November 18, 2018

ЛЕЧЕНИЕ НЯК(НЕСПЕЦИФИЧЕСКИЙ ЯЗВЕННЫЙ КОЛИТ)

неспецифический язвенный колит

Лечение НЯК. (неспецифический язвенный колит) является хроническим заболеванием воспалительной природы. Он возникает из-за диффузного поражения слизистой оболочки толстой кишки. Болезнь неприятна тем, что причины ее достаточно размыты, точно установить их не удается. Существует несколько теорий, одна из которых связана с нарушением иммунитета. В группу риска входят люди с наследственной предрасположенностью к НЯК, наличием инфекции в ЖКТ, люди с ослабленной иммунной системой.

Неспецифический язвенный колитФото лечение НЯК

Исследования позволяют утверждать, что в толстом кишечнике локализуются антигены. Нормальный здоровый иммунитет не порождает антитела к антигенам, так как они распознаются как родные. При аутоиммунном заболевании система перестает идентифицировать антиген в качестве собственного и формирует антитела. Это приводит к разрушению клеток. Когда деструктивный процесс усиливается и приобретает значительные масштабы, начинается воспаление в толстом кишечнике.

Движение неспецифического язвенного колита начинается с прямой кишки. Далее воспаление проходит по всей территории слизистой оболочки толстой кишки. Треть зафиксированных случаев ограничена прямой и сигмовидной кишкой. Чаще всего воспаление захватывает область прямой кишки, сигмовидной, ободочной и поперечной.

Заболевание характеризуется острой стадией и фазой ремиссии. Симптомы различаются, все зависит от формы и состояния организма пациента в целом.

Лечение НЯК (неспецифического язвенного колита) проводит врач-гастроэнтеролог. Эта болезнь трудно Фото внутренние боли при НЯКподдается воздействию извне, но НЯК излечим. Для стабилизации состояния придется приложить много усилий, пройти курс терапии и изменить режим питания. При обострении необходимо обращаться к специалисту за медицинской помощью, так как самостоятельно преодолеть работать с симптомами сложно и небезопасно. В стадии ремиссии нужно регулярно наблюдаться у врача, чтобы отслеживать общее состояние и проявление воспалительного процесса.

При обострении НЯК нужно строго соблюдать постельный режим до тем пор, пока симптомы не станут менее интенсивными. При наступлении ремиссии разрешается вести привычный образ жизни, работать, заниматься нетяжелыми физическими нагрузками.

Лечение НЯК современные методики

Неспецифический язвенный колит в хронической форме пугает многих пациентов, которые с ним сталкиваются. Однако во время лечения и периода реабилитации придется следовать строгой диете и следить за состоянием кишечника, регулярно проверять кал, сдавать анализы. Стадии ремиссии протекают годами, не доставляя никакого дискомфорта человеку, но при неблагоприятном случае может наступить обострение. Полностью НЯК излечим, при неосложненной стадии и качественном лечении, статистика предлагает обнадеживающие цифры.

Современная базисная терапия включает препараты 5-аминосалициловой кислоты (5-АСК), или салицилаты. Однако из-за развития большого количества побочных эффектов специалисты усовершенствовали препарат и предложили использовать для борьбы с неспецифическим язвенным колитом форму 5-АСК без использования сульфапиридина с отличным от других механизмом освобождеия действующих веществ в ЖКТ. Среди наименований можно выделить Салофальк, Пентаа, Мезакол. Предпочтение отдается препаратам, выпускаемым в таблетках, оболочка разработана таким образом, чтобы вещество расщеплялось в нужном отделе ЖКТ.

При неудачах с 5-АСК или обнаружении внутрикишечного осложнения специалисты останавливаются на лечении кортикостероидами. Они дают блокировку фосфолипазы А2, препятствуют зарождению метаболитов и снижают действие цитокинов.

