Kodi lactic acidosis - zimayambitsa ndi zizindikiro za matendawa, kuwunika, njira zochizira ndi kupewa

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Momwe lactic acidosis imakhalira

Vuto lovuta kwambiri lomwe limadzalo kulowa m'magazi ndi mkaka acidosis. Lactic acidosis yamtundu 2 matenda a shuga imatha kuchitika atatha kugwiritsa ntchito mankhwala ochepetsa shuga. Izi zimachitika mwanjira yokonzekera mitundu yayikulu (Metformin, Bagomet, Siofor, Glyukofazh, Avandamet). Vutoli lagawidwa m'mitundu iwiri:

1. Lembani A lactic acidosis - minofu hypoxia. Thupi limasowa okosijeni m'matenda ovuta: sepsis, septic shock, pachimake matenda a chiwindi kapena pambuyo kuchita zolimbitsa thupi kwambiri.
2. Mtundu B lactic acidosis sugwirizana ndi hypoxia yamatupi amthupi. Zimachitika munthawi ya chithandizo cha mankhwala ena motsutsana ndi matenda a shuga komanso kachilombo ka HIV. Milisi acidosis yamtunduwu imadziwonetsera yokha motsutsana ndi maziko a uchidakwa kapena matenda opweteka a chiwindi.

Lactic acidosis imapangidwa chifukwa cha kusachita bwino mu ma metabolic a thupi. Mkhalidwe wamatenda umachitika:

• Type 2 shuga.
• Mankhwala osokoneza bongo a Metformin (pamakhala mankhwala enaake m'thupi chifukwa chovuta kuwononga aimpso).
• Njala ya okosijeni (hypoxia) ya minofu itatha mphamvu zolimbitsa thupi. Mkhalidwe wamtunduwu ndi wakakanthawi ndipo umadutsa wokha utapuma.
• Kukhalapo kwa zotupa mthupi (zodetsa kapena chovunda).
• Cardiogenic kapena hypovolemic mantha.
• Kusowa kwa Thiamine (Vit B1).
• Khansa yamagazi (leukemia).
• Kuvulala kofananira.
• Sepsis.
• Matenda opatsirana komanso otupa a etiology osiyanasiyana.
• Kukhalapo kwa uchidakwa,
• Kutulutsa magazi kwambiri.
• Kulingalira mabala m'thupi la wodwala matenda ashuga.
• Pachimake myocardial infaration.
• Kulephera kopindulitsa.
• Kulephera kwina.
• Matenda a chiwindi.
• Mankhwala ochepetsa mphamvu ya kachilombo ka HIV. Gulu la mankhwalawa limapereka katundu wambiri mthupi, chifukwa chake zimakhala zovuta kwambiri kukhala ndi lactic acid m'magazi.

Zizindikiro za lactic acidosis

Milika acidosis imapanga kuthamanga kwa mphezi, kwenikweni m'maola ochepa. Zizindikiro zoyambirira za lactic acidosis zimaphatikizapo:

• mkhalidwe wopanda chidwi
• kupweteka kumbuyo kwa sternum ndi minofu yamatumbo,
• kusanja m'mlengalenga,
• ziume zopaka ndi khungu,
• chikaso chamaso kapena khungu,
• kuwoneka kupuma kwapang'onopang'ono,
• kuwoneka kugona.

A woipa mawonekedwe a lactic acidosis wodwala akuwonetsedwa ndi mtima kulephera. Kuphwanya koteroko kumapangitsa kusintha kwa mphamvu ya myocardium (kuchuluka kwa kuchuluka kwa mtima kumawonjezera). Kupitilira apo, kuchuluka kwa thupi la munthu kumakulirakulira, kupweteka pamimba, kusanza, kusanza, kutsegula m'mimba, ndi kusowa kudya. Ndiye zotupa za lactic acidosis zimawonjezeredwa:

• areflexia (mawonekedwe amodzi kapena zingapo kulibe),
• Hyperkinesis (kayendedwe ka minofu kamodzi kapena gulu la minofu),
• paresis (ziwalo zosakwanira).

Asanayambike hyperlactacidemic coma, zizindikiro za metabolic acidosis zimawonekera: wodwalayo amakula ndikuyamba kupuma kwamkokomo (misozi imamveka patali), mothandizidwa ndi momwe thupi limayesera kuchotsa lactic acid mthupi, ndipo DIC - syndrome (intravascular coagulation) imawonekera. Ndipo pali zizindikiro zakugwa: choyamba, oliguria imayamba (kutsika kwa mkodzo), kenako anuria (osakodza). Nthawi zambiri pamakhala mawonekedwe a hemorrhagic necrosis ya zala zakutsogolo.

