Hyperglycemic ndi hypoglycemic chikomokere

Kutsatira zakudya zoyenera ndikumwa mankhwala, odwala matenda ashuga amatha kukhala moyo wathunthu. Koma chifukwa cha zinthu zina, odwala ena amakumana ndi zovuta. Chimodzi mwa zoopsa kwambiri ndi kukomoka kwa hyperglycemic.

Vutoli limachitika chifukwa cha kuchepa kwa insulin m'magazi pomwe chiwopsezo cha kuchuluka kwa shuga. Mavuto akuopseza moyo.

Matenda a pathogenesis a hyperglycemic coma ndi chifukwa cha kusokonekera kwa kagayidwe kachakudya mthupi la munthu wodwala matenda ashuga. Ndi kuperewera kwa insulin kosakwanira, timadzi tambiri tambiri tambiri timene timagwira m'magazi, metabolism imasokonekera. Glucose samalowa m'maselo amthupi, koma amakhalabe m'magazi. Popita nthawi, kuchuluka kwa shuga kumadziwika. Matendawa amatchedwa hyperglycemia. Matupi a Ketone amapangidwa, gluconeogenesis imakhazikitsidwa m'chiwindi, acidosis imachitika, ndipo kuledzera kwa CNS kumachitika. Izi zimabweretsa kudwala matenda ashuga.

Pali gulu la gulu lomwe limakupatsani mwayi wodziwira mtundu wa zovuta malinga ndi etiology ndi makina a chitukuko.

Mu 80% ya omwe adapezeka kuti ali ndi vuto la ketoacidotic. Nthawi zambiri, amakula mwa odwala omwe ali ndi matenda ashuga 1. Nthawi zambiri amapezeka mwa achinyamata osakwana zaka 20. Malinga ndi ziwerengero, munthu m'modzi mwa atatu omwe ali ndi matendawa adakumana ndi vuto lofananalo. Fomuyi imatha kusinthidwa kukhala hyperosmolar komanso mosemphanitsa.

Hyperglycemic coma yopanda ketosis imapezekanso. Vutoli limaphatikizidwa ndi kuwonjezeka kwa kuchuluka kwa shuga m'magazi, pomwe thupi silikuyamba kuthana ndi minofu yamafuta chifukwa cha mphamvu. Zotsatira zake, matupi a ketone samamasulidwa, monga ndi ketoacidotic chikomokere.

Pafupifupi, 4-31% ya imfa yalembedwa. Nthawi zambiri imfa imapezeka mwa okalamba komanso odwala omwe ali ndi thupi lofooka.

Kutengera ndi etiology, kukomoka kwa hyperglycemic kumakula patatha maola ochepa kapena masiku. Thupi limapwetekedwa ndi ma ketones opangidwa, kuchuluka kwa asidi-osokoneza kumasokonekera, ndipo zizindikiro za kuchepa mphamvu kwa thupi ndi hypovolemia zimawonekera. Matendawa amatchedwa precoma.

• kumverera kwa ludzu, kuyanika kuchokera kumkamwa ndi pakhungu,
• polyuria
• ntchito yochepetsedwa komanso magwiridwe antchito onse,
• kupweteka m'mimba, kusanza, kutsekula m'mimba,
• kusowa kwa chakudya
• chikumbumtima, kusinza, kusakwiya (kukulira pang'onopang'ono).

Minofu kamvekedwe ikhoza kuchepa. Fungo limachokera mkamwa mwa wodwala - fungo la acetone kapena zowola. Mpweya umakhala wakuya ndikuwomba. Ngati matendawa amakhala masiku angapo, kuchepa kwa thupi kumatha kuzindikirika.

Mu 50% ya odwala okhala ndi hyperglycemic chikomokere, mawonekedwe a pseudoperitonitis amadziwika: kusokonezeka ndi kupweteka kwa khoma lam'mimba, kupweteka pamimba, kupindika kwamphamvu kwambiri. Zizindikiro zoterezi zimawonekera chifukwa cha zochita za ketone m'mimba.

Zizindikiro mu akulu ndi ana ali ofanana.

Thandizo loyamba ndi chithandizo

Ngati zizindikiro za kukomoka kwa hyperglycemic zadziwika, ambulansi iyenera kuyitanidwa. Ngati wodwala akudziwa, madokotala asanafike, zinthu zotsatirazi ziyenera kuchitidwa:

1. Gonekerani wodwala pambali pake,
2. kuphimba ndi bulangeti lofunda
3. Mangani lamba, mangani, vulani zovala zolimba,
4. kuwongolera zimachitika, kupuma komanso malo a lilime kuti lisagwere,
5. kupereka mankhwala a insulin
6. apatseni madzi
7. kuyeza kukakamiza ndi gawo lochepa, ngati kuli kotheka, perekani mankhwala.

Ngati kupuma kwamangidwa, kuyambiranso kuyenera kuchitidwa: kutikita minofu ya mtima ndi kupuma kochita kupanga. Ambulansi iyenera kuyitanidwa nthawi yomweyo, ngakhale wodwalayo atakhazikika.

Wodwala amagonekedwa m'chipatala. Asanayambe chithandizo, kuyezetsa magazi kwa shuga ndi kuyesa kwa mkodzo kukhalapo kwa matupi a ketone momwemo kumachitidwa. Wodwalayo amapaka jakisoni ndi insulin. Mlingo wa mahomoni amawerengedwa potengera kuopsa kwa vutolo.

