Nrog rau kev nce qib hauv qab zib hauv tus poj niam thaum cev xeeb tub, qhov kev pheej hmoo ntawm kev tsim cov me nyuam mob ntshav qab zib (DF) nce ntxiv. Tus kab mob yog cov tsos mob ntawm endocrine thiab metabolic dysfunctions, mob polysystemic mob.
Cov ntshav qab zib hauv plab yog dab tsi?
DF yog qhov nyuaj ntawm cov tsos mob tshwm sim hauv tus me nyuam hauv plab nrog kev ua tsis tau zoo nyob hauv niam. Cov tshuaj tsis tu ncua nkag mus rau ntawm qhov chaw tiv thaiv kev tiv thaiv, dhau qhov xav tau nws hauv kev tsim kab mob.
DF yog qhov nyuaj ntawm cov tsos mob tshwm sim hauv tus me nyuam hauv plab nrog kev ua tsis tau zoo nyob hauv niam.
Ketones thiab amino acids nkag mus nrog rau cov piam thaj. Insulin thiab glucagon, uas yog pancreatic hormones, tsis raug xa los ntawm niam. Lawv pib tsim los ntawm nws tus kheej tsuas yog 9-12 lub lis piam. Tawm tsam cov keeb kwm no, hauv thawj peb lub hlis, cov suab thaj protein tshwm sim, cov qauv ntawm cov ntaub so ntswg yog cuam tshuam los ntawm cov dawb radicals. Lub cev ketone ntau dhau lom lub cev muaj tshwm sim.
Cov txheej txheem no ua rau muaj kev cuam tshuam tsis zoo hauv lub plawv, cov hlab ntsha, raum thiab lwm yam kabmob. Kev mob ntshav qab zib yog qhov qhia tau hais txog kev hloov pauv hauv tus menyuam hauv plab, cuam tshuam ntawm ntau yam haujlwm. Cov chaw kuaj mob thiab kuaj pom cov tsos mob tau muab cais rau hauv cov tshuaj raws li ICD-10 code.
Thaum lawv tsim insulin lawv tus kheej, tus me nyuam hlab pas yuav tsum tawg, ua rau muaj cov insulin ntau heev. Kev pham thiab tsis muaj zog lecithin metabolism tshwm sim.
Tom qab yug menyuam, embryofetopathy yog regresses lossis pib mus rau lwm yam kabmob - ntshav qab zib ntawm cov menyuam mos.
Cov ua tseem ceeb
Cov xwm txheej hauv qab no hauv niam tuaj yeem ua rau hauv DF:
- hyperglycemia;
- ua txhaum ntawm lipid synthesis;
- tshaj dawb radicals;
- ketoacidosis;
- hyperinsulinemia (ntshav qab zib kom tsawg);
- qhov tseem ceeb txo cov ntshav qabzib ntau dhau vim tias siv cov tshuaj ntau dhau;
- tshuaj mob ntsws.
Me nyuam hauv plab yuav tshwm sim hauv cov poj niam cev xeeb tub uas mob ntshav qab zib kuaj ua ntej xeeb tub, thiab hauv lub xeev muaj mob ntshav qab zib. Tom qab 20 lub lim piam ntawm qhov kev xeeb tub, mob ntshav qab zib hauv lub cev mellitus qee zaum tsim, vim tias DF kuj tseem tuaj yeem loj hlob tau. Nrog rau kev nce qib ntawm cov piam thaj hauv niam, qhov taw qhia hauv plab hauv plab kuj tseem yuav nce ntxiv.
Cov tsos mob thiab cov tsos mob ntawm tus mob muaj menyuam hauv plab
Nrog fetopathy, tus me nyuam muaj insulin cell hyperplasia, vim tias qhov hypertrophy ntawm islets ntawm Langerhans loj hlob hauv cov neeg mob caj dab. Lwm yam cim ntawm tus kabmob:
- kev txhim kho cov rog ua lub siab;
- ntev li ntawm deposition ntawm subcutaneous rog;
- kev nce hauv ob lub raum, mob siab thiab qog adrenal nrog kev txhim kho tsis zoo ntawm cov kabmob no;
- kev tsim cov glycogen granules hauv cov ntaub so ntswg epithelial ntawm lub raum leeg;
- hloov pauv ntawm phab ntsa ntawm cov hlab ntsha me me raws li hom kev mob ntshav qab zib microangiopathy.
