Атеросклероз сосудов – патологическое заболевание, когда характерно образование холестериновых бляшек на внутренней стенке сосуда. Болезнь для лиц старше 40 лет, доктора рекомендуют людям, достигшим этого возраста, соблюдать профилактические меры.
Лечение атеросклероза направлено на нормализацию кровотока в ткани мозга. При подозрении на болезнь нужна диагностика. Терапия имеет утешительные прогнозы.
Почему возникает атеросклероз?
Атеросклероз зависит от уровня холестерина в крови. Факторы, которые способствуют повышению уровня холестерина являются причинами атеросклероза. Основными причинами медики называют несбалансированное питание, табакокурение, алкоголь и сахарный диабет. Существует круг лиц, которые подвержены поражению сосудов:
- По статистике патология характерна для мужчин старше 40-45 лет.
- Немаловажную роль играет наследственная предрасположенность. Например, если кто-то из родных имел атеросклероз сосудов – риск заболеть повышается в несколько раз. Таким лицам показано соблюдение профилактических мер.
- Сопутствующие заболевания сосудов и вен могут повлиять на развитие атеросклероза. К таковым относят запущенный варикоз.
- Заболевание может возникнуть у лиц, которые курят сигареты. Никотин и другие составляющие табачного дыма значительно нарушают функционирование сосудов, и повышают риск развития тромбов.
- Ожирение различных степеней провоцирует сахарный диабет, для которого характерно повышения уровня холестерина в крови.
С чего начать терапию?
Основой лечения атеросклероза сосудов является медикаментозная терапия. Чтобы таблетки и другие препараты эффективно подействовали, пациенту нужно пересмотреть привычный образ жизни. Атеросклероз сосудов спровоцирован некоторыми факторами, например, неправильным питанием, чрезмерным употреблением алкоголя, табакокурением и малоподвижным образом жизни. Для начала нужно устранить тот фактор, который повлиял на возникновение болезни. Если продолжать усугублять здоровье – никакое лечение не поможет избавиться от болезни.
Перед тем как лечить атеросклероз сосудов головного мозга, для начала нужно наладить питание. Именно этот фактор в большинстве случаев провоцирует атеросклероз сосудов. Жареные продукты до золотистой корочки, жирные соусы, майонезы, копченые колбасы и другие полуфабрикаты – продукты относятся к тем, которые повышают норму холестерина в крови. Употребление соли сводится до минимума. Идеальным питанием считаются блюда:
- Диетическое мясо птицы.
- Кефир, ряженка, натуральные йогурты, сыры и другие кисломолочные продукты без искусственных добавок.
- Рыба (минтай, щука), крупы.
- Макаронные изделия из твёрдых сортов пшеницы.
- Напитки на основе лекарственных трав.
- Компоты из сухофруктов.
- Овощи, ягоды, фрукты.
Блюда нужно готовить на пару или отваривать. Нельзя жарить, использовать растительное масло.
Следующим критерием являются умеренные физические нагрузки, точнее, пешие прогулки на свежем воздухе. Больным атеросклерозом очень полезна спокойная ходьба. Ежедневно пациенты должны гулять минимум по одному часу. При этом не стоит совершать слишком тяжёлых физических нагрузках: силовые тренировки, поднятие тяжестей.
Завершающим этапом является отказ от вредных привычек. Пациенту придётся расстаться с сигаретой навсегда, отказаться от спиртного.
Медикаментозная терапия
Лечение атеросклероза сосудов необходимо проводить комплексно. После ряда диагностических мер пациенту назначаются препараты для лечения атеросклероза сосудов головного мозга:
- Средства, которые нормализуют жировой обмен. Они снижают уровень липидов в крови, способствуют рассасыванию холестериновых бляшек, предотвращают развитие тромбов. Лекарства группы эффективны для пациентов, которые страдают лишним весом. Эффективными средствами являются препарат Фенофибрат. Лекарство содержит в составе 145 мг фенофибрата. Назначают средство при высоком холестерине. К противопоказаниям относят детский возраст, патологии печени и почек.
- Препараты для лечения ишемического синдрома. Таблетки от ишемического синдрома называют антиагрегантами. Эти лекарства необходимы для образования кровяных сгустков. После курса лечения препаратами пациент замечает, что уровень артериального давления приходит в норму, исчезают болевые ощущения в голове и другие симптомы заболевания. К наиболее эффективным средствам относят Дипиридамол. В составе содержится 25 мг активного вещества дипиридамола. Лекарство от атеросклероза сосудов головного мозга показано тем людям, которые страдают от энцефалопатии, атеросклероза, венозного тромбоза. К основным противопоказаниям относят инфаркт миокарда.
