Zizindikiro zoyambirira za hypoglycemia akhanda

Palibe tanthauzo la hypoglycemia potengera maphunziro mwatsatanetsatane.

Zowopsa zake zimaphatikizira kukhwima, kulemera / kukula pang'ono kwa mbadwo wamthumbu, komanso asphyxia wamatumbo. Kuzindikira kumayesedwa mwamphamvu komanso kutsimikiziridwa ndi kuyesedwa kwa shuga. Izi zimadalira matenda oyambitsawa. Kuchiza ndi zakudya zopatsa mphamvu kapena shuga m'magazi.

Malinga ndi kafukufuku wa ma neonatologists ku England kumapeto kwa zaka za 80s, malire ochepera a plasma glucose, omwe amawonetsa kusintha kwa dziko la hypoglycemia, kuyambira 18 mpaka 42 mg / dL!

Makhalidwe "abwinobwino" am'magazi a glucose (GC) omwe amakhala atangobadwa kumene samatulutsa chiwonetsero cha kuleza kwa glucose, koma ndi chifukwa cha kuchedwa kwa kudya kwa akhanda mu 60s. Ponena za makanda obadwa msanga ndi tiana tating'onoting'ono pakubwera msana, chiwopsezo cha hypoglycemia ndichokwera kwambiri kuposa chokwanira cha ana athanzi anthawi yayitali chifukwa chosungidwa ndi michere ya glycogenolysis. Kumayambiriro koyambirira kwa kudyetsa, kuchuluka kwa HA mkati mwa sabata la 1 la moyo kumakhala mkati mwa 70 mg / dl.

Kulongosola kwaposachedwa kwamabuku kumene kwa hypoglycemia potengera kuchuluka kwa HA muumoyo wakhanda kwatsopano sikunasinthe kwenikweni m'malo mokomera tanthauzo lantchito. Funso silomwe lidapangidwa kale kuti "hypoglycemia", "koma" ndi gawo lanji la HA lomwe limafunikira kuti ziwalo zanthupi la mwana makamaka ubongo "?

Ophunzira awiri pawokha adapanga kafukufuku payekha kuti awone momwe otsika a HA amagwirira ntchito muubongo omwe amapanga lingaliro lomwelo:

• Lucas (1988) adachita kuyesa kwa ana muubongo kwambiri (n = 661) ndikuwonetsa kuti pagulu la ana omwe kuchuluka kwa GK kwawo kumatsika pang'onopang'ono mpaka pansi pa 2.6 mmol / L kwa masiku osachepera atatu, koma zizindikilo zidali sanachoke, ali ndi miyezi 18, kuchepa kwa mitsempha kunadziwika nthawi zambiri kuposa kagulu kolamulira. Zotsatira izi zidatsimikiziridwa pambuyo pake ndi kafukufuku wa kafukufuku wa Duvanel (1999) pakuwunika ntchito ya mitsempha mwa ana obadwa asanabadwe azaka 5, ndipo zidadziwika kuti zochitika zobwereza za hypoglycemia ndizomwe zimapangitsa kwambiri pakukula kwa psychomotor ya mwana.
• Koh (1988) mu kafukufuku wake pogwiritsa ntchito njira za neurophysiological adasanthula ubale womwe ulipo pakati pa kuchuluka kwa HA ndi kupezeka kwa zamomwe zimayambitsa zam'kati mwa ana akhanda. Nthawi yomweyo, mwa ana omwe GK yawo siyinatsike m'munsi mwa 2.6 mmol / L, palibe zofunikira za m'mawu zomwe zinalembedwapo, mosiyana ndi gulu la ana omwe ali ndi mitengo yotsika ya shuga (n = 5).

Kutengera ndi zotsatira za kafukufukuyu, mfundo zotsatirazi zitha kufikiridwa:

• Choyamba, kukhalabe ndi glycemia> 2.6 mmol / L kumalepheretsa kuwonongeka kwa mitsempha yolimba komanso yolimba.
• Kachiwiri, nthawi yayitali komanso yopanda nthawi yambiri ya hypoglycemia imawoneka yolakwika kwambiri kwa mwana wakhanda kuposa kukhala wamtundu kapena wosakwatiwa. Kupezeka kwa zizindikiro zamatenda azakhansa nthawi yayitali kumakhala kofala, ndipo sikuwonetsa njira yofatsa ya hypoglycemia. Chifukwa chake, Hypoglycemia yodziwika bwino imayenera kuganiziridwa ngati yovuta kwambiri ndikufunika kowonjezereka kwa chithandizo ndikuwongolera.

Tanthauzo

Makanda anthawi zonse komanso asanakwane (kuphatikiza SGA): 4300 g.

Kukula Kwofunikira / Hyperinsulinism:

• Mankhwala othandizira amayi (thiazides, sulfonamides, β-mimetics, tocolytics, diazoxide, mankhwala antidiabetes, propranolol, valproate).
• Mwana kuchokera kwa mayi yemwe ali ndi matenda a shuga (mpaka 30%).
• Polyglobulia.
• Wiedemann-Beckwith Syndrome (1: 15000).
• Congenital hyperinsulinism (kale lija: nezidioblastosis), insulinoma (chosowa kwambiri).
• Leucine-hyperinsulinism.

Zakudya zamafuta ochepa:

Zofooka za michere ya gluconeogenesis:

• fructose-1,6-bisphosphatase
• phosphoenolpyruvate carboxy kinases
• pyruvate carboxylase

Zofooka za michere ya glycogenolysis (glycogenoses yomwe imakonda hypoglycemia):

• shuga-6-phosphatase (mtundu I)
• enzyme ya nthambi zisanu ndi zinayi (debranching enzyme) (mtundu III)
• chiwindi phosphorylases (mtundu VI)
• phosphorylase kinases (mtundu IX)
• glycogen synthetase (mtundu 0).

Zofooka mu amino acid metabolism: mwachitsanzo maple syrup matenda, tyrosinemia.

Organ acidemia: mwachitsanzo propionic acidemia, methylmalonic acidemia.

Galactosemia, fructose tsankho.

Zofooka mu makutidwe ndi okosijeni amafuta acids.

Kudya shuga wokwanira kuchokera ku chakudya.

Matenda a mahomoni: kukula kwa kuperewera kwa mahomoni, kuchepa kwa ACTH, kuchepa kwa glucagon, hypothyroidism, kuperewera kwa cortisol, zovuta zapadera komanso zophatikiza.

Zifukwa zina: cholakwika pochita kulowetsedwa mankhwala, yopuma mu mayendedwe a kulowetsedwa mankhwala maziko a mkulu magazi a shuga, kwambiri matumbo matenda, kusinthana magazi, peritoneal dialysis, indomethacin mankhwala, kulowetsedwa kwa shuga mwa mkulu catheter mu umbilical mtsempha wamagazi.

Zizindikiro ndi hypoglycemia akhanda

Nthawi zambiri, sizimachitika. Zizindikiro za Neuroglycopenic zimaphatikizira kupweteka, chikomokere, zochitika za cyanotic, ziphuphu, bradycardia, kapena kulephera kupuma komanso hypothermia.

Chenjezo: Zizindikiro zakuchipatala zitha kupezeka mu hyperglycemia yayikulu, chifukwa chake, pazokayikitsa, nthawi zonse dziwa GC!

• Kupanda chidwi, kufooka kwa mayamwa (zizindikiro za hypoglycemia mwa ana okulirapo).
• Kuda nkhawa, thukuta.
• Spasms.
• Tachycardia, kusinthasintha kwa magazi.
• Tachypnea, ziphuphu zakumaso ndi matenda a cyanosis.
• Kufuula kwadzidzidzi.

Kuzindikira kwa hypoglycemia akhanda

• Magazi a usiku wonse amapima.

Zizindikiro zonse ndizosazindikira komanso zimapezekanso mwa akhanda omwe ali ndi matenda osokoneza bongo, sepsis, hypocalcemia, kapena opioid achire syndrome. Chifukwa chake, akhanda omwe ali pachiwopsezo cha kapena popanda izi amafunika kuyesedwa kwa glucose posachedwa. Miyezi yochepa kwambiri imatsimikiziridwa mwa kupenda zitsanzo zamwazi za venous.

Chenjezo: hypoglycemia = ntchito kuzindikira!

• Motani?: Zoyeserera zomwe zimagwiritsidwa ntchito mozama kwambiri pakuwongolera glycemic m'migawo yotsika ya miyeso yomwe imachokera ndi njira yomwe hexokinase amagwiritsidwa ntchito mu labotale, i.e., mfundo zonse za glucose zotsika pazotsatira za miyezo yogwiritsira ntchito mayeso amayesa kufufuzidwa ndi njira yantchito. Malangizo: HA 4300 g pobadwa, makanda kuchokera kwa amayi omwe ali ndi matenda ashuga, ana akhanda asanachitike.
• Liti? Kuyang'anira kuwunika kwa GC, 1/2, 1, 3, ndi maola 6 mutabereka, ndiye malingana ndi zowonetsa.

Kuzindikiritsa koyambirira: choyamba, osapatula matenda omwe alibe metabolic, monga sepsis, kusokonezeka.

Hypoglycemia yobwerezanso /

• Kutsimikiza mtima kwa maziko a hypoglycemia ofunika kwa metabolite wa P-hydroxybutyrate, mafuta ache, ma lactate ndi mipweya yamagazi.
• zina kusiyanitsa matenda algorithm.
• Kukhazikika kozindikira - motsogozedwa ndi magulu anayi.

Chithandizo cha hypoglycemia akhanda

• Dextrose kudzera m'mitsempha (kupewa ndi kuchiza).
• Zakudya zamagulu.
• Nthawi zina glucagon wa mu mnofu.

Makanda oopsa omwe amakhala pachiwopsezo chachikulu amawagwirira ntchito. Makanda ochokera kwa amayi omwe ali ndi matenda a shuga omwe amagwiritsa ntchito insulin nthawi zambiri amapatsidwa shuga wamadzi 10% kuchokera pakubadwa. Ana ena obadwa kumene omwe ali pachiwopsezo omwe samadwala ayenera kuyamba kudya chakudya cham'mawa pafupipafupi ndi zosakaniza kuti apereke chakudya.

Ngati shuga achepa kufika pa 120 ml / kg / tsiku for 60 feed).

• Mwadzidzidzi shuga bolus 3 ml / kg 10% shuga, mubwerezenso ngati kuli kofunikira.
• Pambuyo pa bolus, kulowetsedwa kwa shuga wa 5 ml / kg / ola la 10% shuga.
• Musaiwale za zowonjezera zamlomo zamkati zama glucose. Onjezerani maltodextrin ku mkaka wosakaniza (kumapangitsa kuti insulin ikhale yocheperako kuposa iv glucose).
• Pakusowa kanthu: Kuchulukitsa pang'onopang'ono pamathandizo a iv glucose ndi 2 mg / kg / mphindi mpaka 12 mg / kg / min.
• Ngati zinthu sizikuyenda bwino atatengedwa pamwambapa: kukhazikitsidwa kwa gluon rut: mlingo wa akhanda athanzi (eutrophic) 0,5 mg / kg iv, s / c kapena iv. Osagwiritsa ntchito ndi HH kapena SGA!

Chenjezo: Kuwongolera kwambiri, chifukwa zotsatira zake ndizakanthawi kochepa!

Chenjezo: shuga wamkulu wa glucose → kukondoweza kwamphamvu kwa kupanga kwa insulin ↔ kutsitsa kwina kwa glycemia!

Ngati zotsatira zake sizikwaniritsidwa:

• Octreotide (analog of somatostatin) 2 - 20 mcg / kg / tsiku s / c kwa majekeseni atatu a 3-4, ndizothekanso iv panthawi yothandizirana ndi kubereka hyperinsulinism.
• Monga chomaliza: diazoxide, chlorothiazide.

