Alamun cutar ketoacidosis na ciwon sukari kuma me yasa yake da haɗari

Idan ba'a kula da ciwon sukari ba, zai iya haifar da rikitarwa da yawa wanda zai iya haifar da rauni ba kawai, har ma da mutuwar mai haƙuri. Ketoacidosis mai ciwon sukari yana ɗayan mummunan haɗari na rashi na insulin, wanda zai haifar da mutum cikin coma a cikin kwanakin.

A cikin 20% na lokuta, ƙoƙarin likitoci don cirewa daga koko ba shi da amfani. Mafi sau da yawa, ketoacidosis yana faruwa a cikin marasa lafiya da masu ciwon sukari tare da mummunan rauni na aikin pancreatic, waɗanda aka wajabta insulin ta hanyar allura. Koyaya, masu ciwon sukari nau'in 2 na iya shan wahala sosai daga wannan rikitarwa idan suka fara cin zarafin shaye-shaye ko kuma kwace magunguna masu rage yawan sukari.

Menene ketoacidosis mai ciwon sukari

Kalmar "acidosis" ta fito daga Latin "acidic" kuma yana nufin raguwa a cikin pH na jiki. Prefix "keto" yana nuna cewa karuwa cikin acidity ya faru ne saboda karuwa a cikin taro na jikin ketone a cikin jini. Bari muyi dalla-dalla dalla dalla abin da ya sa wannan ke faruwa da yadda ciwon sukari mellitus ke shafar ma'aunin acid-base.

A cikin metabolism na yau da kullun, babban tushen samar da makamashi shine glucose, wanda ake samarwa kowace rana tare da abinci a matsayin carbohydrates. Idan bai isa ba, ana amfani da ajiyar glycogen, wanda aka adana a cikin tsokoki da hanta kuma yana aiki a matsayin nau'i na depot. Wannan wurin ajiya yana da ikon buɗewa da sauri kuma yana yin rashin rashin glucose na ɗan lokaci, yana ɗaukar adadin a rana ɗaya. Lokacin da glycogen kantuna suka yanke, ana amfani da adon mai. Kayan mai yana karyewar glucose, yana fitowa a cikin jini kuma yana ciyar da kashin jikinsa. Lokacin da ƙwayoyin mai ke rushewa, ana kirkiro sassan ketone - acetone da keto acid.

Ciwon sukari da hauhawar jini zai zama abin da ya wuce

• Normalization na sukari -95%
• Cirewa kan jijiyoyin mara wuya - 70%
• Cire zuciyar mai karfin zuciya -90%
• Rabu da cutar hawan jini - 92%
• Increasearuwar kuzarin rana, inganta bacci da dare -97%

Mun haɗu da samuwar acetone a cikin jiki sau da yawa: yayin asara mai nauyi, ƙwaƙwalwar motsa jiki, yayin cin abinci mai kima, maras nauyi. A cikin mutum mai lafiya, wannan tsari ba shi da kulawa, kodan ya cire lokacin cire ketones daga jiki, ba a lura da maye da pH motsi.

Tare da ciwon sukari, ketoacidosis yana faruwa da sauri kuma yana haɓaka da sauri. Ko da tare da isasshen ƙwayar glucose, ƙwayoyin suna cikin gajeru. Anyi bayanin wannan ta rashin cikakken insulin ko kuma rashi mai ƙarfi, saboda insulin shine yake buɗe ƙofar glucose a cikin tantanin. Split glycogen da kantin mai ba su da ikon inganta yanayin, sakamakon glucose ne kawai ke haifar da hyperglycemia a cikin jini. Jikin, yana ƙoƙarin shawo kan rashin abinci mai gina jiki, yana haɓaka fashewar fats, taro na ketones yana haɓaka da sauri, ƙodan ya daina shawo kan cirewar su.

