Hypoglycemic coma (Zizindikiro, algorithm mwadzidzidzi ndi zotulukapo)

Zotsatira za matenda ashuga zimachedwa kwambiri, wodwalayo nthawi zambiri amakhala ndi nthawi yokwanira kuzindikira zizindikiro, kukaonana ndi dokotala, kusintha chithandizo. Vuto loperesa la hypoglycemic, mosiyana ndi zovuta zina, silimalepheretsedwa nthawi yomweyo, chifukwa limakula mwachangu komanso mwachangu munthu woganiza bwino.

Mothandizidwa ndi izi, wodwala amangodalira thandizo la ena omwe samakhala ndi chidziwitso chokhudza matenda a shuga ndipo amatha kusokoneza munthu yemwe ali ndi chidakwa chowonjezera. Kuti mukhale ndi thanzi, komanso ngakhale moyo, odwala matenda ashuga ayenera kuphunzira momwe angapewere shuga wambiri, kuchepetsa kuchuluka kwa mankhwalawa munthawi yake, pakakhala mwayi wambiri wofoola, ndikudziwitsa hypoglycemia mwa zizindikiro zoyambirira. Kukhala kofunikira kuphunzira malamulo a chisamaliro chadzidzidzi kwa othandizira komanso kudziwana nawo.

Ndikofunikira kuphunzira: Hypoglycemia mu matenda osokoneza bongo (kuchokera kuzizindikiro mpaka zamankhwala)

Matenda a shuga ndi kupsinjika kudzakhala chinthu chakale

• Matenda a shuga -95%
• Kuthetsa kwa mitsempha thrombosis - 70%
• Kuthetsa kwa kugunda kwamtima kwamphamvu -90%
• Kuthana ndi kuthamanga kwa magazi - 92%
• Kuwonjezeka kwa mphamvu masana, kukonza kugona usiku -97%

Hypoglycemic coma - ndi chiyani?

Nthawi zambiri, chikomokere chimachitika motsutsana ndi maziko a matenda oopsa a shuga, makamaka kwa odwala omwe amapatsidwa insulin. Hypoglycemia yayikulu imatha kukhalanso mwa anthu okalamba odwala matenda ashuga omwe amamwa mankhwala kwa nthawi yayitali omwe amalimbikitsa kapangidwe ka insulin. Nthawi zambiri chikomokere chimaletsedwa chokha kapena kuchotsedwa kuchipatala ngati wodwalayo amaperekedwa nthawi yake. Hypoglycemic coma ndiyomwe imayambitsa kufa 3% ya odwala matenda ashuga.

Vutoli limatha kukhala chifukwa cha matenda ena, momwe insulin yochulukirapo imapangidwira kapena glucose amasiya kuyenda m'magazi.

Khodi ya ICD-10:

• E0 - chikomokere cha matenda a shuga 1,
• E11.0 - Mitundu iwiri,
• E15 ndi hypoglycemic coma yosagwirizanitsidwa ndi matenda a shuga.

Zoyambitsa kuphwanya

Kukhalitsa mwachizolowezi kwa nthawi yayitali kapena kutsika kwamphamvu kwa shuga kumayambitsa kukomoka kwa shuga. Zitha kuchitika chifukwa cha izi:

1. Kuphwanya ntchito pokonza insulin:

• kuchuluka kwa insulin yochepa chifukwa cha kuchuluka kolakwika;
• kugwiritsa ntchito insulin yamakono kukonzekera ndi kuchuluka kwa U100 ndi syringe yachikale yopangidwira njira yothetsera yowonjezera - U40;
• panalibe chakudya pambuyo pa insulin
• kusintha kwa mankhwalawa popanda kusintha kwa mankhwala ngati am'mbuyowo anali ofooka, mwachitsanzo, chifukwa chosasungidwa mosayenera kapena moyo wa alumali womwe watha;
• kuyikiridwa ndi singano ya syringe yakuya kwambiri kuposa momwe amafunikira;
• kuchuluka kwa insulin chifukwa cha kutikita minofu kapena kutentha kwa jakisoni.

