Ukuphambuka okubalulekile ekwakhekeni kwegazi kuyithinta kakhulu inhlala-kahle yabantu. Ukwanda kwezinga le-glucose kumanani abucayi kuyabulala - i-hyperglycemic coma ikhula ngokungenakuvinjwa. Ukwazi ukuqaphela kancane kancane, umzimba uyeka ukuxhasa imisebenzi ebalulekile ebalulekile - ukuhamba kwegazi nokuphefumula.
Ukulimala kwe-carbohydrate metabolism kushukela kukwenza amathuba okuba nethambo likhulu kakhulu kunakubantu abaphilile.
I-Hyperglycemia ubufakazi obujwayelekile kakhulu bokwelashwa okungafanele kwalesi sifo. I-Coma ngenxa kashukela omningi ingenzeka kunoma yimuphi unyaka, kepha iyingozi kakhulu kubantu asebekhulile nezingane. Kulezi ziguli, ngisho nokuphuma ngokuphumelelayo komthambo kungathinta kakhulu impilo yakamuva, kudale ukungasebenzi kahle kwezitho zonke zomzimba, kufaka phakathi ubuchopho.
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%
Izizathu zokuthuthukiswa kwezinkinga
Imbangela enkulu ye-hyperglycemic coma ukuntula kwe-insulin. Ngenxa yokushoda kwayo, ukuthathwa koshukela okuvela egazini yizicubu kuyaphazamiseka, ukukhiqizwa kwawo esibindini kuyakhula. Ushukela unqwabelana egazini, izinso ziyayihluza bese izama ukuyisusa emzimbeni kumchamo, kepha ziyehluleka ukubekezelela i-glycemia ephezulu kakhulu. Ukukhula kweshukela kuhambisana nokuphazamiseka okuningi kwe-metabolic, ekuphenduleni indlala yeseli, ukuqhekeka kwamafutha kuqala, ngoba la mahomoni - ama-catecholamines, STH, ama-glucocorticoids akhishwa ngobuningi.
Ngenxa yalokhu, ukuhlanganiswa kwezidumbu ze-ketone kusuka kumafu kuyaqala. Imvamisa, kufanele iguqulwe esibindini ibe ngama-acid anamafutha, kepha ngenxa yamaphutha kumetabolism, aqala ukuqongelela egazini futhi abangele ukudakwa. Ngaphezu kwalokho, i-ketoacidosis, ukunqwabelana kwemizimba ye-ketone, inyusa i-acidity, okuthi yona ikhuphule ukuwohloka kwamaprotheni nezicubu, kuphakamise ukomisa kanye nokulahleka kwama-electrolyte.
Ukwephulwa okunjalo okuningi ngeke kudlule ngaphandle kokulandela, kuthintela imisebenzi yazo zonke izinhlelo. Nge-hyperglycemic coma, izitho ziqala ukwehluleka ngokulandelana, kuze kube ngomphumela obulalayo.
Ukuntuleka kwe-insulin okubucayi kungenzeka ngenxa yalezi zizathu ezilandelayo:
- Uhlobo lwesifo sikashukela sokuqala ngaphandle kokuxilongwa ngesikhathi.
- Yeqa ukuphathwa kwe-insulin nefomu lesifo esincike ku-insulin, amalungiselelo enkohliso we-insulin.
- Thayipha isifo sikashukela sesi-2 sesigaba esinzima ngaphandle kokwelashwa nokudla okufanele.
- Amaphutha amakhulu ekudleni kashukela - ukusetshenziswa kwesikhathi esisodwa senani elikhulu lama-carbohydrate asheshayo - imayelana nama-carbohydrate alula futhi ayinkimbinkimbi.
- Ukucindezela okukhulu, izifo ezithathelwanayo, unhlangothi noma ukushaya kwenhliziyo.
- Ukuxilongwa ngokudla okonakele, izidakamizwa.
- Ukukhulelwa kushukela ngaphandle kokulungiswa kwempatho ebekiwe ngaphambili.
