Hyperglycemic chikomokomo: mwadzidzidzi, manesi a algorithm

Chaka ndi chaka, chiwonjezeko cha anthu ambiri amadwala matenda a shuga. Matendawa ndi njira yoopsa kwambiri, zotsatira zake zomwe sizongochepetsa moyo wa wodwalayo, komanso zimatha kupha. Matenda angayambitse matenda owopsa monga hyperglycemic coma. Zotsatira zake ndi kutaya chikumbumtima komanso kulephera kwa ziwalo. Pazomwe zafotokozedwazo, ndikufuna kudziwa chomwe chimapangitsa kuti pakhale vuto la hyperglycemic, chisamaliro chamankhwala azadzidzidzi chazomwe zimachitika. Tilankhulanso izi.

Kodi hyperglycemic coma ndi chiani?

Hyperglycemia ndi vuto la shuga, lomwe limakhala pachimake. Vutoli limaphatikizidwa ndi kuwonjezeka kopita patsogolo kwa kuchuluka kwa shuga m'magazi motsutsana ndi maziko a kuchepa kwa insulin. Ndikofunikira kudziwa kuti chisamaliro chodzidzimutsa cha hyperglycemic coma ndichofunikira kupulumutsa wodwalayo. Munthu aliyense wodalira insulini, komanso abale ake, ayenera kudziwa bwino momwe zochita zimasinthira pazovuta.

Kufunika kwa chisamaliro chodzidzimutsa cha hyperglycemic coma kumakhudza makamaka achinyamata ndi ana omwe atapezeka ndi matenda ashuga okha. Mavuto ngati amenewa samapezeka mwa anthu omwe ali achikulire ndipo akhala akudwala kwazaka zambiri. Kuphatikiza apo, chikomokere sichimapezeka konse mwa odwala matenda ashuga omwe onenepa kwambiri.

Zosiyanasiyana zamatsenga

Madokotala amasiyanitsa mitundu ingapo ya chikomero cha hyperglycemic. Algorithm yadzidzidzi pazomwe zili zonse zimakhala ndi zosiyana. Chifukwa chake, amasiyanitsa:

ketoacidotic chikomokere
hypersomolar chikomokere
lactic acidosis kuti chikomokere.

Ketoacidosis iyenera kumvetsedwa ngati kupangika kwa matupi a ketone m'magazi. Vutoli limayamba motsutsana ndi maziko a matenda ashuga, omwe wodwalayo sangachite popanda jakisoni wokhazikika wa insulin.

Nawonso, hypersomolar coma imachitika ndi matenda a shuga 2. Ndi chikhalidwe chamtunduwu wamatenda, matupi a ketone ndi abwinobwino. Komabe, munthu amakhala ndi vuto lodzidzimutsa m'magazi a shuga kuti achepetse mfundo. Komanso mu nkhani iyi, kuchepa thupi kwa thupi kumawonedwa.

Lactic acid coma imadziwika ndi zolimbitsa thupi zamatumbo a mkodzo. Mkhalidwe umapangidwa pang'onopang'ono pakukula kwa matenda a shuga omwe amadalira insulin. Vuto lalikulu pano ndikuzunguliridwa kwa unyinji wa lactic acid m'mwazi.

Njira zoyambira kukhazikitsa chikomokere

Matenda a pathological amatha kuchitika mothandizidwa ndi zinthu zingapo:

insulin
kuchuluka kwa chakudya chamagulu omwera mwa chakudya,
kuchita zolimbitsa thupi kwambiri
kupsinjika kwakukulu, kugwedezeka kwamakhalidwe, kukhumudwa kwakanthawi.

Ndiyenera kunena kuti kusowa kwa chakudya chamagulu komanso kusokonezeka kwamaganizidwe sikumayambitsa kuperewera kwa hyperglycemic. Kudzipereka kuti musadziwe zolimbitsa thupi ndi matenda ashuga kulinso kovuta. Chifukwa chake, nthawi zambiri, hyperglycemic coma, algorithm yothandizira odwala mwadzidzidzi yomwe ikukambidwa pambuyo pake, amapezeka mwa anthu omwe akuloleza insulin.

Chithunzi cha kuchipatala

Mkhalidwe wamatumbo umakula pang'onopang'ono. Zizindikiro zake zamatenda a shuga zimawonekera masiku angapo. Kukhala bwino kwa wodwalayo kumangokulira pang'onopang'ono, kumayamba kusokonekera. Mikhalidwe yovuta imasinthidwa pang'onopang'ono ndikuwonongeka kwakanthawi. Mukakumana ndi wodwala, pali zolepheretsa kuganiza, kukomoka.

Kukula kwa vuto la hyperglycemic chikhoza kutsimikiza. Khungu lomwe limakhala ndi izi nthawi zambiri limatembenuka, zotupa zopumira zimachitika. Mphepo yomwe imachokera pakatikati kamlomo imakhala ndi fungo la acetone. Lilime limakhala louma.

Pambuyo pake, kutsika kwakukulu kwa kuthamanga kwa magazi kumachitika, kugunda kwa mtima kumawonjezereka. Ngati wodwala amatha kukhalabe ndi ludzu, ludzu lalikulu, nseru, komanso kusanza kumadziwika.

Kuti mudziwe zomwe zimapangitsa kuti akwaniritse kuphika kumalola kukambirana ndi wodwalayo, ngati kudziwa kwake kumadziwika. Ngati munthu sayankha pazokopa zakunja, mutha kuzindikira zovuta zake pofufuza zinthu zake. Anthu odwala matenda ashuga nthawi zambiri amakhala ndi ma insulin, mapu a matendawa. Mwa zina, kupezeka kwa malembo angapo pambuyo pobayidwa, komwe nthawi zambiri kumakhala ntchafu ndi pakhungu la pamimba, kumatha kuwunikira malingaliro pazovuta za vutoli.

Hyperglycemic coma: algorithm mwadzidzidzi dokotala asanafike

Ndi vuto la mtundu uwu, ndikofunikira kwambiri kupereka chithandizo choyamba kwa wodwala nthawi yomweyo. Chifukwa chake, ndikudwala matenda a shuga, algorithm yadzidzidzi ikuwonetsa izi:

Munthu amakhala pamtunda wokhazikika.
Wodwala amapatsidwa mpweya wabwino. Kuti muchite izi, chotsani zovala zakunja, chotsani lamba, zomangira, ndi zina zambiri.
Mutu watembenukira kumbali. Kupanda kutero, wovutitsidwayo akhoza kumayimbidwa ndi zinsinsi za m'mimba chifukwa cha kusanza.
Fotokozani ngati wodwala akutenga jakisoni wa insulin. Ngati zikutsimikiziridwa, pangani zikhalidwe zoperekera mulingo woyenera wa mankhwala m'magazi.
Ngati ndi kotheka, lembani kuchuluka kwa kukakamiza kuti mufotokozere anthu ogwira ntchito ma ambulansi.
Dokotala asanafike, munthu amapatsidwa tiyi wokoma.
Kupuma kukamira kapena kugunda kumatha, wovutikayo amapuma mwadzidzidzi kapena kutikita minofu yamtima mwachindunji.

Thandizo lakuchipatala

Kodi algorithm ya namwino yochitira chiyani ya hyperglycemic coma ndi iti? Thandizo lachipatala mwadzidzidzi pano limaphatikizapo, jakisoni wa insulin. Choyamba, mankhwalawa amawayikidwa m'magazi kudzera mu syringe. Kenako pitilizani kudyetsedwa kulowa mthupi ndi dontho limodzi ndi njira ya shuga 5%. Kuchulukana kwachilendo kwa shuga m'magazi popewa kuyambika kwa matenda ashuga kwambiri.

Wodwala akangoperekedwa kuchipatala, amachapitsa zam'mimba komanso matumbo. Pachifukwa ichi, 4% bicarbonate solution imagwiritsidwa ntchito. Mchere umalowetsedwa m'mitsempha, zomwe zimathandizira kubwezeretsa kuchuluka kwamadzi mu thupi. Kenako sodium bicarbonate imaperekedwa kwa magazi, zomwe zimapangitsa kuti zibwezeretsanso ma elekitratiki omwe adatayika panthawi ya kuukira.

Chifukwa chake tidasanthula ma algorithm a chisamaliro chodzidzimutsa. Ndi kuperewera kwa hyperglycemic, monga mukuwonera, tanthauzo lazovuta ndizovuta. Mkhalidwe umadziwika ndi kusapezeka kwa zizindikiro zotchulidwa. Chifukwa chake, nthawi zina zimakhala zovuta kuti munthu wopanda pake azindikire momwe vuto limayambira. Popewa zovuta, odwala matenda ashuga ayenera kulabadira kuchuluka kwa insulini yoyenera panthawi yake.

Hyperglycemic coma - chisamaliro chodzidzimutsa (algorithm)

Kanema (dinani kusewera).

Hyperglycemic chikomokere - vuto lomwe limayambitsidwa ndi kuchepa kwa insulin mthupi. Nthawi zambiri, kukomoka komwe kumayenderana ndi kuperewera kwa insulin ndi vuto la shuga. Kuphatikiza apo, izi zitha kuchitika chifukwa chakutha kwa jakisoni wa insulin kapena kudya kosakwanira. Algorithm yothandizira odwala mwadzidzidzi chifukwa cha kukomoka kwa hyperglycemic iyenera kudziwika ndi aliyense yemwe ali ndi wodwala matenda ashuga m'mabanja.

