Usizo lokuqala lwe-ketoacidosis yesifo sikashukela

Isifo sikashukela i-mellitus yisifo esifihlayo, esiyingozi ngenxa yezinkinga ezinkulu zaso. Enye yazo, i-ketoacidosis yesifo sikashukela, yenzeka lapho, ngenxa yokungalingani kwe-insulin, amaseli eqala ukucubungula ukunikezwa kwe-lipid yomzimba esikhundleni se-glucose.

Njengomphumela wokuqhekeka kwe-lipid, kwakheka imizimba ye-ketone, ebangela ushintsho ekulinganisweni kwe-acid-base.

Yini ingozi yokushintshwa kwe-pH?

I-pH evumelekile akufanele idlule kwe-7.2-7.4. Ukwanda kwezinga le-acidity emzimbeni kuhambisana nokuwohloka kwenhlala-kahle yesifo sikashukela.

Ngakho-ke, kukhiqizwa kakhulu imizimba ye-ketone, ikhula kakhulu i-acidity kanye nokwanda kokuqina kwesiguli. Uma ungamsizi umuntu onesifo sikashukela ngesikhathi, kuzokhuphuka ukoma, okungaholela ekufeni ngokuzayo.

Ngokwemiphumela yokuhlaziywa, kungenzeka ukunquma ukuthuthukiswa kwe-ketoacidosis ngalolo shintsho:

• egazini kukhona ukwanda kokuqina kwemizimba ye-ketone engaphezu kwe-6 mmol / l noshukela ngaphezulu kwe-13.7 mmol / l;
• imizimba ye-ketone ikhona nomchamo;
• Izinguquko ze-acidity.

I-Pathology ivame ukubhaliswa ngesifo sikashukela sohlobo 1. Kubantu abanesifo sikashukela sohlobo 2, i-ketoacidosis ijwayelekile kakhulu. Esikhathini esiyiminyaka eyi-15, ngaphezulu kwe-15% yokufa kwabantu ngemuva kokuvela kwe-ketoacidosis yesifo sikashukela.

Ukuze unciphise ubungozi bokuthi kube nengxaki enjalo, isiguli kudingeka sifunde ukubala ngokuzimela umthamo we-insulin ye-hormone futhi sazi inqubo yokulimala kwe-insulin.

Izimbangela eziphambili zokuthuthuka kwe-pathology

Izidumbu zeKetone ziqala ukukhiqizwa ngenxa yokuphazamiseka ekusebenzeni kwamaseli nge-insulin, kanye nokuphelelwa ngamandla komzimba.

Lokhu kungenzeka nge-Type 2 sikashukela mellitus, lapho amaseli alahlekelwa ukuzwela kwawo ku-hormone noma ngesifo sikashukela sohlobo 1, lapho amanyikwe alimele eyeka ukukhiqiza i-insulin eyanele. Njengoba isifo sikashukela sidala ukubanda komchamo omkhulu, lokhu kuhlanganiswa kwezinto kubangela i-ketoacidosis.

Izimbangela ze-ketoacidosis zingaba izizathu ezinjalo:

• ukuthatha i-hormonal, izidakamizwa ze-steroid, ama-antipsychotic kanye nama-diuretics;
• isifo sikashukela ngesikhathi sokukhulelwa;
• umkhuhlane isikhathi eside, ukugabha, noma isifo sohudo;
• ukungenelela kokuhlinzwa, i-pancreatectomy iyingozi kakhulu;
• ukulimala
• Isikhathi sohlobo 2 sikashukela mellitus.

Esinye isizathu singabhekwa njengokwephulwa kwesheduli nenqubo yemijovo ye-insulin:

• ukusetshenziswa kwama-hormone okuphelelwe yisikhathi;
• isilinganiso esingavamile sokuhlushwa ushukela wegazi;
• ukwephulwa kokudla ngaphandle kwesinxephezelo se-insulin;
• ukulimala isirinji noma iphampu;
• ukuzelapha ngezindlela ezihlukile zokujova ezingeqiwe.

