kuzunzika kwa odwala 65 peresenti omwe ali ndi zochitika zoyamba ndi zapadera za Raynaud. Mankhwalawa amathandizanso kuchiza zilonda zam'manja pala zala kapena zala.
Odwala ena athandizidwa ndi mankhwala osokoneza bongo otchedwa alpha blockers omwe amatsutsana ndi zochita za norepinephrine, mahomoni omwe amachititsa mitsempha ya magazi. Madokotala ena amapereka mankhwala omwe amatsitsimutsa mitsempha ya magazi, monga nitroglycerine phala, yomwe imagwiritsidwa ntchito kwa zala, kuthandiza kuchiza zilonda zakhungu. Kawirikawiri, odwala omwe ali ndi kachilombo ka kachiwiri sangayankhe ngati mankhwala omwe ali ndi njira yoyamba ya matendawa.
Odwala ayenera kukumbukira kuti chithandizo cha Raynaud chodabwitsa sichili nthawi zonse.
Chitsime:
NIH Publication No. 01-4911