Mob ntshav qab zib mellitus yog endocrine pathology uas yog fraught nrog tus lej ntawm cov mob thiab mob hnyav. Kev ua txhaum ntawm cov txheej txheem metabolic tshwm sim tawm tsam keeb kwm ntawm insulin kuj ua rau muaj kev cuam tshuam hauv kev ua haujlwm ntawm txhua qhov tseem ceeb hauv nruab nrog cev thiab kev siv tshuab.
Ib qho teeb meem txaus ntshai yog qhov kev txhim kho lub raum tsis ua haujlwm. Qhov tshwm sim yog kev ua txhaum ntawm kev zam tsis ua haujlwm, stagnation ntawm cov tshuaj phem hauv lub cev. Tawm tsam cov keeb kwm yav dhau los ntawm hyperglycemia, qhov pib ntawm kev them nyiaj rov qab rau hauv daim ntawv ntawm kev puas tsuaj rau tus kheej ntawm cov piam thaj thiab cov kev sib txuam hauv cov ntshav ntawm qhov ntau ntawm cov kab mob lactic acid, uas tsis muaj lub sijhawm yuav raug zam vim yog teeb meem lub raum. Tus mob no yog hu ua lactic acidosis. Nws yuav tsum tau kho tam sim ntawd thiab tuaj yeem ua rau kom muaj kev lactic acidosis tsis xeev rov qab.
Cov ntaub ntawv dav dav
Lactic acidosis hauv type 2 diabetes mellitus tsis yog mob ua ke, txawm li cas los xij, nws hnyav heev. Qhov txiaj ntsig tau tshwm sim tsuas yog pom hauv 10-50% ntawm qhov xwm txheej. Lactate (lactic acid) tshwm sim hauv lub cev vim qhov piam thaj ntawm cov piam thaj, tab sis lub raum tsis muaj peev xwm ua kom nws cov ntshav ntau npaum li ntawd.
Kev kuaj mob kuaj pom - lub hauv paus rau kev lees paub qhov kev kuaj mob
Oversaturation ntawm txoj hlab ntshav nrog lactate ua rau kev hloov pauv hauv nws cov acidity. Kev kuaj mob tau lees paub los ntawm kev txiav txim siab txog qib lactic acid siab tshaj 4 mmol / L. Lub npe thib ob rau qhov kev cuam tshuam txog ntshav qab zib no yog lactic acidosis.
Cov laj thawj tseem ceeb
Lactic acidosis hauv ntshav qab zib hom 2 tsis pom nyob hauv txhua tus neeg mob, tab sis tsuas yog nyob hauv qab ntawm qee yam cuam tshuam:
Cov tsos mob ntawm Hyperglycemic Coma- pathology ntawm cov txheej txheem hauv metabolic ntawm cov noob keeb kwm yav dhau los;
- qhov kev qhia ntawm ib qho tseem ceeb ntawm fructose mus rau hauv lub cev, kev hla lub plab zom mov;
- dej cawv lom;
- kev puas tsuaj tshuab;
- los ntshav
- o, kis kab mob;
- cyanide lom, ntev ntev ntawm kev siv salicylates, biguanides;
- mob ntshav qab zib mellitus, kev siv tshuaj tsis tuaj yeem tswj kav, ua ke nrog lwm yam kev cuam tshuam;
- hypovitaminosis B1;
- daim ntawv ceev heev ntawm anemia.
Pathology tuaj yeem txhim kho tsis tsuas yog tiv thaiv keeb kwm ntawm "tus kab mob qab zib", tab sis kuj tom qab lub plawv nres, mob hlab ntsha tawg.
Kev tsim kho tshuab
Tom qab cov carbohydrates nkag mus rau tib neeg lub cev los ntawm kev mob hnyuv, cov txheej txheem ntawm lawv cov hniav lwj tau kav hauv ntau theem. Yog tias tsis muaj cov tshuaj insulin txaus (qhov no tshwm sim rau theem tom qab ntawm hom 2 yam nrog kev qias neeg ntawm cov kab mob pancreatic), kev rhuav tshem ntawm cov carbohydrates rau hauv dej thiab lub zog tau qeeb qeeb tshaj qhov tsim nyog thiab yog nrog cov kev txuam nrog pyruvate.
