Lactic acidosis mu mtundu 2 matenda a shuga: Zizindikiro ndi mankhwala a lactic chikomokere

Lactic acidosis - mkhalidwe wa metabolic acidosis chifukwa cha kuchuluka kwa lactic acid m'magazi. Lactic acidosis si vuto linalake matenda a shugaSD), koma ali ndi chilengedwe cha polyetiological.

Kukula kwake kumatha kuyambitsidwa ndi matenda ndi mikhalidwe yodziwika ndi:

1) minofu hypoxia - mtundu A lactic acidosis - cardiogenic, endotoxic, Hypovolemic mantha, kuchepa magazi, CO poyizoni, khunyu, pheochromocytoma,
2) kuchuluka kwa mapangidwe ndikuchepetsa kugwiritsidwa ntchito kwa lactate (mtundu wa B1 lactic acidosis - aimpso kapena kwa chiwindi, matenda a oncological ndi hemoblastoses, matenda opatsirana, matenda opatsirana a shuga, mtundu wa B2 lactic acidosis - kugwiritsa ntchito biguanides, poyizoni ndi methanol kapena ethylene glycol, cyanides, kuchuluka kwa makulidwe a makolo a fructose. B3 - cholowa cha metabolic - kuperewera kwa glucose-6phosphate dehydrogenase, methylmalonic acidemia.

Lactate - kagayidwe kachakudya kamakhudzidwa kagayidwe ka chakudya. Pamodzi ndi pyruvate, lactate ndi gawo lapansi lopanga shuga mkati mwa neoglucogeneis. Kupanga kwa lactate kumawonjezeka mu zochitika za hypoxia, pamene aerobic zoletsa ndi activation ya anaerobic glycolysis zimachitika, chomaliza chomwe ndi lactic acid. Pankhaniyi, kuchuluka kwa kutembenuka kwa lactate kukhala pyruvate ndikugwiritsa ntchito kwake pa neoglucogeneis ndi kotsika kuposa momwe amapangira. Nthawi zambiri, mulingo wa lactate ku pyruvate ndi 10: 1.

Chifukwa chake, lactic acidosis imatha kukhala m'matenda osiyanasiyana osiyanasiyana, kuphatikizapo matenda ashuga, koma chiopsezo cha matenda ake a shuga ndichokwera kwambiri kuposa anthu omwe alibe matendawa. Izi ndichifukwa choti kuwonongeka kwa matenda osokoneza bongo a shuga, komwe nthawi zambiri kumawonedwa mwa odwala, kumathandizira mkhalidwe wa hypoxia wosachiritsika chifukwa chakuwonjezeka kwa hemoglobin ya glycated, yomwe ili ndi mgwirizano wowonjezereka wa mpweya.

Kuphatikiza apo, odwala matenda a shuga, makamaka okalamba, akuvutika lembani matenda ashuga 2SD-2)Monga lamulo, amakhala ndi matenda osiyanasiyana okhudzana ndi mtima, omwe amakhala ndi matenda a hypoxia. Mkhalidwe wa hypoxia yayikulu imadziwikanso ndi zovuta zazikulu za matenda ashuga monga ketoacidotic ndi hyperosmolar coma, kenako gulu lactic acidosis limakulirakulira kwakukulu momwe mkhalidwewo uliri wa odwalawo, komanso moyo wawo wabwino.

Kuperewera kwa insulini mu shuga kumapangitsanso zofunikira zoyambitsa kukula kwa mtundu B lactic acidosis, chifukwa kuchepa kwamtunduwu wa minofu ya pyruvate dehydrogenase kumabweretsa kuwonjezeka kwa syntact lactate.

Choyambitsa chachikulu cha lactic acidosis mwa odwala omwe ali ndi matenda ashuga chimawerengedwa kuti amatenga mankhwala ochepetsa shuga kuchokera ku gulu la Biguanide - phenformin ndi buformin, omwe adatha kuyambitsa anaerobic glycolysis m'matumbo ang'ono ndi minofu, potero amawonjezera kupanga lactate ndikuletsa neoglucogenesis m'chiwindi. Chifukwa cha zovuta zomwe zili pamwambapa komanso kuwopsa kwa mankhwalawa, mankhwalawa sapezeka. Metformin - mankhwala amakono a greatuanide - samatsogolera ku kudziunjikira kotereku chifukwa cha zinthu zina zopanga ndi ma pharmacokinetic. Chiwopsezo cha lactic acidosis yokhala ndi phenformin ndi milandu 0-0.084 yokha mwa odwala 1000 pachaka.

Chifukwa chake, mwayi wokhala ndi lactic acidosis ndiwokulira kwambiri kwa odwala omwe ali ndi matenda a shuga a 2. Mwachilengedwe, nthawi zambiri imakhala yosakanikirana (mtundu A + mtundu B). Zambiri zimakhudzidwa ndi pathogenis yake. Nthawi yomweyo, osatenga biguanides, koma njira yokhazikika yokhala ndi chizindikiro cha hypoxia komanso kuwonongeka kwa matenda ashuga, komwe anaerobic glycolysis imayambitsidwa ndikuwonjezera kwa lactate kumachitika, imakhala ndi gawo lofunikira kwambiri. Kuphatikiza kwa matenda a impso kwa odwala omwe ali ndi matenda osokoneza bongo, omwe amachepetsa kuchulukitsidwa kwa lactate, ndikofunikira kowonjezereka mu pathogenesis ya lactic acidosis, chifukwa chake mu 80-90% ya milandu yomwe imayambitsa kukula kwake ndi kulephera kwa impso.

Chithunzi cha chipatala cha lactic acidosis sichimawoneka bwino ndipo poyamba chimawoneka ngati kutopa kochulukira, kufooka kowonjezereka, kugona, kusanza, ndi kusanza, zomwe zimafanana ndi kuwonongeka kwa matenda ashuga. M'malo mwake, chizindikiro chokhacho chomwe dokotala amatha kuzindikira pokhudzana ndi lactic acidosis ndi mawonekedwe a kupweteka kwa minofu chifukwa cha kudzikundikira kwa lactic acid.

Sekulu acidosis mwa odwala matenda ashuga amatha kukhala maola ochepa ndipo zizindikilo zake zimatha kukhala zolimbitsa thupi (kupuma kwa Kussmaul), zotumphukira za m'mimba zomwe zimachepa kwambiri ndi kuthamanga kwa magazi, kusokonezeka kwa mitsempha ya mtima, chisokonezo, kusokonezeka kapena chikomokere. Choyambitsa kufa kwa odwala ndi, monga lamulo, kukulitsa kuchepa kwamtima kapena kufooka kwa malo opumira.

Zizindikiro

Kuzindikira kwa lactic acidosis kumakhala kovuta, chifukwa, choyambirira, palibe zizindikiro zenizeni mu chithunzi chake chachipatala, ndipo chachiwiri, nthawi zambiri zimakhazikika motsutsana ndi zovuta zam'mbuyo zamatenda akulu, omwe mwa iwo eni amayambitsa zovuta zamitsempha komanso mtima zomwe zimayambitsa kusokonezeka kwa chikumbumtima. Kuzindikira kwa lactic acidosis kumatsimikiziridwa ndi kuchuluka kwambiri kwa lactic acid m'magazi, kupezeka kwa decompensated metabolic acidosis mowerengera acid-base boma (KShchS) ndi anion kupatula kuchuluka.

Nthawi zambiri, mulingo wa lactate m'magazi a venous umachokera ku 0,5 mpaka 2.2 mmol / L, ochepa - kuyambira 0,5 mpaka 1.6 mmol / L. Magawo a Serum lactate pamtunda wa 5.0 mmol / L ndi mawonekedwe a diagnostic a lactic acidosis. Kuzindikira kwa lactic acidosis kumakhala kotheka ngakhale ndi mulingo wa lactate wa 2.2 mpaka 5.0 mmol / l wokhala ndi magazi a pH ochepera 7.25. Kuthandizira pakuzindikira lactic acidosis ndi gawo lotsika la bicarbonate (HCO3) mu seramu (15 meq / l.), Kotero, kuti zitsimikizidwe za lactic acidosis, choyambirira, kutsimikiza kwa labotiki kwa lactate m'magazi ndikofunikira, komwe sikuchitika.

Pozindikiritsa mosiyanasiyana, ndikofunikira kupatula matenda a diabetesic ketoacidosis, podziwa kuti lactic acidosis simadziwika ndi kuchuluka kwa matupi a ketone m'magazi ndipo, motero, mkodzo, komanso kuchuluka kwambiri kwa shuga m'magazi.

Chithandizo cha lactic acidosis cholinga chake ndicho kuthana ndi manjenje, hypoxia, acidosis, kusokonezeka kwa ma electrolyte, kukonza matenda osokoneza bongo ngati kuli kofunikira, komanso kuphatikizira chithandizo cha matenda ophatikizika omwe angakhale chifukwa cha lactic acidosis.

Njira yokhayo yochotsera lactic acid mthupi ndi extracorporeal dialysis (hemodialysis) pogwiritsa ntchito lactate-free buffer, yomwe imangoyambika pambuyo pa umboni wa labotiki ya lactic acidosis.

Chotsani owonjezera CO₂chifukwa cha acidosis, hyperventilation ya mapapo imatha kupereka, yomwe wodwalayo ayenera kuyamwa. Cholinga cha pulmonary hyperventilation ndikuchepetsa pCO₂ mpaka 25-30 mm Hg Kubwezeretsanso kwa intracellular pH mu hepatocytes ndi cardiomyocyte pankhaniyi kumatha kusintha kagayidwe kake ndikuthandizira kuchepa kwa magazi lactate.

Kuonjezera ntchito ya pyruvate dehydrogenase ndi glycogen synthetase michere, motero, kuchepetsa mapangidwe a lactate, kulowetsedwa kwa shuga mkati mwa 5-12,5 g pa ola limayikidwa limodzi ndi insulin yocheperako pakati pa magawo a 2-4-6. ola lililonse. Poganizira hemodynamic magawo, vaso- ndi mtima kukonzekera ndi mankhwala.