Pofuna kupewa kuperewera kwa okalamba mwa achikulire, tikulimbikitsidwa kupatsa insulin yoposa 50-100. Hafu ya mlingo woyamba wa jekeseni imalowetsedwa ndi 20 ml ya saline, gawo lachiwiri limaperekedwa. Ndi precoma, ½ yathunthu ya timadzi timadzi timene timafunika. Komanso, insulin iyenera kuperekedwa pakadutsa maola awiri. Mlingo umayikidwa kutengera kuchuluka kwa shuga m'magazi. Mlingo wa tsiku ndi tsiku wa insulin ya chikomero cha hyperglycemic umasiyana magawo 400 mpaka 1000.

Gawani zakumwa zam'mimba ndi 4% sodium bicarbonate solution. Njira ya Saline ndi Ringer imayendetsedwa kudzera m'mitsempha. Pakadutsa maola 4, glucose 5% amapaka jekeseni. 4% sodium bicarbonate solution imayesedwanso. Masana, 5-6 l amadzimadzi amaperekedwa kwa odwala achinyamata, osaposa 2-3 l kwa okalamba odwala. Ola lililonse, kupanikizika kumayezedwa, ndipo ngati ndi kotheka, kumawonjezeka.

Pambuyo poyambitsa chithandizo, odwala ena amakhala ndi hypokalemia. Vutoli limadziwika ndi kuphwanya mzere wamtima, kukokana kwa minofu, paresis ya peristalsis. Pali kusinthasintha kwa kutentha, komwe kumatha kubweretsa kulowetsedwa kwa matenda.

Ichi ndi chiyani

Kupumira pang'onopang'ono ndi palpitation panthawi yopuma imayambitsa imfa.

Shuga amachepetsedwa nthawi yomweyo! Matenda a shuga m'kupita kwa nthawi angayambitse matenda ambiri, monga mavuto amawonedwe, khungu ndi tsitsi, zilonda zam'mimba, zilonda zam'mimba komanso matenda otupa! Anthu amaphunzitsa zinzake zowawa kuti azisintha shuga. werengani.

Hypo-and hyperglycemic coma ndi chikomokere chomwe chimachitika motsutsana ndi maziko amasinthidwe a shuga m'thupi. Ndi kuwonjezeka kwakukulu kwa shuga m'magazi a shuga, hyperglycemia imachitika, yovuta ndi chikomokere. Ngati shuga ali otsika kwambiri, chikomokere cha hypoglycemic chimachitika. Mosasamala mtundu wa matenda, matenda a wodwalayo amadziwika ndi kupezeka kwa kukhudzika, kunjenjemera, kufooka kwa minofu, kufinya kwamatumbo, komanso kusazindikira.

Hyperglycemic chikomacho chimayambitsa

Chifukwa chachikulu chokhala ndi vuto la hyperglycemic coma ndikusowa kwa insulin mthupi la wodwala wodwala matenda ashuga. Ndi hyperglycemic coma, insulin yogwira ntchito imatsika kwambiri. Zotsatira zake, kukhudzana kwa glucose ndi minyewa kumasokonekera, shuga amadzuka m'chiwindi, zizindikiro za glucosuria, hyperglycemia, acidosis, kupsinjika kwakukulu kwa mtima wamanjenje, womwe umalumikizidwa ndi kuchepa kwa glucose komwe kumachitika ndi maselo aubongo ndikusokonekera kwa zakudya zama cell zamaubongo.

Hyperglycemic kapena diabetesic coma imadziwika ndi kuchuluka kwa shuga m'magazi, komabe, njira zomwe zimayamwa chifukwa cha kuchepa kwa insulin zimasokonekera, zomwe zimasiyanitsa ndi vuto la hypoglycemic coma.

Zomwe zimathandizira kukulitsa kukomoka kwa hyperglycemic zikuphatikiza: kupezeka kwa njira zotupa mthupi ndi matenda a virus, kugwiritsa ntchito maswiti ambiri ndi mlingo wokhazikika wa insulini, ntchito yopanda mphamvu ya zinthu zina zolimbikitsa zomwe zimathandizira kapamba kuti apange insulin, ndipo ndandanda ya insulin.

Hyperglycemic coma ili ndi zosankha zingapo. Choyamba, ndi hyperketonemic acidotic coma, yomwe imayendera limodzi ndi mawonekedwe a acidosis. Kachiwiri, ndi kukomoka kwa hyperosmolar, komwe kumadziwika ndi kuphwanya kwakukulu kwa kayendetsedwe ka kayendedwe ka madzi, magazi ndi kupangika kwa ma cations m'maselo aubongo pamaso pakukodza kwamikodzo komanso kuwonongeka kwamchere. Chachitatu, ndi chikomokere (hyperlactacidemic coma), chomwe chimapangidwa chifukwa cha matenda opatsirana kwambiri, aimpso osakwanira komanso chifukwa cha ntchito ya hepatic, komanso pambuyo poti mwadya biguanides. Zonsezi zimaphwanya kuphwanya dongosolo lactate ndi pyruvate, mapangidwe a glycolysis ndi mapangidwe amphamvu metabolic acidosis komanso kuwonongeka kwa kotekisi yam'mimba.

Zoyambitsa Hyperglycemic Coma

Nthawi zambiri, vuto la hyperglycemic coma limayamba mwa odwala omwe ali ndi matenda a shuga omwe amadalira insulin. Kawirikawiri, zovuta za mtundu wachiwiri zimapezeka.

Kuwonjezeka kwakukulu kwa shuga m'magazi kumayambitsidwa ndi izi:

• matenda osadziwika a shuga kapena mtundu wina wamatendawa.
• mankhwala othandiza
• kukana insulin mankhwala a mtundu 1 shuga,
• Mlingo wosakwanira, kuchuluka kwakatikati pakati pa kayendetsedwe ka mahomoni,
• kutenga othandizira omwe amachititsa kuti insulini ikhale ndi insulin,
• Zakudya zopanda thanzi: magawo akuluakulu kapena zakudya zambiri zokhala ndi shuga m'zakudya,
• kumwa magulu ena a mankhwala omwe amathandizira kuwonetsa kwa insulin: prednisone kapena diuretics.

