Zizindikiro ndi chithandizo cha chikomokere cha hypoglycemic: chisamaliro chadzidzidzi cha mankhwalawa
Njira zothetsera hypoglycemia mwa odwala matenda a shuga omwe amalandila shuga wochepetsa shuga ziyenera kuyambitsidwa pa plasma glucose Kuthetsa kuperewera kwa insulin, • kulimbana ndi kusowa kwamadzi ndi hypovolemia, • Kubwezeretsa ndalama zamagetsi ndi KShchS, • Kuzindikiritsa komanso kuchiza matenda ophatikizika ndi mikhalidwe (yadzetsa DKA kapena kupangika). Pa prehospital kapena pabalaza: 1. Kuwunikira kofotokozera za glycemia ndikuwunika gawo lililonse la mkodzo pamatumbo a ketone, 2. Yochepa-insulin (ICD) magawo 20 / m, 3. 0,9% yankho la intravenous sodium chloride drip pamlingo wa 1 l / h. M'chipinda chopangira chisamaliro chachikulu kapena kumalo osamalira odwala: (Chithandizo chofatsa cha DKA chikuchitika mu dipatimenti ya endocrinology / achire). Therapy ya Insulin - Malonda Ochepera(bwino glycemic control ndikuchepetsa chiopsezo cha hypoglycemia ndi hypokalemia kuposa mode wamkulu): Mtsempha wa intravenous (iv) wa insulin: 1. Mlingo woyambirira wa ICD: mayunitsi 0,15 / kg IV. Mlingo wofunikira umasonkhanitsidwa mu syringe ya insulin, 0,9% NaCl imawonjezeredwa 1 ml ndikuyendetsedwera pang'onopang'ono (mphindi 2-3). 2. Maola otsatirawa: ICD pa mayunitsi 0,5 / kg pa ola limodzi mwanjira imodzi: - Njira 1(kudzera infusomat): kulowetsedwa kosalekeza kwa mayunitsi 0,1 / kg / ola. Kukonzekera kwa kulowetsedwa: 50 mayunitsi a ICD + 2 ml ya 20% albumin kapena 1 ml ya magazi a wodwalayo (kuti ateteze insulin mu dongosolo, yomwe ndi 10-50% ya mlingo), voliyumu imasinthidwa kukhala 50 ml ya 0,9% NaCl. - Njira yachiwiri(pakalibe infusomat): yankho lomwe lingakhale ndi ICD ndende ya 1 unit / ml kapena 1 unit / 10 ml ya 0,9% NaCl mu / Drip (+ 4 ml ya 20% albumin / 100 ml yankho la njira yoletsera insulin sorption).Zoyipa: kukonza kwa yaying'ono ya ICD ndi kuchuluka kwa madontho kapena ml ya osakaniza kumafuna kukhalapo kwa ogwira ntchito ndi kuwerengera mosamala, ndikovuta kutumiza waukulu. - Njira yachitatu(yabwino kwambiri pakalibe infusomat): IV kulowetsedwa bolus (pang'onopang'ono) 1 nthawi / ola ndi syringe mu chingamu cha kulowetsedwa. Kutalika kwaacacodynamic zotsatira za ICD pamenepa kuli mpaka mphindi 60.Ubwino: palibe sorption ya insulin (simukufunikira kuwonjezera albumin kapena magazi ku yankho), kuwerengera molondola ndi kukonza kwa mankhwalawa, osagwira ntchito pang'ono kuposa momwe mungasankhire 2. 3. Intramuscular (i / m) insulin Therapy (yochitidwa ngati sikutheka kulowa iv, komanso mawonekedwe ofatsa a DKA, pakalibe kusokonezeka kwa hemodynamic) Mulingo wokweza wa ICD ndi mayunitsi 0,4 / kg (theka - mu / mu, theka mkati / m), ndiye mu / m pa mayunitsi 5 / ola. Zoyipa: vuto la kusokonekera kwa cellcirculation (kugwa, chikomokere), ICD imalowerera kwambiri, kutalika kochepa kwa singano ya insulin kumapangitsa kuti pasakhale kovuta kuti mupeze jakisoni, majekeseni 24 patsiku samakhala bwino kwa wodwalayo. Ngati glycemia sichepa 2 maola atangoyamba kumene chithandizo cha IM, amasinthira ku makonzedwe a IV. Kuchepa kwa kuchepa kwa glycemia sikupitilira 4 mmol / l / ola (chiwopsezo cha osmotic gradient pakati pa intracellular ndi extracellular space ndi ubongo edema); patsiku loyamba, kuchuluka kwa shuga m'magazi sayenera kukhala osachepera 13-15 mmol / l. Kusintha kwa insulin Palibe kuchepa kwa maola awiri oyamba Wonjezerani mlingo wotsatira wa ICD (mpaka magulu a 0,2 / kg), onetsetsani kuchuluka kwa hydration Kutsika kwa pafupifupi 4 mmol / L pa ola limodzi kapena kuchepa kwama glucose mpaka 15 mmol / L Kuthandiza mulingo wotsatira wa ICD (mayunitsi 0,55 / kg) Kuchepetsa> 4 mmol / L pa ola limodzi Pitani muyezo wotsatira wa ICD, pitilizani kudziwa glycemia ola limodzi Sinthani chithandizo cha insulin cha SC: ndikusintha kwamachitidwe, hemodynamics yokhazikika, kuchuluka kwa shuga m'magazi -12 11-12 mmol / L ndi pH> 7.3, amasintha kupita ku SC management ya ICD maola 4 ndi 6 aliwonse osakanikirana ndi IPD. 0,9% NaCl (pamlingo wokonzedwa wa Na + plasma Mulingo wa kukhazikitsidwa kwa KCl (g mu h) pH yophatikizidwa, yozungulira Osayendetsa potaziyamu Ngati mulingo wa K + sukudziwika, kulowetsedwa kwa potaziyamu kumayambika osapitilira maola 2 pambuyo pa kuyamba kwa insulin, kuyang'aniridwa ndi ECG ndi diuresis. Malangizo a metabolic acidosis: The etiological chithandizo cha metabolic acidosis ku DKA ndi insulin. Zisonyezero zoyambitsa sodium bicarbonate:magazi pH Popanda kutsimikiza kwa pH / KHS, kukhazikitsidwa kwa bicarbonate kumatsutsana! Kuchokera pamawuwo zimamveka kuti chomwe chimayambitsa matenda a hypoglycemic coma ndi hypoglycemia womwe umakhalapo. Ganizirani zomwe zimayambitsa hypoglycemia. Nthawi zambiri, matendawa amatha kukhala mwa anthu odwala matenda ashuga. Matendawa amaphatikizidwa ndikusakwanira kwa insulin ya mahomoni ndi beta masamba a kapamba. Nthawi zina, insulin katulutsidwe imatha kukhala yokhazikika, koma pazifukwa zosadziwika, maselo okhala ndi insulin yodziwika bwino amasiya kuyamwa insulin, yomwe imapangidwa ndi kapamba. Izi zimabweretsa mkhalidwe wopitilira hyperglycemia wokhala ndi chithunzi chotchuka: kuchuluka kwa chilala, ludzu, lomwe limakupangitsani kumwa mpaka malita asanu ndi limodzi amadzimadzi, kufooka ndi malaise mutatha kudya, kuchepa thupi komanso zizindikiro zina. Izi zimakakamiza anthu kuti atenge insulin yakunja, chifukwa mwanjira ina hyperglycemic chikomokere kapena zotsatirapo zina zovuta zimatha kuchitika. Kuphatikiza pa shuga yemwe amadalira insulin, palinso mitundu ina yomwe insulin imapangidwa pang'ono kuposa momwe amafunikira, zomwe zimayambitsa zizindikiro za matenda ashuga, koma osatchulika kapena kuwonetsedwa kokha mutatha kudya zakudya zamatumbo. Kwa odwala