Ketoacidosis mummunan ciwo ne wanda ke haɓaka tare da rashin insulin. Ilimin halin dan Adam yana da haɗari ga rayuwa, tun da wuri precoatous jihar ya shigo cikin sauri, ya biyo baya. Rashin kulawar gaggawa zai haifar da mutuwa. Wani rikice-rikicen makamancin wannan na iya haɓaka a cikin yara da manya tare da nau'in ciwon sukari na 1, duk da haka, tare da nau'in ciwon sukari na 2, ba a gwada gano ketoacidosis.
Dalilai
Ketoacidosis yana haɓaka tare da rashin insulin, idan jiki ba zai iya yin amfani da glucose da amfani dashi don makamashi ba. Sakamakon haka, wannan abu ya tara cikin jini. Tunda kwayoyin halitta suke fuskantar matsananciyar yunwar, ana yin aikin rama, kuma jiki yana neman samun makamashi ta hanyar lalata lipids.
Tsarin yana aiki tare da haɗin ketone, wanda ya tara a cikin jini. Ana kiran irin wannan cutar ta "ketosis." Kodan ba za su iya cire yawancin sharar ba sannan kuma suka koma acetone. Acidosis yana haɓaka, yana zama sanadin shan maye na jiki. Daidaituwar alkaline na jini ya fadi kasa da 7.3 pH, asalinta yana ƙaruwa (ana ɗaukar darajar al'ada ta 7.35-7.45 pH al'ada ce).
Akwai digiri 3 na ketoacidosis:
- Sauki. Alamar farko ta maye ta kasance - tashin zuciya. Hauka yakan zama mai sa maye (ciwon suga), iska mai ƙuna tana farawa kamar acetone.
- Matsakaici. Yanayin ya yi muni, ciki ya yi zafi, mutumin ba shi da lafiya. An lura da lalacewar tsarin zuciya da jijiyoyin jini: rage karfin hauhawar jini, hauhawar zuciya (daga bugun 90 a minti daya).
- Mai nauyi. Hankali ya zama mai rauni, ɗalibai sun zama kunkuntar, daina amsa ga haske. Jikin yana fuskantar matsanancin rashin ruwa a jiki. Kamshin acetone ya zama mai ƙarfi sosai, ana samun sauƙin ji a cikin dakin da mai haƙuri yake.
Sanadin ketoacidosis sun hada da:
- Theaddamar da nau'in 1 na ciwon sukari (tare da cutar ba a gano shi ba);
- Ba daidai ba magani na insulin-dogara da ciwon sukari (ƙididdigar ƙirar ba daidai ba, ƙarshen insulin insulin, kurakurai a cikin abincin);
- Amfani da ƙarewar hypoglycemic jamiái ko magungunan da aka adana ba daidai ba;
- Jiyya na tiyata;
- Raunin da ya faru
- Damuwa
- Wani tsawan lokaci na rashin maganin da ke fama da rashin insulin, tare da rashi insulin;
- Ciki
- Shan magungunan da ke lalata tasirin insulin (alal misali corticosteroids, diuretics, hormones).
Hanyar ciwon sukari na tsananta wasu cututtukan: cututtukan da ke cikin tsarin numfashi, tsarin urinary, cututtukan cututtukan cututtukan cututtukan zuciya, bugun zuciya, bugun jini. Ketoacidosis a cikin yara sau da yawa yakan faru ne sakamakon ciwon sukari wanda ba a bincika shi ba (wanda ya fara nuna cutar), lokuta masu zuwa ana haifar da kurakurai a far.
Kwayar cutar
Pathology yana haɓaka cikin sauri, tsawon lokacin yana daga 1 zuwa kwanaki da yawa. Alamar farkon ketoacidosis na faruwa ne sakamakon karuwar glucose saboda ƙarancin insulin matakan.
Wadannan sun hada da:
- Thirstara yawan ƙishirwa;
- Rashin ƙarfi
- Urin saurin hanzari;
- Fata mai bushewa, membran mucous.
Akwai alamun ketosis, acidosis: amai, tashin zuciya, ciki ya fara rauni. Yana jin ƙamshin acetone daga bakinku. Intoxication yana haifar da rashin lafiyar tsarin juyayi na tsakiya, wanda alamomin halayyar halayya ke tabbatar dasu:
- Jin zafi a kai;
- Haushi;
- Abubuwan da suka saba da hankali;
- Damuwa
- Rashin Gaggawa.
Idan babu cikakken isasshen taimako, coma yakan faru, rashin lafiyar fitsari yana tasowa. Dakatar da numfashi, zukata suna haifar da mutuwa.
