Hypoglycemic coma zizindikiro zodziwikiratu zochita algorithm

Ngati muli ndi anthu omwe ali ndi matenda ashuga m'mabanja mwanu kapena abwenzi apamtima, ndiye kuti muyenera kudziwa momwe chisamaliro chadzidzidzi chimaperekedwera kwa chikho cha hypoglycemic.

Uku ndikovuta kwambiri komwe kumachitika ndi kuchepa kwamphamvu kwa shuga m'magazi.

Chimodzi mwazifukwa zazikulu zothandizira kuti izi zitheke ndikuphwanya kagayidwe kazachilengedwe.

Zoyambitsa Matenda a shuga

Matenda a shuga asamachitike nthawi zambiri, koma amakhala ndi zotsatirapo zoyipa kwa wodwalayo. Pali zifukwa ziwiri zazikulu zochepetsera shuga mpaka mulingo wosavomerezeka:

Magazi amakhala ndi insulini yambiri. Awa ndi mahomoni omwe amafunika kuperekera shuga m'maselo a thupi. Ngati ndizochulukirapo, ndiye kuti shuga mumagazi amayamba kuchepa, ndipo minofu yake imakulanso.
Osakwanira kudya shuga m'magazi pamlingo wambiri wa insulin. Kuphwanya kumeneku kumachitika chifukwa cha mavuto azakudya kapena kuchita masewera olimbitsa thupi mopitirira muyeso.

Anthu odwala matenda ashuga ayenera kutsatira malangizo onse a dokotala. Zakudya zopanda pake, mlingo wosayenera mukalandira insulin, kapena kuphwanya njira ya jakisoni, zakudya zopanda pake, kapena kumwa mankhwala osokoneza bongo kumatha kubweretsa boma la hypoglycemic, ndipo chisamaliro chodzidzimutsa pamenepa ziyenera kuperekedwa moyenera komanso munthawi yochepa kwambiri, apo ayi wodwalayo angafe.

Zowopsa kwa odwala matenda ashuga komanso mankhwala omwe amachepetsa shuga ya magazi. Mwachitsanzo, mankhwala osokoneza bongo a Glibenclamide angayambitse kugwa kwamphamvu kwa glucose. Zotsatira zake, chithunzi chotchedwa shuga chikomokere chimayamba.

Zizindikiro za dziko la hypoglycemic

Akadwala amene amadwala matenda ashuga samachitika mwadzidzidzi. Nthawi zambiri amamutsogolera ndi precom. Ngati ndizotheka kuzizindikira m'nthawi yake, ndiye kuti thandizo lomwe lingaperekedwe likuthandizirani kuti musakhale mu mpumulo. Muyenera kuchitapo kanthu mwachangu: mphindi 10-20.

Zizindikiro zamtunduwu zithandizira kuzindikira precom. Maselo aubongo ndiye woyamba kuvutika ndi kudumpha kwa glucose, kotero wodwala amayamba kudandaula:

Chizungulire
Kufooka ndi kupanda chidwi
Kugona
Njala
Kugwedeza manja
Kuchulukitsa thukuta.

Kuchokera pakusintha kwakunja, khungu la khungu limatha kuzindikira. Kuti tithane ndi izi, ndikokwanira kupatsa tiyi wokoma wa shuga, maswiti kapena shuga pang'ono. Mafuta a chokoleti kuchokera ku chokoleti kapena ayisikilimu amawayamwa pang'onopang'ono, motero sizoyenera.

Kuchuluka kwa shuga kosayembekezereka kumakulitsa kuyambika kwa zizindikiro. Ndipo akhala akudziwika kale kuti atha kukomoka. Pali zosokoneza pamalankhulidwe ndi mgwirizano wamachitidwe. Nthawi yotsatira, odwala matenda ashuga - kukomoka kumayamba.

Zizindikiro za chikomokere

Ngati wodwala sanathandizidwe ndi hypoglycemia, amagwa ndi shuga. Wodwala matenda ashuga sadziwa kale. Zizindikiro zomwe zikuwonetsa mawonekedwe akuwukira:

Khungu, lozizira komanso loyera pakhungu,
Thukuta,
Zingwe
Zosangalatsa pamtima
Kubweza
Zofooka zazing'ono pakuwala.

Mukakweza matope a wodwala, mutha kuwona kuti ana ake amapukusidwa kwambiri. Kuopsa kwa kukomoka kumachitika chifukwa chakuti munthu amagwera mwadzidzidzi. Nthawi yomweyo, amatha kulandira zowonjezera zina: kukhala nawo nawo pangozi, kugwa kuchokera kumtunda, ndikuvulala kwambiri.

Ndi chifuwa cha hypoglycemic, algorithm yolondola yokhala ndi vuto ladzidzidzi ili ndi gawo lalikulu: kupopera mbewu mankhwalawa ndi madzi, kusuntha nkhope ndikufuula sikungabwezeretse wodwalayo malingaliro. Njira zonse zachangu zikuyenera kumwedwa mpaka ntchito yothandizira kupumula kwa odwala matenda ashuga.

Hypoglycemia mwa ana

Hypoglycemic coma mu ana ndiowopsa chifukwa imakhudza masoka awo amanjenje. Mwana sangadandaule chifukwa cha kuwonongeka kwa thanzi, chifukwa chake, chisamaliro chokwanira chimayenera kuwonetsedwa kwa makolo ake. Kuthandizira pa nthawi yake kupulumutsa moyo wa mwana wawo.

