Pampu ya insulin: momwe imagwirira ntchito, kuyerekezera kwachitsanzo, mtengo

Pampu ya insulin ndi chida chaching'ono chomwe chimayendetsa mabatire ndikulowetsa insulin inayake m'thupi la munthu. Mlingo wofunikira ndi pafupipafupi zimakhazikika kukumbukira kukumbukira kwa chipangizocho. Komanso, adotolo opezekapo ayenera kuchita izi, chifukwa Magawo onse ndi amodzi pamunthu aliyense.

Chipangizochi chili ndi magawo angapo:

Pampu Ndi pampu yomwe insulin imaperekedwako, ndi kompyuta momwe machitidwe onse oyendetsera chipangizocho alimo.
Katiriji Ichi ndiye chiwiya chomwe insulin ilimo.
Kulowetsedwa. Mulinso singano yopyapyala (cannula), yomwe insulin imalowetsedwa pansi pakhungu ndi machubu kuti athe kulumikiza chidebe ndi insulin. Ndikofunikira kusintha zonsezi masiku atatu,
Zabwino komanso, ndikufuna mabatire.

Catheter ya cannula imalumikizidwa ndi chigamba pamalo pomwe insulin nthawi zambiri imalowetsedwa ndi syringes, i.e. m'chiuno, m'mimba, m'mapewa. Chipangacho chimakonzedwera lamba la wodwala pogwiritsa ntchito chidutswa chapadera.

Mphamvu momwe insulin ilili iyenera kusinthidwa atangomaliza, kuti asasokoneze dongosolo la kaperekedwe ka mankhwala.

Pump-based insulin therapy ndi yabwino kwambiri kwa ana, chifukwa mlingo womwe amafunikira si wawukulu kwambiri, ndipo zolakwika pakuwerengera ndi kuyambitsa zingayambitse mavuto. Ndipo chida ichi chimakulolani kuwerengera kuchuluka kwa mankhwalawa moyenera kwambiri.

Dokotala ayenera kukhazikitsa chipangizochi. Imayambitsa magawo ofunikira ndikuphunzitsa munthuyo kugwiritsa ntchito moyenera. Sizingatheke kuchita izi nokha, chifukwa cholakwitsa chimodzi chokha chitha kubweretsa mavuto osaneneka, komanso kudwala matenda ashuga.

Pompo amatha kuchotsedwa pomwe akusambira. Koma zikatha izi, munthu yemwe ali ndi matenda ashuga amayenera kudziwa shuga wawo wamagazi kuti awonetsetse kuti mulingo wake sukuwatsutsa.

Pampu ya Insulin: Upangiri wothandizira kukhazikitsa Holiday Bolus

Posachedwa tchuthi, zomwe zikutanthauza kuti padzakhala mphatso, zodabwitsa komanso phwando lokhala ndi zakudya zingapo zosangalatsa. Nthawi yayitali ya tchuthi nthawi zambiri imakhala limodzi ndi hyperglycemia. Koma, mukamagwiritsa ntchito pampu kwambiri, mutha kuchepetsa chiopsezo chaproplyial glycemia hyperglycemia kangapo.

Kodi angachite bwanji?

Pali mapampu awiri pamilandu iyi omwe angathandize kuthana ndi ntchitoyi:

lalikulu mafunde bolus
mafunde awiri

Ichi ndi chiyani

Chingwe pamtunda - mtundu wa insulin yunifolomu nthawi yayitali (kuyambira mphindi 30 mpaka maola 8). Ntchitoyi imagwira ntchito paphwando lalitali. Komanso, fundu ya mraba yolumikizika imagwiritsidwa ntchito ngati njira yogaya chakudya ikuchepetsedwa, mwachitsanzo, chakudyacho ndi mafuta kwambiri kapena pali matenda am'mimba (nthawi zambiri gastroparesis).

Kanema (dinani kusewera).

Pawiri mafunde (pampu ya Accu-Chek - multiwave) - njira yosakanikirana yoperekera insulin. Chifukwa cha ntchito iyi, pampu imayambitsa pompopompo pompopompo (mu Accu-Chek - standard), kenako ndikupitiliza kuperekera mankhwalawo mu mraba wave wave. Ntchitoyi ndi yosavuta kugwiritsa ntchito popanga mafuta othamanga komanso othamanga, mafuta amapezeka muzakudya. Boma limatcha nthabwala "pizza-bolus".

Momwe mungakhazikitsire njira zapadera zoperekera bolus?
Ndimapereka mwachitsanzo pampu ya Medtronic.

Kukhazikitsa ntchito yapadera yopereka insulin, yambitsa njira iwiri / lalikulu la bolus.Ngati njirayi ili ndi vuto, funde yolowera kawiri / sikokwanira siyingakonzeke kapena kulowa.

1. MAIN MENU> BOLUS> DOUBLE / SQUARE BOLUS. Dinani AST.
2. Pogwiritsa ntchito mivi, sankhani PA ndikusindikiza AST. Tsopano kusankhaku kwachitika. Tulukani menyu pogwiritsa ntchito batani la ESC.

Konzekerani masanjidwe akulu:

Zosankha zazikulu> Bolus> Ikani Bolus. Press Press.

a. Sankhani BOLUS WAVE SQUARE. Dinani AST. Chojambula cha SET SQUARE BOLUS chikuwonekera.
b. Lowetsani kuchuluka kwa insulini yoyesa kwambiri kwa bolodi yolimba ndi kukanikiza AST.
c. Screen ya SQUARE DURATION (nthawi yayikulu-bolus nthawi) imawonekera. Lowetsani nthawi yomwe mudzayendetsere insulin pamachitidwe awa, ndikusindikiza AST.

Chithunzi cha BOLUS SUPPLY (jekeseni wa bolus) chikuwoneka. Pampu imapereka mawu / kugwedezeka koyambirira ndi kumapeto kwa mankhwalawa. Pakukonzekera kwa bolus, mtundu wa bolus ndi voliyumu ziziwonetsedwa pazenera mpaka magawo onse a insulin atalowa.

Konzani bolashi-yama-kawiri:

Zosankha zazikulu> Bolus> Ikani Bolus. Press Press.

a. Sankhani DOUBLE WAVE BOLUS ndikudina AST. Chithunzi cha INSTALL DUAL BOLT TOTAL chikuwonekera.
b. Lowani kuchuluka kwa insulini kwa bolashi-yoweyula ndi kukanikiza AST.

Chiwerengero cha insulin chomwe mumalowetsa SET DOUBLE BOL YONSE Chiwonetsero chokwanira ndi kuchuluka kwathunthu kwa bolus insulin ndi mraba wave bolus yomwe imapanga chiwopsezo chachiwiri cha bolus.

c. Kusunthira pazenera lotsatira, akanikizire / kusintha kusintha kwa zinthu zabwinobwino (TSOPANO) ndi gawo lalikulu la bolus-wave-iwiri. Dinani AST.

! Chonde dziwani kuti gawo lililonse limawonetsedwa.

d. SQUARE DURATION mawonekedwe (nthawi yayikulu-bolus nthawi) Lowetsani nthawi yomwe mukufuna kutsata izi ndikusindikiza AST.

Ogwiritsa ntchito pampu ya Accu-Chek.
Choyamba muyenera kuyambitsa ntchito za Square ndi bolus angapo.

1. Menyu> Pezani "Sinthani Menyu"> Dinani chizindikiro.
2. Tsamba la "Select mtumiaji>" limawonekera.
3. Gwiritsani ntchito mivi kuti musankhe "Advancedenyu" ndikudina chizindikiro kuti mutsimikizire.
4. Tsopano mutha kulumikizidwa ndi Square Wave Bolus ndi Multiwave Bolus (Double Wave).
5. Kenako, pitirirani monga tafotokozera pamwambapa, kodolani pazenera m'malo mwa ACT.

Pampu ya insulin - momwe imagwirira ntchito, kuchuluka kwake ndi momwe mungapezere kwaulere

Kuti moyo ukhale wosavuta ndikusintha kayendedwe ka shuga, ma insulin achire anthu odwala matenda ashuga amatha kugwiritsa ntchito insulin. Chipangizochi chimawerengedwa kuti ndi njira yotsogola kwambiri poperekera mahomoni. Kugwiritsa ntchito pampu kumakhala ndi zotsutsana pang'ono, mutatha kuphunzitsa mokakamiza wodwala aliyense yemwe amadziwa bwino masamu kuti apirire.

Mitundu yapompopompo yaposachedwa ndiyokhazikika ndipo imapereka glucose wabwino kwambiri komanso hemoglobin, kuposa kuyika insulin ndi cholembera. Zachidziwikire, zida izi zilinso ndi zovuta. Amayenera kuyang'aniridwa, zothetsera zimasinthidwa pafupipafupi ndikukonzekera kupereka insulin njira yakale ngati zinthu sizinachitike mwadzidzidzi.

Pampu ya insulin imagwiritsidwa ntchito ngati njira ina yopangira syringes ndi zolembera. Kuwona kwa dosing kwa pampu kumakhala kwakukulu kwambiri kuposa momwe mumagwiritsira ntchito ma syringes. Mlingo wocheperako wa insulin womwe ungagwiritsidwe ntchito kwa ola limodzi ndi magawo a 0,025-0.05, kotero ana ndi odwala matenda ashuga omwe ali ndi chidwi chambiri ndi insulini amatha kugwiritsa ntchito chipangizocho.

