Coma Hyperosmolar Ọrịa mamịrị

Coma Hyperosmolar Ọrịa mamịrị bụ iche Comaji mmebi iwu dị elu metabolism ya na oria ọrịa shuga n'etiti mmụba dị ukwuu glucose n'ime ọbaranke ruru 55 mmol / l ma ọ bụ karịa.

Ejiri hymarosmolar coma bụ mmiri akpịrị nke ahụ, hyperchloremia, hypernatremia, exicosis cellular, azotemia. Adị cma dị ihe dị ka pasent ise nke coms niile, na ọnwụ nke ọnwụ ya sitere na pasent 20 ruo 50.

Mmepe nke coma na-ewere nwayọ. Site na ụbọchị ise ruo ụbọchị iri na anọ, steeti precomatous, nke a na-eji sọks metabolism na-emetụta ya. N’oge a, iro ụra, ọrịa shuga, akpịrị ịkpọ nkụakpọnwụ nkụ, adịghị ike. Ihe mgbaàmà ndị a na-abawanye ngwa ngwa, mkpụmkpụ ume na-apụta, isi nke acetone dị afọ.

Hyperosmolar coma na-etolite n'ime ndị ọrịa mgbe afọ iri ise gasịrị na ụdị ọrịa shuga mellitus nke 2, nke a na-akwụ ụgwọ site na iji obere ọgwụ ọgwụ na-ebelata sulfonamide ma ọ bụ nri. N'ime ndị na-erubeghị afọ iri anọ, ụdị coma dị ụkọ, ọ bụ ezie na ikpe ndị dịpụrụ adịpụ na-eme mgbe ụfọdụ.

Ihe dị ka ọkara nke ndị na-arịa ọrịa hyperosmolar, ọdịdị ya metụtara ọrịa shuga, n'ọkara nke abụọ, coma mepụtara maka ihe ndị ọzọ.

Isi ihe na - eduga na mmepe nke coma bụ:

Ọria na -akpo ọnya afọ na ọnya afọ, nke afọ ọsịsa na ọgbụgbọ na-eso
Nnukwu akwara na ọrịa ụbụrụ
Mmekpa ahụ na ọkụ
Ọrịa na-efe efe
Isonye na ọrịa dị iche iche

Ọzọkwa, ụdị ọbara dị iche iche na-eso akpata mmepe nke ụdị Coma a, gụnyere ndị nke ịwa ahụ gụnyere. Codị coma dị otú ahụ na-arịa ọrịa shuga nwekwara ike ịmalite n'ihi ọrịa ụbụrụ na -akpata, ịba ọcha n'anya, mmeghe nke nnukwu onunu ogwu nke mannitol, hypertonic na saline solution, n’oge ọgwụgwọ ya na immunosuppressants, glucocorticoids na diuretics. Mmeghe nke glucose na oke oriri nke carbohydrates, dịka iwu, na-eme ka ọnọdụ ahụ ka njọ.

A na-enye usoro ọgwụgwọ ọgwụgwọ na ngalaba nlekọta ahụike ma ọ bụ na ngalaba nlekọta ahụike. Uzo nke iwepu onye ọrịa na hyperosmolar coma bu ntinye nke obere insulin na ihe ngwọta nke sodium chloride. N'ihe banyere mbubreyo nyocha, ihe puru omume nke onwu riri nne.

Mmụta: Gụsịrị akwụkwọ na Mahadum Vitebsk State Medical University nwere asambodo na Surgery. Na mahadum ahụ, ọ bụ onye isi nke Council of Student Scientific Society. Ọzụzụ ọzọ na 2010 - na ọpụrụiche "Oncology" na 2011 - na ọpụrụiche "Mammology, ụdị oncology visual."

Ahụmahụ: Na-arụ ọrụ na netwọk ọgwụ gbasara ahụike ruo afọ 3 dị ka dọkịta na-awa (Vitebsk mberede ụlọ ọgwụ, Liozno CRH) na ngalaba oncologist na traumatologist na-arụ ọrụ oge. Na-arụ ọrụ dị ka onye nnọchi anya ugbo n'oge afọ na Rubicon.

Egosiputara ndumodu 3 nke isiokwu ya bụ “Nchọpụta nke ọgwụ mgbochi na-adabere n'ụdị agbụrụ microflora”, ọrụ abụọ meriri na ntuli aka n'asọmpị Republic-nyocha nke akwụkwọ nyocha ụmụ akwụkwọ (edemede 1 na 3).

Hyperosmolar coma na ọrịa shuga mellitus (pathogenesis, ọgwụgwọ)

Otu n'ime ihe jọgburu onwe ya ma na-amụkwa ọmụmụ gbasara ọrịa shuga bụ hyperosmolar coma. A ka nwere arụmụka gbasara usoro mmalite ya na mmepe ya.

Vidiyo (pịa igwu egwu).

Ọrịa ahụ abụghị nnukwu ọrịa, ọnọdụ nke ndị ọrịa mamịrị nwere ike ịka njọ ruo izu abụọ tupu enwee mmalite nke nsụhọ. Ọtụtụ mgbe, Coma na-eme n’etiti ndị gbara afọ iri ise. Ọ bụghị mgbe niile ka ndị dọkịta mepụtara nchọpụta ziri ezi na enweghị ozi na onye ọrịa ahụ nwere ọrịa shuga.

N'ihi nnabata ụlọ ọgwụ na-abịakarị, ihe isi ike nke nchoputa, njọ nke ahụ, hyperosmolar coma nwere ọnụ ọgụgụ dị elu nke 50%.

>> Ọrịa mamịrị - ụdị ya na nlekọta mberede na nsonazụ ya.

Vidiyo (pịa igwu egwu).

Mkpụrụ ndụ hyperosmolar bụ ọnọdụ nke mwepu na nsụhọ na sistemụ niile: mmegharị ahụ, ọrụ gbasara obi yana ihe ọkụkụ na-ebelata, mmamịrị na-akwụsị ịpụ apụ. N'oge a, mmadụ na-enwe nguzozi n'ụzọ nkịtị na ndụ na ọnwụ. Ihe kpatara ọgba aghara ndị a niile bụ hyperosmolarity nke ọbara, ya bụ, mmụba siri ike na njupụta ya (karịa 330 mosmol / l nwere ụkpụrụ nke 275-295).

Ejiri ụdị coma a bụ glucose ọbara dị elu, karịa 33.3 mmol / L, yana oke akpịrị. N'okwu a, ketoacidosis bụ onye na - anọghị ahụ ketone na mmamịrị site na nnwale, iku ume nke onye ọrịa mamịrị adịghị isi acetone.

Dabere na nhazi mba dị iche iche, hyperosmolar coma dị ka nke mebiri metabolism-salt metabolism, koodu dika ICD-10 bu E87.0.

Ọnọdụ hyperosmolar na-eduga n'ọchị kama ọ na-esiri ike; na usoro ọgwụgwọ, otu ikpe na-eme na ndị ọrịa 3300 kwa afọ. Dabere na ọnụ ọgụgụ, afọ ole onye ọrịa dị afọ iri ise na itoolu, ọ na-arịa ọrịa shuga na-enweghị insulin na-arịa ọrịa shuga, mana ọ naghị achịkwa ọrịa ya, yabụ, ọ nwere ọtụtụ nsogbu, gụnyere ọrịa mamịrị nephropathy na ọdịda akụrụ. N'ime ụzọ n'ụzọ atọ nke ndị ọrịa nọ n'ọrịa shuga, ọ na-arịa ọrịa shuga ogologo oge, mana achọpụtaghị ya, n'ihi ya, a naghị agwọ ya oge niile.

