Kulephera kwa aimpso mwa agalu

Zizindikiro za matendawa

Ntchito za impso m'thupi ndizosiyanasiyana - sizimangokhala gawo lotulutsa, komanso kutenga nawo gawo mu metabolism ya mapuloteni, chakudya ndi lipids, kuwongolera acid-base balance, osmotic pressure, madzi bwino, kuthamanga kwa magazi, ndi zina zambiri. Choncho, ndi chitukuko cha matenda mu Thupi kusokonezedwa ndi chiwerengero chachikulu cha njira, ndi zizindikiro za matenda a impso agalu akhoza kukhala zosiyanasiyana. Mwachitsanzo, izi zikhoza kukhala zizindikiro za matenda a m'mimba, matenda a shuga, urolithiasis, matenda a chingamu, nthawi zina, mukhoza kukayikira kukhalapo kwa thupi lachilendo m'mimba kapena m'matumbo.

Zizindikiro zazikulu za kulephera kwa impso mwa agalu ndi izi:

• kukana kudya kapena kusowa chilakolako;

• kusanza;

• ulesi, kukhumudwa;

• fungo losasangalatsa la mkamwa;

• ludzu lowonjezeka;

• pafupipafupi pokodza;

• kuonda.

Monga tikuonera, zizindikiro za matenda ndi khalidwe la osiyanasiyana pathologies, choncho matenda ayenera kutsimikiziridwa ndi mayesero. Mu chipatala, muyenera kuchita zotsatirazi:

• kuyesa magazi wamba ndi biochemical;

• kuyesa mkodzo wamba;

• kuchita ultrasound pamimba patsekeke;

• kuyeza kuthamanga kwa magazi (tonometry);

• kusaganizira matenda ena ndi zizindikiro zofanana, ndi zofunika kuchita X-ray ya m`mimba patsekeke.

Kutengera zotsatira za kafukufukuyu, zizindikiro zotsatirazi za kulephera kwa impso mwa agalu zitha kudziwika:

• kuwonjezeka kwa urea, creatinine, phosphorous mu biochemistry;

• kuchepa kwa magazi m'thupi molingana ndi kuyezetsa magazi;

• proteinuria, hematuria, kuchepa kwa mkodzo;

• kuwonjezeka kwa kuthamanga kwa magazi pa tonometry.

Chifukwa cha kuchuluka kwa impso, pafupifupi 60-70% ya minofu ya impso iyenera kufa kuti zizindikiro za matendawa ziwoneke, ndipo mpaka pamenepo galu sangakhale ndi zizindikiro za kukhalapo kwa matendawa. Kumayambiriro kwa matenda a impso, kuchuluka kwa nephrons akufa kumatha kufika 75%! Kusauka kwa matendawa kumagwirizanitsidwa ndi mbali iyi - panthawi yomwe chiweto chimakhala ndi zizindikiro za matendawa ndipo n'zotheka kupanga matenda, monga lamulo, palibe chomwe chingathandize. Chinthu chinanso pa zotsatira zoipa ndi chakuti nthawi zambiri eni ake sadziwa n'komwe kuti galu ali ndi vuto la impso, lembani zizindikiro zonse za ukalamba ndipo musapite ku chipatala chowona.

Acute aimpso kulephera (ARF)

Kulephera kwaimpso kwa agalu ndi matenda omwe amayamba chifukwa cha kuwonongeka kwa impso ndipo amatsagana ndi azotemia (mwachitsanzo, kuchuluka kwa urea ndi creatinine pakuyezetsa magazi), kusokonezeka kwamadzi ndi electrolyte bwino komanso acid-base balance.