Katemera wachilengedwe wa insulini amagawika kukhala yoyambira, yomwe imasunga kuchuluka kwa timadzi timadzi, mosasamala kanthu za zakudya, komanso bolus, yomwe imatulutsidwa poyankha kukula kwa shuga. Ngati ma syringe amagwiritsidwa ntchito panjira ya matenda a shuga, insulin yayitali imagwiritsidwa ntchito kukwaniritsa zofunikira za thupi za mahomoni, komanso yochepa musanadye.

Pampu imadzaza ndi insulin yochepa kapena yochepa kwambiri, kuti muthe kutengera kubisalira kwakumbuyo, imayilowetsa pansi pa khungu nthawi zambiri, koma m'malo ochepa. Njira iyi yoyendetsera imakupatsani mwayi wowongolera shuga kuposa kugwiritsa ntchito insulin yayitali. Kuwongolera kubwezeretsedwa kwa matenda a shuga kumadziwika osati kokha ndi odwala omwe ali ndi matenda amtundu wa 1, komanso ndi mbiri yayitali ya mtundu 2.

Makamaka zotsatira zabwino zimawonetsedwa ndi mapampu a insulin popewa neuropathy, ambiri odwala matenda ashuga amatha, matendawo amayenda pang'onopang'ono.

Pampu ndi yaying'ono, pafupifupi 5x9 cm, chipangizo chachipatala chomwe chimatha kubayira insulin pansi pa khungu mosalekeza. Ili ndi chophimba chaching'ono komanso mabatani angapo owongolera. Selo yokhala ndi insulin imayikidwa mu chipangizocho, imalumikizidwa ndi kulowetsedwa: machubu oonda opindika ndi cannula - pulasitiki yaying'ono kapena singano yachitsulo. Cannula imakhala pansi pa khungu la wodwala aliyense amene ali ndi matenda ashuga, motero amatha kupaka insulin pansi pa khungu mumadontho ang'onoang'ono mosalekeza.

Mkati mwa pampu ya insulin mumakhala piston yomwe imakankhira kuseri kwa mahomoni ndi pafupipafupi ndikudyetsa mankhwalawo mu chubu, kenaka kudzera mu cannula mumafuta ochulukirapo.

Kutengera mtundu wake, pampu ya insulin ikhoza kukhala ndi:

njira yowunika shuga
automulin insulin shutdown ntchito ya hypoglycemia,
Zizindikiro zochenjeza zomwe zimayambika chifukwa cha kusintha kwamphamvu kwa glucose kapena kumene sikupita pamlingo wamba,
kuteteza madzi
mphamvu yakutali
kuthekera kosunga ndikusamutsa chidziwitso pakompyuta chokhudza mlingo ndi nthawi ya jakisoni wambiri, shuga.

Ubwino waukulu wa pampu ndikutha kugwiritsa ntchito kokha insulin. Imalowa m'magazi mwachangu ndikuchita mosasunthika, motero imapambana kwambiri chifukwa cha insulin yayitali, momwe mayamwidwe ake amatengera zinthu zambiri.

Ubwino wosakayikira wa mankhwala a insulin insulin ungaphatikizeponso:

Kuchepetsa punctures khungu, lomwe limachepetsa chiopsezo cha lipodystrophy. Mukamagwiritsa ntchito ma syringe, pafupifupi jakisoni 5 amapangidwa patsiku. Ndi pampu ya insulin, kuchuluka kwa ma punctures kumachepetsedwa kamodzi pakapita masiku atatu.
Mlingo wolondola. Ma syringe amakulolani kuti mupeze insulin molondola ndi mayunitsi a 0,5, pampu imamwetsa mankhwalawa mu kuwonjezeka kwa 0,1.
Kuwongolera kuwerengera. Munthu wodwala matenda ashuga kamodzi amalowetsa kuchuluka kwa insulini pa 1 XE kukumbukira zinthu, kutengera nthawi ya tsiku komanso kuchuluka kwa shuga. Kenako, musanadye chilichonse, ndikokwanira kulowa kuchuluka kokha kwa chakudya, ndipo chida chanzeru chimawerengera insulin.
Chipangizocho chimagwira ntchito mosayang'aniridwa ndi ena.
Kugwiritsa ntchito pampu ya insulin, ndikosavuta kukhala ndi shuga wamagulu ena mukamasewera masewera, maphikidwe a nthawi yayitali, komanso odwala matenda ashuga ali ndi mwayi wokana kutsatira chakudyachi molimba popanda kuvulaza thanzi lawo.
Kugwiritsa ntchito zida zomwe zitha kuchenjeza za kuchuluka kwambiri kapena shuga wochepa kwambiri kumachepetsa chiopsezo cha matenda a shuga.

Wodwala aliyense wodwala matenda a shuga omwe amadalira insulin, mosasamala mtundu wa matenda, amatha kukhala ndi insulin. Palibe zotsutsana kwa ana kapena kwa amayi apakati komanso oyamwitsa. Zomwe zimachitika ndikutha kudziwa bwino malamulo oyendetsera chipangizocho.

Ndikulimbikitsidwa kuti pampu iyikiridwe odwala omwe ali ndi chiphuphu chosakwanira cha matenda a shuga, kuchuluka kwambiri m'magazi a shuga, hypoglycemia yausiku, komanso shuga yayikulu. Komanso, chipangizocho chikutha kugwiritsidwa ntchito bwino ndi odwala omwe ali ndi insulin.

Chofunikira kwa wodwala yemwe ali ndi matenda ashuga ndimatha kudziwa magawo onse a mankhwala a insulini: kuwerengetsa zam'thupi, kukonzekera katundu, kuwerengetsa kwa mlingo. Musanagwiritse ntchito pampu paokha, wodwala matenda ashuga ayenera kudziwa bwino ntchito zake zonse, azitha kuzipatsanso pawokha komanso kuyambitsa mtundu wa kusintha kwa mankhwalawo. Pampu ya insulin simaperekedwa kwa odwala omwe ali ndi matenda amisala. Cholepheretsa kugwiritsa ntchito chipangizochi chitha kukhala chosawoneka bwino cha wodwala matenda ashuga amene salola kugwiritsa ntchito chidziwitso.

Kuti phulusa la insulin lisatulutse zotsatira zoyipa, wodwalayo nthawi zonse azikhala ndi zida zothandizira:

cholembera chodzaza ndi jakisoni wa insulin ngati chipangirocho chalephera,
dongosolo kulowetsedwa kosintha
insulin tank
mabatire a pampu,
magazi shuga mita
chakudya champhamvu kwambirimwachitsanzo, mapiritsi a shuga.

Kukhazikitsa koyamba kwa pampu ya insulin kumachitika moyang'aniridwa ndi dokotala, nthawi zambiri kuchipatala. Wodwala matenda a shuga amadziwa bwino momwe chida chimagwirira ntchito.

Momwe mungakonzekere ntchito pampu:

Tsegulani ma phukusi ndi chosungiramo insulin.
Ikani mankhwalawa mankhwala momwemo, nthawi zambiri Novorapid, Humalog kapena Apidra.
Lumikizani posungira ndi kulowetsedwa kogwiritsa ntchito cholumikizira kumapeto kwa chubu.
Yambitsaninso pampu.
Ikani thanki mu chipinda chapadera.
Yambitsani ntchito yolimbikitsa pa chipangizocho, dikirani mpaka chubuyo itadzazidwa ndi insulin ndipo dontho lithe kumapeto kwa cannula.
Gwiritsani cannula pamalo a jakisoni wa insulin, nthawi zambiri pamimba, koma ndizothekanso m'chiuno, matako, mapewa. Singano ili ndi tepi yomatira, yomwe imakonza zolimba pakhungu.

Simuyenera kuchotsa cannula kuti musambe. Imachotsedwa mu chubu ndikutseka ndi kapu yapadera yamadzi.

Akasinja amakhala ndi 1.8-3.15 ml ya insulin. Ndizotayidwa, sizingagwiritsidwenso ntchito. Mtengo wa thanki imodzi umachokera ku ma ruble 130 mpaka 250. Makina a kulowetsedwa amasinthidwa masiku atatu aliwonse, mtengo wamalo ndi 250-950 rubles.

Chifukwa chake, kugwiritsa ntchito pampu ya insulin tsopano ndikokwera mtengo kwambiri: zotsika mtengo komanso zosavuta ndiz 4,000 pamwezi. Mtengo wautumiki ukhoza kufikira rubles 12,000. Zinthu zowunikira mosalekeza zamagulu a shuga ndizokwera mtengo kwambiri: sensa, yopangidwira masiku 6 ovala, imakhala pafupifupi ma ruble 4000.

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Kuphatikiza pazowonjezera, pali zida zogulitsa zomwe zimapangitsa moyo kukhala wosavuta ndi pampu: tatifupi zophatikiza ndi zovala, zokutira mapampu, zida zokhazikitsira cannulas, matumba ozizira a insulin, komanso zomata zoseketsa zapampu za ana.

Ku Russia, ndizotheka kugula ndipo, ngati kuli kotheka, kukonza mapampu a opanga awiri: Medtronic ndi Roche.

Makhalidwe oyerekeza azithunzizi:

Chitupa cha matenda a shuga. Zosiyanasiyana, cholinga, mfundo yogwiritsira ntchito ndi zina.

Kumwa mitundu yosiyanasiyana yamankhwala ndizodziwika bwino kwa anthu ambiri. Komabe, pali matenda omwe kufunikira kwakanthawi komanso kugwiritsa ntchito mankhwala mthupi ndikofunikira.

