Kodi lactic acidosis: kufotokozera ndi zoyambitsa lactic acidosis

Lactic acidosis ndi osowa kwambiri, owopsa owopsa chifukwa cha zina matenda (matenda kapena syndromes).

ICD-10	E87.2
ICD-9	276.2
Diseasesdb	29145
Medlineplus	000391
eMedicine	nkhani / 768159
Mesh	D000140

Zambiri

Choyambitsa chachikulu pakukula kwa chikhalidwe chowopsya ichi (kufa kwake kumachokera ku 50 mpaka 90% ya milandu yonse) ndikudziunjikira kwambiri kwa lactic acid m'madzi am'magazi komanso zotumphukira zamisempha yamanjenje. Kuwala kwake kumapangitsa kuchepa kwa acidity ya magazi osakhalitsa.

Lactate imapangidwa m'thupi mkati mwa kuwonongeka kwa glucose - gwero lalikulu la chakudya chamagulu, zinthu zofunika pazomwe zimagwira ntchito kwamanjenje ndi ubongo. Njira imeneyi imatchedwa anaerobic metabolism.

Titha kunena kuti lactic acidosis ndi gawo la thupi la munthu pamene njira yolowera m'magazi a lactic acid imachitika mwachangu kwambiri kuposa kuchotsedwa kwake.

Zimayambitsa lactic acidosis

matenda obadwa nawo a metabolism (methylmalonic acidemia, mtundu 1 glycogenosis),
kholo (kudutsa m'mimba thirakiti) makonzedwe akulu a fructose,
kugwiritsa ntchito ethylene glycol kapena methanol,
pheochromocytoma (chotupa cha adrenal gland),
matenda opatsirana opatsirana
kuwonongeka kwambiri kwa chiwindi ndi impso,
kudya kwambiri ma salicylates,
poizoni wa monoxide
uchidakwa wambiri,
magazi akulu
cyanide poyizoni,
dziko lodzidzimutsa
kutenga magogo,
kuchepa magazi m'thupi
khunyu.

Zomwe zimayambitsa

Zotsatira zotsatirazi zimatha kukhala zovutitsa zomwe zimakhudza kuchuluka kwa thupi la lactic acid mu matenda a shuga:

minofu hypoxia (kufa ndi njala ya oxygen) ndi kuchuluka kwa thupi,
kulephera kupuma kwapadera (kusagwira ntchito),
kusowa kwa mavitamini (makamaka gulu B),
kuledzera
infaration chachikulu myocardial,
kuwonongeka kwaimpso,
magazi akutuluka
zaka kuyambira 65,
mimba

Mkulu woyambitsa chitukuko cha lactic acidosis ndi njala yokhala ndi mpweya (hypoxia). Pansi pa vuto lakuchepa kwa mpweya, kuphatikizika kwa lactic acid kumachitika (kumayambitsa kusokonekera kwa lactate ndi anaerobic glycolysis).

Ndi magawo omwe alibe mpweya wa oxygen, ntchito ya enzyme yomwe imayambitsa kusintha kwa pyruvic acid kukhala acetyl coenzyme A Inayamba, asidi a pyruvic amasintha kukhala lactate (lactic acid), yomwe imatsogolera lactic acidosis.

Gawo loyambirira. Lactic acidosis mu gawo loyambirira limadziwonetsa lokha. Zizindikiro zotsatirazi zimawonedwa:

kupweteka mu peritoneum,
kufooka wamba
akukumbutsa
zimbudzi zotayirira.

Chizindikiro chokhacho kumayambiriro kwa vuto lomwe lingapangitse munthu kuti aganize za lactic acidosis ndi myalgia (kupweteka kwa minofu), makamaka atatha kulimbitsa thupi kwambiri.

Gawo lapakati. Momwe kuchuluka kwa lactic acid kumasonkhanira, kukulitsa kwa hyperventilation syndrome (DHW) kumayamba. Ndi DHW, pali kuphwanya kusinthana kwa mapapu, komwe kumapangitsa kuti mpweya wambiri ukhale m'magazi. Kupuma kwa Kussmaul kumayamba kupangika, kumadziwika ndi zochitika zazing'ono, zamkati, kupuma kwambiri komanso mpweya wambiri. Kupuma kotereku kumayendera limodzi ndi phokoso.

Pakati gawo lactic acidosis, zizindikiro za mtima kulephera (ochepa hypotension) zimawonekera, zomwe, kuchuluka, kungayambitse kugwa (dontho lakuthwa mu kuthamanga kwa magazi). Potengera maziko awa, kukula kwa oliguria.Kuda nkhawa kwamagalimoto kumayamba, delirium, womwe umasinthidwa ndi chikumbumtima (chosokonezeka chikumbumtima) chotsatira kutsekemera.

Mochedwa. Lactocytadic chikomokere. Kwa lactic acidosis, kusowa kwamadzi sichinthu wamba, popeza zizindikiro za matendawa zimayenda mwachangu kwambiri, kuyambira gawo loyamba mpaka lomaliza, ndi maora ochepa okha omwe amatha.

Zizindikiro

Ndikovuta kwambiri kuzindikira lactic acidosis. Chithunzi cha matendawa chikuwonetsedwa ndi ma labothemic maphunziro a magawo a magazi. Kafukufukuyu akuwonetsa kuchuluka kwa lactate, ndipo mukamawerenga data-based state state, kuwonjezereka kwa nthawi ya anionic ya plasma kumapezeka. Zotsatirazi zikuwonetsa kukhalapo kwa lactic acidosis:

kuchuluka kwa lactate mu seramu magazi ukufika 2 mmol / l (ndi muyezo wa 0,4-1.4),
kuchuluka kwa ndende ya bicarbonate kumakhala ndi zochepera 10 mmol / l (zomwe zili pafupifupi 20),
kuchuluka kwa zinthu za nitrogen zomwe zimakhala ndi mapuloteni zimachulukitsa (hyperazotemia),
Zizindikiro za kuchuluka kwa lactic ndi pyruvic acid 10: 1,
kuchuluka kwachulukidwe ka lipid (hyperlipidemia),
pH yamagazi imagwera pansi 7.3.

Pofuna kuchiritsa lactic acidosis, njira zoyambirira zachipatala ndizofunikira kuthana ndi zovuta zamagetsi, acidosis, kugwedezeka ndi hypoxia. Malangizo othandizira odwala matenda a carbohydrate ndikuchizira matenda ofanana, omwe amatha kukhala othandizira kuwoneka kwa lactic acidosis, amachitika.

Njira yothandiza kwambiri yopangira kuchuluka kwa lactic acid mu zotumphukira zimakhala ndi hemodialysis.

Kuti athetse kukhathamira kwa mpweya wa monoxide, womwe umachitika chifukwa chophwanya ufulu wa pH, wodwalayo amakhala ndi vuto lochita kupukusira m'mapapo. Kwa wodwala uyu ndikulimba.

Kuchitira lactic acidosis ndikuchepetsa mulingo wa lactate mthupi, ndikofunikira kuwonjezera kukulitsidwa kwa pyruvate dehydrogenase ndi glycogen synthetase. Pazomwezi, kulowetsedwa kwa glucose (5-12,5 g / h) amathandizira pakhungu nthawi yomweyo ndikufupikitsa insulini (imayendetsedwa ola limodzi mu magawo a 2-4-6).

Kuyambiranso kwa alkaline intracellular bwino kumachitika ndi kuchepa kwa kaboni dayokisi mu plasma mpaka 25-30 mm RT. Art. Izi zimathandizira kuchepa kwa asidi lactic.

Kuphatikiza apo, mankhwala a cardio- ndi vasotonic amalembedwa, ndi mawonekedwe awo a hemodynamic amatengedwa. Pa pH yotsika 7.0, 2,5-5% sodium bicarbonate imayendetsedwa kudzera mu mankhwalawa (mankhwalawa amaperekedwa pang'onopang'ono, pogwiritsa ntchito dontho la voliyumu ya 100 ml). Nthawi yomweyo, kuwongolera kuchuluka kwa potaziyamu ndi kuchuluka kwa pH m'magazi kumayang'aniridwa nthawi zonse.

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

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 kukomoka kwa hyperlactacidemic coma, chifukwa chake kudwala kumeneku ndikofunikira pakati pa odwala matenda a shuga, omwe ayenera kudziwa zomwe zimayambitsa matenda.

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 yamankhwala ndimankhwala 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.

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 zaku malekezero.

Lactic acidosis - pathological mkhalidwe womwe umayamba ndi kulimbikira kwamlingo wa lactic acid m'magazi mpaka 5 mmol / l kapena kuposa. Amawonetsedwa ndi zizindikiro za kuledzera - nseru, kusanza, chizungulire, nkhawa. Pambuyo pake, kulephera kupuma ndi kupsinjika kwamphamvu m'mapapo, kusokonezeka mu mawonekedwe a stupor ndi chikomokere ndi khalidwe. Njira zazikulu zodziwitsira matenda ndi kuyezetsa magazi a magazi ndi mkodzo. Chithandizo chimaphatikizapo hemodialysis, makina mpweya wabwino, shuga njira kulowetsedwa, mankhwala kukonza matenda ophatikizika.

