Malangizo a matenda a matenda a shuga ana

Matendawa matenda a shuga amakhalanso akuwonekera ali ana ndipo amakhala achiwiri pafupipafupi pakati pa matenda apakati pa ana.

Izi zobadwa nazo komanso zosachiritsika zam'mimba zimayambika chifukwa cha kukanika kwa metabolism ndipo zimadziwika ndi kuwonjezeka kwa kuchuluka kwa shuga m'madzi a m'magazi.

Thanzi la wodwala pang'ono komanso mwayi wokhala ndi zovuta zazikulu zimadalira kuzindikira kwakanthawi ndi chithandizo.

Gulu la matenda

Pathogenesis yamatendawa ndi yovuta pakuyamwa kwa glucose m'maselo a ziwalo, zomwe zimabweretsa kuchuluka kwake m'magazi. Izi zitha kuchitika chifukwa cha kusakwanira kaphatikizidwe ka insulin kapena pamene ma cell receptor amataya chidwi chawo ndi mahomoni.

Kutengera pakusiyana kwa makina a chitukuko cha matenda, matenda opatsirana a shuga agawidwa m'mitundu ingapo:

Matenda a shuga 1 amtundu wa shuga amadalira insulin. Amayamba chifukwa chakuwonongeka kwa minofu ya kapamba yomwe imayambitsa insulini. Zotsatira zake, kuchuluka kwa mahomoni osakwanira kumapangidwa ndipo kuchuluka kwa glucose m'madzi a m'magazi kumayamba kuchuluka. Matenda a shuga a Type 1 ndi matenda obadwa nawo ndipo amapezeka makamaka mwa ana ndi achinyamata kuyambira ali ndi zaka 12.
Matenda a 2 a shuga ndi njira yodziyimira payokha ya insulin. Pankhaniyi, palibe kuchepa kwa insulin, koma maselo amatenga mphamvu m'thupi ndipo kupatsidwa kwa glucose mu minofu kumakhala kovuta. Zimayambitsanso kuwonjezeka kwa shuga mthupi. Matenda a shuga a Mtundu Wachiwiri ali mwana samapezeka ndi moyo wonse. Odwala achikulire azaka zopitilira 35- 40 amatha kutenga matendawa.

Psychology imafotokozedwa molingana ndi kuopsa kwa maphunzirowo:

1 digiri - mawonekedwe ofatsa omwe ali ndi khola la plasma shuga osapitirira 8 mmol / l,
2 digiri - mkhalidwe woyenera komanso kusintha kwa mankhwala a shuga masana ndi ndende yofika 14 mmol / l,
Giredi 3 - mawonekedwe owopsa ndi kuwonjezeka kwa glucose kuposa 14 mmol / L.

Potengera chithandizo, shuga imasiyana m'magawo:

gawo la kubwezeretsa - munthawi ya mankhwala, zizindikiro za shuga zimasungidwa pamlingo wovomerezeka,
gawo lamagawo - kuchuluka pang'ono kwa shuga chifukwa cha mankhwala,
gawo lowonongeka - thupi sililandira chithandizo chanthawi zonse ndipo shuga imakhala yowonjezereka.

Zoyambitsa matenda

The etiology ya matendawa imasiyana kutengera mtundu wa matenda.

Chifukwa chake, zifukwa zomwe zimapangitsa kukula kwa fomu yodalira insulin ndizophatikizira:

matenda a kapamba,
kupanikizika kwa nthawi yayitali
kudyetsa mwachangu makanda,
matenda a virus
zakumwa zoopsa zoopsa.
kubadwa kwatsopano kwa kapamba.

Matenda a 2 a shuga amayamba chifukwa cha izi:

chibadwa
osiyanasiyana kunenepa,
mimba yoyambirira
kumangokhala
mavuto azakudya
kumwa mankhwala okhala ndi mahomoni
kutha msinkhu
matenda a endocrine.

Nthawi zambiri, kuyambika kwa matenda ashuga mwa ana sikungalephereke, monga momwe angapangidwire achikulire, kupatula zinthu zomwe zingayambitse kuphwanya kwa kagayidwe kazakudya m'moyo.

Zizindikiro za matenda ashuga mwa ana

Chipatala cha ana mwa akhanda chimadziwika ndi izi:

Kuchepetsa thupi
kukodza pafupipafupi komanso kutulutsa mkodzo wambiri,
ludzu lalikulu
mkodzo wowala komanso wowonekera,
chikhumbo chachikulu
chizolowezi chododometsa komanso maonekedwe a chiphuphu,
kuwoneka kwa malo wowoneka bwino pazovala zamkati ndi zovala zamkati,
matenda a chingamu
ulesi ndi misozi,
kuthana kwambiri ndi matenda oyambitsidwa ndi tizilombo komanso matenda opatsirana.

Mukakalamba, mutha kulabadira zizindikiro zotere:

kutopa,
kusachita bwino komanso kusachita bwino kusukulu,
kutsika kwamawonedwe owoneka,
kugona tulo ndi kugona tulo,
khungu louma ndi pakamwa
maonekedwe a kuyabwa
kutuluka thukuta kwambiri
kunenepa
kusakhazikika
atengeke ndi fungal ndi bacteria bacteria.

Kuyang'anira mwana mosamala kudzakuthandizani kuti muwone zizindikiro zoyambitsa panthawi yake ndikuzindikira matenda ake m'magawo oyambilira. Kuchira kwakanthawi moyenera kumathandizira kupewa zovuta komanso kusamalira wodwalayo.

Kanema wochokera kwa Dr. Komarovsky okamba za zomwe zimayambitsa ndi matenda a shuga:

Mavuto

Kuchuluka kwa shuga m'magazi kumapangitsa kuti pakhale zovuta komanso zovuta zovuta. Zotsatira zoyipa zimapangidwa m'masiku ochepa komanso maola angapo, ndipo mwanjira iyi, thandizo lachipatala lofunikira limafunikira, apo ayi chiopsezo cha kufa chikuwonjezeka.

Izi zikuphatikizira izi:

Hyperglycemia - imachitika chifukwa cha kuchuluka kowopsa m'magulu a shuga. Kukodza mwachangu komanso ludzu losatha kumawonedwa. Mwanayo amakhala woopsa komanso wodwala. Pali nthawi zingapo za kusanza, kufooka kukukula. Mwanayo amadandaula mutu. Mtsogolomo, zimachitika kuti zimachitika ndipo zimapanikizika. Ngati chithandizo sichingaperekedwe pa nthawi, ndiye kuti dziko lokongola limayamba, kenako kumangokhala osazindikira ndikuchitika.
Ketoacidotic chikomachi ndi chowopsa, chikuyenda ndi kuchepa kwa mavuto ndi kupweteka kwam'mimba. Nkhope ya mwana imasanduka yofiira, lilime limakhala rasipiberi ndipo limakutidwa ndi zokutira yoyera yoyera. Fungo la acetone limawonekera kuchokera mkamwa, ndipo mwanayo amafooka. Kuyankhula kumakhala kovuta, kupuma kwamphamvu kumawoneka. Kuzindikira kumakhala kovuta ndipo kukomoka kumachitika.
Hypoglycemic chikomokere - kuchepa kwakukulu kwa ndende ya plasma kumakhala chifukwa cha hypoglycemia. Khalidwe la mwana limakhazikika. Amakhala woopsa komanso wowopsa, kenako komanso wosangalala kwambiri. Kumva njala ndi ludzu kumawonjezeka. Khungu limakhala lonyowa, ana amapepuka, kufooka kumangilira. Vutoli litha kuyimitsidwa popatsa wodwala madzi okoma kapena chidutswa cha chokoleti ndikuyimbira mwachangu ambulansi, apo ayi mkhalidwe womasuka umachitika ndipo mwanayo atha kuzindikira.

Mkulu wama glucose amasintha kapangidwe kake ndimagazi ndikuyambitsa zovuta zamagazi. Chifukwa cha kuvutika kwa mpweya, mpweya wamkati umakhudzidwa ndipo mphamvu yothandizira ziwalo zimachepa.

Kusintha kwazomwe kumachitika kwa nthawi yayitali, koma sikuwopsa kwambiri.

Nthawi zambiri motsutsana ndi maziko a matenda ashuga, matenda otsatirawa amapangidwa:

Nephropathy ndi kuvulala kwambiri kwa impso komwe kumayambitsa kukula kwa impso. Vuto loopsa lomwe limawopseza moyo wa wodwalayo ndipo limafunikira kumuyika chiwalo chokhudzidwa.
Encephalopathy - limodzi ndi kusakhazikika kwa malingaliro komanso popanda kulandira chithandizo chanthawi yake kumabweretsa zovuta m'maganizo.
Ophthalmopathy - imayambitsa kuwonongeka kwa mitsempha ndi mitsempha yamagazi, yomwe imayambitsa matenda amkati, strabismus, kuwonongeka kwa mawonekedwe. Ngozi yayikulu ndikuthekera kwakukulu kwa kubwezeretsanso kwam'mimba, komwe kumapangitsa khungu.
Arthropathy - chifukwa cha kupsinjika, kusunthika kwamalo olumikizana ndi khungu kumachitika ndipo matendawa amatchulidwa.
Neuropathy - mu nkhani iyi, mantha amthupi amavutika. Kupweteka ndi dzanzi m'miyendo, kuchepa mphamvu kwa miyendo imatha kuonedwa. Matenda am'mimba ndi mtima zimachitika.

Kuopsa kwa zovuta komanso kuopsa kwa zotsatirazi zimatengera ngati matenda ashuga amathandizidwa komanso momwe mankhwalawo amasankhidwa. Bwino shuga wambiri m'thupi limalipidwa, ndiye kuti zimachepetsa kuwonongeka kwa ziwalo zamkati komanso kupewa kutulutsa mpweya.

Zizindikiro

Njira yoyamwitsa ndiyofunika kwambiri m'magawo oyamba azindikira matenda a shuga kwa ana.

Namwino amathandizanso pakupeza zofunikira kuti apange chithunzi chowoneka bwino cha zomwe zimayambitsa matendawa, amatenga nawo mbali pakukonzekera wodwalayo maphunziro a labotale komanso othandizira, komanso amapereka chithandizo cha unamwino pochiza kuchipatala komanso kunyumba.

Namwino amapeza kuchokera kwa makolo zokhudzana ndi matenda omwe amakumana nawo komanso m'mbuyomu mwana, za kukhalapo kwa matenda opatsirana a shuga mwa iwo kapena abale awo. Amaphunzira za madandaulo, mawonekedwe a zochita za tsiku ndi tsiku za mwana komanso chakudya chake. Imawunikanso thupi la wodwalayo, imafufuza momwe khungu limakhalira ndi m'kamwa, limayesa kuthamanga komanso kulemera

Gawo lotsatira ndikuphunzira mayeso:

General matenda kusanthula kwamkodzo ndi magazi.
Kuyesedwa kwa magazi kwa shuga. Kuchuluka kwa 5.5 mmol / L kumatsimikizira kuti matendawa ndi ozindikira.
Mayeso a kulolera a glucose. Kuyesedwa kwamagazi awiri kumachitika, pamimba yopanda kanthu komanso maola angapo wodwala atapatsidwa yankho la shuga. Miyezo ya shuga pamwamba pa 11 mmol / L imawonetsa matenda ashuga.
Kuyesedwa kwa magazi a insulin ndi glycosylated hemoglobin. Kuchuluka kwa insulini kumawonetsa kuchuluka kwa matenda.
Kupenda kwa Ultrasound kwa kapamba. Zimakupatsani mwayi kuti mufufuze momwe ziwalozo zilili ndikuwona malo owonongeka a ndulu.

