Cev xeeb tub ntshav qab zib

Kab lus no tham txog txhua yam yuav ua li cas yog tias tus poj niam tau kuaj mob ntshav qab zib ua ntej muaj menyuam hauv plab. Yog tias cov ntshav siab cov ntshav qabzib tau pom tias lub sijhawm muaj menyuam hauv plab, qhov no hu ua kev mob ntshav qab zib hauv nruab ce. Ntshav Qab Zib Hom 1 lossis 2, raws li txoj cai, tsis yog qhov sib txuam rau kev ua leej niam, tab sis muaj kev pheej hmoo ntau ntxiv rau tus poj niam thiab tus menyuam hauv plab.

Txoj hauv kev zoo tshaj plaws los tiv thaiv cov teeb meem ntshav qab zib hauv cov poj niam cev xeeb tub yog los ntawm kev soj ntsuam koj cov ntshav qab zib kom siab

Mob ntshav qab zib yuav tsum tau saib xyuas los ntawm kws kho mob. Tus poj niam cev xeeb tub uas muaj ntshav qab zib tau nyob hauv qab kev saib xyuas ntawm kws kho mob yug menyuam-kws kho mob poj niam. Yog tias tsim nyog, lawv kuj tig mus rau cov kws kho mob nqaim: tus kws kho qhov muag (lub qhov muag), tus nephrologist (ob lub raum), kws kho plawv (mob plawv) thiab lwm tus. Txawm li cas los xij, kev ntsuas tseem ceeb yog txhawb qib ntshav qab zib kom nyob sib luag, uas tus neeg mob nws tus kheej ua.

Nws yog qhov zoo los them rau cov ntshav qab zib, uas yog, kom ua tiav cov ntshav qabzib yuav luag zoo li cov neeg muaj kev noj qab haus huv - qhov no yog qhov tseem ceeb uas yuav tsum tau ua kom yug tau cov menyuam ib txwm muaj thiab tswj kev noj qab haus huv ntawm tus poj niam. Qhov ze tshaj ntawm cov ntshav qab zib cov txiaj ntsig yog qhov zoo tshaj, qhov tsawg dua qhov muaj feem ntawm cov teeb meem nyob rau txhua theem ntawm cev xeeb tub, txij thaum xeeb tub mus rau kev yug menyuam.

Kev soj ntsuam kev pheej hmoo thiab contraindications rau cev xeeb tub nrog ntshav qab zib

Tus poj niam uas muaj tus mob ntshav qab zib hom 1 lossis hom 2 yuav tsum raug kuaj los ntawm kws kho mob yug me nyuam, kws kho mob poj niam, endocrinologist thiab kws tshaj lij nyob rau theem ntawm kev npaj xeeb tub. Nyob rau tib lub sijhawm, tus neeg mob lub sijhawm, qhov tshwm sim ntawm lub cev xeeb tub kom tau txiaj ntsig, thiab qhov kev pheej hmoo ntawm kev pheej hmoo yuav ua kom muaj kev txhim kho ntshav qab zib muaj teeb meem raug soj ntsuam.

Cov poj niam muaj ntshav qab zib yuav tsum tau soj ntsuam dab tsi nyob rau theem ntawm kev ntsuas qhov tshwm sim ntawm qhov tshwm sim cev xeeb tub:

1. Ua ntsuas ntshav rau glycated hemoglobin.
2. Yeem ntsuas ntshav qab zib nrog glucometer 5-7 zaug hauv ib hnub.
3. Kev ntsuas ntshav siab nyob hauv tsev nrog ntsuas ntshav siab, thiab kuj tseem txiav txim siab tias puas muaj teeb meem tom qab ntshav. Qhov no yog ib qho kev poob siab hauv cov ntshav siab, uas tau pom los ntawm kiv taub hau thaum nce siab los ntawm qhov chaw zaum lossis dag.
4. Mus kuaj xyuas seb koj ob lub raum. Sau cov zis txhua hnub los txiav txim rau creatinine kev tshem tawm thiab cov ntsiab lus protein. Kuaj ntshav rau ntshav creatinine thiab urea nitrogen.
5. Yog tias pom muaj protein hauv cov zis, kuaj seb puas mob plab.
6. Kuaj nrog tus kws kho mob ntsej muag kom kuaj xyuas cov xwm txheej ntawm cov hlab ntsha retinal. Nws yog qhov tsim nyog hais tias cov ntawv piav qhia ntawm cov pob txha muaj nrog cov duab thaij xim. Lawv yuav pab ua kom pom kev zoo sib piv thiab ntsuas cov kev pauv thaum rov kuaj dua.
7. Yog tias tus poj niam muaj ntshav qab zib tau muaj hnub nyoog 35, muaj kev txom nyem ntawm txoj hlab ntshav siab, mob qog, rog, rog hauv cov ntshav siab, muaj teeb meem rau cov hlab ntsha ntu, tom qab ntawd koj yuav tsum tau hla ECG.
8. Yog tias ECG tau qhia txog kab mob pathology lossis muaj cov tsos mob ntawm cov kab mob plawv, tom qab ntawd nws raug nquahu kom hla kev tshawb fawb nrog lub nra.
9. Kuaj mob rau cov tsos mob ntawm tus mob hlwb paj hlwb. Tshawb xyuas qhov kev ua kom zoo, qhov mob, qhov kub thiab kev co ntawm qhov rhiab ntawm cov hlab qhov ntswg, tshwj xeeb tshaj yog nyob ntawm ceg thiab taw
10. Kuaj yog tias autonomic neuropathy tau tsim: kev mob plawv, lub plab zom mov, urogenital thiab nws lwm cov ntawv.
11. Ntsuam xyuas koj txoj kev ua kom lub qog ntshav qab zib. Puas yog cov neeg mob ntshav qab zib feem ntau mob? Nws hnyav npaum li cas? Cov tsos mob tshwm sim zoo li cas?
12. Soj ntsuam rau cov ntshav qab zib peripheral vascular txhab
13. Kuaj ntshav rau cov thyroid hormones: thyroid stimulating hormone (TSH) thiab thyroxine pub dawb (T4 pub dawb).

