Hyperosmolar na-abụghị ketone coma (Ọnọdụ hyperosmolar mamịrị, ọrịa hyperosmolar na-abụghị ketogenic, Nnukwu hyperosmolar na-abụghị acidotic)

Hyperosmolar coma (hyperglycemic, nke na-abụghị ketonemic, na-abụghị acidotic) Typedị shuga pụrụ iche bụ nke ọrịa mamellitus na-egosipụta na-arịa ọrịa shuga na-eme na-enweghị ketoacidosis site na nzụlite hyperglycemia siri ike, na-eru 33.0 mmol / l na elu. Ọkụ akpịrịkpa mmiri, exicosis cellular, hypernatremia, hyperchloremia, azotemia na enweghị ketonemia na ketonuria tolite. Hyperosmolar coma mejupụtara 5-10% nke comas hyperglycemic niile. Ọnwụ na-eru 30-50%.

Hyperosmolar coma na-etolite n'ime ndị ọrịa karịa afọ iri abụọ megide nzụlite NIDDM, na-akwụghachi ụgwọ site na ị smallụ obere ọgwụ sulfa ma ọ bụ ọgwụ na-ebelata shuga. N'ime ndị ọrịa na-erubeghị afọ 40 adịghị obere. Dabere na ọnụ ọgụgụ, ihe fọrọ nke nta ka ọkara nke ndị mepụtara hyperosmolar enweghị ọrịa shuga na mbụ, na 50% nke ndị ọrịa mgbe ha hapụsịrị coma, ọ dịghị mkpa nchịkwa insulin kwa mgbe.

Pathogenesis

Isi ihe na - akpasu iwe nke ọrịa shuga hyperosmolar bụ mmiri na - eme ka mmiri ghara ibu ibu nke insulin insulin na - amụba, na - ebute mmụba nke glycemia. Mmepe nke akpịrị ịkpọ nkụ na hyperosmolarity na-eduga:

Ọkpụkpụ hyperosmolar syndrome na-akwalite ọbara na - ebuputa site na usoro dị iche iche, gụnyere n'oge ịwa ahụ. Mgbe ụfọdụ ụdị coma mamịrị na - etolite n'oge ọgwụgwọ ya na diuretics, glucocorticoids, immunosuppressants, iwebata nnukwu mmiri nke saline, usoro hypertonic, mannitol, hemodialysis na peritoneal dialysis. Ọnọdụ ahụ jọrọ njọ site na iwebata glucose na oke oriri nke carbohydrates.

Pathogenesis edit |Ozi izugbe

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:

• Ọrịa shuga na-adịghị mma. Ọ kpatara ọgwụ insulin na-ezughị ezu, na-ahapụ ịgba ọgwụ ọzọ, ịhapụ ị hyụ ọgwụ hypoglycemic nke nje, ịkagbu ọgwụgwọ oge, njehie na usoro nke ịisterụ insulin. Ihe egwu GONC bụ na ihe mgbaàmà ahụ apụtaghị ozugbo, ndị ọrịa anaghị a attentiona ntị na njehie ndị nwere ikike ọgwụgwọ.
• Ọrịa dị iche iche. Ihe mgbakwunye nke ọrịa ndị ọzọ siri ike na-eme ka ohere nke hyperosmolar hyperglycemic na-abụghị ketone coma. Mgbaàmà na-etolite n'ime ndị ọrịa na-efe efe, yana na ọrịa pancreatitis nke nnukwu decompensated, mmerụ ahụ, ọnọdụ ujo, infarction myocardial, ọrịa strok. N'ime ụmụ nwanyị, afọ ime bụ oge dị ize ndụ.
• Gbanwee na nri oriri. Ihe kpatara nsogbu a nwere ike bụrụ mmụba na ụba carbohydrates na nri. Ọtụtụ mgbe nke a na-eme nwayọ ma ndị ọrịa anaghị ele ya anya dị ka imebi nri ọgwụgwọ.
• Ọnwụ na-efe efe. Akpịrị akpọnwụ na-apụta mgbe ị na-a diụ ihe ọ ,ụ ,ụ, ọkụ, hypothermia, vomiting, na afọ ọsịsa. Na mgbakwunye, GONK na-akpasu iwe site na enweghi ike imebi ọnọdụ ịkpọ nkụ (enweghị ike ịdọpụ uche na ebe ọrụ wee mebie mmiri, enweghị mmiri ọ inụ inụ na mpaghara ahụ).
• Medicationakingụ ọgwụ. Enwere ike ịmalite mmalite nke ihe mgbaàmà site na iji ọgwụ mgbatị ahụ ma ọ bụ ọgwụ ndị na-ewepụ mmiri mmiri n'ahụ. Ọgwụ “dị ize ndụ” gụnyekwara corticosteroids, beta-mgbochi na ụfọdụ ọgwụ ndị ọzọ na-emebi nnabata glucose.

