Abanesifo sikashukela, njengabo bonke abantu abaphilile, abanaso isidingo sokuhlinzwa. Kulokhu, kuphakama umbuzo wangempela: kungenzeka yini ukuthi uhlinzwe isifo sikashukela?
Isifo sikashukela isifo sikashukela yisifo esingapheli, esibonakaliswa ukwephulwa kokusebenza kwezinqubo ze-metabolic ne-carbohydrate emzimbeni. Ukungabonakali kwe-pathology kulele eqinisweni lokuthi ligcwele izinkinga eziningi.
Iziguli ezinesifo sikashukela zihlushwa izifo ezifanayo zokuhlinza njengabanye abantu. Kodwa-ke, banokuthambekela okukhulu kokuthuthukisa izinqubo zokuhlanzeka kanye nokuvuvukala, ngemuva kokuhlinzwa, inkambo yokugula okungaphansi imbi kakhulu.
Ngaphezu kwalokho, ukusebenza kungavusa ukuguqulwa kohlobo lwashukela lokugcina lube uhlobo olucacile, kanye nokuphathwa isikhathi eside kwe-glucose ne-glucocorticoids ezigulini ezithinta kabi amaseli we-beta angaphansi. Kungakho, nezinkomba zokusebenza, kunama-nuances amaningi wokuqalisa ukusebenza kwawo, kukhona amalungiselelo athile.
Kuyadingeka ukubheka ukuthi ushukela nokuhlinzwa kuhlangene kanjani, futhi yiziphi izimo ezidingekayo ekungeneleleni? Yini ukulungiswa kwenqubo, futhi iziguli zilulama kanjani? Udinga futhi ukuthola ukuthi yikuphi ukwelashwa kokuhlinzwa kwesifo sikashukela?
Ukuhlinzwa nezimiso zalo maqondana nalesi sifo
Kuyafaneleka ukusho ngaso leso sikhathi ukuthi i-pathology uqobo lwayo akuyona neze indlela yokuvimbela ukuhlinzwa. Isimo esibaluleke kunazo zonke okumele sibhekwe ngaphambi kwenqubo ukunxephezelwa kwalesi sifo.
Kungcono ukuthi wazi ukuthi ukusebenza kungahlukaniswa ngombandela kube yinkimbinkimbi futhi kube lula. Amalunga angabizwa, ngokwesibonelo, ukususwa kwezipikili ezifakiwe emunweni, noma ukuvulwa kwethumba. Kodwa-ke, ngisho nokusebenza okulula kakhulu kwabanesifo sikashukela kufanele kwenziwe emnyangweni wokuhlinzwa, futhi ngeke kwenziwe ngaphandle kokuphuma.
Ukuhlinzwa okuhleliwe kuyenqatshelwa uma kunokubuyiselwa okuncane kwesifo sikashukela. Ekuqaleni, kuyadingeka ukwenza yonke imisebenzi okuhloswe ngayo ukunxephezela lesi sifo esingaphansi. Ngokuqinisekile, lokhu akusebenzi ezimeni lapho impikiswano yempilo nokufa ixazululwa.
Ukuphikisana ngokuphelele nokuhlinzwa kuthathwa njenge-coma yesifo sikashukela. Okokuqala, isiguli kufanele sisuswe esimweni esibucayi, bese kuphela lapho sisebenza.
Izimiso zokwelapha ngokuhlinzwa kwesifo sikashukela ngamaphuzu alandelayo:
- Isifo sikashukela, sebenza ngokushesha ngangokunokwenzeka. Lokho wukuthi, uma umuntu enesifo sikashukela i-mellitus, khona-ke, njengomthetho, abalibali isikhathi eside ngokuhlinzwa.
- Uma kungenzeka, shintsha isikhathi sokusebenza ungene esimweni esibandayo.
- Ihlanganisa incazelo eningilizayo ye-pathology yesiguli esithile.
- Njengoba ubungozi bezinqubo ezithathelwanayo bukhuphuka, konke ukungenelela kuyenziwa ngaphansi kokuvikelwa kwama-antibhayirasi.
Isimo salesi sifo ngaphambi kokuhlinzwa sihlanganisa iphrofayili ye-glycemic.
Imisebenzi Yokulungiselela
Isifo sikashukela i-mellitus ekuhlinzeni yicala elikhethekile. Wonke umuntu ohlinzwe isifo sikashukela, futhi ikakhulukazi ngokuphuthumayo, kufanele enze isivivinyo sikashukela wegazi.
Abanesifo sikashukela badinga imijovo yamahomoni ngaphambi kokuhlinzwa. Uhlobo lokwelashwa lwalesi sidakamizwa lujwayelekile. Emini, i-hormone ihanjiswa ezigulini kaningana. Njengomthetho, ukwethulwa kwayo kuyelulekwa kusuka izikhathi ezintathu kuya kwezi-4.
Uma inkambo yesifo sikashukela isebenza, noma icala likhulu kakhulu, khona-ke i-hormone ilimala amahlandla ayisihlanu ngosuku. Usuku lonke, ushukela wegazi ulinganiswa ezigulini.
