Txawm tias 10 xyoo dhau los, kev tsis muaj qhov tseeb lossis cov tshuaj tiv thaiv cov tshuaj insulin kuj xam tias yog teebmeem feem ntau ntawm cov neeg laus.
Tam sim no muaj ntau qhov xwm txheej hais txog kev soj ntsuam ntawm tus kab mob no hauv cov menyuam yaus thiab cov hluas.
Rau cov tub ntxhais kawm ntawm cov tsev kawm kho mob muaj ib daim npe ntawm cov npe uas lawv ua txoj haujlwm ywj pheej. Feem ntau muaj cov keeb kwm kev kho mob nram qab no: hom 2 mob ntshav qab zib mellitus, mob ntshav siab, mob ntshav siab.
Tus kws kho mob yav tom ntej yuav tsum nkag siab qhov kev teeb tsa ntawm cov haujlwm zoo li no thiab cov ntsiab lus tseem ceeb uas yuav tsum tau them sai sai rau.
Neeg mob
Tus Neeg Mob: Tirova A.P.
Hnub nyoog 65 xyoos
Haujlwm: so haujlwm
Chaw nyob: st. Hlwv 24
Kev yws
Thaum lub sijhawm nkag, tus neeg mob yws ntawm kev nqhis dej heev, lub qhov ncauj qhuav, nws raug yuam kom haus dej txog 4 litres ntawm dej thaum nruab hnub.
Tus poj niam sau tseg ua kom rog tuaj. Tus pojniam pib tso zis ntau zaus. Tsis ntev los no, nws khaus ntawm daim tawv nqaij thiab zoo li laim tawv hauv nqua tau tshwm sim.
Ib qho kev tshawb fawb ntxiv pom tias tus neeg mob nres ua tsis tau haujlwm hauv tsev vim yog kiv taub hau, thiab tsaus muag tau sau tseg ob peb zaug. Xyoo dhau los, mob mob sab sab sternum thiab ua tsis taus pa thaum lub cev ua rau muaj kev ntxhov siab.
Keeb kwm kho mob
Raws li tus neeg mob, 2 xyoo dhau los, thaum lub sijhawm kuaj xyuas ib txwm muaj, cov ntshav siab ntxiv (7.7 mmol / l) tau tsim los.
Tus kws kho mob pom zoo ntxiv kev soj ntsuam, kev ntsuam xyuas ntawm carbohydrate kam rau ua.
Tus poj niam tsis quav ntsej tus kws kho mob cov lus pom zoo, txuas ntxiv ua nws txoj kev ua neej dhau los, hauv kev sib txuas nrog cov txiv neej xav noj ntau dua, nws tau hnyav 20 kg. Txog ib hlis dhau los, txog siav thiab mob hauv siab tshwm sim, pib pom tias muaj ntshav siab nce mus rau 160/90 hli Hg.
Ntawm kev pom zoo ntawm ib tus neeg nyob ze, nws tau thov cov nplooj zaub qhwv nrog zib ntab rau nws lub hauv pliaj, nqus ib nkawm qos rau, thiab nqa tshuaj Aspirin. Nyob rau hauv kev sib txuas nrog nce nqhis dej thiab nce tso zis (feem ntau yog thaum tsaus ntuj), nws nrhiav kev pab kho mob.
Anamnesis ntawm lub neej ntawm tus neeg mob
Yug rau lub Xya hli ntuj 15, 1952, thawj zaug thiab tsuas yog tus menyuam ntawm tsev neeg.Poj niam cev xeeb tub mas ib txwm muaj. Nws tau pub mis niam.
Cov xwm txheej hauv zej zog tau sau tseg tias yog qhov txaus siab (tus kheej lub tsev nrog txhua yam). Tau txais kev txhaj tshuaj tiv thaiv raws li lub hnub nyoog. Thaum muaj hnub nyoog 7 kuv tau mus kawm ntawv, muaj qhov nruab nrab zoo. Nws tau mob qhua dej thiab ua qoob.
