Ukunakekelwa okuphuthumayo komzimba onesifo sikashukela

Isifo sikashukela siyinkimbinkimbi yesifo sikashukela, ehambisana ne-glycemia ephezulu, eyenzeka ngokumelene nesizinda sokuphelelwa ngokuphelele kwe-insulin noma isihlobo futhi idinga usizo ngokushesha. Isimo sithathwa njengesibucayi, singakhula ngokushesha (emahoreni ambalwa) noma isikhathi eside (kufika iminyaka eminingana).

Ukunakekelwa okuphuthumayo kwesifo sikashukela esinezigaba ezimbili:

• pre-medical - kuvela izihlobo zesiguli noma zimane nje lezo eziseduzane;
• umuthi - Ukungenelela kwezokwelashwa okufanele ngabamele beqembu le-ambulensi kanye nabasebenzi bezikhungo zezokwelapha.

Izinhlobo ze-coma

Isimo se-ketoacidotic sibonakaliswa ukwakheka kwezidumbu ze-acetone (ketone) ezinenombolo ebalulekile egazini nomchamo. Kuvela inkinga yohlobo lwe-insulin oluncike ku-insulin.

I-pathogenesis ye-hyperosmolar coma ihlotshaniswa nokuphelelwa ngamandla komzimba kanye ne-osmolarity ephezulu yegazi. Ikhula ezigulini zohlobo oluzimele lwe-insulin.

Ukwehluka kwezimpawu

Ukubonakaliswa kwemitholampilo kwalezi zinhlobo ezimbili zamahlaya sikashukela kuyafana:

• ukoma kwe-pathological;
• umuzwa womlomo owomile;
• i-polyuria;
• ukubanjwa okukhokhisa;
• isicanucanu nokuhlanza
• Ubuhlungu esiswini.

Ukuhogela kwe-acetone kuwukubonakaliswa okuhlukanisa i-ketoacidosis kwezinye izimo ezimbi

Iphuzu elibalulekile lokwehlukanisa izifunda komunye nomunye ubukhona bephunga le-acetone emoyeni oxoshwe ngesikhathi se-ketoacidosis kanye nokungabikho kwayo ku-hyperosmolar coma. Lesi sibonakaliso esithile siyinkomba yokuthi kukhona kwenani eliphakeme lemizimba ye-ketone.

Amanye amaqhinga

Isigaba sangaphambi kokwelashwa

Usizo lokuqala lwanoma uluphi uhlobo lokukhubazeka kwesifo sikashukela kufanele luqale ngochungechunge lwemicimbi kuze kufike ongoti abaqeqeshiwe.

Yini i-glycemia kushukela

1. Isiguli kufanele sibekwe endaweni evundlile ngaphandle kokuphakanyiswa.
2. Ukususa izingubo noma ukususa lezo zingxenye zekhabethe elingaphezulu ezidala izithiyo zokukusiza.
3. Ngokuphefumula okufushane nokuphefumula okujulile, vula iwindi ukuze kutholakale umoya omusha.
4. Ukuqapha njalo kwezimpawu ezibalulekile ngaphambi kokufika kwe-ambulensi (ishayela, ukuphefumula, ukusabela kwabacasulayo). Uma kungenzeka, qopha idatha ukuze uyinikeze ochwepheshe abaqeqeshiwe.
5. Uma ukuboshwa kokuphefumula noma i-palpitations kwenzeka, qhubekela phambili ekuvuseleleni kwe-cardiopulmonary. Ngemuva kokuba isiguli sesiphinde sazi, ungamshiyi yedwa.
6. Thola isimo sokuqaphela kwesiguli. Buza igama lakhe, iminyaka, ukuthi ukuphi, ubani oseceleni kwakhe.
7. Lapho umuntu egeza, akunakwenzeka ukuphakamisa, ikhanda kufanele liguqulwe ngasohlangothini lwalo ukuze ukugabha kungafisi.
8. Uma kwenzeka ukuthi kuhlaselwe ngokuhlukumezanayo, umzimba wesiguli ujikelezwe ngasohlangothini lwayo, kufakwe into eqinile phakathi kwamazinyo (kuyenqatshelwe ukusebenzisa insimbi).
9. Uma ufisa, udinga ukufudumeza umuntu ngamaphampu wokushisa, isiphuzo.
10. Uma isiguli sikwelashwa kwe-insulin futhi sinomqondo osobala, msize enze umjovo.

