Lokacin da take hakkin ya faru a cikin metabolism, yanayi ya haɓaka, tare da wasu alamomi masu ba da daɗi. Dakatar da su ba bisa ka'ida ba a wasu yanayi har ma yana kai ga mutuwa.
Hakanan irin waɗannan rikice-rikice na iya faruwa tare da gazawa a cikin metabolism metabolism, wanda ke faruwa yayin ciwon sukari. Sau da yawa tare da irin wannan cuta, babban adadin glucose yana tarawa a cikin jiki, wanda ke haifar da bayyanar cututtukan hyperglycemia. Wannan halin shine halayyar ciwon sukari na 2.
Kuma a cikin marasa lafiyar da ke dogara da insulin, yawan jini yana faruwa, wanda yawan haɗuwar glucose a cikin ganyayyaki yana raguwa sosai. Idan ba a daidaita matakin sukari ba a cikin tsararren lokaci, to cutar tarin ƙwaƙwalwar ƙwayar cuta za ta haɓaka - yanayin yanayin da ke faruwa lokacin da ƙananan abun da ke cikin carbohydrate ya isa matakan mahimmanci.
Hadarin wannan rikicewa shine yana iya haifar da rikicewar ƙwayar cuta, haɓaka da ciwon ciki. A cikin nau'in haɗarin da ke ƙara haɗari sune marasa lafiya waɗanda ke da rikice-rikice a cikin tsarin jijiyoyin jini, wanda ƙananan matakan sukari na iya haifar da bugun jini, basur na ciki da myocardium. Sabili da haka, yana da mahimmanci a san menene glycemic coma da hyperglycemia, da kuma yadda za a dakatar da waɗannan yanayin cikin sauri.
Abubuwan Cuba na Ciwon Mara
Sau da yawa glycemic coma na faruwa idan kashi na insulin ba daidai bane. Hakanan, abubuwan da ke haifar da mummunan lalacewa a cikin lafiyar lafiyar masu ciwon sukari na iya kwanciya a cikin rashin abinci mai kyau na sulfonylurea da cin zarafin abinci na carbohydrate.
M, ciwon sukari da hypoglycemic coma haɓaka a cikin marasa lafiyar da ke fama da insulin tare da nau'ikan kamuwa da cutar siga. Haka kuma, a wannan yanayin, ba shi yiwuwa a gano wani abinda ya shafi na waje wanda ya karu da hankalin mutum zuwa insulin.
A wasu halayen, mummunan lalacewa na iya haifar da:
- maye na jikin mutum;
- aiki mai ƙarfi na jiki;
- azumi.
Abubuwan da ke haifar da cutar sune rikice-rikice da ke tattare da cututtukan sukari. Waɗannan sun haɗa da rashin aiki na hanji, koda, hanta da cututtukan endocrine.
Amma a mafi yawan lokuta, hypoglycemia yana faruwa ne lokacin da aka wuce yawan aikin insulin. Wannan yana faruwa lokacin da aka ƙididdige yawan magungunan ba daidai ba ko kuma idan an gudanar dashi ba daidai ba (intramuscularly).
Hakanan, raguwa mai yawa a cikin sukari na iya tsokani ta hanyar rashin yawan ƙwayar carbohydrate bayan gudanar da insulin mai laushi. Wani dalili shine aiki na jiki ba tare da ƙarin amfani da abinci cikin sauri ba.
Bugu da kari, wasu masu ciwon sukari, don hanzarta aiwatar da aikin insulin, suna tausa wurin allurar da kwayoyin, wanda yawanci yakan haifar da zubar jini. Wani coma na glycemic na iya haɓaka a irin waɗannan halaye:
- barasa
- farkon haihuwa;
- katsewa daga hadaddiyar insulin-antibody, wanda ke ba da gudummawa ga sakin hormone mai aiki;
- mai cutar hanta;
- girgiza insulin da aka yi amfani da shi a cikin tabin hankali;
- kisan kai abubuwa da ƙari.
