Hypercalcemia yog ib qho mob txaus ntshai rau lub cev, thiab txawm tias me ntsis ntawm nws cov nqi, lees paub tias yog tus qauv, yuav tsum tau saib xyuas. Cov calcium ntau dhau tuaj yeem cuam tshuam rau kev ua haujlwm ntawm cov kabmob feem ntau, suav nrog cov tseem ceeb tshaj plaws xws li lub hlwb, ob lub raum thiab lub plawv.
Hypercalcemia - yog dab tsi?
Hypercalcemia yog ib yam mob uas cov calcium ntau hauv cov ntshav siab dhau lawm. Cov khoom no plays lub luag haujlwm tseem ceeb hauv kev ua haujlwm ntawm lub cev. Txawm tias menyuam yaus paub txog nws. Cov niam txiv, cov kws qhia ntawv txhawb kom lawv haus cov mis nyuj thiab piav qhia tias nws muaj cov kab mob, ua tsaug uas lawv yuav loj hlob thiab muaj pob txha noj qab nyob zoo. Hauv tib neeg lub cev, 99% ntawm cov khoom siv calcium muaj nyob hauv cov pob txha thiab tsuas yog 1% hauv cov ntshav. Cov kab mob cuam tshuam tsis tsuas yog cov pob txha, tab sis kuj tseem ua haujlwm ntawm lub plawv, cov leeg, cov hlab ntsha thiab cov txheej txheem ntshav coagulation. Tab sis nrog kev noj ntau dhau ntawm calcium carbonate ntsev thiab ntau tshaj ntawm hydrochloric acid nyob rau hauv lub plab, muaj kev nqus ntawm cov khoom los ntawm txoj hnyuv thiab.nws txo excretion los ntawm ob lub raum. Yog tias tus mob no mob ntev, nws ua rau calcium deposition ntawm lub pob kws, ob lub raum, plab mucosa, cov ntaub so ntswg nyob ib ncig ntawm cov pob qij txha, thiab cov phab ntsa vascular.
Hypercalcemia thiab mob qog noj ntshav
Nyob rau hauv chav kawm ntawm ntau yam kab mob neoplastic, cov txheej txheem ntawm kev puas tsuaj ntawm cov pob txha pob txha tshwm sim. Osteolysis ua rau cov pob txha metastases. Feem ntau cov pob txha mob cancer tshwm sim los ntawm ntau yam myeloma, oncology ntawm lub mis, prostate, mob ntsws cancer, thyroid cancer, zais zis cancer. Pob txha metastases kuj tuaj yeem tshwm sim nrog lwm cov qog.
Yog vim li cas
feem ntau ua rau muaj calcium ntau tshaj yog:
- Kev nqus ntau dhau ntawm cov khoom hauv plab hnyuv.
- Vitamin D overdose.
- Endogenous zus tau tej cov vitamin D los ntawm cov hlwb nyob rau hauv tej qog nqaij hlav (xws li Hodgkin tus kab mob) los yog nyob rau hauv cov kab mob ntev (xws li sarcoidosis).
- pob txha mob ntau dhau.
- pob txha hlav.
- ntau dhau ntawm cov tshuaj parathyroid hormone, kev loj hlob hormone, thyroxine, adrenaline.
- Ntev mus ntev ua rau muaj calcium ntau ntxiv los ntawm cov pob txha.
- YHypervitaminosis A.
- Siv tshuaj xws li thiazides.
- Iron toxins.
qog nqaij hlav tuaj yeem tso cov tshuaj parathyroid hormone (PTH), uas ua rau cov calcium ntau dhau. Cov tsos mob ntawm poj niamhypercalcemia feem ntau tshwm sim hauv mob qog noj ntshav mis, mob qog noj ntshav zes qe menyuam thiab mob raum.
Kev faib tawm
Kev kho mob ntawm hypercalcemia nyob ntawm qhov concentration ntawm calcium hauv cov ntshav yog raws li hauv qab no:
- light (< 3.2 mmol / L);
- hnyav (> 3.4 mmol / L).
3, 2-3, 4 mmol / l;
Hypercalcemic ntsoog yog ib yam mob uas ua rau muaj kev phom sij rau lub neej (≧ 3.7 mmol/L).
Tshawb nrhiav nrog cov calcium ntau hauv cov ntshav
- Qhov concentration ntawm ionized calcium yog qhov tseeb dua qhov cim ntawm qhov hnyav ntawm hypercalcemia. Cov cai hauv chav kuaj yog 1-1.3 mmol / l.
- Kev xav ntawm creatinine, chlorides, phosphates, magnesium los ntsuas lub raum ua haujlwm.
