Umgomo oyinhloko wokwelapha ushukela ukuqinisa i-glycemia. Noma yikuphi ukuphambuka kwenani le-glucose kusuka kokujwayelekile kuthinta kabi isimo sesiguli futhi kungaholela ezinkingeni eziyingozi.
Ukushoda kwe-insulin isikhathi eside emzimbeni kwandisa ubungozi be-hyperglycemic coma. Lesi simo sibeka usongo olukhulu empilweni yesiguli, ngoba imvamisa ihambisana nokulahlekelwa ukwazi. Kungakho kubalulekile ukuthi abantu abasondelene nabo bazi izimpawu zokuqala zale nkimbinkimbi kanye ne-algorithm yezenzo yokunakekelwa okuphuthumayo kwesiguli.
Kungani kukhula ukoma?
I-Hyperglycemic coma yenzeka ngenxa yezinga likashukela eliphakeme, eliqhubeka isikhathi eside.
I-pathogenesis yalesi simo kungenxa yokushoda kwe-insulin nokusetshenziswa glue kwe-glucose, okuholela ezinqubweni ezilandelayo emzimbeni:
- izidumbu ze-ketone zenziwa;
- okunamafutha kwesibindi kukhula;
- i-lipolysis ithuthukiswa ngenxa yokuqukethwe kwe-glucagon ephezulu.
Ukuhlukaniswa kweComa:
- I-Ketoacidotic. Ukuthuthukiswa kwaso kuvame kakhulu ukutholakala ezigulini ezixhomekeke ku-insulin futhi kuhambisana nokukhula kwemizimba ye-ketone.
- I-Hyperosmolar - Kuvela ezigulini ezinhlobo lwesibili lwesifo. Kulesi simo, umzimba uhlushwa ukomisa kanye namanani aphezulu kashukela.
- I-Lactic acidosis - ukunqwabelana kwe-lactic acid egazini ngokwenyuka okulinganiselwe kwe-glycemia kuwuphawu lwale hlobo lokuthamba.
I-etiology yesimo se-pathological iqukethe ukubola kwesifo sikashukela, amaqhinga wokuphatha akhethwe ngokungafanele noma ukutholwa kwesifo okungafanele.
Ukuvela kokwehla komzimba kungabangelwa yizici ezilandelayo:
- ukungahambisani nohlelo lokujova;
- ukungafani phakathi kwenani lomuthi olawulwa kanye nama-carbohydrate adliwayo;
- ukwephulwa kokudla;
- ukuguqulwa kwe-insulin;
- ukusetshenziswa kwehomoni eqandisiwe noma ephelelwe yisikhathi;
- ukuthatha imishanguzo ethile (i-diuretics, i-prednisone);
- ukukhulelwa
- izifo
- izifo zepancreas;
- ukungenelela kokuhlinzwa;
- ukucindezela
- ukuhlukumezeka kwengqondo.
Kubalulekile ukuqonda ukuthi noma iyiphi inqubo yokuvuvukala eyenzeka emzimbeni inegalelo ekwandeni kokusetshenziswa kwe-insulin. Iziguli azihlali zinaka leli qiniso uma kubalwa umthamo, okuholela ekuphepheni kwe-hormone emzimbeni.
Uzokhipha nini i-alamu?
Kubalulekile ukuqonda ukuthi yiziphi izimo lapho isiguli sidinga ukunakekelwa okuphuthumayo. Kulokhu, kwanele ukwazi izinkomba zokuqina okuye kwavela ngenxa ye-hyperglycemia. Umtholampilo ngokuvela kwale nkimbinkimbi uyahlukahluka ngokuya ngesigaba sokukhula kwayo.
Kunezikhathi ezi-2:
- i-precoma;
- ukhubazeka ngokulahlekelwa ukwazi.
Ukuboniswa kokuqala:
- i-malaise;
- ubuthakathaka
- ukukhathala kokuqala okusheshayo;
- ukoma okukhulu;
- isikhumba esomile nokubukeka kokulunywa;
- ukulahleka kwesifiso.
Uma kungekho zinyathelo zokumisa izimpawu ezifakwe kuhlu, isithombe somtholampilo siyaqina, kuvela izimpawu ezilandelayo:
- ukwazi okungaphelele;
- ukuphefumula okungavamile;
- ukuntuleka kokusabela ezenzakalweni ezungeze;
- izindwani zamehlo zingathamba;
- ukwehla komfutho wegazi, kanye nokushayeka;
- indlala yesikhumba;
- ukwakheka kwezindawo ezimnyama ebusweni be-mucous bomlomo.
