Imininingwane yokubaluleka okubalulekile: izimpawu nezimpawu zokusondela kwesifo sikashukela

Isifo sikashukela yisifo esiyingozi kakhulu.

Kubonakala ngokuqukethwe okukhuphukile noma okunoshukela wegazi ophakeme kuyi-plasma yegazi lesiguli ngenxa yokuntuleka kokuvikelwa kwe-insulin nokuphikiswa kwe-insulin ezingeni lamaselula, okuvusa ukungasebenzi kahle ezinhlelweni eziningi zomzimba.

Inkinga enkulu kakhulu kule pathology ukukhohlisa kwesifo sikashukela. Ngokungenelela okungalindelekile futhi kuphuthumayo, kungaholela ekufeni. Ngaphezu kwalokho, izinkomba zikashukela ezinesifo sikashukela zingenzeka ngazo zombili izinhlobo zesifo sikashukela, ezine-hyperglycemia ne-hypoglycemia.

Kuyini ukukhohlisa sikashukela?

I-Coma yisimo esibucayi, esibucayi kakhulu lapho izinqubo ze-metabolism kanye ne-metabolic ziphazamiseka. Ngenxa yalokhu, onesifo sikashukela uqongelela ama-metabolites ayingozi futhi anobuthi, athinta kabi ukusebenza kwawo wonke amasistimu, kufaka phakathi isistimu yezinzwa ephakathi.

Izinhlobo nezimbangela

Isifo sikashukela, ukwehluleka okukhulu kwama-hormone kwenzeka.

Ngokuya ngebhalansi yezindlela ezahlukahlukene zokucindezela emzimbeni, izinhlobo ezahlukahlukene zama-com ziyahlukaniswa:

• ketoacidotic;
• i-hyperosmolar;
• i-lactacidemic;
• hypoglycemic.

Lolu hlobo noma lolu hlobo lokukhohlisa luphawula ubungozi nobungozi besifo sikashukela ngokungalulami, ukwelashwa okungafundile noma ukungatholakali ngokuphelele kokunakekelwa kwempilo.

I-ketoacidotic coma yenzeka ngesifo sikashukela sohlobo 1 (okuvamisile - uhlobo 2). Ikhula kancane ngenxa yokungabi bikho ngokuphelele kwe-insulin yemvelo ngenxa yokungalingani okukhulu kwe-carbohydrate metabolism.

Kulesi simo, amangqamuzana awakwazi ukudonsa ushukela abawadingayo, ngoba i-insulin ingumqhubi othize woshukela nge-membrane yabo. Lokho wukuthi, izinga likashukela we-plasma liyakhuphuka, kepha amaseli awalitholi. Lokhu kuholela ekuntulekeni kwamandla kanye nokudangala ezingeni lamaselula.

Indlela yokuqhekeka kwamafutha (i-lipolysis) iyenziwa ngenkani, i-metabolism yamafutha acid kanye nokuqongelelwa kwama-lipid metabolites, okuyimizimba ye-ketone, ayathuthukiswa.

Ngokwe-metabolism ejwayelekile yama-carbohydrate namafutha, izidumbu ze-ketone ezakhiwe zithunyelwa yizinso, kepha ku-ketosis yesifo sikashukela, ziqongelela kakhulu egazini.

Izinso azikwazi ukubhekana nokukhululwa kwama-lipid metabolites amaningi.Ngalesi simo, imizimba ye-ketone isebenzisa umthelela wayo onobuthi ohlelweni lwezinzwa olusezingeni eliphakathi kanye nezinye izinhlelo, okuholela ekutholakaleni kwe-ketoacidotic coma.

Ngalesi sifo, kunqunywa izinga eliphezulu likashukela esigulini. I-coma enjalo iyisimo esibucayi futhi esiyingozi kakhulu esidinga ukungenelela kwezokwelashwa ngokushesha.

Ngaphandle kwalokhu, kungaholela emonakalweni omkhulu ongalungiseki ohlelweni oluphambili lwezinzwa nokufa. I-Coma yalolu hlobo yenzeka ikakhulukazi ezigulini ezingelashwa ngendlela engafanele, kanye nangokukhanselwa okuzimele kokwelashwa kwe-insulin.

Inqubo yokubonakaliswa nokwenzeka kwe-ketoacidotic coma ingahlukaniswa ngezigaba ezintathu:

• ngokulinganiselayo noma ekuqaleni kwalokho, lapho izimpawu zingahambisani noma zithambile, zingaqhubeka kuze kube amasonto ambalwa;
• ukubola, lapho isiguli sesikhulumile izimpawu ze-ketoacidosis;
• coma.

I-Hyperosmolar coma ibonakaliswa yi-hyperglycemia ebizwayo. Izimpawu zibonakaliswa amandla amabi we-carbohydrate metabolism futhi aboniswa ukwephulwa kwengcindezi ye-osmotic eplasma.