Zomwe zimayambitsa matenda a hyperglycemic coma zimadalira. Ngati muwongolera, ndiye kuti kupanikizika kungapewedwe.

Mtundu wachiwiri wa matenda ashuga, vuto limachitika kawirikawiri chifukwa chalephera kugwira bwino ntchito kapamba. Zotsatira zake, mulingo wa insulin m'magazi umatsikira, zomwe zimabweretsa kuchuluka kwa shuga.

Hyperglycemic chikomokere Zizindikiro

Zizindikiro zowonetsera za hyperglycemic coma zimagwirizanitsidwa ndi poyizoni wa thupi makamaka ndi dongosolo lamanjenje lamkati ndi ma ketones, kuchepa kwa madzi ndi kusintha kosangalatsa kwa acid ndi alkaline mpaka acidosis. Monga lamulo, zizindikiro za poizoni zimayamba pang'onopang'ono ndipo kukomoka kwa hyperglycemic kumayambitsidwa ndi dziko labwino. Nthawi zina zizindikiro za kuchepa thupi zimakulitsa tsiku lonse, zimakhala ndi ludzu lalikulu, polyuria, kuchepa kwa ntchito ndi thupi, komanso matenda a anorexia ofooka. Mtsogolomo, mawonetseredwe a acidosis ndi ketosis mu mawonekedwe a kusakwiya, kupweteka kwam'mimba, kusanza, kuwonda kawirikawiri komanso kuchepa kwa chilakolako chokwanira zimawonjezeredwa, ndipo kudziwa zovuta kosiyanasiyana kumathandizanso.

Pakufufuza kwakuthupi, zizindikiro zonse za hypovolemia ndi kuchepa madzi m'thupi zimadziwika. Izi zimadziwika ndi khungu louma komanso ma mucous membrane, kutsika kwa tgorotchi ndi ma khungu, ma hypotension ochepa, ndi tachycardia. Kuphatikiza apo, odwala omwe ali ndi vuto la kuchepa kwa hyperglycemic amakhala ndi kamvekedwe ka minofu kotsika, pamene odwala akutulutsa mpweya, mutha kununkhiza fungo la acetone kapena fungo la maapulo owola. Poyerekeza ndi kumbuyo kwa acidosis yayikulu, kupuma kwa Kussmaul kumamveka m'njira zamkati, zakuya komanso zamkati.

Pafupifupi theka la odwala omwe ali ndi vuto laukoma la hyperglycemic ali ndi zizindikiro zonse za pseudoperitonitis: khoma lamkati lowawa, kupweteka kwam'mimba, komanso kuchepa kwa peristalsis. Mukamayeseza pamimba, nthawi zina m'mimba mumapezekanso chifukwa cha chizimba monga hypokalemia. Zizindikiro zam'mimba zopweteka kwambiri zimapangidwa chifukwa cha zochita za matupi a ketone pamatumbo ndi matumbo, komanso chifukwa chamadzi am'mimba.

Chizindikiro cha hyperglycemic chikomokere, pomwe hypokalemia imayamba mankhwala atayamba. Nthawi yomweyo, phokoso la mtima limasokonekera mwa odwala, kukokana kwa minofu ndi maresi a peristalsis amachitika. Kuphatikiza apo, pali kusintha kwamphamvu ngati kutentha ndi kuwonjezeka kapena kutsika, komwe kungakhale chifukwa cha matenda.

Zizindikiro za kusokonezeka mphamvu zimakhazikika pang'onopang'ono. Poyamba, dziko lodzala ndi chododometsa chachilendo limawonekera, ndiye kuti stupor imadziwika ndipo kukomoka kwa hyperglycemic kumachitika, komwe kumadziwika ndi kuchepa kapena kutayika kwa zinthu zonse zamtsogolo, mtsogolomo izi zimabweretsa kugwa ndi oligoanuria. M'mayeso a mkodzo, shuga wofunikira amatsimikizika ndi mawonekedwe a matupi a ketone.

Hyperglycemic coma (hyperosmolar) ndi mkhalidwe womwe magazi am'mimba amachulukira chifukwa cha kuchuluka kwa glucose ndikuchepa kwa magazi ndi hypovolemia. Vutoli la hyperglycemic silimayambitsidwa ndi ketoacidosis, koma ndi kukhalapo kwa hyperosmolarity ya extracellular, yomwe imayamba chifukwa cha kuperewera kwa madzi m'thupi ndi ma hyperglycemia. Mwa ana, sizimachitika.

Monga lamulo, chitukuko cha hyperglycemic coma (hyperosmolar) chimakhudzidwa ndi: kuchuluka kwa zakudya zopezeka m'matumbo, matenda osiyanasiyana obwera chifukwa cha magazi, monga coronary ndi chithokomiro, opaleshoni yaubongo, matenda, kuvulala, kuperewera kwa madzi ndi zina zotere.

Zizindikiro za hyperglycemic coma (hyperosmolar) ndizodziwika pang'onopang'ono ndipo pambuyo pake zingayambitse kudandaula kwa hypovolemic. Odwala ali ndi khungu lowuma, turgor yochepetsedwa, kupumira msanga, kuthamanga kwa magazi ndi kutentha, ma eye ofewa, kupsinjika kwa minofu, kukokana kwa epileptiform, oliguria, hemiparesis yokhala ndi pathological Babinsky Reflex ndi zizindikiro za etiology ya meningeal. Fungo la acetone silinatsimikizidwe ndipo chizindikiro cha Kussmaul sichinawonedwe.

