Kulawar gaggawa don cutar ketoacidotic saboda cutar sankara
| Ketoacidosis mai ciwon sukari | |
|---|---|
 Tsarin sunadarai na jikin ketone ukun: acetone, acetoacetic, da beta-hydroxybutyric acid. | |
| ICD-10 | E 10.1 10.1, E 11.1 11.1, E 12.1 12.1, E 13.1 13.1, E 14.1 14.1 |
| ICD-9 | 250.1 250.1 |
| Cututtuka | 29670 |
| eMedicine | med / 102 |
Ketoacidosis mai ciwon sukari (ketoacidosis) Shin wani bambance bambancen metabolic acidosis yana hade da cin zarafin ƙwayar carbohydrate wanda ya haifar da rashi na insulin: babban taro na glucose da jikin ketone a cikin jini (ƙimar dabi'un abubuwa masu mahimmanci) wanda aka kirkira sakamakon lalacewar metabolism na mai acid (lipolysis) da kuma lalata amino acid. Idan keta rikicewar metabolism ba ta tsayawa a cikin lokaci mai dacewa, cutar ketoacidotic mai ciwon sukari ta haɓaka.
Ketoacidosis marasa ciwon sukari (cututtukan acetonemic a cikin yara, ciwo na cyclic acetonemic vomiting, vomiting acetonemic) - wani alamun bayyanar cututtuka wanda ya haifar da ƙaruwa cikin taro na jikin ketone a cikin jini na jini - yanayin cututtukan cututtukan da ke faruwa a cikin yara, wanda aka nuna shi ta hanyar maimaita yanayin tashin hankali, wani lokaci mai cike da nutsuwa. Yana tasowa sakamakon kurakurai a cikin abincin (tsayayyen dogon hutu ko yawan cin abinci mai ƙima), kazalika da tushen yanayin somatic, kamuwa da cuta, cututtukan endocrine da lalacewar tsarin juyayi na tsakiya. An bambanta Primary (idiopathic) - yana faruwa a cikin 4 ... 6% na yara masu shekaru 1 zuwa 12 ... shekaru 13 da sakandare (saboda cututtukan) ciwo na acetonemic.
A yadda aka saba, a cikin jikin mutum, sakamakon babban metabolism, ana amfani da jikin ketone koyaushe kuma amfani da kyallen (tsokoki, kodan):
Sakamakon daidaitawar ƙarfin aiki, yawan haɗuwarsu a cikin plasma na jini ba shi da kyau.
Etiology
Ketoacidosis na masu fama da cutar sankara yayin farko a tsakanin manyan matsalolin cututtukan cututtukan endocrine, mace-macen ya kai 6 ... 10%. A cikin yara masu ciwon sukari-dogara da sukari mellitus, wannan shine mafi yawan sanadin mutuwa. Duk shari'ar wannan yanayin za'a iya kasu kashi biyu:
- ciwon sukari mai cutar sankara - yanayin da ake samu ta hanyar karuwar jikin ketone a cikin jini da kyallen takarda ba tare da nuna illa mai guba da faruwar cutar rashin ruwa a jiki ba,
- cutar ketoacidosis - a cikin yanayin rashin karancin insulin a cikin lokaci ta hanyar sarrafawa ko kuma abubuwanda ke haifar da karuwar lipolysis da ketogenesis ba a cire su ba, tsarin tafiyar ya ci gaba kuma yana haifar da ci gaban ketoacidosis na asibiti.
Don haka, bambance-bambancen pathophysiological na waɗannan yanayin suna raguwa zuwa tsananin yanayin rikice-rikice na rayuwa.
Shirya Etiology |
Cutar Ketoacidotic don kamuwa da cutar siga
Mafi yawan rikicewar cututtukan cututtukan cututtukan zuciya shine ketoacidotic coma. Dangane da ƙididdigar daban-daban, 1-6% na masu ciwon sukari suna fuskantar wannan cuta. Matakin farko, ketoacidosis, an canza shi ta hanyar canje-canjen ƙwayoyin cuta a cikin jikin mutum. Idan ba a tsayar da wannan yanayin a cikin lokaci ba, rikicewar ciki na tasowa: babban motsi a cikin tafiyar matakai na rayuwa yana faruwa, asarar hankali, ayyuka na tsarin juyayi, ciki har da na tsakiya, suna rushewa. Marasa lafiya na buƙatar kulawa ta gaggawa da isar da saurin zuwa wurin likita. Tsinkayar cutar ta dogara ne da matakin coma, lokacin da ba a san komai ba, da kuma damar raunin jiki.
