Matenda a matenda ashuga: zoyambitsa, zizindikiro, zotsatira zake

Matenda a shuga ndi vuto lomwe limachitika ndi matenda a shuga. Vutoli limayamba kuthamanga. Kulephera kuchitapo kanthu mwadzidzidzi kumatha kudzetsa mavuto akulu azaumoyo ngakhale kufa. Chifukwa chake, ndikofunikira kuti aliyense wodwala matenda ashuga azindikire zomwe zimayambitsa matenda osokoneza bongo komanso zomwe ayenera kuchita akapezeka.

Mitundu ya Diabetesic Coma

Pali mitundu inayi ya chikomokere cha matenda ashuga: ketoacidotic, hyperosmolar, hyperlactacidemic ndi hypoglycemic.

Mtundu woyamba wa shuga umayamba ketoacidotic chikomokere. Zimachitika motsutsana ndi maziko osowa insulini komanso kukwera kwakuthwa kwa shuga m'magazi. Zotsatira zake, kuchuluka kwa glucose kumachepetsedwa, kagayidwe kake kamachepa, kugwira ntchito bwino kwa machitidwe onse ndipo ziwalo zina zimachitika. Ketoacidotic coma imayamba mkati mwa masiku 1-2 (nthawi zina mwachangu). Mlingo wa shuga pomwe chikomokere chimatha kufika 19-33 mmol / l ndikukwera pamwamba. Pakakhala kuti palibe nthawi yake, wodwala matenda ashuga amatha kukomoka kwambiri.

Matenda a 2 a shuga amayambitsa hyperosmolar coma. Mtunduwu umayambanso chifukwa chosowa insulini. Zimaphatikizidwa ndi kuchepa kwamphamvu kwa thupi ndi kuchuluka kwachuma, shuga ndi urea ion m'magazi. Mothandizidwa ndi hyperosmolarity, zovuta zazikulu zimachitika m'thupi la munthu, zomwe nthawi zambiri zimayendera limodzi ndi kusazindikira.

Mitundu iwiri yotsala ya chikomokere cha shuga imakhala yofanana pamitundu iwiri yonseyo. Hyperlactacidemic chikomokere Amayamba ndi kudzikundikira kwa lactic acid m'magazi. Cholinga chake ndikuchepa kwa insulin. Zotsatira zake zakupanga chikomokere, kupangika kwa magazi m'magazi kumasintha, mkhalidwe waumoyo umakulirakulirakulira, ndikuwopa kudziwa.

Mitundu yomwe yatchulidwa ndi chikomokere. Amachitika motsutsana ndi maziko akweza kwambiri magazi a shuga. Njira yosinthira imabweretsa chitukuko hypoglycemic chikomokere. Kupsinjika kumayamba ndi kuchepa kwa glucose wamagazi mpaka gawo lovuta. Izi zimabweretsa mphamvu yanjala yaubongo. Ndi chifuwa cha hypoglycemic, shuga wamagazi amatsika mpaka 3,33-2.77 mmol / lita. Mukanyalanyaza zizindikiro zomwe zimatuluka, kuchuluka kwa glucose kumatha kutsika mpaka 2.77-1.66 mmol / lita. Pankhaniyi, zizindikiro zonse za hypoglycemia zimawonekera. Wodwala wokhala ndi zizindikiro zotere ayenera kupita kuchipatala kuti akalandire chithandizo. Miyezo yovuta ya shuga - 1.66-1.38 mmol / lita - zimapangitsa kuti munthu asamadziwe. Thandizo ladzidzidzi la akatswiri okhawo lingapulumutse munthu.

Mtundu uliwonse wa chikomokere cha shuga umayambitsidwa ndi zomwe zimayambitsa.

Matenda a Hyperglycemic amayamba chifukwa cha kuchepa kwa insulin, komwe kumapangitsa kuti glucose achuluke msanga. Nthawi zambiri, zinthu zotsatirazi zingayambitse kuchepa kwa insulin:

mimba
matenda
kuvulala ndi kuchitapo kanthu,
ntchito kwa nthawi yayitali a glucocorticoids kapena okodzeya,
kuchita masewera olimbitsa thupi kwambiri komanso zochitika zovutitsa,
kulephera kudya, kusala kudya kwanthawi yayitali, kumwa mowa kwambiri.

