Hoʻopilikia i nā maʻi maʻi

ʻO ka maʻi mellitus maʻi hūkē ke ala o ke kino, i hōʻike ʻia e ka nele o ka hana hana i ka insulin a i ʻole hoʻopaʻi ʻia hoʻi o kāna hana. Hiki ke paʻakikī ʻia ka maʻi e ka nui o nā kūlana i hoʻokaʻawale ʻia i nā ʻāpana nui ʻelua: nā pilikia nui a me nā palaka pila (huli). ʻO ia nā kaʻina hana e kūkākūkā ai i loko o ka paukū e hilinaʻi ka lōʻihi a me ke ola o ka mea maʻi.

Maʻi molaʻi

ʻO ka hoʻopiʻi o nā maʻi diabetes me ka ketoacidosis diabetes - decompensation o nā hana metabolic e kū'ē i ke kūlana o ka maʻi lalo, kahi i hōʻike ʻia e nā kumuhana like ʻole:

• kūlike (me ke ʻano type type 1) a i ʻole ka pili (me ke ʻano o nā ala 2 ʻano like ʻole).
• ka pae kiʻekiʻe o ka glucose i ke kahe koko (ma luna o 14 mmol / l);
• ka uluʻana o nā kino acetone i ke koko a me ka urine;
• kahi hoʻololi i ke koko pH i ke kuhikuhi o ka acidosis (pH emi ma lalo o 7.2);
• ʻike ʻole i ka mea maʻi.

ʻO ka mea pōʻino, he hopena i loaʻa ʻole ka hopena me ka ketoacidosis. Wahi a nā ʻike kīnā ʻole, ke kamaʻilio nei mākou e pili ana i ka 7-10% o nā maʻi āpau. Hoʻonui pinepine ʻia mai ka hopena ma mua o ka mea maʻi ʻo ia ka ʻōpio makua e hōʻeha nei i ke kahe koko haʻahaʻa, a inā he nui nā maʻi concomitant.

Pāʻani o ka acetone mai ka waha - he mea nui ka hoʻomaʻamaʻa nui o ka diagnostic no nā hoʻopiʻi

ʻO nā mea hoʻonāukiuki o nā hoʻopiʻi ketoacidotic i ka maʻi diabetes:

• maʻi lēpela;
• nā hana kūwaho o kahi ʻano kūlohelohe;
• hoino kino maoli;
• hoʻoweliweli kaʻaila;
• ka lawe ʻana i nā lāʻau lapaʻau hormonal (glucocorticosteroids, sex sex) a i ʻole diuretics;
• ka manawa e hānau ai ke keiki.

Akā, ʻo ke kumu nui loa o nā hoʻopiʻi ʻia i manaʻo ʻia ʻaʻole pono ke ʻano kūpono o ka maʻi maʻi. Ke kamaʻilio nei mākou e pili ana i ka ʻoki ʻana i kahi inikini insulin, hiki ʻole i ka helu ʻana o ka hōʻawa o ka lāʻau, ke hoʻohana ʻana i kahi laʻina i pau, ke ʻano hewa no ka lawelawe ʻana i ka hormone.

Nā hōʻailona ʻeha a me ka mālama ʻana

Hoʻomaka ka ketoacidosis diabetes i nā hola he nui, a hiki ke lōʻihi i kekahi mau lā. Haʻalele ka makewai, hoʻonui nui urination, ʻili maloʻo, hoʻemi ka nui o ka mea hoʻomanawanui, a ke māhuahua nei ka nāwaliwali mānoino. Ma hope mai, hoʻomaka ka lua, ka ʻōpū o ka ʻōpū, ka ʻohu o ka acetone i ka ea lewa. Nā hōʻailona ʻike ʻike kūmole.

No ka loaʻa ʻana o ka pilikia, ua hoʻoholo ʻia ke kō a me ka acetone i loko o ka urine ma ka hoʻohana ʻana i nā kaula hōʻike. Hoʻohana ʻia kēia ʻano hana e wehewehe i ka ʻano o ka mea maʻi i ka home a i ʻole ma ka lumi ulia o ke keʻena olakino. Hōʻike ka papa ma lalo nei i nā mana o ka maʻi e hoʻoholo ʻia ai ka paʻakikī o ka ketoacidosis maʻi (DKA).

