I-Phenomenon ichazwe nguRaynaud
Ingqungquthela kaRaynaud yintlupheko echaphazela imithwalo yegazi kwiminwe, iinzwane, indlebe kunye neempumlo. Le ngxaki ibonakala ngokuhlaselwa kwe-episodic, ebizwa ngokuba yi-vasospastic attack, eyenza imithwalo yegazi kwiidijithi (iminwe kunye neenzwane) ukuba iminyanzelo (encinci). Isiganeko sikaRaynaud sinokuthi senzeke ngokwazo, okanye sibe sesibini ukuya kwezinye iimeko.
Nangona uqikelelo luhluka, uphando olutshanje lubonisa ukuba isenzo sikaRaynaud sinokuchaphazela ama-5 kuya kwe-10 ekhulwini labantu bonke eMelika. Abasetyhini baninzi ngaphezu kwamadoda ukuba babe neengxaki. Isiqhamo sikaRaynaud sibonakala siqhelekile kubantu abahlala kwiindawo ezinamaqabunga. Nangona kunjalo, abantu abanezifo abahlala kwiindawo ezinzima kakhulu, banokuba nokuhlaselwa kwamanye amaxesha ngexesha lezulu lezulu.
Yintoni eyenzekayo ngexesha lohlaselo?
Kubantu abaninzi, ukuhlaselwa kudla ngokubangela ukutyhafisa okanye ukuxinezeleka kwengqondo. Ngokubanzi, ukuhlaselwa kuthintela iminwe okanye iminwe kodwa kungathintela impumlo, imilomo, okanye indlebe.
Ukunikezelwa kweGazi okuNciphise kwiZiqhamo
Xa umntu ebonakala ebanda, impendulo yomzimba ihamba ngokukhawuleza ilahleko lokushisa nokugcina ubushushu bayo obukhulu. Ukugcina lo bushushu, imivenge yegazi elawula ukuhamba kwegazi kwindawo yesikhumba ishukumisela igazi kwiimitha ze-arridi kufuphi nomhlaba ukuya emithanjeni ejulile emzimbeni.
Kubantu abanemisebenzi kaRaynaud, le mpendulo yomzimba isisigxina ngokuphambuka kwe-spasmodic yeemida ezincinci zegazi ezinikezela igazi kwiminwe nangezwane. Imingxube yeminwe kunye neenzwane nayo iyakwazi ukuwa. Ngenxa yoko, ukunikezelwa kwegazi kwimida kuyancipha kakhulu, kubangela ukuphendula okubandakanya ukuguqulwa kwesikhumba kunye nezinye iinguqulelo.
Utshintsho kwesikhumba soMbala kunye noMoya
Xa uhlaselo luqala, umntu unokufumana izigaba ezintathu zenguqu yombala wesikhumba (omhlophe, obomvu, obomvu) kwiminwe okanye kwizwane. Umyalelo wokutshintsha kombala awufanekanga kubo bonke abantu, kwaye kungekhona wonke umntu onemibala emithathu.
- I-Pallor (ubumhlophe) iyakwenzeka ngokuphendula kwi-arterioles kunye nokuwa kwe-arteries ye-digital.
- I-Cyanosis (blueness) ingabonakala ngenxa yokuba iminwe okanye iinzwane azifumani ngokwaneleyo igazi elityebileyo legazi.
Iminwe okanye iinzwane nazo zivakalelwa zibandayo kwaye zinzima. Ekugqibeleni, njengoko i-arterioles iyancipha kwaye igazi libuyela kumadijithi, kubomvu. Njengoko ukuhlaselwa kuphelile, ukuphosa kunye nokubetha kungenzeka kwiminwe nasezinzwaneni. Uhlaselo lungapheli ngaphantsi komzuzu ukuya kwiiyure eziliqela.
I-Phenomenon kaRaynaud ikhetha njani?
Oogqirha bahlalutya into kaRaynaud njengeyona ndlela yokuqala okanye yesibini . Kwincwadi yoncedo lwezonyango, "into ephambili kaRaynaud" ingabizwa ngokuba:
- Isifo sikaRaynaud
- Idiopathic isenzo sikaRaynaud
- isifo sikaRaynaud esisisiseko
Iimpawu ze-idiopathic kunye neziprayimari zombini zithetha ukuba isizathu asiyazi.
