Zomwe zimayambitsa lactic acidosis yokhala ndi matenda oopsa a 2 shuga, Zizindikiro, matenda, njira zakuchizira ndi kupewa

Lactic acidosis yamtundu 2 matenda a shuga ndi vuto losowa kwambiri komanso loopsa lomwe limadziwika chifukwa chodzikundikira lactic acid m'malo osiyanasiyana.

Yang'anani! Mu International Classization of Diseases (ICD-10), lactic acidosis ikuwonetsedwa ndi code E87.2.

Zambiri: pathogenesis

Mawu akuti "lactic acidosis" amafotokoza kuwonjezeka kwa kuchuluka kwa lactate m'magazi mpaka 8 mmol / L. Pali zifukwa zazikulu ziwiri za lactic acidosis: ketoacidosis yayikulu ndi metformin. Acidosis, yomwe imachitika chifukwa chogwiritsa ntchito metformin, mu 30% ya milandu imatsogolera pakuphedwa kwa wodwalayo.

Mwambiri, mawonekedwe a lactic acidosis ndi zochitika zosowa. Mu Russian Federation, pakati pa 1990 ndi 2002, milandu 51 idadziwika. Odwala 100,000 aliwonse omwe amalandila metformin amakhala ndi lactic acidosis.

Kukula kwa lactic acidosis chifukwa cha metformin kungathe kupewedwa ngati odwala omwe ali ndi matenda a mtima kapena omwe adalakwitsa m'mbuyomu akana mankhwala. Metformin siyingathe kutumikiridwa pansi pa zinthu zotsatirazi:

Kuvulala kwamtundu uliwonse - chiwindi ndi matenda ena a chiwindi.
Chidakwa chachikulu,
Kulephera kwina
Cardiogenic mantha,
Sepsis ndi matenda ena akuluakulu - chibayo (chibayo) kapena kapamba (kutupa kwa kapamba),
Pulmonary embolism
Matenda owopsa a m'mapapo
Mwachitsanzo, kufa kwa minofu (necrosis), ngati magazi amachepa,
Njala, ngakhale ngati gawo la chakudya chochepetsa thupi,
Zotupa zoyipa,
Ketoacidosis omwe alipo
Mimba

Lactic acidosis amawonetsedwa pazotsatira zotsatirazi:

Kusanza, kusanza, kusowa chilonda ndi kupweteka kwam'mimba,
Kupumira mofulumira (Hyperventilation),
Matenda azamatenda
Nkhawa, chisokonezo, kutopa ndi kuperewera.

Chifukwa cha kupuma bwino, thupi limayesetsa 'kusokoneza' thupi mwa kumasula mpweya woipa mwa kupuma.

Lactic acidosis imayamba ngati pyruvate imanyoza lactic acid. Lactate imatha kuchotsedwa pang'ono mu chiwindi pa gluconeogeneis. Ngati chiwindi chitha kugwira ntchito bwino, kudzikundikira kwakukulu kwa lactate kumawonedwa.

Kuletsa kupuma kwamtambo kumathandizira kwambiri pakuyambitsa lactic acidosis. Mwachitsanzo, Metformin imalepheretsa kusuntha kwa ma elekitironi mu kupuma. Izi zimathandizira kagayidwe ka anaerobic. Zomwezo zimagwiranso ntchito kulowetsedwa ndi fructose kapena sorbitol. Kusowa kwa Thiamine kumabweretsa kuchepa mu ntchito ya citrate. Zotsatira zake, pyruvate imamangilira ndikutembenukira mokulira kukhala lactate.

Zifukwa zazikulu

Anthu omwe ali ndi lactic acidosis ali ndi mkaka wambiri m'magazi awo, zomwe zimapangitsa kuthana ndi vuto lachiwopsezo. Lactic acidosis imatha kupezeka chifukwa cha mankhwala, nephropathy ndi hepatopathy.

Zina mwazomwe zimaphatikizira kuphatikizira kwa pulmonary embolism, chikhalidwe chododometsa, kapena ngakhale opaleshoni, yomwe ingayambitsenso acidization ya thupi. Lactic acidosis imatha kupezekanso mwa othamanga omwe amachita masewera olimbitsa thupi.

Mawonekedwe

Milisi acidosis imatha kuyambitsa zizindikiro zosiyanasiyana. Zizindikiro zake zimaphatikizapo kusanza, nseru, kupweteka m'mimba, kupuma msanga, kutopa, kupuma, kufoka, komanso kufooka. Nthawi zambiri, mtima wogwiritsa ntchito mtima amapezekanso.

