Kukoma kwa shuga: Zizindikiro, zizindikiritso ndi zotsatira zake

Odwala odwala matenda a shuga amadzifunsa: Matenda a matenda ashuga: ndi chiyani? Kodi munthu wodwala matenda ashuga amayembekezera chiyani ngati simumamwa insulin panthawi yake komanso kupewa chithandizo chodzitchinjiriza? Ndipo funso lofunika kwambiri lomwe limadetsa nkhawa madipatimenti opanga ma endocrine m'makiriniki: Ngati magazi ndi 30, ndichitenji? Kodi malire oti akhale ndi malire ndi otani?
Sichikhala cholondola kunena za matenda okhudzana ndi matenda ashuga, chifukwa mitundu inayi ya chikomokere imadziwika. Atatu oyambayo ndi hyperglycemic, omwe amaphatikizidwa ndi kuchuluka kwa shuga m'magazi.

Ketoacidotic chikomokere

Ketoacidotic chikomacho ndichikhalidwe cha odwala omwe ali ndi matenda a shuga 1. Mkhalidwe wovuta uwu umachitika chifukwa cha kuchepa kwa insulini, chifukwa chomwe kugwiritsidwa ntchito kwa glucose kumachepetsedwa, kagayidwe kazigawo onse amatsitsidwa, ndipo izi zimayambitsa kulakwitsa kwa ntchito yamakina onse ndi ziwalo zamunthu aliyense. Chofunikira kwambiri cha ketoacidotic chikomachi ndi kusakwanira kwa insulini komanso kulumikizana kowopsa m'magazi a magazi. Hyperglycemia imafika - 19-33 mmol / l ndi kukwera. Zotsatira zake ndi kukomoka kwakukulu.

Nthawi zambiri, vuto la ketoacidotic limakula mkati mwa masiku 1-2, koma pamaso pazinthu zopsetsa mtima, zimatha kuyamba msanga. Mawonekedwe oyamba a mtundu wa matenda ashuga ndi chizindikiro cha kuchuluka kwa shuga m'magazi: kuchuluka kwa ulesi, kufuna kumwa, polyuria, kupuma kwa acetone. Khungu ndi mucous zimasokonekera, pali ululu wam'mimba, mutu. Pamene chikomacho chikukula, polyuria ikhoza kulowa m'malo mwa anuria, kuthamanga kwa magazi, kugunda kwamkati, kuchuluka kwa minofu kumawonedwa. Ngati magazi a ndende ali pamwamba pa 15 mmol / l, wodwala amayenera kuyikidwa kuchipatala.

Ketoacidotic coma ndiye digiri yomaliza ya matenda ashuga, owonetsedwa ndi kuwonongeka kwathunthu, ndipo ngati simupereka chithandizo kwa wodwala, kufa kumatha kuchitika. Thandizo ladzidzidzi liyenera kutchedwa yomweyo.

Kwa insulin yosakwanira kapena yosakwanira insulin, zifukwa zotsatirazi zimagwira ntchito:

Wodwalayo sakudziwa za matenda ake, sanapite kuchipatala, chifukwa chake matenda a shuga sanawapezeke munthawi yake.
Insulin yolowa siili yoyenera, kapena kutha,
Kuphwanya kwambiri zakudya, kugwiritsa ntchito zakudya zamafuta m'mimba, mafuta ambiri, mowa, kapena njala yayitali.
Kufuna kudzipha.

Odwala ayenera kudziwa kuti ndi matenda amtundu wa 1 shuga, kufunikira kwa insulin kumawonjezera pazochitika zotsatirazi:

pa mimba
ndi matenda ophatikizika,
pavuto komanso opaleshoni,
ndi okhazikika a glucocorticoids kapena okodzetsa,
panthawi yochitachita zolimbitsa thupi, zochitika zama psychoemotional.

The pathogenesis of ketoacidosis

Kuperewera kwa insulin ndi chifukwa cha kuchuluka kwa mahomoni a corticoid - glucagon, cortisol, catecholamines, adrenocorticotropic ndi mahomoni a somatotropic. Glucose ndi woletsedwa kulowa m'chiwindi, m'maselo a minofu ndi minyewa ya adipose, mulingo wake m'magazi umakwera, ndipo mkhalidwe wa hyperglycemia umachitika. Koma nthawi yomweyo, maselo amakhala ndi vuto la mphamvu. Chifukwa chake, odwala matenda a shuga amakhala ndi vuto lofooka, lopanda mphamvu.

Pofuna kubwezeretsanso njala, thupi limayambitsa njira zina zopangira mphamvu - zimayambitsa lipolysis (kuwonongeka kwa mafuta), chifukwa chomwe mafuta aulere acids, mafuta osavomerezeka a asidi, triacylglycerides amapangidwa. Ndikusowa kwa insulin, thupi limalandira 80% yamphamvu panthawi yomwe makutidwe a mafuta aulere acids, ndi zopangidwa ndi kuwonongeka kwawo (acetone, acetoacetic ndi β-hydroxybutyric acid), omwe amapanga matupi awo otchedwa ketone, kudziunjikira. Izi zikufotokozera kuchepa thupi kwa odwala matenda ashuga. Kuchuluka kwa matupi a ketone m'thupi kumatenga mphamvu zamchere, chifukwa chomwe ketoacidosis imayamba - matenda oopsa a metabolic. Imodzi ndi ketoacidosis, kagayidwe kazinthu kamadzi kamasokoneza.

Hyperosmolar (non-ketoacidotic) chikomokere

Hyperosmolar coma imakonda kwambiri odwala omwe ali ndi matenda ashuga a 2. Mtundu uwu wa chikomokere m'matenda a shuga umachitika chifukwa chosowa insulini, ndipo umadziwika ndi kufooka kwa thupi, hyperosmolarity (kuchuluka kwa sodium, glucose ndi urea m'magazi).

Hyperosmolarity ya plasma yamagazi imabweretsa kusokonezeka kwakukulu kwa ntchito za thupi, kuchepa kwa chikumbumtima, koma pakalibe ketoacidosis, yomwe imafotokozedwa ndikupanga insulin ndi kapamba, sikokwanira kuthana ndi hyperglycemia.

Kutha kwa thupi, komwe ndi chimodzi mwazomwe zimayambitsa matenda a diabetesic hyperosmolar coma

kugwiritsa ntchito kwambiri okodzetsa,
kutsuka ndi kusanza kwa matenda amtundu uliwonse,
kukhala m'malo otentha, kapena kugwira ntchito pamalo otentha kwambiri,
kusowa kwa madzi akumwa.

Zotsatirazi zimakhudzanso kumayambira kukomoka:

Kuperewera kwa insulin
Odwala matenda ashuga,
Mankhwala osokoneza bongo omwe amakhala ndi ma carbohydrate, kapena jekeseni wama glucose akulu,
kapena peritoneal dialysis, kapena hemodialysis (njira zokhudzana ndi kuyeretsa impso kapena peritoneum).
Kutuluka magazi kwa nthawi yayitali.

Kukula kwa hyperosmolar coma kumakhala ndi zizindikiro wamba ndi ketoacidotic chikomokere. Kutalika kwa boma kumatenga nthawi yayitali bwanji malinga ndi kapamba, kutulutsa bwino kwa insulin.

Hyperlactacidemic chikomokere ndi zotsatira zake

Hyperlactacidemic coma imachitika chifukwa cha kudzikundikira kwa lactic acid m'mwazi chifukwa chosowa insulini. Izi zimapangitsa kuti pakhale kusintha kwamomwe magazi amapangidwira ndikusokonezeka kwa chikumbumtima. Zotsatirazi zimatha kuyambitsa kukomoka kwa hyperlactacidemic:

Osakwanira kuchuluka kwa mpweya m'magazi chifukwa cha mtima ndi kupuma kulephera komwe kumakhalapo chifukwa cha matenda a mphumu, matenda ammimba, kulephera kwa magazi, mtima,
Matenda otupa, matenda,
Matenda a impso kapena chiwindi
Kuledzera

Choyambitsa chachikulu cha hyperlactacidemic chikomono ndi kusowa kwa oxygen m'magazi (hypoxia) motsutsana ndi maziko a kuchepa kwa insulin. Hypoxia imalimbikitsa anaerobic glycolysis, yomwe imapanga lactic acid yambiri. Chifukwa chosowa insulini, ntchito ya enzyme yomwe imalimbikitsa kutembenuka kwa pyruvic acid kukhala acetyl coenzyme yafupika. Zotsatira zake, asidi a pyruvic amasinthidwa kukhala lactic acid ndipo amadziunjikira m'magazi.

Chifukwa cha kuchepa kwa mpweya, chiwindi chimalephera kugwiritsira ntchito lactate owonjezera. Mwazi wosinthika umayambitsa kuphwanya kwa contractility ndi kusangalala kwa minofu ya mtima, kuchepetsa ziwiya zotumphukira, zomwe zimayambitsa kukomoka.

Zotsatira zake, komanso, munthawi yomweyo, zizindikiro za hyperlactacidemic coma ndi kupweteka kwa minofu, angina pectoris, nseru, kusanza, kugona, kugona tulo.

Pozindikira izi, mutha kupewa kukomoka, komwe kumayamba patapita masiku ochepa, mutamuika wodwala kuchipatala.

Mitundu yonse pamwambapa ya ma com ndi hyperglycemic, ndiye kuti, ikukula chifukwa cha kuwonjezeka kwambiri kwa shuga m'magazi. Koma kusintha koteroko ndikothekanso, pamene shuga achepetsa kwambiri, kenako kukomoka kwa hypoglycemic kumatha kuchitika.

Hypoglycemic chikomokere

Hypoglycemic coma mu matenda a shuga imakhala ndi njira yosinthira, ndipo imatha kukhazikika pomwe kuchuluka kwa glucose m'magazi kumachepetsedwa kwambiri mpaka kuperewera kwa mphamvu muubongo.

Izi zimachitika mu milandu yotsatirayi:

Ngati bongo wa insulin kapena mankhwala ochepetsa magazi amaloledwa.
Wodwala atatha kudya insulin sanadye pa nthawi, kapena zakudya zake zinali zochepa m'matumbo,
Nthawi zina ntchito ya adrenal imachepa, mphamvu ya insulin-yoletsa chiwindi, chifukwa chake, chidwi cha insulin chimawonjezeka.
Pambuyo pogwira ntchito zolimbitsa thupi kwambiri,

Kuchepa kwa glucose kuubongo kumadzetsa hypoxia ndipo, chifukwa chake, kusokonekera kwa maproteni ndi michere m'maselo a chapakati mantha.

Kuchuluka kwanjala
kuchepa kwamphamvu kwamthupi ndi m'maganizo,
kusintha kwa machitidwe ndi chikhalidwe chosayenera, chomwe chitha kufotokozedwa mwaukali kwambiri, nkhawa,
kugwirana chanza
tachycardia
womvera
Kuthamanga kwa magazi

Ndi kuchepa kwa shuga m'magazi mpaka 3.33-2.77 mmol / l (50-60 mg%), zochitika zoyambirira za hypoglycemic zimachitika. Munthawi imeneyi, mutha kuthandiza wodwalayo pomupatsa kuti amwe tiyi kapena madzi otsekemera ndi magawo anayi a shuga. M'malo mwa shuga, mutha kuyikamo uchi, kupanikizana.