Pakadali pano, pali zifukwa zotsutsana ndi kugwiritsa ntchito sodium bicarbonate mu lactic acidosis, pofotokoza za kupangika kwapafupipafupi kwa pulmonary edema, hypertonicity, rebound alkalosis, hypokalemia, kuchuluka kwa hypoxia, ndi zina zotere. Zidziwikanso kuti kugwiritsa ntchito sodium bicarbonate mu lactic acidosis kungayambitse kuwonjezereka kwa paracosis. chifukwa cha kuchuluka kwa intracellular acidosis, kuchuluka kwa lactate, chifukwa chake, pali malamulo okhwima ogwiritsira ntchito: ndizotheka kugwiritsa ntchito bicarbonate ndi sodium pH

Type 2 matenda a shuga ndi matenda osachiritsika, owonetsedwa ndi kuphwanya kagayidwe kazakudya koyambitsa matenda a hyperglycemia chifukwa cha kukana kwa insulini komanso kukayika kwa chinsinsi cha β-cell, komanso lipid metabolism ndi chitukuko cha atherosulinosis.

SD-1 ndi nthenda yokhazikika ya autoimmune yomwe imatsogolera ku chiwonongeko cha kapamba wopanga ma pancreatic β-cell ya islet, yomwe imawonetsedwa ndi kuperewera kwenikweni kwa insulin. Nthawi zina, odwala omwe ali ndi matenda oopsa a shuga - 1 amakhala ndi zolemba zowonongeka za autoimmune ku β-cell (idiopathicabetes-1).

Zimayambitsa lactic acidosis

Nthawi zambiri, lactic acidosis imayamba mtundu wachiwiri wa matenda ashuga odwala omwe, motsutsana ndi matenda omwe amayambitsidwa, adakumana ndi myocardial infarction kapena stroke.

Zifukwa zazikulu zomwe zimathandizira kukulitsa lactic acidosis mthupi ndi izi:

• kuperewera kwa chakudya m'maselo a minofu ndi ziwalo za thupi,
• kukula kwa magazi m'thupi,
• magazi obwera chifukwa chotaya magazi ambiri,
• kuwonongeka kwambiri kwa chiwindi
• kukhalapo kwa kulephera kwa aimpso, kukulitsa pamene mukutenga metformin, ngati pali chizindikiro choyamba kuchokera pamndandanda womwe watchulidwa,
• kulimbitsa thupi kwambiri,
• kupezeka kwa zochitika zadzidzidzi kapena sepsis,
• mtima kumangidwa
• kupezeka kwa thupi la matenda osachiritsika a shuga komanso ngati mankhwala opatsirana mwa matenda ashuga atengedwa,
• kupezeka kwa zovuta za matenda ashuga m'thupi.

Kupezeka kwa matenda am'mimba kumatha kupezeka mwa anthu athanzi chifukwa cha momwe zimakhudzira thupi la munthu mikhalidwe ina komanso kwa odwala matenda a shuga.

Nthawi zambiri, mkaka acidosis imayamba kukhala ndi matenda ashuga motsutsana ndi njira yosalamulirika ya shuga.

Kwa odwala matenda ashuga, thupi ili ndi losafunikira komanso loopsa, chifukwa pamatha izi.

Lactic acid chikomaso chimatha kupha.

Zizindikiro zake

Mu shuga lactic acidosis, zizindikiro ndi zizindikilo zimatha kukhala motere:

• chikumbumtima
• kumva chisoni,
• kulephera kudziwa
• kumverera kwa nseru
• maonekedwe akusanza ndikusanza lokha,
• kupuma pafupipafupi komanso kwanthawi yayitali
• Maonekedwe a ululu m'mimba,
• mawonekedwe ofooka kwambiri m'thupi lonse.
• kuchepa kwamagetsi,
• Kukula kwa lactic coma.

Ngati munthu ali ndi mtundu wina wa matenda a shuga, ndiye kuti kulowetsedwa kwa lactic acid kumawonedwa patapita nthawi yoyamba kufalikira.

Wodwala akagwa, amakhala kuti:

1. Hyperventilation
2. kuchuluka glycemia,
3. kutsika kwa kuchuluka kwa ma bicarbonate m'madzi a m'magazi komanso kuchepa kwa magazi pH,
4. ma ketoni ochepa amadziwika mkodzo,
5. mulingo wa lactic acid m'thupi la wodwalayo umakwera mpaka 6.0 mmol / l.

Kukula kwa zovuta kumachitika kwambiri ndipo mkhalidwe wa munthu wodwala matenda a shuga 2 umakulirakulira pang'onopang'ono kwa maola angapo otsatizana.

Zizindikiro zomwe zimayenderana ndi kuphatikizika kwa vutoli ndizofanana ndi zovuta zina, ndipo wodwala yemwe ali ndi matenda osokoneza bongo amatha kugwa ndimisempha yochepa komanso yokwera kwambiri m'thupi.

Kuzindikira konse kwa lactic acidosis kumakhazikika pa kuyesa kwa magazi.

Chithandizo ndi kupewa lactic acidosis pamaso pa matenda a shuga

Chifukwa chakuti kupanikizika kumeneku kumayamba chifukwa cha kuchepa kwa mpweya m'thupi, njira zochizira munthu zochotsa munthu mdziko lino zimakhazikitsidwa makamaka ndi pulani ya maselo a minofu yaumunthu ndi ziwalo zokhala ndi mpweya. Pachifukwa ichi, zida zojambula zam'mapapo zolimbitsa thupi zimagwiritsidwa ntchito.

Mukamachotsa munthu ku mtundu wa lactic acidosis, ntchito yayikulu ya dotolo ndikuchotsa hypoxia yomwe yachitika m'thupi, chifukwa ndi ichi makamaka chomwe chikuyambitsa lactic acidosis.

Pakukonza njira zochizira, kupanikizika ndi zizindikiro zonse zofunika za thupi zimayang'aniridwa. Kuwongolera kwapadera kumachitika ngati anthu achikulire amachotsedwa m'boma lactic acidosis, omwe ali ndi vuto lotenga magazi ndipo amakhala ndi zovuta komanso zovuta m'magazi.

Musanazindikire wodwala lactic acidosis, magazi amayenera kutengedwa kuti aunikidwe. Mukuchita kafukufuku wa labotale, pH ya magazi ndi kuyika kwa ayoni a potaziyamu mkati mwake amatsimikiza.

Njira zonse zimachitidwa mwachangu kwambiri, popeza umunthu kuchokera pakukhazikika kwa thupi la wodwalayo ndiwokwera kwambiri, ndipo nthawi yosintha kuchokera ku yachilendo kupita ku matenda ndi yochepa.

Ngati milandu yoopsa ikapezeka, kutumikiridwa kwa potaziyamu kumachitika, mankhwalawa amayenera kuperekedwa pokhapokha magazi acid asachepera 7. Kupanga mankhwala popanda zotsatira zoyenera kuyenera kuletsedwa.

Magazi acidity amawunika wodwala maola awiri aliwonse. Kubweretsa potaziyamu bicarbonate kuyenera kuchitika mpaka nthawi yomwe sing'anga ikhale ndi acidity yopitilira 7.0.

Ngati wodwala walephera aimpso, hemodialysis ya impso imachitidwa. Kuphatikiza apo, peritoneal dialysis ikhoza kuchitidwa kuti ibwezeretse yachilendo mlingo wa potaziyamu bicarbonate m'thupi.

Pofuna kuchotsa thupi la wodwala ku acidosis, mankhwala a insulin okwanira komanso utsogoleri wa insulin amagwiritsidwanso ntchito, cholinga chake ndikukonza kagayidwe kazachilengedwe.

Popanda kuyezetsa magazi a biochemical, ndizosatheka kukhazikitsa wodwala wodalirika. Popewa kukula kwa matenda am'magazi, wodwala amafunikira kuti apereke maphunziro ofunikira kuchipatala zikafika zizindikiro zoyambirira za matenda.

Pofuna kupewa kutukuka kwa lactic acidosis mthupi, mphamvu ya kagayidwe kazakudya m'thupi la wodwala yemwe ali ndi matenda ashuga iyenera kulamulidwa bwino. Kanemayo munkhaniyi akukamba za zoyamba za matenda ashuga.

Kodi lactic acidosis ndi chiani ndipo bwanji?

Kuti thupi lizigwira ntchito bwino, magawo onse a ziwalo zake amafunikira - mahomoni, zinthu za m'magazi, mwanabele, michere.

Kusokera mumapangidwe kumachitika chifukwa chaphwanya kagayidwe kazachilengedwe ndipo zimabweretsa zotsatira zowopsa kwa anthu.

Acidosis ndi mkhalidwe womwe kuchuluka kwa asidi kumawonedwa m'magazi.

Zachilengedwe pang'onopang'ono zamchere za magazi zimasintha molingana ndi kuchuluka kwa acidity. Izi sizimachitika mthupi lathanzi, koma chifukwa cha zochitika zosiyanasiyana zamatumbo.

Zambiri

Lactic acidosis yamtundu wa 2 matenda a shuga sichinthu chofala, komabe, ndi chachikulu kwambiri. Zotsatira zabwino zimawonedwa pokhapokha mu 10-50% ya milandu.Lactate (lactic acid) amawonekera m'thupi chifukwa cha kupasuka kwa glucose, koma impso sizingathe kuzimasulira zochuluka motero.

Kusinthasintha kwa magazi osakhalitsa ndi lactate kumabweretsa kusintha kwa acidity yake. Kuzindikira kumatsimikiziridwa mwa kudziwa mulingo wa lactic acid pamwamba pa 4 mmol / L. Dzina lachiwiri la kuphatikizika kwa shuga ndi lactic acidosis.

