Isiqaqa Hyperosmolar: oonobangela, iimpawu, isifo, unyango

isiqaqa Hyperosmolar adla olufunyanwa izigulane ezindala ngaphezu kweminyaka engama-50 abaphethwe seswekile ukuba ndinomoya ukusa kumkhamo ngcathu, ngokulula babuyekezwe yi ukutya ezizodwa kunye namayeza. Phuhlisa kwimvelaphi degridratatsii ephilayo isiphumo womchamo, imithambo zezifo zengqondo kunye nezintso. Lokusweleka ngenxa isiqaqa hyperosmolar efika kwinqanaba ka-30%.

izizathu

isiqaqa Hyperosmolar, nto leyo ebangela enxulumene kwinqanaba glucose, kukho ingxaki seswekile kwaye kwesiphumo ukunyuka elibukhali kwi iswekile egazini (ngaphezu kwe-55.5 mmol / l) xa zidityaniswe ne hyperosmotic kunye nokungabikho acetone egazini.

Izizathu zale meko zezi:

• emzimbeni ebukhali kukhokelela ukugabha enogonyamelo, urhudo, ukutsha okanye ngexesha unyango elide ngokusebenzisa amayeza umchamo;
• intswelo okanye kukunqongophala okupheleleyo insulin, zombini zemveli kunye angaphandle (isizathu le nto isenokuba ukunqongophala kwencindi okanye irejimeni yonyango engafanelekanga);
• ukwanda kwemfuno insulin, nto leyo inokubangelwa ukuphazamiseka gross ukudla, ulawulo ngokwendawo amalungiselelo iswekile, kwezifo ezosulelayo (ingakumbi inyumoniya kunye ezasulelayo izitshanguba womchamo) emva kotyando, ukwenzakala, amayeza, banayo iimpawu abamelene insulin ( e iihomoni ezithile kunye amalungiselelo glyukokorstikoidov).

Pathogenesis

Ngelishwa, indlela yophuhliso karhulumente sifo ayiqondwa ngokupheleleyo. Kukholelwa ukuba uphuhliso kule ingxaki kuchaphazela glucose ukukhululwa izintso kwafa kunye nokunyusa inani weli emzimbeni kunye nophuhliso isibindi sakhe. Xa le mveliso bacinezelwa insulin, kwakunye Ukuthintela ukusetyenziswa glucose yi kwizihlunu zomzimba. Oku konke kuhlanganiswe emzimbeni.

Ukongeza, kukholelwa ukuba ubukho kwi zemveli zabantu (amiliswe ngaphakathi emzimbeni) insulin abangaphangeliyo iinkqubo ezifana lipolysis (ucazululo amanqatha) kunye ketogenesis (ukuyilwa iiseli lwegciwane). Noko ke, le insulin ayilingene ukucinezela isixa iglukhozi yenziweyo sisibindi. Ngoko ke zolawulo eziyimfuneko insulin angaphandle.

Ukuba waphulukana ngokukhawuleza kolwelo ngesixa-mali esikhulu kunciphisa BCC (umthamo wegazi), nto leyo ekhokelela ukuqina egazini kwaye kwandiswe osmolarity. Oku kwenzeka kungenxa yokwanda xi glucose, potassium kunye sodium ion.

iimpawu

isiqaqa Hyperosmolar sikhula, iimpawu ezivelayo kwangaphambili iintsuku ezimbalwa okanye iiveki. Kulo mzekelo, isigulana ezikhula imiqondiso ukuba uphawu seswekile decompensated (amaqondo eswekile yegazi ayikwazi kuhlengahlengiswa neziyobisi):

• polyuria (ukwanda umchamo Ukwakheka);
• ukwanda ome;
• ukwanda kome kakhulu eluswini, inwebu yangaphakathi;
• ngequbuliso komzimba;
• ubuthakathaka njalo;
• Kuyinto yoko eqhelekileyo emzimbeni yempilo: ukunciphisa nethoni yelo ulusu, amehlo, uxinzelelo lwegazi kunye neqondo lobushushu.

iimpawu lwezempilo

Ukongezelela, iimpawu ukuze ilandelwe luvo:

• ukuba nemibono;
• hemiparesis (buthathaka iintshukumo ngokuzithandela);
• ukuphazamiseka intetho, usibeka slurred;
• zesifo ziqhu;
• areflexia (ikhaliphe engekho omnye okanye ngaphezulu) okanye giperlefksiya (ukwandisa ingqondo);
• uhlobo imisipha;
• ukwazi kakuhle.

Iimpawu kuvela kwiintsuku nje ezimbalwa ngaphambi kokuba baqale ukuphuhlisa isiqaqa hyperosmolar ebantwaneni okanye abadala.

iingxaki kunokwenzeka

Kwimeko uncedo ngesiquphe basenokuba iingxaki. Common zezi:

• ukuxhuzula, enokuthi ikhatshwe twitching Neenkophe, ubuso (ezi mpawu inokuba engabonakaliyo kwabanye);
• thrombosis ndlela obukhulu;
• pancreatitis (ukukrala kwe-pancreas);
• insufficiency kwezintso.

Utshintsho kwakhona kwenzeka phecana zesisu, ezibonakala ukugabha, ukuqumba, iintlungu esiswini, ukuphazamiseka motility wamathumbu (ngamanye amaxesha kukho emathunjini), kodwa babe phantse unnoticeable.

