Konke Okufuneka Ukwazi NgeCardiorenal Syndrome

Eli qumrhu linokubetha izibini ezibalulekileyo ngokufanayo

Njengoko igama libonisa, "i-cardio" (ngokubhekiselele entliziyweni), kunye ne "renal" (malunga neentso) yinkampani ethile yekliniki apho ukuhla kwentsebenziswano yentliziyo kubangela ukuhla kwezinto zentsholongwane (okanye ngokulandelana). Ngenxa yoko, igama le-syndrome libonisa ukusebenzisana okungonakalisayo phakathi kwezi zimbini ezibalulekileyo.

Ukuqhubela phambili; ukusebenzisana kwindlela ezimbini.

Ngenxa yoko, akusiyo nje intliziyo leyo ukuwa kwayo kungadonsa izintso phantsi kwayo. Enyanisweni, isifo seengtso, zombini esisisigxina (ixesha elincinci, ukuqala ngokukhawuleza) okanye isifo esingapheliyo (ixesha elide, isifo esiqhekezayo esisigxina) singabangela iingxaki ngentliziyo. Ekugqibeleni, iqumrhu elizimeleyo (njengesifo sikashukela) singalimaza zombini iintso nentliziyo, ekhokelela kwingxaki ngokusebenza komzimba.

I-Cardiorenal syndrome inokuqala kwiimeko ezibuhlungu apho kuphazamiseka kwentliziyo ngokukhawuleza (umzekelo, ukuhlaselwa kwentliziyo ekhokelela ekuphelelweni kweentliziyo ezinqabileyo) kubangela intlungu. Nangona kunjalo, loo nto ayinakuba yiyo yonke into ukususela kwimihla yokuhlala isifo esingapheliyo senhliziyo (CHF) inokukhokelela ekunciphiseni okwenyukayo kwintsebenzo yesifo. Ngokufanayo, izigulane ezinezifo ezingasigxina (CKD) zisengozini ephezulu yesifo senhliziyo.

Ngokusekelwe kwindlela okusebenzisana ngayo kunye nokukhula, i-cardiorenal syndrome ihlulwe ngamacandelwana amaninzi, iinkcukacha zazo ezingaphezu kweli nqaku.

Nangona kunjalo, ndiya kuzama ukunika uluhlu olubalulekileyo lwezinto ezingabalulekanga ukuba umntu oqhelekileyo unokufuna ukwazi ngezigulane ezinengxaki ye-cardiorenal syndrome.

Kutheni Ufanele Ukwazi NgeCardiorenal Syndrome: Impembelelo

Siphila kwixesha elaphakade liba nesifo senhliziyo. Abangaphezu kwama-700,000 baseMelika bafumana ukuhlaselwa kwentliziyo rhoqo ngonyaka, kwaye abantu abangaphezu kwama-600,000 bafa ngesifo senhliziyo minyaka yonke.

Enye yeengxaki zolu khuselo lweentliziyo zomoya. Xa ukuhluleka kwesinye isiqhelo kuhambelana nomsebenzi wesibini, kubaluleke kakhulu ukuba isigulane sifumane isigulane. Ngokomzekelo, ukwanda kwinqanaba le-serum creatinine ngo-0.5 mg / dL kuphela kudibene ne-15 ekhulwini kwandisa umngcipheko wokufa (kwimeko ye-cardiorenal syndrome).

Ngenxa yokuba le mpawu, i-cardiorenal syndrome yindawo yophando olunamandla. Akuyiyo into engaqhelekanga nayiphi na indlela. Ngosuku lwesithathu lokuhlala esibhedlele, ukuya kuma-60 eepesenti zezigulane (ezivunyelwe ukunyangwa kwintliziyo ye-congestive heart failure) zingabangela ukonakala komsebenzi weezintso ezihlukeneyo, kwaye ziya kufumaneka nge-cardiorenal syndrome.

Ziziphi izinto ezijongene nobungozi?

Ngokucacileyo, akusiyo wonke umntu ovelisa isifo okanye isifo sesifo esiza kususa ingxaki kwenye inye. Nangona kunjalo, izigulane ezithile ziba ngumngcipheko ophezulu kunabanye. Izigulane zilandelayo zibhekwa njengengozi enkulu:

• Igazi elonyukayo
• Sikashukela
• Umdala wobudala
• Imbali ekhoyo ngaphambili ye-heart failure okanye isifo sesifo

I-Cardiorenal Syndrome Ihlakulela njani?

I-Cardiorenal syndrome iqala ngomzamo wethu womzimba wokugcina ukujikeleza okwaneleyo. Nangona le mizamo inokuba luncedo kwixesha elifutshane, phezu kwexesha elide, ezi nguqulelo ziba yi-maladaptive kwaye zikhokelela ekunyameni komsebenzi wequmrhu.

