Iziguli zesifo sikashukela ziyazibuza: isifo sikashukela: kuyini? Ngabe ulindelani onesifo sikashukela uma ungasebenzisi i-insulin ngesikhathi futhi uvikele ukwelashwa kokuthibela? Futhi umbuzo obaluleke kakhulu okhathaza iziguli zeminyango ye-endocrine emitholampilo: Uma ushukela wegazi ungama-30, yini okufanele ngiyenze? Futhi uyini umkhawulo wokweqa?
Kuzoba okulungile ngokwengeziwe ukukhuluma ngesifo sikashukela, ngoba izinhlobo ezi-4 zokukhohlisa ziyaziwa. Amathathu okuqala yi-hyperglycemic, ehlotshaniswa nokugcwala koshukela egazini.
I-ketoacidotic coma
I-Ketoacidotic coma iyisici seziguli ezinesifo sikashukela sohlobo 1. Lesi simo esibucayi senzeka ngenxa yokushoda kwe-insulin, ngenxa yalokho ukusetshenziswa kwe-glucose kuncishisiwe, i-metabolism iyonakaliswa kuwo wonke amazinga, futhi lokhu kuholela ekungasebenzi kahle kwemisebenzi yazo zonke izinhlelo nezinhlaka ngazinye. Isici esiyinhloko se-ketoacidotic coma ukuphathwa kwe-insulin okwanele kanye nokugxuma okubukhali kweglucose yegazi. I-Hyperglycemia ifinyelela - 19-33 mmol / l nangaphezulu. Umphumela ukujula okujulile.
Imvamisa, i-ketoacidotic coma ikhula kungakapheli izinsuku ezingama-1-2, kepha lapho kunezinto ezicasulayo, ingaqhamuka ngokushesha. Ukubonakaliswa kokuqala kwencazelo yesifo sikashukela kuyizimpawu zokwanda ushukela wegazi: ukuqina okubabayo, isifiso sokuphuza, i-polyuria, ukuphefumula kwe-acetone. Isikhumba nolwelwesi lwamafinyila kushunqiswa ngokweqile, kunobuhlungu besisu, ikhanda. Lapho ikhephu landa, i-polyuria ingathathelwa indawo yi-anuria, kwehle umfutho wegazi, ukunyuka kwenhliziyo, kuyabonakala imisipha. Uma ukuhlushwa ushukela wegazi kungaphezulu kwe-15 mmol / l, isiguli kufanele sibekwe esibhedlela.
I-Ketoacidotic coma yisiqu sokugcina sikashukela, esivezwa ukulahlekelwa ngokuphelele kokungazi, futhi uma ungamsizi isiguli, ukufa kungenzeka. Usizo oluphuthumayo kufanele lubizwe ngokushesha.
Ngokuphathwa kwe-insulin okungalungile noma okwanele, kusebenza izizathu ezilandelayo:
- Isiguli asazi ngalesi sifo saso, asizange siye esibhedlela, ngakho-ke isifo sikashukela asitholakalanga ngesikhathi.
- I-insulin efakiwe inekhwalithi enganele noma iphelelwe yisikhathi;
- Ukwephulwa okuphelele kokudla, ukusetshenziswa kwama-carbohydrate agaya ukudla kalula, inala yamafutha, utshwala noma indlala ende.
- Isifiso sokuzibulala.
Iziguli kufanele zazi ukuthi ngesifo sikashukela sohlobo 1, isidingo sokunyuka kwe-insulin kulezi zimo ezilandelayo:
- ngesikhathi sokukhulelwa
- nezifo ezihlangene,
- ezimweni zokulimala nokuhlinzwa,
- ngokulawulwa isikhathi eside kwama-glucocorticoids noma ama-diuretics,
- ngesikhathi sokuzivocavoca ngokomzimba, izimo ezicindezelayo zengqondo.
I-pathogenesis ye-ketoacidosis
Ukushoda kwe-insulin kungumphumela wokukhiqizwa okwandayo kwama-corticoid mahormone - glucagon, cortisol, catecholamines, adrenocorticotropic kanye namahomoni somatotropic. I-glucose ivinjiwe ukuthi ingangeni esibindini, iye kumaseli emisipha nezicubu ze-adipose, izinga layo egazini liyakhuphuka, futhi isimo se-hyperglycemia siyenzeka. Kepha ngasikhathi sinye, amaseli abhekana nendlala yamandla. Ngakho-ke, iziguli ezinesifo sikashukela zithola isimo sobuthakathaka, sokungabi namandla.
