Ngisho eminyakeni eyi-10 eyedlule, ukumelana ngokuphelele ne-insulin bekubhekwa njengenkinga yabantu abadala.
Manje kunamacala amaningi emitholampilo mayelana nokuxilongwa kwalesi sifo ezinganeni nasebusheni.
Kubafundi bezikole zezokwelapha kunohlu lwezihloko lapho benza khona imisebenzi ezimele engafanele. Okuvame kakhulu yimilando elandelayo yezokwelapha: hlobo 2 sikashukela mellitus, hypertension ye-arterial, i-acute coronary syndrome.
Udokotela wesikhathi esizayo kufanele aqonde ngokuphelele ukwakheka komsebenzi onjalo nezinto eziphambili okufanele zinakwe.
Isineke
Isiguli: UTirova A.P.
Iminyaka engu-65 yobudala
Umsebenzi: uthathe umhlalaphansi
Ikheli lasekhaya: st. Pushkin 24
Izikhalazo
Ngesikhathi zokwamukelwa, isiguli sikhononda ukoma okunzima, umlomo owomile, uphoqelelwa ukuphuza amalitha amane amanzi ngesikhathi sosuku.
Amanothi wowesifazane ukhuphuka ukukhathala. Waqala ukuchama kaningi. Muva nje, ukuqubuka kwesikhumba kanye nomuzwa wokuxinana emilenzeni.
Ucwaningo olwengeziwe luthole ukuthi isiguli siyayeka ukwenza imisebenzi ejwayelekile yasendlini ngenxa yesiyezi, futhi ukuthamba kwaphawulwa kaninginingi. Ngonyaka owedlule, izinhlungu ezingemuva kokuqina kanye nokuphefumula komoya ngesikhathi sokuzivocavoca ngokomzimba bekulokhu kuphazamisa.
Umlando wezokwelapha
Ngokusho kwesiguli, eminyakeni engu-2 eyedlule, ngesikhathi sokuhlolwa okujwayelekile, kwamiswa amazinga okukhuphuka kweglue (7.7 mmol / l).
Udokotela wancoma ukuhlolwa okwengeziwe, isivivinyo sokubekezelela i-carbohydrate.
Owesifazane akazinakanga izincomo zikadokotela, uqhubeke nokuhola indlela yakhe yempilo yangaphambili, maqondana nokukhula kwesifiso sokudla, waba nesisindo esingu-20 kg. Cishe inyanga edlule, ukuphefumula komoya nezinhlungu esifubeni kwavela, kwaqala ukuqaphela ukwanda kwengcindezi yegazi kuya ku-160/90 mm Hg.
Ngokuncoma komakhelwane, wafaka iqabunga leklabishi noju ebunzini lakhe, wafaka isigaxa somhluzi wamazambane, wasethatha u-Aspirin. Mayelana nokwanda okomileyo nokuchama okwengeziwe (ikakhulukazi ebusuku), wafuna usizo lodokotela.
I-Anamnesis yempilo yeziguli
Wazalwa ngoJulayi 15, 1952, ingane yokuqala nokuwukuphela kwayo emndenini.Ukukhulelwa komama kwakujwayelekile. Wayelusa ibele.
Izimo zenhlalo ziphawulwe njengezanelisayo (indlu yangasese enazo zonke izinto). Kutholwe imigomo ngokuya ngeminyaka. Eminyakeni engu-7 ngaya esikoleni, ngangisebenza ngokulingana. Wayenenkukhu futhi isimungumungwane.
Isikhathi sokuzala sasingalingani, ukuya esikhathini kwakuyiminyaka engu-13 ubudala, njalo ngenyanga, kwakungekho buhlungu. Ukuya esikhathini esikhathini esingama-49. Ingabe amadodana amabili amadala, ukukhulelwa nokubeletha kuqhubeke ngokujwayelekile, bekungekho ukukhipha isisu. Eminyakeni engama-25, umsebenzi wokususa i-appendicitis, bekungekho ukulimala. Umlando we-allergic awunasisindo.