Специалисты утверждают, что лечение не будет приносить плоды, пока не будет пересмотрено питание пациента. Диета для людей с неспецифическим язвенным колитом важна, так как использование безопасных продуктов не дает воспалительному процессу развиваться. Показано повышенное количество калорий. На взрослого человека весом до 80 кг рассчитано 3000 ккал в день. Лечение НЯК запрещает употреблять:

  • алкогольные и газированные напитки;
  • молочную продукцию;
  • грибы и специи;
  • жирное мясо;
  • кислые фрукты;
  • шоколад, кофе, какао крепкий чай;
  • необработанные овощи, семечки;
  • все бобовые и кукурузу;
  • кетчуп, попкорн, майонез.

Благоприятно на состояние кишечника при неспецифическом язвенном колите влияют свежие фрукты и ягоды некислых сортов, крупы. Каши, вареные яйца, диетическое мясо, печень, морепродукты, сыр.

Что сегодня предлагает медицина для лечения НЯК?

Для борьбы с воспалительным процессом при неосложненной стадии неспецифического язвенного колита назначается комплексная терапия. Активно применяются лекарственные средства из категории аминосалицилатов. При обострении используют сульфасалазин в дозировке, определяемой врачом. Его нужно принимать до тех пор, пока не наступит облегчение и стадия ремиссии. Потом дозировка меняется и продолжается поддерживающая терапия. Используется месалазин для лечения обострений, при проявлении симптомов назначаются ректальные свечи с салофальком или месалозолом.

При агрессивном течении заболевания врачи применяют кортикостероиды. В тяжелых случаях эти препараты хорошо помогают снять воспаление, температуру и улучшить общее состояние. Несмотря на то, что у кортикостероидов множество противников, в некоторых ситуациях кроме них ничего не помогает. Считается, что гормональная терапия негативно сказывается на иммунной системе человека и наносит ей непоправимый вред. Однако в небольших дозах и при корректной терапии применение кортикостероидов не опасно.

Лечение  НЯК преднизолоном длится до месяца с последующим понижением дозы. При лечении НЯК показано применение иммунодепрессантов, например, Циклоспорина А и Азатиоприна. В качестве симптоматического лечения врач подбирает противовоспалительные препараты, которые мягко снимают боли и улучшают общее состояние. Популярны ибупрофен и парацетамол. При неспецифическом язвенном колите обязательно нужно восполнять недостаток витаминов и минеральных веществ, особенно витаминов групп С и В.

Связь между иммунитетом и НЯК обнаружена не так давно, использование иммунодепрессантов до сих пор отрабатывается в лабораторных условиях. За последние несколько лет активно стали применяться кортикостероиды местного действия. Они хуже всасываются в кишечнике и хорошо метаболизируются при первичном попадании в печень. У таких препаратов гораздо меньше побочных эффектов, чем у системного кортикостероидного препарата. В категорию современных решений для борьбы с НЯК можно отнести беклометозон дипропирнат, будезонид, флутиказона дипропионат.

Какие прогнозы?

Благодаря современным методикам лечения и уходу за пациентами терапия дает положительные результаты в 80% случаев. Прогнозы для легкой и среднетяжелой формы неспецифического язвенного колита более позитивные, в подавляющем большинстве достигается полная ремиссия. При тяжелой форме все зависит от множества факторов. Опасны осложнения, которые может дать НЯК: кишечное кровотечение, разрыв стенки кишки, образование свищей и абсцесса, сужение просветов кишечника.

Неспецифический язвенный колит может проявиться по-разному, это зависит от степени поражения кишечника и выраженности воспалительного процесса. Среди основных симптомов можно выделить кровотечение, которое обнаруживается в стуле. Чем ниже локализация кровотечения, тем более красные частички видны в каловых массах.

Если воспаление в верхних отделах, то кровяные сгустки окрашивают массу в темный, почти черный цвет. При НЯК стул становится частым, доходит до 6 раз за день. Чем тяжелее форма заболевания, тем чаще происходит дефекация, она сопровождается дискомфортом и болевыми ощущениями. В каловых массах может присутствовать кровь, слизь, гнойные выделения.

Частой жалобой пациента с НЯК является синдром неполного опорожнения. Позывы возникают часто, но после посещения туалета результата никакого нет. В отличие от других кишечных расстройств, при НЯК позыв к дефекации возникает даже ночью. Такой симптом часто сопровождают запоры, это связано со спазмами в прямой кишке из-за воспаления. Все это сопровождается затяжной болью.

Лечение НЯК

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