Ketoacidosis mai ciwon sukari

Ketoacidosis babban ciwo ne na ciwon sukari. Yana haɓakawa a cikin marasa lafiya waɗanda ba a horar da su don magance cutar su ba. Bayan karanta labarin, zaku koyi duk abin da kuke buƙata game da alamun cutar game da kula da cutar ketoacidosis na yara a cikin yara da manya. Shafin yanar gizo na masu ciwon sukari -Med.Com yana haɓaka abincin maras ƙwayoyi-mai sauƙi - hanya mai tasiri don sarrafa nau'in 1 da nau'in ciwon sukari na 2. A cikin masu ciwon sukari da ke bin wannan abincin, matakan gwaji sukan nuna kasancewar ketones (acetone) a cikin fitsari da jini. Wannan ba shi da lahani, kuma babu abin da za a yi yayin da sukarin jini yake al'ada. Acetone a cikin fitsari ba ketoacidosis ba tukuna! Babu bukatar tsoratar da shi. Karanta cikakken bayani a kasa.

Ketoacidosis mai ciwon sukari: alamu da magani a cikin yara da manya

Idan akwai batun karancin insulin, sel ba za su iya amfani da glucose a matsayin tushen ƙarfin kuzari ba. A wannan yanayin, jiki ya canza zuwa abinci tare da kitsen ajiyar sa. Lokacin da kitse ya karye, ketone jikin (ketones) ana samarwa da karfi. Lokacin da ketones da yawa suka yi yawa a cikin jini, kodan basu da lokaci don cire su daga jiki kuma acidity na jini yana ƙaruwa. Wannan yana haifar da bayyanar cututtuka - rauni, tashin zuciya, amai, ƙishirwa, da ƙanshi na acetone daga bakin. Idan ba a dauki matakin gaggawa ba, mai ciwon sukari zai fada cikin rashin lafiya kuma yana iya mutuwa. Marasa lafiya suna iya sanin yadda zasu kawo yanayin zuwa ketoacidosis. Don yin wannan, kuna buƙatar maye gurbin ajiyar ƙwayar cuta a kai a kai kuma kuyi allurar insulin. Isasan da ke ƙasa an bayyana dalla-dalla yadda za a bi da ketoacidosis masu ciwon sukari a gida da asibiti. Da farko dai, kuna buƙatar gano inda acetone a cikin fitsari ya fito da kuma wane magani ne yake buƙata.

Menene bambanci tsakanin ketoacidosis na ciwon sukari da acetone a cikin fitsari

A cikin ƙasashen da ke magana da Rasha, ana amfani da mutane don tunanin cewa acetone a cikin fitsari yana da haɗari, musamman ga yara. Tabbas, acetone abu ne mai-ƙamshi wanda ake amfani dashi don narke gurɓataccen gurbataccen mai tsabtace gidaje. Babu wanda a cikin hankalin su da zai so ya dauke ta a ciki. Ko yaya, acetone yana daya daga cikin nau'ikan kwayoyin ketone da za'a iya samu a jikin mutum. Hankalinsu a cikin jini da fitsari yana ƙaruwa idan shagunan carbohydrates (glycogen) sun lalace kuma jiki ya canza zuwa abinci tare da kitsen mai. Wannan yakan faru ne a cikin yara ƙanana da ke aiki a jiki, haka kuma a cikin masu ciwon sukari waɗanda ke bin abinci mai ƙayyadaddun carbohydrate.

Acetone a cikin fitsari bashi da haɗari har sai idan babu fitar danshi. Idan tsarukan gwaji don ketones sun nuna kasancewar acetone a cikin fitsari, wannan ba alama ce ta soke rage yawan abincin da ake amfani da shi a cikin mai haƙuri ba. Yaro ko ɗan yara masu ciwon sukari yakamata yaci gaba da bin tsarin abinci ya kuma kula sosai da shan ruwa mai yawa. Kada a ɓoye insulin da sirinji zuwa nesa. Sauyawa zuwa tsarin abinci na carbohydrate mara ƙarfi yana ba masu ciwon sukari damar sarrafa cutar su ba tare da allurar insulin kwata-kwata ba. Goma, duk da haka, babu tabbacin da za a iya bayarwa game da wannan. Wataƙila, a cikin lokaci, har yanzu kuna yin allurar cikin ƙananan allurai. Acetone a cikin fitsari ba ya cutar da koda da kodan ko wasu gabobin ciki, muddin sukarin jini ya saba kuma jikin mai cutar sikari ba ya fama da raunin ruwa. Amma idan kun rasa haɓakar sukari kuma ba ku cika shi da allurar insulin ba, wannan na iya haifar da ketoacidosis, wanda ke da haɗari da gaske. Tambayoyi masu zuwa ne game da acetone a cikin fitsari.

Acetone a cikin fitsari wani lamari ne da ke faruwa tare da tsayayyen abinci mai karancin carbohydrate. Wannan ba cutarwa bane muddin sukarin jini ya saba. Tuni dubun dubatan masu ciwon sukari a duniya ke sarrafa cututtukan su tare da rage cin abinci mai suna carbohydrate. Magungunan hukuma suna sanya shi a cikin ƙafa, ba da son rasa abokin ciniki da samun kudin shiga ba. Ba a taɓa samun rahotannin cewa acetone a cikin fitsari zai cutar da kowa ba. Idan wannan kwatsam ya faru, to abokan adawar mu za su fara ihu game da shi a kowane lungu.

