Hyperosmolar non-ketone coma (Diabetesic hyperosmolar mkhalidwe, Non-ketogenic hyperosmolar coma, Acute hyperosmolar non-acidotic shuga)

Hyperosmolar chikomokere (hyperglycemic, non-ketonemic, non-acidotic) Kodi ndi mtundu wapadera wodwala matenda ashuga, wodziwika ndi kusokonezeka kwakukulu kwa metabolic mu matenda osokoneza bongo omwe amachitika popanda ketoacidosis motsutsana ndi maziko oopsa a hyperglycemia, mpaka 33.0 mmol / l ndi apamwamba. Kuchepa kwa madzi m'thupi, ma exicosis a cellular, hypernatremia, hyperchloremia, azotemia posowa ketonemia ndi ketonuria. Hyperosmolar coma imapanga 5-10% ya mitundu yonse yamasewera a hyperglycemic. Imfa imafika 30-50%.

Hyperosmolar coma nthawi zambiri imayamba kupezeka mwa odwala opitilira zaka 50 motsutsana ndi maziko a NIDDM, omwe amalipiritsa pomwa mankhwala ochepa a mankhwala a sodium kapena mankhwala ochepetsa shuga. Odwala osakwana zaka 40 amakhala ocheperako. Malinga ndi ziwerengero, pafupifupi theka la anthu omwe adayamba kudwala matenda a hyperosmolar adalibe matenda ashuga kale, ndipo mwa 50% ya odwala atachoka ku chikomokere sipafunikanso kuperekanso insulin.

Pathogenesis

Chochititsa chachikulu cha Hyperosmolar diabetesic coma ndi kuchepa madzi m'thupi kumbuyo kwa kuwonjezeka kwa insulin, zomwe zimapangitsa kuti glycemia iwonjezeke. Kukula kwa kuchepa kwa madzi m'thupi ndi hyperosmolarity kumabweretsa:

Kukula kwa hyperosmolar syndrome kumalimbikitsidwa ndi kuchepa kwa magazi kwa magawo osiyanasiyana, kuphatikiza pa opareshoni. Nthawi zina khansa ya mtunduwu ya shuga imayamba kumachitika pakumwa mankhwala okodzetsa, glucocorticoids, immunosuppressants, kuyambitsa milingo yayikulu ya saline, mayankho a hypertonic, mannitol, hemodialysis ndi peritoneal dialysis. Vutoli limakulirakulira ndikuyambitsidwa kwa glucose komanso kudya zakudya zopatsa mphamvu kwambiri.

Sinthani ya Pathogenesis |Zambiri

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

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

• Chithandizo cha matenda osokoneza bongo. Mavuto amayamba chifukwa cha insulin yokwanira. Kuopsa kwa GONC ndikuti zizindikirazi sizimawoneka nthawi yomweyo, ndipo odwala samalabadira zolakwika zovomerezeka zamankhwala.
• Matenda onga. Kuphatikiza kwa ma pathologies ena owopsa kumawonjezera mwayi wa hyperosmolar hyperglycemic non-ketone coma. Zizindikiro zimakhazikika mu odwala opatsirana, komanso pancreatitis yovuta kwambiri, kuvulala, zododometsa, kulowetsedwa kwa myocardial, stroke. Mwa akazi, kutenga pakati ndi nthawi yoopsa.
• Sinthani muzakudya. Zomwe zimayambitsa kupsinjika zingakhale kuchuluka kwa chakudya chamagulu m'zakudya. Nthawi zambiri izi zimachitika pang'onopang'ono ndipo samaziwona ngati kuphwanya chithandizo chamankhwala.
• Kutayika kwamadzi. Kuchepa kwa madzi kumachitika pakudya diuretics, kuwotcha, hypothermia, kusanza, ndi kutsekula m'mimba. Kuphatikiza apo, GONK yakwiyitsidwa ndi dongosolo lomwe silingatheke kuthetsa ludzu (kulephera kusokoneza ntchito ndi kupangitsa kuti madzi athere, kusowa kwa madzi akumwa m'deralo).
• Kumwa mankhwala. Kukhazikika kwa matendawa kumayamba chifukwa chogwiritsa ntchito ma diuretics kapena mankhwala ofewetsa tulo omwe amachotsa madzimadzi m'thupi. Mankhwala "Oopsa" amaphatikizanso corticosteroids, beta-blockers ndi mankhwala ena omwe amaphwanya kulolera kwa glucose.

