Mmepe nke hyperosmolar coma na ọrịa shuga mellitus na-apụtakarị na ndị okenye nwere ụdị ọrịa na-abụghị insulin. N'ọtụtụ nke ihe, Coma na - abụ ọnọdụ megide ọdịda nke akwara. Ọkpụkpụ akụrụ na akwara ọbara nke ụbụrụ, yana iji ụdị ọgwụ dị ka steroid na diuretics nwere ike bụrụ ihe ọzọ na-akpasu iwe. Ọgwụ ogologo oge enweghị ọgwụgwọ maka hyperosmolar coma nwere ike ibute ọnwụ.
Ihe kpatara mmepe
Isi ihe na-akpalite uto nke ụdị ọrịa mamịrị bụ imebi nguzo mmiri-mmiri eletriki (akpịrị mmiri) nke anụ ahụ yana oge nke insulin na-eme n'otu oge. N'ihi ya, ọkwa glucose ọbara onye ọrịa na-ala elu.
Enwu mmiri nwere ike ịkpalite ọgbụgbọ, afọ ọsịsa, ọnya afọ, ọbara ọgbụgba, yana oke ọkụ. Na mgbakwunye, ụkọ insulin na ndị ọrịa nwere ọrịa shuga na-abụkarị n'ihi ihe ndị a:
- oke ibu
- pathology nke pancreas (pancreatitis, cholecystitis);
- ihe ọ bụla nke ịwa ahụ;
- ajọ njehie nri;
- usoro nje na mpaghara urinary;
- ọnụọgụ glucose dị ukwuu n'ọbara mgbe a na-enye ya ọbara;
- pathology nke akwara obi (akwara, nkụchi obi).
![](http://img.diabetesentity.com/img/diab-2020/8214/diabeticheskaya-giperosmolyarnaya-koma.jpg)
Nnyocha egosila na pyelonephritis na mmụba mmamịrị na-enwe mmetụta dị mma na mmepe nke hyperosmolar coma na usoro ya. N'ụfọdụ, Coma nwere ike itolite n'ihi ị diụ diuretics, immunosuppressants, yana iwebata saline na ngwọta hypertonic. Ọzọkwa n’oge usoro ịba ọcha n’anya.
Ọrịa
Hyperosmolar coma na-amalite nwayọọ nwayọọ. Na mbido, onye ọrịa na-etolite adịghị ike dị ukwuu, akpịrị ịkpọ nkụ na oke urin. N'onye, ihe ngosi dị otú ahụ nke ọrịa na-eso akpata mmepe nke akpịrị. Mgbe ahu enwere akpukpo aru ma olu nke nkuchi anya belata nke oma. N'ọnọdụ ụfọdụ, edekọtara nnukwu ihe dị arọ.
Mmetụta nke nsụhọ na-etolite na ụbọchị 2-5. Ọ na-amalite n'ụra oké ụra ma mechie ajọ akpịrị. Ume ume mmadu na aru oru ugboro ugboro, ma odi iche na nke ketoacidotic coma, enweghi isi acetone mgbe ume iku ume. A na-egosipụta ọgbụgba nke usoro akwara ozi n'ụdị nke tachycardia, mgbu ọkụ, arrhythmia na ọbara mgbali elu.
![](http://img.diabetesentity.com/img/diab-2020/8214/diabeticheskaya-giperosmolyarnaya-koma-2.jpg)
Ihe mmepe nke hyperosmolar coma bu ụzọ ihe ịrịba ama nke shuga dị elu
Nke nta nke nta, oke mmamịrị na-ebelata, ma emesịa gbanwee gaa na oke nsogbu (mmamịrị na-akwụsị ịba).
Site n'akụkụ nke akwara ozi, imebi ndị dị otú a na-egosi:
- okwu nzuzu;
- akụkụ ahụ ma ọ bụ akụkụ ahụ́ zuru ezu;
- ẹphe adụ ike;
- na-abawanye na mgbanwe akụkụ ma ọ bụ, ọzọ, ọnụnọ ha zuru ezu;
- Ọdịdị nke ahụ ọkụ n'ihi oke ikuku nke thermoregulation.
Zọ nyocha
Isi nsogbu nke usoro nchọpụta mgbe ọrịa shuga malitere bụ na a ga-emerịrị ya ozugbo enwere ike. Ma ọ bụghị ya, onye ọrịa ahụ nwere ike ịmalite inwe nsonaazụ a na-atụgharịghị echegharị na, n'ihi nke ahụ, ọnwụ. Mmepe nke coma dị ize ndụ karịsịa, tinyere oke mbelata ọbara na sinus tachycardia.
![](http://img.diabetesentity.com/img/diab-2020/8214/diabeticheskaya-giperosmolyarnaya-koma-3.jpg)
Ọbara glucose ọbara - usoro nchọpụta ngwa ngwa maka ọrịa shuga
N’agbazighi ike, dọkịta na-eleba anya n’ihe ndị a mgbe ị na-achọpụta ọrịa:
![](http://img.diabetesentity.com/img/diab-2020/8214/diabeticheskaya-giperosmolyarnaya-koma-4.jpg)
- enweghị isi nke acetone na ikuku ekuru;
- ọbara mgbali elu;
- njirimara akwara ozi akwara nke hyperosmolar coma;
- mmebi nke mmamịrị ma ọ bụ ọnụnọ ya kpamkpam;
- ọbara mgbali elu.
Agbanyeghị, nsogbu ndị ọzọ akọwapụtara na nyocha ahụ enweghị ike ikwu maka mmepe nke ụdị ọrịa shuga dị otú a, ebe ọ bụ na ha bụ n'ọdịdị n'ọtụtụ ọrịa. Dịka ọmụmaatụ, ọkwa dị elu nke hemoglobin, sodium, chlorine, ma ọ bụ sel ọbara.
Usoro ọgwụgwọ
Fọrọ mgbe niile, usoro ọgwụgwọ ọ bụla bụ ebumnuche ịnye onye ọrịa nlekọta ahụike mberede. Ọ gụnyere nhazi iwu nke mmiri mmiri na mmiri zuru oke na osmolarity plasma. Iji mezuo nke a, mepụta usoro infusion. Nhọrọ nke ihe ngwọta dabere na ọnụọgụ sodium dị n'ọbara. Ọ bụrụ n ’itinye uche nke ihe ahụ dị elu zuru ezu, tinye ntinye gluu 2%. N'ọnọdụ ebe oke sodium dị n'etiti oke kwesịrị, a na-ahọrọ 0,55% ngwọta. N'oge usoro ahụ, mmiri mmiri na-abanye n’arụ ọbara, ọkwa glucose dị n’ọbara ji nke nta nke nta belata.
Usoro infusion a rụrụ dị ka ụfọdụ atụmatụ si dị. N’oge izizi, a na-etinye onye ọrịa ọrịa site na 1 lita 1.5 nke ihe ngwọta. N'ime awa 2 na-esote, a na-ebelata ego ya ka ọ bụrụ lita 0,5. A na-eme usoro a ruo mgbe ekpochapụrụ kpamkpam, na-enyocha olu mmamịrị na nrụgide venous mgbe niile.
N'aka nke ọzọ, ha na-eme ihe omume iji belata hyperglycemia. Maka ebumnuche a, a na-eji insulin tinye ya n'ahụ, ọ bụghị ihe karịrị nkeji 2 n'otu awa. Ma ọ bụghị ya, mbelata nke glucose na hyperosmolar coma nwere ike ịkpalite ụbụrụ. N’ime ihe ozo, enwere ike inye insulin n’olu n’ebe onodu uzo okpukpo obara ruru 11-13 mmol / L.
![](http://img.diabetesentity.com/img/diab-2020/8214/diabeticheskaya-giperosmolyarnaya-koma-5.jpg)
Mmepe nke hyperosmolar coma chọrọ ụlọ ọgwụ ọrịa ngwa ngwa
Nchikota na prognosis
Otu n'ime nsogbu ndị na-akpatakarị ụdị ọrịa shuga bụ thrombosis. Iji gbochie ya, a na-enye onye ọrịa ọrịa heparin. N'oge usoro ahụ, ndị dọkịta jiri nlezianya nyochaa ọkwa nke ọbara coagulation. Iwebata plasma-dochie ọgwụ ọgwụ albumin na-enyere aka belata ihe ize ndụ nke ịmalite ọrịa obi.
N'ọnọdụ nke nnukwu akwara okpu, a na-eme hemodialysis. Ọ bụrụ na akpịrị na-akpasu iwe nke mkpasu iwe, a na-eji ọgwụ nje eme ya.
Nnyocha nke hyperosmolar coma bụ ihe na-akụda mmụọ. Ọbụna na oge nlekọta ahụike n'oge, ọnụ ọgụgụ ọnwụ na-eru 50%. Ọnwụ onye ọrịa nwere ike ime n'ihi ọdịda akụrụ, ụba thrombosis, ma ọ bụ ụbụrụ.
Dị ka ndị a, usoro mgbochi maka hyperosmolar coma adịghị adị. Ndị ọrịa shuga kwesịrị ịtụ glucose ọbara ha n’usoro n’oge. Ọzọkwa, oriri na-edozi ahụ na enweghị àgwà ọjọọ na-arụ ọrụ dị mkpa.