ʻO ka stenosis aʻa Renal > ʻO ka maʻi maʻamau a me nā puʻuwai

ʻO ka stenosis arene Renal he maʻi ia e ka ʻāʻī a i ʻole ke kāohi ʻia o nā huawai o ka renal. Hōʻike nā ʻikepili mai nā haʻawina epidemiological e pili ana ka pathology i 6.8% o nā kānaka he 65 a keu paha. ʻO ka pōʻino o ka patology aia ma 73% o nā hihia me kona papa kūlohelohe no ʻehiku mau makahiki, make ka poʻe maʻi.

Nā kumu o ke kūloko o ka uahi o Renal Aren
Hoʻomaopopo o ka Renal Artery Stenosis
Diagnosis o koena stenosis artery
ʻO ka hoʻomaʻamaʻa ʻana o ka stenosis māmā
ʻO ka prognosis no ka stenosis hāmeʻa renal

I nā mea maʻi me ka stenosis renal artery, holo kahe i ke keiki palupalu a palupalu a ma kahi liʻiliʻi he nui ma mua o ka mea e pono ai, e alakaʻi ai i kahi maʻi i loko o ke kaʻina filtration a hoʻonui i ke kaomi. Hoʻokumu ʻia nā maʻi luhi e ka pōpoki. Inā ʻaʻole e mālama ʻia ka maʻi nui, ʻaʻole ka lōʻihi o ke keiki a hiki ʻole ke hana hou i kāna mau hana. ʻO ka maʻi ma ke ʻano he hopena maikaʻi loa i ke olakino o ka olakino: hōʻeha ʻia ka pale o ka hormonal, ua nalowale ka protein, ua loli ka nui o ke koko, a ʻano hoʻi ke ʻano o ke kīʻaha moku.

Nā kumu o ke kūloko o ka uahi o Renal Aren

I waena o nā maʻi e hoʻonāukiuki i ka stenosis o nā ʻalihi renal, atherosclerosis a fibromuscular dysplasia.

Atherosclerotic, ʻo ia hoʻi, i hui pū ʻia e ka hoʻokumu ʻana i nā kīlā silaka nā ʻāpana o ka kiko i wehe ʻia mai nā paia, ʻo ia ka stenosis renal maʻamau i ka hoa pili ʻana i ka maʻi mellitus, ka maʻi naʻau coronary, a i ʻole hypertension arterial.

Ma kēia hihia, ua hoʻokomo pono nā pōpoki ma nā hihia he nui i loko o ka moku aortic, i loko o nā hopena koʻikoʻi nui loa no ka mea maʻi.

Mawaena Fibromuscular ma ke kumu o ka stenosis, pinepine ia i nā ʻano o ka pathology mana ona a he nui ka maʻi o nā wahine o 30-45 mau makahiki. ʻO kēia maʻi ka mānoanoa ʻana o ka fibrous a i ʻole a me nā ʻili lili e uhi ana i nā paia o nā pākuʻi.

I kekahi o nā hihia, hiki i ka stenosis renal ke hoʻonāukiuki i ka aneurysms arterial, shunts arteriovenous, nonspecific aortoarteritis, thrombosis a embolism o nā renal arteri, hoʻopili ʻana i nā moku ʻula e kahi kino ʻē aʻe a ʻaʻa paha, nephroptosis.

ʻO nā ʻōmaʻomaʻi i kahi e hoʻomohala ai i ka stenosis arela o ke koʻi e hiki ke kanalua i nā kumu mua:

koko koko kiʻekiʻe
nā mālamalama maikaʻi ʻole
kahi ʻemi i hoʻokahi a i ʻole nā lua.

Wahi a nā helu helu, me ka stenosis renal pīhoihoi, hoʻomau ʻia ke koko kiʻekiʻe (hypertension) i nā poʻe i ʻoi aku ma mua o ka 50 e hōʻike ana, ma ke ʻano he lula, ʻo fibromuscular dysplasia, a i nā mea maʻi i ʻoi aku ma mua o 50, atherosclerosis o nā māla ʻehā.

Inā loaʻa i ka stenosis o nā aʻa ke kuʻi i ka pilikia o ka pale, a laila hiki ke hōʻike ʻia e nā ʻeha palu ma ka pae lumbar, a ma ke alualu ʻana i ka holomua, ka renal infarction.

Me ka hui pū ʻana o ka stenosis renal a me ka atherosclerosis i nā moku ʻē aʻe a i ʻole, no ka laʻana, ka nonspecific aortoarteritis, ischemia (ka lawa o ka hoʻokahe koko) o ka ʻeha gastrointestinal, kiʻekiʻe a lalo.

ʻĀnōpia a me ka mālama ʻana i ka stenosis arela renal

E hōʻike i ka stenosis renal artery i loko o ke keʻena phlebology o ka haukapila o MedicCity, he ʻano hoʻāʻo ai biochemical, ka nānā ʻana aku i ka ultrasound o nā pūpū, me ka ultrasound dopplerography a me ka nānā ʻana i nā ʻenehana renal, nā mea hana X-ray (no ka mea, ma ka urology a me ka angiography renal).

Me ka hōʻike ʻana o ka stenosis renal artery, hōʻike maikaʻi ʻia ka lāʻau lapaʻau ma ke ʻano a me ka hōʻike ʻana i nā lāʻau lapaʻau.

ʻO ke ʻano maʻamau o ka lilo ʻana i ka stenosis aropaʻi a ka mea i hana ʻia e fibromuscular dysplasiaka dilamation o ka balopona endovascular me ka hoʻokō ʻana o nā hua hao.

I atherosclerotic hiki ke hoʻohana ʻia nā stenosis renal no ka mālama ʻana:

shunting (celiac, mesenteric, aortic)
renal artery endarterectomy.

I kekahi o nā pilikia, ua hōʻike ʻia ka haʻalele ʻana o ka stenotic ʻāpana o ka aral i ʻole me ka reimplantation i loko o ka aorta, ka palapala noi o ka anastomosis, a i ʻole prosthetics o ka renal artery e ka vogogog autograft a synthetic prosthesis i hōʻike ʻia.

ʻO ka stenosis arene Renal ma muli o nephroptosis, maʻamau e koi i ka hoʻokō ʻana o nephropexy.

Inā hikiʻole ke hana hana i ka hana reconstructive (hoʻihoʻi), ʻo nā kauka - nā maʻi maʻi vascular i nā nephrectomy.

Manaʻo mākou e nānā pinepine ʻoe i nā kīʻaha puʻuwai a me ke koko ke pale i nā maʻi nui a me nā hoʻopiʻi kikowaena. Hāʻawi ke MedicCity i ka hoʻopiʻi piha a me ka nānāʻana o nā maʻi vascular e hoʻohana i nā lāʻau holomua loa. ʻO ka ʻānō e mālama ʻia e nā phlebologists mākaukau o ke kiʻekiʻe kiʻekiʻe.

E hāʻawi ka poʻe kikowaena kikowaena i nā ʻike e pono ai no kāu mau nīnau āpau.

Hiki iā ʻoe ke hoʻohana i nā puka i lalo nei e nīnau i kahi nīnau i ko mākou loea, hoʻonohonoho i kahi manawa me ka haukapila a noi paha e kāhea i kahi kelepona. E noi i kahi nīnau a i kuhikuhi paha i ka pilikia āu e makemake ai e hoʻokaʻaʻike iā mākou, a ma kahi manawa e kokoke mai ana e kelepona aku mākou iā ʻoe e wehewehe i ka ʻike.

Atherosclerosis

ʻO ka pinepine, ʻo ka stenosis o nā ʻeneka kūwau e hoʻonāuki i ka atherosclerosis. Pili ʻia kēia ʻōlelo i ke kaʻina o ka hōʻiliʻili ʻana i ka palaki mai ke kolamu, nā ʻoka a me nā calcium i nā ʻohe renal, kahi o lākou i ʻeha ʻia. Hoʻopili ka pilikia o ke kiʻi ʻana i kēia maʻi me ka nui o ka makahiki. Ma ka pilikia me nā maʻi me nā aortic lesions, hypertension arterial, a me nā iliac artery iliac. Hōʻike kēia ʻano i ka neʻe ʻana o kekahi pūʻulu o nā moku ma muli o ka stenosis, sclerosis, obliteration of arteries, atherothrombotic disorders. ʻO ka pinepine, aia ka stenosis i nā ʻāpana proximal o nā palaleka o ka renal e kokoke ana i ka aorta, i nā wahi waena, i ke kahua o ka bifurcation o nā wahī, i nā lālā mamao o nā aralial.