Tụnyere ketoacidotic coma, hyperosmolar coma pụtara ugboro 10 obere oge. Ọtụtụ mgbe, ndị na-arịa ọrịa shuga na-akwụsị ihe ngosipụta ya ọbụna n’oge dị mfe ịkwụsị, n’ebughị n’obi ya - ha na-eme ka glucose ọbara kwụsị, na-amalite ị drinkingụkwu mmiri, ma na-agakwuru onye na-arịa ọrịa nephrologist n’ihi nsogbu akụrụ.

Hyperosmolar coma na-etolite n'ime ọrịa shuga mellitus n'okpuru nduzi nke ihe ndị a:

Enwela akpịrịkpa n'ihi nnukwu nkụ, ị overụbiga ihe oke ma ọ bụ ogologo oge nke ịureụ nsị, nsị na ọnya afọ, nke ọgbụgbọ na ọnya na-esonyere ya.
Enweghị insulin n'ihi ị dueabeghị nri, ị frequentụ ọgwụ ugboro ugboro na-ebelata shuga, ọrịa siri ike ma ọ bụ mgbatị anụ ahụ, ịgwọ ọgwụ ọgwụ homonụ na-egbochi mmepụta insulin.
Oria mamiri oria shuga.
Ọrịa akụrụ na-adịte aka na-enweghị ọgwụgwọ kwesịrị ekwesị.
Ọrịa ịba ọcha n’anya ma ọ bụ ọbara ọgbụgba n’ime ọbara mgbe ndị dọkịta amataghị ọrịa shuga n’ebe onye ọrịa nọ.

Na mmalite nke hyperosmolar coma na-ejikọkarị hyperglycemia. Ọrịa glucose na-abanye n'ọbara ọbara site na nri, imeju na-emekwa n'otu oge, ntinye ya na anụ ahụ na-agbagọjikwa n'ihi mgbochi insulin. N'okwu a, ketoacidosis anaghị eme, na ebumbebebeghi nke ọma na ihe kpatara ọpụpụ a. Researchersfọdụ ndị nyocha kwenyere na ụdị hymarosmolar nke coma na-etolite mgbe insulin ezuola iji gbochie ndakpọ abụba na ịmepụta ahụ ketone, mana ọ dị ntakịrị igbochi ndakpọ nke glycogen na imeju na ịmepụta glucose. Dabere na nsụgharị ọzọ, a na-egbochi iwepụ abụba sitere na anụ ahụ adipose n'ihi ụkọ nke homonụ na mmalite nke nsogbu hyperosmolar - somatropin, cortisol na glucagon.

Mgbanwe ndị ọzọ na-akpata ọrịa na-ebute cokerosmolar coma. Site na mmụba nke hyperglycemia, olu mmamịrị na-abawanye. Ọ bụrụ na akụrụ na-arụ ọrụ oge niile, mgbe ahụ a gafere ihe karịrị 10 mmol / L, glucose na-amalite ịpụpụ na mmamịrị. Site na arụ ọrụ akụrụ nwere nsogbu, usoro a anaghị adịkarị, mgbe ahụ, shuga na-agbakọta na ọbara, ọnụọgụ nke mmamịrị na-abawanye n'ihi mmụba azụ akụrụ dị, akụrụ na-amalite. Liquid na-ahapụ sel na oghere dị n’etiti ha, olu nke na-ekesa ọbara na-ebelata.

N'ihi akpịrị nke ụbụrụ akpọnwụ akpọnwụ, ihe mgbaàmà akwara ozi na - eme, ịba ụba ọbara na - akpalite thrombosis, ma na - eduga n'ịbara ọbara ahụ n'ahụ ezughị ezu. Na nzaghachi nye akpịrị ịkpọ nkụ, ịmepụta aldosterone homonụ na-abawanye, nke na-egbochi sodium ịbanye na mmamịrị n'ọbara, hypernatremia na-amalitekwa. Ya, n'aka nke ya, na-akpalite ọbara ọgbụgba na ọzịza na ụbụrụ - Coma na - eme.

Mmepe nke hyperosmolar coma na-ewe otu izu abụọ. Mmalite nke mgbanwe bụ n'ihi mmụba na-akwụ ụgwọ ọrịa shuga, mgbe ahụ ihe ịrịba ama nke akpịrị ịkpọ nkụ na-esonye. N'ikpeazụ, ihe mgbaàmà akwara ozi na nsonaazụ osmolarity ọbara dị elu na-apụta.

Hyperosmolar coma na-abụghị ketone - nnukwu nsogbu nke ụdị ọrịa shuga 2 nke ọrịa, nke metabolism na-akpata, mmụba na ọkwa ya n'ọbara, mmụba dị ukwuu na osmolarity plasma, akpịrị ọgbụgba intracellular, na enweghị ketoacidosis. Ihe mgbaàmà bụ isi bụ akpọnwụ akpọnwụ akpọnwụ, oke mmiri, ọbara ọgbụgba, nhụjuanya, ịba ụba ụra, hallucinations, okwu incoherent. Maka nchọpụta, a na-anakọta anamnesis, a na-enyocha onye ọrịa, a na-emekwa ọtụtụ nyocha ụlọ nyocha ọbara na mmamịrị. Ọgwụgwọ gụnyere ịmegharị mmiri, iweghachite nkịtị insulin, kpochapu na igbochi nsogbu.

Ebu ụzọ kọwaa hyperosmolar na-abụghị ketone coma (GONK) bụ aha mbu ndị ọzọ bụ hyperosmolar co-non-ketogenic, ọrịa shuga hyperosmolar, ọrịa hyperosmolar na-abụghị acidotic. Aha nsogbu a na - akọwa njiri mara ya - nchịkọta nke kinetically na - arụ ọrụ nke serum dị elu, ọnụ ọgụgụ insulin zuru oke iji kwụsị ketonogenesis, mana anaghị egbochi hyperglycemia. A naghị achọpụta GONK, n'ihe dị ka 0.04-0.06% nke ndị ọrịa nwere ọrịa shuga. Na 90-95% nke ikpe, a hụrụ ya na ndị ọrịa nwere ọrịa shuga nke 2 yana megide ọdịda akụrụ. N'ihe nwere nnukwu ihe egwu bụ ndị agadi na ndị okenye.

GONK na-etolite ntọala nke akpịrị ọgbụgba. Ọnọdụ ndị a na - enwekarị bụ polydipsia na polyuria - mmụba mmụba na mmamịrị na ọtụtụ izu ma ọ bụ ụbọchị tupu mmalite nke ọrịa ahụ. Maka nke a, ndị agadi bụ ndị otu nọ n'ihe ize ndụ - a na-enwekarị echiche ha maka akpịrị ịkpọ nkụ, na arụ ọrụ ezumike na-agbanwe. N'ime ihe ndị ọzọ na-akpata ọgba aghara, enwere:

N’adịghị ike insulin, glucose na-erugharị n’ọbara ọbara abanyeghị sel. Ọnọdụ nke hyperglycemia amalite - ọkwa shuga dị elu. Agụụ nke mkpụrụ ndụ na - akpata ngịkọta nke glycogen site na imeju na akwara, nke na - eme ka ọwanyelata glucose na plasma. Enwere polymoia osmotic na glucosuria - usoro mgbapụta maka iwepụ shuga dị na mmamịrị, nke, na-enye nsogbu, mmiri mmiri na-emetụta ya, ọrụ akụrụ na-agwụ ike. N'ihi polyuria, hypohydration na hypovolemia n'ụdị, electrolytes (K +, Na +, Cl -) na-efu, homeostasis nke mpaghara ime na arụ ọrụ nke usoro ọbara na-agbanwe. Otu ihe pụrụ iche nke GONC bụ na ọkwa insulin ka zuru ezu iji gbochie ketones, mana ọ dị ala iji gbochie hyperglycemia. Mmepụta homonụ Lipolytic - cortisol, homonụ na-eto eto ka dị mma, nke na-akọwara enweghị ketoacidosis.