Vim lub fact tias cov ntau qhov ntsuas ntawm pyruvate ua siab, lactic acid tau sau hauv cov ntshav. Nws nyhav rau kev ua haujlwm ntawm cov nruab nrog sab hauv hauv txoj hauv kev lom.
Lactic acid molecule - ib yam khoom uas muaj cov cev ntau zuj zus hauv lub cev ua rau kev txhim kho ntawm cov kab mob lactic acidosis
Qhov tshwm sim yog txoj kev loj hlob ntawm hypoxia, uas yog, lub hlwb thiab cov nqaij ntawm lub cev yuav tsis tau txais oxygen txaus, uas ntxiv rau kev ua rau lub xeev ntawm acidosis. Qib no cov ntshav pH ua rau qhov tseeb tias cov tshuaj insulin poob nws cov haujlwm ntau dua, thiab cov lactic acid nce siab dua thiab siab dua.
Nrog kev muaj mob ntawm cov mob pathological, mob ntshav qab zib ua rau lub cev tsis nco qab yog tsim, nrog rau intoxication ntawm lub cev, lub cev qhuav dej thiab acidosis. Cov kev pom zoo li no tuaj yeem ua rau neeg tuag taus.
Neej Neeg
Cov tsos mob ntawm tus kab mob lactic acid ntau ntxiv hauv ob peb teev. Feem ntau, tus neeg mob yws ntawm cov duab hauv qab no:
- mob taub hau
- Kiv taub hau
- bouts ntawm xeev siab thiab ntuav;
- tsis nco qab zoo;
- mob hauv plab;
- tsav tsheb tsis zoo;
- mob leeg
- tsaug zog lossis, hloov pauv, pw tsis tsaug zog;
- nquag ua pa nrov.
Cov tsos mob zoo li no tsis yog tshwj xeeb, vim tias lawv tuaj yeem pom tsis yog nrog kev txuam nrog ntawm cov kab mob lactic acid, tab sis kuj tiv thaiv keeb kwm ntawm ntau cov teeb meem ntxiv.
Coma yog lub cim ntawm theem kawg hauv kev txhim kho cov mob lactic acidosis. Nws ua ntej los ntawm kev ua kom tsis zoo ntawm tus neeg mob lub cev, lub ntsej muag tsis muaj zog, daim tawv nqaij qhuav thiab cov qog ua kua, Kussmaul's ua pa (nrov nrov nrawm nrog ua pa sib dhos). Lub suab ntawm tus neeg mob lub qhov muag qis qis dua, lub cev kub nce txog 35.2-35.5 degrees. Ntsej muag ntawm lub ntsej muag yog ntse dua, ob lub qhov muag sagging, zis tsis tuaj. Tsis tas li ntawd, muaj kev kub ntxhov ntawm kev nco qab.
Kev loj hlob ntawm kev hnov qab yog zaum kawg ntawm kev ua kom mob ntshav qab zib
Cov txheej txheem yuav ua tau nyuaj ntxiv los ntawm kev txhim kho DIC. Qhov no yog ib qho mob uas cov ntshav intravascular coagulation tshwm sim, kev tsim cov ntshav khov heev.
Kev kuaj mob
Kev kuaj pom cov kab mob pathology yog qhov nyuaj txaus. Raws li txoj cai, qhov xwm txheej yuav paub tseeb los ntawm kev kuaj ntsuas. Hauv cov ntshav muaj theem siab ntawm lactate thiab lub sij hawm anionic ntawm lub ntshav. Cov ntsiab lus hauv qab no qhia qhov kev loj hlob ntawm pathology:
- qhov ntsuas ntawm lactate siab dua 2 mmol / l;
- cov lus qhia ntau ntawm bicarbonates tsawg dua 10 mmol / l, uas yuav luag ob zaug qis dua li ib txwm;
- theem ntawm nitrogen thiab nws cov derivatives nyob rau hauv cov ntshav nce;
- lactic acid yog 10 npaug ntau dua pyruvic acid;
- rog qhov taw qhia yog qhov nce ntxiv;
- ntshav acidity hauv qab 7.3.