I-cascade eqhelekileyo eyenza i-cardiorenal syndrome ingaqalisa kwaye iguquke ngokulandelelanayo:

1. Ngenxa yezizathu ezininzi (i-coronary disease isifo esisisisodwa), isigulane sinokuphuhlisa ukunciphisa intliziyo yokupompa igazi elaneleyo, iqumrhu esibizwa ngokuba yi-congestive heart failure okanye i-CHF.
2. Ukunciphisa kwimveliso yentliziyo (ebizwa nangokuthi "ukuphuma komzimba") kukhokelela ekunciphiseni ukuzaliswa kwegazi kwimithambo yegazi (iirrire). Thina kuthiwa oogqirha bathi "ukunciphisa umthambo wegazi osebenzayo".
3. Njengoko inyathelo ezimbini libuhlungu, umzimba wethu uzama ukuhlawula. Iinkqubo esiye sazenza zonke njengenxalenye yokuziqhelanisa ukukhahlela kuyo. Enye yezinto zokuqala eziya kwi-overdrive yinkqubo yeentlanzi, ngokukhethekileyo into ebizwa ngokuthi "inkqubo yeentlungu" (SNS). Le nxalenye yenkqubo ehambelana neyobizwa ngokuba yindiza okanye impendulo yokulwa. Umsebenzi owandayo kwinkqubo yesantya evelwano iya kubala umda wokuzama ukuphakamisa uxinzelelo lwegazi kunye nokugcina ukunyuswa komzimba.

1. Iintso chip ngokunyusa umsebenzi wezinto ezibizwa ngokuba yi-"renin-angiotensin-aldosterone system" (RAAS). Injongo yale nkqubo inokunyusa uxinzelelo kunye nomthamo wegazi kwi-circulation circulation. Iyenjenjalo ngeendlela ezininzi (kuquka ukuxhasa inkxaso-nkqubo ye-nervous sympathetic system), kunye nokugcinwa kwamanzi kunye netyuwa kwiintso.
2. I-pituitary gland iyaqala ukupompoza i-ADH (okanye i-hormone ye-anti-diuretic), iphinde iholele ekugcinweni kwamanzi kwiintso.

I-physiology ecacileyo yendlela nganye ichazwe ngaphaya kweli nqaku. Ndimele ndigcizelele ukuba amanyathelo angentla angakhange athuthuke ngendlela eqhelekileyo, kodwa kunokuba afane. Kwaye ekugqibeleni, oku akukho uluhlu olubanzi.

Isiphumo somnatha weendlela ezingenasihlomelo apha ngasentla kukuba ukuba ityuwa kunye namanzi athile aqale ukugcinwa emzimbeni, okwenza umthamo opheleleyo we-body fluid ukhuphuke. Oku, phakathi kwezinye izinto, kuya kwandisa ubungakanani benhliziyo kwixesha elide (utshintsho olubizwa ngokuthi "cardiomegaly"). Ngokomgaqo, xa isisu senhliziyo esoluliwe, isiphumo senhliziyo kufuneka sanda. Oku kusebenza kuphela ngaphakathi kwinqanaba elithile. Ngaphandle koko, intlawulo yenhliziyo ayiyi kunyuka naphezu kokunyuka / ukuphakama okwandiswayo okulandela inzuzo engapheliyo kwindleko yegazi. Lo mzekelo uboniswe ngokugqithiseleyo kwiincwadi zonyango njengento ethiwa "i- Frank-Starling curve ".

Ngenxa yoko, isigulane sishiywe ngentliziyo ekhulisiweyo, i-cardiac incorded output, kunye nomninzi kakhulu emzimbeni (eziphambili zeCFF). Ukugqithiswa kwamanzi kuya kubakho kwiimpawu kuquka ukuphefumula, ukuvuvukala okanye i-edema, njl.

Ngoko ke le nto inokulimaza njani kwiintso? Ewe, iindlela ezi ngasentla zenza oku kulandelayo:

• Ukunciphisa igazi leengtso, into ebizwa ngokuba yi "vasalonstriction".
• Ukugqithisa okweqile kwi-patient's affected circulation kwandisa uxinzelelo phakathi kweengso.
• Ekugqibeleni, uxinzelelo ngaphakathi kwesisu luya kunyuka, into ebizwa ngokuthi "intra-venture".

Zonke ezo ntshintsho ze-maladaptive zihlangene ukuze zinciphise iinjongo 'ukunikezelwa kwegazi (ukungcola) okukhokelela ekusebenzeni kweentso ezibi. Le ngcaciso yegama izokukunika ingcamango yendlela intliziyo engaphumeleli idonsa ngayo izintso nayo.

Le yindlela enye yeendlela ze-cardiorenal syndrome ezinokuphuhlisa. Ukuqala kokuqala kunokuba lula kwiintso endaweni apho, apho iintsholongwane ezingasebenzi (izifo zesifo esasigxina esasigxina), zenza umbane ogqithiseleyo ukwakhiwa emzimbeni (akuqhelekanga kwizigulane ezinezifo zengqondo). Lo mkhuhlane ogqithiseleyo ungaphinda ukhulule intliziyo kwaye ubangele ukuba ihluleke ngokuqhubekayo.