Nā Palekana Neʻepekema

ʻO nā hanana neʻe neʻe ne līpili e liʻiliʻi paha i ka stenosis. Kēia mau alaʻala e pili ana i ka aneurysms, hypoplasia, occlusion a me ka hoʻopiʻi ʻana i waho o ka palaualeka, a me ka vasculitis, thrombosis, nephroptosis, aʻai o ka arteriovenous.

Kuhi pū kekahi kauka i kekahi mau mea pili i ka hopena. Ke loaʻa nei kēia mau mea ʻike mua i ka:

ulaula
meaʻai maikaʻi (ka nui o nā meaʻai i kahi ʻai momona kiʻekiʻe, ka momona, a me ka kolamu ma ka meaʻai),
ʻopi momona
predisposition genetic
maʻi maʻi maʻi lēwa
hoʻonui i nā glucose o ke koko a me ka kolamu,
hiʻona kiʻekiʻe.

Hoʻomaopopo o ka Renal Artery Stenosis

ʻO kahi hoʻokolohua holoʻokoʻa me ka nephrologist no nā poʻe maʻi e hopohopo nei i kēia mau kūlana:

ʻO ka nele o Renal - ʻike ʻia ma muli o ka hana renal impaired, ma muli o ke kahe ana o kā lākou koko ma muli o ke kahe ʻana o nā ʻāpana i ke anawaena.
ʻO ke koko koko kiʻekiʻe, ʻaʻole hiki ke hoʻemi ʻia e ka koho ʻana i nā lāʻau antihypertensive.
ʻO ke ʻano o ke kani hiki ke ʻike i ke nānā ʻana i ka ʻōpū me ka stethoscope.
Hoʻonui ka nui o ke koko (hōʻeha a hōʻemi paha) i nā mea maʻi me ka mōʻaukala o kahi hōʻeha a i ʻole ka myocardial infarction.
Hoʻonui ka paipai i nā poʻe maʻi i ʻoi aku ma mua o 30 mau makahiki a ʻoi aku ka makahiki ma mua o 50 mau makahiki.
Hāpai ʻia ka hana papau a ma hope o ka lawe ʻana i nā lāʻau antihypertensive e like me ka blocker receptor receptor a i ʻole he angiotensin e hoʻohuli ai i ka enzyme inhibitor.

Pēlā hiki iā mākou ke ʻōlelo, ua loaʻa i ka stenosis renal hāmeʻa i loko o nā mea maʻi me ka maʻi hypertension a me ka hana ʻole ʻole. ʻO nā hōʻailona maʻamau o ka stenosis renal e pili ana: dizziness, sleep disturb, shortness of breath, palpitations, muscle weak, memory impairment, lower back pain, emotional instability, lele ma mua o nā maka, kaʻe ʻana i ka ʻūhā, luaʻi a me ke kanu, hoʻemi a hoʻonui ʻia urination.

Diagnosis o koena stenosis artery

Pūnaewele noiʻi. ʻO ka hoʻonui ʻana o ke kō urea nitrogen a me ka serum creatine nā hōʻailona mua o ka maʻi e mālama pono ana ke kauka. No ka loaʻa ʻana o ka hōʻike, hoʻāʻo ʻia ka urine ma mua, i hōʻike ʻia, i mua o ka maʻi o ka maʻi me ka maʻi urinary, a me ka proteinuria.
ʻO ka ultrup Duplex o nā renal nā hopena kūpono loa a me ka pololei hoʻi no ka hoʻomohala ʻana i ka maʻi, ka mea e hiki ai iā ʻoe ke nānā i ka hōʻemi o ka stenosis ma ke nānā ʻana i ka wikiwiki o ke kahe koko i loko o nā ʻalā. Hōʻike ʻia ka heleʻana o ka pathology e ka wikiwiki o ke kahe koko, i hoʻonāukiuki ma ka liʻiliʻi ʻana i nā ʻāpana. Eia nō naʻe, pono e noʻonoʻo i ka mau maʻi i ka momona a i ʻole nā flatulence, pono ʻole nā hopena o ka ultrasound.
Nā lāʻau koʻikoʻi. Hoʻohana pū ʻia kēia ʻano hana e hoʻopaʻa i ka helu filtration glomerular i loko o nā keiki.
Hoʻomauleʻa resonance résonance. Hiki i kēia ʻano ke kiʻi i kahi kiʻi o nā ʻāpana renal a me ka aorta. ʻO nā pono o MRI no ka hōʻikeʻana o ka stenosis kona non-invasiveness a me ka hiki ke kiʻi i kahi kiʻi ʻekolu-kiʻi o ka wahi i hoʻopili ʻia o ka artery. Eia nō naʻe, ua loaʻa kēia hana o kēia hana: nā kumukūʻai kiʻekiʻe, overestimation o ka nui o ka stenosis, a me ka hikiʻole i kekahi mau hihia ke hoʻokaʻawale i nā stenosis mai ka maleʻana.
ʻO ka arteriography renal koho: hiki iā ʻoe ke hoʻoholo i ka nui a me kahi o ka lesion o ka ʻalani. Hoʻokuʻu ʻia ma ka hoʻolaha ʻana i nā lāʻau lapaʻau radiopaque.

ʻO ka hoʻomaʻamaʻa ʻana o ka stenosis māmā

I ka hoʻomaka, ke mālama ʻana i ka stenosis renal arela e hoʻopili ai i ka lawe ʻia ʻana o nā mea i hoʻopili ʻia. Akā i kēia mau lā aia nā ala hoʻokele kūpono a me nā konservative no ka hoʻopau ʻana i kēia maʻi.

Ke kaukaʻi nei ka lāʻau lapaʻau i nā mea kikoʻī:

ʻO ke kahua mua (hoʻohālikelike hypertension). Ma kēia hana o ka palolo, he maʻi maikaʻi ka maʻi a me ka hana maʻamau maʻamau, ʻo ke kaumaha ke ʻano maʻamau a ʻoi aku paha i kona palena kiʻekiʻe. No ka mālamaʻana i ka stenosis, hiki i ke kauka ke kuhikuhi i nā lāʻau antihypertensive a i ʻole ka diuretic.
ʻO ke kahua ʻelua (uku uku). Ua hōʻike ʻia ke kiʻi o ke kino o nā maʻi i kēia mahele: ke hele mau nei ka maʻi hypertension, ʻike ʻole ʻia ka hopena, a me ko lākou hōʻemi. Pono ka mea maʻi i ka hoʻomehana ākea ma lalo o ka nānā o kahi kauka.
Ke kolu hana (decompensation). Hoʻomaʻamaʻa ka maʻi i ka hypertension koʻikoʻi, ʻaʻole hiki ke hoʻokaʻawale ʻia me ke kōkua o nā lāʻau antihypertensive, hana pinepine ka ʻeha i ka hana a me ka hoʻēmi ʻana i ka nui. Ma muli o ka lohi ʻana o ka olakino o ka mea maʻi, ua mālama ʻia ka hoʻomaʻamaʻa ʻana iā ia i kahi haukapila.

I nā mahele āpau o ka maʻi, ua kuhikuhi pinepine nā kauka i nā lāʻau lapaʻau mai nā pūʻulu o nā blockers blockers kaiotensin-II a me nā mea hoʻopaʻa ACE inhibitors. E hoʻohaʻahaʻa i ka kolamu ma ke koko a hoʻopaʻa i nā poli a ka atherosclerotic i loko o ka pili, i kuhikuhi ʻia nā lāʻau mai nā papa o nā statins.

No ka mālama pono ʻana o ka stenosis, hoʻokaʻawale aku ka ulaula a me ke kaupaona ʻana ma ka hihia o ka momona. Eia kekahi, pono ʻoe e hahai i kaʻai haʻahaʻa-haʻahaʻa, e kōkua i ka hoʻohaʻahaʻa ʻana i ke kōpaʻa koko koko a pēlā e pale ai i ka hōʻemi kino o ka maʻi diabetes. ʻO ke ʻano ʻai like hoʻi e kōkua i ka hoʻohaʻahaʻa haʻahaʻa i ke koko, e hoʻohiolo i ka hoʻomohala ʻana o nā atherosclerosis a me nā stenosis.

