Kodi lactic acidosis mu shuga ndi momwe angachiritsire

Ndi kagayidwe kabwinobwino, lactate (womwe umachokera ku lactic acid) ndi pyruvate (womwe umachokera ku pyruvic acid) amapezeka m'magazi. Amalembera 1:10. Ndi matenda operewera, kukhathamiritsa kwa lactate kumawonjezera katatu kapena kupitirira apo, ndikuyambitsa metabolic acidosis, yowonjezereka ndi hypoxia. Pakati pamagazi chimasunthidwa mbali ya acid, yomwe imakulitsa kukana kwa insulin, komwe, kumathandizira kaphatikizidwe ka lactic acid. “Bwalo loyipa” likupanga.

Vutoli limapatsa mphamvu kufalikira kwa pyruvic acid chifukwa chosowa insulini. Izi zimathandizira kuti pakhale kuchuluka kwa lactic acid, komwe kumakhala kovulaza thanzi.

Kuphatikiza apo, chifukwa cha kukana insulini, mahomoni amthupi a contra-metabolism amayamba kupanga mwachangu, omwe amasokoneza kagayidwe ka mafuta ndikuwonjezera kuchuluka kwamafuta acids. Mchitidwewu umakhudza dongosolo lamagetsi amkati ndikuyambitsa zizindikiro za neuropsychiatric.

Intoxication, acidosis ndi kuchepa kwa chinyezi zimatsogolera pakupanga chikumbumtima cha matenda ashuga. Kuledzera kumakulitsidwa ndi kagayidwe kakang'ono kamapuloteni, kamene kamathandizira kuti ma hyperazotemia awonjezeke (kuchuluka kwa zinthu za metabolic m'magazi).

Zotsatira zake ndi:

kufooka
kuwonongeka kwa mtima
kukulira kwa mkulu mantha ntchito.

Ndi lactic acidosis, kupuma ntchito kumachepa (kupuma kwa Kussmaul)

Chilichonse mwazinthu izi zimatha kupha.

Lactic acidosis mu mtundu 2 wa shuga amachitika, monga lamulo, ndi kuphatikiza kwa zinthu zingapo, monga:

kuchuluka kwa lactic acid chifukwa chogwiritsa ntchito ma biguanides (mapiritsi omwe amachepetsa shuga ya magazi), kuwonongeka kwakukulu kwa matenda ashuga, acidosis yochokera kwina,
kuchepa kwa chilolezo cha lactic acid ndi zakumwa zoledzeretsa, ma cell a chiwindi,
kuchepa kwakanthawi kofanana ndi lactic acid ndi biguanides chifukwa cha kuwonongeka kwa impso kapena kugunda kwamitsempha ya radiopaque,
minofu hypoxia chifukwa cha mtima kulephera, mtima matenda, pathologies a zotumphukira mitsempha, matenda a kupuma dongosolo, magazi a mitundu yosiyanasiyana
Zotsatira zomwe zimakwiyitsa kudzikundikira kwa lactic acid (kuwonongeka kwa mphamvu ya thupi, kupweteka kwapakati, kupsinjika, zovuta za matenda ashuga, zaka zopitilira 60, kuvulala kwambiri, matenda okhudzana ndi matenda opatsirana kapena otupa, magazi, matenda a AIDS, ndi zina zambiri),
kusowa kwa thiamine m'thupi (vitamini B 1).

Mimba ndiyomwe imayambitsa matenda a shuga a lactic acid 2

Ndikosatheka kuneneratu kuonekera kwa zovuta izi; zifukwa zonse ndizofanana. Ngati wodwalayo ali pachiwopsezo, ndikofunikira kumwa metformin ndi mankhwala ena onse omwe ali nazo.

Zizindikiro za lactic acidosis zimawoneka mwadzidzidzi, zimakula patangotha maola ochepa ndipo zimabweretsa zovuta zosasintha popanda kulandira chithandizo chamankhwala panthawi yake. Poterepa, palibe omwe amatsogola omwe amawonedwa.

Chizindikiro chokha choyambirira chomwe chimakhala chosiyana ndi lactic acidosis ndi kupweteka kwa minofu (myalgia), pakakhala kulimbitsa thupi kwambiri. Zizindikiro zotsalira zomwe zimayamba kumayambiriro kwa lactic acidosis zitha kukhala zachilengedwe pamavuto osiyanasiyana azaumoyo.

syndromes ululu pamimba,
kutsegula m'mimba, kusanza, kutentha kwa mtima,
yachedwa kutulutsa mkodzo kapena kufafaniza,
kugona, kapena, kusowa tulo,
kufooka
kupuma movutikira
mphwayi
kumverera kolemetsa kuseri kwa sternum.