matenda amtunduwu, chithandizo nthawi zambiri chimakhala ndikumwa mankhwala omwe amalimbikitsa katemera wa insulin komanso zakudya zapadera. Mankhwala ochepetsa shuga, mwachitsanzo, Glibenclamide, ali ndi zovuta zingapo, ndipo atamwa mopitirira muyeso, amatha kupweteka. Mukamagwiritsa ntchito mankhwala a insulin, madokotala amapatsa chidwi kwambiri makamaka chifukwa chokhala ndi insulin yocheperapo kapena yotalikirapo. Ultra-yochepa-insulin m`malo othandizira amachokera ku makonzedwe nthawi yomweyo yomwe thupi likufunikira ndikofunikira kwambiri - musanadye (popeza chochitikacho chimachitika pakapita kanthawi) komanso usiku. Ndibwino chifukwa cha mawonekedwe a mankhwalawa kuti pali kuthekera kwakukulu kovutitsa matenda a hypoglycemic, mwachitsanzo, ngati pambuyo pa insulin, kudya sikunatsatidwe. Mukamagwiritsa ntchito njira ya insulin yothandizira (gawo limodzi mwa magawo atatu a insulin yotsitsimutsa yotsalira, yopumulirayo imatenga nthawi yayitali), chikhalidwe chofunikira kwambiri kwa munthu ndikutsatira kwambiri zakudya. Zakudya ndizofunikira kuti tipewe kukula kwa hyper- ndi hypoglycemia, komanso hypoglycemic coma. Zakudya zowerengeka, chakudya chisanu ndi zisanu ndi chimodzi, zofunikira zonse zakwaniritsidwa: kufunikira kwa zakudya, kuyerekezera kuchuluka kwa mikate ndi kuchuluka kwa insulini yoyendetsedwa. Pazifukwa zina, pamakhala kusamvana kwakukulu pakati pa insulin ya anthu (mahomoni omwe amayendetsa mafuta a glucose) komanso kudya zakudya zamagulu ambiri. Chifukwa chakuti kuchuluka kwakokwanira kwa insulini kumazungulira mthupi, ndipo shuga m'magazi samachuluka, mkhalidwe wa hypoglycemia umayamba womwe umatha kupangitsa munthu kukhala ndi vuto la hypoglycemic coma. Munthu amene amatanganika ndi nkhawa zake za tsiku ndi tsiku sazindikira chizindikiritso cha pang'onopang'ono cha nthawi. Kuphatikiza apo, ngakhale powona chakudyacho, wodwalayo amatha kubaya molakwika kapena mwadala insulini osati molingana ndi malamulo (osati pansi pa khungu, koma intramuscularly). Izi zimabweretsa kuyamwa mwachangu komanso mphamvu kwambiri ya insulin, yomwe imapangitsa kukhala ndi vuto la hypoglycemia ndipo pambuyo pake imayambitsa kukomoka kwa hypoglycemic. Njira ina yophwanya regimen ndi malamulo operekera insulin ndiko kumwa mowa tsiku latha. Zadziwika kale kuti mowa umasokoneza kagayidwe kamunthu kazakudya (kuphatikizapo shuga). Zosakonzekera zolimbitsa thupi popanda kukonza zakudya ndi insulin zingayambitse kukomoka kwa hypoglycemic. Mwanjira ina, pambuyo pa kukhazikitsa kwa mahomoni, thupi lakuthwa linatsatiridwa, komwe kunalibe mphamvu zokwanira (zomwe zimatengedwa kwambiri pokonza shuga). Pali zochitika zina zosagwiritsidwa ntchito masiku onse pamene munthu amene ali ndi insulin yaulere mwadzidzidzi akufuna kudzipulumutsa yekha pogwiritsa ntchito mankhwala osokoneza bongo. Anthu oterewa amatha kupulumutsidwa ngati m'mbuyomu adafunafuna chithandizo cham'maganizo kapena usiku womwewo atayankhula zofanananso ndi okondedwa. Kwazaka makumi angapo tsopano, hypoglycemic coma yakhala ikugwiritsidwa ntchito ngati njira yothandizira odwala pochiza matenda amisala. Mankhwala osokoneza bongo a insulin, limodzi ndi mankhwala a electroconvulsive, amachepetsa kukula kwa odwala omwe ali ndi matenda oopsa, omwe akupita patsogolo kwambiri a matenda a schizophrenia ndi matenda ena amisala. Njira zotere zimachitika pokhapokha kuchipatala atakonzekera kwanthaŵi yayitali ndipo, motero, amaphatikizidwa ndi chiwopsezo china. Kwa anthu okalamba omwe ali ndi matenda a shuga, ndizosowa kwambiri, koma kwambiri hypoglycemia kapena hypoglycemic coma amatha kupezeka chifukwa cha kumwa mankhwala a hypoglycemic. Mwachidziwikire, milandu ngati iyi idalembedwa atatenga waukulu waukulu wa mankhwala a sulfonylurea (Glycvidon, Glibenclamide, ndi zina) komanso wopanda chakudya chokwanira masana. Ndipo, mwachidziwikire, chimodzi mwazomwe zimayambitsa hypoglycemic coma ndi vuto la Mlingo, mwachitsanzo, polemba insulini mu gawo lina la voliyumu yosiyanasiyana ndikulembanso (syringes ndi muyezo wapakati wa 40 ndi 100 magalamu pa millilita amagwiritsidwa ntchito), ndipo, chifukwa chake, kuyambitsa mlingo wopitilira muyeso umodzi wa 1, 5 - 2 kawiri. Nthawi zina, kuyambitsa koteroko kumatha kudzetsa nkhawa kwambiri komanso kupweteka kwakanthawi. Chisonkhezero chachindunji cha kupezeka kwa dziko la hypoglycemia chimaphatikizidwa ndi chotupa cham'mimba chomwe maselo ake amapanga insulin - insuloma. Kukula kwa tumor kwamasamba apancreatic okhala ndi zisumbu zogwira ntchito za Langerhans kumatha kubweretsa zovuta zambiri kwa wodwalayo, chifukwa ndizovuta kwambiri kuzindikira. Nthawi zina, katulutsidwe ka insulin ndi chotupa kamakhala kovuta kwambiri, komwe kumapangitsa nthenda ya hypoglycemic. Zomwe zili pamwambazi zimatha kubweretsa kukula kwadzidzidzi kwa hypoglycemic coma ndi kukula kwapang'onopang'ono kwa hypoglycemia, pambuyo pake - kukomoka. Kliniki ya hypoglycemic coma mwa odwala ambiri imakonda kupaka mafuta, ora loyamba, ochepa amalabadira zomwe akuzizazo. Kuwonetsera koyambirira kwa kuchepa kwamagazi a glucose kumalumikizidwa ndi "kufa ndi njala" kwa ubongo ndi njira zokhudzana ndi ma cell mu ma neurocytes ndi ma synapses (ma cell a ubongo), chifukwa maselo amayamba kupanga mphamvu kuzinthu zomwe sizimapangidwira izi. Poyerekeza ndi kufooka, mutu umadzuka, womwe suthandizidwenso ndi opweteka. Kuzizira kwa manja ndi miyendo, chinyezi cha m'manja ndi kumapazi zimadziwika. "Kutentha kwamoto" kumawonekera, ndipo nthawi yotentha, kukomoka kumathandizanso chifukwa cha kuphwanya kwa magazi ndi kutulutsa magazi. Pallor ndi dzanzi (kumva kukuwa) kwa mbali yamkati mwa nasolabial, yomwe imawonetsa momveka bwino kuchuluka kwa ubongo ndi mpweya ndi glucose, zimadziwika. M'dziko