Lactic acidosis ku Latin imatanthawuza "lactic acid". Vutoli limatchulidwanso kuti lactacidemia, lactic coma, hyperlactatacidemia, lactic acidosis. Mu ICD-10, matenda am'mimba amaperekedwa ku gulu la zovuta zamagulu amchere wamchere ndi acid-base (kalasi - matenda a Endocrine system). Ili ndi vuto losowa kwambiri. Zomwe ziliri zenizeni sizinadziwike, koma zapezeka kuti pafupifupi theka la ovutikawo amapezeka mwa odwala omwe amapezeka ndi matenda a shuga.Pakati pagulu la odwala, malinga ndi kafukufuku wakunja, pafupipafupi lactic acidosis ndi 0.006-0.008%. Kukula kwa zovuta sikudalira kuti ndi amuna kapena akazi, kumakhala kolembetsedwa kwambiri mwa anthu azaka 35 mpaka 84.

Lactic acidosis imatha kupangidwa chifukwa cha kuchuluka kwa lactate, kusakwanira kwake kudzera mu impso tubules komanso / kapena kusokonezeka kwa metabolic mu chiwindi, momwe kuwonongeka kwa pyruvate komanso mapangidwe a glucose omwe amapangira mankhwala osagwirizana ndi carbohydrate. Zomwe zimayambitsa ma metabolic akusuntha ndi:

Herederal matenda a kagayidwe. Pali mtundu wa acidosis wofunitsitsa. Ndi izo, kuphwanya kumawonedwa pamlingo wa michere yofunika ya metabolism ya carbohydrate, zizindikiro zimawonedwa pambuyo pobadwa.
Matenda a shuga. Nthawi zambiri kudzikundikira kwa lactate kumachitika chifukwa cha kugwiritsidwa ntchito kwa Biguanides - mankhwala a hypoglycemic. Kuopsa kwa kuphwanya kumawonjezeka ndi kuchepa kwa chiwindi ndi impso, kuperewera kwa mpweya wa minofu mutatha kuchita masewera olimbitsa thupi, kupuma kwamatenda, kuchepa kwa vitamini, kumwa mowa, komanso kutenga pakati.
Matenda a mtima. Lactacidemia imapangidwa m'magulu a mtima, omwe amalemedwa ndi mavuto azungulire, pambuyo pa mtima kugwiritsa ntchito AIK, ndi sepsis, hypovolemic ndi cardiogenic mantha ndi DIC. Zizindikiro za acidosis zikuchulukirachulukira.
Momwe mungakhazikitsire. Lactic acidosis imatha kudwala khansa (makamaka ndi pheochromocytoma), mwa odwala omwe ali ndi chikomokere. Vutoli limapangidwanso chifukwa cha zotupa zambiri za impso ndi chiwindi.
Intoxication. Chiwopsezo cha lactic acidosis chimawonjezeka ndi uchidakwa. Kwa omwe kudya kwa carbon monoxide, ethylene glycol, methanol, mchere wa salicylic ndi hydrocyanic acid, mankhwala ena a chlorides.

Lactic acidosis amadziwika ndi kulimbikira kwamphamvu kwa lactic acid, ochepa magazi acidization. Lactic acid ndi gwero lamphamvu, koma, mosiyana ndi glucose, kagayidwe kake kamapezeka anaerobically (popanda kuphatikiza okosijeni pazomwe zimachitika). Amapangidwa ndi maselo ofiira am'magazi, minofu yam'mimba, minofu ya pakhungu ndi dongosolo lamanjenje lamkati, impso, m'mimba mucous membrane, retina, ndi chotupa neoplasms. Kupititsa patsogolo kwa lactate nthawi zambiri kumachitika chifukwa cha hypoxia, pomwe kusintha kwa glucose kukhala adenosine triphosphate kumakhala kosatheka.

Kuphatikiza apo, lactic acidosis imachitika chifukwa chosagwiritsa ntchito acid ndi impso ndi chiwindi. Njira yayikulu yogwiritsira ntchito pathological ndi kuphwanya gluconeogeneis, komwe nthawi zambiri mkaka wa lactate umasinthidwa kukhala glucose kapena oxidized kwathunthu mu mawonekedwe a citric acid synthesis reaction. Njira yowonjezera yochotsera - chotseka kudzera mu impso - imayendetsedwa pomwe gawo lactic acid lofanana ndi 7 mmol / l. Ndi cholowa lactic acidosis, zolakwika zobadwa nazo mu kaphatikizidwe ka michere zofunika kuti ziwonongeke za pyruvic acid kapena kutembenuka kwa mankhwala osapatsa carbohydrate kukhala glucose.

Malinga ndi kukula kwa chithunzichi, kuopsa kwa maphunzirowa kumasiyanitsa magawo atatu a lactic acidosis: koyambirira, pakati komanso mochedwa. Kukula kwawo kumachitika mwachangu kwambiri, patangopita maola ochepa zizindikiritso zimayamba kukula. Kugawika kwina kumakhazikitsidwa pamachitidwe a etiopathogenetic omwe amayambitsa kupanikizika. Malinga ndi izi, mitundu iwiri ya hyperlactatacidemia imasiyanitsidwa:

Wopeza (mtunduA). Nthawi zambiri chimatha pambuyo 35 zaka. Zimayambitsidwa ndikuphwanya kwa kuperekera kwa oksijeni ndi magazi ku zimakhala. Zizindikiro zamankhwala zokhala ndi metabolic acidosis zimawonedwa - Ntchito za CNS ndizolepheretsa, kupuma kwamphamvu komanso kugunda kwa mtima kumasintha. Ubale wolunjika pakati pa mulingo wa lactacidemia ndi zizindikiro zamitsempha zimayang'aniridwa.Ndi matenda a shuga, pamakhala kuthekera kwakukulu kokulira, kuchepa kwakukulu kwa kuthamanga kwa magazi.
Congenital (mtunduB). Amawonekera kuyambira pobadwa, nthawi zambiri kuyambira paubwana, amatanthauza mitundu yamatenda a metabolic. Kuyambira masiku oyamba amoyo, mitsempha ndi kupuma zimatsimikizika: myotic hypotonus, areflexia, stupefaction, dyspnea, polypnoea, zizindikiro za mphumu.

Chitukuko cha pachimake pamakhala pachimake pazopeza lactatacidemia, chithunzi chonse cha chipatala chikuchitika mu 6-18 maola. Zizindikiro za zomwe zatsogola nthawi zambiri zimakhala palibe. Pa gawo loyamba, acidosis imadziwonetsa yosakhala makamaka: odwala amawona kufooka, chidwi, kupweteka kwa minofu ndi chifuwa, kusokonezeka kwa m'mimba mwanjira ya kusanza, chimbudzi, ndi kupweteka kwam'mimba. Gawo lapakati limaphatikizidwa ndi kuwonjezeka kwa kuchuluka kwa lactate, motsutsana ndi kumbuyo komwe kumachitika zochitika zamapapu. Ntchito yosinthana ndi mpweya m'mapapu imasokonezeka, kaboni dioksidijini imadziunjikira m'thupi. Kusintha kwa kupumira ntchito kumatchedwa kupuma kwa Kussmaul. Kusinthana kwazinthu zazing'ono zamiyendo yokhala ndi mpweya wozama komanso kupuma kwamphamvu kumawonedwa.

Zizindikiro za mtima wozama komanso kuperewera kwa mtima kumapezeka. Kwa odwala, kuthamanga kwa magazi kumachepa kwambiri, hypotension ikukwera nthawi zonse, kungayambitse kugwa. Kupanga mkodzo kumachepa, oliguria amakula, kenako anuria. Zizindikiro zosiyanasiyana zamitsempha zimawululidwa - areflexia, spastic paresis, hyperkinesis. Kuchulukitsa nkhawa zamagalimoto, delirium. Pakutha kwa gawo lapakati, DIC imachitika. Thrombosis yokhala ndi zotupa za hemorrhagic necrotic nthawi zambiri imapezeka. Pomaliza, psychomotor mukubwadamuka m'malo mwa stupor ndi chikomokere. Ntchito yamanjenje, yamtima, yopuma komanso kwamikodzo imalephereka.

Ndi mtundu B lactic acidosis, Zizindikiro zimakonda kupezeka masiku oyamba amoyo. Kusokonezeka kwa kupuma kukuonekera pang'onopang'ono: dyspnea - kufupika kwa mpweya, kumva kusowa kwa mpweya, polypnoea - kupuma kwapang'onopang'ono, mikhalidwe ngati mphumu - kutsokomola, milomo, kuvuta kupumira mkati ndi kunja. Pakati pazisonyezo zamitsempha, kuchepa kwa minofu, areflexia, kukokana kwina, magawo a chikumbumtima chotsimikiza amakhazikika. Pali kukanidwa kwa chifuwa ndi chosakanikirana chopanga, kusanza pafupipafupi, kupweteka kwam'mimba, zotupa pakhungu, kuwunika kosalekeza. M'tsogolomu, nthawi zambiri amachedwetsa kukhazikika m'malingaliro ndi thupi.

Lactic acidosis ndiowopsa chifukwa cha chiwopsezo chachikulu cha matenda a edema ndi kufa. Mwayi waimfa umachulukirachulukira pokhapokha pakakhala chithandizo chamankhwala pakubwera maola ochepa atatha zizindikiro. Vascular hypotension ndi hypoxia ya ubongo imatsogolera pakupanga matenda osiyanasiyana a ubongo, kuchepa kwa mitsempha. Pambuyo pachimake nthawi, odwala amadandaula kwa nthawi yayitali, chizungulire. Pakhoza kukhala mawu osokoneza ndi kukumbukira, komwe kumafunikira njira zodzikonzera.

