Tlhokomelo ea tšohanyetso bakeng sa lefu la tsoekere la ketoacidosis ho bana le lilemong tsa bocha

E.N.Sibileva
Hlooho ea Lefapha la Bareki ba bana, FPK ea Univesithi ea Bongaka ea Leboea, Moprofesa oa Setsoalle, Hlooho ea Litsebi tsa Bana, Lefapha la Bophelo, Tsamaiso ea Setereke sa Arkhangelsk

Lefu la tsoekere ke lefutso le tšosang le ho feta la tsoekere ka potlako. Boemo bona bo tšoauoa ka ho kopana ha insulin le ho haella ka bongata ha insulin.

Ketoacidosis e tšoauoa ka:
▪ high hyperglycemia le osmotic diresis tse nang le acetonuria,
▪ Ho fokotseha ka sekhahla ha mali a "buffer" ka lebaka la protabolism ea "protabolism",
▪ Ho felisoa ha li-bicarbonate, liphetoho tse kenyellelitseng boemo ba acid bo tataisong ea metabolism e matla.

Kholo ea mathata a tebileng a metabolic le khaello ea insulin e sa kopaneng e lebisa ho hypovolemia, letšoao le felileng la polokelo ea potasiamo liseleng, le ho bokellana ha β-hydroxybutyric acid tsamaisong ea methapo e bohareng. Ka lebaka leo, matšoao a tleleniki a tla tšoauoa ke lefu le matla la hemodynamic, ho hloleha ha methapo ea methapo ea methapo, ho akheha ho fihlela ho akheha, le lefu la heestasis.

Maemong a sa tloaelehang, ho bana ho na le:
1. Hyperosmolar coma:
▪ hyperglycemia e phahameng
▪ Ho boloka sodium 'meleng
▪ a phatlalatsa ho felloa ke metsi
▪ ketosis e leka-lekaneng
2. Lactatecedemic coma - komello e sa tloaelehang ho bana, hangata kholisong ea eona ho na le "hypoxia" e boima ea lisele tse ngata ka ho bokellana ha lactate maling.

Phekolo ea lefu la tsoekere la ketoacidosis

1. Khalemelo ea khaello ea insulin
2. Motsoalle o mong hape
3. Ho felisoa ha hypokalemia
4. Ho felisoa ha acidosis

Pele a etsa kalafo, mokuli o koaheloa ke hotetsi, sesepa sa nasogastric, catheter ka har'a senya se kenngoa ka mpeng.

Khalemelo ea khaello ea insulin

Ho sebelisoa insulin e nkang nakoana. Ho molemo ho tsamaisa insulin ka lineamate ka tharollo ea 10% ea li-albin; haeba ho se na molaomat, insulin e kenngoa ka jete ka hora. Motsoako oa insulin oa pele ke 0.2 U / kg, ebe ka mor'a hora e le 0,1 U / kg / hora. Ka ho fokotseha ha tsoekere ea mali ho ea ho 14-16 mmol / l, tekanyetso ea insulin e theoha ho 0,05 U / kg / hora. Ka ho fokotseha ha tsoekere ea mali ho 11 mmol / L, re fetola ts'ebetso ea insulin ka mor'a lihora tse ling le tse ling tse 6.

Tlhokahalo ea insulin ha e qhaloa ho komisi ke likarolo tse 1-2 / kg / ka letsatsi.
Hlokomela! Sekhahla sa ho fokotseha ha tsoekere ea mali ha sea lokela ho feta 5 mmol / hora! Ho seng joalo, nts'etsopele ea "edema ea" cerebral edema e ka etsahala.

Motsoalle o mong hape

Mokelikeli o baloa ho latela lilemo:
▪ ho bana ba lilemo tse 3 tsa pele tsa bophelo - boima ba 150-200 ml / kg / letsatsi, ho latela boemo ba ho omella,
▪ ho bana ba baholo - 3-4 l / m2 / letsatsi
Kamor'a metsotso e 30 ea ho kenyelletsa lethal dose la letsatsi le letsatsi la 1/10. Lihoreng tse 6 tse qalang, 1/3 ea tekanyetso ea letsatsi le letsatsi, lihoreng tse 6 tse latelang - dose letsatsi le letsatsi lethal dose, 'me u lekane.
Ho loketse ho enta mokelikeli ka infusomat, haeba e le sieo, bala ka hloko palo ea marotholi ka motsotso. Tharollo ea chloride ea 0,9% ea sodium e sebelisoa e le tharollo ea ho qala. Saline ha ea lokela ho fuoa lihora tse fetang tse peli. Joale ho hlokahala hore o fetohele tharollo ea glucose ea 10% hammoho le tharollo ea Ringer ka karolelano ea 1: 1. Mokelikeli ohle o kengoang ka sefutho o futhumatsoa ka mocheso oa 37 ° C. haeba ngoana a fokotsehile haholo, re sebelisa tharollo ea 10% ea albin pele re qala ts'ebetso ea li-crystalloids ka boima ba 5 ml / kg, empa eseng ho feta 100 ml, hobane li-colloids li boloka mokelikeli o maling maling.