I-Cardiorenal Syndrome ichongwa njani?

Ugqirha lwezonyango ngudokotela oqaqambileyo uya kubakhokelela ekuxilongweni kokuzikhusela. Nangona kunjalo, iimvavanyo eziqhelekileyo ukujonga i-kidney kunye nomsebenzi wentliziyo kuya kuba luncedo, nangona kungenjalo kungabalulekanga. Ezi mvavanyo zi:

• Ngeentso: Iimvavanyo zegazi nge-creatinine / GFR kunye neemvavanyo zomchamo ngegazi, iiprotheyini, njl. Inqanaba le-sodium emcinini linokuba luncedo (kodwa kufuneka litshintshwe ngokucophelela kwizigulane kwi-diuretics). Ukujonga iimvavanyo ezifana ne-ultrasound kudlalwa njalo.
• Kwintliziyo: Ukuhlolwa kwegazi nge troponin, BNP, njl. Olunye uphando njengesi-EKG, i-echocardiogram, njl.

Umguli oqhelekileyo uya kuba neembali zesifo senhliziyo kunye nokudlulayo kwangoku (CHF), ehamba kunye nemimiselo engentla ngasemsebenzini wezintso ezibuhlungu.

Unyango lweCardiorenal Syndrome

Njengoko kuchazwe ngasentla, ukuphathwa kwe-cardiorenal syndrome yindawo echaphazelekayo yophando ngezizathu ezicacileyo. Izigulane ezinezifo ze-cardiorenal syndrome zihlala zihlala esibhedlele kunye nokunyuka komzimba kunye nomngcipheko omkhulu wokufa. Ngoko ke, unyango olufanelekileyo lubalulekile. Nazi ezinye iindlela:

1. Ekubeni i-cascade ye-cardiorenal syndrome ngokuqhelekileyo isetyenziswe yintliziyo engaphumeleli ekukholeni umthamo ogqithiseleyo wemithi, i-diuretic medication (eyenzelwe ukukrazula umthamo ogqithiseleyo emzimbeni) ngowona mgca wonyango. Usenokuva ngezinto ezibizwa ngokuthi "iipilisi zamanzi" (ngokuthethiwa ngokuthi "i-loop diuretics", umzekelo oqhelekileyo ngu-furosemide, okanye uLasix). Ukuba isigulane siyagula ngokwaneleyo ukuba idinga ukulaliswa esibhedlele, ukusetyenziswa kwezigulane ze-intravenous loop diuretics. Ukuba iilus injections zala mayeza ayisebenzi, kuqhutywe ukuqhuma okuqhubekayo.
2. Nangona kunjalo, unyango alukho ngqo. Umyalelo wecawa ye-diuretic ngamanye amaxesha unokwenza ukuba ugqirha "ugqithise i-runway" ngokususwa kwamanzi, kwaye wenze ukuba inqanaba le-serum creatinine likhuphuke (eliguqulela kwisimo senhliziyo esimbi ngakumbi). Oku kunokwenzeka ukusuka kwi-drop in kidneys. Ngenxa yoko, i-diuretic dosing ifuna ukulingana ngokufanelekileyo phakathi kokushiya isigulane "some kakhulu" vs "sinamanzi kakhulu."
3. Ekugqibeleni, khumbula ukuba ukusebenza kwe-loop diuretic kuxhomekeke kwiinjongo 'umsebenzi kunye nekhono layo lokufumana umbane ogqithiseleyo. Ngenxa yoko, iinjongo zidla ngokuba yi-link ebuthathaka kwi-chain. Oko kukuthi, kungakhathaliseki ukuba i-diuretic enamandla kangakanani, ukuba iintsholongwane zingasebenzi kakuhle, akukho mzimbeni ongasuswa emzimbeni naphezu kwemizamo enobudlova.
4. Kwimeko ekhankanywe apha ngasentla, imithi engabonakaliyo yokufumana umbane njengama-aqua pheresis okanye nokuba i-dialysis ingafuneka. Ezi zonyango ezingenayo ziphikisana kwaye ubu bungqina ngoku lube neziphumo eziphikisanayo. Ngenxa yoko, akukho nhlobo ukuba yile ndlela yokuqala yonyango yale meko.
5. Kukho amanye amachiza avame ukuvavanywa (nangona kwakhona akukona okokuqala unyango lokuqala lwamanyathelo) kwaye ezi ziquka oko kuthiwa ngama-inotropes (okwandisa amandla okupompa kwenhliziyo), i-renin-angiotensin blockers, kwakunye neziyobisi zokulinga ukuphatha i-cardiorenal syndrome tolvaptan.