Kwa odwala ambiri, izi zimakhala ziyeso zazikulu. Kufanizira kwaukadaulo ndi zamankhwala kumapereka chiyembekezo chokhala ndi moyo wathunthu kwa anthu ambiri.

Ngakhale kuti sizotheka kwathunthu kuchira kuchokera ku matenda ashuga, kupanga matekinoloje azachipatala kumathandizira kukhalabe ndi moyo wabwino pamlingo womwewo. Chimodzi mwazida zamakonozi ndi pampu yopitilira insulin kwa odwala matenda ashuga.

Zipangizo zoterezi zimatha kupewa chisokonezo cha jekeseni wosalekeza.

Poganizira za mtundu waukadaulo wa chipangizocho, zovuta za mtengo wopanga wa chipangizocho ndi wokwera kwambiri. Komabe, odwala ambiri omwe amagwiritsa ntchito pampu amalankhula za kubweza kwakukulu komanso ndalama zowononga chifukwa chosowa kufunika kogulira majakisoni ambiri a jakisoni.

Chifukwa chiyani tikufunika pampu, ili ndi chiyani. Malangizo ake, zomwe zimagwiritsidwa ntchito.

Ntchito ya insulin ndiyo kuyamwa kwa shuga, kuchepa kwake, komanso kusungitsa kagayidwe kazinthu kena kake komanso njira zina zofunika kwambiri za metabolic.Ndi matenda a pancreatic, izi ndizosatheka, motero, kukhalabe ndi miyezo ya shuga mthupi, kuwunika kosasintha kwa magawo ake ndikuwonetsa Mlingo woyenera wa analogue yoyenerera imafunika.

Kuti thupi likhale ndi thanzi labwino, wodwala matenda ashuga ayenera kuchita zinthu zambiri tsiku lililonse:

kuchuluka kwa shuga ndi glucometer,
kudya okhwima
kutsatira kwambiri dongosolo la mankhwala,
kuwongolera Mlingo, kusintha ngati pakufunika,
kuwerengetsa chakudya chamagulu amoto.

Zochita zonsezi zimafuna bungwe, chifukwa ngati simunachite chimodzi mwazomwe tachitazi, pamakhala chiwopsezo chovuta, komanso milandu ikuluikulu. Osanena kuti jakisoni siowonekera kwa alendo, kuwongolera kumafuna kukonzekera kochepa komanso kukhala kwakanthawi.

Pampu ya insulini imathetsa mndandanda pafupifupi wamavuto athunthu omwe amabwera mwa odwala matenda ashuga a insulin. Chifukwa chogwiritsidwa ntchito, kuyambitsa analogue ya mahomoni aumunthu kumatha kukhala ntchito yovuta ngakhale pakakhala koyenera kumwa mankhwalawa koposa 5 patsiku. Kusowa kwa magwiritsidwe nthawi zonse m'malo osiyanasiyana kumachepetsa kusasangalala kwa chithandizo cha matenda ashuga.

Cholinga chachikulu cha chipangizocho ndi:

kuthandizira kuperekera mankhwala,
kuwerengedwa kolondola
kuwunika kwa chakudya
kudya kosalekeza kwa mankhwala
kukhala ndi kuchuluka kwa shuga pokhapokha ndi insulin yochepa.

Kuchiza kwa insulin ndikothandiza kwambiri chifukwa cha zochita zokha za zochita zake pakukwaniritsidwa kwake. Mukagwiritsidwa ntchito moyenera, kugwiritsa ntchito chipangizocho kumakupatsani mphamvu yogwiritsira ntchito kagayidwe kazakudya pogwiritsa ntchito mtundu umodzi wokha wa mahomoni.

Ndikofunikira. Pampu imalola penapake kuti isinthe. Komabe, kuwongolera pakugwira ntchito kwa chipangizocho, kukhalapo kwa iye ndi kuchuluka kwa mankhwalawa, kuyimitsidwa m'malo kwatsopano kumakhalabe ndi munthuyo.

Ndani wakhazikitsa pampu: Zizindikiro ndi ma contraindication

Mu shuga mellitus, pampu siimaperekedwa kwa odwala onse motsatana, amatembenukira ku mtundu uwu wa kaperekedwe ka mankhwala ku thupi motsatira:

Wodwalayo mwiniwakeyo adanenapo zakukhumba, ndipo alibe zotsutsana ndi chipatalacho.
kubayirira insulin sikulipira chindapusa chonse cha matenda ashuga,
kulumikizidwa pafupipafupi komanso kolowera m'magazi a glucose amawonedwa - kusokonezedwa kotero kumatha kuyambitsa zovuta m'matumbo,
zochitika za hypoglycemic nthawi zambiri zimachitika, zikuwonekera kwambiri ndipo zimachitika usiku,
zaka za ana - mwa ana, kukonzekera kwa insulin kumakhudzidwa mwachangu kuposa achikulire, choncho nthawi zonse pamakhala chiwopsezo chokhala ndi machitidwe okondweretsa ndi ma comatose,
pakati mwa mayi akudwala matenda ashuga, komanso pa nthawi yoyamwitsa.

Zipangizo zamakono pakupitiliza insulin mosalekeza zimakhala ndi kapangidwe kake kotero kuti pafupifupi wodwala aliyense amatha kuphunzira kugwiritsa ntchito pampu mosavuta, komabe pali zotsutsana ndi kuyika kwake, izi ndi monga:

kudwala matenda amisala
kuwonongeka kwamawonekedwe - wokhala ndi mawonekedwe osakwanira bwino, wodwalayo sangathe kuwona njira yomwe angagwiritsire ntchito popereka mankhwalawa, omwe nthawi zambiri amachititsa kuti pakhale zovuta zazikulu,
osayang'anira kudya kwapadera kwa odwala matenda ashuga komanso njira - amakhala ndi chilichonse motsatana, sawerengera kuchuluka kwa chakudya, amakana kuchita masewera olimbitsa thupi ndipo sawerengera kuchuluka kwa insulin.

Zofunika! Poyamba kugwiritsa ntchito chipangizochi, wodwalayo amafunika kuwunika pafupipafupi ndi dokotala - ngati izi sizingatheke pazifukwa zilizonse, ndibwino kubaya insulin m'thupi ndi syringe pakadali pano.

Ngakhale dzina lodziwika, pampu ndi gawo chabe la chipangizocho. Kutengera ndi wopanga ndi mtundu wa kachitidweko, zida zake zimatha kukhala zosiyanasiyana. Mndandanda wa zigawo za mitundu yodziwika bwino waperekedwa patebulopo.

Tebulo 1. Kukonzekera kwathunthu ndi kuwononga kachitidwe kofala kwambiri kwamakonzedwe a insulin okha:

Kuphatikiza apo, pali zida zina ziwiri zamankhwala, zomwe nthawi zambiri siziphatikizidwa mu phukusi, koma zimagwiritsidwa ntchito ndi odwala.

Mwa mitundu ina ya mapampu, opanga amapanga chida chomwe chimathandizira kukhazikitsa kwa cannulas. Yokonzekera kulowetsedwa, kuphatikizapo catheter, imayikidwa mu chipangizocho.

Pamene batani lipanikizidwa, kasupe amafalikira, ndikuyambitsa singano ndi gawo limodzi lakuthwa kumanzere kumanja ndikutulutsa mafuta.

Ma model azida zoterezi amatha kusiyanasiyana kutengera mtundu wa catheter.

Ndikofunikira. Kwa anthu omwe ali ndi thupi la asthenic, komanso ana, akatswiri amalimbikitsa kugwiritsa ntchito zida zoterezi ndi catheter woikidwa pakona pa madigiri 45. Izi zimachitika chifukwa cha chiwopsezo cha singano kulowa m'minofu minofu yokhala ndi mafuta ochepa.

Kuti muwone glucose mumadzi othamanga, imagwiritsa ntchito sensor yapadera. Kamangidwe kake kamakhala ndi subcutaneous yamagetsi yamagetsi, transmitter yomwe imafikitsa ma siginecha a wayilesi kwa wolandila kuti awone bwino zomwe zikuwonetsedwa.

Sensor iyenera m'malo masiku onse a 6-7.

Malinga ndi zotsatira za idatha, ndizotheka kusintha mlingo wa insulin, kupenda momwe mankhwalawo amathandizira. Tsopano opanga mapampu akugwira ntchito pa luso la chipangizocho kuyang'anira momwe munthu aliri mtunda wautali polumikizana ndi chida ndi foni pogwiritsa ntchito pulogalamu. Chida ichi ndi chofunikira makamaka kwa ana ndipo makolo akuda nkhawa ndi za mwana wawo.

Kugwiritsa ntchito mankhwala a insulin oterewa pochiza matenda a shuga kwa ana kumathandiza kwambiri.

Ndikofunikira. Kuchedwa kwa chidziwitso mukamagwiritsa ntchito sensor ndi mphindi 3-20, chifukwa chake simuyenera kusiya kugwiritsa ntchito mita. Izi zimachitika pazifukwa zathupi, kuperekera kwa glucose kuchokera ku capillaries kupita mu madzi a interellular kumatenga nthawi. Komanso chifukwa chaukadaulo, kulumikizana kwa ma electrode ndi glucose, kusamutsa deta, kukonza kumatenga nthawi.

Mitundu ina imakhala ndi lamba wa pampu ya insulin, kugwiritsa ntchito kwake komwe kumapangitsa kuti chipangizocho chizikhala cholimba kwambiri.

