Ukwanda kwamazinga kashukela egazini aze afike ku-31 mmol / L kungaba uphawu lokuxakaniseka okunzima kwesifo sikashukela - i-hyperosmolar coma. Kulesi simo, kunokuphelelwa ngamandla okubukhali kwama-milestones ezicutshini zomzimba, ukuphazamiseka kwe-carbohydrate metabolism kufinyelela ezingeni eleqile, izinga lezisekelo ze-sodium ne-nitrogenous egazini liyanda.
Cishe isigamu seziguli, lolu hlobo lokukhohlakala kwesifo sikashukela luyabulala. Imvamisa, lokhu kwanda kwenzeka ezigulini ezinesifo sikashukela sohlobo 2, ezisebenzisa imithamo emincane yemithi enciphisa ushukela.
Isimo se-hyperosmolar cishe asitholakali kwabanesifo sikashukela esingaphansi kweminyaka engama-40, kanti ingxenye yalabo abanesifo sikashukela ingakatholakali. Ngemuva kokuphuma ekhefini, iziguli zidinga ukulungiswa kokwelashwa okwenziwayo - kungenzeka kunikezwe i-insulin.
Izimbangela zokukhopha kuhlobo 2 sikashukela
Isici esiyinhloko esiholela ekwandeni okukhulu kwe-hyperglycemia ukuntuleka kwe-insulin. Ama-pancreas angagcina amandla okufihla i-insulin, kepha ngenxa yokuthi akukho ukusabela okuvela ohlangothini lwamaseli, ushukela wegazi uhlala uphakeme.
Lesi simo sikhuliswa wukuphelelwa ngamanzi emzimbeni ngokulahleka kakhulu kwegazi, kufaka phakathi ukuhlinzwa okuningana kwesisu, ukulimala, ukushiswa. Ukwehla emzimbeni kungahle kuhambisane nokusetshenziswa komthamo omkhulu we-diuretics, i-saline, i-Mannitol, i-hemodialysis noma i-peritoneal dialysis.
Izifo ezithathelwanayo, ikakhulukazi lezo ezinomkhuhlane ophakeme, kanye ne-pancreatitis noma i-gastroenteritis ngokuhlanza nokuhudula, ukuphazamiseka kokujikeleza kwengqondo okubuchopho noma inhliziyo kuholela ekubuyeni kwesifo sikashukela. Isimo singakhula ngokwengeziwe ngokufakwa kwezixazululo zama-glucose, ama-hormone, ama-immunosuppressants, kanye nokudla i-carbohydrate.
Izimbangela zokuphazamiseka kwebhalansi yamanzi zingaba:
- Isifo sikashukela.
- Ukuvinjelwa komkhuhlane ezigulini ezinokwehluleka kwenhliziyo.
- Umsebenzi wezinso ongasebenzi kahle.
Isizathu sokwephulwa kwebhalansi yamanzi nakho kungadonsa isikhathi eside komzimba ngokujuluka okukhulu.
Izimpawu Nokuxilongwa
I-Hyperosmolar coma ikhula kancane. Isikhathi se-precomatose sihlala ezinsukwini ezinhlanu kuya kweziyi-15. Imiphumela yokuphazamiseka kwe-carbohydrate metabolism ibonakaliswa ukoma okwandayo nsuku zonke, ukuphuma komchamo ngokweqile, ukusikeka kwesikhumba, ukwanda kokudla, ukukhathala okusheshayo, kufinyelela ekuqothulweni komsebenzi wezimoto.
Iziguli zikhathazekile ngomlomo owomile, oba ongapheli, ukozela. Isikhumba, ulimi nolwelwesi lwe-mucous zomile, amachashazi wamehlo ayacwila, athambile ekuthinteni, kuboniswa izici zobuso. Ukuqhubeka kobunzima bokuphefumula nokwazi ukungasebenzi kahle.
Ngokungafani ne-ketoacidotic coma, okuyinto ejwayelekile yohlobo lweshukela sikashukela futhi ikhula kaningi ezigulini ezisezincane, ngesimo se-hyperosmolar akukho phunga le-acetone elivela emlonyeni, akukho msindo ophilayo futhi ophefumulayo kaningi, ubuhlungu besisu nokungezwani kodonga lwangaphakathi lwesisu.
Izimpawu ezejwayelekile zokwehla kwesimo esimweni se-hyperosmolar zingukuphazamiseka kwemizwa:
- I-Convulsive syndrome.
- Ukuthathwa kwe-Epileptoid.
- Ubuthakathaka emilenzeni ngekhono elincishisiwe lokuhamba.