Khalemelo ea potasiamo

Ho tlameha ho hopoloa hore khalemelo e sa lekaneng ea potasiamo e fokotsa phello ea kalafo! Hang ha moroto o qala ho arohana le catheter (ke lihora tse 3-4 ho tloha qalong ea kalafo), ho hlokahala hore o tsoelepele ka tokiso ea potasiamo. Tharollo ea potasiamo chloride 7.5% e tsamaisoa ka tekanyo ea 2-3 ml / kg / letsatsi. E ekeletsoa mokelikeli o kenang ka lebelo la 2-2,5 ml ea potasiamo chloride ka 100 ml ea mokelikeli.

Khalemelo ea Acidosis

Bakeng sa ho lokisa acidosis, ho sebelisoa motsoako o futhumetseng, o sa tsoa etsoa oa 4% oa 4 ml / kg. Haeba BE e ka tsejoa, joale lethal la bicarbonate ke 0,3-BE x boima ba ngoana ka kilo.
Khalemelo ea acidosis e etsoa ka lihora tse 3-4 tsa kalafo, eseng pejana, hobane kalafo ea "insulin" e nang le phepelo ea metsi 'meleng e lokisa ketoacidosis hantle.
Lebaka la ho hlahisoa ha sopho ke:
▪ Adynamia e sa khaotseng
▪ ho ruruha ha letlalo
▪ Ho phefumoloha ka lerata haholo

Molemong oa phekolo ea lefu la tsoekere, ho nooa litekanyetso tse nyane heparin Li-unit tse 100 / kg / letsatsi ka liente tse 4. Haeba ngoana a tla ka mocheso, ho sebelisoa meriana e thibelang likokoana-hloko hangata.
Haeba ngoana a tla le matšoao a pele a ketoacidosis (DKA I), i.e. leha ho na le metabolic acidosis, e tšoauoa ka litletlebo tsa dyspeptic (ho nyekeloa hoa pelo, ho hlatsa), bohloko, ho hema ka matla, empa letsoalo le bolokiloe, hoa hlokahala:

1. Hlatsoa mpa ka tharollo ea 2% soda le ho e.
2. Ho beha tlhoekiso ebe enema ea bongaka e nang le tharollo e futhumetseng ea 2% soda le ho e bophahamo ba 150-200 ml.
3. Tsamaea ka kalafo ea infusion, e kenyeletsang tharollo ea albin, tharollo ea 'mele, haeba boemo ba tsoekere bo sa felle ka 14-16 mmol / l, joale ho sebelisoa litharollo tsa glucose tsa 10% le Ringer ka karolelano ea 1: 1. Phekolo ea infusion ntlheng ena hangata e baloa lihora tse 2-3 ho latela litlhoko tsa letsatsi le letsatsi, hobane kamora moo, o ka fetohela ho 'mele o nchafatsang mmele.
4. Phekolo ea "insulin" e etsoa ka tekanyo ea 01. U / kg / h, ha tekanyo ea tsoekere e le 14-16 mmol / L, tekanyo ke 0,05 U / kg / h mme ka tekanyo ea glucose ea 11 mmol / L re fetohela ho tsamaiso ea subcutaneous.

Maano a ho khanna ngoana ka mor'a ho emisa ketoacidosis

1. Bakeng sa matsatsi a 3 - ja No. 5 ntle le mafura, ebe tafoleng ea 9.
2. Ho nooa haholo, ho kenyelletsoa le litharollo tsa alkaline (metsi a nang le liminerale, tharollo ea 2% soda le ho e) lino tse nang le 'mala o bofubelu ba lamunu, hobane li na le potasiamo e ngata.
3. Ka molomo, tharollo ea 4% ea potasiamo ea chloride, 1 tafoleng. 1. khaba makhetlo a 4 ka letsatsi bakeng sa matsatsi a 7-10, hobane khalemelo ea hypokalisthia ke nako e telele.

4. Insulin e laetsoe ka liente tse 5 ka mokhoa o latelang: ka 6 hoseng, le pele ho lijo tsa hoseng, lijo tsa motšeare, lijo tsa mantsiboea le bosiu. Tekanyetso ea pele ke li-unit tsa 1-2, tekanyetso ea ho qetela ke likarolo tse 2-6, halofo ea pele ea letsatsi - 2/3 ea lethal dose ea letsatsi le letsatsi. Tekanyetso ea letsatsi le letsatsi e lekana le tekanyetso ea ho tlosoa ketoacidosis, hangata boima ba 'mele oa 1 U / kg. Phekolo e joalo ea insulin e etsoa ka matsatsi a 2-3, ebe ngoana o fetisetsoa kalafo ea mantlha ea bolus.

Hlokomela Haeba ngoana ea nang le ketoacidosis ea ntseng a eketseha a e-na le keketseho ea mocheso, ho fanoa ka lithibela-mafu tse pharaletseng. Mabapi le mathata a heestasis a bakoang ke hypovolemia le metabolic acidosis e tsoetseng pele, heparin e laetsoe lethal dose ea letsatsi le letsatsi ea 100 U / kg ea boima ba 'mele bakeng sa thibelo ea vaerase e kopantsoeng ea vascular. Tekanyetso e fetisoa ka makhetlo a mane, sethethefatsi se fanoa ka taolo ea coagulogram.