Zifukwa zopangira OPN zikuphatikiza:

• kuphwanya kayendedwe ka magazi chifukwa cha mantha, kutaya magazi, matenda a mtima, aimpso thrombosis ndi zina zazikulu;

• kugwiritsa ntchito mankhwala a nephrotoxic, monga maantibayotiki ena, mankhwala osagwiritsa ntchito steroidal odana ndi kutupa, immunosuppressive ndi chemotherapy mankhwala, kapena poizoni ndi nephrotoxic zinthu, monga ethylene glycol;

• kukhalapo kwa matenda oopsa a systemic, matenda a autoimmune, matenda opatsirana (mwachitsanzo, leptospirosis), etc.

Kuzindikira kumakhala kovuta kutengera:

1. Mbiri yodziwika bwino (kumwa mankhwala kapena zinthu zina za nephrotoxic, opaleshoni, zovulala, etc.);

2. Zizindikiro zapadera (kukana kudya mwadzidzidzi, mphwayi, kusanza, kutsekula m'mimba, mpweya woipa, kugwedezeka, kusagwirizana m'malo ndi kuchepa kwa mapangidwe a mkodzo mpaka kukodza kwathunthu);

3. Ndi ma laboratory diagnostics:

   • kuyezetsa magazi kumatha kudziwa kuchuluka kwa hematocrit, kuchuluka kwa leukocyte ndi lymphopenia;

   • malinga ndi biochemistry yamagazi, kuwonjezeka kwapang'onopang'ono kwa urea, creatinine, phosphorous, potaziyamu ndi shuga kumadziwika;

   • urinalysis imatsimikizira kuchepa kwa kuchuluka kwa mkodzo, proteinuria, glucosuria;

   • zotsatira za X-ray ndi ultrasound mu pachimake chitukuko cha ndondomeko, monga ulamuliro, sasintha. 

Kodi galu watsala ndi nthawi yayitali bwanji kuti akhale ndi moyo ngati impso zake zalephera kudalira kuchuluka kwa kuwonongeka kwawo, kuthamanga kwa chipatala komanso kulondola kwamankhwala omwe amaperekedwa.

Chronic renal failure (CRF) mwa agalu

Kulephera kwaimpso kwanthawi yayitali ndi matenda amthupi omwe amadziwika ndi kuwonongeka kosasinthika kwa impso, kuphwanya kutulutsa kwa nitrogen metabolism m'thupi komanso kusokonezeka kwamitundu yambiri ya homeostasis (ndiko kuti, kusasunthika kwa chilengedwe chamkati). thupi).

Matendawa akhoza kuonedwa ngati gawo lomaliza la kupitirira kwa mitundu yosiyanasiyana ya matenda a impso: kobadwa nako malformations, glomerulonephritis, amyloidosis, pyelonephritis, nephrolithiasis, polycystic matenda ndi ena ambiri. Zambiri mwazizindikirozi zitha kupangidwa kokha ndi biopsy (kutenga chidutswa cha chiwalo cha histology), motero, nthawi zambiri, amalankhula za nephropathy yosatha ngati chomaliza.

Monga tafotokozera pamwambapa, kuwonongeka kwa 75% ya minofu ya impso kumabweretsa kusokonezeka kwa impso: ntchito ya ndende imachepa (zomwe zimabweretsa kuchepa kwa mkodzo), pali kuchedwa kwa kutulutsa kwa nayitrogeni. kagayidwe mankhwala (ichi ndi gawo lomaliza la mapuloteni kagayidwe mu thupi), ndipo mochedwa CRF mu agalu akufotokozera uremia - poyizoni wa thupi ndi kuvunda mankhwala. Komanso, impso zimapanga hormone erythropoietin, yomwe imayambitsa kaphatikizidwe ka maselo ofiira a magazi - choncho, impso zikalephera, kaphatikizidwe ka hormone imachepa ndipo kuchepa kwa magazi m'thupi kumayamba pang'onopang'ono.

Monga momwe zimakhalira pachimake matenda, matenda a aimpso kulephera kumachitika pamaziko a anamnesis ndi zotsatira zowunikira: hypoplastic anemia, kuchuluka kwa creatinine ndi urea wa nayitrogeni wamagazi, hyperphosphatemia, acidosis, hyperkalemia amapezeka. Kuchepetsa kuchuluka kwa mkodzo (mwa agalu ochepera 1,025 hl), proteinuria yocheperako imathekanso (mapuloteni mumkodzo amawonjezeka).