Kwayar cutar ketoacidosis a cikin yara sun yi kama da alamun bayyanar cututtuka a cikin manya. Wani yanayi mai kama da wannan a cikin wannan rukuni na marasa lafiya shima yana daya daga cikin mafi girman sakamakon cutar sankara. Ketoacidosis shine ɗayan manyan abubuwan da ke haifar da mutuwa a cikin yara masu wannan cutar.
Abinda yakamata ayi
An shawarci masu ciwon sukari su sayi mitar glucose na jini da kuma gwajin gwaji don tantance jikin ketone a cikin fitsari. Idan dukkanin alamomi masu girma biyu ne, kuma alamu da aka nuna a sama sun haɓaka, kuna buƙatar kiran motar asibiti. Dole ne a kai mara lafiya zuwa asibiti idan mutumin yana da rauni sosai, bushewar jiki, kuma ya sami tabin hankali.
Kyakkyawan dalilai don kiran motar asibiti:
- Jin zafi a bayan sternum;
- Amai
- Ciwon ciki;
- Yawan zafin jiki (daga 38.3 ° C);
- Babban matakin sukari, yayin da mai nuna alama bai amsa matakan da aka ɗauka a gida ba.
Ka tuna cewa rashin aiki ko rashin kulawa sau da yawa yakan zama mai mutuwa.
Binciko
Kafin sanya mai haƙuri a asibiti, ana gudanar da gwaje-gwaje masu sauri don matakin glucose da ketone a cikin jini, fitsari. Lokacin yin bincike, ana yin amfani da sakamakon gwajin jini don tantance matakin electrolytes (potassium, sodium, da dai sauransu). An kiyasta pH na jini.
Don gano wasu cututtukan cututtukan cuta, aiwatar da hanyoyin bincike na gaba:
- Nazarin Urinal;
- ECG
- X-ray.
Wani lokaci kuna buƙatar yin ƙididdigar hoto mai kwakwalwa. Yana da mahimmanci a ƙayyade matsayin ketoacidosis da bambantawa da sauran yanayin m:
- Yunwar "ketosis;
- Lactic acidosis (mai wuce haddi na lactic acid);
- Alkohol ketoacidosis;
- maye asfirin;
- guba tare da ethanol, methanol.
Game da kamuwa da cuta da ake zargi, kamuwa da sauran cututtuka, ana gudanar da ƙarin gwaje-gwaje.
Jiyya
Kulawa da ilimin cututtukan kwayoyin halitta na ketosis yana farawa tare da kawar da abubuwan da suka haifar da tsokani. Tasirin yana hana mai kitse. An wajabta mai haƙuri a alkaline abin sha (maganin soda, ruwan alkaline, Regidron).
Suna ba da shawarar shan enterosorbents, hepatoprotectors. Idan mara lafiyar bai ji daɗi ba, an sanya ƙarin allura ta insulin "mai sauri", kuma hanyar sarrafa insulin ta motsa jiki shima yana taimakawa.
Maganin Ketoacidosis
Ana yin magani na ketoacidosis a asibiti. Babban burin shine daidaita matakan insulin. Matakan warkewa sun hada da matakai 5:
- Harkokin insulin;
- Ikon bushewa;
- Rashin cikakken potassium, sodium;
- Symptomatic far na acidosis;
- Farfadowar cututtukan concomitant.
Ana gudanar da insulin ta hanyar ciki, ta amfani da hanyar ƙananan allurai, wanda shine mafi aminci. Ya ƙunshi a cikin aikin sa'a na insulin a cikin raka'a 4-10. Sesananan allurai suna taimaka wajan rage ƙwayar tsoka, jinkirta fitar da glucose a cikin jini, da inganta haɓakar glycogen. Ana buƙatar saka idanu akai-akai na matakan sukari.
Droppers na sodium chloride an yi, ana ci gaba da sarrafa potassium (adadin yau da kullun kada ya wuce 15-20 g). Alamar matakin potassium ya kamata ya zama 4-5 meq / l. A cikin awanni 12 na farko, jimlar yawan ruwan allurar kada ta zarce 10% na nauyin jikin mai haƙuri, in ba haka ba haɗarin huhun huhun ya karu.
Tare da amai, ana yin laushi na ciki. Idan shaƙawa ta ci gaba, an haɗa mai haƙuri da injin motsa iska. Wannan zai hana huhun huhu.
Ana yin maganin ne da nufin kawar da acidity na jini, duk da haka, an gabatar da sodium bicarbonate ne kawai idan pH na jini bai wuce 7.0 ba. Don hana ƙwanƙwasa jini, an kuma tsara heparin a cikin tsofaffi.
An ba da kulawa ta musamman ga kulawa da sauran cututtukan da zasu iya haifar da ci gaban mahaifa (rauni, ciwon huhu, da sauransu). Don hana cututtuka masu kamuwa da cuta, ana amfani da allurar rigakafin ƙwayar ƙwayar ƙwayar ciki. Tare da haɓakar kamuwa da cuta, ƙwayoyin rigakafi da suka dace suna haɗuwa da jiyya. Idan cututtukan maɓallin ƙwaƙwalwar hanji suna tasowa, jiyya tare da corticosteroids, diuretics ya zama dole, kuma ana yin aikin injin.
An kirkiro yanayi mai kyau ga mai haƙuri, wanda ya haɗa da tsabtace baki, ma'anar fata. Masu ciwon sukari tare da ketoacidosis suna buƙatar saka idanu akan agogo. Ana sahihan alamun masu zuwa:
- Gwaje-gwaje na asibiti na fitsari, jini (bayan shigar asibiti, sannan kuma - tare da wani lokaci na kwanaki 2-3);
- Gwajin jini na gaggawa don sukari (a kowace awa, kuma lokacin da sukari ya kai 13-14 mmol / l - tare da tazara na 3 hours);
- Binciken hanji na acetone (a cikin kwanakin farko 2 - 2 p / day, daga baya - 1 p / day);
- Eterayyade matakin sodium, potassium (2 p. / Day);
- Kimanta matakan phosphorus (idan mai haƙuri ya yanke jiki saboda ƙarancin abinci mai gina jiki);
- Eterayyade jini pH, hematocrit (1-2 p. / Day);
- Eterayyade nitrogen, creatinine, urea;
- Kulawa da yawan fitsari da aka saki (a cikin awa daya har zuwa lokacin da ake sake dawo da tsarin aikin hanji);
- Auna karfin matsewa;
- Tsammani saka idanu akan ECG, bugun zuciya, hawan jini, zazzabi.
Ana aiwatar da maganin ketoacidosis a cikin yara bisa ga makirci makamancin wannan, wanda ya haɗa da: injections akai-akai na insulin "sauri", gabatarwar mafita a cikin jiki, alli, alkalin jini. Wani lokaci ana buƙatar heparin. A yanayin zafi, ana amfani da shirye-shiryen rigakafi tare da rawar da yawa.
Abinci mai gina jiki don ketocacidosis
Abinci mai gina jiki ya dogara da tsananin yanayin haƙuri. Abincin don mai ciwon sukari a cikin jihar predomatous bai kamata ya ƙunshi mai ba, an cire su har tsawon kwanaki 7-10. Abincin mai wadataccen abinci mai kariya yana iyakantacce, kuma ana kara carbohydrates (amma ba sukari ba). Anyi amfani da sorbitol, xylitol, suna da kaddarorin antiketogenic. Bayan al'ada, an yarda ya hada da mai, amma ba a baya ba sai bayan kwana 10. Suna canzawa zuwa menu na yau da kullun a hankali.
Idan mai haƙuri ba zai iya cin abinci da kansu ba, ana gabatar da ruwa mai ƙarancin ƙarfi, maganin glucose (5%). Bayan haɓaka, menu ya hada da:
- Rana ta 1: a sauƙaƙe narkewar carbohydrates (semolina, zuma, jam), abin sha mai yawa (har zuwa lita 1.5-3), ruwan ma'adinan alkaline (misali, Borjomi);
- Rana ta 2: oatmeal, dankalin masara, masara, kayan-madara mai tsabta, kayayyakin burodi;
- Rana ta 3: broth, mashed naman an ƙara shigar da shi cikin abincin.
A cikin kwanaki 3 na farko bayan an samu dila, an cire furotin na dabbobi daga menu. Suna canzawa zuwa abinci mai gina jiki a cikin sati guda, amma dole ne ƙarancin ya zama mai iyaka har sai an sami matsayin biyan diyya.
Yin rigakafin Ketoacidosis
Yarda da matakan kariya zai hana ketoacidosis. Wadannan sun hada da:
- Yin amfani da allurai na insulin wanda ya yi daidai da sukari;
- Kulawar glucose na jini (ta amfani da glucometer);
- Amfani da abubuwan gwaji don gano ketone;
- Kwarewar kai na canje-canje a cikin jihar don daidaituwa da daidaita sakin hypoglycemic;
- Yin makaranta don masu ciwon sukari.
Bidiyo mai dangantaka:
