Ndị ọrịa mamịrị na-eche: coma mamịrị: gịnị ka ọ bụ? Kedu ihe onye na-arịa ọrịa shuga na-atụ anya ma ọ bụrụ na ị wereghị insulin n'oge, ma gbochie ọgwụgwọ mgbochi? Na ajụjụ kachasị mkpa na-echegbu ndị ọrịa nke ngalaba endocrine n'ụlọ ọgwụ: Ọ bụrụ na shuga dị n'ọbara bụ 30, gịnị ka m kwesịrị ime? Kedụ ihe ọ ga-akarị?
Ọ ga-adị mma karịa ikwu okwu banyere coma mamịrị, ebe ọ bụ na amaara 4 ụdị coma. Atọ ndị mbụ bụ hyperglycemic, jikọtara ya na ịba ụba nke shuga n'ọbara.
Ketoacidotic coma
Ihe e ji mara ketoacidotic bụ maka ndị ọrịa nwere ụdị shuga 1. Ọnọdụ a dị oke egwu na-apụta n'ihi ụkọ insulin, n'ihi nke a na-ebelata ike glucose, metabolism na-agbadata na ọkwa niile, nke a na-eduga na-emebi emebi ọrụ nke sistemụ niile na akụkụ ahụ mmadụ. Isi ihe etiological nke ketoacidotic coma bụ insulin insulin zuru oke na oke ima elu na glucose ọbara. Hyperglycemia ruru - 19-33 mmol / l na elu. Ihe si na ya pụta bụ nkụtọ miri emi.
Ọtụtụ mgbe, ketoacidotic coma na-etolite n'ime ụbọchị 1-2, ma ọnụnọ nke ihe ndị na-akpata ya, ọ nwere ike ịmalite ngwa ngwa. Ihe ngosiputa mbu nke oria mamia bu ihe iriba ama nke mmụba shuga: ị letụ mmiri, agụụ ị increasingụ mmiri, polyuria, ume iku acetone. Akpukpo aru na akpukpo mucous na-emebiga ihe ókè, enwere mgbu afọ, isi ọwụwa. Ka coma na-abawanye, polyuria nwere ike dochie ya site na anuria, ọbara mgbali na-ada, na-abawanye ụba obi, na-ahụ hypotension muscle. Ọ bụrụ n’oghere shuga dị n’elu 15 mmol / l, a gha edobe onye ọrịa n’ụlọ ọgwụ.
Ketoacidotic coma bụ ogo ogo ikpeazụ nke ọrịa shuga, nke mwepu zuru oke, ma ọ bụrụ na ịnyereghị onye ọrịa aka, ọnwụ nwere ike ịdapụta. Ekwesịrị ịkpọ enyemaka enyemaka ozugbo.
Maka insulin ma ọ bụ ezughi ezu na nchịkwa insulin, ihe ndị a na-arụ ọrụ:
- Onye ọrịa ahụ amaghị banyere ọrịa ya, ọ gaghị ụlọ ọgwụ, ya mere achọpụtaghị ọrịa shuga n'oge oge.
- Insulin a gbanyere n’ime ya adịghị mma.
- Imebi ihe oriri riri oke, iji carbohydrate di mfe iributa ihe, abụba buru ibu, mmanya, ma obu ogologo agu.
- Ọchịchọ igbu onwe ya.
Ndị ọrịa kwesịrị ịmara na site n'ọrịa shuga 1, mkpa insulin na-abawanye n'ọnọdụ ndị a:
- n'oge ime
- na-efe efe consolitant,
- n'ihe banyere mmerụ ahụ na ịwa ahụ,
- na nchịkwa ogologo oge nke glucocorticoids ma ọ bụ diuretics,
- n'oge mgbagha anụ ahụ, ọnọdụ nrụgide psychoemotional.
Ọrịa pathogenesis nke ketoacidosis
Enweghị insulin bụ n'ihi mmụba nke homonụ corticoid - glucagon, cortisol, catecholamines, adrenocorticotropic na homonụ nke somatotropic. A machibidoro glucose ịbanye na imeju, banye na sel nke akwara na adipose anụ ahụ, ọkwa ya na ọbara na-ebili, ọnọdụ ịba ọcha n'anya na-apụta. Ma n'otu oge ahụ, mkpụrụ ndụ na-enwe agụụ ike. N'ihi ya, ndị ọrịa na-arịa ọrịa shuga na-enweta ọnọdụ nke adịghị ike, enweghị ike.