- Никотиновая кислота. Для патологического изменения сосудов характерно нарушение кровообращения в тканях и невротических нарушениях. Для устранения данных симптомов доктора рекомендуют своим пациентам принимать никотиновую кислоту. Данное средство отлично дополняет основную медикаментозную терапию, нормализует обмен веществ, восстанавливает кровообращение, очищает организм от свободных радикалов. Данное лекарство можно употреблять исключительно после консультации с лечащим врачом. У никотиновой кислоты широкий список противопоказаний. Показания к применению обширны, но атеросклероз занимает лидирующие позиции. Нельзя принимать гипертоникам, критерии оговариваются с врачом.
- Витамины. В качестве дополнительной терапии атеросклеротических заболеваний назначают витамины, в особенности витамины группы С. Даже после успешного лечения атеросклероза высок риск развития повторного заболевания. Для того чтобы более-менее поддерживать уровень холестерина в крови необходим витамин С. Он способствует очищению сосудов и предотвращает образование холестериновых бляшек.
- Препараты, которые нормализуют артериальное давление. Для атеросклероза сосудов головного мозга характерно повышение уровня артериального давления. Для предотвращения симптома заболевания доктор назначает лекарства, которые относятся к группе ингибиторов. Эффективными средства принято считать Каптоприл, Эналаприл. Средства от атеросклероза сосудов головного мозга показаны при гипертонии, а также при заболеваниях, которые могут спровоцировать высокое давление.
- Таблетки для нормализации кровообращения. При атеросклерозе сосудов головного мозга нужно нормализовать ткани сосудов и поступление в ткани кислород, сосуды необходимо своеобразно расслабить. Для этой цели использовать средства, которые способствуют снятию спазма гладкой мускулатуры. К ним относят Папаверин или Дротаверин. Показаний к использованию много, из противопоказаний: патологии печени.
Название медикаментозных средств указано в информационных целях. Перед использованием того лекарства необходима консультация лечащего врача.
Народные средства
Лечить атеросклероз сосудов головного мозга лишь народными средствами – неэффективно и бесполезно. Иногда доктор назначает народные рецепты в качестве дополнительной терапии, а также людям, которые склонны к развитию атеросклероза. Рассмотрим несколько рецептов для терапии сосудистых патологий:
- Семена укропа необходимо довести до кипения на водяной бане. Полученный отвар принимают внутрь по несколько глотков натощак и вечером перед сном. Курс лечения составляет 21 день.
- Листья клевера хорошо показали себя в лечении от склероза. Их мелко измельчают и заливают кипятком. Настой должен стоять в тёмном месте около суток. Принимают перед первым приемом пище по половине стакана. Срок лечения составляет две недели.
- Жидкий мёд смешивают с поджаренными семенами льна. Полученную массу нужно употребить перед завтраком по одной чайной ложке. Курс составляет 10 дней.
- Ягоды боярышника заливают чистым спиртом. Настаивают в стеклянной банке в течение недели. Далее настойку фильтруют. После первого приёма пищи, а также на ночь, нужно в 50 граммах воды разводит 3-5 капель настойки. Курс лечения две недели.
- Ягоды смородины и брусники заливают кипятком и добавляют две ложки мёда. Настаивают сутки и принимают жидкость каждое утро по 13 стакана. Лечение длится 10 суток.
Несмотря на тот фактор, что ингредиенты в рецептах вполне безобидны – насчёт их приёма нужно проконсультироваться с врачом. Иногда необходима корректировка дозировки и срока лечения.
Профилактика атеросклероза сосудов
Чтобы предотвратить развитие бляшек в сосудах головного мозга, люди старше 40 лет должны соблюдать следующие факторы:
- Не курить и избегать общества курящих.
- Отказаться от спиртных напитков.
- Питаться небольшими порциями.
- Не употреблять вредную пищу.
- Чаще бывать на свежем воздухе.
- Проявлять физическую активность.
- Полноценно отдыхать.
- Устраивать зарядку по утрам.
- Минимум один раз в год посещать невролога в качестве профилактики.
Вылечить атеросклероз сосудов без каких-либо осложнений и последствий можно в том случае, если патология выявлена вовремя. Для начала пациент должен посетить доктора, пройти диагностику и приступить к лечению атеросклероза сосудов головного мозга медикаментозными препаратами. Необходимо слушать врача, выполнять его рекомендации.
