Matenda a matenda ashuga hyperosmolar

Hyperosmolar Diabetesic Coma ndizosiyanasiyana chikomokereyodziwika ndi kuphwanya kwakukulu kagayidwe ndi matenda matenda ashuga Pakati pochulukirapo shuga mu magaziomwe amafika 55 mmol / l kapena kupitilira.

Hyperosmolar coma imadziwika ndi kufooka kwa thupi, hyperchloremia, hypernatremia, cell exicosis, azotemia. Chisoni choterechi chimakhala pafupifupi faifi peresenti ya ma comes onse, ndipo mwayi wake woti amwalira ndi kuyambira 20 mpaka 50 peresenti.

Kukula kwa chikumbumtima kumachitika pang'onopang'ono. Kuyambira masiku asanu mpaka khumi ndi anayi, dziko lokometsetsa, lomwe limadziwika ndi kuwonongeka kwa kagayidwe kazakudya, limatha kukhalapo. Nthawi imeneyi, kugona, matenda ashuga, ludzukamwa yowuma, kufooka. Zizindikirozi zimawonjezeka msanga, kupuma movutikira kumawoneka, kununkhira kwa acetone mu zaka zotopa.

Hyperosmolar coma nthawi zambiri imayamba kupezeka odwala atakwanitsa zaka makumi asanu ndimatenda a 2 shuga, omwe amalipiritsa pogwiritsa ntchito mankhwala ochepetsa shuga a sulfonamide kapena zakudya. Mwa anthu osakwanitsa zaka makumi anai, vuto lotere limakhala losowa, ngakhale nthawi zina kumachitika zinthu zina.

Pafupifupi theka la anthu omwe adadwala hyperosmolar coma, mawonekedwe ake amaphatikizidwa ndi matenda ashuga, theka lachiwiri, chikomokere pazifukwa zina.

Zinthu zazikulu zomwe zimatsogolera pakupanga kukomoka ndi:

• Pancreatitis ndi gastroenteritis, yomwe imatsatana ndi matenda am'mimba komanso kusanza
• Pachimake coronary ndi cerebrovascular ngozi
• Kuvulala ndikuwotcha
• Matenda opatsirana
• Kulowa matenda opatsirana

Komanso, mitundu yosiyanasiyana ya magazi amathandizira kuti pakhale mtundu wa chikomokere, kuphatikizapo omwe amayamba chifukwa cha opaleshoni. Kukomoka kwa matenda ashuga kotereku kumatha kupangidwanso chifukwa cha kufinya kwamitsempha, hemodialysis, kuyambitsidwa kwa Mlingo waukulu wa mannitol, hypertonic ndi saline njira, munthawi ya mankhwala ndi ma immunosuppressants, glucocorticoids ndi diuretics. Kukhazikitsidwa kwa shuga ndi kumwa kwambiri kwa zakudya zamafuta, monga lamulo, kumakulitsa vutoli.

Njira zochizira zimaperekedwa m'chipinda chothandizira kwambiri kapena m'malo osungirako anthu ovomerezeka. Zovuta zakuchotsa wodwala ku hyperosmolar coma ndikuyambitsa kuchuluka kwa insulin ndi yankho la sodium chloride. Pankhani yodzazindikira mochedwa, mwayi woti umwalira ndi wokwera.

Maphunziro: Omaliza maphunziro ku Vitebsk State Medical University omwe ali ndi digiri ku Surgery. Ku yunivesiteyo, adatsogolera Council of the Student Science Science Society. Maphunziro ena mu 2010 - mu "Oncology" apadera komanso mu 2011 - mu apadera "Mammology, mawonekedwe a oncology".

Zokumana nazo: Gwirani ntchito pachipatala chodziwikiratu kwa zaka zitatu monga dokotala wa opaleshoni (Vitebsk emergency hospital, Liozno CRH) ndi oncologist wachigawo komanso wa traumatologist wa nthawi yayitali. Gwira ntchito ngati nthumwi yaulimi mzaka zonse ku Rubicon.

Adapereka malingaliro atatu omasulira pamutu wakuti "Kukhathamiritsa kwa mankhwala opha maantibayotiki kutengera mtundu wa microflora", 2 ntchito zidapeza mphotho mu republican mpikisano-wamaapepala owerengera ophunzira (magawo 1 ndi 3).

Hyperosmolar chikomine mu matenda a shuga (pathogeneis, mankhwala)

Chimodzi mwa zoopsa komanso nthawi yomweyo wosaphunzira bwino za matenda ashuga ndi hyperosmolar coma. Pali kutsutsanabe pamakina omwe adachokera ndikukula kwake.

Matendawa alibe pachimake, mkhalidwe wa anthu odwala matenda ashuga amatha kukhala wowopsa kwa masabata awiri isanakwane kuvuta koyamba kwa chikumbumtima. Nthawi zambiri, chikomokere chimapezeka mwa anthu opitilira zaka 50. Madokotala nthawi zambiri samatha kudzipangitsa kuti adziwe ngati wodwala ali ndi matenda ashuga.

Chifukwa chakulandila kuchipatala mochedwa, zovuta zodziwonetsa, kuwonongeka kwambiri kwa thupi, chikomokere cha hyperosmolar chimakhala ndi chiwopsezo chachikulu cha kufa kwa 50%.

>> Matenda a shuga - mitundu yake ndi chisamaliro chadzidzidzi ndi zotsatira zake.

Kusekerera kwa hyperosmolar ndi vuto lotha kuzindikira m'machitidwe onse: mphamvu, ntchito za mtima ndi kuchepa kwa thupi, mkodzo umasiya kuchotsedwa. Munthu panthawiyi amakhala ndi malire pam moyo ndi imfa. Choyambitsa mavuto onsewa ndi hyperosmolarity yamagazi, ndiko kuti, kuchulukana kwamphamvu mu kupsinjika kwake (kuposa 330 mosmol / l wokhala ndi chizolowezi 275-295).

Mtundu wamtunduwu umadziwika ndi shuga wamagazi ambiri, pamwamba pa 33.3 mmol / L, komanso kutopa kwambiri. Pankhaniyi, ketoacidosis kulibe - matupi a ketone samapezeka mkodzo ndi mayeso, kupuma kwa wodwala matenda ashuga sikufungo la acetone.

Malinga ndi gulu lapadziko lonse lapansi, hyperosmolar coma imatchulidwa kuti ndikuphwanya kagayidwe kamchere wamadzi, khodi malinga ndi ICD-10 ndi E87.0.

Matenda a hyperosmolar amayamba kudwala mwadzidzidzi; muzochitika zachipatala, vuto limodzi limapezeka mwa odwala 3300 pachaka. Malinga ndi ziwerengero, pafupifupi odwala ali ndi zaka 54, akudwala matenda a shuga osadalira insulin 2, koma osawongolera matendawa, motero, ali ndi zovuta zingapo, kuphatikizapo matenda ashuga a nephropathy omwe amalephera. Mu gawo limodzi mwa magawo atatu a odwala omwe ali ndi chikomokere, matenda a shuga ndiwotalika, koma sanapezeke ndipo, motero, sanalandiridwe nthawi yonseyi.

Poyerekeza ndi ketoacidotic coma, hyperosmolar coma imachitika kangapo ka 10. Nthawi zambiri, mawonetseredwe ake ngakhale osavuta amasiyidwa ndi odwala matenda ashuga okha, osazindikira ngakhale pang'ono - amasintha shuga m'magazi, amayamba kumwa kwambiri, komanso amatembenukira kwa a nephrologist chifukwa cha vuto la impso.

