Nlekọta ahụike mberede maka ketoacidosis na-arịa ọrịa shuga n’ime ụmụaka na ndị nọ n’oge uto

E.N.Sibileva
Onye isi nke Ngalaba Na-ahụ Maka Ọrịa ,mụaka, Mahadum FPK Northern State Medical University, Prọfesọ Prọfesọ, Onye Isi Ọgwụ Endocrinologist, Ngalaba Ahụike, Nchịkwa nke mpaghara Arkhangelsk

Ọrịa mamịrị ketoacidosis bụ nsogbu ọrịa shuga na-eto ngwa ngwa. Egosiputa onodu a site na njiko insulin zuru oke na nke idi nso, nke ikpeazu nke a na-ebute site na mmụba nke anụ ahụ nke ma ndị na - alụ ọlụ ikuku na - achọghị ịba.

Ejiri Ketoacidosis mara:
Elu hyperglycemia na osmotic diuresis na acetonuria,
Na-agbada n'ụzọ dị ukwuu n'ihi akụrụngwa protin,
Kpochapu bicarbonates, na-ebute mgbanwe na steeti acid na mpaghara nke nnukwu metabolos acidosis.

Uto nke ọrịa metabolic siri ike na ụkọ insulin a na-achịkwaghị achịkwa na-eduga na hypovolemia, akara mpempe nke ihe nchekwa potassium na anụ ahụ, yana nchịkọta nke β-hydroxybutyric acid na sistemụ akwara. N’ihi nke a, a ga-amata mgbaàmà nke ajọ ọrịa akwara mkpali, nsogbu akwara amụkwo maka ịda mba, nsogbu ịmara ruo coma, na nsogbu ahụike.

N'ọnọdụ ndị a na-adịghị ahụkebe, na ụmụaka enwere:
1. Mkpụrụ obi Hyperosmolar:
Per elu hyperglycemia
Njigide sodium n’arụ
Na -akpọ mmiri mmiri
K ketosis na-agafeghị oke
2. Cactatecedemic coma - coma rarest nke ụmụaka, na-abụkarị na nzụlite ya enwere hypoxia anụ ahụ dị ukwuu na mkpokọta lactate n'ime ọbara.

Ọrịa mamịrị ketoacidosis

1. Imezi ụkọ insulin
2. Friza
3. Mkpochapu hypokalemia
4. Mwepụ nke acidosis

Tupu o gwọọ ọgwụ, onye ọrịa ahụ kpuchiri okpomoku, a na-etinye tube nasogastric, catheter n'ime eriri afo.

Imezi ụkọ insulin

A na - eji insulin eme ihe dị mkpụmkpụ. Ọ kachasị mma ịnye insulin site na lineamate na azum 10% albumin, ọ bụrụ na enweghi lineomat, insulin na-agbanye jet kwa awa. Usoro izipu insulin bụ 0.2 U / n'arọ, mgbe nke a gasị, elekere 0.1 U / kg / awa. Site n’ibelata shuga dị n’ọbara ruo 14-16 mmol / l, ọ̀tụ̀tụ̀ insulin na-agbadaru ruo 0.05 U / kg / awa. Site na mbelata ọbara shuga ruo 11 mmol / L, anyị na-agbanwe gaa na nchịkwa insulin na-adị ala elekere isii ọ bụla.

Mkpa insulin mgbe ewepụrụ ya na mmiri bụ 1-2 nkeji / n'arọ / ụbọchị.
Ntị! Ọnụego mbelata glucose ọbara ekwesịghị gafere 5 mmol / awa! Ma ọ bụghị ya, mmepe nke ụbụrụ ga - ekwe omume.

Friza

A na-agbakọ ọnya mmiri ahụ dabere na afọ:
▪ n'ime ụmụaka afọ atọ mbụ nke ndụ - 150-200 ml / n'arọ ibu / ụbọchị, dabere ogo nke akpịrị ịkpọ nkụ.
N'ime ụmụaka toro eto - 3-4 l / m2 / ụbọchị
N'ime nkeji iri atọ mbụ nke iwebata 1/10 kwa ụbọchị. N'ime awa 6 mbụ, 1/3 nke ọgwụ kwa ụbọchị, n'ime awa 6 sochirinụ - dose kwa ụbọchị, wee kwee.
Ọ dị mma iji infusomat bufee mmiri mmiri, ma ọ bụrụ na ọ nọghị, jiri nwayọ gbakọọ ọnụọgụ nke nkeji kwa nkeji. A na - eji sodium chloride 0.9% mee ihe dịka mmalite. Ekwesịrị ijizi saline gafee elekere abụọ. Mgbe ahụ ọ dị mkpa ka ịgbanwee gluu 10% glucose na ngwakọta Ringer na oke nke 1: 1. A na-ewe mmiri niile ka a na-awụnye ya intravenally mgbe ọ na-adị 37 Celsius. ọ bụrụ na nwatakịrị ahụ nwere nkụda mmụọ, anyị na-eji 10% albumin na-edozi tupu ịmalite nchịkwa nke kristal na ọnụego 5 ml / n'arọ ibu, mana ọ bụghị karịa 100 ml, n'ihi colloids ka idowe mmiri na mmiri.

