Matenda a shuga ketoacidosis: zimayambitsa, Zizindikiro, mankhwala

Matenda a shuga a matenda ashuga ketoacidosis (DKA) ndiwopseza kwambiri a matenda ashuga. Zizindikiro zake zimaphatikizira kusanza, kupweteka kwam'mimba, kupuma movutikira, kukodza pokoka, kufooka, kusokonezeka, komanso nthawi zina kugona. Mpweya wa munthu umatha kukhala ndi fungo linalake. Kukhazikika kwa zizindikiro kumachitika mwachangu.

Kodi matenda ashuga a ketoacidosis ndi chiyani

Matenda a diabetesic ketoacidosis (DKA) ndi omwe amayamba chifukwa cha kuchepa kwa madzi m'thupi chifukwa cha kuperewera kwa insulin, shuga yayikulu magazi, ndi ma organic acid omwe amatchedwa ketones.
Shuga ketoacidosis imalumikizidwa ndi kuphwanya kwakukulu kwamapangidwe amthupi, omwe amachotsedwa ndi chithandizo choyenera.
Matenda a matenda ashuga ketoacidosis nthawi zambiri amapezeka mwa anthu omwe ali ndi matenda amtundu wa 1, koma amatha kupezeka mwa aliyense amene ali ndi matenda ashuga.
Popeza matenda amtundu woyamba a shuga amakhudza anthu osakwana zaka 25, matenda ashuga a ketoacidosis amapezeka kawirikawiri mgulu laka, koma matendawa amatha kupezeka ali ndi zaka zilizonse. Amuna ndi akazi amakhudzidwa chimodzimodzi.

Zomwe zimayambitsa matenda a kishuga Ketoacidosis

Matenda a diabetes ketoacidosis amachitika munthu amene ali ndi matenda ashuga. Popeza poyankha izi, kupsinjika kwa thupi kumachitika, mahomoni amayamba kuphwanya minofu, mafuta ndi ma cell a chiwindi kukhala glucose (shuga) ndi mafuta acids ogwiritsa ntchito ngati mafuta. Ma mahomoniwa amaphatikiza glucagon, mahomoni okula, ndi adrenaline. Mafuta amafuta awa amasinthidwa kukhala ma ketoni ndi njira yotchedwa oxidation. Thupi limadyanso minofu yake, mafuta, ndi ma cell a chiwindi kuti apange mphamvu.

Mu matenda ashuga a ketoacidosis, thupi limachoka ku kagayidwe kabwinobwino (pogwiritsa ntchito mafuta ngati mafuta) kupita kumalo anjala (kugwiritsa ntchito mafuta ngati mafuta). Zotsatira zake, pali kuwonjezeka kwa shuga m'magazi chifukwa insulin sikupezeka m'mayendedwe a glucose m'maselo kuti adzagwiritse ntchito pambuyo pake. Mwazi wamagazi ukakwera, impso sizitha kupitiliza shuga wambiri mu mkodzo, zomwe zimapangitsa kuti kukodza kuyambe komanso kuchepa thupi. Nthawi zambiri, anthu odwala matenda ashuga ketoacidosis amataya pafupifupi 10% amadzi amthupi awo. Komanso, kukodza kochulukirapo, kutayika kwakukulu kwa potaziyamu ndi mchere wina kumadziwika.

Zomwe zimayambitsa matenda a diabetes ketoacidosis mwa anthu omwe ali ndi matenda ashuga ndi:

Matenda omwe amatsogolera ku m'mimba, kusanza komanso / kapena kutentha,
Mlingo wakusowa kapena wolakwika wa insulin
Omwe apezeka kumene kapena sakudziwika matenda a shuga.

Zomwe zimayambitsa matenda a diabetes ketoacidosis ndi monga:

vuto la mtima (vuto la mtima)
sitiroko
kuvutika
kupsinjika
uchidakwa
kugwiritsa ntchito mankhwala osokoneza bongo
opaleshoni

Maperesenti ochepa okha amilandu omwe alibe vuto lililonse.

