Hyperosmolar Diabetesic Coma (GDK) - zovuta za shuga, zomwe zimayamba chifukwa cha kuchepa kwa insulin, yodziwika ndi kuperewera kwa madzi m'thupi, hypergoscolarity, zomwe zimayambitsa kuwonongeka kwakukulu kwa ntchito ya ziwalo ndi machitidwe komanso kusazindikira, komwe kumadziwika ndi kusowa kwa ketoacidosis.

Zimakhala zofala kwambiri kwa anthu achikulire omwe ali ndi matenda osokoneza bongo omwe amadalira shuga, omwe amangolandira chithandizo chamankhwala chokha kapena mankhwala a hypoglycemic. zinthu zaumunthu (kudya kwambiri zam'mimba mkati kapena mkati / pakubweretsa shuga wambiri, zifukwa zonse zobwera chifukwa cha kusowa kwamadzi: kutsegula m'mimba, kusanza, kuthira okodzetsa, kukhalabe munthawi yotentha, kuwotcha kwambiri, magazi akulu, hemodialysis kapena peritoneal dialysis)

GDK pathogenesis: hyperglycemia -> glucosuria -> osmotic diuresis ndi polyuria -> kuchepa kwa magazi m'thupi ndi kuchepa kwa magazi, kuchepa kwa magazi mkati mwa ziwalo zamkati, kuphatikiza impso -> kuchepa kwa madzi m'thupi -> kutsegula kwa RAAS magazi kusungidwa sodium ndi kuwonjezeka lakuthwa kwa magazi osmolarity -> kusokonezeka kwa mafungo ofunikira a ziwalo zofunika, ma hemorrhages oyambira, etc., ketoacidosis kulibe, chifukwa pali kuchuluka kwina kwamkati mwa insulin kokwanira kupangitsa lipolysis ndi ketogeneis.

Chipatala ndi matenda a GDK:

Amakula pang'onopang'ono, mkati mwa masiku 10 mpaka 14, ali nthawi yayitali precomatose ndi madandaulo a odwala omwe ali ndi ludzu lalikulu, kamwa yowuma, kuwonjezereka kufooka, pafupipafupi, kukodza pokoka, kugona, khungu louma lokhala ndi turgor ndi zotanuka

Wokoma:

- chikumbumtima chatayika kwathunthu, pamatha kupezeka nthawi zina khunyu komanso maukodzo ena (nystagmus, ziwalo,

- khungu, milomo, lilime ndi louma kwambiri, khungu turgor limachepetsedwa kwambiri, nkhope zakuthwa nkhope, maso owala, mawonekedwe owoneka bwino

- pamakhala kupfupika nthawi zonse, koma palibe kupuma kwa Kussmaul ndipo palibe fungo la acetone mu mpweya wotuluka

- zimachitika pafupipafupi, kudzaza kofooka, kawirikawiri kofikira, kumveka kwa mtima ndi gonthi, nthawi zina kukakamira, kuthamanga kwa magazi kumachepetsedwa kwambiri.

-mimba ndi yofewa, yopweteka

- oliguria ndi hyperazotemia (monga chiwonetsero cha pang'onopang'ono chaimpso kulephera)

Zambiri zasayansi: LHC: hyperglycemia (50-80 mmol / l kapena kuposa), hyperosmolarity (400-500 mosm / l, magazi osmolarity osadziwika> , OAK: kuchuluka kwa hemoglobin, hematocrit (chifukwa cha kuchuluka kwa magazi), leukocytosis, OAM: glucosuria, nthawi zina albuminuria, kusowa kwa acetone, acid-base complement: pH yachilendo magazi ndi bicarbonate

1. Kubwezeretsanso kwa thupi: m'maola oyamba ndizotheka kugwiritsa ntchito yankho la 0.9% NaCl, kenako 0.45% kapena 0,6% NaCl yankho, kuchuluka kwathunthu kwamadzimadzi omwe adalowetsedwa ndi / ndi kwakukulu kuposa ndi ketoacidosis, popeza kufooka kwa thupi ndikwambiri kwambiri: tsiku loyamba ndikofunikira kuyambitsa malita 8 amadzimadzi, ndi malita atatu mu maola atatu oyamba

2. Pamaso pa kusanza ndi zizindikiritso zam'mimba zotsekemera - nasogastric intubation

3. Mankhwala a insulin omwe ali ndi Mlingo wa insulin yaying'ono: motsutsana ndi maziko a kulowetsedwa kwa 0,45% ya NaCl ya mtsempha wa magazi nthawi yomweyo 10-

ZIWEREZO 15 za insulin zotsatiridwa ndi kayendetsedwe ka 6-10 PIECES / h, kuchuluka kwa shuga m'magazi kumatsika mpaka 13.9 mmol / L, kuchuluka kwa insulini kumatsikira mpaka 3 PIECES / h.