Pa radiograph ngati aimpso kulephera kwa agalu, mawonekedwe osagwirizana a impso ndi kuchepa kwa kukula kwawo amatha kuzindikirika, malinga ndi ultrasound - mawonekedwe a heterogeneous, sclerosis ya parenchyma, kutayika kwathunthu kwa zigawo (kusokonezeka kwa cortico-medullary ), kuchepa kwa kukula kwa chiwalo.

Kutengera kufunikira kwa kuchuluka kwa creatinine mu seramu yamagazi, magawo 4 a CRF mwa agalu amasiyanitsidwa:

1. siteji ya nonazotemic - izi zingaphatikizepo kuphwanya kulikonse kwa impso popanda chifukwa chodziwika bwino chokhudzana ndi kukhalapo kwa nephropathy. Kusintha koyambirira kwa impso ndi ultrasound kumatha kuzindikirika, mu mkodzo - kuchuluka kwa mapuloteni komanso kuchepa kwa kachulukidwe. Malinga ndi biochemistry yamagazi, kuwonjezeka kosalekeza kwa creatinine kumazindikirika (koma mkati mwanthawi zonse).

2. Wofatsa aimpso azotemia - Miyezo ya serum creatinine ndi 125-180 μmol. Pansi pamtengo wa creatinine XNUMXbtha kukhala wosiyana ndi wanthawi zonse, koma pakadali pano, zosokoneza zilizonse pakugwira ntchito kwa mkodzo zimawonedwa kale ndi ziweto. Zizindikiro za kulephera kwa impso mwa agalu zingakhale zofatsa kapena kulibe.

3. Moderate aimpso azotemia - Miyezo ya serum creatinine ndi 181-440 μmol. Panthawi imeneyi, monga lamulo, zizindikiro zosiyanasiyana za matendawa zilipo kale.

4. kwambiri aimpso azotemia - creatinine imaposa 441 μmol. Panthawi imeneyi, mawonetseredwe aakulu a matendawa ndi zizindikiro zodziwika za kuledzera zimawonedwa.

Chithandizo cha impso kulephera kwa agalu

Ndiye ngati galu ali ndi vuto la impso, kodi angachiritsidwe? Njira zothandizira komanso mwayi wothetsa kulephera kwa impso mwa agalu zimasiyana kwambiri malinga ndi mtundu wake.

Chithandizo cha pachimake aimpso kulephera ikuchitika yekha m'chipatala moyang'aniridwa ndi dokotala. Thandizo lapadera (pathogenetic) limayikidwa, lomwe cholinga chake ndi kuthetsa chomwe chimayambitsa matendawa. Symptomatic mtsempha mankhwala nthawi zonse ikuchitika kuti normalize madzi-electrolyte bwino ndi asidi-m'munsi bwino, ndi kuchotsa poizoni. Kuyeza magazi, chikhalidwe cha wodwalayo, kuchuluka kwa mkodzo wolekanitsidwa kumayang'aniridwa tsiku ndi tsiku - chifukwa cha izi, catheterization ya chikhodzodzo ndi kuika mkodzo ndizovomerezeka.

Pokhalabe ndi chilakolako chofuna kudya, zakudya zapadera zimaperekedwa chifukwa cha kulephera kwa impso mwa agalu, ndi kusanza ndi kusowa kwa njala - zakudya zazikulu ziyenera kuperekedwa kudzera m'mitsempha kapena kudzera m'machubu apadera (probe ya nasophageal, etc.).

Ngati kuledzera kwambiri, kusapezeka kapena kutha kutha kwa mkodzo komanso kusagwira ntchito kwamankhwala osamalitsa m'masiku 1-3 ogonekedwa m'chipatala, dialysis ikulimbikitsidwa (iyi ndi njira yochotsa zinyalala ndi madzi ochulukirapo kuchokera m'thupi. thupi).