Txij xyoo 1965, kev faib tawm yog tsim los ntawm American kws kho mob kev txawj ntse-kws kuaj mob tus yawg R. White tau siv los soj ntsuam qhov pheej hmoo ntawm cov me nyuam hauv lub plab tsis ua haujlwm. Qhov txaus ntshai nyob ntawm:

• lub sijhawm ua ntshav qab zib hauv tus poj niam;
• thaum muaj hnub nyoog li cas tus mob pib;
• mob ntshav qab zib li cas twb muaj lawm.

Qib ntawm kev pheej hmoo mob ntshav qab zib hauv tus poj niam cev xeeb tub raws li P. White

Sau ntawv:

• DR - ntshav qab zib retinopathy; DN - ntshav qab zib nephropathy; CHD - mob plawv mob plawv; CRF - mob raum tsis ua haujlwm.
• Chav Kawm A - qhov pheej hmoo tsawg tshaj plaws ntawm teeb meem, chav kawm RF - qhov tsis txaus ntseeg tshaj plaws ntawm kev tshwm sim thaum cev xeeb tub.

Kev faib tawm no tau zoo rau cov kws kho mob thiab cov poj niam uas muaj hom 1 lossis hom 2 ntshav qab zib uas tau npaj muaj menyuam.

Txoj kev pheej hmoo ntshav qab zib yog dabtsi rau leej niam thiab menyuam hauv plab

Txoj kev pheej hmoo ntawm kev tsim muaj hom ntshav qab zib 1 thaum lub sijhawm menyuam yaus yog:

• txog 1-1.5% - nrog hom 1 ntshav qab zib hauv niam;
• txog 5-6% - nrog hom 1 ntshav qab zib hauv leej txiv;
• ntau dua 30% - yog hom ntshav qab zib hom 1 ntawm niam thiab txiv ob leeg.

Tus poj niam thiab cov kws kho mob uas sab laj rau nws nyob rau theem ntawm kev npaj xeeb tub yuav tsum tau muab cov lus teb ntsuas rau cov lus nug:

• Mob ntshav qab zib yuav cuam tshuam li cas rau kev xeeb tub thiab menyuam kev noj qab haus huv? Txoj hmoo zoo li cas thiaj li muaj taus menyuam thiab yug menyuam?
• Kev xeeb menyuam yuav cuam tshuam rau ntshav qab zib li cas? Nws puas txhawb kev tsim kho nrawm ntawm nws qhov teeb meem phom sij?

Cov txheej txheem tiv thaiv tsis pub muaj menyuam hauv cov pojniam muaj ntshav qab zib:

• cov mob nephropathy mob siab (cov paum creatinine> 120 μmol / L, tus nqi glomerular pom 2 g / hnub);
• ntshav siab uas tsis tuaj yeem tswj tau, i.e, ntshav siab dua 130-80 hli RT. Art., Txawm tias qhov tseeb hais tias poj niam noj tshuaj kho ntshav siab;
• proliferative retinopathy thiab maculopathy, ua ntej laser retinal coagulation;
• kev mob plawv hauv lub plawv, tsis khov kho angina pectoris;
• mob hnyav los yog mob ntev thiab mob kis (mob ntsws, pyelonephritis, thiab lwm yam);
• mob ntshav qab zib tsis nco qab - hauv thawj peb lub hlis thaum cev xeeb tub yog qhov qhia rau nws cov khoom neeg txiav tawm.