Hyperosmolar coma imayamba matenda a shuga mellitus mothandizidwa ndi izi:

1. Kuthetsa madzi m'thupi kwambiri chifukwa cha kupsa kwambiri, kugwiritsa ntchito bongo mopitirira muyeso, poyizoni ndi matenda am'matumbo, omwe amayenda ndi kusanza komanso kutsegula m'mimba.
2. Kuperewera kwa insulini chifukwa chosagwirizana ndi zakudya, kuchotsera pafupipafupi kwa mankhwala ochepetsa shuga, matenda owopsa kapena kulimbitsa thupi, chithandizo cha mankhwala osokoneza bongo omwe amalepheretsa kupanga insulin.
3. Matenda a shuga osadziwika.
4. Kutalika kwa impso popanda chithandizo choyenera.
5. Hemodialysis kapena glucose wolowa pamene madokotala sakudziwa za shuga m'm wodwala.

Kukhazikika kwa hyperosmolar coma nthawi zonse kumayendera limodzi ndi hyperglycemia. Glucose imalowa m'magazi kuchokera mu chakudya ndipo imapangidwa nthawi yomweyo ndi chiwindi, kulowa kwake mu minofu ndizovuta chifukwa chotsutsana ndi insulin. Pankhaniyi, ketoacidosis sichimachitika, ndipo chifukwa chakusowa kwawo sichinadziwikebe bwinobwino. Ofufuza ena amakhulupirira kuti mtundu wa hyperosmolar wa coma umayamba pamene insulin ikukwanira kuletsa kuwonongeka kwa mafuta ndi mapangidwe a matupi a ketone, koma ochepa kwambiri kuti athe kutsekereza kuchepa kwa glycogen m'chiwindi ndikupanga shuga. Malinga ndi mtundu wina, kumasulidwa kwa mafuta acids kuchokera ku minyewa ya adipose kumapanikizika chifukwa chosowa ma hormone kumayambiriro kwa vuto la hyperosmolar - somatropin, cortisol ndi glucagon.

Kusintha kwina kwa pathological komwe kumayambitsa hyperosmolar coma kumadziwika bwino. Ndi kupita patsogolo kwa hyperglycemia, kuchuluka kwa mkodzo kumawonjezeka. Ngati impso imagwira ntchito mwachizolowezi, ndiye kuti malire a 10 mmol / L akapitilira, shuga amayamba kuthiridwa mkodzo. Ndi vuto laimpso, matendawa samachitika nthawi zonse, ndiye kuti shuga amadziunjikira m'magazi, ndipo kuchuluka kwa mkodzo kumawonjezeka chifukwa cha kulowetsedwa kwa impso, kuperewera kwa madzi kumayamba. Madzi amasiya maselo ndi malo pakati pawo, kuchuluka kwa magazi omwe amayendayenda kumachepa.

Chifukwa cha kuchepa mphamvu kwa maselo a muubongo, kusintha kwa minyewa kumachitika, kuwonjezeka kwa magazi kumakhumudwitsa thrombosis, ndipo kumayambitsa kusakwanira kwa magazi ku ziwalo. Potengera kuchepa kwa madzi, mapangidwe a aldosterone amakula, omwe amalepheretsa sodium kulowa mkodzo kuchokera m'magazi, ndipo hypernatremia imayamba. Iyenso amakwiya ndipo amatupa mu ubongo - chikomokere chimachitika.

Kukula kwa vuto la hyperosmolar kumatenga sabata limodzi kapena awiri. Kusintha kumachitika chifukwa chakuwonongeka pakubwezeredwa kwa shuga, kenako zizindikiro za kuchepa thupi. Pomaliza, zizindikiro zamitsempha ndi zotsatira za kuthamanga kwa magazi zimachitika.

Hyperosmolar non-ketone coma - kuphatikiza kwamphamvu kwa matenda a shuga 2, okhala ndi vuto la shuga komanso kuwonjezeka m'magazi, kuwonjezereka kwa plasma osmolarity, kutulutsa kuchepa kwa magazi, komanso kusowa kwa ketoacidosis. Zizindikiro zazikulu ndi polyuria, kuchepa thupi, kuchepa kwa minofu, kukokana, kugona kugona, kuyerekezera zinthu zina, kuyankhula mosagwirizana. Pozindikira, anamnesis amatengedwa, wodwala amawunika, ndipo mayeso angapo a labotale magazi ndi mkodzo amachitidwa. Chithandizo chimaphatikizanso kukhathamiritsa thupi, kubwezeretsanso kuchuluka kwa insulin, kuchotsa ndi kupewa zovuta.

Hyperosmolar non-ketone coma (GONK) idafotokozedwa koyamba mu 1957, mayina ake ena ndi ketogenic hyperosmolar coma, diabetesic hyperosmolar state, acute hyperosmolar non-acidotic kishu. Dzinali limafotokozanso za machitidwe ake akuluakulu - kuchuluka kwa ma seramu odziwika a seramu ndi okwera, kuchuluka kwa insulin kumakwanira kuyimitsa ketonogenesis, koma sikuletsa hyperglycemia. GONK samapezeka kawirikawiri, pafupifupi 0.04-0.06% ya odwala matenda ashuga. Mu milandu 90-95%, amapezeka mwa odwala omwe ali ndi matenda a shuga a 2 komanso amalephera aimpso. Pangozi yayikulu ndi okalamba komanso a senile.

GONK imakula chifukwa cha kufooka kwamadzi. Pafupipafupi zinthu zam'mbuyomu ndi polydipsia ndi polyuria - kuchuluka kwa mkodzo ndi ludzu kwa milungu ingapo kapena masiku asanafike matendawa. Pachifukwachi, okalamba ndi gulu lomwe limakhala pachiwopsezo - kaonedwe kawo ka ludzu nthawi zambiri limasokonekera, ndipo ntchito ya impso imasinthidwa. Mwa zina mwazinthu zokhumudwitsa, pali:

Ndi kuchepa kwa insulin, shuga yemwe amayenda m'magazi samalowa m'maselo. Mkhalidwe wa hyperglycemia umayamba - msinkhu wokwera shuga. Njala yam'mimba imasokoneza kutsika kwa glycogen ku chiwindi ndi minofu, zomwe zimapangitsanso kuchuluka kwa shuga kulowa m'magazi. Pali osmotic polyuria ndi glucosuria - njira yowonjezera yopanga shuga mumkodzo, pomwe, imasokonezeka ndi kuchepa kwamadzi, kutaya madzi msanga, kuwonongeka kwaimpso. Chifukwa cha polyuria, hypohydration ndi hypovolemia mawonekedwe, ma electrolyte (K +, Na +, Cl -) amataika, homeostasis yamkati wamkati ndikugwira ntchito kwa kusintha kwa dongosolo. Chomwe chimasiyanitsa ndi GONC ndikuti kuchuluka kwa insulin kumakhalabe kokwanira kuti tiletse mapangidwe a ma ketones, koma otsika kwambiri kuti athe kupewa hyperglycemia. Kupanga kwamahomoni a lipolytic - cortisol, mahomoni okula - amakhalabe otetezeka, omwe amafotokozanso kusowa kwa ketoacidosis.

