Isifo sikashukela i-mellitus siyingozi ngenxa yezinkinga zaso, esinye sazo yi-ketoacidosis.
Lesi yisimo esibi sokuntuleka kwe-insulin okungenzeka, uma kungekho zindlela zokulungiswa kwezokwelapha, okuholele ekufeni.
Ngakho-ke, yiziphi izimpawu ezivelele kulesi simo nokuthi ungavimba kanjani umphumela omubi kakhulu.
I-ketoacidosis yesifo sikashukela: kuyini?
Isifo sikashukela se-ketoacidosis yisimo se-pathological esihambisana nokungasebenzi kahle kwe-carbohydrate metabolism ngenxa yokushoda kwe-insulin, ngenxa yalokho inani le-glucose ne-acetone egazini lidlula kakhulu imingcele evamile yokuziphatha komzimba.
Ibizwa nangokuthi uhlobo olubunjiwe lwesifo sikashukela.. Kungokwesigaba sezimo ezisongela impilo.
Ukuthuthukiswa kwe-ketoacidosis kungabonakala ngezimpawu zomuntu, ezizokhulunywa ngokuhamba kwesikhathi.
Ukuxilongwa kwesimo somtholampilo kususelwa egazini le-biochemical kanye nokuhlolwa komchamo, nokwelashwa kwe:
- isinxephezelo se-insulin yokwelapha;
- ukuphindisela emzimbeni (ukuphinda uqede ukulahleka ngokweqile kwe-fluid);
- ukubuyiselwa kwe-electrolyte metabolism.
Ikhodi ye-ICD-10
Ukuhlukaniswa kwe-ketoacidosis ku-mellitus yesifo sikashukela kuya ngohlobo lwesisekelo sesifo, ekuhlanganisweni kwekhodi okufakwa ".1":- I-E10.1 - ketoacidosis ene-insulin ethembele kwesifo sikashukela;
- I-E11.1 - nge-mellitus engavikelekile nge-insulin;
- I-E12.1 - nesifo sikashukela i-mellitus ngenxa yokungondleki;
- I-E13.1 - nezinye izindlela ezibekiwe zesifo sikashukela;
- I-E14.1 - nezindlela ezingacacisiwe zesifo sikashukela.
Ketoacidosis kushukela
Ukuvela kwe-ketoacidosis ezinhlotsheni ezahlukahlukene zesifo sikashukela kunezimpawu zayo.
Uhlobo olu-1
Isifo sikashukela sohlobo loku-1 sibizwa nangokuthi-insulin-wate, ulutsha.
Kuyindlela ye-autoimmune lapho umuntu ehlala eyidinga i-insulin, ngoba umzimba awuyakhi.
Ukwephulwa kwendalo kungokwemvelo.
Imbangela yokuqalwa kwe-ketoacidosis kuleli cala ibizwa ngokuthi ukuntuleka kwe-insulin ngokuphelele. Uma uhlobo lwe-1 yesifo sikashukela lungatholakalanga ngesikhathi, isimo se-ketoacidotic singase sibe isibonakaliso se-pathology eyinhloko kulabo ababengazi ngokuxilongwa kwabo, futhi ngenxa yalokho abakutholanga ukwelashwa.
Izinhlobo ezi-2
Isifo sikashukela sohlobo 2 siyindlela yokutholwa lapho i-insulin yenziwe emzimbeni.
Esigabeni sokuqala, inani laso lingahle libe yinto evamile.
Inkinga umuzwa wokuncipha kwezicubu esenzweni saleli protein le-protein (elibizwa ngokuthi yi-insulin ukumelana) ngenxa yezinguquko ezibhubhisayo kumaseli we-pancreatic beta.
Ukuntuleka kwe-insulin okuhlobene. Ngokuhamba kwesikhathi, njengoba i-pathology ikhula, ukukhiqizwa kwe-insulin yakho kuyehla, futhi kwesinye isikhathi kuvimbela ngokuphelele. Lokhu kuvame ukufaka ukukhula kwe-ketoacidosis uma umuntu engatholi ukwesekelwa okwanele kwemithi.
