I-Hyperosmolar coma yisimo esiyingozi esibonakaliswa yinkinga enkulu yesifo se-metabolic futhi sikhula kushukela.
Imvamisa, i-hyperosmolar coma ivela kubantu asebekhulile abanesifo sikashukela esilinganiselayo.
Ezimweni ezingaphezu kwesigamu, lesi simo siholela ekufeni kwesiguli, ngakho-ke kufanele wazi ukuthi ukunakekelwa okuphuthumayo kwenziwa kanjani i-hyperosmolar coma. Kulokhu, kufanelekile ukuqonda izindlela zokuvela kwayo nentuthuko.
Izizathu
Indlela yokuthuthuka kwe-hyperosmolar coma ayiqondakali ngokuphelele ososayensi kuze kube manje.
Ngokuya ngezinhlobo, izixhumanisi ezibalulekile ku-pathogenesis ye-hyperosmolar diabetesic coma yi-plasma hyperosmolarity kanye nokwehla kokuthathwa kwe-glucose amaseli obuchopho.
Ukuthuthukiswa kwayo kuya ngokuhambisana nesizinda sesimo se-hyperosmolarity - kukhuphuke kakhulu uma kuqhathaniswa ne-glucose ejwayelekile ne-sodium esegazini, ngokumelene nesizinda se-diuresis ebalulekile.
Inani elikhulu lalezi zingxube ze-osmotic kakhulu, ezingena buthaka kumaseli wezicubu, zibangela umehluko phakathi kwengcindezi engaphakathi kwengqamuzana noketshezi lwe-pericellular. Lokhu kuholela ekuphepheni kwamangqamuzana, ikakhulukazi ubuchopho. Uma inqubo ikhula, ukuphuma komzimba okujwayelekile kwenzeka.Ukulahleka kwamanzi okuvele kungamaphesenti angama-20 okukhona emzimbeni kungabulala.
Isiguli esinezimpawu ezinjalo sidinga ukwelashwa ngokushesha - ke amathuba okusinda andiswa kakhulu.
Ngaphezu kwalokho, i-microcirculation iyaphazamiseka ebuchosheni, futhi umfutho we-cerebrospinal fluid uyancipha.
Konke lokhu kuholela ekuphulweni okukhulu ekuhlinzekweni kwezinto ezibalulekile kumaseli wobuchopho, okuholela ekuweni kokuwa komzimba. Imvamisa, cishe ikota yeziguli ezakha i-hyperosmolar hyperglycemic coma bezingazi ngezinkinga ezinamazinga kashukela egazini. Lababantu abatholakalanga ukuthi banesifo sikashukela ngokuhamba kwesikhathi, ngoba ngaphambi kokukhubazeka, akuzange kube nezimpawu eziphazamisa kakhulu umuntu.
Izici Ezithinta I-Coma
Ukuba khona kwesifo sikashukela esigulini ngokuvamile akuholeli ekwakhiweni kwe-hyperosmolar coma. Iqoqo lezizathu ezithinta kabi izinqubo ze-metabolic futhi liholele ekuphelisweni komzimba kuholela ekutholakaleni kwalesi sifo.
Izimbangela zokuphelelwa ngamandla kungaba:
- ukuhlanza
- isifo sohudo
- izifo ezithathanayo;
- buthaka wokoma, isimilo sabadala;
- izifo ezithathelwanayo;
- Ukulahleka kwegazi okubalulekile - ngokwesibonelo, ngesikhathi sokuhlinzwa noma ngemuva kokulimala.
Futhi izici zobungozi ezijwayelekile zokukhula kwe-hyperosmolar coma yizinkinga zokugaya ukudla okubangelwa i-pancreatitis noma i-gastritis. Ukulimala nokulimala, i-myocardial infarction nayo ingadala i-coma kubantu abanesifo sikashukela. Enye into ebeka engcupheni ubukhona besifo esenzeka ngokubonakaliswa komkhuhlane.
Imbangela yokuwoxoka ingaba futhi ukwelashwa okungafanele kwezidakamizwa okubekelwe ukwelashwa kwesifo sikashukela. Ikakhulu kaningi, le nqubo iba nokukhula kwe-overdose noma i-hypersensitivity uqobo lapho uthatha inkambo yokugaya noma i-glucocorticoids.
