I-Hypoglycemic coma (izimpawu, i-algorithm ephuthumayo kanye nemiphumela)

Imiphumela yesifo sikashukela ibambezeleka kakhulu, isiguli kwesinye isikhathi sinesikhathi esanele sokuqaphela izimpawu, ukubonana nodokotela, ukulungisa ukwelashwa. I-hypoglycemic coma, ngokungafani nezinye izinkinga, ayivikeleki njalo futhi imiswe ngesikhathi, njengoba ikhula ngokushesha futhi inciphisa umuntu amandla okucabanga kahle.

Kulesi simo, isiguli singathembela kuphela ekusizeni abanye abangahlali njalo benolwazi ngesifo sikashukela futhi bangadida umuntu ngokudakwa okujwayelekile. Ukuze ulondoloze impilo, futhi ngisho nokuphila, abanesifo sikashukela badinga ukufunda ukuthi bangakugwema kanjani ukwehla okunoshukela okunamandla, banciphise umthamo wezidakamizwa ngesikhathi, lapho kunethuba eliphezulu lokuvusa ukoma, futhi banqume i-hypoglycemia ngezibonakaliso zokuqala. Kuzoba wusizo ukufunda imithetho yokunakekelwa okuphuthumayo komzimba futhi ujwayele izihlobo nabo.

Kubalulekile ukutadisha: I-Hypoglycemia ku-mellitus yesifo sikashukela (kusuka kuzimpawu kuya ekwelashweni)

Isifo sikashukela nokucindezela kuzoba yinto yesikhathi esedlule

• Ukwehlela ushukela -95%
• Ukuqedwa kwe-vein thrombosis - 70%
• Ukuqedwa kokushaya kwenhliziyo okuqinile -90%
• Ukuqeda umfutho wegazi ophakeme - 92%
• Ukwanda kwamandla ngesikhathi sosuku, ngcono ukulala ebusuku -97%

I-Hypoglycemic coma - kuyini?

Imvamisa, i-coma ivela ngokungemuva kwesifo sikashukela i-mellitus, ikakhulukazi ezigulini ezinqunywe amalungiselelo e-insulin. I-hypoglycemia ebukhali nayo ingakhula kubashukela asebekhulile abadla izidakamizwa isikhathi eside ezothuthukisa ukwakheka kwe-insulin yabo. Imvamisa i-coma ivinjelwa yona uqobo noma iqedwe esikhungweni sezokwelapha uma isiguli sihanjiswa lapho ngesikhathi. I-Hypoglycemic coma iyimbangela yokufa kuma-3% abantu abanesifo sikashukela.

Lesi simo singaba wumphumela wezinye izifo, lapho kukhiqizwa khona i-insulin ngokweqile noma ushukela uyeke ukungena egazini.

Ikhodi ye-ICD-10:

• I-E0 - ukhehla sohlobo 1 sikashukela,
• I-E11.0 - Izinhlobo ezi-2,
• I-E15 yi-hypoglycemic coma engahlotshaniswa nesifo sikashukela.

Izimbangela zokwephulwa komthetho

I-hypoglycemia ehlala isikhathi eside noma ukwehla okubukhali koshukela kuvuselela ikhekhe le-hypoglycemic. Zingabangelwa yilezi zinto ezilandelayo:

1. Ukwephulwa kokusetshenziswa noma ukuphathwa kwamalungiselelo we-insulin:

• ukukhuphuka komthamo we-insulin emfushane ngenxa yokubala okungalungile;
• ukusetshenziswa kwamalungiselelo e-insulin yesimanje ngokufakwa kwe-U100 ngesirinji ephelelwe isikhathi eyenzelwe ikhambi elihlanjululwe kakhulu - U40;
• kwakungekho kudla kakhulu ngemuva kokuphathwa kwe-insulin;
• ukushintshwa komuthi ngaphandle kokulungiswa kwamthamo uma owedlule ubebuthakathaka, ngokwesibonelo, ngenxa yesitoreji esingafanele noma impilo yeshelufu ephelelwe yisikhathi;
• ukufakwa kwenaliti yesirinji kujule kunokuba kudingekile;
• ukwanda kwe-insulin ngenxa yokugcotshwa noma ukufudumeza kwesayithi lomjovo.

