Hyperosmolar coma > Ọrịa mamịrị

Esemokwu
Ntụgharị uche
Nkwarụ okwu
Isi mara mmụọ
Ahụ́ mkpọnwụ
.Bawanye ụba
Obere okpomọkụ
Ọbara mgbali elu
Akpịrị ịkpọ nkụ
Adịghị Ike
Ibu ibu
Mmepo
Akpụkpọ anụ
Akọrọ akpụkpọ mucous
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 nke sistemụ ahụ niile, mgbe mgbanwe na-agbadata, ọrụ obi na-ebelata, yana thermoregulation na-ebelata. N’ime ọnọdụ a, enwere nnukwu ọnwụ.

Nkewa

Hyperosmolar coma nwere ọtụtụ iche:

Hyperglycemic coma. Achọpụtara ya na mmụba shuga dị n'ọbara, nke na-eduga n'ị intoụbiga mmanya ókè na nke nwere mmetụta uche, enwere ike ịgbakwunye ịba ụba nke ịta lactic acid.
Hyperglycemic hyperosmolar coma bụ ụdị ngwakọta nke ọrịa pathologies mgbe nsụsị mmụọ na-apụta n'ihi oke shuga na oke osmotic ogige na carbon metabolism arụ ọrụ. Mgbe a na-achọpụta ya, ọ dị mkpa inyocha onye ọrịa maka ọrịa na-efe efe na akụrụ, n'ime oghere imi, ka o nyochaa oghere na akwara nwa, ebe ọ bụ na enweghi ketoacidosis n'ọtụtụ a.
Ketoacidotic coma. Ejikọtara ya na enweghị insulin n'ihi ọgwụgwọ a họọrọ nke ọma, nke na-enye aka na ndagide nke ịnye glucose na mkpụrụ ndụ yana mbelata na ojiji. Mgbaàmà na-etolite ngwa ngwa, prognosis nke ọgwụgwọ dị mma: mgbake na-apụta na 85% nke ikpe. Onye ọrịa ahụ nwere ike inwe oke akpịrị ịkpọ nkụ, afọ mgbu, onye ọrịa ahụ nwere oke iku ume ya na isi acetone, ọgba aghara na-egosi na uche.
Hyperosmolar na-abụghị ketoacidotic coma. Ihe e ji mara ya bụ ọrịa ụbụrụ na-arịa nnukwu ọrịa nke nwere mmiri akpịrị ịkpọ nkụ na mmiri exsicosis. Onweghi mkpo nke ozu ketone, odi nfe. Ihe kpatara ya bu enweghi insulin na akpukpo oku. Usoro mmepe ana - egbu oge - ihe dị ka izu abụọ mgbe o jiri nwayọ nwayọ nke ọrịa.

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

Symptomatology

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

oke agu
Akpụkpọ anụ na akpụkpọ anụ mucous,
Ihu 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'otu oge, isi a na-esi n'ọnụ ya yie ihe na-esi ísì ụtọ.

Diagnostics

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 usoro inyefe mmiri ara ehi n'ọtụtụ: ọ dị elu karịa na ketoacidotic coma, nke eji mmiri mmiri, 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:

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

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

Nsogbu enwere ike

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 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, ọgwụ nke homonụ 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.

, , , ,

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 akparamaagwa:

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.

Oria di iche

A na - edozi ọdịiche dị n'etiti hyperosmolar coma na ihe ndị ọzọ enwere ike ime nke mmụọ.

N'inye agadi afọ nke ndị ọrịa, a na-ejikarị nchọpụta ọdịiche dị na mmebi nke mgbasa ụbụrụ na hematoma dị ala.

Otu ọrụ dị oke mkpa bụ nchọpụta ọdịiche dị na hyperosmolar coma na ọrịa ketoacidotic na hypoglycemic karịsịa.

, , , , ,

Hyperosmolar coma ọgwụgwọ

A ga-enwerịrị ndị ọrịa nwere hyperosmolar n'ụlọ ọgwụ na ngalaba nlekọta ahụike / ngalaba nlekọta ahụike. Mgbe emechara nchoputa wee bido usoro ọgwụgwọ, ọ dị ndị ọrịa mkpa ịlele ọnọdụ ha oge niile, gụnyere nlebara anya parameters, isi ahụ, yana palọm.

Ọ bụrụ na ọ dị mkpa, ndị ọrịa na-enyocha ikuku, catheterization nke eriri afo, nrụnye nke catheter na-efe efe na nri nri parenteral. N'ime ngalaba nlekọta kpụ ọkụ n'ọnụ / ngalaba nlekọta ahụ ike:

nyocha ngwa ngwa nke glucose ọbara 1 oge kwa elekere na glucose ọbara ma ọ bụ 1 oge awa 3 mgbe ị na-agbanye n'ọchịchị subcutaneous,
Mkpebi nke ketone n'ahụ ke ọbara ugboro abụọ n'ụbọchị (ma ọ bụrụ na ọ gaghị ekwe omume - mkpebi siri ike nke ozu ketone na mmamịrị 2 r / ụbọchị),
Mkpebi ọkwa K, Na n'ọbara 3-4 ugboro n'ụbọchị,
Ọmụmụ ihe banyere acid-base steeti 2-3 ugboro ụbọchị ruo na-adịgide adịgide norm nke pH,
njikwa mmamịrị kwa oge ruo mgbe a kpochapụrụ akpịrịkpa mmiri,
Nlekota ECG
njikwa ọbara mgbali elu, ọnye obi, ọnọdụ ahụ dum kwa awa 2,
nyocha nke ngụgụ
nyocha nke ọbara, mmamịrị 1 oge n’ime ụbọchị 2-3.