lino, anthu amakhala achiwawa, osafuna kutsutsidwa. Ndi kuwonjezeka kwa hypoglycemia, kutopa kumawonjezeka, ndipo kuchuluka kwa ntchito kumachepa kwambiri, makamaka pamlingo waluntha. Kupuma pang'ono kumawoneka pakuyenda komanso kupepuka. Kutsika kwakanthawi kwamawonekedwe owoneka kumatheka mpaka gawo lama glucose lifunika. Popita nthawi, kunjenjemera kwa zala, ndipo pambuyo pake magulu ena a minofu, amakula. Odwala onse popanda kusiyanasiyana amakhala ndi chidwi champhamvu chanjala. Nthawi zina amatchulidwa kotero kuti amafotokozeredwa ngati kumverera kwakumaso pa nseru. Pambuyo pake magawo a chitukuko cha hypoglycemic chikomokere, kuwoneka kawiri ndikotheka, kuvuta kuyang'anitsitsa maso, ndi kusawona bwino mitundu (mitundu imawoneka yosalala kapena chilichonse imakhala imvi.) Kuphwanya m'dera la mitsempha yoyendetsera kayendedwe ka mitsempha kumayambitsa kuchepa kwa kayendedwe kolondola, komwe kumatha kubweretsa ngozi kuntchito komanso kunyumba, poyendetsa galimoto komanso pochita zomwe zikuchitika. Ngati zoterezi zakufikirani munthu panthawi yomwe amakhala kuchipatala chachipatala, ndikofunikira kuti mufotokozere izi kwa anamwino ndi dokotala. Adzachita mayeso ofunikira (mkodzo wa acetone, magazi a shuga) ndikupitilira ndi mankhwala a hypoglycemic coma. Mwa zovuta zomwe zili mu mtima., Tachycardia yowonjezereka iyenera kudziwidwa. Awa ndi mtundu wa kusokonezeka kwa mitsempha ya mtima. Nthawi zina, tachycardia imatha kugunda mpaka 100 mpaka 135 kapena kupitirira pamphindi, ndipo kumakhala ndi mantha, kupuma movutikira, kutentha kwamphamvu kumalumikizana ndikumva kugunda kwa mtima. Mukamamwa zakudya zopatsa mphamvu monga zakudya zotsekemera (tiyi wotsekemera, maswiti, kiyibodi ya shuga), mtima umakhazikika "pansi, kugunda kwam'mimba kumachepa, ndipo zizindikiro zina zimasowa popanda kufufuza. Hypoglycemic coma ndi imodzi mwazikhalidwe zochepa zomwe zimakhala ndi chitukuko chokwanira. Zizindikiro zomwe zimakhala zokhazo za hypoglycemic coma ziyenera kulimbikitsa kuperekedwa kwa thandizo loyamba ndi thandizo loyamba. Zoonadi, pakukomoka, thupi la munthu lili pafupi ndi mzere wamoyo ndi imfa, ndipo cholakwika chilichonse chamankhwala kapena chithandizo chadzidzidzi chimatha kupha. Boma la precomatose lili ndi zinthu zingapo: kugunda kwakuthwa kwa ukoloni ndi kuponderezedwa kapena khunyu. Zimayamba ndikupindika kwa minofu mthupi lonse ndipo zimakulirakulira mwachangu kwambiri - kugwidwa mwamphamvu. Vutoli limakhala lowopsa chifukwa limawonekera mosayembekezereka, ndipo munthu akhoza kukhala wovulala pa ngozi yagalimoto, kugwa kuchokera kumtunda. Mkhalidwe wa hypoglycemic chikomichi chimachitika chifukwa cha zomwe medulla oblongata amapanga hypoglycemia. Pakufufuza kwatsatanetsatane: khungu limakhala lotumbululuka, lozizira, thukuta lomata, kupuma kumafooka pang'ono, kuthamanga kwa magazi ndikwacibadwa kapena kukwezedwa, zimachitika kuti zimachitika mwanjira yabwinobwino kapena kuwonjezeka pang'ono, mawondo ndi maondo amawongolera. Kuzindikira kulibe, zomwe zikuwonetsedwa ndi kusayankha kwa chidwi cha thupi, mwachitsanzo, kumayenda pamasaya, kufuula, kumadzuka ndi madzi ozizira ndi njira zina zothandizira "kudzuka". Milandu yambiri idalembedwa pomwe anthu, atatha kupuma kwa hypoglycemic coma, akuti awona chilichonse chikuchitika kuchokera kumbali. Izi sizitsimikiziridwa ndi sayansi ndipo zimawerengedwa kuti ndi zabodza kwambiri munthu akamwalira. Mayankho mu magawo oyamba a kukomoka kwa hypoglycemic amasintha pang'ono. Koma chovuta kwambiri ndikulephera kwa kupuma. Izi zikutanthauza kuti kupuma kwa wodwalayo (mtundu, kufanana, kuya) kuyenera kuyang'aniridwa moyenera panthawi ya mayendedwe kapena kutulutsa.Ngati kupuma kumakhala kopepuka, ndiye kuti, pomwe galasi limakulirakulira, ndikofunikira kuyambitsa zothandizira kupuma, popeza, mutaphonya mphindi, mutha kutaya munthu. Chipatala cha hypoglycemic coma chimaphatikiza zizindikiro zambiri zadzidzidzi, ndipo kuyerekezera kokha kwa zonse zomwe zikuwoneka pachithunzithunzi chimodzi kungathandizire othandizira oyenda pangozi, wachibale kapena munthu wamba. Ngati munthu walandila thandizo moyenera, amadzuka mphindi 10-30 (pakadalibe zovuta za chikomokere). Mfundo zazikuluzikulu za kakulidwe ndi kachitidwe ka hypoglycemic mu ana ndizofanana ndi zomwe zimachitika mwa akulu. Zomwe zimayambitsa kuchepa kwa hypoglycemic mu ana amathanso kukhala osagwirizana ndi insulin, kugona kwa nthawi yayitali, kusowa kwa zakudya zomwe zimapangitsa kuti pakhale matenda obadwa nawo (kutaya kwa enzyme, glucose, galactose kapena kuvomerezera kwa fructose). Mu ana, hypoglycemia imakhala yovuta kwambiri kusiyanasiyana ndi zinthu zosiyanasiyana, chifukwa ana, makamaka a msukulu zamaphunziro, nthawi zambiri samatha kufotokoza zomwe zimawakhudza. Ndikupweteka mutu, mwana akhoza kukhala wosasamba, wovuta. Ndi vuto la kupweteka kwam'mimba (kupweteka kwam'mimba, monga mawonekedwe owonetsa a hypoglycemia), chidwi chochepetsedwa mwa ana, amatha kukana chakudya, ngakhale kuti njala ndi chimodzi mwazidziwitso za hypoglycemia. Pa gawo lotsatira la hypoglycemia mwa ana, amakhala owopsa, osayang'anira chilichonse, osalumikizana kwathunthu. Zonsezi zimachitika motsutsana ndi moyo wakale. Kusintha kotereku m'makhalidwe a mwana kumayenera kuchenjeza makolo. Monga mwa achikulire, khungu lotumbululuka, kunjenjemera kwambiri kwa manja, komanso thukuta la m'manja limawonedwa. Kuphatikiza apo, chizungulire chimachitika, makamaka komanso kukomoka ndikusintha maonekedwe a thupi (ndikukwera kolimba). Tiyenera kukumbukira kuti mu ana onse Zizindikiro zimakula mwachangu, ngakhale chipatala chokhala ndi vuto la hypoglycemic sichimasiyana ndi zomwe zimachitika mwa akulu: kuyambiranso msanga, kukokana, kusazindikira, mawonekedwe