Uma isifo sikashukela singanxephezeli isikhathi eside, isiguli siba nezinkinga ezinkulu eziningi, ezivame ukubangela ukoma nokufa. Izimbangela zokuncipha kwemizwa kanye ne-koma kufanele zifunwe ngenani elinganele le-glucose egazini (hypoglycemia) noma ngokweqile kwalo (hyperglycemia).
Zonke izinhlobo zama-coma zivame ukukhula ngesifo esilahliwe sohlobo lwesibili, ukungahambisani nokudla okuphakanyisiwe kwe-carb.
Nge-hyperglycemia, i-hyperosmolar coma iyenzeka, ihlukaniswa ngokuhlanganiswa kokuphela komzimba ne-hyperosmolarity yegazi, ukuntuleka kwephunga le-acetone kusuka emgodleni womlomo.
Kuyini i-hyperosmolar coma
Lesi simo se-pathological siyinkimbinkimbi yesifo sikashukela i-mellitus, sitholakala kaningi kune-ketoacidosis coma futhi sinezimpawu zeziguli ezihluleka ukuqina kwezinhlungu.
Izimbangela eziyinhloko zokukhopha yilezi: ukugabha okukhulu, ukuhuda, ukusebenzisa kabi izidakamizwa ezi-diuretic, ukuntuleka kwe-insulin, ukuba khona kwesimo esibi sesifo esithathelwanayo, kanye ne-insulin hormone yokulwa. Futhi, i-coma ingaba ukwephulwa okukhulu kokudla, ukuphathwa ngokweqile kwezixazululo ze-glucose, ukusetshenziswa kwabaphikisi be-insulin.
Kuyaphawuleka ukuthi ama-diuretics avame ukudala i-hyperosmolar coma kubantu abanempilo yeminyaka ehlukene, ngoba izidakamizwa ezinjalo zinomphumela omubi we-carbohydrate metabolism. Lapho kukhona umbono ofana nesifo sikashukela, imithamo emikhulu yesizathu esibuhlungu:
- ukonakala ngokushesha kwe-metabolism;
- ukubekezelela ushukela okhubazekile.
Lokhu kuthinta ukuhlangana kokuzila ukudla kwe-glycemia, inani le-hemoglobin ye-glycated. Kwezinye izimo, ngemuva kwe-diuretics, izimpawu zesifo sikashukela kanye ne-non-ketonemic hyperosmolar coma kukhuphuka.
Kunephethini ukuthi izinga lama-glycemia elinesifo sokuthola isifo sikashukela lithinteka kakhulu kubudala bomuntu, ukuba khona kwezifo ezingamahlalakhona, kanye nesikhathi sokuphola. Intsha ingahle ibhekane nezinkinga zempilo ngemuva kweminyaka engu-5 kuqale okokuhlinzwa, kanye neziguli esezikhulile kungakapheli unyaka noma emibili.
Uma umuntu esevele eguliswa yisifo sikashukela, isimo siyinkimbinkimbi kakhulu, izinkomba ze-glycemia zizoba zimbi ezinsukwini ezimbalwa ngemuva kokuqala kokusetshenziswa kwensiza.
Ngaphezu kwalokho, izidakamizwa ezinjalo zinomphumela omubi kuma-metabolism wamafutha, zandisa ukugcwala kwe-triglycerides ne-cholesterol.
Izimbangela zeComa
Odokotela abasenaso isiqiniseko ngezimbangela zokubandakanyeka kwesifo sikashukela njenge-hyperosmolar coma.
Into eyodwa eyaziwayo ukuthi iba ngumphumela wokuqongelela ushukela egazini ngenxa yokuvinjelwa ukukhiqizwa kwe-insulin.
Ukuphendula lokhu, i-glycogenolysis, i-gluconeogeneis, enikezela ngokwanda ezitolo ezinoshukela ngenxa yokudla kwaso, iyasebenza. Umphumela wale nqubo ukwanda kwe-glycemia, ukwanda kwe-osmolarity yegazi.
Lapho i-hormone egazini inganele:
- ukumelana nayo kuyaqhubeka;
- amangqamuzana omzimba awatholi inani elifanelekile lomsoco.
I-Hyperosmolarity ingavimbela ukukhishwa kwama-acid aqukethe izicubu ze-adipose, ukuvimbela i-ketogenesis ne-lipolysis. Ngamanye amagama, ukugcinwa kweshukela okungeziwe kusuka ezitolo ezinamafutha kuncishiswa kumazinga abucayi. Lapho le nqubo incipha, inani lemizimba ye-ketone evela ekuguqukeni kwamafutha libe ushukela liyancishiswa. Ukungabikho noma ukuba khona kwezidumbu ze-ketone kusiza ekuboneni uhlobo lwe-coma kushukela.
I-Hyperosmolarity ingaholela ekukhiqizweni okwandayo kwe-cortisol ne-aldosterone uma umzimba unganawo umswakama. Ngenxa yalokho, umthamo wegazi elijikelezayo uyancipha, i-hypernatremia iyanda.
