Izindlela zokuqala zosizo ze-hypoglycemic coma

Ukujwayeza izinga le-glycemia kuwumsebenzi ophambili obhekene nesiguli esithola isifo sikashukela. Ukuguquguquka okubukhali kumanani we-glucose akugcini nje ngokulimaza isimo sesiguli, kodwa futhi kungadala ukukhula kwezinkinga eziyingozi.

Omunye wemiphumela yenkambo engalawulwa yesifo sikashukela yi-hypoglycemic coma, eyenzeka ngokuncipha kwamazinga kashukela. Lesi simo sibonisa ngokuthuthuka okusheshayo kombani futhi uma usizo olungesilo, lungadala ukufa.

I-pathogenesis nezimbangela zesimo se-pathological

Ukuhlushwa kwe-glucose ephansi enamazinga aphezulu e-insulin (ukushaqeka kwe-insulin) kungadala i-hypoglycemic coma. Lesi simo sibonisa ukusabela okukhethekile komzimba, lapho umsebenzi wezinzwa eziphakeme uphazamiseka futhi nama-neurons obuchopho athinteka khona. Ukushoda kwe-glucose isikhathi eside kubangela ukulamba kwe-oksijini ne-carbohydrate. Umphumela wale nqubo ukushona kweminyango noma izingxenye zobuchopho.

I-insulin coma ibonakala ngokuhla kwe-glucose ngaphansi kwe-3.0 mmol / L. Ngomzuzu onjalo, umuntu uhlangabezana nemizwa ehlukahlukene engathandeki. Isimo sikhula ngokushesha, sikhula njalo ngemizuzu. Ezimweni eziningi, i-coma yenzeka kwiziguli ezithembela ku-insulin. Ukuvela kwayo kungenxa yamaqhinga angalungile okwelapha lesi sifo, kanye nokungaqondi kwemithetho yokujova.

Izizathu eziyinhloko:

• ukweqisa kwe-insulin lapho isiguli sifake inani elingalungile lomuthi noma sisebenzise uhlobo olungalungile lomkhiqizo (ngokwesibonelo, isipontsho i-U40 esikhundleni se-U100);
• umuthi uphathwa nge-intramuscularly, hhayi ngokuzithoba;
• Ukudla akubonwa, futhi ukudla okulula okuphelelwe isikhathi kuyaphuthelwa;
• Izikhathi ezinde zokudla phakathi kokudla;
• ushintsho lokudla nokudla;
• umjovo we-hormone osebenzayo omfishane ngaphandle kokudla okulandelayo;
• ukwenza umsebenzi owengeziwe womzimba ngaphandle kokusebenzisa kwangaphambili ama-carbohydrate
• ukuntuleka kokulawulwa kwe-glycemic ngaphambi kokubala umthamo wehomoni, ngenxa yalokho izidakamizwa eziningi zidakiwe kunalokho okudingekayo;
• ukushesha kwegazi endaweni yomjovo ngenxa yokunyakaza okuphelele kokuzivocavoca;
• ukuphuza utshwala;
• ukukhulelwa, ikakhulukazi izinyanga zokuqala lapho isidingo se-insulin sincipha;
• ukukhuluphala kwesibindi;
• isiguli sisesimweni se-ketoacidosis;
• ukusetshenziswa kwezidakamizwa ezithile, ngokwesibonelo, ukusetshenziswa kwabantu asebekhulile bezidakamizwa ze-sulfanilamide lapho kukhona ukulimala okungapheli kwesibindi, inhliziyo noma izinso;
• ukuphazamiseka kwesistimu yokugaya.

I-Hypoglycemia ingenzeka futhi kumntwana osanda kuzalwa owayengazalwa ngaphambili kunalokho obekulindelekile, noma uma enezinkinga zentliziyo eziwoqobo.

Izimpawu

Umtholampilo we-hypoglycemia uncike ijubane lokubonakala kwawo.

Izimpawu zokuqala:

• umuzwa wendlala;
• ubuthakathaka
• ukujuluka
• Isiyezi
• ukozela
• umuzwa wokwesaba ngaphandle kwesizathu;
• ikhanda
• indlala yesikhumba.

Uma kungekho zinyathelo zokumisa izimpawu zokuqala ze-hypoglycemia, kuvela isimo esibi, esihambisana nezimpawu ezilandelayo:

• i-tachycardia;
• i-paresthesia;
• ubunzima bokuphefumula
• ukuthuthumela
• iminyakazo
• i-arousal (psychomotor);
• ukwazi okufiphele.

Ngokungazinaki isikhathi eside kwalezi zimpawu, ukukhohlakala kwenzeka.

Ukuboniswa okulandelayo kuyisimo sakho:

• ukungabonakali kwemvelo kwamanani wezinsimbi;
• abafundi abahlisiwe;
• ukukhuphuka kwenhliziyo;
• ukukhuphuka okuncane komfutho wegazi;
• ukwehlisa izinga lokushisa lomzimba;
• Ukuthuthukiswa kwezimpawu ze-Kernig;
• ukwanda kwe-tendon kanye ne-periosteal reflexes;
• ukulahlekelwa ukwazi.