amkati: kupuma pang'ono, kugunda kwa mtima, kutsitsa magazi. Zotsatira zoyipa kapena kusokonekera kwa muubongo kumachitika mwachangu, chifukwa chake, moyo ndi thanzi la mwana zimadalira kuthamanga ndi mgwirizano wa zochita za anthu omwe akuwathandiza. Pofuna kuchiza matenda oopsa monga hypoglycemic coma kuti ikhale yogwira mtima, muyenera kuwonetsetsa kuti vutoli likomoka, ndiye kuti chikomokere ndi hypoglycemic. Kuzindikira koyenera pankhaniyi ndikofunikira kwambiri. Mwachitsanzo, ngati chikomokere cha hyperglycemic chikukayikiridwa, njira yoyambira yothetsera shuga ingaphe. Zambiri zimatengera ngati pali mboni zomwe zingafotokoze zomwe munthu akuchita asanataye chikumbumtima chake, kufotokoza madandaulo ake, kupereka zambiri zamankhwala omwe wodwala akhala akumwa posachedwapa. Ngati mboni zatsimikizira kukomoka, ndipo pambuyo poti wathedwa nzeru, koyambirira kwa insulin, kapena kufa kwa nthawi yayitali ndi wolakwiridwayo, ndiye kuti njira zotsitsimutsa ndi matenda a hypoglycemic coma zitha kuyambitsidwa bwino. Ndipo ngati munthu wapezeka kale ali osazindikira, palibe chilichonse chogwiritsa ntchito mankhwala (insulin kapena mankhwala ochepetsa shuga) pafupi, ndiye muyenera kumapita naye kuchipatala, komwe amayesa mwachangu kuchuluka kwa shuga, acetone, matupi a ketone, ndi pambuyo - achire miyeso. Mu gawo loyambirira la chitukuko cha hypoglycemic coma (mkhalidwe wa hypoglycemia), njira yabwino kwambiri yokhala ndi chikomokere ndi kudya zakudya zotsekemera komanso zopatsa mphamvu. Nthawi yomweyo, maswiti amtundu wa chokoleti sayenera kudyedwa, chifukwa amakhala ndi mafuta ambiri, zonunkhira, othandizira zonunkhira zoyambira zabodza komanso shuga pang'ono. Ndibwino kuti munthu wodwala matenda ashuga azinyamula malamba angapo mthumba lawo, koma osati chokoleti. Dokotala amayenera kulankhula ndi anthu omwe ali ndi matenda ashuga, makamaka ndi ana kapena makolo awo, zakufunika kwa kudya, machitidwe a kumwa mankhwalawo, komanso magawidwe oyenera olimbitsa thupi. Musamale ndi insulin yotalikilapo. Ndikulimbikitsidwa kuti ziziperekedwa pansi pa khungu la m'chiuno kapena phewa, popeza mayamwidwe ake m'malo awa pang'onopang'ono. Ntchito yofunikira kwambiri ndikupanga kafukufuku wamasana masana. Izi zikuthandizira ntchito yosankha insulin kuti iyende usiku ndipo izitha kuteteza hypoglycemia kugona. Anthu omwe ali ndi matenda amtundu woyamba a shuga amafunika kudya malinga ndi momwe amafunikira mphamvu. Mwanjira ina, kuchuluka kwa zopatsa mphamvu zomwe zikubwera ziyenera kugwiritsidwa ntchito mokwanira ndi thupi, ndipo kuchuluka kwa insulin yomwe ingabayidwe kuyenera kufanana ndi chakudya chamafuta. Kuthandizira kuwerengera kwa zopatsa mphamvu mwa odwala kungagwiritsidwe ntchito m'magome osiyanasiyana osonyeza kufunika kwa zopangira zanuzanu komanso chakudya chamagulu. Koma kuwerengetsa katundu wa chakudya mu zinthu zomwe amagwiritsa ntchito buledi. Chimodzi mwa zinthu ngati izi chimafanana ndi magalamu 12 a zakudya komanso zakudya zamafuta. Kapena 25 magalamu a mkate wamba. Magawo a mkate amagwiritsidwa ntchito podziletsa pakudya kwa anthu odwala matenda ashuga, amapangidwa kuti azitha kusintha mtundu wa anthu odwala matenda ashuga, kuwazolowera kukhala ndi udindo paumoyo wawo. Zochizira za hypoglycemic coma, 10% glucose solution yotsatsira mamilimita 100 mpaka 250 amagwiritsidwa ntchito. Izi ndizofunikira kuti shuga azikhala nthawi zonse m'magazi. Ngati wodwalayo sanadzayambenso kuphwanya shuga, njira ziyenera kutengedwa kuti muchepetse matenda a ubongo - mothandizidwa mwamphamvu ndi 15% yankho la Mannitol kuchokera pa 1 mpaka 2,5 milligrams pa kilogalamu ya kulemera kwa thupi, ndikulowetsedwa ndi Furosemide (Lasix) 75 - 110 mg m'mitsempha. Mannitol ndi woimira gulu la osmotic diuretics, zochita zake zimakhazikitsidwa ndi malamulo akuthupi a kayendedwe ka mamolekyulu am'madzi ndi mankhwala osokoneza bongo. Imayikidwa osasinthika ndi mamolekyulu amadzi. Lasix imatanthauzanso zida zamafuta a impso, imathandizira mapangidwe a mkodzo ndi chimbudzi chake. Iyenera kuperekedwa mosamala, chifukwa imatha kuyambitsa kupukusa - kusasiya kwamadzi ndi thupi. Pankhani yoletsa kapena kuchiza matenda amtundu wa hypoglycemic coma, mankhwalawa monga Piracetam kapena Nootropil ali oyenera. Mankhwalawa ndi oimira ena otchedwa nootropics - mankhwala omwe amasintha kufalitsa kwa chithokomiro. Amagwiritsidwanso ntchito kwa okalamba komanso odwala omwe adachita ngozi yapakhungu. Poletsa kuchuluka kwambiri kwa kuthamanga kwa magazi mu ziwiya zaubongo, njira yogwiritsa ntchito ya magnesium sulfate, yomwe imadziwika kuti Magnesia, imagwiritsidwa ntchito. Nthawi zambiri kutumikiridwa mpaka 10 ml (kutengera kulemera kwa thupi) mu ndende yopanda 25%. Kukhazikitsidwa kwa yankho la glucose kuyenera kuchitika motsogozedwa ndi labotale ya mulingo wake m'magazi. Masewera a glucose akafika 14 - 16 mmol pa lita imodzi, insulini yotsalira yochepa imayenera kutumikiridwa mosavomerezeka pamankhwala ochepera 6 mayunitsi atatu alionse mpaka 5. Chipatala cha hypoglycemic coma ndi umboni wowonekeratu kuti mkhalidwe uwu ndiwowopsa kwambiri pamoyo wamunthu. Mavuto obwera chifukwa cha hypoglycemic comma wokhala ndi mankhwala osayamba kapena osayendetsedwa bwino mosiyanasiyana amatha kuchepetsa moyo wamunthu, kutsata kulumala kapena mitundu ina yowonongeka. Mwa zovuta pachimake cha hypoglycemic chikomokere, matenda a ubongo kapena matenda am'mimba chifukwa cha matenda oopsa amatha kuchitika. Chifukwa chake, ndikofunikira kuti akuwongoleredwe ndi malamulo a gwiritsani ntchito popereka chisamaliro chodzidzimutsa cha hypoglycemic coma. Choyamba, wovutikayo amaphatikizidwa ndi 1 ml ya glucagon, yomwe imalimbikitsa kupanga shuga kuchokera ku glycogen m'chiwindi. Ngati