Chizindikiro chapamwamba ndicho kupuma mofulumira. Kupumira mwachangu kumakwaniritsa acidosis. Amadziwika ndi kupuma kwakuya kwambiri komanso pafupipafupi, momwe thupi limafotokozera asidi owonjezera mwanjira ya mpweya woipa. Wodwalayo amatha kumva kuperewera, nkhawa, komanso kutentha thupi. Popitiliza matendawa, kusokonezeka, kusokonezeka kwa chikumbumtima kapena kukomoka ndizothekanso.

Lactic acidosis imatha kukhala ndi mphamvu kwambiri mthupi komanso ziwalo zake motero imatha kubweretsanso imfa ya womenyedwayo. Makamaka pakalibe chithandizo, pamakhala ngozi yoti wodwalayo amwalira chifukwa cha matendawa. Mu diabetesology, odwala ambiri omwe amatenga metformin amafa ndi acidosis.

Zizindikiro

Dokotala amatha kudziwa lactic acidosis kudzera mu mayeso a labotale. Lactic acidosis imachitika pamene pH isachepera 7.36, ndipo nthawi yomweyo, kuyendetsedwa kwa lactate kupitilira 5 mmol / L. Ngati wodwala ali ndi pH yotsika komanso wozungulira wa lactate m'malo osiyanasiyana, izi zimawonetsa metabolic acidosis.

Njira ya lactic acidosis ndi yosiyana. Choyamba, ukadaulo womwe unanena kuti lactic acidosis imayamba kugwira ntchito yofunika kwambiri pakukula. Ngati lactic acidosis imachitika pambuyo pakuchita zolimbitsa thupi kwambiri, zizindikiro zake zimatha nthawi yopuma. Komabe, ngati zovuta zamagulu zimayambitsa acidosis, pamakhala ngozi yayikulu pamoyo wa wodwalayo. Wodwalayo amatha kugwa.

Mavuto

Odwala amatha kuwona zizindikiro zomwe zili pamwambapa. Choyipa chachikulu, zizindikirozi zimatha kudwalanso wodwala, chifukwa chake ayenera kuthandizidwa mulimonse. Odwala amadwala palpitations ndi nseru. Palinso kufooka wamba ndi kutopa konsekonse.

Kulimbana ndi matenda kumachepetsedwa kwambiri. Nthawi zina, odwala amatha kudwala matenda a mtima kapena kufa mwadzidzidzi kwa coronary. Kukomoka kapena kusokonezeka kwina kumatha kuchitika komanso kuchepetsa kwambiri moyo wa wodwalayo. Mwa odwala ena, izi zimayambitsanso nkhawa zam'kati komanso kupuma movutikira.

Lactic acidosis nthawi zambiri amathandizidwa ndi mankhwala. Amatha kuchepetsa ndikuchepetsa zizindikiro kuti okhudzidwawo abwerere ku moyo wanthawi zonse. Mavuto apadera nthawi zambiri samachitika. Kuchita bwino kwa lactic acidosis sikukhudza moyo wodwala.

Njira zothandizira ndi kuwongolera

Lactic acidosis imachiritsidwa pang'onopang'ono. Kuti achepetse kuchuluka kwa asidi m'thupi, madokotala amagwiritsanso ntchito mankhwala ochepetsa bongo.

Madotolo ayenera kuchotsa zomwe zimapangitsa kuti zizisokoneza. Odwala amapatsidwa mankhwala a alkaline bicarbonate, omwe amalepheretsa kuchuluka kwa acid m'thupi. Ndikofunika kuti kupanga asidi kumachedwetsa kapena kusiya.

Bicarbonate ndikulimbikitsidwa kuti iziperekedwa mosamala kwambiri. Nthawi zina mankhwalawa amatha kukulitsa acidosis. Ngati pali zizindikiro zosonyeza kuti mankhwalawa samapereka zotsatira zoyenera, chithandizo chiyenera kuyimitsidwa nthawi yomweyo. Monga chithandizo china, madzi osiyanasiyana atha kuperekedwa.

M'pofunikanso kukonza oxygenation ya zimakhala za anthu kuti zovuta za acidosis zitha kupewedwa. Wodwala akayamba acidosis chifukwa cha matenda ashuga, insulin iyenera kuperekedwa kwa wodwalayo. Kukonzekera kwa Vitamini kapena ngakhale dialysis kumatha kusintha mkhalidwe wa wodwalayo.

Wodwala akakhala ndi chiwindi chowonongeka, kupatsirana kwa ziwalo kokha ndi komwe kungathandize wodwalayo. Ngati kuwonongeka kwa maselo a chiwindi, tikulimbikitsidwa kuchitira zizindikiro.