Hauv cov menyuam yug tshiab nrog DF, kev pom dav dav ntawm lub cev, kev tiv thaiv lub cev yog ua txhaum (qhov ntim ntawm lub plab yog 2 lub lis piam ua ntej ntawm lub taub hau loj, feem ntau lub taub hau ncig yog ntau me dua li lub xub pwg girdle). Cov yam ntxwv ntawm tus kab mob:
- hnyav tshaj 4 kg;
- tawv nqaij liab liab-cyanotic;
- muaj petechiae;
- ib qho loj npaum li cas ntawm cheese zoo li roj nplua nyeem;
- yellowness ntawm daim tawv nqaij thiab qhov muag daj;
- txhawb nqa hemoglobin theem;
- teeb meem lossis tsum tsis ua pa tom qab yug menyuam;
- xa tuaj tsis raws sij hawm;
- cov nqaij mos thiab tawv nqaij o tuaj, vim qhov tshwm sim ntawm lub ntsej muag zoo li puffy.
Tus menyuam yug tshiab muaj qhov pw tsis zoo, ua rau muaj kev tso siab ntau, nws tsis nqus zoo.
Cov kev kuaj mob tsim nyog
Cov txheej txheem tseem ceeb rau kev kuaj pom tus me nyuam hauv plab yog qhov xoo hluav taws xob (ultrasound scan), uas yog ua nyob rau thawj zaug thiab thib ob tus txiav plaub zaug ib zaug, 2 lossis 3 zaug hauv 3 hlis dhau los. Thaum muaj ntshav qab zib hauv niam, kev kuaj mob yog kuaj txhua lub lim tiam tom qab 30 lossis 32 lub lis piam.
Thaum lub sij hawm kawm, tus kws kho mob qhia ib macrosomia, kev ua txhaum ntawm tus ntsuas ntawm lub cev. Txog DF, cov ntsuas hauv qab no yog cov yam ntxwv:
- ob npaug nkhaus ntawm lub taub hau;
- nyob hauv thaj tsam ntawm lub pob txha taub hau, qhov chaw nchav-ua tsis pom kev;
- dual lub cev contour (qhov ua rau yuav muaj kev txhim kho puffiness lossis tshaj cov roj ntsha tsis txaus);
- polyhydramnios.
Ib tug xov tooj ntawm lwm qhov kev tshawb fawb tau siv los qhia txog kev kuaj mob:
- Kev ntsuam xyuas ntawm lub xeev biophysical ntawm tus menyuam. Rau ntau tshaj li ib teev thiab ib nrab, qhov kev ua haujlwm hauv lub nroog, ua pa, thiab lub plawv dhia hauv lub cev. Morphofunctional kev loj hlob ntawm lub hlwb raug ntsuas.
- Cardiotocography nrog cov kev xeem ua haujlwm. Lub plawv dhia yog raug ntsuas raws ntau yam.
- Dopplerometry txhawm rau tshuaj xyuas kev ua haujlwm ntawm lub paj hlwb. Tus naj npawb ntawm kev mob plab hauv lub plawv mob, qhov ntim thiab lub sijhawm ntawm kev tso ntshav tawm ntawm txoj hlab ntsws ntawm sab laug, qhov sib piv ntawm cov ntshav sib kis hauv txoj hlab ntaws, cov systolic-diastolic piv tau kawm.
Cov cim ntsuas cim biochemical rau kev kuaj ntshav thiab cov zis yog kuaj kom pom cov teeb meem metabolic thiab endocrine ntawm cov placenta.
Yuav kho cov mob ntshav qab zib fetopathy li cas?
