Ikhoma Hyperosmolar: izimbangela, izimpawu, uphethwe, ukuphathwa

ikhoma Hyperosmolar ngokuvamile kutholakala iziguli abaneminyaka engama 50 abaphethwe isifo sikashukela imnene degree ngokulinganisela, kalula kwavuzwa olukhethekile lokudla kanye nemithi. Utfutfukisa ngokumelene ngemuva umzimba degridratatsii okuholela isisu, izifo semithambo yobuchopho nezinso. Nokufa kusukela ikhoma hyperosmolar ifinyelela 30% ezingeni.

izizathu

ikhoma Hyperosmolar, elibangela okuhlobene ezingeni glucose, a ubunzima sikashukela futhi umphumela ukwanda kokutheleleka kudlange kakhulu izinga likashukela egazini (ngaphezu kuka-55,5 mmol / l) lihambisana hyperosmotic futhi ukungabi khona acetone egazini.

Izizathu zalokhu mkhuba yilezi:

• amanzi emzimbeni abukhali okuholela enobudlova ukuhlanza, ukukhishwa isisu, ukusha noma ngesikhatsi ukwelashwa isikhathi eside ngokusebenzisa imithi isisu;
• ukuntula noma ukungabakhathaleli nhlobo insulin, kokubili endogenous futhi exogenous (isizathu lesi simanga kungase kube ukuntuleka kwe-insulini noma okungafanele ukwelashwa lwemithi);
• anda ukufunwa insulini, okungaveza kusukela thuthuva okwedlulele Ukudla, abaphathi bagxila amalungiselelo glucose, izifo ezithathelwanayo (ikakhulukazi inyumoniya futhi ezithathelwanayo pheshana urinary izilonda) ngemuva kokuhlinzwa, ukulimala, imithi, ezithinta izakhiwo insulin abamelene ( e-hormone ethile futhi glyukokorstikoidov amalungiselelo).

pathogenesis

Ngeshwa, indlela yentuthuko esifweni bengayiqondi ngokugcwele. Kukholakala ukuthi ukuthuthukiswa lokhu inkinga kuthinta ukuvinjelwa glucose ukukhululwa izinso, anda ukulethwa ketshezi emzimbeni futhi ukukhiqizwa yayo nge kwesibindi. Uma lokhu okuphumayo is bebengaphuzile ngu-insulin, kanye ekuvimbeni ukusetshenziswa glucose by kwezicubu neuropathy. Lokhu konke kuhlangene amanzi emzimbeni.

Ngaphezu kwalokho, kuthiwa lokhu khona kule endogenous womuntu (kwakheka ngaphakathi emzimbeni) insulini kuvimbela izinqubo ezifana lipolysis (ukuhlukaniswa amafutha) kanye ketogenesis (kumiswa germ cells). Nokho, lokhu insulini alanele ukucindezela lemali glucose okuyinto kuveza esibindini. Ngakho-ke akuyona ekuphathweni kudingekile insulin exogenous.

Uma ukulahlekelwa okusheshayo uketshezi esiningi kunciphisa bcc (igazi ivolumu), okuholela ukuqina igazi futhi sandise osmolarity. Lokhu kwenzeka kungenxa ukwanda lokuhlushwa glucose, i-potassium ne-sodium ion.

izimpawu

ikhoma Hyperosmolar eba, izimpawu ezivela kusengaphambili izinsuku ezimbalwa noma amasonto. Kulokhu, isiguli ezikhulayo izimpawu ukuthi kukhona isici sikashukela decompensated (amazinga kashukela egazini ayikwazi kushintshwe izidakamizwa):

• polyuria (kwenyuke umchamo kumiswa);
• anda ukoma;
• ukoma okwandisiwe isikhumba, nolwelwesi lwamafinyila;
• okungazelelwe kwesisindo;
• ubuthakathaka njalo;
• Kuyinto buwumphumela ovamile amanzi emzimbeni ukuwohloka kwempilo: ukunciphisa tone yesikhumba, izinhlamvu zamehlo, umfutho wegazi futhi lokushisa.

izimpawu zokungasebenzi kahle kwemizwa

Ngaphezu kwalokho, kungenzeka izimpawu ebonwe isimiso sezinzwa:

• ukusangana;
• hemiparesis (buthakathaka ukunyakaza yokuzithandela);
• inkulumo neziyaluyalu, it is wafaka egwinya;
• ukuquleka eziphikelelayo;
• areflexia (ikhaliphe ukungabi eyodwa noma ngaphezulu) noma giperlefksiya (ukwandisa ikhaliphe);
• imisipha uhlobo;
• ukwazi kahle.

Izimpawu avele izinsuku ezimbalwa ngaphambi izoqala ukuthuthukisa ikhoma hyperosmolar ezinganeni noma abadala.

yezinkinga kungenzeka

Uma kwenzeka usizo kungakabi yisikhathi angagcina ukuxakeka. Ezivamile yilezi:

• ukuquleka, okuyinto kungase kuhambisane ukunyakazisa amajwabu amehlo, ubuso (lezi zimpawu zingase zibe engabonakali kwabanye);
• deep vein thrombosis;
• pancreatitis (ukuvuvukala kwamanyikwe);
• esingamahlalakhona kwezinso.

Izinguquko zenzeka pheshana emathunjini, abonakala ukuhlanza, ukuvuvukala, ubuhlungu besisu, motility emathunjini iziyaluyalu (ngezinye izikhathi kukhona isimiso emathunjini), kodwa zingase zibe cishe unnoticeable.