- Ukunyakaza kwamehlo okubandakanya.
- Inkulumo enesizungu.
Lezi zimpawu ziwuphawu lwengozi e-acute cerebrovascular ngengozi, ngakho-ke, iziguli ezinjengalezi zingahle zitholakale ngokungafanele ngesifo sohlangothi.
Ngokuqhubeka kwe-hyperglycemia kanye nokuphelelwa ngamandla, ukusebenza kwenhliziyo kuyaphazamiseka, umfutho wegazi wehla, kuba nokushaya kwenhliziyo okuvamisile, ukuchama kuncipha kuze kuphele ukungabikho komchamo, ngenxa yokuqina kwegazi, i-vascular thrombosis yenzeka.
Ekuhlolweni kwelebhu, i-glycemia ephezulu iyatholakala - ushukela wegazi 31 mmol / l (ungafinyelela ku-55 mmol / l), izidumbu ze-ketone azitholakali, izinkomba ze-acid-base balance zisezingeni lomzimba, ukuhlushwa kwe-sodium kudlula okwejwayelekile.
I-Urinalysis ingabona ukulahleka okukhulu kwe-glucose lapho kungekho i-acetone.
Ukwelashwa kwe-Hyperosmolar
Uma ushukela wegazi ukhuphukele kuma-31 mmol / l, khona-ke isiguli sisodwa ngeke sikwazi ukubuyisa ukuphazamiseka kwe-metabolic. Zonke izindlela zokwelashwa kufanele zenziwe kuphela ezindlini zokunakekelwa kakhulu noma ezikhungweni zokunakekelwa kakhulu. Lokhu kungenxa yokuthi sidinga ukubhekwa njalo kwezokwelashwa kanye nokuqashwa kwamapharamitha amakhulu e-lab.
Ukubuyisela umthamo ojwayelekile wokujikeleza kwegazi kungokwenkomba eyinhloko yokwelashwa. Njengoba ukuqothuka kwamanzi emzimbeni kususwa, ushukela wegazi uzokwehla. Ngakho-ke, kuze kube yilapho kwenziwa ukwakhiwa kabusha komzimba okwanele, i-insulin noma eminye imithi ayinqunyelwe.
Ukuze ungakhuphi ukwephula ukwakheka kwegazi kwe-electrolyte, ngaphambi kokuqala kokwelashwa kokungenelela, kuyadingeka ukuthola okuqukethwe kwama-sodium ion egazini (in meq / l). Kuya ngokuthi iziphi izisombululo ezizosetshenziselwa i-dropper. Kungenzeka kube nezinketho ezinjalo:
- Ukuhlushwa kwe-Sodium ngaphezulu kwe-165, izixazululo ze-saline ziyaqinisekiswa. Ukulungiswa kokuphelelwa ngamanzi emzimbeni kuqala ngo-2% ushukela.
- I-Sodium iqukethe egazini kusuka ku-145 kuya ku-165, kulokhu, kunqunywa isisombululo se-0,45% se-hypotonic sodium chloride.
- Ngemuva kokuncishiswa kwe-sodium ngaphansi kwe-145, kunconyelwa isisombululo se-0.9% saline sodium chloride yokwelashwa.
Ngehora lokuqala, njengomthetho, udinga ukuphonsa amalitha ayi-1.5 ekhambi elikhethiwe, amahora angama-2-3, ama-500 ml, bese usuka ku-250 kuya ku-500 ml ngehora ngalinye elilandelayo. Inani loketshezi olwethuliwe lungadlula i-excretion yalo ngo-500-750 ml. Ngezimpawu zokuhluleka kwenhliziyo, udinga ukwehlisa izinga lokuphanjululwa komzimba kabusha.
Yini okufanele ngiyenze uma, ngemuva kokuthola isinxephezelo esiphelele sokuphela komzimba, noshukela wami wegazi usalokhu uphakamile? Esimweni esinjalo, ukuphathwa kwe-insulin esebenza kahle ngofuzo kukhonjisiwe. Ngokungafani nesifo sikashukela sikashukela, isimo se-hyperosmolarity asidingi imithamo ephezulu yehomoni.
Ekuqaleni kokwelashwa kwe-insulin, amayunithi ama-2 e-hormone afakwa ohlelweni lokufakwa ngaphakathi (kwi-tube yokuxhuma ye-dropper). Uma ngemuva kwamahora angama-4-5 ukusuka ekuqaleni kwezokwelapha, ukunciphisa ushukela kuya ku-14-15 mmol / l kungatholakali, umthamo ungandiswa kancane kancane.