Kupewa

Pafupifupi nthawi zonse, matendawa amatha kupewedwa. Ndikofunika kuti mankhwala ochepetsa shuga wamagazi amwe kokha ngati chiwindi ndi impso zili bwino.

Uphungu! Anthu odwala matenda ashuga a mtundu 2 amalangizidwa kuti akapemphe malangizo azachipatala akayamba kuwonekera. Makamaka, kulumikizana ndikofunikira kwa odwala omwe ali ndi zovuta za matenda ashuga.

Kudziyendetsa nokha lactic acidosis kumatha kubweretsa zotsatira zosatsimikizika ndi kufa. Zithandizo za chikhalidwe cha anthu zimaletsedwa kumwa, popeza kuchedwetsa chithandizo kungakulitse matendawa. Pazizindikiro zoyambirira, ndikofunikira kukaonana ndi dokotala nthawi yomweyo kuti muchepetse zovuta zina. Kulandira chithandizo mosavomerezeka nthawi zambiri kumabweretsa kudwala kwa wodwala kapena mavuto akulu. Ngati wodwalayo sakudziwa, itanani ambulansi nthawi yomweyo.

Ichi ndi chiyani

Mu shuga mellitus, kukana kwa insulin kumayambitsa kusokonezeka kwa magwiridwe antchito ndi ziwalo. Poyerekeza ndi kagayidwe kachakudya ka metabolic, kulephera kwa impso kumayamba. Ngati impso sizingathe kuthana ndi katundu, ndiye kuti zinthu zovulaza ndi poizoni zimadziunjikira m'thupi.

Ndi kulipidwa kwabwino kwa shuga, kudziwononga kwa glucose m'magazi kumachitika, owonjezera wa lactic acid amawonekera, omwe amadziunjikira m'thupi motsutsana ndi kukonza ndi impso ntchito. Kuthamanga kwa magazi ndi mkaka wa m'mawere kumayambitsa zizindikiro za magazi a 7,3.

Lactic acid imawononga molakwika kupezeka kwa ziwalo ndi minofu ndi mpweya. Ndi hypoxia, acidosis imayamba, ntchito za insulin zimachepa kwambiri, milingo ya lactate imawonjezeka. Maselo ochulukirapo a pancreatic atha, ndizowopsa zomwe zimachitika chifukwa cha lactic acidosis.

Madokotala amatsimikizira kuphatikizika kwa shuga ndi lactic acid ndende ya 4 mmol / L kapena kuposerapo. Ndikokwanira kuyerekeza zomwe mulibe ndikuwonetsa momwe zingakhalire: magazi ochepa - mpaka 1.6 mmol / l, venous - osaposa 2.2 mmol. Lactic acidosis chifukwa cha mankhwalawa imakwiyitsa kukula kwa lactic acidotic chikomokere ndi imfa.

Kodi mungachotsere acetone mu mkodzo ndi shuga? Werengani mfundo zothandiza.

Mndandanda wamankhwala omwe ali ndi antiandrogenic mphamvu kwa akazi ndi zomwe amagwiritsidwa ntchito akufotokozedwa patsamba lino.

Zifukwa zachitukuko

Vuto lowopsa limayamba pang'onopang'ono mwa chiwerengero chonse cha anthu odwala matenda ashuga akamalimbana ndi zinthu zoyambitsa. Chimodzi mwazifukwa zake ndikuphwanya kugwiritsa ntchito mankhwala osokoneza bongo, kutsika kowopsa m'magazi a shuga. Mankhwala a gulu la Biguanide ayenera kumwedwa moyenera malinga ndi chiwembucho, ndikusintha kwa nthawi ndi nthawi monga amalangidwira ndi endocrinologist.

Mayina:

Ndi kulephera kwa aimpso, matenda oopsa a dongosolo la excretory, biguanides sinafotokozedwe.

Zomwe zimayambitsa lactic acidosis yokhala ndi matenda osokoneza bongo omwe samadalira insulin:

matenda opatsirana komanso otupa,
kukhazikitsidwa kwa kuchuluka kwa shuga m'magazi,
matenda obadwa nawo omwe amayambitsa matenda a metabolic,
shuga wowerengeka, wolamulira bwino komanso mankhwala, kuphatikiza pamavuto osiyanasiyana,
kuchepa magazi kwambiri,
kuperewera kwa mavitamini B,
kuledzera
kutaya magazi
kugwiritsa ntchito mankhwala kwa nthawi yayitali potengera salicylic acid, poyizoni wa cyanide,
anavutika ndi stroko kapena mtima.

