Matenda a shuga amaphatikizika ndi kuwonjezeka kwa glycemia chifukwa cha kusokonekera kwa kupanga kwa insulin kapena chifukwa chochepetsetsa pa insulin receptors mu minofu. Chizindikiro chodziwitsa ndi kusungunuka kwa glucose yoposa 7 mmol / l musanadye kapena ndi muyeso wosasintha wa 11 mmol / l.
Ndi njira yowonongeka ya matenda ashuga, pamatha kuwonjezereka chizindikiro, ngati shuga ali 33 mmol / L kapena Lapamwamba, ndiye kuti madzi am'mimba amayamba kukula, zomwe zingayambitse kudwala.
Vutoli limatchedwa hyperosmolar coma, kusazindikira kwakanthawi komanso kuperekanso mphamvu kwakanthawi kumabweretsa imfa.
Amayambitsa hyperosmolar coma mu shuga
Hyperosmolar coma imakhala yofala kwambiri mu mtundu 2 wa matenda ashuga, imayamba kudziwonetsa mwa matendawa mozindikira komanso moyenera odwala.
Chifukwa chachikulu cha kuwonongeka kwa matenda ashuga mu zochitika zotere ndikuwonongeka kwamadzi pamene kumalumikizidwa ndi, kuphatikizapo matenda opatsirana, kusokonezeka kwakazungulira m'mitsempha muubongo kapena mtima, ndi enterocolitis kapena gastritis yam'mimba, kusanza, malo akulu owotcha.
Kutulutsa madzi m'thupi kumapangitsanso magazi kwambiri panthawi ya polytrauma, opareshoni. Kutenga Mlingo wambiri wa okodzetsa, ma immunosuppressants, glucocorticoids, komanso intravenous ya mannitol, mayankho a hypertonic, peritoneal dialysis kapena hemodialysis kumapangitsa kuchuluka kwa shuga m'magazi.
Kukomoka kwa hyperosmolar kumatha kuchitika ndi kuchuluka kwa insulini, komwe kungakhale chifukwa cha zifukwa izi:
- Kuphwanya zakudya kwa nthawi yayitali.
- Mankhwala osokoneza - kusakhazikika kwa insulin mtundu 2 shuga.
- Kukhazikitsidwa kwa njira zowonjezera shuga.
- Wodwala wosavomerezeka akukana kulandira chithandizo.
The pathogenesis of hyperosmolarity syndrome
Kuwonjezeka kwa shuga m'magazi kumachitika pakakhala zovuta zochulukirapo zamafuta m'thupi, kuchuluka kwa shuga m'magazi a chiwindi, chidziwitso chotsika cha insulini motsutsana ndi maziko a insulin kukana ndi kuchepa madzi m'thupi.
Nthawi yomweyo, insulin, yomwe imapangidwa ndi kapamba kapena kulowetsedwa m'thupi, imatha kulepheretsa kuwonongeka kwa minofu ya adipose ndikupanga matupi a ketone, koma ndizochepa m'magazi kuti lipangitse kuchuluka kwa shuga m'chiwindi. Uku ndiye kusiyana pakati pa chikhalidwe cha hyperosmolar ndi dziko la ketoacidotic.
Kuchita kwambiri kwa shuga kumayambitsa kuwonongeka kwa madzimadzi chifukwa chokopa ndi mamolekyu a glucose kuchokera ku minofu kupita kukagona kwamitsempha ndi chimbudzi. Izi zimathandizira kupanga aldosterone ndi cortisol ochulukitsa, zomwe zimapangitsa kuwonjezeka kwa zomwe zimakhala ndi sodium ions m'magazi ndipo kenako m'magazi a cerebrospinal.
Kuwonjezeka kwa sodium mu minofu ya mu ubongo kumabweretsa kukula kwa edema ndi vuto la mitsempha mu boma la hyperosmolar.
Zizindikiro za chikomokere
Kuchulukana kwa glycemia kumachitika pang'onopang'ono kwa masiku 5 mpaka 12. Nthawi yomweyo, zizindikiro za matenda ashuga zimapita patsogolo: ludzu limakulirakulira, kuchuluka kwa mkodzo kumawonjezeka, kumangokhala ndi njala, kufooka kwambiri, komanso kuchepa thupi.
Kutulutsa madzi kumabweretsa kuuma kwambiri pakhungu ndi mucous nembanemba, pakamwa pouma kosasunthika, komwe sikumachotsedwa ndimadzi akumwa, mawonekedwe amkati amaso, komanso mawonekedwe a nkhope amakhala akuthwa, kupuma pang'ono kumatha kuchitika, koma palibe fungo la acetone komanso kupuma kwapafupipafupi (mosiyana ndi dziko la ketoacidotic) .
Mtsogolomo, kuthamanga kwa magazi ndi kutentha kwa thupi kumatsika, kukomoka, ziwalo, khunyu imatha kuwoneka, kutupa chifukwa cha vein thrombosis kumachitika, kuchuluka kwa mkodzo kumachepa mpaka kusowa kwathunthu. Woopsa milandu, kukomoka kumatha.
Laborator zizindikiro za hyperosmolar dziko:
- Glycemia pamtunda wa 30 mmol / L.
- Magazi osmolarity ndi oposa 350 (wabwinobwino 285) mosm / kg.
- Mchere wama sodium wambiri.
- Kuperewera kwa ketoacidosis: palibe matupi a ketone m'magazi ndi mkodzo.
- Kuchulukitsa kwa hemoglobin, maselo oyera ndi urea m'magazi.