Kusiyanitsa kwa Coma

Popeza pali mitundu itatu ya chikomero cha hyperglycemic, thandizo lomwe limaperekedwa kuchipatala limasiyana ndi lirilonse la iwo:

ketoacidotic chikomokere,
hyperosmolar chikomokere,
lactic acidosis.

Ketoacidosis amadziwika ndi mapangidwe a matupi a ketone (acetone) ndipo amakula motsutsana ndi maziko a matenda a shuga a insulin. Boma la hyperosmolar limachitika ndi matenda amtundu wa 2, matupi a ketone kulibe, koma odwala ali ndi shuga komanso kuthamanga kwamthupi.

Lactic acidosis imadziwika ndi glycemia wocheperako poyerekeza ndi ma pathologies awiri oyamba, amapanga matenda osokoneza bongo omwe amadalira insulin ndipo amadziwika ndi kudziunjikira kwakukulu kwa lactic acid m'magazi.

Zizindikiro za ketoacidosis ndi hyperosmolar coma ndi zofanana. Chithunzi cha chipatala chikukula pang'onopang'ono. Ludzu kwambiri, chimbudzi chachikulu, mkodzo, kusanza komanso kusanza, kukomoka kumawonekera.

Kuphatikiza apo, kunyumba, mutha kumveketsa kuchuluka kwa shuga (wokhala ndi hyperosmolar coma imatha kufika 40 mmol / L ndi kutalika, ndi ketoacidosis - 15-20 mmol / L) ndikuwona kukhalapo kwa matupi a acetone mu mkodzo pogwiritsa ntchito mayeso owonetsa.

Kuchita ludzu kwambiri komanso polyuria sikuti ndi lactic acidosis; mulibe matupi a ketone. Kunyumba, ndizovuta kudziwa.

Thandizo loyamba

Kwa mtundu uliwonse wa chikomokere cha hyperglycemic, akatswiri othandiza pakagwiridwe kadzidzidzi amayenera kutchedwa mwachangu ndipo njira zotsatizana ziyenera kuchitidwa asanafike. Thandizo loyamba ndi ili:

Ikani wodwalayo pamalo oyimirira.
Patsani mpweya wabwino, osakhazikika kapena chotsani zovala zakunja. Ngati ndi kotheka, chotsani tayeyo.
Tembenuzani mutu wa wodwalayo kumbali kuti kukasanza, munthu asakuduleni.
Yang'anani momwe lilime liliri. Ndikofunikira kuti palibe kubwerera.
Fotokozani ngati wodwalayo ali pa insulin. Ngati yankho ndi inde, pangani zofunikira kuti apange jakisoni payekha kapena kumuthandiza kuperekera timadzi tomwe timafunikira.
Yang'anirani kuthamanga kwa magazi ndi kugunda. Ngati ndi kotheka, lembani zizindikiro kuti muwadziwitse akatswiri a ambulansi za iwo.
Ngati wodwalayo ali "wamantha," mkenthereni ndikuphimba ndi bulangeti kapena kum'pukuta.
Imwani mokwanira.
Ngati mtima wamangidwa kapena kupuma, mpofunika kukhazikikanso.

Mbali Zakubwezeretsa

Kuyambitsanso kuyenera kuyamba mwa akulu ndi ana, osadikirira kufika kwa akatswiri a ambulansi, atangoyamba kumene chizindikiro: kusowa kwamkati pamitsempha yama carotid, kusowa kupuma, khungu limayamba kuyimitsidwa pang'onopang'ono, ophunzirawo amachepetsedwa ndipo samvera kuwala.

Ikani wodwalayo pansi kapena kolimba, ngakhale kumtunda.
Muzigwetsa kapena kudula zovala zakunja kuti mufike pachifuwa.
Sinthirani kumbuyo mutu wa wodwalayo momwe mungathere, ikani dzanja limodzi pamphumi, ndikuyika nsagwada ya m'mbuyo ndi inayo. Njirayi imapereka mwayi wokhala wolumikizira ndege.
Onetsetsani kuti palibe matupi achilendo mkamwa ndi mmero, ngati kuli kotheka, chotsani ntchofu ndikuyenda mwachangu.

Pakamwa mpaka pakamwa. Choko, chopukutira kapena mpango chimayikidwa pamilomo ya wodwala. Mpweya wozama umatengedwa, milomo imakanikizidwa mwamphamvu kukamwa kwa wodwalayo. Kenako amatuluka mwamphamvu (kwa masekondi 2-3), kwinaku akumatseka mphuno kwa munthu. Kuchita bwino kwa mpweya wabwino wozungulira kumatha kuonekera pakukweza chifuwa. Pafupipafupi kupumira kuli maulendo 16-18 pamphindi.

Kutikita minofu yamtima. Manja onse amaikidwa mbali yotsika ya sternum (pafupifupi pakati pa chifuwa), kukhala kumanzere kwa munthu. Mphamvu zamphamvu zimagwirizidwira msana, ndikusunthira pamwamba pa chifuwa ndi 3-5 masentimita akuluakulu, 1.5-2 cm mwa ana. Pafupipafupi ma Clicks ndi nthawi 50-60 pamphindi.

Ndikuphatikizika kwa kupuma mkamwa ndi pakamwa komanso kutikita minofu yamtima, komanso zochitika za munthu m'modzi, kupuma kamodzi kuyenera kusinthidwa ndi zovuta za 4-5 pachifuwa. Kubwezeretsa kumachitika asanachitike akatswiri a ambulansi kapena pokhapokha patakhala zizindikiro za moyo mwa munthu.

Ketoacidotic chikomokere

Chofunikira ndikumayamba kwa insulin. Choyamba, umayendetsedwa mu jet, kenako amathira shuga wambiri 5% kuti muchepetse kuyambika kwa matenda a hypoglycemic. Wodwalayo amasambitsidwa ndi m'mimba ndikutsuka matumbo ndi 4% bicarbonate solution. Kuphatikiza kwamitsempha yamchere, kukonza kwa Ringer kubwezeretsa kuchuluka kwa madzimadzi m'thupi ndi sodium bicarbonate kuti abwezeretse ma elekitironi otaika.

Kuthandizira ntchito ya mtima ndi mitsempha yamagazi, glycosides, cocarboxylase amagwiritsidwa ntchito, chithandizo cha okosijeni chimachitika (kuchuluka kwa mpweya wa thupi).

Hyperosmolar boma

Chisamaliro chodzidzimutsa chokhala ndi chikomokere chili ndi kusiyana:

Kukonzekera kulowetsedwa kwakukulu (patsiku mpaka malita 20) kumagwiritsidwa ntchito kubwezeretsa kuchuluka kwa madzimadzi m'thupi (saline yokhudza thupi, yankho la Ringer),
insulin imawonjezeredwa ku physiology ndi jekeseni yotsika, kotero kuti shuga yayamba kuchepa,
pamene kuwerengera kwa glucose kufika 14 mmol / l, insulin imayendetsedwa kale pa 5% shuga,
ma bicarbonates sagwiritsidwa ntchito, chifukwa palibe acidosis.

Lactic acidosis

Zomwe zimapatsa mpumulo wa lactic acidosis chikomokani motere:

Blue ya Methylene imalowetsedwa m'mitsempha, kulola kumanga kwa ayoni a hydrogen,
Makonzedwe a Trisamine
peritoneal dialysis kapena hemodialysis yoyeretsa magazi,
kukoka kwa mtsempha wa sodium bicarbonate,
Mlingo wochepa wa kulowetsedwa kwa insulin pa 5% shuga monga njira yochepetsera kuchepa kwakanthawi kwa kuchuluka kwa ma glucose m'magazi.

Kudziwitsa momwe angaperekere chithandizo choyamba mu dziko la hyperglycemic, komanso kukhala ndi luso lotha kukonzanso zinthu, kukhoza kupulumutsa moyo wa munthu. Kudziwa kumeneku ndikofunika osati kwa odwala matenda ashuga okha, komanso kwa abale awo ndi abwenzi.

Zizindikiro za hyperglycemic coma ndi algorithm yodzidzimutsa

Zizindikiro za chiwonetsero cha hyperglycemic coma zimagwirizanitsidwa ndi kuledzera kwa ketone, kuperewera kwa asidi-base komanso kuperewera kwa madzi m'thupi. Hyperglycemic coma imayamba masana (komanso nthawi yayitali). Zoyeserera za chikomokere ndi:

Kanema (dinani kusewera).

mutu
kusowa kwa chakudya
nseru
ludzu ndi kamwa yowuma
lilime lophimbidwa
Kununkhira kwa acetone kuchokera mkamwa,
kukomoka kwa m'mimba thirakiti,
kuchepetsedwa kwa mavuto
mphwayi
kugona
amnesia
kamvekedwe kakang'ono ka minofu
kuchuluka kukodza.

