Многие патологии оканчиваются травматическими осложнениями. Тромбоз в системе нижней полой вены возникает вследствие многих причин хирургического, метаболического, инфекционного и эндокринологического генеза. Состояние угрожает жизни пациента, поскольку тромботические массы могут оторваться и попасть с током крови в сердце, легкие и головной мозг. Поэтому своевременная диагностика и лечение помогут не только улучшить самочувствие пациента, но и спасти его.
ВАЖНО ЗНАТЬ! Даже "запущенный" варикоз можно вылечить дома, без операций и больниц. Просто прочитайте что говорит Екатерина Андреева читать рекомендацию.
Этиология и патогенез
Провоцируют тромбоз нижней полой вены следующие факторы:
- Обширные абдоминальные, торакальные и хирургические вмешательства. Операции на брюшной полости и грудной клетке сопровождаются образованием тромбов, которые мигрируют в систему нижней полой вены.
- Травма крупных трубчатых костей. При них возникает тромбоэмболия кусочками отделившегося костного мозга. Иммобилизация переломов также участвует в застое крови и тромбообразовании.
- Длительное обездвиживание. Пациенты с инсультами и другими тяжелыми состояниями вынуждены длительно пребывать в лежачем положении. Возникает застой в определенных участках, где и образуются тромбы.
- Пожилой возраст. Люди мало двигаются, что способствует образованию участков тромботических наслоений.
- Беременность. Меняется метаболизм женщины. Повышается концентрация тромбообразующих факторов. Увеличенная матка давит на сосуды, перекрывая частично просвет для тока крови.
- Период после родов. Часто образовываются тромбы при выполнении операции кесарева сечения. Возможна тромбоэмболия околоплодными водами.
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Более редкие факторы
Тромбоз нижней полой вены угрожает развиться даже при длительных перелетах или поездках в одном положении.
Симптомы венозного тромбоза
К тексту есть комментарии вы можете их прочитать
Вначале этот процесс может иметь размытую картину без четких признаков. Позже развиваются следующие симптомы:
- Боли в голенях и икрах нижних конечностей. Болезненные ощущения усиливаются при движении.
- Наличие на ногах вздувшихся вен. Возникает тромбофлебит — воспаление вен на фоне тромбирования сосудов.
- Отечность нижних конечностей. Кожа вследствие натяжения приобретает глянцевый оттенок. Может наблюдаться синюшность.
- Боль в коленном и голеностопном суставах.
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Как проводится диагностика?
Исследования состоят из общеклинических и специфических методов. К первым относятся забор крови и мочи на анализ, выполнение ультразвукового обследования брюшной полости. Среди специфических выделяют:
Очень важно! Андреева E.: "Я могу порекомендовать лишь одно средство для быстрого лечения варикоза" читать далее.
- Измерение уровня D-димера. Его уровень повышается при тромбозах любого генеза.
- Ангиография нижней полой вены. Это рентгенографическое обследование с использованием контраста поможет определить локализацию закупорки, ее величину и степень перекрытия просвета.
- Магнитно-резонансная флебография. Противопоказана людям с металлическими имплантами.
- Ультразвуковое дуплексное сканирование. С его помощью проводят дифференциальную диагностику с другими патологиями, имеющими похожие симптомы. Среди них лимфедема, опухолевые новообразования, инфильтрация при воспалении.
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Лечение тромбоза нижней полой вены
Назначения зависят от основного заболевания, спровоцировавшего этот процесс. Если тромбофлебит имеет опухолевый генез, проводят таргетную или лучевую терапию рака. Если причиной является образ жизни, корректируют его. Выделяют такие принципы терапии:
С помощью Фраксипарина образовавшийся кровяной сгусток рассасывается.
- Лизис (разрушение) образовавшихся тромбов с помощью тромболитиков. К таковым относятся препараты «Фраксипарин», «Эноксапарин».
- Введение антиагрегантов «Клопидогрел», «Тикагрелор».
- Антикоагулянты, препятствующие свертываемости крови.
- Симптоматическая терапия при осложнениях, отразившихся на деятельности легких, сердца, органов пищеварения и выделительной системы.
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Как предупредить?