Chenjezo: kusinthasintha kwakukulu mu GC.

• Nifedipine.
• Kwa masiku angapo, hydrocortisone. Kuchita: kukondoweza kwa gluconeogeneis. Kuchuluka kwa kupuma kwa glucose. M'mbuyomu, milingo ya cortisol ndi insulin inayesedwa kwa hypoglycemia.

Chidule: Ndalama zothandizira pakamwa kwambiri momwe zingathere, mu / momwe zingafunikire.

Kupewa kwa hypoglycemia akhanda

Mwa amayi apakati omwe ali ndi matenda ashuga, kusunga kwambiri glycemia, makamaka mochedwa

Kudyetsa koyambirira komanso pafupipafupi kuyambira ola la 3 la moyo, makamaka HH ndi SGA.

Samalani kwambiri kuperekanso zakudya pafupipafupi, kuphatikiza mutachinya (osachepera maola 4). Mu NN omwe akukonzekera kukacha, mu 18% ya milandu pamakhala zochitika za mochedwa hypoglycemia ndikuchedwa kudyetsa.

Zolemba zaukadaulo wazachipatala

Hypoglycemia ndi seramu glucose wochepera 40 mg / dl (ochepera 2.2 mmol / l) nthawi zonse kapena osachepera 30 mg / dl (ochepera 1.7 mmol / l) mwa makanda asanakwane. Zomwe zimayambitsa ngozi zimaphatikizapo kusakhazikika kwa kukhazikika kwa thupi komanso kusokonekera kwa msambo. Zomwe zimayambitsa ndizovuta kwambiri masitolo a glycogen ndi hyperinsulinemia. Zizindikiro za hypoglycemia zimaphatikizapo tachycardia, cyanosis, kukokana ndi ziphuphu.

Kuzindikiritsa kwa hypoglycemia kumalimbikitsidwa komanso kutsimikiziridwa ndi kutsimikiza kwa shuga. Kukula kwake kumadalira chomwe chimayambitsa, mankhwalawa ndi zakudya zowonjezera kapena shuga wamkati.

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Nchiyani chimayambitsa hypoglycemia mwa akhanda?

Hypoglycemia mu wakhanda imatha kukhala yochepa kapena yokhazikika. Zomwe zimayambitsa kuchepa kwa hypoglycemia ndizosakwanira kapena kusakhazikika kwa ntchito ya enzyme, komwe kumayambitsa malo osakwanira a glycogen. Zomwe zimayambitsa kupitirira kwa hypoglycemia ndi hyperinsulinism, kuphwanya kwa mahomoni opatsirana komanso matenda obadwa nawo monga glycogenosis, kusokonezeka kwa gluconeogeneis, makutidwe ndi okosijeni aacids.

Masitolo osakwanira a glycogen pobadwa nthawi zambiri amapezeka m'mimba mwa ana osabadwa omwe ali ndi vuto lochepa kwambiri, makanda omwe amakhala ocheperako chifukwa cha kuperewera kwa thupi, komanso makanda omwe ali ndi vuto lodana ndi kubereka. Anaerobic glycolysis amatsitsa m'masitolo a glycogen mwa ana oterowo, ndipo hypoglycemia imatha kukhazikika nthawi iliyonse m'masiku ochepa, makamaka ngati nthawi yayitali pakati paadyetsa kapena kuchuluka kwa michere kumakhala kotsika. Chifukwa chake, kusunga zakumwa za shuga zakunja ndizofunikira popewa hypoglycemia.

Hyperinsulinism yochepa kwambiri imapezeka kwambiri mwa ana kuchokera kwa amayi omwe ali ndi matenda ashuga. Nthawi zambiri zimachitika ndi kupsinjika kwa thupi mwa ana ocheperapo ndi mayeso. Zomwe zimayambitsa ndizambiri zimaphatikizapo hyperinsulinism (yoperekedwa ndi ziwalo zonse za autosomal pressomal recessive cholowa), erythroblastosis yayikulu, Beckwith-Wiedemann syndrome (momwe islet cell hyperplasia imaphatikizidwa ndi zizindikiro za macroglossia ndi umbilical hernia). Hyperinsulinemia imadziwika ndi kutsika kwamphamvu kwa seramu glucose woyamba maola awiri pambuyo pobadwa, pomwe kuperekera kwa glucose kosatha mwa placenta kumatha.

Hypoglycemia imatha kukhazikikanso ngati njira yokhazikika yothetsera shuga igwira mwadzidzidzi.

Zizindikiro za hypoglycemia mwa akhanda

Ana ambiri alibe zizindikiro za hypoglycemia. Hypoglycemia yomwe imakhalapo kwa nthawi yayitali kapena yayikulu imayambitsa masamba a michere komanso a minyewa oyambira kumene. Zizindikiro zamasamba zimaphatikizapo thukuta, tachycardia, kufooka, komanso kuzizira kapena kunjenjemera. Zizindikiro zapakati pa mitsempha za hypoglycemia zimaphatikizira kupweteka, chikomokere, matenda a cyanosis, ziphuphu zakumaso, bradycardia kapena kupuma, hypothermia. Kutha kwam'mimba, kusowa kudya, hypotension, ndi tachypnea zitha kudziwika. Mawonekedwe onse ndi opanda tanthauzo ndipo amadziwikanso mu akhanda omwe akumana ndi asphyxia, omwe ali ndi sepsis kapena hypocalcemia, kapena ndi opioid achire syndrome. Chifukwa chake, odwala omwe ali pachiwopsezo ndi kapena popanda zizindikirozi amafunika kuwunika msanga wamagazi a capillary. Mulingo wocheperako umatsimikiziridwa ndi kutsimikiza kwa shuga m'magazi a venous.

Chithandizo cha hypoglycemia akhanda

Makanda oopsa kwambiri amakhala ndi chithandizo chamankhwala. Mwachitsanzo, ana ochokera kwa amayi omwe ali ndi matenda a shuga omwe amadalira insulin nthawi zambiri amalandila kulowetsedwa kwa 10% ya shuga akangobadwa kumene kapena amapatsidwa shuga pakamwa, komanso kwa odwala omwe ali ndi msanga kapena kwa ana omwe ali ndi vuto la kupuma. Ana omwe ali pachiwopsezo ayenera kulandira msanga, pafupipafupi kudyetsa osakaniza kuti awapatse chakudya.

Mwa mwana aliyense wakhanda yemwe glucose wake amachepetsa wocheperako kapena wofanana ndi 50 mg / dl, kulandira chithandizo choyenera kuyenera kuyambitsidwa ndi chakudya chokwanira kapena kukonzanso kwamitsempha yotsekemera ndi kuchuluka kwa 12.5%, pamlingo wa 2 ml / kg kwa mphindi zopitilira 10, Kuzungulira kungaperekedwe, ngati kuli kotheka, kudzera mwa catheter wapakati. Kenako kulowetsedwa kuyenera kupitiliza pamlingo womwe umapangitsa kuti pakhale shuga wa 4-8 mg / (kg), mwachitsanzo, 10% yankho la glucose pamlingo pafupifupi 2.5-5 ml / (kg h). Seramu glucose iyenera kuyang'aniridwa kuti iwongolere kuchuluka kwa kulowetsedwa. Ndi kusinthika kwa mkhalidwe wakhanda, kudyetsa kwapakati pang'onopang'ono kumatha kulowetsa kulowetsedwa mkati, pomwe kuchuluka kwa shuga kukupitilizabe. Kulowetsedwa kwa shuga mkati mwazinthu kumayenera kuchepa pang'onopang'ono, chifukwa kusiya kwadzidzidzi kungayambitse hypoglycemia.

Ngati kuli kovuta kuyambitsa kulowetsedwa kwa mwana wakhanda yemwe ali ndi hypoglycemia, glucagon pa mlingo wa 100-300 μg / kg intramuscularly (pazipita 1 mg) nthawi zambiri kumachulukitsa kuchuluka kwa shuga, izi zimatha maola 2-3, kupatula kwa akhanda omwe atsika masitolo a glycogen. Hypoglycemia, kukonzanso kwa kulowetsedwa kwa glucose pamlingo wambiri, amatha kuthandizidwa ndi hydrocortisone pa mlingo wa 2,5 mg / kg intramuscularly 2 pa tsiku. Ngati hypoglycemia imakhala kukana chithandizo, zifukwa zina (mwachitsanzo, sepsis) ziyenera kuyikidwa pambali ndipo mwina, kuyesa kwa endocrinological kuyenera kuyikidwa kuti kuzindikire hyperinsulinism yokhazikika komanso glycogenolysis.

Trogogiccemia wosakhalitsa: zimayambitsa makanda atsopano

Mpweya ndi glucose ndiye magwero amoyo wa thupi.Pambuyo pa hyperbilirubinemia, neonatal hypoglycemia imadziwika kuti ndi chinthu chachiwiri chomwe chimafunikira kuti mwana akhale kuchipatala nthawi yayitali atabadwa. Mwana yemwe ali ndi vuto lotere amafunika kumuunika mosamalitsa, chifukwa matenda ambiri amatha kutsagana ndi hypoglycemia.

Ndipo shuga wochepetsetsa kwambiri wa mwana wakhanda wobadwa kumene ndi mwana wa chaka choyamba cha moyo amaonedwa kuti ndi wowopsa kwambiri wathanzi. Zimakhudza kwambiri thanzi la ubongo komanso minofu yonse.

Osakhalitsa (osakhalitsa) neonatal hypoglycemia

Mwana akabadwa, amakumana ndi mavuto ambiri. Pa nthawi ya leba ndi pakudutsa mwana kudzera pakubala kwa amayi, shuga amamasulidwa kuchokera ku glycogen m'chiwindi, ndipo chizolowezi cha shuga m'magazi chimasokonekera.

Izi ndizofunikira popewa kuwonongeka kwa minyewa yaubongo ya mwana. Mwana akapanda kuchepa shuga, thupi lake limachepa.

Izi sizikhala nthawi yayitali, chifukwa chifukwa cha machitidwe amomwe amadzipatsira okha kuchuluka kwa shuga m'magazi, kuphatikiza kwake kumabwereranso kwina.

Nthawi zambiri izi zimatha kukhazikitsidwa chifukwa cha mkhalidwe wosasamala wa ogwira ntchito kuchipatala (hypothermia), izi zimachitika makamaka kwa ana osabadwa kapena ana oonda kwambiri. Ndi hypothermia, hypoglycemia imatha kupezeka mwa mwana wamphamvu.

Wamtundu

Ana anthawi zonse amoyo wathanzi amakhala ndi malo ogulitsira akuluakulu a glycogen m'chiwindi. Zimapereka mwayi kwa mwana kulimbana ndi zovuta zomwe zimakhudzana ndi kubadwa. Koma ngati kukula kwa intrauterine kwa mwana wosabadwayo kumachitika ndi vuto lililonse, hypoglycemia mwa mwana wotere imatenga nthawi yayitali ndipo kumafunikanso kuwongolera pogwiritsa ntchito mankhwala a shuga.

Hypoglycemia yomwe imakhalapo kwa nthawi yayitali imakula msanga, makanda olemera komanso ana osakhalitsa.

Monga lamulo, gulu la ana akhanda kumene limakhala ndi mapuloteni ochepa, mapuloteni a adipose komanso hepatic glycogen.

Kuphatikiza apo, chifukwa cha kuchepa kwa michere mwa ana oterowo, makina a glycogenolysis (kuphwanya glycogen) amayamba kuchepa. Zomwe zimalandiridwa kuchokera kwa amayi zimatha msanga.