Kukhalapo kwa ma antibodies ku insulin, tyrosine phosphatase kapena glutamate decarboxylase m'magazi kuphatikiza ndi deta ya kuwonongeka kwa kapamba kumatsimikizira mtundu 1 wa shuga.

Mankhwala othandizira

Malangizo azachipatala okhudzana ndi matenda ashuga mwa ana zimadalira mtundu wa matenda omwe apezeka.

Malangizo ofunikira ndi awa:

mankhwala
chakudya
zochita zolimbitsa thupi,
physiotherapy.

Ndi matenda a mtundu 1, maziko a mankhwalawa ndi insulin. Zingwe zimapangidwa pansi pa khungu ndi syringe kapena pampu ya insulin. Khungu limatsukidwa kale ndikakonzedwa ndi zakumwa zoledzeretsa.

Homoni imayeneranso kuperekedwa pang'onopang'ono ndipo ndikofunikira kusintha malo omwe ali ndi jekeseni, kupewa kulowa m'thupi limodzi.

Jekeseni amatha kuchitira khola lam'mimba, ma umbilical dera, ntchafu, pamphumi ndi phewa.

Dokotala amawerengetsa kuchuluka ndi jakisoni wa tsiku ndi tsiku, ndipo dongosolo la insulin yoyang'anira liyenera kuyang'aniridwa mosamala.

Kuphatikiza apo, mankhwalawa amatha kuikidwa:

othandizira othandizira
anabolic steroids
anti-yotupa ndi antibacterial mankhwala,
anzawo ochepetsa
Kukonzekera kwa sulfonylurea
zovuta za mavitamini.

electrophoresis
Katemera
maginotherapy
kukondoweza kwa magetsi
kutikita minofu.

Kugwirizana ndi zakudya ndizofunikira pamoyo wa wodwala pang'ono.

Mfundo zazikuluzikulu za kadyedwe ndi izi:

zakudya zitatu zazikuluzikulu ndi zakudya zazakudya zitatu tsiku lililonse,
mafuta ambiri ali mu theka loyamba la tsiku,
chotsani shuga ndikuisintha ndi zotsekemera zachilengedwe,
kukana kudya zakudya zamafuta oopsa, maswiti ndi zakudya zamafuta,
chotsani makeke ndi zinthu zophika ufa wa tirigu muzakudya,
Chepetsa zipatso zako,
yambitsani zatsopano zamasamba, masamba, zipatso ndi zipatso zopanda zipatso.
sinthani mkate Woyera ndi rye kapena ufa wathunthu,
nyama, nsomba ndi mkaka zizikhala zochepa m'mafuta,
kuchepetsa mchere, zonunkhira ndi zonunkhira zotentha m'zakudya,
kumwa tsiku lililonse madzi abwino ofunika kuti madzi asungidwe bwino, pamlingo wa 30 ml pa kilogalamu ya kulemera.

Zakudya zopatsa thanzi ziyenera kukhala njira ya moyo ndipo zikhala zofunikira kuzitsatira pafupipafupi. Mwana wachikulire ayenera kuphunzitsidwa kuwerengera XE (magulu a buledi) ndi kusanja syringe kapena cholembera.

Pokhapokha ngati mutachita izi, mutha kukhalabe ndi shuga wambiri m'magazi am'magazi ndikuyembekeza moyo wa mwana.

Kanema kuchokera kwa mayi wa mwana yemwe ali ndi matenda ashuga:

Zotsogola ndi kupewa

Kodi tingatani kuti tisadwale matenda ashuga? Tsoka ilo, palibe chilichonse ngati matendawa amayambitsidwa ndi majini.

Pali njira zingapo zodzitetezera, kugwiritsa ntchito komwe kumangochepetsa chiopsezo, ndiye kuti, kuchepetsa mwayi wamatenda amtundu wa endocrine ndikuteteza mwana ku matenda:

Kuteteza mwana pamavuto,
kumwa mankhwala aliwonse, makamaka mahomoni, ayenera kuuzidwa ndi dokotala,
wakhanda ayenera kuyamwa,
Ana okulirapo ayenera kutsatira mfundo za zakudya zoyenera, osagwiritsa ntchito maswiti ndi makeke,
kuwunika kulemera kwa mwana, kuletsa kukula kwa kunenepa kwambiri,
khalani ndi mayeso pafupipafupi miyezi 6 iliyonse,
chiritsani matenda otupa komanso opatsirana nthawi,
Chitani zolimbitsa thupi tsiku lililonse.

Kodi matenda ashuga angachiritsidwe? Tsoka ilo, matendawa ndi osachiritsika. Ndi matenda a 2 a shuga, kuchotsedwa kwa nthawi yayitali kumatheka komanso kufunikira kwa mankhwala ochepetsa shuga kumatha kuchepetsedwa, koma malinga ndi kudya kwambiri komanso kuchita masewera olimbitsa thupi moyenera.

Kutsatira malingaliro onse a dotolo ndi malingaliro abwino amalola mwana wodwala matenda ashuga kukhala ndi moyo wabwinobwino, amakula, akule, aphunzire ndipo mosiyana ndi anzawo.

Wolemba nkhani yasayansi pankhani zamankhwala ndi zaumoyo, wolemba pepala lasayansi - Zilberman L.I., Kuraeva T.L., Peterkova V.A.

Pafupipafupi mtundu wa matenda a shuga 2 a mellitus (T2DM), kuphatikiza pakati pa achichepere, adachulukirachulukira, ndipo T2DM idayamba kulembedwa mu achinyamata ngakhale ana azaka zamisanachitike. Matendawa amakula motsutsana ndi maziko a kunenepa kwambiri komanso metabolic syndrome, koma ndi asymptomatic kwa nthawi yayitali, chifukwa chake, kuzindikiritsa kumafunikira kufufuza kwakanthawi kofufuza. Malangizowa azachipatala amapangidwa mu IDE ya FSBI ENC ndikufotokoza zovuta, kuwunika ndi kuwongolera odwala omwe ali ndi matenda a shuga 2.

Zolemba pazaka yasayansi pamutu wakuti "Maupangiri azachithandizo azachikhalidwe a matenda azitsamba 2 a ana ndi achinyamata"

Malangizo azachipatala a Federal a matenda ndi matenda a shuga 2 a ana ndi achinyamata

Ph.D. L.I. SILBERMAN, MD T.L. KURAEVA, membala wolingana RAS, prof. V.A. PETERKOVA, bungwe la akatswiri la Russian Association of Endocrinologists

Federal State Budgetary Institution Endocrinological Science Science Center la Unduna wa Zaumoyo wa Russia, Moscow

Mawu ofunika: T2DM, ana ndi achinyamata, hyperinsulinemia, insulin kukana, biguanides

Malangizo azachipatala a Federal pa diagnostics ndi chithandizo cha matenda a shuga 2 mwa ana ndi achinyamata

L.I. ZIL'BERMAN, T.L. KURAEVA, V.A. PETERKOVA, gulu la akatswiri la Russian Association of Endocrinologists

Federal state budget budget institution "Endocrinological Research Center", Russian Ministry of Health, Moscow

Matenda a shuga a Type 2 shuga mellitus (DM2) akuchulukirachulukira pazaka zapitazi. Kukula kwake mwachangu kumakhudza maphunziro ang'onoang'ono pakati pa azaka zina kuphatikizapo achinyamata ndi asanafike nthawi yobala. Matendawa amakula mothandizana ndi kunenepa kwambiri komanso metabolic syndrome koma amakhalanso asymptomatic nthawi yayitali. Chifukwa chake, kupezeka kwake kumafunikira kusaka kwachangu. Malangizo azachipatala omwe alipo pakali pano akuwunikira zovuta zazikulu zokhudzana ndi njira zodziwira matenda komanso njira zothandizira madokotala pakusamalira odwala omwe akupereka matenda a shuga 2.

Mawu ofunikira: lembani matenda a shuga a 2, ana ndi achinyamata, hyperinsulinemia, insulin kukana, biguanides.

HELL - kuthamanga kwa magazi

ACE - angiotensin-kusintha enzyme

GPN - glucose yothamanga ya plasma

Matumbo

IRI - Insulin Resistance Index

HDL - lipoproteins yapamwamba kwambiri

LDL - lipoproteins otsika

MRI - kulingalira kwamphamvu yamagalasi. NAFLD - chiwindi chamafuta chamafuta

NGN - kuphwanya glycemia

NTG - kulolerana kwa shuga

- mayeso a kuloza glucose

- mayesero azachipatala osinthidwa

- lembani matenda ashuga 1

- lembani matenda ashuga 2

- polycystic ovary syndrome

- ma antigen of the main main of histos-human m'dera (anthu leukocyte antijeni)

- shuga wamkulu wachinyamata (Kukula kwa Onset Diabetes the the Little)

Njira zomwe zimagwiritsidwa ntchito kupangira / kusankha umboni:

- fufuzani pazosamba zamagetsi.

Kufotokozera kwa njira zomwe zimagwiritsidwa ntchito kupangira / kusankha ndi kusanthula umboni

Umboni wotsimikizira izi ndi zofalitsa zomwe zaphatikizidwa mu Library ya Cochrane

zaposachedwa, EMBASE ndi Media database. Kuya kwakufufuza kunali zaka 5.

Njira zomwe zimagwiritsidwa ntchito poyesa kuchuluka kwa umboni:

- kuwunika kwa kufunikira malinga ndi chiwembu (tsamba 1, 2).

Njira zomwe zimagwiritsidwa ntchito kupenda umboni:

- Ndemanga za meta-kusindikiza,

- ndemanga zatsatanetsatane ndi matebulo aumboni.

Tebulo 1. Maikidwe a kuyeza mphamvu ya malingaliro

Ma meta-apamwamba apamwamba, kusanthula kwadongosolo kwa mayesero olamulidwa mosasankhidwa (ma RCT), kapena ma RCT omwe ali ndi chiopsezo chochepa kwambiri cha kukondera

Makamaka anachita meta-kusanthula, mwadongosolo, kapena ma RCT okhala ndi chiopsezo chochepa cha zolakwika mwadongosolo

Meta-amasanthula, mwadongosolo, kapena ma RCT omwe ali ndi chiwopsezo chachikulu cha kukondera

Mawunikidwe apamwamba kwambiri a maphunziro owongolera milandu kapena maphunziro a cohort

Mawunikidwe apamwamba owunika owunika kapena owerengeka kwambiri

chiopsezo chosakanikirana kapena kukondera komanso kuthekera kwa ubale wapakati

Maphunziro owongolera bwino oyang'anira milandu kapena maphunziro a cohort omwe ali ndi chiopsezo chapakati pazotsatira

Kusakaniza kapena kukondera ndi mwayi wapakati paubwenzi wapakati

Maphunziro a Milandu - Kuwongolera kapena maphunziro a cohort omwe ali pachiwopsezo chachikulu cha kusakanikirana kapena

zolakwika mwatsatanetsatane komanso kuthekera kwapakati pa ubale wa causal

Maphunziro osasanthula (mwachitsanzo: kufotokozera kwamilandu, zochitika zamilandu)

Tebulo 2. Chiyeso chakuyeretsa bwino momwe ziyenera kutsimikizidwira

Kuwunika kosachepera umodzi, kuwunika mwadongosolo, kapena RCT kuvotera ngati 1++, kugwiritsidwa ntchito mwachindunji kwa anthu omwe akufuna, ndikuwonetsa kukhazikika kwa zotsatira,

kapena gulu la umboni, kuphatikiza zotsatira za kafukufuku zomwe zidavoteredwa 1+, zikugwira ntchito mwachindunji kwa anthu omwe akuwonetsedwa ndikuwonetsa kulimba kwa zotsatira

Mu Evidence Gulu, lomwe limaphatikizapo zotsatira za kafukufuku wovomerezeka ngati 2 ++, zimagwira ntchito mwachindunji pa chandamale

kuchuluka kwa anthu ndikuwonetsa kutsimikizika kwa zotsatira, kapena umboni wochokera ku maphunziro omwe adavotera 1 ++ kapena 1 +

C Gulu la umboni kuphatikiza zotsatira za kafukufuku zomwe zidavoteredwa ngati 2+, zikugwira ntchito mwachindunji kwa anthu omwe akuwonetsedwa ndikuwonetsa kulimba kwa zotsatirapo, kapena umboni wotsimikizika kuchokera ku maphunziro omwe adavotedwa ngati 2++

D Level 3 kapena 4 umboni

mwina umboni wochokera kumaphunziro omwe adavotera 2+

Njira zomwe zimagwiritsidwa ntchito poyesa kuchuluka kwa umboni:

Ma tebulo aumboni adadzazidwa ndi mamembala a gululi.

