Ibhalansi ye-Acid-base emzimbeni onempilo igcinwa ezingeni elingaguquki, igazi linokuphendula okubuthakathaka kwe-alkali. Lapho iphambuka ibheke ku-acidization, i-metabolic acidosis iyakhula, i-alkalization - alkalosis. Ukuhlaselwa ohlangothini lwe-acid kuvame kakhulu, odokotela babo bonke ubuchwepheshe babhekana nakho.
I-Acidosis uqobo lwayo ayenzeki; ihlala ikhula ngenxa yokuphazamiseka noma izifo. Kunezimbangela eziningi ze-acidosis: kusuka kushukela kuya ku-overdose ye-ascorbic acid. Kuzo zonke izimo, izinqubo emzimbeni ziqhubeka ngokufanayo: ukusabela kwe-biochemical kwehlisa ijubane, amaprotheni aguqula ukwakheka kwawo. Lesi simo siyingozi kakhulu, kuze kube ukwehluleka kwezitho nokufa.
I-Metabolic acidosis - kuyini?
Amaprotheni akhona kuwo wonke amaseli omzimba wethu. Zitholakala kuma-hormone, nama-enzyme, nasezivikelweni zomzimba. Amaprotheni ama-amphoteric, okungukuthi, anezinto zombili acid nezisekelo. Benza umsebenzi wabo ebangeni elincanyana pH: 7,37 - 7,43. Ngokuphambuka kukho, amaprotheni aguqula isakhiwo sawo ngokungenakuphikiswa. Ngenxa yalokhu, ama-enzyme alahlekelwa umsebenzi, iziteshi ze-ion ziyabhujiswa, ama-membrane amaseli ayayeka ukufeza imisebenzi yawo, ama-receptors ahluleke, futhi ukudluliswa kwe-nerve impulses kuyaphazamiseka.
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%
Emiphumeleni emibi kangako, umzimba uyazivikela ngokuzimela ngosizo lohlelo lwe-buffer lwamazinga athile. Eyokuqala i-bicarbonate. Usawoti we-carbonic acid, ama-bicarbonate akhona njalo egazini, okuthi, ngokukhuphuka kokuqukethwe kwe-asidi yegazi, akuchithe ngokushesha lokho. Njengomphumela wokusabela, kwakheka i-carbonic acid, enquma i-carbon dioxide namanzi.
Ukuxineka kwama-bicarbonates egazi kugcinwa izinso, inqubo ephikisanayo iyenzeka: ama-ion hydrogen ion amaningi akhishwa emchameni, bese i-bicarbonate ibuyiselwa egazini.
Uma ama-acid ngamanani akhuphukile evela ngaphandle noma akhiwa emzimbeni, i-acidosis iyakhula. Kuboniswa ukwehla ku-PH kuye ku-7.35 nangaphansi. Isizathu sokushintsha kokulinganisa kwe-acid-base kungakhuphuka kakhulu kokudla kwe-carbon dioxide, ukulimala kwezinso ngokuqothuka komsebenzi wabo wokubuyisa izindawo ezigcinwe nge-bicarbonate, ukuhoxa ngokweqile kwezisekelo ngomgudu wesisu. Kungadala i-acidization nezinqubo ezihlanekezelwe ze-metabolic, lapho kwenzeka khona i-metabolic acidosis.
Izizathu kanye nentuthuko
Ukwelapha i-acidosis, akwanele ukwethula ama-bicarbonate alahlekile egazini. Ngaphezu kwalokho, kwezinye izimo, ukwethulwa kwabo kungaba yingozi. Ukuqeda i-acidosis, kuyadingeka ukuqonda ngaphansi kwethonya lokuthi yiziphi izinto ezaqala ukuzithuthukisa.
Izimbangela ezingaba khona ze-metabolic acidosis:
- Ukushoda kwe-insulin noma ukumelana kanzima ne-insulin. Ngenxa yalokhu, izicubu azitholi ukondleka futhi ziyaphoqelelwa ukuthi zisebenzise amafutha aqhekezayo ukwakha ama-acid.
- Ukwenziwa okuqinisiwe kwe-lactic acid ezifweni zesibindi, ukuntuleka kwe-insulin kushukela, ukuntuleka kwe-oksijini kwezicubu ngenxa yezifo zemithambo yegazi, amaphaphu, inhliziyo.
