ʻO 10 mau makahiki i hala aku nei, ua manaʻo nui ʻia ka pale kūʻokoʻa o ka insulin a ma ke ʻano he pilikia o ka poʻe kahiko.
I kēia manawa he nui nā maʻi lapaʻau e pili ana i ka maʻi ʻana o kēia pathology i nā keiki a me nā ʻōpio.
No nā haumāna o nā kula olakino kekahi papa inoa o nā kumuhana e hana ai lākou i nā hana kūʻokoʻa mandatory. ʻO nā mea maʻamau ka inoa moʻolelo olakino: type 2 diabetes mellitus, hypertension arterial, syndrome coronary syndrome.
Pono ke kauka e hiki ke hoʻomaopopo pono i ke ʻano o ia hana a me nā mea nui e pono ai e mālama.
Hoʻomanawanui
ʻOinga: Tirova A.P.
He 65 mau makahiki
Ka hana: hoʻokuʻu
Kahua hale: st. Pushkin 24
Nā hoʻopaʻi
I ka manawa e hoʻopiʻi ai, e hoʻopiʻi ka mea maʻi i ka make nui loa, ka malo maloʻo, ua koi ʻia ʻo ia e inu a hiki i ka 4 lita o ka wai i ka lā.
Ua hoʻonui ʻia kahi wahine momona. Hoʻomaka pinepine ʻo ia i nā pi. I kēia manawa, ua puka hou mai ke ʻano o ka ʻili o ka ʻili a me kahi manaʻo o ka maʻemaʻe ʻana i nā umauma.
Ua ʻike ʻia kahi noiʻi hou ua pau ka mea maʻi i ka hana ʻana i nā hana maʻamau ma muli o ke kaumaha, a ua palupalu ʻia ka nui o nā manawa. I ka makahiki i hala iho nei, ua pilikia ka ʻeha ma hope o ka sternum a me ka pōkole o ka hanu i ka wā o ka hoʻoikaika kino.
ʻO ka mōʻaukala olakino
Wahi a ka mea maʻi, mau makahiki 2 i hala aku nei, i ka wā nānā loiloi, ua hoʻonui ʻia kahi kiʻekiʻe o ke kahe koko (7.7 mmol / l).
Kauka ke kauka i kahi hana hou, kahi hōʻike hoʻokaʻawale kaleka.
Ua haʻalele ka wahine i nā ʻōlelo a ke kauka, hoʻomau i ke alakaʻi ʻana i kona ola o mua, i ka pili me ka hoʻonui nui ʻana, loaʻa iā ia i 20 kg ka paona. Ma kahi he mahina i hala aku nei, ua puka mai ke pōkole o ka hanu a me ka ʻeha ʻana o ka umauma, a ʻike i ka piʻi o ka pehu o ke koko i ka 160/90 mm Hg
Ma ke noi ʻia ʻana o kahi hoalauna, ua noi ʻo ia i ka lau kāpeti me ka meli i kona lae, hoʻopiha ʻia i kahi ʻaina o ka ʻuala, a lawe iā Aspirin. I ka pili me ka nui o ka makewai a me ka nui o ka urination (ʻoi aku ka pō), ʻimi ʻo ia i ke kōkua olakino.
Anamnesis o ke ola o ka maʻi
Ua hānau ʻia ʻo Iulai 15, 1952, ke keiki mua a hoʻokahi wale nō ma ka ʻohana.ʻO ka mākeke mare ka mea maʻamau. Ua hānai ʻo ia.
Ua nānā ʻia nā kūlana olakino he ʻoluʻolu (hale pilikino me nā lako waiwai). Loaʻa i nā pale ma muli o ka makahiki. I nā makahiki 7 i hele wau i ke kula, loaʻa ka hana maʻamau. Loaʻa iā ia ka hīmeni a me ka makā.
He kīnā ʻole ka wā popertal, ʻo ka menstruation mua he 13 mau makahiki, ʻo ka malama maʻamau, me ka ʻeha ʻole. Menopause ma 49. Loaʻa iā 2 nā keiki makua, ʻo ka hāpai ʻana a me ka hānau ʻana o ka hānau keiki, ʻaʻohe ʻōpiopio. I nā makahiki 25, he hana e ʻoki ai i ka appendicitis, ʻaʻohe mea hōʻeha. ʻAʻole ka lawe ʻia ʻana o ka moʻaukala alikaʻi.
