Ukuthuthukiswa kwe-hyperosmolar coma ku-mellitus yesifo sikashukela kuvame kakhulu ukwenzeka kubantu asebekhulile abanohlobo lwesifo olungathembisi i-insulin. Esikhathini esiningi samacala, ukukhohlisa kwenzeka ngemuva kwesizinda sokwehluleka kwezinso. Ama-pathologies wezinso nemithambo yegazi yobuchopho, kanye nokusetshenziswa kwamaqembu anjalo wezidakamizwa ama-steroid nama-diuretics kungaba yinto eyengezelelayo. Ukwelashwa isikhathi eside kwe-hyperosmolar coma kungaholela ekufeni.
Izizathu zokuthuthuka
Izici ezibangela ukuthuthukiswa kwalolu hlobo lwesifo sikashukela ukwephulwa komthamo wamanzi we-electrolyte (dehydrate) womzimba kanyekanye kanyekanye nokuntuleka kwe-insulin. Njengomphumela, izinga likashukela egazini likhuphuka.
Ukwehla emzimbeni kungadala ukugabha, uhudo, ukugaya umzimba, ukuncipha kwegazi, nokushiswa kanzima. Ngaphezu kwalokho, ukushoda kwe-insulin ezigulini ezinesifo sikashukela kuvame ukwenzeka ngenxa yezizathu ezilandelayo:
- ukukhuluphala
- i-pathology ye-pancreas (pancreatitis, cholecystitis);
- noma yikuphi ukungenelela kokuhlinzwa;
- amaphutha amakhulu wokudla okunempilo;
- izinqubo zokutheleleka ezenziwe ekhaya ohlelweni lokuchama;
- ukushaya okubunjiwe kwenani elikhulu likashukela egazini lapho kuhanjiswa ngaphakathi;
- i-pathology yesistimu yenhliziyo (isifo sohlangothi, ukushaya kwenhliziyo).
Ucwaningo luye lwabonisa ukuthi i-pyelonephritis kanye nokuphuma komchamo okulimazayo kunomthelela oqondile kukho kokubili ukuthuthukiswa kwe-hyperosmolar coma kanye nenkambo yayo. Kwezinye izimo, i-coma ingakheka ngenxa yokudla kakhulu ama-diuretics, ama-immunosuppressants, ngokwethulwa kwezixazululo ze-saline kanye ne-hypertonic. Futhi ngesikhathi senqubo ye-hemodialysis.
Izimpawu
I-Hyperosmolar coma ivame ukukhula kancane kancane. Ekuqaleni, isiguli siba nobuthakathaka obukhulu, ukoma kanye nokuchama ngokweqile. Ngokubambisana, ukubonakaliswa okunjalo kwe-pathology kufaka isandla ekuthuthukisweni komzimba. Bese kuba khona ukoma kwesikhumba futhi ithoni yezimpawu zamehlo incishiswe kakhulu. Kwezinye izimo, ukulahleka kwesisindo okuqinile kuyaqoshwa.
Ukulimazeka kokuqwashisa nakho kuba ezinsukwini ezingama-2-5. Kuqala ukudonsa kanzima futhi kugcina ngokuba ne-coma ejulile. Ukuphefumula komuntu kuya njalo futhi kube ngezikhathi ezithile, kepha ngokungafani ne-ketoacidotic coma, akunaphunga le-acetone lapho kuqhuma umoya. Ukuphazamiseka kwesistimu yenhliziyo kuboniswa ngesimo se-tachycardia, ishayela ngokushesha, i-arrhythmia ne-hypertension.
Ukuthuthukiswa kwe-hyperosmolar coma yandulelwa yizimpawu zikashukela ophezulu wegazi
Kancane kancane, ukuchama ngokweqile kuyancipha, futhi ekugcineni kuguquke kube yi-anuria ngokuphelele (umchamo uyeka ukugeleza ungene esinyeni).
Ngasohlangothini lohlelo lwezinzwa, ukwephulwa okunjalo kuvela:
- inkulumo engafundile;
- ukukhubazeka okuyingxenye noma okuphelele;
- ukubanjwa isifo sokuwa;
- ukukhuphuka kokukhishwa kwengxenye noma, ngakolunye uhlangothi, ukungabikho kwabo okuphelele;
- ukubonakala komkhuhlane ngenxa yokungasebenzi kahle kwe-thermoregulation.
Izindlela Zokuxilonga
Ubunzima obukhulu bezindlela zokuxilonga lapho kukhubazeka ikhefu likashukela ukuthi kufanele lwenziwe ngokushesha okukhulu. Ngaphandle kwalokho, isiguli singase siqale ukuba nemiphumela engenakuphikwa futhi, ngenxa yalokho, ukufa. Ukuthuthuka komthambo kuyingozi ikakhulukazi, kuhambisana nokuncipha ngokweqile komfutho wegazi ne-sinus tachycardia.