Kuphatikiza apo, mtundu uwu wa hyperglycemic coma imadziwika ndi kuchepa kwamadzi, osmolarity ndi glycemia. Zizindikiro za ludzu, polyuria ndi polydipsia ndizodziwikanso zamtunduwu wa hyperglycemic coma. Koma oliguria yokhala ndi azotemia imakula msanga, mosiyana ndi ketoacidosis. M'tsogolo, mwana amakhala asthenic, kugona, kuyerekezera zinthu zina. Panthawi yachipatala, odwala ena amakhala ndi malungo komanso mantha.

Kuphatikiza apo, Zizindikiro za vuto lalikulu la neuropsychiatric zimawoneka molawirira kwambiri, zomwe zingayambitse kuzindikira koyenera. Zizindikiro zamitsempha zonsezi mokhudzana ndi kukomoka, meningism, psychological reflexes zimatha kusintha mwachangu pakadutsa maola angapo.

Hyperglycemic coma (lactic acidemia) imadziwika ndi odwala okalamba omwe ali ndi matenda am'mapapo, impso, chiwindi, mtima, komanso uchidakwa.

Pali mitundu ingapo ya hyperglycemic coma (lactic acidemia), yomwe ndimtundu woyamba womwe umayamba chifukwa cha minofu hypoxia. Chachiwiri chimadziwika ndi matenda a ziwalo ndi machitidwe. Mtundu wachitatu umakhudzidwa ndi mankhwala osokoneza bongo. Popanga mtundu wachinayi wa hyperglycemic coma, zovuta pamtundu wa majini zimatenga nawo mbali.

Zizindikiro za chikomero cha hyperglycemic zimakhudzana ndi mawonekedwe a thupi la wodwala wokhala ndi lactic acid. Monga lamulo, zizindikiro za S.S.N.

Gulu lamavuto

Odwala ena amakhala ndi mavuto. Mwa zina mwazinthu izi ndizinthu zakunja kapena zamkati zakunja kwa odwala matenda ashuga.

Zovuta ndi odwala omwe ali ndi matenda otupa kapena ma virus a bronchi ndi mapapu. Matendawa amakhudza kagayidwe kake komanso kagwiridwe kake ka thupi la odwala matenda ashuga. Mkhalidwe wofooka wathanzi umadziwika mwa anthu omwe adavulala posachedwa kapena opaleshoni.

Mwayi wokhala ndi matenda ashuga umakhala wambiri mwa amayi oyembekezera panthawi yobereka komanso pakubala. Izi zimachitika makamaka ngati mayi ali ndi matenda ashuga.

Chiwopsezo cha vuto la matenda ashuga chikuwonjezeka mwa omwe amasuta, odwala omwe amamwa mowa ndikuphwanya zakudya. Nthawi zambiri, kukomoka kumachitika mwa ana omwe ali ndi shuga wa 13 mmol / L. Nthawi zambiri, ana amadya maswiti mobisa komanso zinthu zina zoyipa kuchokera kwa makolo awo.

Vutoli limatha kuchitika mwa odwala omwe apezeka ndi matenda ashuga posachedwapa. Nthawi zina amaphwanya zakudya mosadziwa kapena kulumpha ndikumwa mankhwala.

Kupewa

Popewa kuchepa kwa hyperglycemic:

• Onani kuchuluka kwa mankhwala a insulin ndikusunga nthawi yake,
• osagwiritsa ntchito mankhwala omwe atha,
• gwiritsitsani zakudya: idyani zakudya zovomerezeka zokha,
• pewani kupsinjika
• lekani kusuta ndi kumwa mowa,
• yang'anani mwatsatanetsatane magazi anu a insulin ndi shuga.

Wodwala yemwe wadwala matenda a hyperglycemic adayenera kupita kukonzanso. Izi zimafuna kudya koyenera, kukhala wakhama pantchito komanso wathanzi. Anthu odwala matenda ashuga apange kuperewera kwa mavitamini ndi michere yomwe sanalandire, kukhala okomoka.

Zifukwa zazikulu

Kuti muthandizire bwino, muyenera kuzindikira mtundu wa kuperewera. Njira yamankhwala imatengera izi. Zolakwa zikachitika, mkhalidwe wa wodwalayo umakulirakulira, ndipo chiwopsezo cha kufa chiwonjezereka. Zoyambitsa zazikulu za hypoglycemic coma:

• kusowa kwa wodwala matenda ashuga za njira zopewera kuperewera,
• kumwa mowa
• kuyambitsa matenda olakwika a insulin molakwika kapena kusazindikira, kusowa chakudya pambuyo jakisoni,
• Mlingo wowonjezera wa mapiritsi okonzekereratu omwe amachititsa kuti insulin iphatikizidwe.

Hyperglycemic chikomayi chimachitika pazifukwa zotsatirazi:

• kusowa kwazidziwitso wodwala matenda ashuga,
• jakisoni wa insulin wosadziwika kapena kudumphadumpha
• cholakwika pakuwerenga kuchuluka kwa insulin,
• kusintha kwa mtundu wa kukonzekera kwa insulin,
• kunyalanyaza zakudya mu shuga
• matenda oyamba, opaleshoni kumbuyo kwa matenda ashuga,
• kupsinjika

Zizindikiro za pathologies

Kuopsa kwa kudwala matenda ashuga kumayambira kugonjetsedwa kwa ubongo komanso kuphedwa kwakukulu. Psychology imodzi kuchokera kwina imasiyanasiyana osati pazomwe zimayambitsa, komanso zikhalidwe, ngakhale muzovuta kwambiri, mosasamala mtundu wa kupuma, kumachepa kupumira komanso palpitations. Zizindikiro za hypoglycemia sizovuta kusiyanitsa ndi ziwonetsero zama shuga ambiri. Kusiyana kwa zisonyezo za maboma awa kukuwonetsedwa bwino ndi tsamba lofananira:

Ngati banja lili ndi matenda ashuga, muyenera kufunsa dokotala kuti mupeze mbali zonse za thandizo loyamba.

