Coma matenda ashuga

Matenda a shuga - mkhalidwe womwe umayamba chifukwa cha kusowa kwa insulin mthupi mwa odwala matenda a shuga. Kuperewera kwa insulin kumapangitsa kukulitsa kuchuluka kwa shuga m'magazi ndi "njala" yamatumbo omwe amadalira insulin omwe sangathe kugwiritsa ntchito shuga popanda kutenga insulin. Poyankha "njala" yokhudza thupi m'chiwindi, kaphatikizidwe ka gluconeogenesis) ndi matupi a ketone kuchokera ku acetyl-CoA iyamba - ketosis imayamba, osagwiritsidwa ntchito bwino ndi matupi a ketone komanso kuchuluka kwa acidosis - ketoacidosis. Kudzikundikira kwa zinthu zomwe zimakhala ndi ma oxidised metabolic, makamaka lactate, kumabweretsa kukula kwa lactic acidosis. Nthawi zina, kusokonezeka kwakukulu kwa kagayidwe kachakudya komwe kumayambitsa matenda osokoneza bongo kumayambitsa kukula kwa hyperosmolar coma.

Matenda okhudzana ndi matenda ashuga amatha nthawi yayitali - vuto lalitali kwambiri m'mbiri ya wodwala kukhala mukudwala ndizopitilira zaka makumi anayi.

Zochita Choyamba

Hyperglycemic coma imayamba pang'onopang'ono, kupitilira tsiku limodzi kapena kupitirira apo, wodwalayo amamwa kwambiri, pakadali pano kuchuluka kwa shuga m'magazi kumawonjezeka (pafupipafupi 3.3-5,5 mmol / l) mwa katatu.

Maonekedwe ake amatsogozedwa ndi kupepuka, kusowa kudya, kupweteka mutu, kudzimbidwa kapena kutsegula m'mimba, kusanza, kupweteka kwam'mimba, komanso kusanza nthawi zina.

Ngati mu nthawi yoyamba ya chitukuko cha matenda ashuga sichinayambike munthawi yake, wodwalayo amapita kukakhala kugwada (kukayikira, kuiwala, kugona), khungu lake limakhala lakuda.

Mbali yodziwika bwino ya kupuma ndiyakuti kuwonjezera pakuwonongeka kokwanira, khungu limakhala louma, lotentha kukhudza, kununkhira kwa maapulo kapena acetone kuchokera mkamwa, kugunda kofooka, komanso kuthamanga kwa magazi. Kutentha kwa thupi ndikwabwinobwino kapena kukweza pang'ono. Makatani amaso ndiwofewa kukhudza.

Zochita Choyamba

Wodwalayo akasiya kudziwa, iyenera kuyikidwa kuti isapumuse, ndikuyimbira ambulansi nthawi yomweyo. Pamavuto ndi kusiyanasiyana kwa vuto la kuchepa kwa vuto la hyperglycemic, njira zonse ziyenera kumwedwa. Choyamba, wodwalayo amayenera kuyikidwa bwino, kupewa kutulutsa lilime, kulowa m'malo oyeserera, kenako kuchititsa syndromic mankhwala - kukonza magazi, mtima ndi kulephera kupuma malinga ndi mawonekedwe. Chimodzi mwazonse zothandizira pa chikondwererochi chikuphatikiza kuyambitsa 10-20 ml ya 40% shuga m'mitsempha. Ndi kuperewera kwa hyperglycemic, kuchuluka kwa shuga sikungayambitse kuchepa kwa mphamvu mu ma metabolic, pomwe ndi hypoglycemic coma imatha kupulumutsa moyo wa wodwala. Tiyenera kukumbukira kuti ngakhale ndi shuga wochepa, wodwalayo sadzatulutsa kwambiri mpaka kalekale. Ngati nthawi yokwanira yadutsa wodwala asanapezeke, mawonekedwe ake pakhungu likhala louma kale, lomwe limatha kusokeretsa.

Poledzera pachimake, kutsekeka kwa 40% glucose kumasonyezedwanso m'matumbo a mtima (kupsyinjika kwa ubongo ndi hematoma, ischemic lesion, matenda a ubongo). Mlandu wotsiriza, kukonzekera kwamitsempha ya Lasix (furosemide) kumasonyezedwanso (2-5 ml, ngati palibe kuchepa kwakukulu kwa kuthamanga kwa magazi). Ndikofunikirabe kufotokoza momwe chimakhalira komanso kuchitira ena chithandizo chapadera. Odwala onse omwe ali ndi vuto la etiology yosadziwika amatengedwa kupita kumalo osungirako odwala kwambiri, omwe ali ndi poyizoni - kumeneko, kapena ku dipatimenti ya toxology, ndi kuvulala kwa craniocerebral ku dipatimenti ya neurosuction.

Ketoacidotic chikomaso (bwanji)

Imakhala yoyamba kuchuluka pakati pa zovuta za matenda ashuga. Imfa imafika pa 5-15%. Ichi ndiye chifukwa chachikulu cha imfa mwa ana omwe ali ndi matenda ashuga.

Chifukwa - Kuperewera kwathunthu kapena insulin:

olakwika insulin mankhwala (kuchepa kwa insulin, kuchepetsedwa mlingo osagwiritsidwa ntchito, kugwiritsa ntchito ntchito insulin kukonzekera, kuyendetsa bwino kayendetsedwe kake),

kuphwanya kwamphamvu kwa kadyedwe (kugwiritsa ntchito mafuta osokoneza bongo, mpaka pang'ono - chakudya),

kuchuluka kwakufunika kwa insulini (matenda aliwonse okhathamira, njira zopangira opaleshoni, kuvulala, zochitika zovuta).

Maulalo ofunikira pathogenesis AS ndi izi:

kuphwanya glucose ntchito ndi insulin amadalira minyewa ndi kukula kwa hyperglycemia,

kuchepa madzi m'thupi, hypovolemia, hypoxia ya minofu (kuphatikiza dongosolo lamkati lamanjenje),

mphamvu "yanjala" mu minofu ndi kutsegula kwa ketogenesis,

Momwe amakulira pang'onopang'ono masiku angapo. M'mapangidwe ake, nthawi zonse kumatha kusiyanitsa nyengo yamtundu woyeserera, pamene zizindikiro za matenda a shuga zimatha (ludzu, polyuria, asthenic syndrome, kuchepa thupi) pang'onopang'ono, kuchuluka kwa matenda a ketosis (kununkhira kwa acetone mu mpweya wotuluka, matenda a anorexia, nseru) ndi acidosis (kusanza, kupweteka) m'mimba). Kumbukirani kuti kupweteka kwam'mimba kwambiri kungafanane ndi matenda opaleshoni. Kuwoneka kwa zikumba zotayirira ndikotheka.

Chitsimikiziro chogwirizira pakusintha kwa dziko lokometsetsa kwa amene akumwalira. Pali magawo atatu a AS:

Ndine Art. - kukayikira: chikumbumtima chimasokonezeka, wodwala amakhala phee, amagona mosavuta, koma amatha kuyankha mafunso osafunikira,

Luso Lachiwiri. - Stupor: wodwalayo ali m'tulo tofa nato, momwe amachitira osakwiya mwamphamvu amasungidwa,

Zojambula za III. -Kumangotaya chikumbumtima osagwirizana ndi zoyambitsa.

