Hypoglycemic syndrome yog txuam nrog kev tsis txaus ntawm cov piam thaj hauv tib neeg lub cev. Nws tuaj yeem tshwm sim tsis tau tsuas yog hauv cov neeg mob ntshav qab zib mellitus, tab sis kuj rau cov neeg noj qab haus huv. Tshwj xeeb tshaj yog feem ntau qhov tshwm sim no tshwm sim tom qab hnyav lub cev thiab kev yoo mov ntev, nrog rau cov poj niam cev xeeb tub.
Kev piav qhia
Hypoglycemic syndrome yog ib yam mob tshwm sim los ntawm cov ntshav qabzib ntawm < 2.75 mmol / L. Nyob rau hauv cov ntaub ntawv no, ntau yam teeb meem ntawm lub autonomic paj hlwb tshwm sim. Cov tsos mob no feem ntau cuam tshuam nrog ntshav qab zib mellitus, nrog cov teeb meem hauv cov txheej txheem ntawm kev kho cov piam thaj txo qis.
Nyob rau hauv tus neeg noj qab haus huv, qib qabzib tau tswj hwm ntawm qhov tsis tu ncua (nrog me ntsis sib txawv) nrog kev pab ntawm cov tshuaj hormones glycoregulatory. Yog tias nws cov ntsiab lus nyob rau hauv thaj tsam ntawm 2.75-3.5 mmol / L, cov tsos mob ntawm hypoglycemic syndrome yuav yog qhov tsawg lossis tsis tuaj. Kev poob qis hauv cov concentration yog cuam tshuam nrog kev ua txhaum ntawm kev nkag mus ntawm cov piam thaj rau hauv cov ntshav thiab nws cov kev noj los ntawm ntau cov ntaub so ntswg.
Raws li kev faib tawm thoob ntiaj tebCov kab mob ICD-10 hypoglycemic syndrome belongs rau 4th chav kawm ntawm pathologies txuam nrog cov kab mob ntawm endocrine system thiab metabolic ntshawv siab.
Yog vim li cas
Nyob rau hauv lub pathogenesis ntawm kev loj hlob ntawm hypoglycemia, muaj 2 pawg loj ntawm yam:
- Physiological. Tus mob no tshwm sim hauv cov neeg noj qab haus huv tom qab yoo mov thiab ploj ntawm nws tus kheej tom qab noj mov.
- YPathological. Pawg no yog vim pathologies ntawm endocrine system thiab lwm yam kabmob.
Hauv cov tshuaj niaj hnub no, muaj ntau dua 50 hom hypoglycemia. Pathological ua rau hypoglycemic syndrome yog:
- Cov yam ntxwv ntawm lub cev - adrenal tsis txaus; cov qog nqaij hlav hauv cov hlwb endocrine ntawm tus txiav; qaug zog heev ntawm lub cev, ua npaws ntev; loj malignant neoplasms nyob rau hauv daim siab thiab adrenal cortex; kis-tshuaj lom neeg poob siab; cov qog tsim cov tshuaj insulin (insulinomas); autoimmune insulin syndrome (thaum tsis muaj ntshav qab zib mellitus); kab mob ntshav siab (leukemia, lymphoma, myeloma); cov xwm txheej cuam tshuam nrog kev tsim cov tshuaj insulin ntau dhau (qhov teeb meem tom qab kev phais tom qab tshem tawm ib feem ntawm lub plab, thawj theem ntawm ntshav qab zib, nce rhiab heev rau leucine hauv cov menyuam yaus); daim siab pathology (cirrhosis, toxic lesions); pituitary insufficiency, txo zus tau tej cov tshuaj hormones thiab cortisol; muaj cov tshuaj tiv thaiv rau insulin receptors; congenital metabolic ntshawv siab nyob rau hauv daim siab (glycogenosis thiabaglycogenosis, aldolase enzyme deficiency, galactosemia).
- Lwm yam - haus cawv (vim li ntawd, kev noj qab haus huv ntawm daim siab txo qis); noj tej yam tshuaj (teev hauv qab no); kev noj zaub mov tsis txaus, noj tsis txaus ntawm carbohydrates nrog zaub mov; insulin overdose hauv kev kho mob ntshav qab zib mellitus; nce insulin rhiab heev, kev kho mob mus sij hawm ntev nrog cov tshuaj txo cov piam thaj.
