Isifo sikashukela sikashukela

I-Ketoacidosis iyinkimbinkimbi yesifo sikashukela. Kukhula ezigulini ezingaziqeqeshelwe ukulawula izifo zazo. Ngemuva kokufunda i-athikili, uzofunda konke okudingayo mayelana nezimpawu zokwelapha i-ketoacidosis enesifo sikashukela ezinganeni nakubantu abadala. Iwebhusayithi yeDiabetes-Med.Com ikhuthaza ukuthi kudliwe ama-carbohydrate amancane - okuyindlela ephumelelayo yokulawula uhlobo 1 nesifo sikashukela. Kwisifo sikashukela esilandela lokhu kudla, imichilo yokuhlola ivame ukukhombisa ubukhona bama-ketones (acetone) kumchamo nasegazini. Lokhu akunangozi, futhi akukho okudingeka kwenziwe ngenkathi ushukela wegazi ujwayelekile. I-acetone emchameni ayisikho ketoacidosis okwamanje! Akunasidingo sokwethuka. Funda imininingwane engezansi.

I-ketoacidosis yesifo sikashukela: Izimpawu nokwelashwa ezinganeni nakubantu abadala

Esimweni sokuntuleka kwe-insulin, amaseli awakwazi ukusebenzisa ushukela njengomthombo wamandla. Kulesi simo, umzimba ushintshela ekudleni onamafutha aso. Lapho amafutha ephukile, imizimba ye-ketone (ama-ketones) ikhiqizwa ngenkuthalo. Lapho ama-ketones amaningi kakhulu ejikeleza egazini, izinso azinaso isikhathi sokuwasusa emzimbeni futhi i-acidity yegazi inyuka. Lokhu kudala izimpawu - ubuthakathaka, isicanucanu, ukugabha, ukoma kanye nephunga le-acetone ephuma emlonyeni. Uma izinyathelo eziphuthumayo zingathathwanga, onesifo sikashukela uzowela futhi angafa. Iziguli ezinolwazi ziyazi ukuthi zingasilethi kanjani isimo ku-ketoacidosis. Ukuze wenze lokhu, udinga ukubuyisa kabusha ukongiwa kwamanzi emzimbeni futhi wenze imijovo ye-insulin. Ngezansi kuchazwe ngokuningiliziwe ukuthi ungaselapha kanjani isifo sikashukela ekhaya nasezibhedlela. Okokuqala, udinga ukuthola ukuthi i-acetone yomchamo ivelaphi nokuthi ikuphi ukwelashwa okudingayo.

Uyini umehluko phakathi kwesifo sikashukela se-ketoacidosis ne-acetone kumchamo

Emazweni akhuluma isiRussia, abantu bajwayele ukucabanga ukuthi i-acetone yomchamo iyingozi, ikakhulukazi ezinganeni. Ngempela, i-acetone iyiphunga elimnandi elisetshenziselwa ukuncibilikisa ukungcola kwabahlanzayo abomile. Akekho engqondweni yabo efaneleyo ongafuna ukuyithatha ngaphakathi. Kodwa-ke, i-acetone ingenye yezinhlobonhlobo zezidumbu ze-ketone ezingatholakala emzimbeni womuntu. Ukugxilisa kwabo egazini nomchamo kuyakhuphuka uma izitolo zama-carbohydrate (glycogen) ziphelile futhi umzimba ushintshela ekudleni ezinamafutha abekelwe kuwo. Lokhu kwenzeka kaningi ezinganeni ezinemizimba emincane ekhuthele ngokomzimba, kanye nakulabo abanesifo sikashukela abalandela ukudla okune-carbohydrate ephansi.

I-acetone kumchamo ayinangozi kuze kungabikho ukomisa. Uma imivimbo yokuhlolwa kwama-ketones ibonisa ubukhona be-acetone emchameni, lokhu akuyona inkomba yokukhansela ukudla okunama-carbohydrate aphansi esigulini sikashukela. Umuntu omdala noma umntwana onesifo sikashukela kufanele aqhubeke nokulandela ukudla futhi anakekele ukuphuza uketshezi olwanele. Ungayifihli i-insulin kanye nesirinji kude. Ukushintshela ekudleni okuphansi kwe-carbohydrate kuvumela abanesifo sikashukela abaningi ukuthi balawule isifo sabo ngaphandle kwemijovo ye-insulin. Okuyishumi, noma kunjalo, azikho iziqinisekiso ezinganikezwa ngalokhu. Mhlawumbe, ngokuqhubeka kwesikhathi, kusadingeka ukuthi ufake umjovo we-insulin ngemithamo emincane. I-acetone kumchamo ayilimazi izinso noma ezinye izitho zangaphakathi, inqobo nje uma ushukela wegazi ujwayelekile futhi nomzimba wesifo sikashukela ungabi nokuntuleka kwamanzi. Kepha uma uphuthelwa ukwanda koshukela bese ungawubeki ngaphezulu ngemijovo ye-insulin, lokhu kungaholela eketoacidosis, okuyingozi ngempela. Lokhu okulandelayo yimibuzo nezimpendulo mayelana ne-acetone kumchamo.

I-acetone kumchamo iyinto evamile eyenzeka ngokudla okuqinile kwe-carbohydrate. Lokhu akunangozi uma nje ushukela wegazi usujwayelekile. Sekungamashumi ezinkulungwane zabanesifo sikashukela emhlabeni wonke abalawula izifo zabo ngokudla okuphansi kwe-carbohydrate. Umuthi osemthethweni uyibeka esondweni, ungafuni ukulahlekelwa yikhasimende nemali engenayo. Akukaze kube nemibiko yokuthi i-acetone yomchamo ingalimaza noma ngubani. Uma lokhu kwenzeka ngokuzumayo, khona lapho abaphikisi bethu bazoqala ukumemeza ngakho kuzo zonke izinkalo.