Lōkia i kēia manawa. Noho ka mea maʻi i nā kūlana kūlohelohe maikaʻi, hana no 30 mau makahiki ma ke ʻano he mea kūʻai i loko o kahi hale kūʻai. Kūʻai kaʻai ʻole, hele ka nui i ka ʻai.
Ua make nā mākua i ka wā kahiko, ua loaʻa koʻu makuakāne i nā maʻi diabetes type 2, lawe i nā lāʻau hāolaʻa. ʻAʻohe hoʻopau a me ka hoʻōlapa ʻana i nā pōkoki i hoʻokahi mau lā. ʻAʻole wau i hele i kahi ʻē aʻe, ʻaʻole wau i pili me nā maʻi maʻi maʻi. ʻO kekahi moolelo o ka maʻi pākī a me ka maʻi maʻi hepatitis e hōʻole ʻia.
Ka nānā ākea
ʻO ke kūlana o ka hōʻeha haʻahaʻa. Loaʻa ka pae o ka ʻike (GCG = 15 mau poʻomanaʻo) kaha, ikaika, kūpono, ʻike ʻāpono. Ke kiʻekiʻe 165 cm, ke kaupaona 105 kg. Hōkuhi kikoypersthenic.
ʻAeʻulaʻula ka ʻili, hoʻomaʻemaʻe, maloʻo. ʻO nā melemus i nā ʻōniʻomaʻo nā ʻulaʻula, hina.
ʻAi ʻia ka turgor ʻūpī, ʻaʻole i hoʻopuka ʻia nā maʻi microcirculatory. ʻAʻole hoʻohālikelike ʻia nā ʻōpū, ʻaʻohe holo. ʻAʻole kahi wela. ʻAʻole nā hoʻonui a lymph i hoʻonuiʻia. ʻAʻole palpable ka ʻōmaʻomaʻo thyroid.
ʻO ka hanu maʻamau ma o nā ala kūlohelohe, NPV = 16 rpm, ʻaʻole i hoʻopili ʻia nā ʻili o nā kōkua. Pākuʻi ʻia ka umauma ma ke ʻano o ke ao ʻana o ka ea, he ʻano kūpono, ʻaʻole maʻa ʻia, ʻaʻole ʻeha i ka palpation.
ʻAʻole i ʻike ʻia ka hoʻokūkū hoʻokūkū a me luna topographic (palena o ka māmā i loko o nā palena maʻamau). Auscultatory: alo aku i ka hanu, ʻōwili ʻia me nā pulmonary āpau.
Ma ka wahi o ka puʻuwai i ka wā e nānā ai, ʻaʻohe loli, ʻaʻole ʻike ʻia ka ʻino apical.
Pāpī ka pulse ma luna o nā hāpuna peripheral, symmetrical, hoʻopiha maikaʻi, ka ʻōpū o ka nui = 72 rpm, kahe koko o ka puna / 150/90 mm Hg Me ka kamaʻilio ʻana, aia nā palena o ke kūwaho a me ka pili o ka puʻuwai kaulike i loko o nā palena maʻamau. Auscultatory: kaniʻe nā leo kani, pono ka ʻāhane, ʻaʻole i lohe ʻia nā kani pololi.
Ua maloʻo ka alelo, ua uhi ʻia me ka uhi keʻokeʻo ma ke aʻa, ʻaʻole ʻohi ʻia ka hana kai, ʻaʻohe papa o ka lani. Hoʻonui ka ʻōpū i ka poloka ma muli o ka momona subcutaneus, komo i ka hana o ka hanu. ʻAʻohe hōʻailona i ka hypertension portal.
Me ka nui o ka palpation o nā protrusion hernial a me ka ʻeha ʻaʻole i ʻike ʻia.
Hoʻohanohano Shchetkina - Blumberg maikaʻiʻole. He paʻakikī ka palpation hohonu no ka nui o ka momona subcutaneous.
Wahi a Kurlov, ʻaʻole i hoʻonui ʻia ka palaka, ma ke kihi o ka paona kumu kūʻai, ʻo ka palpation i ka gallbladder ʻaʻole ʻeha. Loaʻa nā hōʻailona o Ortner a me Georgievsky. ʻAʻole palpable nā palaka, ua hoʻomau ka urination, hoʻonui ʻia ka diuresis. Ke kūlana neurological ʻole me nā hiʻohiʻona.
