Isifo sikashukela i-mellitus yisifo esiyingozi ngenxa yezinkinga zaso.
Umuntu, ngokuya ngezincomo ezifanele, angahlala naye iminyaka eminingi noma, ngakolunye uhlangothi, angafaka isandla ekubhujisweni komzimba okusheshayo kanye nezinto ezinjenge-hyperosmolar coma.
I-Etiology ne-pathogenesis
I-etiology ye-hyperosmolar coma ihlotshaniswa nendlela yokuphila yomuntu. Kubhekwa ikakhulukazi kubantu abanohlobo lwesibili lwe-mellitus yesifo sikashukela futhi ikakhulukazi kubantu asebekhulile, ezinganeni - lapho kungekho kubuswa ngabazali. Isici esiyinhloko esidala ukwanda okukhulu koshukela wegazi phambi kwe-hyperosmolarity kanye nokungabikho kwe-acetone egazini.
Izizathu zalesi simo zingaba:
- ukulahleka okukhulu koketshezi komzimba ngenxa yokusebenzisa isikhathi eside imishini yokugaya, ukuhuda noma ukugabha, ngokushiswa;
- i-insulin enganele ngenxa yokwephulwa kwe-insulin therapy noma lapho ayenziwanga;
- ukufunwa okuphezulu kwe-insulin, kungabangelwa ukungondleki, izifo ezithathelwanayo, ukulimala, ukusetshenziswa kwezidakamizwa ezithile noma ukwethulwa kweglue egxilwe.
I-pathogenesis yenqubo ayicaci ngokuphelele. Kuyaziwa ukuthi izinga loshukela egazini likhuphuka kakhulu, futhi ukukhiqizwa kwe-insulin, kunalokho, kuyancipha. Ngasikhathi sinye, ukusetshenziswa kwe-glucose kuvinjelwe izicubu, izinso ziyeke ukuyicubungula futhi ziwubhebhethekise umchamo.
Uma kunokulahleka okukhulu kukamanzi ngumzimba, khona-ke umthamo wokujikeleza kwegazi uyancipha, uba mnene futhi u-osmolar ngenxa yokwanda kokuxineka kweglucose kanye ne-sodium ne-potassium ion.
Izimpawu ze-hyperosmolar coma
I-Hyperosmolar coma inqubo eyenzeka kancane kancane eba ngaphezulu kwamasonto ambalwa.
Izimpawu zakhe zikhula kancane bese kuvela isimo:
- ukwanda komchamo;
- ukoma okwandayo;
- ukwehla okunamandla kwesikhashana ngesikhathi esifushane;
- ubuthakathaka obungapheliyo;
- ukoma okuphezulu kwesikhumba nolwelwesi lwe-mucous;
- ukonakala okujwayelekile kwempilo.
Ukuwohloka okujwayelekile kuboniswa ngokungathandi ukuhamba, ukwehla komfutho wegazi kanye lokushisa, kanye nokwehla kwezwi lesikhumba.
Ngaso leso sikhathi, kunezimpawu ze-neva, ezikhonjiswe ku:
- ukwenza buthaka noma ukwanda ngokweqile kwama-reflexes;
- imibono;
- ukukhubazeka kwenkulumo;
- ukubonakala kokuquleka;
- ukungazi kahle;
- ukwephulwa kokungahleliwe kokunyakaza.
Uma kungekho zinyathelo ezanele, ama-stupor ne-coma kungenzeka, lapho ngamaphesenti angama-30 amacala aholela ekufeni.
Ngaphezu kwalokho, njengoba izingqinamba zibonwa:
- ukubanjwa isifo sokuwa;
- ukuvuvukala kwamanyikwe;
- i-vein thrombosis ejulile;
- ukwehluleka kwezinso.
Izindlela zokuxilonga
Ukuze kutholakale isifo esifanele futhi unikezwe umuthi wokwelashwa we-hyperosmolar coma ku-mellitus yesifo sikashukela, kubalulekile ukwenza isifo. Kufaka amaqembu amabili ayinhloko wezindlela: ukuqoqa i-anamnesis ngokuhlolwa kweziguli nokuhlolwa kwelebhu.
Ukuhlolwa kwesiguli kufaka phakathi ukuhlolwa kwesimo sakhe ngokwezimpawu ezingenhla. Elinye lamaphuzu abalulekile ukuhogela i-acetone emoyeni ekhishwa yisiguli. Ngaphezu kwalokho, izimpawu ze-neurological zibonakala kahle.
Ezifundweni zaselabhorethri, kusetshenziswa igazi, lapho kuhlolwa khona ushukela, i-osmolarity, okuhlushwa kwe-sodium. I-Glucose nayo ifundelwa umchamo, womabili ama-biomatadium ahlaziywa i-acidosis nemizimba ye-ketone.
Ezinye izinkomba ezingavusa isimo esifanayo sesiguli nazo ziyahlolwa:
- amazinga e-hemoglobin ne-hematocrit;
- ukubalwa kweseli elimhlophe;
- urea nitrogen okuhlushwa egazini.
Uma kunokungabaza noma isidingo sokuthola izinkinga, kungenziwa ezinye izindlela zokuhlola:
- I-Ultrasound ne-X-ray yama-pancreas;
- electrocardiogram nabanye.
Ividiyo emayelana nokuthola i-coma kushukela:
Ukwelashwa kwe-pathology
Izindlela zokwelapha zingahlukaniswa ngamazinga amabili: ukunakekelwa okuphuthumayo nokwelashwa okuqhubekayo ukuze kubuyiswe isimo somzimba.