Yiziphi izigaba ezihlukaniswa
Imvamisa, ukukhula kwe-hyperglycemic coma kuthatha izinsuku ezimbalwa, noma ngisho amasonto, kepha ezimweni ezingavamile, lesi simo singenzeka emahoreni ambalwa. Kungakhathalekile ukuthi inani lokukhuphuka kwe-hyperglycemia, ukuphazamiseka komuntu kokuqwashisa ngesikhathi sokuqala kokhilimu, kudlula izigaba ezithile:
- I-Somnolence (stateoma). Kulesi sigaba, isiguli siba zimbi kakhulu zonke izimpawu zesifo sikashukela: umchamo ukhishwa ngokwengeziwe, kukhona ukoma okuhlala njalo nokulunywa kwesikhumba. Ngenxa yokuqala kokudakwa, kuphakama izinhlungu zesisu nomcanuzelo. Umuntu onesifo sikashukela uzizwa ebuthakathaka, elele. Ingalala esimweni esingajwayelekile, kepha uma uyivusa, iyakwazi ukuphendula imibuzo ngokujwayelekile futhi yenze ngokwanele.
- I-Sopor (isiqala ukoma). Ubuthi bomzimba bukhuphuka, ukugabha kwenzeka, nobuhlungu emgodini wokugaya ukudla. Imvamisa, iphunga le-acetone liyabonakala emoyeni okhiphele ngaphandle. Ukuqwashisa kuvinjelwe ngokuqinile: noma isiguli sikwazi ukuvuka, asikwazi ukusabela ngokujwayelekile esimweni, sisheshe silale futhi. Lapho ikhehla likhula, amandla okuvula amehlo kuphela asala, ama-ingqondo aqine.
- Qeda ukoma - Isimo sokulahlekelwa ukwazi. Isikhumba sesiguli esinesifo sikashukela somile, ukoma kwakhe kunciphile, izindebe zakhe zimbozwe ngamakhaza. Ama-Reflexes awekho, ukuphefumula kuyaqhubeka isikhashana.
Izimpawu zokuqalwa kwe-hyperglycemic coma
| Ukuphazamiseka emzimbeni | Izimpawu zokuqala |
| Ukukhula ushukela wegazi | Ukunyusa umthamo womchamo, ukulunywa kwesikhumba kanye nezicubu zomzimba, ikakhulukazi ezithweni zangasese, isifiso sokudla. |
| Ukomisa | I-integument eyomile - isikhumba esiqoqwe ku-crease, siqonde isikhathi eside kunokujwayelekile, siyaphumula. Ukwanda kwenhliziyo, ukungasebenzi kahle kwenhliziyo, ukuncipha kwesisindo okungenasizathu. |
| Ukuntuleka kokudla kwezicubu | Ubuthakathaka, ukukhathala okungapheli, ikhanda, ukuphefumula okujulile, ubomvu besikhumba esihlathini nakumahlo. |
| I-Intoxication | Ukuqunjelwa, iphunga le-acetone, "isisu esibuhlungu", isiyezi. |
Kusukela ekubonakaleni kwalezi zibonakaliso kuya ekuguqukeni komqondo kuya esigabeni esilandelayo, kuvame okungenani kudlule usuku, kepha ngenxa yezimpawu ngazinye, ukwazi ukungasebenzi kahle kungenzeka ngokushesha. Ngakho-ke, ngokusola kokuqala kokuqala kwe-hyperglycemic coma isidingo sokubiza i-ambulensikunokuba uzame ukubhekana nalesi simo ngokwabo futhi, ngaphezu kwalokho, ungazami ukuya esikhungweni sezokwelapha ngenkathi ushayela imoto yakho siqu.
Usizo lokuqala lwe-hyperglycemic coma
Usizo lokuqala olusebenzayo lwe-hyperglycemic coma ekhaya lunganikezwa kuphela uma isiguli sazi, futhi sinaye i-glucometer nesirinji ene-insulin. Lapho kuvela izimpawu eziyisixwayiso, kunqunywa ushukela wegazi. Uma kungaphezu kwe-15 mmol / l, kufakwa "umthetho wamaayunithi ayisishiyagalombili - kusetshenziswa i-insulin ngokushesha emayunithi angama-8 ngaphezulu komthamo ojwayelekile.
