Isifo sikashukela i-mellitus sihambisana nokwanda kwe-glycemia ngenxa yokukhiqizwa okungathelelekile kwe-insulin noma ukusabela okuncishisiwe kokutholwa yi-insulin receptors kwezicubu. Isibonakaliso sokuxilonga igxila likashukela elingaphezu kuka-7 mmol / l ngaphambi kokudla noma ngesilinganiso esingahleliwe esingaphezu kuka-11 mmol / l.
Ngenkambiso ebunjiwe yesifo sikashukela, kungahle kube nokwenyuka kwalesi sikhombi, uma ushukela ungama-33 mmol / L noma ngaphezulu, bese kuthi ukwanda komzimba kukhule emzimbeni, okungaholela enkomeni
Le nkinga ibizwa ngokuthi yi-hyperosmolar coma, ukuntuleka kokuxilongwa okufika ngesikhathi kanye nokuvuselelwa komzimba ophuthumayo kuholela ekufeni.
Izimbangela ze-hyperosmolar coma kushukela
I-Hyperosmolar coma ivame kakhulu kuhlobo lwe-2 yesifo sikashukela, ingaqala ukuzibonakalisa ikulesi simo ngokuxilongwa kwephuze kanye nokwelashwa okungalungile kweziguli.
Isizathu esiyinhloko sokwehla kwesifo sikashukela ezimweni ezinjalo ukulahleka kukamanzi lapho kuhlotshaniswa, kubandakanya izifo ezithathelwanayo, ukuphazamiseka kokujikeleza kwezifo ezitsheni zomqondo noma kwenhliziyo, nge-enterocolitis noma i-gastritis enesifo sohudo, ukuhlanza, indawo enkulu yokushiswa.
Ukwehla komzimba nakho kungadala ukulahleka okukhulu kwegazi ngesikhathi se-polytrauma, ukuhlinzwa kokuhlinzwa. Ukuthatha imithamo emikhulu ye-diuretics, ama-immunosuppressants, ama-glucocorticoids, kanye nokuphathwa kwe-intravenous kwe-mannitol, izixazululo ze-hypertonic, dialysis ye-peritoneal noma i-hemodialysis kukhuthaza ukwanda koshukela wegazi.
I-hyperosmolar coma ingenzeka ngokufunwa kwe-insulin, okungahle kube ngenxa yezizathu ezinjalo:
- Ukwephulwa okungekho emthethweni nokuhlala isikhathi eside kokudla.
- Ukwelashwa okungafanele - ukuphathwa okungatheni kwe-insulin ngohlobo 2 sikashukela.
- Ukwethulwa kwezixazululo zeglue ezigxile.
- Ukwenqaba kwesiguli okungagunyaziwe ekwelashweni.
I-pathogenesis ye-hyperosmolarity syndrome
Ukwanda koshukela wegazi kwenzeka lapho kunokukhulu kwe-carbohydrate elula emzimbeni, ukukhuphuka kwe-glucose okukhiqizwa amaseli wesibindi, secretion ephansi ye-insulin ngokumelene nesizinda sokumelana nokuqina kwe-insulin.
Ngasikhathi sinye, i-insulin, ekhiqizwa ama-pancreas noma ejova emzimbeni, ingavimbela ukwehlukana kwezicubu ze-adipose kanye nokwakheka kwezidumbu ze-ketone, kepha iphansi egazini ukuze inxephezele ukwakheka koshukela kwesibindi. Lokhu ngumehluko phakathi kwesimo se-hyperosmolar kanye nesimo se-ketoacidotic.
Ushukela omningi uholela ekulahlekelweni uketshezi ngenxa yokuheha kwawo ngama-molecule eglucose kusuka ezicutshini kuya embhedeni we-vascular kanye nokuphuma komchamo. Le nqubo inegalelo ekukhiqizweni kwe-aldosterone ne-cortisol ngamanani andayo, okubangela ukwanda kokuqukethwe kwama-sodium ions egazini bese kuthi ku-cerebrospinal fluid.
