Hyperosmolar coma ndi vuto lowopsa lomwe limadziwika ndi vuto lalikulu la metabolic ndipo limayamba shuga.
Nthawi zambiri, Hyperosmolar coma imapezeka mwa anthu achikulire omwe ali ndi matenda ashuga odziletsa.
Kuposa theka la milandu, izi zimapangitsa kuti wodwalayo afe, chifukwa chake muyenera kudziwa momwe chisamaliro chamankhwala chimachitikira kwa hyperosmolar coma. Pachifukwa ichi, ndikofunikira kumvetsetsa zomwe zimachitika ndikupanga chitukuko.
Zifukwa
Njira yopanga chitukuko cha hyperosmolar coma sichimamveka bwino ndi asayansi mpaka pano.
Kutengera ndi mitundu, maulalo ofunikira mu pathogenesis ya hyperosmolar diabetesic coma ndi plasma hyperosmolarity ndi kuchepa kwa kugwidwa kwa glucose ndimaselo aubongo.
Kukula kwake kumachitika motsutsana ndi maziko a dziko la hyperosmolarity - kuchuluka kwambiri poyerekeza ndi kuphatikizika kwa glucose ndi sodium m'magazi, motsutsana ndi maziko azofunikira za diuresis.
Ambiri mwa zinthu zosakaniza kwambiri za osmotic, zomwe zimalowa mofooka m'maselo a minyewa, zimayambitsa kusiyana pakati pa kukakamizidwa mkati mwa khungu ndi madzi amadzimadzi am'madzi. Izi zimabweretsa kuchepa kwa maselo, makamaka ubongo. Ngati izi zikuchitika, kuchepa kwa madzi m'thupi kumachitika.Kutayika kwa madzi 20% omwe ali kale m'thupi kumatha kupha.
Wodwala wokhala ndi zizindikiro zotere amafunikira chithandizo cham'tsogolo - ndiye kuti mwayi wopulumuka ukuwonjezeka kwambiri.
Kuphatikiza apo, ma microcirculation amasokonezeka mu ubongo, ndipo kuthamanga kwa madzi amchere kumachepa.
Zonsezi zimabweretsa kuphwanya kwakukulu pakuperekedwa kwa zinthu zofunika ku ma cell aubongo, zomwe zimapangitsa kugwa ndi chikomokere. Pafupifupi pafupifupi kotala la odwala omwe adayamba kukhala ndi hyperosmolar hyperglycemic coma samadziwa za zovuta za kuchuluka kwa shuga m'magazi. Anthu awa sanapezeka kuti ali ndi matenda a shuga m'kupita kwa nthawi, chifukwa asanakhale chikomokere, sizinayambitsa zizindikiro zosokoneza kwambiri munthuyo.
Zomwe Zimakhudza Coma
Kukhalapo kwa shuga kwa wodwala nthawi zambiri sikuti kumayambitsa kukula kwa hyperosmolar coma. Zifukwa zingapo zomwe zimakhudza njira zama metabolic zomwe zimayambitsa kuperewera kwa madzi m'thupi kumabweretsa kupezeka kwa matendawa.
Zomwe zimayambitsa kusowa kwamadzi zingakhale:
- kusanza
- kutsegula m'mimba
- matenda wamba;
- kufooketsa ludzu, mikhalidwe ya okalamba;
- matenda opatsirana;
- kuchepa kwakukulu kwa magazi - mwachitsanzo, pakuchita opareshoni kapena pambuyo povulala.
Zowopsa zomwe zimayambitsa kukula kwa hyperosmolar chikomono ndimavuto am'mimba omwe amayamba chifukwa cha kapamba kapena gastritis. Kuvulala komanso kuvulala, kubalalika kwa myocardial kungayambitsenso kukomoka kwa anthu odwala matenda ashuga. Chinanso choopsa ndicho kupezeka kwa matenda omwe akuwonekera akuwonetsa kutentha thupi.
Zomwe zimayambitsa kupweteka kumayeneranso kukhala mankhwala osayenera omwe amathandizidwa pochiza matenda ashuga. Makamaka nthawi zambiri, njirayi imayamba ndi mankhwala osokoneza bongo kapena Hypersensitivity yomwe imadziwoneka yokha mukamachita maphunziro a okodzetsa kapena glucocorticoids.