Pa shuga wa magazi a 2.77-1.66 mmol / l, zizindikiro zonse za hypoglycemia zimawonedwa. Ngati pali munthu pafupi ndi wodwala yemwe angapereke jakisoni, shuga amatha kulowa m'magazi. Koma wodwalayo amayenera kupita kuchipatala kuti akalandire chithandizo.

Ndikusowa kwa shuga kwa 1.66-1.38 mmol / L (25-30 mg%) ndi kutsika, chikumbumtima nthawi zambiri chimatha. Mwachangu muyenera kuyimba ambulansi.

Kodi kudwala matenda ashuga ndi chiyani ndipo zimayambitsa ndi mitundu yanji?

Tanthauzo la chikomokere ndi matenda ashuga - pamakhala mkhalidwe womwe wodwala matenda ashuga amataya chikumbumtima akakhala kuti ali ndi kuchepa kapena kuchuluka kwa shuga m'magazi. Ngati ali ndi vutoli ngati wodwala sangapatsidwe chithandizo mwadzidzidzi, ndiye kuti chilichonse chitha kupha.

Zomwe zimayambitsa chiwonetsero cha matenda ashuga ndikuwonjezereka kwa ndende zamagazi, komwe kumachitika chifukwa chosakwanira katemera wa insulin ndi kapamba, kusadziletsa, kusaphunzira komanso anthu ena.

Popanda insulin yokwanira, thupi silingathe kupanga shuga chifukwa cha zomwe sizisintha kukhala mphamvu. Kusowa koteroko kumabweretsa kuti chiwindi chimayamba kudzipangira payekha shuga. Pokana ndi maziko awa, pali mphamvu yogwira matupi a ketone.

Chifukwa chake, ngati shuga achuluka m'magazi mwachangu kuposa matupi a ketone, ndiye kuti munthu amasiya kuzindikira ndikuyamba kudwala matenda ashuga. Ngati ndende ya shuga ikwera pamodzi ndi matupi a ketone, ndiye kuti wodwalayo angagwe mu ketoacidotic coma. Koma pali mitundu ina yamikhalidwe yotere yomwe iyenera kulingaliridwa mwatsatanetsatane.

Mwambiri, mitundu iyi ya chikomokere cha shuga imadziwika:

achina,
hyperglycemic,
ketoacidotic.

Hypoglycemic chikomokere - chitha kuchitika pamene kuchuluka kwa shuga m'mtsinje wamagazi kutsika modzidzimutsa. Vutoli litenga nthawi yayitali bwanji, chifukwa zambiri zimatengera kuopsa kwa hypoglycemia komanso thanzi la wodwalayo. Matendawa atha kudwala matenda osokoneza bongo omwe amathamangira pakudya kapena iwo omwe samatsata mlingo wa insulin. Hypoglycemia imawonekanso pambuyo povutitsa kapena kuledzera.

Mtundu wachiwiri - kukomoka kwa hyperosmolar kumachitika ngati vuto la shuga 2, lomwe limayambitsa kusowa kwa madzi komanso shuga wambiri wamagazi. Kuyamba kwake kumachitika ndi glucose wambiri kuposa 600 mg / l.

Nthawi zambiri, hyperglycemia yowonjezera imalipidwa ndi impso, zomwe zimachotsa glucose wambiri ndi mkodzo. Pankhaniyi, chifukwa cha kukhazikika kwa mtima ndi chakuti pakuchepa kwamadzi ndi impso, thupi limakakamizidwa kupulumutsa madzi, chifukwa chomwe hyperglycemia imayamba.

Hyperosmolar s. matenda ashuga (Latin) amakula nthawi 10 kuposa hyperglycemia. Kwenikweni, mawonekedwe ake amapezeka ndi mtundu wachiwiri wa shuga mwa odwala okalamba.

Ketoacidotic diabetesic coma amakula ndi mtundu 1 shuga. Mtundu wamtunduwu umatha kuonedwa pamene ma ketones (ovuta ma acetone acids) akadziunjikira m'thupi. Zina mwazinthu zopanga mafuta acid zimachitika chifukwa cha kuchepa kwambiri kwa insulin.

Hyperlactacidemic coma mu shuga imachitika kawirikawiri. Izi ndizodziwika kwa okalamba omwe ali ndi vuto la chiwindi, impso ndi mtima.

Zomwe zimapangitsa kukula kwa mtundu uwu wa matenda ashuga ndi maphunziro ochulukirapo ndikugwiritsira ntchito molakwika kwa hypoxia ndi lactate. Chifukwa chake, thupi limapatsidwa mankhwala a lactic acid, omwe amaphatikizika mopitirira muyeso (2-4 mmol / l). Zonsezi zimabweretsa kuphwanya koyenera kwa lactate-pyruvate komanso mawonekedwe a metabolic acidosis omwe ali ndi kusiyana kwakukulu kwa anionic.

Vuto lochokera ku mtundu wa 2 kapena matenda ashuga 1 ndi lovuta kwambiri komanso loopsa kwa munthu wamkulu yemwe ali ndi zaka 30 zakubadwa. Koma izi ndizowopsa makamaka kwa odwala ochepa.

Khansa ya matenda ashuga mwa ana nthawi zambiri imayamba ndi matenda omwe amadalira insulin omwe amakhala zaka zambiri. Nthawi zambiri azimayi odwala matenda ashuga amawonekera pasukulu yasekondale kapena pasukulu, nthawi zina pachifuwa.

Komanso, osakwana zaka 3, zinthu zotere zimachitika nthawi zambiri kuposa akulu.

Zizindikiro

Mitundu ya chikomokere ndi matenda ashuga ndizosiyana, kotero chithunzi chawo chachipatala chikhoza kukhala chosiyana. Chifukwa cha kuperewera kwa ketoacidotic, kuchepa madzi m'thupi kumadziwika, kumatsatana ndi kuchepa kwa thupi mpaka 10% ndi khungu louma.

Zikatero, nkhope imasanduka yowoneka bwino (nthawi zina imakhala yofiyira), ndipo khungu kumapeto, manja amasanduka achikasu, matuza ndi masamba. Ena odwala matenda ashuga ali ndi furunculosis.

Zizindikiro zina zokhala ndi matenda ashuga okhala ndi ketoacidosis ndi kupuma zowola, nseru, kusanza, kufinya minofu, kuziziritsa kwamiyendo, ndi kutentha pang'ono. Chifukwa cha kuledzera kwa thupi, kupanikizika kwam'mapapo kumatha kuchitika, ndipo kupuma kumakhala kaphokoso, kozama komanso pafupipafupi.

Mtundu wa matenda a shuga ukapezeka mu mtundu wachiwiri wa matenda ashuga, zizindikilo zake zimaphatikizanso kamvekedwe ka timisomaso ndikuchepetsa ana. Nthawi zina, kuchuluka kwa eyelid komanso strabismus kumadziwika.

Komanso, kukhala ketoacidosis kumayendera limodzi ndi kukodza pafupipafupi, komwe kumatha kununkhira fungo la fetal. Nthawi yomweyo, m'mimba mumapweteka, matumbo amayamba kufooka, ndipo kuthamanga kwa magazi kumachepetsedwa.

Ketoacidotic coma mu odwala matenda ashuga akhoza kukhala osiyanasiyana kusiyanasiyana - kuyambira kugona mpaka kutha. Kuzindikira kwa ubongo kumathandizira kuyambika kwa khunyu, kuyerekezera zinthu m'magazi, kuwongolera komanso kusokoneza.

Hyperosmolar diabetesic coma sign:

kukokana
kusowa kwamadzi
kusokonekera kwa mawu
malaise
zamitsempha
kusuntha kwamaso kwakanthawi ndi mwachangu,
kawirikawiri ndi kufooka pokodza.

Zizindikiro za chikomine cha matenda ashuga okhala ndi hypoglycemia ndizosiyana pang'ono ndi mitundu ina ya chikomokere. Vutoli limatha kudziwika ndi kufooka kwakukulu, njala, nkhawa zopanda pake ndi mantha, kuzizira, kunjenjemera ndi thukuta la thupi. Zotsatira za matenda obwera chifukwa cha matenda ashuga omwe ali ndi hypoglycemia ndi kulephera kuzindikira komanso mawonekedwe a kugwidwa.

Hyperlactacidemic diabetesic coma imadziwika ndi lilime louma komanso khungu, mtundu wa Kussmaul kupuma, kugwa, hypotension, ndikuchepetsa turgor. Komanso, nthawi yopumira, yotalika maora angapo mpaka masiku angapo, imayendetsedwa ndi tachycardia, oliguria, kudutsa mu anuria, kufewa kwa nsidze.

Hypoglycemic coma ndi mitundu ina yamikhalidwe yofananira mwa ana imakula pang'onopang'ono. Matenda a shuga amakhalapo limodzi ndi mavuto am'mimba, nkhawa, ludzu, kugona, mutu, kusowa kudya komanso nseru. Ndikamakula, kupuma kwa wodwalayo kumayamba phokoso, mwakuya, zimachitika mwachangu, ndipo zotsatira zake zimakhala.

Mu shuga mellitus mu makanda, mwana akayamba kugona, amakhala ndi polyuria, kudzimbidwa, polyphagy komanso ludzu lokwanira. Ma diapodi ake amayamba kufinya mkodzo.

Mwa ana, zimawonetsa zofananira monga akulu.

Zoyenera kuchita ndi matenda a shuga?

Ngati chithandizo choyambirira cha zovuta za hyperglycemia sichili mwadzidzidzi, ndiye kuti wodwala yemwe ali ndi vuto la matenda ashuga omwe zotsatira zake zimakhala zowopsa amatha kutsegula m'mapapo komanso matenda a ubongo, thrombosis, zomwe zimayambitsa matenda a mtima ndi stroko, oliguria, aimpso kapena kulephera kupuma, ndi ena. Chifukwa chake, atazindikira kuti wodwalayo wapezeka kale, wodwala ayenera kupatsidwa chithandizo ndi matenda a shuga.

Chifukwa chake, ngati mkhalidwe wa wodwalayo watsala pang'ono kukomoka, ndiye kuti kuyitanitsa kwadzidzidzi kuyenera kuchitidwa. Pomwe iye akuyendetsa, ndikofunikira kuyika wodwalayo pamimba pake kapena pambali pake, kulowa zolowetsa ndikuletsa lilime kuti lisaponye. Ngati ndi kotheka, sinthani nkhawa.

Zoyenera kuchita ndi matenda a shuga omwe amayamba chifukwa cha kuchuluka kwa ma ketoni? Muno, kulumikizana kwa machitidwe ndikuwongolera ntchito zofunika za odwala matenda ashuga, monga kupanikizika, kugunda kwa mtima, kudziwa komanso kupumira.

Ngati khansa ya lactatacidemic yapanga matenda a shuga, ndikofunikira kuchitanso chimodzimodzi ndi ketoacidotic. Koma kuphatikiza pa izi, ma-electrolyte amadzi ndi acid-base balance ziyenera kubwezeretsedwanso. Kuthandizanso wodwala matenda a shuga a mtundu uwu amakhala popereka njira yothetsera shuga kwa insulin kwa wodwalayo ndikupanga mankhwala opatsa chidwi.

Ngati khansa yofatsa ya hypoglycemic ikupezeka m'mitundu yachiwiri ya shuga, kudzithandizira ndikotheka. Nthawiyi sikhala motalika, choncho wodwalayo ayenera kukhala ndi nthawi yokwanira kudya chakudya chambiri (zidutswa zingapo za shuga, supuni yodzaza, kapu ya madzi a zipatso) ndikuyamba kuchita bwino kuti asadzivulaze ngati atha kuzindikira.