1. Ukwemukelwa kwama-hypoglycemic agents ahlobene nokutholakala kwe-sulfanilurea. Imithi enezithako ezisebenzayo i-glibenclamide, glyclazide ne-glimepiride ikhishwa kancane emzimbeni futhi, ngokusetshenziswa isikhathi eside, inganqwabelana kuyo, ikakhulukazi ngezinkinga ezinso. I-overdose yalawa ma-ejenti nayo ingavusa i-hypoglycemic coma.
2. Umsebenzi obalulekile womzimba, awesekelwa ukungena kwama-carbohydrate, onesifo sikashukela esincike ku-insulin.
3. Ukuphuza utshwala ngamanani amakhulu (ngaphezu kwama-40 g ngokuya ngotshwala) kuyasithinta kabi isibindi futhi kuvimbela nokwakheka kweglue kuwo. Imvamisa, i-hypoglycemic coma kuleli cala kukhula ephusheni, ekuseni amahora.
4. I-Insulinoma iyi-neoplasm ekwazi ukuzenzela ngokwayo i-insulin. Ama-tumors amakhulu akhiqiza izinto ezifana ne-insulin.
5. Ukuphazamiseka emsebenzini wama-enzyme, ngokuvamile amafa.
6. Ukwehluleka kwe-Hepatic ne-renal ngenxa ye-hepatosis enamafutha noma i-cirrhosis, i-nephropathy yesifo sikashukela.
7. Izifo zesisu eziphazamisa ukungena kweglucose.

Nge-diabetes ye-neuropathy kanye nokudakwa kotshwala, ukubonakaliswa kokuqala kwe-hypoglycemia kunzima ukuzizwa, ngakho-ke ungakwazi ukweqa ushukela omncane bese ulethe isimo sakho sikwehla. Ukonakala kwezimpawu kuyabonakala nasezigulini ezine-hypoglycemia ejwayelekile. Baqala ukuzizwa bengasebenzi kahle emzimbeni lapho ushukela wehla ngaphansi kwe-2 mmol / l, ngakho-ke banesikhathi esincane sokunakekelwa okuphuthumayo. Ngakolunye uhlangothi, abanesifo sikashukela abanoshukela ophakeme njalo baqala ukuzizwa izimpawu ze-hypoglycemia lapho ushukela usujwayelekile.

Yini isimilo seKhodi Yomphakathi

Izimpawu ze-hypoglycemia azixhomekile kumbangela eyayibangele. Kuzo zonke izimo, isithombe somtholampilo sokukhula komqondo siyefana.

Imvamisa, ushukela wegazi ongaguquki ugcinwa ngisho nokushoda kwama-carbohydrate ngenxa yokuwohloka kwezitolo ze-glycogen kanye nokwakheka kweglucose esibindini kusuka ezinkambisweni ezingezona i-carbohydrate. Lapho ushukela wehla uye ku-3.8, uhlelo lwezinzwa lwe-autonomic lusebenza emzimbeni, izinqubo ezihlose ukuvikela i-hypoglycemic coma ziqale, bese kuthiwe ama-insulin antagonists: i-glucagon yokuqala, bese kuba yi-adrenaline, futhi ekugcineni, i-hormone yokukhula ne-cortisol. Izimpawu ze-hypoglycemia ngalesi sikhathi ziyinkomba ye-pathogenesis yezinguquko ezinjalo, zibizwa nge- "vegetative". Kwizazi zesifo sikashukela esinolwazi, i-secretion ye-glucagon bese i-adrenaline incipha kancane, ngasikhathi sinye izimpawu zokuqala zesifo ziyancipha, futhi nengozi ye-hypoglycemic coma iyanda.

Ngokuncipha kwe-glucose kuye ku-2.7, ubuchopho buqala ukubulawa yindlala, ama-neurogenic anezelwa izimpawu zezimpawu. Ukubukeka kwabo kusho ukuqala kwesikhwanyana sohlelo lwezinzwa oluphakathi. Ngokuhla kweshukela okubukhali, womabili amaqembu ezimpawu avela cishe ngasikhathi sinye.