Ndi chitukuko cha kulephera kwaimpso kwa etiology iliyonse, mwiniwake wa ziweto ayenera kumvetsetsa kuti matenda a matendawa ndi osamala mpaka osakhala bwino, zovuta zosiyanasiyana zimatheka panthawi ya chithandizo. Muyeneranso kukonzekera kuchipatala chamtengo wapatali cha nthawi yayitali - poyesera kuchiza chiweto chovuta kwambiri kunyumba, mukhoza kutaya nthawi, ndiyeno mwayi wochira umachepetsedwa kwambiri. Koma ndi chithandizo choyenera komanso cha panthawi yake, galu ali ndi mwayi uliwonse wochira ndi kuchira.

Chithandizo cha matenda aimpso kulephera agalu akhoza kukhala symptomatic. Pankhaniyi, ndikofunikira kuzindikira kuti CRF ndi matenda opitilira, osasinthika omwe amatha kufa: ngati chiweto chidapatsidwa gawo la 4 (terminal), ndiye kuti sangakhale ndi moyo wopitilira mwezi umodzi.

Ngakhale kukhalabe ndi chilakolako cha chiweto chokhala ndi CRF, chinthu chachikulu ndikutsata zakudya zapadera (mfundo zomwe tidzakambirana pansipa) ndikuwunika kuyezetsa magazi pakapita nthawi.

Pamaso pa kusanza ndi kukana kudya, mankhwala a antiemetic (monga maropitant, metoclopramide), komanso gastroprotective mankhwala (sucralfate) ndi H2 receptor antagonists (ranitidine) amagwiritsidwa ntchito.

Ndi kuchuluka kwa phosphorous m'magazi a biochemistry, mankhwala omwe amamanga phosphorous m'matumbo, otchedwa phosphate binders (mwachitsanzo, ipakitine), amalembedwa.

Ndi kulimbikira kukana kudya, kusanza kosalekeza, ndi zizindikiro zina za kuledzera kwa uremic, chithandizo chamankhwala ndi mtsempha wamagazi ndi kuyang'anira kuyezetsa magazi ndikofunikira kuti chiweto chikhazikike.

Komanso, ndikukula kwa CRF mu ziweto, kuwonjezeka kwa kuthamanga kwa magazi kumawonedwa nthawi zambiri, chifukwa chowongolera zomwe angiotensin-converting enzyme inhibitors (ACE inhibitors) amalembedwa ndikuwongolera kwa proteinuria ndi azotemia (popeza mankhwalawa amatha kukulirakulira). kuopsa kwa CRF).

Pamene chikhalidwe cha chiweto chimakhazikika, njira ya matendawa ndi mphamvu ya chithandizo imayesedwa nthawi ndi nthawi. Ndi njira yapakatikati ya matendawa, ndikofunikira kuti mufufuze galu kamodzi pa mwezi umodzi uliwonse.

Agalu omwe ali ndi CRF amakhala nthawi yayitali bwanji zimatengera momwe matendawa akukulira. Kudziwiratu kwa nthawi yayitali sikuli bwino, matendawa amadutsa m'miyezi kapena zaka zingapo.

zakudya

Tiyeni tikambirane za zakudya mu impso kulephera. Zakudya ndi imodzi mwa njira zofunika kwambiri kusunga thupi ndi kuchepetsa kukula kwa zizindikiro matenda aakulu impso, ndi pachimake impso kulephera ndi chimodzi mwa zigawo zofunika kwambiri mankhwala. Komanso, yankho la funso lakuti galu yemwe ali ndi vuto la impso adzakhala ndi moyo kwa nthawi yayitali bwanji zimadalira zakudya zopangidwa bwino.