Hoʻomaʻamaʻa ʻia ke ʻano:

• kaʻina hana insulin;
• ka hoʻoponopono ʻana i ka kaulike wai-electrolyte;
• ka haʻaleleʻana o nā loli i ke koko pH;
• maʻi o nā maʻi concomitant.

ʻO ka hyperglycemia Hyperosmolar

ʻO kēia kahi hōkole o ka "maʻi aloha", ka mea i ʻike ʻia me ka waiho ʻole o nā kino acetone i ka pā a me ka koko, a hele pū ʻia me nā kaila gula kiʻekiʻe (hiki i 50 mmol / l), kiʻekiʻe osmolarity plasma a me nā maʻi he nui. ʻO kēia pathology kahi hiʻohiʻona maʻamau o ka hoʻomohalaʻana o nā ʻōmole i ka maʻi diabetes type 2.

ʻO ka halaʻole o ka hoʻoponopono inu inu kekahi o nā kumu o ka hoʻomohala ʻana i ka coma hyperosmolar

ʻO nā mea wīwī no ka hoʻomohala ʻana i ka mokuahi hyperosmolar:

• mai nā maʻi ʻōpū me ka hyperthermia, nā puka o ka luaʻi;
• embolism pulmonary;
• maʻi huʻi o ka pankreas;
• thrombosis o nā moku mesenteric;
• kahe koko
• kuni a nā kūlana;
• ʻeha lima;
• huehue peritoneal;
• wela ʻole a hypothermia.

Hōʻikeʻike o ka hoʻopiʻi a me kona nānā ʻana

Hoʻopilikiaʻana i ka maʻi diabetes

ʻO ka hoʻopiʻi Hyperosmolar e ulu wikiwiki i ka pae o ka ketoacidosis. Hōʻike nā hōʻailona mua i kekahi mau lā, a i ʻole he mau pule, ma mua o ke kiʻi ʻālana kikinike. Ma ka loiloi, ua pōkole ka mea maʻi: ua maloʻo kona ʻili a me nā membanes, a ua hoʻemi ʻia ka turgor, ʻike ʻia ka palpation i nā ʻano ʻāpana o nā palupalu.

Ma hope mai, ua emi ke koko, ma hope o ka urination nui, he manawa nui o ka hoʻēmi ʻana i ka urine a i ʻole ke hōʻoki ʻia ʻana. ʻAʻohe mea momona o ka acetone i ka ea hau a me nā kino acetone i loko o ke koko a me ka urine (nā hōʻailona kikoʻī e ʻae ai i ka hoʻokaʻawale ʻana i ka hoʻopiʻi).

Nā hōʻailona neurological o kahi hoʻopiʻi o ka ʻano type like me 2 diabetes mellitus:

• nahoa
• haunaele ʻōlelo;
• nystagmus (ka holo ʻana o ka leʻaleʻa o ka maka);
• paresis a paralysis;
• bilateral makapō i kahi hapaha a i ʻole hapa o ke kahua o ka nānā.

Hoʻohālikelike ka hoʻomaʻamaʻa ʻana o nā patology me ka hana ʻana i ka terapi no ka ketoacidosis, akā aia kekahi mau hiʻohiʻona. Hoʻomaka ka huina ma ka hopena glucose, ma hope e huli lākou i kahi hypotonic, a laila hoʻohā i kahi hopena physiological o ka sodium chloride. ʻO ka haʻahaʻa o ke kō anuʻu kiʻekiʻe ma ke kino e emi lohi, e like me ka hyperosmolarity.

Lactic acidosis (lactic acidosis)

He kūlana pāpilikia kēia kahi pilikia paʻakikī o ka maʻi maʻi. Hoʻohālikelike ia e ka metabolic acidosis a me ke kiʻekiʻe o ka lactic acid i ke koko. Eia nō naʻe, ʻo ka acidact lactic acidosis i loko o nā hihia maʻi he mau undiagnosed, nā hopena hōʻeha i loaʻa i ka 80% o nā maʻi.

Hōʻike ʻia ke kūlana e ka neʻe lohi ʻana o ka lactic acid mai ke kino. Hiki iā ia ke kūʻē i ka mua o ka hoʻomohala ʻana o ka hypoxia kiko i ka manawa o nā kūlana haʻalulu o nā ʻano kumu like ʻole, me ke ʻano o ke ake ʻole o ka puʻuwai naʻau, me nā mea make o ka carbon dioxide.

