Glycemic coma: txim thiab cov tsos mob

Thaum ib qho kev ua txhaum tshwm sim hauv cov metabolism, cov kev mob tshwm sim, nrog ntau tus cwj pwm tsis zoo. Lawv qhov kev ncua tsis dhau qee zaus kuj ua rau muaj kev tuag.

Cov teeb meem zoo li no tseem tuaj yeem tshwm sim nrog kev ua tsis tiav ntawm cov metabolism hauv cov metabolism, uas tshwm sim thaum lub sijhawm muaj ntshav qab zib. Feem ntau nrog cov kab mob zoo li no, cov piam thaj ntau hauv lub cev, uas ua rau cov tsos mob ntawm hyperglycemia. Tus mob no yog yam ntxwv mob ntshav qab zib hom 2.

Thiab nyob rau hauv cov neeg mob insulin, kev tiv thaiv ntshav qab zib feem ntau tshwm sim, uas cov ntsiab lus ntawm cov piam thaj hauv lub qog ua rau tsawg. Yog tias cov piam thaj hauv lub cev tsis zoo li qub hauv lub sijhawm, tom qab ntawv lub ntsej muag hypoglycemic yuav pib - qhov mob uas tshwm sim thaum cov ntsiab lus tsis tshua muaj carbohydrate nce mus txog qib siab.

Kev phom sij ntawm qhov kev cuam tshuam no yog qhov nws tuaj yeem ua rau mob puas hlwb, suav nrog dementia. Hauv kev muaj mob pheej hmoo ntau dua yog cov neeg mob uas muaj mob tsis txaus nyob hauv cov hlab plawv, nyob rau hauv cov ntshav qab zib tsawg tuaj yeem ua rau mob stroke, retinal hemorrhage thiab myocardium. Yog li, nws yog ib qho tseem ceeb kom paub txog dab tsi glycemic coma thiab hyperglycemia yog, thiab yuav ua li cas kom sai rau cov mob no.

Kev Mob Ntshav Qab Zib coma

Feem ntau glycemic coma tshwm sim yog tias qhov koob tshuaj ntawm insulin tsis raug. Tsis tas li, qhov ua rau ua rau lub ntsej muag tsis zoo nyob rau hauv kev noj qab haus huv ntawm tus mob ntshav qab zib tuaj yeem dag nyob rau hauv kev noj tsis haum ntawm sulfonylurea thiab kev tsim txom cov zaub mov carbohydrate.

Feem ntau muaj ntshav qab zib thiab hypoglycemic coma, txhim kho nyob rau hauv cov neeg mob insulin-tiv thaiv cov kab mob ntshav qab zib tsis ruaj khov. Ntxiv mus, hauv qhov no, nws tsis yooj yim sua kom ntes ib qho txiaj ntsig sab nraud ntawm qhov nce siab hauv rhiab heev rau insulin.

Hauv lwm qhov xwm txheej, ua rau tsis zoo rau los vim yog:

1. intoxication ntawm lub cev,
2. kev siv dag zog kom tawm dag zog,
3. kev yoo mov.

Lwm yam hauv qab yog qhov muaj feem cuam nrog ntshav qab zib. Cov no suav nrog kev ua haujlwm tsis zoo ntawm cov hnyuv, raum, mob siab thiab endocrine.

Tab sis feem ntau, hypoglycemia tshwm sim thaum ntau npaum li cas ntawm cov tshuaj insulin tau raug overestimated. Qhov no tshwm sim thaum cov tshuaj tau txiav txim siab tsis raug lossis yog tias nws raug tswj tsis raug (intramuscularly).

Tsis tas li ntawd, qhov kev poob zoo hauv cov piam thaj tuaj yeem ua rau muaj kev cuam tshuam los ntawm kev noj zaub mov uas tsis muaj carbohydrate ntau tom qab kev siv tshuaj insulin tsawg. Lwm qhov laj thawj yog kev qoj ib ce tsis tas siv ntxiv ntawm cov zaub mov sai sai.

