Zinthu zotsatirazi zitha kuganiziridwa monga zinthu zomwe zikuthandizira kukulitsa lactic acidosis:

Matenda opatsirana komanso otupa.
Kutulutsa magazi kwakukulu.
Pachimake myocardial infaration.
Uchidakwa wambiri.
Kuchita masewera olimbitsa thupi kwambiri.
Matenda a chiwindi.
Kulephera kwina.

Malo apadera pakati pazinthu zodzitetemera ndi kutenga biguanides. Tikuyenera kudziwa kuti kuwonongeka kwa chiwindi kapena impso, ngakhale mlingo wocheperako wa gluuanides ungayambitse lactic acidosis chifukwa chakuchulukitsa kwa mankhwala m'thupi.

Sinthani ya Pathogenesis |

Lactic acidosis

Lactic acidosis (lactic acidosis, lactacidemia, hyperlactatacidemia, lactic acidosis) ndi mkhalidwe womwe lactic acid imalowera m'magazi mwachangu kwambiri kuposa momwe adatulutsira, zomwe zingayambitse kukula kwamavuto oopsa m'moyo. Milandu yoposa 50%, lactic acidosis amalembetsa mu odwala matenda a shuga.

Potengera komwe lactic acidosis, ubongo edema ndi kupindika kwake kwamkati, kupuma kolimba, ndipo imatha kuyamba.

Lactic acid ndiye chinthu chomaliza cha anaerobic glycogenolysis ndi glycolysis, gawo lapadziko lapansi la gluconeogenesis, limagwiritsidwa ntchito ngati chida champhamvu ndi minofu ya mtima. Kuwonjezeka kwa zomwe zili ndi lactic acid m'magazi makamaka kumalumikizidwa ndi kupangika kwake kwa minofu ndi kuchepa kwa mphamvu ya chiwindi kuti isinthe lactic acid kukhala glucose ndi glycogen. Pankhani ya matenda a shuga a mellitus, kuchuluka kwa asidi a lactic m'magazi kumatha kuwonjezeka chifukwa chakuletsa kukhudzika kwa matenda a pyruvic acid komanso kuchuluka kwa NAD-N / NAD. Kuzunza kwa magazi a lactic acid kumatha kuchita ngati njira ina yowunikira.

Zoyambitsa ndi Zoopsa

Hypoxia yomwe imapezeka m'matumbo am'mimba chifukwa chokhala ndi kupsinjika kwa nthawi yayitali kumatha kuyambitsa lactic acidosis. Komanso, njira ya pathological imatha kukhala ndi matenda a shuga, kupweteka kwamatumbo, matenda opatsirana komanso kutupa, kulephera kupuma, kulowerera kwam'mimba, kulowetsedwa kwamatumbo kapena mapapu, kulephera kwa aimpso, matenda a chiwindi, magazi akulu, kuvulala kwambiri, uchidakwa.

Zowopsa zake ndizophatikizira:

matenda obadwa nawo
chitetezo chokwanira
kugwedeza
khunyu
kumwa mankhwala (mwachitsanzo, Biguanides, makamaka pamaso pa matenda a chiwindi ndi impso),
kuchepa kwa mavitamini m'thupi (makamaka vitamini B₁),
poizoni wa monoxide
cyanide poyizoni,
kugwiritsa ntchito methanol kapena ethylene glycol,
parenteral makonzedwe a fructose muyezo waukulu.

Ndi lactic acidosis, kuthandizira kuchipatala pamafunika wodwala kuti athe kukonza acidosis ndi hypoxia.

Lactic acidosis

Lembani A (yolumikizidwa ndi hypoxia ya minofu)

Lembani B (losagwirizanitsidwa ndi hypoxia ya minofu)

Cardiogenic, endotoxic, hypovolemic mantha

Matenda a congenital metabolic (mtundu 1 glycogenosis, methyl malonic acidia)

Kulephera kwa chiwindi ndi (kapena) chiwindi

Paresteral makonzedwe apamwamba Mlingo wa fructose

Methanol kapena ethylene glycol

Kusiyanitsa mitundu

kulimbana ndi hypoxia,
mankhwala a insulin.

Type 2 matenda a shuga ndi matenda osachiritsika omwe amadziwika ndi kuphwanya kagayidwe kazakudya koyambitsa matenda a hyperglycemia chifukwa cha kukana kwa insulini komanso kukayika kwa chinsinsi cha β-cell, komanso lipid metabolism ndi chitukuko cha atherosulinosis.

SD-1 ndi nthenda yokhazikika ya autoimmune yomwe imatsogolera ku chiwonongeko cha kapamba wopanga ma pancreatic β-cell ya islet, yomwe imawonetsedwa ndi kuperewera kwathunthu kwa insulin. Nthawi zina, odwala omwe ali ndi matenda oopsa a shuga - 1 amakhala ndi zolemba zowonongeka za autoimmune ku β-cell (idiopathicabetes-1).

Zizindikiro za Lactic Acidosis

Lactic acidosis, monga lamulo, amakula kwambiri, patangopita maola ochepa, osakhala ndi zizindikiro zakutsogolo. Odwala amadandaula za kupweteka kwa minofu, kupweteka kumbuyo kwa sternum, dyspepsia, chidwi, kugona kapena kugona. Mkhalidwe wa wodwalayo umakulirakulira msanga, kuwonjezereka kwa acidosis kumayendera limodzi ndi kupweteka kwam'mimba komanso kusanza, mitsempha yam'magazi (areflexia, hyperkinesis, paresis).

Muzovuta kwambiri, Zizindikiro za lactic acidosis ndizowonetsa kulephera kwamtima, zomwe zimakulitsidwa ndi acidosis yayikulu pamene njira ya pathological ikupita. Kuwonongeka kwa chikumbumtima ndikukula kwa matendawa kumayambitsidwa ndi kupha mphamvu, mawonekedwe a wodwalayo akupuma mwaphokoso (phokoso lakupuma lomwe limamveka patali), ndipo palibe fungo la acetone mlengalenga lomwe limatulutsa. Wodwala amakula, choyamba ndi oligoanuria, kenako ndi anuria, ndikutsatiridwa ndikugawa kwa intravascular coagulation (DIC). Mwa odwala ena, hemorrhagic necrosis ya zala zakumtunda ndi zam'munsi zimadziwika pakati pa zizindikiro za lactic acidosis.

Zolemba za maphunziro a lactic acidosis mwa ana

Mtundu wa cholowa cha lactic acidosis umaonekera mwa ana aang'ono omwe ali ndi acidosis yayikulu, limodzi ndi kupuma kwambiri. Odwala amakhala ndi minofu hypotension, kuchepetsedwa kwa chitukuko cha psychomotor. Nthawi zambiri, mkhalidwe wodwala umayenda bwino ndi ukalamba, koma nthawi zina njira yotsitsimutsa imadzetsa imfa.

