Isifo sikashukela okuthiwa isifo sikashukela sibizwa ngokuthi yingcindezelo yokwazi komuntu ngokubhekene nesizinda sokuphazamiseka okubabazekayo komzimba emzimbeni okubangelwa yi-hyperglycemia ebucayi. Ekusebenzeni kwemitholampilo, lo mqondo ubandakanya i-hyperglycemic ketoacidotic ne-hyperosmolar coma.
Isifo sikashukela esibangelwa isifo sikashukela sithathwa njengesimo esibi esidinga ukunakekelwa okuphuthumayo. Ukungabikho ngesikhathi okunjalo kuholela ekufeni kwesiguli. Kumele kukhunjulwe ukuthi i-coma iyashintsha futhi ukuthuthukiswa kwayo kungavinjelwa.
Isifo sikashukela sikashukela
Lesi yisimo sokuncipha okubabazekayo, okubonakala ngamanani aphezulu kashukela kanye nemizimba ye-acetone esegazini (ngesiLatin - i-acetonaemia), ne-ketoacidotic coma isimo saso esidalulwa kakhulu futhi esibi kakhulu. Le ntuthuko ibonwa kuma-3-5% azo zonke iziguli ezinenkinga yesifo sikashukela esincike ku-insulin. Ukufa kwenzeka emaphesenti angama-5- 30%.
Izimbangela ze-hyperglycemic ketoacidotic coma:
- ukuntuleka kokutholwa kwesifo ngesikhathi;
- ukwephulwa ohlelweni lokwelashwa kwe-insulin;
- izifo ezithathelwanayo ezihlasela kakhulu;
- ukwelashwa okunganele kwe "sifo esimnandi" kuhambisana nokungenelela kokuhlinzwa, izimo ezicindezelayo, usizi;
- ukwanda kwezifo ezihlelekile;
- i-pathology yenhliziyo nemithambo yegazi;
- ukuhlinzwa kwe-pancreatic;
- ukungahambisani nemithetho yokudla okunempilo;
- ukudakwa nge-ethyl alcohol;
- isigamu sesibili sokukhulelwa.
Indlela yokuthuthukisa
Ukuntuleka kwe-pancreatic kubangela ukuthuthuka kokuntuleka kwe-insulin. Njengoba izinga le-hormone liphansi ukuze "ukuvula umnyango" kumaseli ukuze kuthathwe ushukela, amazinga egazi lawo asezingeni eliphakeme. Umzimba uzama ukunxenxa i-pathology ngokwehlukana kwe-glycogen kanye nokuvela kwe-monosaccharide kusuka kumaphrotheni akhiwe esibindini kusuka kumaphrotheni aqhamuka ekudleni.
I-Hyperglycemia - isisekelo sokubukeka kokufana kwesifo sikashukela
Ushukela omningi uphumela ekukhuphukeni kwengcindezi ye-osmotic, okucasulayo ukukhishwa kwamanzi nama-electrolyte kumaseli. I-Hyperglycemia inegalelo ekulahlekelweni kwamanzi okukhulu kumchamo kanye nokuvela kweshukela emchameni. Ukuqothuka okubalulekile kuyakhula.
Ukuqothuka kwe-lipid decomposition kwenzeka, ama-radicals wamahhala, i-cholesterol, ama-triglycerides aqongelela egazini. Bonke bangena esibindini, baba isisekelo sokubonakala kokugcwala kwemizimba ye-ketone. Imizimba ye-acetone ingena egazini nomchamo, okwephula i-acidity futhi icasule ukuthuthukiswa kwe-metabolic acidosis. Le yi-pathogenesis ye-ketoacidotic coma kushukela.
Izimpawu
Umtholampilo ukhula kancane kancane. Lokhu kungathatha izinsuku ezimbalwa noma iminyaka eminingana. Izinqubo ezinzima zokutheleleka, ukwanda kwezifo ezingamahlalakhona, ukushaya kwenhliziyo noma unhlangothi kungadala izimpawu emahoreni ambalwa.
Isikhathi se-precoma sihambisana nokuboniswa okunjalo:
- umuzwa we-pathological wokoma nomlomo owomile;
- iphunga elinamandla le-acetone emoyeni okhiphe amandla;
- i-polyuria;
- ukwehla okukhulu kwamandla okusebenza;
- ubuhlungu besisu besisu;
- Izici ezikhonjiwe, iso elishonile (izimpawu zokuphelelwa ngamanzi emzimbeni).
Ukuhogela kwe-acetone kuwuphawu oluvumela umehluko wezinkinga ezinzima zesifo sikashukela
Kamuva, i-turgor yesikhumba iyancipha, i-tachycardia, ukuphefumula okujulile nokunomsindo kuvela. Ngaphambi kokuqalwa kwe-coma uqobo, i-polyuria ithathelwa indawo yi-oliguria, ukugabha okukhulu, kuvela i-hypothermia, kuthi ithoni yezimpawu zamehlo inciphe.