Ngati kunyalanyaza zizindikiritso zoonekera za precomatose ndi kusapezeka kwa zokwanira, pamapeto pake, munthu angagwe osazindikira.

Thandizo loyamba lazithandizo zadzidzidzi za hyperglycemic coma limakhazikitsa njira zingapo zotsatizana. Choyamba, muyenera kuyitanira ambulansi. Poyembekezera kudza kwa akatswiri, algorithm ya chisamaliro chodzidzimutsa cha hyperglycemic coma ndi iyi:

Kupatsa wodwalayo malo oyimirira.
Kuchepetsa lamba, lamba, taye, kuti osakhazikika pazovala zolimba.
Onetsetsani kuti mwayendetsa chilankhulo (ndikofunikira kuti zisapusitsike!)
Pangani jakisoni wa insulin.
Yang'anirani zokakamiza. Ndi kuchepa kwakukulu kwa kuthamanga kwa magazi, perekani mankhwala omwe amawonjezera kuthamanga kwa magazi.
Patsani zakumwa zambiri.

Chisamaliro chodzidzimutsa cha hyperglycemic coma

Wodwala wodwalayo ayenera kuchipatala. Ku chipatala, zochitika zotsatirazi zimachitika:

Choyamba, ndege, kenako nkugwetsa insulin.
Chitani chilonda cham'mimba, ikani ma enema oyeretsa ndi 4% sodium bicarbonate solution.
Ikani dontho ndi mchere, njira ya Ringer.
5% shuga imayendetsedwa maola 4 aliwonse.
4% sodium bicarbonate solution imayambitsidwa.

Ogwira ntchito zamankhwala ola lililonse amawona kuchuluka kwa glycemia ndi kukakamizidwa.

Odwala omwe ali ndi matenda a shuga amadziwa bwino kufunika kotsatira zakudya komanso chithandizo chamankhwala chomwe dokotala amakupatsani. Kupanda kutero, kukomoka kwadzidzidzi m'magazi a shuga kumatha kubweretsa zovuta zazikulu, zomwe zimapangitsa kuti pakhale kuperewera kwa magazi.

Kodi hyperglycemic ndi hypoglycemic coma ndi chiyani?

Hyperglycemic coma ndi chikhalidwe chovuta cha wodwala matenda ashuga, momwe mumakhala kutayika kokwanira.

Kukula kwa matendawa kumatengera njira yamatendawa. Kukula kwa chikomokere kwa hyperglycemic kumayambitsidwa ndi kupsinjika kwa shuga m'magazi ndikuwonjezereka kwa insulin. Zotsatira zake, kusokonezeka kwakukulu kwa metabolic kumawonedwa, zotsatira zake ndiko kutayika kwa zifukwa ndi chikomokere.

Hypoglycemic coma imamveka ngati mkhalidwe womwe umayambitsidwa ndi kuchuluka kwa insulin mthupi la wodwala wodwala matenda ashuga.

Coma imayamba pang'onopang'ono. Kuchokera ku zizindikiritso zoyambirira mpaka kugona, wodwalayo amatha kupita kwa maola angapo mpaka milungu ingapo. Zimatengera kuchuluka kwa shuga m'magazi komanso kutalika kwa shuga?

Zizindikiro zoyambirira zomwe zikusonyeza kuti chikomokere pang'onopang'ono ndi:

kupweteka mutu, kukulira nthawi,
Zizindikiro za poizoni
kusokonezeka kwa mitsempha - kumverera kwa nkhawa kapena kupanda chidwi,
kutaya mphamvu
ludzu lomwe likukulirakulira.

Chifukwa cha chikomokere, kuledzera kwamphamvu komanso kwamphamvu kwa dongosolo lonse lamanjenje kumachitika, chifukwa chake mkhalidwe uwu umadziwika ndi zovuta zamanjenje, mpaka kutayika kwa chifukwa.

Ngati palibe chomwe chikuchitika, mutazindikira zizindikiro zoyambirira, wodwalayo adzakulitsidwa. Atangotsala pang'ono kugona, wodwalayo amapuma fungo la acetone, amapumira movutikira.

Hyperglycemic coma imayamba pazifukwa izi:

kudziwika ndi matenda ashuga ngati matendawa ali kale kale,
kuphwanya zakudya
Mlingo woyenera ndi jakisoni wosadziwika,
mavuto amanjenje
matenda opatsirana opatsirana.

Mkhalidwe uwu ndi wofanana ndi matenda amtundu wa 1 shuga, momwe kuperewera kwa insulin kumawonedwa. Odwala omwe ali ndi matenda a shuga a mtundu wachiwiri, chikomokere choterechi chimakhala chosowa kwambiri, ndimawonekedwe a shuga m'magazi.

Hyperglycemic coma imatha kupha, chifukwa chake ndikofunikira kwambiri kuzindikira zizindikiritso zake pa nthawi yake. Kuzindikira panthawi yovutikira ndikupita kwa dokotala kungapulumutse moyo wa wodwalayo. Kuti muchite izi, muyenera kudziwa kuti glycemic coma ndi chiyani komanso ndizomwe zimadziwika ndi matendawa.

Kuphatikiza pazizindikiro zomwe zili pamwambapa, zomwe zimawonekera pang'onopang'ono pachigawo choyambirira cha matendawa, kufiyira kwa khungu la nkhope kumatha kuzindikirika mwa wodwalayo. Odwala nthawi zambiri amadandaula zaumauma ndi pakamwa.

Chizindikiro china chodziwika ndi chakuti khungu la nkhope limakhala lofewa kwambiri, khungu limatayika kwambiri, ndipo nkhope imakhala yotupa. Ngati muphunzira chilankhulo cha wodwalayo, mudzazindikira kuti kuvekera kwofiirira.

Pamaso pa chikomokere, pamakhala kukoka kowonjezereka, kutsika pang'ono komanso kutentha pang'ono kwa thupi.

Mkhalidwe wa hypoglycemic umayamba mwachangu kwambiri. Kuchokera pakuwonekera kwa zizindikiro zoyambirira mpaka kukomoka kwa chikumbumtima, mphindi zochepa zimadutsa. Izi zimadziwika ndi zizindikiro zotsatirazi:

kukomoka mtima,
thukuta kwambiri
kumva kwamphamvu njala
migraine
miyendo ndi kunjenjemera miyendo,
kupumira kwakanthawi.

Hypoglycemic coma imatha kuchitika chifukwa chopsinjika kwambiri thupi chifukwa cha masewera, kuchepa kwathunthu kwa chakudya chamafuta, kapena mlingo waukulu wa insulin.

Hypo ndi hyperglycemic diabetesic coma ngati sanalandire imfa.

Ngati chikomokere cha hyperglycemic chikukula mwadzidzidzi, chisamaliro chodzidzimutsa chimatha kupulumutsa moyo wa wodwalayo. Monga lamulo, odwala matenda ashuga nawonso amadziwa zomwe zimayambitsa kupuma ndipo amatha kuchenjeza ena kapena kuimbira foni dokotala.

Komabe, ngati chikomero cha hyperglycemic chikayamba mwadzidzidzi, ziyenera kukumbukiridwa kuti chisamaliro chodzidzimutsa chimatha kupulumutsa moyo wamunthu, njira zotsatirazi zikuthandizira:

thandizani wodwala kubaya insulini
Wodwala akamwalira, ayikeni kumbali yake.
muyenera kuyitanitsa adotolo
yang'anirani momwe wodwala amapumira,
kuwongolera kugunda kwa mtima.

Palibe chomwe chingachitike kunyumba ngati wodwalayo watha kale kuzindikira. Zimangokhala zowonetsetsa kuti wodwalayo samachita mwangozi chifukwa chokhala ndi lilime lowilidwa ndikudikirira kufika kwa gulu lodzidzimutsa.

Tiyenera kukumbukira kuti chimodzi mwazizindikiro za matenda a shuga ndikuphwanya kwa ubongo ntchito. Izi zitha kukhala limodzi ndi wodwalayo osadandaula. Nthawi zambiri zimachitika kuti wodwalayo pazifukwa zina safuna kuyimbira dokotala ndipo amayesetsa kutsimikizira ena kuti akudziwa zoyenera kuchita. Potere, muyenera kuyitanitsa kuchipatala, mosiyana ndi chitsimikiziro chonse cha wodwalayo.

Thandizo loyamba ngati vuto la hypoglycemic likufanana ndendende ndikuthandizira chikomokere. Chokhacho chofunikira kukumbukira ndikuti ngati vuto la hypoglycemia, insulini silingatumizidwe dokotala asanafike.

Ngati pali wodwala yemwe ali ndi matenda ashuga m'banjamo, ndikofunikira kukumbukira ambulansi ya ambulansi ndikukhala ndi nambala ya foni ya dokotala yomwe ilipo.

Palibe chisamaliro chadzidzidzi kunyumba chokhala ndi vuto lachiberekero lomwe lingalowe m'malo mwa chithandizo chamankhwala kuchipatala. Wodwala atadwala, chinthu choyamba kuchita ndikuyitanitsa adokotala.