A cewar kididdigar, 80-90% na marasa lafiya da aka shigar da su asibiti a cikin yanayin ketoacidotic coma zasu iya samun ceto.
Cutar Ketoacidotic - menene?
Irin wannan nau'in kwayar cuta yana nufin rikicewar cututtukan zuciya na cututtukan zuciya. Waɗannan rikice-rikice ne da ke farawa saboda hauhawar jini - hawan jini mai yawa. Wannan nau'in kwayar cutar cuta ce ta haɓaka cikin hanzari a cikin kowane nau'in metabolism, motsawa cikin daidaitawar ruwa da ƙwayoyin lantarki a cikin jiki, da kuma take hakkin ma'aunin acid-base na jini. Babban bambanci tsakanin ketoacidotic da sauran nau'in coma shine kasancewar jikin ketone a cikin jini da fitsari.
Yawancin hadarurruka sakamakon rashi na insulin:
- cikakke, idan kansa kansa hormone ba hada, kuma ba maye gurbin magani ba da za'ayi,
- dangi lokacin da insulin yake, amma saboda karfin jarin insulin ne kwayoyin jikinsu suke ganewa.
Yawancin lokaci coma na tasowa da sauria cikin 'yan kwanaki. Sau da yawa, ita ce ta farkon alamar nau'in ciwon sukari na 1. Tare da nau'in insulin-mai cuta na cutar, rikice-rikice na iya tarawa a hankali, tsawon watanni. Wannan yakan faru ne lokacin da mara lafiya bai biya kulawa ba saboda magani kuma ya daina auna glycemia a kai a kai.
Pathogenesis da haddasawa
Tsarin ƙwayar ƙwayar cuta na coma yana dogara ne akan yanayin rikice-rikice - ƙwayoyin jikin mutum suna matsananciyar yunwar, yayin da akwai babban matakin glucose a cikin jini, babban tushen samar da makamashi.
Sakamakon hauhawar sukari, yawan jini yana ƙaruwa, wanda shine adadin adadin barbashi da aka narke a ciki. Lokacin da matsayinta ya wuce miliyan 400 / kilogiram, kodan sun fara cire ƙwayar glucose mai yawa, suna shafawa kuma cire su daga jiki. Yawan fitsari yana ƙaruwa sosai, ana rage yawan ƙwayar ciki da sauran abubuwa saboda tasirinsa zuwa tasoshin. Fitsari yana farawa. Jikin mu yana amsa shi ta hanya daidai: yana dakatar da fitar fitsari domin ya kiyaye sauran ruwa. Yawan jini yana raguwa, dan ganinsa yana ƙaruwa, yana farawa jini clots.
A gefe guda, sel waɗanda ke fama da yunwa sun tsananta yanayin. Don rama don rashin ƙarfi, hanta yana jefa glycogen cikin jini mai daɗin rai. Bayan yankewar ajiyar ajiyar, fatima ta fara yin aiki. Yana faruwa tare da samuwar ketones: acetoacetate, acetone da beta-hydroxybutyrate. Yawanci, ana amfani da ketones a cikin tsokoki kuma an keɓance su a cikin fitsari, amma idan da yawa daga cikinsu, insulin bai isa ba, kuma urination yakan tsaya saboda ƙonewa, sai su fara tarawa a cikin jiki.
Cutar yawan taro na jikin ketone (ketoacidosis):
- Ketones suna da sakamako mai guba, saboda haka mai haƙuri yana fara amai, raɗaɗin ciki, alamun sakamako akan tsarin juyayi na tsakiya: na farko, tashin hankali, sannan kuma rashin farin ciki na farkawa.
- Abubuwan acid ne masu rauni, sabili da haka, tara ketones a cikin jini yana haifar da wuce haddi na rogen hydrogen ion a ciki da kuma rashin sodium bicarbonate. A sakamakon haka, pH na jini ya ragu daga 7.4 zuwa 7-7.2. Acidosis yana farawa, tare da hana zuciya, juyayi da tsarin narkewa.
