Zvose Zvaunoda Kuziva NeCardiorenal Syndrome

Iri sangano rinogona kugogodza nhengo mbiri dzinokosha panguva imwe chete

Sezvinoratidzwa nezita racho, "cardio" (inotaura nezvemoyo), uye "renal" (inosangana neitsvo) iyo inonyanya kushandiswa mune zvepfungwa apo kunonoka mukati memwoyo kunotungamirira mukuderera kwebasa repimpumu (kana zvinopesana). Nokudaro, zita rechirwere rinonyatsoratidza kushamwaridzana kunokuvadza pakati pezvikamu zviviri zvinokosha.

Kuti uwedzere kujekesa; kushamwaridzana inzira mbiri.

Nokudaro, haisi iyo mwoyo iyo kuparara kwayo kunogona kukwevai itsvo pasi nayo. Zvechokwadi, chirwere chetsvo, zvose zviri zviviri (nguva pfupi, kamwe kamwe-kamwe) kana kusingaperi (chirwere chenguva refu, chinotonhora chinotanga kuitika) chinogona kukonzera matambudziko nemoyo wemabasa. Pakupedzisira, sangano rekuzvimiririra (sechirwere cheshuga) rinogona kukuvadza zvose mafungiro nemoyo, zvichiita kuti dambudziko rive nhengo dzese.

Cardiorenal syndrome inogona kutanga mumamiriro ezvinhu akaoma apo kukurumidza kuwedzera kwemoyo (somuenzaniso, kurwisa kwemwoyo kunotungamirira kukuvhiringidza kwemwoyo kusakundikana) kunokuvadza itsvo. Zvisinei, izvo zvingasava zvakadaro nguva dzose kubvira panguva refu-yakagara isingagumi mwoyo yekusagadzikana kwemoyo (CHF) inogonawo kutungamirira kunonoka asi kunowedzera kuwedzera kwepfungwa. Saizvozvowo, varwere vane chirwere chisingaperi chepfungwa (CKD) vari pangozi yakakura yepfungwa yepfungwa.

Kubva pakuita kuti kubatana uku kwakatangwa uye kukura, cardiorenal syndrome inogoverwa muzvikamu zvakasiyana-siyana, zvinyorwa zvisingasviki pane zvinyorwa izvi.

Zvisinei, ini ndichaedza kupa mhedziso yezvinhu zvisingabatsiri izvo munhu wepakati angave achida kuziva pamusoro pevarwere vanorwara necardiorenal syndrome.

Nei Uchifanira Kuziva Nezve Cardiorenal Syndrome: iyo Inofanirwa

Tiri kurarama munguva inogara iine huwandu hwehutano hwemwoyo. Vanopfuura 700 000 vokuAmerica vanoona kurwadziwa kwemoyo gore negore, uye vanopfuura 600 000 vanhu vanofa nehosha yemwoyo gore negore.

Chimwe chezvinetso zveizvi ndiko kukanganisa mwoyo kusakundikana. Kana kukanganisa kwechimwe nhengo kunomesa basa rechipiri, rinonyanya kukuvadza kurapwa kwemurwere. Semuenzaniso, kuwedzera kwe serumusiki creatinine level ne 0.5 mg / dL chete kunosanganiswa nekuwandisa kwe15% kunowedzera ngozi yekufa (mukugadzikana kwe cardiorenal syndrome).

Zvichigoverwa izvi, cardiorenal syndrome inzvimbo yekutsvakurudza kwakasimba. Haisi chikamu chisingazivikanwi nenzira ipi zvayo. Nezuva rechitatu rekurapwa, kusvika kusvika 60 muzana yevarwere (vanobvumirwa mukurapa kubvumira mwoyo kusakundikana) vanogona kuwedzera kukura kwepfungwa basa kune zvakasiyana-siyana, uye vanozoongororwa ne cardiorenal syndrome.

Ndezvipi Zviitiko Zvengozi?

Zviri pachena kuti havasi vose vanoita mwoyo kana zvirwere zvepfungwa vachabvisa chinetso nechimwe chikamu. Zvisinei, vamwe varwere vanogona kunge vari mungozi yakanyanya kupfuura vamwe. Varwere vane zvinotevera vanofungidzirwa kuti vane ngozi yakawanda:

• High blood pressure
• Chirwere cheshuga
• Vakuru vakwegura
• Nhoroondo yekare-yekare yakakanganisika yemwoyo kana chirwere chepfungwa

Ko Cardiorenal Syndrome Inobudirira Sei?

Cardiorenal syndrome inotanga nekuedza kwemuviri wedu kuchengetedza kukwira kwakakwana. Kunyange zvazvo kuedza uku kungave kunobatsira munguva shoma, pamusoro penguva refu, izvi zvinoshanduka zvikava maradaptive uye zvinotyisa kuwedzera kwechimiro chebasa.