Maziko a kupsinjika kwa chikumbumtima ndi poizoni wazovuta zamkati zamatenda a metabolic (makamaka ketonemia), komanso ubongo hypoxia.

Zizindikiro zina zamatenda a AS:

Zizindikiro zakuchepa kwa madzi m'thupi (khungu lowuma, mucous nembanemba, kuchepa kwa minofu turgor),

matenda a shuga m'mataya,

Kupuma kwa Kussmaul acidotic (kawirikawiri, kwamtopola, mwakuya) ndikubwezerera kwa metabolic acidosis,

Fungo lamphamvu la acetone mu mpweya wotuluka.

hypotension minofu, kuphatikizapo kukhathamiritsa kwa minofu ya maso, yomwe imawonetsedwa ndikutsatira ma eyeb,

kusintha kwa mtima wamagazi (ochepa ma hypotension, tachycardia, mawu omveka m'mitima, kusokonezeka kwa miyeso),

kusokonezeka kwa minofu yam'mimba, zizindikiro zabwino za kupsinjika kwa peritoneal chifukwa cha zotupa zazing'onoting'ono za peritoneum, kukhumudwitsa kwa ketoacidosis pamitsempha yamitsempha,

Zizindikiro za injini yamafuta oyaka mkati (kusanza "malo a khofi"),

zizindikiro zamitsempha (hyporeflexia, reflexes ya pathological, mkhutu wa craniocerebral innervation, ndi zina).

Zizindikiro zaku Laborator za AS:

Hyperketonemia ndi ketonuria,

electrolyte imbalance: hyponatremia, hypochloremia, maolaola - hyperkalemia (kugawa pakati pa intracellular ndi extracellular potaziyamu mu metabolism acidosis), kenako - hypokalemia,

Hyperazotemia (chifukwa chosokonezeka kusefedwa kwa impso muzochitika za hypovolemia),

hematorenal syndrome (neutrophilic leukocytosis ndi kosunthira kumanzere, proteinuria yaying'ono, silinda -, erythrocyturia).

Iyenera kutsimikiziridwa kuti ketonuria ndi metabolic acidosis amawonedwa ngati mameseji akuluakulu a labotale ya AS.

1. Kugonekedwa kuchipatala.

2. Kutupa kwam'mimba ndi matumbo ndi sodium bicarbonate solution, catheterization la chikhodzodzo.

3. Kuyatsa mwana.

5. Mankhwala a insulin: insulin yochepa (mwachitsanzo, actrapid) imagwiritsidwa ntchito, vial (1 ml = 40 mayunitsi), njira yoyendetsera imalowa.

Magazi a shuga amapezeka ola limodzi.

Mlingo woyamba wa insulin umabayidwa kudzera m'mitsetse ya 0.1-0.2 mayunitsi / kg mu 100 ml ya saline yanyama. Kenako amasinthana ndi iv kukamwa kwa insulin pa mlingo wa mayunitsi a 0-0-0.2 / kg / ola.

Ndi kuchepa kwa shuga m'magazi mpaka 10-11 mmol / l, amasinthira ku intramuscular kapena subcutaneous makonzedwe a insulini pamtengo wa mayunitsi a 0-0-05,5 / kg maola 4 aliwonse ndikusintha pang'onopang'ono kupita ku 4-form.

6. Kulowetsedwa chithandizo mu kuchuluka kwa tsiku lililonse: mpaka 1 g - 1000 ml, zaka 1-5 - 1500, zaka 5-10 - 2000, zaka 10-15 - 2000-3000 ml (pafupifupi 50-150 ml / kg) tsiku). Maola 6 oyambilira, ndikofunikira kulowa 50% ya pafupifupi tsiku lililonse la mankhwala, mu maola 6 otsatira - 25%, m'maola 12 otsala tsiku loyamba la mankhwala - 25%. Zothetsera zimayambitsidwa mwa mawonekedwe ofunda (37).

Mankhwala osankhidwa a kulowetsedwa ndi njira ya isotonic sodium chloride.

Ndi kuchepa kwa shuga m'magazi mpaka 14 mmol / l, amasinthana ndi magwiridwe ena a shuga 5% ndi minyewa yachilengedwe pamiyeso yofanana.

N`zotheka kugwiritsa ntchito mapuloteni (proteinin solution) - popanda hyperazotemia, plasma - 10-20 ml / kg.

7. Malo a Heparin 100-150 / kg pa tsiku / / kapena s.

8. Ma anti-sipekitiramu othandizira.

9. mankhwala a alkaline (4% sodium bicarbonate solution, trisamine) - ndi kuchepa kwa magazi pH mpaka 7.0.

Mlingo wa 4% sodium bicarbonate solution (mu ml) = kulemera (kg) BE 2 (kapena 3) (kapena avareji ya 4 ml / kg).

Njira yoyendetsera ndi iv drip, theka loyamba la mlingo wowerengeka umaperekedwa, ndipo CRR imakonzedwanso.

10. Mankhwala othandizira - glycosides yamtima, okhala ndi hypokalemia - kukonzekera kwa potaziyamu (panangin, 7.5% potaziyamu njira ya 1 ml / kg), mavitamini B, C, KKB, ndi zina zambiri.

11. Zakudya zam'mimba zimaperekedwa mwachangu, wodwalayo akayambanso kudziwa (misuzi ya zipatso ndi mbatata zosenda, chimanga, zakudya, masamba ophika, supu). Mbale zonse zimaphikidwa popanda mafuta.

Hypoglycemic coma -uku ndikuphwanya chikumbumtima chifukwa cha kutsika kwakukulu kapena kuthamanga kwa shuga m'magazi.

Nthawi zambiri, kuzindikira kumatha magazi a glucose akatsika mpaka 1.4-1.7 mmol / L. Ndikofunika kukumbukira kuti odwala omwe ali ndi matenda ashuga, minyewa ya mu ubongo imasinthasintha kukhala hyperglycemia, kotero, zizindikiro za mitsempha ya hypoglycemia zimatha kuwonekera pang'onopang'ono koma kuthamanga kwa glucose.

Kwakukulu chifukwa hypoglycemia - kulakwitsa kwa insulinemia (wofunikira kwambiri) kufikira msinkhu wa glycemia munthawi yanthawi. Zambiri:

kuphwanya zakudya (kulumpha chakudya chapanthawi yake kapena chakudya choperewera mkati mwake),

zolimbitsa thupi zosakonzekera,

chiwindi ndi impso ntchito.

kusanza, zimbudzi zotayirira,

Mkulu pathogenetic factor mu kukula kwa hypoglycemic chikomokere - mphamvu njala ya maselo aubongo. Pafupipafupi mobwerezabwereza, makamaka makamaka mikhalidwe yozama ya hypoglycemic posachedwa imabweretsa kuwonongeka kosasinthika kwa ubongo wama cortex, womwe nthawi zambiri umatha kuwoneka ngati cerebroasthenia ndikuchepetsa luntha.