Wodwala adzavomerezedwa kuchipatala kwakanthawi, kofunikira kuti awone momwe alili. Chithandizo cha matenda a shuga a hyperglycemic chikomachi ndicholinga chofuna kuchepetsa matenda a shuga. Ndi kulumikizana kwakanthawi ndi chipatala, mankhwalawa azikhala ndi izi:

kugwiritsa ntchito mankhwala kuti muchepetse shuga,
kugwiritsa ntchito jakisoni "ifupi "a insulin,
kuchotsa kwa zomwe zimapangitsa,
kubwezeretsanso kwamadzi kwakutaya thupi.

Njira zoterezi zithandiza kuyimitsa boma la precomatose komanso kupewa mavuto.

Ngati kupita kwa dotolo kunachitika pambuyo pake, ndiye kuti munthuyu wagwa kale, chithandizo chingatenge nthawi yayitali ndipo palibe amene angatsimikize kuti zinthu zikuyenda bwino. Ngati wodwalayo sakudziwika, mankhwalawo akuphatikizira kupumitsa kwam'mapapo ndi kutsimikizira kwa m'mimba. Kuwongolera shuga kumachitika ola limodzi, limodzi ndi jakisoni wa insulin.

Kutsatira momveka bwino malangizo a dokotala anu kungathandize kuti musakhale ndi vuto la matenda ashuga.

Pewani kuchepa kapena kuchuluka kwa insulini mthupi.
Tsatirani malangizo omwe angapangidwe pakudya.
Osati overexert, zolimbitsa thupi ziyenera kukhala zofatsa.
Pewani kuchuluka kwamphamvu kwa shuga m'magazi.

Ngati zizindikiro zina zikuwoneka, muyenera kufunsa dokotala mosazengereza kapena kuyesa kuyimitsa nokha. Chithandizo chamankhwala chapanthawi yake chithandiza kupewa kupsinjika kwa hyperglycemia - dementia, yomwe imachitika chifukwa cha kuwonongeka kwamitsempha ya thupi.

Matenda a shuga amasiya chizindikiritso cha munthu. Ngati mungapirire pamenepa ndipo musanyalanyaza malangizo a dokotala, matenda ashuga sadzakhala sentensi, koma mawonekedwe a moyo. Mutha kukhala ndi matenda ashuga, chinthu chachikulu ndikuchiza thanzi lanu mosamala.

Hyperglycemic Coma Emergency Algorithm

Cholinga chachikulu cha chithandizo cha matenda a shuga ndikukhazikitsa index ya glycemic. Kupatuka kwina kwamtundu wama glucose kuchokera ku nthawi zonse kumakhudza mkhalidwe wa wodwalayo ndipo kumatha kubweretsa zovuta zowopsa.

Kusowa kwa insulin kwakutali m'thupi kumawonjezera chiopsezo cha chikomokere cha hyperglycemic. Vutoli limadzetsa chiwopsezo pamoyo wa wodwalayo, chifukwa nthawi zambiri limayendera limodzi ndi kusazindikira. Ichi ndichifukwa chake ndikofunikira kuti anthu azungulira azindikire zoyamba za vutoli komanso kuchuluka kwa machitidwe kuti athandize odwala.

Hyperglycemic coma imachitika chifukwa cha kuchuluka kwa shuga, komwe kumakhalapo kwa nthawi yayitali.

Tizilombo toyambitsa matenda tomwe timatulutsa chifukwa cha kuperewera kwa insulin komanso kugwiritsa ntchito shuga m'magazi, zomwe zimapangitsa zotsatirazi mthupi:

matupi a ketone amapangidwa,
mafuta a chiwindi amayamba,
lipolysis imalimbikitsidwa chifukwa cha kuchuluka kwa glucagon.

Ketoacidotic. Kukula kwake kumachitika nthawi zambiri mwa odwala omwe amadalira insulin ndipo amathandizidwa ndi kukula kwa matupi a ketone.
Hyperosmolar - amapezeka mwa odwala omwe ali ndi mtundu wachiwiri wa matenda. Mothandizidwa ndi izi, thupi limakhala ndi vuto losowa madzi m'thupi ndipo limatsitsa kwambiri shuga.
Lactic acidosis - chifukwa cha kupweteka kwamtunduwu, kudzikundikira kwa lactic acid m'mwazi kumakhala kukuwonjezereka kwa glycemia.

Kutsimikiza kwa matenda a pathological kumakhala ndi kuwonongeka kwa matenda ashuga, njira zosankhidwa bwino zosagwiritsidwa ntchito mosiyanasiyana kapena kuzindikira matendawo.

Maonekedwe a chikomokere amayambitsidwa ndi izi:

osagwirizana ndi ndondomeko ya jakisoni,
kusiyana pakati pa kuchuluka kwa mankhwala omwe amaperekedwa ndi chakudya
kuphwanya zakudya
kusintha kwa insulin
gwiritsani ntchito mahomoni oundana kapena omwe atha ntchito,
kumwa mankhwala ena (okodzetsa, prednisolone),
mimba
matenda
matenda a kapamba
othandizira opaleshoni
kupsinjika
kuvutika m'maganizo.

Ndikofunikira kumvetsetsa kuti njira iliyonse yotupa yomwe imachitika m'thupi imathandizira kuwonjezeka kwa insulin. Odwala samalingalira izi nthawi zonse poti awerenge kuchuluka kwake, zomwe zimapangitsa kuchepa kwa mahomoni m'thupi.

Ndikofunikira kumvetsetsa komwe nthawi zomwe wodwala amafunikira chisamaliro chofunikira. Chifukwa cha izi, ndikokwanira kudziwa zizindikiro za chikomokere chomwe chachitika chifukwa cha hyperglycemia. Chipatala chomwe chimapezeka ndi zovuta zotere chimasiyana kutengera gawo la kukula kwake.

Pali nthawi ziwiri:

choyambirira
kukomoka.

malaise
kufooka
kufulumira kutopa,
ludzu lalikulu
Khungu lowuma ndi mawonekedwe
kusowa kwa chakudya.

Pokhapokha pakuletsa njira zomwe zalembedwa, chithunzi cha chipatala chikukula, zizindikiro zotsatirazi zimachitika:

kudziwa zolakwika
kupuma kosowa
kusowa kochita kuzungulira zochitika
nsidze zitha kukhala zofewa,
kutsika kwa kuthamanga kwa magazi, komanso kugunda kwamtima,
khungu
kapangidwe ka malo amdima pakamwa.

Chizindikiro chachikulu chomwe chikuwonetsa kukula kwa chikumbumtima chimawerengedwa ngati mulingo wa glycemia. Kufunika kwa chizindikiritso ichi pa nthawi ya kuyeza kumatha kupitilira 20 mmol / L, kufikira zina mwa malo chizindikiro cha 40 mmol / L.

Thandizo loyamba limaphatikizapo izi:

Itanani chithandizo chamankhwala mwadzidzidzi.
Ikani munthuyo mbali imodzi. Mothandizidwa ndi thupilo, chiopsezo cholimbikitsa kusanza mu kupuma, komanso kusunga lilime, chimachepetsedwa.
Mupatseni mpweya wabwino, mumasule wodwalayo zovala zolimba, khazikitsani kolala kapena chovala mpango.
Pimani mulingo wopsinjika ndi wowunika magazi.
Yang'anirani kukoka kwake, ndikujambulira zisonyezo zonse madokotala asanafike.
Valani wodwala ndi bulangeti lofunda ngati akumva kutentha.
Mukamakhalabe ndikumeza kwa munthu kumayenera kuledzera ndi madzi.
Wodwala yemwe amadalira insulin amayenera kupatsidwa jakisoni wa insulin malinga ndi Mlingo woyenera. Ngati munthu angathe kudzipereka yekha, ndiye kuti muyenera kuwongolera kayendetsedwe ka mankhwala. Kupanda kutero, izi ziyenera kuchitidwa ndi wachibale pafupi naye.
Chitani izi kupumira, komanso kutikita kunja kwa mtima ngati kuli kotheka.

Zomwe sizingachitike:

Siyani wodwalayo kuti angomala
kuletsa wodwala panthawi ya jakisoni wa insulin, poganiza kuti izi ndizosakwanira,
kukana chithandizo chamankhwala, ngakhale atakhala kuti ali bwino.

Kuti muthandizire abale ake odwala, ndikofunikira kusiyanitsa kukomoka kwa hypo- ndi hyperglycemic coma. Kupanda kutero, zochita zolakwika sizingangochepetsa zovuta za wodwalayo, komanso zimatha kuyambitsa mavuto ena, mpaka kumwalira.

Pokhala kuti alibe chidaliro chakuti chikomachi chimayamba chifukwa cha kuchuluka kwa shuga, munthu amafunika kupatsidwa madzi otsekemera kuti amwe, ndipo ngati atha kuzindikira, yankho la glucose liyenera kuperekedwa mwachangu. Ngakhale atakhala kuti ali ndi glycemia yayikulu, momwemonso ambulansi isanafike, ichi chikhala chisankho chokhacho.

Mtundu wa kukomoka kwa hyperglycemic ukhoza kutsimikiziridwa pamaziko a kuyesa kwachembere komanso magazi ambiri, komanso urinalysis.