4. Njira yoyendetsera shuga ndi potaziyamu imakhala yofanana ndi ketoacidotic chikomokere, phosphates (80-120 mmol / tsiku) ndi magnesium (6-12 mmol) imayambitsidwanso, makamaka pamaso pa kugwidwa ndi arrhythmias.

Lactacidemic Diabetesic Coma (LDC) - kuphatikizika kwa matenda ashuga, kukulaku chifukwa cha kusowa kwa insulin ndi kudzikundikira kwa lactic acid m'magazi, zomwe zimapangitsa kuti acidosis ikhale yovuta kwambiri komanso kuti musamadziwe.

Etiology of LDK: matenda opatsirana komanso otupa, hypoxemia chifukwa cha kupuma komanso mtima kulephera kosiyanasiyana, matenda a chiwindi osachiritsika ndimatenda a chiwindi, matenda a impso osalephera komanso aimpso,

Pathogenesis wa LDK: hypoxia ndi hypoxemia -> kutsegulira kwa anaerobic glycolysis -> kudzikundikira kwa kuperewera kwa lactic acid + insulin -> kuchepa kwa ntchito ya pyruvate dehydrogenase, yomwe imalimbikitsa kutembenuka kwa PVA kukhala acetyl-CoA -> PVA ikadutsa lactate, lactate siyikuphatikizanso glycogen (chifukwa cha kwa hypoxia) -> acidosis

Chipatala ndi matenda a LDK:

- chikumbumtima chatayika kwathunthu, pakhoza kukhala nkhawa yamagalimoto

- khungu limakhala lotumbululuka, nthawi zina limakhala ndi ma cyanotic hue (makamaka pakakhala matenda amtima, ophatikizidwa ndi hypoxia)

- Kussmaul chopanda chopanda fungo mu mpweya wotuluka

- zimachitika pafupipafupi, kudzazidwa kofowoka, nthawi zina kwamatumbo, kuthamanga kwa magazi kumachepetsedwa kuti kugwe (ndi acidosis yayikulu chifukwa cha kusokonezeka kwa myocardial contractility ndi zotumphukira zamitsempha yamagazi

- pamimba pamakhala kofewa, osati kovuta, pamene acidosis imachulukirachulukira, matenda am'mimba amalimba (mpaka kusanza kwambiri), kupweteka kwam'mimba kumawonekera

Hyperosmolar chikomine mu matenda a shuga (pathogeneis, mankhwala)

Chimodzi mwa zoopsa komanso nthawi yomweyo wosaphunzira bwino za matenda ashuga ndi hyperosmolar coma. Pali kutsutsanabe pamakina omwe adachokera ndikukula kwake.

Matendawa alibe pachimake, mkhalidwe wa anthu odwala matenda ashuga amatha kukhala wowopsa kwa masabata awiri isanakwane kufooka koyamba kwa chikumbumtima. Nthawi zambiri, chikomokere chimapezeka mwa anthu opitilira zaka 50. Madokotala nthawi zambiri samatha kudzipangitsa kuti adziwe ngati wodwala ali ndi matenda ashuga.

Chifukwa chakulandila kuchipatala mochedwa, zovuta zodziwonetsa, kuwonongeka kwambiri kwa thupi, chikomokere cha hyperosmolar chimakhala ndi chiwopsezo chachikulu cha kufa kwa 50%.

Kodi Hyperosmolar coma ndi chiyani?

Kusekerera kwa hyperosmolar ndi vuto lotha kuzindikira m'machitidwe onse: mphamvu, ntchito za mtima ndi kuchepa kwa thupi, mkodzo umasiya kuchotsedwa. Munthu panthawiyi amakhala ndi malire pam moyo ndi imfa. Choyambitsa mavuto onsewa ndi hyperosmolarity yamagazi, ndiko kuti, kuchulukana kwamphamvu mu kupsinjika kwake (kuposa 330 mosmol / l wokhala ndi chizolowezi 275-295).