Yakamata a gano mai cutar ketoacidosis kuma a bi dashi lokacin da mara lafiyar ya sami sukarin jini na 13 mmol / L ko sama. Yayin da sukari ya zama al'ada kuma yana da daɗi, babu abin da ke buƙatar musamman. Ci gaba kan tsayayyen abincin carb mai tsauri idan kana son ka guji rikitar ciwon sukari.

Karka gwada jininka ko fitsari kwata-kwata da gwajin gwaji don ketones (acetone). Karku ajiye wadannan tsaran gwajin a gida - zaku rayu da nutsuwa. Madadin haka, auna sukarin jininka sau da yawa tare da mitar glucose na jini - da safe akan komai a ciki kuma har sa'o'i 1-2 bayan cin abinci. Yi aiki da sauri idan sukari ya hau. Sugar 6.5-7 bayan cin abinci ya rigaya ya munana. Ana buƙatar canje-canje a cikin abinci ko allurar insulin, koda kuwa endocrinologist ɗinku ya ce waɗannan kyakkyawan alamun ne. Haka kuma, kuna buƙatar aiki idan sukari a cikin masu ciwon sukari bayan cin abinci ya haɗu sama da 7.

Matsayi na daidaituwa ga cututtukan sukari a cikin yara yana haifar da jijiyoyin jini, jinkiri na haɓaka, da kuma maganganun cututtukan cututtukan jini suma zasu yiwu. Ciwon mara na jijiyoyin jiki yakan bayyana daga baya - yana da shekaru 15-30. Mai haƙuri da kansa da iyayensa za su magance waɗannan matsalolin, ba endocrinologist wanda ya sanya abincin mai cutarwa wanda aka cika shi da carbohydrates. Kuna iya yarda da likita don jinsin, ci gaba da ciyar da yaranku da abinci mai cike da carbohydrate. Kada a yarda mai ciwon sukari ya tafi asibiti inda abincin bai dace da shi ba. Idan za ta yiwu, a kula da wani endocrinologist wanda ya amince da rage cin abinci mai-carbohydrate.

Yana da kyau ga masu ciwon sukari, kamar kowa, su haɓaka dabi'ar shan ruwan sha mai yawa. Sha ruwa da ganye na ganye a 30 ml a kowace kilogiram 1 na nauyin jiki a rana. Zaku iya yin kwanciya bayan kun sha kullun. Sau da yawa zaku shiga bayan gida, watakila ma da dare. Amma kodan zai kasance cikin tsari tsawon rayuwarsu. Mata sun lura cewa karuwar yawan shigar ruwa bayan wata daya yana inganta bayyanar fatar. Karanta yadda ake kula da sanyi, amai, da gudawa a cikin mutane masu ciwon siga. Cututtukan cututtukan cuta ba su da daidaitattun yanayi waɗanda ke buƙatar ayyuka na musamman don hana ketoacidosis a cikin marasa lafiya da ciwon sukari.

Menene haɗarin ketoacidosis masu ciwon sukari

Idan acidity na jini ya tashi akalla dan kadan, to mutumin zai fara jin rauni kuma yana iya fadawa cikin rashin lafiya. Wannan shine abin da ke faruwa tare da ketoacidosis mai ciwon sukari. Wannan halin yana buƙatar taimakon likita na gaggawa, saboda yakan haifar da mutuwa.

Idan mutum ya kamu da cutar ketoacidosis mai ciwon sukari, to wannan yana nufin cewa:

• yawan jini yana karuwa sosai (> 13.9 mmol / l);
• taro na jikin ketone a cikin jini yana ƙaruwa (> 5 mmol / l);
• tsiri na gwaji yana nuna kasancewar ketones a cikin fitsari;
• acidosis ya faru a cikin jiki, i.e. ma'aunin acid-base ya koma haɓaka acidity (jini mai jijiya pH <7.3 tare da al'ada na 7.35-7.45).

A Rasha, yawan ketoacidosis a cikin 1990-2001 a cikin marasa lafiya da ke da nau'in ciwon sukari na 1 shine 0.2 a cikin mutum ɗaya a shekara, tare da nau'in ciwon sukari na 2 - 0.07 a cikin haƙuri a kowace shekara. A cikin ƙasashe masu tasowa, wannan adadi sau da yawa yana ƙasa da ƙasa. Yawan mace-mace a cikin ketoacidosis na masu ciwon sukari a cikin Rasha shine 7-19%, a Turai da Amurka - 2-5%.

Duk marasa lafiya da masu ciwon sukari yakamata suyi koyi da hanyoyin auna sukari na farin ciki tare da glucometer kuma su zabi matakin da ya dace na insulin. Idan mai ciwon sukari ya samu horo sosai, to yuwuwar ketoacidosis kusan ba komai bane. Shekaru da yawa, fama da ciwon sukari kuma a lokaci guda ba fadowa a cikin cutar rashin lafiya ba - wannan ainihin haƙiƙa ne.

