Matenda a shuga amapezeka motsutsana ndi kuwonongeka kwa makoma a mtima ndi kuchuluka kwa shuga komanso kukula kwa magazi osakwanira, kusungika pafupifupi ziwalo zonse ndi machitidwe.
Kuperewera kwa michere minofu chifukwa cha zovuta mayamwidwe a shuga ndi kuchepa kwa chitetezo chokwanira, zimayambitsa kukula kwapafupipafupi kwa zovuta pa nthawi ya opaleshoni. Kuphatikiza apo, njira yochira pambuyo pochita opaleshoni imalephereka ndi kuchira kwapang'onopang'ono kwa mabala a postoperative.
Pankhaniyi, odwala matenda a shuga amafunika njira zapadera zodzikonzera ndi opaleshoni pakuchita opaleshoni.
Kukonzekera kwa opaleshoni ya shuga
Ntchito yayikulu yopewa zovuta pambuyo pakuchita opaleshoni ndikukonza shuga yayikulu yamagazi kwa odwala matenda ashuga. Mwa izi, zakudya zimayendetsedwa makamaka. Malamulo oyamba a chithandizo chamankhwala musanachite opareshoni:
- Kuchotsera kwa zakudya zopatsa mphamvu kwambiri.
- Zakudya zisanu ndi chimodzi patsiku m'magawo ang'onoang'ono.
- Kutulutsidwa kwa shuga, maswiti, ufa ndi confectionery, zipatso zotsekemera.
- Chepetsani mafuta a nyama ndipo siyani zakudya zamafuta ambiri: nyama yamafuta, mafuta okazinga a nyama, zakudya, mafuta anyama, mafuta amchere, kirimu tchizi ndi zonona, batala.
- Kuletsa zakumwa zoledzeretsa.
- Kupititsa patsogolo zakudya ndi zakudya zamafuta kuchokera kumasamba, zipatso zopanda zipatso, chinangwa.
Ndi mtundu wocheperako wa shuga kapena kulekerera kwa glucose, chakudya chokhwima chingakhale chokwanira kuchepetsa shuga m'magazi, nthawi zina, kusintha kwa mankhwala ochepetsa shuga kumachitika. Mapiritsi okhala ndi nthawi yayitali ndi insulin amathetsedwa kwa odwala tsiku lililonse. Kugwiritsa ntchito insulin yayifupi kumasonyezedwa.
Ngati magazi a glycemia aposa 13.8 mmol / l, ndiye kuti 1 - 2 magawo a insulin amalumikizidwa kudzera mu ora lililonse, koma otsika kuposa 8.2 mmol / l sikulimbikitsidwa kutsitsa chisonyezo. Pokhala ndi shuga yayitali, amawongoleredwa ndi mulingo wapafupi ndi 9 mmol / l komanso kusowa kwa acetone mkodzo. Kutupa kwa shuga mumkodzo sikuyenera kupitirira 5% ya chakudya chamagulu mu chakudya.
Kuphatikiza pa kusungirako shuga kwa odwala omwe ali ndi matenda ashuga, amachita:
- Chithandizo cha zovuta m'mtima komanso kuthamanga kwa magazi.
- Kusamalira impso.
- Chithandizo cha matenda a shuga.
- Kupewa matenda opatsirana.
Mu matenda a shuga, pali chiopsezo chachikulu chotenga matenda a mtima, matenda oopsa. Zilonda zamtima zimatha kukhala mu mtundu wa ischemic matenda, myocardial dystrophy, mtima neuropathy. Chimodzi mwa matenda a mtima ndi mitundu yosautsa yamtima, yomwe imawonetsedwa ndi kukhudzika, kusazindikira, kapena kuphwanya mzere wamtima.
M'matenda a mtima, kuperewera kwa mphamvu pachimake kumapita patsogolo kwambiri, ndikupangitsa kufa mwadzidzidzi. Odwala omwe ali ndi matenda ashuga sanawonetsedwe chithandizo chachikhalidwe ndi beta-blockers ndi othandizira calcium chifukwa cha zovuta zawo pa kagayidwe kazakudya.
