Isifo sikashukela sikashukela siyindlela ebunjiwe yesifo sikashukela esihambisana nokuntuleka kwe-insulin. Lesi sifo sihambisana nokwanda kweglucose yegazi nemizimba ye-ketone. I-DKA yenzeka ngenxa yokwehluleka kwe-metabolic ezigulini ezinesifo sikashukela futhi kuyinkimbinkimbi evame kakhulu.
Kuyini ketoacidosis?
I- "Acidosis" ihunyushwa isuselwa olimini lwesiLatin ngokuthi "acidic" futhi isho uguquko kubhalansi olususelwa emthanjeni we-acid lukukhuphuka kwe-acidity. Njengoba imbangela yale nqubo ingukunyuka kokuxineka kwemizimba ye-ketone, isiqalo “keto” sengezwe egameni elithi “acidosis”.
Buyini ubudlelwano phakathi kokungalingani kwe-metabolic kanye nesifo sikashukela? Ake sizame ukuchaza. Imvamisa, umthombo omkhulu wamandla yi-glucose, engena emzimbeni ngokudla. Inani elilahlekile linxephezelwa ngokuqwabelana kwe-glycogen emisipheni nasezibindini.
Njengoba imithombo yokulondolozwa ye-glycogen ilinganiselwe, futhi ivolumu yayo yakhelwe isikhathi esingangosuku, kuyithuba lama-fat deposits. Amafutha aphulwe phansi kushukela, futhi ngenxa yalokho unxephezela ukuntuleka kwawo. Imikhiqizo yokubola yamafutha ngama-ketones, noma imizimba ye-ketone - i-acetone, i-acetoacetic ne-beta-hydroxybutyric acid.
Ukwanda kokuxineka kwe-acetone kungenzeka ngesikhathi sokuvivinya umzimba, ukudla, nokudla okungenakulinganiswa okune-predominance yokudla okunamafutha kanye nenani elincane le-carbohydrate. Emzimbeni ophilile, le nqubo ayibangeli ukulimala ngenxa yezinso, ezikhipha ngokushesha izidumbu ze-ketone, futhi ibhalansi ye-PH ayiphazamiseki.
Isiguli esinesifo sikashukela kufanele sifundiswe ukuthi singasiphatha kanjani ukugula kwaso: kufanele sifunde ukulawula amazinga kashukela bese sibala umthamo we-insulin ngokuya ngokudla
Isifo sikashukela sikashukela sikhula ngokushesha ngisho nokudla okujwayelekile nokuntuleka komzimba. Isizathu silele ekusweleni noma ukungabikho ngokuphelele kwe-insulin, ngoba ngaphandle kwawo, ushukela awunakungena kumaseli. Kunesimo "sokulamba phakathi kwenala," lapho ushukela usanele, kepha akunazimo zokusetshenziswa kwaso.
Amafutha ne-glycogen ngeke kuthinte inqubo, futhi amazinga e-glucose ayaqhubeka ukukhuphuka. I-Hyperglycemia iyanda, isilinganiso sokuwohloka kwamafutha siyanda, futhi ngenxa yalokho, ukugcwala kwezidumbu ze-ketone kusongela. Ngokukhula komkhawulo wezinso, i-glucose ingena ohlelweni lomchamo futhi ikhishwa ngamandla yizinso.
Izinso zisebenza kuze kube semkhawulweni wamakhono azo, futhi kwesinye isikhathi azikwazi ukubekezelela, kuyilapho inani elikhulu loketshezi nama-electrolyte lilahlekile. Ngenxa yokulahleka okukhulu koketshezi, ama-coagulates egazi kanye nendlala ye-oksijini kwenzeka ezicutshini. I-tishu hypoxia ikhuthaza ukwakheka kwe-lactic acid (lactate) egazini, egcwele ukuthuthukiswa kwe-lactic coma, lactic acidosis.
Imvamisa, inkomba ye-PH yegazi isemaphakathi no-7.4, ngenani layo ngezansi kwe-7 kusongela ngqo empilweni yomuntu. I-ketoacidosis yesifo sikashukela ingaholela ekwehleni okunjalo emahoreni ambalwa nje, bese kuthi ukukhohlisa ketoacidotic kungakapheli usuku noma ngaphezulu kwalokho.
Izizathu
Isimo sokuwohloka okukhanyayo singabangelwa ukuntuleka kwe-insulin kunoma yiluphi uhlobo lwesifo sikashukela. Uhlobo 1 sikashukela luvame ukuhambisana nokushoda ngokuphelele kwe-insulin. Kuhlobo lwesifo sikashukela sohlobo 2, kuvela ukuntuleka kwe-insulin.