Kunezizathu eziqondile ezingavusa isimo se-ketoacidotic esibangelwa ukuntuleka okukhulu kwe-insulin:
- isikhathi esilandela izindlela ezedlule zokusungula imizwa, kanye nokulimala;
- isimo sokusebenza ngemuva kokuhlinzwa, ikakhulukazi uma ukungenelela kokuhlinzwa kuhlangene nama-pancreas;
- ukusetshenziswa kwemithi ebhekiswe ku-mellitus yesifo sikashukela (ngokwesibonelo, ama-hormone ngamanye kanye nama-diuretics);
- ukukhulelwa kanye nokuncelisa okwalandela.
Iziqu
Ngokuya kobukhulu besimo, i-ketoacidosis ihlukaniswe ngama-degree ama-3, ngalinye lihlukile ekubonisweni kwalo.
Imnene iboniswe kulokho:
- umuntu uhlushwa ukuchama kaningi. Ukwehla okwenziwe uketshezi kuhambisana nokoma okungapheli;
- "dizzy" kanye nekhanda, ukozela okungapheli kuyazwakala;
- ngokumelene nesizinda se-nausea, isifiso sokudla siyancipha;
- ubuhlungu esifundeni se-epigastric;
- umoya ophele ngamakhala we-acetone.
Isilinganiso le degree ikhonjiswa ngokuwohloka futhi ibonakaliswa iqiniso lokuthi:
- ukwazi kudideka; ukusabela kwehlisa ijubane;
- ama-tendon ekhalipha ancishisiwe, futhi ubukhulu babafundi cishe abushintshiwe kusukela ekuchayelweni kokukhanya;
- i-tachycardia ibonwa ngemuva kwesizinda somfutho wegazi ophansi;
- kusuka kwipheshana emathunjini, kufakwa izimbumbulu nezithulu ezikhululekile;
- imvamisa yokuchama iyancishiswa.
Isindayo iziqu zivezwa ngu:
- ukuwela esimweni sokungazi lutho;
- ukuvimbela kwezimpendulo ze-reflex zomzimba;
- Ukunciphisa abafundi ngokungatholakali ngokuphelele kokukhanya;
- ukuba khona okubonakalayo kwe-acetone emoyeni okhipha umoya, noma kukude kude nomuntu;
- Izimpawu zokuphelelwa amandla emzimbeni (isikhumba esomile nesilungu se-mucous);
- ukuphefumula okujulile, okungavamile futhi okunomsindo;
- ukwanda kwesibindi, okubonakalayo phezu kwe-palpation;
- ukukhuphuka koshukela wegazi kuya ku-20-30 mmol / l;
- ukugcwala okukhulu kwemizimba ye-ketone emchameni nasegazini.
Izizathu zokuthuthuka
Imbangela evame kakhulu yeketoacidosis uhlobo lwesifo sikashukela 1.
Isifo sikashukela se-ketoacidosis, njengoba kushiwo ngaphambili, senzeka ngenxa yokushoda (ngokuphelele noma isihlobo) se-insulin.
Kwenzeka ngenxa:
- Ukufa kwamaseli we-pancreatic beta.
- Ukwelapha okungalungile (inani elanele le-insulin elilungiselelwe).
- Ukudla ngokungahambisani namalungiselelo we-insulin.
- Ukugxuma okubukhali kwesidingo se-insulin nge:
- izilonda ezithathelwanayo (i-sepsis, inyumoniya, i-meningitis, i-pancreatitis nabanye);
- izinkinga ngomsebenzi wezitho zesistimu ye-endocrine;
- imivimbo nokushaya kwenhliziyo;
- ukuchayeka ezimweni ezicindezelayo.
