Yuav tswj ntshav siab li cas hauv cov neeg mob Dialysis

Ntshav siab yog ib qho teeb meem ntawm kev saib xyuas hemodialysis (MHD) cov neeg mob, thiab nws tseem yog qhov tseem ceeb ua rau kev tuag thiab lwm yam mob plawv thiab cerebrovascular teeb meem hauv cov neeg mob lim ntshav. Cov ntaub ntawv los ntawm Tuam Tshoj thiab Tebchaws Meskas qhia tias 91 feem pua ​​-98.2 feem pua ​​​​ntawm cov neeg mob MHD muaj ntshav siab. Lub xub ntiag ntawm kub siab tsis tau tsuas yog aggravate qhov kev loj hlob ntawmmob ntevraumkab mobtab sis kuj nce qhov xwm txheej thiab kev tuag ntawm cov kab mob plawv. Yog li ntawd, kev tswj ntshav siab yog ib qho kev ntsuas tseem ceeb los txhim kho cov kev mob tshwm sim ntawm cov neeg mob hemodialysis thiab tiv thaiv cov teeb meem ntsig txog ntshav siab.

Nyem rau cov txiaj ntsig ntawm cistanche rau kev lim ntshav

Hauv chav tshaj tawm hauv xov xwm ntawm "Cov Hluas Hais Lus", Xib Fwb Li Junhua los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Nephrology, Tongji Tsev Kho Mob Affiliated rau Tongji Medical College ntawm Huazhong University of Science thiab Technology tau qhia rau peb txog cov teeb meem, teeb meem, thiab kev daws teeb meem los ntawm cov neeg mob lim ntshav hauv cov ntshav. tswj siab. Kuj tseem koom nrog kev sib tham yog xibfwb Yao Ying los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob Nephrology, Tsev Kho Mob Tongji, Tongji Medical College, Huazhong University of Science thiab Technology, thiab xibfwb Li Zi, los ntawm Lub Tsev Haujlwm Saib Xyuas Kev Kho Mob, Tsev Kho Mob West China, Sichuan University.

Feem ntau ntawm cov ntshav siab hauv cov neeg mob hemodialysis

Cov ntaub ntawv los ntawm Tuam Tshoj hauv xyoo 2009 tau pom tias qhov muaj feem ntau ntawm cov ntshav siab ntawm cov neeg mob hemodialysis hauv kuv lub tebchaws yog 91 feem pua. Yog li, dab tsi yog qhov ntsuas ntshav siab rau cov neeg mob hemodialysis? Hmoov tsis zoo, raws li xyoo 2014, qhov kev faib ua feem no tseem tsawg dua 45 feem pua. Qhov ntawd yog hais tias: yuav luag txhua tus neeg mob hemodialysis raug kev txom nyem los ntawm cov ntshav siab, thiab tsawg dua ib nrab ntawm lawv tuaj yeem ua tiav kev tswj ntshav siab.

Cov ntshav siab siab ntau dua li qhov kev hloov pauv yooj yim. Raws li qhov tseem ceeb ntawm kev pheej hmoo rau cov kab mob plawv, kev tswj tsis zoo ntawm cov ntshav siab hauv cov neeg mob hemodialysis ua rau muaj kev pheej hmoo ntawm kev tuag. Raws li ib tug multicenter, yav tom ntej, randomized, factorial tsim soj ntsuam kev sim uas kav ntev li 4 xyoo thiab cuv npe kawm 1453 hemodialysis cov neeg mob, cov xwm txheej plawv suav rau 53 feem pua ​​​​ntawm tag nrho cov neeg tuag nyob rau hauv cov neeg mob dialysis. Yog li ntawd, kev tiv thaiv theem nrab ntawm kev kub siab hauv cov neeg mob lim ntshav tuaj yeem txhim kho txoj sia nyob ntawm cov neeg mob.

