Glycemic coma: Zotsatira ndi zizindikiro

Ngati kuphwanya kumachitika mu kagayidwe, zinthu zimayamba, limodzi ndi zizindikilo zingapo zosasangalatsa. Kusiya kwawo kwadzidzidzi nthawi zina kumabweretsa kufa.

Mavuto oterewa amathanso kuchitika mwa kulephera kwa kagayidwe kazakudya, kamene kamachitika nthawi ya matenda ashuga. Nthawi zambiri ndi matenda oterewa, kuchuluka kwa glucose amadziunjikira m'thupi, zomwe zimabweretsa chiwonetsero cha hyperglycemia. Matendawa ndi amtundu wa matenda ashuga a 2.

Ndipo odwala omwe amadalira insulin, hypoglycemia imachitika kawirikawiri, momwe kuchuluka kwa shuga mumitsempha kumachepa kwambiri. Ngati shuga sangakhale munthawi yake munthawi yake, ndiye kuti chikomokere chitha kukhala chovuta - zomwe zimachitika pomwe chakudya chamafuta chimafika pamavuto ambiri.

Kuopsa kwa vutoli ndikuti kumatha kupangitsa matenda a ubongo, kuperewera ndi dementia. Omwe ali pachiwopsezo chachikulu ndi odwala omwe ali ndi vuto la mtima, momwe shuga yochepa imatha kuyambitsa stroke, hemorrhage ndi myocardium. Chifukwa chake, ndikofunikira kudziwa zomwe glycemic coma ndi hyperglycemia ili, ndi momwe mungapewere izi.

Matenda A shuga a Coma

Nthawi zambiri kukomoka kwa glycemic kumachitika ngati mlingo wa insulin sunali wolondola. Komanso, zomwe zimayambitsa kusokonezeka kwakukuru m'magazi a odwala matenda ashuga zitha kugona moperewera chifukwa cha sulfonylurea komanso kugwiritsa ntchito chakudya chopatsa mphamvu.

Ambiri odwala matenda ashuga ndi hypoglycemic, amakula mwa odwala omwe amadalira insulin omwe ali ndi mitundu yosakhazikika ya matenda ashuga. Kuphatikiza apo, pankhaniyi, ndizosatheka kuzindikira chinthu chakunja chomwe chikuwonjezera kwambiri chidwi cha insulin.

Nthawi zina, kuwonongeka koopsa kumatha kuchitika ndi:

kuledzera kwa thupi,
zolimbitsa thupi,
kusala.

Zomwe zimayambitsa ndizovuta zomwe nthawi zambiri zimakhala ndi shuga. Izi zimaphatikizapo kusagwira bwino ntchito kwamatumbo, impso, chiwindi ndi endocrine matenda.

Koma nthawi zambiri, hypoglycemia imachitika pamene kuchuluka kwa insulin kwadwala kwambiri. Izi zimachitika ngati kuchuluka kwa mankhwalawo amawerengedwa molakwika kapena ngati kwayendetsedwa molakwika (intramuscularly).

Komanso, kuchepa kwambiri kwa shuga kungayambitsidwe chifukwa cha kusowa kwa chakudya chamafuta pambuyo pa kukhazikika kwa insulin. Cholinga china ndikuchita zolimbitsa thupi popanda kugwiritsa ntchito zakudya zopukusa msanga.

Kuphatikiza apo, ena odwala matenda ashuga, kuti apititse patsogolo insulini, amasintha tsamba la jakisoni wa mahomoni, omwe nthawi zambiri amabweretsa bongo. Vuto lina lomwe limadzetsa matenda a glycemic limatha kuchitika mwanjira izi:

mowa
mimba yoyambirira
Kutumphuka kwa insulin-antibody tata, yomwe imathandizira kuti amasulo azigwira ntchito,
mafuta amchiwindi,
insulin mantha omwe amagwiritsidwa ntchito mu zamisala,
zochita zodzipha ndi zina zambiri.

Komanso, hypoglycemia imatha kukhala ndi insulin yambiri, pamene odwala matenda ashuga amachotsedwa pa ketoacidotic chikomokere. Vutoli limachitika ndi vuto la mahomoni.