Cev Xeeb Tub Npaj Rau Cov Poj Niam Mob Ntshav Qab Zib

Yog li, koj tau nyeem ntu ntawv dhau los, thiab txawm li cas los xij, tau txiav txim siab tias yuav xeeb tub thiab muaj menyuam. Yog li, tom qab ntawd rau tus poj niam muaj ntshav qab zib, theem ntawm kev npaj cev xeeb tub yuav pib. Nws yuav tsum muaj kev siv zog ntau thiab tuaj yeem ntev heev, tab sis nws yog qhov yuav tsum tau dhau los dhau nws thiaj li ua rau cov xeeb ntxwv muaj kev noj qab haus huv.

Lub ntsiab cai tseem ceeb: koj tuaj yeem pib conception tsuas yog thaum koj tus nqi ntawm glycated hemoglobin HbA1C txo mus rau 6.0% lossis qis dua. Thiab cov kev ntsuas ntshav qab zib feem ntau uas koj noj nrog qhov ntsuas ntshav qabzib yuav tsum yog qhov qub. Daim ntawv qhia txog ntshav qab zib nws tus kheej yuav tsum khaws thiab txheeb xyuas tus kws kho mob txhua 1-2 asthiv.

Tsis tas li, ntshav siab yuav tsum nyob hauv qis dua 130/80, txawm tias koj tsis noj tshuaj. Nco ntsoov tias cov tshuaj "tshuaj" siab zoo cuam tshuam rau txoj kev loj hlob ntawm tus menyuam. Yog li ntawd, lub sijhawm cev xeeb tub lawv yuav tsum raug tshem tawm. Yog tias koj tsis tuaj yeem tswj hwm kev kub siab yam tsis tau noj tshuaj txawm tias tsis muaj menyuam hauv plab, nws zoo dua tso txoj kev ua niam ua txiv. Vim tias qhov kev pheej hmoo tsis zoo ntawm kev tshwm sim cev xeeb tub yog qhov muaj feem ntau.

Txhawm rau kom muaj txiaj ntsig zoo ntshav qab zib, thaum npaj rau cev xeeb tub, tus poj niam yuav tsum tau ua cov hauv qab no:

• txhua txhua hnub los ntsuas ntshav qab zib nrog ib glucometer tsis hnov ​​mob ntawm lub plab khoob thiab 1 teev tom qab noj mov;
• nws yog qee zaum xav tau ntsuas koj cov piam thaj tseem nyob ntawm 2 lossis 3 thaum sawv ntxov - nco ntsoov tias tsis muaj qhov tsaus ntuj hypoglycemia;
• tus tswv thiab siv lub hauv paus-bolus regimen ntawm insulin txoj kev kho;
• yog tias koj noj cov tshuaj txo ntshav qab zib rau hom ntshav qab zib hom 2, muab pov tseg thiab hloov mus rau cov tshuaj insulin;
• kev tawm dag zog nrog ntshav qab zib - yam tsis ua dhau, nrog kev lom zem, tsis tu ncua;
• ua raws li kev noj haus uas muaj txwv nyob rau hauv carbohydrates, uas tau nrawm nrawm, noj 5-6 zaug hauv ib hnub hauv qhov me me

Lwm cov haujlwm ntxiv rau kev npaj cev xeeb tub nrog ntshav qab zib:

• ntsuas kev ntsuas ntshav siab;
• yog tias kub siab, tom qab ntawd nws yuav tsum tswj hwm, thiab "nrog cov npoo", vim hais tias thaum cev xeeb tub cov tshuaj rau kub siab yuav tsum tau tshem tawm;
• kuaj xyuas ua ntej los ntawm tus kws kho qhov muag thiab kho tus mob hlwb;
• noj folic acid ntawm 500 mcg / hnub thiab poov tshuaj iodide ntawm 150 mcg / hnub, yog tias tsis muaj contraindications;
• txiav luam yeeb.

Ntshav Qab Zib Cev xeeb tub: Yuav ua li cas kom muaj ib tus menyuam noj qab nyob zoo

Thaum cev xeeb tub nrog ntshav qab zib, tus poj niam yuav tsum mob siab tswj nws cov ntshav qab zib kom ze rau qhov tseem ceeb. Ntxiv mus, them lub ntsiab rau cov ntshav qabzib nyob hauv 1 thiab 2 teev tom qab noj mov. Vim tias nws yog lawv uas tuaj yeem nce ntxiv, thiab yoo mov cov ntshav qab zib kom zoo yuav nyob li qub lossis qis dua.

Thaum sawv ntxov, koj yuav tsum kuaj ketonuria nrog cov tev sib xeem, piv txwv li yog tias ketones tau tshwm sim hauv cov zis. Vim hais tias cov poj niam cev xeeb tub uas muaj ntshav qab zib muaj qhov muaj peev xwm ntau ntxiv ntawm cov nocturnal phaum ntu uas muaj ntshav qab zib tsawg. Lub sijhawm ntu no yog ua kom pom los ntawm pom ntawm ketones thaum sawv ntxov tso zis. Raws li kev tshawb fawb, ketonuria cuam tshuam nrog kev poob qis ntawm kev txawj ntse coefficient hauv cov xeeb ntxwv yav tom ntej.