Lub sijhawm pubertal tsis yooj yim, thawj zaug coj khaub ncaws muaj hnub nyoog 13 xyoos, ib hlis tsis tu ncua, tsis muaj mob. Lub hnub nyoog ntawm 49. Muaj 2 tus tub cov laus, muaj menyuam hauv plab thiab yug menyuam hauv ib txwm muaj, tsis muaj kev rho menyuam. Thaum muaj hnub nyoog 25 xyoos, kev khiav haujlwm rau kev tshem tawm pob txha caj qaum, tsis muaj qhov raug mob. Keeb kwm kev tsis haum yog tsis lub nra.
Tam sim no so haujlwm. Tus neeg mob nyob hauv kev txaus siab hauv zej zog, tau ua haujlwm rau 30 xyoo ua tus muag khoom hauv khw muag khoom noj khoom haus. Cov khoom noj tsis xwm yeem, carbohydrates yeej nyob hauv cov zaub mov noj.
Cov niam txiv tau tag sim neej thaum laus, kuv txiv tau raug mob ntshav qab zib hom 2, noj cov tshuaj txo cov ntshav qab zib. Haus dej cawv thiab siv tshuaj yeeb tsis haus, haus ib qho luam yeeb ib hnub. Kuv tsis tau mus txawv teb chaws, Kuv tsis nyob hauv kev sib cuag nrog cov neeg mob sib kis. Lub keeb kwm ntawm tus kab mob ntsws thiab mob rau daim siab tsis kam lees.
Kev soj ntsuam dav dav
Lub xeev ntawm sim hnyav. Qib ntawm kev nco qab yog qhov tseeb (GCG = 15 ntsiab lus), nquag, txaus, muaj rau cov khoom sib cuag. Qhov siab 165 cm, hnyav 105 kg. Hypersthenic physique.
Cov tawv nqaij yog daj ntseg liab, huv, qhuav. Ua kom pom cov qog ua kua yog xim liab, ntub dej.
Cov ntaub so ntswg mos turgor yog qhov txaus siab, microcirculatory mob tsis tau hais. Cov pob qij txha tsis deformed, txav rau tag nrho, tsis muaj o. Tsis kub ib ce. Cov leeg ntshav tsis ua kom loj. Cov thyroid caj pas tsis yog palpable.
Cov pa tshwj xeeb ua pa tawm ntawm cov pa hauv cov huab cua, NPV = 16 rpm, cov leeg ua haujlwm pabcuam tsis koom nrog. Lub hauv siab yog symmetrically koom nrog kev ua pa ntawm txoj pa, muaj txoj cai zoo, tsis deformed, yog tsis mob ntawm palpation.
Sib piv thiab thaj chaw ntawm lub cev nqaij daim tawv tsis pom (ciaj ciam ntawm lub ntsws tsis pub dhau ib txwm muaj). Auscultatory: vesicular ua tsis taus pa, symmetrically nqa tawm tag nrho cov pulmonary teb.
Hauv thaj tsam ntawm lub siab thaum kuaj, tsis muaj kev hloov pauv, tus txiv qhov ua tsis muaj tseeb yog tsis pom.
Cov mem tes yog palpated ntawm cov hlab ntsha peripheral, zoo sib xws, txhaws zoo, lub plawv dhia = 72 rpm, ntshav siab 150/90 hli Hg Nrog percussion, rau ib thaj tsam ntawm tsis thiab tus txheeb ze mob dullness yog tsis pub dhau ib txwm txwv. Auscultatory: lub suab nrov yog muffled, lub suab sib dhos yog qhov tseeb, pathological nrov tsis hnov.
Tus nplaig qhuav, npog nrog dawb txheej ntawm lub hauv paus, qhov nqos tau ua tsis tawg, lub ntuj yog tsis muaj yam ntxwv. Lub plab yog nce hauv ntim vim yog rog subcutaneous, siv kev ua pa. Tsis muaj cov cim ntawm portal tawg.
Nrog sab nqaij tawv palpation ntawm hernial tiv thaiv thiab mob tsis tau sau tseg.
Cov tsos mob Shchetkina - Blumberg tsis zoo. Sib sib zog nqus zawv zawg palpation yog qhov nyuaj vim muaj cov rog tshaj subcutaneous rog.
Raws li Kurlov, lub siab tsis ua kom siab, ntawm lub npoo ntawm cov nqi uas tsis tseem ceeb, palpation hauv lub zais plab yog qhov tsis mob. Cov tsos mob ntawm Ortner thiab Georgievsky yog qhov tsis zoo. Lub raum tsis yog palpable, tso zis yog dawb, diuresis yog nce. Neurological xwm txheej tsis muaj nta.
