I-Hyperglycemic coma ingenzeka esigulini esinesifo sikashukela uma singalashwa kahle, futhi ngenxa yalokhu, ushukela wegazi ukhuphuka kakhulu. Odokotela babiza inkomba yeglucose yegazi “glycemia.” Uma ushukela wegazi uphakanyisiwe, babe sebethi isiguli sine- “hyperglycemia”.
Uma ungathathi ushukela wegazi ngaphansi kolawulo ngesikhathi, khona-ke i-hyperglycemic coma ingahle ivele
I-Hyperglycemic coma - ukungazi kahle ngenxa kashukela wegazi ophakeme. Kwenzeka ikakhulu kubantu abanesifo sikashukela asebekhulile abangalawulwa ushukela wegazi labo.
I-Hyperglycemic coma ezinganeni yenzeka, njengomthetho, ngokuhambisana ne-ketoacidosis.
I-Hyperglycemic coma ne-ketoacidosis yesifo sikashukela
I-Hyperglycemic coma ivame ukuhambisana ne-ketoacidosis. Uma umuntu onesifo sikashukela enobuthakathaka obalulekile be-insulin, khona-ke amaseli awasitholi ushukela owanele futhi angashintshela ezondlameni ngokugcinwa kwamafutha. Lapho amafutha ephukile, kukhiqizwa imizimba ye-ketone, kufaka phakathi i-acetone. Le nqubo ibizwa nge- ketosis.
Uma imizimba eminingi ye-ketone ijikeleza egazini, lapho-ke yandisa i-acidity yayo, futhi idlulela ngale kwesimo somzimba. Kukhona ukuguquguquka kokulinganisela kwe-acid-base komzimba ngakunyuka kwe-acidity. Le nto eyingozi iyingozi enkulu, futhi ibizwa nge- acidosis. Ngokubambisana, i-ketosis ne-acidosis ibizwa nge- ketoacidosis.
Kulesi sihloko, sizoxoxa ngezimo lapho i-hyperglycemic coma yenzeka khona ngaphandle kwe-ketoacidosis. Lokhu kusho ukuthi ushukela wegazi uphezulu kakhulu, kepha ngasikhathi sinye, umzimba wesifo sikashukela awushintshi ukondla ngamanoni akhe. Izidumbu zeKetone azikhiqizwa, futhi ngenxa yalokho i-acidity yegazi ihlala ingaphansi kwemikhawulo ejwayelekile.
Lolu hlobo lokubandakanyeka okukhulu kwesifo sikashukela lubizwa nge- “hyperosmolar syndrome.” Akunamandla kangako kune-dietoic ketoacidosis. I-Osmolarity ukuhlukunyezwa kwento ngesixazululo. I-Hyperosmolar syndrome - okusho ukuthi igazi likhulu kakhulu ngenxa yokuqukethwe okuphezulu kwe-glucose kuyo.
Ukuxilonga
Lapho isiguli esine-hyperglycemic coma singena esibhedlela, into yokuqala eyenziwa odokotela ukuthola ukuthi une-ketoacidosis noma cha. Ukuze wenze lokhu, hlaziya ngokucophelela umchamo wakho wokuba khona kwezidumbu ze-ketone usebenzisa umucu wokuhlola, futhi uqoqe neminye imininingwane edingekayo.
Ungayiphatha kanjani i-hyperglycemic coma ene-ketoacidosis ichazwa ngokuningiliziwe esihlokweni esithi "Diabetesic ketoacidosis". Futhi lapha sizoxoxa ngokuthi odokotela benzani uma i-coma yesifo sikashukela ingahambisani ne-ketoacidosis. Ngenkathi isiguli esine-hyperglycemic coma sithola ukwelashwa okunzulu, izimpawu zayo ezibalulekile kufanele siqashwe ngokucophelela. Ukuqapha kwabo kwenziwa ngokwesikimu esifanayo nasekwelapheni i-ketoacidosis.
I-Hyperglycemic coma, ene-ketoacidosis noma ngaphandle kwayo, ingaxakaniswa ne-lactic acidosis, isb., Ukugcwala ngokweqile kwe-lactic acid egazini. I-Lactic acidosis imbi kabi kakhulu i-prognosis yemiphumela yokwelashwa. Ngakho-ke, kuyathandeka ukukala izinga le-lactic acid egazini lesiguli.