Ungafunda kabanzi ngezimpawu zesifo sikashukela esikulesi sihloko.
Ukuxilonga
Izinkomba zaselabhoretha ze-ketoacidotic coma ku-mellitus yesifo sikashukela:
- izibalo ze-glycemia ngaphezulu kwe-35-40 mmol / l;
- i-osmolarity - ifike ku-320 mosm / l;
- i-acetone egazini nomchamo;
- i-acidity yegazi iyehla iye ku-6.7;
- ukwehla kwamazinga e-electrolyte;
- amazinga aphansi e-sodium;
- amanani aphezulu e-cholesterol ne-triglycerides;
- amazinga aphakeme we-urea, i-nitrogen, i-creatinine.
Kubalulekile! I-ketoacidosis idinga ukwahluka nge-hypoglycemic coma.
I-Hyperosmolar coma
I-coma yesifo sikashukela ebonakala ushukela wegazi ophakeme ngaphandle kokwakhiwa kwemizimba ye-ketone. Lesi simo sihambisana nokuphelelwa ngamandla komzimba futhi kubalwa ama-5-8% ezimo zawo wonke amahlaya wesifo sikashukela. Ukufa kwenzeka kuzo zonke izimo zesithathu zomtholampilo ngaphandle kosizo olwanele.
Ikhula kaningi kwabadala, ezinganeni akwenzeki. I-Hyperosmolar coma ku-mellitus yesifo sikashukela ibonakala ngesimo sayo esincike ku-insulin. Izibalo zithi esikhathini esiningi, kungokuthuthuka kwengqinamba yokuthi iziguli zifunda ngokuba khona kwesifo esikhona.
Abantu asebekhulile abanesifo sikashukela sohlobo 2 - okuphikisana nesibalo sabantu ngengozi ekhulayo yokwanda kwe-hyperosmolar coma
Izimbangela zokuthuthuka kwe-pathology zingaba:
- Izifo ezithinta umzimba - izifo ezijoyine ngengozi ezandisa isimo sesifo esiyimbangela;
- izifo ezithathelwanayo;
- usizi noma ukushiswa;
- ukuphazamiseka kokujikeleza kwesitho esibuhlungu;
- izifo zepheshana lesisu, ezihambisana nokuhlasela kokuhlanza kanye nohudo;
- ukulahleka kwegazi;
- ukungenelela kokuhlinzwa;
- ukusetshenziswa kwesikhathi eside kwezidakamizwa ze-hormonal, ama-diuretics, ama-immunosuppressants, ama-mannitol.
Kubalulekile! Ukwethulwa kweglucose kanye nokudla kwemikhiqizo yama-carbohydrate kungasenza sibhebhethekise lesi simo.
Indlela yokuthuthukisa
Izigaba zokuqala zamanani aphezulu kashukela wegazi zihambisana nokuvela kweshukela emchameni kanye nokuphuma kwawo okuthuthukile (polyuria). Ukwanda kwengcindezi ye-osmotic kwenzeka, okufaka isandla ekuphumeni kwezicubu namaseli we-fluid nama-electrolyte, kanye nokwehla kokugeleza kwegazi ezinso.
Ukwehla komzimba kubangela ukukhuphuka kwengqamuzana amaseli egazi abomvu namaplatelet. Njengomphumela wokuphelelwa ngamanzi emzimbeni, ukukhiqizwa kwe-aldosterone kuyathuthukiswa, i-sodium igcinwa egazini, okufaka isandla ekwakhekeni kwama-hemorrha amancane emithanjeni yobuchopho. Izimo ezivelile ziphakamisa i-osmolarity yegazi iphakeme kakhulu
Izimpawu
I-Precoma ihambisana nezimpawu ezifanayo nesimo se-ketoacidosis. Iphuzu elibalulekile elisetshenziselwa ukuhlukanisa isimo ukungabi bikho kwe “sithelo” noma iphunga le-acetone emoyeni okhiphe umoya. Iziguli ziphawula ukuvela kwezimpawu ezilandelayo:
Ungayisusa kanjani i-acetone emzimbeni onesifo sikashukela ekhaya- ukoma
- i-polyuria;
- ubuthakathaka
- isikhumba esomile;
- izimpawu zokuphelelwa ngamanzi emzimbeni (izici zobuso ziyalolwa, ithoni yezimpawu zamehlo iyancipha);
- ukuphefumula kakhulu;
- ukubonakala kokuqagela kwe-pathological;
- iminyakazo
- ukubanjwa isifo sokuwa.
Ukuntuleka kokunakekelwa okuphuthumayo kuholela ekuthuthukisweni kwe-stupor kanye nokulahlekelwa ukwazi.