Mosiyana ndi ketoacidotic, kukomoka kwa hypoglycemic nthawi zambiri kumakula kwambiri, mwadzidzidzi, motsutsana ndi maziko a mkhalidwe wodwala. Zimayambitsidwa pokhapokha nthawi yayifupi yowonetsera dziko la hypoglycemic (nthawi zambiri limakhala ndi glycemia mlingo wa 1.7-2.8 mmol / l).

Mu chithunzi cha chipatala cha matenda a hypoglycemic, zizindikiro za neuroglycopenia (zomwe zimakhudzana ndi kuchepa kwa kuthamanga kwa glucose mkati mwa dongosolo lamanjenje) ndi hypercatecholaminemia (zomwe zimayambitsidwa ndi kuchuluka kwakukondweretsa pamlingo wamahomoni otsutsana ndi mahomoni) zimasiyanitsidwa.

kuchepa kwa thupi ndi luntha,

machitidwe osayenera ndi machitidwe (kulira osagwedezeka, chisangalalo, kukwiya, Autism, negativism),

kusintha kwakanthawi kuchokera kumbali ya masomphenya ("chifunga", kusefukira kwa "ntchentche", diplopia).

Monga lamulo, zizindikiro za neuroglycopenia zikutsogolera.

Pakusowa thandizo pa nthawi yake, chikomokere chimayamba:

masticatory minofu trismus, minofu minofu,

chizindikiro chabwino cha Babinsky,

kamvekedwe kabwino ka diso

Kupsinjika kwa magazi nthawi zambiri kumachulukitsidwa.

Chachikulu njira zasayansi ndi hypoglycemia (pakakhala chizindikiro cha vuto la hypoglycemic posachedwa kutsimikiza kwa glycemia mulingo).

1. Ndi boma la hypoglycemic, tikulimbikitsidwa kuti muthe kutenga mosavuta chakudya cham'mimba (mapiritsi a shuga, msuzi, tiyi wotsekemera) kuchuluka kwa magawo awiri a mkate kapena chakudya wamba. Kuwunikiranso mobwerezabwereza kwa glycemia kumachitika pambuyo pa ola limodzi.

2. Pankhani ya kukomoka kwa hypoglycemic, mankhwala a glucagon-glucagen (IM kapena SC) amaperekedwa pa prehospital gawo: mpaka zaka 10 - 0,5 mg, wamkulu kuposa zaka 10 - 1 mg.

3. M'magulu azachipatala, jakisoni wambiri wa 20% shuga (1 ml = 200 mg) umachitika pa 200 mg / kg. Ngati chikumbumtima sichikabwezeretsedwa, amasinthana ndi iv-dripose solution ya 5-10% ya glucose (50-100 mg mg mu 1 ml, motero) pa mlingo wa 10 mg / kg / min. (mpaka kupumula kwa chikumbumtima ndi / kapena mawonekedwe a glucosuria).

4. M'mavuto akulu, glucocorticoids amalowetsedwa iv. Dexamethasone (pafupifupi tsiku lililonse la 200-500 mcg / kg), lomwe mulibe ntchito ya mineralocorticoid, amawakonda. Kutulutsa mawonekedwe: ma ampoules a 1 ndi 2 ml (4 ndi 8 mg wa dexamethasone, motero).

Etiology ndi pathogenesis

Zomwe zimayambitsa kukula kwa HA mu matenda ashuga ndi matenda ndi mikhalidwe yomwe imayambitsa, kumbali imodzi, kuchepa mphamvu kwa thupi, ndipo, kumbali ina, kumakulitsa kuchepa kwa insulin. Chifukwa chake, kusanza, kutsegula m'mimba ndi matenda opatsirana, pachimake pancreatitis, pachimake cholecystitis, sitiroko, etc., kuchepa kwa magazi, kuwotcha, kugwiritsa ntchito okodzetsa, kuphwanya ndende ntchito ya impso, ndi zina.

Matenda apakati, njira zopangira opaleshoni, kuvulala, ndi kugwiritsa ntchito mankhwala ena (glucocorticoids, catecholamines, mahomoni ogonana, ndi zina zambiri) kumawonjezera kuchepa kwa insulin. Pathogenesis yachitukuko cha HA sichidziwika bwino. Zomwe zimachokera mu hyperglycemia yotchulidwa popanda kusowa kwenikweni kwa insulin sizikudziwika bwino. Sizikudziwikanso chifukwa chomwe glycemia yayitali kwambiri, ikuwonetsa kuchepa kwa insulin, palibe ketoacidosis.

Kuwonjezeka koyamba kwa shuga m'magazi a shuga kwa odwala omwe ali ndi matenda a shuga 2 kungachitike pazifukwa zingapo:

1. Kuthetsa magazi chifukwa cha zifukwa zosiyanasiyana kusanza, kutsegula m'mimba, kutsitsa ludzu mwa okalamba, kumwa Mlingo waukulu wothandiza okodzetsa.
2. Kuchulukitsa kwa shuga m'chiwindi pakubowola kwa shuga komwe kumayambitsidwa ndi matenda amtundu kapena kuperewera kwa mankhwala.
3. Kuchuluka kwachilendo kwa glucose m'thupi pakulowetsedwa kulowetsedwa kwa glucose.

Kuwonjezeka kopita patsogolo kwa kuchuluka kwa shuga m'magazi pakukonzekera kwa hyperosmolar coma akufotokozera zifukwa ziwiri.

Choyamba, kuwonongeka kwa impso kwa odwala omwe ali ndi matenda ashuga, omwe amachititsa kuchepa kwa glucose excretion, amatenga nawo mbali pa izi. Izi zimathandizidwa ndi kuchepa kwokhudzana ndi zaka zakale kusefera, kumakulirakulira chifukwa cha kuchepa kwa madzi m'thupi komanso matenda am'mbuyomu.

Kachiwiri, kawopsedwe wa glucose amatha kutenga gawo lofunikira pakukula kwa hyperglycemia, yomwe imalepheretsa insulin katulutsidwe ndikugwiritsanso ntchito kwa minofu ya glucose. Kuchulukitsa kwa hyperglycemia, kukhala ndi poizoni m'maselo a B, kumalepheretsa katulutsidwe ka insulin, kamene kamapangitsa kuchuluka kwa hyperglycemia, ndipo kotsiriza kumalepheretsanso kubisalira kwa insulin kwambiri.

Mitundu yosiyanasiyana ilipo poyesa kufotokoza kusowa kwa ketoacidosis mwa odwala omwe ali ndi matenda ashuga omwe amayamba ndi hepatitis C. Mmodzi wa iwo amafotokozera izi chifukwa chobisalira mkati mwa insulin odwala omwe ali ndi matenda a shuga a 2, pomwe insulini yoperekedwa mwachindunji imakhala yokwanira kuletsa lipolysis ndi ketogeneis, koma osakwanira pakugwiritsira ntchito kwa shuga.Kuphatikiza apo, gawo lina la izi litha kuseweredwa ndi kupindika kochepa kwamahomoni awiri ofunikira a lipolytic, cortisol ndi kukula kwamafuta (STG).