1. Kulandila kwa othandizira a hypoglycemic okhudzana ndi zotengera za svetfanilurea. Mankhwala okhala ndi zosakaniza zogwira glibenclamide, glyclazide ndi glimepiride amachotsedwa pang'onopang'ono kuchokera mthupi ndipo, pogwiritsa ntchito nthawi yayitali amatha kudziunjikira, makamaka ndi zovuta ndi impso. Mankhwala osokoneza bongo mwa othandizawa amathanso kupangitsa kukhala ndi vuto la hypoglycemic.
2. Kuchita zolimbitsa thupi kwamphamvu, kosathandizidwa ndi kudya zamafuta, okhala ndi matenda a shuga a insulin.
3. Kumwa mowa wambiri (oposa 40 g pokhudzana ndi mowa) kumawononga chiwindi ndipo kumalepheretsa kaphatikizidwe ka shuga mkati mwake. Nthawi zambiri, hypoglycemic coma pamenepa amakula m'maloto, m'mawa kwambiri.
4. Insulinoma ndi neoplasm yomwe imatha kudzipangira payekha payokha. Zotupa zazikulu zomwe zimatulutsa zinthu monga insulin.
5. Kusokonezeka mu ntchito ya michere, nthawi zambiri cholowa.
6. Hepatic ndi aimpso kulephera chifukwa cha mafuta hepatosis kapena cirrhosis, matenda ashuga nephropathy.
7. Matenda am'mimba omwe amasokoneza mayamwidwe a glucose.

Ndi matenda a shuga ndi kuledzera kwa matenda ashuga, mawonetseredwe oyamba a hypoglycemia ndi ovuta kumva, kotero mutha kudumphira shuga pang'ono ndikubweretsa vuto lanu. Kuchepa kwa zizindikiro kumawonekanso kwa odwala omwe amakhala ndi hypoglycemia pafupipafupi. Amayamba kumva kuperewera kwa ntchito m'thupi shuga ikamatsika 2 mmol / l, motero amakhala ndi nthawi yochepa yoperekera chithandizo chodzidzimutsa. Komanso, anthu odwala matenda ashuga okhala ndi shuga wambiri amayamba kumva zizindikiro za matenda a hypoglycemia shuga likakhala labwinobwino.

Chomwe chimadziwika ndi Code Code

Zizindikiro za hypoglycemia sizimatengera chomwe chinayambitsa. Pazochitika zonse, chithunzi cha chipatala cha kukula kwa chikomono ndi chimodzimodzi.

Nthawi zambiri, shuga wamagazi nthawi zonse amasungidwa ngakhale ndikusowa kwa chakudya chifukwa cha kuwonongeka kwa mashopu a glycogen komanso mapangidwe a shuga m'chiwindi kuchokera pazinthu zopanda mafuta. Shuga akamatsika mpaka 3,8, dongosolo lodziyimira palokha limayendetsedwa mthupi, njira zomwe zimalepheretsa kuperewera kwa hypoglycemic, ndipo insulin antagonists amapangidwa: glucagon woyamba, kenako adrenaline, ndipo pomaliza, mahomoni okula ndi cortisol. Zizindikiro za hypoglycemia panthawiyi zikuwonetsa za kusintha kwa masinthidwe amtunduwu, amatchedwa "vegetative". Mwa odwala matenda ashuga, kupuma kwa glucagon kenako adrenaline kumachepa, nthawi yomweyo zizindikiro zoyambirira za matendawa zimachepa, ndipo chiopsezo cha kukomoka kwa hypoglycemic chikukula.

Ndi kuchepa kwa glucose mpaka 2.7, ubongo umayamba kufa ndi njala, neurogenic imawonjezeredwa ndi mawonekedwe azomera. Mawonekedwe awo amatanthauza kuyamba kwa zotupa za chapakati mantha dongosolo. Ndi dontho lakuthwa la shuga, magulu onse awiriwa amachitika nthawi yomweyo.