Ukuze ngandlela-thile kubuyise indlala yamandla, umzimba uqala ezinye izindlela zokuphinda usebenze kabusha - kusebenze i-lipolysis (ukubola kwamafutha), okuphumela ekwakhekeni kwamafutha acid yamahhala, acid acid engafaniyo, i-triacylglycerides. Ngokuntuleka kwe-insulin, u-80% wamandla umzimba owuthola ngenkathi ku-oxidation wamafutha acid amahhala, uqongelela ngemikhiqizo yokuwohloka kwawo (i-acetone, i-acetoacetic ne-β-hydroxybutyric acid), eyakha imizimba ebizwa ngokuthi yi-ketone. Lokhu kuchaza ukulahleka kwesisindo okubukhali kwesifo sikashukela. Ukugcwala ngokweqile kwezidumbu ze-ketone emzimbeni kudonsa izinqolobane ze-alkaline, ngenxa yalokho ketoacidosis ikhula - i-metabolic pathology enzima. Ngesikhathi esifanayo nge-ketoacidosis, i-metabol-electrolyte metabolism iyaphazamiseka.
I-Hyperosmolar (non-ketoacidotic) coma
I-Hyperosmolar coma ithambekele ezigulini ezinesifo sikashukela sohlobo 2. Lolu hlobo lwe-coma ku-mellitus yesifo sikashukela lwenzeka ngenxa yokuntuleka kwe-insulin, futhi lubonakala ngokuphelelwa ngamandla komzimba, i-hyperosmolarity (ukukhuphuka kokuqina kwe-sodium, glucose ne-urea egazini).
I-Hyperosmolarity ye-plasma yegazi iholela ekulimazeni okukhulu kwemisebenzi yomzimba, ukulahlekelwa ukwazi, kepha uma kungekho ketoacidosis, okuchazwa ngokukhiqizwa kwe-insulin yi-pancreas, engasenele ukuqeda i-hyperglycemia.
Ukuphelelwa ngamandla komzimba, okungenye yezimbangela ze-diabetesic hyperosmolar coma,
- ukusetshenziswa ngokweqile kwama-diuretics,
- isifo sohudo nokuhlanza kwanoma ikuphi i-etiology,
- ukuhlala ezindaweni ezinesimo sezulu esishisayo, noma ukusebenza emazingeni okushisa aphakeme;
- ukuntuleka kwamanzi okuphuza.
Izici ezilandelayo zithinta ukuqala kokwehla komqondo:
- Ukuntuleka kwe-insulin;
- Isifo sikashukela esiphikisayo;
- Ukuhlukumezeka kokudla okuqukethe ama-carbohydrate, noma imithamo emikhulu yemijovo kashukela;
- noma i-peritoneal dialysis, noma i-hemodialysis (izinqubo ezihlobene nokuhlanzwa kwezinso noma i-peritoneum).
- Ukopha isikhathi eside.
Ukuthuthukiswa kwe-hyperosmolar coma kunezimpawu ezivamile nge-ketoacidotic coma. Isikhathi esingakanani isimo sezwe esithandeka ngaso sonke isikhathi sincike esimweni samanyikwe, amandla alo okukhiqiza i-insulin.
I-Hyperlactacidemic coma nemiphumela yako
I-Hyperlactacidemic coma yenzeka ngenxa yokuqongelela kwe-lactic acid egazini ngenxa yokuntuleka kwe-insulin. Lokhu kuholela ushintsho ekwakhekeni kwamakhemikhali kwegazi nokulahlekelwa ukwazi. Izici ezilandelayo ziyakwazi ukuvusa i-hyperlactacidemic coma:
- Inani elinganele le-oksijini egazini ngenxa yokwehluleka kwenhliziyo nokuphefumula okukhona lapho kukhona ama-pathologies anjenge-asthma ye-bronchial, bronchitis, ukuhluleka kwegazi kokujikeleza, i-inhliziyo inhliziyo;
- Izifo zokuvuvukala, izifo;
- Isifo sezinso noma sesibindi esingamahlalakhona;
- Ukuvikelwa kotshwala;
I-Pathogenesis
Imbangela enkulu ye-hyperlactacidemic coma ukuntuleka kwe-oksijini egazini (hypoxia) ngemuva kokushoda kwe-insulin. I-Hypoxia ivuselela i-anaerobic glycolysis, ekhiqiza ngokweqile i-lactic acid. Ngenxa yokuntuleka kwe-insulin, umsebenzi we-enzyme okhuthaza ukuguqulwa kwe-pyruvic acid ube yi-acetyl coenzyme uyancishiswa. Ngenxa yalokho, i-pyruvic acid iguqulwa ibe yi-lactic acid bese inqwabelana egazini.