Daim ntawv teev cov kev ua si rau mob ntshav qab zib cev xeeb tub:

1. Tus poj niam cev xeeb tub noj zaub mov noj yuav tsum tsis txhob nruj heev, muaj cov "carbohydrates" kom txaus kom tiv thaiv kev tshaib plab ketosis. Kev noj zaub mov kom tsawg rau cov ntshav qab zib hauv plab yog qhov tsis tsim nyog.
2. Kev ntsuas cov ntshav qab zib nrog ib glucometer - tsawg kawg 7 zaug hauv ib hnub. Ntawm lub plab khoob, ua ntej thiab tom qab noj mov tag, hmo ntuj, thiab qee zaum thaum hmo ntuj. Kev noj tshuaj ntawm cov tshuaj insulin yuav tsum tau kho rau cov ntshav qab zib tsis yog nyob rau ntawm lub plab khoob, tab sis tom qab noj mov tas.
3. Kev siv tshuaj kho ntshav qab zib rau cov neeg cev xeeb tub yog qhia ntxaws ntxiv hauv cov lus hauv qab no.
4. Tswj cov tsos ntawm ketones (acetone) hauv kev tso zis, tshwj xeeb nrog kev pib ua ntej thiab tom qab 28-30 lub lis piam ntawm cev xeeb tub. Lub sijhawm no, xav tau cov tshuaj insulin ntau ntxiv.
5. Kev kuaj ntshav rau glycated hemoglobin yuav tsum tau noj tsawg kawg yog 1 zaug hauv ib hlis.
6. Noj folic acid ntawm 500 mcg / hnub mus txog rau 12 lub lim tiam ntawm cev xeeb tub. Cov poov tshuaj iodide ntawm 250 mcg / hnub - hauv qhov tsis muaj contraindications.
7. Kev kuaj xyuas tus kws kho mob nrog rau kev kuaj pob nyiaj - 1 zaug nyob rau ib hlis. Yog hais tias cov kab mob ntshav qab zib retinopathy nthuav dav los yog preproliferative retinopathy sai sai zuj zus lawm, laser retinal laser coagulation tau ua tiav tam sim ntawd, txwv tsis pub ua tiav qhov muag tsis pom kev yog hem.
8. Mus ntsib kws kho mob leeg ib tus kws kho mob zuaj ib ce, kws kuaj mob endocrinologist los yog kws kho ntshav qab zib. Txog 34 lub lim piam ntawm cev xeeb tub - txhua 2 lub lis piam, tom qab 34 lub lis piam - txhua hnub. Hauv qhov no, ib qho kev ntsuas ntawm lub cev qhov hnyav, ntshav siab, kuaj cov zis tawm dav dav.
9. Yog tias kuaj pom tus kab mob txeeb zig hauv ntshav qab zib, cov poj niam cev xeeb tub yuav tsum tau noj tshuaj tiv thaiv kab mob raws li kws kho mob sau tseg (!). Nws yuav nyob rau hauv kuv lub hlis thib - penicillins, hauv II lossis III trimesters - penicillins lossis cephalosporins.
10. Cov kws kho mob thiab tus poj niam cev xeeb tub nws tus kheej saib xyuas kev loj hlob thiab kev mob ntawm tus me nyuam hauv plab. Ultrasound yog ua raws li kws kho mob kws kho mob kev txawj ntse.

Cov tshuaj siab dab tsi yog kws kho mob sau tseg hauv lub cev xeeb tub:

• Sib tham nrog koj tus kws kho mob tias koj yuav tsum tau txiav txim siab magnesium-B6 thiab taurine rau kev kho kev mob ntshav siab tsis muaj tshuaj.
• Ntawm cov tshuaj "tshuaj", methyldopa yog cov tshuaj xaiv.
• Yog tias cov methyldopa tsis pab txaus, calcium blockers lossis β1-xaiv adrenergic blockers yuav tau raug txiav txim.
• Cov tshuaj kho ntshav qab zib - tsuas yog rau cov kev mob hnyav heev (ua kua dej ceev, lub ntsws muaj ntsws, lub plawv tsis ua haujlwm).

Thaum cev xeeb tub, txhua ntsiav tshuaj ntsig txog cov chav kawm hauv qab no yog contraindicated:

• ntshav qab zib cov tshuaj txo qis qis;
• los ntawm kev kub siab - ACE inhibitors thiab angiotensin-II receptor blockers;
• cov neeg npaj laib;
• cov tshuaj tua kab mob (aminoglycosides, tetracyclines, macrolides, thiab lwm yam);
• statins txhawm rau txhim kho cov ntshav roj cholesterol.