Algorithm Yothandizira Choyamba

Zizindikiro zamasamba zimachotsedwa mosavuta mukamadya zakudya zamafuta othamanga. Pankhani ya shuga, 10-20 magalamu nthawi zambiri amakhala okwanira. Kupitilira mlingo osavomerezeka, chifukwa mankhwala osokoneza bongo amatha kuyambitsa vuto - hyperglycemia. Kweza shuga wamagazi ndikuwongolera mkhalidwe wa wodwalayo, maswiti angapo kapena zidutswa za shuga, theka la kapu ya mandimu kapena koloko yotsekemera ndikokwanira. Anthu odwala matenda ashuga nthawi zambiri amakhala ndi chakudya champhamvu kwambiri kuti ayambe kulandira chithandizo pa nthawi yake.

Tcherani khutu! Ngati wodwala watchulidwa acarbose kapena miglitol, shuga sangayimitse hypoglycemia, popeza mankhwalawa amalepheretsa sucrose. Thandizo loyamba la hypoglycemic coma pamenepa lingaperekedwe ndi shuga weniweni m'mapiritsi kapena yankho.

Wodwalayo akadali wachidziwitso, koma osathanso kudzithandiza, amapatsidwa chakumwa chilichonse chotsekemera kuti ayimitse hypoglycemia, ndikuonetsetsa kuti sakudandaula. Zakudya zouma panthawiyi zili pachiwopsezo cha kusangalala.

Ngati chikumbumtima chatha, muyenera kuyimba ambulansi, ikani wodwalayo kumbali yake, onetsetsani ngati misewu ya ulere ndi ngati wodwalayo akupuma. Ngati ndi kotheka, yambani kuchita kupumira kokumba.

Hypoglycemic coma imathetsedweratu ngakhale madokotala asanafike, chifukwa izi ndizoyambira zofunikira. Mulinso mankhwala osokoneza bongo komanso syringe yake. Moyenera, aliyense wodwala matenda ashuga ayenera kunyamula katundu uyu naye, ndipo banja lake liyenera kugwiritsa ntchito. Chida ichi chimatha kulimbikitsa kupanga shuga m'magazi, motero kuzindikira kumatha kubwerera kwa wodwala pakatha mphindi 10 jakisoni.

Kupatula kunja kumachitika chifukwa cha kuledzera komanso kuchuluka kwa insulin kapena glibenclamide. Poyamba, chiwindi chikugwira ntchito yoyeretsa thupi la zinthu zowola zamkaka, chachiwiri, malo ogulitsira a glycogen m'chiwindi sichingakwanitse kusokoneza insulin.

Zizindikiro

Zizindikiro za hypoglycemic coma sizodziwika mwachindunji. Izi zikutanthauza kuti amathanso kuchitika chifukwa cha zina zomwe zimayenderana ndi matenda a shuga. Mwachitsanzo, anthu odwala matenda ashuga okhala ndi shuga wambiri amatha kumva ludzu chifukwa cha kukana kwamphamvu kwa insulin, komanso ndimatenda amishuga, kugunda kwamtima komanso thukuta kumatha kuchitika. Kutembenuka musanayambike kukomoka kumakhala kolakwika mosavuta kwa matenda a khunyu, ndipo kuvuta kwamantha kumakhala ndi zizindikiro zofananira monga hypoglycemia.

Njira yokhayo yotsimikizika ya hypoglycemia ndi kudzera mu mayeso a labotale omwe amayeza glucose wa plasma.

Kuzindikira kumachitika potsatira zotsatirazi:

1. Glucose ndi wochepera 2.8, wokhala ndi zizindikiro za hypoglycemic coma.
2. Glucose amakhala ochepera 2.2 ngati zizindikiro zotere sizinawoneke.