Chimwe chinokonzera chinokonzera cardiorenal syndrome chinogona kutanga uye kuchinja maererano nematanho anotevera:

1. Nokuda kwezvikonzero zvakawanda (coronary heart disease ndiyo imwe inokonzera chikonzero), murwere anogona kukura kuderedzwa kwekwaniso yemwoyo yekuputira ropa yakakwana, imwe nhengo yatinoshevedza kushaya mwoyo kusakundikana kana CHF.
2. Kuderedza mumoyo wemitengo (inonziwo "chibereko chemoyo") kunotungamirira kuderedza kuzadzwa kweropa mune mishonga yeropa (arteri). Isu isu vanachiremba vanoti izvi "zvakaderera kubuda ropa rehutano".
3. Sezvo danho rechipiri rinotambudza, muviri wedu unoedza kubhadhara. Nzira dzese dzatakagadziriswa sechikamu chekushanduka-shanduka dzinopinda mune. Chimwe chekutanga chekutanga chinopinda muhuwandu hwehutachiona ndeche hurongwa hwekutya, kunyanya chimwe chinhu chinonzi "tsitsi rweshungu" (SNS). Ichi chikamu chemuitiro iwoyo unobatanidza neinoti inomhanya kana kurwisa mhinduro. Basa rakawedzerwa remunzwira tsitsi rwenheyo rinopedza mishonga mukuedza kuwedzera kukonzerwa kweropa nekuchengetedza sopusi yeganda.

1. Iyo itsvo dzichipinda nekuwedzera basa rechinhu chinonzi "renin-angiotensin-aldosterone system" (RAAS). Chinangwa chemugadziriro iyi ndechekuwedzera kuwedzera uye kuwedzerwa kweropa muhupenyu hwekupararira. Izvo zvinodaro nenzira dzakasiyana-siyana-maitiro (kusanganisira kutsigira zvakataurwa pamusoro apa zvinoshungurudza manzwiro ehurumende), pamwe chete nemvura uye munyu kuchengetedza muitsvo.
2. Nhengo yedu yepituitary inotanga kuputira kunze kweAdh (kana kuti hormone inorwisa-diuretic), zvakare inotungamirira mukuchengetedza mvura kubva kuitsvo.

Izvo zvine hutano hwehutano hwemhando imwe neimwe yakanyanyisa iri kunze kwepamusoro pechinyorwa ichi. Ndinofanira kusimbisa kuti matanho ari pamusoro apa haasi kufambira mberi nenzira yakasiyana, asi panzvimbo yakafanana. Uye pakupedzisira, iyi haisi urongwa hwakakwana.

Mucherechedzo wemugumisiro wemigwagwa iripo yepamusoro ndeyekuti kunyanya munyu nemvura zvinotanga kuchengetwa mumuviri, zvichiita kuti muviri wehutachiona hwemuviri hukwire. Izvi, pakati pezvimwe zvinhu, zvichawedzera kukura kwemoyo pane imwe nguva (shanduko inonzi "cardiomegaly"). Mukutaura, kana musikana wemwoyo wakatambanudzwa, chibereko chemoyo chinofanira kukura. Izvi zvinongoshanda chete mune imwe nzvimbo. Kupfuura izvozvo, mwoyo wekubuda hauzowedzere pasinei nekuwedzera kwekuwedzera / kukura iyo inotevera kuwedzera kusingaperi muropa rehuwandu. Ichi chiitiko chinoratidzwa zvakajeka mumabhuku ekurapa sechinhu chinonzi " Frank-Starling Curve ".

Nokudaro, murwere anowanzosiyiwa nemoyo wakawedzerwa, kuora mwoyo kwechibereko, uye kunyanyisa kwemuviri mumuviri (makadhiiniti ane zvikamu zveCF). Kusvibiswa kwemhepo kunotungamirira kune zviratidzo zvinosanganisira kupfupika kwemhepo, kuzvimba kana edema, nezvimwewo.

Saka izvi zvose zvinokuvadza sei kuitsvo? Zvakanaka, nzira dzakasarudzwa dzinoitawo zvinotevera:

• Deredza kuderedza ropa reinso, chinonzi "renal vasoconstriction".
• Kuwedzerwa kwemvura kunotapurirwa mumurwere ane hanya kunowedzera kuoma mukati meitsvo 'mitsetse pamwe chete.
• Pakupedzisira, kushungurudzika mukati mamuviri kunogona kukwira, chimwe chinhu chinonzi "intra-mimba hypertension".

Zvose izvi zvinosvibisa maradaptive zvinoungana kuti zvidimbure kuderedza itsvo 'ropa (perfusion) rinotungamirira kuhutachiona hwehupi hunoita. Ichi tsanangudzo yezvinyorwa zvichange zvichitarisira kukupa pfungwa yekuti mwoyo wakakundikana unokwevera pasii netsvo nawo.