Zizindikiro zake

Kuphatikizika kwa zizindikiritso zosayipa zomwe zimakhala ndi lactic acidosis kumadziwonetsa pakapita maola angapo. Zizindikiro zoyambirira za lactic acidosis zikaonekera, kuthandizira kuchipatala pamafunika.

Gawo loyamba lachitukuko cha zovuta - zovuta:

nseru, kusanza,
kupweteka mutu kwambiri
myalgia (zilonda mu minofu minofu),
chizungulire, kusazindikira.
kupuma kumakuwa kwambiri, kufulumizitsa
mgwirizano wolakwika,
munthu amadandaula za kugona kapena kugona.
kusapeza bwino pamimba.

Popanda chithandizo, mulingo wa lactate m'thupi umakwera, mpweya wambiri wa minofu ndi ma cell a ubongo umayamba. Kwa izi zimawonjezeredwa paresis, kuphwanya kwa thupi.

Gawo lotsatira, lowopsa kwambiri ndi kuperewera kwa lactic acidotic. Munthawi imeneyi, si odwala onse omwe angapulumutsidwe: chithandizo chokwanira ndichotheka mosaposa theka la milandu.

Zizindikiro zapadera musanayambe mkhalidwe wowopsa:

ziume zowuma ndi ma khungu
Mpweya wa Kussmaul
kutsika kwa kutentha mpaka madigiri 35,5 kapena kuchepera,
kufooka wamba
kuwonongeka kwakukulu pamachitidwe ambiri,
nkhope zakuthwa,
kulibe mkodzo,
makutu amaso
kulephera kudziwa
chitukuko cha intravascular coagulation, mapangidwe ambiri amaundana magazi (DIC).

Zotheka

Kuperewera kwakanthawi komanso koyenera pothandizidwa ndi lactic acidosis kumayambitsa chitukuko cha matenda a shuga. A kwambiri mkhalidwe ndi chifukwa cha yogwira kuledzera motsutsana maziko a kusokonekera kwa zinthu zaola, kuchuluka kwa lactic acid ndi kuchepa madzi m'thupi.

Zotsatira zoyipa za njira za pathological zimawonjezeka ndikuphwanya mapuloteni, kuchuluka kwa ammonia ndi urea. Zotsatira zake ndikuwonjezereka kwa kuchuluka kwa ziwalo zoyipa m'magazi ndi mkodzo, kukula kwa njala ya okosijeni ya ubongo.

Zambiri za hypoxia zimakhala ndi zovuta zowopsa:

kugwa kwa mtima,
kupuma pafupipafupi
kuchuluka magazi
kuphwanya kwamphamvu ntchito yamanjenje,
kutsitsa minofu kamvekedwe.

Malamulo ndi njira zochizira

Ndi chitukuko cha matenda amtundu wa 2 shuga, chithandizo chamankhwala chofunikira ndichofunikira. Sizotheka nthawi zonse kulosera zamtundu wa shuga. Moyo wa wodwalayo umatengera kuzindikira kwa achibale omwe anali pafupi panthawi yamayambiriro a chizindikiro cha lactic acidosis komanso ziyeneretso za madokotala othandizira.

Choyamba, muyenera kuthetsa hypoxia ndi acidosis, kukhazikika machitidwe othandizira amoyo. Ndikofunika kuchotsa wodwalayo kuti asatekeseke, kuti azitha kupumira m'mapapo. Ngati wodwalayo sakudziwa, ndiye kuti mpweya wofunikira mu oxygen umafunikira.

Madokotala amachotsa kuchuluka kwa acidity yamagazi, kupatutsa mavuto obwera chifukwa cha owonjezera lactic acid ndi yankho la sodium bicarbonate. Ndondomeko zimachitika tsiku ndi tsiku mpaka kukhazikika kwa zizindikiro zazikulu mthupi zimachitika. Mu tsiku limodzi, wodwalayo salandira kuposa malita awiri a alkaline solution.

Kuphatikiza apo, insulin yochepa yokhala ndi glucose, mtima ndi vasotonics imasankhidwa kuti ichititse ntchito zina za mtima ndi mtima. Munthawi yamankhwala, kuyezetsa magazi kumafunika kuti mupeze potaziyamu yambiri ndi pH ya magazi.

Dziwani zambiri zopewetsa matenda a shuga kwa ana ndi akulu, komanso werengani malingaliro othandizira akatswiri.

Pazokhudzana ndi malamulo komanso mawonekedwe a kudya kwa hypothyroidism ya tezi ya chithokomiro zalembedwa munkhaniyi.