Kusungabe yachilengedwe matupi a ketone ya plasma ndikusungitsa boma lokhala ndi asidi kwa nthawi yayitali kumafotokozera zamankhwala a GONK: palibe kuthamanga komanso kupumira, palibiretu zizindikiro paziwonetsero zoyambirira, kuwonongeka kwa kupezeka bwino kumachitika ndi kuchepa kwamphamvu kwa magazi, kukanika kwa ziwalo zofunika zamkati. Mawonekedwe oyamba nthawi zambiri amakhala opanda nzeru. Amachokera ku chisokonezo ndi chisokonezo mpaka kukomoka kwambiri. Kukhumudwa kwa minofu yakumaloko komanso / kapena kulumikizidwa pamodzi kumawonedwa.

Pakupita masiku kapena masabata, odwala amamva ludzu kwambiri, amadwala matenda ochepa, tachycardia. Polyuria imawonetsedwa ndi kukakamiza pafupipafupi komanso kukodza kwambiri. Zovuta zamkati mwa dongosolo lamanjenje zapakati zimaphatikizapo zizindikiro zamagetsi ndi minyewa. Kusokonezeka kumachitika ngati delirium, pachimake hallucinatory-delusional psychosis, kugwidwa kwa catatonic. Zowonjezera kapena zochepa zotchulidwa zakukula kwamitsempha yamagetsi yam'magazi ndi mawonekedwe - aphasia (kusweka kwa mawu), hemiparesis (kufooka kwa minofu ya miyendo mbali imodzi ya thupi), tetraparesis (kuchepa kwa magwiridwe antchito amiyendo ndi miyendo), kusokonezeka kwa mphamvu ya ma polymorphic, kusokonezeka kwa m'mitsempha ya m'mimba.

Palibe chithandizo chokwanira, kuchepa kwamadzi kumachulukirachulukira ndipo pafupifupi malita 10. Kuphwanya kayendedwe kamchere wamchere kumathandizira kukulitsa kwa hypokalemia ndi hyponatremia. Kupuma ndi mtima kumabweretsa mavuto - kusefukira kwa chibayo, kupuma kwamatenda osokoneza bongo, thrombosis ndi thromboembolism, magazi chifukwa chofalitsidwa. Pathology ya kufalitsidwa kwamadzimadzi imatsogolera ku pulmonary ndi ubongo edema. Zomwe zimayambitsa imfa ndi kusowa kwamadzi komanso kusayenda bwino kwa magazi m'thupi.

Kuyesedwa kwa odwala omwe ali ndi GONK yokayikiridwa kumatengera kutsimikiza kwa hyperglycemia, hyperosmolarity wa plasma ndi chitsimikiziro cha kusowa kwa ketoacidosis. Kuzindikira kumachitika ndi endocrinologist. Zimaphatikizaponso kusonkha kwa zidziwitso zokhudzana ndi zovuta komanso magawo a mayeso a labotale. Kupanga matenda, njira zotsatirazi ziyenera kuchitidwa:

• Kutolere zamankhwala ndi zamankhwala. Adokotala a endocrinologist amawerengera mbiri yachipatala, amatenga mbiri yowonjezera yazachipatala pakuwunika kwa wodwala. Kukhalapo kwa kupezeka kwa matenda a shuga II a mellitus, okalamba wazaka zopitilira 50, kusokonezeka kwa impso, kusagwirizana ndi malangizo a dokotala pokhudzana ndi chithandizo cha matenda ashuga, ziwalo zothandizirana ndi matenda opatsirana amachitira umboni ku GONK.
• Kuyendera Panthawi yoyesedwa ndi katswiri wa matenda am'mimba ndi endocrinologist, zizindikiro za kuchepa kwa madzi zimatsimikizika - minofu turgor, kamvekedwe ka diso kumachepetsedwa, kamvekedwe ka minofu ndi mawonekedwe a thupi a tendon amasinthidwa, kuthamanga kwa magazi ndi kutentha kwa thupi kumachepa. Mawonekedwe a ketoacidosis - kupuma movutikira, tachycardia, mpweya wa acetone kulibe.
• Zoyeserera zasayansi. Zizindikiro zazikulu ndi kuchuluka kwa glucose pamwamba pa 1000 mg / dl (magazi), osmolality ya plasma nthawi zambiri imaposa 350 mosm / l, ndipo milingo ya ma ketoni mumkodzo ndi magazi ndi yabwinobwino kapena pang'ono. Mlingo wa shuga mumkodzo, kuchuluka kwake ndi kuchuluka kwa phula m'magazi kumayang'anira kusungika kwa impso, mphamvu zowonjezera thupi.

Pokonzekera matenda osiyanasiyana, ndikofunikira kusiyanitsa pakati pa hyperosmolar non-ketone coma ndi matenda ashuga a ketoacidosis. Kusiyana kwakukulu pakati pa GONC ndi kalozera wotsika kwambiri wa ketone, kusowa kwa zizindikiro zakuchipatala za kuchuluka kwa ketone, ndi mawonekedwe a zizindikiro kumapeto kwa hyperglycemia.

Thandizo loyamba limaperekedwa kwa odwala omwe ali m'malo osamalira odwala kwambiri, ndipo atakhazikika pompopompo - m'zipatala zosamalira odwala nthawi zonse. Mankhwalawa cholinga chake ndi kuthetseratu madzi m'thupi, kubwezeretsanso zochitika za insulin ndi madzi osakanikirana ndi madzi, komanso kupewa zovuta. Malangizo aumwini ndi amodzi, amaphatikiza zotsatirazi:

• Kukonzanso madzi m'thupi. Jekeseni wa hypotonic njira ya sodium kolorayidi, potaziyamu mankhwala enaake. Mlingo wamagetsi m'magazi ndi zizindikiro za ECG zimayang'aniridwa nthawi zonse. Kulowetsedwa mankhwala umalimbana kusintha kayendedwe ka magazi ndi zotupa, kuwonjezera magazi. Mlingo wa kayendetsedwe ka madzimadzi umakonzedwa molingana ndi kusintha kwa kuthamanga kwa magazi, kugwira ntchito kwa mtima, ndi mulingo wamadzi.
• Mankhwala a insulin. Insulin imayendetsedwa kudzera m'mitsempha, kuthamanga ndi mlingo zimatsimikiziridwa payekhapayekha. Pamene chizindikiro cha glucose chikayandikira chabwinobwino, kuchuluka kwa mankhwalawo kumachepetsedwa kukhala woyambira (kale woperekedwa). Pofuna kupewa hypoglycemia, kuwonjezera kwa kulowetsedwa kwa dextrose nthawi zina kumakhala kofunikira.
• Kupewa ndikuchotsa zovuta. Pofuna kupewa matenda a minyewa ya m'mimba, mankhwala a oxygen amachitika, glutamic acid imayendetsedwa kudzera m'mitsempha. Mulingo woyenera wa ma electrolyte amabwezeretsedwa pogwiritsa ntchito osakaniza a glucose-potaziyamu-insulin. Zizindikiro mankhwala a zovuta kuchokera kupuma, mtima ndi kwamikodzo dongosolo ikuchitika.

