Isifo sikashukela i-mellitus singokweqembu lezifo lapho amazinga kashukela egazi enyuka. Lesi simo kungaholela ekutheni ukuguga ngaphambi kwesikhathi komzimba kanye nomonakalo cishe kuzo zonke izitho nezinhlelo zawo.
Izazi ezingama-Endocrinologists ziyaqiniseka ukuthi uma kuthathwa izinyathelo zokuvimbela futhi kuthathwa ukwelashwa okunekhono, ezimweni eziningi kungenzeka ukuvimbele noma ngisho ukuvimba ukuqala kwe-coma kushukela. Ngempela, ezimweni eziningi, ubunzima obunjalo buvela ngokwelashwa okungakenzeki, ukuzithiba okwanele nokungahambisani nokudla.
Ngenxa yalokhu, isimo se-hypoglycemic siyakhula, okuholela ekuthuthukisweni kwe-coma ku-mellitus yesifo sikashukela. Kwesinye isikhathi ukuntuleka kokukhululeka okufika ngesikhathi kwento enjalo kungakubangela nokufa.
Kuyini ukukhohlisa kwesifo sikashukela futhi yini izimbangela nezinhlobo zazo?
Ukuchazwa komqondo kunesifo sikashukela - kusho isimo lapho umuntu onesifo sikashukela elahlekelwa ukwazi lapho kunokushoda noma ngokweqile kwe-glucose egazini. Uma ukulesi simo isiguli singanikezwa ukunakekelwa okuphuthumayo, khona-ke konke kungabulala.
Izimbangela ezihola phambili zesifo sikashukela ukukhuphuka okusheshayo kokuxineka kweglucose, okubangelwa ukufihlwa okunganele kwe-insulin yi-pancreas, ukuntuleka kokuzithiba, ukwelashwa okungafundile nabanye.
Ngaphandle kwe-insulin eyanele, umzimba awukwazi ukucubungula ushukela ngenxa yalokho okungaphenduki amandla. Ukushoda okunjalo kuholela eqinisweni lokuthi isibindi siqala ukukhiqiza ngokuzimele ushukela. Ngokuphikisana nalokhu ingemuva, kunokuthuthuka okusebenzayo kwemizimba ye-ketone.
Ngakho-ke, uma ushukela unqwabelana egazini ngokushesha kunemizimba ye-ketone, khona-ke umuntu ulahlekelwa ukuqaphela bese eba nethonya lesifo sikashukela. Uma ukugcotshwa koshukela kukhuphuka kanye nokuqukethwe kwemizimba ye-ketone, isiguli singawela ku-ketoacidotic coma. Kepha kunezinye izinhlobo zezimo ezinjalo okufanele zibhekwe ngemininingwane eminingi.
Ngokuvamile, lezi zinhlobo zokwehla kwesifo sikashukela ziyahlukaniswa:
- i-hypoglycemic;
- i-hyperglycemic;
- ketoacidotic.
I-Hypoglycemic coma - Kwenzeka lapho ushukela wegazi wehla ngokuzumayo. Akunakwenzeka ukusho ukuthi lesi simo sizohlala isikhathi esingakanani, ngoba okuningi kuncike ekuweni kwe-hypoglycemia nasempilweni yesiguli. Lesi simo sisengozini yokuba nesifo sikashukela seqa ukudla noma labo abangalandeli umthamo we-insulin. I-Hypoglycemia ivela futhi ngemuva kokusebenzisa ngokweqile noma kabi ngokweqile.
Uhlobo lwesibili - i-hyperosmolar coma kwenzeka njengengxaki yesifo sikashukela sohlobo 2, esibangela ukuntuleka kwamanzi noshukela wegazi ngokweqile. Ukuqalwa kwayo kwenzeka ngezinga le-glucose elingaphezu kwama-600 mg / l.
Imvamisa, i-hyperglycemia eyeqile inxephezelwa izinso, ezisusa ushukela omningi ngomchamo. Kulokhu, isizathu sokukhula komqondo ukuthi ngesikhathi sokukhipha amanzi emzimbeni okwenziwe izinso, umzimba uphoqelelwa ukuba wonge amanzi, okungadala i-hyperglycemia enzima.
I-Hyperosmolar s. I-diabetesicum (Latin) iba kaningi kakhudlwana kune-hyperglycemia. Ngokuyisisekelo, ukubukeka kwayo kutholakala njengohlobo 2 sikashukela ezigulini esezikhulile.
I-ketoacidotic diabetesic coma iba nesifo sikashukela sohlobo 1. Lolu hlobo lwe-coma lungenzeka lapho ama-ketones (ama-acetone acid ayingozi) aqongelela emzimbeni. Yimikhiqizo emisha yokwenziwa kwamafutha acid eyenziwe ngesikhathi sokuntuleka kwe-insulin ye-hormone.