Zizindikiro za matendawa
Hyperosmolar odwala matenda ashuga amakula msanga. Kuchokera munthawi yachilengedwe kupita kwa makolo, masiku angapo amapita, ndipo nthawi zina maola angapo.
Choyamba, wodwalayo amayamba kudwala polyuria yowonjezereka, limodzi ndi ludzu ndi kufooka wamba.
Zizindikiro zimakulirakulira, pakapita nthawi kugona, madzi am'madzi amawonekera. Pambuyo masiku angapo, ndipo makamaka pachimake matenda - ndipo patapita maola ochepa, mavuto ndi chapakati mantha dongosolo kuonekera - zoletsa ndi kuzimiririka kwa zomwe. Wodwala akapanda kuthandizidwa, zizindikirazi zimachulukana ndipo zimasanduka chikomokere.
Kuphatikiza apo, kuyerekezera zinthu m`maganizo, kuwonjezeka kwa minofu, kusunthika kosasunthika, areflexia ndikotheka. Nthawi zina, chitukuko cha hyperosmolar coma chimadziwika ndi kuwonjezeka kwa kutentha.
Hyperosmolar diabetesic coma imathanso kuchitika kwa nthawi yayitali ya immunosuppressants ndi wodwala, komanso pambuyo pa njira zina zochizira.
Hemodialysis, kukhazikitsidwa kwa njira zochuluka zokwanira zamchere, magnesia, ndi mankhwala ena omwe amalimbana ndi kuthamanga kwa magazi ndizowopsa.
Ndi hyperosmolar coma, kusintha kwa ma pathological m'magazi kumadziwika. Kuchuluka kwa glucose ndi osmolar zimachulukirachulukira, ndipo matupi a ketone sapezeka pakuwunikaku.
Kusamalira mwadzidzidzi
Monga tanena kale, kulibe chithandizo choyenera chachipatala, chikomoka chimapha.
Chifukwa chake, ndikofunikira kupereka wodwala chithandizo choyenera. Njira zoyenera zokhala ndi chikomokere zili m'chipinda chothandizira odwala kapena kuchipinda chadzidzidzi.
Ntchito yofunikira ndikubwezeretsanso madzi omwe thupi limataya, ndikupangitsa zizindikirazo kukhala zabwinobwino. Mafuta amadzilowetsa mthupi kudzera m'mitsempha, komanso mokwanira.
Mu ola loyamba la zamankhwala, mpaka malita 1.5 amadzi ndivomerezeka. M'tsogolomu, mlingo umachepetsedwa, koma kuchuluka kwa infusions tsiku ndi tsiku kumakhalabe kofunikira kwambiri. M'mawola 24, malita 6 mpaka 10 amatsanulira magazi a wodwalayo. Pali nthawi zina pamene yankho lalikulu likufunika, ndipo kuchuluka kwamadzimadzi komwe kumayambitsidwa kumafikira 20 malita.
Kapangidwe ka yankho kumatha kusiyanasiyana kutengera ndi mayesedwe a magazi a labotale. Chofunikira kwambiri pazizindikiro izi ndi sodium.
Kuzungulira kwazinthu izi mumitundu yambiri ya 145-165 meq / l ndiye chifukwa chobweretsa yankho la sodium. Ngati ndende ikukwera, njira zamchere zimaphatikizidwa. Zikatero, kuyambitsidwa kwa shuga kumayamba.
Makonzedwe a insulin pokonzekera hyperosmolar chikomono sichimachitika. Chowonadi ndi chakuti ntchito yokonzanso madzi kumadzi imachepetsa shuga wamagazi komanso popanda zina zowonjezera. Pokhapokha pokhapokha, pali inshuwaransi yochepa - mpaka magulu awiri pa ola limodzi. Kukhazikitsidwa kwa kuchuluka kwa mankhwala ochepetsa mphamvu ya glucose kumatha kuvuta mankhwalawa.