Kev kho mob ntawm fetopathy yog tsom rau tshem tawm cov kev tshwm sim muaj ntshav qab zib hauv leej niam. Txhawm rau kev kho kom ua haujlwm tau zoo, tus poj niam yuav tsum tau soj ntsuam nws cov ntshav qabzib siab thiab ntshav siab.
Ua los tiv thaiv kev tawm tsam
Thoob plaws hauv lub cev xeeb tub, glycemic tswj hauv niam yog nqa tawm, kev kho mob insulin yog nqa tawm (kho yog tsim nyog). Txhua txhua 3 lossis 4 teev, kuaj cov ntshav qabzib hauv lub cev txhua hnub.
Nws yog ib qho tsim nyog yuav tsum tau ua raws li kev noj zaub mov nrog kev txwv tsis pub muaj calorie, nws yog qhov yuav tsum tau noj cov vitamins kom muaj nuj nqis metabolism.
Kev Yug Me Nyuam
Tus kws kho mob txiav txim siab lub sijhawm siab tshaj plaws ntawm kev yug menyuam. Yog tias kev xeeb tub hla dhau yam tsis muaj teebmeem, lub sijhawm no yog 37 lub lim tiam. Yog tias muaj kev hem thawj rau kev noj qab haus huv ntawm leej niam lossis tus menyuam, tau txiav txim siab txog qhov xav tau kev xa menyuam ua ntej 36 lub lis piam.
Thaum lub sijhawm ua haujlwm, theem ntawm glycemia yog tswj hwm. Yog tias tus poj niam cov kua ntshav qab zib qis dhau, nws poob lub zog (ntau qhov khoom yuav tsum txo cov phab ntsa ntawm lub tsev menyuam), kev yug menyuam yog qhov nyuaj vim tsis muaj zog hauv leej niam. Muaj kev pheej hmoo ntawm kev txhim kho hypoglycemic coma tom qab yug menyuam.
Cov kev ntsuas nram no yog coj los:
- kev nthuav qhia ntawm cov dej qab zib tov kom tiv thaiv ketoacidosis;
- Cov tsos mob ntawm kev mob ntshav qab zib yog nres los ntawm cov khoom noj sai (noj cov dej qab zib lossis ib tee dej nrog kua qab zib);
- nrog rau kev nriaj, hydrocortisone yog siv;
- Txhawm rau txhim kho cov txheej txheem hauv metabolic, kev daws teeb meem vitamin tau siv.
Hauv lub xub ntiag ntawm fetopathy, ib qho kev txiav txim siab feem ntau ua rau kev yug menyuam.
Hauv lub xub ntiag ntawm fetopathy, ib qho kev txiav txim siab feem ntau ua rau kev yug menyuam. Muaj peev xwm yug yam tsis tau yug nyob ntawm lawv lub sijhawm. Yog tias lawv siv sijhawm ntev dua 8 teev, mus rau chav phais mob.
Kev kho tom qab yug menyuam tas
Vim tias qhov tsis muaj teeb meem ntev ntxiv ntawm cov piam thaj hauv cov ntim dhau los tom qab yug me nyuam thiab muaj cov insulin ntau heev, cov ntshav qog ua kom ntshav qab zib tuaj yeem txhim kho hauv cov menyuam mos. Cov leeg nqaij ua haujlwm poob qis, siab thiab lub cev kub cev poob, thiab qhov kev pheej hmoo ntawm kev ua pa tuaj poob ntxiv. Txhawm rau tiv thaiv kom tsis txhob muaj teeb meem, cov kua nplaum tov tshuaj rau tus menyuam hauv ib nrab ib teev tom qab yug menyuam tas. Thaum tsis ua pa, khoom siv chaw dim pa tau siv. Txhawm rau kom lub ntsws ua kom ncaj, ib qho surfactant tuaj yeem muab rau tus menyuam. Nov yog qhov tshuaj tshwj xeeb uas pab koj tus menyuam ua pa tawm.
Nyob rau thawj hnub tom qab yug los, tus kws kho mob yug me nyuam saib xyuas tus me nyuam lub pa zoo zoo li paib ntawm DF Kev kuaj ntshav biochemical rau calcium thiab magnesium, glycemia, urinalysis, thiab electrocardiography yog qhov tsim nyog.