Kuyeserera kwa odwala kumachitika mwadzidzidzi. The endocrinologist ikuchita diagnostics, ndipo kufunsira kwa neurologist kumawonjezeranso mankhwala. Lactic acidosis ndi yovuta kwambiri kuzindikiritsa mwakuthupi - Zizindikiro zimasiyana, m'magawo onse kupweteka kwamisempha kokha. Chithunzi chonsecho ndi chofanana ndi mitundu ina ya encephalopathy, yomwe imakhala ndi hypoglycemia, panthawi yomwe kukula kwa lactate kumakhala kwabwinobwino. Kuzindikira kumatsimikiziridwa pamaziko a kafukufuku wambiri wa labotale. Mulinso:

Kuyesa kwamwazi wamagazi. Imachitika pofuna kudziwa kusintha kwa kagayidwe kachakudya kosakanikirana ndi lactic acid ndi glucose.Mlingo wa lactate woposa 3 mmol / l, kuchuluka kwa glucose komanso mankhwala okhala ndi nayitrogeni, kuwonjezeka koperewera kwa kuchuluka kwa lipids, kuchuluka kwa lactic ndi pyruvic acid ndi 1:10.
Kuwerenga zamkati zamkodzo. Malinga ndi deta yomaliza, kusungidwa kwa impso komanso kuchuluka kwa lactate excretion kumadziwika. Zotsatira za Urinalysis zikuwonetsa kuchuluka kwa acetone, glucose.
Magazi pH. Kuyesa kumakupatsani mwayi kuti muwone momwe mpweya ndi oxygen zimakhalira. Ndi lactatacidemia, kuchuluka kwa ndende ya bicarbonate kumakhala kochepera 10 mmol / l, mtengo wa pH umachokera ku 7.3 mpaka 6.5.

Therapy ya kobadwa nako mawonekedwe lacticacidemia ikuchitika magawo. Choyamba, kusinthana kwa acidotic mu pH bwino kumachotsedwa, pambuyo pake zakudya zapadera zimalembedwa: Matenda a gluconeogenesis amawongoleredwa ndi kudyetsa pafupipafupi kwa mwana wamafuta omwe amakhala ndi zakudya zopatsa thanzi, kusokonezeka kwa gawo la oxidation la pyruvate kumafuna kuchuluka kwa mafuta muzakudya, zomwe zili zawo ziyenera kufikira 70% ya zopatsa mphamvu za tsiku ndi tsiku. Chithandizo cha mitundu yotengedwa ya lactic acidosis imapangidwira kubwezeretsa bwino kwa electrolyte, kuphatikiza acidosis, hyperglycemia, kugwedeza ndi kuperewera kwa mpweya. Ndondomeko zotsatirazi zimachitika:

Hemodialysis, kulowetsedwa. Kuyeretsa magazi kunja kwa thupi ndiyo njira yothandiza kwambiri yolumikizira mkaka wa magazi m'thupi. Njira yothetsera shuga imaperekedwanso kudzera m'mitsempha. Mofananamo, jakisoni wa insulin amachitidwa. Kuphatikizika kotere kumapangitsa ntchito ya pyruvate dehydrogenase ndi glycogen synthetase enzymes.
Mpweya wabwino wam'mapapo. Kuchotsa kwa kaboni monoxide wopangidwa chifukwa chophwanya mulingo wa pH kumachitika mwa njira yamagetsi yothandizira. Kuyambiranso kwamchere wa alkaline kumachitika pamene kuchuluka kwa mpweya wa mpweya m'madzi a m'magazi kumatsika mpaka 25-30 mm RT. Art. Makina amachepetsa ndende ya lactate.
Kumwa mankhwala a mtima. Mankhwala a gululi amalimbikitsa kulera kwa minofu ya mtima, kubwezeretsa mzere. Cardiac glycosides, adrenergic agents, omwe si glycoside cardiotonics amagwiritsidwa ntchito.

Zotsatira za lactic acidosis zimakonda bwino ndi chithandizo chokwanira cha matenda oyambitsidwa, kuperekera nthawi komanso kukwanira kwa kulowetsedwa. Izi zimatengera mtundu wa lactacidemia - kupulumuka ndikokwera pakati pa anthu omwe ali ndi mtundu wa A pathology (otenga). Kupewa kumachepetsa kupewa hypoxia, kuledzera, kulandira chithandizo choyenera cha matenda ashuga mosamala kwambiri pakulimbana ndi matenda a biguanides ndikuwathetsedwa kwawo posachedwa pokhudzana ndi matenda omwe akuphatikizana (chibayo, chimfine). Odwala ochokera m'magulu omwe ali ndi chiwopsezo chachikulu - omwe ali ndi matenda a shuga limodzi ndi pakati, okalamba - ayenera kuwunika mosamala mkhalidwe wawo, pazizindikiro zoyambirira za kupweteka kwa minofu ndi kufooka, pitani kuchipatala.

Lactic acidosis mu mtundu 2 matenda a shuga: Zizindikiro ndi mankhwala a lactic chikomokere

Kodi lactic acidosis ndi chiyani komanso kuti matendawa ndi otani a shuga - mafunso omwe amatha kumveka kawirikawiri kuchokera kwa odwala a endocrinologist. Nthawi zambiri funsoli limafunsidwa ndi odwala omwe ali ndi mtundu wachiwiri wa matenda ashuga.

Lactic acidosis mu matenda ashuga ndi njira yovuta kwambiri yowonjezera matendawa. Kukula kwa lactic acidosis mu matenda ashuga kumachitika chifukwa cha kudzikundikira kwa lactic acid m'maselo a ziwalo ndi minyewa mothandizidwa ndi kulimbitsa thupi kwambiri mthupi kapena kuchitidwa ndi zinthu zoyipa pa munthu zomwe zimapangitsa kuti pakhale zovuta.

Kuzindikira kwa lactic acidosis mu shuga kumachitika ndi ma laboratization a lactic acid m'magazi a anthu. Lactic acidosis imakhala ndi chochitika chachikulu - kuchuluka kwa lactic acid m'magazi ndi kopitilira 4 mmol / l ndipo mawonekedwe a ion ndi ≥ 10.

Mwa munthu wathanzi, lactic acid imapangidwa yaying'ono tsiku ndi tsiku chifukwa cha zochita za metabolic m'thupi. Pulogalamuyi imakonzedwa mwachangu ndi thupi kupita ku lactate, yomwe, ikalowa m'chiwindi, imapitilanso kukonzedwa. Kudzera magawo angapo pokonza, lactate imasinthidwa kukhala kaboni dayokili ndi madzi kapena kukhala glucose ndimapangidwe amodzi a bicarbonate anion.

Ngati thupi liziunjikira lactic acid, ndiye kuti lactate imalephera kutulutsidwa ndikukonzedwa ndi chiwindi. Izi zimapangitsa kuti munthu ayambe kupanga lactic acidosis.

Kwa munthu wathanzi, kuchuluka kwa lactic acid m'magazi sikuyenera kupitilira chizindikiro cha 1.5-2 mmol / l.

Nthawi zambiri, lactic acidosis imayamba mtundu wachiwiri wa matenda ashuga odwala omwe, motsutsana ndi matenda omwe amayambitsidwa, adakumana ndi myocardial infarction kapena stroke.

Zifukwa zazikulu zomwe zimathandizira kukulitsa lactic acidosis mthupi ndi izi:

kuperewera kwa mpweya ndi minyewa ya thupi ndi ziwalo za thupi,
kukula kwa magazi m'thupi,
magazi obwera chifukwa chotaya magazi ambiri,
kuwonongeka kwambiri kwa chiwindi
kukhalapo kwa kulephera kwa aimpso, kukulitsa pamene mukutenga metformin, ngati pali chizindikiro choyamba kuchokera pamndandanda womwe watchulidwa,
kulimbitsa thupi kwambiri,
kupezeka kwa zochitika zadzidzidzi kapena sepsis,
mtima kumangidwa
kupezeka kwa thupi la matenda osachiritsika a shuga komanso ngati mankhwala opatsirana mwa matenda ashuga atengedwa,
kupezeka kwa zovuta za matenda ashuga m'thupi.

Kupezeka kwa matenda am'mimba kumatha kupezeka mwa anthu athanzi chifukwa cha momwe zimakhudzira thupi la munthu mikhalidwe ina komanso kwa odwala matenda a shuga.

Nthawi zambiri, mkaka acidosis imayamba kukhala ndi matenda ashuga motsutsana ndi njira yosalamulirika ya shuga.

Kwa odwala matenda ashuga, thupi ili ndi losafunikira komanso loopsa, chifukwa pamatha izi.

Lactic acid chikomaso chimatha kupha.

Mu matenda a shuga lactic acidosis, zizindikiro ndi zizindikilo zimatha kukhala motere:

chikumbumtima
kumva chisoni,
kulephera kudziwa
kumverera kwa nseru
maonekedwe akusanza ndikusanza lokha,
kupumira pafupipafupi komanso kwanthawi yayitali
Maonekedwe a ululu m'mimba,
maonekedwe ofooka kwambiri m'thupi lonse.
kuchepa kwamagetsi,
Kukula kwa lactic coma.

Ngati munthu ali ndi mtundu wina wa matenda a shuga, ndiye kuti matendawa amatuluka kwakanthawi patatha zizindikiro zoyambirira.

Wodwala akagwa, amakhala kuti:

Hyperventilation
kuchuluka glycemia,
kutsika kwa kuchuluka kwa ma bicarbonate m'madzi a m'magazi komanso kuchepa kwa magazi pH,
ma ketoni ochepa amadziwika mkodzo,
mulingo wa lactic acid m'thupi la wodwalayo umakwera mpaka 6.0 mmol / l.

Kukula kwa zovuta kumachitika kwambiri ndipo mkhalidwe wa munthu wodwala matenda a shuga 2 umakulirakulira pang'onopang'ono kwa maola angapo otsatizana.