- PTH concentration.
- Kev xav ntawm vitamin D metabolites.
- Alkaline phosphatase concentration rau kev ntsuam xyuas pob txha resorption.
Yog tias cov calcium ntau dhau nrog cov qib PTH qis, koj yuav tsum xav txog seb puas yog mob qog noj ntshav. Txhawm rau kom paub meej qhov xwm txheej no, koj yuav tsum hu rau tus kws kho mob oncologist kom sai li sai tau.
Yog tias hypercalcemia nrog rau qib PTH siab, hyperparathyroidism feem ntau yog qhov ua rau. Txhawm rau kho tus kab mob, nws yog qhov zoo dua mus ntsib kws kho mob endocrinologist.
Symptoms
Hypercalcemia nws tus kheej yog cov tsos mob ntawm ntau yam kab mob hnyav, thiab cov teebmeem ntawm cov kabmob sab hauv tuaj yeem ua rau muaj kev phom sij thiab rov qab tsis tau.
Cov tsos mob ntawm cov calcium ntau dhau:
- ua rau lub raum tsis ua haujlwm: ua rau polyuria, lub cev qhuav dej, ua kom lub cev tawm hauv cov zis, uas ua rau lub raum pob zeb;
- Cov kab mob hauv plab: xeev siab, ntuav, tsis qab los noj mov, cem quav, peptic rwj ntawm lub plab lossis duodenum, mob pancreatitis. Feem ntau muaj xim hlau saj hauv qhov ncauj;
- cov tsos mob plawv: kub siab, tachycardia (nce plawv dhia), arrhythmia (lub plawv dhia tsis xwm yeem),
- cov tsos mob ntawm lub hauv nruab nrab paj hlwb: mob taub hau, tsaug zog, txawm coma;
- cov tsos mob neuromuscular: cov leeg tsis muaj zog, lub ntsej muag tuag tes tuag taw.
Yog tias qhov concentration ntawm microelement hauv cov ntshav siab tshaj 3.7 mmol / l, hypercalcemic ntsoog tshwm sim. Qhov no yog cov tsos mob txaus ntshai nrog kev tsis nco qab, mob plab hnyav, ntuav thiab xeev siab, polyuria ua rau lub cev qhuav dej, arrhythmias (ECG hloov pauv tuaj yeem ua rau lub plawv nres) thiab coma.
Kev kho mob
Tom qab kuaj pom cov tsos mob ntawm calcium ntau dhau hauv lub cev, qhov ua rau (mob) yuav tsum raug txiav txim siab thiab kho tus mob. Tom qab kev kho mob, nws raug nquahu kom rov sim kuaj xyuas cov teebmeem ntawm kev kho mob.
Kev kho yuav tsum pib los ntawm kev muab cov kua dej ntau rau lub cev. Ib qho 0.9% NaCl tov yog qhov zoo tshaj plaws siv vim tias cov tshuaj calcium uas muaj cov ntshav siab ntau feem ntau nrog hyponatremia. Nws tau kwv yees tias nrog kev nce qib ntawm hypercalcemia, cov kua dej tsis txaus yog 3-6 litres. Feem ntau3-4 litres ntawm 0.9% NaCl yog siv nyob rau hauv thawj 24 teev, thiab nyob rau hauv cov hnub tom ntej - 2-3 litres / 24 teev. Kev ywg dej zoo yog qhov tseem ceeb los txhim kho lub raum ntws thiab tso cai rau Furosemide kom txo cov calcium hauv cov ntshav, tab sis qhov no tsuas yog siv tau rau 15% ntawm cov neeg mob. Tus nqi ntawm cov kua dej yuav tsum tau hloov kho tus kheej nyob ntawm lub xeev ntawm kev ncig thiab lub raum. Qee lub sij hawm subcutaneous irrigation (hypodermolysis) yog siv es tsis txhob ntawm qhov ncauj los yog intravenous tswj.
kauj ruam tom ntej hauv kev tawm tsam hypercalcemia yog kev siv bisphosphonates kom txo qis kev ua haujlwm ntawm osteoclast. Cov txiaj ntsig tshwj xeeb yog nitrogen bisphosphonates, piv txwv li pamidronate, alendronate thiab zolendronate thiab clodronate.