Saboda haka, karancin insulin a cikin ciwon sukari yana haifar da hyperosmolarity, canzawa cikin ma'aunin acid-base, bushewa, da guba na jiki. Hadaddun wadannan rikice-rikice yana haifar da ci gaba da ƙwayar cuta.
Matsaloli masu iya haifar da kwaro:
- aka rasa farkon nau'in ciwon sukari 1,
- da wuya ku mallaki sukari a kowane irin sukari,
- rashin ingancin ilimin insulin: kurakurai a cikin lissafin kashi, injections skipping, alkalami na kwance mara kyau ko ƙare, gurbata, insulin da ba shi dace.
- mai karfi wuce haddi na carbohydrates tare da babban GI - nazarin tebur na musamman.
- Rashin insulin saboda karuwar kwayar halittar antagonist, wanda yake yiwuwa tare da raunin da ya faru, cututtuka masu wahala, damuwa, cututtukan endocrine,
- magani na dogon lokaci tare da steroids ko antipsychotics.
Alamar ƙwayar cutar ketoacidotic
Ketoacidosis yana farawa ne daga ɓarkewar ƙwayar cutar sankarar bargo - hauhawar sukari cikin jini. Alamar farko tana da alaƙa da haɓaka cuta: ƙishirwa da haɓaka yawan fitsari.
Rage tashin zuciya da taushi suna nuna karuwa a cikin ƙwayar ketone. Ana iya sanin Ketoacidosis a wannan lokacin ta amfani da tsaran gwaji. Yayinda matakin acetone ya tashi, raunin ciki yana farawa, sau da yawa tare da alamar Shchetkin-Blumberg: ƙwaƙwalwar tana ƙaruwa lokacin da likitan ya matsa ciki da sauri kuma ya cire hannunsa. Idan babu wani bayani game da ciwon sukari a cikin mai haƙuri, kuma ba a auna matakan ketones da glucose ba, irin wannan zafin zai iya zama kuskure ga appendicitis, peritonitis, da sauran hanyoyin kumburi a cikin peritoneum.
Wata alama ta ketoacidosis shine haushi daga cibiyar numfashi kuma, a sakamakon haka, bayyanar numfashin Kussmaul. Na farko, mai haƙuri yana sha iska sau da yawa kuma a sama, sannan numfashi ya zama da wuya kuma yana da amo, tare da ƙanshin acetone. Kafin kirkirar shirye-shiryen insulin, wannan alama ce ta nuna cewa ketoacidotic coma yana farawa kuma kusan mutuwa.
Alamun rashin ruwa a jiki fata ne bushe da mucous membranes, rashin yawan ƙoshin ruwa da hawaye. Urgwan fata shima yana raguwa, idan kuka tsinke shi a cikin wani cakuda, zai dawo da hankali kamar yadda aka saba. Sakamakon asarar ruwa ta hanyar kilo da yawa, nauyin jikin mai ciwon sukari yana raguwa.
Sakamakon raguwa a cikin karfin jini, ana iya lura da rushewar orthostatic: mai haƙuri ya sauke matsin lamba yayin canji mai ƙarfi a cikin yanayin jikin mutum, don haka ya yi duhu a idanu, mai narkewa. Lokacin da jiki ya daidaita da sabon matsayi, matsin lambar ya zama daidai.
Alamomin dakin gwaje-gwaje na dakunan gwaje-gwaje
| Alamar | Daraja | |
| Hyperglycemia, mmol / L | > 18, yawanci kusan 30 | |
| Ragewa a cikin jini pH | 6,8-7,3 | |
| Rage jini na bicarbonate, meq / l | 300, 3 | |
Cutar Coma - saukarwar zafin jiki, kasala na tsokoki, zalunci na sassauci, rashin tunani, nutsuwa. Mai ciwon sukari yana asarar sani, da farko yana iya murmurewa na ɗan lokaci, amma yayin da kwayar tayi zurfi, ta daina ba da amsa ga kowane haushi.