Zofunika! Chisamaliro chachikulu chimaperekedwa kwa ana omwe amabadwa kwa amayi omwe ali ndi matenda ashuga. Nthawi zambiri ana awa amakhala ochuluka kwambiri, ndipo kuchuluka kwa glucose m'magazi awo kumachepetsa msanga. Izi ndichifukwa cha hyperinsulinemia.

Makanda obadwa kumene pamaso pa mkangano wa Rhesus amakumana ndi mavuto omwewo. Amakhala kuti ndi mitundu yovuta ya kusamvana, ma hyperplasia a maselo a kapamba amatha kupanga, omwe amapanga insulin. Zotsatira zake, minofu imatenga glucose mwachangu kwambiri.

Pangozi

Mkhalidwe wa wakhanda umawunikidwa pamlingo wa Apgar. Umu ndi momwe kuchuluka kwa hypoxia ya ana kumatsimikizidwira. Choyamba, ana amadwala hypoglycemia, yemwe kubadwa kwake kunali kofulumira ndipo ankatsagana ndi kutaya magazi kwambiri.

Hypoglycemic state imakulanso mwa ana omwe ali ndi mtima arrhythmias. Amathandizanso kuti amayi azigwiritsa ntchito mankhwala ena aliwonse omwe ali ndi pakati.

Zomwe zimayambitsa kuchepa kwa hypoglycemia

Hypoglycemia wosakhalitsa nthawi zambiri amayamba chifukwa cha matenda osiyanasiyana. Mtundu uliwonse wamtundu wake (pathogen ilibe kanthu) imabweretsa hypoglycemia. Izi ndichifukwa choti mphamvu zambiri zimagwiritsidwa ntchito polimbana ndi matendawa. Ndipo, monga mukudziwa, glucose ndiye gwero lamphamvu. Kukula kwa chizindikiro cha neonatal hypoglycemic kumatengera kuopsa kwa nthendayi.

Gulu lina lalikulu limakhala ndi akhanda omwe ali ndi vuto la mtima lochoka komanso magazi amayenda. Zikakhala zotere, hypoglycemia imayambitsa magazi osayenda bwino mu chiwindi ndi hypoxia. Kufunika kwa jakisoni wa insulini kumazimiririka mu zonsezi

• kulephera kwazungulira,
• kuchepa magazi
• hypoxia.

Kulimbikira hypoglycemia

Nthawi zambiri pamatenda ambiri mthupi mumakhala kuphwanya njira ya metabolic. Nthawi zina pamakhala zolakwika zosasinthika zomwe zimalepheretsa mwana kukula ndikuyika moyo wake pachiwopsezo.

Ana oterewa, atapimidwa bwino, amasankha zakudya zoyenera ndi chithandizo chamankhwala. Ana akuvutika ndi kubereka kwa galactosemia, mawonetseredwe ake amamveka kuchokera masiku oyamba amoyo.

Pambuyo pake, ana amakula ndi fructosemia. Izi ndichifukwa choti fructose imapezeka mumasamba ambiri, uchi, timadziti, ndipo zinthuzi zimadzetsedwa muzakudya za mwana pambuyo pake. Kukhalapo kwa matenda onsewa kumafunika kudya kwamphamvu pamoyo.

Kukula kwa hypoglycemia kumatha kudzetsa kusokonekera kwa mahomoni ena. Poyamba pankhaniyi ndikusakwanira kwa ma pituitary gland ndi adrenal gland. Zoterezi, mwana amakhala akuyang'aniridwa ndi endocrinologist.

Zizindikiro za matenda amtunduwu zimatha kuchitika mwa mwana komanso pambuyo pake. Ndi kukula kwa maselo a pancreatic, kuchuluka kwa insulin kumawonjezeka ndipo, motero, kuchuluka kwa shuga m'magazi kumachepa.

Kuwongolera izi pogwiritsa ntchito njira zachikhalidwe ndizosatheka. Zotsatira zake zimatheka pokhapokha ngati akuchita opareshoni.

Hypoglycemia ndi zizindikiro zake

1. Kupumira mwachangu.
2. Kumva nkhawa.
3. Kuthekera kwakukulu.
4. Kutunda kwa miyendo.
5. Kudzimva chisoni kosatha.
6. Matenda opatsirana.
7. Kuphwanya kupuma mpaka kusiya.
8. Lethargy.
9. Kufooka minofu.
10. Kugona.

Kwa mwana, kukokana komanso vuto la kupuma ndizowopsa.

Nthawi zambiri, hypoglycemia amalembedwa tsiku loyamba la moyo wa mwana.

Kuzindikira matendawa

Mwa ana a chaka choyamba cha moyo ndi ana akhanda, ziyeso zotsatirazi zimatengedwa kuti adziwe kuti hypoglycemia imakhala yayitali kapena yayitali:

• kuchuluka kwa shuga m'magazi,
• chosonyeza mafuta acids aulere,
• Kutsimikiza kwamankhwala a insulin,
• kutsimikiza kwa mulingo wa kukula kwa mahomoni (cortisol),
• kuchuluka kwa matupi a ketone.

Ngati mwana ali pachiwopsezo, kufufuza kumachitika mu maola 2 oyambirira a moyo wake. Kutengera izi, mtundu ndi kuchuluka kwa neonatal hypoglycemia kumatsimikiziridwa, zomwe zimapangitsa kupereka mankhwala oyenera kwa mwana.

Ndani ali pachiwopsezo

Hypoglycemia imatha kuchitika mwa mwana aliyense, komabe pali gulu linalake langozi lomwe limaphatikizapo ana:

1. kusamalira mwana
2. asanakwane
3. ndi zizindikiro za hypoxia,
4. obadwira kwa amayi omwe ali ndi matenda ashuga.

Mwa makanda oterewa, misempha ya magazi imatsimikizika pambuyo pobadwa (mkati mwa ola limodzi la moyo).

Ndikofunikira kudziwa mwachangu hypoglycemia wakhanda, chifukwa chithandizo chamanthawi yake komanso kupewa zimateteza mwana ku kukula kwamavuto akulu amodzi.

Pakatikati pakutsata mfundo za kukula kwa perinatal. Ndikofunikira kuyamba kuyamwitsa posachedwa, kupewa kukula kwa hypoxia, komanso kupewa hypothermia.

Choyamba, ndi neonatal hypoglycemia, madokotala a jekeseni a 5% amayamba kugwiritsira ntchito shuga. Ngati mwana ali kale kuposa tsiku, njira 10% ya glucose imagwiritsidwa ntchito. Pambuyo pake, kuyezetsa magazi kuchokera kwa chidendene cha wakhanda nthawi yomweyo kupita kumunsi kumayesedwa.

Kuphatikiza apo, mwana amapatsidwa chakumwa mu mawonekedwe a shuga kapena amawonjezera mkaka. Ngati njirazi sizibweretsa kufunika, chithandizo cha mahomoni ndi glucocorticoids chimagwiritsidwa ntchito. Ndikofunikanso kudziwa chomwe chimayambitsa hypoglycemia, izi zimapangitsa kupeza njira zabwino zothandizira kuti athe.

Hypoglycemia mu makanda

Pali zopatuka zamagulu a shuga mwa ana m'magazi pakubadwa. Gulu lalikulu kwambiri pakati pa makanda ndi ana asanakonzekere. Masabata ochepa mwana wosabadwa, makamaka pomwe amakhala osakonzekera kukhala payekha. Mchere wotsika kwambiri ndiye kuti umangowonetsa osati kukhalapo kwa hypoglycemia, komanso zovuta zina zowopsa. Ngati kuchuluka kwa shuga mwa wakhanda kumakhala kosakwana 2.2 mmol / l, ichi ndi chizindikiro choopsa kwa madokotala ndi makolo.

Mafuta achuma aulere amagwiritsidwa ntchito ngati mafuta m'chiwindi, mtima, komanso minofu yamafupa, kapena amakhala chiwindi m'magulu otsika kwambiri a lipoprotein. Malipoti ena awonetsa kuchepa kwa kulolerana kwa kulowetsedwa kwa lipid kwa ana ang'ono chifukwa chamisinkhu yokhala ndi bere komanso ana obadwa kumene osakwana milungu 32. Izi zimatheka nthawi zambiri popereka lipids mkati mwa maola 24. “Windo” lopanda lipids silimafunikira, pomwe mankhwalawa samayikidwa kuti ayeretse magazi a lipids.

Onse ali ndi zofanana dzira yolk phospholipid emulsifier ndi glycerol. Komabe, aliyense wa iwo ali ndi ma phospholipids ochulukirapo kuposa momwe amafunikira kuphatikiza ma triglycerides, owonjezera amasintha kukhala tinthu tating'onoting'ono kukhala triglycerides ndi phospholipid bilayers ndipo amadziwika kuti liposomes. Kwa mtundu uliwonse wa triglycerides womwe wapatsidwa, ndikofunikira kulowa mu emulsion voliyumu kawiri pa 10% poyerekeza ndi 20%, motero, kwa triglycerides, emulsion yokwanira 10% imawonjezeka ndipo mwina mpaka ma liposomes ochulukirapo kanayi kuposa emulsion 20%.

Makanda obadwa kumene omwe ali ndi hypoglycemia osadziwika nthawi zambiri samakhala ndi moyo pakubala. Ichi ndi chimodzi mwazomwe zimayambitsa kufa kwa ana. Ndi matenda oyenera, mwana ayenera kulandira chithandizo nthawi yomweyo. Koma ngakhale atathandizidwira mwana pa nthawi yake ndipo atha kupulumuka, zotsatira zake zimakhala zowawa. Ena mwa ana awa ali ndi matenda amkati. Pamodzi ndi matendawa, nthawi zina amathandizana ndi kubwezeretsa m'maganizo ndi kupititsa patsogolo, komwe kumatha kuganiziridwa pambuyo pake. Uku ndikudziwitsa kovuta kwa mwana komanso kwa banja lake lonse. Zimatenga chithandizo chazitali, pogwiritsa ntchito njira zamakono kwambiri.

Emulsion ya 10% yawonetsedwa kuti imalumikizidwa ndi plasma triglycerides yapamwamba komanso kuchuluka kwa cholesterol ndi phospholipids m'magazi a ana asanakwane, mwina chifukwa chokhala ndi phospholipid yapamwamba. Owonjezera phospholipid liposomes mu 10% emulsion amakhulupirira kuti amapikisana ndi tinthu tokhala ndi triglyceride tomwe timamangirira ku malo a lipase, zomwe zimapangitsa kuti pang'onopang'ono hydrolysis ya triglycerides. Posachedwa, 10% ya lipid emulsions imapezeka ndi theka la phospholipid emulsifier.

Mu kafukufuku wa ana osabadwa, adaleredwa bwino, popanda kuchuluka kwa pathological mu ndende ya triglycerides kapena cholesterol mu seramu. Pali malipoti azotsatira zoyipa zam'mapapo am'mimba zomwe zimaphatikizidwa, zomwe zimaphatikizira ndi ma bilirubin osalunjika kuchokera kumasamba omangika mu albimins, zomwe zimapangitsa kuti chiwopsezo chikhale chotupa, kutsutsana ndi chitetezo cha mthupi, matenda a coagulase-negative staphylococci ndi mycosis, thrombocytopenia ndi kuchuluka kwa lipids ku macrophages, komanso kuchuluka kwa lipids ku macrophages. kusinthana kwa mpweya wa pulmonary.

Akamakula, shuga m'magazi amafunika kutsata njira yomwe makolo ambiri amakamba. Pakupatuka kuchoka pamalire omwe akuyembekezeredwa kuchokera pa 3.1 mpaka 5, 5 mmol l, ndikofunikira kuti mupange mayeso a mwanayo ndikuwunika kuti adziwe zomwe zikuyambitsa mayesowo. Magazi akamayesedwa posachedwa ndimatenda a mwana wakhanda ndipo, ngati kuli kotheka, chithandizo champhamvu ndi kukhazikitsidwa kwa kulowetsedwa kwa glucose kumayamba, chiyembekezo chambiri chakuti mwana adzapulumutsidwa.