- Ukuphuza ngokweqile, kuhambisana nokuhlanza nesikhathi esilandelayo sokuzila.
- Ukuzila ukudla isikhathi eside noma ukweqisa okunamafutha ekudleni.
- Ukufakwa emzimbeni lapho kudliwa: i-ethylene glycol - utshwala, okuyingxenye ye-antifreeze; i-salicylic acid enkulu kune-1.75 g nge-kg ngayinye yesisindo; methanol.
- Ukunikeza ubuthi obunamandla we-toluene, oqukethe upende, ama-varnish, i-glue, i-solvent.
- Ukuncipha kwe-renal glomerular okwehlisiwe ngenxa ye-nephropathy, pyelonephritis, nephrossteosis, ukwelashwa ngezidakamizwa ezithile: izidakamizwa ezilwa nokuvuvukala; i-amphotericin - isidakamizwa se-antifungal; i-tetracycline iyi-antibiotic; Ukulungiswa kwe-lithium - psychotropics; i-acetazolamide (diacarb); spironolactone (Veroshpiron) - ama-diuretics.
- Ukulahleka kwama-hydrocarbons avela emgodini wokugaya ukudla ngenxa yesifo sohudo, ama-fistulas angaphandle.
- I-overdose ye-metformin, umuthi obekelwe uhlobo loshukela olungaxhomekeki ku-insulin. Ukwemukelwa kweMetformin ezigulini ezinenkinga yesibindi noma yezinso.
- Ukukhishwa okunganele kwe-adrenal cortex kwe-aldosterone noma i-deoxycorticosterone.
- I-potassium eyeqile ngokwephula ukuphuma kwayo yizinso.
- Ukwethulwa kwama-asidi kumsoco wabazali noma i-ammonium chloride yokudambisa ukuvuvukala.
- I-necrosis enkulu yezicubu zomzimba ngenxa yokucindezelwa isikhathi eside, ukushiswa, i-myopathy, izilonda eziyinqaba nokushintshwa kwezihlakala ku-mellitus yesifo sikashukela.
Izinhlobo zezifo
Ngokuya ngembangela yokuqongelela kwama-acid egazini, i-acidosis ihlukaniswe izinhlobo:
| Uhlobo lwe-acidosis | Ukwephula umthetho | Izizathu |
| I-ketoacidosis | Ngenxa yokuntuleka koshukela, umzimba uphoqelelwa ukwanelisa izidingo zawo ngokuwohloka kwamafutha acid. Le nqubo ihambisana nokwanda ukwakheka kwama-keto acid. | I-Diabetes mellitus: uhlobo 1 - umthamo onganele we-insulin noma umuthi owonakalisiwe, uhlobo 2 - ukumelana ne-insulin okuqinile ngenxa yokuntuleka kwesikhathi eside kwesinxephezelo. Indlala ende, utshwala. |
| I-Lactic acidosis | Ukwanda kokuhlungelwa kwe-lactic ne-pyruvic acid. Ukwakheka kwabo kuthuthukiswa ngokuntuleka komoya-mpilo. | Imnene - ngemuva komthwalo emisipha, ikakhulukazi kubantu abangafundile. Kakhulu - ngezifo zesibindi, ezivame ukuhlanza igazi le-asidi. Kungabhekelwa ezifweni eziholela ekubulambeni i-oksijini: inhliziyo, i-pulmonary, vascular, ngokuntuleka kwe-hemoglobin. Amathuba we-lactic acidosis akhulisa ukungena okungalawulwa kweMetformin kushukela. |
| I-tubal yangempela | Ama-acid awakhiwa. Umswakama uyanda ngenxa yokuntuleka kwama-bicarbonates. I-Proximal acidosis ukwephula ukubuya kwama-bicarbonates egazini. I-distal - ukususwa okunganele kwama-ion hydrogen. | I-Proximal acidosis - i-nephrotic syndrome, i-hepatic vein thrombosis, i-myeloma, i-cysts, ukusetshenziswa kwesikhathi eside kwe-diuretics, ukuntuleka kwe-aldosterone. I-distal acidosis - i-pyelonephritis, i-nephropathy, ukuthatha umuthi ongathinta isilinganiso sokuhlungwa komchamo ku-glomeruli. |
| Acidosis ngokudakwa | Ukuqinisekiswa kwemikhiqizo yokubola, isibonelo, i-oxalic acid lapho usebenzisa i-ethylene glycol noma i-formic acid lapho unoshevu nge-methanol. | Ukungabheki kwezinyathelo zokuphepha lapho usebenza ngezinto ezinobuthi, ukusetshenziswa kophuzo oludakayo kanye nemithi eyeqisayo yemithi. |
Indlela ehlanganisiwe ye-acidosis nayo iyenzeka, ikakhulukazi ezigulini ezinenkinga yokugula okungamahlalakhona. Isibonelo, ubungozi be-acidosis ngenxa kashukela omningi kushukela likhuphuka kakhulu ngokusetshenziswa kotshwala kanye nephropathy yesifo sikashukela.