Tshuaj uas ua rau hypoglycemia
Los ntawm cov tshuaj, tus mob no tuaj yeem ua rau muaj kev siv tshuaj xws li:
- Ysulfonylureas;
- salicylates ("Aspirin", "Askofen", sodium salicylate, "Asfen", "Alka-Seltzer", "Citramon" thiab lwm yam);
- tshuaj insulin thiab tshuaj hypoglycemic;
- tshuaj tiv thaiv kev nyuaj siab;
- sulfanilamide tshuaj tua kab mob ("Streptocid", "Sulfazin", "Sulfasalazine", "Sulfadimethoxin", "Ftalazol" thiab lwm yam);
- tshuaj tiv thaiv kab mob (kom tshem tawm cov tshuaj tsis haum);
- lithium npaj ("Mikalit", "Litarex", "Sedalite", "Priadel", "Litonite", GHB thiab lwm yam);
- beta-blockers ("Atenolol", "Betaxolol", "Bisoprolol", "Medroxalol" thiab lwm yam);
- NSAIDs.
Reactive Fasting Hypoglycemia
Ib hom hypoglycemia yog lig dumping syndrome. Hypoglycemic syndrome tshwm sim tom qab 2-3 teev tom qab noj mov (thaum ntxov, nqus cov piam thaj sai hauv cov hnyuv nrog cov tshuaj insulin ntau dhau) lossis 4-5 teev tom qab (kawg theem). Hauv qhov xwm txheej kawg, kev mob ntshav qab zib tsis ntev tuaj yeem qhia txog kev txhim kho ntawm thawj theem ntawm hom 2 mob ntshav qab zib mellitus. Hauv cov neeg mob zoo li no, tsis pub dhau 1-2 teev tom qab noj mov, cov piam thaj ntau dhau ntawm tus nqi ib txwm muaj, thiab tom qab ntawd poob qis dua qhov kev txwv.
Late hypoglycemia kuj pom nyob rau hauv cov neeg haus cawv nrog rau npias lossis kua txiv hmab txiv ntoo. Cov laj thawj tseem ceeb ntawm hypoglycemia yog cov kab mob metabolic hauv qab no:
- enzyme tsim tawm hauv daim siab;
- oxidation ntawm fatty acids;
- Ycarnitine metabolism;
- synthesis ntawm ketone lub cev.
Hypoglycemic syndrome tom qab noj mov hauv cov xwm txheej zoo li no tau pom txij li thaum yau, kev cuam tshuam los ntawm lub paj hlwb predominate. Kev tawm tsam tsis yog nyob ntawm hom khoom noj, thiab kev siv cov khoom qab zib alleviates tus neeg mob tus mob. Lub mechanism ntawm kev loj hlob ntawm xws li hypoglycemia tsis to taub zoo. Feem ntau muaj glycemic syndrome tom qab kev cob qhia lossis lwm yam kev ua ub no ntawm lub cev ua ke nrog kev noj mov tsis raws sijhawm.
Cov kws tshaj lij ntseeg tias qhov nrawm nrawm ntawm cov zaub mov ntawm lub plab mus rau hauv cov hnyuv ua rau muaj kev tsim cov tshuaj insulin ntau ntxiv hauv cov txiav, uas ua rau muaj kev loj hlob ntawm tus mob no.
Post-surgical hypoglycemia
Hypoglycemic syndrome tom qab phais tau pom hauv cov neeg mob tom qab kev phaiscov kab mob ntawm lub plab zom mov. Kev pheej hmoo yog cov neeg mob uas tau txais kev pab cuam phais hauv qab no:
- Kev txiav ib feem ntawm lub plab lossis cov hnyuv.
- Hla cov hlab ntsha vagus kom txo qis kev tsim cov hydrochloric acid hauv plab.
- Kev tshem tawm ntawm pylorus ua raws li kaw qhov tsis xws luag.
- Txuas lub jejunum rau lub qhov ua hauv plab.
Hypoglycemic syndrome tom qab phais plab tuaj yeem tshwm sim 1.5-2 teev tom qab noj mov. Qhov tshwm sim no cuam tshuam nrog kev ua txhaum ntawm lub reservoir ua haujlwm ntawm lub cev thiab kev nkag mus sai ntawm cov piam thaj rau hauv cov hnyuv me.
Tam sim tom qab yug me nyuam, tus menyuam txoj hlab ntaws ntshav qabzib nyob nruab nrab ntawm 60-80% ntawm leej niam cov ntshav qabzib. Tom qab 1-2 teev, theem ntawm cov tshuaj no txo qis. Tom qab 2-3 teev, nws pib stabilizes, vim yog lub siab ua haujlwm, cov txheej txheem ntawm kev faib glycogen rau cov piam thaj tau qhib. Hauv kev tshawb fawb txog kev kho mob, nws tau sau tseg tias yog tias tus menyuam tsis tau txais zaub mov thaum thawj hnub ntawm lub neej, ces hypoglycemia tshwm sim hauv yuav luag ib nrab ntawm tag nrho cov menyuam mos.