Kuyalule futhi ukwenza ukuhlolwa kwegazi okwesikhathi se-prothrombin nesikhathi sokucwaswa kwengxenye yesikhathi se-thromboplastin (APTT). Ngoba nge-hyperosmolar syndrome, imvamisa ukwedlula i-ketoacidosis yesifo sikashukela, i-DIC ikhula, isb., Ukumelana kwegazi kuyaphazamiseka ngenxa yokudedelwa okukhulu kwezinto ze-thromboplastic kusuka izicubu
Iziguli ezinesifo se-hyperglycemic hyperosmolar syndrome kufanele zihlolwe ngokucophelela lapho zifuna ukuthola isifo, kanye nezifo ezibangela ukuvuvukala kwama-lymph node. Ukuze wenze lokhu, udinga ukuhlola:
- sinanas paranasal
- umthambo womlomo
- izitho zesifuba
- isisu esiswini, kufaka phakathi i-rectum
- izinso
- palpate the lymph node
- ... futhi ngasikhathi sinye hlola izinhlekelele zenhliziyo.
Izimbangela ze-Hyperosmolar Diabetesic Coma
I-Hyperosmolar hyperglycemic coma yenzeka izikhathi ezingaba ngu-6 ukuya kwezi-6 kuye kaningi kune-siketoicidosis yesifo sikashukela. Ngale nkinga enkulu, njengomthetho, abantu abadala abanesifo sikashukela sohlobo 2 bangeniswa esibhedlela. Kepha umehluko kulo mthetho ojwayelekile uvame ukwenzeka.
Indlela ebangela ukuthuthukiswa kwe-hyperosmolar syndrome imvamisa iyizimo ezikhulisa isidingo se-insulin futhi ziholele ekuphepheni komzimba. Nalu uhlu lwabo:
- izifo ezithathelwanayo, ikakhulukazi lezo ezinomkhuhlane ophakeme, ukuhlanza, nohudo (isifo sohudo);
- infarction myocardial;
- i-pulmonary embolism;
- i-pancreatitis eyingozi (ukuvuvukala kwamanyikwe);
- ukuvinjwa kwamathumbu;
- isifo sohlangothi;
- ukusha okukhulu;
- ukopha okukhulu;
- ukwehluleka kwezinso, i-peritoneal dialysis;
- i-endocrinological pathologies (i-acromegaly, thyrotooticosis, hypercortisolism);
- ukulimala, ukungenelela kokuhlinzwa;
- imiphumela yomzimba (ukuhlaselwa ukushisa, i-hypothermia nabanye);
- ukuthatha imishanguzo ethile (ama-steroid, ama-sympathomimetics, ama-somatostatin analogues, ama-phenytoin, ama-immunosuppressants, ama-beta-blockers, ama-diuretics, ama-calcium antagonists, i-diazoxide).
I-Hyperglycemic coma imvamisa ingumphumela wesiguli esikhulile esphuza ngamabomu uketshezi oluncane. Iziguli zenza lokhu, zizama ukunciphisa ukuvuvukala kwazo. Ngombono wezokwelapha, ukuncoma ukunciphisa umkhawulo wokuphuza uketshezi ezithweni zenhliziyo nezinye izifo akulungile futhi kuyingozi.
Izimpawu ze-hyperglycemic coma
I-Hyperosmolar syndrome iba nokukhula kancane kune-siketoicidosis yesifo sikashukela, imvamisa kungapheli izinsuku noma amasonto ambalwa. Ukuphelelwa ngamandla kweziguli kungaba nzima kakhulu kune-ketoacidosis. Njengoba izidumbu ze-ketone zingakhiwa, azikho izimpawu zokuma kwe-ketoacidosis: Ukuphefumula okungajwayelekile kweKussmaul kanye nephunga le-acetone emoyeni oxoshe.
Ezinsukwini zokuqala zokukhula kwe-hyperosmolar syndrome, iziguli ziye zinxusa njalo ukuthi zichame. Kepha ngesikhathi sokufika esibhedlela, ukuphuma komchamo kuvame ukuba buthaka noma kumiswe ngokuphelele, ngenxa yokuphelelwa ngamandla komzimba. Ku-ketoacidosis yesifo sikashukela, ukugcwala okwandayo kwemizimba ye-ketone kuvame ukudala ukugabha. Nge-hyperosmolar syndrome, ukugabha akuvamile, ngaphandle uma kunezizathu ezithile zalokho.
I-Hyperglycemic coma iba ne-10% yeziguli ezine-hyperosmolar syndrome. Kuya ngokuthi igazi likhulu kangakanani nokuthi kungakanani okuqukethwe kwe-sodium kulolu cwaningo lwe-cerebrospinal. Ngokungezelela ebuchomeni nasekomukeni, ukwazi ukungasebenzi kahle kungabonakala ngesimo sokuphaphama kwengqondo, ukukhohlisa kanye nokudonsela amehlo.
