Ukunakekelwa okuphuthumayo kwe-ketoacidotic coma ngenxa yesifo sikashukela

I-Ketoacidotic coma iwumphumela onobungozi futhi oyingozi kakhulu wesifo sikashukela. Kwenzeka ngenxa yokuntuleka kwe-insulin egazini, okuvela ngemuva kwesizinda sokwelashwa kwe-insulin okungakhethwe kahle. Uma umuntu enganikezwa ukwelashwa okufika ngesikhathi futhi efanelekile, angafa.

Izibalo zikhombisa ukuthi i-ketoacidotic coma ivela ku-0,4% wezifo sikashukela. Cishe njalo, lo mbuso ungamiswa. Ingozi enkulu kakhulu le nto ikhona kubantu asebekhulile nasezinganeni.

Izizathu

I-ketoacidotic coma ibangelwa ukwelashwa okungafanele kwe-insulin yesifo sikashukela.

Lokhu kungabangelwa:

• Ukuphuza ngokweqile utshwala ngesikhathi sokwelashwa;
• Ukwephulwa kwendlela yokuphatha izidakamizwa;
• Ukungena okungalungile noma okungajwayelekile kwemithi ekwehlisa ushukela;
• Umthamo onganele we-insulin noma weqa ukuphathwa kwawo;
• Ukuba khona kwemikhuba emibi eshintsha ukukhiqizwa kwe-insulin;
• Ukuqina kwesifo sikashukela ngezinye izifo;
• Ukuthatha izidakamizwa eziningi;
• Ukuntuleka kokulawulwa kwe-metabolic.

Uma ukwazi ukubona imbangela yaso eqondile, udokotela uzokwazi ukwenza izinyathelo ezifanele zokuqeda izinkinga ezinkulu.

Izimpawu

Izimpawu ze-ketoacidotic coma zincike ohlotsheni lwalesi simo. Kunemikhakha eminingi yemitholampilo edinga imiphumela ehluke ngokuphelele enkingeni. Ochwepheshe banamathela kulolu hlaka olulandelayo:

• I-ketoacidotic coma esiswini - ibonakala njengobuhlungu obukhulu esiswini, umkhuhlane, umlomo owomile, kulandelwa ukulahlekelwa ukwazi.
• I-Renal ketoacidotic coma - ingaqashelwa yi-proteinuria, i-nephroangiopathy, kanye noshintsho ekwakhiweni kokuqina kokuwochama komchamo.
• Inhliziyo ye-ketoacidotic coma - ibonakala kwesilonda esibi sesistimu yenhliziyo, ukuwa kungenzeka.
• I-Encephalopathic ketoacidotic coma - ingaqashelwa yi-asymmetry ye-reflexes, hemiparesis, ukulimala kwemithambo yobuchopho obungenalutho. Umuntu unekhanda elinzima, inkungu.

Izigaba

Amazinga we-ketoacidotic coma ahlukaniswa ngokuhamba kancane kwawo. Ukusuka kuzibonakaliso zokuqala zalesi simo kuze kufike ekuqaleni komqondo, kudlula izinsuku ezimbalwa. Konke kuqala ngesifo se-acid-base. Ochwepheshe bahlukanisa izigaba ezilandelayo:

• Ukuqala kwe-ketoacidosis - kubonakala njengezimpawu ze-mellitus ezinwebekile zesifo sikashukela. Umuntu uqala ukuhlushwa ukoma okungapheli, umuzwa womlomo owomile, ikhanda, isicanucanu nokuhlanza. Ubuye nephunga elizwelayo le-acetone ephuma emlonyeni wakhe. Ngokwempilo, lesi simo singanqunywa ngokwanda okubukhali kweglucose yegazi.
• Idlozi - livela kuphela uma kungekho sinyathelo esenziwe ngokushesha. Kubonakala ngokuhlanza njalo, ukuhuda, noma ukuqunjelwa. Iziguli eziningi zikhononda ngobuhlungu obukhulu esiswini, ukozela, ukudideka nokunganakwa.
• IComa inkinga enkulu edinga ukunakekelwa ngokushesha kwezokwelapha. Umuntu ulahlekelwa ukuqaphela, ukuphefumula okujulile nokunomsindo kwenzeka kuye. Zonke izinqubo zangaphakathi ziqala ukuqhubeka ngendlela ekhethekile.

Ukunakekelwa okuphuthumayo

Isifo sikashukela isifo sikashukela yisifo esibi okufanele sazi zonke izihlobo ezisondelene nabantu besiguli.

Uma kunesidingo, kufanele baqonde ukuthi yini edingekayo kubo.

I-algorithm yokuqalwa kwe-ketoacidotic coma imi kanje:

1. Lapho kuvela izimpawu zokuqala zokuqina kwesiguli: ukulahleka kwengqondo, ukuphefumula okungajwayelekile, kubalulekile ukubiza i-ambulensi;
2. Ngaphambi kokuba udokotela afike, kuyadingeka ukuthi uhlole izinga lomfutho wegazi kanye nokushaya kwenhliziyo njalo ngemizuzu emi-5;
3. Zama ukubuza isiguli imibuzo ukuze ihlale iqaphela;
4. Ishaye ubuso bayo bese uyihlikihla izindlebe ngezinhloso ezifanayo.

