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BEMORII GIPERTONIYA

gipertoniyaBEMORII GIPERTONIYA (Morbus hypertonicus), bemorii galayoni khun, bemorii fishorbalandi, bemorii muzminest, ki zimni on fishori sharayon (arteriya) ba tavri doimi, vale dar marhalahoi avval sari har chand vaqt baland meshavad. Dar mavridi B. g. fishori balandi sharayon oqibati illathoi digar, mas., bemorihoi gurda, baze gadudhoi tarashshuhi dokhili va g. nest, hol on ki fishori khun metavonad hangomi in bemoriho niz baland gardad. Binobar hamin dukhture, ki avvalin bor fishori balandi sharayon (khususan dar odami javon)-ro oshkor mekunad, odatan, tadqiqoti ilovagi meguzaronad, to ki sarivaqt bemorii digari sababgori fishorbalandiro oshkor sozad.
Sababi B. g. to ba okhir malum nest. Ammo omilhoi asosie, ki onro ba vujud meorand va fishori sharayonro muntazam baland nigoh medorand, nagz malum meboshand. Dar bayni onho omili avvalin va asosi nojurihoi marbut ba asab ast. Zinai ibtidoi emotsiyaho va gamu anduh buda, onho hatto ba odamoni solim niz sakht tasir merasonand (az jumla fishori khunro baland mekunand). Dar odame, ki giriftori B. g. ast, az sababhoi nochiz ham aksulamali ehsosii amiq va purshiddat padid meoyad; dar ayni hol fishori sharayon khele baland shuda, nisbat ba odami solim bisyortar davom mekunad (nig. Fishori khun). Hususiyati chunin aksulamali dastgohi tanzimi fishori sharayon boz dar hamin ast, ki bo mururi takror yoftani on fishori balandi khun tadrijan, vale yakzayl va ba muhlati beshtar boqi memonad. Dar davomi mohu solho takror yoftani vaziyathoi hayotii nomusoid dar nihoyati kor ba tashakkuli B. g. ovarda merasonad.
Ba inkishofi B. g. mekhanizmi tanzimi khiltii (gumoravii) fishori khun niz musoidat mekunad. Dar tanzimi in holat naqshi asosiro gurda mebozad. Dar natijai tagyirote, ki dar faoliyati gurda hangomi B. g. ba amal meoyad, mekhanizmi khilti dar marhalai avvali paydoishi bemori ba kor shuru karda, bo mururi zamon sahmi on dar rohi ba darajai baland nigoh doshtani fishori sharayoni meafzoyad. Bar khilofi mekhanizmhoi khosi sirf asabho tasiroti khilti dar tanzimi fishori sharayoni tagyiroti nisbatan tuloniro ba vujud meovarad va dar natija fishorbalandi ustuvor megardad.
Aksulamalhoi gipertenziyavii ehsosi asosan hamin tavr ba bemorii muzmin tabdil meyoband. Tasiri in guna mekhanizmho dar solhoi minbada fishori balandi sharayonro ustuvor (yane doimi) mesozad. In marhalai inkishofi bemori khele firebanda ast: bo faro rasidani on bemor bisyor vaqt ehsosi nokhushro gum mekunad, dar u tasavvuroti durugini behbudi ba amal meoyad, dar natija nisbati tabobat beetinoii khatarnok zohir karda meshavad.
Rushdi B. g.-ro bo tadbirhoi sarivaqtii muolijavi bozdoshtan va hatto qafo zadan mumkin ast. Muayyan shudaast, ki bo rohi khilti baland shudani fishori sharayon ba bozmondani khloridi natriy (yane namaki osh) dar organizm aloqamand ast. CHunki hangomi B. g. ikhroji on tavvasuti gurdaho (bo peshob) az organizm sust meshavad. Barziyodii namak dar organizm bevosita gipertenziyai sharayoniro ba vujud meovarad va agar in barziyodi bartaraf karda shavad, fishori khun ba etidol meoyad.
Dar ustuvorii gipertenziya mekhanizmi seyum (na az rui ahamiyat, balki muvofiqi tashreh) – kori purshiddati dil hangomi barziyodii hajmi khuni dar gardish buda niz shirkat mevarzad. In namudi gardishi khunro «gardishi khuni giperkinezi» menomand. On dar baland gashtani fishori sharayoni bisyor marizoni gipertoniya sahmi nazarras meguzorad. Sukhan dar borai odamone meravad, ki gipertenziyai mutadili asosan sistolavi dorand. Dar Kongressi IX umumijahonii kardiologho (Moskva, 1982) in shakli B. g. «gipertenziyai narm» nomida shuda bud.
