Ọrịa shuga IIdị nke Abụọ

Calcium (2.3-2.75) 2.89

10.30.2002 Nchoputa na iju ajuju nke onye ọrịa. Okpomoku 36.5 0 С. HELL 130/90 mmHg Oche dị mma, na-alụbeghị di. Onye ọrịa ahụ na-eme mkpesa nke ihe mgbu na ọnụọgụ ụkwụ, ihe mgbu na nkwonkwo ikpere. Na nyocha: akpukpo ukwu nke ukwu di iche-iche, kwuputara, gbajiri agbaji. Ọnọdụ akpụkpọ ahụ bụ ihe nkịtị, akpụkpọ ahụ mucous nke ọnụ na egbugbere ọnụ ya bụ pink, na-agbanweghị.

November 1, 2002 E duziri ọmụmụ ihe dị mma. Achọpụtaghị mgbanwe dị iche iche na ọnọdụ onye ọrịa ahụ. Okpomoku 36.7 0 С, olu obara 130/85 mm Hg Oche dị mma. Na nyocha, onye ọrịa ahụ dị jụụ, zaa ajụjụ ndị bụ isi. Mkpesa nke nkụda mmụọ na mgbanwe na ọnọdụ ahụ, na-ebuli. Onye ọrịa na-emega ahụ, na-eleta ụlọ ahụike, na-anata ọgwụgwọ edepụtara.

Nọvemba 4, 2002 Onye ọrịa nọ na ahụike, ọ nọ n'ọyị. Onye ọrịa ahụ na-enwe obi ụtọ, na-ekwupụta mmụba dị ukwuu, ma e jiri ya tụnyere oge tupu ntinye n'ụlọ ọgwụ. Onye ọrịa ahụ ewetaghị mkpesa ndị ọzọ. Na nzụlite usoro ọgwụgwọ ahụ, ọnọdụ nke akpụkpọ ụkwụ ụkwụ ka ọ ka mma, ịcha edo edoghị anya. Agụụ dị mma. A na-achọ oche ahụ mma. Okpomoku 36.7 0 С. HELL 125/90 mmHg

Anyị na-achọpụta ọrịa shuga na mkpesa (polydipsia, polyuria, mmụba dị ukwuu na ahụ), data nyocha ụlọ (glycemia dị mkpa, glucosuria). N'otu oge ahụ, ọdịdị nke mmepe na usoro (usoro nwulite agbatịwo ogologo oge, enweghị oge ngosipụta nke ụlọ ọgwụ), ibu dị arọ, ịdị nkọ na ọnụ ọgụgụ isi ya na ndị ọrụ hypoglycemic (maninil) na-egosi ụdị ọrịa shuga II. Ọnọdụ ahụ kwekọrọ na ịdị njọ, n'ihi na enwere nsogbu nke ọrịa shuga: retinopathy I (ọrịa mamịrị retle phlebopathy, retinal hypertensive angiopathy na anya abụọ), nephropathy m (edema, ọbara mgbali elu), microangiopathy na polyneuropathy distal (mkpesa nke ihe mgbu, ọnụọgụ nke aka na ụkwụ, mgbanwe akpụkpọ ahụ trophic) ukwu ala). N'oge a, onye ọrịa nọ n'ọkwa nkwụghachi ụgwọ, dịka ọtụtụ mkpesa edepụtara n’elu na ọkwa nke akpịrị.

Etiopathogenesis. Oge pathogenetic nke ọrịa shuga mellitus nke abụọ bụ mmebi nke nguzosi ike nke ndị nabatara cell na insulin, n'otu aka, ma, n'aka nke ọzọ, mwepu nzuzo nke mkpụrụ ndụ beta nke ngwa ntụ ntụ islet. A na-ekpebi ihe ndị ae mejupụtara site na mkpụrụ ndụ ihe nketa, dị ka egosipụtara site n'inweta ibu dị arọ. Ihe kpatara iwe a, o doro anya, oke ibu na oke mgbanwe na ọkwa homonụ n’oge ịtụrụ ime, yana gestosis siri ike n’oge ime nke abụọ.

Ọgwụ shuga na-ebelata: shuga 0.08 g 2 r / ụbọchị, mbadamba 2 na nri

Lipoic acid 0.025g 1tab ugboro atọ n'ụbọchị

Nicotinic acid 0.05 g na mbadamba 1. 3p / ụbọchị

IV pentoxifylline ntapu 100 mg na 400 ml 0.9% NaCl

Vit. B1 (thiamine) 0.05 ampoules nke 1 ml / m Numero 10

A nabatara onye ọrịa ahụ na ngalaba ahụ na 10/18/02 nwere ihe mgbaàmà nke mbibi ụdị ọrịa shuga II nke ọrịa mellitus. Ebumnuche ọgwụgwọ na nke a bụ mgbazi nke metabolism metabolism, mmezi ọnọdụ ahụ na ịkwụsị nkwụsị nke nsogbu. Na-emegide usoro ọgwụgwọ ahụ, ọnọdụ onye ọrịa ahụ kawanye mma, mkpesa nke polyuria, polydipsia kwụsịrị, ọbara mgbali na glycemia belatara. A zụrụ onye ọrịa ahụ ịgbaso iwu ndị dị mkpa maka nchịkwa ọrịa. A napụrụ onye ọrịa ahụ n'ụlọ nkwụghachi ụgwọ. Na-atụ aro: nri, ịmachi ihe oriri kalori nri, ọnụọgụ nke carbohydrates na-agbari ngwa ngwa ma na-ejigide oke nchekwa nke protein: abụba: carbohydrates = 20: 25: 55. Ọgwụ ọgwụ na ọgwụ shuga dị mbadamba abụọ ugboro abụọ kwa ụbọchị na nri. Nleba anya na mpaghara endocrinologist na ntụzi nke usoro ọgwụgwọ dabere na ọrịa ahụ. A na-atụ aro ka argonlasercoagulation nke retina nke anya abụọ na ileba anya na ịzọ oculist. Mgbochi nke mmepe nke ụkwụ mamịrị - nlekọta ọcha maka ụkwụ, nyocha nke ụkwụ mgbe ị na-eleta dọkịta ọbụlagodi 1 oge n’ime ọnwa isii.

Amụma: ọ bụrụ na agbaso ndụmọdụ ndị ahụ, ọnọdụ ụgwọ ọrịa ọrịa ogologo oge na enweghị usoro nke nsogbu enwere ike.

Anamnesis nke ndụ ọrịa onye ọrịa, mkpesa ya na nnabata. Mee atụmatụ maka nyocha nnwale nke onye ọrịa, nyocha nke nsonaazụ ya. Ihe omuma banyere ichoputa oria a: microgoniopathy nke oria di ala na mpaghara ala ala. Atụmatụ ọgwụgwọ maka ọrịa a, prognosis maka ndụ.

Idobe ezigbo ọrụ gị na ntọala ihe ọmụma dị mfe. Jiri mpempe akwụkwọ dị n'okpuru

Studentsmụ akwụkwọ, ụmụ akwụkwọ gụsịrị akwụkwọ, ndị sayensị na-eto eto na-eji ihe ọmụma ihe ọmụmụ ha na ọrụ ha ga-ekele gị nke ukwuu.

Ezitere ya na http://www.allbest.ru/

Ọzụzụ agụmakwụkwọ steeti dị elu

"Mahadto Ahụike Saratov State

ha. V.I. Zlọ Ọrụ Federal Federal Razumovsky Maka Ahụike na Ọha na Mmekọrịta "

(GOU VPO Saratov State Medical University V.I. Razumovsky Roszdrav)

Onye isi Ngalaba: Dọkịta nke Medicine, prof. Rodionova T.I.

Afọ: afọ 78 (02.08.1934)

Nchọpụta ọgwụgwọ kachasị: :dị mịnịstrị shuga nke abụọ, achọpụtara nke mbụ, ogbo nke mkpokọta metabolic.

Nsogbu: Ischemia ụkwara ụbụrụ nke usoro ọmụmụ jikọtara ọnụ. Ọrịa ịrịa ọrịa mamịrị bụ usoro na - enweghị protinerative. Ọrịa shuga microangiopathy nke akụkụ ala. Polyneuropathy na-arịa ọrịa mamịrị. Ọrịa ịba ọcha n'anya.

Njikọ: Ọbara mgbali elu 3 ogo, ihe egwu 4. Atherosclerosis nke aorta, akwara ọbara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

N'azụ: Oke ibu IIa.

2. Afọ: afọ 78 (08/02/1934)

4. Adresị: Saratov.

5. Ọrụ: okenye obodo

6. ofbọchị nnabata ụlọ ọgwụ ahụ: 12.10.12g.

7. Kedu ụlọ ọgwụ ahụike ka a na-ekwu banyere ụlọ ọgwụ: ụlọ ọgwụ na ebe obibi

8. Nchoputa nke ulo oru ogwu dibia aria nke oma: diabetes udiri oria abuo nke II, nke achoputara, ọkwa nke deproti usoro.

9. Ọrịa nyocha:

Ihe mbu: Mellitus oria II, nke mbuchoputara, ogbo nke decompensation metabolic.

Nsogbu: Ischemia ụkwara ụbụrụ nke usoro ọmụmụ jikọtara ọnụ. Ọrịa ịrịa ọrịa mamịrị bụ usoro na - enweghị protinerative. Ọrịa shuga microangiopathy nke akụkụ ala. Polyneuropathy na-arịa ọrịa mamịrị. Ọrịa ịba ọcha n'anya.

Yiri: akwara obi. Ọkwa ọbara 3, ihe egwu 4. Atherosclerosis nke aorta, akwara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

N'azụ: Oke ibu IIa.

· Mgbe nnabata, onye ọrịa mere mkpesa nke akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ mgbe niile, mmụba urination, gụnyere mmamịrị abalị, mmụba mmamịrị, mụbara shuga na 12 mmol / l,

Itching na ukwu.

Ahụhụ, ọnụnọ na daa jụụ ụkwụ,

Nkwarụ ncheta, isi ọwụwa nke oge na - enweghị edetu ọfụma, nsogbu ure,

App agụụ belatara, belata belata kilogram 7 n’ime ọnwa 3 gara aga, adịghị ike izugbe.

Na-atụle onwe ya onye ọrịa kemgbe June 2012, mgbe ọ malitere ime ememe mkpesa ndị ahụ dị n'elu. Ọrịa malitere nke nta nke nta. Ná mmalite nke oge ọkọchị, a na-ekwupụta mkpesa obere oge, agakwaghị dọkịta.

Ná mmalite October, ọnọdụ onye ọrịa bịara ka njọ (adịghị ike mụbara, ibu belata bụ 7 n'arọ, akpịrị ịkpọ nkụ malitere inye gị nsogbu oge, urination mụbara ugboro 15 n'ụbọchị, ugboro 3 n'abalị, itching na inguinal mpaghara).