Hana hoʻomaʻamaʻa

I nā pilikia paʻakikī, hiki ke ho'ōla ʻia ka stenosis me ka hoʻohana ʻana i nā ʻano conservative, no laila pono e hoʻopili i nā mea hoʻoponopono. ʻO ka pinepine, ʻo ka hana o ka hāmeʻa e kuhikuhi ʻia no kēia mau hōʻailona: ka kaʻi pectoris unstable a me ka edema pulmonary i mua o ka stenosis hemodynamically koʻikoʻi, hiki ʻole ke kuʻuna ke ola, stenosis arterial ma ke ʻano o kahi hana hana, hypertension kahe, ka stenosis bilateral hemodynamically nui.

Hoʻokomo ʻia ʻo Bypass - hana i kahi ala hou no ke kahe koko (e kaheu ana i ka wahi i hoʻopili ʻia o ka lāʻau) me ka hoʻohana ʻana i nā puʻupuʻu.
ʻO Angioplasty ka hoʻonuiʻana o kahi moku ʻāeʻa e ka hoʻokomo ʻana i kahi baluna i loko.
ʻO ka hoʻolele ʻana ka hoʻonui ʻia ʻana o ka aralima ke hoʻohana me ka mesh a springy stent, kahi i waiho i loko o ka moku, me ia e hoʻonui ai a hoʻomaikaʻi i ke kahe koko.
ʻO ka pale ʻana i kahi kahua paʻa - kahi lawe ʻana i kahi wahi i pā ʻia i kahi pā mahi.
ʻO ka Prosthetics kahi hana hana hou e hana pinepine ʻia ma hope o ka loaʻa ʻana o ka palaualelo renal. Ua hoʻohuli ʻia e hoʻihoʻi i ka kahe koko maʻamau e nā prosthetics o ka renal artery implant.
ʻO ka Neftectomy kahi ʻano radical o ka mālama ʻana i nā patology, e pili ana i ka hoʻopau piha ʻana o ka huina i hoʻopili ʻia.

ʻO ka prognosis no ka stenosis hāmeʻa renal

Ma kahi e hoʻomaʻamaʻa ʻole ʻia ka maʻi e hoʻonāukiuki i nā hopena like ʻole e like me ka hōʻeha, ka pūpiki a me ka puʻuwai naʻau, vascular atherosclerosis. Ma ka hihia o ka wā kūpono, i ka wā ʻaʻole i hele aʻe ka palaualoko i kahi paʻakikī paʻakikī, ʻike ʻia ka hoʻomaikaʻi ʻana no ka mea maʻi. E lilo i 4-6 mau mahina e ola hou i ka stenosis.

I mea e pale ai i ka stenosis hāmeʻa renal:

e hoʻomaʻamaʻa i kahi maʻi kino i hoʻokahi manawa i ka makahiki ke hōʻoia i ke ʻano o ka hana ʻana a me ke koko.
ʻai maikaʻi - hāʻawi i ka makemake i ka ʻiʻo ʻai, nā hua, ka palena o ka hoʻopuka ʻana o ka paʻakai, ka meaʻai kēkē, nā kīkaka, nā huakai, nā pōpoki, nā pata, ka lard
e hana pinepine
e mālama i kahi paona olakino
hāʻawi pio a me ka uahi,
Pōʻalo ka naʻau a me ke kaumaha,
hoʻohana ka hoʻokele ʻana.

Hoike ʻike

ʻO ka stenosis arene Renal kekahi o nā pilikia nui loa i ka urology i kēia lā. Hoʻomohala ka Patology ma muli o ka congenital a loaʻa nā loli i nā moku arterial, e alakaʻi ana i ka emi ʻana o ke kahe koko a me ka hoʻomohala ʻana o ka nephrogenic hypertension. He hoʻohālikelike ʻana i ka hypertension parenchymal i kumu o nā maʻi ʻulaʻi mua (glomerulonephritis, pyelonephritis, nephrolithiasis, hydronephrosis, polycystosis, ʻili, cyst, kidney tuberculosis, etc.), ma ka hihia o ka stenosis renal, kūlia kaomi non-vasenic arteriosis pili me nā nonalal aralosis.

ʻO ke hypertension i kumu ʻia e nā hanana a me nā stenosing o nā ʻalā o ka renal i hoʻopaʻa ʻia ma ka 10-15% o nā mea maʻi me nā mea nui a ma ka 30% me ka hypertension nephrogenic. Hiki i ka maʻi ke hele pū me nā hoʻopiʻi weliweli ola: cardiovascular failed, stroke, myocardial infarction, kidney renal failed.

ʻO nā kumu maʻamau o ka stenosis renal artery o ka atherosclerosis (65-70%) a me nā fibromuscular dysplasia (25-30%). ʻO ka stenosis atherosclerotic e loaʻa i nā kāne ma mua o 50 o kona mau makahiki he 2 mau manawa pinepine ma mua o nā wahine. I ka manawa like, hiki ke hoʻokaʻawale ʻia nā ʻāpana o ka atheromatous ma nā ʻāpana ākea o nā koina aralima kokoke i ka aorta (ma 74%), i nā waena waena o nā aramona (a i ka 16%), ma ka palena o ka bifurcation arterial (ma ka 5%) a i ʻole nā kihi o nā koina o nā renal (ma ka 5% o nā hihia) . ^ E Ha yM. Loaʻa pinepine nā lōkī i nā atherosclerotic o nā lāʻau renal e kūʻē i kahi kūmole o ka maʻi mellitus o ka maʻi mellitus, ma mua o ka pono o ka arterial, maʻi ischemic.

ʻO ka papaʻi ma muli o ka congenital segmental fibromuscular dysplasia (fibrous a i ʻole ka palalulu ʻana o nā membrane a i nā uaua) he mau manawa hou i hiki mai i nā wahine i ʻoi aku ma mua o 30-40 mau makahiki. I ka nui o nā hihia, ua pani ʻia nā leʻe stenosing i waena o ka māhele waena o ka lāʻau hāpau.E like me nā hiʻohiʻona o nā hiʻohiʻona morphological a me ka arteriographic, intimal, medial a peromedial fibromuscular dysplasia. ʻO ka stenosis arene Renal me ka hyperplasia fibromuscular i loaʻa pinepine i ka localaterater bilateral.

Ma kahi o 5% o nā hihia, maʻi ʻia nā maʻi e nā kumu ʻē aʻe, e komo pū ana i ka aneurysms arterial, shunts arteriovenous, vasculitis, maʻi o Takayasu, thrombosis a embolism o ka renal artery, hoʻopili ʻana i nā moku ohaʻa mai waho mai e ke kino haole a hōʻeha ʻana, nephroptosis, coarctation o ka aorta, etc. hoʻōla i ka ʻenehana paʻakikī o ka ʻōnaehana renin-angiotensin-aldosterone, ka mea i hui pū ʻia e ka pumehana renal hypertension.

Hōʻike ʻia ka stenosis arene Renal e nā ʻehā maʻamau ʻelua: ʻo ka maʻi hypertension a me nephropathy ischemic. ʻO ka hoʻomohala koʻikoʻi o ka hypertension mau ma lalo o nā makahiki he 50, i ke ʻano he kānāwai, e noʻonoʻo iā mākou e pili ana i ka fibromuscular dysplasia, a i nā mea maʻi i ʻoi aku ma mua o 50 mau makahiki - e pili ana i ka stherosis atherosclerotic. Hiki i ke hypertension arterial me kēia pathology ke kūpaʻa i ka lāʻau antihypertensive a hōʻailona ʻia e nā helu kiʻekiʻe o ke koko diastolic, e hōʻea ana i ka 140-170 mm RT. ʻAniā. ʻO nā holomua hypertensive me ka hypasension vasorenal ka loaʻa ʻole.

Hoʻomau pinepine ʻia ka hoʻomohala ʻana i ka maʻi hypertension me ka hōʻailona cerebral - ka ʻeha, ka puʻu wela, ke kaumaha, ma ke poʻo, ke ʻeha o ka māka, tinnitus, flickering "lele" i mua o nā maka, ka hoʻoluhi ʻana i ka hoʻomanaʻo, moe hiamoe, irritability. Hoʻopili i ka puʻuwai hema ke kōkua i ka loaʻa ʻana o ka puʻuwai puʻuwai, i hōʻike ʻia e nā palpitations, ʻeha i ka naʻau, ka naʻau puʻupuʻu ma hope o ke koʻikoʻi, pōkole o ka hanu. Ma ka stenosis koʻikoʻi, hoʻomohala ʻia ka edema pulmonary e ulu hou.

