Hypotension Orthostatique (Hypotension Posturale)

Hypotension orthostatique — yitwa kandi hypotension postural — ni ubwoko bwa hypotension iterwa no guhagarara nyuma yo kwicara cyangwa kuryama. Hypotension orthostatique ishobora gutera guhinda umutwe cyangwa gucika intege, ndetse no kugwa.

Hypotension orthostatique ishobora kuba ari ntoya. Ibihe bishobora kuba bigufi. Ariko kandi, hypotension orthostatique iramara igihe kirekire ishobora kugaragaza ibibazo bikomeye. Ni ngombwa kubona umuvuzi w’ubuzima niba ukunda kumva ucika intege igihe uhagaze.

Hypotension orthostatique ya hato na hato iterwa n’ikintu kigaragara, nko kubura amazi cyangwa kuruhuka igihe kirekire mu buriri. Iyi ndwara iroroshye kuvurwa. Hypotension orthostatique ikaze isanzwe ari ikimenyetso cy’ikindi kibazo cy’ubuzima, bityo kuvura biterwa n’intandaro.

Ikimenyetso cy'indwara y'igitutu gito iyo umuntu ahagaze (orthostatic hypotension) gikunze kugaragara ni ukurwara umutwe cyangwa guhinda umutwe iyo umuntu ahagaze avuye mu kwicara cyangwa kuryama. Ibi bimenyetso bikunda kumara iminota mike.

Ibimenyetso n'ibigaragara ku muntu ufite indwara y'igitutu gito iyo ahagaze (orthostatic hypotension) birimo:

• Kurwara umutwe cyangwa guhinda umutwe iyo ahagaze
• Kubura neza uko ubona
• Intege nke
• Kugwa (syncope)
• Gusinzira

Urujijo cyangwa guhorana umutwe rimwe na rimwe bishobora kuba bito - biterwa no kubura amazi mu mubiri, isukari yo mu maraso iri hasi cyangwa ubushyuhe bukabije. Urujijo cyangwa guhorana umutwe bishobora kandi guterwa no guhagarara nyuma yo kwicara igihe kirekire. Iyo ibi bimenyetso bibaye rimwe na rimwe gusa, nta mpamvu yo guhangayika.

Ni ngombwa kubona umuvuzi w'ubuzima iyo ibimenyetso byo kugwa umuvuduko w'amaraso bikunze kugaragara. Gutakaza ubwenge, kabone niyo byaba ibya sekondes, ni ikintu gikomeye. Bisaba kubona umuvuzi ako kanya.

Komeza umubare w'ibimenyetso byawe, igihe byabaye, igihe byamaze ndetse n'icyo wakoraga icyo gihe. Vuga n'umuvuzi wawe niba ibimenyetso bigaragara mu bihe bishobora kuba bibi, nko mu gihe utwaye imodoka.

Iyo umuntu ahagaze avuye mu kwicara cyangwa kuryama, imbaraga z'isi zituma amaraso ateranira mu maguru no mu nda. Igitsure cy'amaraso kigabanuka kuko amaraso make arimo asubira mu mutima.

Ubusanzwe, utunyangingo twihariye (baroreceptors) turi hafi y'umutima n'imitsi y'umutwe, tubona igitsure cy'amaraso kigabanutse. Ibyo tunyangingo twohereza ubutumwa mu bwonko. Ibyo bituma umutima ukubita cyane kandi ukayobya amaraso menshi, bigatuma igitsure cy'amaraso kiguma kimwe. Ibyo tunyangingo binagabanya imitsi y'amaraso kandi bikongera igitsure cy'amaraso.

Hypotension orthostatique ibaho iyo ikintu cyabujije umubiri gukora neza mu kugabanya igitsure cy'amaraso. Ibintu byinshi bishobora gutera hypotension orthostatique, birimo:

• Kuma kwamazi. Umuhumetso, kuruka, kudakoresha amazi ahagije, impiswi nyinshi cyane no gukora imyitozo ikomeye cyane bigatuma umuntu akora ibyuya byinshi, byose bishobora gutera kumazi. Kumazi bigabanya umubare w'amaraso. Kumazi gake bishobora gutera ibimenyetso bya hypotension orthostatique, nko kugira intege nke, guhinda umutwe no kunanirwa.
• Ibibazo by'umutima. Bimwe mu bibazo by'umutima bishobora gutera igitsure cy'amaraso gito birimo umuvuduko muke cyane w'umutima (bradycardia), ibibazo by'amavavu y'umutima, ikibazo cy'umutima n'ikibazo cy'umutima. Ibyo bibazo birinda umubiri guhita ayobya amaraso menshi iyo ahagaze.
• Ibibazo by'imisemburo. Ibibazo by'umwijima, kudakora neza kw'imisemburo ya adrenal (indwara ya Addison) no kugira isukari nke mu maraso (hypoglycemia) bishobora gutera hypotension orthostatique. Diyabete na yo irashobora kubikora, kuko ishobora kwangiza imiyoboro y'umubiri ifasha kohereza ubutumwa bugengwa igitsure cy'amaraso.
• Indwara z'ubwonko. Zimwe mu ndwara z'ubwonko, nka Parkinson, atrophy y'imiterere myinshi, Lewy body dementia, kudakora neza kw'ubwonko bwose hamwe na amyloidosis, bishobora kubangamira ubushobozi bw'umubiri bwo kugenzura igitsure cy'amaraso.
• Kurya ibiryo. Bamwe mu bantu bagira igitsure cy'amaraso gito nyuma yo kurya (hypotension postprandiale). Iyo ndwara ibaho cyane mu bantu bakuze.

Ibintu bishobora gutera hypotension orthostatic harimo:

• Imyaka. Hypotension orthostatic igaragara cyane mu bantu bafite imyaka 65 n'irenga. Uturambu karemano (baroreceptors) turi hafi y'umutima n'imitsi yo mu ijosi, dukurikira igitutu cy'amaraso, dushobora kugenda buhoro buhoro uko umuntu akura. Nanone, umutima w'umuntu ugeze mu zabukuru ushobora kugorana kwihuta kugira ngo ubone uburyo bwo kugabanya igitutu cy'amaraso.
• Imiti. Iyi miti irimo imiti ikoreshwa mu kuvura igitutu cy'amaraso cyihuta cyangwa indwara z'umutima, nka diuretics, alpha blockers, beta blockers, calcium channel blockers, angiotensin-converting enzyme (ACE) inhibitors na nitrates.

Imiti indi ishobora kongera ibyago bya hypotension orthostatic irimo imiti ikoreshwa mu kuvura indwara ya Parkinson, imiti imwe n'imwe ibarwa mu miti yo kuvura ihungabana, imiti imwe n'imwe yo kuvura indwara zo mu mutwe, imiti ituma umubiri utuje, imiti yo kuvura ikibazo cyo kubura ubushobozi bw'igitsina, n'imiti ikomeye.

• Indwara zimwe na zimwe. Indwara zishobora kongera ibyago byo kugira igitutu cy'amaraso gito harimo zimwe mu ndwara z'umutima, nka ibibazo by'amavavu y'umutima, gufatwa n'indwara y'umutima no kunanirwa kw'umutima. Nanone harimo zimwe mu ndwara z'imiterere y'ubwonko, nka indwara ya Parkinson. Kandi harimo indwara zitera kwangirika kw'imitsi (neuropathy), nka diyabete.
• Ubushyuhe. Kuba ahantu hashyushye bishobora gutera ibyuya byinshi kandi bishobora gutera kukama, ibyo bikaba bishobora kugabanya igitutu cy'amaraso no gutera hypotension orthostatic.
• Kuryama mu buriri. Kuryama mu buriri igihe kirekire kubera uburwayi cyangwa imvune bishobora gutera intege. Ibi bishobora gutera hypotension orthostatic.
• Inzoga. Kunywa inzoga bishobora kongera ibyago bya hypotension orthostatic.

Hypotension ya orthostatic ihoraho ishobora gutera ingaruka zikomeye, cyane cyane mu bantu bakuze. Izo ngaruka zirimo:

• Ugwa. Kugwa kubera kubura ubwenge ni ingaruka isanzwe iba ku bantu bafite hypotension ya orthostatic.
• Stroke. Impinduka z'umuvuduko w'amaraso uva mu gihagararo no kwicara kubera hypotension ya orthostatic bishobora kuba ikintu gishobora gutera stroke kubera kugabanuka kw'amaraso ajya mu bwonko.
• Indwara z'umutima. Hypotension ya orthostatic ishobora kuba ikintu gishobora gutera indwara z'umutima n'ingaruka zabyo, nko kubabara mu kifuba, gucika intege kw'umutima cyangwa ibibazo by'umuvuduko w'umutima.