Атеросклерозом головного мозга называют постоянно прогрессирующее поражение сосудистого русла, расположенного в центральном органе нервной системы. В медицинской литературе встречаются и другие определения этой патологии, к примеру, церебральный атеросклероз, атеросклеротическое повреждение сосудов мозга, однако при этом суть заболевания не меняется. Нарушается функционирование ЦНС, что в дальнейшем ведет к необратимым последствиям, если отсутствует надлежащее лечение. Церебральный атеросклероз сосудов головного мозга имеет в своей основе этиологический и патологический механизмы возникновения недуга. Они обусловлены дисбалансом пептидно-липидного обмена. Это оказывает негативное воздействие на внутренние стенки мозговых сосудов в голове, поражающимися продуктами распада этих веществ, а также непосредственно липидными комплексами, образующими атеросклеротические бляшки.
Накопленная статистика утверждает, что в церебральном русле, наиболее часто происходит поражение атеросклерозом сосудов кровоснабжающих таламус. Также затрагиваются такие органы, как подкорковые узлы, варолиев мост. Чаще всего формируются накопления фиброзного типа, реже жировых веществ.
Мужчины более подвержены такой патологии, нежели женщины. Патологические изменения сосудов головного мозга у них происходят на 15 лет раньше. И все же после 50 лет, сосуды церебрального русла страдают одинаково как у мужчин, так и у женщин. В этом возрасте особенно важна профилактика атеросклероза сосудов головного мозга. Она включает сбалансированный режим питания, а также ЛФК в комплексе: физкультура, гимнастика, массирующие манипуляции. Согласно статистическим исследованиям, стало известно, что за последнюю декаду увеличился показатель больных данной патологией, которые не достигли 35 лет. Также, атеросклероз сосудов головного мозга часто выявляется у пациентов склонных к гипертонии. Именно люди страдающие скачками артериального давления попадают в зону риска.
Терапия атеросклероза сосудов головного мозга
Процесс лечения атеросклероза церебрального типа длительный, и нередко продолжается всю оставшуюся жизнь.
Занимаются такой патологией лечащий врач – невропатолог. Им проводится диагностика атеросклероза сосудов головного мозга. В случае обнаружения недуга, оценивается степень тяжести заболевания. Соответственно поставленного диагноза, обеспечивается необходимый курс лечения. Это может быть консервативная терапия. Главная ее задача – улучшение кровоснабжения мозга, и предупреждение возникновения ромбов.
Можно ли вылечить атеросклероз, используя только медикаментозное воздействие? Ответ положительный, но определяется стадией заболевания и тем, насколько пациент точно принимает предписанные лекарства. Если признаки атеросклероза сосудов головного мозга требуют медикаментозное лечение, предлагаются следующие варианты:
- антикоагулянтная терапия, целью которой является минимизация риска возникновения ишемии мозговых тканей. Для этого применяют ацетилсалициловую кислоту и клопидогрел. Перед их назначением проводят исследование свертывающей способности крови;
- с целью стабилизации нейрорегуляции эндокринных желез используют тонизирующие или же седативные лекарства. Могут прописываться небольшие дозировки эстрогена или тиреоидина;
- также используются средства понижающие уровень холестерина в сыворотке крови. Возможна лечебная терапия статинами (ингибируют синтез жирового спирта в гепатоцитах – ловастатин, симвастатин, аторвастатин), фибратами (понижают уровень холестерина в сыворотке – фенофибрат, гемфиброзил). Также применяются лекарства, влияющие на выведение холестерина из организма. К ним относят секвестранты желчных кислот и аниообменные смолы (колестипол, хестирамин). Для понижения всасывания холестерина в кишечнике используют атромид, эзитимиб, микслерон;
- чтобы снизить ишемическое мозговое расстройство применяются йодсодержащие препараты, а также диоспонин. Еще для этого могут использовать калия йодид, раствор йода. Такие препараты принимают определенными не длительными курсами, чтобы избежать возникновения йодизма;
- с терапевтической целью применяют большие дозы (в несколько раз выше суточной нормы) витаминов групп B, C (аскорбиновая кислота);
- комплексная терапия предусматривает медикаменты, направленные на профилактику возникновения расстройства кровообращения. Они включают сосудистые дилятаторы, коронаролитики и антикоагулянтные средства.
Если во время лечения обнаруживают стенозы, которые значительно влияют на процесс кровообращения, или же полное закрытие бляшками сосудов, или нестабильные атеросклеротические образования, сосудистые хирурги рассматривают вопрос о необходимости применения хирургического лечения.
Часто его единственный способ как лечить атеросклероз головного мозга, при атеросклерозе головного мозга просто нет права рисковать состоянием пациента. В медицине наших дней проведение хирургических вмешательств с целью восстановления проходимости сосудов находится на достойном уровне, в особенности сосудов мозга.