Zizindikiro

Hyperlactacidemia ndizovuta kuzindikira pokhapokha ngati pali zovuta zomwe sizikutsimikiziridwa ndi zotsatira zoyesa. Zizindikiro za lactic acidosis zimagwiritsidwa ntchito ngati umboni wothandiza. Zambiri odalirika ndi ma labotale, omwe amachokera muyezo wa lactic acid. Kuphatikiza apo, adazindikira:

• kuchuluka kwa ma bicarbonate (okhala ndi lactic acidosis, amachepetsa msanga),
• kuchuluka kwa hyperglycemia,
• kusowa kwa acetone mu mkodzo (acetonuria).

Kodi lactic acidosis ndi chiani?

Lactaciosis yamtundu wa 2 matenda a shuga samachitika kawirikawiri, koma imabweretsa zotsatirapo zoyipa. Mu 50% ya milandu, lactic acidosis (hyperlactacidemia) imapha.

Ngati tilingalira za lactic acidosis kuchokera pamalingaliro azinthu zamitundu mitundu, ndiye mawonekedwe a lactate (lactic acid) m'magazi a anthu. Zimachitika chifukwa cha kusweka kwa glucose ambiri, omwe impso sizingathe

Thupi la munthu wathanzi limatulutsa lactic acid mu Mlingo wocheperako chifukwa cha zochita za metabolic. M'magawo angapo, lactate imakonzedwa m'madzi ndi kaboni diokosijeni kapena glucose. Ndi kupanga lactic acidosis, hyperlactatemia imachitika - mkhalidwe womwe acidity ya magazi osinthika, maselo amaleka kulemekezedwa mokwanira ndi mpweya, mphamvu ya insulin imachepa, ndipo lactic acid index imangowonjezera m'malo mwake.

Ngati wodwala sapatsidwa chithandizo chamankhwala panthawi, hyperglycemic hyperlactacidic coma (lactic acidosis) imachitika. Ndiye lactic acidosis ndi chiopsezo cha matenda ndi chiyani?

Zifukwa zachitukuko

Lactic acidosis imayamba mtundu wachiwiri wa anthu odwala matenda ashuga omwe amadziwika kuti ali ndi vuto la stroke kapena myocardial infarction.

Zomwe zimapangitsa kuti lactate acidosis ikhale:

• poyizoni wa mowa
• Mankhwala kuphatikiza yofunika kuchuluka kwa fructose mu thupi,
• magazi
• matenda ndi zotupa
• matenda obadwa nawo a kagayidwe kachakudya ka thupi,
• mabala
• cyanide poyizoni,
• hypovitaminosis B1,
• kuchepa magazi kwambiri,
• kukhalapo kwa zilonda zoyipa kapena zotupa.

Zizindikiro

Wodwala akakula lactic acidosis mu mtundu wachiwiri wa matenda ashuga, Zizindikiro zake zimapezeka bwino kwambiri m'magawo oyambira, chifukwa matenda awa a shuga amakula msanga ndipo amakhala ndi zotsatirapo zoyipa kwambiri kwa wodwalayo.

Popeza dzina la matendawa - lactic acidosis, zizindikiro zake zimagwirizana kwambiri ndi kuwonjezeka kwa magazi a wodwalayo a lactic acid.

Kuzindikira kwa shuga - ingomwani tsiku lililonse.

Zizindikiro za lactic acidosis zili ndi chithunzi ichi:

• chizungulire ndi mutu
• kusanza ndi kusanza
• chisokonezo,
• ntchito zamagalimoto
• kupweteka m'mimba
• kupweteka kwa minofu
• Matenda ogona amtundu wina (kugona, kusowa tulo),
• kupuma pafupipafupi.

Mukazindikira lactic acidosis, zizindikirazo ziyenera kukhala zokhudzana ndi zovuta zina, popeza zizindikiro zofananira sizimangokhala kokha ndi kudzikundikira kwa lactic acid. Ndipo monga tanena kale m'nkhaniyi, lactic acidosis, zizindikiro zoyambirira zomwe zatchulidwa pamwambapa, pamapeto pa chitukuko zimawonetsedwa ndi kusazindikira kwa wodwala komanso chikomokere.