Ukuvela kwezimpawu ezinjalo kufanele kube yisizathu sokudla ngokushesha ama-carbohydrate kanye nokufuna usizo lodokotela.

Isimo esiphuthumayo - i-algorithm yesenzo

Iziguli ezinesifo sikashukela kufanele ziqiniseke ukuthi zitshela izihlobo zazo ngezici zokwelashwa, nangemiphumela eyingozi engaba khona. Lokhu kuyadingeka kubantu abasondelene nabo ukuthatha izinyathelo ezidingekayo zokuqeda ukubonakaliswa kwe-hypoglycemic coma.

Usizo lokuqala lubandakanya izinyathelo ezilandelayo:

1. Beka isiguli ohlangothini olulodwa ukuvikela ukujaha ngenxa yokuhlanza ukungena ezindleleni zomoya. Ngenxa yalesi simo, kungenzeka ukuthi ugweme ukwehliswa kolimi.
2. Khipha umgogodla womlomo ekudleni (uma kunesidingo).
3. Mboza isiguli ngezingubo zokulala ezimbalwa ezifudumele.
4. Njalo qapha ukushaya nokuhamba kokuphefumula kwesiguli. Uma bengekho, kuyaphuthuma ukuqala ukwenza ukuzivocavoca kwenhliziyo nokwenza ukuphefumula kokufakelwa (uma kunesidingo).
5. Uma isiguli sinemisebenzi yokugwinya, udinga ukumenzela ukuthi aphuze isiphuzo esimnandi. Enye indlela, amaswidi noma amanye amaswidi ngeke asebenze, ngoba azongenwa isikhathi eside. Ngaphezu kwalokho, ohlelweni lokudla i-muffin noma ushokoledi, isimo sesiguli singase sibe sibi kakhulu, angahle alahlekelwe ukwazi noma ukugwinya.
6. Uma kungabikho ama-carbohydrate asesandleni nokugcinwa kokuzwela kobuhlungu kumuntu, ukukhishwa kwe-catecholamines (adrenaline, serotonin ne-dopamine) kufanele kusebenze kusetshenziswa ukugoqa noma ukucwilisa.
7. Usizo lokuqala kumuntu osesimweni sokungazi kufanele lube nezinyathelo zokuphakamisa amazinga kashukela. Uma kukhona isirinji ene-glucagon, kufanele idluliselwe esigulini ngokungabonakali (ngevolumu engu-1 ml) noma ngaphakathi. Ngemuva kwalokho udinga ukubiza i-ambulensi.

Kubalulekile ukukwazi ukwahlukanisa izimpawu zesimo se-hypoglycemic ne-hyperglycemic coma. Esimweni sokuqala, isiguli kufanele siphathwe i-glucose, futhi kwesibili - i-insulin. Ukusetshenziswa ngokungafanele kwesidakamizwa kwandisa ingozi yokufa.

Ukugwema ukuqala kwesimo esisongela impilo, isiguli kufanele kuqala sithathe inani elincane lama-carbohydrate ukuvimbela ukwehla ku-glycemia, bese sikala izinga le-glucose nge-glucometer. Ngemuva kokuthola imiphumela yokuhlolwa, kuyadingeka ukuthi uthathe izinyathelo ezifanele zeleveli yesikhombi (injin insulin noma injeksi glucose), bese ulinda odokotela ukuthi bafike.

Ukuxilongwa okuhlukile

Kutholakala ukuthi kukhona i-insulin coma ezigulini ezinesifo sikashukela, kanye nokuphazamiseka emanyikwe. Uhlolo oluphambili lwelabhoratri isampula yegazi ukukala ushukela.

Okwe-coma, ukwehla kwenkomba kungaphansi kuka-2 mmol / l. Ezigulini ezihlala zibe ne-hyperglycemia, ukwehla kwamazinga kashukela okufika ku-6 mmol / L kubhekwa njengesimo se-pathological. Ezimweni ezinjalo, ukunquma imbangela yokukhohlisa kungaba nzima. Isimo se-glycemia esigulini esinesifo sikashukela yi-7 mmol / L.

Ukungazi lutho futhi kuyinkimbinkimbi yokuthola lesi sifo. Asikho isikhathi sokwenza ukuhlolwa kwegazi, ngakho-ke, udokotela angahlukanisa i-hyperglycemia kusuka ku-hypoglycemia kuphela ngokugxila ekubonisweni kwangaphandle (ukoma, umbala wesikhumba, izintende zezimvula ezimanzi, iminyakazo). Noma yikuphi ukubambezeleka kungabiza impilo yeziguli.