Kev noj haus rau ntshav qab zib kom cev xeeb tub

Ntawm lub vev xaib no, peb hais kom txhua tus neeg mob rau txoj kev kho mob ntshav qab zib hom 2 thiab tseem hom 1 hloov mus rau cov zaub mov tsis muaj zaub mov zoo. Qhov kev noj haus no tsis haum nkaus xwb:

• thaum cev xeeb tub;
• nrog mob raum tsis ua haujlwm.

Kev noj zaub mov kom tsis txhob muaj ntsev ntau rau cov poj niam cev xeeb tub uas muaj ntshav qab zib tau raug txwv, vim nws tuaj yeem cuam tshuam kev loj hlob ntawm tus me nyuam hauv plab.

Qhov txwv tsis pub muaj carbohydrates nyob rau hauv cov zaub mov feem ntau ua rau qhov tseeb tias lub cev hloov mus ua khoom noj nrog nws tus kheej cov rog rog. Qhov no pib ketosis. Ketone lub cev raug tsim los, suav nrog cov acetone, uas tuaj yeem pom hauv cov zis thiab hauv cov ntxhiab ntawm cov pa. Hauv ntshav qab zib hom 2, qhov no yuav zoo rau tus neeg mob, tab sis tsis yog thaum cev xeeb tub.

Raws li koj nyeem hauv tsab xov xwm “Insulin thiab Carbohydrates: Qhov Tseeb Koj Yuav Tsum Tau Paub”, kom tsawg koj tau txais carbohydrates tsawg, nws yuav yooj yim yog tswj cov ntshav qab zib. Tab sis thaum cev xeeb tub - txhawm rau tiv thaiv qhov kev loj hlob ntawm ketosis tseem ceeb dua. Kev nce cov ntshav qabzib tuaj yeem ua rau muaj kev nyuaj rau cev xeeb tub thiab yug menyuam. Tab sis ketonuria tseem txaus ntshai dua. Yuav ua li cas?

Carbohydrates, uas tau nqus sai, tsis muaj nqis rau kev noj qab haus huv hauv ntshav qab zib. Tab sis thaum cev xeeb tub, koj tuaj yeem tso cai rau koj tus kheej noj zaub qab zib (carrots, beets) thiab txiv hmab txiv ntoo, uas nyob rau hauv lub neej qub nws raug nquahu kom tsis txhob noj zaub mov noj. Thiab ua tib zoo saib xyuas qhov tshwm sim ntawm ketones hauv cov zis nrog kuaj kab ntawv.

Cov tshuaj yav tas los tau pom zoo noj ntshav qab zib rau cov poj niam cev xeeb tub nrog 60% carbohydrates. Nyob rau hauv xyoo tas los no, lawv tau lees paub txog cov txiaj ntsig ntawm kev txo cov feem pua ​​ntawm cov carbohydrates thiab tam sim no pom zoo kom muaj kev noj haus uas 40-45% carbohydrates, 35-40% rog thiab 20-25% protein.

Cov poj niam cev xeeb tub uas muaj ntshav qab zib tau qhia kom noj zaub mov me me 6 zaug hauv ib hnub. Cov no yog 3 pluas noj pluas mov thiab 3 cov khoom noj txom ncauj ntxiv, suav nrog thaum tsaus ntuj kom tsis txhob mob txhaws ntshav. Cov neeg tshawb nrhiav feem coob ntseeg tias kev noj zaub mov tsis muaj mob rau cov ntshav qab zib yuav tsum muaj cev muaj zog, txawm hais tias poj niam rog dhau.

Kev txhaj tshuaj insulin

Thaum cev xeeb tub, qhov rhiab ntawm cov ntaub so ntswg mus rau qhov kev ua ntawm insulin txo qis hauv lub cev ntawm tus poj niam hauv qab ntawm cov tshuaj hormones placental, i.e., insulin tsis kam. Txhawm rau them rau qhov no, tus txiav ua qab pib tsim cov tshuaj insulin ntxiv. Kev yoo mov cov ntshav qab zib tseem nyob qub lossis qis dua, thiab tom qab noj mov nws sawv tseem ceeb.

Tag nrho cov no zoo sib xws rau kev txhim kho hom ntshav qab zib 2. Tab sis cov no yog ib txwm ib txwm hloov ua pa hloov pauv txhawm rau paub tseeb tias kev loj hlob ntawm lub cev xeeb tub. Yog tias ua ntej txiav ua tiav lawm tus kws ua haujlwm ntawm qhov txwv ntawm nws lub peev xwm, tom qab ntawd thaum cev xeeb tub tus poj niam yuav muaj ntshav qab zib mob tsis tsaug zog, vim tias tam sim no nws tsis tuaj yeem tiv cov kev hnyav nce.

Cov poj niam cev xeeb tub tau nquag siv tshuaj insulin tsis yog rau cov ntshav qab zib hom 1, tab sis kuj tseem muaj ntshav qab zib hom 2 thiab ntshav qab zib hauv lub cev, yog tias tsis tuaj yeem tswj cov ntshav qab zib ib txwm los ntawm kev noj haus thiab kev tawm dag zog.

