Konke Okudingeka Ukwazi Nge-Cardiorenal Syndrome

Lesi sakhiwo singakhipha izitho ezimbili ezibalulekile kanyekanye

Njengoba igama liphakamisa, "i-cardio" (ephathelene nenhliziyo), kanye ne "renal" (ephathelene nezinso) yinhlangano ethile yokwelashwa lapho ukwehla komsebenzi wenhliziyo kuholela ekuncipheni kwezinso zezinso (noma ngokuphambene nalokho). Ngakho, igama le-syndrome empeleni libonisa ukuxhumana okulimazayo phakathi kwalezi zitho ezimbili ezibalulekile.

Ukuqhubeka nokuchaza; ukuxhumana kuyindlela emibili.

Ngakho-ke, akusiyo nje inhliziyo enqamula ukubola kwayo izinso phansi. Eqinisweni, isifo sezinso, kokubili okusheshayo (isikhathi esifushane, ukuzumayo okungazelelwe) noma okungapheli (isifo eside, esiyingozi esingapheliyo) singabangela nezinkinga ngenhliziyo. Okokugcina, inhlangano eyimfihlo eyimfihlo (njengesifo sikashukela) ingalimaza kokubili izinso nenhliziyo, okuholela enkingeni kokusebenza kombili komzimba.

I-Cardiorenal syndrome ingase iqale ezimweni ezimbi lapho ukuqhuma kwantliziyo kungazelelwe (isibonelo, ukuhlaselwa kwenhliziyo okuholela ekuhlulekeni kwenhliziyo okukhulu) kulimaza izinso. Kodwa-ke, lokhu kungase kungabi njalo njalo kusukela ukuhluleka kwenhliziyo okungapheliyo (CHF) okungapheli isikhathi eside kungaholela ekunciphiseni okuqhubekayo kokuqhubeka kwezinso zezinso. Ngokufanayo, iziguli ezinesifo esingenasifo sezinso (CKD) zisengozini enkulu yesifo senhliziyo.

Ngokusekelwe ukuthi lokhu kusebenzisana kuqaliswa kanjani futhi kuthuthuke, i-cardiorenal syndrome ihlukaniswe ngamaqembu amaningi, imininingwane engaphezulu kwalesi sihloko.

Kodwa-ke, ngizolinga ukunikeza ukubuka konke okubalulekile okungenzeka ukuthi umuntu ojwayelekile angadinga ukwazi ngeziguli eziphethwe yi-cardiorenal syndrome.

Kungani Kufanele Ukwazi Nge-Cardiorenal Syndrome: Impumelelo

Siphila esikhathini saso sonke isifo se-cardiovascular. Abantu abangaphezu kuka-700 000 baseMelika bathola ukuhlaselwa yinhliziyo minyaka yonke, futhi abantu abangaphezu kuka-600 000 bafa ngesifo senhliziyo minyaka yonke.

Enye yezinkinga zalokhu ukuhluleka kwenhliziyo ukuphoqa. Uma ukwehluleka kwesinye isitho kunzima ukusebenza komsebenzi wesibili, kubiza kakhulu ukuguliswa kwesiguli. Isibonelo, ukwanda kwezinga le-serum creatinine ngo-0.5 mg / dL kuphela kuhlotshaniswa nengozi engamaphesenti angu-15 yokwandisa amathuba okufa (esimweni se-cardiorenal syndrome).

Njengoba kunikezwe lezi zindlela, i-cardiorenal syndrome yindawo yokucwaninga ngamandla. Akuyona into engavamile nganoma iyiphi indlela. Ngosuku lwesithathu esibhedlela, iziguli ezingamaphesenti angama-60 (ezivunyelwe ukwelashwa kwe-congestive heart failure) zingase zibhebhetheke kakhulu kwezinso zezinso, futhi zizotholakala ne-cardiorenal syndrome.

Yiziphi Izinkinga Zengozi?

Ngokusobala, akuwona wonke umuntu odala isifo senhliziyo noma izinso uyobe esusa inkinga ngesinye isitho. Kodwa-ke, iziguli ezithile zingase zibe yingozi kakhulu kunezinye. Iziguli ezilandelayo zibhekwa njengengozi enkulu:

• Umfutho wegazi ophezulu
• Isifo sikashukela
• Iqembu lobudala elikhulile
• Umlando okhona ngaphambilini wokuhluleka kwenhliziyo noma isifo sezinso

I-Cardiorenal Syndrome Ithuthukisa Kanjani?

I-Cardiorenal syndrome iqala ngomzamo wethu womzimba wokugcina ukujikeleza okwanele. Nakuba le mizamo ingase izuzise esikhathini esifushane, ngaphezu kwesikhathi eside, lezi zinguquko ziba yi-maladaptive futhi ziholele ekudleni komzimba.