Sanadin Ketoacidosis

Ketoacidosis a cikin masu ciwon sukari yana haɓaka tare da rashi insulin a cikin jiki. Wannan rashi na iya zama “cikakke” a cikin nau'in 1 na ciwon sukari ko "dangi" a cikin nau'in ciwon sukari na 2.

Abubuwan da ke kara haɗarin haɓakar kamuwa da cutar sukari:

• Cututtukan da ke da alaƙa da kamuwa da cuta, musamman hanyoyin kumburi da cututtuka;
• ayyukan tiyata;
• raunin da ya faru
• yin amfani da kwayoyi waɗanda suke insulin antagonists (glucocorticoids, diuretics, hormones na jima'i);
• da amfani da kwayoyi wadanda ke rage karfin jijiyoyin jiki zuwa aikin insulin (antipsychotics da sauran rukunin magunguna);
• ciki (ciwon suga na ciki);
• raguwa daga cikin insulin cikin dogon lokaci na nau'in ciwon sukari na 2;
• maganin cututtukan farji (tiyata) a cikin mutanen da basu da ciwon sukari a baya.

Dalilin ketoacidosis shine rashin halayen marasa lafiyar mara lafiyar ::

• tsallake allurar insulin ko barinsu ba tare da izini ba (mara lafiyar yana 'dauke' kansa ta hanyar hanyoyin da ba na al'ada ba na maganin masu ciwon suga);
• ko da wuya saurin duba kansa na jini tare da glucometer;
• mara lafiya bai sani ba ko ya sani, amma ba ya bin ka'idodi don tsara adadin insulin, dangane da glucose a cikin jininsa;
• akwai karuwar rashin insulin saboda wata cuta mai dauke da cutar ko shan karin carbs din, amma ba a rama shi ba;
• allurar ƙare insulin ko wacce ba ta adana ta daidai;
• rashin dacewar allurar insulin;
• alkalami na insulin yana aiki da kyau, amma marassa lafiya ba sa sarrafa shi;
• Ribar insulin ba ta da inganci.

Specialungiya ta musamman na marasa lafiya da ke fama da cutar ta ketoacidosis masu ciwon sukari sune waɗanda suka rasa allurar insulin saboda suna ƙoƙarin kashe kansu. Mafi sau da yawa, waɗannan matasa matasa ne masu ciwon sukari na 1. Suna da mummunar matsala ta tunani ko rashin hankalin mutum.

Sanadin cutar ketoacidosis mai ciwon sukari yawanci kurakuran likita ne. Misali, ba a gano wani sabon nau'in ciwon sukari guda 1 na ciwon sukari ba akan lokaci. Ko insulin ya jinkirta tsawon lokaci a cikin nau'in ciwon sukari na 2, kodayake akwai alamun halayen da ke nuna ƙwayar insulin.

Bayyanar cututtuka na ketoacidosis a cikin ciwon sukari

Ketoacidosis mai ciwon sukari yana tasowa, yawanci a cikin 'yan kwanaki. Wani lokaci - a cikin ƙasa da rana 1. Da farko, alamun cutar hawan jini ya yawaita sakamakon karancin insulin:

• matsananciyar ƙishirwa;
• urination akai-akai;
• bushe fata da mucous membranes;
• asarar nauyi mai wahala;
• rauni.

Sannan ana hade su da alamun ketosis (samar da aiki na jikin ketone) da acidosis:

• tashin zuciya
• amai
• ƙanshi na acetone daga bakin;
• baƙon abu mara ƙarfi na numfashi - yana da hayaniya da zurfi (da ake kira Kussmaul na numfashi).

Bayyanar cututtuka na rashin damuwa na tsarin juyayi na tsakiya:

• ciwon kai
• haushi;
• ja da baya;
• bari;
• nutsuwa
• precoma da ketoacidotic coma.

Jikunan kwayoyin ketone suna haushi da hanji. Hakanan, ƙwayoyin sa suna bushewa, kuma saboda tsananin ciwon sukari, matakin potassium a jiki yana raguwa. Duk wannan yana haifar da ƙarin alamun cutar ketoacidosis mai ciwon sukari, wanda yayi kama da matsalolin tiyata tare da ƙwayar gastrointestinal. Ga jerin su:

• ciwon ciki
• bango na ciki yana da tashin hankali da azaba yayin buguwa;
• peristalsis an rage.

Babu shakka, alamun da muka lissafa alamomi ne na asibiti cikin gaggawa. Amma idan sun manta don auna sukarin jinin mai haƙuri da duba fitsari don jikin ketone ta hanyar amfani da tsirin gwajin, to za a iya kuskuren zuwa asibiti cikin sashen masu cutar ko kuma tiyata. Wannan yakan faru.

Bayyanar cutar ketoacidosis na ciwon sukari

A matakin prehospital ko a cikin shigarwar, ana yin gwaje gwaje na jini don sukari da fitsari don jikin ketone. Idan fitsari mara lafiya bai shiga cikin mafitsara ba, ana iya amfani da jijiyar jini don tantance ketosis. A wannan yanayin, ana sanya digo na serum a tsiri na gwaji don tantance ketones a cikin fitsari.

Shin wajibi ne don kafa matsayin ketoacidosis a cikin haƙuri kuma gano abin da rikitarwa na ciwon sukari shine cutar ketoacidosis ko cutar hyperosmolar? Tebur mai zuwa yana taimakawa.