I-coma iqala ngenxa ye-edema yamakhorali, ehambisana nezimpawu ze-neurological uma kungalingani:
- i-electrolyte;
- amanzi.
I-osmolarity yegazi isheshiswa ngokumelene nesizinda se-mellitus engafakwanga ushukela kanye ne-pathologies yezinso ezingalapheki.
Izimpawu
Ezimweni eziningi, izinkomba ze-hyperosmolar coma ezisondelayo zifana kakhulu nokuboniswa kwe-hyperglycemia.
Umuntu onesifo sikashukela uzozwa ukoma okuqinile, umlomo owomile, ubuthakathaka bemisipha, ukuwohloka okusheshayo, uzothola ukuphefumula okusheshayo, ukuchama, kanye nokunciphisa umzimba.
Ukopha ngokweqile nge-hyperosmolar coma kuzodala ukwehla kwamazinga okushisa omzimba, ukwehla ngokushesha komfutho wegazi, ukuqhubekela phambili kwe-hypertension ye-arterial, ukungazi kahle kwemizwa, umsebenzi wethambo owenziwe buthaka, ithoni yezimpawu zamehlo, isikhumba somzimba, ukuphazamiseka emsebenzini wenhliziyo nesigqi senhliziyo.
Izimpawu ezengeziwe zizoba:
- ukunciphisa abafundi;
- i-hypertonicity yemisipha;
- ukuntuleka kwe-tendon ekhombisa;
- ukuphazamiseka kwemizwa.
Ngokuhamba kwesikhathi, i-polyuria ithathelwa indawo yi-anuria, kuba nezinkinga ezinzima, ezibandakanya ukulimala, umsebenzi we-renal ophazamisekile, i-pancreatitis, i-venous thrombosis.
Izindlela zokuxilonga, ukwelashwa
Ngokuhlaselwa kwe-hyperosmolar, odokotela bafaka ngokushesha isisombululo se-glucose, lokhu kuyadingeka ukumisa i-hypoglycemia, ngoba umphumela obulalayo ngenxa yokuncipha okukhulu kashukela wegazi kwenzeka kaningi kunokwanda kwawo.
Esibhedlela, i-ECG, ukuhlolwa kwegazi likashukela, ukuhlolwa kwegazi okunamakhemikhali ukuthola inani lama-triglycerides, potassium, sodium ne-cholesterol ephelele kwenziwa ngokushesha okukhulu. Kubalulekile futhi ukwenza uvivinyo womchamo ojwayelekile wamaprotheni, ushukela kanye nama-ketones, ukuhlolwa kwegazi okujwayelekile.
Lapho isimo sesiguli sesijwayelekile, uzonikezwa ukuhlolwa kwe-ultrasound, i-X-ray yamanyikwe kanye nokunye ukuhlolwa ukuvimbela izinkinga ezingaba khona.
Umuntu ngamunye onesifo sikashukela, onesifo sokuwa, udinga ukuthatha izinyathelo eziningana zokuphoqelelwa ngaphambi kokulashwa esibhedlela:
- ukubuyiselwa kanye nokugcinwa kwezinkomba ezibalulekile;
- okusheshayo kwezimpawu zokuxilonga
- i-glycemic normalization;
- ukuqothula ukomisa;
- ukwelashwa kwe-insulin.
Ukugcina izinkomba ezibalulekile, uma kunesidingo, ukufeza umoya omncane wokufakelwa kwamaphaphu, qapha izinga lokucindezela kwegazi nokugeleza kwegazi. Lapho ingcindezi incipha, ukuphathwa kwe-intravenous solution ye-0.9% sodium chloride solution (1000-2000 ml), isixazululo se-glucose, iDextran (400-500 ml), i-Reftan (500 ml) ngokusetshenziswa okuhlangene okungenzeka kweNorepinephrine, iDopamine iyakhonjiswa.
Nge-hypertension ye-arterial, i-hyperosmolar coma ku-mellitus yesifo sikashukela ihlinzeka ngokujwayelekile kokucindezela kube ngamazinga angeqi ngokwejwayelekile i-10-20 mm RT. Ubuciko. Ngalezi zinhloso, kuyadingeka ukufaka i-1250-2500 mg ye-magnesium sulfate, kuphakanyiswa ukumnika noma i-bolus. Ngokwenyuka okuncane kwengcindezi, akukho ngaphezu kwe-10 ml ye-aminophylline ebonisiwe. Ukuba khona kwe-arrhythmias kudinga ukubuyiselwa kwesilinganiso senhliziyo.
Ukuze kungalimali endleleni eya esikhungweni sezokwelapha, isiguli siyahlolwa, ngenxa yalesi sizathu, kusetshenziswa imichilo ekhethekile yokuhlola.
Ukulungisa ngokwejwayelekile izinga le-glycemia - imbangela enkulu ye-coma ku-mellitus yesifo sikashukela, kuboniswa ukusetshenziswa kwemijovo ye-insulin. Kodwa-ke, esigabeni sangaphambi kokubeletha lokhu akwamukeleki, i-hormone ifakwa ngqo esibhedlela. Kulesi sikhungo sokunakekelwa okujulile, isiguli sizothathwa masinyane ukuze sihlaziywe, sithunyelwe elabhorethri, futhi ngemuva kwemizuzu engu-15 umphumela kufanele utholakale.