Khungu lowuma lingasonyeze lactaciadosis

Miyezo ya lactate imachulukira mwachangu, zomwe zimatsogolera ku:

kulipiritsa Hyperventilation chifukwa minofu hypoxia. Izi zimapangitsa kuwoneka ngati kupuma kwamkokomo, komwe kumamveka patali mita angapo, nthawi zina kumasintha kukhala kupuma (Kussmaul kupuma). Mukatulutsa, fungo la ma acetone silimachitika,
kulephera kwamtima kwambiri, komwe sikungathetsedwe ndi njira zonse. Pali dontho lakuthwa la kuthamanga kwa magazi. Zinthuzi zimakulirakulira chifukwa cha phokoso losokoneza mtima, lomwe lingayambitse kuphwanyaphwanya ndi kugwa,
kudzipereka minofu kungodzipereka kumabweretsa kukokana,
kusowa kwa mpweya ndi glucose m'matumbo kumapangitsa mitsempha kutulutsa. Kupezeka kwa kuchuluka kwa excitability (hyperkinesis) kapena paresis kumawonedwa. Makamaka chidwi chimasokonekera. Dera la delirium limasinthidwa ndi stupor,
intravascular coagulation (DIC). Chizindikiro ichi ndichowopsa. Ngakhale atayimitsa kaye zizindikiro za lactic acidosis, ziwalo zamagazi zimapitilizabe kupyola magazi, komwe kungayambitse thrombosis (kufinya kwamitsempha yamagazi). Izi zikuwoneka ndi mawonekedwe a necrosis a zala zamiyendo ndi mbolo mwa amuna. Izi zimakwiyitsa matenda osokoneza bongo, komanso kudula.

Chithunzi cha chipatala cha lactic acidosis ndi chofanana ndi zomwe zimapangitsa kuti thupi lizipezeka pa methanol, acetic acid, salicylates, komanso ketoacidosis.

Kumbukirani kuti thandizo loyamba lomwe limachitika chifukwa cha lactic acidosis limachitika chifukwa chodwala. Kupweteka kwamisempha kumachitika, misempha ya shuga imayesedwa, ndipo ndi kuwonongeka kwakuthwa muumoyo, ambulansi imayitanidwa. Kudzichitira nokha zovuta kumabweretsa zotsatira zoyipa.

Zizindikiro

Diagnosis ya lactic acidosis imachitika kokha kuchipatala ndipo imaphatikizapo:

Mbiri yotenga poyankhulana ndi wodwalayo kapena anthu omwe akutsagana naye.
Kuphunzira kwa zodwala zam'magazi.
Kuyesedwa kwa magazi komwe kumayeza mulingo wa lactic acid, kusiyana kwa anion, ndikuwunikanso boma la acid-base.

Ndi lactic acidosis, mulingo wa lactic m'magazi uyenera kukhala 2.2-5.0 mmol / l, pH m'magazi sayenera kukhala yapamwamba kuposa 7.25. Kuzindikira kumatsimikiziridwa ndi kuchepa kwa bicarbonate kosakwana 18 meq / l komanso kuchuluka kwa anionic disc (kusiyana pakukhazikika pakati pa sodium ndi kuchuluka kwa chloride ndi bicarbonates) oposa 16 meq / l.

Komanso, odwala matenda ashuga lactic acidosis amasiyanitsa ndi:

ketoacidosis, momwe imanunkhira acetone kuchokera pamlomo wamkati ndikuwoneka kwa hyperketonemia ndi ketonuria
uremic acidosis, yomwe imadziwika ndi kuchuluka kwa creatinine m'magazi (kupitirira 180 μmol / l).

Kuzindikira kwa lactic acidosis kuyenera kuchitika mwaukadaulo.

Ku chipatala, ndikofunikira kuthana ndi hypoxia ndi acidosis posachedwa.

Matenda a pH m'magazi amapezeka ndi mtsempha wa magazi a sodium bicarbonate. Mofananamo, zomwe zili za potaziyamu m'magazi, komanso ma pH pazowunikira zimayang'aniridwa. Mankhwalawa amatha kuyambitsa mavuto, mpaka matenda a ubongo. Pachifukwa ichi, njirayi imasinthidwa kuti pH ikhale yotsika kuposa 7.0, mlingo wa mankhwalawa suyenera kupitirira malita awiri patsiku.

Pochotsa wodwalayo chikomokere, mankhwala a trisamine ndi methylene buluu amagwiritsidwa ntchito.

Kuwonongeka kwa hypoxia kutha kuchitika pogwiritsa ntchito mankhwala a okosijeni, komanso makina othandizira mpweya.