Ngenxa yokushoda komoya-mpilo, isibindi asikwazi ukusebenzisa i-lactate eyeqile. Igazi elishintshiwe libangela ukwephulwa kwe-contractility kanye ne-excitability yemisipha yenhliziyo, ukuncipha kwemithambo yethambo, okuholele ekhefini
Imiphumela, futhi ngasikhathi sinye, izimpawu ze-hyperlactacidemic coma Ubuhlungu bemisipha, i-angina pectoris, isicanucanu, ukuhlanza, ukozela, ukuqwashisa ngamehlo.
Ukwazi lokhu, ungavimba ukuqala kokubola, okuvela ezinsukwini ezimbalwa uma ufaka isiguli esibhedlela.
Zonke izinhlobo ezingenhla zama-com yi-hyperglycemic, okungukuthi, ukuthuthuka ngenxa yokwanda okubukhali koshukela wegazi. Kepha inqubo yokubuyela emuva iyenzeka, lapho izinga likashukela lehla kakhulu, khona-ke i-hypoglycemic coma ingavela.
I-Hypoglycemic coma
I-Hypoglycemic coma ku-mellitus yesifo sikashukela inemishini eguqukayo, futhi ingakhula lapho inani le-glucose esegazini liyancipha kakhulu kangangokuba kube nokushoda kwamandla engqondweni.
Lesi simo senzeka ezimweni ezilandelayo:
- Lapho kuvunyelwe i-overdose ye-insulin noma eyehlisa ushukela izidakamizwa zomlomo;
- Isiguli asidlanga ngesikhathi ngemuva kokuthatha i-insulin, noma ukudla kwakungekho ku-carbohydrate;
- Ngezinye izikhathi umsebenzi we-adrenal, amandla okuvimbela i-insulin ayancipha, ngenxa yalokho, ukuzwela kwe-insulin kuyanda.
- Ngemuva kokusebenza kanzima ngokomzimba;
Ukuhlinzekwa okungekuhle kwe-glucose ebuchosheni kukhuthaza i-hypoxia futhi, ngenxa yalokho, ukungasebenzi kahle kwamaprotheni nama-carbohydrate emangqamuzaneni esistimu yezinzwa esemqoka.
Izimpawu ze-hypoglycemia:
- Ukwanda kwemizwa yendlala;
- ukwehla kokusebenza ngokomzimba nangokwengqondo;
- ushintsho esimweni sokuziphatha nasesimweni esingafanele, esingakhonjiswa ngolaka olwedlulele, imizwa yokukhathazeka;
- ukuxhawula isandla;
- i-tachycardia;
- pallor
- Ukwanda kwengcindezi yegazi;
Ukwehla kweshukela egazini kuya ku-3.33-2.77 mmol / L (50-60 mg%), kwenzeka into yokuqala emnene ye-hypoglycemic. Kulesi simo, ungamsiza isiguli ngokumuphuzisa itiye elifudumele noma amanzi amnandi anezingcezu ezi-4 zoshukela. Esikhundleni sikashukela, ungafaka i-spoonful of uju, ujamu.
Ngeveli likashukela wegazi lika-2.77-1.66 mmol / L, zonke izimpawu zesimo se-hypoglycemia ziyabonakala. Uma kunomuntu oseduze nesiguli esinganikeza imijovo, ushukela ungangeniswa egazini. Kepha isiguli kusazofanela siye esibhedlela siyolashwa.
Ngokushoda ushukela kwe-1.66-1.38 mmol / L (25-30 mg%) nangaphansi, ukwazi ngokuvamile kuvame ukulahleka. Uphuthumayo kudingeka ushayele i-ambulensi.
