Letsoalo la lefu la tsoekere le bitsoa khatello ea kelello ea motho khahlano le tšenyo ea methapo ea metabolic e mpe 'meleng e bakoang ke hyperglycemia e tebileng. Thutong ea bongaka, mohopolo ona o kenyelletsa hyperglycemic ketoacidotic le hyperosmolar coma.
Ho ba le lefu la tsoekere ho nkoa e le boemo bo hlobaetsang bo hlokang ho fana ka tlhokomelo e hlokahalang ea maemo a tšohanyetso. Ho ba sieo ka nako ho joalo ho lebisa lefung la mokuli. Ho lokela ho hopoloa hore ho fokotseha hoa fetoha hape mme nts'etsopele ea eona e ka qojoa.
Lefu la tsoekere la ketoacidosis
Sena ke boemo ba ho fokola ka matla, bo khetholloang ka litekanyetso tse phahameng tsa tsoekere le 'mele oa acetone maling (Latin - acetonaemia), le ketoacidotic coma ke boemo ba eona bo tsebahalang ka ho fetesisa. Nts'etsopele e bonoa ho 3-5% ea bakuli bohle ba nang le lefu la tsoekere le lahleloang ke "insulin". Lefu le hlaha ho 5-30% ea linyeoe.
Lisosa tsa hyperglycemic ketoacidotic coma:
- ho haelloa ke tšoaetso ea lefu lena ka nako;
- tlolo ea molao ka morero oa kalafo ea insulin;
- mafu a tšoaetsanoang a hlobaetsang;
- kalafo e sa lekaneng ea "lefu le monate" hammoho le ts'ebetso ea ho buoa, maemo a sithabetsang, khatello ea maikutlo;
- ho mpefala ha maloetse a systemic;
- lefu la pelo le methapo ea mali;
- ho buuoa ka pancreatic;
- ho se latele melao ea phepo e nepahetseng;
- botaoa le joala la ethyl;
- halofo ea bobeli ea boimana.
Sistimi ea nts'etsopele
Ho haella ha pancreatic ho baka tsoelo-pele ea khaello ea insulin. Kaha boemo ba lihormone bo tlase e le hore "li ka bula mamati" liseleng tsa ho kenella tsoekere, maling a eona a maemong a phahameng haholo. 'Mele o leka ho lefella lefu lena ka ho phatloha ha glycogen le motsoako oa monosaccharide o tsoang liprotheine tse tsoang liprotheong tse tsoang lijong.
Hyperglycemia - motheo oa ponahalo ea komello ea lefu la tsoekere
Tsoekere e phahameng e baka keketseho ea khatello ea osmotic, e qholotsang tokollo ea metsi le li-electrolyte tse tsoang liseleng. Hyperglycemia e baka tahlehelo e kholo ea metsi ka har'a moroto le ponahalo ea tsoekere ka har'a moroto. Ho felloa ke matla 'meleng hoa hlaha.
Ho senyeha ha lipid ho hlaha, li-radicals tsa mahala, cholesterol, li-triglycerides li bokellana maling. Kaofela ha tsona li kena ka har'a sebete, e ba motheo oa ponahalo ea 'mele o mongata oa ketone. 'Mele oa Acetone o kenella maling le mohalong, e leng ho hatellang acidity le ho qholotsa nts'etsopele ea metabolic acid. Ena ke pathogenesis ea ketoacidotic coma ho lefu la tsoekere.
Matšoao
Tleliniki e ntse e ntlafala butle butle. Sena se ka nka matsatsi a 'maloa kapa lilemo tse' maloa. Lits'oaetso tse matla tsa ts'oaetso, ho ata ha maloetse a sa foleng, ho nyekeloa ke pelo kapa stroke li ka baka matšoao ka lihora tse 'maloa.
Nako ea mantlha e tsamaea le lipontšo tse joalo:
- methapo ea kutlo ea lenyora le molomo o omileng;
- monko o matla oa acetone moeeng o felletseng;
- polyuria;
- ho fokotseha ho hoholo ha basebetsi;
- bohloko ba ka mpeng;
- likarolo tse boletsoeng, mahlo a chabileng (matšoao a ho omella).
Monko oa acetone ke letšoao le lumellang phapang ea mathata a hlobaetsang a lefu la tsoekere
Hamorao, turgor ea letlalo ea fokotseha, tachycardia, phefumoloho e tebileng le e lerata e hlaha. Pele ho nts'etsopele ea komisi ka boeona, polyuria e nkeloa sebaka ke oliguria, ho hlatsa haholo, hypothermia e hlaha, 'me molumo oa liso tsa mahlo o fokotseha.