Isifo sikashukela sikashukela kwesinye isikhathi kwesinye isikhathi siba wuphawu lokuqala lwesifo sikashukela sohlobo 1 uma isiguli singazi ukuthi siyagula futhi asikutholi ukwelashwa. Le ndlela isifo sikashukela sokuqala sitholakala cishe kwengxenye yesithathu yeziguli.
I-ketoacidosis yenzeka kuphela ngokushoda okuqinile kwe-insulin kanye nokwanda okubukhali kweglucose yegazi.
Izici eziningi zingavusa ukuthuthukiswa kwe-ketoacidosis, okungukuthi:
Imikhuba yoshukela wegazi kwabesifazane- amaphutha ekuphuzeni i-insulin - umthamo ongafanele, ukusetshenziswa kwezidakamizwa impilo yeshelufu ephelelwe yisikhathi, ukwehluleka okungalindelekile kwesirinji noma ipompo;
- iphutha lezokwelapha - ukuqokwa kwezidakamizwa zethebhulethi ukunciphisa ushukela wegazi ngesidingo esibonakalayo sesiguli semijovo ye-insulin;
- ukuthatha izidakamizwa ze-insulin antagonist ezikhulisa ushukela wegazi - ama-hormone nama-diuretics;
- ukwephulwa kokudla - ukwanda kwekhefu phakathi kokudla, inani elikhulu lama-carbohydrate asheshayo ekudleni;
- ukwelashwa ngama-antipsychotic anciphisa umuzwa we-insulin;
- ukuncika kotshwala nokuphazamiseka kwemizwa okuvimbela ukwelashwa okwanele;
- ukusetshenziswa kokunye, amakhambi abantu esikhundleni sokwelashwa kwe-insulin;
- Izifo ezihlangana - i-endocrine, inhliziyo, ukuvuvukala nokutheleleka;
- ukulimala nokuhlinzwa. Ngemuva kokuhlinzwa kuma-pancreas kubantu abangakaze babe nesifo sikashukela, inqubo yokukhiqizwa kwe-insulin ingaphazamiseka;
- ukukhulelwa, ikakhulukazi kuhambisana ne-toxicosis enzima ngokuhlanza njalo.
Ezigulini ezingama-25 kweziyikhulu, imbangela ye-ketoacidosis ku-mellitus yesifo sikashukela yi-idiopathic, ngoba akunakwenzeka ukuthola ukuxhumana nezinye izici. Isidingo esandayo se-insulin singenzeka ezinganeni zesikole nasebusheni ngezikhathi zokulungiswa kwehomoni kanye novalo lwezinzwa.
Kukhona futhi amacala avamile okwenqaba ngenhloso ukuphatha i-insulin ngezinhloso zokuzibulala. Intsha enesifo sikashukela sohlobo 1 ngokuvamile izama ukuzibulala ngale ndlela.
Ukwahlukanisa nezimpawu
I-ketoacidosis iba ngezigaba ezintathu:
- i-ketoacidotic precoma, isigaba 1;
- ukuqala kwe-ketoacidotic coma, isigaba 2;
- ephelele i-ketoacidotic coma, isigaba 3.
Esikhathini esiningi, kusukela kwesokuqala ukuya esigabeni sokugcina, kudlula izinsuku ezingama-2,5 kuya kwezingu-2. Kukhona umehluko uma ukukhohlisa kwenzeka kungadlula usuku olulandelayo. Ngokubambisana nokwanda kwe-glucose yegazi nokunye ukuphazamiseka kwe-metabolic, isithombe somtholampilo siya ngokuya sishiwo.
Izimpawu ze-ketoacidosis yesifo sikashukela zihlukaniswe phakathi kokuqala nokufika sekwephuzile. Okokuqala, kunezimpawu ze-hyperglycemia:
- umlomo owomile, umuzwa wokoma njalo;
- ukuchama njalo
- ukuncipha nobuthakathaka.
Isifo sikashukela sikashukela sikashukela luhlobo lwe-hyperglycemic coma futhi senzeka cishe ezigulini ezingama-40 kweziyinkulungwane
Bese kuba nezimpawu zokubonakala kokukhiqizwa kwe-ketone - ushintsho kusigqi sokuphefumula, esibizwa ngokuthi ukuphefumula kukaKussmaul. Umuntu uqala ukuphefumula ngokujulile nangomunyu, ngenkathi ephefumula umoya kaningi kunokujwayelekile. Ngaphezu kwalokho kunephunga le-acetone elisuka emlonyeni, isicanucanu nokuhlanza.
