Kev hais txog cov teeb meem txaus ntshai uas mob ntshav qab zib tuaj yeem ua, ib qho tsis tuaj yeem hais txog cov kab mob lactic acidosis. Tus kab mob no tsis tshua pom tshwm sim, qhov tshwm sim ntawm kev ntsib nws lub sijhawm 20 xyoo ntawm lub neej nrog ntshav qab zib tsuas yog 0.06%.
Rau ib nrab ntawm cov neeg mob uas "muaj hmoo" poob rau cov feem ntawm ib feem pua, mob lactic acidosis yuav ua rau tuag taus. Xws li lub siab tuag tau piav qhia los ntawm kev hloov kho sai ntawm tus kabmob thiab qhov tsis muaj tus yam ntxwv pom tseeb hauv thawj theem. Paub txog dab tsi tuaj yeem ua rau cov kab mob lactic acidosis nyob rau hauv cov ntshav qab zib, nws ua li cas nws tus kheej, thiab yuav ua li cas yog tias koj xav tias tsam muaj cov kab mob no, yuav muaj ib hnub cawm koj lossis cov neeg koj hlub.
Lactic acidosis - nws yog dab tsi
Lactic acidosis yog kev ua txhaum ntawm cov ntshav qabzib metabolism, uas ua rau cov ntshav acidity ntau ntxiv, thiab yog li ntawd, kev rhuav tshem cov hlab ntshav, pathology ntawm kev ua haujlwm hauv lub siab, thiab kev txhim kho ntawm hyperlactacidemic coma.
Nquag, cov piam thaj mus rau hauv cov ntshav nkag mus rau hauv lub hlwb thiab zom rau hauv dej thiab carbon dioxide. Hauv qhov no, lub zog raug tso tawm, uas muab tag nrho cov haujlwm ntawm tib neeg lub cev. Hauv kev ua tiav ntawm kev hloov pauv nrog carbohydrates, ntau tshaj kaum tawm cov tshuaj lom neeg tshwm sim, txhua qhov yuav tsum tau qee yam kev mob. Cov enzymes tseem ceeb uas muab cov txheej txheem no ua rau lub zog insulin. Yog hais tias vim tias mob ntshav qab zib nws tsis txaus, cov piam thaj hauv lub cev yog qhov tshuaj tiv thaiv nyob rau theem ntawm pyruvate tsim, nws tau hloov mus rau hauv lactate hauv cov neeg loj.
Mob ntshav qab zib thiab siab surges yuav yog ib yam dhau los
- Li qub ntawm qab zib -95%
- Kev tshem tawm ntawm cov hlab ntsha thrombosis - 70%
- Ntaus tau ntawm lub plawv dhia muaj zog -90%
- Kev tshem tawm ntshav siab - 92%
- Qhov nce hauv lub zog nruab hnub, txhim kho pw tsaug zog thaum hmo ntuj -97%
Hauv cov neeg muaj kev noj qab haus huv, qhov feem ntau ntawm lactate hauv cov ntshav yog tsawg dua 1 mmol / l, nws dhau mus yog siv los ntawm daim siab thiab lub raum. Yog tias qhov kev nqus ntawm cov kab mob lactic acid hauv cov ntshav ntau dhau qhov peev xwm ntawm cov kabmob ua kom tshem tawm nws, kev hloov pauv ntawm cov kua qaub-lub hauv paus sib npaug ntawm cov ntshav mus rau cov kua qaub sab tshwm sim, uas ua rau kev txhim kho ntawm lactic acidosis.
Thaum lactate hauv cov ntshav accumulates ntau dua 4 mmol / l, maj mam nce ntxiv ntawm acidity ua spasmodic. Qhov xwm txheej no tau loj dua los ntawm qhov muaj zog hauv cov tshuaj insulin nyob hauv ib puag ncig acidic. Kev cuam tshuam ntawm cov protein thiab cov rog metabolism ntxiv yog ntxiv rau kev cuam tshuam ntawm cov metabolism hauv cov metabolism, cov qib ntawm fatty acids hauv cov ntshav nce siab, cov khoom lag luam hauv lub cev zom zaws, thiab qaug cawv tshwm sim. Lub cev tsis muaj peev xwm tawg tawm ntawm lub voj voog ntawm nws tus kheej.
Txawm hais tias cov kws kho mob tsis tuaj yeem ua kom lub nrawm no ruaj khov, thiab yog tias tsis muaj kev pab kho mob, kev mob loj lactic acidosis tas mus li thaum tuag.