Для профилактики процессов человек, предрасположенный к их возникновению, должен регулярно проходить осмотры у семейного доктора или флеболога. Мониторинг результатов лабораторных анализов и инструментальных методов исследования поможет вовремя заподозрить проблему. Человек должен придерживаться здорового образа жизни, желательно отказаться от курения вообще. Предотвратить тромбозы помогут регулярные занятия спортом, правильное питание, профилактика стрессов.
Чем опасно заболевание?
Вследствие этого состояния развиваются следующие патологии:
Профилактика
Для предупреждения следует регулярно проходить медицинские осмотры, учитывать консультации терапевтов и узких специалистов по сосудистым патологиям. Своевременное лечение преэклампсии, возникающей вследствие отторжения плода у беременных женщин, поможет предотвратить тромбоэмболию в молодом возрасте. Диагностика, сдача анализов людьми пожилого возраста также обезопасит их от закупорки сосудов, сохранит здоровье и жизнь.
Вам все еще кажется, что вылечить варикоз невозможно?
Судя по тому, что вы сейчас читаете эти строки — победа в борьбе с расширением вен и некрасивыми участками на теле пока не на вашей стороне.
И вы уже думали о стационарном лечении? Оно и понятно, ведь варикоз — очень опасное заболевание, которое при несвоевременном лечении может закончиться летальным исходом. Звездочки на ногах, быстрая утомляемость, ужасные вздувшиеся вены. Все эти симптомы знакомы вам не понаслышке.
Но возможно правильнее лечить не следствие, а причину? Рекомендуем прочитать историю Екатерины Андреевой. Читать статью >>
Как начинается заболевание
Тромбоз нижней полой вены делится на 2 типа. Признаки разные, поэтому докторам легче определить, что именно происходит.
- ТИП 1: перекрыт участок над зоной отхождения почечных артерий
Характерным симптомом является комплексное ухудшение состояния организма пациента. Больше всего страдают почки, повышается отечность. Анализы показывают белок в моче, низкий протеин в крови и почечную недостаточность.
- ТИП 2: перекрыт участок под зоной отхождения почечных артерий
Ухудшается внешний вид человека, появляются проблемы с функциональностью конечностей. Второй тип имеет симптомы, которые несут серьезный дискомфорт.
Все начинается с подкожных гематом, при осмотре у терапевта их сразу видно. Ноги все в отеках, которые переходят на лобок и мошонку.
Такие симптомы ведут к развитию трофических язв и сильных болей. Неприятные ощущения останавливаются в верхней части ноги и паху, давление вызывает запоры.
Для некоторых пациентов все усложняется такими симптомами, как рвота или лишь тошнота.
Что касается мужчин, то импотенция или отсутствие сексуального желания также относятся к симптомам развития болезни. А главный симптом, на который нужно обратить внимание, – это неприятное онемение ног, постоянные мурашки, чувство тревоги.
Причины заболевания
Причин появления данной патологии может быть довольно много. Стоит заметить, что образованию тромбов подвержена абсолютно вся сердечно-сосудистая система. Однако именно в ногах чаще всего образуются опасные сгустки. Происходит это из-за чрезмерной нагрузки на нижние конечности. Подобная проблема была у человека всегда, с того момента как эволюция сделала его прямоходящим.
Тем не менее нельзя сказать, что абсолютно все находятся в группе риска. В основном тромбоз проявляется у тех людей, которые ведут нездоровый образ жизни и не проводят профилактические меры для укрепления сосудов.
Согласно мнению специалистов, все причины, из-за которых у человека может развиться тромбоз, делятся на 3 группы:
- В первую очередь это касается повреждений стенок сосудов, что может произойти из-за различных факторов. К примеру, на сосудистую систему нижних конечностей может быть оказано механическое воздействие. Нередко повреждение сосудов происходит из-за инфекции либо аллергии. Подобное явление провоцирует появление шероховатостей на стенке. В результате этого некоторые клетки начинают задерживаться, накапливаться, а после формироваться в тромб.
- Причиной может стать повышенная свертываемость крови. Это провоцирует образование тромбов, которые начинают концентрироваться в области нижних конечностей. Особенно часто подобное явление отмечается у тех, кто много времени проводит на ногах и имеет вредные привычки.
