Ngati mu matenda a shuga a m'mellitus amapangika pansi pomwe lactic acid imadziunjikira kwambiri mu minofu ndi magazi, lactic acidosis imatheka. Imfa zikafika izi ndizapamwamba kwambiri, zimafika 90%. Chifukwa chake, odwala matenda ashuga ayenera kudziwa tanthauzo - lactic acidosis. Ndikofunika kuti amvetsetse kuti, ndani amakulitsa, komanso momwe angapewerere kuti zisachitike.
Zifukwa zachitukuko
Gulu lamavuto limaphatikizapo odwala omwe ali ndi matenda ashuga azaka zopitilira 50. Monga lamulo, matenda awo oyambira amavutitsidwa ndi chiwindi, mtima kapena kulephera kwaimpso. Mwachindunji lactate acidosis pa se sichimachitika. Amayamba nthawi imodzi ndimadwala matenda ashuga.
Lactic acid imatha kudzikundikira mbali zosiyanasiyana za thupi: khungu, mafupa a mafupa, ndi ubongo. Kuchulukitsa kwake kumapangidwa ndi katundu wochepa kwambiri: chizindikiro ndikumva kuwawa ndi kuwonongeka kwa minofu. Ngati zosagwira bwino ntchito zikuwonedwa m'thupi, ndiye kuti asidi wambiri amalowa m'magazi.
Nthawi zambiri zimawonedwa mwa anthu odwala matenda ashuga, omwe ayenera kudziwa zonse zokhudza lactic acidosis: zomwe zimayambitsa maonekedwe, momwe zimakhalira. Zomwe zimapangidwira kwambiri lactic acid kuwonjezera pa zochitika zolimbitsa thupi zimaphatikizapo:
- kuvulala kovuta;
- mawonekedwe osalephera a chidakwa;
- kuvulala kwambiri kwa chiwindi;
- mavuto ndi kugwira ntchito kwa mtima dongosolo;
- kulephera kwaimpso;
- yotupa njira.
Ndi mikhalidwe imeneyi, kufunikira kwa matendawa kumakulanso. Komanso, lactic acidosis yamtundu 2 wa shuga imatha kuyamba chifukwa:
- Chithandizo cha Fenformin (chophatikizika);
- ozungulira kagayidwe kachakudya;
- kusakwanira kwa magazi kumisempha;
- matenda ashuga ketoacidosis;
- hypersmolar coma, momwe ketosis siinawonedwe.
Komanso, matendawa amatha kukhala chizindikiritso cha chotupa chapang'onopang'ono, leukemia, leukemia. Koma nthawi zambiri minofu hypoxia imabweretsa kudzikundikira kwa lactic acid.
Kuwonetsedwa kwa matendawa
Anthu odwala matenda ashuga ayenera kudziwa zizindikiro za lactic acidosis. Matendawa amakula msanga, m'maola ochepa munthu amadwala. Palibe chizindikiro cha kudwala ndipo izi zimadziwika kuti ndizowopsa kwambiri.
Zotsatirazi zikuwonetsa kukula kwa izi:
- adawoneka kupweteka m'misempha;
- mphwayi
- kufooka
- kumva kutopa;
- kukakamiza kutsika;
- chisokonezo, mpaka pakuwonongeka kwake;
- kusowa pokodza kapena kuchepa kwakukulu kwa kuchuluka kwa mkodzo;
- Kukula kwa zizindikiro za pulmonary hyperventilation (kotchedwa kupuma kwa Kussmaul);
- chisokonezo m'dera kumbuyo kwa sternum;
- wodwalayo akachuluka, kusanza kutseguka, kupweteka kwam'mimba kumawonekera.
Izi ndi zizindikiro zazikulu za lactic acidosis mu shuga. Akawonekera, muyenera kupita kuchipatala. Muzipatala, amatha kutenga magazi kuti awunikidwe kuti adziwe kuchuluka kwa asidi a lactic: amakwera kwambiri. Gawo limaposa 6 mmol / L.
Magawo ena a labotale omwe amakhala ndi hyperlactatemia amawunikanso:
- hyperphosphatemia (mayesero a azotemia);
- kutsika kwa magazi pH;
- CO dontho2 m'magazi;
- kuchepa kwa ma bicarbonates a plasma.
Kuyesedwa kwa magazi ndi kutsimikiza kwa zizindikiro zikufunika. Kupatula apo, zizindikiro za matendawa zimadziwika ndi mikhalidwe ina. Wodwala matenda ashuga amatha kugwa m'misempha yochepa kwambiri m'magazi komanso kuthamanga.
Ndi lactic acidosis, zotsatira zakupha ndizotheka: wodwalayo amayamba kulephera kwamtima, ziwalo zina zamthupi, kuphatikiza ziwalo zopumira, ndizotheka.
Zotsatira zake, izi zimapangitsa kuti pakhale phokoso lactacidemic. Asanayambike, kupuma kwamkokomo kumaonekera. Odwala omwe ali ndi DIC amawonekera. Awa ndi mkhalidwe womwe kuphatikizika kwa mitsempha kumayamba.
Zizindikiro za lactic acidosis zimaphatikizanso mawonekedwe a hemorrhagic necrosis ya zala, intravascular thrombosis. Nthawi yomweyo, ziwalo zowuma ndi khungu zimadziwika.
Njira zamachiritso
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.
Nthawi yomweyo, zofunikira zonse zimayang'aniridwa. Chidwi chachikulu chimaperekedwa kwa anthu achikulire omwe ali ndi vuto loopsa, mavuto a chiwindi, impso.
Ngati hyperlactatemia itatsimikiziridwa ndi kusanthula, kuchuluka kwa pH ndi kochepera 7.0, ndiye kuti wodwalayo amayamba kubayidwa 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. Imawunikira maola 2 aliwonse: kulowetsedwa kwamankhwala kumapitirirabe mpaka pH ifikire oposa 7.0.
Ngati munthu wodwala matenda ashuga okhala ndi vuto laimpso amalephera, ndiye kuti hemodialysis ya impso imachitidwa nthawi yomweyo.
Popewa kukula kwa mtima kulephera, mutha kugwiritsa ntchito 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 kwazinthu zodziwikiratu ndi chithandizo cha panthawi yake kuchipatala ndi 50%. Ngati mutenga nthawi ndipo osalabadira zizindikiro zomwe zikudwala mwachangu, ndiye kuti kufa kumatha kufikira 90%. Mwanjira yonyalanyazidwa, ngakhale madokotala sangathe kupulumutsa wodwalayo.
Kupewa
Njira yayikulu yopeweretsera lactic acidosis coma ndiyo chithandizo chanthawi yake cha madokotala. Ngati chithandizo chamankhwala choyenerera chimaperekedwa, ndiye kuti mutha kusiya izi.
Mutha kuletsa kukula kwa lactic acidosis ngati malingaliro onse a dokotala akutsatiridwa. Kumwa mankhwala ochepetsa shuga, mlingo uyenera kuonedwa. Mwachitsanzo, mankhwala osokoneza bongo a Metformin angayambitse lactic acidosis. Muyeneranso kusamala mukamamwa mankhwala ena a odwala matenda ashuga: Glucophage, Avandamet, Siofor, Bagomet.