Kwakhona, kukho ukuphazamiseka vestibular.

ekuxilongweni

Ukuba urhanela isifo isiqaqa hyperosmolar, uxilongo isekelwe iimvavanyo elebhu. Ngokukodwa, uphando lubonise amazinga aphezulu igazi glucose osmolarity. Ukongeza, amanqanaba kunokwenzeka ephakamileyo sodium, isiqulatho eliphezulu zizonke protein serum kunye nitrogen eyintsalela. kwinqanaba urea nako zandiswe. Kuphando kwemizimba umchamo ketone (acetone, acetoacetic acid kunye betaoksimaslyanaya) yini uzimisele.

Ngaphezu koko, akukho ivumba acetone umoya okhutshwa ngumntu kumguli ketoacidosis (ukuphazamiseka carbohydrate metabolism) apho endawathetha giperoglikemiey negazi osmolarity. Isigulana langoku yoluvo iimpawu, ezifana okungaqhelekanga Babinski (Baleka ulwandiso reflex), awongezelelekileyo izihlunu ithoni, luceliwe nystagmus (vukele oscillatory intshukumo yamehlo).

ume phakathi kwezinye zophando:

• Ultrasound kunye noviwo X-ray zepancreas;
• electrocardiography;
• ukulinganisa izinga glucose egazini.

Okubaluleke kakhulu uxilongo umahluko. Oku kungenxa yokuba gipersmolyarnaya isiqaqa isenokuba isiphumo kuphela seswekile kodwa kwaye hepatic sezintso insufficiency kwisifundo abafumana womchamo thiazide.

unyango

Ukuba unesifo isiqaqa hyperosmolar, ukhathalelo olungxamisekileyo kukuba ukuphelisa degidrotatsii, hypovolemia abuyisele plasma osmolarity.

Ukuba kuliwe ukuxovwa komzimba usebenzisa isisombululo hypotonic sodium chloride. Igalelo elivela iilitha ezi-6 ukuya kwezili-10 ngosuku. Ukuba kuyimfuneko isixa ukunyuka isisombululo. Kwisithuba iiyure ezimbini emva kokuqala imeko zophendlo lwezifo kwafuneka ukuba aveze iilitha ezi-2 sodium chloride isisombululo i.v., kulandele intshayelelo zamathontsana ipasisa ngesantya 1 l / h. Amanyathelo athathiweyo ukuze ukuzinza osmolarity kunye noxinzelelo lwegazi nasezimpahleni lwemithambo. A uphawu emzimbeni kukuba ukuphelisa imbonakalo sezingqondweni yesigulane.

Ukuba unesifo isiqaqa hyperosmolar, unyango ufuna giperoglikemii unciphiso. Ukulungiselela le njongo, intramuscularly kwaye yegazi alawulwa insulin. Kufuneka ukuphumeza ulawulo olungqongqo lwe uyondelelwano lwee- iswekile egazini. Ithamo lokuqala iiyunithi-50, nto leyo yahlulwe kubini kwaye eyaziswa emzimbeni ngeendlela ezahlukeneyo. Kwimeko indlela yolawulo hypotension yegazi kuphela. insulin Enye elawulwa-mali ofanayo ngedriphu efakwa kunye intramuscular. La manyathelo yenziwa de inqanaba glucose 14 mmol / l.

Scheme ulawulo kwencindi inokuba nomahluko:

• 20 IU intramuscularly kanye kuphela;
• 5-8 U yonke imizuzu engama-60.

Xa kunokwenzeka ukuba inqanaba iswekile lehla laya 13,88 mmol / l, isisombululo hypotonic sodium chloride kuyimfuneko ukuba indawo isisombululo iswekile yegazi.

Ngexesha unyango isiqaqa hyperosmolar kufuna esweni rhoqo potassium igazi, ukususela ukususwa imeko zophendlo lwezifo kufuna kulawulo potassium chloride.

Ngenjongo yokuthintela nokudumba ingqondo ezibangelwa izigulane hypoxia butofelwe ilawulwa glutamic acid isixa ml-50. Kwakhona ufumana lweeHedfowuni iyafuneka, kuba nengozi ukunyuka thrombosis kakhulu. Oku kufuna ulawulo lwe igazi ekunqandeni.

Njengomgaqo, angabikho zingqondweni hyperosmolar ikhula izigulane abanenqanaba wobulali okanye ngcathu seswekile, ngoko ngokukhuselekileyo ukuba umzimba Uyabubona insulin kakuhle. Ngoko ke, kucetyiswa ukuba bafake ngeedosi ezincinane ichiza.

Profilatika ukungaphili

Ekuthinteleni iimfuno, kwakunye nenkqubo sentliziyo, oko kukuthi, yokuthintela isifo sentliziyo. Nale njongo i "Kordiamin", "Strofantin", "Korglikon". Phantsi koxinzelelo kwanciphisa leyo kwinqanaba rhoqo, kucetyiswa ulawulo Grand isisombululo, kwaye efakwa plasma gemodeza, albumin abantu kunye negazi lonke.

Silumkele ...

Ukuba unesifo seswekile kufuneka rhoqo Kwathi sihlolwe kwi endocrinologist kwaye ukuzalisekisa zonke iimfuno zawo, ngakumbi, ukulawula iswekile yegazi. Oku kuya ukuphepha iingxaki zesi sifo.