Kukomoka kwa matenda ashuga kumatchedwa kuponderezana kwa chizindikiritso cha munthu chokhudzana ndi kusokonezeka kwakukulu kwa metabolic m'thupi chifukwa cha vuto la hyperglycemia. Muzochita zamankhwala, lingaliro ili limaphatikizapo hyperglycemic ketoacidotic ndi hyperosmolar coma.
Matenda a matenda ashuga amaonedwa kuti ndi vuto lalikulu lomwe limafunikira chithandizo chamankhwala chodzidzimutsa. Kusakhalako panthawi yake kumabweretsa kudwala. Tiyenera kukumbukira kuti chikomokere chimasinthidwa ndipo chitukuko chake chitha kupewedwa.
Matenda a shuga ketoacidosis
Awa ndi mkhalidwe wowonongeka pachimake, womwe umadziwika ndi kuchuluka kwa mathuga am'magazi ndi acetone m'magazi (Latin - acetonaemia), ndi ketoacidotic coma ndi boma lotchuka kwambiri. Kukula kumawonedwa mu 3-5% mwa odwala onse omwe akudwala matenda a shuga. Imfa imachitika mu 5-30% ya milandu.
Zimayambitsa hyperglycemic ketoacidotic chikom:
- kusowa kwa nthawi yake matendawa;
- kuphwanya njira ya insulin mankhwala;
- matenda opatsirana pachimake;
- chithandizo chokwanira cha "matenda okoma" osakanikirana ndi chithandizo cha opaleshoni, zochitika zovuta, zoopsa;
- kuchuluka kwa matenda a dongosolo;
- matenda a mtima ndi mtsempha wamagazi;
- opaleshoni yam'mimba;
- osagwirizana ndi malamulo okhudzana ndi zakudya;
- kuledzera ndi ethyl mowa;
- theka lachiwiri la pakati.
Njira yopititsira patsogolo
Kuperewera kwa pancreatic kumayambitsa kupitilira kwa insulin. Popeza kuchuluka kwa mahomoni kumakhala kotsika kuti "athe kutsegula chitseko" kumaselo kuti azitha kudya shuga, magazi ake amakhala pamlingo wokwera kwambiri. Thupi likuyesayesa kulipirira matenda am'mimba chifukwa cha kutha kwa glycogen komanso kapangidwe ka monosaccharide kuchokera ku mapuloteni omwe amapangidwa m'chiwindi kuchokera kumapuloteni omwe amachokera ku chakudya.
Hyperglycemia - maziko a mawonekedwe a matenda a shuga
Mchere wambiri umapangitsa kuchuluka kwa osmotic kupanikizika, komwe kumayambitsa kutulutsa kwa madzi ndi ma electrolyte m'maselo. Hyperglycemia imathandizira kuti madzi azithanso mkodzo komanso kuwonekera kwa shuga mkodzo. Kutha kwamadzi ambiri kumayamba.
Kuphatikizika kwa lipid kumachitika, ma free radicals, cholesterol, triglycerides amadziunjikira m'magazi. Onsewa amalowa m'chiwindi, ndikukhala maziko a mawonekedwe a owonjezera a matupi a ketone. Matupi a acetone amalowa m'magazi ndi mkodzo, zomwe zimaphwanya acidity ndikupangitsa kukula kwa metabolic acidosis. Ichi ndiye pathogenesis wa ketoacidotic chikomokere mu shuga.
Zizindikiro
Chipatalachi chikukula pang'onopang'ono. Izi zitha kutenga masiku angapo kapena zaka zingapo. Njira zopatsirana zambiri, kuchuluka kwa matenda osachiritsika, kugunda kwa mtima kapena matenda opha ziwopsezo zimatha kubweretsa zizindikiro m'maola ochepa.
Nthawi yeniyeni imayendera limodzi ndi mawonekedwe:
- matenda a ludzu ndi pakamwa lowuma;
- fungo lamphamvu la acetone mu mpweya wotuluka;
- polyuria;
- kuchepa kwakukulu pantchito;
- ululu pamimba syndrome;
- mawonekedwe owonetsedwa, maso owala (zizindikiro za kusowa kwamadzi).
Kununkhira kwa acetone ndi chizindikiro chomwe chimalola kusiyanitsa zovuta zamagulu a shuga
Pambuyo pake, khungu turgor limachepetsa, tachycardia, kupuma kwakuya komanso kwamkati kumawonekera. Asanayambike kukomoka palokha, polyuria imasinthidwa ndi oliguria, kusanza kwambiri, hypothermia imawonekera, ndipo kamvekedwe ka mawonekedwe amachepa.