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.

Ihe mgbaàmà nke coma hyperosmolar

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.

Nsochi

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.

Diagnostics

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.

Hyperosmolar coma ọgwụgwọ

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.

Amụma na Mgbochi Ya

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.

Nsogbu enwere ike ibute oria a

Site na mbelata nke glucose na akpukpo ahu nile akụkụ ụbụrụ ma ọ bụ ụkwara ume ọkụ nwere ike ibilite. Ndị agadi na-arịa ọrịa obi na ọbara mgbali elu. Ọdịnaya dị elu nke potassium n’ahụ nwere ike ịkpata ọnwụ mmadụ.

Ọrịa

Ihe mbu emere n’oge ọgwụgwọ bu kpochapu akpukpo ahihia, mgbe emesotara osmolarity obara ma mee ka onodu glucose di ala.

N'ime ụlọ ọgwụ onye ọrịa, kwa awa, a na-ewere ọbara iji nyocha maka ọtụtụ ụbọchị. Ugboro abụọ n'ụbọchị, a na-eme nnyocha na ketones n'ime ọbara, a na-enyocha steeti acid-body nke ahụ.

A na-enyocha oke mmamịrị na-agbanwe ka oge na-aga. Ndị dọkịta na-enyocha ọbara mgbali na cardiogram mgbe niile.

Iji kwụsị ịhydụ mmiri, a na-edozi sodium chloride 0.45% (n’ime awa izizi nke ụlọ ọgwụ 2-3 lita). Ọ na-abanye n'ahụ ahụ n'ime otu ebe. Mgbe ahụ, a na-ewebata azịza nke nrụgide osmotic n'ime n'ọbara ọbara yana njikwa insulin ọzọ. Usoro nke insulin agaghị agafe nkeji iri na ise. Ebumnuche ọgwụgwọ bụ ịhazi oke glucose na ahụ.

Ọ bụrụ na ụba nke sodium dị elu, mgbe ahụ, a na-eji glucose ma ọ bụ dextrose agbanwe mee ihe kama sodium chloride. Ọzọkwa, ọ dị mkpa inye onye ọrịa ahụ nnukwu mmiri.

Mgbochi Ọrịa

Mgbochi ọrịa ahụ:

Iri nri Mbelata ma ọ bụ mwepu zuru oke na nri nke carbohydrates (sugar na ngwaahịa nwere ya). Nsonye na menu nke akwụkwọ nri, azụ, anụ ọkụkọ, ihe ọ naturalụ naturalụ eke.
Mmega ahụ. Mmụta anụ ahụ, egwuregwu.
Nyocha ahụike mgbe niile.
Udo nke obi. Ndụ enweghị nchekasị.
Ike nke ndị ị hụrụ n'anya. Enyemaka enyemaka oge ọ bụla.

Egwuregwu vidiyo bara uru

Ihe nkiri ahụike na-enye aka banyere nlekọta mberede maka ọrịa shuga:

Coma Hyperosmolar Ọrịa mamịrị - Oria bu oria ajuju, aghotaghi ya nke oma. Ya mere, ndị ọrịa nwere ọrịa shuga kwesịrị ịmụrụ anya mgbe niile. Must ga-echetarịrị nsonaazụ ya. Anabataghị imebi nguzogide mmiri na ahụ.

Ikwesiri ịgbasochi ihe oriri anya, rie insulin n'oge, nke dọkịta na-elele kwa ọnwa, na-emegharị ahụ ma na-eku ume ikuku ugboro ugboro.

Kedu ihe bụ hyperosmolar coma

Ọnọdụ a na - arịa ọrịa bụ ihe na - akpata ọrịa shuga mellitus, a na - achọpụta ya erughị ketoacidosis ma ọ bụ njirimara ndị ọrịa nwere akwara gbasara akụrụ.

