Cutar Hyperosmolar a cikin ciwon sukari na mellitus (pathogenesis, magani)

Ofaya daga cikin mummunan cutar amma har yanzu ba a yi nazarin rikice-rikice ba game da ciwon sukari shine ƙwaƙwalwar jini hyperosmolar. Har yanzu dai akwai mahawara game da tsarin asalinsa da ci gabanta.

Cutar ba ta zama m ba, yanayin mai ciwon sukari na iya taɓar da makonni biyu kafin ɓacin rai na farko. Mafi yawan lokuta, laima yakan faru ne a cikin mutane sama da 50. Likitoci ba koyaushe ne ke iya yin madaidaicin bayyanar cututtuka ba tare da bayanin cewa mai haƙuri yana da ciwon sukari ba.

>> Cutar masu ciwon sukari - nau'ikansa da kulawa ta gaggawa da sakamakonsa.

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%

Mene ne coma hyperosmolar

Cutar hyperosmolar yanayi ne tare da asarar hankali da rashin ƙarfi a cikin dukkanin tsarin: farfadowa, aikin zuciya da bushewar fitsari, fitsari yana dakatar da kasancewa a keɓe. Mutum a wannan lokacin yana daidaita ma'aunin rai da mutuwa. Dalilin duk waɗannan rikice-rikice shine hauhawar jini, wato, haɓaka mai ƙarfi a cikin ɗimbinsa (fiye da masallacin 330 / l tare da ƙa'idar 275-295).

Ana nuna wannan nau'in coma ta hanyar glucose na jini, sama da 33.3 mmol / L, da kuma yawan zafin jiki. A lokaci guda, ketoacidosis ba ya nan - ba'a gano gawar ketone a cikin fitsari ta hanyar gwaje-gwaje ba, numfashin mai ciwon sukari baya jin ƙanshi na acetone.

Dangane da rarrabuwar ƙasa da ƙasa, an tsara cutar coperosmolar a matsayin cin zarafin ƙwayar gishiri-gishiri, lambar bisa ga ICD-10 shine E87.0.

Halin hyperosmolar yana haifar da rashin jin daɗi yayin da wuya; a cikin aikin likita, shari'ar 1 a cikin marasa lafiya 3300 a shekara tana faruwa. A cewar kididdigar, matsakaicin shekarun mai haƙuri yana da shekaru 54, yana rashin lafiya da rashin nau'in insulin-dogara da ciwon sukari na 2, amma ba ya kula da cutar tasa, sabili da haka, yana da rikitarwa masu yawa, ciki har da cutar cututtukan cututtukan zuciya tare da gazawar renal. A cikin kashi ɗaya bisa uku na marasa lafiya a coma, ciwon sukari yana tsawan lokaci, amma ba a gano shi ba, a saboda haka, ba a yi maganin sa ba duk wannan lokacin.

Idan aka kwatanta da coma ketoacidotic, cope din hyperosmolar yakan faru sau 10 kasa da yawa. Mafi sau da yawa, bayyanar sa ko da a wani mataki mai sauƙi ne masu ciwon sukari kansu ke dakatar da su, ba tare da ma lura da su ba - suna daidaita glucose na jini, suna fara shan ƙarin abubuwa, kuma suna komawa ga masanin ilimin ƙwayar cuta saboda matsalolin koda.

Dalilai na ci gaba

Hyperosmolar coma yana tasowa a cikin ciwon sukari na mellitus a ƙarƙashin rinjayar abubuwan da ke biyo baya:

1. Zazzabin rashin ruwa mai yawa sakamakon yawan konewa, yawan wucewar jiki ko tsawaita amfani da diuretics, guba da cututtukan hanji, wanda ke tattare da yawan amai da gudawa.
2. Rashin insulin saboda rashin yarda da abincin, yawan shan kwayoyi na rage sukari, mummunan cututtuka ko aikin motsa jiki, magani tare da magungunan hormonal wanda ke hana samar da insulin na kansa.
3. Rashin kula da ciwon sukari.
4. Kamuwa da cuta na dogon lokaci tare da kodan ba tare da kulawa mai kyau ba.
5. Hemodialysis ko glucose yayin da likitoci ba su san ciwon sukari ba a cikin mai haƙuri.

Pathogenesis

A farkon haila na hyperosmolar coma koyaushe yana tare da mummunan hyperglycemia. Glucose yana shiga cikin jini daga abinci kuma kullun hanta ke samar dashi, shigowar shi cikin kyallen takura yana rikitarwa saboda juriyawar insulin. A wannan yanayin, ketoacidosis bai faru ba, kuma ba a tabbatar da dalilin wannan rashi daidai ba. Wasu masu binciken sun yi imanin cewa nau'in kwayar cutar coma yana tasowa yayin da insulin ya isa ya hana fashewar fats da samuwar ƙwayoyin ketone, amma kaɗan kaɗan don murƙushe faɗuwar glycogen a cikin hanta don samar da glucose. Dangane da wani fasalin, sakin fatima mai narkewa daga tso adi nama ana takura shi ne sakamakon karancin kwayoyin hodar iblis a farkon cututtukan hyperosmolar - somatropin, cortisol da glucagon.

Changesarin canje-canje na cututtukan cututtukan cututtukan da ke haifar da ƙwaƙwalwar ƙwayar cuta hyperosmolar sananne ne. Tare da ci gaban hyperglycemia, ƙwayar fitsari yana ƙaruwa. Idan kodan yayi aiki na yau da kullun, to idan lokacin da aka wuce 10 mmol / L ya wuce, glucose zai fara zama cikin fitsari. Tare da aiki na nakasa mai lalacewa, wannan tsari ba koyaushe yake faruwa ba, sannan sukari ya tara a cikin jini, kuma yawan fitsari yana ƙaruwa sakamakon lalacewa mai narkewa a cikin kodan, bushewar fata farawa. Liquid yana barin sel da sarari tsakanin su, ƙara yawan zub da jini yana raguwa.

Sakamakon bushewar sel kwakwalwa, alamomin cututtukan zuciya suna faruwa; increasedara yawan coagulation na jini yana haifar da thrombosis, yana haifar da isasshen wadatar jini ga gabobin. Don magance rashin ruwa, samar da aldosterone na hormone yana ƙaruwa, wanda ke hana sodium isa ga fitsari daga jini, kuma hypernatremia yana haɓaka. Ita, bi da bi, tana tsokanar basur da kumburi a cikin kwakwalwa - kwaro na faruwa.

Alamomi da alamomin cutar

Haɓaka ƙwayar ƙwaƙwalwar ƙwayar cuta yana ɗauka zuwa mako biyu. Farawar canji ya samo asali ne sakamakon lalacewa a cikin diyya mai cutar siga, to alamu na rashin ruwa ya shiga. Aƙarshe, bayyanar cututtuka na jijiyoyi da sakamako na osmolarity na jini mai yawa ya faru.

Sakamakon gaskiyar cewa aikin dukkan gabobin an keta shi tare da cutar mahaifa, wannan yanayin ana iya rufe shi ta hanyar bugun zuciya ko alamomi masu kama da haɓakar kamuwa da cuta. Encephalopathy na rikice-rikice na iya kasancewa ana zaton shi saboda cututtukan ƙwayar mahaifa. Don hanzarta yin daidaitaccen ganewar asali, likita dole ne ya san game da ciwon sukari a cikin tarihin mai haƙuri ko a lokaci don gano shi bisa ga binciken.

Abubuwan bincike masu mahimmanci

Bayyanar cututtuka ya danganta da bayyanar cututtuka, gwaje-gwajen dakin gwaje-gwaje, da ciwon sukari. Duk da gaskiyar cewa wannan yanayin ya zama ruwan dare a cikin tsofaffi waɗanda ke da nau'in cuta na 2, ƙwayar hyperosmolar na iya haɓaka a cikin nau'in 1, ba tare da la'akari da shekaru ba.

Yawancin lokaci, ana buƙatar cikakken bincike na jini da fitsari don yin bincike:

Don gano yadda zuciyar ta lalace, kuma ko za ta iya juriya da farfadowa, an yi ECG.

Algorithm na gaggawa

Idan mai ciwon sukari ya suma ko kuma yana cikin yanayin rashin isa, abu na farko da yakamata ayi shine a kira motar asibiti. Za'a iya ba da kulawa ta gaggawa don maganin cutar hyperosmolar kawai a cikin sashin kulawa mai zurfi. Da sauri za a isar da marassa lafiya zuwa can, yayin da ya samu damar rayuwa, mafi karancin gabobi zasu lalace, kuma zai iya murmurewa da sauri.

Yayin jiran jiran motar asibiti:

1. Sanya mara lafiya a gefen sa.
2. Idan za ta yiwu, kunsa ta don rage asarar zafi.
3. Saka idanu numfashi da palpitations, idan ya cancanta, fara numfashin wucin gadi da kuma tausawar zuciya kai tsaye.
4. Auna sukari na jini. Idan ya kasance mai karfin wuce haddi, yi masa allurar gajere. Ba za ku iya shiga insulin ba idan babu glucoseeter kuma glucose din data babu, wannan aikin na iya tayar da mutuwar mai haƙuri idan yana da cutar tarin fuka.
5. Idan akwai dama da gwaninta, sanya ayaba tare da ruwan gishiri. Adadin gudanarwa yana faduwa ne da sakan daya.

Lokacin da mai ciwon sukari ya shiga cikin kulawa mai zurfi, yana yin gwaje-gwaje mai sauri don tabbatar da ganewar asali, idan ya cancanta, haɗa zuwa na'urar fitarwa, mayar da fitar fitsari, saka catheter a cikin jijiya don gudanar da magunguna na dogon lokaci.

Ana lura da yanayin mai haƙuri koyaushe:

• Ana auna glucose a cikin awa daya.
• Kowane sa'o'i 6 - potassium da sodium matakan.
• Don hana ketoacidosis, ana kula da jikin ketone da acidity na jini.
• Ana yin lissafin adadin fitsari da aka tattara duk tsawon lokacin da aka sanya magidanta.
• Sau da yawa duba bugun jini, matsi da zazzabi.

Babban hanyoyin da aka ba da magani shine maido da daidaituwa-gishiri-gishiri, kawar da hyperglycemia, farjin cututtukan da ke tattare da rikice-rikice da rikice-rikice.

Gyara yawan rashin ruwa da kuma maye gurbin lantarki

Don dawo da ruwa a cikin jiki, ana aiwatar da infusions na volumetric - har zuwa lita 10 a kowace rana, sa'a ta farko - har zuwa lita 1.5, to, ƙarar maganin mafita ta awa daya a hankali an rage shi zuwa lita 0.3-0.5.

An zabi maganin ne gwargwadon alamun sodium da aka samo yayin gwaje gwaje:

Tare da gyaran rashin ruwa, baya ga maido da ajiyar ruwa a cikin sel, yawan jini kuma yana ƙaruwa, yayin da ake cire yanayin hyperosmolar kuma matakin sukari na jini ya ragu. Ruwan zazzabi yana faruwa ne da wajabcin sarrafa glucose, tunda raguwarsa mai kyau na iya haifar da raguwa cikin hanzari cikin matsin lamba ko na hanji.

Lokacin da fitsari ya bayyana, sake sarrafa sinadarin potassium a jiki yana farawa. Yawancin lokaci shine potassium chloride, a cikin rashin gazawar koda - phosphate. An zaɓi taro da girma na gudanarwa gwargwadon sakamakon gwajin jini akai-akai don potassium.

Ikon hawan jini

Ana gyara glucose na jini ta hanyar insulin, ana gudanar da insulin a takaice, a cikin kadan allurai, da kyau ta hanyar ci gaba. Tare da hyperglycemia mai tsananin gaske, allurar cikin ciki na adadin zuwa raka'a 20 ana fara aiki da farko.

Tare da matsanancin rashin ruwa, ba za a iya amfani da insulin ba har sai an dawo da ma'aunin ruwa, glucose a waccan lokacin ya ragu da sauri. Idan ciwon sukari da ƙwayar cuta na jini suna rikitarwa ta hanyar cututtukan concomitant, ana buƙatar insulin fiye da yadda aka saba.

Gabatar da insulin a wannan matakin na magani ba yana nufin cewa mai haƙuri zai canza yanayin ci gaba da rayuwarsa ba. Mafi sau da yawa, bayan inganta yanayin, ana iya rama masu ciwon sukari na nau'in 2 ta hanyar cin abinci (abincin don ciwon sukari na 2) da kuma shan magunguna masu rage sukari.

Farfadowa don Rashin Tsarkewa

Tare da maido da batun osmolarity, ana aiwatar da gyara wanda ya riga ya faru ko ana zargin an keta doka:

1. Hypercoagulation an cire shi kuma an hana thrombosis ta hanyar gudanar da heparin.
2. Idan lalacewa ta ƙasa ta ɓaci, ana yin hemodialysis.
3. Idan ƙin jinin haila yana tsokanar cututtukan koda da sauran gabobin, an wajabta maganin rigakafi.
4. Ana amfani da Glucocorticoids azaman maganin warkewa.
5. A karshen magani, an wajabta bitamin da ma'adanai don yin asarar rayukansu.

Abin da ya kamata tsammani - hasashen

Hasashen cutar sankara na hyperosmolar coma ya dogara ne akan lokacin fara kula da lafiya. Tare da kulawa na lokaci, ana iya hana ko kuma dawo da hankali cikin lokaci. Sakamakon jinkirin ilimin, 10% na marasa lafiya da wannan nau'in cutar ta mutu. Dalilin da ya sa sauran cututtukan masu haɗari ana ɗauka cewa tsufa ne, tsawon lokaci uncompensated ciwon sukari, "bouquet" na cututtukan da suka tara a wannan lokacin - gazawar zuciya da koda, angiopathy.

Mutuwa tare da ƙwayar hyperosmolar na faruwa sau da yawa saboda hypovolemia - raguwa a cikin jini. A cikin jikin, yana haifar da karancin gabobin ciki, da farko gabobin da suke da canjin canji yanzu. Hakanan, ƙwayar cuta ta hanji da ƙanƙan ƙwayoyin thromboses zasu iya ƙare da rashin lafiya.

Idan ilimin ya kasance a kan kari kuma mai tasiri, mai haƙuri tare da ciwon sukari ya dawo da hankali, alamun coma ya ɓace, glucose da osmolality jini suna daidaita. Cututtukan cututtukan ƙwaƙwalwar ƙwaƙwalwa yayin barin dimaita na iya wucewa daga couplean kwanaki zuwa watanni. Wasu lokuta cikakken dawo da ayyuka baya faruwa, gurguwa, matsalolin magana, raunin tunani na iya tsayawa.