Kusamalira mwadzidzidzi

Thandizo lodzidzimutsa liyenera kuperekedwa mofulumira. Zochita zilizonse zimatha kuchitika pokhapokha ngati mzindawo wazindikiridwa ndipo mtundu wa chikomacho wapezeka. Thandizo loyamba limasiyana malinga ndi kuchuluka kwa shuga m'thupi, zomwe zimayambitsa hyperglycemic kapena hypoglycemic coma. Mfundo zazikuluzikulu zakuchipatala zimaperekedwa pagome:

Kusiyanitsa mitundu

Pankhani ya chikomero cha hyperglycemic ndi hypoglycemic, kudziwika mosiyanasiyana kumachitika ndikuwonongeka kwa ubongo, glucosuria ndi acidosis. Kwa izi, magawo otsatirawa amakumbukiridwa:

• mbiri yakale
• Gawo lotsalira la nayitrogeni m'magazi,
• kuchuluka kwa shuga
• kukhalapo kwa bondo ndi Achilles kumatha.

Kodi zikuwonekabe zosatheka kuchiritsa matenda ashuga?

Poona kuti mukuwerenga izi tsopano, kupambana polimbana ndi shuga wambiri sikuli kumbali yanu.

Ndipo mudaganizapo kale za chithandizo kuchipatala? Ndizomveka, chifukwa matenda ashuga ndi matenda oopsa, omwe, ngati sanapatsidwe, amatha kufa. Udzu wokhazikika, kukodza mwachangu, masomphenya osalala. Zizindikiro zonsezi mumazidziwa nokha.

Koma kodi ndizotheka kuchitira zomwe zimayambitsa m'malo mothandizira? Timalimbikitsa kuwerenga nkhani yokhudza matenda a shuga omwe alipo masiku ano. Werengani nkhani >>

Hyperglycemic chikomacho mwa ana

Muubwana, kukomoka kwa hyperglycemic kumachitika chifukwa cha kuchuluka kwa shuga m'magazi mpaka pafupifupi 13 mmol / L.

Chomwe chimapangitsa kukula kwa vuto la kuchepa kwa hyperglycemic nthawi zambiri chimawonedwa ngati matenda a shuga, komanso chithandizo chamankhwala osafunikira komanso kuzindikira mochedwa matendawa. Malinga ndi akatswiri ena, pakapangidwe kameneka pamakhala kuphwanya malamulo a chikhalidwe cha neuro-mahomoni. Olemba ena akuti zifukwa zomwe zimapangidwira kukula kwa hyperglycemic coma mu ana zitha kukhala: njira zolakwika za mankhwala a insulin, kutanthauza kuti, mankhwala osokoneza bongo omwe sanalowe m'malo mwake ndi mtundu wina, womwe mwana alibe chidwi, matenda akudya, zovuta pachimake matenda opatsirana matenda opatsirana a purulent, ma pathologies a SS.S., kuchitapo kanthu kwa opaleshoni, mantha amanjenje, kugwiritsa ntchito mankhwala a corticosteroid mu Mlingo wofunikira. Chifukwa chake, zinthu izi zimathandizira kuwonjezeka kwa kufunikira kwa insulin, ndipo ichi chimakhala chifukwa chokhazikitsidwa ndi mawonekedwe oterewa monga insental insufficiency and metabolic syndrome.

Malinga ndi makina a chitukuko, hyperglycemic coma mu ana ndi hyperglycemic ketoacidotic, hyperglycemic hyperosmolar popanda ketoacidosis ndi lacticacidemia.

Vuto lalikulu la matenda a ketoacidotic, komwe ndiko kupezeka kwambiri kwa matenda a shuga, kumadziwika chifukwa cha kuchepa kwa insulin, komwe kumachitika matenda osapezekanso kapena ngati insulin yachulukitsidwa chifukwa cha matenda, kuvulala, maopaleshoni, kupsinjika, etc. chifukwa cha matenda ashuga osadziwika.

Hyperglycemic coma (ketoacidotic) imayamba pang'onopang'ono patadutsa masiku angapo. Ndi insulin yokwanira m'thupi, njira zogwiritsira ntchito shuga wa mwana zimasokonekera. Ndipo izi zimayambitsa hyperglycemia ndi glucosuria, zomwe zimathandizira kupanga ketosis.

Zizindikiratu mosiyanasiyana magawo atatu otsatizana a kukomoka kwa hyperglycemic: ketoacidosis yabwino, boma lokondweretsa komanso chikomokere.

Ana odwala omwe ali ndi ketoacidosis wolimbitsa amakhala ndi zizindikiro za kufooka kwapafupipafupi, amakhala oopsa, otopa msanga, ndipo amafuna kugona nthawi zonse. Ena amadandaula za tinnitus, amadwala komanso amakhala ndi ludzu pafupipafupi, koma chilimbikitso chawo chimachepa. Nthawi zina ana oterewa amamva kupweteka m'mimba komanso kukoka pafupipafupi. Kuchokera kwa odwala oterowo, fungo la acetone limamveka pakukambirana. Mu mkodzo, glucosoria wolimbitsa thupi ndi matupi a ketone amawonedwa. M'magazi - hyperglycemia, ketonemia ndi kuchepa pang'ono kwa pH.