Ntuzi nke potassium

Ekwesịrị icheta na mmezi nke potassium na-ebelata mmetụta nke ọgwụgwọ! Ozugbo mmamịrị bidoro ikewapụ ya na kateeti (ọ bụ awa 3-4 site na mmalite ọgwụgwọ), ọ dị mkpa ịga n’ihu site na ntụzi nke potassium. A na-achịkwa ihe na-eme ka Sọlọtọ chloride 7.5% na ọnụego nke 2-3 ml / n'arọ / ụbọchị. A na - etinye ya na mmiri mmiri a gbanyere na ọnụego 2-2.5 ml nke potassium chloride kwa 100 ml nke mmiri.

Ndozi Acidosis

Iji dozie acidosis, a na-eji mmiri soda 4% soda nke 4 ml / n'arọ a na-ekpo ọkụ, nke a kwadebere ọhụrụ. Ọ bụrụ na a ga - ekpebisi ike na BE, yabụ, ọgwụ bicarbonate bụ 0.3-BE x dị nwatakịrị na kilogram.
A na-eme mgbazi Acidosis na awa 3-4 nke ọgwụgwọ, ọ bụghị na mbụ, n'ihi Usoro insulin na-eji mmiri mmiri na-agbazi ketoacidosis nke ọma.
Ihe kpatara iwebata soda bụ:
Ent adynamia na-ekweghị akwụsị akwụsị
▪ marb nke anụ ahụ
Breathing oké ume iku ume

Na ọgwụgwọ nke ọrịa mamịrị acidosis, a na-edenye obere doses heparin 100 nkeji / n'arọ / ụbọchị n'ime 4 injections. Ọ bụrụ na nwatakịrị ahụ nwere ọnọdụ okpomọkụ, a na-enye ọgwụ mgbochi oke ngwa ngwa.
Ọ bụrụ na nwatakịrị ahụ ji akara mmalite nke ketoacidosis (DKA I), i.e. n'agbanyeghị metabolic acidosis, nke mkpesa dyspeptik (nke ọgbụgbọ, vomiting), mgbu, iku ume miri emi, mana echebere nsụhọ, ọ dị mkpa:

1. Jiri mmanu 2% were mmanu mmanu sachaa afo.
2. Iji tinye nsacha ma mesịa ọgwụ enema nwere mmiri ọkụ nke 2% soda n’ime olu 150-200 ml.
3. Na -eme ọgwụ infusion, nke gụnyere albumin ngwọta, ọgwụgwọ physiological, ma ọ bụrụ na glucose adịghị agafe 14-16 mmol / l, mgbe ahụ, a na-eji ihe ngwọta nke glucose 10% na Ringer mee ihe na 1: 1. A na-agbakọ usoro ọgwụgwọ infusion na nke a maka awa 2-3 na-adabere n'ihe ndị a chọrọ kwa ụbọchị, n'ihi na-emecha, inwere ike ịgbanwee rehydration ọnụ.
4. A na-eme insulin ọgwụ na ọnụego nke 0.1 U / kg / h, mgbe ọkwa glucose bụ 14-16 mmol / L, dose ahụ bụ 0.05 U / kg / h yana n'ọkwa glucose nke 11 mmol / L anyị na-atụgharị gaa na nchịkwa subcutaneous.

Usoro nke ịdu nwata mgbe ọ kwụsịrị ketoacidosis

1. Maka ụbọchị 3 - nri Nke 5 na-enweghị abụba, mgbe ahụ okpokoro 9.
2. drinking drinkingụbiga mmanya ókè, gụnyere mmiri alkaline (mmiri ịnweta, ihe ọ ofụ sodaụ nke 2% soda), ihe ọ juụ juụ nwere agba odo-acha ọbara ọbara, n'ihi ha nwere potassium nke ukwuu.
3. Site n'ọnụ, 4% potassium chloride solution, 1 dess.-1 tebụl. ngaji 4 ugboro n'ụbọchị maka ụbọchị 7-10, n'ihi na mgbazi nke hypokalisthia bụ ogologo oge.

4. Enyere insulin na inje 5 n'ime usoro a: na elekere isii nke ụtụtụ, wee gafee ụtụtụ, nri ehihie, nri abalị na abalị. Usoro izizi bụ nkeji 1-2, nke ikpeazụ bụ 2-6 nkeji, na ọkara mbụ nke ụbọchị - 2/3 nke usoro kwa ụbọchị. Bọchị kwa ụbọchị ya na ọnụọgụ mkpochapụ si ketoacidosis, nke na-abụkarị ogo 1 U / n'arọ. A na-eme ụdị ọgwụ insulin ahụ ruo ụbọchị 2-3, mgbe nke ahụ gasịrị, agafere nwata ahụ na ọgwụgwọ bolus.

Rịba ama Ọ bụrụ na nwatakịrị nwere ketoacidosis nwere uto okpomoku, a na-enye ọgwụ mgbochi oke. Na njikọta ọrịa hemostasis kpatara hypovolemia na metabolic acidosis, a na-atụgharị heparin kwa ụbọchị nke 100 U / n'arọ nke ịdị arọ ahụ maka igbochi mgbasa nke ọrịa coagulation mgbasa. A na-ekesa ọgwụ ahụ ihe karịrị 4 injections, a na-agwọ ọgwụ n'okpuru njikwa coagulogram.