kuyambitsa sikunapereke zotsatira zomwe zikuyembekezeka, izi zikuwonetsa kuchepa kwa malo ogulitsira am'madzi glycogen kapena kumwa mowa tsiku latha. Kenako, glucose (40%) shuga yothetsera shuga imayendetsedwa pamitsempha, mu ndege, kamodzi mpaka 110 ml (kutengera kulemera kwa thupi komanso momwe thupi limayankhira ku makonzedwe). Izi zikuyenera kuthandizira kuchuluka kwa shuga m'magazi, komanso m'malo abwino - kutuluka kwa munthu kuchokera kumapazi mwachindunji kumapeto kwa kulowetsedwa. Ngati makonzedwe a hypertonic solution, chipatala cha hypoglycemic coma chikutsalira, ndikofunikira kuti mupite mpaka pakubaya jekeseni wa glucose yotsikirako ya m'munsi ndende ya 250-300 ml. Pofuna kupewa edema ya m'magazi, munthu amayenera kuyambitsa intravenous drip osmotic diuretics (Mannitol ndi Manitol). Ndipo kenako - omwe amatchedwa okodzetsa mwadzidzidzi (Furosemide kapena Lasix). Onetsetsani kuti mwayika ma catheter osachepera awiri - kulowetsedwa kwa mankhwala osokoneza bongo komanso chikhodzodzo, monga diuretics idzagwiritsidwa ntchito. Mochenjera, insulini yocheperako iyenera kuperekedwa ngati mulingo wa glycemia ufikira 13 - 17 mamililita pa lita imodzi ya magazi kuti achepetse yokhazikika, popanda kuyambitsa kudwala kwatsopano kwa hypoglycemic coma. Palinso njira yosagwiritsa ntchito mankhwala mosamalitsa yokhala ndi kukomoka kwa hypoglycemic. Awa ndi ma tweak amphamvu komanso mikwingwirima m'dera lamisempha yayikulu kwambiri. Izi zimatsutsana ndikuti pakuwonekera pakhungu, kuchuluka kwa adrenaline ndi ma catecholamine ena amatsitsidwa m'magazi, zomwe zimapangitsa kuti shuga azikhala mwadzidzidzi m'chiwindi. Koma, kachiwiri, njira iyi sichithandiza pakuchepa kwa masitolo a glycogen. Pakusamalidwa kwambiri, akuwunika ma neurologist-resuscitator ndi cardiologist amayenera kuwunikira kuti alembe ndikuwunika kwa electrocardiogram ndi electroencephalogram. Njira izi zikuthandizani kuti muyeze kuwonongeka kwa njira ya hypoglycemic chikomokere, komanso kuneneratu zovuta za chikumbumtima cha hypoglycemic. Akachoka ku chikomokere, wodwalayo ayenera kuyang'aniridwa mosamala kuti asayambirenso. The endocrinologist wophunzirayo aunikire njira zamankhwala ndikumuwunika wodwalayo, zomwe zingaphatikizepo njira zonse za labotale ndi zothandizila patsiku kwa sabata limodzi kapena awiri. Kuphatikiza apo, kukonza zakudya ndikofunikira. Ziyenera kukhazikitsidwa panjira yatsiku ndi tsiku, magwiridwe antchito ndi kusinthasintha kwa tsiku ndi tsiku mu glycemia. Popewa kugwedezeka kwa hypoglycemia, kudya pafupipafupi kumafunikira pogwiritsa ntchito chakudya chochepa kwambiri cha carb. Mankhwala a insulin amafunikanso kusintha malinga ndi zochita za tsiku ndi tsiku. Ngati ndi kotheka, ziyenera kukhala zotsekemera - zithandizire kuchepa kwa insulin yomwe imapangidwa pakudya (ultrashort action). Kukhazikika kwa insulini kumapangitsa kuti mavuto azovuta azisokoneza komanso azolimbitsa thupi, zomwe nthawi zambiri zimachitika pogwiritsa ntchito insulin. Kudya kuyenera kuyenerana ndi mphamvu yofunikira. Nthawi zambiri, kugawa koteroko kumagwiritsidwa ntchito kuti pafupifupi kotala ya zakudya zonse zomwe zimatengedwa ndizakudya zam'mawa komanso chakudya chamadzulo, chakudya chamasana - pafupifupi 15%, ndipo zotsalazo ziyenera kukhala "zokhwasululira" zapakatikati. Chifukwa chake, kupewa kumathandiza kwambiri kuteteza chiwonetsero cha matenda a hypoglycemia ndi chitukuko cha chikomokere. Malangizo onse a dokotala kwa wodwala yemwe amapezeka ndi matenda osokoneza bongo ndizovomerezeka. Kutengera kudziletsa kwa wodwala kuti mkhalidwe wa kagayidwe kake ka zakudya, ndipo motero thupi lonse, limatengera. Zakudya zoyenera, ndondomeko yophatikizidwa bwino tsiku ndi tsiku, chakudya komanso mankhwalawa zimathandiza munthu kukhala wathanzi labwino, motero, amakhala ndi moyo wabwino. Mankhwala a hypoglycemic coma palokha imaphatikizapo kupumula kwa zizindikiro komanso kupewa zotsatira. Kusamalidwa kwadzidzidzi kwa chikomokere kwa hypoglycemic kumakhudzanso kuchuluka kwa shuga m'magazi. Ndikofunikanso kupewa zovuta zosafunikira ku dongosolo lamkati lamanjenje ndi mtima. Njira izi zikuphatikiza njira zoteteza matenda osokoneza bongo, matenda oopsa osokoneza bongo, omwe amayamba chifukwa cha kuyambitsa mankhwala a diuretic. Pa gawo lomaliza la chithandizo cha chikomokere, munthu ayenera kulandira chithandizo choyambiranso. Izi ndizofunikira pochotsa zotheka za magazi ndi kutulutsa madzi muyezo. Akatulutsa m'chipatala pambuyo pa kuphwanya kwa magazi, wodwala amayenera kuwunika madokotala azachipatala kuti adziwe zovuta zina zilizonse zomwe sizinawonekere kapena zofatsa. Hypoglycemic coma (kapena insulin mantha) ndi momwe thupi limapwetekera, zomwe zimachitika chifukwa cha kutsika kwa glucose kwanthawi yayitali komanso kuchuluka kwa insulini m'magazi. Thupi lamanjenje lapakati (makamaka ubongo) limasowa mphamvu zambiri, limayendetsa ndikugwirizanitsa ntchito ya ziwalo zonse ndi machitidwe. Kuphwanya ntchito ya maselo aubongo, kukanika kovuta kwamachitidwe ena a thupi kumachitika, komwe kumayambitsa imfa. Ndi kusakhalitsa kwa glucose kwa nthawi yayitali, mpweya ndi chakudya cham'mimba zimayamba m'matipi. Chifukwa cha kuchepa kwa zinthuzi muubongo, zimachitika kuti wina amatchedwa "neuroglycopenia" mu mankhwala. Mwanjira zina, kufa pang'onopang'ono kwa magawo ake ndi madipatimenti ena kumachitika, njirazi zimawonekera kunja, zimazindikira kukomoka kwa matenda ashuga oyambitsa maziko a hypoglycemia. Malinga ndi gulu la padziko lonse lapansi la matenda a 2010, matendawa ndi amgulu la matenda amtundu wa endocrine omwe amayamba chifukwa cha kuperewera kwa zakudya m'thupi komanso njira za metabolic. Kuti muwonetsetse chikumbumtima chopanda matenda ashuga, mankhwalawo amagwiritsidwa