Izinkomba zokuxilonga
Ukuxilongwa kwe-hyperosmolar coma kusekwe ekunqumeni ubukhona be-hyperglycemia ngaphezulu kwe-45-55 mmol / L. I-Sodium esegazini - ifinyelela ku-150 mmol / l, potassium - ifinyelela ku-5 mmol / l (ngesilinganiso esiyi-3.5 mmol / l).
Izinkomba ze-Osmolarity zingaphezulu kwama-370 mosm / kg, cishe amayunithi ayi-100 aphakeme kunezinombolo ezijwayelekile. I-Acidosis kanye nemizimba ye-ketone ayitholakali. Ukuhlolwa kwegazi okujwayelekile kungakhombisa i-leukocytosis, ukwanda kwe-hematocrit ne-hemoglobin, ukwanda okuncane kwamazinga e-nitrogen.
Ukuxilongwa kwelabhorethri - isisekelo sokwehlukana kwezinkinga
Usizo lokuqala
Noma imuphi ama-coms wesifo sikashukela adinga usizo lokuqala, ngaphezu kokwelashwa okuyinhloko. Okokuqala, kuyadingeka ukubiza iqembu labasebenza ngama-ambulensi, futhi baze bafika, benze uchungechunge lwezenzo:
- Beka isiguli endaweni enezingqimba futhi unikeze ukufinyelela komoya.
- Ikhanda kufanele liguqulwe ngakwesobunxele noma ngasohlangothini lwesokunene, ukuze kuthi lapho ukuhlanza kungenzeki ukuhlanza ukuhlanza.
- Uma kwenzeka kuba nokuthathwa kwesihlungu sokuwa phakathi kwamazinyo, kubalulekile ukufaka into eqinile (hhayi insimbi!). Lokhu kuyadingeka ukuze ulimi lungawi.
- Uma isiguli sikwazi ukukhuluma, hlola ukuthi sisebenzisa i-insulin therapy. Uma kunjalo, siza ukujova i-hormone.
- Ngamakhaza, fudumeza isiguli ngengubo, ipedi yokushisa.
- Nikeza amanzi okuphuza ngenani olifunayo.
- Bheka ngokucophelela umfutho wegazi lakho nokushaya kwenhliziyo. Uma kwenzeka ukuboshwa kwenhliziyo noma ukuphefumula, qhubeka nokuvuselelwa kwenhliziyo.
- Ungamshiyi yedwa isiguli.
Eminye imisebenzi yenziwa yiqembu le-ambulensi khona lapho nasesibhedlela ngemuva kokulaliswa esibhedlela.
Ungafunda okuningi ngokunakekelwa okuphuthumayo komkhuhlane wesifo sikashukela kule ndatshana.
Isigaba sezokwelapha
Ukuqagela okuhle kwe-ketoacidosis kungatholakala kuphela nge-insulin. Imithamo yokuqala ihanjiswa ngaphakathi, ilandelwa ngokudonsa i-intravenous ngokuhambisana ne-5% ushukela (ukuvimbela i-hypoglycemia).
Ukwelashwa kwe-infusion - ingxenye yokwelashwa okuyinkimbinkimbi nokululama kwesiguli
Kusetshenziswa isixazululo se-bicarbonate, isiguli sihlanjwa ngepheshana lesisu. Ama-electrolyte alahlekile futhi uketshezi abuyiselwa ukumfakwa kwe-saline, isixazululo se-Ringer, i-sodium bicarbonate. Ama-glycosides e-Cardiac, i-oxygen therapy, i-cocarboxylase nawo abekiwe.
Isimo se-hyperosmolar sidinga ukumiliselwa okukhulu (i-saline ngokomzimba nge-insulin, isixazululo se-Ringer - 15-18 l ngosuku lokuqala). Nge-glycemia engu-15 mmol / L, i-insulin ilawulwa ngokudonsa ngamandla emzimbeni kushukela. Izisombululo ze-bicarbonate azidingeki, ngoba izidumbu ze-ketone azikho.
Isikhathi Sokululama
Ukuvuselelwa kabusha kweziguli ngemuva kokukhubazeka kwesifo sikashukela kuqukethe ukuhlala kwabo esibhedlela se-endocrinological nokulandela izeluleko zodokotela ekhaya.
- Ukubambelela ngokucophelela ekudleni komuntu ngamunye.
- Ukuziqapha kwezinkomba zikashukela nokuxilongwa kwelebhu okufika ngesikhathi.
- Ukuzivocavoca okwanele.
- Ukunamathela ngqo ekwelashweni kwe-insulin nokusetshenziswa kwama-hypoglycemic agents.
- Ukuvimbela izinkinga ezinzima futhi ezingamahlalakhona.
- Ukwenqatshwa kwemithi yokuzilolonga nemikhuba emibi.
Ukuhambisana nale mithetho kuzovikela ukwephulwa okukhulu futhi kulondoloze isimo sesinxephezelo salesi sifo esiyimbangela.