Zizindikiro zomwe zimayenderana ndi kupezeka kwa vutoli ndizofanana ndi zovuta zina, ndipo wodwala yemwe ali ndi matenda ashuga amatha kugwa ndimisempha yochepa komanso yowonjezera ya shuga mthupi.

Kuzindikira konse kwa lactic acidosis kumakhazikika pa kuyesa kwa magazi.

Chithandizo ndi kupewa lactic acidosis pamaso pa matenda a shuga

Chifukwa chakuti kupanikizika kumeneku kumayamba chifukwa cha kuchepa kwa mpweya m'thupi, njira zochiritsira zochotsa munthu pamkhalidwewu ndizokhazikitsidwa ndi pulani ya maselo a minofu yaumunthu ndi ziwalo zokhala ndi mpweya. Pachifukwa ichi, zida zojambula zam'mapapo zolimbitsa thupi zimagwiritsidwa ntchito.

Mukamachotsa munthu ku mtundu wa lactic acidosis, ntchito yayikulu ya dotolo ndikuchotsa hypoxia yomwe yachitika m'thupi, chifukwa ndi ichi makamaka chomwe chikuyambitsa lactic acidosis.

Pakukonza njira zochizira, kupanikizika ndi zizindikiro zonse zofunika za thupi zimayang'aniridwa. Kuwongolera kwapadera kumachitika ngati anthu achikulire amachotsedwa m'boma lactic acidosis, omwe ali ndi vuto lotenga magazi ndipo amakhala ndi zovuta komanso zovuta m'magazi.

Musanazindikire wodwala lactic acidosis, magazi amayenera kutengedwa kuti aunikidwe. Mukuchita kafukufuku wa labotale, pH ya magazi ndi kuyika kwa ayoni a potaziyamu mkati mwake amatsimikiza.

Njira zonse zimachitidwa mwachangu kwambiri, popeza umunthu kuchokera pakukhazikika kwa thupi la wodwalayo ndiwokwera kwambiri, ndipo nthawi yosintha kuchokera ku yachilendo kupita ku matenda ndi yochepa.

Ngati milandu yoopsa ikapezeka, kutumikiridwa kwa potaziyamu kumachitika, mankhwalawa amayenera kuperekedwa pokhapokha magazi acid ali ochepera 7. Kupanga mankhwala popanda zotsatira zoyenera kuyenera kuletsedwa.

Magazi acidity amawunika wodwala maola awiri aliwonse. Kubweretsa potaziyamu bicarbonate kuyenera kuchitika mpaka nthawi yomwe sing'anga ikhale ndi acidity yopitilira 7.0.

Ngati wodwala walephera aimpso, hemodialysis ya impso imachitidwa. Kuphatikiza apo, peritoneal dialysis ikhoza kuchitidwa kuti ibwezeretse yachilendo mlingo wa potaziyamu bicarbonate m'thupi.

Pofuna kuchotsa thupi la wodwala ku acidosis, mankhwala a insulin okwanira komanso utsogoleri wa insulin amagwiritsidwanso ntchito, cholinga chake ndikukonza kagayidwe kazachilengedwe.

Popanda kuyezetsa magazi a biochemical, ndizosatheka kukhazikitsa wodwala wodalirika. Pofuna kupewa kukhazikika kwa matenda am'magazi, wodwalayo amafunika kupereka maphunziro ofunikira kuchipatala zikafika zizindikiro zoyambirira za matenda.

Pofuna kupewa kutukuka kwa lactic acidosis mthupi, mphamvu ya kagayidwe kazakudya m'thupi la wodwala yemwe ali ndi matenda ashuga iyenera kulamulidwa bwino. Kanemayo munkhaniyi akukamba za zoyamba za matenda ashuga.

Chisoni
Kusowa tulo
Kupweteka kwam'mimba
Kupweteka kwa minofu
Kusamvera miseche
Kulephera kwina
Matenda a minofu
Kubweza
Kugona
Kupumira mwachangu

Lactic acidosis, kapena, monga momwe amatchedwanso, lactic acidosis, yomwe imakhumudwitsa hyperlactacidemic coma, imakhala yovuta kwambiri, imathandizanso kwa matenda osokoneza bongo ndipo imayambitsidwa chifukwa cha kudzikundikira kwa lactic acid mthupi (chigoba, ubongo ndi khungu) kwambiri kuchuluka ndi kukula kwa metabolic acidosis. Lactic acidosis, zizindikiro zomwe makamaka zimayenera kudziwika kwa odwala omwe ali ndi matenda osokoneza bongo, zimayambitsidwa ndi zinthu zingapo, zomwe tikambirana pansipa.

Izi zotsatirazi zimayambitsa kukula kwa lactic acidosis:

Matenda otupa komanso opatsirana
Kutulutsa magazi kwakukulu.
Kuledzera kumalephera.
Acute myocardial infaration,
Kuvulala kwambiri
Kulephera kwina
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 matenda a shuga, kumwa mankhwala a antipyretic mtundu ndi kukhalapo kwa thunthu mankhwala. Ngakhale mlingo wake wocheperako wa impso kapena chiwindi ungayambitse lactic acidosis, womwe umathandizidwa makamaka ndikudzikundikira 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 kwachidziwikire kwa hypoxia imatha kukhala khansa ya m'magazi, komanso mitundu ingapo yamachitidwe a chotupa.Izi zimaphatikizaponso kulephera kupuma, kupweteka kwamtima kwamapapo amodzi am'mapapo, matumbo, komanso kuchepa kwa thupi la thiamine.

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. Potengera maziko awa, 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. Mikhalidwe ikaipa 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 matenda a shuga. 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.

Kuzindikira kwa lactic acidosis ndi zizindikiro zomwe tatchulazi ndizovuta kudziwa, ngakhale zimawerengedwa ngati njira yothandizira. Ma labotale ndi odalirika, omwe amachokera pakatsimikiza pankhani iyi ya kuchuluka kwa lactic acid m'magazi, komanso kuchepa kwake kwa bicarbonates ndi reskalinity, hyperglycemia komanso chifukwa cha acetonuria.

Mukamaganiza ndi lactic acidosis ndi zizindikiro zake, chithandizo chimatsimikiziridwa makamaka pakuchotsa kwa hypoxia, komanso acidosis mwachindunji. Chisamaliro chodzidzimutsa cha lactic acidosis ndi zizindikiro zimaphatikizapo kukhazikitsa kwa njira yothetsera sodium bicarbonate (2,5 kapena 4%) ndi voliyumu mpaka mpaka 2 l / tsiku ndi kukapumira. Pankhaniyi, kuwongolera kuyenera kusungidwa ndikuwonetsa kuchuluka kwa pH, komanso zizindikiro za mulingo wa magazi a potaziyamu. Komanso, chithandizo cha lactic acidosis ndi zizindikiro ndizovomerezeka ndi insulin. Monga gawo lina la lactic acidosis ndi zizindikiro zamankhwala, ma carboxylase othandizira amagwiritsidwa ntchito ndi njira yotsika ndikumayambitsa pafupifupi 200 mg / tsiku .. Ndikofunikira kuyendetsa plasma yamagazi, milingo yaying'ono ya heparin, yomwe imathandizira kukonza kwa hemostasis, komanso kukhazikitsa kwa reopoliglukin.

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, zimafuna kukhazikika pakutsimikiza kwa munthu payekha pakulipira mwachangu ngati matenda amtundu wofanana (chimfine kapena chibayo, etc.). Zizindikiro za lactic acidosis ndizofunikanso pankhani ya njira zowonjezera, chifukwa chake, odwala matenda a shuga akamatenga biguanides ayeneranso kuganizira za nkhaniyi.

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

Chitsogozo cha Endocrinology, Mankhwala - M., 2011. - 506 c.
Briscoe Paul Matenda A shuga. Mafunso ndi mayankho (kumasulira kuchokera ku Chingerezi). Moscow, Kron-Press Publishing House, 1997, masamba 201, kufalitsidwa kwa makope 10,000.
Kamensky A. A., Maslova M. V., Chiwerengero A. V. Ma Horone amalamulira dziko. Endocrinology yotchuka, Buku la AST-Press - M., 2013. - 192 c.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka pamalowo kuti athetse zovuta osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusayiti, kukambirana ndi akatswiri ndizofunikira nthawi zonse.

