Isifo sikashukela yi-endocrine pathology egcwele izinkinga eziningi ezinzima nezingamahlalakhona. Ukwephulwa kwezinqubo ze-metabolic ezenzeka ngokumelene nesizinda sokumelana ne-insulin kubangela ukungasebenzi kahle kuzo zonke izinhlaka nezinhlelo ezibalulekile.
Enye yezinkinga eziyingozi ukuthuthukiswa kokuhluleka kwezinso. Umphumela wukwephulwa komsebenzi we-excretory, ukuqina kwezinto ezinobungozi emzimbeni. Ngokuphikisana nesizinda se-hyperglycemia, ukuqala kwamandla okuphoqelela ngendlela yokuzilimaza kwe-glucose nokuqongelela egazini inani elikhulu le-lactic acid, engenaso isikhathi sokudululwa ngenxa yenkinga yezinso. Lesi simo sibizwa nge- lactic acidosis. Kudinga ukulungiswa ngokushesha futhi kungaholela ekwakhiweni kwe-lactic acidosis coma.
Imininingwane ejwayelekile
I-Lactic acidosis yohlobo 2 lwesifo sikashukela akuyona isimo esijwayelekile, noma kunjalo, yimbi kakhulu. Umphumela omuhle ubonwa kuphela kumacala ayi-10-50%. I-lactate (i-lactic acid) ivela emzimbeni ngenxa yokuqhekeka kwe-glucose, kepha izinso azikwazi ukuyincenga ngesilinganiso esikhulu kangako.
Imiphumela yokuxilongwa kwelabhoratri - isisekelo sokuqinisekisa ukutholwa
Ukudluliselwa ngokweqile kwegazi elingelinye ne-lactate kuholela ekuguqukeni kweasidi yayo. Ukuxilongwa kuqinisekiswa ngokuthola inani le-lactic acid ngaphezulu kwe-4 mmol / L. Igama lesibili lale nkinga yesifo sikashukela yi-lactic acidosis.
Izizathu eziyinhloko
I-Lactic acidosis yohlobo 2 sikashukela ayitholakali kuzo zonke iziguli, kodwa kuphela ngaphansi kwethonya lezinto ezithile ezisikhathazayo:
Izimpawu ze-Hyperglycemic Coma- i-pathology yezinqubo ze-metabolic zemvelo yamafa;
- ukwethulwa kwenani elikhulu le-fructose emzimbeni, kudlula umgudu wesisu;
- ubuthi botshwala;
- ukulimala kwemishini;
- ukopha
- ukuvuvukala, izifo ezithathelwanayo;
- ubuthi be-cyanide, ukusetshenziswa isikhathi eside kwama-salicylates, ama-biguanides;
- isifo sikashukela i-mellitus, umuthi ongalawuleki, kuhlangene nezinye izinkinga;
- I-hypovitaminosis B1;
- uhlobo olunamandla lwe-anemia.
I-Pathology ayikwazi ukuvela kuphela ingemuva lesifo "esimnandi", kepha futhi ngemuva kokuhlaselwa yisifo senhliziyo.
Indlela yokuthuthukisa
Ngemuva kokuthi ama-carbohydrate angene emzimbeni womuntu ngethambo lesisu, inqubo yokubola kwawo ihlala ngezigaba eziningana. Uma ingekho i-insulin eyanele ekhishwe (lokhu kwenzeka ezigabeni zakamuva zesifo sohlobo 2 ngokuncipha kwamangqamuzana e-pancreatic), ukwehlukaniswa kwezakhamzimba namanzi namandla kuhamba kancane kunokuba kunesidingo futhi kuhambisana nokuqongelelwa kwe-pyruvate.
Ngenxa yokuthi izinkomba eziningi ze-pyruvate ziba phezulu, i-lactic acid iqoqwa egazini. Kuvame ukuthinta ukusebenza kwezitho zangaphakathi ngendlela enobuthi.
I-lactic acid molecule - into ukuqunjelwa kwayo emzimbeni kuholela ekuthuthukisweni kwe-lactic acidosis
Umphumela uba ukukhula kwe-hypoxia, okungukuthi, amangqamuzana nezicubu zomzimba ngeke kutholwe umoya-mpilo owanele, okubuye kwandise isimo se-acidosis. Leli zinga le-pH yegazi liholela eqinisweni lokuthi i-insulin ilahlekelwa ngumsebenzi wayo ngokwengeziwe, futhi i-lactic acid ikhuphuka iba ngaphezulu nangaphezulu.
Ngokuqhubeka kwesimo se-pathological, kwenziwa ikoma lesifo sikashukela, kuhambisana nokudakwa komzimba, ukomisa kanye ne-acidosis. Ukubonakaliswa okunjalo kungabulala.
Izimpawu
Izimpawu ze-lactic acidosis zanda amahora amaningi. Ngokuvamile, isiguli sikhononda ngesithombe esilandelayo somtholampilo:
- ikhanda
- Isiyezi
- ukuphefumula kwenhliziyo kanye nokuhlanza;
- ukungazi kahle;
- Ubuhlungu esiswini;
- umsebenzi wezimoto ongalungile;
- Ubuhlungu bemisipha
- ukozela noma, ngakolunye uhlangothi, ukuqwasha;
- ukuphefumula kaningi okukhulu.
