Hyperosmolar coma mu matenda osokoneza bongo: chisamaliro chodzidzimutsa, njira zodzitetezera ndi chizindikiro choyamba chakuyandikira

Tsoka ilo, matenda ashuga ayamba kukhala mliri wa gulu lamakono. Matendawa amakhudza osati okalamba okha, komanso achinyamata ndi ana.

Komabe, ngati mumatsatira malangizo onse a dotolo ndikutsatira moyo wina, mutha kukhala bwino ndi matenda anuwo, osadzilingalira nokha kuti mulibe vuto lililonse kapena ayi.

Komabe, ndikofunikira kuyang'anira moyo wanu nthawi zonse ndikuyesera kuti zinthu ziziyenda bwino. Chowonadi ndi chakuti matenda ashuga ali ndi zotsatira zoyipa zomwe zimatha kuvulaza kwambiri ngakhale kufa.

Chimodzi mwazovuta izi ndi hyperosmolar coma mu shuga.

Mutha kupeza mayankho a mafunso awa munkhaniyi. Ndipo tsopano tiyeni tiwone mwachidule momwe matenda ashuga alili, tilingalire za zomwe akuwonetsa, mawonekedwe ake ndi kuwazindikira.

Matenda oyamba. Tanthauzo ndi zifukwa

Matenda a shuga ndi matenda ovuta a endocrine, omwe amadziwika ndi kuwonjezeka kwa shuga m'magazi ndipo amathandizana ndi zovuta zama metabolic monga mchere, mafuta, chakudya, mchere wamchere ndi mapuloteni.

Komanso, pakukula kwa matenda, kapamba, amene amapanga kwambiri insulin, timadzi tambiri timene timayendetsa shuga ndikupanga shuga m'magazi athupi lonse. Monga mukuwonera, insulini imayang'anira kuchuluka kwa shuga m'magazi, motero ndikofunikira kwa odwala ambiri omwe ali ndi matenda ashuga.

Zomwe zimayambitsa matendawa ndi cholowa, kunenepa kwambiri, matenda am'mimba, kusokonezeka kwam'mimba, kusokonezeka kwa m'mimba komanso ena ambiri.

Zomwe Zimakhudza Coma

Kukhalapo kwa shuga kwa wodwala nthawi zambiri sikuti kumayambitsa kukula kwa hyperosmolar coma. Zifukwa zingapo zomwe zimakhudza kagayidwe kachakudya ndipo zimayambitsa kuperewera kwa thupi kumapangitsa kuti matendawo apezekenso.

Zomwe zimayambitsa kusowa kwamadzi zingakhale:

• kusanza
• kutsegula m'mimba
• matenda oyamba nawo
• kufooketsa ludzu, khalidwe la okalamba,
• matenda opatsirana
• kuchepa kwakukulu kwa magazi - mwachitsanzo, pakuchita opareshoni kapena pambuyo povulala.

Zowopsa zomwe zimayambitsa kukula kwa hyperosmolar chikomono ndimavuto am'mimba omwe amayamba chifukwa cha kapamba kapena gastritis. Kuvulala komanso kuvulala, kubalalika kwa myocardial kungayambitsenso kukomoka kwa anthu odwala matenda ashuga. Choopsa china ndi kukhalapo kwa matenda omwe amapezeka ndikuwonetsa kutentha thupi.

Zomwe zimayambitsa kupweteka kumayeneranso kukhala mankhwala osayenera omwe amathandizidwa pochiza matenda a shuga. Makamaka nthawi zambiri, njirayi imayamba ndi mankhwala osokoneza bongo kapena Hypersensitivity yomwe imadziwoneka yokha mukamachita maphunziro a okodzetsa kapena glucocorticoids.

Zizindikiro za matendawa

Hyperosmolar diabetesic coma amakula msanga. Kuchokera munthawi yachilengedwe kupita kwa makolo, masiku angapo amapita, ndipo nthawi zina maola angapo.

Choyamba, wodwalayo amayamba kudwala polyuria yowonjezereka, limodzi ndi ludzu ndi kufooka wamba.

