Hyperglycemic coma nwere ike ime na onye ọrịa nwere ọrịa shuga ma ọ bụrụ na elezighị ya nke ọma, n’ihi nke a kwa, ọbara ọbara na-ebili nke ukwuu. Ndị dọkịta na-akpọ ihe na-egosi ọbara shuga bụ́ “glycemia.” Ọ bụrụ n'ọbara shuga dị elu, mgbe ahụ ha na-ekwu na onye ọrịa ahụ nwere “hyperglycemia”.
Ọ bụrụ n ’ị wereghị shuga dị n’ọbara n’oge, mgbe ahụ ịba ụba hyperglycemic nwere ike ime
Hyperglycemic coma - adịghị emetụta nsụchi n'ihi nnukwu ọbara shuga. Ọ na - ebuputa bụ na ndị ọrịa mamịla agadi, ndị anaghị achịkwa ọbara ọbara ha.
Hyperglycemic coma na ụmụaka na-apụta, dịka iwu, yana njikọta na ketoacidosis.
Hyperglycemic coma na ọrịa shuga ketoacidosis
Hyetoglycemic coma na-esokarị ketoacidosis. Ọ bụrụ na ndị ọrịa mamịrị nwere ụkọ insulin n'ụzọ dị ukwuu, mkpụrụ ndụ agaghị enweta glucose zuru oke ma nwee ike gbanwee nri na-edozi site na nchekwa abụba. Ọ bụrụ na agbaji abụba, a na-emepụta ahụ ketone, gụnyere acetone. A na-akpọ usoro a ketosis.
Ọ bụrụ na ozu ọtụtụ ketone na-ekesa n'ime ọbara, ha na-abawanye acidity ya, ọ na-agabiga ihe gbasara ahụike. Enwere ntụgharị na ntụle acid-body nke anụ ahụ maka mmụba nke acidity. Ihe ịtụnanya a dị oke egwu, a na-akpọkwa ya acidosis. Na njikọta, a na-akpọ ketosis na acidosis ketoacidosis.
N'isiokwu a, anyị ga-atụle ọnọdụ ebe ọrịa hyperglycemic na-eme na-enweghị ketoacidosis. Nke a pụtara na ọbara shuga dị oke elu, mana n’otu oge ahụ, ahụ onye na-arịa ọrịa shuga adịghị agbanwe ya na nri ya na abụba ya. Anụ ahụ Ketone emepụtaghị, yabụ acidity ọbara na-adịgidekwa n’oche kwesịrị.
A na-akpọ ụdị nsogbu a nke ọrịa shuga “hyperosmolar syndrome.” Ọ dị oke njọ karịa ketoacidosis na-arịa ọrịa shuga. Osmolarity bụ ịta ihe nke ihe n’otu osisa. Ọrịa hyperosmolar - nke pụtara na ọbara siri oke ike n’ihi oke ọdịnaya glucose dị n’ime ya.
Diagnostics
Mgbe onye ọrịa nwere hyperglycemic coma batara n'ụlọ ọgwụ, ihe mbụ ndị dọkịta na-eme bụ ịchọpụta ma o nwere ketoacidosis ma ọ bụ na ọ nweghị. Iji mee nke a, mee nyocha nke mmamịrị maka ọnụnọ nke anụ ahụ ketone na-eji mpempe ule, ma na-anakọta ozi ndị ọzọ dị mkpa.
Etu esi akoto akpukpo aru nke hyperglycemic na ketoacidosis na edemede “Diabetic ketoacidosis”. Na ebe a anyị ga-atụle ka ndị dọkịta si eme ihe ma ọ bụrụ na ketoacidosis esoghị ọrịa shuga. Ọ bụ ezie na onye ọrịa nwere hyperglycemic coma na-anabata ọgwụgwọ kpụ ọkụ n'ọnụ, a ga-enyocharịrị ihe ịrịba ama ya dị mkpa. A na-enyocha nlekọta ha n'otu usoro ahụ dị ka ọgwụgwọ ketoacidosis si agwọ ọrịa.
Hyperglycemic coma, nwere ma ọ bụ na-enweghị ketoacidosis, nwere ike ịdị mgbagwoju anya site na lactic acidosis, i.e., ịta oke nke lactic acid n'ime ọbara. Lactic acidosis na-aka njọ prognosis nke nsonaazụ ọgwụgwọ. Ya mere, ọ bụ ihe ịchọ mma iji tụọ lactic acid n’ọbara onye ọrịa.