Tsis tas li ntawd, qee qhov mob ntshav qab zib, txhawm rau txhawm rau ua kom sai ntawm cov kua dej, ua rau cov qhov chaw txhaj tshuaj ntawm cov tshuaj hormones, uas feem ntau ua rau muaj kev sib txuam ntau dhau. Lub cev zom zaws glycemic tuaj yeem tsim kho hauv cov xwm txheej zoo li no:

• haus cawv kom tsawg
• cev xeeb tub thaum ntxov
• kev sib tawg ntawm cov insulin-antibody complex, uas ua rau muaj kev tso tawm ntawm cov tshuaj nquag,
• daim siab ua rog,
• insulin poob siab siv hauv kev xav,
• yus tua yus thiab ntau dua.

Tsis tas li, hypoglycemia tuaj yeem txhim kho nrog kev siv tshuaj ntau dhau, thaum mob ntshav qab zib tau muab tshem tawm ntawm ketoacidotic coma. Tus mob no tshwm sim nrog lub cev tsis muaj tshuaj txaus.

Yog li, ib qho tsis txaus ntseeg cov ntshav qab zib tau sau yog tias cov suab thaj ua rau muaj zog thiab tawg glycogen los ntawm cov khoom uas tsis yog carbohydrate hauv lub siab tsis them nyiaj rau qhov feem ntawm cov piam thaj. Lub ntsej muag mob ntshav qab zib kuj tseem yuav tshwm sim thaum cov kua nplaum tawm ntawm lub qog sai dua li nws tau tso cai los ntawm lub siab los yog nqus tau cov hnyuv.

Nws yog qhov tseem ceeb tshaj plaws tias sulfonamides feem ntau tsis ua rau kev mob ntshav qab zib. Feem ntau tom qab noj cov tshuaj no, nws tshwm rau cov neeg laus ntshav qab zib uas muaj mob plawv, raum, lossis mob siab.

Tsis tas li ntawd, kev siv sulfonamides nrog rau lwm cov tshuaj (salicylates, acetylsalicylic acid) yuav ua rau muaj qhov rov qab nco qab.

Qhov kev sib xyaw no ua rau qhov tseeb tias cov plasma protein khi sulfanilamides, lawv cov zis hauv lub cev tso tawm tsawg, vim tias cov kev mob siab rau tsim rau cov tsos ntawm kev tsis pom kev tsis haum.

Symptomatology

Cov tsos mob ntawm ntau hom mob ntshav qab zib tsis zoo yog lawv zoo sib xws. Yog li, nws muaj peev xwm ua tau kom paub tseeb nws cov hom nrog kev pab ntawm kev kuaj mob thiab kuaj ntshav kuaj. Qhov pib tshwm sim muaj xws li:

1. suab nrov thiab kiv taub hau nyob hauv ntshav qab zib,
2. nqhis dej heev
3. ntuav thiab xeev siab
4. malaise
5. tsis qab los noj mov
6. tsis nco qab
7. nquag tso zis
8. tsaug zog
9. leeg leeg leeg.

Lub cev tsis meej pem hauv ntshav qab zib yog tshwm sim los ntawm qhov tsis nco qab, tus neeg tsis muaj qhov fab rau stimuli thiab tsis nco qab txog qhov tshwm sim.

Cov duab kho mob nrog hypoglycemic coma yog txawv me ntsis ntawm ketoacidotic thiab hyperglycemic cov tshuaj tiv thaiv. Muaj 4 theem ntawm cov ntshav qab zib tsawg, uas suav nrog kev ua kom lub qog ua kom poob mus rau hauv lub cev tsis tsaug zog.