Zifukwa zazikulu

Lactic acidosis mu mtundu 2 wa shuga samapezeka mwa odwala onse, koma mothandizidwa ndi zina zoyambitsa:

• matenda a kagayidwe kachakudya njira chibadidwe,
• kukhazikitsidwa kwa kuchuluka kwa fructose mthupi, kudutsa m'mimba,
• poyizoni wa mowa
• kuwonongeka kwamakina
• magazi
• zotupa, matenda opatsirana,
• poyizoni wa cyanide, kugwiritsa ntchito salicylates nthawi yayitali,
• matenda osokoneza bongo a shuga osaphatikizika pamodzi ndi zovuta zina,
• hypovitaminosis B1,
• kwambiri mawonekedwe a kuchepa magazi.

Pathology imatha kukhala osati kokha motsutsana ndi maziko a "matenda okoma", komanso pambuyo pa vuto la mtima.

Njira yopititsira patsogolo

Mafuta akamalowera m'thupi la munthu kudzera m'mimba, njira yothetsera kusweka kwawo imakhala m'magawo angapo. Ngati palibe insulin yokwanira yomwe imatulutsidwa (izi zimachitika m'magawo apambuyo a matenda a 2) ndi kuchepa kwa maselo a pancreatic), kuwonongeka kwa mafuta ndi madzi ndi mphamvu kumachedwa pang'ono kuposa momwe kumafunikira ndipo kumayendetsedwa ndi kuphatikizika kwa pyruvate.

Chifukwa chakuti zochulukitsa zowonetsa za pyruvate zimakhala zokwera, lactic acid imasonkhanitsidwa m'magazi. Amakonda kugwira ntchito kwa ziwalo zamkati moopsa.

Zotsatira zake ndikukula kwa hypoxia, ndiye kuti, maselo ndi minyewa yathupi sizilandira mpweya wokwanira, womwe umakulitsa boma la acidosis. Mlingo wa magazi pH umabweretsa kuti insulini imataya ntchito yake kwambiri, ndipo lactic acid imakwezeka kwambiri.

Ndi kukula kwa matenda, kudwala matenda a shuga amapangidwa, limodzi ndi kuledzera kwa thupi, kuchepa mphamvu kwa thupi ndi acidosis. Mawonekedwe oterewa akhoza kupha.

Mawonekedwe

Zizindikiro za lactic acidosis zimawonjezeka maola angapo. Nthawi zambiri, wodwalayo amadandaula za chithunzi chotsatira chachipatala:

• mutu
• chizungulire
• kusanza ndi kusanza,
• chikumbumtima
• kupweteka m'mimba
• ntchito zamagalimoto
• kupweteka kwa minofu
• kugona, kapena, kusowa tulo,
• kupuma pafupipafupi.

Zizindikiro zotere sizili zachindunji, chifukwa zimawonedwa osati ndi kudzikundikira kwa lactic acid, komanso motsutsana ndi maziko azovuta zina zingapo.

Coma ndi chizindikiro cha gawo lotsiriza pakupanga lactic acidosis. Zimayambitsidwa ndikuwonjezereka kwa vuto la wodwalayo, kufooka kwambiri, khungu lowuma komanso mucous membrane, kupuma kwa Kussmaul (kupuma kwamphamvu ndi phokoso losungika). Kamvekedwe ka mawonekedwe a wodwalayo amachepetsa, kutentha kwa thupi kumatsikira mpaka madigiri 35.2-35,5. Nkhope zanu zakuthwa, maso akuwongoka, palibe kutulutsa mkodzo. Kupitilira apo, pamakhala kutayika.

Njirayi itha kukulitsidwa ndi kukula kwa DIC. Awa ndi mkhalidwe womwe magazi amapangira magazi, amapanga magazi kwambiri.

Njira zothandizira ndi kuwongolera

Kuthandizidwa kuchipatala kuyenera kukhala ndi cholinga chothana ndi kusintha kwa magazi acidity, mantha, kukondera kwa elekitirodi. Mofananamo, endocrinologists akuwongolera chithandizo cha mtundu wa 2 matenda a shuga.

Popeza kuchuluka kwa mpweya wambiri wa kaboni kumapangidwa motsutsana ndi maziko a kuphwanya magazi acid, vutoli liyenera kuthetsedwa. Wodwalayo amapsinjika kwambiri m'mapapo (ngati wodwalayo sakudziwa, ndiye kuti makulitsidwe amafunikira).

Glucose yemwe amakhala ndi insulin yocheperako amagundidwa m'mitsempha (pofuna kukonza zovuta za metabolic) kumbuyo kwa njira ya matenda ashuga), yankho la sodium bicarbonate. Vasotonics ndi cardiotonics (mankhwala othandizira ntchito ya mtima ndi mitsempha yamagazi) ndi mankhwala, heparin ndi reopoliglukin amatumizidwa paz Mlingo wochepa. Kugwiritsa ntchito ma diagnostics a labotale, kuchuluka kwa magazi ndi kuchuluka kwa potaziyamu kumayang'aniridwa.

Sizotheka kuchitira wodwala kunyumba, chifukwa ngakhale akatswiri odziwa bwino ntchito sangakhale ndi nthawi yothandizira wodwalayo. Pambuyo pokhazikika, ndikofunikira kuwona kupumula kwa kama, chakudya chokhazikika, komanso kuyang'anira kuthamanga kwa magazi, acidity, ndi shuga m'magazi.

Kupewa

Monga lamulo, sizingatheke kuneneratu kukula kwa lactic acidosis mu mtundu 2 wa matenda ashuga. Moyo wa wodwalayo umatengera anthu omwe amamuzungulira panthawi yopanga zovuta, komanso ziyeneretso za ogwira ntchito kuchipatala omwe adafika pakufunikira.

Popewa kukula kwa matenda a m'matumbo, upangiri wa chithandizo cha endocrinologist uyenera kuyang'aniridwa mosamala, ndipo mankhwala omwe amachepetsa shuga ayenera kumwedwa panthawi yake komanso molondola. Ngati mwaphonya kumwa mapiritsi, simuyenera kumwa mopitilira kuchuluka nthawi yotsatira. Muyenera kumwa kuchuluka kwa mankhwalawa omwe adapangidwa nthawi imodzi.

Panthawi yodwala matenda opatsirana kapena kachilombo, kachilombo ka matenda ashuga kamatha kuthana mosayembekezereka ndi mankhwala omwe adamwa. Zizindikiro zoyambirira za matendawa zitawoneka, muyenera kulumikizana ndi dokotala kuti mupeze kusintha kwamankhwala ndi mankhwalawa.

Ndikofunika kukumbukira kuti lactic acidosis si matenda omwe "amachoka". Kufunafuna thandizo pa nthawi yake ndiye njira yabwino.

Kodi zimayambitsa lactic acidosis ndi ziti?

Mkhalidwe womwe udalankhulidwa ukhoza kupangika chifukwa cha zinthu zosiyanasiyana, mwachitsanzo, matenda am'mimba komanso opatsirana. Kuphatikiza apo, kutaya magazi kwambiri, kupezeka kwa uchidakwa wambiri ndi kuphwanya kwakhungu kwam'mimba kumayesedwa ngati zinthu zazing'ono. Kupitilira apo, akatswiri akuti chifukwa cha mtundu wachiwiri wa matenda ashuga, amatha kutha kuchita izi:

• kuvulala kwambiri
• kukhalapo kwa kulephera kwa impso,
• Matenda a pathological omwe amagwirizana ndi chiwindi.

Zomwe zimatsogolera zomwe zimapangitsa kuti pakhale lactic acidosis ziyenera kuganiziridwa ngati kugwiritsidwa ntchito kwa Biguanides. Chifukwa chake, nthawi zambiri odwala matenda ashuga amagwiritsa ntchito Metformin. Komabe, ziyenera kukumbukiridwa kuti mu nthawi yomwe yaperekedwa, zizindikiro za matendawa zimapangidwa ndendende mwa odwala omwe nthawi yomweyo amagwiritsa ntchito mankhwala ena. Ili ndiye gulu lotsitsa shuga ndi zomwe zidapangidwira zikuchokera.

Pamaso kuwonongeka kwa impso kapena chiwindi, ngakhale kuchuluka kwakukulu kwa ma guru kungayambitse lactic acidosis.

Kuti muzindikire lactic acidosis mu shuga, ndikulimbikitsidwa kuti mutchere khutu ku zomwe zimapangidwa.

Kuwonetsedwa kwa lactic acidosis mu matenda ashuga kungakhale kusakhalapo kwathunthu, ndipo kusintha kwa boma mwachindunji ku mawonekedwe owopsa kungatenge maola awiri kapena atatu. Odwala matenda ashuga amawona kupweteka m'misempha ndi zizindikiro zina zosasangalatsa zomwe zimawoneka kumbuyo kwa sternum. Lactic acidosis imadziwika ndi mawonekedwe monga kusakonda, kuchuluka kwa kupuma. The mwadzidzidzi kugona ndi kugona mwina.

Kupezeka kwa mtima kulephera kungatchulidwe kukhala chizindikiro chapadera cha mtundu waukulu wa acidosis. Ndikulimbikitsidwa kuti:

• kuphwanya koteroko kumalumikizidwa ndi contractility, yomwe imadziwika ndi myocardium pakukonzekera lactic acidosis,
• zina lactic acidosis limatha kumalumikizidwa ndi kuwonongeka kwamtsogolo kwakukulu,
• Komabe, atawonjezera kuchuluka kwa acidosis, kupweteka pamimba, komanso kusanza, akuzindikiridwa.

Ngati vuto la matenda ashuga lactic acidosis (kapena, monga ena amanenera, lactic acidosis) likukula m'tsogolo, ndiye kuti matendawa amatha kukhala osiyanasiyana. Sitingathe kulankhula za areflexia, komanso paresis (chosakwanira ziwalo) kapena hyperkinesis (kusunthasuntha kwamisempha yosiyanasiyana).

Zizindikiro za chikomokere ndi lactic acidosis

Asanayambike chikomokere, chomwe chimakhudzana ndi kufooka, wodwala matenda ashuga amatha kupezeka ndi kupuma kwamphamvu komanso phokoso losakhalitsa mkati mwa kupuma. Ndizachilendo kuti fungo la asetone silimayambitsa lactic acidosis. Nthawi zambiri, kupuma kotereku kumapangidwa ndimatenda a metabolic acidosis a 2.