Njira zomwe zimagwiritsidwa ntchito popereka malingaliro:

Malangizo Abwino

Kuyeserera koyenera kumakhazikitsidwa pazochitika zaumoyo wa mamembala a gulu lokhala ndi malingaliro othandizira.

Kusanthula mtengo sikunachitike, ndipo zofalitsa pa pharmacoeconomics sizinaphatikizidwe.

Njira zovomerezeka:

- Katswiri wakunja,

- kuwunika kwaukatswiri wamkati.

Kufotokozera kwa njira zotsimikizika

Malangizowa ndi oyambira

Mitunduyi idawunikiridwa ndi akatswiri odziyimira pawokha

Iwo omwe adapemphedwa kuyankhapo makamaka pamlingo womwe kumasulira kwa umboni wopangidwira kumveka.

Ndemanga adalandiridwa kuchokera kwa madotolo oyang'anira ndi oyang'anira madokotala oyang'anira madera okhudzana ndi kufotokozera kwanu komanso kufunikira kwa malingaliro ngati chida chogwirira ntchito cha tsiku ndi tsiku.

Kufunsira ndi kuwunika kwa akatswiri Kusintha kwaposachedwa kwa malingaliro awa kunaperekedwa mwa mtundu woyambirira wa zokambirana ku Congress of Endocrinologists pa Meyi 20–22, 2013 (Moscow), pamisonkhano ya ana endocrinologists pa June 22-23, 2013 (Arkhangelsk) ndi Seputembara 5-6, 2013 mzinda (Sochi). Mtundu woyambirira wakhazikitsidwa kuti ukambirane kwambiri pa tsamba la FSBI ESC kuti anthu omwe satenga nawo mbali pazokambirana ndi misonkhano akhale ndi mwayi wotenga nawo mbali pazokambirana ndikuwongolera malingaliro.

Malangizowo akuwunikidwanso ndi akatswiri odziimira omwe adapemphedwa.

Choyamba, kupereka ndemanga pa kukhazikika komanso kulondola kwa kutanthauzira kwa maziko aumboni komwe kumayambitsa malangizowo.

Pa kukonzanso komaliza ndi kuwongolera bwino, malingaliro azithandizidwanso ndi anthu omwe amagwira ntchito, kuti awonetsetse kuti ndemanga zonse ndi katswiri zimayang'aniridwa, chiwopsezo cha zolakwika mwadongosolo pakupanga makonzedwe amachepetsedwa.

Mphamvu zamavomerezo (A - D) amaperekedwa m'mawu a malingaliro.

Tanthauzo, njira zodziwira matenda komanso matenda a shuga

Matenda a shuga mellitus (DM) ndi gulu lochita kupewetsa matenda amtundu wa metabolic omwe amadziwika ndi matenda a hyperglycemia chifukwa cha kubisala kwapakati kapena kuchitapo kwa insulin, kapena kuphatikiza kwa zovuta izi. Mu matenda a shuga, mumakhala zovuta zama carbohydrate, mafuta ndi mapuloteni, omwe amayamba chifukwa chophwanya zochita za insulin pa minofu yomwe mukufuna.

Ochulukirapo (90%) a matenda onse a shuga ali ana ndiunyamata ndi mtundu 1 wa matenda a shuga (T1DM), omwe amadziwika ndi kuperewera kwa insulin chifukwa cha kuwonongeka kwa ma pancreatic p-cell.

Osati mtundu 1 wa shuga ndikuphwanya kwa kagayidwe kazakudya, wopangidwa chifukwa cha insulin yotulutsa yomwe sikukwaniritsa zofuna za thupi. Izi zitha kukhala chifukwa cha kukana insulini, kuchuluka kwa insulini kosakwanira, kuphwanya njira zake zobisika, komanso kulephera kwatsopano kwa cell-cell.

Kuzindikira kwa matenda ashuga kumadalira kusintha kwam'magazi a glucose komanso kupezeka kapena kusapezeka kwa zizindikiro za f).

Pali njira zitatu zoyezera matenda a matenda a shuga (tebulo 3).

Mtundu woyamba wa matenda a shuga 1, matenda owoneka ndi maso amawonedwa mwa ana mu milandu 30%: polyuria, polydipsia, kuchepa kwa mawonekedwe, kuchepa thupi posakaniza glucosuria ndi ketonuria (C).

Kuzindikira kumatsimikiziridwa mwachangu ngati chiwopsezo chachikulu cha plasma glucose wapezeka. Ngati matupi a ketone alipo m'magazi ndi mkodzo, chithandizo chofunikira chimasonyezedwa. Kuyembekezera mpaka tsiku lotsatira kuti mutsimikizire hyperglycemia kumatha kukhala koopsa, chifukwa kukhazikitsa ketoacidosis ndikotheka.

Ngati kutsimikiza kwa plasma glucose masana kapena mutatha kudya kumatsimikizira kuti matenda a shuga, OGTT sikuchitika f). Pazinthu zokayikitsa, kutsata kwa nthawi yayitali kumachitika ndikuyesedwa mobwerezabwereza.

Palibe zizindikiro za matenda ashuga, matendawa amapangidwa kokha pamaziko a hyperglycemia yokhazikika.

Njira zoyenera zophunzirira kusala kudya kwa glucose (GPN):

- GPN Sindingapeze zomwe mukufuna? Yeserani ntchito yosankha mabuku.

- GPN 5.6-6.9 mmol / l - glycemia (NGN) woperewera,

- GPN> 7.0 mmol / L - kupezedwa kwa matenda ashuga, komwe kuyenera kutsimikizidwa molingana ndi njira zomwe zili pamwambapa.

Momwe mungadziwe zotsatira za OGTT (plasma glucose patatha maola 2 mutatsitsa shuga - GP2):

- GP2 11.1 mmol / L - kuwunika kovomerezeka kwa matenda ashuga, komwe kuyenera kutsimikiziridwa molingana ndi njira zomwe tafotokozazi.

NTG ndi NGN zimawerengedwa ngati magawo apakatikati pakati pa kagayidwe kabwino ka carbohydrate ndi matenda a shuga f).

Gulu la Matenda a shuga

Gulu la anthu odwala matenda ashuga limaperekedwa pagome. 4.

Tebulo 3. Njira zoyesera za matenda ashuga (ISPAD, 2009)

Zizindikiro zomwe zimaphatikizidwa ndi kupezeka kwa shuga a plasma> 11.1 mmol / L *. Kuzindikiritsa kumawerengedwa mwachisawawa nthawi ina iliyonse masana osaganizira nthawi yomwe yadutsa kuchokera chakudya chomaliza

Kuthamanga shuga m'magazi> 7.0 mmol / L **. Mimba yopanda kanthu imalongosoledwa ngati kudya maola 8 apitawo kapena kupitilira.

Glucose wa 2 plasma pambuyo pochita masewera olimbitsa thupi pakumayesa kwa mayeso okhudzana ndi glucose (OGTT)> 11.1 mmol / L. Pa katundu, ndendende 75 g ya madzi am'madzi osungunuka m'madzi (kapena 1.75 g / kg)

Zindikirani * - ya capillary magazi athunthu> 11.1 mmol / l, wa venous magazi onse> 10.0 mmol / l, ** -> 6.3 wa venous ndi capillary magazi onse.

Tebulo 4. Gulu la masanjidwe obisika a carbohydrate metabolism (ISPAD, 2009)

I. T1DM imatha kuwonekera pazaka zilizonse, koma nthawi zambiri mwa ana ndi achinyamata

A. Matenda a shuga a autoimmune amadziwika ndi kufa kwa maselo a p, maselo a autoantibodies kwa ma p-cell, kuperewera kwathunthu kwa insulini, kudalira kwathunthu kwa insulin, maphunziro oopsa omwe amakhala ndi ketoacidosis, kuyanjana ndi majini a histocompatibility tata (HLA)

B. Idiopathic shuga imapezekanso ndimatenda a p-cell komanso chizolowezi cha ketoacidosis, koma popanda zizindikiro za autoimmune (ma autoantibodies eni ake ndi mayanjano ndi dongosolo la HLA). Mtundu wamatendawa umadziwika ndi odwala ochokera ku Africa ndi ku Asia.

II. T2DM - mtundu wofala kwambiri wa matenda ashuga pakati achikulire, amadziwika ndi kuchepa kwa insulin chifukwa cha kuphwanya kwapakati komanso insulin: kuyambira insulin kukana ndi kusowa kwa insulini kupita pachinsinsi chachinsinsi, kapena kuphatikiza insulin

III. Mitundu ina yapadera ya matenda ashuga. Gawoli limaphatikizapo mitundu yosiyanasiyana yakudziyimira payokha ya matenda ashuga (makamaka magawo amtundu wokhala ndi cholowa chamtundu wa monogenic), wophatikizidwa kukhala ma subtypes osiyana

A. Zofooka za genetic pantchito ya P-cell:

1. Chromosome 12, HNF-1a (MODY3)

2. Chromosome 7, GCK (MODY2)

3. Chromosome 20, HNF-4a (MODY1)

4. Chromosome 13, IPF-1 (MODY4)

5. Chromosome 17, HNF-1 / i (MODY5)

6. Chromosome 2, NeuroDl (MODY6)

7. Kusintha kwa mitochondrial DNA

8. Chromosome 6, KCNJ11 (Kir6.2), ABCC8 (Sur 1)

9. Ena, chomwe chimapangitsa ndi vuto la monogenic mu kapangidwe ka insulin

B. Zofooka zamtundu wa insulin:

1. Lembani A Insulin Resistance

2. Leprechaunism (Donohue syndrome)

3. Rabson-Mendelhall Syndrome

4. Lipoatrophic shuga

5. Mitundu ina ya shuga yomwe imayamba chifukwa cha masinthidwe amtundu wa insulin receptor. Matenda owoneka bwino obwera chifukwa cha kuchepa kwa thupi kuchokera ku hyperglycemia komanso hyperinsulinemia kuti achepetse shuga. Donoghue Syndrome ndi Rabson-Mendelhall Syndrome kuwonekera muubwana ndipo akuwonetsa kutchulidwa kukana insulin

C. Matenda a pancreas exocrine

2. Zowawa, kapamba

3. Pancreatic neoplasms

4. cystic fibrosis (cystic fibrosis)

6. Fibro-yowerengeka pancreatopathy

7. Matenda enanso osiyanasiyana, omwe, limodzi ndi kuphwanya kwakukulu kwa ntchito ya pancreatic, kusakwanira kwa chinsinsi cha maselo a islet kumawonekeranso.