Kusowa kwa ketoacidosis ndi hyperosmolar coma kumafotokozedwanso ndi kuchuluka kosiyanasiyana kwa insulin ndi glucagon pazomwezi pamwambapa - mahomoni a mbali ina pokhudzana ndi lipolysis ndi ketogeneis. Chifukwa chake, pakukomoka kwa matenda ashuga, kuchuluka kwa glucagon / insulin kumachitika, ndipo ngati GK, insulin / glucagon imapambana, yomwe imalepheretsa kutseguka kwa lipolysis ndi ketogeneis. Ofufuza ambiri apeza kuti hyperosmolarity ndi kuchepa kwa madzi komwe kumayambitsa palokha kumatha kulepheretsa lipolysis ndi ketogeneis.

Kuphatikiza pa hyperglycemia yomwe ikukula pang'onopang'ono, hyperosmolarity ku HA imathandizanso ku hypernatremia, komwe kumachokera komwe kumalumikizidwa ndi hyperproduction yolipira ya aldosterone poyankha kuchepa kwamadzi. Hyperosmolarity ya plasma yamagazi ndi mkulu osmotic diuresis koyambirira magawo a kukhathamiritsa kwa hyperosmolar coma ndizomwe zimayambitsa kukula kwa hypovolemia, kuchepa madzi m'thupi, kugwa kwa mtima komanso kuchepa kwa magazi m'magazi.

Kuchepa kwamphamvu kwa maselo aubongo, kuchepa kwa kuthamanga kwa madzi a m'magazi, kutsika kwamitsempha ndikuwonekera kwa ma membrane omwe amatha kuyambitsa mitsempha imayambitsa chikumbumtima ndi zizindikiro zina zamitsempha. Nthawi zambiri amawonedwa pamatumbo, ma hemorrhages ang'onoang'ono am'munsi mu ubongo amawonedwa ngati chifukwa cha hypernatremia. Chifukwa cha kukula kwa magazi ndi minofu ya thromboplastin yolowa m'magazi, dongosolo la hemostasis limayendetsedwa, ndipo chizolowezi cha thrombosis cham'deralo ndi chofalikira chikukula.

Chithunzi cha chipatala cha GC chimayamba pang'onopang'ono kuposa khansa ya ketoacidotic - kwa masiku angapo ngakhale milungu ingapo.

Zizindikiro za kubwezeretsa kwa DM (ludzu, polyuria, kuchepa thupi) zikuyenda tsiku ndi tsiku, zomwe zimayendera limodzi ndi kufooka kwapafupipafupi, mawonekedwe a minofu "akupiringika", akudutsa tsiku lotsatira kukomoka kwanuko kapena wamba.

Kuyambira m'masiku oyamba matendawa, chikumbumtima chitha kuperewera, kenako, kuchulukirachulukira, zovuta izi zimadziwika ndi kuwonekera kwa kuyerekezera zinthu m'mizere, kutsekemera ndi chikomokere. Kuwonongeka kwa chikumbumtima kumafika pamlingo wa kupuma koyenera pafupifupi 10% ya odwala ndipo zimatengera kukula kwa plasma hyperosmolarity (ndipo, motero, pa ubongo wa hyporratremia wa cerebrospinal).

Mbali ya GK - kukhalapo kwa zizindikiro za minyewa ya polymorphic: kukomoka, kusokonezeka kwa malankhulidwe, paresis ndi ziwalo, nystagmus, zizindikiro za pathological (S. Babinsky, etc.), khosi lolimba. Chizindikiro ichi sichikhala mgulu lomveka bwino la mitsempha ndipo chimawonedwa ngati kuphwanya kwambiri magazi.

Mukamawunika odwala otere, zizindikiro za kuchepa mphamvu kwa madzi m'thupi zimakopa chidwi, makamaka kuposa ndi ketoacidotic chikomokere: khungu louma ndi mucous nembanemba, kukulitsa nkhope, kutsika toni yamaso, khungu turgor, kamvekedwe ka minofu. Kuyankha kumachitika pafupipafupi, koma osaya ndi fungo ndiye ma acetone mumlengalenga wopumira. Kugunda kumachitika pafupipafupi, kocheperako, nthawi zambiri ngati ulusi.

Kupsinjika kwa magazi kumachepetsedwa kwambiri. Nthawi zambiri komanso kale kuposa ndi ketoacidosis, anuria imachitika. Nthawi zambiri pamakhala kutentha kwambiri kwa chiyambi. Kusokonezeka kwamagazi chifukwa chamatenda am'mimba kumapangitsa kuti pakhale chidwi cha kusokonekera kwa magazi.

Zizindikiro

Kuzindikira matenda oopsa a hyperosmolar kunyumba ndikovuta, koma ndizotheka kuyerekeza kuti wodwala ali ndi matenda osokoneza bongo, makamaka ngati vuto lomwe lakhazikitsidwa ndi njira iliyonse yomwe idayambitsa kuperewera kwa thupi. Zachidziwikire, chithunzithunzi cha zamankhwala chokhala ndi mawonekedwe ake ndizomwe zimayambitsa matenda a hepatitis C, koma zambiri zowunika zamankhwala zimagwiritsa ntchito ngati chitsimikiziro cha matenda.

Monga lamulo, kusiyanitsa mitundu ya HA kumachitika ndi mitundu ina ya hyperglycemic chikomokere, komanso kusokonezeka kwakukulu kwa kufalitsa kwamkati, matenda obwera ndi ubongo, ndi zina zambiri.

Kuzindikiritsa kwa hyperosmolar coma kumatsimikiziridwa ndi kuchuluka kwambiri kwa glycemia (nthawi zambiri pamakhala 40 mmol / l), hypernatremia, hyperchloremia, hyperazotemia, Zizindikiro zakukula kwa magazi - polyglobulia, erythrocytosis, leukocytosis, hematocrit okwera, komanso mphamvu ya plmma yolimba kwambiri. -295 mOsmol / l.

Kuwonongeka kwa chikumbumtima pakusowa kuwonjezeka komvekera kopanda plasma osmolarity ndizokayikitsa makamaka pokhudzana ndi matenda a ubongo. Chizindikiritso chofunikira kwambiri chachipatala cha HA ndi kusowa kwa fungo la acetone mu mpweya wotulutsidwa komanso kupuma kwa Kussmaul.

Komabe, ngati wodwalayo akhala m'chipatala masiku atatu, zizindikiro za lactic acidosis zitha kujowina ndipo kupuma kwa Kussmaul kumatha kupezeka, komanso nthawi ya kafukufuku acid-base mamiriro (KHS) - acidosis yoyambitsidwa ndi kuchuluka kwa lactic acid m'magazi.

Mankhwala a GC ali munjira zambiri zofanana ndi mankhwala a ketoacidotic coma, ngakhale ali ndi mawonekedwe ake ndipo ali ndi cholinga chothana ndi kuchepa madzi m'thupi, kuthana ndi manjenje, kusintha kwa electrolyte komanso acid-base usawa (munthawi ya lactic acidosis), komanso kuthetseratu magazi a hyperosmolarity.

Kugwiritsira ntchito hospitalization kwa odwala omwe ali ndi vuto la hyperosmolar coma kumachitika mu chipinda chothandizira kwambiri. Pachipatala, kuchiritsa kwa m'mimba kumachitidwa, catheter wamkodzo amayikiridwa, mankhwala a oxygen akupangidwa.