Njengamanje osethathe umhlalaphansi. Isiguli sihlala ezimweni zenhlalo ezenelisayo, sisebenze iminyaka engama-30 njengomthengisi esitolo sokwenza izinto zidayizi. Ukudla okungajwayelekile, ama-carbohydrate ayenzeka ekudleni.
Ababelethi bashona sebekhulile, ubaba wami waba nesifo sikashukela sohlobo 2, waphuza amaphilisi anciphisa ushukela. I-Alcohol nezidakamizwa azidli, kubhema ipakethe elilodwa likagwayi ngosuku. Angihambanga phesheya, ngangingahlangani neziguli ezingatheleleki. Kunqatshelwa umlando wesifo sofuba kanye ne-hepatitis yegciwane.
Ukuhlolwa okujwayelekile
Isimo sobukhulu obukhulu. Izinga lokwazi licacile (GCG = 15 amaphuzu), kuyasebenza, kwanele, kutholakala kokuxhumana okukhiqizayo. Isisindo esingu-165 cm, isisindo esingu-105 kg. I-Hypersthenic physique.
Isikhumba siphuzi, sihlanzekile, somile. Ulwelwesi olubonakalayo olubunjiwe lupinki, lumanzi.
I-tishu turgor ethambile iyenelisa, ukuphazamiseka kwe-microcirculatory akukhulunywa. Amajoyinti awonakalisiwe, ukunyakaza kugcwele, akukho ukuvuvukala. Hhayi umkhuhlane. Izizinda ze-lymph azikhuliswanga. Indlala yegilo ayiveliseki.
Ukuphefumula okuzenzakalelayo ngemizila yomoya yemvelo, i-NPV = 16 rpm, izicubu ezisizayo azithinteki. Isifuba sibandakanyeke ngokulinganayo kumjikelezo wokuphefumula, sinesimo esifanele, asikhubazekile, asinhlungu kubuhlungu be-palpation.
I-pathology yokuqhathanisa ne-topographic percussion ayitholakalanga (umngcele wamaphaphu ngaphakathi kwemingcele evamile). I-Auscultatory: Ukuphefumula oku-vesicular, okwenziwe ngokuvumelanayo kuwo wonke amasimu we-pulmonary.
Endaweni yenhliziyo ngesikhathi sokuhlolwa, akukho zinguquko, ukuthambekela kwe-apical akubonwa.
Ukushaywa kwenhliziyo kugxiliwe emithanjeni ye-peripheral, symmetrical, ukugcwaliswa okuhle, ukushaya kwenhliziyo = i-72 rpm, umfutho wegazi 150/90 mm Hg Ngokuqonda, imingcele yokuqonda ngokuphelele nethinta inhliziyo ingaphakathi kwemingcele evamile. I-Auscultatory: Imisindo yenhliziyo igxiliwe, isigqi silungile, imisindo ye-pathological ayizwakali.
Ulimi lome, lumbozwe ngembobo emhlophe empandeni, isenzo sokugwinya asiphuliwe, isibhakabhaka asinazo izici. Isisu sikhuphuka ngevolumu ngenxa yamafutha angaphansi, sibamba iqhaza esenzweni sokuphefumula. Azikho izimpawu zokuphazamiseka kwengqondo okuphathelene ne-portal hypertension.
Nge-palpation emangalisa ngokweqile ye-hernial protrusion and soreness ayizange ibonwe.
Izimpawu Shchetkina - Blumberg negative. I-palpation ejulile ye-sliding inzima ngenxa yamafutha amaningi we-subcutaneous.
Ngokusho kukaKurlov, isibindi asikhulisiwe, emaphethelweni e-arch ebizayo, i-palpation gallbladder ayinabuhlungu. Izimpawu zika-Ortner noGeorievsky azinangqondo. Izinso aziveliseki, ukuchama kumahhala, ukukhuphuka kukhuphukile. Isimo se-Neurological ngaphandle kwezici.