I-Algorithm yoNcedo lokuQala

Izimpawu zemifino ziqedwa kalula ngokuthatha i-carbohydrate esheshayo. Ngokuya ushukela, amagremu ayi-10-20 ngokuvamile anele. Ukweqisa lo muthi akukanconywa, ngoba i-overdose ingadala isimo esiphikisayo - i-hyperglycemia. Ukuphakamisa ushukela wegazi futhi uthuthukise isimo sesiguli, amaswidi ambalwa noma izingcezu zoshukela, isigamu sengilazi noma isobho elimnandi kwanele. Abantu abanesifo sikashukela bavame ukuphatha ama-carbohydrate asheshayo ukuze baqale ukwelashwa ngesikhathi.

Nakani! Uma isiguli sinqunywa i-acarbose noma i-miglitol, ushukela awukwazi ukumisa i-hypoglycemia, ngoba le mithi ivimba ukuqhekeka kwe-sucrose. Usizo lokuqala lwe-hypoglycemic coma kuleli cala lunganikezwa nge-glucose emsulwa kumathebhulethi noma isixazululo.

Lapho umuntu onesifo sikashukela esazi, kodwa engasakwazi ukuzisiza, unikezwa noma yisiphi isiphuzo esimnandi ukumisa i-hypoglycemia, aqinisekise ukuthi akapheki. Ukudla okwomile ngalesi sikhathi kusengozini yokufiswa.

Uma kunokulahlekelwa ukwazi, udinga ukubiza i-ambulensi, ubeke isiguli ngasohlangothini lwayo, uhlole ukuthi imigwaqo yomoya imahhala nokuthi isiguli siyaphefumula yini. Uma kunesidingo, qala ukwenza ukuphefumula kokufakelwa.

I-Hypoglycemic coma ingaqedwa ngokuphelele ngisho nangaphambi kokufika kodokotela, ngoba lokhu kusethwa kokunakekelwa kosizo lokuqala. Kubandakanya i-glucagon yezidakamizwa kanye nesirinji yokuphatha kwayo. Ngokufanelekile, wonke umuntu onesifo sikashukela kufanele aphathe le khithi naye, futhi umndeni wakhe kufanele ukwazi ukuyisebenzisa. Leli thuluzi liyakwazi ukuvusa ngokushesha ukukhiqizwa kwe-glucose esibindini, ngakho-ke ukwaziwa kubuyela esigulini kungakapheli imizuzu eyi-10 ngemuva komjovo.

Ukukhishwa kubangelwa ukuqola ngenxa yokudakwa kotshwala nemithamo eminingi ye-insulin noma ye-glibenclamide. Esimweni sokuqala, isibindi simatasa sihlanza umzimba wemikhiqizo ebolayo yotshwala, esimweni sesibili, izitolo ze-glycogen esibindini ngeke zanele ukungalinganiseli i-insulin.

Ukuxilonga

Izimpawu ze-hypoglycemic coma azicacanga. Lokhu kusho ukuthi zingabangelwa ezinye izimo ezihambisana nesifo sikashukela mellitus. Isibonelo, abanesifo sikashukela abanoshukela ophakeme njalo bangazizwa belambile ngenxa yokumelana nokuqina kwe-insulin, futhi nge-neuropathy yesifo sikashukela, ukushaya kwenhliziyo nokujuluka kungenzeka. Ukuqunjelwa ngaphambi kokuba ukoma kuqale ukungaziphathi kalula isithuthwane, futhi ukuhlaselwa ukwethuka kube nezimpawu ezifanayo ze-hypoglycemia.

Ukuphela kwendlela ethembekile yokuqinisekisa i-hypoglycemia ngokusebenzisa ukuhlolwa kwelabhoratri okala ushukela we-plasma.

Ukuxilongwa kwenziwa ngaphansi kwale mibandela elandelayo:

1. I-glucose ingaphansi kuka-2.8, enezimpawu ze-hypoglycemic coma.
2. I-glucose ingaphansi kuka-2.2 uma izimpawu ezinjalo zingabonwa.

Ukuhlolwa kokuxilonga kusetshenziswa futhi - 40 ml yesisombululo sikashukela (40%) kufakwa emthanjeni. Uma ushukela wegazi wehlile ngenxa yokuntuleka kwama-carbohydrate noma i-drug overdose yesifo sikashukela, izimpawu ziyancipha ngokushesha.

