Kulawa ta gaggawa ga ketoacidosis mai ciwon sukari a cikin yara da matasa

E.N.Sibileva
Shugaban Sashen ilimin likitanci, FPK na Jami'ar Likitocin Arewa, Mataimakin Farfesa, Babban Likita Endocrinologist, Ma'aikatar Lafiya, Gudanar da Yankin Arkhangelsk

Ketoacidosis mai ciwon sukari shine mafi kamuwa da kwayar cutar hanta da sauri. Wannan halin yana tattare da haɗuwa da rashin daidaituwa na karancin insulin, makomar gaba ɗaya ta haifar da haɓaka jiki na duka masu lalata insulin na ciki da na rashin haila.

Ketoacidosis yana halin:
Hy babban hauhawar jini da osmotic diuresis tare da acetonuria,
Decrease raguwa mai yawa a cikin kayyakin abubuwan da ke cikin jini saboda sinadarin catabolism,
Kawar da bicarbonates, haifar da canje-canje a cikin tushen-acid a cikin shugabanci na acidosis na rayuwa mai ƙarfi.

Haɓakar mummunan cuta na rayuwa tare da rashi insulin rashin daidaituwa yana haifar da hypovolemia, raunin ƙwayar ƙwayar potassium a cikin kyallen, da kuma haɗuwar β-hydroxybutyric acid a cikin tsarin juyayi na tsakiya. Sakamakon haka, bayyanar cututtuka na asibiti za a san shi ta hanyar mummunar cuta a cikin mahaifa, rashin haihuwa mai rauni, gazawar hankali har zuwa ƙwayar cuta, da cuta mai cuta.

A lokuta da dama, cikin yara akwai:
1. Cutarwa na ciki:
▪ hawan jini
Sodium riƙewa a cikin jiki
▪ furta rashin ruwa a jiki
K ketosis na matsakaici
2. Lactatecedemic coma - the corest coma a cocin, yawanci a cikin haɓakawarsa akwai rashin ƙarfi hypoxia tare da tara ƙwayar lactate a cikin jini.

Ciwon sukari na cutar ketoacidosis

1. Gyara karancin insulin
2. Ruwan sanyi
3. kawar da hypokalemia
4. Cire acidosis

Kafin gudanar da aikin jiyya, mara lafiya yana mamaye da heaters, bututu na nasogastric, catheter a cikin mafitsari ana sanya shi a ciki.

Gyara rashi insulin

Ana amfani da insulin gajere. Zai fi kyau gudanar da insulin ta hanyar jerawa a cikin maganin albumin 10%; idan babu layi, insulin yana cikin jet a awa. Maganin farko na insulin shine 0.2 U / kg, sannan bayan awa daya 0.1 U / kg / awa. Tare da raguwar sukari na jini zuwa 14-16 mmol / l, kashi na insulin ya ragu zuwa 0.05 U / kg / awa. Tare da rage yawan sukari na jini zuwa 11 mmol / L, muna canzawa zuwa ƙananan insulinaneous na insulin kowane 6 hours.

Bukatar insulin lokacin da aka cire daga coma shine 1-2 raka'a / kg / rana.
Hankali! Matsakaicin raguwar glucose na jini kada ya wuce 5 mmol / awa! In ba haka ba, haɓakar edema zai yiwu.

Zazzagewa

Ana lasafta ruwa a cikin shekaru:
A cikin yara na shekaru 3 na farko na rayuwa - 150-200 ml / kg nauyi / rana, gwargwadon matakin rashin ruwa,
▪ a cikin manyan yara - 3-4 l / m2 / rana
A cikin mintina 30 na farko na gabatarwar 1/10 na yau da kullun. A cikin awanni 6 na farko, 1/3 na maganin yau da kullun, cikin awanni 6 masu zuwa - dose kashi na yau da kullun, sannan kuma a ko'ina.
Yana da kyau a saka allurar ruwa tare da infusomat, idan ba ta kasance a can, ƙididdige adadin saukad da na minti daya. Ana amfani da maganin 0.9% sodium chloride bayani azaman mafita. Ya kamata a gudanar da ruwan gishiri fiye da 2 hours. Don haka wajibi ne don canzawa zuwa maganin glucose na 10% a hade tare da maganin Ringer a cikin rabo na 1: 1. Duk ruwan da aka gabatar dashi cikin ruwa yana zafi zuwa 37 ° C. idan yaro ya raunana sosai, muna amfani da maganin 10 albumin 10% kafin fara gudanar da ayyukan crystalloids a cikin nauyin 5 ml / kg, amma ba fiye da 100 ml ba, saboda colloids yafi riƙe ruwa a cikin jini.

Gyara potassium

Dole ne a tuna cewa isasshen gyaran potassium yana rage tasirin magani! Da zaran fitsari ya fara rarrabe ta cikin catheter (yana da awanni 3-4 zuwa farkon farawar), ya zama dole a ci gaba da gyaran potassium. Ana sarrafa maganin ƙwaƙwalwar ƙwayar ƙwaƙwalwar ƙwayar ƙwaƙwalwa 7.5% a cikin adadin 2-3 ml / kg / rana. An haɗa shi da ruwa mai allura a cikin adadin 2-2.5 ml na potassium chloride a cikin 100 ml na ruwa.

Gyara Acidosis

Don gyara acidosis, ana amfani da ruwan soda mai dumi 4% na soda 4 ml / kg. Idan ana iya ƙaddara BE, to, maganin bicarbonate shine 0.3-BE x nauyin yaron a cikin kilogiram.
Ana aiwatar da gyaran Acidosis a cikin sa'o'i 3-4 na jiyya, ba a baya ba, saboda maganin insulin tare da rehydration yana gyara ketoacidosis lafiya.
Dalilin gabatarwar soda shine:
Ynam m adynamia
▪ marbban fata
▪ mai zurfin numfashi

A cikin lura da ciwon sukari na acidosis, an tsara ƙananan allurai heparin Raka'a 100 / kg / rana a cikin inje 4. Idan yaro ya zo da zazzabi, ƙwayar ƙwayar cuta mai ƙwayar cuta za ta kasance kai tsaye.
Idan yaro ya zo da alamun farkon ketoacidosis (DKA I), i.e. duk da metabolic acidosis, wanda ake nuna shi a cikin gunaguni na rashin damuwa (tashin zuciya, amai), zafi, numfashi mai zurfi, amma an kiyaye hankali, ya zama dole:

1. Kurkura ciki tare da maganin 2% soda.
2. Don sanya tsabtacewa sannan kuma likita mai ƙoshin lafiya tare da maganin dumi na 2% soda a cikin adadin 150-200 ml.
3. Don aiwatar da aikin kumburi, wanda ya hada da maganin albumin, bayani na kimiyyar lissafi, idan matakin glucose bai wuce 14-16 mmol / l ba, to ana amfani da mafita na glucose 10% da Ringer a cikin rabo na 1: 1. Jiko farji a wannan yanayin ana yin lissafin yawan sa'o'i 2-3 akan bukatun yau da kullun, saboda daga baya, zaku iya canzawa zuwa rehydration na baki.
4. Ana yin insulin a cikin kudi na 0.1 U / kg / h, lokacin da glucose matakin shine 14-16 mmol / L, kashi shine 0.05 U / kg / h kuma a matakin glucose na 11 mmol / L muna canzawa zuwa gudanarwar subcutaneous.

Dabarar gudanar da yaro bayan dakatar da ketoacidosis

1. Don kwanaki 3 - abincin No. 5 ba tare da mai ba, sannan tebur 9.
2. Shaye-shaye masu yawa, gami da maganin alkaline (ruwan ma'adinai, maganin maganin 2% soda), ruwan 'ya'yan itace waɗanda ke da launi mai ruwan-orange, saboda sun ƙunshi adadin mai yawa na potassium.
3. Ta bakin baki, 4% potassium chloride bayani, 1 dess.-1 tebur. cokali sau 4 a rana don kwanaki 7-10, saboda gyaran hypokalisthia lokaci ne mai tsawo.

4. An wajabta insulin a cikin injections 5 a cikin yanayin da ke gaba: a 6 a.m., sannan sannan kafin karin kumallo, abincin rana, abincin dare da dare. Kashi na farko shine raka'a 1-2, kashi na karshe shine raka'a 2-6, a farkon rabin rana - 2/3 na yawan yau da kullun. Girman yau da kullun daidai yake da kashi don kawarwa daga ketoacidosis, yawanci 1 U / kg nauyin jiki. Ana aiwatar da irin wannan maganin insulin na kwanaki 2-3, sannan sai a juyar da yaro zuwa ilmin likitancin bolus na asali.

Lura Idan yaro da ke da ketoacidosis mai tasowa yana da haɓaka cikin zazzabi, an tsara maganin rigakafi na ƙwayar cuta. Dangane da rikice-rikice na hemostasis wanda ya haifar da haɓakar hypovolemia da acidosis na rayuwa, an wajabta heparin a cikin kullun na 100 U / kg na nauyin jiki don rigakafin yaduwar cututtukan jijiyoyin bugun jini. Ana rarraba maganin akan allura 4, ana gudanar da maganin ne ƙarƙashin kulawar coagulogram.