Pitani ku http://vse-o-gormonah.com/hormones/testosteron/kak-ponizit-u-zhenshin.html ndikuwerengera zomwe zimayambitsa testosterone yowonjezereka mwa azimayi, komanso momwe mungachepetse mahomoni mwachilengedwe. .

Gawo lotsatira ndi chithandizo cha kukonzanso thupi:

makonzedwe olimbitsa a carboxylase,
kukonza insulin,
kuyambitsa kwa magazi,
Mlingo wocheperako wa heparin amaperekedwa kuti athetse DIC
kukhazikitsidwa kwa reopoliglyukin.

Pambuyo kukhazikika, kubereka kwazizindikiro zofunika, wodwalayo ali m'chipatala. Ndikofunikira kutsatira zakudya, kuwongolera mphamvu ya glucose and acid acidity, komanso kuyeza kuthamanga kwa magazi.Pobwerera kunyumba, muyenera kutsatira malangizo a endocrinologist, kumwa mankhwala a hypoglycemic mosamala, nthawi zonse muzigwiritsa ntchito glucometer yachikhalidwe kapena yosasokoneza.

Malangizo othandiza

Lactic acidosis imatha kukhala ndi chithandizo choyipa cha matenda ashuga pogwiritsa ntchito mankhwala a greatuanide. Kuchepa kwambiri kwa shuga m'magazi limodzi ndi kulephera kwa aimpso kumabweretsa msokonezo, kuchuluka kwa lactic acid, kuledzera kwa thupi.

Popewa lactic acidosis, muyenera kutenga malangizo akulu mosintha, malinga ndi zomwe dokotala wanena, siyani kusintha kwayekha pazomwe zikuchitika tsiku ndi tsiku. Mukamapereka mankhwala, muyenera kuyeserera mosamala ziwalo zonse ndi machitidwe kuti mupewe matenda oopsa a kwamikodzo. Pamaso pa kulephera kwa impso, ndikofunikira kusankha mankhwala a gulu lina kuti azitha kuthana ndi shuga.

Ndikofunikira kuyeza shuga katatu patsiku tsiku lonse kuti muwone kuopsa kwa hypoglycemia. The mwayi wa lactic acidosis ukuwonjezeka ndi zosayenera mankhwala a shuga, kusowa kuyang'anira tsiku lililonse kuchuluka kwa shuga. Kulephera kutsatira malamulo a zamankhwala, kusafuna kugwiritsa ntchito mita, kutsatira zakudya kungapangitse kugwa kwambiri kwa shuga, kukula kwa hypoglycemia.

Mfundo zofunika:

Poyerekeza ndi kuthana ndi pulogalamu yotsatira ya hypoglycemic, simungatenge mapiritsi awiri otsatira nthawi imodzi m'malo amodzi: hypoglycemia ikhoza kukhala,
ndikupanga kachilombo koyambitsa matenda kapena kachilombo, muyenera kufunsa dokotala mwachangu kuti mupeze chithandizo choyenera. Sizotheka nthawi zonse kulosera zamomwe chamoyo chofooka komanso kapamba wakhudzidwa ndi mankhwala othandizira kapena othandizira. Pazithandizo, mumayenera kupumula kama, kugona kwa dokotala kuti mupeze chiwopsezo cha lactic acidosis ndi njira zina zoyipa.

Ndi matenda a shuga, lactic acidosis imayamba yomweyo. Kuyamba kwa matenda ochepa m'mawola ochepa kumatha kulowa mu mawonekedwe owopsa. Phunzirani momwe mungapewere zovuta pamavidiyo otsatirawa:

Njira yopititsira patsogolo

Ndi kagayidwe kabwinobwino, lactate (womwe umachokera ku lactic acid) ndi pyruvate (womwe umachokera ku pyruvic acid) amapezeka m'magazi. Amalembera 1:10. Ndi matenda operewera, kukhathamiritsa kwa lactate kumawonjezera katatu kapena kupitirira apo, ndikuyambitsa metabolic acidosis, yowonjezereka ndi hypoxia.

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

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

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

Zotsatira zake ndi:

kufooka
kuwonongeka kwa mtima
kukulira kwa mkulu mantha ntchito.

Chilichonse mwazinthu izi zimatha kupha.

Ndi kulephera kwa aimpso, matenda oopsa a dongosolo la excretory, biguanides sinafotokozedwe.

