Cutar Hyperglycemic na iya faruwa a cikin mai haƙuri da ciwon sukari idan ba a kula da shi sosai ba, kuma saboda wannan, sukari jini ya hauhawa sosai. Likitoci suna kiran mai nuna alamar glucose din jini “glycemia.” Idan aka haɓaka sukari na jini, to sai su ce mara lafiyar yana da “hyperglycemia”.
Idan baku dauki sukari na jini a ƙarƙashin kulawa cikin lokaci ba, to cutar sikila zata iya faruwa
Hyma na hyperglycemic coma - illa gajiya saboda yawan ƙwayar jini. Yana faruwa da farko a cikin tsofaffi masu ciwon sukari waɗanda ba su sarrafa sukarin jininsu ba.
Coma Hyperglycemic a cikin yara yana faruwa, a matsayin mai mulkin, a hade tare da ketoacidosis.
Coma mai yawan motsa jiki da ketoacidosis mai ciwon sukari
Coma na hyperglycemic shine yawanci tare da ketoacidosis. Idan mai ciwon sukari yana da mahimmancin karancin insulin, to ƙwayoyin ba su samun isasshen glucose kuma suna iya canzawa zuwa abinci mai gina jiki ta hanyar ajiyar mai. Lokacin da kitse ya karye, ana samar da gawar ketone, gami da acetone. Ana kiran wannan aikin ketosis.
Idan gawarwakin ketone da yawa suna yawo a cikin jini, to sai su kara yawan acid dinta, kuma hakan ya wuce yadda ake tsarin halittar jiki. Akwai canzawa a cikin ma'aunin acid-base na jikin mutum zuwa karuwa cikin acidity. Wannan sabon abu yana da haɗari sosai, kuma ana kiran shi acidosis. Tare, ketosis da acidosis ana kiransu ketoacidosis.
A cikin wannan labarin, zamu tattauna yanayi inda hyperglycemic coma ke faruwa ba tare da ketoacidosis ba. Wannan yana nufin cewa sukarin jini yana da girma sosai, amma a lokaci guda, jikin mai ciwon sukari baya canzawa zuwa abinci mai gina jiki tare da kitsensa. Ba a samar da gawar Ketone ba, sabili da haka acidity na jini ya kasance a cikin iyaka.
Wannan nau'in rikitarwa na ciwon sukari shine ake kira "hyperosmolar syndrome." Ba shi da ƙasa da ciwo fiye da ketoacidosis na ciwon sukari. Osmolarity shine maida hankali ne akan abu a cikin mafita. Hyperosmolar syndrome - ma'ana cewa jinin yayi kauri sosai saboda yawan abun ciki na glucose a ciki.
Binciko
Lokacin da haƙuri tare da hyperglycemic coma ya shiga asibiti, abu na farko da likitoci ke yi shine tantance idan yana da ketoacidosis ko a'a. Don yin wannan, yi zurfin bincike akan fitsari don kasancewar jikin ketone ta amfani da tsiri, tare kuma tattara sauran bayanan da suka wajaba.
Yadda za a bi da cutar rashin daidaituwa tare da ketoacidosis an bayyana dalla-dalla a cikin labarin "Ciwon ƙoshin ketoacidosis". Kuma a nan zamu tattauna yadda likitoci keyi idan mai ciwon sikila ba tare da ketoacidosis ba. Yayinda mai haƙuri da cutar rashin lafiya ta jiki ke karɓar magani mai mahimmanci, dole ne a kula da alamunsa a hankali. Ana gudanar da aikin sa ido daidai da tsarin iri ɗaya kamar yadda ake amfani da ketoacidosis.
Hyma na hyperglycemic coma, tare da ko ba tare da ketoacidosis ba, ana iya rikitarwa ta hanyar lactic acidosis, i.e., taro mai yawa na lactic acid a cikin jini. Lactic acidosis ya lalata mummunan tasirin sakamako na jiyya. Saboda haka, yana da kyawawa don auna matakin lactic acid a cikin jinin mai haƙuri.