Isifo sikashukela se-ketoacidosis kufanele sitholakale futhi siphathwe kuphela lapho isiguli sinoshukela wegazi we-13 mmol / L noma ngaphezulu. Ngenkathi ushukela uvamile futhi ujabule, akukho lutho olukhethekile okudingeka lwenziwe. Qhubeka nokudla okuqinile kwe-carb uma ufuna ukugwema izinkinga zesifo sikashukela.

Ungalihloli igazi noma umchamo wakho nhlobo ngemivimbo yokuhlolwa kwama-ketones (acetone). Ungagcini lezi zemicu yokuhlola ekhaya - uzophila ngokuzola. Esikhundleni salokho, kala ushukela wegazi lakho njalo ngemitha kashukela wegazi - ekuseni esiswini esingenalutho kanye namahora angama-1-2 ngemuva kokudla. Thatha isinyathelo ngokushesha uma ushukela ukhuphuka. Ushukela 6.5-7 ngemuva kokudla sekukubi vele. Izinguquko zokudla noma imithamo ye-insulin iyadingeka, noma ngabe i-endocrinologist yakho ithi lezi yizinkomba ezinhle kakhulu. Ngaphezu kwalokho, udinga ukwenza okuthile uma ushukela kushukela likashukela ngemuva kokudla ukhuphuka ngaphezulu kwe-7.

Ukwelashwa okujwayelekile kwesifo sikashukela ezinganeni kubangela ama-spikes ushukela wegazi, ukubambezeleka kokuthuthuka, kanye namacala we-hypoglycemia kungenzeka. Izinkinga ze-vascular ezingapheli zivame ukuvela ngokuhamba kwesikhathi - eneminyaka engu-15-30 ubudala. Isiguli uqobo nabazali bayo bazobhekana nalezi zinkinga, hhayi i-endocrinologist ephoqa ukudla okulimazayo okugcwele kakhulu kuma-carbohydrate. Ungavuma nodokotela ngezinhlobo, uqhubeke nokondla ingane yakho ngokudla okune-carbohydrate ephansi kakhulu. Ungavumeli umuntu onesifo sikashukela ukuthi aye esibhedlela lapho ukudla kungafanele khona. Uma kungenzeka, welashwa ngudokotela ovumayo (i-endocrinologist) ovumela ukudla okune-carbohydrate ephansi.

Kuhle ukuba abanesifo sikashukela, njengawo wonke umuntu, bakhulise umkhuba wokuphuza uketshezi oluningi. Phuza amanzi netiye le-herbal ku-30 ​​ml nge-1 kg yesisindo somzimba ngosuku. Ungalala kuphela ngemuva kokuphuza okujwayelekile kwansuku zonke. Izikhathi eziningi kuyofanele uye endlini encane, mhlawumbe nasebusuku. Kepha izinso zizohleleka konke impilo yabo. Abesifazane baqaphela ukuthi ukwanda kokudla okungamanzi ngemuva kwenyanga kuthuthukisa ukubukeka kwesikhumba. Funda ukuthi ungawelapha kanjani amakhaza, ukugabha, nohudo kubantu abanesifo sikashukela. Izifo ezithathelwanayo yizimo ezingezona ezejwayelekile ezidinga izenzo ezikhethekile ukuvikela i-ketoacidosis ezigulini ezinesifo sikashukela.

Iyini ingozi yesifo sikashukela sikashukela

Uma i-acidity yegazi ikhuphuka okungenani kancane, khona-ke umuntu uqala ukuzwa ubuthakathaka futhi angawela enkingeni. Lokhu kwenzeka nge-ketoacidosis yesifo sikashukela. Lesi simo sidinga ukungenelela okuphuthumayo kwezokwelapha, ngoba kuvame ukuholela ekufeni.

Uma umuntu kutholakale ukuthi unesifo sikashukela sikashukela, lokhu kusho ukuthi:

• ushukela wegazi ukhuphuka kakhulu (> 13.9 mmol / l);
• ukukhuphuka kwemizimba ye-ketone egazini kuyanda (> 5 mmol / l);
• umucu wokuhlola ukhombisa ubukhona bama-ketones emchameni;
• i-acidosis yenzeka emzimbeni, i.e. i-acid-base esele isishintshele ekwandeni kwe-acidity (i-arterial blood pH <7.3 ngesilinganiso se-7.35-7.45).

E-Russia, imvamisa ye-ketoacidosis ngo-1990-2001 ezigulini ezinesifo sikashukela sohlobo loku-1 yayingamacala angama-0,2 umuntu ngamunye ngonyaka, ngesifo sikashukela sohlobo 2 - amacala angama-0.07 ngesiguli ngasinye ngonyaka. Emazweni athuthukile, lesi sibalo siphansi kaningana. Ukushona kwe-ketoacidosis yesifo sikashukela eRussia kungama-7-19%, eYurophu nase-USA - 2-5%.

Zonke iziguli ezinesifo sikashukela kufanele zifunde izindlela zokulinganisa ushukela ngaphandle kwegazi nge-glucometer futhi zikhethe isilinganiso esifanele se-insulin. Uma onesifo sikashukela eqeqeshwe kahle, khona-ke amathuba e-ketoacidosis cishe ayi-zero. Kwaphela amashumishumi eminyaka, sinesifo sikashukela futhi ngasikhathi sinye esingazange siwele ekhefini likashukela - lokhu kungokoqobo ngokuphelele.

Izimbangela zeKetoacidosis

I-Ketoacidosis kushukela likashukela iba nokushoda kwe-insulin emzimbeni. Lokhu kusilela kungaba "ngokuphelele" kuhlobo 1 sikashukela noma "isihlobo" kuhlobo 2 sikashukela.