Sharuɗɗan ganewar asali don cutar ketoacidosis da ciwon sukari

Dole ne a rarrabe cutar ketoacidosis (bambancin ganewar asali) daga wasu cututtukan ƙoshin lafiya:

• getoacidosis giya;
• “Yunwar” ketosis;
• lactic acidosis (lactic acid mai yawa a cikin jini);
• guba na salicylate (asfirin, giya salicylic, da sauransu);
• guba na methanol (giya na methyl, guba ga mutane);
• maye tare da ethyl barasa;
• ciwan guba.

A cikin ketoacidosis na mai ciwon sukari, gwajin jini kusan koyaushe yana nuna damuwa mai narkewa a cikin jini na leukocytosis. Amma ya kamata a tuhume kamuwa da cuta kawai idan leukocytosis ya wuce 15x10 ^ 9 / l.

A lokaci guda, al'ada ko ma saukar da zafin jiki jikin har yanzu ba ya ba da tabbataccen tabbacin cewa mara lafiya ba shi da tsarin cuta da kumburi. Saboda acidosis, hypotension da na gefe na jijiyoyin jiki (shakatawa na jijiyoyin jini) suna ba da gudummawa ga ragewa.

Maganin kamuwa da cutar ketoacidosis: cikakkun bayanai na likitoci

Hanyar warkewa don ketoacidosis a cikin ciwon sukari mellitus ya ƙunshi abubuwa 5, kuma dukansu daidai suke da mahimmanci don maganin nasara. Ga jerin su:

• ilimin insulin;
• sake ruwa (sake maye gurbin raunin ruwa a cikin jiki);
• gyaran rikicewar wutan lantarki (cikewar rashi na potassium, sodium da sauran ma'adanai);
• kawar da acidosis (daidaituwa na ma'aunin acid-base);
• lura da concomitant cututtuka da za su iya tsokani wani babban rikitarwa na ciwon sukari.

A matsayinka na mai mulkin, an kwantar da mai haƙuri da ciwon sukari mai cutar ketoacidosis a cikin sashin kulawa mai zurfi da kuma ɓangaren kulawa mai zurfi. A can ne yake karkashin kulawa da kula da mahimman alamomi, gwargwadon wannan tsarin:

1. bayyana bincike na glucose na jini - lokaci 1 a awa daya, har sai sukari jini ya sauka zuwa 13-14 mmol / l, sannan sai a sake maimaita wannan binciken duk awanni 3;
2. nazarin fitsari don acetone - sau 2 a rana don kwanaki 2 na farko, sannan lokaci 1 a rana;
3. cikakken bincike na jini da fitsari - ana yi nan da nan bayan shigar, sannan kuma a sake maimaita kowane kwanaki 2-3.
4. sodium, potassium a cikin jini na jini - sau 2 a rana;
5. phosphorus - kawai a cikin marasa lafiya na rashin shan barasa, ko kuma idan akwai alamun rashin abinci mai gina jiki;
6. gwajin jini don saura na nitrogen, urea, creatinine, chloride - nan da nan akan shigar, sannan 1 lokaci a cikin kwanaki 3;
7. hematocrit, bincike na gas da pH na jini - 1-2 sau a rana har zuwa lokacin da aka samar da jihar acid-base.;
8. sarrafa diuresis na hourauka (catheter urinary na dindindin) - har sai an cire fitsarin jiki ko har sai lokacin da aka dawo da fatar kuma a kan fitar da urination al'ada ce;
9. iko da matsanancin matsanancin kwari;
10. ci gaba da sanya idanu kan hauhawar jini, bugun zuciya da zafin jiki (ko kuma a kalla a kowane awanni 2);
11. ci gaba da saka idanu akan ECG (ko rajistar ECG aƙalla 1 lokaci ɗaya kowace rana);
12. idan ana zargin kamuwa da cuta, an tsara ƙarin ƙarin binciken da ya dace.

Don ƙarin ƙididdigar adadin daidaituwa na sodium a cikin jini, ana amfani da dabara don lissafa abin da ake kira "matakan sodium da aka daidaita".An gyara Na + = ana auna Na + 1.6 * (glucose -5.5) / 5.5

Koda kafin asibiti, mai haƙuri yakamata ya fara sarrafawa cikin maganin 0.9% na gishiri na NaCl a kimanin kimanin 1 lita a awa daya, haka ma intramuscularly allurar 20 na insulin gajere.

Idan mai haƙuri yana da matakin farko na ketoacidosis na masu ciwon sukari, an kiyaye farji, sannan kuma babu wani babban tsari mai rikitarwa, to za a iya gudanar da shi a cikin sashin endocrinology ko warkewa. Tabbas, idan ma'aikatan wadannan bangarorin sun san abin da ake buƙatar aiwatarwa.

Ciwon sukari ketoacidosis insulin far

Ketoacidosis maye gurbin insulin shine kawai magani wanda zai iya katse hanyoyin jikin mutum wanda ke haifar da haɓaka wannan rikicewar cutar ciwon sukari. Makasudin insulin shine don daukaka matakin insulin a cikin jini zuwa 50-100 mcED / ml.

