Ciwon sukari mellitus cuta ce wacce take da haɗari saboda rikicewarta.
Mutumin, wanda ya dace da shawarwarin da suka dace, na iya zama tare da shi tsawon shekaru ko, a taƙaice, yana ba da gudummawa ga lalata jiki da sauri da kuma irin wannan yanayin a matsayin hyperosmolar coma.
Etiology da pathogenesis
Haɗin etiology na hyperosmolar coma yana da alaƙa da rayuwar mutum. Ana lura dashi galibi a cikin mutane masu nau'in ciwon sukari na biyu kuma mafi yawan lokuta a cikin tsofaffi, cikin yara - in babu kulawar iyaye. Babban abin da ke haifar da shi shine karuwa sosai a cikin sukarin jini a gaban hyperosmolarity da kuma rashin acetone a cikin jini.
Dalilin wannan yanayin na iya zama:
- babban asarar ruwa ta jiki sakamakon tsawaita amfani da diuretics, zawo ko amai, tare da ƙonewa;
- karancin insulin a sakamakon cin zarafin insulin ko lokacin da ba'a yi shi ba;
- babban bukatar insulin, ana iya haifar dashi ta rashin abinci mai guba, cuta mai yaduwa, raunin da ya faru, amfani da wasu magunguna ko gabatarwar glucose.
A pathogenesis na aiwatar da ba a sarari bayyana. An sani cewa matakin glucose a cikin jini ya hauhawa sosai, kuma samar da insulin, akasin haka, yana raguwa. A lokaci guda, ana katange amfani da glucose a cikin kyallen, kuma kodan sun daina sarrafa shi kuma suna yin feshe shi a cikin fitsari.
Idan akwai babban asarar ruwa ta jiki, to kuwa yawan zubar jini yana raguwa, zai zama mai yawa da osmolar saboda karuwar yawan glucose, da kuma sinadarin sodium da ion.
Kwayar cutar cututtukan mahaifa
Hyperosmolar coma tsari ne na hankali wanda ke haɓaka sama da makonni da yawa.
Alamomin a hankali suna haɓaka kuma suna bayyana ta hanyar:
- increasedara yawan fitsari;
- karuwar ƙishirwa;
- nauyi asara cikin kankanin lokaci;
- rauni koyaushe;
- babban bushewar fata da huji;
- janar gaba daya na rashin lafiya.
Ana nuna rashin lalacewa gaba ɗaya cikin rashin yarda don motsawa, saukarwa da saukar karfin jini da zazzabi, da raguwar sautin fata.
A lokaci guda, akwai alamun alamun, waɗanda aka bayyana a cikin:
- rauni ko wuce gona da iri na reflexes;
- hallucinations;
- rashi magana;
- bayyanar cututtukan abubuwa;
- mai rauni sosai;
- take hakkin bazuwar ƙungiyoyi.
Idan babu ingantattun matakan, wawa da sihiri na iya faruwa, wanda a cikin kashi 30 na lokuta ke haifar da mutuwa.
Bugu da kari, kamar yadda aka lura da rikice-rikice:
- amo mai rarrafe;
- kumburin koda;
- zurfin jijiya thrombosis;
- na gazawar.
Matakan bincike
Don ingantacciyar ganewar asali da kuma takardar neman magani don maganin cutar hyperosmolar coma a cikin ciwon sukari na mellitus, ya wajaba don gudanar da bincike. Ya ƙunshi manyan rukuni biyu na hanyoyin: tattara ananesis tare da gwajin haƙuri da gwaje-gwaje na dakin gwaje-gwaje.
Nazarin mai haƙuri ya haɗa da kimantawa game da yanayinsa bisa ga alamun da ke sama. Ofayan mahimman mahimman abubuwa shine ƙanshin acetone a cikin iska wanda mai haƙuri ya ƙare. Bugu da kari, alamun cutar a bayyane suke.
Don nazarin dakin gwaje-gwaje, ana amfani da jini, a cikin abin da ake ƙididdige yawan glucose, osmolarity, taro sodium. Hakanan ana yin nazarin glucose a cikin fitsari, ana kimanta biomaterials don acidosis da jikin ketone.
Sauran manuniya da za su iya tsokani irin wannan yanayin mara lafiyar ana kuma kimanta su:
- haemoglobin da matakan jini;
- fararen kwayar halittar jini;
- urea nitrogen taro a cikin jini.
Idan akwai shakku ko buƙatar gano rikice-rikice, sauran hanyoyin gwaje-gwaje ana iya tsara su:
- Duban dan tayi da kuma X-ray na koda;
- electrocardiogram da sauransu.
Bidiyo game da gano kwayar cutar coma a cikin ciwon sukari:
Jiyya na Pathology
Za'a iya raba matakan warkewa zuwa matakai biyu: kulawa ta gaggawa da kuma karin magani domin dawo da yanayin jikin.
Kulawar gaggawa
Tare da maganin rashin lafiya na hyperosmolar, matsayin mutum yana da wuya kuma yana ƙaruwa da kowane minti, saboda haka yana da mahimmanci a ba shi taimakon farko daidai da fitar dashi daga wannan yanayin. Specialistwararren farfadowa ne kawai zai iya ba da irin wannan taimako, inda dole ne a ɗauki haƙuri da wuri-wuri.