Izici ezikhulisa ubungozi bokuthola i-ketoacidosis yesifo sikashukela:

• Izifo ezihambisana nesifo sikashukela, ikakhulukazi izinqubo zokutheleleka nezifo;
• imisebenzi yokuhlinzwa;
• ukulimala
• ukusetshenziswa kwezidakamizwa ezingabaphikisi be-insulin (glucocorticoids, diuretics, ama-hormone ocansi);
• ukusetshenziswa kwezidakamizwa okwehlisa ukuzwela kwezicubu ezenzweni ze-insulin (antipsychotic atypical namanye amaqembu ezidakamizwa);
• ukukhulelwa (isifo sikashukela esikhulelwe);
• ukudangala kokulondelwa kwe-insulin enkambweni ende yesifo sikashukela 2;
• i-pancreatectomy (ukuhlinzwa kuma-pancreas) kubantu abangakaze babe nesifo sikashukela ngaphambili.

Imbangela yeketoacidosis ukuziphatha okungafanele kwesiguli sikashukela ::

• ukweqa imijovo ye-insulin noma ukuhoxiswa kwayo okungagunyaziwe (isiguli "sithathwa kakhulu" ngezindlela ezingezona zenkambiso zokwelapha isifo sikashukela);
• ukuziqapha kakhulu kokuzihlola ushukela wegazi nge-glucometer;
• isiguli asazi noma sazi, kepha asihambisani nemithetho yokulawula umthamo we-insulin, kuye ngo-glucose osegazini lakhe;
• kwaba nesidingo esandayo se-insulin ngenxa yesifo esithathelwanayo noma ukuthatha inani elengeziwe lama-carbohydrate, kodwa akuzange kunxephezelwe;
• injove insulin ephelelwe yisikhathi noma engagcinwanga kahle;
• inqubo engafanele yomjovo we-insulin;
• ipeni lesirinji le-insulin alisebenzi kahle, kepha isiguli asililawuli;
• Iphampu ye-insulin inephutha.

Iqembu leziguli ezikhethekile ezine-ketoacidosis yesifo sikashukela yilabo abaphuthelwa imijovo ye-insulin ngoba bezama ukuzibulala. Imvamisa, laba besifazane abancane abanesifo sikashukela sohlobo 1. Banezinkinga ezinkulu zengqondo noma ukuphazamiseka kwengqondo.

Imbangela ye-ketoacidosis yesifo sikashukela imvamisa amaphutha ezokwelashwa. Isibonelo, uhlobo olusanda kutholwa lwesifo sikashukela esingu-1 alwatholakalanga ngesikhathi. Noma i-insulin ibambezelwe isikhathi eside kakhulu kuhlobo 2 lwesifo sikashukela, yize bekukhona izinkomba zenhloso yokwelashwa kwe-insulin.

Izimpawu ze-ketoacidosis kushukela

I-ketoacidosis yesifo sikashukela iba, ngokuvamile ezinsukwini ezimbalwa. Kwesinye isikhathi - esikhathini esingaphansi kosuku olungu-1. Okokuqala, izimpawu zokushukela okukhulu kwegazi zanda ngenxa yokuntuleka kwe-insulin:

• ukoma okukhulu;
• ukuchama njalo;
• isikhumba esomile nolwelwesi lwe-mucous;
• ukwehla kwesisindo okungashintshi;
• ubuthakathaka.

Ngemuva kwalokho bahlanganiswa nezimpawu ze-ketosis (ukukhiqizwa okusebenzayo kwezidumbu ze-ketone) kanye ne-acidosis:

• isicanucanu
• ukuhlanza
• iphunga le-acetone elisuka emlonyeni;
• isigqi sokuphefumula okungajwayelekile - kunomsindo futhi kujulile (okubizwa ngokuphefumula kukaKussmaul).

Izimpawu zokucindezeleka kwesistimu yezinzwa ephakathi:

• ikhanda
• ukungahambi kahle;
• ukubuyiselwa emuva;
• ubuqili;
• ukozela
• i-thoroma ne-ketoacidotic coma.

Imizimba ye-ketone engaphezulu icasule ipheshana lesisu. Futhi, amangqamuzana akhe ayakhipha amanzi emzimbeni, futhi ngenxa yesifo sikashukela esikhulu, izinga le-potassium emzimbeni liyancipha. Konke lokhu kudala izimpawu ezengeziwe zesifo sikashukela sikashukela, esifana nezinkinga zokuhlinzwa nepheshana lesisu. Nalu uhlu lwabo:

• Ubuhlungu besisu
• udonga lwesisu alushubile futhi lubuhlungu lapho i-palpating;
• i-peristalsis iyancishiswa.

Ngokusobala, izimpawu esizibalile yizinkomba zokulaliswa esibhedlela okuphuthumayo. Kepha uma bakhohlwa ukukala ushukela wegazi wesiguli futhi bahlole umchamo wesidumbu se-ketone usebenzisa umucu wokuhlola, lapho-ke bangalaliswa ngephutha esibhedlela somnyango wokutheleleka noma wokuhlinzwa. Lokhu kwenzeka kaningi.

Ukuxilongwa kwe-ketoacidosis yesifo sikashukela

Esigabeni se-prehospital noma emnyangweni wokwamukelwa, kwenziwa ngokushesha ukuhlolwa kwegazi ngoshukela nomchamo wezidumbu ze-ketone. Uma umchamo wesiguli ungangeni kwi-bladder, i-serum yegazi ingasetshenziswa ukuthola i-ketosis. Kulokhu, ithonsi le-serum lifakwa emgqeni wokuhlola ukuthola ama-ketones emchameni.

Kuyadingeka ukuthola ubungako be-ketoacidosis esigulini futhi uthole ukuthi iyiphi inkinga yesifo sikashukela i-ketoacidosis noma i-hyperosmolar syndrome? Ithebula elilandelayo liyasiza.

Izindlela zokuxilonga zesifo sikashukela sikashukela kanye ne-hyperosmolar syndrome

I-ketoacidosis yesifo sikashukela kufanele ihlukaniswe (ukuxilongwa okuhlukile) kwezinye izifo eziyingozi:

• i-ketoacidosis yotshwala;
• "Ukulamba" ketosis;
• i-lactic acidosis (i-lactic acid esegazini);
• ubuthi be-salicylate (i-aspirin, utshwala be-salicylic, njll);
• ubuthi be-methanol (i-methyl alcohol, ubuthi kubantu);
• ukudakwa nge-ethyl alcohol;
• ubuthi be-paraldehyde.