Odwala azitha kudziwa matendawa pawokha, kuti adziwe momwe matendawo alili komanso zomwe zimawonetsa m'matenda a shuga, ndiye kuti mwayi wazotsatira zake ndiwotheka kwambiri. Matendawa akamakula, mkhalidwe wa wodwalayo umacheperachepera - kusanza, kupweteka kwam'mimba kumawonekera.

Chiwopsezo cha thrombosis ndi hemorrhagic necrosis yam'munsi komanso kumtunda kuli kotheka. Makamaka chidwi ayenera kulipira kuti kuphwanya Reflexes ndi kumachitika mwadzidzidzi minyewa contractions. Wodwala amatha kudziwa zizindikiro zonsezi za lactic acidosis yekha ndipo amafunsira dokotala.

Zithandizo zamankhwala a shuga

Kumayambiriro kwa chithandizo, ziyenera kukumbukiridwa kuti lactate acidosis ndi matenda omwe amayamba chifukwa choperewera ndi mpweya m'magazi. Ichi ndichifukwa chake mankhwalawa onse azachipatala ayenera kukhazikika poti chidziwitsochi chimakhala chodwala cha oxygen. Munthu ayenera kutulutsidwa kunja kwa dziko lino pokhutiritsa maselo a ziwalo ndi minofu ya thupi ndi mpweya.

Madokotala amadziwa kuti lactic acidosis mu matenda osokoneza bongo amakhala osakanizidwa mothandizidwa ndi mpweya wabwino. Kuti munthu athetse wodwala matendawa, ziyenera kukumbukiridwa kuti matendawa ndi hypoxia, womwe umayambitsa matenda ndi matendawo.

Kuthetsa hypoxia ndi ntchito yofunika kwa dokotala. Pakudzinyenga kwachipatala, akatswiri mosamala amayang'anira kuthamanga kwa magazi m'mitsempha ya wodwala, komanso kuwunika momwe zizindikiro zonse zofunika kwambiri za thupi zilili.

Ngati lactic acidosis ikapezeka mwa wodwala wazaka zapamwamba, kuwunika kwapadera kwa magawo a thupi kuyenera kuchitika, popeza m'badwo uwu nthawi zambiri umakhala ndi matenda oopsa, ndipo vuto la chiwindi limathanso.

Dongosolo lonse lazodzichitira limachitika mwachangu, popeza kuopseza kuti zotsatira zakupha ndizokwera kwambiri, ndipo kusintha kuchoka ku boma kupita kwachikhalidwe kumatenga nthawi yayitali. Ndizotheka kusokoneza lactic acidosis kokha kuchipatala. Pamaziko a kuyezetsa magazi, madokotala amazindikira kuopsa kwa matendawa, makamaka pamavuto ovuta kwambiri pamene magazi acid asachepera 7, poticamu bicarbonate amaperekedwa kwa wodwala.

Zikachitika kuti lactic acidosis imayendera limodzi ndi kulephera kwa aimpso, hemodialysis imachitika. Monga njira zowonjezera, peritoneal dialysis ikhoza kuchitika, yomwe ibwezeretsa mulingo wa potaziyamu bicarbonate m'thupi. Iyenera kuganiziridwanso mukamayambitsa lactic acidosis kuti ndi matenda omwe amafunika chithandizo cha insulin kuti abwezeretsenso kagayidwe kazakudya m'thupi la wodwalayo. M'pofunika kuganizira kuthetsa lactic acidosis kuti matendawa amafunika kuwunika kwambiri kagayidwe kazakudya m'thupi la wodwala yemwe ali ndi matenda a shuga.

Kupewa ndi malingaliro

Musanagwiritse ntchito njira zodzitetezera, muyenera kumvetsetsa kuti lactic acidosis ndi chiyani ndikutha kuzindikira zomwe zimadziwika. Matendawa ndi ovuta kuwazindikira komanso kuneneratu. Kuti mupewe izi, ziyenera kukumbukiridwa kuti matendawa amafunika kulondola pakumwa mankhwala ndikutsatira malangizo a dokotala. Muyenera kutsatira mlingo wa mankhwalawa. Ngati piritsi silinatenge nthawi, silikulimbikitsidwa kuti muwonjezere mankhwalawa mukamamwa mankhwalawo, chifukwa izi zimatha kuyambitsa bongo kapena kuyambitsa mavuto.

Muyenera kudziwa kuti lactic acidosis imatha kuchitika motsutsana ndi maziko a matenda kapena kachilombo.