Zizindikiro zimakulirakulira, pakapita nthawi kugona, madzi am'madzi amawonekera. Pambuyo masiku angapo, komanso makamaka pachimake matenda - ndipo patapita maola ochepa, mavuto ndi chapakati mantha dongosolo kuonekera - zoletsa ndi kuzimiririka kwa zomwe. Wodwala akapanda kuthandizidwa, zizindikirazi zimachulukana ndipo zimasanduka chikomokere.

Kuphatikiza apo, kuyerekezera zinthu m`maganizo, kuwonjezeka kwa minofu, kusunthika kosasunthika, areflexia ndikotheka. Nthawi zina, chitukuko cha hyperosmolar coma chimadziwika ndi kuwonjezeka kwa kutentha.

Hyperosmolar diabetesic coma imathanso kuchitika kwa nthawi yayitali ya immunosuppressants ndi wodwala, komanso pambuyo pa njira zina zochizira.

Hemodialysis, kukhazikitsidwa kwa njira zochuluka zokwanira zamchere, magnesia, ndi mankhwala ena omwe amalimbana ndi kuthamanga kwa magazi ndizowopsa.

Ndi hyperosmolar coma, kusintha kwa ma pathological m'magazi kumadziwika. Kuchuluka kwa glucose ndi zinthu za osmolar zimachulukirachulukira, ndipo matupi a ketone kulibe pakuwunika.

Thandizo lazadzidzidzi

Monga tanena kale, kulibe chithandizo choyenera chachipatala, chikomoka chimapha.

Chifukwa chake, ndikofunikira kupereka wodwala chithandizo choyenera. Njira zoyenera zokhala ndi chikomokere zili m'chipinda chothandizira odwala kapena kuchipinda chadzidzidzi.

Ntchito yofunikira ndikubwezeretsanso madzi omwe thupi limataya, ndikupangitsa zizindikirazo kukhala zabwinobwino. Mafuta amadzilowetsa mthupi kudzera m'mitsempha, komanso mokwanira.

Mu ola loyamba la zamankhwala, mpaka malita 1.5 amadzi ndivomerezeka. M'tsogolomu, mlingo umachepetsedwa, koma kuchuluka kwa infusions tsiku ndi tsiku kumakhalabe kofunikira kwambiri. Kwa maola 24, malita 6 mpaka 10 a thonje amatsanuliridwa m'mwazi wa wodwalayo. Pali nthawi zina pamene yankho lalikulu likufunika, ndipo kuchuluka kwa madzi obweretsa kumafikira 20 malita.

Kapangidwe ka yankho kumatha kusiyanasiyana kutengera ndi mayesedwe a labotale. Chofunikira kwambiri pazizindikiro izi ndi sodium.

Kuphatikizika kwa chinthu ichi mndandanda wa 145-165 meq / l ndiye chifukwa chobweretsa yankho la sodium. Ngati ndende ikukwera, njira zamchere zimaphatikizidwa. Zikatero, kuyambitsidwa kwa shuga kumayamba.

Kukhazikitsidwa kwa insulin kukonzekera pa hyperosmolar chikomokoma sikuchitika kawirikawiri. Chowonadi ndi chakuti ntchito yokonzanso madzi kumadzi imachepetsa shuga wamagazi komanso popanda zina zowonjezera. Pokhapokha pokhapokha, pali inshuwaransi yochepa - mpaka magulu awiri pa ola limodzi. Kukhazikitsidwa kwa kuchuluka kwa mankhwala ochepetsa mphamvu ya glucose kumatha kuvuta mankhwalawa.

Nthawi yomweyo, milingo ya electrolyte imayang'aniridwa. Ngati pakufunika thandizo, limapangidwanso pogwiritsa ntchito njira zachipatala zomwe anthu ambiri amavomereza. M'malo owopsa monga hyperosmolar coma, chisamaliro chadzidzidzi chimaphatikizapo mpweya wabwino. Ngati ndi kotheka, zida zina zothandizira moyo zimagwiritsidwa ntchito.

Mpweya wosavulaza

Chithandizo cha hyperosmolar chikomokere chimaphatikizira kuvulala kwamatumbo. Kuti athetse kusungika kwamadzimadzi m'thupi, catheter ya mkodzo ndiyofunika.