Zomwe zimayambitsa ketoacidotic chikomachi ndi poyizoni ndi matupi a ketone ndi acetone. Kuperewera kwa insulin kumapangitsa kuti thupi liyambe kubwezeretsa mphamvu kuchokera ku mapuloteni ndi mafuta, osati kuchokera ku glucose. Munthawi yopanga mphamvu molakwika, ma ketones ndi acetone acetic acid amapangidwa pamiyeso yambiri. Kuchulukitsa kwawo kumatenga malo osungirako zamchere ndipo kumayambitsa ketoacidosis (metabolism yayikulu) komanso kusokonezeka kwa kagayidwe kazinthu kamadzi.

Kupitilira patsogolo kwa hyperosmolar coma kumatha kuchitika chifukwa chogwiritsa ntchito kwambiri diuretics, kutsegula m'mimba ndi kusanza kwa etymology iliyonse, nyengo yotentha ndi kutentha kwambiri kwa mpweya, peritoneal dialysis kapena hemodialysis, kukhetsa magazi kwa nthawi yayitali.

Lactacidemic chikomachi chimatha kuyambitsa mtima kapena kupuma. Kukomoka nthawi zina kumayamba ndi mphumu ya bronchial, bronchitis, kulephera kwa magazi, mtima pathologies. Nthawi zambiri chomwe chimayambitsa kukomoka ndi kutupa ndi matenda, chiwindi kapena matenda a impso. Odwala omwe ali ndi vuto lauchidakwa nthawi zonse amakhalanso pachiwopsezo.

Zomwe zimayambitsa kuperewera kwa hypoglycemic kukugona pakusowa kwa magazi. Vutoli lingayambitse kuchuluka kwa insulini kapena kutsitsa shuga m'mlomo. Nthawi zambiri hypoglycemia imachitika chifukwa choti munthu wodwala matenda ashuga atatha kudya insulin adaphonya chakudya kapena amadya chakudya chokwanira. Nthawi zina shuga wochepa amawoneka motsutsana ndi maziko a kuchepa kwa ntchito kwa adrenal kapena kulepheretsa mphamvu ya chiwindi. Chifukwa china cha kuperewera kwa hypoglycemic ndi ntchito yolimbitsa thupi.

Zizindikiro za kudwala matenda ashuga

Mtundu uliwonse wa chikomokere cha matenda ashuga uli ndi mawonekedwe ake. Ngakhale Zizindikirozi nthawi zambiri zimakhala zofanana, kuzindikira komaliza kumatha kupangidwa pambuyo pa kuyesedwa kwa maabara.

Hyperglycemic coma imayendera limodzi ndi zizindikiro zomwe zasonyezedwa pansipa.

Kuchulukitsa ludzu.
Kukodza pafupipafupi.
Kufooka kwapafupipafupi, komwe nthawi zambiri kumayendetsedwa ndi mutu.
Wosangalatsa mtima, wotsatira kugona.
Anachepetsa chilako.
Nusea (nthawi zina umatsatiridwa ndi kusanza).

Zina mwazowonjezera za hyperosmolar coma ndi kuchepa thupi, kusokonekera kwa kulankhula ndi areflexia (chizindikiro cha kukomoka).

Zizindikiro za ketoacidotic chikomokere pang'onopang'ono. Pankhaniyi, madokotala ali ndi mwayi chisanafike chovuta kuti achitire chithandizo chonse. Komabe, ngati wodwala matenda ashuga samalabadira zoyamba za matendawa, ndiye kuti kukula kwa vutolo, kuwonetseredwa ndi kupuma kwakuya komanso kwamkati, kupweteka kwam'mimba popanda kutulutsa kwina, kutha mphamvu, ndikotheka. Chizindikiro chodziwika bwino cha ketoacidotic chikomaso ndi kununkhira kwa acetone kuchokera mkamwa.

Lactacidemic coma, mosiyana ndi mitundu yapita, imayenda mofulumira kwambiri ndikuwonekera mu mawonekedwe a kugwa kwa mtima. Mwa zodziwika za kuperewera uku, munthu amatha kuwona kufooka komwe kakukula, kugona, kugona, komanso kusokonezeka kwa chikumbumtima.

Zizindikiro za chikomero cha hypoglycemic ndizosiyana pang'ono ndi zizindikiro za kukomoka kwa hyperglycemic. Izi zimaphatikizapo mantha, kuda nkhawa, thukuta kwambiri, kunjenjemera ndi kumva kwamphamvu njala. Ngati simuchita zinthu moyenera, thupi limatha kukulira: kufooka, kukomoka kumawonekera. Momwegee wa hypoglycemic coma ndimatha kuzindikira.