Ọ dịkwa mma ịme nyocha ọbara maka oge prothrombin na arụ ọrụ ọkara nke thromboplastin (APTT). N'ihi na ọrịa hyperosmolar karịa mgbe ọ na-arịa ọrịa ketoacidosis nke ọrịa mamịrị, DIC na-etolite, ee, a na-ama jijiji coagulation ọbara n'ihi mwepụta nke thromboplastic ihe site na anụ ahụ.
Ekwesịrị iji nlezianya nyochaa ndị ọrịa nwere hyperglycemic hyperosmolar syndrome maka ịchọpụta ọdịmma nke ọrịa, yana ọrịa ndị na-akpata ọnya akpa ume. Iji mee nke a, ịkwesịrị inyocha:
- paranasal sinuses
- mẹ onyẹ alị
- akụkụ ahụ
- eriri afọ, tinyere eriri aka
- akụrụ
- palp lymph nodes
- ... na n'otu oge ịlele maka ọdachi dakwasịrị.
Ihe Na-akpata Ọrịa Shuga Hyperosmolar
Hyperosmolar hyperglycemic coma na-eme ihe dị ka ugboro 6-10 karịa obere ketoacidosis na-arịa ọrịa shuga. Site na nnukwu nsogbu a, dịka iwu, a na-anabata ndị agadi nwere ọrịa shuga 2 n'ụlọ ọgwụ. Mana ewezuga usoro iwu izugbe a na-eme.
Usoro na-akpali akpali maka mmepe nke ọrịa hyperosmolar bụ oge ọnọdụ na-eme ka ọ dịkwuo mkpa maka insulin ma na-eduga n'ibe mmiri. Nke a bụ ndepụta nke ha:
- ọrịa na-efe efe, ọkachasị ndị nwere oke ọkụ, vomiting, na afọ ọsịsa (afọ ọsịsa);
- infarction myocardial;
- ọria ume;
- nnukwu pancreatitis (mbufụt nke pancreas);
- ihe mgbochi eriri afọ;
- ọnya;
- oke oku;
- nnukwu ọbara ọgbụgba;
- ọdịda akụrụngwa, nsogbu ọgbụgba;
- pathologies endocrinological (acromegaly, thyrotoxicosis, hypercortisolism);
- mmerụ ahụ, ịwa ahụ;
- mmetụta anụ ahụ (ọrịa strok, hypothermia na ndị ọzọ);
- na-a certainụ ọgwụ ụfọdụ (steroid, ọrịa ọmịiko, somatostatin analogues, phenytoin, immunosuppressants, beta-blockers, diuretics, calcium antagonists, diazoxide).
Coma hyperglycemic na-abụkarị nsonaazụ nke onye agadi na-ama ụma ị drinkingụ obere mmiri mmiri. Ndị ọrịa na-eme nke a, na-anwa ibelata ọzịza. Site na echiche ahụike, nkwanye ka amachibido mmiri dị na obi na ọrịa ndị ọzọ ezighi ezi ma dịkwa ize ndụ.
Ihe mgbaàmà nke coma hyperglycemic
Ọrịa hyperosmolar na-etolite nwayọ karịa nke ọrịa ketoacidosis na-arịa ọrịa shuga, ọ na-abụkarị n'ime ụbọchị ole na ole ma ọ bụ izu. Ọrịa nkụ nwere ndidi nwere ike sie ike karịa nke ketoacidosis. Ebe ọ bụ na ahụ ketone adịghị etolite, enweghị akara njirimara nke ketoacidosis: iku ume Kussmaul pụrụ iche na isi nke acetone na ikuku ikuku.
N'oge mmalite nke mmepe hyperosmolar syndrome, ndị ọrịa na-enwekarị mkpụpụta urinate. Mana n ’ụlọ ọgwụ, npụtapụta mmamịrị esighị ike ma ọ bụ kwụsịchaa kpamkpam, n’ihi mmiri akpịrị. Na ketoacidosis nke na-arịa ọrịa shuga, ịba ụba nke anụ ketone na-ebute vomiting. Site na ọrịa hyperosmolar, vomiting dị ụkọ, ọ gwụla ma enwere ihe ndị ọzọ kpatara ya.
Hyperglycemic coma na-etolite n'ihe dị ka 10% nke ndị ọrịa nwere ọrịa hyperosmolar. Ọ dabere n'otú ọbara siruru n’ibu na ole ihe sodium dị na mmiri cerebrospinal abawanyela. Na mgbakwunye na ịda mbà na coma, nsụhọ mmụọ nwere ike igosipụta onwe ya n'ụdị psychomotor iwe, delirium na hallucinations.