I-insulin emfushane esetshenziswayo isetshenziswa njalo. Kwesinye isikhathi kungenzeka ukuphatha i-insulin esezingeni eliphakathi nendawo, kepha ngqo kusihlwa. Lokhu kusekelwe eqinisweni lokuthi ngaphambi kokungenelela uqobo, kuzodingeka ukulungiswa kwethoni.
Ukulungiselela ukuhlinzwa kufaka phakathi ukudla okhethekile okuthembela kwisifo sokuhlinzwa, kanye nesifo sikashukela. Lapho isiguli singenakungqubuzana, sinikezwa ukuba siphuze uketshezi oluningi ngangokunokwenzeka.
Izici zokulungiselela:
- Uma ngemuva kokuhlinzwa isiguli singakwazi ukubuyela ekudleni okujwayelekile, khona-ke ngaphambi kokungenelela, uhhafu womthamo ojwayelekile we-insulin ubhalwa.
- Ngemuva kwemizuzu engama-30, kwethulwa isixazululo sikashukela.
Kuyaqapheleka ukuthi i-anesthesia iholela eqinisweni lokuthi umzimba womuntu udinga i-insulin eningi kunokujwayelekile. Lo mzuzu kufanele ubhekwe ngaphandle kokuhluleka ngaphambi kokuhlinzwa.
Izindlela zokulungela isiguli ukuhlinzwa:
- Izinga leshukela egazini. Okujwayelekile kuleli cala amayunithi angama-8-9. Ezimweni eziningi, izinkomba ezingafika kumayunithi ayi-10 ziyavumeleka, lokhu kuyasebenza kulezi ziguli esezigula isikhathi eside.
- Akukho shukela noma i-acetone emchameni.
- Yehlise umfutho wegazi.
Ngobusuku bokungenelela ku-6 am glucose control emzimbeni. Uma isiguli sanda ushukela wegazi, khona-ke amayunithi ama-4-6 e-insulin ayalaliswa (ushukela amayunithi angama-8-12), lapho ushukela uphezulu kakhulu, amayunithi angaphezu kuka-12, lapho-ke amayunithi ayi-8 e-insulin afakwa.
Ukuvuselela umzimba, i-anesthesia: izici
Uhlobo 2 lwesifo sikashukela, kunezimo ezithile zesikhathi sokuvuselela isimo. Okokuqala, ushukela wegazi ulawula kaningana ngosuku. Okwesibili, ukusetshenziswa kwezidakamizwa ezinciphisa ushukela.
Ngohlobo 1 sikashukela, ukululama ngaphandle kokulawulwa kwe-insulin akunakwenzeka. Lokhu kungaholela esigulini esisungula i-acidosis. Futhi kuphela ezimweni ezingavamile kakhulu lapho izinga le ushukela wegazi elijwayelekile lingagcinwa kulesi sigaba seziguli.
I-insulin ikhishwa ezingxenyeni ezincane zamayunithi angeqi ngaphezulu kwe-8, kaningana ngosuku, kanye nesixazululo sikashukela esiyi-5%. Ukuhlolwa kwe-urine kufanele kwenziwe nsuku zonke, ngoba kungenzeka ukuthi ukubukeka kwemizimba ye-ketone kuyo akunqunyelwe.
Cishe ngosuku lwesithupha, inqobo nje uma isiguli sikwazi ukuqina, isinxephezelo sikashukela i-mellitus sigcinwe, singadluliselwa kumodi ejwayelekile yokuphatha i-hormone, okungukuthi, leyo eyayinamathela ngaphambi kokuhlinzwa.
Ngemuva kokuhlinzwa, isiguli singadluliselwa ezidakamizweni ze-sulfonylurea, kodwa ngemuva kwezinsuku ezingama-25-30. Uma nje ukuphulukiswa kuhambe kahle, izibiliboco azizange zikhanyiswe.
Izici zokungenelela okuphuthumayo:
- Kunzima ukubala umthamo we-hormone, ngakho-ke kukhethwa ngakunye, kususelwa ekuhlolweni kwegazi nomchamo.
- Ukulawulwa kweshukela egazini kwenzeka futhi phakathi nokuhlinzwa uma kuthatha isikhathi esingaphezu kwamahora amabili.
Kuyaqapheleka ukuthi ezigulini ezinesifo sikashukela, umthungo uzokwelapha isikhathi eside ukwedlula kubantu abajwayelekile. Naphezu kwezingozi ezinkulu zokuthuthukisa izinqubo zokuvuvukala, ngokwelashwa okwanele nokulandela zonke izincomo, konke kuzophola. Umuthi wokupholisa ungalunywa, kepha akudingekile ukuwuhlanganisa uma isiguli sifuna ukuba sikwazi ukwelapha ngokujwayelekile.
Lapho wenza i-anesthesia, kubaluleke kakhulu ukuqapha izinkomba ezisegazini lesiguli. Ushukela ungakhuphuka kakhulu, okuzoba nomthelela ongemuhle ekuqalisweni kokunye kokungenelela.