Vim li cas rau qhov tsos
Mob ntshav qab zib mellitus yog nyob deb ntawm tib qho laj thawj ntawm kev tsim kho cov kab mob lactic acidosis, nyob rau hauv ib nrab ntawm cov xwm txheej nws tshwm sim los ntawm lwm cov kab mob loj.
| Yam pheej hmoo | Qhov cuam tshuam rau cov ntshav qabzib Metabolism |
| daim siab mob | ntev ua txhaum ntawm ntxuav ntawm cov ntshav los ntawm lactic acid |
| quav cawv | |
| lub raum khiav tsis zoo | ib ntus tsis ua hauj lwm hauv cov txheej txheem ntawm kev zam ntawm lactate |
| Kev tso dej ntawm cov neeg ua haujlwm sib piv rau kev kuaj mob x-ray | |
| lub plawv tsis ua hauj lwm | cov pa oxygen tshaib plab ntawm cov nqaij mos thiab nce ntxiv ntawm lactic acid |
| cov kab mob ua pa | |
| leeg noj ntshav tsis nqis | |
| hemoglobin tsis txaus | |
| kev sib xyaw ntawm ob peb yam kab mob uas ua pa hauv lub cev | qhov kev txuam nrog lactate vim muaj ntau yam - ob qho tib si ua kom ntau ntxiv thiab ua kom tsis muaj zog ntawm cov lactic acid |
| Lub cev tsis muaj zog ua vim lub hnub nyoog laus | |
| ntau yam mob ntshav qab zib | |
| raug mob hnyav | |
| cov kab mob kis hnyav | |
| ntev tsis txaus cov vitamin B1 | ib nrab thaiv ntawm cov khoom noj metabolism |
Kev phom sij loj tshaj plaws ntawm cov kab mob lactic acidosis hauv ntshav qab zib tshwm sim yog tias tus kab mob no koom ua ke nrog cov kev pheej hmoo saum toj no.
Metformin, ib qho tshuaj uas feem ntau siv rau cov ntshav qab zib hom 2, kuj tuaj yeem ua rau cov piam thaj hauv ntshav tsis txaus. Feem ntau, lactic acidosis yuav tshwm sim nrog kev siv tshuaj ntau dhau, ib qho tshwm sim ntawm ib tus neeg lossis nrog nws cov kev txuam nrog hauv lub cev vim qhov ua rau lub siab los yog lub raum tsis ua haujlwm.
Cov tsos mob ntawm cov kab mob lactic acid nyob hauv hom 1 thiab 2 mob ntshav qab zib
Cov kab mob lactic acid feem ntau tau nyaij mus ua ib qho mob uas txawv. Lub sijhawm los ntawm thawj cov cim qhia rau kev hloov pauv tsis tau hauv lub cev yuav siv sijhawm tsis tshaj ib hnub. Ntawm cov pib tshwm sim ntawm lactic acidosis, tsuas yog ib qho tshwj xeeb - myalgia. Qhov no yog qhov leeg mob tshwm sim los ntawm cov lactate ntau ntau. Peb txhua tus tau hnov cov nyhuv ntawm cov kab mob lactic thaum peb rov ua kom lub cev ua haujlwm tom qab so ntev. Cov kev xav zoo li qub, muaj sia. Qhov sib txawv ntawm kev mob nrog mob lactic acidosis yog tias nws tsis muaj kev sib txuas nrog cov leeg mob.
Nco ntsoov kawm: >> Kev paub txog mob acid - yog vim li cas koj thiaj li ntshai nws?
Cov tsos mob uas tseem tshuav ntawm lactic acidosis tau yooj yim yog vim li cas cov tsos mob ntawm lwm yam kab mob.
Yuav muaj cai:
- mob hauv siab
- txog siav
- nquag ua pa
- daim di ncauj xiav, ntiv taw, lossis tes;
- zoo nkaus li muaj puv hauv plab;
- txoj hnyuv cuam tshuam;
- ntuav
- apathy
- pw tsaug zog.
Raws li qib lactate nce, cov cim tshwm sim uas yog tus yam ntxwv ua haujlwm rau acidity cuam tshuam:
- Kev siv lub cev ua kom txhim kho cov ntaub so ntswg ua pa oxygen mov ua rau ua kom tsis muaj suab nrov, ua pa tob.
- Vim tias lub plawv tsis ua haujlwm, lub siab poob thiab arrhythmia tshwm sim.
- Cov tsub zuj zuj ntawm lactate provokes mob cramps.
- Kev noj haus tsis txaus rau lub hlwb ua rau ib qho kev hloov pauv ntawm kev muaj lub siab tsis txaus, thiab kev npau taws thiab ib ce tuag tes tuag taw ntawm cov leeg tau tshwm sim.