Njira zodziwira lactic acidosis mu odwala matenda ashuga

Njira zodziwonera lactic acidosis yokhala ndi zizindikiro zonse zomwe zaperekedwa zimakhala zovuta. Ichi ndichifukwa chake zizindikiro za matenda zidzatengedwe, koma kokha ngati kusiyanasiyana kothandizirana. Poganizira izi, ndikulimbikitsidwa kuti mutchuthire kwambiri kuti ndizidziwitso za labotale zomwe zimakhala ndi kudalirika kokhazikika, zomwe zimatengera kuzindikira kwa lactic acid m'magazi.

Kwa zaka zambiri ndakhala ndikuphunzira za zovuta za DIABETES. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russian Academy of Medical Sayansi yakwanitsa kupanga mankhwala omwe amachiritsa odwala matenda ashuga mellitus. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 100%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipilira mtengo wonse wa mankhwalawo. Ku Russia ndi mayiko a CIS odwala matenda ashuga kale Julayi 6 alandire mankhwala - ZAULERE!

Kuphatikiza apo, akatswiri ayenera kuzindikira zizindikiro monga kuchepa kwa kuchuluka kwa bicarbonate m'magazi, kuchuluka kwa hyperglycemia, komanso kusowa kwa acetonuria.

Zochizira

Ndi zizindikiro za pathology ndi lactic acidosis yokha, chisamaliro chodzidzimutsani chidzakhala mu njira yolumikizira yankho la sodium bicarbonate (4% kapena 2.5%). Mavoliyumu omwe akuyembekezeka ayenera kukhala okwanira malita awiri patsiku. Ndikulimbikitsidwa kuti nthawi zonse muziyang'anira kuchuluka kwa pH-to-magazi potaziyamu.

Kuphatikiza apo, pamaso pa lactic acidosis ndi zizindikiro zake, chithandizo cha insulin chimayambitsidwa ngati njira yochira. Ponena zamankhwala, ndikofunikira kuti mutchere khutu kuti:

• ikhoza kukhala yamitundu iwiri, yomwe ndi yogwiritsa ntchito ma genetic opangira ma algorithm kapena chithandizo chokhala ndi monocomponent pogwiritsa ntchito "insulin" yayifupi
• mankhwalawa zizindikiro za lactic acidosis mu shuga, kugwiritsa ntchito njira ya carboxylase pogwiritsa ntchito njira yotsekemera ndikovomerezeka. Izi ndizowona poyambitsa pafupifupi 200 mg mu maola 24,
• Chithandizo cha mankhwalawa chikuphatikizira kupaka magazi a m'magazi komanso kugwiritsa ntchito heparin pang'ono.

Izi zonse mtsogolo ziyenera kuthandiza kukonzanso kwa heestasis.. Kuti odwala matenda ashuga a lactic acidosis asalumikizidwe ndi zovuta komanso kuti asakulitse chikhalidwe cha anthu odwala matenda ashuga, timalimbikitsidwa kwambiri kuchita nawo njira zina zodzitetezera.

Kodi miyezo yoletsa diabetesic lactic acidosis ndi iti?

Cholinga chachikulu cha njira zodzitetezera ku matenda omwe aperekedwawa tiyenera kuiganizira ngati kupatula vuto lokhala ndi vuto la kugona. Ndikulimbikitsidwa kwambiri kuti mupewe chilichonse chomwe chingaphatikizidwe ndi hypoxia. Kuphatikiza apo, kulingalira kwa kayendetsedwe ka chiwongolero cha matenda a shuga, ngakhale atakhala koyamba kapena mtundu wachiwiri, sikunapatsidwe kufunika kofanana kwambiri ndi kapangidwe ka kupewa.

Kodi lactic acidosis ndi chiani?

Lactic acidosis (lactic acidosis) imatchedwa kuwonjezeka kwa zomwe zili lactic acid m'magazi. Izi zimapangitsa kuti pakhale kupangika kowonjezereka ndikulephera kutulutsa kuchokera mthupi ndi impso ndi chiwindi. Awa ndimalo osowa kwambiri, zomwe zimachitika chifukwa cha matenda ena.

Chofunika: Ndi imodzi mwazovuta za matenda ashuga odwala okalamba. Kuthekera kwa kufa ndi zoposa 50%.

Lactic acid m'thupi ndi chipangizo cha glucose processing. Kuphatikizika kwake sikufuna oxygen, imapangidwa nthawi ya anaerobic metabolism. Ambiri mwa asidi amalowa m'magazi kuchokera kumisempha, mafupa, ndi khungu.

Mtsogolomo, lactates (mchere wa lactic acid) uyenera kudutsa m'maselo a impso ndi chiwindi. Ngati njirayi idasokonekera, zipatso za asidi zimachulukirachulukira komanso mopitirira malire. Lactate yowonjezera imapangidwa chifukwa cha kusokonezeka kwakukulu kwa metabolic.

Pathology imawonedwa ndi kuphatikizika komanso kusokonezeka kwapakati - matenda a impso, matenda ofiira a m'magazi.

Kuwongolera kwa lactates ndikofunikira kwa othamanga, popeza kukula kwawo ndikotheka ndi katundu wolemera.

Lactic acidosis ndi mitundu iwiri:

1. Mtundu A - wochititsidwa ndi kusowa kwa minofu ya okosijeni ndipo umachitika chifukwa cha kupuma, matenda amtima, kuchepa magazi, poyizoni.
2. Mtundu B - umachitika chifukwa cha mapangidwe osayenera a asidi. Lactic acid amapangidwa mopambanitsa ndipo samataya shuga a mellitus, matenda a chiwindi.

Lactic acidosis nthawi zambiri imabweretsa:

• matenda a oncological (lymphomas),
• shuga
• kupweteka kwa impso (mitundu yayikulu ya glomerulonephritis, nephritis),
• matenda a chiwindi (hepatitis, cirrhosis),
• matenda amtundu
• poyizoni, kuphatikizapo omwe amayamba chifukwa cha mankhwala (Metformin, Fenformin, Methylprednisolone, Terbutaline ndi ena),
• matenda opatsirana opatsirana
• poyizoni wazakumwa zoopsa,
• khunyu.

Mlingo wabwinobwino wa lactate / pyruvate m'magazi (10/1) ndizofunikira kwambiri. Kuphwanya gawo ili m'njira yowonjezera lactate kumawonjezeka mofulumira ndipo kungayambitse wodwala kwambiri.

Kudziwitsa mulingo wa lactate wambiri kumachitika pogwiritsa ntchito kusanthula kwa biochemical. Zizolowezi sizimafotokozedwa ndi miyezo yapadziko lonse lapansi, chifukwa zimatengera njira zofufuzira ndi zinthu zomwe zimagwiritsidwa ntchito.

Akuluakulu, chizindikiro cha mulingo wabwinobwino wamagazi chili m'magawo a 0.4-2.0 mmol / L.

Zomwe zimachitika popanga matenda a shuga

Chimodzi mwa zifukwa zazikuluzikulu zomwe zimakhazikitsa lactic acidosis ndikuphwanya kwa kupezeka kwa oxygen m'matumbo, chifukwa cha zomwe anaerobic glucose metabolism imayamba.

Mu matenda akulu a shuga, ndikuwonongeka kowonjezereka kwa impso ndi chiwindi, kayendedwe ka okosijeni kumachepetsedwa kwambiri, ndipo ziwalo zomwe zimathandizira pakuchotsa lactates m'magazi sizitha kupirira.

Lactic acidosis mu mtundu 2 wa shuga ndi vuto lalikulu matendawa. Vutoli limapezeka kawirikawiri kwa okalamba (opitilira zaka 50) omwe ali ndi mavuto amtima, kwamikodzo komanso zida zamafuta. Lactic acidosis nthawi zambiri imayamba yokha, nthawi zambiri imakhala yofanana ndi matenda a shuga.

Zomwe zimathandizira pakukula kwa mkhalidwe:

• kuwonongeka kwa chiwindi
• kuchepa magazi - kuchepa kwachitsulo, kupusa,
• mimba
• matenda a impso,
• kutaya magazi kwambiri
• kupsinjika
• matenda akumitsempha
• matenda oncological
• ketoacidosis kapena mitundu ina ya acidosis.

Nthawi zambiri provocateur wa lactic acidosis amagwiritsa ntchito mankhwala, makamaka, biguanides, ndi nyengo yowonongeka ya matenda ashuga. Biguanides (Metformin) amachiza matenda a shuga.

Nthawi zambiri kuphatikiza kwa zinthu zingapo kumachitika.Woopsa matendawa kumabweretsa pafupipafupi minofu hypoxia, mkhutu aimpso ntchito chifukwa kuledzera.

kuchokera kwa Dr. Malysheva okhudza Metformin:

Zizindikiro ndi mawonekedwe a mkhalidwe wowopsa

Zizindikiro za kuchuluka kwa mkaka m'magazi - kutopa, kutopa, kugona, zizindikiro za dyspepsia, nseru ndi kusanza zimayang'anidwanso. Zizindikirozi ndizofanana ndi matenda ashuga osawerengeka.

Ululu wa minofu ukhoza kunena za kuchuluka kwa lactic acid, ngati utagwira ntchito molimbika. Ndi pamaziko awa kuti chitukuko cha lactic acidosis nthawi zambiri chimatsimikiziridwa. Zowawa ndizofanana ndi myalgic, zimapatsa pachifuwa. Zizindikiro zina sizili zachindunji, chifukwa chake zimamasuliridwa molakwika.

Njira zoyambika za katulutsidwe wa lactic acid zimakula msanga, mkhalidwe wa wodwalayo ukuipiraipira mwachangu. Maola ochepa amapita ku hyperlactocidemic chikomokere. Munthawi imeneyi, zovuta zambiri zamthupi zimayamba - ma kati ndi zotumphukira zamitsempha, kupuma.