Zosatheka mosavutikira, kugona tulo mwadzidzidzi komanso kusowa kudya kungapangitse ana kukhala pachiwopsezo. Kuphatikiza kwa zizindikiro zonsezi, makolo amayenera kudziwa kuchuluka kwa shuga kwa mwana. Mwana akhoza kusiya kuzindikira mosayembekezereka. Choyipa chachikulu ndichoti izi zikachitika usiku kugona. Kukoma kwa shuga kumayendera limodzi ndi kupatsirana komwe kumachitika, kutuluka thukuta kwambiri, komanso kupuma.

Thandizo loyamba

Kuthandiza munthu yemwe ali ndi vuto la hypoglycemia kumakhala kumamupatsa chakudya champhamvu kwambiri. Chakudya chokoma kapena tiyi chingathandize kukweza shuga m'magazi ndiku kupewa kugwa. Ngati wodwalayo anakomoka musanakhale ndi nthawi yokumupatsa shuga, muyenera kuyimbira foni ambulansi nthawi yomweyo.

Akangokhala osazindikira, jakisoni wa mamililita 60 wa njira ya shuga 40% imatha kuchotsa wodwalayo. Pakadali mphindi ziwiri zokha, wodwala matenda ashuga ayenera kuchira. Pambuyo pake, kuti mupewe kuwukira kwachiwiri, ndikofunikira kupatsa wodwalayo zovuta zam'madzi (mwachitsanzo, zipatso).

Ngati palibe yankho la shuga pafupi, ndiye kuti mutha kulowetsa shuga ndi cholembera cha syringe ya Glucagon. Mlingo wa mankhwalawa amapangidwa poganizira kulemera kwa thupi la wodwalayo. Mankhwalawa amatha kupangitsa chiwindi kuti chikhale ndi glycogen, yomwe idzaonetsetsa kuti shuga akupita m'magazi. Ngati sichinali chochitika chimodzi chomwe mwatenga kuchokera ku chithandizo chazachipatala cha hypoglycemic coma chabwezeretsa wodwalayo chikumbumtima, amafunikira kuchipatala mwachangu. Kupanda kuyankha kwake kukusonyeza kukula kwa zovuta.

Glycemic Revenue Sequence

Musanatenge chilichonse, onetsetsani kuti musanakhale ndi vuto la hypoglycemic. Kuti muchite izi, ngati kuli kotheka, funsani wodwalayo kapena muwone momwe zonse zidachitikira, ndi ena. Kumbali yanu, chisamaliro chodzidzimutsa chomwe chimakhala ndi vuto la kuchepa kwa thupi chikuwoneka motere:

Sankhani shuga yanu yamagazi ndi glucometer.
Muyikeni wodwala pambali pake, yeretsani zamkati kuchokera kuzotsalira za chakudya.
Apatseni wodwala othamanga kwambiri.
Chitanani foni mwachangu nthawi yomweyo.
Pamaso pa syringe ndi Glucagon, lowetsani mosapitirira 1 ml.

Sizoletsedwa kutsanulira zakumwa zotsekemera mkamwa mwa munthu amene wakwiya. Izi zimapangitsa kuti asphyxiation. Pachimake zovuta za chikomokere akhoza kukhala edema kapena zotupa mkati mwake. Kuthamanga kwa zomwe mumachita komanso kutsatira njira zolondola pamachitidwe otere kungapulumutse moyo wa munthu.

Chithandizo cha mankhwala akumwa

Ngati wodwala yemwe ali ndi vuto la kuchepa kwa vutoli atengedwera kuchipatala, ndiye kuti amamulembera maphunziro ake. Gawo lake loyamba ndikukhazikitsa mayeso a 40% a glucose mpaka 110 ml, kutengera kulemera kwa thupi. Zitatha izi chithunzithunzi cha chipere sichingasinthe, amayamba kukayikira jakisoni wa yankho lomwelo, koma ndi kupsinjika kochepa komanso kwakukulu. Ngati chikomokere chikuchitika chifukwa cha mankhwala osokoneza bongo omwe amachepetsa shuga, ndiye kuti shuga amayamba kulumikizidwa mpaka glycemia wabwinobwino ndikuchotsa kwathunthu zotsalira zamankhwala omwe atengedwa m'thupi.

Pofuna kupewa matenda a ubongo, kutsitsa kwa magazi kwa wodwalayo ndi okodzetsa kumalola (Mannitol, Manitol, Furosemide, Lasix). Munthawi yamankhwala, dokotala wamtima ndi wamanjinga amayeneranso kuyeserera kupewa kuti zovuta zisachitike. Pambuyo pa kumasuka kwawo, wodwalayo amayang'aniridwa ndi endocrinologist. Amamulembera mayeso ofunikira kuti adziwe momwe odwala matenda ashuga am'pezere chakudya.

Kuthandiza mwana

Mu ana, hypoglycemic coma imalumikizidwa ndi kukula kwamavuto, kotero ma algorithm powathandiza azikhala osiyana pang'ono. Ndi insulin yokwanira mthupi, iyenera kulipiridwira, osatengera zomwe zimayambitsa izi. Mothandizidwa ndi glucometer, makolo ayenera kuyeza kuchuluka kwa shuga ndikuyika insulin m'magawo ang'onoang'ono (kale adagwirizana ndi adokotala). Potere, akulu sayenera:

Mantha
Patsani chisangalalo mwa mwana
Siyani mwana wanu ngakhale kwa mphindi zochepa

Kuwongolera glucose kumachitika maola 2 aliwonse. Munthawi imeneyi, mwana ayenera kupatsidwa zakumwa zambiri kapena kum'patsa msuzi wamafuta ochepa. Zakudya zolemera zimayenera kutayidwa mwana asanabwerere mwakale. Kukhazikitsidwa kwa mankhwala aliwonse (kupatula insulin) ndikungokhala kwina. Chifukwa chake, ma jakisoni kapena jakisoni wa mankhwala atha kuchitika kokha ndi madokotala oitanidwa ndi makolo.

