ISHEMIYAI DIL

ISHEMIYAI DIL, bemorii dilu ragho, ki dar natijai norasoii khuni mushaki dil – miokard (oqibati aterosklerozi sharayonhoi iklilii dil ast) ba vujud meoyad. Mafhumi «ishemiyai dil» amrozi shadidi dil (monandi stenokardiya, saktai dil) va illathoi muzmini on (kardiosklerozi diffuzi va juzi)-ro darbar megirad. Azbaski inkishofi bemori ba aterosklerozi ragho vobasta ast, onro kardiosklerozi tasallubi ham menomand. Hangomi I. d. kori dil (zafi dil va nomurattabii tapishi dil) khele mushkil meshavad (nig. Silsilai dilu ragho). Jarayoni I. d. nomuntazam buda, khuruji bemori ba davrai nisbatan orom ivaz megardad. Huruji stenokardiya hangomi faoliyati jismoni yake az avvalin padidahoi klinikii I. d. buda, minbad bemori muddati daroz davom meyobad. Odatan, ba stenokardiya (hangomi kori jismoni) bad az chand vaqt khuruje, ki dar holati oromi sar mezanad, hamroh meshavad. Dar davrai avji bemori inkishofi saktai mushaki dil baso khatarnok ast.
I. d. dar jumhuri besh az pesh gustarish meyobad. Bo darnazardoshti in s. 2007 Hukumati Jumhurii Tojikiston dar robita ba «Barnomai millii peshgiri, tashkhis va muolijai ishemiyai dil dar davrai solhoi 2007 – 2015» qaror qabul kard. Maqsadi asosii barnoma past namudani surati afzoishi giriftori, favt va mayubi az I. d. ast. Barnomai mazkur baland bardoshtani sathi marifati mutakhassisoni tib va aholiro roje ba masoili peshgiri, tashkhis va muolijai I. d., behtar namudani sifati tashkhis, rasondani kumaki bosamari tibbi ba marizon dar nazar dorad.
I. d. masalai muhimi ijtimoist. Ba tufayli peshrafti ilmu tekhnika, tagyiri ijtimoiyu iqtisodi va komyobihoi tibbu nigahdorii tandurusti saviyai bemorshavii aholi digargun shud: epidemiyahoi toun, domana va dig. bemorihoi siroyatiro tadrijan amrozi dilu ragho, khususan I. d. ivaz kardand.
Bo inkishofi I. d. bisyor omilhoi dokhiliyu beruni (omilhoi khavfnok) musoidat menamoyand. Ba omilhoi asosie, ki mujibi I. d. meshavand, ikhtiloli mubodilai lipidho (charbu) – dar tarkibi khun afzudani miqdori kholesterin (giperkholesterinemiya), gipertenziyai sharayoni, diabeti qandi, tamokukashi, kamharakati, asaboniyati bardavom va g. taalluq dorand.
Dar ravandi ishemiyai miokard (mushaki dil) nomuvofiqati bayni talaboti mushaki dil ba oksigen va moddahoe, ki tavassuti raghoi iklilii tangshuda meoyand, maqomi kalon dorad. CHi qadare, ki surokhi rag ziyod tang shuda boshad, tafovut va kori dil hamon qadar meafzoyad.
Ishemiyai miokard ba faoliyati dil tasiri noguvor merasonad. Ishemiyai kutohmuddat bo khuruji stenokardiya padid meoyad (damkutohi, charkh zadani sar va g.). Agar ishemiya 20 – 30 daq. davom yobad, distrofiyai manbaii miokard ba vujud meoyad. Ishemiyai nisbatan bardavom, khususan dar mavridi bo sudda basta budani arteriyai iklili (koronari), boisi mavti hamon qitai mushaki dil gashta, bo saktai dil anjom mepazirad.
I. d.-ro az rui majmui alomathoi gunoguni bolini tashkhis mekunand. Az usulhoi elektrkardiografiya, ekhokardiografiya, tadqiqi radioizotopi, mushohidai monitori, tashkhisi vazifavii kori dil va g. istifoda karda meshavad.
Hangomi khuruji dardi muqarrari davomoti on va tasiri nitroglitserinro ba inobat megirand. Huruji stenokardiya, odatan, duru daroz nest (az 5 to 30 daq.) va baroi rafi on nitroglitserin tasiri khub merasonad (badi 1 – 3 daq. ba zeri zabon giriftan dard nest meshavad). Dar vaqti distrofiyai (osebi) manbaii miokard dard mamulan 20 – 30 daq. davom mekunad (istifodai nitroglitserin tasiri nopurra va kutohmuddat merasonad). Alomati saktai mushaki dil duru daroz (az 30 daq. to chand soat va hatto ruz) davom kardani dard ast (on nisbatan purshiddat buda, badi istifodai nitroglitserin raf nameshavad).
Hangomi shiddat yoftani hama guna khelhoi I. d. mumkin ast faoliyati gunoguni dil khalal yobad. Muolijai I. d. ba tavri kompleksi surat megirad.
Parhez ahamiyati kalon dorad, baroi in dar voyai khurok boyad miqdori ravgani hayvonot va angishtobi zudhazm kam, ravganhoi rastani, vitaminhoi S va guruhi V bisyor boshand, tvorog, gushti beravgan, mohi, sabzavotu mevai tar beshtar istemol shavad, az dilbastagi ba mashruboti spirtdor khuddori boyad kard. Har ruz chor marotiba khurdani taom (energiyai shaboruziash taqr. 2500 kkal) tavsiya meshavad. Kori jismoni sharti muhimi peshgirii I. d. ast. Gayr az mehnati fikri, baroi sayru gasht, kori jismoni, varzish va g. vaqt judo kardan lozim. Rukhsatii mehnati va ruzhoi istirohatro berun az shahr, bo sayohat guzaronidan mufid ast. Az kashidani sigoru nos boyad dast kashid. Sarivaqt va muttasil muolija kardani galayoni khun, diabeti qandi, farbehi ahamiyati kalon dorad. Muvofiqi shavqu ragbat va qobiliyat intikhob namudani kasb, tashkili durusti mehnat va munosibati khayrkhohona nisbati atrofiyon ba peshgirii I. d. musoidat mekunand.