Zolinga za chithandizo chamankhwala cha aimpso kulephera kwa agalu ndi monga:

• kupereka thupi ndi mphamvu zonse;

• mpumulo wa zizindikiro za matenda a impso ndi kuledzera kwa uremic;

• pazipita zotheka kuchepetsa kuphwanya madzi, electrolyte, vitamini, mchere ndi asidi-m'munsi bwino;

• kuchepetsa kupitirira kwa aimpso kulephera.

Kenako, tikambirana mbali zazikulu za chakudya cha aimpso kulephera.

Kuchepetsa chiwopsezo cha kuwonongeka kwa mapuloteni m'thupi, zomwe zimabweretsa kuwonda ndikuwonjezera kuledzera, ndikofunikira kupereka chiweto chokhala ndi mphamvu zokwanira zosungunuka mosavuta. Tiyenera kukumbukira kuti mphamvu zopanda mapuloteni zimaphatikizapo chakudya ndi mafuta. Popanga zakudya za agalu omwe ali ndi matenda a impso, mafuta ochulukirapo nthawi zambiri amawonjezeredwa, zomwe zimapangitsa kuti chakudyacho chikhale ndi mphamvu, chimapangitsa kuti chikhale chokoma komanso chokoma.

Chifukwa zakudya zama protein ambiri zimakulitsa kukula kwa nephropathy, mapuloteni apamwamba ayenera kugwiritsidwa ntchito moyenera popanga zakudya. Zatsimikiziridwa kuti kuchepa kwa kuchuluka kwa mapuloteni mwa kuchepetsa kudya kwa amino acid osafunikira kungachepetse kudzikundikira kwa mankhwala a nitrogen metabolism ndipo, chifukwa chake, kuchepetsa maonekedwe a matendawa.

Chofunikira kwambiri ndikuchepetsa kuchuluka kwa phosphorous m'zakudya, zomwe (zotsimikiziridwa) zimachulukitsa kupulumuka kwa agalu, zimalepheretsa kuchepa kwa calcium m'thupi (chifukwa chakukula kwa hyperparathyroidism yachiwiri) ndipo, chifukwa chake. , amachepetsa kukula kwa osteodystrophy ndi calcification ya minofu yofewa.

Ndikofunikanso kuchepetsa sodium (yomwe ndi gawo la mchere wa tebulo) muzakudya kuti muchepetse kuthamanga kwa magazi (komwe ndi zotsatira za matenda a impso).

Tiyenera kukumbukira kuti mavitamini osungunuka m'madzi amachotsedwa mumkodzo, chifukwa chake, ndi polyuria motsutsana ndi maziko a matenda a impso, kusowa kwawo kumatheka. Kutayika kwa mavitamini kumeneku kungayambitse matenda a anorexia, choncho zakudya ziyenera kuwonjezeredwa ndi mavitamini osungunuka m'madzi.

Kuwonjezeka kwa kuchuluka kwa ulusi wa zakudya kumasonyezedwa kwa matenda a impso, chifukwa amatsatizana ndi kuchepa kwa matumbo a m'mimba, ndipo zakudya zowonjezera zimatha kusintha chikhalidwe ndi kuyenda kwa m'mimba.

Choncho, ngati galu bwino kudyetsedwa pamaso pa aimpso kulephera, zakudya mankhwala ndi waukulu ogwira njira kuthetsa matenda zizindikiro za uremia nyama. Ndipo katswiri wazodyetsera zanyama amatha kusankha chakudya choyenera cha kulephera kwa impso: kupitilira apo, zitha kukhala chakudya cham'mafakitale (monga Royal Canin Renal, Hill's K / d, Purina NF), kapena chakudya cham'nyumba chomwe chimapangidwa payekhapayekha (nthawi zambiri zimatengera pa ng'ombe, mbatata ndi mafuta a masamba).

Nkhaniyi sikupempha kuchitapo kanthu!

Kuti mudziwe zambiri za vutoli, timalimbikitsa kulankhulana ndi katswiri.

Funsani vet

October 8 2020

Kusinthidwa: February 13, 2021