I-Ketoacidosis iyinkinga enkulu yesifo sikashukela ekhula ngokuntuleka kwe-insulin. I-Pathology isongela impilo, ngoba isimo sokuzibusa masisha singena ngokushesha, silandelwa yi-coma. Ukuntuleka kokunakekelwa okuphuthumayo kuzoholela ekufeni. Ukuqhamuka nenkinga efanayo kungakhula ezinganeni nakubantu abadala abanesifo sikashukela sohlobo 1, noma kunjalo, abanesifo sikashukela sohlobo 2, i-ketoacidosis ayitholakali kalula.
Izizathu
I-ketoacidosis iba nokukhula kwe-insulin, uma umzimba ungakwazi ukusebenzisa ushukela bese uyisebenzisela amandla. Ngenxa yalokhu, le nto iqongelela egazini. Njengoba amangqamuzana ehlangabezana nendlala yamandla, kusetshenziswa izindlela zokuhlaziya, futhi umzimba ufuna ukuthola amandla ngokwaphula ama-lipids.
Inqubo ihambisana nokuhlanganiswa kwe-ketone, enqwabelana egazini. I-pathology efanayo ibizwa nge- "ketosis." Izinso azikwazi ukususa imfucuza engaka eguqulwa iguqulwe i-acetone. I-Acidosis iyakhula, iba imbangela yokudakwa kanzima komzimba. Ibhalansi ye-alkaline yegazi yehla ngaphansi kwe-7.3 pH, i-acidity yayo ikhuphuka (inani elijwayelekile le-7.35-7.45 pH libhekwa njengejwayelekile).
Kunama-degree ama-3 we-ketoacidosis:
- Easy. Isibonakaliso sokuqala sokudakwa siyavela - isicanucanu. Ukuchama kuba njalo (isifo sikashukela), umoya ophelile uqala ukunuka njengase-acetone.
- Okuphakathi. Isimo siba sibi kakhulu, isisu sibuhlungu, umuntu uyagula. Ukwehluleka kohlelo lwezinhliziyo kuyabhekwa: kwehlisa umfutho wegazi, ukukhuphuka kwenhliziyo (kusuka ekushayweni okungama-90 ngomzuzu).
- Isindayo. Ukuqwashiswa kukhubazekile, abafundi baba mancane, bayeke ukuphendula. Umzimba uzwa ukopha kakhulu emzimbeni. Iphunga le-acetone liba namandla kakhulu, lizwakala kalula egumbini okukhona kulo isiguli.
Izimbangela ze-ketoacidosis zifaka:
- Ukuqala kohlobo lwesifo sikashukela sohlobo 1 (olunenkinga yokugula);
- Ukwelashwa okungalungile kwesifo sikashukela esincike ku-insulin (ukubalwa kwamthamo okungalungile, ukuphathwa sekwephuzile kwe-insulin, amaphutha ekudleni);
- Ukusetshenziswa kwama-ejenti we-hypoglycemic ose kuphelelwe isikhathi noma imishanguzo egcinwe ngokungeyikho;
- Ukwelashwa kokuhlinzwa;
- Ukulimala
- Ukuxineka
- Inkambo ende yesifo sikashukela esingancikeli i-insulin, ehambisana nokushoda kwe-insulin;
- Ukukhulelwa
- Ukuthatha izidakamizwa ezikhulisa imiphumela ye-insulin (isb. Corticosteroids, diuretics, amahormone).
Inkambo yesifo sikashukela ikhulisa ezinye izifo: ukutheleleka kohlelo lokuphefumula, uhlelo lomchamo, izifo ezingamahlalakhona zezifo zamanyikwe, ukushaya kwenhliziyo, unhlangothi. I-ketoacidosis ezinganeni zivame ukwenzeka ngenxa yesifo sikashukela esincike ku-insulin (ngokubonakala kwesifo okokuqala), amacala alandelayo abangelwa amaphutha ekwelashweni.
Izimpawu
I-Pathology ikhula ngokushesha, isikhathi sesifundo sisuka 1 kuye ezinsukwini eziningana. Izimpawu zokuqala ze-ketoacidosis kungenxa yokwanda kweshukela ngenxa yamazinga e-insulin anganele.
Lokhu kufaka phakathi:
- Ukwanda komile;
- Ubuthakathaka
- Ukuchama okusheshayo;
- Isikhumba esomile, ulwelwesi lwama-mucous.
Kunezimpawu ze-ketosis, i-acidosis: ukugabha, isicanucanu, isisu siqala ukulimala. Iphunga i-acetone ephuma emlonyeni wakho. Ukuxilongwa kuholela ekucindezelekeni kwesistimu yezinzwa, okunqunywa yizimpawu zokubonisa:
- Ubuhlungu ekhanda;
- I-Lethargy;
- Ukusabela okuhamba kancane;
- Ukomela
- Ukucasuka.
Uma kungekho sizo olwanele ngesikhathi esifanele, ukukhohlisa kuyenzeka, ukungasebenzi kahle kokuphefumula kuyavela. Yekani ukuphefumula, izinhliziyo zidala ukufa.