O ka ithuta ho eketsehileng ka matšoao a lefu la tsoekere ho sengoloa sena.
Ts'oaetso
Matšoao a laboratori ea komello ea ketoacidotic ho lefu la tsoekere:
- lipalo tsa glycemia kaholimo ho 35-40 mmol / l;
- osmolarity - ho fihlela ho 320 mosm / l;
- acetone maling le moroto;
- acidity ea mali e fokotseha ho 6,7;
- ho fokotseha ha maemo a electrolyte;
- maemo a tlase a sodium;
- lipalo tse phahameng tsa cholesterol le triglycerides;
- maemo a phahameng a urea, naetrojene, creatinine.
Bohlokoa! Ketoacidosis e hloka phapang pakeng tsa komello ea hypoglycemic.
Hyperosmolar coma
Komisi ea lefu la tsoekere e tšoauoa ka tsoekere e phahameng ea mali ntle le sebopeho sa 'mele oa ketone. Boemo bona bo tsamaisana le ho felloa ke metsi 'meleng le litlaleho tsa 5-8% tsa maemo ohle a lefu la tsoekere. Lefu le hlaha maemong ohle a boraro a kliniki moo ho hloka thuso e lekaneng.
E hola hangata ho batho ba baholo, ho bana ha e etsahale. Hyperosmolar coma ho lefu la tsoekere mellitus e bontša sebopeho sa eona se itšetlehileng ka insulin. Lipalo-palo li re maemong a mangata, ke ha nts'etsopele ea khatello e joalo e le hore bakuli ba ithuta ka boteng ba lefu le ka tlase.
Batho ba baholo ba nang le lefu la tsoekere la mofuta oa 2 - phehisano ea baahi e nang le kotsi e kholo ea ho ba le komello ea hyperosmolar coma
Lisosa tsa nts'etsopele ea pathology e ka ba:
- mafu a tšoaetsanoang - ka phoso o kopane le li-pathologies tse eketsang boemo ba lefu le ka tlase;
- mafu a tšoaetsanoang;
- ho sithabela kapa ho chesa;
- mathata a ho potoloha ha mali;
- mafu a sefuba sa ka mpeng, a tsamaisana le litlhaselo tsa ho hlatsa le lets'ollo;
- tahlehelo ea mali;
- ts'ebetso ea ho buoa;
- tšebeliso ea nako e telele ea lithethefatsi tsa lihormone, diuretics, immunosuppressants, mannitol.
Bohlokoa! Ho hlahisoa ha tsoekere le tšebeliso ea lihlahisoa tsa lik'habohaedreite ho ka mpefatsa boemo le ho feta.
Sistimi ea nts'etsopele
Mehato ea pele ea lipalo tse phahameng tsa tsoekere ea mali e tsamaisana le ponahalo ea tsoekere maling ka moriring le tšebetso ea eona e ntlafalitsoeng (polyuria). Keketseho ea khatello ea osmotic e etsahala, e tlatsetsang ho tsoa ha lisele le lisele tsa mokelikeli le li-electrolyte, hammoho le phokotso ea phallo ea mali lipelong.
Ho haelloa ke metsi ho baka hore gluse ea lisele tse khubelu tsa mali le liplatelete. Ka lebaka la ho fokolloa ke metsi, tlhahiso ea aldosterone e ntlafatsoa, sodium e bolokiloe maling, e leng tlatsetso ho theheng ha lisele tse nyane liseleng tsa boko. Maemo a hlahileng a phahamisa ho hlaka hoa mali le ho feta.
Matšoao
Precoma e tsamaea le matšoao a tšoanang le boemo ba ketoacidosis. Ntlha ea bohlokoa e sebelisetsoang ho khetholla boemo ke ho se be le "litholoana" kapa monko oa acetone moeeng o tsoang. Bakuli ba hlokomela ponahalo ea matšoao a latelang:
Mokhoa oa ho tlosa acetone 'meleng le lefu la tsoekere lapeng- lenyora
- polyuria;
- bofokoli
- letlalo le omeletseng;
- matšoao a ho omella (likarolo tsa sefahleho li bohale, molumo oa likhalase tsa mahlo oa fokotseha);
- ho hema ka thata;
- ponahalo ea li-pathological reflexes;
- cramps
- lefu la sethoathoa.
Ho hloka tlhokomelo ea maemo a tšohanyetso ho lebisa ho nts'etsopele ea maikutlo le tahlehelo ea kelello.