Nọgide na-enwe ọkwa nkịtị nke plasma ketone body na ịnọgide na-enwe acid-base steeti ogologo oge na-akọwapụta akụrụngwa nke GONK: enweghị hyperventilation na mkpụmkpụ ume, ọ fọrọ nke nta enweghị mgbaàmà na mbido mbụ, mmebi nke ịdị mma na-apụta na mbelata ọbara akara, nsị nke akụkụ ahụ dị mkpa. Ngosipụta nke mbụ na-abụkarị mmụọ isi. Ọ na-esite na ọgba aghara na disorientation ruo coma miri emi. A na-achọpụta nsogbu mọzụlụ na / ma ọ bụ ọdụ ọdịdọ.

N'ime ụbọchị ma ọ bụ izu, ndị ọrịa na-enwe akpịrị ịkpọ nkụ, na-ata ahụhụ site na akwara hypotension, tachycardia. A na-egosipụta Polyuria site n'iku ume ugboro ugboro na mmamịrị afọ. Ọgba aghara nke usoro akwara ozi nke etiti gụnyere mgbaàmà uche na akwara ozi. Mgbakasị ahụ na-aga n'ihu dị ka ihe nbibi, akwara siri ike-echiche mkpaghasị uche, ọdịdọ ihe mgbapụta. Ngosiputa nke puru iche nke akwara oria akwara bu ihe akparamagwa - aphasia (mmebi okwu), hematparesis (mbelata aru nke ukwu na ogwe aka), oria akwara polymorphic, nsogbu uche akwara.

Na enweghị ọgwụgwọ zuru oke, ụkọ mmiri na-abawanye oge niile ma na-enwe ọkara 10. Mmebi nke nguzogide-etinye nnu-mmiri nyere aka na mmepe nke hypokalemia na hyponatremia. Nsogbu akụkụ iku ume na obi na - ebilite - ịba ume, nrịanrịa iku ume, thrombosis na thromboembolism, ọbara ọgbasa n'ihi mgbasa nke intravascular intaguvascular. Ọrịa ụkwara mmiri na-eduga n’ọkpụkpụ azụ na akụkụ ụbụrụ. Ihe na-akpata ọnwụ bụ akpọnwụ akpọnwụ na nnukwu ọrịa mgbasa.

Nyochaa nke ndị ọrịa na-eche na GONK dabere na mkpebi siri ike nke hyperglycemia, hyperosmolarity plasma na nkwenye nke enweghị ketoacidosis. Ọrịa nyocha na-eme site na endocrinologist. O tinyere ihe omuma banyere ogwu banyere nsogbu na otu ule nyocha. Iji mee nyocha, usoro ndị a ga-emerịrị:

Nchịkọta nke nyocha ụlọ ọgwụ na nke na-eme ihe. Otu endocrinologist na-amụ akụkọ banyere ahụike, na-anakọta akụkọ gbasara ahụike ọzọ n'oge nyocha onye ọrịa. Ọnụnọ nke nchoputa nke ụdị ọrịa shuga II nke afọ, afọ karịa afọ 50, ọrụ ezughị ezu ọrụ, enweghị nrube isi nke dọkịta na-ekwu banyere ọgwụgwọ nke ọrịa shuga, akụkụ ahụ na-efe efe na ọrịa na-efe efe na-agba akaebe GONK.
Nnyocha N'oge nyocha anụ ahụ nke onye ọkachamara n’akparamàgwà na endocrinologist, ekpebiri ihe ịrịba ama nke akpịrị ịkpọ nkụ - turgor anụ ahụ, ụda nku anya, a na-agbanwe ụda olu na akwara, mgbali ọbara na ọnọdụ ahụ. Ihe ngosi di iche nke ketoacidosis - mkpirisi iku ume, tachycardia, acetone ume adịghị.
Nnwale ụlọ nyocha. Ihe nrịba ama bụ ọkwa glucose karịa 1000 mg / dl (ọbara), plasma osmolality na-adịkarị karịa 350m / l, ọkwa nke ketones dị na mmamịrị na ọbara bụ ihe dị mma ma ọ bụ nke dị elu. Ọkwa glucose dị n’ime mmamịrị, ihe ruru ya n’otu n’otu n’otu n’otu n’arụpụta ọbara n’arụ n’ichekwa ọrụ akwara, ikike imebi ahụ.

N'ime usoro nyocha dị iche, ọ dị mkpa ịmata ọdịiche dị n'etiti hyperosmolar na-abụghị ketone coma na ọrịa mamịrị ketoacidosis. Isi ihe dị iche n'etiti GONC bụ ndepụta ketone dịtụ ala, enweghị akara nke ọgwụ ketone na-arịa, yana ọdịdị nke mgbaàmà n'oge ngwụsị nke hyperglycemia.

A na-enyere ndị ọrịa aka na ngalaba nlekọta ahụike, yana mgbe a gbasasịrị ọnọdụ ahụ - n ’ụlọọgwụ nlekọta ọfụma na n’ịgwọ ọrịa. Usoro ọgwụgwọ a chọrọ iji kpochapụ mmiri akpọnwụ, weghachi ọrụ nkịtị nke insulin na metabolism mmiri, yana igbochi nsogbu. Usoro ọgwụgwọ ahụ bụ nke onwe ya, tinye ihe ndị a:

Friza. A na-enye ọgwụ mgbochi nke spoum chloride nke sodium chloride. A na-enyocha ọkwa nke electrolytes n'ọbara na ECG egosi. Usoro ọgwụgwọ nke ọgwụ na-agba ume iji melite mgbasa na ikuku nke mmamịrị, na-amụba ọbara mgbali. A na-emeziwanye usoro nchịkwa mmiri dịka mgbanwe na ọbara mgbali, ọrụ obi na nguzo mmiri.
Usoro ọgwụgwọ insulin. A na-elekọta insulin n'ime mkparịta ụka, a na-ekpebi ọsọ na usoro nke otu otu. Mgbe ngosipụta nke glucose na-abịaru nso na nkịtị, a na-ebelata ọgwụ ahụ ka ọ ruo basal (enyere ya na mbụ). Iji zere hypoglycemia, mgbakwunye nke ngwakọta dextrose dị mkpa mgbe ụfọdụ.
Mgbochi na mkpochapu nsogbu. Iji gbochie akụkụ akụkụ ụbụrụ, a na-eme ọgwụgwọ oxygen, a na-edozi acid a na-ahụ anya. Ejiri ngwakọta electrolytes eweghachi site na iji ngwakọta glucose-potassium-insulin. A na - eme ọgwụgwọ Symptomatic nke nsogbu site na iku ume, akwara na usoro urinary.

Hyperosmolar hyperglycemic nke na-abụghị ketone coma jikọtara ya na ihe egwu nke ọnwụ, yana nlekọta ahụike n'oge, ọnụego ọnwụ na-ebelata 40%. Mgbochi ụdị ọ bụla nke ọrịa mamịrị kwesịrị ilekwasị anya na ụgwọ kachasị zuru oke maka ọrịa shuga. Ọ dị mkpa ka ndị ọrịa soro nri, belata oriri nke carbohydrates, na-enye ahụ ahụ oge niile, ọ bụghị ịhapụ mgbanwe nnwere onwe na usoro nke iji insulin, na-a drugsụ ọgwụ shuga. Womenmụ nwanyị dị ime na puerperas chọrọ mgbazi nke ọgwụ insulin.