Kuphatikiza pa mankhwala a insulin ofunikira, kuthandizira kwambiri komanso monocomponent insulin kumachitika.

Wodwala akamagwiritsa ntchito mankhwala a biguanides nthawi isanayambike, amasamba m'mimba ndikuwapatsanso mankhwala ofunikira (oyambitsa kaboni, ndi zina). Nthawi zina, hemodialysis imagwiritsidwa ntchito popititsa patsogolo kuchoka kwa lactic acid.

Pazinthu zotsutsana ndi mantha, mayankho osintha a plasma ndi adrenergic agonists (Dopamine, Norepinephrine, etc.) amagwiritsidwa ntchito.

Mlingo wochepa wa heparin umachotsa DIC.

Zowonjezera zomwe zimapangitsa lactic acidosis (matenda oopsa, kuchepa magazi, ndi zina) zimathetsedwanso.

Kulankhulana pafupipafupi ndi dokotala kumachepetsa chiopsezo cha zovuta za matenda ashuga

Njira zopewera

Mtundu wachiwiri wa matenda ashuga ndi matenda omwe amafunikira kuwunikira thanzi lanu nthawi zonse:

amapimidwa ndi dokotala nthawi zonse,
osadzisilira. Mankhwala onse ayenera kumwedwa kokha pothandizidwa ndi adokotala. Kupanda kutero, pogwiritsa ntchito bongo mopitirira muyeso, amatha kupanga lactic acid,
Chitani zinthu zoyenera kupewa ndi tizilombo toyambitsa matenda,
kuwunikira kusintha kwamachitidwe azachipatala mukamagwiritsa ntchito biguanides,
kutsatira zakudya, zolimbitsa thupi ndi zochita tsiku ndi tsiku,
zizindikiro zosokoneza zikawoneka, nthawi yomweyo imbani ambulansi.

Nthawi zambiri, wodwalayo amaphunzira za matenda ake a shuga pambuyo podziwa kuti ali ndi lactic acidosis. Mayeso apachaka athandiza kupewa matenda owopsa.

Lactic acidosis - ndi chiyani? Mutha kupeza yankho la funso kuchokera pazomwe zalembedwa m'nkhaniyi. Kuphatikiza apo, zidziwitso pazomwe zimapendekera izi, zoyambitsa zomwe zimachitika komanso njira zomwe zilipo kale zowongolera zidzawonetsedwa kwa inu.

Zambiri zokhudzana ndi matendawa

Chifukwa chake, mutu wa zokambirana zathu ndi lactic acidosis. Ndi chiyani komanso momwe mungachitire? Uku ndikutembenuka komwe hyperlactacidemic coma imakwiya. Vutoli ndilothandiza makamaka kwa odwala matenda ashuga. Kupatula apo, kudzikundikira kwa lactic acid mthupi (pakhungu, ubongo, mafupa am'mimba, ndi zina) kumatha kukulitsa chitukuko. Musanamvetsetse momwe mungapewere zovuta zotere, muyenera kuganizira zomwe zimayambitsa kupezeka kwake.

Zoyambitsa zazikulu

Lactic acidosis (Zizindikiro ndi chithandizo cha matendawa azikambirana pansipa) zitha kuchitika chifukwa cha matenda monga:

matenda opatsirana komanso otupa,
kuvulala kwambiri
kulephera kwa aimpso
uchidakwa wambiri,
pachimake myocardial infaration,
magazi akulu
matenda a chiwindi.

Mwa zina, pakati pazinthu zomwe zimayambitsa lactic acidosis, malo apadera amatengedwa ndi Biguanides. Chifukwa chake, mankhwala ochepetsa shuga, ngakhale atakhala ochepa Mlingo wambiri, atha kuyambitsa izi, makamaka chiwindi kapena impso. Tiyeneranso kudziwa kuti matenda omwe amawerengedwa nthawi zambiri amapezeka ndi chigoba minofu hypoxia, yomwe imayamba chifukwa chokhala ndi nthawi yayitali. Kuphatikiza apo, chomwe chimayambitsa matendawa nthawi zina ndi khansa ya m'magazi ndi njira zina zingapo zotupa. Izi zimaphatikizaponso kulephera kupuma komanso kuchepa kwa thiamine m'thupi.

Lactic acidosis: Zizindikiro za matendawa

Pathology imakula mwachangu ndipo imaphimba thupi lonse maola ochepa. Kuyenera kudziwitsidwa kuti isanayambike matenda a pachimake, wodwalayo nthawi zambiri alibe chilichonse. Ngakhale pali zisonyezo zina zomwe zimatha kumveka kuti magazi alipo ochulukirapo, zizindikirazi ndi izi:

kupweteka kwa minofu
mphwayi
kupweteka kumbuyo kwa sternum,
kupumira msanga
kusowa tulo, kapena, kuwodzera.