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

Zizindikiro za kukomoka kwa hyperosmolar

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

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

Mavuto

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

Zizindikiro

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

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

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

Hyperosmolar coma chithandizo

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

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

Zotsogola ndi kupewa

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

Mwina zotheka matenda

Ndi kuchepa kwa glucose komanso kufooka thupi lonse ubongo kapena pulmonary edema imatha kuchitika. Okalamba amakhala ndi matenda a mtima komanso amachepetsa kuthamanga kwa magazi. Zinthu zambiri za potaziyamu m'thupi zitha kuchititsa munthu kufa.

Kuchiza matenda

Chinthu choyamba chomwe chimachitika nthawi ya mankhwalawa ndikuti madzi am'madzi amachotsedwa, kenako osmolarity wamagazi amabwezeretsedwa ndipo mulingo wa glucose umakhazikika.

M'chipatala cha wodwala, ora limodzi, magazi amatengedwa kuti amawunikira masiku angapo. Kawiri pa tsiku, kafukufuku amachitika pa ma ketoni m'mwazi, acid-based state of the body is chehe.

Kuchuluka kwa mkodzo komwe kumachitika pakapita nthawi kumayang'aniridwa mosamala. Madokotala nthawi zonse amayang'ana kuthamanga kwa magazi ndi mtima.

Kuti muchepetse kusowa kwa madzi m'thupi, njira ya 0,45% ya sodium chloride imayendetsedwa (mu maola oyamba kuchipatala 2-3 malita). Imalowa mthupi kudzera mu chikwangwani. Kenako, mavuto okhala ndi vuto la osmotic amalowetsedwa m'magazi ndi kuphatikizira kwa insulin. Mlingo wa insulin suyenera kupitilira magawo khumi ndi asanu. Cholinga cha mankhwalawa ndikusintha mtundu wa glucose mthupi.

Ngati kuchuluka kwa sodium kwambiri, ndiye kuti glucose kapena dextrose solution amagwiritsidwa ntchito m'malo mwa sodium chloride. Komanso, wodwalayo amafunika kupatsidwa madzi ambiri.

Kupewa matenda

Kupewa matendawa ndi:

Kudya wathanzi Kuchepetsa kapena kupatula kwathunthu mu chakudya chamafuta (shuga ndi zinthu zomwe muli). Kuphatikizidwa muzosankha zamasamba, nsomba, nkhuku, timadziti zachilengedwe.
Zochita zolimbitsa thupi. Maphunziro akuthupi, masewera.
Kupimidwa pafupipafupi kwachipatala.
Mtendere wa mumtima. Moyo wopanda kupsinjika.
Luso la okondedwa. Thandizo la panthawi yake.

Kanema wothandiza

Kanema wothandiza wokhudzana ndi chisamaliro chamadwala odwala matenda ashuga:

Hyperosmolar Diabetesic Coma - Matendawa ndi othandizira komanso osamveka. Chifukwa chake, odwala matenda a shuga ayenera kukhala atcheru nthawi zonse. Nthawi zonse muyenera kukumbukira zotsatira zake. Kuphwanya mulingo wamadzi mu thupi sikuyenera kuloledwa.

Muyenera kutsatira mosamalitsa zakudya, kumwa insulin panthawi yake, woyesedwa ndi dotolo mwezi uliwonse, amayenda kwambiri ndikupumira mpweya watsopano pafupipafupi.

Kodi Hyperosmolar coma ndi chiyani?

Matenda amtunduwu ndiophatikizira matenda a shuga, amapezeka kawirikawiri kuposa ketoacidosis chikomokere ndipo amadziwika ndi odwala omwe ali ndi vuto laimpso.