Mmepo
Adịghị Ike
Nkwarụ okwu
.Bawanye ụba
Akpụkpọ anụ
Ntụgharị uche
Akpịrị ịkpọ nkụ
Obere okpomọkụ
Ọbara mgbali elu
Ọbara
Esemokwu
Ibu ibu
Akọrọ akpụkpọ mucous
Ahụ́ mkpọnwụ
Isi mara mmụọ
Lykpọnwụ akụkụ ahụ

Hyperosmolar coma bụ ihe mgbagwoju anya nke ọrịa shuga mellitus, nke a na-egosipụta hyperglycemia, hyperosmolarity nke ọbara. E gosiputara ya na akpukpo ahihia (idi mmiri) na enweghi ketoacidosis. A na-ahụta ya n’ebe ndị ọrịa gbagoro afọ 50 nwere ụdị ọrịa shuga mellitus nwere ike jikọta ya na oke ibu. Imirikiti a na-aputa ndi mmadu n’ihi nlebara anya nke oria a ma obu nnonye ya.

Foto a na-adakarị nwere ike ịmalite ruo ọtụtụ ụbọchị ruo mgbe mmụọ zuru oke na enweghị nzaghachi nye ihe mkpali.

A na-achọpụta ya site na usoro nyocha ụlọ na usoro nyocha. Emere ọgwụgwọ a iji wedata shuga ọbara, weghachite nguzo mmiri na iwepụ mmadụ na Coma. Prognosis adịghị njọ: na 50% nke ikpe na-akpata nsonaazụ na-apụta.

Hyperosmolar coma na ọrịa shuga mellitus bụ ihe a na-ahụkarị anya ma bụrụ nke a na-ahụ na 70-80% nke ndị ọrịa. Hyperosmolarity bụ ọnọdụ nke jikọtara ya na nnukwu ihe nke ihe dịka glucose na sodium n'ime ọbara mmadụ, nke na-eduga n'ibe ụbụrụ, mgbe emesịrị ahụ ahụ dum.

Ọrịa a na - ebute n'ihi ọnụnọ ọrịa shuga n'ime mmadụ ma ọ bụ n'ihi nsị nke metabolism metabolism, nke a na - ebute mbelata insulin na mmụba nke ịba ụba na ahụ ketone.

Ọbara shuga nke onye ọrịa na-ebili n'ihi ihe ndị a:

akpịrị na-egbu egbu nke anụ ahụ mgbe ọ gbasịrị nnukwu ọgbụgba, afọ ọsịsa, obere mmiri ị ,ụ mmiri, iji mkparị,
abawanye umeji imeju na-akpata site na mgbụsị akwụkwọ ma ọ bụ ọgwụgwọ na-ezighi ezi,
Igha mkpụrụ glucose dị ukwuu ma a gwọọ ihe ọgwụgwọ intravenous.

Mgbe nke a gasịrị, akụrụ na-arụ ọrụ akụrụ, bụ nke na-emetụta mwepu nke glucose na mmamịrị, oke ya bụ mmiri na-egbu ahụ dum. Nke a na - egbochikwa ịmịpụta insulin na ojiji nke shuga site na anụ ahụ ndị ọzọ. N'ihi nke a, ọnọdụ onye ọrịa ahụ ka njọ, na-ebelata ọbara ọgbụgba, a na-ahụ akpọnwụ mkpụrụ ndụ ụbụrụ, mgbali na-ebelata, mmụọ na-ama jijiji, ọbara ọgbụgba ga-ekwe omume, ọgba aghara na sistemụ na-akwado ndụ ma mmadụ daba na mmiri.

Ọrịa hyperosmolar ọrịa shuga bụ ọnọdụ nke nsụhọ na arụ ọrụ niile sistemụ, mgbe mgbanwe na-agbadata, ọrụ obi na-ebelata, yana thermoregulation na-ebelata. N’ime ọnọdụ a, enwere nnukwu ọnwụ.

Hyperosmolar coma nwere ọtụtụ iche:

Isi ihe dị iche na - ejikọ ọnụ site na isi ihe kpatara - ọrịa shuga. Hyperosmolar coma na - etolite n'ime izu abụọ na atọ.

Hyperosmolar coma nwere akara ndị a na-esote, nke buru ụzọ mebie mmụọ:

oke agu
Akpụkpọ anụ na akpụkpọ anụ mucous,
Ahụ mmadụ na-ebelata
adighi ike na anaemia.

Ọbara ọbara onye ọrịa ahụ na-agbadata, ọnọdụ ahụ wee daa, a hụkwara:

N'ọnọdụ siri ike, nleghara anya, mgbakasị ahụ, ahụ mkpọnwụ, nkwarụ okwu ga-ekwe omume. Ọ bụrụ na enyeghị nlekọta ahụike, mgbe ahụ ihe egwu nke ọnwụ na-abawanye nke ukwuu.

Site na ọrịa shuga na ụmụaka, enwere nnukwu ịba ụba, agụụ na-abawanye oke, na nbibi na-ebute nsogbu na sistem. N'okwu a, isi ahụ si n'ọnụ ya na-eyi ísì ụtọ.

N'ọtụtụ oge, onye ọrịa nwere ọrịa hyperosmolar na-abụghị ketoacidotic coma na-aga ozugbo na nlekọta ahụike, ebe a na-achọpụta ngwa ngwa ihe kpatara ọnọdụ a. A na-elebara onye ọrịa ahụ anya, mana na-akọwaghị ihe niile dị na ya, ọ naghị arụ ọrụ nke ọma ma na-enye ohere naanị imezi ọnọdụ onye ọrịa ahụ.

nnwale ọbara maka insulin na shuga, yana maka lactic acid,
a na-enyocha nyocha mpụga nke onye ọrịa, a na-enyocha mmeghachi omume.

Ọ bụrụ na onye ọrịa ahụ daa tupu mmalite nke nsogbu ịmara, a na-enye ya nyocha ọbara, nyocha mmamịrị maka shuga, insulin, maka ọnụnọ nke sodium.

Edere cardiogram, nyocha nke ultrasound nke obi, ebe ọrịa shuga nwere ike ibute ọrịa obi ma ọ bụ nkụchi obi.

Dọkịta ahụ ga-ekewa ọny ụbụrụ na ụbụrụ ụbụrụ, ka ị ghara ime ka ọnọdụ ahụ ka njọ site na ịdepụta ọgwụ diuretics. A na-eme nyocha nke isi ahụ.

Mgbe etinyere nchọpụta ziri ezi, a na-anara onye ọrịa n'ụlọ ọgwụ ma nye ya ọgwụgwọ.

Nlekọta ihe mberede nwere ihe ndị a:

a na - akpọ ụgbọ ihe mberede,
ntụgharị na ọnya ọbara tupu dọkịta abịa,
A na-enyocha ngwa okwu onye ọrịa, a ga-etegharị ntị ya, na-etinye ya na ntì ka onye ọrịa wee ghara ịta ụta,
ọ bụrụ na onye ọrịa nọ na insulin, mgbe ahụ, a na-agbanye insulin n'ime subcutaneously ma na-enye mmiri ọ drinkụ pụ na mmiri brackish.

Mgbe ọ gachara ụlọ ọgwụ onye ọrịa ahụ wee chọpụta ihe kpatara ya, a na-enye ọgwụgwọ kwesịrị ekwesị dabere n'ụdị Coma.