Ingxenye ye-plasma yegazi ethathwe lapho ingeniswa esibhedlela iqandisiwe. Uma, ngemuva kokuqeda i-coma, izimbangela zayo azikhonjwa, le plasma yathunyelwa ukuze ihlaziye kabanzi.

Ukwelashwa kokugula

Ngomqondo ophansi, ukwazi ukwazi ukuvuselela ingqondo kubuyiselwa ngokushesha ngemuva kohlolo lokuxilonga. Esikhathini esizayo, abanesifo sikashukela bazodinga kuphela ukuhlolwa ukuthola izimbangela zokuphazamiseka kwe-hypoglycemic kanye nokulungiswa kwendlela ebekade ibekiwe yokwelapha isifo sikashukela. Uma isiguli singaphinde siphaphame, kutholakala ukuthi kukhubazeka kanzima. Kulokhu, inani le-40% yesisombululo sikashukela esilawulwa ngaphakathi sandiswa ngo-100 ml. Ngemuva kwalokho baphendukela ekuphathweni okuqhubekayo ngepompo le-dropper noma ye-infusion yesisombululo se-10% kuze kube yilapho ushukela wegazi ufinyelela ku-11-13 mmol / L.

Uma kuvela ukuthi sekuqhamuke ikhephu ngenxa yokweqisa kwama-ejenti we-hypoglycemic, bakhipha usizi esiswini futhi banikeze ama-enterosorbents. Uma i-insulin enamandla kakhulu ye-insulin kungenzeka futhi ingaphansi kwamahora ama-2 kudlule umjovo, kutholakala izicubu ezithambile endaweni yomjovo.

Ngesikhathi esifanayo kanye nokuqedwa kwe-hypoglycemia, ukwelashwa kwezinkinga zayo kwenziwa:

1. Ama-diuretics ane-edema yamakhorali okusolwayo - i-mannitol (isixazululo esingu-15% ngesilinganiso se-1 g ngekhilogremu yesisindo), bese eyi-lasix (80-120 mg).
2. I-Nootropic Piracetam ithuthukisa ukuphuma kwegazi engqondweni futhi isize ukugcina amakhono okuqonda (i-10-20 ml yesisombululo esingu-20%).
3. I-insulin, amalungiselelo e-potassium, i-ascorbic acid, lapho sekuvele ushukela owanele egazini futhi ukungena kwayo ezicutshini kudinga ukuphuculwa.
4. I-Thiamine yesifo sokudakayo noma sokukhathala okusolisayo.

Izinkinga ze-hypoglycemic coma

Lapho kwenzeka izimo ze-hypoglycemic ezinzima, umzimba uzama ukuvimba imiphumela emibi ohlelweni lwezinzwa - kusheshisa ukukhishwa kwama-hormone, kwandise ukuphuma kwegazi kwenhliziyo amahlandla amaningi ukukhuphula ukuhamba kwe-oxygen ne-glucose. Ngeshwa, izinqolobane ezinxephezelayo ziyakwazi ukuvimbela ukulimala kobuchopho isikhathi esifushane esifanele.

Uma ukwelashwa kungakhiqizi imiphumela engaphezu kwengxenye yehora, kungenzeka kakhulu ukuthi kuvela izinkinga. Uma ikhehla lingaqedi amahora angaphezu kwama-4, ithuba lama-psychology ama-nerological acinzekile alungile. Ngenxa yokubulawa yindlala isikhathi eside, i-edema yamakhemikhali, i-necrosis yezindawo ezithile iyakhula. Ngenxa yokuningi kakhulu kwe-catecholamines, ithoni yemikhumbi iyancipha, igazi okukuzo liqala ukuqina, i-thrombosis kanye nokulimana okuncane kokuvela.

Ku-diabetesics asebekhulile, i-hypoglycemic coma ingaba yinkimbinkimbi ngokuhlaselwa yisifo senhliziyo nemivimbo, ukulimala kwengqondo. Imiphumela yesikhathi eside nayo iyenzeka - ukuwohloka komqondo kokuqala, isithuthwane, isifo sikaParkinson, isifo sokuqina kwesibindi.