- Третьей возможной причиной является медленное кровообращение. Такой патологией страдает немалое количество людей. При этом подобное явление может быть очень опасным, так как провоцирует тромбоз. В результате у человека могут быть проблемы с НПВ. Главная опасность такой ситуации заключается в том, что кровь не может нормально циркулировать. В результате некоторая часть жидкости просто отбрасывается назад. На месте застоя и появляются тромбы. Чаще всего подобное явление связано с малоподвижным образом жизни и некоторыми патологиями сосудистой системы.
Все причины могут появляться и одновременно. Это самая опасная ситуация, которая вызывает тромбоз нижней полой вены.
По происхождению тромбозы бывают первичными и вторичными. Первичные развиваются из-за генетических особенностей, врожденных дефектов, повреждений самой нижней полой вены.
Причины вторичных тромбозов – опухоль, распространяющаяся на этот сосуд или распространение процесса тромбообразования с более мелких вен.
Сам тромб в НПВ причины имеет в состоянии крови и сосудов.
Для образования сгустка крови, который перекрывает просвет вены и мешает оттоку крови, нужны три условия:
- Изменение состава крови, приводящее к повышению свертываемости.
- Замедление тока крови.
- Повреждение стенки сосуда.
Сначала образуется небольшой сгусток, который постепенно увеличивается, приводя к тромбозу. Этот процесс может распространяться от более мелких вен к более крупным.
Вторичный тромбоз нижней полой вены нередко проявляется, когда в организме происходят изменения, в результате которых создаются для него благоприятные условия.
К примеру, процессы тромбообразования нередко активизируются во время беременности, при долгом постельном режиме или некоторых заболеваниях.
Тромб может образоваться на любом участке кровеносной сети, однако больше всего этому подвержены нижние конечности и область малого таза. Этой особенности человек обязан эволюции: когда произошел переход к прямохождению, на ноги стала создаваться большая нагрузка при хождении.
Вместе с этим кровообращение затруднилось, поскольку крови приходится развивать большую скорость циркуляции для течения в вертикальном направлении.
Как и для любой разновидности тромбоза, для поражения нижней полой вены характерно множество причин, все их можно объединить в три большие группы.
Повреждения внутренней поверхности стенки вены
Это может произойти по разным причинам, которые можно условно разделить на механические, аллергические и инфекционные. В результате повреждения поверхность становится шероховатой и «тормозит» отдельные кровяные клетки, которые зацепляются за нее и, накапливаясь, формируют тромб.
Повышенная свертываемость крови
Для каждого человека характерен свой показатель свертываемости – у кого-то он в пределах нормы, у других ниже, у третьих выше. В последнем случае существует повышенная вероятность образования тромбов, причем в большинстве случаев в нижней части тела, где нередко образуются застои.
Повышенная свертываемость крови может наблюдаться из-за врожденных генетических аномалий, приобретенных патологий или даже негативного влияния вредных привычек и внешней среды.
Замедленное кровообращение
Проверяем признаки заболевания
Многие симптомы и проблемы в брюшной полости могут быть похожими на плохую работу нижней полой вены. Поэтому в первую очередь нужно идти к врачу.
Он сможет проверить видимые признаки и поставить предположительный диагноз. Но этого недостаточно.
Дальше начинается компьютерная диагностика. Процедура называется флебография.
В организм вводится контрастное вещество. Пациент идет на рентген и получает качественное фото.
Там видна локализация тромбоза. В большинстве случае врач назначает еще и УЗИ, чтобы оценить состояние брюшной полости.
Напоследок пациент сдает биохимический анализ крови, анализ мочи и анализ крови на свертываемость.
Тромбоз полой вены и его симптомы
Болезнь может поражать не только нижнюю, но и в верхнюю полую вену. При этом по признакам они несколько отличаются. При тромбообразовании в НПВ в первую очередь отмечается очень сильная отечность ног. Иногда бывает и так, что все туловище ниже пояса отекает. Это сопровождается сильной болью, а на животе могут показаться вены.
Но специалисты говорят, что подобная ситуация считается редкостью. Все дело в том, что тромбы нечасто образуются непосредственно в самой нижней вене. Они могут появиться раньше на одном из ответвлений, а после переместиться. Это будет создавать частичную помеху для движения кровотока, поэтому и симптоматика выражается не так явно. Но признаки отечности и боль все же будут беспокоить пациента.
