Ọrịa shuga mellitus bụ ọrịa, ihe kacha gosipụta ya bụ mmụba na shuga ọbara. Isi ihe nke oria a bu oria hyperglycemia, site na nkwughachi ya, enwere ike ibuo akari ma enwere nsogbu oria shuga.
Ọbara glucose dị elu na-emebi mgbidi vaskụla ma na-ebute mmepe nke ọrịa akụrụ, retina, akụkụ ụjọ akwara, ụkwụ shuga, angioeuropathies nke ogo ịdị iche iche.
N’ezighi ezi maka ịrịa ọrịa shuga mellitus ma ọ bụ ọnụnọ nke ọrịa na-efe efe nwere ike ibute shuga n'ọbara shuga site na mmepe nke ọrịa mamịrị, nke chọrọ nlekọta ahụike mberede.
Ihe na-akpata hyperglycemia na ọrịa shuga
Mmụba na shuga ọbara n'ụdị ọrịa shuga 1 na-emetụta ụkọ insulin zuru oke. A na-ebibi mkpụrụ ndụ beta nke dị na pancreas n'ihi ihe emere. Viruses, ihe na-egbu egbu, ọgwụ, nrụgide na-akpasu ụdị mmebi ahụ. Ọrịa dị n'ọrịa ndị a na-ebute site n'ọbara.
N'ime ụdị shuga nke 2, ịdebe insulin ogologo oge nwere ike ọ gaghị adị iche na nke a na-ahụkarị, mana ndị na-anabata insulin anaghị anabata homonụ a. Isi ihe na-ebute uto nke ọrịa shuga bụ oke ibu megide mmalite nke ịkọ ọdịnihu. Seconddị nke abụọ nke ọrịa shuga na-apụta site na ụkọ insulin.
Site na ụkọ insulin zuru oke ma ọ bụ nke dị ala, glucose enweghị ike ịbanye na mkpụrụ ndụ ma hazie ya iji mepụta ike. Yabụ, ọ na-adịgide n'ime arịa ahụ, na-eme ka mmiri mmiri si na uru ahụ pụta, ebe ọ bụ ihe na-arụ ọrụ nke ukwuu. Fia mmiri na-ebilite n'ime ahụ, ebe ọ bụ na akụrụ na-ewepụ ọ̀tụ̀tụ̀ nke mmiri na-arịa ya na glucose.
Dabere ogo ịba nke hyperglycemia, a na-eme atụmatụ usoro shuga:
- Ilddị nrịba: glycemia na-ebu ọnụ n'okpuru 8 mmol / l, enweghị glucosuria ma ọ bụ na enwere ọnyị nke glucose na mmamịrị. Na-akwụ ụgwọ site na nri, ọrụ angiopathy.
- Ogo na-adịghị ala ala: shuga na-ebu ọnụ ruo 14 mmol / l, glucosuria kwa ụbọchị adịghị elu karịa 40 g, ketoacidosis na-eme n'oge ụfọdụ. Ọgwụ dị na mbadamba ma ọ bụ insulin (ihe ruru 40 nkeji) kwa ụbọchị.
- Ogo siri ike: glycemia nke dị n’elu 14 mmol / l, glucosuria dị elu, a na-eduzi insulin na nnukwu usoro, enwere ọrịa angioneuropathies na-arịa ọrịa shuga.
N’ihi ya, ọ bụrụ na enwere ọbara shuga iri na isii ma ọ dị njọ maka ọrịa mamịrị, azịza ajụjụ yiri nke a nwere ike ịbụ nke ziri ezi, ebe ọ bụ na mgbaàmà a na-ezo aka n’arụ shuga dị ukwuu.
Ọnọdụ a nwere ike ibute nnukwu ọrịa shuga - ketoacidosis nke na-arịa ọrịa shuga.
