【動(dong)脈粥樣(yang)硬(ying)化(hua)(hua)癥狀(zhuang)】動(dong)脈粥樣(yang)硬(ying)化(hua)(hua)的原因 動(dong)脈粥樣(yang)硬(ying)化(hua)(hua)的治療
病因
一、高(gao)(gao)血(xue)壓(ya):高(gao)(gao)血(xue)壓(ya)患者動(dong)脈粥樣硬化發病率明顯(xian)增(zeng)高(gao)(gao)。
二、高(gao)血(xue)脂(zhi)癥(zheng):動脈(mo)粥樣(yang)硬化常見于高(gao)膽(dan)固(gu)醇血(xue)癥(zheng)。
三、吸煙。
四、糖尿病。
五、肥胖。
癥狀
主(zhu)(zhu)要決定于(yu)血(xue)(xue)管(guan)(guan)病(bing)變及受累器(qi)官的缺(que)血(xue)(xue)程度,主(zhu)(zhu)動(dong)(dong)(dong)(dong)脈(mo)粥(zhou)樣(yang)硬(ying)化(hua)(hua)常無癥狀(zhuang),冠狀(zhuang)動(dong)(dong)(dong)(dong)脈(mo)粥(zhou)樣(yang)硬(ying)化(hua)(hua)者(zhe),若管(guan)(guan)徑狹窄達75%以上,則(ze)可發(fa)生心絞痛(tong)、心肌梗塞、心律失(shi)常,甚至猝死。腦(nao)動(dong)(dong)(dong)(dong)脈(mo)硬(ying)化(hua)(hua)可引(yin)起腦(nao)缺(que)血(xue)(xue)、腦(nao)萎縮,或造成(cheng)腦(nao)血(xue)(xue)管(guan)(guan)破裂出血(xue)(xue),腎動(dong)(dong)(dong)(dong)脈(mo)粥(zhou)樣(yang)硬(ying)化(hua)(hua)常引(yin)起夜尿(niao)、頑固(gu)性(xing)高血(xue)(xue)壓(ya)、嚴重(zhong)者(zhe)可有腎功能不全。腸系膜動(dong)(dong)(dong)(dong)脈(mo)粥(zhou)樣(yang)硬(ying)化(hua)(hua)可表(biao)現(xian)為飽(bao)餐后腹痛(tong)便(bian)血(xue)(xue)等癥狀(zhuang)。下肢(zhi)動(dong)(dong)(dong)(dong)脈(mo)粥(zhou)樣(yang)硬(ying)化(hua)(hua)引(yin)起血(xue)(xue)管(guan)(guan)腔(qiang)嚴重(zhong)狹窄者(zhe)可出現(xian)間(jian)歇性(xing)跛行(xing)、足背動(dong)(dong)(dong)(dong)脈(mo)搏動(dong)(dong)(dong)(dong)消失(shi),嚴重(zhong)者(zhe)甚至可發(fa)生壞疽(ju)。
檢查
1、患者(zhe)(zhe)常有血膽(dan)固醇、甘油三酯增高,高密度(du)脂蛋(dan)白減低,脂蛋(dan)白電泳圖(tu)形異常,多數(shu)患者(zhe)(zhe)表現為第(di)(di)Ⅲ或(huo)第(di)(di)Ⅳ型高脂蛋(dan)白血癥。
2、X線檢查可見主(zhu)動脈伸長、擴張(zhang)和扭(niu)曲(qu),有時(shi)可見鈣質沉著。
3、動(dong)脈造(zao)影可顯(xian)示四肢動(dong)脈、腎動(dong)脈與冠狀(zhuang)動(dong)脈由于(yu)粥樣(yang)硬(ying)化(hua)所(suo)造(zao)成的管腔狹窄、病變部位及范圍。
4、多(duo)普勒超聲(sheng)波檢查有助于判斷(duan)四肢(zhi)動脈、腎動脈血(xue)流通暢情(qing)況。
治療
一、一般治療:
(一)合理飲食(shi):飲食(shi)總熱量不應過(guo)高防(fang)止超(chao)重。
(二)堅持適(shi)量的體力(li)活動。
(三)合理(li)安排(pai)工(gong)作(zuo)及(ji)生活。
(四)其他:提(ti)倡不吸煙,可飲少(shao)量酒。
二、控制易患因素:如患有糖(tang)(tang)(tang)尿(niao)病(bing)、應(ying)(ying)(ying)及時控制血(xue)(xue)(xue)糖(tang)(tang)(tang),包(bao)括飲食控制。Ⅱ型糖(tang)(tang)(tang)尿(niao)病(bing)的降糖(tang)(tang)(tang)藥物應(ying)(ying)(ying)以不引起高胰(yi)島素血(xue)(xue)(xue)癥(zheng)為宜如達美康等;如有高血(xue)(xue)(xue)壓則(ze)應(ying)(ying)(ying)給降壓藥,使(shi)血(xue)(xue)(xue)壓降至(zhi)適當水平,如有血(xue)(xue)(xue)膽(dan)(dan)固醇增高,則(ze)應(ying)(ying)(ying)控制高膽(dan)(dan)固醇適當給予降脂藥物。
