Chisamaliro chodzidzimutsa cha ketoacidotic chikomokere chifukwa cha matenda ashuga

Ketoacidotic chikomachi ndi chowopsa komanso chowopsa chifukwa cha matenda ashuga. Imachitika chifukwa chosowa insulini m'magazi, yomwe imayamba motsutsana ndi maziko a insulin mankhwala osankhidwa bwino. Ngati munthu sapatsidwa chithandizo chamankhwala chapanthawi komanso chofunikira, akhoza kufa.

Ziwerengero zikuwonetsa kuti ketoacidotic chikomokere amapezeka 0,4% ya anthu odwala matenda ashuga. Pafupifupi nthawi zonse, boma limatha kuyimitsidwa. Chiwopsezo chachikulu chomwe chimachitika mwa okalamba ndi ana.

Zifukwa

Ketoacidotic chikomachi chimayamba chifukwa cha insulin yolakwika ya matenda ashuga.

Izi zitha kukhala chifukwa cha:

• Kumwa zakumwa zoledzeretsa pakumwa;
• Kuphwanya njira yaukazi;
• Kulondola kapena kosakhazikika kwa mankhwala ochepetsa shuga;
• Mlingo wosakwanira wa insulin kapena kudumpha makina ake;
• Kukhalapo kwa zizolowezi zoyipa zomwe zimasintha kupanga insulin;
• Kuperewera kwa matenda ashuga ndi matenda ena;
• Kumwa mankhwala angapo;
• Kuperewera kwa kagayidwe kachakudya.

Ngati mungathe kudziwa chomwe chimayambitsa, dokotala amatha kuchita zoyenera kuti athetse zovuta zazikulu.

Zizindikiro

Zizindikiro za ketoacidotic chikomokere zimatengera mtundu wa zotere. Pali maphunziro angapo azachipatala omwe amafunikira zotsatira zosiyana ndi vutoli. Akatswiri amatsatira gawoli:

• Gastrointestinal ketoacidotic chikomokere - chimawoneka ngati ululu wam'mimba, kutentha thupi, pakamwa lowuma, ndikutsatira chikumbumtima.
• Renal ketoacidotic chikomokere - chitha kuzindikiridwa ndi proteinuria, nephroangiopathy, komanso kusintha kwa kuyimitsidwa kwamayendedwe amkodzo.
• Mtima ketoacidotic chikomokere - imadziwonetsa mu khungu lalikulu la mtima, ikhoza kugwa.
• Encephalopathic ketoacidotic chikomokere - imatha kuzindikira ndi asymmetry ya Reflex, hemiparesis, kuwonongeka kwamitsempha yaubongo. Munthu amakhala ndi mutu waukulu, chifunga.

Masiteji

Magawo a ketoacidotic chikomaso amadziwika pakati pang'onopang'ono. Kuchokera kuzizindikiro zoyambirira za izi mpaka kumayambiriro kwa chikomokere, pafupifupi masiku angapo akudutsa. Zonsezi zimayamba ndi vuto la asidi-acid. Akatswiri amasiyanitsa magawo otsatirawa:

• Kuyamba ketoacidosis - kumawoneka ngati zizindikilo za matenda opatsirana a shuga. Munthu amayamba kudwala ndi ludzu losatha, kumva kukamwa kowuma, mutu, nseru komanso kusanza. Amanenanso fungo lamphamvu la acetone kuchokera mkamwa mwake. Pafupipafupi, vutoli limatha kutsimikizika ndi kuwonjezereka kwakuthwa kwa shuga m'magazi.
• Kholo - limangokhala pokhapokha ngati palibe kuchitapo kanthu mwachangu. Amadziwika ndi kusanza kosalekeza, kutsegula m'mimba, kapena kudzimbidwa. Odwala ambiri amadandaula za kupweteka kwambiri pamimba, kugona, kusokonezeka ndi chidwi.
• Coma ndi vuto lalikulu lomwe limafunikira kuchipatala msanga. Munthu amalephera kudziwa, amapuma mwamphamvu ndipo mwa phokoso amapezeka mwa iye. Njira zonse zamkati zimayamba kuchitika mwanjira yapadera.

Kusamalira mwadzidzidzi

Matenda a shuga ndi matenda oopsa omwe achibale onse apafupi ndi anthu odwala ayenera kudziwa.

Ngati ndi kotheka, ayenera kumvetsetsa zomwe amafuna kwa iwo.

Algorithm ya kuyambika kwa ketoacidotic coma ndi motere:

1. Zizindikiro zoyambirira zikaipiraipira kwa wodwalayo: kuwonongeka, kupuma pang'ono, ndikofunikira kuyimbira ambulansi;
2. Dokotala asanafike, ndikofunikira kuyang'ana kuchuluka kwa kuthamanga kwa magazi ndi kugunda kwa mtima mphindi zisanu zilizonse;
3. Yesani kufunsa wodwalayo mafunso kuti adikire;
4. Menya nkhope yake ndikupukutira khutu ndi cholinga chomwecho.