Hakanan, hypoglycemia na iya haɓaka tare da yawan ƙwayar insulin, lokacin da aka cire mai ciwon sukari daga cikin ketoacidotic coma. Wannan yanayin yana faruwa tare da rashi na hormone.
Don haka, ana yin rikodin sukari na jini wanda ba a rage shi idan yana aiki da glucose da rushewar glycogen daga abubuwan da ba su da ƙwayoyi a cikin hanta ba su rama adadin kuzarin glucose. Coma mai ciwon sukari shima yana haɓaka lokacin da aka fitar da glucose daga ƙwayar hanzari fiye da yadda hanta ke aiki dashi ko hanjin hanji.
Abin lura ne cewa sulfonamides ba sa yawan haifar da ƙwaƙwalwar ƙwayar cuta. Sau da yawa bayan ɗaukar wannan rukuni na kwayoyi, yana bayyana a cikin tsofaffi masu ciwon sukari waɗanda ke da zuciya, koda, ko gazawar hanta.
Bugu da ƙari, yin amfani da sulfonamides tare da wasu kwayoyi (salicylates, acetylsalicylic acid) na iya ba da gudummawa ga farkon ƙwayar cuta.
Wannan haɗin yana haifar da gaskiyar cewa sunadaran plasma sun ɗaure sulfonamides, fitowar su a cikin fitsari ya ragu, saboda abin da ya dace da yanayin don yanayin bayyanarwar ƙin jini.
Symptomatology
Cutar cututtukan cututtukan cututtukan cututtukan jini suna da alaƙa da yawa. Sabili da haka, yana yiwuwa a gano daidai da nau'in sa tare da taimakon binciken likita da gwaje-gwaje na dakin gwaje-gwaje. Abubuwan da aka fara bayyana sun hada da:
- amo da haushi a cikin ciwon suga;
- matsananciyar ƙishirwa;
- amai da tashin zuciya;
- malaise;
- karancin ci;
- asarar hankali;
- urination akai-akai
- nutsuwa
- ƙwayar damuwa.
Cutar cutar siga mai saurin kamuwa da cuta ana bayyana ta ta hanyar lalacewa, rashin amsawa ga motsawar da nuna rashin damuwa ga abin da ke faruwa.
Hoto na asibiti tare da hypoglycemic coma ya ɗan bambanta da yanayin ketoacidotic da hyperglycemic dauki. Akwai matakai guda 4 na karancin sukari na jini, wanda ya haɗu da hypoglycemia wanda ke gudana cikin coma.
A farkon matakin, hypoxia na sel mai juyayi na tsakiya, wanda ya hada da cortex na cerebral, yana faruwa. Sakamakon haka, mai haƙuri ya zama mai yawan farin ciki ko baƙin ciki kuma yanayinsa ya canza. Rashin rauni na tsoka, ciwon kai, tachycardia, yunwa da hyperhidrosis suma suna bayyana.
A cikin kashi na biyu na rage yawan glucose a cikin tsintsiya, an lura da tsananin zagi, diplopia, tashin hankali da hauhawar fuskar fuska. Hakanan, mai haƙuri yana fara yin la'akari da kansa ba daidai ba.
A mataki na uku, malfunctions na midbrain suna ba da gudummawa ga haɓaka sautin tsoka da kuma bayyanar maƙogwaro. A lokaci guda, tachycardia, sweating da hauhawar jini suna ƙaruwa. Pupilsaliban mai haƙuri suna diate, yanayinsa duka yana kama da amai na kwance.
Mataki na huɗu shine ƙwaƙwalwar jini, wanda ke tare da ɓarna daga cikin ɓangarorin kwakwalwa na sama. Bayyananun na asibiti:
- karuwar zuciya;
- asarar hankali;
- tachycardia;
- gumi
- pupilsan makaranta
- karamin karuwa a cikin zafin jiki;
- kunnawar jijiyoyin da kuma raunin jiki.