Ihe kpatara ketoacidosis na ọrịa shuga
Mmepe nke ketoacidosis na-ewere ọnọdụ nke nnukwu glycemia na mmụba nke ọnụ ọgụgụ ketone n'ime ọbara. Ihe na-akpata ya bụ ụkọ insulin. Firstdị nke mbụ nke ọrịa shuga nwere ike ịmalite ketoacidosis n'oge nyocha, na ụdị ọrịa shuga 2 ọ na - apụta na ngwụsị nke ọrịa ahụ, mgbe ike nke pancreas gwụsịrị.
Refjụ insulin ma ọ bụ nnabata nke insulin, ọrịa na ọnya ọnya, ịwa ahụ, were homonụ na diuretics, na iwepu akwara na-eduga n'ọrịa hyperglycemia na ketoacidosis.
Enweghị insulin na-eduga n'ịbawanye n'ọkwa glucagon, hormone na-eto, cortisol na adrenaline n'ime ọbara, nke na-akpali nkwụsị nke glycogen na imeju na ịmepụta glucose na ya. Nke a na-eduga na mmụba nke glycemia. Na mgbakwunye, na enweghị insulin, ndakpọ nke protein na abụba na-amalite site na mmụba nke ọkwa amino acid na ọdụdụ abụba n'ime ọbara.
Ebe ọ bụ na glucose adịghị n’ime sel, ahụ gị malitere inweta ike abụba. na usoro nke mmeghachi omume ndị dị otú ahụ ketone ahu na - guzobe - acetone na organic asịd. Mgbe ọkwa ha dị elu karịa akụrụ nwere ike iwepu, ketoacidosis na-amalite n'ime ọbara. Abụba sitere n'ihe oriri riri, anaghị esonye na ketogenesis.
Ọnọdụ a juputara na oke mmiri. Ọ bụrụ na onye ọrịa enweghị ike ị drinkụ mmiri zuru oke, mgbe ahụ oke ahụ nwere ike ịbụ ihe dị ka 10% nke anụ ahụ, nke na-eduga n'ịkpa oke ahụ.
Seconddị nke abụọ nke ọrịa shuga na decompensation bụ ọnọdụ hyperosmolar na-esokarị. Ebe ọ bụ na insulin dịnụ na-egbochi ịmepụta ahụ ketone, mana ebe ọ bụ na enweghị mmeghachi omume ya, hyperglycemia na-abawanye. Mgbaàmà nke mgbụsị ọgwụ hyperosmolar:
- Mmepụta mmamịrị gabigara ókè.
- Akpịrị ịkpọ nkụ a na-apụghị inyocha.
- Ahụ erughị ala
- Etu ahu aru.
- Ọbara mgbali elu.
- Oke sodium dị n'ọbara.
Ihe na - akpata steeti hyperosmolar nwere ike ịbụ akpịrị ịkpọ nkụ nke nwere ọgwụ diuretic, vomiting, ma ọ bụ afọ ọsịsa.
E nwekwara njikọta nke ketoacidosis na hyperosmolar decompensation.
Ihe ịrịba ama nke ketoacidosis
A na-enwe mmụba nke ọrịa shuga mellitus site na mmụba nwayọ nke mgbaàmà hyperglycemia. Ketoacidosis na-etolite n'ime otu ụbọchị ma ọ bụ karịa, ebe ọnụ na-ebu nkụ na-abawanye, ọ bụrụgodị na onye ọrịa na-a drinksụ nnukwu mmiri. N'otu oge, ọrịa, isi ọwụwa, nsogbu nke eriri afọ n'ụdị ọnya afọ ma ọ bụ afọ ntachi, mgbu afọ na mgbe ụfọdụ ọgbụgbọ na-abawanye na ndị ọrịa.
Mmụba nke hyperglycemia na-eduga n’inwe nghọta, ọdịdị nke mkpọtụ na iku ume ugboro ugboro, anụ ahụ na-enwe nkụ na-ekpo ọkụ, isi nke acetone si n’ọnụ, na mgbe a na-agbanye ya na nku anya, a na-ekpughe ịdị nro ha.