Kupewa kwa hypoglycemic chikomokere

Njira zopewera zimakhazikika pakuwunika kuchuluka kwa shuga m'magazi. Wodwalayo amatha kuwunikira pawokha kunyumba pogwiritsa ntchito glucometer. Wodwala yemwe amadalira insulin sayenera kusintha kuchuluka kwa jakisoni woperekedwa ndi adokotala, makamaka pakakhala kulephera kwa impso.

Hypoglycemic coma (kapena, monga momwe amatchulidwira kuti "okonda" odwala matenda ashuga - "hypa") ndichinthu chowopsa kwambiri, pomwe zimadalira thandizo loyambira, kuphatikizapo moyo wa wodwala.

Chithandizo champhamvu cha algorithm yokhala ndi chikomokere

Yang'anani! Ngati munthu wasowa chikumbumtima kapena wapafupi ndi izi - werengani ndime yotsatirayi kuti musataye nthawi, ndikuchitapo kanthu mwachangu !

Algorithm mwachidule: Ngati wodwalayo akudziwa, mumupatse chakumwa chokoma kapena china chotsekemera (ngati sakufuna, mupangeni). Ngati wodwala walephera, tsatirani imodzi mwamalemba awa:

Mosamala ndi pang'onopang'ono kutsanulira zakumwa zotsekemera mkamwa mwake kapena kuyika mphesa kapena mapiritsi ochepa a glucose mkamwa mwake.
Ngati chakudya chamafuta othamanga sichitha kuperekedwa pakamwa la wodwalayo kudzera pakamwa, ikani glucagon jakisoni ntchafu kapena mkono, popanda kupha tizilombo toyambitsa matenda, mutha kudutsa malaya kapena mathalauza mwachindunji. Ngati palibe glucagon, ndiye kuti mutha kuyika jakisoni wa 30-50 ml ya 40-50% shuga yankho .
Ngati palibe glucagon ndi glucose, kuyitanitsa ambulansi mwachangu , ndikuyika wodwalayo pamalo oyimirira.

Kodi chiwopsezo cha hypoglycemic coma ndi chiani?

Hypoglycemic coma imapezeka mwa odwala matenda a shuga omwe ali ndi shuga ochepa magazi. Wodwalayo amatha kugwera mofulumira mu chikomokere (hypoglycemic coma), makamaka pambuyo poyambira matenda oyamba a shuga.

Zizindikiro za chikomokere mu hypoglycemic sizochepa kwenikweni poyerekeza ndi vuto la matenda ashuga (wokhala ndi shuga wokwezeka wapamwamba).

Wodwala amatha kukhala wodziletsa, wosakhazikika, nthawi zina ngakhale wankhanza. Panthawi imeneyi, amatha kusokonezeka.

Ngati wodwalayo akudziwa, ndikokwanira kuti amwe shuga kapena adye china chake chokoma ndipo shuga awonjezeke. Koma ngati wodwala matenda ashuga afika, ndiye kuti ndizosatheka kumukakamiza kuti alandire maswiti, chifukwa chake ndikofunikira kupereka thandizo mwadzidzidzi.

Algorithm yosamalira mwadzidzidzi chifukwa cha hypoglycemic coma

Zochitika 1. Wodwalayo amadziwa.

Kuti achite izi, ayenera kumwa mapiritsi ochepa a glucose kapena kumwa madzi otsekemera (makamaka ofunda). Nthawi zina wodwalayo amakhala ndi mantha ndipo safuna kudya maswiti, ndiye muyenera kuyesa kumukakamiza kapena kumupangitsa kuti azichita.

Zochitika 2. Wodwalayo anasiya kuzindikira.

Ngati wodwala matenda ashuga agwera osakomoka, ndiye kuti sangathenso kutafuna ndikumwa payekha, choncho muyenera kuyesetsa kuthira mosamala mkamwa mwake. Mutha kuyika mphesa pakati pa mano ake ndi tsaya lake kuti iye asungunuke pang'onopang'ono ndipo, limodzi ndi malovu, alowetsetsetse.

Ngati mwaphunzitsidwa, mutha kumupatsa jakisoni wa shuga kapena kulowa Glucagon - Mankhwala omwe odwala matenda ashuga nthawi zambiri amakhala nawo pamavuto awo. Jakisoni wotereyu amatha kupulumutsa moyo wa munthu wodwala matenda ashuga ndi chikomokere.

Jakisoni wa glucagon ndi wabwino chifukwa amatha kuyikidwa paliponse pakhungu kapena minofu, mwachitsanzo, ntchafu. Lamuloli silifunikira kuyeretsedwa musanalowe jakisoni, popeza mphindi iliyonse amawerengera. Mutha kubayikiranso glucagon kudzera mu zovala (mwachitsanzo, mpaka pakati pa thalauza lanu).

Glucagon imagwiritsidwa ntchito popereka chithandizo chodzidzimutsa cha hypoglycemic coma.