Bayyanar cututtuka
Domin gano cutar ketoacidosis da tawayar lokaci a gaba, mai haƙuri da ciwon sukari yana buƙatar auna glucose jini a cikin kowane yanayi mai shakka:
- tare da tashin zuciya
- tare da raunin ciki na kowane irin tsananin da yanayin,
- tare da warin acetone daga fata, lokacin numfashi,
- idan ƙishirwa da rauni sun lura a lokaci guda,
- idan an yi karancin numfashi,
- tare da m cututtuka da kuma exacerbation na na kullum.
Idan an gano hyperglycemia sama da 13, marasa lafiya da ke cikin insulin ya kamata su yi allurar rigakafin miyagun ƙwayoyi, tare da nau'in ciwon sukari na 2, ware carbohydrates kuma ɗaukar wakilai na hypoglycemic. A cikin halayen guda biyu, kuna buƙatar duba glucose na jini a kowace awa, kuma tare da ƙarin haɓakawa, da sauri neman taimakon likita.
Bayyanar cututtuka a cikin bangon asibiti yawanci ba shi da wahala idan likita yana sane cewa mara lafiyar yana da ciwon sukari. Don yin nazarin cutar “ketoacidotic coma”, ya isa yin ilimin halittar jini da na urinalysis. Babban ma'aunin shine hyperglycemia, sukari da ketones a cikin fitsari.
Idan coma ta haifar da ciwon sukari, ana yin gwajin ketoacidosis lokacin da mai haƙuri yana da alamun rashin ruwa, yanayin halayya, asarar nauyi.
An rarraba coma na Ketoacidotic zuwa matakai bisa ga alamomin masu zuwa:
| Alama | Coma mataki | ||||
| ketoacidosis | precoma | coma | |||
| Halin mumbus membranes | Dry | Dry, launin ruwan kasa | Dry, tare da crusts, sores a kan lebe | ||
| Hankali | Babu canzawa | Damuwa ko nutsuwa | Sopor | ||
| Fitsari | Babban girma m | Smallarami ko a'a | |||
| Amai | Da wuya, tashin zuciya yana wurin. | Akai-akai, hatsi mai ruwan kasa | |||
| Numfashi | Babu canzawa | Jin, babbar murya, zafin yana iya kasancewa | |||
| Kirga jini, mmol / l | glucose | 13-20 | 21-40 | ||
| ketones | 1,7-5,2 | 5,3-17 | |||
| bicarbonates | 22-16 | 15-10 | ≤ 9 | ||
| pH | ≥ 7,3 | 7,2-7,1 | Don kawai 147 rubles!
Don dawo da ma'aunin ruwa, ana auna mai haƙuri kuma ana sanya masu juji tare da sodium chloride: 10 ml a kowace kilogiram na nauyi, tare da matsanancin ƙoshin ruwa - 20 ml, tare da girgiza hypovolemic - 30 ml. Idan bayan wannan bugun ya zama mai rauni, za'a maimaita jiyya. Lokacin da fitsari ya bayyana, an rage sashi. Ana iya kulawa da mara lafiyar mai cutar sankara ta kowace rana. babu fiye da 8 l na ruwa. Harkokin insulinAna yin babban insulin na sukari (> 30) a lokaci guda kamar yadda zazzabin bushewar fata. Idan karancin ruwa mai mahimmanci ne, kuma sukari bai wuce 25 ba, ana fara aiwatar da insulin a ƙarshen don hana hypoglycemia saboda haɗuwar jini lokaci guda da kuma canza glucose cikin sel.