Kuphatikiza apo, chizindikiro chachikulu cha matenda amtunduwu chimatchedwa kulephera kwamtima. Kupatula apo, ndi matenda omwe amakhala ovuta chifukwa cha acidity yowonjezereka.

Zizindikiro za lactic acidosis zimawonekera kwambiri ndi matendawa. Pankhaniyi, wodwalayo amamva mseru. Pakapita kanthawi, kusanza kumawonedwa mwa odwala, omwe kupweteka kwambiri pamimba kumalumikizana. Zotheka kuti pakadali pano munthu asalandire thandizo, vuto lake limakula kwambiri. Zikakhala choncho, wodwalayo amasiya kuzindikira zenizeni. Amayamba kuyankha pang'onopang'ono machitidwe a anthu omwe amakhala pafupi naye. Nthawi zina wodwalayo amakhala ndi minyewa ingapo mosiyanasiyana, chifukwa cha kukokana kwake, pomwepo mphamvu yakuwongolera galimoto imayamba kufooka.

Wopumira wa hyperlactacidemic coma ndi kupuma kwakanthawi. Pankhaniyi, palibe fungo lochokera kunja lomwe limawonedwa (mwachitsanzo, monga ketoacidosis). Pambuyo pake munthu amangozindikira.

Lactic acidosis: mankhwalawa

Ndi matenda oterowo, chithandizo chamankhwala chiyenera kukhala ndi cholinga chothetsa mwachangu hypoxia ndi acidosis. Kusamalira mwadzidzidzi kumaphatikizapo njira yovomerezeka ya (sodium) ya sodium bicarbonate (4 kapena 2,5%) mpaka malita awiri patsiku. Pankhaniyi, madokotala amayenera kuyang'aniridwa mwamphamvu ndi pH ndi potaziyamu m'magazi. Kuphatikiza apo, insulin mankhwala kapena monocomponent insulin yovomerezeka imayenera kuvomerezeka kwa lactic acidosis. Monga mankhwala ena owonjezera, madokotala amagwiritsa ntchito intravenous carboxylases (dontho) mu 200 mg patsiku. Kukhazikitsidwa kwa rheopolyglucin, madzi a m'magazi, komanso milingo yaying'ono ya heparin, yomwe imathandizira kukonza kwa hemostasis, imayeneranso.

Kupewa matenda

Yankho la funso: "Lactic acidosis - ndi chiyani?" mukudziwa. Nanga mungapewe bwanji mavuto? Njira zodzitetezera zomwe zimalepheretsa kuchepa kwa hyperlactacidemic coma ndizoletsa hypoxia ndikuwongolera chindapusa cha shuga. Lactic acidosis yochokera kugwiritsidwa ntchito kwa Biguanides imafuna okhwima pa kutsimikiza kwa mankhwala.

Nthawi zambiri, matendawa amapezeka kwa odwala omwe samadziwa za matenda awo a shuga, chifukwa matendawa amapezeka popanda kulandira chithandizo. Pofuna kupewa kuoneka ngati lactic acidosis, mankhwala onse omwe dokotala amakupatsani ayenera kuwonedwa mosamala. M'pofunikanso kuwunika momwe matendawa amayendera, kumayesedwa pafupipafupi ndi zamankhwala, kuyesedwa ndikuchita bwino. Ngati mukukayikira kulikonse kwa lactic acidosis, muyenera kulumikizana ndi endocrinologist osachedwa. Pokhapokha ngati mutha kupewa mavuto osavomerezeka ndikuchotsa zisonyezo zosasangalatsa zomwe zimayenderana ndi matendawa.

Lactate ndi lactic acid, acidosis ndi algorithm yowonjezera acidity. Chifukwa chake, lactic acidosis imapangidwa ngati lactic acid imadziunjikira m'thupi la munthu. Matendawa ndi oopsa kwambiri m'matenda a shuga, chifukwa amatha kupangitsa zovuta zingapo, mwachitsanzo, hyperlactacidemic coma. Popeza izi komanso matenda ena, tikulimbikitsidwa kuti tisamalire zomwe zimayambitsa, zizindikiro, ndi mawonekedwe a mankhwalawa a lactic acidosis mu shuga.

Kodi zimayambitsa lactic acidosis ndi ziti?