Wodwala wokhala ndi vuto la hyperosmolar ayenera kugonekedwa kuchipatala nthawi yomweyo. Mu dipatimenti, glycemia m'magazi imayang'aniridwa ola lililonse, matupi a ketone mumkodzo ndi magazi amawunikira kawiri pa tsiku, ndipo ma elekitiropa am'magazi ndi zamchere amatsimikiza katatu patsiku. Kuyang'anira pafupipafupi diuresis, kukakamiza, kutentha kwa thupi.
Ngati ndi kotheka, yang'anirani kuwunika kwa electrocardiogram, kuwunika kwa mapapu a X ndi mapangidwe ake aubongo.
Kusiyanitsa kosiyanitsa kwa hyperosmolar chikomokere ndi ngozi ya pachimake ya ubongo, chotupa muubongo.
Zida zamankhwala a hyperosmolar coma
Kuchiza kumayamba ndi kuyambitsa mayankho amitsempha yama sodium kolorayidi ndi shuga. Pankhaniyi, mulingo wa sodium m'magazi umaganiziridwa: ngati ndiwopamwamba kuposa momwe amagwiritsidwira, ndiye kuti glucose amagwiritsidwa ntchito, mosapeneka pang'ono pazochitika, yankho la 0.45% limayambitsidwa, ndipo malinga ndi chizolowezi, yankho lokhazikika la 0.9% isotonic.
Pa ola loyamba, 1-1.5 L imalowetsedwa kudzera m'mitsempha, ndipo kuchuluka kwa madzimadzi ndi 300-500 ml. Nthawi yomweyo, masisitere aumunthu kapena ma genulin opangidwira kwakanthawi insulin kapena insulini yocheperako pang'ono amawonjezeredwa ndi dontho. Iyenera kumililidwa pamlingo wa 0 PESCES pa ola limodzi pa kilogalamu imodzi ya odwala.
Mavuto akulu komanso kuchuluka kwa mabungwe awo kungapangitse kuti matenda a ubongo akhale athithithi. Popeza odwala nthawi zambiri amakhala okalamba kapena osachepera zaka zambiri, ngakhale kuchuluka kwa madzi m'thupi kumapangitsa kuti m'mitsempha mwanga mutha kulephera.
Chifukwa chake, kuyamwa pang'ono pang'onopang'ono komanso kuchepa kwapang'onopang'ono kwa shuga m'magazi kumalimbikitsidwa. Kufunika kwa insulini mwa odwala otere nthawi zambiri kumakhala kotsika.
Kupewera kwa hyperosmolar chikomokere mu shuga
Chitsogozo chachikulu chopewa kukula kwa kuphatikizika kwa shuga uku ndikumayang'anira shuga nthawi zonse. Izi zikuthandizira kuzindikira kukula kwake komanso kupewa kutekeseka kwa ubongo.
Hyperglycemic chikomokere chimapezeka kwambiri kwa odwala omwe amamwa mankhwala ochepa ochepetsa shuga m'mapiritsi ndipo samakonda kuyeza magazi. Chifukwa chake, odwala omwe ali ndi matenda a shuga a 2 amalimbikitsidwa tsiku lililonse magazi ndi mkodzo. Kuti muchite izi, mutha kugwiritsa ntchito mita ndikupanga mayeso.
Ngati shuga akwera, muyenera kumwa kaye kuposa madzi wamba osakhalitsa osagwiritsa ntchito zodyetsa, kofi, tiyi, zakumwa za shuga, zakumwa, zakumwa zoledzeretsa komanso zakumwa zoledzeretsa.
Odwala omwe adaphonya kumwa mapiritsi kapena kuperekera insulin ayenera kumwa mankhwalawo. Chakudya chotsatira chizikhala ndi zakudya zama protein ndi masamba atsopano. Ndikulimbikitsidwa kusiya kwathunthu mankhwala a confectionery kapena ufa, kuphatikiza omwe ali ndi matenda ashuga, kuti shuga asakhale magazi.
Kwa masiku osachepera asanu atapezeka shuga ambiri m'mwazi kuchokera pachakudya asatchule:
- Mkate oyera, makeke.
- Shuga ndi okoma.
- Kaloti owiritsa, beets, dzungu, mbatata.
- Zipatso ndi zipatso zokoma.
- Porridge.
- Zipatso zouma.
- Nyama yamafuta, mkaka ndi nsomba.
- Mitundu yonse ya zakudya zamzitini komanso zakudya zosavuta.
Ndikulimbikitsidwa kuphika zakudya zoyambira zamasamba chifukwa mbale zam'mbali zimagwiritsa ntchito masamba owiritsa kuchokera pamndandanda wololedwa: kolifulawa, broccoli, zukini, ndi biringanya. Ndikulimbikitsidwa kugwiritsa ntchito nyama yopanda nsomba ndi nsomba mu mawonekedwe owiritsa, masaladi ochokera ku masamba amadera, kabichi, nkhaka ndi tomato ndi masamba mafuta, zakumwa zam'madzi popanda shuga ndi zipatso.
Onetsetsani kuti mukumana ndi dokotala kuti musinthe mlingo wa mankhwala omwe mwalandira munjira yomwe mukufuna, ndipo ngati zizindikiro zakukula kwambiri kwa shuga, pali kufooka kwambiri kapena kugona, kusokonezeka m'malo, ndiye kuti muyenera kuyitanitsa ambulansi kuti mukagonekere kuchipatala.
Zambiri pa boma la hyperglycemic zimaperekedwa mu kanema munkhaniyi.