Ngokuya ngezinga lesinxephezelo, i-acidosis ihlukaniswe ngamafomu ama-3:
- acidosis ekhokhelweIzimpawu azivamile, i-acidity isondele kumkhawulo ophansi wesimo esijwayelekile, esizinzile. Ukwelashwa okukhethekile akudingekile, kuyadingeka ukuthola nokuqeda imbangela yokwephulwa;
- i-acidosis engaphansi: isimo semingcele, ukubhekwa kuyadingeka;
- ifomu elibolile le-metabolic acidosis - i-pH yegazi incishiswa kumanani asongela impilo noma iyaqhubeka incipha. Ukulaliswa esibhedlela ngokuphuthumayo, ukulungiswa kwe-acidity ngezixazululo ezikhethekile kuyadingeka, kwezinye izimo izindlela zokuvuselela kabusha. Ngaphandle kokwelashwa, i-acidosis ebunjiwe ingadala ukoma futhi iholele ekufeni kwesiguli.
Izindlela zokuthola isilinganiso se-metabolic acidosis:
| Ukuhlwaya | Isinxephezelo | Ukukhokhelwa | Ukubuyiselwa |
| pH | ≈ 7,4 | 7,29-7,35 | < 7,29 |
| Izisekelo ze-Buffer, mmol / l | 50 | 40-49 | < 40 |
| Ama-bicarbonates angokoqobo, mmol / l | 22 | 16-21 | < 16 |
| Ama-bicarbonates ajwayelekile, mmol / l | 24 | 19-23 | < 19 |
| Ukucindezela kwe-carbon monoxide egazini, mmHg | 40 | 28-39 | < 28 |
Izimpawu nezimpawu
Kusukela endaweni yokubukwa kwe-pathophysiology, i-acidosis inqubo evamile ehambisana nezimpawu ezijwayelekile. I-acidosis enxephezelwe ingabonakala kuphela ngoshintsho ekwakhiweni kwegazi nomchamo. Izimpawu esigulini njengamanje zincike ngokuphelele kwisifo esidale ukuthi i-acidity iguquke.
Njengoba isimo siba sibi kakhulu, uphawu lokuqala olujwayelekile lwazo zonke izinhlobo ze-acidosis luyavela - ukukhuphuka, ukuphefumula kaningi. Kuchazwa ngokwanda kokuqukethwe kwe-carbon dioxide egazini ngenkathi kusebenza amasistimu we-buffer womzimba. Lapho kuqala ukulamba kwe-oksijeni kwezicubu, ukufupheka komzimba kwenzeka, ukuphefumula kuba okomqondo - kuba nomsindo, ikhefu phakathi kokuphefumula lifinyezwe, bese kunyamalala ngokuphelele.
Nge-metabolic acidosis, kukhona ukukhishwa okubukhali kwe-adrenaline nabandulelayo bayo, ngakho-ke, umsebenzi wenhliziyo uyasheshiswa, ngenxa yokuthi i-pulse ivuselela, ukuphuma kwegazi kuyanda ngesikhathi ngasinye, bese ingcindezi iphakama. Kancane kancane, amaprotheni ezinhlaka zamangqamuzana alahlekelwa eminye yemisebenzi yawo, ama-ion hydrogen angena emangqamuzaneni, bese i-potassium iwashiya. I-calcium ishiya amathambo; i-hypercalcemia yenzeka egazini. Ngenxa yokudlula kwama-electrolyte egazi, izimpawu ziyaguquka ziye kolunye: amaconsi okucindezela, i-arrhythmia yenzeka. Izimpawu ezinjalo zikhombisa ukuthi i-acidosis isidlulele esigabeni esinzima.
