Kev tswj ntshav qabzib hauv cov neeg mob Dialysis
Dec 29, 2022
Uremia belongs rau theem kawg ntawm ntau yam kab mob raum, thiab cov neeg mob uremia feem ntau xav tau kev kho mob hemodialysis kom ntev lawv txoj sia nyob. Nyob rau hauv xyoo tas los no, tus naj npawb ntawm cov neeg mob ntshav qab zib nephropathy tab tom ua rau hemodialysis tau nce ib hnub. Cov teeb meem thiab kev tuag ntawm cov neeg mob ntshav qab zib nrog kev saib xyuas hemodialysis yog siab dua li cov neeg mob uas tsis yog ntshav qab zib. Hypoglycemia feem ntau tshwm sim thaum hemodialysis, thiab nws qhov kev puas tsuaj loj dua. Mob hnyav; Txawm li cas los xij, qee cov neeg mob ntshav qab zib hauv hemodialysis tsis tau ua raws li txoj kev npaj hypoglycemia vim lawv ntshai hypoglycemia thaum lub sij hawm lim ntshav, ua rau hyperglycemia hnyav.
Nyem rau cistanche deserticola rau mob raum
Yog li ntawd, yuav ua li cas tswj cov ntshav qab zib kom zoo hauv cov neeg mob ntshav qab zib hemodialysis yog ib qho teeb meem ntsig txog kev lim ntshav uas yuav tsum tau daws sai.
Rau cov neeg mob ntshav qab zib uas tau txais hemodialysis, kev teeb tsa cov hom phiaj hypoglycemic yuav tsum ua raws li cov xwm txheej tshwj xeeb ntawm cov neeg mob thiab ua raws li lub hauv paus ntsiab lus ntawm tus kheej, uas txawv ntawm ib tus neeg mus rau lwm tus. Lub hauv paus ntsiab lus tseem ceeb tshaj plaws yog ua tib zoo saib xyuas kev nyab xeeb. "Kev txo qis qab zib yog qhov tseem ceeb, thiab tus nqi ntawm kev nyab xeeb yog siab dua." Ntawm qhov tod tes, hypoglycemia yuav tsum tau tiv thaiv, thiab ntawm qhov tod tes, mob metabolic mob, kab mob, thiab lwm yam teeb meem tshwm sim los ntawm pom tseeb hyperglycemia yuav tsum raug zam.
Xyoo 2019 tsab ntawm "Cov Lus Qhia Txog Kev Kho Mob rau Kev Tiv Thaiv thiab Kev Kho Mob Ntshav Qab Zib Kab Mob hauv Suav Teb" tau tshaj tawm cov hom phiaj tswj ntshav qab zib: HbA1c yuav tsum tsis pub tshaj 7 feem pua, thiab HbA1c yuav tsum tsis pub tshaj 8 feem pua rau cov neeg mob ntshav qab zib nephropathy nrog eGFR.<60ml·min-1·1.73m2. For elderly patients, the HbA1c control target can be appropriately relaxed to 8.5%. The 2020 edition of the "Expert Consensus on HbA1c Control Targets and Strategies for Adults with Type 2 Diabetes" in China recommends that HbA1c be controlled at 7.0% to 9.0%. However, since patients undergoing hemodialysis are often accompanied by anemia, the life span of red blood cells is shortened, which reduces the measured value of HbA1c. Therefore, the measured value of HbA1c in these patients should be interpreted cautiously and can be combined with glycated albumin and blood glucose monitoring results (fasting blood glucose, Postprandial blood glucose) to comprehensively evaluate blood glucose control status.
Cov neeg mob ntshav qab zib uas tau txais hemodialysis yuav tsum tau ceeb toom kom ntxiv dag zog rau kev saib xyuas tus kheej ntawm cov ntshav qab zib, tuav qhov xwm txheej ntawm kev tswj ntshav qab zib, kuaj ntshav qab zib hauv lub sijhawm, thiab kho cov tswv yim kho mob raws sijhawm. Tshwj xeeb tshaj yog thaum lim ntshav, cov ntshav qab zib hloov pauv thiab asymptomatic hypoglycemia feem ntau tshwm sim. Cov laj thawj feem ntau suav nrog cov hauv qab no: Ntawm ib sab, vim tias qhov hnyav molecular ntawm cov piam thaj me me thaum lub sij hawm lim ntshav, nws tuaj yeem nkag mus rau hauv daim nyias nyias nyias. Ntawm qhov tod tes, insulin yog ib qho loj molecule, uas tsis yooj yim rau kev tso tawm thaum lub sij hawm lim ntshav, thiab thaum lub raum tsis ua hauj lwm tshwm sim, qhov degradation ntawm insulin los ntawm lub raum yuav txo qis, thiab nws cov metabolic clearance ntawm insulin kuj yuav txo tau. , uas yuav yooj yim ua rau cov tshuaj insulin ntau hauv lub cev, Tsis tas li ntawd, hemodialysis tuaj yeem txo cov tshuaj insulin thiab txhim kho cov tshuaj insulin, yog li hypoglycemia feem ntau tshwm sim thaum lub sijhawm lim ntshav.