Mutha kudziwa zambiri za zofooka za matenda ashuga zomwe zalembedwa munkhaniyi.
Zizindikiro
Laborator Zizindikiro za ketoacidotic chikomokere matenda a shuga:
- ziwerengero za glycemia pamwambapa 35-40 mmol / l;
- osmolarity - mpaka 320 mosm / l;
- acetone m'magazi ndi mkodzo;
- acidity magazi amachepetsa mpaka 6.7;
- kutsika kwa milingo yama electrolyte;
- magawo otsika a sodium;
- kuchuluka kwa cholesterol ndi triglycerides;
- milingo yayikulu ya urea, nayitrogeni, creatinine.
Zofunika! Ketoacidosis imafuna kusiyanitsidwa ndi hypoglycemic coma.
Hyperosmolar chikomokere
Khoma la matenda ashuga limadziwika ndi shuga wambiri wopanda mapangidwe a matupi a ketone. Vutoli limatsatiridwa ndi kuchepa kwamadzi ndipo limakhala chifukwa cha 5-8% ya anthu onse odwala matenda ashuga. Imfa imachitika mu zochitika zitatu zilizonse zachipatala popanda thandizo lokwanira.
Nthawi zambiri amakula mwa achikulire, mwa ana sizimachitika. Hyperosmolar coma mu matenda osokoneza bongo amadziwika ndi mawonekedwe ake omwe amadalira insulin. Ziwerengero zimati nthawi zambiri, ndimachitidwe osokonezeka chotere omwe odwala amaphunzira za kukhalapo kwa matenda oyamba.
Okalamba omwe ali ndi matenda a shuga a 2 - omwe amakhudzidwa ndi kuchuluka kwa anthu omwe ali pachiwopsezo chokhala ndi vuto la hyperosmolar coma
Zomwe zimayambitsa chitukuko cha matenda a m'matumbo zingakhale:
- matenda oyamba nawo - mwanjira yolumikizana mwanjira yomwe imakulitsa mkhalidwe wamatenda;
- matenda opatsirana;
- kuvutika kapena kuwotcha;
- pachimake matenda;
- matenda am`mimba thirakiti, limodzi ndi mavuto kusanza ndi kutsegula m'mimba;
- kuchepa kwa magazi;
- othandizira opaleshoni;
- kugwiritsa ntchito mankhwala a mahomoni kwakanthawi, ma diuretics, ma immunosuppressants, mannitol.
Zofunika! Kuyambitsidwa kwa glucose komanso kudya mafuta ochulukirapo kungapangitse vutoli.
Njira yopititsira patsogolo
Magawo oyamba a kuchuluka kwa shuga m'magazi amaphatikizidwa ndi mawonekedwe a glucose mu mkodzo ndi chimbudzi chake chowonjezera (polyuria). Kuwonjezeka kwa kupanikizika kwa osmotic kumachitika, zomwe zimapangitsa kutuluka kwa minofu ndi maselo amadzimadzi ndi ma electrolyte, komanso kuchepa kwa magazi m'm impso.
Kuchepa kwa thupi kumayambitsa gluing yama cell ofiira am'magazi ndi mapulateleti. Chifukwa cha kuchepa kwa madzi, kupanga aldosterone kumatheka, sodium imasungidwa m'magazi, zomwe zimapangitsa kuti pakhale zotupa zazing'onoting'ono m'mitsempha yaubongo. Mikhalidwe yomwe idawonekera imakweza osmolarity wa magazi kwambiri.
Zizindikiro
Precoma imayendera limodzi ndi zomwezi monga boma la ketoacidosis. Mfundo yofunika kugwiritsidwa ntchito kusiyanitsa mkhalidwewo ndi kusapezeka kwa “chipatso” kapena fungo la acetone mumlengalenga. Odwala amawona mawonekedwe otsatirawa:
Momwe mungachotsere acetone kuchokera mthupi ndi shuga kunyumba- ludzu
- polyuria;
- kufooka
- khungu louma;
- Zizindikiro zakumaso (mawonekedwe amaso akuthwa, kamvekedwe ka mawonekedwe amaso akuchepa);
- kupuma movutikira;
- maonekedwe a pathological Reflex;
- kukokana
- khunyu.
Kuperewera kwa chisamaliro chodzidzimutsa kumayambitsa kukulitsidwa kwa stupor ndi kutaya chikumbumtima.