Hakanan yana da kyau a yi gwajin jini na lokacin prothrombin da kuma kunna lokaci na thromboplastin (APTT). Saboda tare da cututtukan hyperosmolar sau da yawa fiye da tare da ketoacidosis na masu ciwon sukari, DIC yana haɓaka, i.e., coagulation jini yana da damuwa saboda sakin mai yawa na abubuwa na thromboplastic daga kyallen takarda
Yakamata a bincika marassa lafiya da ke cikin cututtukan hyperglycemic hyperosmolar syndrome a cikin binciken da ake yi na kamuwa da cuta, da kuma cututtukan da ke haifar da kumburi kumburi. Don yin wannan, kuna buƙatar bincika:
- paranasal sinuses
- da bakin kogo
- kirji gabobin
- ciki, ciki har da dubura
- kodan
- shafa nono na nono
- ... kuma a lokaci guda bincika cututtukan zuciya da jijiyoyin jini.
Sanadin cututtukan Cutar Ruwa mai Ruwa
Hyperosmolar hyperglycemic coma yana faruwa ne kusan sau 6-10 sau da yawa fiye da ketoacidosis mai ciwon sukari. Tare da wannan rikicewar rikicewar, a matsayin mai mulkin, tsofaffi waɗanda ke da nau'in ciwon sukari na 2 ana shigar da su zuwa asibiti. Amma ban da wannan dokar galibi yakan faru.
Hanyar haifar da haifar da cututtukan hyperosmolar shine yawanci yanayi wanda ke kara buƙatar insulin kuma yana haifar da bushewa. Ga jerin su:
- cututtuka, musamman waɗanda ke da zazzabi, amai, da gudawa (zawo);
- karancin lalacewa;
- huhun hanji;
- m pancreatitis (kumburi da pancreas);
- toshewar hanji;
- bugun jini;
- ƙonewa mai yawa;
- babban zub da jini;
- gazawar koda, yanayin ciwon ciki;
- cututtukan endocrinological (acromegaly, thyrotoxicosis, hypercortisolism);
- raunin da ya faru, ayyukan tiyata;
- tasirin jiki (bugun zafi, zazzabin cizon sauro da sauransu);
- shan wasu magunguna (steroids, sympathomimetics, somatostatin analogues, phenytoin, immunosuppressants, beta-blockers, diuretics, alli antagonists, diazoxide).
Coma mai yawan motsa jiki shine yawanci sakamakon tsofaffi mai haƙuri da gangan yana shan ruwa kaɗan. Marasa lafiya suna yin wannan, suna ƙoƙarin rage kumburinsu. Daga ra'ayi na likitanci, shawarar don rage yawan shan ruwa a cikin zuciya da sauran cututtuka ba daidai ba ne kuma yana da haɗari.
Bayyanar cututtukan cututtukan mahaifa
Maganin Hyperosmolar yana haɓakawa da sannu a hankali fiye da ketoacidosis mai ciwon sukari, yawanci a cikin fewan kwanaki ko makonni. Rashin ruwa mai haƙuri yana iya zama mai tsanani fiye da ketoacidosis. Tunda ba a kafa jikin ketone ba, babu alamun halayyar ketoacidosis: Kussmaul baƙon abu ne da ƙanshi na acetone a cikin iska mai ƙyalli.
A farkon kwanakin ci gaban cututtukan hyperosmolar, marasa lafiya suna da sha'awar motsa jiki akai-akai. Amma a lokacin zuwa asibiti, fitowar fitsari yawanci yana da rauni ko kuma ya daina tsayawa gaba ɗaya, saboda ƙwanƙwasawa. A cikin ciwon ketoacidosis na mai ciwon sukari, yawan haɓakar jikin ketone galibi yana haifar da amai. Tare da cututtukan hyperosmolar, vomiting yana da wuya, sai dai idan akwai wasu dalilai na hakan.
Hyperglycemic coma yana haɓaka a kusan 10% na marasa lafiya da ke fama da cutar hyperosmolar. Ya dogara da yadda farin jini yake da yadda abun sodium a cikin ƙwayar cerebrospinal ya karu. Bugu da ƙari ga rashin tausayi da coma, ƙwaƙwalwar lalaci na iya bayyana kanta a cikin nau'in tashin hankali na psychomotor, delirium da hallucinations.