Wodwalayo ali:

• mavuto a dyspeptic
• kutsika kwamatumbo a mkodzo mpaka kutsokomola,
• Hypoxia imapangitsa kumverera kosowa kwa mpweya, kupuma kwamphamvu kwamphamvu imayamba (kupuma kwa Kussmaul) ndikubuma,
• kuchuluka coagulability ndi mapangidwe magazi ndi kupanga kwa necrosis mu miyendo,
• kutentha kwa mtima, kusokonekera kwa ntchito,
• kutayika kwamayendedwe, kukondwerera,
• khungu lowuma, ludzu,
• kutsika kwa kuthamanga kwa magazi, kuchepa kwa kutentha kwa thupi,
• mavuto a zotumphukira mantha dongosolo chifukwa kukomoka ndi kuwonongeka.

Vutoli limasiyana ndi ketoacidosis pakakhala kuti palibe fungo la acetone pa nthawi yomwe akupuma. Zochitika pamtima ndizovuta kuzikonza ndi mankhwala. Mukhoza kuyamba kumatha maola ochepa.

Thandizo loyamba komanso chithandizo

Zizindikiro za lactic acidosis sizodziwika mwachindunji, choncho wodwalayo ayenera kukayezetsa magazi mwachangu. Thandizo lingaperekedwe kokha pachipatala. Ndikofunikira kusiyanitsa vutoli ndi ketoacidosis ndi uremic acidosis.

Mkhalidwe lactic acidosis akuwonetsedwa ndi:

1. Miyezo ya lactate ili pamwamba pa 5 mmol / L.
2. Kuchepetsa ma bicarbonates ndi magazi pH.
3. Kuchulukitsa kwa anionic gawo la plasma.
4. Kuchulukitsa kwa nayitrogeni wotsalira.
5. Hyperlipidemia.
6. Kuperewera kwa acetonuria.

Ndikosatheka kukonza mkhalidwe wa wodwala kunyumba, kuyesera kuthandizira kutha. Kugonekedwa kuchipatala, kuyezetsa kwakanthawi ndi kuzindikirika kwa lactic acidosis ndi kupatsanso mphamvu pambuyo pake kungayimitse kukula kwa chikumbumtima.

Pa mankhwala, zochita ziwiri zazikulu zimafunika - kuthetseratu hypoxia ndi kuchepa kwa lactic acid ndi mapangidwe ake.

Kuletsa mapangidwe osalamulirika a lactates kumathandizira kuchuluka kwa minofu ndi mpweya. Kwa wodwala awa, amalumikizidwa ndi mpweya wabwino. Nthawi yomweyo, kuthamanga kwa magazi kumakhazikika.

Chofunikira pakuchotsa kwa wodwala ku vuto lalikulu ndikuzindikira zomwe zimayambitsa lactic acidosis komanso chithandizo cha matenda oyenera.

Kutulutsa owonjezera lactic acid, hemodialysis imagwiritsidwa ntchito.

Kuti achulukitse pH ya magazi, bicarbonate ya sodium imayendetsedwa. Zowonjezera zake ndizosachedwa kupitilira maola angapo.

Pankhaniyi, pH iyenera kukhala pansi pa 7.0. Chizindikirochi chimayang'aniridwa maola 2 aliwonse.

Mankhwala, heparin amagwiritsidwanso ntchito kupewa thrombosis, mankhwala a gulu la carboxylase, Reopoliglukin.

Kukhazikitsidwa kwa insulin sikofunikira, nthawi zambiri amagwiritsidwa ntchito pazingwe zochepa.

Mavuto omwe angakhalepo, kupewa

Vuto lactic acidosis ndi chikomokere. Vutoli limatha kukula patangopita maola ochepa. Kupambana kwa chithandizo kumatengera luso la ogwira ntchito, omwe nthawi ndi nthawi adzazindikira zoopsa kwa wodwalayo. Kusanthula mwachangu kumafunikiranso.

Ndi lactic acidosis, vutoli limakulirakulira msanga - pamatha kuchepa kwa zinthu zamkati, kuchepa kwa mavuto ndi kutentha mpaka 35 °, kupsinjika. Kulephera kwa mtima kumatha kubweretsa kulowerera m'maso. Kugwa kumabwera - wodwalayo amataya chikumbumtima.

Njira zazikulu zopewera lactic acidosis ndikulipira shuga. Kulandila kwa mankhwala operekedwa ndi endocrinologist kuyenera kuchitika molingana ndi malingaliro omwe akukonzekera. Ngati mwaphonya mlingo, simungathe kubwezeretsa kufooka kwanu ndi kuchuluka.

Osagwiritsa ntchito upangiri wa omwe akudwala, komanso gwiritsani ntchito mankhwala omwe amawathandiza, popanda kusankha katswiri. Odwala omwe ali ndi matenda ashuga sayenera kugwiritsa ntchito mankhwala othandizira, omwe amalimbikitsidwa ndi makampani ambiri.

Ndikofunikira kuti shuga isakhale yokhazikika, pitani pafupipafupi kwa endocrinologist ndikuyesera mayeso. Mukasinthana ndi mankhwala atsopano, muyenera kuwunika momwe zinthu ziliri popanda kupitirira kapena kuchepetsa kuchuluka kwake.

Ndikofunikira kutsatira zakudya zomwe zimaperekedwa, komanso kukhala ndi moyo wokangalika. Izi zikuthandizira kukonza kagayidwe kazakudya ndi magazi ku ziwalo. Njira yabwino yosungitsira thanzi ndi chithandizo cha spa. Njira zamankhwala amakono zimakupatsani mwayi wopewa matenda a shuga.

Adalimbikitsa Zolemba Zina Zogwirizana

Lactic acidosis: Zizindikiro, chithandizo, zimayambitsa

Munkhaniyi muphunzira:

• Zolinga 1
• 2 Zizindikiro
• 3 Kuzindikira
• 4 Chithandizo

Chimodzi mwazomwe zimayambitsa kufa kwa odwala ndi matenda a shuga ndi hyperglycemic coma, yomwe imatha kukhala ketoacidotic, hyperosmolar kapena hyperlactacidic.

Njira yotsiriza ndi hyperglycemic hyperlactacidic coma (kapena lactic acidosis, lactic acidosis, lactic acidosis) mu matenda a shuga ndi osowa kwenikweni, koma kufa pankhaniyi ndi 30-90%.

Mokulira, lactic acidosis ndi vuto lopanda tanthauzo la matenda osokoneza bongo omwe amapezeka chifukwa cha kuperewera kwa insulin komanso kuchuluka kwa lactate (lactic acid) m'magazi, zomwe zimapangitsa kuti acidosis ikhale yovuta kwambiri komanso kuti asiye kudziwa.

Lactic acidosis imakonda kukhala ndi mtundu wa 2 shuga komanso mwina chifukwa cha metformin. Vutoli limachitika, nthawi zambiri limakwanitsa zaka 35-84 ndipo nthawi zambiri silipezeka.

Zofunika!
Tiyenera kukumbukira kuti lactic acid imapangidwa nthawi zonse mthupi la munthu aliyense ndipo ndi chinthu chachilengedwe chopangidwa ndi cell metabolism. Anthu ambiri amadziwa zomwe zimachitika pakapita masiku angapo pambuyo poti thupi lonse “loluka” lililonse lipweteke.

Chifukwa chachikulu cha izi ndendende kudzikundikira kwa lactate. Mwa anthu athanzi, lactic acid imadyedwa pang'onopang'ono pazosowa za thupi popanda zotsatira.

Komabe, mu matenda ashuga okhala ndi hypoxia yayitali, Zizindikiro za lactic acidosis zitha kukulitsa kuchepa kwa chikumbumtima.

Poganizira zomwe zimayambitsa, mitundu iwiri ya lactic acidosis imasiyanitsidwa: A ndi B. Lactic acidosis ya mtundu A ndi chifukwa chakuchepa kwa kuchepa kwa mpweya wa minofu mwa anthu omwe ali ndi minyewa yoyambilira ya hypoxia ndipo amatha kupezeka ngakhale pakalibe matenda a shuga.

Zomwe zimayambitsa minofu hypoxia:

• Cardiogenic mantha
• endotoxic ndi hypovolemic mantha,
• poizoni wa monoxide
• kuchepa magazi
• pheochromocytoma,
• khunyu ndi ena.

Mtundu B lactic acidosis sugwirizana ndi hypoxia yoyambirira ndipo umachitika mu zotsatirazi ndi matenda:

• shuga mellitus, makamaka othandizira ndi Biguanides (metformin),
• matenda a impso
• kulephera kwa chiwindi
• njira neoplastic
• khansa
• uchidakwa
• matenda opatsirana komanso otupa,
• poyizoni ndi salicylates, cyanides, ethanol, methanol.

Monga lamulo, lactic acidosis imayamba kukhalapo kwa zinthu zingapo zopsetsa mtima.

Chidwi cha akatswiri a matenda ashuga ku lactic acidosis ndi chifukwa chakuti amatha kuyamba motsutsana ndi maziko a chithandizo cha nthawi yayitali ndi biguanides. Makamaka milandu ya chiwindi ndi impso kuwonongeka, ngakhale mlingo wamba wa metformin ukhoza kukhala chifukwa cha lactic acidosis, pafupipafupi kukula komwe, malinga ndi akatswiri osiyanasiyana, ndimilandu 2.7-8.4 pachaka pa odwala 100,000 omwe amalandila mankhwalawa.

Gome - Milandu ya lactic acidosis yokhala ndi metformin

Komabe, zikagwiritsidwa ntchito moyenera, metformin yomwe imagwiritsidwa ntchito pano siziwonjezera ngozi ya lactic acidosis.

Cholumikizira chachikulu mu pathogenesis ya lactic acidosis ndi minofu hypoxia, yomwe imayendetsa anaerobic glycolysis ndipo imabweretsa kudzikundikira kwa lactic acid mu minofu ndi magazi ndi kukula kwa acidosis ndi kuledzera. Lactate ndiye chomaliza metabolic mankhwala mu anaerobic glycolysis. Nthawi yomweyo, pansi pa zochitika za hypoxia, mapangidwe a glycogen kuchokera ku lactate mu chiwindi amalepheretsa.