Mukayika jakisoni wa glucose, ndiye kuti mulingo wotsatira: 30-50 ml ya 40-50% shuga, ndiye 10-25 g ya shuga. Ngati chikomokere cha hypoglycemic chikuchitika mwa mwana, tikulimbikitsidwa kupaka jekeseni ya 20% ya glucose pa mlingo wa 2 ml / kg thupi. Ngati wodwalayo sakuchira, bwerezani mankhwalawo. Ngati sizithandiza, itanani ambulansi.

Ngati glucagon kapena glucose sakanakhoza kubereka, ndipo mano a wodwalayo amapukusidwa kotero kuti ndi kosatheka kutsanulira lokoma, ikani wodwalayo pamalo oyima ndikuyitanitsa ambulansi mwachangu.

Ngati wodwala yekha watuluka osadziwa chilichonse ambulansi isanafike, nthawi yomweyo amudye chakudya kapena kumwa chakumwa chokoma (tiyi wotsekemera wa tiyi, cola). Pambuyo pake, ndikulimbikitsidwa kudya chakudya pang'onopang'ono - mkate kapena phala.

Atapereka chisamaliro chodzidzimutsa, mkhalidwe wa wodwalayo, monga lamulo, umakhazikika. Pambuyo pake, pendani zomwe zimayambitsa hypoglycemic coma ndikusintha mlingo wa mankhwalawo kapena chakudya kuti izi zisadzabwerenso.

Hypoglycemic coma - akufotokoza Pulofesa S.A. Rabinovich

Njira zothetsera hypoglycemia mwa odwala matenda a shuga omwe amalandila shuga wochepetsa shuga ziyenera kuyambitsidwa pamlingo wa m'magazi a plasma 7.3 sintha ku SC management ya ICD maola 4 mpaka 6 aliwonse kuphatikiza IPD.

Kuchulukanso kwamthupi: 1 lita imodzi mu ola la 1 (poganizira zamadzimadzi zomwe zimayambitsidwa gawo la prehospital), 0,5 lita - mu 2nd ndi 3 ora, malita 0,25-0,5 maola otsatirawa. Kutenga thupi pang'onopang'ono ndikothekera: 2 l maola 4 oyambirira, ina 2 l maola 8 otsatira, ndiye 1 l maola onse a 8. Chiwerengero chonse cha kulowetsedwa pamaola 12 oyambira sichinaposa 10% ya kulemera kwa thupi. Ngati kukonzanso madzi m'thupi ndi DKA kumayamba ndi 0,45% NaCl (zochitika zosowa kwambiri za hypernatremia), kuchuluka kwa kulowetsedwa kumachepetsedwa mpaka 4-14 ml / kg pa ola limodzi.

Kuchuluka kwamphamvu kwa ana: 10-20 ml / kg, ndi hypovolemic mantha - 30 ml / kg, koma osapitirira 50 ml / kg mu maola 4 oyamba azithandizo.

Mlingo wokonzanso madzi umasinthidwa malinga ndi CVP kapena malinga ndi lamulo: kuchuluka kwa madzi obwera pa ola limodzi sayenera kupitilira mkodzo wowonjezera wa ola limodzi ndi oposa 0.5-1 l.

Kubwezeretsa chisokonezo cha elekitirodi

Kulowetsa kulowetsedwa kwa potaziyamu kumayamba nthawi yomweyo ndikuyambitsa insulin kuchokera pakuwerengera:
Mulingo wa kukhazikitsidwa kwa KCl (g mu h)

pH yophatikizidwa, yozungulira

Osayendetsa potaziyamu
Ngati mulingo wa K + sukudziwika, kulowetsedwa kwa potaziyamu kumayambika osapitilira maola 2 pambuyo pa kuyamba kwa insulin, kuyang'aniridwa ndi ECG ndi diuresis.
Malangizo a metabolic acidosis:

The etiological chithandizo cha metabolic acidosis ku DKA ndi insulin.
Zisonyezero zoyambitsa sodium bicarbonate: magazi pH Maso