ʻO nā kumu ʻē aʻe e pili ana i ka maʻi diabetes

• akeʻa a palau ʻole ʻole a pōʻai ʻole;
• anemia
• hana hoʻowalā;
• lōkohu
• lawa adrenal;
• wela wela;
• ka hoʻohana ʻana i nā lāʻau lapaʻau (salicylates, ethanol, biguanides).

Molakika Lactic acid - kahi waiwai e hōʻuluʻulu i loko o ke kino ma ke kūkaʻa ʻana o ka hoʻomehana lactic acidosis

I mea e hoʻoponopono pololei ai i kahi kūlana o ka pathological, pono e hoʻomaʻemaʻe i ka pae o ka lactate i ke koko. Ma ke kānāwai, ʻo kāna mau kuhikuhi ma mua o ka 2.2 meq / l, ʻoi aku ka manawa - 5 meq / l. He mea paʻakikī ke hana i kahi maʻi kūpono, no ka mea ʻaʻole ʻole nā ​​hōʻailona. Hiki iā lākou ke hoʻomohala ma ke ʻano o ka lāhulu nui biguanide. ʻO ka hōʻailona wale nō e manaʻo ai he ʻehaʻeha ʻo ia. Hele maila ia i ka hope o ka hōʻiliʻiliʻana o ka waikawa lactic i loko o ke kino.

Hoʻolālā ʻia ka hana i loko o ke koho i ka maʻi o ka oxygen, intravenous administration of glucose me ka insulin short-acting, ka hoʻomaka ʻana o nā wai liʻiliʻi o ka sodium bicarbonate, a me ka hemodialysis.

Hypoglycemia

ʻO kahi hiʻohiʻona hoʻohālikelike o ka maʻi maʻamau i nā keiki a me nā pākeke. Hōʻike ʻia ke kūlana me ka emi ʻana o nā helu glucose koko ma lalo o 2.7 mmol / L, a hele ʻia me kahi kiʻi haukapila, ma lalo o ka 2.2 mmol / L, inā paha he mau hōʻailona paha. ʻElo mau ʻano maʻi o ka hypoglycemia:

• hōʻoluʻolu - hiki i ka mea maʻi ke hoʻopau kūʻokoʻa i kahi hōʻike o nā hoʻopiʻi.
• hōʻeha nui - ke hele nei me ka naʻau kokoke i ka mea iʻike ʻole ʻia, ʻaʻole hiki i ke kanaka ke kūʻokoʻa kūʻokoʻa i ka hoʻopiʻi ʻana.

ʻO nā kumu ka mea e hoʻonāukiuki ai i ka hoʻopili ʻana i ka hoʻopiʻi i ka maʻi diabetes mellitus o ka ʻano mua a i ʻole ʻelua. Hoʻokaʻawale ʻia nā mea i pili me ka lāʻau lapaʻau hypoglycemic i ʻekolu pūʻulu nui:

1. ʻO kahi overdose o ka insulin a i nā papaʻaila puna wai - ke kuhi hewa ʻole i ka mea maʻi i ka laʻi (hoʻohana ʻia ʻoi aʻe ma mua o ka pono), nā hewa i ka hana o ka peni insulin, kahi mita glucose glucose koko (nui aʻe ma mua o ka mea maoli nō ia), he overdose manaʻoʻoki ma ke kāʻei o nā pahuhopu suicidal.
2. ʻO nā hoʻololi i ka hana o ka insulin a i nā papa paha o nā māka hypoglycemic - ke hoʻololi ʻana mai kekahi lāʻau i kekahi, a hoʻolōʻihi i ka wehe ʻana o ka lāʻau i ke kūleʻa o ka hana ʻana i ka papaleka, ka hiki ʻana o nā antibodies i ka hormone pancreatic, ka ʻĀina hoʻokele hewa, hui pū ʻana me kekahi mau aila hypoglycemic.
3. Ka hoʻonui ʻana o ka naʻau i ka hormone - hana hoʻoikaika kino kino, ke manawa ma hope o ka hānau ʻana o ke pēpē i ka mālamalama, adrenal a i ʻole hemahema.