Pakakhala chithandizo choyenera, ketoacidosis wokwanira amadutsa mu hyperglycemic precoma. Chifukwa chake, mwana wodwala amayamba kudwala ndikusanza pafupipafupi. Amakhala wopanda chidwi ndi chilichonse chomzungulira. Kenako kupweteka kwam'mimba kumakulirakulira komanso kupweteka mumtima. Mwanayo amakhalanso ndi ludzu, nthawi zambiri amakodza komanso amakhala osazindikira, koma zomwe amachita zimamulepheretsa pang'ono. Mafunso akhoza kuyankha monosyllabic komanso slurred. Khungu limakhala louma, loyipa komanso lozizira kukhudza. Ming'alu ndi zopondera zimawonekera pamilomo, khwangwala wamakhola, ndipo lilime limakhala ndi kapezi yoyera komanso utoto wofiirira wofiirira wokhala ndi masikono m'mphepete mwa mano. Mawonekedwe onse a tendon amakhala ofooka, ndipo hyperglycemia imafika pafupifupi 25 mmol / L. Matendawa amatha kukhala maola angapo kapena masiku angapo. Koma popanda kukhazikitsa njira zochizira, gawo lokomoka limachitika.

Gawoli limadziwika ndi kutayika kwa chikumbumtima, kuchepa kwa kutentha, kuuma komanso kupuma kwa khungu, kuchepa kwa minofu, kamvekedwe ka maso kochepa, komanso kuzimiririka kwa zinthu zina. Potere, mwana amayamba kupumira kwambiri, mwachangu komanso mokuwa. Pali inhale yakutali komanso chinsalu chachifupi chokhala ndi fungo losakanikirana la ma acetone kapena maapulo akhathamira. Fungo ili lidzakhalapo mchipinda cha mwana wodwala. Kuphatikiza apo, kupuma kokhazikika, kocheperako kumamveka, kuthamanga kwa magazi kumachepa, makamaka diastolic, yomwe ingayambitse kugwa. Panthawi imeneyi, pakukhazikika, m'mimba mumakhala wodekha, wosunthika pang'ono ndipo sikugwira nawo ntchito yopumira. Ma diagnostics a Laborator amadziwa hyperglycemia pafupifupi 50 mmol / l, acetonuria ndi glucosuria. Matupi a Ketone, creatine, urea amachulukitsidwa kwambiri m'magazi, ndipo sodium, m'malo mwake, amachepetsedwa. Leukocytosis yokhala ndi neutrophilic imadziwikanso.

Hyperglycemic coma imatha kuthandizira kuoneka ngati ntchito yosakwanira impso, chifukwa chake ketonuria ndi glucosuria amachepetsa kapena kuyimitsidwa kwathunthu.

Hyperglycemic coma (ketoacidotic) malinga ndi A.A. Martynov ali ndi mitundu inayi yamagawo amodzimodzi monga pamimba, mtima, aimpso ndi encephalopathic.

Chipatala cham'mimba chimadziwika ndi mphamvu ya dyspeptic phenomena, kupweteka kwam'mimba komanso minyewa yakhumi ya peritoneum patsogolo. Nthawi zina pamakhala kusanza kwamitundu ya khofi, kumakhala ma atomu am'mimba, zonsezi zimatsutsana ndi "pamimba pamimba."

Mtima umadziwika ndi zizindikiro za kugwa kwa mtima komanso mtima kulephera kwa cyanosis, tachycardia, dyspnea wolimbikitsa, mtima.

Mkhalidwe woyipa wa mawonekedwe a impso umapezeka mwa ana omwe ali ndi matenda a shuga a nephropathy, omwe amawonekera ndi vuto laysysicic. Nthawi zina, auria ndi pachimake aimpso amawonedwa.

Fomu la encephalopathic ndi amodzi mwa ovuta kwambiri mu hyperglycemic coma (ketoacidotic), yomwe imadziwika ndi zizindikiro zomwe zimakhudzana ndi kusokonekera kwa magazi m'thupi.

Hyperglycemic coma chithandizo

Kumayambiriro kwenikweni kwa chithandizo cha chikomokere cha hyperglycemic, njira imodzi yofunika kwambiri ndi kuchiritsa pogwiritsa ntchito Mlingo waukulu wa insulin yosavuta ndikukhazikitsa njira yofunikira ya NaCl yankho ndi 2.5% sodium bicarbonate solution.

Choyamba, wodwala yemwe ali ndi vuto la kutsekemera kapena matenda a hyperglycemic amafunika kuperekedwa ku dipatimenti ya IT (chisamaliro chachikulu).

Mfundo zachithandizo zimakhazikika pazochita monga kuchititsa kuchepetsedwa kwa maselo ndi malo ena, kupanga mankhwala obwezeretsa ndikumayambitsa insulin yosavuta, kusintha zizindikiritso zazikuluzikulu za asidi ndi boma la electrolyte, komanso kupewa iatrogenic hypoglycemia. Ndipo pamaso pa matenda a matenda opatsirana komanso a virus, ndikofunikira kuchita chithandizo choyenera, kuzindikira ndikuchiza matenda ena omwe athandizira kukulitsa chikomokere cha hyperglycemic ndikumupatsa mankhwala othandizira.

Njira zamankhwala zochizira hyperglycemic coma zitha kugawidwa pawiri. Choyamba, ndi insulin mankhwala, ndipo chachiwiri, ndi kulowetsedwa. Monga lamulo, mitundu itatu ya mankhwala a insulini imagwiritsidwa ntchito pochiza chikomokere. Njira yoyamba imadziwika ndi makonzedwe osasintha a misempha yaying'ono ya insulin. Njira yachiwiri imadziwika ndi njira yomwe imagwiritsa ntchito insulin pang'ono. Ndipo njira yachitatu ndi njira yomwe Mlingo wofunikira wa mankhwalawa umaperekedwa pogwiritsa ntchito makonzedwe ena.