Etiology (zoyambitsa) za lactic acidosis

kuchepa kwa minofu oxygenation - minofu hypoxia. Chofunikira kwambiri chimaphatikizidwa ndi zovuta zamagazi (cardiogenic, septic, hypovolemic shock). Kutheka kwa lactic acidosis mu ochepa hypoxemia, makamaka kwakanthawi komanso kosaya, ndikukaika. Palibenso umboni wachindunji wowonjezera pamlingo wa lactic acid m'magazi okhala ndi vuto la kuchepa magazi ngati palibe zizindikiro zakuya mwadzidzidzi. Komabe, kukhalapo kwa mitundu yonse ya hypoxemia theoretically kumathandizira kukulitsa lactic acidosis. Otsatirawa akuwonetsedwa muzochitika zonse zamatenda owopsa, odwala omwe ali ndi vuto losakhazikika la hemodynamics, kuthandizira kwa inotropic, matenda a compression, ndi zina zambiri. Ndikofunikira kudziwa zoyeserera za CBS ndi njira ya Astrup, kusiyana kwa anionic ndi mulingo wamagazi lactate,
ntchito ya chiwindi chosokoneza imabweretsa kuchepa kwa kuthekera kwake kotembenuza lactic acid kukhala glucose ndi glycogen. Chiwindi chogwira ntchito nthawi zambiri chimatulutsa lactate, ndipo mwa mantha mphamvu izi zimasokoneza.
kusowa kwa thiamine (vitamini B ₁ ) zingayambitse kukulitsa kwa lactic acidosis pakalibe kulephera kwa mtima. Kusowa kwa Thiamine kumadziwika m'mikhalidwe yovuta, nthawi zambiri mwa odwala omwe amamwa mowa kwambiri, ndi chizindikiro cha Wernicke. Kuperewera kwa Thiamine kumathandizira kuwonjezeka kwa lactic acid chifukwa cha kuletsa kwa oxidation wa pyruvate mu mitochondria. Mlingo wa lactate mu seramu yamagazi umakwera kwambiri pakumwa mowa, ndipo patatha masiku 1-3, lactate acidosis imadutsa ketoacidosis,
kuchuluka kwa gawo la dextrorotatory isomer la lactic acid - D-lactic acidosis. Izi zimapangika chifukwa cha zochita za tizilombo tosiyanasiyana tomwe timagwetsa shuga m'matumbo. D-lactate acidosis imakonda odwala pambuyo pamimba: zochulukitsa zam'matumbo, kugwiritsa ntchito anastomoses yamatumbo, etc., komanso mwa onenepa kwambiri. Njira zantchito yantchito zokhazokha zimangolola levorotatory isomer ya lactic acid kuti itsimikizidwe Kukhalapo kwa D-lactate acidosis kuyenera kuganiziridwa mwa odwala omwe ali ndi osakwanira metabolic acidosis komanso kusiyana kwakukulu kwa anionic.Mavuto am'mimba, m'mimba, opaleshoni yam'mimba, mwina dysbiosis, angasonyeze kuphwanya uku. Zikuwoneka kuti matendawa ndiofala, koma nthawi zambiri sawapezeka.
zifukwa zina zomwe zimayambitsa lactic acidosis mu mayunitsi osamalira kwambiri odwala ndi lactic acidosis omwe amagwiritsidwa ntchito ndi mankhwala. Lactic acidosis imatha kuyambitsa infusions wautali wa adrenaline. Adrenaline imathandizira kutha kwa glycogen mu minofu yamafupa ndikuwonjezera kupanga kwa lactate. Kuwonjezeka kwa lactic acidosis kumathandizidwa ndi zotumphukira vasoconstriction, zomwe zimatsogolera ku anaerobic metabolism.

Lactic acidosis imatha kupanga ndi sodium nitroprusside. Kagayidwe kachakudya zimaphatikizidwa ndikupanga ma cyanides, omwe amatha kusokoneza njira za oxidative phosphorylation ndikupangitsa lactic acidosis.

Kupanga kwa cyanide kumatha kuchitika popanda kuwonjezeka milingo ya lactate. Kuchepa kwa kuchuluka kwa lactic acid wokhala ndi hyperventilation wa nthawi yayitali komanso kukhazikitsidwa kwa njira zamchere zamankhwala (zoyambitsidwa lactate acidosis) sizikuwonetsedwa.

matenda obadwa nawo a metabolism (methylmalonic acidemia, mtundu 1 glycogenosis),
kholo (kudutsa m'mimba thirakiti) makonzedwe akulu a fructose,
kugwiritsa ntchito ethylene glycol kapena methanol,
pheochromocytoma (chotupa cha adrenal gland),
matenda opatsirana opatsirana
kuwonongeka kwambiri kwa chiwindi ndi impso,
kudya kwambiri ma salicylates,
poizoni wa monoxide
uchidakwa wambiri,
magazi akulu
cyanide poyizoni,
dziko lodzidzimutsa
kutenga magogo,
kuchepa magazi m'thupi
khunyu.

Pakati pazifukwa zokopa, kudya kwautali kwa agalu kumakhala pamalo apadera. Ngakhale mlingo wocheperako wa mankhwalawa (malinga ndi kukhalapo kwa aimpso kapena kwa chiwindi) ungapangitse mawonekedwe a lactic acidosis.

Pochiza wodwala ndi biguanides, kukula kwa lactic acidosis kumachitika chifukwa cha kusokonekera kwa malowedwe a pyruvic acid (pyruvate) kudzera mmatumbo a ma cell ma cellochondria. Pankhaniyi, pyruvate mwachangu amayamba kutembenuka kuti awoneke.

Zotsatira zotsatirazi zimatha kukhala zovutitsa zomwe zimakhudza kuchuluka kwa thupi la lactic acid mu matenda a shuga:

minofu hypoxia (kufa ndi njala ya oxygen) ndi kuchuluka kwa thupi,
kulephera kupuma kwapadera (kusagwira ntchito),
kusowa kwa mavitamini (makamaka gulu B),
kuledzera
infaration chachikulu myocardial,
kuwonongeka kwaimpso,
magazi akutuluka
zaka kuyambira 65,
mimba

Mkulu woyambitsa chitukuko cha lactic acidosis ndi njala yokhala ndi mpweya (hypoxia). Pansi pa vuto lakuchepa kwa mpweya, kuphatikizika kwa lactic acid kumachitika (kumayambitsa kusokonekera kwa lactate ndi anaerobic glycolysis).

Gawo loyambirira. Lactic acidosis mu gawo loyambirira limadziwonetsa lokha. Zizindikiro zotsatirazi zimawonedwa:

kupweteka mu peritoneum,
kufooka wamba
akukumbutsa
zimbudzi zotayirira.

Chizindikiro chokhacho kumayambiriro kwa vuto lomwe lingapangitse munthu kuti aganize za lactic acidosis ndi myalgia (kupweteka kwa minofu), makamaka atatha kulimbitsa thupi kwambiri.

Pakati gawo lactic acidosis, zizindikiro za mtima kulephera (ochepa hypotension) zimawonekera, zomwe, kuchuluka, kungayambitse kugwa (dontho lakuthwa mu kuthamanga kwa magazi).

Lactic acidosis imakula msanga, koma zizindikiro zake zoyambirira zimatha kukhala matenda osokoneza bongo, kupweteka kwa minofu, angina pectoris. Chochititsa chidwi ndi kusowa kwa zotsatira za kutenga analgesics.

Nthawi zambiri amakayikira kuti iyi ndi lactic acidosis, zizindikiro ngati izi odwala omwe ali ndi matenda ashuga amalola kuda nkhawa, kufooka, adynamia, kupweteka mutu, nseru, kusanza, kukokoloka mpaka kugwa, kupweteka pamimba, kugona, komwe kumakhala kupusa, stupor ndi coma, anuria motsutsana ndi kuphwanya kwa impso.

Khungu limakhala lotumbululuka, cyanotic, zimachitika pafupipafupi. Mtima kulephera, ochepa hypotension, kupuma movutikira, kulimbitsa hyperventilation, kupuma kwa Kussmaul kumachitika.

Popeza chitukuko chake mwachangu, chomwe sichili ndi chikhalidwe cha hyperglycemic, ndikofunikira kusiyanitsa mwachangu lactic acidosis kutha kwa chikumbumtima.

Gome - Kusiyanitsa kwakuzindikira kwa zizindikiro za hyper- ndi hypoglycemic

Chizindikiro	Hypoglycemia	Hyperglycemia
Yambani	Swift (mphindi)	Pang'onopang'ono (maola - masiku)
Misomali, mucous nembanemba	Madzi, otuwa	Zouma
Kutulutsa mawu	Zokwera kapena zabwinobwino	Kutsitsidwa
Belly	Palibe chizindikiro cha matenda	Kutupa, zopweteka
Kupsinjika kwa magazi	Khola	Kutsitsidwa

Lactic acidosis imawonekera chifukwa cha:

Matenda otupa komanso opatsirana,
Kutulutsa magazi kwakukulu,
Uchidakwa wambiri,
Acute myocardial infaration,
Kuvulala kwambiri.
Kulephera kwina
Matenda a chiwindi.

Chofunikira chomwe chimayambitsa lactic acidosis imatenga biguanides, mwachitsanzo, Metformin imatengedwa nthawi zambiri. Pankhaniyi, Zizindikiro za lactic acidosis zimawonekera kwa odwala omwe ali ndi matenda osokoneza bongo, akumamwa mankhwala a gulu lomwe limachepetsa shuga ndi izi.

Ngati impso kapena chiwindi zakhudzidwa, ngakhale mlingo wochepa wa greatuanides ungayambitse lactic acidosis. Vutoli limayambika chifukwa cha kudzikundikira kwa mankhwala m'thupi.

Lactic acidosis imachitika ndi chigoba minofu hypoxia. Hypoxia imatha kuchitika, mwachitsanzo, kuchita masewera olimbitsa thupi kwa nthawi yayitali. Pamafunikanso chithandizo chamankhwala.

Ngati palibe kuwonekeratu kwa hypoxia, ndiye kuti zomwe zimayambitsa matendawa zimakhala khansa ya m'magazi ndi njira zina zingapo zotupa. Zifukwa zina zimaphatikizapo:

Kulephera kopindulitsa
Matenda owopsa a m'modzi mwa mapapu,
Mtsempha wamkati
Kuchepa kwa Thiamine m'thupi.

Lactic acidosis, nthawi zambiri, imalowa m'malo owuma kwambiri, pafupifupi maola angapo. Nthawi zambiri, matendawa amatha kupezeka kwathunthu, koma chithandizo ndichofunikira.