Donistani mekhanizmhoi asosii inkishofi B. g. baroi darki maslihathoi dukhturon doir ba nizomi mehnatu istirohat yori merasonad. In tavsiyaho bar on asos yoftaand, ki baroi peshgirii inkishofi minbadai B. g. boyad shiddati taassuroti asabiyu ruhiro past kard. Bahri noil gashtan ba in beshtar faoliyati balandi jismoni musoid ast. Binobar in harakati faol (agar az jihati surat va davomat oqilona boshad), khususan sayrugashti piyoda, navhoi sabuki sport va kori jismoni metavonand nojurihoi hayotii harruzaro ivaz kunand. Va baraks, istirohat dar nazdi televizor va bozihoe, ki diqkati ziyodro talab mekunand (mas., shohmot, bozihoi kompyuteri va g.) hama vaqt boisi oromii asabho nameshavand. Onho chun tadbiri peshgirii aksulamalhoi fishorbalandi ahamiyati ziyod nadorand, zero biduni harakathoi faoli jismoni gormonhoi gadudi boloi gurda (adrenalin va noradrenalin), ki shiddati ehsosotro sust mekunad, ba mubodila komilan jalb karda nameshavand. Baroi chunin shiddatro past kardan, pizishk majbur meshavad bazan doruhoero tavsiya kunad, ki asabhoro orom mesozand.
Harchand taassufovar ast, kam kardan yo tamoman ba taom naandokhtani namak yake az chorahoi zaruri va dastrasi muqobilat ba baland gashtani fishori sharayon dar mavridi B. g. meboshad. Ilmi tib vositahoi ziyodero dar ikhtiyor dorad, ki bo yorii onho gurdaho namakro bo peshob beshtar ikhroj mekunand (bo in roh ba poyonravii darajai fishori khun kumak rasonda meshavad). Binobar in aksar vaqt ba giriftoroni B. g. doruhoi peshobron medihand, to ki khloridi natriy bo shosha bisyor ikhroj gardad. Ammo ravshan ast, ki agar khuroki bemor kamnamak boshad, kori gurda baroi ikhroji on oson va doru kamtar sarf meshavad.
Mahdud kardani istemoli namaki osh bahri peshgiri (yo barham dodan)-i navi giperkinezii khungardish, ki gipertenziyai sharayonro ba vujud meovarad, musoidat mekunad. Agar dar organizm namak jam shavad, pas malum, ki ob ham jam meshavad. Dar natija hajmi khungardish meafzoyad. Tarafi digari in masala niz vujud dorad, ki on makhsusan baroi mavjudiyati «gipertenziyai narm» muhim meboshad. Malum, ki bazan faqat kam kardani vazni ziyodati kifoya ast to biduni doru fishori sharayoni odam mutadil gardad. Zero bo nest shudani boftahoi ravganii nodarkor shabakai khunraghoi khurdu khurdtarin, ki peshtar nabud, vale bo mururi afzoishi boftahoi ravgani afzudaast, barham mekhurad. Dar in guna shabakai khunraghoi ilovagi gardishi zarurii khun faqat ba vositai baland bardoshtani fishori khun ba roh monda meshavad. In holat dar navbati khud kori purzuri dilro talab mekunad, zero na miqdor va na qutri arteriyahoi kaloni ba boftaho gizorasoni odam nametavonad ziyod shavad. YAne jam gashtani boftahoi ravgani ba odam nafaqat vaznini meovarad, balki dilro majbur mesozad, ki dar sharoiti dar silsilai khunragho baland budani fishor kor kunad.
Binobar in har shakhs metavonad be istifodai doru mustaqilona B. g.-ro peshgiri kunad yo ba paydo shudani on mone shavad. In khulosa nafaqat baroi peshgiri kardani B. g., balki baroi tabobati shaklhoi «narm»-i on, ki dar 70 – 80% bemoron mushohida meshavad, khele muhim ast. Tasiri peshgiri va muolijai «bedoru» bo mushohidoti ziyode az boloi bemoroni gipertoniya, ki tavsiyahoi roje ba harakati faol, gizoi kamkaloriya va ba khurok kamtar andokhtani namakro rioya mekardand, isbot shudaast. Mushohidahoi yaksola nishon dodand, ki galayoni khuni aksariyati onho mutadil shuda, vazni badan kam gardidaast, ba istemoli doruhoi fishorfaror hojat namondaast.