Pamaso pa matenda ashuga ana, oyambitsa chikomokere amakhala mutu, nseru komanso kusanza, kutaya chidwi (mpaka kusakhalapo kwake), ludzu lalikulu, kugona. Kukodza pafupipafupi, lilime lowuma ndi milomo ndizothekanso.

Thandizo loyamba

Kudziwa zizindikiro za matenda obwera chifukwa cha matenda ashuga kumathandizira kutha kwamtsogolo pakapita nthawi. Pa chizindikiro choyamba cha zovuta, ambulansi imayenera kuyitanidwa nthawi yomweyo. Asanachitike madokotala, wodwala matenda ashuga ayenera kupatsidwa chithandizo chodzidzimutsa. Choyamba, ikani wodwala kumbali yake kapena pamimba pake. Tsatirani lilime, onetsetsani kuti sil kumira ndipo sakupumira. Lolani mpweya watsopano kulowa m'chipinda cha odwala matenda ashuga.

Kupitilira apo, pamitundu yosiyanasiyana ya matenda a shuga, njira zamasamaliro ndizosiyana pang'ono. Ndi mtundu wa hyperosmolar, kukulani ndikusambitsa miyendo ya wodwala. Yang'anani kuchuluka kwa shuga ndi glucometer, kuyesa mkodzo ndi mzere wa mayeso a ketone. Palibe chochita china chofunikira. Yembekezerani ambulansi ifike.

Mitundu ya Ketoacidotic ndi lactacidemic ya kukomoka imafunikira kulowerera mwachangu ndi akatswiri. Potere, sizigwira ntchito poletsa kukula kwa mpungwepungwe mwa kuyesayesa pawokha. Chomwe mungachite ndikuwunika momwe wodwala amapumira komanso kugunda kwa mtima mpaka dokotala atafika.

Ndikokhala ndi vuto la hypoglycemic, ndikofunikira kupereka chithandizo chodzidzimutsa mwachangu kwambiri. Nthawi zambiri mawonekedwe ofatsa samatsagana ndi kutayika kwa chikumbumtima. Pankhaniyi, wodwalayo amatha kutenga payekha njira zoyenera. Pazizindikiro zoyambirira za kusowa kwa magazi, muyenera kudya pang'ono pang'onopang'ono chakudya (mkate, pasitala), kumwa tiyi ndi shuga kapena kusungunuka mapiritsi 4-5 a shuga. Hypoglycemia yayikulu imapangitsa kukomoka kwambiri. Ndi zochitika izi, wogwiridwayo sangathe popanda thandizo lakunja. Ngati wodwala ali ndi vuto la kumeza, imwani ndi madzi aliwonse okoma (osamwa zakumwa ndi zotsekemera za izi). Pakakhala kuti pakumenyetsa zinthu zowuma, ikani shuga pang'ono pansi pa lilime.

Kumbukirani: ndi mtundu uliwonse wa chikomokere cha matenda ashuga, insulin siyololedwa popanda chilolezo cha dokotala.

Pambuyo pachipatala muukoma wa matenda ashuga, cholinga chachikulu cha madotolo ndicho kusintha mtundu wa shuga m'magazi komanso kagayidwe kake ka thupi lonse. Chithandizo chimachitika moyang'aniridwa ndi achipatala ndipo amakhala ndi magawo angapo. Choyamba, wodwalayo amapatsidwa mlingo wa insulin (vuto la hypoglycemia, shuga liyenera kuperekedwa). Kenako, kulowetsedwa mankhwala ikuchitika ndi njira zapadera kuti abwezeretse madzi bwino, electrolyte kapangidwe ndi kusintha magazi acidity. Pambuyo masiku angapo chithandizo, wodwalayo amasamutsidwa ku dipatimenti ya endocrinology ndikusungidwa m'chipatala mpaka mkhalidwe ukhazikika.

Ndikofunika kukumbukira kuti chithandizo chanthawi yake komanso chithandizo chamankhwala chothandiza chingathandize kupewe mavuto omwe amakhalapo chifukwa cha matenda ashuga: kupuwala, edema, kugunda kwa mtima, sitiroko, sepsis, chikomokere kapena kufa.

