Kuwonjezeka kwa shuga m'magazi mpaka 31 mmol / L kungakhale chizindikiro cha kusokonezeka kwakukulu kwa matenda a shuga - hyperosmolar coma. Mu chikhalidwe ichi, pali kuchepa kwamphamvu kwamamidwe am'mimba m'thupi, kusokonekera kwa metabolism yamatumbo kumafikira kwambiri, mulingo wa masodium ndi nitrogenous m'magazi ukuwonjezeka.
Pafupifupi theka la odwala, matendawa amapha. Nthawi zambiri, matenda amtunduwu amapezeka mwa odwala omwe ali ndi mtundu wachiwiri wa matenda a shuga, omwe amamwa mankhwala ochepetsa shuga.
Boma la hyperosmolar silimapezeka m'matenda a shuga osakwanitsa zaka 40, ndipo theka la omwe ali ndi matenda ashuga sanapezekebe. Atatuluka chikomokere, odwala amafunika kuwongolera mankhwalawa akuchitika - insulin ikhoza kutumikiridwa.
Zomwe zimayambitsa kuperewera kwamitundu yachiwiri ya matenda ashuga
Chinthu chachikulu chomwe chimatsogolera kuwonjezeka kwakuthwa kwa hyperglycemia ndikusowa kwa insulin. Zikondazo zimatha kukhalabe ndi insulin, koma chifukwa chakuti palibe zomwe zimachitika kuchokera kumbali ya maselo, shuga wamagazi amakhalabe wokwera.
Vutoli limachulukirachulukira ndikusowa kwamadzi ndikutaya kwambiri magazi, kuphatikizanso opaleshoni yam'mimba yambiri, kuvulala, kuwotcha. Kuthowa madzi mthupi kumatha kuphatikizidwa ndikugwiritsa ntchito milingo yayikulu ya diuretics, saline, Mannitol, hemodialysis kapena peritoneal dialysis.
Matenda opatsirana, makamaka omwe ali ndi kutentha thupi kwambiri, komanso kapamba kapena gastroenteritis ndi kusanza komanso kutsegula m'mimba, kusokonezeka kwa magazi m'thupi mu ubongo kapena mtima kumayambitsa kuwonongeka kwa matenda ashuga. Vutoli limatha kukulitsidwa chifukwa cha kuyamwa kwa mayankho a glucose, mahomoni, immunosuppressants, komanso kudya zakudya zamagulu ambiri.
Zomwe zimayambitsa kusokonezeka kwa madzi ndizotheka:
- Matenda a shuga.
- Kutsekeka kwamphamvu kwa odwala omwe ali ndi vuto la mtima.
- Matenda aimpso.
Cholinga chophwanya mulingo wamadzi amathanso kupitilira kutentha kwa thupi ndi thukuta kwambiri.
Zizindikiro ndi Kudziwitsa
Hyperosmolar coma imayamba pang'onopang'ono. Nthawi ya precomatose imatha kupitilira masiku 5 mpaka 15. Mavuto a kagayidwe kazakudya amawonetsedwa ndi ludzu tsiku lililonse, kutuluka kwamkodzo kwamkati, kuyabwa kwa khungu, kulakalaka kudya, kutopa msanga, mpaka kufafaniza ntchito zamagalimoto.
Odwala amakhudzidwa ndi kamwa yowuma, yomwe imakhala yosalekeza, kugona. Khungu, lilime ndi mucous nembanemba, maimidwe amaso amatha, amakhala ofewa kukhudza, mawonekedwe a nkhope amalozedwa. Kupita patsogolo kovuta kupuma komanso kusokonezeka kwa chikumbumtima.
Mosiyana ndi ketoacidotic chikomokere, chomwe chimakhala chofanana ndi matenda amtundu woyamba 1 ndipo ndimakonda kudwala achinyamata, ndimakhala kuti palibe fungo la acetone kuchokera mkamwa, palibe phokoso komanso kupuma pafupipafupi, kupweteka kwam'mimba komanso kuvutikira kukhoma kwamkati.
Zizindikiro za chikomokere mu vuto la hyperosmolar ndizovuta zamitsempha:
- Matenda opatsirana.
