Ua ntej cev xeeb tub
Yog tias koj muaj ntshav qab zib, yuav tsum tau npaj muaj menyuam. Pib kev sib txuas lus nrog ib tug kws kho mob pojniam endocrinologist tsawg kawg li rau lub hlis ua ntej kev sim neej thiab sim ua kom tau txais kev nplua nyiaj rau cov ntshav qab zib.
Hom mob ntshav qab zib thiab txoj kev ua neej
Ntshav qab zib mellitus yog ib qho mob ntxiv hauv qab zib (piam thaj) hauv cov ntshav thiab cov zis.
- Muaj cov hom mob ntshav qab zib nram qab no:
1. Ntshav qab zib ntawm thawj hom yog insulin-nyob nrog. Vim li cas, insulin nyob rau hauv lub cev tsis yog tsim los ntawm nws tus kheej, vim li ntawd, cov suab thaj tsis ua tiav. Tsis tshua muaj pes tsawg ntawm cov piam thaj hauv cov ntshav hu ua hypoglycemia, ntshav qab zib heev - hyperglycemia. Thaum twg yog qhov tsim nyog los soj ntsuam lub cev ntawm lub cev ketone hauv cov zis. Kev noj zaub mov kom haum thiab lub cev qoj ib ce, kev soj ntsuam xyuas ntshav qab zib yuav ua rau lub neej ntawm ib tug neeg mob nrog hom 1 mob ntshav qab zib mellitus kom nyob ze rau qhov qub.
2. Ntshav qab zib ntawm hom ob yog tsis txuam nrog cov tshuaj insulin. Feem ntau tshwm sim rau cov neeg muaj hnub nyoog 40 xyoo nrog nrog ntau lub cev qhov hnyav.
3. Pancreatic diabetes. Kev tsim tawm rau cov neeg uas muaj tus txiav ua rau lub cev, lub luag hauj lwm hauv lub cev rau kev tso pa ntawm insulin.
4. Lub npe hu ua ntshav qab zib mellitus ntawm cov poj niam cev xeeb tub, los yog gestational diabetes mellitus (HSD). Qhov no yog qhov ua txhaum cai ntawm cov kab mob carbohydrate, uas tshwm sim los yog thawj zaug paub thaum cev xeeb tub. Hauv li ntawm ib nrab ntawm cov neeg mob, GDD kis tau tom qab yug me nyuam tsis muaj kab, thiab ib nrab - tsim rau hom 2 mob ntshav qab zib.
Cov mob loj yog qhov mob ntawm cov ntshav qab zib thiab tsis tuaj yeem ua teeb meem loj (mob tsis ua hauj lwm hauv lub cev, mob qog nqaij hlav hauv lub plawv, mob qog nqaij hlav nrog cov hlab ntsha tshiab ntawm lub fundus, thiab lwm yam). Tiv thaiv kom tsis txhob muaj cov kab mob ntshav qab zib, nws yog ib qho txaus ntshai heev rau tus cev xeeb tub: ntshav qab zib siab tuaj yeem tiv thaiv kom txhob tso tus me nyuam hauv plab hauv lub plab, uas tshwm sim feem ntau hauv thawj peb lub hlis cev xeeb tub. Tsis tas li ntawd, qaub ncaug tuaj yeem tshwm sim. Nws yuav raug coj mus kuaj mob ua ntej: xws li lwm tus poj niam, nws yuav tsis tuaj yeem kuaj xyuas cov kab mob kis tau los ntawm kev sib deev, nrog ib tug kws kho paj hlwb, ib tug kws kho mob (qhov no yog qhov kev kuaj ntshav qab zib tshaj 10 xyoo), oculist - mus kuaj xyuas cov hlab ntsha ntawm lub fundus, nrog rau tus menyuam kawm ntawv. Ua ultrasound ntawm cov thyroid caj pas thiab mus xyuas cov kws kho mob endocrinologist. Yog tias tsim nyog, mus xyuas tus kws kho mob nephrologist thiab mus rau qhov kev sab laj hauv chaw ua haujlwm "Diabetic Stop". Cov kev kuaj sim nram qab no yuav tsum ua:
♦ glycated hemoglobin;
♦ microalbuminuria (UIA);
♦ kuaj ntshav kuaj ntshav;
♦ kuaj ntshav biochemical (creatinine, protein ntau, albumin, bilirubin, tag nrho cov cholesterol, triglyceride, ACT, ALT, qabzib, uric acid);
♦ kev ntsuam xyuas zis;
♦ Kev soj ntsuam ntawm qhov ntsuas tau glomerular (Reberg's test);
♦ Kev ntsuam xyuas tsom rau Nechiporenko;
♦ Kev noj zaubmov kom muaj kev sib txig (yog tias tsimnyog);
♦ kev txheeb xyuas kev ua haujlwm ntawm cov thyroid (kev xeem rau TTG dawb T4, AT rau TPO).