Zizindikiro zasayansi:

kuchuluka kwakukulu kwa glucose ndi lactic acid wambiri,
kupezeka kwa matupi a ketone (mkodzo),
kuchuluka kwa hematocrit ndi hemoglobin, kuwonetsa kuchepa kwamadzi,
kutsitsa milingo ya potaziyamu ndikuonjezera sodium yamagazi.

M'magawo omwe anthu amapeza, kuyezetsa magazi kumagwiritsidwa ntchito popanga shuga pogwiritsa ntchito glucometer. Kutengera ndi zotsatira zake, adotolo amasankha njira zothandizira.

Makanema okhudza kuperewera kwa shuga:

Chizindikiro chodzikonzanso ndi:

kusowa kupuma kapena kugunda,
mtima kumangidwa
khungu lamtambo,
kusowa kwa zochita za ophunzira pamene kuwala kumalowa.

Ndi chizindikiro pamwambapa, simuyenera kudikirira mpaka ambulansi ifike.

Achibale a wodwalayo ayenera kuyamba kudziyimira pawokha malinga ndi malingaliro otsatirawa:

Ikani wodwalayo pamalo olimba.
Tsegulani mwayi wofikira pachifuwa, ndikuumasulani ku zovala.
Sinthirani kumbuyo mutu wa wodwalayo ndi kuyika dzanja lake pamphumi pake, ndikukutambasulira nsagwada yam'munsi patsogolo ndi inayo kuti muwone ngati pakuyenda mlengalenga.
Chotsani zinyalala za chakudya pamlomo wamkamwa (ngati kuli kotheka).

Mukamapuma movutikira, ndikofunikira kukhudza pakamwa pa wodwalayo ndi milomo yake, popeza ndidayikapo chidacho kapena chidutswa choyera. Kenako muyenera kupanga mpweya wambiri, kutseka mphuno ya wodwalayo pasadakhale. Kuchita bwino kwa mchitidwewu kumatsimikiziridwa ndi kukweza kwa chifuwa pakadali pano. Chiwerengero cha kupumira pamphindi chitha kupitirira 18.

Kuchita minofu yamtima yosalunjika, manja ayenera kuyikidwa pambali yachitatu ya sternum ya wodwalayo, yomwe ili kumanzere kwake. Maziko a ndondomekoyi ndi kugwedeza kwamphamvu komwe kumapangidwira msana. Pakadali pano, kusintha kwa nkhope ya sternum mpaka mtunda wa 5 cm mwa akulu ndi 2 cm mwa ana kuyenera kuchitika. Pafupifupi 60 pamphindi.Ndi kuphatikiza kwa izi ndi kupuma kokumba, kupuma konse kumayenera kusinthana ndikudina ka 5 pachifuwa.

Zochitikazo zikuyenera kubwerezedwa mpaka madokotala atafika.

Phunziro la kanema pa kutembenuka mtima:

Pankhani ya ketoacidosis chikomokere, insulin ndiyofunikira (koyamba ndi ndege, kenako ndi dontho la njira yotsetsereka mu glucose solution yoletsa hypoglycemia). Kuphatikiza apo, sodium bicarbonate, glycosides ndi njira zina zimagwiritsidwa ntchito kuchirikiza ntchito ya mtima.
Ndi hyperosmolar chikomokere, kukonzekera kulowetsedwa amadziwitsidwa kuti abwezere madziwo mthupi, insulin imayendetsedwa.
Lactic acidosis imathetsedwa pogwiritsa ntchito antiseptic Methylene Blue, Trisamine, sodium bicarbonate solution, ndi insulin.

Zochita za akatswiri zimadalira mtundu wa chikomokere ndipo zimachitidwa kuchipatala.

Chithandizo cha matenda ashuga chimafuna kuthandizidwa povomerezeka. Kupanda kutero, chiopsezo chokhala ndi zovuta zingapo komanso kuyambika kwa chikomokere kumakulanso.

Ndikotheka kupewa zoterezi mothandizidwa ndi malamulo osavuta:

Tsatirani zakudya ndipo musagwiritse ntchito mafuta ochulukirapo.
Wunikirani glycemia.
Chitani jakisoni wonse wa mankhwala munthawi yake molingana ndi Mlingo wovomerezeka ndi dokotala.
Sanjani mosamala zomwe zimayambitsa zovuta za matenda ashuga kuti musankhe zina zomwe zingayambitse vuto lanu.
Nthawi zambiri amapita kukayezetsa kuchipatala kuti adziwe mtundu wamatendawa (makamaka panthawi yapakati).
Chitani mtundu wina wa insulin kokha kuchipatala komanso moyang'aniridwa ndi dokotala.
Chitani matenda aliwonse opatsirana.

Ndikofunikira kumvetsetsa kuti kudziwa malamulo a othandizira odwala panthawi ya chikomokere ndikofunikira osati kwa wodwala yekha, komanso kwa abale ake. Izi zimapewa zochitika zowopsa.

9. Fotokozerani zamkati zamkati:

- swab wothira madzi ndi 3% hydrogen peroxide solution (0,1% adrenaline solution, 5% aminocaproic acid solution, naphthyzine, etc.) kapena

- hepaticatic sponge (fibrin filimu)

10. Konzani mankhwala:

- 5% aminocaproic acid solution

- 1% vicasol yankho

- 0.025% hadroxon yankho

- 12,5% yankho la dicinone

- 10% yankho la calcium chloride (calcium gluconate)

- 5% yankho la ascorbic acid.

11. Tsatirani malangizo a dokotala.

12. Yang'anani mkhalidwe wa mwana: kuthamanga kwa magazi, kukoka, NPV, ndi zina zambiri.

13. Ngati ndi kotheka, gonekerani kuchipatala ku dipatimenti ya ENT.

Hypoglycemic coma ndi mkhalidwe wodziwika ndi kuchepa kwa shuga wamagazi.

1. Mankhwala osokoneza bongo a insulin.

2. Chakudya choperewera, kulumphira chakudya.

3. Kuchita masewera olimbitsa thupi.

Precoma. Kukhazikika ndikwadzidzidzi: kufooka wamba, kuda nkhawa, kukwiya, njala, thukuta, kulimba, miyendo. Chisokonezo.

Coma Kuwonongeka kwa chikumbumtima, kukokana. Khungu limakhala lotumbululuka, thukuta lolemera. Kamvekedwe ka nsidze ndikwabwinobwino. Mpweya umakhala wamba. Kuthamanga kwa mtima ndikwabwinobwino kapena mwachangu. Kuthamanga kwa magazi ndikwabwinobwino kapena kukwezedwa. Palibe fungo la acetone.

Mafuta a m'magazi ndi otsika. Palibe shuga kapena acetone mkodzo.

Emergency care algorithm.

1. Imbani adotolo kudzera pagulu lachitatu.

2. Gonani pansi, chitetezeni ku kuvulala, ikani kena kofewa pansi pamutu panu, tembenuzirani mutu wanu (chenjezo lakutulutsa lilime).

3. Ngati ndi kotheka, gwiritsani ntchito mpweya, perekani mpweya wabwino, ngati zingatheke, kuthandizira mpweya.

4. Konzani mankhwala:

- 40% yankho la shuga

- 0,5% yankho la diazepam (relanium, seduxen) kapena 20% sodium hydroxybutyrate solution

- 0.1% adrenaline yankho

- 3% prednisolone yankho

5. Tsatirani kuikidwa ndi adotolo.

6. Mutatha kudziwa bwino, mudyetsereni mwana chakudya chamagulu: chakudya choyera, phala, mbatata zosenda, zakudya zina.

7. Yang'anirani mkhalidwe wa mwana: kuthamanga kwa magazi, mapapu, NPV, shuga wamagazi, ndi zina zambiri.

8. Ngati ndi kotheka, pitani kuchipatala.

Hyperglycemic (diabetesic) coma ndi mkhalidwe wodziwika ndi kuchuluka kwa shuga wamagazi, komanso kudziunjikira m'thupi la zinthu za metabolic metabolic (matupi a ketone).

1. Kuzindikira mochedwa matenda a shuga.

2. Musakhale ndi insulin yokwanira.

3. Kuphwanya zakudya (nkhanza), mafuta.

4. Matenda amkati (matenda, kuvulala kwam'mutu komanso kwamthupi, ndi zina).

Precoma. Kukula kwapang'onopang'ono kumachitika pang'onopang'ono masiku angapo: ludzu lochulukirapo, kuchepa kwa chakudya, kuperewera, kufooka, kupweteka mutu, kugona. Kusanza, kusanza, kupweteka kwam'mimba. Kununkhira kwa acetone kuchokera mkamwa. Kuzindikira kwamphamvu, kuyankhula modekha.

Coma Kutaya chikumbumtima. Khungu ndi mucous nembanemba. Kamvekedwe ka mawonekedwe Mpweya wabwino kwambiri, Kussmaul. Kugunda kumachitika pafupipafupi, kudzazidwa kofooka. Kupanikizika kwa magazi kumachepetsedwa. Kuthetsa minofu. Oliguria. Fungo loipa la acetone.

Mulingo wa glucose wamwazi umakwezedwa. Mu mkodzo, shuga ndi acetone zimapezeka.

Emergency care algorithm.