В зависимости от того, какая именно часть вены была закупорена, зависит и локализация боли. Иногда подобный симптом появляется только с одной стороны, но бывает так, что он затрагивает все нижние конечности. Тромбоз верхней полой вены приводит к сильной боли в пояснице и животе.
Кожа на ногах может приобрести синюшный оттенок, а также станет отчетливо виден сосудистый рисунок.
При наличии подобных признаков необходимо обязательно обратиться к врачу. Если боль сильная, следует вызвать скорую помощь. Это важно, так как тромб в организме человека может стоить ему жизни.
Тромбоз нижней полой вены симптомы имеет обусловленные функциями этого крупного сосуда. Нижняя полая вена – сосуд, собирающий кровь от нижних конечностей, а также от органов таза и несет ее к правому желудочку сердца.
Тромб в нижней полой вене препятствует нормальному кровотоку, и сердце получает меньше крови, соответственно уменьшается и ее выброс в легкие.
Получается, что при проблемах в системе этого сосуда организм недополучает кислорода, поэтому могут страдать все органы. Нижняя полая вена образуется при слиянии двух вен: левой и правой подвздошной.
Тромбоз нижней полой вены у беременных обусловлен увеличением матки и давлением с ее стороны.
Особенно это ощущается в положении лежа. У женщины при этом может быть головокружение, ощущение дискомфорта, нехватки воздуха, возможны снижение артериального давления и дефицит кислорода.
Тромбоз подвздошных вен
Часто тромбоз носит восходящий характер и начинается в подвздошных венах. Для него характерны следующие симптомы:
- изменение цвета кожи ног,
- проступание рисунка подкожных вен в районе паха и лобка,
- увеличение паховых лимфоузлов,
- отечность ног,
- тупые ноющие боли в пояснице.
Изменение цвета кожных покровов происходит в случаях образования тромба в глубокой бедренной вене. Боли в спине и в пояснице могут быть на первых порах единственным симптомом.
Часто болезнь проявляется сильными болями, сопровожденными отеками и обильными покраснениями. Так же имеется сильное влияние на общее состояние больного. Повышенная утомляемость, сонливость и хроническая усталость постоянно присутствует у пациентов.
Больше половины случаев проходит бессимптомно или же с не ярко выраженными симптомами, такими как легкие отеки и редкие распирающие боли. По этой причине многие не спешат обращаться за помощью к врачу, не подозревая о всей серьезности данных симптомов.
Более подвержены тромбозу полой вены женщины, нежели мужчины. Причины тому спорны.
Гормональные препараты, которые принимают большинство женщин, неотъемлемую роль в образование тромбов, но не стоит забывать про повышенную усталость и не нормированный рабочий день – это так же сказывается на женском здоровье.
С каждым годом число людей подверженных этому заболеванию и треть из них женщины после сорока лет, растёт.
Так в зоне риска находятся люди, страдающие ожирением или набирающие стремительно массу тела. Тромбы могут появляться на многих частях тела, но в большей степени подвержены нижние конечности. К симптомам тромбоза нижней полой вены можно отнести расширение вен, головокружение и сильную тяжесть в ногах.
Как вылечить заболевание
Проще всего лечебные мероприятия проходят в том случае, когда тромбоз полой вены диагностируется на ранней стадии ее развития. Но заметить тромб бывает сложно, пока не появятся характерные симптомы, которые приведут к необходимости проведения тщательной диагностики.
В случае с ранним выявлением тромбообразования можно обойтись и безоперационными методами, например, использовать эффективные медикаменты. В таком случае пациента могут положить в стационар, чтобы специалисты смогли наблюдать за эффективностью лечения.
При необходимости врач может в экстренном порядке назначить хирургическое лечение. Это требуется в тех ситуациях, когда лекарственные препараты не только не дают должного результата, но и усугубляют ситуацию.
Задача любого врача – обеспечить нормальную работу нижней полой вены. Добиться этого он может с помощью таких методов лечения, как медикаменты или операция. Первый вариант более щадящий. С него и начинают.
В медикаментозное лечение входит применение антикоагулянтов. Это сложные препараты, которые борются непосредственно с тромбозом в брюшной полости.
Они разжижают кровь, чтобы все сгустки проходили быстрее, не застревая в узких местах. Препараты используются в лечении против воспалений.