Kuwerengera kwa insulin pampu kumadalira kuwunika kwa data kuchokera ku sensor kapena glucometer, komanso kuchuluka kwa chakudya chamafuta, ndipo pulogalamu yapadera idzawonetsetsa kuyambitsa kwake. Gawolo likufotokozerani momwe makina ogwiritsira ntchito odzipereka a insulin amagwirira ntchito, zomwe muyenera kuyang'ana mukamagwiritsa ntchito.

Chofunikira chomwe chimasiyanitsa njirayi ndi chithandizo chamasiku onse cha insulin ndikugwiritsa ntchito mtundu wochepa wa insulin. Mwayiwu udawoneka chifukwa cha pulogalamu yoyendetsera insulin mosaposanso muyezo yaying'ono kuti isasunge gawo la mahomoni. Mlingo wa mankhwalawa womwe umapitilizidwa kutumizidwa umatchedwa basal.

Mlingo wa mankhwala womwe umaperekedwa kudzera m'mawu am'manja osinthanitsa ndi zakudya zamagulu azakudya zomwe madokotala amatchedwa bolus. Pafupifupi mitundu yonse yamakono ili ndi mthandizi wa bolus.

Chofunikira kwambiri ndikutha kuwerengera molondola mlingo womwe umafunikira kuti muchepetse kuzungulira kwa shuga. Mawerengerowo amachokera pazidziwitso za shuga, kuchuluka kwa mahomoni omwe adalowetsedwa kale m'thupi, ndi zizindikiro zina zomwe zimayambitsidwa m'dongosolo.

Ndikofunikira. Makina aliwonse omwe amafunikira kuwongoleredwa ndi anthu. Mukamagwiritsa ntchito, zinthu zosayembekezereka zimatha kuchitika, zomwe zimatha kukhala zoletsa kumwa mankhwala komanso kukulitsa zovuta.

Komwe ndi momwe kukhazikitsa dongosolo, zovuta zotheka

Nthawi zambiri, pakukhazikitsa pampu koyamba, amachitika ndi katswiri pokambirana ndi adokotala omwe amapezekapo. M'tsogolomu, mapangidwe a insulin pump amapangidwa ndi wodwalayo payekha.

Kuti mudziwe njira yobweretsera catheter ndikuyamba pampu molondola, muyenera kutsatira malamulo oyambira:

Tcherani khutu. Kukhazikitsa dongosolo pamaso pa bedi kumadzaza ndi hyperglycemia. Usiku, palibe njira yoyezera shuga ndikuwunika magwiridwe antchito ya insulin yobereka.

Kugwiritsa ntchito matekinoloje osiyanasiyana ndi zinthu zina zatsopano, kuphatikiza inshuwaransi ya insulin, kumakhala ndi zoopsa zake komanso zabwino zake. Akatswiri pantchito zaukadaulo wazachipatala akugwira ntchito nthawi zonse kuthetsa mavuto omwe amagwiritsidwa ntchito, kukonza ntchito, komanso kugwiritsa ntchito chitetezo. Pakadali pano, pali zabwino komanso zoopsa zogwiritsa ntchito chipangizochi.

Tebulo nambala 2. Malingaliro abwino komanso osagwiritsa ntchito ukadaulo.

Bessessen, D.G. Kunenepa kwambiri komanso kunenepa kwambiri. Kupewa, kuzindikira ndi kuchiza / D.G. Zopanda mphamvu. - M: Binom. Laborator of Chidziwitso, 2015. - 442 c.
Zazikulu, G. Kusokonezeka kwa metabolid ya lipid. Diagnostics, kliniki, chithandizo / G. Galler, M. Ganefeld, V. Yaross. - M: Mankhwala, 1979. - 336 p.
Grollman Arthur Clinical endocrinology ndi maziko ake achilengedwe, Medicine - M., 2015. - 512 p.

Ndiloleni ndidziwitse. Dzina langa ndi Elena. Ndakhala ndikugwira ntchito ya endocrinologist kwa zaka zoposa 10. Ndikukhulupirira kuti pakadali pano ndili katswiri pantchito yanga ndipo ndikufuna kuthandiza alendo onse omwe amapezeka patsamba lino kuti athetse zovuta koma osati ntchito. Zinthu zonse za tsambalo amazisonkhanitsa ndikuzikonza mosamala kuti athe kufotokoza zambiri zofunikira. Musanagwiritse ntchito zomwe zikufotokozedwa pa webusaitiyi, kufunsana ndi akatswiri ndizofunikira nthawi zonse.

Njira zoyendetsera

Poganizira kuti munthu aliyense ndi payekhapayekha, pali mitundu iwiri ya mankhwala a insulin. Chipangizocho chimatha kugwira ntchito m'njira ziwiri:

Poyamba, kupezeka kwa insulin m'thupi la munthu kumachitika mosalekeza. Chipangizocho chimakonzedwa payekhapayekha, chomwe chimakupatsani mwayi wokhazikika wa mahomoni m'thupi tsiku lonse. Dokotala amasintha chida chake kuti insulini iperekedwe mwachangu pamlingo womwe wasonyezedwa. Gawo lochepetsetsa limachokera ku mayunitsi 0,1. pa ola limodzi.

Pali magawo angapo oyambira insulin:

Masana.
Usiku uliwonse. Monga lamulo, thupi limafunikira insulini yochepa panthawiyi.
M'mawa Munthawi imeneyi, m'malo mwake, kufunikira kwa insulin kumakwera.

Magawo awa amatha kusinthidwa pamodzi ndi dokotala kamodzi, kenako sankhani yomwe ikufunika panthawiyi.

Bola ndi gawo limodzi la insulini yokhala ndi mahandiredi ambiri kuti athetse shuga wambiri m'magazi.

Pali mitundu ingapo ya mabululo:

Zoyimira. Pankhaniyi, mlingo woyenera wa insulin umaperekedwa kamodzi. Nthawi zambiri amagwiritsidwa ntchito ngati chakudya chokhala ndi chakudya chochuluka komanso mapuloteni ochepa. Izi zimabwezeretsa shuga m'magazi mwachangu.
Chiwere. Pogwiritsa ntchito insulin yamtunduwu imagawidwa pang'onopang'ono m'thupi. Nthawi yomwe mahomoni azidzachita mthupi azikula. Mtunduwu ndi wabwino kugwiritsa ntchito ngati chakudya chadzaza ndi mapuloteni komanso mafuta.
Pawiri. Potere, mitundu iwiri yapitayi imagwiritsidwa ntchito nthawi imodzi. Ine.e. Choyamba, mlingo woyenera wokwanira umaperekedwa, ndipo kutha kwake kumatenga nthawi yayitali. Njira iyi ndi bwino kugwiritsa ntchito mukamadya zakudya zamafuta komanso zamoto kwambiri.
Zabwino. Poterepa, machitidwe a mawonekedwe omwewo amawonjezeka. Amagwiritsidwa ntchito pakudya, chifukwa chomwe shuga m'magazi amakwera mofulumira kwambiri.

Katswiriyu amasankha njira yoyenera yoperekera insulin kwa wodwala aliyense payekhapayekha.

Chithandizo cha insulin chogwiritsa ntchito pampu chikukula kwambiri. Itha kugwiritsidwa ntchito ndi aliyense amene ali ndi matenda a shuga. Komabe, pali zizindikiro zina zomwe madokotala amalangizira kugwiritsa ntchito njirayi. Mwachitsanzo:

Ngati kuchuluka kwa shuga ndi kosakhazikika, i.e. nthawi zambiri imakwera kapena kugwa kwambiri.
Ngati munthu nthawi zambiri amakhala ndi zizindikiro za hypoglycemia, i.e. kuchuluka kwa glucose kumagwera pansi 3.33 mmol / L.
Ngati wodwalayo ali ndi zaka 18. Nthawi zambiri zimakhala zovuta kuti mwana akhazikitse kuchuluka kwa insulini, ndipo cholakwika cha kuchuluka kwa mahomoni omwe amaperekedwa chimatha kubweretsa zovuta zazikulu.
Ngati mayi akukonzekera kutenga pakati, kapena ngati ali kale ndi pakati.
Ngati pali matenda a m'mawa, kuwonjezeka kwa shuga m'magazi musanadzuke.
Ngati munthu akuyenera kubayira insulin pafupipafupi komanso waukulu.
Ngati wodwala yekha akufuna kugwiritsa ntchito insulin pump.
Ndi kwambiri matenda ndi zovuta chifukwa chake.
Anthu omwe amakhala moyo wokangalika.

Contraindication

Chipangizocho chili ndi chake:

Chida chotere sichimagwiritsidwa ntchito mwa anthu omwe ali ndi matenda amtundu uliwonse. Izi ndizoyenera chifukwa munthu amatha kugwiritsa ntchito mpope mokwanira, zomwe zimabweretsa zovuta zathanzi.
Ngati munthu safuna kapena sangaphunzire momwe angachiritsire matenda ake, i.e. amakana kuganizira za glycemic index ya zinthu, malamulo ogwiritsira ntchito chipangizocho ndikusankha njira yoyenera ya insulin.
Pompo siligwiritsa ntchito insulin yokhala nthawi yayitali, yochepa chabe, ndipo izi zimakupangitsani kulumpha kowopsa m'magazi a magazi ngati mungazimitse chipangizocho.
Ndi m'maso ochepa kwambiri. Zikhala zovuta kuti munthu athe kuwerenga zolembedwa papompo.

