Hyperglycemic coma imatha kudwala wodwala matenda ashuga ngati sagwidwa bwino, ndipo chifukwa cha izi, shuga m'magazi amakwera kwambiri. Madokotala amatcha chizindikiro cha shuga m'magazi “glycemia.” Ngati shuga wadzuka, ndiye kuti wodwalayo ali ndi "hyperglycemia".
Ngati simumayamwa magazi pakanthawi kake, ndiye kuti matendawa akhoza kuchitika
Hyperglycemic chikomokere - kusokonezeka kwa chikumbumtima chifukwa cha shuga. Zimachitika makamaka mwa odwala matenda ashuga omwe samawongolera shuga.
Hyperglycemic chikomanda mwa ana kumachitika, monga lamulo, limodzi ndi ketoacidosis.
Hyperglycemic chikomokere ndi matenda ashuga ketoacidosis
Hyperglycemic coma nthawi zambiri imayendera limodzi ndi ketoacidosis. Ngati wodwala matenda ashuga ali ndi vuto lalikulu la insulin, ndiye kuti maselo samapeza shuga wokwanira ndipo amatha kusinthira ku chakudya chopatsa thanzi. Mafuta akaphwanyidwa, matupi a ketone, kuphatikiza acetone, amapangidwa. Njirayi imatchedwa ketosis.
Ngati matupi ambiri a ketone amayendayenda m'magazi, ndiye kuti amachulukitsa acidity, ndipo amapitilira gawo lanyama. Pali kusuntha kwa asidi-maziko olimbitsa thupi kupita pakuwonjezeka kwa acidity. Izi ndizowopsa, ndipo zimatchedwa acidosis. Pamodzi, ketosis ndi acidosis amatchedwa ketoacidosis.
M'nkhaniyi, tikambirana za momwe kukomoka kwa hyperglycemic kumachitika popanda ketoacidosis. Izi zikutanthauza kuti shuga wamwazi ndiwambiri, koma nthawi yomweyo, thupi la wodwala matenda ashuga silisintha kuti likhale ndi mafuta. Matupi a Ketone samapangidwa, chifukwa chake acidity ya magazi imakhalabe yochepa.
Matenda a shuga amtunduwu amatchedwa "hyperosmolar syndrome." Siwodwalanso kuposa matenda ashuga a ketoacidosis. Osmolarity ndiko kusungunuka kwa chinthu mu njira. Hyperosmolar syndrome - kutanthauza kuti magazi ndiwakhungu kwambiri chifukwa cha kuchuluka kwa shuga mkati mwake.
Zizindikiro
Wodwala yemwe ali ndi vuto la hyperglycemic coma alowa kuchipatala, chinthu choyamba chomwe madokotala amachita ndikuwona ngati ali ndi ketoacidosis kapena ayi. Kuti muchite izi, pendani mkodzo pakuwonetsa matupi a ketone pogwiritsa ntchito chingwe choyezera, komanso sonkhanitsani zina zofunikira.
Momwe mungachiritsire matenda a hyperglycemic coma wokhala ndi ketoacidosis akufotokozedwa mwatsatanetsatane m'nkhani ya "Diabetesic ketoacidosis". Ndipo apa tikambirana momwe madotolo amathandizira ngati chikomokere cha matenda ashuga sichitsatira ndi ketoacidosis. Pomwe wodwala yemwe ali ndi vuto la kuchepa kwa magazi m'thupi (hyperglycemic coma) akulandila chithandizo champhamvu, zizindikilo zake zofunika ziyenera kuyang'aniridwa mosamala. Kuwunika kwawo kumachitika molingana ndi chiwembu chofanana ndi chithandizo cha ketoacidosis.
Hyperglycemic coma, yokhala ndi ketoacidosis kapena yopanda mankhwala, imatha kupanikizika ndi lactic acidosis, i.e, kuphatikiza kwakukulu kwa lactic acid m'magazi. Lactic acidosis imakulitsa kwambiri zakukula kwa zotsatira za mankhwala. Chifukwa chake, ndikofunikira kuyeza mulingo wa lactic acid m'magazi a wodwala.
Amathandizanso kupanga magazi kuyeserera kwa prothrombin nthawi ndikuyambitsa gawo la thromboplastin time (APTT). Chifukwa ndi hyperosmolar syndrome, nthawi zambiri kuposa matenda ashuga a ketoacidosis, DIC imayamba, i.e.