Kuzo zonke lezi zimo, isidingo esandayo se-insulin sibangelwa ukwanda kokuqashelwa kwama-hormone okuthintela ukusebenza kwawo, kanye nokungazweli kwezicubu ezanele esenzweni saso.
Izimpawu
Izimpawu ze-ketoacidosis zachazwa ngokuningana ngenhla uma kukhulunywa ngobubi balesi simo. Izimpawu zesikhathi sokuqala zanda ngokuhamba kwesikhathi. Kamuva, ezinye izimpawu zokuphazamiseka kwezinkinga nokuqina kwesimo kuyenezelelwa kukho.
Uma sikhipha iqoqo lezimpawu "zokukhuluma" ze-ketoacidosis, khona-ke lokhu kuzoba:
- i-polyuria (ukuchama kaningi);
- i-polydipsia (ukoma okungapheli);
- i-exicosis (ukomisa komzimba) kanye nokomisa okuphumayo kwesikhumba nolwelwesi lwama-mucous;
- ukwehla ngokushesha kwesisindo kusuka ekutheni umzimba usebenzisa amafutha ukukhiqiza amandla, ngoba i-glucose ayitholakali;
- Ukuphefumula kweKussmaul kungenye indlela ye-hyperventilation ku-ketoacidosis yesifo sikashukela;
- ubukhona be-"acetone" obucacile emoyeni ophelelwe yisikhathi;
- ukuphazamiseka komgudu wamathumbu emathunjini, kuhambisana nokucanuzelelwa nokuhlanza, kanye nobuhlungu besisu;
- ukonakala okuthuthuka ngokushesha, kuze kufike ekwakhiweni kwesigaxa se-ketoacidotic.
Ukuxilongwa nokwelashwa
Imvamisa, ukuxilongwa kwe-ketoacidosis kuyinkimbinkimbi ngokufana kwezimpawu ngazinye nezinye izimo.
Ngakho-ke, ukuba khona kwe-nausea, ukugabha nobuhlungu ku-epigastrium kuthathwa njengezibonakaliso ze-peritonitis, futhi umuntu uphela emnyangweni wokuhlinzwa esikhundleni se-endocrinological.
Ukuthola i-ketoacidosis yesifo sikashukela mellitus, izinyathelo ezilandelayo ziyadingeka:
- ukubonisana nodokotela we-endocrinologist (noma udokotela wesifo sikashukela);
- ukuhlaziywa kwe-biochemical of umchamo negazi, kufaka phakathi i-glucose kanye nemizimba ye-ketone;
- i-electrocardiogram (ukukhipha infarction ye-myocardial);
- i-radiography (ukubheka ama-pathologies wesibili wokutheleleka wohlelo lokuphefumula).
Udokotela unquma ukwelashwa okusekelwe emiphumeleni yokuhlolwa nasekuxilongweni komtholampilo.
Lokhu kunaka imingcele efana:
- izinga lobukhulu besimo;
- isilinganiso sobukhulu bezimpawu ezibolekayo.
Ukwelapha kuqukethe:
- ukuphathwa kwe-intravenous kwezidakamizwa eziqukethe i-insulin ukwenza ngokwejwayelekile inani le-glucose egazini, ngokubheka isimo njalo;
- izindlela zokuphelelwa ngamanzi emzimbeni okuhlose ukugcwalisa uketshezi oluhoxiswe ngokweqile. Imvamisa lokhu kwehla nge-saline, kepha kukhonjiswa isisombululo seglue ukuvimbela ukuthuthukiswa kwe-hypoglycemia;
- izindlela zokubuyisela inkambo ejwayelekile yezinqubo ze-electrolytic;
- Ukwelashwa kwe-antibacterial. Kuyadingeka ukuvimbela izinkinga zokutheleleka;
- ukusetshenziswa kwama-anticoagulants (imishanguzo ehlisa umsebenzi wegazi), ekuvimbeleni i-thrombosis.