Chida chaching'onochi chili ndi zabwino zambiri:

Umoyo wa wodwala umayenda bwino. Munthu safunikira kuda nkhawa nthawi zonse kuti asayiwale kupereka jakisoni panthawi, insulin yokha imadyetsedwa mthupi.
Mapampuwa amagwiritsa ntchito insulin yochepa, yomwe imakuthandizani kuti musachepetse zakudya zanu.
Kugwiritsa ntchito chida ichi kumathandiza munthu kuti asadzitamandire matenda ake, makamaka ngati nkofunika m'malingaliro mwake.
Chifukwa cha chipangizochi, mlingo womwe umafunikira amawerengedwa molondola, mosiyana ndi ma syringes a insulin. Kuphatikiza apo, wodwala amatha kusankha mtundu wa momwe amagwiritsira ntchito mahomoni omwe amafunikira pakadali pano.
Ubwino mosakayikira ndikuti kugwiritsa ntchito chipangizocho kumatha kuchepetsa kuchuluka kwa khungu lanu.

Komabe, pampu ya insulin ilinso ndi zinthu zoipa zomwe muyenera kudziwa. Mwachitsanzo:

Mtengo wokwera. Kusamalira chida choterocho ndiokwera mtengo kwambiri, chifukwa zowonjezera zimayenera kusinthidwa nthawi zambiri.
Masamba obayira angayambitse kutupa.
Ndikofunikira kuyang'anira kayendetsedwe konse ka pampu, momwe mabatire amafunikira kuti chipangizocho chisatseke nthawi yolakwika.
Popeza ichi ndi chipangizo chamagetsi, kusowa kwaukadaulo ndizotheka. Zotsatira zake, munthu amayenera kubayira insulin m'njira zina kuti athetse vuto lakelo.
Ndi chipangizo chimodzi, matendawa sangathe kuchiritsidwa. Muyenera kutsatira njira yoyenera yamoyo, kuyang'anira kuchuluka kwa shuga m'magazi, kusunga magawo a mkate m'zakudya.

Kodi pampu ya insulin imagwira ntchito bwanji?

Zipangizo za anthu odwala matenda ashuga, monga pampu ya insulin, zikuchulukirachulukira. Chiwerengero cha odwala chikuwonjezeka, chifukwa chake, kuti athane ndi matendawa pamafunika chida chothandiza kuti athandizire kuperekera mankhwala mosamala.

Chipangizocho ndi pampu yomwe imatulutsa insulin pamalamulo oyendetsedwa ndi kayendetsedwe ka kayendedwe, imagwiritsa ntchito mfundo zachinsinsi za insulin m'thupi la munthu wathanzi. Mkati mwa pampu mumakhala bokosi la insulin. Bokosi losinthika la mahomoni limaphatikizira cannula yoyenera kupaka pansi pa khungu ndi machubu angapo olumikiza.

Kuchokera pazithunzi mutha kudziwa kukula kwa chipangizocho - chikufanana ndi pager. Insulini yochokera kuchosunga kudzera mu ngalande imadutsa mu cannula kupita munthaka ya subcutaneous.Chovuta, kuphatikiza posungira komanso cholembera kuyika, chimatchedwa infusion system. Ndi gawo lina lomwe matenda ashuga amafunika kusintha pambuyo masiku atatu ogwiritsa ntchito.

Pofuna kupewa kutengera kwa insulin, makonzedwe omwewo ndi kusintha kwa kulowetsedwa, malo omwe mankhwalawo amasintha. Cannula imayikidwa nthawi zambiri m'mimba, m'chiuno, kapena malo ena omwe insulin imabayidwa ndi njira zamakono zopangira jakisoni.

Zina za pampu kwa odwala omwe ali ndi matenda oopsa:

Mutha kukonzekera kuchuluka kwa insulin yobereka.
Kutumikiridwa ikuchitika yaying'ono.
Mtundu umodzi wa insulin yocheperako kapena ultrashort kanthu umagwiritsidwa ntchito.
Malowedwe owonjezera a mankhwalawa amaperekedwa kwa hyperglycemia yayikulu.
Kupezeka kwa insulin ndikokwanira masiku angapo.

Chipangizocho chimapangidwira ndi insulin iliyonse yomwe ikuchita mwachangu, koma mitundu ya ultrashort ili ndi mwayi: Humalog, Apidra kapena NovoRapid. Mlingo umatengera chitsanzo cha pampu - kuchokera pa 0,025 mpaka 0,1 PIECES pa kupatsira aliyense. Izi magawo a kulowa kwa mahomoni m'magazi kumabweretsa njira yoyendetsera kuyandikira kwachilengedwe.

Popeza kuchuluka kwa insulini yakumbuyo yam'mbuyo sikumakhala kofanana panthawi zosiyanasiyana zamasiku, zida zamakono zimatha kukumbukira kusintha kumeneku. Malinga ndi ndandanda, mutha kusintha kuchuluka kwa insulin kutuluka m'magazi mphindi 30 zilizonse.

Asanadye, chipangizocho chimakonzedwa pamanja. Mlingo wa bolus wa mankhwalawa zimatengera kapangidwe kazakudya.

Ubwino wa pampu yodwala

ShugaManWomenSomenShuga yanu kapena sankhani jenda kuti mupeze ndemangaLevel0.58 Kuyang'ana osapezedwaTchulani zaka za manAge45 KusakaNot anapezaYambirani zaka za mkaziAge45

Pampu ya insulin siyingachiritse matenda ashuga, koma kugwiritsidwa ntchito kwake kumathandiza kuti moyo wa wodwala ukhale wabwino. Choyamba, zida zimachepetsa kusinthasintha kwakanthawi kwa shuga m'magazi, zomwe zimatengera kusintha kwa kuthamanga kwa insulin ya nthawi yayitali.

Mankhwala ofupikira ndi a ultrashort omwe amagwiritsidwa ntchito kupangira chipangizocho kukhala ndi chokhazikika komanso chodalirika, kuyamwa kwawo m'magazi kumachitika pafupifupi nthawi yomweyo, ndipo Mlingo wake ndi wocheperako, zomwe zimachepetsa chiopsezo cha zovuta za jakisoni wa insulin ya matenda ashuga.

Pampu ya insulin imathandizira kudziwa kuchuluka kwa insulin. Izi zimaganizira kukhudzika kwaumwini, kusinthasintha kwa tsiku ndi tsiku, chakudya chokwanira, komanso glycemia ya wodwala aliyense. Magawo onsewa amalowetsedwa mu pulogalamuyi, yomwe imawerengera yekha kuchuluka kwa mankhwalawo.

Kuwongolera uku kwa chipangizocho kumakupatsani mwayi woganizira za shuga, komanso kuchuluka kwa zakudya zomwe zimapangidwira kuti muzidya. Ndikotheka kutumiza mlingo wa bolus osati nthawi yomweyo, koma agawireni munthawi yake. Kufunikira kwa mpope wa insulin malinga ndi anthu odwala matenda ashuga omwe ali ndi zaka zopitilira 20 ndikofunikira pakudya yayitali komanso kugwiritsa ntchito pang'onopang'ono chakudya.

Zotsatira zoyenera kugwiritsa ntchito pampu ya insulin:

Gawo laling'ono pakayendetsedwe ka insulin (0,1 PESCES) komanso kutsimikiza kwakukulu kwa mankhwala.
Nthawi 15 zopweteka pakhungu.
Kuwongolera shuga wamagazi ndikusintha kwa chiwongola dzanja cha mahomoni kutengera zotsatira zake.
Kudula mitengo, kusungirako glycemia ndi kumwa kwa mankhwalawo kuyambira mwezi umodzi mpaka miyezi isanu ndi umodzi, ndikuwasamutsa pakompyuta kuti iwasanthule.

Zizindikiro ndi zotsutsana pakukhazikitsa pampu

Pofuna kusinthana ndi insulin makina ogwiritsa ntchito pampu, wodwalayo ayenera kuphunzitsidwa bwino momwe angakhalire magawo a kupatsirana kwa mankhwalawa, komanso kudziwa mlingo wa insulin pakudya ndi chakudya.

Pampu ya matenda a shuga ikhoza kukhazikitsidwa pokhapokha wodwala atapempha. Ndikofunika kugwiritsa ntchito mankhwalawa pakakhala zovuta pakulipirira matendawa, ngati kuchuluka kwa hemoglobin ya glycated mu akulu kuli pamwamba pa 7%, ndipo mwa ana - 7.5%, komanso kusinthasintha kwakukulu pakuphatikizidwa kwa shuga m'magazi.

Kuchiza kwa insulin kumawonetsedwa ndi madontho a shuga pafupipafupi, makamaka kuwopsa kwa matenda a hypoglycemia, ndi vuto la "m'mawa kutacha", pakubala kwa mwana, pakubala, komanso pambuyo pawo. Ndikulimbikitsidwa kugwiritsa ntchito chipangizochi kwa odwala omwe ali ndi vuto losiyanasiyana la insulin, kwa ana, ndi kuchepetsedwa kukula kwa shuga ya autoimmune ndi mitundu yake ya monogenic.

Contraindication yokhazikitsa pampu:

Kuzindikira kwa wodwala.
Kuperewera kwa luso la kudziletsa kwa glycemia ndi kusintha kwa insulin kutengera chakudya ndi zochita zolimbitsa thupi.
Matenda amisala.
Masomphenya otsika.
Kutheka kwa kuyang'aniridwa kwamankhwala nthawi yophunzitsira.

Ndikofunikira kuganizira za chiopsezo cha hyperglycemia chifukwa pakalibe insulin yayitali m'magazi. Ngati vutoli latha, ndiye kuti mankhwala atasiya kugwira ntchito, ketoacidosis imayamba pakatha maola 4, ndipo pambuyo pake chikomokere matenda ashuga.