Zonke lezi zimpawu ezingenhla ziyizinkomba zokulaliswa esibhedlela eziphuthumayo. Njengoba ukubonakaliswa kwe-ketoacidosis kufana nezinye izifo, isiguli sivame ukulethwa esibhedlela sokuhlinzwa noma izifo ezithathelwanayo. Ngakho-ke, kubaluleke kakhulu ukukala ushukela wegazi wesiguli bese ubheka ukuba khona kwe-ketone emzimbeni womchamo.
Ezigulini ezine-ketoacidosis, izinkinga zingaba khona - i-pulmonary edema, i-thrombosis yendawo ethile yasekhaya, i-pneumonia ne-edema yamangqamuzana.
Ukuxilonga
Ngokusekelwa kwezikhalazo nokuhlolwa kwesiguli, ukuxilongwa okuyisisekelo kanye nokuba khona kwezifo ezisesistimu ezikhulisa inkambo ye-ketoacidosis kuyasungulwa. Ngesikhathi sokuhlola, kuboniswa izimpawu zomlingiswa: iphunga le-acetone, izinhlungu ngesikhathi sokuqina kwesisu, ukusabela okungavinjelwe. Umfutho wegazi uvame ukuba phansi.
Ukuqinisekisa ukutholwa nokuxilongwa okuhlukile, kuyenziwa ukuhlolwa kwelabhoratri kwegazi nomchamo. Lapho okuqukethwe ushukela egazini kukhulu kune-13.8, singakhuluma ngokuthuthukiswa kwe-ketoacidosis, inani lale nkomba kusuka ku-44 kuya phezulu libonisa isimo esihle sesiguli.
Amazinga kashukela we-urinary ku-ketoacidosis angama-0.8 nangaphezulu. Uma umchamo ungasakhishwa, khona-ke imichilo ekhethekile yokuhlola isetshenziswa ngokusetshenziswa kwegazi legazi kubo. Ukungezelelwa kwegazi urea kukhombisa ukungasebenzi kahle kwezinso nokuphelelwa amandla emzimbeni.
Ukuthuthukiswa kwe-ketoacidosis kungahlulelwa ngeveli le-amylase, i-enzyme yamanyikwe. Umsebenzi wakhe uzoba ngaphezulu kwama-awa ayi-17 / ihora.
Lapho i-ketoacidosis yenziwa nge-infusion therapy ngesisombululo se-isotonic sodium chloride futhi yenze imijovo ye-insulin
Njengoba i-diuresis inyuka ngaphansi kwethonya le-hyperglycemia, izinga le-sodium esegazini lehla ngaphansi kwe-136. Esikhathini sokuqala kwe-ketoacidosis yesifo sikashukela, inkomba ye-potassium iyenyuka, engadlula ku-5.1. Ngokuthuthukiswa kokuphelelwa ngamanzi emzimbeni, i-potassium kancane kancane iyancipha.
Ama-bicarbonate wegazi adlala indima yohlobo lwe-alkaline buffer egcina ibhalansi esezingeni le-acid esivamile. Nge-acidization eqinile yegazi ngama-ketones, inani lama-bicarbonates liyancipha, futhi ezigabeni zokugcina ze-ketoacidosis zingaphansi kwe-10.
Isilinganiso se-cations (i-sodium) ne-anions (chlorine, bicarbonates) imayelana ne-0. Ngokwakhiwa okwandayo kwemizimba ye-ketone, isikhawu se-anion singakhula kakhulu.
Ngokuncipha kwesilinganiso sekhabhoni dioksidi egazini, ukujikeleza kwe-cerebral kuyaphazamiseka ukunxephezela i-acidity, okungaholela esiyezi nasekufeni.
Uma kunesidingo, iziguli zinikezwa i-electrocardiogram ukuthi ikhiphe ukuhlaselwa yinhliziyo ngemuva komzimba. Ukuze ungafaki ukutheleleka kwe-pulmonary, yenza i-x-ray yesifuba.
Ukuxilongwa okuhlukile (okwehlukile) kwenziwa nezinye izinhlobo ze-ketoacidosis - utshwala, abalambile kanye ne-lactic acid (lactic acidosis). Isithombe somtholampilo singaba nezici ezifanayo ezinobuthi nge-ethyl ne-methanol, i-paraldehyde, i-salicylates (i-aspirin).