Mkhalidwe womwe udalankhulidwa ukhoza kupangidwa chifukwa cha zinthu zosiyanasiyana, mwachitsanzo, matenda am'thupi otupa komanso opatsirana. Kuphatikiza apo, kutaya magazi kwambiri, kupezeka kwa uchidakwa wambiri ndi kuphwanya kwakhungu kwam'mimba kumayesedwa ngati zinthu zazing'ono. Kupitilira apo, akatswiri akuti chifukwa cha mtundu wachiwiri wa matenda ashuga, amatha kutha kuchita izi:

kuvulala kwambiri
kukhalapo kwa kulephera kwa impso,
Matenda a pathological omwe amagwirizana ndi chiwindi.

Zomwe zimatsogolera zomwe zimapangitsa kuti pakhale lactic acidosis ziyenera kuganiziridwa ngati kugwiritsa ntchito Biguanides.Chifukwa chake, nthawi zambiri odwala matenda ashuga amagwiritsa ntchito Metformin. Komabe, ziyenera kukumbukiridwa kuti mu nthawi yomwe yaperekedwa, zizindikiro za matendawa zimapangidwa ndendende mwa odwala omwe nthawi yomweyo amagwiritsa ntchito mankhwala ena. Ili ndiye gulu lotsitsa shuga ndi zomwe zidapangidwira zikuchokera.

Pamaso kuwonongeka kwa impso kapena chiwindi, ngakhale kuchuluka kwakukulu kwa ma guru kungayambitse lactic acidosis.

Mkhalidwe woperekedwa umalumikizidwa ndi kudziunjikira kwa mankhwala m'thupi la munthu.

Kuti muzindikire lactic acidosis mu shuga, ndikulimbikitsidwa kuti mutchere khutu ku zomwe zimapangidwa.

Kuwonetsedwa kwa lactic acidosis mu matenda ashuga kungakhale kusakhalapo kwathunthu, ndipo kusintha kwa boma mwachindunji ku mawonekedwe owopsa kungatenge maola awiri kapena atatu. Odwala matenda ashuga amawona kupweteka m'misempha ndi zizindikiro zina zosasangalatsa zomwe zimawoneka kumbuyo kwa sternum. Lactic acidosis imadziwika ndi mawonekedwe monga kusakonda, kuchuluka kwa kupuma. The mwadzidzidzi kugona ndi kugona mwina.

Kupezeka kwa mtima kulephera kungatchulidwe kukhala chizindikiro chapadera cha mtundu waukulu wa acidosis. Ndikulimbikitsidwa kuti:

kuphwanya koteroko kumalumikizidwa ndi contractility, yomwe imadziwika ndi myocardium pakukonzekera lactic acidosis,
zina lactic acidosis limatha kumalumikizidwa ndi kuwonongeka kwamtsogolo kwakukulu,
Komabe, atawonjezera kuchuluka kwa acidosis, kupweteka pamimba, komanso kusanza, akuzindikiridwa.

Ngati vuto la matenda ashuga lactic acidosis (kapena, monga ena amanenera, lactic acidosis) likukula m'tsogolo, ndiye kuti matendawa amatha kukhala osiyanasiyana. Sitingathe kulankhula za areflexia, komanso paresis (chosakwanira ziwalo) kapena hyperkinesis (kusunthasuntha kwamisempha yosiyanasiyana).

Zizindikiro za chikomokere ndi lactic acidosis

Atangotsala pang'ono kumayambiriro kwa chikomokere, komwe kumalumikizidwa ndi kusokonezeka kwa chikumbumtima, wodwala matenda ashuga amatha kupezeka ndi kupuma kwamphamvu komanso phokoso losagwirizana ndi dongosolo la kupuma. Ndizachilendo kuti fungo la asetone silimayambitsa lactic acidosis. Nthawi zambiri, kupuma koteroko kumapangidwa ndi mtundu wachiwiri wa metabolic. Kuyang'aniridwa kuyeneranso kulipidwa kuuma kwa zimagwira pang'onopang'ono komanso dera la lilime, khungu lophatikizika, lomwe lingatanthauzenso kuyambika kwa chikomokere.

Njira zodziwira lactic acidosis mu odwala matenda ashuga

Njira zodziwonera lactic acidosis yokhala ndi zizindikiro zonse zomwe zaperekedwa zimakhala zovuta. Ichi ndichifukwa chake zizindikiro za matenda zidzatengedwe, koma kokha ngati kusiyanasiyana kothandizirana. Poganizira izi, ndikulimbikitsidwa kuti mutchere khutu chifukwa chakuti ndizowona zam'magazi zomwe zimakhala ndi kudalirika kokhazikika, zomwe zimatengera kuzindikirika kwa zizindikiro za lactic acid m'magazi.

Kuphatikiza apo, akatswiri ayenera kuzindikira zizindikiro monga kuchepa kwa kuchuluka kwa bicarbonate m'magazi, kuchuluka kwa hyperglycemia, komanso kusowa kwa acetonuria.