2. Cushing's Syndrome

8. Ma endocrinopathies ena, chifukwa cha kutsutsana kwa mahomoni omwe amapangidwa mopitirira muyeso, angayambitse kutsika kwa magwiridwe antchito othandizira pancreatic p-cell

E. matenda ashuga oyambitsidwa ndi mankhwala kapena mankhwala ena

3. Nicotinic acid

5.Madzi a chithokomiro

7. P-adrenergic agonists

11. Mankhwala ena. Njira zomwe amachita zimasiyana: kuwonongeka kwa zotumphukira zochita za insulin, kuwonjezeka kwa insulin kukana.Muubwana, kugwiritsa ntchito kwa-interferon ndikofunikira kwambiri, chifukwa cha matenda a shuga a autoimmune omwe ali ndi vuto lalikulu la insulin

1. Kubadwa kwa rubella

3. Ena. Matenda ena a ma virus amatitsogolera ku kufa kwa ma p-cell ndi kukula kwa insulin kwathunthu. Zowonongeka mwachindunji ku islet app virusus ndizosowa

Tebulo 4. Kutengeka kwamatenda a carbohydrate metabolism (ISPAD, 2009) (kupitilizidwa)

G. Mitundu yosiyanasiyana ya matenda ashuga

1. okhwimitsa matenda a minofu (minyewa yolimba, matenda owuma) - chotupa cha autoimmune chapakati cha mantha amodzi omwe amadziwika ndi kukhazikika kwa minyewa ya axial yokhala ndi kuphipha kwapadera, ma antibodies kuti glutamate decarboxylase apezeke, ndipo matenda a shuga amapezeka pafupifupi 50% ya milandu

2. Autoimmune polyglandular syndrome yamitundu I ndi II

3. Matenda ena omwe amapezeka ndimapangidwe a autoantibodies ku insulin receptors ndi a systemic lupus erythematosus, pigmented papillary dystrophy ya khungu (acanthosis nigricans). Pankhaniyi, kutchulidwa kwa insulin kukana kumawonedwa.

H. Mitundu ina ya ma genetic syndromes nthawi zina imagwirizanitsidwa ndi matenda a shuga

DM imatha kukhala gawo la ma genndromes ambiri, kuphatikiza:

1. Tungsten Syndrome

2. Down syndrome

3. Matenda a Shereshevsky-Turner

4. Klinefelter syndrome

5. Lawrence - Mwezi - Beadle Syndrome

6. Prader-Willi matenda

7. Ataxia wa Friedreich

8. Huntington's chorea

10. Myotonic dystrophy

Muubwana, matenda a Wolfram (DIDMOAD) ndiofala kwambiri.

IV. Matenda a Gestational kishuga (shuga ya amayi apakati) - vuto lililonse lomwe limapangitsa kuti metabolism asokonezeke (kuphatikiza kulekerera kwa glucose) wopezeka nthawi yapakati. Kupatula kwa matenda ashuga osakanikirana kumayenderana ndi chiopsezo chakufa kwa ziwopsezo za kufa kwa pangozi ya kubereka komanso kusinthika kwa kubereka kwa amayi apakati omwe ali ndi kagayidwe kazakudya.

Kugawidwa kwa matenda ashuga si mtundu 1 malinga ndi International Classization of matenda (ICD-10)

Pakugawidwa kwamayiko padziko lonse kwamatenda (ICD-10), shuga yosadalira insulin imaperekedwa mu ma rubric E11-E14.

E11. Matenda osagwirizana ndi insulin

E11.0 Matenda a shuga omwe samadalira insulin

E11.1 Matenda a shuga omwe amadalira insulin osakhala ndi ketoacidosis

E11.2 Mellitus wosadalira insulin yemwe amadwala impso

E11.3 Mellitus wa shuga wosadalira insulin yemwe ali ndi vuto la maso

E11.4 Matenda a shuga osadalira insulini omwe ali ndi vuto la mitsempha

E11.5 Matenda a shuga osadalira insulini omwe amakhala ndi vuto la zotumphukira zamagazi

E11.6 Matenda a shuga omwe samadalira insulini ndi zovuta zina zotchulidwa

E11.7 Matenda a shuga omwe amadalira insulin omwe amakhala ndi zovuta zingapo

E11.8 Matenda a shuga osadalira insulini omwe ali ndi zovuta zosadziwika

E11.9 Matenda a shuga omwe amadalira insulin popanda zovuta

Matenda a shuga a E12 omwe amagwirizana ndi kuperewera kwa zakudya m'thupi.

Matenda a shuga a E12.0 omwe amagwirizana ndi kuperewera kwa zakudya m'thupi, okhala ndi chikomokere

Matenda a shuga a E12.1 omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi, omwe ali ndi ketoacidosis

Matenda a shuga a E12.2 omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi, ndi kuwonongeka kwa impso

Matenda a shuga a E12.3 omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi, ndi kuwonongeka kwa maso

Matenda a shuga a E12.4 omwe amagwirizana ndi vuto la kuperewera kwa zakudya m'thupi, omwe ali ndi zovuta zamitsempha

Matenda a shuga a E12.5 omwe amagwirizana ndi vuto la kuperewera kwa zakudya m'thupi, omwe ali ndi vuto la kufalikira kwa magazi

Matenda a shuga a E12.6 omwe amayamba chifukwa cha kuperewera kwa zakudya m'thupi, ndi zovuta zina zomwe zidatchulidwa

Matenda a shuga a12.7 omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi, omwe ali ndi zovuta zingapo

Matenda a shuga a E12.8 omwe amaphatikizidwa ndi kuperewera kwa zakudya m'thupi, ndi zovuta zosadziwika

Matenda a shuga a E12.9 omwe amagwirizana ndi kuperewera kwa zakudya m'thupi, popanda zovuta

E13 Mitundu ina ya shuga

E13.0 Mitundu ina yamatenda a shuga omwe amakhala ndi chikomokere

E13.1 Mitundu ina ya shuga ndi ketoacidosis

E13.2 Mitundu ina yodziwika bwino ya shuga ndi kuwonongeka kwa impso

E13.3 Mitundu ina yamatenda a shuga omwe ali ndi vuto la maso

E13.4 Mitundu ina yodziwika bwino ya matenda ashuga komanso kuwonongeka kwa mitsempha

E13.5 Mitundu ina ya shuga yomwe ili ndi zovuta kuzungulira kwaziphuphu

E13.6 Mitundu ina ya shuga ndi zovuta zina zotchulidwa

E13.7 Mitundu ina yamatenda a shuga omwe amakhala ndi zovuta zingapo

E13.8 Mitundu ina yamatenda a shuga omwe ali ndi zovuta zosadziwika

E13.9 Mitundu ina ya matenda ashuga popanda zovuta

E14 SD, yosadziwika

Matenda a shuga a E14.0, osadziwika ndi coma E14.1 shuga, osadziwika ndi ketoacidosis

Zovuta za ENDOCRINOLOGY, 5, 2014 61

Matenda a shuga a E14.2, osadziwika ndi kuwonongeka kwa impso

Matenda a shuga a E14.3, osadziwika ndi kuwonongeka kwa maso

Matenda a shuga a E14.4, osadziwika ndi zovuta zamitsempha

Matenda a shuga a E14.5, osadziwika ndi zotumphukira zamagazi

Matenda a shuga a E14.6, osadziwika ndi zovuta zina zomwe zidatchulidwa

Matenda a shuga a E14.7, osadziwika ndi zovuta zingapo

Matenda a shuga a E14.8, osadziwika ndi zovuta zosadziwika

Matenda a shuga a E14.9, osadziwika popanda zovuta

T2DM - tanthauzo, chithunzi ndi

T2DM imadziwika ndi hyperglycemia motsutsana ndi maziko a insulin yolimbana ndi zovuta zosiyanasiyana. Nthawi zambiri, kukula kwa matenda ashuga amtundu wa 2 kumalumikizidwa ndi komwe kumadziwika kuti metabolic syndrome. Malinga ndi tanthauzo la WHO, wodwala yemwe ali ndi vuto la shuga 2 kapena (wodwala yemwe ali ndi vuto la shuga), wodwalayo amayamba kudwala matenda a metabolic pamaso pazochitika ziwiri mwazotsatirazi: kunenepa kwambiri pamimba, kuthamanga kwa magazi, kuchuluka kwamatenda am'mimba komanso / kapena kuchepa kwa HDL mu plasma, microalbuminuria.

Chithunzi cha chipatala cha T2DM mwa ana ndi achinyamata chimadziwika ndi izi:

- matendawa amakhala ndi mawonekedwe,

- adapezeka ali ndi zaka zopitilira 10 (pafupifupi zaka zaka 13.5) (D),

- kunenepa kwambiri kapena kunenepa kwambiri (85%) ndi khalidwe (C),

- palibe kuyanjana ndi HLA haplotypes omwe amalinganiza za chitukuko cha matenda 1 a shuga,

- zolemba za immunological (autoantibodies ICA, GADa, IA2) sizotsimikizika, kapena mtundu umodzi wokha wotsimikizika, ndi gawo lawo ndilotsika,

- mu milandu 30%, chiwonetsero chachikulu cha ketosis (D),

- chitetezo chokwanira cha insulin ndi hyperinsulinism ndi insulin kukana,

- pafupipafupi mgwirizano ndi zigawo za metabolic syndrome: nephropathy (Micro- kapena macroalbuminuria) - panthawi yodziwitsa, atha kupezeka mu 32% ya milandu (C), ochepa matenda oopsa - mpaka 35% (D), dyslip

Mlingo wa C-peptide, insulin

Care ya Matenda a shuga a ADA, 2000: 23: 381-9

Mkuyu. 1. Kusiyanitsa kodziwika kwa algorithm a shuga kwa achinyamata. 62

Tebulo 5. Zizindikiro za insulin

Kuwerengera kwa Index Index

HOMA-IR (Homeostasis lachitsanzo) (И600.) / 22,5 Sindikutha kupeza zomwe mukufuna? Yeserani ntchito yosankha mabuku.

Matsuda (nthawi ya OGTT) 10,000> 2.5

Zindikirani G - kusala kwambiri kwa glucose, GSr - kuchuluka kwa glucose nthawi ya OGTT, IRI - kusala kudya kwa insulin, IRIS - mulingo wambiri wa insulin panthawi ya OGTT, OGTT - mayeso a shuga a pakamwa.

demy - mpaka 72% (D), matenda osokoneza bongo a mafuta a chiwindi (NAFLD) - steatohepatitis imatha kuchitika mu milandu 30%, matenda ashuga retinopathy (mpaka 9-12%) (D), dongosolo la kutupa - kuchuluka kwa mapuloteni a C-reactive, cyto- Kines ya kutupa ndi leukocytes (D).

Kukana kwa insulini ndikuphwanya kwachilengedwe kwa insulini komanso momwe ma insulini amakhudzira insulin panthawi ya pre-and post-receptor level, zomwe zimapangitsa kuti pakhale kusintha kwakukulu kwa metabolic komanso limodzi ndi chiphuphu cha hyperinsulinemia magawo oyamba.

Kukana kwa insulini kumadziwika ngati chindapusa chimodzi chasinthana ndi chizolowezi (Table 5).