I-ketoacidosis, kwenzeka, yenzeka ngenxa yephutha elikhona lapho kutholakala ukuthi kunesifo sikashukela futhi, ngakho-ke, ukuqala kokubambezeleka kokwelashwa nge-insulin.

Izimpawu zesifo

Izidumbu zeKetone zakha kancane kancane, imvamisa kusuka kwizimpawu zokuqala kuya ekuqaleni kwesimo esihle, kudlule izinsuku ezimbalwa. Kepha futhi kunenqubo esheshayo yokwandisa i-ketoacidosis. Kubalulekile ukuthi wonke umuntu onesifo sikashukela abhekele inhlalakahle yakhe ngokucophelela ukuze aqaphele izimpawu ezesabekayo ngesikhathi futhi abe nesikhathi sokuthatha izinyathelo ezidingekayo.

Esigabeni sokuqala, unganaka ukubonakaliswa okunjalo:

• ukomelela okukhulu kwezitho zomzimba nezikhumba;
• ukuphuma komchamo njalo njalo
• ukoma okungapheli;
• ukulunywa kuyavela;
• ukulahlekelwa amandla;
• ukwehla kwesisindo okungachazwanga.

Lezi zimpawu zihlala zinganakwa, ngoba ziyimpawu yesifo sikashukela.

Ushintsho lwe-acidity emzimbeni kanye nokwakheka okwandisiwe kwama-ketones kuqala ukuzibonakalisa ngezimpawu ezibaluleke ngokwengeziwe:

• kukhona ukuhlaselwa isicanucanu, kuphenduka ukuhlanza;
• ukuphefumula kuba ngomsindo futhi kujule;
• kukhona iphunga le-aftertaste nephunga le-acetone emlonyeni.

Ngokuzayo, isimo siba sibi kakhulu:

• ukuhlaselwa kwe-migraine kuvela;
• izwe elomayo futhi elifayo;
• ukuncipha kwesisindo kuyaqhubeka;
• Ubuhlungu buba khona esiswini nasemphinjeni.

I-Pain syndrome ivela ngenxa yokuphelelwa ngamanzi emzimbeni kanye nomphumela ocasulayo wemizimba ye-ketone kwizitho zokugaya ukudla. Ubuhlungu obukhulu, ukwanda kokungezwani kodonga lwangaphandle lwe-peritoneum nokuqunjelwa kungadala iphutha lokuxilonga futhi kubangele izinsolo zesifo esithathelwanayo noma sokuvuvukala.

Phakathi naleso sikhathi, kuvela izimpawu zesimo sokuqaqamba:

• ukomisa kakhulu;
• ulwelwesi lwe-mucous olomile nesikhumba;
• isikhumba siphenduka siphinde sibande;
• ubomvu bebunzi, izihlathi nezibunu kuvela;
• izicubu nezwi lesikhumba kwehla;
• ingcindezi yehla kakhulu;
• ukuphefumula kuba ngumsindo futhi kuhambisana nephunga le-acetone;
• ukwazi kuba ngamafu, bese umuntu ewa ekhubeni.

Ukuxilongwa kwesifo sikashukela

Nge-ketoacidosis, i-glucose coeffnty ingafinyelela ngaphezu kwe-28 mmol / L. lokhu kunqunywa yimiphumela yokuhlolwa kwegazi, isifundo sokuqala sokuphoqelela, esenziwa ngemuva kokuba isiguli sifakwe ophikweni lokunakekelwa olunzulu. Uma umsebenzi we-impso wezinso ulimale kancane, khona-ke izinga likashukela lingaphansi.

Isikhombi esinqumayo sokuthuthukiswa kwe-ketoacidosis kuzoba khona kwama-ketones ku-serum yegazi, engagcinwa nge-hyperglycemia ejwayelekile. Ukuba khona kwezidumbu ze-ketone emchameni kuzophinde futhi kuqinisekise ukutholwa.

Ngokuhlolwa kwegazi kwe-biochemical, kungenzeka ukunquma ukulahleka ekwakhekeni kwama-electrolyte, kanye nezinga lokuncipha kwe-bicarbonate ne-acidity.