Isibonakaliso esiyinhloko esikhombisa ukuthi ukukhula kwenhliziyo kubhekwa njengezinga le-glycemia. Inani lalesi sikhombisi ngesikhathi sokulinganisa lingadlula i-20 mmol / L, lifinyelele kwezinye izimo uphawu lwe-40 mmol / L.
Usizo lokuqala
Usizo lokuqala lubandakanya okulandelayo:
- Shayela usizo lwezempilo oluphuthumayo.
- Beka umuntu ohlangothini olulodwa. Kulesi sikhundla somzimba, ingozi yokuthuthuzela ekuhlanzeni ungene emgudwini wokuphefumula, kanye nokugcinwa kolimi, iyancishiswa.
- Nikeza umoya omusha, ukhulule isiguli ezingutsheni eziqinile, uqinise ikhola noma ususe isikhafu.
- Linganisa izinga lokucindezela ngethrekhi yomfutho wegazi.
- Bheka ukushaya ngamandla, uqopha zonke izinkomba ngaphambi kokufika kodokotela.
- Mboza isiguli ngengubo efudumele uma ebanda.
- Ngenkathi kugcina ukuvela kokugwinya komuntu kufanele kudakwe ngamanzi.
- Isiguli esithembela i-insulin kufanele sinikezwe umjovo we-insulin ngokuya ngemithamo enconyiwe. Uma umuntu ekwazi ukuzinikeza usizo lokuzisiza, kuzodingeka ulawule inqubo yokulawulwa kwezidakamizwa. Ngaphandle kwalokho, lokhu kufanele kwenziwe yisihlobo esiseduze kwakhe.
- Yenza ukuphefumula kokufakelwa, kanye nokuzivocavoca kwangaphandle kwenhliziyo uma kunesidingo.
Yini engenziwa:
- shiya isiguli sisodwa uma kwenzeka sikhubazekile;
- ukuvikela isiguli ekwenzeni imijovo ye-insulin, maqondana nalezi zenzo njengezinganele;
- yenqaba ukunakekelwa kwezokwelashwa, noma ngabe umuntu ezizwa engcono.
Ukusiza izihlobo zesiguli, kubalulekile ukuhlukanisa phakathi kwe-hypo- ne-hyperglycemic coma. Ngaphandle kwalokho, isenzo esibi ngeke nje sidambise isimo sesiguli, kodwa futhi kungaholela emiphumeleni engenakuphikwa, kuze kube sekufeni.
Esimweni sokungakholelwa ukuthi i-coma ibangelwa amazinga aphezulu kashukela, umuntu udinga ukunikezwa amanzi amnandi okuwaphuza, futhi uma elahlekelwe ukwazi, ikhambi le-glucose kufanele liphathwe ngokuqondile. Naphezu kweqiniso lokuthi kungenzeka ukuthi vele unayo i-glycemia ephezulu, esesimweni esifanayo ngaphambi kokuba kufike i-ambulensi, lesi kuzoba ukuphela kwesinqumo esifanele.
Ukuxilongwa okuhlukile
Uhlobo lwe-hyperglycemic coma lunganqunywa ngesisekelo sokuhlolwa kwegazi okune-biochemical nokujwayelekile, kanye ne-urinalysis.
Izimpawu zaselabhorethri zokukhohlisa:
- ukweqiwa okukhulu kweshukela noshukela we-lactic acid;
- ukuba khona kwezidumbu ze-ketone (kumchamo);
- ukukhuphuka kwe-hematocrit ne-hemoglobin, okubonisa ukuphuma komzimba;
- amazinga aphansi e-potassium kanye nokwanda kwe-sodium egazini.
Ezimweni ezitholwe ngumphakathi, kuhlolwa igazi kusetshenziselwa ushukela usebenzisa i-glucometer. Ngokusekelwe kumphumela, udokotela ukhetha amaqhinga osizo.
Indaba yevidiyo emayelana nekoma kushukela:
Ukuvuselela
Izinkomba zokuvuselelwa kabusha yilezi:
- ukuntuleka kokuphefumula noma ukushaya ngamandla;
- ukuboshwa kwenhliziyo;
- umbala wesikhumba oluhlaza okwesibhakabhaka;
- ukungabikho kwanoma yikuphi ukusabela kwabafundi lapho ukukhanya kungena kubo.