Mndandanda wazotsatira zoyeserera zasayansi, kuphatikiza pazomwe zimavomerezeka, zimaphatikizapo kutsimikiza kwa glycemia, potaziyamu, sodium, urea, creatinine, CSR, lactate, matupi a ketone, ndi plasma osmolarity.

Kuthanso madzi m'thupi la HA kumachitika m'njira yayikulu kuposa momwe amachotseredwa ku ketoacidotic chikomokere (kuchuluka kwa madzi obayira kumafikira malita 6-10 patsiku). Mu ola la 1, 1-1.5 L yamadzimadzi imalowetsedwa m'mitsempha, mu ora la 2-3 - 0,5-1 L, maola otsatirawa - 300-500 ml.

Kusankhidwa kwa yankho kumalimbikitsidwa potengera zomwe zili sodium m'magazi. Pa mulingo wama sodium woposa 165 meq / l, kukhazikitsidwa kwa njira zamchere kumapangidwira ndipo kuthanso kwamadzi kumayamba ndi 2% shuga. Pa mulingo wa sodium wa 145-165 meq / l, kuthanso magazi kumachitika ndi njira ya 0.45% (hypotonic) sodium chloride.

Kuthanso madziwumwini kumayambitsa kutsika kwamphamvu kwa glycemia chifukwa cha kuchepa kwa magazi, ndikuyang'anira kukhudzika kwakukulu kwa insulin yamtunduwu wa chikomokere, kuyendetsedwa kwake kwa intravenous kumachitika mu milingo yocheperako (pafupifupi magawo awiri a insulin yomwe ingachitike mwachidule "mu kulowetsa" kwa ola limodzi). Kuchepetsa glycemia ndi oposa 5.5 mmol / L, ndi osmolarity wa plasma woposa 10 mOsmol / L pa ola limodzi kumawopseza kukula kwa pulmonary edema ndi ubongo.

Ngati atatha maola 4-5 kuchokera poyambira kukonzanso madzi m'thupi, kuchuluka kwa sodium kumachepa, ndipo hyperglycemia imapitirira, kukonzekera kwa ora kwa insulin panthawi ya magawo a 6 - 6 ndi mankhwala (monga ketoacidotic chikomokere). Ndi kuchepa kwa glycemia pansipa 13.5 mmol / l, mlingo wa insulin womwe umayendetsedwa umachepetsedwa ndi theka ndipo umakhala pafupifupi magawo a 3-5 maola ola lililonse. Posunga glycemia pamlingo wa 11-13 mmol / l, kusowa kwa acidosis ya etiology iliyonse ndikuchotsa madzi am'mimba, wodwalayo amapatsidwa gawo la subulinaneous la insulin yemweyo muyezo ndi gawo la maola 2-3 kutengera mlingo wa glycemia.

Kubwezeretsanso kwa potaziyamu kumayambira mwina nthawi yomweyo atazindikira kuti ndi otsika kwambiri m'magazi ndikugwira impso, kapena maola awiri atayamba kulowetsedwa. Mlingo wa potaziyamu kutumikiridwa zimatengera zomwe zili m'magazi. Chifukwa chake, potaziyamu m'munsimu 3 mmol / L, 3 g wa potaziyamu mankhwala enaake (owuma) amapaka jekeseni ola limodzi, pamlingo wa potaziyamu wa 3-4 mmol / L - 2 g wa potaziyamu calcium, 4-5 mmol / L - 1 g wa potaziyamu potaziyamu. Ndi potaziyamu pamwamba pa 5 mmol / L, kukhazikitsidwa kwa yankho la potaziyamu mankhwala enaakewa.

Kuphatikiza pa zomwe zalembedwazo, kuwongolera kugwa kumachitika, mankhwala othandizira amachitidwa, ndipo ndi cholinga chopewa thrombosis, heparin imayikidwa pa 5000 IU intravenous 2 kawiri patsiku motsogozedwa ndi dongosolo la heestasis.

Kugona kwakanthawi kachipatala, kuzindikira koyambirira komwe kunayambitsa kukula, ndipo motero kuchotsedwa kwake, komanso chithandizo cha matenda amtunduwu, ndizothandiza kwambiri pakuchiza matenda a chiwindi C.

Anthu odwala matenda ashuga hypoglycemic

Hypoglycemic coma ndi chikomokere cha matenda ashuga chomwe chimayamba chifukwa cha kutsika kwa shuga m'magazi ("shuga") pansipa.

Komabe, mwa odwala omwe ali ndi glycemia wambiri, kuchepa kwa chikumbumtima kumatha kuchitika ndi kuchuluka kwambiri.

• insulin yambiri ndi yomwe imapangitsa kwambiri
• mankhwala osokoneza bongo ochepetsa shuga,
• kusintha kwa moyo (kuchita masewera olimbitsa thupi, kufa ndi njala) popanda kusintha njira yolandirira insulin,
• kuledzera
• matenda owopsa komanso kuchulukitsa kwa matenda,
• mimba ndi mkaka wa m`mawere.

Ndi kuchepa kwa shuga m'magazi pansi pazovuta, kuchuluka kwa mphamvu ya mpweya ndi mpweya wa ubongo kumachitika. Kukhudza mbali zosiyanasiyana za ubongo, kumayambitsa zizindikiro zomwe zikugwirizana.

Mkhalidwe wa hypoglycemic umayamba ndi kufooka, thukuta, chizungulire, kupweteka mutu, manja akunjenjemera. Njala yayikulu ikuwoneka. Kenako machitidwe osayenera ajowina, pakhoza kukhala achiwawa, munthu sangathe kukhazikika. Kuwona ndi kuyankhula kumakulirakulira. Pakapita nthawi, khunyu limodzi ndi kusazindikira limayamba, kumangidwa kwa mtima ndi kupuma ndizotheka.

Zizindikiro zimawonjezeka mofulumira, mkati mwa mphindi. Ndikofunika kuthandizanso wodwalayo panthawi yake, kupewa kuthawa kwanthawi yayitali.

A shuga a Hyperglycemic Coma

Ndi chikomero cha hyperglycemic, misempha ya m'magazi imakwezedwa. Mitundu itatu ya chikomokere chakumaso chimadziwika:

1. Matenda a shuga a ketoacidotic.
2. Matenda a matenda ashuga hyperosmolar.
3. Anthu odwala matenda ashuga lactacidemic chikomokere.

Tiyeni tizingokhalira kuphunzira mwatsatanetsatane.

Matenda a shuga a ketoacidotic

Matenda a shuga a ketoacidotic amayamba ndi matenda ashuga ketoacidosis (DKA). DKA ndi mkhalidwe womwe umayendera limodzi ndi kuwonjezeka kowopsa m'magazi a glucose ndi matupi a ketone ndi mawonekedwe awo mkodzo. DKA imayamba chifukwa cha kusowa kwa insulin pazifukwa zosiyanasiyana.

• insulin yokwanira kwa odwala (anaiwala, kusakaniza mlingo, cholembera chasweka, etc.),
• matenda owopsa, chithandizo cha opaleshoni,
• kuyamba kwa matenda ashuga amtundu 1 (munthu sakudziwa za kufunika kwa insulini),
• mimba
• kumwa mankhwala omwe amalimbikitsa shuga.