Ukuhlaziywa kwedatha nezifundo ezikhethekile
Ukuqinisekisa ukutholakala kwezifo zokwelashwa, kunconywa izifundo eziningana:
- ukuhlolwa kwegazi komtholampilo: hemoglobin - 130 g / l, erythrocyte - 4 * 1012 / l, inkomba yombala - 0.8, ESR - 5 mm / h, ama-leukocytes - 5 * 109 / l, ama-neutrophils ahlukanisiwe - 3%, i-nuclei ehlukanisiwe - 75%, ama-eosinophils - 3 %, ama-lymphocyte -17%, ama-monocytes - 3%;
- urinalysis: umbala womchamo - utshani, ukusabela - i-alkaline, amaprotheni - cha, ushukela - 4%, amaseli egazi amhlophe - cha, amaseli abomvu egazi - cha;
- ukuhlolwa kwegazi kwe-biochemical: inani lamaprotheni - 74 g / l, albhamuin - 53%, globulin - 40%, i-creatinine - 0,08 mmol / ilitha, urea - 4 mmol / l, cholesterol - 7.2 mmol / l, ushukela wegazi 12 mmol / l.
Kunconywe ukubhekwa kwezinkomba zaselabhoratri ku-Dynamics
Idatha yocwaningo lwensimbi
Imininingwane elandelayo yocwaningo esebenzayo yatholakala:
- electrocardiography: isigqi se-sinus, izimpawu ze-hypertrophy engakwesobunxele;
- isifuba x-ray: Amasimu we-pulmonary ahlanzekile, ama-sinuses akhululekile, izimpawu ze-hypertrophy zenhliziyo yesokunxele.
Ukubonisana kwabachwepheshe abanjengo-neurologist, ophthalmologist nodokotela ohlinza ngemithambo kunconyiwe.
Ukuxilongwa kokuqala
Thayipha isifo sikashukela sesi-2. Ukwehla okulinganiselayo.
Ukuqondiswa kokuxilongwa
Njengoba kunikezwe izikhalazo zesiguli (ukoma, i-polyuria, i-polydipsia), umlando wezokwelapha (ngokweqile okunomsoco wama-carbohydrate), ukuhlolwa kwenhloso (ukwanda kwesisindo somzimba, isikhumba esomile), imingcele yokuhlolwa kwelebhu kanye nethala (hyperglycemia, glucosuria), ukuxilongwa komtholampilo kungenziwa.Okuyinhloko: thayipha isifo sikashukela esi-2, ngokulinganisela, okuncishisiwe.
Concomitant: Izinga eliphakeme le-hypertension 2, 2 degrees, ingozi enkulu. Ingemuva: Ukukhuluphala okunempilo.
Ukwelashwa
Ukunakekelwa kwesibhedlela okunconyelwe esibhedlela se-endocrinological ukuze ukhethe ukwelashwa.
Imodi imahhala. Ukudla - inombolo yetafula 9.
Ukushintshwa kwendlela yokuphila - ukwehla kwesisindo, ukwanda komzimba okwandayo.
Izidakamizwa ze-Oral hypoglycemic:
- I-Gliclazide 30 mg izikhathi ezimbili ngosuku, uthathe ngaphambi kokudla, uphuze nengilazi yamanzi;
- I-Glimepiride 2 mg kanye, ekuseni.
Ukulawulwa kweglucose egazini ngokuguquguquka, nokungasebenzi kahle kwezokwelapha, ukuguqukela ku-insulin.
Ukuhlelwa ngokweqile kwengcindezi yegazi
Lisinopril 8 mg izikhathi 2 ngosuku, ngaphambi kokudla.
Amavidiyo ahlobene
Okuningi ngohlobo 2 sikashukela kuvidiyo:
Kubalulekile ukukhumbula ukuthi uhlobo 2 sikashukela lungalashwa kahle ngokushintshwa kokudla nendlela yokuphila. Ukuxilongwa akusona isigwebo, kepha kuyizaba zokunakekela impilo yakho kuphela.