Aia nā mea pili i ka meaʻaiʻai a ke kanaka. No ka laʻana, hiki i ka mea maʻi ke hūnā i ka manawa o ka kīʻai a nui a i kīʻaiʻai paha, ka hana pilikino ʻaʻole paha i helu ʻia ma ka nui o ka lāʻau lapaʻau, ka komo ʻana i ka wai ʻona, nā 12 mau pule o ka hapai a me ka wā lactation e ʻike ʻia.

ʻO ke kōpaʻa koko haʻahaʻa - kahi kūlana o ka hypoglycemia e koi koke i ka hoʻoponopono lāʻau

Nā hōʻailona ʻeha a me ka mālama ʻana

I ka wā o ka precoma, nā hoʻopiʻi o ka maʻi mellitus (type 1, type 2, form gestational) hoʻopiʻi i nā maʻi no ka ʻohi ʻana o ka ʻeha, ka ʻeha, ka puʻuwai, ka haʻalulu, ka ʻeha a me ka pōloli ʻeha.

Ma hope nā hōʻailona o kahi hui neuroglycopenic o nā hōʻailona e hui. Hoʻopili kēia i ka nāwaliwali, ka nānāʻana o ka ʻili o ke kino, ka manaʻo o ka makaʻu, ka makaʻuʻole i ka wa a me ka manawa, ka nalowale o ka hoʻomanaʻo ʻana. ʻO ka papa inoa kekahi o ka hoʻomaopopo ʻana a me ka coma.

ʻO nā hana e hoʻopau ai i ke kūlana hypoglycemic pono e hoʻomaka i loko o ka poʻe maʻi me ka maʻi diabetes, i ka pae ʻana o ka glucose i ka pae o 3.3-3.7 mmol / L. ʻO kēia kahi koho maikaʻi loa i ʻae ʻia e hoʻokahe i ke kō. Hōʻalo ʻia ka hypoglycemia ma ka hoʻokomo ʻana i kahi mea momona. ʻO kahi laʻana, pīkī, nā pīpī, nāʻaila wela, kaʻa. Pono ka maʻi diabetes ma ka hoʻomehana ʻana i kahi mea momona ma ka lima.

Nā hana no ka hoʻopiʻi nui ʻana (me ka maʻi mellitus type 1, 2, ʻano ʻano gestational):

1. E kau i ka mea ma kona ʻaoʻao, i ʻole i ka ʻike a me nā kīpuka o ka luaʻi, ʻaʻole e nauʻe mai ka luaʻi i ka bronchi.
2. E wehe i nā ʻūpala meaʻai āpau mai ka waha waha. ʻAʻole hiki iā ʻoe ke hoʻopiha i kahi kanaka me nā mea momona i loko o kona waha inā ke ʻike ʻole ʻole ia.
3. Hoʻokomo ʻia kahi hopena glucose i ka vein a hiki i ka mea maʻi i kona mau maka.
4. Hoʻokomo ʻia ka Glucagon ma lalo o ka ʻili a me ka ʻiʻo. Hoʻokuʻu ʻia kēia waiwai i ka waiʻu syringe.
5. ʻO ka halemai i loko o ke keʻena o ka haukapila endocrinology a i ʻole ka lawelawe o ka resuscitation a me ka mālama koʻikoʻi.

Inā hele kekahi i ke coma no kahi o nā hola 4-6, ʻo ka hopena o ka ulu ʻana o ka edema cerebral a me ka hopena hōʻeha i hoʻonui pinepine ʻia.

Nā maʻi hōʻeha

ʻO ke lōʻihi lōʻihi a me ke ola o ke ola maʻi ma ka manawa e pili ana i nā hopena hoʻopiʻi o ka maʻi diabetes mellitus i ulu a pehea hoʻi ka holomua. ʻO nā maʻi āpau āpau o ka maʻi maʻi i hoʻokaʻawale ʻia i nā pūʻulu he nui: microvascular, pathology macrovascular, maʻi neuropathy maʻi.