Pambuyo pa izi ndizotheka kuyambitsa maphunziro athunthu obwezeretsa, ndipo ndikulimbikitsidwa kuti nthawi ndi nthawi muzifufuza momwe zinthu ziliri.

Zochizira

Ndi zizindikiro za pathology ndi lactic acidosis yokha, chisamaliro chodzidzimutsani chidzakhala mu njira yolumikizira yankho la sodium bicarbonate (4% kapena 2,5%). Mavoliyumu omwe akuyembekezeka ayenera kukhala okwanira malita awiri patsiku. Ndikulimbikitsidwa kuti nthawi zonse muziyang'anira kuchuluka kwa pH mpaka potaziyamu m'magazi.

Kuphatikiza apo, pamaso pa lactic acidosis ndi zizindikiro zake, chithandizo cha insulin chimayambitsidwa ngati njira yochira. Ponena zamankhwala, ndikofunikira kuti mutchere khutu kuti:

ikhoza kukhala yamitundu iwiri, yomwe ndi yogwiritsa ntchito ma genetic opangira ma algorithm kapena chithandizo chokhala ndi monocomponent pogwiritsa ntchito "insulin" yayifupi
mankhwalawa zizindikiro za lactic acidosis mu shuga, kugwiritsa ntchito njira ya carboxylase pogwiritsa ntchito njira yotsekemera ndikovomerezeka. Izi ndizowona poyambitsa pafupifupi 200 mg mu maola 24,
Chithandizo cha mankhwalawa chikuphatikizira kupaka magazi a m'magazi komanso kugwiritsa ntchito heparin pang'ono.

Izi zonse mtsogolo ziyenera kuthandiza kukonzanso kwa heestasis. . Kuti odwala matenda ashuga a lactic acidosis asamagwirizanenso ndi zovuta komanso kuti asakuze zochitika za anthu odwala matenda ashuga, timalimbikitsidwa kwambiri kuchita nawo njira zina zodzitetezera.

Kodi miyezo yoletsa diabetesic lactic acidosis ndi iti?

Cholinga chachikulu cha njira zodzitetezera ku matenda omwe aperekedwawa tiyenera kuiganizira ngati kupatula vuto lokhala ndi vuto la kugona. Ndikulimbikitsidwa kwambiri kuti mupewe chilichonse chomwe chingaphatikizidwe ndi hypoxia. Kuphatikiza apo, kulingalira kwa kayendetsedwe ka chiwongolero cha matenda a shuga, ngakhale atakhala koyamba kapena mtundu wachiwiri, sikunapatsidwe kufunika kofanana kwambiri ndi kapangidwe ka kupewa.

Ndizofunikira kudziwa kuti lactic acidosis, zizindikiro zazikulu zomwe, monga tanena kale, zimatha kugwiritsidwa ntchito pogwiritsa ntchito Biguanides, zimafunikira kudziwa bwino. Izi ndizofunikira kwambiri chifukwa cha kufafaniza mwachangu ngati pali matenda obwera palimodzi, mwachitsanzo, chibayo.

Chifukwa chake, lactic acidosis ndi vuto losasangalatsa kwambiri latsamba lomwe limatha kutsagana ndi matenda ashuga.

Nthawi zambiri, icho komanso chizindikiro chilichonse chimayamba mosayembekezereka komanso mwachangu, zimayambitsa kukomoka. Ichi ndichifukwa chake ndikofunikira kwambiri kutchera khutu ku zomwe zikuwonetsa munthawi yake komanso osanyalanyaza chithandizo chanthawi yake - zonsezi zimathetsa kukula kwa zovuta ndi zotsatirapo zovuta.

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Kodi dzina la "shuga" limatanthauzanji?

Ndi mahomoni ati omwe ndi osakwanira mtundu 1 shuga?

Ndi chizindikiro chiti CHONSE Chopanda matenda a shuga?

Kodi chifukwa chachikulu chakukhazikitsidwa kwa matenda a shuga 2 ndi chiyani?

Lactic acidosis imakhala yovuta, yomwe imayamba chifukwa cha kudzikundikira kwa lactic acid m'matumbo, khungu ndi ubongo, komanso kukula kwa metabolic acidosis. Lactic acidosis imayambitsa kukula kwa hyperlactacidemic coma, chifukwa chake, mankhwalawa ndi othandiza pakati pa odwala matenda a shuga, omwe ayenera kudziwa zomwe zimayambitsa matenda.