Saboda wannan, ana cigaba da gudanar da insulin na “gajeru” insulin 4-10 a kowace awa, matsakaita na raka'a 6 a kowace awa. Irin waɗannan hanyoyin don maganin insulin ana kiransu "ƙarancin kashi" ajali. Suna magance lalacewar kitse da kuma samar da jikin ketone, suna hana sakin glucose a cikin jini ta hanta, kuma suna ba da gudummawa ga aikin glycogen.

Don haka, manyan hanyoyin haɗin gwiwa a cikin hanyoyin ci gaban ketoacidosis masu ciwon sukari an cire su. A lokaci guda, maganin insulin a cikin “ƙarancin kashi” ajali yana ɗaukar ƙananan haɗarin rikitarwa kuma yana ba da izini mafi kyawun sarrafa sukari na jini fiye da tsarin "ƙwayar cuta mai girma"

A cikin asibiti, mai haƙuri da ketoacidosis mai ciwon sukari yana karɓar insulin a cikin hanyar ci gaba mai saurin shiga ciki. Na farko, ana yin insulin gajere a cikin kwano (a hankali) a cikin “kaya” na 0.15 U / kg, a matsakaita shine 10-12 UNITS. Bayan wannan, an haɗa mai haƙuri zuwa infusomat don ya sami insulin ta hanyar ci gaba da jiko a cikin adadin raka'a 5-8 a awa daya, ko raka'a 0.1 / awa / kg.

A kan filastik, adsorption na insulin yana yiwuwa. Don hana shi, ana bada shawara don ƙara albumin ɗan adam a cikin mafita. Umarnin don shirya cakuda cakuda: ƙara 50 ml na 20% albumin ko 1 ml na jinin mai haƙuri zuwa raka'a 50 na "ɗan gajeren" insulin, sannan kawo jimlar girma zuwa 50 ml ta amfani da 0.9% NaCl saline.

Rashin maganin insulin a cikin asibiti idan babu infusomat

Yanzu mun bayyana wani zaɓi na daban don maganin insulin cikin ciki, idan babu infusomat. Ana iya gudanar da insulin na ɗan gajeren lokaci sau ɗaya a cikin awa ɗaya ta hanyar bolus, sannu a hankali, tare da sirinji, a cikin cakuda tsarin jiko.

Cikakken kashi daya na insulin (alal misali, raka'a 6) yakamata a cika cikin sirinji na 2 ml, sannan sai a ƙara 2 ml tare da 0.9% na maganin NaCl. Saboda wannan, ƙarawar cakuda a cikin sirinji ya ƙaru, kuma ya sami damar yin allurar a hankali, a tsakanin mintuna 2-3. Ayyukan '' gajere '' insulin zuwa cikin sukarin jini yakai tsawon awa 1. saboda haka, ana iya daukar nauyin tafiyar da lokaci 1 a cikin awa ɗaya ingantacce.

Wasu marubutan suna ba da shawarar maimakon irin wannan hanyar yin allurar insulin “mara-ƙaranci” a raka'a 6 a kowace awa. Amma babu wani tabbaci cewa irin wannan ingantaccen tsarin aikin ba zai zama mafi muni fiye da gudanarwar cikin zuciya ba. Ketoacidosis mai ciwon sukari yakan kasance tare da ratsa jiki mara nauyi, wanda ke kawo rikicewar insulin, sarrafa intramuscularly, har ma fiye da ƙasa.

An haɗa allurar gajere a cikin sirinjin insulin. Allura ta wucin gadi ba zai yuwu ba. Ba tare da ambaton gaskiyar cewa akwai ƙarin damuwa ga haƙuri da ma'aikatan lafiya ba. Sabili da haka, don lura da ketoacidosis na ciwon sukari, ana bada shawarar gudanar da insulin cikin jini.

Ya kamata a gudanar da insulin a cikin subcutaneously ko intramuscularly kawai tare da wani yanayi mai laushi na ketoacidosis mai ciwon sukari, idan mai haƙuri ba shi cikin mummunan yanayin kuma baya buƙatar kasancewa a cikin sashin kulawa mai zurfi da kulawa mai zurfi.

Inganta maganin insulin

Sashi na insulin 'gajere' an daidaita shi gwargwadon dabi'un sukari na yanzu, wanda yakamata a auna kowace awa. Idan a cikin awanni 2-3 na farko matakin glucose a cikin jini baya raguwa kuma yawan jikewar jiki tare da ruwa ya ishe, to kashi na gaba na insulin na iya ninkawa.

A lokaci guda, ba za a iya rage yawan sukari a cikin jini da sauri ba ta 5.5 mmol / l a awa daya. In ba haka ba, mai haƙuri na iya fuskantar hatsarin mawuyacin maɓallin farji. A saboda wannan dalili, idan yawan raguwar sukari na jini ya kusanto daga ƙasa zuwa 5 mmol / l a awa daya, to kashi na gaba na insulin ya ragu. Kuma idan ya wuce 5 mmol / l awa ɗaya, to allurar insulin ta gaba gaba ɗaya ta tsallake, yayin da ake ci gaba da sarrafa sukarin jini.

Idan, a ƙarƙashin rinjayar insulin therapy, sukari na jini ya ragu a hankali fiye da 3-4 mmol / l a kowace awa, wannan na iya nuna cewa mai haƙuri har yanzu yana bushewa ko aikin koda ya raunana. A wannan yanayin, kuna buƙatar sake kimantawa da yawaitar jini yana yaduwa da kuma yin bincike kan matakin ƙirar creatinine a cikin jini.