Muaj ntshav qab zib ntau tuaj yeem ua rau muaj kev xeeb tub hauv lub cev, uas yog qhov txaus ntshai rau tus menyuam hauv plab thiab poj niam. Ntshav qab zib fetopathy - manifested nyob rau hauv tus me nyuam los ntawm edema ntawm subcutaneous rog, tsis muaj peev xwm ua haujlwm ntawm ntau yam kabmob. Tej zaum yuav tsim teeb meem tseem ceeb thaum ntxov sijhawm yug menyuam.

Macrosomy yog qhov hnyav tshaj los ntawm tus me nyuam hauv plab, nyob hauv qab tus cwj pwm ntawm cov piam thaj ntau ntxiv hauv leej niam cov ntshav. Nws ua rau muaj kev nyuaj siab thaum dhau los ntawm kev yug tus menyuam, ua ntej hnub yug, ua rau tus menyuam lossis tus pojniam raug mob thaum menyuam yug menyuam.

Yog li, tsis txhob tos kom pib cov tshuaj insulin nrog ntshav qab zib hauv cov poj niam cev xeeb tub, yog tias tsim nyog. Kev kho mob insulin yog tsim los ntawm kws kho mob. Ib tug poj niam yuav tsum xav txog kev siv lub tshuab nqus insulin es tsis txhob siv cov tshuaj pleev ib ce nrog cov kua ntswg lossis cov xaum nqus.

Thov nco ntsoov tias nyob hauv ib nrab hnub ntawm kev xeeb tub, qhov xav tau tshuaj insulin tuaj yeem nce ntau. Cov koob tshuaj rau kev txhaj tshuaj insulin tej zaum yuav tsum tau nce ntxiv los ntawm qhov tseem ceeb ntawm 2-3 piv nrog ntau npaum li cas tau txhaj ua ntej cev xeeb tub. Nws nyob ntawm qhov ntsuas ntawm cov ntshav qab zib tom qab noj mov, uas tus poj niam txhua lub sijhawm ntsuas tsis hnov ​​mob nrog glucometer.

Mob ntshav qab zib thiab nephropathy (teeb meem hauv lub raum)

Ntshav qab zib nephropathy yog lub npe nyuaj rau ntau qhov mob txhab ntawm lub raum thiab lawv cov hlab ntshav uas tshwm sim muaj ntshav qab zib. Nov yog qhov kev phom sij txaus ntshai uas cuam tshuam 30-40% ntawm cov neeg mob ntshav qab zib thiab feem ntau ua rau lub raum tsis ua haujlwm.

Raws li tau qhia thaum pib ntawm tsab xov xwm no, mob nyhav nephropathy yog kev tiv thaiv kev xeeb tub. Tab sis ntau tus poj niam uas muaj mob ntshav qab zib nephropathy ntawm "me me" lossis "mob hnyav" feem ntau yuav xeeb tub thiab ua leej niam.

Feem ntau ntawm cov mob ntshav qab zib nephropathy, yug ntawm tus me nyuam siv tau tuaj yeem xav pom. Tab sis, feem ntau yuav ua, chav kawm ntawm cev xeeb tub yuav nyuaj, kev saib xyuas tshwj xeeb thiab kev kho mob hnyav yuav tsum ua. Qhov tshwm sim tsis zoo tshaj plaws yog rau cov poj niam uas muaj qhov tsis pom kev ua haujlwm hauv lub raum, nrog kev ua kom tsis txhob muaj cov ntshav me me thiab muaj qhov muaj zog ntawm creatinine ntau dua nyob hauv cov ntshav ntshav (coj mus kuaj - tshawb xyuas!).

Ntshav qab zib nephropathy tsub kom qhov kev pheej hmoo tsis zoo tshwm sim rau lub cev xeeb tub rau cov laj thawj hauv qab no:

• Ob peb zaug ntau zaus ntxiv, cev xeeb tub yog qhov nyuaj los ntawm preeclampsia. Tshwj xeeb tshaj yog rau cov poj niam uas mob ntshav qab zib nephropathy uas tau muaj ntshav siab ua ntej xeeb tub. Tab sis txawm hais tias tus poj niam thaum xub thawj muaj ntshav siab, preeclampsia tseem muaj feem ntau.
• Kev yug ntxov uas mob ntshav qab zib nephropathy tshwm sim ntau zaus. Vim tias tus poj niam tus mob yuav loj tuaj, lossis me nyuam yaus yuav muaj kev pheej hmoo. Hauv 25-30% ntawm cov neeg mob, kev yug menyuam tshwm sim ua ntej 34 lub lis piam ntawm cev xeeb tub, hauv 50% ntawm tus neeg mob - txog rau 37th lub lim tiam.
• Hauv cev xeeb tub, tawm tsam keeb kwm ntawm nephropathy, nyob rau 20% ntawm cov neeg muaj mob depletion lossis qis dua ntawm lub cev xeeb tub.

