Zamoyo zonse zachilengedwe za thupi zimakhala ndi mulingo wa pH. Mwachitsanzo, momwe m'mimba mumakhalira ndi acidic (pH 1.5-2), ndipo magazi ndi amchere pang'ono (average pH 7.3-7.4). Kusunga izi pamlingo woyenera ndikofunikira kwa moyo wabwinobwino wamunthu. Kutulutsa kwamtundu uliwonse komwe kumachitika mthupi nthawi zonse kumakhudzidwa kwambiri ndi kusokonezeka kwa mulingo wa acid-base.
Zomwe zimachitika
Ketoacidosis imatha kuyambitsa izi:
- kuchuluka zolakwika za insulin pochizira matenda a shuga 1;
- kupatuka panjira yachilendo ya jakisoni (kudumpha, ndikuchedwa pang'ono);
- kugwiritsa ntchito mankhwala omwe adatha omwe ataya ntchito;
- m`malo insulin mankhwala ndi wowopsa "wowerengeka" ndi njira zina chithandizo;
- matenda a shuga 1 osadziwika, omwe munthuyo sanadziwe, chifukwa chake sanapange insulin m'magazi.
Ketoacidosis imathanso kudwala matenda a shuga a mtundu wachiwiri. Izi zimachitika pakapita nthawi yayitali matendawa, chifukwa chomwe amapanga okha insulin, amasokonezeka, ndipo nthawi zina amatsekedwa kwathunthu. Kuphatikiza apo, pali zinthu zina zosadziwika bwino zomwe zimapangitsa kuti thupi lake lichepe chifukwa chake akhoza kukhala ndi matenda ashuga a ketoacidosis:
- chikhalidwe pambuyo matenda opatsirana, kupuma ndi mavairasi, kuvulala;
- nthawi yogwira ntchito (makamaka pa opaleshoni ya pancreatic, ngakhale munthu atakhala kuti alibe matenda ashuga kale);
- kugwiritsa ntchito mankhwala ophatikizidwa kwa odwala matenda ashuga, omwe amafooketsa insulin (awa akuphatikizapo mahomoni ena ndi okodzetsa);
- mimba ndi kuyamwitsa.
Insulin iyenera kusungidwa mothandizidwa ndi malangizowo, popeza ndizovuta kuneneratu za thupi lake ngati mankhwala omwe awonongedwa akaperekedwa
Zizindikiro
Ketoacidosis mu matenda a shuga mellitus, ngakhale ndiwadzidzidzi, koma amakula pang'onopang'ono, ndikuwonjezereka kwa zizindikiro. Chifukwa chake, ndikukaika kwakuthupi m'thupi, ndibwino kuti muyesenso shuga ndi glucometer ndikuyesa mayeso a acetone mu mkodzo kunyumba.
Kuwonetsedwa koyambirira kwa ketoacidosis ndi:
- kulakalaka kumwa kosamwa;
- kukodza pafupipafupi;
- mutu
- Chizungulire
- ulesi.
Kuzindikira kwaumunthu pakadali pano kwasungidwa. Amatha kuganiza ndikuwunika momwe zinthu ziliri, ngakhale kuchuluka kwa glucose m'magazi kumakwezedwa kale, ndipo matupi a ketone amapezeka mumkodzo, omwe nthawi zambiri sayenera kukhalapo.
Komanso, thanzi la munthu limakulirakulira pang'onopang'ono, ndipo mkhalidwe wokoma umakula. Zizindikiro za gawo ili la matenda ashuga ketoacidosis:
- kupuma kwamkamwa;
- kununkhira kwa acetone kuchokera kwa munthu yemwe amamveka ngakhale patali;
- stupor (Mkhalidwe womwe munthu samayankha pazinthu zopsetsa mtima, sangathe kuyankhula ndi kuganiza momveka bwino, koma nthawi yomweyo, palibe chosokoneza);
- kuchuluka kwa mtima;
- khungu louma ndi mucous nembanemba;
- kutsitsa magazi;
- kusanza (nthawi zambiri ndi kuphatikizika kwa magazi am'mimba a venous).