Isici se-hyperosmolar syndrome yizimpawu ezenzeka kaningi futhi ezahlukahlukene zomonakalo ohlelweni lwezinzwa. Uhlu lwabo lubandakanya:
- iminyakazo
- ukukhubazeka kwenkulumo;
- ukunyakaza kokuzungeleza okusheshayo kwezimpawu zezindlebe (nystagmus);
- ukwenza buthaka kokunyakaza ngokuzithandela (i-paresis) noma ukukhubazeka okuphelele kwamaqembu emisipha;
- ezinye izimpawu zemizwa.
Lezi zimpawu zihlukahlukene kakhulu futhi azihambelani kunoma iyiphi i-syndrome ecacile. Ngemuva kokususa isiguli esimweni se-hyperosmolar, zivame ukunyamalala.
Usizo nge-hyperglycemic coma: Imininingwane enemininingwane kadokotela
Ukwelashwa kwe-hyperosmolar syndrome ne-hyperglycemic coma kwenziwa ikakhulu ezimisweni ezifanayo nokwelashwa kwe-ketoacidosis yesifo sikashukela. Kepha kunezici esikhuluma ngazo ngezansi.
Akunakudingeka ukuthi amazinga kashukela wegazi ancishiswe ngokushesha kune-5.5 mmol / L ngehora ngalinye. I-osmolarity (density) ye-serum yegazi akufanele inciphe ngokushesha kunokuba nge-10 mosmol / l ngehora. Ukwehla okubukhali kwalezi zinkomba kuhlanganiswe nemithetho eqinile, ngoba kukhulisa ubungozi be-edema ye-pulmonary edema ne-cerebral edema.
Ekuqoqweni kweNa + ku-plasma> 165 meq / l, ukwethulwa kwezixazululo ze-saline kuqinisekisiwe. Ngakho-ke, isixazululo se-glucose esingu-2% sisetshenziswa njengoketshezi ukuqeda ukomisa. Uma izinga le-sodium lingu-145-165 meq / l, bese usebenzisa isisombululo se-0,45% se-hypotonic of NaCl. Lapho izinga le-sodium lehla <145 meq / l, ukuphanjululwa komzimba kabusha kuyaqhubeka ngo-saline womzimba 0,9% NaCl.
Ehoreni lokuqala, kufakwa amalitha we-1-1,5 koketshezi, ku-2nd naku-3 - amalitha ayi-0,5, bese kuba ngu-300-500 ml ngehora. Izinga lokuphindisela emzimbeni lilungiswa ngendlela efanayo nakwi-ketoacidosis yesifo sikashukela, kepha ivolumu yayo yokuqala uma kwenzeka i-hyperosmolar syndrome ikhudlwana.
Lapho umzimba wesiguli uqala ukugcwala uketshezi, isb., Ukuphuma komzimba kuqedwe, lokhu ngokwako kuholela ekwehleni okucacile kokuxineka kweglue egazini. Ku-comerglycemic coma, ukuzwela kwe-insulin kuvame ukwanda. Ngalezi zizathu, ekuqaleni kokwelashwa, i-insulin ayiphathwa nakancane noma ayiphathwanga ngemithamo emincane, cishe amayunithi ama-2 we-insulin "emfishane" ngehora.
Ngemuva kwamahora angama-4-5 ukusuka ekuqaleni kokwelashwa kokungenelela, ungashintshela ohlelweni lokudonswa kwe-insulin oluchazwe esigabeni esithi "Ukwelashwa kwe-ketoacidosis", kepha kuphela uma ushukela wegazi ususezingeni eliphezulu kakhulu nokugcwala kwama-sodium ion ku-plasma yegazi kuncipha.
Ku-hyperosmolar syndrome, kuvame ukuba ne-potassium eyengeziwe ukulungisa ukungabikho kwe-potassium emzimbeni wesiguli kune-ketoacidosis yesifo sikashukela. Ukusetshenziswa kwe-alkalis, kufaka phakathi i-baking soda, akuboniswanga i-ketoacidosis, futhi ikakhulukazi i-hyperosmolar syndrome. I-pH ingancipha uma i-acidosis ikhula ngokufakwa kwezinqubo ze-purulent-necrotic. Kepha ngisho kulezi zimo, i-pH ayivelakancane kakhulu ingaphansi kuka-7.0.
Sizame ukwenza lokhu kwendatshana nge-hypoglycemic coma ne-hyperosmolar syndrome kube wusizo ezigulini. Siyethemba ukuthi odokotela bangayisebenzisa njenge “sheet cheat” elula.