Pafupifupi 50% ya milandu yonse ya lactic acidosis imanenedwa mwa odwala omwe ali ndi matenda ashuga.

Zizindikiro

Ngati lactic acidosis ikukayikiridwa, mawonetseredwe azachipatala amatengedwa ngati gawo lothandizira. Lactic acidosis imatha kukayikiridwa ndi mtundu uliwonse wa metabolic acidosis, womwe umalumikizidwa ndi kusiyana kwa anionic. Ndi lactic acidosis, kuchuluka kwa anionic kosiyanasiyana kumatha kusinthasintha, koma sizachilendo. Pambuyo pakupereka magazi pakupanga zamankhwala am'magazi, kuyenera kuyambiranso kutentha kwa 0 mpaka + 4 C C kuti magazi asaphatikizidwe ndi lactic acid. Kuti atsimikizire matendawa, kuchuluka kwa lactic acid m'mwazi wa wodwalayo kutsimikiza. Pankhaniyi, kutsimikiza osati kumanzere- komanso ndi dextrorotatory isomer ya lactic acid kumakhala ndi phindu lofufuzira. Kuphatikiza apo, ndi lactic acidosis, kuchepa kwa zomwe zili mu bicarbonate m'magazi ndi hyperglycemia yabwino. Acetonuria pamkhalidwewu palibe.

Kusiyanitsa kosiyana kwa lactic acidosis kumachitika ndi hypoglycemia ya magwero osiyanasiyana (kuphatikizapo glycogenosis), encephalopathy.

Ndi lactic acidosis, kuthandizira kuchipatala pamafunika wodwala kuti athe kukonza acidosis ndi hypoxia.

Kusamalira mwadzidzidzi kumaphatikizaponso kukoka kwa mtsempha wa 2.5 kapena 4% wa sodium bicarbonate mpaka 2 malita patsiku. Pankhaniyi, kuchuluka kwa magazi pH komanso kuchuluka kwa potaziyamu kuyenera kuyang'aniridwa. Ngati ndi kotheka, mankhwala a insulin amachitika, mankhwala ogwiritsira ntchito m'malo mwa plasma amathandizira kudzera m'mitsempha kuti azitha kukonza hemodynamics, plasma ya m'magazi ndi heparin kuti azikonza hemostasis. Hypoxia imachotsedwa ndi chithandizo cha okosijeni; mpweya wabwino ungafunike. Pankhani ya lactic acidosis mutatenga biguanides, hemodialysis ikhoza kukhala yofunikira.

Mtundu wa cholowa cha lactic acidosis umaonekera mwa ana aang'ono omwe ali ndi acidosis yayikulu, limodzi ndi kupuma kwambiri.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Potengera komwe lactic acidosis, ubongo edema ndi kupindika kwake kwamkati, kupuma kolimba, ndipo imatha kuyamba.

Kukula kwa matendawo kwa mtundu wa lactic acidosis kumatengera matenda omwe adayambapo, pamlingo wa lactic acid m'magazi a wodwala, komanso pa nthawi yake komanso kufunika kwa mankhwalawo. Ndi kukula kwamavuto, komanso mtundu wobadwa nawo wa lactic acidosis, matendawa amafooka.

Kupewa

Pofuna kupewa kukula kwa lactic acidosis, tikulimbikitsidwa:

munthawi yomweyo chithandizo cha matenda omwe lactic acidosis ingachitike (makamaka kulipira matenda a shuga komanso kupewa hypoxia), kutsatira malangizo onse a dokotala.
Pewani kugwiritsa ntchito mankhwala osokoneza bongo
kuwonjezera chitetezo chokwanira
kusiya zizolowezi zoipa,
kupewa kupsinjika kwamthupi ndi m'malingaliro.

Pachizindikiro choyamba cha lactic acidosis, muyenera kufunsa chithandizo chamankhwala nthawi yomweyo.

Malangizo ogwiritsira ntchito mankhwala

Mankhwala ena a hypoglycemic amathanso kubweretsa zovuta, mwachitsanzo, kumwa mankhwala a matenda a viral ndi catarrhal nthawi yomweyo.

Mabala okopa amatha kukhala chifukwa choyamba cha lactic acidosis.

Nthawi zambiri pamakhala mankhwala osokoneza bongo omwe ali ndi biguanides, vuto la impso, lakhala lothandizira lactic acidosis. Kukhazikika kwa mankhwalawa ndi thupi kumatha kuyambitsa izi.

Ngati wodwalayo adayiwala za kumwa mankhwalawo, ndiye kuti simuyenera kulipira izi ndikumamwa mapiritsi angapo nthawi imodzi. Kuchulukitsa mlingo wa mankhwalawa kumatha kuyambitsa mavuto akulu mthupi.

Zizindikiro za matenda a shuga

Nthawi zambiri, palibe chomwe chimawonetsera ma lactic acidosis. Komabe, m'nthawi yochepa kwambiri, m'maola ochepa chabe, zizindikiro za matenda owopsa zimawonekera. Zoyambirira zakale ndizophatikizira: kupweteka m'misempha ndi kumbuyo kwa sternum, mkhalidwe wopanda chidwi, kugona, kugona mopumira.

Yang'anani! Komanso, chizindikiro chachikulu cha lactic acidosis chimayamba - mtima kusakwanira, kuphatikizidwa ndi kuchuluka acidity. Kupitilira apo, ndi kupita patsogolo kwa matenda am'mimba, kupweteka kwam'mimba kumawonekera, limodzi ndi mseru, kusanza

Ngati simutenga chithandizo chofunikira, wodwalayo akuipiraipira.

Pamakhala kuchedwa. Munthu samachita zambiri mozungulira, pomwe nthawi zambiri amasiya kuzindikira. Wodwalayo amatha kungodzipereka minyewa, kukokana, ntchito, ntchito zamagalimoto zimafooka.

Ndi chitukuko cha lactic acidosis, chikomokere chimachitika. Mbira yake ndi mawonekedwe a kupuma kwakanthawi ndikuthanso kudziwa.

Chithandizo

Ndi zovuta zowopsa za matenda ashuga, wodwala amafunika kuthandizidwa mwachangu. Akayikidwa kuchipatala, amamuyika jekeseni wa sodium bicarbonate. Pankhaniyi, kuyang'anira kuchuluka kwa potaziyamu m'magazi kumachitika.