Kuti mukonzekere opaleshoni kwa odwala omwe ali ndi matenda a mtima, mapangidwe a dipyridamole amagwiritsidwa ntchito - Curantil, Persantine. Zimasintha kufalikira kwa magazi, zimalimbitsa mphamvu ya mtima ndipo nthawi yomweyo imathandizira kusuntha kwa insulin.
Kuchepetsa kuthamanga kwa magazi kwa odwala omwe ali ndi shuga kumakhala kovuta chifukwa cha insulin posunga sodium. Pamodzi ndi sodium, madzimadzi amasungidwa m'thupi, edema ya khoma la chotengera imapangitsa kuti chidwi chake pakuchitika kwa mahomoni a vasoconstrictive. Kuphatikiza apo, kuwonongeka kwa impso mu shuga, kusintha kwa mitsempha m'mitsempha yamagazi komanso kunenepa kwambiri kumawonjezera matenda oopsa.
Kuti muchepetse kupsinjika, ndibwino kuchitira limodzi ndi mankhwala ochokera ku magulu omwe amaletsa adrenergic: beta 1 (Betalok), alpha 1 (Ebrantil), komanso angiotensin-akatembenuza enzyme inhibitors (Enap, Kapoten). Kwa anthu achikulire, chithandizo chimayamba ndi diuretics, kuphatikiza ndi mankhwala ochokera m'magulu ena. Katundu wochepetsera kuponderezedwa adadziwika mu Glyurenorm.
Zizindikiro za nephropathy zikawoneka, mchere umakhala wochepa kwa 1-2 g, mapuloteni a nyama mpaka 40 g patsiku. Ngati chiwonetsero cha mafuta operewera metabolism sichitha ndi chakudya, ndiye kuti mankhwala amathandizidwa kuti muchepetse cholesterol. Mu diabetesic polyneuropathy, kugwiritsidwa ntchito kwa Thiogamm kapena Belithion kukuwonetsedwa.
Kukonzekera kwa immunological kumachitidwanso, ndikuwonetsa - mankhwala othandizira.
Matenda a shuga
Nthawi ya opareshoni, amayesa kukhalabe ndi shuga m'magazi, kupewa kuchepa kwake, chifukwa izi zimatha kubweretsa zovuta mu ubongo. N`zosatheka kuyang'ana pa zizindikiro za hypoglycemia pansi pa vuto la opaleshoni. General opaleshoni salola kuti apezeke, chifukwa chake kuyesa kwa magazi kumagwiritsidwa ntchito ngati shuga. Amatenga maola 2 aliwonse.
Mlingo waukulu wa mankhwala oletsa kupweteka, komanso kukhazikika kwawo kwakanthawi kumachepetsa shuga. Chifukwa chake, pakuchita opaleshoni pakuchita opareshoni, shuga ndi insulin zimaperekedwa. Kuchita kwa insulin panthawi ya opaleshoni yotalikirapo kuposa momwe imakhalira, kotero shuga yokhazikika imasinthidwa mwachangu ndi hypoglycemia.
Mukamagwiritsa ntchito mankhwala osokoneza bongo, muyenera kulingalira momwe zimakhudzira kagayidwe kazachilengedwe:
- Kupweteka kwamankhwala okhala ndi Ether ndi Fluorotan kumawonjezera kuchuluka kwa shuga.
- Ma Barbiturates amalimbikitsa kulowa kwa insulin m'maselo.
- Ketamine imathandizira ntchito zapamba.
- Zovuta zazing'ono zimapangidwa ndi: droperidol, sodium oxybutyrate, nalbuphine.
Kuchita kwakanthawi kochepa kumachitika pansi pa opaleshoni yakumaloko, mwa odwala omwe alibe nkhawa amatha kupitilizidwa ndi antipsychotic. Pogwira ntchito kumapeto kwenikweni ndi gawo la cesarean, opaleshoni ya msana kapena ya epidural imagwiritsidwa ntchito.