- Matenda a Epileptoid.
- Kufooka miyendo ndi kuchepetsedwa mphamvu yosuntha.
- Kuyenda kopenya ndi maso.
- Kuyankhula osamveka.
Zizindikirozi ndizodziwika mwangozi yamatenda osokonekera kwambiri, chifukwa chake, odwala otere amatha kupezeka kuti ali ndi vuto la stroke.
Ndi kupita patsogolo kwa hyperglycemia ndi kuchepa kwa madzi m'thupi, ntchito zamtima zimasokonekera, kuthamanga kwa magazi kumatsika, kumakhala kugunda kwamtima kosavuta, kwamikodzo kumachepa mpaka kusowa kwamkodzo, chifukwa cha kuchuluka kwa magazi, kupindika kwamitsempha kumachitika.
Pozindikira za labotale, glycemia wapamwamba wapezeka - shuga wamagazi 31 mmol / l (amatha kufikira 55 mmol / l), matupi a ketone sakupezeka, zizindikiro za acid-base usawa zili pamlingo wazamoyo, ndende ya sodium imakhala yachilendo.
Urinalysis imatha kuwona kutayika kwakukulu kwa glucose popanda acetone.
Chithandizo cha Hyperosmolar
Ngati shuga lamwazi litakwera mpaka 31 mmol / l, ndiye kuti wodwala yekhayo sangathe kulipira zovuta za metabolic. Njira zonse zakuchipatala ziyenera kuchitika kokha m'malo osamalira odwala kwambiri. Izi ndichifukwa choti timafunikira kuyang'aniridwa kawirikawiri kuchipatala ndikuwunikira magawo akuluakulu a labotale.
Kubwezeretsanso kuchuluka kwa magazi mozungulira kumayambira pazomwe akuyenera kulandira. Madzi akamatha, shuga m'magazi amayamba kuchepa. Chifukwa chake, kufikira atakwaniranso kuthanso magazi, mankhwala a insulin kapena ena alibe.
Pofuna kukulitsa kuphwanya kwa mawonekedwe amkati mwa magazi, magazi asanayambe kulowetsedwa, ndikofunikira kudziwa zomwe zili mu ayoni m'magazi (meq / l). Zimatengera njira ziti zomwe zingagwiritsidwe ntchito ngati dontho. Pangakhale zosankha izi:
- Kutseka kwa sodium pamtunda wa 165, njira zamchere zimapangidwira. Malangizo am'madzi amayamba ndi 2% shuga.
- Sodium ili m'magazi kuyambira 145 mpaka 165, motere, yankho la 0,45% hypotonic sodium chloride limayikidwa.
- Pambuyo pakuchepetsa kwa sodium pansi pa 145, njira ya 0.9% ya saline sodium chloride imalimbikitsidwa kuti ichiritsidwe.
Kwa ola loyamba, monga lamulo, muyenera kuthira malita 1.5 a njira yosankhidwa, kwa maola awiri ndi atatu, 500 ml, kenako kuchokera pa 250 mpaka 500 ml kwa ola lililonse lotsatira. Kuchuluka kwamadzimadzi omwe adalowetsa akhoza kupitilira kuchuluka kwake kwa 500-750 ml. Ndi zizindikiro zakulephera kwa mtima, muyenera kuchepetsa kuchepa kwa madzi m'thupi.
Ndichitenji ngati, nditatha kulipira kwathunthu kufooka kwamadzi, ndipo shuga yanga ndikadakwezedwa? Zikakhala zotere, makina a insulin omwe adapangidwa kuti asinthidwe amasonyezedwa. Mosiyana ndi matenda ashuga a ketoacidosis, mkhalidwe wa hyperosmolarity sufuna kuchuluka kwakukulu kwa mahomoni.
Kumayambiriro kwa mankhwala a insulin, magawo awiri a mahomoni amawayikiridwa ndi kulowetsedwa mu mtsempha wa magazi (mu chubu cholumikizira cha dontho). Ngati atatha maola 4-5 kuyambira chiyambi cha chithandizo, kuchepetsa shuga mpaka 14-15 mmol / l sikukwaniritsidwa, mlingowo ungakulidwe pang'onopang'ono.