Ukwelashwa
Ukwelapha i-ketoacidosis yesifo sikashukela kwenziwa kuphela ezimweni zokuma. Izindawo zayo eziphambili zinjengokulandelayo:
- ukwelashwa esikhundleni se-insulin;
- ukwelashwa kwe-infusion - ukuphinda ukhiphe amandla emzimbeni (ukuphinda uqede uketshezi olulahlekile nama-electrolyte), ukulungisa i-PH;
- ukwelashwa kanye nokuqedwa kwezifo ezihlangene.
I-Acid-base esele, noma i-PH - kungenye yezinto ezibaluleke kakhulu ezibona ukuthi kunamathuba amaningi okuthola izifo eziningi; nokushintshashintsha kwalo ngakolunye uhlangothi, ukusebenza kwezitho nezinhlelo kuyaphazamiseka, umzimba uvikeleke
Ngesikhathi ehlala esibhedlela, isiguli sihlala sibhekelwe izimpawu ezibalulekile ngokuya ngecebo elilandelayo:
- ukuhlolwa kwe-glucose okusheshayo - ngehora, kuze kuthi inkomba kashukela yehle iye ku-14, emva kwalokho igazi lidonswe kanye njalo emahoreni amathathu;
- ukuhlolwa komchamo - amahlandla ama-2 ngosuku, ngemuva kwezinsuku ezimbili - isikhathi esingu-1;
- i-plasma yegazi ye-sodium ne-potassium - izikhathi ezi-2 ngosuku.
Kufakwa i-catheter yomchamo ukulawula umsebenzi wokuchama. Lapho isiguli sithola ukwazi futhi ukuchama okuvamile kubuyiselwa, i-catheter iyasuswa. Njalo emahoreni amabili noma ngaphezulu kwegazi, umfutho nokushisa komzimba kuyalinganiswa.
Usebenzisa i-catheter ekhethekile ene-transmitter, ingcindezi ye-venous central (umfutho wegazi ku-atrium yangakwesokudla) nayo iyaqashwa. Ngakho-ke, isimo sohlelo lokujikeleza kwegazi luyahlolwa. I-electrocardiogram yenziwa ngokuqhubekayo noma kanye ngosuku.
Kubalulekile ukwazi ukuthi ngisho nangaphambi kokulaliswa esibhedlela, umuntu onesifo sikashukela udinga ukufaka umjovo we-sodium chloride ngomthamo we-1 litre / ihora kanye ne-insulin engamaminithi amafushane angama-20.
Ukwelashwa kwe-insulin
Ukwelashwa kwe-insulin kuyindlela enkulu engasusa izinqubo ze-pathological eziholele ekukhuleni kwe-ketoacidosis. Ukuphakamisa izinga le-insulin, kubanjiswa ngemithamo emifushane yamayunithi ama-4-6 ngehora. Lokhu kusiza ukunciphisa ijubane ukuqhekeka kwamafutha nokwakhiwa kwama-ketones, yingakho ukukhishwa kwe-glucose kwesibindi. Ngenxa yalokhu, ukukhiqizwa kwe-glycogen kuyanda.
I-insulin iphinde inikezwe isiguli ngendlela yokudonsa ngemodi eqhubekayo. Ukugwema i-insulin adsorption, i-serum albhamuin yabantu, i-sodium chloride ne-1 ml yegazi lesiguli yenezelwa kwikhambi lokwelashwa.
Imithamo ye-insulin ingashintshwa ngokuya ngemiphumela yokulinganisa. Uma kungekho umphumela olindelekile emahoreni amabili noma amathathu okuqala, umthamo uphindwe kabili. Kodwa-ke, kwenqatshelwe ngokuphelele ukwehlisa ushukela wegazi ngokushesha okukhulu: ukwehla kokuxineka okungaphezulu kuka-5.5 mol / l ngehora kusongela ukuthuthukiswa kwe-edema yamakhorali.
Ukuvuselelwa komzimba
Ukubuyisa izindawo ezigcina uketshezi, kufakwa i-saline engu-0.9% nge-sodium chloride. Endabeni yamazinga aphezulu e-sodium yegazi, kusetshenziswa isisombululo se-0.45%. Lapho kuqeda ukuswelakala koketshezi, umsebenzi wezinso uvuselelwa kancane kancane, futhi ushukela wegazi wehla ngokushesha okukhulu. Ushukela omningi uqala ukukhiqizwa ngokwengeziwe emchameni.