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:

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.
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 . Thupi ili limakhala la kanthawi kochepa chabe ndipo limangopita lokha ikapuma.
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 limapatsa katundu mthupi, motero nkovuta 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 (phokoso limamveka patali), mothandizidwa ndi momwe thupi limayesera kuchotsa lactic acid mthupi, ndipo DIC imawonekera (intravascular coagulation). Ndipo pali zizindikiro zakugwa: choyamba, oliguria imayamba (kutsika kwa mkodzo), kenako anuria (osakodza). Nthawi zambiri pamakhala mawonekedwe a hemorrhagic necrosis ya zala zakutsogolo.

Lactic acidosis mankhwala

Zizindikiro za lactic acidosis zikuwoneka, thandizo loyambirira kwa thupi la munthu liyenera kuperekedwa mwachangu, lomwe limapangidwa kudzera m'mitsempha ya 4% kapena 2,5% ya sodium bicarbonate (mpaka 2000 ml patsiku). Mankhwala, kugwiritsa ntchito insulin mankhwala kwa nthawi yayitali kapena kugwiritsa ntchito mankhwalawa. M'chipatala, makonzedwe a carboxylase amagwiritsidwanso ntchito (kugwiritsidwa ntchito mwa mtsempha - 200 mg patsiku). Kuphatikiza apo, yankho la reopoliglyukin, madzi a m'magazi, heparin (yaying'ono) Mlingo.

Lactic acidosis imakhala yovuta, ngakhale ndiyosowa. Vutoli limachitika pamene zili za lactic acid m'magazi ziziunjikana, kupitirira zizolowezi.

Dzina lina la matendawa ndi lactic acidosis (kusintha kosintha kwa acidity). Mu shuga mellitus, kuphatikizika kumeneku ndi kowopsa kwambiri, chifukwa kumabweretsa chikomokere kwa hyperlactacidemic.

Mankhwalawa amayika kuwunika kwa "lactic acidosis" ngati kuchuluka kwa lactic acid (MK) mthupi kupitilira 4 mmol / l.

Pomwe mulingo wabwinobwino wa asidi (womwe umayezedwa mu mEq / l) wamagazi a venous amachokera ku 1.5 mpaka 2.2 ndipo magazi owonjezera amachokera ku 0.5 mpaka 1.6. Thupi labwino limatulutsa MK pang'ono, ndipo limagwiritsidwa ntchito nthawi yomweyo, ndikupanga lactate.

Lactic acid imadziunjikira m'chiwindi ndipo imang'ambika m'madzi, mpweya wa monoxide ndi glucose. Ndi kudzikundikira kwa lactate yambiri, zotuluka zake zimasokonekera - lactic acidosis kapena kusintha kosangalatsa mumalo ac acid kumachitika.

Izi zimakulanso popeza insulin imayamba kugwira ntchito. Kenako, kukana insulini kumalimbikitsa kupanga mahomoni apadera omwe amasokoneza kagayidwe ka mafuta. Thupi limasowa madzi, kuledzera kwake ndi acidosis kumachitika. Zotsatira zake, chikomero cha hyperglycemic chimapangidwa. Kuledzera kwambiri kumatha chifukwa cha zovuta zomanga thupi.

Mitundu yambiri ya zinthu za metabolic imadziunjikira m'magazi ndipo wodwalayo amadandaula:

kufooka wamba
kulephera kupuma
mtima kulephera
kupsinjika kwa mtima kwamanjenje.

Zizindikiro izi zimatha kupha.

Zizindikiro

Matendawa amawonekera mwadzidzidzi, amakula msanga (maora angapo) ndipo popanda kulandira chithandizo kwakanthawi kachipatala kumabweretsa zotsatirapo zoyipa. Chizindikiro chokhacho cha lactic acidosis ndi kupweteka kwa minofu, ngakhale kuti wodwalayo sanachite zolimbitsa thupi. Zizindikiro zina zomwe zimatsagana ndi lactic acidosis mu matenda osokoneza bongo zimatha kukhala zodziwika mu matenda ena.

Monga lamulo, lactic acidosis mu shuga imayendera limodzi ndi izi:

chizungulire (kutayika kwa chikumbumtima),
nseru ndi kugwedezeka
kupweteka mutu kwambiri
kupweteka kwam'mimba
kuphwanya mgwirizano
kupuma movutikira
chikumbumtima
maluso ofooka a magalimoto
kukodza pang'onopang'ono, mpaka kuthe.