Zomwe zimayambitsa kukhumudwa ndi izi: kusanza kwambiri, kutsegula m'mimba, kugwiritsa ntchito mankhwala osokoneza bongo, kuchepa kwa insulin, kupezeka kwa mawonekedwe owopsa a matenda opatsirana, komanso insulin hormone kukana. Komanso kukomoka kungakhale kuphwanya kwakukulu kwa zakudya, kugwiritsa ntchito njira zothetsera shuga, kugwiritsa ntchito insulin antagonists.

Ndizachilendo kuti diuretics nthawi zambiri imayambitsa kukomoka kwa hyperosmolar mwa anthu athanzi amisinkhu yosiyanasiyana, chifukwa mankhwalawa amakhala ndi vuto la metabolism ya carbohydrate. Pamaso pa cholowa chamtundu wa matenda ashuga, waukulu Mlingo wa okodzetsa chifukwa:

1. kuthamanga kwa metabolic,
2. kulolerana kwa shuga.

Izi zimakhudza kuchuluka kwa kudya kwa glycemia, kuchuluka kwa hemoglobin ya glycated. Nthawi zina, pambuyo okodzetsa, zizindikiritso za matenda a shuga ndi non-ketonemic hyperosmolar coma zimachuluka.

Pali dongosolo lomwe mulingo wa glycemia wokhala ndi chiyembekezo cha matenda a shuga umakhudzidwa kwambiri ndi zaka za munthu, kupezeka kwa matenda osachiritsika, nthawi yodwalitsa. Achinyamata amatha kukhala ndi mavuto azaumoyo patatha zaka 5 atayambanso kukodzetsa, komanso odwala okalamba asanathe chaka chimodzi kapena ziwiri.

Ngati munthu wadwala kale matenda ashuga, vutolo limakulirakulira, zizindikiro za glycemia zidzakulirakulira patatha masiku angapo atayamba kugwiritsa ntchito diuretic.

Kuphatikiza apo, mankhwalawa amakhala ndi vuto loyipa la metabolism yamafuta, kuwonjezera kuchuluka kwa triglycerides ndi cholesterol.

Zoyambitsa Coma

Madokotala akadali otsimikiza za zomwe zimayambitsa matenda ashuga monga hyperosmolar coma.

Chinthu chimodzi chimadziwika kuti chimakhala chifukwa chokhala ndi glucose m'magazi chifukwa choletsa kupanga insulin.

Poyankha izi, glycogenolysis, gluconeogenesis, yomwe imawonjezera malo ogulitsa shuga chifukwa cha kagayidwe kake, imayambitsa. Zotsatira zake ndikuwonjezereka kwa glycemia, kuchuluka kwa osmolarity wamagazi.

Pamene mahomoni m'magazi sikokwanira:

• kukana kwake kumapitirira,
• maselo amthupi samalandira zakudya zofunikira.

Hyperosmolarity ikhoza kulepheretsa kutulutsidwa kwamafuta acids kuchokera ku minofu ya adipose, kuletsa ketogenesis ndi lipolysis. Mwanjira ina, katulutsidwe ka shuga wowonjezera kuchokera m'masitolo amafuta amachepetsedwa. Mchitidwewu ukayamba kuchepa, kuchuluka kwa matupi a ketone omwe amachokera pakusintha mafuta kukhala glucose kumachepetsedwa. Kusakhalapo kapena kukhalapo kwa matupi a ketone kumathandizira kuzindikira mtundu wa chikomokere mu shuga.

Hyperosmolarity imatha kubweretsa kuchuluka kwa cortisol ndi aldosterone ngati thupi lilibe chinyezi. Zotsatira zake, kuchuluka kwa magazi ozungulira kumachepa, hypernatremia imakulanso.

Mtsitsi umayamba chifukwa cha matenda ammimba, omwe amalumikizana ndi minyewa yam'mimba ngati vuto lake ndi vuto:

Magazi osmolality imathandizira kuthana ndi maziko a shuga osakwanira komanso matenda a impso.

Nthawi zambiri, zizindikiro za kukomoka kwa Hyperosmolar zikufanana kwambiri ndi mawonekedwe a hyperglycemia.

Wodwala matenda ashuga amadzimva ludzu lamphamvu, kukamwa kowuma, kufooka kwa minofu, kusweka msanga, azichita kupumira mwachangu, kukodza, komanso kunenepa kwambiri.