A ranar farko a asibiti, yana da kyau a rage sukarin jini zuwa sama da mm mm / mm 13. Lokacin da aka kai wannan matakin, fara jiko na 5-10% glucose. Ga kowane g 20 na glucose, raka'a 3-4 na gajeren insulin ana allurar dashi cikin cakulan. 200 ml na 10% ko 400 ml na 5% bayani yana dauke da gram 20 na glucose.

Ana sarrafa glucose ne kawai idan mai haƙuri har yanzu bai iya ɗaukar abinci da kanshi ba, kuma rashi insulin kusan an cire shi. Gudanarwar glucose ba magani bane ga masu ciwon sukari a kowane lokaci. An yi shi don hana hypoglycemia, kazalika don kula da osmolarity (yawanci na yau da kullun ruwaye a cikin jiki).

Yadda ake canzawa zuwa ƙarƙashin insulin na insulin

Bai kamata a jinkirta maganin insulin ba. Lokacin da yanayin mai haƙuri ya inganta, saukar karfin jini, an kiyaye sukari na jini a matakin da bai wuce 11-12 mmol / L da pH> 7.3 - zaku iya canzawa zuwa gudanarwar insulin. Za a fara da allurai na 10-14 raka'a a kowane 4 hours. Ana daidaita shi gwargwadon sakamakon sarrafa sukari na jini.

An ci gaba da gudanar da aikin insulin na “gajarta” zuwa wani tsawon awa 1-2 bayan allurar farko da take ciki, don kada wani katsewa a cikin aikin insulin. Tuni a ranar farko ta allurar ciki, za a iya amfani da insulin da aka ɗauka lokaci guda. Maganin sa na farko shine raka'a 10-12 sau 2 a rana. Yadda za a gyara shi an bayyana shi a cikin labarin “Sashi na cuididdigar Sashi da Fasaha don Gudanar da Inshorar”.

Rehydration a cikin ketoacidosis na ciwon sukari - kawar da rashin ruwa

Wajibi ne a yi ƙoƙarin yin aƙalla rabin rabin raunin ruwa a jikin mai haƙuri tuni a farkon ranar farawa. Wannan zai taimaka wajan rage yawan sukarin jini, saboda za a dawo da kwararar jinin koda, kuma jiki zai iya cire karin glucose a cikin fitsari.

Idan matakin farko na sodium a cikin ƙwayar jini ya kasance al'ada (= 150 meq / l), to yi amfani da maganin hypotonic tare da maida hankali na NaCl na 0.45%. Adadin gabatarwa shine 1 lita a farkon awa, 500 ml kowane a awa na 2 da na 3, sannan 250-500 ml / awa.

Hakanan ana amfani da saurin rage zafin ruwa a ciki: lita 2 a cikin awanni 4 na farko, wani lita 2 a cikin awa 8 masu zuwa, sannan 1 lita na kowane awa 8. Wannan zaɓi da sauri yana mayar da matakan bicarbonate kuma yana kawar da bambancin anionic. Cakuda sodium da chlorine a cikin jini yana tashi kasa.

A kowane hali, ana daidaita yawan allurar ruwa dangane da matsin ɗin nan na tsakiya (CVP). Idan kasa da 4 mm aq. Art. - 1 lita a awa daya, idan HPP ta kasance daga 5 zuwa 12 mm aq. Art. - Lita 0.5 a awa daya, sama da 12 mm aq. Art. - 0.25-0.3 lita awa daya. Idan mai haƙuri yana da zubar rashin ruwa mai mahimmanci, to ga kowane sa'a zaka iya shigar da ruwa cikin ƙarar da ba ta fi 500-1000 ml fiye da yawan fitsari da aka saki ba.

Yadda za a hana zubar ruwa mai yawa

Jimlar adadin ruwan in allurar a cikin farkon 12 hours na ketoacidosis far ya kamata yayi daidai da 10% na nauyin jikin mai haƙuri. Loadaukar ruwa mai zafi yana kara haɗarin cutar huhun ciki, don haka ya kamata a sa ido akan CVP. Idan ana amfani da maganin hypotonic saboda karuwar abun da ke cikin sodium a cikin jini, to ana gudanar da shi cikin ƙaramin girma - kamar 4-14 ml / kg awa ɗaya.

Idan mai haƙuri yana da girgizawar hypovolemic (saboda raguwa a cikin yawan ƙwayar jini, ƙwayar systolic “babba” zai tsaya da ƙarfi a ƙasa 80 mm Hg ko CVP ƙasa da Hg mm 4 mm), to gabatar da colloids (dextran, gelatin) shine shawarar. Domin a wannan yanayin, gabatarwar wani 0.9% NaCl bayani na iya zama bai isa ya daidaita yanayin haɓakar jini da dawo da zubar jini zuwa kyallen ba.

A cikin yara da matasa, haɗarin maƙarƙashiyar ƙwayar cuta yayin cutar ketoacidosis mai ciwon sukari yana ƙaruwa. An shawarce su dasu saka ruwa don cire ruwa a cikin 10-20 ml / kg a cikin awa 1 na farko. A cikin kwanakin 4 na farko na maganin, jimlar yawan ruwa da aka gudanar kada ta wuce miliyan 50 / kg.

