Kuthamanga kwa magazi "J Curve"
"Dokotala wanga anayamba kundisamalira chifukwa cha kuthamanga kwamphamvu kwa magazi miyezi isanu ndi umodzi yapitayo, ndipo kuwerenga kwanga kunachokera 155/90 mpaka 120/70, zomwe ndinkaganiza kuti zinali zodabwitsa. Kotero sabata yatha, ndinadabwa pamene dokotala wanga anandiuza kuti anali atakakamiza kwambiri kuthamanga kwanga kwa magazi, ndipo ndinasiya kumwa magazi. Funso langa ndilo: Kodi amamva chiyani? Ochepa kwambiri? Kodi ichi ndi chinthu chonchi, kapena ndiyenera kudzipeza ndekha dokotala watsopano? "- Anatero Sidney wa ku Oregon
Zomwe zikuchitika, Sidney, dokotala wanu akuwoneka kuti akutsatira zowonjezera zokhudzana ndi mankhwala opatsirana kwambiri. Pali zina zomwe zimasonyeza kuti kuthamanga kwa magazi komwe kumawoneka kuti kwakukulu mwa munthu wosaphunzitsidwa (120/70 mwachitsanzo), kungakhale kotsika kwambiri kwa munthu pa chithandizo cha magazi.
Kuthamanga kwa magazi, kapena kuthamanga kwa magazi, ndi matenda omwe amavomereza kwambiri kuti, ngati osatengedwera, angapangitse myocardial infarction (matenda a mtima) , kupweteka kwa mtima , kupweteka , ndi matenda a impso. Ngati muli ndi matenda oopsa kwambiri ndibwino kuti inu ndi dokotala mutenge njira zoyenera kuti muchepetse kuthamanga kwanu kwa magazi, musanathe kuwonongeka kwa mtima wanu, ubongo kapena impso.
Gawo limenelo la equation likuwonekera. Mtsutso umakhalapo momwe chithandizo cha matenda oopsa kwambiri chiyenera kukhalira.
Kodi Cholinga cha Kuchiza Choyenera N'chiyani?
Kwa zaka zambiri, akatswiri odwala matenda opatsirana kwa magazi ankakonda kunena kuti, "Pankhani ya kuthamanga kwa magazi, zotsikazo zimakhala bwino." Mawu amenewa nthawi zonse anali owonjezera, chifukwa kuchepetsa kuthamanga kwa magazi kuchepa kwambiri, kungayambitse kumutu kapena ngakhale syncope .
Koma chifukwa cha kuchepa kwakukulu, "kuchepa kwabwino" kunkaoneka ngati koyenera, chifukwa anthu ambiri ndi oona - kuchepetsa kuthamanga kwa magazi, kuchepa kwa matenda a mtima kapena impso.
Zangoganiziridwa kuti lamulo lomwelo liyenera kugwiritsidwa ntchito kwa odwala omwe ali ndi matenda opatsirana kwambiri.
Pambuyo pake, kafukufuku wosaneneka wasonyeza kuti mukamachepetsa kuthamanga kwa magazi kwa odwala omwe ali ndi matenda oopsa, zotsatira zawo zimakula bwino. Kotero madotolo amamva kuti amachepetsetsa kupsyinjika kwa magazi awo momwe angathere, malinga ngati odwala awo analibe zizindikiro za kumutu kapena orthostasis .
Ichi ndi chifukwa chake zolinga zamakono zowononga matenda aumphawi zimatchulidwa ngati "zochepa kuposa" mtengo (monga, systolic blood pressure kupitirira 140 mm Hg), mmalo mwazikhalidwe zosiyanasiyana (monga, systolic pressure pakati pa 130 - 140 mm Hg) .
Zangokhala zaka zaposachedwapa kuti paradigm iyi ndi "pansi bwino" yafika pansi pa funso lalikulu. Tsopano zikuwoneka kuti zingakhale zotheka kuchepetsa kuthamanga kwa magazi pansipa mtengo wapatali, ndipo kungakhale kovulaza pakuchita zimenezo.