Hoʻokumu ka Vasorenal hypertension i nā pae nui. Ma ke ʻano o ka uku, normotension a i ʻole ka palena o ka hypertension arterial, hoʻoponopono ʻia e nā lāʻau lapaʻau, mālama ʻia, hana mau ka hana o ka hana o ke keiki. Hōʻike ʻia ke ʻano o ka uku i ka pae ʻai me ka hypertension stabil arterial, kahi hoʻohaʻahaʻa hōʻemi i ka hana ʻoi a me ka liʻiliʻi o ko lākou pā.

Ma ka hoʻomaka ʻana o ka decompensation, lilo a hypertension arertial, hoʻōla i ka antihypertensive therapy, ua hoʻemi nui ʻia nā hana o ke akepaʻa, ua hoʻemi ʻia ka nui o nā kuhi i 4 cm. nā lālā o 5 a i ʻole cm.

Hōʻike ʻia ka Nephropathy e nā hōʻailona o ka ischemia o ke keiki - he kaumaha o ka kaumaha a hōʻeha paha i ka ʻeha hope o ke kua, me ka infarction o ke keiki - hematuria. Hoʻokomo pinepine ka hyperaldosteronism kūhule, i hōʻike ʻia e ka palupalu ʻana o nā mākala, polyuria, polydipsia, nocturia, paresthesias, a me nā ʻenehana tetany.

ʻO ka hui pū ʻana o ka stenosis renal artery me ka hōʻino i nā loko vascular (me ka atherosclerosis, nonspecific aortoarteritis) hiki ke hele pū me nā hōʻailona o ischemia o nā haʻahaʻa a i luna a keu paha, nā hanana gastrointestinal. ʻO ka holomua ka holomua o ka patula e alakaʻi i nā hoʻopiʻi vascular a me nā renal - nā haukaʻi retinal, ka maʻi cerebrovascular ululā, ka maʻi myocardial, a me ka pōʻino ʻole.

ʻO ka wānana a me ke kālai

ʻO ka hoʻomaʻamaʻa ʻana o ka stenosis renal arela e hiki ai i ka hoʻoponopono ʻana o ke kahe o ke koko i 70-80% o nā mea maʻi me ka fibromuscular dysplasia a me 50-60% me atherosclerosis. ʻO ka manawa o ka hoʻōho kino ma waena o ke koko e hiki ke piʻi a hiki i 6 mau mahina. No ka hoʻopauʻana i ke koena o ka hypertension arterial, kuhikuhi nā lāʻau antihypertensive. Hāpai ʻia nā mea maʻi e nānā ʻānō e ka nephrologist a me cardiologist. Pākuʻi ʻia ka pale ʻana i ka manawa kūpono a me ka mālama ʻana i nā maʻi i alakaʻi i ka hoʻomohala ʻana i ka stenosis.

ʻO ka ʻike maʻamau a me nā code no ICD-10

ʻO ka stenosis Arterial, ʻo ia ka hoʻopaʻa ʻana i ka lōʻihi o nā lāʻau ʻalopona i hoʻokahi manawa, a i kā lākou mau lālā, i mālama ʻia e ka puʻupuʻu o ka ʻili o ka huehue. ʻOi loa ka mea, akā ʻo kēia palu i manaʻo ʻia kekahi o nā mea koʻikoʻi loa ʻaʻole wale i ka nephrology a me ka urology, akā i ka cardiology.

Ma kahi kanaka olakino, kānana ʻia ke koko e nā ʻōpū, ma muli o ke ʻano o ka urula mua, kahi ʻano like o ke ʻano o ke koko, a ma ka pale ʻana, ka nui o ke koko e komo ai i nā ʻāpana o ka urinary, e hoʻēmi ʻia ana, a ua kānana ʻia ka ʻino, ʻo ia ke kumu no ka hoʻonui ʻana i ke koko.

Hoʻopili ʻia nā stenoses ma muli o ke ʻano:

hema-hema
lima ʻākau
palipale.

Ua loaʻa i ka maʻi kona code e like me ka MKD - I15.0 -renovascular hypertension.

ʻO nā kumu hanana

ʻO ke kumu nui o ka patology (ma 7 mau hihia mai 10) ʻo ia ke ʻano o nā paleke atheromatous ma nā paia o nā kīhaka. ʻO nā kumu ʻē aʻe e hoʻonāukiuki i ka maʻi:

fibromuscular dysplasia (congenital a loaʻa paha),
ʻeha hōʻeha
nā loli pili i nā makahiki
momona momona
maʻi mellitus maʻiʻi.

Ma hope o ka hoʻopili ʻana o ke koko i nā kolo o nā keiki, ʻike lākou i ka pololi o ka oxygen, ke alakaʻi nei i nā loli degenerative a nalowale lākou i ka hana kānana.

ʻO ka Stenosis ka hopena ma ke kaʻe ʻana o nā pāla atherosclerotic ʻelua mau mea e hoʻopilikia i nā kāne ma mua o nā wahine. Akā ʻo fibromuscular dysplasia e lilo i kumu no ka maʻi i nā manawa pinepine i loko o nā wahine i ʻoi aku ma mua o 40 mau makahiki.

Nui kekahi mau maʻi ʻē aʻe e hoʻonāukiuki i ka hiki ʻana o kēia alahele (ma kahi o 5% o 100%):

aneurysm arterial,
vasculitis
ʻO ka maʻi ʻo Takayasu
trombosis hāmeʻa maʻi,
hoʻoweliweli ʻana o ka moku waho
nphropotosis.

ʻO ke ʻano o nā mea i hana i ka maʻi, ke alakaʻi nei i ka hana hōʻino ʻana o ke kahe o ke koko a me ka hōʻino i nā kino o loko.

Nā Hoʻomaka

No ka stenosis o nā māla renal, ʻelua mau hōʻailona nui e kū nei i ka maʻi - hypertension arterial a me ischemic nephropathy.

ʻO ka mea mua i hui pū ʻia me ka hōʻeha o ka pilikia, ʻeha ma nā maka, tinnitus, ke ʻano o nā "hōkū" i mua o nā maka, nāwaliwali o ka hoʻomanaʻo ʻana, ka haunaele hiamoe, huhū.

Ma muli o ka halaʻole i ka hana o ka ʻōnaehana cardiovascular, he nui ka piʻi ʻana o ka puʻuwai, ka manaʻo i ka pume ma hope o ka umauma e hele mai ana, ʻike ʻia ka pōkole o ka hanu. Eia kekahi, hiki i nā mea maʻi ke loaʻa i ke ʻeha hoʻi hope, hematuria, loaʻa paha nā hoʻohewa.

ʻO nā hōʻailona i nā ʻāpana ʻokoʻa

Hele kekahi maʻi i kona hoʻomohala ʻana i kēlā me kēia mau la, o kēlā me kēia.

Hōʻike ʻia ka hana mua i ka mālama ʻana i nā pōpoki, hōʻike ka mea maʻi i ka normotension a i ʻole ka hypertension arterial moderate, hiki iā ia ke hoʻoponopono me nā lāʻau lapaʻau.
Hōʻike ʻia ke ʻano o ka subcompensation e ka hana renal impaired, paʻa i ka hypertension arterial. Hiki i ka ʻāpana o ka urinary ke emi iki i ka nui.
Decompensation - ua hōkole ʻia ka hana renal pono ʻole iā ia, ua nui loa ka paʻakikī o ka ʻōpū o ke ake, paʻakikī e mālama, hiki i ka huakaʻi hele ke hele i ka nui a hiki i 4 cm.
ʻO ke kahua ʻoihana - lilo ka maʻi hypertension, piʻi i ke koko i ka nui o 250-280 hui a ʻaʻole ʻae ʻia i ka lāʻau lapaʻau. ʻAʻole hana ke ʻākina i kāna mau hana, e hoʻemi paha ka nui i lalo o 5 cm.

Hoʻopau i nā pilikia renal, e lilo i ka hope loa o ka maʻi, ua hoʻomau ka hoʻomanawanui i nā hōʻailona o ka hoʻohālikelike - ʻāha a me ka luaʻi, ke poʻo, ke kuʻi. Hiki mua nā mea maʻi e like me ka maʻi palupalu, me ka hana ʻana i ka kahe o ka ʻōpū.