Hyperosmolar hyperglycemic non-ketone coma imalumikizidwa ndi chiopsezo cha kufa, ndi chithandizo chamankhwala chapanthawi yake, chiwopsezo chaimfa chimatsitsidwa mpaka 40%. Kupewa mtundu uliwonse wa chikomokere cha matenda ashuga kuyenera kuyang'anitsitsa chindalama chokwanira cha matenda ashuga. Ndikofunika kuti odwala azitsatira zakudya, kuchepetsa kudya, kudya thupi nthawi zonse, kulimbitsa thupi, osalola kusintha kwa njira yogwiritsa ntchito insulin, kumwa mankhwala ochepetsa shuga. Amayi oyembekezera komanso puerperas amafunikira kukonza insulin.

• Zingwe
• Zofooka
• Kusokonekera kwa mawu
• Kuchulukitsa chilakolako
• Khungu lowuma
• Chisokonezo
• Ludzu lalikulu
• Kutentha kochepa
• Kuthamanga kwa magazi
• Anemia
• Zizindikiro
• Kuchepetsa thupi
• Zouma mucous nembanemba
• Kufa ziwalo
• Chikumbumtima
• Kufa pang'ono

Hyperosmolar coma ndi kuphatikizika kwa matenda a shuga, omwe amadziwika ndi hyperglycemia, hyperosmolarity ya magazi. Amawonetsedwa mu kusowa kwamadzi (kuchepa madzi m'thupi) komanso kusowa kwa ketoacidosis. Amawonedwa mwa odwala omwe ali ndi zaka zopitilira 50 omwe ali ndi mtundu wina wodwala matenda a shuga, amatha kuphatikizidwa ndi kunenepa kwambiri. Nthawi zambiri zimapezeka mwa anthu chifukwa cha chithandizo choyipa cha matenda kapena kusakhalapo.

Chithunzi cha chipatala chimatha kukhala masiku angapo mpaka kutayika kokwanira komanso kusowa poyankha kukondweretsa kwakunja.

Imapezeka ndi njira zowunika zasayansi ndi zida. Mankhwalawa cholinga chake ndi kuchepetsa magazi, kubwezeretsanso madzi ndikuchotsa munthu pakhungu. Matendawa alibe vuto: mu 50% ya milandu imachitika.

Hyperosmolar coma mu matenda a shuga ndi chizolowezi chomwenso chimachitika mu 70-80% ya odwala. Hyperosmolarity ndi chikhalidwe chomwe chimalumikizidwa ndi zinthu zambiri monga glucose ndi sodium m'magazi a munthu, zomwe zimayambitsa kuchepa kwa ubongo, pambuyo pake thupi lonse limasowa madzi.

Matendawa amapezeka chifukwa cha kupezeka kwa matenda ashuga mwa munthu kapena ndi chifukwa chophwanya kagayidwe kazakudya, ndipo izi zimayambitsa kuchepa kwa insulin komanso kuwonjezeka kwa ndende ya glucose ndi matupi a ketone.

Mwazi wa wodwala umadzuka pazifukwa zotsatirazi:

• kuchepa thupi kwa thupi pambuyo kusanza kwambiri, kutsekula m'mimba, kumwa madzi pang'ono, kuzunza okodzetsa,
• kuchuluka kwa shuga kwa chiwindi komwe kumachitika chifukwa cha kubwezeretsa kapena chithandizo chosayenera,
• Kuchuluka kwa shuga ndende pambuyo makonzedwe a mtsempha wa magazi.

Pambuyo pa izi, kugwira ntchito kwa impso kumasokonekera, komwe kumakhudza kutuluka kwa glucose mkodzo, ndipo zochulukazo zimapweteka thupi lonse. Izi zimalepheretsa kupanga insulini komanso kugwiritsa ntchito shuga ndi minofu ina. Zotsatira zake, mkhalidwe wa wodwalayo ukuwonjezereka, kuthamanga kwa magazi kumachepetsedwa, kuchepa kwa magazi mu cell kumawonedwa, kukakamizidwa kumachepetsedwa, chikumbumtima chimasokonekera, zotupa zimatha, kusokonezeka m'machitidwe othandizira amoyo ndipo munthu amagwa.

Hyperosmolar diabetesic coma ndi mkhalidwe wolephera kuzindikira momwe thupi lonse limagwirira ntchito, pamene luntha limachepa, ntchito yamtima imazirala, ndipo matenthedwe amachepa. Muno, muli pachiwopsezo chachikulu cha kufa.

Hyperosmolar coma ili ndi mitundu ingapo:

Iliyonse mwa mitunduyi imalumikizidwa ndi chifukwa chachikulu - matenda ashuga. Hyperosmolar chikomacho chimayamba pakatha milungu iwiri kapena itatu.

Hyperosmolar coma ili ndi zizindikiro zotsatirazi, zomwe zimayambitsa kuphwanya chikumbumtima:

• ludzu lalikulu
• khungu louma ndi nembanemba
• kulemera kwa thupi kumachepa
• kufooka kwakukulu ndi kuchepa magazi.

Kuthamanga kwa magazi a wodwala kumachepa, kutentha kwa thupi kumatsika, komanso kumawonedwa:

Munthawi yayitali, kuyerekezera zinthu m'maganizo, kusokoneza, kufooka, kulephera kulankhula. Ngati chithandizo chachipatala sichiperekedwa, ndiye kuti chiwopsezo cha kufa chimakulitsidwa kwambiri.

Ndi matenda a shuga kwa ana, kumachepa kwambiri thupi, kudya kwambiri, komanso kuwonongeka kumabweretsa mavuto mu mtima. Potere, fungo lochokera mkamwa limafanana ndi fungo labwino.

Nthawi zambiri, wodwala yemwe ali ndi vuto la hyperosmolar non-ketoacidotic coma amapita kuchipatala mosamala kwambiri, kumene chifukwa cha izi amapezeka mwachangu. Wodwalayo amapatsidwa chisamaliro choyambirira, koma osamveketsa chithunzi chonse, sichothandiza kwenikweni ndipo amangolola wodekha kuti azikhala wodekha.

• kuyezetsa magazi kwa insulin ndi shuga, komanso lactic acid,
• kuyesedwa kwakunja kwa wodwala kumachitika, zimachitika zimayendera.

Wodwala atagwa matenda asanakudziwe, adayesedwa kuti ayesedwe magazi, mkodzo poyesa shuga, insulini, kupezeka kwa sodium.

Cardiogram imayikidwa, kupenda kwa mtima kwa mtima, chifukwa matenda a shuga angayambitse kugunda kapena kugunda kwa mtima.

Dokotala amayenera kusiyanitsa matenda ndi matenda a mitsempha ya m'magazi, kuti achulukitse vutolo mwa kupereka mankhwala okakamiza. Kulemba pamutu kwamutu kumachitika.

Kudziwa bwino matenda akakhazikitsidwa, wodwalayo amapita kuchipatala ndipo amalandira chithandizo.

Thandizo ladzidzidzi lili ndi izi:

• ambulansi amatchedwa,
• Kugundika ndi kuthamanga kwa magazi kumayendera dokotala asanafike,
• zida zoyankhula za wodwalayo zimayang'aniridwa, mafupa am'mutu amayenera kupukutidwa, kumakhazikika pamasaya kuti wodwalayo asataye chikumbumtima,
• ngati wodwala ali ndi insulin, ndiye kuti insulini imabayidwa mosazindikira komanso amamwa kwambiri madzi akumwa.