Anesthesia ya matenda a shuga mellitus mwa jakisoni kapena kuyambitsa catheter iyenera kuchitika mokwanira chifukwa cha kuwuma kwathunthu chifukwa cha chiwopsezo cha odwala pakukula msambo.
Kupanikizika kwa magazi sikuthanso kuchepetsedwa kwambiri, chifukwa anthu odwala matenda ashuga samaloleza hypotension. Mwambiri, kupanikizika kumachulukitsidwa ndi madzi amkati ndi ma elekitirodi. Mankhwala a Vasoconstrictor ali osavomerezeka.
Kubwezeretsa kuchepa kwa magazi, musagwiritse ntchito dextrans - Polyglyukin, Reopoliglyukin, popeza agwidwa ndi glucose. Kuwongolera kwawo kungayambitse kwambiri hyperglycemia ndi glycemic coma.
Yankho la Hartman kapena Ringer siligwiritsidwa ntchito, chifukwa lactate kuchokera kwa iwo m'chiwindi amatha kusintha shuga.
Mavuto
Mavuto obwera pambuyo pa odwala omwe ali ndi matenda ashuga amalumikizidwa ndikuti kuchepa kwa magazi, kugwiritsa ntchito mankhwala opha ululu ndi kupweteka pambuyo pa opaleshoni yambitsa kuphatikizira kwa kaphatikizidwe ka shuga mu chiwindi, mapangidwe a matupi a ketone, ndi kuwonongeka kwa mafuta ndi mapuloteni.
Ndi opaleshoni yayikulu kapena pogwira ntchito yochizira matenda a shuga, hyperglycemia ikhoza kukhala yapamwamba kwambiri. Chifukwa chake, odwala amawaika m'malo osamalira kwambiri komanso shuga m'magazi, mtima ndi mapapu zimayang'aniridwa maola 2 aliwonse.
Insulin yochita zinthu mwachidule imagwiritsidwa ntchito poletsa ketoacidosis ndi chikomokere. Lowani mkati mwanjira yothetsera shuga 5%. Glycemia imasungidwa m'malo osiyanasiyana 5 mpaka 11 mmol / L.
Kuyambira tsiku lachisanu ndi chiwiri pambuyo pa opareshoni, mutha kubwezeretsa wodwala ku insulin kapena mapiritsi ochepa kuti muchepetse shuga. Kusintha pamapiritsi, kumwa kwa mankhwalawa kumathetsedwa poyamba, kenako tsiku lililonse ndipo, pamapeto pake, mlingo wam'mawa.
Kusungitsa kuchuluka kwa glucose m'magazi, kupweteka kokwanira pambuyo pa opaleshoni ndikofunikira. Nthawi zambiri, ma analgesics amagwiritsidwa ntchito pa izi - Ketanov, Nalbufin, Tramadol.
Odwala omwe ali ndi matenda ashuga pambuyo pantchito amalembedwa mankhwala omwe amaphatikiza mitundu iwiri mpaka itatu amagwiritsidwa ntchito. Semisynthetic penicillin, cephalosporins ndi aminoglycosides amagwiritsidwa ntchito. Kuphatikiza pa maantibayotiki, metronidazole kapena clindamycin ndi mankhwala.
Kusakanikirana kwa mapuloteni kumagwiritsidwa ntchito pazakudya za makolo, chifukwa kugwiritsa ntchito njira yayitali kwa glucose kumabweretsa hyperglycemia, ndipo kugwiritsa ntchito lipid kusakanikirana kumayambitsa matenda a diabetesic ketoacidosis. Kuphatikiza kuchepa kwa mapuloteni, omwe amathanso kuwonjezera shuga wamagazi, zosakaniza zapadera za odwala matenda ashuga - Nutricomp Diabetes ndi Diazon - apangidwa.
Zambiri zamtundu wa mankhwala opatsirana zimaperekedwa mu kanema munkhaniyi.