Ntau cov txheej txheem pathological thiab cov teeb meem muaj feem cuam tshuam tuaj yeem cuam tshuam qhov kev hloov pauv ib txwm muaj thiab ua rau cov neeg mob hypoglycemic syndrome:
- muaj ntshav qab zib mellitus thiab kub siab nyob rau hauv tus niam uas muaj kev cia siab, nws siv cov tshuaj narcotic, qee yam tshuaj (fluoroquinolones, quinine, beta-blockers, tshuaj antiepileptic);
- prematurity;
- oxygen starvation;
- hypothermia;
- niam xeeb ntau yam;
- kab mob ntshav (polycythemia thiab lwm yam);
- kab mob sib kis;
- paj hlwb puas;
- hormone deficiency;
- qhia txog "Indomethacin" (nrog rau qhov qhib ductus arteriosus) thiab Heparin;
- pathologies cuam tshuam nrog kev tsim cov amino acids tsis zoo thiab lwm yam kab mob.
Ib qho tsis zoo kuj yog qhov tseeb tias thaum cev xeeb tub cov poj niam tsis tau txais kev noj haus thiab lawv feem ntau txhaj cov piam thaj hauv cov hlab ntsha. Qhov kev pheej hmoo loj tshaj plaws ntawm hypoglycemia yog sau tseg hauv thawj 24 teev tom qab yug me nyuam, tab sis hauv qee cov menyuam yaus - txog li 3 hnub.
Cov menyuam mos yug tshiab muaj kev cuam tshuam rau tus mob no ntau dua li cov neeg laus, vim lawv muaj lub hlwb-rau-lub cev hnyav dua. Nws yog cov piam thaj uas muab ib nrab ntawm tag nrho lub zog xav tau ntawm tus menyuam (tus so yog cov amino acids thiab lactic acid). Cov hlwb hauv hlwb noj cov piam thaj ntau heev. Qhov txaus ntshai ntawm tus mob no nyob rau hauv qhov tseeb hais tias txawm lub sij hawm luv luv "kev tshaib kev nqhis" ntawm lub hlwb ua rau nws cov hlwb puas. Cov txiaj ntsig no yuav ua rau muaj tus cwj pwm mus sij hawm ntev thiab tom qab ntawd nthuav tawm nyob rau hauv daim ntawv ntawm kev puas siab puas ntsws thiab kev tsis pom kev hauv tus menyuam.
Raws li ICD-10, hypoglycemic syndrome nyob rau hauv cov me nyuam mos yog nyob rau pawg P-70. Nws kuj tseem tuaj yeem txhim kho hauv cov menyuam noj qab haus huv yog tias lawv qhov hnyav dua li 2.5 kg, vim tias lawv tau txo cov khw muag khoom glycogen thiab cov enzymatic system tseem tsis tau tsim. phom sijyog malnutrition ntawm leej niam cev xeeb tub (tshaib plab). Qhov xav tau ntawm cov piam thaj ib hnub rau cov menyuam yaus yog li 7 g.
Signs
Cov tsos mob ntawm hypoglycemic syndrome yog:
- kev tshaib nqhis;
- mob plab, xeev siab, ntuav;
- kev qaug zog;
- tshee tshee;
- saw;
- xav kub, liab lossis daj;
- lub plawv dhia, tachycardia, poob ntshav siab.
Los ntawm sab ntawm lub hauv nruab nrab lub paj hlwb, cov tsos mob hauv qab no tau sau tseg:
- kiv taub hau;
- drowsy;
- -hlawv cov kev xav, goosebumps;
- mob taub hau;
- muag qhov muag;
- pom kev tsis pom kev (ob npaug ntawm cov khoom);
- kev puas hlwb;
- txhawj xeeb;
- amnesia;
- tsis nco qab, tsis nco qab.
Qhov kev tshwm sim ntawm cov tsos mob no tuaj yeem sib txawv - los ntawm qhov mob me me, qhov kev tawm tsam ntev li ob peb feeb thiab tus neeg mob qhov kev mob tshwm sim zoo txaus, mus rau qhov hnyav, thaum cov neeg mob poob lawv lub peev xwm ua haujlwm. Rau cov neeg uas muaj insulinoma, tsuas yog qhov kev tsis txaus siab yuav tshwm sim sai heev thaum noj mov, hmo ntuj, lossis tom qab qoj ib ce.