Site na mkpesa ndị a, onye ọrịa tụgharịrị n'ụlọ ọgwụ na ebe obibi. Onye na-ahụ maka mpaghara ahụ nyere iwu ka ụlọ ọgwụ na-agwọ ọrịa na mmụba nke glycemia ruo 14 mmol / l na ọnụnọ acetone na mmamịrị (+). Emere nchọpụta ahụ: elldị mịnịstrị shuga nke II, nke akọwapụtara nke mbụ, ọkwa nke mkpokọta metabolic. 10/12/12 E zigara onye ọrịa ahụ maka ịga ụlọ ọgwụ n'ụlọ ọgwụ 9th, endocrinology ngalaba mberede.

Onye ọrịa ahụ bi na Saratov, n'ụlọ ya. Arụ ọrụ. Omume ndị gbara afọ 18 adịghị egbu mgbu. Menopause site na afọ 44. Enweela ime afọ abụọ, 2 gwụsịrị site na nnyefe ngwa ngwa. Grew ma tolite dika ogo ya.

Ebe oru: onye n’ego ezumike nka.

Prof. Ọ dịghị mmerụ ahụ n'oge ọrụ ahụ dum.

Nke ọrịa kwuru nnukwu akụkụ okuku ume na ọrịa, Influenza.

Tubkwara nta, ịba ọcha n'anya, ịba ọcha n'anya, HIV - gọrọ.

Akụkọ ihe mere eme adịghị nfụkasị.

E nweghị ọrịa ọrịa a na-ebute agha n’ezinụlọ.

Na ịkpọtụrụ ndị ọrịa na-efe efe.

Emeghị mmịnye ọbara.

Oge ogwugwo agbasa: iyi nke aka ekpe n’afọ 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

Ọrịa ọnya ọgbụgba: ọbara mgbali elu nke ogo nke atọ, ihe ize ndụ 4 edobere na 55 site n'aka ndị ọrụ izugbe na polyclinic n'ebe obibi, ka a na-enye ọgwụ. Ọ na-a drugsụ ọgwụ mgbochi mgbe niile (ọ naghị echeta aha ahụ). Onweghị nkụchi obi, ọrịa strok.

Ebumnuche nyocha nke onye ọrịa

N'oge nlekọta, ọnọdụ onye ọrịa ahụ afọ ojuju. Nghọta doro anya. Ọnọdụ: nọ n'ọrụ. Ngosiputa nke di na anya na anya adighi ike.

Ogologo: 150kg, Ibu ibu - 68.7 n'arọ. BMI = 30.5. Ahụ okpomọkụ 36.6 Celsius C

Akpụkpọ ahụ na akpụkpọ ahụ mucous na-ahụ nke agba na-ahụkarị, na-enweghị rashes pathologies na pigmentation, turgor akpụkpọ ahụ na-ebelata.

Mgbanwe na akpukpo aru nke akpukpo aru: akpukpo aru akpọnwuwo, aka na ukwu adiiri na mmetu.

Ọnọdụ mbọ na ntutu: nkwụ na-emebi emebi, na-emeghe. Ntutu dị gịrịgịrị.

Lymph nodes abụghị palpable.

Akpukpo aru nke Subcutaneous ka emechara nke oma, kesaa ya. Anaghị aza aza.

Usoro akwara: na - enweghi ogwu.

Onweghi ihe ogwara n’ọkpụkpụ azụ ma ọ bụ mmebi nke ọkpụkpụ pelvic. Mmegharị ahụ na nkwonkwo niile anaghị egbu mgbu, n'uju.

Ọkpụkpụ akụrụngwa

A naghị agbanwe ọdịdị nke obi na mpaghara obi. Igwe ọkụ akwara obi, ịgba egwu carotid, wiwi jugular, na epigastric pulsation adịghị. Ọsọ obi bụ 88 kwa nkeji.

Pulse 90 gbagwojuru / min, rhythmic, zuru ezu, ezigbo nha, ọ bụghị nrụgide. Ekpebiri Ripple na akwara akwara ozi.

Oghere apical na oghere nke 5 intercostal bụ 2 cm gaa site na ahịrị etiti etiti aka ekpe. Apical impulse wụsara, elu. Ekpebisiri ike n’olu Cardiac, systolic, na-ama jijiji.

Oke nke ikwu obi dullness:

N'aka nri - na oghere intercostal anọ n'akụkụ aka nri nke sternum.

Nke di elu - n'etiti ahịrị aka ekpe na uzo adila n’ebe ozo nke oghere intercostal ato.

N'aka ekpe - na oghere intercostal 5 cm 2 site na etiti aka ekpe - eriri clavicular.

HELL -160/90. Nke kachasị elu bụ isi okwu, ụda na-ada ụda, muffled. A na - anụ ụda olu na ebe nkwonkwo na ọnọdụ tricuspid valve na - ege ntị ma na - adịkarị ogologo karịa ụda abụọ, ụda olu na - ege ntị nke aorta na ogwe na - akawanye ụda 1. A naghị anụ ụda olu na mkpọtụ.

Ofdị iku ume - igbe, enweghị mgbochi na agagharị nke mgbidi obi. Onweghị ume iku ume n’oge nlekọta. Ikpu ume site na imi abughi ihe siri ike. Ofdị iku ume bụ diaphragmatic. NPV 16 mmeghari n'otu nkeji. Ofdị obi dị hypersthenic, enweghị nkwarụ, ọ naghị egbu mgbu n'oge palpation, aka nri na aka ekpe na-etinye aka na omume nke iku ume. Mkparịta ụka kpebiri nha ụda doro anya. Auscultation na-ege ntị na vesicular iku ume, enweghị shuga na -akwụsị agbago, ịdị elu nke elu nke ngụgụ dị n'ihu 3 cm, n'azụ 6 cm, ubi Krenig 7 cm.

Cusstụle ọnụnọ: na akụkụ ikpere nke obi, ụda bụ otu olu, pịkụl doro anya.

ala ala nkuume

Usoro ahịrị dị larịị

Ahịrị etiti akara

Axillary akara

Usoro ntụgharị nke XI thoracic vertebra

Ihe mucous nke dị nro na nke okpo siri ike, mgbidi nke na-esote ọkwa, ogwe dị okirikiri: pink, ooh, dị ọcha. Ogwu agafereghị ọkwa dị egwu. A na-ahụ akwa onu. Desna agbanweghi. Ire, ya na akwa ocha, gbue na mgbọrọgwụ. Afọ ahụ na-apụta, na-arụ ọrụ, ọbụlagodi, na-ekere iku ume. Anaghị ekpebi ihe na-ahụ anya, mkpụrụ nke na-eto eto na ịgbatị akwara nke afọ dị. A na-achọ oche oche ahụ mma.

Site na palpal nke anụ ahụ, afọ ahụ dị nro, na-egbu mgbu na hypochondrium dị mma, ọ nweghị ọdịiche dị na akwara ikiri ụkwụ nke akwara na-anaghị abawanye. Ihe mgbaàmà nke oge ezighi ezi. Peristalsis echekwara.

Site na palpation miri emi na mpaghara ụlọ aka ekpe, ekpebiri udi nke cylindrical, ihe na-agbanwe agbanwe nke sigmoid colon n'ụdị ezigbo ure, 1.5 cm n'obosara, enweghi mgbu, na-enweghị ike chụpụrụ. Na mpaghara ụlọ aka nri, a na-apịpụ akwa akwa n'ụdị silinda sịkwara dị larịị. A na-akọwapụta eriri transceral na mpaghara eriri mmiri n'ụdị transverse lie arcuate gbadata agbada, obere drọd ịba ọcha yana dayameta nke 2,5 cm. Noise na-efesa afọ n’elu afọ na-enweghị ihe ọ bụla, achọpụtaghị ihe ọ bụla.

Na palpation miri emi: nsọtụ akwara na-apụta 0,5 cm site na nsọtụ ọnụ ọnụ nri dị ọnụ.

A ga-ekpebi oghere gbasara ọgịrịga - ihe mgbu azụ n'oge palpation. Na nnukwu ọgbụgba mmiri, akwara kpebisiri ike.

Oche di ubochi nile, achoro ya mma.

Mgbe ị na-enyocha mpaghara lumbar nke ịcha ọbara ọbara, ọzịza, ọnụnọ achọpụtaghị. Enweghị anụ ahụ nke akwara lumbar. Udiri ihe di egwu bu ihe di njo na akuku. Ekpebie akụrụ, eriri afọ n’oge palpation. Rinchapu ure n’enweghi oria, na osiso. Nocturia.

Usoro ụjọ na akụrụngwa anụ ahụ

Echekwara uche. Kwadoro na oge na oghere. Enweghị mmụọ uche. Omume ahụ na-arụ ọrụ. Ọpụpụ. Ntughari (pharyngeal, abdominal, tendon - periosteal: ulnar, ikpere, Achilles) - agbajighi agbaji. Meningeal mgbaàmà (olu siri ike, mgbaàmà nke Kernig, Brudzinsky) anọghị.

Ofmụaka nwere ọdịdị dị mma, nha, na-anabata ọkụ nke ọma. Ntughari nke nku anya gi n’uju.

Enweghị nsogbu ihi ụra. Ebe nchekwa: belata. Oge isi ọwụwa na-eme na-enweghị nsụkọ doro anya. Ọhụụ na-ebelata, ịnụ ihe, isi anaghị arụ ọrụ. Na ọnọdụ Romberg kwụsiri ike.

Mee: hypersthenic. Akpukpo aru nke Subcutaneous ka emechara nke oma, kesaa ya.

Ogologo: 150kg, Ibu ibu - 68.7 n'arọ. BMI = 30.5

Hairdị ntutu nke nwanyị.

Iri akwara thyroid na-ebuwanye. Exophthalmos anọghị.

Enwere mmebi nke nghọta nke ụdị uwe na sọks, a na-ebelata ikike ịma mma.

A na-ebelata nrụtụ aka na ihu okpomọkụ nke mkpịsị ụkwụ.

Gburugburu ukwu ahụ bụ 118 cm, ntụpọ nke hips bụ 116. OT / O = 0.99.

Ọbara ọbara Systolic n'ụkwụ nke 110 mm. Hg. Art.

Ihe mbu: Mellitus oria II, nke mbuchoputara, ogbo nke decompensation metabolic.

Nsogbu: Ischemia ụkwara ụbụrụ nke usoro ọmụmụ jikọtara ọnụ. Ọrịa ịrịa ọrịa mamịrị bụ usoro na - enweghị protinerative. Ọrịa shuga microangiopathy nke akụkụ ala. Polyneuropathy na-arịa ọrịa mamịrị.

Njikọ: Ọbara mgbali elu 3 ogo, ihe egwu 4. Atherosclerosis nke aorta, akwara ọbara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

N'azụ: Oke ibu IIa.