Dịka ọ dị na ketoacidosis mamịrị, isi ụzọ ọgwụgwọ maka ndị ọrịa nwere hyperosmolar coma bụ nhụcha mmiri, ọgwụgwọ insulin (iji belata plasma glycemia na hyperosmolarity), mgbazi nke ọgba aghara electrolyte na nsogbu acid-base).

Friza

Sodium chloride, 0.45 ma ọ bụ 0.9% ngwọta, na-akụda intravenously 1-1.5 L n'oge awa nke 1 nke infusion, 0,5-1 L n'oge nke abụọ na 3rd, 300-500 ml na awa sochirinụ. Ọbara sodium chloride na-ekpebi ọkwa nke sodium n'ime ọbara. Na ọkwa nke Na + 145-165 meq / l, a na-edozi ihe ngwọta nke sodium chloride na mkpokọta 0.45%, na ọkwa nke Na + +> 165 meq / l, iwebata usoro nnu nwere contraindicated, na ndị ọrịa dị otú a, a na-eji mmiri glucose eme ihe maka mmiri mmiri.

Dextrose, 5% ihe ngwọta, na-akụda 1-1.5 L n'oge awa nke 1 nke infusion, 0.5-1 L n'oge oge nke abụọ na 3, 300-500 ml - na awa ndị na-esote. Osmolality nke infusion agbanwe agbanwe:

0.9% sodium chloride - 308 mosm / n'arọ,
0.45% sodium chloride - 154 mosm / n'arọ,
5% dextrose - 250m / n'arọ.

Hydkụ mmiri nke ọma na-enyere aka belata hypoglycemia.

, ,

Usoro ọgwụgwọ insulin

A na-eji ọgwụ ndị dị mkpụmkpụ:

Insulin nsogbu (mkpụrụ ndụ ma ọ bụ ọkara ihe sịntetik) intravenously na ihe ngwọta nke sodium chloride / dextrose na ọnụego 00.5-0.1 U / kg / h (ebe ọkwa glucose dị n'ọbara kwesịrị belata karịa 10m / kg / h).

N'ihe banyere njikọta nke ketoacidosis na ọrịa hyperosmolar, a na-eme usoro ahụ dabere na usoro izugbe nke ọgwụgwọ ọrịa ketoacidosis.

, , , , ,

Nyocha banyere arụmọrụ ọgwụgwọ

Ihe ịrịba ama nke usoro ọgwụgwọ dị mma maka hyperosmolar coma gụnyere mweghachi nke nsụhọ, mwepu nke ngosipụta ụlọ ọgwụ nke hyperglycemia, mmezu nke ọkwa glucose ọbara lekwasịrị anya na osmolality plasma nkịtị, mwepu nke acidosis na nsogbu elektrolyte.

, , , , , ,

Njehie na oge ezighi ezi

Hydme mmiri ngwa ngwa yana mbelata nke ọbara dị ala nwere ike ibute Plasma osmolarity na mmepe nke ụbụrụ (ọkachasị na ụmụaka).

N'inye agadi ọrịa nke ndị ọrịa yana ọnụnọ nke ọrịa concomitant, ọbụna mmiri mmiri nke ọma na-ebu mmiri nke ọma nwere ike ibute ọgbụgba nke obi na nkụ mkpụrụ.

Mbelata ogo glucose ọbara dị ngwa nwere ike ime ka mmiri mmiri extracellular na-abanye n’ime sel na-eme ka hypotension artpot na oliguria na -akpata.

Iji potassium eme ihe ọbụna na hypokalemia dị obere na ndị nwere oligo- ma ọ bụ anuria nwere ike ibute hyperkalemia na-eyi ndụ egwu.

Nkwekọrịta nke phosphate na akụrụ gbasara akwara a machibidoro ya iwu.

, , , ,

Mgbaàmà nke akwara ozi

Na mgbakwunye, enwere ike ịhụ ihe mgbaàmà sitere na sistemụ ụjọ:

hallucinations
hemiparesis (adịghị ike mmegharị nke afọ ofufo),
ọria aghara ikwu okwu, a na-eme ka ọ maa jijiji,
nọgidesighị ike n'ihe
Areflexia (enweghi ike mgbanwe, otu ihe ma ọ bụ karịa) ma ọ bụ hyperlefxia (mgbanwe ume).
uru ahụ
isi mmụọ.

Ihe mgbaàmà na-egosi ụbọchị ole na ole tupu hyperosmolar coma amalite ịmalite n'ime ụmụaka ma ọ bụ ndị okenye okenye.

Mgbochi nke nsogbu

Ọ dịkwa mkpa iji gbochie obi ime mmụọ, ya bụ, mgbochi nke ọdịda akụrụngwa. Maka nzube a, a na-eji "Cordiamin", "Strofantin", "Korglikon". Site na nrụgide belatara, nke dị na ọkwa oge niile, a na-atụ aro ka ọ na-ahụ maka edozi DOXA, yana nchịkwa nchịkwa nke plasma, hemodesis, albumin mmadụ na ọbara dum.