Izinga lokubona kwegazi nalo libalulekile. Igazi elithambile livimbela ukusebenza kwemisipha yenhliziyo, okuholela ekubulalekeni kwe-oksijini kwe-myocardium nengqondo. Ukulimazeka okungathi sína kwezitho ezibalulekile kuholela ezinkingeni ezimbi kakhulu ngemuva kwephambi kokukhubazeka noma ukoma.

Okunye ukubala kwegazi okuthi i-creatinine ne-urea kuzokunaka. Izinga eliphakeme lezinkomba libonisa ukukhipha amanzi emzimbeni, ngenxa yalokho amandla okuhamba kwegazi ancipha.

Ukwanda kokuxinana kwamangqamuzana amhlophe egazi kuchazwa isimo sokuxineka somzimba ngokumelene nesizinda se-ketoacidosis noma isifo esithinta izifo.

Ukushisa kwesiguli akuhlali ngaphezulu kwejwayelekile noma kuncishiswe kancane, okubangelwa yingcindezi ephansi kanye nokushintshwa kwe-acidity.

Ukuxilongwa okuhlukile kwe-hypersmolar syndrome ne-ketoacidosis kungenziwa kusetshenziswa itafula:

Izinhlobo zokwelashwa

Isifo sikashukela sikashukela sithathwa njengesiyingozi. Lapho umuntu onesifo sikashukela eba mkhulu ngokuzuma, udinga ukunakekelwa okuphuthumayo. Uma kungekho ukukhululeka okufika ngesikhathi kwe-pathology, kukhubazeka kakhulu i-ketoacidotic futhi, ngenxa yalokho, ukulimala kwengqondo nokufa kungenzeka.

Usizo lokuqala, udinga ukukhumbula i-algorithm yezenzo ezifanele:

1. Ukuqaphela izimpawu zokuqala, kuyadingeka, ngaphandle kokulibala, ukubiza i-ambulensi futhi kwazise umchithi ukuthi isiguli sinesifo sikashukela futhi sinephunga le-acetone. Lokhu kuzovumela ithimba lezokwelapha elifikile ukuthi lingalenzi iphutha futhi lingazifaki isiguli nge-glucose. Isenzo esinjengalesi sizoholela emiphumeleni emibi.
2. Jikela isisulu eceleni kwakhe futhi umnikeze umoya ongcolile.
3. Uma kungenzeka, hlola ukushaya ngamandla, umfutho kanye nokushaya kwenhliziyo.
4. Nikeza umuntu umjovo oshubile we-insulin emfushane kumthamo wamaunithi ama-5 futhi ube khona eduze kwalowo ohlukunyezwayo aze afike odokotela.

Impilo nempilo yesifo sikashukela kuya ngezenzo ezicacile nezolile ngesikhathi sokuhlasela.

Ukufika kodokotela kuzonikeza isiguli umjovo we-insulin we-insulin, ubeke i-dropper enosawoti ukuvimbela ukopha futhi uzodluliselwa ekunakekelweni okukhulu.

Uma kwenzeka i-ketoacidosis, iziguli zibekwa endaweni yokunakekelwa kakhulu noma ophikweni lokunakekelwa olunzulu.

Izindlela zokubuyisa esibhedlela zimi ngale ndlela elandelayo:

• isinxephezelo se-insulin ngomjovo noma ngokuphatha ukuphatha;
• ukubuyiselwa kwe-acidity efanele;
• isinxephezelo ngokuntuleka kwama-electrolyte;
• ukuqothula ukomisa;
• ukukhululeka kwezinkinga ezivela ngemuva ngemuva kokuphulwa.