Kuyingozi ukuphatha amayunithi we-insulin angaphezu kwe-6 ngehora, ikakhulukazi ngokulawulwa kanyekanye kwesixazululo se-hypotonic sodium chloride. Lokhu kuholela ekwehleni okusheshayo kwe-osmolarity yegazi, uketshezi olusuka egazini luqala ukungena ngaphakathi kwezicubu ngokwemithetho ye-osmosis (kuzo ukucwilisa usawoti kuphezulu), okwenza i-pulmonary ne-edema yobuchopho ingaphenduki.
Ukuvimbela i-hyperosmolar coma
Yini okufanele uyenze ukuvimba ukuthuthukiswa kwezinkinga ezinzima zesifo sikashukela, kufaka phakathi izimo ezisongela impilo njenge-hyperosmolar coma. Isimo esibaluleke kakhulu ukuqapha njalo ushukela wegazi nokufinyelela okufika ngesikhathi ekunakekelweni kwezokwelapha.
I-ketoacidotic ne-hyperosmolar coma zibonakala ngokukhuphuka kancane kancane kwe-glycemia, ngakho-ke ngisho nezinga likashukela ngaphezulu kwe-12-15 mmol / l nokungakwazi kokulihlisa kanye nezinga elinconyiwe, udinga ukuvakashela i-endocrinologist.
Kukalwa i-glycemia kunconywa uhlobo 2 sikashukela okungenani isikhathi esisodwa ngosuku, uma amaphilisi enqunyelwe futhi okungenani izikhathi ezi-4, nge-insulin therapy. Kanye ngesonto, bonke abanesifo sikashukela, kungakhathalekile ukuthi banesifo sikashukela, indlela abaphuza ngayo kanye noshukela, badinga ukudala iphrofayili ephelele ye-glycemic - izilinganiso zithathwa ngaphambi nangemva kokudla.
Ngaphambi kokuvakasha, kunconyelwa ukuthi kuncishiswe inani lemikhiqizo yama-carbohydrate namafutha ezilwane ekudleni futhi uphuze amanzi ajwayelekile, uyilahle ngokuphelele ikhofi, itiye elinamandla, futhi ikakhulukazi ukubhema notshwala.
Ekwelashweni kwezidakamizwa, ukulungiswa kwenziwa kuphela ngesivumelwano nodokotela. Akukalulekanga ukuthatha izidakamizwa ngokuzimela eqenjini le-diuretics kanye nama-hormone, ama-sedative kanye nama-antidepressants.
Iziguli ezinenkambo engafakwanga yohlobo 2 yesifo sikashukela zichaziwe:
- Imijovo ye-insulin esebenza isikhathi eside izikhathi ezi-1-2 ngosuku ngenkathi uthatha amaphilisi anciphisa ushukela.
- I-insulin esebenza isikhathi eside, i-metformin, ne-insulin esebenza isikhathi esifushane ekudleni okuyinhloko.
- Ukulungiswa okuhlala isikhathi eside kwe-insulin 1 isikhathi ngosuku, imijovo emifushane 3 times 30 imizuzu ngaphambi kokudla.
Ngokuvimbela i-hyperglycemia engalawulwa, iziguli ezinesifo sikashukela sohlobo 2 kufanele zishintshwe ukuze zixube noma i-monotherapy ene-insulin ekusebenzeni okuphansi kwamathebulethi ukunciphisa ushukela. Isimo kuleli cala kungaba ukwanda kwezinga le-glycated hemoglobin ngaphezulu kwe-7%.
I-insulin ingabelwa iziguli ezinesifo sohlobo lwesifo sikashukela esijwayelekile, izimpawu ze-neuropathy, ukulimala kwezinso ne-retina, ngokungezelelwa kwezifo ezithathelanayo noma ezinzima kakhulu zezitho zangaphakathi, ukulimala nokuhlinzwa, ukukhulelwa, isidingo sokusebenzisa izidakamizwa ze-hormonal, nemithamo emikhulu yokuhlanza umzimba.
Njengoba ukubonakaliswa komtholampilo kwe-hyperosmolar coma kufana ne-pathologies ye-vascular acute yengqondo, kunconyelwa ukuthi zonke iziguli ezinesifo sohlangothi esisolisayo noma ezinezimpawu ezingenakuchazwa kuphela ngokuhlukunyezwa kwemizwa zibheke ushukela wegazi nomchamo.
Mayelana ne-hyperosmolar coma echazwe kuvidiyo kule ndatshana.