Ndi kukhazikitsidwa kwa lipids, akhanda omwe ali ndi hyperbilirubinemia amaperekedwa mosamala ndi plasma triglycerides. Matenda a lipid amatha kukhala ndi zotsatirapo zabwino. Co-makonzedwe a lipid emulsion ali ndi phindu mu mtima endothelium wa zotumphukira mitsempha, zomwe zimabweretsa nthawi yayitali ya venous permeability. Chifukwa chake, lipid venosis imatha kukulitsa mphamvu ya Phototherapy ndikukhala yowonjezereka kwa iyo. Kupsinjika kwa chitetezo chathupi komanso chiopsezo cha sepsis nthawi zambiri zimagwirizanitsidwa ndi kugwiritsidwa ntchito kwa mtsempha wa magazi a lipid emulsions.

Hypoglycemia yatsopano

Pambuyo pobadwa kwa mwana, mphamvu zake zimafunidwa ndimagulu am'mayi, omwe amasungidwa ngakhale mu umbilical mtsempha, ndipo shuga amapangidwa chifukwa cha glycogenolysis. Komabe, malo ogulitsira a glycogen amathetsa msanga, ndipo mwa ana onse akhanda, kutsika kwa shuga m'magazi kumadziwika mu ora loyamba kapena lachiwiri la moyo.

Zomwe zili zazing'ono zimagwera mphindi 30-90 zoyambirira. Mu wakhanda ana azaka zonse olandila chakudya chokwanira mu ma 4 maola amoyo, kuwonjezeka kwapang'onopang'ono kwa shuga m'magazi kumayambira pa ola la 2 ndikufika pa ola la 4 pafupifupi pakati pa 2.2 mmol / L, ndipo pofika tsiku loyamba - kupitilira 2, 5 mmol / l.

Tiyenera kudziwa kuti makanda obadwa kumene, kuphatikiza ana akhanda asanachitike, amatha kupanga ndi kugwiritsa ntchito shuga, ndipo mapangidwe ake amatha kupitilizidwa kwambiri.

Komabe, pazonse, kayendedwe ka glucose wamagazi sabata yoyamba ya moyo sikakhazikika, komwe kumawonetsedwa pakusiyana kwake kuchokera ku hypoglycemia kupita ku hyperglycemia.

Hypoglycemia ya akhanda ingakhudze ubongo (kuchokera pakuyamba kuyerekeza kusintha), motero, njira zakutsimikiza ndizofunikira kwambiri.

Pakadali pano, ambiri a neonatologists ali ndi lingaliro loti gawo la hypoglycemia la akhanda liyenera kukhala kutsika kwa shuga m'magazi 2 mmol / l maola awiri oyamba amoyo komanso osakwana 2.22 mmol / l pambuyo pake. Chizindikirochi chimagwira ntchito chimodzimodzi kwa ana obadwa nthawi yayitali komanso asanabadwe.

Malinga ndi chizindikiro cha pathogenetic cha hypoglycemia, makanda obadwa kumene amagawidwa kukhala osakhalitsa komanso okhazikika. Zoyambazo nthawi zambiri zimakhala zazifupi kwakanthawi, nthawi zambiri zimakhala zochepa masiku oyamba amoyo, ndipo pambuyo pokonzanso sizikufuna chithandizo chachitetezo cha nthawi yayitali, zomwe zimayambitsa sizikhudza zomwe zimapangitsa kagayidwe kazakudya.

Hypoglycemia yokhazikika ya ana obadwa kumene imakhazikitsidwa ndi zovuta zapakhomo zomwe zimayendera limodzi ndi zovuta zamatumbo kapena mitundu ina ya kagayidwe ndipo zimafunikira kukonzanso kwa nthawi yayitali pokonza shuga. Njira iyi ya hypoglycemia ndi chimodzi mwazomwe zimayambitsa matenda ena, ndipo sayenera kudziwika ndi hypoglycemia ya akhanda ngakhale atakhala kuti apezeka tsiku liti.

Zifukwazomwe zimayambitsa kuchepa kwa magazi kwa ana akhanda zimagawika m'magulu atatu.

Gulu loyamba limaphatikizapo zinthu zomwe zimakhudza kagayidwe kazakudya kamayi oyembekezera: mayi wodwala yemwe amadalira insulin kapena mayi woyembekezera atatsala pang'ono kubereka kuchuluka kwa shuga.

Gulu lachiwirili limawonetsa mavuto abwinobwino: kusowa kwa magazi kwa mwana wosabadwa, kusokonekera kwa nthawi yobereka, kuziziritsa, matenda komanso kusakwanira kwa moyo wathanzi.

Gulu lachitatu limaphatikizira kuyambitsa kwa iatrogenic: kufinya kwamphamvu kwa kulowetsedwa kwakutali kwa njira yayikulu yothetsera shuga, kulowetsedwa kwa intomethacin pazotseguka za ductus arteriosus, komanso kugwiritsa ntchito insulin kwa nthawi yayitali.

Intrauterine hypotrophy ndimomwe imayambitsa kuchepa kwa hypoglycemia. Matenda ake amayamba chifukwa cha kuchepa msanga kwa glycogen. Odwala oterewa amawonetsedwa kulowetsedwa.

Pakati pang'onopang'ono hypoglycemia ya akhanda komanso kupitirira kwa hypoglycemia komwe kumachitika pobadwa nako, pali mitundu yapakati pomwe hypoglycemia imakhalapo nthawi yayitali, imadziwika, ndi umodzi (mipando yachibale yomwe siikugwirizana ndi kubadwa kwatsopano osati chifukwa cha kufupika kwa hyperinsulinism, ndi kwina - kumafuna kukula kwa glucose magazi mukamagwiritsa kulowetsedwa mankhwala a glucose okwera kwambiri, oposa 12-15 %. Kuti matenda a metabolism a ana akhale otere, maphunziro a masiku 10 amafunikira Solu Cortef.

Zizindikiro za hypoglycemia mwa akhanda

Mwa makanda, mitundu iwiri ya hypoglycemia imasiyanitsidwa: amodzi ndi asymptomatic. Yotsirizirayi imawonetsedwa kokha ndi kuchepa kwa shuga m'magazi.

Mawonetseredwe azachipatala a hypoglycemia yomwe akuwonetseredwa kuti akuwoneka ndi vuto, zomwe zimayambitsa zingapo mwa iwo okha popanda kukhudzika, pakamwa pa glucose kapena kulumikizana kwakanthawi kanyengo sikupita.

Zizindikiro zomwe zimawonedwa ndi hypoglycemia sizili zachindunji, zitha kugawidwa kukhala somatic (kufupika kwa mpweya, tachycardia) ndi mitsempha. Omaliza ali ndi magulu awiri opambana.

Loyamba limaphatikizapo zizindikiro za kusangalala kwamitsempha yamagetsi (kukwiya, kupindika, kunjenjemera, kukokana, nystagmus), chachiwiri - zizindikiro za kupsinjika (minyewa, kuchepa thupi, kusachita masewera olimbitsa thupi, kupha ziwopsezo za ziphuphu kapena ziwopsezo za cyanosis)

Kuwonetsedwa kwapamwamba kwambiri kwa chiwopsezo cha hypoglycemia m'gulu loyambalo la zizindikiro ndi kupweteka, chachiwiri - chikomokere.

Zizindikiro za ana obadwa kumene amatha kukula pang'onopang'ono ndikufutidwa, popanda kuwonekera bwino, kapena kupitiliza ngati kuukira kwadzidzidzi mwachangu, mwadzidzidzi. Kuwonetsedwa kwamankhwala kwa hypoglycemia kumadalira kuchuluka kwa kutsika kwa glucose ndi kusiyana kwake pamlingo, ndikamanena kwambiri zosintha izi, chiwonetserocho chikuwoneka bwino.

Pankhani imeneyi, kukula kwa vuto lodana ndi matenda m'thupi la mwana wakhanda motsutsana ndi matenda a shuga omwe amapezeka nthawi yayitali ndiwofotokozera kwambiri: Kukula mwadzidzidzi, kuchuluka kwa minofu, adynamia, kusazindikira, chikomokere.

Kuwerengera kumapitilira mphindi-mphindi, ndikuyankha mwachangu kwa jet intravenous glucose solution.

Inde, mawonetseredwe azachipatala a hypoglycemia akhanda motsutsana ndi insulin makonzedwe ali owala kwambiri, koma tidawona chithunzithunzi chomwechi munjira inayake yopumira ngakhale osagwiritsa ntchito.

Nthawi zambiri, chizindikiro chosakhalitsa cha hypoglycemia cha ana akhanda omwe ali ndi chithunzithunzi chakuwoneka ngati chiwopsezo chapadera pakumwa ndi 10% yankho la glucose chimasiya mwachangu ndipo sichimayambiranso, ndipo mwa odwala ena omwe ali osakwatiwa kapena obwerezabwereza ndi omwe amatha.

Fomu ya asymptomatic, malinga ndi olemba akunja, imapezeka muopitilira theka la milandu yopatsika kwa nthawi yochepa ya ana akhanda.

Ambiri mwa mitundu ya asymptomatic yamafupipafupi a hypoglycemia mwa ana obadwa kumene komanso kutsata kwabwino kwa ana awa mwachiwonekere kumawonetsera kusoweka kwachidziwikire pakati pa zomwe zili ndi shuga m'magazi a seramu yotengedwa kuchokera chidendene ndi kuzungulira kwake m'mitsempha yaubongo ndi CSF.

Omalizirawa ndi omwe amawona kuchuluka kwa ubongo ndi shuga. Kuchuluka kwa kuchuluka kwa glucose mu ubongo wa akhanda ndipo kuphatikiza kwake kwabwino mkati mwake kumagawitsanso kuchuluka kwa shuga pakati pa bongo ndi zotumphukira.

Kuzindikira kwa hypoglycemia yatsopano ya ana obadwa kumene ndi mawonekedwe ake ofatsa kumatha kubweretsa zovuta zina, popeza zizindikiro zake sizachilendo ndipo zimatha kuchitika mofanananso m'mitundu ina, kuphatikiza zina zofanana. Zinthu ziwiri ndizofunikira pakukhudzika kwake: kuchuluka kwa glucose kumakhala kotsika kuposa 2.2-2.5 mmol / l ndikuchepa kwa zizindikiro, zomwe zimawerengedwa kuti "hypoglycemic," pambuyo pakupanga shuga.

Ziwonetsero

Zizindikiro za hypoglycemia zatsopano za ana zatsopano zimatha kubweretsa zilonda zamatumbo zingapo. Pankhaniyi, chikhalidwe cha kuukira (kupweteka, kutaya mtima), nthawi yake komanso pafupipafupi ndizofunikira. Kuphatikizika kwa zinthu izi kumapangitsa kuneneraku kukhala kwakukulu.

Ana omwe ali pachiwopsezo cha kukhazikika kwa hypoglycemia kwa akhanda akhonza kupatsidwa prophylactic intravenous glucose kulowetsedwa kuyambira maola oyamba amoyo, ngakhale atayesedwa magazi kapena ayi.

Gulu lamavuto ndi:

• akhanda omwe ali ndi vuto la kuperewera kwa zakudya m'thupi,
• makanda kuchokera kwa amayi omwe ali ndi matenda ashuga 1,
• ana akulu pomatha kubereka kapena kulemera makilogalamu anayi,
• Ana omwe ali ndi vutoli sangalandire chakudya chokwanira.

Ndi kulowetsedwa wakhungu, kulowerera kwa shuga mkati mwake sikungadutse 4-5 mg / (kg-min), womwe njira ya 2,5% ya shuga ndi 2,5 ml / kg / h. Njira zina zimadalira shuga.

