Usizo Lokuqala Lwesifo Sikashukela

Isifo sikashukela i-mellitus yisifo esiyingozi, esibonakala ngokunyuka okubukhali ushukela wegazi, hhayi kuphela phezulu, kepha phansi. Konke lokhu kuholela ekuthuthukisweni kwe-hyperglycemic noma i-hypoglycemic coma, evame ukubulala iziguli. Ngakho-ke, lapho kuvela izimpawu zokuqala zalezi zimo, onesifo sikashukela kumele anikeze usizo lokuqala ngokushesha. Futhi yini indinganiso yokunakekelwa kwesifo sikashukela, manje uzothola.

Kafushane ngalesi sifo

Isifo sikashukela sikhula kulezi zimo ezilandelayo:

• ukushoda kwe-insulin emzimbeni (uhlobo 1 sikashukela, kubizwa nangokuthi kuya nge-insulin);
• kwehlise ukuzwela kwamangqamuzana ukuya ku-insulin (uhlobo 2 sikashukela).

I-insulin yi-hormone ephula futhi ifaka ushukela. Siyabonga kuye ukuthi umzimba uthola amandla adingekayo ekusebenzeni kwawo okujwayelekile. Ama-pancreas abhekele ukukhiqizwa kwe-insulin. Uma kwenzeka kulimala amangqamuzana akhe, le nqubo iyaphazamiseka bese kuqala ukukhula kwesifo sikashukela.

I-T2DM, njengomthetho, iyatholakala emvelweni futhi ikhula ngokuqhamuka ngemuva kokungondleki kahle, indlela yokuphila engenzi lutho, ukusetshenziswa kabi kotshwala, njll. Ukuthuthuka kwesifo sikashukela sohlobo 1 kuvame ukubangelwa isimo sofuzo futhi kutholakala ikakhulu ebuntwaneni.

Kubaluleke kakhulu ukulawula isifo sikashukela sohlobo loku-1 ezinganeni, ngoba ukubonakala kwalo kuholela ekwephulweni kwe-carbohydrate metabolism emzimbeni, okuphumela ekuzuzeni ngokushesha kwesisindo. Lokhu kungayilimaza kabi impilo yengane ephelele futhi kuvuse ukukhula kwezinye izifo eziyingozi ngokulinganayo, kufaka phakathi isifo se-cholesterol, imithambo ye-varicose (ngokuvamile izimpawu zokuqala zenzeka eminyakeni eyi-12-16), i-thrombophlebitis, i-pathologies yesistimu yenhliziyo kanye njll.

Izimpawu eziphambili zesifo sikashukela yilezi:

• umlomo owomile nokoma okungapheli;
• ukunciphisa isisindo (nge-T1DM) noma ukukhuphuka kwayo (nge-T2DM);
• amanxeba amade okuphulukisa nokusika esikhunjeni;
• ukukhuphuka kokujuluka;
• ubuthakathaka bemisipha;
• ukomiswa nokulunywa kwesikhumba.

Njengoba kushukela, i-glucose iyayeka ukudonswa amangqamuzana bese inqwabelana egazini, ukuphuma kwayo emzimbeni kuvela ezinsweni ngomchamo. Lokhu kunikeza umthwalo oqinile kwizitho zohlelo lomchamo, ezingavusa ukubonakala kwezinye izimpawu, ngokwesibonelo:

• ukuchama njalo;
• Ubuhlungu esiswini;
• isicanucanu
• ukuncipha komzimba.

Ukungondleki kuyimbangela ejwayelekile yesifo sikashukela kubantu abasha.

Ngenxa yokuthi inqubo yokuthathwa koshukela ngamangqamuzana iyaphazamiseka, umzimba uqala ukudonsa amandla ezitolo zawo, okungukuthi kusuka kumadiphozithi amafutha. Ukuthola amandla kubo kuthatha amandla amaningi emzimbeni futhi kuvuse ukuvela kwemizimba ye-ketone egazini. Nazo, ziholela ekubonakala kwezinkinga ezahlukahlukene, phakathi kwazo kukhona i-hyperglycemic coma ne-ketoacidosis.