Futhi, kukhona iziyaluyalu vestibular.

ukuhlola

Uma usola ekuxilongelweni ikhoma hyperosmolar, uphethwe kusekelwe ukuhlolwa laboratory. Ikakhulu, i-Uphenyo luveze komfutho namazinga kashukela egazini futhi osmolarity. Ngaphezu kwalokho, kungenzeka amazinga aphakeme sodium, wokuqukethwe lelisetulu Imininingwane serum protein ne -nitrogen asalile. urea ezingeni kungabuye anda. Esikhathini ukuphenywa kokuphulwa umchamo ketone emizimbeni (acetone, acetoacetic acid betaoksimaslyanaya) ke akunqunywa.

Ngaphezu kwalokho, akukho iphunga acetone emoyeni iyaphuma yisiguli futhi ketoacidosis (ukuphazamiseka carbohydrate umzimba) engiwakhulume giperoglikemiey negazi osmolarity. Isiguli izimpawu samanje esithinta izinzwa, ezifana okungavamile Babinski (Jog isandiso reflex), kukhuphuke imisipha ithoni, nystagmus zamazwe amabili (okungalindelekile oscillatory ukunyakaza kwamehlo).

ivelele phakathi kwezinye survey:

• Ultrasound futhi-X-ray luhlolo kwamanyikwe;
• electrocardiography;
• sokunquma ezingeni glucose egazini.

Okubaluleke kakhulu kuba uphethwe umehluko. Lokhu kungenxa yokuthi gipersmolyarnaya ikhoma Ungase ube yini umphumela sikashukela nje kuphela kodwa futhi futhi hepatic kwezinso esingamahlalakhona kuncike kokuthola isisu thiazide.

ukwelashwa

Uma sisheshe ikhoma hyperosmolar, ukunakekelwa okuphuthumayo ukushabalalisa degidrotatsii, hypovolemia futhi ubuyisele plasma osmolarity.

Ukuze ulwe hydration umzimba esetshenziswa isixazululo hypotonic of sodium chloride. Wokufaka kusukela amalitha ngosuku 6 kuya ku-10. Uma lemali edingekile ukwanda isixazululo. Ebangeni elingamahora amabili usuka lapho kuqala isimo sokugembula edingekayo ukwethula 2 amalitha sodium chloride isixazululo i.v., kulandele isingeniso amaconsi sihamba ngesilinganiso 1 l / h. Izinyathelo wenyuselwa ukuzinza osmolarity nomfutho wegazi izitsha emithambo yegazi. A uphawu amanzi emzimbeni ukushabalalisa ukubukeka ukwazi lesiguli.

Uma sisheshe ikhoma hyperosmolar, impatho kudinga giperoglikemii ukunciphisa. Ngenxa yale njongo, intramuscularly futhi ngemithambo yegazi iqondiswa insulini. It liyadingeka ukuze afeze control esiqinile ushukela egazini okuhlushwa. Umthamo sokuqala amayunithi 50, okuyinto uhlukaniswa uba nengxenye futhi busuka umzimba ngezindlela ezahlukene. Endabeni hypotension ekuphathweni indlela ngemithambo yegazi kuphela. insulini Eminye yaphathwa esilinganayo ukuvuza emthanjeni futhi esicutshini. Lezi zinyathelo abazenzi kuze ezingeni glucose 14 mmol / l.

Isikimu yokuphathwa insulin zingahluka:

• 20 IU intramuscularly kanye kuphela;
• 5-8 U njalo ngemva kwemizuzu engu-60.

Esimweni ukuthi izinga likashukela lehla 13,88 mmol / l, isixazululo hypotonic of sodium chloride ezidingekayo esikhundleni isixazululo glucose.

Phakathi ukwelashwa ikhoma hyperosmolar kudinga nokuqapha njalo igazi potassium, kusukela ukususwa isimo sokugembula kudinga esasikhipha potassium chloride.

Ngenjongo nokuvinjelwa ubuchopho edema okubangelwa iziguli hypoxia ngemithambo yegazi iqondiswa glutamic acid isamba 50 ml. Futhi heparin ethola liyadingeka, ngoba ingozi thrombosis inyuka kakhulu. Lokhu kudinga ukulawula igazi ekunqandeni.

Njengomthetho, ikhoma hyperosmolar eba in iziguli esiteji okuncane noma okusesilinganisweni sikashukela, ukuze sikwazi ngokuphepha bathi umzimba Uyabubona insulini kahle. Ngakho-ke, kutuswa ukuba bafake ngemithamo emincane zomuthi.

yezinkinga Profilatika

Esikhathini nokuvimbela izidingo, futhi yisimiso senhliziyo nemithambo yegazi, okungukuthi, nokuvimbela isifo senhliziyo. Nge le njongo a "Kordiamin", "Strofantin", "Korglikon". Zacindezelwa encishisiwe okuyinto ezingeni njalo, kutuswa ekuphathweni Dox isixazululo, futhi emthanjeni plasma gemodeza, albumin nangegazi labantu lonke.

Qhubeka ufuna ...

Uma une sitholakele isifo sikashukela kufanele njalo baphumelele ekuhlolweni ngesikhathi endocrinology futhi ukufeza zonke izidingo zawo, ikakhulukazi, ukulawula izinga likashukela egazini. Lokhu kuzogwema yezinkinga sifo.