Ana amfani da insulin kawai. Don gabatarwarsa, ana amfani da infusomat - na'urar da ke ba da cikakkiyar ingantacciyar kwararar magunguna a cikin jijiya. Aikin ranar farko na jiyya shine rage sukari zuwa 13 mmol / l, amma ba sauri fiye da 5 mmol / l a awa daya. An zaɓi kashi ɗaya daban-daban dangane da matakin sukari a cikin haƙuri da gaban kasancewar insulin juriya, yawanci kusan raka'a 6 a kowace awa. Idan mai haƙuri bai sake yin tunani ba na dogon lokaci, ana saka insulin da glucose don rage ƙoshin makamashi. Da zaran mai ciwon sukari ya fara cin abinci da kanshi, sai ya narke da sarrafa iskar. Idan ƙwayar ketoacidotic ta faru a cikin cututtukan da ba su da insulin-insulin, bayan sake farfadowa mara lafiya ba dole ne ya canza zuwa insulin ba, za a bar shi tare da magani na baya - abinci na musamman da magunguna masu rage sukari. Yin rigakafin QCMai haƙuri ne kawai mai haƙuri da kansa zai iya hana coma. Babban yanayin shine biyan diyya na cutar. Matsa kusa da matakin sukari zuwa makasudin, ƙarancin rikicewar rikicewar cutar. Idan glucose sau da yawa ya wuce 10, ko ma 15 mmol / l, kowane karkacewa daga hanyar rayuwa na yau da kullun na iya haifar da rashin lafiya: rashin lafiya, rashin lafiyar abinci, tashin hankali mai tsanani. Kada kayi ƙoƙarin shawo kan matsalar rashin wari wanda zai fara shi kaɗai idan kana jin bacci ko gajiya sosai. Kwarewa cikin wannan halin na iya shuɗewa cikin mintina kaɗan. Idan kana da yawan sukari kuma kana jin rashin lafiya, kira motar asibiti, kira maƙwabta, buɗe ƙofar gaban don likitoci su hanzarta shiga cikin ɗakin idan ba za ka iya tashi daga gado ba. Sanar da kanka da kowane nau'in ciwon sukari, kuma bar danginka su karanta game da su. Buga ka'idojin taimakon farko, sanya su a cikin sanannen wuri. A cikin fasfot ɗinku, walat ko allon waya, sanya bayani game da nau'in ciwon sukari, wajabta magani da sauran cututtuka. Sanar da abokan aiki da abokai cewa kuna da ciwon sukari, gaya mani irin alamun cututtukan da kuke buƙatar kiran motar asibiti. Theaƙƙarfan cutar coma ya dogara da daidaitattun ayyukan wasu da likitocin gaggawa. Matsaloli da ka iya yiwuwaMafi haɗarin rikitarwa na cutar ketoacidotic shine ƙwaƙwalwar ƙwayar cuta. Yana farawa a cikin awanni 6-48. Idan mai haƙuri bai san komai ba a wannan lokacin, kumburi yana da matukar wuya a gane shi. Ana iya zargin shi ta hanyar rashin ƙarfin aiki mai mahimmanci, wanda aka tabbatar ta hanyar duban dan tayi ko CT na kwakwalwa. Edema yana farawa mafi yawan lokuta lokacin da ake yin magani mai zurfi na ketoacidotic tare da cin zarafi: sukari yana raguwa da sauri fiye da yadda aka dawo da ƙarancin ruwa, kuma ana kawar da ketones. Idan ketoacidosis mai tsananin ƙarfi da matakin glucose na ƙasa da 8 mmol / l sunci gaba, haɗarin maƙarƙashiyar mahimmiyyar haɓaka shine mafi girma. Sakamakon edema karuwa ne sau biyu a cikin hadarin mutuwa daga ƙonewa, mummunan matsalolin jijiyoyin jiki, har zuwa ciki har da lalata jiki. Matsalar yiwuwar gurgunta magana, rasa magana, rashin lafiyar kwakwalwa. Har ila yau, rikice-rikicen ƙwayar cuta na ciki sun hada da babban yawan ƙwayoyin cuta, gudawar zuciya da gazawar koda, amai da gudawa, amai da rashin bacci. Tabbatar koya! Shin kuna tsammanin kulawa da kwayoyin hana daukar ciki da insulin shine hanya daya tilo da za'a kula da sukari? Ba gaskiya bane! Kuna iya tabbatar da wannan da kanku ta hanyar fara amfani da shi. kara karantawa >> Kulawar gaggawa
Idan ya cancanta, ya kamata su fahimci abin da ake buƙata daga gare su. Algorithm don farawar ketoacidotic coma shine kamar haka:
Lokacin da motar asibiti ta isa, likitocin zasuyi wadannan ayyukan:
Bayan wannan, nan da nan aka kwantar da marassa lafiya zuwa asibiti. Yawanci, ana tura irin waɗannan marasa lafiya zuwa sashin kulawa mai zurfi. Duk matakan da suka dace na warkewa ana yin su a can. Siffofin jiyyaKulawa da marasa lafiya da alamun bayyanar cutar ketoacidotic ko tare da mummunar siffar ta na buƙatar asibiti cikin gaggawa. Ana tura waɗannan mutane zuwa sashin kulawa mai zurfi, inda suke ƙarƙashin kulawar likitocin da ke halartar koda yaushe. Bayan haka, ana gudanar da rarrabuwa a kan cutar. Don bambanta magabata daga coma, ana gudanar da ƙananan ƙwayar insulin na 10 - 10-20 ga mai haƙuri. Sauran magungunan warkewa ana sanya su ne kawai bayan an sami ingantaccen ganewar asali. Jiyya don cutar sikari na buƙatar maye gurbin insulin kai tsaye. Wannan zai taimaka wajen daidaita matakan sukari na jini, wanda ke haifar da haɓaka gaba ɗaya cikin walwala. Bayan wannan, ana ba mai haƙuri maganin sodium wanda ke taimakawa kawar da rashin ruwa a jiki.