Ku-ketoacidosis yesifo sikashukela, ukuhlolwa kwegazi cishe njalo kukhombisa ukucindezela kwe-neutrophilic leukocytosis. Kodwa ukutheleleka kufanele kusolwe kuphela uma i-leukocytosis ingaphezulu kwe-15x10 ^ 9 / l.

Ngasikhathi sinye, izinga lokushisa lomzimba elijwayelekile noma elehlisiwe alikasinikezi isiqinisekiso esiqinile sokuthi isiguli asinayo inqubo yokutheleleka nokuvuvukala. Ngoba i-acidosis, i-hypotension kanye ne-vasodilation eseceleni (ukuphumula kwemithambo yegazi) kunomthelela ekunciphiseni kwayo.

Ukwelashwa kwe-ketoacidosis yesifo sikashukela: imininingwane enemininingwane odokotela

Ukwelashwa kwe-ketoacidosis ku-mellitus yesifo sikashukela kunezakhi ezi-5, futhi zonke zibalulekile ngokulinganayo ekwelashweni okuphumelelayo. Nalu uhlu lwabo:

• ukwelashwa kwe-insulin;
• ukuphindisela emzimbeni (ukugcwaliswa kabusha kokuswelakala koketshezi emzimbeni);
• ukulungiswa kokuphazamiseka kwe-electrolyte (ukubuyiselwa kabusha kokushoda kwe-potassium, i-sodium namanye amaminerali);
• ukuqedwa kwe-acidosis (i-normalization ye-acid-base ibhalansi);
• Ukwelashwa kwezifo ezihambisanayo ezingavusa inkinga enkulu yesifo sikashukela.

Njengomthetho, isiguli esine-ketoacidosis yesifo sikashukela singeniswa esibhedlela endaweni yokunakekela abaguli kakhulu. Lapho, ulawulwa futhi aqashwe izinkomba ezibalulekile, ngokuya ngohlelo olulandelayo:

1. Ukuhlaziywa okucacile kwe-glucose yegazi - isikhathi esingu-1 ngehora, kuze kube yilapho ushukela wegazi wehlela ku-13-14 mmol / l, bese uphinda lokhu kuhlaziya njalo emahoreni ama-3;
2. ukuhlaziywa komchamo we-acetone - amahlandla ama-2 ngosuku ezinsukwini zokuqala ezingama-2, bese kuba yisikhathi esingu-1 ngosuku;
3. Ukuhlaziywa okujwayelekile kwegazi nomchamo - kwenziwa ngokushesha lapho kwamukelwa, bese kuphinda njalo emva kwezinsuku ezingama-2-3;
4. i-sodium, i-potassium ku-plasma yegazi - izikhathi ezi-2 ngosuku;
5. i-phosphorus - kuphela ezigulini ezinotshwala obungamahlalakhona, noma uma kunezimpawu zokungondleki;
6. ukuhlolwa kwegazi kwe-nitrogen eseleyo, i-urea, i-creatinine, i-serum chloride - ngokushesha lapho kuvunywa, bese kuthi isikhathi esingu-1 ezinsukwini ezi-3;
7. i-hematocrit, ukuhlaziywa kwegesi ne-pH yegazi - izikhathi ezi-1-2 ngosuku kuze kufane nokwejwayelekile kwesimo se-acid-base .;
8. ukulawulwa kwehora kwe-diuresis (i-catheter yomchamo engapheli) - kuze kuphele ukuqothuka komzimba noma kuze kube yilapho ukwazi ukwazi kubuyiselwa futhi ukuchama kuyinto evamile;
9. Ukulawulwa kwengcindezi ye-venous central;
10. ukuqapha okuqhubekayo komfutho wegazi, ukushaya kwenhliziyo kanye nokushisa komzimba (noma ukukalwa okungenani njalo emahoreni ama-2);
11. ukuqapha okuqhubekayo kwe-ECG (noma ukubhaliswa kwe-ECG okungenani isikhathi esingu-1 ngosuku);
12. uma kusolwa ukutheleleka, kuyabhalwa ezinye izivivinyo ezifanele.

Ngokwesilinganiso esinembayo sokuqoqwa kwe-sodium ku-plasma yegazi, ifomula isetshenziselwa ukubala lokho okubizwa ngokuthi “izinga le-sodium elilungisiwe”.Ukulungiswa kwe-Na + = kulinganise i-Na + 1.6 * (glucose -5.5) / 5.5

Ngisho nangaphambi kokulaliswa esibhedlela, isiguli kufanele masinyane siqale ukuphatha isisombululo se-0.9% sikasawoti we-NaCl ngesilinganiso esingu-1 litre ngehora, kanye nokufaka intramuscularly injunithi engama-20 ye-insulin ebambela amafushane.

Uma isiguli sinesigaba sokuqala se-ketoacidosis yesifo sikashukela, ukwaziwa kuyalondolozwa, futhi akunasifo esinamandla sokuqina, ngakho-ke kungaqhutshwa emnyangweni we-endocrinological noma wezokwelapha. Vele, uma abasebenzi bale minyango bazi ukuthi yini okudingeka yenziwe.

Isifo sikashukela se-ketoacidosis insulin therapy

Ukwelashwa kwe-insulin ketoacidosis ukuphela kwendlela yokwelashwa engaphazamisa izinqubo zomzimba eziholela ekwakhiweni kwale nkinga yesifo sikashukela. Umgomo wokwelapha i-insulin ukukhulisa izinga le-insulin esegazini le-serum liye ku-50-100 mcED / ml.

Kulokhu, ukuphathwa okuqhubekayo kwe-insulin "emfishane" kwenziwa amayunithi angama-4-10 ngehora, ngokwesilinganiso amayunithi ayi-6 ngehora. Imithamo enjalo yokwelashwa kwe-insulin ibizwa ngokuthi uhlobo olusezingeni eliphansi. Bacindezela ngempumelelo ukwehlukana kwamafutha nokukhiqizwa kwemizimba ye-ketone, kuvimbela ukukhishwa kweglucose egazini ngesibindi, futhi kufake isandla ekwakhekeni kwe-glycogen.