Iji mezie nwughari agụụ nri, ahụ ahụ na-amalite usoro ndị ọzọ nke ịwughachi ume - ọ na - eme ka lipolysis (abụba mbelata), nke na - ebute nguzobe abụba na - enweghị abụba, acid na - enweghị abụba, triacylglycerides. N’inwe insulin, 80% nke ike ahụ na-enweta n’oge a na-eme ka fatịlịmị acid na-akwụghị ụgwọ, na-agbakọta site na ngwaahịa nke mmebi ha (acetone, acetoacetic na β-hydroxybutyric acid), nke mejupụtara ahụ a na-akpọ ahụ ketone. Nke a na-akọwa oke ibu ọnwụ nke ndị ọrịa mamịrị. Ọkpụkpọ ketone dị n’ahụ na-anabata ihe ndị a na-eme n’ime alkaline, n’ihi nke ketoacidosis na - etolite - ọrịa metabolic siri ike. N'otu oge na ketoacidosis, metabolism mmiri na-emetụta mmiri.
Hyperosmolar (nke na-abụghị ketoacidotic) coma
Hyperosmolar coma na-emetụta ndị ọrịa nwere ọrịa shuga nke 2. Ofdị coma dị na ọrịa shuga mellitus na-apụta n'ihi enweghị insulin, ọ na-ejikwa oke mmiri nke ahụ, hyperosmolarity (mmụba nke sodium, glucose na urea n'ime ọbara).
Hyperosmolarity nke plasma ọbara na-eduga ná nnukwu mmebi nke ọrụ ahụ, enweghị mwepu, mana na enweghị ketoacidosis, nke a na-akọwapụta site na imepụta insulin site na pancreas, bụ nke ezughi oke iwepu hyperglycemia.
Mmiri na-egbu n'ime ahụ, nke bụ otu n'ime ihe na-akpata ọrịa mamịrị hyperosmolar coma
- ị excessiveụbiga mmanya ókè,
- afọ ọsịsa na ọgbụgbọ nke etiology ọ bụla,
- ibi na mpaghara ihu igwe na-ekpo ọkụ, ma ọ bụ na-arụ ọrụ na oke ikuku;
- enweghị mmiri ọ drinkingụ .ụ.
Ihe ndị a na-emetụtakwa mmalite nke coma:
- Enweghị insulin;
- Na -akpata insipidus na-arịa ọrịa shuga;
- Iri ihe oriri nke nwere carbohydrates, ma obu otutu onunu glucose;
- ma ọ bụ ọrịa akwara, ma ọ bụ usoro akụrụngwa (usoro metụtara ịsachapụ akụrụ ma ọ bụ peritoneum).
- Ọbara na-adịte aka.
Mmepe nke hyperosmolar coma nwere akara ndị a na-ahụkarị na ketoacidotic coma. Ogologo oge steeti precomatous na-adịgide na steeti pancreas, ikike ya imepụta insulin.
HyperlactacPs coma na nsonaazụ ya
HyperlactacPs coma na-eme n'ihi ụba nke lactic acid n'ime ọbara n'ihi insulin. Nke a na - ebute mgbanwe nke mejupụtara kemịkalụ nke ọbara na ọnwụ nke nsụhọ. Ihe ndi a nwere ike ime ka akpomkpomoku ojoo dikwa
- Okuku oxygen zuru oke n’ime ọbara n’ihi ọrịa obi na iku ume iku ume na-ebilite n’ihu ọnya ọrịa dịka ụkwara ume ọkụ, akwara, ọrịa ọbara, akwara obi;
- Ọrịa, oria;
- Akụrụ na-adịghị ala ala ma ọ bụ ọrịa imeju;
- Mmanya na-egbu egbu na-egbu egbu;
Pathogenesis
Isi ihe kpatara hyperlactacPs coma bụ enweghị oxygen na ọbara (hypoxia) na ndabere nke erughi insulin. Hypoxia na-akpali glycolysis anaerobic, nke na-emepụta oke lactic acid. N'ihi enweghi insulin, a na-ebelata ọrụ nke enzyme nke na-akwalite ntụgharị nke pyruvic acid na acetyl coenzyme. N'ihi ya, a gbanwere ọgwụ pyruvic ka ọ bụrụ acid lactic ma na-agbakọta n'ime ọbara.