Wodwala matenda a shuga amapatsidwa jakisoni wowonjezera wa insulin. Ngati ndi kotheka, mlingo wake wa tsiku ndi tsiku umasinthidwa, kapena mankhwalawa amagwiritsidwa ntchito. Komanso mankhwalawa, njira ya carboxylase imagwiritsidwa ntchito, yomwe imayendetsedwa kukapumira. Monga adalembera dokotala, kuyambitsa plasma yamagazi ndikotheka. Heparin amathandizidwa (muyezo yaying'ono).

Zithandizo za anthu

Kuphatikiza kwakukulu kwa zovuta mankhwala, kugwiritsa ntchito mankhwala azitsamba ndizovomerezeka. Muthanso kunena zina za maphikidwe a mankhwala achikhalidwe:

Chomera chimasinthasintha kuchuluka kwa lactate. Oledzera komanso oledzera m'malo mwa tiyi. Kenako muyenera kupewa kudya kwa ola limodzi.

Imabwezeretsa bwino kagayidwe. Mtengowo umakulolani kuti mumange lactic acid, yemwe amatuluka mwachilengedwe.

Chinyengo. 250 ml ya zouma zowuma zimathiridwa ndi madzi otentha. Chifukwa chakumwa chimaphatikizidwa ndikuwamwa 100 ml kawiri pa tsiku.
Tincture. Mbewuyi imaphatikizidwa ndi glycerin mu chiyerekezo cha 1: 4. Kusakaniza kuyenera kuphatikizidwa kwa masiku 21. Amatengedwa supuni kawiri patsiku.
Vinyo Maziko ndi vinyo wokhala ndi mipanda yolimba (yofiyira). Mu 500 ml ya vinyo, supuni ya mbewu imawonjezeredwa. Adakhazikitsidwa kwa mwezi umodzi. Musanagone, tengani supuni imodzi.

Mbewu izi zimachepetsa asidi komanso zimabwezeretsa m'mimba chakudya. Mbewu zodzaza ndimadzi ofunda adzapatsa pafupifupi ola limodzi. Osakaniza aledzera kwathunthu osachotsa flaxseed. Ndondomeko amachitika pamimba yopanda kanthu.

Zithandizo zonse ndizothandiza, koma musanagwiritse ntchito, muyenera kufunsa endocrinologist.

Mitundu yotsatirayi ya zovuta imasiyanitsidwa molingana ndi njira zomwe zimapangidwira kukula kwa acidosis:

Osapuma acidosis,
Repiratory acidosis (mpweya wambiri ndi mpweya wambiri)
Mtundu wosakanizika wa acidosis (vuto lomwe limayambitsidwa ndi mitundu yosiyanasiyana ya acidosis).

Non-kupumula acidosis nayenso ikukhudzidwa ndi magulu otsatirawa:

Excretory acidosis - chikhalidwe chomwe chimayamba pakakhala kuphwanya kwa ntchito pochotsa zidulo m'thupi (kuwonongeka kwa impso),
Metabolic acidosis ndiye mkhalidwe wovuta kwambiri womwe umadziwika ndi kudzikundikira kwa ma acid amkati mwa thupi lathu,
Exo native acidosis ndi gawo lowonjezera ndende ya asidi chifukwa cha kuyamwa kwa zinthu zambiri zomwe zimasinthidwa kukhala ma acid panthawi ya kagayidwe.

Malinga ndi mulingo wa pH, acidosis imatchulidwa kuti:

Zolipidwa
Zolipidwa
Idalipira.

PH ikafika pazofunikira zambiri (7.24) komanso pazofunikira (7.45) (zabwinobwino pH = 7.25 - 7.44), kuwonongeka kwa mapuloteni, kuwonongeka kwa maselo, komanso kutayika kwa ntchito ya enzyme kumachitika, zomwe zingayambitse imfa ya thupi.

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

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

Onetsetsani kuti mwayeza shuga la magazi pafupipafupi 5-7 tsiku lonse kuti mudziwe zoopsa zake munthawi yake. The mwayi wa lactic acidosis ukuwonjezeka ndi zosayenera mankhwala a shuga, kusowa kuyang'anira tsiku lililonse kuchuluka kwa shuga. Kulephera kutsatira malamulo a zamankhwala, kusafuna kugwiritsa ntchito mita, kutsatira zakudya kungapangitse kugwa kwambiri kwa shuga, kukula kwa hypoglycemia.

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

Ndi maphunziro aposachedwa a endocrine pathology okhala ndi zizindikiro zowoneka bwino, mutha kudumpha kukula kwa zovuta zovuta. Madokotala amalimbikitsa anthu kuti aphunzire zambiri ngati achibale awo achikulire apezeka ndi matenda ashuga

Ndikofunikira kudziwa momwe lactic acidosis imakhalira mtundu wachiwiri wa matenda a shuga, ndizomwe zimayambitsa zovuta.

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

Chitukuko cha pachimake pamakhala pachimake pazopeza lactatacidemia, chithunzi chonse cha chipatala chikuchitika mu 6-18 maola. Zizindikiro za zomwe zatsogola nthawi zambiri zimakhala palibe. Pa gawo loyamba, acidosis imadziwonetsa yosakhala makamaka: odwala amawona kufooka, chidwi, kupweteka kwa minofu ndi chifuwa, kusokonezeka kwa m'mimba mwanjira ya kusanza, chimbudzi, ndi kupweteka kwam'mimba. Gawo lapakati limaphatikizidwa ndi kuwonjezeka kwa kuchuluka kwa lactate, motsutsana ndi kumbuyo komwe kumachitika zochitika zamapapu. Ntchito yosinthana ndi mpweya m'mapapu imasokonezeka, kaboni dioksidijini imadziunjikira m'thupi. Kusintha kwa kupumira ntchito kumatchedwa kupuma kwa Kussmaul. Kusinthana kwazinthu zazing'ono zamiyendo yokhala ndi mpweya wozama komanso kupuma kwamphamvu kumawonedwa.

Zizindikiro za mtima wozama komanso kuperewera kwa mtima kumapezeka. Kwa odwala, kuthamanga kwa magazi kumachepa kwambiri, hypotension ikukwera nthawi zonse, kungayambitse kugwa. Kupanga mkodzo kumachepa, oliguria amakula, kenako anuria. Zizindikiro zosiyanasiyana zamitsempha zimawululidwa - areflexia, spastic paresis, hyperkinesis. Kuchulukitsa nkhawa zamagalimoto, delirium. Pakutha kwa gawo lapakati, DIC imachitika. Thrombosis yokhala ndi zotupa za hemorrhagic necrotic nthawi zambiri imapezeka. Pomaliza, psychomotor mukubwadamuka m'malo mwa stupor ndi chikomokere. Ntchito yamanjenje, yamtima, yopuma komanso kwamikodzo imalephereka.