Izimpawu ze-ketoacidosis ezinganeni ziyefana nokuboniswa kwe-pathology kubantu abadala. Isimo esifanayo kuleli qembu leziguli singenye yemiphumela emibi kakhulu yesifo sikashukela. I-Ketoacidosis ingenye yezimbangela ezinkulu zokufa kwezingane ezinalesi sifo.
Okufanele ukwenze
Ochwepheshe besifo sikashukela bayalulekwa ukuba bathenge imitha kashukela egazini nemichilo yokuhlola ukuthola imizimba ye-ketone emchameni. Uma zombili izinkomba ziphezulu, kanti nezimpawu ezikhonjiswe ngenhla zanda, udinga ukubiza i-ambulensi. Isiguli kufanele siphuthunyiswe esibhedlela uma umuntu ebuthakathaka kakhulu, ephelelwe amanzi emzimbeni, futhi unesifo sokungazi kahle.
Izizathu ezinhle zokubiza i-ambulensi:
- Ubuhlungu ngemuva kwe-sternum;
- Ukuqhafaza
- Ubuhlungu besisu;
- Ukushisa okushisa (kusuka ku-38.3 ° C);
- Izinga likashukela eliphezulu, ngenkathi inkomba ingaphenduli kuzinyathelo ezithathwe ekhaya.
Khumbula ukuthi ukungasebenzi noma ukuphathwa ngokungafanele kuvame ukubulala.
Ukuxilonga
Ngaphambi kokubeka isiguli esibhedlela, kwenziwa izivivinyo ezisheshayo zezinga le-glucose ne-ketone egazini, umchamo. Lapho wenza ukuxilongwa, imiphumela yokuhlolwa kwegazi ukuthola inani lama-electrolyte (i-potassium, i-sodium, njll) ayabhekwa. I-pH yegazi ilinganiselwa.
Ukubona ezinye izimo ze-pathological, yenza izinqubo ezilandelayo zokuxilonga:
- I-Urinalysis;
- ECG
- Isifuba x-ray.
Kwesinye isikhathi udinga ukwenza i-tomography ehlanganisiwe yobuchopho. Kubalulekile ukunquma izinga le-ketoacidosis kanye nokwehlukanisa kwezinye izimo ezibandayo:
- Indlala "ketosis;
- I-Lactic acidosis (okweqile kwe-lactic acid);
- I-ketoacidosis yotshwala;
- ukudakwa kwe-aspirin;
- ubuthi nge-ethanol, methanol.
Uma kwenzeka kunegciwane elisolwa, ukuthuthukiswa kwezinye izifo, kwenziwa ezinye izivivinyo.
Ukwelashwa
Ukwelashwa kwe-pathology yesigaba se-ketosis kuqala ngokuqedwa kwezimbangela ezayicasulayo. Imenyu ikhawula amafutha. Isiguli sinqunywe isiphuzo se-alkaline (isisombululo se-soda, amanzi amaminerali we-alkaline, iRegidron).
Bancoma ukuthatha ama-enterosorbents, ama-hepatoprotectors. Uma isiguli singazizwa singcono, kunikezwe umjovo owengeziwe we-insulin, futhi irejimeni yokuqinisa insulin yokwelapha iyasiza.
Ukwelapha Ketoacidosis
Ukwelashwa kwe-ketoacidosis kwenziwa esibhedlela. Umgomo oyinhloko ukuhlela amazinga e-insulin ngokwejwayelekile. Izindlela zokwelapha zifaka izigaba ezi-5:
- Ukwelashwa kwe-insulin;
- Ukulawulwa kwamanzi emzimbeni;
- Ukubuyiselwa kokuntuleka kwe-potassium, sodium;
- Ukwelashwa okubonakalayo kwe-acidosis;
- Ukwelashwa kwe-concomitant pathologies.
I-insulin ikhishwa ngemithambo, kusetshenziswa indlela yemithamo emincane, ephephe kakhulu. Kuqukethe ekuphatheni kwe-insulin ngehora. Imithamo emincane isiza ukucindezela inqubo yokuqhekeka kwe-lipid, ukubambezela ukukhishwa kwe-glucose egazini, futhi ithuthukise ukwakheka kwe-glycogen. Ukuqapha njalo kwamazinga kashukela kuyadingeka.
Ama-Droppers we-sodium chloride ayenziwa, i-potassium ilawulwa ngokuqhubekayo (inani lansuku zonke akufanele lidlule ku-15-20 g). Inkomba yezinga le-potassium kufanele ibe ngu-4-5 meq / l. Emahoreni ayi-12 okuqala, umthamo ophelele wetshezi olimale akufanele ube ngaphezu kwesilinganiso se-10 sesisindo somzimba wesiguli, ngaphandle kwalokho ubungozi be-pulmonary edema buyanda.
Ngokuhlanza, kwenziwa i-gastric lavage. Uma ukukhula kukhula, isiguli sixhunywe kwi-ventilator. Lokhu kuzovikela i-lung edema.
Ukwelashwa kwenziwa okuhlose ukuqeda i-acidity yegazi, noma kunjalo, i-sodium bicarbonate ingeniswa kuphela uma i-pH yegazi ingaphansi kuka-7.0. Ukuvimbela ukubanga kwegazi, asebekhulile banezelwe i-heparin ngokwengeziwe.