Kev txheeb xyuas cov ntaub ntawv thiab cov kev tshawb fawb tshwj xeeb
Txhawm rau kom paub tseeb cov kev kuaj mob, ntau cov kev tshawb fawb pom zoo:
- soj ntsuam ntshav kuaj: hemoglobin - 130 g / l, erythrocytes - 4 * 1012 / l, qhov taw qhia xim - 0.8, ESR - 5 hli / teev, leukocytes - 5 * 109 / l, stab neutrophils - 3%, ntu ntu nuclei - 75%, eosinophils - 3 %, lymphocytes -17%, monocytes - 3%;
- urinalysis: tso zis muaj xim - khaub thuas, tshuaj tiv thaiv - alkaline, protein - tsis muaj, piam thaj - 4%, cov qe ntshav dawb - tsis muaj, ntshav liab - tsis muaj;
- Kev kuaj ntshav biochemical: tag nrho cov protein - 74 g / l, albumin - 53%, globulin - 40%, creatinine - 0.08 mmol / litre, urea - 4 mmol / l, roj cholesterol - 7.2 mmol / l, ntshav qab zib 12 mmol / l.
Pom zoo kom soj ntsuam cov ntsuas ntsuas hauv kev ua kom zoo li qub
Cov ntaub ntawv tshawb fawb seev
Cov ntaub ntawv tshawb fawb txuas ntxiv tau txais:
- hluav taws xob hluav taws xob: sinus atherosclerosis, cov cim ntawm sab laug ventricular hypertrophy;
- xoo hauv siab: pulmonary teb yog huv si, sinuses yog pub dawb, cov cim qhia ntawm hypertrophy ntawm lub plawv sab laug.
Kev sab laj ntawm cov kws tshwj xeeb xws li tus kws kho paj hlwb, tus kws kho qhov muag thiab kws kho qhov muag vaum tau pom zoo.
Kev kuaj mob ua ntej
Mob ntshav qab zib Hom 2. Muaj mob hnyav.
Kev ncaj ncees rau kev kuaj mob
Muab cov lus tsis txaus siab ntawm tus neeg mob (nqhis dej, polyuria, polydipsia), keeb kwm kev kho mob (kev noj haus ntawm cov zaub mov carbohydrates), kev tshuaj xyuas lub hom phiaj (nce lub cev hnyav, tawv nqaij qhuav), kev kuaj thiab cov khoom siv (hyperglycemia, glucosuria), kev kuaj mob tuaj yeem ua tau.Lub Koom Haum Me Nyuam: hom 2 mob ntshav qab zib mellitus, mob nyhav, mob ncua.
Cov ntsiab lus loj: kub siab 2 theem, 2 degrees, muaj kev phom sij ntau. Keeb kwm yav dhau los: rog rog rog rog.
Kev Kho Mob
Pom zoo kom pw hauv tsev kho mob hauv endocrinological tsev kho mob txhawm rau xaiv kev kho.
Hom yog pub dawb. Noj - cov lej 9.
Txoj kev ua neej hloov txoj kev ua neej - poob phaus, ua si lub cev ntau ntxiv.
Qhov ncauj hypoglycemic tshuaj:
- Gliclazide 30 mg 2 zaug ib hnub, noj ua ntej noj mov, haus nrog ib khob dej;
- Glimepiride 2 mg ib zaug, thaum sawv ntxov.
Ntshav qabzib nyob rau hauv kev tswj hauv kev hloov pauv, nrog qhov tsis muaj txiaj ntsig ntawm kev kho, hloov mus rau insulin.
Kev kho ntshav siab
Lisinopril 8 mg 2 zaug ib hnub, ua ntej noj mov.
Related videos
Ntau ntxiv ntawm cov ntshav qab zib hom 2 hauv cov yeeb yaj kiab:
Nws yog ib qho tseem ceeb kom nco ntsoov tias hom ntshav qab zib hom 2 tuaj yeem raug kho tau zoo nrog rau kev noj haus thiab kev ua neej hloov kho. Kev kuaj mob tsis yog kab lus, tab sis tsuas yog kev zam rau kev saib xyuas koj li kev noj qab haus huv.