Ukwanda kwe-sodium ezicutshini zobuchopho kuholela ekuthuthukisweni kwe-edema nokuphazamiseka kwemizwa ku-hyperosmolar state.
Izimpawu ze-hyperosmolar coma
Ukwanda kwe-glycemia kuvame ukwenzeka kancane kancane esikhathini esiyizinsuku ezinhlanu kuya kweziyi-12. Ngesikhathi esifanayo, izinkomba zesifo sikashukela ziyaqhubeka: ukoma kuyanda, ukuphuma komchamo, kunomuzwa ongapheli wendlala, ubuthakathaka obukhali, kanye nokunciphisa umzimba.
Ukwehla komzimba kuholela ekomeleleni okukhulu kwesikhumba nezitho zomzimba, umlomo owomile njalo, ongasuswa ukugcwala koketshezi, ukufakwa kwezibuko zamehlo, nezici zobuso ziyalolwa, ukufiphala komoya kungenzeka, kepha akukho phunga le-acetone nokuphefumula okuzwakala njalo (ngokungafani nesimo se-ketoacidotic) .
Esikhathini esizayo, umfutho wegazi kanye nokushisa komzimba kuyehla, ukwehluleka, ukukhubazeka, ukubanjwa kwe-epileptoid kungahle kuqhume, ukuvuvukala ngenxa ye-vein thrombosis kwenzeka, umthamo womchamo wehla ngokungabikho ngokuphelele. Ezimweni ezinzima, ukhehla uphela ngokufa.
Izimpawu zaselabhorethi zesimo se-hyperosmolar:
- IGlycemia ngenhla kuka-30 mmol / L.
- I-osmolarity yegazi inkulu kune-350 (evamile 285) mosm / kg.
- Isodium ephezulu yegazi.
- Ukuntuleka kwe-ketoacidosis: azikho izidumbu ze-ketone egazini nomchamo.
- Ukunyuka kwe-hemoglobin, amaseli amhlophe egazi ne-urea esegazini.
Isiguli esine-hyperosmolar state kufanele silaliswe esibhedlela ngokushesha. Emnyangweni, ushukela wegazi ubhekwa njalo ngehora, imizimba ye-ketone yomchamo negazi ihlolisiswa izikhathi ezi-2 ngosuku, futhi ama-electrolyte egazi nokusabela kwe-alkaline kunqunywa izikhathi ezingama-3-4 ngosuku. Ukuqapha njalo kwe-diuresis, ingcindezi, izinga lokushisa lomzimba.
Uma kunesidingo, qapha ukuqapha kwe-electrocardiogram, ukuhlolwa kwe-X-ray kwamaphaphu kanye ne-compact tomography yengqondo.
Ukuxilongwa okuhlukile kwe-hyperosmolar coma kanye neengozi ezinobungozi be-cerebrovascular, isimila sobuchopho.
Izici zokwelashwa kwe-hyperosmolar coma
Ukwelashwa kuqala ngokufakwa kwezixazululo ezifakiwe ze-sodium chloride ne-glucose. Kulokhu, izinga le-sodium esegazini liyabhekelelwa: uma lingaphezu kokujwayelekile, lapho-ke kusetshenziswa ushukela, ngokweqile okujwayelekile kwesilinganiso, kwethulwa isixazululo se-0.45%, kanti ngokwesimo, isixazululo esijwayelekile se-0.9% isotonic.
Ngesikhathi sehora lokuqala, i-1-1.5 L ifakwa ngaphakathi, futhi umthamo wamanzi u-300-500 ml. Ngasikhathi sinye, i-insisynthetic yomuntu noma i-insulin esebenza nge-insulin esebenza ngokubambelela okufushane noma i-insulin esezingeni eliphansi ifakwa kwi-dropper. Kufanele ifakwe ngesilinganiso sama-PIERES angu-0,1 ngehora nge-1 kg yesisindo sesiguli.