Chifukwa chake, shuga wopanda magazi amalembedwa ngati kaphatikizidwe ka shuga ndi kuchepa kwa glycogen kuchokera ku chinthu chosagwiritsidwa ntchito m'thupi mu chiwindi sikulipira chiwopsezo cha kuchotsa kwa shuga. Vuto lalikulu la matenda ashuga limapezekanso shuga akamatuluka mwachangu kuposa momwe amapangidwira ndi chiwindi kapena kufinya matumbo.

Ndizofunikira kudziwa kuti sulfonamides nthawi zambiri samayambitsa hypoglycemia. Nthawi zambiri mutamwa gulu ili la mankhwalawa, imawoneka mwa anthu odwala matenda ashuga omwe ali ndi vuto la mtima, impso kapena chiwindi.

Kuphatikiza apo, kugwiritsa ntchito sulfonamides ndi mankhwala ena (salicylates, acetylsalicylic acid) kungathandizire kuti pakhale mpungwepungwe.

Kuphatikizika uku kumabweretsa chakuti mapuloteni a plasma amamangirira sulufilamides, kutulutsa kwawo mkodzo kumachepa, chifukwa chomwe mawonekedwe abwino amapangika chifukwa cha kuwonekera kwa hypoglycemic.

Zizindikiro

Zizindikiro za mitundu yosiyanasiyana ya chifuwa cha matenda ashuga ndizofanana. Chifukwa chake, ndizotheka kuzindikira mtundu wake molondola mothandizidwa ndi mayeso a chipatala ndi mayeso a labotale. Mawonekedwe oyambira akuphatikiza:

phokoso ndi chizungulire mu shuga,
ludzu lalikulu
kusanza ndi mseru
malaise
kusadya bwino
kulephera kudziwa
kukodza pafupipafupi
kugona
mavuto.

Kupsinjika kwakukulu mu shuga kumawonetsedwa ndi chikumbumtima chobisala, kusachita poyambitsidwa ndi chidwi ndi zomwe zikuchitika.

Chithunzi cha chipatala chokhala ndi hypoglycemic coma ndizosiyana pang'ono ndi ketoacidotic ndi hyperglycemic reaction. Pali magawo anayi a shuga wamagazi ochepa, omwe amaphatikizapo hypoglycemia yoyenda mu chikomokere.

Pakumayambiriro, hypoxia ya m'magazi amkati wamanjenje, kuphatikiza cham'mimba cham'mimba, imachitika. Zotsatira zake, wodwalayo amasangalala kwambiri kapena kuvutika maganizo ndipo amasintha. Kufooka kwa minofu, kupweteka mutu, tachycardia, njala ndi hyperhidrosis zimawonekeranso.

Mu gawo lachiwiri lachepetsa shuga m'mitsempha, thukuta kwambiri, diplopia, chisangalalo cha galimoto ndi Hyperemia ya nkhope zimadziwika. Komanso, wodwalayo amayamba kudzilemetsa wokwanira.

Pa gawo lachitatu, kusayenda bwino kwa ma midbrain kumathandizira kukulitsa kamvekedwe ka minofu ndi mawonekedwe a kugwidwa. Nthawi yomweyo, tachycardia, thukuta komanso matenda oopsa. Mwana wa wodwalayo amamuchepetsa, ndipo mkhalidwe wake ndi wofanana ndi khunyu.

Gawo lachinayi ndi kukomoka kwa hypoglycemic, komwe kumayendera limodzi ndi kulakwitsa kwa ubongo wapamwamba. Mawonekedwe ake azachipatala:

kugunda kwa mtima
kulephera kudziwa
tachycardia
thukuta
ana opukusidwa
kuwonjezeka pang'ono kwa kutentha kwa thupi,
kutsegula kwa tendon ndi periosteal Reflex.

Kulephera kugwira ntchito pakoma kumatha kupha munthu chifukwa cha matenda a edema. Zizindikiro zake ndikusokonezeka kwa mtima, kutentha, kusanza, kupuma movutikira komanso kupezeka kwa zizindikiro zodwala.