Ngokwazisa kwe-saline, kuyadingeka ukuqapha i-CVP (ingcindezi ye-venous central), ngoba inani lomchamo okhishwe lincike kubo. Ngakho-ke, ngisho nasendaweni yokuphelelwa ngamandla okubalulekile, umthamo we-injected fluid akufanele wedlule umthamo womchamo okhishwe ngaphezu kwelitha.
Isifo sikashukela sohlobo 2 sivela ezigulini eziyi-9 kweziyishumi futhi sithinta kakhulu abantu asebekhulile
Umthamo ophelele we-saline ejoziwe ngosuku akufanele udlule i-10% yesisindo sesiguli. Ngokuncipha komfutho wegazi ophezulu (ngaphansi kwama-80), kufakwa i-plasma yegazi. Ngokushoda kwe-potassium, kubhalwa kuphela ngemuva kokubuyiselwa komsebenzi we-urinary.
Ngesikhathi sokulashwa, izinga le-potassium ngeke likhuphuke ngokushesha, ngenxa yokubuyela kwalo esikhaleni se-intracellular. Ngaphezu kwalokho, ngesikhathi sokuphathwa kwezixazululo zesaline, kulahleka okungokwemvelo kwama-electrolyte ngomchamo. Kodwa-ke, ngemuva kokubuyiselwa kwe-potassium kumaseli, okuqukethwe kwayo kusegazini kuyinto yokwemvelo.
Ukulungiswa komswakama
Kumanani ajwayelekile kashukela wegazi kanye nokutholakala okwanele kwamanzi emzimbeni, ibhalansi esezingeni le-acid iyaqina kancane kancane futhi iguqukele ekubhekeni i-alkalization. Ukwakhiwa kwezidumbu ze-ketone kuyaphela, futhi uhlelo lokubuyisa olutholakalayo lubhekana ngempumelelo nokulahlwa kwalo.
Kungakho-ke kungekho zinyathelo ezengeziwe ezidingekayo: isiguli akufanele siphuze amanzi amaminerali noma isixazululo se-baking soda. Ezimweni ezithile kuphela, lapho i-acidity yegazi incipha iye ku-7, kanye nezinga le-bicarbonates - kuya ku-5, lapho kuboniswa khona ukumakwa kwe-sodium bicarbonate. Uma i-alkalization yegazi isetshenziswa ngamanani aphezulu, khona-ke umphumela wokwelapha uzoba okuphambene:
- izicubu hypoxia ne-acetone entanjeni yomgogodla izokwanda;
- ingcindezi izoncipha;
- ukushoda kwe-calcium ne-potassium kuzokhula;
- umsebenzi we-insulin ukhubazekile;
- isilinganiso sokukhiqizwa kwezidumbu ze-ketone sizokhuphuka.
Ekuphetheni
Umlando wesifo sikashukela mellitus waqala ngomlando wesintu. Abantu bafunda ngakho ngaphambi kwenkathi yethu, njengoba kufakazelwa yimibhalo yesandla egciniwe yase-Egypt yasendulo, iMesopotamiya, iRoma neGreece.Kuleyo minyaka yokuqala, ukwelashwa bekukhawulelwe kumakhambi, ngakho-ke iziguli zazibhekene nokuhlupheka nokufa.
Kusukela ngo-1922, lapho kusetshenziswa i-insulin okokuqala, kungenzeka ukunqoba isifo esinamandla. Ngenxa yalokhu, ibutho lezinkulungwane zamaRandi eziguli ezidinga i-insulin bakwazi ukugwema ukufa ngaphambi kwesikhathi ngenxa yesifo sikashukela.
Namuhla, isifo sikashukela kanye nezinkinga zaso, kufaka phakathi i-ketoacidosis, kuyelapheka futhi sinokuthuthuka okuhle. Kodwa-ke, kubalulekile ukukhumbula ukuthi ukunakekelwa kwezokwelapha kumele kufike ngesikhathi futhi kwanele, ngoba lapho kubambezeleka, isiguli siwela ngokushesha ebuthakathakeni.
Ukuvimbela ukuthuthukiswa kwe-ketoacidosis yeswekile futhi ulondoloze impilo enhle, kuyadingeka ukusebenzisa kahle amadivaysi enzelwe ukuphathwa kwe-insulin nokugcina izinga likashukela wegazi lilawulwa njalo. Yiba nempilo!