Nā maʻi hōʻeha - nā ala e hiki ʻole ke hoʻōla

ʻO ka hui o nā ala o ka microvascular me ka retinopathy (hōʻino i ka mea nānā loiloi) a me nā nephropathy (hōʻeha i ka ʻōpū). ʻO nā ʻōmike Macrovascular e hōʻike ʻia e ka maʻi naʻau coronary, ka lolo a me nā kīʻaha koko o nā ʻāpana haʻahaʻa. Ma muli o ka wahi o ka pōʻino e kahele ʻia ana i ka peripheral a me autonomic.

Na ka papa ʻaina ʻOkopi

ʻO kekahi o nā ʻano like ʻole o ka pōʻino o ka vascular i ke alo o ka maʻi mellitus, kahi i hōʻike ʻia i ka komo ʻana i ke kaʻina pili o nā huaʻehā. ʻElua mau ʻano:

• nodular glomerulosclerosis;
• ʻO kahi glomerulosclerosis kahi ʻano ʻē aʻe.

ʻO ka hopena he pilikia ʻole. Hoʻokomo ʻia ka Nephropathy i kēlā me kēia maʻi pākēlolo i loaʻa i ka maʻi 1 mau maʻi, a ma kēlā me kēia ʻehā o nā ʻelima o kahi ʻano like ʻole o ka maʻi o ka maʻi. Ma ke ʻano he kānāwai, he hopena hoʻopiʻi ka 10-15 mau makahiki ma hope o ka hoʻomaka ʻana o ka maʻi diabetes.

Hoʻoulu ka nephropathy diabetic i ka loaʻa ʻole o ka lawa pono o ka kō koko koko, ke koko, me ka mea o kahi predisposition hoʻoilina. ʻO ka hōʻailona koʻikoʻi ka maʻi kino o ka pōʻino o ka pōʻino o ka microalbuminuria (ke ʻano o ka liʻiliʻi o ka protein i loko o ka urine), kahi e komo ai i ka proteinuria (he nui ka nui o nā protein i loko o ka urinary fluid).

ʻO Glomerulosclerosis - kahi ʻano pathological o ke keiki, me ka hele ʻana o ka protein i ka urine

Hāʻawi ka Microalbuminuria i kēia mau helu aʻe: 20-199 mg / ml albumin i loko o ka pāʻai, 30-299 mg i hoʻoulu ʻia i kēlā me kēia lā. I ka proteinuria, ʻoi aku nā helu ma mua o 200 mg / ml a me 300 mg, kēlā

Nā kuʻuna o ke ʻano:

• kāohi glycemic;
• ACE inhibitors;
• statins a fibrates (i ka loaʻa ʻole o ka hāpai ʻana);
• ka palena o ka protein intake i ka meaʻai.

Retinopathy Diabetic

ʻO ka hāʻule ʻana o ka choroid ma kahi o ka maʻi maʻi. Hoʻomohala ia ma hope o nā makahiki he 5-7 mai ka hoʻomaka ʻana o ka maʻi i kēlā me kēia maʻi maʻamau, ma hope o 20 mau makahiki - ma ka 85% o nā hihia.

Hiki ke ʻike ʻia nā papa o ka retinopathy (nā kiʻi me kahi kūlana i hoʻololi ʻia o ka waihona kālā ma nā pūnaewele kūikawā).

• Koho maʻalahi - ma ka nānā ʻana i hoʻoholo ʻia e ka hiki ʻana o nā aneurysms liʻiliʻi a me nā exudates paʻa, ʻaʻohe kuhi ʻana mai ka mea maʻi.
• Maculopathy - hemorrhages a me ka hiki ʻana o nā exudates paʻa i ka macula i nānā ʻia, ke hele mau nei ka ʻike acuity.
• Preproliferation - ke hele mai o ke ʻano o nā exudates palupalu, e hui pū ʻia nā veins, nā maʻi komo intracellular.
• Proliferation - neoplasms, hoʻohaʻahaʻa i ka acuity ʻike a hiki i ka makapō, glaucoma.

Nui! No ka mālamaʻana, ua kuhikuhi ʻia ka hoʻoponopono ʻana i ka glycemia, i ka hoʻomaka ʻana o ka preproliferation - laser photocoagulation (ʻae ʻia e hōʻemi i ka ʻike maka), ma ka hana proliferation - vitrectomy.