Phakathi kwezimpawu ezivame ukwenzeka, ukugabha nohudo nakho kungahlukaniswa. Zibangelwa ukudakwa ngama-ketones, izinto ezithathwe ngaphandle noma ukwanda kwephimbo lezinzwa, okuholela ekunyukeni kwezindlala nokugundana.
Izimpawu nazo ziyaqashelwa kusukela ohlangothini lwesistimu yezinzwa ephakathi: isiguli sicwiliswe esimweni esaphukile, silele, sizizwa sinobulwelwe. Ukungakhathaleli kungashintshana ngokungacasuki nentukuthelo. Ngokwanda kwe-acidosis, isiguli siphelelwa amandla.
Izimpawu zokubonisa izinhlobo ezithile ze-metabolic acidosis:
- kwe-ketoacidosis, iphunga le-acetone elivela esikhunjeni somlomo nesiguli lijwayelekile, ubuhlungu obukhulu besisu, ukungezwani kodonga lwesisu. Isifo sikashukela, i-ketoacidosis iqala kuphela ngezinga eliphakeme likashukela, elihambisana nokoma, i-polyuria kanye nolwelwesi lwe-mucous olomile;
- izibonakaliso zokuqala ze-acidosis ezibangelwa ukuthatha imithi zifaka ukwehla kokusebenza kwazo;
- lapho i-metabolic acidosis ihambisana nokudakwa kanzima, isiguli singathola ukuphefumula okungalingani - okungaphezulu, okungajwayelekile;
- uma i-acidosis ibangelwa yisifo sezinso, ikakhulukazi ukuhluleka kwe-renal, izimpawu ze-hypocalcemia zivame ukubonwa: i-inhliziyo fibrillation, imisipha yokuncipha. Ukuphefumula kwesiguli kungaba nephunga le-ammonia;
- ukwanda okwenziwe nge-lactic acid ngesikhathi se-lactic acidosis kubonakaliswa yibuhlungu bemisipha, kwandiswe umthwalo kubo. Uma imbangela ye-lactic acidosis ibiyinkinga yamaphaphu, isikhumba sesiguli siqale siphuzi, kancane kancane siphenduke sibe bomvu bese simbozwa ngesithukuthuku.
Ukuxilongwa kwe-acidosis
Ukuxilongwa kwe-acidosis kwenziwa ngezigaba ezimbili. Esokuqala sinquma ukuthi ngabe kukhona ukuguquka kwe-acidity yegazi kanye nohlobo lwayo. Elesibili libonisa imbangela ye-metabolic acidosis.
Isimo se-acid-base state, noma i-pH yegazi, okuqukethwe komoya-mpilo nekhabhoni dioksi kuyo kunganqunywa elabhoratri kusetshenziswa ukuhlaziywa kwegesi. Igazi lithathwa kumthambo we-radial, kwesinye isikhathi kusuka kuma-capillaries asemunwe. Ukuhlaziywa kuthatha imizuzu engekho ngaphezulu kwe-15.
Ukunquma uhlobo lwe-acidosis ezimweni eziningi, izifundo ezisezingeni le-glucose ne-lactate egazini, imizimba ye-ketone yomchamo yanele:
| Ukuxilongwa | Imiphumela yokuhlaziywa, mmol / l | |||
| Ushukela wegazi | Izidumbu zeKetone | Igazi lactate | ||
| Norm | 4,1-5,9 | akatholakali | 0,5-2,2 | |
| I-ketoacidosis | onesifo sikashukela esingakhokhwanga | >11 | >1 | okujwayelekile |
| non-sikashukela | okujwayelekile noma okuphakeme kancane | |||
| I-Lactic acidosis | okujwayelekile | okujwayelekile | > 2,2 | |
Esigabeni sezokwelashwa, kuyadingeka ukuqeda ukwephulwa okubangele i-acidosis. Ukuyikhomba, izifundo eziningi zingaqhutshwa, kuya ngezifo ezatholakala ngaphambili esigulini nesithombe somtholampilo.