Bayan wannan, ƙwararren likita yana bincika matakin glucose na jini a kowace awa, bayan haka yana yin alƙawarin da ya dace. Tare da haɓakawa a cikin yanayin, kashi na insulin a hankali yana raguwa. Don kawar da alamun bayyanar rashin ruwa na jiki gaba ɗaya, tare da coma mai ciwon sukari, ana saka adadin ruwa mai yawa a cikin jijiya a cikin jijiya. Da farko, ana amfani da maganin sodium chloride don wannan dalili. Dole ne a ɗauka a zuciya cewa, dangane da tsawon lokacin da aka yi amfani da shi, ragin gudanarwa na miyagun ƙwayoyi ya bambanta. Lokacin da hankalin mai haƙuri ya koma al'ada, maganin jiko yana tsayawa. Kurakurai na jiyya
Kulawa da haƙuriLokacin da haƙuri yana cikin ƙwayar ketoacidotic, ana kula dasu koyaushe. Likita yakamata yasan yadda jikinsa yake aiki domin ya daidaita yanayin kulawa. Ana gudanar da iko kamar haka:
An bayyana irin wannan mummunan kula da mai haƙuri ta hanyar gaskiyar cewa mai haƙuri na iya samun rikitarwa a kowane lokaci. Za'a iya kiran mafi yawan sakamakon rashin lahani na ƙwayar cutar ketoacidotic
Matsaloli da ka iya yiwuwaCutar Ketoacidotic mummunan sakamako ne na ciwon sukari. Idan ba a kula da lafiyar likita ba ko kuma ba ta dace ba, mai haƙuri na iya fuskantar matsaloli masu wahala. Babban haɗarin shine cutar mahaifa. Irin wannan sabon abu a cikin mafi yawan lokuta suna ƙare da mutuwa. Zai yuwu a gane yiwuwar puffness a cikin kwakwalwa ta hanyar rashin canje-canje masu kyau a cikin mai haƙuri, duk da duk matakan da ke warkewa. A wannan yanayin, likita ya gano babban ci gaba a cikin metabolism na carbohydrates da fats.
Don tabbatar da wannan cutar, ƙwararren ya tura mai haƙuri don yin lissafin tomography da encephalography na duban dan tayi. Hakanan ana yin EEC da REC don kimanta ayyukan da ke gudana a cikin kwakwalwa. Tare da taimakonsu, zaku iya gano kowane matsala kuma ku tsara yadda ya dace.
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Ciwon sukari mellitus cuta ce mai mahimmanci da duk kusancin dangi da mutanen masu haƙuri ya kamata su sani.
Bayan likita ya tabbatar da kwayar cutar ketoacidotic, sai ya ba da allurar insulin ga mai haƙuri. An yi jigilar jet ko intramuscularly a cikin adadin 10-20 raka'a awa daya.
Kulawa da cutar ketoacidotic na buƙatar cancantar girma daga likita mai halartar. Irin wannan yanayin tare da maganin da ba a zaɓa ba na iya haifar da sakamako ba kawai, har ma ga mutuwa. Bincike ya nuna cewa kurakuran da ke gaba suna yawan fuskantar haɗuwa a cikin magani:
Ana iya gane edema ta hanyar ragewar ɗalibai zuwa haske ko da rashinsa, edema na jijiyoyi ko ophthalmoplegia.