Wani fasalin cututtukan hyperosmolar shine alamu na yau da kullun da bambance bambancen lalacewar tsarin juyayi. Jerin sunayen sun hada da:
- katsewa
- rashi magana;
- rashin saurin motsawa cikin rudanin gira (nystagmus);
- rauni na ƙungiyoyi na son rai (paresis) ko cikakkiyar raunin ƙungiyoyin tsoka;
- sauran bayyanar cututtuka na jijiyoyin jiki.
Waɗannan bayyanar cututtuka suna da bambanci sosai kuma basu dace da kowane irin ciwo ba. Bayan cire mai haƙuri daga yanayin hyperosmolar, yawanci sukan ɓace.
Taimakawa tare da cutar motsa jiki: cikakken bayani game da likita
Jiyya don cututtukan hyperosmolar da cutar hyperglycemic coma ana aiwatar da su ne kacokan kan ka'idodi iri ɗaya kamar yadda ake kula da cutar ketoacidosis. Amma akwai fasalulluka wadanda muke magana a ƙasa.
A kowane hali yakamata a rage matakan sukari na jini da sauri fiye da 5.5 mmol / L na kowane awa. Yawan jini (yawanci) na jijiyoyin jini bai kamata ya ragu da sauri sama da 10 na masallaci / l a awa daya ba. Decreasearancin raguwa a cikin waɗannan alamomin suna da cikakken kariya, saboda yana ƙaruwa haɗarin huhun huhun ciki da kuma cututtukan cerebral.
A taro na Na + cikin plasma> 165 meq / l, gabatarwar hanyoyin samar da ruwan gishirin ya saba. Sabili da haka, ana amfani da maganin glucose na 2% a matsayin ruwa don kawar da bushewa. Idan matakin sodium shine 145-165 meq / l, to yi amfani da maganin hypotonic na 0C5% na NaCl. Lokacin da sodium matakin ya ragu <145 meq / l, ana ci gaba da rehydration tare da saline na jiki 0.9% NaCl.
A cikin sa'a ta farko, ana shigar da ruwa na 1-1.5 na ruwa, a cikin na 2 da na 3 - 0.5-1 lita, sannan 300-500 ml a awa daya. An daidaita yawan rehydration daidai da na ketoacidosis na masu ciwon sukari, amma ƙarar sa na farko idan ya kamu da cutar sikila ya fi girma.
Lokacin da jikin mai haƙuri ya fara zama mai cike da ruwa, i.e., an cire bushewar jiki, wannan a cikin kansa yana haifar da raguwa a fili a cikin taro na glucose a cikin jini. A cikin cutar motsa jiki na hyperglycemic, yawanci hankalin insulin yawanci yana ƙaruwa. Saboda waɗannan dalilai, a farkon farawar, ba a gudanar da insulin kwata-kwata ko ana gudanar da shi a cikin ƙananan allurai, kimanin raka'a 2 na "gajere" a cikin awa daya.
Bayan sa'o'i 4-5 bayan fara aikin jiko, zaku iya canzawa zuwa tsarin kulawar insulin na insulin wanda aka bayyana a sashen “Jiyya na ketoacidosis mai ciwon sukari”, amma idan sukari jini ya yawaita sosai kuma yawan kumburin sodium a cikin jini yana raguwa.
A cikin cututtukan hyperosmolar, yawanci ana buƙatar ƙarin potassium don daidaita ƙarancin ƙwayar potassium a jikin mai haƙuri fiye da ketoacidosis na mai ciwon sukari. Amfani da alkalis, ciki har da yin burodi soda, ba a nuna shi ga ketoacidosis, har ma fiye da haka don cututtukan hyperosmolar. PH na iya raguwa idan acidosis ya haɓaka tare da ƙari da ayyukan purulent-necrotic. Amma ko da a cikin waɗannan halayen, pH yana da wuya sosai a ƙasa da 7.0.
Munyi ƙoƙarin yin wannan labarin game da cutar hypoglycemic coma da hyperosmolar syndrome suna da amfani ga marasa lafiya. Muna fatan likitocin zasu iya amfani da shi azaman “takardar yaudara”.