I-cascade ejwayelekile eyenza i-cardiorenal syndrome ingaqala futhi iguquke ngezinyathelo ezilandelayo:

1. Ngezizathu eziningi (isifo senhliziyo esisodwa sinesizathu esivamile), isiguli singathuthukisa ukunciphisa ikhono lenhliziyo lokuphampa igazi elanele, into esiyibiza ngokuthi ukungenwa kwesifo senhliziyo noma i-CHF.
2. Ukunciphisa ekuphumeni kwenhliziyo (okubizwa nangokuthi "ukukhishwa kwenhliziyo") kuholela ekunciphiseni ukugcwaliswa kwegazi emithonjeni yegazi (imishanguzo). Thina odokotela bathi lokhu "kunciphise umthamo wegazi osebenzayo".
3. Njengoba isinyathelo sesibili sibuhlungu, umzimba wethu uzama ukukhokhela. Izinqubo esizithuthukile sonke njengengxenye yokuziphendukela kwemvelo ziqala. Into eyodwa yokuqala engena kwi-overdrive yisimiso sezinzwa, ngokuqondile into ebizwa ngokuthi "uhlelo lomzwelo oluzwelayo" (SNS). Lesi yingxenye yesistimu efanayo ehlotshaniswa nalokho okuthiwa indiza noma impendulo yokulwa. Umsebenzi owandayo wesimiso somzwelo ozwakalayo uzoba nomthelela emithanjeni emzamweni wokwehlisa umfutho wegazi nokugcina ukukhishwa kwamalungu.

1. I-kidneys chip ngokunyusa umsebenzi wezinto okuthiwa yi-"renin-angiotensin-aldosterone system" (RAAS). Umgomo walesi simiso futhi ukwandisa ukucindezela kanye negazi legazi ekujikelezeni kwegazi. Ukwenza kanjalo ngezinhlelo eziningi ezincane (kufaka phakathi ukusekela isimiso sezinzwa esizwe ngenhla), kanye nokugcinwa kwamanzi nosawoti ezinso.
2. I-pituitary gland yethu iqala ukukhipha i-ADH (noma i-hormone ephikisayo), iphinde iholele ekugcinweni kwamanzi kusuka ezinsweni.

I-physiology eningiliziwe yendlela ngayinye ecacile ayikho ngaphezu kwalesi sihloko. Kufanele ngigcizelele ukuthi izinyathelo ezingenhla aziqhubeki ngendlela ehambisanayo, kepha kunalokho kufane. Futhi ekugcineni, lokhu akulona uhlu olunzulu.

Umphumela wenetha lezinqubo ezingenhla zokukhokha ukuthi wukuthi usawoti namanzi amaningi aqala ukugcinwa emzimbeni, okwenza umthamo ophelele wegciwane lomzimba ukhuphuke. Lokhu, phakathi kwezinye izinto, kuzokwandisa usayizi wenhliziyo esikhathini esithile (ushintsho olubizwa ngokuthi "i-cardiargaly"). Empeleni, lapho imisipha yenhliziyo isuliwe, ukukhishwa kwenhliziyo kufanele kwandiswe. Lokhu kusebenza kuphela ngaphakathi kwebanga elithile. Ngaphandle kwalokhu, ukukhiqizwa kwenhliziyo ngeke kwande naphezu kokwandiswa / usayizi okhulayo okulandela inzuzo engapheli emthamo wegazi. Lesi simo siboniswa ngokukhululekile ezincwadini zezokwelapha njengento ethiwa yi " Frank-Starling curve ".

Ngakho-ke, isiguli ngokuvamile sishiywe ngenhliziyo ekhulisiwe, ukukhishwa kwenhliziyo okunciphise, kanye noketshezi oluningi emzimbeni (izici eziyinhloko ze-CHF). Ukweqa ngokweqile kwamanzi kuzoholela ezimpawu ezifaka ukuphefumula, ukuvuvukala noma i-edema, njll.

Ngakho konke lokhu kuyingozi kanjani izinso? Lezi zindlela ezingenhla zenza okulandelayo:

• Nciphisa ukunikezwa kwegazi lezinso, okuthiwa "vasoconstriction ye-renal".
• Uketshezi okwedlulele kokusakaza kwesiguli esithintekile kwandisa ingcindezi ngaphakathi kwezinso 'emithanjeni kanye.
• Ekugcineni, ingcindezi ngaphakathi kwesisu ingahle ikhuphuke, into ebizwa ngokuthi "intra-intra-intestinal hypertension".

Zonke lezi zinguquko ezingathintekiyo zihlangana ndawonye ukuze zinciphise izinso 'igazi (perfusion) okuholela ekusebenzeni kwezinso ezibi kakhulu. Le ncazelo ecacile izokunikeza ithemba lokuthi inhliziyo ehlulekayo idonsela phansi izinso nayo.

