Hyperglycemic chikomokere - thandizo loyamba ndi zizindikiro

Vuto lalikulu la matenda ashuga ndi kukomoka kwa magazi. Ichi ndi chikhalidwe chomwe chikuwonjezera kuchepa kwa insulin mthupi komanso kuchepa kwa kugwiritsidwa ntchito kwa shuga. Chikomokere chimatha kukhala ndi mtundu uliwonse wa matenda ashuga, komabe, zochitika za kupezeka kwa matenda ashuga 2 ndizosowa kwambiri. Nthawi zambiri, kukomoka kwa matenda ashuga kumachitika chifukwa cha matenda a shuga 1 - amadalira insulin.

Pali zifukwa zingapo zomwe zimapangitsa kuti chikumbumtima chisachitike:

• matenda osokoneza bongo a shuga
• chithandizo chosayenera
• mwadzidzidzi makonzedwe a insulin kapena kuyambitsa osakwanira mlingo,
• kuphwanya zakudya
• kumwa mankhwala ena, monga prednisone kapena diuretics.

Kuphatikiza apo, zinthu zingapo zakunja zomwe zimayambitsa kupangika kwa ma sema zimatha kusiyanitsidwa - matenda osiyanasiyana omwe amafalitsidwa ndi wodwala yemwe ali ndi matenda osokoneza bongo, kulowererapo kwa opaleshoni, kupsinjika, ndi kuvulala kwamisala. Izi ndichifukwa choti ndi zotupa m'mthupi kapena kuwonjezeka kwa nkhawa, kumwa kwa insulin kumawonjezeka kwambiri, komwe sikuti nthawi zonse kumaganiziridwa mukamawerenga kuchuluka kwa insulin.

Zofunika! Ngakhale kusinthika kuchokera ku mtundu wina wa insulin kupita ku wina kumatha kupangitsa kuti muwoneke matenda a hyperglycemic, chifukwa chake ndi bwino kuisintha moyang'aniridwa ndikuwonetsetsa momwe thupi liliri kwakanthawi. Ndipo musalole kuti muzigwiritsa ntchito insulini yozizira kapena yatha!

Mimba komanso kubala mwana ndizinthu zomwe zingayambitsenso vuto lofananalo. Ngati mayi woyembekezera ali ndi mtundu wina wa matenda a shuga, omwe samawaganizira, chikomokere chimatha kupha onse mayi ndi mwana. Ngati matenda a shuga atapezeka kale asanabadwe, muyenera kuyang'anitsitsa momwe aliri, auzeni zilizonse zazidziwitso kwa gynecologist ndikuwunika magazi anu.

Kwa odwala omwe ali ndi matenda a shuga 2, kupindika, kuchepa kwa thupi, kumayambitsidwa ndi matenda omwe amachitika ndi ntchito ya kapamba, mwachitsanzo, kapamba ka penancic. Izi zimabweretsa kuti insulini, yopangidwa moperewera, imakhala yochepera - chifukwa, zovuta zimatha kubuka.

Gulu lamavuto

Vutoli ndilowopsa kwambiri, koma osati nthawi zonse kukhala zovuta. Gulu lachiwopsezo limaphatikizapo - odwala omwe ali ndi matenda osachiritsika, opaleshoni, wamayi.

Chiwopsezo cha kukhala chikomokere mu hyperglycemic chimachulukitsidwa kwambiri kwa iwo omwe amakonda kuphwanya zakudya zomwe amapatsidwa kapena osaganizira mopepuka mlingo wa insulin womwe umayendetsedwa. Kumwa mowa kwambiri kungayambitsenso kusweka.

Zidadziwika kuti hyperglycemic coma siimakhala yomwe imayamba mwa odwala atakalamba, komanso kwa iwo onenepa kwambiri. Nthawi zambiri, izi zimawonekera mu ana (nthawi zambiri zimachitika chifukwa chophwanya chakudyacho, chomwe makolo samakonda kukayikira) kapena odwala adakali aang'ono komanso nthawi yayifupi. Pafupifupi 30% ya odwala matenda a shuga ali ndi zizindikiro zamatsenga.