Ntau qhov kev sim tshuaj ntsuam xyuas tau tshawb fawb txog kev sib raug zoo ntawm kev tuag thiab ntshav siab hauv cov neeg mob ntshav siab ntawm kev lim ntshav. Qhov kev pheej hmoo ntawm kev tuag tau nce ntxiv hauv cov neeg mob ntshav siab ntawm kev lim ntshav. Ntxiv nrog rau qhov circadian atherosclerosis hauv cov neeg mob lim ntshav, lawv cov ntshav siab kuj hloov pauv vim kev lim ntshav.

Yuav ua li cas txiav txim siab txog ntshav siab tswj cov hom phiaj hauv cov neeg mob dialysis?

Cov neeg mob hemodialysis yog qhov tshwj xeeb, yog li nws feem ntau lees paub hauv zej zog kev kawm tias cov ntshav siab cuam tshuam rau qhov tshwm sim ntawm cov kab mob plawv thiab cerebrovascular, kev ua neej zoo, thiab kev tuag ntawm cov neeg mob, vim yog cov yam ntxwv ntawm hom hemodialysis, ib puag ncig sab hauv. ntawm cov neeg mob nthuav qhia lub xeev ntawm kev hloov pauv raws sijhawm. Lub teb chaws cov lus qhia tseem tsis tau muaj kev pom zoo rau txoj kev ntsuas ntshav siab, ntsuas lub sijhawm ntsuas ntshav siab, thiab cov qib tswj ntshav siab tshwj xeeb: K / DOQI cov lus qhia 2005 pom zoo kom ntshav siab ua ntej lim ntshav.<140 0mmhg,="" blood="" pressure="" after="" dialysis=""><130 0mmhg="" (type="" c="" evidence),="" and="" it="" is="" clearly="" pointed="" out="" that="" some="" of="" the="" data="" are="" from="" non-hemodialysis="" patients,="" and="" the="" target="" value="" is="" set="" with="" reference="" to="" the="" blood="" pressure="" of="" the="" general="" population.="" the="" conclusions="" are="" mostly="" from="" observational="" trials,="" and="" there="" are="" few="" randomized="" controlled="">

Hauv kev teb rau cov teeb meem pos no, "Tuam Tshoj Hemodialysis Adequacy Clinical Practice Guidelines" tau taw qhia tias yuav tsum tau them nyiaj tshwj xeeb rau cov ntshav siab ua ntej lim ntshav. Rau qee qhov, cov ntshav siab ua ntej lim ntshav tuaj yeem cuam tshuam txog qhov ntim ntawm cov hlab ntsha, qhov hnyav ntawm lub cev qhuav dej, thiab RAAS kev ua haujlwm ntawm tus neeg mob, thiab nws tseem tuaj yeem cuam tshuam seb qhov kev kho mob lim ntshav tau "tso rov qab" tus neeg mob mus rau lub xeev ze rau. qhov hnyav qhuav.

Qee cov neeg mob ntshav siab ua ntej lim ntshav, thiab kev tswj ntshav siab ua ntej kev lim ntshav kuj yog qhov tseem ceeb hauv kev tiv thaiv kab mob plawv thiab cerebrovascular. Yog li ntawd, raws li cov ntaub ntawv uas twb muaj lawm thiab qhov xwm txheej tiag tiag hauv kuv lub tebchaws, Suav cov lus qhia pom zoo tias ntshav siab ua ntej kev lim ntshav yuav tsum tau tswj hwm ntawm SBP <160 mmhg="" (nrog="" rau="" kev="" kho="">

Kev tswj tus kheej los ntawm kev pom ntawm kev lim ntshav mechanism

Txhawm rau tswj cov ntshav siab hauv cov neeg mob hemodialysis kom zoo, nws yuav tsum nkag siab txog lub luag haujlwm tseem ceeb uas lub raum ua si hauv kev tswj ntshav siab. Kev tswj lub raum ib txwm muaj peev xwm yog qhov qub, thiab qhov pheej hmoo ntawm kev kub siab tuaj yeem zam dhau los ntawm kev tswj hwm neurohumoral. Txawm li cas los xij, vim qhov poob ntawm lub raum tsis ua haujlwm hauv cov neeg mob hemodialysis, lub raum tsis tuaj yeem tshem tawm cov dej ntau dhau thiab sodium hauv lub cev, ua rau muaj kab mob raum, ua kom lub zog ntawm renin-angiotensin-aldosterone system (RAAS), thiab txhim kho cov paj hlwb. excitation, thiab kub siab yog yam tsis muaj kev zam.