Odwala amazindikira kupweteka kwa minofu ndi zomverera zosasangalatsa zomwe zimawoneka kumbuyo kwa sternum. Lactic acidosis ili ndi zizindikiro izi:

Kuwonetsedwa kwa mtima kulephera ndi zizindikiro zapamwamba za acidosis yayikulu. Kuphwanya koteroko kumakwiyitsa mgwirizano, wokhala ndi myocardium, pomwe lactic acidosis imayamba.

Pambuyo pa izi, lactic acidosis imayambitsa kupundula pang'onopang'ono, momwe, chifukwa cha kuchuluka kwa acidosis, m'mimba amayamba kupweteka, kusanza kumawonedwa.

Ngati wodwala ali ndi vuto lactic acidosis limakulirakulira, ndiye kuti matendawa amatha kukhala osiyanasiyana: kuchokera ku areflexia kupita paresis ndi hyperkinesis.

Atatsala pang'ono kuyamba kwa chikomokere, komwe kumayendera limodzi ndi kusazindikira, wodwalayo amayamba kupuma mofuula ndi phokoso losamveka bwino. Fungo la asitone silimayambitsa lactic acidosis. Nthawi zambiri, kupuma kwamtunduwu kumachitika ndi metabolic acidosis.

mankhwala a biguanides (mankhwala a hypoglycemic),
kuphwanya kayendedwe ka magazi ndi kuperekera kwa okisijeni minofu ndi ziwalo,
mimba odwala matenda ashuga
chimfine, matenda opatsirana,
Kulephera kwa kagayidwe kachakudya,
impso, chiwindi,
ketoacidosis.

Kupweteka kwam'mimba
Kubweza
Kugona
Kusowa tulo
Kupweteka kwa minofu
Chisoni
Kulephera kwina
Matenda a minofu
Kupumira mwachangu
Kusamvera miseche

Matenda otupa komanso opatsirana
Kutulutsa magazi kwakukulu.
Kuledzera kumalephera.
Acute myocardial infaration,
Kuvulala kwambiri
Kulephera kwina
Matenda a chiwindi (aakulu).

Herederal matenda a kagayidwe. Pali mtundu wa acidosis wofunitsitsa. Ndi izo, kuphwanya kumawonedwa pamlingo wa michere yofunika ya metabolism ya carbohydrate, zizindikiro zimawonedwa pambuyo pobadwa.
Matenda a shuga. Nthawi zambiri kudzikundikira kwa lactate kumachitika chifukwa cha kugwiritsidwa ntchito kwa Biguanides - mankhwala a hypoglycemic. Kuopsa kwa kuphwanya kumawonjezeka ndi kuchepa kwa chiwindi ndi impso, kuperewera kwa mpweya wa minofu mutatha kuchita masewera olimbitsa thupi, kupuma kwamatenda, kuchepa kwa vitamini, kumwa mowa, komanso kutenga pakati.
Matenda a mtima. Lactacidemia imapangidwa m'magulu a mtima, omwe amalemedwa ndi mavuto azungulire, pambuyo pa mtima kugwiritsa ntchito AIK, ndi sepsis, hypovolemic ndi cardiogenic mantha ndi DIC. Zizindikiro za acidosis zikuchulukirachulukira.
Momwe mungakhazikitsire. Lactic acidosis imatha kudwala khansa (makamaka ndi pheochromocytoma), mwa odwala omwe ali ndi chikomokere. Vutoli limapangidwanso chifukwa cha zotupa zambiri za impso ndi chiwindi.
Intoxication. Chiwopsezo cha lactic acidosis chimawonjezeka ndi uchidakwa. Kwa omwe kudya kwa carbon monoxide, ethylene glycol, methanol, mchere wa salicylic ndi hydrocyanic acid, mankhwala ena a chlorides.

Zizindikiro za mtima wozama komanso kuperewera kwa mtima kumapezeka. Kwa odwala, kuthamanga kwa magazi kumachepa kwambiri, hypotension ikukwera nthawi zonse, kungayambitse kugwa. Kupanga mkodzo kumachepa, oliguria amakula, kenako anuria. Zizindikiro zosiyanasiyana zamitsempha zimawululidwa - areflexia, spastic paresis, hyperkinesis. Kuchulukitsa nkhawa zamagalimoto, delirium. Pakutha kwa gawo lapakati, DIC imachitika.Thrombosis yokhala ndi zotupa za hemorrhagic necrotic nthawi zambiri imapezeka. Pomaliza, psychomotor mukubwadamuka m'malo mwa stupor ndi chikomokere. Ntchito yamanjenje, yamtima, yopuma komanso kwamikodzo imalephereka.

Ndi mtundu B lactic acidosis, Zizindikiro zimakonda kupezeka masiku oyamba amoyo. Kusokonezeka kwa kupuma kukuonekera pang'onopang'ono: dyspnea - kufupika kwa mpweya, kumva kusowa kwa mpweya, polypnoea - kupuma kwapang'onopang'ono, mikhalidwe ngati mphumu - kutsokomola, kumayimba mluzu, kuliza komanso kutuluka. Pakati pazisonyezo zamitsempha, kuchepa kwa minofu, areflexia, kukokana kwina, magawo a chikumbumtima chotsimikiza amakhazikika. Pali kukanidwa kwa chifuwa ndi chosakanikirana chopanga, kusanza pafupipafupi, kupweteka kwam'mimba, zotupa pakhungu, kuwunika kosalekeza. M'tsogolomu, nthawi zambiri amachedwetsa kukhazikika m'malingaliro ndi thupi.

Hemodialysis, kulowetsedwa. Kuyeretsa magazi kunja kwa thupi ndiyo njira yothandiza kwambiri yolumikizira mkaka wa magazi m'thupi. Njira yothetsera shuga imaperekedwanso kudzera m'mitsempha. Mofananamo, jakisoni wa insulin amachitidwa. Kuphatikizika kotere kumapangitsa ntchito ya pyruvate dehydrogenase ndi glycogen synthetase enzymes.
Mpweya wabwino wam'mapapo. Kuchotsa kwa kaboni monoxide wopangidwa chifukwa cha kuphwanya kwa pH moyenera kumachitika mwa njira yamagetsi yothandizira. Kuyambiranso kwamchere wa alkaline kumachitika pamene kuchuluka kwa mpweya wa mpweya m'madzi a m'magazi kumatsika mpaka 25-30 mm RT. Art. Makina amachepetsa ndende ya lactate.
Kumwa mankhwala a mtima. Mankhwala a gululi amalimbikitsa kulera kwa minofu ya mtima, kubwezeretsa mzere. Cardiac glycosides, adrenergic agents, omwe si glycoside cardiotonics amagwiritsidwa ntchito.

kuchepa kwa magazi pama bicarbonate,
kuchuluka kwa Hyperglycemia,
kusowa kwa acetonuria.

Lactic acidosis: woyamba chizindikiro cha matenda

lilime louma
zipolopolo zowuma
khungu lowuma.

Ndi chizindikiro cha vutoli komanso lactic acidosis imo, chisamaliro chodzidzimutsa chimakhala pakukhazikika kwa yankho la sodium bicarbonate (4% kapena 2,5%) mpaka malita awiri patsiku.

Metformin imagwiritsidwa ntchito ngati matenda a shuga, amatsitsa hyperglycemia, koma samatulutsa hypoglycemia. Mosiyana ndi zotumphukira za sulfonylurea, zomwe zimaphatikizapo mankhwala a sulfonamide, Metformin simalimbikitsa kupanga insulin.

Ngati bongo ndi Metformin mu matenda ashuga, lactic acidosis imatha kukhala ndi vuto lowopsa. Cholinga chake ndi kuchuluka kwa mankhwalawa chifukwa cha kuwonongeka kwa impso.

Ngati zizindikiro za lactic acidosis zikuwoneka, ndiye kuti kuli bwino kusiya kugwiritsa ntchito Metformin. Wodwala amafunikira kuchipatala. Metformin imathetsa hemodialysis muzochitika zamankhwala. Kuphatikiza apo, chithandizo chamankhwala chimachitika.

Hypoglycemia imatha kukhala ngati Metformin imatengedwa ndi sulfonylureas.

Ndikofunikira kuyang'anira ma pH ndi kuchuluka kwa potaziyamu m'magazi.

Kuphatikiza apo, ndi lactic acidosis ndi zizindikiro, insulin yothandizira yogwira mwachibadwa zochita kapena chithandizo chamankhwala chokhala ndi insulin "yofupika" imagwiritsidwa ntchito ngati chithandizo.

Pochiza matenda ndi lactic acidosis, ma carboxylase amathanso kutumikiridwa ndi njira yokhomakhota poyambitsa pafupifupi 200 mg patsiku.

Mothandizidwa ndi michere ya michere ya zamankhwala am'magazi, mamolekyulu a shuga amaphulika ndikupanga mamolekyulu awiri a pyruvic acid (pyruvate).

Ndi mpweya wokwanira, pyruvate imakhala chinthu choyambira kwambiri pazofunikira zazikulu za metabolic mu cell. Pakachitika njala ya oxygen, imasanduka lactate.

Nthawi zambiri, mulingo wa pyruvate ndi lactate ndi 10: 1, mothandizidwa ndi zinthu zakunja, muyezo ungasunthe. Pali chiopsezo cha moyo - lactic acidosis.

minofu hypoxia (kuwopsa kwa poizoni, poyizoni wa kaboni dayokosi, kuchepa magazi kwambiri, khunyu),
njala yopanda minofu ya okosijeni (poyizoni ndi methanol, cyanides, biguanides, kulephera kwaimpso / chiwindi, oncology, matenda oopsa, matenda a shuga).

