Isifo sikashukela senzeka ngokumelene nesizinda sokulimala kwezindonga ze-vascular ngamazinga aphezulu kashukela kanye nokuthuthukiswa kokuhlinzekelwa kwegazi okunganele, ukubekwa cishe kwazo zonke izitho nezinhlelo.
Ukuntuleka kokudla kwezicubu ngenxa yobunzima bokufakwa kweglucose kanye nokwehla kokungazethezeki, kuholele ekukhuleni okuvame kakhulu kwezinkinga ngesikhathi sokungenelela kokuhlinzwa. Ngaphezu kwalokho, inqubo yokutakula ngemuva kokuhlinzwa ihlangene nokwelashwa okuhamba kancane kwamanxeba we-postoperative.
Kulokhu, iziguli ezinesifo sikashukela zidinga amaqhinga akhethekile wokulungiselela kokusebenza kanye ne-anesthesia ngesikhathi sokuhlinzwa.
Ukulungiselela ukuhlinzwa kwesifo sikashukela
Umsebenzi oyinhloko ukuvimbela izinkinga ngemuva kokuhlinzwa ukulungisa ushukela ophezulu wegazi kwiziguli ezinesifo sikashukela. Kulokhu, lokhu kudla kuyalawulwa ikakhulukazi. Imithetho eyisisekelo yokwelashwa kokudla ngaphambi kokuhlinzwa:
- Ukukhishwa kokudla okunekhalori ephezulu.
- Ukudla okuyisithupha ngosuku emikhakheni emincane.
- Ukukhishwa ushukela, amaswidi, ufulawa kanye ne-confectionery, izithelo ezimnandi.
- Khawulela amafutha ezilwane futhi ungafaki ukudla okuphezulu ku-cholesterol: inyama enamafutha, amafutha okuthosi wezilwane, ukudla, isaladi, ukhilimu omuncu onamafutha, ushizi wekhishi no-ukhilimu, ibhotela.
- Ukuvinjwa kotshwala.
- Ukucebisa kokudla ngemfino yokudla kusuka emifino, izithelo ezingafakiwe, i-bran.
Ngefomu emincane yesifo sikashukela noma ukubekezelela i-glucose engasebenzi kahle, ukudla okuqinile kunganele ukwehlisa ushukela wegazi, kuzo zonke ezinye izimo, ukulungiswa kwamthamo kwemithi yokwehlisa ushukela kuyenziwa. Amathebhulethi asebenza isikhathi eside ne-insulin akhanselwa iziguli ngosuku. Ukusetshenziswa kwe-insulin emfushane kubonisiwe.
Uma i-glycemia yegazi ingaphezulu kwe-13.8 mmol / L, khona-ke i-1 - 2 IU ye-insulin iphathwe ngokuhlinzwa njalo ngehora, kepha iphansi kuka-8.2 mmol / L akunconywa ukwehlisa inkomba. Ngenkambo ende yesifo sikashukela, baqondiswa izinga elisondele ku-9 mmol / l nokungabikho kwe-acetone emchameni. Ukwehla kwe-glucose kumchamo akufanele kudlule i-5% yokuqukethwe kwe-carbohydrate ekudleni.
Ngaphezu kokugcina ushukela wegazi ezigulini ezinesifo sikashukela, zenza:
- Ukwelashwa kokuphazamiseka enhliziyweni nokucindezelwa kwegazi.
- Ukunakekelwa kwezinso.
- Ukwelashwa kwe-neuropathy yesifo sikashukela.
- Ukuvimbela izinkinga ezithathelwanayo.
Esikhathini sikashukela, kunengozi enkulu yokuhlaselwa yisifo senhliziyo, umfutho we-arterial hypertension. Izilonda zenhliziyo zingaba sesimweni sesifo se-ischemic, i-myocardial dystrophy, i-cardiac kwemisipha ye-neuropathy. Isici sezifo zenhliziyo yizindlela ezingezinhlungu zokuhlaselwa yinhliziyo, okubonakaliswa ngokuhlaselwa ukugcwala, ukulahlekelwa ukwazi, noma ukwephula isigqi senhliziyo.