Matšoao a ho khetholla
Ho hlahlojoa ha hyperosmolar coma ho ipapisitse le ho tseba ho ba teng ha hyperglycemia kaholimo ho 45-55 mmol / L. Sodium e maling - ho fihla ho 150 mmol / l, potasiamo - ho fihla ho 5 mmol / l (ka mokhoa o tloaelehileng oa 3.5 mmol / l).
Matšoao a Osmolarity a kaholimo ho 370 mosm / kg, e batlang e le litsi tse 100 ho feta lipalo tse tloaelehileng. Litopo tsa Acidosis le ketone ha li bonoe. Teko e akaretsang ea mali e ka bontša leukocytosis, keketseho ea hematocrit le hemoglobin, keketseho e nyane maemong a naetrojene.
Tlhahlobo ea mahlale - motheo oa phapang ea mathata
Thuso ea pele
Mang kapa mang a lefu la tsoekere a hloka thuso ea pele, ntle le kalafo ea mantlha ea bongaka. Pele ho tsohle, hoa hlokahala ho letsetsa basebetsi ba ambulense, 'me ho fihlela ba fihla, ba etsa letoto la liketso:
- Bea mokuli sebakeng se tsitsitseng mme a fe moea phallo.
- Hlooho e lokela ho buloa ka lehlakoreng le letšehali kapa le letona, e le hore ha ho hlatsa ho sa etsahala ho hlatsa.
- Haeba ho na le tsietsano ea sethoathoa pakeng tsa menoana, ho bohlokoa ho kenya ntho e tsitsitseng (eseng tšepe!). Sena sea hlokahala e le hore leleme le se ke la oa.
- Haeba mokuli a khona ho bua, hlahloba hore na o sebelisa insulin kalafo. Haeba ho joalo, thusa ho enta hormone.
- Ka ho futhumala, futhumatsa mokuli ka kobo, pampiri e futhumatsang.
- Fana ka metsi hore a noe ka bongata boo u bo batlang.
- Hlahloba khatello ea mali le methapo ea pelo ea hau haufi-ufi. Tabeng ea ho tšoaroa ha pelo le ho hema, tsoela pele ka ho tsosa pelo le pelo.
- Se ke oa tlohela mokuli a le mong.
Mesebetsi e meng e etsoa ke sehlopha sa ambulense hang-hang le sepetlele kamora ho kena sepetlele.
U ka bala ho eketsehileng ka tlhokomelo ea tšohanyetso bakeng sa bokuli ba lefu la tsoekere lengolong lena.
Mohato oa bongaka
Katleho e ntle ea ketoacidosis e ka fumaneha feela ka insulin. Lidao tsa pele li fanoa ka methapo, li lateloa ke ho tsuba ka bongata hammoho le glucose ea 5% (thibelo ea hypoglycemia).
Phekolo ea infusion - karolo ea kalafo e rarahaneng le ho hlaphoheloa ha mokuli
Ho sebelisa tharollo ea bicarbonate, mokuli o hlatsoa ka pampitšana ea mala. Li-electrolyte tse lahlehileng le mokelikeli li khutlisoa ka ho kenngoa ha letsoai, tharollo ea Ringer, sodium bicarbonate. Cardiac glycosides, pheko ea oksijene, cocarboxylase le tsona li laetsoe.
Mmuso oa hyperosmolar o hloka infusion e kholo (saline ea 'mele e nang le insulin, tharollo ea Ringer - 15-18 l bakeng sa letsatsi la pele). Ka glycemia ea limilimithara tse 15 / L, insulin e kenngoa ka sekhahla ka sekhahla sa tsoekere. Litharollo tsa bicarbonate ha li hlokehe, kaha 'mele oa ketone o le sieo.
Nako ea ho hlaphoheloa
Ntlafatso ea bakuli kamora ho ba le lefu la tsoekere ho ba lula sepetleleng sa endocrinological le ho latela likeletso tsa lingaka lapeng.
- Ho khomarela ka hloko lijong tsa motho ka mong.
- Ho itlhokomela matšoao a tsoekere le tlhahlobo ea nako ea laboratori ka nako.
- Ho ikoetlisa ka ho lekaneng.
- Ho latela kalafo ka botlalo ka insulin le tšebeliso ea li-hypoglycemic agents.
- Thibelo ea mathata a hlobaetsang le a sa foleng.
- Ho hana kalafo le mekhoa e mebe.
Ho latela melao ena ho tla thibela tlolo ea molao e matla le ho boloka puseletso ea bokuli bo ka tlase.