Kutuluka kwa lactic acidosis kumathandizanso ku kholo la madzi amadzimadzi okhala ndi fructose, sorbitol kapena xylitol.

Lactic acidosis imayamba msanga mokwanira, koma zovuta za dyspeptic, kupweteka kwa minofu, ndi angina pectoris zitha kukhala zizindikiro zake zoyambirira. Chochititsa chidwi ndi kusowa kwa zotsatira za kutenga analgesics.

Nthawi zambiri amakayikira kuti iyi ndi lactic acidosis, zizindikiro ngati izi odwala omwe ali ndi matenda ashuga amalola kuda nkhawa, kufooka, adynamia, kupweteka mutu, nseru, kusanza, kukokoloka mpaka kugwa, kupweteka pamimba, kugona, komwe kumakhala kupusa, stupor ndi coma, anuria motsutsana ndi kuphwanya kwa impso.

Khungu limakhala lotumbululuka, cyanotic, zimachitika pafupipafupi. Mtima kulephera, ochepa hypotension, kupuma movutikira, kulimbitsa thupi, kupuma kwa Kussmaul kumachitika.

Tsoka ilo, palibe magawo omwe amasiyanitsa ndi lactic acidosis, chifukwa chake, kupezeka kwa lactic acidosis kumakhala kovuta nthawi zonse.

Popeza kukula kwake komwe sikumachitika mwachangu, komwe sikumakhala kwa zochitika za hyperglycemic, ndikofunikira kusiyanitsa mwachangu lactic acidosis kutha kwa chikumbumtima.

Lactic acidosis yamtundu 2 shuga

Kodi muli ndi matenda ashuga a 2?

Woyang'anira Institute of matenda a shuga: “Tayetsani mita ndikuyesa. Palibenso Metformin, Diabetes, Siofor, Glucophage ndi Januvius! Mgwireni ndi izi ... "

Ngati mu matenda a shuga a m'mellitus amapangika pansi pomwe lactic acid imadziunjikira kwambiri mu minofu ndi magazi, lactic acidosis imatheka.

Imfa zikafika izi ndizapamwamba kwambiri, zimafika 90%. Chifukwa chake, odwala matenda ashuga ayenera kudziwa tanthauzo - lactic acidosis.

Ndikofunika kuti amvetsetse kuti, ndani amakulitsa, komanso momwe angapewerere kuti zisachitike.

Zifukwa zachitukuko

Gulu lamavuto limaphatikizapo odwala omwe ali ndi matenda ashuga opitilira zaka 50. Monga lamulo, matenda awo osakanikirana ndi ovuta chifukwa cha chiwindi, mtima kapena kulephera kwaimpso. Mwachindunji lactate acidosis pa se sichimachitika. Amayamba nthawi imodzi ndimadwala matenda ashuga.

Lactic acid imatha kudzikundikira mbali zosiyanasiyana za thupi: khungu, mafupa achikopa, ndi ubongo. Kuchuluka kwake kumapangika pakatundu kwambiri: chikwangwani chimapweteka komanso minyewa imasokonekera. Ngati zosagwira bwino zimawonedwa m'thupi, ndiye kuti asidi wambiri amalowa m'magazi.

Nthawi zambiri zimawonedwa mwa anthu odwala matenda ashuga, omwe ayenera kudziwa zonse zokhudza lactic acidosis: zomwe zimayambitsa maonekedwe, momwe zimakhalira. Zomwe zimapangidwira kwambiri lactic acid kuwonjezera pa zochitika zolimbitsa thupi zimaphatikizapo:

• kuvulala kovuta
• mtundu wosamwa wauchidakwa,
• kuvulala kwambiri kwa chiwindi,
• mavuto ndi kugwira ntchito kwa mtima
• kulephera kwa aimpso
• yotupa njira.

Ndi mikhalidwe imeneyi, kufunikira kwa matendawa kumakulanso. Komanso, lactic acidosis yamtundu 2 wa shuga imatha kuyamba chifukwa:

• Chithandizo cha Fenformin (chopinga chovuta)
• kulephera kwa kagayidwe kachakudya,
• magazi osakwanira ku minofu,
• matenda ashuga ketoacidosis,
• hypersmolar coma, momwe ketosis siinawonedwe.

Komanso matendawa amatha kukhala chisonyezo cha chotupa chomwe chikukula, khansa ya m'magazi, leukemia. Koma nthawi zambiri minofu hypoxia imabweretsa kudzikundikira kwa lactic acid.

Kuwonetsedwa kwa matendawa

Anthu odwala matenda ashuga ayenera kudziwa zizindikiro za lactic acidosis. Matendawa amakula msanga, maola ochepa munthu amadwala. Palibe chizindikiro cha kudwala ndipo izi zimadziwika kuti ndizowopsa kwambiri.

Zotsatirazi zikuwonetsa kukula kwa izi:

• kupweteka kwa minofu komwe kumawoneka
• mphwayi
• kufooka
• kutopa
• kukakamiza kutsika
• chisokonezo, mpaka kutayika kwake,
• kusowa kwamikodzo kapena kuchepa kwakukulu kwa kuchuluka kwa mkodzo,
• Kukula kwa zizindikiro za pulmonary hyperventilation (kotchedwa kupuma kwa Kussmaul),
• kusapeza bwino m'dera kumbuyo kwa sternum,
• wodwalayo akachuluka, kusanza kumatseguka, kupweteka kwam'mimba kumawonekera.

Izi ndi zizindikiro zazikulu za lactic acidosis mu shuga. Akawonekera, muyenera kupita kuchipatala. Muzipatala, amatha kutenga magazi kuti awunikidwe kuti adziwe kuchuluka kwa asidi a lactic: amakwera kwambiri. Gawo limaposa 6 mmol / L.

Magawo ena a labotale omwe amakhala ndi hyperlactatemia amawunikanso:

• Hyperphosphatemia (may azotemia test),
• kutsika kwa magazi pH
• dontho mu CO2 m'mwazi,
• kuchepa kwa ma bicarbonates a plasma.

Kuyesedwa kwa magazi ndi kutsimikiza kwa zizindikiro zikufunika. Kupatula apo, Zizindikiro za matendawa zimadziwika ndi mikhalidwe ina. Wodwala matenda ashuga amatha kugwa m'misempha yochepa kwambiri m'magazi komanso kuthamanga.

Ndi lactic acidosis, zotsatira zakupha ndizotheka: wodwalayo amayamba kulephera kwamtima, ziwopsezo za ziwalo zina za thupi, kuphatikizanso ziwalo zopumira.

Zotsatira zake, izi zimapangitsa kuti pakhale phokoso lactacidemic. Lisanayambike, kupuma kwamkokomo kumaonekera. Odwala omwe ali ndi DIC amawonekera. Awa ndi mkhalidwe womwe kuphatikizika kwa mitsempha kumayamba.

Zizindikiro za lactic acidosis zimaphatikizanso mawonekedwe a hemorrhagic necrosis ya zala, intravascular thrombosis. Nthawi yomweyo, ziwalo ndi ma khungu owuma zimadziwika.

Njira zamachiritso

Hyperlactacidemia mu odwala matenda ashuga amayamba motsutsana ndi maziko a kuperewera kwa oxygen. Chifukwa chake, choyambirira, kuchipatala, ndikofunikira kukhutitsa thupi ndi mpweya momwe mungathere. Izi zimachitika pogwiritsa ntchito mpweya wabwino. Madokotala akuyenera kuthetsa chitukuko cha hypoxia posachedwa.

Nthawi yomweyo, zofunikira zonse zimayang'aniridwa. Chidwi choperekedwa chimaperekedwa kwa anthu okalamba omwe ali ndi vuto la matenda oopsa, mavuto a chiwindi, impso.

Ngati hyperlactatemia itatsimikiziridwa ndi kusanthula, kuchuluka kwa pH ndi kochepera 7.0, ndiye kuti wodwalayo amayamba kubayila bicarbonate wa sodium. Yankho limakonzedwa kuchokera kumadzi osabala, sodium bicarbonate, wofanana ndi potaziyamu mankhwala ena.

Lowani ndi dontho kwa maola awiri. Kuchuluka kwa yankho kumatha kusiyanasiyana kutengera pH.

Imawunika maola awiri aliwonse: kulowetsedwa kwamankhwala kumapitirirabe mpaka pH ifikire oposa 7.0.

Ngati munthu wodwala matenda ashuga okhala ndi vuto laimpso amalephera, ndiye kuti hemodialysis ya impso imachitidwa nthawi yomweyo.

Ndikotheka kupewa kukula kwa mtima kulephera ndi mankhwala apadera. Mlingo wocheperako, Reopoliglukin, Heparin akhoza kutchulidwa. Kusankhidwa kwa mankhwala a insulin okwanira ndikofunikira. Izi zipangitsa kuti kagayidwe kazinthu kazinthu zina.

Ndi chitukuko cha lactic acidosis chikomokere, njira za antiseptic zimaperekedwa kwa wodwala. Pa nthawi yomweyo kuchita antishock mankhwala. Trisamine imagwiritsidwa ntchito pochepetsa mawonetseredwe a lactic acidosis.

Kuthekera kwa kuthekera kwazinthu ndi chithandizo chakanthawi kuchipatala ndi 50%. Ngati mutenga nthawi ndipo osalabadira zizindikiro zomwe zikudwala mwachangu, ndiye kuti kufa kwawo kungathe kufika 90%. Mwanjira yonyalanyazidwa, ngakhale madokotala sangathe kupulumutsa wodwalayo.

Lactic acidosis pamaso pa mtundu 2 shuga

Matenda a shuga ndi njira ya endocrine yomwe imakhala ndi zovuta zingapo zovuta. Kuphwanya kagayidwe kachakudya komwe kumachitika motsutsana ndi maziko a insulin kukana kumayambitsa vuto mu ntchito ya ziwalo zonse zofunika komanso machitidwe.

Chimodzi mwamavuto owopsa ndikupanga kulephera kwa impso. Zotsatirazi ndikuphwanya kwa ntchito yowonekera, kuzimiririka kwa zinthu zovulaza m'thupi.