Ekwesịrị ime nnwale nyocha nke na-akwado ketoacidosis na ngosipụta mbụ nke hyperglycemia. N'ime ule ọbara, a na-ekpebi mmụba shuga nke ihe karịrị 16-17 mmol / l, anụ ketone dị na ọbara na mmamịrị. N ’ụlọ ọgwụ, a na-eme ụdị ule ahụ:
- Glycemia - kwa awa.
- Ahụ dị na Ketone n'ime ọbara na mmamịrị - awa 4.
- Ọbara electrolytes.
- Ọgụgụ ọbara zuru ezu.
- Ọbara ọbara.
- Mkpebi ọbara pH.
Ọgwụ nke hyperglycemia na ketoacidosis
A na-enye onye ọrịa nwere ihe ịrịba ama ketoacidosis mmiri ọgwụ nwere saline physiological ozugbo a na-edozi insulin 20 na-adị obere oge intramuscularly.
Mgbe ahụ, a na-aga n'ihu na-enye insulin ahụ ike ma ọ bụ na akwara na ọnụego nke 4-10 nkeji kwa elekere, nke na-egbochi mmebi nke glycogen site na imeju ma na-egbochi ketogenesis. Iji gbochie idozi insulin, a na-ahụzi albumin n'otu karama.
A ga-eji nwayọ belata hyperglycemia, ebe ọ bụ na ịrịda shuga na-eto ngwa ngwa nwere ike ibute osmotic edema, karịchaa ụbụrụ ụbụrụ. N'ime ụbọchị ịchọrọ iru ogo 13-14 mmol / l. ọ bụrụ na onye ọrịa agaghị enwe ike ịri nri na aka ya, mgbe ahụ, a na - enye ya glucose 5% dịka isi iyi ike.
Mgbe onye ọrịa nwetaghachiri mmụọ, ma glycemia emeela ka ọ dị larịị nke 11-12 mmol / l, a na-atụ aro ya: moreụọkwu mmiri, ị nwere ike iri mmiri ọka, maskin poteto, akwukwo nri ma ọ bụ ihe ọka mashed ofe. Site na ụdị glycemia dị otú ahụ, a na-ahụ insulin subcutaneously na mbụ nkebi, ma emesia dị ka usoro a si chọọ.
Mgbe ị na-ewepụ onye ọrịa na steeti ketoacidosis nke ọrịa mamịrị, a na-eji ọgwụ ndị a:
- Sodium chloride 0.9% na ego nke 7-10% nke oke ahụ n'ime elekere 12 mbụ.
- Nọchiri plasma na nrụgide systolic n'okpuru 80 mm Hg. Art.
- Ọbara pasili na-achịkwa potassium kloride. Na mbu, onye ọrịa na - enweta ọgwụ ogwu nke potassium, wee mezie potassium na mbadamba otu izu.
- A na-ejikarị soda infusion emezi acidosis.
A na-eji mmiri ọgwụ sodium 0.45% mee ihe maka ịgwọ ọnọdụ hyperosmolar na etinyere insulin ma ọ bụ edepụtara ya na obere usoro onyonye. Ndụmọdụ ndị ọrịa maara Iji gbochie thrombosis, a na-enye ndị ọrịa agadi ihe heparin.
Iji gbochie mmụba nke shuga ọbara na mmepe nke ketoacidosis na ọrịa shuga, ọ ga-ekwe omume naanị na iji nlezianya na-atụle ọkwa nke glycemia, na-agbaso nri na-egbochi mmachi nke carbohydrates dị mfe, na-a waterụ mmiri zuru oke, na-edozi dose nke insulin ma ọ bụ mbadamba maka ọrịa na-abaghị uru, oke anụ ahụ, nrụgide mmetụta uche.
A na-egosi ozi banyere hyperglycemia na vidiyo dị n'isiokwu a.