I-ketoocytosis yisimo esibi kakhulu esingabulala. Ngakho-ke, lapho kwenzeka, kudingekile ngokushesha ukusiza onesifo sikashukela.

I-ketoocytosis ibonakala ngezimpawu ezilandelayo:

• ukuphazamiseka kwesigqi senhliziyo;
• ukoma okukhulu;
• ukunciphisa ukuphuma komchamo;
• ukubonakala kwephunga le-acetone elivela emlonyeni;
• isifo sohudo
• isicanucanu nokuhlanza
• indlala yesikhumba;
• kunciphise ukusebenza kobuchopho, njll.

Ukunciphisa nokwandisa ushukela wegazi ngaphezu kwemingcele ejwayelekile nakho kuyingozi esigulini. Uma, ekuqaleni kwe-hypoglycemia noma i-hyperglycemia, isiguli singeke sinikezwe ukunakekelwa kwezokwelapha ngesikhathi, izingozi zokuthola i-hypoglycemic noma i-hyperglycemic coma zanda kaningana. Futhi bangaholela ekufeni endabeni yamahora, i-edema yamakhorali, ukulahleka kombono, njll.

Ushukela wegazi

Futhi ukuvimbela ukukhula kwalezi zimo, abanesifo sikashukela kudingeka balinganise ushukela wegazi labo njalo nge-glucometer futhi bathathe izinyathelo zokuyilawula. Esimweni lapho ukuzihlola ngokwakho kuveza ukwanda okuqhubekayo kweglucose yegazi kanye nemizimba ye-ketone (amanye amamodeli wama-glucometer nawo awalinganisa nawo), kufanele uvakashele udokotela ngokushesha futhi umazise ngezinkinga eziqubukile.

Isimo se-Hyperglycemic

Usizo lokuqala lwesifo sikashukela lumane luyadingeka lapho isimo se-hyperglycemic senzeka. Kuboniswa ukugxuma okubukhali kushukela wegazi okungaphezu kwemingcele ephezulu yokujwayelekile. Kuvela ngenxa yokwakheka okunganele kwe-insulin yi-pancreas noma ngesidingo esengeziwe somzimba saleli hormone nge:

Usizo lokuqala lwe-hyperglycemic coma

• ukukhulelwa;
• ukulimala;
• ukungenelela kokuhlinzwa;
• ukuthuthukiswa kwezifo ezithathelwanayo.

Lapho uthola isifo sikashukela, isimo se-hyperglycemic senzeka ezimweni eziningi:

• ukudla ngaphandle kwemijovo ye-insulin;
• ukwephula imithetho yokuphatha imijovo ye-insulin (ifakwa ngokungagodli, futhi abanye abantu bayifaka ngomjovo we-intramuscularly, okungafanele yenziwe).

Ngenxa yalokhu, umzimba uqala ukuzwa ukuntuleka kwe-insulin, ukuhlala ngo-glucose egazini, namaseli aqala ukuzwa indlala yamandla. Kulesi simo, amaseli wamafutha aqala ukukhipha i-oxid bese aphonsa izinto eziyingozi egazini - imizimba ye-acetone ne-ketone. Okuqukethwe kwegazi labo eliphakeme kuthinta kabi uhlelo oluphakathi lwezinzwa, imithambo yegazi nomsebenzi wesicubu senhliziyo.

I-Acidosis inezigaba eziningana zokukhula kwayo:

• isigaba esisesilinganisweni sokuvezwa kwezidumbu ze-ketone emzimbeni (umuntu uzizwa ebuthakathaka obuncane futhi ethuthumela emzimbeni);
• isiteji se-precoma (ukuhlanza kuyavela, izinsimbi zesikhumba ziphenduka ziphuzi, i-palpitations ishesha, njll);
• coma.

Izimpawu zesimo se-hyperglycemic

I-Acidosis ezigabeni zokuqala zokukhula kwayo iziveza ngezindlela ezihlukile. Imvamisa, iziguli zikhononda ngokuqina kokuncipha, ukusebenza okwehlisiwe, ukuntuleka kwesifiso sokudla, ukubukeka kwe-tinnitus, ukuchama ngokushesha, ukoma okungenakuqhathaniswa nobuhlungu esiswini esingezansi.