Matenda a shuga ndi vuto lalikulu la matenda ashuga. Chifukwa chake, odwala matenda ashuga ayenera kukumbukira kuti kudziletsa kokha, kutsata kulemera, kutsatira malamulo okhudzana ndi zakudya, kuchita masewera olimbitsa thupi pafupipafupi komanso kukana kumwa mankhwalawa kungathandize kukhala ndi moyo wonse komanso kupewa kutuluka kwa mkhalidwe wowopsa.

Zosiyanasiyana

Matenda a shuga ndi awa:

ketoacidotic,
hyperosmolar
lactic acididemic,
hypoglycemic.

Zomwe zimayambitsa kupita patsogolo mumtundu uliwonse wa chikoma ndizosiyana. Chifukwa chake, chomwe chimayambitsa kupita patsogolo kwa chikomokere kwa hyperosmolar ndikuwonjezereka msanga kwa kuchuluka kwa shuga m'magazi motsutsana ndi maziko am'madzi. Izi ndizosiyanasiyana mtundu wa 2 shuga.

Chomwe chimapangitsa kuti ketoacidotic chikulire chikhale ndi kuchuluka kwa ma acid omwe amatchedwa ma ketones m'thupi la munthu. Zinthu izi ndi zinthu za metabolism zamafuta, ndipo zimapangidwa chifukwa chosowa insulini kwambiri. Mtundu wamtunduwu umayenda bwino ndi matenda ashuga amtundu woyamba.

Lactic acid coma ndiye vuto lalikulu kwambiri la matenda ashuga, omwe amapita patsogolo motsutsana ndi zovuta za mtima, mapapu, ndi chiwindi. Zingathenso kuyamba ngati wodwala akuledzera.

Chomwe chikukula kwambiri kwa kuchepa kwa hypoglycemic nchakuti kuchepa kwambiri kwa shuga m'magazi. Vutoli limachitika kawirikawiri ndi matenda amtundu 1 shuga. Zomwe zimapangitsa kuchepa kwa shuga ndizakudya zosafunikira kapena kuyambitsa insulin yambiri.

Zizindikiro

Mtundu uliwonse wamtundu uli ndi zizindikiro zake. Ndikofunikira kudziwa onse a iwo, kuti zizindikiro zoyambirira zikaonekera, nthawi yomweyo ayambe kupatsa odwala chithandizo chodzidzimutsa. Kuzengeleza kukhoza kumutaya moyo wake.

Zizindikiro za hyperosmolar coma:

kusowa kwamadzi kwambiri
ntchito yolakwika
kubweza
kugona
ludzu
Pakadutsa masiku angapo asanadutse, wodwalayo amakhala ndi vuto lofooka,
kuyerekezera
kamvekedwe ka minofu kakuchuluka,
kukomoka ndikotheka
osangalatsa. Chizindikiro cha kukhazikika kwa chikomokere. Wodwala amatha kusowa zinthu zina.

Zizindikiro za ketoacidotic chikomokere kuonekera wodwala pang'onopang'ono. Nthawi zambiri zimatenga masiku angapo. Koma pankhaniyi, kuyenda pang'onopang'ono "kuli pafupi" kwa madotolo, chifukwa isanayambike chikumbumtima pali nthawi yoti muzindikire zomwe zimawoneka ndikuchita chithandizo chokwanira.

Zizindikiro zamtunduwu wamtunduwu:

nseru ndi kusanza zotheka
polyuria
ludzu
kufooka
kugona

Wodwala akamakula, chipatalachi chimathandizidwa ndi zizindikiro:

kupuma kumakhala kwakuya komanso kaphokoso kwambiri
kusanza kwambiri
kupweteka kwapweteka pamimba, komwe sikamvetseka bwino,
kubweza
chizindikiritso cha mtundu uwu wa chikomacho ndi mawonekedwe a fungo la asetoni kuchokera mkamwa,
chikumbumtima.

Mosiyana ndi ketoacidotic coma, lactic acidemia imapita patsogolo mwachangu. Chipatalachi chimawonetsedwa makamaka ndi kugwa kwa mtima. Zizindikiro zotsatirazi zimapezekanso:

kufooka kwakula msanga
nseru ndi kugwedezeka
kukomoka
kupweteka pamimba,
zamkhutu
chikumbumtima.

Zizindikiro za hypoglycemic coma:

kunjenjemera
mantha
nkhawa zazikulu
kutuluka thukuta kwambiri
kufooka wamba
kumva kwamphamvu njala
kukokana
kulephera kudziwa.