Ndi chifuwa cha hypoglycemic, thandizo loyamba ndikuwonetsetsa kuti munthu akutetezedwa ndikuphatikizanso zinthu izi:
Mugonereni wodwalayo mozungulira
Tembenuzani mutu wanu chammbali
Kukhazikitsa zizindikiro zofunika asanafike madokotala: kugunda kwa mtima, kupuma, kumachitika.
Mosiyana ndi chikhulupiriro chofala chakuti madzi ali ndi shuga amayenera kuthiridwa mkamwa mwa wolakwirayo ngakhale atakomoka, izi sizingachitike!
Ngati muli ndi chizolowezi cha jakisoni wa mu mnofu ndi mankhwala "Glucagon", muyenera kupereka jakisoni nthawi yomweyo.
Pafupifupi odwala onse omwe ali ndi matenda ashuga amapita ndimankhwala ofunikira. Chifukwa chake, werengani zinthu za munthu ngati sakhudzidwa. Ngati munthuyo akadali m'bungwe la makolo, afotokozereni ngati ali ndi mankhwala oyenera, komanso mu mankhwalawa omwe ayenera kumwa.
Glucagon imatha kuperekedwa gawo lililonse la thupi, pansi pakhungu, kapena minofu. Pazinthu zadzidzidzi, jakisoni umaperekedwa kudzera mu zovala, chifukwa palibe nthawi yoti musataye kachilombo pakadali pano.
Ngati ogwira ntchito azachipatala asanafike, munthu adazindikira, muyenera kupitiliza kumuthandiza. Kuti muchite izi, tsatirani izi:
Kupereka chakumwa chaching'ono kuti mumwe chakumwa chokoma kapena kudya zotsekemera,
Pambuyo kudya zakudya zazakudya zomwedwa ndi zakumwa, amapatsidwa zakudya zomanga thupi.
Madokotala apitiliza kuthandizira kukhazikitsa shuga 40% m'mitsempha.
Kuperekanso chithandizo kumayambitsidwa ndi zomwe zimayambitsa hypoglycemia ndipo nthawi yomwe wodwalayo ali pachiwonetsero.
Zoyambitsa mwadzidzidzi
Kodi chifukwa chakuchepa kwa kuchuluka kwa shuga ndi chiyani? Pali zifukwa zambiri. Komabe, madokotala amasiyanitsa magawo awiri a zochitika zomwe zimatha kupangitsa kukhala ndi hypoglycemic coma.
Gulu limodzi pazifukwa - kuchuluka kwa insulini m'mwazi. Ntchito yayikulu ya insulin ndikuyendetsa glucose ku ziwalo ndi minofu. Pakachuluka kuchuluka kwake, pafupifupi shuga onse amalowa kuchokera m'madzi kulowa m'matumbo, ndipo gawo lake laling'ono limalowa m'magazi.
Kugwiritsa insulin kwambiri nthawi zambiri kumapezeka mwa odwala omwe ali ndi matenda a shuga. Izi ndichifukwa cha izi:
Mlingo woyenera wa mankhwala osaganizira kuchuluka kwa mankhwalawa.
Muyeneranso kusamala ndi kusankha kwa ma syringe. Kwa jakisoni wa insulini, ma syringes apadera amagwiritsidwa ntchito, pomwe chiwerengero cha zigawo zomwe zimagwirizana ndi mlingo wina umalembedwa.
Njira yolakwika yoyendetsera mankhwalawa: jakisoni wa insulin amachitika pansi pa khungu. Ngati mankhwalawa alowa m'matumbo a minofu, kuphatikiza kwake kumawonjezeka kwambiri.
Odwala omwe ali ndi matenda a pancreatic, pamene thupi lipanga insulin yambiri, amathanso kuchita hypoglycemia.
Gulu lachiwiri la zinthu zomwe zimapangitsa hypoglycemic kuphatikiza kuperewera kwa chakudya komanso kugawa zolimbitsa thupi. Poterepa, kuchuluka kwa insulin m'magazi sikupitirira zomwe zimachitika, koma kuchuluka kwa shuga kumachepetsedwa.
Kumwa mowa kumakhudza kugwira ntchito kwa chiwindi. Mu thupi ili, monga mukudziwa, kapangidwe kazinthu zonse zofunika za magazi zimachitika. Mowa wa Ethyl umawonjezera katundu pa chiwindi, chifukwa cha izi, glycogen sangathe kuthana ndi kuchuluka kwa shuga, omwe amasunga shuga wofunikira musanadye komanso pambuyo pake. Zotsatira zake, maola 2-3 mutatha kudya, kuchuluka kwa glucose m'magazi kumatsika.
Amayi omwe nthawi zambiri amagwiritsa ntchito shuga wowotcha kapena amachepetsa zakudya zamafuta nawonso amakonda kuchita hypoglycemia.
Kupsinjika, kuchita masewera olimbitsa thupi mopitirira muyeso, kukhumudwa kwakanthawi - zinthu zomwe zimayambitsa kuchepa kwa shuga m'magazi.
Zotsatira zake
Chisamaliro chodzidzimutsa cha hypoglycemic coma iyenera kuperekedwa mwachangu komanso moyenera. Nthawi zambiri wodwala akamatha kugona, amakhala kuti ali ndi vuto la chotupa muubongo, amalepheretsa kugwira ntchito kwamanjenje. Mwa odwala akuluakulu, kuwonetsa pafupipafupi kwa hypoglycemia kumabweretsa kusintha kapena kuwonongeka kwa umunthu, komanso mwa ana - kuchedwa kukukula m'maganizo. Komanso, kuthekera kwa kufa kwa wodwala ndikokwera kwambiri.
Hypoglycemic chikomokere - kutha kuzindikira chifukwa cha kuyambika kwa gawo loyipa kwambiri mu shuga. Wodwala yemwe amagwa ndi vuto la hypoglycemic nthawi zambiri amakhala ndi khungu lotuwa. Tachycardia imakonda kudziwika - kuwonjezeka kwa kugunda kwa mtima mpaka 90 kumenyedwa pamphindi kapena kupitirira.
Vutolo likamakulirakulira, kupuma kumachepa, kuthamanga kwa magazi, kuchepa, komanso kuzizira kwa khungu kumadziwika. Ophunzira samayankha pakuwala.