Izimpawu zesifo
I-Hyperosmolar diabetesic coma ikhula ngokushesha ngokwanele. Ukusuka esimweni esijwayelekile somzimba kuya kokhokho, kudlula izinsuku eziningana, futhi kwesinye isikhathi amahora amaningi.
Okokuqala, isiguli siqala ukuhlushwa yi-polyuria eyanda njalo, ihambisana nokoma nobuthakathaka obujwayelekile.
Izimpawu ziyakhula, ngemuva kwesikhashana kuhoxe, ukuphuma komzimba kuvele. Ngemuva kwezinsuku ezimbalwa, futhi nenkambo enkulu yesifo - nangemva kwamahora ambalwa, kuvela izinkinga zohlelo oluphambili lwezinzwa - ukunqwabelana nokushiyeka kokuphendula. Uma isiguli singalutholi usizo oludingekayo, lezi zimpawu ziyanda bese ziphenduka ukhehla.
Ngaphezu kwalokho, ukucatshangelwa kwemizwa, ukwanda kwezicubu zomzimba, ukunyakaza okungalawuleki, i-areflexia kungenzeka. Kwezinye izimo, ukuthuthukiswa kwe-hyperosmolar coma kubonakala ngokukhuphuka kwezinga lokushisa.
I-Hyperosmolar diabetesic coma nayo ingavela ngokuphathwa isikhathi eside kwama-immunosuppressants yisiguli, nangemuva kwezinqubo ezithile zokwelapha.
I-Hemodialysis, ukwethulwa kwezixazululo ezanele ezanele ze-saline, i-magnesia, nezinye izidakamizwa ezilwa nomfutho wegazi ophezulu ziyingozi.
Nge-hyperosmolar coma, izinguquko ze-pathological ekwakhiweni kwegazi ziyatholakala. Inani le-glucose nezinto ze-osmolar landa kakhulu, futhi izidumbu ze-ketone azikho kulokho kuhlaziywa.
Ukunakekelwa okuphuthumayo
Njengoba sekushiwo, lapho kungekho ukunakekelwa kwezokwelashwa okufanele, ukukhohlisa kuyabulala.
Ngakho-ke, kuyaphuthuma ukuhlinzeka isiguli ngokunakekelwa okufanele kwezokwelapha. Izinyathelo ezidingekayo uma kwenzeka kufikelwa i-coma zisegunjini lokunakekelwa elinamandla noma egumbini lokuphuthumayo.
Umsebenzi obaluleke kakhulu ukubuyisa uketshezi olulahlekelwe ngumzimba, ukuletha izinkomba zisezingeni elijwayelekile. Isikhunta sifakwa emzimbeni emzimbeni, futhi ngesamba esibalulekile.
Ehoreni lokuqala lokwelashwa, kuze kufinyelele kumalitha ayi-1,5 uketshezi okwamukelekayo. Esikhathini esizayo, umthamo uyancishiswa, kepha ivolumu yansuku zonke ye-infusions ihlala ibaluleke kakhulu. Emahoreni angama-24, amalitha ayisi-6 kuya kwayi-10 solution athululelwa egazini lesiguli. Kunezikhathi lapho inani elikhulu kakhulu lesisombululo lidingeka, futhi umthamo we-liquid owethulwayo ufinyelela kumalitha angama-20.
Ukwakheka kwesixazululo kungahlukahluka ngokuya ngokuhlolwa kwegazi kwelebhu. Okubaluleke kakhulu kulezi zinkomba kungukuqukethwe kwe-sodium.
Ukuqoqwa kwalesi simo ebangeni le-145-165 meq / l yisizathu sokufakwa kwekhambi le-sodium. Uma ukuhlushwa kuphakeme, izixazululo zikasawoti ziyaphikiswa. Ezimweni ezinjalo, ukwethulwa kwekhambi le-glucose kuqala.
Ukuphathwa kwamalungiselelo we-insulin ngesikhathi se-hyperosmolar coma akuvamile ukwenziwa. Iqiniso ngukuthi inqubo yokuvuselela umzimba uqobo yehlisa izinga loshukela egazini futhi ngaphandle kwezinyathelo ezengeziwe. Ezimweni ezihlukile kuphela, kwenziwa umthamo olinganiselwe we-insulin - kuze kufinyelele kumayunithi ama-2 ngehora. Ukwethulwa komthamo omkhulu wezidakamizwa ezinciphisa ushukela kungakuphazamisa ukwelashwa kwe-coma.