Intego y'umuganga mu kugenzura hypotension y'umubiri ni ugusanga impamvu no gusuzuma uburyo bwo kwivuza. Impamvu ntibisanzwe iba izwi. Umuganga ashobora gusesengura amateka y'ubuzima, imiti n'ibimenyetso kandi akora isuzuma ry'umubiri kugirango afashe gusuzuma icyo kintu. Umuganga nanone ashobora gushyiraho icyo cya mbere muri ibi bikurikira: Electrocardiogram (ECG cyangwa EKG). Iyi ngero yihuse kandi idatuma ububabure ikora kugenzura ibikorwa by'umurongo w'amashanyarazi mu mutima. Mu gihe cy'electrocardiogram (ECG), abasuzumyi (electrodes) bafatirwa ku gituza kandi rimwe na rimwe ku maboko cyangwa ibirenge. Imyenda ihujwe na mashini, ikora gusohora cyangwa kwerekana ibisubizo. ECG ishobora kwerekana impinduka mu rwego rw'amashanyarazi mu mutima cyangwa imiterere y'umutima n'ibibazo byo gutanga amaraso n'umwuka mu musatsi w'umutima. ECG ntishobora kumenya impinduka z'amashanyarazi mu mutima rimwe na rimwe. Umuganga wawe ashobora kugushishikariza kugenzura umutima wawe murugo. Icyuma cyo gufata umutima, cyitwa Holter monitor, gishobora gufatwa iminsi imwe cyangwa irenga kugirango gikore ibikorwa by'umutima mu gihe cy'ibikorwa bya buri munsi. Umuntu ufite isuzuma ry'itebure y'itebure atangira ngo yambare ku mubiri ku tebure. Imyenda ifata umuntu mu gace. Nyuma yo kwambara ku mubiri igihe runaka, itebure irasohozwa mu gace kigaragaza nk'uko umuntu yihagaze. Umuganga areba uko umutima n'umurongo w'amashanyarazi uwo ukorera uwo mutima uhindura ibyo bigaragaza. * Kugenzura umuvuduko w'amaraso. Ibi birimo kugenzura umuvuduko w'amaraso mugihe wicaye no kugenda. Kugabanuka kwa milimetero 20 z'umwuka w'umwuka (mm Hg) mu mibare y'icyambere (systolic blood pressure) mu minota 2 kugeza 5 nyuma yo guhaguruka ni ikimenyetso cya hypotension y'umubiri. Kugabanuka kwa mm Hg 10 mu mibare y'ikinyejana (diastolic blood pressure) mu minota 2 kugeza 5 nyuma yo guhaguruka nanone bivuga hypotension y'umubiri. * Gusuzuma amaraso. Ibi bishobora gutanga amakuru yerekeye ubuzima bwose, harimo hypoglycemia cyangwa anemia. Byombi bishobora gutuma umuvuduko w'amaraso uba hasi * Electrocardiogram (ECG cyangwa EKG). Iyi ngero yihuse kandi idatuma ububabure ikora kugenzura ibikorwa by'umurongo w'amashanyarazi mu mutima. Mu gihe cy'electrocardiogram (ECG), abasuzumyi (electrodes) bafatirwa ku gituza kandi rimwe na rimwe ku maboko cyangwa ibirenge. Imyenda ihujwe na mashini, ikora gusohora cyangwa kwerekana ibisubizo. ECG ishobora kwerekana impinduka mu rwego rw'amashanyarazi mu mutima cyangwa imiterere y'umutima n'ibibazo byo gutanga amaraso n'umwuka mu musatsi w'umutima. ECG ntishobora kumenya impinduka z'amashanyarazi mu mutima rimwe na rimwe. Umuganga wawe ashobora kugushishikariza kugenzura umutima wawe murugo. Icyuma cyo gufata umutima, cyitwa Holter monitor, gishobora gufatwa iminsi imwe cyangwa irenga kugirango gikore ibikorwa by'umutima mu gihe cy'ibikorwa bya buri munsi. * Echocardiogram. Amajwi y'amashanyarazi akoreshwa kugirango akore amashusho y'umutima mu gihe cyo gukora. Echocardiogram ishobora kwerekana uko amaraso akora mu mutima no mu mibare y'umutima. Iyo ngero ishobora gufasha gusuzuma indwara y'umutima. * Gusuzuma umutima. Gusuzuma umutima bikorwa mu gihe cyo gukora imikorere, nka kugenda ku mashanyarazi. Abantu badashobora gukora imikorere bashobora guhabwa imiti yo gukora umutima ukore byimbitse. Umutima uracyakorwa kugenzurwa na electrocardiography, echocardiography cyangwa izindi ngero. * Gusuzuma itebure. Gusuzuma itebure bireba uko umubiri uhindura ibyo bigaragaza. Bikorwa ngo yambare ku mubiri ku tebure ifite imiterere y'umubiri. Impinduka mu gace zigaragaza nk'uko umuntu yihagaze. Umuvuduko w'amaraso ukorwa kenshi mugihe itebure irasohozwa. * Valsalva maneuver. Iyi ngero idakoresha imiti isuzuma uko umurongo w'amashanyarazi ukora neza. Iyo ngero isaba ko umuntu ahumeka neza kandi akurikirane amashanyarazi mu kanwa, nk'aho yagerageza kuvura ikirere. Umutima n'umuvuduko w'amaraso byagenzurwa mu gihe cy'iyo ngero.