ʻO nā hoʻololi i nānā ʻia i ka wā o ka nānā ʻana o ka waihona kālā o ka mea maʻi ma ke kua o ka retinopathy

ʻO ka neuropathy maʻi maʻi

ʻO kahi hoʻopiʻi maʻi maʻamau i hōʻailona ʻia e ka hōʻino ʻana o ka enaena. 15 mau makahiki ma hope o ka hoʻomohala ʻana o nā maʻi diabetes i ka 80% o nā maʻi. Hele ia i ka wā o ke kāwili ʻana o vascular, loli i nā hana o ke kuhihewa.

Hoʻokomo ʻia ka neuropathy peripheral me nā hoʻopiʻi o ka ʻoi ʻana, nā maʻi hōʻeha ma nā ʻoihana haʻahaʻa, nā wīwī, keʻa ʻana. Aia kekahi hewaʻole i ka ʻike o ka kaohi ʻana i ke ea, he hoʻohaʻahaʻa i ka hoʻopili, hoʻoweliweli i ka ʻeha (ʻaʻole pinepine nā maʻi maʻi maʻi i ka nānā ʻana o ka ʻōpala, nā hōʻeha ma nā wāwae, ka mea e alakaʻi ai i ka maʻi a me ka hoʻomohala ʻana i ka maʻi maʻi maʻi diabetes). Aia nā pō poina, ka hiki ʻole ke hele i kahi lōʻihi ʻole, hiki i ka hiki ke ʻano lewa.

I ka hana hewa ʻana o ke kino o ka wahī, ua kamaʻilio mākou e pili ana i ka neuropathy autonomic:

• palaka ma kekahi ʻaoʻao o ka puʻuwai - dizziness, haʻahaʻa haʻahaʻa haʻahaʻa, palpitations puʻuwai;
• kaʻi ʻana i nā molopela i lalo - pilikia i ka ʻili, ka noho ʻana o ka urinary;
• ʻeha ka hōʻeha o ka ʻōpū - hoʻouka i ke aho a me ka hoʻopuka, gastroparesis;
• neuropathy hoʻomaʻemaʻe - maloʻo a maloʻo paha.

ʻO nā kumumanaʻo o ka mālama ʻana ke loaʻa ʻana o nā helu glycemic optimal, ka lawe ʻana i nā antidepressants a me anticonvulsants, ka hoʻomākaukau ʻana i ka wai thioctic, nā huaora B-series, a me ka physiotherapy.

Nā lāʻau lapaʻau Thioctic acid - kahi hui o nā lāʻau lapaʻau i hoʻohana nui ʻia i ka maʻi diabetes

ʻO ka maʻi wāwae maʻi maʻi

ʻO kēlā ʻano hoʻonāukiuki e hōʻike ʻia nei i ka hiki ʻana mai o ka maʻi, nā ʻūhā a me ka luku ʻana paha i nā kiko hohonu o nā wāwae, ka mea e kū nei i ke kahe o ke kipi o ke koko i ka hopena o ka hōʻeha ʻana i nā moku o nā puʻu haʻahaʻa. Hoʻokomo ʻia ma kahi hapaha o ka maʻi maʻi. Hiki ke ʻike ʻia ke kaʻina hana pili me ka maʻi me nā kiʻi i kau ʻia ma nā pūnaewele kūikawā.

ʻO nā hui pilikia no ke kūkulu ʻia ʻana o ka maʻi maʻi ka:

• nā maʻi maʻi me nā polyneuropathy peripheral;
• ka loaʻa ʻana o nā kūlana holomua o nā kahe koko;
• deformities kapuai o kekahi kumu;
• ka heleʻana o nā koi ʻē aʻe o ka maʻi maʻi;
• i ka ulaula a me ka inu rama;
• hiʻona kiʻekiʻe.

Hoʻokumu ʻia ka mea lapaʻau ma ka therapy insulin, ka lawe ʻana i nā antibiotics, heparin, nā mālamalama antiplatelet, venotonics, hoʻoikaika i ka lāʻau, antispasmodics a me nā NSAID.
ʻO nā maʻi mellitus a me nā maʻi he ʻelua mau huaʻōlelo, akā, ʻo ka mea, ʻaʻole hiki ke noho kaawale. He mea nui e pale i ke kūkulu ʻana i nā kūlana o nā pathological, no ka mea hiki ʻole ke hoʻōla iā lākou i kēia manawa.