Lapho i-ambulensi ifika, odokotela kuzofanela benze imicimbi elandelayo:

• Yethula umthamo omncane we-insulin ngokungachemile;
• Yethula usawoti ukwenza lula ukomisa.

Ngemuva kwalokhu, isiguli singeniswa esibhedlela ngokushesha futhi siyiswe esibhedlela. Imvamisa, iziguli ezinjengalezi zithunyelwa esikhungweni sokunakekela abagulayo. Zonke izindlela zokwelapha ezidingekayo zenziwa lapho.

Ukuxilonga

Ngokuthola kwe-ketoacidotic coma, kuhlolwa kabanzi isiguli kuyenziwa. Uma eqaphela, udokotela ubuza imibuzo ecacisa bese ebuza ngezici zesimo sakhe. Ngemuva kwalokho, isiguli siya ochungechungeni lokuhlolwa kwelebhu okukuvumela ukuba wenze isiphetho sokugcina. Ukuxilongwa kwalesi simo kufaka okulandelayo:

• Izinga le-glucose ngenxa yokuhlolwa kwegazi okujwayelekile lisukela ku-16-38 mmol / ilitha.
• Futhi, ngenxa yalolu cwaningo, ungabona inani elikhulayo le-hematocrit ne-hemoglobin, elikhombisa ukuphelelwa ngamandla okunamandla.
• Izidumbu zeKetone ku-OAM zizothuthukiswa kakhulu.
• Izinga le-sodium esegazini lizokwenyuka, futhi i-potassium izonyuswa. Lokhu kungafundwa emiphumeleni yokuhlolwa kwegazi okune-biochemical. Ukukhula kwe-Urea kubuye kuhlolwe lapho.
• Ukuhlolwa kwegazi kwe-Acid-alkaline kukuvumela ukuthi ukhombe ukuphazamiseka kwe-metabolic. Kubonakala ngokwanda kwe-osmolarity kuze kube ngu-300 mosmol / l.
• Umfutho wegazi wehla, futhi isilinganiso senhliziyo siyakhuphuka.

Izici zokwelapha

Ukwelashwa kweziguli ezinezimpawu zokukhubazeka kwe-ketoacidotic noma ngefomu eliyingozi kudinga ukulaliswa esibhedlela ngokushesha. Abantu abanjalo bathunyelwa esikhungweni sokunakekela abagulayo, lapho bengaphansi kokuqashwa njalo kodokotela abakhona. Ngemuva kwalokho, ukuxilongwa okuhlukile kuyenziwa. Ukwehlukanisa ukhokho ne-coma, kudluliselwa ama-insulin angama-10-20 kumguli. Ezinye izindlela zokwelapha zinqunywa kuphela ngemuva kokutholwa kokuxilongwa okuyikho.

Ukwelapha isifo sikashukela kudinga ukuphindwaphindwa kabusha kwe-insulin. Lokhu kuzosiza ukuguquguqula amazinga kashukela egazi, okuphumela enhlalakahleni ephelele. Ngemuva kwalokhu, isiguli sinikezwa isisombululo se-sodium esisiza ukuqeda ukomisa.

Ngemuva kokuthi udokotela eqinisekise ukuthi ukhubazekile yi-ketoacidotic coma, unikeza iziguli imijovo ye-insulin. Bajova jet noma intramuscularly ngesilinganiso samayunithi ayi-10-20 ngehora.

Emva kwalokhu, uchwepheshe uhlola izinga likashukela wegazi njalo ngehora, emva kwalokho enze isikhathi esifanele.

Ngokuthuthuka kwesimo, umthamo we-insulin uyancipha kancane kancane.

Ukuqeda ukubonakaliswa kokuphelelwa ngumzimba okujwayelekile komzimba, onesifo sikashukela, inani elikhulu lamanzi lifakwa emthanjeni lingene emithanjeni. Ekuqaleni, isisombululo se-sodium chloride sisetshenziselwa le njongo. Kumele kukhunjulwe ukuthi, ngokuya kwesikhathi sokwelashwa, izinga lokuphatha umuthi liyahluka. Lapho ukwazi kwesiguli kubuyela kokujwayelekile, ukwelashwa kokungena kumiswa.

Amaphutha wokwelashwa

Ukwelashwa kwe-ketoacidotic coma kudinga iziqu eziphakeme kusuka kudokotela ohambelayo. Isimo esinjalo sokwelashwa okukhethwe ngendlela engafanele kungaholela emiphumeleni emibi kuphela, kodwa nasekufeni. Ucwaningo luye lwabonisa ukuthi amaphutha alandelayo kaningi ahlangabezana nawo ekwelashweni:

1. Ukwelashwa kwe-insulin okunganele, okuvame ukuholela ekwehleni okubukhali koshukela wegazi;
2. Izinga elinganele lokuphanjuliswa komzimba lingaholela ekushayweni kwe-hypovolemic;
3. Ukuhluleka ukulawula izinga le-glucose egazini, ngenxa yokuthi umzimba alikutholi ukwelashwa okufanele;
4. Izinga lokwehla ushukela wegazi lishesha kakhulu, okubangela ulwelwesi lobuchopho;
5. Izinga elilinganiselwe le-potassium replenishment rate, elibangela uhlelo lwezinhliziyo ukuba lihlupheke.