Dongosolo La Mayeso a DM2 Omwe Akukayikira:

1. Kuzindikiritsa za matenda a shuga molingana ndi njira yodziwira matenda (onani tsamba 3).

2. Kudziwitsa kuchuluka kwa immunoreactive insulin (IRI) pamimba yopanda ndi / kapena motsutsana ndi maziko a kuchuluka kwa shuga (ngati kuli kofunikira).

3. Kuwerengera kwa ma indices a insulin kukana - HOMA, Caro ndi Matsuda.

4. Kuzindikira kwa glycated hemoglobin level.

5. Kusanthula kwamwazi mu magazi (ntchito za AlAT ndi ASAT, magawo a HDL, LDL, triglycerides, cholesterol yathunthu, urea, creatinine, uric acid, protein ya C-reactive).

6. Kudziwitsa mwachindunji ma autoantibodies (ICA, GADa, kwa tyrosine phosphatase).

Malinga ndi zotsatira za mayeso, kuwunika kwa T2DM mwa ana ndi achinyamata kwakhazikitsidwa pazotsatira izi:

1. Kuwonongeka kwa matendawa pazaka zopitilira 10.

2. Kuwonjezeka kwa kuthamanga kwa glucose wamagazi opitilira 7.0 mmol / L ndi / kapena nthawi ya OGTT kupitilira maola 11.1 mmol / L pambuyo maola 2 (onani tebulo 3).

3. Mlingo wa hemoglobin wa glycated> 6.5% (D).

4. Mulingo wa insulini uli mkati moyenera kapena wopitilira tanthauzo la kupezeka kwake, kupezeka kwa insulini

kukana f), ndi matenda a zaka zopitilira 2-3 f).

5. Kukhalapo kwa achibale a digiri yoyamba ndi / kapena yachiwiri ya kinshipi ndikuphwanya carbohydrate metabolism (DM, NTG, NGN) f).

6.Kunenepa kwambiri kapena kunenepa kwambiri (kupezeka mu 85% ya milandu) (C).

Ngati wodwala alandila mankhwala a insulin, ndiye kuti chinsinsi chotsalira cha insulin chitha kuwerengedwa ndi kuchuluka kwa C-peptide - chinsinsi cha C-peptide choposa zaka 3 pambuyo poti chiwonetsero cha matendawa sichiri chizolowezi kwa odwala omwe ali ndi matenda a shuga 1.

Njira zowonjezera zowunikira komwe kumatsimikiziridwa kuti muli T2DM:

2. Ultrasound yam'mimba.

3. Ultrasound yamchiberekero zamchiberekero (za kuphwanya mapangidwe a kutha msambo kapena msambo pakati pa atsikana).

4. Kuwunika kwamphamvu kwa kuthamanga kwa magazi (ndi kuchuluka kwa kuthamanga kwa magazi oposa 90% o).

5. Kuyang'ana kwa akatswiri: Optometrist, neurologist, cardiologist, malinga ndi zofunikira), genetics (malingana ndi zidziwitso).

Njira Zosamalira Odwala Odalirika

Kuwongolera wodwala pamaziko a kunja

1. Kuyendera ndi endocrinologist - 1 nthawi m'miyezi itatu.

2. Kuzindikira kwa glycated hemoglobin - 1 nthawi m'miyezi itatu.

3. Kuyang'anira shuga wamagazi - kutsimikiza kusala kudya ndi shuga m'magazi a f). Mu matenda owopsa kapena okhala ndi hyper- and hypoglycemia, tanthauzo la f) limasonyezedwa. Odwala pa insulin mankhwala kapena mankhwala a sulphanilurea kukonzekera amafunika kuwunika asymptomatic hypoglycemia f).

4. Kuyesedwa kwa magazi pafupipafupi - kamodzi pa miyezi 6.

5. Kusanthula kwamkodzo mkodzo - 1 nthawi m'miyezi 6.

6. Kuyesa kwa magazi a biochemical - kamodzi pachaka (ntchito za AlAT ndi AsAT, cholesterol yathunthu, LDL, triglycerides, protein-C yogwira, uric acid).

7. Kudziwitsa microalbuminuria mu 3 servings mkodzo - 1 nthawi pachaka.

8. Kuyang'anira magazi - paulendo uliwonse wopita kwa dokotala.

9. Ultrasound yamimba yam'mimba - 1 nthawi pachaka.

10. Kuonana ndi ophthalmologist, neurologist - 1 nthawi pachaka.

11. Kugonekedwa pachipatala - kamodzi pachaka, kuwonjezereka kwa zizindikiro za matenda ashuga (polyuria, polydipsia), ndi / kapena kuchuluka kwa hemoglobin wa glycated oposa 7.0% - kuchipatala kosakhazikika.

Kusamalira ana

Ku chipatala, kuyesedwa kowonjezereka kumachitika:

2. Ultrasound yam'mimba.

3. Ultrasound yamchiberekero zamkati (malinga ndi mawonekedwe).

4. Kuwunikira kwamphamvu kwa kuthamanga kwa magazi (malinga ndi zisonyezo).

5. MRI (malinga ndi zomwe zikuwonetsa).

6. Kuyang'ana kwa akatswiri - Optometrist, neurologist, gynecologist (malinga ndi zidziwitso), genetics (malinga ndi zidziwitso).

Mankhwala othandizira odwala omwe ali ndi matenda amtundu wa 2

Mankhwala oyambira amatsimikiziridwa ndi zizindikiro za matenda, kuopsa kwa hyperglycemia, komanso kupezeka kapena kusowa kwa ketosis / ketoacidosis. Monga T1DM, pamaso pa zizindikiro, makamaka kusanza, vutoli limatha kufulumira (D), chifukwa chake, woyamba kupatsidwa mankhwala ndi insulin (A). Pakakhala zizindikiro zazikulu, mankhwalawa amasankhidwa ndi metformin (D). Mlingo woyambirira ndi 250 mg / tsiku kwa masiku atatu, ndi kulolerana kwabwino, mlingo umakulitsidwa 250 mg 2 pa tsiku, ngati kuli kotheka, titration ya mlingo imachitika kwa masiku 3-4 mpaka mlingo waukulu utafika - 1000 mg kawiri pa tsiku.

Kusamutsa kuchokera ku insulin kupita ku metformin nthawi zambiri kumatha kuchitika mkati mwa masiku 7 mpaka 14, kuyambira kuyambira nthawi yomwe kukhazikika kwa metabolic kumachitika - nthawi zambiri pakatha masabata 1-2 atazindikira kuti ali ndi vuto. Pakukula kulikonse kwa mankhwala a metformin, mlingo wa insulin umachepetsedwa ndi 10-20% (D).

Pambuyo pakutha kwa mankhwala a insulin, pafupipafupi kudziwa kuchuluka kwa shuga m'magazi kumatha kuchepetsedwa mpaka 2 pa tsiku - pamimba yopanda kanthu komanso maola awiri atatha kudya komaliza (D).

Zolinga zakuchiritsa kwakanthawi ndi izi:

- kuchepa thupi,

- kukonza kuthekera kwa kulekerera zolimbitsa thupi,

- kusintha kwa shuga m'magazi, kukhathamiritsa hemoglobin wochepera 7.0%,

- Kuwongolera matenda ophatikizika, kuphatikizapo matenda oopsa, kukanika, nephropathy ndi hepatosis.

Ntchito yofunikira pakuchiza T2DM imaseweredwa ndimaphunziro a wodwala ndi banja lake. Iyenera kuyang'ana pakusintha kwamachitidwe (zakudya ndi zochita zolimbitsa thupi).Wodwala ndi banja lake ayenera kuphunzitsidwa kuyang'anira kuchuluka kwa zakudya zomwe zimadyedwa, kudya moyenera komanso machitidwe olimbitsa thupi. Zotsatira zabwino kwambiri zimapezeka mukaphunzitsidwa ndi gulu la akatswiri, kuphatikizapo wathanzi komanso wama psychologist.

Njira Zamakhalidwe

Mankhwala othandizira pakudya ndi ofunika: kuchepetsa kuchuluka kwa zakudya zopezeka tsiku ndi tsiku ndi 500 kcal, kuletsa kudya mafuta, makamaka kuchuluka, komanso kugaya chakudya mosavuta (zakumwa za shuga, chakudya chofulumira), kuchuluka kwa fiber, masamba, ndi zipatso m'zakudya. M'pofunika mosamalitsa kudya.

Zochita zolimbitsa thupi ziyenera kukhala zosachepera mphindi 50-60 patsiku, muyenera kuchepetsa kuwonera mapulogalamu a pa TV ndi makalasi pakompyuta kwa maola awiri patsiku.

Pharmacotherapy amalembedwa ngati sizikanatheka kukwaniritsa zomwe mukufuna mwa masinthidwe a moyo.

Biguanides. Metformin imagwira zolandirira insulin mu chiwindi, minofu ndi adipose minofu; zotsatira zake zimatchulidwa kwambiri m'chiwindi. Choyambirira cha anorectic chingalimbitse thupi. Kugwiritsa ntchito nthawi yayitali kumalumikizidwa ndi kuchepa kwa 1% ya hemoglobin ya glycated. Metformin imatha kuthetsa vuto losakhazikika kwa ovuta mu atsikana omwe ali ndi PCOS ndikuwonjezera mwayi wokhala ndi pakati (A).

Zotsatira zoyipa zomwe zingachitike kuchokera m'matumbo amtumbo (kupweteka kwam'mimba, kutsegula m'mimba, mseru). Nthawi zambiri, amatha kupewedwa pang'onopang'ono popereka mankhwalawa kwa milungu itatu ndikutsatira malangizo omwe amamwa mankhwala akudya.

Chiwopsezo chokhala ndi lactic acidosis yokhala ndi metformin yotsika kwambiri. Metformin sayenera kulembedwa kwa odwala omwe ali ndi vuto la impso, matenda a chiwindi, mtima kapena mapapo, kapena munthawi yomweyo ndi mankhwala a radiopaque. Kwa matenda am'mimba, metformin iyenera kuyimitsidwa kwakanthawi (A).

Insulin Ngati mukumwa mankhwalawa pogwiritsa ntchito mankhwala ochepetsa shuga m'mlomo ndizovuta kukwaniritsa chiwonetsero chokwanira cha glycemic, kuikidwa kwa insulin analogue osakhalitsa popanda zotsatira zoyipa kungakupatseni zokhutiritsa.

Zovuta za ENDOCRINOLOGY, 5, 2014

Glucose (HA)> 12.5 ID1c> 9% kapena ketosis kapena _ ketoacidosis_

HA musanadye 4.5-6.5 Postprandial nsonga HA 6.5 / 9.0> (ID1c> 7%

Kuganizira za mankhwala ena: kukonzekera kwa sulfonylurea

insulin glargine yokha kapena kuphatikiza ndi insulin yochepa

Kuvomerezana! BRD0, 2009

Mkuyu. 2. Njira ya mankhwala a ana ndi achinyamata omwe ali ndi matenda a shuga a 2.

Mkuyu. 3. Njira yolumikizira chithandizo cha matenda amtundu wa 2 ana.

kuchuluka kwa mankhwala popanda kufunika kwa mankhwala a insulin omwe amagwiritsidwa ntchito ndi zakudya (prandial insulin). Mankhwala a Metformin ayenera kupitilizidwa. Ngati postprandial hyperglycemia ikupitilira, insulin yocheperako imatha kuwonjezeredwa ku regimen yothandizira.