Kodi khansa ya m'magazi ndi chiyani

Kuphatikizika kwa hyperglycemia, kapena chikomokere cha shuga, ndimomwe thupi limalumikizirana ndi kuchuluka kwa shuga m'magazi osakwanira kupanga insulin. Mu mndandanda wapadziko lonse - gulu la matenda - hyperglycemia amalembedwa pansi pa code mcb E 14.0. Matendawa amakula kwambiri mwa anthu omwe ali ndi matenda osokoneza bongo a mtundu woyamba 1, ndipo nthawi zambiri amakhala ndi vuto la matenda a shuga.

Kutengera mtundu wa maphunzirowo ndi zomwe zimawoneka ngati hyperglycemia mu shuga mellitus, imagawidwa m'mitundu ingapo:

• Hyperosmolar coma - imachitika ndi ketoacidosis wokhala ndi glucose wambiri komanso sodium, kuyamwa kwazinthu izi mkati mwa khungu komanso kuchepa thupi konsekonse kwa thupi. Amapezeka mwa odwala 50 wazaka.
• Ketoacidotic chikomokere - chifukwa cha kuperewera kwa insulin, kuchuluka kwa glucose, mawonekedwe a matupi a ketone, kutsika mkodzo, kuchuluka kwa acidity komanso kuwononga mitundu yonse ya kagayidwe.

Zoyambitsa Hyperglycemic Coma

Pakhoza kukhala zifukwa zingapo za kuonekanso kwa matendawa m'matenda a shuga, omwe ambiri amayanjana ndi chithandizo chokwanira cha matenda oyambitsidwa:

• mankhwala osakwanira a insulin
• wodwala akukana chithandizo cha insulin,
• kumwa mankhwala otsika mtengo kapena atha ntchito,
• kunyalanyaza malangizo, kusala kudya kwanthawi yayitali, kusagwirizana ndi zakudya.

Zomwe zimayambitsa kukomoka kwa hyperglycemic ndi monga:

• matenda a kapamba
• njira zotupa kwambiri ndi matenda opatsirana,
• kuvulala miyendo kwambiri komwe kunapangitsa kuti inshuwaransi idye kwambiri.
• kupsinjika kwakukulu
• kuphwanya kayendedwe ka kayendedwe ka mahomoni,
• kupezeka kosadziwika kwa matenda ashuga.

Pathogenesis wa hyperglycemic chikomokere

Wodwala yemwe ali ndi matenda ashuga, amakhala ndi matenda oshuga omwe amayamba kwambiri, nthawi yayitali, njira zimathandizira. Ngati kapamba amatulutsa insulin yokwanira, ndiye kuti chikomokere cha matenda a shuga chimachitika pokhapokha ngati impso yake ili ndi vuto. Onse kukula kwa algorithm ndi motere:

1. kuwonjezeka kwapang'onopang'ono kwa shuga wamagazi
2. Kusintha kwa kagayidwe kachakudya pa cellular,

Ma pathogenesis a hyperglycemic coma motsutsana ndi maziko a insulin akusowa ndi osiyana. Kenako thupi limasowa mphamvu. Kubwezeretsanso ndalama, thupi limayamba kusintha mapuloteni ndi mafuta kukhala glucose, pomwe impso sizitha kuchotsa zinthu zonse zowola mwachangu. Choopsa kwambiri pazakumwa zonse zokhala matupi a ketone. Zotsatira zake, thupi limakumana ndi katundu wambiri: kumbali imodzi - kusowa mphamvu, inayo - ketoacidosis.

Zizindikiro za hyperglycemic chikomokere

Vuto la matenda ashuga limagawika m'magawo awiri: precoma ndi hyperglucoseemia, zomwe zimapangitsa kuti musakhale chikumbumtima. Nthawi yosintha pakati pa magawo imatha kukhala maola 24 kupita masiku angapo. Pakusintha kwa wodwala, nkhawa zotsatirazi:

• ludzu losalekeza komanso pakamwa louma
• mkodzo wowonjezeka
• kutopa,
• khungu
• kuchepetsa khungu,
• Kuchepetsa kwambiri thupi
• m'mimba kupweteka ndi kusanza,
• kutsegula m'mimba
• kusowa kwa chakudya.