1. Ibu ọnụ shuga ọbara (ugboro abụọ n'izu)

2. Glycemic profaịlụ

3. Nnwale ọbara zuru oke (na ike)

4. Sugar na mmamịrị kwa ụbọchị (ugboro abụọ n'izu),

5. Ọbara cholesterol, profaịlụ nke egbugbere ọnụ

6. Transaminases (aspartic na alan na ọbara)

7. Urea, creatinine.

9. Urine Acetone Qualitatively

10. Nnyocha gbasara mmamịrị (na mgbanwe)

11. Nnwale dịka Nechiporenko, Zimnitsky kwuru.

12. Serum bilirubin na iberibe ya

14. Reovasography nke nsọtụ ala,

15. Ihe omumu ihe omimi (imeju, imeju, akwara, splin),

17. Usoro ndị ọkachamara:

1. Ọnọdụ: ụlọ ọrụ

2. Isiokwu Nke 9 (usoro ọgwụgwọ nri)

3. Mkpụrụ ọgwụ na-akụda shuga dị mbadamba.

4. Antihypertensive ọgwụ (maka ọgwụgwọ nke ọbara mgbali elu)

5.Nkwadebe Alfa lipoic acid (ọgwụgwọ polyneuropathy)

6. Nootropics (ọgwụgwọ HIGM)

7. Ọgwụ mgbochi ọgwụ

9. Nleta nke Ulo akwukwo oria Dika

Data nke uzo nyocha ihe ndi ozo na ichota ndi dibia nke ogwu ndi ozo

12/10/12. Nnwale ọbara shuga

Ọbara glucose: 17.6 mmol / L

Nnwale irine maka shuga na acetone:

Uri mmamịrị: 3 g / L

Agba: edo edo edo

Epithelium: ewepụghị: dị ịrịba ama

Mkpụrụ ndụ ọbara uhie: gbanwere 8-10 na s / s

Mkpụrụ ndụ ọbara ọcha: 7.2 * 109 / L

Platelet: 307 puku

Neutroph mkpirisi: 0

Neutroph nke.: 69

Ọbara glucose 16.30: 12. mmol / l

Ọbara glucose 22.00: 13.3 mmol / l

Nyocha ọbara maka RMP: adịghị mma.

Nnyocha ọbara biochemical:

ngụkọta protein - 60g / l

urea - 7,7 mmol / l

creatinine - 114 μmol / l

ngụkọta bilirubin 14 μmol / l

eduzi: 4 micromol / l

anọghị 10 μmol / l

Ngwakọta cholesterol: 6.2 mmol / L

Uric acid: 357 μmol / liter

13.10.12. Profaili glycemic

Ọbara glucose 07,00: 9.4 mmol / L

Ọbara ọbara 12.00: 13.2 mmol / l

Ọbara glucose 16.30: 15.0 mmol / l

Ọbara glucose 22.00: 13.6 mmol / l

Acineone Acetone - nke na - adịghị mma

Scraping on I / g na feces na M / g site na usoro Kalantaryan (neg.)

Na-amụ cr. na RMP-EM syphilis nwere kaadị. antigen (neg.)

14.10.12 mmamịrị Acetone: adịghị mma

Ọbara ọbara 12.00: 7.4 mmol / l

Ọbara glucose 16.30: 11.4 mmol / l

Ọbara glucose 22.00: 7.6 mmol / l

10 / 15/1 mmamiri Acetone: nke ojoo

Nnwale ọbara shuga

Ọbara glucose: 6.6 mmol / L

10.16.12 Sample Nechiporenko

Mkpụrụ ndụ ọbara: nkeji 1250 / ml

Mkpụrụ ndụ ọbara uhie: 0 nkeji / ml

10.17.12 Nnyocha emere dika Zimnitsky si kwuo:

06.00-09.00: ọnụọgụ 200 ml., Nnukwu ike ndọda: 1010

09.00-12.00: ọnụọgụ 200 ml., Nnukwu ike ndọda: 1012

12.00-15.00: ọnụ ọgụgụ nke 200 ml., Ike ndọda 1013

15.00-18,00: ọnụ ọgụgụ nke 200 ml., Nnukwu ike 1012

18.00-21.00: ọnụọgụ 200ml., Ike ndọda 1011

21.00-00.00: nọmba nke 100 ml., Ike ndọda 1013

00.00-03.00: ọnụ ọgụgụ nke 100 ml., Ike ndọda 1012

03,00-06.00: nari 200 ml., Ike ndọda 1013

Daily diuresis kwa 800 ml.

Abalị diuresis 600 ml.

Mkpokọta diuresis: 1400 ml.

Agba: edo edo edo

Epithelium: ewepụghị: dị ịrịba ama

10/15/12. Rheovasography nke akụkụ ala: Mmechi: ofdị mgbasa ọbara: ọ kachasị na ngalaba niile. A na -ebelata ọbara mgbari elu n'ụkwụ ya n'aka nri, na shin dị n'aka nri. Egosipụtara nnweta ọbara dị n'ụkwụ ụkwụ (dị ala n'aka ekpe karịa 40% n'aka nri) yana n'ụkwụ (n'aka ekpe na-erughị 26% n'aka nri). Ọkpụkpụ ọbara juru n’ukwu / ala ala n’aka nri bụ 1.35 (N = 1.4-1.6). A na-abawanye mgbochi vaskụla n’ukwu na ala n’aka nri, ụkwụ ala n’aka ekpe, na nke nkịtị n’ụkwụ ekpe.

ECG: Mmechi: Thelọ ịgba ahụ bụ eziokwu, sinus. Obi obi nke 77 gbagwojuru n'otu nkeji. Ahịrị latrik nke obi bụ kwụ ọtọ. Mmebi nke usoro ọgbụgba. Mgbanwe na-agbanwe agbanwe na ebili mmiri T na myocardium nke ventricle ekpe.

Mmechi: Ultrasonic ihe ịrịba ama nke ịba ọcha n'anya. Nchikota n’olu nke ogwe-ukwu. Mgbanwe mgbanwe na pancreas. Bilateral hydrocalicosis.

Ndụmọdụ nke Neurologist: Mkpesa banyere nrụgide nke ncheta, isi ọwụwa ugboro ugboro na - enweghị nhịahụ doro anya, aka na ụkwụ. A na-amụ ihe anamnesis. Ebumnuche: nsụhọ doro anya, kọntaktị. Chekwara chekwara. A na-ebelata ọhụụ, ịdị na-ahụcha ụcha. Pupilsmụ akwụkwọ D = S, mmeghachi omume nke ọkụ dị ndụ, palpebral akpọpu D = S, mmegharị nke nku anya. Ijekota, ebe echekwara ulo. A na-echekwa nchedo ihu na ihu, a na-echekwa nkwekọrịta, njikọta njikọta. Nasolabial, mpempe ihu D = S; enweghị asymmetering mgbe anya jiji ezé wee gbue ezé. Ntị bụ ihe dị mma. Iri mmiri n'efu, na-enye mgbanwe site na ogwe ahụ dị nro na mgbidi nke pharyngeal na-esote. Ire asusu nile n’enweghi oghari. Mmetụta uche: ụdị hepesthesia polyneuritic (n'ụdị "uwe" na "sọks"). Mpaghara moto: mmegharị nke na-arụ ọrụ na olu zuru oke, ike akwara 5 isi, ụda olu anaghị agbanwe agbanwe. Onweghi olu atrophies. Tendon na periosteal reflexes D = S. Abia n’obodo D = S. Enweghị ọgwụ mgbanwe. Na Romberg ọnọdụ kwụsiri ..

Nchọpụta: Ischemia ụkwara ụbụrụ nke sitere na agwakọta (atherosclerotic, mamịrị na hypertonic sitere). Phasegbọala polyneuropathy sensọ mamịrị diaal. Na-atụ aro: 1. Piracetam 20% -10.0 na otu ugboro n’ụbọchị Nke 5, mgbe ahụ mexidol 125 mg ugboro atọ kwa ọnwa.

Atụrụ nke dọkịta na-awa ahụ: Mkpesa mgbu, ọnụọgụ nke dị na mpaghara ala. Enwetara ya na data RVG. Ọnọdụ localis: mmegharị akwara dị na nsọtụ nke ụdị bụ isi, kwụrụ ụgwọ. Ihe ịrịba ama nke ọrịa angiopathy na-arịa ọrịa shuga - pulsation na mpụta na-echekwa, belata.

Ọrịa: microangiopathy mamịrị nke mpaghara ala ala.

Akwadoro: mbadamba nnabata Doxy-chem 0,5 na nke 1. 2 / d maka ọnwa anọ.

Ndụmọdụ gbasara ọghọm: Nwa akwụkwọ ahụ nwere ọgwụ (Sol. Mydriacili 0,5%). OU: Ada. Ọkpụkpụ ahụ pụtara. Reflọg a na-akpọ 'fundus reflex' Fundus: optic akwara diski acha odo odo, oke ala doro anya. Okpu mmiri dị warara, otu ihe na-ezighi ezi, chịkọtara. Thedọ ndị ahụ dị.

Nchọpụta: Ọrịa protinerative ọrịa mamịrị na - arịa ọrịa retinopathy.

Na-atụ aro: Ileba anya na dọkịta na-ahụ maka ọrịa anya na ebe obibi.

Nchoputa mbu: Mellitus oria II, nke emere ka amara ya, mejuputa usoro nke metabolic.

Nsogbu: Ischemia ụkwara ụbụrụ nke usoro ọmụmụ jikọtara ọnụ. Ọrịa ịrịa ọrịa mamịrị bụ usoro na - enweghị protinerative. Ọrịa shuga microangiopathy nke akụkụ ala. Polyneuropathy na-arịa ọrịa mamịrị. Ọrịa ịba ọcha n'anya.

Njikọ: Ọbara mgbali elu 3 ogo, ihe egwu 4. Atherosclerosis nke aorta, akwara ọbara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

N'azụ: Oke ibu IIa.

Na nyocha, nsụhọ doro anya, ọnọdụ ahụ dị nso na-eju afọ.

Mkpesa nke akpịrị ịkpọ nkụ, akpịrị kpọrọ nkụ, isi ọwụwa. Akpukpo ahụ dị ọcha, agba ọ bụla na iru mmiri.

Soundsda obi na-akụ nkọ. Breathingkụkụ vesịl na-enweghị ume ala. NPV 18 min

Pkwaa afọ n’azu n’akpa n’akụkụ nile nke afọ.

Fiz. ụgbọ mmiri anaghị agbaji

3. Rp.: Tab. Amaril 0.001 Nke 20

D.S. N'ime, mbadamba 2 1 r / ụbọchị. Tupu nri ụtụtụ.

4. Rp.: Tab. Metformin 0,5 .20

D.S. N'ime. Na 1 t 2r / s jiri nri. Orningtụtụ na mgbede.

5. Tab. Captoprili 0.025 Nke 10

D.S. N'ime. 1 t 2r / d. Otu awa tupu nri.