Pazinthu zoyambirira, ma syringe okhawo amagwiritsidwa ntchito kupangira insulin infusions. Mpaka pano, njirayi imadziwika ponseponse padziko lapansi ndipo mawonekedwe ake ali motere: ndi kuchuluka kwa glucose wofika mpaka 33.3 mmol / l, mankhwalawa amayamba ndikuwongolera kosalekeza kwa insulin, komwe kuthamanga kwake kuli magawo 6 mpaka 10 pa ola limodzi, komanso pamitengo yapamwamba kuchokera ku chizindikiro ichi - 12-16 mayunitsi pa ola limodzi.

Chithandizo cha hyperglycemic chikomvu chagawidwa m'magawo atatu. Poyambirira, ndikofunikira kuchepetsa kuchuluka kwa glucose kukhala mamilion 16 pa lita imodzi. Kenako amayamba kukonza mkhalidwe wa wodwalayo kuti azitha kudya yekha. Ndipo gawo lachitatu la chithandizo cha kukomoka kwa hyperglycemic ndikusintha kwa wodwalayo kukhala njira yake yamoyo.

Mankhwala a insulin amachitika ndikuwunika pafupipafupi kuchuluka kwa shuga kumayambiriro kwa mankhwala ola lililonse, ndipo patatha maola awiri, ndikugwiritsa ntchito mankhwalawa okwanira kulowetsedwa. Pokhapokha ngati glucose sangatsike ndi makumi atatu peresenti mkati mwa maola atatu kapena anayi, ndiye kuti amayesa kuwonjezera kuchuluka kwa ntchito yomwe amagwiritsidwa ntchito poyamba, pafupifupi kawiri. Atafikira glucose wokwanira mamilimita khumi ndi chimodzi pa lita imodzi, mlingo wa insulini umachepetsedwa kukhala magawo awiri mpaka anayi pa ola limodzi. Ndi glycemia wa mamiliyoni khumi ndi limodzi mpaka khumi ndi atatu pa mankhwalawa, mankhwalawa amathandizidwa mosagawanika kwa magawo anayi mpaka asanu ndi limodzi maola awiri kapena anayi. Pambuyo pake, ndi shuga wa mamiliyoni khumi mpaka khumi ndi awiri pa lita imodzi, sikulimbikitsidwa kupitiliza kuyang'anira insulin kuti tipewe kuwonongeka kwa boma la hypoglycemic.

Maluso a kulowetsedwa mankhwala a hyperglycemic chikomaso amagawika magawo atatu. Mu gawo loyamba la chithandizo, phys. rr Pa ola loyamba la mankhwalawa, jekeseni wamkati amtundu umodzi wa mankhwalawa amachitidwa, kenako amamuwonjezera theka. M'tsogolomu, pamene zizindikiro zam'madzi zidzachotsedwa pang'onopang'ono, pathupi. yankho limayambitsidwa pang'onopang'ono mpaka shuga atafika mamilimita khumi ndi umodzi pa lita imodzi.

Ndipo pamaso pa hypokalemia, amayamba kuwongolera pasanathe maola awiri kuchokera pachiwonetsero cha mankhwala pogwiritsa ntchito njira. Chifukwa chaichi, yankho la potaziyamu mankhwala enaake limaperekedwa. Ndipo kusintha matenda oyambira a asidi, njira yokhazikitsidwa ndi NaHC yokhala ndi NaHC imayikidwa pamaso pa acidosis ndi pH pansipa isanu ndi iwiri. Mankhwala onse a kulowetsedwa amawongoleredwa ndi kukakamiza kwapakati kwa venous ndikuwonetsa mkodzo wa maola.

Pa gawo lachiwiri la chithandizo cha kukomoka kwa hyperglycemic, wodwala akayambanso kuzindikira kuti asataye shuga, amayamba kulowetsedwa ndi 5% ya shuga 200 ml pa ola limodzi ndi insulin (4 mayunitsi). Pambuyo pa izi, wodwalayo amatha kumwa tiyi wokoma kapena kudya chidutswa cha shuga.

Gawo lomaliza la mankhwalawa likuchitika kale mu dipatimenti yapadera. Pankhaniyi, jakisoni wokhazikika wa insulin amaperekedwa pambuyo maola anayi kapena asanu ndi limodzi, ndi kuvomerezedwa kwa shuga. Pambuyo pa jakisoni aliyense wa insulin, wodwalayo ayenera kudya zakudya zokhala ndi 50 g zamagulu a mafuta. Kenako kuyambitsidwa kwa mavutowo kuthetsedwa, ndipo wodwalayo amayamba kudya chakudya pakumwa. Zakudya Nambala 9 zimayikidwa, zomwe zimapatula kudya zakudya zamafuta kwakanthawi ya acetonuria ndipo zitatha, kwa masiku ena khumi. Kuphatikiza apo, pofuna kupewa njira zochotsekera atachotsedwa mu hyperglycemic chikomokere, wodwalayo adamulamula kuti apumule masiku asanu ndi awiri.

Nthawi zina, pamene ma syringe othomoka sakhala, amayamba njira monga kupangika kwa insulin yaying'ono. Mlingo wonse wogwiritsidwa ntchito wa mankhwalawa ndi wofanana ndi njira yoyamba ya mankhwala, koma ma jet intravenous okha ola lililonse amagwiritsidwa ntchito pano.