Hypoglycemia ingathandizire kukulitsa zotsatira zazitali komanso zamakono. Mavuto a pakali pano amapanga maola angapo atachepetsa shuga. Izi zikuwonetsedwa ndi kulowerera kwa myocardial, aphasia, kusayenda bwino kwa magazi m'ziberekero zamagazi.

Ndipo zovuta zazitali zimachitika pambuyo pa masiku awiri kapena ngakhale miyezi ingapo. Izi zimaphatikizapo khunyu, parkinsonism, ndi encephalopathy.

Kuzindikira ndi thandizo loyamba

Pofuna kudziwa mtundu uliwonse wa chikomokere mu matenda a shuga, kuphatikiza pa kukhalapo kwa zizindikiro za zovuta ndi kuyezetsa kuchipatala, kuyesedwa kwa ma labot ndikofunikira. Pachifukwa ichi, magazi ndi mkodzo amatengedwa kuchokera kwa wodwalayo pakuwunikanso mozama komanso zamankhwala amodzi, ndipo kuyezetsa magazi kwa glucose kumachitidwanso.

Kukoma kwambiri kumadziwika ndi kuchuluka kwa glucose m'magazi (oposa 33 mmol / l) ndi mkodzo. Ndi ketoacidosis, ketone imapezeka mu mkodzo, vuto la hyperosmolar coma, kuchuluka kwa plasma osmolarity (wopitilira 350 mosm / l) kumadziwika, ndi hyperlactacidemia yowonjezera lactic acid wapezeka.

Koma mayeso a hypoglycemia akuwonetsa kuchepa kwamphamvu kwa shuga m'magazi. Muno, kugundika kwa glucose kumakhala kochepera 1.5 mmol pa lita.

Pofuna kupewa kukomoka kwa glycemic kuti asadutse patsogolo, anthu odwala matenda ashuga amafunika thandizo la nthawi yake. Mulinso zinthu zingapo izi:

Kuyimba kwa ambulansi.
Wodwala ayenera kuyikidwa pambali pake kuti asawonongeke.
Ngati ndi kotheka, chotsani zinyalala za chakudya pakamwa.
Ngati ndi kotheka, gwiritsani ntchito glucometer muyeso wa shuga.
Ngati wodwala ali ndi ludzu, muyenera kumwa.
Jakisoni wa insulin popanda kuyezetsa magazi ndizoletsedwa.

Ngati zili zodziwika kuti chifukwa chakukula kwa vuto la kuperewera kwa shuga, wodwalayo ayenera kumwa tiyi kapena madzi okoma kwambiri. Ndikwabwino kumwa wodwala ndi supuni.

Maswiti okoma, makamaka oyamwa, odwala matenda ashuga sayenera. Kupatula apo, chakudya cholimba chitha kumamwa nthawi yayitali kuposa njira yadzimadzi. Kuphatikiza apo, pakumizidwa kwa chakudya chamafuta amtunduwu, munthu amatha kuzembetsa kapena kusazindikira.

Koma ngati wodwalayo sakudziwika, ndiye kuti simuyenera kumuthandiza. Kupatula apo, madziwo amatha kulowa mu kupuma thirakiti, ndichifukwa chake imatsamwitsidwa.

Pamaso pa glucagonate, munthu yemwe ali ndi vuto la hypoglycemic amapatsidwa 1 ml yankho kudzera mu ndulu kapena modutsa.

Chithandizo ndi kupewa

Odwala omwe ali ndi zizindikiro za matenda a shuga amakhomedwa kuchipatala mothandizidwa kwambiri. Kuti muzindikire, insulin (yoposa 10-20 magawo) imaperekedwa kwa odwala matenda ashuga asananyamuke. Njira zochiritsira zotsalira zimachitika m'chipatala.

Ngati chomwe chimayambitsa kukomoka chinali kusowa kwa glucose, ndiye kuti 20-100 ml ya glucose solution (40%) imabayidwa kudzera m'mitsempha kwa wodwalayo. Pakakhala mavuto akulu, iv kapena iv glucocorticoids kapena glucagon amapezeka. Komanso, pakhungu, mutha kulowa yankho la adrenaline (0%) mu 1 ml.