Halin yana da rikitarwa ta hanyar osmotic diuresis, wanda ke faruwa tare da sukari mai yawa na jini. Andarin yawa da fitsari ke keɓe, bushewar ruwa ke tasowa, ƙwayoyin lantarki sun ɓace. Lokacin da yawan ƙwayar intercellular ta faɗi saboda karancin ruwa, kodan sun rage samuwar fitsari, glucose da acetone su kasance a jiki a cikin adadin mai yawa. Idan insulin ya shiga cikin jini, zai zama da wahala a gare shi ya cika aikinsa, kamar yadda insulin juriya yake tasowa.

Yawan acidity na jini kusan 7.4, digo cikin pH ya riga ya koma 6.8 ya sa rayuwar mutum ba ta yiwuwa. Ketoacidosis a cikin ciwon sukari na iya haifar da irin wannan raguwa a cikin kwana ɗaya kawai. Idan ba ku fara jiyya a kan lokaci ba, mai haƙuri tare da ciwon sukari yana haɓaka yanayin rashin nuna damuwa, nutsuwa, sai a koma can cikin cutar sankarau da kuma mutuwa.

Acetone a cikin fitsari da ketoacidosis - bambance-bambance

Kamar kowane mutane masu lafiya, marasa lafiya da ciwon sukari mellitus lokaci-lokaci suna fuskantar al'ada, "ketoacidosis" mai jin yunwa ". Mafi sau da yawa, yana faruwa ne a cikin ƙananan yara masu bakin ciki ko lokacin da suke cin abinci tare da ƙuntatawa na carbohydrates. Tare da isasshen adadin ruwa da glucose a cikin jini a cikin kewayon al'ada, jiki yana sarrafa kansa don kiyaye daidaituwa - yana cire jikin ketone ta amfani da kodan. Idan a wannan lokacin kuna amfani da tsararren gwaji na musamman, zaku iya gano kasancewar acetone a cikin fitsari. Wani lokacin fushin sa yakan ji sanyi a cikin iska. Acetone yana zama haɗari ne kawai tare da yanayin rashin ruwa, wanda zai iya faruwa tare da isasshen ruwan sha, matsanancin rashin ƙarfi, zawo mai zafi.

Acetone a cikin fitsari tare da ciwon sukari ba dalili bane don dakatar da abinci mai ƙarancin carb. Haka kuma, a wannan lokacin, kuna buƙatar kulawa da sukari na jini a hankali. Anaruwar yawan glucose a saman 13 mmol / L yana haifar da haɓakar haɓakar kamuwa da cutar ketoacidosis.

Janar mulki: gano acetone a cikin fitsari na buƙatar magani kawai tare da bushewa da ciwon suga. Yin amfani da tsaran gwajin ba koyaushe ba ma'ana. Yarda da abinci da aka tsara, tsarin sha na yau da kullun, shan kwayoyi na lokaci da kuma kula da sukari akai-akai tare da glucoeter yana rage haɗarin cutar ketoacidosis.

Sanadin cutar

Ketoacidosis yana haɓaka a cikin nau'in 1 da nau'in ciwon sukari na 2 wanda kawai ba shi da babban rashin insulin, wanda ke haifar da karuwa sosai a cikin glucose jini.

Wannan halin yana yiwuwa a cikin halaye masu zuwa:

1. Har yanzu ba a gano cutar sukari ba, ba a gudanar da magani. Za a gano nau'in 1 na ciwon sukari a cikin kashi ɗaya cikin uku na lokuta kawai lokacin da ketoacidosis ya faru.
2. Halin nuna kulawa ga shan kwayoyi - ƙididdigar sashi mara daidai, ƙirar insulin injections.
3. Rashin ilimin a cikin haƙuri tare da ciwon sukari mellitus yadda za a ƙididdige yawan adadin kuma gudanar da insulin.
4. Ciki da guba mai guba, wanda ke bayyane ta hanyar lalataccen vomiting.
5. Rashin tausayi a cikin nau'in ciwon sukari na 2 don canzawa zuwa insulin, lokacin da ƙwayar hanji ta rasa aikinta, kuma magungunan rage sukari sun zama kasa.
6. Yin amfani da maganin cututtukan fata na gargajiya ba tare da kula da sukari na jini ba.
7. Errorsarin kurakurai masu mahimmanci a cikin abincin - yawan adadin carbohydrates mai sauri, tsawon lokaci tsakanin abinci.
8. Ayyukan tiyata, raunin da ya faru, mummunan cututtuka, raunin huhu da tsarin urogenital, bugun zuciya da bugun jini, idan ba a sanar da likita game da cutar sankara ba kuma bai kara yawan magunguna akan lokaci ba.
9. Rashin lafiyar kwakwalwa, shan giya, hana karbar isasshen ilimin cututtukan zuciya.
10. Katse insulin don dalilai na kashe kansa.
11. Amfani da insulin karya ko karewa, ajiya mara kyau.
12. Lalacewa ga glucometer, alkalami insulin, famfo.
13. Adana magunguna waɗanda ke rage ƙarfin insulin, alal misali, maganin tari.
14. Shan magungunan - insulin antagonists (corticosteroids, diuretics, hormones).

Bayyanar cututtuka na ketoacidosis a cikin ciwon sukari

Ketoacidosis yawanci yana tasowa a cikin kwanaki 2-3, tare da hanya mara kan gado - a rana. Bayyanar cututtukan cututtukan cututtukan cututtukan ƙwayar cuta na ketoacidosis suna ƙaruwa da haɓakar hauhawar jini da haɓakar rikice-rikice na rayuwa.

Hanyoyin bincike na DC

Gano cutar kowane cuta ta fara ne da tarihin likita - fayyace yanayin rayuwar mai haƙuri da kuma cututtukan da aka gano a baya. Ketoacidosis na masu ciwon suga ba ya banbanta. An tabbatar da kasancewar ciwon sukari, nau'ikansa, tsawon lokacin cutar, magunguna da aka tsara da kuma lokacin gudanarwar su. Har ila yau, an bayyanar da kasancewar cututtukan da ke tattare da cututtukan da ke haifar da haɓakar ci gaban ketoacidosis.

Mataki na gaba na ganewar asali shine binciken haƙuri. Alamun farko da aka gano na rashin ruwa, ƙanshi na acetone, jin zafi lokacin danna kan bangon gaban ciki shine dalilin zargin ci gaban ketoacidosis mai ciwon sukari. Abubuwan haɗari har ila yau sun haɗa da bugun jini akai-akai da karancin jini, rashin wadataccen amsar tambayoyin likita.

Bayanai na asali game da canje-canje a cikin jiki yayin ketoacidosis ana bayar da shi ta hanyoyin dakin gwaje-gwaje don nazarin fitsari da jini. A kan aiwatar da binciken an ƙaddara:

1. Glucose a cikin jini. Idan mai nuna alama ya fi girma 13.88 mmol / L, ketoacidosis yana farawa, lokacin da aka kai 44, yanayin da ake ciki yana faruwa - gwajin jini don sukari.
2. Jikin Ketone a cikin fitsari. An gudanar da binciken ne ta amfani da tsiri mai gwaji. Idan fitsari ya riga ya faru kuma ba'a fitar da fitsari ba, ana amfani da jijiyar jini zuwa tsiri don bincike.
3. Glucose a cikin fitsari. An ƙaddara yayin babban binciken fitsari. Wuce matakin 0.8 mmol / L yana nufin cewa glucose na jini ya fi 10 girma, kuma wataƙila ketoacidosis mai ciwon sukari.
4. Urea jini. Karuwancin yana nuna rashin ruwa da kuma aiki na koda.
5. Amylase a cikin fitsari. Wannan enzyme da ke tattare da rushewar carbohydrates, ɓoye fitsarinsa. Idan aikin amylase ya wuce 17 u / h, haɗarin ketoacidosis yana da girma.
6. Osmolarity na jini. Yana bayanin abubuwan da ke cikin jini na mahallin daban-daban. Tare da ƙara matakan glucose da ketones, osmolarity kuma yana ƙaruwa.
7. Wutar lantarki a cikin jini. Arin raguwar matakan sodium da ke ƙasa 136 mmol / l yana nuna rashin ƙarfi na nama, ƙaruwar diuresis a ƙarƙashin rinjayar hyperglycemia. Ana lura da ƙwayar potassium fiye da 5.1 a farkon matakan ketoacidosis, lokacin da ions potassium suka fita daga sel. Tare da ƙara yawan bushewa, matakin potassium ya faɗi ƙasa da ƙimar al'ada.
8. Cholesterol na jini. Babban matakin sakamako ne sakamakon kasawa na rayuwa.
9. Bicarbonates na jini. Abubuwa ne na alkaline waɗanda ke aiki a matsayin mai ɗaukar kaya a cikin jiki - mayar da pH na al'ada na jini yayin da aka kwantar da shi tare da jikin ketone. A cikin ketoacidosis na mai ciwon sukari, bicarbonates ya yanke, kuma kare ya daina aiki. Ragewa daga matakin bicarbonates zuwa 22 mmol / l yana nuna farkon ketoacidosis, matakin ƙasa da 10 yana nuna babban matakinsa.
10. Tazara na Anionic. An lasafta shi azaman bambanci tsakanin cations (yawanci ana kirkiri sodium) da anions (chlorine da bicarbonates). A yadda aka saba, wannan tazara tana gab da sifili, tare da ketoacidosis yana ƙaruwa saboda tarin keto acid.
11. Man gas. Rage matakin carbon dioxide a cikin jini na jijiya yana faruwa ne don rama acidity na jini, yayin da jiki ke ƙoƙarin canza pH zuwa gefen alkaline. Rashin carbon dioxide mai rauni yana shafar bayar da jini zuwa kwakwalwa, wanda ke haifar da tsananin damuwa da asarar hankali.

Hakanan ana gudanar da bincike na musamman - cardiogram don gano ƙarancin ciki a cikin zuciya, kuma musamman yanayin prear infarction, kazalika da x-ray na gabobin kirji don gano yiwuwar kamuwa da cututtukan huhu.

Hadaddun waɗannan ƙididdigar da nazarin suna ba da cikakken hoto na canje-canje da ke faruwa a cikin mai haƙuri kuma yana ba ka damar tsara magani wanda ya isa daidai da tsananin cutar. Tare da taimakon bincike, ana aiwatar da bambanci na ketoacidosis na masu ciwon sukari tare da sauran yanayin masu kama.

Jiyya mafi mahimmanci

Haɓaka ketoacidosis alama ce ta asibiti mai gaggawa. An fara amfani da warkarwa a gida ta hanyar allurar kansa ta cikin insulin gajeran aiki. Lokacin hawa cikin motar asibiti, an sanya dropper don yin asarar sodium. Kulawa da cutar ketoacidosis mai saurin kamuwa da cuta ya faru ne a sashen warkewar, jihar precomatous tana buƙatar sanya wuri cikin kulawa mai zurfi. A asibiti, ana yin duk gwaje-gwaje masu mahimmanci kai tsaye, kuma ana bincika glucose, potassium da sodium kowace awa. Idan akwai mai nazarin gas a cikin sashen, kowane sa'a ana amfani dashi don karɓar bayani game da glucose, urea, electrolytes, da carbon dioxide a cikin jini.

Canjin Insulin

Ana amfani da insulin don kula da ketoacidosis a kowane yanayi, ba tare da la'akari da ko a baya an umurce shi da mai haƙuri da ciwon sukari na 2 ko yana da isassun magunguna don rage sukari. Sai kawai gabatarwar insulin daga waje zai iya kawar da sanadin cutar ketoacidosis mai ciwon sukari tare da nakuda wajen aiki, dakatar da canje-canje na rayuwa: dakatar da rushewar kitse da samuwar ketones, karfafa haɓakar glycogen a cikin hanta.

Idan ba a allurar insulin ba a lokacin jiyya ta gaggawa, lokacin da mai haƙuri ya shiga asibiti, lura da ketoacidosis yana farawa ta hanyar gudanar da jijiya na babban adadin insulin - har zuwa raka'a 14. Bayan irin wannan nauyin, ana bincika glucose a kai a kai don hana ci gaban hypoglycemia. Yakamata sukari jini yai yawa sama da 5 mmol / l a awa daya, don kar a tayar da daidaituwa tsakanin matsin lambar da ke cikin sel da kuma cikin tazara. Wannan yana da haɗari ta hanyar faruwa da yawa na edema, ciki har da a cikin tsarin kwakwalwa, wanda aka cika tare da saurin ƙwaƙwalwar ƙwayar cuta.

Nan gaba, yakamata a saka insulin a cikin kananan allurai har sai an samu raguwar glucose zuwa 13 mmol / l, wannan ya isa a cikin awa 24 na farko na magani. Idan mara lafiya bai ci abinci da kanshi ba, ana saka glucose a cikin insulin bayan ya kai ga wannan maida hankali. Ana buƙata don tabbatar da bukatun kuzarin ƙwayoyin cuta. Ba a son shi don gudanar da glucose a cikin wucin gadi na dogon lokaci, da zaran an sami mai juya shi zuwa wani abinci na yau da kullun tare da wajabta kasancewar dogayen carbohydrates a cikin abincin.

A cikin sakewa, insulin ya shiga cikin jinin mara lafiya ta hanyar jinkirin (daga raka'a 4 zuwa 8 a kowace awa) allurar cikin jijiya.Anyi wannan ta amfani da na'urar ta musamman - masu zartarwa, wanda nau'in famfo ne wanda yake ba ku damar shigar da kwayoyi tare da babban inganci. Idan dakin bai sanye da kayan ƙanshin ba, sannu a hankali ana shigar da insulin daga sirinji zuwa cikin bututu mai nutsuwa. Ba shi yiwuwa a zuba shi a cikin kwalbar, tunda wannan yana ƙara haɗarin adadin sashi da ba daidai ba da kuma sanya magani a cikin ganuwar ciki na tsarin jiko.

Lokacin da yanayin mai haƙuri ya inganta, sai ya fara cin abinci da kansa, kuma sukari jini ya tsaya cak, gudanar da aikin kwantar da hankali na insulin gajeren zango ya maye gurbinsu, sau 6 a rana. An zaɓi kashi ɗaya akayi daban-daban, gwargwadon glycemia. Sannan ƙara insulin "tsayi", wanda ke aiki na dogon lokaci. Bayan kwanciyar hankali, ana saki acetone na kimanin kwanaki 3, ba a buƙatar magani daban.

Gyara bushewa

Ana cire bushewar ruwa ta hanyar gabatarwar salim 0.9%. A cikin awa ɗaya na farko, ƙarfinsa bai wuce lita ɗaya da rabi ba, a cikin sa'o'in da suka biyo baya, gwamnatin ta rage jinkirin yin la'akari da samuwar fitsari. An yi imanin cewa saline ɗin da aka yiwa allurar yakamata kada ya wuce rabin lita ya wuce yawan fitsari da ƙodan ke kwance. Ana zubar da lita 8 na ruwa a kowace rana.

Idan hawan jini na sama ya ragu sosai kuma bai wuce 80 mmHg ba, ana yin zub da jini.

Maimaita rashi electrolyte

Rashin yawan ruwan soda ana biya shi yayin gyaran fitsari, tunda Saline shine sinadarinsa. Idan aka gano karancin potassium ta hanyar bincike, ana cire shi daban. Gabatar da potassium na iya farawa nan da nan bayan fitsari. Don wannan, ana amfani da potassium chloride. A cikin awa ɗaya na farko na maganin, ba fiye da 3 g na chloride ya kamata a saka ba, to, a hankali ana rage yawan kashi. Manufar shine a sami haɗakar jini aƙalla 6 mmol / L.

A farkon jiyya, matakan potassium zai iya faduwa, duk da maye gurbin asarar da aka yi. Wannan ya faru ne saboda gaskiyar cewa ya dawo cikin sel wanda ya bar a farkon ci gaban ketoacidosis mai ciwon sukari. Bugu da ƙari, tare da gabatarwar saline a cikin adadi mai yawa, rashin daidaituwa na diuresis yana ƙaruwa, wanda ke nufin asarar halitta na ƙwayoyin lantarki a cikin fitsari. Da zaran akwai isasshen potassium a cikin kyallen takarda, matakin sa a cikin jini zai fara haɓaka.

Normalization na jini acidity

A cikin mafi yawan lokuta, ana cire acid na jini a cikin yaki da hyperglycemia da rashin ruwa a jiki: insulin yana dakatar da samar da ketones, kuma yawan adadin ruwa yana ba ku damar sauri cire su daga jiki tare da fitsari.

Ba a bada shawarar alkinta jini ba saboda dalilai masu zuwa:

• rashin potassium da alli;
• insulin yana raguwa, ketones suna ci gaba da yin tsari;
• saukar karfin jini;
• karuwar yunwar oxygen ta kyallen takarda.
• mai yiwuwa karuwa a matakin acetone a cikin ƙwayar cerebrospinal.

Saboda dalilai iri ɗaya, ruwan sha na alkaline a cikin nau'in ruwan ma'adinai ko kuma maganin maganin yin burodi ba a sake ba shi izini ga marasa lafiya tare da ketoacidosis. Kuma kawai idan aka furta ketoacidosis mai ciwon sukari, acidity na jini ba ƙasa da 7 ba, kuma bicarbonates jini sun ragu zuwa 5 mmol / l, gudanarwar maganin kwantar da hankali na soda a cikin tsari na musamman na sodium bicarbonate na masu amfani da ruwa.

Sakamakon cutar

Sakamakon cutar ketoacidosis na ciwon sukari ya lalata dukkan tsarin jiki, daga kodan har zuwa hanyoyin jini. Don mayar da su, kuna buƙatar dogon lokaci, a lokacin da kuke buƙatar kiyaye sukari daidai.

Mafi yawan rikitarwa:

• farhythmia,
• cuta rikicewar jini a cikin gabar jiki da gabobin,
• gazawar koda
• raguwa mai ƙarfi a cikin matsin lamba,
• lahani ga tsoka,
• ci gaban mummunan cututtuka.

Babban mummunan sakamako shine ƙima mai laushi, wadda take kaiwa zuwa ga ƙwaƙwalwar hanji, riƙewar numfashi da bugun zuciya. Kafin kirkirar insulin, ketoacidosis a cikin ciwon sukari koyaushe yana nufin mutuwa ne mai kusa. Yanzu adadin mutuwar daga bayyanar ketoacidosis ya kai 10%, a cikin yara masu fama da cutar siga wannan shine mafi yawan dalilin rashin wucewa. Kuma ko da samun rashin lafiya sakamakon kokarin likitoci ba koyaushe yana nufin samun sakamako mai nasara bane. Sakamakon cututtukan mahaifa, wasu daga cikin ayyukan jikin sun lalace, ba daidai ba har zuwa lokacin da mara lafiya ya canza shi zuwa yanayin ciyayi.

Cutar ba ta zama alaƙa ta masu ciwon suga ba har ma da dakatar da samar da insulin. Amfani da magunguna na zamani na iya rage haɗarin ketoacidosis zuwa sifili da kuma sauƙaƙa sauran rikice-rikice na ciwon sukari.