Yog li, ntim ntau dhau, dej thiab sodium khaws cia, RAAS, thiab kev sib koom siab paj hlwb yog cov txheej txheem tseem ceeb ntawm hemodialysis ntshav siab. Thiab ntau qhov kev tshawb fawb tau lees paub tias muaj kev sib raug zoo ntawm kev ua siab zoo thiab kub siab hauv cov neeg mob lim ntshav: lub raum puas yog qhov tseem ceeb ntawm kev ua rau lub paj hlwb muaj zog, thiab kev ua siab zoo tuaj yeem ua rau txhua tus neeg mob dialysis. Kev pheej hmoo ntawm kev tuag thiab mob plawv.

Hauv kev kho mob tshwj xeeb, cov lus qhia rau lub raum kub siab suav nrog kev tswj lub ntim raws li qhov txuas tseem ceeb tshaj plaws hauv kev kho mob ntshav siab hauv cov neeg mob dialysis. Nws yuav tsum nruj me ntsis tswj kev noj cov sodium thiab dej kom ua tiav kev tswj ntshav siab, thiab ua kom lub sijhawm lim ntshav rau cov neeg uas tsis tuaj yeem ua tiav cov ntshav siab los ntawm kev tswj hwm kev noj cov sodium thiab dej.

Tsis tas li ntawd, rau cov neeg mob uas muaj zog RAAS / kev ua siab ntev, cov tshuaj uas tuaj yeem txo qis RAAS thiab cov paj hlwb kev xav, xws li RAASi (ACEI lossis ARB), yuav tsum tau tsom; rau cov neeg mob uas muaj ntshav siab thaum lub sij hawm lim ntshav, lim ntshav yuav tsum tsis txhob xaiv cov tshuaj Antihypertensive uas yooj yim tshem tawm yuav tsum tau xaiv rau cov tshuaj uas nyuaj rau tshem tawm los ntawm dialyzes, xws li ARB thiab CCB.

Raws li cov lus xaus ntawm cov kev tshawb fawb luam tawm, ntawm kev ua lag luam ib ntsiav tshuaj ua ke ua ke (SPC), olmesartan medoxomil / amlodipine FDC muaj ob qho zoo ntawm kev tsis yooj yim tshem tawm los ntawm kev lim ntshav thiab muaj zog tiv thaiv kev mob ntshav siab. Nws cov nyhuv antihypertensive zoo dua li qhov nruab nrab: qhov txo qis ntawm SBP thiab DBP yog qhov siab dua li qhov nruab nrab, thiab nws tsuas yog SPC uas ua rau txo qis ntawm DBP ntau tshaj 15mmHg. Tsis tas li ntawd, raws li kev tshawb fawb thoob ntiaj teb hauv Suav teb, 8-lub limtiam ntshav siab ua raws tus nqi rau cov neeg mob uas muaj ntshav siab refractory (nrog ntau dua lossis sib npaug rau 3 qhov kev pom zoo ntawm cov tshuaj tiv thaiv ntshav siab tseem qis dua) yog siab li 62.5. feem pua.

Dab tsi yog qhov phom sij ntawm kev kub siab hauv cov neeg mob lim ntshav thiab yuav tswj ntshav siab li cas?