Thaum cev xeeb tub
Cev xeeb tub rau cov poj niam uas muaj SD-1 muaj ntau tus yam ntxwv. Cov neeg uas muaj ntshav qab zib paub txog lawv cov ntshav qab zib, tab sis lawv tsis paub tas li thaum cev xeeb tub, qhov piam thaj hauv qab yuav tsum nyob hauv qab no. Txoj cai rau cov poj niam cev xeeb tub nrog ntshav qab zib yuav tsum ntsuas kev ntsuas ntshav qab zib tsawg kawg - 8 zaug hauv ib hnub. Tus poj niam yog tus poj niam, tus poj niam, tus poj niam, tus poj niam, tus poj niam, tus poj niam, tus poj niam thiab tus txiv neej. Ib tug poj niam muaj peev xwm poob nco thiab txawm poob mus rau lub coma. Cov tsos mob ntawm hypoglycemia: mob taub hau, kiv taub hau, kev tshaib plab, tsis pom kev, ntxhov siab, txhaus siab heev, swb, trembling, ntxhov siab vim, tsis meej pem. Yog tias koj muaj ib qho ntawm cov saum no, koj yuav tsum xyuas cov ntshav qab zib. Yog tias qhov no tsis muaj peev xwm, koj yuav tsum tsis txhob siv lub cev ua si, noj cov tshuaj sai-digestible carbohydrates (12 grams yog 100 ml kua txiv hmab txiv ntoo los yog qab zib qab zib, los yog 2 lub suab thaj, los yog 1 lub rooj, ib spoonful ntawm zib mu). Tom qab no, koj yuav tsum tau noj qeeb digestible carbohydrates (12-24 g - ib daim khob cij, ib khob yogurt, ib lub kua). Ib qib siab qab zib hauv cov ntshav ntawm leej niam tuaj yeem ua rau txoj kev loj hlob ntawm tus me nyuam txoj kev mob pathology, xws li ntshav qab zib fetopathy. Nws tuaj yeem ua sai sai lossis qeeb kev loj hlob ntawm fetus, polyhydramnios, o ntawm cov nqaij mos. Ib tug menyuam mosliab tuaj yeem raug kev txom nyem los ntawm kev ua pa thiab cov hlab ntsha paj hlwb, hypoglycemia. Cov ntshav qab zib siab tau "ua rau me nyuam" ua rau tus me nyuam thiab tom qab qhov kev ua rau endocrine lossis neurological hauv cov hluas. Kom tsis txhob muaj lub txim li no, thaum lub sij hawm cev xeeb tub thiab tag nrho 9 lub hlis ntawm kev tos, nrog nraim nrog tus kws kho mob. Nrog rau cov ntshav qab zib ntxiv, koj yuav tsum tshem tawm cov kev ua ub no thiab tshawb xyuas cov zis rau lub cev ketone (qhov no yuav ua tau rau siv cov tshuaj strips muag hauv lub tsev muag tshuaj), thiab siv cov lus tso cai ntawm koj tus gynecologist-endocrinologist thaum muaj glycemia. Khaws ib phau ntawv khaws tseg rau hauv qhov chaw uas koj sau cov suab thaj, qhov nyiaj ntawm carbohydrates, cov khoom noj muaj pes tsawg leeg, cov koob tshuaj insulin. Tsis txhob hnov qab saib koj ua li cas, thiab ntsuas ntshav siab. Nws yog ib qho tsim nyog los soj ntsuam lub xub ntiag ntawm ketone lub cev nyob rau hauv cov zis thiab txog lawv cov xwm yeem qhia rau koj tus kws kho mob. Tej zaum nws yuav tsum ntsuas los ntsuas qhov ntim tsis yog ntawm cov qaug dej qaug cawv xwb, tab sis kuj ntawm cov kua dej tawm (diuresis). Txawm nrog kev mob ntshav qab zib thaum lub sij hawm cev xeeb tub, nws yog ib qho nyuaj ua kom tiav ntawm cov ntshav qab zib hauv cov ntshav.
Yog tias tsim nyog, tus kws kho mob tuaj yeem xa koj mus rau:
♦ Dopplerography - siv ultrasound, cov ntshav khiav mus kuaj hauv cov hlab ntaws, qhov chaw mos thiab hauv plab me;
♦ kev mob khomob (cardiotocography) - nws tau ntsuam xyuas seb tus menyuam mos qhov twg ua pa tshav pa (hypoxia).