Ndiowopsa kupangira zigawo 6 za insulin pa ola limodzi, makamaka ndi munthawi yomweyo. Izi zimabweretsa kugwa kwamphamvu mu magazi osmolarity, madzimadzi ochokera m'magazi amayamba kulowa m'matimu molingana ndi malamulo a osmosis (mwa iwo kuchuluka kwa mchere kumakhala kwakukulu), ndikupangitsa kusintha kosasintha kwa mapapu ndi ubongo.
Kupewa kwa hyperosmolar chikomokere
Zoyenera kuchita kuti muchepetse kukula kwa zovuta za matenda ashuga, kuphatikizapo zinthu zomwe zingawononge moyo monga hyperosmolar coma. Chofunika kwambiri ndikuwonetsetsa kuchuluka kwa shuga ndi kupeza nthawi yayitali kuchipatala.
Ketoacidotic ndi hyperosmolar coma amadziwika ndi kuwonjezeka kwapang'onopang'ono kwa glycemia, kotero ngakhale ndi shuga wamkulu pamwamba pa 12-15 mmol / l ndi kusakwanitsa kutsetsereka komanso mulingo wofunikira, muyenera kupita ku endocrinologist.
Kuyeza kwa glycemia ndikulimbikitsidwa kwa mtundu wa matenda a shuga osachepera 1 kamodzi patsiku, ngati mapiritsi adalembedwa ndipo nthawi 4, ndi insulin. Kamodzi pa sabata, onse odwala matenda ashuga, mosasamala mtundu wa shuga, njira zomwe amamwa komanso kuchuluka kwa shuga, amafunika kupanga mbiri yonse ya glycemic - miyeso imatengedwa musanadye komanso pambuyo pake.
Asanapiteko, tikulimbikitsidwa kuti muchepetse kuchuluka kwa chakudya chamafuta ndi nyama zamafuta m'zakumwa ndi kumwa madzi abwinobwino, kusiya khofi, tiyi wamphamvu, makamaka kusuta ndi zakumwa zoledzeretsa.
Mankhwala Sipangofunika kumwa palokha mankhwalawa pagulu la okodzetsa ndi mahomoni, mankhwala osokoneza bongo ndi antidepressants.
Odwala omwe sanawerengeredwe mtundu wa matenda a shuga a 2 amapatsidwa:
- Jekeseni wambiri wa insulin 1-2 patsiku mukumwa mapiritsi ochepetsa shuga.
- Insulin yayitali, metformin, ndi insulin yocheperako pachakudya chachikulu.
- Kukonzekera kwa insulin kwa nthawi yayitali 1 patsiku, jakisoni wafupika 3 pakadutsa mphindi 30 asanadye.
Popewa kusakhazikika kwa hyperglycemia, odwala omwe ali ndi matenda a shuga 2 ayenera kusinthidwa kuphatikiza kapena monotherapy yokhala ndi insulin pakuchepetsa kwa mapiritsi kuti muchepetse shuga. Choyimira pankhaniyi chikhoza kukhala kuchuluka kwa hemoglobin wa glycated pamwamba 7%.
Insulin ikhoza kuperekedwa kwa odwala omwe ali ndi matenda a shuga a nthawi yayitali, Zizindikiro zakuthana ndi vuto la impso, kuwonongeka kwa impso ndi retina, ndikuwonjezera kwa matenda opatsirana kapena owopsa a ziwalo zamkati, kuvulala ndi ntchito, mimba, kufunika kwa kugwiritsa ntchito mankhwala a mahomoni, ndi Mlingo waukulu wa okodzetsa.
Popeza mawonetseredwe azachipatala a hyperosmolar coma ali ofanana ndimatenda am'mimba otupa, tikulimbikitsidwa kuti odwala onse omwe ali ndi vuto la stroke kapena omwe ali ndi zizindikiro zomwe sizingafotokozedwe kokha ndi zovuta zamitsempha amayang'ana shuga ndi mkodzo.
About hyperosmolar coma ofotokozedwa mu kanema munkhaniyi.