Hyperosmolar coma gụnyere usoro ọgwụgwọ ndị a:

mkpochapu akpukpo ahihia na ujo,
mweghachi nke itule electrolyte,
a na-ewepụ hyperosmolarity ọbara,
ọ bụrụ na achọpụtara lactic acidosis, mmechi na normalization nke lactic acid na-eme.

A na-anabata onye ọrịa n'ụlọ ọgwụ, a na-asa afọ, a na-etinye catherger urinary, a na-eme ọgwụgwọ oxygen.

Site n'ụdị coma a, a na-enye mmiri ọgwụ na-enye mmiri ara ehi oke: ọ dị elu karịa na ketoacidotic coma, nke ịhydụ mmiri ọkụ, yana ọgwụ insulin.

A na-agwọ ọrịa ahụ site na iweghachi olu mmiri n'ime ahụ, nke nwere ike ịnwe ma glucose na sodium. Ma, na nke a, enwere nnukwu ọnwụ nwere ike ịnwụ.

Site na coma hyperglycemic, a na-ahụta insulin na-aba ụba, yabụ na-enyeghị ya iwu, a na-enyekwa nnukwu sọtin kama. Iji alkalis na bred eme ihe adịghị eme ya na ketoacidosis ma ọ bụ jiri hyperosmolar coma.

Ndụmọdụ ndị a na-ahụ maka ụlọ ọgwụ dị ka o wepụsịrị onye ọrịa na Coma ma kwalite ọrụ niile na ahụ ya bụ ndị a:

na-acribedụ ọgwụ n'oge,
Eferela usoro ọgwụgwọ enyere n'iwu,
na - achịkwa shuga ọbara, na - eme ọtụtụ ugboro,
na - achịkwa ọbara ọgbụgba, na - a drugsụ ọgwụ ọ bụla na - enyere aka n'ịhazi ya.

Achịkwala ọrụ, zuo ike, karịchaa n'oge nrụzigharị.

Ọrịa ndị a na - ahụkarị hyperosmolar coma bụ:

Na ngosipụta mbụ nke mgbaàmà nke ọrịa, onye ọrịa ahụ kwesịrị ịnye nlekọta ahụike, nyocha ma depụta ọgwụgwọ.

Coma n'ime ụmụaka bụ ihe a na-ahụkarị karịa ndị okenye, amụma ndị na-adịghị mma na-akọwa ya. Ya mere, ndi nne na nna kwesiri ileba anya n’ahu ike nke umu aka, na nmalite mgbaàmà nke mbu choro enyemaka ahuike.

Ihe mgbochi ga-agụnye mmejuputa atumatu nke ọgwụgwọ, ị clina ntị na nri nri, yana ileba anya na ọnọdụ nke mmadụ. Ọ bụrụ na ihe ịrịba ama mbụ nke ọrịa bilitere, gakwuru dọkịta ozugbo.

Ọ bụrụ n’uche na ị nwere Hyperosmolar coma na njiri mara nke ọrịa a, mgbe ahụ ndị dọkịta nwere ike inyere gị aka: onye endocrinologist, therapist, pediatrician.

Anyị na-enyekwa maka iji ọrụ nyocha ọrịa oria n'ịntanetị, nke na-ahọrọ ọrịa ndị a na-ahụ anya dabere na mgbaàmà ndị etinyere.

Hyponatremia bụ ụdị a na - ahụkarị bụ eleghara mmiri-electrolyte mgbe oke mbelata ihe nlebara sodium sọdum. Ọ bụrụ na enyemaka adịghị n'oge, a gaghị ewepụ ohere nke onye nwere ike ịnwụ.

Nsi Arsenic bu mmepe nke usoro a na - akpasu iwe site na ihe ndi ojoo na aru aru. Ọnọdụ yiri nke ahụ mmadụ na - esochi ihe mgbaàmà akpọrọ ma na enweghị ọgwụgwọ a kapịrị ọnụ nwere ike ibute mmepe nke nnukwu nsogbu.

Ndị nwere mmasị na akwụkwọ akụkọ ihe mere eme ga-agụrịrị banyere ọrịa ọgbụgbọ, nke mebiri obodo niile oge ụfọdụ. Ọzọkwa, a na-ahụ ebe e zoro aka na ọrịa a n'akụkụ ụwa niile. Ruo ugbu a, ọrịa ahụ emerighị kpamkpam, agbanyeghị, ikpe ndị dị na etiti latvia bụ ihe dị ụkọ: ọnụ ọgụgụ kachasị ukwuu nke ndị ọrịa nwere ọgbụgbọ na-apụta na mba ụwa atọ.

Ọbara ịba ọcha n'anya bụ ọnọdụ dị ize ndụ nke ọbara ọgbụgba na-enwe n'ihi ntiwapụ arịa ọbara n'ihi oke ọbara mgbali elu. Dabere na ICD-10, a na-ekechi pathology na ngalaba I61. Ofdị ọrịa strok a bụ ihe kachasị njọ ma nwekwaa prognosis ka njọ. Ọtụtụ mgbe, ọ na-etolite n'ime ndị dị afọ 35 ruo afọ iri ise, bụ ndị nwere akụkọ banyere ọbara mgbali elu ma ọ bụ atherosclerosis.

Cysticercosis bụ ọrịa nje na-aga n'ihu n'ihi ọgbụgba ọnya anụ ezi na-abanye ahụ mmadụ. Ọ bụ nke otu cestodoses. Larvae nke anụ ezi ahụ na-abanye na afọ mmadụ ma n'ime ya ka ọ napụtara. Nke nta nke nta, ha na-abanye na akụkụ mbụ nke eriri afọ, ebe ha na-emebi mgbidi ya yana ọbara na-agbasa n'ahụ mmadụ niile.

Site na mmega ahụ na ị abstụ ihe ọ ,ụ mostụ, ọtụtụ mmadụ nwere ike ime na-enweghị ọgwụ.

Hyperosmolarity - Nke a bụ ọnọdụ n'ihi ụba ọdịnaya nke osmotic ogige n'ime ọbara, ihe kachasị pụta bụ glucose na sodium. Ọdịiche na - esighi ike n’ime ha n’ime sel na - ebute oke oncotic na mmiri extracellular na intracellular, n’ihi nke, nke mbu, mmiri na - egbu intracellular (nke bụ ụbụrụ), ma emesakwa oke mmiri nke anụ ahụ.

Hyperosmolarity nwere ike ịmalite n'ọtụtụ ụdị ọrịa, mana ya na ọrịa shuga mellitus (ọrịa shuga) ihe ọghọm nke ịmalite ya dị elu karịa. Ọtụtụ mgbe hyperosmolar coma (HA) na-etolite na ndị agadi na-ata ahụhụ ụdị shuga mellitus 2 (SD-2)otu obula, na onodu nke ketoacidosis, dika egosiri na mbu, enwekwara osiso na plasma osmolarity, mana eziokwu nke hyperosmolar coma ụdị shuga mellitus (SD-1) otu.

Atụmatụ ndị pụrụ iche nke koodu obodo - oke glucose ọbara (ihe ruru 50 mmol / l ma ọ bụ karịa), enweghị ketoacidosis (ketonuria anaghị ewepu ọnụnọ nke HA), hypernatremia, plasma hyperosmolarity, nkọcha na nkọcha mkpụrụ ndụ, nsogbu nke akwara ozi, nsogbu na ọnwu dị elu.

E jiri ya tụnyere ketoacidotic hyperosmolar ọrịa mamịrị, nke a bụ ihe rarer mana ihe siri ike nke ịrịa ọrịa mamịrị oke.