IPhenomenon yasePrayimen Primary
Uninzi lwabantu abanobuqili bukaRaynaud banefom yokuqala (inguqu ekhuselekileyo).
Umntu onesiseko esiyinqobo sikaRaynaud asinaso isifo esisisiseko okanye iingxaki zonyango ezichaphazelekayo. Abasetyhini abaninzi kunabesilisa abachaphazelekayo, kwaye malunga nama-75% kuwo onke amacala afunyanwe kubasetyhini abaphakathi kweminyaka eyi-15 no-40 ubudala.
Uphando lubonisa ukuba abangaphantsi kwe-10% yabantu abahlaselayo kuphela kwiiminyaka emininzi, ngaphandle kokubandakanyeka kwezinye iinkqubo zomzimba okanye izitho, abanqabile okanye baya kuphuhlisa izifo zesibini emva koko.
Iprohenomenon yesiSebenzi saseRaynaud
Nangona isicatshulwa sikaRaynaud sisesigxina kakhulu kuneyona ndlela ephambili, ngokuqhelekileyo iimeko eziyinkimbinkimbi kunye neyingozi. ISekondari kuthetha ukuba izigulane zinesifo esisisigxina okanye imeko eyenza iprogram kaRaynaud.
Izifo ezixubileyo zezifo ziyizona zinto zixhaphake kakhulu. Ezinye zezi zifo zinciphisa ukuhamba kwegazi ukuya kumadijithi ngokubangela ukuba iindonga zendiza zegazi zikhuphe kwaye iinqanawa zibe lula kakhulu. Isiganeko sikaRaynaud sibonakala kwizigulane ezine:
- i-scleroderma (malunga no-85%)
- izifo ezixubileyo zezicubu (malunga no-85%)
- lupus (i-systemic lupus erythematosus) (malunga ne-33%)
Ingqungquthela kaRaynaud nayo ingenzeka kwizigulane ezinezinye izifo zenyama , kuquka:
- Sjögren's syndrome
- dermatomyositis
- polymyositis
Izizathu ezinokubangela isistim sesiqhelo sikaRaynaud, ngaphandle kwezifo zenyama, zi:
- i-carpal tunnel syndrome
- isifo sokuphazamiseka kwesifo
- ezinye iziyobisi (ezifana ne-beta-blockers, izilungiso ze-ergotamine, i-agents e-chemotherapy ezithile)
- iziyobisi ezibangelwa i-vasoconstriction (njengamanye amayeza atshisayo kunye nama-narcotics)
- abantu kwimisebenzi ethile (njengabasebenzi abonakaliswe kwi-vinyl chloride okanye abasebenzi abasebenzisa izixhobo ezixubileyo)
Abantu abanesicwangca sikaRaynaud bahlala befumana iingxaki zonyango ezichaphazelekayo. Iingxaki ezinzulu ziyizilonda zesikhumba okanye i-gangrene kwiminwe okanye kwizwane. Izilonda ezibuhlungu kunye ne-gangrene ziqhelekileyo kwaye zinokuba nzima ukunyanga. Ubuthathaka kwisisipha se-esophagus kunokubangela ukugquma okanye ubunzima bokugwinya.
Ukuba ugqirha ugxeka into eyenziwa nguRaynaud, uya kucela isigulane ngembali yonyango enzulu. Ugqirha uya kuhlolisisa isigulane ukulawula ezinye iingxaki zonyango. Isigulane sinokuhlaselwa kwe-vasospastic ngexesha lokutyelela i-ofisi, okwenza kube lula ugqirha ukuba ahlolisise into kaRaynaud. Uninzi oogqirha bakuthola kulula ukufumana ingxaki kaRaynaud kodwa kunzima ukufumanisa uhlobo lwesifo.
Inkcazo yokuxilongwa kwiPhenomenon kaRaynaud
Oogqirha basebenzisa iindlela ezithile zokuxilonga ukuxilonga iprojekthi yokuqala okanye yesibini uRayaud.