6. Thiogamma 600 mg. + sodium chloride 0.9% 200 ml. intravenously ntapu 1 oge kwa ụbọchị na 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 Nke 10

D.S. N'ime mbadamba 1 otu ugboro n'ụbọchị na 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Mebata ampoules abụọ intravenles 1 oge kwa ụbọchị na 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. N'ime. 1 t 1 r / s. Na mgbede.

Na nyocha, nsụhọ doro anya, ọnọdụ ahụ dị nso na-eju afọ.

Enweghị mkpesa. Akpukpo ahụ dị ọcha, agba ọ bụla na iru mmiri.

Soundsda obi na-akụ nkọ. Breathingkụkụ vesịl na-enweghị ume ala. NPV 17 min

Pkwaa afọ n’azu n’akpa n’akụkụ nile nke afọ.

Fiz. ụgbọ mmiri anaghị agbaji

3. Rp.: Tab. Amaril 0.001 Nke 20

D.S. N'ime, mbadamba 2 1 r / ụbọchị. Tupu nri ụtụtụ.

4. Rp.: Tab. Metformin 0,5 .20

D.S. N'ime. Na 1 t 2r / s jiri nri. Orningtụtụ na mgbede.

5. Tab. Captoprili 0.025 Nke 10

D.S. N'ime. 1 t 2r / d. Otu awa tupu nri.

6. Thiogamma 600 mg. + sodium chloride 0.9% 200 ml. intravenously ntapu 1 oge kwa ụbọchị na 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 Nke 10

D.S. N'ime mbadamba 1 otu ugboro n'ụbọchị na 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Mebata ampoules abụọ intravenles 1 oge kwa ụbọchị na 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. N'ime. 1 t 1 r / s. Na mgbede.

Na nyocha, nsụhọ doro anya, ọnọdụ ahụ dị nso na-eju afọ.

Enweghị mkpesa. Akpukpo ahụ dị ọcha, agba ọ bụla na iru mmiri.

Soundsda obi na-akụ nkọ. Breathingkụkụ vesịl na-enweghị ume ala. NPV 19 min.

Pkwaa afọ n’azu n’akpa n’akụkụ nile nke afọ.

Fiz. ụgbọ mmiri anaghị agbaji

3. Rp.: Tab. Amaril 0.001 Nke 20

D.S. N'ime, mbadamba 2 1 r / ụbọchị. Tupu nri ụtụtụ.

4. Rp.: Tab. Metformin 0,5 .20

D.S. N'ime. Na 1 t 2r / s jiri nri. Orningtụtụ na mgbede.

5. Tab. Captoprili 0.025 Nke 10

D.S. N'ime. 1 t 2r / d. Otu awa tupu nri.

6. Thiogamma 600 mg. + sodium chloride 0.9% 200 ml. intravenously ntapu 1 oge kwa ụbọchị na 10.00.

7. Rp.: Tab. Cardiomagnil 0.075 Nke 10

D.S. N'ime mbadamba 1 otu ugboro n'ụbọchị na 18.00.

8. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Mebata ampoules abụọ intravenles 1 oge kwa ụbọchị na 10.00.

9. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. N'ime. 1 t 1 r / s. Na mgbede.

Ihe omimi: ezigbo (enweghi mkpesa).

ọrịa mamịrị microangiopathy

ХХХ, gbara afọ 78, na-anata ọgwụgwọ na Ngalaba Endocrinology nke 9 KGB site na 12.10 na nyocha nke

Ihe mbu: Mellitus oria II, nke mbuchoputara, ogbo nke decompensation metabolic.

Nsogbu: Ischemia ụkwara ụbụrụ nke usoro ọmụmụ jikọtara ọnụ. Ọrịa ịrịa ọrịa mamịrị bụ usoro na - enweghị protinerative. Ọrịa shuga microangiopathy nke akụkụ ala. Polyneuropathy na-arịa ọrịa mamịrị. Ọrịa ịba ọcha n'anya.

Njikọ: Ọbara mgbali elu 3 ogo, ihe egwu 4. Atherosclerosis nke aorta, akwara ọbara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

N'azụ: Oke ibu IIa.

Achọpụtara ọrịa shuga mellitus na ndabere nke mkpesa ndị na-arịa ọrịa shuga nke akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ, ịba ụba urination, mmamịrị abalị, mmụba mmamịrị, itching na mpaghara inguinal, na mmụba nke shuga ọbara ruo 12 mmol / l. Ihe ndị nwere ike ibute ọrịa a bụ:

Hypodynamia, ọnụnọ nke ọrịa a n'ime ezinụlọ, oke ibu, nrụgide, ọbara mgbali elu, afọ ime siri ike na ịmụ nwa. (polyhydramnios, mkpụrụ buru ibu).

N'ime onye ọrịa a, ihe ndị dị ize ndụ bụ: Hypodynamia, ọkwa nke IIa oke ibu, ọbara mgbali elu (ogologo oge).

Typedị II sitere na afọ nke ọrịa ahụ gosipụtara (afọ 78), ọrịa ahụ bidoro nwayọ, a kpochapụrụ ụlọ ọgwụ ahụ, a na-ezochi ọrịa ahụ (mkpesa na-agafeghị ala n'oge mbido ọkọchị, ọnọdụ onye ọrịa ahụ kawanyere njọ site na mbido Ọktoba (adịghị ike mụbara, akpịrị ịkpọ nkụ ghọrọ inye nsogbu oge niile, mmamịrị na-agbago elu ugboro iri na ise n'ụbọchị, nke ugboro atọ n'abalị, itching pụtara na mpaghara inguinal).

For Na nke mbụ, achọpụtara ọrịa n'ụlọọgwụ na ebe obibi na 10/12/12 dịka nyocha glucose ọbara nke onye ọrịa na-ebu ọnụ. Ha ruru 12 mmol / L.

Nkesa nke oria a bu oria bu glucose na eburu onu obara 9.7 mmol / L, post-trandial 15.0 mmol / L, 13.6 mmol / L n’oge eji ehi ura.

Ihe kpatara ọrịa shuga:

Chem Ischemia ụkwara akwara nke jenerarị agwakọtara (atherosclerotic, hypertensive, diabetes) sitere na mkpesa onye ọrịa na - ekwu maka isi ọwụwa na - enweghị ntụpọ, ọgbụgbọ, nkwubi okwu sitere na onye isi akwara akwara (ebe nchekwa ihe), data nyocha ebumnuche.

Nchọpụta ọrịa mamịrị bụ usoro na - abụghị nke na - eto eto nke dabere na ebumnuche ebumpụta ụwa (echiche dị ala), echiche nyocha nke ophthalmologist (OU: Calm. Cornea bụ transperent. Veins dized

Micro Ọrịa microriaiopathy nke akụkụ ala dị ala na nyocha sitere na ebumnuche ebumnuche (akpụkpọ ahụ dị oyi n'ahụ aka), nyocha nyocha nke onye na-awa ahụ: Ọnọdụ mpaghara: ụgwọ mgbasa akwara dị na nsọtụ nke ụdị ahụ. Ihe ịrịba ama nke ọrịa shuga akpịrị - a na-echekwa, ịmịchapu mmiri na - agbada, na - ebute nsonaazụ Reovasography nke nsọtụ ala: mmechi: A na - ebelata ọbara ọbara n'ụzọ dị ukwuu n'ụkwụ n'aka nri, n'ụkwụ ụkwụ aka nri. Egosipụtara nnweta ọbara dị n'ụkwụ ụkwụ (dị ala n'aka ekpe karịa 40% n'aka nri) yana n'ụkwụ (n'aka ekpe na-erughị 26% n'aka nri). Ọkpụkpụ ọbara juru n’ukwu / ala ala n’aka nri bụ 1.35 (N = 1.4-1.6). A na-abawanye mgbochi vaskụla n’ukwu na ala n’aka nri, ụkwụ ala n’aka ekpe, na nke nkịtị n’ụkwụ ekpe.

Poly polyneuropathy na-arịa ọrịa uche na-eme ihe site na mkpesa nke ihe mgbu, ọnụọgụ na ịkwụkwụ nke ụkwụ, data nyocha ebumnuche (enwere mmebi nke ụdị nke oghere na sọks, a na-ebelata ikike ọgụgụ isi).

He ịba ọcha n'anya bụ nyocha na nyocha nke onye ọrịa (imeju na-agbapụta 0,5 cm site na nsọtụ ọnụ ọnụ aka nri).

· Yiri: ọbara mgbali elu nke ogo 3, ihe egwu 4. Atherosclerosis nke aorta, akwara ọbara, arịa ụbụrụ. Ọnọdụ dịka ahịrị ara ekpe na 2005 maka ọrịa kansa, ọgwụ na-esochi ya.

· N'azụ: Oke ibu IIa (BMI 30.5).

N'oge ọnụnọ ụlọ ọgwụ, ọnọdụ onye ọrịa nwere ọ ka mma (mkpesa dị ka ọnụ akọrọ, akpịrị ịkpọ nkụ mgbe niile, ịsa ahụ ugboro ugboro, gụnyere n'abalị, mmụba mmamịrị, itching na mpaghara inguinal, mgbu, ọnya na oyi na-atụ ụkwụ apụ n'anya)

N'oge ọnụnọ ya n'ụlọ ọgwụ, onye ọrịa nwere ọgwụgwọ ndị a:

2. Rp.: Tab. Amaril 0.001 Nke 20

D.S. N'ime, mbadamba 2 1 r / ụbọchị. Tupu nri ụtụtụ.

3. Rp.: Tab. Metformin 0,5 .20

D.S. N'ime. Na 1 t 2r / s jiri nri. Orningtụtụ na mgbede.

4. Tab. Captoprili 0.025 Nke 10

D.S. N'ime. 1 t 2r / d. Otu awa tupu nri.

5. Thiogamma 600 mg. + sodium chloride 0.9% 200 ml. intravenously ntapu 1 oge kwa ụbọchị na 10.00.

6. Rp.: Tab. Cardiomagnil 0.075 Nke 10

D.S. N'ime mbadamba 1 otu ugboro n'ụbọchị na 18.00.

7. Rp.: Sol. Pyracetam 20% - 5 ml. D.S. Mebata ampoules abụọ intravenles 1 oge kwa ụbọchị na 10.00.

8. Rp.: Tab. Sinvastatini 0.01 No.20

D.S. N'ime. 1 t 1 r / s. Na mgbede

9. Agụmakwụkwọ n’ụlọ akwụkwọ shuga.

Amụma maka ndụ

Dịtụ mma maka ndụ n'ihi ọrịa ngwụsị afọ nke ọrịa na ọnụnọ nke ọtụtụ nsogbu.

Onye na-elekọta mmadụ (arụrụ ọrụ mmegharị ahụ, ọrịa a agaghị ebi ndụ mmekọrịta).