Mtundu wamtunduwu umadziwika ndi shuga wamagazi ambiri, pamwamba pa 33.3 mmol / L, komanso kutopa kwambiri. Pankhaniyi, ketoacidosis kulibe - matupi a ketone samapezeka mkodzo ndi mayeso, kupuma kwa wodwala matenda ashuga sikufungo la acetone.

Malinga ndi gulu lapadziko lonse lapansi, hyperosmolar coma imatchulidwa kuti ndikuphwanya kagayidwe kamchere wamadzi, khodi malinga ndi ICD-10 ndi E87.0.

Matenda a hyperosmolar amayamba kudwala mwadzidzidzi; muzochitika zachipatala, vuto limodzi limapezeka mwa odwala 3300 pachaka. Malinga ndi ziwerengero, pafupifupi odwala ali ndi zaka 54, akudwala matenda a shuga a 2 osadalira insulin, koma osawongolera matenda ake, chifukwa chake ali ndi zovuta zingapo, kuphatikizapo matenda ashuga a nephropathy omwe amalephera. Mu gawo limodzi mwa magawo atatu a odwala omwe ali ndi chikomokere, matenda a shuga ndiwotalika, koma sanapezeke ndipo, motero, sanalandiridwe nthawi yonseyi.

Poyerekeza ndi ketoacidotic coma, hyperosmolar coma imachitika kangapo ka 10. Nthawi zambiri, mawonetseredwe ake ngakhale osavuta amasiyidwa ndi odwala matenda ashuga okha, osazindikira ngakhale pang'ono - amasintha shuga m'magazi, amayamba kumwa kwambiri, komanso amatembenukira kwa a nephrologist chifukwa cha vuto la impso.

Zifukwa zachitukuko

Hyperosmolar coma imayamba matenda a shuga mellitus mothandizidwa ndi izi:

1. Kuthetsa madzi m'thupi kwambiri chifukwa cha kupsa kwambiri, kugwiritsa ntchito bongo mopitirira muyeso, poyizoni ndi matenda am'matumbo, omwe amayenda ndi kusanza komanso kutsegula m'mimba.
2. Kuperewera kwa insulini chifukwa chosagwirizana ndi zakudya, kuchotsera pafupipafupi kwa mankhwala ochepetsa shuga, matenda owopsa kapena kulimbitsa thupi, chithandizo cha mankhwala osokoneza bongo omwe amalepheretsa kupanga insulin.
3. Matenda a shuga osadziwika.
4. Matenda a impso nthawi yayitali osalandira chithandizo choyenera.
5. Hemodialysis kapena glucose wolowa pamene madokotala sakudziwa za shuga m'm wodwala.

Kukhazikika kwa hyperosmolar coma nthawi zonse kumayendera limodzi ndi hyperglycemia. Glucose imalowa m'magazi kuchokera mu chakudya ndipo imapangidwa nthawi yomweyo ndi chiwindi, kulowa kwake mu minofu ndizovuta chifukwa chotsutsana ndi insulin. Pankhaniyi, ketoacidosis sichimachitika, ndipo chifukwa chakusowa kwawo sichinadziwikebe bwinobwino. Ofufuza ena amakhulupirira kuti mtundu wa hyperosmolar wa coma umayamba pamene insulin ikukwanira kuletsa kuwonongeka kwa mafuta ndi mapangidwe a matupi a ketone, koma ochepa kwambiri kuti athe kutsekereza kuchepa kwa glycogen m'chiwindi ndikupanga shuga. Malinga ndi mtundu wina, kumasulidwa kwa mafuta acids kuchokera ku minyewa ya adipose kumapanikizika chifukwa chosowa ma hormone kumayambiriro kwa vuto la hyperosmolar - somatropin, cortisol ndi glucagon.