Pakumuunika wodwalayo, dokotalayo amatha kudziwa zomwe ali ndi "m'mimba pamimba": kupweteka, kupsinjika kwa minofu m'mimba komanso chizindikiro cha chotupa cha peritoneum. Chifukwa chake, ketoacidosis nthawi zina imatha kusokonezedwa ndi ma opaleshoni a dongosolo la kugaya chakudya. Pakakhala chithandizo chokwanira, gawo la sopor limatha kukhala ndi zotsatira zowopsa kwambiri za ketoacidosis - chikomokere.
Zizindikiro zina za ketoacidosis zimapezekanso m'matenda ena, motero zimafunikira kusiyanitsidwa ndi nthawi ndi mowa, poyizoni wa mankhwala osokoneza bongo, njira zopatsirana komanso syncope "yanjala"
Coma
Mwazi wamwazi mu chikomokere umatha kufika 20-30 mmol / L. Pankhaniyi, acetone imadziwika mu mkodzo nthawi zonse. Coma yokhala ndi ketoacidosis imawonetsedwa ndi zizindikiro izi:
- kulephera kudziwa;
- kuletsa kwamitundu yambiri yofunika;
- kutsika kwakuthwa kwa kupanikizika;
- kukoka kofooka;
- kupuma kwakuya ndi kaphokoso;
- kusowa kochita kukakamiza kwa mwana kuti ayunikire;
- fungo lakuthwa la acetone mchipinda chonse momwe muli wodwala;
- kuchepa kowopsa pokodza (kapena kusakhalapo kwathunthu);
- phokoso komanso kupuma kwakukuru.
Kuwonjezeka kwa shuga m'magazi ndi kupezeka kwa ma ketoni mu mkodzo ndi chizindikiro chakuti shuga satha, ndipo munthu amafunika thandizo la kuchipatala
Thandizo loyamba
Ngati wodwala matenda ashuga ali ndi zizindikiro zonse za ketoacidosis, muyenera kuyimbira ambulansi kuchipatala ndi adokotala. Izi zikachitika, ndiye kuti mwayi waukulu wowalandira mwachangu komanso wopambana ndi zovuta zochepa. Dokotala asanafike, wodwala akhoza kuthandizidwa:
- perekani malo okhala modekha;
- kuti muwone ngati akudziwa (ngati wodwala matenda ashuga sayankha mafunso, mutha kuyesa "kumuwonjezera" pomupukutira khutu ndikugwedeza mapewa ake pang'ono);
- Osasiya munthu osakudalirani;
- perekani wodwalayo mwayi wokhala ndi mpweya wabwino, chotsani zovala zake zomwe zimakakamiza pachifuwa.
Ketoacidosis sikuyenera kulandira chithandizo chokha kunyumba. Choopsa kwambiri pamenepa ndi kugwiritsa ntchito mankhwala aliwonse. Ogwira ntchito zachipatala okha ndi omwe angapereke thandizo loyenerera, kotero asanafike ambulansi, chinthu chofunikira kwambiri sikuti kuvulaza munthuyo. M'malo mogwiritsa ntchito njira zoyipa zochizira, ndibwino kukonzekera zolemba za wodwalayo ndikusonkhanitsa zinthu kuchipatala kuti musataye nthawi yofunikira pa izi.
Kuyembekezera dokotala, sikofunikira kukakamiza wodwala kuti amwe kwambiri, chifukwa kuchuluka kwa madzimadzi kumawongoleredwa ngakhale kuchipatala. Mukapatsidwa mankhwala a intaneti tsiku loyamba, sayenera kupitilira 10% ya kulemera kwa thupi kwa munthu
Mfundo za chithandizo cha mankhwala
Ketoacidosis wapezeka nthawi iliyonse sangathe kuthandizidwa kunyumba. Awa ndi vuto lopweteka kwambiri mthupi momwe munthu amafunikira chithandizo chamankhwala pokhapokha ngati akuwonjezereka. M'chipatala, mankhwala otsatirawa nthawi zambiri amaperekedwa kwa wodwala:
- insulini kuti muchepetse magazi;
- saline yachilengedwe kuti athetse kusowa kwamadzi;
- mankhwala a alkaline kuti athetse kusuntha kwa pH kupita kumbali ya asidi ndikubwezeretsa bwino;
- mankhwala othandizira chiwindi;
- electrolyte mayankho kulipira kutaya kwa mchere ndi kukhalabe ndi mtima ntchito.