I-Hyperlactacidemic coma kusifo sikashukela kwenzeka kakhulu kakhulu. Lokhu kuhlukahluka kweziguli esezikhulile ezinesibindi sokulimala, izinso nenhliziyo ukusebenza.
Izizathu zokuthuthuka kwalolu hlobo lukashukela sikashukela ukwanda okwenziwe kanye nokusetshenziswa kabi kwe-hypoxia ne-lactate. Ngakho-ke, umzimba unobuthi nge-lactic acid, eqoqwe ngokweqile (2-4 mmol / l). Konke lokhu kuholela ekuphulweni kwebhalansi ye-lactate-pyruvate kanye nokuvela kwe-metabolic acidosis nomehluko obalulekile we-anionic.
Ukuqola okuvela kuhlobo 2 noma isifo sikashukela esi-1 kuyinkinga enkulu kakhulu futhi eyingozi kumuntu omdala oseneminyaka engama-30 ubudala. Kepha le nto iyingozi ikakhulukazi kwiziguli ezincane.
Isifo sikashukela ezinganeni sikashukela ezinganeni zivame ukuba nefomu lesifo esincike ku-insulin esigcina iminyaka eminingi. Amahlaya kashukela ezinsaneni ngokuvamile avela esikoleni sokuqala noma esikoleni, kwesinye isikhathi esifubeni.
Ngaphezu kwalokho, ngaphansi kweminyaka emithathu, izimo ezinjalo zenzeka kaningi kakhulu kunabantu abadala.
ISymbomatology
Izinhlobo ze-coma nesifo sikashukela azifani, ngakho-ke isithombe sabo somtholampilo singase sehluke. Ngakho-ke, i-ketoacidotic coma, ukomisa kuyinto enempilo, kuhambisana nokulahleka kwesisindo kufika ku-10% nesikhumba esomile.
Kulokhu, ubuso baphenduka ngobuhlungu obuphakathi (kwesinye isikhathi baphenduka bubomvu), nesikhumba esisekelweni, izintende zezandla ziphenduka ziphuzi, iziqaqa kanye namaphikisi. Abanye abanesifo sikashukela bane-furunculosis.
Ezinye izinkomba zokuba nesifo sikashukela esine-ketoacidosis ukuphefumula okubolile, isicanucanu, ukugabha, ukopha izicubu zomzimba, ukupholisa umlenze kanye nokushisa okuphansi. Ngenxa yokudakwa komzimba, i-hyperventilation yamaphaphu kungenzeka, futhi ukuphefumula kuba nomsindo, kujule futhi kuvame.
Lapho kunenkinga yesifo sikashukela sohlobo 2 lwesifo sikashukela, izimpawu zayo ziba nezwi elinciphile lezimpawu zamehlo nokuncipha kwabafundi. Ngezikhathi ezithile, ukwanda kwesikhwehlela esingaphezulu kanye ne-strabismus kuyaphawulwa.
Futhi, ukukhula kwe-ketoacidosis kuhambisana nokuchama okuvame ukuzenzekela, lapho ukhipha khona iphunga le-fetus. Ngasikhathi sinye, isisu sibuhlungu, isisu semathumbu siba buthakathaka, futhi nezinga lomfutho wegazi liyancishiswa.
I-Ketoacidotic coma in diabetesics ingaba namazinga ahlukene kobunzima - ukusuka ekushoneni kuya ekwethweni. Ukuxilongwa kobuchopho kufaka isandla ekuqalekeni kwesithuthwane, ukuqunjelwa ingqondo, ukukhohlisa nokudideka.
Izimpawu ze-Hyperosmolar diabetesic coma:
- iminyakazo
- ukomisa;
- ukukhubazeka kwenkulumo;
- i-malaise;
- izimpawu zemizwa;
- ukunyakaza ngokuzithandela nokushesha kwehlo;
- ukuchama okungandile nokubuthakathaka.
Izimpawu zokwehla kwesifo sikashukela nge-hypoglycemia zihlukile kancane kwezinye izinhlobo zikhehla. Lesi simo singabonakala ngobuthakathaka obukhulu, indlala, ukukhathazeka okungenasisekelo nokwesaba, ukubanda, ukuthuthumela nokujuluka komzimba. Imiphumela yokuma kwesifo sikashukela nge-hypoglycemia ukulahleka kwengqondo nokubukeka kokuhlaselwa.
I-Hyperlactacidemic diabetesic coma ibonakala ngolimi olomile nesikhumba, ukuphefumula kohlobo lwe-Kussmaul, ukuwa, umfutho wegazi, nokuncipha kwe-turgor. Futhi, isikhathi se-coma, esihlala emahoreni ambalwa kuya ezinsukwini eziningana, sihambisana ne-tachycardia, i-oliguria, idlula i-anuria, ukuthamba kwezimpawu zamehlo.