В наше время существуют следующие виды хирургических вмешательств, чтобы вылечить атеросклероз сосудов головного мозга:
Эндартерктомия
Метод основан на удалении жировой бляшки через открытый доступ. Для этого производят разрез кожи, что позволяет открыть доступ к поврежденному сосуду. Дальше оперирующий врач проводит локальную остановку кровотока, быстро рассекает стенку пораженной магистрали и убирает сформировавшуюся жировую бляшку. После проведенных мероприятий, производится ушивание прооперированного участка посредством наложения сосудистого шва. Данный метод позволяет убирать отложения внечерепных магистралей.
Стенты и баллоны
С целью устранения атеросклеротических образований локализованных во внутричерепных сосудах применяют баллоны и стентирование.
В этом случае проводится удаление бляшки эндоскопическим методом. Эндоскоп с закрепленным стентом вводят в самый большой сосуд (чаще — бедренная артерия), далее, под постоянным рентгенконтролем стент продвигают до места, где сосуд поражен атеросклеротичским образованием. В этом месте устанавливается стент, посредством которого происходит расширение просвета сосуда и возобновление кровотока.
Необходимо помнить о том, что атеросклероз относится к хроническим заболеваниям, и требует пожизненного лечения. Прогноз зависит от своевременности выявления патологии и правильности проводимой терапии. В неврологической практике имели место случаи обширных форм церебрального атеросклероза, однако люди при этом оставались дееспособными и прожили довольно длительное время. И все ж, иногда первые клинические симптомы заболевания заканчиваются летальными исходами. Потому, врачи невропатологи отводят очень особую роль диагностике заболевания и правильному его комплексному лечению.
Диета при атеросклерозе сосудов головного мозга
Патологические изменения в сосудах головного мозга – это болезнь, которую невозможно предугадать. Несоблюдение правильного режима питания, особенно когда болезнь в стадии обострения, может привести к появлению внезапных приступов. Врачи предлагают несколько вариантов диетических столов, включающие в себя определенный набор продуктов, в которых на период болезни нуждается организм человека.
Питание при атеросклерозе сосудов головного мозга включает в себя следующие этапы:
- Пациенты с нормальным и избыточным весом, особенно с ожирением, должны уменьшить количество калорий, потребляемых в течение дня. Калорийность должна быть снижена на 10-15% от общего объема.
- Постепенно сокращать, а в последующем исключить из ежедневного рациона те продукты, где содержится избыток жиров животного происхождения. К ним относятся не постное мясо, рыба яичные желтки и т.д.
- Рекомендуется недосаливать пищу.
- Как можно меньше употреблять продукты, содержащие много витамина D.
- Супы готовить на воде или овощном бульоне, от рыбных и мясных лучше отказаться.
- Включить в свой рацион творог, сельдь (предварительно вымоченную), треску, содержащие липотропные вещества.
- Можно употреблять растительные масла: кукурузное, подсолнечное, льняное и хлопковое.
- Каждый день съедать не менее 30г белка. Он содержится в яйцах, нежирном мясе, рыбе, кисломолочных продуктах.
- Обязательно устраивать разгрузочные диеты, особенно если есть лишний вес. На их время основной рацион творог, кефир, яблоки и т.д.
- Чрезмерное употребление свежих овощей, фруктов, не обработанных термически.
Последняя диета наиболее доступна и проста. В ряде случаев ее может дополнять массаж при атеросклерозе сосудов головного мозга. Основное направление такой диеты – это понижение в крови уровня холестерина и нормализация кровообращения. Особенностью данной диеты является ограничение, пациентом количества потребляемой воды, включая кофе и чай. В сутки ему достаточно пить жидкости в объеме 1,5 л. Количество калорий, потребляемых за день, должно быть не больше 2500 ккал. Если больной имеет избыточный вес, калораж сокращают еще на 700 ккал. Полностью исключается соль, жареные продукты. Питание дробное, делится на шесть приемов пищи в день.
Пациенты с патологией атеросклероза должны придерживаться диеты на протяжении долгого времени. Возможно, что такой режим питания останется на всю жизнь. Чеснок. Творог, капуста и овсянка станут частым гостем пациента с данным заболеванием. Точно подобранный и правильно составленный режим приема пищи поможет не только улучшить состояние человека. Это отличное средство, как для лечения, так и профилактики атеросклероза.
Лечение атеросклероза сосудов можно проводить не только препаратами, но и продуктами питания. Нужно обязательно соблюдать диету и принимать витаминную пищу.
