Ushukela wegazi 35, kusho ukuthini, iziguli zinesithakazelo kuzo? Ukuqunjelwa okunjalo kwe-glucose emzimbeni wesifo sikashukela kubonisa izinga leshukela, njengomphumela lapho ukusebenza kwawo wonke amasistimu angaphakathi nezinhlelo kuvinjelwe.
Ngokuphikisana nesizinda sezinkomba ezinjalo, ushukela ungakhula ngokuqinile futhi ube ngaphezulu kwamayunithi angama-40, okusho ukuthi kungenzeka ukuthi kube nezinkinga ezinkulu ezithuthukayo. Ngaphezu kwalokho, ingozi yokuqhubeka kwemiphumela engemihle iyanda.
Isifo sikashukela isifo esingelapheki yisifo esingamahlalakhona, "ukungathembeki" okukukuthuthuka kwezinkinga eziningi - ukuthikameza okubukwayo kuze kufiphale, ukwehluleka kwezinso, ukuqothuka kwemikhawulo engezansi, njll.
Kuyadingeka ukuthi ucabangele ukuthi kusho ukuthini uma ushukela ukhuphuke ngaphezu kwama-46 amayunithi, futhi yiziphi izinkinga ezingaba khona?
Izinkinga ezinkulu zoshukela ophezulu
Isisho esithi hyperglycemic state sisho ukwanda ushukela emzimbeni womuntu ngaphezu kwemingcele eyamukelekayo. Ukuhlushwa ushukela kusuka kumayunithi angama-3.3 kuya ku-5.5 kubhekwa njengezinkomba ezijwayelekile.
Uma ushukela osemzimbeni womuntu esiswini esingenalutho uphakeme ngaphezu kwamayunithi angama-6.0, kodwa engaphansi kuka-7.0 mmol / l, khona-ke bakhuluma ngesimo se-prediabetesic. Okusho ukuthi, lokhu kudalwa kwezifo akusoshukela okwamanje, kepha uma izinyathelo ezifanele zingathathwanga, amathuba okuthuthuka kwayo aphezulu kakhulu.
Ngamanani kashukela ngaphezulu amayunithi angama-7,0 esiswini esingenalutho, kuthiwa isifo sikashukela sinjalo. Futhi ukuqinisekisa ukutholwa, kutholakala izifundo ezengeziwe - ukuhlolwa kokuzwela kwe-glucose, hemoglobin ye-glycated (ukuhlaziya kukhombisa okuqukethwe ushukela ezinsukwini ezingama-90).
Uma ushukela ukhuphuka ngaphezu kwamayunithi angama-30 ukuya kwangama-30, lesi simo se-hyperglycemic sisongela ngezinkinga ezinzima kakhulu ezingakhula ngezinsuku ezimbalwa noma amahora ambalwa.
Izinkinga ezivame kakhulu zesifo sikashukela esibuhlungu kakhulu:
- I-Ketoacidosis ibonakala ngokuqongelela emzimbeni wemikhiqizo ye-metabolic - imizimba ye-ketone. Njengomthetho, obonwa ezigulini ezinesifo sikashukela sohlobo 1, kungaholela ekuphazamisekeni okungenakulungiswa ekusebenzeni kwezitho zangaphakathi.
- I-hyperosmolar coma iba lapho ushukela ukhuphuka emzimbeni uye emazingeni aphezulu, ngezinga elikhulayo le-sodium. Kwenzeka ngokumelene nesizinda sokuphelelwa ngamandla. Ngokuvamile kutholakala uhlobo 2 lwesifo sikashukela abaneminyaka engaphezu kwama-55 ubudala.
- I-lactacidic coma ivela ngenxa yokuqongelela i-lactic acid emzimbeni, ibonakala ngokungazi kahle, ukuphefumula, ukwehla okubucayi kwengcindezi yegazi kuyatholakala.
Ebuningini bezithombe zemitholampilo, lezi zinkinga zikhula ngokushesha, phakathi namahora ambalwa. Kodwa-ke, i-hyperosmolar coma ingakhombisa ukukhula kwayo izinsuku eziningana noma amasonto ngaphambi kokuqala komzuzu obalulekile.