Ukunakekelwa kwesifo sikashukela ngesikhathi esifanele kuyisiqinisekiso somphumela omuhle

I-ketoacidotic coma

I-algorithm yokungenelela esigabeni sezokwelapha incike ekuthuthukisweni kwe-coma ku-mellitus yesifo sikashukela. Ukunakekelwa okuphuthumayo kule ndawo kuqukethe ukufaka ishubhu le-nasogastric ukufisela isisu esiswini. Uma kunesidingo, ukufakwa kanye nokugcwala komzimba nge-oxygen (oxygen oxygen) kuyenziwa.

Ukwelashwa kwe-insulin

Isisekelo sokuthola ukunakekelwa kwezokwelapha okuqeqeshiwe ukuziphatha kwezokwelapha kakhulu kwe-insulin. Kusetshenziswa kuphela i-hormone ebamba amabanga amafushane, enikezwa ngemithamo emincane. Okokuqala, faka kuze kufike ku-20 IU yesidakamizwa emisipha noma ngaphakathi, khona-ke ihora ngalinye nge-6-8 IU enezisombululo ngesikhathi sokufakwa.

Uma i-glycemia inganciphi kungakapheli amahora ama-2, umthamo we-insulin uyaphinda kabili. Ngemuva kokuhlolwa kwelebhu okubonisa ukuthi izinga likashukela selifinyelele ku-11-14 mmol / l, inani le-hormone lehliswa ngesigamu futhi alusahanjiswa kwi-physiology, kepha kwisixazululo se-glucose sokuhlushwa kwe-5%. Ngokuncipha okuqhubekayo kwe-glycemia, umthamo we-hormone uyancipha ngokufanele.

Lapho izinkomba sezifinyelele ku-10 mmol / l, isidakamizwa se-hormonal siqala ukuphathwa ngendlela yendabuko (ngokwezifiso) njalo emahoreni ama-4. Ukwelashwa okunamandla okunjalo kuhlala izinsuku ezingama-5 noma kuze kube yilapho isimo sesiguli sithuthuka.

Ukuhlolwa kwegazi - amandla okulawula ushukela wegazi

Kubalulekile! Ezinganeni, umthamo ubalwa ngale ndlela elandelayo: kanye nge-0,1 UNITS ngekhilogremu yesisindo, bese inani elilinganayo njalo ngehora lisemisipha noma emzimbeni.

Ukuvuselelwa komzimba

Lezi zixazululo ezilandelayo zisetshenziselwa ukubuyisa uketshezi emzimbeni, oluphethwe ukumiliselwa:

• i-sodium chloride 0,9%;
• ushukela we-5% okuhlushwa;
• Ringer-Locke.

I-Reopoliglyukin, iHemodez nezinye izixazululo ezifanayo azisetshenziswa, ukuze izinkomba ze-osmolarity zegazi zingakhuphuki ngokuqhubekayo. I-1000 ml yokuqala ye-fluid ifakiwe kwihora lokuqala lokunakekelwa kweziguli, okwesibili kungakapheli amahora ama-2, okwesithathu kungakapheli amahora ama-4. Kuze kube kunxeshezelwe komzimba, wonke u-800-1000 ml olandelayo we-fluid kufanele alawulwe emahoreni angama-6-8.

Ukulungiswa kwe-acidosis kanye ne-electrolyte ibhalansi

Izinkomba ze-acidity ephezulu kwe-7.1 zibuyiselwa ngokufakwa kwe-insulin kanye nenqubo yokuvuselela umzimba. Uma izinombolo ziphansi, i-4% sodium bicarbonate iphathwa ngaphakathi. I-enema ibekwa nesixazululo esifanayo futhi isisu siyagezwa uma kunesidingo. Ngokuhambisana, ukuqokwa kwe-potassium chloride ekugxiliseni okungu-10% kuyadingeka (umthamo ubalwa ngokuhlukile ngokuya ngenani le-bicarbonate engeziwe).