Diabetes Diet Guide for Hemodialysis Patients
Kev noj zaub mov kom tsim nyog ntawm carbohydrates, thiab tswj cov protein, dej, thiab sodium kom tsawg yog qhov tseem ceeb tshwj xeeb rau kev lim ntshav.
Cov neeg mob ntshav qab zib mellitus ntawm kev lim ntshav xaiv cov khoom noj uas muaj suab thaj tsawg, muab cov khoom noj txom ncauj ntawm cov pluas noj, thiab ua cov khoom noj kom raug los tswj cov ntshav qab zib. Tam sim no, tsis muaj cov txheej txheem kho mob cuam tshuam rau kev tawm tswv yim tswj kev ceev cov ntshav qabzib thiab 2- teev tom qab cov ntshav qabzib hauv cov neeg mob hemodialysis. Hais txog kev noj cov protein ntau, yog tias tus neeg mob tau lim ntshav txaus, cov protein ntau tuaj yeem ncav cuag 1. /2 (xws li qaib, nqaij nyuj, qe, thiab lwm yam).
Hais txog kev noj cov dej thiab sodium, cov neeg mob hyperglycemia muaj qhov xav tau nqhis dej, thiab nquag haus dej ntau dhau, thiab cov neeg mob ntshav qab zib yuav muaj edema. Qhov hnyav nce ntawm cov neeg mob lim ntshav yuav tsum tau tswj ntawm 3 feem pua rau 5 feem pua ntawm cov qauv cev hnyav. Yog tias tus neeg mob qhov hnyav qhuav yog 50 kg, qhov hnyav nce ntawm tus neeg mob ntawm kev lim ntshav txhua hnub yuav tsum tsis pub tshaj 1.5 kg, thiab qhov hnyav nce yuav tsum tsis pub tshaj 2.5 kg txhua ob hnub.
Kev saib xyuas mob ntawm cov tshuaj hypoglycemic hauv cov neeg mob hemodialysis
Kev sib cuam tshuam ntawm lub raum tsis ua haujlwm thiab cov tshuaj hypoglycemic yuav ua rau muaj kev cuam tshuam ntawm kev tswj cov ntshav qab zib kom ruaj khov, thiab cov metabolism hauv cov tshuaj hypoglycemic hauv cov neeg mob hemodialysis kuj tseem hloov pauv. Yog li, cov neeg mob hemodialysis yuav tsum tau hloov kho kom tsim nyog thaum siv cov tshuaj hypoglycemic. Kev kho.
Hauv 2016, "Cov Lus Qhia rau Kev Tswj Xyuas Cov Neeg Laus Mob Ntshav Qab Zib rau Hemodialysis" muab los ntawm Joint Inpatient Treatment Group (JBDS-IP) ntawm British Diabetes Society tau hais meej meej tias feem ntau cov neeg mob qhov ncauj hypoglycemic yuav tsum tau siv nrog ceev faj lossis txwv rau cov neeg mob hemodialysis. .
Piv txwv li, metformin tuaj yeem ua rau muaj kev pheej hmoo ntawm lactic acidosis thiab yuav tsum tau siv nrog ceev faj hauv cov neeg mob ntshav qab zib nephropathy, yuav tsum zam rau cov neeg mob CKD (theem 3b-5), thiab yuav tsum tsis txhob siv rau hauv cov neeg mob uas kho hemodialysis. ; sulfonylureas tuaj yeem ua rau muaj qhov tshwm sim ntawm hypoglycemia, cov neeg mob uas kho hemodialysis yuav tsum raug txwv; acarbose CKD (theem 4-5) yuav tsum tau zam, thiab nws tsis tau pom zoo siv rau cov neeg mob kho hemodialysis. SGLT-2 inhibitors tuaj yeem siv rau hauv cov kab mob raum thaum ntxov (CKD theem 1-3a) yam tsis muaj kev hloov tshuaj tab sis yuav tsum tau zam nyob rau hauv nruab nrab mus rau hnyav CKD (theem 3b-5). Rau kev txhaj tshuaj, qhov kev paub tam sim no nrog GLP-1RA hauv kev saib xyuas cov neeg mob hemodialysis tsis txaus, yog li nws tsis pom zoo siv. Cov lus qhia rau kev tiv thaiv thiab kev kho mob ntshav qab zib nephropathy qhia tias mob hnyav CKD (theem 4-5) yuav tsum zam.