Pofuna kupewa kukula kwa kuledzera kwa madzi, wodwalayo amapatsidwa njira yothetsera shuga mu sodium chloride. Ndili ndi chikwangwani chovomerezeka, Mannitol imagwiritsidwa ntchito.

Mankhwala osagwiritsidwa mwadzidzidzi amatengera kutseguka kwa glucose metabolism. Chifukwa chaichi, wodwalayo akuwonetsedwa mu / m kasamalidwe ka Cocarboxylase (100 mg) ndi yankho la ascorbic acid (5 ml). Kuphatikiza apo, wodwalayo amapatsidwa mpweya wothira mpweya komanso mankhwala omwe amathandizira pakugwira ntchito kwa mtima.

Ndizofunikira kudziwa kuti ndi hypoglycemic coma, insulin singagwiritsidwe ntchito. Popeza zimangokulitsa zovuta, zomwe zimatha kufa.

Komabe, ngati wodwala matenda ashuga apezeka ndi hyperglycemia, pamenepo, m'malo mwake, amawonetsedwa ndi insulin. Kuphatikiza apo, sodium bicarbonate ndi NaCl amaperekedwa kwa wodwala.

Panthawi yodwala matenda ashuga, mavuto amakumana ndi mitsempha ya mtima, mtima ndi zotumphukira zamagazi, zomwe zimachepetsa kuyamwa kwa mankhwalawa kuchokera ku minofu yolowerera. Chifukwa chake, gawo loyamba la mlingo wa insulin limabayidwa kudzera m'mitsempha.

Akuluakulu odwala matenda ashuga ali ndi chiwopsezo chachikulu cha kusakwanira kwa coronary. Kuchokera pamenepa zimachitika kuti zitha kutumizidwa ndi inshuwaransi yoposa 100 ya insulin. Komanso, mlingo wa mahomoni umachepetsedwa ndi theka ngati wodwala ali precom.

Kupewa kukomoka kwa glycemic ndi:

kusiya zosokoneza,
machitidwe olondola a tsiku ndi tsiku
kuwongolera ndende yamagazi,
Mankhwala othandizira pakudya, osafuna kudya zakudya zamafuta ambiri.

Kuphatikiza apo, wodwalayo ayenera kumwa ndalama zochepetsera shuga wokwanira muyezo womwe dokotala amafunikira. Amaphunziranso zodwala matenda ashuga ndipo, vuto la hypoglycemia, likhale ndi chakudya chamagulu am'thupi nthawi yomweyo.

Ngati wodwala matenda ashuga amakonda kuchepa kwambiri m'madzi a m'madzi am'magazi, ndiye kuti kuchuluka kwa shuga kumatha kuchuluka mpaka 10 mmol / L. Kuchulukitsa kumeneku ndikotheka chifukwa cha kufooka kwa kufalikira kwa ubongo komanso kuperewera kwa mphamvu ya m'magazi.

Kuti muthe kumwa mankhwala angapo (ma tetracyclines, anticoagulants, salicylates, beta-blockers, anti-tuberculosis), ndikofunikira kuyang'anira kusamala kwa kuchuluka kwa shuga. Kupatula apo, mankhwalawa amathandizira kupanga insulin ndipo amakhala ndi vuto la hypoglycemic.

Pofuna kupewa kuperewera kwa glycemic, zakudya za tsiku ndi tsiku ziyenera kuphatikizapo mapuloteni (50%), chakudya chamafuta ndi mafuta. Kuphatikiza apo, zakudya zopatsa thanzi (maulendo 8 pa tsiku) zimalimbikitsidwa kupatula zonunkhira zotentha, khofi wamphamvu komanso tiyi. Ndikofunikanso kusiya mowa ndi fodya.

Mu kanema munkhaniyi, dokotala amafotokoza mwatsatanetsatane mitundu yonse ya chikomokere cha matenda ashuga ndikupereka malingaliro oyamba ndi thandizo.