Ihe ndị na-akpalite uto nke HA na ọrịa shuga bụ ọrịa na ọnọdụ na-akpata, n'otu aka, akpịrị ịkpọ nkụ, ma, n'aka nke ọzọ, na-abawanye ụkọ insulin. Yabụ, ọgbụgbọ, ọgbụgbọ na-efe efe na ọrịa na-efe efe, nnukwu ọrịa ogbu na nkwonkwo, nnukwu cholecystitis, ọrịa strok, wdg, ọbara ọgbụgba, ọkụ, ojiji nke akwara, ọrụ ịta akụrụ nke akụrụ, wdg na-eduga na akpịrị.

Ọrịa ọgbụgba, ọgwụ ịwa ahụ, mmerụ ahụ, na iji ọgwụ ụfọdụ (glucocorticoids, catecholamines, homonụ mmekọahụ, wdg) na-abawanye ụkọ insulin. Ọrịa pathogenesis nke mmepe nke HA abụchaghị ihe doro anya. Isi mmalite nke ụdị hyperglycemia akpọrọ enweghị enweghị ihe yiri insulin zuru oke apụtachaghị nke ọma. O doghị anya ihe kpatara ya na nnukwu ọrịa glycemia dị otú ahụ, nke na-egosi erughi insulin nke ọma, enweghị ketoacidosis.

Mmalite izizi n'ọbara glucose n'ọbara n'ime ndị ọrịa nwere ụdị shuga 2 nwere ike ime ọtụtụ ebumnuche:

1. Ọkụ akpịrịkpa n’ihi ọtụtụ ihe ọgbụgbọ, ọnya afọ, belatara akpịrị ịkpọ nkụ n’ebe ndị agadi nọ, na-a largeụ ọgwụ ọ ofụ largeụ buru ibu.
Formationmalite imeju glucose n’ime imeju n’oge ọrịa shuga na-akpata site n’edoro ọrịa ma ọ bụ ọgwụgwọ ezughị ezu.
3. exmebiga glucose na-aba ụba n’ahụ n’ime oge mgbakasị ọgbụgba nke usoro glucose dị n’uche.

A na-akọwa mmụba na-aga n'ihu na nchịkọta nke glucose n'ọbara n'oge mmepe nke ọbara hyperosmolar site na ihe abụọ.

Nke izizi, ọrụ ezumike n’ọrụ n’arụ ndị ọrịa ọria mamịrị, nke na-ebute mbelata glucose n’ere, na-ekere òkè na nke a. Emere nke a site na mbelata afọ dị na mkpocha mkpụrụ ndụ, na-eme ka ọ dị njọ site na ọnọdụ nke akpịrị ịkpọ nkụ na ọrịa ọrịa mkpọnwụ gara aga.

Nke abuo, oria glucose nwere ike rụọ ọrụ dị mkpa na ọganiihu nke hyperglycemia, nke nwere mmetụta inhibitory na insulin secretion na ojiji glucose anụ ahụ. Perbawanye hyperglycemia, na-enwe nsị na-egbu egbu na mkpụrụ ndụ B, na-egbochi ịmịnye insulin, nke na-eme ka ịbawanye hyperglycemia pụta, nke ikpeazụ na-egbochikwa insulin insulin ọzọ.

Versionsdị dịgasị iche iche dị na mnwale ịkọwa enweghị ketoacidosis na ndị ọrịa nwere ọrịa ịba ọcha n'anya C Otu n'ime ha kọwara ihe ịtụnanya a site na izochi insulin n'ahụ na ndị ọrịa nwere ọrịa shuga nke 2, mgbe insulin nyefere ya na imeju zuru oke iji gbochie lipolysis na ketogenesis, mana ezughi iji glucose na mpaghara ahụ. Na mgbakwunye, ụfọdụ ọrụ na nke a nwere ike rụọ ọrụ site na ịta ọkwa nke homonụ Lipolytic abụọ dị mkpa, cortisol na homonụ ibu (STG).

A kọwapụtaghị enweghị ketoacidosis na hyperosmolar coma site na ogo insulin na glucagon dị iche iche n'ọnọdụ ndị dị n'elu. - homonụ nke akụkụ ndị ọzọ n'akụkụ metụtara lipolysis na ketogenesis. Ya mere, na mmiri mamịrị, ọbara glucagon / insulin na-enwe ike, ma n'ihe gbasara GK, insulin / glucagon na-emeri, nke na-egbochi ịgbalite lipolysis na ketogenesis. Ọtụtụ ndị ọrụ nyocharaala na hyperosmolarity na akpịrị ịkpọ nkụ nke ọ na-akpata n'onwe ha nwere ihe na-egbochi lipolysis na ketogenesis.

Na mgbakwunye na hyperglycemia na-aga n'ihu, hyperosmolarity na HA na-enyekwa aka na hypernatremia, mmalite nke ejikọtara ya na hypoproduction aldosterone na mmeghachi nke akpịrị. Hyperosmolarity nke plasma ọbara na osmotic diuresis na mbido mbụ nke mmepe nke hyperosmolar coma bụ ihe na-akpata mmepe ngwa ngwa hypovolemia, akpukpọ mmiri, mbibi akwara na mbelata ọbara na-agbapụta n'ahụ.

Ọkpụkpụ mkpụrụ ndụ ụbụrụ na-emekpa ahụ ike, mbelata nke ọ̀tụ̀tụ̀ mmiri mmiri ụbụrụ, obere microcirculation na-emetụta akụkụ ahụ na neurons na-akpata nsụ isi yana mgbaàmà ndị ọzọ. A na-ahụkarị n'oge a na-eme nchọpụta onwe, obere ọbara ọgbụgba na-emetụta ihe dị n'ụbụrụ na-ele anya dị ka nsonaazụ hypernatremia. N'ihi ọbara ọgbụgba na thromboplastin anụ ahụ na-abanye n'ọbara ọbara, sistemụ hemostasis na-arụ ọrụ, na -echekarị mpaghara ma gbasaa thrombosis.

Onyonyo a na-ahụ maka ọrịa nke GC na-agbadata ọbụna nwayọ karịa karịa ketoacidotic coma - ọtụtụ ụbọchị na izu.

Ihe nrịba ama nke ọgbụgba DM (akpịrị ịkpọ nkụ, polyuria, belata ibu) na-aga n’ihu kwa ụbọchị, nke na-esochi ike adịghị n’ogbugbu, ọdịdị akwara “na-agbagharị”, na-agafe na ụbọchị na-esote ihe ọdịdọ mpaghara.

Site na ụbọchị mbụ nke ọrịa ahụ, enwere ike ịmachi mmụọ n'ụdị mmelata nghazi, na-esote, na-akawanye njọ, a na-egosipụta ọgba aghara ndị a site n'ọdịdị nke ihe atụ, delirium na coma. Mmetụta nke nsụhọ ruru ogo nke coma kwesịrị ka ihe dịka 10% nke ndị ọrịa ma dabere n'ịba ụba hyperosmolarity nke plasma (ma, ya mere, na hypernatremia fluid).

Njirimara GK - ọnụnọ nke mgbaàmà akwara polymorphic: ọdịdọ, nsogbu ikwu okwu, paresis na ahumkpo, nystagmus, mgbaàmà nke ọrịa (S. Babinsky, wdg), olu na-ekwesi olu ike. Achọpụtara ọrịa a enweghị nsogbu ọ bụla na akwara ozi akwara ozi, a na-ahụkarị ya dịka nnukwu mmebi nke ọrịa ụbụrụ.