Zimayambitsa hypoglycemic chikomokere
Hypoglycemic coma imayamba chifukwa chimodzi mwazifukwa zitatu:
wodwala matenda a shuga samaphunzitsidwa nthawi kuti ayime kufatsa kwa hypoglycemia,
kumwa kwambiri (njira yoopsa kwambiri),
adalowetsa cholakwika (chachikulu kwambiri) cha insulin, sichidagwirizanitsa ndi kudya kwa chakudya chamagulu kapena ntchito zolimbitsa thupi.
Werengani nkhaniyo "" - - kodi odwala matenda ashuga angayimitse bwanji nthawi yokhayokha atamva kuti ali ndi matenda ake oyamba.
Kodi ndi chiopsezo chotani cha kuchuluka kwa insulin komwe kungayambitse matenda a hypoglycemic:
sanazindikire kuti insulini inali 100 PIECES / ml m'malo mwa 40 PIECES / ml ndipo adabweretsa mlingo wowonjezera nthawi 2.5 kuposa momwe amafunikira,
mwangozi insulini osati mwanjira, koma intramuscularly - chifukwa, zochita zake imathandizira kwambiri.
Wogwiritsa ntchito insulini yokhala ndi "ifupi "kapena" ultrashort ", wodwalayo amaiwala kulumidwa kuti adye.
masewera olimbitsa thupi osakonzekera - mpira, njinga, ski, kusambira, ndi zina zambiri - popanda muyeso wina wamagazi m'magazi ndikudya zakudya zopatsa mphamvu,
ngati wodwala matenda ashuga ali ndi mafuta a chiwindi,
aakulu aimpso kulephera () amachepetsa "kugwiritsa ntchito" insulin, ndipo motere, mlingo wake uyenera kuchepetsedwa pakapita nthawi,
Hypoglycemic coma nthawi zambiri imachitika ngati wodwala matenda ashuga aposa kuchuluka kwa insulin. Amachita izi kuti adziphe kapena kuti azidziyerekeza.
Hypoglycemic chikomokere pamasamba amowa
Mtundu woyamba wa matenda ashuga, mowa samaloledwa, koma uyenera kumwa pang'ono. Werengani zambiri mu nkhani "". Ngati mumamwa kwambiri, ndiye kuti mwayi wokhala ndi hypoglycemic coma ndiwokwera kwambiri. Chifukwa ethanol (mowa) umaletsa kaphatikizidwe ka shuga m'chiwindi.
Hypoglycemic coma mutamwa zakumwa zoopsa ndizowopsa. Chifukwa akuwoneka ngati chidakwa wamba. Kuti mumvetsetse kuti zovuta ndizovuta, woledzera yekha kapena anthu omwe amakhala nawo alibe nthawi. Komanso chifukwa nthawi zambiri zimachitika osati pambuyo panu, koma pambuyo maola ochepa.
Zizindikiro
Kuti musiyanitse chikumbumtima cha hypoglycemic coma ku hyperglycemic coma (i.e. chifukwa cha shuga wambiri), muyenera kutero. Koma osati zophweka. Pali zochitika zina zapadera pomwe wodwala amakhala ndi matenda a shuga kwa nthawi yayitali, koma sanalandire chithandizo, ndipo wayamba kumwa mapiritsi a insulin ndi / kapena shuga.
Mwa odwala oterowo, hypoglycemic coma imatha kuchitika ndimagazi a shuga kapena okwera - mwachitsanzo, pa 11.1 mmol / L. Izi ndizotheka ngati shuga m'magazi amatsika msanga kuchokera pamitengo yapamwamba kwambiri. Mwachitsanzo, kuyambira 22.2 mmol / L mpaka 11.1 mmol / L.
Zina zasayansi zantchito sizimalola kuti zidziwike molondola kuti chikomokere mwa wodwalayo ndicholondola kwambiri. Monga lamulo, wodwalayo alibe shuga mu mkodzo, pokhapokha ngati glucose adachotsedwa mu mkodzo musanayambike chikomokere.
Chisamaliro chodzidzimutsa cha hypoglycemic coma
Ngati wodwala matenda ashuga auma chifukwa cha kuphwanya kwa magazi, ndiye kuti ena ayenera:
uyikeni pambali pake
mumasule pakamwa pazakudya,
ngati angathe kumeza - imwani ndi chakumwa chokoma,
Akakomoka kuti asimezenso, - osam'thira madzi mkamwa kuti asakakamize kufa,
ngati wodwala matenda ashuga ali ndi syringe ndi iye, mupetseni 1 ml ya mankhwalawa kapena m'mitsempha,
itanani ambulansi.
Kodi adotolo azichita chiyani:
Choyamba, 60 ml ya glucose 40% yothetsera shuga adzagwiritsiridwa ntchito kudzera m'mitsempha, kenako amawunika ngati wodwalayo ali ndi chikomokere - hypoglycemic kapena hyperglycemic
ngati wodwalayo sakodzanso, amayamba kumubaya jekeseni wa 5-10% shuga m'matumbo ndi kupita naye kuchipatala
Kutsatira chithandizo kuchipatala
Ku chipatala, wodwalayo amawunika kuti apeze zovuta zowonongeka muubongo kapena mtima wamatumbo (kuphatikizapo intracranial hemorrhage). Dziwani ngati panali mankhwala ochulukirapo a mapiritsi ochepetsera shuga kapena insulin.
Ngati panali mapiritsi ochulukirapo, ndiye kuti m'mimba mumachitika zinthu zofunikira ndikuyika makala. Ngati bongo wa insulini (makamaka ntchito nthawi yayitali), ntchito yopanga jakisoni imachitika ngati sipanathe maola atatu itatha.
Kugwa kwa njira ya 10% ya glucose kumapitilizidwa mpaka shuga ya magazi ibwerera mwabwinobwino. Pofuna kupewa kuthirira kwamadzimadzi, sinthanani shuga 10% ndi 40%. Wodwala akapanda kulengedwa mkati mwa maola 4 kapena kuposerapo, edema ya m'magazi ndi "zovuta" (kufa kapena kulumala) ndizotheka kwambiri.
Ngati wolakwiridwayo akudziwa