Izinkinga
Isikhathi sokukhula kwe-ketoacidosis singasukela emahoreni ambalwa siye ezinsukwini eziningana, kwesinye isikhathi isikhathi eside. Uma ungathathi izinyathelo, kungadala izinkinga eziningi, phakathi kwazo:
- Ukuphazamiseka kwemetabolic, ngokwesibonelo, okuhambisana "nokukhipha" izinto ezibalulekile zokulandela umkhondo ezifana ne-potassium ne-calcium.
- Ukuphazamiseka okungasebenzi kwe-metabolic. Phakathi kwazo:
- ukuthuthukiswa okusheshayo kwama-pathologies athelelekayo wokutheleleka;
- ukwenzeka kwezimo zokushaqeka;
- i-arterial thrombosis ngenxa yokuphelelwa ngamandla komzimba;
- i-pulmonary kanye ne-edema yobuchopho;
- coma.
Isifo sikashukela sikashukela ketoacidotic
Lapho izinkinga ezinkulu ze-carbohydrate metabolism ezibangelwa i-ketoacidosis zingaxazululwa ngendlela yesikhathi esifanele, kuba nengxenye ebeka impilo yomdlavuza ketoacidotic.
Kwenzeka ezimweni ezine kwezikhulu, ngokufa kwabantu abaneminyaka engaphansi kwengama-60 kuye kuma-15%, nakwisifo sikashukela esidala - 20%.
Lezi zimo ezilandelayo zingadala ukukhula komkhovu:
- umthamo omncane kakhulu we-insulin;
- ukweqa umjovo we-insulin noma ukuthatha amaphilisi okwehlisa ushukela;
- ukukhanselwa kokwelashwa okulinganisa inani le-glucose egazini, ngaphandle kwemvume kadokotela;
- isu elingalungile lokuphatha ukulungiselela i-insulin;
- ukuba khona kwama-pathologies afanayo nezinye izici ezithinta ukuthuthukiswa kwezinkinga ezinzima;
- ukusetshenziswa kwemithamo yotshwala engagunyaziwe;
- ukuntuleka kokuziqapha kwesimo sempilo;
- ukuthatha umuthi ngamunye.
Izimpawu zesifo se-ketoacidotic coma ikakhulu sincike esimweni saso:
- ngesimo sesisu, kubonakaliswa izimpawu ze "peritonitis yamanga" ezihambisana nokuphulwa kohlelo lokugaya ukudla;
- ngesifo senhliziyo, izimpawu eziyinhloko ukungasebenzi kahle kwenhliziyo nemithambo yegazi (hypotension, tachycardia, pain pain);
- kwifomu lezinso - ukushintshana ngokuchama okungajwayelekile ngezikhathi ze-anuria (ukuntuleka kwesifiso sokukhipha umchamo);
- nge-encephalopathic - kuvela iziyaluyalu ezinzima zokujikeleza kwegazi, okukhonjiswa ngamakhanda nesiyezi, ukuwa kwe-acuity ebonakalayo nokucanuzelelwa kwenhliziyo.
Ukuhlanganiswa kwe-ketoacidotic coma ngokuhlaselwa yisifo senhliziyo noma izinkinga zokujikeleza kobuchopho, kanye nokungatholakali kokwelashwa, ngeshwa kunikeza umphumela obulalayo.
Ukunciphisa ubungozi bokuqala kwesimo okuxoxwe ngalo kule ndatshana, izindlela zokuvimbela kumele zibhekwe:
- ngokushesha futhi ngokunembile uthathe umthamo we-insulin obekwe udokotela wakho;
- gcina imithetho esetshenzisiwe yokudla;
- funda ukulawula isimo sakho futhi uqaphele izimpawu zezinto eziwohlayo ngesikhathi.
Ukuvakasha njalo kudokotela kanye nokusebenza ngokuphelele kwezincomo zakhe, kanye nokunaka impilo yakhe, kuzogwema izimo ezinobungozi nezingozi ezifana ne-ketoacidosis kanye nezinkinga zayo.