1. Imbani adotolo kudzera pagulu lachitatu.

2. Onetsetsani kuti pakuyenda mpweya wabwino, ngati kungatheke - chithandizo cha okosijeni.

3. Tsitsani m'mimba ndi yankho la 4% ya sodium bicarbonate, kusiya gawo la yankho m'mimba.

4. Pangani enema yotsuka ndi 4% sodium bicarbonate solution.

5. Konzani mankhwala:

-kapangidwe ka insulin pang'ono: actrapid, homorap

- mayankho kulowetsedwa: yankho la 0.9% sodium chloride, yankho la Ringer, 5% shuga, "Chlosol"

6. Tsatirani malangizo a dokotala.

7. Yang'anirani mkhalidwe wa mwana: kuthamanga kwa magazi, mapapu, NPV, shuga wamagazi, ndi zina zambiri.

8. Ngati ndi kotheka, pitani kuchipatala.

Choyamba thandizo la hyperglycemic chikomokere

Hyperglycemic coma ndi vuto lalikulu lomwe limadza chifukwa chosowa kwambiri insulin mthupi mwa odwala matenda a shuga. Pamaso pa matenda otere, wozunzidwayo amafunikira chisamaliro chachipatala komanso kuchipatala. Kodi algorithm yothandizira odwala mwadzidzidzi ndi chiyani? Zomwe zimayambitsa kukhumudwa kwa hyperglycemic coma? Muwerenga za izi komanso zambiri m'nkhani yathu.

Monga momwe zamakono zamankhwala zimasonyezera, kukomoka kwa hyperglycemic kumayamba pang'onopang'ono - kuyambira maola 10-12 mpaka tsiku limodzi. Mosasamala mtundu wamtunduwu wa pathological, komanso kuchuluka kwake, munthu ayenera kupereka chisamaliro chamankhwala chisanachitike. Thandizo loyamba la odwala matenda ashuga ndi awa:

Kusamutsa munthu pamalo opingasa,
Kupereka mpweya wabwino pochotsa zovalazo, kutsegula mawindo ndi zitseko,
Menyani wovulalayo kumbali yake osazindikira kwanthaŵi yayitali, kuti mupewe kukokoloka msanga pakamwa ndi kusanza kapena chifukwa chakulankhula lilime,
Kukhazikitsidwa kwa insulin. Zimawonetsedwa pokhapokha ngati wosamalira amadziwa kuchuluka kwa mankhwalawo, mwachitsanzo, wachibale, mkazi kapena mwamuna,
Kuyang'anira zizindikiro zofunika ndi kukhazikitsidwa kwa buku lopulumutsira buku kuti mubwezeretsenso kupumula ndi kupuma.

Algorithm yankho ladzidzidzi pazizindikiro za hyperglycemic coma, yoperekedwa ndi madokotala a ambulansi, zimatengera mtundu wa matenda a shuga omwe amadziwika.

Zochita ndi ketoacidotic chikomokere:

Jekiseni wosakwiya wosuntha wa insulin,
Drip insulin ndi shuga ya 5% yopewa kuthana ndi vuto la hypoglycemic mobwerezabwereza,
Kuyeretsa matumbo komanso kupukusa kwam'mimba,
Kutsitsa kwa mtsempha wa sodium bicarbonate, saline kubwezeretsa bwino ma electrolyte,
Chithandizo chothandizira pakuwongolera mtima ndi zida zina zamthupi. M'ndime iyi, chithandizo cha okosijeni chimagwiritsidwa ntchito, cocarboxylase, glycosides ndi mankhwala ena amagwiritsidwa ntchito ngati pakufunika.

Zofunika kuchitidwa ndi hyperosmolar coma:

Kukonzekera kwakukulu kwa kulowetsedwa (makamaka njira ya Ringer),
Kugwetsa kulowetsedwa kwa insulin ndi kuyang'anira shuga
Kuwunikira momwe zinthu ziliri asanafike kuchipatala.

Kusamalira mwadzidzidzi lactic acidosis chikom:

Intravenous Trisomine jakisoni
Jakisoni wovunda wa methyl buluu, yomwe imakulolani kuti mumange ma hydrogen ion ambiri,
Paresteral makonzedwe ang'onoang'ono a insulin, sodium bicarbonate, 5% shuga.

Hyperglycemia monga chizindikiritso chachikulu chazachipatala ndi kuwonjezeka kwa shuga m'magazi am'magazi poyerekeza ndi zofunikira. Pali magawo asanu a izi - kuchokera pa mtundu wocheperako wa zam'tsogolo ndikupanga kukula kwamakhalidwe abwino komanso kukomoka palokha.

Choyambitsa chachikulu cha matenda a hyperglycemia, kupanga pafupipafupi, ndiko kupezeka kwa odwala matenda ashuga. Kuperewera kwa insulin kumadzetsa kuwonjezereka kwa kuchuluka kwa shuga mu seramu yamagazi. Njira ina yopangira hyperglycemia ndiko kuphwanya kwadongosolo kwa mgwirizano wa mahomoni ndi minofu ya minyewa.

Zomwe zimayambitsa kawirikawiri matenda a hyperglycemia omwe amapezeka kunja kwa mtundu uliwonse wa matenda a shuga ndi awa:

Zakudya zamagulu onse zomwe sizikudya mokwanira komanso kudya kwambiri komanso kudya zakudya zambiri zopatsa mphamvu.
Kupsinjika Kwakukulu ndi kukhumudwa,
Zoopsa thupi
Ntchito yapadera
Mitundu ikuluikulu ya matenda opatsirana.

Zizindikiro za hyperglycemia ndizosiyanasiyana ndipo zimatengera gawo la kukula kwa matenda. Nthawi zambiri, ngakhale dokotala wodziwa zambiri popanda zotsatira za mayeso a labotale omwe atsimikizira kuchuluka kwakukulu kwa shuga m'magazi, amatha kudziwa zovuta za wodwalayo, mwachilengedwe, ngati wozunzidwayo sakukhalanso ndi vuto.

Zizindikiro za hyperglycemia zimayamba kuonekera pang'onopang'ono. Zizindikiro:

Kukoka pafupipafupi ndi ludzu lalikulu
Kutopa ndi kuzindikira kopepuka
Khungu lowuma komanso zamkamwa zimagwira pakamwa.
Kupuma kwamphamvu
Arrhasmia.

Zizindikiro za hyperglycemic coma:

Kusazindikira
Kukoka kosangalatsa,
Fungo la ma acetone kapena maapulo kuchokera pamkamwa,
Kutentha pang'ono pang'ono kwa thupi,
Kuthamanga kwa magazi
Khungu lotentha komanso lowuma kwambiri.

Monga momwe machitidwe azachipatala amasonyezera, hyperglycemic coma mwa ana amsinkhu uliwonse imakula msanga kuposa achikulire chifukwa chazinthu zofooka zowonjezera kulipira kwa seramu glucose. Nthawi zambiri pamakhala chitukuko cha ketoacidosis wolumikizidwa ndi kuchepa kwamafuta acid metabolism.

Madokotala a ambulansi azitha kudziwa bwino za khanda ndikusankha momwe angagonekere kuchipatala. Popeza simukudziwa, kuperekera wodwalayo kuchipatala chakuchipatala kwakanthawi kofunikira ndikofunikira.

Thandizo lodzidzimutsa la odwala matenda ashuga limaperekedwa pomwepo ndi madokotala azadzidzidzi - Uku ndi kulowetsedwa kwa mayankho, insulin, komanso mankhwala othandizira. Pakupuma kapena palpitations, kutsitsimuka kwathunthu kumachitika mpaka kukhazikikanso kwa makina ofunikira.

Chofunikira kwambiri popewa kukula kwa hyperglycemia mobwerezabwereza mwa ana ndi:

Kuyang'anira mosamalitsa kutsatira malingaliro onse a dotolo,
Malangizo a moyo ndi zakudya,
Mankhwala okhazikika a insulin kapena mapiritsi ochepetsa shuga, makamaka mtundu 1 ndi matenda a shuga 2.

Monga gawo lowunika momwe munthu aliri ndi vuto la hypoglycemic, madongosolo a mayeso a zasayansi amathandizidwanso. Zizindikiro zazikulu:

Mlingo wa glucose. Zoposa 22,5 mmol / l
Kuchepetsa thupi. Oposa 0.5 peresenti masana,
Kuchepa kwa thupi. Zopitilira 4 malita
Nitrogen wotsalira. Zoposa 36 mmol / l,
Hyperbetalipoproteinemia. Pamwamba 8,000 mg / l
Glucosuria. Zoposa 200 t / tsiku,
magazi pH 7.2 ndi pansipa
Zizindikiro zina. Magazi omwe amaphatikiza magazi amathandizidwa kwambiri, metabolid ya lipid imasokonezeka, acetonuria, hyperketonemia imapangidwa. Kukumana kwa ma bicarbonate kumachepa, zomwe zili hemoglobin, leukocytes, ESR zimachulukirachulukira.