Kuphatikizika kwa lactate kumawonjezeka mwachangu ndikupita ku:

kupuma kwamkati, nthawi zina kumasanduka kubuula,
kukanika kwa mtima, komwe sikungathetsedwe mwanjira zonse.
kutsitsa (lakuthwa) kuthamanga kwa magazi, kulephera kwamtima;
pachimake minofu kukokana (kukokana),
magazi akutaya. Matenda owopsa kwambiri. Ngakhale zizindikiro za lactic acidosis zikatha, ziwalo zamagazi zimapitilirabe kuyenda m'matumbo ndipo zimatha kuyambitsa magazi. Izi zimayambitsa necrosis ya chala kapena kuyambitsa gangore,
kuperewera kwa mpweya m'maselo a muubongo omwe amapanga hyperkinesis (Chimwemwe). Chidwi cha wodwalayo chimabalalika.

Kenako pamakhala kukomoka. Ili ndiye gawo lomaliza pakupanga matendawa. Kuwona kwa wodwalayo kumachepa, kutentha kwa thupi kumatsikira mpaka madigiri 35.3. Maso a wodwalayo amawoloweka, kukodza kumatha, kenako amatha.

Ndikofunika kukumbukira kuti zoyamba za matendawa zimafunikira kuchipatala. Maluwa atayamba kuwonekera, muyenera kuyeza glucose ndikuyitanira ambulansi!

Makanema okhudzana nawo

Mutha kudziwa zomwe zovuta za shuga zimayambitsa vidiyo iyi:

Kufunsira thandizo la kuchipatala pa nthawi, mutha kupulumutsa moyo wanu. Lactic acidosis ndi zovuta zobisika zomwe sizingatheke kuloledwa pamiyendo. Chigawo chokhala ndi vuto la lactic acidosis coma ndichabwino kwambiri kwa wodwala. Kuyesayesa kulikonse kuyenera kuchitidwa kuti zisadzachitikenso. Vutoli limathetsedwa ndi endocrinologist. Dokotala amayenera kuthandizidwa atangodziwa kuchuluka kwa acid mu minofu.

Chithunzi cha kuchipatala

Kukula kwa lactic acidosis mu matenda a shuga kumachitika m'maola ochepa, ndipo palibe zowonekera mwachipatala. Wodwala angamve izi:

kupumira msanga
kufooka
mphwayi
kugona kapena kugona,
kupweteka kumbuyo kwa sternum
kupweteka kwa minofu
Zizindikiro za dyspeptic (nseru, kusanza, kutentha kwa mtima).

Ine.e.Zizindikiro zomwe zimawonedwa m'matenda ambiri zimathandizira kuzindikira.

Posachedwa, chifukwa cha kuchuluka kwa acidosis, zizindikiro zakulephera kwamtima zimayamba kuchuluka. Pakadali pano, kusintha kwamapangidwe amkati mwa myocardial minofu kumapangidwa, komwe kumawonetsedwa ndikusokonekera kwa ntchito zake za kulera.

Ndi kupita patsogolo kwa njira ya pathological, zochitika zambiri za wodwalayo zimawawa, kupweteka kwam'mimba kumawonekera. Mofulumira, zizindikiro zamanjenje zimalumikizana - areflexia ndi paresis, mpaka hyperkinesis.

Gawo lomaliza la pathogenesis la lactic acidosis ndi chikomokere. Nthawi isanayambike kukomoka imadziwika ndi izi:

khungu lowuma la mucous wodwala,
kulephera kudziwa
kupuma kwamphamvu komwe kumamveka patali (kupuma kwa Kussmaul).

Ndi kukulira kwa zovuta za chikomokere, zizindikiro zakugwa zimayambika, ndimatenda aimpso (oligoanuria, otsatiridwa ndi anuria). Nthawi zambiri njirazi zimatsatiridwa ndi DIC (intravascular coagulation), yomwe imafotokozedwa mu intravascular thrombosis ndipo pambuyo pake imatsogolera ku hemorrhagic necrosis pazala zakumapeto.

Lactic acidosis imatha kupezeka ndi kuyesedwa kwa magazi komwe kumawonetsa kuchuluka kwa lactate, kuchepa kwa bicarbonates ndikusunga alkalinity.

Izi zovuta za matenda ashuga zimafuna chisamaliro chamankhwala. Njira zoyambira ziyenera kuyesedwa kuti zithetse mzere woyipawu, ndipo chifukwa chake ndikofunikira:

Kulimbana ndi hypoxia,
Kuthetsa acidosis.

Kusintha matenda a pH ndi kusinthitsa zochita za lactic acid, sodium bicarbonate solution (koloko) nthawi zambiri amagwiritsidwa ntchito. Yankho limalowetsedwa kudzera m'mitsempha, osapitilira malita awiri patsiku, motsogozedwa ndi potaziyamu m'magazi komanso kusintha kwa pH. Pambuyo pa izi, chithandizo cha mankhwala obwezeretsedwayo chimachitika, chomwe chimaphatikizapo izi: