Nlekọta ihe mberede maka coma mamịrị

Ọrịa shuga bụ nnukwu nsogbu nke ọrịa shuga, yana nnukwu glycemia, nke na-ebilite ụkọ insulin zuru oke ma ọ bụ nke dị ala ma chọọ enyemaka ozugbo. A na-ahụta ọnọdụ ahụ dị egwu, nwere ike ịmalite ngwa ngwa (na awa ole na ole) ma ọ bụ ogologo oge (ruo ọtụtụ afọ).

Usoro nlekọta mberede maka ọrịa shuga na-enwe nkebi abụọ:

• tupu ọgwụgwọ - ọ na-abụ ịbụ ndị ikwu nke onye ọrịa ma ọ bụ naanị ndị nọ nso;
• ọgwụ - nnweta ahụike ahụike sitere n’aka ndị nnọchi anya otu ụgbọ ihe mberede na ndị ọrụ nke ụlọọgwụ.

Pesdị coma

Ejiri ọnọdụ ketoacidotic site na nguzo acetone (ketone) nwere ọnụọgụ dị ukwuu n'ọbara na mmamịrị. Mgbagha na-ebilite ụdị ụdị insulin na-akpata “ọrịa na-atọ ụtọ”.

A na - ejikọ pathogenesis nke coperosmolar coma na oke mmiri na oke oke osmolarity. Ọ na - etolite n'ime ndị ọrịa nwere ụdị ọrịa na - apụtaghị insulin.

Ọdịiche na mgbaama

Ngosiputa ogwu nke udiri oria abuo ndi mmadu gosiputara:

• ọnya ọgbụgba;
• mmetụta nke akpọnwụ akpọnwụ;
• polyuria;
• ọdụ ọdịdọ;
• ọgbụgbọ na ọgbụgbọ
• mgbu n'ime afọ.

Isi nke acetone bụ ngosipụta nke na-achọpụta ọdịiche dị na ketoacidosis na ọnọdụ ndị ọzọ siri ike

Isi ihe dị mkpa na ịkọwapụta steeti na ibe ya bụ ọnụnọ nke isi acetone na ikuku nwere oke n'oge ketoacidosis na enweghị ya na hyperosmolar coma. Ngosipụta nke a bụ ihe na-egosi ọnụnọ nke ọnụnọ ketone dị elu.

Usoro ndị ọzọ

Ọgwụ tupu ahụ ike

Ihe enyemaka mbụ maka ụdị ọria mamịrị kwesịrị ịmalite site na usoro ihe omume ruo ọbịbịa nke ndị ọkachamara ruru eru.

Gịnị bụ glycemia na ọrịa shuga

1. Ekwesịrị itinye onye ọrịa ahụ n’elu ala kwụ ọtọ n’enweghị mbuli elu.
2. Imeghe akwa ma ọ bụ wepu akụkụ ndị ahụ nke akwa mkpuchi elu nke mepụtara ihe mgbochi iji nyere aka.
3. Site na ume mkpụmkpụ na iku ume miri emi, mepe windo ka enwere ike ikuku dị mma.
4. Nyochaa mgbe niile maka ihe ịrịba ama dị mkpa tupu ọbịbịa nke ụgbọ ihe mberede (ọsịsọ, iku ume, mmeghachi omume na-akpasu iwe). Ọ bụrụ na ọ ga-ekwe omume, dekọ data iji wee nye ya ndị ọkachamara ruru eru.
5. Ọ bụrụ na njide iku ume ma ọ bụ ahụ ike, gaa ozugbo ịmalitegharị cardiopulmonary. Mgbe onye ọrịa nwetasịrị onwe ya, ahapụkwala ya aka.
6. Kpebisie ike na ọnọdụ nke onye ọrịa. Jụọ aha ya, afọ, ebe ọ nọ, onye nọ ya nso.
7. Mgbe mmadụ na-agbọ ọfụma, ọ gaghị ekwe omume ibuli, a ga-atụgharị isi ya n'akụkụ ya ka ọ ghara ịpịa mmadụ.
8. N'ihe banyere ọgụ mkparị, a na-atụgharị ahụ onye ọrịa n'akụkụ ya, a na-etinye ihe siri ike n'etiti ezé (amachibidoro iji ọla).
9. Chọọ, need ga-eji okpomoku kpo oku mmadu.
10. Ọ bụrụ na onye ọrịa ahụ nọ na ọgwụ insulin ma nwee uche zuru oke, nyere ya aka ka gbaa ya ọgwụ.

Oge ilebara ndị ọrịa mamịrị ọgụ oge bụ ihe nkwa dị mma ga-esi na ya pụta

Ketoacidotic coma

Ihe algorithm nke ntinye aka na ọkwa ahụike dabere na mmepe nke coma na ọrịa shuga mellitus. Nlekọta ahụike mberede na ntanetị ebe a gụnyere ịchekwa nasogastric tube iji wee chọọ afọ ya. Ọ bụrụ na ọ dị mkpa, a na-etinye intubation na saturation nke ahụ na ikuku oxygen (ikuku oxygen).

Usoro ọgwụgwọ insulin

Ntọala nke nlekọta ahụike ruru eru bụ omume nke ọgwụgwọ insulin. Naanị na-eji homonụ dị mkpụmkpụ, nke a na-ahụ na obere doses. Nke mbu, tinye ihe ruru 20 IU nke ogwu n’ime akwara ma obu tinye ya n’azu, mgbe obula obula maka 6-8 IU nwere ihe nlere n’oge mbu.

Ọ bụrụ na glycemia anaghị agbasa n'ime awa 2, insulin insulin okpukpu abụọ. Mgbe nyocha ụlọ nyocha gosipụtara na ọkwa shuga eruola 11-14 mmol / l, ego nke homonụ ahụ ji ọkara belata ma gharazie inye ya na physiology, mana na gluu nke 5% ịta. Site n’ibelata mgbakwunye na glycemia, ọ̀tụ̀tụ̀ homonụ ahụ na-agbadata ya.

Mgbe ndị gosipụtara erutela 10 mmol / l, a malitere inye ọgwụ ọgwụ homonụ n'ụzọ ọdịnala (subcutaneously) kwa awa anọ. Usoro ọgwụgwọ dị otú ahụ kpụ ọkụ n'ọnụ na-adịgide ruo ụbọchị 5 ma ọ bụ ruo mgbe ọnọdụ onye ọrịa ahụ ka ọ ka mma.

Nnwale ọbara - ikike ịchịkwa shuga ọbara

Dị Mkpa! Maka ụmụaka, a na-agbakọ dose ahụ dị ka ndị a: otu ugboro 0.1 UNITS kwa kilogram nke ịdị arọ, mgbe ahụ otu ego kwa awa na akwara ma ọ bụ intravenously.

Friza

A na-eji usoro ndị a iji weghachi mmiri dị n'ahụ, nke infusion na-eduzi:

• sodium chloride 0.9%;
• glucose nke 5% ịta;
• Ringer-Locke.

A naghị eji Reopoliglyukin, Hemodez na ụdị ngwọta ndị ọzọ, nke mere na ihe ngosi osmolarity egosi adịghị abawanye. A na-agbanye mmiri 1000 ml nke mbụ n'ime nlekọta ndị ọrịa, nke abụọ n'ime awa 2, nke atọ n'ime awa anọ. Ruo mgbe mmiri ga - akwụghachi akpukpọ ahụ, mmiri ọ bụla dị 800-1000 mil ga-enye n'ime awa 6-8.

Ndozi nke acidosis na itule electrolyte

A na - eweghachi ndị na - egosipụta acid acid karịa 7.1 site na ntinye nke insulin na usoro mmiri mmiri. Ọ bụrụ na ọnụ ọgụgụ ndị ahụ pere mpe, a na-edozi sodium bicarbonate 4% na ntanetị. A na-etinye enema site na otu ihe ngwọta ma na-asa afọ ma ọ bụrụ na ọ dị mkpa. N’otu aka ahu, achoro choro nke potassium chloride na mkpesa 10% (ana atule ogwu a n’otu n’otu dabere na bicarbonate agbakwunye).

Ọgwụ infusion bụ akụkụ nke usoro ọgwụgwọ zuru oke maka coma mamịrị

Iji weghachi potassium na ọbara, a na-eji potassium chloride. A na-akwụsị ọgwụ ahụ mgbe ọkwa nke ihe ahụ ruru 6 mmol / L.

Usoro ndị ọzọ

Ọ mejupụtara usoro ndị a:

1. Obere usoro insulin ruo mgbe a ga-enweta ọkwa achọrọ.
2. 2.5% sodium bicarbonate ngwọta intravenously na-ahazi acidity ọbara.
3. Na ọnụọgụ ọbara dị ala - Norepinephrine, Dopamine.
4. Cerebral edema - diuretics na glucocorticosteroids.
5. Ọgwụ antibacterial. Ọ bụrụ na anya a na-ahụ anya n’ọrịa anya, mgbe ahụ, a na-enye onye nnọchi anya nke penicillin otu, ọ bụrụ na ọrịa a dị, a na-agbakwunye Metronidazole na ọgwụ nje.
6. Ọ bụ ezie na onye ọrịa ahụ na-ahụ izu ike ụra - usoro ọgwụgwọ heparin.
7. Kwa awa 4, a na-enyocha ọnụnọ nke urination, na - anọghị ya - catheterization nke eriri afo.

Hyperosmolar coma

Ndị otu ụgbọ ihe mberede na-ewepụta ụdọ nasogastric ma na-achọkwa ihe dị n'ime afọ. Ọ bụrụ na ọ dị mkpa, a na-etinye intubation, ọgwụ oxygen, resuscitation.

Atụmatụ nke inye nlekọta ahụike:

• Iji weghachi ihe ngosi osmolarity egosi, a na-eme usoro ọgwụgwọ infusion dị ukwuu, nke na-amalite site na usoro hypotonic sodium chloride. N’oge izizi, a na-awụnye lita mmiri 2, lita 8-10 ọzọ na-agbanye n’ime awa iri abụọ na anọ sochirinụ.
• Mgbe shuga ruru 11-13 mmol / l, a na-etinye mmiri glucose n'ime akwara iji gbochie hypoglycemia.
• A na - etinye insulin n'ime akwara ma ọ bụ na akwara n'ime ego nke 10-12 (otu oge). Ọzọkwa gaa na 6-8 EGO kwa awa.
• Ndị na-egosi potassium na ọbara dị n'okpuru nkịtị na-egosi mkpa maka iwebata potassium chloride (10 ml kwa 1 lita nke sodium chloride).
• Usoro ọgwụgwọ Heparin ruo mgbe onye ọrịa malitere ịmalite ije ije.
• Site na mmepe nke ụbụrụ ụbụrụ - Lasix, homonụ adrenal.

Lọ ọgwụ onye ọrịa bụ ihe dị mkpa maka mmepe nke nnukwu nsogbu oria shuga

Iji kwado ọrụ nke obi, a na-agbakwunye cardiac glycosides na dropper (Strofantin, Korglikon). Iji meziwanye usoro metabolic na oxidative - Cocarboxylase, vitamin C, otu B, glutamic acid.

Ihe di ezigbo mkpa bu nri nri nke ndi obia mgbe emesiri onodu ha ike. Ebe ọ bụ na eweghachiri mmụọ zuru oke, a na-adụ ya ọdụ ka ọ rụọ ọrụ carbohydrates digestible - semolina, mmanụ a honeyụ, jam. Ọ dị mkpa ị drinkụ ọtụtụ - ihe ọicesụ (ụ (site na oroma, tomato, apụl), mmiri alkaline na-ekpo ọkụ. Na-esote, gbakwunye ofe, nkpuru mmiri ara, akwukwo nri na nkpuru osisi. N’izu ahụ, emeghị ka amị ihe oriri na protein dị n’etiti ụmụ anụmanụ banye n’ime nri.