Izici ze-analgesia ye-intravenous: kubalulekile ukukhetha umthamo owanele womuthi; kwamukelekile ukusebenzisa i-anesthesia yendawo ukuhlinza isikhashana; ama-hemodynamics kufanele abhekelwe, njengoba abanesifo sikashukela bengakubekezeleli ukwehla komfutho wegazi.
Ngokungenelela okuthi inqubo yayo ibambezelwe isikhathi eside, i-multicomponent anesthesia isetshenziswa kaningi.
Yisifo sakhe sikashukela esibekezelelwe kahle, ushukela ngokuqinisekile ngeke asukume.
Ukwehliswa ushukela nokuhlinzwa
Kwenzeka ukuthi isiguli sidinga ukuhlinzwa ngokuphuthumayo ngemuva kwembuyiselo enganele yesifo. Kulesi simo, ukungenelela kunconywa ngokumelene nesizinda sezinyathelo ezizosusa i-ketoacidosis.
Lokhu kungatholakala uma imithamo ye-insulin eshintshwe ngokuqinile inikezwa iziguli ngokwanele. Ukwethulwa kwe-alkalis emzimbeni wesiguli akufiseleki kakhulu ngoba kubangela imiphumela eminingi.
Iziguli zingakhuphula ushukela, kukhona i-intracellular acidosis, ukuntuleka kwe-calcium emzimbeni, i-hypotension ye-arterial, kanye nokukhula kwe-edema yokuvuvukala.
Uma inani le-asidi lingaphansi kwesikhombisa, i-sodium bicarbonate ingahanjiswa. Kuyadingeka ukuhlinzeka ngokuhlinzekwa komoya-mpilo emzimbeni. Ngokuphikisana nalesi sizinda, ukwelashwa kwe-antibacterial kunconywa, ikakhulukazi ekushiseni komzimba okuphezulu.
I-insulin ehlanganisiwe yethulwa (i-fractional), udinga ukulawula ukugcwala kweglucose egazini.
Ngaphezu kwalokho, i-hormone esebenza isikhathi eside iyabanjiswa, kepha ukulawulwa kwe-glycemic kusagcinwa.
Ukusebenza kwesifo sikashukela
Ukuhlinzwa kwe-Metabolic kuyindlela yokungenelela yokuhlinzwa esiza ukubuyisa ukusebenza kohlelo lwe-metabolic. Ngokusekelwe kwizifundo eziningi, "ukuhlinzwa kwe-gastric bypass" kufanele ukunakwa okukhulu.
Uma wenza ukuhlinzwa okunjalo kwesifo sikashukela, ungamisa ushukela wegazi ngokwezinga elidingekayo, unciphise isisindo ngokweqile ezingeni elidingakalayo, futhi ususe ukuqeda ukudla ngokweqile (ukudla ngokushesha kungena i-ileum, kudlula amathumbu amancane).
Ucwaningo kanye nezibalo kukhombisa ukuthi ukwelashwa kwesifo sikashukela kuyasebenza impela, futhi ngamaphesenti angama-92 amathuba okusindisa iziguli ekuphuzeni imithi.
Inzuzo yale ndlela ukuthi le nqubo ayinangqondo, ukuhlinzwa kwenziwa nge-laparoscopy. Lokhu kunciphisa amathuba okuphendula okubi, ukuthuthukiswa kwezinqubo zokuvuvukala.
Ngaphezu kwalokho, ukuvuselelwa akusithathi isikhathi eside, ukuhlinzwa okwenziwe akusishiyi izibazi, isiguli asidingi ukuba esibhedlela isikhathi eside.
Izici zenqubo yilezi ezilandelayo:
- Kunemikhawulo yeminyaka yenqubo - iminyaka engama-30-65.
- Ukwethulwa kwe-insulin akuyona ngaphezu kweminyaka eyisikhombisa.
- I-pathology yesipiliyoni engabi ngaphezu kweminyaka eyi-10.
- I-hemoglobin ye-Glycated ayilawulwa kahle.
- Inkomba yesisindo somzimba ngaphezulu kwama-30, uhlobo 2 sikashukela mellitus.
Ngokuqondene nezinga lokufa, liphansi kunaleyo yokusebenza "kwendabuko". Kodwa-ke, lokhu kusebenza kuphela kulezi ziguli ezinenkomba yomzimba wazo omkhulu kune-30.
Ngakho-ke, ukuhlinzwa ngokumelene nesifo sikashukela i-mellitus kungenzeka. Kungenziwa ngezindlela ezinzima ze-pathology. Into esemqoka ukuthola isinxephezelo sesifo ngokwanele noma ngaphansi.
Ukungenelela kudinga udokotela ohlinzayo ofanele kakhulu nodokotela obulala izinzwa, kanti kubaluleke kakhulu ukuqapha isimo sesiguli kulo lonke ulwazi lokukhohlisa. Ividiyo ekulesi sihloko ikhuluma ngokuhlinzwa kwesifo sikashukela.