Pab thiab tswj cov kev paub ua tiav
Kev pab kho mob yuav tsum yog txhawm rau tiv thaiv kev hloov pauv hauv cov ntshav acidity, poob siab, hluav taws xob tsis txaus. Nyob rau hauv parallel, endocrinologist kho qhov kev kho mob ntawm hom 2 mob ntshav qab zib mellitus.
Txij li thaum cov pa roj carbon monoxide ntau tsim los tiv thaiv keeb kwm ntawm kev ua txhaum ntawm cov ntshav acidity, cov teebmeem no yuav tsum tau muab tshem tawm. Tus neeg mob hla ntawm hyperventilation ntawm lub ntsws (yog tias tus neeg mob tsis nco qab lawm, ces yuav tsum muaj kev nkag mus).
Cov ntshav qabzib luv luv nrog insulin yog txhaj rau hauv cov hlab ntsha (rau kev kho cov teeb meem ntawm cov khoom noj tiv thaiv ntshav qab zib), ib qho kev daws teeb meem ntawm sodium bicarbonate. Vasotonics thiab cardiotonics tau sau tseg (tshuaj los txhawb kev ua haujlwm ntawm lub plawv thiab cov hlab ntsha), heparin thiab reopoliglukin yog muab rau hauv cov tshuaj me me. Siv tshuaj ntsuas kab mob hauv ntshav, ntshav acidity thiab qib potassium yuav raug saib xyuas.
Txoj kev lis ntshav loj yog ib qho tseem ceeb ntawm kev kho mob ntshav qab zib mob ntsws lactic acidosis
Nws tsis tuaj yeem kho tus neeg mob hauv tsev, vim tias txawm tias cov kws tshaj lij muaj peev xwm tsis tuaj yeem muaj sijhawm los pab tus neeg mob. Tom qab ua kom ruaj khov, nws yog ib qho tseem ceeb kom soj ntsuam kev pw hauv txaj, noj zaub mov nruj, thiab soj ntsuam cov ntshav siab, acidity, thiab ntshav qab zib.
Kev Tiv Thaiv
Raws li txoj cai, nws tsis tuaj yeem kwv yees kev txhim kho ntawm cov kab mob lactic acidosis hauv ntshav qab zib hom 2. Lub neej ntawm tus neeg mob nyob ntawm cov tib neeg uas nyob ib puag ncig nws thaum lub sijhawm txhim kho cov teeb meem, thiab cov kev tsim nyog ntawm cov neeg ua haujlwm kho mob uas tuaj txog ntawm kev thov.
Txhawm rau tiv thaiv kev txhim kho ntawm pathology, cov lus qhia ntawm kev kho tus mob endocrinologist yuav tsum nruj me ntsis, thiab cov tshuaj muaj ntshav qab zib kom tsawg yuav tsum tau noj nyob rau hauv lub sijhawm thiab noj tshuaj. Yog tias koj tsis tau noj tshuaj, koj tsis tas yuav noj ob zaug dua lwm zaus tom qab noj. Koj yuav tsum haus cov tshuaj uas tau teev tseg nyob rau ib zaug.
Thaum lub caij cov mob uas kis tau tus mob los yog kis tau, tus mob ntshav qab zib tuaj yeem hnov mob tsis haum rau siv tshuaj kho. Thaum thawj cov tsos mob tshwm sim, koj yuav tsum hu rau tus kws kho mob tshwj xeeb txog kev noj tshuaj kho thiab kho dua tshiab.
Nws yog ib qho tseem ceeb kom nco ntsoov tias lactic acidosis tsis yog kab mob uas "ploj mus". Nrhiav kev pab kom raws sij hawm yog tus yuam sij rau qhov txiaj ntsig kom tau.