Mavuto ambiri omwe amapezeka kukomoka kwa hyperglycemic:

Asphyxia yemwe amayamba kuthyola masanzi kapena lilime lothina kuti munthu asapatsidwe thandizo,
Ma areflexia osakhalitsa, omwe amaphatikizidwa ndi kuwonongeka kwa mitsempha chifukwa cha kukokoloka kwa nthawi yayitali,
Paresis yolimbitsa kapena yakuya (mphamvu yachepera mu gulu la minofu kapena minofu),
Kufa pang'ono kapena kukomoka kwathunthu,
Myocardial infarction ndi ochepa ochepa thrombosis,
Kuwonongeka kwa ntchito zingapo zam'maganizo ndikuwonongeka kwa luso lamalingaliro,
Matenda olimba a metabolic.

Chifukwa chake, njira zoyenera zothandizira kupewa kubwerezanso kwa matendawa zimaphatikizapo kutsatira chithandizo chothandizidwa ndi endocrinologist, poganizira uphungu wa akatswiri ena ofunikira. Zochitika zazikulu:

Kuyang'anira pafupipafupi shuga mu seramu yamagazi pogwiritsa ntchito mita ya shuga m'magazi,
Jakisoni munthawi ya insulin kapena mapiritsi ochepetsa shuga, kutengera mtundu wa matenda ashuga,
Kukonza zakudya ndikupangitsa kuti zigwirizane ndi zoyesedwa ndi katswiri wazakudya,
Zochita zolimbitsa thupi moyenera machitidwe olimbitsa thupi, ochitikira kunyumba,
Kukhazikika kwa miyambo ya circadian ya kugona ndi kudikira pakugawa nthawi yokwanira kupumula,
Kukana zizolowezi zoyipa, makamaka - kumwa mowa,
Zochita zina ngati pakufunika.

Victor Sistemov - katswiri pa 1Travmpunkt

Nkhani yolembedwa ndi C. Best "Nthawi yayitali kwambiri m'mbiri ya kuphunzira za matenda ashuga" m'buku la "Diabetes" (lolemba R. Williamson). Moscow, yosindikiza nyumba "Mankhwala", 1964. (m'chilankhulo choyambirira, bukuli lidasindikizidwa mu 1960).
Elena Yuryevna Lunina Cardiac autonomic neuropathy mu mtundu 2 matenda a shuga, LAP Lambert Academic Publishing - M., 2012. - 176 p.
Perekrest S.V., Shainidze K.Z., Korneva E.A. Kachitidwe ka mitsempha yama orexin. Mapangidwe ndi ntchito, ELBI-SPb - M., 2012. - 80 p.
Rosenfeld E.L., Popova I.A. Glycogen matenda, Mankhwala - M., 2014. - 288 p.
Filatova, M.V. masewera olimbitsa thupi a shuga mellitus / M.V. Filatova. - M.: AST, Sova, 2008 .-- 443 p.

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

Zomwe zimachitika

Pali zifukwa zingapo zoyambitsa kukomoka kwa hyperglycemic, ndipo amagawika m'magulu awiri. Loyamba limaphatikizapo chithandizo chosayenera, kudziwitsidwa kosadziwika kwa matenda a shuga, zolakwika za insulin, kuphwanya zakudya, kugwiritsa ntchito mankhwala otsika mtengo pochiza kapena mankhwala okhala ndi alumali omwe atha omwe samapereka zotsatira zofunika, komanso kufafaniza insulin.

Lachiwiri limaphatikizapo zinthu zotsatirazi ndi matenda:

kupsinjika kwakukulu (kunapezeka kuti pamavutikidwe a shuga wamagazi amawonjezeka kwambiri),
pancreatic necrosis (necrosis ya kapamba, chifukwa chake kupanga kwa insulin kumachepa),
kuvulala kwa kuthekera kwakanthawi ndi njira zopangira opaleshoni,
matenda otupa ndi opatsirana.

Kupezeka kwa vuto la hyperglycemic coma ndikotheka chifukwa cha matenda osokoneza bongo a mtundu uliwonse.

Kusamalira mwadzidzidzi

Aliyense angathe kuyang'anizana ndi vuto ngati kuli kofunikira kupereka chithandizo choyamba asanafike othandizira. Ngati mukukayikira kuti munthu ali ndi vuto la kuchepa kwa magazi, muyenera kuchita izi:

Dziwani ngati pali zamkati (mutha kuchita izi pamitsempha kapena mitsempha. Njira yosavuta yochitira izi ndi khosi kapena dzanja).
Yang'anani zotchinga pakamwa (mwachitsanzo, mano kapena chakudya).
Tembenuzani munthu kumbali yake kuti lilime lisagwere kapena kupewa kuthamangitsidwa chifukwa chakusanza.
Yembekezerani kubwera kwa madotolo, ndipo ngati wodwalayo ali ndi foni abale ake.

Chithandizo cha hyperglycemic chikomokere, mosasamala kanthu zomwe zimayambitsa chinthu chimodzi - insulin.

Mankhwalawa amachitika kuchipatala. Ngati wodwalayo ali wathanzi boma, ndiye kuti mankhwalawo amakhala mu kuperekera kwa insulin komanso muyezo wa ola la shuga. Kuchitira pa nthawi yake kupewa

Ngati wodwalayo ali kale chikomokere, zikutanthauza kuti akufunika chithandizo chamankhwala mwadzidzidzi. Thandizo ili limaphatikizapo zinthu zotsatirazi:

mpweya wochita kupuma, kukhazikika kwa tracheostomy,
Kukhazikitsa kaseti kakodzo,
mankhwala a insulin (omwe amachitika ndi ma insulin achidule),
shuga wamagazi,
kubwezeretsanso kuchuluka kwa kuzungulira magazi mwa kulowetsamo mchere kapena njira ya Ringer (mwachitsanzo, kuchepetsa kuchepa kwa madzi m'thupi),
kukhazikitsidwa kwa njira ya shuga ya 5% pambuyo pakukhazikika kwa shuga m'magazi (kubwezeretsa chilengedwe chamkati),
kubwezeretsanso kwa kutaya kwa ma electrolyte mwa kulowetsedwa,
detoxification (kuchotsa kwa poizoni m'thupi).

Kuphatikiza apo, kuchipatala kangapo patsiku amachita zoyeserera zamagazi ndi zamankhwala amodzi, komanso urinalysis kwa matupi a ketone. Zizindikiro zamitsempha zikatha ndipo munthuyo ayambiranso kudziwa bwino, ndikofunikira kuchita kafukufuku wa ubongo wa CT. Kugwiritsa ntchito, zimatsimikiziridwa ngati pali zotupa zam'magazi mu ubongo.

Nthawi ya kukonzanso kwa munthu aliyense imakhala yosiyana ndipo zimatengera kuopsa kwa vuto la metabolic. Pambuyo pakuwongolera kuchipatala, komwe kumatenga nthawi kuchokera masiku angapo, wodwalayo amasamutsidwa kudipatimenti ya endocrinology.

Pa gawo lotsatira la chithandizo, ndikofunikira kukhazikitsa chomwe chimayambitsa matenda awa. Mungafunike kufunsa akatswiri ena (akatswiri a zamankhwala, opanga maopaleshoni, gastroenterologists) ndi mayeso othandizira (diagnostics a ultrasound).

Mtsogolomo, ntchito ya wodwala ndi dokotala wopezekayo ndikusankha mtundu woyenera wa insulin, womwe ungapangitse shuga kukhala yabwinobwino.

Hyperglycemic chikomacho mwa ana

Hyperglycemic chikomacho ndi vuto lowopsa lomwe limatha kukhalapo odwala matenda ashuga azaka zilizonse, ana nawonso ndi osiyana. Mwa ana, izi nthawi zambiri zimachitika chifukwa cha matenda a shuga 1, omwe amadziwika ndiubwana komanso unyamata.

Mu mwana, komanso munthu wamkulu, kuchuluka kwa shuga m'magazi, kuledzera kwa ubongo kumachitika, ndipo zotsatira zake, kusokonezeka ndi kusazindikira.

Nthawi zambiri, chiwonetsero choyamba cha matenda ashuga ndi chikomero cha hyperglycemic, ndiko kuti, makolo samadziwa za kukhalapo kwa matenda ashuga mwa mwana. Zomwe zimayambitsa ndi zizindikiro za kukomoka kwa hyperglycemic zimakhala chimodzimodzi mu akulu. Ngati chithandizo sichikuperekedwa panthawi yake, moyo wa mwana uli pachiwopsezo.

Ngozi ili poti mwana sangadzifufuze bwinobwino, akukayikira ngati ali ndi vuto lililonse. Udindo mu izi uli kwathunthu ndi makolo, ndikofunikira kuganizira bwino za thanzi la ana. Madokotala amafuna mayeso okonzekera kuchipatala, ngakhale mwana atakhala kuti alibe nkhawa.

Tsoka ilo, matenda ashuga osawoneka akuwopseza ndi vuto lalikulu kwambiri monga hyperglycemic coma. Njira zobwezeretsa mochedwa zomwe zimayambitsidwa mochedwa zimachepetsa kuchuluka kwa zotsatira zabwino.