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Антибиотики в схеме лечения назначаются в тех случаях, когда тромбоз стал следствием инфекции. Сначала врач назначает для лечения только общие антибиотики, а после детального анализа – специальные.
Если образовался тромб в нижней полой вене, лечение может быть консервативным, а в случае необходимости оперативным.
Среди консервативных методов наиболее действенна фибринолизин-гепариновая терапия, однако она эффективна менее, чем у половины больных.
Методом выбора при тромбозе глубоких вен чаще бывает хирургический. Современная ангиохирургия позволяет избавлять пациента от тромба и восстанавливать просвет вены.
Для получения максимально возможных результатов лечение нужно начинать насколько возможно раньше.
Лечение напрямую зависит от степени болезни. При начальной стадии или легком течении более серьезной, врач может назначить медикаментозное лечение. Основным лекарственным средством является препарат Гепарин. Он вводится внутривенно, с постепенным уменьшением дозы.
Во время применения Гепарина необходим постоянный контроль свёртываемости крови (до шести раз в сутки). Варфарин, Кумадин – вспомогательные препараты для подавления протромбина. Также возможно назначение некоторых Геоморфологических препаратов.
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Для хирургического вмешательства нужны резкие показания: сильное воспаление вены с тромбом, риск разрыва тромба или легочной артерии, распространение тромба по вене, отсутствие сцепления с веной (свободное передвижение тромба).
Оперативное вмешательство заключается в аппликации вены, установки артериовенозного шунта и Кава-фильтра. Перед операцией пациенту на ночь дают успокоительное и снотворное, для того что бы во время операции он находился в спокойном состояние, так как чрезмерная возбудимость и волнение могут привести к обрыву тромба.
Данная операция имеет ряд противопоказаний. Людям на острой стадии тромбоза вен, пациентам с болезнями сердца и сердечно сосудистой системы, а также имеющие тяжелые инфекционные заболевания на стадии обострения – нельзя делать операцию.
При тромбозе полой вены рекомендуется диета с полным исключение продуктов с содержанием витамина К и частичное исключение продуктов с витамином С. Уменьшение количества потребляемой жидкости входит в обязательный пункт лечения. Красный и зелёный перец, чеснок хорошо разжижают кровь, поэтому стоит обязательно включить их в диету.
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Если тромбоз диагностировался на ранних стадиях развития, есть возможность вылечить его без операции, то есть с помощью медикаментов. Терапия проводится в стационаре, где лечащий врач может постоянно наблюдать за состоянием пациента и при необходимости провести экстренное хирургическое вмешательство.
Возникновение тромбоза нижней полой вены опасно для жизни человека и требует обязательного врачебного вмешательства. Подобное патологическое состояние провоцируется различными сосудистыми заболеваниями.
Причины развития патологии
Патология чаще всего бывает вторичной. При этом кровяной сгусток попадает в вену с током крови. Первичная форма встречается редко и провоцируется хроническими заболеваниями сосудов.
Причины возникновения тромбоза нижней полой вены:
- курение;
- хронические инфекции;
- злокачественные опухоли;
- операции на нижних конечностях;
- беременность;
- тяжелые роды;
- заболевания крови;
- нарушения метаболизма;
- прием гормональных лекарств;
- заболевания сердца;
- длительное пребывание в неподвижном состоянии, например, во время тяжелой болезни;
- ожирение.
Тромбоз верхней полой вены возникает по тем же причинам и чаще всего диагностируется у пожилых людей.
Повреждения венозной стенки
Причиной является повреждение стенки вены. Патология характеризуется воспалительным процессом и травмированием сосуда, в результате чего внутри него образуется тромб, который и приводит к закупорке. Повреждение возникает при истончении вены, а также при потере эластичности.
Высокая свертываемость крови
Провоцирующим фактором тромбоза полой вены является повышенная скорость агрегации тромбоцитов, в результате чего формируются сгустки. Патологическая свертываемость крови сопряжена с потреблением жирной пищи, заболеваниями сердечно-сосудистой системы и малоподвижным образом жизни.
Медленный кровоток
Дополнительным фактором развития тромбоза считается нарушение кровообращения. Это возможно при патологиях сердца, а также при гипотонии. Медленный кровоток способствует склеиванию тромбоцитов, в результате чего формируется сгусток, закупоривающий просвет вены.