Ambulansi ikafika, madokotala amayenera kuchita izi:

• Yambitsani mlingo wochepa wa insulin mosakakamira;
• Lowetsani saline kuti uthandize kusowa kwamadzi.

Pambuyo pa izi, wodwalayo amapezeka m'chipatala nthawi yomweyo ndikupititsidwa kuchipatala. Nthawi zambiri, odwala oterewa amatumizidwa kumalo osungirako odwala kwambiri. Njira zonse zochiritsira zofunikira zimachitika kumeneko.

Zizindikiro

Pozindikira kuti muli ndi vuto la ketoacidotic, kumayesa wodwalayo mwatsatanetsatane kumachitika. Ngati akuzindikira, dokotala amafunsa mafunso omveka bwino ndipo amafunsa za zomwe akukumana nazo. Pambuyo pake, wodwalayo amapita kukayezetsa angapo kwa labotale komwe kumakupatsani mwayi wotsiriza. Kuzindikira za vutoli kumaphatikizapo izi:

• Mlingo wa glucose chifukwa cha kuyesa kwa magazi kwazonse kumachokera 16-16 mmol / lita.
• Komanso, chifukwa cha kafukufukuyu, mutha kuwona kuchuluka kwa hematocrit ndi hemoglobin, yomwe imawonetsa kuchepa kwamphamvu kwamadzi.
• Matupi a Ketone ku OAM adzakulitsidwa kwambiri.
• Mulingo wa sodium m'magazi utha kuchuluka, ndipo potaziyamu azichulukitsidwa. Izi zitha kuphunziridwa kuchokera ku zotsatira za kuyezetsa kwamwazi wamagazi. Kukula kwa Urea kumayesedwanso kumeneko.
• Kuyesa kwa magazi a acid-alkaline kumakupatsani mwayi wodziwa zovuta za metabolic. Amadziwika ndi kuwonjezeka kwa osmolarity mpaka 300 mosmol / l.
• Kupsinjika kwa magazi kumatsika, ndipo kugunda kwa mtima kumawonjezeka.

Zochizira

Chithandizo cha odwala omwe ali ndi vuto la ketoacidotic chikomokere kapena mawonekedwe ake akhungu amafunika kuchipatala msanga. Anthu oterowo amatumizidwa kumalo osungirako odwala kwambiri, komwe amayang'aniridwa ndi asing'anga. Pambuyo pake, matenda osiyanasiyana amachitika. Kuti musiyanitse kholo kuchokera ku chikomokere, ma 10ulin a insulin amatumizidwa kwa wodwala. Njira zina zochizira zimapangidwira pokhapokha kupezeka kwa matenda oyenera.

Chithandizo cha matenda ashuga chikufuna kumalizidwanso mwachangu kwa insulin. Izi zikuthandizira kuti shuga azikhala ndi shuga, zomwe zimapangitsa kukhala bwino. Zitachitika izi, wodwalayo amapatsidwa njira yothetsera sodium yomwe imathandiza kuti madzi athetse madzi m'thupi.

Dokotala atatsimikizira kekeacidotic chikomokere, amapatsa jakisoni wa insulin kwa wodwalayo. Amabayidwa jet kapena intramuscularly pamlingo wa magawo 10-20 pa ola limodzi.

Pambuyo pa izi, katswiri amayang'ana kuchuluka kwa shuga m'magazi aliwonse, pambuyo pake amapanga nthawi yoyenera.

Ndi kusintha kwa mkhalidwe, mlingo wa insulin umachepa pang'onopang'ono.

Kuthetsa kuwonekera kwa kuchepa thupi kwakuthupi, ndi chikomokere matenda a shuga, madzi ambiri amalowetsedwa m'mitsempha. Poyamba, yankho la sodium chloride limagwiritsidwa ntchito pazifukwa izi. Tiyenera kukumbukira kuti, kutengera nthawi yayitali ya chithandizo, mankhwalawa amayendetsedwa ndi mankhwalawa amasiyana. Chikumbumtima cha wodwalayo chikadzayamba kuchita bwino, kulowetsedwa kumayimitsidwa.