I-Hypoglycemic coma nezinye izinhlobo zezimo ezifanayo ezinganeni zikhula kancane kancane. Isifo sikashukela sihambisana nokungajabuli esiswini, ukukhathazeka, ukoma, ukozela, ikhanda elibi, isifiso sokudla kanye nesicanucanu. Njengoba sikhula, ukuphefumula kwesiguli kuba nomsindo, kujule, ukushaya kwenhliziyo kuyapholisa, bese kuqhamuka hypotension ye-arterial.
Njengoba kunoshukela ezinsaneni, lapho ingane iqala ukuwa, iba nesibindi, ukugoqeka, ukophala kanye nokoma okwandayo. Amaphaphu akhe aba nzima kumchamo.
I-Glycemic coma ezinganeni ibonakaliswa yizimpawu ezifanayo nakwabadala.
Yini okufanele uyenze uma unesifo sikashukela?
Uma usizo lokuqala lwezinkinga ze-hyperglycemia lungelona iqiniso, khona-ke isiguli esinenkinga yesifo sikashukela emiphumeleni yaso iyingozi kakhulu singaphumela ku-edema ye-pulmonary ne-cerebral edema, thrombosis, okuholela ekuhlaselweni yisifo senhliziyo nemivimbo, i-oliguria, i-renal noma ukwehluleka ukuphefumula, nabanye. Ngakho-ke, ngemuva kokuxilongwa kutholakele, isiguli kufanele sisheshe sinikeze usizo ngesifo sikashukela.
Ngakho-ke, uma isimo sesiguli sesiseduze nokufelwa, khona-ke ucingo oluphuthumayo oluphuthumayo kufanele lwenziwe. Ngenkathi ezoshayela, kuyadingeka ukubeka isiguli esiswini sakhe noma eceleni kwakhe, faka umgodi futhi kuvimbele nolimi ukuba lungashoni. Uma kunesidingo, yenza ukucindezela kube okujwayelekile.
Yini okufanele uyenze uma unesifo sikashukela esibangelwa ukweqiwa kwama-ketones? Kulesi simo, i-algorithm yezenzo ukulungisa imisebenzi ebalulekile yesifo sikashukela, njengokucindezela, ukushaya kwenhliziyo, ukwazi nokuphefumula.
Uma i-lactatacidemic coma ikhule ku-mellitus yesifo sikashukela, kuyadingeka ukuthatha izinyathelo ezifanayo uma kwenzeka kune-ketoacidotic. Kepha ngaphezu kwalokhu, ibhalansi yama-electrolyte ne-acid-base kufanele ibuyiselwe. Futhi, usizo ngesifo sikashukela salolu hlobo siqukethe ukuphatha isisombululo se-glucose nge-insulin esigulini nasekwenziweni kwezimpawu zesifo.
Uma i-coma emnene ye-hypoglycemic itholakala ngohlobo 2 sikashukela, ukuzisiza kungenzeka. Le nkathi ngeke ihlale isikhathi eside, ngakho-ke isiguli kufanele sibe nesikhathi sokuthatha i-carbohydrate esisheshayo (ama-cubes ambalwa kashukela, isipuni sejamu, ingilazi yejusi yezithelo) futhi sithathe isikhundla esikahle ukuze singazilimazi uma kungenzeka siphelelwe yimizwa.
Uma i-hypoglycemia ku-mellitus yesifo sikashukela icasulwa yi-insulin, umphumela wayo uhlala isikhathi eside, khona-ke ukudla ngesifo sikashukela kubandakanya ukuthatha kancane ama-carbohydrate ngesilinganiso se-1-2 XE ngaphambi kokulala.
Ifomu elinzima lidinga umjovo wesisombululo se-glucose (40%) noma i-glucagon (1 mg) kumuntu omdala. Kepha lapho umisa lesi simo ezinganeni, umthamo uyamiswa. Uma isiguli singaphinde siphaphame, siyobe sesiphuthunyiswa esibhedlela, lapho ukwelashwa kwesifo sikashukela kususelwa ekudonselweni kwekhambi le-glucose (10%).
Ukwazi ukuthi kunesifo sikashukela okulula kanjani ukubona izimpawu zayo futhi kuvikele ukukhula kwemiphumela emibi ngendlela esheshayo. Impela, uma uqonda ukuthi yisiphi isifo sikashukela esidinga ukusizwa ngokuphuthumayo, ungamnikeza usizo olukhulu ngoba isisombululo se-glucose esithathwe ngesikhathi sizosiza ukusindisa impilo yomuntu, futhi izinga elijwayelekile le-glycemia lizosiza ukugwema ukuthuthukiswa kwemiphumela emibi eminingana.
Isazi nevidiyo ezikulesi sihloko zizokhuluma ngezimpawu nangezindlela zokwelapha isifo sikashukela.