Ngezimpawu ezingenhla, akufanele ulinde kuze kufike i-ambulensi.
Izihlobo zesiguli kufanele ziqale ukuzimela ngokwezincomo ezilandelayo:
- Beka isiguli endaweni enzima.
- Vula ukufinyelela esifubeni, ukuyikhulula ezingutsheni.
- Tshekisa ikhanda lesiguli emuva bese ubeka isandla sakhe ebunzini lakhe, bese welula umhlathi ongezansi ngaphambili nolunye ukuze uqinisekise ukutholakala kwe-airway patency.
- Susa imfucumfucu yokudla emgodini womlomo (uma kunesidingo).
Lapho wenza ukuphefumula kokufakelwa, kuyadingeka ukuthinta ngokuqinile izindebe zomlomo wesiguli ngebhanti noma ngendwangu ehlanzekile ebekwe kuso. Ngemuva kwalokho udinga ukwenza i-exhalations ejulile, ukuvala ikhala lesiguli ngaphambi kwesikhathi. Ukusebenza kwezenzo kunqunywa ukuphakanyiswa kwesifuba ngalesi sikhathi. Inani lokuphefumula ngomzuzu lingafinyelela izikhathi eziyi-18.
Ukuze wenze ukuphefumula kwenhliziyo okungaqondile, izandla kufanele zibekwe engxenyeni yesithathu engezansi yes sternum yesiguli, esesandleni sayo sobunxele. Isisekelo senqubo ukuthuthumela okunamandla okwenzelwe umgogodla. Ngalesi sikhathi, ukuguquka kobuso be-sternum kuya kubude be-5 cm kubantu abadala kanye nama-2 cm ezinganeni kufanele kwenzeke. Cishe ompompi abangu-60 ngomzuzu. Lapho uhlanganisa lezi zenzo nokuphefumula okwenziwe ngamakhala, umoya ngamunye kufanele uhambisane nokuchofoza okuyi-5 endaweni yesifuba.
Izenzo ezichaziwe kufanele ziphindwe kuze kufike odokotela.
Isifundo sevidiyo sokuvuselela abanye:
Imicimbi yezokwelapha:
- Uma kudalwa i-ketoacidosis coma, i-insulin iyadingeka (okokuqala nge-jet, bese kuthi ngendlela yokwehla ibe ne-dilution ku-glucose solution ukuvikela i-hypoglycemia). Ngaphezu kwalokho, kusetshenziswa i-sodium bicarbonate, glycosides nezinye izindlela ukusekela umsebenzi wenhliziyo.
- Nge-hyperosmolar coma, amalungiselelo we-infusion anqunyelwe ukubuyisa uketshezi emzimbeni, i-insulin ilawulwa ngokudambisa.
- I-Lactic acidosis iqedwa ukusetshenziswa kwe-antiseptic Methylene Blue, Trisamine, solution ye-sodium bicarbonate, kanye ne-insulin.
Izenzo zabachwepheshe zincike ohlotsheni lomthambo futhi zenziwa esibhedlela.
Ungakuvimbela kanjani usongo empilweni?
Ukwelashwa kwesifo sikashukela kudinga ukugcinwa kwezincomo zokwelashwa. Ngaphandle kwalokho, ubungozi bokuqhamuka nezinkinga ezahlukahlukene kanye nokwanda kokuqaqamba kukhuphuka.
Kungenzeka uvikele imiphumela enjalo ngosizo lwemithetho elula:
- Landela ukudla futhi ungasebenzisi kabi ama-carbohydrate.
- Gada amazinga we-glycemia.
- Yenza yonke imijovo yesidakamizwa ngendlela esifike ngesikhathi ngokuya ngemithamo ebekwe udokotela.
- Funda ngokucophelela izimbangela zezinkinga zesifo sikashukela ukuze ungafaki izinto ezivusa inkanuko ngangokunokwenzeka.
- Izikhathi ezithile ziye zivivinywe kwezokwelashwa ukuthola izindlela zesifo (ikakhulukazi ngesikhathi sokukhulelwa).
- Yenza inguquko kolunye uhlobo lwe-insulin kuphela esibhedlela futhi ngaphansi kokuqondisa udokotela.
- Phatha noma yisiphi isifo esithathelwanayo.
Kubalulekile ukuqonda ukuthi ulwazi ngemithetho yokusiza iziguli ngesikhathi sekhefana ayidingeki esigulini kuphela, kodwa nasezihlotsheni zayo. Lokhu kugwema izimo ezisongela impilo.