Ukwelashwa kokungenelela kuyingxenye yokwelashwa okuphelele kwesifo sikashukela

Ukubuyisela i-potassium egazini, kusetshenziswa i-potassium chloride. Umuthi uyamiswa lapho izinga lezinto lifinyelela ku-6 mmol / L.

Amanye amaqhinga

Siqukethe izinyathelo ezilandelayo:

1. Imithamo emincane ye-insulin kuze kufike lapho amazinga afunekayo etholwa.
2. 2,5% isisombululo se-bicarbonate we-sodium ukungena ngaphakathi ukuze umzimba ube ngokwejwayelekile acidity.
3. Ngezinombolo eziphansi zomfutho wegazi - Norepinephrine, Dopamine.
4. I-Cerebral edema - ama-diuretics nama-glucocorticosteroids.
5. Imithi elwa namagciwane. Uma ukugxila kokutheleleka kungabonakali, khona-ke kuqokwa ummeleli weqembu le-penicillin, uma ukutheleleka kukhona, iMetronidazole ingezwa ku-antibiotic.
6. Ngenkathi isiguli sibheka ukuphumula kombhede - ukwelashwa kwe-heparin.
7. Njalo emahoreni angama-4, ukuba khona kokuchama kuyabhekwa, uma ungekho - ukulawulwa kwesinye isigaxa.

I-Hyperosmolar coma

Iqembu le-ambulensi lisungula ishubhu le-nasogastric futhi lenze isifiso sokuqukethwe esiswini. Uma kunesidingo, ukufakwa emanzini, i-oxygen oxygen, ukuvuselelwa kuyenziwa.

Izici zokuhlinzekwa kwezokunakekelwa kwempilo:

• Ukubuyisela izinkomba ze-osmolarity zegazi, ukwelashwa okukhulu kwe-infusion kuyenziwa, okuqala ngesisombululo se-hypotonic sodium chloride. Ehoreni lokuqala, kufakwa amalitha ama-2 koketshezi, amanye amalitha angama-8-10 ayajovwa emahoreni angama-24 alandelayo.
• Lapho ushukela ufinyelela ku-11-13 mmol / l, kufakwa isisombululo sikashukela emthanjeni ukuvikela i-hypoglycemia.
• I-insulin ifakwa emsipha noma emithanjeni ngenani lamayunithi ayi-10-12 (kanye). Ngaphezu kwalokho ku-6-8 PIECES njalo ngehora.
• Izinkomba ze-potassium esegazini ngezansi okujwayelekile zibonisa isidingo sokwethulwa kwe-potassium chloride (10 ml nge-1 litre ye-sodium chloride).
• Ukwelashwa kweHeparin kuze kube yilapho isiguli siqala ukuhamba.
• Ngokukhula kwe-edema yamabele - I-Lasix, ama-adrenal mahormone.

Ukulaliswa esibhedlela kwesiguli kuyimfuneko yokuqala ukuthuthukiswa kwezinkinga ezinzima zesifo sikashukela

Ukusekela umsebenzi wenhliziyo, ama-glycosides enhliziyo afakiwe kwi-dropper (Strofantin, Korglikon). Ukwenza ngcono izinqubo ze-metabolic and oxidative - Cocarboxylase, amavithamini C, iqembu B, i-glutamic acid.

Okubaluleke kakhulu ukondliwa kweziguli ngemuva kokuzinza kwesimo sazo. Njengoba ukwazi ukwazi kubuyiselwa ngokuphelele, kuyalulekwa ukusebenzisa ama-carbohydrate wokugaya - i-semolina, uju, ujamu. Kubalulekile ukuphuza kakhulu - ama-juices (kusuka ku-orange, utamatisi, ama-apula), amanzi afudumele we-alkali. Okulandelayo, engeza iphalishi, imikhiqizo yobisi, imifino nezithelo puree. Phakathi nesonto, ama-lipid namaprotheni okuvela ezilwaneni empeleni angeniswa ekudleni.