Kuphatikiza apo, kugwiritsa ntchito othandizira othandizira kuti mtima ukhale wogwira ntchito kumachitika. Izi ndizofunikira, chifukwa cha kukalamba kwa odwala omwe adalowa mu hyperosmolar coma, pamodzi ndi mavitamini ambiri omwe atulutsidwa m'magazi.

Kuyambitsidwa kwa potaziyamu kumachitika atangoyamba kumene chithandizo, kapena atalandira zotsatira za mayeso oyenera 2-2.5 maola atavomerezedwa ndi wodwalayo. Pankhaniyi, chikhalidwe chododometsa ndi chifukwa chokana kugwiritsira ntchito kukonzekera kwa potaziyamu.

Ntchito yofunika kwambiri mu hyperosmolar coma ndikulimbana ndi matenda ophatikizana omwe amakhudza mkhalidwe wa wodwalayo. Popeza imodzi mwazomwe zimayambitsa kukomoka imakhala matenda osiyanasiyana, kugwiritsa ntchito mankhwala oyenera kumakhala koyenera. Popanda chithandizo chotere, mwayi wazotsatira zabwino umachepa.

Mumkhalidwe wofanana ndi hyperosmolar coma, chithandizo chimaphatikizanso kupewa thrombosis. Matendawa ndi amodzi mwa zovuta kwambiri za hyperosmolar coma. Kusakwanira kwa magazi komwe kumachitika chifukwa cha thrombosis pakokha kungayambitse mavuto ambiri, chifukwa chake, ndi chithandizo cha chikomokere, kuyikiridwa kwa mankhwala oyenera kumasonyezedwa.

Mungatani?

Chithandizo chabwino kwambiri, chofunikira, chiyenera kuvomerezeka ngati kupewa matenda.

Odwala omwe ali ndi matenda ashuga amayenera kuyang'anira kuchuluka kwa shuga ndikuyang'ana ndi dokotala ngati atakula. Izi zitha kupewa kukula kwa chikomokere.

Tsoka ilo, palibe njira zochizira kunyumba zomwe zingathandize munthu ndi chitukuko cha hyperosmolar coma. Komanso, kuwononga nthawi pazida komanso njira zosagwiritsa ntchito zomwe sizithandiza wodwala kumatha kubweretsa zotsatirapo zoyipa kwambiri.

Chifukwa chake, chinthu chokhacho chomwe munthu wamba angagwiritse ntchito ndi hyperosmolar coma ndikuyitanitsa gulu la madokotala posachedwa kapena kuperekera wodwalayo kuchipatala choyenera. Potere, mwayi wodwala umachulukirachulukira.

Makanema okhudzana nawo

Ulaliki wothandiza, womwe umafotokoza zomwe zimayambitsa ndi zizindikiro za hyperosmolar coma, komanso mfundo zoyambira kutsata:

Mwambiri, zovuta zazikulu za matenda monga hyperosmolar coma zimangotanthauza kuchitapo kanthu koyenera. Tsoka ilo, ngakhale izi sizitanthauza kuti wodwalayo adzapulumuka. Chiwerengero cha anthu omwe amwalira ndi mtundu uwu wa chikomokere ndiwokwera kwambiri, makamaka chifukwa cha chiwopsezo chachikulu chokhala ndi ma concomitant pathologies omwe amawononga thupi komanso osagwirizana ndi chithandizo.

• Imakhazikika pamisempha ya shuga kwa nthawi yayitali
• Imabwezeretsa kapangidwe ka insulin

Phunzirani zambiri. Osati mankhwala. ->

Matenda oyamba. Zizindikiro ndi Kudziwitsa

Zizindikiro zikuluzikulu za matendawa ndi monga ludzu lokhazikika komanso mkamwa wowuma, kukodza kwambiri, thukuta kwambiri, kuchiritsa kwa nthawi yayitali, kupweteka m'mutu komanso chizungulire, dzanzi lakuthwa, edema, kuthamanga kwa magazi ndi zina zotero.

Kodi kudziwa kukhalapo kwa matenda odwala? Ngati zizindikiro zomwe zili pamwambazi zilipo, muyenera kufunsa dokotala yemwe akupatseni matenda enaake.