Cov tsos mob hauv cov menyuam yug tshiab thiab menyuam mos
Cov menyuam mos yug tshiab tsis muaj cov cim tshwj xeeb ntawm hypoglycemia. Muaj ntau yam tshwm sim tuaj yeem ua ke nrog lwm yam pathologies. Yog li ntawd, tsuas yog txhim khu kev qha kev ntsuasyog qib ntawm cov piam thaj hauv cov ntshav. Cov menyuam mos uas raug mob tuaj yeem ntsib cov hauv qab no:
- pom kev cuam tshuam - ncig ntawm lub qhov muag, lawv qhov kev hloov pauv ntau zaus;
- xov tsis muaj zog quaj;
- limb tremor, lethargy or hyperexcitability;
- qaug zog, nquag regurgitation, tsis kam noj;
- tawm hws ntau dhau;
Hypoglycemic coma
Nyob rau theem kawg ntawm tus mob hypoglycemic syndrome los ntawm coma (tsis nco qab, ua tsis taus pa thiab lub plawv dhia). Yog vim li cas rau qhov no yog qhov tsis txaus ntawm cov piam thaj hauv cov paj hlwb ntawm lub paj hlwb, uas ua rau lawv qhov o thiab kev puas tsuaj rau cov cell membranes.
Lub ntsiab lus ntawm tus mob no yog:
- mob tshwm sim;
- tawm hws ntau dhau ntawm daim tawv nqaij;
- tsis muaj acetone ua pa tsw tsw;
- kev ua haujlwm tsav tsheb, convulsions.
Hypoglycemic coma tuaj yeem ua rau tsis muaj kev hloov pauv pathological hauv lub hauv paus paj hlwb, mus rau cerebral edema. Yog tias qhov tsis muaj qabzib nyob hauv lub sijhawm ntev, ces qhov tshwm sim tuag tshwm sim. Cov ntu ntu ntawm cov ntshav qab zib ntau dhau tom qab tshwm sim raws li kev hloov ntawm tus cwj pwm, nco tsis tau, kev puas siab puas ntsws, kev puas hlwb.
Diagnosis
Kev txheeb xyuas tus mob hypoglycemic yog ua raws li cov txheej txheem hauv qab no.
Cov kab mob neuropsychiatric mob hnyav feem ntau ua rau cov neeg mob raug kuaj tsis raug. Qhov no tau pom nyob rau hauv 75% ntawm cov neeg mob uas muaj insulinoma, uas ua yuam kev kho mob vwm, vegetovascular dystonia, neurasthenia.
Cov neeg mob uas muaj tus mob hypoglycemic, nrog rau cov neeg mob ntshav qab zib, yuav tsum tau saib xyuas tus kheej tsis tu ncua nrog glucometers.
Kev kho mob
Kev kho mob ntawm tus mob nyob ntawm nws theem (qhov hnyav). Hauv qhov mob me, nws txaus los noj cov zaub mov me me uas muaj cov carbohydrates yooj yim digestible (tshuaj yej nrog qab zib, syrup lossis compote raws li cov txiv hmab txiv ntoo qab zib, khoom qab zib, chocolate, jam).
Kev mob ntshav qab zib ntau dhau yuav tsum tau mus pw hauv tsev kho mob kom tsis txhob muaj teeb meem. Hauv tsev kho mob, 40% qabzib tov yog muab tso rau hauv cov hlab ntsha. Kev kho mob ntawm hypoglycemic coma yog nqa tawm hauv chav saib xyuas mob hnyav. Yog tias cov kua qab zib tsis pab, ces adrenaline lossis glucagon yog siv, tom qab ntawd tus neeg mob rov qab nco qab tsis pub dhau 15-20 feeb. Lwm yam tshuaj thiab kev kho mob kuj tseem siv:
- "Hydrocortisone" (yog tias tsis muaj txiaj ntsig ntawm cov tshuaj yav dhau los);
- glucose daws nrog cocarboxylase, insulin, potassium npaj (kom txhim kho metabolism);
- ascorbic acid tov;
- kev daws teeb meem ntawm magnesium sulfate, "Mannitol" (kom tiv thaiv cerebral edema);
- oxygen therapy;
- pub ntshav ntshav.
Tom qabTxhawm rau tshem tawm ntawm coma, tus neeg mob tau muab tshuaj uas txhim kho cov ntshav microcirculation thiab cov txheej txheem metabolic hauv lub cev:
- glutamic acid;
- "Aminalon";
- "Cavinton";
- Cerebrolysin thiab lwm yam.
Nyob rau hauv cov ntaub ntawv ntawm insulinoma, kev kho mob radical tshaj plaws yog kev phais tshem tawm cov qog.
Txhawm rau tiv thaiv tus mob no, cov neeg mob tau pom zoo kho kev noj zaub mov thiab noj cov zaub mov feem (tsawg kawg 5-6 pluas noj ib hnub). Cov neeg mob kuj tau txais kev kho mob physiotherapeutic (electrotherapy, hydrotherapy).