Ndi asymptomatic hypoglycemia, makanda osakhazikika ayenera kulandira chithandizo cha kulowetsedwa ndi 10% shuga ya 4-6 ml / kg / h.

Mu Hypoglycemia wodziwika bwino, 10% yankho la shuga amaperekedwa pa 2 ml / kg pa mphindi imodzi, ndiye pamlingo wa 6-8 mg / kg / min.

Chithandizo cha asymptomatic makamaka chisonyezo cha hypoglycemia chatsopano cha ana chimayenera kuchitika mothandizidwa ndi shuga osachepera katatu patsiku. Pambuyo pakufika pamlingo wa shuga m'migawo ya 3.5-4 mmol / L, kuchepetsedwa kwapang'onopang'ono kumachepetsedwa, ndipo ndikakhazikika pazowonadi izi, makonzedwe amasiya.

Kuperewera kwa mankhwalawa kumapangitsa kukayikira kukhalapo kwa nthawi yayitali hypoglycemia wakhanda. Ana oterowo amafunikira kuwunika kuti asawazindikire kusokonezeka kwachiwiri ndi hypoglycemia.

Zoyambitsa, zotsatira ndi chithandizo cha hypo- ndi hyperglycemia mu makanda

Hypoglycemia mu makanda ndimalo osowa kwambiri, ngati sitikulankhula za kanthawi kochepa kameneka.

Amayi ambiri oyembekezera saganiza kuti kutsika kapena kukweza glucose pamavuto ovuta kumabweretsa chiwopsezo chachikulu pakukula kwa mwana.

Komabe, mavuto amatha kupewedwa ngati mukudziwa zizindikiro za hypoglycemia, mwa munthu wamkulu komanso mwa munthu wobadwa kumene. Ndikofunikira kudziwa njira zomwe zimagwiritsidwa ntchito kuti matendawo asinthe.

Zotsatira za mimba pa shuga

Mayi aliyense ali ndi pakati adzaganiza za thanzi la mwana. Komabe, sikuti nthawi zonse samalabadira kudalira kwa mwana wosabadwayo pazikhalidwe zake.

Chifukwa chakulemera mopitirira muyeso, mzimayi amatha kusintha ndikukana kudya kapena kutsatira zakudya popanda kufunsa katswiri. Pankhaniyi, kuchuluka kwa chakudya cham'magazi kumatha kusintha kwambiri.

Mawonekedwe a mahomoni achikazi panthawi yoyembekezera amakhala ndi zosintha zazikulu, mwachitsanzo, kapamba amayamba kupanga insulini yambiri mothandizidwa ndi estrogen ndi prolactin, pomwe anthu omwe ali kutali ndi matenda monga matenda a shuga satha nthawi zonse kumvetsetsa kuti kuchuluka kwa glucose kumagwa mosavomerezeka.

Muzochitika zazikulu, ngati pali vuto lakulitsa vuto monga hypoglycemia mwa amayi apakati, ziwalo zonse zamkati zimavutika, pali kuthekera kwakukulu kwa chiwopsezo cha mkhalidwe wakuthupi komanso wamaganizidwe osati mwana wosabadwayo, komanso amayi.

Kapena mosinthanitsa, amayi, chifukwa chofunitsitsa kudya china chake chachilendo, akuwonjezeka ndipo amaphwanya mbali yokhayo ya mahomoni, ndikupangitsa kukula kwa matenda ashuga. Komanso, monga momwe zinalili poyamba, sizotheka nthawi zonse kuzindikira kuwonjezeka kwa shuga - hyperglycemia panthawi yoyembekezera ndi yoopsa.

Koma mwana amakula ndikulandira zinthu zonse zofunikira kuchokera kwa mayi, kuwonjezera kapena kusungunuka kwa shuga kumatha kuwononga thanzi lake. Popeza sangathe kudziwongolera yekha tokha mahoni.

Hyperglycemia mwa amayi apakati ingayambitse hyperglycemia ya akhanda komanso kukula kwa matenda osokoneza bongo kwa makanda kuyambira pobadwa.

Ichi ndichifukwa chake ndikofunikira kwambiri kuwongolera kudya kwa mayi woyembekezera, kuwunika kuchuluka kwa shuga, makamaka ngati ali ndi matenda a shuga kapena ngati pali kuphwanya njira zina za metabolic.

Muyeneranso kumvetsera mkhalidwe wa thupi lanu, kuwona kutopa kwambiri, ludzu losatha, muyenera kufunsa dokotala yemwe akukupatsani pakati.

Ingobadwa - vuto kale

Mavuto omwe ali ndi kuchuluka kwa shuga m'magazi athanzi mwatsopano siachilendo. Nthawi zambiri hyperglycemia ya akhanda kapena hypoglycemia imakhudzanso makanda osakwana msambo omwe ali ndi thupi lozama.

Ndikofunikira kuzindikira kuti pali pang'onopang'ono hypoglycemia ya akhanda (omwe amakhala osakhalitsa) - mkhalidwe wabwinobwino m'maola ochepa a mwana.

Popeza thupi silinakhazikitse glucose yake, m'mphindi zoyambirira za moyo limagwiritsa ntchito malo omwe amapezeka m'chiwindi. Pomwe kutha kwatha ndikuyamba kudyetsa, shuga amayamba kuchepa. Nthawi zambiri mumaola ochepa kapena masiku onse zonse zimayamba kukhala zabwinobwino.

Zomwe zimawoneka pomwe glucose sikokwanira

Mwana wakhanda asanabadwe nthawi zambiri amakhala ndi vuto lokhala ndi hypoglycemia, pomwe pali zambiri za izi.

Zizindikiro zomwe hypoglycemia zitha kukayikiridwa ndi izi:

• kulira kofooka pakubadwa
• wofooka woyamwa
• kulavulira
• cyanosis
• kukokana
• ziphuphu
• minofu yamaso yachepa,
• kayendedwe kabwino ka diso
• ulesi wambiri.

Zizindikiro za Hypoglycemic zimaphatikizanso thukuta lochulukirapo ndi khungu louma, kuthamanga kwa magazi, kusokonezeka kwa phokoso la mtima.

Popeza sizizindikiro zonse za hypoglycemia zomwe zimatha kuchitika, kupereka magazi pafupipafupi ndikofunikira kuti muzindikire, chifukwa zizindikiro zoterezi zimatha kuyankhulanso zina zazikulu za matenda.

Kodi ndizomwe zimayambitsa matenda?

Zowopsa zomwe zimayambitsa matenda nthawi zonse zimaganiziridwa pakusamalira kwina kulikonse ndikubadwa.

Ngati pali zizindikiro za hypoglycemia, akatswiri, choyamba, onetsetsani zomwe zimayambitsa kukula kwa matenda oopsa, kotero kuti malinga ndi zomwe mwalandira, sankhani chithandizo choyenera.

Hypoglycemia nthawi zambiri imayamba pazifukwa zotsatirazi:

1. Kupezeka kwa matenda ashuga mwa mayi yemwe ali ndi vuto, komanso kugwiritsa ntchito mankhwala a mahomoni kudzera mwa iye. Pali hypoglycemia wosakhalitsa woyambira, kuyambira maola 6 mpaka 12 a mwana wakhanda.
2. Preterm kapena mimba yambiri ndi ana ambiri osakwana 1500 g Itha kuchitika pasanathe maola 12 mpaka 48. Choopsa kwambiri ndikubadwa kwa mwana sabata la 32 la mimba.
3. Mavuto obadwa nawo (asphyxia, kuvulala kwa ubongo, kutaya magazi). Hypoglycemia imatha kukhazikika nthawi iliyonse.
4. Mavuto ndi mahomoni a mwana (adrenal dysfunction, hyperinsulinism, zotupa, mapuloteni ophatikizika ndi kuphatikizika kwa chakudya). Nthawi zambiri misempha ya shuga imatsika sabata pambuyo pobadwa.

Mwa ana omwe ali pachiwopsezo, magazi amatengedwa kuti awunikidwe maola atatu aliwonse masiku awiri oyamba amoyo, ndiye kuti kuchuluka kwa zoperekera magazi kumachepetsedwa, koma kuchuluka kwa shuga kumayang'aniridwa osachepera masiku 7.

Matendawa

Nthawi zambiri, kugwiritsa ntchito mankhwalawa sikufunikira, koma pamavuto ena, kusowa kwa glucose komwe kungayambitse kusokonezeka kwamitsempha yamagetsi, kusintha chithandizo chadzidzidzi.

Ngati mavutowo sanabwerenso patapita masiku angapo, sitikuyankhula za kanthawi kochepa, koma za hypoglycemia, komwe kungakhale kwobadwa nako kapena kwachilengedwe, kukhala chifukwa chobadwa ndi zovuta.

Ngati hypoglycemia yatsopano yatsopanoyo ndiyosakhalitsa ndipo ilibe zizindikiro zoonekeratu zomwe zimasokoneza moyo, malinga ndi zolemba za AAP (American Academy of Pediatrics), chithandizo chomwe chikugwiritsidwa ntchito chimapereka zotsatira zofanana ndi kusowa kwa chithandizo.

Malinga ndi njira zomwe khazikitsidwe kamankhwala a WHO, ndikofunikira kuti mwana wakhanda azilandira pafupipafupi kuchuluka kwa chakudya, mosasamala kanthu za mankhwala okhala ndi shuga.

Kuphatikiza apo, ngati mwana akulavula msanga kapena ngati alibe kuyamwa, kudyetsa kudzera chubu kumagwiritsidwa ntchito.

Mwanjira imeneyi, wakhanda amathanso kudyetsedwa mkaka wa m'mawere ndi osakaniza.

Miyezi ya shuga ikakhala kuti ili yovuta kwambiri, makonzedwe amkati kapena mtsempha wa magazi kuti achulukitse shuga amagwiritsidwa ntchito.

Pankhaniyi, glucose wotsika kwambiri wogwiritsidwa ntchito poyamba amagwiritsidwa ntchito kudzera m'mitsempha yochepera, ngati nthawi yomweyo palibe zotsatira, kuthamanga kumawonjezeka.

Kwa mwana aliyense, mankhwalawa amasankhidwa. Ngati mtsempha wa mtsempha wa magazi sapereka zotsatira zake, mankhwala a corticosteroid amachitika.

Komanso, ngati Normoglycemia siinakhazikitsidwe kwa nthawi yayitali, mwana satulutsidwa ku dipatimenti yoyanjana, mayeso owonjezera amatengedwa ndipo chithandizo chofunikira chimasankhidwa.

Normoglycemia imakhazikitsidwa ngati kuchuluka kwa glucose sikusintha kwa maola makumi awiri ndi awiri popanda kugwiritsa ntchito mankhwala.

Yang'anani! Zowopsa!

Hypoglycemia wosakhalitsa m'magulu atsopano nthawi zambiri sakhala ndi zotsatira zoyipa kwa thupi ndipo amadutsa mwachangu.

Kenako, monga kupitiliza kwa hypoglycemia pa nthawi yoyembekezera komanso pambuyo pobadwa, kumatha kukhudza kwambiri kukula kwa thupi, m'maganizo ndi m'maganizo a ana.

Nthawi zambiri matenda a m'magazi ochepera magazi amatha kubweretsa izi:

• kupita patsogolo kwamaganizidwe
• zotupa za muubongo
• kukulitsa khunyu,
• chitukuko cha matenda a Parkinson.

Komanso chinthu choopsa kwambiri chomwe chitha kuchepetsa shuga ndi imfa.

Mimba ndi nthawi yabwino kwambiri ya moyo komanso mwayi wopatsa mwana zinthu zonse zofunika, ndikumuteteza ku ngozi.