Chipangizo chothandizira kupopera insulin mankhwala ndi odwala ambiri, koma ndi okwera mtengo. Pankhaniyi, njira yothandizira odwala matenda ashuga atha kulandira kwaulere kuchokera kwa ndalama zomwe boma lagawa. Kuti muchite izi, muyenera kulumikizana ndi endocrinologist kumalo komwe mumakhala, kuti mupeze malingaliro pazakufunika kotereku kuperekera insulin.

Mtengo wa chipangizochi umadalira mphamvu zake: kuchuluka kwa thankiyo, mwayi wosintha momwe mulili, poganizira momwe mankhwalawo amadzidalira, kuchuluka kwa chakudya, chiwopsezo cha glycemia, kuwonetsa alamu, ndi kukana kwamadzi.

Kwa odwala omwe ali ndi mawonekedwe otsika, muyenera kuyang'anira kuwunika kwa mawonekedwe, mawonekedwe ake ndi kukula kwake.

Kapangidwe kake ndi kagwiritsidwe ntchito ka pampu yamadzi

Mapangidwe ndi kapangidwe ka kayendetsedwe ka pampu yamadzi pafupifupi pamagalimoto onse ali pafupifupi ofanana, makamaka poyerekeza tsatanetsatane wa omwe amapanga nyumba. Zomwezi zitha kunenedwa za komwe pampu ili.

Pampu yamadzi imayikidwa pafupi ndi radiator ndipo, injini ikayambika, imayendetsedwa ndi lamba woikira nthawi ya hydraulic (lamba wa nthawi).

Kapangidwe ka pampu kamakhala ndi zigawo zikuluzikulu izi: nyumba, shaft, zoyendetsera, kuyendetsa galimoto, kubereka, chidindo cha mafuta ndi chimbudzi cha drive ya drive. Shaft yokhala ndi chowongoletsa pamapeto pake imayikidwa pachikuto. Shaft imayendetsedwa ndi lamba wokonzera nthawi. Zizungulira, zomwe zimapangitsa kuti magetsi azikhala mu kachipangizoka, zimapangitsa kuti zizungulira pafupipafupi ndipo potero zimaziziritsa injini.

Pulogalamu yotsogola imayikidwa kumapeto kwa shaft, m'matembenuzidwe ena amapampu amaikiratu fanizira. Lamba wokonzera nthawi amayikidwa mwachindunji pa pulley yoyendetsa. Mphamvu yozungulira ya injini imaperekedwa kudzera mu lamba wakugawa ma hydraulic ndi drive drive kupita ku shaft, potero kukakamiza wopangitsa kuti atembenuke ndikuyendetsa dongosolo lonse.

Nthawi zambiri, pampu imayamba kusokonekera chifukwa cha kuvala kwa bokosi lodzikongoletsera lomwe lakhazikitsidwa pakati pa wowongolera ndi nyumba. Chisindikizo cha mafuta chikayamba kukhala ndi moyo, chimazizira (antifreeze kapena antifreeze) chimayamba kusunthira mmalo mwake ndikulowa zimbalangondo, ndikuchotsa mafuta.

Amisiri abwino amadziwa kuti kuti pakhale zoterezi ndi zoipa kwambiri, pafupifupi kufa. Imayamba kulira popanda mafuta ndipo posachedwa imalephera. Pankhaniyi, zotulukapo zake ndi chimodzi: zimbalangondo zimangokhala ndipo pampu imaleka kugwira ntchito.

Zomwe zimapangitsa kuti madzi asungunuke

Ngati mungadziwe injini yanthawi yake ndi kuisamalira bwino, ndiye kuti pampu yamadziyo itenga nthawi yayitali ndipo sikukuvutitsani. Chowonadi ndi chakuti pampu ndi chipangizo chosavuta ndipo chimasweka kwambiri. Koma pali kusiyanasiyana kumalamulo onse, ndipo pampu imakhudzanso.

Pali zifukwa zingapo zomwe pampu yamagalimoto imalephera:

Kulephera kwa magawo ena a pampu. Izi ndizomwe zimachitika makamaka pa chisindikizo cha mafuta, chomwe chimatha ndipo chimatulutsa. Zimachitika kuti wotsogolera kapena wobala akusweka.
Zopanda chilema chifukwa pomwe pampu idalibe yoyipa.
Pokonza mpope womwewo kapena magawo ena apafupi, woyendetsa malowo analakwitsa.

Zotsatira zoyipa cha pampu yamadzi

Ngati pampu yamadzi sigwira ndipo antifreeze kapena antifreeze isazungulira pa dongosololi, ndiye kuti kutentha kwa injini kumakwera msanga ndipo muvi wa sensor kutentha kwa madzi papulogalamu ya zida ukuyamba kukwera, mpaka kufika povuta. Zikhala zokwanira kuyendetsa galimoto ndi pampu yolakwika pang'ono pang'ono kotero kuti chowonjezera mu radiator chikute.

Mudzaphunzira za izi osati kokha ndi muvi wokukira, komanso mawonekedwe a utsi wochokera pansi pa hood komanso fungo lotentha lamadzi. Zinthu zoterezi sizingaloledwe mwanjira iliyonse, apo ayi injiniyo ikhoza kupanikizika. Ndipo ili ndi limodzi mwa zolephera zazikulu kwambiri zomwe sizivuta kukonza. Mwinanso, muyenera kulumikizana ndi othandizira magalimoto ndipo kwakanthawi kochepa musakhale ndi mayendedwe.

Kusagwira bwino pampu yamadzi kumatha kuonetsedwa ndi kuzizira komwe kumayambira. Kutchetchera pang'ono kwagalimoto sikubweretsa ngozi yayikulu ndipo kumalola kuyendetsa kwina kwa galimoto. Madziwo azungulira m'malo ozizira, mwachizolowezi.

Ntchito yanu pamenepa ndikuwunika momwe mulumikizira radiator ndikuyiyika munthawi yake. Koma musatulutsire vutoli kwa nthawi yayitali, popeza kutayikira kumatha mphamvu, ndipo simudzatha kukonza vutolo munthawi yake, makamaka ngati mukuyendetsa galimoto yanu kwambiri.

Matenda wamba ampope amadzi

Monga tanena kale, chipangizo cha pampu yamadzi ndichosavuta, chifukwa palibe zovuta zambiri. Mitundu yofala kwambiri komanso yodziwika yosweka:

mayimbidwe
wochititsa sakhala wadongosolo
Wosinjirira saugwira bwino shafu, mwachitsanzo kusala kwake kumasulidwa,
mpope wamadzi, chifukwa cha jitter wa injini yosalekeza, sugwirizana paphiri, ndipo mpweya umatuluka.

Pampu ya insulin: kufotokozera kwa chipangizo ndi mfundo yothandizira

Chipangizocho chili ndi mawonekedwe ake ovuta ndipo ndi:

Pampu, yomwe ndi pampu ya mahomoni ndi yolamulira,
Msika wosinthira wa insulin,
M'malo kulowetsedwa set (cannula ndi chubu dongosolo).

Wokhala ndi insulin yochepa (wa bongo wa insulin yambiri, onani nkhani ina). Pampu imodzi ndiyokwanira kwa masiku angapo, pambuyo pake pamafunika kukweza thanki (kapena m'malo mwake katoni - mumitundu yamakono).

Pampu ya insulin ya matenda ashuga, kwenikweni, ndi "wothandizira" wa kapamba, chifukwa amatsata ntchito yake. Ndikudziwika kuti posachedwa mitundu idzawoneka pamsika womwe, ndi ntchito yawo, adzafanana kwambiri ndi kapamba, chifukwa amatha kudzipulumutsa mwaokha pazokha zomwe zimafunikira pobwezeretsa chakudya.

Singano nthawi zambiri imayikidwa pamimba. Imakonzedwa palimodzi ndi pampu ndi catheter yokhala ndi zomatira zomatira, ndipo njira yoyendetsera, yomwe idasungidwa kale deta, imamangirizidwa ndi lamba. Komanso, insulin imayendetsedwa yokha molingana ndi magawo omwe adakhazikitsidwa kale.

Kodi pampu yopanda utupu ndi chiyani?

Pampu ya vacuum poyambirira idapangidwa kuti athane ndi vuto la erectile. Kukula kwa mbolo kunali koyipa. Kodi mfundo iyi ndi yotani?

Pampu ya vacuum ndi silinda wowonekera, botolo lomwe lili ndi zolowera koma lopanda zotulutsa. Moyenerera, pali malo ogulitsira, koma ndi bowo laling'ono ndi payipi yolumikizidwa. Mphepete yopyapyala imaphatikizika pampope kupopera mpweya kuchokera ku babu. Pampu nthawi zambiri imayimiriridwa ndi babu wotsika mtengo wamanja, monga, mwachitsanzo, zimachitika m'mapampu ogulitsa ogulitsa otsika mtengo. Pamapampu okwera mtengo, mfuti yapadera yapampu yokhala ndi chida chapanikiziro imayikidwa kuti iwonerere kupsinjika kwa mu botolo.

Mfundo zoyendetsera ntchito ndi zosavuta:

Mbolo imayikidwa mu botolo.
Botolo limakanikizidwa mwamphamvu ku pubis.
Mpweya umaponyedwa kuchokera mu chubu pogwiritsa ntchito pampu ya dzanja. Vuto lotopetsa limapangidwa mu botolo kapena, monga momwe akunenera, vacuum. Zotsatira zake, matupi am'madzi amadzala ndi magazi, omwe amachititsa kuti pakhale kupanga.