Txhua 2 teev twg, kev pub niam mis rau menyuam noj. Nquag noj mov rov qab ua rau cov piam thaj thiab cov insulin sib npaug.
Txhawm rau tshem tawm cov mob neurological, cov kev daws teeb meem uas muaj calcium thiab magnesium yog siv. Thaum tsis ua haujlwm ntawm daim siab ua haujlwm, dosed irradiation nrog UV yog kev kho mob.
Dab tsi yog qhov zoo?
Cov menyuam yaus uas yug los ntawm leej niam uas muaj ntshav qab zib muaj qhov pheej hmoo ntawm tus mob no loj zog tuaj lawm yav tom ntej. Endocrinologist pom tias qhov tseem ceeb ntawm pathology yog muaj ntau dua los ntawm caj ces, ntau dua li keeb kwm ntawm lub fetopathy. Xws li cov menyuam yaus ua rau lub cev tsis muaj zog ntawm lipid metabolism thiab rog dhau ntawm qee qhov, muaj qee yam kev cuam tshuam ntawm cov hlab ntsha thiab cov hlab ntsha hlwb, lub hlwb tsis ua haujlwm. Cov kev hloov no muaj tsawg heev nrog kev ntsuas kho kom raws sijhawm.
Cov tsos mob ntawm tus me nyuam hauv plab yug me nyuam maj mam ploj mus thaum tsis muaj qhov ua tsis tau thiab tsis muaj teeb meem. Tom qab 2-3 lub hlis, nws nyuaj rau qhov paub qhov txawv ntawm cov menyuam yaus ntawm qhov noj qab nyob zoo.
Qhov tshwm sim thiab kwv yees ntawm kev kuaj pom tsis tseeb
Thaum tsis muaj qhov tsim nyog yuav tau kho thiab ua tib zoo saib xyuas tus poj niam lub sijhawm thaum cev xeeb tub, tus kab mob tuaj yeem ua rau muaj kev phom sij txaus ntshai:
- neonatal mob ntshav qab zib mellitus (tuaj yeem tsim mus rau hom ntshav qab zib hom II);
- ntaub so ntswg hypoxia;
- hypocalcemia;
- kev nyuaj siab mob ntsws;
- ntshav tshuaj qis;
- kev puas siab puas ntsws thiab kev mob hlwb (vim yog hypomagnesemia);
- cardiomyopathy;
- hyperbilirubinemia
- perinatal asphyxia;
- polycythemia;
- cov hlab ntsha raum thrombosis;
- zaus tachypnea.
Cov kab mob thaiv tsis tau tuaj yeem ua rau tus me nyuam mos tuag.
Ua raws li cov lus qhia ntawm tus kws kho mob tuaj kawm, qhov pom tias yuav luag yog qhov zoo rau tus menyuam thiab leej niam. Cov tsos mob ntawm tus kab mob pathology raug pom hauv thawj lub lim tiam ntawm tus me nyuam lub neej, maj mam rov qab hloov dua tshiab.
Kev Tiv Thaiv
Thaum npaj kev cev xeeb tub, nws yog ib qho tsim nyog yuav tsum kuaj xyuas seb puas muaj cov piam thaj hauv ntshav. Hauv cov ntshav qab zib mellitus, nws tau pom zoo kom ua tiav cov nyiaj them rov qab nyob rau ntau lub hlis ua ntej kev xeeb tub, thiab kom muaj kev tswj hwm tus nqi tsis zoo thaum xeeb tub. Nws yog ib qho tsim nyog yuav tsum tau soj ntsuam kom nruj kev saib xyuas kom noj tshuaj ntawm cov tshuaj insulin, hloov rau kev noj haus.
Txhawm rau zam kev cuam tshuam, nws yog ib qho tsim nyog ua raws li cov lus pom zoo los ntawm tus kws kho mob saib xyuas thiab raws sijhawm teem sijhawm kuaj mob.