Ukungezelela umthamo noma ukujova i-insulin kaninginingi emahoreni angama-2 alandelayo akunakwenzeka, ukuze ungavuseleli ukwehla okushukela okushukela. Uma i-glycemia ingalungiswa ngale ndlela, kufanele kubizwe i-ambulensi.
Kusukela esigabeni se-precoma, zonke iziguli ezisezingeni le-hyperglycemic zidinga ukulaliswa esibhedlela. Umsebenzi walabo abaseduze ngenkathi odokotela belindile ukunciphisa imiphumela engahle ibe yinhliziyo.
I-Algorithm yoNcedo Lokuqala:
- Qinisekisa ukuthi uthola umoya ophelele we-oksijini: Izingubo zangaphandle ezingafakwanga, okokugqokisa uthayi nebhande, vula iwindi egumbini.
- Beka isiguli eceleni kwakhe, uhlole ukuthi ngabe ulimi luvala imigwaqo yomoya. Uma kunamazinyo, asuse.
- Uma kungenzeka, fudumeza isiguli siphele.
- Uma isiguli sazi, mnike isiphuzo. Musa ukusebenzisa iziphuzo ezinoshukela.
- Gada ukushaya kwenhliziyo nokuphefumula. Ngokuma, ukusekela impilo ngokufakwayo kuze kufike odokotela.
Ukwelashwa
Ngokuya ngezinkinga ezikhona emzimbeni, i-hyperglycemic coma ivame ukuhlukaniswa nge-ketoacidotic (ngokuqongelela i-acetone) nezinhlobo ezingaziwa kakhulu: i-hyperosmolar (enomzimba omningi) ne-lactic acidotic (ngokushintshashintsha okukhulu kwe-acid acid). Ukwelashwa kwazo zonke izinhlobo ze-hyperglycemic coma kufaka phakathi ukulungiswa koshukela wegazi ngosizo lwe-insulin therapy kanye nokubuyiselwa kwemali esele kasawoti emzimbeni.
Ekuqaleni, i-insulin esheshayo iphathwa ngokuqhubekayo kumithamo emincane, ngemuva kokwehlisela ushukela kuye ku-16 mmol / l, kufakwe izidakamizwa ezinde, futhi ethubeni lokuqala isiguli sidluliselwa kwirejimeni ejwayelekile yokwelashwa kwesifo sikashukela i-mellitus. Ngemuva kokuqeda i-hyperglycemia, i-glucose ihanjiswa ngamanani amancane esigulini ukuze kuqinisekiswe izidingo zamandla. Lapho nje eqala ukudla eyedwa, amaconsi ayakhanselwa.
Amaqhinga afanayo ayalandelwa ekwelapheni ukomisa: okokuqala, i-saline ne-potassium chloride ingeniswa egazini ngobuningi, bese belawula nje ukuthi isiguli sisebenzisa amanzi anele yini. Ukudakwa kwe-acetone kunciphisa njengoba ukuphuma komchamo kuqala.
I-acidity acid ivame ukubuyiselwa ngokuzimela njengoba ukwakheka kwegazi kulungiswa. Kwesinye isikhathi kuyadingeka ukunciphisa i-acidity ngamandla, bese kusetshenziswa ama-droppers ane-sodium bicarbonate yalokhu.
Phakathi kwezinyathelo eziphuthumayo, ukuxilongwa nokwelashwa kwezifo okubangele i-hyperglycemic coma nakho kuyaqokonyiswa. Imvamisa yenziwa kanyekanye ngokukhishwa kokwephulwa egazini.
Yiziphi izinkinga ezingase ziphakame
Njengomthetho, ukuxilongwa okufika ngesikhathi kanye nokulethwa kwesiguli esibhedlela kusiza ukugwema izinkinga ezinkulu. Iziguli zobudala obusha nobuphakathi zilulama ngokushesha futhi zingaphila impilo ejwayelekile.