Симптомы
Тромбоз верхней полой вены может никак не проявляться в течение некоторого времени. При полной обструкции возникает тяжелая симптоматика.
Инфраренальный сегмент
Тромб формируется в подвздошной вене с левой или правой стороны. Конечности могут отекать и краснеть. При этом признаки патологии проявляются не только в ногах. Может ощущаться боль внизу живота — через кожу в этой области видна сосудистая сетка.
Печеночный сегмент
При обструкции супраренального сегмента в печени скапливается большое количество крови. При этом возникают такие проявления, как:
- отек;
- боли в правом подреберье;
- увеличение печени;
- появление желтого оттенка кожи.
Ренальный и супраренальный сегменты
При поражении данных областей можно столкнуться со следующими симптомами:
- общим неудовлетворительным самочувствием;
- лихорадкой;
- повышением АД;
- болями в пояснице;
- бледностью кожи;
- варикоцеле;
- тошнотой и рвотой;
- нарушениями стула;
- ухудшением оттока мочи.
Лечение патологии
Тромбоз верхней полой вены устраняется так же, как и при поражении нижнего сегмента. Применяют медикаменты, а в сложных случаях прибегают к хирургическому вмешательству. В качестве вспомогательной терапии используют народные рецепты и диетическое питание.
Медикаментозный метод
Терапия направлена на восстановление кровотока. Для этого применяют:
- Тромболитики. Назначают для устранения кровяных сгустков. К таким препаратам относят Варфарин, Тромбо АСС и другие.
- Флеботоники. Снижают давление в сосудах, препятствуя их расширению и улучшая отток крови. Чаще всего для лечения применяют такие препараты, как Флебодиа и Венарус.
- Антикоагулянты. Способствуют разжижению крови. Для этих целей часто применяют ацетилсалициловую кислоту.
- НПВС. Назначают для устранения воспаления и избавления от боли. К таким медикаментам можно отнести Диклофенак, Найз и т.д.
Медикаментозная терапия эффективна на начальной стадии тромбофлебита и венозной недостаточности.
Оперативный метод
Удаление тромба необходимо при высоком риске эмболии легкого, что опасно летальным исходом. Наиболее распространенной методикой является эндоваскулярная операция, которая проводится при помощи специального катетера, позволяющего расширить просвет сосуда.
Иногда вену ушивают, применяя миниатюрные скобы и создавая таким образом фильтр. В крайних случаях прибегают к перевязке сосудов. Хирургическое вмешательство по удалению тромба часто проводится под общим наркозом. Доступ к сгустку осуществляется с помощью тонкого зонда, за движением которого можно проследить на мониторе компьютера.
После извлечения тромба больному необходимо принимать препараты, влияющие на свертываемость крови. Реабилитация не занимает много времени.
Методы народной медицины
Методы народной медицины не смогут помочь избавиться от тромба, но улучшат состояние стенки сосудов, что важно для полного излечения. Полезным свойством обладает вербена. 2 ч.л. сырья рекомендуется залить 250 мл кипятка и оставить на час. Затем жидкость нужно профильтровать и принимать по 2 ст. л. 3 раза в день перед едой. Курс лечения составляет не менее 2-3 месяцев.
Для улучшения состояния сосудов часто применяют свежевыжатый цитрусовый сок. Лучше всего для этих целей употреблять апельсиновый. Добавлять сахар в него не рекомендуется. Выпивать нужно по 1 стакану через 1 час после завтрака. Делать это следует на протяжении 2 месяцев. Сок цитрусовых содержит витамин С, который укрепляет стенки сосудов.
Диетическое питание
При наличии тромбоза полой вены важно устранить такой провоцирующий фактор, как ожирение. Для этого необходимо снизить потребление жиров. Важно исключить мясо, жареные блюда, сливочное масло, фастфуд и т.д. В рационе должна преобладать растительная клетчатка. Разрешена отварная курица и рыба.
В меню должны входить фрукты, овощи, зерна пшеницы, крупы, орехи, рыбий жир и зеленый чай. Питание должно быть дробным и сбалансированным. Важно соблюдать питьевой режим. Необходимо употреблять больше воды, отвара шиповника и травяных чаев. От кофе и алкоголя лучше отказаться совсем.
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