Ndi mtundu B lactic acidosis, Zizindikiro zimakonda kupezeka masiku oyamba amoyo. Kusokonezeka kwa kupuma kukuonekera pang'onopang'ono: dyspnea - kufupika kwa mpweya, kumva kusowa kwa mpweya, polypnoea - kupuma kwapang'onopang'ono, mikhalidwe ngati mphumu - kutsokomola, milomo, kuvuta kupumira mkati ndi kunja. Pakati pazisonyezo zamitsempha, kuchepa kwa minofu, areflexia, kukokana kwina, magawo a chikumbumtima chotsimikiza amakhazikika. Pali kukanidwa kwa chifuwa ndi chosakanikirana chopanga, kusanza pafupipafupi, kupweteka kwam'mimba, zotupa pakhungu, kuzindikira kwa zitsekozo. M'tsogolomu, nthawi zambiri amachedwa kukulitsa m'maganizo ndi thupi.

Malamulo ndi njira zochizira

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

Choyamba, muyenera kuthetsa hypoxia ndi acidosis, kukhazikika machitidwe othandizira amoyo

Ndikofunika kuchotsa wodwalayo kuti asatekeseke, kuti azitha kupumira m'mapapo. Ngati wodwalayo sakudziwa, ndiye kuti mpweya wofunikira mu oxygen umafunikira

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

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

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

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

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

Gawo lotsatira ndi chithandizo cha kukonzanso thupi:

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

Pambuyo kukhazikika, kubereka kwazizindikiro zofunika, wodwalayo ali m'chipatala. Onetsetsani kuti mukutsatira zakudya, onetsetsani kuti mukusunthika kwa glucose and acidity, yeretsani magazi

Pobwerera kwanu, muyenera kutsatira kusankhidwa kwa endocrinologist, kumwa mankhwala a hypoglycemic mosamala, nthawi zonse muzigwiritsa ntchito yokhayo.

Hyperlactacidemia mu odwala matenda ashuga amayamba motsutsana ndi maziko a kuperewera kwa oxygen. Chifukwa chake, choyambirira, kuchipatala, ndikofunikira kukhutitsa thupi ndi mpweya momwe mungathere. Izi zimachitika pogwiritsa ntchito mpweya wabwino. Madokotala akuyenera kuthetsa chitukuko cha hypoxia posachedwa.

Zizindikiro zonse zofunika zimayang'aniridwa nthawi yomweyo.

Chidwi choperekedwa chimaperekedwa kwa anthu okalamba omwe ali ndi vuto la matenda oopsa, mavuto a chiwindi, impso.

Ngati hyperlactatemia itatsimikiziridwa ndi kusanthula, kuchuluka kwa pH ndi kochepera 7.0, ndiye kuti wodwalayo amayamba kubayila sodium bicarbonate kudzera m'mitsempha. Yankho limakonzedwa kuchokera kumadzi osabala, sodium bicarbonate, wofanana ndi potaziyamu mankhwala ena. Lowani ndi dontho kwa maola awiri. Kuchuluka kwa yankho kumatha kusiyanasiyana kutengera pH. Imawunikidwa maola 2 aliwonse: kulowetsedwa kwamankhwala kumapitirirabe mpaka pH ifika kupitirira 7.0.

Ngati munthu wodwala matenda ashuga okhala ndi vuto laimpso amalephera, ndiye kuti hemodialysis ya impso imachitidwa nthawi yomweyo.

Ndikotheka kupewa kukula kwa mtima kulephera ndi mankhwala apadera. Mlingo wocheperako, Reopoliglukin, Heparin akhoza kutchulidwa. Kusankhidwa kwa mankhwala a insulin okwanira ndikofunikira. Izi zipangitsa kuti kagayidwe kazinthu kazinthu zina.

Ndi chitukuko cha lactic acidosis chikomokere, njira za antiseptic zimaperekedwa kwa wodwala. Pa nthawi yomweyo kuchita antishock mankhwala. Trisamine imagwiritsidwa ntchito pochepetsa mawonetseredwe a lactic acidosis.

Kuthekera kwa kuthekera kwazinthu ndi chithandizo chakanthawi kuchipatala ndi 50%. Ngati mutenga nthawi ndipo osalabadira zizindikiro zomwe zikudwala mwachangu, ndiye kuti kufa kwawo kungathe kufika 90%. Mwanjira yonyalanyazidwa, ngakhale madokotala sangathe kupulumutsa wodwalayo.

Kodi lactic acidosis amathandizidwa bwanji?

Lactic acidosis, kapena lactic acidosis, ndi mkhalidwe womwe ukuwonjezereka mwachangu kwambiri kwa lactic acid m'magazi a munthu. Asitimuyi samachotsedwako mwachangu pomwe amadzaza, ndipo magazi amunthu amakhala acidic kwambiri. Lactic acidosis imatha kukhala yoopsa, ndipo omwe amapezeka nayo angafunike thandizo la kuchipatala.

Kuthana ndi vutoli kungafunike kuchipatala, ma intravenous hydration, mankhwala kapena maantacid, ndipo nthawi zina ngakhale chithandizo cha impso chomwe chimathandiza kuchotsa lactic acid m'magazi. Kusankhidwa kwa njira yoyenera yoyenera nthawi zambiri kumadalira kuuma kwa lactic acidosis, komanso chomwe chimayambitsa.

Ochita masewera nthawi zambiri amakhala ndi machitidwe a lactic acidosis chifukwa chophunzitsidwa kwambiri. Pogwira ntchito kwambiri, minyewa imatha kugwiritsa ntchito okosijeni mwachangu kwambiri kotero kuti thupi lilibe nthawi yobwezeretsanso madzi ake.

Uphungu! Pakakhala mpweya wokwanira kuti ucheke lactic acid, asidiyu amamangika m'magazi, zomwe zimapangitsa kupuma movutikira komanso kumva kutentha komanso kutopa m'misempha. Mtundu uwu wa lactic acidosis ndi wofatsa ndipo nthawi zambiri safuna chithandizo china kupatula kupumula kwa minofu.

Wothamanga akapumula, thupi limayamba kuchira lokha, ndipo palibe zotsatira zosakhalitsa kapena zoopsa zomwe zimachitika.

Lactic acidosis mu shuga

Pakati pa zifukwa zokopa, kudya kwautali kwa agalu kumakhala malo apadera. Ngakhale mlingo wocheperako wa mankhwalawa (malinga ndi kukhalapo kwa impso kapena hepatic dysfunction) ungapangitse mawonekedwe a lactic acidosis.

Pafupifupi theka la milandu ya lactic acidosis imayamba mwa odwala matenda a shuga.