Pambuyo pakupita kuchipatala wodwala ndikuzindikira zifukwa zake, chithandizo choyenera chimaperekedwa malinga ndi mtundu wa chikomokere.

Hyperosmolar coma imakhudzanso zotsatirazi zochizira:

• kuchotsa kwamadzi ndi mantha,
• kubwezeretsa ndalama zamagetsi,
• magazi hyperosmolarity amachotsedwa,
• ngati lactic acidosis yapezeka, kutsirizika ndi kuphatikizika kwa lactic acid kumachitika.

Wodwala amagonekedwa m'chipatala, m'mimba mumatsukidwa, ndimatumba amkodzo amamuyika, mankhwala a oxygen amachitidwa.

Ndi mtundu uwu wa chikomokere, kuthanso madzi m'thupi m'magawo ambiri kumayikidwa: ndi okwera kwambiri kuposa mankhwala okhala ndi ketoacidotic, momwe amakonzanso madzi amthupi, komanso insulin.

Matendawa amathandizidwa pobwezeretsa kuchuluka kwa madzimadzi m'thupi, omwe angakhale ndi glucose komanso sodium. Komabe, pankhaniyi, pali chiopsezo chachikulu cha kufa.

Ndi chikomero cha hyperglycemic, insulin yowonjezereka imawonedwa, chifukwa chake sinafotokozedwe, ndipo potaziyamu yambiri imayendetsedwa m'malo mwake. Kugwiritsa ntchito alkalis ndi koloko yowotchera sikumachitika ndi ketoacidosis kapena ndi hyperosmolar coma.

Malangizo azachipatala atachotsa wodwalayo ndikusintha matenda onse m'thupi ndi motere:

• Imwani mankhwala nthawi,
• musapitirire mlingo womwe waperekedwa,
• lawani shuga m'magazi, yesetsani mayeso nthawi zambiri,
• lawani kuthamanga kwa magazi, gwiritsani ntchito mankhwala omwe amathandizira kuti pakhale zovuta.

Osamagwira ntchito mopumira, kupumula kwambiri, makamaka pakukonzanso.

Mavuto ambiri omwe ali ndi vuto la hyperosmolar coma ndi awa:

Pakuwonetsedwa koyamba kwa matenda azachipatala, wodwalayo ayenera kupereka chithandizo chamankhwala, kumuunikira komanso kupereka chithandizo.

Coma mwa ana ndiofala kwambiri kuposa achikulire ndipo amadziwika ndi kulosera zopanda pake kwambiri. Chifukwa chake, makolo ayenera kuyang'anira thanzi la mwana, ndipo pazizindikiro zoyambirira amafuna chithandizo chamankhwala.

Njira zodzitetezera zimaphatikizapo kukhazikitsidwa kwa malingaliro azachipatala, kutsatira zakudya zamagulu, komanso kuwunika momwe munthu alili. Ngati zizindikiro zoyambirira za matenda zikuwonekera, pitani kuchipatala msanga.

Ngati mukuganiza kuti muli nacho Hyperosmolar chikomokere ndipo zizindikiro zodziwika ndi matendawa, ndiye kuti madokotala amatha kukuthandizani: wa endocrinologist, wothandizira, wazachipatala.

Tiperekanso kugwiritsa ntchito ntchito yathu yofufuzira matenda omwe ali pa intaneti, yomwe imasankha matenda omwe angakhalepo kutengera ndi zomwe zidalowetsedwa.

Hyponatremia ndi mtundu wofala kwambiri wamadzi wamagetsi pakakhala kuchepa kwakukulu mu seramu sodium. Popanda thandizo pa nthawi yake, mwayi wakufa sikuwonongedwa.

Poizoni wa Arsenic ndikokula kwa njira ya m'magazi yomwe imaphatikizidwa ndi kuphatikizika kwa poizoni m'thupi. Mkhalidwe wofanana ndi munthu umayendera limodzi ndi zizindikiro zotchulidwa ndipo pakakhala kuti palibe chithandizo chamankhwala zimayambitsa kukula kwakukulu.

Omwe ali ndi chidwi ndi mabuku azakale ayenera kuti amawerenga za miliri ya kolera, yomwe nthawi zina imasokosera m'mizinda yonse. Komanso, zonena za matendawa zimapezeka padziko lonse lapansi. Mpaka pano, matendawa samagonjetsedwa kwathunthu, komabe, milandu yakumtunda wapakati ndizosowa kwambiri: kuchuluka kwakukulu kwa odwala ndi kolera kumachitika m'maiko achitatu.

Hemorrhagic stroke ndi mkhalidwe wowopsa womwe umadziwika ndi mitsempha ya magazi chifukwa chotupa m'mitsempha yamagazi mothandizidwa ndi kuthamanga kwa magazi. Malinga ndi ICD-10, mankhwalawa adalemba m'gawo I61. Mtundu wamtunduwu ndiwokhwima kwambiri komanso umadwala kwambiri. Nthawi zambiri, amakula mwa anthu azaka 35-50, omwe ali ndi mbiri yokhudza matenda oopsa kapena atherosulinosis.

Cysticercosis ndimatenda oyamba omwe amapita patsogolo chifukwa cha kulowa kwa mphutsi za nkhumba zam'mimba zodutsa thupi la munthu. Ndilo gulu la cestodoses. Mphutsi za nkhumba zam'mimba zimalowa m'mimba mwa munthu ndipo zimamasulidwa ku chipolopolo. Pang'onopang'ono, amasunthira m'chigawo choyambirira cha m'matumbo, pomwe amawononga makhoma ake komanso kutuluka kwa magazi kufalikira thupi lonse la munthu.

Pogwiritsa ntchito masewera olimbitsa thupi komanso kudziletsa, anthu ambiri amatha kuchita popanda mankhwala.

Hyperosmolarity - Izi ndi zomwe zimachitika chifukwa cha kuchuluka kwa mankhwala omwe ali osmotic m'magazi, ofunika kwambiri omwe ali ndi glucose ndi sodium. Zotsatira zopanda mphamvu za iwo mu cell zimayambitsa kusiyana kwakukulu kwa kuthamanga kwa oncotic mu madzi akunja ndi kutsekeka kwatsoka, chifukwa chomwe, choyamba, kuchepa kwa madzi m'thupi (makamaka ubongo) kumachitika, kenako kuchepa kwa madzi m'thupi.

Hyperosmolarity imatha kukhazikika m'njira zosiyanasiyana zamatenda, koma ndi shuga mellitus (shuga) chiopsezo chakukulitsa ndichokwera kwambiri. Nthawi zambiri hyperosmolar coma (HA) amakulira mu okalamba akuvutika lembani matenda ashuga 2SD-2), mu mkhalidwe wa ketoacidosis, monga tawonera kale, palinso kuwonjezeka kwa plasma osmolarity, koma zowona za hyperosmolar coma ndi lembani matenda ashuga 1SD-1) osakwatiwa.

Zida zapadera za Code Code - kuchuluka kwambiri kwa shuga wamagazi (mpaka 50 mmol / l kapena kuposa), kusowa kwa ketoacidosis (ketonuria sikumapatula kukhalapo kwa HA), hypernatremia, plasma hyperosmolarity, kuchepa kwamadzi ndi ma cell exicosis, kusokonezeka kwamitsempha yamagazi, kuzama kwamphamvu komanso kuchuluka kwaimfa.