ntchito - E-15. Kukula kwa matenda ammimba kumalumikizidwa ndi kuphwanya kwa mapangidwe a kapamba, ntchito yake yomwe ndikuwonetsetsa kuti magazi a glucose akhazikika. Magawo oyamba a matendawa ndi ovuta kuzindikira. Kutsika kwa shuga kumachitika pang'onopang'ono. Ubongo, womwe maselo ake akumva njala, ukuyesera kulipirira kuchepa kwa michere kuchokera kuzinthu zina. Zotsatira za njirayi, wodwalayo amakhala ndi kufooka, pamakhala kupweteka kwapafupipafupi, komwe mankhwala opweteka amathandizira. Vutoli limatchedwa hypoglycemic aura (preursor). Mitsempha ya glucose itatsikira kwambiri (2.78 mmol / L), kudwala kwawothumbo kwawonetsa kwambiri: Ngati zizindikiro zoyambirira za hypoglycemic coma zikunyalanyazidwa ndi wodwalayo, vutolo limakulirakulira. Kupuma pang'ono kumawonekera, manja ndi miyendo zimanjenjemera, masinthidwe akuchepa. Pambuyo pake magawo amtundu amadziwika ndi chipatala chotsatira: Ndi mawonetsedwe oterowo, muyenera kufunafuna chithandizo chamankhwala nthawi yomweyo. Khansa yomwe yapezeka munthawi yake imachiritsidwa. Mayeso amakono a labotale athandizira kudziwa msanga kuchuluka kwa shuga m'magazi ndikupanga mwachangu njira zochizira. Ngati chithandizo sichinaperekedwe, izi zimayambitsa kudwala kwa wodwalayo, kusazindikira, ndi zina zosokoneza pamachitidwe a moyo. Hypoglycemic mantha amayamba mwa odwala matenda a shuga. Izi zimachitika chifukwa chophwanya Mlingo wa jakisoni wa insulin kapena zakudya zomwe sizimalola kuti anthu azidya zakudya zophatikiza thupi nthawi yayitali komanso azisunga nthawi. Pali nthawi zina pamene odwala wodwala kwambiri omwe amadalira insulin, pazifukwa zakunja, kusazindikira bwino kukonzekera kwa insulin ndipo timadzi tating'onoting'ono timene timayamba. Muzochita zamankhwala, zomwe zimayambitsa kuphwanya kwa insulin ya ndende nthawi ya jakisoni yomwe imayambitsa matenda a shuga imafotokozedwa: Pali zinthu zingapo zomwe zimapangitsa kuti odwala omwe ali ndi matenda ashuga azitulutsa shuga: Pathology imapezeka mwa ana omwe ali ndi matenda osokoneza bongo chifukwa cha kuchuluka kwa insulin, kuperewera kwa zakudya, kuperewera kwa thupi, matenda a impso komanso chiwindi. Matendawa amawonedwa mwa akhanda, ngati mwana wabadwa pasanachitike, ndi wobadwa nawo a mtima. Khungu la insulini limakwiyitsidwa ndi vuto la okosijeni la mwana wosabadwa, lotentha thupi. Pathogenesis ya chikomokere chogwirizana ndi kusowa kwa shuga m'magazi motsutsana ndi kuchuluka kwa insulin. Matendawa amakhudza dongosolo lamanjenje ndipo limakula mwachangu, magawo onse amadutsa mphindi zochepa. The chipatalachi akufotokoza magawo asanu a chitukuko cha matenda: 1. Mawonekedwe a kumva njala yayikulu ndi kusokonekera kwayanjana ndi kufa kwa mitsempha yama cell a chithokomiro, chifukwa chake gawo ili limatchedwa "cortical". 2. Mawonekedwe a autonomic reaction - palpitations, thukuta, njala yosatha, kusinthasintha kwa khungu (wotumbululuka kapena wofiyira), kunjenjemera, kupweteka kwa mutu. Izi ndichifukwa cha kuwonongedwa kwa ma subcortical malo mu hypothalamus. Kuzindikira nthawi yomweyo kumadziwika. 3. Pa gawo lotsatira, zomangamanga zimapitilirabe kugwa, limodzi ndi kusokonezeka kwa chikumbumtima. Izi zimakwiyitsa kuyerekezera zinthu zina, delirium. Wodwalayo amakhala wokwiya, amachita zinthu zosakhudzidwa kapena ali ndi nkhawa kwambiri. 4. Ma neurons a kumtunda kwa medulla oblongata amafa. Izi zimayambitsa kukokana, kusazindikira bwino ndipo zimapangitsa kuti mukhale ndi vuto lalikulu. 5. Kuphatikiza apo, njira yakufa imakhudza mbali zam'munsi za medulla oblongata, momwe mumakhala malo operekera njira zofunika (kufalikira kwa magazi, kupuma, chimbudzi, chimbudzi). Pakatikati pa zochitika zamtima ndi kupuma zimakhudzidwa kaye, pambuyo pake chikomokere ndi imfa. Vuto la insulini limapezedwa ngati wodwala ali ndi matenda a shuga, matenda a kapamba, poganizira zizindikiro za matenda. Phunziro lantchito yayikulu ndikudziwa kuchuluka kwa shuga m'magazi. Kwa omwe akuwonetsa kuchepa kwapakati - pansipa 20 kapena 2-4 mmol / l. Ngati wodwalayo poyambirira anali ndi shuga yoposa 20, ndiye kuti zamatenda zimachitika ndimatenda a shuga a 6-8 mmol / L. Poterepa, kupezeka kuti ndi chikomokere kumakhala kovuta kwambiri. Chikhalidwe kwa munthu wathanzi ndi 7 mmol / L. Ngati wodwalayo sakudziwa, njira zodziwira zovuta ndizovuta. Dokotalayo amatha kuyang'ana kwambiri pazisonyezo zakunja (ziume ndi khungu, khungu, kunyowa, zochita za ana, kuponderezedwa kwa dongosolo lamanjenje la autonomic). Ndikofunikira kudziwa mtundu wa chikomokere, kusankha kwa njira zochizira kumatengera izi. Ngati wodwalayo sakudziwa, amayesedwa kuti adziwe ngati ali ndi vuto linalake. Algorithm ya kuchitapo kanthu ndikukhazikitsa 40-60 ml ya glucose kudzera mu namwino (ndende ya 40%). Ngati chikomokere ndi chofatsa, munthuyo amabwerera mwachangu. Chithandizo cha matenda oopsa a hypoglycemic chikuphatikizira jakisoni wambiri wa shuga kapena kukoka kwake. Chizindikiro china chachikulu ndi nthawi ya tsiku pamene kuukira kunachitika. Kugwedezeka kwa insulin kumachitika m'mawa mutatha kuchita masewera olimbitsa thupi, osapeza kadzutsa, mumikhalidwe yovuta. Mitundu yofatsa ya insulin, wodwala akazindikira, ayenera kuchita zinthu zosavuta: idyani zakudya zochepa (pafupifupi 100 g) zamagetsi am'mafuta pang'ono. Mwachitsanzo, idyani mkate kapena mbale ya phala, imwani ndi yankho la shuga (supuni imodzi mu kapu yamadzi). Kuti muwonjezere msanga kuchuluka kwa shuga m'magazi, maswiti, uchi, zotsekemera, shuga msuzi ndizoyenera. Pakatha mphindi 30 zilizonse muyenera kuyendetsa shuga. Wodwala kwambiri, wodwala amayenera kuyikidwa kuchipatala. Chithandizo chachikulu ndicho kupaka shuga. 