Izimpawu eziphambili zesimo se-hyperglycemic

Ngasikhathi sinye, uma ukhuluma nesiguli kude, ungabona ukuvela kwephunga elibi elivela emlonyeni wakhe, okungelona elezimvelo ngaphansi kwezimo ezijwayelekile.

Njengomthetho, uma phambi kwezimpawu ezinjalo ukuhlolwa kwegazi kwenziwa kusetshenziswa i-glucometer, khona-ke ukwanda okubukhali kwamazinga kashukela wegazi kungabonakala. Ingahluka ngaphakathi kwe-19-20 mmol / l. Kukhona indinganiso ethile yokunakekelwa okukhethekile kwezokwelapha isifo sikashukela i-mellitus, esithi ngezinkomba ezinjalo ze-glucose egazini, imizamo kufanele yenziwe masinyane ukuze banciphise. Kulokhu, kusetshenziswa izidakamizwa ezikhethekile zokunciphisa ushukela. Lapho nje izinga leshukela lehliselwa kumanani ajwayelekile, ukuqoqwa kwezidumbu ze-ketone kuzokwehla futhi nesimo sesiguli sizothuthuka.

Isifo sikashukela sibonisa isithombe esimeme ngokwengqondo. Ngokukhula kwayo, iziguli zivame ukuzwa lezi zimpawu ezilandelayo:

• isicanucanu esikhulu;
• ukuhlanza
• ubuthakathaka bemisipha;
• ukunganaki konke okwenzeka nxazonke;
• ukuphazamiseka kwesigqi senhliziyo;
• Ubuhlungu enhliziyweni kanye nesisu esisezansi;
• ukuchama njalo.

Ngokuqala kwe-hyperglycemic coma, isiguli sidinga ukulashwa ngokuphuthumayo esibhedlela

Iziguli ezinalezi zimo ezinzima zingazizwa zingathandeki isikhathi eside (kufika ezinsukwini ezi-2). Njengomthetho, bayazi esiteji se-precoma, kepha ngasikhathi sinenkinga ye-CNS, engaziveza ngesimo se-elethism, ukunganaki, njll.

Ukubonakala kwesiguli nakho kuyashintsha. Isikhumba sithola ukugcwala okuluhlaza okwesibhakabhaka, komile futhi kungabi nakulunga. Ingaphezulu lezindebe lingaqhekeka futhi libe buhlungu. Isici esihlukile salesi simo ukubukeka kokuhlanganiswa komoya onsundu olimini.

Uma kwenzeka ukuthi lapho kuqala isayensi yesifo sikashukela, isiguli singanikezwa ukunakekelwa kwabahlengikazi, izimpawu zizokwanda bese kuba nokukhubazeka kwe-hyperglycemic. Ngomlingiswa wakhe, isithombe esilandelayo somtholampilo:

• ukwehluleka ukuphefumula;
• i-tachycardia;
• iphunga elixakile le-acetone ephuma emlonyeni;
• izindlebe ezimnandi;
• ukwehlisa umfutho wegazi;
• ukwanda kwezicubu zomzimba;
• ukomisa komzimba;
• ukwehla kwezinga lokushisa lomzimba.

Ukuthuthukiswa kwe-hyperglycemic coma kuhlala kuhambisana nezimpawu zokulimala kunoma yiziphi izitho nezinhlelo zangaphakathi. Futhi kaningi kakhulu yipheshana lesisu, uhlelo lwenhliziyo noma uhlelo lwezinzwa oluphakathi.

Uma kungekho ukwelashwa okwanele, i-hyperglycemic coma ingaholela ekufeni!

Ukwenza ukuxilongwa okunembile futhi unqume amaqhinga okwelashwa okuqhubekayo, kuyadingeka ukuthi kuhlolwe igazi nomchamo. Isibonakaliso esiyinhloko sokuqalwa kwe-hyperglycemic coma ukukhuphuka koshukela wegazi ngaphezu kwe-30 mmol / L.