Ngakho-ke, izixhumanisi eziphambili ekuhlelweni kokuthuthukiswa kwe-ketoacidosis yesifo sikashukela ziyaqedwa. Ngasikhathi sinye, ukwelashwa kwe-insulin kuhlobo “oluphansi” kunobungozi obuphansi bezinkinga futhi kuvumela ukulawulwa okungcono koshukela wegazi kunhlobo yomuthi “omkhulu”.

Esibhedlela, isiguli esine-ketoacidosis yesifo sikashukela sithola i-insulin ngendlela yokumfaka okuqhubekayo kwe-intravenous. Okokuqala, i-insulin esebenza ngokubambisana ifakwa ngaphakathi kwe-bolus intravedly (kancane) ngomuthi “wokulayisha” ongama-0.15 PIECES / kg, ngokwesilinganiso iba ngu-10 PIECES. Ngemuva kwalokhu, isiguli sixhunywe kwi-infusomat ukuze ithola i-insulin ngokutheleleka okuqhubekayo ngesilinganiso samayunithi angama-5-8 ngehora, noma amayunithi angu-0,1 / ihora / kg.

Kwipulasitiki, i-adsorption ye-insulin kungenzeka. Ukuyivimbela, kunconyelwa ukungeza i-albhamu ye-serum yabantu kusisombululo. Imiyalo yokulungiselela umxube wokungenelela: engeza ama-50 ml we-20% ye-albhamuin noma i-1 ml yegazi lesiguli kumayunithi angama-50 we-insulin "emfushane", bese uletha inani eliphelele ku-50 ml usebenzisa i-0.9% NaCl saline.

I-intravenous insulin therapy esibhedlela lapho kungekho khona i-infusomat

Manje sesichaza enye indlela yokwelashwa kwe-insulin engenayo i-insulin, uma kwenzeka kungekho infusomat. I-insulin ebambela amafushane ingalawulwa kanye ngehora ngokufakwa emzimbeni nge-bolus, kancane, ngesirinji, ohlelweni lwe-infusion.

Umthamo owodwa ofanele we-insulin (ngokwesibonelo, amayunithi ayi-6) kufanele ugcwaliswe kwisirinji esingu-2 ml, bese ufaka ku-2 ml ngesisombululo se-Na9l kasawoti. Ngenxa yalokhu, umthamo wengxube kwisirinji uyakhuphuka, futhi kungenzeka ukuthi ujova i-insulin kancane, ngaphakathi kwemizuzu engama-2-3. Isenzo se-insulin "emfishane" ukwehlisa ushukela wegazi sithatha ihora elilodwa. ngakho-ke, imvamisa yokuphatha isikhathi se-1 ngehora ingabhekwa njengesebenzayo.

Abanye ababhali batusa esikhundleni sendlela enjalo yokujova i-insulin "emfishane" emayunithi ayi-6 ngehora. Kepha abukho ubufakazi bokuthi leyo ndlela esebenza kahle ngeke ibe yimbi kakhulu kunokuphathwa kwe-intravenous. Isifo sikashukela se-ketoacidosis sivame ukuhambisana nokujikeleza kwe-capillary engaphili kahle, okuhlanganisa ukumuncwa kwe-insulin, ukuphathwa ngendlela efanelekile, futhi kube nzima ngokwedlula zonke.

Inalithi yobude obufushane ihlanganiswe kwisirinji ye-insulin. Ngokuvamile akunakwenzeka ukumnika umjovo we-intramuscular. Ukungasho ukuthi kuneziphazamiso ezengeziwe ezigulini nabasebenzi bezokwelapha. Ngakho-ke, ekwelashweni kwe-ketoacidosis yeswekile, kunconywa ukuphathwa kwe-insulin.

I-insulin kufanele iphathwe ngokungaziphathi noma ngokungenamgogodla kuphela ngesigaba esibuhlungu se-ketoacidosis yesifo sikashukela, uma isiguli singekho esimweni esibucayi futhi asidingi ukuhlala endaweni yokunakekelwa okukhulu nokunakekelwa okujulile.

Ukulungiswa komthamo we-insulin

Umthamo we-insulin "omfushane" ulungiswa ngokuya ngamanani wamanje kashukela wegazi, okufanele alinganiswe njalo ngehora. Uma emahoreni okuqala angama-2-3 izinga le-glucose egazini lingehli futhi izinga lokugcotshwa komzimba ngoketshezi lanele, khona-ke umthamo olandelayo we-insulin ungaphindwa kabili.

Ngasikhathi sinye, ukugcwala koshukela egazini akunakuncishiswa ngokushesha kunokuba ngo-5.5 mmol / l ngehora. Ngaphandle kwalokho, isiguli singase sizwe i-edema eyingozi yamakhorali. Ngalesi sizathu, uma izinga lokuncipha koshukela wegazi selisondele kusuka phansi laya ku-5 mmol / l ngehora, khona-ke umthamo olandelayo we-insulin uyanqanyulwa. Futhi uma idlule ku-5 mmol / l ngehora, khona-ke ukujova okulandelayo kwe-insulin kuvamile ukweqa, ngenkathi kuqhubeka nokulawula ushukela wegazi.

Uma, ngaphansi kwethonya lokwelashwa kwe-insulin, ushukela wegazi wehla kancane kakhulu kuno-3-4 mmol / l ngehora, lokhu kungakhombisa ukuthi isiguli sisenamanzi noma umsebenzi wezinso uthambile. Kulesi simo, udinga ukubuyekeza kabusha ivolumu yokujikeleza kwegazi futhi uhlaziye izinga le-creatinine egazini.