Poyerekeza ndi matenda a shuga a ketoacidotic hyperosmolar coma, izi ndizosowa koma zowonjezera zovuta za kuwawa kwa matenda ashuga.

Zomwe zimayambitsa kukula kwa HA mu matenda ashuga ndi matenda ndi mikhalidwe yomwe imayambitsa, kumbali imodzi, kuchepa mphamvu kwa thupi, ndipo, kumbali ina, kumakulitsa kuchepa kwa insulin. Chifukwa chake, kusanza, kutsegula m'mimba ndi matenda opatsirana, pachimake pancreatitis, pachimake cholecystitis, sitiroko, etc., kuchepa kwa magazi, kuwotcha, kugwiritsa ntchito okodzetsa, kuphwanya ndende ntchito ya impso, ndi zina.

Matenda apakati, njira zopangira opaleshoni, kuvulala, ndi kugwiritsa ntchito mankhwala ena (glucocorticoids, catecholamines, mahomoni ogonana, ndi zina zambiri) kumawonjezera kuchepa kwa insulin. Pathogenesis yachitukuko cha HA sichidziwika bwino. Zomwe zimachokera mu hyperglycemia yotchulidwa popanda kusowa kwenikweni kwa insulin sizikudziwika bwino. Sizikudziwikanso chifukwa chomwe glycemia yayitali kwambiri, ikuwonetsa kuchepa kwa insulin, palibe ketoacidosis.

Kuwonjezeka koyambirira kwa shuga m'magazi a shuga kwa odwala omwe ali ndi matenda a shuga 2 kungachitike pazifukwa zingapo:

1. Kuthetsa magazi chifukwa cha zifukwa zosiyanasiyana kusanza, kutsegula m'mimba, kutsitsa ludzu mwa okalamba, kumwa Mlingo waukulu wothandiza okodzetsa.
2. Kuchulukitsa kwa shuga m'chiwindi pakubowola kwa shuga komwe kumayambitsidwa ndi matenda amtundu kapena kuperewera kwa mankhwala.
3. Kuchuluka kwachilendo kwa glucose m'thupi pakulowetsedwa kulowetsedwa kwa shuga.

Kuwonjezeka kopita patsogolo kwa kuchuluka kwa shuga m'magazi pakukonzekera kwa hyperosmolar coma akufotokozera zifukwa ziwiri.

Choyamba, kuwonongeka kwa impso kwa odwala omwe ali ndi matenda ashuga, omwe amachititsa kuchepa kwa glucose excretion, amatenga nawo mbali pa izi. Izi zimathandizidwa ndi kuchepa kwokhudzana ndi zaka zakale kusefera, kumakulirakulira chifukwa cha kuchepa kwa madzi m'thupi ndi matenda am'mbuyomu.

Kachiwiri, kawopsedwe wa glucose amatha kutenga gawo lofunikira pakukula kwa hyperglycemia, yomwe imalepheretsa insulin katulutsidwe ndikugwiritsanso ntchito kwa minofu ya glucose. Kuchulukitsa kwa hyperglycemia, kukhala ndi poizoni m'maselo a B, kumalepheretsa katulutsidwe ka insulin, komwe kumakulitsa hyperglycemia, ndipo kumapeto kwambiri kumapangitsa insulini kubisala.

Mitundu yosiyanasiyana kwambiri ilipo poyesa kufotokoza kusowa kwa ketoacidosis mwa odwala omwe ali ndi matenda ashuga omwe amayamba ndi hepatitis C Mmodzi wa iwo akufotokozera izi chifukwa chobisalira mkati mwa insulin odwala omwe ali ndi matenda a shuga a 2, pomwe insulini yoperekedwa mwachindunji imakwanira kuletsa lipolysis ndi ketogeneis, koma osakwanira kugwiritsa ntchito glucose pachipumi. Kuphatikiza apo, gawo lina la izi litha kuseweredwa ndi kupindika kocheperako kwamahomoni awiri ofunikira a lipolytic, cortisol ndi kukula kwamafuta (STG).

Kusowa kwa ketoacidosis mu hyperosmolar coma kumafotokozedwanso ndi kuchuluka kosiyanasiyana kwa insulin ndi glucagon pazomwe zili pamwambapa. - mahomoni a mbali ina pokhudzana ndi lipolysis ndi ketogeneis. Chifukwa chake, pakukomoka kwa matenda ashuga, kuchuluka kwa glucagon / insulin kumachitika, ndipo ngati GK, insulin / glucagon imapambana, yomwe imalepheretsa kutseguka kwa lipolysis ndi ketogeneis. Ofufuza ambiri apeza kuti hyperosmolarity ndi kuchepa kwa madzi komwe kumayambitsa palokha kumatha kulepheretsa lipolysis ndi ketogeneis.

Kuphatikiza pa hyperglycemia yomwe ikukula pang'onopang'ono, hyperosmolarity ku HA imathandizanso ku hypernatremia, komwe kumachokera komwe kumalumikizidwa ndi hyperproduction yolipira ya aldosterone poyankha kuchepa kwamadzi. Hyperosmolarity ya plasma yamagazi ndi mkulu osmotic diuresis koyambirira magawo a kukhathamiritsa kwa hyperosmolar coma ndizomwe zimayambitsa kukula kwa hypovolemia, kuchepa madzi m'thupi, kugwa kwa mtima komanso kuchepa kwa magazi m'magazi.

Kuchepa kwamphamvu kwa maselo aubongo, kuchepa kwa kuthamanga kwa madzi a m'magazi, kutsika kwamitsempha yama cell komanso mphamvu ya nembanemba imayambitsa chikumbumtima champhamvu komanso zizindikiro zina zamitsempha. Nthawi zambiri amawonedwa pamatumbo, ma hemorrhages ang'onoang'ono am'munsi mu ubongo amawonedwa ngati chifukwa cha hypernatremia. Chifukwa cha kukula kwa magazi ndi minofu ya thromboplastin yolowa m'magazi, dongosolo la hemostasis limayendetsedwa, ndipo chizolowezi cha thrombosis cham'deralo ndi chofalikira chikukula.

Chithunzi cha chipatala cha GC chimayamba pang'onopang'ono kuposa khansa ya ketoacidotic - kwa masiku angapo ngakhale milungu ingapo.

Zizindikiro za kubwezeredwa kwa DM (ludzu, polyuria, kuchepa thupi) zikuyenda tsiku lililonse, komwe kumayendetsedwa ndi kufooka wamba, kuwoneka ngati minyewa "ikupindika", kudutsa tsiku lotsatira kukomoka kwanuko.

Kuyambira m'masiku oyamba a matendawa, chikumbumtima chimatha kusokonezeka, kenako, kuchulukirachulukira, zovuta izi zimadziwika ndi kuwonekera kwa kuyerekezera zinthu m'magazi, kutsekemera ndi chikomokere. Kuwonongeka kwa chikumbumtima kumafika pamlingo wa kupuma koyenera pafupifupi 10% ya odwala ndipo zimatengera kukula kwa plasma hyperosmolarity (ndipo, motero, pa cerebrospinal fluid hypernatremia).

Mbali ya GK - kukhalapo kwa zizindikiro za minyewa ya polymorphic: kukomoka, kusokonezeka kwa mawu, kupweteka kwa ziwalo, ziwalo, nystagmus, zizindikiro za m'matumbo (S. Babinsky, etc.), khosi lolimba. Chizindikiro ichi sichikhala mgulu lomveka bwino la mitsempha ndipo chimawonedwa ngati kuphwanya kwambiri magazi.