Kusintha kwina kwa pathological komwe kumayambitsa hyperosmolar coma kumadziwika bwino. Ndi kupita patsogolo kwa hyperglycemia, kuchuluka kwa mkodzo kumawonjezeka. Ngati impso imagwira ntchito mwachizolowezi, ndiye kuti malire a 10 mmol / L akapitilira, shuga amayamba kuthiridwa mkodzo. Ndi vuto laimpso, matendawa samachitika nthawi zonse, ndiye kuti shuga amadziunjikira m'magazi, ndipo kuchuluka kwa mkodzo kumawonjezeka chifukwa cha kulowetsedwa kwa impso, kuperewera kwa madzi kumayamba. Madzi amasiya maselo ndi malo pakati pawo, kuchuluka kwa magazi omwe amayendayenda kumachepa.

Chifukwa cha kuchepa mphamvu kwa maselo a muubongo, kusintha kwa minyewa kumachitika, kuwonjezeka kwa magazi kumakhumudwitsa thrombosis, ndipo kumayambitsa kusakwanira kwa magazi ku ziwalo. Potengera kuchepa kwa madzi, mapangidwe a aldosterone amakula, omwe amalepheretsa sodium kulowa mkodzo kuchokera m'magazi, ndipo hypernatremia imayamba. Iyenso amakwiya ndipo amatupa mu ubongo - chikomokere chimachitika.

Pokhapokha njira zotsitsimutsa kuti zithetsere vuto la hyperosmolar, zotsatira zakupha sizitha.

Zizindikiro zake

Kukula kwa vuto la hyperosmolar kumatenga sabata limodzi kapena awiri. Kusintha kumachitika chifukwa chakuwonongeka pakubwezeredwa kwa shuga, kenako zizindikiro za kuchepa thupi. Pomaliza, zizindikiro zamitsempha ndi zotsatira za kuthamanga kwa magazi zimachitika.

Chifukwa chakuti kugwira ntchito kwa ziwalo zonse kumaphwanyidwa ndi chikomokere (Hyperosmolar coma), izi zitha kutsekedwa ndi vuto la mtima kapena zizindikiro zofanana ndi kukula kwa matenda opatsirana. Chifukwa cha edema ya ubongo, zovuta za encephalopathy zitha kukayikiridwa. Kuti adziwe matenda ake mwachangu, adotolo ayenera kudziwa za matenda ashuga m'mbiri ya wodwalayo kapena kuti adziwe nthawi yoyenera.

Zoyenera kudziwa

Kuzindikira kumakhazikika pazizindikiro, matenda a labotale, komanso matenda ashuga. Ngakhale kuti matendawa amafala kwambiri mwa anthu achikulire omwe ali ndi matenda a 2, hyperosmolar coma imatha kukhala mtundu 1, ngakhale utakhala ndi zaka zingati.

Nthawi zambiri, kuyezetsa magazi ndi mkodzo kofunikira popanga matenda:

Kuti mudziwe momwe mtima umawonongekera, komanso ngati ungapirire kutulutsa, ECG yachitika.

Algorithm mwadzidzidzi

Wodwala yemwe ali ndi matenda ashuga akafafaniza kapena akufooka, chinthu choyamba kuchita ndi kuyitanira ambulansi. Thandizo ladzidzidzi la hyperosmolar coma lingaperekedwe kokha kumalo osamalira odwala. Wodwalayo akapulumutsidwa mwachangu, mwayi wake wopulumuka, ziwalo zochepa zimawonongeka, ndipo adzachira mwachangu.

Mukuyembekezera ambulansi yomwe mukufuna:

1. Mugoneke wodwala pambali pake.
2. Ngati ndi kotheka, kukulani kuti muchepetse kutentha.
3. Amayang'anira kupuma ndi maukwati, ngati kuli kotheka, yambani kupuma movutikira komanso kutikita minofu yamtima mwachindunji.
4. Pimani shuga. Ngati muli ndi mphamvu zochulukirapo, jekesani insulin yochepa. Simungathe kulowetsa insulini ngati palibe glucometer ndipo kuchuluka kwa glucose kulibe, izi zimatha kupangitsa wodwalayo kufa ngati ali ndi hypoglycemia.
5. Ngati pali mwayi ndi luso, ikani dontho ndi saline. Mulingo wa makonzedwe ndi dontho mphindi.

Wodwala matenda ashuga akayamba kuthandizidwa, amapita kuchipatala mosamala kuti adziwe ngati kuli koyenera, kulumikizana ndi mpweya wabwino, kubwezeretsa mkodzo, ndikuyika catheter mu mtsempha kwa nthawi yayitali.