- Qhov tsim los ntawm cov ntshav txhaws, feem ntau feem ntau nyob hauv cov nqua.
Yog tias cov kab mob lactic acid tsis tuaj yeem nres nyob rau ntawm theem no, tus neeg mob ntshav qab zib muaj zog tsis nco qab lawm.
Cov hauv paus ntsiab lus ntawm kev kho mob
Raws li tau txais tus mob ntshav qab zib uas xav tias muaj cov kab mob lactic acidosis hauv ib lub tsev kho mob, nws tau soj ntsuam:
- Lactate hauv cov ntshav. Ib qho kev kuaj mob tau ua yog tias nws qib siab tshaj 2.2 mol / L.
- Ntshav bicarbonates. Tus nqi qis dua 22 mmol / L tuaj yeem lav lactic acidosis.
- Acetone hauv cov zis yog txiav txim siab kom paub qhov txawv acidity vim yog lactic acid los ntawm ketoacidosis.
- Ntshav creatinine tso cai rau koj los ua tus txawv uremic acidosis.
Lub hom phiaj tseem ceeb ntawm kev kho mob yog cov normalization ntawm ntshav acidity thiab tshem tawm ntawm cov pa oxygen tshaib plab.
| Kho kev taw qhia | Txujci | Nta |
| Acidity txo | Tshuaj kev tswj hwm ntawm sodium bicarbonate | Qhov tsuas tshuaj yog suav nrog qhov raug siab, cov txheej txheem tswj hwm tau ua haujlwm tas li. Ib daim cardiogram thiab ntsuas ntshav siab ua qhov tsis tu ncua, thiab kuaj cov ntshav electrolytes. |
| Trisamine tso ntshav nrog | Nws siv es tsis txhob bicarbonate nrog kev muaj zog acidity ntau thiab qhov kev pheej hmoo ntawm lub plawv tsis ua hauj lwm, muaj cov nyhuv sai alkalizing. | |
| Kev cuam tshuam ntawm kev hloov pauv ntawm pyruvate rau lactate | Methylene xiav | Cov tshuaj muaj redox lub zog thiab tuaj yeem oxidize enzymes koom nrog hauv cov metabolism hauv qabzib. |
| Kev Hypoxia Kev Ntaus | Kev kho cov pa oxygen | Siv cov khoom cua tsis zoo lossis cov nplaim hluavtaws ntxiv cov pa oxygenation. |
| Xaus ntawm ib qho kev tshaj tawm ntawm cov tshuaj metformin | Lub plab zom mov, siv cov sorbents | Nws yog nqa tawm ua ntej ntawm txhua yam. |
| Siv ceev xwmphem qhov mob hnyav | Hemodialysis | Lactose-free dialysate siv. |
Kev Tiv Thaiv
Txhawm rau tiv thaiv cov kab mob lactic acidosis, koj xav tau tshuaj xyuas koj li kev noj qab haus huv tas li:
- Tom qab 40 xyoo, txhua 3 lub xyoos, cov ntshav pub dawb yog tsim nyog los txiav txim siab txog qib piam thaj. Cov kab mob lactic acid feem ntau tshwm sim thaum cov ntshav qab zib hom 2 tsis tau kuaj, uas txhais tau hais tias tsis muaj kev kho mob.
- Nrog rau kev txheeb xyuas tus mob ntshav qab zib, koj yuav tsum ua raws txhua tus kws kho mob cov lus pom zoo, yauv mus kuaj mob kom raws sijhawm txhawm rau paub txog kev muaj feem ua mob lactic acidosis.
- Yog tias koj noj cov tshuaj metformin, nyeem cov npe ntawm contraindications hauv cov lus qhia. Yog tias ib qho ntawm cov kab mob tau teev tseg hauv nws tshwm sim, tam sim ntawd hu rau tus kws kho mob endocrinologist kom thim lossis kho qhov tshuaj ntawm cov tshuaj.
- Tsis txhob tshaj qhov tau teev tseg ntawm Metformin yam tsis tau tso cai los ntawm kws kho mob, txawm tias kev them nyiaj rau ntshav qab zib tsis txaus.
Yog tias koj muaj cov tsos mob zoo ib yam li cov kev mob ntawm cov kab mob lactic acidosis, koj yuav tsum hu rau lub tsheb tos neeg mob. Kev mus ncig ywj siab rau tus kws kho mob uas tau mus kawm lossis npaj siab tiv thaiv tus kab mob ntawm koj tus kheej tuaj yeem ua rau tu siab kawg.