Ihe ndị na-akpata coma bụ: ajọ ọgbụgbọ, afọ ọsịsa, ị abuseụ ọgwụ diuretic, ụkọ insulin, ọnụnọ nke nnukwu ọrịa na-efe efe, na nguzogide ọgwụ insulin. Ọzọkwa, coma nwere ike ịbụ nnukwu mmebi nke nri, nchịkwa gabigara ókè nke ngwọta glucose, iji ọgwụ mgbochi insulin.

Ọ bụ ihe kwesịrị ịrịba ama na diuretics na-akpalitekarị mmiri ọgwụ hyperosmolar na ndị nwere afọ ndụ dị mma, ebe ọgwụ ndị dị otú ahụ nwere mmetụta ọjọọ na metabolism metabolism. Ọnụnọ nke ọrịa metụtara ọrịa metụtara ọrịa shuga, nnukwu usoro ọgwụgwọ diuretic kpatara:

1. ngwa ngwa metabolism,
2. nsị glucose ike.

Nke a na-emetụta ịta nke glycemia na-ebu ọnụ, ọnụego nke hemoglobin glycated. N'ọnọdụ ụfọdụ, mgbe ọ gachara ọgwụ ọgbụgba, akara nke ọrịa shuga mellitus na hyperosmolar coma na-abụghị ketonemic.

E nwere usoro a na-emetụta ogo mmadụ nke afọ glycemia na ọnọdụ nke ịrịa ọrịa shuga na afọ mmadụ, ọnụnọ nke ọrịa na-adịghị ala ala, oge ọnya. Ndị na-eto eto nwere ike ịnwe nsogbu ahụike afọ 5 mgbe mmalite nke ọrịa akwara, na ndị ọrịa agadi n'ime otu afọ ma ọ bụ abụọ.

Ọ bụrụ na mmadụ arịaworị ọrịa shuga, ọnọdụ a ga-agbagha karịa, ihe ndị na-egosi glycemia ga-akawanye njọ n'ime ụbọchị ole na ole mgbe ịmalite ịrịa ọrịa diuretic.

Na mgbakwunye, ọgwụ ndị dị otú ahụ nwere mmetụta ọjọọ na metabolism abụba, mee ka uche nke triglycerides na cholesterol dịkwuo elu.

Ihe na-akpata Coma

Ndị dọkịta amabeghị ihe kpatara ọrịa shuga dị ka hyperosmolar coma.

Otu ihe amaara na ọ bụrụ nsonaazụ glucose na ọbara n'ihi ihe mgbochi insulin.

Na nzaghachi na nke a, a na-arụ ọrụ glycogenolysis, gluconeogenesis, nke na-enye mmụba na ụlọ ahịa shuga n'ihi metabolism ya. Nsonaazụ nke usoro a bụ mmụba nke glycemia, mmụba nke osmolarity ọbara.

Mgbe homonụ dị n’ọbara ezughi:

• iguzogide ya na-aga n'ihu,
• Anụ ahụ adịghị enweta oke nri nri.

Hyperosmolarity nwere ike igbochi ịhapụ abụba abụba site na anụ ahụ adipose, na-egbochi ketogenesis na lipolysis. N’aka ozo, a na - edobe nzuzo nke okpukpo ozo si n’ebe a na-echekwa abuba rue uzo di nkpa. Mgbe usoro a ga-akwụsịlata, ọnụ ọgụgụ nke ahụ ketone na-esite na ntụgharị abụba ka ọ bụrụ glucose na-ebelata. Ọnụnọ ma ọ bụ ọnụnọ nke ozu ketone na-enyere aka ịchọpụta ụdị coma na-arịa ọrịa shuga.

Hyperosmolarity nwere ike ibute ịba ụba nke cortisol na aldosterone ma ọ bụrụ na ahụ adịghị ike na mmiri. N'ihi ya, olu nke ikesa ọbara na-ebelata, hypernatremia na-abawanye.

Ọnọdụ akpịrị na-amalite amalite n'ihi ụbụrụ, nke metụtara ihe mgbaàmà akwara na enweghị mmebi:

Osmolality ọbara na-agbadata megide mmalite nke ọrịa shuga na-enweghị ụkwara ume ọkụ na ọrịa akụrụ na-adịghị ala ala.

N’ihe ka n’ọnụ ọgụgụ, ihe mgbaàmà nke coma hyperosmolar na-abịa nso yiri ngosipụta nke hyperglycemia.

Onye na-arịa ọrịa shuga ga-enwe akpịrị ịkpọ nkụ, akpịrị na-akpọ nkụ, ike ọgwụgwụ, mgbakasị ahụ ngwa ngwa, ọ ga-enweta ume ngwa ngwa, urination, na oke belata.