Pochiza wodwala ndi biguanides, kukula kwa lactic acidosis kumachitika chifukwa cha kusokonekera kwa malowedwe a pyruvic acid (pyruvate) kudzera mmatumbo a ma cell a mitochondria. Pankhaniyi, pyruvate mwachangu amayamba kutembenuka kuti awoneke. Lactic acid owonjezera amalowa m'magazi, ndiye m'chiwindi, pomwe lactic acid amasinthidwa kukhala glycogen. Ngati chiwindi sichikugwirizana ndi ntchito yake, lactic acidosis imayamba.

Zomwe zimayambitsa

Zotsatira zotsatirazi zimatha kukhala zovutitsa zomwe zimakhudza kuchuluka kwa thupi la lactic acid mu matenda a shuga:

minofu hypoxia (kufa ndi njala ya oxygen) ndi kuchuluka kwa thupi,
kulephera kupuma kwapadera (kusagwira ntchito),
kusowa kwa mavitamini (makamaka gulu B),
kuledzera
infaration chachikulu myocardial,
kuwonongeka kwaimpso,
magazi akutuluka
zaka kuyambira 65,
mimba

Mkulu woyambitsa chitukuko cha lactic acidosis ndi njala yokhala ndi mpweya (hypoxia). Pansi pa vuto lakuchepa kwa mpweya, kuphatikizika kwa lactic acid kumachitika (kumayambitsa kusokonekera kwa lactate ndi anaerobic glycolysis).

Ndi magawo omwe alibe mpweya wa oxygen, ntchito ya enzyme yomwe imayambitsa kusintha kwa pyruvic acid kukhala acetyl coenzyme A Inayamba, asidi a pyruvic amasintha kukhala lactate (lactic acid), yomwe imatsogolera lactic acidosis.

Zinthu ndi matenda omwe angayambitse lactic acidosis

Kukula kwa matendawa kumawonedwa pamaziko a zinthu zilizonse ndi matenda omwe amatsogolera kuphwanya minofu yomwe imaperekedwa ndi mpweya, kuwononga kwambiri glucose popanda mpweya.

Njira yakale kwambiri yomwe imagwiritsidwa ntchito, yotchedwa process of glucose oxidation by cell, imachita zinthu zabwino pamavuto, mwachitsanzo, pakuthamanga, kusambira, masewera olimbitsa thupi ndi zina zambiri. Mu zolengedwa zopanda unicellular, lactic acid imatulutsidwa m'chilengedwe; kupangidwe kwakukulu kumachitika popanda mavuto.

Mu thupi la munthu wokhala ndi zinthu zambiri, limawopseza moyo. Mwa kugwiritsika ntchito kwa nthawi yayitali ngati mtundu uwu wa kusweka kapena kukhathamiritsa kwa glucose m'magazi, kudzikundikira kwa lactic acidity kumapangidwa.

Pamaso kuwonekera kwa lactic acidosis, pali zinthu zina zomwe zimayambitsa matendawa:

Zotupa komanso zopatsirana
Kutulutsa magazi kwambiri
Matenda a chiwindi (hepatitis, cirrhosis, kuperewera, jaundice),
Myocardial infaration
Mowa
Kuvulala kwambiri.

Malinga ndi kukula kwa chithunzichi, kuopsa kwa maphunzirowa kumasiyanitsa magawo atatu a lactic acidosis: koyambirira, pakati komanso mochedwa. Kukula kwawo kumachitika mwachangu kwambiri, patangopita maola ochepa zizindikiritso zimayamba kukula. Kugawika kwina kumakhazikitsidwa pamachitidwe a etiopathogenetic omwe amayambitsa kupanikizika. Malinga ndi izi, mitundu iwiri ya hyperlactatacidemia imasiyanitsidwa:

Wogula (Mtundu A). Nthawi zambiri chimatha pambuyo 35 zaka. Zimayambitsidwa ndikuphwanya kwa kuperekera kwa oksijeni ndi magazi ku zimakhala. Zizindikiro zamankhwala zokhala ndi metabolic acidosis zimawonedwa - Ntchito za CNS ndizolepheretsa, kupuma kwamphamvu komanso kugunda kwa mtima kumasintha. Ubale wolunjika pakati pa mulingo wa lactacidemia ndi zizindikiro zamitsempha zimayang'aniridwa. Ndi matenda a shuga, pamakhala kuthekera kwakukulu kokulira, kuchepa kwakukulu kwa kuthamanga kwa magazi.
Congenital (mtundu B). Amawonekera kuyambira pobadwa, nthawi zambiri kuyambira paubwana, amatanthauza mitundu yamatenda a metabolic. Kuyambira masiku oyamba amoyo, mitsempha ndi kupuma zimatsimikizika: myotic hypotonus, areflexia, stupefaction, dyspnea, polypnoea, zizindikiro za mphumu.

Kodi lactic acidosis ndi chiani?

Lactic acidosis (lactic acidosis) imatchedwa kuwonjezeka kwa zomwe zili lactic acid m'magazi. Izi zimapangitsa kuti pakhale kupangika kowonjezereka ndikulephera kutulutsa kuchokera mthupi ndi impso ndi chiwindi. Awa ndimalo osowa kwambiri, zomwe zimachitika chifukwa cha matenda ena.

Chofunika: Ndi imodzi mwazovuta za matenda ashuga odwala okalamba. Kuthekera kwa kufa - oposa 50%

Lactic acid m'thupi ndi chipangizo cha glucose processing. Kuphatikizika kwake sikufuna oxygen, imapangidwa nthawi ya anaerobic metabolism. Ambiri mwa asidi amalowa m'magazi kuchokera kumisempha, mafupa, ndi khungu.

Mtsogolomo, lactates (mchere wa lactic acid) uyenera kudutsa m'maselo a impso ndi chiwindi. Ngati njirayi idasokonekera, zipatso za asidi zimachulukirachulukira komanso mopitirira malire. Lactate yowonjezera imapangidwa chifukwa cha kusokonezeka kwakukulu kwa metabolic.

Pathology imawonedwa ndi kuphatikizika komanso kusokonezeka kwapakati - matenda a impso, matenda ofiira a m'magazi.

Kuwongolera kwa lactates ndikofunikira kwa othamanga, popeza kukula kwawo ndikotheka ndi katundu wolemera.

Lactic acidosis ndi mitundu iwiri:

Mtundu A - wochititsidwa ndi kusowa kwa minofu ya okosijeni ndipo umachitika chifukwa cha kupuma, matenda amtima, kuchepa magazi, poyizoni.
Mtundu B - umachitika chifukwa cha mapangidwe osayenera a asidi. Lactic acid amapangidwa mopambanitsa ndipo samataya shuga a mellitus, matenda a chiwindi.