Preeclampsia yog qhov kev xeeb tub uas mob hnyav uas ua rau cov ntshav tsis txaus rau lub plab, tsis muaj khoom noj thiab oxygen rau cov menyuam hauv plab. Nws cov tsos mob yog:

• ntshav siab;
• o tuaj
• qhov nce ntxiv ntawm cov protein nyob hauv cov zis;
• tus poj niam tab tom nce ceeb thawj vim yog cov dej ceev hauv lub cev.

Nws yog ib qho nyuaj los twv ua ntej seb puas cev xeeb tub yuav ua kom muaj kev loj hlob ntawm cov ntshav qab zib mob raum. Muaj tsawg kawg yog 4 yam yuav cuam tshuam rau qhov no:

1. Feem ntau, thaum cev xeeb tub, theem ntawm glomerular pom nce ntxiv txog 40-60%. Raws li koj paub, ntshav qab zib nephropathy tshwm sim vim muaj ntau dua glomerular pom. Yog li, cev xeeb tub tuaj yeem ua rau txoj kev tsis haum ntawm tus mob ntshav qab zib no.
2. Ntshav siab yog qhov tseem ceeb ua rau lub raum puas tsuaj. Yog li, kub siab thiab preeclampsia, uas feem ntau tshwm sim hauv cov poj niam cev xeeb tub uas muaj ntshav qab zib, tuaj yeem muaj qhov tsis zoo rau lub raum kev ua haujlwm.
3. Thaum cev xeeb tub, poj niam lub cev noj zaub mov yuav tsum muaj feem pua ​​ntawm cov protein, vim tias tus me nyuam hauv plab xav tau ntau. Tab sis cov protein ntau hauv kev noj zaub mov ua rau muaj kev nce ntxiv hauv glomerular filtration. Qhov no tuaj yeem ua kom lub ntuj muaj ntshav qab zib nephropathy.
4. Hauv kev mob ntshav qab zib nephropathy, cov neeg mob feem ntau tau siv tshuaj kho mob - ACE inhibitors - uas qeeb cov kev txhim kho lub raum puas tsuaj. Tab sis cov tshuaj no cuam tshuam tsis zoo rau kev loj hlob ntawm tus me nyuam hauv plab, yog li lawv tau muab tso tseg thaum cev xeeb tub.

Ntawm qhov tod tes, thaum cev xeeb tub, cov poj niam muaj ntshav qab zib raug qhia kom ua tib zoo saib xyuas lawv cov ntshav qab zib kom qis. Thiab qhov no tuaj yeem muaj txiaj ntsig zoo rau lub raum kev ua haujlwm.

Cov tsos mob ntawm lub raum muaj teeb meem feem ntau tshwm sim nyob rau theem lig ntawm tus mob ntshav qab zib nephropathy. Ua ntej qhov no, tus kab mob tau kuaj pom raws li kev soj ntsuam ntawm cov zis rau cov protein. Ua ntej, albumin tshwm sim hauv kev tso zis, thiab qhov no hu ua microalbuminuria. Tom qab ntawd, lwm cov protein, loj dua ntxiv, ntxiv.

Proteinuria yog qhov excretion ntawm protein nyob hauv zis. Thaum cev xeeb tub, cov poj niam mob ntshav qab zib nephropathy feem ntau muaj cov proteinuria ntau ntau. Tab sis tom qab yug menyuam, nws muaj peev xwm poob qis dua qib qub. Tib lub sijhawm, qhov cuam tshuam tsis zoo uas cev xeeb tub muaj nyob rau ntawm lub raum ua haujlwm yuav tshwm sim tom qab.

Kev yug menyuam muaj qhov mob ntshav qab zib rau poj niam cev xeeb tub

Rau cov poj niam cev xeeb tub uas muaj ntshav qab zib, lo lus nug txog ntev npaum li cas nws yug lub sijhawm txiav txim siab ntawm tus kheej. Hauv qhov xwm txheej no, cov kws kho mob xav txog hauv qab no:

• tus mob ntawm fetus;
• cov degree ntawm kev paub tab ntawm nws lub ntsws;
• muaj cov kev mob cev xeeb tub;
• hom ntawm cov chav kawm ntawm mob ntshav qab zib.

Yog tias tus poj niam thaum cev xeeb tub muaj ntshav qab zib hauv lub cev, thiab tib lub sijhawm nws muaj ntshav qab zib sai, tom qab ntawv nws yuav coj tus menyuam mus rau lub sijhawm ntuj yug.

Yuav tsum tau phais plab menyuam los yog yug menyuam lub cev yog lub luag haujlwm tseem ceeb. Kev yug tus kheej hauv tus poj niam uas mob ntshav qab zib yog tau yog tias cov xwm txheej hauv qab no tau ntsib:

• mob ntshav qab zib yog tswj tau zoo;
• tsis muaj mob hnyav ntxiv;
• qhov hnyav ntawm tus me nyuam hauv qab yog tsawg dua 4 kg thiab nws nyob rau hauv ib txwm mob;
• cov kws kho mob muaj peev xwm soj qab xyuas cov xwm txheej ntawm cov menyuam hauv plab thiab saib xyuas qib ntshav qabzib hauv cov ntshav ntawm leej niam thaum yug menyuam.