Kuwonjezeka kwakukulu kwa mulingo wa lactic m'thupi ndi chinthu chomwe chofunikira kuchipatala mwachangu. Mpaka 50% ya milandu yomwe yadziwika ndiyopha!

Ngati ph ndi yotsika kuposa 7.0, njira yokhayo yopulumutsira wodwalayo ndi hemodialysis - kuyeretsa magazi.
Kuti muchepetse CO2 owonjezera, mapangidwe oopsa am'mapapo amafunikira.
M'malo ocheperako, kupezeka kwa akatswiri panthawi yake, dontho la alkaline (sodium bicarbonate, trisamine) ndilokwanira. Mlingo wa makonzedwe amatengera kupanikizika kwapakati kwapakati. Ma metabolism atasintha, mutha kuyamba kutsika lactate m'magazi. Mwa izi, njira zosiyanasiyana zoperekera njira yothetsera shuga ndi insulin zitha kugwiritsidwa ntchito. Monga lamulo, awa ndi magawo 2-8. pa liwiro la ml / h.
Ngati wodwala ali ndi zinthu zina zomwe zimakhudzana ndi lactic acidosis (poyizoni, kuchepa kwa magazi m'thupi), chithandizo chawo chimachitika molingana ndi mfundo yakale.

Momwe matendawo amachira kuchokera ku lactic acidosis ndi osauka. Ngakhale chithandizo chokwanira komanso kupezeka kwa madokotala panthawi yake siziteteza moyo. Chifukwa chake, odwala matenda ashuga, makamaka iwo omwe akutenga metformin, ayenera kumvetsera matupi awo mosamala ndikuwonetsetsa kuti shuga yawo yayandikira.

Pambuyo pakuphatikizika kwa kuchuluka kwa asidi, lactic acidosis imasinthidwa kukhala metabolic acidosis.

Ndikofunikira kwambiri kwa anthu onse omwe ali ndi matenda ashuga kudziwa zizindikiro zazikulu za lactic acidosis.

Zochizira odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, mankhwalawa kuphatikiza metformin biguanide amagwiritsidwa ntchito. Ngati wodwala akudwala matenda a impso, mankhwalawa angayambitse kukula kwa lactic acidosis. Zotsatira zoyipa zoyipa za mankhwala kapena mankhwala osokoneza bongo amatha kuyambitsa mavuto.

Chisamaliro chodzidzimutsa kwa wodwalayo chimachitika ndi njira ya mtsempha wa sodium bicarbonate. Kubwezeretsa pH ya magazi, odwala amatenga Trisamine. Ngati mulingo woyimira acid uli pansipa 7, hemodialysis imachitika.

Pa chithandizo, mawonekedwe a kuthamanga kwa magazi, kuchuluka kwa pH, potaziyamu ndi calcium m'magazi amayang'aniridwa nthawi zonse, electrocardiogram imapangidwa.

Kupanga kwamitsempha yamagazi kapena reopoliglyukin, dontho lokhala ndi carboxylase limachitika. Ma Anticoagulants amathandizidwa kuti achepetse kuchepa kwa magazi. Milingo ya glucose imakhala yofanana ndikulowetsa insulin.

Chithandizo chimasankhidwa mosiyanasiyana payekhapayekha kwa wodwala aliyense, poganizira kuopsa kwa vutolo. Chithandizo cha mankhwalawa chimachitika kuchipatala moyang'aniridwa ndi antchito azachipatala.

Ganizirani zovuta za Biguanides, tengani mankhwala mosamala dokotala,
kulimbitsa chitetezo chokwanira
kuchitira panthawi yake kachilomboka, kuzizira moyang'aniridwa ndi dokotala,
kuyanʻanila kwa endocrinologist.

Odwala omwe ali ndi matenda a shuga a mtundu wa I ndi II ayenera kuyang'anira kuchuluka kwa shuga m'magazi, kuchitira chithandizo, kupewa dokotala.Ndikofunikira kutsatira malingaliro a dokotala, kutsatira zakudya zamafuta ochepa, ndikukhala ndi moyo wathanzi.

Lactic acidosis mu matenda ashuga ndi zotsatira za njira yosalamulira yamatendawa. Zotsatira zake, kagayidwe kachakudya kamasokonekera, ma organic acids amapangidwa m'mitundu yambiri ndipo amadziunjikira minofu ndi ziwalo.

Zomwe zili patsamba lino zimangoperekedwa pazolinga zophunzitsira zodziwika bwino, sizitanthauza chidziwitso komanso kulondola kwa zamankhwala, sikuwongolera kuchitapo kanthu. Osadzisilira.

Dzina la matendawa limapangidwa motere: lactate ndi α-hydroxypropionic (2-hydroxypropanoic) acidosis, acid ndi njira ya oxidation. Kwa odwala matenda ashuga komanso kwa munthu wathanzi, matenda awa amathanso kukhala owopsa, chifukwa ndi omwe amakhala chifukwa chokhazikika cha hyperlactacidemic coma. Kodi izi zikuchitika bwanji?

dontho mu kuthamanga kwa magazi
kufooka
kulephera kwa mtima
Zizindikiro zam'mapapo mwanga,
kulemera m'miyendo
kusanza ndi kusanza
kusokonezeka kwa mtima
kupumira msanga
kugwedeza
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 yemwe ali ndi matenda a shuga akudandaula 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.

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 kwachidziwikire kwa hypoxia imatha kukhala khansa ya m'magazi, komanso mitundu ingapo yamachitidwe a chotupa.

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 matenda a shuga.

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.

1 imasunthira kukamwa. Choopsa kwambiri ndichakuti kagayidwe kachakudya ka odwala omwe akutenga ma biguanides (kutsekeka kwa chiwindi ndi minyewa kumayamba), komwe kumayambitsa lactic acidosis komanso metabolic acidosis.

Gulu

Wogula (Mtundu A). Nthawi zambiri chimatha pambuyo 35 zaka. Zimayambitsidwa ndikuphwanya kwa kuperekera kwa oksijeni ndi magazi ku zimakhala. Zizindikiro zamankhwala zokhala ndi metabolic acidosis zimawonedwa - Ntchito za CNS ndizolepheretsa, kupuma kwamphamvu komanso kugunda kwa mtima kumasintha. Ubale wolunjika pakati pa mulingo wa lactacidemia ndi zizindikiro zamitsempha zimayang'aniridwa. Ndi matenda a shuga, pamakhala kuthekera kwakukulu kokulira, kuchepa kwakukulu kwa kuthamanga kwa magazi.
Congenital (mtundu B). Amawonekera kuyambira pobadwa, nthawi zambiri kuyambira paubwana, amatanthauza mitundu yamatenda a metabolic. Kuyambira masiku oyamba amoyo, mitsempha ndi kupuma zimatsimikizika: myotic hypotonus, areflexia, stupefaction, dyspnea, polypnoea, zizindikiro za mphumu.

Mavuto

Vascular hypotension ndi hypoxia ya ubongo imatsogolera pakupanga matenda osiyanasiyana a ubongo, kuchepa kwa mitsempha. Pambuyo pachimake nthawi, odwala amadandaula kwa nthawi yayitali, chizungulire. Pakhoza kukhala mawu osokoneza ndi kukumbukira, komwe kumafunikira njira zodzikonzera.

Zizindikiro Zofunikira za Lactic Acidosis

Matendawa amapezeka mwachangu kwambiri, popanda zizindikiro zokuchenjezani.Pachimake lactic acidosis imayamba mu maola 2-3 ndipo nthawi yomweyo imayambitsa kuwonongeka kwakukulu, kusiya kuzindikira.

Zizindikiro zakukula kwa lactic acidosis mu mtundu 1 ndi mtundu 2 matenda ashuga:

kupweteka pachifuwa,
minofu, mutu,
kuthamanga kwa magazi
Kupuma kwa Kussmaul (kupuma pafupipafupi, kwamkokomo),
Kutulutsa kwamkodzo,
ulesi, mphwayi,
kusowa kwa vitamini B,
khungu lowuma,
kugona kapena kugona,
kutopa pambuyo poyeserera pang'ono thupi.

Mukadutsa mayeso azachipatala mu seramu yamagazi, kuwonjezeka kwa kuchuluka kwa lactic acid kumapezeka, ndipo mulingo wa asidi-wocheperako umachepetsedwa. Fungo lodziwika bwino la acetone pakupuma silimachitika.

Kodi zizindikiro za lactic acidosis ndi ziti, matendawa amawonetsedwa bwanji, ndipo ndi ziti zazikuluzikulu zake? Wodwalayo akamakula, nseru, kusanza, kupweteka m'mimba kumachitika. Magazi a magazi amayamba, magazi amawundana, hemorrhagic necrosis mu phalanges kumtunda ndi m'munsi malekezero.

Reflexes yawonongeka, minyewa yodzipereka pakhungu imawonekera. Kulephera kwamtima kumayamba motsutsana ndi maziko a kuchepa kwa mpweya m'matenda amisempha, chiopsezo cha sitiroko, kupunduka kwamatumbo, matumbo, mapapu kumawonjezeka.

Lactic acidosis imakwiyitsa ziwalo zamkati ndi machitidwe omwe amatsogolera wodwala kuti afe ngati chithandizo cha chipatala sichinaperekedwe pa nthawi.

Nthawi zambiri amakula bwino (patangopita maola ochepa), oyambitsawa nthawi zambiri samapezeka kapena alibe mawonekedwe. Odwala amatha kupweteka minofu, kupweteka pachifuwa, zizindikiro za kukomoka, kupumira mwachangu, chidwi, kugona, kapena kugona.