Thaum pib theem, hypoxia ntawm lub hauv nruab nrab lub paj hlwb cov hlwb, suav nrog cerebral cortex, tshwm sim. Raws li qhov tshwm sim, tus neeg mob dhau los ua siab dhau lossis nyuaj siab thiab nws txoj kev xav pauv. Nqaij tsis muaj zog, mob taub hau, tachycardia, tshaib plab thiab hyperhidrosis kuj tshwm sim.

Hauv theem ob ntawm kev txo qis qabzib nyob hauv cov qog ntshav, tawm hws ntau, diplopia, lub cev muaj zog thiab hyperemia ntawm lub ntsej muag tau sau tseg. Tsis tas li, tus neeg mob pib luj nws tus kheej tsis txaus.

Hauv theem peb, kev ua haujlwm tsis zoo ntawm lub cev ntaj ntsug ua rau txhawm rau txhawm rau nce cov leeg nqaij thiab qhov pom ntawm qaug dab peg. Tib lub sijhawm, tachycardia, tawm hws thiab mob ntshav siab ntxiv. Tus neeg mob cov tub ntxhais kawm tau mob ntaug tas, thiab nws cov mob uas zoo ib yam yog muaj qhov qaug dab peg.

Qeb plaub yog thaum lub siab tsis nco qab, uas nrog los ntawm kev ua haujlwm tsis zoo ntawm lub paj hlwb sab saud. Nws soj ntsuam ces:

• lub plawv dhia
• tsis nco qab
• tachycardia
• hws
• dilated cov tub ntxhais kawm
• nce me ntsis hauv lub cev kub,
• kev ua kom rov qab ntawm cov leeg thiab periosteal reflexes.

Kev tsis ua dab tsi hauv txoj kev tsis nco qab tuaj yeem ua rau tuag taus vim yog mob hlwb. Nws cov tsos mob yog lub siab lub ntsws cuam tshuam nrog, qhov kub thiab txias, ntuav, ua pa luv thiab muaj cov tsos mob ntawm cov leeg.

Kev mob ntshav qab zib tuaj yeem pab txhawb kev txhim kho ntawm lub sijhawm ntev thiab tam sim no. Cov teeb meem niaj hnub no hauv thawj ob peb teev tom qab txo cov suab thaj. Qhov no yog ua pov thawj los ntawm myocardial infarction, aphasia, malfunctions nyob rau hauv lub hlwb ncig.

Thiab cov teeb meem ncua ntev yuav tshwm sim tom qab 2-3 hnub lossis txawm tias ntau lub hlis. Cov no suav nrog kev tuaj yeem kho mob vwm, mob hlwb, thiab mob encephalopathy.

Kev kuaj mob thiab cov khoom pabcuam thib ib

Txhawm rau kuaj xyuas txhua yam tsis nco qab nyob rau hauv ntshav qab zib mellitus, ntxiv rau muaj cov tsos mob tshwm sim thiab kuaj mob, kev kuaj mob hauv chav kuaj yog qhov tsim nyog. Rau lub hom phiaj no, ntshav thiab zis yog tau los ntawm tus neeg mob rau kev tshuaj ntsuam thiab biochemical tsom, thiab kev kuaj ntshav qabzib kuj tseem ua.

Feem ntau cov neeg nyob tsis hnov ​​qab yog yam ntxwv ntawm cov piam thaj hauv ntshav (ntau dua 33 mmol / l) thiab hauv cov zis. Nrog ketoacidosis, ketone raug kuaj pom nyob rau hauv cov zis, nyob rau hauv cov ntaub ntawv ntawm hyperosmolar coma, qhov nce ntshav plasma osmolarity (ntau dua 350 mosm / l) yog sau tseg, nrog hyperlactacidemia ib qho dhau ntawm lactic acid tau kuaj pom.

Tab sis kev ntsuam xyuas cov ntshav qog ntshav yuav qhia tau qhov kev poob zoo ntawm cov ntshav qab zib hauv cov ntshav. Hauv cov mob no, cov kua nplaum ntawm cov piam thaj muaj tsawg dua 1.5 mmol ib lim.

