Txhua txhua xyoo, cov kab mob ntshav qab zib ua tau zoo dua. Qhov no tso cai rau koj kom tsis txhob muaj teeb meem vascular los yog ncua lub sijhawm ntawm lawv cov tsos. Yog li, rau cov poj niam uas muaj ntshav qab zib, qhov ntev ntawm lub sijhawm yug menyuam nce ntxiv.
Mob ntshav qab zib tuaj yeem ua rau nws tsis yooj yim los xaiv txoj hauv kev tiv thaiv kom txhob muaj mob.
Tib lub sijhawm, txhua tus pojniam muaj mob ntshav qab zib yuav tsum muaj kev npaj ua cev xeeb tub. Koj tuaj yeem pib xeeb thaum koj cov ntshav qab zib kom nyob sib luag li cas, uas yog, kev them nyiaj rau ntshav qab zib tau tiav lawm.
Kev xeeb tub uas tsis tau teem cia nrog ntshav qab zib hem muaj teeb meem loj heev rau tus poj niam thiab nws tus xeeb ntxwv. Qhov no txhais tau tias qhov teeb meem ntawm kev tswj tsis pub muaj ntshav qab zib yog qhov tseem ceeb heev. Nws tau txais ntau lub siab los ntawm ob tus kws kho mob thiab lawv cov neeg mob ntshav qab zib.
Xaiv txoj kev tiv thaiv kom tsim nyog yog ib txoj haujlwm nyuaj. Qhov teeb meem no tau txiav txim siab ib leeg rau txhua tus poj niam. Yog tias nws mob ntshav qab zib, tom qab ntawd ntxiv cov nuances tshwm sim. Hauv tsab xov xwm hnub no, koj yuav kawm txhua yam koj xav tau, ua ke nrog koj tus kws kho mob, txiav txim siab txog qhov tsis muaj txiaj ntsig rau ntshav qab zib.
Cov hauv qab no piav qhia txog txoj kev ua kom tsis muaj me nyuam zoo tam sim no. Lawv tsim nyog rau cov poj niam muaj ntshav qab zib, nyob ntawm lawv cov cim qhia. Peb yuav tsis tham txog qhov kev xyob txhiaj, kev sib daj sib deev, kev haus cawv thiab lwm txoj hauv kev tsis ncaj ncees.
Nkag mus siv tau txoj kev tiv thaiv rau cov poj niam uas muaj ntshav qab zib
| Mob | COC | Txhaj tshuaj | Ntiv nplhaib ib thaj | Bye | Kev cog lus | Cu-IUD | LNG-Navy |
|---|---|---|---|---|---|---|---|
| Nws tau siv los ua cov ntshav qab zib hauv plab | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Tsis muaj teeb meem vascular | 2 | 2 | 2 | 2 | 2 | 1 | 2 |
| Muaj cov teeb meem ntawm cov ntshav qab zib: nephropathy, retinopathy, neuropathy | 3/4 | 3/4 | 3/4 | 2 | 2 | 1 | 2 |
| Kev mob hnyav vascular los yog lub sijhawm muaj ntshav qab zib ntau dua 20 xyoo | 3/4 | 3/4 | 3/4 | 2 | 2 | 1 | 2 |
Dab tsi yog cov lej txhais tau:
- 1 - kev siv tus qauv tso cai;
- 2 - feem ntau tsis muaj kev sib cav sib ceg rau kev siv ntawm txoj kev;
- 3 - kev siv txoj hauv kev feem ntau tsis tau txais kev pom zoo, tshwj tsis yog qee kis uas tsim nyog txwv tsis pub siv lossis kev siv tsis raug cai;
- 4 - kev siv ntawm hom yog contraindicated kiag li.
Tsim:
- COCs - cov tshuaj ua ke tswj kev txwv tsis pub muaj menyuam yaus uas muaj cov tshuaj hormones los ntawm subclasses ntawm estrogens thiab progestins;
- POC - tshuaj tiv thaiv cev xeeb tub uas tsuas yog muaj progestogen;
- Cu-IUD - ib qho khoom siv hluav taws xob muaj cov tooj liab;
- LNG-IUD yog cov khoom siv tshuaj tiv thaiv muaj cov levonorgestrel (Mirena).