Ubuvuzi bwa hypotension orthostatic bugamije impamvu yayo kuruta igitutu cy'amaraso gito ubwacyo. Urugero, niba kukama ari byo biterwa na hypotension orthostatic, umuvuzi wawe ashobora kugutekerezaho guhindura imibereho nko kunywa amazi menshi. Niba imiti itera igitutu cy'amaraso gito iyo uhagaze, ubuvuzi bushobora kuba guhindura umwanya cyangwa guhagarika imiti.

Kuri hypotension orthostatic yoroheje, imwe mu buvuzi bworoshye ni ukwicara cyangwa kuryamira hasi ako kanya umaze kumva ucika intege umaze guhagarara. Akenshi, ibimenyetso bizashira. Rimwe na rimwe, imiti irakenewe kuvura hypotension orthostatic.

Niba hypotension orthostatic idakira iyo wahinduye imibereho, imiti ishobora kuba ikenewe kongera igitutu cy'amaraso cyangwa umubare w'amaraso. Ubwoko bw'imiti biterwa nubwoko bwa hypotension orthostatic.

Imiti ishobora gukoreshwa mu kuvura hypotension orthostatic irimo midodrine (Orvaten), droxidopa (Northera), fludrocortisone cyangwa pyridostigmine (Mestinon, Regonol).

Ganira n'umuvuzi wawe ku byiza n'ibibi by'iyi miti kugira ngo umenye iyihe ikubereye.

Uburyo bumwe bworoheje bushobora gufasha gucunga cyangwa gukumira hypotension orthostatic. Ibyo birimo:

Udupfukamunwa tw'igitutu, twitwa kandi udupfukamunwa dufasha, dukomesha amaguru, bikongerera umuvuduko w'amaraso. Umuntu ufite ubumenyi bwo kubyambika ashobora kugufasha kubyambara.

• Kwambara udupfukamunwa tw'igitutu tugera ku kirenge. Ibi bishobora gufasha kongera umuvuduko w'amaraso no kugabanya ibimenyetso bya hypotension orthostatic. Wambare umunsi wose, ariko ubikureho igihe ugiye kuryama no mu gihe uri kuryama.
• Kunywara amazi ahagije. Kuguma wisutse amazi bituma wirindira ibimenyetso by'umuvuduko muke w'amaraso. Nunywa amazi menshi mbere y'igihe kirekire uhagaze, cyangwa igihe cyose ugiye gukora ibikorwa bishobora gutera ibimenyetso.
• Kwirinda inzoga. Inzoga zishobora kuba mbi kuri hypotension orthostatic, bityo zigabanye cyangwa uzirinde burundu.
• Kongera umunyu mu mirire. Ibi bigomba gukorwa witonze kandi nyuma yo kubiganiraho n'umuganga. Umunyu mwinshi ushobora gutuma umuvuduko w'amaraso ugera hejuru y'igipimo cyiza, bikaba byatuma ugira ibindi bibazo by'ubuzima.
• Kurya amafunguro make. Niba umuvuduko w'amaraso ugabanuka nyuma yo kurya, kurya amafunguro make kandi adafite isukari nyinshi bishobora kugufasha.
• Gukora imyitozo. Gukora imyitozo ngororamubiri n'imyitozo yo gushimangira umubiri bishobora kugufasha kugabanya ibimenyetso bya hypotension orthostatic. Irinde gukora imyitozo mu gihe cy'ubushyuhe bukabije n'ubunyerere.
• Kwikorakorera no kwerekera mu buryo runaka. Reka umukono wawe urekere imbere mbere yo kwicara. Kugira ngo ugabanye ibimenyetso, komeza imikono yawe hamwe, komeza igifu na buri kibuno. Gukora squat, kugenda ahantu hamwe cyangwa guhaguruka ku ntoki.
• Guhaguruka buhoro buhoro. Himuka buhoro buhoro uvuye kuryama ukajya guhagarara. Nanone, igihe ugiye kuva mu buriri, icara ku nkengero y'uburiri iminota imwe mbere yo guhaguruka.
• Kuhagurutsa umutwe w'uburiri. Kuryama n'umutwe w'uburiri uhagaze gato bishobora gufasha kurwanya ingaruka z'uburemere.