Txhawm rau tiv thaiv lub ntsej muag glycemic los ntawm kev vam meej, cov mob ntshav qab zib xav tau sijhawm thiab tsim nyog thawj cov kev pabcuam hauv kev tsis nco qab. Nws suav nrog tus lej ntawm cov yeeb yam hauv qab no:

1. Tsheb tos neeg mob hu.
2. Tus neeg mob yuav tsum pw ntawm nws ib sab kom nws tsis ua rau nws ua tsis taus pa.
3. Yog tias tsim nyog, tshem cov zaub mov khib nyiab tawm ntawm lub qhov ncauj.
4. Yog tias ua tau, tom qab ntawd siv cov kua nplaum ntsuas qhov theem ntawm cov piam thaj.
5. Yog hais tias tus neeg mob yog nqhis dej, koj yuav tsum haus nws.
6. Kev txhaj tshuaj insulin tsis muaj ntshav kuaj yog txwv tsis pub.

Yog tias nws ntseeg tau paub tias yog vim li cas rau kev txhim kho kev tsis nco qab nyob hauv cov piam thaj hauv qab zib, ces tus neeg mob yuav tsum haus dej qab zib lossis dej qab zib heev. Nws yog qhov zoo dua rau haus tus neeg mob nrog diav.

Qab zib, tshwj xeeb tshaj yog nqus cov khoom qab zib, cov ntshav qab zib tsis tau qhia. Tom qab tag nrho, cov zaub mov tawv yuav tau nqus ntev dua li ntawm cov tshuaj ua kua. Ntxiv mus, thaum lub sij hawm nqus ntawm carbohydrates nyob rau hauv daim ntawv no, ib tug neeg muaj peev xwm txhawm chim ntawm nws lossis tsis nco qab.

Tab sis yog tias tus neeg mob nyob hauv lub xeev tsis nco qab lawm, ces koj yuav tsum tsis txhob muab tshuaj qab zib rau nws. Tom qab tag nrho, cov kua tuaj yeem nkag mus rau hauv qhov chaw ua pa, uas yog vim li cas nws txhawm chim.

Nyob rau hauv muaj cov glucagonate, ib tus neeg nyob rau hauv lub qog hypoglycemic yog muab 1 ml ntawm cov tshuaj ua ke lossis subcutaneously.

Kev khomob thiab kev tiv thaiv

Cov neeg mob uas muaj mob ntshav qab zib tsis tsaug zog yog yuav tsum tau pw hauv tsev kho mob ceev hauv chav saib xyuas mob nyhav. Kev kuaj mob, tshuaj insulin (tsis pub ntau tshaj 10-20 units) yog muab rau cov ntshav qab zib ua ntej kev thauj mus los. Cov kev kho mob seem uas yog kho nyob hauv tsev kho mob.

Yog tias qhov ua rau tsis nco qab yog qhov tsis muaj cov piam thaj, tom qab ntawv 20-100 ml ntawm cov kua nplaum (40%) tau txhaj tshuaj rau tus neeg mob. Thaum muaj mob hnyav, pom lossis iv glucocorticoids lossis glucagon pom. Tsis tas li, nyob rau hauv daim tawv nqaij, koj tuaj yeem nkag mus daws qhov tshuaj adrenaline (0.1%) hauv ib qho nyiaj ntawm 1 ml.

Txhawm rau tiv thaiv kev txhim kho ntawm cov dej intoxication, tus neeg mob tau kho cov kua qab zib hauv sodium chloride. Nrog rau qhov rov qab zoo li qub, Mannitol siv.

Kev kho mob tsis yog maj nrawm yog los ntawm kev ua ntawm cov metabolism hauv cov piam thaj. Rau lub hom phiaj no, tus neeg mob tau qhia nyob rau hauv / m kev tswj hwm ntawm Cocarboxylase (100 mg) thiab ib qho kev daws teeb meem ntawm ascorbic acid (5 ml). Tsis tas li ntawd, tus neeg mob tau muab cov pa oxygen thiab cov tshuaj siv uas pab rau kev ua haujlwm ntawm cov hlab plawv.