40% yankho mpaka 100 ml ya jekeseni. Njirayi imabwerezedwanso mpaka chikumbumtima chidzafika kwa wodwalayo ndipo mulingo wabwinobwino wamagazi umabwezeretsedwa. Ngati izi sizinathandize, ikani dontho. Pakukhumudwa kwanthawi yayitali, njira zoperekera chithandizo zimaphatikizidwa ndi mahomoni apadera. Vuto la insulini ndi loopsa lomwe limakhala ndi zotsatirapo zake chifukwa cha zovuta zoyambirira ndi zosayenera. Vuto lowopsa ndi matenda a ubongo; Ngati chikomokere chikuchitika pafupipafupi, mwa akulu pamakhala kusintha kwamunthu, m'maganizo mwa ana kumakula. M'badwo uliwonse, imfa ya wodwalayo siyipatula. Pathology imakhala pachiwopsezo chachikulu kwa okalamba omwe ali ndi matenda a ischemia ndi matenda oyenda magazi. Zotsatira zoyipa zimaphatikizira kuwonongeka kwa maselo aubongo (encephalopathy), komwe magazi omwe amapezeka m'malo awa amasokonekera ndipo ma neurons amamva kuperewera kwa chakudya ndi kuperewera kwa zakudya. Imfa yakufa ya maselo am'mitsempha ya minyewa imakhudzana ndikuwonongeka kwa munthu. Mitundu yofatsa ya insulin imayambitsa matenda osakhalitsa amanjenje. Ndi chithandizo chanthawi yake kuchipatala, kuchuluka kwa glucose kumabwezeretsedwa mwachangu, ndipo zizindikiro za hypoglycemia zimatha popanda kufufuza. Kukula kwa matendawa muzochitika zotere ndikabwino. Mitundu ikuluikulu ya chikomokere, chithandizo chokwanira chimayambitsa stroko, matenda a ubongo, imfa. Mankhwala a insulin ndi zotsatira za hypoglycemia. Kuyenera kuyang'aniridwa popewa glycemia, chithandizo choyenera cha matenda a shuga. Odwala matenda a shuga ayenera: Hypoglycemic coma ndi mkhalidwe womwe mitsempha yamkati imayankha kuchepa kapena kugwa mwadzidzidzi m'magazi a shuga. Mankhwala, pansi pa matenda amadziwika gawo lomaliza la chiwonetsero cha matenda a hypoglycemic. Zoterezi zimachitika mwadzidzidzi ndipo zimadziwika ndi maphunziro owopsa. Potere, munthu amasiya kuzindikira ndipo amatha kudwala matenda amanjenje yapakati. Mankhwala, matenda am'mimba amawonedwa ngati kuphwanya kwakukulu kwa kugwira ntchito kwa endocrine system. Chifukwa chake, ndikofunikira kukana thandizo loyambira nthawi. Choyamba, ndikofunikira kudziwa ngati vutoli lidayambika chifukwa cha kuchuluka kwa shuga m'magazi (hyperglycemia) kapena kutsika kwakukulu pamlingo wa chinthu ichi, chomwe chikuwonetsa hypoglycemia. Kukomoka kumachitika mwa odwala matenda ashuga pakakhala kutsika kwamphamvu kwa shuga. Izi zimachitika ngati kuchuluka kwa insulini yomwe imaperekedwa kwa wodwala sikufanana ndi kuchuluka kwa zakudya zomwe zimamwa (makamaka, kuchuluka kwa chakudya chamafuta). Masewera a shuga pamamita ochepera 2.77 mmol pa lita imodzi, chikomero cha hypoglycemic nthawi zambiri chimayamba kukula. Choyambitsa chachikulu cha matenda ndi insulin-wodwala matenda osokoneza bongo a labial mawonekedwe oopsa. Kuphatikiza apo, zinthu zotsatirazi zimatha kupangitsa izi: Nthawi zina kuchepa kwa shuga m'magazi kungayambitse insulin. Vutoli limachitika pamene mulingo wa insulin udalizidwa. Kukula kwa matenda am'mimba ndikuchitika chifukwa cha kuyamwa kwa zinthu zowonjezera ndi mlingo wosankhidwa molakwika kapena kuyambitsa kwake mu mtsempha. Kupsinjika kwamphamvu kwakuthupi ndi psychoemotional, komanso kudya zakudya zamafuta ochepa kwa nthawi yayitali kumathandizira kupezeka kwa matenda am'mimba mwa munthu yemwe alibe matenda ashuga. Mankhwala, magawo otsatirawa a chikomokere amasiyanitsidwa: M'magawo oyamba, mutakhala mogwirizana ndi algorithm ya chithandizo choyambirira, mavuto owopsa amatha kupewedwa. Nthawi zambiri, zamatsenga zimadziwoneka ndendende, modzidzimutsa. Pa gawo loyamba la chitukuko, amadziwika ndi izi: M'malo okondweretsa, kupsa mtima komanso kukwiya kumawonekera, mu kusungunuka kwa ana ndi kulira, madandaulo abwinobwino. M'magawo awa, achikulire amakumana ndi malovu otsetsereka ndi kukokana, komwe mankhwala amatchedwa chizindikiro cha Babinsky. Chikomokere chikayamba kukula, kupuma kwa wodwalayo kumangokhala kwapamwamba. Ali ndi bradycardia, hypotension. Chizindikiro chofunikira chomwe chithandizo chofunikira ndikofunikira ndi kutaya chikumbumtima. M'mayeso a labotale, shuga wambiri m'magazi amapezeka. Ndi pathology, mulingo wake udzakhala pansi pa 2.77 mmol. Ngati zoopsa zotere zikuchitika, ndikofunikira kusiyanitsa pakati pa kuwonetsa kwa hypo- ndi hyperglycemia, chitanipo kanthu ndikuyimbira ambulansi posachedwa. Thandizo loyamba limatha kupulumutsa moyo wa munthu yemwe ali ndi vuto la hypoglycemic komanso kupewa zovuta. Komabe, pofuna kukulitsa vutoli, ndikofunikira kusiyanitsa zizindikiro za hypoglycemia zomwe zafotokozedwa pamwambapa kuchokera kuzizindikiro za vuto lomwe shuga ya magazi imakwera kwambiri. Algorithm mwadzidzidzi chifukwa cha kukomoka chifukwa cha hypoglycemia: Njira zoyambira zoyenera zithandizira kupewa zovuta zoopsa. Mchipatala, wodwalayo amapezeka, amamuyendera kuti awononge zoopsa mu ubongo ndikugwiritsidwa ntchito kwamatenda a mtima. Ndikofunikanso kudziwa ngati wodwalayo sanamwe mankhwala omwe amathandiza kuchepetsa magazi. Mukafuna kudziwa kuchuluka kwa insulin, tsamba lamakonzedwe ake limasankhidwa modabwitsa. Njirayi ndi yotheka ngati gawo pakati pa jakisoni ndi kulowa kuchipatala sizidutsa maola atatu. Chithandizo cha matenda a hypoglycemic ziyenera kuphatikizapo: Popewa matenda a edema, wodwalayo amapaka jekeseni wamkati ndi Dexamethasone kapena Prednisolone. Njira yomwe namwino azigwiritsa ntchito pakupanga shuga (gawo khumi) kuchoka pang'onopang'ono mpaka shuga itayamba kukhala yabwinobwino. Kuti thupi lisadzaze ndi madzimadzi, madokotala amasintha glucose 10 peresenti ndi 40 peresenti. Pofuna kupewa izi, wodwala yemwe ali ndi matenda ashuga ayenera kutsatira malamulo awa: Izi njira zochepetsera zimachepetsa chiopsezo cha matenda. Hypa ya Hypoglycemic imawonedwa ngati yowopsa, imabweretsa zotsatirapo zoyipa. Kuti