Ad na-ekwenye na nri hypocaloric (1600 kcal) yana mmachi abụba juru afọ, mbelata oriri cholesterol (ihe na-erughị 300 mg kwa ụbọchị), yana iji nri oriri na elu. Eri obere nri ruo ugboro 4-5 n’ụbọchị. Mmachi nnu na mmanya.,

Hea ntị na nhazi nke mbadamba mbadamba shuga,

Controlchịkwa glucose ọbara otu ugboro kwa ụbọchị na ugboro anọ kwa ụbọchị ugboro atọ n'izu.

Vention Mgbochi nsogbu (ị alụ ọgwụ alfa-lipoic, nootropics, vitamin B6, ọgwụ mgbochi oke).

· Nlere site na endocrinologist, cardiologist, neurologist, ophthalmologist na onye okacha amara na ulo ogwu obodo.

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Akwụkwọ ndị yiri ya

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Ọgwụ gbasara ahụike: Typedị shuga mellitus nke 2, nke gbara ọtọ, agbada

Aha zuru oke onye ọrịa: ________
Afọ iri isii na ise
Ubochi omumu: 04/11/1939
Ọkachamara na ebe ọrụ: ezumike nka
Nwoke: nwanyi
Mba: .mụ Ukraine
Ọnọdụ: ____________
Ofbọchị nnata: 04/13/2004 na 17.05
Onye duziri: SOP dika emechara

Mkpesa ndị ọrịa
Onye ọrịa ahụ na-eme mkpesa nke akpịrị ịkpọ nkụ, akpịrị na-akpọ nkụ, mmụba nke mmamịrị ahụ a tọhapụrụ, itching nke anụ ahụ, na nso nso a na-ebelata acuity visual, mgbu na ụkwụ aka nri, mgbe niile, ihe mgbu, ịpị ụfụ, oge mkpịsị aka na mkpịsị ụkwụ, oge mmetụta nke ụkwụ n'ụkwụ. .
Onye ọrịa ahụ na-egosi adịghị ike, ike ọgwụgwụ n’oge ọrụ ụlọ. Nnyocha ọzọ chọtara na onye ọrịa nwere nchegbu banyere akpịrị ịkpọ nkụ, isi ọwụwa tinyere mmụba ọbara mgbali ruo 200/130 mm. Hg. Art. N'oge mmega ahụ, enwere ihe mgbu na-egbu mgbu n'azụ sternum, na-eme ka aka ekpe ya, agụba aka ekpe, nke na-agafe n'iji nitroglycerin. Ahụhụ palpitị ugboro ugboro na-enye ya nsogbu. N'oge nyocha ahụ, achọpụtara na ncheta dị ntakịrị: ọ na-esiri onye ọrịa ike icheta ụbọchị ọmụmụ, aha, aha okporo ụzọ, wdg.

Akụkọ banyere ahụike
Onye ọrịa ahụ chọpụtara na ọ na-arịa ọrịa shuga na 2002, mgbe ọ dị afọ 63, mgbe a na-eme nnyocha mgbochi n'ụlọ ọgwụ a na-abawanye glucose ọbara. Onye na-ahụ maka mpaghara ahụ tụrụ aro maka nri, a na-ezigara ya na endocrinologist, nke a chọpụtara na ụdị ọrịa shuga mellitus nke II, edepụtara ọgwụ, aha nke onye ọrịa ahụ anaghị echeta. N'oge nyocha, onye ọrịa ahụ hụrụ mmetụta akpịrị ịkpọ nkụ na mmụba. Emere ọgwụgwọ a na ngalaba endocrinology nke SOKB, nke onye dibia bekee na-ahụ, nyochapụtara nchọpụta ahụ: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. NK IIA Art. Mgbe ọgwụgwọ ahụ gasịrị, ọnọdụ ahụ kawanyere mma.
Mgbe ọ gbasasịrị, a na-atụ aro ka dibia bekee hụ ma lekwa ọkwa glucose 1 oge / ọnwa. Anaghị m agbaso ndụmọdụ ahụ, a medicationsụrụ m ọgwụ n'oge ụfọdụ. Otu ugboro n'afọ ọ na -ebi ọgwụ mgbochi ọrịa. Ugbu a, a na-ahazi ya maka ọgwụgwọ na mgbazi.

Anamnesis nke ndụ onye ọrịa

A mụrụ ya na 04/11/1939, na a zụlitere n'ezinụlọ nwere ọnọdụ mmekọrịta dị mma. Nri bu ihe eke. N'ime ezinụlọ, o tolitere ma zụlite ya na ụmụnne nwoke abụọ ị tọrọ. N'oge ọ bụ nwata, ọ naghị ata ahụhụ n'ihi oyi. Enwetabeghị data gbasara ọrịa ụmụaka ndị ọzọ.
Oge uto ya agbaghaghị agbagha, e nweghị oge ọ bụla ma ọ bụ mee ngwangwa. A malitere ịhụ nsọ site na afọ 13, enweghị mgbu, menopause na afọ 48. Onweghị mmerụ ahụ, mmerụ ahụ, mkpọchi shei. A wara ya ahụ mgbe ọ dị afọ 13-14 maka ọrịa appendicitis. Bimụ nwa 3, otu nwa nwụrụ n’oge ọ dị obere, akọwapụtaghị ọnụ ọgụgụ afọ ime. Onye ọrịa a so n’òtù ndị mmadụ na-emekọ ihe. Ihe
nchekwa zuru oke. A na-edozi ụlọ a nke ọma, ebe ọ bụ na 1989, ruo taa, bi n'ụlọ nwere ọnụ ụlọ atọ, ikuku na-ekpo ọkụ nke ọma, ọkụ, udu mmiri bụ ihe dị mma. Nri ahụ na-adị oge niile, nke dị mma, na-anaghị eri anụ. Uwe kwekọrọ na ọnọdụ ihu igwe na ọnọdụ mmekọrịta onye ọrịa.
Onye ọrịa ahụ nwere ụlọ akwụkwọ sekọndrị, osi ite. Ọ lara ezumike nká ugbu a. Ọ rụrụ n'ụlọ ebe a na-eri nri na ahịhịa Frunze. Ọnọdụ arụ ọrụ anaghị eduga na imebi nri onye ọrịa. Ihe egwu dị na ụlọ ọrụ, enweghị mmerụ ahụ.
Ndị nne na nna nwụrụ n’oge agadi. Ọ nweghị ike ịnweta ozi ọ bụla gbasara nketa. Nditọete ẹsima. .Mụaka nwere ahụ ike. O nweghi ihe omuma banyere onodu ahuike ndi ozo.
Akụkọ mmekpa ahụ gbasara nri, ọgwụ, inhalation, antigens epidermal adịghị arọ.
A Doesụ sịga, anaghị a alcoholụbiga mmanya ókè, ọ naghị a drugsụ ọgwụ ọjọọ. Eya orọ, ire ogwu enerieen̄ ya, ogwu usọ ikwaan̄. Emeghị mmịnye ọbara. Anọghị m na ndị ọrịa na-efe efe; ahụghị m njem na mpụga Ukraine afọ 3 gara aga.

Nzube ebumnuche
Nnyocha General
Ọnọdụ izugbe na-eju afọ. Nghọta doro anya. Ọnọdụ ahụ nọ n'ọrụ. Ihu dị ndụ. Ogo dị 175 cm, kilogram 80. Nordị aru normosthenic. Ntughari, uzo - adighi agbanwe agbanwe, emeputara ya nke oma. Onye ọrịa ahụ bụ kọntaktị, zuru oke, ikwu okwu n’uche. Nzube zuru oke, ncheta na - ezighi ezi, na ebe nchekwa. Ọdịdị ihu: nkịtị, ndụ. Akpukpo ahu di ocha. Na ala ala apịtị, na mkpọchi cyanotic. Achọpụtara hyperkeratosis, ọkachasị akpọọ n'ọsọ. A na-ebelata akpụkpọ turgor, a na-echekwa ịdị ọcha. Iru mmiri na-agafeghị oke. Onweghi ihe ndia choputara. A na-ekpebi ọnya ikpere na mgbidi akụkụ ihu dị na mpaghara iliac dị mma. Ngme ka usoro akpụkpọ ahụ sie ike, banyeosity na mgbasawanye nke akwara ndị dị elu. Ibe ndị mucous nke conjunctiva, amaokwu nke imi bụ pink, dị ọcha, enweghị ntụpọ. Ọcha ụcha na-acha uhie uhie. Ntutu isi ahụ dị ọcha. Achọpụtaghị imebi ntutu isi n'ụdị nke uto gabigara n'ahụ ma ọ bụ ntutu nkwọcha, ụdị ntutu nwanyị. Ntu ahụ na-adị mma, na-egbu maramara, na-enweghị mgbagha transverse, na mkpịsị ụkwụ a na-agbanwe - na-abawanye, na-acha odo odo, na-acha odo odo.
A na-etolitekwa anụ ahụ dị obere ala, kesaa ya n'akpụghị aka, yana oke n'ime ogwe ya. Passta, enweghi edema. A na-eme ka akwara nke aka na aka ya nwee afọ ojuju nke ọma, a na-ebelata ụda na ike, enweghị ọnya. A na-ahụta hypotrophy nke akwara nke oghere ndị dị obosara, ukwu ala. Onweghị mpaghara ndị ọzọ nwere nnukwu hypotension, paresis, na ahụ mkpọnwụ.
Ejiri usoro ọkpụkpụ. Onweghi nkwarụ nke okpokoro isi, obi, pelvis ma ọ bụ ọkpọ. Nokwụ ewepụghị. Nzipu ezighi ezi. Palpation enweghi mgbu. Achọpụtaghị nkwonkwo ahụ, enweghị mgbochi ọ bụla na mmegharị ahụ na-agafe agafe na-arụ ọrụ, ihe mgbu n'oge mmegharị, nkụchi, mgbanwe nhazi, hyperemia na ọzịza nke anụ ahụ dị nro.
N ’ọmụmụ gbasara akwara ozi, a na-amụ apịaji ala. Mgbe ị na-enyocha ahụ mammary glands, a chọpụtaghị mgbanwe ọrịa.
Ọkpụkpụ thyroid adịghị eme ihe. Na nyocha, ọ nweghị mgbanwe n'ụdị olu.