Esibhedlela, baqapha isiguli, baqaphe:
- uphefumula
- ingcindezi
- lokushisa komzimba
- ukushaya kwenhliziyo.
Kuyadingeka futhi ukwenza i-electrocardiogram, ukuqapha ibhalansi yama-electrolyte. Ngokusekelwe kumphumela wokuhlolwa kwegazi nomchamo, udokotela wenza isinqumo sokushintsha izimpawu ezibalulekile.
Ngakho-ke usizo lokuqala lwe-coma sikashukela kuhloswe ngalo ukuqeda ukomisa, okungukuthi, ukusetshenziswa kwezixazululo ze-saline kukhonjisiwe, i-sodium ihlukaniswa amandla okugcina amanzi kumaseli womzimba.
Ehoreni lokuqala, babeka u-1000-1500 ml we-sodium chloride, emahoreni amabili alandelayo, umuthi 500-1000 ml wesidakamizwa uphathwa ngaphakathi, futhi ngemuva kwalokho i-300-500 ml ye-saline yanele. Ukuthola inani ngqo le-sodium akunzima; Izinga lakhona livame ukuqashwa ngeplasma yegazi.
Igazi lokuhlaziywa kwe-biochemical lithathwa kaningi phakathi nosuku, ukunquma:
- sodium izikhathi 3-4;
- ushukela 1 isikhathi ngehora;
- imizimba ye-ketone izikhathi 2 ngosuku;
- acid-base state izikhathi 2-3 ngosuku.
Ukuhlolwa kwegazi okujwayelekile kwenziwa kanye njalo ezinsukwini ezingama-2-3.
Lapho izinga le-sodium lenyuka lifinyelela ku-165 mEq / l, awukwazi ukufaka isisombululo salo esinamanzi, kulesi simo kudingeka isixazululo seglucose. Ngaphezu kwalokho, i-dropper ibekwa ngesisombululo se-dextrose.
Uma ukuvuselelwa komzimba kwenziwa kahle, lokhu kunomthelela omuhle kuzo zombili ibhalansi yama-electrolyte kanye ne-glycemia. Enye yezinyathelo ezibalulekile, ngaphandle kwalezo ezichazwe ngenhla, ukwelashwa kwe-insulin. Emzabalazweni wokulwa ne-hyperglycemia, i-insulin esebenza ngokufushane iyadingeka:
- okwenziwe ngokwedlule;
- ubunjiniyela bozalo lomuntu.
Kodwa-ke, ukukhetha kufanele kunikezwe i-insulin yesibili.
Ngesikhathi sokwelashwa, kuyadingeka ukukhumbula isilinganiso sokutholwa kwe-insulin elula, lapho i-hormone iphathwa ngaphakathi, isikhathi sokusebenza singaba yimizuzu engama-60, ngokuphatha okungaphansi - kuze kufinyelele emahoreni angama-4. Ngakho-ke, kungcono ukuphatha i-insulin ngokungaziphathi. Ukwehla okusheshayo kweglucose, ukuhlaselwa kwe-hypoglycemia kwenzeka ngisho nangamanani amukelekile ashukela.
I-Diabetesic coma ingaqedwa ngokuphatha i-insulin kanye ne-sodium, dextrose, isilinganiso sokufakwa ngu-0.5-0.1 U / kg / ihora. Kuyenqatshelwa ukuphatha inani elikhulu le-hormone ngokushesha; lapho usebenzisa amayunithi we-6-12 we-insulin elula, i-0.1-0.2 g ye-albhamuin kukhonjiswa ukuvimbela ukungena kwe-insulin.
Ngesikhathi sokufakwa, ukugxila kwe-glucose kufanele kugadwe ngokuqhubekayo ukuze kuqinisekwe ukunemba kwemithamo. Kumuntu onesifo sikashukela, ukwehla kwamazinga kashukela kungaphezulu kwe-10 mosm / kg / h. Lapho i-glucose incipha ngokushesha, i-osmolarity yegazi yehla ngezinga elifanayo, ivuse izinkinga ezisongela impilo - i-edema ye-cerebral. Izingane zizoba sengozini ikakhulukazi kulokhu.
Kunzima kakhulu ukubikezela ukuthi isiguli esekhulile siyozizwa kanjani siphikisana nesizinda sokuziphatha okuyikho kwezindlela zokuvuselela esibhedlela naphakathi nokuhlala kuso. Ezimweni ezisezingeni eliphakeme, abanesifo sikashukela babhekene neqiniso lokuthi ngemuva kokuphuma kwe-hyperosmolar coma, kunokuvinjwa komsebenzi wenhliziyo, i-pulmonary edema. Iningi le-glycemic coma lithinta asebekhulile ngezinso ezingapheli kanye nokwehluleka kwenhliziyo.
Ividiyo ekulesi sihloko ikhuluma ngezinkinga ezinzima zesifo sikashukela.