Mgbe ị na-enyocha ndị ọrịa dị otú ahụ, mgbaàmà nke akpịrị ịkpọ nkụ na-adọta uche, na karịa karịa na ketoacidotic coma: akpụkpọ akpịrị na akpụkpọ ahụ mucous, na -eme ka ọdịdị ihu, belata tonus nke nku anya, akpụkpọ anụ ahụ, ụda olu. Ntughari mmiri na - achoghari otutu oge, mana ogwe osisi di obere ma achoghi nma. Ọkpụkpụ na-adịkarị obere, dị obere, na-enwekarị eri.

Ọbara ọbara na-ebelata nke ọma. Ọtụtụ mgbe na karịa karịa na ketoacidosis, ọrịa na-eme. Otutu mgbe enwere otutu oria nke ndi si malite. Ọkpụkpụ okirikiri n'ihi akpọnwụ akpịrị na-ebute mmepe nke ujo hypovolemic.

Dichọpụta ọbara ọgbụgba na hyperosmolar n'ụlọ bụ ihe siri ike, mana ọ nwere ike itule ya na onye ọrịa nwere ọrịa mellitus, ọkachasị ebe mmepe nke coma tupu usoro ọgbaghara ọ bụla kpatara akpọnwụ akpukpo ahụ. N’ezie, eserese ya na ihe omuma ya bu ihe ndabere maka nchoputa nke ịba ọcha n’anya C, mana data nyocha nke ulo nyocha emere dika nkwenye nke nchoputa ya.

Dịka iwu, a na-eburu nchọpụta ọdịiche nke HA na ụdị hyperglycemic coma ndị ọzọ, yana nnukwu nsogbu nke mgbasa ụbụrụ, ọrịa nke ụbụrụ, wdg.

Achọpụtara nchoputa nke hyperosmolar coma site na oke glycemic ụkpụrụ (nke kachasị elu karịa 40 mmol / l), hypernatremia, hyperchloremia, hyperazotemia, ihe ịrịba ama nke ndakpọ ọbara - polyglobulia, erythrocytosis, leukocytosis, hematocrit dị elu, na kwa osmolarity dị elu nke 5, -295 mOsmol / l.

Mwepu nke nsụhọ na enweghị mmụba doro anya na osmolarity plasma dị irè bụ ihe a na-enyo enyo n'ụzọ bụ isi na cobral coma. Otu ihe dị mkpa banyere nchọpụta ọrịa nke ọdịiche dị na HA bụ enweghị isi acetone na ikuku ikuku na iku ume Kussmaul.

Agbanyeghị, ọ bụrụ na onye ọrịa ahụ nọrọ na steeti a ụbọchị 3-4, ihe ịrịba ama nke lactic acidosis nwere ike isonye wee chọpụta ike iku ume Kussmaul, yana n'oge ọmụmụ ihe ahụ. ọnọdụ acid-base (KHS) - acidosis kpatara ihe na-abawanye n’ime lactic acid n’ime ọbara.

Usoro ọgwụgwọ GC dị n'ọtụtụ dịka ọgwụgwọ nke ketoacidotic coma, ọ bụ ezie na ọ nwere njirimara nke ya ma na-achọ ikpochapụ akpịrị ịkpọ nkụ, ịlụ ọgụ na-akpata ịma jijiji, idozi usoro electrolyte na nguzozi acid-base (n'ọnọdụ nke lactic acidosis), yana iwepụ hyperosmolarity ọbara.

A na-arụ ụlọ ọgwụ nke ndị ọrịa na steeti hyperosmolar na ngalaba nlekọta ahụike. N'ime ọkwa ụlọ ọgwụ, a na-eme larịị gastric, a na-etinye catheter urinary, a na-ehibe usoro ọgwụgwọ oxygen.

Ndepụta nke nyocha ụlọ nyocha dị mkpa, na mgbakwunye na ndị a nakweere n'ozuzu ha, gụnyere mkpebi nke glycemia, potassium, sodium, urea, creatinine, CSR, lactate, ozu ketone, na plasma dị mma.

A na - eme friza na HA n'ogo buru ibu karịa mgbe e wepụtara site na ketoacidotic coma (ego nke mmiri gbanyere mmiri ruru 6-10 lita kwa ụbọchị). N'ime awa nke 1st, 1-1.5 L nke mmiri na-abanye n'ime ya, n'ime oge 2-3 - 0.5-1 L, n'ime awa ndị na-eso ya - 300-500 ml.

A na-atụ aro ịhọrọ maka ngwọta dabere na ọdịnaya sodium dị n'ọbara. Na ọkwa sodium ọbara dị ihe karịrị 165 meq / l, iwebata saline ngwọta bụ contraindicated ma rehydration na-amalite na gluu mmiri 2%. Na ọkwa sodium nke 145-165 meq / l, a na-eji mmiri sodium chloride 0.45% (hypotonic) sodium friza.

Fluzeze na-eduga na mbelata nke glycemia n'ihi mbelata ọbara ịba, ma na-eburu n'uche ịdị elu nke insulin na ụdị cma a, a na-arụ ọrụ nchịkwa ya na obere usoro (ihe dị ka nkeji abụọ nke insulin na-eme mkpụmkpụ "n'ime chịm" nke sisitem kwa elekere). Mbelata glycemia site na ihe karịrị 5.5 mmol / L, yana plasma osmolarity karịa 10 mOsmol / L kwa elekere na-eyi mmepe mmepe nke ụbụrụ na ụbụrụ.

Ọ bụrụ na mgbe awa 4-5 sitere na mmalite mmiri, sodium na-agbada, na hyperglycemia siri ike na-aga n'ihu, a na-achịkwa nchịkwa intravenous elele na insulin n'ogo nke nkeji 6-8 (dịka nke ketoacidotic coma). Site na mbelata nke glycemia dị n'okpuru 13.5 mmol / l, a ga-belata ọgwụ insulin na-agbadata site na ọkara ma belata nkezi nke 3-5 kwa elekere. Mgbe ị na-ejigide glycemia na ọkwa nke 11-13 mmol / l, enweghị acidosis nke etiology na mkpochapu akpọnwụ, a na-ebugharị onye ọrịa na subulinaneous management nke insulin n'otu oge ahụ na nkeji nke awa 2-3 dabere na ọkwa nke glycemia.

Iweghachite erughi potassium na - ebido ozugbo ọ chọpụtara na ọ dị obere n'ọbara yana akụrụ na - arụ ọrụ, ma ọ bụ awa 2 mgbe mmalite ọgwụ infusion. Ọgwụ potassium a na-enye na-adabere n’ihe dị n’ime ọbara ya. Yabụ, na potassium dị n'okpuru 3 mmol / l, 3 g nke potassium chloride (ihe akọrọ) a na-agbanye ya n'ime elekere kwa elekere, na potassium nke 3-4 mmol / l - 2 g nke potassium chloride, 4-5 mmol / l - 1 g nke potassium chloride. Site na potassium dị elu karịa 5 mmol / L, iwebata ihe ngwọta nke potassium chloride na-akwụsị.

Na mgbakwunye na usoro ndị edepụtara, a na-eme ihe nchịkwa ọdịda, a na-eme ọgwụgwọ ọgwụ nje, na ebumnuche igbochi thrombosis, a na-enye ọgwụ heparin na 5000 IU intravenously 2 ugboro kwa ụbọchị n'okpuru nchịkwa nke sistemu usoro.

Oge nnabata ụlọ ọgwụ, ịchọpụta ihe kpatara ihe butere mmepe ya, na mkpochapu ya, yana ịgwọ ọrịa conconitant, bụ nnukwu uru dị mkpa na ọgwụgwọ ịba ọcha n'anya C.