Izinto ezibonakalayo zevidiyo ngezimbangela zokwehla kwesifo sikashukela:

Ukwelashwa kokugula

Ukusizwa ekusetshenzisweni kwesibhedlela kubandakanya imisebenzi elandelayo:

1. Abangama-40 bajovela ngaphakathi noma i-60 ml yesisombululo se-glucose enenqwaba yama-40%.
2. Uma ungekho umphumela wokujova, isiguli sinikezwa i-dropper ukuze sinikeze isisombululo se-5% kashukela kuze kube yilapho ukwazi kuye kubuyela kukho.
3. Nge-coma ejulile, isiguli sifakwa futhi nge-200 mg ye-hydrocortisone.
4. Kwezinye izimo, kungadingeka ukuthi wenze umjovo oshubile we-adrenaline ngenani le-1 ml yesisombululo (nge-0,1% okuhlushwa) noma i-ephedrine chloride.
5. Uma isiguli sinemithambo emibi, lapho-ke kungenye indlela yomjovo we-intravenous, Dripcous glucose ongashisi noma ukusetshenziswa kwe-enema evolumu engu-500 ml kusetshenzisiwe.
6. Ukuthuthukisa ukusebenza kwenhliziyo kungadinga ukusetshenziswa kwe-caffeine, i-camphor, noma izidakamizwa ezifanayo.

Izimpawu zokuphumelela kwezenzo ezithathwe uchwepheshe:

• ukululama kokubona esigulini;
• ukunyamalala kwazo zonke izimpawu;
• ukulungiswa kweshukela.

Uma isimo sesiguli singathuthuki ngemuva kwamahora ama-4 kusukela esikhathini sokufakwa kwe-glucose ngaphakathi, khona-ke ingozi yokuthola inkinga efana ne-cerebral edema iba ngaphezulu kakhulu. Umphumela walesi simo awunakuba ukukhubazeka kuphela, kodwa futhi nokufa.

Imiphumela kanye nokubikezela

Imiphumela yomuntu oye waba ne-hypoglycemic coma ingahluka. Lokhu kungenxa yesikhathi somthelela omubi wokuntuleka kwama-carbohydrate esimweni samangqamuzana nomsebenzi wezitho zangaphakathi.

Izinkinga:

• i-edema yamakhemikhali;
• ukuphazamiseka okungalungiseki ohlelweni oluphambili lwezinzwa (uhlelo lwezinzwa oluphakathi);
• ukuthuthukiswa kwe-encephalopathy ngenxa yomonakalo kumaseli obuchopho;
• ukuphazamiseka kokuhlinzekwa kwegazi;
• ukuqala kokubulawa yindlala kwama-oksijini;
• ukufa kwezicubu zezinzwa okuholela ekuwohlokeni kobuntu;
• izingane eziye zahlushwa ukhubazeka zivame ukubuyiselwa ngokomqondo.

Indlela emnene yokushaqeka kwe-insulin ingaholela ekuphazamisekeni kwesikhashana kwesistimu yezinzwa. Izindlela zokwelapha ezisheshayo zingabuyisela ngokushesha amazinga e-glucose futhi ziqede ukubonakaliswa kwe-hypoglycemia.

Kulokhu, izimpawu zalesi simo azishiyi mkhondo ekuqhubekeni kwesiguli. Izindlela ezinkudlwana zokweyisa, izindlela zokwelashwa ezinganele ziholela emiphumeleni emibi, kufaka phakathi ukuthuthukiswa kokushaywa unhlangothi kanye ne-edema yamakhorali.

Izinto zevidiyo ku-hypoglycemia:

Izindlela zokuvimbela

Ukuvela kokushaqeka kwe-insulin kungenxa yokuqalwa kwe-hypoglycemia. Ukuvimbela ukwehla okubukhali kwe-glucose, irejimeni yokwelashwa kufanele ibhekwe ngokucophelela, futhi kuthathwe izinyathelo zokuvimbela.

Izincomo ezibalulekile:

• qaphela inkomba ye-glycemia - lokhu kwanele ukubheka amanani eglucose ngaphambi nangemva kokudla, kanye nokudla okungahleliwe;
• qaphela ukusabela komchamo;
• qaphela isimo ngaphambi nangemva kwemijovo ye-insulin;
• khetha umthamo ofanele we-insulin obekwe udokotela wakho;
• Ungashiyi ekhaya ngaphandle kwamaswidi;
• Musa ukwandisa umthamo wezidakamizwa ze-hypoglycemic ngokwakho;
• landela ukudla nokudla okusungulwe udokotela;
• hlola i-glycemia njalo ngaphambi kokuzivocavoca;
• ukutshela abantu cishe ngazo zonke izinkinga ezihambisana nalesi sifo, futhi ubafundise imithetho yokuziphatha lapho isimo se-hypoglycemic senzeka.

Kubalulekile kubo bonke abantu, ikakhulukazi ebudaleni, ngezikhathi ezithile ukuba bahlolwe ngudokotela ukukhomba isifo sikashukela ezigabeni zokuqala zokukhula kwayo. Lokhu kuzosiza ukuvikela ukukhula kwezinkinga eziningi, kufaka phakathi i-hypoglycemia, ngisho nakulabo abangazi ngokuqhubeka kwesifo.