Xaiv qee txoj kev tiv thaiv mob ntshav qab zib rau cov ntshav qab zib
| Kev noj qab haus huv ntawm tus poj niam muaj ntshav qab zib | Txoj kev tiv thaiv kev xeeb tub | |
|---|---|---|
| Ntsiav tshuaj | Neeg kho tshuab, hauv zos, phais | |
| Cov ntshav qab zib hom 1 uas muaj kev tswj tau zoo txog lawv cov ntshav qab zib, yam tsis muaj teebmeem hais tawm hauv plab los |
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| Yam 2 mob ntshav qab zib cov neeg mob uas ua tiav lawv cov hom phiaj hais txog ntshav qab zib, i.e., tswj tau tus kabmob zoo |
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| Cov ntshav qab zib hom 2 uas cov neeg mob ntshav triglycerides thiab ua kom lub siab ua haujlwm tsis zoo | Tsis muaj |
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| Cov neeg muaj ntshav qab zib hom 1 uas tswj tsis tau nws cov ntshav qab zib thiab / lossis muaj kev cov nyom hnyav heev | Tsis muaj |
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| Cov neeg mob ntshav qab zib hom 1 uas muaj mob hnyav thiab / lossis tus uas twb muaj 2 lossis ntau tus menyuam lawm | Tsis muaj |
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Qhov chaw ntawm cov ntaub ntawv: cov lus qhia soj ntsuam "Algorithms rau kev kho mob tshwj xeeb rau cov neeg mob ntshav qab zib mellitus", kho los ntawm II. Dedova, M.V. Shestakova, 6th tsab, 2013.
Yog hais tias ib tug poj niam uas mob ntshav qab zib muaj meej kev kho mob contraindications rau cev xeeb tub, ces xav txog kev txaus siab phais mob kom tsis muaj menyuam. Tib yam yog tias koj twb "daws koj cov kev ua me nyuam."
Sib xyaw ua ke ntawm qhov ncauj
Tshuaj sib xyaw ua ke ntawm qhov ncauj (COCs) yog cov tshuaj tiv thaiv kev xeeb tub uas muaj ob hom tshuaj hormones: estrogens thiab progestins. Cov tshuaj estrogen ua ib feem ntawm kev tswj hwm kev noj tshuaj puv rau lub cev tsis muaj peev xwm ntawm estradiol, ntuj tsim los ntawm kev ua haujlwm hauv lub cev. Yog li, kev tswj hwm ntawm lub cev ntas yog tswj. Thiab progestin (progestogen) muab cov txiaj ntsig zoo ntawm COCs.
Ua ntej noj tshuaj tiv thaiv tshuaj hormonal, sab laj rau koj tus kws kho mob thiab mus kuaj mob hemostasiological. Cov no yog cov ntshav kuaj rau platelet kev ua si, AT III, factor VII thiab lwm yam. Yog tias qhov kev ntsuam xyuas tau tig mus ua qhov tsis zoo - hom kev tiv thaiv kev tiv thaiv no tsis haum rau koj, vim tias muaj kev pheej hmoo ntxiv ntawm kev mob ntshav txha caj qaum.
Tam sim no, kev sib xyaw ua ke ntawm qhov ncauj yog qhov mob nrov thoob plaws ntiaj teb, kuj yog ntawm cov poj niam uas muaj ntshav qab zib. Cov laj thawj rau qhov no:
- COCs ntseeg tau kev tiv thaiv tiv thaiv kev xeeb tub uas tsis xav tau;
- feem ntau lawv ua tau zoo los ntawm cov poj niam;
- tom qab txiav cov ntsiav tshuaj, feem ntau ntawm cov poj niam cev xeeb tub hauv 1-12 lub hlis;
- kev noj tshuaj yog qhov yooj yim dua li muab cov ntsia hlau, ua ib qho kev txhaj tshuaj, thiab lwm yam.
- hom kev tiv thaiv no muaj ntxiv kev kho mob thiab kho kho cov teebmeem.