Poyerekeza ndi maziko a hyperglycemia, kuyamba kwa mphamvu zowonjezera mphamvu zakudziwononga kwa glucose ndi kudzikundikira m'magazi ambiri a lactic acid, omwe alibe nthawi yoti atulutsidwe chifukwa cha vuto la impso.

Matendawa amatchedwa lactic acidosis. Zimafunika kukonzanso mwachangu ndipo zimatha kupangitsa kuti lactic acidosis chikomokere.

Lactic acidosis mu matenda a shuga: Zizindikiro ndi mankhwala

Lactic acid chikomokere kapena lactic acidosis - Izi ndizowopsa, koma, mwamwayi, zovuta zachilengedwe zomwe zimachitika chifukwa cha kusalinganika kwa omwe ali nawo pakatikati pa kuphwanya kwa glucose, pyruvic ndi lactic acid, ndi zotumphukira zawo - pyruvate ndi lactate. Nthawi zambiri, ma pyruvic ndi ma lactic acids amapezeka mu seramu yamagazi m'chiwerengero cha 10 mpaka 1. Pyruvates amadyetsa maselo, ndipo ma lactates amatumizidwa ku chiwindi ndikuwapanganso shuga, ndikupanga glycogen.

Lactic acid molekyulu

Koma vuto la insulin, kuwonongeka kwa mapangidwe ake a pyruvic acid kumathandizira kwambiri ndipo mulingo umasunthira kumayendedwe a lactates. Mulingo wa 0.4-1.4 mmol / ml, mulingo wawo umakwera pamitengo ya 2 ndi pamwamba.

Zotsatira zake, njira ya metabolic mthupi lonse imasokonekera, minofu hypoxia imachitika, ndipo mitsempha ndi mtima, chiwindi ndi impso zimakhudzidwa kwambiri. Kugonjetsedwa komaliza kumapangitsa kuti pakhale zozungulira - lactates ndi shuga amadziunjikira m'magazi, koma palibe zotulutsa zawo ndi mkodzo.

Ngati wodwala sathandizidwa kwa maola angapo, zotsatira zakupha sizingatheke.

Kodi lactic acidosis ingachiritsidwe kunja kwa chipatala?

Sizingatheke! Vuto ndikuti popanda chithandizo chamankhwala kuchipatala ndizosatheka kuthana ndi acidosis yayikulu - mukufunika kuchepa kwa magazi m'thupi mwa kulowetsedwa kwa sodium bicarbonate kapena zina, mankhwala amphamvu kwambiri, kapena chodwala chachikulu - hemodialysis.

Vutoli limakulirakulira chifukwa chakuti zizindikiro za lactic acidosis sizitchulidwa monga zizindikiritso za ketone coma mu shuga, momwe fungo lamphamvu la acetone limachokera m'thupi la wodwalayo, mkodzo komanso kupuma. Kuzindikira koyenera kwa lactic acidosis kumatha kupangidwa kokha pamaziko a kuyezetsa magazi ndipo, mwa zina, kutengera anamenis.

Zomwe zimayambitsa Lactic Coma

Lactic acidosis sitha kutchedwa kuti chizindikiro kapena kusokonezeka kwa matenda a shuga a mtundu woyamba kapena wachiwiri. Matenda a shuga amatha kukhala chimodzi mwazifukwa zopangitsa matenda osokoneza bongo kukhala pachimake.

Kuchuluka kwa lactic acid ndi ma lactates kumawonedwa nthawi zonse pogwira ntchito yolimbitsa thupi.

Ochita masewera ena amateur mwina amadziwa momwe zilonda zam'mimba pambuyo poti sizilimbitsa thupi ndizowonetsera kwa lactic acidosis yofatsa.

Omanga thupi, omwe amalimbikitsanso kulimbitsa thupi ndi jakisoni wa insulin, amatha kukhala achisoni kwambiri. Ngati wokonda kwambiri lactic acid aponya kumbuyo kapena kutsikira kumbuyo, ndiye kuti wachisoni amakhala ndi acidosis yowononga yomwe "imaphimba" thupi lonse mwadzidzidzi.

Kuchulukitsa nthawi yayitali kumabweretsa zovuta za lactic acid, zomwe zimapangitsa kuti zinthu zisinthe. Palibe misa ya minofu yomwe ingathandize kuimitsa.

Kugonekedwa kwachipatala kokha ndi komwe kungapulumutse wothamanga wamphamvu kwambiri, ndipo sizikudziwika bwinobwino zomwe zimapangitsa kuti acidosis ichitike posakhalitsa.

Lactic acid chikomwa chimatha kukhala mnzake wazikhalidwe zina zomwe sizikugwirizana mwachindunji ndi insulin komanso shuga: magazi obwera chifukwa cha kuchepa kwa magazi, kuphulitsa magazi, kupha zakumwa zoledzeretsa, impso ndi chiwindi.

Odwala onse omwe ali ndi matenda a shuga a mtundu wachiwiri omwe amatenga metformin ndi ma biguanides ena (onani apa mankhwala omwe amagwiritsidwa ntchito ngati matenda ashuga): mankhwalawa amalepheretsa kugwiritsa ntchito ziwindi ndi chiwindi, ndipo iwo (mankhwalawa) ali ndi zotsatira zowonjezereka, kudziunjikira m'thupi kosatha . Kuchepa kwa khansa ya lactic acidosis mukamatenga ma biguanides kumawonjezeka kwambiri chifukwa cha matenda a chiwindi ndi kuchuluka kwambiri chifukwa cha kumwa kawirikawiri, komwe sikunasonyezedwe kwa matenda ashuga (onani buku la "Ndingamwe mowa ndi shuga").

Zizindikiro za Lactic Acidosis

Mkhalidwewu ndi wofanana ndi zovuta zina za metabolic zomwe zimachitika mosayembekezereka komanso mwachangu.

Chithunzicho chitha kukhala chopanikizika ndi zomwe zimayambitsa matenda okhudzana - makamaka mtima, chiwindi, ndi impso. Osowa kwambiri, lactic acid coma imayikidwa pa ketone kapena osmolar imodzi.

Ndikofunikira kupulumutsa kuchokera kwa aliyense, koma kumbukirani kuti lactic acidosis imathamanga kwambiri ndipo zotulukapo zake zimakhala zowononga thupi.

Lactic acidosis pafupifupi nthawi zonse kusowa kwa harbinger a matenda oopsa. Zizindikiro zimawonekera mwadzidzidzi ndikukula ngati avalasi. Odwala amasokonezedwa ndi kukoka kupweteka m'misempha, kulemera kumbuyo kwa sternum, dyspepsia, chidwi, kugona, kapena,, kusowa tulo.

Posakhalitsa zochitika za kulephera kwa mtima zimayamba: minyewa yamtima imayamba kupangika, kupuma movutikira kumawonekera.

Chizindikiro cha acidosis iliyonse ndi kupuma kwamphamvu kwa Kussmaul kwa mamitala angapo, koma, mosiyana ndi ketoacidosis, ndi lactic acidosis, mpweya wotulutsidwa sukununkhira ngati acetone.

Wodwala amakhala ndi ululu wam'mimba, kutsegula m'mimba kwambiri, kusanza. Kutulutsa kwamkodzo kumayamba kuchepa ndikuyima paliponse. Kusokonezeka pakupereka kwa okosijeni ndi glucose mu ubongo kumayambitsa kukhudzika kwamitsempha - kuchepa kwa mphamvu, paresis, kapena, mosiyana, hyperkinesis.

ICE syndrome imachitika - magazi amawundana mwachindunji m'matumbo. Kuwonetsera uku kwa acidosis ndi imodzi mwamigodi yomwe imachedwa nthawi.

Ngakhale poyizoni wa lactate atayimitsidwa, ma magazi amapitilira kuyenda m'matumbo mpaka atapeza china chomamatira.

Chizindikiro chachedwa kwambiri cha matendawa ndi kutsokomola kwa zala ndi zala zakumaso chifukwa chazinthu zamphongo chifukwa chatsekeka mitsempha yamagazi ndimisempha yamagazi. Ngati zinthu sizingachitike munthawi yake, kubala ndi kuduladula sikungapeweke.

Maola ochepa atadwala koyamba, wodwala amagwa.

Zizindikiro za lactic acidosis ndizofanana ndikuwonetsa poyizoni ndi methanol, salicylates, acetic acid. Kuzindikira kolondola koperekedwa kumayesedwa ndi kuyezetsa magazi kwa zomwe zili ndi lactate. Kuzindikira kumathandizidwa ndi kufotokozera kwa wodwalayo kapena, ngati sakudziwa, ndi abale ndi abwenzi.

Thandizo lactic acidosis

Chithandizo cha lactic acidosis iyenera kukhala yodzidzimutsa ndikuchitika kuchipatala. Lactic acidosis imadziwika kuti ndi yofunika kwambiri mwadzidzidzi (emergency) endocrinological, nayo mphindi iliyonse imakhala yamtengo wapatali. Ntchito ya madotolo ndi kukweza pH yamagazi kuti ikhale pamiyeso 7 ndikuwonjezera mphamvu ya lactate.

Pa gawo loyambirira, izi zimatheka chifukwa cha kukoka kwa sodium bicarbonate kapena kukonzekera kwamphamvu kwa trisamine. Mtundu wa Methylene umapangidwanso kuti umange ma hydrogen ion.

Mofananamo, othandizira othandizira ndikuwongolera zochitika pamtima zimachitika, chifukwa nthawi zambiri, kufa ndi lactic acidosis kumachitika chifukwa cholephera mtima. Wodwalayo nthawi zambiri amalumikizidwa ndi mpweya wabwino.

Ngati mtsempha wamitsempha wothandizira omwe amachepetsa acidity ya magazi seramu samapereka chifukwa, hemodialysis yotsimikizika ya dialysate yopanda lactic acid ndiyofunikira.

Atangotaya mpumulo wazizindikiro zowopsa m'moyo, chithandizo chamankhwala chimachitika ndi cholinga chofuna kuthetsa thrombosis ndi hemorrhagic necrosis ya zala zakumapeto, komanso mbolo mwa amuna.