Nthawi zonse wodwala amayang'aniridwa:

• glucose amayesedwa ola limodzi
• maola 6 aliwonse - potaziyamu ndi sodium,
• kupewa ketoacidosis, matupi a ketone ndi acidity yamagazi amawongoleredwa,
• kuchuluka kwa mkodzo komwe kumatulutsidwa kumawerengeredwa nthawi yonse yomwe akhetsa mainki,
• kukoka, kupsinjika ndi kutentha nthawi zambiri kumayendera.

Njira zazikulu za chithandizo ndikubwezeretsanso kwamchere wamchere, kuchotsa kwa hyperglycemia, chithandizo cha matenda oyanjana ndi zovuta.

Kukonza madzi am'madzi ndi kubwezeretsanso kwa ma elekitirodi

Kubwezeretsa madzimadzi m'thupi, kulowetsedwa kwa volumetric intravenous infusions - mpaka 10 malita patsiku, ola loyamba - mpaka malita 1.5, ndiye kuchuluka kwa yankho lomwe limayendetsedwa pa ola limachepetsedwa pang'onopang'ono mpaka malita 0,3-0,5.

Mankhwala amasankhidwa malinga ndi zigawo za sodium zomwe zimapezeka pa mayeso a labotale:

Doctor of Medical Science, Mutu wa Institute of Diabetesology - Tatyana Yakovleva

Ndakhala ndikuphunzira matenda a shuga kwa zaka zambiri. Zimakhala zowopsa anthu ambiri akamwalira, ndipo makamaka amakhala olumala chifukwa cha matenda ashuga.

Ndithamangira kunena mbiri yabwino - Endocrinological Research Center ya Russia Academy of Medical Science idatha kupanga mankhwala omwe amachiritsiratu matenda ashuga. Pakadali pano, kugwiritsa ntchito bwino kwa mankhwalawa kuyandikira 98%.

Nkhani ina yabwino: Unduna wa Zaumoyo wateteza kukhazikitsidwa kwa pulogalamu yapadera yomwe imalipira mtengo wa mankhwalawo. Ku Russia, odwala matenda ashuga mpaka Meyi 18 (kuphatikiza) nditha kuipeza - Kwa ma ruble 147 okha!

Ndi kukonzanso kwam'madzi, kuphatikiza pakubwezeretsa malo osungiramo madzi m'maselo, kuchuluka kwa magazi kumawonjezerekanso, pomwe dziko la hyperosmolar limachotsedwa ndipo mulingo wamagazi amachepa. Kukonzanso madzi mkaka kumachitika ndi kulamulidwa kwa glucose, chifukwa kuchepa kwake kothamanga kumatha kubweretsa kugwa kwakanthawi kwa mavuto kapena matenda a edema.

Pamene mkodzo umawonekera, kubwezeretsanso kwa zosowa za potaziyamu m'thupi kumayamba. Nthawi zambiri amakhala potaziyamu mankhwala enaake, pakakhala kulephera kwa aimpso - phosphate. Ndende ndi kuchuluka kwa kayendetsedwe amasankhidwa malinga ndi zotsatira za kuyesedwa kwa magazi pafupipafupi kwa potaziyamu.

Hyperglycemia Control

Mwazi wamagazi umakonzedwa ndi insulin, insulin imayendetsedwa mwachidule, muyezo wochepetsetsa, moyenera mwa kulowetsedwa kosalekeza. Ndi hyperglycemia wokwera kwambiri, jakisoni wambiri wamadzi m'thupi mpaka magawo 20 amachitidwa kale.

Ndikusowa kwamadzi kwambiri, insulini singagwiritsidwe ntchito kufikira madzi atabwezeretsedwa, shuga panthawiyo amachepetsa msanga. Ngati matenda ashuga ndi hyperosmolar coma ali ovuta kwambiri ndi matenda oyanjana, insulini ingafunike kuposa masiku onse.

Kukhazikitsidwa kwa insulin panthawiyi yamankhwala sikutanthauza kuti wodwalayo asinthana ndikuyamba moyo wake wonse. Nthawi zambiri, atakhazikika pamatenda, matenda amtundu wa 2 amatha kulipidwa pakudya (zakudya zamtundu wa 2 shuga) komanso kumwa mankhwala ochepetsa shuga.