Koma njira yachitatu yochizira matenda a hyperglycemic coma imadziwika ndi kukhazikitsidwa kwa insulin mu Mlingo wofunikira, komabe, lero sikugwiritsidwa ntchito. Chofunikira chake ndikuyambitsa limodzi la insulin 40-60 mayunitsi popanda chidwi ndi kulowetsedwa, motero nthawi zambiri limakhala chifukwa cha lactic acidosis, edema yodwala, kuchepa kwambiri kwa glucose, komwe kunayambitsa imfa.

Njira zochizira matenda osiyanasiyana opatsirana komanso yotupa imaphatikizanso kugwiritsa ntchito mitundu yambiri ya maantibayotiki. Ngati pa chithandizo pali opaleshoni ya matenda, mwachitsanzo, gwere latsoka, ndiye kuti opaleshoni yodzidzimutsa yakhazikitsidwa. Koma opaleshoni isanachitike, wodwalayo ayenera kutulutsidwa kunja kwa chiphuphu. Matenda ena onse omwe anapangitsa kuti akhale ndi vuto la hyperglycemic akhoza kulandira chithandizo.

Hyperglycemic coma emergency

Hyperglycemic coma imadziwika ndi chitukuko chochepa pang'onopang'ono masiku angapo. Nthawi yomweyo, kuchuluka kwa glucose m'magazi a wodwalayo kumakhala komwe kumapangitsa kuti pakhale zinthu zopweteka mthupi, zomwe zimapangidwa kuchokera pokonza chakudya. Monga lamulo, wodwala yemwe ali ndi vuto la matenda, mwachitsanzo, shuga amadziwa bwino zomwe zimakhala ngati hyperglycemic chikomokere ndipo amatha nthawi zonse kuwongolera zinthu pakuwonetsa zizindikiro. Kuti achite izi, iye samapatula zakudya zokhala ndi zakudya m'zakudya zake, amasinthanso kumwa piritsi kapena jakisoni wa jakisoni, ndikuyamba kumwa madzi ambiri.

Koma nthawi zina, kukomoka kwa hyperglycemic kumatha kupangidwanso ndi zifukwa zina, mwachitsanzo, mutalandira kuvulala, chifukwa cha matenda opatsirana, kumwa mowa, pakati pathupi kapena pambuyo povuta. Potere, wovutikayo amafunikira chisamaliro chamankhwala madokotala asanafike.

Choyamba muyenera kuwonetsetsa kuti ichi ndi chikhalidwe cha chikomokere, osati chizindikiro cha matenda ena. Choyamba, muyenera kudziwa kuti kumayambiriro kwa kuukira, wodwalayo akadali wamantha, amayamba kufooka, kumva kugona, kuzunzidwa ndi ludzu, akukana kwathunthu kudya, atatha kudya, akudandaula kukokana pafupipafupi komanso kupweteka pamutu, ndipo komanso kupuma kwambiri. Pankhaniyi, ndikofunikira kudziwa kuchokera kwa wodwala ngati akumwa mankhwala a insulin ndipo, ngati ndi choncho, kuti athandize wodwalayo kuperekera mlingo woyenera wa mankhwalawo, ndipo ngati zingatheke, perekani wodwalayo kuti amwe madzi ambiri. Ikani mozungulira ndikuwonetsetsa kuti pakupezeka mpweya wabwino, kenako pemphani chithandizo chamankhwala choyenerera.

Pofuna kutaya chikumbumtima, kuchepa mphamvu kwa khungu, maonekedwe a zizindikilo zoyamba kugwirana ndi miyendo, kutsika kwa magazi komanso kununkhira kwamphamvu kwa wodwala, ndikofunikira kupereka mayunitsi a 50-100 a insulin mosadukiza komanso mwamphamvu kwambiri. Ngati wovutikayo wasiya kupuma kapena kugunda kwa mtima sikumveka, ndiye kuti njira zotsitsimutsa zimayambika mwa njira yopuma molunjika ndi kupumira kwamankhwala madokotala asanafike. M'pofunikanso kuwongolera zamkati kuti mupewe imfa ya wodwalayo.

Nthawi zambiri pomwe wodwala amapezeka kuti ali osazindikira, nthawi zambiri pamakhala zovuta zina zodziwitsa anthu ena komanso kuwathandiza mwadzidzidzi. Pankhaniyi, ndikofunikira kufufuza wodwalayo ndikupeza zomwe zimapangitsa kuti musakhale chikumbumtima. Kodi pali mabala ena aliwonse chifukwa chakumenyedwa, mabala, ma jakisoni, pali fungo la asetoni, palpation imatsimikiziridwa ngati ma eye ali mokhazikika, etc. Ngati pali zizindikiro zosonyeza kuti muli ndi vuto la hyperglycemic, ndikofunikira kupereka chithandizo choyamba. Pankhaniyi, amafunika kupatsa wodwala malo oyimirira ndi kutembenukira kumutu, kulepheretsa lilime kuti lis kumira, komanso kupanga mpweya wopumira mwaulere.

Chisamaliro chadzidzidzi cha hyperglycemic coma chidzaperekedwa kale mu ambulansi. Pankhaniyi, kupatsanso madzi m'thupi, yankho la 0.9% NaCl mpaka lita imodzi, yankho la Ringer mpaka lita imodzi yokhala ndi mavitamini B, C imayamwa jakisoni, Cocarboxylase, glycosides yamtima imathandizidwanso. Kuti athetse asidiosis, njira ya 4% ya Na bicarbonate imayambitsidwa 300 ml pa ola limodzi, komanso kudzera m'mitsempha - 20 ml ya Panangin kapena 10% KCl.