ʻO wai e hoʻopili aku a pehea e hoʻoponopono ai ʻoe

Inā loaʻa kekahi mau hōʻailona e hōʻike ana i nā pilikia me nā keiki, ʻo ka mea mua i pono ke kūkākūkā i kahi mea lapaʻau, inā e hōʻiliʻili i kahi anamnesis, hopohopo ke kauka e ʻōlelo nei nā maʻi o ka maʻi e pili ana i ke ala o ka maʻi, a laila e ʻōlelo ʻia ka mea maʻi e ʻōlelo aku i ka urologist a me nephrologist.

I mea e ʻike ai i nā mea maʻi loea, pono e hoʻokō i kekahi o nā hōʻike kikoʻī, me nā ʻano hana penei:

ʻO ka pōkole o nā pūpū a me ka ʻōpū
Dopplerometry
CT angiography
mākaukau
uukee
PET
scintigraphy

Ma kahi o nā haʻawina loea kūikawā, ʻike ʻia ka mea maʻi i nā hoʻokolohua ʻē aʻe, ke kumu nui i ʻike ʻia ai ke kumu o ka stenosis:

hōʻike loiloi kino a me ka biochemical test,
urinalysis
electrocardiography
aila.

Koho ʻia nā kaʻina āpau āpau e ka neʻe i ke kauka ʻana i kēlā me kēia, ma muli o nā maʻi.

Kukola

ʻO ka mea hou loa, ʻo ke ala wale nō i hana ʻia e mālama ai i ka stenosis arela renal i manaʻo ʻia he mea hana - ʻo ia hoʻi, ua neʻe ʻia ka huehue ʻino.

Ma mua o ka hoʻomaka ʻana i ka mālama ʻana, ʻōlelo ʻia ka mea maʻi e haʻalele i ka hoʻohana ʻana i ka paʻakai, ka waiʻona a me ka uahi ʻana, ʻoi aku, inā ua hoʻomoe ka mea maʻi, a laila ʻo ia mua o ka mea a pau e pono ai e hoʻemi i ka paona.

Nā lāʻau lapaʻau

Me kēia pathology, ʻoi aku ka lāʻau lapaʻau ka ʻoi aku o kahi ʻano kōkua, ʻaʻole hiki iā ia ke kāpae i ke kumu kumu o ka maʻi hypertension a me ischemia o nā pēpē.

ʻO ka mea mua, pono ia e hoʻonaninani pono i ke kaomi, no kēia mea kahi hōʻailona o antihypertensive a me diuretics a me nā mea blockers e hoʻohana ʻia. I ka wā e hoʻohana ai i kēia mau lāʻau, he mea nui e hoʻomalu i ka hana a nā ʻāpana o ka urinary i hōʻeha ʻole ʻia ka mālama ʻana iā lākou.

No laila hiki ke hoʻohana ʻia iā Cucksril, maʻa mau ke ʻano he 6.25-12.5 mg ʻekolu mau manawa i ka lā, inā ʻaʻole hoʻi i hoʻihoʻi ʻia ka paipai maʻamau i loko o hoʻokahi hebedoma, ua hoʻonui ʻia ka hana i 25 mg 4 mau manawa i ka lā.

ʻAʻole hiki ke hoʻohana ʻia kēia lāʻau lapaʻau i nā maʻi me ka maʻi mellitus a me nā puʻuwai kaumaha. I nā hihia penei, e pili ana kēia mau mea penei:

ʻO ka beta-blockers Cardioselective (Egiloc ma kahi pānaʻi o 100 mg i kēlā me kēia lā, ma nā kūlana koʻikoʻi, he piʻi ka piʻi a hiki i ka 200 mg ʻae ʻia).
Ane i nā laka pākia palaki lemu (nifedipine a 20 mg i ka lā),
ʻOi Loop diuretics (Furosemide - ke koho ʻia nei ka pākeke i kēlā me kēia hihia),
ʻO nā agonist receptor Imidazoline (Moxonidine 0.2-0.6 mg i kēlā me kēia lā, e like me nā ʻōlelo a ke kauka).

I ke kohoʻana o ka hala o ka lāʻau lapaʻau, pono ia e nānā i ke kiʻekiʻe o ka creatinine a me ka pāima ma ke koko o ka mea maʻi.

No nā mea maʻi me ka stenosis atherosclerotic, pono ʻia nā statins e hoʻohaʻahaʻa i ka kolamu, no ka laʻana:

Atoris: hoʻomaka ka intake me 10 mg i kēlā me kēia lā, ʻo ka nui loa ka nui o 80 mg,
Rosucard: ka hopena mai 5 a 40m i kēlā me kēia lā, ʻaʻole i hoʻohana ʻia no ka hāʻule ʻana i ka renal koʻikoʻi,
Liptonorm: ka uku ʻana ma muli o ke kūlana o ka mea maʻi mai 10 a 40 mg i kēlā me kēia lā.

Kahi ʻia ka koho o ka lāʻau lapaʻau a me ka hala ʻana i kēlā me kēia hihia i kēlā me kēia kanaka, i ka nānā ʻana i ka filtration, e pili ana paha i nā maʻi.

ʻO nā maʻi me ka maʻi maʻi maʻi e kuhikuhi ʻia i ka insulin.

Hoʻolā hewa

Inā hoʻopili ʻia ka lumen o ka moku e ʻoi aku ma mua o 65%, a laila ʻaʻole pono ka loaʻa ʻana o ka lāʻau lapaʻau, ʻo ke ala wale nō e hoʻihoʻi ai i ka loaʻa o ke koko i ka lolo. Eia kekahi, ʻo ka hōʻike ʻana no ka hōʻiliʻili ʻoi ʻana:

hoʻihoʻi ʻokoʻa ka pili bilateral,
i ka hanana e ulu ana ka palolo i kahi keiki hoʻokahi e hana pono ai,
he stenosis i hiki i ke kaohi o ka hypertension.

Inā loʻohia kekahi mea maʻi i ka stenosis bilateral, baloon angioplasty ka hopena maikaʻi loa - ʻo ia hoʻi, ke hāʻawi ʻia nei i kahi palaka kūikawā ma o ka arinal femoral i loko o ke ana o ka artery kuʻina, a laila hoʻi i hoʻolōʻihi ʻia, ka mea e kōkua ai i ka hoʻonui ʻia o ka lāʻau.

Hiki ke hoʻohana ʻia ke ala hoʻokele - me ka hoʻohana ʻana i kahi catheter baluna, kahi stent (microtubule) e lawe ʻia mai i ke kahua o ka huki ʻana o ka moku, a laila hoʻohua ʻia ke kuli a pana ʻia ka paʻu i loko o ka paia o ka moku, e mālama ana i kona lumen i ka wā e hiki mai ana.

ʻO kekahi manawa ke hana ka mea maʻi i ka prosthetics o nā wahī, i hana hou ʻia ka ʻāina i hoʻopili ʻia, e hana ʻia kēia hana ma hope o ka haʻalele ʻana i ka wahi i hoʻopā ʻia ai ka moku - ua hana ʻia kahi mea hoʻopiʻi kūikawā e hoʻihoʻi i ka kahe o ke koko i ka ʻōpala inā ua hana ʻia kahi hana ma mua o ka hana.

Inā nui ka nui o nā moku, a ua nalowale ke ahonui i kāna hana, a laila e hoʻoneʻe ʻia.

ʻOi aʻe ma ka Renal Artery Stenosis

ʻO ka stenosis arene Renal he kikoʻī i ka lumen o kahi moku, ma muli o ke ʻano o nā ʻano pathological. Hōʻike ʻia ka maʻi i nā ala nefropathic. ʻO nā lāʻau arenal ka nui o nā kīʻaha nui e hoʻolako i ke koko i nā kao ʻili. Me ka stenosis, ʻike pinepine lākou i ka emi o ka diameter. ʻO ka hopena, pilikia ka hōʻiliʻili o ke koko i nā keiki. Ke alakaʻi nei kēia ʻano i nā pilikia koʻikoʻi e like me ke hypertension pae ānina, ka hopena ʻole o ka pilikia. Aia nā lāʻau he 2 i ka hoʻolālāʻana o ka stenosis. I waena o lākou:

ʻO ke koho Atherosclerotic. Hoʻomaopopo ia i ka hapa nui o nā poʻe maʻi e loaʻa nei i kēia ala pili. ʻO kahi hana e like me ka hoʻomohala ʻana o ka stenosis ka ʻōlelo kaaniani o ka lumen o ka moku me nā kolamu kolika. Hōʻike pinepine ʻia ka komo ʻana o ka moku ma ka wā kahiko.
Mawaena Fibromuscular. ʻO kēia koho no ka hoʻomohala ʻana o ka pathology he mea maʻamau. Hiki iā ia ke lilo i loko o nā wahine waena, a i waena hoʻi o nā kaikamahine ʻōpio. ʻO ka ʻōpū i ka pōpilikia he kuleana hānau hoʻoilina.