Kodwa kwesinye isikhathi izimpawu ze-acidosis ezinzima nazo ziyaqashelwa ngokwanda kokuxineka koshukela kuya ku-11-12 mmol / l. Njengomthetho, lokhu kwenzeka phambi kokukhulelwa noma ukuhlukunyezwa kotshwala. Imvamisa, ukuqala kwe-acidosis kubhekwa ebusheni, obuhambisana nokungondleki kanye nokucindezela okungapheli.

Ngaphezu kwalokho, ngesikhathi kuhlolwa umchamo welebhu, i-glycosuria iyatholakala, okungukuthi, okuqukethwe okukhulayo kwe-glucose ne-acetone entweni yokuhlola yezinto eziphilayo, obekungafanele kube yinto evamile nakancane. I-acetone nayo itholwa ukuhlolwa kwegazi okune-biochemical.

Siza ngesimo se-hyperglycemic

Ukunakekelwa okuphuthumayo kwesifo sikashukela kuyadingeka noma okwamanje lapho kuvela izimpawu zokuqala ze-acidosis. Okokuqala udinga ukwenza ukuhlolwa kwegazi. Uma imiphumela idlula i-13 mmol / l, sekuvele kunesidingo sokuphathwa ngokuphuthumayo kwe-insulin. Ngaphezu kwalokho, isiphuzo esiningi siyadingeka, ngoba kulesi sigaba se-hyperglycemic state, ukuchama kaningi kuyaphawulwa futhi kunezingozi ezinkulu zokuphelelwa ngamandla emzimbeni.

Ngaso leso sikhathi, kudingeka uhlole izinga likashukela wegazi njalo emahoreni ama-2 bese ufaka imijovo ye-insulin kuze kube yilapho izinkomba zazo sezijwayelekile. Njengomthetho, kulezi zimo, sebenzisa umthamo ojwayelekile we-insulin, owawunqunywe udokotela ngaphambilini. Uma imijovo ehlanganiswa nokuphuza kakhulu inganikeli imiphumela emihle kungakapheli amahora angama-6-8, kuyaphuthuma ukubiza iqembu lodokotela. Ngenkathi i-ambulensi isazohamba, akusafanele usenze imizamo yokwehlisa ushukela wegazi ngomjovo, ngoba lokhu kungaholela ekwandeni kwe-insulin emzimbeni.

Izimo ezingase zivele ngokunyuka okubukhali koshukela wegazi

Izinhlobo ezinzima zesimo se-hyperglycemic zivame ukutholakala kulabo bantu abangakatholakalanga ukuthi banesifo sikashukela i-mellitus. Ngenxa yalokho, abanazo izindlela ezingabasiza basebenzise ushukela wegazi labo futhi bazinze isimo sabo, ngakho-ke badinga usizo lodokotela.

Imvamisa, iziguli ezinjengalesi zingeniswa esibhedlela ngokushesha. Futhi kulokhu, i-algorithm elandelayo yezenzo isetshenziswa ikakhulukazi:

• ukuphathwa kwe-intravenous kwekhambi le-sodium chloride;
• ukwelashwa kwe-insulin;
• ukuphathwa ngomlomo kwesixazululo seRegidron (kuvimbela ukuphuma komzimba);
• Ukuhlinzekwa komoya ophuma kumamaski (esimweni esiphuthumayo).

Ngaphezu kwalokho, kuthathwa izinyathelo zokuqeda i-acidosis. Kulokhu, ukuqhutshwa kwesisu nge-sodium bicarbonate kanye ne-catheterization ye-bladder kuyenziwa. Kuphoqelekile ukuxhuma isiguli kudivayisi yokuqapha, ekuvumela ukuthi ubhekele isimo sakhe. Uma isiguli sinokwehla komfutho wegazi, ukuphathwa kwe-intravenous kwe-prednisone ne-hydrocortisone kunqunyelwe. Yonke imisebenzi eyengeziwe yabelwa ngamunye, ngokuya ngesimo sesiguli.

