Ukwelashwa okungafanele kwesifo sikashukela - ukwenqaba kwezidakamizwa ezinqunyiwe, ukungakwazi ukulawula ushukela wegazi, ukuntuleka kokuthola usizo lwezokwelapha okufika ngesikhathi lapho isifo esithathelwanayo noma esinye isifo esihambisana naso, kuholela ezinkingeni ezinkulu ngesimo sokuwohloka komzimba.
Isifo sikashukela esihambisana nesifo sikashukela sihambisana ne-hyperglycemia enzima, ukopha kakhulu futhi usongo ezimpilweni zeziguli. Izinga elikhulu le-hyperglycemia lingaqalwa ngohlobo lwe-ketoacidotic (enesifo sikashukela sohlobo 1) noma i-hyperosmolar (uhlobo 2 sikashukela).
Uma izinga likashukela wegazi lingama-34, khona-ke udokotela kuphela onganquma ukuthi enzeni esimweni esinjalo, ukuzilapha ngokwakho kusongela impilo. Ukwelashwa kwalezi zimo kwenziwa kuphela ezimeni zamayunithi wokunakekelwa kakhulu.
Izimbangela zeComa
Izimo zeComatose zingaba wuphawu lokuqala lwesifo sikashukela ngokuxilongwa ngokushesha noma inkambo ende yesifo. Isici esiyinhloko esidala ukwanda koshukela egazini ukuntuleka kwe-insulin. Ngohlobo 1 sikashukela, ukungabikho kwehomoni yakho siqu kuholela ku-ketoacidosis.
Imvamisa, izimo ze-ketoacidotic zenzeka ngethamo elikhethwe ngokungafanele le-insulin, ukwenqaba ukwelashwa, ukwephulwa kwendlela yokulawulwa kwezidakamizwa, izimo ezicindezelayo, ukungenelela kokuhlinzwa, ukungenwa izifo ezithinta kakhulu noma ezinzima.
Ngokushoda okukhulu kwe-insulin egazini kanye noshukela emangqamuzaneni, umzimba uqala ukusebenzisa izitolo ezinamafutha njengomthombo wamandla. Okuqukethwe kwegazi kwamafutha acid kuyanda, okusebenza njengomthombo wemizimba ye-ketone. Kulokhu, ukusabela kwegazi kuguqukela ohlangothini lwe-acid, futhi izinga likashukela libangela ukulahleka okubonakalayo koketshezi umchamo.
I-Hyperosmolar coma ivame kakhulu ukwenza inkambo yohlobo 2 lwesifo sikashukela, ukuthuthukiswa kwayo kungenzeka kakhulu kubantu asebekhulile abathatha amaphilisi ukulungisa i-hyperglycemia futhi kunciphise ukuphuza kwamanzi. Izimbangela eziyinhloko zokukhohlisa yilezi:
- I-acute coronary circulation disorder.
- Izifo ezithathelwanayo ngemuva kwesizinda sokushisa komzimba okuphezulu.
- Ukuqina noma ukwanda kwe-pancreatitis engapheli.
- Ukopha, ukulimala, ukusha, ukungenelela kokuhlinzwa.
- Izifo zamathumbu.
- Ukwehluleka kwangempela
Ngohlobo 2 sikashukela, i-insulin egazini kungenzeka yanele ukuvimba ukwakheka kwezidumbu ze-ketone, kodwa ngenxa yokwanda kwezinga lama-catecholam egazini, akwanele ukunxenxa ukukhuphuka kwe-glucose egazini.
Ukubonakaliswa komtholampilo kwe-hyperosmolar coma kuhlotshaniswa nokuphelelwa ngamandla komzimba kanye nomonakalo ohlelweni lwezinzwa oluphakathi.
Izimpawu zokukhohlisa kukashukela
Ukhubazeka kwesifo sikashukela kubonakaliswa ukwanda kancane kancane kwezimpawu, okukuhlukanisa nezimo ze-hypoglycemic, lapho umuntu engahle angazi ngokuzumayo.