Mukamawunika odwala otere, zizindikiro za kuchepa mphamvu kwa madzi m'thupi zimakopa chidwi, makamaka kuposa ndi ketoacidotic chikomokere: khungu louma ndi mucous nembanemba, kukulitsa nkhope, kutsika toni yamaso, khungu turgor, kamvekedwe ka minofu. Kuyankha kumachitika pafupipafupi, koma osaya ndi fungo ndiye ma acetone mumlengalenga wopumira. Kugunda kumachitika pafupipafupi, kocheperako, nthawi zambiri ngati ulusi.

Kupsinjika kwa magazi kumachepetsedwa kwambiri. Nthawi zambiri komanso kale kuposa ndi ketoacidosis, anuria imachitika. Nthawi zambiri pamakhala kutentha kwambiri kwa chiyambi. Kusokonezeka kwamagazi chifukwa chamatenda am'mimba kumapangitsa kuti pakhale chidwi cha kusokonekera kwa magazi.

Kuzindikira matenda oopsa a hyperosmolar kunyumba ndikovuta, koma ndizotheka kuyerekeza kuti wodwala ali ndi matenda osokoneza bongo, makamaka ngati vuto lomwe lakhazikitsidwa ndi njira iliyonse yomwe idayambitsa kuperewera kwa thupi. Zachidziwikire, chithunzithunzi cha zamankhwala chokhala ndi mawonekedwe ake ndizomwe zimayambitsa matenda a hepatitis C, koma zambiri zowunika zamankhwala zimagwiritsa ntchito ngati chitsimikiziro cha matenda.

Monga lamulo, kusiyanitsa mitundu ya HA kumachitika ndi mitundu ina ya hyperglycemic chikomokere, komanso kusokonezeka kwakukulu kwa kufalitsa kwamkati, matenda obwera ndi ubongo, ndi zina zambiri.

Kuzindikiritsa kwa hyperosmolar coma kumatsimikiziridwa ndi kukwera kwambiri kwa glycemic (nthawi zambiri pamakhala 40 mmol / l), hypernatremia, hyperchloremia, hyperazotemia, zizindikiro za kukula kwa magazi - polyglobulia, erythrocytosis, leukocytosis, hematocrit okwera, komanso kwambiri plasma osmolar -295 mOsmol / l.

Kuwonongeka kwa chikumbumtima pakusowa kuwonjezeka komvekera kopanda plasma osmolarity ndizokayikitsa makamaka pokhudzana ndi matenda a ubongo. Chizindikiritso chofunikira kwambiri chachipatala cha HA ndi kusowa kwa fungo la acetone mu mpweya wotulutsidwa komanso kupuma kwa Kussmaul.

Komabe, ngati wodwalayo akhala m'chipatala masiku atatu, zizindikiro za lactic acidosis zitha kujowina ndipo kupuma kwa Kussmaul kumatha kupezeka, komanso nthawi ya kafukufuku acid-base mamiriro (KHS) - acidosis yoyambitsidwa ndi kuchuluka kwa lactic acid m'magazi.

Mankhwala a GC ali munjira zambiri zofanana ndi mankhwala a ketoacidotic coma, ngakhale ali ndi mawonekedwe ake ndipo ali ndi cholinga chothana ndi kuchepa madzi m'thupi, kuthana ndi manjenje, kusintha kwa electrolyte bwino komanso acid-base usawa (munthawi ya lactic acidosis), komanso kuthetseratu magazi a hyperosmolarity.

Kugwiritsira ntchito hospitalization kwa odwala omwe ali ndi vuto la hyperosmolar coma kumachitika mu chipinda chothandizira kwambiri. Pachipatala, kuchiritsa kwa m'mimba kumachitidwa, catheter wamkodzo amayikiridwa, mankhwala a oxygen akupangidwa.

Mndandanda wazotsatira zoyeserera zasayansi, kuphatikiza pazomwe zimavomerezeka, zimaphatikizapo kutsimikiza kwa glycemia, potaziyamu, sodium, urea, creatinine, CSR, lactate, matupi a ketone, ndi plasma osmolarity.

Kuthanso madzi m'thupi la HA kumachitika m'njira yayikulu kuposa momwe amachotseredwa ku ketoacidotic chikomokere (kuchuluka kwa madzi obayira kumafikira malita 6-10 patsiku). Mu ola la 1, 1-1.5 L yamadzimadzi imalowetsedwa m'mitsempha, mu ora la 2-3 - 0,5-1 L, maola otsatirawa - 300-500 ml.

Kusankhidwa kwa yankho kumalimbikitsidwa potengera zomwe zili sodium m'magazi. Pa mulingo wama sodium woposa 165 meq / l, kukhazikitsidwa kwa njira zamchere kumapangidwira ndipo kuthanso kwamadzi kumayamba ndi 2% shuga. Pa mulingo wa sodium wa 145-165 meq / l, kuthanso magazi kumachitika ndi njira ya 0.45% (hypotonic) sodium chloride.

Kuthanso madziwumwini kumayambitsa kutsika kwamphamvu kwa glycemia chifukwa cha kuchepa kwa magazi, ndikuyang'anira kukhudzika kwakukulu kwa insulin yamtunduwu wa chikomokere, kuyendetsedwa kwake kwa intravenous kumachitika mu Mlingo wochepa (pafupifupi magawo awiri a insulin yomwe ingachitike mwachidule "mu kulowetsa" kwa ola limodzi). Kuchepetsa glycemia ndi oposa 5.5 mmol / L, ndi osmolarity wa plasma woposa 10 mOsmol / L pa ola limodzi kumawopseza kukula kwa pulmonary edema ndi ubongo.

Ngati atatha maola 4-5 kuchokera poyambira kukonzanso madzi m'thupi, kuchuluka kwa sodium kumachepa, ndipo hyperglycemia imapitirira, kukonzekera kwa ora kwa insulin panthawi ya magawo a 6 - 6 ndi mankhwala (monga ketoacidotic chikomokere). Ndi kuchepa kwa glycemia pansipa 13.5 mmol / l, mlingo wa insulin womwe umayendetsedwa umachepetsedwa ndi theka ndipo umakhala pafupifupi magawo a 3-5 maola ola lililonse. Posunga glycemia pamlingo wa 11-13 mmol / l, kusowa kwa acidosis ya etiology iliyonse ndikuchotsa madzi am'mimba, wodwalayo amapatsidwa gawo la subulinaneous la insulin yemweyo muyezo ndi gawo la maola 2-3 kutengera mlingo wa glycemia.

Kubwezeretsanso kwa potaziyamu kumayambira mwina nthawi yomweyo atazindikira kuti ndi otsika kwambiri m'magazi ndikugwira impso, kapena maola awiri atayamba kulowetsedwa. Mlingo wa potaziyamu kutumikiridwa zimatengera zomwe zili m'magazi. Chifukwa chake, potaziyamu m'munsimu 3 mmol / l, 3 g wa potaziyamu mankhwala enaake (owuma) amapaka jekeseni ola limodzi, pamsasa wa potaziyamu wa 3-4 mmol / l - 2 g wa potaziyamu mankhwala ena, 4-5 mmol / l - 1 g wa potaziyamu potaziyamu. Ndi potaziyamu pamwamba pa 5 mmol / L, kukhazikitsidwa kwa yankho la potaziyamu mankhwala enaakewa.