Kusungunuka kwa insulin, kuwonjezera pa kutayika kwenikweni kwa chikumbumtima, kumakhala ndi zizindikiro zapadera zingapo zam'mbuyomu. Pamene hyperglycemia ndi vuto la ketoacidotic litafika poyerekeza, polyuria imasinthidwa ndi oliguria kapena kusapezeka kwathunthu kwa mkodzo. Kenako kupuma kwamphamvu kwa Kussmaul kumawonekera, kumakhala kaphokoso kawirikawiri komanso kaphokoso ka mpweya, komanso kusokonezeka kwa kalankhulidwe komanso kusamva bwino.

Zizindikiro za hyperglycemic coma ndi izi:

• khungu lowuma,
• kupuma pafupipafupi komanso kwamphamvu
• Kununkhira kwa acetone kuchokera mkamwa,
• matope amadzuwa
• nsidze zofewa
• mawonekedwe amilomo yofiirira pamilomo,
• zochita ndi zokondweretsa zimachepetsedwa kapena palibe kuwunikira konse,
• mikangano yamafuta a khungu la peritoneum,
• kukoka kwamanyazi
• lilime louma
• kuthamanga kwa magazi, kutentha, Hyperemia ndikotheka,
• kamvekedwe ka minofu pakukangana, kukokana ndikotheka,
• mwa odwala omwe ali ndi vuto losiyana ndi chikomokere, madotolo amawona kutentha thupi ndi kudandaula.

Hyperglycemic Coma Chithandizo

Munthawi yabwino, njira yothandizira mankhwalawa ndikuwonetsetsa kuchuluka kwa shuga m'magazi, ndikofunikira kwambiri kudziwa kuti shuga yayamba bwanji. Mlingo wabwinobwino wama glucose ndi 3.5 mmol / L; 33-35 mmol / L amadziwika kuti ndiye wofunikira kwambiri. Komabe, chikomokere chimatha kuchitika ngati shuga ali pansi pazowoneka bwino, matendawa amatchedwa - hypoglycemic coma.

Kwambiri chithandizo cha hyperglycemic chikomokere ndi chindapusa cha matenda a shuga kumachitika kokha m'chipatala, kuchipatala cholimbikitsanso kwambiri:

1. Choyamba, ntchito ya madotolo ndi kusintha matenda a shuga, kupewa kukula kwa anuria ndi ketoacidosis chikomokere.
2. Vuto la hypoglycemic litadutsa, amayamba kubwezeretsa madzi otayika. Njira yothetsera wa sodium chloride imayambitsidwa kudzera mwa dontho limodzi ndi kuyimitsidwa kwa 10% ya potaziyamu wa potaziyamu, wotenthetsedwa mpaka madigiri 36.6.
3. Popewa zovuta zomwe zingayambitse chikomokere, mankhwalawa onse amawerengedwa mosamala pa mbiri yachipatala komanso zaka za wodwalayo.

Zizindikiro za chikomokere

Hyperglycemic coma imayamba patangopita maola ochepa, ndipo nthawi zina ngakhale masiku. Zizindikiro za chikomokomo chikubwera pang'onopang'ono. Zizindikiro zoyambirira ndi:

• ludzu losaletseka, kamwa yowuma,
• polyuria
• kusanza, kusanza,
• Khungu
• Zizindikiro zodziwika za kuledzera ndi kufooka, kupweteka kumutu, kutopa.

Ngati pali chizindikiro chimodzi, nthawi yomweyo onani kuchuluka kwa shuga m'magazi. Pokhala pafupi ndi chikomokere, chimatha kufika 33 mmol / L ndi kupitilira. Choyipa chachikulu mdziko lino ndikuchisokoneza ndi poyizoni wazakudya wamba, popanda kugwirizana ndi hyperglycemia. Izi zimabweretsa chifukwa chakuti nthawi yomwe ikufunika kuchitapo kanthu kuti vuto la chikomokere laphwanyidwe ndiye kuti mavuto akuchitika.

Ngati palibe njira zomwe zachitidwa kuti mupeze insulin yowonjezera, zizindikirazo zimasintha mwanjira inayake, mankhwalawa amayamba: m'malo mwa polyuria - anuria, kusanza kumakulirakulira, kumakhala kambiri, koma sikubweretsa mpumulo. Fungo la acetone limatuluka mkamwa. Ululu pamimba umatha kukhala osiyanasiyana mosiyanasiyana - kuchokera kupweteka mpaka kupweteka. Pali matenda otsekula m'mimba kapena kudzimbidwa amakula, ndipo wodwala adzafunika kuthandizidwa.