Zomwe zimayambitsa lactic acidosis yokhala ndi matenda osokoneza bongo omwe samadalira insulin:

matenda opatsirana komanso otupa,
kukhazikitsidwa kwa kuchuluka kwa shuga m'magazi,
matenda obadwa nawo omwe amayambitsa matenda a metabolic,
shuga wowerengeka, wolamulira bwino komanso mankhwala, kuphatikiza pamavuto osiyanasiyana,
kuchepa magazi kwambiri,
kuperewera kwa mavitamini B,
kuledzera
kutaya magazi
kugwiritsa ntchito mankhwala kwa nthawi yayitali potengera salicylic acid, poyizoni wa cyanide,
anavutika ndi stroko kapena mtima.

Zizindikiro Zofunikira za Lactic Acidosis

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

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

Ngati munthu ali ndi mtundu wina wa matenda a shuga, ndiye kuti kulowetsedwa kwa lactic acid kumachitika pakapita nthawi pambuyo pake kuyamba kwa vuto.

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 kuphatikizika kwa vutoli ndizofanana ndi zovuta zina, ndipo wodwala yemwe ali ndi matenda osokoneza bongo amatha kugwa ndimisempha yochepa komanso yowonjezera ya shuga mthupi.

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 kupunduka 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: kuyambira areflexia mpaka 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.

Popita nthawi, lactic acidosis imayamba kudziwonetsa ndi zizindikiro zakugwa. Choyamba, oligoanuria amawonekera, ndipo pambuyo pa anuria. Chifukwa cha izi, kukula kwa DIC kumayamba - intravascular coagulation. Ngati zoterezi zapezeka, adotolo ayenera kulandira chithandizo mosachedwa.

Zizindikiro za lactic acidosis ndi mawonekedwe a intravascular thrombosis ndi hemorrhagic necrosis, zala ndi manja.

Zizindikiro zake:

lilime louma
zipolopolo zowuma
khungu lowuma.

Kuti muwone momwe wodwalayo alili ndi matendawa, ndikofunikira kumvetsetsa kuti izi ndizovuta zachilendo ndipo ndizofala kwambiri kwa anthu omwe ali ndi mavuto ambiri azaumoyo (kawirikawiri kwa anthu achikulire omwe ali ndi matenda ashuga omwe ali ndi vuto la chiwindi lomwe lilipo kale).

Matendawa amakula kwambiri ndipo matendawo akuwonjezeka maola ochepa.

Nthawi zambiri munthu amamva ndikukumana ndi izi:

chikumbumtima
kusuntha kwa zifukwa
chizungulire
kulephera kudziwa
nseru
kusanza
kupuma pafupipafupi
kupweteka kwam'mimba
kufooka kwambiri m'thupi
ntchito zamagalimoto zimafooka
lactic acid coma (munthu amagwa pakatha nthawi yayitali pamaso pa zizindikiro zomwe zili pamwambapa)

Izi zikachitika:

Hyperventilation
glycemia wokwera bwino (wokhala ndi matenda ashuga komanso osowa kwambiri akapezeka wambiri)
kutsika kwa placma bicarbonates ndi pH yake (mulingo wa CO2 m'magazi)
kupezeka kwa ma ketoni m'magazi ndikosavomerezeka, ndipo mkodzo wawo ndiwosafunikira (pokhapokha ngati akusala nthawi yayitali)
Hyperphosphatemia (ndi chithunzi chosalimbikitsa cha azotemia)
mulingo wa lactic acid umaposa mtengo wa 6.0 mmol / l - chitsimikiziro chodziwika bwino cha matenda

Ngati mungayang'ane zizindikiro zomwe zili pamwambapa, ndiye kuti zambiri mwazizindikirozi zimatha kupatsidwa matenda ena kapena zovuta zina, zomwe, monga lamulo, zimakula mwachangu. Munthu wodwala matenda ashuga amatha kugwa ndimisempha ya m'magazi ochepa komanso wokwezeka, ndipo matendawa amafanananso. Chifukwa chake, kupezeka kwathunthu kwa lactic acidosis kumakhazikika pakuyesa kwa magazi! Ngati simutenga zitsanzo, ndiye kuti lingaliro limayambitsa imfa ya wodwalayo.

Gawo loyamba lachitukuko cha zovuta - zovuta:

nseru, kusanza,
kupweteka mutu kwambiri
myalgia (zilonda mu minofu minofu),
chizungulire, kusazindikira.
kupuma kumakuwa kwambiri, kufulumizitsa
mgwirizano wolakwika,
munthu amadandaula za kugona kapena kugona.
kusapeza bwino pamimba.

Popanda chithandizo, mulingo wa lactate m'thupi umakwera, mpweya wambiri wa minofu ndi ma cell a ubongo umayamba. Kwa izi zimawonjezeredwa paresis, kuphwanya kwa thupi.