Rashin aiki a cikin ƙwayar cuta na iya haifar da mutuwa sakamakon cututtukan ƙwaƙwalwar ƙwayar cuta. Alamar sa sune rikicewar zuciya, zazzabi, amai, gazawar numfashi da kuma bayyanar cututtuka na meningeal.
Hypoglycemia na iya ba da gudummawa ga ci gaban tasirin dogon lokaci da tasirin halin yanzu. Rikice-rikice na halin yanzu ya haifar a cikin sa'o'i biyu na farko bayan rage darajar sukari. An bayyana wannan ta hanyar infarction na zuciya (myocardial infarction), aphasia, malfunctions a cikin gudanawar cerebral.
Kuma rikitarwa na dogon lokaci yana faruwa bayan kwanaki 2-3 ko ma watanni da yawa. Waɗannan sun haɗa da cututtukan fata, da ƙwayar cuta, da kuma encephalopathy.
Diagnostics da taimakon farko
Don gano kowane nau'in coma a cikin ciwon sukari na mellitus, ban da kasancewar alamun rikice-rikice da gwajin likita, gwaje-gwajen dakin gwaje-gwaje wajibi ne. A saboda wannan dalili, ana ɗaukar jini da fitsari daga haƙuri ga janar da nazarin halittu, kuma ana yin gwajin taro na glucose.
Yawancin coma an san shi ta hanyar wuce haddi na glucose a cikin jini (fiye da 33 mmol / l) da fitsari. Tare da ketoacidosis, ana gano ketone a cikin fitsari, a cikin yanayin hyperosmolar coma, an lura da haɓakar osmolality plasma (fiye da 350 na masallaci / l), tare da hyperlactacidemia an gano ƙwayar cutar lactic acid.
Amma gwaje-gwaje na hypoglycemia yana nuna raguwa mai ƙarfi a cikin matakin sukari a cikin jini. A wannan yanayin, yawan ƙwayar glucose ba shi da ƙasa mil mm 1.5 a kowace lita.
Don hana gycemic coma daga ci gaba, masu ciwon sukari suna buƙatar taimakon farko da dacewa a cikin coma. Ya ƙunshi da yawa daga cikin wadannan ayyuka:
- Kiran motar asibiti.
- Yakamata a dage mai haƙuri a gefenta don kada yayi shayin.
- Idan ya cancanta, cire tarkace abinci daga bakin.
- Idan za ta yiwu, to, yin amfani da glucometer auna matakin sukari.
- Idan mai haƙuri yana jin ƙishirwa, ya kamata ka sha shi.
- An haramta allurar insulin ba tare da gwajin jini ba.
Idan amintaccen abu ne sananne cewa dalilin ci gaban ƙira yana kasancewa a cikin ƙarancin glucose, to mai haƙuri ya kamata ya sha shayi mai sauƙin ko ruwa. Zai fi kyau a sha mai haƙuri tare da tablespoons.
Mai dadi, musamman maɗaukakar maciji, masu ciwon sukari bashi da kyau. Bayan haka, za a iya tunawa da abinci mai ƙarfi sosai fiye da mafita na ruwa. Haka kuma, yayin shan sinadarin carbohydrates a wannan hanyar, mutum na iya cishi a kansa ko kuma ya rasa hankali.
Amma idan mai haƙuri yana cikin yanayin rashin sani, to ya kamata ku ba shi mafita mai dadi. Bayan duk wannan, ruwa na iya shiga jijiyoyin numfashi, wannan shine dalilinda zai shaƙewa.
A gaban glucagonate, ana ba mutum 1 cikin maganin farin jini tare da 1 ml na mafita a cikin ciki ko a ƙarƙashin ƙasa.
Jiyya da rigakafin
Marasa lafiya da alamun cutar sankarau na asibiti cikin gaggawa a cikin rukunin kulawa mai zurfi. Don ganewar asali, ana yin insulin (ba fiye da raka'a 10-20 ba) ga masu ciwon sukari kafin sufuri. Sauran hanyoyin warkewa ana yin su ne a asibiti.