Gyara rikicewar lantarki

Aƙalla 4-10% na marasa lafiya da ke da ketoacidosis masu ciwon sukari suna da hypokalemia akan ƙaddamarwa, watau, karancin potassium a cikin jiki. Suna fara magani tare da gabatarwar potassium, kuma ana jinkirta maganin insulin har sai potassium a cikin jini yana tashi zuwa akalla 3.3 meq / l. Idan bincike ya nuna hypokalemia, to wannan alama ce ta kulawa da kula da sinadarin potassium, koda kuwa fitowar fitsari mara lafiya ce ko bata nan (oliguria ko anuria).

Ko da matakin farko na potassium a cikin jini yana cikin iyakokin al'ada, mutum na iya tsammanin raguwarsa ta lalace yayin lura da cutar ketoacidosis na masu ciwon sukari. Yawancin lokaci ana lura da shi awanni 3-4 bayan fara normalization na pH. Domin tare da gabatarwar insulin, kawarda rashin ruwa da kuma raguwar yawan sukari a cikin jini, za'a samar da potassium mai yawa tare da glucose a cikin sel, sannan kuma a fitar dashi a cikin fitsari.

Ko da mara lafiya matakin farko na potassium, ana cigaba da gudanar da sinadarin potassium daga farkon insulin far. A lokaci guda, suna himmatuwa don kaiwa ga kimar potassium ta plasma daga 4 zuwa 5 meq / l. Amma ba zaku iya shiga fiye da 15-20 g na potassium a kowace rana. Idan ba ku shiga cikin potassium ba, to, haɓakar hypokalemia na iya haɓaka jarin insulin kuma ya tsoma baki tare da daidaituwa na sukari na jini.

Idan ba a san matakin potassium a cikin jini ba, to, gabatarwar potassium ya fara ne ba da awanni 2 ba bayan farawar insulin, ko kuma tare da wani ruwa na lita 2. A wannan halin, ana kula da ECG da yawan fitar fitsari (diuresis).

Rashin gudanar da potassium a cikin ciwon sukari na ketoacidosis *

* Tebur ya dogara ne akan littafin 'Ciwon sukari. M da rikitarwa rikicewa ”ed. I.I.Dedova, M.V. Shestakova, M., 2011
** a cikin 100 ml na 4% KCl bayani ya ƙunshi 1 g na potassium chloride

A cikin cutar ketoacidze na ciwon sukari, gwamnatin phosphate ba bu mai kyau ba saboda ba ta inganta sakamakon magani ba. Akwai iyakataccen jerin alamomi wanda aka wajabta sinadarin phosphate a cikin adadin 20-30 meq / l jiko. Ya hada da:

• bayyana hypophosphatemia;
• anemia
• tsananin rauni na zuciya.

Idan ana gudanar da phosphates, to lallai ya zama dole a sarrafa matakin alli a cikin jini, saboda akwai hadarin faduwar gabarsa. A cikin lura da ketoacidosis na masu ciwon sukari, yawanci magnesium ba koyaushe ba ne gyara.

Cutar Acidosis

Acidosis motsi ne a ma'aunin acid-base zuwa haɓaka acidity. Yana tasowa lokacin da, saboda karancin insulin, jikin ketone ya shiga cikin jini sosai. Tare da taimakon isasshen maganin insulin, samar da jikin kwayoyin halittar ketone. Hakanan, kawar da rashin ruwa a jiki yana taimakawa wajen daidaita abubuwan da ke faruwa a PH, saboda yana daidaita zubar jini, gami da cikin kodan, wanda ke cire ketones.

Ko da mai haƙuri yana da mummunar acidosis, haɗuwa da bicarbonate kusa da pH na al'ada ya kasance na dogon lokaci a cikin tsarin tsakiya. Hakanan a cikin ƙwayar cerebrospinal (ƙwayar cerebrospinal), ana kula da matakin abubuwan jikin ketone sosai fiye da na jini.

Gabatarwar alkalis zai iya haifar da sakamako masu illa:

• ƙarancin ƙarancin potassium;
• haɓaka cikin acidosis na ciki, koda pH na jini ya tashi;
• munafiki - rashi alli;
• rage gudu daga ketosis (samar da jikin ketone);
• take hakkin da keɓaɓɓen kwana na oxygenhemoglobin da hypoxia na gaba (rashin isashshen sunadarin oxygen);
• jijiyoyin jini;
• maganin cututtukan dake kusa da bakin ciki acidosis, wanda zai iya taimakawa ciwanrin kwakwalwa.

An tabbatar da cewa nadin sodium bicarbonate baya rage mace-macen masu fama da cutar ketoacidosis. Sabili da haka, alamun da ke gabatarwa suna daɗaɗɗun kunkuntar. Yin amfani da soda akai-akai yana da rauni sosai. Ana iya gudanar dashi kawai a pH na jini kasa da 7.0 ko daidaitaccen darajar bicarbonate wanda ƙasa da 5 mmol / L. Musamman idan an lura da lalacewar jijiyoyin bugun gini ko potassium a lokaci guda, wanda ke barazanar rayuwa.