Izimpawu ezinjalo azicacanga, ngoba zingabukwa hhayi kuphela ngokuqongelela kwe-lactic acid, kodwa futhi nangasemuva kwezinye izinkinga ezithile.
I-Coma iwuphawu lwesigaba sokugcina ekwakhiweni kwe-lactic acidosis. Kwandulelwa ukwanda kwesimo sesiguli, ubuthakathaka obukhali, isikhumba esomile nolwelwesi lwama-mucous, ukuphefumula kukaKussmaul (ukuphefumula okusheshayo okunomsindo onesigqi esigciniwe). Ithoni yezamehlo eziguli iyancipha, izinga lokushisa lomzimba lehla laya kuma-35.2-35,5 degrees. Izici zobuso zilukiwe, amehlo ayabubula, umchamo awukho. Ngaphezu kwalokho, kulahleka ukwazi.
Ukuthuthukiswa kwenhliziyo yisigaba sokugcina sokuxinwa kwesifo sikashukela
Inqubo ingakhula ngokwanda kwe-DIC. Lesi yisimo okwenzeka ngaso lapho ukuhlangana kwegazi ngaphakathi emzimbeni, ukwakheka okukhulu kweziqalo zegazi.
Ukuxilonga
Ukuxilongwa kwe-pathology kunzima ngokwanele. Njengomthetho, isimo siqinisekiswa izivivinyo zaselebhu. Egazini kunezinga eliphakeme le-lactate kanye nokukhishwa kwe-anionic kweplasma. Amaphuzu alandelayo akhombisa ukuthuthukiswa kwe-pathology:
- izinkomba ze-lactate ngaphezulu kwe-2 mmol / l;
- izinkomba eziningi ze-bicarbonates engaphansi kwe-10 mmol / l, ecishe iphansi kabili kunokujwayelekile;
- izinga le-nitrogen nokuphuma kwalo egazini kukhuphuka;
- i-lactic acid iphindwe kayishumi kune-asidi yepyruvic;
- inkomba yamafutha inyuswa kakhulu;
- i-acidity ngezansi kwe-7.3.
Amasu okusiza kanye nabaphathi
Usizo lwezokwelapha kufanele luhlose ukulwa nezinguquko kwi-acidity yegazi, ukushaqeka, ukungalingani kwe-electrolyte. Ngokufana, ama-endocrinologists alungisa ukwelashwa kwe-Type 2 sikashukela mellitus.
Njengoba inani elikhulu le-carbon monoxide lakhiwa ngokumelene nesizinda se-acidity yegazi, le nkinga kufanele ibhekwe. Isiguli sihlangabezana nokuhlaselwa kwamaphaphu (uma isiguli singazi, khona-ke ukushutheka kuyadingeka).
I-glucose esebenza ngokufushane nge-insulin ifakwa emthanjeni (ngokulungiswa kokuphazamiseka kwe-metabolic ngokumelene nesizinda senqubo yesifo sikashukela), isixazululo se-sodium bicarbonate. Ama-Vasotonics ne-cardiotonics anqunyelwe (izidakamizwa ukusekela umsebenzi wenhliziyo nemithambo yegazi), i-heparin ne-reopoliglukin zilawulwa ngemithamo emincane. Kusetshenziswa ukuxilongwa kwelabhorethri, amazinga egazi kanye namazinga e-potassium ayaqashwa.
Ukumnika okukhulu kuyingxenye ebalulekile yokwelashwa kwe-diabetesic lactic acidosis
Akunakwenzeka ukwelapha isiguli ekhaya, ngoba ngisho nochwepheshe abaqeqeshiwe kakhulu abakwazi ukuhlala benesikhathi sokusiza isiguli. Ngemuva kokuzinza, kubalulekile ukugcina ukuphumula kombhede, ukudla okuqinile, nokubheka njalo ukucindezela kwegazi, i-acidity noshukela wegazi.
Ukuvimbela
Njengomthetho, akunakwenzeka ukubikezela ukuthuthukiswa kwe-lactic acidosis kuhlobo 2 sikashukela. Impilo yesiguli incike kulabo bantu abamzungezile ngesikhathi sokuthuthuka kwengxaki, kanye neziqu zabasebenzi bezokwelapha abafike ngesidingo.
Ukuze uvimbele ukuthuthukiswa kwe-pathology, izeluleko zokwelapha i-endocrinologist kufanele zibhekwe ngokuqinile, futhi izidakamizwa ezinciphisa ushukela kufanele zithathwe ngomthamo ofanele futhi onembile. Uma uphuthelwe ukuphuza iphilisi, awudingi ukuphuza okuphindwe kabili ngokuzayo lapho umuthi uphuza. Kufanele uphuze inani lomuthi obekwe ngesikhathi esisodwa.
Ngesikhathi sezifo zemvelaphi ethelelekayo noma yegciwane, umuntu onesifo sikashukela angaphendula ngendlela engalindelekile emithini eqediwe. Lapho kuvela izimpawu zokuqala zalesi sifo, kufanele uthintane nochwepheshe ohambele ukulungiswa kwemithamo namarejimthi okwelashwa.
Kubalulekile ukukhumbula ukuthi i-lactic acidosis ayisona isifo "esihamba". Ukufuna usizo ngesikhathi esifanele kuyisihluthulelo somphumela omuhle.