Noma iziphi zalezi zimo isikhathi sokufuna usizo lodokotela olufanele; ukuphuthuma kokuphuthumayo kwesiguli kuyadingeka.
Ukunganaki lesi simo amahora amaningi kungabiza impilo yesiguli.
Ketoacidosis kwisifo sikashukela
I-ketoacidosis yesifo sikashukela iyinkimbinkimbi kakhulu yesifo esingamahlalakhona okungaholela ekuphazanyisweni okuningi kwezitho zangaphakathi, ukomzimba kanye nokufa.
Lesi simo se-pathological sivela lapho inqwaba yoshukela inqwabelana emzimbeni wesiguli, kepha umzimba awukwazi ukuwuthola, ngoba kune-insulin encane noma ayinawo nhlobo.
Kodwa-ke, umzimba udinga ukuthola amandla ukuze usebenze, njengomphumela lapho umzimba "uthatha" izinto zamandla kusuka emafutheni ezinamafutha, ngesikhathi sekwephuka lapho izidumbu ze-ketone zikhishwa, okuyizinto ezinobuthi.
Le nkinga iba lapho ingemuva kwesidingo esibukhali somzimba umthamo omkhulu we-insulin. Futhi imbangela ingaba yile mibandela elandelayo:
- I-viral noma i-patologies ethelelekayo (izifo zokuphefumula ezinamandla, umkhuhlane kanye nabanye).
- Ukwephulwa kwemvelo ye-endocrine.
- Ukuxineka (ikakhulukazi ezinganeni).
- Isifo sohlangothi, ukushaya kwenhliziyo.
- Ngemuva kokuhlinzwa.
- Isikhathi sokukhulelwa (isifo sikashukela sabesifazane abakhulelwe).
Ngokuphikisana nesizinda soshukela olwedlulele okwedlula amayunithi angama-35, isiguli sihlala sifuna ukuphuza uketshezi, ngokulandelana, kukhona ukwanda kwamandla adonsa umchamo ngosuku. Ukomiswa kolwelwesi lwama-mucous nesikhumba, kutholakala imalaveve ejwayelekile.
Uma lesi simo singanakwa, khona-ke isithombe somtholampilo senezelwa isicanucanu, ukugabha, iphunga elithile kusuka emgodini womlomo, futhi ukuphefumula kuya ngokujulile futhi kube nomsindo.
Ukwelashwa kwe-ketoacidosis kuhlanganisa amaphuzu ayisihlanu ayisihluthulelo. Ukwelashwa kwe-insulin kuyenziwa, kuphuma uketshezi emzimbeni, ukuntuleka kwe-potassium, i-sodium kanye nezinye izinto zamaminerali, i-acidosis iyaqedwa, i-concomitant pathologies iyelashwa.
Isikhombisi sokululama ngempumelelo sibhekwa njengokuncipha koshukela kuya ezigabeni eziyi-11 futhi ngaphansi kwalezi zibalo.
I-Hyperosmolar coma: izimpawu nemiphumela
I-Hyperosmolar coma ivame ukwenzeka kwabanesifo sikashukela, abangamalungu eqembu labantu abangaphezu kweminyaka engama-50. Ukufa ngenxa yalesi simo se-pathological kufinyelela ku-40-60% kuzo zonke izithombe zokwelashwa.
Lokhu kudalwa kwenhliziyo kukhula ngemuva kwesimo se-metabolic yesifo sikashukela esingabhalisiwe, futhi kwenzeka kanye namazinga kashukela amaningi emzimbeni, amayunithi angaphezu kwama-50, kuhlangene ne-plasma hyperosmolarity, lapho kungekho-ketoacidotic complication.
Indlela esebenza ngayo leyo ngxaki ayiqondakali ngokuphelele. Odokotela basikisela ukuthi lo mphumela ongemuhle uvela ngemuva kwesizinda sesimo se-hyperglycemic, lapho kunokuvinjwa kokumbiwa kukashukela ezinso.
I-Hyperosmolar coma ingakhula ezinsukwini ezimbalwa noma amasonto ambalwa. Okokuqala, isiguli sibonisa izimpawu njengesifiso esinamandla sokuphuza, ukusheshe sichame futhi sikuchaze, buthakathaka.