Pakadali pano, thupi la wodwala yemwe ali ndi matenda ashuga amatha kuyankha mosayembekezereka mankhwala omwe amayamba. Pazizindikiro zoyambirira, ndikofunikira kuzindikira zamatenda ndikupitilira chithandizo chake. Mankhwala odzipatsa okha sakhala oyenera pano, chifukwa chake ayenera kuikidwa ndi katswiri atatenga anamnesis. Kuthandizira pa nthawi yake kumathandizira kuchotsa matendawa posachedwa, ndipo kumangokhala kukumbukira kukumbukira kwa wodwalayo.

Matenda a shuga nthawi zonse amayambitsa zovuta zakupha. Mwazi wamagazi ochulukirapo ndi woopsa kwambiri.

Aronova S.M. adafotokoza za chithandizo cha matenda ashuga. Werengani kwathunthu

Etiology (zoyambitsa) za lactic acidosis

Izi zotsatirazi zimayambitsa kukula kwa lactic acidosis:

• Matenda otupa komanso opatsirana
• Kutulutsa magazi kwakukulu.
• Kuledzera kumalephera.
• Lakuthwa
• Kuvulala kwambiri
• Matenda a chiwindi (aakulu).

Mokwanira pazinthu zomwe zimayambitsa lactic acidosis ndi zizindikiritso za mtundu wofananira, malo apadera amatumizidwa kuti atenge biguanides. Pankhaniyi, lactic acidosis zizindikiro amapezeka odwala kumwa antidiabetes mankhwala ndi kukhalapo kwa thunthu mankhwala. Ngakhale mlingo wake wocheperako wa impso kapena chiwindi ungayambitse lactic acidosis, womwe umathandizidwa makamaka ndikudziunjikira kwa mankhwalawa mthupi.

Kukula kwa lactic acidosis kumachitika ndi hypoxia komwe kumachitika mu minofu ya mafupa, mwachitsanzo, ikhoza kuphatikizidwa ndi kupsinjika kwa thupi kwakanthawi. Zomwe zimayambitsa lactic acidosis popanda kupezeka kwodziwikiratu kwa hypoxia imatha kutumikiranso, komanso mitundu ingapo yamachitidwe a chotupa. Izi zimaphatikizaponso kulephera kupuma, kupweteka kwamtima kwamapapo amodzi am'mapapo, matumbo, komanso kuchepa kwa thupi la thiamine.

Lactic acidosis: Zizindikiro

Makamaka kukula kwa lactic acidosis kumachitika mu mawonekedwe owopsa mkati mwa maola angapo, pomwe sipangakhale zotsatira zake. Kenako odwala amatha kumva kupweteka kwa minofu ndi kupweteka komwe kumachitika kumbuyo kwa sternum. Zizindikiro zamtundu ndizosiyanasiyana za zizindikiro za dyspeptic, chidwi, kupumira msanga, kugona,, kapena, kugona.

Zizindikiro zomwe zikupezeka, pakadali pano, ndizowonekera mwa mawonekedwe a mtima kulephera, omwe pambuyo pake amakula ndi acidosis yayikulu. Poyerekeza ndi momwe zinthu zasinthira, zosintha pambuyo pake zimawonekera mu contractility, mawonekedwe a myocardium.

Kupitilira apo, kuwonongeka kwapang'onopang'ono mu mphamvu ya wodwalayo kumadziwika, momwe kusanza ndi kupweteka kwam'mimba kumatha kugwirizanitsidwa ndi kuwonjezeka kwa acidosis. Ngati vutoli likukula ndi lactic acidosis, zizindikirazo zimadziwikanso ndi mitundu yosiyanasiyana ya minyewa, kuyambira areflexia mpaka paresis ndi hyperkinesis.

Atangotsala pang'ono kuyamba kwa chikomokere, limodzi ndi kuwonongeka kwa chikumbumtima, pamakhala kupumula kwamkokomo, komwe kumadziwika ndi kupuma kwamveka komwe kumveka patali, pomwe fungo la acetone lodziwika ndi izi limasowa mpweya wotuluka. Kupuma kwamtunduwu nthawi zambiri kumayenderana ndi metabolic acidosis.