Kukhazika wovutitsidwa.
Mupatseni mankhwala aliwonse omwe ali ndi shuga (shuga woyengetsa, uchi, jamu, zakumwa za shuga) posachedwa.
Zizindikiro zitatha, muyenera kudya bwino kupewa kubwereza hypoglycemia.
Ngati thanzi lanu silikuyenda bwino, itanani ambulansi nthawi yomweyo.

Mankhwala
Hypoglycemia wa mankhwala osokoneza bongo nthawi zambiri amapezeka m'mayendedwe odwala matenda ashuga ndipo amakwiya ndimankhwala osayenera. Zotsatira zake, insulin yochuluka imatulutsidwa, zomwe zimapangitsa kuchepa kwa shuga m'magazi ndi hypoglycemia.
Pakati pa omwe alibe matenda a shuga, hypoglycemia imatha kuchitika mukamatenga:
Mankhwala ena kuti muchepetse kuthamanga kwa magazi anu: atenolol, metoprolol, propranolol.
Ma antidepressants ena: phenelzine, tranylcypromine.
Ndi mankhwala ena: quinine, haloperidol, trimethoprim (sulfamethoxazole).
Kuperewera kwa zakudya m'thupi
The yogwira hypoglycemia pambuyo chakudya mkulu chakudya. Zotsatira zake, shuga ya magazi imakwera mwachangu, zomwe zimapangitsa kuti insulini itulutsidwe kwambiri.
Reactive hypoglycemia imatha kupezeka mwa anthu omwe amavutika kugaya fructose, galactose, kapena leucine.
Mavuto a ziwalo zamkati
Mwakutero, ndi pituitary gland, adrenal gland, kapamba, impso kapena chiwindi.
Gland imayang'anira kupanga mahomoni ofunikira m'thupi kuti achulukitse shuga. Izi ndi:
Cortisol ndi adrenaline amamasulidwa ku ma adrenal glands.
Glucagon, yomwe imamasulidwa ku kapamba.
Ngati mahomoni awa sagwira ntchito moyenera, hypoglycemia ikhoza kuchitika.
Ngati chiwindi sichingasunge bwino chakudya kapena kuwasintha kukhala shuga, hypoglycemia imatha kuchitika.
Chotupa cha pancreatic chitha kupangitsanso hypoglycemia mwa kupangitsa insulin mosalekeza.
Hypoglycemia imatha kupezekanso ngati vuto laimpso.
Zina zomwe zingayambitse

Kuchita zolimbitsa thupi kwambiri.
Kuthetsa madzi m'thupi.
Thupi.
Mowa wambiri umamwetsa.