Nnwale akụkụ iku ume

Ọkpụkpụ bụ ihe dị n ’udi. Akụkụ akụkụ iku ume dị elu na-agafe agafe, ọnweghị ọrịa na-apụ apụ. Ikuku a na-ekpochapụ na-enweghị isi isi iyi.
Etu ahụ bụ nhazi dị oke mma, a na-edokwa okwute ahụ anya n'otu ọkwa. Fossae nke supraclavicular na subclavian bụ ndị na-emerụ emerụ, ebe iku ume anaghị agbanwe ụdị ha. UM UBARA na-agbada, na-agagharị na synchronously na ụda.
Ofdị iku ume gwakọtara. Usoro iku ume - 16 kwa nkeji. Aka nri na aka ekpe aka ekpe na-agagharị. Azụ mọ aka adịghị etinye aka na iku ume.
Pkwaa obi. Obi na-agbanwe agbanwe, a na-ama ụda olu na ike nrịgo na mpaghara Symmetrical. Onweghi ihe ntiwapu na nhichapu. Onweghị ọnya ahụ dị n'etiti oghere ahụ.
N'iburu n'uche mkparịta ụka na mpaghara izi ezi, ụda ụkwara ahụ bụ otu ihe na akụkụ abụọ, a na-echekwa gamoror sonority.
Site na ntụgharị uche nke mkpụrụ ndụ, ókè nke akpa ume dị n'etiti oke, ngụkọta ngụgụ nke akụkụ akwara azụ bụ 6 cm.
Site na iji ume na iku ume na-emetụta mmụọ ngụgụ, ana-ekpu ume iku ume karịa akụkụ elu nke ngụgụ. Achọpụtaghị mkpọtụ iku ume ọzọ.

Ọmụmụ banyere akụrụngwa obi

Mgbe ị na-enyocha mpaghara obi nke akwara obi, protrusions na aorta, a na - ahụtaghị ihe a na - akpọ pulmonary artery, yana epigastric pulsation ahụghị. Entlọ mmebi nke mpaghara mpaghara obi anaghị egbu mgbu. A na-ekpebi ụdị mkpaghasị ahụ n'oge nyocha na mkpịsị ụkwụ ka ana-ekpebisi ike na oghere oghere intercostal V, site na eriri etiti midclavicular site na 2 cm, agbasaghị, ihe dịka 2 cm n'obosara, adịghị ike. Achọpụtaghị mgbaji aka nri. Enweghị mgbaàmà mkpụrụ osisi.
Site na nchegharị nke obi, ókè a na-ahụ maka nkụda mmụọ obi:
1. Aka nri - 1.5 cm si n'akụkụ aka nri nke sternum.
2. Oke elu - n'akụkụ elu elu nke ọgịrịga III.
3. N'aka ekpe - 1.5 cm site na akara aka ekpe etiti-clavicular.
Ogo nke ogwe vaskụla bụ 6.5 cm.
N'oge a na - eme ka obi jiri iku ume na oge na - egbu oge, ụda obi na - esighi ike, a na-anụ ụda vesvet timbre, ụda ahụ ezighi ezi, ọnụego obi = 78 kụrụ / min. Ntughari na bifurcation nke ụda obi, ụda olu nke gallop, a naghị ahụ ụda ndị ọzọ. A na-ekpebi mkpesa na-adịghị ike, dị nro, nke dị mkpụmkpụ systolic. Ọdịdị nke mkpọtụ anaghị agbanwe agbanwe mgbe onye ọrịa gbanwere ọnọdụ. Anaghị eme mkpọtụ mgbagharị ihu abụọ.
Ahụhụ na akwara ahụ a na-ahụ anya nke akwara dị nwa oge, ihe nrịba ama nke ịgba egwu carotid, isi ọwụwa abụghị. Eriri aka na ukwu Enweghị ihe ọria akwara na 'corut medusae'. Achọpụtaghị pulite Venous. Ọkpụkpụ akwara dị na akwara ozi radial ha abụọ nwere otu uru, pulse bụ arrhythmic, ugboro ole a bụ 78 kwa nkeji, enweghi ụdọ ọyị, ọsịsọ ahụ siri ike, sie ike, enweghị otu. A na-efegharị ifegharị azụ na oge, carotid, femoral, akwara popliteal. Na a.dorsalis pedis abụghị palpable.
Ọbara ọbara - 200/130 mm Hg, otu aka abụọ.

Usoro nri

Nku ọnụ dị otu larịị, egbugbere ọnụ ya nwere pink, na-enweghị rashes na cracks. Igwe mucous nke onu a isụ bụ pink, dị ọcha, nke na-egbu maramara. Anaghị agbanwe goms. Asusu adighi abawanye, enweghi ncheta. Ihu igwe, pharynx, na-enweghị atụmatụ. Ogwu agafereghị ọkwa dị egwu.
Afọ ahụ dị ezigbo mma. Ọbara na-abata n'ime oghere afọ ka ekwesighi site na ntụgharị. Achọpụtaghị ihe ịrịba ama nke ọgbụgba ọbara n'ọbara, n'ụdị nke jeliifish na njikọta vaskụla na-ewusi mgbidi nke akụkụ ihu. Enweghị akara nke flatulence, peristalsis anya, agba na-ekpo ọkụ n'oge ọmụmụ ahụ ahụla.
Site na oke mmebi nke mkpịsị mkpụrụ osisi ya na otube, mpaghara akụkụ, n'akụkụ mpaghara ọcha nke afọ. Enweghị ọnya ahụ. Akara Shchetkina - Blumberg adịghị mma.
Site na palpation miri emi dị omimi, sigmoid colon dị n'ime ya n'ụzọ ziri ezi, 3 cm n'obosara, na-agbanwe, mgbidi ahụ dị mma, ọbụlagodi, mkpanaka, enweghi mgbu, enweghị mkpọtụ. A na-etinye Caecum n'ụzọ ziri ezi, dayameta 3 cm, na-agbanwe, mgbidi ahụ dị mma, ọbụlagodi, na-agafe agafe, na-enweghị ike, enweghị mgbu na palpation, enweghị mkpọtụ. Ihe njegharị na-arịgo ma na-agbadata eriri ala, ọ bụghị palpal.
Anụ a na-efegharị abụghị palpable. Palpation nke saịtị amụma adịghị egbu mgbu.
Site na ntụle imeju Kurlov, akụkụ ya dị 10/9/8 cm, n'otu n'otu. Na palpal nke imeju, achọpụtaghị ihe mgbu, akụkụ ala nke imeju ahụ agaghị esite n'okpuru ọnụ ọnụ ọnụ dị ọnụ ala. Mgbe ị na-enyocha mpaghara akpịrị dị, ọ nweghị mgbanwe a hụrụ. Palpation nke mpaghara amụma adịghị egbu mgbu, ihe mgbaàmà Courvoisier, Musse, Ortner adịghị mma.
Dayameta nke nkpuru osisi ahụ dị 6 cm, ogologo ya dị cm iri abụọ na abụọ, obere akụkụ adịghị ike.

Ihe omumu nke urinary system

Akụrụ aka ekpe na aka nri ke kehoraizin na obosara adịghị akwụkwụ ọtọ. Ọrịa Pasternatsky adịghị njọ n'akụkụ abụọ. Afọ ezighi ezi, ụda mkparị dị na mbara ihu na-enweghị isi. Palpation nke ureter isi enweghi mgbu. Ugba oke abụghị ihe siri ike, nọọrọ onwe ya, ruo 2l / ụbọchị.

Ọmụmụ nke usoro ụjọ ahụ

Na nyocha, enwere ụdị asymmetry nke ihu, ịdị larịị nke nasolabial n'akụkụ aka ekpe. Ọdịdị ihu adịghị ike, adịghị arụ ọrụ. Okwu, ịkpọ oku adịghị ichegbu. Enweghị ihe ọ bụla nke asụsụ. Pupilsmụ akwụkwọ na-emegharị emezigharị, mmeghachi omume nke ọkụ na ebe obibi bụ otu, nke a na-egosikarị. Ọhụụ na-ebelata. Nchikota na - ejide n'aka. Mgbe enyocha ya na ọkwa supine, akara nke esemokwu (Lasegue) dị mma, akpọpụtara ya n'aka nri. Onweghi mgbanwe ndị ọzọ na-achọpụta mgbanwe, ụkwara akwara na-enweghị atụmatụ, D = S. A na-ebelata ihe mgbu na akwara azụ na mpaghara ala dị ala site na ọkwa ikpere. N’ebe ndị ọzọ agbanwebeghị. Onweghi nkwonkwo aka nile a gbasara agbatị.

Izi ezi nke ihe mbu choputara
Site na mkpesa nke onye ọrịa: akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ, mmụpụta mmụba, mgbu n'ụkwụ aka nri, oge niile, mgbu, ịpị, mkpịsị ụkwụ oge, mmetụta nke ikpo ụkwụ,
akụkọ banyere ahụike: na 2002 choputara oria mellitus oria II n’oge nguzobe nke onye ọrịa choputara na enwere akpiri ịkpọ oku mgbe nile, okpukpu anwu anwu, ekwuputara ya nchoputa ya na atumatu atumatu.
data nyocha ebumnuche: akpụkpọ ahụ nwere nkụ, na-aga ije na nsọtụ ala, mkpọchi-cyanotic, hyperkeratosis ka akọwapụtara, yana akpọ ụkwụ, mbelata akpụkpọ ahụ, ntu na-agbanwe n’ụdị hypertrophy na mbibi na mkpịsị ụkwụ, hypotrophy nke akwara nke oghere introsseous oghere nke ụkwụ, ala ala ụkwụ ụkwụ. on a.dorsalis pedis abụghị palpable, ihe mgbu na tactile uche na-ebelata na ala na nsọtụ site n'ogo ikpere,
mee g'ẹhu-ụtso mee ya
1. isi: diabetesdị shuga nke abụọ
2. nsogbu: ọrịa shuga nke arịa nke obere oke ala.
Dabere na mkpesa onye ọrịa na-ekwu banyere: dizzness, isi ọwụwa tinyere mmụba nke ọbara mgbali ruo 200/130 mm. Hg. Art. Ọdịdị a mgbe a na-enwe ihe mgbu na-egbu mgbu n'azụ azụ sternum, na-emegharị ya n'aka ekpe, mgbada aka ekpe, nke na-agafe n'iji nitroglycerin, mmetụta nke palpitations,
akụkọ banyere ahụike: na 2002, onye dọkịta na-ahụ maka ọrịa, nyochara ọrịa obi na-arịa ischemic. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. Art NK IIA.,.
data ebumnuche ebumnuche: a na-ekpebi ihe apical n'oge nyocha na palpation na oghere V intercostal, na-esite n'ahịrị midclavicular site na 2 cm, ọ bụghị awụfu, ihe dịka 2 cm n'obosara, na ntụgharị nke obi, ogwe aka ekpe nke nkụda mmụọ ọyịre bụ 1.5 cm gaa site n'aka ekpe. ahịrị etiti-etiti, ya na mmetụ obi, ụda olu dara mba, a na-anụ ụda oge, ụda ngwụcha ezighi ezi, adịghị ike, nro, mkpụmkpụ systolic mkpesa, agwa nke mkpọtụ ahụ anaghị agbanwe mgbe ọnọdụ onye ọrịa gbanwere, pulse ari michen, tensi, ike, full, ọbara mgbali - 200/130 mm HG,
Nwere ike ịme nyocha nke mbido ọrịa concomitant: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Symptomatic akwara ọbara. NK IIA Art.