Iyi inongova imwe yenzira dzinoitwa cardiorenal syndrome inogona kukura. Nzira yekutanga inogona nyore kuva iyo itsvo panzvimbo pacho, uko kusagadzikana kwetsvo (chirwere chakapora chirwere chepfungwa, somuenzaniso) chinokonzera kuwedzera kwemvura kunowedzera mumuviri (kwete isingaoneki kune varwere vane chirwere chepfungwa). Izvi zvinodhaka zvakanyanya zvinogona kuwandisa mwoyo uye zvichiita kuti zvisike zvishoma nezvishoma.

Ko Cardiorenal Syndrome Inowanikwa Sei?

Kurasikirwa kwekliniki nechiremba ane njere kakawanda kunotungamirira kukunyatsoongorora. Zvisinei, zviyero zviyero kutarisa itsvo nemoyo zvinoshanda zvichave zvinobatsira, kunyange zvisingaiti zvachose. Aya maedzo ndeokuti:

• Nokuda kwetsvo: Ruzivo rweRopa ye creatinine / GFR uye kuongororwa kwemuviri nokuda kweropa, mapuroteni, nezvimwe. Nhamba ye sodium mumuginho inogona kubatsira (asi inoda kududzirwa zvakanyatso ku varwere vane diuretics). Kufananidza miedzo yakafanana neye ultrasound inowanzoitwawo saizvozvo.
• Nokuda kwemwoyo: Ropa kuongorora kwe troponin, BNP, nezvimwewo Mamwe mapurisa akaita EKG, echocardiogram, nezvimwewo.

Izvo zvinoratidzira murwere zvinogona kuva nehutano hwechirwere chepfungwa nekukurumidza kuwedzera (CHF), pamwe chete nezviratidzo zvepamusoro zvekuwedzera kwepfungwa basa.

Kurapa kweCardiorenal Syndrome

Sezvambotaurwa, kutarisira kwe cardiorenal syndrome inzvimbo inoshanda yekutsvakurudza kwezvikonzero zvakajeka. Varwere vane cardiorenal syndrome vanoziva nguva nenguva vachipatara uye kuwedzera kukuvara uyewo pangozi yekufa. Saka, kurapa kwakakosha kunokosha. Heano mamwe maitiro:

1. Sezvo kuputika kwe cardiorenal syndrome kunowanzogadzirwa nemoyo usina kukonzera kuendesa kuwandisa kwehuwandu hwemvura inoshandiswa, inonzi diuretic (yakagadzirirwa kubvisa kuwedzera kwechirwere kubva mumuviri) ndiyo mutsara wokurapa. Iwe ungangodaro wakanzwa nezvezvinonzi "mapiritsi emvura" (anonyanya kunzi "loop diuretics", muenzaniso wakafanana furosemide, kana Lasix). Kana murwere ari kurwara zvakakwana kuti awane hospitalist, zvirwere zve intravenous loop diuretics zvinoshandiswa. Kana bhojisi zvirongwa zvemishonga iyi isingashandisi, kuenderera mberi kunogona kudiwa.
2. Zvisinei, kurapwa hakusi izvo zvakananga. Iro mishonga chaiyo ye loop diuretic dzimwe nguva inoita kuti chiremba "awedzere marwagwa" nemvura yakasunungurwa, uye anoita kuti serum creatinine yero inokwira (iyo inoshandura kuva yakanyanya kushaya mafungiro). Izvi zvinogona kuitika kubva pakudonha kwetsvo muropa ropa. Nokudaro, diuretic dosing inofanirwa kuedza kuenzanisa kwakanaka pakati pokusiya murwere "zvakare wakaoma" vs "yakaomawo."
3. Pakupedzisira, rangarira kuti kushanda kweiloop diuretic kunobva maitsvo 'basa uye kukwanisa kwayo kuwedzera kubuda kwemvura. Nokudaro, itsvo inogona kazhinji kuva chibatanidza chisina simba mumaketani. Izvozvi, pasinei nokuti yakasimba sei diuretic, kana itsvo dzisingashande zvakakwana, hapana hutachiona hunogona kubviswa mumuviri pasinei nekuedza kwechisimba.
4. Mumamiriro ezvinhu ari pamusoro apa, zvirwere zvisingaiti kuti uwane mvura yakadai se aqua pheresis kana kunyange dialysis inogona kudiwa. Izvi zvisingakanganisi kurapwa zvinokakavara uye uchapupu kusvika ikozvino zvakaguma migumisiro inopesana. Nokudaro, pasina nzira iyo ndiyo inotanga kurapa kwechiitiko ichi.
5. Kune mimwe mishonga inowanzoedzwa (kunyange zvakare isiri iyo inowanikwa mumutambo wokutanga mushonga) uye izvi zvinosanganisira izvo zvinonzi inotropes (izvo zvinowedzera simba remhepo rinopisa), renin-angiotensin blockers, pamwe chete nemishonga yekuedza kurapa cardiorenal syndrome se tolvaptan.