N'ihi ụkọ oxygen, imeju enweghị ike ị excessụ ọgwụ lactate gabigara ókè. Ọkpụkpụ ọbara gbanyere na-emebi ma ọ bụrụ na akwara obi na - emebi akwara obi, na - emechi arịa arịa, na - ebute Cma
Nsonaazụ, na n'otu oge ahụ, akara nke hyperlactacacu coma bụ mgbu olu, angina pectoris, ọgbụgbọ, ọgbụgbọ, ura, ịmị amụ.
Mara nke a, ị ga - egbochi mbido coma, nke na - amalite n’ime ụbọchị ole na ole ma ọ bụrụ n’itinye onye ọrịa n'ụlọ ọgwụ.
Ofdị com ndị a niile dị n'elu bụ hyperglycemic, ya bụ, itolite n'ihi mmụba dị elu na shuga ọbara. Ma usoro mgbanwe dịkwa mfe, mgbe ọkwa shuga dara nke ukwuu, mgbe ahụ hypoglycemic coma nwere ike ime.
Hypoglycemic coma
Hypoglycemic coma na ọrịa shuga mellitus nwere usoro ntụgharị, ọ nwere ike ịmalite mgbe ọnụọgụ glucose dị n'ọbara belata ike ụbụrụ na-adị na ụbụrụ.
Ọnọdụ a na-eme n'ọnọdụ ndị a:
- Mgbe enwere nnabata insulin ma ọ bụ ọgwụ mmụba shuga na-ebelata;
- Onye ọrịa ahụ erighị nri n'oge n'oge ọ takingụsịrị insulin, ma ọ bụ ihe oriri erughi na carbohydrates;
- Mgbe ụfọdụ ọrụ adrenal, ikike imeju insulin na - egbochi imeju na - ebelata, n'ihi ya, ọgụgụ isi insulin na-abawanye.
- Mgbe arụ ọrụ siri ike gasịrị;
Inye glucose na ụbụrụ dị ala na-akpalite hypoxia, n'ihi ya, metabolism nke protein na carbohydrates na-akpata ike n'ihi mkpụrụ ndụ nke usoro ụjọ ahụ.
Ihe ịrịba ama nke hypoglycemia:
- Mmetụta agụụ nke ịba ụba;
- arụmọrụ nke anụ arụ na nke uche;
- mgbanwe mgbanwe ọnọdụ na omume na-ekwesịghị ekwesị, nke enwere ike igosipụta na oke iwe, mmetụta nke nchegbu;
- aka ịma jijiji;
- tachycardia;
- pallor
- Ọbara mgbali elu;
Site na mbelata ọbara shuga ruo 3.33-2.77 mmol / L (50-60 mg%), ihe ịtụnanya hypoglycemic dị nro na-eme. Na ọnọdụ a, ịnwere ike inyere onye ọrịa ahụ aka site na ịnye ya mmiri tii ma ọ bụ mmiri ọ sweetụ piecesụ na-4 iko shuga. Kama shuga, ị nwere ike itinye ngaji mmanụ a ,ụ, jam.
Site n'ọkwa shuga dị 2.77-1.66 mmol / L, a na-achọpụta ihe ịrịba ama niile e ji amata hypoglycemia. Ọ bụrụ na enwere onye nọ nso na onye ọrịa ahụ nke nwere ike inye ọgwụ ịgba, enwere ike itinye glucose n'ime ọbara. Mana onye ọrịa ahụ ka ga-aga ụlọ ọgwụ maka ọgwụgwọ.
Site na ụkọ shuga nke 1.66-1.38 mmol / L (25-30 mg%) na ala, ọgụgụ isi na-efukarị. Ngwa ngwa ịchọrọ ịkpọ ambulance.