Ma hope o ke nānā ʻana i ke kumu hana pono e hiki ke hoʻokau i kahi maʻi ʻana o ka stenosis arela ʻaia. He ʻano papa inoa ka ICD ma nā wahi a pau o ka honua. Loaʻa i nā maʻi he nui, ʻo kēlā me kēia i loaʻa kahi code. Hoʻopili ʻia ka stenosis arene Renal i nā ʻaoʻao 2, ma muli o ke kumu o kona hiki ʻana. ʻO kekahi koho ʻo ia ka code I15.0, ʻo ia ka mea "renovascular hypertension." ʻO kekahi code ICD kekahi ʻo Q27.1. Uku ia no "stenosis congenital o ka araloli kūʻai." Pono nā kūlana ʻelua i ka mālama ʻia e kahi urologist a i ʻole loina manuʻa.

Stenosis Renal Arenosis: mau kumu o nā mākaʻikaʻi

ʻO ke kuʻikahi o ka lumen o nā māla peripheral e ʻōlelo ʻia ana i ke ala o nā ʻōnaehana vascular. Aia nā kumu ākea ʻē aʻe o ka stenosis. ʻO ka mea maʻamau ka mea maʻamau o ka atherosclerosis. E like me ʻoe e ʻike ai, ma ka hapanui he nui i nānā ʻia ma ka poʻe e nui ke kaumaha, ke alakaʻi nei i kahi ala maʻalahi a i ʻole ka maʻi i ka maʻi maʻi. Hiki i ke atherosclerosis hoʻomohala ma mua o ka manawa. Eia naʻe, ʻike pinepine ʻia a hiki i nā ʻano o nā lāʻau clogged e kū mai. ʻO nā kumu ʻē aʻe o ka stenosis i loaʻa:

Mawaena Fibromuscular. Pili ʻia kēia huaʻala i ka pōpoki genen congenital e hopena i ka nele o nā palu mau iʻa ma ka paia o ka moku. Hānā ʻia nā pathology i nā wahine o kēlā me kēia makahiki.
ʻO ka aneurysm o nā ʻoki o nā keiki.
ʻO nā Tumors o nā moku peripheral.
Congenital a loaʻa vasculitis.
ʻO ke kaomi ʻana o ka lāʻau hālealīkē e nā neoplasms e puka mai ana i nā io o nā kino pili.

Loaʻa nā kumu i papa inoa ʻia i nā hihia liʻiliʻi. No laila, e nānā wale ʻia lākou ma hope o ka wehe ʻana i ka atherosclerosis.

Ka mīkini i ka hoʻolālāʻana o hypertension

ʻO ke kumu nui o ka stenosis o nā māla o ke keiki ka mea e hoʻonui ai i ke koko. No laila, me kēia ʻōlepa haumanu, pono ia kahi hana e pili ana i ka ʻōnaehana. Pehea e pili ana i ka stenosis aralula a me ka hypertension? Hoʻokomo ʻia nā hana me 2 ma ka hoʻonui ʻana i ke koko:

Hoʻoulu i ka ʻōnaehana renin-angiotensin. Ma lalo o ke kumu o kēia mau mea ola, e kūleʻa ana nā wahi e haki a nā ʻĀina arterioles. ʻO ke hopena, hoʻonui ka pale o nā moku peripheral. Pēlā e piʻi ai ke koko i ka wahī.
Hana i ka aldosterone.Hana ʻia kēia hormon i ka cortex adrenal. Ma ka maʻamau, ke kū mau nei i ke kino. Eia naʻe, me ka stenosis artery, hoʻonui ʻia kona hana. Ma muli o ka nui o nā ald testosterone, nā huaʻai a me nā sodium e hōʻuluʻulu i loko o ke kino. ʻO kēia, ma ke kumu, he kumu no ka hoʻonui ʻana i ke koko.

I ka hopena o ka hypertension maʻi maʻamau, hele mai nā loli ma ka ʻaoʻao o ka ʻōnaehana cardiovascular. ʻO ka ventricle hema ka mea maʻi hypertrophies a me nā pā. ʻO kēia ke kumu nui o ka hypertension.

ʻOkoʻa ka maʻi ʻokoʻa

Hāʻawi ʻia i ka ʻoiaʻiʻo e alakaʻi nei ka maʻi hypertensive, he kūʻokoʻa ka stenosis renal e like me nā ala o ka cardiac, aheric atherosclerosis. Hiki nō paha ke ʻano like me nā maʻi a Itzingo-Cush a me ka pheochromocytoma.

Inā lanakila nā hōʻailona o ischemic nephropathy, a laila ʻokoʻa ka stenosis me nā pathological maʻi o nā keiki. ʻO kēia ka pyelo- a me glomerulonephritis. Eia kekahi, hiki ke ʻike ʻia nā hōʻailona like me ka hoʻopiʻi ʻana i ka maʻi maʻi.

ʻO ka maʻi conservative no ka stenosis hāmeʻa renal

Hoʻomaka ka mālama ʻana i ka stenosis renal artery i nā hana conservative. Me ka hypertension i kumu ʻia e ka wāʻu ʻia o nā moku ʻōiwi, pono ke hui ʻia o kekahi mau lāʻau lapaʻau. ʻOi aku ka makemake o Angiotensin e hoʻohuli ai i ka inhibitor enzyme. ʻAʻole mālama ʻia kēia mau lāʻau lapaʻau no ka palau ʻana i ka varo atherosclerotic kino. ʻO nā hui pū kekahi o nā pūʻulu o nā lāʻau lapaʻau:

Nā māka hua Beta. Hoʻopili kēia me ka lāʻau "Metoprolol", "Coronal", "Bisoprolol".
Nā diopetics Loop. ʻO ka lāʻau lapaʻau i koho he mea lapaʻau Furosemide.
Nā mea ʻokoʻa paleka saluran kalepa. I waena o lākou nā lāʻau lapaʻau "Verapamil", "Diltiazem".

Eia kekahi, pono e lawe ka mea maʻi i nā lāʻau lapaʻau e pono ai no ka mālama ʻana i ka maʻi ma lalo (atherosclerosis, diabetes mellitus).

Ka hoʻomohala ma hope o ka mālama ʻana i ka stenosis

ʻO kahea o ka ʻaoʻao o ka lesion (stenosis o ka aralima hema paha a i ʻole paha), ka pono o ka prognosis ma hope o ke kaʻina e pili ana i nā ʻōlelo a ke kauka a me ke ʻano kino o ka mea maʻi. ʻO ka manawa pinepine, hiki i ka lāʻau lapaʻau ke hoʻokō i kahi hopena maikaʻi. Ma hope o kekahi mau mahina, hiki ke normalization i ke koko i loko o 60-70% o nā maʻi.

Kāohi

Pākuʻi ʻia nā hana kūpono i ka mālama mau ʻana i ke kahe o ke koko ma mua o ka hoʻopiʻi ʻana o ka dizziness a me ka tinnitus, nā hōʻea ʻana me ka inu wai. I mea e hōʻalo ai i ka holomua o ka atherosclerosis, pono ia e hahai i kahi meaʻai hypocholesterol kūikawā, alakaʻi i kahi ʻano hana. Pono kekahi mau maʻi e lawe i nā lāʻau lapaʻau kūikawā - statins.

ʻO ka lāʻau lapaʻau

E like me ka lāʻau lapaʻau, ʻaʻole hiki ke hoʻōla i nā lāʻau kuʻuna i ka stenosis, eia naʻe, hiki ke hoʻomaikaʻi i ke ʻano o nā moku koko a hōʻemi i nā hōʻailona maʻi. No ia mau mea, hiki ke hoʻohana i nā infusions ho'ōla, decoction.