A pH na 6.9-7.0, 4 g na sodium bicarbonate an gabatar da shi (200 ml na maganin 2% a hankali a hankali a kan awa 1). Idan pH har ma da ƙananan, 8 g na sodium bicarbonate an gabatar da su (400 ml na maganin 2% na 2% a cikin 2 hours). Matsayin pH da potassium a cikin jini an ƙaddara kowace sa'o'i 2. Idan pH ya kasa da 7.0, to ya kamata a maimaita aikin gwamnati. Idan taro na potassium yana ƙasa da 5.5 meq / l, ƙarin 0.75-1 g na potassium chloride ya kamata a kara shi don kowane g 4 na sodium bicarbonate.

Idan ba zai yiwu a iya tantance alamun alamomin ƙasa ta acid ba, to, haɗarin daga gabatarwar kowane alkali “a makance” ya fi ƙarfin fa'ida. Ba'a ba da shawarar don samar da maganin shayar da soda ga marasa lafiya ba, ko dai don sha ko a hankali (ta dubura). Hakanan babu buƙatar shan ruwan alkaline na ruwa. Idan mai haƙuri zai iya sha da kansa, to shayi mara kyau ko ruwa mara kyau ya dace.

Ayyukan marasa mahimmanci

Ya kamata a samar da isasshen aikin numfashi. Tare da pO2 da ke ƙasa 11 kPa (80 mmHg), an wajabta maganin oxygen. Idan ya cancanta, za a ba wa maraƙin cikin babban ɗakin ɗakin ɗakin ɗakin baƙin ciki. Game da asarar hankali - kafa bututu na ciki don ci gaba da fata (yin famfo) na abinda ke ciki. Hakanan ana saka catheter a cikin mafitsara don samar da cikakken ƙididdigar ma'aunin sa'a na ma'aunin ruwa.

Ana iya amfani da ƙananan allurai na heparin don hana ƙwaƙwalwar jini. Manuniya ga wannan:

• shekarun tsufa na haƙuri;
• coma mai zurfi;
• bayyana hyperosmolarity (jini yayi kauri sosai) - fiye da masallacin 380 / l;
• haƙuri yana ɗaukar magungunan zuciya, maganin rigakafi.

Dole ne a wajabta maganin ta rigakafi na rigakafi, koda kuwa ba a samo asalin kamuwa da cuta ba, amma zafin jiki yana sama. Saboda hauhawar jini (zazzabi) a cikin ketoacidosis mai ciwon sukari koda yaushe yana nufin kamuwa da cuta.

Ketoacidosis mai ciwon sukari a cikin yara

Ketoacidosis masu ciwon sukari a cikin yara yawanci yakan faru ne a karo na farko idan basu iya gano cutar sukari irin ta 1 a lokaci ba. Kuma sau da yawa na ketoacidosis ya dogara da yadda za a bi da hankali da lura da ciwon sukari a cikin matashi mai haƙuri.

Kodayake ketoacidosis a cikin yara ana ɗaukarsa alama ce ta nau'in ciwon sukari na 1, har ila yau, yana iya haɓaka cikin wasu matasa masu fama da ciwon sukari na 2. Wannan sabon abu ya zama ruwan dare tsakanin yara 'yan Spain da ke fama da cutar sankara, kuma musamman a tsakanin Barorin Amurkawa.

An gudanar da binciken ne akan matasa Ba-Amurkan da ke dauke da ciwon sukari na 2. Ya juya cewa a lokacin bayyanar cutar, 25% daga cikinsu suna da ketoacidosis. Bayan haka, suna da hotonan kwantar da hankali game da ciwon sukari na 2. Masana kimiyya har yanzu basu gano dalilin wannan sabon al'amari ba.

Bayyanar cututtuka da lura da ketoacidosis na ciwon sukari a cikin yara daidai yake da na manya. Idan iyaye suka sa ido a kan yaransu a hankali, za su sami lokacin ɗaukar mataki kafin ya faɗi cikin cutar sankarau. Lokacin da aka tsara adadin insulin, saline da sauran magunguna, likita zaiyi gyare-gyare don nauyin jikin yaron.

Sharuddan nasara

Sharuɗɗa don warwarewa (ingantacciyar magani) na ketoacidosis na ciwon sukari sun haɗa da matakin sukari na jini na 11 mmol / L ko ƙananan, kazalika da gyara aƙalla biyu daga cikin abubuwanda ke nuna yanayin acid-base. Ga jerin wadannan alamomin:

• magani bicarbonate> = 18 meq / l;
• venous jini pH> = 7.3;
• bambancin anionic <= 14 meq / l;

Labarin ya ba da cikakken bayani game da abubuwan da ke haifar da, alamu da magani na ketoacidosis masu ciwon sukari, ciki har da yara. Hanya mafi kyau don hana wannan cuta ta cutar ciwon suga ita ce ilimantar da mara lafiya. Ketoacidosis a cikin yara yawanci yakan faru ne idan likita ya dauki alamun ciwon sukari na wasu cututtuka. Sabili da haka, yana da mahimmanci ga likitoci da iyaye su tuna jerin alamun bayyanar cututtuka. Muna fatan wannan labarin ya kasance da amfani ga masu ciwon sukari, da ƙaunatattun su, har ma da likitoci.