Chithandizo cha Matenda Olumikizana

Pamodzi ndi kubwezeretsa kwa osmolarity, kukonza komwe kudachitika kale kapena kumayikiridwa akutsutsana kumachitika:

1. Hypercoagulation imachotsedwa ndipo thrombosis imalepheretsedwa ndikupereka heparin.
2. Ngati kulephera kwa impso kukukulirakulira, hemodialysis imachitika.
3. Ngati hyperosmolar chikomokere chikukwiyitsidwa ndi matenda a impso kapena ziwalo zina, maantibayotiki amafunsidwa.
4. Glucocorticoids amagwiritsidwa ntchito ngati mankhwala a antishock.
5. Pamapeto pa chithandizo, mavitamini ndi michere amaikidwa kuti apange zotayika zawo.

Zomwe ungayembekezere - kuneneratu

Kukula kwa hyperosmolar coma kwakukulu kumatengera nthawi yakuyamba chithandizo chamankhwala. Ndi chithandizo cha panthawi yake, chikumbumtima sichitha kupewetsa kapena kubwezeretsa nthawi. Chifukwa chachedwa kuchira, 10% ya odwala omwe ali ndi chikomokereyi amafa. Zomwe zimapangitsa kuti milandu yotsala imphedwe imawonedwa kuti ndi nkhalamba, matenda a shuga osawerengeka, "maluwa" amatenda omwe atengedwa panthawiyi - kulephera kwa mtima ndi impso, angiopathy.

Imfa yokhala ndi hyperosmolar coma imachitika nthawi zambiri chifukwa cha hypovolemia - kuchepa kwa magazi. Mthupi, zimapangitsa kusowa kwa ziwalo zamkati, makamaka ziwalo zosintha kale. Komanso, edema yam'mimba komanso zopweteka zazikulu zakufa zitha kufa.

Ngati mankhwalawa anali a panthawi yake komanso ogwira ntchito, wodwalayo ayambiranso kuzindikira, zizindikiro za chikomokere zimatha, shuga ndi magazi osmolality amakhala. Matenda a m'mitsempha ya m'magazi akasiya chikomokere amatha masiku angapo mpaka miyezi ingapo. Nthawi zina kubwezeretsa kwathunthu kwa ntchito sikuchitika, ziwalo, vuto la kulankhula, matenda amisala amatha kupitilira.

Onetsetsani kuti mwaphunzira! Kodi mukuganiza kuti kuyamwa kwa mapiritsi ndi insulini kwa nthawi yonse yokhayo ndi njira yokhayo yosungira shuga m'manja? Sichowona! Mutha kutsimikizira izi nokha ndikuyamba kuzigwiritsa ntchito. werengani zambiri >>

Etiology ndi pathogenesis

Kutsimikiza kwa hyperosmolar coma kumalumikizidwa ndi moyo wa munthu. Amawonedwa makamaka mwa anthu omwe ali ndi mtundu wachiwiri wa matenda osokoneza bongo komanso nthawi zambiri okalamba, ana - osayang'aniridwa ndi makolo. Chochititsa chachikulu ndikuwonjezera kuchuluka kwa shuga m'magazi pamaso pa hyperosmolarity komanso kusowa kwa acetone m'magazi.

Zomwe zimapangitsa izi:

• kuchepa kwakukulu kwa madzimadzi ndi thupi chifukwa chogwiritsa ntchito nthawi yayitali pakukodzetsa, kutsegula m'mimba kapena kusanza, kupsa.
• insulin yokwanira chifukwa chophwanya insulin kapena ngati sichichita,
• kuchuluka kwa insulin, kumatha chifukwa cha kuperewera kwa zakudya m'thupi, matenda opatsirana, kuvulala, kugwiritsa ntchito mankhwala ena kapena kuyambitsa shuga.

The pathogenesis ya ndondomekoyi sichikudziwikiratu. Amadziwika kuti kuchuluka kwa glucose m'magazi kumakwera kwambiri, ndikupanga insulin, m'malo mwake, imachepa. Nthawi yomweyo, kugwiritsidwa ntchito kwa glucose kumatsekeka, ndipo impso zimasiya kuzikonza ndikuzipaka mkodzo.