Odwala omwe ali ndi hyperglycemic hyperosmolar syndrome ayenera kupendedwa mosamala pofufuza matenda amtundu, komanso matenda omwe amachititsa kutupa kwa m'mimba. Kuti muchite izi, muyenera kufufuza:
- ma paranasal sinuses
- m'kamwa
- pachifuwa
- pamimba, kuphatikizapo rectum
- impso
- palpate zamitsempha
- ... ndipo nthawi yomweyo chekeni kuwonongeka kwa mtima.
Zoyambitsa Hyperosmolar Diabetesic Coma
Hyperosmolar hyperglycemic chikomokere zimachitika kangapo ka 6-10 nthawi zambiri kuposa matenda ashuga a ketoacidosis. Ndi zovuta kwambiri izi, monga lamulo, anthu achikulire omwe ali ndi matenda a shuga a 2 amavomerezedwa kuchipatala. Koma kuphatikiza pa lamulo ili nthawi zambiri kumachitika.
Njira yomwe imayambitsa kupangika kwa hyperosmolar syndrome nthawi zambiri imakhala mikhalidwe yomwe imakulitsa kufunika kwa insulin ndikuwongolera kuchepa madzi m'thupi. Nayi mindandanda wawo:
- matenda opatsirana, makamaka omwe ali ndi kutentha thupi, kusanza, ndi kutsekula m'mimba (m'mimba);
- myocardial infarction;
- pulmonary embolism;
- pachimake kapamba (kutupa kwa kapamba);
- matumbo kutsekeka;
- sitiroko;
- kuwotcha kwakukulu;
- magazi akulu;
- kulephera kwa impso, peritoneal dialysis;
- endocrinological pathologies (acromegaly, thyrotooticosis, hypercortisolism);
- kuvulala, kulowererapo;
- zolimbitsa thupi (kutentha kwa sitiroko, hypothermia ndi ena);
- kumwa mankhwala ena (ma steroid, sympathomimetics, somatostatin analogues, phenytoin, immunosuppressants, beta-blockers, diuretics, calcium antagonists, diazoxide).
Hyperglycemic coma nthawi zambiri imayamba chifukwa cha munthu wokalamba yemwe amamwa madzi pang'ono. Odwala amachita izi, kuyesa kuchepetsa kutupira kwawo. Malinga ndi zamankhwala, malingaliro ochepetsa kuchepa kwamadzi m'magazi ndi matenda ena siolondola komanso owopsa.
Zizindikiro za hyperglycemic chikomokere
Hyperosmolar syndrome imayamba pang'onopang'ono kuposa matenda ashuga a ketoacidosis, nthawi zambiri pakangotha masiku kapena milungu ingapo. Kuchepa kwa madzi m'thupi kumatha kukhala koopsa kwambiri kuposa ketoacidosis. Popeza matupi a ketone sakhazikika, palibe zizindikiro zodziwika za ketoacidosis: kupuma kosadziwika kwa Kussmaul ndi kununkhira kwa acetone mu mpweya wotulutsidwa.
M'masiku oyambilira a hyperosmolar syndrome, odwala amakhala ndi chidwi chofuna kukodza. Koma pa nthawi yakufika kuchipatala, kutulutsa mkodzo nthawi zambiri kumakhala kofooka kapena kusiyiratu, chifukwa cha kusowa kwamadzi. Mu diabetesic ketoacidosis, kuchuluka kwa matupi a ketone nthawi zambiri kumayambitsa kusanza. Ndi hyperosmolar syndrome, kusanza ndikosowa, pokhapokha ngati pali zifukwa zina.
Hyperglycemic coma imayamba pafupifupi 10% ya odwala omwe ali ndi hyperosmolar syndrome. Zimatengera kuchuluka kwa magazi ndi kuchuluka kwa zomwe sodium m'magazi a cerebrospinal adakula. Kuphatikiza pa kuponderezedwa ndi chikomokere, kusokonezeka kwa chikumbumtima kumatha kudziwonetsa mwa psychomotor mukubwadamuka, kukoka komanso kuyerekezera zinthu zina.