ʻIliʻu mauna pele. No ka hana ʻana i kēia, 200 gr. ninini i ka waiūa cortex 600 ml o ka wai a e hoʻolapalapa no ka wela haʻahaʻa no 3 mau hola, inu pono i 3 tbsp. punetē ma mua o ka papaʻaina.
Kahiki. E kāwili i ka 80 mau kāleka o ke kāleka i kahi kāwili, hoʻohui i 200 pākaha o ka vodka, a hoʻopaʻa i 10 mau lā i ka pō. E lawe he 10 mau manawa ʻelua i kēlā me kēia lā ma mua o ka papaʻaina.
Ala a ʻūhā. Lawe iā 10 tbsp. la l hawthorn a me 5 tbsp. punetē o nā kūloʻe o ka nahele, kuʻi a ninini i ʻelua mau wai kaila o ka wai ʻana. E kāwili i ka ipu me kahi kāwele a waiho i kahi mahana no kahi lā. Kūʻai, hoʻohana i 1 tbsp. ma mua o ka ʻai ʻana.

ʻO kaʻoiaʻiʻo, hikiʻole ke lanakila i ka stenosis me kēia mau kūlima, akā hiki iā ʻoe ke hoʻomaikaʻi i ke ʻano o ke ola, ʻo ke ʻano wale nō i nā ʻano maʻi me ke kūkākūkā me kāu kauka.

Nā hopena a me nā hopena

ʻO ke ʻano o kēia alahele he maʻi pōpilikia nui ma muli o nā hopena hoʻopiʻi koʻikoʻi. No laila hiki ke kumu:

ischemia mānoanoa
pilikia kūlohelohe
edema poloka,
ʻiopalae angiopathy,
puʻuwai puʻuwai
he poho.

I kekahi hihia, ke hoʻolōʻihi nei ka mea maʻi i kona kipa ʻana i ka loea a ʻaʻole mālama pono i nā hōʻailona, ʻoi aku ka nui o ka hōʻeha o nā maʻi.

No ke aha he stenosis o ka ʻākau, ka hope o ka renal artery, bilateral

ʻO ka hapa nui o nā maʻi (e pili ana i 70%) he atherosclerosis ke kumu nui etiological. Hoʻopilikia ia i nā kāne ma hope o ka 50 ma mua o ka manawa o ka wahine. ʻO kahi lokona maʻamau o ka pleka atherosclerotic he lālā ia mai ka aorta. ʻO nā kūlana ʻoi aku ka hele ʻana o ka stenosis: ka maʻi hypertension a me ischemic, maʻi mellitus.

Hoʻomaʻamaʻa ʻia ka ʻiliʻili maoli o nā pae o nā arteri, ma ke ʻano he kānāwai, i ka wahine ma hope o 35 makahiki. Aia ka mākaʻikaʻi liʻiliʻi i kēia mau hihia. E pili paha ka hoʻonui ʻana i ka membrane i loko a i ʻole paha o kekahi, akā ʻoi aku ka nui o nā ʻehā o nā keiki.

I waena o nā kumu like ʻole maʻamau.

aortic aneurysm a i ʻole nā hui,
pili ka pili o ka arteriovenous (hoʻomohala ulu)
ʻO ka maʻi Takayasu
ʻōnaehana ʻōnaehana vasculitis
pani ana i kahi kīʻaha me kahi thrombus, embolus,
ke kaomi ʻana ma ka moku ʻaʻe,
kala ʻole o kaʻeha.

Aopic aneurysm - hoʻokahi o nā kumu o ka stenosis renal artery

ʻO ka nele o ke kahe koko e kōkua i ka hoʻōlaʻana o ka mahi renin-angiotensin-aldosterone. Ke alakaʻi nei kēia i kahi papa mau o ka hypertension arterial.

Kūleʻa mākou i ka heluhelu ʻana i kahi ʻatikala ma ka loaʻa ʻana o ka maʻi hypertension. Mai ia ʻoe e aʻo ai i ka pōʻino o ka maʻi a me kona maʻi, nā ʻano lāʻau a me nā hōʻeha kūpono.

A eia kekahi e pili ana i ka hypertension pae lua.

Nā ʻōhumu o ka hoʻomaka ʻana o ka maʻi

I ka ʻike mua ʻana i ke koko koko kiʻekiʻe, pono mau ia e kāpae i kona kumu ulu ʻana, me ka hoʻokumu ʻana i ka arterial. ʻO ka hiʻohiʻona nui o kēlā hypertension maʻamau ka helu o nā helu haʻahaʻa o ka haʻahaʻa (diastolic). Hiki iā ia ke hoʻonui i ka 140 - 160 mm RT. ʻAniā. ma kahi ʻano o 90. He hoʻololi pinepine ʻo Renal hypertension i nā hōʻeha a hōʻailona ʻia e ka maʻi nāwaliwali i nā lāʻau antihypertensive.

Me ka hoʻonui nui ʻana, ʻike ka poʻe maʻi i kēia mau hōʻailona:

ʻeha ma ke kua o ke poʻo, nā maka ʻ alo, ke kaumaha ma ke poʻo.
wela uila
tinnitus
ʻO ka holo ʻana o ka hiamoe, mau huhū, luhi,
ka ʻā ʻana o nā ʻōpū a i ʻole nā maka i mua o ka maka.
mahuahua ka puʻuwai naʻau
ʻaʻano pōkole
cardialgia, kaomi ma hope o ka sternum,
ʻO ka edema pulmonary me ke ala hoʻi i ka pathology koʻikoʻi.

Me ka piʻi mālie o ke kaomi, ua ʻike ʻia nā hana like o kēia maʻi:

ʻO ka uku hoʻohālike, he hoʻohaʻahaʻa ʻia, hoʻohaʻahaʻa ʻia me nā lāʻau lapaʻau, hana nā keiki i kahi maʻamau.
Pūnaewele pili - hoʻonui pinepine i ke kaomi, e hoʻohaʻahaʻa i ka hiki ke kānana o nā kuhi, e hōʻemi ana i ko lākou nui.
Decompensation - hiki ke hoʻokaʻawale ʻia ka hypertension koʻikoʻi, ʻaʻole hiki ke hoʻokaʻawale ʻia me nā mea lapaʻau, hana ʻole i ka māka, hana i nā aʻaluhi.

No ka nephropathy, ʻo ia ka mea i hōʻike ai ka ʻeha, kaumaha i ka ʻāina lumbar, ke kīwaha ʻana i nā wāwae a ma lalo o nā maka, nāwaliwali o ka naʻau, nā nui o ka urination a me ka makewai, ka nui o ka pō i ka pō ka nui o ke ao, ka ʻāwili a me ka hōʻeuʻeu ʻana o nā limahana.

E nānā i kahi wikiō e pili ana i ka hōʻailona a me ka mālama ʻana no ke kaomi koko:

He aha ka meaʻinoʻole i ka stenosis artery

Ke hoʻomau nei ka piʻi ʻana o ke koko i kēlā mau ʻōuli:

angiopathy retina a hoʻoemi ʻia ka ʻike,
ulia a i ʻole ulia pōʻai cerebrovascular (hahau a hōʻeha i ka ischemic)
puʻuwai puʻuwai,
kaʻe lele ʻana
kaomi ʻana i ka kānana koko, uremia.

ʻO ka hoʻomohala ʻana o ka mea maʻi

Ma ke nānā ʻana, ʻo nā palu o ka ʻili a me ka palaualelo o nā wāwae a me ke alo hiki ke hoʻomaopopo ʻia. Me ka percussion, hoʻonui ʻia nā palena o ka myocardium ma muli o ka ventricle hema. ʻO ka hoʻolohe ʻana i ka puʻuwai ke hōʻike i kahi leo 2 keu ma luna o ka aorta a me kahi ʻōhumu maʻamau ma ka ʻōpū o luna.

I mea e wehewehe pono ai i ke ʻano, hōʻike ʻia kahi hoʻokolohua:

biochemistry koko - nā māhuahua o koina,
urinalysis - ʻ cellslelo i loko o ke koko, protein,
ʻOi aku ka piha o nā kuhi - ka emi o ka nui o ka punetēpē,
urography - haʻahaʻa haʻahaʻa a hoʻolōʻihi i ka hoʻohālikelike o nā keiki,
ka renogram radioisotope hōʻike i kahi hoʻololi i ka nui a me ke ʻano o ka pūpū i hoʻopili ʻia, ka hana a me ke kahe koko.
Hoʻopau ʻo arteriography i kahi a me ka lōʻihi o ka stenosis, kona kumu a me ka ʻike nui.

Nā lāʻau lapaʻau

Hoʻohana ʻia nā lāʻau antihypertensive - nā mea hōʻiliʻili o nā ʻĀpana beta, nā renin, nā kalima o ka calcium, aldosterone, no ka mea he mea maikaʻi loa lākou no ka hano ʻana o ka maʻi hypertension.