Oletsa kudwala matenda ashuga ana:

kugona
Mutu wamisempha yosiyanasiyana,
nseru ndi kugwedezeka
kusowa kwa chakudya mpaka pomwe palibe,
ludzu lalikulu
polyuria
lilime ndi milomo.

Ngati chithandizo chodzidzimutsa sichinaperekedwe, ndiye kuti kupuma kwa mwana kudzakhala kwakuya komanso kwamkokomo, kuthamanga kwa magazi kumachepa pang'onopang'ono, kugunda kwa mtima kumawonjezeka, kufalikira kwa khungu kumatsika ndipo chikomokere chidzachitika.

Thandizo lodzidzimutsa la odwala matenda ashuga

Ngati mukudziwa zizindikiro za chikomokere cha matenda ashuga, ndiye kuti mutha kupewa kupitilira kwake pakapita nthawi. Ndikofunikira, zikafika, kuyimbira ambulansi nthawi yomweyo ndikupereka chithandizo chamankhwala okhudzana ndi matenda ashuga asanafike. Njira zothandizira mitundu yosiyanasiyana ya chikomizo ndizosiyana pang'ono.

Kuthandiza ndi hyperosmolar coma:

wodwala amatembenukira kumbali yake,
yang'anani lilime lanu kuti lisagwe,
kupereka mpweya wabwino.

Ngati muli ndi vuto la ketoacidotic, ndikofunikira kuyimbira foni dokotala, chifukwa sizotheka kupewa izi palokha. Asanafike, ndikofunikira kuyang'anitsitsa kupumira komanso kugunda kwa mtima wa womenyedwayo. Njira zomwezi zimagwiritsidwa ntchito pakukula kwa lactic acidic chikomokere.

Ngati mawonetseredwe a zizindikiro za kuyambika kwa vuto la hypoglycemic, muyenera kupatsa wodwalayo shuga kapena kupanga tiyi wokoma.

Njira zochizira

Chithandizo cha matenda a zam'magazi chili ndi magawo anayi:

chithandizo cha insulin mwadzidzidzi
kusintha kwa madzi mthupi la munthu,
kusintha kwa mulingo wa michere ndi ma electrolyte,
matenda ndi chithandizo choyenera matenda omwe anakhumudwitsa.

Cholinga choyambirira cha kulandira chithandizo ndikusintha shuga mumagazi. Komanso, njira yochizira imathandizidwa ndi kulowetsedwa. Wodwalayo amapatsidwa njira zosalimba zomwe zimathetsa kusowa kwamadzi.

Chithandizo cha matenda a zamitsempha chimachitika pokhapokha pokhapokha ndikuyang'aniridwa ndi madokotala. Ndikofunika kukumbukira kuti ichi ndi chowopsa kwambiri kuti, popanda kulandira mankhwala moyenera panthawi yake, chitha kupha. Chifukwa chake, nthawi zambiri chithandizo chimachitika mothandizanso kutsitsimuka.

Zoyambitsa ndi Zoopsa

Chifukwa chachikulu chomwe chitukuko cha matenda a shuga chikuyendera ndi kuchepa kwa insulin m'thupi la odwala matenda ashuga. Izi sizimangowonjezera kuchuluka kwa shuga m'magazi, komanso kuchepa kwa mphamvu ya zotumphukira zomwe sizingatenge glucose popanda insulin.

Kuchulukitsa kwa hyperglycemia kumafuna kuwonjezeka kwa kuthamanga kwa osmotic mu madzi akunja kwa madzi am'mimba komanso kuchepa kwa magazi mkati. Zotsatira zake, osmolarity wamagazi amawonjezeka, kuopsa kwa hypoglycemia kumawonjezeka, komwe kumayambitsa chitukuko cha dziko logwedezeka.

Matenda a shuga ndi matenda oopsa omwe angayambitse zovuta zowopsa m'moyo.

Kuperewera kwa insulin kumalimbikitsa kusuntha kwa mafuta acids kuchokera ku minofu ya adipose, yomwe imayambitsa kupangika kwa matupi a ketone m'maselo a chiwindi (beta-hydroxybutyric acid, acetoacetate, acetone). Kupanga kwambiri matupi a ketone okhala ndi asidi kumabweretsa kuchepa kwa kuchuluka kwa bicarbonate ndipo, motero, kuchuluka kwa pH kwa magazi, ndiye kuti metabolic acidosis imapangidwa.

Ndi kukula kwa hyperglycemia, kuchuluka kwambiri kwa magazi m'magazi kumachitika, zomwe zimayambitsa kuphwanya kwa impso (excretory) ya impso. Zotsatira zake, odwala amakhala ndi hypernatremia, hyperosmolarity yowonjezereka. Komanso, milingo ya bicarbonates ndi pH imakhalabe yochepa, popeza ketoacidosis palibe.

Chifukwa cha kusowa kwa insulin mu shuga, ntchito ya pyruvate dehydrogenase, enzyme yomwe imayambitsa kusintha kwa pyruvic acid kukhala acetyl coenzyme A, imachepa. Izi zimapangitsa kuchuluka kwa pyruvate ndikusintha kwake kukhala lactate. Kuchulukitsa kwakukulu kwa lactic acid mthupi kumayambitsa acidosis, komwe kumatseketsa ma adrenergic receptors a mtima ndi mitsempha yamagazi, kumachepetsa ntchito ya contractile ya myocardial. Zotsatira zake, kukomoka kwambiri kwa dysmetabolic ndi cardiogenic kumayamba.

Zinthu zotsatirazi zingayambitse kudwala matenda ashuga:

zolakwika zazikulu za chakudya (kuphatikiza kuchuluka kwa chakudya chamagulu m'zakudya, makamaka zosavuta kugaya),
kuphwanya chiwembu cha insulin kapena kumwa mankhwala ochepetsa shuga,
mankhwala osankhidwa bwino a insulin,
mantha akulu,
matenda opatsirana
othandizira opaleshoni
kutenga pakati komanso kubereka mwana.

Mitundu yamatenda

Kutengera mawonekedwe a kuperewera kwa kagayidwe kachakudya, mitundu iyi ya chikomokere cha diabetes imasiyanitsidwa:

Ketoacidotic chikomokere - chifukwa cha poizoni wakuthupi komanso makamaka dongosolo lamanjenje lamatumbo ndimatumbo a ketone, komanso kuwonjezeka kwa kusokonezeka pamagetsi amagetsi a electrolyte komanso acid-base.
Hyperosmolar hyperglycemic non-ketone coma ndi zovuta za mtundu II shuga mellitus, wodziwika ndi kutchulidwa kwakuthupi komanso kusowa kwa ketoacidosis.
Hyperlactacidemic chikomokere. Matenda a shuga sindiwo okha omwe amachititsa kuti lactic acid ikhale m'thupi la wodwalayo - monga lamulo, mankhwala osokoneza bongo a Biguanides (mankhwala a hypoglycemic) amakhala chifukwa cha lactic acidosis.

Imfa mu ketoacidotic chikomokere ukufika 10%. Ndi hyperosmolar hyperglycemic non-ketone coma, chiwopsezo cha kufa pafupifupi 60%, ndi hyperlactacidemic coma - mpaka 80%.

Mtundu uliwonse wa chikomokere cha matenda a shuga umadziwika ndi chithunzi cha matenda. Zizindikiro zazikulu za hyperosmolar hyperglycemic non-ketone coma ndi:

polyuria
kutulutsa madzi,
kuchuluka kwamisempha,
kukokana
kuchuluka kugona
kuyerekezera
cholakwika ntchito.

Ketoacidotic chikomokere chimayamba pang'onopang'ono. Imayamba ndi nthawi yayitali, yowonetsedwa ndi kufooka kwakukulu, ludzu lalikulu, nseru, komanso kukodza pafupipafupi. Ngati thandizo lofunikira siliperekedwa pano, vutoli limakulirakulira, zizindikiro zotsatirazi zimachitika:

kusanza kosamveka
kupweteka kwambiri pamimba
kupuma kwamphamvu
Kununkhira kwa maapulo oyamba kapena ma acetone ochokera mkamwa,
kubweza mpaka kuchotsedwa kwathunthu kwa chikumbumtima.

Hyperlactatacidemic coma imakula mofulumira. Zizindikiro zake:

kufooka kwakula msanga
kukoka kwamanyazi (pafupipafupi, kudzaza kofooka),
dontho mu kuthamanga kwa magazi
khungu loyera,
kusanza, kusanza,
kuda nkhawa mpaka kutayika kwathunthu.