Zotsatira zoyipa za insulin zimaphatikizapo hypoglycemia, zomwe ndizosowa mu mtundu 2 shuga ndi insulin mankhwala, komanso kuwonda.

Dyslipidemia, ochepa matenda oopsa, ndi albuminuria yokhala ndi T2DM ndizofala kwambiri kuposa T1DM, atha kupezeka kale atapezeka kuti akuwunika ndipo amayenera kuwunika pambuyo poti awongolere kuchuluka kwa shuga m'magazi.

Matenda oopsa a arterial ndi albuminuria

Ndi a arterial hypertension (BP> 95th percentile) kapena kukhalapo kwa albuminuria, zoletsa za ACE zimathandizidwa kapena, ngati zingakhale zovuta, angiotensin f receptor blockers.

Ngati mumachepetsa kuthamanga kwa magazi ndi / kapena kuchepetsa albuminuria munthawi ya mankhwala pogwiritsa ntchito mankhwala amodzi

parata sipambana; kuphatikiza chithandizo kungafunike f).

Zotsatira zoyipa za ACE zoletsa zimaphatikizapo chifuwa, hyperkalemia, kupweteka kwa mutu, ndi kusabala.

Kuyesa kwa dyslipidemia kuyenera kuchitika posakhalitsa atazindikira, ngati nkotheka kukwaniritsa kuwongolera kwamagazi a glucose, kenako pachaka f). Zigawo za LDL zomwe zikulephera ndizosachepera 2.6 mmol / L.

Ndi mzere wamalire (2.6-3.4 mmol / L) kapena wokwezeka LDL (> 3.4 mmol / L), mbiri ya lipid imayang'anidwanso pambuyo pa miyezi 6 ndipo chakudyacho chimasinthidwa kuti chichepetse kuchuluka kwathunthu komanso mafuta okwanira.

Ngati misempha ya LDL ikhalabe yokwezeka kwa miyezi itatu mpaka itatu poyesa kukhathamiritsa, chithandizo cha mankhwala ndizotheka. Mankhwala a Statin ndi otetezeka komanso ogwira ntchito kwa ana, ngakhale pakadali pano palibe chidziwitso chokhudza chitetezo chamtundu wautali (ma statin adayikidwa pambuyo pofunsana ndi a mtima).

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60. Kuwongolera kwambiri kwa shuga m'magazi ndi sulphonylureas kapena insulini poyerekeza ndi chithandizo chamwadzidzidzi komanso chiwopsezo cha zovuta za odwala omwe ali ndi matenda a shuga 2 (UKPDS 33). Kanyumba. 1998,352 (9131): 837-853. doi: 10.1016 / s0140-6736 (98) 07019-6

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Hyperglycemia: zoyambitsa ndi zizindikiro

The etiology ya matendawa imasiyana kutengera mtundu wa matenda.

Matenda a 2 a shuga amayamba chifukwa cha izi:

chibadwa
osiyanasiyana kunenepa,
mimba yoyambirira
kumangokhala
mavuto azakudya
kumwa mankhwala okhala ndi mahomoni
kutha msinkhu
matenda a endocrine.

Nthawi zambiri, hyperglycemia ndi chiwonetsero cha kuwonongeka kwa matenda ashuga. Kukula mwadzidzidzi kwa shuga kungayambitse vuto la paroxysmal momwe munthu angafunikire chithandizo chodzidzimutsa.

Zoyambitsa Hyperglycemia

Mwa munthu wathanzi, hyperglycemia popanda chifukwa chachilendo nthawi zambiri imakhala chizindikiro cha kusokonezeka kwa metabolic ndipo imawonetsa ngati chitukuko cha matenda osokoneza bongo kapena chiwonetsero cha matenda awa.

Kuwonjezeka kwakukulu kwa shuga m'magayidwe ashuga kumayambika chifukwa chosowa insulini, mahomoni a kapamba. Insulin imachepetsa (inhibits) kayendedwe ka glucose pama cell membrane, ndipo zomwe zili ndi shuga wamagazi m'magazi zimakwera.

Ndi matenda a shuga 1 amtundu wa kapamba, kapamba samatulutsa insulini mokwanira, komanso matenda amtundu wa 2, insulini ikhoza kukhala yokwanira, koma zimachitika kuti thupi limakumana ndi mahomoni - kukana kukhalapo kwake. Matenda onsewa amayambitsa kuwonjezeka kwa mamolekyulu am'magazi m'magazi ndipo amayambitsa mawonekedwe.

Zizindikiro za matenda ashuga mwa ana

Matendawa matenda a shuga amakhalanso akuwonekera ali ana ndipo amakhala achiwiri pafupipafupi pakati pa matenda apakati pa ana.

Izi zobadwa nazo komanso zosachiritsika zam'mimba zimayambika chifukwa cha kukanika kwa metabolism ndipo zimadziwika ndi kuwonjezeka kwa kuchuluka kwa shuga m'madzi a m'magazi.

Thanzi la wodwala pang'ono komanso mwayi wokhala ndi zovuta zazikulu zimadalira kuzindikira kwakanthawi ndi chithandizo.

Mosiyana ndi zomwe ambiri amakhulupirira, matenda a shuga amawopseza osati okhawo omwe atha kuthana ndi msinkhu wina ndipo, kuphatikiza apo, akuvutika ndi kunenepa kwambiri, koma ngakhale ana. Chifukwa chake, ndikofunikira kuyang'anira thanzi la makanda anu ndikudziwa momwe zizindikiro zoyambirira za matenda ashuga mwa ana zimawonekera.

Zomwe zimayambitsa matendawa

Ngati timalankhula za ana, ndiye kuti amapezeka ndi matenda ashuga amtundu woyamba. Ndizofunikira kudziwa kuti nthawi zambiri amayamba kutenga matenda opatsirana mwa ana omwe ali ndi chibadwa chakukula kwa matendawa.

Ngati m'modzi mwa makolo ali ndi matenda a shuga, ndiye kuti mwana ayenera kuthandizidwa mosamala kwambiri. Koma nthawi yomweyo, simuyenera kuyesetsa kumuteteza kuzinthu zonse zokhumudwitsa: ndikokwanira kudziwa chizindikiro choyamba, kukumbukira chomwe chimayambitsa matendawa, kuyang'anira mwana mosamala ndikupereka magazi nthawi ndi nthawi kuti ayang'ane kuchuluka kwa shuga.

Ngati mayi wa mwana adadwala matenda a shuga, ndiye kuti ma cell ake a pancreatic amakhala ndi chidwi ndi zovuta za ma virus angapo, kuphatikizapo rubella, herpes, chikuku, ndi mumps. Iliyonse mwa matendawa imatha kudzetsa chitukuko cha matenda ashuga.

Zakudya za ana omwe amayi awo amadwala matendawa amafunika kuyang'aniridwa mosamala. Osachepera chaka, ana awa ayenera kudyetsedwa mkaka wa m'mawere kuti asagwidwe ndi mapuloteni a ng'ombe, omwe amapezeka muzosakaniza.

Ndikofunikanso kuwunika momwe ana amalemera, kuwawonjezera mtima, kukulitsa chitetezo chokwanira, komanso kupewa kupsinjika ngati kuli kotheka.

Zizindikiro zowopsa

Koma ngakhale kukhazikitsidwa kwa malingaliro onse nthawi zina sikutsimikizira kuti mwana amakhalabe wathanzi. Chifukwa chake, kuwonjezera pa njira zodzitetezera, ndikofunikira kuwunika kusintha pang'ono kwa khalidweli komanso kudziwa momwe mungazindikire kuyambuka kwa matendawa.

Izi zikuthandizira kuzindikira vutoli papulogalamu pomwe mwana adzangoyimitsa shuga. Izi zitha kutenga mwana nthawi yoyang'aniridwa ndi achipatala, kumuthandiza kupewa komanso kupewa matenda a shuga.

Makolo ayenera kukhala atcheru ndi zizindikiro izi:

kuchuluka kwa ludzu kwa mwana popanda chifukwa,
kukodza kwambiri,
kuwonda kwambiri zinyenyeswazi, mwana m'milungu yochepa chabe amatha kutaya 10 kg.

Nthawi yomweyo, kuchuluka kwa zakumwa zoledzeretsa ndizodabwitsa kwambiri, ndikamakula kwambiri, ndipo mwana amatha kuyamba kumwa malita angapo a madzi patsiku. Nthawi zambiri ana azaka zopitilira 5 amayamba kukodza usiku, ngakhale izi zisanachitike.

Ngati mwana adayamba kumwa zochulukirapo, koma mukukayika, ndiye kuti muthawire kutaya zizindikiro zosadziwika. Izi zimaphatikizapo khungu louma komanso zimagwira mucous, pomwe lilime limapakidwa utoto wa rasipiberi, ndipo khungu limachepa.

Ndikofunikira kumvetsetsa mu nthawi yomwe khanda liyenera kuyesedwa. Inde, pamakhala zochitika zina pafupipafupi pomwe makolo sanayang'ane kwambiri pazizindikiro, chifukwa chake, ana adagonekedwa m'chipatala ovulala kwambiri.

Mankhwalawa amayamba, matendawo amapitilira ndipo amapezeka kuti ali ndi vuto lalikulu kwambiri.

Chithunzi chotheka cha chipatala

Koma nthawi zina, matenda amtunduwu amayamba ndi zizindikiro zina. Mwana akapanda kukhala ndi hypoglycemia, vuto lomwe shuga ya magazi limatsika kwambiri, ndiye kuti amakhalanso ndi zina.

Mwanayo azidzadandaula chifukwa chotopa, kufooka, kudzakhala kuwawa komanso kuziziritsa, manja ake adzagwedezeka. Kulakalaka kwambiri kwa maswiti, kutsekemera kwa khungu kumasonyezanso kuyambika kwa matendawa.

Mwa ena, matenda ashuga amayamba kubisika. Zikondazo zimachepetsa kupanga insulini pang'onopang'ono, zomwe zimapangitsa kuti shuga azikhala pang'ono m'magazi a mwana.

Chithunzi cha chipatala pamenepa ndi chosavomerezeka, chifukwa mwana nthawi zambiri samamva kuyambika kwa matendawa. Chizindikiro chosadziwika cha matenda ashuga chikhoza kukhala khungu la mwana.

Mutha kukayikira kuti china chake sichinali bwino ndi ma abscesses, zilonda, kapena matenda ena oyamba ndi mafangasi. Umboni wa njira yobisika ya matenda a shuga ungathenso kukhala stomatitis, yovuta kupweteka, totupa pa mucous membrane, kuphatikizira kumaliseche kwa atsikana.

Chifukwa chakuti matenda ashuga ndi matenda obadwa nawo (nthawi zambiri), makolo ambiri omwe ali ndi matenda otere nthawi yomweyo amafuna kudziwa ngati nthendayi yoyipa idaperekedwa kwa mwana wawo, ndipo kale m'masiku oyamba amoyo, zinyenyeswazi zimayamba kuyang'ana zizindikiro za matenda a shuga mu ana.

Zizindikiro za shuga kwa mwana mpaka chaka
Matenda a shuga ndi ana
Zizindikiro za matenda ashuga mwa ana ochepera zaka 5
Kodi ndi zizindikiro ziti zopereka mwana mwachangu kwa dokotala?
Momwe mungadziwire matenda a shuga?

Ena, m'malo mwake, amadzichepetsera pazifukwa zosamveka, kuti asangoyenda ndi mwana kuti amukaye. Kodi zizindikiro za matenda a shuga kwa mwana ndi ziti, ndi momwe mungadziwire matenda amisempha? Tikambirana izi mopitilira.

Zizindikiro za shuga kwa mwana mpaka chaka

Ngati ndizosavuta ndi ana okulirapo, ndiye kuti mungadziwe bwanji matenda omwe ali m'mwana wochepera wazaka chimodzi? Izi ndi zina mwazizindikiro kwambiri za matenda ashuga mwa ana aang'ono:

Zakudya zamafuta ambiri, pakamwa pouma pakadali pomwepo,
kuwonda mwadzidzidzi ndi chakudya chokhazikika,
mawonekedwe a pustules pakhungu - mikono, miyendo, nthawi zina thupi. Khungu limakhala louma,
Kusintha kwa mkodzo kuti kuwala. Ndikulimbikitsidwa kuti mumayeso a mkodzo mwachangu,
kusala kudya kwa magazi. Alamu yachilendo.

Matenda a shuga ndi ana

Ndikofunikira kwambiri kuyang'anira ana mpaka chaka chimodzi, popeza nthawi yobala mwaiyo imatenga nthawi yayitali, pambuyo pake matendawa amathanso kukhala oopsa. Monga lamulo, ana amakula ndi shuga yemwe amadalira matenda a shuga, ndiye kuti, mtundu 1.

Makolo omwe akudwala matendawa amayenera kuwunika ana awo mosamala kuti adziwe kukula kwa matendawa munthawi ndikuyamba chithandizo.

Simungakhale ndi chiyembekezo. Izi zimabweretsa zovuta zazikulu, chithandizo chachitali komanso chovuta kwambiri.

Mwana akadzakwanitsa zaka zitatu kapena kuchepera, mayi aliyense wosamala amamuwulula za matenda ake osawerengeka popanda mawu osafunikira komanso zodandaula. Chizindikiro chimodzi chodziwikiratu, cha chochitika chakuthupi ndi madontho omatira a mkodzo pamphika kapena pachimbudzi cha chimbudzi.

Momwe mungapewere matenda a shuga: mutetezeni amayi ndi abambo ku matendawa

Ziribe kanthu momwe mankhwala apitira, matenda osachiritsika akadalipo. Pakati pawo pali shuga. Malinga ndi ziwerengero, pafupifupi anthu 55 miliyoni padziko lonse lapansi akudwala matendawa. Ngati titha kukumbukira odwala ambiri omwe ali ndi mtundu wina wa matenda ashuga, ndiye kuti kuchuluka kwawo kudzachulukanso ndi 10 miliyoni.

Anthu omwe ali ndi matendawa amatha kukhala moyo wawo wonse. Komabe, kuyang'anira zakudya ndi glucose kosalekeza sikuwonjezera moyo wachimwemwe. Pofuna kupewa zovuta zina, muyenera kudziwa momwe mungapewerere matenda ashuga.

Munthu ayenera kusankha payekha kuti akufuna kumenyera nkhondo moyo wake kapena kuisiya yokha, osaganizira zamawa. Wodwala wodwala matenda a shuga ayenera kukonzekera zoletsa zina, koma izi zithandiza kukhala ndi thanzi lake lomwelo komanso kupewa zovuta za matendawa.

Type 2 matenda a shuga: kuzindikira ndi kuchiza

Association of General Practitioners (Family Madokotala) a Russian Federation

DIAGNOSIS, KUTHENGA NDI KULENGA

POPHUNZITSIRA MITUNDU YA ASILI

Madivelopa: R.A. Nadeeva

2. Makhodi malinga ndi ICD-10

3. Epidemiology ya matenda ashuga a 2

4. Zinthu ndi magulu omwe ali pachiwopsezo

5. Kusanthula mtundu 2 shuga

6. Gulu la anthu odwala matenda ashuga. Zofunikira pakapangidwe kazomwe zimayambitsa matenda ashuga.

7. Mfundo zofunika kuzindikiritsa matenda akulu muzochitika. Kusiyanitsa mitundu.

8. Njira zoyesera kuti adziwe matenda oyamba

9. Kugawika kwa zovuta za matenda ashuga.

10. Mfundo zazikuluzikulu za chithandizo chamankhwala

10.1. Algorithm yosankha payekha zolinga za HbA1c

10.2. Zizindikiro za lipid metabolism control

10.3. Kuyang'anira Kuthamanga Kwa Magazi

10.4. Kusintha kwamoyo

10.5. Mankhwala

10.6. Kukonzekera kwa njira zamankhwala kutengera HbA1c yoyambirira

10.7. Mankhwala a insulin a matenda a shuga 2.

10.8. Zida zamankhwala a matenda a shuga a 2 pakukalamba.

10.9. Zokhudza chithandizo cha matenda amishuga amtundu wa 2 mwa ana ndi achinyamata.

10.10. Zida zamankhwala a shuga 2 amayi oyembekezera.

11. Zizindikiro za upangiri waukadaulo

12. Zizindikiro zakuchipatala

13. Kupewa. Maphunziro odwala

15. Kuyang'anira odwala omwe ali ndi matenda a shuga a 2 popanda zovuta

AH - matenda oopsa

aGPP-1- glucagon-ngati peptide agonists 1

HELL - kuthamanga kwa magazi

GDM - matenda a shuga

DKA - matenda ashuga ketoacidosis

DR - matenda a shuga a retinopathy

IDDP-4 - dipeptyl peptidase inhibitors

ICD - yochepa-insulin (kopitilira muyeso) insulin

BMI - index yam'mimba

IPD - kanthu ka insulin (yayitali)

NGN - kuphwanya glycemia

NTG - kulolerana kwa shuga

PGTT - mayeso a kulolera glucose

PSSP - mankhwala amkamwa a hypoglycemic

RAE - Russian Association of Endocrinologists

MSP - mankhwala ochepetsa shuga

TZD - thiazolidinediones (glitazones)

FA - zolimbitsa thupi

CKD - matenda a impso

XE - mkate mkate

HLVP - kwambiri kachulukidwe lipoprotein cholesterol

HLNP - otsika kachulukidwe lipoprotein cholesterol

HbA1c - hemoglobin wa glycosylated

Matenda a shuga mellitus (DM) ndi gulu la matenda a metabolic (metabolic) omwe amadziwika ndi matenda a hyperglycemia, omwe amachitika chifukwa cha kubisala kwa insulin, zotsatira za insulin, kapena zina mwazinthu izi. Matenda oopsa a hyperglycemia mu shuga amaphatikizidwa ndi kuwonongeka, kusagwira ntchito komanso kusakwanira kwa ziwalo zosiyanasiyana, makamaka maso, impso, mitsempha, mtima ndi mitsempha yamagazi.

E10 wodwala matenda a shuga a insulin

E11 Matenda a shuga osadalira insulin

E12 Matenda a shuga

E13 Mitundu ina yachilendo ya matenda a shuga

E14 Matenda a shuga, osadziwika

Matenda a shuga a O24

R73 glucose wambiri

(zimaphatikizira kulekerera kwa glucose ndi kusala kudya kwa glucose)

3. Epidemiology ya matenda ashuga a 2.

Pazonse zomwe zimapangidwira shuga, mtundu 2 shuga ndi 90-95%. Pazaka 30 zapitazi, kuchuluka kwa anthu odwala matenda ashuga kwaturukira matenda opatsirana monga chifuwa chachikulu komanso kachilombo ka HIV.

Chiwerengero cha odwala matenda ashuga padziko lonse lapansi pazaka 10 zapitazi chachulukirapo kuposa pamenepo ndipo afikira anthu 371 miliyoni pofika chaka cha 2013. Kukula kwachulukidweko kudapangitsa United Nations mu Disembala 2006 kukhazikitsa lingaliro lopempha "kukhazikitsidwa kwa mapulogalamu amtundu woletsa, kuchiza komanso kupewa matenda ashuga komanso zovuta zake komanso kuphatikizidwa kwawo m'mapulogalamu azaumoyo aboma."

Malinga ndi State Register of Patients ndi matenda a shuga kuyambira Januware 2013 ku Russia, kuli odwala 3.779 miliyoni omwe ali ndi matenda a shuga pankhani yofikira kuzipatala. Komabe, kuchuluka kwakeko kumakhala kokwirikiza 3-4 kuposa kolembetsa “mozungulira”. Omwe ali pafupifupi 7% ya anthu. M'madera ambiri ku Europe, kuchuluka kwa matenda ashuga a 2 ndi 3-8% (palimodzi ndi kulekerera kwa glucose - 10-15%).

Zotsatira zowopsa za mliri wapadziko lonse wa anthu odwala matenda ashuga ndizovuta zake zamitsempha - nephropathy, retinopathy, kuwonongeka kwa ziwiya zikuluzikulu za mtima, bongo, zotumphukira zamagawo am'munsi. Izi ndi zovuta zomwe ndizomwe zimayambitsa kupunduka komanso kufa kwa odwala omwe ali ndi matenda ashuga.

4. Zinthu ndi magulu omwe ali pachiwopsezo.

Zomwe zimayambitsa matenda a shuga a 2

- Kunenepa kwambiri komanso kunenepa kwambiri (BMI≥25 kg / m2 *).

- Mbiri ya mabanja a matenda ashuga (makolo kapena abale ake omwe ali ndi matenda ashuga a 2)

-Mwadzidzidzi kuchita masewera olimbitsa thupi.

- Kuthamanga kwamatumbo glycemia kapena mbiri yovuta ya kulolera kwa shuga.

-Gestationalabetes mellitus kapena kubadwa kwa mwana wosabadwa m'mbiri.

-Arterial Hypertension (≥140 / 90 mm Hg kapena mankhwala a antihypertensive).

- HDL cholesterol ≤0.9 mmol / L ndi / kapena triglyceride level ≥2.82 mmol / L.

Njira yoyamwitsa ndiyofunika kwambiri m'magawo oyamba azindikira matenda a shuga kwa ana.

Matenda a shuga a Mtundu 2 masiku ano akukhudza anthu ochulukirachulukira. Chilichonse chokhudza matenda a shuga a 2 chikuyamba kale kudziwika kuchokera manyuzipepala, pa wailesi yakanema, pa intaneti.

Matendawa amadziwika osati kokha ndi kuphwanya kagayidwe kazakudya, monga nzika zambiri zimakhulupirira, komanso mwa kupatuka kwa mitundu ina ya kagayidwe: mafuta, protein, ndi vitamini. Akatswiri ambiri ofufuza za matenda am'mimba amati mtundu wa shuga wachiwiri ndi mtundu 1 wodwala matenda obwera chifukwa cha shuga.

Nkhaniyi imanena za matenda ashuga: Zizindikiro, zoyambitsa, zovuta za matenda a shuga (chiyani), mankhwala a matenda a shuga a 2, mawonekedwe a mankhwala.

Kodi shuga ndi chiyani?

Kuchokera kwa odwala, endocrinologist ku phwando nthawi zambiri amamva: "Ndili ndi matenda ashuga a 2." Koma si aliyense amene amamvetsa zomwe zimayambitsa metabolism iyi.

Matenda a diabetes a endocrinopathies a mitundu yonseyi amaphatikizidwa kuti matenda amtundu wa metabolic amawonongeka. Insulin pakukula kwa kusintha kwa pathological ndi chifanizo chachikulu.

Pokhapokha poyamba, chifukwa cha kuwonongeka kwa maselo a kapamba (islets of Langerhans) ndi njira ya autoimmune kapena ndi omwe akutenga matenda, kupangika kwa timadzi timeneti kumasokoneza. Nthawi yomweyo, kumwa kwa glucose - gawo lalikulu lamphamvu - mwa ma cell a ziwalo ndi minofu imasokonekera, chifukwa ma insulin a michere amafunika kugwiritsa ntchito michere iyi kuchokera m'magazi.