На сегодняшний день одним из ключевых факторов нарушения мозгового кровообращения, занимающего ведущее место среди причин смертности и инвалидизации населения высокоразвитых стран, является церебральный атеросклероз артерий головного мозга. Эта типичная болезнь цивилизации, характеризующаяся сужением просвета внутричерепных сосудов, питающих мозговые ткани, приводит к развитию атеросклеротического стеноза, являющегося главным «виновником» ишемического инсульта, дисциркуляторной энцефалопатии и сосудистых деменций (старческого слабоумия).
Механизм развития атеросклероза сосудов головного мозга
Атеросклероз в переводе с греческого означает твердая, плотная кашица (ἀθέρος — мякина, кашица, σκληρός — плотный, твердый). Это хроническое заболевание крупных артерий, сопровождающееся липидной инфильтрацией внутренней мембраны и разрастанием соединительной ткани в сосудистой стенке. Первые признаки патологического процесса могут выявляться в среднем и даже в достаточно молодом возрасте (15-20 лет).
На сегодняшний день, наряду с общепринятой теорией липопротеидной фильтрации (накоплением жировых молекул в сосудистой стенке) существуют другие гипотезы патогенеза церебрального атеросклероза: первичное нарушение защитных свойств внутреннего эпителия сосуда, перекисное окисление липидов, дефицит эссенциальных полиеновых жирных кислот, наличие тромботических, гемостатических и воспалительных факторов.
На ранней стадии патологического процесса, связанного с нарушением липидного обмена, на поверхности ранее поврежденной сосудистой стенки начинает накапливаться холестерин (нерастворимое в воде соединение, являющееся основой атеросклеротической бляшки). Постепенно на данном скоплении откладываются соли кальция и нити неоформленной соединительной ткани, в связи с чем, поверхность атеросклеротической бляшки начинает приобретать неправильную выпуклую форму.
Сужая просвет сосуда, холестериновый «нарост» затрудняет прохождение крови и создает предпосылки к возникновению турбулентных завихрений кровяного потока. Это приводит к разрушению клеток крови (тромбоцитов и лейкоцитов) и постепенному формированию тромба, способного при неблагоприятных для организма условиях оторваться и закупорить мозговую артерию. Вместе с тем спровоцировать острое нарушение кровообращения в сосудах головного мозга и привести к облитерации может оторвавшая холестериновая бляшка (размягченная эфирами холестерина или просто не успевшая затвердеть).
Чаще всего церебральный атеросклероз поражает внутреннюю и наружную сонные артерии.
Факторы риска и причины возникновения церебрального атеросклероза
Главная причина развития патологического процесса – нарушение липидного обмена, приводящее к отложению липопротеидов на стенках кровеносных сосудов. Спровоцировать данное состояние могут как экзогенные (внешние), так и эндогенные (внутренние) факторы.
Неизменяемые (немодифицируемые) факторы риска
- Возраст (чем старше человек, тем выше вероятность развития атеросклероза);
- Пол (церебральный атеросклероз чаще выявляется у мужчин вследствие недостаточной выработки эстрогена, помогающего расщеплять жиры);
- Наследственная предрасположенность.
Изменяемые (модифицируемые) факторы
- Нарушение жирового обмена (первичная и вторичная гиперхолистеринемия, высокое содержание холестерина низкой плотности, пониженный уровень холестерина высокой плотности, повышенное содержание в плазме крови триглицеридов);
- Артериальная гипертензия;
- Метаболический синдром;
- Повышенная масса тела, ожирение;
- Курение;
- Злоупотребление алкоголем;
- Гиподинамия (малоподвижный образ жизни);
- Нарушение углеводного обмена (сахарный диабет);
- Нерациональное питание с преобладанием в пищевом рационе животных жиров;
- Почечная недостаточность;
- Хронические воспалительные процессы;
- Гиперфибриногенемия (повышенная свертываемость крови);
- Высокий уровень гомоцистеина в крови;
- Психоэмоциональное перенапряжение, частые стрессовые и конфликтные ситуации.
По данным статистики атеросклероз сосудов головного мозга чаще всего обнаруживается у мужчин, достигших 45-50 лет, и у женщин после шестидесяти.
Виды атеросклероза сосудов головного мозга
- Метаболический;
- Возрастной;
- Воспалительный (туберкулезный, сифилитический);
- Гиалиноз (церебральный атеросклероз, развивающийся на фоне гипертонии);
- Токсический;
- Аллергический;
- Медиакальциноз Менкеберга (первичное отложение солей кальция в средней оболочке артерий).