Izimpawu ezijwayelekile ze-ketoacidosis kanye nesimo se-hyperosmolar ziyabonakala ngenxa kashukela wegazi ophakeme kanye nokulahleka koketshezi lomzimba.
Izinsuku eziningana, iziguli zizizwa zoma ukoma, ubuthakathaka, isifiso sokudla sithathelwa indawo isicanucanu futhi sikuthande ukudla, ukuchama kuba njalo futhi kuvame kakhulu, ikhanda, isiyezi kanye nokuphazamiseka.
I-ketoacidosis ibonakala ngezimpawu zokuqina kwe-acid kwegazi, ukuphefumula okuzwakala njalo, ukubukeka kwephunga le-acetone emoyeni okhiphele ngaphandle. Ngenxa yomphumela ocasulayo we-acetone kulwelwesi lwama-mucous, kunobuhlungu besisu nokungezwani kodonga lwangaphakathi lwesisu, ukugabha okuphindaphindayo, okuholela ekuxilongeni okungeyikho kwe-pathology eyingozi.
Izimpawu ezijwayelekile zesimo se-hyperosmolar:
- Ukuphuma komchamo okwedlulele, okuthathelwa indawo ukungatholakali ngokuphelele.
- Ubuthakathaka obukhali, ukuphefumula kanye nama-palpitations.
- Ama-eyeball athambile uma ecindezelwa.
- Yehla emfuthweni wegazi.
- Ukulahlekelwa ukwazi ngokufaka ikhehla.
- Ukuqhekeka, ukunyakaza kwamehlo kwesiphithiphithi.
- Ukulimazeka kwenkulumo.
Ukuxilongwa kwethambo
Ukuze unqume ngokufanele imbangela yesifo sokuwa, isiguli sihlolelwa igazi nomchamo ngokushesha ngemuva kokwamukelwa emnyangweni. Egazini elinombuso we-ketoacidotic, kutholakala izinga eliphakeme le-hyperglycemia, ushintsho ekuphenduleni ohlangothini lwe-acid, izidumbu ze-ketone, kanye nokuphazamiseka kokuhlanganiswa kwe-electrolyte.
Emchamweni, kutholakala amazinga aphakeme kashukela kanye ne-acetone. Izimpawu ezingenzeka zingaba i-leukocytosis, ukwanda kwe-creatinine ne-urea egazini (ngenxa yokwanda kokuwohloka kwamaprotheni). Ngokuya kobukhulu besimo, i-glycemia ingasukela ku-16 iye ku-35 mmol / L.
I-Hyperosmolar coma ibonakala ngokukhuphuka koshukela wegazi kusuka ku-33 kuye ku-55 mmol / l, ukukhuphuka kwegazi osmolarity, ukungabikho kwama-ketones kanye ne-acidosis, kanye nevolumu yegazi elinganele. Amazinga we-sodium, chloride, kanye nezisekelo ze-nitrogenous aphakeme, futhi i-potassium iphansi.
Umchamo, i-glucosuria emenyezelwe, i-acetone ayinqunywa.
Ukwelashwa Kwe-Diabetes Coma
Ukunciphisa i-glucose yegazi, zonke iziguli, kungakhathalekile ukuthi zelashwa kanjani, kufanele zidluliselwe ngokuphelele ku-insulin. Kulokhu, umthetho oyinhloko ukwehla kancane ushukela wegazi. Lokhu kuyadingeka ukuze kuvikelwe ukuthuthukiswa kwe-edema yamakhemikhali.
Kuphela kusetshenziswa amalungiselelo e-insulin alungiselelwe abantu ngokwezakhi zomzimba. Isingeniso sabo ekuqaleni senziwa ngaphakathi, ngoba ushukela wegazi uyancipha - ngokwe-intramuscularly, bese ushintshela kwindlela yendabuko esezingeni eliphansi yokwelashwa kwe-insulin.