Otu njirimara nke ọrịa hyperosmolar bụ akara na-egosipụta ugboro ugboro na iche iche nke emebi usoro akwara. Ndepụta ha gụnyere:
- ogwe
- nkwarụ okwu;
- mkpali imeghari ugha nke nku anya (nystagmus);
- na-akụda mmegharị afọ ofufo (paresis) ma ọ bụ ahụ ike zuru oke nke otu uru ahụ;
- ọrịa mgbaàmà ndị ọzọ.
Ihe mgbaàmà ndị a dịgasị iche iche, ha adabaghị na ọrịa ọ bụla doro anya. Mgbe ewepụsịrị onye ọrịa na steeti hyperosmolar, ha na-apụ n'anya.
Enyemaka na hyperglycemic coma: ozi zuru ezu maka dọkịta
A na-eme ọgwụgwọ maka hyperosmolar syndrome na hyperglycemic coma tumadi n'otu ụkpụrụ dị ka ọgwụgwọ nke ketoacidosis nke ọrịa mamịrị. Mana enwere njirimara ndị anyị na-ekwu n'okpuru.
Na onodu obula ekwesighi ibelata ogo shuga obara kariri 5.5 mmol / L kwa oge obula. Osmolarity (njupụta) ọbara ọbara ekwesịghị ibelata ngwa ngwa karịa site na mọmol / l kwa elekere. Mbelata pụtaranụ n'ihe ngosi ndị a machibidoro iwu, n'ihi na ọ na-ebulite ihe ọghọm nke ụbụrụ na edem ụbụrụ.
Na ntinye uche Na + na plasma> 165 meq / l, iwebata saline agbanwe agbanweala. Ya mere, ejiri glucose 2% mee ihe dika mmiri iji wepu mmiri. Ọ bụrụ na sodium larịị bụ 145-165 meq / l, mgbe ahụ jiri 0.45% hypotonic ngwọta nke NaCl. Mgbe sodium dị larịị <145 meq / l, a na-aga n'ihu ịgbanye ume ọkụ na 0.9% NaCl.
N'ime oge awa mbụ, a na-agbanye lita mmiri 1-1.5 nke mmiri, na nkeji nke abụọ na nke atọ - 0,5-1-1, mgbe ahụ 300-500 ml kwa awa. A na-emegharị ọnụego frize ahụ n'otu ụzọ ahụ dị na ketoacidosis mamịrị, mana olu mbụ ya bụrụ nke ọrịa hyperosmolar ka ukwuu.
Mgbe aru onye oria bidoro juputa na mmiri, ee, a na - ewepu oke mmiri, nke a n’onwe ya na - eduga nbelata nke oke glucose na obara. Na mmiri ọgwụ hyperglycemic, a na-amụba uche nke insulin. Maka ebumnuche ndị a, na mmalite ọgwụ, a naghị enye insulin ma ọlị ma ọ bụ na-enye ya obere obere usoro, ihe dị ka nkeji 2 nke insulin “dị mkpụmkpụ” kwa awa.
Mgbe awa 4-5 gachara site na mmalite nke njikọta ọgwụ, ị nwere ike ịgbaghari na insulin dosing regimen nke akọwapụtara na ngalaba “ọgwụgwọ nke ọrịa ketoacidosis”, mana ọ bụ naanị ma ọ bụrụ na shuga ọbara dị oke elu na ntinye nke sodium ion na plasma ọbara na-ebelata.
Na ọrịa hyperosmolar, a na-achọkarị potassium karịa iji dozie erughi potassium n'ahụ ahụ onye ọrịa karịa na ketoacidosis mamịrị. Achọpụtaghị ojiji nke alkalis, gụnyere soda, maka ketoacidosis, yana ọbụna karịa maka hyperosmolar syndrome. PH nwere ike ibelata ma ọ bụrụ na acidosis amalite na mgbakwunye nke usoro purulent-necrotic. Mana ọbụlagodi n'ọnọdụ ndị a, pH na-adịkarị ala karịa 7.0.
Anyị nwara ịme ederede a banyere hypoglycemic coma na hyperosmolar syndrome bara uru maka ndị ọrịa. Anyị nwere olile anya na ndị dọkịta nwere ike iji ya dịka “akwụkwọ aghụghọ”.