Hydụbiga mmiri ókè, ịba ụba n'ọkpụkpụ ume, mbelata ọbara mgbali elu, mgbali elu nke akwara ozi, ike na -eme ka ọrụ na-esighi ike, oke nke nku anya, akwara anụ ahụ, ọgba aghara na ọrụ obi na mgbali obi.

Ihe mgbaàmà ndị ọzọ ga - abụ:

1. warara nke umu akwukwo
2. umeji ọbara
3. enweghi ike ogwugwo,
4. nsogbu meningeal.

Ka oge na-aga, a na-edochi polyuria site na anuria, nsogbu ndị siri ike na-etolite, nke gụnyere ọrịa strok, ọrụ na-arụ ọrụ ezumike, pancreatitis, thrombosis venous.

Zọ nyocha, ọgwụgwọ

Site na mwakpo hyperosmolar, ndị dọkịta na-etinye ọgwụ glucose ozugbo, nke a dị mkpa iji kwụsị hypoglycemia, ebe ọ bụ na nsonaazụ na-egbu egbu n'ihi nsị shuga dị n'ọbara na-apụta ọtụtụ mgbe karịa mgbe ọ na-abawanye.

N ’ụlọ ọgwụ, a na-eme ECG, nnwale ọbara maka shuga, nnwale ọbara biochemical iji chọpụta ọkwa triglycerides, potassium, sodium na cholesterol zuru oke ka enwere ike ngwa ngwa o kwere mee. Ọ dịkwa mkpa ịme nnwale mmamịrị n'ozuzu maka protein, glucose na ketones, nyocha ọbara n'ozuzu ya.

Mgbe emere ọnọdụ onye ọrịa ahụ ọgwụ, a ga-edenye ya nyocha nke ultrasound, X-ray nke pancreas, na ụfọdụ nnwale ndị ọzọ iji gbochie nsogbu enwere ike.

Ọrịa shuga ọ bụla, nke nọ na nsogbu, kwesịrị ime ọtụtụ ihe tupu amanye ụlọ ọgwụ:

• mweghachi na mmezi nke ndị dị mkpa gosipụtara,
• nyocha ngwa ngwa,
• nhazi iwu glycemia
• mkpochapu akpukpo ahihia,
• ọgwụ insulin.

Iji nọgide na-egosi ihe dị mkpa, ọ bụrụ na ọ dị mkpa, na-eme ka ikuku ara ma na-emegharị ahụ, na-elele ọkwa nke ọbara mgbali na mgbasa ọbara. Mgbe nrụgide ahụ belatara, nchịkwa intravening nke 0.9% sodium chloride solution (1000-2000 ml), glucose solution, Dextran (400-500 ml), Reftan (500 ml) na ojiji Norepinephrine enwere ike, Dopamine gosipụtara.

Site na ọbara mgbali elu, hyperosmolar coma na ọrịa shuga mellitus na-enye nhazi nke nrụgide dị ka ọkwa nke na-agabigaghị RTV 10-20 nke mbụ. Art. Maka ebumnuche ndị a, ọ dị mkpa itinye 1250-2500 mg nke magnesium sulfate, a na-ahụ maka infusion ma ọ bụ bolus. Site na mmụba dị nta, enweghị ihe karịrị 10 ml nke aminophylline. Ọnụnọ nke arrhythmias chọrọ iweghachi ọnụego obi.

Ka ọ ghara ibute nsogbu na ụzọ ụlọ ọgwụ, a na-anwale onye ọrịa ahụ, maka ebumnuche a, a na-eji mpempe nnwale pụrụ iche.

Iji mezie ọkwa nke glycemia - isi ihe kpatara coma na ọrịa shuga mellitus, a na-egosipụta ojiji injections insulin. Agbanyeghị, na prehospital ogbo nke a anabataghị, a na-abanye homonụ ahụ n'ụlọ ọgwụ ozugbo. N'ime ngalaba nlekọta ahụike, a ga-ewere onye ọrịa ozugbo maka nyocha, zigara ya ụlọ nyocha, mgbe nkeji iri na ise ga-enwetara nsonaazụ ya.

N'ụlọ ọgwụ, ha na-enyocha onye ọrịa, nyochaa:

1. na-eku ume
2. nsogbu
3. ahụ ọkụ
4. obi obi.

