Hyperosmolar chikomokere: zimayambitsa, zizindikiro, matenda, mankhwala

Hyperosmolar chikomokere ambiri amangoti matenda odwala wamkulu kuposa zaka 50 amene amadwala matenda a shuga kwa ofatsa digiri zolimbitsa, mosavuta kulipidwa chifukwa ndi kudya zakudya zapadera mankhwala. Mpatuko ndi maziko degridratatsii chamoyo chifukwa okodzetsa, matenda mtima kwa ubongo ndi impso. Imfa kwa chikomokere hyperosmolar ukufika mlingo 30%.

zifukwa

Hyperosmolar chikomokere, zomwe zimabweretsa ofanana msinkhu wa shuga, ndi vuto la shuga ndi chifukwa cha nyamuka lakuthwa mu shuga m'magazi (kuposa 55,5 mmol / l) osakaniza hyperosmotic ndi pakalibe acetone m'magazi.

Chifukwa chodabwitsa ndi awa:

• lakuthwa kuchepa madzi m'thupi chifukwa mu kusanza chiwawa, kutsegula m'mimba, zilonda zamoto kapena pa chithandizo yaitali mwa kugwiritsa ntchito mankhwala diuretic;
• akusowa kapena kusowa wathunthu wa insulin, onse amkati ndi exogenous (chifukwa zodabwitsazi angakhale kupanda insulin kapena mankhwala molakwika kamwedwe);
• kuwonjezeka kwa insulin, yomwe ingakhalepo aakulu chisokonezo zakudya, utsogoleli anaikira kukonzekera shuga, matenda opatsirana (makamaka chibayo ndi matenda a njira ya mkodzo zotupa thirakiti) pambuyo opaleshoni, kuvulala, mankhwala, amene ali ndi katundu wa muzikangana insulin ( mu mahomoni makamaka ndi kukonzekera glyukokorstikoidov).

pathogenesis

Mwatsoka, limagwirira chitukuko cha boma matenda si bwino. Akukhulupirira kuti chitukuko cha vuto izi zimakhudza anatseka misewu shuga kumasulidwa ndi impso, ndipo inachuluka yobereka thunthu mu thupi ndi kupanga ake ndi chiwindi. Pamene linanena bungwe ili mosavuta mwa insulin komanso kutsekereza magwiritsidwe a shuga ndi zimakhala zotumphukira. Izi zonse pamodzi madzi m'thupi.

Komanso, amakhulupirira kuti kukhalapo mu amkati anthu (anapanga mkati thupi) insulin kumabwezera mmbuyo njira monga lipolysis (kuwonongedwa kwa mafuta) ndi ketogenesis (mapangidwe maselo nyongolosi). Komabe, insulin izi singakwane kupondereza kuchuluka kwa shuga amene amapangidwa ndi chiwindi. Choncho makonzedwe kofunika insulin exogenous.

Ngati imfa mofulumira madzimadzi zambiri amachepetsa Bcc (magazi buku), imbaenda thickening magazi ndi kuonjezera osmolarity. Izi zimachitika ndi chifukwa kuwonjezeka mu ndende ya shuga, potaziyamu ndi sodium wochuluka ayoni.

zizindikiro

Hyperosmolar chikomokere zingachitike zizindikiro za wosawoneka pasadakhale kwa masiku angapo kapena masabata. Pankhaniyi, wodwalayo kukula zizindikiro ndi khalidwe la matenda a shuga decompensated (shuga sangakhoze kusintha mankhwala):

• polyuria (kuchuluka mkodzo mapangidwe);
• chinawonjezeka ludzu;
• kuchuluka dryness wa khungu, zikopa mucous;
• mwadzidzidzi kuwonda;
• zonse kufooka;
• Ndi chifukwa wamba madzi m'thupi kudwala: kuchepetsa kamvekedwe ka khungu, eyeballs, kuthamanga kwa magazi ndi kutentha.

zizindikiro minyewa

Komanso, zizindikiro akhoza anamuona pa wamanjenje dongosolo:

• kuyerekezera zinthu m'maganizo;
• hemiparesis (chifooke kayendedwe kwawo);
• lokhudza kulankhula, ndi kuika slurred;
• kulimbikira kukomoka;
• areflexia (bongo pakalibe chimodzi kapena zingapo) kapena giperlefksiya (kuonjezera bongo);
• minofu kupsyinjika;
• mkhutu kutsitsimuka.

Zizindikiro kuonekera masiku pang'ono izo kuyamba kukhazikitsa hyperosmolar chikomokere ana kapena akulu.

zosokonezeka zotheka

Mu nkhani ya chithandizo mwamsanga chifukwa angathe zosokonezeka. Common ndi:

• kukomoka kumene limodzi ndi kukokana zikope, nkhope (zizindikiro zimenezi kungakhale kosaoneka ndi ena);
• kwambiri mtsempha thrombosis;
• kapamba (kutupa kapamba);
• aimpso insufficiency.

Zosintha zina zimachitika thirakiti m'mimba, wosawoneka kusanza, bloating, kupweteka m'mimba, matenda m'mimba motility (nthawizina pali matumbo kutsekeka), koma akhale pafupifupi unnoticeable.