Ukuqapha isimo sesiguli, iqoqo lezifundo empeleni liyenziwa:

• ukuba khona kwe-acetone kumchamo kulawulwa umbhangqwana wokuqala wezinsuku kabili ngosuku, ngokuzayo - kanye ngosuku;
• ukuvivinya ushukela ngehora kuze kube yilapho kusungulwa isigaba se-13.5 mmol / l, khona-ke ngezikhathi ezithile ezingamahora amathathu;
• igazi lama-electrolyte lithathwa kabili ngosuku;
• igazi nomchamo wokuhlolwa okujwayelekile komtholampilo - ngesikhathi sokungeniswa esibhedlela, bese kuba nekhefu lezinsuku ezimbili;
• i-acidity yegazi ne-hematocrit - kabili ngosuku;
• igazi lokufunda ngezinsalela ze-urea, phosphorus, nitrogen, chloride;
• inani elilawulwa ihora lomchamo;
• kuthathwa izinyathelo ezijwayelekile zokushaywa kwenhliziyo, ukushisa, ingcindezi ye-arterial ne-venous;
• ukusebenza kwenhliziyo kubhekwa ngokuqhubekayo.

Uma usizo luhlinzekwe ngendlela yesikhathi futhi isiguli sazi, khona-ke ngemuva kokuzinza sidluliselwa emnyangweni we-endocrinological noma wezokwelapha.

Izinto zevidiyo ekunakekelweni okuphuthumayo kwesiguli esine-ketoacidosis:

Ukwelashwa kwesifo sikashukela se-ketoacidosis

Kungenzeka ukuvimbele ukuvela kwe-pathology ngemijovo e-insulin ehlelekile, kugcina izinga le-hormone okungenani lama-50 mcED / ml, lokhu kwenziwa ngokuphatha imithamo emincane yesidakamizwa esisebenza esifushane njalo ngehora (kusuka kumayunithi ama-5 kuye kwayi-10). Ukwelashwa okunjalo kunganciphisa ukuwohloka kwamafutha nokwakheka kwama-ketones, futhi futhi akuvumeli ukwanda kokuhlushwa kwe-glucose.

Esimweni sesibhedlela, umuntu onesifo sikashukela uthola i-insulin ngokuphathwa okuqhubekayo kwe-intravenous ngokusebenzisa i-dropper. Endabeni yokuthola ithuba eliphezulu lokukhula kwe-ketoacidosis, i-hormone kufanele ingene esigulini ngokunensa futhi ingaphazamiseki kumayunithi / ihora angama-5-9.

Ukuvimbela ukunqwabelanisa ngokweqile kwe-insulin, i-albhamu yabantu yengezelelwa kwethonsi esikumthamo ka-2,5 ml ngama-50 amayunithi e-hormone.

I-prognosis yosizo esifike ngesikhathi iyathandeka. Esibhedlela, i-ketoacidosis iyama futhi isimo sesiguli siyazinza. Ukufa kungenzeka kuphela lapho kungekho ukwelashwa noma ngesikhathi sokuqalisa izindlela ezingafanele zokuvuselela.

Ngokulashwa okubambezelekile, kunengozi yemiphumela ebuhlungu:

• kwehlise ukunakekelwa kwe-potassium noma ushukela egazini;
• ukugcwala koketshezi emaphashini;
• isifo sohlangothi;
• iminyakazo
• ukulimala kobuchopho;
• ukuboshwa kwenhliziyo.

Ukuhambisana nezincomo ezithile kuzosiza ukuvimbela amathuba we-ketoacidosis complication:

• ukukala njalo amazinga kashukela emzimbeni, ikakhulukazi ngemuva koxinzelelo lwezinzwa, usizi kanye nezifo ezithathelanayo;
• ukusebenzisa imichilo eqondile ukukala izinga lemizimba ye-ketone emchameni;
• kahle inqubo yokusebenzisa imijovo ye-insulin futhi ufunde ukubala umthamo odingekayo;
• landela isheduli yemijovo ye-insulin;
• Musa ukuzindla bese ulandela zonke izincomo zikadokotela;
• Ungathathi imithi ngaphandle kokuqokwa uchwepheshe;
• ukwelashwa okufika ngesikhathi kwezifo ezithathelwanayo nokuvuvukala nokuphazamiseka kokugaya ukudla;
• Namathela ekudleni;
• yenqaba imikhuba emibi;
• phuza uketshezi olwengeziwe;
• naka izimpawu ezingajwayelekile futhi masinyane ufune usizo lodokotela.