Ngati zakhumudwitsidwa ndi insulin, momwe zimakhalira nthawi yayitali, ndiye kuti kudya ndi odwala matenda ashuga kumaphatikizapo kumwa pang'onopang'ono mafuta ochulukirapo mu 1-2 XE asanagone.

Kusamalira kwadzidzidzi kwa zochitika zokhudzana ndi endocrine

Makolowo omwe amakhulupirira kuti chidziwitso chomwe chatchulidwa munkhaniyi sichingakhale chothandiza kwa iwo ndipo ana awo athanzi atseka tsambalo ndipo sadzadziwa zambiri. Omwe ali ndi omwe ali ndi chidwi ndi omwe adzazindikira kuti matenda amtundu wamtundu wa endocrine nthawi zambiri amakula mwa anthu omwe ali ndi thanzi labwino komanso machitidwe omwe amafunikira thandizo nthawi zambiri amakhala akutsutsana ndi maziko owoneka amoyo wathanzi. Mikhalidwe yotere, choyambirira, imaphatikizapo kukomoka - hypoglycemic ndi matenda ashuga, malamulo opulumutsa omwe nkhaniyi idaperekedwa.

Kuganizira zinthu ziwiri zomwe zidatipangitsa kuti tizikhala ndi vuto la shuga. Choyamba, ndi izi zomwe nthawi zambiri zimachitika mwadzidzidzi, mwa odwala matenda a shuga, komanso nthawi zina m'mawonekedwe a ana athanzi, omwe amafunikira zochita mwachangu, zogwirizana komanso zoyenera kuchokera kwa makolo ndi akulu omwe ali pafupi. Kachiwiri, zizindikilo za ma coms izi ndizowonekera, ndipo ngakhale munthu yemwe ali ndi vuto laukadaulo yemwe sakhudzana ndi mankhwala atha kuwamvetsetsa, ndipo atazindikira kuti ali ndi matenda oyamba, amapereka thandizo loyenerera.

Kwa iwo omwe sakudziwa, onse awiriwa - onse odwala matenda ashuga komanso a hypoglycemic - ndi zovuta za mtundu wosavomerezeka wa matenda ashuga. Komabe, njira zopititsira kukhazikitsidwa kwa zinthu izi ndizosiyanasiyana: ngati chikomokere cha hypoglycemic chakhazikika chifukwa cha kutsika kwambiri kwa shuga m'magazi komwe kumayambitsa zifukwa zingapo, hypoglycemia, ndiye kutsika kwa shuga kwa magazi kwa nthawi yayitali - hyperglycemia imabweretsa kudwala matenda ashuga. Kuzindikira, chithandizo, ngakhale thandizo loyambirira kwa mwana yemwe ali ndi vuto la endocrine limachokera pa kusiyana kumeneku.

Hypoglycemic mkhalidwe ndi hypoglycemic chikomokere

Chifukwa chake, hypoglycemia. Kuchuluka kwa shuga m'magazi a odwala omwe ali ndi matenda ashuga ndizowopsa, makamaka chifukwa chakuti popanda glucose - gwero lamphamvu - palibe chiwalo chimodzi chathupi chamunthu chitha kugwira ntchito moyenera. Ndipo ubongo ndi woyamba kuvutika motere, zomwe zimayambitsa zizindikiritso za hypoglycemia. Zomwe zimayambitsa kwambiri za hypoglycemia ndizovuta zakudya (kudumpha chakudya), zakudya zopanda mafuta ambiri, masewera olimbitsa thupi kwambiri (osasinthidwa ndi zakudya komanso kusintha kwa kayendetsedwe ka insulin), cholakwika cha insulin dosing, komanso kusanza mobwerezabwereza ndi / kapena kutsekula m'mimba, komwe kumachepetsa kufunikira kwa insulin. Matenda a Hypoglycemic nthawi zambiri amapezeka chakudya chamasana kapena usiku, nthawi zambiri - m'mawa kapena masana. Hypoglycemia imachitika kawirikawiri m'masukulu ophunzirira komanso ana asukulu omwe ali ndi matenda osokoneza bongo ndipo nthawi zambiri amakhala ana.

Ngakhale hypoglycemia imadziwika ndi kuchuluka kwambiri komanso kuchuluka kwa zizindikiro, kusintha kwa wodwala nthawi zambiri kumadutsa m'njira zingapo zotsatizana. Mitundu yofatsa ya hypoglycemia mwa ana imadziwika ndi malaise, nkhawa, mantha, kusokonezedwa, kusamveranso, thukuta kwambiri (mawonekedwe a thukuta losadziwika), khungu lotuwa, kupindika, minofu kugwedezeka. Maonekedwe akumva njala ndikudziwika, pakhoza kukhala kumverera kwa tsekwe zogoneketsa thupi, kumverera kofika tsitsi kapena villi mkamwa kapena pakhungu kuzungulira, mawu osyasyalika nthawi zina amadziwika. Ngati thandizo la panthawi yake siliperekedwa, mkhalidwe wa mwana ukupitilirabe, zizindikilo za hypoglycemia zimawonekera, zomwe zimaphatikizapo chisokonezo, kusakhazikika, kuyankhula kwamwano, masomphenya ndi kugwirizanitsa magalimoto, ndikupangitsa mwana kuwoneka ngati munthu woledzera. Mwanayo atha kukhala waukali kapena wamakhalidwe, kenako osazindikira. Nthawi zambiri mwa ana, hypoglycemia imayambitsa khunyu yofanana ndi khunyu.

Kutsika kwina kwa shuga m'magazi kumamupangitsa mwana kukhala wodwala kwambiri, yemwe amadziwika ndi chithunzichi. Mwanayo sakudziwa, ali wotumbululuka komanso wanyowa chifukwa cha thukuta kwambiri. Kusintha kumachitika nthawi ndi nthawi, pamakhala kugunda kwamphamvu kwambiri kosagwirizana ndi kupuma kwapafupipafupi kwa kupuma. Chofunikira kusiyanitsa kwa chikumbumtima cha hypoglycemic kuchokera kwa odwala matenda ashuga ndiko kusowa kwa fungo la acetone mumlengalenga. Kugwiritsa ntchito glucometer yosunthika kumathandizira kuzindikira matenda a hypoglycemic - kuchuluka kwa glucose m'magazi okhala ndi hypoglycemia kumakhala kotsika kwambiri kuposa malire amodzi, omwe ndi 3.3 mmol / L kwa anthu azaka zonse.

Thandizo loyamba. Ndi isanayambike zizindikiro za hypoglycemia (malo ofatsa a hypoglycemia), chinthu chofunikira komanso chokwanira ndikulowetsa chakudya chochepa cham'mimba chambiri. Mwana yemwe ali ndi vuto la hypoglycemia ayenera kupatsidwa kachidutswa ka shuga, maswiti, kupanikizana, uchi, shuga m'mapiritsi, msuzi wa zipatso pang'ono kapena chakumwa chosakhala bwino (fanta, sprite, mandimu, Pepsi, ndi zina). Ngati vuto la mwanayo silikuyenda bwino, kukhudzidwa kwa zomwe zili ndi shuga ziyenera kubwerezedwa, kenako ndikuyimbani gulu la ambulansi. Kutsanulira zakumwa zotsekemera mkamwa mwa wodwalayo osakomoka sikungatheke - madziwo amatha kulowa m'mapapu ndikuwapangitsa kuti mwanayo afe.

Kutsata kwa glucagon, timadzi timene timatulutsa glucose wamkati m'chiwindi, amatanthauzanso njira zoyambira za hypoglycemia. Nthawi zambiri mankhwalawa amakhala m'nyumba yothandizira odwala matenda a shuga - madokotala amalimbikitsa mwamphamvu kuti muzisunga m'malo osavuta komanso odziwika bwino kwa abale ndi abale a wodwala. Glucagon imatha kuthandizidwa pamaso pa chikumbumtima komanso osazindikira chikumbumtima cha wodwala yemwe ali ndi hypoglycemia.

Mwana akapezeka ndi zizindikiro za kukomoka kwa hypoglycemic, njira zotsatirazi ziyenera kuchitidwa. Choyamba, ndikofunikira kuwonetsetsa kuti mpweya ubwerere pamapapu - mwakutero mabatani omwe ali kolala samakhazikika, lamba amasula kapena kumasula, zenera kapena zenera limatseguka. Ndikofunikira kutembenuzira mwana kumbali yake (kuteteza lilime kuti lisamatirire) ndikuyeretsa zomwe zili mkamwa (masanzi, zinyalala za chakudya, ndi zina). Izi zimatsatiridwa ndikuyitanidwa ku timu ya ambulansi komanso motsatana (ngati kupezeka) 1 mg ya glucagon imayendetsedwa intramuscularly.

Palibe chifukwa chomwe muyenera kubayira insulin (ngakhale mankhwalawa akupezeka mu zinthu zomwe akuchitidwazo) - pamaso pa chikumbumtima cha hypoglycemic, insulin ikupangitsani zotsatira zoyipa.

Palibe owopsa kuposa hypoglycemia ndi mkhalidwe wautali wokwezeka wamagazi wokhala ndi mawonekedwe a mtundu wophatikizika wa matenda a shuga. Hyperglycemia imayendera limodzi ndi kupuwala kwa mafuta ndi mapuloteni omwe amapanga matupi a ketone ndi acetone - zinthu zoopsa kwambiri zomwe zimadziunjikira m'thupi ndipo zimayambitsa zowonongeka zamkati. Poganizira zovuta zamtunduwu, mtundu uwu wa matenda a shuga umatchedwa ketoacidosis, ndipo chikomokere chomwe chimachitika ndi ketoacidosis yayikulu chimatchedwa ketoacidotic coma.

Mosiyana ndi hypoglycemia, ketoacidosis imakula pang'onopang'ono, zimapangitsa kuzindikira matendawa ndikuthandizira mwana. Komabe, nthawi zina (mwachitsanzo, mu makanda), kuchuluka kwa ketoacidosis kumathandizira kwambiri komanso kumakhumudwitsa nthawi yochepa kwambiri. Zomwe zimapangitsa kuti pakhale ma ketoacidosis ndi matenda ashuga (ketoacidotic) ndi insulin mankhwala osakwanira, zomwe zimapangitsa kuti thupi likhale ndi insulin motsutsana ndi maziko a matenda osiyanasiyana, kuledzera, kupsinjika, kuvulala, kuchita opaleshoni komanso mankhwala ena.

Gawo loyamba la ketoacidosis mwa ana limayendera limodzi ndi nkhawa, kusowa kudya chifukwa cha ludzu lalikulu, kupweteka mutu, nseru, kusanza, kupweteka kwam'mimba, komwe kungafanane ndi matenda am'mimba otupa. Lilime louma ndi milomo, mapokoso ndi kukoka pafupipafupi ndi kugona zimadziwika. M'tsogolomo, munthu amayamba kuzindikira pang'ono pang'onopang'ono, amakoka, amapuma, amakhala phokoso komanso phokoso, ndipo zimachitika pafupipafupi. Khungu la mwana wokhala ndi ketoacidosis limakhala lozizira, louma, lotupa komanso losakhazikika. Chizindikiro chofanana ndi ketoacidosis ndikuwoneka ngati kununkhira kwa acetone kuchokera mkamwa. Ngati pali glucometer mkati mwa momwe mungafikire ndipo muli ndi luso logwiritsa ntchito, mutha kudziwa kuchuluka kwa shuga mumagazi - ndi ketoacidosis pali msana wambiri wa glycemia - pamwambapa 16-20 mmol / l.