muwonjezere mwayi wopulumutsa moyo komanso kupewa zovuta, muyenera kudziwa zomwe zimapangitsa kuti mukhale ndi matenda komanso algorithm ya zochita. Kuti mumvetsetse momwe izi zilili, mawu omwe amagwiritsidwa ntchito kuti azindikire angathandize. Kuchokera ku Chigriki chakale "ὑπό" adatanthauziridwa kuti "kuchokera pansi", "γλυκύς" - "lokoma", "αἷμα" - "magazi". Mwanjira ina, uku ndi kuchepa kwa glucose wamagazi. Chizindikiro ichi ndichoposa 3.5 mmol / L. Kutsatira kwatsika kwamphamvu kwa shuga, mayendedwe achilengedwe amatsatira. Amatchedwa hypoglycemic coma. Dzina lachiwiri ndi mantha a insulin. Glucose akakumana ndi mpweya, adenosine triphosphoric acid amapangidwa. Chifukwa cha kuwola kwake, mphamvu imatulutsidwa, yomwe ndiyofunikira kwambiri kuti thupi lonse lizigwira ntchito. Glucose amaperekedwa ndi chakudya. Imabwera mu shuga ndi zakudya. Pazakukhudzidwa, thupi limafunikira mahomoni apadera - insulin. Poona izi, kutsika kwa shuga m'magazi kuli ndi zifukwa zotsatirazi: Hypoglycemic syndrome nthawi zambiri imayamba mu odwala matenda ashuga. Komabe, lino si gulu lokhalo la anthu omwe akukumana ndi vuto lofananalo. Hypoglycemia imapezekanso nthawi zotere: Kugwa msanga kwa magazi m'magazi sikotetezeka. Zimatengera kukomoka kwa hypoglycemic. Zotsatira zakuchitika izi ndizosatsimikizika kwambiri. Pa gawo loyamba, kusokonezeka kosasinthika mu ubongo kumachitika. Nthawi zambiri ntchito yanzeru imakhala yovuta. Nthawi zina, kukomoka kwa hypoglycemic kumapangitsa kuti matenda a dementia adze. Kuphatikiza apo, motsutsana ndi kuwonongeka kwa ubongo, khunyu ndi psychosis zimawonedwa. Nthawi yomweyo, kuchepa kwambiri kwa shuga m'magazi kumadzaza ndi zotsatirazi: Pamtima pazinthu izi ndikuchepa kwambiri kwa kuchuluka kwa shuga m'magazi. M'pofunikanso pakugwira ntchito yamanjenje. Chifukwa cha kusowa kwa glucose, ubongo umavutika. Kuphatikiza apo, chotupa sichimawonedwa m'malo onse nthawi imodzi, koma mosiyana komanso m'njira zina. Hypoglycemic chikomacho chimayamba pakakhala kuti palibe chithandizo chokwanira motere: Nthawi zambiri, matendawa amapezeka mwa anthu odwala matenda ashuga. Muzochita zachipatala, zochitika zoterezi zimafotokozedwa pamene hypoglycemia imachitika - chikomokere: Hypoglycemic coma imatha kupezeka mwa munthu yemwe alibe matenda ashuga. Zinthu zotsatirazi zimadzetsa izi: Pali mitundu ingapo yophwanya lamulo. Muzochita zamankhwala, mitundu yotsatana ya shuga m'thupi imadziwika: Zizindikiro zokomera Hypoglycemic zili ndi zomwe zimadziwika mwachindunji ku izi. Vutoli lagawidwa kukhala precom ndi kwa ndani. Magawo awa ndi osiyana. Kukula komwe zizindikiro za hypoglycemic coma zimawonekera zimadalira gawo lake. Ponena za precoma, zimachitika mkati mwa mphindi 20-30. Vutoli limachitika ndi izi: Pali magawo asanu pakupanga izi. Usiku, kuchuluka kwa mawonetseredwe a zizindikiro izi sikumatchulidwa pang'ono. Wovutikayo amakhala ndi tulo tabwinobwino; Nthawi zambiri munthu akamadzuka, amakhala ndi nkhawa komanso amapha. Nthawi zambiri, shuga akayamba kudya, matendawa amakula. Ngati kukomoka kwa hypoglycemic kumachitika masana, kumayendera limodzi ndi zizindikilo izi: Kupenda wodwalayo kumachitika ndi katswiri kapena endocrinologist. Kuzindikira matenda a hypoglycemic coma akuphatikizira izi: Mkhalidwe wovuta ukuyamba msanga. Pachifukwa ichi, mankhwalawa a hypoglycemic coma cholinga chake ndikubwezeretsanso misempha yamagazi. Therapy imayimiridwa ndi izi: Pofuna kupewa kuwonjezeka kwa zinthu, munthu ayenera kuchita mwachangu komanso molondola. Chithandizo choyamba cha hypoglycemic coma chizitha kupulumutsa moyo wamunthu. Mphindi iliyonse yotayika imawonjezera mwayi wokhala ndi zotsatira zosasintha. Chisamaliro chodzidzimutsa cha hypoglycemic coma ndi motere: Nthawi zambiri, thandizo limaperekedwa munthawi yake komanso molondola. Poona izi, zapamwamba pambuyo pa chikumbumtima cha hypoglycemic ndizabwino kwa odwala ambiri. Vutoli limathetsedwa bwino ndipo pambuyo povomerezeka kwa chithandizo chanthawi zonse, zizindikiritso zonse zimabwereranso. Pambuyo pochoka kuchipatala, wodwalayo ayenera kutsatira mosamalitsa zomwe dokotala wamupatsa. Pambuyo popereka chithandizo kwa wodwala osazindikira, kusintha koyamba kumachitika pambuyo pa maola 4. Ngati izi sizingachitike, chiopsezo cha edema yamatumbo chimakulanso. Pankhaniyi, chikumbumtima cha hypoglycemic chimakhala chikuwala ndi kulumala kwa wodwala kapenanso ngakhale kufa. Kuphatikiza apo, kutsika kwamphamvu kwa shuga m'magazi kumayambitsa kusokonezeka kwa magazi. Zotsatira zake, izi zimabweretsa kuyankhula kwamisala, stroko, mtima kapena khunyu. Ndiosavuta kupewa vuto kusiyana ndi kuthana ndi mavuto ake pambuyo pake. Kukula kwa hypoglycemic coma kumachepetsedwa ngati mungatsatire zotsatirazi:Njira zochizira
Amayambitsa hypoglycemic chikomokere
Hypoglycemic coma zizindikiro
Zizindikiro za chikomokere
Hypoglycemic chikomacho mwa ana
Chithandizo cha hypoglycemic chikomokere
Chisamaliro chodzidzimutsa cha hypoglycemic coma
Kodi hypoglycemic coma
Khodi ya ICD-10
Magawo a matenda
Zizindikiro
Mavuto omwe angakhalepo komanso zotsatirapo zake
Kupewa
Pathology
Zomwe zimachitika
Magawo a pathological mkhalidwe
Zizindikiro ndi mawonekedwe a mkhalidwe
Thandizo loyamba
Chithandizo cha makolo
Njira zopewera
Kodi hypoglycemia ndi chiyani?
Hypoglycemia - Amayambitsa
Kodi chiwopsezo cha hypoglycemia ndi chiani?
Hypoglycemic chikomokere - pathogenesis
Hypoglycemic chikomokere - zimayambitsa
Hypoglycemic chikomokere - Zizindikiro
Hypoglycemic chikomokere - magawo
Hypoglycemic coma - kuzindikira
Hypoglycemic chikomokere - mankhwala
Hypoglycemic coma - algorithm yodzidzimutsa
Hypoglycemic chikomokere - zapamwamba
Hypoglycemic chikomokere - zotsatira zake
Hypoglycemic chikomokere - kupewa