Choyamba, izi, zachidziwitso, kuyezetsa magazi kwa shuga. Kumbukirani kuti shuga yamagazi sayenera kupitirira 5.5 mmol / L? Ngati ichulukitsidwa kwambiri (kuchokera pa 6.7 mmol / l), ndiye kuti matenda a shuga atha kupezeka.

Kuphatikiza apo, adotolo omwe amatha kupezawa akhoza kukupatsani mayeso owonjezera - kuyeza glucose komanso kusinthika kwake tsiku lonse, kuwunika kuti mupeze kuchuluka kwa insulin m'magazi, urinalysis kuti muyeze maselo oyera am'magazi, glucose ndi mapuloteni, ultrasound yam'mimbamo yam'mimba ndi ena.

Ndikofunika kukumbukira kuti shuga ndi matenda oopsa komanso owopsa, chifukwa amakhala ndi zovuta zosasangalatsa komanso zopweteka. Choyambirira, ndimphamvu, nthawi zina imasokoneza kayendedwe, kutupa, kupweteka komanso kugona m'miyendo, kuwonongeka kwa phazi ndi zilonda zam'mimba, gangre yosasinthika komanso matenda osokoneza bongo a hyperosmolar diabetes.

Kodi kudwala matenda ashuga ndi chiyani

Monga tafotokozera pamwambapa, Hyperosmolar diabetesic coma ndi vuto lalikulu la nthendayi - matenda ashuga.

Tsoka ilo, zotsatira zakupha ndi izi ndizothekera kwambiri. Ndi makumi anayi ndi makumi asanu ndi limodzi kudza makumi asanu ndi limodzi pa zana.

Zomwe zimachitika mthupi

Tsoka ilo, tizilombo toyambitsa matenda a hyperosmolar coma sichimamvetsetseka bwino ndipo chifukwa chake sichinafotokozedwe bwino. Komabe, zimadziwika kuti mkati mwa zovuta izi njira zina zamkati zimachitika, zomwe zimagwira monga othandizira.

Hyperosmolar coma mu shuga ndi chifukwa cha zinthu zingapo zazikulu kapena njira zingapo zomwe zimachitika m'thupi la wodwalayo. Choyamba, kudumpha kowopsa m'magazi a shuga (mpaka 55,5 mmol / L kapena kuposa pamenepo) komanso kuwonjezeka kowopsa kwa mulingo wa sodium m'madzi a m'magazi (kuchokera pa 330 mpaka 500 mosmol / L kapena kupitilira).

Komanso kukomoka kumatha kukhala chifukwa cha kuchepa mphamvu kwa maselo a chamoyo chonse, pomwe madzimadzi amathamangira m'malo ophatikizana, potero amayesera kuchepetsa kuchuluka kwa shuga ndi sodium.

Kodi pali zifukwa zenizeni zomwe zimayambitsa matenda obwera chifukwa cha hyperosmolar coma omwe angayambire kudwala matenda oopsa amenewa?

Zinthu zoyambitsa

Nthawi zambiri kuwonetsedwa kwa matenda ashuga kumakhala chifukwa cha zomwe zimayambitsa:

• kusowa kwam'mimba (kutsegula m'mimba, kusanza, kuthira madzi okwanira, kugwiritsa ntchito mphamvu yayitali pakukodzetsa, ntchito yaimpso),
• kusowa kwa insulini (wodwalayo amaiwala kuti achivomereze kapena asokoneza mwanjira yake chithandizo),
• kuchuluka kwa insulini (izi zimachitika chifukwa chophwanya zakudya, kuzizira ndi matenda opatsirana),
• matenda osadziwika a shuga (wodwalayo sangakayikire za matenda ake, chifukwa chomwe salandira chithandizo chofunikira, chifukwa cha chikomokere),
• kugwiritsa ntchito mankhwala opondera,
• kukhudzana ndi opareshoni.

Chifukwa chake, tidazindikira zomwe zingayambitse matendawa. Tiyeni tsopano tizindikire zizindikiro za kukomoka kwa hyperosmolar.