Ukuphathwa kwe-insulin ku-ketoacidosis kuboniswa emahoreni okuqala okwelashwa, futhi lapho isuswa ku-hyperosmolar coma in sikashukela, imithamo emincane yomuthi inqunywa kuphela ngemuva kokubuyiselwa kwethamo elijwayelekile loketshezi emzimbeni.
Ukwelashwa kokungenelela, isisombululo somzimba se-sodium chloride siyasetshenziswa, uma kunesilinganiso esiphezulu se-sodium esegazini, khona-ke ukugxila kwayo kuyancitshiswa - kulungiswe isisombululo se-0.45%. Ukuphindisela emzimbeni kwenziwa kakhulu ngosuku lokuqala ngaphansi kokuphathwa kohlelo lwezinhliziyo nezinso.
Ngaphezu kwalokho, ekwelapheni ukwelashwa kwesifo sikashukela:
- Ukwelashwa nge-antioxidant - ukwethulwa kwevithamini B12.
- Isixazululo sePotassium.
- Heparin ulungiselela ukuncipha kwegazi.
- Ama-antibiotic.
- Imithi yenhliziyo.
Ngemuva kokuba isimo seziguli sesizinzile, zingaziphekela ukudla ngokwazo, kunconywa amanzi amaminerali we-alkaline, ukudla okugcotshisiwe okukhanyayo okunomkhawulo we-carbohydrate elula namafutha ezilwane.
Ngokuya ngezinga likashukela wegazi, imithamo ye-insulin ehlala isikhathi eside (ilawulwa izikhathi eziyi-1-2 ngosuku) nokubamba okufushane (imijovo ngokunqenqemana ngaphambi kokudla ngakunye) kukhethiwe. Futhi, ukwelashwa kwenziwa ngenxa yezimo ezaholela ekubumbeni kwesifo sikashukela i-mellitus, kanye nokuvinjezelwa kwe-thrombosis.
Ungakuvimbela kanjani ukuthuthukiswa kwesifo sikashukela?
Umthetho omkhulu wokuvikela ukuthuthukiswa kwezinkinga zesifo sikashukela ngendlela ye-coma acute ukulawulwa kweshukela egazini. I-comma yesifo sikashukela iba kancane kancane, ngakho-ke, ngokukhuphuka ushukela ongaphezu kuka-11 mmol / l nokungakwazi ukufezekisa ukuncishiswa kwawo ngokwandisa umthamo wezidakamizwa ezinqunyelwe, udinga ukubonana nodokotela ngokuphuthumayo.
Kubalulekile ezimweni ezinjalo ukuthatha inani elanele lamanzi okuphuza ahlanzekile, futhi ungafaki ngokuphelele imikhiqizo emnandi nefulawa ekudleni, kanye nenyama enamafutha, ukhilimu omuncu nebhotela. Kunconywa kakhulu izitsha zemifino nezinhlanzi ezibilisiwe. Ukudla ikofi netiye elinamandla kufanele kuncishiswe ngenxa yokuguquguquka komzimba.
Uma ukwelashwa kwe-insulin kushiwo, khona-ke ukuphazamiseka kwayo kwenqatshelwe ngokuphelele. Iziguli ezinesifo sikashukela akufanele zizindle ngazo zombili lesi sifo kanye nezifo ezithathelanayo noma ezithathelanayo. Kuyingozi ikakhulukazi ukwenqaba ngokunqobele ukwelashwa okwehlisa ushukela bese ushintshela kokudla okungezelelwe kokudla.
Kuhlobo 2 sikashukela i-mellitus, ukukhuphuka okungalawulwa koshukela wegazi kungasho ukwehla emandleni we-pancreas ukukhiqiza i-insulin yayo. Inkambo yesifo sikashukela iba ngenkani kwe-insulin. Ngakho-ke, kubalulekile ukufuna ukunakekelwa kwezokwelapha ngesikhathi esifanele uma kungenzeki ukunxephezela ushukela ngamaphilisi anqunyelwe.
Isazi kuvidiyo ekulesi sihloko sizokhuluma ngesifo sikashukela.