Yayin motar motar asibiti tana tafiya, kuna buƙatar sanya mutumin a gefe ɗaya kuma ku rufe da wani abu don rage asarar zafi. A wannan yanayin, wajibi ne don kula da numfashinsa, kuma idan ya cancanta, yi numfashi na wucin gadi ko kuma tausawar zuciya kai tsaye.
Bayan shiga asibiti, ana ba wa mara lafiya gwaje-gwaje masu sauri don yin ingantaccen ganewar asali, sannan an tsara magunguna don cire mai haƙuri daga mummunan yanayin. An wajabta masa sarrafa ruwa na cikin ruwa, yawanci maganin hypotonic, wanda za'a maye gurbinsa da isotonic. A wannan yanayin, ana ƙara electrolytes don daidaita metabolism na ruwa-electrolyte, da kuma maganin glucose don kula da matakin al'ada.
A wannan yanayin, an kafa tsarin kulawa akai-akai na alamu: matakin glucose, potassium da sodium a cikin jini, zazzabi, matsa lamba da bugun jini, matakin jikin jikin ketone da acidity na jini.
Tabbatar don sarrafa fitar fitsari don guje wa edema, wanda zai haifar da mummunan sakamako, sau da yawa saboda wannan ana bai wa mara lafiya catheter.
Karin ayyuka
A cikin layi ɗaya tare da maido da daidaituwa na ruwa, an wajabta maganin insulin ga mara haƙuri, wanda ya haɗa da sarrafa jijiyar ciki ko gudanarwar jijiya.
Da farko, an gabatar da raka'a 50, wanda aka kasu kashi biyu, yana gabatar da bangare guda a ciki, kuma na biyun ta cikin tsokoki. Idan mai haƙuri yana da hypotension, to ana yin insulin ne kawai ta jini. Sannan narkarda dusar kankara ta ci gaba har sai lokacinda glycemia ya kai mm 14 mmol / L.
A wannan yanayin, ana kulawa da matakan sukari na jini koyaushe, kuma idan ya faɗi zuwa 13.88 mmol / l, ana ƙara glucose akan mafita.
Yawancin ruwa mai shiga jiki na iya tsokanar cututtukan hanji a cikin mara lafiya; domin a hana shi, ana ba mai haƙuri maganin kwantar da hankali na glutamic acid a cikin adadin mil 50. Don hana thrombosis, ana wajabta heparin kuma ana kula da alamun jini.
Karatun Bidiyo:
Hasashen da rigakafin
Tsinkayar cutar ta dogara ne da lokacin taimako. Ba da daɗewa ba an samar da shi, ƙarancin rikice-rikice da rikice-rikice ya faru a cikin wasu gabobin. Sakamakon rikice-rikice rikice rikice ne na gabobin, wanda kafin hakan yana da wasu cututtuka. Da farko dai, hanta, cututtukan hanta, da kodan da jijiyoyin jini suna shafa.
Tare da magani na lokaci, damuwa zai zama kaɗan, mai haƙuri ya sake dawo da hankali a cikin fewan kwanaki, matakan sukari suna daidaita, kuma alamun coma ya ɓace. Ya ci gaba da rayuwarsa ta yau da kullun ba tare da jin sakamakon rashin lafiyar ba.
Kwayoyin cutar na jijiyoyi na iya ɗaukar makonni da yawa ko ma watanni. Tare da mummunan shan kashi, bazai tafi ba, kuma mai haƙuri ya kasance gurgu ko mai rauni. Late kulawa yana cikin ɓarna tare da mummunan rikice-rikice har zuwa mutuwar mai haƙuri, musamman a cikin waɗanda ke da wasu cututtukan.
Yin rigakafin yanayin mai sauki ne, amma yana buƙatar saka idanu akai-akai. Ya ƙunshi don magance cututtukan cututtukan gabobin ciki, musamman tsarin jijiyoyin jini, kodan da hanta, tunda sun fi ƙarfin aiki ga ci gaban wannan yanayin.
Wani lokacin rashin wadatar jini na faruwa a cikin mutanen da basu san ciwon su ba. A wannan yanayin, yana da mahimmanci a kula da alamun, musamman ƙishirwa na yau da kullun, musamman idan akwai dangi a cikin dangin da ke fama da ciwon sukari.
Hakanan yana da mahimmanci a bi shawarar likita ga marasa lafiya da ke fama da cutar siga:
- koyaushe sanya ido a kan matakin glucose a cikin jini;
- ku bi abincin da aka wajabta.
- Kada ku keta abincin;
- Kada ku canza sashi na insulin ko wasu kwayoyi don kanku;
- Kada ku ɗauki magunguna marasa sarrafawa;
- lura da ayyukan motsa jiki;
- saka idanu kan alamomin halin jikin.
Duk waɗannan hanyoyin ne cikakke m wanda kawai ka tuna. Bayan duk wannan, ciwon sukari mellitus yana faruwa ne saboda yanayin rayuwa mara kyau kuma saboda hakan yana haifar da mummunan sakamako.