Zomwe zimachitika ndi matenda a shuga

Matenda a matenda ashuga nthawi zambiri amawonekera pakati pa ana asukulu zamisukulu yakusukulu komanso odwala kusukulu omwe akudwala matenda ashuga. Kukula kwake kumayendetsedwa ndi mkhalidwe wa pathological wotchedwa precoma. Mwachidziwitso, zimadziwonetsa:

nkhawa, yomwe yasinthidwa ndi kugona.
mutu
cramping m'mimba ululu
kusanza, kusanza,
kuchepa kwamtima
polyuria
malingaliro olimba a ludzu.

Matenda a metabolic akachuluka, kuthamanga kwa magazi kumachepa, ndipo kugunda kwamkati kumawonjezeka. Mpweya umakhala wakuya ndikuwomba. Khungu limataya kuchepa kwake. Muzovuta kwambiri, chikumbumtima chimatha.

Makanda, odwala matenda ashuga amakula msanga, kudutsa mtundu wa matenda. Zizindikiro zake zoyambirira:

kudzimbidwa
polyuria
polyphagy (mwana amafunitsitsa bere ndi kuyamwa, ndikupumira pafupipafupi)
ludzu lochulukirapo.

Zikauma, ma diap amakhala olimba akamayanika, omwe amalumikizidwa ndi mpweya wambiri mumkodzo (glucosuria).

Zizindikiro

Chithunzi chamankhwala cha odwala matenda ashuga sichowonekera nthawi zonse. Chofunika kwambiri pakuwazindikira ndi kafukufuku wa zasayansi yemwe amatsimikiza:

mulingo wa glycemia
kupezeka kwa matupi a ketone m'magazi am'magazi,
wamagazi magazi pH
kuchuluka kwa ma electrolyte mu plasma, makamaka sodium ndi potaziyamu,
phindu la plasma osmolarity,
mafuta acid msinkhu
kukhalapo kapena kusowa kwa acetone mu mkodzo,
seramu lactic acid ndende.

Chifukwa chachikulu chomwe chitukuko cha matenda a shuga chikuyendera ndi kuchepa kwa insulin m'thupi la odwala matenda ashuga.

Odwala odwala matenda ashuga amathandizidwa m'chipinda chothandizira odwala. Njira zochizira matenda amtundu uliwonse zimakhala ndi zake. Chifukwa chake, ndi ketoacidotic chikomokere, mankhwala a insulini ndikukonzanso kwamadzi-electrolyte ndi vuto la acid-base limachitika.

Therapy ya hyperosmolar hyperglycemic non-ketone coma imaphatikizapo:

intravenous makonzedwe a kuchuluka kwa hypotonic sodium kolorayidi njira hydration,
mankhwala a insulin
mtsempha wa magazi a potaziyamu mankhwala enaake omwe amayang'aniridwa ndi ECG ndi ma elekitirodi a magazi,
kupewa matenda a edema (mtsempha wa magazi makonzedwe a glutamic acid, oksijeni mankhwala).

Chithandizo cha hyperlactacidemic chikomachi chimayamba ndi kulimbana ndi kuchuluka kwa lactic acid, komwe njira ya sodium bicarbonate imayendetsedwa kudzera m'mitsempha. Kuchuluka kwa yankho, komanso kuchuluka kwa oyang'anira, amawerengedwa pogwiritsa ntchito njira zapadera. Bicarbonate imayendetsedwa molamulidwa ndi potaziyamu ndende ndi magazi pH. Pofuna kuchepetsa kuopsa kwa hypoxia, mankhwala a oxygen amachitika. Odwala onse omwe ali ndi lactacidemic coma amawonetsedwa ndi insulin - ngakhale ali ndi shuga.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Matenda a shuga ndi matenda oopsa omwe angayambitse zovuta zowopsa:

Hypo- kapena hyperkalemia,
chibayo,
kupuma mavuto syndrome
matenda edema,
pulmonary edema
thrombosis ndi thromboembolism, kuphatikizapo pulmonary thromboembolism.

Matenda a matenda obwera ndi matenda ashuga ndiwofunika. Imfa za ketoacidotic chikomaso ngakhale m'malo apadera zimafikira 10%. Ndi hyperosmolar hyperglycemic non-ketone coma, kuchuluka kwaimfa kuli pafupifupi 60%. Imfa yayikulu kwambiri imawonedwa ndi hyperlactacidemic coma - mpaka 80%.

M'mabuku azachipatala, milandu imafotokozeredwa pomwe wodwala anali atadwala zaka zopitilira 40.