Raws li tau hais los saum toj no, kev mob ntshav siab hauv cov neeg mob ntshav lim ntshav tau cuam tshuam ncaj qha rau hauv qhov kev pheej hmoo siab ntawm cov hlab plawv, thiab tsis zoo li lwm cov neeg mob ntshav siab, qhov kev pheej hmoo ntawm cov kab mob plawv hauv cov neeg mob no tseem tsis tau muaj cov txheej txheem kuaj mob ntshav siab, thiab qhov pib tshwm sim. ntawm nce. Thiab thaum cov xwm txheej ntawm cov hlab plawv tshwm sim, lub neej zoo ntawm cov neeg mob no yuav poob qis dua, yog li nws tseem ceeb heev uas yuav tsum tau tswj cov ntshav siab hauv cov neeg mob no. Lub pathogenesis ntawm kev lim ntshav cov neeg mob ntshav siab yog qhov nyuaj dua thiab qhov kev pheej hmoo ntawm cov kab mob plawv yog siab dua li ntawm cov pej xeem, uas yuav tsum tau muaj kev cuam tshuam los ntawm ib tus neeg sib txawv ntawm cov neeg mob lim ntshav sib txawv. Yog li ntawd, qhia meej txog qhov ua rau muaj ntshav siab hauv cov neeg mob yog qhov kev cuam tshuam.

Lub luag haujlwm ntawm SPC yog dab tsi hauv kev tswj cov ntshav siab hauv cov neeg mob lim ntshav?

Qhov txiaj ntsig loj tshaj ntawm SPC yog txhawm rau ua kom cov neeg mob ua raws. Yog li ntawd, rau cov neeg mob refractory hypertension, simplifying txoj kev ntawm kev noj tshuaj yam tsis tau hloov cov tshuaj compatibility tswv yim yuav muaj kev cuam tshuam zoo dua rau kev tswj ntshav siab, thiab tib yam muaj tseeb rau cov neeg mob dialysis. CCB feem ntau siv nyob rau hauv Suav cov pej xeem thiab cov tshuaj muaj txiaj ntsig zoo heev, uas yog pom tseeb rau txhua tus hauv kev kho mob ua haujlwm; Ntxiv rau, cov tshuaj ARB tuaj yeem cuam tshuam RAAS zoo, tiv thaiv lub plawv thiab lub raum ua haujlwm, thiab muaj qhov txo qis los ntawm kev lim ntshav, uas yog qhov tshwj xeeb tshaj yog tsim nyog rau kev ntxiv ntim. Lwm hom kev lim ntshav uas tsis yog hom nce ntxiv yog siv rau cov neeg mob ntshav siab. SPC ntawm ob qho tib si tsis tsuas yog ua tiav cov kev sib koom ua ke ntawm cov ntshav siab ntawm ob lub tswv yim, tab sis qhov sib ntxiv ntawm ARB tuaj yeem txo cov peripheral edema los ntawm CCB kom tus neeg mob cov tshuaj txaus siab dua.

Cov neeg mob dialysis tuaj yeem noj cistanche

Cistanche yog ib qho ntawm cuaj Suav tshuaj ntsuab. Nws yog nto moo li ginseng, Ganoderma lucidum, thiab Cordyceps Sinensis. Cov nyhuv tshuaj ntawm Cistanche tau teev tseg raws li qib siab hauv "Shen Nong's Classic of Materia Medica", yog li nws tau siv los ua cov khoom siv tshuaj suav tshuaj hauv Suav teb rau ntau tshaj 2,000 xyoo. Cov kev tshawb fawb pharmacological niaj hnub no tau pom tias Cistanche nplua nuj nyob hauvphenylethanoidglycosidesnrog verbascoside thiab echinacoside raws li lub cim tseem ceeb, uas tuaj yeem ua rau muaj kev loj hlob ntawm tib neeg lub raum hlwb los ntawm 8-10 zaug. Cistanche tuaj yeem tiv thaiv lub raum tubular hlwb, tiv thaiv cov kab mob hauv lub raum interstitial, qeeb tus nqi ntawm nephritis, thiab tseem tuaj yeem tiv thaiv kab mob thib ob hauv cov neeg mob.mob ntevraumua tsis tiavthiabpolycysticraumkab mob. Noj Cistanche hauvlim ntshavcov neeg mob tuaj yeem pab txhim kho cov nyhuv curative thiab rov qab losraummuaj nuj nqi

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