Ndiye lactic acidosis imadziwika ndi zizindikiro mu mawonekedwe a kugwa: choyamba ndi oligoanuria, kenako ndi anuria, motsutsana ndi kumbuyo komwe kukhazikitsidwa kwa intravascular coagulation (kapena DIC) kumachitika. Nthawi zambiri, lactic acidosis zizindikiro zimadziwika ndi kupezeka kwa intravascular thrombosis ndi hemorrhagic necrosis yokhudza zala ndi manja. Tisaiwale kuti kukulira msanga kwa lactic acidosis, komwe kumachitika patangopita maola ochepa, sikuthandizira kuzindikira kwa zizindikiritso zokhala ndi vuto la matenda ashuga. Zizindikiro izi zimaphatikizaponso ziume za mucous nembanemba, komanso khungu louma lonse. Ndizofunikira kudziwa kuti pamenepa, mpaka 30% ya odwala omwe ali ndi hyperosmolar ndi odwala matenda ashuga ali ndi zinthu zogwirizana ndi kupezeka kwa lactate acidosis.

Kupewa kwa Coma

Kupewa, komwe kumathandizira kupewa kuyambika kwa lactacidemic chikomokere kumbuyo kwa lactic acidosis, zizindikiro zomwe tidaziwona pamwambapa, zimaphatikizira, kupewa hypoxia, komanso pamawu olamulira pakulipira shuga. Komanso, lactic acidosis, zizindikiro zomwe zimatha kugwiritsidwa ntchito ndi biguanides, zimafunikira okhwima pakutsimikiza kwa Mlingo wawo pothana nawo pokhapokha ngati pali matenda a mtundu womwewo (kapena zina). Zizindikiro za lactic acidosis ndizothandizanso pakuwonjezera njira, chifukwa chake odwala omwe ali ndi matenda osokoneza bongo atatenga biguanides ayeneranso kuganizira za nkhaniyi.

Pazokayikitsa zilizonse zokhudzana ndi lactic acidosis, komanso zovuta zomwe tafotokozazi m'nkhaniyi, muyenera kulankhulana ndi endocrinologist.

Kodi chilichonse ndicholondola m'ndimeyi malinga ndi zamankhwala?

Yankho lokha ngati mwatsimikizira chidziwitso chachipatala.

Matenda okhala ndi zofananira:

Si chinsinsi kuti m'thupi la munthu aliyense munjira zosiyanasiyana, kuphatikizapo chimbudzi cha chakudya, tizilombo tating'onoting'ono timakhudzidwa. Dysbacteriosis ndimatenda omwe chiŵerengero ndi kapangidwe ka tizilombo tomwe timakhala m'matumbo timaphwanya. Izi zimatha kubweretsa chisokonezo chachikulu m'mimba ndi matumbo.

Kuchita mopitirira malire ndi mkhalidwe womwe masiku ano nthawi zambiri umayang'anizana osati ndi akulu okha, komanso ndi ana. Amadziwika ndi kuchepetsedwa ntchito, kugona, kusasamala komanso kusakwiya. Komanso, anthu ambiri amakhulupirira kuti kugwira ntchito mopitirira muyeso si vuto lalikulu, komanso kuti kugona bwino kumangokhala. M'malo mwake, ndizosatheka kuti muchepetse kuphwanya kwamtunduwu kwa kugona tulo. M'malo mwake, kulakalaka kugona kosalekeza komanso kulephera kupezanso mphamvu mutagona ndiye zizindikiro zazikulu zakugwira ntchito mopitirira muyeso.

Lactic acidosis (lactic acidosis, lactacidemia, hyperlactatacidemia, lactic acidosis) ndi mkhalidwe womwe lactic acid imalowera m'magazi mwachangu kwambiri kuposa momwe adatulutsira, zomwe zingayambitse kukula kwamavuto oopsa m'moyo. Milandu yoposa 50%, lactic acidosis amalembetsa mu odwala matenda a shuga.

Potengera komwe lactic acidosis, ubongo edema ndi kupindika kwake kwamkati, kupuma kolimba, ndipo imatha kuyamba.

Lactic acid ndiye chinthu chomaliza cha anaerobic glycogenolysis ndi glycolysis, gawo lapadziko lapansi la gluconeogenesis, limagwiritsidwa ntchito ngati chida champhamvu ndi minofu ya mtima. Kuwonjezeka kwa zomwe zili ndi lactic acid m'magazi makamaka kumalumikizidwa ndi kupangika kwake kwa minofu ndi kuchepa kwa mphamvu ya chiwindi kuti isinthe lactic acid kukhala glucose ndi glycogen. Pankhani ya matenda a shuga a mellitus, kuchuluka kwa asidi a lactic m'magazi kumatha kuwonjezeka chifukwa chakuletsa kukhudzika kwa matenda a pyruvic acid komanso kuchuluka kwa NAD-N / NAD. Kuzunza kwa magazi a lactic acid kumatha kuchita ngati njira ina yowunikira.