Chiwalo mamembala atatha kupompa kumakhalanso nthawi yayitali, yomwe imalola, molumikizana ndi kugwiritsa ntchito ndalama kuchokera ku zotumphukira za Viagra kapena mphete ya erection.

Komabe, ogwiritsa ntchito mapampu a vacuum adazindikira kuti pambuyo pakupopa magawo, mbolo imawoneka yayikulupo kwambiri kuposa masiku onse. Monga momwe zimakhalira pambuyo pake, kugwiritsa ntchito pampu yopanda thukuta kunakulitsa mbolo, koma osati kwa nthawi yayitali: kumapeto kwa tsiku, mbolo nthawi zonse limangoganiza kukula kwake wakale. Ataphunzira izi, ogulitsa zida zogonana adayamba kugulitsa pampu yopuma ngati chida chowonjezera mbolo. Umu ndi momwe pampu yopukuta idatchuka.

Kuchuluka kwakanthawi

Nchiyani chimapangitsa kuti kupompa kuwonjezeke kwakanthawi?

Njira 1. Pokhala nthawi yayitali (pafupifupi nthawi yamaseti muphunzira pambuyo pake munkhaniyi) kupompa, ulusi wa elastin mu mkanjo wa mbolo watambasulidwa. Izi zimathandizira kuti matupi omata akhale ndi magazi ambiri, zomwe zimapangitsa kuti mbolo zizikulirakulira. Pakatha maola angapo, ulusi wa elastin ukadzakhalanso utali wawo wakale, kubowoleza kwa mbolo kumabwereranso ku chizolowezi chake.
Mechanism 2. Njira yachiwiri yolimbikitsira mbolo ndi kutuluka kwa zamitsempha. Pakupopa, osati magazi ambiri, komanso zamitsempha zimawonjezeredwa ndi mbolo. Imayang'ana pakhungu (pamphumi), yomwe imayambitsa zotsatira za zomwe zimatchedwa "donut" ndikamaliza gawo lopopera. M'makalasi oyamba ndi ma pompu, lymph imadzaza mwamphamvu. Pambuyo pake, kuchuluka kwa zamitsempha nthawi yopukuta kumachepetsedwa kwambiri. Mwambiri, ma lymph si owopsa, ndipo sichizindikiro chonyansa. Kuphatikiza apo, maola angapo atatha kalasi, mwanabele amasiya mbolo yanu kudzera munjira zam'mimba, ndipo zonse zibwerera mwachizolowezi. Ngati ndi kotheka, onetsetsani kuti kuchuluka kwa zamitsempha sizowonjezera.

Kuchulukana kwamuyaya

Kuti muwonjezeke mosalekeza, muyenera kuphatikiza kugwiritsa ntchito pampu ndi masewera olimbitsa thupi. Kenako, ndi mitundu yapadera yopopera, itha kutambasula zovala, ndipo muzotsatira, "ikitsani" mapara. Ndi lirilonse la ntchito izi, ndi njira yabwino, pampu yopumira imakwanitsa.

Pompu ya vacuum itha kugwiritsidwa ntchito ngati chida chodziyimira pawokha, kapena ikhoza kuphatikizidwa ndi pulogalamu yayikulu yolemba. Njira yachiwiri ndiyabwino.

Pogwiritsa ntchito pampu molumikizana ndi masewera olimbitsa thupi, mutha kukwaniritsa zotsatira zazikulu zowonjezera IF. Chifukwa chake, pogwiritsa ntchito pampu yopumira, mutha kuwonjezera kutalika ndi kutulutsa kwa mbolo.

Kupopa kwapakatikati

Kupompa kwachidziwikire kutumphuka mu flask wambiri. Mphamvu ya vacuum mu fosholo yotere imapangitsa kuti mbolo itunduke, ndikudzaza matako ndi magazi mpaka malire. Ndi malaya otambasuka, njira yopopera iyi imathandizira kuwonjezera kukondoweza kwa mbolo.

Momwe mungapangire pulogalamu yophunzitsira zolinga zonsezi? Werengani nkhaniyo.

Malamulo Otetezera Kugwirira Ntchito ndi Pampu Yopuma

Pampu ya vacuum ndi njira yothandiza yokulitsira mbolo. Komabe, mosagwiritsa ntchito mosaganizira, mumangovulala ndikugunda kwa mbolo. Werengani nkhaniyi mosamala musanagwiritse ntchito chipangizocho.

Musaphwanye malamulo ngati awa:

Ngati mukumva kupweteka, imitsani nthawi yomweyo. Dziwani chomwe chimayambitsa kupweteka. Ngati choyambitsa ndikuvulala, ndiyembekezerani machiritso athunthu gawo lotsatira.Ngati choyambitsa ululu anali, mwachitsanzo, kudina pakati pakhungu, muyenera kuthana ndi vutoli ndikuyambiranso gawo lanu lopukusira.
Osathamanga. Osabweretsa gawo lopopera! Onjezerani kupanikizika (moyenera, muchepetseni, popeza phukusi limapangidwa mu botolo) bwino, sabata ndi sabata. Chinsinsi cha kukula sikuli m'zonyamula misala, koma mwa kuphunzitsidwa bwino.
Palibe chifukwa chakuti muyenera kupitilira nthawi yopompa kuti mufikire mphindi zoposa 40! Ola limodzi ndi nthawi yolemetsa. Pofika pano mufunika kuyandikira bwino. Ndi utupu wautali, magazi amasiya kuyenda momasuka mbolo, chifukwa chomwe maselo a mbolo amayambira kufa. Ndikuuza za kupitilira pokoka pansipa.
Osatupa nthawi zambiri. Gawo lopopa ndi chinthu chosangalatsa kwambiri: membala pampu ndi wokulirapo, chomwe ndi chabwino kuwona. Komabe, simuyenera kupopa katatu patsiku. Cholinga chanu ndikukulitsa mbolo, osayang'ana mayendedwe osakhalitsa. Makalasi pafupipafupi amasokoneza kukula. Chifukwa chake, tsatirani dongosolo la maphunziro, lomwe mudzaphunzire pambuyo pake m'nkhaniyo.

Ndinaona kuti ndi ntchito yanga kukuchenjezani zolakwitsa zazikulu kupopa, koma musathamangire kuchita mantha. Mbolo ndiyodabwitsa, ndiyovuta kuipweteka. Ndi maphunziro oyenera, chiopsezo chovulala chimakhala chovuta.

Ntchito Yophunzitsira Pumphu

Ganizirani mapulogalamu awiri awa:

Pulogalamu yoyamba cholinga chake ndikutambasula chikhoto cha mbolo.
Pulogalamu yachiwiri ikufuna kupopa mapaipi.

Pa pulogalamu zonsezi, pamafunika ma flasks awiri osiyana. Mng'oma ndi pampu yopopera mpweya ndi chilengedwe padziko lonse lapansi. Kwa mtundu woyamba wa maphunziro mumafunika chubu yopapatiza. Momwe mungasankhire kukula kwa botolo potengera kukula kwa mbolo, ndinafotokoza m'nkhaniyi "Momwe mungasankhire pampu yopumira."

Pulogalamu yokweza alben (kutalika)

Pulogalamu yonyamula iyenera kukhala yopapatiza: chiwalo chokhazikikacho sichikula mulifupi pakunyamula, makoma a botolo akuwonjezera kukulitsa, mmalo mwake chiwalocho chimakulitsidwa kutalika.

Ndalongosola kale mfundo zambiri munkhani zam'mbuyomu, zomwe mungawerenge nthawi zonse pa menquestions.ru mu gawo "Kuchulukitsa IF".

Kutikita minofu - 5 min.
Kutentha kwanyengo - mphindi 10-15.
Kutambasula kosavuta mbali zonse - mphindi 10-15.
Chingwe cholimbitsa kwambiri - 10 min.
Zingwe kapena Kutambasulira (momwe mungafunire). Mutha kuphatikizanso zomwe mungachite pano, komanso kukhala pamphumi.
Yosavuta jelk - 50 reps. Musanayambe kupopa, muyenera kukonzekera membala kuti azinyamula ndi pampu. Jelk ndiye woyenera kwambiri pazolinga izi. Zouma kapena chonyowa, momwe mungafunire.
Kulongedza. Tsopano tifotokoza mwatsatanetsatane momwe gawo lopopera limachitikira.

Njira Yonyamula

Bweretsani mbolo ku 80-90% ya erection, mafuta ndi kirimu kapena mafuta odzola, kenako ikani mu chubu ndikuwakanikiza mwamphamvu ku pubis. Yesetsani kuletsa Vaselini kuti asagwere mu scrotum, apo ayi imaphatikizidwamo. Izi zikachitika, musalekerere: chotsani chikalacho, pukuta ndi tinsalu chowuma, ndikuyambiranso mboloyo muchotsekerocho. Ngati mkangano usokonezeka ndi chojambulachi, ndiye kuti mafuta opaka mkati ndi mkati mwa mafuta oterera a kirimu. Slip iyenera kukhala 100%.

Pamapampu apamwamba kwambiri pali manometer, zimawonetsa kukakamiza pampu. Sindingakupatseni mayeso okwanira, chifukwa kwa wina mayunitsi anayi angaoneke ngati katundu wowoneka, pomwe winayo sangamve chilichonse. Muyenera kuwunikira kukakamiza pa chifukwa china: muyenera kudziwa nthawi yomwe munayambira, kuti pang'onopang'ono muwonjezere katundu ndipo osapinda ndodo.