Ngosuku lokuqala esibhedlela, kungakuhle ukuthi wehlise ushukela wegazi ungabi ngaphezu kuka-13 mmol / L. Lapho leli zinga lifinyelelwa, qala ukumnika kwe-5-10% ushukela. Kuwo wonke ama-20 g kashukela, amayunithi ama-3-4 e-insulin amafushane afakwa emzimbeni wezinsini. I-200 ml ye-10% noma i-400 ml yesisombululo se-5% iqukethe amagremu angama-20 kashukela.

IGlucose ihanjiswa kuphela uma isiguli sisakwazi ukuthatha ukudla ngokwaso, futhi ukuswelakala kwe-insulin kucishe kuqedwe. Ukuphathwa kwe-glucose akuyona indlela yokwelashwa kwe-ketoacidosis yesifo ngasinye. Kwenziwa ukuvikela i-hypoglycemia, kanye nokugcina ama-osmolarity (ukuxinana okujwayelekile koketshezi emzimbeni).

Ungashintshela kanjani ekuphathweni kwe-insulin

Ukwelashwa kwe-insulin kwe-intravenous akufanele kubambezeleke. Lapho isimo sesiguli sithuthuka, umfutho wegazi uzinzile, ushukela wegazi ugcinwa ngezinga elingaphezu kwe-11-12 mmol / L ne-pH> 7.3 - ungashintsha ekuphathweni kwe-insulin okulula. Qala ngomthamo wamayunithi ayi-10-14 njalo emahoreni ama-4. Ilungiswa ngokuya ngemiphumela yokulawulwa kukashukela wegazi.

Ukuphathwa okungaphakathi kwe-insulin "emfishane" kuqhutshelwa kwamanye amahora angama-1-2 ngemuva kokulimala kokuqala, ukuze kungabikho ukuphazamiseka esenzweni se-insulin. Kakade ngosuku lokuqala lomjovo ongasasebenzi, i-insulin esebenza isikhathi eside ingasetshenziswa ngasikhathi sinye. Umthamo wayo wokuqala amayunithi ayi-10-12 izikhathi ezi-2 ngosuku. Ungayilungisa kanjani echazwe esihlokweni esithi “Ukubala Ukulinganiswa Namasu Okuphathelene Ne-Insulin Administration”.

Ukuvuselelwa komzimba ku-ketoacidosis yesifo sikashukela - ukuqeda ukopha

Kuyadingeka ukuthi silwele ukwenza okungenani ingxenye yokuntuleka kwamamanzi emzimbeni wesiguli osukwini lokuqala lokwelashwa. Lokhu kuzosiza ukwehlisa ushukela wegazi, ngoba ukugeleza kwegazi lezinso kuzobuyiselwa, futhi nomzimba uzokwazi ukukhipha ushukela omningi kumchamo.

Uma izinga lokuqala le-sodium ku-serum yegazi lalijwayelekile (= 150 meq / l), bese usebenzisa isixazululo se-hypotonic nge-NaCl okuhlushwa kwe-0.45%. Izinga lokwethulwa kwalo yi-1 litre ngehora 1, 500 ml lilinye ngamahora we-2 nelesi-3, bese kuba ngu-250-500 ml / ihora.

Kubuye kusetshenziswe izinga lokupholisa kancane kancane: 2 amalitha amahora okuqala ama-4, amanye amalitha ama-2 emahoreni ayi-8 alandelayo bese kuthi ilitha elilodwa kuwo wonke amahora ayi-8. Le nketho ibuyisa ngokushesha amazinga e-bicarbonate futhi iqede umehluko we-anionic. I-sodium ne-chlorine ku-plasma yegazi ikhuphuka kancane.

Kunoma yikuphi, izinga lomjovo we-fluid ulungiswa ngokuya nge-central venous pressure (CVP). Uma ingaphansi kuka-4 mm aq. Ubuciko. - 1 litre ngehora, uma i-HPP isuka ku-5 iye ku-12 mm aq. Ubuciko. - 0.5 amalitha ngehora, ngaphezulu kuka-12 mm aq. Ubuciko. - 0.25-0.3 amalitha ngehora. Uma isiguli sinokuphelelwa ngamandla okubalulekile, ngakho-ke ngehora ngalinye ungafaka uketshezi ngevolumu engadluli kuka-500-1000 ml weqa umthamo womchamo okhishwe.

Ungakuvimbela kanjani ukulayisha ngokweqile kwe-fluid

Inani eliphelele loketshezi olwafakwa phakathi namahora okuqala we-12 eketoacidosis therapy kufanele lihambisane nesisindo esingaphezu kwe-10% sesisindo somzimba sesiguli. Ukulayishwa okuningi kwe-Fluid kwandisa ingozi ye-edema yamaphaphu, ngakho-ke i-CVP kufanele ibhekwe. Uma isixazululo se-hypotonic sisetshenziswa ngenxa yokuqukethwe okunyuswe kwe-sodium egazini, ke sikhishwa ngevolumu encane - cishe i-4-14 ml / kg ngehora.

Uma isiguli sinokwethuka kwe-hypovolemic (ngenxa yokwehla kwethamo lokujikeleza kwegazi, umfutho wegazi “syst” ophakeme uhlala ngokuqinile ungaphansi kuka-80 mm Hg noma i-CVP engaphansi kuka-4 mm Hg), khona-ke kuthunyelwa ukusungulwa kwama-colloids (dextran, gelatin). Ngoba kulokhu, ukwethulwa kwekhambi le-NaCl le-0.9% kungenzeka kunganele ngokwanele ukucindezela kwegazi futhi kubuyisele ukunikezwa kwegazi kwezicubu.

Ezinganeni nasentsheni, ubungozi be-edema yamakhorali ngesikhathi sokwelashwa kwe-ketoacidosis yesifo sikashukela kuyanda. Bayalwa ukuba bafake uketshezi ukuqeda ukomisa ngesilinganiso se-10-20 ml / kg ngehora lokuqala. Emahoreni angama-4 okuqala wokwelapha, umthamo ophelele we-ketshezi olungiselelwe akufanele wedlule i-50 ml / kg.