Tamomi jihathoi digari muolijai B. g. purra dar uhdai dukhtur buda, khudmuolijai bemor hargiz ravo nest. Ba in munosibat boyad qayd kard, ki muolijai B. g. hamchun bemorii muzmin hatman boyad chand sol muttasil davom kunad. Roh dodan ba fosilahoi bayni istemoli doru va muddati onhoro (vobasta ba rafti B. g. va tasiri muolija ba organizmi bemor) faqat pizishk muqarrar mekunad. Odami giriftori B. g. boyad donad, ki dar rafti tabobat bartaraf gardidani ehsosi vaznin, khususan past shudani fishori sharayon, odatan, zud muyasar megardad. Vale in tasiri muvaqkat va guzaranda buda, baroi khatmi tabobat asos shuda nametavonad. Ilova bar in, be ijozati dukhtur qat namudani muolija ba buhroni gipertoni, yane tezu tund shudani zuhuroti asosii bemori va khele baland gashtani fishori khun sabab meshavad.
Dar surati nogahon bad shudani ahvoli bemor dukhturro jeg zada, to omadani u bemorro ba holati nimkhez dar bistar yo kursii munosib meshinonand, ba kafu soqi poyash garmkunak, khardalkogaz meguzorand, yo bo kurpa mepechonand, korvalol yo valokordin (30 – 35 qatra dar yak bor) khuronida, voyai gayrinavbatii doruero, ki istemol mekard, medihand. Agar dar pushti qafasi sina (bayni shona) dard paydo shavad, zud ba zeri zabon nitroglitserin mepartoyand. Agar dardi sakhti sar paydo shavad, yak qursi dorui peshobronro, ki pesh baroi tabobati B. g. istifoda meshud, khurdan mumkin ast.
Hangomi muolijai B. g. vazifai muhim on ast, ki fishori sharayon dar darajai baroi bemor muvofiq nigoh doshta, hattalimkon ba baland va hamchunin zud past shudani on peshgiri karda shavad. Az had ziyod past kardani fishor zarurat nadorad, chunki dar in hol magzi sar, mushakhoi dil va gurda bo khun tamin gashta nametavonand. Binobar hamin, beparvoyona istifoda burdani doruhoi fishorfaror, ki bisyoriashon zud va sakht tasir merasonand, qatiyan mumkin nest. Doimo befosila yo bofosila az rui tainoti dukhtur va ba miqdori zaruri istifoda kardani doru, inchunin hatman rioya namudani tavsiyahoi u doir ba gizo va tartibi koru istirohat muvofiqi maqsad meboshad. Bo vujudi in hangomi chunin tabobat ham goho zeri tasiri nojurihoi ruhi khuruji B. g. (hatto buhronhoi gipertoni) az ehtimol dur nest. Vale ba tufayli muolijai doimii peshina in dushvoriho osontar bartaraf meshavand.
Natijai mushohidaho nishon medihad, ki B. g. bedavo nest. Vositahoi ziyodi hozirazamon va tajribai amalii tib baroi dar darajai zaruri nigoh doshtani fishori sharayon kofi buda, bo hamin metavonand ba avji B. g. mone shavand. In guna tadbir nafaqat oqibati badi mariziro peshgiri mekunad, balki ehtimoli inkishofi aterosklerozro niz bozmedorad.
Olimoni tojik muqarrar kardand, ki avji B. g. va orizahoi vaznini on (saktai dil, saktai mayna) ba obu havo niz vobasta ast. B. g. beshtar dar faslhoi bahoru tiramoh avj megirad, ki ehtimol sababi on tagyir yoftani fishori barometri va borishoti ziyod boshad. Dar mohhoi tobiston B. g. nisbatan kam meshavad.
Tadbirhoi peshgirii B. g. va tavsiyahoe, ki baroi bemoroni gipertoni doda meshavand, mushobehi yakdigarand. Onhoro boyad har nafare, ki hangomi muoina dar u fishori balandi khun oshkor karda shudaast, rioya kunad. CHorahoi peshgiri makhsusan baroi ashkhose (aksaran javonon) zarur ast, ki ba B. g. mayli irsi dorand.
Ad.: Lang G.F., Gipertonicheskaya bolezn, L., 1960; Mansurov H.H., Portalnaya gipertoniya, D., 1963; Hamidov N.H., Arterialnie gipertonii v starshikh vozrastakh, D., 1985; Hamon muallif, Biokhimicheskie faktori riska ateroskleroza i arterialnoy gipertonii u lis pojilogo i starcheskogo vozrasta, D., 2000; Mansurov H.H., Bolezni sosudov pecheni i portalnaya gipertenziya, D., 2005.

H.H. Mansurov.

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