Kubhekelwa kakhulu ekwelashweni kwamanye ama-pathologies angaholela ekwakhiweni komthambo (i-trauma, i-pneumonia, njll.). Ukuze uvikele izifo ezithathelwanayo, kusetshenziswa imijovo ye-penicillin yokuhlangana. Ngokuthuthukiswa kokutheleleka, ama-antibiotics afanele axhumekile ekwelashweni. Uma i-edema yamakhemikhali ikhula, ukwelashwa nge-corticosteroids, i-diuretics iyadingeka, futhi kwenziwa umoya omncane owenziwe.
Izimo ze-Optimum zenzelwe isiguli, ezibandakanya inhlanzeko yomlomo, isikhumba somzimba. Isifo sikashukela esine-ketoacidosis sidinga ukuqashelwa kwewashi. Izinkomba ezilandelayo ziyaqashwa:
- Ukuhlolwa komchamo komchamo, igazi (lapho ungeniswa esibhedlela, bese - - kube nezikhathi ezingama-2-3);
- Ukuhlolwa kwegazi okusheshayo koshukela (ngehora, futhi lapho ushukela ufinyelela ku-13-14 mmol / l - ngokuphumula kwamahora ama-3);
- Ukuhlaziywa komchamo we-acetone (ezinsukwini zokuqala ezi-2 - 2 k. / Usuku, ngokulandelayo - 1 k. / Usuku);
- Ukunqunywa kwezinga le-sodium, potassium (2 k. / Usuku);
- Ukuhlolwa kwamazinga we-phosphorus (uma isiguli sinciphile ngenxa yokungondleki kahle);
- Ukunqunywa kwe-pH yegazi, i-hematocrit (1-2 p. / Day);
- Ukunqunywa kwe-nitrogen, i-creatinine, i-urea;
- Ukuqapha inani lomchamo okhishwe (ngehora kuze kube inqubo evamile yokuchama ibuyiselwe);
- Izilinganiso zokucindezela kwe-Vein;
- Ukuqapha njalo kwe-ECG, ukushaya kwenhliziyo, umfutho wegazi, izinga lokushisa.
Ukwelashwa kwe-ketoacidosis ezinganeni kwenziwa ngokwesikimu esifanayo, kufaka phakathi: imijovo ejwayelekile ye-insulin "esheshayo", ukwethulwa kwezixazululo zomzimba, i-calcium, i-alkalization yegazi. Kwesinye isikhathi i-heparin iyadingeka. Emazingeni okushisa aphezulu, kusetshenziswa amalungiselelo we-antibhakthiki onobubanzi besenzo.
Umsoco we-ketocacidosis
Ukudla okunempilo kuncike ekujuleni kwesimo sesiguli. Ukudla komuntu onesifo sikashukela esimweni esidume kakhulu akufanele kube namafutha, akufakwanga izinsuku ezingama-7-10. Ukudla okunothe ngamaphrotheni kunomkhawulo, futhi ama-carbohydrate egaya (kodwa hhayi ushukela) ayangezwa. I-sorbitol esetshenzisiwe, i-xylitol, inezakhiwo ze-antiketogenic. Ngemuva kokujwayelekile, kuvunyelwe ukufaka amafutha, kepha hhayi ngaphambi kwezinsuku eziyi-10. Bashintsha imenyu ejwayelekile kancane kancane.
Uma isiguli singakwazi ukudla ngokwaso, kwethulwa uketshezi lwabazali, isixazululo sikashukela (5%). Ngemuva kokuthuthuka, imenyu ifaka phakathi:
- Usuku lokuqala: ama-carbohydrate angagayeka kalula (i-semolina, uju, ujamu), isiphuzo esiningi (kuze kufinyelele kumalitha ayi-1,5), amanzi wamaminerali we-alkali (isib. Borjomi);
- Usuku 2: i-oatmeal, amazambane ecubuziwe, ubisi, imikhiqizo yobisi olunoshukela, imikhiqizo yebhikawozi;
- Usuku 3: umhluzi, inyama ecubuziwe yengezwe ekudleni.
Ezinsukwini zokuqala ezi-3 ngemuva kokungcebeleka, amaprotheni ezilwane awafakwa kwimenyu. Baphendukela ekudleni okujwayelekile phakathi nesonto, kepha amafutha kumele ancishiswe kuze kufinyelele izwe lokuncindezela.
Ukuvimbela Ketoacidosis
Ukuhambisana nezinyathelo zokuvimbela kuzogwema i-ketoacidosis. Lokhu kufaka phakathi:
- Ukusetshenziswa komthamo we-insulin ohambelana noshukela;
- Ukuqapha ushukela wegazi (usebenzisa i-glucometer);
- Ukusetshenziswa kwemichilo yokuhlola ukuthola i-ketone;
- Ukuzazisa ngokwakho kwezinguquko zombuso ukuze uguqule ngokuzimela ulungiselele umthamo we-hypoglycemic;
- Ukufundela isifo sikashukela.
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