Zolakwa zamankhwala

Chithandizo cha ketoacidotic chikomichi chimafunikira kuyenerezedwa kwambiri ndi madokotala. Mkhalidwe wotere wokhala ndi chithandizo chosankhidwa mosayenera ungayambitse osati zowawa zokha, komanso ngakhale kufa. Kafukufuku wasonyeza kuti zolakwika zotsatirazi zimakumana nawo kwambiri nthawi zambiri:

1. Mankhwala osakwanira a insulin, omwe nthawi zambiri amachititsa kuti magazi achepetse;
2. Kuchepa kwa madzi okwanira kungayambitse kuchepa kwa hypovolemic;
3. Kulephera kuyang'anira kuchuluka kwa shuga m'magazi, chifukwa chomwe thupi sililandira chithandizo choyenera;
4. Kuchepa kwa shuga m'magazi kumathamanga kwambiri, zomwe zimayambitsa nembanemba waubongo;
5. Mlingo wosakwanira wa potaziyamu, womwe umapangitsa mtima wamavuto.

Kuyang'anira odwala

Wodwala akakhala kuti ali ndi vuto la ketoacidotic, amayang'aniridwa nthawi zonse. Dokotalayo ayenera kudziwa momwe thupi lake limagwirira ntchito kuti akonze mankhwalawo moyenera. Kuwongolera kumachitika motere:

1. Ola lililonse - kukoka, kuthamanga kwa magazi, kuchuluka kwa kupuma, shuga m'magazi, mkhalidwe wa chikumbumtima, kuchuluka kwa madzimadzi, kugwiritsidwa ntchito kwa mpweya m'magazi ochepa;
2. Maola aliwonse a 2-4 - kuchuluka kwa ma ketoni ndi zinthu zina zam'mimbamu mu seramu;
3. Maola 8 aliwonse - kutentha ndi thupi;
4. Pambuyo pokodza chilichonse, mulingo wa glucose ndi ma ketoni mumkodzo.

Kuwongolera kwakukulu kwa wodwalayo kumafotokozedwa ndikuti wodwalayo amatha kukhala ndi zovuta nthawi iliyonse. Zotsatira zoyipa kwambiri za ketoacidotic chikomokere cha mankhwala ake zitha kutchedwa:

• Hyperglycemia kapena hypoglycemia;
• Hyperchloremia;
• Zotupa za Thromboembolic;
• Kulephera kwamphamvu;
• Njala ya oxygen, yomwe minofu imamwalira;
• Matenda a metabolism.

Kupewa

Pofuna kupewa zovuta, ndikofunikira kukumbukira kukumbukira kupewa ketoacidotic chikomokere. Zochita ndikuphatikizapo:

• Kuyang'ana shuga m'magazi kamodzi pa sabata;
• Kutsatira zakudya zapadera;
• Kumwa mankhwala omwe amachepetsa shuga;
• Kuyang'anira momwe thupi limakhalira;
• Kukana zizolowezi zoipa;
• Kuchitira panthawi yake matenda onse akutuluka;
• Kuyendera pafupipafupi kwa adotolo;
• Kusungabe moyo wathanzi;
• Moyo wokangalika.

Wodwala amatha kuzindikira zizindikiro zoyambirira za ketoacidotic chikomaso palokha. Ndikofunika kwambiri kuti katswiri wazithandizo azidziwiriratu zoyenera kuchita. Poterepa, munthu athe kudzipezera payekha chithandizo chamankhwala popewa kukula kwamavuto akulu. Kuwunikira pafupipafupi shuga kumathandizanso kuyendetsa thupi, komanso kupewa ketoacidotic chikomokere.

Zovuta zotheka

Ketoacidotic chikomaso ndi vuto lalikulu la matenda ashuga. Ngati wodwala sanalandire bwino kapena mosazindikira, angadwala kwambiri. Choopsa chachikulu ndi matenda a edema. Zodabwitsa zoterezi mu milandu yambiri zimatha ndiimfa. Ndikothekanso kuzindikira mawonekedwe a puffuff mu ubongo ndi kusasinthika kwabwino kwa wodwala, ngakhale njira zonse zochiritsira zikuchitika. Poterepa, adotolo amawunika kusintha kwakukulu mu kagayidwe kazakudya zamafuta ndi mafuta.

Cerebral edema imatha kuzindikiridwa ndi kuchepetsedwa kwa zomwe ophunzira amapita pakuwala kapena ngakhale posakhalapo, edema ya optic nerve kapena ophthalmoplegia.

Kuti atsimikizire izi, katswiri amatumiza wodwala kuti atumizidwe ndi makina ophatikizira a patelefoni.

EEC ndi REC amachitidwanso kuti awunike momwe zimachitika mu ubongo. Ndi thandizo lawo, mutha kudziwa zovuta zomwe zikuchitika komanso kupereka mankhwala oyenera.

Pofuna kupewa zovuta zazikulu za matendawa, katswiriyo ayenera kutumiza wodwalayo pafupipafupi kuti akayezetse magazi. Ndikofunikira kudziwa kuchuluka kwa ma electrolyte m'magazi, hemostasis ndi hemodynamics. Kuzindikiritsa panthawi yake zovuta zilizonse kungathandize kuzithetsa mwachangu, kuti chiwopsezo cha zovuta zilizonse ikhale zochepa.