Hoʻoikaika ʻikepili a me nā noiʻi kūikawā
No ka hōʻoia i ka maʻi maʻi maʻa, ua noi ʻia kekahi mau noiʻi:
- Holo koko koko: hemoglobin - 130 g / l, nāhele koko ʻulaʻula - 4 * 1012 / l, hōʻailona ʻokoʻa - 0.8, ESR - 5 mm / h, nā keʻokeʻo keʻokeʻo - 5 * 109 / l, nā neutrophils stab - 3%, hoʻokaʻawale - 75%, eosinophils - 3 %, lymphocytes -17%, monocytes - 3%;
- urinalysis: ka waiū - ka ʻōpala, ka hana - ka alkaline, ka palaka - ʻaʻole, glucose - 4%, nā keʻena koko keʻokeʻo - ʻaʻole, ʻōpala koko ʻōmaʻomaʻo - ʻaʻohe;
- hōʻikeʻike koko huakaʻi: huina piha - 74 g / l, albumin - 53%, globulin - 40%, mea hana - 0,08 mmol / lita, ʻōrea - 4 mmol / l, kolamu - 7,2 mmol / l, glucose i ka koko 12 mmol / l.
Hōʻike ʻia ka nānā ʻana i nā hōʻailona o ka papa hana i ka dinamics
ʻImi noiʻi noiʻi
ʻO ka ʻikepili noiʻi noiʻi waiwai i loaʻa mai:
- electrocardiography: sinus ritmeʻa, nā hōʻailona o ka hypertrophy hema hema;
- pahu x-ray: maʻemaʻe nā kīpaha pulmonary, ʻaʻohe noa nā sinuses, nā hōʻailona o ka hypertrophy o ka naʻau hema.
Manaʻo ʻia ke kūkākūkā ʻana o nā mea loea e like me ka neurologist, ophthalmologist a me nā kauka maʻi vascular.
ʻO ka hoʻomanawanui ma mua
ʻAno maʻi type 2. Ka hoʻokaumaha ʻōpū.
ʻO ka hōʻoia o ke maʻi hopena
Hāʻawi ʻia i nā hoʻopiʻi a ka mea maʻi (make wai, polyuria, polydipsia), ka mōʻaukala olakino (ka nui o nā mea ʻai i ka momona), ka hoʻomaʻamaʻa ʻōnaehana (ʻoi aku ka nui o ke kino, ke kino maloʻo), ka laboratorium a me nā mea waiwai (hyperglycemia, glucosuria), hiki i kahi maʻi lapaʻau.Ka-pae: type 2 diabetes mellitus, moder, subcompensated.
Kūkulu: hypertension 2 mau mākēkē, 2 mau kiʻekiʻe, ka pilikia kiʻekiʻe. Hōʻike: ka momona momona.
Hoʻomaʻamaʻa
ʻO ka hale hoʻomaha ma ka hale hoʻomaha endocrinological e koho ai i ka lapaʻau.
He manuahi nā ʻano. Diet - papa helu 9.
Hoʻololi ke ola maʻamau - lilo ka kaumaha, hoʻonui i ke kino kino.
Nā lāʻau lapaʻau hypallycemic oral:
- ʻO Gliclazide 30 mg 2 mau manawa i ka lā, i lawe ʻia ma mua o ka papaʻaina, inu me kahi ipu wai;
- Glimepiride 2 mg hoʻokahi, i ke kakahiaka.
ʻO ka kaohiʻana o ke kō koko i loko o ka dinamics, me ka hana ʻole o ka lapaʻau, ka hoʻololi i ka insulin.
Ka hopena o ke kahe koko
Lisinopril 8 mg 2 mau manawa i ka lā, ma mua o ka papa ʻaina.
Nā wikiō pili
ʻOi aku hou ma ke ʻano type diabetes 2 i ke wikiō:
He mea nui e hoʻomanaʻo e hiki ke mālama maikaʻi i ka maʻi maʻamau ʻo 2 me ka hoʻoponopono a me ka loli. ʻAʻole kahi maʻi ka maʻi, akā ke kala wale nō ka mālama i kou olakino.