Kuchuluka kwa madzi m'thupi ndi chikomokere kwa magazi kumapangitsa kuchepa kwa kutentha kwa thupi, kutsika kwamphamvu kwa magazi, kupitilirabe kuthamanga kwa magazi, chikumbumtima champhamvu, kufooka kwa minofu, kutulutsa kwamaso, khungu.

Zizindikiro zowonjezera zidzakhala:

1. kuchepa kwa ana
2. minofu hypertonicity
3. kusowa kwa tendon Reflex,
4. matenda amisala.

Popita nthawi, polyuria imasinthidwa ndi anuria, zovuta zazikulu zimayamba, zomwe zimaphatikizapo stroke, matenda aimpso, kapamba, venous thrombosis.

Njira zodziwitsa, mankhwala

Ndi vuto la hyperosmolar, madokotala nthawi yomweyo amapaka jekeseni wa glucose, izi ndizofunikira kuyimitsa hypoglycemia, chifukwa zotsatira zakupha chifukwa chakuchepa kwambiri kwa shuga m'magazi kumachitika pafupipafupi kuposa momwe zimakhalira.

Ku chipatala, ECG, kuyezetsa magazi kwa shuga, kuyezetsa kwamwazi wambiri kuti mudziwe kuchuluka kwa triglycerides, potaziyamu, sodium ndi cholesterol yokwanira kumachitika mofulumira. Ndikofunikanso kuyezetsa mkodzo wapakati pa protein, glucose ndi ma ketones, kuyezetsa magazi konse.

Wodwala akakhala kuti ali ndi vuto lililonse, amamuwuza kuti azimufufuzira ndi ma CD ake, X-ray ya kapamba, ndi mayeso ena kuti mavutowo athe.

Aliyense wodwala matenda ashuga, amene ali ndi vuto lodzikakamiza, ayenera kuchita zinthu zingapo zofunika asanagonekere kuchipatala:

• Kubwezeretsa ndikusamalira zikwangwani zofunikira,
• mayankho othamanga,
• Matenda a glycemic,
• Kuthetsa kwamadzi,
• mankhwala a insulin.

Kuti musunge zizindikiritso zofunika, ngati kuli kotheka, chitani mapapo am'kati, kuwunika kuchuluka kwa kuthamanga kwa magazi ndi kuthamanga kwa magazi. Kupanikizika kumachepa, kukhazikika kwa 0,9% sodium chloride solution (1000-2000 ml), njira ya glucose, Dextran (400-500 ml), Reftan (500 ml) pogwiritsa ntchito Norepinephrine, Dopamine ikusonyeza.

Ndi ochepa matenda oopsa, hyperosmolar coma mu shuga mellitus imaperekanso yachilendo kukakamizidwa kwa milingo yopitilira masiku 10-20 mm RT. Art. Pazifukwa izi, ndikofunikira kuyika 1250-2500 mg wa magnesium sulfate, imayendetsedwa kulowetsedwa kapena bolus. Ndi kuwonjezeka pang'ono kwa mavuto, zosaposa 10 ml ya aminophylline zimasonyezedwa. Kukhalapo kwa arrhythmias kumafuna kubwezeretsanso mtima.

Popewa kuvulaza panjira yopita kuchipatala, wodwalayo amayesedwa, chifukwa chaichi, mikwingwirima yapadera imagwiritsidwa ntchito.

Kuthetsa matenda a glycemia - chifukwa chachikulu chokhala ndi matenda a shuga, kugwiritsa ntchito jakisoni wa insulin. Komabe, prehospital siteji iyi ndi yosavomerezeka, timadzi timadzi timatenthedwe timalowa kuchipatala. Mu malo osamalidwa bwino, wodwalayo amatengedwera nthawi yomweyo kuti awunikidwe, atumizidwe ku labotale, pambuyo pa mphindi 15 zotsatira ziyenera kupezeka.

M'chipatala, amayang'anira wodwala, kuwunika:

1. kupuma
2. kukakamiza
3. kutentha kwa thupi
4. kugunda kwa mtima.