Zoyambitsa ndi Zoopsa

Hypoxia yomwe imapezeka m'matumbo am'mimba chifukwa chokhala ndi kupsinjika kwa nthawi yayitali kumatha kuyambitsa lactic acidosis. Komanso, njira ya pathological imatha kukhala ndi matenda a shuga, kupweteka kwamatumbo, matenda opatsirana komanso kutupa, kulephera kupuma, kulowerera kwam'mimba, kulowetsedwa kwamatumbo kapena mapapu, kulephera kwa aimpso, matenda a chiwindi, magazi akulu, kuvulala kwambiri, uchidakwa.

Zowopsa zake ndizophatikizira:

• matenda obadwa nawo
• kumwa mankhwala (mwachitsanzo, Biguanides, makamaka pamaso pa matenda a chiwindi ndi impso),
• kuchepa kwa mavitamini m'thupi (makamaka vitamini B 1),
• kugwiritsa ntchito methanol kapena ethylene glycol,
• parenteral makonzedwe a fructose muyezo waukulu.

Ndi lactic acidosis, kuthandizira kuchipatala pamafunika wodwala kuti athe kukonza acidosis ndi hypoxia.

Zizindikiro za Lactic Acidosis

Lactic acidosis, monga lamulo, amakula kwambiri, patangopita maola ochepa, osakhala ndi zizindikiro zakutsogolo. Odwala amadandaula za kupweteka kwa minofu, kupweteka kumbuyo kwa sternum, dyspepsia, chidwi, kugona kapena kugona. Mkhalidwe wa wodwala umakulirakulira msanga, kuwonjezereka kwa acidosis kumayendera limodzi ndi kupweteka kwam'mimba komanso kusanza, minyewa yam'mimba (areflexia, hyperkinesis, paresis).

Muzovuta kwambiri, Zizindikiro za lactic acidosis ndizowonetsa kulephera kwamtima, zomwe zimakulitsidwa ndi acidosis yayikulu pamene njira ya pathological ikupita. Kuwonongeka kwa chikumbumtima ndikukula kwa matendawa kumayambitsidwa ndi kupha mphamvu, mawonekedwe a wodwalayo akupuma mwaphokoso (phokoso lakupuma lomwe limamveka patali), ndipo palibe fungo la acetone mlengalenga lomwe limatulutsa. Wodwala amakula, choyamba ndi oligoanuria, kenako ndi anuria, ndikutsatiridwa ndikugawa kwa intravascular coagulation (DIC). Mwa odwala ena, hemorrhagic necrosis ya zala zakumtunda ndi zam'munsi zimadziwika pakati pa zizindikiro za lactic acidosis.

Zolemba za maphunziro a lactic acidosis mwa ana

Mtundu wa cholowa cha lactic acidosis umaonekera mwa ana aang'ono omwe ali ndi acidosis yayikulu, limodzi ndi kupuma kwambiri. Odwala amakhala ndi minofu hypotension, kuchepetsedwa kwa chitukuko cha psychomotor. Nthawi zambiri, mkhalidwe wodwala umayenda bwino ndi ukalamba, koma nthawi zina njira yotsitsimutsa imadzetsa imfa.

Pafupifupi 50% ya milandu yonse ya lactic acidosis imanenedwa mwa odwala omwe ali ndi matenda ashuga.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Potengera komwe lactic acidosis, ubongo edema ndi kupindika kwake kwamkati, kupuma kolimba, ndipo imatha kuyamba.

Kukula kwa matendawo kwa mtundu wa lactic acidosis kumatengera matenda omwe adayambapo, pamlingo wa lactic acid m'magazi a wodwala, komanso pa nthawi yake komanso kufunika kwa mankhwalawo. Ndi kukula kwamavuto, komanso mtundu wobadwa nawo wa lactic acidosis, matendawa amafooka.

Kuwonetsedwa kwa matendawa

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

Zotsatirazi zikuwonetsa kukula kwa izi:

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

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

Magawo ena a labotale omwe amakhala ndi hyperlactatemia amawunikanso:

• Hyperphosphatemia (may azotemia test),
• kutsika kwa magazi pH
• dontho mu mulingo wa CO 2 m'magazi,
• kuchepa kwa ma bicarbonates a plasma.