Thandizo loyamba. Zizindikiro zoyambirira za ketoacidosis zikaonekera, ndikofunikira kufunsa dokotala mwachangu. Ngakhale insulini idaperekedwa kwa mwana wodwala pafupipafupi komanso pa Mlingo wokhazikitsidwa, kukula kwa ketoacidosis kumawonetsa kusakwanira kwa chithandizo chofunikira komanso kufunika kwawongoleredwe mwachangu. Nthawi zina, kulumikizana ndi telefoni ya endocrinologist ndikovomerezeka, koma mwayi wakuchezerana ndi nkhope ulipo, uyenera kugwiritsidwa ntchito nthawi yomweyo. Pazakudya za wodwalayo, mafuta omwe ali ndi malire, kumwa kwa zamchere kumayikidwa - madzi amchere amchere, koloko ya sodium, rehydron.

Kuthandiza mwana kuti asamudziwe ndi zizindikiro za ketoacidotic chikomokere sayenera kuyamba chifukwa cha insulin. Modabwitsa, insulin yotere ingaphe wodwalayo. Chowonadi ndi chakuti insulini, mutalowa m'thupi la wodwalayo mu ketoacidotic coma, imayambitsa kuthamanga kwa magazi kuchokera m'magazi kupita ku maselo, pomwe glucose "imatulutsa" madzi owonjezera nawo, zomwe zimapangitsa kukula kwa ma cell ndi minofu. Edema ya ziwalo zamkati ndipo koposa zonse, bongo, limayambitsanso zoyipa zoyambitsidwa ndi insulin mankhwala oyamba, omwe samathandizidwa ndi mankhwala ena ofunikira pamenepa. Insulin adzafunikira kuperekedwa - koma kenako, ambulansi itakwana komanso kuchipatala kwa mwana. Pakadali pano, kumbukirani - palibe insulin!

Ntchito yayikulu yopulumutsa mumkhalidwe woterewu ndikusungitsa ntchito zofunika za thupi la mwanayo madokotala asanafike (ambulansi iyenera kuyitanidwa atangopeza mwana yemwe sakudziwa). Pachifukwa ichi, mwana ayenera kuyatsidwa pamimba pake, ndikuwonetsetsa kuti mpweya wabwino, amasula pakamwa pake kuchokera ku matupi akunja, chakudya ndi masanzi. Mlengalenga ndi mawonekedwe apumidwe adzafunika kuwonedwa panthawi yonse yoyang'anira gulu la ambulansi - iyi ndiye ntchito yayikulu yopulumutsa mosasamala komanso chisamaliro chachikulu chosafunikira kwa mwana yemwe ali ndi vuto la ketoacidotic.

Coma ndi zomwe zachitika m'mbuyomu ndizovuta kwambiri, zomwe zimatha kupangitsa kuti ngakhale munthu wamkulu wazamaganiza. Koma tikumbukire kuti osati zaumoyo zokha, komanso moyo wa mwana zimatengera kulondola, mgwirizano, kulondola komanso kuthamanga kwa njira zopulumutsira munthawi imeneyi. Ndikofunikira kuti mukhale pamodzi momwe ndingathere ndikuyang'ana kwambiri pazomwe mwachita. Ndipo malingaliro amatha kusiyidwa pambuyo pake. Samalirani thanzi lanu!

Zambiri za hypo- ndi hyperglycemic state mu ana

Mwana wodwala wodwala matenda ashuga , nthawi zambiri amakhudzidwa ndi zinthu zina mukamachulukana ndikuchepetsa kuchuluka kwa shuga m'magazi. Hypoglycemic coma imachitika chifukwa chakuthwa

ndi kutsika kwadzidzidzi m'magazi a shuga, ndi mankhwala osokoneza bongo a insulin kapena kudya kosakwanira pambuyo pobayira jakisoni.

Mwana akatembenuka, amayamba kudwala ndipo mwina atatsala pang'ono kufa.

Sichichita monga momwe zimakhalira nthawi zonse, imatha kukhazikika pansi, kusintha, kapena, kupsa mtima,

Wokugwedeza akhoza kumumenya

Mwana amatuluka thukuta kwambiri, koma khungu lake limazizira.

Kupuma kwa mwana kumachitika pafupipafupi, kungosintha pang'ono komanso pakapita nthawi, koma sipadzakhala fungo la acetone mmenemo,

Nthawi zambiri pamakhala mseru kapena mutu,

Mwana adzasokonezedwa - samayankha nthawi zonse mafunso osavuta.

Ngati munthawi imeneyi mwana samapatsidwa chilichonse chotsekemera (makamaka pakumwa zakumwa), ndiye kuti atha kuzindikira ndipo zizindikiro zonse za matenda obwera chifukwa cha hypoglycemic zidzakulanso.

Ngati mukuwona zizindikiritso zingapo zomwe zikuwonetsa mu ana, muyenera kuchita izi:

Mpatseni chidutswa cha shuga, chakumwa cha glucose (kapena mapiritsi a glucose), kapena chakudya chilichonse chabwino. Mukasintha, mupatsenso maswiti,

Zinthu zikamayenda bwino, sonyezani mwanayo kwa dotolo kuti mudziwe chifukwa chake matenda akewo akuipiraipira, kapena ngati mlingo wa insulini uyenera kuunikidwanso,

Ngati mukulephera kudziwa, fufuzani kaye

mpweya wabwino wa mwana, ndipo ngati kupuma kumayambira, yambani kupuma mwaumbuli ,

Nthawi yomweyo, pemphani wina kuti ayitane ambulansi mwachangu. Mukamayimba, onetsetsani kuti mwana ali ndi vuto la kuchepa kwa magazi,

Zizindikiro zoyambirira za hypoglycemia zikaonekera, mwana sayenera kungosiyidwa yekha kusukulu kapena kunyumba kwa mphindi imodzi!

HYPERGLYCEMIA mwa mwana lilinso ndi machitidwe ake. Matenda a matenda ashuga (hyperglycemia) amakula mwa ana omwe amadzazindikira mochedwa komanso kusowa kwa chithandizo chamankhwala poyambira matendawa.Komanso mu kupezeka kwake kumatha kuchita zinthu monga kuphwanya boma, kutchukitsa mtima, ndi matenda ogwirizana. Zizindikiro za matenda a shuga

Mwana amakonda kupita kuchimbudzi,

Khungu limakhala lotentha kukhudza, nkhope “ndiyaka”,

Amakhala woopsa ndipo wagona,

Madandaulo athanzi

Mwana amangokhalira kudandaula za ludzu

Kusanza ndi kusanza kumawonekera

Fungo la mpweya lomwe mwana amatulutsa limafanana ndi fungo la ma acetone kapena maapulo oboola,

Kupuma kumakhala pafupipafupi komanso kosaya.

Ngati panthawiyi mwana sanathandizidwe, ndiye kuti

satha kukumbukira ndipo mkhalidwe wa hyperglycemic coma ubwera.

Zizindikiro zoyambirira za hyperglycemia zitawoneka, zotsatirazi ziyenera kuchitika:

Funsani mwana ngati wadya zomwe sizimamuyenerera,

Dziwani ngati jakisoni wa insulin waperekedwa

Sonyezani mwanayo kwa asing'anga,

Mwana akakhala kuti alibe chikumbumtima, muyenera kuwunika mpweya wabwino kuti muwone ngati kupuma kwakeko ndikwabwino,

Ngati kupuma kwamira - yambani kuchita kupuma pakamwa ndi pakamwa,

Ndikofunikira kuyimba ambulansi. Poimba, ziyenera kunenedwa kuti mwina mwanayo wodwala matenda ashuga .

Chithandizo cha matenda ashuga ana ayenera kukhala okwanira, ndi kuvomerezedwa kugwiritsa ntchito insulin ndi zakudya mankhwala. Chithandizo siziyenera kuphatikizapo kupumula kwamatenda athu, komanso kupatsanso chitukuko cha thupi. Zakudya zopatsa thanzi ziyenera kukhala pafupi ndi msinkhu wachilengedwe, koma ndi mafuta ndi shuga. Kugwiritsa ntchito chakudya chamagulu okwanira ayenera kukhala ochepa. Ndi kuwonjezeka kwa chiwindi, zakudya zonse zokometsera ndi zokazinga ziyenera kuperekedwa kuchakudya cha mwana, chakudya chiyenera kukhala chovunda. Mlingo wa tsiku ndi tsiku wa insulin umakhazikitsidwa mosiyanasiyana, poganizira glycosuria ya tsiku ndi tsiku. Mlingo wa tsiku ndi tsiku wa insulin yoyambira koyamba ungathe kuwerengedwa mosavuta ndikugawa tsiku lililonse dzuwa lomwe limatayika. Zosintha zonse pakuika kwa mankhwala a insulin ayenera kuchitika kokha ndi endocrinologist.

Pambuyo pakutha kwa zizindikiro za chikomokere, khofi, tiyi, zophera, msuzi, apulo wosenda, nyama yowotchera, masamba a zipatso amapatsidwa. Pang'onopang'ono sinthani ku chakudya chopatsa thanzi ndi mafuta ochepa. Mukakwatirana

kulipira, mutha kusamutsa wodwala kuti aphatikize chithandizo ndi kugwiritsa ntchito insulin yayitali.

Matenda a shuga ana

LudmilaSeputembara 6, 2011Matenda a Endocrine mwa AnaPalibe Ndemanga

Amatengera matenda ofala kwambiri a endocrine.

Etiology ndi pathogenesis . Gawo la ana omwe amadwala matenda ashuga ndi ochepa (8-10%), koma matenda ashuga ali ana amakhala ndi vuto lalikulu la insulin, lomwe limatsimikiza kuwonongeka kwake. Mu etiology ya matenda ashuga pali nkhani zambiri zomwe sizinathetsedwe.

Matenda a shuga mu ana makamaka ndi matenda obadwa nawo; Mtundu wa cholowa cha polygenic chokhudza zinthu zingapo chimadziwika. Tsopano mellitus wodwala yemwe amadalira insulin amayamba chifukwa cha matenda a autoimmune, komwe kumachitika komwe kumakhala kofala pambuyo pa matenda opatsirana. Kukhalapo kwa insulin kumatsimikiziridwa mu kapamba, chifukwa cha chitukuko cha kuperewera kwa insulin. Chifukwa cha kuchepa kwa insulin, zovuta zingapo za metabolic zimayamba, zomwe zazikulu zake ndizovuta za kagayidwe kazakudya, kakulidwe ka hyperglycemia, glucosuria, polyuria. Metabolism yamafuta imangokhala m'mitsempha (kuchuluka kwa lipolysis, kutsika-synthesis, kuchuluka kwa mafuta osapangika, matupi a ketone, cholesterol). Kuphwanya kuphatikiza kwa chakudya chamafuta minofu kumabweretsa lactic acidosis. Acidosis imakhalanso chifukwa cha kuwonjezeka kwa neogeneis. Zotsatira zake, kuchepa kwa insulin kumasokonezeranso mapuloteni komanso metabolism yamadzi.

Kuti mupeze vuto la preclinical of carbohydrate metabolism, muyeso wololera wama glucose umagwiritsidwa ntchito. Kuwonetsetsa makamaka pankhaniyi kumayenera ndi ana ochokera ku gulu lowopsa, omwe amaphatikizapo ana obadwa ndi thupi lolemera kuposa 4,500 g, ana omwe ali ndi mbiri yodwala matenda a shuga, amakhala ndi kutupa kwa pancreatic, ndi onenepa kwambiri, etc.