Minyewa ya magazi ikatsika kwambiri, thupi limatulutsa adrenaline. Izi zimabweretsa zofanana ndi nkhawa:
Mankhwala, thukuta.
Kutaya chikumbumtima.
Tachycardia (kuthamanga kwamtima).
Kugwedeza zala, milomo.
Khansa yapakhungu, njala yayikulu.
Zovuta.
Ubongo ukakhala kuti usakhale ndi glucose wokwanira, zizindikiro zotsatirazi zimachitika:
Kufooka, kutopa.
Chizungulire, kupweteka mutu.
Zovuta ndi kusumika.
Kugona, chisokonezo.
Vuto lakulankhula.
Kunja, zizindikiro zoterezi zitha kukhala zolakwika chifukwa cha kuledzera.
Hypoglycemia imatha kudwala khunyu, chikomokere, komanso kuwonongeka kwa ubongo.
Zizindikiro za hypoglycemia zimatha kuonekera pang'onopang'ono komanso modzidzimutsa.
Zakudya za hypoglycemia
Cholinga cha chakudyacho ndicho kukhazikika m'magazi a shuga kuti magazi asatope kwambiri. Nawa malingaliro:
Katatu kudya zakudya zofunikira panthawi yoyenera.
Chakudya chizikhala ndi magulu atatu a zinthu: masamba, chimanga, mkaka, nyama, nkhuku, nsomba.
Zakudya zokhazikika nthawi ndi nthawi pakati pa chakudya. Zosakhazikika ziyenera kukhala ndizakudya zamagulu ena, zomanga thupi ndi zomanga thupi.
Chepetsani kudya zakudya zomwe zili ndi shuga wambiri kapena wofulumira: makeke ndi makeke, ayisikilimu, kupanikizana.
Pali kuchuluka okwanira kwa fiber (kuyambira 25 mpaka 38 g patsiku): mpunga wa bulauni, buledi wa tirigu, nyemba, zipatso ndi ndiwo zamasamba.
Pewani kusala mowa.
Muchepetse khofi ndi zakumwa zina zokhala ndi caffeine chifukwa zimachepetsa shuga.
Kumwa madzi ambiri.
Kodi hypoglycemia ndi chiyani?
Ngati, mosasamala kanthu za zomwe zimayambitsa, kuchuluka kwa shuga m'magazi kumatsika kwambiri, ma neurons a ubongo amayamba kupeza kuperewera kwa chakudya ndi mpweya, chifukwa chomwe matenda omwe amayamba msanga m'maganizo amayamba, mpaka kutsika kwakuya.
Nthawi zambiri, zizindikiro za hypoglycemia zimayamba chizindikiro cha 3 mmol / L chikafika, ndi 1-2 mmol / L, kukomoka kumayamba. Komabe, mukalandira chithandizo cha insulin, vutoli limatha kuyamba milingo iyi isanachitike ngati shuga yayamba kutsika kwambiri. Choopsa chachikulu ndikuti kuyambira gawo loyambira mpaka kukomoka kwambiri, zimatha kutenga mphindi 15-30, pambuyo pake munthu amatha kuzindikira.
Njira yokhayo yopewa kupuma kwambiri ndikubwezeretsanso thupi wake munthawi yake, yomwe, ndi chisamaliro chodzidzimutsa. Sikuti nthawi zonse hypoglycemia imatha kupezeka kuti imadziwika, yomwe imatenga mphindi zamtengo wapatali.
Zolinga zake
Zifukwa zitatu zokha zomwe nthawi zambiri zimabweretsa chiwopsezo pamoyo wa wodwalayo, koma, mwatsoka, zimapitilirabe:
Wodwalayo adwala posachedwa ndipo sanaphunzire momwe angawopsezere kapena kusiya nthawi.
Mukamamwa mowa. Vuto ndiloti thupi limakhudzana mosiyanasiyana ndi zakumwa zomwe zimamwa, zimakhudzanso mphamvu ya mankhwalawa omwe amaperekedwa. Kuphatikiza apo, mkhalidwe wa kuledzera uli wofanana kwambiri ndi hypoglycemic, zomwe zimapangitsa kuzindikira kwake kukhala kovuta.
Mukabaya insulin, nthawi zina zimakhala zovuta kuganizira kuchuluka kwa chakudya chamafuta (chakudya chosadziwika, malo okonzekera), kapena masewera olimbitsa thupi ofunikira omwe amafunika kuti "adye" glucose. Nthawi zina mlingo wokhathamiritsa kwambiri umaperekedwa molakwika. Nthawi zina, insulin yothamanga imapatsidwa jakisoni wamkati m'malo mwa subcutaneous. Izi zimathandizira kuyankha kwa thupi ku insulin.
Munthu akangodziwa za matenda ake, ayenera kukambirana nthawi yomweyo komanso mosamala ndi adokotala momwe angapezere zakudya, kuchuluka kwa zochita zolimbitsa thupi. Kuphatikiza apo, kwanthawi yoyamba, muyenera kuwona kuchuluka kwa shuga m'magazi tsiku lanu lonse kuti mupeze molondola mawonekedwe a thupi, kufunikira kwake kwa insulini, komanso momwe ma jakisoni amathandizira. Izi zimachepetsa chiopsezo cha dontho lakuthwa la shuga. Ndikofunikira kwambiri kukonzekera nthawi yausiku kuti glycemia isachitike m'maloto.
Chithandizo cha Chipatala Hypoglycemia
Njira zochizira kuchipatala sizosiyana kwambiri ndi chisamaliro cha prehospital. Ngati zizindikiro zikapezeka, wodwalayo ayenera kugwiritsa ntchito mankhwala okhala ndi shuga kapena kumwa mapiritsi a piritsi. Ngati pakamwa sizingatheke, mankhwalawa amaperekedwa kudzera mu mawonekedwe a yankho. Ngati vutoli silikuyenda bwino, lingafunike kulowererapo osati kokha kwa endocrinologist, komanso akatswiri ena (cardiologist, resuscitator, etc.).
Akatha kuchotsewa, zakudya zomwe zimakhala ndi zovuta m'mimba zimatha kufunikira kuti zisayambenso. M'tsogolomu, ndikofunikira kusintha kuchuluka kwa othandizira omwe amagwiritsidwa ntchito ndi wodwalayo, muphunzitseni kuchita izi payekha ndikulimbikitsa kudya moyenera.
Zinthu zololera ndi ana
Zomwe zimayambitsa ndi zizindikiro za mkhalidwe wa hypoglycemic mwa ana zimakhala zofanana ndi za akuluakulu. Komabe, pali zovuta zazikulu:
Mwana, makamaka wocheperako, samangolephera kufotokoza za vuto lakelo, komanso kuzindikira Zizindikiro zomwe zimawonekera, kuti atembenukire kwa akulu kuti akathandizidwe, kotero kuzindikira vutoli ndikovuta kwambiri.
Mwa ana, nthawi yokhala kuti yatsala pang'ono kuchepa, njira zonse zimachitika mwachangu, kuphatikizapo kuwonongeka kwa ubongo ndi kufa. Kuthandizira mwadzidzidzi, kuyankha mwachangu kuchokera kwa achikulire omwe ali ndi udindo wokhudzana ndi mwana, komanso kuchokera kwa ogwira ntchito kuchipatala omwe avomera kuyitanidwa ndikofunikira.
Zizindikiro zina zomwe zimakuthandizani kumvetsetsa kwa kukhalapo kwa hypoglycemia mwa ana ndi izi:
Mwana wakhanda nthawi zambiri amakhala misozi, amavutika. Amakhala ndi ululu wam'mimba, womwe umalepheretsa chizindikiro cha njala, ndipo nthawi zambiri mwana amakana chakudya.
Kenako imakhala yaulesi, siyimayanjana, imakhala yosayanjana ndi zilonda zakunyumba.
Asanataye chikumbumtima, chizungulire chimawonjezeredwa, makamaka poyesera kukwera.
Ndikukomoka, kupsinjika kumatsika msanga, kupumira kumachepa ndipo kugunda kwa mtima kumachepa.
Ngati achikulire amadziwa za matenda a mwana, shuga ngati kuli kotheka, chitani kanthu kanthawi ndikupulumutsa moyo wake.
Matenda a shuga si chiganizo, koma mwayi wowunikira thanzi lanu mosamala. Zomwezi zimagwiranso ntchito kwa okondedwa omwe ali ndi matenda ashuga. Ayenera kudziwa momwe munthu amene ali ndi vuto la hypoglycemia, kuthandizira kuyang'anira thupi lake, ndikuziteteza ku zolakwika zina ndi zovuta zina.