Gawo lotsatira, lowopsa kwambiri ndi kuperewera kwa lactic acidotic. Munthawi imeneyi, si odwala onse omwe angapulumutsidwe: chithandizo chokwanira ndichotheka mosaposa theka la milandu.

Zizindikiro zapadera musanayambe mkhalidwe wowopsa:

ziume zowuma ndi ma khungu
Mpweya wa Kussmaul
kutsika kwa kutentha mpaka madigiri 35,5 kapena kuchepera,
kufooka wamba
kuwonongeka kwakukulu pamachitidwe ambiri,
nkhope zakuthwa,
kulibe mkodzo,
makutu amaso
kulephera kudziwa
chitukuko cha intravascular coagulation, mapangidwe ambiri amaundana magazi (DIC).

Njira zopewera

Anthu ambiri omwe amapezeka ndi lactic acidosis nthawi zambiri sankaganiza kuti ali ndi matenda ashuga. Chifukwa chake, kuti musatenge shuga wambiri, ndikofunikira kuti nthawi zina mumayezetse shuga.

Cholinga chachikulu chopewera ndikuchotsa mwayi womwe ungakhalepo pakoma. Zomwe zimayambitsa hypoxia ziyenera kupewedwa.

Kufikika kwa madotolo panthawi yake kudzapulumutsa moyo. Mavuto osokoneza bongo amtundu wa shuga wachiwiri samalekeredwa pamiyendo. Kwa munthu, ndipabwino kwambiri kupulumuka lactic acidotic coma. Pofuna kupewa kubwereza zomwe zikuchitika mtsogolo, kuyesayesa kwakukulu kuyenera kuchitidwa. Vutoli lidzathetsedwa kokha ndi endocrinologist, yemwe akuyenera kufunsidwa atazindikira kwambiri acidity.

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

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

Nthawi zambiri, wodwalayo amaphunzira za matenda ake a shuga pambuyo podziwa kuti ali ndi lactic acidosis. Kuyesedwa kwa magazi pagazi kumakuthandizani kupewa matenda owopsa.

Poyerekeza ndi kudutsa mlingo wotsatira wa mankhwala a hypoglycemic, simungatenge mapiritsi awiri otsatira nthawi imodzi m'malo amodzi: hypoglycemia ikhoza kukhala,
ndikupanga kachilombo koyambitsa matenda kapena kachilombo, muyenera kufunsa dokotala mwachangu kuti mupeze chithandizo choyenera. Sizotheka nthawi zonse kulosera zamomwe chamoyo chofooka komanso kapamba wakhudzidwa ndi mankhwala othandizira kapena othandizira. Pazithandizo, mumayenera kupumula kama, kugona kwa dokotala kuti mupeze chiwopsezo cha lactic acidosis ndi njira zina zoyipa.

Ndi maphunziro aposachedwa a endocrine pathology okhala ndi zizindikiro zowoneka bwino, mutha kudumpha kukula kwa zovuta zovuta. Madokotala amalimbikitsa anthu kuti aphunzire zambiri ngati achibale awo achikulire apezeka ndi matenda ashuga. Ndikofunikira kudziwa momwe lactic acidosis imakhalira mtundu wachiwiri wa matenda a shuga, ndizomwe zimayambitsa zovuta.

Kodi lactic acidosis ndi chiani?

Chifukwa chake, lactic acidosis, kapena lactic acidosis, ndizovuta kwambiri zomwe zimachitika mu odwala matenda ashuga, koma nthawi zina mwa anthu athanzi. Pathology imayambika chifukwa cha kudzikundikira kwa lactic acid mthupi, monga minofu ya mafupa, ubongo ndi khungu. Pambuyo poti asidi akwanira, lactic acidosis imatenga mawonekedwe ena (metabolic acidosis). Poterepa, titha kuyankhula za chiwopsezo chachikulu pamoyo wa munthu, chifukwa magazi amalandila asidi, omwe amakwiya chifukwa cha kuchepa kwa chiwerengero cha bicarbonate mmenemo.

Chifukwa chake, aliyense wodwala matenda ashuga ayenera kudziwa bwino lomwe lactic acidosis, ndizomwe zimayambitsa ndi zizindikilo zake. Izi zitha kupewa kupewa kukula kwambiri ndi zovuta zoyipa.

Zimayambitsa ndi zizindikilo za momwe zinthu zilili

Zomwe zimachitika pakukula kwa matenda a pathological amatha kukhala osiyana: kuchokera pamatenda otupa komanso opatsirana mpaka matenda opweteka a chiwindi. Polankhula mwatsatanetsatane pazifukwa, tcherani khutu ku:

magazi akulu
mtundu wosamwa wauchidakwa,
pachimake myocardial infaration,
kuvulala kwambiri
kulephera kwa aimpso.