Gawo lomaliza musanachitike chikomokere, khungu limakhala louma komanso lozizira, kutentha, kutentha kwa thupi pang'onopang'ono. Kamvekedwe ka mawonekedwe amaso kumagwa - akakanikizidwa, amakhala ngati ofewa, khungu turgor limachepetsedwa. Pali tachycardia, kuthamanga kwa magazi kumatsika.

Kupuma kwamkokomo kwa Kussmaul kumadziwika chifukwa cha kupuma kocheperako komwe kumachitika ndi mpweya wamphamvu komanso kamphamvu kwambiri. Fungo la acetone popuma. Lilime ndi louma, lopakidwa ndi zokutira. Zitachitika izi kukomoka kowona - munthu amasiya kuzindikira, samayankha chifukwa chakunja.

Mlingo wa kukula kwa vuto la hyperglycemic coma nthawi zonse umakhala payekhapayekha. Nthawi zambiri, precoma imatenga masiku 2-3. Ngati chithandizo kuchipatala sichikuperekedwa kuchipatala, amwalira pasanathe maola 24 kuyambika.

Chisamaliro chodzidzimutsa cha hyperglycemic coma

Pazizindikiro zoyambirira za shuga m'magazi, muyenera kufunsa dokotala kapena kuyitanitsa chithandizo chodzidzimutsa, makamaka ngati zizindikilo za mwana zimapezeka. Ngakhale mutakhala kuti simukudziwa zomwe zimayambitsa odwala kapena matenda a shuga, okhathamira kapena shuga ochepa, mumaperekabe shuga kwa okhudzidwayo. Ndi nkhawa ya insulin, izi zimatha kupulumutsa moyo wa munthu, ndipo ngati matendawa amayamba chifukwa cha kuchuluka kwa shuga, izi sizingadzetse vuto.

Thandizo lina lonse lothandizira mwadzidzidzi kwa vuto la kuchepa kwa vuto la hyperglycemic lili ndi izi:

• Ngati wodwalayo sakudziwika, ndikofunikira kuti awone ngati akupumira mofulumira, kuti amve kupweteka, kuti awone ana. Mukakhala kuti mulibe kukoka, nthawi yomweyo yambani kutulutsa minofu yamtima yosalunjika. Ngati wodwalayo akupuma, mugwire kumanzere kwake, mupatseni mpweya wabwino.
• Wodwala akazindikira, ayenera kupatsidwa zakumwa kapena zinthu zokhala ndi shuga.

Matenda a shuga - njira

Mfundo yayikulu pakukula kwa chikomokere ndi kuphwanya kwa ma cellular metabolism chifukwa chakuchulukitsa kuchuluka kwa shuga m'magazi am'magazi.

Kuchuluka kwa glucose komanso kuperewera kwa insulin kumapangitsa kuti ma cell a thupi sangathe kugwiritsa ntchito mphamvu za kutsekeka kwa glucose ndikumva mphamvu ya "mphamvu". Pofuna kupewa izi, kagayidwe ka maselo amasintha - kuchokera ku shuga, amasinthira njira yopanda glucose yopangira mphamvu, ndipo, makamaka, kuwonongeka kwa mapuloteni ndi mafuta ku glucose kumayamba. Izi zimathandizira kuti pakhale kuchuluka kwa zinthu zowola, chimodzi mwazo ndi matupi a ketone. Mankhwalawa ndi oopsa ndipo nthawi yomweyo kupezeka kwawo kumapangitsa kuti asangalale, komanso chifukwa chodzikundikira - poyizoni wa thupi, kupsinjika kwa mtima ndi ubongo. Mokulira kuchuluka kwa hyperglycemia ndi matupi a ketone ochulukirapo - amalimbitsa thupi ndi zotsatirapo za chikomokere.

Mankhwala amakono amapereka mitsempha yoyesa kuti mupeze matupi a ketone mumkodzo. Ndizomveka kuzigwiritsa ntchito ngati mulingo wa glucose m'magazi upitilira 13mm mmol / l, komanso matenda omwe angayambitse kusanza. Mamita ena a glucose m'magazi ali ndi ntchito yofufuza matupi a ketone.