Iimpawu: I-Phenomenon yasePrayimen yasePrayimen
Inkqubo yokuxilonga esetyenziselwa ukuxilonga imbambano yokuqala ye-raynaud iquka:
- Ukuhlaselwa kweepasospastic ze-epistortic (spitor) okanye i-cyanosis (blueness) (Qaphela: abanye oogqirha baquka umbandela owongeziweyo wobu hlaselo ubuncinane iminyaka emi-2)
- Iphethini ye-nailfold capillary eqhelekileyo
- Vavanyo lwe-anti-nuclear anti-nuclear (ANA)
- Isantya sokunyuselwa kwe-erythrocyte yesiqhelo (ESR)
- Ukungabikho kwezikhonkwane okanye izilonda zesikhumba, okanye i-gangrene (ukufa kwesisu) kwiminwe okanye kwizwane
Iimpawu: I-Phenomenon yesiSeko seRaynaud
Inkqubo yokuxilonga esetyenziselwa ukuxilongwa kwimeko ye-raynaud yesibini ibandakanya:
- Ukuhlaselwa kweepasospastic periodical of pallor (ubumhlophe) kunye ne-cyanosis (blueness)
- Iphethini ye-capillary engavumelekanga
- Uvavanyo lwe-anti-nuclear antibody (ANA)
- Isantya esingaqhelekanga se-erythrocyte (ESR)
- Ubuninzi bokubeka izibonda okanye izilonda zesikhumba, okanye i-gangrene kwiminwe okanye kwizwane
Iimvavanyo zokuxilongwa kwi-Phenomenon kaRaynaud
Uvavanyo oluninzi lunokuthi luyalelwe ngugqirha wakho ukukunceda uqinisekise ukuxilongwa kukaRaynaud.
Capillaroscopy
I-capillaroscopy ye-Nail fold (ukufundwa kwamaplasilla ngaphansi kwe-microscope) inokunceda ugqirha ukuba ahlule phakathi kwezinto eziziiprayimari neziphambili zikaRaynaud.
Ngethuba lo vavanyo, ugqirha ubeka utywala lweoli kwiiplanga zesikhumba, isikhumba kwisiseko somnwe. Ugqirha uvavanya iipilisi ze-nail phantsi kwe-microscope ukujonga ukungabikho kweemilambo ezincinci zegazi ezibizwa ngokuba yi-capillaries. Ukuba i-capillaries ikhulisiwe okanye iphosakele, isigulane sinokuthi isifo sesifo sesisifo.
Ugqirha unokuphinde ulayishe iimvavanyo ezimbini zegazi, uvavanyo lwe -anti-nuclear anti-antibody (ANA) kunye ne-erythrocyte sedimentation rate (ESR).
Uvavanyo lwe-Antinuclear Antibody (ANA)
Uvavanyo lwe- anti-nuclear test (ANA) luhlola ukuba umzimba uvelisa iiprotheyini ezikhethekileyo (iintsholongwane) zihlala zifumaneka kubantu abanezifo zesisu okanye ezinye izifo ezizenzekelayo. Izigulane ezinezifo ezixhamlayo zezifo okanye ezinye izifo ezizenzekelayo, zenza amachiza omzimba kwi-nucleus, okanye kwisikhululo somyalelo, weeseli zomzimba. Ezi zinqamana zibizwa ngokuba yi-anti-nuclear antibodies kwaye zivavanywa ngokubeka i-serum yegazi kwi-microdicope slide equkethe iiseli kunye ne-nuclei ebonakalayo. Into equkethe idayi ye-fluorescent yongezwa idibanisa kuma-antibodies. Ngaphantsi kwe-microscope i-antibodies ezingavamile zingabonwa zibopha kwi-nuclei.
I-Erythrocyte yeSetymentation Rate (ESR)
Isantya se-erythrocytes sedimentation (ESR) luvavanyo lovavanyo lokuhlambalaza.
Uvavanyo lwe-sedryation sedimentation (ESR) luyimilinganiselo yokuvuvukala emzimbeni kunye nokuvavanya indlela iiseli ezibomvu zegazi eziphuma ngayo kwigazi elingenagunya ngokulinganisa izinga apho amangqamuzana egazi obomvu awela phantsi kwebhubhu phezu kwexesha. Isantya sokwanda kwesantya sihambelana nokunyuka okungekho okwenziwe ngokukrakra emzimbeni. Kudla ngokuba kuthiwa "sedrate" efutshane.