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

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

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

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

Njira zamachiritso

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

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

Ngati hyperlactatemia itatsimikiziridwa ndi kusanthula, kuchuluka kwa pH ndi kochepera 7.0, ndiye kuti wodwalayo amayamba kubayila sodium bicarbonate kudzera m'mitsempha. Yankho limakonzedwa kuchokera kumadzi osabala, sodium bicarbonate, wofanana ndi potaziyamu mankhwala ena. Lowani ndi dontho kwa maola awiri. Kuchuluka kwa yankho kumatha kumasiyanasiyana kutengera pH. Imawunikidwa maola 2 aliwonse: kulowetsedwa kwamankhwala kumapitirirabe mpaka pH ifika kupitirira 7.0.

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

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

Ndi chitukuko cha lactic acidosis chikomokere, njira za antiseptic zimaperekedwa kwa wodwala. Nthawi yomweyo, anti-shock therapy imachitika. Trisamine imagwiritsidwa ntchito pochepetsa mawonetseredwe a lactic acidosis.

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

Zizindikiro za lactic acidosis

Vutoli limayamba patangopita maola ochepa. Zizindikiro zake zazikulu ndi:

• dontho mu kuthamanga kwa magazi
• kufooka
• kulephera kwa mtima
• Zizindikiro zam'mapapo mwanga,
• kulemera m'miyendo
• kusanza ndi kusanza
• kusokonezeka kwa mtima
• kupumira msanga
• kupweteka m'mimba komanso kumbuyo kwa sternum.

Zizindikirozi ndizofanana ndi kuchuluka kwakukulu kwa shuga m'magazi. Mkhalidwe wa ketoacidosis amakhalanso pansi pazizindikiro.

Kusiyanitsa kwakukulu pakati pawo ndi kukhalapo kwa zowawa m'misempha, monga pambuyo pophunzira zolimbitsa thupi. Ndi ketoacidosis, palibe ululu.

Ngati wodwala wodwala matenda a shuga adandaula za kupweteka kwa minofu, ndikofunikira kuyeza kuchuluka kwa shuga m'magazi ndikuwona momwe munthu aliri. Kuwonongeka kowopsa mu thanzi, kupezeka kwa zizindikirozi kumawonetsa lactic acidosis. Muyenera kuyimba ambulansi. Ndikosatheka kudzipereka nokha thandizo lanu.

Amayambitsa lactacidemia

Lactic acidosis imatha kukhala mukumwa mankhwala ochepetsa shuga. Kapangidwe ka mankhwalawa nthawi zambiri kumakhala ndi chinthu chachikulu. Chosakaniza chotere chimalepheretsa chiwindi kuti chiwononge lactate owonjezera. Ndi owonjezera lactate m'thupi la munthu, kukula kwa chikomokere mkaka ndikotheka.

Kudzikundikira kwa lactic acid m'thupi lathu kumachitika chifukwa cha kufooka kwa mpweya wa zimakhala, zomwe, zimayambitsa kutsika kwa pH m'magazi.

Matenda omwe amadziwika ndi hypoxia amatha kupweteka lactacidemia. Awa ndimatenda a mtima. Molumikizana ndi matenda a shuga, chiopsezo cha lactic acidosis chimakulanso.

Chimodzi mwazinthu zomwe zimapangitsa kukula kwa mkaka ukhoza kukhala kulephera kwa kagayidwe kachakudya. Lactacidic chikomoko kwenikweni sichimakula mwa ana omwe ali ndi matenda ashuga.

Njira zochizira

Chithandizo cha lactic acidosis mu matenda a shuga amachitika mu chisamaliro chokwanira ndipo chimaphatikizapo zinthu izi:

• mtsempha wamagazi wa bicarbonate wa sodium,
• kuyambitsa kwa methylene buluu kuti muchepetse chikomokere,
• ntchito mankhwala trisamine - amachotsa hyperlactatacidemia,
• hemodialysis ndi kuchepa kwa pH m'magazi

Kukula kwa lactic acidosis kumatheka osati kokha mu matenda a shuga, komanso matenda ena angapo omwe amatsatana ndi kuchepa kwa kuperekanso kwa oksijeni ku minofu, pomwe kuwonongeka kwa glucose ndi metabolism yamphamvu kumachitika molingana ndi mtundu wa anaerobic. Amadziwika ndi kupangika kwakukulu kwa lactic acid, yomwe imatuluka m'magazi.

Komanso, pathological mkhalidwe umachitika pamaso pa matenda a ziwalo zomwe zimagwiritsa ntchito ndikuchotsa lactic acid. Izi zimachitika ndi matenda a impso ndi chiwindi, zomwe zimatsatana ndi kulephera kugwira ntchito kwawo.