Ngasikhathi sinye, amazinga we-electrolyte ayaqashwa. Uma kuvela isidingo, senziwa kabusha ngezindlela ezamukelwa ejwayelekile kwezokwelapha. Esimweni esiyingozi njenge-hyperosmolar coma, ukunakekelwa okuphuthumayo kubandakanya umoya omncane ophoqelelwe. Uma kunesidingo, kusetshenziswa amanye amadivaysi okusekela impilo.
Umoya omncane ongangeni komoya
Ukwelashwa kwe-hyperosmolar coma kuhlanganisa ukugcwala okuphathelene esiswini. Ukuqeda ukugcinwa kwamanzi okungenzeka kugcwele emzimbeni, i-catheter yomchamo isetshenziswa nakanjani.
Ngaphezu kwalokho, ukusetshenziswa kwezitho zokwelapha ukugcina ukusebenza kwenhliziyo kuyenziwa. Lokhu kuyadingeka, uma kunikezwa iminyaka yobudala yeziguli engena ku-hyperosmolar coma kanye neziningi zezixazululo ezifakwe egazini .. Ngokuvamile kuvela isimo lapho kunokuntuleka kwe-potassium emzimbeni wesiguli. Kulokhu, le nto nayo ingeniswa egazini ngesikhathi sokwelashwa.
Ukwethulwa kwe-potassium kwenziwa ngokushesha ngemuva kokuqala kokwelashwa, noma lapho sekutholwe imiphumela yokuhlaziya okufanelekile amahora angama-2-2,5 ngemuva kokwamukelwa kwesiguli. Kulesi simo, isimo sokushaqazeka siyisizathu sokwenqaba ukuphatha amalungiselelo e-potassium.
Umsebenzi obaluleke kakhulu ku-hyperosmolar coma ukulwa nezifo ezihlangene ezithinta isimo sesiguli. Uma kunikezwe ukuthi enye yezimbangela ezivame kakhulu zokukhohlisa kungaba yizifo ezahlukahlukene, ukusetshenziswa kwama-antibiotic kuvunyelwe. Ngaphandle kokwelashwa okunjalo, amathuba emphumela omuhle ancishisiwe.
Esimweni esifana ne-hyperosmolar coma, ukwelashwa kufaka nokuvikela i-thrombosis. Lesi sifo singenye yezinkinga ezivame kakhulu ze-hyperosmolar coma. Ukuhlinzekwa kwegazi okunganele okuvela ku-thrombosis ngokwayo kungaholela emiphumeleni emibi, ngakho-ke, ngokuphathwa kwe-coma, ukuphathwa kwezidakamizwa ezifanele kubonisiwe.
Yini ongayenza wena?
Ukwelashwa okuhle kakhulu, yiqiniso, kufanele kuqashelwe njengokuvimbela kwalesi sifo.
Iziguli ezinesifo sikashukela kufanele zilawule ngokuqinile izinga le-glucose futhi zibonane nodokotela uma zikhuphuka. Lokhu kuzovimbela ukuthuthukiswa kokukhohlisa.
Ngeshwa, azikho amakhambi asekhaya angasiza ngempumelelo umuntu ngokwakhiwa kwe-hyperosmolar coma. Ngaphezu kwalokho, ukuchitha isikhathi ngezindlela ezingasebenzi nezindlela ezingasizi isiguli kungaholela emiphumeleni emibi kakhulu.
Ngakho-ke, okuwukuphela kwendlela i-layman engasiza ngayo nge-hyperosmolar coma ukubiza iqembu lodokotela ngokushesha okukhulu noma ngokushesha ukuletha isiguli esikhungweni esifanele. Kulokhu, amathuba esiguli ayanda.
Amavidiyo ahlobene
Isethulo esinolwazi, lapho izimbangela nezimpawu ze-hyperosmolar coma, kanye nemigomo yosizo lokuqala, zihlolwa kabanzi:
Ngokuvamile, isimo esibucayi kangako se-pathological njenge-hyperosmolar coma sisho ukungenelela okufaneleka ngokushesha. Ngeshwa, ngisho lokhu akuhlali kuqinisekisa ukusinda kwesiguli. Amaphesenti okushona kwalolu hlobo lokuthamba aphakama impela, ikakhulukazi ngenxa yengozi enkulu yokuthola ama-pathologies angama-concontitant abhubhisa umzimba futhi amelana nokwelashwa.