Zizindikiro zake za matenda ashuga ketoacidosis

Munthu wodwala matenda ashuga a ketoacidosis akhoza kukumana ndi chimodzi mwa zingapo mwa zotsatirazi:

ludzu kwambiri
kukodza pafupipafupi
kufooka wamba
kusanza
kusowa kwa chakudya
chisokonezo
kupweteka kwam'mimba
kupuma movutikira
Mpweya wa Kussmaul
odwala
khungu lowuma
kamwa yowuma
kugunda kwa mtima
kuthamanga kwa magazi
kuchuluka kwa kupuma
khalidwe zipatso kupuma
kutaya chikumbumtima (matenda ashuga ketoacidotic)

Mukafuna chithandizo chamankhwala

Mukamaonana ndi dokotala:

Ngati muli ndi matenda amtundu uliwonse wa shuga, funsani dokotala wanu ngati muli ndi shuga wambiri (nthawi zambiri amaposa 19 mmol / L) kapena kuwonjezeka kwapang'onopang'ono komwe sikumayankha mankhwala a kunyumba.
Ngati muli ndi matenda ashuga komanso kusanza kumayamba.
Ngati muli ndi matenda ashuga komanso kutentha kwa thupi lanu kwakwera kwambiri.
Ngati mukumva kusowa bwino, yang'anani kuchuluka kwanu kwamkodzo ndi mizere yoyeserera yopanga tokha. Ngati milingo ya mkodzo wa ketone ndi yokwanira kapena yapamwamba, funsani dokotala.

Muyenera kuyitanitsa ambulansi liti:

Munthu wodwala matendawa amayenera kupita kuchipatala chachipatala ngati:

akuwoneka wodwala kwambiri
wopanda madzi
ndi chisokonezo chachikulu
ofooka kwambiri

Ndikofunikanso kuyimba ambulansi ngati munthu wodwala matenda a shuga awonekera:

kupuma movutikira
kupweteka pachifuwa
kupweteka kwambiri pamimba ndi kusanza
kutentha kwambiri (pamwamba pa 38.3 ° C)

Matenda a matenda ashuga ketoacidosis

Kuzindikira kwa matenda ashuga a ketoacidosis nthawi zambiri kumachitika adokotala atalandira mbiri yachipatala ya wodwalayo, kumamuunikira ndikuwunika mayeso a labotale.

Kupanga matenda, kuyezetsa magazi kudzachitika kulemba kuchuluka kwa shuga, potaziyamu, sodium ndi ma electrolyte ena m'magazi. Magulu a Ketone ndi kuyesa kwa impso nthawi zambiri amachitidwa limodzi ndi magazi (kuyeza magazi pH).

Mayeso ena atha kugwiritsidwanso ntchito ngati mufufuza za matenda omwe angayambitse matenda ashuga a ketoacidosis, kutengera mbiri yanu ya zamankhwala ndi zotsatira zoyesedwa. Njira zodziwitsira matenda zimaphatikizapo:

pachifuwa x-ray
electrocardiogram (ECG)
urinalysis
composed tomography ya ubongo (nthawi zina)

Kudzithandiza kunyumba kwa odwala matenda ashuga ketoacidosis

Kusamalira kunyumba nthawi zambiri kumakhala kopetsa matenda a shuga a ketoacidosis komanso kuchepetsa kwambiri shuga komanso magazi okwanira.

Ngati muli ndi matenda a shuga 1, muyenera kuwunika shuga wanu wamagazi monga momwe dokotala amakupangirirani. Chongani shuga yanu yamagazi pafupipafupi pazinthu zotsatirazi:

ngati mukumva bwino
ngati mulimbana ndi matenda
ngati mwadwala posachedwapa kapena mwavulala

Dokotala wanu angakulimbikitseni kulandira chithandizo cha shuga wokwanira pamagazi ndi ma jakisoni ena owonjezera a insulin. Anthu omwe ali ndi matenda ashuga ayenera kukonzekera njira zowonjezera jakisoni wowonjezera wa insulin, komanso kuwunika pafupipafupi magazi a mkodzo ndi maukodzo amkodzo pochiritsira kunyumba, pamene misempha ya magazi ayamba kukwera.

Khalani atcheru kuti muone ngati muli ndi matenda ndikusunga madzi abwino pomwa madzi okwanira opanda shuga tsiku lonse.