Ngakhale kupambana konse kwa sayansi ya zamankhwala, pafupifupi 50% ya milandu ya lactic acidosis, ngakhale ndi chithandizo kuchipatala chamakono, imapha. Mwachitsanzo, wosewera mpira wotchuka komanso womvera pa TV Vladimir Maslachenko amwalira ndi izi. Mwa njira, lactic acidosis imagwira amayi nthawi zambiri kuposa amuna.

Tikulemberanso kuopsa kwakukulu kokhala ndi lactic acidosis mu matenda a shuga:

1. Matenda a chiwindi ndi impso, osatha kulimbana ndi kuchoka kwa lactic acid ndi mkaka wa m'mawere.
2. Matenda akulu a mtima dongosolo, zomwe zimakhudza kagayidwe.
3. Mowa.
4. Kulandila kwa biguanides, metformin ndi kufanana kwake, komwe kumalepheretsa kugwiritsidwa ntchito kwa chiwindi ndi chiwindi.
5. Kuchita masewera olimbitsa thupi mopitirira muyeso, zomwe zimayambitsa kutulutsidwa kwakukulu kwa lactic acid m'magazi.

Lactic acid chikomokoma sichimagwirizana ndi kumwa mkaka. Sizigwirizana mwachindunji ndi shuga wamagazi ndi kuthekera kwa kapamba kuti apange insulini.

Vutoli ndilosatheka kwenikweni, madokotala amatha kudziwa magulu ena omwe ali pachiwopsezo.

Ngati wodwala matenda a shuga akuphatikizidwa mu imodzi mwazo, kugwiritsa ntchito metformin, onse mwachindunji komanso monga gawo la mankhwala osakanikirana, sayenera kuphatikizidwa.

Lactic acidosis ndi yovuta kupewetsa, koma chovuta kwambiri kuchiza. Mwamwayi, vutoli ndilosowa kwambiri.

Lactic acidosis mu shuga: Zizindikiro, kuyezetsa magazi kofunikira, chithandizo ndi kupewa

Lactic acidosis imakhala yovuta, ngakhale ndiyosowa. Vutoli limachitika pamene zili za lactic acid m'magazi ziziunjikana, kupitirira zizolowezi.

Dzina lina la matendawa ndi lactic acidosis (kusintha kosintha kwa acidity). Mu shuga mellitus, kuphatikizika kumeneku ndi kowopsa kwambiri, chifukwa kumabweretsa chikomokere kwa hyperlactacidemic.

Kodi lactic acidosis mu shuga ndi chiyani?

Mankhwalawa amayika kuwunika kwa lactic acidosis ngati kuchuluka kwa lactic acid (MK) mthupi kudutsa 4 mmol / l.

Pomwe mulingo wabwinobwino wa asidi (womwe umayezedwa mu mEq / l) wamagazi a venous amachokera ku 1.5 mpaka 2.2 ndipo magazi owonjezera amachokera ku 0.5 mpaka 1.6. Thupi labwino limatulutsa MK pang'ono, ndipo limagwiritsidwa ntchito nthawi yomweyo, ndikupanga lactate.

Lactic acid imadziunjikira m'chiwindi ndipo imang'ambika m'madzi, mpweya wa monoxide ndi glucose. Ndi kudzikundikira kwa lactate yambiri, zotuluka zake zimasokonekera - lactic acidosis kapena kusintha kosangalatsa mumalo ac acid kumachitika.

Izi zimawonjezera mwayi wokhala ndi matenda ashuga, chifukwa insulin imayamba kugwira ntchito. Kenako, kukana insulini kumalimbikitsa kupanga mahomoni apadera omwe amasokoneza kagayidwe ka mafuta. Thupi limasowa madzi, kuledzera kwake ndi acidosis kumachitika. Zotsatira zake, chikomero cha hyperglycemic chimapangidwa. Kuledzera kwambiri kumatha chifukwa cha zovuta zomanga thupi.

Mitundu yambiri ya zinthu za metabolic imadziunjikira m'magazi ndipo wodwalayo amadandaula:

• kufooka wamba
• kulephera kupuma
• mtima kulephera
• kupsinjika kwa mtima kwamanjenje.

Zizindikiro izi zimatha kupha.

Zizindikiro

Matendawa amawonekera mwadzidzidzi, amakula msanga (maora angapo) ndipo popanda kulandira chithandizo kwakanthawi kachipatala kumabweretsa zotsatirapo zoyipa.

Chizindikiro chokhacho cha lactic acidosis ndi kupweteka kwa minofu, ngakhale kuti wodwalayo sanachite zolimbitsa thupi.

Zizindikiro zina zomwe zimatsagana ndi lactic acidosis mu matenda osokoneza bongo zimatha kukhala zodziwika mu matenda ena.

Monga lamulo, lactic acidosis mu shuga imayendera limodzi ndi izi:

• chizungulire (kutayika kwa chikumbumtima),
• nseru ndi kugwedezeka
• kupweteka mutu kwambiri
• kupweteka kwam'mimba
• kuphwanya mgwirizano
• kupuma movutikira
• chikumbumtima
• maluso ofooka a magalimoto
• kukodza pang'onopang'ono, mpaka kuthe.

Kuphatikizika kwa lactate kumawonjezeka mwachangu ndikupita ku:

malonda-pc-2

• kupuma kwamkati, nthawi zina kumasanduka kubuula,
• kukanika kwa mtima, komwe sikungathetsedwe mwanjira zonse.
• kutsitsa (lakuthwa) kuthamanga kwa magazi, kulephera kwamtima;
• pachimake minofu kukokana (kukokana),
• magazi akutaya. Matenda owopsa kwambiri. Ngakhale zizindikiro za lactic acidosis zikatha, ziwalo zamagazi zimapitilirabe kuyenda m'matumbo ndipo zimatha kuyambitsa magazi. Izi zimayambitsa necrosis ya chala kapena kuyambitsa gangore,
• kuperewera kwa mpweya m'maselo a muubongo omwe amapanga hyperkinesis (Chimwemwe). Chidwi cha wodwalayo chimabalalika.

Kenako pamakhala kukomoka. Ili ndiye gawo lomaliza pakupanga matendawa. Kuwona kwa wodwalayo kumachepa, kutentha kwa thupi kumatsikira mpaka madigiri 35.3. Maso a wodwalayo amawoloweka, kukodza kumatha, kenako amatha.

Ndikofunika kukumbukira kuti zoyamba za matendawa zimafunikira kuchipatala. Maluwa atayamba kuwonekera, muyenera kuyeza glucose ndikuyitanira ambulansi!

Lactic acidosis sangathe kuwapeza kunyumba, kuyesera konse kuti achiritse okha mwaimfa. Kuchiza kuyenera kuchitika kokha kuchipatala.

Popeza matendawa amakhumudwitsidwa makamaka chifukwa chosowa mpweya, chithandizo chake chimachokera munjira yokhutiritsa maselo a thupi ndi mpweya. Izi zimachitika pogwiritsa ntchito mpweya wabwino.

Makina mpweya wabwino

Chifukwa chake, choyambirira, adokotala sapatula hypoxia, chifukwa chachikulu cha lactic acidosis. Izi zisanachitike, ndikofunikira kuyesa mayeso onse azachipatala posachedwa, chifukwa wodwalayo ali pamavuto akulu kwambiri.

Muzovuta kwambiri, adotolo amatipatsa sodium bicarbonate, koma malinga ndi momwe acidity ya magazi imachepera 7.0. Nthawi yomweyo, kuchuluka kwa pH kwa magazi a venous kumayang'aniridwa nthawi zonse (maola awiri aliwonse) ndipo bicarbonate imabayidwa mpaka mtengo wa acidity wopitilira 7.0 ufikire. Ngati wodwala akudwala aimpso, hemodialysis imachitika (kuyeretsa magazi).

Anthu odwala matenda ashuga amapatsidwa nthawi yomweyo mankhwala a insulin. Wodwala amapatsidwa dontho (shuga ndi insulin) kuti akonze zovuta za metabolic.

Mankhwala amatengedwa kuti azigwira ntchito ya mtima ndi mitsempha yamagazi. Pofuna kuchepetsa kuchuluka kwa magazi, njira yothira koloko nthawi zambiri imagwiritsidwa ntchito.

Amabayidwa kudzera m'mitsempha (voliyumu ya tsiku ndi tsiku ndi malita awiri) ndipo amayang'anira kuchuluka kwa potaziyamu m'magazi komanso mphamvu zake.

Chithandizo chowonjezera ndi motere:

• Madzi a m'magazi amaphatikizidwa m'mitsempha,
• carboxylase solution imalinso ndi mtsempha,
• heparin imayendetsedwa
• reopoliglukin yankho (mlingo wocheperako kuti muchepetse kusokonekera kwa magazi).

Acidity ikafupika, thrombolytics (njira yotulutsa magazi) imayikidwa kwa wodwala matenda a shuga a mtundu wachiwiri.

Zomwe zili ndi vuto lactic zomwe zachitika zikuwonetsa chithandizo chokwanira komanso chosakwanira kwa matenda ashuga.Chifukwa chake, mavuto atatha, ndikofunikira kulimbitsa chithandizo cha matenda oyambira. Ndi matenda abwinobwino, muyenera kutsatira kadyedwe, kupumula pakama ndi kuwunika kuchuluka kwa magazi.

Mutha kudziwa zomwe zovuta za shuga zimayambitsa vidiyo iyi:

Kufunsira thandizo la kuchipatala pa nthawi, mutha kupulumutsa moyo wanu. Lactic acidosis ndi zovuta zobisika zomwe sizingatheke kuloledwa pamiyendo.

Chigawo chokhala ndi vuto la lactic acidosis coma ndichabwino kwambiri kwa wodwalayo. Kuyesayesa kulikonse kuyenera kuchitidwa kuti zisadzachitikenso. Vutoli limathetsedwa ndi endocrinologist.

Dokotala amayenera kuthandizidwa atangodziwa kuchuluka kwa acid mu minofu.