二、降血脂藥物:1、消(xiao)膽(dan)胺。2、安妥明。3、煙(yan)酸(suan)。4、不飽(bao)和脂(zhi)肪酸(suan)。如益壽寧、血脂(zhi)平(ping)及心脈樂等。6、藻酸(suan)雙酯(zhi)鈉。
三、抗血小板藥物:
1、阿斯匹林。
2、潘生丁。
3、抵克立得。
動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)粥樣硬(ying)化的(de)(de)特(te)點是(shi)指(zhi)動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)發生(sheng)了非炎(yan)癥性(xing)、退行性(xing)和(he)(he)(he)增(zeng)生(sheng)性(xing)的(de)(de)病變,導致管壁增(zeng)厚變硬(ying),失去彈(dan)性(xing)和(he)(he)(he)管腔(qiang)縮(suo)小。動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)粥樣硬(ying)化的(de)(de)病理變化主要累(lei)及體循環(huan)系統的(de)(de)大型(xing)彈(dan)力(li)型(xing)動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(如主動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo))和(he)(he)(he)中型(xing)肌(ji)彈(dan)力(li)型(xing)動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)(以冠(guan)狀動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)和(he)(he)(he)腦動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)罹患最多),受累(lei)動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)的(de)(de)病變從(cong)內(nei)膜開始,先后有(you)多種病變同時(shi)存在,包括局部有(you)脂(zhi)質(zhi)和(he)(he)(he)復合糖類積聚,出血(xue)和(he)(he)(he)血(xue)栓形成(cheng),纖(xian)維組(zu)織(zhi)增(zeng)生(sheng)和(he)(he)(he)鈣質(zhi)沉(chen)著,并有(you)動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)中層的(de)(de)逐漸退化和(he)(he)(he)鈣化。現代(dai)細胞分子生(sheng)物學技術顯(xian)示,動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)粥樣硬(ying)化病變都具(ju)有(you)平(ping)滑肌(ji)細胞增(zeng)生(sheng),大量膠原纖(xian)維、彈(dan)力(li)纖(xian)維和(he)(he)(he)蛋(dan)白多糖等(deng)結締組(zu)織(zhi)基質(zhi)形成(cheng),以及細胞內(nei)外脂(zhi)質(zhi)積聚的(de)(de)特(te)點。由于在動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)內(nei)膜積聚的(de)(de)脂(zhi)質(zhi)外觀呈現黃色粥樣,因此(ci)稱為動(dong)(dong)(dong)(dong)(dong)脈(mo)(mo)(mo)(mo)粥樣硬(ying)化。
動(dong)(dong)(dong)脈(mo)(mo)(mo)粥(zhou)樣硬化:是指動(dong)(dong)(dong)脈(mo)(mo)(mo)光(guang)滑(hua)摧摸(mo)受到破壞,長期血(xue)壓升高(gao)可(ke)促進動(dong)(dong)(dong)脈(mo)(mo)(mo)粥(zhou)樣硬化的(de)形成。從(cong)而(er)出現膽(dan)固(gu)(gu)醇、膽(dan)固(gu)(gu)醇脂及(ji)甘(gan)油三脂、血(xue)肌酐(gan)沉著、升高(gao)。動(dong)(dong)(dong)脈(mo)(mo)(mo)粥(zhou)樣硬化一般發(fa)生(sheng)在(zai)冠狀動(dong)(dong)(dong)脈(mo)(mo)(mo)、使動(dong)(dong)(dong)脈(mo)(mo)(mo)狹窄,則引起冠心病,也(ye)可(ke)發(fa)生(sheng)在(zai)主動(dong)(dong)(dong)脈(mo)(mo)(mo)、腦(nao)動(dong)(dong)(dong)脈(mo)(mo)(mo)、腎動(dong)(dong)(dong)脈(mo)(mo)(mo)等,從(cong)而(er)引起相應部位的(de)病變,產生(sheng)不同的(de)嚴重后果(guo)。