Esigulini senhliziyo, ukungasebenzi kahle kwe-coronary insuffeed kuhamba kahle, okuholela ekufeni kungazelelwe. Iziguli ezinesifo sikashukela azikhonjiswanga impatho yendabuko ngabathengi be-beta-blockers kanye nabaphikisi be-calcium ngenxa yomphumela wazo omubi ekuguleni kwe-carbohydrate.
Ukulungiselela ukuhlinzwa kweziguli ezinesifo sikashukela esinesifo senhliziyo, kusetshenziswa amalungiselelo e-dipyridamole - Curantil, Persantine. Kuthuthukisa ukuhamba kwegazi okuphathelene nolunye uhlangothi, kuqinisa ukuzamazama kwenhliziyo ngasikhathi sinye kusheshise ukuhamba kwe-insulin kwezicubu.
Ukunciphisa umfutho wegazi ezigulini ezinesifo sikashukela kuyinkimbinkimbi ngomphumela we-insulin ekugcinweni kwe-sodium. Ngokubambisana ne-sodium, uketshezi lugcinwa emzimbeni, i-edema yodonga lomkhumbi luyenza ithambekele esenzweni samahomoni e-vasoconstrictive. Ngaphezu kwalokho, ukulimala kwezinso kushukela, izinguquko ze-atherosulinotic emithanjeni yegazi nokukhuluphala kwandisa umfutho wegazi ophakeme.
Ukunciphisa ingcindezi, kungcono ukwelapha ngezidakamizwa ezivela emaqenjini avimba i-adrenergic: i-beta 1 (Betalok), i-alpha 1 (Ebrantil), kanye ne-angiotensin-converting enzyme inhibitors (Enap, Kapoten). Kubantu asebekhulile, ukwelashwa kuqala nge-diuretics, kuhlanganiswa nezidakamizwa ezivela kwamanye amaqembu. Indawo yokucindezela okwehlayo yaphawulwa eGlyurenorm.
Lapho kuvela izimpawu ze-nephropathy, usawoti ukhawulelwe ku-1-2 g, amaprotheni ezilwane afinyelela ku-40 g ngosuku. Uma ukubonakaliswa kwama-metabolism angasebenzi kahle kungasuswa ekudleni, khona-ke izidakamizwa zibekelwa ukwehlisa i-cholesterol. Kwi-polyneuropathy yesifo sikashukela, ukusetshenziswa kweThorogma noma iBelithion kukhonjisiwe.
Ukulungiswa kwe-immunological nakho kwenziwa, kanye nezinkomba - ukwelashwa ngama-antibiotic.
Isifo sikashukela i-anesthesia
Ngesikhathi sokuhlinzwa, zizama ukugcina izinga le-glucose egazini, livikele ukuncipha kwalo, ngoba lokhu kungaholela ezinkingeni ebuchosheni. Akunakwenzeka ukugxila kwizimpawu ze-hypoglycemia ngaphansi kwezimo zokuhlinzwa kwe-anesthesia. I-anesthesia ejwayelekile ayivumeli ukuthi itholwe, ngakho-ke kuhlolwa igazi ngoshukela. Kuthathwa njalo emahoreni ama-2.
Imithamo emikhulu ye-anesthetics, kanye nokuphatha kwabo isikhathi eside kunciphisa ushukela wegazi. Ngakho-ke, ngesikhathi se-anesthesia ngesikhathi sokusebenza, kuhlanganiswa ingxube ye-glucose ne-insulin. Isenzo se-insulin ngesikhathi sezinzwa sisinde kunaphansi kwezimo ezijwayelekile, ngakho-ke izinga elijwayelekile likashukela lithathelwa indawo yi-hypoglycemia.
Lapho usebenzisa izidakamizwa i-anesthesia, udinga ukucabanga ngomthelela wawo kuma-carbohydrate metabolism:
- I-inestation anesthesia ene-Ether neFluorotan inyusa amazinga kashukela.
- Ama-Barbiturates akhuthaza ukungena kwe-insulin kumaseli.
- I-Ketamine ithuthukisa umsebenzi we-pancreatic.
- Umphumela omncane kakhulu we-metabolism ukhishwa yi: droperidol, sodium oxybutyrate, nalbuphine.