Kuyesedwa koyesa kumagwiritsidwanso ntchito - 40 ml ya glucose solution (40%) imalowetsedwa mu mtsempha. Ngati shuga wamwazi watsika chifukwa cha kusowa kwa chakudya chamafuta kapena mankhwala osokoneza bongo a shuga, Zizindikiro zimatha.

Gawo la madzi a m'magazi olowetsedwa kuchipatala limakhala louma. Ngati, atathetsa chikomokere, zomwe sizimayambitsa sizikudziwika, plasma iyi imatumizidwa kuti ikawunikidwe bwino.

Mankhwala othandizira

Ndikungokhala pang'ono, chikumbumtima chimabwezeretseka mukangoyezetsa matenda ake. Mtsogolomo, odwala matenda ashuga adzafunika kokha kuyesedwa kuti adziwe zomwe zimayambitsa kusokonekera kwa hypoglycemic ndikukonzanso njira yomwe kale idalembedwa chifukwa cha matenda ashuga. Ngati wodwalayo sanakhalenso ndi chikomokere, amapezekanso. Pankhaniyi, kuchuluka kwa shuga 40% yoyendetsedwa kudzera mkati imakulitsidwa mpaka 100 ml. Kenako amasinthana ndi makonzedwe opitilira ndi dontho kapena kulowetsedwa kwa 10% yankho mpaka shuga wamagazi afikire 11-13 mmol / L.

Zitapezeka kuti chikomokere chachitika chifukwa cha mankhwala ochulukitsa a hypoglycemic othandizira, amatha kutsuka kwa m'mimba ndikupatsa enterosorbents. Ngati mankhwalawa ali ndi insulin yayikulu ndipo sipanathe maola awiri kuchokera kuti jakisoni, minyewa yofewa ituluke m'malo a jekeseni.

Pa nthawi yomweyo ndi kuwonongedwa kwa hypoglycemia, chithandizo cha zovuta zake zimachitika:

1. Ma diuretics omwe amaganiza kuti ali ndi edema ya m'magazi - mannitol (15% yothetsera mlingo wa 1 g pa kilogalamu ya kulemera), ndiye lasix (80-120 mg).
2. Nootropic Piracetam imasintha magazi m'magazi ndipo imathandizira kukhalabe ndi kuzindikira (10-20 ml ya yankho la 20%).
3. Insulin, kukonzekera kwa potaziyamu, ascorbic acid, pamene pali shuga wokwanira kale m'magazi ndipo kulowa kwake mu minofu kumayenera kukonzedwa.
4. Thiamine kwa amamuganizira hypoglycemic chikomokere kapena kutopa.

Mavuto a hypoglycemic chikomokere

Mikhalidwe yamphamvu kwambiri ya hypoglycemic itachitika, thupi limayesetsa kupewa zotsatirapo zoipa zamitsempha yamagazi - imathandizira kumasulidwa kwa mahomoni, imachulukitsa magazi amitsempha kangapo kuti achulukitse mpweya ndi glucose. Tsoka ilo, malo osungira zachilengedwe amatha kuletsa kuwonongeka kwa ubongo kwakanthawi kochepa.

Ngati chithandizo sichikubala zipatso kwa nthawi yoposa theka la ora, ndiye kuti mavuto atheka. Ngati chikomokere sichikumatha kwa maola opitilira 4, mwayi wa mphamvu zamitsempha zambiri zosintha ndizabwino. Chifukwa cha njala yayitali, matenda a edema, necrosis ya madera ena amakula. Chifukwa cha kuchuluka kwa ma catecholamines, mamvekedwe amitsempha amachepa, magazi mwa iwo amayamba kusayenda, thrombosis komanso zotupa zazing'onoting'ono zimachitika.

Mwa odwala matenda ashuga okalamba, kukomoka kwa hypoglycemic kumatha kupikisidwa ndi vuto la mtima ndi stroko, kuwonongeka kwamaganizidwe. Zotsatira za nthawi yayitali ndizothekanso - dementia woyambirira, khunyu, matenda a Parkinson, encephalopathy.