Chizindikiro cha hyperosmolar syndrome ndi zizindikiro zomwe zimawonongeka kawirikawiri m'magazi amanjenje. Mndandanda wawo ukuphatikizapo:
- kukokana
- kusokonekera kwa mawu;
- athanzi othamanga amtundu wamatumbo (nystagmus);
- kufooketsa mayendedwe odzifunira (paresis) kapena ziwalo zathunthu zamagulu amisempha;
- Zizindikiro zina zamitsempha.
Zizindikirozi zimakhala zosiyana siyana ndipo sizigwirizana ndi mtundu wina uliwonse womveka. Pambuyo pochotsa wodwala ku boma la hyperosmolar, nthawi zambiri zimatha.
Kuthandizira ndi kukomoka kwa hyperglycemic: Zambiri mwatsatanetsatane kwa dokotala
Chithandizo cha hyperosmolar syndrome ndi hyperglycemic chikomichi chimachitika makamaka pa mfundo zomwezo monga chithandizo cha matenda ashuga a ketoacidosis. Koma pali mawonekedwe omwe timakambirana pansipa.
Palibe chifukwa chake ngati kuchuluka kwa shuga m'magazi kumachepetsedwa mofulumira kuposa 5.5 mmol / L kwa ola lililonse. Osmolarity (density) yamagazi seramu sayenera kuchepetsedwa mwachangu ndi 10 mosmol / l pa ola limodzi. Kuchepa kwakuthwa kwa zizindikirozi kumatsutsana kwenikweni, chifukwa kumawonjezera chiopsezo cha pulmonary edema ndi edema yam'mimba.
Pazakudya za Na + mu plasma> 165 meq / l, kukhazikitsidwa kwa njira zamchere kumatsutsana. Chifukwa chake, yankho la shuga 2% limagwiritsidwa ntchito ngati madzi kuti achepetse madzi m'thupi. Ngati mulingo wa sodium ndi 145-165 meq / l, ndiye gwiritsani ntchito 0.45% hypotonic solution ya NaCl. Mkulu mulingo wa sodium utachepa <145 meq / l, kuperekanso madzi m'thupi kumapitilizidwa ndi saline yachilengedwe 0,9% NaCl.
Mu ora loyamba, malita 1-1,5 amadzimadzi adalowetsedwa, mu 2nd ndi 3 - 0,5 malita, ndiye 300-500 ml pa ola limodzi. Kuchulukanso kwam'mimba kumasintha m'njira yomweyo monga matenda ashuga a ketoacidosis, koma kuchuluka kwake koyamba mu vuto la hyperosmolar ndikokulirapo.
Thupi la wodwalayo litayamba kudzazidwa ndi madzi, mwachitsanzo, kuchepa kwamadzi kumatha, izi palokha zimatsogolera kutsika kwachilengedwe kwa shuga m'magazi. Mu chikomero cha hyperglycemic, kuchepa kwa insulin nthawi zambiri kumachulukitsidwa. Pazifukwa izi, kumayambiriro kwa mankhwalawa, insulini siyikuperekedwa konse kapena kutumikiridwa muyezo yaying'ono, pafupifupi magawo awiri a insulin "yifupi" pa ola limodzi.
Pambuyo maola 4-5 kuyambira poyambira kulowetsedwa, mutha kusintha njira ya insulin yotchulidwa mu gawo "Chithandizo cha matenda ashuga ketoacidosis", pokhapokha ngati magazi a magazi akadali apamwamba kwambiri komanso kuchuluka kwa ma sodium ions m'magazi amachepetsa.
Ndi hyperosmolar syndrome, nthawi zambiri amafunika kuyambitsa potaziyamu yambiri kuti athetse vuto la kuchepa kwa potaziyamu m'thupi la wodwalayo kuposa matenda a shuga a ketoacidosis. Kugwiritsa ntchito alkalis, kuphatikizapo koloko yophika, sikumasonyezedwa ketoacidosis, komanso makamaka kwa hyperosmolar syndrome. The pH imatha kuchepa ngati acidosis imayamba ndikupanga njira za purulent-necrotic. Koma ngakhale muzochitika izi, pH ndiyosowa kwambiri pansi pa 7.0.
Tidayesa kupanga nkhaniyi pankhani ya hypoglycemic coma ndi hyperosmolar syndrome kuti ikhale yothandiza kwa odwala. Tikukhulupirira kuti madokotala amatha kugwiritsa ntchito ngati "chinyengo".