Lokhu kuholela ekushintsheni kwezimpawu zalo zokuphila futhi, ngenxa yalokho, ekusebenzeni kabi kuzo zonke izinhlelo ezibalulekile emzimbeni. Lolu hlobo lwe-coma lwenzeka ngenxa yokumelana ne-insulin ngohlobo 2 sikashukela futhi kutholakala kakhulu ezigulini esezikhulile (ezineminyaka engama-50).

I-Hyperglycemic coma ikhula kancane, ngokwanda kancane kancane kwezimpawu. Ngalesi sifo, ukulashwa esibhedlela okuphuthumayo nezindlela zokwelapha ziyadingeka ukulungisa isimo sesiguli.

Ukungenelela okungazelelwe kwezokwelapha kungaholela ekulimaleni kobuchopho obulalayo.

I-Hyperglycemic coma yisimo esibi kakhulu, ukufa kwabantu kungama-50%. Ngakho-ke, isikhathi esidlulile ekuboneni i-pathology kuya ekuqaleni kwezinyathelo ezidingekayo zokwelapha kubaluleke kakhulu.

I-Lactacidemic coma yisimo esiyingozi futhi esiyingozi lapho umphumela obulalayo ubonwa emaphesenti angama-75 wamacala. Kuyinto evamile kunezinye izinkinga ezinkulu zesifo sikashukela futhi ibizwa nangokuthi yi-lactic coma.

Le nkinga iba nesifo sikashukela uma iqhathaniswa nemvelaphi yezifo ezenzeka ndawonye (ukulahleka okukhulu kwegazi, ukufakwa kwe-myocardial infarction, inqubo yokutheleleka okunesifo, ukuhluleka kwe-renal kanye ne-hepatic, ukukhathala okungapheli kanye nokuzikhandla komzimba okukhulu).

Isici esiyinhloko se-lactacidemic coma ukuthi izimpawu zivele kungazelelwe futhi ngokushesha okukhulu ngezidakamizwa ezingezinhle ze-pathological. I-Hypoglycemic coma ibonakala ngokuncipha kwamazinga kashukela futhi ihlala itholakala kakhulu kusifo sikashukela sohlobo 1.

Kwenzeka ngenxa yokuthi isiguli siqala ukufaka umthamo we-insulin overestimated bese siveza ukuzikhandla ngokweqile komzimba.

Esinye isizathu i-pancreatic insulinoma, eqala ukukhiqiza i-insulin eningi kakhulu, ukugcwala kwe-glucose glucose kuyancipha, konke kudlulela emangqamuzaneni.

Izicubu zomgogodla (ikakhulukazi, ubuchopho) zinenkinga yalokhu, okudala izimpawu nezimpawu zomtholampilo zalolu hlobo lomthambo. Ngokulashwa okufika ngesikhathi, i-hypoglycemic coma imiswa ngokushesha.

Ukuze uthole lokhu, ungasebenzisa ukuphathwa kwe-glucose okungamaphesenti angama-40. Uma ungamniki isiguli usizo, kungahle kube nomonakalo omkhulu ohlelweni lwangaphakathi lwezinzwa, kuze kufike ekulahlekelweni kwengxenye yemisebenzi yomzimba.

Yiziphi izimpawu kanye nezimpawu zokuphazamiseka kwesifo sohlobo 1 nohlobo 2 lwesifo sikashukela?

Uhlobo ngalunye lukakhoma lwandulelwa yizimpawu ezithile. Ngohlobo 1 sikashukela, zivame ukubizwa kakhulu, kepha akudingekile. Kufanele ubanake futhi, uma uzizwa ungathandeki, shayela udokotela ngokushesha.

Nazi ezinye zezimpawu zesimo esibucayi:

• Ngaphambi kokuba kudaleke i-ketoacidotic, umuntu uhlangabezana nobuthakathaka obuqhubekayo, ukoma okhubazayo nge-diuresis eyengeziwe, isifiso sokuhlanza nokuphelelwa yisifiso sokudla. Ngesikhathi sokuphefumula kanye nokuphuma komchamo, kuzwakala iphunga elinamandla le-acetone (acidosis). Kubonakala amabala abomvu esihlathini, esifana nokuqhuma (i-hyperemia yobuso);
• I-hyperosmolar coma yandulelwa ukukhathala nobuthakathaka, ukomisa okhubazayo ngokubonakaliswa kokuqina kolwelwesi lwamafinyila, ukozela, ukuchama kaningi, ukoma kanye nokuncipha kokuqina kwesikhumba, ukufupheka komoya ngokubonakaliswa kwe-asphyxiation;
• Ngaphambi kokuba kukhubazeke i-lactacidemic, buthakathaka futhi kubuzwe izinhlungu zemisipha, ukukhathazeka, ukozela kuhambisane nokuqwasha, kubhalwe ubuhlungu be-spasmolytic esiswini ngokuhlanza. Ngomfutho omubi, kukhona ukulahleka kwe-reflexes ne-paresis ngenxa yokulimala kobuchopho;
• Ngaphambi kokuba kudaleke i-hypoglycemic, isiguli sizwa umuzwa wokulamba, ubuthakathaka, ukuqina, ukuqina kwemilenze, ukuthuthumela, ukujuluka, isiyezi. Ukuphefumula okumbalwa nokuphefumula kancane. Ukulahlekelwa okungenzeka kokungazi.