Chithunzi cha chipatala. Mawonetseredwe azachipatala a shuga amatengera gawo la matendawa. Gulu la shuga mellitus lidapangidwa ndi M.I. Martynova. Matenda a shuga a manplay amadziwika ndi mawonekedwe a ludzu, polyuria, usiku ndi usana kukodza kwamkodzo, kuchuluka kapena, kawirikawiri, kuchepa kwa chakudya, kuchepa thupi kwa mwana, kuchepa mphamvu, ulesi, maphunziro apamwamba, kusokonekera. Pakadali pano a shuga, hyperglycemia wolimba ndi glycosuria amapezeka. Nthawi zambiri, nthawi yoyambira ya matenda (pachaka chonse) imadziwika ndi maphunziro olembetsa komanso kusowa kwenikweni kwa insulin. Pambuyo pa miyezi 10 ya chithandizo, kubwezeretsa kwathunthu kwa njirayi kumatha kuchitika mwa ana 10 mpaka 10 osafunikira insulin kapena chofunikira chochepa kwambiri tsiku lililonse (mpaka 0,3 U / kg). Pakutha kwa chaka cha pathology, kufunika kwa insulin kukukula, koma motsatira njira yokhazikika.

Nthawi yamavuto osokonezeka amadziwika ndi kufunika kwambiri kwa insulin, nthawi zina wachibale amakana insulini, makamaka panthawi ya preubertal, komanso pamaso pa zovuta zina za matenda ashuga (matenda opatsirana, zovuta zina).

The udindo wa chipatala ndi kagayidwe kachakudya mu matenda a shuga ndi chodziwika ndi kusowa kwa matenda zizindikiro za matenda ndi matenda a kagayidwe kachakudya njira: Normoglycemia kapena glycemia zosaposa 7-8 mmol / l, kusowa kwa glycemia tsiku ndi tsiku osapitirira 5 mmol / l, kusowa kwa glucosuria kapena kuperewera kwa mkodzo - oposa 5 peresenti ya shuga ya chakudya. Kulipiritsa kwachipatala kumadziwika ndi kusapezeka kwa madandaulo komanso zizindikiro zamatenda a shuga omwe akupitiliza kusokonezeka kwa kagayidwe kazakudya ndi mafuta kagayidwe.

Pali digiri yocheperako (yopanda ketoacidosis) ndi ketoacidotic decomproll, yomwe imawopseza kukula kwa chikomokere cha matenda ashuga chifukwa chosagwirizana ndi mwana wodwala. Zomwe zimayambitsa kukula kwa matenda osokoneza bongo zimatha kukhala zosiyana: kuzindikira mochedwa matenda a shuga, kuphwanya zakudya, mankhwala a insulini, kuwonjezera kwa matenda omwe amakumana nawo komanso zinthu zovuta.

Chowoneka bwino kwambiri cha matenda ndi kagayidwe kachakudya ka odwala matenda ashuga mwa ana ndi chifuwa chachikulu (ketoacidotic), mawonetseredwe azachipatala omwe amachitika chifukwa cha kukula kwa metabolic acidosis, ketoacidosis, magawo osiyanasiyana a hyperglycemia komanso kusokonezeka kwa ma electrolyte bwino. Mwa siteji ndimakomoka, kugona, kufoka, kufooka, chilala, kuchuluka kwa chakudya, mawonekedwe a nseru, kusanza, ndi kununkhira kwa acetone kuchokera mkamwa ndi mawonekedwe. Gawo lachiwiri limadziwika ndi chikumbumtima chovuta (chosayenda bwino), kuthamanga kwa mtima (kuthamanga kwa magazi, kutulutsa kwamitsempha yamagazi, kuchepa kwa kusefedwa), polyuria, kusinthana ndi oliguria, kusanza, kupweteka kwa minofu, phokoso, kupumira kwambiri, hyporeflexia. Sta III chikomacho chimadziwika ndi kutaya mtima kwathunthu, kuphwanya kwamphamvu kwa mtima dongosolo (cyanosis, mtima syncope, anuria, kupezeka kwa edema), pathological chikhalidwe cha kupuma, areflexia. Poyerekeza ndi kuphwanya thupi, kupezeka kwa chizindikiritso cha m'mimba ndikotheka. Chizindikiro cha hematorenal chingayambike: magawo apakati a magazi ofiira, leukocytosis yokhala ndi neutrophilic, kukhalapo kwa mapuloteni, zunifolomu ndi ma cylinders mkodzo.

Ndi matenda a shuga kwa ana, vuto la hyperlactacidemic lingaoneke. Chizindikiro cha mawonedwe azachipatala a njira iyi ndi kupuma koyambirira, komwe kumayendera limodzi ndi zodandaula za chifuwa, kumbuyo kwa sternum, m'dera lumbar komanso mumtima. Lakuthwa decompensated metabolic acidosis ndi pang'ono subfebrile glycemia ndi khalidwe.

Njira yachitatu yokhala ndi matenda ashuga mu ana imatha kukhala chikomokere (Hyperosmolar coma), chodziwika ndimatenda osiyanasiyana am'mitsempha: nkhawa, kukhumudwa, kupsinjika, ndi kutentha thupi. Matenda a metabolism amadziwika ndi glycemia wokwera kwambiri, kuwonjezeka kwa seramu sodium, kuchuluka kwa chlorides, mapuloteni athunthu, nayitrogeni wotsalira, urea, kusowa kwa ketoacidosis, acidosis, ndi kufinya thupi.

Njira ya matenda a shuga kwa ana imatha kusokonezedwa ndi kukula kwa vuto la hypoglycemic coma, zomwe zimayambitsa zosiyana: kuphwanya zakudya, kuchuluka kwa insulini, kuchita masewera olimbitsa thupi mopitirira muyeso. Malo a hypoglycemic amadziwika ndi kutopa, kuda nkhawa, chizungulire, thukuta, pallor, kufooka kwa minofu, manja akunjenjemera, njala, mawonekedwe a tendon yapamwamba. Ndi kukula kwa hypoglycemic chikomokere, kusokonezeka kwathunthu kwa chikumbumtima, ma tonic-clonic spasms a choreoform ndi kayendedwe kosintha, kwakanthawi mono- ndi hemiplegia amawonedwa. Mwa ana aang'ono, kuukira kwa hypoglycemia kumatha kuwonetsedwa ndi chisangalalo chakuthwa, kukuwa, dziko laukali, kusasamala. Hypoglycemia nthawi zambiri imachitika pamene shuga m'magazi amatsika kwambiri, ngakhale kuti mikhalidwe ya hypoglycemic imayamba kukula ndi shuga wambiri, koma ndi kuchepa kwamphamvu kwambiri.

Kuzindikira . Sizovuta pamaso pa zozizwitsa zamatenda zamatenda ndi ma labotale. Matenda a shuga owonekera ayenera kusiyanitsidwa ndi matenda a shuga insipidus, thyrotoxicosis. Panthawi yokhala ndi vuto la matenda ashuga, pamafunika kusiyanitsa pakati. appendicitis, meningitis, kusanza kwa acetonemic. Hypoglycemic coma imasiyanitsidwa ndi khunyu.

Ziwonetsero . Zimadziwika ndi kukhalapo kwa zotupa zam'mimba.

Chithandizo . Mfundo zazikuluzikulu zochizira matenda a shuga kwa ana ndi njira yothandizira pakudya, kugwiritsa ntchito njira zosiyanasiyana za insulin komanso kutsatira zakudya. Mtengo wa caloric wa tsiku ndi tsiku umagawidwa motere: kadzutsa - 30%, chakudya chamasana - 40%, tiyi wamadzulo - 10%, chakudya chamadzulo - 20%. Chifukwa cha mapuloteni, 15-16% ya ma calories amaphimbidwa, chifukwa cha mafuta - 25%, chifukwa cha chakudya chamafuta - 60%. Mtengo wa shuga wa chakudya (100 peresenti ya chakudya, 50% mapuloteni) umawaganiziridwa, omwe safunikira kupitirira 380-400 g yama chakudya tsiku. Zochizira ana, mitundu yambiri ya insulin imagwiritsidwa ntchito (Gome 21). Umboni wotsimikizika wa maphunziro a vitamini, angioprotectors, choleretic ndi hepatotropic mankhwala

Chithandizo cha matenda osokoneza bongo kwa mwana

Kuopsa kwa matenda ashuga mwa mwana

Matenda a shuga amakhalanso amadziwika chifukwa choopsa.

Matenda ofatsa - kuthamanga kwa shuga m'magazi kumachulukitsa kufika pa 7.8-9 mmol / l, shuga mu mkodzo atha kusakhalapo kapena kutsimikiza wambiri - mpaka 1%. Kufikira pano, matenda ashuga a ketoacidosis ndi chikomono sizikupezeka, palibe zovuta za micro- and macro-mtima. Angiopathy (kusintha m'mitsempha ya diso) ndi kuwonongeka koyambirira kwa impso (nephropathy ya 1 mpaka 2 degree) kumatha kuchitika.

Matenda abwinobwino a shuga - shuga wamagazi mpaka 11-16 mmol / l, mkodzo - mpaka 2-4%, milandu ya ketoacidosis imadziwika kale, i.e. wodwala matenda ashuga. Pali zovuta: matenda a shuga a retinopathy (sclerosis a retina) a 1 degree, nephropathy a 3 degree (ma microscopic kuchuluka kwa mapuloteni amawoneka mu mkodzo), arthropathy, hiropathy (kuchepetsa kuchepa kwa mafupa, makamaka manja, amapezeka 15-30% ya achinyamata ndi matenda a shuga a mellitus), angiopathy a miyendo ya digiri ya 2-3 (kuchepa kwa ziwiya zazing'onoting'ono zamiyendo), polyneuropathy yokhudza malekezero (mitsempha yamitsempha - kuchepa kwa chidwi).

Matenda akulu a shuga - kuchuluka kwa shuga m'magazi kumatha kusinthika, kungakhale kwakukulu kuposa 16-17 mmol / l, kusokonezeka kwa metabolic kukufotokozedwa, pali njira yosakhazikika ya matenda a shuga - pafupipafupi ketoacidosis (kukhalapo kwa acetone mu mkodzo), chikomokere. Mavuto akupita patsogolo: matenda ashuga a retinopathy a 2nd 3, nephropathy a 4 (mapuloteni mu mkodzo) kapena digiri ya 5 ndi kulephera kwaimpso, mitsempha ya ziwalo zosiyanasiyana zopweteka kwambiri, encephalopathy (kusowa kwa dongosolo lamanjenje lamkati), matenda am'mimba 2-3rd digiri, macroangiopathy (kuchepa kwa ziwiya zazikulu zamiyendo ndi manja), matenda am'mimba amishuga, kuphatikiza ndi kuwona kochepetsedwa, kukula kwakuthupi ndi kugonana (Moriak and Nobekur syndromes).