Pali zinthu zingapo zomwe zimapangitsa kuti lactic acid iwonjezeke m'thupi lathu, zomwe zimayambitsa lactic acidosis, omwe adatinso amapezeka.

Nthawi yomweyo, pakuchepa kwa kuchuluka kwa mpweya wamagazi, mapapu sagwira ntchito moyenera, ndipo ziwalo zonse zimayamba kudwala chifukwa cha kuchepa kwa mpweya. Kuti alipire mkhalidwewo, maselo amayamba kuphwanya glucose mumtundu wa anaerobic, ndikamasulidwa kwa lactate.

Kulephera kwa mtima

Zimatengera kuwoneka kwa lactic acidosis yamtundu womwewo ngati kulephera kwa m'mapapo. Koma ndikuphwanya mtima, kumakhala kuchepa kwa kuchuluka kwa magazi omwe amachokera m'mitsempha yake, komwe kumabweretsa kuchuluka kwakukulu kwa atria. Izi zimadzetsa kuwonjezeka kwa kuthamanga mumagulu ang'onoang'ono amwazi ndikudutsa mu edema yovuta kwambiri yam'mapapo, komanso mapapo am'mimba omwe amakanika ndikulephera kwa mtima.

Kulephera kwina

Chofunikira kwambiri pa impso ndikumasulidwa kwa zinthu zonse zosafunikira komanso zapoizoni m'thupi. Impso zimayang'aniranso kuchuluka kwa zinthu zina mthupi, ngati zochuluka kwambiri za izo, impso zimayamba kuwakhwimitsa kwambiri, zomwe zimachitika ndi thupi lanyama, lactic acid. Kulephera kwamkati sikubweretsa zotsatira zomwe mukufuna, ndipo lactic acid imadziunjikira m'thupi.

Ndi matenda opatsirana ambiri, kuwonongeka kwakukulu kwa magazi ndi mabakiteriya kumachitika, izi zimakwiyitsa kwambiri magazi.

Mikhalidwe imeneyi, kufalikira kwa magazi m'magulu ang'onoang'ono a m'magazi kumayima ndipo minofu imayamba kudwala hypoxia.

Zomwe zimathandizira kuwonjezeka kwa milingo ya lactate.

Zodabwitsa

Pankhaniyi, kuphatikiza kwa lactic acid kumachitika ndi mpweya wamatenda a minofu chifukwa cha vasospasm. Izi zimachitika ngati chitetezo cha thupi ku chinthu chowonongeka cha pathogenic, chomwe chimapangitsa kutsika kwa magazi pazipazi, ndikuthandizira magazi kulowa ziwalo zamkati.

Amathandizira kuwonjezera kuchuluka kwa poizoni m'magazi, amawononganso chiwindi ndi impso, ziwalo zomwe zimawononga ndikuchotsa poizoni wonse mthupi. Komanso, ethanol ikaphulika nthawi ya kagayidwe, zinthu zomwe zimayamba kuwonongeka zimamasulidwa, imodzi mwazo ndi lactic acid.

Njira za tumor

Pankhaniyi, pali kusintha kwa mtundu wa kagayidwe kachakudya kosinthika khansa, nthawi zambiri mtundu wa anaerobic wa kutulutsa kwa lactate umawonedwa mwa iwo. Ndipo chifukwa cha kukula kwa neoplasm, ziwiya zomwe zimapereka mitsempha yamagazi zimapanikizika, zomwe zimayambitsa kuperewera kwa mpweya chifukwa cha khansa komanso minofu yoyandikana nayo.

Mwa anthu omwe ali ndi matenda ashuga, omwe ali ndi vuto la insulin, enzyme, pyruvate dehydrogenase, imayatsidwa.

Pa mphamvu kagayidwe, mothandizidwa ndi kwachilengedwenso mankhwala, pyruvic acid amawola kukhala mankhwala omaliza, opangidwa ndi lactic acid. Izi zimabweretsa kuwonjezeka kwa kuchuluka kwa lactic acid m'magazi. Koma mukamamwa mankhwala a hypoglycemic, biguanides, pamakhala kuwonjezeka kwakukulu kwa kuchuluka kwa lactate. Izi ndichifukwa choti mankhwala a gululi amadziunjikira m'chiwindi ndi impso, zomwe zimalepheretsa chimbudzi ndikugwiritsa ntchito lactate ndi ziwalozi.