Zizindikiro za matendawa

Chifukwa chakuti munthu azolowere mawonekedwe a munthu wodwala matenda ashuga, amatha kufunafuna thandizo kwa iyemwini kapena kwa mnzake posachedwa, ndipo mwina ataletsa kukula kwa matenda akulu.

Ndizofunikira kudziwa kuti zizindikiro za hyperosmolar coma zimatha kudwala masiku angapo matendawa omwe asanafike pokhapokha, chifukwa chake khalani osamala komanso odikira kuti mulumikizane ndi achipatala pakapita nthawi.

Chinthu choyamba chomwe muyenera kulabadira ndikuti masiku angapo chikomoka chisanachitike, wodwalayo amakhala ndi ludzu komanso pakamwa lowuma, ndipo zizindikirazo zimakhala ndi mawonekedwe osaneneka.

Khungu panthawiyi limakhala louma, zimagwira mucous zimalephereranso chinyezi ndipo zimayambitsa nkhawa.

Kufooka kosalekeza, kugona, ndi ulesi zimachitika.

Zizindikiro zotsatirazi za chikomokere mu Hyperosmolar zimatha kuchepa kwambiri pakukakamizidwa, kugunda kwa mtima, komanso kukodza pafupipafupi. Nthawi zina kukomoka komanso khunyu kumachitika.

Ngati wodwala sananyalanyaze izi ndikuwonana ndi dokotala panthawi. Kodi muyenera kuchita chiyani ngati zizindikiro zonse zikusowa ndipo chikomokere chachitika? Thandizo ladzidzidzi lomwe lingaperekedwe kwa womenyedwayo lingapulumutse moyo wake ndipo lingakhale ndi phindu pobwezeretsa m'tsogolo.

Kodi chofunikira kuchita ndi chiyani?

Momwe mungathandizire wodwala kunyumba?

Choyambirira komanso chofunikira kwambiri ndikusakhala ndi mantha ndikukhala momasuka. Ndipo, zoona, konkriti amayenera kuchitidwa.

Wokondedwa wanu akamadwala matenda ashuga, chisamaliro chanthawi yomweyo chimayenera kukhala motere:

1. Itanani dokotala nthawi yomweyo.
2. Phimbani wodwalayo ndi zofunda zofunda ndi / kapena ozungulirani ndi zotenthetsa.
3. Ngati pali mwayi ndi luso, mutha kubaya 500 ml ya saline mu mtsempha.

Gulu lakufika kwa madotolo lidzapatsa wodwalayo thandizo loyamba ndikuyamba naye kuchipatala.

Thandizo lakuchipatala

Kodi kupita ku asing'anga kungatani ngati wodwala wapezeka kuti ali ndi vuto la kukomoka? Algorithm yodzidzimutsa ili motere:

1. Siyani kusowa kwamadzi. Kuti muchite izi, mutha kuyika kafukufuku m'mimba kuti muchepetse kusanza. Ndikofunikanso kubwezeretsa thupi la wodwalayo ndi madzi okwanira.Pofuna kupewa kuchepa mphamvu kwa maselo amthupi, wodwala angafunike madzi ochuluka mpaka malita makumi awiri patsiku.
2. Pewani zovuta zama metabolic komanso kusintha kwa mtima.
3. Magazi ochulukirapo (hyperglycemia) ayenera kukhala okhazikika. Kuti muchite izi, ikani ma intravenous dropers a njira ya sodium kolorayidi.
4. Chepetsani madzi okwera a plasma. Izi zitha kuchitika ndi jakisoni wa insulin.

Koma si zokhazo. Kodi ndi chithandizo chiti chomwe chingachitike ndi hyperosmolar coma?

Kupitiliza chithandizo

Popeza hyperosmolar coma ikhoza kuyambitsa zovuta kuchokera ku ubongo, m'mapapu, ndi mtima, chisamaliro chokwanira chikuyenera kuperekedwa popewa matenda awa. Mwachitsanzo, kuti muchepetse edema yaubongo, muyenera kuyika dontho ndi sodium bicarbonate. Ndikofunikanso kuchita chithandizo cha okosijeni, chomwe chingapangitse maselo a wodwalayo ndi magazi ake ndi mpweya wabwino wofunikira ndipo zidzakhala ndi zotsatira zabwino pazochitika zonse za wodwalayo.