Chithandizo cha matenda ashuga amachitidwa kwa moyo ndipo ndi othandizira ena, i.e. amalipira kuchepa kwa insulini ya mahomoni m'thupi, imakulipira chifukwa chosakhalapo kapena kuchepa kwa maselo a kapamba. Pafupipafupi, m'mabanja omwe agogo, amalume kapena amalume akudwala matenda ashuga, matendawa amawonekera ali aunyamata kapena aunyamata ndipo amayamba ngati mtundu wachiwiri wa matenda ashuga. Komabe, pali ana ndi achinyamata ochepa otere, pafupifupi 4-5% ya ana onse odwala matenda ashuga. Kuphatikiza apo, kunenepa kwambiri ndikuthandizira pakukula kwa matenda ashuga amtundu wa 2. Mabanja ena amakhala ndi kaphwando ka chakudya. Makolo amayesetsa kwambiri kupangitsa kuti mwana adye zambiri. Kafukufuku akuwonetsa kuti ophunzira opitilira 10% amasekondale ndi onenepa kapena onenepa kwambiri. Nthawi zambiri, kunenepa kumeneku kumachitika chifukwa cha cholowa chamtsogolo, kukhazikitsidwa kwa malamulo komanso kudya kwambiri. Koma kunenepa kulikonse kumachitika limodzi ndi kuchepa kwa mphamvu ya mwana komanso kuchepa kwa zochita zake, komanso ndi vuto la metabolic, lomwe limayambitsa matenda amtima komanso kugaya chakudya, komanso ana onenepa kwambiri nthawi zambiri amakhala ndi matenda a shuga.

Mkhalidwe wowopsa chifukwa chakuchepa kwambiri kwa insulin ndi chifuwa cha matenda ashuga. Imawerengedwa ngati vuto la matenda ashuga, ndipo imakwiya chifukwa cha kusalinganika pakati pa shuga ndimagazi a ketone. Ndipofunika kuchitapo kanthu kuti mupulumutse wodwalayo.

Kodi chimayambitsa matenda a shuga ndi chiyani?

Kuphwanya carbohydrate-alkaline bwino kungayambitse kuledzera thupi, komanso mphamvu yonse yamanjongo, yomwe imayambitsa kukomoka. Zotsatira zake, matupi a ketone amayamba kudziunjikira m'thupi, komanso ma acid (beta-hydroxybutyric ndi acetoacetic). Chifukwa cha izi, kuchepa thupi kwa thupi lonse kumachitika. Matupi a Ketone amakhudza malo opumira. Wodwalayo amayamba kumva kuperewera, zimavuta kupuma.

Coma imachitika chifukwa cha kuchepa mphamvu kwa kagayidwe kazakudya. Ndikapanda insulin yokwanira m'chiwindi, glycogen yaying'ono imapangidwa, zomwe zimapangitsa kuti shuga azitha kupeza magazi komanso kusakhala ndi chakudya chama cell. Mu minofu, chinthu chapakatikati chimapangidwa pamiyeso yambiri - lactic acid. Zosintha mu kagayidwe kazakudya zimayambitsa kuphwanya mitundu yonse ya kagayidwe.

Pamene glycogen imayamba kuchepa m'chiwindi, mafuta ochokera ku depot amayamba. Zotsatira zake, sizimatha kutentha konse, ndipo matupi a ketone, ma acid, acetone amayamba kudziunjikira. Thupi limataya zinthu zambiri zofunika kutsatira. Poterepa, kuchuluka kwa mchere mu zakumwa kumachepa, acidosis imachitika.

Hyperglycemia

Ndi misere yayikulu yamwazi, wodwalayo atha kugwera m'modzi mwazinthu izi:

Hyperosmolar. Amadziwika ndi kusokonezeka kwa metabolic, kuchuluka kwa shuga kumachuluka, kuchepa kwa madzi kumachitika pamaselo a ma cell. Koma, mosiyana ndi mitundu ina ya chikomokere, wodwala matenda ashuga wokhala ndi chifuwa chachikulu sichimanunkhira acetone kuchokera mkamwa mwake. Vutoli limayamba makamaka mwa anthu omwe ali ndi zaka zopitilira 50, koma nthawi zina amapezeka mwa ana osaposa zaka ziwiri ngati mayi akudwala matenda a shuga a 2.
Lactacidemic. Zimawoneka chifukwa cha anaerobic glycolysis, pamene glucose sagwiritsidwa ntchito, kotero thupi limafuna kupeza mphamvu chifukwa cha moyo wawo. Chifukwa chake machitidwewa amayamba kuchitika, zomwe zimayambitsa kupangidwa kwa zinthu zowola za acidic zomwe zimakhudza kugwira ntchito kwa mtima ndi mitsempha yamagazi. Zizindikiro za matendawa ndi kusanza koopsa, kupweteka kwa minofu, kapena kusamva chidwi.
Hyperglycemic (ketoacidotic). Kukomoka kotere kumakwiyitsidwa ndikusapezeka kapena kusalandira chithandizo choyenera. Chowonadi ndi chakuti, ngati mulibe mankhwala a insulin kapena osakhalapo, ma cell a thupi samamwa glucose, motero minofu imayamba "kufa ndi njala". Izi zimayambitsa kuponderezana komwe kumaphwanya mafuta. Chifukwa cha metabolism, mafuta acids ndi matupi a ketone amawonekera, kudyetsa kwakanthaŵi maselo aubongo. Mtsogolo, kudzikundikira kwamatupi otere kumachitika, ndipo chifukwa chake, ketoacidosis.

Hypoglycemia

Mkhalidwe womwe umachitika ndi kuchepa kwakukuru m'magazi a shuga. Zimakwiya chifukwa cha kusowa kwa chakudya kapena kuchuluka kwa insulin, ndipo nthawi zambiri - othandizira a hypoglycemic. Coma imayamba pakanthawi kochepa. Chidutswa cha shuga kapena piritsi la glucose chingathandize kupewa zoyipa.

Matenda a shuga

Nthawi zambiri wodwala sagwedezeka nthawi yomweyo, izi zimayambitsidwa ndi precoma. Umu ndi momwe wodwalayo amakumana ndi zotulukapo zingapo zosasangalatsa chifukwa chakusokonekera kwamkati wamanjenje. Wodwalayo ali:

ulesi
kupanda chidwi
mawonekedwe a khungu pamaso,
kuchepa kwa ana
chisokonezo.

Ndikofunika kwambiri kuti nthawi ino munthu akhale ndi wodwala ndikuyitanitsa ambulansi mwachangu kuti chindunji chisasanduke chikomoka.

Zizindikiro za comatose za matenda ashuga

Matenda a matenda ashuga samachitika nthawi yomweyo. Pambuyo pokomera, ngati palibe njira zomwe zingachitike, wodwalayo akuipiraipira, zizindikiro zotsatirazi zikufotokozedwa:

malingaliro ofooka
kugona
ludzu
mutu
kusanza ndi kusanza
kuthamanga kwa magazi
kugunda kwa mtima
kutsitsa kutentha kwa thupi.

Munthu amatha kulephera kuzindikira, minofu ndi khungu zimakhazikika. Kupsinjika kwa magazi kumapitilirabe kutsika.

Chizindikiro chochititsa chidwi kwambiri chomwe mungadziwe kuyambika kwa kupuma ndicho kukhalapo kwa kununkhira kwa acetone kuchokera mkamwa. Kukomoka kumatha kukhala kwakanthawi kapena kumatha maola angapo, ngakhale masiku. Ngati simukutenga njira zofunikira zothandizira, wodwalayo amadzazindikira ndikufa.

Chizindikiro china chachikulu ndikusayanjana kwathunthu ndi zochitika zonse. Kuzindikira kumacheperachepera, koma nthawi zina kuwunikira kumachitika. Koma pamlingo wokulirapo, kuzindikira kumatha kutsekeka kwathunthu.

Kodi zizindikiro za matenda a shuga ndi ziti?

Dokotala amatha kudziwa kuyambika kwa matenda ashuga ndi izi:

khungu lowuma ndi kuyabwa,
mpweya wowawasa
kuthamanga kwa magazi
waludzu kwambiri
kufooka wamba.

Ngati simukuchitapo kanthu, ndiye kuti wodwalayo ali ndi zovuta:

kusanza kumachitika pafupipafupi, komwe sikubweretsa mpumulo.
ululu wam'mimba kwambiri
kutsegula m'mimba kumachitika
kupsinjika kumatsika
mtima tachycardia.

Ndi chifuwa cha hyperglycemic, zizindikiro zotsatirazi zimawonekera:

kumverera kofooka
kulakalaka kudya nthawi zonse,
thukuta
kunjenjemera thupi lonse
nkhawa ndi mantha.

Kodi wodikirira akudikirira bwanji?

Zotsatira za kukhala ndi vuto la matenda ashuga zitha kuzindikirika ndi mawu amodzi: thupi lonse limasokonezeka. Izi zimachitika chifukwa cha njala yosalekeza yama cell, yomwe imakhudzidwa ndi kuchuluka kwa glucose m'magazi.

Coma imatha kukhala yayitali kwambiri - kuchokera maola angapo mpaka milungu ingapo ngakhale miyezi. Zotsatira zake ndi:

mgwirizano wolakwika pamaulendo,
mawu osamveka
zosokoneza mu ntchito ya mtima, impso,
ziwalo zamiyendo.

Ndikofunikira kwambiri kupereka chithandizo chamankhwala mwadzidzidzi. Ngati ambulansi ifika nthawi yolakwika, edema ya ubongo imachitika.

Matenda a shuga odwala

Nthawi zambiri, ana aang'ono sapezeka nthawi zonse mozindikira. Mkhalidwe wokongola nthawi zambiri umalakwitsa chifukwa cha kupezeka kwa matenda, meningitis, matenda am'mimba, kusanza kwa acetonemic. Poyerekeza izi, mwana amakhala wopanda nkhawa chifukwa mwana amalandila chithandizo mosiyanasiyana.

Mu ana, mitundu yosiyanasiyana ya chikomokere imasiyanitsidwa. Vuto lalikulu kwambiri la ketoacidotic. Makolo ayenera kuyang'anitsitsa ana awo, chifukwa mtundu uwu waukoma suvuta kuzindikira. Zizindikiro za matendawa ndi:

kufuna kumwa madzi nthawi zonse,
kukodza pafupipafupi
kuchepa kwamtima
kuwonda
khungu lowuma.

Hyperlactatemic coma imatha kupezeka mwa mwana motsutsana ndi maziko akuti kuwonongeka kwa glucose kumachitika ndi mpweya wokwanira, zomwe zimapangitsa kudzikundikira kwa lactic acid. Kusintha kwamitundu yonseyi kumabweretsa zotsatirazi:

Mwana amakwiya, nthawi zina amakhala wankhanza,
kupuma movutikira kumachitika
kusasangalala mumtima.
zotupa m'miyendo ndi miyendo.

Ndikovuta kwambiri kudziwa izi mu ana ang'ono, makamaka ana akhanda, chifukwa kulibe matupi a ketone.

Thandizo lodzidzimutsa la odwala matenda ashuga

Mitundu yosiyanasiyana ya chikomokere imatha kupewedwa, ndipo ndi chikomokere kuti muchepetse mkhalidwe wa wodwala. Kuti muchite izi, muyenera kudziwa za chisamaliro chadzidzidzi:

At ketoacidotic chikomokere yambani kuperekera insulin. Nthawi zambiri, milingo yaying'ono imayendetsedwa intramuscularly poyamba, kenako imasamutsidwa kukhala waukulu. Wodwalayo amagonekedwa m'chipinda chothandizira kwambiri.
At hypersmolar chikomokere Pali kulimbana nthawi imodzi ndi kusowa kwamadzi ndi shuga wambiri. Chifukwa chake, sodium kolorayidi imayendetsedwa moperewera ndipo insulin imayendetsedwa kudzera m'mitsempha kapena intramuscularly. Kupitiliza kosalekeza kwa shuga ndi magazi osmolarity kukupitilizabe. Wodwala amayikidwa m'chipinda chothandizira odwala kwambiri.
At Hyperlactacidemic chikomokere sodium bicarbonate, yemwenso amasakanikirana ndi insulin ndi shuga, amayambitsidwa kuti athandizire. Ngati kugwa kumawonedwa, ndiye kuti polyglucin ndi hydrocortisone ndi mankhwala. Amagonekedwa m'chipatala.