Cov kev txwv tsis pub siv rau kev sib xyaw ua ke ntawm qhov ncauj rau cov poj niam uas muaj ntshav qab zib:
- ntshav qab zib tsis tau them rov qab, i.e., ntshav qab zib nyob qis tus nqi;
- ntshav siab dua 160/100 hli RT. st .;
- lub tshuab cua sov ua txhaum (mob hnyav ntshav lossis nce ntshav khov);
- mob ntshav qab zib hnyav rau cov ntshav qab zib twb tau tsim tawm - proliferative retinopathy (2 lub hauv paus), ntshav qab zib nephropathy nyob rau theem ntawm microalbuminuria;
- tus neeg mob tsis muaj kev txawj tswj tus kheej txaus.
Cov tshuaj tiv thaiv kom tsis txhob txais cov tshuaj estrogen ua ib feem ntawm kev sib xyaw ua ke ntawm qhov ncauj:
- nce kev pheej hmoo ntawm cov ntshav txhaws thiab kev txhaws ntawm cov hlab ntshav (coj mus kuaj thiab tshawb xyuas!);
- kuaj mob cerebrovascular kev huam yuaj, mob taub hau;
- cov kab mob siab (kab mob siab, Rotor, Dabin-Johnson, Gilbert syndromes, mob ntsws, lwm yam kab mob uas ua nrog mob siab ua haujlwm);
- los ntshav los ntawm qhov chaw mos, qhov ua rau tsis meej;
- kev tiv thaiv qog noj hlav.
Qhov tseeb ua kom muaj kev phom sij ntawm cov tshuaj estrogen:
- haus luam yeeb
- mob ntshav liab nruab nrab;
- hnub nyoog tshaj 35 xyoo;
- rog dhau 2 degrees;
- kev txom nyem tsis muaj keeb kwm hauv kab mob plawv, i.e., tau muaj mob ntawm cov hlab plawv lossis mob hlab ntsha hauv tsev neeg, tshwj xeeb ua ntej hnub nyoog 50 xyoo;
- lactation (noj niam mis).
Rau cov poj niam muaj ntshav qab zib, cov tshuaj tiv thaiv qis thiab micro koob sib xyaw ua ke qhov ncauj yog qhov tsim nyog.
Cov COCs tsawg-muaj - tsawg dua 35 μg ntawm cov tshuaj tiv thaiv estrogen. Cov no suav nrog:
- monophasic: "Marvelon", "Femoden", "Regulon", "Belara", "Jeanine", "Yarina", "Chloe";
- peb-theem: "Tri-Regol", "Peb-Merci", "Trikvilar", "Milan".
Microdosed COCs - muaj 20 mcg lossis tsawg dua ntawm cov khoom estrogen. Cov no suav nrog kev npaj monophasic "Lindinet", "Logest", "Novinet", "Mercilon", "Mirell", "Jacks" thiab lwm yam.
Rau cov poj niam mob ntshav qab zib, lub luag haujlwm tshiab hauv kev pov tseg yog qhov kev txhim kho ntawm KOK, uas muaj estradiol valerate thiab dienogest, nrog kev siv tshuaj ntau npaum li cas ("Klayra").
Txhua qhov sib xyaw ua ke ntawm qhov ncauj nce triglyceride ntau ntau hauv cov ntshav. Tab sis qhov no yog qhov tsis txaus ntshai muaj feem cuam tshuam rau cov poj niam uas twb muaj hypertriglyceridemia ua ntej noj cov tshuaj. Yog tias tus poj niam muaj mob dyslipidemia (ua tsis tau rog rog), COCs kuj muaj kev nyab xeeb. Tab sis thaum lawv nkag los, koj yuav tsum tau mus soj ntsuam ntshav tas li rau triglycerides.
Vaginal hormonal nplhaib NovaRing
Txoj kev paum ntawm kev tswj hwm cov tshuaj hormones steroid rau kev xeeb tub yog, rau ntau yam, zoo dua li kev noj tshuaj. Cov concentration ntawm cov tshuaj hormones hauv cov ntshav tau khaws cia ruaj khov. Cov tshuaj yeeb dej caw tsis raug nthuav tawm los ntawm kev nkag mus rau thawj lub siab, raws li nrog kev nqus ntawm cov ntsiav tshuaj. Yog li, thaum siv qhov kev tiv thaiv kev xeeb menyuam, qhov kev siv tshuaj txhua hnub cov tshuaj hormones tuaj yeem txo qis.