Ngati kutayika kwakukulu kwa madzi ndi thupi, ndiye kuti kuchuluka kwa magazi omwe amayendayenda kumachepa, kumakhala kowonda kwambiri komanso osmolar chifukwa cha kuchuluka kwa glucose, komanso ayodini ndi potaziyamu.

Zizindikiro za kukomoka kwa hyperosmolar

Hyperosmolar coma ndimapangidwe apang'onopang'ono omwe amapezeka kwa milungu ingapo.

Zizindikiro zake zimayamba kukula ndikuwonekera:

• kuchuluka kwamikodzo,
• ludzu lochulukirapo
• kuchepa thupi kwakanthawi m'nthawi yochepa,
• kufooka kosalekeza
• kuyanika pakhungu ndi mucous nembanemba,
• kuwonongeka kwa thanzi.

Kuwonongeka kwakukulu kumawonetsedwa pakusafuna kusuntha, kutsika kwa magazi ndi kutentha, komanso kuchepa kwa kamvekedwe ka khungu.

Nthawi yomweyo, pali zizindikiro zamitsempha, zowonetsedwa mu:

• kufooketsa kapena kukweza kwambiri mawonekedwe a Reflex,
• kuyerekezera
• kusokonekera kwa mawu
• kulanda
• chikumbumtima
• kuphwanya kwamtundu wa kayendedwe.

Pakakhala popanda zokwanira, stupor ndi chikomokere zimatha, zomwe mu 30 peresenti ya milandu imabweretsa kufa.

Kuphatikiza apo, monga zovuta zikuwonekera:

• khunyu
• kutupa kwa kapamba,
• mitsempha yakuya,
• kulephera kwa aimpso.

Njira zoyesera

Kuti mupeze matenda oyenera ndi matenda a hyperosmolar coma mu matenda osokoneza bongo, kudziwika ndikofunikira. Zimaphatikizapo magulu awiri akuluakulu a njira: mbiri ya zamankhwala ndi woyeserera wodwala ndi mayeso a labotale.

Kuyesedwa kwa wodwala kumaphatikizapo kuwunika momwe alili malinga ndi zizindikiro zomwe zili pamwambapa. Chimodzi mwa zofunikira ndi kununkhira kwa acetone mumlengalenga wotulutsa wodwala. Kuphatikiza apo, zizindikiro zamitsempha zimawonekera bwino.

Zizindikiro zina zomwe zingapangitse wodwala chimodzimodzi zimayesedwanso:

• milingo ya hemoglobin ndi hematocrit,
• kuchuluka kwa maselo oyera
• urea nayitrogeni ndende m'magazi.

Ngati mukukayikira kapena ngati mukufunikira kuzindikira zovuta, njira zina zoyeserera zitha kuperekedwa:

• Ultrasound ndi X-ray ya kapamba,
• electrocardiogram ndi ena.

Kanema wofufuza za vuto la matenda ashuga:

Kusamalira mwadzidzidzi

Ndi comerosmolar coma, maudindo a munthu ndi ovuta ndipo amayamba kuvuta ndi mphindi iliyonse, chifukwa chake ndikofunikira kuti amupatse chithandizo choyenera kuti amuchotsere. Katswiri wokhazikika yemwe angapereke chithandizo chotere, komwe wodwalayo ayenera kutengedwa posachedwa.

Ma ambulansi akuyenda, muyenera kumuika munthu mbali imodzi ndikuphimba ndi china chake kuti muchepetse kutentha. Pankhaniyi, ndikofunikira kuyang'anira kupuma kwake, ndipo ngati kuli kotheka, pumulani mwamagetsi kapena kutulutsa mtima wosalunjika.

Atalowa kuchipatala, wodwalayo amapatsidwa mayeso ofulumira kuti adziwe zoyenera, kenako mankhwala amayikidwa kuti amuchotsere wodwalayo pamavuto akulu. Amamuika kudzera m'madzi amadzimadzi, nthawi zambiri amakhala yankho la hypotonic, kenako amasinthana ndi isotonic. Pankhaniyi, ma electrolyte amawonjezeredwa kuti athetse metabolism yama-electrolyte yam'madzi, komanso yankho la glucose kuti ikhalebe yokhazikika.