Kepha kunezimpawu zokubonakala kwezinhlobo eziningi zecom. Kumele ziqwashise umuntu onesifo sikashukela, noma ngabe engenazo ezinye izimpawu:

• ukoma okukhulu nokuchama okusheshayo. Enye yezimpawu ezibaluleke kakhulu zangaphandle ukuthi umuntu unesifo sikashukela. Kungaba futhi i-harbinger ye-ketoacidotic noma i-hyperosmolar coma;
• ikhanda kanye nomfutho wegazi ophansi. Izimpawu ezibonisa ukuqala kwe-lactacidemic noma i-hypoglycemic coma. Izimpawu ezidinga ukunakekelwa kwezokwelashwa okuphuthumayo;
• ukudideka, ubuthakathaka. Uma isiguli sibhekana nobuthakathaka, ukukhathala, ukunyakaza kwakhe kuyehla, nemicabango yakhe idideke, lesi simo singabonisa ukonakala kwe-ketoacidotic noma i-hypoglycemic;
• ukuphefumula okujulile okunomsindo. Isibonakaliso esinjalo siyabonakala nge-lactacidemic coma futhi sidinga ukungenelela ngokushesha;
• ukugcwala kwenhliziyo kanye nokuhlanza. Zenzeka nge-ketoacidotic ne-lactacidemic coma futhi ziyizimpawu eziphazamisa kakhulu;
• iphunga lomlomo. Isibonakaliso sokuxilonga esiyingqayizivele siyisibonakaliso esiyinhloko se-ketosis yesifo sikashukela. Futhi, umchamo wesiguli ungaba nephunga njenge-acetone;
• ezinye izinkomba zokukhohlisa kukashukela. Ngaphezu kwalezi zimpawu ezingenhla, iziguli zingase zizwe ukulahleka okubukhali kokubona, ukushesha, ukungabekezeki, ukuncipha kokuqina, ukushaya kwenhliziyo okusheshayo, ukwethuka, ukuphazamiseka kokukhuluma, umuzwa wokwesaba nokukhathazeka, ukuzindonda kolimi.

Imiphumela engaba khona ebuchosheni nakwezinye izitho zomzimba

Nge-coma noshukela wegazi ophakeme, i-lipid metabolism iyaphazamiseka, i-lipid peroxidation iyathuthukiswa, ethinta kabi futhi ibhubhise ama-neurons, ibangele isifo sohlangothi kanye nokuwohloka komqondo (isifo i-Alzheimer ingaqala kwabesifazane asebekhulile).

I-glucosuria ye-Urinary iholela ekulimaleni kwezinso nasekuthuthukiseni ukuhluleka kwe-renal acute. Kulesi simo, ibhalansi ye-electrolyte yegazi iyaphazamiseka (maqondana ne-acidization), okucasulayo uhlobo oluhlukile lwe-arrhythmia. Ukuqongelelwa kwama-metabolic ama-metabolic anobuthi emzimbeni kuholela ekulimaleni kwesibindi okukhulu (i-cirrhosis, i-hepatic coma).

Ngomqondo we-hypoglycemic coma, usongo olukhulu ukulimala kwengqondo okungalungiseki, ngoba ama-neurons awatholi amandla anele ngesimo se-glucose futhi aqale ukufa ngokushesha, okuholela ekushintsheni kobuntu, ukwehla komqondo, ingane ingantula ubuhlakani.

Usizo lokuqala

Isifo sikashukela esinesifo sikashukela singaba nezimbangela nezimpawu ezahlukahlukene. Kunzima kumuntu ojwayelekile ukuthola lokhu, futhi esimweni esiphuthumayo, isenzo esingenzi nzuzo singalimaza kakhulu.

Ngakho-ke, nge-coma, usizo lokuqala oluhle kakhulu lwesiguli luzoba ucingo oluphuthumayo oluvela kudokotela.

Isimo sezulu

Kuzo zonke izinhlobo zikashukela onesifo sikashukela, i-prognosis ihlala icophile kakhulu, ngoba konke kuncike ekunakekelweni kwezokwelashwa okuqeqeshiwe. Ngefomu le-lactacidemic, cishe kuhlala kungathandeki.

Amavidiyo ahlobene

Izimpawu nosizo lokuqala lwe-coma yesifo sikashukela:

Wonke umuntu onesifo sikashukela kudingeka azi ukuthi ukukhohlakala kwesifo sikashukela akuyona imiphumela edingekile futhi engenakugwenywa yalesi sifo. Njengomthetho, ukhula ngephutha lesiguli uqobo.

Esikhathini sikashukela, kufanele uqonde ngokucophelela izimbangela zalokhu kugula, ulandele zonke izincomo zodokotela. Indlela ehlanganisiwe nokunakekela impilo yomuntu uqobo kuphela ezosiza ukuthuthukisa ikhwalithi yempilo futhi igweme ukonqena.