Isimo se-Hypoglycemic

Isimo se-hypoglycemic sibonakala ngokuncipha okukhulu koshukela wegazi (ngaphansi kuka-2.8 mmol / l) futhi kwenzeka lapho:

• ukukhulisa umthamo wemijovo ye-insulin;
• ukusetshenziswa njalo kwezidakamizwa ezinciphisa ushukela.

Le mishanguzo iqala ukusebenza ngemuva kwemizuzu eyi-10-15 ngemuva kokuphatha noma ukuphatha. Bacubungula i-glucose ngenkuthalo, futhi uma ngemuva kwabo umuntu ekhohlwa ukudla, ushukela wegazi wehla kakhulu (ushukela awukhiqizwa ngumzimba, kodwa ungena ngqo ngokudla).

Ukuthuthukiswa kwe-hypoglycemia

Ukuqala kwe-hypoglycemia kungenzeka futhi ngokuqhamuka ngemuva:

• ukuntuleka kwe-carbohydrate ekudleni;
• ukuzikhandla ngokweqile komzimba;
• ukuvela kwesimila se-pancreatic;
• ukungasebenzi kwe-yegilo;
• ukuntuleka okungapheli kwe-adrenal;
• ukusetshenziswa kabi kotshwala.

Izimpawu zesimo se-hypoglycemic

I-Hypoglycemic coma ibonakala ngentuthuko esheshayo. Ekuqaleni kokukhula kwayo, isiguli sinekhanda elibuhlungu, umuzwa onamandla wendlala, ukukhuphuka kokujuluka kanye nokuqina kwesikhumba. Ngemuva kwemizuzu engama-20 kuye kwengama-30, ukushaya kwenhliziyo kuba njalo, ukuthuthumela kuvela emzimbeni, ukuphazamiseka okubukwayo kuyaphawulwa. Kwesinye isikhathi ezigulini ezine-hypoglycemic coma, ukuphazamiseka kwesistimu yezinzwa kuyabonakala, okukhonjiswa ngokuhlaselwa ngobudlova. Okulandelayo, umswakama wesikhumba kanye nokuncanyana emilenzeni kuyaphawulwa.

Izimpawu ze-hypoglycemia

Isici esiyingqayizivele se-hypoglycemic coma ukuthi ngesikhathi sokukhula, ukuphefumula nokushaya kwenhliziyo kwesiguli kuhlala kujwayelekile. Ukuhlolwa kwegazi kwe-biochemical ngasikhathi sinye kukhombisa amanani aphansi kashukela wegazi - ngaphansi kuka-2.8 mmol / l.

Siza ngesimo se-hypoglycemic

Lapho kwenzeka isimo se-hypoglycemic, kubalulekile futhi ukwenza izinyathelo eziphuthumayo okuhloswe ngazo ukusimama amazinga kashukela wegazi. Ngokungafani ne-hyperglycemia, kulokhu kulula kakhulu ukukwenza.

Esigabeni sokuqala sokukhula kwe-hypoglycemia, kwanele ukumane sinikeze isiguli itiye elimnandi noma sidle uswidi. Imiphi imikhiqizo ezonikezwa njengamanje ayinandaba, into esemqoka ukuthi ziqukethe kalula ama-carbohydrate azogcwalisa umzimba ngokushesha nge-glucose futhi athuthukise isimo sesiguli.

Esimweni lapho usizo ngokuqala kwe-hypoglycemia lungazange lunikezwe ngesikhathi futhi umuntu akazi lutho, kuyadingeka ukuthi abize iqembu lodokotela. Njengomthetho, ukuphathwa kwe-intravenous kwesisombululo se-glucose sama-40% kusetshenziselwa ukuguqula ushukela wegazi, okubuyisela isiguli esimweni esijwayelekile ngemuva kwemizuzu engu-5-10. Uma lezi zinyathelo zinganikezi umphumela omuhle, i-glucagon iyasetshenziswa (nayo iphathwa ngaphakathi).

Kumele kuqondwe ukuthi i-hyperglycemia ne-hypoglycemia yizimo eziyingozi ezingaholela ekufeni. Ngakho-ke, lapho kuvela izimpawu zokuqala zokukhula kwazo, i-ambulensi kufanele ibizwe ngokushesha.