Zomwezi zimagwiranso ntchito pakupewera kwa hypoglycemia kapena kukonza zofunika zonse za mayi ndi mwana wosabadwa panthawi yoyembekezera komanso mwa akhanda.

Funsani wolemba funso pamawu ake

Hypoglycemia yatsopano

Hypoglycemia yatsopanoyo ndi chinthu chowopsa kwambiri. Ndi iye yemwe amadziwika kuti ndi chimodzi mwazomwe zimayambitsa kukula kwamatenda akulu amthupi, komanso kufa kwamwana wakhanda. Mwamwayi, zimachitika kawirikawiri - mankhwala amalemba zochitika 1-3 pamitundu yatsopano yatsopano.

Muyenera kudziwa kuti vutoli limatha kupewa kapena kuwazindikira munthawi yake koyambirira - ndiye kuti kuchitira hypoglycemia kuyenda mwachangu komanso bwino.

Kodi neonatal hypoglycemia ndi chiyani?

Timalankhula za hypoglycemia mu makanda atsopano, tikulankhula za kuchuluka kwa glucose mu seramu ndi plasma. Mu chilankhulo cha manambala, izi zikufotokozedwa ndi zizindikiro zotsatirazi: 2.2 mmol / L ndi 2.5 mmol / L, motsatana.

Hypoglycemia ndiyosakhalitsa komanso yokhazikika. Hypoglycemia yochepa imapezeka kuchipatala, chifukwa imayamba mu maola 6 mpaka 10 mwana atabadwa. Pankhaniyi, kuneneraku ndikabwino momwe zingathere - vutoli limatha mofulumira. Popanda kusiya kufufuza mu mawonekedwe a mitsempha yamavuto.

Nthawi zambiri, matendawa amakhudza ana osabadwa, pakati pazinthu zina zowopsa ndikofunikira kuwonetsa zovuta zotsatirazi.

• Kuchepetsa kagayidwe kachakudya michere mwa mayi,
• Amayi odwala matenda ashuga
• Mavuto ena obala mwana wosabadwayo,
• Kubweretsa zovuta
• Hyperinsulinism
• Kulakwika kwa tinthu timene timatulutsa khanda,
• Zovuta zomwe zimalandiridwa ndi mwana ndi cholowa.

Kuzindikira kwa hypoglycemia kumachitika kokha ndi adokotala potengera mayeso a labotale. Mayeso oyamba a akhanda omwe ali pachiwopsezo akuphatikiza magazi sampuli yoyesedwa. Amatengedwa mu ola loyamba atabadwa, kenako masiku ena awiri maola atatu aliwonse.Kuti muchotse kukayikira konse, wodwalayo amangoyang'anidwanso masiku ena awiri, pomwe amawunikanso maola 6 aliwonse.

Zizindikiro komanso matenda a hypoglycemia akhanda

Kuzindikira koyambirira kwa hypoglycemia mu makanda kungachitike popanda kuyesedwa. Zizindikiro za matendawa zimaphatikizapo mawonetsedwe otsatirawa.

• Mu mwana, toni am'maso amachepa, chiwonetsero cha oculocephalic chatsopano chazimiririka, maso amayenda bwalo mozungulira.
• Mwanayo amamva kufooka, chifukwa chake amakana chakudya. Amasenda chofooka, kudya, kulavulira. Mwana amakhala wosakwiya, wamanjenje, wowopsa kapena, mosintha, kwambiri. Pali kulira kopitilira muyeso kopitilira muyeso komanso kunjenjemera kwa minofu.
• Matenthedwe a mwana amakhala osakhazikika, mwana amakhala wotupa komanso amatuluka thukuta popanda chifukwa. Arterial hypotension ndi chizolowezi cha hypothermia zimadziwikanso.

Ngati chithandizo sichinayambike kapena sichikupatsani zotsatira zake, zizindikiro zake zimakulirakulira. Mwanayo akhoza kugwa, kusokonezeka kwa chikumbumtima kumachitika, zizindikiro za tachycardia zikuwonekera, cyanosis, ziphuphu, etc.

Chithandizo cha hypoglycemia mu makanda atsopano amakhala ndi kulowetsedwa kwa shuga m'magazi. Mulingo uliwonse umafunikira munthu payekha ndipo jekeseni imapangidwa ndi katswiri yemwe amatenga nawo mbali wodwala pang'ono.

Ngati njirayi ikuyenda bwino, kuchira sikumatenga nthawi yayitali - atatha masiku 2-3, kulowetsedwa kwa shuga kumachepetsedwa molimba mtima. Ngati thupi la mwana siligwirizana ndi mankhwalawa, hydrocartisone imagwiritsidwa ntchito.

Kudyetsa pafupipafupi ndi kusakaniza komwe kumawonjezera kuchuluka kwa machulukitsidwe a nyama kumachitidwanso.

Chithandizo cha akhanda omwe ali pachiwopsezo chachikulu chimachitika.

Hypoglycemia mwa ana ndi akhanda zimayambitsa ndi zizindikiro za matenda kapena kuwukira

Hypoglycemia mwa ana Ndi mkhalidwe wodziwika ndi shuga wochepa, kapena mulingo wambiri wamagazi. Hypoglycemia mu wakhanda imatha kukhala imodzi mwazomwe thupi limachita pakusintha kwachilengedwe.

Hypoglycemia mu terminology yamankhwala, yomwe imadziwikanso kuti insulin mantha, ndimomwe zimachitika chifukwa cha thupi lomwe limayambitsidwa ndi shuga wambiri m'magazi (osachepera 4 mmol / l). Hypoglycemia syndrome imapezeka mwa ana omwe ali ndi matenda amtundu 1, koma nthawi zina amatha kupezeka mwa ana ndi achinyamata omwe ali ndi matenda a shuga a mtundu wachiwiri.

Nthawi zambiri amapezeka odwala akutenga sulfonylurea. Zakudya zopanda pake, insulin yokwanira, matenda okhudzana ndi thupi kapena kuchita masewera olimbitsa thupi popanda chindapusa chifukwa cha mitengo yamagetsi zimatha kuyambitsa matenda a hypoglycemia. Ngati singayimitsidwe, zingayambitse kuwonongeka.

Nthawi zina, munthu amatha kupweteka.

Mwana yemwe ali ndi hypoglycemia amatha kuyamba kukwiya, thukuta, kunjenjemera, kudandaula kuti ali ndi njala. Nthawi zambiri, kudya chakudya chamagulu (monga msuzi kapena maswiti) omwe amakonza zinthu.

Glucose mu mawonekedwe a mapiritsi kapena yankho ingagwiritsidwenso ntchito. Mwana amene amasintha chifukwa cha vuto la hypoglycemia, amabwerera mwachangu pambuyo pobayira jekeseni wa glucose.

Izi zikuthandizira kuti magazi abwerere mwachangu.

The yogwira hypoglycemia ana

Mtundu wosowa wa matendawa, womwe umadziwika kuti ana (hypoglycemia) womwe umatha kugwira ana, umatha kupezeka mwa anthu opanda matenda a shuga. Ndi yogwira hypoglycemia, magazi a m'magazi amatsika mpaka 3.5 mmol / L pafupifupi maola anayi chakudya chatha, zomwe zimapangitsa kuti magazi omwe ali ndi shuga omwe anthu omwe ali ndi matenda ashuga akhale nawo akhale nawo.

Kusala kudya kwa hypoglycemia kumakhalanso kofala. Ichi ndi chikhalidwe chomwe shuga m'magazi ndi 3.5-4.0 mmol / L m'mawa mutadzuka kapena pakati pa chakudya. Mankhwala ena komanso maanipulogalamu azachipatala angayambitse matenda a hypoglycemia ana popanda matenda a shuga.

Mwa ana omwe ali ndi matenda ashuga, hypoglycemia imapezeka kwambiri kwa odwala omwe ali ndi matenda a shuga 1 (omwe amadziwikanso kuti shuga kapena matenda a shuga) kuposa odwala omwe ali ndi matenda a shuga 2.

Hypoglycemia ndi zomwe zimayambitsa

Zomwe zimayambitsa hypoglycemia zimabisika mumayendedwe a kuphatikiza chakudya ndi mphamvu ya metabolism m'thupi la munthu. Ndi kutulutsidwa kwambiri kwa insulin m'magazi a mwana, kuukira kwa hypoglycemia kumatha kuchitika, ngakhale atakhala kuti ali ndi vuto la matenda ashuga.

Hypoglycemia mwa ana ndi achinyamata omwe ali ndi matenda ashuga angayambitse ngati insulin yochulukirapo yaikidwa.

Kuchita kupsinjika kwakuthupi ndi m'maganizo popanda kudya zakudya zoyenera, mankhwala ena, kudumpha chakudya, komanso kumwa mowa kumatha kuyambitsa vuto.

Hypoglycemia mu matenda osokoneza bongo ndi chofala kwambiri chomwe wodwalayo ayenera kulimbana nacho yekha munthawi yake.

Reactive hypoglycemia imatha kuchitika chifukwa cha enzymatic matenda atatha opaleshoni ya m'mimba.

Hypoglycemia mwa ana opanda matenda a shuga amatha chifukwa cha zotupa za insulin, zovuta zina za m'magazi, mankhwala (kuphatikizapo mankhwala a sulfonamide ndi milingo yayikulu ya aspirin), komanso matenda oopsa a somatic. Ana omwe ali ndi zaka 10 sagwidwa.

Hypoglycemia ndi zizindikiro zake

Makolo ayenera kukumbukira kuti sizizindikiro zonse za hypoglycemia zomwe zingazindikiridwe popanda kuyezetsa magazi mosamalitsa. Muyenera kusamala ndi kusintha kulikonse pamakhalidwe ndi zakudya za mwana wanu. Makamaka ngati mukukayikira kuti walephera kuloza shuga. Zizindikiro za hypoglycemia zingaphatikizeponso:

• kusakhazikika kwa gait,
• mantha ndi kusakwiya
• chizungulire ndi kugona.
• kutuluka thukuta kwambiri
• chisokonezo pakulankhula, kulephera kutchula mawu ndi zilembo zingapo,
• kumva kutopa ndi kusakhala ndi chidwi,
• njala
• kumverera kwa nkhawa.

Hypoglycemia mu shuga: mukakumana ndi dokotala

Hypoglycemia mu shuga amayamba chifukwa cha kuchuluka kwa insulin komanso kuchepa kwa shuga m'magazi aana. Ana omwe amakhala ndi vuto la hypoglycemia ayenera kuwonetsedwa posamalira odwala posachedwa. Zingakhale zofunikira kusintha insulini, mlingo, kapena kusintha kwina kwa makhwala aposachedwa.

Ngati mwana kapena wachinyamata yemwe ali ndi matenda ashuga ayamba kuwonetsa shuga wochepa wa magazi popanda chisonyezo chilichonse, izi sizingachitike. Komabe, adotolo ayenera kudziwa zosintha zonse za mwana wodwala. Kuperewera kwa chithandizo chamankhwala chapanthawi yake kwa hypoglycemia syndrome kungachititse kuti musamale.

Zimayambitsa hypoglycemia

Hypoglycemia mu wakhanda imatha kuchitika pafupipafupi komanso nthawi zina.

Zomwe zimayambitsa hypoglycemia, zomwe zimadziwunikira nthawi ndi nthawi, zimaphatikizapo:

• gawo lapansi losakwanira
• ntchito ya enzyme ya mwana, yomwe ingayambitse kuchepa kwa kudzikundikira kwa glycogen.

Hypoglycemia yokhazikika imatha kuchitika pazifukwa izi:

• hyperinsulinism mwa mwana,
• kuphwanya kapangidwe ka mahomoni,
• cholowa cholowa matenda.