Chifukwa chosowa insulini, timadzi timene timathandiza kuyamwa glucose, maselo amthupi "amakhala ndi njala". Izi zimayambitsa chiwindi. Imayamba kupanga shuga m'misika yama glycogen. Chifukwa chake, mulingo wa shuga m'magazi umakwera kwambiri. Panthawi imeneyi, impso zimayesetsa kuchotsa shuga wambiri mkodzo, potulutsa madzi ambiri. Pamodzi ndi amadzimadzi, potaziyamu yofunika kotero amachotsedwa m'thupi.

Kumbali inayo, pazinthu zopanda mphamvu, kuwonongeka kwa mafuta kumayendetsedwa, komwe matupi a ketone amapanga.

Zizindikiro zake

Ketoacidosis imakula pang'onopang'ono masiku angapo.

Pa gawo loyamba, kuchuluka kwa shuga m'magazi kumakwera mpaka 20 mmol / L ndi kukwera. Izi zimaphatikizidwa ndi ludzu lalikulu, chimbudzi cha mkodzo wambiri, kamwa yowuma, ndi kufooka. Kupweteka kwam'mimba, nseru, fungo la acetone kuchokera mkamwa.

M'tsogolo, mseru ndi m'mimba zimawonjezeka, kusanza kumawonekera, ndipo kuchuluka kwa mkodzo kumachepa. Wodwalayo ndi woopsa, wowopsa, kupuma kwambiri, komanso fungo loopsa la acetone mkamwa mwake. Kutsegula m'mimba, kupweteka komanso kusweka mtima, kutsitsa magazi.

Pakapita nthawi, chikomokere chimayamba kugwa chikumbumtima, kupuma kwamphamvu komanso kugwira ntchito kwa ziwalo zonse.

Matenda a matenda ashuga hyperosmolar

Diabetesic hyperosmolar coma (DHA) ndi chikomokere chomwe chatukuka kwambiri chifukwa cha kutayika kwambiri kwamadzi ndi thupi, ndikumasulidwa kwa matupi ochepa a ketone kapena popanda iwo.

• vuto limodzi ndi kutayika kwamadzi ambiri (kusanza, kutsegula m'mimba, magazi, kuyaka),
• matenda owopsa
• matenda akulu (myocardial infarction, pachimake kapamba, pulmonary embolism, thyrotooticosis,
• kumwa mankhwala (ma diuretics, ma adrenal mahomoni),
• kutentha kapena kutuluka kwa dzuwa.

Ndi kuwonjezeka kwa shuga m'magazi kukhala ambiri (oposa 35 mmol / L, nthawi zina mpaka 60 mmol / L), kutulutsa kwake mkodzo kumayendetsedwa. Modabwitsa kuchuluka kwa diuresis limodzi ndi kutayika kwakukulu kwamadzimadzi kuchokera munjira ya m'mimba (kutsegula m'mimba, kuwotcha, ndi zina) kumayambitsa magazi ndikusokonekera kwa maselo ochokera mkati, kuphatikiza maselo aubongo.

DHA nthawi zambiri imayamba mwa achikulire omwe ali ndi matenda ashuga a 2. Zizindikiro zimachitika pang'onopang'ono masiku angapo.

Chifukwa cha kuchuluka kwa shuga m'magazi, ludzu, kukodza kwambiri, khungu louma komanso kufooka kumawonekera. Kugunda kwamwadzidzidzi ndi kupuma komwe, kuthamanga kwa magazi kumachepa. Mtsogolomo, zovuta zamitsempha zimayamba: chisangalalo, chomwe chimasinthidwa ndi kugona, kuyerekezera zinthu, kukhumudwa, kuwonongeka kwa mawonekedwe, komanso m'malo ovuta kwambiri - chikomokere. Kupuma kwamphamvu, ngati ku DKA, ayi.

Anthu odwala matenda ashuga lactacidemic chikomokere

Diabetesic lactacidemic coma (DLC) ndi chikomokere chomwe chimayamba pakalibe mpweya m'matimu, limodzi ndi kuwonjezeka kwa lactic acid (lactate) m'magazi.

• Matenda omwe amaphatikizidwa ndi kuchepa kwa mpweya wa minofu ya minofu (kulowerera m'mitsempha, kufooka kwa mtima, matenda am'mapapo, kulephera kwaimpso, ndi zina zambiri).
• Leukemia, magawo apamwamba a khansa.
• Mowa.
• Poizoni ndi ziphe, zakumwa zoledzeretsa.
• Kutenga metformin mu waukulu Mlingo.

Ndi njala ya okosijeni, ochulukirapo wa lactic acid amapangidwa minofu. Kupha poizoni ndi lactate kumayamba, komwe kumasokoneza kugwira ntchito kwa minofu, mtima ndi mitsempha ya magazi, komwe kumakhudza kuperekedwa kwa mitsempha.

DLK imakula msanga, patangopita maola ochepa. Zimaphatikizidwa ndi kuwonjezeka kwa shuga wamagazi kumagulu ang'onoang'ono (mpaka 15-16 mmol / l).

DLK imayamba ndikumva kupweteka kwambiri minofu ndi mtima zomwe sizingathetsedwenso ndi ma pinkiller, nseru, kusanza, kutsekula m'mimba, ndi kufooka. Kugwedezeka kumachitika mwachangu, kuthamanga kwa magazi kumachepa, kupuma pang'ono kumawonekera, komwe kumatsitsidwa ndi kupuma kwamphamvu. Chikumbumtima chasweka, kukomoka kumayamba.

Chithandizo cha matenda ashuga

Pochita, zochitika ziwiri zotsutsana ndizachilendo - hypoglycemia ndi matenda ashuga ketoacidosis. Kuti muthandize bwino munthu, muyenera kumvetsetsa zomwe tikukumana nazo pakadali pano.

Thandizo Loyamba la Matenda A shuga

Zizindikiro za matendawa zikawoneka, wodwalayo ayenera kudya zakudya zopatsa mphamvu zamafuta (4-5 zidutswa za shuga, maswiti awiri a 2 ndi kumwa 200 ml ya madzi).
Ngati izi sizithandiza, kapena munthuyo ali ndi vuto la hyperglycemic, muyenera kuyimbira foni gulu la ambulansi nthawi yomweyo. Madokotala azithandiza mwadzidzidzi.

Diabetesic Coma Emergency Algorithm

1. Hypoglycemic coma:

• 40-100 ml ya glucose 40% yankho limayendetsedwa kudzera m'mitsempha
• kapena 1 ml ya glucagon solution.

• intramuscularly - 20 magawo a insulin yochepa,
• kudzera m`mitsempha - 1 lita imodzi ya mchere.

• 1 lita imodzi ya mchere imayendetsedwa kudzera mu ola limodzi.

• Kukhazikitsidwa kwa mchere wamkati kumayambira.

Pambuyo pa chisamaliro chodzidzimutsa, gulu la ambulansi la odwala limaperekedwa kuchipatala, komwe amapitiliza chithandizo ku dipatimenti yosamalira odwala komanso kuyambiranso.