Uvavanyo lweCold Stimulation
Uvavanyo olushukumisayo lokubanda luyomnye uvanyo ogqirha wakho angayisebenzisa ukuze ahlolisise umcimbi kaRaynaud. Uvavanyo lokunyusa okubandayo lubonisa ukufudumala komnwe ngamnye emva kokufakwa emanzini okuhlamba amanzi.
Iintsholongwane zokufudumala ziyaqhotyoshela kwiminwe yakho kwaye amazinga okushisa aqoshiwe kuze kubekho ukushisa komnwe wakho kufana nokubekwa ngaphambi kokuba kufakwe kwindawo yokuhlamba amanzi.
Yintoni Uphando Olwenziwa Ngokunceda Abantu AbanoPhenomenon kaRaynaud?
Abaphengululi bafunda iindlela zokufumana uphando ngokucacileyo kwimeko kaRaynaud kwaye baqikelele kwaye bajonge ikhosi yabo kunye nokuzibandakanya nezinye izifo. Bavavanya nokusetyenziswa kwamachiza amatsha ukuphucula ukuhamba kwegazi kwimeko kaRaynaud. Abaphandi kwi-scleroderma nakwezinye izifo ezixhamlayo zezifo ziphanda nophando lukaRaynaud malunga nezi zifo.
Iinjongo zonyango kukunciphisa inani kunye nobukhulu bokuhlaselwa kunye nokukhusela umonakalo kunye nokulahleka kwimizimba kwiminwe nasezinzwaneni. Uninzi oogqirha banomdla ekuphatheni izigulane ezineziprayimari eziziiprayimari nezisesekondari; oko kukuthi, bacebisa unonophelo lwezonyango kunye nezenzo zokunceda kuqala.
Oogqirha banokumisela amagulane kwizigulane ezithile, ngokuqhelekileyo abo banesicwangca se-Raynaud.
Ukongezelela, izigulane zonyango ziphathwe nayiphi na isifo okanye isimo esibangela isicwangca sesibini sikaRaynaud.
IziNyango ezingekho phantsi kweMithi kunye neMilinganiselo yoNcedo
Amanyango amaninzi kunye nozinyathelo zokunceda unokunciphisa ubunzima bokuhlaselwa kukaRaynaud nokukhuthaza uluntu jikelele.
Thatha inxaxheba ngexesha lokuhlaselwa:
Ukuhlaselwa akufanelekanga. Ubungakanani nobukhulu bungancinciwa ngezenzo ezimbalwa ezilula. Isenzo sokuqala nesona sibaluleke kakhulu kukufudumala izandla okanye iinyawo. Kwimozulu ebanda, abantu kufuneka bangene ngaphakathi. Ukufudumala kwamanzi afudumele kwiminwe okanye ngeenzwane okanye ukuwafaka kwisitya samanzi afudumeleyo kuya kubakhuthaza. Ukuthatha ixesha lokuphumla kuya kunceda ukunceda ukuphelisa ukuhlaselwa. Ukuba imeko exinzelelekileyo ibangela ukuhlaselwa, umntu unokunceda ukuyeka ukuhlaselwa ngokuphuma kwimeko exinzelelekileyo nokuphumla. Abantu abaqeqeshwe kwi-biofeedback bangasebenzisa le ndlela kunye nokufudumala izandla okanye iinyawo emanzini ukuze bancede banciphise ukuhlaselwa.
Gcina ushushu:
Kubalulekile kungekuphela nje ukugcina imiphefumlo efudumeleyo kodwa ukuphepha ukuphazamisa nayiphi na inxalenye yomzimba. Kwimozulu ebanda, abantu abaneRaynaud bamele baqwalasele ngokukodwa ukugqoka.
- Kunokucetyiswa izicwangciso ezininzi zokugqoka iimpahla, iisokisi, iinqanawa, kunye neiglavu okanye i-mittens.
- Isitya sibalulekile kuba ukhululo lomzimba lulahleka ngesikhumba.
- Amagxa kufuneka agcinwe omile aze afudumele.
- Abanye abantu bakufumanisa kuncedo ukugqoka iimitha kunye neesokisi zokulala ngexesha lobusika.
- Amachiza okufudumala kwamachiza, afana neenqwelo ezincinane zokufudumala ezinokufakwa kwiipokotshi, izikhwebu, izibhoto okanye izicathulo, kunokunika ukhuseleko olongezelelweyo ngexesha elide ngaphandle kwexesha.