Nws tsim nyog sau cia tias nrog hypoglycemic coma, cov tshuaj insulin tuaj yeem siv tsis tau. Vim tias nws yuav tsuas yog zam dhau qhov nyuaj, uas tuaj yeem ua rau tuag.

Txawm li cas los xij, yog tias tus mob ntshav qab zib tau kuaj pom tias muaj tus kab mob hyperglycemia, tom qab ntawd, ntawm qhov tsis sib xws, nws tau qhia tshuaj insulin rau hauv kev txhaj tshuaj ntau dua. Ntxiv rau, sodium bicarbonate thiab NaCl yog tswj hwm tus neeg mob.

Lub sijhawm mob ntshav qab zib tsis nco qab, muaj teeb meem tshwm sim nrog cov hlab ntsha, lub plawv thiab ntu ncig, uas ua rau kom qeeb ntawm kev nqus ntawm cov tshuaj los ntawm cov nqaij mos subcutaneous. Yog li, thawj feem ntawm cov koob tshuaj insulin raug txhaj rau cov leeg ntshav.

Cov neeg mob ntshav qab zib muaj kev pheej hmoo mob hlab ntsha tsis txaus. Los ntawm qhov no nws ua raws li lawv tuaj yeem ua haujlwm tsis pub dhau 100 PIECES ntawm insulin. Tsis tas li, qhov koob tshuaj ntawm lub cev lawm txo los ntawm ib nrab yog tias tus neeg mob nyob hauv precom.

Kev tiv thaiv ntawm glycemic coma yog:

• muab mus rau qhov tsis zoo,
• txoj kev ua raws cai txhua hnub
• tswj ntshav qabzib concentration,
• Kev kho kev noj haus, nrog kom tsawg ntawm cov carbohydrates ceev.

Ntxiv mus, tus neeg mob yuav tsum nquag noj cov nyiaj uas txo cov piam thaj hauv qhov ntau npaum li kws kho mob tau sau tseg. Nws kuj yuav tsum kawm txog cov tsos mob ntawm tus mob ntshav qab zib tsis xeev (coma) thiab, thaum muaj ntshav qab zib tsawg, muaj cov zom zaub mov sai nrog nws.

Yog hais tias tus mob ntshav qab zib yog nquag ua rau txo cov ntshav qab zib hauv cov ntshav qab zib, tom qab ntawd cov ntshav qabzib feem ntau yuav nce ntxiv mus txog 10 mmol / L. Qhov dhau heev no yog qhov ua tiav ntawm qhov ua tsis tiav hauv lub hlwb thiab cov kev tiv thaiv tsis txaus.

Thaum noj ntau yam tshuaj (tetracyclines, anticoagulants, salicylates, beta-blockers, tshuaj tiv thaiv tuberculosis), nws yog ib qho tseem ceeb uas yuav tau ua tib zoo saib xyuas cov ntshav qab zib. Tom qab tag nrho, cov tshuaj no ua rau tsim cov tshuaj insulin thiab muaj cov nyhuv hypoglycemic.

Txhawm rau tiv thaiv glycemic coma, cov zaub mov noj txhua hnub yuav tsum muaj protein (50%), cov carbohydrates nyuaj thiab cov rog. Ntxiv mus, cov zaub mov fractional (8 zaug hauv ib hnub) nrog kev zam ntawm cov ntsim ntsim, muaj kas fes thiab tshuaj yej muaj kev pom zoo. Nws yog ib qho tseem ceeb rau kev tso quav cawv thiab luam yeeb.

Hauv qhov yeeb yaj kiab hauv tsab xov xwm no, kws kho mob yuav piav qhia txhua yam ntawm kev mob ntshav qab zib tsis xeev thiab muab lus qhia rau cov neeg pab ua ntej.