Ndi chifuwa cha hypoglycemic kuchipatala, kukhazikika kwa shuga kumapitirirabe mpaka chizindikiritso chitha.
Ndi chifuwa cha hyperglycemic, njira zosiyanasiyana zimachitidwa:

• Insulin yogwira ntchito mwachidule imayendetsedwa kudzera m'mitsempha.
• Voliyumu yamadzimadzi yotayika ndi thupi imapangidwanso.
• Kulimbana kumachitika chifukwa chomwe chimayambitsa kukomoka.
• Miyezo ya potaziyamu, sodium, chlorine imakhala yofanana.
• Njala ya oxygen imathetsedwa.
• Ntchito zamkati ndi ubongo zimabwezeretseka.

Zotsatira za hyperglycemic com

Hyperglycemic coma imadziwika ndi ambiri omwe amafa. Amafika:

• ndi ketoacidotic chikomokere - 5-15%,
• ndi Hyperosmolar chikomokere - mpaka 50%,
• ndi lactacidemic chikomokere - 50-90%.

Kupanda kutero, zotsatirazi zikufanana ndi omwe ali ndi chikomokere.

Kodi chikomokere ndi chiyani?

Mwambiri, chikomokere ndi vuto lalikulu lomwe likukula, lomwe limatsagana ndi kuponderezana kwa ntchito zazikulu zonse. Kuchepa mphamvu kwa mphamvu yamkati yamanjenje kumaonekera mwa kutaya chikumbumtima, zimachitika pakukhudzika kwakunja, kuwonekera. Palinso kupsinjika kwa kupuma, kuchepa kwakukulu kwa kuchuluka kwake kumadziwika. Wodwalayo sangathe kupuma yekha, madokotala amalumikiza ndi mpweya wabwino. Kuchepa kwa mphamvu yamtima wama mtima kumawonekera ndikuchepa kwa kuthamanga kwa mtima komanso kutsika kwa magazi. Kuti athetse vutoli, madokotala amayamba kugwiritsa ntchito mankhwala omwe amapangitsa kuthamanga kwa magazi ndikukhala manambala wamba. Palinso kuchepa kwa kuwongolera kukodza, kayendedwe ka matumbo. Popanda chithandizo cha panthawi yake, wodwala wotere amamwalira.

Hypoglycemic chikomokere

Zimachitika ndi kuponya magazi msanga. Anthu odwala matenda ashuga omwe akudziwa zambiri, makamaka kwa odwala omwe ali ndi vuto la matenda ashuga 1, ndizovuta kwambiri kulolera shuga wamagazi pang'ono kuposa mkulu. Pamaso kupuma, wodwalayo nthawi zambiri amakhala ndi vuto la hypoglycemia - amakhala ndi njala, kufooka, chizungulire. Zomwe zimayambitsa matenda a hypoglycemic ndi awa:

• Wodwalayo adapanga jakisoni wa insulin, koma alibe nthawi yakudya.
• Wodwalayo adachita masewera olimbitsa thupi, ndipo sanadye kwa nthawi yayitali.
• Wodwala amatchulidwa kwambiri Mlingo wa hypoglycemic wothandizira.

Ndikosavuta kuthandiza munthu wodwala matenda ashuga yemwe akukumana ndi vuto la hypoglycemic - amafunika kupatsidwa mtundu wina wa zopatsa mphamvu monga tiyi wotsekemera, chidutswa cha shuga kapena buledi. Wokayika ngati wodwalayo sakudziwika, wodwalayo amapaka jekeseni wothandizirana ndi shuga ndipo nthawi yomweyo amaperekedwa kuchipatala.

Hyperosmolar, lactic acidosis chikomaso ndizochepa. Amakonda kwambiri odwala omwe ali ndi matenda ashuga a 2.

Coma mu matenda ashuga ndi vuto lalikulu kwambiri. Pofuna kutaya wodwala matenda ashuga, ndikofunikira kuyimba ambulansi posachedwa.

Kodi matenda ndi chiyani?

Choyambirira, ndikofunikira kudziwa kuti chomwe chimakhala ndi shuga ndi chiyani. Monga mukudziwa, ntchito yamakina onse a ziwalo (makamaka ubongo) imalumikizidwa ndi kusinthana kwa glucose, komwe ndi mphamvu yama cell. Thupi la odwala matenda ashuga amakonda kusinthasintha kwa shuga m'magazi. Ndipo munkhaniyi tikulankhula za kuwonjezeka kwambiri komanso kuchepa kwamphamvu kwa shuga. Kusintha koteroko kuli ndi zovuta zoyipa kwambiri. Ndipo nthawi zina, odwala amakumana ndi vuto ngati shuga chikomokere.

Mpaka pano, pali mitundu inayi yayikulu ya chikomokere yomwe imayenderana ndi matenda a shuga. Fomu iliyonse ili ndi mawonekedwe ake, omwe muyenera kudziwa.

Hyperlactacidemic chikom: mawonekedwe ndi zotsatira zake

Mtundu uwu wamtundu umawonedwa ndi hypoxia (kufa ndi mpweya wa okosijeni), popanga maziko a kuchepa kwa insulin. Zikatero, mankhwalawo amaphatikizidwa ndi kudzikundikira kwa lactic acid, komwe kumapangitsa kuti magazi asinthe. Zotsatira zake ndizakuchepa kwa ziwiya zotumphukira, kusokonekera kwa mgwirizano ndi kusangalala kwa myocardium.

Nthawi zambiri, mtundu uwu wa chikomokere matenda a shuga umagwirizanitsidwa ndi kulephera kwa mtima ndi kupuma, njira zotupa, ndi matenda. Zowopsa zake zimaphatikizira matenda a chiwindi ndi impso, uchidakwa.

Hyperosmolar coma ndi zomwe zimayambitsa

Mtundu wamtunduwu umalumikizidwa ndi kuchepa mphamvu kwa thupi, chifukwa chomwe osmolarity pamagazi amasintha. Palinso kuwonjezeka kwa glucose, urea ndi sodium ion. Pathology imayamba pang'onopang'ono - masiku angapo kapena masabata amatha kutha pakati pa kuyamba kwa chizindikiritso choyambirira ndikusazindikira.

Chiwopsezo chokhala ndi kukomoka kwa hyperosmolar kumakulanso ndi kulephera kwa aimpso, kuvulala, kupsa mtima, magazi, ndi mikwingwirima. Zomwe zimayambitsa ngozi zimaphatikizapo thupi lawo siligwirizana, dzuwa komanso kutentha kwa sitiroko, matenda opatsirana.

Kuthetsa madzi m'thupi nthawi zina kumachitika chifukwa chogwiritsa ntchito magazi mosaletseka, kusanza kwambiri, kapena kutsegula m'mimba nthawi yayitali. Zifukwa zake zimaphatikizidwa ndi boma losamwa moyenera, okhala kumadera omwe kumatentha kwambiri.

Zizindikiro za chikomokere

Zizindikiro zoyambirira zikuphatikiza kugona komanso kufooka kwambiri, komwe kumayamba kukula. Chifukwa cha kusowa kwamadzi, wodwalayo amadwala ludzu. Khungu ndi minyewa yam'mimba imakhala youma, kuchuluka kwa mkodzo wa tsiku ndi tsiku kumachepetsedwa.