Ngaphezu kwalokho, izimpawu zokuphelelwa ngamandla ziyaphawulwa:
- Kwehlisela i-turgor yesikhumba.
- I-tonus yama-eyeball iyancipha.
- Umfutho wegazi uyancipha.
- Izinga lokushisa lomzimba liyancipha.
Esimweni esinzima sesimo se-pathological, isiguli sakha ukoma. Izinkinga ezivame kakhulu i-vein thrombosis ejulile, kanye nomonakalo wezinso ku-mellitus yesifo sikashukela kanye ne-pancreatitis, ukubanjwa kwesithuthwane.
Izici zokwelashwa kwalesi simo ukuthi kwenqatshelwe ngokuphelele ukunciphisa ushukela kakhulu. Inketho enhle ukunciphisa ushukela ngeyunithi ezi-5 ngehora. Futhi, i-osmolarity yegazi akufanele inciphise ngokushesha kunokuba amayunithi ayi-10 ngemizuzu engama-60.
Uma unganamatheli ku-protocol yezokwelapha, khona-ke ingozi yokuvuvukala kwamaphaphu nobuchopho ikhuphuka kakhulu.
I-Lactacidotic coma
I-Lactacidic coma iyinkinga engafani nhlobo yesimo se-hyperglycemic ku-diabetesics, kepha ihlotshaniswa nethuba lokufa eliphezulu, futhi ingozi yokufa ingama-80%.
Njengomthetho, lesi simo se-pathological sibonwa kwabanesifo sikashukela esidala abanomlando wokugula okufana nesistimu yezinhliziyo, ukungasebenzi kahle kwesibindi nezinso.
I-pathogenesis yokwehla komqondo isuselwa ekugxileni kwe-glucose ephezulu kakhulu emzimbeni womuntu ngokumelene nesizinda sokuntuleka kwe-hormone egazini. Isimo somtholampilo walesi sifo sikhula ngokushesha okukhulu, siyahluka ngokuqhubeka.
Izimpawu ezilandelayo ziyabonakala ezigulini:
- Ubuhlungu esiswini.
- Ukuhlaselwa isicanucanu kuya ekuhlanzeni.
- Ubuthakathaka obujwayelekile.
- Ubuhlungu bemisipha ngenkathi buhamba.
- Ukunganaki, ukubekezela nobuthakathaka.
- Ukomela noma ukuqwasha.
- Ukukhohlisa, ukukhishwa ngamehlo (akuvamile).
Uma izinyathelo zingathathwanga ngesikhathi sokumisa isimo esibucayi esigulini, khona-ke ugaxeka. Ngokwempilo, izimpawu zokuphelelwa ngamandla ziyatholakala, ukuphefumula kwesiguli kuba nomsindo futhi kujule, umfutho wegazi uyancipha, futhi ukushaya kwenhliziyo kuba ngokushesha.
I-Lactacidic coma ingakhula ngaphansi kwethonya lezinto eziningi:
- Ngokumelene nesizinda se-hyperosmolar coma, esingabonakali nge-ketosis.
- Lapho kwenzeka isifo sikashukela sikashukela senzeka, i-lactic acidosis ibhekwe cishe ku-8 - 11% yamacala;
- Ngenxa yokugeleza kwegazi okunganele ezicutshini.
- Ngesikhathi sokukhulelwa ngokumelene nesifo sikashukela sokukhulelwa, noma isifo sikashukela sabesifazane abakhulelwe.
- Ukwehluleka okuzenzakalelayo kwezinqubo ze-metabolic emzimbeni.
Ukwelashwa kwesimo se-pathological kuqukethe ukulungisa i-acid ne-alkaline esele emzimbeni, ukubuyisela amanzi ne-electrolyte metabolism, kanye nokwelashwa okubonisa izimpawu. Kanye nokujwayelekile kokuphazamiseka kwamangqamuzana ngesisombululo se-glucose ngenani elidingekayo le-insulin.
Ngakho-ke, singaphetha ngokuthi amazinga kashukela aphezulu kakhulu kungenzeka ukuthi athuthukise izinkinga eziningi ezingabiza impilo yesiguli.
Ividiyo ekulesi sihloko iveza indlela yokudla ushukela wegazi ophezulu.