Thandizo lodzidzimutsa la odwala matenda ashuga

Ngati pali umboni wa chikomokomo chomwe chikubwera, ndikofunikira kuperekera insulin mosadukiza - maola awiri ndi atatu, malingana ndi kuchuluka kwa shuga m'magazi, kuwongolera kwa shuga pamaola 2 aliwonse. Zakudya zamafuta ochulukirapo ziyenera kukhala zochepa. Onetsetsani kuti mumamwa potaziyamu ndi magnesium, kumwa madzi amchere amchere - izi zitha kupewa hyperacidosis.

Ngati kuwonjezereka kwa insulin kawiri konse kwadutsa, ndipo matendawa sanakhazikike kapena kuwonjezereka, ndiye kuti muyenera thandizo la kuchipatala. Kupita kwa dokotala ndikofunikira ngakhale cholembera imagwiritsidwa ntchito kutulutsira insulin ndipo izi zimaloleza kukhazikika. Katswiriyu athandizira kumvetsetsa zomwe zimayambitsa kupsinjika ndikupereka chithandizo chokwanira.

Ngati wodwalayo ali ndi vuto lalikulu ndipo watsala ndi chikumbumtima, chithandizo chofunikira chimafunikira. Ndikotheka kuchotsa wodwala ku chikomokere chokhala ndi zotsatirapo zochepa chifukwa chakuchipatala.

Ma ambulansi isanafike, mutha kupereka thandizo:

• Ikani wodwala mbali imodzi kuti muchepetse kusanza ndi kuyamwa kwa lilime,
• kutentha kapena kuphimba ndi zotenthetsa,
• onetsetsani kugunda kwanu ndikupumira,
• mukasiya kupuma kapena palpitations, yambani kusamba - kupuma movutikira kapena kutikita minofu yamtima.

Magawo atatu "ASATSITSE" mathandizidwe oyamba!

1. Simungasiye wodwala yekha.
2. Simungamulepheretse kupereka insulin, ponena za izi ngati zochita zosakwanira.
3. Simungakane kuyimba ambulansi, ngakhale vutolo litakhazikika.

Hyperglycemic Coma Prevention

Pofuna kuti thupi lisabweretse zovuta ngati chikomokere, ndikofunikira kutsatira malamulo osavuta: kutsatira chakudya nthawi zonse, kuyang'anira kuchuluka kwa shuga m'magazi, ndikuwongolera insulin panthawi yake.

Zofunika! Onetsetsani kuti mwatchera khutu kutha kwa nthawi ya insulin. Simungagwiritse ntchito ntchito!

Ndikwabwino kupewa kupsinjika ndi kuchita masewera olimbitsa thupi. Matenda opatsirana aliwonse amathandizidwa.

Makolo a ana omwe amapezeka ndi matenda amtundu woyamba amayenera kuyang'anira kwambiri zakudya. Nthawi zambiri, mwana amaphwanya chakudyacho mobisa kwa makolo ake - ndibwino kufotokozera pasadakhale zotsatira zonse za machitidwe otere.

Anthu athanzi amafunika kuwunika shuga wawo wamagazi pafupipafupi; ngati nayamba, ndikofunikira kulumikizana ndi endocrinologist.

Kubwezeretsanso pambuyo pa kukomoka kapena kupweteka

Pambuyo pamavuto akulu kwambiri monga chikomokere, chisamaliro chachikulu chimayenera kulipidwa nthawi yakukonzanso. Wodwala akamachoka kuchipatala, muyenera kulenga zonse kuti achire kwathunthu.

Choyamba, tsatirani malangizo onse a dokotala. Izi zimagwiranso ntchito pazakudya ndi moyo. Ngati ndi kotheka, siyani zizolowezi zoyipa.

Kachiwiri, pangani kusowa kwa mavitamini, michere ndi micro yambiri yotayika panthawi yokhayo. Tengani mavitamini, osatengera kuchuluka, komanso kuchuluka kwa chakudya.

Ndipo, chomaliza, musataye mtima, musataye mtima ndikuyesera kusangalala tsiku lililonse. Kupatula apo, matenda a shuga si sentensi, ndi njira chabe ya moyo.