Lactic acidosis nthawi zambiri imabweretsa:

matenda a oncological (lymphomas),
shuga
kupweteka kwa impso (mitundu yayikulu ya glomerulonephritis, nephritis),
matenda a chiwindi (hepatitis, cirrhosis),
matenda amtundu
poyizoni, kuphatikizapo omwe amayamba chifukwa cha mankhwala (, Fenformin, Methylprednisolone, Terbutaline ndi ena),
matenda opatsirana opatsirana
poyizoni wazakumwa zoledzeretsa,
khunyu.

Mlingo wabwinobwino wa lactate / pyruvate m'magazi (10/1) ndizofunikira kwambiri. Kuphwanya gawo ili m'njira yowonjezera lactate kumawonjezeka mofulumira ndipo kungayambitse wodwala kwambiri.

Kudziwitsa za mulingo wa lactate kumachitika pogwiritsa ntchito kusanthula kwa biochemical. Zizolowezi sizimafotokozedwa ndi miyezo yapadziko lonse lapansi, chifukwa zimatengera njira zofufuzira ndi zinthu zomwe zimagwiritsidwa ntchito.

Akuluakulu, chizindikiro cha mulingo wabwinobwino wamagazi chili m'magawo a 0.4-2.0 mmol / L.

Zizindikiro za acidosis zimatengera mphamvu ya pH kuloza kumbali ya acidic. Pankhani ya mitundu yovuta ya matenda, njira yofatsa ya zizindikiro sizimachitika kapena yaying'ono komanso yodziwika, komabe, pakuwonjezeka kwa kuchuluka kwa zinthu za acidic, kufooka, kutopa kumawonekera, kupuma kumasintha, kugwedezeka ndi chikomokere ndikotheka.

Zizindikiro za acidosis zitha kuphimbidwa ndikuwonetsa zamomwe zimayambira kapena zimafanana kwambiri ndi izi, zomwe zimapangitsa kuzindikira kukhala kovuta. Mild acidosis nthawi zambiri imakhala yovuta kwambiri, imakhala yolimba - imapatsitsanso kupuma movutikira, ndizotheka kuchepetsa kutsekeka kwa minofu ya mtima ndi zomwe zimachitika paziwalo zamitsempha zam'mimba kwa adrenaline, zomwe zimakhudza kudandaula kwa mtima ndi mtima.

Metabolic acidosis imayendera limodzi ndi kupuma kwapadera kwamtundu wa Kussmaul, komwe cholinga chake ndikubwezeretsanso acid-base mozungulira ndikuwonjezera kuya kwa kupumira, momwe mpweya wambiri umatulutsidwa mu mpweya wozungulira.

Ndi kupuma (kupuma) acidosis yoyambitsidwa ndi kuchepa kwa kugunda kwa gasi wa alveolar, kupuma kudzakhala kopanda, mwina ngakhale kufulumizitsidwa, koma osazika mizu, chifukwa alveoli sangathe kupereka mpweya wabwino komanso kusinthana kwa mpweya.

Zambiri zolondola zokhudzana ndi kuphatikizika kwa kaboni dayokisi m'magazi a wodwala, omwe adotolo atha kupeza popanda kuphatikiza njira zina zowunikira, zimaperekedwa poyesa mtundu wa kupumira. Zitadziwika kuti wodwalayo ali ndi acidosis, akatswiri amafunika kudziwa zomwe zimayambitsa.

Zovuta zazing'ono zazidziwitso zimapezeka ndi kupuma acidosis, zomwe zimayambitsa zomwe nthawi zambiri zimadziwika mosavuta. Nthawi zambiri, gawo loyambitsa limapangitsa kupweteka kwa mutu, chibayo, ma pulmonary edema. Kuti mumvetse bwino zomwe zimayambitsa metabolic acidosis, maphunziro owonjezera akuchitika.

A acidosis yolinganizidwa mozama imapezeka popanda chizindikiro chilichonse, ndipo matendawa amakhala mwa kuwunika machitidwe amkati a magazi, mkodzo, ndi zina.

Ndi kuwonongeka kwa acidosis, kusokonezeka kumachitika kumbali ya ubongo, mtima ndi mitsempha yamagazi, kugaya chakudya, komwe kumalumikizidwa ndi ischemic-dystrophic njira motsutsana ndi maziko a hypoxia ndi kudzikundikira kwa asidi ochulukirapo. Kuwonjezeka kwa kuchuluka kwa mahomoni a adrenal medulla (adrenaline, norepinephrine) kumapangitsa tachycardia, matenda oopsa.

Wodwala ndi kuwonjezeka kwa mapangidwe a catecholamines amakumana ndi palpitations, amadandaula pakuwonjezeka kwa kugunda kwa mtima komanso kusinthasintha kwa kuthamanga kwa magazi. Pamene acidosis imakulirakulira, arrhythmia imatha kujowina, nthawi zambiri kupindika kwa bronchi kumachitika, chinsinsi cha m'mimba chimbudzi chikukula, kotero kusanza ndi kutsegula m'mimba kumatha kukhala chimodzi mwazizindikiro.

Zotsatira za acidization zamkati mwazinthu zokhudzana ndi ubongo zimadzetsa kugona, kutopa, kufooka, chidwi, mutu. Muzovuta kwambiri, chikumbumtima chovulala chimawoneka ngati chikomokere (mwachitsanzo mellitus, mwachitsanzo), pomwe wodwala sayankha kukhudzidwa kwakunja, ophunzirawo amachepetsedwa, kupuma kumakhala kochepa komanso kosazama, kamvekedwe ka minofu ndi kusakhazikika.

Ndi kupuma acidosis, mawonekedwe a wodwalayo amasintha: khungu limasintha mtundu kuchokera ku cyanotic kukhala pinki, limakutidwa ndi thukuta lomata, kuwongola nkhope kumawonekera. Mu magawo oyamba kupuma acidosis, wodwalayo amatha kusokonezeka, euphoric, kuyankhula, komabe, ndi kudzikundikira kwa zinthu za acidic m'magazi, machitidwewo amasintha kukhala opanda chidwi, kugona. Decompensated kupuma acidosis kumachitika ndi stupor ndi chikomokere.

Kuwonjezeka kwa kuya kwa acidosis mu matenda a kupuma kwamthupi kumayendetsedwa ndi hypoxia mu minofu, kuchepa kwa chidwi chawo ndi mpweya, komanso kupsinjika kwa malo opumira mu medulla oblongata, pomwe kusinthana kwa mpweya m'mapapu parenchyma kumayamba kuchepa.