Этапы развития церебрального атеросклероза
- Начальная стадия (образование липидных пятен и полосок). Данные формирования представляют собой желтоватые или желто-серые участки, не возвышающиеся над поверхностью сосудов, склонные к слиянию.
- Стадия прогрессирования (образование фиброзных бляшек). Плотно-эластичные поражения, возвышающиеся над поверхностью интимы, представляют собой круглые либо овальные «наросты» белого или желтоватого цвета. Как правило, они сливаются между собой, резко сужая сосудистый просвет и придавая внутренней поверхности артерии бугристый вид (так называемый стенозирующий атеросклероз).
- Стадия атероматоза (формирование отложенной атеросклеротической бляшки с характерным изъязвлением, кровоизлиянием и наложением тромботических масс). На данном этапе, из-за распада сложных лабильных жиро-белковых комплексов, в толще бляшки образуется мелкозернистый тканевой детрит (патологическая масса, состоящая из жировых скоплений, кристаллов холестерина, дегенерированных клеток эпителия и соединительно-тканных волокон).
- Завершающая стадия (атерокальциноз). Характеризуется обызвествлением (петрификацией) фиброзных бляшек и резкой деформацией сосудов.
Симптомы атеросклероза сосудов головного мозга
На начальной (ишемической) стадии заболевания пациенты жалуются на нарушение концентрации внимания и тупые, ноющие головные боли, возникающие вследствие сужения артерии атеросклеротической бляшкой, застоя крови и недостаточного снабжения головного мозга кислородом. На раннем этапе боли возникают после психической нагрузки, однако с течением времени они приобретают постоянный характер. Некоторые больные становятся вспыльчивыми, агрессивными, отмечается склонность к истерикам и депрессиям. Зачастую после полноценного отдыха негативные симптомы проходят, никак не отражаясь на работоспособности человека.
Для тромбонекротической стадии выраженных клинических проявлений церебрального атеросклероза характерно медленное прогрессирование симптомов. В данный период головные боли становятся более выраженными и продолжительными, постепенно ухудшается память, нарушается сон и трудоспособность, замедляется мышление, появляется шум в ушах, а также отмечается излишняя суетливость. Пациенты жалуются на головокружение, обмороки, возникновение трудностей с запоминанием текущих событий (при этом отдаленная память остается сохранной), развитие нарушения мелкой моторики рук, чувство нарушенного равновесия и неустойчивости в ногах. Для данной стадии заболевания свойственны периодические возникновения мозговых кризов (транзиторных ишемических атак), характеризующихся сильнейшими головными болями, нарушением зрительных и речевых функций, парезом нижней половины лица, ослабеванием или исчезновением чувствительности в конечностях, гемипарезом (параличом одной стороны тела). Как правило, подобная симптоматика наблюдается на протяжении 24-48 часов, после чего состояние пациента постепенно восстанавливается. В данной ситуации речь идет о преходящем нарушении мозгового кровообращения.
Если по истечении двух суток больному не становится легче, возникает подозрение на острое нарушение мозгового кровообращения (ишемический инсульт), требующее срочной медицинской помощи.
Заключительная (склеротическая) стадия атеросклероза сосудов головного мозга, которую нередко называют стадией сосудистой деменции, характеризуется отклонениями в психической деятельности (когнитивными, эмоциональными и поведенческими). Отмечается полная потеря работоспособности, деградация профессиональных умений, утрата ориентиров во времени и пространстве, неспособность контролировать свои потребности. Пациент забывает приобретенные навыки, в связи с чем ему требуется постоянная помощь в быту. По мере прогрессирования слабоумия констатируется полная деградация личности и дезадаптация к окружающей обстановке, развивается волчий аппетит или отвращение к еде, наблюдается самопроизвольная дефекация и мочеиспускание, зрительные и речевые отклонения. Такие больные требуют постоянного присмотра.
Диагностика церебрального атеросклероза
Постановка диагноза осуществляется неврологом. При этом учитываются данные анамнеза, жалобы пациента, клиническая картина заболевания и результаты диагностического обследования, включающие в себя:
Лабораторные методы диагностики
- Иммунологический анализ крови;
- Биохимический анализ крови (определение уровня триглицеридов, холестерола, ЛПВП, ЛПНП).