Abantu abanomdla kaRaynaud bafanele baqaphele ukuba umoya womoya ungabangela ukuhlaselwa. Ukuguqula umoya okanye ukugqoka i-sweater kunokunceda ukukhusela ukuhlaselwa. Abanye abantu bafumanisa ukuba luncedo ukusebenzisa iziglasi zokusela kunye nokubeka iiglavu ngaphambi kokuba uthathe ukutya okufudumele okanye okufrijini.
Yeka Ukubhema:
I-nicotine kwi-cigarettes ibangela ukufudumala kwesikhumba, kwaye kunokukhokelela ekuhlaselweni.
Uxinzelelo lwezandla:
Ulawulo lwengcinezelo lubalulekile. Ukuxinezeleka nokukhathazeka ngokomzimba kungabangela ukuhlaselwa, ngokukodwa kubantu abanobuchule bokuqala bukaRaynaud, ukufunda ukuqonda nokukhusela iimeko ezixinzeleleyo kunokunceda ukulawula inani lokuhlaselwa. Abantu abaninzi baye bafumanisa ukuba ukuphumula okanye ukuqeqeshwa kwe-biofeedback kunokunceda ukunciphisa inani kunye nobukhulu bokuhlaselwa. Ukuqeqeshwa kwe-Biofeedback kufundisa abantu ukuba bazise ukushisa kweminwe yabo phantsi kolawulo lokuzithandela.
Ukuzivocavoca:
Oogqirha abaninzi bakhuthaza izigulane ezinomsebenzi kaRaynaud, ngokukodwa uhlobo oluphambili, ukuqhuba rhoqo.
Uninzi lwabantu lufumanisa ukuba lo msebenzi:
- khuthaza impilo yonke
- kwandisa umgangatho wamandla
- kunceda ukulawula ubunzima
- khuthaza ukulala okuphumayo
Kufuneka uhlale uthetha nodokotela wakho ngaphambi kokuba uqalise inkqubo yovavanyo. Abantu abanesicwangca se-Raynaud kufuneka baxoxe noogqirha babo ngaphambi kokuba basebenze ngaphandle kwimozulu ebanda.
- Ukutya / Ukuzivocavoca
Jonga wakho Ugqirha:
Abantu abanengxaki kaRaynaud kufuneka babone oogqirha babo ukuba bakhathazekile okanye besaba ngokuhlaselwa okanye ukuba banemibuzo malunga nokuzinyamekela. Bamele bahlale bebona oogqirha xa ukuhlaselwa kwenzeka kuphela kwicala elinye lomzimba (esinye isandla okanye unyawo olunye) kwaye nayiphi na ixesha ukuhlaselwa kubangela izilonda okanye izilonda kwiminwe okanye kwizwane.
Unyango ngamayeza
Abantu abanesiganeko sikaRaynaud sesekondari banamathuba angaphezu kwalabo abanefomula ephambili yokuphathwa ngamachiza.
Oogqirha abaninzi bakholelwa ukuba izidakamizwa ezisemgangathweni nezona zikhuselekileyo ziyi-calcium-channel blockers, eziphucula izihlunu ezihamba kakuhle kwaye zinciphise imilambo encinci yegazi. Ezi ziyobisi ziyancipha ubukhulu kunye nobukhulu bokuhlaselwa kwi-65% yezigulane ezineziganeko eziphambili nezesekondari zikaRaynaud. Ezi nkunkuma nazo zinokunceda ukuphilisa izilonda zesikhumba kwiminwe okanye kwizwane.
Ezinye izigulane ziye zafumana ukuxhamla nezidakamizwa ezibizwa ngokuba yi-alpha blockers ezichasene nezenzo ze-norepinephrine, ihomoni ebeka imithwalo yegazi. Abanye oogqirha bayayichaza isilwanyana esenza ukuba imilambo yegazi ibuyele, njenge-nitroglycerine paste, esetyenziswa kwiminwe, ukunceda ukuphulukisa izilonda zesikhumba. Ngokuqhelekileyo, izigulane ezinefomati yesibini aziyi kuphendulwa ngokunjalo kunyango njengalezo zihlobo oluphambili lwesifo.
Izigulane kufuneka zihlale zikhumbule ukuba unyango lukaRaynaud luhlala luphumelele.
Umthombo:
I-Publication NIH No. 01-4911