Akā me ka stenosis, he liʻiliʻi ka nui o kā lākou kuleana, no ka mea ke kū nei kēia ʻano maʻi i ka nui o nā lāʻau e hoʻokaʻawale i ke koko. Hoʻohana pinepine ʻia ka manawa i ka hiki ʻole ke hana i kahi hana a i ʻole e hoʻomākaukau ai no ka preoperative.

E pili ana i ka pale ʻana o ka ACE, he ʻano nui nā kūlana o nā kauka, ʻaʻole ia no ka mea maʻi no ka maʻi koʻikoʻi a i ʻole ka bilateral stenosis, no laila, ʻaʻole i hoʻohana ʻia no ka monotherapy.

Eia kekahi, me ka hoʻokumu ʻana i ka atherosclerotic kumu o ka pathology, e kauoha ʻia e noi i kekahi mea ʻai a me nā lālō e hoʻohaʻahaʻa i ka kolamu koko. Inā lawa ka hana o ke keiki, hiki ke kuhikuhi ʻia nā hemodialysis.

Nā mea lawelawe

Inā hoʻopaʻa ʻia ka stenosis renal i kahi angiogram, a laila he hōʻailona ia no ka mālama ʻana i ka lāʻau. Hiki ke lawe ʻia kēia mau ʻano ʻano like ʻole:

ka pālaha pōkole ma ka ʻoihana endovascular,
hoʻokena
ka wehe ʻana i ka palena o ka ʻāʻī a me ka huki ʻana i ke koena i ke aorta a i ʻole ka hoʻonohonoho ʻana i kahi moʻo,
ka hemo ʻana o ka membrane i loko me nā plakona atherosclerotic,
ka huehue o ka pūpū i ka wā e hoʻohaʻahaʻa ana.
ka hemo 'ana' ia i hiki ole ai ke hoihoi i ka paepae o ka lāʻau.

He aha ka mea inā hana renal aren stenosis a me hypertension e ulu

ʻAʻole hiki ke hoʻōla ʻia kēlā maʻi me ka ʻole o ka hoʻohana ʻana i nā hana o nā hana ʻoi aku ka renal revascularization. ʻAʻole paʻa ka hoʻihoʻi pilikino ʻana i ka pōpoki o ke kīʻaha.

No laila, ʻo ka manaʻolana wale no ka lāʻau lapaʻau ʻo ia ka hōʻemi. Inā ʻaʻole ia e hana ma ka manawa kūpono (a hiki i ka nulē ke hana i kāna hana), a laila ma kahi o ke ʻano o ka maʻi intravascular, i hiki ke hana ʻia me ka hoʻokipa ʻole, e hana ʻia ka pīpī. Hoʻopilikia maikaʻi loa kēia me ka lesi bilateral.

Hoʻomaopopo no ka mea maʻi

Aia i ke kumu o ka stenosis, mālama ʻia ka lāʻau lapaʻau i ke kaʻe o ke koko mai 70% (me ka mānoanoa ʻana o nā membran o ka artery) i ka 50% (me nā loli atherosclerotic). Ma hope o ka pau ʻana o ka hōʻea o ka endovascular, hoʻomaka ke hoʻoponopono hou mai 1 a 3 mau mahina, a me ka pale o ka ʻōpū kuʻuna maʻamau, e hala paha i nā mahina ʻeono.

Ma ka stenosis koʻikoʻi, keu i ka manawa like i ka manawa a me ka ʻaoʻao hema a me ka ʻoi loa ʻole nā huakaʻi ʻole me ka hōʻino ʻole ʻana, ua make ʻia nā mea maʻi, he nui ka make o ka make ʻole o ka pēpē, ka naʻau, nā mea hōʻeha maʻi o ka vascular.

Manaʻo mākou e heluhelu i ka ʻatikala ma ka stenosis o ka arotid carotid. Mai ia ʻoe e aʻo ai i nā hōʻailona o ka patology a me nā mea kūpono i nā ʻano, nā ʻano o nā pathology, ke nānā ʻana a me ka mālama ʻana.

A eia hou aʻe e pili ana i ka atherosclerosis o ka aorta ʻōpū.

Hoʻokumu ka stenosis arene Renal me ka hoʻomālamalama congenital i ka pā a i ka lesi atherosclerotic. ʻO nā hōʻike nui he ala koʻikoʻi o ka hypertension, kūpaʻa i nā lāʻau lapaʻau, nephropathy. No ka mālamaʻana, hiki i nā lāʻau lapaʻau a me nā hana hōʻola i ke ʻano o ka hypertension moderate. I nā hihia āpau āpau, hiki ke hōʻola wale ʻia nā mea kōkua - ka hana kirihue, shunting a i ʻole ka hoʻokau ʻana, ka wehe ʻana i ka wahi i hoʻopaʻa ʻia.

ʻO ka pono no ka mālama ʻana i ka maʻi hypertension ma muli o nā hōʻailona e hōʻeha i ka maikaʻi o ke ola. ʻO nā pale a me nā lāʻau lapaʻau, ʻo ia hoʻi nā lāʻau lapaʻau e kōkua i ka mālama ʻana i ke hypertension me ka stenosis renal artery, me ka pani ʻole ʻana.

Ua kuhikuhi ʻia nā ʻae o ACE no nā lāʻau lapaʻau no ka mālama ʻana i ka maʻi hypertension. Ke kōkua nei kā lākou hana i ka moku e hoʻonui, a ʻo ka papa hoʻonohonoho ka mea e koho ai i ka hanauna hope loa a i ʻole ka mua, me ka nānā ʻana i nā hōʻailona a me nā contraindications. Aia nā hopena ʻaoʻao, e like me ka huhū. I kekahi manawa inu lākou me ka diuretics.

Ua manaʻo ʻia ʻo ia kekahi o nā Valsartan hou loa mai ke kaomi. ʻO nā mea antihypertensive e hana i nā papa a me nā capsules. E kōkua ana ka lāʻau lapaʻau i kēlā me nā mea i loaʻa ka pūpū ma hope o nā lāʻau maʻamau no ke kaomi.

Kuhi nā kolikoli koloka i ka ʻeneka carotid i kahi hoʻoweliweli koʻikoʻi i ka lolo. Hoʻomaʻamaʻa pinepine ka lāʻau lapaʻau i nā mea hana. ʻO ka hoʻohemo ʻana e nā ala ʻē aʻe ʻaʻole pono ia. Pehea e hoʻomaʻemaʻe ai me ka meaʻai?

He paʻakikī ke mālama ʻana i nā pilikia i ka hana ʻana i ka pilikia ma mua o ka pilikia. ʻO nā kumu no kona helehelena nā hemahema, kahi pupuhi i ka ʻōpū, ke kau ʻana o kahi stent a me nā mea ʻē aʻe. Hoʻohālike nā ʻōmaʻomaʻi me nā renal colic i hoʻoponopono ʻia.

Hoʻopuka ke atherosclerosis o nā māla no ka maʻi ʻana ma muli o ka wā o ka makahiki, nā hana ʻino, ʻoi aku ka nui. I ka wā mua, hūnā ʻia nā hōʻailona, inā i ʻike ʻia, a laila holomua ka maʻi. I kēia hihia, pono ke lāʻau lapaʻau a i ʻole ka hōʻola ʻana.

Ma hope o 65 mau makahiki, ʻaʻole stenotic atherosclerosis o ke ʻōpū o ka ʻōpū a me nā ʻili iliac i loaʻa i loko o 1 mai 20 o ka poʻe. He aha ke ʻano o ka hoʻomaʻamaʻa ʻana i kēia hihia?

Ma muli o nā atherosclerosis a me nā maʻi ʻē aʻe, hiki ke piʻi i ka stenosis o ka arotene carotid. Hiki iā ia ke hōʻeha a me ka hemodynamically koʻikoʻi, ʻokoʻa i nā keke like ʻole. E hoʻolaʻa ka hōʻailona i nā koho lapaʻau, ʻoiai inā makemake ʻia kahi hana. He aha ka hoʻomaikaʻi ʻana no ke ola?

Lawe ʻia ka hana e ʻohe a me ke ʻano ke kīpē, a me ka hopena o ka lāʻau lapaʻau, ʻaʻohe hopena kūpono. He maʻi contraindications a me ke kukahuli renal.