Chithandizo cha odwala matenda ashuga a Coma

Ndikudwala matenda ashuga, ndikofunikira kwambiri kuyambitsa chithandizo chanthawi yake. Pankhaniyi, madokotala amatha kutsatira njira zotsatirazi:

Insulin imayendetsedwa mu Mlingo wochepa, kudzera m'mitsempha. Kuyesedwa kwa magazi kumatengedwa kuchokera kwa wodwala maola onse awiri ndi atatu kuti atsimikizire shuga ndi mkodzo kukhalapo kwa shuga ndi acetone mmenemo. Ngati zotsatira zake sizinawoneke, pitilizani kumapangidwanso mpaka wodwalayo akazindikira bwino komanso kuti zizindikiro zonse zakufa ziwonongeka.
Pofuna kupewa kuchuluka kwa insulini, matupi a ketone amatenthedwa, shuga amaphatikizidwa ndi ola limodzi pambuyo pa insulin. Jakisoni amene ali ndi shuga nthawi zina amayenera kuchitidwa kangapo patsiku.
Kotero kuti kugwa kwamitsempha sikumachitika komanso kuthana ndi acidosis, saline yokhala ndi bicarbonate ya soda imathandizira kutsika. Pambuyo pa maola awiri, jekeseni wothandizidwa ndi sodium chloride wayamba.
Kuti njira za oxidative zizichitika mwachangu, wodwalayo amaloledwa kutulutsa mpweya kuchokera kuphilo. Pama malekezero ikani ma penti otentha.
Kuti athandizire mtima, jakisoni wokhala ndi khofi ndi camphor amaphatikizidwa. Wodwala amamuika mavitamini: B1, B2, ascorbic acid.
Wodwala atatuluka chikomokere, amapatsidwa tiyi wokoma, compote, Borjomi. Pang'onopang'ono, mlingo wa insulin umayamba kuchepa, kutumikiridwa maola 4 aliwonse. Zakudya za wodwala zimasinthidwa ndi zinthu zatsopano, nthawi zomwe zimamwa mankhwala zimachulukitsidwa.
Zinthu za Lyotropic zimayikidwa, zomwe zimapezeka mu oat ndi phala la mpunga, tchizi chokhala ndi mafuta ochepa. Ndikofunikira kuchepetsa kugwiritsa ntchito zakudya zamafuta. Kenako pitani ku koyamba mlingo wa insulin.

Kanema: Matenda a shuga ndi chithandizo choyamba

Katswiriyu anene za mitundu, zizindikiro, zomwe zimayambitsa, zotsatira za matenda a matenda ashuga:

Zizindikiro ndi thandizo loyamba la hyperglycemia ndi hypoglycemia zimapezeka mu kanema:

Muyenera kusamala pokhudzana ndi wodwala yemwe ali ndi matenda ashuga. Tengani mitundu yonse ya chithandizo chamankhwala chokhazikitsidwa ndi dokotala, tsatirani malangizo onse ndi malingaliro, musanyalanyaze. Onetsetsani kuti mwatsata chakudya. Pewani kukomoka.

Matenda a shuga ndi matenda oopsa a endocrine system, omwe amaphatikizidwa ndi kuperewera kwathunthu kapena pang'ono pang'onopang'ono m'thupi la munthu la hormone insulin (kuchokera ku Latin insula - chilumba) chopangidwa ndi kapamba. Zotsatira za kuphwanya koteroko ndikuwonjezereka kwamphamvu m'magazi a shuga (hyperglycemia), zomwe zimabweretsa zovuta zambiri zowopsa m'moyo. Matenda a shuga ndi limodzi mwa zovuta za matenda ashuga, limodzi ndi vuto lalikulu la munthu, nthawi zambiri zimamupha.

Pathogenesis yamatenda ndi yovuta kwambiri. Chifukwa chachikulu chomwe chitukuko cha kuperewera kwa shuga kumakhudzira ndi shuga m'magazi a anthu. Izi zitha kuchitika chifukwa chosowa insulini, mankhwala osayenera, kukana kudya komanso zinthu zina zolimbikitsa. Popanda insulini, kusintha kwa shuga m'magazi ndikosatheka. Zotsatira zake, kuwonjezeka kwa kaphatikizidwe ka glucose komanso kuwonjezeka kwa kupanga kwa ketone kumayambira m'chiwindi. Ngati kuchuluka kwa shuga kupitirira kuchuluka kwa ma ketoni, wodwalayo amataya chikumbumtima, kukomoka kwa glycemic kumachitika.

Mitundu yamatenda

Coma matenda a shuga ali ndi magulu awa:

ketoacidotic - imayamba chifukwa chakuchuluka kwa ma ketoni m'thupi komanso kugwiritsa ntchito kwawo mosakwanira. Mankhwala, matendawa ali ndi dzina - ketoacidosis,
Hyperlactacidemic - mkhalidwe womwe umayambitsidwa ndi kuchuluka kwa thupi la lactate (chinthu chosakanikirana chifukwa cha zochita za metabolic),
Hyperosmolar - mtundu wapadera wa matenda a shuga omwe amachitika chifukwa cha kusokonezeka kwa metabolic m'thupi motsutsana ndi matenda a shuga,
hyperglycemic - amapezeka ndi kuchuluka kwambiri kwa shuga m'magazi,
hypoglycemic - mkhalidwe wowopsa womwe umayamba kutsika lakutsika kwa shuga m'magazi a wodwala.

Zofunika! Ndikosatheka kudziyimira pawokha mtundu wa matenda a shuga. Mavuto akayamba, wodwala amayenera kupita kuchipatala mwachangu.

Zizindikiro zamitundu yosiyanasiyana ya matenda a shuga zimafanana ndipo ndikotheka kudziwa mtundu wina wa chikomicho mothandizidwa ndi njira zofufuzira zasayansi.

Mutha kudziwa zambiri za zodwala matenda ashuga.

Mawonetsedwe wamba a dziko lokongola amaphatikizapo kufooka, mutu, ludzu, njala, ndi mawonekedwe ena

Zizindikiro zofala za matenda a shuga

Zizindikiro zodziwika bwino za matenda ashuga ndi:

kumverera kwa ludzu
kukodza pafupipafupi
kutopa, kufooka, thanzi,
wolimba kapena paroxysmal mutu
kugona, kapena, kusangalala kwakukulu,
kusowa kwa chakudya
kukhumudwa kwamaso, glaucoma nthawi zina kumachitika,
nseru, chizungulire, kusanza.

Popanda chithandizo choyenera, wodwalayo amakhala ndi matenda, omwe amadziwika kuti ndi machitidwe owona.

Zowona zowona

Kukomeka kwenikweni mu shuga ndi momwe wodwalayo alili, limodzi ndi zizindikiro zotsatirazi:

osayang'anira anthu ozungulira ndi zochitika,
kusokonezeka kwa chikumbumtima ndi nthawi yakuunikira,
muzovuta, palibe chochita ndi chidwi chakunja.

Pakufufuza kwakunja, dokotala amapeza zizindikilo zingapo:

khungu lowuma,
ndi hyperglycemic kapena ketoacidotic chikomokere, fungo la ma acetone kuchokera kumkamwa la wodwalayo limamveka,
dontho lakuthwa magazi.
malungo
kufewa kwa nsidze.

Matendawa amafunika kuthandizidwa mwachangu, ndipo nthawi zambiri amakwiya.

Zizindikiro za hyperglycemic chikomokere

Odwala omwe ali ndi vuto la mtundu uwu, zizindikiro zotsatirazi zimachitika:

kuchuluka kwakukulu kwa njala,
kunjenjemera m'thupi
malaise, kufooka, kutopa,
kutuluka thukuta kwambiri
kuchuluka kwa nkhawa, kukulira kwa mantha.

Ngati mkati mwa mphindi zochepa munthu wokhala ndi vutoli asamadyeko zotsekemera, pamakhala chiwopsezo cha kutaya chikumbumtima, mawonekedwe a kugwidwa. Khungu la wodwalayo limanyowa, maso amakhala ofewa.

Hyperglycemic coma ndi mtundu wofala kwambiri wamagulu a shuga, omwe amaphatikizidwa ndizowonetsa ambiri

Mawonekedwe a hypersmolar coma

Matenda a shuga a mtundu uwu amakula pang'onopang'ono, kuyambira maola angapo mpaka masiku angapo. Pankhaniyi, mawonetsero otsatirawa amachitika:

kukula kwa madzi am'madzi,
general malaise
zodabwisa
kusuntha kwadzidzidzi kwa mawonekedwe amaso, osakhalitsa,
mawonekedwe a kugwidwa,
zovuta kuyankhula
utachepa mkodzo.

Zofunika! Hypersmolar chikomayi ndizosowa, zomwe zimapezeka makamaka kwa odwala okalamba.

Zizindikiro za hypoglycemic coma

Chipatala cha hypoglycemic coma chimakhala ndi mafuta ambiri. Amakula pang'onopang'ono, limodzi ndi kuwonongeka pang'onopang'ono m'moyo wabwino.

Mutu womwe sugwiritsidwa pakamwa,
manja ndi mapazi ozizira
kutuluka thukuta kwambiri
kufooka
maonekedwe a njala,
kukomoka
kumva kutentha
kukomoka kwa dermis,
kupuma pang'ono poyenda, kupumira kwakanthawi.

Wodwalayo amakhala wosakwiya, amalephera kugwira ntchito, ndipo amatopa msanga. Ndi njira yovuta, munthu amayamba kuwona, kuwonerera mseru, kugwedezeka m'manja ndi miyendo, pambuyo pake minofu ina yonse ya thupi. Zizindikirozi nthawi zambiri zimadziwika kuti precoma (precomatose state).

Zofunika! Zizindikiro zapamwambazi zikawoneka, kupita kuchipatala kuyenera kukhala mwachangu. Mphindi iliyonse yochedwa imatha kutaya munthu moyo.

Zomwe zimachitika ndi matenda a shuga

Muubwana, zovuta zamtunduwu zimayamba motsogozedwa ndi zinthu zambiri zopsetsa mtima. Zifukwa zake zimaphatikizapo kumwa kwambiri maswiti, kuvulala pathupi, kuchepa kwa kagayidwe kachakudya, njira yokhala pansi, mankhwala osayenera a mankhwala okhala ndi insulin, mankhwala osayenera, kuzindikira mochedwa matendawa.

Zizindikiro za kuukira kwa ana zimakhala zovuta kupita osazindikira, nkhawa, kulakalaka kudya ndi zochitika zina

Zowonera zakuwukira zikuphatikizapo mawonetsero otsatirawa:

mwana amadandaula kuti wadwala mutu
nkhawa zimayamba, ntchito imayamba kusowa chidwi,
mwana alibe chidwi,
nseru nthawi zambiri limodzi ndi kusanza
Pali zopweteka m'mimba
zopindika zimapeza mthunzi wotumbuluka, kutanuka kwake kumataika.