M'tsogolomu, ma mitsempha osiyanasiyana a mitsempha amawonekera. Nthawi zina kukomoka komanso kuyamwa kumawonedwa. Mutha kuwona kusintha kwakanthawi kothina kwamaso.

Pathogenesis ndi zizindikiro za hypoglycemia

Poyerekeza ndi kutsika kwa kuchepa kwa shuga kufika pa 2.77-1.66 mmol / l, zizindikiro zamakhalidwe zimayamba kuonekera. Munthu amazindikira kuchuluka kwa njala. Thupi limanjenjemera, khungu limakhala lofiirira.

Pali kuchepa kwa ntchito zamaganizidwe ndi thupi. Kuphwanya dongosolo lamanjenje ndikotheka, makamaka kosayenera mawonekedwe, mawonekedwe a nkhawa ndi mantha, kupsa mtima kwakukulu, kusintha kwa malingaliro. Kuperewera kwa glucose kumayendetsedwa ndi tachycardia komanso kuthamanga kwa magazi.

Ngati kuchuluka kwa shuga kutsika mpaka 1.38 mmol / L, wodwalayo nthawi zambiri amasiya kuzindikira. Zikatero, muyenera kumubweretsa ku dipatimenti yachipatala msanga.

Njira zoyesera

Kwa munthu wodwala matenda ashuga, zizindikiritso ndi zomwe madokotala sangazindikire. Pambuyo pofufuza wodwalayo, katswiri amatha kudziwa za matenda ake ndikuwathandiza. Komabe, kuzindikira koyenera ndikofunikira. Choyamba, kusanthula kwa ma laboratory ndi biochemical kwa magazi ndi mkodzo kumachitika.

Ndi hypoglycemia, kuchepa kwa shuga kumatha kuzindikirika, nthawi zina zonse - kukwera kwake mpaka 33 mmol / l kapena kuposa. Kupezeka kwa matupi a ketone, kuwonjezeka kwa plasma osmolarity, kuchuluka kwa lactic acid m'magazi kumazindikiridwa. Ndi chikomokere, ntchito yamanjenje ndi ziwalo zina zimayesedwa. Ngati zovuta zachitika, chidziwitso chothandizira ndi chofunikira.

Khomali la shuga: zotsatira zake

Tsoka ilo, izi zimawonedwa ngati zofala. Kodi vuto la shuga limakhala bwanji? Zotsatira zake zimakhala zosiyanasiyana. Vutoli limaphatikizidwa ndi zolephera zazikulu za metabolic. Kuletsa kwa chapakati mantha dongosolo. Kukomoka kumatha kukhala masiku angapo, miyezi kapena zaka. Wodwala akamakhala mu vuto lofananalo, amakhala ndi mwayi wokhala ndi vuto monga matenda a chithokomiro.

Ndi chithandizo chokwanira, zotsatira zake zimakhala zabwino. Komano, edema yam'mimba imatha kuwononga kwambiri dongosolo lamanjenje ndipo, motero, kuwonongeka kwa magwiridwe antchito. Mwachitsanzo, odwala ena amakhala ndi vuto la kukumbukira komanso kulankhula, mavuto ndi mgwirizano. Mndandanda wazotsatira ungaphatikizeponso zovuta za mtima. Coma mu matenda a shuga a ana nthawi zina zimadzetsa kuchedwa kwakula kwa malingaliro ndi thupi.

Tsoka ilo, odwala nthawi zambiri samatha kuchira chifukwa cha zovuta zoyipa. Ichi ndichifukwa chake ndikofunikira kusamalira chitetezo.

Coma cha matenda ashuga: thandizo loyamba

Odwala omwe ali ndi matenda ashuga, monga lamulo, amachenjezedwa za kuthekera kotukuka ndikulankhula za algorithm ya kuchitapo kanthu. Kodi mungatani ngati wodwala wasonyeza kuti ali ndi vuto la shuga? Zotsatira zake zimakhala zoopsa kwambiri, motero wodwala ayenera kuyeza glucose pogwiritsa ntchito glucometer. Ngati kuchuluka kwa shuga ndikwezedwa, muyenera kulowa insulin, ngati itsitsidwa, idyani maswiti kapena kumwa tiyi wokoma.

Ngati wodwalayo watha kale kuzindikira, ndikofunikira kumuyika kumbali yake kuti alepheretse lilime kugwa komanso kusanza m'mapazi. Ngati wodwala ali ndi mano owachotsa, amafunikanso kuchotsedwa. Ndikulimbikitsidwa kukulunga wozunzidwayo kuti muzitha kutenthetsa miyendo yam'munsi. Chotsatira, muyenera kuyitanitsa gulu la ambulansi - wodwala amafunika thandizo mwachangu komanso woyenera.

Njira zamankhwala zochizira zomwezi

Wodwala akagonekedwa m'chipatala, dokotalayo amayesa kuchuluka kwa shuga m'magazi - choyambirira, chizindikirochi chimayenera kukhala chofanana. Kutengera ndi momwe alili, insulin (hyperglycemia) kapena glucose solution (hypoglycemia) imaperekedwa kwa wodwala.

Mukukonzekera kuperewera, thupi la munthu limataya mavitamini, michere yambiri ndi zinthu zina zambiri zothandiza. Ichi ndichifukwa chake mankhwalawa omwe odwala matenda ashuga amaphatikizira kugwiritsa ntchito mankhwala omwe amathandizira kubwezeretsa mawonekedwe a electrolyte, kuthetsa kuchepa kwa madzimadzi, kuyeretsa magazi a poizoni.

Ndikofunikira kwambiri kudziwa kukhalapo kwa zovuta ndi zifukwa zomwe zimakhalira kukomoka, kenako ndikuwathetsa.

Kupewa kuperewera kwa shuga

Mavuto a matenda ashuga, chikomokere makamaka, akhoza kukhala owopsa. Chifukwa chake kuli bwino kuunikira momwe mulili ndikusunga malamulo osamala:

• muyenera kutsatira ndondomeko yazakudya zomwe adokotala adatsatila ndikutsatira zakudya,
• wodwala amayenera kupita kwa dotolo kukapimidwa, kukayezetsa,
• kudziwunikira komanso kutsatira malamulo a chitetezo ndikofunikira (wodwalayo ayenera kukhala ndi glucometer naye ndikuyezera shuga wamagazi pafupipafupi),
• moyo wokangalika umalimbikitsidwa, kuyenda pafupipafupi mumlengalenga, kuchita masewera olimbitsa thupi,
• ndikofunikira kutsatira malingaliro enieni ndikusunga Mlingo wa insulin ndi mankhwala ena,
• Palibe chifukwa chomwe muyenera kudzilingalira nokha ndikugwiritsa ntchito njira zina zamankhwala osagwiritsa ntchito endocrinologist.

Kutsatira malamulo osavuta motere nthawi zambiri kumathandiza kupewa zovuta, kuphatikizapo kuyambika kwa chikomokere. Ngati pali kusintha kochititsa mantha, muyenera kufunsa dokotala.