Nthawi yomweyo, milingo yama electrolyte imayang'aniridwa. Ngati pakufunika thandizo, limapangidwanso pogwiritsa ntchito njira zambiri zomwe zimagwirizana ndi zamankhwala. M'malo owopsa monga hyperosmolar coma, chisamaliro chadzidzidzi chimaphatikizapo mpweya wabwino. Ngati ndi kotheka, zida zina zothandizira moyo zimagwiritsidwa ntchito.
Mpweya wosavulaza
Chithandizo cha hyperosmolar chikomokere chimaphatikizira kuvulala kwamatumbo. Kuti athetse kusungika kwamadzimadzi m'thupi, catheter wa kwamikodzo amagwiritsidwa ntchito mosalephera.
Kuphatikiza apo, kugwiritsa ntchito othandizira othandizira kuti mtima ukhale wogwira ntchito kumachitika. Izi ndizofunikira, chifukwa cha kukalamba kwa odwala omwe adalowa mu hyperosmolar coma limodzi ndi mavitamini ambiri omwe atulutsidwa m'magazi. Nthawi zambiri pamakhala zochitika pamene kusowa kwa potaziyamu m'thupi la wodwalayo. Poterepa, izi zimapangidwanso m'magazi panthawi ya chithandizo.
Kuyambitsidwa kwa potaziyamu kumachitika pokhapokha pakuyamba chithandizo, kapena mutalandira zotsatira za kusanthula koyenera maola 2-2,5 pambuyo povomerezeka kwa wodwalayo. Pankhaniyi, mkhalidwe wofinya ndi chifukwa chokana kugwiritsira ntchito kukonzekera kwa potaziyamu.
Ntchito yofunika kwambiri mu hyperosmolar coma ndikulimbana ndi matenda ophatikizana omwe amakhudza mkhalidwe wa wodwalayo. Popeza imodzi mwazomwe zimayambitsa kukomoka imatha kukhala matenda osiyanasiyana, kugwiritsa ntchito mankhwala oyenera kumakhala koyenera. Popanda chithandizo chotere, mwayi wazotsatira zabwino umachepa.
Mumkhalidwe wofanana ndi hyperosmolar coma, chithandizo chimaphatikizanso kupewa thrombosis. Matendawa ndi amodzi mwa zovuta kwambiri za hyperosmolar coma. Kusakwanira kwa magazi komwe kumachitika chifukwa cha thrombosis pakokha kungayambitse mavuto ambiri, chifukwa chake, ndi chithandizo cha chikomokere, kuyikiridwa kwa mankhwala oyenera kumasonyezedwa.
Mungatani?
Chithandizo chabwino kwambiri, chofunikira, chiyenera kuvomerezeka ngati kupewa matenda.
Odwala omwe ali ndi matenda ashuga amayenera kuyang'anira kuchuluka kwa shuga ndikuyang'ana ndi dokotala ngati atakula. Izi zitha kupewa kukula kwa chikomokere.
Tsoka ilo, palibe njira zochizira kunyumba zomwe zingathandize munthu ndi chitukuko cha hyperosmolar coma. Komanso, kuwononga nthawi pazinthu zosakwanira ndi njira zomwe sizithandiza wodwala kumabweretsa zotsatira zoyipa kwambiri.
Chifukwa chake, chinthu chokhacho chomwe munthu wothandizila angathandizire ndi hyperosmolar coma ndikuyitanitsa gulu la madokotala posachedwa kapena kupulumutsa wodwala ku malo oyenera. Potere, mwayi wodwala umachulukirachulukira.
Makanema okhudzana nawo
Chiwonetsero chodziwitsa, zomwe zimayambitsa ndi zizindikiro za hyperosmolar coma, komanso mfundo za chithandizo choyamba, zimawunikidwa mwatsatanetsatane:
Mwambiri, vuto lalikulu la matenda monga hyperosmolar coma limatanthawuza kulowererapo kwakanthawi. Tsoka ilo, ngakhale izi sizitanthauza kuti wodwala adzapulumuka. Chiwerengero cha anthu omwe amafa ndi mtundu uwu waukoma ndiwokwera kwambiri, makamaka chifukwa cha chiwopsezo chachikulu chokhala ndi ma concomitant pathologies omwe amawononga thupi komanso osagwirizana ndi chithandizo.