Hypoglycemia mu wakhanda imatha kuchitika chifukwa cha kusokonezeka kwakukulu kwa kulowetsedwa kwa kulowetsedwa kwamadzimadzi a shuga. Itha kukhalanso chotsatira cha kusayenera kwa catheter kapena umbilical sepsis.

Hypoglycemia mu akhanda akhoza kukhala chizindikiro cha matenda akulu kapena matenda:

• sepsis
• Hypothermia,
• polyglobulia,
• khansa yotupa,
• matenda amtima wamilandu,
• intracranial mayamwidwe.

Hyperinsulinism imakonda kupezeka pazifukwa zotsatirazi:

• mayi woyembekezera anali ndi mankhwala osokoneza bongo
• Mwanayo adabadwa kwa mayi yemwe ali ndi matenda ashuga,
• polyglobulia anapezeka ali mwana,
• matenda obadwa nawo.

Kuphatikiza apo, kusokonekera kwa mahomoni m'thupi la akhanda kungayambitse hypoglycemia.

Zizindikiro za matendawa mu ana aang'ono

Tsoka ilo, matendawa alibe. Chimodzi mwazizindikirozi ndimakomoka, ziphuphu, komanso bradycardia.

Ngati mwana ali ndi vuto lalikulu la hypoglycemia, sangakhale ndi zizindikiro zilizonse, motero ndikofunikira kuyeza kuchuluka kwa glucose, komanso kumvetsera mwapadera pazizindikiro zotere:

• Mwana amakhala wofooka poyamwa bere kapena botolo,
• Mwana alibe nkhawa ndipo amatuluka thukuta kwambiri,
• zam'mimba
• mwana amadumphira mu magazi ndipo pali tachycardia,
• Mwanayo akhoza kuyamba kukuwa mwadzidzidzi.

Ndemanga ndi ndemanga

Ndili ndi matenda a shuga a 2 - osadalira insulin. Mnzake adalangiza kuti achepetse magazi ndi DiabeNot. Ndinalamula kudzera pa intaneti. Adayamba kulandira. Ndimatsata zakudya zosasamala, m'mawa uliwonse ndidayamba kuyenda ma kilomita 2-3 ndikuyenda pansi. M'masabata awiri apitawa, ndazindikira kuchepa kwa shuga m'mamawa m'mawa asanadye chakudya cham'mawa kuyambira 9,3 mpaka 7.1, ndipo dzulo ngakhale mpaka 6.1! Ndikupitiliza njira yodzitetezera. Ndileka zolemba zabwino.

Makulidwe a seri a triglyceride amayenera kuwunikira pokonzekera kwa lipid emulsion, kenako sabata. Makanda azakudya zopatsa thanzi amayenera kulamulidwa kuchokera pamalingaliro a metabolic chifukwa cha kusokonezeka komwe kumachitika muyezo wamadzimadzi ndi ma elekitirodiya, shuga homeostasis, ntchito ya chiwindi ndi moyenera acid-base. Kusalolerana kwamafuta kungayang'anitsidwe tsiku lotsatira la intralipid makonzedwe, ndi machitidwe a micrococyte mu capillary chubu yowonera seramu supernatant pambuyo pofikira mwachitsanzo.

Kuti magwiridwe antchito oyenera komanso athanzi, maselo amthupi amayenera kulandira shuga ndi shuga wina. Ngati akuluakulu alandira mlingo woyenera kuchokera ku chakudya, ndiye kuti makanda obadwa kumene kuchokera mkaka wa m'mawere, kotero muyenera kuyang'anitsitsa zakudya za mwana, makamaka mayi akamadwala ndi matenda a shuga. Potere, thupi limatulutsa insulini yowonjezera, yomwe imathandiza shuga wochepa.

Ngati supernatant ali ndi gawo lopanda kanthu, mlingo wina wa intralipid sungagwiritsidwe ntchito patsikuli, ngati ali ndi utoto wamakaso achikasu, mlingo woyenera wa tsiku lino utha kulowetsedwa. Ndizomveka kuti mchitidwewu ndi magawo abwino a mafuta achilengedwe aulere, triglycerides ndi cholesterol m'magazi.

Osachokapo mwachangu. Musayambe kukakamiza pakamwa posachedwa kwambiri. Gwiritsani ntchito chubu cha nasogastric mu makanda onse osakwana masabata 32 a bere. Musachulukitse zochuluka. Mwana amene kupuma kwake kumapitirira 60 miniti kapena ali ndi vuto la hypothermia sangathe kupatsidwa pakamwa.

Zomwe zimayambitsa shuga wochepa wakhanda:

• Mwana musanabadwe.
• Intrauterine fetal matenda operewera.
• Amayi ali ndi matenda ashuga.
• Kubadwa, limodzi ndi asphyxia wa mwana.
• Kuika magazi.
• Hypothermia kapena matenda m'thupi la mwana.
• Kuperewera kwa chakudya, kuperewera kwa chakudya, kupatula kwakatikati pakati poyamwitsa.
• Zambiri zomwe zimakhala ndimatupi a ketone.

Chizindikiro cha matendawa m'magulu akhanda sichikupezeka, koma nthawi zina chimadziwoneka ndi zizindikiro zotsatirazi:

Osamapereka chakudya pakamwa kwa wakhanda wobadwa kumene yemwe ali ndi mbiri ya mayi wozungulira kapena amene ali ndi ntchofu kwambiri mpaka chubuwo ataperekedwa m'mimba ngakhale atawunika mayeso. Lemberani zakumwa zanu zamadzimadzi ndi zopatsa mphamvu.

Mu makanda omwe ali pachiwopsezo cha necrotizing enterocolitis, yesetsani mayeso ochepetsa shuga kamodzi patsiku, makamaka ngati wodwala wayamba mkamwa. Yesetsani kuti mwana akhale wakhanda pang'onopang'ono podyetsa, popeza izi zimathandizira kutsitsa kwam'mimba ndikuchepetsa chiopsezo chobwezeretsanso komanso kufunitsitsa.

• Magazi osokoneza.
• Neologicalological pathologies a genesis apakati (omwe apezeka pamayeso azachipatala).
• Kugwedezeka mwamphamvu kwa miyendo kapena zala.
• Kutentha kwa kuzizira, kunjenjemera.
• Thukuta kwambiri.
• Kukhazikika kwa khungu ndi mucous nembanemba mu buluu.
• Kuyimitsa komwe kumakhala kupuma kwa nthawi yayitali - kuchokera pa 10 mpaka 30 masekondi.
• Kutsitsa kwa mtima kumakhala kotsika kuposa kumamenya 100 pamphindi.
• Kupsinjika. Kuwonekera zolephera pakati pa kuusa moyo ndi kutulutsa.
• Kutentha kochepa kwa thupi, chifukwa chomwe thupi la wakhanda silingathandizire njira zoyenera za metabolic.

Mawonetsedwe oterewa sianthu mwachilengedwe ndipo amapezeka osakanikirana ndi ena, kotero ngati mungazindikire chizindikiro chilichonse, muyenera kufunsa thandizo kuchokera kwa dokotala. Komanso, chimodzi mwazizindikiro za shuga wochepa mwa mwana wakhanda chimawerengedwa kuti chimapumira mofulumira. Kuwongolera glycemia kunyumba, tikulimbikitsidwa kugwiritsa ntchito ma glucometer apadera omwe amayeza shuga wamagazi ndikupereka zotsatira mkati mwa miniti.

Nthawi zonse funsani namwino musanakweze voliyumu kapena musinthe njira yobweretsera. Phunzitsani amayi anu kudyetsa kapena kudyetsa mwana wake. Musamupemphe kuti achite zofanana ndi zomwe sangathe. Kulemera kwa kubala kumagwiritsidwa ntchito kuwerengera ndalama musanabwerenso kubadwa.

10% ya lipid emulsions iyenera kupewedwa chifukwa cholekerera bwino. Ndikofunikira kuyesa kuchuluka kwa triglycerides mu seramu yamagazi isanayambike kulowetsedwa kwa lipid yoyamba, chifukwa chomaliza chimaperekedwa, kenako sabata iliyonse. Njira yoyamba ya hydration ndi njira yoyenera yaubwino.

Mwa ana omwe adabadwa kuchokera kwa amayi omwe ali ndi matenda ashuga, zizindikiro zoyambirira za matendawa zimawonekera m'maola oyambira, komanso mwa iwo omwe abadwa kuchokera kwa amayi athanzi pasanathe masiku atatu.

Sizotheka nthawi zonse kuzindikira shuga yochepa m'magazi mwa mwana munthawi yake, popeza zizindikiro za hypoglycemia zimakhala ndi kufanana kwina ndi kupuma kwamatenda, pamene mapapo amalephera chifukwa chochepa kwambiri cha kusakaniza kwa envelopu ya alveolar kumayendera limodzi ndi kufupika, kupakika khungu ndi kupindika pakumapuma. Zizindikiro zofananazo zimapezekanso ndi intracranial hemorrhage.

Zoyambitsa, Zowopsa, ndi Zowopsa

Tsimikizirani bwino mtundu wake. Mukasintha nkhaniyo, chotsani template iyi. Matendawa ndi abwino kwa akhanda omwe alibe zizindikiro kapena amene asintha hypoglycemia ndi chithandizo. Komabe, hypoglycemia ikhoza kubwerera kwa ochepa mwa ana atalandira chithandizo. Vutoli limatha kubwerera pomwe makanda amachotsedwa m'mitsempha asanakhale okonzeka kudya chakudya chamlomo. Zomwe zimapangitsa kupitiliza kwa hypoglycemia.

Mu ana awa, anaerobic glycolysis amadya glycogen ndipo hypoglycemia imatha kuchitika nthawi iliyonse m'masiku ochepa, makamaka ngati nthawi yayitali pakati pa chakudya sichikhala nthawi yayitali kapena ngati chakudya chochepa. Chifukwa chake, kudya okhazikika kwa glucose wakunja ndikofunikira kuti muteteze hypoglycemia. Hyperinsulinism yochepa imakhudza, nthawi zambiri, ana a amayi omwe ali ndi matenda ashuga ndipo ndiwofanana kwambiri ndi kuchuluka kwa chiwongolero cha matenda ashuga.Komanso ndizofala mwa akhanda omwe ali ndi vuto lakuthupi komanso samakonda kuchita masewera olimbitsa thupi.

Zomwe zimakhala zowonongeka mwana akangobadwa ndi shuga wochepa

Mwana akabadwa ndi shuga wotsika, kodi pamakhala ngozi yotani? Zotsatira zake ndi ziti? Kodi nchiyani chikuwopseza matendawa? Zotsatira zakutsitsidwa kwa shuga m'thupi la mwana wakhanda zitha kukhala matenda osiyanasiyana, kuphatikizapo imfa, mwachitsanzo, kuwonongeka kwamitsempha ya m'miyendo ndi manja, pang'ono kapena kuwonongeka kwathunthu kwa mawonekedwe, matenda amtima, komanso kufa chifukwa cha kufa kwa maselo aubongo omwe ali ndi shuga. Popeza shuga wochepa mwa mwana ndi wovuta kudziwa, kukhazikika kwa matendawa kumatha kubweretsa zovuta izi:

Zomwe zimayambitsa kwambiri ndizobadwa nako hyperinsulinism, erythroblastosis yayikulu, ndi matenda a Beckwith-Wiedemann. Nthawi zambiri, hyperinsulinemia imayambitsa kuchepa msanga kwa ma seramu woyamba 1-2 pambuyo pobadwa, pomwe kuperekera kwa glucose kosokoneza kumadutsana ndi placenta.