Zizindikiro zakuzindikira
Kuzindikira kwa hyperosmolar coma kumakhazikika pakudziwa kukhalapo kwa hyperglycemia pamwambapa 45-55 mmol / L. Sodium m'magazi - mpaka 150 mmol / l, potaziyamu - mpaka 5 mmol / l (ndi muyezo wa 3.5 mmol / l).
Zizindikiro za Osmolarity ndizoposa 370 mosm / kg, zomwe zimakhala pafupifupi mayunitsi 100 kuposa ziwerengero zabwinobwino. Acidosis ndi matupi a ketone sakupezeka. Kuyesedwa kwa magazi kokwanira kumatha kuwonetsa leukocytosis, kuchuluka kwa hematocrit ndi hemoglobin, kuchuluka pang'ono kwa nayitrogeni.
Laborator diagnostics - ndiye maziko kusiyanasiyana kwa zovuta
Thandizo loyamba
Aliyense wa odwala matenda ashuga amafuna chithandizo choyamba, kuwonjezera pa chithandizo chamankhwala chachikulu. Choyamba, ndikofunikira kuyimba gulu la ambulansi, ndipo mpaka atafika, achite zinthu zingapo:
- Ikani wodwalayo pamalo oyima ndikuwapatsa mwayi wowerenga.
- Mutu umasunthidwira mbali yakumanzere kapena kumanja, kuti kusanza kusamachitike.
- Potenga khunyu pakati pa mano, ndikofunikira kuyika chinthu cholimba (osati chitsulo!). Izi ndizofunikira kuti lilime lisagwere.
- Ngati wodwala amatha kuyankhula, onani ngati akugwiritsa ntchito mankhwala a insulin. Ngati inde, thandizani jakisoni.
- Ndi kuzizira, sonkhanitsani wodwala ndi bulangeti, pesi lotenthetsera.
- Mupatseni madzi akumwa kuchuluka komwe mukufuna.
- Yang'anirani bwino kuthamanga kwa magazi ndi kugunda kwa mtima wanu. Ngati mtima wamangidwa kapena kupuma kwamtima, pitilizani ndi mtima wokhalitsa.
- Osangosiya wodwala yekha.
Ntchito zina zimachitika ndi gulu la ambulansi nthawi yomweyo komanso kuchipatala mutagonekedwa kuchipatala.
Mutha kuwerenga zambiri za chisamaliro chamankhwala odwala matenda ashuga m'nkhaniyi.
Gawo lazachipatala
Chidziwitso chabwino cha ketoacidosis chitha kupezeka ndi insulin. Mlingo woyamba amaperekedwa kudzera m'mitsempha, kenako kutsitsa magazi kudzera mu 5% glucose (kupewa hypoglycemia).
Kulowetsedwa mankhwala - gawo la zovuta chithandizo ndi kuchira wodwala
Kugwiritsa ntchito njira ya bicarbonate, wodwalayo amasambitsidwa ndi thirakiti la m'mimba. Ma electrolyte otayika ndi madzimadzi amabwezeretsedwa ndi kulowetsedwa kwa saline, yankho la Ringer, sodium bicarbonate. Cardiac glycosides, okosijeni wa okosijeni, cocarboxylase amakhazikikanso.
Momwe boma la hyperosmolar limafunikira kulowetsedwa kwakukulu (masisitimu amchere ndi insulin, yankho la Ringer - 15-18 l kwa tsiku loyamba). Ndi glycemia wa 15 mmol / L, insulin imayendetsedwa kudzera m'mitsempha yamagazi. Mayankho a Bicarbonate safunika, chifukwa matupi a ketone kulibe.
Kubwezeretsa nthawi
Kukonzanso odwala atatha kudwala matenda ashuga kumakhala kwawo kuchipatala cha endocrinological ndikutsatira upangiri wa madokotala kunyumba.
- Kutsatira mosamalitsa chakudya chamunthu aliyense.
- Kudziyang'anira pawokha mayendedwe a shuga ndi kuwunika kwakanthawi kantchito.
- Zochita zolimbitsa thupi zokwanira.
- Kutsatira kwenikweni kwa mankhwala a insulin komanso kugwiritsa ntchito othandizira a hypoglycemic.
- Kupewa zovuta komanso zovuta.
- Kukana kudzipereka wekha ndi zizolowezi zoipa.
Kutsatira malamulowa kumapewetsa kuphwanya kwachilungamo ndikusunga chindapusa cha matendawa.