Amanani amakhulu ezisombululo kanye nezinga eliphakeme labaphathi bawo kungaholela ekwakhiweni kwe-edema yamakhemikhali. Njengoba iziguli zivame ukuba ubudala obuphambili noma obudala, ngisho nesilinganiso esijwayelekile sokuvuselelwa komzimba siholela ekudonselweni kwe-pulmonary phakathi kokuhluleka kwenhliziyo.
Ngakho-ke, kunconywa ukungena kancane kokwehla komoya kanye nokwehla kancane kancane koshukela egazini. Isidingo se-insulin ezigulini ezinjalo ngokuvamile siphansi.
Ukuvimbela i-hyperosmolar coma kushukela
Inkomba enkulu yokuvikela ukukhula kwale nkinga enkulu yesifo sikashukela ukubheka ushukela wegazi njalo. Lokhu kuzosiza ukuqaphela ukukhula kwayo ngesikhathi esifanele futhi kuvikele ukuthuthukiswa kokukhubazeka kwengqondo.
I-Hyperglycemic coma ivela kaningi ezigulini ezithatha imithamo emincane yezidakamizwa ezinciphisa ushukela kumathebulethi futhi azivamile ukukala ukugxila kweglucose yegazi. Ngakho-ke, iziguli ezinesifo sikashukela sohlobo 2 zinconywa ushukela wegazi nsuku zonke nokuhlolwa komchamo. Ukuze wenze lokhu, ungasebenzisa imitha nemichilo yokuhlola.
Uma ushukela ukhuphuka, kufanele uphuze kuqala kunamanzi amsulwa ajwayelekile futhi ungabandakanyi ukusetshenziswa kwezimonyo, ikofi, itiye, iziphuzo ezinoshukela, ama-jusi, iziphuzo ezinekhabhoni nezotshwala, ubhiya.
Iziguli ezingaphuthelwa ukuphuza iphilisi noma ukuphatha i-insulin zidinga ukuthatha iphuthi elilahlekile. Ukudla okulandelayo kufanele kuqukethe ukudla okunamafutha amaningi wamaphrotheni kanye nemifino emisha. Kunconywa ukuba balahle ngokuphelele ama-confectionery noma imikhiqizo kafulawa, kufaka phakathi onesifo sikashukela, ukwenza ushukela wegazi ube ngokwejwayelekile.
Ubuncane bezinsuku ezinhlanu ngemuva kokutholakala kwenani elikhulu loshukela egazini kusuka ekudleni ngaphandle:
- Isinkwa esimhlophe, namakhekhe.
- Ushukela kanye noswidi.
- Izaqathe abilisiwe, beet, ithanga, amazambane.
- Izithelo namajikijolo amnandi.
- Iporridge.
- Izithelo ezomile.
- Inyama enamafutha, ubisi nemikhiqizo yezinhlanzi.
- Zonke izinhlobo zokudla okusemathinini nokudla okulula.
Kunconywa ukupheka izifundo zokuqala zemifino, ngoba izitsha eziseceleni zisebenzisa imifino ebilisiwe kusuka ohlwini oluvunyelwe: i-cauliflower, i-broccoli, i-zucchini ne-isitshalo seqanda. Kunconywa ukusebenzisa inyama nenhlanzi enamafutha ngendlela ebilisiwe, amasaladi avela emifino enamahlamvu, iklabishi, ukhukhamba notamatisi ngamafutha zemifino, iziphuzo ze-lactic ngaphandle koshukela nezithelo.
Qiniseka ukuthi uthintana nodokotela ukuze alungise umthamo wezidakamizwa obekiwe ngendlela okuhleliwe ngayo, futhi uma izimpawu zokukhuphuka ushukela omningi kunobuthakathaka obukhali noma ukudinwa, ukudideka esikhaleni, khona-ke kufanele ngokushesha ushayele i-ambulensi ukuze ilaliswe esibhedlela.
Imininingwane ngesimo se-hyperglycemic inikezwe kuvidiyo ekulesi sihloko.