Matenda a shuga a ketoacidosis

Mafuta obwezeretsanso komanso kupatsidwa mankhwala a insulin ndi njira yoyamba komanso yovuta kwambiri yodwala matenda ashuga a ketoacidosis. Magawo awiri ofunikawa amachotsa kuchepa kwa madzi m'thupi, kutsika kwa magazi m'magazi ndikubwezeretsanso shuga komanso ma elekitirodi. Madzimadzimadzi amayenera kuperekedwa mwachisawawa, kupewa kuchuluka kwambiri kwa kukhazikitsidwa kwake komanso mavoliyumu akulu chifukwa choopsa chotupa cha edema. Potaziyamu nthawi zambiri amawonjezeredwa kwa saline kwa intravenous makonzedwe kuti athetse kufooka kwa ma electrolyte ofunikawa.

Kukhazikika kwa insulin sikuyenera kuchepetsedwa - kuyenera kufotokozedwa ngati kulowetsedwa kosalekeza (osati monga bolus - mlingo waukulu womwe umaperekedwa mwachangu) kuyimitsa kupangidwanso kwa ma ketones ndikukhazikitsa minyewa yamtunduwu ndikupereka potaziyamu kumaselo a thupi. Mwazi wamagazi utatsika pansi pa 16 mmol / L, shuga amatha kutumikiridwa molumikizana ndi kayendetsedwe ka insulin kuti muchepetse kukula kwa hypoglycemia (shuga yamagazi ochepa).

Anthu omwe adapezeka ndi matenda ashuga a ketoacidosis nthawi zambiri amalowetsedwa kuchipatala kuti amalandire kuchipatala ndipo amalandilidwa kuchipatala chowonjezera.

Anthu ena omwe ali ndi acidosis yofatsa ndikutayika pang'ono kwamadzimadzi ndi ma electrolyte omwe amatha kumwa madzimadzi pawokha ndikutsatira malangizo achipatala amatha kuthandizidwa mosasamala kunyumba. Komabe, amafunikirabe kutsatiridwa ndi dokotala. Anthu omwe ali ndi matenda a shuga omwe akusanza ayenera kuloledwa kuchipatala kapena kuchipinda chodzidzimutsa kuti awonenso ndi kulandira chithandizo.

Pankhani ya kuchepa kwakuthupi kwam'mimba ndi malire a matenda ashuga a ketoacidosis, mutha kuthandizidwa ndikupita kunyumba kuchokera ku dipatimenti yadzidzidzi ngati ndinu wodalirika ndikutsatira malangizo onse a dokotala.

Ngakhale mutalandira chithandizo kunyumba kapena kuchipatala, ndikofunikira kupitiliza kuyang'anitsitsa shuga yanu yamagazi ndi miyeso ya ketone ya urine. Mwazi wokwera wamagazi uyenera kuyang'aniridwa ndi milingo yowonjezera ya insulin ndi madzi ambiri opanda shuga.

Kusamalidwa kwakanthawi yayitali kuyenera kuphatikizapo zochita zomwe zingapangitse kuti magazi azithamanga. Unamwino umaphatikizapo kuwunika ndi kuwunika zovuta za matenda a shuga poyerekeza ndi kuyezetsa magazi a hemoglobin A1C, impso ndi cholesterol, ndikuwunika koyesa kwameso kwa odwala matenda ashuga komanso kuwunika pafupipafupi (kuzindikira mabala kapena kuwonongeka kwa mitsempha).

Momwe mungapewere matenda ashuga a ketoacidosis

Zochita zomwe munthu wodwala matendawa angatenge kuti apewe matenda a diabetesic ketoacidosis ndi monga:

Kuwunikira mosamala ndi shuga la magazi, makamaka mukakhala ndi matenda, kupsinjika, kupsinjika kapena matenda ena akulu.
Ma jakisoni owonjezera a insulin kapena mankhwala ena a shuga monga momwe dokotala wanenera,
Onani dokotala posachedwa.

Kuzindikira komanso kusokonezeka kwa mankhwala

Ndi chithandizo chowononga, anthu ambiri omwe amadwala matenda a shuga a ketoacidosis angayembekezere kuchira kwathunthu. Milandu yakufa ndiyosowa kwambiri (2% ya milandu), koma imatha kuchitika pamene matendawa sanalandiridwe.

Ndizothekanso kukula kwa zovuta chifukwa cha matenda, kuwonda ndi kuwonongeka kwa mtima. Mavuto omwe amadza chifukwa cha matenda ashuga a ketoacidosis ndi monga: