Ketoacidosis na ciwon sikila wani nau'in sikari ne wanda ke tattare da ciwon sukari wanda ke hade da karancin insulin. Cutar na tare da haɓakar glucose na jini da jikin ketone. DKA yana faruwa ne sakamakon gazawar metabolism a cikin marasa lafiya da ke fama da cutar sankara kuma shine mafi yawan rikice rikice.
Menene ketoacidosis?
An fassara "Acidosis" daga harshen Latin kamar "acidic" kuma yana nufin juyawa a ma'aunin acid-jikin mutum zuwa karuwa cikin acidity. Tunda sanadin wannan aikin ƙara haɓaka ne ga yawan ketone, an ƙara kari "keto" zuwa kalmar "acidosis".
Menene dangantakar tsakanin rashin daidaituwa na rayuwa da ciwon sukari? Bari muyi kokarin bayyanawa. A al'ada, babban tushen samar da makamashi shine glucose, wanda ke shiga jiki da abinci. Adadin da ya ɓace yana rama ta hanyar ƙwayar glycogen a cikin tsokoki da hanta.
Tunda ajiyar glycogen ta iyakance, kuma an tsara girmanta har kusan kwana guda, lokaci ne na adon mai. Kayan mai yana karyewar glucose, don haka ya rama karancinsa. Abubuwan lalata na fats sune ketones, ko jikin ketone - acetone, acetoacetic da beta-hydroxybutyric acid.
Anara yawan maida hankali na acetone na iya faruwa yayin motsa jiki, abinci, tare da rage cin abinci mara daidaituwa tare da yawancin abinci mai ƙima da ƙananan adadin carbohydrates. A cikin ƙoshin lafiya, wannan tsari ba ya haifar da lalacewa saboda ƙodan, wanda ke cire hanzarin cire ketone, kuma daidaitawar PH ba ta da damuwa.
Dole ne a koyar da mai haƙuri da ciwon sukari kan yadda ake sarrafa lafiyarsa: ya kamata ya koyi sarrafa matakan sukari da ƙididdige yawan insulin dangane da abinci
Ketoacidosis mai ciwon sukari yana haɓaka da sauri sosai koda tare da tsarin abinci na yau da kullun da kuma rashin motsa jiki. Dalilin ya rataya ne a cikin rashi ko kuma rashin samun insulin, domin in ba tare da shi ba, glucose ba zai shiga cikin sel ba. Akwai halin da ake ciki na "yunwar a tsakiyar yalwa," lokacin da glucose ya isa, amma babu wasu yanayi don amfanin sa.
Kayan mai da glycogen ba zai iya shafar tsarin ba, kuma matakan glucose na ci gaba da tashi. Hyperglycemia na karuwa, yawan kitsen mai yana karuwa, kuma a sakamakon haka, tarawar sassan jikin ketone ya zama barazana. Tare da haɓakawa a ƙwanƙwalin ƙirar, glucose ya shiga cikin tsarin urinary kuma kodan ya motsa shi sosai.
Kodan suna aiki har iyakar ƙarfin su, wani lokacin kuma ba za su iya jurewa ba, yayin da adadin ƙwayar ruwa da electrolytes ya ɓace. Sakamakon asarar ruwa mai yawa, coagulates jini da matsananciyar yunwar oxygen suna faruwa a cikin kyallen. Tissue hypoxia yana haɓaka samuwar lactic acid (lactate) a cikin jini, wanda ya cika tare da haɓakar lactic coma, lactic acidosis.
A bisa ga al'ada, alamar PH na jini tana kan matsakaita 7.4, tare da ƙimar da ke ƙasa da 7 akwai barazanar kai tsaye ga rayuwar ɗan adam. Ketoacidosis mai ciwon sukari na iya haifar da wannan raguwa a cikin 'yan awanni kaɗan, kuma cocin ketoacidotic yakan faru ne a cikin kwana ɗaya ko kaɗan.
Dalilai
Halin rashin kuzari na iya haifar da rashin insulin a cikin kowane nau'in ciwon sukari. Ciwon sukari na nau'in 1 yawanci yana tare da cikakken karancin insulin. A cikin nau'in ciwon sukari na 2, karancin insulin na haɓaka.
Ketoacidosis mai ciwon sukari shine alamar farko ta nau'in 1 na ciwon sukari idan mai haƙuri bai san cewa ba shi da lafiya ba kuma bai sami magani ba. Wannan shi ne yadda ake gano cutar ta farko a kusan kashi ɗaya bisa uku na marasa lafiya.
Ketoacidosis yana faruwa ne kawai tare da karancin insulin da kuma ƙaruwa sosai a cikin glucose jini.
Abubuwa da yawa zasu iya tayar da ci gaban ketoacidosis, sune:
Tsarin sukari na jini a cikin mata- kurakurai a cikin insulin - sashi mara kyau, yin amfani da kwayoyi tare da rayuwar kare shiryayye, ƙarancin tsammani na insulin insulin ko famfo;
- kuskuren likita - alƙawarin magungunan kwamfutar hannu don rage sukari na jini tare da bayyanar da mai haƙuri na buƙatar allurar insulin;
- shan insulin antagonist magunguna waɗanda ke haɓaka sukari jini - hormones da diuretics;
- keta cin abincin - karuwa a lokacin hutu tsakanin abinci, yawan adadin carbohydrates mai sauri a cikin abincin;
- jiyya tare da maganin tsufa da ke rage halayyar insulin;
- dogaro na barasa da raunin jijiyoyi waɗanda ke hana isasshen magani;
- yin amfani da madadin, magunguna na mutane maimakon maganin insulin;
- cututtukan haɗin gwiwa - endocrine, cututtukan zuciya, kumburi da cuta;
- rauni da kuma tiyata. Bayan tiyata a kan cututtukan fata a cikin mutanen da ba su da ciwon sukari a baya, tsarin samar da insulin zai iya zama mai rauni;
- ciki, musamman tare da yawan guba mai sa maye tare da matsanancin amai.
A cikin 25 cikin marasa lafiya 100, dalilin ketoacidosis a cikin ciwon sukari mellitus shine idiopathic, tun da ba shi yiwuwa a kafa haɗin gwiwa tare da kowane daga cikin abubuwan. Increasedarin buƙatar insulin na iya faruwa a cikin ɗalibai na makaranta da matasa yayin lokutan daidaitawar hormonal da damuwa mai juyayi.
Har ila yau, akwai lokuta da yawa na kin yarda da gudanar da insulin tare da burin kashe kansa. Matasa masu kamuwa da cutar siga 1 suna yawan kashe kansu ta wannan hanyar.
Tsara da alamu
Ketoacidosis yana haɓaka matakai uku:
- ketoacidotic precoma, mataki na 1;
- farawa na cutar ketoacidotic, mataki na 2;
- cikakken ketoacidotic coma, mataki na 3.
A mafi yawan lokuta, daga farkon zuwa matakin karshe, kimanin kwanaki 2.5-3 suka wuce. Akwai wasu keɓaɓɓe lokacin da kwayar ta faru ba tare da ƙari ba bayan kwana guda. Tare tare da haɓaka glucose na jini da sauran rikice-rikice na rayuwa, hoton asibiti yana kara fitowa sosai.
Cutar cututtukan cututtukan ketoacidosis masu rarrabe sun kasu kashi biyu zuwa na farko. Da farko dai, akwai alamun cutar hauka:
- bushe bakin, jin daɗin ƙishirwa kullun;
- urination akai-akai
- nauyi asara da rauni.
Cutar fitsari ta cutar siga wani nau'in cutar sikari ce kuma tana faruwa a kusan 40 daga cikin marasa lafiya dubu.
Sannan akwai alamun halayyar haɓakar samar da ketone - canji a cikin yanayin numfashi, wanda ake kira Kussmaul na numfashi. Mutum ya fara yin numfashi mai zurfi da amo a hankali, yayin da yake numfashi a cikin iska sau da yawa fiye da yadda aka saba. Bugu da kari, akwai warin acetone daga bakin, tashin zuciya da amai.
Dukkanin alamu na sama alamu ne na asibiti na gaggawa. Tun da bayyanar ketoacidosis sun yi kama da sauran cututtuka, ana kawo mai haƙuri zuwa asibiti ko kuma cututtukan cututtuka. Saboda haka, yana da matukar muhimmanci a auna ma'aunin jinin mai haƙuri da kuma duba kasancewar jikin ketone a cikin fitsari.
A cikin marasa lafiya tare da ketoacidosis, rikice-rikice na iya faruwa - huhun huhun ciki, thrombosis na wurare daban-daban, ciwon huhu da kuma cututtukan hanji.
Binciko
Dangane da koke-koke da bincike na haƙuri, ainihin ganewar asali da kuma kasancewar cututtukan cututtukan da ke haifar da haɗarin ketoacidosis an kafa su. A lokacin dubawa, ana lura da alamun halayyar: ƙanshin acetone, jin zafi yayin palpation na ciki, hana halayen. Yawan hawan jini yawanci ƙasa ne.
Don tabbatar da ganewar asali da bambancin ganewar asali, ana yin gwaje gwaje na jini da fitsari. Lokacin da abun ciki na glucose a cikin jini ya fi girma da 13.8, zamu iya magana game da ci gaban ketoacidosis, ƙimar wannan mai nuna alama daga 44 kuma sama yana nuna yanayin mai haƙuri.
Matakan glucose a cikin ketoacidosis sune 0.8 kuma sama. Idan ba a cire fitsari, to, ana amfani da tsararrun gwaje-gwaje tare da aikace-aikacen jijiyoyin jini a kansu. Reaara yawan urea na jini yana nuna lalacewar aikin koda da bushewa.
Za'a iya yin hukunci da ci gaban ketoacidosis ta matakin amylase, enzyme na koda. Ayyukanta zasu wuce raka'a 17 / awa.
Lokacin da aka gudanar da maganin ketoacidosis tare da maganin isotonic sodium chloride kuma yana yin allurar insulin
Tun da diureis yana ƙaruwa a ƙarƙashin rinjayar hyperglycemia, matakin sodium a cikin jini ya ragu a ƙasa 136. A farkon matakan ketoacidosis na ciwon sukari, ƙirar potassium ta tashi, wanda zai iya wuce 5.1. Tare da haɓaka rashin ruwa a jiki, yawan ƙwayoyin potassium a hankali yana raguwa.
Bicarbonates na jini suna yin rawar da wani nau'in buɗaffen alkaline wanda ke tabbatar da daidaiton ginin acid a cikin ka'ida. Tare da acidification mai ƙarfi na jini tare da ketones, adadin bicarbonates yana raguwa, kuma a cikin matakan karshe na ketoacidosis na iya ƙasa da 10.
Matsakaicin cations (sodium) da anions (chlorine, bicarbonates) yawanci kusan 0. Tare da haɓaka samuwar jikin ketone, tazara ta anion na iya ƙaruwa sosai.
Tare da rage adadin carbon dioxide a cikin jini, yaduwar ma'adanai ya rikice don rama acidity, wanda hakan na iya haifar da jijiya da kasala.
Idan ya cancanta, an yiwa marasa lafiya allurar riga-kafi don ware ciwon zuciya dangane da rashin bushewar jiki. Don ware kamuwa da cututtukan huhun ciki, yi x-ray-kirji.
Ana yin rarrabe (rarrabe) ganewar asali tare da sauran nau'ikan ketoacidosis - giya, mai fama da yunwa da lactic acid (lactic acidosis). Hoton na asibiti na iya samun sifofi iri ɗaya tare da guba tare da ethyl da methanol, paraldehyde, salicylates (asfirin).
Jiyya
Ana yin magani don kamuwa da cutar ketoacidosis a cikin tsaka-tsakin yanayi. Babban bangarorinsa sune kamar haka:
- insulin sauya magani;
- jiko farji - rehydration (sake maye gurbin ruwan da aka rasa da na lantarki), gyaran PH;
- lura da kawar da cututtukan da ke tattare da cuta.
Idididdigar-Acid-base, ko PH - yana ɗaya daga cikin mahimman abubuwan da ke ƙayyade yiwuwar haɓaka cututtuka da yawa; tare da jujjuyawarsa a bangare daya ko wata, ayyukan gabobi da tsarinsu sun lalace, kuma jiki ya zama babu kariya
Yayin da yake kwance a asibiti, ana lura da mara lafiya don alamun alamun mahimmanci bisa ga tsarin da ke gaba:
- gwajin glucose mai sauri - a kowace awa, har sai alamar sukari ya faɗi zuwa 14, bayan haka ana zana jini sau ɗaya a cikin kowane sa'o'i uku;
- gwajin fitsari - sau 2 a rana, bayan kwana biyu - 1 lokaci;
- plasma na jini don sodium da potassium - sau 2 a rana.
An saka cathelin urinary don sarrafa aikin urinary. Lokacin da mara lafiyar ya sake farkawa sannan aka dawo da maganin saurin iska, ana cire kirinji. Kowane awa 2 ko sama da haka ana auna karfin jini, bugun jini da zafin jiki.
Yin amfani da catheter na musamman tare da jigilar jigilar, ana kula da matsanancin ƙwayar cuta na venous (hawan jini a cikin atrium dama). Don haka, ana kimanta yanayin yanayin zagayawa. Ana yin aikin lantarki ko dai ci gaba ko sau daya a rana.
Yana da mahimmanci a san cewa tun kafin asibiti, mai ciwon sukari yana buƙatar allurar sodium chloride a cikin girman 1 lita / awa da insulin na ɗan gajeren insulin - raka'a 20.
Harkokin insulin
Harkokin insulin shine babbar hanyar da zata iya kawar da cututtukan cututtukan cututtukan cututtukan da suka haifar da ci gaban ketoacidosis. Don haɓaka matakin insulin, ana gudanar dashi a cikin gajeren allurai na raka'a 4-6 kowane awa. Wannan yana taimakawa rage jinkirin mai da kuma samar da ketones, kuma daga nan hanta fitar da glucose ta hanta. A sakamakon haka, samar da glycogen yana ƙaruwa.
Hakanan ana gudanar da insulin ga mai haƙuri ta hanyar magudanar ruwa a cikin yanayin ci gaba. Don hana adsorption insulin, ƙwayar ƙwayar ƙwayar ɗan adam, albasa, sodium chloride da 1 ml na jinin mai haƙuri an haɗa su zuwa maganin maganin.
Ana iya daidaita allurai na insulin dangane da sakamakon aunawa. In babu sakamakon da ake tsammanin a cikin sa'o'i biyu ko uku na farko, an ninka kashi biyu. Koyaya, an hana shi ƙanƙantar da sukari na jini da sauri: raguwa a cikin taro fiye da 5.5 mol / l a kowace awa yana barazanar haɓakar haɓakar cerebral.
Zazzagewa
Don sake sarrafa ajiyar ruwa, 0.9% saline tare da sodium chloride an saka. Game da matakan sodium haɓaka jini, ana amfani da maganin 0.45%. Lokacin kawar da rashi na ruwa, sannu a hankali ana dawo da aikin koda, kuma sukarin jini na raguwa da sauri. Yawan wucewar glucose ya fara zama da karfi sosai a cikin fitsari.
Tare da gabatarwar saline, ya zama dole don saka idanu da CVP (matsin matsin venous na tsakiya), tunda yawan fitsari da aka saki ya dogara da su. Don haka, koda a yanayin ma'anar shaye-shaye, girman sinadarin shigar ruwa yakamata kada ya wuce yawan fitsari da ya fita sama da lita.
Ciwon sukari na 2 wanda ke faruwa a cikin mutane 9 cikin 10 kuma galibi yakan shafi tsofaffi
Jimlar yawan ruwan inine a rana kada ya wuce 10% na nauyin mai haƙuri. Tare da raguwa a cikin hauhawar jini na sama (ƙasa da 80), ana saka plasma jini. Tare da rashi na potassium, ana sarrafa shi ne kawai bayan maido da aikin urinary.
A lokacin jiyya, matakin potassium ba zai tashi nan da nan ba, saboda dawowa zuwa sararin samaniya. Bugu da kari, a lokacin gudanar da mafita na saline, asarar dabi'a na electrolytes tare da fitsari ke faruwa. Koyaya, bayan maido da potassium a cikin sel, abubuwanda ke cikin tsarin jini shine tsari.
Gyara yanayin
A dabi'un al'ada na sukari na jini da isasshen wadataccen ruwa a jiki, ma'aunin acid-a hankali yana daidaitawa kuma yana jujjuyawa zuwa alkalin. Samuwar sassan jikin ketone ya daina aiki, sannan tsarin da aka fitar da kayan maye ya samu nasara ta hanyar jingina su.
Abin da ya sa ba a buƙatar ƙarin matakan: mai haƙuri kada ya sha ruwan kwalba ko kuma maganin soda. A cikin wasu halaye kawai, lokacin da yawan jini ya ragu zuwa 7, kuma matakin bicarbonates - zuwa 5, an nuna jiko na sodium bicarbonate. Idan aka yi amfani da ikon alkinta jini a cikin mafi girma da yawa, to sakamakon tasirin magani zai zama akasin haka:
- nama hypoxia da acetone a cikin kashin baya za su haɓaka;
- matsin lamba zai ragu;
- karancin alli da potassium zai karu;
- aikin insulin ba shi da kyau;
- ragin samuwar kwayoyin ketone zai karu.
A ƙarshe
Tarihin ciwon sukari mellitus ya fara da tarihin ɗan adam. Mutane sun koya game da shi kafin zamaninmu, kamar yadda rubutattun littattafan tarihi na Masar da Mesopotamiya da Rome da Girka suka tabbatar da hakan.A waɗancan shekarun na farko, magani yana iyakance ga ganye, don haka marassa lafiya suna cikin wahala da mutuwa.
Tun daga 1922, lokacin da aka fara amfani da insulin, yana yiwuwa a kayar da wata cuta mai saurin kamuwa. Sakamakon haka, sojojin da ke dala miliyan-miliyan na marasa lafiya da ke buƙatar insulin sun sami damar guje wa mutuwa daga masu kamuwa da cutar sankarau.
A yau, ciwon sukari da rikice-rikice, ciki har da ketoacidosis, ana iya maganin su kuma suna da sannu-sannu. Koyaya, yana da mahimmanci a tuna cewa dole ne kulawar likita ta zama lokaci kuma ya wadatar, tunda idan aka jinkirta, mai haƙuri ya faɗi cikin sauri.
Don hana ci gaban ketoacidosis na ciwon sukari da kuma kula da kyakkyawar rayuwa, yana da mahimmanci don amfani da na'urorin da aka tsara don gudanarwar insulin kuma kiyaye matakin sukari na jini a ƙarƙashin kulawa koyaushe. Kasance cikin koshin lafiya!