Idan sanadin rashin wadatarwar shine rashin glucose, to 20-100 ml na maganin glucose (40%) ana allurar dashi cikin mara lafiyar. A cikin mawuyacin yanayi, intravenous ko intramuscularly ana gudanar da glucocorticoids ko glucagon. Hakanan, a ƙarƙashin fata, zaku iya shigar da maganin adrenaline (0.1%) a cikin adadin 1 ml.
Don hana haɓakar haɓakar maye, an wajabta mai haƙuri a matsayin maganin glucose a cikin ƙwayoyin sodium. Tare da kwayar cutar daji mai tsawo, ana amfani da Mannitol.
Rashin kula da gaggawa ba ya dogara da kunna aiki na metabolism ba. A saboda wannan dalili, an nuna mai haƙuri a cikin / m na Cocarboxylase (100 MG) da kuma maganin ascorbic acid (5 ml). Bugu da kari, an baiwa mara lafiya iskar oxygen kuma an sanya masa magunguna wadanda ke tallafawa aikin tsarin zuciya.
Yana da mahimmanci a lura cewa tare da hypoglycemic coma, insulin ba za a iya amfani dashi ba. Tunda hakan zai kara tsananta rikice-rikice, wanda hakan kan haifar da mutuwa.
Koyaya, idan an kamu da cutar sankara ta hanta, to, akasin haka, an nuna masa insulin a cikin allurai. Bugu da ƙari, ana sarrafa sodium bicarbonate da NaCl ga mai haƙuri.
A yayin cutar sankara, matsaloli suna tasowa tare da tasoshin jini, zuciya da na waje, wanda ke rage jinkirin shan kwayoyi daga ƙwayar subcutaneous. Sabili da haka, kashi na farko na kashi na insulin an allura cikin ciki.
Tsofaffi masu ciwon sukari suna da babban hadarin rashin wadataccen bugun jini. Daga wannan ya biyo cewa ana iya kulawa dasu sama da 100 NA BIYU na insulin. Hakanan, ana rage adadin kashi na hormone idan mai haƙuri yana cikin precom.
Yin rigakafin ci gaban glycemic coma shine:
- kin yarda da jaraba;
- daidai tsarin yau da kullun;
- sarrafa yawan tattarawar sukari a cikin jini;
- maganin rage cin abinci, tare da iyakantaccen ci na carbohydrates mai sauri.
Haka kuma, mai haƙuri dole ne ya riƙa ɗaukar kuɗaɗen da ke rage sukari a cikin ainihin maganin da likita ya umarta. Yakamata yakamata ya bincika alamun cutar gudawa kuma, idan cutar sikari, suna da ƙwayoyin narkewa cikin sauri.
Idan mai ciwon sukari yana iya haifar da raguwar ƙwayar cuta a cikin ƙwayar plasma, to za a iya ƙara yawan glucose na yau da kullum zuwa 10 mmol / L. Wannan wuce haddi mai yiwuwa ne idan akwai wani abu game da kasawa a cikin aikin jijiyoyin hannu da kuma rashin wadatar zuciya.
Game da shan kwayoyi da yawa (tetracyclines, anticoagulants, salicylates, beta-blockers, anti-tarin fuka), yana da mahimmanci a hankali saka idanu akan yawan sukari. Bayan haka, irin waɗannan kwayoyi suna kunna samar da insulin kuma suna da tasirin hypoglycemic.
Don hana ƙwayar cuta ta glycemic, abincin yau da kullun ya kamata ya haɗa da furotin (50%), carbohydrates masu rikitarwa da fats. Haka kuma, abinci mai narkewa (sau 8 a rana) in banda kayan yaji, ana shawarar bada karfi da shayi. Hakan yana da mahimmanci a daina shan giya da sigari.
A cikin bidiyon a cikin wannan labarin, likita zai yi bayani dalla-dalla ga kowane nau'in cutar sankarau kuma yana ba da shawarwari don taimakon farko.