Nthawi yomweyo, kuyang'anira mayendedwe nthawi zonse kumakhazikitsidwa: kuchuluka kwa glucose, potaziyamu ndi sodium m'magazi, kutentha, kuthamanga ndi kugwedezeka, mulingo wa matupi a ketone ndi acidity ya magazi.

Onetsetsani kuti mukutuluka kwamkodzo kuti mupewe edema, yomwe imabweretsa zotsatira zoyipa, nthawi zambiri catheter imayikidwa pa wodwala chifukwa cha izi.

Zochita zina

Mothandizirana ndi kubwezeretsa bwino kwa mankhwalawa, chithandizo cha insulin chimaperekedwa kwa wodwala, kuphatikiza intravenous kapena mu mnofu makonzedwe a mahomoni.

Poyamba, mayunitsi 50 amabweretsedwa, omwe amagawidwa pawiri, ndikuyambitsa gawo limodzi mozungulira, ndipo lachiwiri kudzera minofu. Ngati wodwala ali ndi hypotension, ndiye kuti insulin imaperekedwa kudzera m'magazi okha. Kenako, kukokoloka kwa mahomoni kumapitirira mpaka glycemia ifike 14 mmol / L.

Mwakutero, kuchuluka kwa shuga m'magazi kumayang'aniridwa nthawi zonse, ndipo ngati ukutsika mpaka 13.88 mmol / l, glucose amawonjezeredwa ku yankho.

Madzi ambiri omwe amalowa mthupi amatha kupangitsa edema kukhala m'magazi; pofuna kupewa, wodwalayo amapatsidwa njira yolimbira yotsatsira glutamic acid mu mililita 50. Pofuna kupewa thrombosis, heparin ndi mankhwala komanso magazi.

Kuneneratu ndi Kuteteza

Kukula kwa matendawo kumadalira nthawi yothandizidwa. Atangoperekedwa, kusokonezeka kocheperako komanso zovuta zina zimachitika ziwalo zina. Zotsatira za chikomokere ndi kuphwanya ziwalo, zomwe m'mbuyomu zisanachitike. Choyamba, chiwindi, kapamba, impso ndi mitsempha yamagazi zimakhudzidwa.

Ndi chithandizo chakanthawi, zosokoneza ndizochepa, wodwalayo amadzizidwanso m'masiku ochepa, kuchuluka kwa shuga kumapangitsa, ndipo zizindikiro za chikomizo zimatha. Amapitiliza moyo wake wabwinobwino popanda kumva kuwawa.

Zizindikiro zamitsempha zimatha kukhala milungu ingapo komanso miyezi. Ndi kugonjetsedwa kwambiri, sikutha kuchoka, ndipo wodwalayo amakhalabe wolumala kapena wolumala. Kusamalira mochedwa kumakhala ndi zovuta zazikulu mpaka kumwalira kwa wodwalayo, makamaka kwa iwo omwe ali ndi matenda ena.

Kupewera kwa vutoli ndikosavuta, koma kumafunikira kuwunikira nthawi zonse. Amakhala ndi kuwongolera ma pathologies a ziwalo zamkati, makamaka mtima dongosolo, impso ndi chiwindi, popeza amatenga nawo gawo limodzi pachitukuko cha izi.

Nthawi zina hyperosmolar coma imapezeka mwa anthu omwe sakudziwa matenda awo a shuga. Pankhaniyi, ndikofunikira kulabadira zomwe zikuwonetsa, makamaka ludzu losalekeza, makamaka ngati pali achibale m'banjamo omwe ali ndi matenda a shuga.

Ndikofunikanso kutsatira malingaliro a dokotala kwa odwala omwe ali ndi matenda ashuga:

• Nthawi zonse muziyang'anira kuchuluka kwa shuga m'magazi,
• kutsatira zakudya zoyenera
• osaphwanya chakudyacho,
• musasinthe mulingo wa insulin kapena mankhwala ena nokha,
• Osamamwa mankhwala osalamulirika
• samalira zolimbitsa thupi,
• kuwunika zisonyezero zamakhalidwe amthupi

Zonsezi ndi njira zopezeka kwathunthu zomwe muyenera kungokumbukira. Kupatula apo, matenda a shuga amachitika chifukwa cha moyo wosayenera ndipo chifukwa chake chimabweretsa zotsatirapo zoyipa.