Owerenga mabakera anena zowona zonse zokhudza matenda ashuga! Matenda a shuga amapita pakatha masiku 10 ngati mumamwa m'mawa. »Werengani zambiri >>>

Chimodzi mwazinthu zodziwika bwino zomwe zimapangitsa tsiku lililonse kukulitsa kwa lactic acidosis imayenera kuganiziridwa ngati kugwiritsa ntchito ma biguanides, omwe ambiri ndi Metformin. Ndi kuwonongeka kwa chiwindi kapena impso, ngakhale mlingo wochepetsetsa wa mankhwalawa ungapangitse kukula kwa matenda. Muzochitika ngati palibe zizindikiro za hypoxia (kuperewera kwa mpweya wa okosijeni), zomwe zimapangitsa kuti pakhale mkhalidwewu ukhoza kukhala khansa ya m'magazi, chotupa.

Mndandanda wazomwe zimayambitsa lactic acidosis umaphatikizapo kulephera kupuma, mawonekedwe owopsa a mtima wam'mapapo. Ikhozanso kukhala vuto la mtima komanso kuchepa kwa thiamine.

Zizindikiro za matendawa nthawi zambiri zimakhala zowawa komanso zimatha patangopita maola ochepa. Nthawi zina, palibe zizindikiro, zomwe zimapangitsa kuti zikhale zosavuta kudziyimira pawokha lactic acidosis. Ngati chithunzi cha chipatala chiri chachikulu, ndiye kuti odwala matenda ashuga amadandaula za kupweteka kwa minofu ndi kusamva bwino kumbuyo kwa sternum, chidwi ndi kupuma mofulumira. Kuphatikiza apo, titha kulankhula za kusowa tulo komanso kugona.

Zizindikiro zowonjezereka zimakhala ndi kulephera kwa mtima, kukwera kwa vutoli, komanso areflexia, paresis ndi chikomokere, kugwa. Izi zimayambitsa chitukuko cha DIC, ndiko kuti kuphatikizika kwa mitsempha. Ngati matendawa atapezeka, muyenera kulandira chithandizo mwachangu.

Chithandizo cha matenda ashuga

Ndi zizindikiro za matendawa ndi lactic acidosis yomwe, thandizo loyamba limakhudzana ndi kuyamwa kwa njira ya sodium bicarbonate (4% kapena 2,5%), voliyumu yomwe imatha kupitilira malita awiri patsiku.

Anthu odwala matenda ashuga akhoza kutengedwa ndipo Metformin, yomwe imachepetsa hyperglycemia, koma sikuti imathandizira pakukula kwa hypoglycemia. Mosiyana ndi mankhwala a sulfonylurea, omwe amaphatikiza mayina a sulfonamide, mankhwalawa samalimbikitsa kupanga insulin. Ngati mankhwala osokoneza bongo omwe apezeka mu shuga, lactic acidosis imatha kupanga ndikuopseza kuti imwalira. Zomwe zimayambitsa matenda a mankhwalawa ndizowerengeka zomwe zimapangidwa chifukwa cha kuwonongeka kwa impso. Ngati zizindikiro zoyambirira za lactic acidosis zichitika, ndiye kuti Metformin ndiyosiyidwa bwino. Tiyenera kukumbukira kuti:

wodwalayo akulimbikitsidwa kuti agonekere kuchipatala posachedwa,
Muzochitika zamankhwala, metformin imachotsedwa bwino ndi hemodialysis,
chinthu chofunikira kuchiza odwala matenda ashuga chizikhala chisonyezo.
hypoglycemia imatha kuchitika ngati Metformin imagwiritsidwa ntchito molumikizana ndi kukonzekera kwa sulfonylurea,
ndikofunikira kuyang'anira pH nthawi zonse komanso kuchuluka kwa potaziyamu m'magazi,
ndi lactic acidosis ndi zizindikiro zake, mankhwala a insulin omwe ali ndi yogwira ma genetic engineering adzagwiritsidwa ntchito ngati chithandizo. Komanso, titha kulankhula za chithandizo chokhachokha chokhala ndi insulin.

Pochiza matenda oopsa kwambiri ndi lactic acidosis, ma carboxylase amatha kugwiritsidwa ntchito kudzera mu njira ya kukokoka chifukwa cha kukhazikitsidwa kwa 200 mg patsiku. Mtsogolomo, mankhwalawa azikhala ndi kupaka magazi a m'magazi komanso magazi ochepa kwambiri a heparin, omwe amakupatsani mwayi kusintha magazi a hemostasis.