Zotsatira zake

Tsoka ilo, ngati kupuma kumatenga nthawi yayitali, zotsatira zake zitha kusinthika. Izi makamaka zimakhudza dongosolo lamanjenje. Kuledzera kwa glucose kumatha kusokoneza ubongo. Kuwonongeka kwakumbukidwe, kusokonezeka, ngakhale kutupa kwa minofu ya muubongo. Kuphatikiza apo, popeza kusanza kumatheka nthawi ya chikomokere, kusanza m'mapapu kumatha kuyambitsa chibayo.

Ana omwe adakumana ndi vutoli amathanso kukhala ndi zotsatirazi. Udindo wa makolo ndi madokotala ndi kupewa kuti mavutowa abwererenso.

Kupewa

Mulingo uliwonse ndiwosavuta kupewa kuposa kuchiza. Choyamba, ngati matenda a shuga akhazikitsidwa, ndikofunikira kutsatira mosamalitsa zomwe dokotala wakupatsani. Kutsatira zakudya, kuchita masewera olimbitsa thupi komanso kulondola kwa mankhwalawa kumachepetsa chiopsezo chokhala chikomokere mpaka zero. Muyenera kuwona palokha tsiku lotha ntchito, mankhwala osungira inshuwaransi ndipo osazigwiritsa ntchito tsiku lanu litatha. Sungani mankhwala molingana ndi malo osungira.

Anthu odwala matenda ashuga nawonso amayenera kuwongolera kuchuluka kwa shuga m'magazi kunyumba ndi glucometer, ndipo pakuwonongeka kwa shuga, funsani kwa dokotala panthawi. Ndi kuchuluka kwa shuga m'magazi, mutha kuwonjezera kuchuluka kwa madzimadzi ku malita 2-3, musanapite akatswiri.

Maulendo okhazikitsidwa ndi madokotala amayenera kuchitidwa ndi odwala kamodzi pachaka.

Kwa ana, udindo moyenerera umaperekedwa kwa makolo. Muyenera kusamala ndikusamala thanzi la mwana wanu.

Pomaliza

Tsoka ilo, odwala matenda ashuga ali pachiwopsezo chotenga chikomero cha hyperglycemic.

Kumbukirani kuti chithandizo choyambitsidwa nthawi chimatsimikizira kuti zotsatira zake zikhala bwino komanso kuchira. Nthawi zambiri, madokotala amatha kuthetsa izi ndipo wodwalayo akuchira.

Moyo wowonjezereka umangodalira wodwala. Ndi moyo woyenera, kutsatira malingaliro omwe madokotala anu akuthandizani, mutha kupewa kukomoka kwa hyperglycemic mtsogolo ndikuletsa matenda kuti asayambenso. Moyo wa wodwala wodwala matenda a shuga umadalira wodwalayo, momwe amachitira, kutenga nawo mbali komanso njira yabwino yodziwira chithandizo.

Hypoglycemic chikomokere.

Hypoglycemic coma ndi mkhalidwe wodziwika ndi kuchepa kwa shuga wamagazi.

1. Mankhwala osokoneza bongo a insulin.

2. Chakudya choperewera, kulumphira chakudya.

3. Kuchita masewera olimbitsa thupi.

Precoma. Kukhazikika ndikwadzidzidzi: kufooka wamba, kuda nkhawa, kukwiya, njala, thukuta, kulimba, miyendo. Chisokonezo.

Mafuta a m'magazi ndi otsika. Palibe shuga kapena acetone mkodzo.

Emergency care algorithm.

1. Imbani adotolo kudzera pagulu lachitatu.

2. Gonani pansi, chitetezeni ku kuvulala, ikani kena kofewa pansi pamutu panu, tembenuzirani mutu wanu (chenjezo lakutulutsa lilime).

3. Ngati ndi kotheka, gwiritsani ntchito mpweya, perekani mpweya wabwino, ngati zingatheke, kuthandizira mpweya.

4. Konzani mankhwala:

- 40% yankho la shuga

- 5-10% shuga njira

- 0,5% yankho la diazepam (relanium, seduxen) kapena 20% sodium hydroxybutyrate solution

- 0.1% adrenaline yankho

- 3% yankho la prednisone

5. Tsatirani kuikidwa ndi adotolo.

6. Mutatha kudziwa bwino, mudyetsereni mwana chakudya chamagulu: chakudya choyera, phala, mbatata zosenda, zakudya zina.

7. Yang'anirani mkhalidwe wa mwana: kuthamanga kwa magazi, mapapu, NPV, shuga wamagazi, ndi zina zambiri.

8. Ngati ndi kotheka, pitani kuchipatala.

Hyperglycemic (diabetes) chikomokere.

Hyperglycemic (diabetesic) coma ndi mkhalidwe wodziwika ndi kuchuluka kwa shuga wamagazi, komanso kudziunjikira m'thupi la zinthu za metabolic metabolic (matupi a ketone).

1. Kuzindikira mochedwa matenda a shuga.

2. Musakhale ndi insulin yokwanira.

3. Kuphwanya zakudya (nkhanza), mafuta.

4. Matenda amkati (matenda, kuvulala kwam'mutu komanso kwamthupi, ndi zina).

Mulingo wa glucose wamwazi umakwezedwa. Mu mkodzo, shuga ndi acetone zimapezeka.

Emergency care algorithm.

1. Imbani adotolo kudzera pagulu lachitatu.

2. Onetsetsani kuti pakuyenda mpweya wabwino, ngati kungatheke - chithandizo cha okosijeni.

3. Tsitsani m'mimba ndi yankho la 4% ya sodium bicarbonate, kusiya gawo la yankho m'mimba.

4. Pangani enema yotsuka ndi 4% sodium bicarbonate solution.

5. Konzani mankhwala:

-kapangidwe ka insulin pang'ono: actrapid, homorap

- mayankho kulowetsedwa: yankho la 0.9% sodium chloride, yankho la Ringer, 5% shuga, "Chlosol"

6. Tsatirani malangizo a dokotala.

7. Yang'anirani mkhalidwe wa mwana: kuthamanga kwa magazi, mapapu, NPV, shuga wamagazi, ndi zina zambiri.

8. Ngati ndi kotheka, pitani kuchipatala.

Momwe mungadziwire wina

Kuti mupeze wodwala thandizo loyambirira la hyperglycemia ndi kupulumutsa moyo wake, muyenera kudziwa zomwe zimadziwika ndi izi. Zizindikiro za kukomoka kwa hyperglycemic kumachitika chifukwa chophwanya mzere wama asidi osakanikirana, kupha madzi m'thupi ndi poyizoni wa thupi ndi ma ketones (zinthu zosakhazikika ndi fungo la acetone).

Kukula kwapang'onopang'ono kwa precoma kumasonyezedwa ndi zizindikiro zotsatirazi:

ludzu losaletseka, kamwa yowuma,
kusowa kwa chakudya
nseru, kusanza,
kupweteka kwa peritoneum,
kukodza pafupipafupi
kupweteka mutu kwambiri
kutaya mphamvu
Fungo lamphamvu la acetone mu mpweya wotuluka.
mawu osamveka
kugona, kusasamala, kapena, nkhawa, nkhawa,
wofatsa chikumbumtima.

Zizindikiro zamakhalidwe omwe akubwera:

Khungu lanu, khungu
lilime lofiirira
zovuta kupuma limodzi ndi phokoso
kufooka, kuthamanga,
kutsika kwa magazi,
kuchepetsa kuchuluka kwa mkodzo wotulutsidwa,
kufooketsa kamvekedwe ka minofu,
kusowa kwa zochita za ophunzira pakuwala kowala,
fungo lamphamvu la acetone
kulephera kudziwa.

Zofotokozera za ubwana

Hyperglycemic chikomanda mwa ana chimakula pamene ndende ya glucose ifika 12-14 mmol / L. Posazindikira kuopsa komwe kumawaopseza, nthawi zambiri amakhala ndi vuto lalikulu la kuperewera kwa zakudya, kudya maswiti, misuzi ya zipatso, zakumwa zozizilitsa kukhosi. Chinanso chomwe chimachitika ndi kuchuluka kwa insulini, mwana akapatsidwa mankhwala ozizira omwe amakhala ndi shuga waukulu.

Chisamaliro chodzidzimutsa cha hyperglycemic coma cholinga chake ndikuchepetsa kuchuluka kwa shuga ndi jakisoni wa insulin. Mwanayo apatsidwe zakumwa zotsekemera zochulukirapo mwachikondi. Kudya kuyenera kuchedwetsedwa mpaka shuga atasintha. Iyenera kuyesedwa maola 1.5-2 aliwonse.

Kupewa Matenda Ati A Diabetes

Kukhazikitsa mwamphamvu malangizo azachipatala kumathandizira kuti izi zisakule. Lotsatira:

Muzipima shuga pafupipafupi.
Pewani kuchuluka kwambiri kapena kuchepa kwa insulini m'magazi, kupaka jekeseni panthawi yake.
Tsatirani malamulo a zaumoyo wanu.
Pewani kuchuluka kwambiri.
Mankhwalawa akutenga matenda.
Sinthani mtundu wina wa insulin kokha kuchipatala.

Thandizo loyambirira la hyperglycemia yoyenera ndi nthawi yoyenera imatha kupewa zinthu zomwe zingaike pachiwopsezo cha moyo wa wodwalayo, ndipo vuto lalikulu kwambiri ndi matenda a maganizo.