Lena enye yezindlela izindlela ze-cardiorenal syndrome ezingathuthuka. I-trigger yokuqala ingaba kalula izinso esikhundleni, lapho izinso ezingasebenzi (isifo esiqhubekayo sezinso eziphefumulayo), kubangela uketshezi oludlulayo ukwakhiwa emzimbeni (okungavamile kwiziguli ezinesifo sezinso). Le fluid ngokweqile ingaba ngaphezu kwenhliziyo futhi ibangele ukuthi ihluleke kancane kancane.

I-Cardiorenal Syndrome Ithola Kanjani?

Ukusola kliniki ngudokotela ohlakaniphile ngokuvamile kuyoholela ekutholeni ukuxilongwa. Noma kunjalo, ukuhlolwa okujwayelekile ukuhlola izinso nenhliziyo kuyasiza, nakuba kungenjalo ngempela. Lezi zivivinyo ziyi:

• Ngezinso: Ukuhlolwa kwegazi ku-creatinine / GFR nokuhlolwa komchamo ngegazi, amaprotheni, njll. Izinga le-sodium emcinini lingase libe usizo (kodwa lidingeke lihunyushwe ngokucophelela ezigulini ezithinta izidakamizwa). Ukuhlola ukuhlolwa okufana ne-ultrasound kuvame ukwenza kahle.
• Inhliziyo: Ukuhlolwa kwegazi kwe-troponin, i-BNP, njll Okunye uphenyo olunjenge-EKG, i-echocardiogram, njll.

Isiguli esivamile singaba nomlando wesifo senhliziyo nokubuhlungu kwamuva (CHF), kuhambisane nemibonakaliso engenhla yokusebenza kwezinso ezimbi.

Ukwelashwa kweCardiorenal Syndrome

Njengoba kushiwo ngenhla, ukuphathwa kwe-cardiorenal syndrome yindawo esebenzayo yokucwaninga ngezizathu ezicacile. Iziguli ezinezifo ze-cardiorenal syndrome zihlala zihlala esibhedlela njalo futhi zikhulayo kanye nokubeka ingozi enkulu yokufa. Ngakho-ke, ukwelashwa okuphumelelayo kubalulekile. Nazi ezinye izinketho:

1. Njengoba ukuqubuka kwe-cardiorenal syndrome kuvame ukuhlelwa yinhliziyo ehlulekayo eholela kumthamo owandayo wemithi ewuketshezi, yokwelashwa (eyenzelwe ukukhipha uketshezi okweqile emzimbeni) iyindlela yokuqala yokwelapha. Kungenzeka ukuthi uke wazizwa okuthiwa "amaphilisi amanzi" (ngokuqondile okuthiwa "i-loop diuretics", isibonelo esivamile yi-furosemide, noma i-Lasix). Uma isiguli sigula ngokwanele ukuthi sidinga ukulaliswa esibhedlela, kusetshenziselwa ukujova kwe-intravenous loop diuretics. Uma ama-bolus injection yale mithi engasebenzi, kungadingeka ukuqhuma okuqhubekayo.
2. Nokho, ukwelashwa akuyona into eqondile. Imishanguzo ye-loop diuretic ngezinye izikhathi ingenza umtholampilo ukuba "angenelele umgwaqo" ngokususwa ketshezi, futhi kubangele ukuthi izinga le-serum creatinine likhuphuke (eliguqulela ekusebenzeni kwezinso ezimbi kakhulu). Lokhu kungase kwenzeke kusukela ekudoneni kwezinso ezingenayo igazi. Ngakho-ke, ukulingana kwe-diuretic kudinga ukushaya ibhalansi elungile phakathi kokushiya isiguli "soma kakhulu" vs "simanzi kakhulu."
3. Okokugcina, khumbula ukuthi ukusebenza kwe-loop diuretic kuncike ezintsheni 'umsebenzi kanye nekhono layo lokuthola amanzi amaningi ngokweqile. Ngakho-ke, izinso zingase zibe isixhumanisi esibuthakathaka kulolu chungechunge. Okungukuthi, kungakhathaliseki ukuthi i-diuretic iqinile kangakanani, uma izinso zingasebenzi kahle, akukho ketshezi okungase kususwe emzimbeni naphezu kwemizamo enobudlova.
4. Kulesi simo esingenhla, ukwelapha okungahambi kahle ukuze uthole uketshezi olunjengama-aqua pheresis noma ngisho ne-dialysis kungadingeka. Lezi zindlela zokwelashwa ezingavamile ziphikisana futhi ubufakazi kuze kube manje ziye zaveza imiphumela ephikisanayo. Ngakho-ke, ayikho indlela yokuqala yokwelashwa kwalesi simo.
5. Kukhona eminye imithi ejwayele ukuhlolwa (nakuba futhi akuyona nje imithi yokwelapha yokuqala ejwayelekile) futhi lokhu kuhlanganisa okuthiwa ama-inotropes (okwandisa amandla okugubha kwenhliziyo), abavimba be-renin-angiotensin, kanye nemithi yokuhlola ukuphatha i-cardiorenal syndrome njenge tolvaptan.