Calcitonin yog lwm yam tshuaj uas txo cov calcium hauv cov ntshav. Nws cuam tshuam nrog kev ua haujlwm ntawm osteoclasts thiab nres lub reabsorption ntawm cov kab hauv cov tubules ntawm ob lub raum. Kev nce hauv nws cov excretion ua rau muaj kev kho mob sai. Vim tias cov nyhuv luv luv los ntawm tachyphylaxis, uas feem ntau tshwm sim tom qab ib lub lim tiam, calcitonin tsuas yog siv thaum pib kho lossis ua ke nrog bisphosphonate. Kev sib xyaw ua ke yog pom zoo rau hypercalcemia siab dua 3.5 mmol / L. Kev siv cov tshuaj corticosteroids yog pom zoo tshwj xeeb tshaj yog nyob rau hauv cov ntaub ntawv ntawm overproduction ntawm vitamin D3. Kev siv cov phosphates hauv qhov ncauj niaj hnub tsis pom zoo vim muaj peev xwm ua rau cov ntaub so ntswg calcification thiab raws plab.
Radioactive isotopes (lawv kev tswj hwm) - lwm txoj kev kho mob rau hypercalcemia tshwm sim los ntawm qog noj ntshavkab mob. Lawv xaiv nyob rau hauv cov pob txha vim lawv affinity rau phosphorus tebchaw thiab rhuav tshem cov qog nqaij hlav cancer los ntawm irradiating lawv. Tsis zoo li kev kho hluav taws xob classical, hluav taws xob tsuas yog tsom rau thaj tsam tam sim ntawm lub cev pob txha, uas tsis txhob irradiation ntawm cov ntaub so ntswg noj qab haus huv. Isotopes ntawm strontium, iodine, phosphorus thiab yttrium yog siv. Iodine feem ntau yog siv los kho cov pob txha metastases hauv thyroid thiab prostate cancer. Feem ntau siv isotope ntawm strontium zoo txo qhov mob hauv 80% ntawm cov neeg mob, cov nyhuv analgesic kav rau lub hlis lossis ntau dua.
kho mob
Lub hom phiaj tseem ceeb ntawm kev kho cov tsos mob yog txhawm rau txo cov tsos mob cuam tshuam nrog hypercalcemia. Kev kho kev tu tsis yog tsuas yog qhov zoo xwb, tab sis kuj yog lub neej expectancy ntawm cov neeg mob nrog pob txha metastases. Feem ntau ua rau cov tsos mob ntawm kev kho mob yog qhov pib ntawm qhov mob. Cov mob no tsis tu ncua, lawv feem ntau hnyav thiab tsis zoo rau kev nplij siab ntawm tus neeg mob lub neej. Hauv kev kho mob, peb-kauj ruam thiaj li hu ua analgesic ladder yog siv. Qhov pib ntawm kev kho mob yog nqa tawm nrog cov tshuaj narcotic nrog maj mam nce hauv lawv cov koob tshuaj thiab kev hloov mus rau cov pab pawg tom ntej ntawm cov tshuaj yog tias qhov mob tshwm sim. Nws yog ib qho tseem ceeb heev uas yuav tau ua raws li koj tus kws kho mob cov lus qhia thiab noj koj cov tshuaj nyob rau lub sijhawm tshwj xeeb. Cov tshuaj kho mob raug pom zoo nrog rau cov tshuaj txhawb nqa. Cov no suav nrog cov tshuaj tiv thaiv kab mob (steroids).
Calcium ntau dhau thiab noj zaub mov: Cov zaub mov twg yuav tsum zam?
Hauv kev kho mob hypercalcemia, kev noj zaub mov kom tsim nyog kuj tau pom zoo - qis hauv calcium thiab nplua nuj hauv phosphorus. Phosphates nce qhov tso tawm cov kab mob los ntawm lub cev. Cov neeg raug mob los ntawm tus mob no yuav tsum txwv tsis pub noj cov cheese daj, tsev cheese, taum dawb thiab noob hnav.
Raws li cov kws kho mob, ntau dhau ntawm calcium carbonate hauv cov pob qij txha tuaj yeem tshwm sim los ntawm kev siv cov dej tsis tu ncua nrog cov ntsiab lus siab ntawm cov khoom no. Cov dej tawv kuj ua rau tsim cov pob zeb raum thiab cov kua tsib. Yog li ntawd, nws raug pom zoo kom haus cov dej lim dej thiab txwv tsis pub haus cov dej ntxhia, uas kuj muaj ntau yam kab mob.
Nws yuav tsum nco ntsoov tias kev noj zaub mov zoo li no ua rau muaj kev rog, yog li kev noj zaub mov me me tab sis tsis tu ncua raug pom zoo. Los ntawm kev tshem tawm cov calcium, koj yuav tsum nco ntsoov muab lub cev nrog cov khoom noj tseem ceeb xws li cov protein, rog, carbohydrates, vitamins thiab ntxhia ntsev.