Magazi Akumwazi "J Curve"
Kafukufuku wina waposachedwapa amasonyeza kuti zotsatira zachipatala kwa odwala omwe amachiza matenda oopsa kwambiri akhoza kutsatira "J curve," zomwe ziwoneka ngati zabwino kwambiri m'magazi enaake. Ngati kuthamanga kwa magazi pamene mukuchiritsidwa kumakhala pamwamba kapena pansi pazomwe zimakhala bwino, zotsatira zachipatala zimakhala zoipa. Ngati J curve hypothesis ndi yeniyeni, ndiye kuti "pansi" ndi paradigm ndibodza - ndipo madokotala ayenera kusamala kwambiri za momwe akuchepetsera kupsinjika kwa magazi awo.
Imodzi mwa maphunziro ofunikira kwambiri omwe anapanga mfundoyi inafalitsidwa mu 2014 mu Journal of the American College of Cardiology. Ochita kafukufuku ochokera ku Southern California Kaiser Group adapeza odwala pafupifupi theka la milioni omwe anachiritsidwa ndi matenda oopsa, ndipo anayerekezera mavuto awo a magazi pa chithandizo cha mankhwala awo. Iwo anapeza kuti systolic yomwe imakhala yabwino kwambiri pamene chithandizo cha mankhwala chinali pakati pa 130 ndi 139 mm Hg, ndipo diastolic yabwino ya magazi inali pakati pa 60 ndi 79 mm Hg. Mavuto a magazi opatsirana odwala omwe anali pamwamba kapena pansi pa mndandandawo adakhudzidwa ndi zotsatira zoipa.
Lingaliro la J curve lingakhale lofunika kwambiri, ndipo tsopano likuvomerezedwa kwambiri, kwa okalamba omwe ali ndi sysilic hypertension. Zotsatira zina zam'tsogolo zimalimbikitsa kuti muzitha kupanikizika kwambiri ndi odwalawa, ndipo madokotala ambiri tsopano ali osamala kwambiri pankhani yothandizira okalamba awo odwala kwambiri.
Komabe, tiyenera kukumbukira kuti maphunziro angapo alephera kudziwa J curve kwa odwala omwe sali okalamba omwe amachiritsidwa ndi matenda oopsa, ndipo funsoli silikutsutsana ndi akatswiri. Koma akatswiri ambiri akhala akuganiza mozama pofotokoza lingaliro la "pansipa", ndipo akatswiri ambiri akubwera kuti avomereze kuti J curve ndi yeniyeni.
Kotero, Sidney, ndondomeko ya dokotala wanu kuti mubwerere kuchipatala chanu chikugwirizana ndi umboni waposachedwapa. Tiyenera kuyembekezera kuti tione ngati magulu a katswiri omwe amapanga chithandizo cha mankhwalawa amatha kumupeza.
Zotsatira:
Sim JJ, Shi J, Kovesdy CP, ndi al. Zotsatira za zovuta za m'magazi zokhudzana ndi kufa kwa anthu komanso kufala kwa nthendayi pakati pa anthu ambiri, omwe ali ndi matenda oopsa kwambiri. Ndi Coll Cardiol. 2014; 64 (6): 588-97 (ISSN: 1558-3597)
Mancia G, Fagard R, Narkiewicz K, ndi al. 2013 ESH / ESC Malangizo othandizira kusamalidwa kwa magazi: Task Force yoyang'anira matenda oopsa kwambiri a European Society of Hypertension (ESH) ndi European Society of Cardiology (ESC). J Hypertens 2013; 31: 1281.
James PA, Oparil S, Carter BL, ndi al. 2014 zowonetsera umboni wokhudzana ndi kuthamanga kwa magazi kwa anthu akuluakulu: lipoti la anthu omwe apatsidwa udindo ku Komiti Yachisanu ndi Iwiri Yogwirizana Yonse (JNC 8). JAMA 2014; 311: 507.