NovaRing lub paum hormonal nplhaib yog qhov muaj txiaj ntsig hauv qhov zoo ntawm lub nplhaib pob tshab, lub taub 54 hli thiab 4 mm tuab hauv ntu ntu. Los ntawm nws, 15 micrograms ntawm ethinyl estradiol thiab 120 micrograms ntawm etonogestrel raug tso tawm rau hauv qhov chaw mos txhua hnub, qhov no yog cov tshuaj tiv thaiv metabolite ntawm desogestrel.
Tus poj niam ib leeg txuas ntawm lub nplhaib sib cais rau hauv qhov chaw mos, yam tsis muaj kev koom tes ntawm cov neeg kho mob. Nws yuav tsum hnav rau 21 hnub, tom qab so ces so li 7 hnub. Hom kev tswj kom tsis txhob muaj menyuam yaus muaj qhov tsis tshua zoo ntawm cov metabolism ntawm cov carbohydrates thiab cov rog, kwv yees li tib yam li cov kab mob sib xyaw ua ke ntawm lub qhov ncauj.
NovaRing lub paum hormonal nplhaib tshwj xeeb yog qhia tshwj xeeb rau kev siv los ntawm cov poj niam uas muaj ntshav qab zib ua ke nrog kev rog, nce ntshav triglycerides lossis ua rau lub siab ua haujlwm tsis zoo. Raws li kev tshawb fawb txawv teb chaws, kev qhia txog poj niam lub paum tsis pauv ntawm qhov no.
Nws yuav muaj txiaj ntsig ntawm no kom nco qab tias cov poj niam muaj rog rog thiab / lossis cov ntshav qab zib vim ntshav qab zib yog qhov tshwj xeeb tshaj yog qhov tsis txaus siab rau qhov tsis txaus ntshai. Qhov no txhais tau tias yog tias koj muaj kev tawm tsam, tom qab ntawd feem ntau nws tsis yog kev phiv los ntawm kev siv NovaRing qhov chaw mos, tab sis tau tshwm sim rau lwm yam.
Intrauterine tshuaj txwv tsis pub muaj
Tshuaj tiv thaiv mob hauv plab yog siv los txog 20% ntawm cov poj niam muaj ntshav qab zib. Vim tias qhov kev xaiv tiv thaiv kev nyab xeeb no tau zoo thiab tib lub sijhawm thim rov qab tiv thaiv kev xeeb tub uas tsis muaj kev tiv thaiv. Cov poj niam yog qhov zoo heev uas lawv tsis tas yuav ua tib zoo saib xyuas txhua hnub, zoo li thaum noj tshuaj txwv.
Lwm cov txiaj ntsig ntxiv ntawm cov tshuaj tiv thaiv mob ntshav qab zib rau cov ntshav qab zib:
- lawv tsis cuam tshuam cov roj carbohydrate thiab rog metabolism;
- tsis txhob ntxiv txoj kev pheej hmoo ntawm cov ntshav txhaws thiab kev txhaws cov hlab ntshav.
Qhov kev tsis zoo ntawm hom kev txwv tsis pub muaj:
- Cov poj niam feem ntau txhim kho lub cev ntas tsis xwm yeem (hyperpolymenorrhea thiab dysmenorrhea)
- nce kev pheej hmoo ntawm ectopic cev xeeb tub
- muaj ntau cov tsos mob ntawm lub plab hu ua pelvic plab hnyuv siab raum tshwm sim, tshwj xeeb yog tias muaj ntshav qab zib cov ntshav muaj piam thaj tas li.
Cov poj niam tsis yug me nyuam tsis pom zoo kom siv tshuaj tiv thaiv kom tsis txhob muaj menyuam.
Yog li, koj tau pom dab tsi yog vim li cas ho xaiv ib los yog lwm txoj kev tswj kom muaj ntshav qab zib. Tus poj niam uas muaj hnub nyoog yug me nyuam yuav tuaj yeem xaiv cov kev xaiv tsim nyog rau nws tus kheej, nco ntsoov ua haujlwm nrog kws kho mob. Nyob rau tib lub sijhawm, npaj siab tias koj yuav tau sim ob peb txoj kev sib txawv kom txog thaum koj txiav txim siab seb qhov twg haum rau koj tshaj plaws.