Komanso, pali matenda vestibular.

diagnostics

Ngati mukukayikira kuti akudwala matenda chikomokere hyperosmolar, matenda zachokera mayeso zasayansi. Makamaka, kufufuza anaulula kofunikira kwambiri magazi shuga ndi osmolarity. Komanso nkutheka okwera kuchuluka kwa sodium, mkulu zili okwana seramu mapuloteni ndi yotsalira asafe. urea mlingo akhoza ziwonjezeke. Mu kufufuza za matupi mkodzo ketone (acetone, acetoacetic acid ndi betaoksimaslyanaya) si zotsimikizika.

Komanso, palibe fungo la acetone mu mpweya wotuluka tikamapuma ndi wodwala ndipo ketoacidosis (chisokonezo cha zimam'patsa kagayidwe) zomwe kutchulidwa giperoglikemiey ndi magazi osmolarity. Wodwala alipo zizindikiro ubongo, monga nthenda Babinski (lumpha kutambasuka reflex), kuchulukitsidwa kwa minofu kamvekedwe, amgwirizano nystagmus (musanaganizire oscillatory kayendedwe ka maso).

onekera mwa Kafukufuku wina:

• Ultrasound ndi X-ray Kupenda kapamba;
• electrocardiography;
• kudziwa mlingo wa shuga m'magazi.

Chofunika kwambiri ndi matenda masiyanidwe. Ichi ndi chifukwa chakuti gipersmolyarnaya chikomokere chingachitike n'chiyani osati matenda a shuga komanso ndi kwa chiwindi aimpso insufficiency nkhani kulandira okodzetsa thiazide.

chithandizo

Ngati matenda hyperosmolar chikomokere, chisamaliro mwadzidzidzi kuchotsa degidrotatsii, hypovolemia ndi kubwezeretsa madzi osmolarity.

Pofuna hydration chamoyo ntchito njira hypotonic wa sodium kolorayidi. Athandizira ku malita 6 mpaka 10 patsiku. Ngati ndi kotheka kuchuluka kwa ukuwonjezeka yankho. Patangotha maola awiri pambuyo isanayambike chikhalidwe pathological chofunika kuti atchule malita 2 sodium kolorayidi njira i.v., kenako oyamba m'malovu akudutsa pa mlingo wa 1 L / h. miyeso anatengedwa kupita normalization osmolarity ndi magazi mu zotengera venous. Chizindikiro cha madzi m'thupi kuchotsa maonekedwe a chikumbumtima cha wodwalayo.

Ngati matenda hyperosmolar chikomokere, mankhwala kumafuna giperoglikemii kuchepetsa. Chifukwa chaichi, intramuscularly ndi m'nsinga kutumikiridwa insulin. Ndi chofunika kuchita ziyang'aniridwe ndende shuga. Mlingo woyamba ndi mayunitsi 50, amene amakhala wogawanika pakati ndi anadzetsa thupi m'njira zosiyanasiyana. Pankhani ya njira hypotension makonzedwe m'nsinga yekha. insulin Komanso kutumikiridwa mu yofanana kukapanda kuleka mtsempha ndi mu mnofu. zonsezi akutsatiridwa mpaka mlingo wa shuga 14 mmol / l.

Chiwembu cha utsogoleli wa insulin angakhale osiyana:

• 20 IU intramuscularly kamodzi;
• 5-8 U aliyense mphindi 60.

Kukachitika kuti mlingo shuga amagwa 13,88 mmol / l, hypotonic njira ya sodium kolorayidi zofunika m'malo shuga njira.

Pa mankhwala hyperosmolar chikomokere amafuna polojekiti zonse potaziyamu magazi, kuyambira kuchotsa chikhalidwe pathological amafuna kugwiritsira mankhwala enaake potaziyamu.

Chifukwa cha kupewa ubongo edema chifukwa odwala hypoxia m'nsinga kutumikiridwa asidi glutamic mu kuchuluka 50 ml. Komanso kulandira heparin chofunika, chifukwa zosavuta thrombosis kwambiri. Zimenezi zimafuna kulamulira clotting magazi.

Monga ulamuliro, hyperosmolar chikomokere akufotokozera odwala ndi wofatsa kapena zolimbitsa siteji ya shuga, kotero ife tikhoza bwinobwino kuti thupi samazidziwa ndi insulin bwino. Choncho, tikulimbikitsidwa kuti jekeseni Mlingo ka mankhwala.

Profilatika zosokonezeka

Kupewa zosowa, ndi dongosolo mtima, ndicho kupewa matenda a mtima. Ndi cholinga ichi "Kordiamin", "Strofantin", "Korglikon". Opanikizika yafupika amene ali pa msinkhu zonse, Ndi bwino makonzedwe Dox njira, ndi mtsempha plasma gemodeza, albumin anthu ndi magazi athunthu.

Khalani funsoli ...

Ngati muli ndi matenda a shuga ayenera nthawi zonse mayesowo pa m'thupi yemwenso ndi kukwaniritsa zofuna zake zonse, makamaka kulamulira shuga. Izi kupewa mavuto a matenda.