Ukusebenza kwesikhashana esifushane kwenziwa ngaphansi kwe-anesthesia yendawo, ezigulini ezingalingani ngokomzwelo zingathuthukiswa ngama-antipsychotic. Emisebenzini emaphethelweni aphansi nasengxenyeni ye-cesarean, isetshenziswa i-anesthesia yomgogodla noma ye-epidural
I-anesthesia yesifo sikashukela i-mellitus ngendlela yemijovo noma ukwethulwa kwe-catheter kufanele yenziwe ngaphansi kwezimo zokungasebenzi ngokuphelele ngenxa yokubekwa phambili kweziguli ekuthuthukisweni kokuqina kwengqondo.
Umfutho wegazi nawo awunakuncishiswa kakhulu, ngoba abanesifo sikashukela abakubekezeleli ukuqina kwegazi. Imvamisa, ingcindezi yanda ngama-intravenous fluid kanye nama-electrolyte. Izidakamizwa zeVasoconstrictor azinconywa.
Ukubuyisa ukulahleka kwegazi, ungasebenzisi ama-dextrans - i-Polyglyukin, i-Reopoliglyukin, ngoba yehle i-glucose. Ukuphathwa kwabo kungadala i-hyperglycemia ne-glycemic coma.
Isixazululo sikaHartman noma uRinger asisetshenziswanga, ngoba i-lactate evela kubo esibindini ingaphenduka ushukela.
Izinkinga
Izinkinga ze-postoperative ezigulini ezinesifo sikashukela zihambisana neqiniso lokuthi ukulahleka kwegazi, ukusetshenziswa kwe-anesthetics nobuhlungu ngemuva kokuhlinzwa kusebenze ukwakheka kwe-glucose esibindini, ukwakheka kwemizimba ye-ketone, kanye nokuqhekeka kwamafutha namaprotheni.
Ngokuhlinzwa okukhulu noma ngesikhathi sokuhlinzwa ukwelapha izinkinga zesifo sikashukela, i-hyperglycemia ingaba phezulu kakhulu. Ngakho-ke, iziguli zibekwa ezikhungweni zokunakekelwa kakhulu noshukela wegazi, ukusebenza kwenhliziyo kanye namaphaphu kubhekwa njalo emahoreni ama-2.
I-insulin esebenza njengento emfushane isetshenziselwa ukuvimbela i-ketoacidosis ne-coma. Faka ngaphakathi ngentambo ngesisombululo se-5% ushukela. I-Glycemia igcinwa ebangeni le-5 kuya ku-11 mmol / L.
Ukusuka osukwini lwesikhombisa ngemuva kokuhlinzwa, ungasibuyisela isiguli ku-insulin noma amaphilisi isikhathi eside ukunciphisa ushukela. Ukushintshela kumathebulethi, umthamo wakusihlwa ukhanselwa ekuqaleni, bese kuthi olunye usuku futhi, ekugcineni, umthamo wasekuseni.
Ukuze ulondoloze izinga elizinzile loshukela egazini, kudingeka usizo olwanele lobuhlungu ngemuva kokuhlinzwa. Ngokuvamile, ama-analgesics asetshenziselwa lokhu - uKetanov, Nalbufin, Tramadol.
Iziguli zesifo sikashukela esikhathini se-postoperative zinikezwa ama-antibiotic anhlobonhlobo lwesenzo nezinhlanganisela zezinhlobo ezi-2 kuya kwezi-3. Ama-penicillin ama-Semisynthetic, cephalosporins nama-aminoglycosides asetshenziswa. Ngokwengeziwe kuma-antibhaktiriya, kunqunywa i-metronidazole noma i-clindamycin.
Izingxube zamaphrotheni zisetshenziselwa ukondliwa kwabazali, ngoba ukusetshenziswa isikhathi eside kwezisombululo ze-glucose kuholela ku-hyperglycemia, kanti ukusetshenziswa kwezingxube ze-lipid kuholela ketoacidosis yesifo sikashukela. Ukungezelela ukuntuleka kwamaprotheni, angakhuphula noshukela wegazi, ukuxubeka okukhethekile kweziguli ezinesifo sikashukela - iNutricomp Diabetes kanye neDiazon - sekuthuthukisiwe.
Imininingwane yezinhlobo zokubulala izinzwa inikezwe kuvidiyo ekulesi sihloko.