Txhawm rau txhim kho lub neej zoo thiab zam qhov tshwm sim ntawm hyperglycemia hnyav lossis hypoglycemia, cov neeg mob ntshav qab zib uas tau kho hemodialysis yuav tsum tau txais kev kho mob insulin, thiab rau cov neeg mob ntshav qab zib tau txais kev kho mob insulin, kev siv cov piam thaj uas muaj dialysate yuav tsum zam thaum lub sij hawm lim ntshav. Qhov tseeb version ntawm kuv lub teb chaws "Cov Kws Tshaj Lij Pom Zoo ntawm Cov Tshuaj Hauv Qhov Ncauj Hypoglycemic rau Hom 2 Diabetic Patients with Chronic Kidney Disease" kuj pom zoo tias cov neeg mob CKD theem 3b -5 yuav tsum tau kho nrog insulin.
Kev ceev faj rau kev kho tshuaj insulin
Kev ceev faj rau kev kho tshuaj insulin muaj xws li:
1) Cov tshuaj insulin ntau npaum li cas sib txawv, yuav tsum tau them nyiaj rau kev txhaj tshuaj kom tsis txhob muaj kev phiv los ntawm kev noj tshuaj tsis raug;
2) Lub sijhawm nruab nrab thiab ua haujlwm ntev ntawm cov tshuaj insulin thiab cov pluas noj yuav tsis nruj, tab sis kev npaj ua kom sai yuav tsum tau siv 30 feeb ua ntej noj mov;
3) Qhov chaw txhaj tshuaj yuav tsum raug xaiv kom tsim nyog. Cov chaw siv feem ntau yog gluteus maximus, plab, thiab sab nraub qaum, thiab yuav tsum tau txhaj tshuaj lem;
4) Ua tib zoo saib xyuas cov tshuaj insulin, feem ntau khaws cia hauv lub tub yees ntawm 5 degree, lub sijhawm khaws cia ntev tuaj yeem ncav cuag 3 xyoos, tab sis feem ntau, nws tsuas yog khaws cia rau 3 lub hlis xwb;
5) Kev siv lub tswv yim ntawm cov tshuaj hypoglycemic rau hnub hemodialysis:
Kev npaj tshwj xeeb ntawm insulin, nws tuaj yeem muab faib ua 3 pawg:
① Txhaj tshuaj luv luv lossis ultra-short-acting insulin ua ntej noj mov, thiab tsis txhob siv cov pluas noj ua ntej hemodialysis; ② Txhaj tshuaj luv luv lossis ultra-short-acting ntxiv rau kev ua haujlwm nruab nrab lossis ua haujlwm ntev insulin ua ntej yuav mus pw, thiab tsis txhob siv cov zaub mov ua ntej hemodialysis; Txhaj tshuaj insulin sib xyaw ua ntej noj hmo, txo qhov koob tshuaj 1/3 ua ntej noj tshais, lossis txo cov tshuaj insulin raws li tus neeg mob yoo mov ntshav qab zib thiab noj zaub mov. Txawm li cas los xij, qee qhov kev tshawb fawb tau qhia tias kev ncua cov tshuaj insulin yuav ua rau cov neeg mob hyperglycemia tsis tu ncua, uas yuav ua rau muaj kev cuam tshuam tsis zoo, thiab kev cuam tshuam tsis zoo ib yam thaum cov koob tshuaj ntawm ntau hom insulin kuj yog halved. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum xav txog hom insulin thiab tus neeg mob tus mob los tsim ib qho kev npaj txo cov tshuaj insulin rau tus neeg mob kom ua tiav cov txiaj ntsig zoo tshaj plaws.
Cov kev tshawb fawb cuam tshuam tau pom tias thawj 2-3 teev ntawm hemodialysis yog nyob rau lub sijhawm ntawm qhov tshwm sim siab ntawm hypoglycemia. Yog li ntawd, kev tiv thaiv thiab kev kho mob ntawm hypoglycemia thaum lub sij hawm hemodialysis tuaj yeem teem sijhawm ntawm 2-3 teev ntawm hemodialysis, thiab kev soj ntsuam cov ntshav qabzib tuaj yeem ua tau nyob rau lub sijhawm no. Thaum lub sij hawm dialysis, tus neeg mob tau qhia kom noj kom zoo. Raws li tus neeg mob tus mob, cov neeg uas noj tau yuav tsum tau noj ua ntej. Yog tias lawv noj tsis tau, 50 feem pua ntawm cov piam thaj tau txhaj rau hauv cov ntshav, thiab cov koob tshuaj tau txiav txim siab raws li cov ntshav qab zib. Yog tias muaj hypoglycemia thaum lub sij hawm hemodialysis, ntsuas cov ntshav qab zib hauv lub sijhawm, txhaj 40-60 mL ntawm 50 feem pua qabzib tso rau hauv txoj hlab ntshav, ntsuas ntshav qab zib tom qab 15 feeb, thiab ua tib zoo saib xyuas tus mob.
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