Muzovuta kwambiri, kukomoka kumachitika, pamakhala kuphatikizika kwa magazi mu ndowe, zotchinga m'maso, kuthamanga kwa magazi ndi kutentha kwa thupi.

Zina mwazovuta za ana ndi kusowa kwamadzi, kukula kwa ziwopsezo zamkati zamkati, m'mapapo mwanga komanso m'magazi a edema, kupezeka kwa kulephera kwa impso, kufupika, komanso kufa.

Zizindikiro

Kupeza matenda okhudzana ndi matenda ashuga mu shuga kumachitika pogwiritsa ntchito kafukufuku wa labotale wamagazi a wodwalayo. Pofuna kudziwa kuti wodwala ndi ndani, wodwala amayesedwa mitundu yotsatirayi ya mayeso:

kuyezetsa magazi konse
kuyesa kwamwazi wamagazi,
kusanthula kwamakemizidwe amkati.

Zambiri zoyesa zimasiyana kutengera mtundu wa chikomokere. Ndi ketoacidotic chikomokere, kuwonjezeka kwa mkodzo wa matupi a ketone kumadziwika. Hyperglycemic coma imayendera limodzi ndi kuchuluka kwa shuga m'magazi kuposa 33 mmol / lita. Ndi hyperosmolar coma, kuwonjezereka kwa osmolarity wa plasma yamagazi kumapezeka. Hypoglycemic coma imadziwika ndi shuga wamagazi ochepa, ochepera 1.5 mmol / lita.

Thandizo loyamba

Ndi kukula kwa matenda a shuga a ana ndi akulu, ndikofunikira kupatsa wodwala thandizo loyenerera. Ngati munthu sakudziwa, muyenera kuchita izi:

Itanani a ambulansi.
Popanda kukoka ndi kupuma, ndikofunikira kuyambitsa kutulutsa mtima kosalunjika ndikupuma movutikira. Munthawi imeneyi, ndikofunikira kuyang'anira ukhondo wa kupuma.
Ngati zimachitika kumveka, kupuma kumayendetsedwa, muyenera kupereka mpweya wabwino, kumasula munthu ku zovala zolimba, kumasula kolala.
Wodwala amayikidwa mbali yake yakumanzere, ngati kusanza, ndikofunikira kuonetsetsa kuti sakunyinyirika.

Moyo ndi thanzi la wodwalayo zimadalira kudziwa kuthandizira kwadzidzidzi mwadzidzidzi kuti pakhale kuukira

Munthawi ya chisamaliro chadzidzidzi, wodwala matenda ashuga ayenera kuyamwa. Ngati zikudziwika kuti vuto lalikulu limachitika chifukwa cha kuchepa kwa shuga m'magazi, wodwalayo ayenera kupatsidwa chakudya kapena madzi okhala ndi shuga.

Dziwani zambiri zothandizira munthu wodwala matenda ashuga.

Zotsatira zake

Khansa yodwala matenda ashuga ndi vuto lalikulu lomwe limatenga maola angapo mpaka milungu ingapo ngakhale miyezi. Mwa zina mwazotsatira, pali kuphwanya mgwirizano wa kayendedwe, matenda a mtima, matenda a impso, chiwindi, zovuta kunena, ziwalo zam'mphepete, kulephera kuwona, kutupa kwa ubongo, mapapu, kulephera kupuma, imfa.

Njira zochizira

Pofuna kupewa zovuta, ndikofunika kuyamba kulandira chithandizo chanthawi yake. Pankhaniyi, wodwalayo amapakidwa jakisoni wa insulin pambuyo nthawi yayitali. Nthawi yomweyo, kuthana ndi magazi kumachitika pofuna kudziwa kukhalapo kwa shuga ndi acetone mmenemo. Popanda kuchitapo kanthu, shuga amaperekedwanso mpaka magawo amomwe amtundu wa biochemical atasinthidwa.

Kuti muchepetse matupi a ketone, shuga amaperekedwa ola limodzi pambuyo pobayira insulin. Pafupifupi zisanu zitha kuchitidwa patsiku la ntchito zotere.

Kukhazikitsidwa kwa saline ndi bicarbonate ya koloko kumathandizira kuti mtima usagwere. Pambuyo maola ochepa, sodium chloride imayendetsedwa kudzera m'mitsempha.

Chithandizo cha matenda a shuga mellitus umalimbana ndikuchotsa wodwalayo chikomokere, kusintha magawo a magazi ake

Mankhwala, wodwalayo amamufikisa mpweya kuchokera kuphilo, womwe umawotchera poizoni. Izi zimawonjezera njira zama metabolic.
Kuti akhalebe ndi mtima wamtima, wodwalayo amapatsidwa jakisoni ndi khofi, mavitamini B 1 ndi B 2, ascorbic acid.

Wodwala atatuluka chikomokere, kukonza kwake kumakhala motere:

kuchepa kwapang'onopang'ono mu mlingo wa insulin,
kuchuluka kwakanthawi pakati pamankhwala,
cholinga cha tiyi wokoma, compote,
kupatula mafuta, zokometsera, mchere, wowawasa, wokazinga,
maziko azakudya ndi mbewu monga chimanga, masamba, zipatso, mkaka.

Zofunika! Kusagwirizana ndi malamulo okonzanso komanso kukana chithandizo kungachititse kuti pakhale kachiwiri.

Kuzindikira kwa wodwala

Matenda a shuga ndi imodzi mwazovuta komanso zovuta za matenda ashuga. Vutoli limafunikira chithandizo chamankhwala mwadzidzidzi, chithandizo choyenera, kutsatira njira zopewera zomwe zimalepheretsa zovuta. Matenda a wodwalayo ndi abwino pokhapokha atavomerezedwa kuchipatala. Nthawi yomweyo, ndikotheka kusintha momwe wodwalayo alili, kupewa mavuto obwera chifukwa cha chikomokere.

Padziko lapansi, pali anthu opitilira 422 miliyoni omwe amapezeka ndi matenda ashuga. Anthu awa amafunikira kugwiritsa ntchito mankhwala a hypoglycemic nthawi zonse, koma chifukwa cha kuchuluka kwa mankhwalawa, kukulitsa moyo wabwino ndizotheka. Zotsatira zowopsa za matenda a shuga ndi kuperewera kwa shuga, vuto lomwe limafunikira kuchipatala msanga.

Kodi kudwala matenda ashuga ndi chiyani

Shuga chikomokere ndi kusokonezeka kwakukulu kwa chikumbumtima komwe kumachitika mwa odwala matenda ashuga. Kusowa kwa insulini kapena kukana insulini kumapangitsa kuchepa kwa glucose mu minofu ndikudziunjikira kwa shuga m'magazi. Yankho la ichi ndi kapangidwe ka shuga ndi chiwindi kuchokera ku acetyl coenzyme A. Zopangidwa ndi kaphatikizidwe panjira iyi ya metabolic ndi matupi a ketone. Zotsatira za kuchuluka kwa matupi a ketone m'magazi, kusintha kwa acid-base ndi electrolyte bwino kumachitika, zomwe zimapangitsa kuti mukhale ndi chikumbumtima chovuta kwambiri.

Zosiyanasiyana

Ndi matenda ashuga, mitundu yotsala ya chikomichi imapezeka:

Mitundu ya Ketoacidotic: mtundu wa matenda a shuga a I.
Hyperosmolar coma: pakuwonjezereka kwa shuga mu mtundu II wa shuga.
Lactacidemic chikomokere - odwala matenda ashuga okhala ndi mtima dongosolo, chiwindi, impso, kuchepa magazi, poyizoni mowa, salicylates, mantha.
Hypoglycemic coma: ngati mlingo wa insulin sugwirizana ndi shuga.

Mu matenda a shuga, chikomokere chimayamba ndi kuchuluka kwa shuga m'magazi: pamtunda wa 33 mmol / L wa mitundu yosiyanasiyana ya asidi, 55 mmol / L wa hyperosmolar, pansipa 1.65 wa hypoglycemic.

Malangizo osayenera a mankhwalawa
zolakwa kumwa mankhwala,
kuchepa thupi
mavuto azakudya
zovuta zovuta za matenda ashuga omwe amayamba chifukwa cha matenda ena (opatsirana, endocrine, malingaliro, kusokonezeka kwa mitsempha, etc.),
kupsinjika
mimba.

Pakukula kwake, chikomokere ndi matenda a shuga chimadutsa pamizere inayi, chomwe chimadziwika kuti chikomokere:

Apa digiri yoyamba ya chikomokere imadziwika ndi kusazindikira. Thupi limachepa, koma momwe ululu umasungidwira.
Chiwonetsero chachiwiri: Kuzindikira kwamphamvu kumayenda, mitundu yonse yamatenda imatayika. Kukoka mwaulesi, kuyenda kwa matumbo kumawonedwa. Kupuma kwachilendo kumachitika.
Digiri yachitatu: kupsinjika kwa kupuma kumakhala kwakukulu. Kutulutsa mawu kumakhala kulibe. Zosokoneza kuchokera ku magulu osiyanasiyana a thupi zimalumikizana.
Digiri yachinayi: kusinthira kukhala kwa pre-state.

Zizindikiro zokhala ndi matenda ashuga omwe ali ndi hyperglycemia:

kusowa kwamadzi,
Fungo la acetone lochokera kwa wodwala (yemwe alibe ndi hyperosmolar coma),
Kuchepetsa ophthalmotonus,
Kupumula kwa mapangidwe a Kussmaul (kusowa ndi hyperosmolar coma).

Zizindikiro za hypoglycemic coma:

chinyezi cha khungu
kuchuluka kwa kukakamizidwa kwa intraocular - zovuta zowoneka ndi maso (chizindikiro cha "diso lamiyala"),
kukulitsa kwa ophunzira
zabwinobwino kapena malungo
kuthamanga kwa zizindikiro.

Ndi acidotic mitundu ya chikomokere, thupi limayesa kulipirira hyperacidosis popanga kupuma kwa alkalosis pogwiritsa ntchito hyperventilation: kupuma kumafulumira, kumakhala kwapamwamba. Kupitilira patsogolo kwa acidosis kumabweretsa mawonekedwe a kupuma kwa Kussmaul, komwe amadziwika ndi:

kupuma kwakukulu
kuvuta kupumira
kukulitsa kupuma pakati pa kupuma.

Matenda a shuga

Coma mu matenda a shuga amayamba pang'onopang'ono: kuchokera maora ochepa mpaka masiku angapo amatha kutha kukumbukira. Chosiyana ndi mawonekedwe a hypoglycemic. Coma imayambitsidwa ndi vuto lomwe likukula - vuto la matenda ashuga. Zizindikiro zake ndi:

Zizindikiro za kuledzera kwamkati: kupweteka mutu, kutopa, mseru, kusanza, kufooka,
Khungu
kamwa yowuma ndi ludzu
kuchuluka kukodza.

Mu gawo lachiwiri la precoma, odwala amagwera mu stupor, kusintha kwa kupuma kumachitika, pseudoperitonitis syndrome (kupweteka kwam'mimba, kupsinjika kwa minofu, zizindikiro za kukwiya kwa peritoneal), Zizindikiro zakusokonekera kwamadzi: khungu louma komanso mucous nembanemba, kuchepa kwa magazi kumatha kuchitika. Hypoglycemia imadziwika ndi minofu hypertonicity, tendon yambiri, komanso thukuta lotuluka.