Okuyinhloko ukuhlolwa kwegazi okuhlukahlukene nokuhlukahlukene, i-urinalysis ejwayelekile.
Ukuphambuka okungenzeka:
- Amaprotheni, amangqamuzana ezinso, amasilinda emchameni, kanye nokukhula kwe-creatinine yegazi kukhombisa izinkinga zezinso.
- Ushukela kumchamo lukhombisa izinga eliphakeme egazini, imvamisa kakhulu ngenxa yesifo sikashukela noma isigaba esibi se-pancreatitis.
- Ukukhula kwe-leukocytes yegazi kusikisela ukuthi i-acidosis yenzeka ngenxa yokuvuvukala nokungasebenzi kahle kwesinye sezitho zangaphakathi. Ama-neutrophils aphakama ngezifo ezibangelwa amagciwane, ama-lymphocyte anezifo ezibangelwa amagciwane.
- Ukwanda kokuxineka kwe-bilirubin noma ukwehla kwamaprotheni egazi kubonwa ngokwehluleka kwesibindi, i-cirrhosis.
Ngokwemiphumela yokuhlaziywa, i-ultrasound, computing noma i-magnetic resonance imaging ingabekwa. Inani lokucwaninga linqunywa ngudokotela, kucatshangelwa imbangela yokusolwa ye-metabolic acidosis.
Izindlela zokwelapha
Into yokuqala okufanele yenziwe lapho kuvela izimpawu ezingenhla ukubiza i-ambulensi, ngoba ukwelapha i-metabolic acidosis ekhaya akusizi futhi kuyabulala. Imvamisa ukwelashwa okunconyiwe nge-soda akunamsebenzi ngokuphelele. I-Sodium carbonate uma ingena esiswini izothuthukiswa ngokuphelele yijusi yesisu, hhayi igramu engangena egazini, ngenxa yalokho, i-pH yayo ihlala ingashintshiwe.
Esibhedlela ukwelashwa nge-acidosis, ngokuyinhloko bazama ukuqeda imbangela eyayibangele. Esikhathini sikashukela, ushukela wegazi uncishiswa ukuphathwa kwe-insulin okufakwa ngaphakathi. Kwi-ketoacidosis engeyona yesifo sikashukela, kungafuneka umsoco wabazali noma i-glucose eyehlayo. Ukwehla kuqedwa ukuphathwa kwe-volumetric ye-saline. Uma ukuntuleka kwegazi kwenzeka lapho i-potassium ibuyela kumaseli, kwethulwa i-potassium chloride. Ngokuhluleka kwe-renal kanye nobuthi ngezinto ezibulalayo, igazi lihlanzwa nge-hemodialysis.
Ukuphathwa okungaphakathi kwezixazululo ze-alkaline kusetshenziswa njengezinyathelo zokugcina, ngoba kungavimba ukuphefumula, ukunciphisa ingcindezi, imiphumela emibi ye-insulin, futhi ukweqisa ngokweqile kungadala i-alkalosis. Ngokuvamile, kusetshenziswa i-sodium bicarbonate ne-trometamol.
I-bodium bicarbonate isetshenziselwa i-metabolic acidosis enkudlwana, lapho i-pH ihlehlela ku-7.1, kanti isiguli sinomfutho wegazi ophansi. Ingasetshenziswa futhi ekulahlekelweni kwama-carbonates ngokusebenzisa umgudu wokugaya ukudla ngokweqile kanye nezidakamizwa ezingeqile. Inani elidingekayo libalwa ifomula. Isixazululo sikhishwa kancane, ngaphansi kokulawulwa okungafani nokwakheka kwegazi.
I-Trometamol iyakwazi ukubopha ama-ion amaningi e-hydrogen, hhayi egazini kuphela, kodwa nangaphakathi kwamangqamuzana. Lesi sidakamizwa sisetshenziswa ezimweni lapho i-acidosis ende ingaba yingozi enhliziyweni yesiguli. Isidingo sokwethulwa kwe-trometamol kuwumsebenzi ojwayelekile wezinso.
Uma ukwelashwa kwenziwa ngendlela yesikhathi futhi izinkinga zivikelekile, i-acidosis iyasuswa ngosuku lokuqala, kuthi ngemuva kwesonto isiguli sikhishwe.