Pomaliza, hypoglycemia ikhoza kuphatikizidwa ndi malo osakwanira a catheter kapena sepsis. Makanda ambiri akhanda asymptomatic. Zizindikiro za adrenergic zimakhala ndi thukuta, tachycardia, ulesi, kapena kufooka komanso kunjenjemera. Pangakhale kusowa chidwi, kuperewera kwa zakudya, kusokonekera kwa magazi, ndi tachypnea. Kuyang'anira shuga pagona la wodwala. . Zizindikiro zonse ndizopanda tanthauzo, komanso zimawonekera mwa akhanda omwe ali ndi asphyxia, sepsis kapena hypocalcemia, kapena pochotsa opiates. Chifukwa chake, mwa akhanda omwe ali ndi chiopsezo chowonjezereka kapena chopanda zizindikiro izi, kuyang'anira msanga wama gluu m'magazi a wodwalayo kuchokera pachitsanzo cha capillary kumafunika.

• Maonekedwe amaundana wamagazi m'mitsempha yamagazi.
• Kukula kwa mitsempha ya thrombophilia ndi varicose.
• Kuphwanya magazi, komwe kungayambitse kusayenda bwino kwa thupi komanso kusakwanira kwa chitetezo chokwanira cha thupi ndi mahomoni ofunika komanso mavitamini.
• Kulephera kwa ziwalo zamkati chifukwa cha kusowa kwambiri kwa magazi.
• Kulimbitsa kwamphamvu
• Zovuta pa luntha, kulingalira ndi kukumbukira. Nthawi zina zotsatira za kupatuka kotereku zimatha kukhala matenda a ubongo. Kuletsa kwazidziwitso kumatha ndi kubwezera kwake kwa shuga m'magazi.
• Kuwonongeka kwa minofu ya mafupa, yomwe pambuyo pake imatha kubweretsa kulumala.

Koma chenjezo la munthawi yake komanso njira zopewera matenda zimathandizira kuchotsa zotsatirapo za hypoglycemia ngakhale m'mayambiriro a kukula kwake, chifukwa mwana wakhanda akangokhala ndi shuga yochepa, chithandizo chiyenera kuyamba nthawi.

Kuzungulira kopanda malire kumatsimikizira mtundu wa venous. Mankhwala a prophylactic a neonates ambiri omwe ali pachiwopsezo akuwonetsedwa. Makanda ena omwe ali pachiwopsezo omwe samadwala amayenera kudyetsedwa koyambirira ndipo nthawi zambiri amakhala ndi mwana wakhanda kuti apereke chakudya.

Magawo a shuga a Serum amayenera kuyang'aniridwa kuti adziwe magawo a kulowetsedwa. Ngati hypoglycemia imalephera kulandira chithandizo, lingalirani zifukwa zina, ndipo mwina, werengani endocrine, fufuzani za hyperinsulinism komanso glycogenolysis.

Kupewa komanso chithandizo

Kupewetsa matenda ndikofunikira kwambiri pakugwira bwino ntchito kwa thupi komanso kusapezeka kwa matenda. Popewa hypoglycemia, muyenera kutsatira malamulo otsatirawa:

• Padera yoyamwitsa. Pazaka pomwe mwana asanakwane, amaloledwa kuphatikiza ndi zakudya, pokhapokha ngati dokotala walola.
• Kuperewera kwa zakudya za ana. Sizingatheke kuti mwana wakhanda azidya china chilichonse kupatula mkaka wa mayi.
• Momwe matenthedwe oyenera a ma diapers, ma diapers, bafuta wogona pabedi. Kusungabe kutentha kwa thupi ndi chinthu choyenera kupewa matenda osachepera shuga.
• Kuyamwitsa kuyenera kuyamba mkati mwa ola limodzi pambuyo pobadwa.
• Ndikwabwino kukonzekera kudya kwamwana nthawi yokhazikika kuti pasadzadye kwambiri kapena chifukwa chosakwanira, chifukwa chomwe matendawa amayamba. Ngati mwana sakuwonetsa zizindikiro za njala (mwana wathanzi amafunsa kuti adye kangapo 4-5 patsiku) ndiye kuti ichi ndi chizindikiro choti mudzapita kwa dokotala.
• Ngakhale msinkhu wobadwa kumene ukhala wochepera milungu 32, ndipo kulemera kwake ndi kochepera 1.5 makilogalamu., Kudyetsa kumathandizidwabe pokhapokha pakuyamwitsa, kupatula malangizo a dokotala.
• Ngati kuchuluka kwa shuga ndi kochepera 2.6 mol, ndiye kuti kulowetsedwa kwa shuga kuyenera kuyambika nthawi yomweyo.

Osatengera kuti khanda limadwala kapena ayi, m'maola ochepa a moyo wake liyenera kulandira glucose wolowa m'thupi.

Ana agalu obadwa kumene amakhala ndi chitetezo chamthupi, chomwe chimayenera kumangidwa nthawi yayitali, kuyambira mkaka wa amayi awo. Chifukwa cha ziwalo ndi machitidwe a ana osakhazikika, ana agalu amakonda kuzisintha mosiyanasiyana, kuphatikiza matenda ndi chilengedwe, zakudya komanso michere. Kuphatikiza apo, nyama zazing'ono sizimayang'anira kutentha kwa thupi, ndipo kutentha kwa thupi kumatha kusinthasintha chifukwa cha kutentha ndi chinyezi. Mphamvu ya glucose imathanso kukhala yoperewera, ndipo kuchuluka kwa shuga m'magazi kumatha kutsikira pamlingo woyenera ngati vuto lakudya, zomwe zingayambitse vuto la hypoglycemia.

Gulu la anthu omwe ali pachiwopsezo limaphatikizapo ana omwe:

• Chimbudzi chimatupa.
• Kulemera kwa thupi kupitilira ma kilogalamu anayi.
• Amayi ali ndi matenda ashuga 1.
• Palibe kuthekera kwa zakudya zamagulu.

Zolinga ndi chidule

Masiku ano, kukula kwa hypoglycemia kuli kwakukulu kwa akulu ndi ana, kuphatikizanso akhanda. Izi ndichifukwa cha zinthu zambiri zomwe zimachitika m'zaka za m'ma 2000 zino. Ndiye chifukwa chake nthendayi imatchedwa mliri wa nthawi yathu ino. Zokhudzana ndi dongosolo lamanjenje, nthendayo imasunthira bwino ku ziwalo zama psychomotor ndipo imakhala gwero la chitukuko cha matenda oyanjana, omwe amatsatana ndi kukomoka komanso kuwonongeka kwa mtima.

Chifukwa chake, hypoglycemia yopanda zizindikilo zoonekeratu imatha kupangitsa matenda a thrombosis kapena mtima, pomwe chizindikirocho kapena malo ake sizowoneka. Chifukwa chake, poyambirira kwa shuga ochepa, muyenera kulumikizana ndi kuchipatala ndikuwunika mayeso oyenera a magazi omwe angathandize kuti mwana asadwale komanso kuti apulumutse moyo wake. Vomerezani kuti zifukwa zodera nkhawa ndizofunika.

Momwe mungayang'anire hypoglycemia

Pofuna kuthana ndi glycemia, pamakhala timiyeso tapadera. Sangapereke zotsatira zenizeni. Ngati mayeso awonetsa mitengo yotsika kwambiri, muyenera kulumikizana ndi labotale kuti mupeze matenda. Ndikofunikira kudziwa kuti chithandizo chiyenera kuyambitsidwa nthawi yomweyo, osadikirira mayeso a labotale. Chiyeso sichingafanane ndi matendawa.

Tiyenera kukumbukira kuti gulu lowopsa limaphatikizapo ana ongobwera kumene osakwana 2800 ndi oposa 4300 magalamu, makanda asanakwane komanso omwe abadwa ndi mayi yemwe ali ndi matenda ashuga.

Ambiri ali ndi chidwi ndi funso loti: kodi mayeso a glycemia index amachitika liti? Amayamba kuyang'anira glycemia theka la ola pambuyo pobadwa, ndiye ola limodzi, atatu, maola 6 pambuyo pake, nthawi zonse pamimba yopanda kanthu. Ngati pali umboni, kuwongolera kumapitilizabe. Mukazindikira koyambirako kukachitika, kusokonezeka kwatsopano ndi sepsis kumachotsedwa.

Hypoglycemia mu akhanda: chithandizo

Chithandizo cha hypoglycemia chimachitika mosiyanasiyana: dextrose amathandizira kudzera m`mitsempha, lingaliro limapangidwa kuti lipereke zakudya zowonjezera, pali zochitika zina pamene glucagon imathandizidwa ndi intramuscularly.

Kwa ana obadwa kwa amayi omwe ali ndi matenda ashuga omwe amatenga insulin, nthawi zambiri, njira zamadzi zamagalimoto zimaperekedwa pambuyo pobadwa. Madokotala amalimbikitsa ana ena omwe ali pachiwopsezo kuti ayambe kudya zosakaniza posachedwa komanso pafupipafupi kotero kuti michere yambiri ilowe m'thupi.

Akapezeka kuti kuchuluka kwa glucose m'magazi a mwana wakhanda kuchepetsedwa, ndikofunikira kuyamba kuchiritsa mwana. Kuti muchite izi, sankhani zakudya zamagulu am'madzi ndi njira yamadzimadzi ya glucose, yomwe imalowetsedwa m'mitsempha.

Pambuyo pa izi, ndikofunikira kuyang'anitsitsa kuchuluka kwa shuga ndikuchita zinthu zofunika mwachangu kwambiri.

Ngati vuto la mwana ndilabwinobwino, mutha kusinthira kuchipatala, koma simungasiye kuyang'anira.

Ndikofunikira kwambiri kuti mumvetsetse kuti mtundu uliwonse wa hypoglycemia, ngakhale utadutsa popanda chizindikiro, uyenera kuthandizidwa. Kuwongolera ndi wotchi kumapitirira mpaka mwana atatsala pang'ono kusuntha. Ngakhale zizindikirozo siziri zofunikira, chithandizo chikufunika.

Hypoglycemia ikhoza kukhala yamitundu iwiri: yochepa komanso yoopsa. Ngati wakhanda ali ndi mtundu woyamba wa matenda, ndiye kuti amapatsidwa 15% maltodextrin ndi mkaka wa amayi. Ngati izi sizingatheke, jekeseni shuga.

Mwanthawi yayikulu, bolus imapangidwa, kenako kulowetsedwa kwa glucose, imawonjezeranso ndi osakaniza. Ngati izi sizikuthandiza, glucagon imayendetsedwa. Pankhaniyi, ndikofunikira kuyang'anitsitsa zizindikirazi, chifukwa zimatha kumverera bwino kwakanthawi.

Zimachitika kuti zonse zomwe zili pamwambapa sizimapereka zotsatira zilizonse, ndiye kuti amayamba kuchita zinthu mopitirira muyeso ndikupereka diazoxide kapena chlorothiazide.

Njira zothandizira ana akhanda

Ndikofunikira kwambiri kwa amayi oyembekezera omwe ali ndi mbiri ya matenda ashuga m'miyezi yotsiriza yoyembekezera kuti atsimikizire kuti kuchuluka kwa glucose ndikwabwinobwino.

Tiyenera kuyesera kuyamba kudyetsa mwana koyambirira komanso kuonetsetsa kuti chakudya chimachitika pafupipafupi. Mwana akangobadwa kumene, ayenera kumadyetsa nthawi zonse.

Kutalikirana pakati pakadyetsa sikuyenera kupitirira maola anayi. Nthawi zambiri pamakhala nthawi zina kuti mwana wakhanda adamuthamangitsira kunyumba wathanzi, ndipo, chifukwa chodyetsa nthawi yayitali, adayamba kudwala mochedwa hypoglycemia.

Hypoglycemia mu akhanda ndi matenda oopsa omwe amafunika kuwunika mwachangu komanso mwachangu. Muyenera kuyang'anira bwino mwana wanu kuti apewe mavuto.

Tikufuna inu ndi mwana wanu mukhale ndi thanzi labwino!