Ukuqapha isiguli

Lapho isiguli sikhubazeka ketoacidotic, ziqashwa njalo. Udokotela kufanele azi ukuthi umzimba wakhe usebenza kanjani ukuze alungise irejimeni yokwelashwa esifike ngesikhathi. Ukulawulwa kwenziwa ngale ndlela elandelayo:

1. Njalo ngehora - ukushaya kwenhliziyo, umfutho wegazi, izinga lokuphefumula, ushukela wegazi, isimo sokuqwashisa, ibhalansi ye-fluid, ukugxilwa kwegesi egazini elivela emithanjeni;
2. Njalo ngamahora we-2-4 - ukuqoqwa kwama-ketones nezakhi zamaminerali ku-serum;
3. Njalo ngamahora we-8 - izinga lokushisa nesisindo somzimba;
4. Ngemuva kokuchama ngakunye, izinga le-glucose nama-ketones kumchamo.

Ukulawulwa okungathi sína kwesiguli kuchazwa iqiniso lokuthi isiguli singaba nezinkinga nganoma yisiphi isikhathi. Imiphumela engathandeki kakhulu ye-ketoacidotic coma edonsa ukwelashwa kwayo ingabizwa:

• I-Hyperglycemia noma i-hypoglycemia;
• I-Hyperchloremia;
• Izilonda ze-Thromboembolic;
• Ukwehluleka kwangempela
• Indlala ye-oksijini, ngenxa yokuthi izicubu ziyafa ngayo;
• Ukuphazamiseka kwemetabolic.

Ukuvimbela

Ukuze uvikele imiphumela emibi, kuhlale kudingekile ukukhumbula ukuvimbela i-ketoacidotic coma. Imisebenzi ifaka phakathi:

• Ukuhlola ushukela wegazi kanye ngesonto;
• Ukuhambisana nokudla okukhethekile;
• Ukuthatha izidakamizwa ezinciphisa ushukela;
• Ukuqapha njalo isimo somzimba;
• Ukwenqaba imikhuba emibi;
• Ukuphathwa ngesikhathi kwazo zonke izifo ezivelayo;
• Ukuhambela njalo kudokotela ohambelayo;
• Ukulonda impilo enempilo;
• Indlela yokuphila esebenzayo futhi esebenzayo.

Isiguli singakwazi ukubona izimpawu zokuqala zokwehla ketoacidotic ngokuzimela. Kubalulekile kakhulu ukuthi uchwepheshe oselashayo atshele kusengaphambili ukuthi yini okufanele unake. Kulokhu, umuntu uzokwazi ngokuzimela ukuthi afune usizo lwezokwelapha ukuvimbela ukwanda kwezinkinga ezinkulu. Ukuqapha njalo ushukela wegazi kuzosiza ukulawula umzimba, kanye nokuvikela i-ketoacidotic coma.

Izinkinga ezingaba khona

I-Ketoacidotic coma iwumphumela onzulu wesifo sikashukela. Uma kunakekelwa okungalungile noma ngokungafanele kwezokwelapha, isiguli singathola ubunzima obukhulu. Ingozi enkulu i-edema yamakhemikhali. Umkhuba onjalo ngobuningi bamacala uphela ngokufa. Kungenzeka uqaphele ukubukeka okungenzeka kokungabikhona kobuchopho ngokungabikho kwezinguquko ezinhle esigulini, naphezu kwazo zonke izindlela zokwelapha ezenziwayo. Kulokhu, udokotela uthola ukuthuthuka okukhulu kumetabolism yama-carbohydrate namafutha.

I-edema ye-cerebral ingaqashelwa ukusabela okunciphisiwe kwabafundi ekukhanyeni noma ngokungatholakali kwayo, ukuvuvukala kwe-opic nerve noma i-ophthalmoplegia.

Ukuqinisekisa lokhu kutholwa, uchwepheshe uthumela isiguli i-compact tomography kanye ne-encyclopediagraphy ye-ultrasound.

I-EEC ne-REC nazo zenziwa ukuhlola izinqubo ezenzeka ebuchosheni. Ngosizo lwabo, ungakhomba noma yiziphi izinkinga bese unquma ukwelashwa okufanele.

Ukuze uvikele imiphumela emibi yalesi sifo, uchwepheshe kufanele asithumele isiguli njalo ukuthi siyohlolwa igazi. Kuyadingeka ukuthola inani lama-electrolyte egazini, i-heestasis kanye ne-hemodynamics. Ukuxilongwa ngesikhathi noma yikuphi ukuphambuka kuzosiza ukukuqeda ngokushesha, ukuze ubungozi bezinkinga bube buncane.