Uma ukwelashwa kokuqala kwe-hyperglycemic coma kungazange kwenziwa ngesikhathi, futhi isiguli siqongelele izinkinga eziningi zesifo sikashukela nezinye izifo ngesikhathi sokuphila kwayo, i-diagnostosis ayinathemba elinjalo. Angakhula i-edema yamakhorali, ukuxabana okukhulu kwegazi kungenzeka, kanye nokusebenza kwezitho zomzimba. Ukuhlala isikhathi eside ekhefini kuyingozi nge-pneumonia kanye nezinye izifo ezingathi sína.
Ngemuva kokushiya ukopha, ezinye iziguli kufanele ziphinde zifunde ukukhuluma futhi zizimele, zingase zibe nokuphazamiseka kwengqondo, izinkinga zenkumbulo, kanye namakhono okuqonda ancipha.
Qiniseka ukuthi ubheka i-athikili yethu ku-lactic acidosis - ilapha.
Ungamvimbela kanjani umuntu
Ezimweni eziningi, ungavikela umuntu uma unesibopho sempilo yakho:
- Landela yonke imiyalo kadokotela, landela ngokuqinile ekudleni - ekudleni kwesifo sikashukela sohlobo 2.
- Uma ushukela ungaphezulu kokujwayelekile, thintana ne-endocrinologist yakho ukuze ulungise umthamo wezidakamizwa.
- Vakashela udokotela wakho ngaso sonke isikhathi lapho kuvela isimo esingavusa isicefe: izifo eziyingozi zamagciwane, ukuvuvukala kwezitho, ukulimala okungathi sína.
- Ukuyala izihlobo ukuthi zixwayise odokotela ngaso sonke isikhathi ngesifo sikashukela ezimweni lapho isiguli uqobo singakwazi ukukwenza lokhu.
- Njalo phatha ucingo ngothintana nesihlobo esinolwazi.
- Thola ikhadi elizokhombisa uhlobo lwesifo sikashukela, ukwelashwa okusetshenziselwa kanye nezifo ezikhona. Yigcine esikhwameni sakho sesifuba noma eduze kwefoni yakho.
- Ungathemba ukuthi ungabhekana nokukhubazeka ngokwakho. Shayela i-ambulensi uma ushukela phakathi nokwelashwa okujwayelekile kudlula i-13-15 mmol / L kanye nezimpawu zokudakwa.
Izici ze-hyperglycemic coma ezinganeni
Izimbangela eziphambili ze-hyperglycemic coma ezinganeni ukuxilongwa kade kwesifo sikashukela namaphutha wokudla ngenxa yokulawulwa okunganele ngabantu abadala. Ingane ayikuqondi ngokuphelele ukungathi sína kokugula kwayo nemiphumela engabakhona, ngakho-ke, ingadla kakhulu ngamaswidi ngenkathi abazali bayo bengekho. Ngokungafani neziguli ezindala, umzimba wengane usabela kakhulu ezimweni ezicindezelayo. Ngayinye yazo idinga ukulawulwa njalo kwe-glycemic. Ekukhuleni, umthamo odingekayo we-insulin ungakhuphuka ngezikhathi zokukhula kwengane okusheshayo nokukhululwa okusebenzayo kwamahomoni.
Izimpawu ezinganeni zivame ukuzwakala kakhulu: ekuqaleni komqondo, izingane ziphuza amanzi amaningi, zingahle zikhononde ngobuhlungu esiswini, bese kuthi esifubeni, zibe nokuhlanzeka kaningi, zibambe izaba. Cishe njalo kunephunga elinamandla le-acetone. Ukwehla komzimba kwenzeka futhi ngokushesha - Amehlo ayacwila, umthamo womchamo uyancipha, umbala wawo uyagcwala. Akuyona yonke ingane ekwazi ukuyichaza kahle imizwa yabo, ngakho-ke, ngezimpawu ezingathandeki ezinganeni ezine-mellitus yesifo sikashukela, udinga ukukala mashukela egazi ngokushesha.