Ukulungiswa kokuphazamiseka kwe-electrolyte

Cishe i-4-10% yeziguli ezine-ketoacidosis yesifo sikashukela ine-hypokalemia phezu kokuvunyelwa, isb., Ukuntuleka kwe-potassium emzimbeni. Baqala ukwelashwa ngokufakwa kwe-potassium, kanti ukwelashwa kwe-insulin kuhlehliswa kuze kuphakanyiswe i-potassium epulini yegazi iye okungenani ku-3.3 meq / l. Uma ukuhlaziywa bekukhombisa i-hypokalemia, khona-ke lokhu kuyinkomba yokulawulwa ngokucophelela kwe-potassium, noma ngabe ukuphuma komchamo wesiguli kubuthaka noma akukhona (oliguria noma i-anuria).

Noma izinga lokuqala le-potassium esegazini lalingaphansi kwemingcele ejwayelekile, umuntu angalindela ukuncipha kwalo okumenyezelwe ngesikhathi sokulashwa kwesifo sikashukela sikashukela. Imvamisa ibonwa emahoreni angama-3-4 ngemuva kokuqala kokujwayelekile kwe-pH. Ngoba ngokwethulwa kwe-insulin, ukuqedwa kokuphelelwa ngamanzi emzimbeni kanye nokwehla kokuxineka koshukela egazini, kuzonikezwa i-potassium eningi nge-glucose kumangqamuzana, futhi kufakwe nomchamo.

Noma ngabe izinga lokuqala le-potassium lesiguli lalijwayelekile, ukuphathwa okuqhubekayo kwe-potassium kwenziwa kusukela ekuqaleni kokulashwa kwe-insulin. Ngasikhathi sinye, bafisa ukuqondisa amanani e-plasma potassium kusuka ku-4 kuye ku-5 meq / l. Kepha awukwazi ukufaka ngaphezu kwe-15-20 g ye-potassium ngosuku. Uma ungangeni i-potassium, khona-ke ukuthambekela kwe-hypokalemia kungakhuphula ukumelana ne-insulin futhi kuphazamise ukujwayela ushukela wegazi.

Uma izinga le-potassium ku-plasma yegazi lingaziwa, khona-ke ukwethulwa kwe-potassium kuqala kungakapheli amahora ama-2 ngemuva kokuqala kokulanywa kwe-insulin, noma ngokuhlangana noketshezi olungu-2 litre. Kulokhu, i-ECG kanye nezinga lokukhishwa komchamo (diuresis) kubhekwa.

Izinga lokuphathwa kwe-potassium ku-ketoacidosis yesifo sikashukela *

* Ithebula lisuselwa encwadini ethi “Diabetes. Izinkinga ezinzima kanye ezingamahlalakhona ”ed. I.I.Dedova, M.V. Shestakova, M., 2011
** ku-100 ml yesixazululo se-4% se-KCl iqukethe i-1 g ye-potassium chloride

Ku-ketoacidze yesifo sikashukela, ukuphathwa kwe-phosphate akululeki ngoba ayithuthukisi imiphumela yokwelashwa. Kukhona uhla olukhawulelwe lwezinkomba lapho kubekelwa khona i-potassium phosprini ngenani le-20-30 meq / l infusion. Kufaka:

• hypophosphatemia ebizwayo;
• i-anemia
• ukwehluleka kwenhliziyo okukhulu.

Uma ama-phosphates elawulwa, khona-ke kuyadingeka ukulawula izinga le-calcium egazini, ngoba kunengozi yokuwa kwawo ngokweqile. Ekwelashweni kwe-ketoacidosis yesifo sikashukela, amazinga e-magnesium ngokuvamile awalungiswa.

Ukuqedwa kwe-Acidosis

I-Acidosis inguquko ekulinganisweni kwe-acid-base ekunyukeni kwe-acidity. Ukhula lapho, ngenxa yokushoda kwe-insulin, imizimba ye-ketone ingena ngokujulile egazini. Ngosizo lokwelashwa okwanele kwe-insulin, ukukhiqizwa kwezidumbu ze-ketone kuyacindezelwa. Futhi, ukuqedwa kokuphelelwa ngamanzi emzimbeni kusiza ukuguqulela i-pH ngokwejwayelekile, ngoba kwenza kube nokugeleza kwegazi okujwayelekile, kufaka phakathi izinso, ezisusa ama-ketones.

Noma isiguli sine-acidosis enzima, ukugcotshwa kwe-bicarbonate eduze kwe-pH evamile kuhlala isikhathi eside kusistimu ephakathi. Futhi emgudwini we-cerebrospinal fluid (i-cerebrospinal fluid), izinga lezidumbu ze-ketone ligcinwa liphansi kakhulu kunakwiplasma yegazi.

Ukwethulwa kwe-alkalis kungaholela emiphumeleni emibi:

• ukwanda kokuntuleka kwe-potassium;
• ukwanda kwe-intracellular acidosis, noma ngabe i-pH yegazi ikhuphuka;
• i-hypocalcemia - ukuntuleka kwe-calcium;
• ukunciphisa ijubane lokucindezela kwe-ketosis (ukukhiqizwa kwezidumbu ze-ketone);
• ukwephula ijika lokuhlukaniswa kwe-oxyhemoglobin ne-hypoxia elandelayo (ukuntuleka komoya-mpilo);
• i-hypertension ye-arterial;
• i-paradoxical cerebrospinal fluid acidosis, engaba nomthelela ku-edema ye-cerebral edema.

Kufakazelwa ukuthi ukuqokwa kwe-sodium bicarbonate akukunciphisi ukushona kweziguli ezine-ketoacidosis yesifo sikashukela. Ngakho-ke, izinkomba zokufakwa kwalo zincishiswe kakhulu. Sebenzisa i-soda njalo kukhungathekiswa. Ingahanjiswa kuphela nge-pH yegazi engaphansi kuka-7.0 noma inani elijwayelekile le-bicarbonate elingaphansi kuka-5 mmol / L. Ikakhulu uma ukuwohloka kwemithambo yegazi noma i-potassium eyeqile ibonwa ngasikhathi sinye, okusongela impilo.