Kuphatikiza pa zomwe zalembedwazo, kuwongolera kugwa kumachitika, mankhwala othandizira amachitidwa, ndipo ndi cholinga chopewa kupindika, heparin imayikidwa pa 5000 IU intravenous 2 kawiri patsiku motsogozedwa ndi heestatic system.

Kugona kwakanthawi kachipatala, kuzindikira koyambirira komwe kunayambitsa kukula, ndipo motero kuchotsedwa kwake, komanso chithandizo cha matenda amtunduwu, ndizothandiza kwambiri pakuchiritsa matenda a chiwindi C.

1. 
   Vasyutin, A.M. Bweretsani chisangalalo cha moyo, kapena Momwe mungachotsere matenda ashuga / A.M. Vasyutin. - M: Phoenix, 2009 .-- 181 p.
2. 
   Evsyukova I.I., Kosheleva N.G. Matenda a shuga: amayi apakati ndi akhanda. SPb., Nyumba yosindikiza "Literature yapadera", 1996, masamba 269, kufalitsa makope 3000.
3. 
   Vladislav, Vladimirovich Privolnev Diabetesic phazi / Vladislav Vladimirovich Privolnev, Valery Stepanovich Zabrosaev und Nikolai Vasilevich Danilenkov. - M: LAP Lambert Academic Publishing, 2013 .-- 151 p.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Zimayambitsa hyperosmolar chikomokere

Hyperosmolar coma imatha kupezeka chifukwa cha:

• kufinya thupi (ndi kusanza, kutsegula m'mimba, kuwotcha, chithandizo chambiri ndi okodzetsa),
• kusakwanira kapena kusowa kwa insulin kapena / kapena insulin yakale (mwachitsanzo, chifukwa cha insulin yokwanira kapena kusakhalapo),
• kuchuluka kwa insulini (kuphwanya kwambiri zakudya kapena kuyambitsa njira zothetsera shuga, komanso matenda opatsirana, makamaka chibayo ndi matenda amkodzo thirakiti, matenda ena akuluakulu, kuvulala ndi maopaleshoni, mankhwala othandizira odwala omwe ali ndi insulin antagonists, glucocorticosteroids, mankhwala a mahomoni ogonana, etc.).

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Ma pathogenesis a hyperosmolar coma samveka bwino. Hyperglycemia yamphamvu imachitika chifukwa cha kuchuluka kwa glucose m'thupi, kuchuluka kwa shuga m'thupi, chiwopsezo cha glucose, kuponderezedwa kwa katemera wa insulin komanso kugwiritsidwa ntchito kwa glucose pogwiritsa ntchito zotumphukira za thupi. Amakhulupilira kuti kukhalapo kwa amkati amkati amasokoneza lipolysis ndi ketogeneis, koma sikokwanira kupondereza mapangidwe a shuga ndi chiwindi.

Chifukwa chake, gluconeogeneis ndi glycogenolysis kumabweretsa kwambiri hyperglycemia. Komabe, kuchuluka kwa insulin m'mwazi ndi matenda ashuga ketoacidosis ndi hyperosmolar coma pafupifupi.

Malinga ndi lingaliro lina, ndi hyperosmolar coma, kuchuluka kwa somatotropic mahomoni ndi cortisol kumakhala kocheperako poyerekeza ndi matenda ashuga a ketoacidosis, kuphatikiza apo, ndi hyperosmolar coma, kuchuluka kwa insulin / glucagon ndikokwanira kuposa matenda ashuga a ketoacidosis. Plasma hyperosmolarity imabweretsa kukakamiza kumasulidwa kwa FFA kuchokera ku adipose minofu ndikuletsa lipolysis ndi ketogenesis.

Kupanga kwa plasma hyperosmolarity kumaphatikizapo kuchuluka kwa aldosterone ndi cortisol poyankha kuchepa madzi m'thupi, chifukwa cha chomwe hypernatremia imayamba. High hyperglycemia ndi hypernatremia imatsogolera ku plasma hyperosmolarity, yomwe imatsogolera ku kutulutsa kuchepa kwa magazi m'thupi. Nthawi yomweyo, zomwe zimapezeka mu sodium zimatulukanso mu madzi a ubongo. Kuphwanya madzi ndi kupendekeka kwa ma cell mu ubongo kumabweretsa kukula kwa maselo am'mitsempha, matenda a edema ndi chikomokere.

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Zizindikiro za kukomoka kwa hyperosmolar

Hyperosmolar chikomayi chimayamba pakapita masiku kapena milungu ingapo.

Wodwalayo amakhala ndi vuto la matenda a shuga ophatikizika, kuphatikizapo:

• polyuria
• ludzu
• khungu louma komanso ma mucous membrane,
• kuwonda
• kufooka, adynamia.

Kuphatikiza apo, pali zizindikiro za kutopa,

• kuchepetsa khungu,
• matani amaso akuchepa,
• kutsika kwa kuthamanga kwa magazi ndi kutentha kwa thupi.

Zizindikiro za Neurological ndizodziwika:

• hemiparesis,
• hyperreflexia kapena areflexia,
• chikumbumtima
• zopweteka (5% odwala).

Woopsa, osakonza hyperosmolar state, stupor ndi chikomokere zimayamba. Mavuto ambiri omwe ali ndi vuto la hyperosmolar coma ndi awa:

• khunyu
• mitsempha yakuya,
• kapamba
• kulephera kwa aimpso.

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Matenda a hyperosmolar chikomokere

Kuzindikira kwa hyperosmolar coma kumapangidwa pamaziko a anamnesis a shuga mellitus, nthawi zambiri mtundu wa 2 (komabe, muyenera kukumbukira kuti hyperosmolar coma imatha kupangidwanso mwa anthu omwe kale sanadziwike matenda a shuga, mu 30% ya milandu, hyperosmolar coma ndiyo chiwonetsero choyamba cha matenda osokoneza bongo) mawonetseredwe azidziwitso a matenda a labotale (choyambirira, hyperglycemia, hypernatremia ndi plasma hyperosmolarity pakalibe acidosis ndi matupi a ketone. Momwemonso kudwala ketoacidosis, ECG imalola kuwonetsa zizindikiro za hypokalemia ndi mtima arrhythmias.

Mawonekedwe a Laborator a hyperosmolar state akuphatikizapo:

• hyperglycemia ndi glucosuria (glycemia nthawi zambiri 30-110 mmol / l),
• kwambiri kuchuluka kwa plmma osmolarity (nthawi zambiri> 350 mosm / kg pansi pa 280-296 mosm / kg), osmolality itha kuwerengedwa ndi formula: 2 x ((Na) (K)) + glucose / 18 magazi urea nitrogen / 2.8.
• Hypernatremia (kuchuluka kapena kwachilendo kwa sodium m'magazi chifukwa chotulutsidwa kwa madzi kuchokera mu danga lamkati kumalo achilendo ndikuthekanso),
• kusowa kwa acidosis ndi ketone matupi m'mwazi ndi mkodzo,
• kusintha kwina (leukocytosis mpaka 15,000-20,000 / μl, osagwirizana ndi matenda, kuchuluka kwa hemoglobin ndi hematocrit, kuwonjezeka kwapakati pa ndende ya urea nitrogen m'magazi) ndikotheka.

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