Ukunakekelwa okuphuthumayo
Nge-hyperosmolar coma, isikhundla somuntu sinzima futhi siba sibi ngomzuzu ngamunye, ngakho-ke kubalulekile ukumnikeza usizo lokuqala kahle futhi simkhiphe kulesisimo. Uchwepheshe wokuvuselela kuphela ongahlinzeka ngalolo sizo, lapho isiguli kufanele sithathwe ngokushesha okukhulu.
Ngenkathi i-ambulensi ihamba, udinga ukubeka umuntu ohlangothini olulodwa futhi umboze ngokuthile ukuze unciphise ukulahleka kokushisa. Kulokhu, kuyadingeka ukuqapha ukuphefumula kwakhe, futhi uma kunesidingo, uphefumula ngokuphefumula noma ukuzivocavoca kwenhliziyo okungaqondile.
Ngemuva kokungena esibhedlela, isiguli sinikezwa izivivinyo ezisheshayo zokwenza ukuxilongwa okuyikho, bese kubekwa izidakamizwa ukuze kususwe isiguli esimweni esibucayi. Ubekelwa ukuphathwa kwe-intravenous fluid, imvamisa isisombululo se-hypotonic, esibe sesitshintshwa nge-isotonic. Kulokhu, ama-electrolyte anezelwa ukulungisa imitha ye-electrolyte, kanye nekhambi le-glucose ukuze kulondolozwe izinga lakhona elijwayelekile.
Kulesi simo, kuqashwa njalo izinkomba kusungulwa: izinga loshukela, i-potassium ne-sodium esegazini, izinga lokushisa, ingcindezi nokushaya ngamandla, izinga lemizimba ye-ketone kanye ne-acid acid.
Qiniseka ukuthi ulawula ukuphuma komchamo ukuze ugweme i-edema, engaholela emiphumeleni emibi, kaningi kulokhu umguli unikezwa i-catheter.
Izenzo ezengeziwe
Ngokuhambisana nokubuyiselwa kokulingana kwamanzi, i-insulin yelulelwa isiguli, kubandakanya ukuphathwa kwe-intravenous noma kwe-intramuscular.
Kuqala kwethulwa amayunithi angama-50, ahlukaniswe ngesigamu, ethula ingxenye eyodwa ngaphakathi, kuthi owesibili ngemisipha. Uma isiguli sine-hypotension, khona-ke i-insulin ikhishwa ngegazi kuphela. Ngemuva kwalokho ukudonsa kwehomoni kuyaqhubeka kuze kube yilapho i-glycemia ifinyelela ku-14 mmol / L.
Kulesi simo, izinga likashukela wegazi ligadwe njalo, futhi uma lehla laya ku-13.88 mmol / l, ushukela ufakwa kusisombululo.
Inani elikhulu loketshezi elingena emzimbeni lingavusa i-edema yamakhorali esigulini; ukuze ivikeleke, isiguli sinikezwa isixazululo esibuhlungu se-glutamic acid emthamo wamamililitha angama-50. Ukuvimbela i-thrombosis, i-heparin inqunyelwe bese izinkomba zokuqina kwegazi zigadwe.
Inkulumo yevidiyo:
Isibikezeli Nokuvimbela
Ukuqashelwa kwalesi sifo ikakhulukazi kuncike esikhathini sosizo. Ngokushesha nje lapho ihlinzekwa, ukwephulwa okuncane kanye nezinkinga ezenzeka kwezinye izitho zomzimba. Umphumela we-coma ukwephulwa kwezitho zomzimba, okwakungaphambi kwalokho kwaba nezifo ezithile. Okokuqala, kuthinteka isibindi, ama-pancreas, izinso nemithambo yegazi.
Ngokulashwa okufika ngesikhathi, ukuphazamiseka kuncane, isiguli siphinda siqaphele ezinsukwini ezimbalwa, amazinga kashukela ajwayelekile, futhi nezimpawu zekhomali ziyanyamalala. Uqhubeka nempilo yakhe ejwayelekile engayizwa imiphumela yesiphuzo.
Izimpawu ze-Neurological zingahlala amasonto ambalwa noma izinyanga. Ngokuhlulwa kanzima, kungenzeka kungahambi, futhi isiguli siqhubeka sikhubazekile noma sikhubazekile. Ukunakekelwa kwesikhashana kugcwele izinkinga ezinkulu kuze kube sekufeni kwesiguli, ikakhulukazi kulabo abanenye i-pathologies.
Ukuvimbela isimo kulula, kepha kudinga ukubhekwa njalo. Kuqukethe ukulawula ama-pathologies wezitho zangaphakathi, ikakhulukazi uhlelo lwenhliziyo, izinso nesibindi, ngoba zibamba iqhaza kakhulu ekuthuthukiseni lesi simo.
Kwesinye isikhathi i-hyperosmolar coma yenzeka kubantu abangabazi ushukela wabo. Kulokhu, kubalulekile ukuthi unake izimpawu, ikakhulukazi ukoma okungapheli, ikakhulukazi uma kukhona izihlobo emndenini onenkinga yesifo sikashukela.
Kubalulekile futhi ukulandela izincomo zikadokotela ezigulini ezinesifo sikashukela:
- qaphela njalo amazinga kashukela egazini;
- bambelela ekudleni okunqunyiwe;
- Musa ukwephula ukudla;
- Ungashintshi umthamo we-insulin noma ezinye izidakamizwa ngokwakho;
- Ungathathi imithi engalawulwa;
- qaphela ukusebenza okwenziwe ngomzimba;
- qaphela izinkomba zesimo somzimba.
Zonke lezi izinqubo ezifinyeleleka ngokuphelele udinga nje ukuzikhumbula. Ngemuva kwakho konke, isifo sikashukela i-mellitus senzeka ngenxa yendlela engalungile futhi ngenxa yaso iholela emiphumeleni emibi.