Komabe, zomwe zikupezeka mu chithunzi cha chipatala cha lactic acidosis ndi mawonekedwe a kulephera kwa mtima, kuchuluka ndi acidosis, komwe kumachitika masinthidwe amomwe amachitika myocardial contractility.

Mu zochita zazikulu, mkhalidwe wa odwala umakulirakulira: pamene acidosis imachuluka, kupweteka kwam'mimba komanso kusanza zitha kuoneka. Zizindikiro zosiyanasiyana zamitsempha zimawululidwa kuchokera ku areflexia kupita ku spastic paresis ndi hyperkinesis.

Asanayambike chikomokere (kutaya chikumbumtima), ngakhale kuti kunalibe fungo la acetone mu mpweya wotopa (wopanda ketonemia), kupuma kwamiseche kwa Kussmaul kumawonedwa, nthawi zambiri kumayendera limodzi ndi metabolic acidosis.

Kuwonongeka ndi oligo- kenako anuria, hypothermia imayamba. Poyerekeza izi, DIC imayamba (intravascular coagulation syndrome), intravascular thrombosis yokhala ndi hemorrhagic necrosis ya zala ndi zala zakuda ndizofala.

Kukula msanga kwa lactic acidosis (maora angapo) sikuti kumathandizira kuzindikira zizindikilo zokhala ndi vuto la matenda ashuga (khungu lowuma, zimagwira pakamwa ndi lilime). 10-30% ya odwala matenda ashuga ndi hyperosmolar ali ndi zinthu zina za lactic acidosis.

Lactic acidosis kupewa

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, zimafuna kukhazikika pakutsimikiza kwa munthu payekha pakulipira mwachangu ngati matenda amtundu wofanana (chimfine kapena chibayo, etc.).

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

Pofuna kupewa khansa ya lactacidemic chifukwa cha lactic acidosis, ndikofunikira kupewa hypoxia ndikuwongolera kuwongolera pa nthawi ya matenda ashuga.

Lactic acidosis, zomwe zimawoneka ngati mugwiritsidwa ntchito ndi biguanides, zimafuna kutsimikiza kwa Mlingo wake mwachangu pochotsa matenda okhudzana, mwachitsanzo, chibayo.

Lactic acidosis imakhala ndi mawonekedwe poyerekeza ndi njira zosinthira, chifukwa chake, odwala matenda ashuga omwe amagwiritsidwa ntchito ndi Biguanides ayenera kuganizira izi pochita chithandizo.

Ngati pali zokayikitsa zilizonse zomwe zimatsutsana ndi lactic acidosis, muyenera kulumikizana ndi endocrinologist.

Ndimamwa metformin, koma ndimakhala ndi shuga wambiri pafupifupi 8-9 mgmol, sindikudziwa chochita ndi dotolo, namwino amangotilandira pang'onopang'ono, ndipo akuwoneka kuti samamvetsetsa kuti matenda ashuga ndi otani.

shuga amadzuka makamaka pambuyo pamavuto komanso kuphwanya zakudya

pa 67 ndimakhala wokangalika, ndimasambira komanso masewera olimbitsa thupi ndimadya kawiri ndikudya, ndikudikirira mauthenga osasangalatsa

Ndakweza shuga, ndinayamba kumwa mapiritsi a metformin; kupsinjika kumatsikira mpaka 100 ndikuganiza kuti ine, dotolo wazachipatala wodziwa ntchito yayikulu, adandiitanira kuchipatala mokakamizidwa; ndikuopa kuti panali vuto lomwe ndidakumana nalo Ndinkamwa mwachizolowezi chifukwa chamankhwala omwe ndimawaletsa ndipo tsopano ndatsala pang'ono kutaya malingaliro kuti ndichite bwanji chikuwoneka kuti shuga sindigwira ntchito mapiritsi mwina ayenera kuyimitsidwa kumwa iwo osapsa mtima kuposa kugona pansi osazindikira

Nthawi zambiri, chowonjezera cha lactic acid chimawoneka mwa odwala omwe samadziwa za matenda awo a shuga, motero zimachitika mosagwirizana komanso popanda chithandizo choyenera. Mtsogolomo, popewa kuyambiranso lactic acidosis, pamafunika kutsatira mosamalitsa malangizo onse a dotolo, kuwunika mphamvu za chitukuko cha anomaly, kumayesedwa pafupipafupi ndi kuyesedwa.

Mwambiri, wodwala yemwe ali ndi matenda ashuga ayenera kumvetsera mosamala thupi lake ndipo, pazizindikiro zowopsa, itanani ambulansi kapena dokotala.

Ngati mukuganiza kuti muli ndi lactic acidosis ndi zizindikiro zomwe zimadziwika ndi matendawa, ndiye kuti endocrinologist angakuthandizeni.

Tiperekanso kugwiritsa ntchito ntchito yathu yofufuzira matenda omwe ali pa intaneti, yomwe imasankha matenda omwe angakhalepo kutengera ndi zomwe zidalowetsedwa.

Matenda otopa kwambiri (abbr. CFS) ndi mkhalidwe womwe kufooka kwamthupi ndi kwakuthupi kumachitika chifukwa cha zinthu zosadziwika ndipo kumatenga miyezi isanu ndi umodzi kapena kupitirira apo.

Matenda otopa kwambiri, zomwe zimayesedwa kuti zimagwirizanitsidwa kwakanthawi ndi matenda opatsirana, zimagwirizana kwambiri ndi kuthamanga kwa moyo wa anthu komanso kuchuluka kwachidziwitso komwe kumamuvutitsa munthu pakuzindikira.

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.

Alport syndrome kapena cholowa nephritis ndi matenda a impso omwe amabadwa nawo. Mwanjira ina, matendawa amagwira ntchito kwa okhawo omwe ali ndi vuto la chibadwa. Amuna amatenga matenda mosavuta, koma azimayi nawonso amadwala.

Zizindikiro zoyambirira zimawonekera mwa ana kuyambira zaka 3 mpaka 8. Matendawa pawokha amatha kukhala asymptomatic. Nthawi zambiri amapezeka nthawi yoyezetsa kapena pofufuza matenda ena oyambira.

Meningitis yamchiberekero ndi kutukusira kwa membrane wa ubongo. Nthawi zambiri, matendawa amakhala ngati mtundu wina wa chifuwa chachikulu.Palibe chosiyana ndi gulu la anthu omwe adayamba kale ali ndi zotupa zamtundu uliwonse.

Pogwiritsa ntchito masewera olimbitsa thupi komanso kudziletsa, anthu ambiri amatha kuchita popanda mankhwala.

Zizindikiro ndi kuchiza matenda a anthu

Kutenganso zinthu kumatha kokha pokhapokha ngati chilolezo cha oyang'anira chikugwirizana ndi kulumikizana komwe kukuchokera.

Zonse zomwe zaperekedwa zimayang'aniridwa ndi dokotala wanu!

Mafunso ndi malingaliro: Adilesi ya imelo yatetezedwa

Zosasinthika, ngakhale ndi chithandizo chanthawi yake komanso chokwanira, kufa kumapitilira 50%.

Kupewa kumachepetsa kupewa hypoxia, kuledzera, kulandira chithandizo choyenera cha matenda ashuga mosamala kwambiri pakulimbana ndi matenda a biguanides ndikuwathetsedwa kwawo posachedwa pokhudzana ndi matenda omwe akuphatikizana (chibayo, chimfine).

Odwala ochokera m'magulu omwe ali ndi chiwopsezo chachikulu - omwe ali ndi matenda a shuga limodzi ndi pakati, okalamba - ayenera kuwunika mosamala mkhalidwe wawo, pazizindikiro zoyambirira za kupweteka kwa minofu ndi kufooka, pitani kuchipatala.

Zowopsa

Kodi lactate amachokera kuti? Thupi limatha kudzikundikira mthupi: m'matumbo minofu, khungu ndi ubongo. Makamaka kuonjezera kwake kumadziwika pambuyo pakuchita zolimbitsa thupi mwamphamvu (minofu yolimba, kupweteka komanso kusasangalala).

Ngati metabolic process italephera ndipo lactic acid ilowa m'magazi ambiri, lactic acidosis imayamba.

Izi zimachitika osati mwa odwala matenda ashuga.

Zinthu zotsatirazi zitha kuyambitsa mavuto:

Matenda opatsirana osiyanasiyana ndikutupa mthupi.
Mowa osachiritsika.
Kutulutsa magazi kwambiri.
Kuvulala kwambiri.
Myocardial infarction mu pachimake mawonekedwe.
Matenda a chiwindi.
Kulephera kwina.

Mu odwala matenda ashuga, izi zosafunikira zimatha kuchitika chifukwa chogwiritsa ntchito mankhwala ochepetsa shuga. Zotsatira zofananazo zimapezeka piritsi la mitundu yayikulu, momwe Metformin, Bagomet, Siofor, Glyukofazh, Avandamet ndi ake.

Hypoxia (kufa ndi njala ya m'mafupa a minofu ya m'magazi) imathanso kukhala chofunikira pamkhalidwewu chifukwa chokhala ndi mphamvu yayitali yolimbitsa thupi. Kukula kwa lactic acidosis kumakhudzidwa ndi mapangidwe a chotupa, khansa yamagazi ndi Edzi.

Mankhwala othandizira lactic acidosis

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

mtsempha wamagazi wa bicarbonate wa sodium,
kuyambitsa kwa methylene buluu kuti muchepetse chikomokere,
ntchito mankhwala trisamine - amachotsa hyperlactatacidemia,
hemodialysis ndi kuchepa kwa magazi pH lactate acidosis, lactic acidosis, kufotokoza, chifukwa, zina