Инструментальные методы диагностики
- Ультразвуковое сканирование сосудов головного мозга;
- Магниторезонансную томографию;
- Транскраниальную допплерографию (оценку кровотока внутричерепных сосудов);
- Ангиографию (контрастное рентгенологическое исследование кровеносных сосудов головного мозга)
Лечение атеросклероза сосудов головного мозга
Лечение атеросклероза сосудов головного мозга проводится в комплексе, включающем в себя патогенетические и симптоматические терапевтические методики и коррекцию поведенческих факторов риска. Пациентам, страдающим церебральным атеросклерозом, настоятельно рекомендуется в корне пересмотреть свой рацион питания, постоянно поддерживать артериальное давление в пределах нормы, а также контролировать уровень холестерина и глюкозы в крови. В обязательном порядке следует отказаться от вредных привычек (курения и потребления спиртных напитков), нормализовать вес, максимально снизить нервно-психическое напряжение, упорядочить режим труда и отдыха, и обеспечить регулярную адекватную физическую нагрузку.
Медикаментозное лечение церебрального атеросклероза направлено на улучшение кровоснабжения мозговых сосудов, нормализацию липидного обмена и реологических показателей крови, уменьшение атеросклеротических бляшек, замедление развития патологического процесса и коррекцию сопутствующих заболеваний.
Патогенетическая терапия
Медикаментозная оптимизация кровообращения
Для коррекции нарушений, возникающих в микроциркуляторном русле, пациентам рекомендуется прием вазоактивных препаратов, влияющих на сосудистое кровообращение. В данную группу медикаментозных средств входят блокаторы кальциевых каналов (нимодипин, циннаризин, флунаризин), ингибиторы фосфодиэстеразы (пентоксифиллин, теофиллин, винпоцетин) и α-адреноблокаторы (нитроглицерин). Неплохо себя зарекомендовал препарат разнонаправленного действия, Танакан, улучшающий микроциркуляцию и стимулирующий нейрональные метаболические механизмы.
Антитромбоцитарная (антиагрегатная) терапия
Антитромбоцитарная терапия – это патогенетически обоснованный метод лечения, направленный на коррекцию и профилактику атеротромбоза. В настоящий момент в клинической практике используется 3 группы антитромбоцитарных препаратов: средства, содержащие аспирин, ингибиторы циклооксигеназы и тиенопиридины.
Наиболее популярным лекарственным средством, использующимся в профилактике и лечении цереброваскулярных патологий, является ацетилсалициловая кислота, снижающая склонность тромбоцитов к агрегации, подавляющая образование тромбина и оказывающая ингибирующее влияние на образование фибрина.
При приеме аспирина в комплексе с другим препаратом антитромбоцитарного ряда, клопидогрелем, характеризующимся альтернативным механизмом подавления тромбоцитов, эффективность лечения существенно увеличивается, а также решается множество проблем, связанных с резистенстностью пациентов к аспирину.
Гиполипидемическая терапия
Применение гиполтипидемических препаратов, стабилизирующих структуру атеросклеротических бляшек, значительно замедляет прогрессирование церебрального атеросклероза и снижает частоту острых преходящих нарушений мозгового кровообращения. Наибольшей гипохолистеринемической активностью обладают статины, нормализующие нарушенную функцию эндотелия. Они оказывают положительное влияние на пролиферацию гладкомышечных клеток артерий и обладают противовоспалительным, антитромбогенным и антиишемическим эффектом. Чаще всего пациентам назначают симвастатин и аторвастатин, с наиболее выраженным гипотриглицеридемическим действием.
В качестве дополнительных препаратов показано использование секвестрантов желчных кислот, применяющихся в комплексе со статинами для дальнейшего снижения уровня холестерина.
Первый гиполипидемический препарат, никотиновая кислота, способная снижать уровень ЛПНП, имеет ряд побочных эффектов, менее эффективна и обладает более высокой токсичностью.
Более действенными гипотриглицеридемическими препаратами являются производные фибриковой кислоты (фибраты). Как правило, они используются в качестве средств комбинированной терапии. К нежелательным побочным эффектам относят повышение концентрации желчи и риск развития желчнокаменной болезни.
Гипотензивная терапия
Немаловажное значение в предупреждении и стабилизации проявлений недостаточности мозгового кровообращения уделяется поддержанию адекватного артериального давления (на уровне 140/80 мм рт. ст.). При лечении церебрального атеросклероза в качестве антигипертензивных медикаментозных средств используют антагонисты рецепторов ангиотензина (ангиоканд, валсортан, ибертан и др.) и ингибиторы ангиотензин-превращающего фермента (эналаприл, цилазаприл, каптоприл и пр.). При приеме препаратов данной группы, помимо нормализации артериального давления, улучшаются когнитивные функции мозга.
Антиоксидантная терапия
По мере прогрессирования патологического процесса отмечается снижение антиоксидантных свойств плазмы. Поэтому при лечении атеросклероза сосудов головного мозга пациентам назначают витамин Е, аскорбиновую кислоту, препараты йода, актовегин, этилметилгидроксипиридина сукцинат.