Ukulinganisa ushukela wegazi - indlela esheshayo yokuxilonga isifo sikashukela
Nakanjani, udokotela ucabanga ngalezi zinto ezilandelayo lapho enza ukuxilongwa:
Izimpawu ze-Hyperglycemic Coma- ukuntuleka kwephunga le-acetone emoyeni okhipha amandla;
- i-hyperosmolarity ephezulu yegazi;
- ukuphazamiseka kwemizwa okubangelwa i-hyperosmolar coma;
- ukwephulwa kokuphuma komchamo noma ukungabikho kwawo ngokuphelele;
- kuphakama ushukela wegazi.
Kodwa-ke, okunye ukuphazamiseka okuhlonziwe ekuhlaziyweni ngeke kukhulume ngokuthuthuka komzimba onjalo wesifo sikashukela, ngoba zihambisana ne-pathologies eminingi. Isibonelo, amazinga aphezulu we-hemoglobin, i-sodium, chlorine, noma amaseli amhlophe egazi.
Izindlela zokwelapha
Cishe njalo, noma yiziphi izindlela zokwelapha ngokuyinhloko zenzelwe ukuhlinzeka isiguli ukunakekelwa okuphuthumayo. Kubandakanya ukwenziwa ngokweqile kokulingana kwamanzi-electrolyte kanye ne-plasma osmolarity. Ukuze wenze lokhu, feza inqubo yokumnika. Ukukhethwa kwekhambi kuncike kusamba esitholakele se-sodium esegazini. Uma ukugcwala kwento kuphezulu ngokwanele, faka isisombululo se-2% kashukela. Ezimweni lapho inani le-sodium lingaphakathi kwebanga elijwayelekile, kukhethwa isisombululo esingu-0.45%. Ngesikhathi senqubo, uketshezi lungena emithanjeni yegazi, futhi izinga likashukela egazini liyancipha kancane kancane.
Inqubo yokumnika yenziwa ngokohlelo oluthile. Ehoreni lokuqala, isiguli singenelwa kusuka ku-1 kuya ku-1.5 amalitha esisombululo. Emahoreni amabili alandelayo, inani layo liyancishiswa libe amalitha ayi-0,5. Inqubo yenziwa kuze kuphele ukuqothuka, ukuqapha njalo umthamo womchamo kanye nengcindezi ye-venous.
Ngokwehlukana, benza imisebenzi ehlose ukunciphisa i-hyperglycemia. Ngale njongo, isiguli sifakwa ngaphakathi emzimbeni nge-insulin, hhayi ngaphezu kwama-2 amayunithi ngehora. Ngaphandle kwalokho, ukwehla okukhulu kwe-glucose ku-hyperosmolar coma kungavusa i-edema yamakhorali. Ngokuzenzakalelayo, i-insulin ingalawulwa kuphela ezimweni lapho izinga likashukela wegazi selifinyelele ku-11-13 mmol / L.
Ukuthuthukiswa kwe-hyperosmolar coma kudinga ukulashwa okuphuthumayo kwesiguli
Izinkinga nokuqagela
Enye yezinkinga ezivamile zokuba nesibindi esinjalo sikashukela yi-thrombosis. Ukuyivimbela, i-heparin inikezwa isiguli. Ngesikhathi senqubo, odokotela baqapha ngokucophelela izinga lokujiya kwegazi. Ukwethulwa kwesidakamizwa se-albhamu esithatha indawo ye-plasma kusiza ekunciphiseni ubungozi bokuthuthukisa i-pathologies ye-inhliziyo.
Ezimweni zokuhluleka kakhulu kwezinso, i-hemodialysis iyenziwa. Uma i-coma ivuse inqubo yokuvuvukala kwe-purulent, khona-ke ukwelashwa kwenziwa ngama-antibiotics.
I-prognosis ye-hyperosmolar coma iyadumaza. Noma ngabe kunakekelwa ngesikhathi esifanele yini, izibalo zokufa zifinyelela kuma-50%. Ukufa kwesiguli kungenzeka ngenxa yokwehluleka kwezinso, ukwanda kwe-thrombosis, noma i-edema yamakhemikhali.
Kanjalo, izindlela zokuvimbela i-hyperosmolar coma azikho. Iziguli ezinesifo sikashukela kufanele zilinganise ushukela wazo wegazi ngendlela esifike ngesikhathi. Futhi, ukondleka kanye nokungabikho kwemikhuba emibi kudlala indima enkulu.