Atụmatụ nyocha ọzọ

1. Nnyocha ọbara nyocha.
2. Nnyocha mmamịrị nke nyocha.
3. Nnyocha ọbara biochemical.
4. RW Nke 371 nke 04/13/04.
5. Nchịkwa banyere feces maka nsị ahịhịa.
6. Nnwale ọbara maka glucose.
7. Nyocha nyocha maka glucose.
8. Ntụle nyocha dịka Nechiporenko kwuru.
9. Nyochaa ure maka ọnwụ protein kwa ụbọchị.
10. Reovasography.
11. ECG
12. Ihe osise nke OGK. Nọmba 35
13. O lee onye oculist anya.
14. ofgba gbasara dibia bekee.
15. Nnwale ọbara maka electrolytes.

Nsonaazụ ụlọ nyocha na ihe ọmụmụ

1. Nnyocha ọbara nke nyocha site na 04/14/04
Haemoglobin - 112 g / l
Mkpụrụ ndụ ọbara uhie - 3.5 * 1012 / l
Ngosiputa agba - 0.9
ESR - 6 mm / h
Mkpụrụ ndụ ọbara ọcha 4.8 * 10 ^ 9 / L
Neutrophils kwụ 2%
Sutmented Neutrophils 76%
Eosinophils 2%
Lymphocytes 17%
Monocytes 3%
2. Nnyocha ọbara nyocha site na 04/23/04
Haemoglobin - 116 g / l
Mkpụrụ ndụ ọbara uhie - 3.6 * 1012 / l
Ngosiputa agba - 0.9
ESR - 8 mm / h
Mkpụrụ ndụ ọbara ọcha 4.4 * 10 ^ 9 / L
Neutrophils kwụ 2%
Sutmented Neutrophils 70%
Eosinophils 4%
Lymphocytes 21%
Monocytes 3%
Leukocytes 2-3 na s / sp.
Mkpụrụ ndụ ọbara uhie 0-1 na n / a.
Epithelium - mba
Enweghị nnu
3. Ntụle nyocha nke mmamịrị nke ụbọchị 04/22/04
Agba nke mmamịrị bụ ahịhịa edo edo
Ngosipụta - Nghọta
Ike ndọda - 1025
Ihe mmeghachi a bụ acidic ntakịrị
Protein - Azụ
Gulukulu - 2%
Mkpụrụ ndụ ọbara ọcha 1-2 na n / a.
Mkpụrụ ndụ ọbara uhie 0-1 na n / a.
Epithelium - mba
Enweghị nnu
4. Nnyocha banyere mmiri ọgwụ 04/14/04
Ngụkọta protein - 76.3 g / l
Albumin - 54%
Globulins - 46%
Urea 3.7 mmol / L
Ọkpụkpọ creatinine 0.07 mmol / L
Cholesterol 7.1 mmol / L
VLDL 0.38 mmol / L
CRP - -
Seromucoids - 0.28 mmol / L
5. RW Nke 371 nke 04/13/04. - neg.
6. Nchịkwa banyere feces maka nsị anụ.
Res.: Enweghị akwa.
7. Nnwale ọbara maka glucose site na 04/13/04
8˚˚ glucose ọbara - 7.06 mmol / l
12˚˚ glucose ọbara - 11.02 mmol / l
18˚˚ glucose ọbara - 9.2 mmol / l
22˚˚ glucose ọbara - 8.2 mmol / l
8. Nyocha nyocha maka glucose site na 04/14/04
Glucose na mmamịrị - 1.25g.
9. Ntughari umere dika Nechiporenko si 04.15.04
Mkpụrụ ndụ ọbara - 3.01 * 10 ^ 6
Mkpụrụ ndụ ọbara uhie - 0.9 * 10 ^ 6
10. Nnyocha maka protein na-efu kwa ụbọchị site na 04/15/04
Protein dị na mmamịrị - 0.064 g / ụbọchị.
11. Reovasography.

Ulo aka ekpe
PI tibia 1.2 1.4 0.8 - 1,2
PI ụkwụ 1.0 1.5 1.0

12. ECG
Mmechi: Ọnọdụ nkịtị nke eriri eletrik nke obi.
Atrial fibrillation, ụdị tachysystolic. Obi obi 90 / min. Ọbara Hypertrophy nke myocardium aka ekpe ventricular myocardium tinyere oke ya. Mgbanwe mgbanwe na myocardium.
14. Ihe osise nke OGK. Nọmba 35
Achọpụtaghị Pathology OGK.
15. Mkparịta ụka na oculist.
Vis OD - 0.8
Os - 0.8
Ebumnuche: igwe ojii mbụ na oghere.
Fundus: HD bụ ezigbo acha uhie uhie, contours doro anya, veins dị ka ọbara, ọbara juru eju.
Mmechi: Ọrịa ọrịa dibia ọrịa mamịrị. Igwe nke anya abụọ ahụ dị mgbagwoju anya.
16. ofgba gbasara dibia bekee.
Mmechi: akwara obi. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. NK IIA Art.
17. Nnwale ọbara maka electrolytes.
Potassium - 6.1 mmol / L
Sodium - 160 mmol / L
Calcium - 2.3 mmol / L
Chlorides - 107 mmol / L

Itsenko-Cushing's Diabetes Mellitus
Hyperglycemia bụ ọrịa a na-ahụkarị, mmezi nke metabolism metabolism na-apụta mgbe a gwọrọ ọrịa na-akpata ọrịa. Hyperglycemia na-adịgide, dị elu, achọpụtara na afọ efu, nke glucosuria na-esokarị

Ọrịa shuga
Glucosuria anaghị adabere na ego nke carbohydrates a na-elekọta, anaghị esonyere ya na hyperglycemia ma ọ bụ ndidi na-anabata carbohydrate. Enweghị angio na neuropathies. Glucosuria dabere na oke carbohydrates a na-achịkwa, yana hyperglycemia ma ọ bụ ndidi na-egbochi carbohydrate.

Ọrịa shuga na-arịa ọrịa shuga
A naghị agakọta Polyuria na glucosuria, ịdị ukwuu nke mmamịrị na hyperglycemia Polyuria adịghị ejikọta ya na glucosuria, njupụta nke mmamịrị na hyperglycemia dị elu.

Igosiputa nyocha nke ikpeazu
Site na mkpesa nke onye ọrịa: akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ, mmụpụta mmụba, mgbu n'ụkwụ aka nri, oge niile, mgbu, ịpị, mkpịsị ụkwụ oge, mmetụta nke ikpo ụkwụ,
akụkọ banyere ahụike: na 2002 choputara oria mellitus oria II n’oge nguzobe nke onye ọrịa choputara na enwere akpiri ịkpọ oku mgbe nile, okpukpu anwu anwu, ekwuputara ya nchoputa ya na atumatu atumatu.
data nyocha ebumnuche: akpụkpọ ahụ nwere nkụ, na-aga ije na nsọtụ ala, mkpọchi-cyanotic, hyperkeratosis ka akọwapụtara, yana akpọ ụkwụ, mbelata akpụkpọ ahụ, ntu na-agbanwe n’ụdị hypertrophy na mbibi na mkpịsị ụkwụ, hypotrophy nke akwara nke oghere introsseous oghere nke ụkwụ, ala ala ụkwụ ụkwụ. on a.dorsalis pedis abụghị palpable, ihe mgbu na tactile uche na-ebelata na ala na nsọtụ site n'ogo ikpere,
usoro nyocha na akụrụngwa: mmụba nke glucose n’etiti 7.5 - 11.02 mmol / l, njiri mara n’ụbọchị, ọnụnọ nke glucose na mmamịrị nke 1.25 g,
oge nyocha nke ndị ọkachamara metụtara: nkwubi okwu nke optometrist - ọrịa ọrịa retinal angiopathy. Mbido mbufe anya abụọ nke anya ya abụọ,
nchọpụta ọdịiche
Nwere ike ime nyocha nke ikpeazụ:
• nke mbụ: ụdị shuga mellitus nke 2, nke gbara ya gharịị, na-agbakọ,
• Nsogbu: ọrịa shuga na arịa nke obere oke ala. Ọrịa mamịrị nke ọrịa mamịrị nke retina. Igwe nke anya abụọ ahụ dị mgbagwoju anya.
Dabere na mkpesa onye ọrịa na-ekwu banyere: dizzness, isi ọwụwa tinyere mmụba nke ọbara mgbali ruo 200/130 mm. Hg. Art. Ọdịdị a mgbe a na-enwe ihe mgbu na-egbu mgbu n'azụ azụ sternum, na-emegharị ya n'aka ekpe, mgbada aka ekpe, nke na-agafe n'iji nitroglycerin, mmetụta nke palpitations,
akụkọ banyere ahụike: na 2002, onye dọkịta na-ahụ maka ọrịa, nyochara ọrịa obi na-arịa ischemic. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. Art NK IIA.,.
data ebumnuche ebumnuche: a na-ekpebi ihe apical n'oge nyocha na palpation na oghere V intercostal, na-esite n'ahịrị midclavicular site na 2 cm, ọ bụghị awụfu, ihe dịka 2 cm n'obosara, na ntụgharị nke obi, ogwe aka ekpe nke nkụda mmụọ ọyịre bụ 1.5 cm gaa site n'aka ekpe. ahịrị etiti-etiti, ya na mmetụ obi, ụda olu dara mba, a na-anụ ụda oge, ụda ngwụcha ezighi ezi, adịghị ike, nro, mkpụmkpụ systolic mkpesa, agwa nke mkpọtụ ahụ anaghị agbanwe mgbe ọnọdụ onye ọrịa gbanwere, pulse ari michen, tensi, ike, full, ọbara mgbali - 200/130 mm HG,
data nke ụlọ nyocha na ụzọ nyocha ngwa:
Nkwubi ECG - ọnọdụ nkịtị nke eriri eletrik nke obi. Atrial fibrillation, ụdị tachysystolic. Obi obi 90 / min. Ọbara Hypertrophy nke myocardium aka ekpe ventricular myocardium tinyere oke ya. Na-agbanwe mgbanwe myocardial,
Ndụmọdụ gbasara akụrụngwa: mmechi - IHD. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. Art NK IIA.,.
inwere ike ichoputa oria nkukota: CHD. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. NK IIA Art.