Препараты комбинированного действия
В данную группу входят препараты, нормализующие венозный отток, реологические свойства крови и микроциркуляцию. К наиболее распространенным лекарственным средствам относят экстракт листьев гинко билоба, дигидроэргокриптин, кавинтон, пирацетам и циннаризин.
Симптоматическая терапия
В качестве медикаментозных средств для симптоматического лечения атеросклероза сосудов головного мозга используются антидепрессанты (амитриптиллин), психотропные средства (галопиридол) и транквилизаторы (диазепам, феназепам). При развитии синдрома сосудистой деменции пациентам рекомендуется прием ингибиторов холинестеразы, влияющих на обмен нейротрансмиттерных систем головного мозга.
Хирургическое лечение атеросклероза сосудов головного мозга
Пациентам с гемодинамически значимым окклюзионно-стенозирующим поражением магистральных артерий головного мозга рекомендуется оперативное вмешательство (стентирование артерий, чрескожная транслюминальная ангиопластика, шунтирование и протезирование сосудов, каротидная эндартерэктомия). Чаще всего хирургической коррекции подвергаются внутренние сонные артерии. Показанием к проведению операции является наличие рыхлой атеросклеротической бляшки или перекрытие более 70% просвета сосуда.
Немедикаментозное лечение
Немедикаментозные методы воздействия включают в себя специальную лечебную гимнастику, адекватную физическую и интеллектуальную нагрузку, рациональную психотерапию и посильное участие пациента в социальной жизни.
Осложнения церебрального атеросклероза
- Дисциркуляторная энцефалопатия, сопровождающаяся неспособностью к длительным нагрузкам, перепадами настроения и метеолабильностью;
- Психопатические изменения личности;
- Эпилептические припадки;
- Мозговой (ишемический) инсульт.
Диета при атеросклерозе сосудов головного мозга
При атеросклерозе сосудов головного мозга рекомендуется свести к минимуму потребление жирных, мясных и молочных блюд, соли, копченостей, яиц, шоколада, какао, крепкого кофе и чая. К противопоказанным продуктам относят крепкие мясные, грибные и рыбные бульоны, субпродукты, жирные и соленые сыры, консервы, жирные сорта рыб, рыбью икру, кремовые изделия, сдобную выпечку, острые и соленые закуски, а также щавель, шпинат, редьку и редис.
В дневной рацион пациента должны входить овощи (лук, чеснок, картофель, капуста, морковь, бобовые, баклажаны), зелень, ягоды и фрукты, растительное масло (подсолнечное, оливковое, соевое, кукурузное), морепродукты и нежирное мясо птицы, мед (при сахарном диабете не более чайной ложки), простокваша, кефир, нежирный творог, пшеничные отруби, грецкие орехи (1-2 шт. в сутки), морская капуста.
Пищу предпочтительнее отваривать или готовить на пару. Для предотвращения сгущения крови следует сбалансировать питьевой режим (до 1,5 литров воды в сутки). Калорийность суточного рациона должна составлять 2000-2500 калорий.
Дополнительные рекомендации для пациентов, страдающих нарушением мозгового кровообращения
Для предотвращения развития церебрального атеросклероза следует неукоснительно соблюдать врачебные рекомендации, включающие в себя:
- постоянный и курсовой прием лекарственных препаратов;
- отказ от курения и потребления алкогольных напитков;
- регулярный контроль веса и артериального давления;
- соблюдение низкокалорийной диеты;
- потребление в пищу продуктов, богатых витаминами;
- выполнение специальных оздоровительных упражнений;
- ежедневные прогулки на свежем воздухе.
Пациентам, страдающим нарушениями памяти, рекомендуется составлять план мероприятий на день, а также записывать всю необходимую информацию и поддерживать интеллектуальную активность (слушать музыку и интересующие радиопередачи, читать, смотреть телетрансляции, заучивать стихотворения, общаться с родными и близкими). Таким больным необходимо как можно дольше вести независимый образ жизни, выполнять посильную работу по дому и сохранять двигательную активность. Во избежание падения пользоваться дополнительными средствами опоры и соблюдать меры предосторожности (принимать душ в сидячем положении, носить удобную нескользкую обувь, использовать специальные ручки и поручни в ванной и в туалете и пр.).
Прогнозы
Церебральный атеросклероз – это хроническая патология, для которой характерно весьма длительное течение. Активное лечение на ранних стадиях заболевания приводит к улучшению состояния пациента и задержке развития патологического процесса. При острых расстройствах мозгового кровообращения и обширном поражении тканей мозга прогноз крайне неблагоприятен.
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