Ọ dịkwa mkpa iji duzie usoro electrocardiogram, nyochaa itule mmiri-electrolyte. Dabere na nsonaazụ ọbara na mmamịrị, dọkịta na-eme mkpebi banyere idozi ihe ịrịba ama dị mkpa.

Yabụ enyemaka mbu maka ịrịa ọrịa mamịrị bụ iji kpochapụ akpịrị, nke ahụ bụ, iji saline Solution gosipụta, sodium ka amata ike ijigide mmiri n’ime sel nke anụ arụ.

N'ime elekere mbụ, ha tinyere 1000-1500 ml nke sodium chloride, n'ime awa abụọ na-esote, a na-enye 500-1000 ml nke ọgwụ ahụ n'ọbara, mgbe nke ahụ gasịrị, 300-500 ml nke saline zuru ezu. Chọpụta ókè sodium adịghị esiri ike; ọ bụ plasma ọbara na-enyocha ọkwa ya.

A na-ewere ọbara maka nyocha nke bioche ọtụtụ oge n'ụbọchị, iji chọpụta:

• sodium ugboro 3-4
• shuga 1 oge kwa awa,
• ozu ketone 2 ugboro n'ụbọchị,
• acid-base steeti 2-3 ugboro n'ụbọchị.

A na-eme nyocha ọbara n'ozuzu ya kwa ụbọchị 2-3.

Mgbe sodium larịị ruo ọkwa nke 165 mEq / l, ị nweghị ike ịbanye na usoro ọgwụgwọ nke mmiri, n'ọnọdụ a, achọrọ glucose. Ọzọkwa, a na-etinye onye na-eji mmiri mmiri dextrose.

Ọ bụrụ na a na-arụ mmiri mmiri n'ụzọ ziri ezi, nke a na-enwe mmetụta bara uru na ma-mmiri electrolyte na ọkwa nke glycemia. Otu n'ime usoro dị mkpa, na mgbakwunye na nke ndị a kọwara n’elu, bụ ọgwụ insulin. N'ọgụ hyperglycemia, a chọrọ insulin nke na-adị mkpụmkpụ:

1. ọkara ihe sịntetik,
2. ọrụ mkpụrụ ndụ ihe nketa.

Agbanyeghị, ekwesịrị inye insulin nke abụọ.

N'oge usoro ọgwụgwọ, ọ dị mkpa icheta ọnụọgụ nke insulin nke insulin dị mfe, mgbe a na-eduzi homonụ ahụ, oge ọrụ ya dị ihe dị ka minit 60, na njikwa subcutaneous - ruo awa anọ. Ya mere, ọ kachasị mma ịnye insulin subcutaneously. Site n'ịbalata glucose ngwa ngwa, ọgụ nke hypoglycemia na-ewere ọnọdụ ọbụna na ogo shuga a na-anakwere.

Enwere ike iwepu coma mamịrị site na ịnye insulin tinyere sodium, dextrose, ọnụego ya bụ 0,5-0.1 U / n'arọ / awa. Amachibidoro ịtọ homonụ ahụ ozugbo; mgbe ị na - eji insulin 6,12 nke insulin dị mfe, a na - egosi 0.1-0.2 g nke albumin iji gbochie nnabata insulin.

N'oge ọgbụgba, ekwesịrị ileba anya ịbawanye glucose kwesịrị ekwesị iji chọpụta etu usoro usoro ha dị. Maka mkpụrụ ndụ mamịrị, iweda shuga dị ihe karịrị 10m / kg / h na-emerụ ahụ. Mgbe glucose na-agbadata ngwa ngwa, osmolarity nke ọbara na-agbadata n'otu ọnụego, na-eme ka ihe mgbagwoju anya dị ize ndụ na ahụike na ndụ - ụbụrụ ụbụrụ. Willmụaka ga-abụ ihe kachasị emetụta na nke a.

O siri ezigbo ike ịkọ ihe ga-eme ka otu agadi onye ọrịa mee ihe ọbụlagodi nzụlite usoro omume mgbapụta ezighi ezi n'ụlọ ọgwụ na oge ọnụnọ ya. N'okwu ndị dị elu, ndị ọrịa mamịrị na-eche eziokwu ahụ bụ na mgbe ọpụsịrị hyperosmolar coma, enwere mgbochi nke ọrụ obi, edema. Imirikiti coma na-emetụta ndị agadi nwere akwara na-adịghị ala ala na nkụda obi.

Vidiyo dị n'isiokwu a na-ekwu maka nnukwu ọrịa nke ọrịa shuga.