Kagayidwe kamalumikizidwa ndi kupumula kwamakina a acid-base usawa. Wodwala wawonjezera tachycardia, chiwopsezo cha kusokonezeka kwa mtima, ndipo ngati chithandizo sichinayambike, chikomokere chimatha ndi chiopsezo chachikulu cha kufa.

Ngati acidosis imayambitsidwa ndi uremia poyambanso kulephera kwa impso, ndiye kuti matendawa akhoza kuphatikizira kupweteka kwa kupindika kwa calcium m'magazi. Ndi kuwonjezeka kwa urea m'mwazi, kusowa kupuma kudzakhala phokoso, fungo la ammonia lidzaonekera.

Mkhalidwewu ulibe zizindikilo zilizonse. Kusintha kwa acidity kumayendetsedwa ndi kuchuluka kwa zizindikiro zosiyanasiyana, zomwe zimakhala zovuta kuzolana. Ichi ndichifukwa chake zimakhala zovuta kudziwa matenda kunyumba.

Mawonekedwe wamba omwe amawonekera ndi mtundu uliwonse wa matendawa ndi monga:

Nthawi zambiri mseru ndi kusanza, pambuyo pake palibe kusintha kwa thanzi,
Zofooka zakuthwa zomwe zimakakamiza wodwala kuti azigona,
Maonekedwe a dyspnea pakupuma. Munthu sangathe "kupuma", chifukwa chake kupuma kwake kumachitika pafupipafupi,
Khungu la pakhungu ndi ma mucous nembanemba (maso, pakamwa ndi m'mphuno),
Maonekedwe a thukuta lozizira pakhungu,
Kuchepetsa kutentha kwa mtima ndikuchepetsa kuthamanga kwa magazi,
Mwinanso kukulitsa khunyu, chizungulire chachikulu ndi kutaya chikumbumtima (mpaka chikomokere).

Monga tanenera, kusintha kwa acidity sikuchitika zokha. Matendawa nthawi zonse amatsogozedwa ndi matenda ena. M'mawu osavuta, tinganene kuti kuwonongeka kwakuthwa chifukwa cha matenda chifukwa cha matenda nthawi zambiri kumakhala chizindikiro choyamba. Pankhaniyi, ndikofunikira kuyitanitsa gulu la ambulansi, lomwe lidzayesetse vutoli ndipo ngati kuli koyenera, gonekerani kuchipatala. Ku chipatala, madokotala akhazikitsa matenda omaliza, ndikupanga maphunziro ofunikira komanso njira zochizira.

Mitundu yotsatirayi ya zovuta imasiyanitsidwa molingana ndi njira zomwe zimapangidwira kukula kwa acidosis:

Osapuma acidosis,
Repiratory acidosis (mpweya wambiri ndi mpweya wambiri)
Mtundu wosakanizika wa acidosis (vuto lomwe limayambitsidwa ndi mitundu yosiyanasiyana ya acidosis).

Non-kupumula acidosis nayenso ikukhudzidwa ndi magulu otsatirawa:

Excretory acidosis - chikhalidwe chomwe chimayamba pakakhala kuphwanya kwa ntchito pochotsa zidulo m'thupi (kuwonongeka kwa impso),
Metabolic acidosis ndiye mkhalidwe wovuta kwambiri womwe umadziwika ndi kudzikundikira kwa ma acid amkati mwa thupi lathu,
Exo native acidosis ndi gawo lowonjezera ndende ya asidi chifukwa cha kuyamwa kwa zinthu zambiri zomwe zimasinthidwa kukhala ma acid panthawi ya kagayidwe.

Malinga ndi mulingo wa pH, acidosis imatchulidwa kuti:

Zolipidwa
Zolipidwa
Idalipira.

Zambiri

Lactic acidosis ku Latin imatanthawuza "lactic acid". Vutoli limatchulidwanso kuti lactacidemia, lactic coma, hyperlactatacidemia, lactic acidosis. Mu ICD-10, matenda am'mimba amaperekedwa ku gulu la zovuta zamagulu amchere wamchere ndi acid-base (kalasi - matenda a Endocrine system). Ili ndi vuto losowa kwambiri. Zomwe ziliri zenizeni sizinadziwike, koma zapezeka kuti pafupifupi theka la ovutikawo amapezeka mwa odwala omwe amapezeka ndi matenda a shuga. Pakati pagulu la odwala, malinga ndi kafukufuku wakunja, pafupipafupi lactic acidosis ndi 0.006-0.008%. Kukula kwa zovuta sikudalira kuti ndi amuna kapena akazi, kumakhala kolembetsedwa kwambiri mwa anthu azaka 35 mpaka 84.

Zimayambitsa Lactic Acidosis

Lactic acidosis imatha kupangidwa chifukwa cha kuchuluka kwa lactate, kusakwanira kwake kudzera mu impso tubules komanso / kapena kusokonezeka kwa metabolic mu chiwindi, momwe kuwonongeka kwa pyruvate komanso mapangidwe a glucose osakanikirana ndi mankhwala osagwirizana ndi carbohydrate. Zomwe zimayambitsa ma metabolic akusuntha ndi:

Herederal matenda a kagayidwe. Pali mtundu wa acidosis wofunitsitsa. Ndi izo, kuphwanya kumawonedwa pamlingo wa michere yofunika ya metabolism ya carbohydrate, zizindikiro zimawonedwa pambuyo pobadwa.
Matenda a shuga. Nthawi zambiri kudzikundikira kwa lactate kumachitika chifukwa cha kugwiritsidwa ntchito kwa Biguanides - mankhwala a hypoglycemic. Kuopsa kwa kuphwanya kumawonjezeka ndi kuchepa kwa chiwindi ndi impso, kuperewera kwa mpweya m'matumbo a minofu mutatha kuchita masewera olimbitsa thupi, kupuma kwa syndromes, kuchepa kwa vitamini, kumwa mowa, komanso kutenga pakati.
Matenda a mtima. Lactacidemia imapangidwa m'mitsempha yama mtima, imalemedwa ndi mavuto azungulire, pambuyo pa mtima kugwiritsa ntchito AIK, ndi sepsis, hypovolemic ndi cardiogenic mantha ndi DIC. Zizindikiro za acidosis zikuchulukirachulukira.
Momwe mungakhazikitsire. Lactic acidosis imatha kudwala khansa (makamaka ndi pheochromocytoma), mwa odwala omwe ali ndi chikomokere. Vutoli limapangidwanso chifukwa cha zotupa zambiri za impso ndi chiwindi.
Intoxication. Chiwopsezo cha lactic acidosis chimawonjezeka ndi uchidakwa. Kwa omwe kudya kwa carbon monoxide, ethylene glycol, methanol, mchere wa salicylic ndi hydrocyanic acid, mankhwala ena a chlorides.