Nthawi zambiri mankhwalawa a hyperosmolar coma amachitika moyang'aniridwa ndi ogwira ntchito. Kuyesedwa kwa magazi ndi mkodzo kumatengedwa nthawi zonse kuchokera kwa wodwala, kuthamanga kwa magazi kumayeza ndipo electrocardiogram imatengedwa. Izi zimachitika pofuna kudziwa kuchuluka kwa glucose, potaziyamu ndi sodium m'magazi, komanso acid-base komanso zomwe zimachitika m'thupi lonse.

Kuzindikira matendawa

Kodi kuzindikira kumeneku kumatanthauza chiyani ndipo ndi ziti zomwe muyenera kuzitsimikizira?

1. Glucose mumkodzo (glucosuric mbiri). Zowonjezerazi zikuchokera ku 8.88 mpaka 9.99 mmol / l.
2. Potaziyamu mumkodzo. Chizolowezi kwa ana chimachokera pa khumi mpaka makumi asanu ndi limodzi mmol / tsiku, kwa akulu - kuyambira makumi atatu mpaka zana mmol / tsiku.
3. Sodium mkodzo. Chizoloŵezi cha ana chimachokera pa makumi anai mpaka zana limodzi ndi makumi asanu ndi awiri a mamol / tsiku, kwa akulu - kuyambira zana limodzi mpaka mazana awiri ndi makumi asanu ndi limodzi.
4. Gluu m'magazi. Chizolowezi kwa ana ndichokera 3.9 mpaka 5.8 mmol / l, kwa akulu - kuyambira 3.9 mpaka 6.1 mmol / l.
5. Potaziyamu m'magazi. Zinthu zake zimachokera ku 3.5 mpaka 5 mmol / l.
6. Sodium m'magazi. Izi zimachokera ku zana limodzi makumi atatu ndi zisanu mpaka zana limodzi makumi anayi ndi zisanu mmol / l.

Kuphatikiza apo, adotolo amatha kupatsidwa mwayi woyezetsa magazi, ma X-ray a kapamba, komanso ECG yokhazikika.

Njira zopewera chithandizo

Pa chithandizo champhamvu kwambiri, muyenera kukumbukira kuti kuchepa msanga m'magazi kungayambitse kuchepa kwa madzi a m'magazi, komwe kumayambitsa matenda edema, komanso kufalikira kwa timadzi timitsempha tomwe timayambitsa maselo. Chifukwa chake, kuyambitsa mankhwala kuyenera kuchitika pang'onopang'ono komanso malingana ndi dongosolo linalake.

Kuphatikiza apo, ndikofunikira kuti musamachulukane ndi jakisoni wa potaziyamu, chifukwa kuphatikizika kwa chinthuchi kungayambitse hyperkalemia. Kugwiritsa ntchito phosphate kumapangidwanso ngati wodwala walephera.

Kulosera zamatenda

Ngakhale, malinga ndi ziwerengero, kufera kwa hyperosmolar coma kumachulukitsa makumi asanu peresenti, kudalirika kwa kuchira kwa wodwalayo kuli chiyembekezo.

Zotsatira zoyipa nthawi zambiri sizimachokera ku chikomokere, koma kuchokera ku zovuta zake, monga wodwala yemwe ali ndi mbiri yokhala ndi matenda ashuga amatha kukhala ndi matenda ena akuluakulu. Zimatha kukhala zowawa za kuchira kwakanthawi.

Komabe, ziyenera kukumbukiridwa kuti mankhwala apita patsogolo. Chifukwa chake, ngati wodwala wodwalayo akwaniritsa mosamalitsa malangizo onse omwe adokotala amapita, kutsatira moyo wabwino komanso kadyedwe kena, adzachira msanga, kugwada ndi kuiwala za mantha ake komanso matenda ake.

Ndikofunikira kuti achibale ndi abwenzi a munthu wotero aphunzire mosamala za matenda ake, ndikuwonetsetsa kuti adziwa malamulo a chithandizo choyambirira kwa wodwala. Ndipo palibe comerosmolar coma yomwe ingakudabwitseni ndipo simudzakhala ndi zotsatira zoyipa, zosasinthika.