Kwi-pH ye-6.9-7.0, i-4 g ye-sodium bicarbonate yethulwa (200 ml yesisombululo esingu-2% ngokungena ngaphakathi kwehora 1). Uma i-pH iphansi ngisho, kufakwa i-8 g ye-sodium bicarbonate (400 ml yesisombululo esifanayo se-2% emahoreni ama-2). Izinga le-pH ne-potassium esegazini linqunywa njalo emahoreni ama-2. Uma i-pH ingaphansi kuka-7.0, khona-ke ukuphathwa kufanele kuphindwe. Uma ukuhlushwa kwe-potassium kungaphansi kuka-5.5 meq / l, kufanele kufakwe i-0.75-1 g ye-potassium chloride kuyo yonke i-4 g ye-sodium bicarbonate.

Uma kungenakwenzeka ukuthola izinkomba zesimo se-acid-base, khona-ke ubungozi kusukela kwethulwa kwanoma iyiphi i-alkali "ngokungaboni" buphakeme kakhulu kunenzuzo engaba khona. Akunconyelwe ukuthi kunikezwe isisombululo sokuphuza i-soda ezigulini, kungaba zokuphuza noma ngohlobo (nge-rectum). Asikho isidingo sokuphuza amanzi amaminerali we-alkaline. Uma isiguli sikwazi ukuphuza sisodwa, khona-ke itiye elingafakwanga noma amanzi angenalutho kufanelekile.

Imisebenzi ebukhali ye-Nonspecific

Umsebenzi wokuphefumula owanele kufanele unikezwe. Nge-pO2 ngaphansi kwe-11 kPa (80 mmHg), ukwelashwa kwe-oxygen kunqunyelwe. Uma kunesidingo, isiguli sinikezwa i-catheter ephakathi nendawo. Uma kwenzeka ulahlekelwe yimizwa - setha ishubhu esiswini yokufisa okuqhubekayo (ukupompa) kokuqukethwe esiswini. I-catheter nayo ifakwa kwi-bladder ukuhlinzeka ngohlolo olunembile lwehora ngebhalansi yamanzi.

Imithamo emincane ye-heparin ingasetshenziswa ukuvikela i-thrombosis. Izinkomba zalokhu:

• iminyaka eyi-senile yesiguli;
• ukoma olujulile;
• i-hyperosmolarity ebekiwe (igazi likhulu kakhulu) - ngaphezu kwama-380 mosmol / l;
• isiguli sisebenzisa izidakamizwa zenhliziyo, ama-antibiotics.

Ukwelashwa kwe-anti-antibiotic kufanele kunqunywe, noma ngabe ukugxila kokutheleleka kungatholakali, kepha izinga lokushisa lomzimba liphakeme. Ngoba i-hyperthermia (fever) ku-ketoacidosis yesifo sikashukela ihlala isho ukutheleleka.

Isifo sikashukela ketoacidosis ezinganeni

Isifo sikashukela se-ketoacidosis ezinganeni sivame ukwenzeka okokuqala uma bengakwazanga ukuthola uhlobo lwesifo sikashukela ngesikhathi. Futhi-ke imvamisa ye-ketoacidosis incike ekutheni ukwelashwa kwesifo sikashukela esigulini esisha kuyokwenziwa ngokucophelela kangakanani.

Yize i-ketoacidosis ezinganeni ibikade ibonwa njengophawu lwesifo sikashukela sohlobo 1, ingakhula nakwenye intsha enesifo sikashukela sohlobo 2. Le nto ijwayelekile phakathi kwezingane zaseSpain ezinesifo sikashukela, futhi ikakhulukazi phakathi kwabantu base-Afrika baseMelika.

Kwenziwe ucwaningo ngentsha yase-Afrika naseMelika enesifo sikashukela sohlobo 2. Kwavela ukuthi ngesikhathi kutholakala lesi sifo sokuqala, ama-25% awo ayene-ketoacidosis. Kamuva, baba nesithombe esivamile somtholampilo sohlobo 2 sikashukela. Ososayensi namanje abakasitholi isizathu sokwenzeka kwalesi simo.

Izimpawu nokwelashwa kwe-ketoacidosis yesifo sikashukela ezinganeni kuvame ukufana nakubantu abadala. Uma abazali beqapha ingane yabo ngokucophelela, bayoba nesikhathi sokuthatha isinyathelo ngaphambi kokuba abe ekhefweni likashukela. Lapho ebeka imithamo ye-insulin, i-saline nezinye izidakamizwa, udokotela uzokwenza izinguquko zesisindo somzimba wengane.

Izindlela Zokuphumelela

Izindlela zokuxazulula (ukwelashwa okuphumelelayo) kwe-ketoacidosis yesifo sikashukela zifaka ushukela wegazi we-11 mmol / L noma ongaphansi, kanye nokulungiswa okungenani kwezimpawu ezintathu kwezimo ezintathu zesimo se-acid. Nalu uhlu lwalezi zinkomba:

• i-serum bicarbonate> = 18 meq / l;
• igazi le-venous pH> = 7.3;
• umehluko we-anionic <= 14 meq / l;

Le ndatshana inikezela ngemininingwane enemininingwane mayelana nezimbangela, izimpawu nokwelashwa kwe-ketoacidosis yesifo sikashukela, kufaka phakathi ezinganeni. Indlela enhle yokuvimbela le nkinga enkulu yesifo sikashukela ukufundisa isiguli. I-ketoacidosis ezinganeni ihlala yenzeka uma udokotela ethatha izimpawu zesifo sezinye izifo. Ngakho-ke, kubalulekile ukuthi odokotela nabazali bakhumbule uhlu lwezimpawu zesifo sikashukela. Siyethemba ukuthi le ndatshana ibe wusizo koshukela, kubathandekayo babo, nakudokotela.