Ndikofunikanso kuyendetsa electrocardiogram, kuwunika bwino-elekitirodi yamagetsi. Kutengera ndi kuyesedwa kwa magazi ndi mkodzo, dokotala amapanga chisankho pakusintha zizindikiritso zofunika.

Chifukwa chake thandizo loyipa la odwala matenda ashuga limayang'ana kuthana ndi madzi am'madzi, ndiye kuti, kugwiritsa ntchito njira zamchere zimasonyezedwa, sodium imadziwika ndi kuthekera kosunga madzi m'maselo a thupi.

Mu ora loyamba, amaika 1000-1500 ml ya sodium chloride, mkati mwa maola awiri otsatira, 500-1000 ml ya mankhwalawa amathandizidwa pamitsempha, ndipo pambuyo pake 300-500 ml ya mchere ndi wokwanira. Kudziwa kuchuluka kwa sodium sikovuta; mulingo wake umayang'aniridwa ndi madzi a m'magazi.

Magazi owerengera zamankhwala amwazi amatengedwa kangapo patsiku, kuti adziwe:

• sodium 3-4 zina
• shuga 1 nthawi iliyonse pa ola limodzi,
• ketone matupi 2 pa tsiku,
• acid-base boma katatu patsiku.

Kuyesedwa kwa magazi kumachitika kamodzi pakapita masiku awiri ndi atatu.

Mulingo wa sodium utakwera mpaka kufika pa 165 mEq / l, simungathe kulowa yankho lake lamadzi, munthawi imeneyi njira yofunikira ya glucose ndiyofunikira. Kuphatikiza apo ikani dontho ndi yankho la dextrose.

Ngati kuthanso kwamphamvu kumachitika molondola, izi zimakhala ndi phindu pamlingo wamagetsi wamagetsi komanso kuchuluka kwa glycemia. Chimodzi mwazinthu zofunika, kuphatikiza pa zomwe tafotokozazi, ndi mankhwala a insulin. Polimbana ndi hyperglycemia, insulin yochepa ndiyofunika:

1. zopanga
2. umisiri wamtundu wa anthu.

Komabe, zokonda ziyenera kuperekedwa kwa insulin yachiwiri.

Mankhwalawa, ndikofunikira kukumbukira kuchuluka kwa insulin yosavuta, pamene mahomoni amathandizidwa ndi intravenrate, nthawi yayitali ndi mphindi 60, ndikuwongolera kwa maola 4 mpaka 4. Chifukwa chake, ndibwino kuperekera insulin mwanjira. Kutsika kwa shuga msanga, kuukira kwa hypoglycemia kumachitika ngakhale ndi shuga wovomerezeka.

Matenda a shuga angathetsedwe ndikupereka insulin limodzi ndi sodium, dextrose, kuchuluka kwa kulowetsedwa ndi 0.5-0.1 U / kg / ola. Sizoletsedwa kupangira mahomoni ambiri nthawi yomweyo; mukamagwiritsa ntchito magawo 6-12 a insulin yosavuta, 0,1-0.2 g wa albumin akuwonetsedwa kuti athetse kulowetsedwa kwa insulin.

Pa kulowetsedwa, shuga ya glucose iyenera kuyang'aniridwa mosalekeza kuti zitsimikizire kulondola kwa mlingo. Pazida zokhala ndi matenda ashuga, kutsika kwa shuga kuposa 10m / kg / h ndikoyipa. Mkulu akayamba kuchepa msanga, magazi obwera m'magazi amatsika chimodzimodzi, zomwe zimapangitsa zovuta ku thanzi ndi moyo - matenda a edema. Ana atha kukhala osatetezeka makamaka pankhaniyi.

Ndikovuta kwambiri kulosera momwe wodwala wokalamba angamverere ngakhale atayambira njira yoyenera yodutsira kuchipatala komanso panthawi yomwe akukhalamo. Muzochitika zapamwamba, odwala matenda ashuga amayang'anizana ndi mfundo yoti atatuluka chikomokere cha hyperosmolar, pali choletsa china cha mtima, mapapu a edema. Matenda ambiri a glycemic amakhudza anthu okalamba omwe ali ndi vuto laimpso komanso mtima.

Kanemayo munkhaniyi akukamba za zovuta za matenda ashuga.