Kupewa

Kupewa kukomoka kwa matenda ashuga kumayeneranso kulipira kwambiri anthu odwala matenda ashuga:

kutsatira zakudya zokhala ndi malire a chakudya,
zolimbitsa thupi zolimbitsa thupi
kupewa masinthidwe amodzi motsatira malamulo a insulini kapena kumwa mankhwala a hypoglycemic okhazikika ndi endocrinologist,
munthawi yake chithandizo cha matenda opatsirana,
Kukonzekera kwa insulin mankhwala mu ntchito nthawi ya amayi apakati, puerperas.

Kodi kudwala matenda ashuga ndi chiyani?

Matenda a shuga ndi odwala kwambiri. Zimayambitsa kuphwanya njira zonse za metabolic mthupi. Pamaso pa zinthu zina zomwe zimayambitsa mavuto, chikomokere chimatha kukhala ndi insulin komanso osadalira insulin. Ndipo zilibe kanthu kuti azilandira kapena sanapezekepo.

Zomwe zimayambitsa matenda A shuga A Coma

Zomwe zimapangitsa kuti pakhale odwala matenda ashuga atha kukhala kuchedwa kwa insulin kapena kukana kugwiritsa ntchito mankhwalawo, cholakwika chake pakupereka mankhwala a insulini ndi mlingo wosankhidwa bwino, kulowetsedwa kwa mtundu wina wa insulin ndi wina, komwe wodwalayo sanamvere.

Kuphwanya zakudya kwambiri mu matenda ashuga kungayambitsenso kukula ngati wodwala watha shuga wambiri kuposa momwe amafunikira, matenda ena akuluakulu (kuphatikizapo opatsirana), manjenje amanjenje, pakati komanso pobereka.

Zizindikiro za kudwala matenda ashuga

Pa gawo loyamba la matenda okhudzana ndi matenda ashuga, odwala amadwala matenda a shuga a ketoacidosis, zomwe zimadziwika ndi izi: pakamwa lowuma ndi ludzu losaletseka, polyuria, pang'onopang'ono imasandulika kukhala anuria. Pali zizindikiro za kuledzera kwa thupi m'njira yowonjezera kufooka, kuchuluka kwa kutopa, kuwonjezereka mutu, nseru ndi kusanza.

Ngati chithandizo sichinayambike pa nthawi, ndiye kuti dyspeptic syndrome imakulitsidwa, kusanza kumachitika mobwerezabwereza ndipo sikubweretsa mpumulo, pamakhala ululu wam'mimba wamitundu ingapo yamphamvu, pamakhala matendawa kapena kudzimbidwa. Kugona, ulesi, kusayang'anira kukukula, odwala asokonezeka munthawi ndi malo, chikumbumtima chimasokonezeka. Mlengalenga watha, kununkhira kwa acetone kumamveka, khungu limakhala louma, kuthamanga kwa magazi, tachycardia, kupuma kwamiseche kwa Kussmaul kumayamba. Zodumphazo ndi stupor zimasinthidwa ndi chikomokere.

Zotsatira za kuperewera kwa shuga

Kuwonjezeka kwakukulu kwamagazi a shuga m'magazi ndipo, monga chotulukapo chake, kukhala ndi vuto la minofu kumayambitsa kusintha kwamatenda m'thupi. Kupanga matenda a shuga a shuga (kuwonjezeka kwamkodzo tsiku ndi tsiku) kumabweretsa kuchepa kwamadzi, ngakhale kuti kuchuluka kwa madzi omwe amamwa ndi odwala kumawonjezeka. Kuchuluka kwa magazi omwe amayenderera m'matumbo kumachepa chifukwa cha izi, ndipo kupanikizika kumatsika kwambiri, zomwe zimayambitsa kuphwanya kwa trophism ya ziwalo zonse ndi minofu, kuphatikizapo ubongo.

Pamodzi ndi madzi, ma electrolyte nthawi zambiri amachotsedwa m'thupi. Choyamba, awa ndi macronutrients monga potaziyamu ndi magnesium, zomwe zimabweretsa kusokonezeka kwakukulu pakugwira ntchito kwa ziwalo zonse ndi machitidwe. Kuti alipire kuchuluka kwa glucose ochulukirapo, zimakhala kuti thupi limayamba kugwetsa masitolo ogulitsa mafuta ndi glycogen. Pankhaniyi, kuchuluka kwa matupi a ketone ndi lactic acid m'magazi kumawonjezeka kwambiri, hyperacidosis imayamba.