Kev ntsuam xyuas ntawm kev siv tshuaj insulin kho yog siv cov kev tshawb fawb ntawm fructosamine (ib qho chaw ntawm albumin ntshav protein nrog ntshav qabzib). Hauv peb lub hlis peb ntawm cev xeeb tub, tus kws kho mob yuav caw koj ntau zaus dua ua ntej. Qhov no yog vim lub fact tias nws yog nyob rau ntawm lub sij hawm no hais tias kev pheej hmoo ntawm cov teeb meem txuam nrog diabetes nce. Gestational diabetes mellitus txawv ntawm gestosis cov poj niam cev xeeb tub. Yog vim li cas nws cov tsos yog txo cov kev mob hlwb rau lawv tus kheej cov insulin. Raws li cov kws tshawb fawb hauv European, qhov GDD prevalence yog los ntawm 1 mus rau 14% ntawm cov poj niam noj qab nyob zoo. Nyob rau hauv qhov kev pheej hmoo - cov poj niam cev xeeb tub uas rog, nrog keeb kwm ntawm obstetric anamnesis. Siv cov ntshav mus kuaj ntshav qab zib thiab kuaj ntshav nrog cov piam thaj. Yog tias cov khab nquag zoo li no, zaum thib ob qhov kev kuaj ntawd yog ua tiav ntawm 24-28th lub lim tiam ntawm cev xeeb tub.
Tus menyuam
Ntau cov poj niam cev xeeb tub uas muaj ntshav qab zib tuaj yeem yug menyuam ywj siab, yog tias tsis muaj lwm yam ntxiv rau kev mob plawv thiab obstetric contraindications rau kev yug menyuam. Polyhydramnios, gestosis thiab urogenital infections yuav ua rau yug ntxov ntxov. Qhov teeb meem feem ntau hauv kev yug me nyuam rau cov neeg mob ntshav qab zib mellitus yog kev xeeb tub hauv plab me me ntawm amniotic kua.
Tom qab yug me nyuam
Feem ntau, niam yog ntshai tias lawv tus menyuam yuav muaj ntshav qab zib. Yog leej txiv ntawm tus me nyuam tsis muaj tus kab mob no, ces qhov tshwm sim los ntawm kev mob ntshav qab zib hauv tus me nyuam yog li 3-5%. Yog tias leej txiv muaj mob ntshav qab zib, qhov kev pheej hmoo yuav raug kwv yees li 30%. Hauv qhov no, nws pom zoo kom ua kev tshuaj ntsuam genetic tests ua ntej cev xeeb tub. Cov menyuam yaus yuav tsum tau txais kev saib xyuas tshwj xeeb. Feem ntau cov menyuam mosliab yog yug nrog kev rog, tabsis nrog cov menyuam ntsws qis qis. Thawj thawj lub sij hawm ntawm lub neej, kev mob ua pa, thiab lub hauv paus ntawm lub paj hlwb hauv lub cev, acidosis, ntshav qabzib theem yuav tsum raug zam; los ua lub plawv kev xeem. Cov me nyuam yug tshiab, hnyav ntau lub cev, o ntawm daim tawv nqaij, ua kom daim siab thiab tus po yuav tau muab pov tseg. Cov me nyuam mos liab nrog SD-1 tsis zoo nruj heev thiab yog li ntawd feem ntau raug mob ntawm jaundice ntawm cov me nyuam mos, qhov tshuaj lom neeg erythema, poob ntau tshaj qhov hnyuv tom qab yug thiab rov qab los qeeb dua. Tab sis txhua yam yog surmountable!
Vanyusha tau yug los ntawm lub plab zis hauv 37 lub lis piam. Nws niam Ole yog 29 xyoo thaum nws tus tub yug. Plaub thiab ib nrab xyoo tom qab ib tug poj niam yug tau ib tug ntxhais. Tsis muaj dab tsi tshwj xeeb? Tej zaum - yog tias tsuas yog thaum lub sijhawm yug ntawm thawj tus menyuam Olya tsis muaj kev paub txog ntawm 19 xyoo! Qhov teeb meem loj rau cov poj niam uas xav kom muaj me nyuam muaj peev xwm ua tau ntshav qab zib hom 1 (SD-1). Cov kws kho mob ntshai ntshai rau lub neej ntawm leej niam thiab tus me nyuam thiab tsis tas yuav npaj los tuav lub luag haujlwm los ua tus cev xeeb tub. Yog li nws tau tshwm sim nrog Olya, uas tsis tau pom thawj kev txhawb nqa los ntawm kws kho mob. Olya hais tias: "Kuv muaj kev txhim khu kev qha - kuv tus txiv. Nws yog nws uas tau nrog kuv mus rau txhua qhov kev sab laj, ntsia txhua hom ntawm cov khoom, nws suav tag nrho cov tshuaj ntawm insulin, nyhav kuv daim khob cij rau qhaub cij ua hauj lwm thiab feem ntau nruj heev raws li kuv kev noj haus. Calmed kuv flashes ntawm hysterics, tsim kuv thaum hmo ntuj, qee zaus txhua txhua xuab moos los ntsuas qhov ntsuas cov piam thaj, kho kuv nrog kua txiv hmab txiv ntoo yog tias tsim nyog thiab zoo li ntawd. Nrog rau qhov no, ib tug yuav tiv thaiv tsis zoo rau leej niam thiab tus me nyuam.Qhov kev ua hauj lwm ntawm endocrinologists thiab midwives yuav tsum xyuas kom muaj kev nplua nyiaj ntawm carbohydrate metabolism hauv txhua theem - los ntawm kev xav ntawm lub neej yug.