Lawv yuav twv yuav raug phais yog tias:

• tus poj niam cev xeeb tub muaj lub plab mog nqaim lossis caws pliav ntawm lub tsev menyuam;
• ib tug poj niam muaj mob ntshav qab zib nephropathy.

Tam sim no hauv ntiaj teb, qhov feem pua ​​ntawm cov caesarean yog 15.2% ntawm cov poj niam noj qab haus huv thiab 20% hauv cov neeg mob ntshav qab zib mellitus, suav nrog kev piav tes. Ntawm cov poj niam uas tau kuaj pom tias mob ntshav qab zib ua ntej cev xeeb tub, ntu kev phais plab tau nce mus rau 36%.

Thaum yug menyuam, cov kws kho mob soj qab xyuas cov piam thaj hauv cov ntshav capillary 1 zaug hauv ib teev. Nws yog ib qho tseem ceeb heev los tswj niam cov ntshav qab zib kom nyob rau theem li ib txwm muaj los ntawm cov piam thaj hauv ntshav thiab muaj cov tshuaj insulin tsawg. Kev siv cov tshuab raj insulin kuj muab cov txiaj ntsig zoo.

Yog tias tus neeg mob, ua ke nrog kws kho mob, tau xaiv qhov phais mob phais, tom qab ntawd lawv npaj nws sawv ntxov. Vim tias thaum lub sijhawm cov sijhawm no cov koob tshuaj "nruab nrab" lossis ntev ntev los ntawm insulin, uas tau muab tshuaj rau thaum hmo ntuj, tseem yuav ua mus ntxiv. Yog li nws yuav muaj peev xwm kom tsis txhob tso cov piam thaj lossis tshuaj insulin hauv cov txheej txheem ntawm kev yug menyuam.

Tom qab lub sijhawm so

Ntawm no peb xav txog qhov xwm txheej thaum tus poj niam pib tsim cov ntshav qab zib insulin-ua ntej kev xeeb tub. Yog tias kuaj ntshav qab zib thawj zaug thaum cev xeeb tub, nyeem kab lus ntawm cov ntshav qab zib hauv lub ntsej muag rau cov poj niam tom qab yug menyuam tas.

Tom qab yug los, cov placenta ceases cuam tshuam rau cov metabolism hauv lub cev ntawm tus poj niam nrog nws cov tshuaj hormones. Raws li, qhov rhiab ntawm cov ntaub so ntswg mus rau insulin nce. Yog li, cov tshuaj insulin rau kev txhaj tshuaj yuav tsum tau txo qis kom tsis txhob mob ntshav qab zib siab heev.

Kwv yees li qhov kev txhaj tshuaj ntawm cov tshuaj insulin tuaj yeem txo los ntawm 50% tom qab yug los ntawm cov txheej txheem ntuj thiab los ntawm 33% thaum phais mob. Tab sis nrog kev kho mob insulin, koj tuaj yeem tsuas yog ua kom pom tseeb ntawm cov kev ntsuas ntawm tus neeg mob, thiab tsis yog rau lwm tus neeg cov ntaub ntawv "nruab nrab". Xaiv txoj kev noj cov ntshav yog yuav tsum tau los ntawm kev ntsuas ntshav qabzib ntau zaus.

Ob peb xyoos dhau los, pub mis niam rau tus poj niam muaj ntshav qab zib muaj teeb meem. Qhov no tau tiv thaiv los ntawm:

• feem pua ​​ntawm cov menyuam yug ntxov;
• muaj teeb meem thaum yug menyuam;
• lub cev zom zaubmov tsis zoo hauv cov pojniam.

Qhov xwm txheej no tam sim no tau hloov pauv. Yog tias ntshav qab zib ua tau zoo thiab tau tus menyuam tau tiav thaum sijhawm, kev pub mis niam yog qhov ua tau thiab pom zoo. Hauv qhov no, nco ntsoov tias qee ntu ntawm cov ntshav qog ua kom ntshav nce mus rau txoj hlab ntaws thiab cov kua mis tsim tawm. Yog li ntawd, koj yuav tsum tau sim tsis tso cai rau lawv.

Yog hais tias tus neeg mob tswj nws cov ntshav qab zib, ces cov lus sib xyaw ntawm nws cov mis yuav zoo ib yam li hauv cov pojniam noj qab haus huv. Tshwj tsis yog tias cov piam thaj cov ntsiab lus yuav raug nce ntxiv. Nws tseem ntseeg tias cov txiaj ntsig ntawm kev pub niam mis noj tshaj qhov teeb meem no.