Mbolo yomwe ili mchikuto chidzafika mpaka utali wonse. Penyani zomverera. Ngati kupweteka kumachitika, siyani seti.

Maphunziro

Pumulani pakati pa mphindi 3-5. Pakadali pano, kutseguka kopepuka kumatha kuchitika. Asanakhale gawo lotsatira, mubweretsenso membala ku 80-90% erection.

Koyamba. Gwiritsani ntchito gawo loyambirira: musayese kutulutsa mpweya wonse kuti mukwezere membayo kuti akwaniritse njira yoyamba. Ngati mutayamba kuchita masewera olimbitsa thupi, thupi limakula. Chilichonse chili ndi nthawi yake. Patsani katundu wambiri kwa mphindi 10.
Kachiwiri. Seti yotsatira ikhoza kuwonjezera kukakamira pang'ono. Apa ndi pomwe kupanikizika kumatengera kothandiza: yang'anani sensa ndikweza kukakamira pang'ono. Tengani mphindi 10-15 kupita kwachiwiri.
Kachitatu. Pachitatu, musachulukitse kukakamira, koma onjezani nthawi mpaka mphindi 20. Mu seti yonse muyenera kusangalala. Palibe zopweteka!

Pambuyo pa seti

Mukatha kulongedzanso, onjezerani kuwala, kwenikweni kubwereza kosavuta kwa 30-50. Osayesa kuchita masewera olimbitsa thupi athunthu, ngati pulogalamu ya mtima. Pankhaniyi, mumafunika jelk kuti magazi azithamanga, chifukwa mukapopa, magazi amayenda munsolo.

Kenako gwiranani mwachangu mphamvu yapakatikati kwa mphindi 5 mpaka 10.

Ganizirani BPFSL musanaphunzire komanso mutaphunzitsidwa. Ngati pambuyo pa maphunziro pali OPS, mukuchita zonse molondola. Ngati sichoncho, werengani nkhanizo mosamala ndikuwunika magwiridwe anu.

Pamapeto pa kulimbitsa thupi, konzekerani mbolo ndi ambulansi kuchokera ku mabala ndi mabala, kapena mafuta ofananawo.

Maphunzirowa atha. Ndandanda yake imakonda 2/1 kapena 3/1. Osayiwala za kupuma, koma simuyenera kukhala aulesi. Tsatirani mkhalidwe wa membala, phunzitsani mwaluso, mwakhama, mverani Mr. Jons`a ndi mbolo yanu ndikutsimikiza.

Kuchulukitsa katundu

Ndipo tsopano zochulukirapo pochulukitsa katundu. Osapitilira zomwe mwakhala mukuchita mlungu wonsewo. Seti yoyamba ndi yopepuka, mphindi 10, yachiwiri idakhala yowonjezera pang'ono komanso mphindi 10-15, yachitatu imapanikizika mphindi 20. Pakatha sabata, pang'ono, kungowonjezera katundu pang'ono pazomwe zidakhazikitsidwa, chifukwa chake, gawo lachiwiri lidzakwezedwa kwambiri, lachitatu likulimbikitsidwa chimodzimodzi koma kwa mphindi 20. Chiwembuchi ndi chophweka.

Chifukwa chake, sabata ndi sabata, pang'onopang'ono kuwonjezera katundu. Izi zikuthandizira kukwaniritsa zotsatira zabwino. Pakatha milungu ingapo, mukapeza chidziwitso, onjezerani nthawi yayitali mpaka mphindi 15 kwa gawo loyamba, mphindi 20 kwa mphindi yachiwiri ndi 25 kwa lachitatu.

Ngati muli ndi chidziwitso chokwanira, mutha kukweza ndi kusintha pulogalamu yanu yophunzitsira, kutengera zitsanzo zomwe ndakupatsani.

Pitilizani njira yokweza zovala mpaka mutakulitsa kusiyana pakati pa BPFSL ndi BPEL mpaka 2 cm kapena kupitilirapo, kenako ndikupitilira kuzungulira kwa mtima. Komabe, ngati muwerenga zolemba zonse zapita ndikuphunzira mwaluso, ndiye kuti mukudziwa kale izi.

Ndondomeko

Misonkhano yopopera pamankhwala olimbitsa imakhala yofanana ndendende ndi njira yotambasulira, pokhapokha ngati chubu pamenepa ndi chotalikirapo, osati chopapatiza, ndipo mbolo imatupa m'lifupi. Nthawi ya gawo ndi mfundo yakuwonjezera katundu ndizofanana. Mutha kuwerenganso zolemba zonse patsamba lathu.

Pakati pa zigawo, gwiritsani nkhonya. Pa 10-15 kumenya nkhonya pakati pa ma seti kumakhala kokwanira. Chitani izi pang'onopang'ono. Ngati mukuwona kuti katundu ndiwambiri, ndiye kuti muchepetse ndikufupikitsani kulimbitsa thupi.

Pamapeto, chitani mafuta opepuka kuti muchepetse magazi.

Maphunzirowa atha. Pamapeto pa kulimbitsa thupi, tsitsani mbolo ndi mafuta "ambulansi kuchokera ku mabala ndi mikwingwirima" kapena analogues. Ndandanda 2/1 kapena 3/1.

Ndi pulogalamuyi, nditatha kutalika kwachikale, ndimatha kuwonjezera kukondoweza kwa mbolo ndi 0.5 cm pamwezi. Zinali zotsatira zabwino! Kupitilira apo, kukula kunachepa, pambuyo pake ndinasinthanso kuzinthu zoyenda pang'onopang'ono.

Muzisamala ndi majini anu. Ngati mukuwona kuti membala sanakonzekere katundu wotereyu kapena kuti sanachiritsidwe, pumulani.

Kuti mufufuze momwe magwiridwe anu amagwira ntchito, mutha kuyeza girth yanu isanayambe komanso nthawi yolimbitsa thupi. Komabe, muyenera kuyesa kuyeza iyo mbolo isanadzaze ndi mwanabele. Girth yomwe idachuluka ndi lymph sizitivuta. Tikufuna OPS yoyera. Ndipo kusiyana kwakukuru pakati pa zoyezera poyambira ndi panthawi yophunzitsira, kuli bwino. Ngati kusiyanasiyana patatha sabata limodzi, muli pamzere olondola.

Mfundo zingapo zingapo

Tsopano lingalirani za mfundo zingapo zofunika pokonza bwino kwambiri.

Moment 1 - Zochita Pamanja + Pampu

Pampu ya vacuum ndiwowonjezera pantchito yayikulu yochita masewera olimbitsa thupi ndikuwonjezera mphamvu ya maphunziro. Osasinthira kugwiritsa ntchito pampu imodzi - ingakhale chisankho cholakwika.

Moment 2 - Lymph

Mukamayeseza mwamphamvu, mbolo “imadzaza” ndi mwanabele. Kuphunzira koyamba kwa zamitsempha kumachitika zambiri, maphunziro ochepa “akangodzala” osakwaniritsidwa.

Ngati pali ma lymphs ambiri, ndiye kuti mutha kugawa maguluwo m'magawo awiri, ndikupumira pakati pa masekondi 30.

Kuponyera kondomu kumalepheretsa kuchuluka kwa mwanabele. Inde, inde, musadabwe. Mu kondomu, khungu limakakamizidwa mwamphamvu, zomwe zimalepheretsa mwanabele kuti usungidwe pansi pake. Izi sizikhudza kuwongolera konse kochita maphunziro.

Moment 3 - Healing creams

Mukamaliza maphunziro, ndikofunikira kugwiritsa ntchito zonona. Izi zikuthandizira kuchiritsa mawanga ofiira msanga ndikuletsa mbolo kuti zisade.

Moment 4 - magazi panthawi yopopa

Ndi kupukusa kwapakale, ndibwino kuti mumamwa aspirin musanaphunzitsidwe (pafupifupi. Ed. Funsani dokotala wanu musanachitike). Amawonjezera magazi ndipo amateteza magazi kuundana.

Pa maphunziro, ndi katundu wowonjezereka, madontho ochepa a magazi amatha kutuluka mu urethra. Izi zikuchitika chifukwa cha kuwonongeka kwa ziwiya zamkati mwa urethra. Poterepa, malizitsani phunziroli nthawi yomweyo ndikupuma mu sabata ziwiri. Mukapuma, imwani Ascorutin kuti mulimbikitse mitsempha yamagazi kapena analogue yotsimikiziridwa. Ndikofunikanso kumwa vitamini E.

Pambuyo pakupuma masabata awiri, yambitsaninso maphunziro, koma yambani pang'onopang'ono: mutatha milungu iwiri yolimbitsa thupi mopepuka, mubwerere ku maphunziro onse.

Moment 5 - Kugonana Pambuyo pa Maphunziro

Ndikhulupilira kuti mutaphunzitsidwa, simuyenera kugonana kapena kuseweretsa maliseche. Dzipatseni nokha ndi membala wanu yopuma. Ndipo gonana nthawi ina.

Moment 6 - Mdima khungu

Pogwiritsa ntchito kupukuta kwapadera, khungu la mbolo limatha kuda pang'ono. Izi zimachitika ngati zinthu zomwe ndafotokozerazo mu pulogalamuyi sizinawonedwe: kuwotha kutentha, kukwaniritsa kuchuluka kwake, kugwiritsa ntchito mafuta ngati ophunzirira. Mulimonsemo, kuchita mdima si chizindikiro chowawa. Ndinafotokoza momwe limagwirira ntchito zamdima zomwe zalembedwa m'mbuyomu.