Vasyutin, A.M. Weghachite ọ joyụ nke ndụ, ma ọ bụ Otu esi ewepụ ọrịa shuga / A.M. Vasyutin. - M.: Phoenix, 2009 .-- 181 p.
Evsyukova I.I., Kosheleva N.G. Ọrịa shuga mellitus: ndị dị ime na ụmụ amụrụ ọhụrụ. SPb., Publọ mbipụta akwụkwọ "Akwụkwọ edemede pụrụ iche", 1996, peeji 269, mgbasa nke mkpụrụ 3000.
Vladislav, Vladimirovich Privolnev ụkwụ ọrịa shuga / Vladislav Vladimirovich Privolnev, Valery Stepanovich Zabrosaev na Nikolai Vasilevich Danilenkov. - M .: LAP Lambert Publishing, 2013 .-- 151 p.

Ka m kọwaa onwe m. Aha m bụ Elena. Anọwo m na-arụ ọrụ dị ka ọkà mmụta endocrinologist ruo ihe karịrị afọ 10. Ekwenyere m na abụ m ọkachamara n'ọhịa m ugbu a, m chọrọ inyere ndị ọbịa niile nọ na saịtị ahụ aka idozi ihe dị mgbagwoju anya ọ bụghị ọrụ. A na-achịkọta ihe niile dị na saịtị ahụ ma jiri nlezianya hazie iji kọọ ozi niile dị mkpa. Tupu itinye ihe akọwara na weebụsaịtị, ndụmọdụ mmetụtara na ndị ọkachamara dị mkpa mgbe niile.

Ihe kpatara hyperosmolar coma

Hyperosmolar coma nwere ike ịmalite n'ihi:

akpịrị na-egbu egbu (na ọgbụgbọ, ọnya afọ, ọkụ, ọgwụgwọ ogologo oge)
ezughi oke ma ọ bụ enweghi nke endogenous na / ma ọ bụ insulin na-ebu ibu (dịka ọmụmaatụ, n'ihi ọgwụgwọ insulin zuru oke ma ọ bụ na enweghị ya),
ịba ụba ịchọrọ insulin (na nnukwu ihe mebiri na nri ma ọ bụ iwebata ihe ngwọta glucose dị ukwuu, yana ọrịa na-efe efe, ọkachasị oyi baa na ọnya ọnya, ọrịa ndị ọzọ na-emetụta ọnya, mmerụ ahụ na ịwa ahụ, ọgwụgwọ ọgwụ na akụrụngwa nke insulin antagonists, glucocorticosteroids, nkwadebe homonụ nke mmekọahụ, wdg).

Achọpụtaghị pathogenesis nke hyperosmolar coma nke ọma. Ọrịa hyperglycemia siri ike na-adị n'ihi ịba ụba glucose n'ime ahụ, mmụba na-aba ụba nke imeju, mmụba glucose, mwepu nke insulin na itinye glucose site na anụ ahụ na-emebi emebi, yana n'ihi akpịrị nke anụ ahụ. E kwenyere na ọnụnọ insulin ọgwụ endogenous na-egbochi lipolysis na ketogenesis, mana ezughị iji gbochie imeju glucose site na umeji.

Ya mere, gluconeogenesis na glycogenolysis na-eduga na nnukwu hyperglycemia. Agbanyeghị, itinye uche nke insulin n'ime ọbara na ketoacidosis mamịrị na hyperosmolar coma fọrọ nke nta ka ọ bụrụ otu.

Dabere na ụkpụrụ ọzọ, ya na hyperosmolar coma, nchịkọta nke homonụ somatotropic na cortisol dị ala karịa nke nwere ketoacidosis mamịrị, na mgbakwunye hyperosmolar, insulin / glucagon ruru dị elu karịa na ketoacidosis nke ọrịa mamịrị. Plasma hyperosmolarity na - eduga na mwepu nke mwepụta nke FFA n'anụ ahụ na-egbochi lipolysis na ketogenesis.

Usoro nke hyperosmolarity nke plasma gụnyere mmụba nke aldosterone na cortisol na nzaghachi mmiri hypovolemia, n'ihi nke hypernatremia na-eto. Ọrịa hyperglycemia dị elu na hypernatremia na-eduga n'ọbara plasma hyperosmolarity, nke n'aka nke ya na-eduga na akpukpo intracellular akpọ. N'otu oge ahụ, ọdịnaya sodium na-agbadakwa na mmiri mkpụrụ mmiri nke cerebrospinal. Mmebi nke mmiri na nguzozi electrolyte na sel nke ụbụrụ na-eduga na mmepe nke mgbaàmà akwara ozi, edema na coma.

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Ihe mgbaàmà nke coma hyperosmolar

Hyperosmolar coma na - etolite n'ime ụbọchị ole na ole ma ọ bụ izu.

Onye ọrịa ahụ na -olite ihe mgbaàmà nke ọrịa deellensus deellensus deellensus, gụnyere:

polyuria
akpịrị ịkpọ nkụ
Akpụkpọ anụ na akpụkpọ anụ mucous,
ifelata
adighi ike, adynamia.

Na mgbakwunye, enwere ihe mgbaàmà nke akpịrị ịkpọ nkụ,

mkpụkọ anụ ahụ,
mbelata nku anya,
mbelata ọbara mgbali elu na ahụ gị.

Ihe mgbaàmà ndị metụtara akwara ozi bụ njirimara:

hemiparesis,
hyperreflexia ma ọ bụ areflexia,
isi mmụọ
nkwarụ (na 5% nke ndị ọrịa).

Na ọnọdụ hyperosmolar siri ike, nke edozighi, nzuzu na coma tolitere. Ọrịa ndị a na - ahụkarị hyperosmolar coma gụnyere:

Akwụkwụ na-adọ adọ
thrombosis miri emi,
ọria aru
gbasara akwara.

Nchoputa nke hyperosmolar coma

A na-eme nchọpụta nke hyperosmolar coma na ntọala nke anamnesis nke ọrịa shuga mellitus, na-abụkarị ụdị nke abụọ (n'agbanyeghị, ekwesiri icheta na hyperosmolar coma nwekwara ike ịmalite na ndị mmadụ na-arịabeghị ọrịa shuga mellitus, na 30% nke ikpe, hyperosmolar coma bụ ngosipụta mbụ nke ọrịa mellitus). ngosiputa nke nyocha ihe omumu ihe omumu (nke mbu, hyperglycemia di nkọ, hypernatremia na hyperosmolarity plasma na enweghi acidosis na ahu ketone. iji gosi akara nke hypokalemia na gbasara obi arrhythmias.

Ngosiputa ihe omimi nke hyperosmolar steeti gunyere:

hyperglycemia na glucosuria (glycemia na-abụkarị 30-110 mmol / l),
osmolarity plasma mụbara (na-abụkarị> 350 mosm / kg n'okpuru 280-296 mosm / kg), enwere ike ịgbakọ osmolality site n'ụkpụrụ: 2 x ((Na) (K)) + glucose ọbara / 18 ọbara urea nitrogen / 2,8.
hypernatremia (itinye sodium dị ala ma ọ bụ nke nkịtị n'ihi ọbara maka ịhapụ mmiri site na oghere intracellular n'ime oghere extracellular nwekwara ike),
enweghi acidosis na aru ketone n’ime obara na mmamiri
Mgbanwe ndị ọzọ (leukocytosis ruo 15,000-20,000 / μl, ejikọtaghị ya na ọrịa, mmụba na haemoglobin na hematocrit, mmụba dị ala na mkpokọta urea nitrogen n'ime ọbara) ga-ekwe omume.

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