Lactic acidosis amadziwika ndi kulimbikira kwamphamvu kwa lactic acid, ochepa magazi acidization. Lactic acid ndi gwero lamphamvu, koma, mosiyana ndi glucose, kagayidwe kake kamapezeka anaerobically (popanda kuphatikiza okosijeni pazomwe zimachitika). Amapangidwa ndi maselo ofiira am'magazi, minofu yam'mimba, zotupa za pakhungu ndi dongosolo lamanjenje lamkati, impso, m'mimba mucous membrane, retina, ndi chotupa neoplasms. Kupititsa patsogolo kwa lactate nthawi zambiri kumachitika chifukwa cha hypoxia, pomwe kusintha kwa glucose kukhala adenosine triphosphate kumakhala kosatheka.

Kuphatikiza apo, lactic acidosis imachitika chifukwa chosagwiritsa ntchito acid ndi impso ndi chiwindi. Njira yayikulu yogwiritsira ntchito pathological ndi kuphwanya gluconeogeneis, komwe nthawi zambiri mkaka wa lactate umasinthidwa kukhala glucose kapena oxidized kwathunthu mu mawonekedwe a citric acid synthesis reaction. Njira yowonjezera yochotsera - chotseka kudzera mu impso - imayendetsedwa pomwe gawo lactic acid lofanana ndi 7 mmol / l. Ndi cholowa lactic acidosis, zolakwika zobadwa nazo mu kaphatikizidwe ka michere zofunika kuti ziwonongeke za pyruvic acid kapena kutembenuka kwa mankhwala osagwiritsa ntchito chakudya m'magazi.

Gulu

Wopeza (mtunduA). Nthawi zambiri chimatha pambuyo 35 zaka. Zimayambitsidwa ndikuphwanya kwa kuperekera kwa oksijeni ndi magazi ku zimakhala. Zizindikiro zamankhwala zokhala ndi metabolic acidosis zimawonedwa - Ntchito za CNS ndizolepheretsa, kupuma kwamphamvu komanso kugunda kwa mtima kumasintha. Ubale wolunjika pakati pa mulingo wa lactacidemia ndi zizindikiro zamitsempha zimayang'aniridwa. Ndi matenda a shuga, pamakhala kuthekera kwakukulu kokulira, kuchepa kwakukulu kwa kuthamanga kwa magazi.
Congenital (mtunduB). Amawonekera kuyambira pobadwa, nthawi zambiri kuyambira paubwana, amatanthauza mitundu yamatenda a metabolic. Kuyambira masiku oyamba amoyo, mitsempha ndi kupuma zimatsimikizika: myotic hypotonus, areflexia, stupefaction, dyspnea, polypnoea, zizindikiro za mphumu.

Zizindikiro za Lactic Acidosis

Mavuto

Lactic acidosis ndiwopseza kwambiri chifukwa cha chiwopsezo chachikulu cha matenda a edema ndi kufa. Mwayi waimfa umachulukirachulukira pakakhala kusowa kwa chithandizo chamankhwala pakubwera maola atangoyamba kumene kwa zizindikiro zoyambirira. Vascular hypotension ndi hypoxia ya ubongo imatsogolera pakupanga matenda osiyanasiyana a ubongo, kuchepa kwa mitsempha. Pambuyo pachimake nthawi, odwala amadandaula kwa nthawi yayitali, chizungulire. Pakhoza kukhala mawu osokoneza ndi kukumbukira, komwe kumafunikira njira zodzikonzera.

Lactic acidosis mankhwala

Therapy ya kobadwa nako mawonekedwe lacticacidemia ikuchitika magawo. Choyamba, kusinthana kwa acidotic mu pH bwino kumachotsedwa, pambuyo pake zakudya zapadera zimalembedwa: Matenda a gluconeogenesis amawongoleredwa ndi kudyetsa pafupipafupi kwa mwana wamafuta omwe amakhala ndi zakudya zopatsa thanzi, kusokonezeka kwa gawo la oxidation la pyruvate kumafuna kuchuluka kwa mafuta muzakudya, zomwe zili zawo ziyenera kufikira 70% ya zopatsa mphamvu za tsiku ndi tsiku. Chithandizo cha mitundu yotengedwa ya lactic acidosis imapangidwira kubwezeretsa bwino kwa electrolyte, kuphatikiza acidosis, hyperglycemia, dziko lodzidzimutsa komanso kuperewera kwa mpweya. Ndondomeko zotsatirazi zimachitika:

Hemodialysis, kulowetsedwa. Kuyeretsa magazi kunja kwa thupi ndiyo njira yothandiza kwambiri yolumikizira mkaka wa magazi m'thupi. Njira yothetsera shuga imaperekedwanso kudzera m'mitsempha. Mofananamo, jakisoni wa insulin amachitidwa. Kuphatikizika kotere kumapangitsa ntchito ya pyruvate dehydrogenase ndi glycogen synthetase enzymes.
Makina mpweya wabwino. Kuchotsa kwa kaboni monoxide wopangidwa chifukwa chophwanya mulingo wa pH kumachitika mwa njira yamagetsi yothandizira. Kuyambiranso kwamchere wa alkaline kumachitika pamene kuchuluka kwa mpweya wa mpweya m'madzi a m'magazi kumatsika mpaka 25-30 mm RT. Art. Makina amachepetsa ndende ya lactate.
Kumwa mankhwala a mtima. Mankhwala a gululi amalimbikitsa kulera kwa minofu ya mtima, kubwezeretsa mzere. Cardiac glycosides, adrenergic agents, omwe si glycoside cardiotonics amagwiritsidwa ntchito.

Zotsogola ndi kupewa

Zotsatira za lactic acidosis zimakonda bwino ndi chithandizo chokwanira cha matenda oyambitsidwa, kuperekera nthawi komanso kukwanira kwa kulowetsedwa.Izi zimatengera mtundu wa lactacidemia - kupulumuka ndikokwera pakati pa anthu omwe ali ndi mtundu wa A pathology (otenga). Kupewa kumachepetsa kupewa hypoxia, kuledzera, kulandira chithandizo choyenera cha matenda ashuga mosamalitsa pa mlingo wa munthu yemwe ali ndi biguanides komanso kutha kwawo pang'onopang'ono pokhapokha ngati pali ziwopsezo zamatenda omwe angayambitse pakati pawo (chibayo, chimfine). Odwala ochokera m'magulu omwe ali ndi chiopsezo chachikulu - okhala ndi matenda a shuga kuphatikiza pakati, kukalamba - ayenera kuwunika mosamala mkhalidwe wawo, pazizindikiro zoyambirira za kupweteka kwa minofu ndi kufooka amafuna uphungu.