Etiopathogenesis
Nke a bụ ọrịa polyetiological.
Tinyegharịa:
1. Nnukwu insulin na-arịa ọrịa shuga mellitus - ụkọ insulin zuru oke - ụdị 1.
2. Insulin bụ ọrịa mellitus nwere nnwere onwe. Ọ na - akpata erughi insulin dị ala. N'ime ọbara nke ndị ọrịa dị otú a, insulin bụ ihe dị mma ma ọ bụ bulie elu. Nwere ike buru ibu ma nweekwa ahụ nkịtị.
Insulin - ọrịa shuga mellitus na-arịa - bụ ọrịa autoimmune. Ndabere nke mmepe ya bụ:
1. ntụpọ nke 6 - chromosome metụtara usoro HLA - D3, D4. Ọrịa a bụ ihe nketa.
2. Nje virus nke mumps, akpịrị, Coxsackie, ọnọdụ nrụgide siri ike, ụfọdụ mmiri ọgwụ. Ọtụtụ nje yiri mkpụrụ ndụ beta. Usoro ahụ ji alụso ọrịa ọgụ na-egbochikarị nje. Ọ bụrụ na enwere nkwarụ, nje islet site na lymphocytes na-apụta. B lymphocytes na-emepụta ọgwụ mgbochi cytotoxic. mkpụrụ ndụ beta na-anwụ, ụkọ insulin na-amalitekwa - ọrịa shuga mellitus.
Mellitus nwere insulin nọọrọ onwe ya nwere ntụpọ sitere na mkpụrụ ndụ ihe nketa, mana ọ na - apụta na enweghị ihe ọ bụla dị n’èzí.
1. Nmehie dị na sel beta n’onwe ha na akwara akụkụ. Ihe nzuzo insulin nwere ike ibu ya ma kpali ume (ya na otutu glucose obara 6.5 mmol / l).
2. Mmetụta anụ ahụ dị n’ime insulin na-ebelata.
3. Mgbanwe na nhazi nke insulin.
Insulin na-enwere onwe ya na-arịa oke ibu. N’okwu a, mkpụrụ ndụ chọrọ insulin ọzọ, ndị na-anabata ya n’ime sel ezughikwa.

Ọgwụgwọ
1. Nọmba nri 9.
A na-agbakọ mgbatị nri na-eburu n'uche ọnọdụ ahụike dum, okike, ndị na-egosi ịdị-elu na ọnụ ahịa ike (maka otu ụdị ọrụ). Nkịtị: 30 kcal / n'arọ nke ibu physiological. Nnukwu anụ ahụ nke onye ọrịa a bụ 55 n'arọ. Gbakọọ: 75x30 = 2250 kcal / ụbọchị.
Nri ugboro ugboro - ugboro 5-6 n'ụbọchị. A na-atụ aro ka ekesa ekenye kwa ụbọchị:

Nri olu na%
Ezumike ụtụtụ mbụ 8 awa 20%
Nri ehihie 12 h. 10%
Nri ehihie 14 h. 20-30%
Nri nri awa 17 10%
Nri abalị 19 ka awa 20%
Nke abụọ nri abalị 21 awa 10%
2. Ọnọdụ ọnọdụ.
3. Mụbaa na anụ ahụ. ibu.
4. Diabeton MR 30mg, 1 mbadamba 1r / d n'ụtụtụ minit 30 tupu nri.
5. mbadamba aspirin 325 ½ n'ime 1 r / d na 19˚˚.
6. Nitrogranulong 0.005, mbadamba 1 n'ime 3 r / d.
7. Captopril 25mg ½ mbadamba n'ime 2p / d.
8. Sol. Vit B6 5% - 2.0 ml intramuscularly 1 r / d kwa ụbọchị.
9. Mildronate 5.0ml intravenously 1r / d.
10. Piracetam 5.0 ml intravenously, 1 r / d.
11. Furosemide 2.0 ml intravenly kwa ụbọchị.
12. Asparkam 1 mbadamba n'ime 3 r / d.
13. Eufilin 0.15 n’abalị.

20.04.04
Onye ọrịa ahụ na-eme mkpesa nke akpịrị ịkpọ nkụ, akpịrị ịkpọ nkụ mgbe ị risịrị nri, polyuria, ọsụsọ, adịghị ike, mgbu ụkwụ nke ọdịdị ebighi ebi, na-enweghị ịkọwapụta, ike na-agafe agafe, na-ebili ma na-agafe n'enweghị ihe doro anya kpatara.
Ebumnuche: ọnọdụ onye ọrịa dị nso na afọ ojuju. Anụ ahụ na-acha odo odo na-acha odo odo. Anaghị aza aza. BH = 18 / nkeji. Na ngụgụ, vesicular iku ume, enweghị wheeze. Ps = 82 / min, ndoju na afọ ojuju na-eju afọ. HELL = 180/100 mmHg N'oge anakpo obi, nke na-esighi ike, a na-anụ ụda velvet timbre, ụda ọkụ ezighi ezi, ọnụego obi = 82 gbagwojuru / min. A na-ekpebi mkpesa na-adịghị ike, dị nro, nke dị mkpụmkpụ systolic. Ire di ocha, obughi kwa ya. Ọkpụkpụ n’ime apịlị ahụ dị nro, enweghi mgbu. Oche dị mma. Diuresis banyere 2l., Independent.
Oge ezumike: gaa n'ihu na usoro ọgwụgwọ dị na ndepụta nke oge ọhụhụ.

29.04.04
Onye ọrịa ahụ na-eme mkpesa na akpịrị ịkpọ nkụ, akpịrị na-akpọ nkụ mgbe o risịrị nri, polyuria, adịghị ike, mgbu na ụkwụ belatara, na-enweghị nsachapụta nke ọma, ike na-erughị ala, na-ebili ma na-agafe n'enweghị ihe pụtara ìhè. Ndetu ndetu mma na ọdịmma.
Ebumnuche: ọnọdụ ahụ na-eju afọ. Akpụkpọ ahụ na-acha odo odo na-acha ọbara ọbara, dị ọcha. BH = 16 / nkeji. Na ngụgụ, vesicular iku ume, enweghị wheeze. Ps = 76 / min, ndoju na afọ ojuju na-eju afọ, oge adịghị, enweghi erughi ala. HELL = 160/100 mm Hg Site na mkpocha obi, a na - anụ ụda na - esighi ike, ụda obi na - ezighi ezi, nha obi = 76 bpm. A na-ekpebi mkpesa na-adịghị ike, dị nro, nke dị mkpụmkpụ systolic. Asụsụ dị ọcha. Ọkpụkpụ n’ime apịlị ahụ dị nro, enweghi mgbu. Oche dị mma 2p / d. Diuresis banyere 2l., Independent.
Oge ezumike: gaa n'ihu na usoro ọgwụgwọ dị na ndepụta nke oge ọhụhụ.
Ịkagbu: piracetam, furosemide.

02.05.04
Onye ọrịa ahụ na-eme mkpesa nke akpịrị ịkpọ nkụ mgbe o risịrị nri, adịghị ike, polyuria.
Ebumnuche: ọnọdụ ahụ na-eju afọ. Akpụkpọ ahụ na-acha odo odo na-acha ọbara ọbara, dị ọcha. BH = 16 / nkeji. N'ime akpa ume, vesicular iku ume, na elu elu dum. Ọma = 80 / min, oge na-adịghị, enweghi ụdọ ọyị. HELL = 160/100 mm Hg Site na mmetụ nke obi, a na-anụ ụda na-esighị ike, ụda nke obi ezighi ezi, ọnụego obi = 80 gbagwojuru / min. Mkpebi siri ike, dị nro, dị mkpụmkpụ systolic; mgbe ọ na-agbanwe ọnọdụ ahụ, ọ naghị agbanwe akụrụngwa ya. A naghị atụ ụtụ asụsụ ahụ. Ọkpụkpụ n’ime apịlị ahụ dị nro, enweghi mgbu. Oche dị mma 2p / d. Diuresis banyere 2l., Independent.
Oge akara aka: kwadebe maka ihapu 03.04.04.
Kagbuo: Sol. Vit B6 5%, Mildronate.

Mmebi
A kpọtara onye ọrịa Karpenko Aleksandra Nikolaevna n'ụlọ ọgwụ endocrinology nke Clọ Ọgwụ Ahụ Ike Pụrụ Iche site na 04/13/04 ruo 05/03/04. Anata site na usoro eji eme mkpesa na-akpaghasị akpịrị ịkpọ nkụ ya, akpịrị na-akpọ nkụ, polyuria, itching nke anụ ahụ, n'oge na-adịbeghị anya mbelata nke visual acuity, ihe mgbu na ụkwụ aka nri, mgbe nile, ihe mgbu, ịpị oge, mkpịsị aka na mkpịsị ụkwụ oge, oge mmetụta nke ụkwụ n'ụkwụ. . Emere nyocha. A mụrụ ihe ngosipụta nke ụlọ nyocha: nyocha nke mmamịrị ụlọ ọgwụ site na 04/22/04 - glucose - 2%, nyocha ọbara maka glucose site na 04/13/04 - 8˚˚ glucose ọbara - 7.06 mmol / l, 12˚˚ glucose ọbara - 11.02 mmol / l, 18˚˚ glucose ọbara - 9.2 mmol / l, 22˚˚ glucose ọbara - 8.2 mmol / l, ECG - ọnọdụ nkịtị nke eriri elektrik nke obi, atrial fibrillation, ụdị tachysystolic. Oku obi 90 / min, ogwe aka nke ventricular myocardial hypertrophy tinyere oke ya, na-agbasa mgbanwe na myocardium. Ọkachamara nke anya. Mmechi: Ọrịa ọrịa dibia ọrịa mamịrị. Igwe nke anya abụọ dị mgbagwoju anya. Ọkpụkpụ akụrụngwa na-atụle. Mmechi: akwara obi. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. Symptomatic akwara ọbara. NK IIA Art. Achoputara ya na isi - oria oria oria abuo n ’udiri oria di nfe, gbara agbado,
nsogbu na - arịa ọrịa shuga nke arịa nke obere oke ala. Ọrịa mamịrị nke ọrịa mamịrị nke retina. Ihe mbupu anya abuo nke anya ya abua, buru ibu - oria obi agha. Atherosclerotic cardiosclerosis. Angina pectoris. Atrial fibrillation, ụdị tachysystolic. O duziri ọgwụgwọ. A na-ahapụ onye ọrịa na ọnọdụ afọ ojuju n'ụlọ. Na-atụ aro: gaa n'ihu na usoro ọgwụgwọ ndị dọkịta depụtara, na nke anụ ahụ. Ibu, nnyocha onwe nke shuga ọbara, ọgwụgwọ inpatient mgbochi nke oge 1 otu afọ.

Ndepụta aha

Balabolkin M.I. Endocrinology: Akwukwo ederede. nkwere. --- M.: Medicine, 1989. 416 p. (Akwụkwọ ọgụgụ. Lit. Maka ndị okpuru na ndị ọrụ ntanetị).
Potemkin V.V. Endocrinology. --- M.: Medicine, 1986. 432 p., Ọrịa.
Medvedev V.V., Volchek Yu.Z. Nchọpụta Ahụike Na-adọkpụ Ahụ: Akwụkwọ Nduzi Maka Ndị Ọrịa / Ed. V.A. Yakovleva. --- St. Petersburg: Hippocrates, 1995. --- 208 p.
Mashkovsky M.D. Ọgwụ Na akụkụ abụọ. Nkebi 1., Nkebi 2 --- M.: Medicine, 1993.