Pofuna kuti lisawononge ubongo, kuchuluka kwa glucose m'magazi sikungachepetse kwambiri. Ndizabwino kwambiri kuti muchepetse izi pogwiritsa ntchito inshuwaransi ya 5,5 mm / ola (izi zitha kuchitika ndi kutsimikizika kwa insulin pa ma unit 4 ndi ola limodzi)
Chithandizo cha ketoacidosis popanda insulin sichingatheke, chifukwa ndi yekhayo mankhwala omwe amachotsa chifukwa cha ketoacidosis. Mankhwala ena onse amafunikiranso ndi wodwala, koma machitidwe awo amathandiza kuchiza ndi kupewa zovuta zomwe zimadza chifukwa cha vutoli.
Mankhwala onse obayidwa amalembedwa m'mbiri ya achipatala. Pali zambiri zojambulidwa pazizindikiro komanso kusintha kulikonse kwa wodwala. Kwa odwala matenda ashuga kuchipatala, ichi ndi chikalata chofunikira kwambiri chachipatala chomwe chili ndi chidziwitso chonse cha ketoacidosis. Wodwalayo amalandira zofunikira kuchokera ku mbiri yakale yakuchipatala pakuchotsedwa kuti akaperekedwe kwa endocrinologist ku chipatala komwe amakhala.
Zolemba za ketoacidosis mwa ana
Matenda a shuga a ketoacidosis mwa ana amawonetsedwa ndi zofanana ndi zomwe zimachitika mwa munthu wamkulu. Ichi ndi chimodzi mwazovuta kwambiri komanso zovuta kwambiri za matenda amtundu 1, zomwe zimabweretsa zotsatira zoyipa chamoyo. Chifukwa chake, muubwana, mawonekedwe a acetone mu mkodzo ndi kulumpha mu shuga ndi chizindikiro chachindunji cha chisamaliro chamankhwala.
Zowonetsera ketoacidosis mu magawo oyamba ana:
- zikuluzikulu zamkhungu, koma kutulutsa nkhope
- kusanza pafupipafupi
- kupweteka kwam'mimba
- kufooka
- fungo la acetone kuchokera ku masanzi, ndowe ndi mkodzo.
Ngati mwana akhala woopsa komanso waludzu nthawi zonse, ndikofunikira kuyeza kuchuluka kwa shuga m'magazi ake posachedwa ndikuwunika kuti apangeone mu mkodzo
Nthawi zina acetone mu mkodzo amawonekera ngakhale mwa ana athanzi omwe saadwala matenda a shuga. Izi ndichifukwa choti kapamba wawo sanakonzekere bwino, ndipo nthawi zina amatha kuyambitsa zovuta. Matendawa amatchedwa "acetonemic syndrome." Amathandizidwanso kuchipatala. Ndi dokotala yekhayo amene amatha kusiyanitsa matenda amodzi kuchokera kwa mnzake, ndipo pazowonjezera izi, kuphatikiza pa mayeso, kufufuza mwatsatanetsatane kwa mwana ndikofunikira.
Kupewa
Popewa ketoacidosis, wodwala aliyense ali ndi mtundu wina wa matenda ashuga ayenera kuyang'anitsitsa thanzi lawo komanso kuwonetsetsa kuti ali ndi thanzi labwino. Ndikofunika kutsatira mfundo izi:
- munthawi yake jakisoni kuchuluka kwa insulin;
- musasinthe mulingo woyenera wa mankhwalawo popanda dokotala;
- kusunga zakudya zomveka ndi zakudya zotchulidwa;
- kuyang'anira shuga wamagazi nthawi zonse;
- Nthawi ndi nthawi onani thanzi la glucometer ndi zolembera za insulin;
- pitani kuchipatala ngati muli ndi zokayikitsa.
Mavuto ambiri a ketoacidosis amatha kukhala edema, chibayo, kulephera kwa mtima ndi zina zopweteka kwambiri m'thupi. Pofuna kupewa izi, pamafunika kuzindikiridwa ndikuchiritsidwa nthawi. Kuyang'anira wodwala kuchipatala pafupipafupi komanso kufotokoza kwake mwatsatanetsatane za kutuluka kwazinthu zina ndizofunikira pakuletsa kubwereza ketoacidosis.