Mtundu wachiwiri wa matenda ashuga: matendawo ndi chiyani, ndipo pali kusiyana kwakukulu kotani kwa matenda amtundu woyamba? Mosiyana ndi matenda amtundu wa shuga 1, pakadali pano, chidwi cha insulin chomwe chimapangitsa chidwi ndi insulin chimatha, chifukwa chake, izi zimachitika chifukwa cha matenda a receptor.

Izi zimadziwika mu kuwonjezeka kwa glucose m'magazi ndi zinthu zina zachilengedwe: hyperglycemia (kuthamanga kwa magazi), glucosuria (kukhalapo kwa shuga mkodzo).

Kuwonjezeka kwa zinthu izi m'madutsanso kumayambitsa kukhathamiritsa kwa glucose. Ichi ndi katundu chomwe chimawonetsedwa ndikupanga makatoni, neuropathy, angiopathy ndi zovuta zina zowopsa.

Gulu la odwala matenda ashuga

Chapakati
Banja
Autosomal great (vasopressin prepro-AVP2 gene kusintha kusintha kwa genro-arginine gene)
Autosomal recessive (Tungsten syndrome matenda ashuga insipidus, shuga mellitus, kuwala kwa maso, ugonthi)
zolakwika anatomical cha m'mimba (septooptic dysplasia, holoprosencephaly)
Walandidwa
zoopsa (mutu zoopsa, kulowererapo kwa mitsempha)
zotupa (craniopharyngioma, germinoma, glioma, metastases zam'mimba zosiyanasiyana)
granulomatous zotupa za chapakati mantha dongosolo (chifuwa chachikulu, sarcoidosis, hertiocytosis X, zamitsempha yamagazi pituitary)
matenda a encephalitis, meningitis, chapakati mantha dongosolo
kuwonongeka kwamitsempha (hemorrhage, hypoxia, sickle cell anemia)
Nephrogenic
Banja
recessive X yolumikizidwa (vasopressin arginine V2 cholandilira gene)
genosos recessive (genaporin-2AQP2 gene)
Walandidwa
metabolic (hypokalemia, hypercalcemia)
aakulu aimpso kulephera
osmotic (shuga mellitus)
nephrocalcinosis
kwamikodzo thirakiti
matenda a impso a polycystic
Polydipsia yoyamba
psychogenic - kukakamiza kwamadzi kwakumwa
Dipsogenic - kutsitsa pakhomo la osmoreceptors chifukwa cha ludzu

Mawonetseredwe azachipatala ndi zizindikiro zake

Zizindikiro zazikulu za ND ndizopitilira polyuria ndi polydipsia (onani njira za polyuria pamwambapa). Palibe nocturnal polyuria (yomwe nthawi zina imawonedwa ngati mawonetseredwe a enuresis), osakwanira kubwezeretsanso kuchepa kwa madzimadzi, khungu lowuma komanso mucous nembanemba.

Mwa ana ang'onoang'ono, madzi am'mimba amatha, kusanza kumachitika pakudya, kudzimbidwa, kutentha thupi, kusokonezeka kwa kugona, kusokonekera, kunenepa kwambiri komanso kunenepa kwambiri.

Ngati chitukuko cha ND chikuchitika chifukwa cha chotupa cha intracerebral (germinoma, craniopharyngioma, glioma, ndi zina), odwala nthawi zambiri amakhala ndi vuto la mitsempha (mutu, ptosis, strabismus, kusowa kwamphamvu kwa zina, ndi zina zotere), kusokonezeka kowoneka (kuchepa mphamvu ndi / kapena kutayika kwa magawo owoneka, diplopia), Zizindikiro zomwe zimakhudzana ndi kutayika kapena kuchepa kwa mahomoni ena a adenohypophysis.

Mbiri yazachipatala

Zaka za kuyambika kwa polydipsia ndi polyuria, komanso chikhalidwe chamadzi akumwa ndizofunika kwambiri pakufufuzanso kwazidziwitso.

Mu matenda am'mapapo ochepa, matendawa nthawi zambiri amawonekera pakati pa zaka 1 mpaka 6. Zizindikiro zimawonjezeka m'zaka zoyambirira zamatenda.

Ndi Tungsten syndrome, matenda a shuga a insipidus muzochitika zambiri zimadziwonekera patatha zaka 10, Kukula kwake kumayendetsedwa ndi chitukuko cha matenda osokoneza bongo a mellitus ndi optic atrophy.

Chikhalidwe chamadzi akumwa

Ndi matenda a shuga a insipidus, odwala amakonda kumwa madzi ozizira osakhala ndi kaboni; kwa odwala omwe ali ndi matenda a shuga, kupuma kwakanthawi kochepa kwamadzi sikungatheke (mwana amafunika madzi aliwonse mphindi 15-30), mosasamala kanthu za kuchuluka kwa ntchito kapena kulakalaka chinthu (kusewera, kuwerenga kusukulu, kuonera TV etc.).

Ngati pali zodandaula zoyenera komanso mawonetseredwe azachipatala, gawo lotsatira lazotsatira za insipidus ya shuga limachitika.

Ndikofunikira kutsimikizira kukhalapo kwa polyuria, chifukwa chaichi kusanthula mkodzo tsiku ndi tsiku komanso / kapena kusanthula kwamkodzo malinga ndi Zimnitsky kumachitika motsimikiza kuchuluka kwake kokwanira komanso osmolality / kachulukidwe ka abale m'magawo, nthawi yomweyo kuchuluka kwa madzimadzi okumwa tsiku lililonse amawerengedwa (kuwunika kukwana kwa kuchuluka kwa madzi)
Dziwani zam'madzi am'magazi
Mu mayeso a biochemical magazi
Sodium (kuphatikizira kuzindikira ma contraindication kuyezetsa ndi kudya kowuma kapena ngati sizingatheke kudziwa kusowa kwa magazi m'magazi), glucose, chlorine, urea, creatinine - kupatula osmotic diuresis
Calcium yonse ndi ionized, potaziyamu, mapuloteni - kupatula zomwe zimayambitsa matenda a nephrogenic shuga insipidus (hypercalcemia, hypokalemia, obstopathy uropathy).

Kupitilira apo, pakuwunika kusiyanitsa pakati pa matenda a shuga ndi polydipsia yoyamba, kuyesedwa kouma kumachitika. Zikuwonetsedwa ngati:

pali hypoosmotic polyuria (osmolality mkodzo wochepera 295 mOsm / kg H2O ndi / kapena kusowa kwa mkodzo wochepera 1005 m'magawo onse a kusanthula kwa Zimnitsky),
mulingo wa sodium plasma wosaposa 143 mmol / l,
ngati osmolality wamagazi ndiwokwera kuposa osmolality wa mkodzo.

Zofunika!
Ngati mulingo wa sodium upambana 143 mmol / l, komanso ngati wodwala ali ndi chotupa cha dera la chiasm-selar kapena histiocytosis ochokera ku maselo a Langerhans, kuyesedwa kwa kudya sikumachitika. Izi zimatha kudzetsa kukhazikitsidwa kwangozi pachiwopsezo chamoyo chifukwa chakukula msanga kwa madzi m'thupi ndi Hypernatremia.

Algorithm popanga mayeso ndi zakudya zouma:

pakati pausiku, mwana amatha kudya kuchuluka kwamadzi omwe akufuna
nthawi ya 8.00 m'mawa wodwala amalemedwa, osmolality ndi mulingo wa sodium m'madzi am'madzi amayezedwa, komanso osmolality (kapena mphamvu inayake) ndi kuchuluka kwa mkodzo, pambuyo pake mwana atasiya kumwa zakumwa, chakudya chomwe mwana amatenga poyesa sayenera kukhala ndi madzi ambiri ndipo ndiosavuta Zakudya zam'mimba zofunikira kugaya (ndikofunikira kugwiritsa ntchito mazira owiritsa, buledi, tirigu wopanda mafuta, nsomba, tchizi chofinya),
Kuyeza kwa thupi, kutsimikiza kwa mulingo wa sodium ndi plasma osmolality, osmolality kapena kupindika kwamkodzo, kutentha kwa thupi, mucous membrane, thanzi la mwana liyenera kuchitika maola 2 aliwonse kapena pafupipafupi, kutengera momwe wodwalayo alili.
ndikofunikira kuwonetsetsa mosamala kuti mwana samamwa madzimadzi panthawi ya mayeso.Kwa odwala ambiri, kuchepa kwamadzi ochepa kwa maola 7-8 (kapena kuchepera) ndikokwanira, vuto la polydipsia yoyamba, mayesowo amatha mpaka maola 12.

Kuyesedwa kumathetsedwa ngati:

kulemera kwa wodwala kumachepetsedwa ndi 3-5% yoyambirira,
kutentha kwa thupi kumakwera
pali kuwonongeka pamachitidwe a wodwala,
wodwala sangathenso kupirira ludzu
kapena / kapena mulingo wa plasma wa sodium upitilira 143 mmol / l,
plasma osmolality upambana 295 mOsm / kg H2O,
ndipo / kapena kusowa kwamkodzo kwamkaka kumakhala kofunikira,
ndipo / kapena kusiyana kwa mkodzo osmolality mu zitsanzo ziwiri zotsatizana ndizochepera 30 mOsm / kg (kapena ndi kuchuluka kwa sodium 3 mmol / l).

Ngati mwana ali ndi matenda a shuga a insipidus, ngakhale chiwonjezeko cha osmolality ndi / kapena mulingo wa sodium m'madzi am'magazi (chifukwa cha kuperewera kwa madzi m'thupi), osmolality wa mkodzo sapitilira plasma osmolality, i.e. 300 mOsm / kg H2O. Pankhaniyi, kumapeto kwa kuyesa, kuuma kwa khungu ndi mucous nembanemba, tachycardia, kuwonjezeka kwa kuwonekera kumatha kuwonedwa. Ngati osmolality wamagazi sasintha kwenikweni pamapeto a sampuyo, ndipo kuperewera kwamkodzo kumawonjezeka mpaka 600-700 mOsm / kg kapena kuposerapo, matenda a shuga a mtundu wina uliwonse sangatengedwe.

Pozindikira kusiyanitsa pakati pa nephrogenic ndi matenda apakati a shuga kumapeto kwa kuyesedwa, desmopressin imayendetsedwa 10 μg intranasally, kapena 0,1 mg pamlomo, kapena 60 μg pang'ono. Asanatenge desmopressin, wodwalayo amafunsidwa kuti atulutsire zotupa kwathunthu. Pambuyo maola 2 ndi 4, mkodzo umayenera kusungidwa kuti muwone kuchuluka ndi osmolality (kapena kachulukidwe kakang'ono). Wodwala amaloledwa kudya ndi kumwa, pomwe kuchuluka kwa zakumwa zamadzimadzi siziyenera kupitirira kuchuluka kwa mkodzo womwe umaperekedwa poyesedwa ndi kudya kouma. Kuwonjezeka kwa kuchuluka kwa mkodzo kopitilira 50% kumawonetsa mawonekedwe apakati a ND, ndipo ochepera 50% akuwonetsa nephrogenic ND (Gome 1). Ngati mwana awulula nephrogenic ND, kumuwunika kowonjezereka ndi kulandira chithandizo kumachitika ndi akatswiri a nephrologists.

Maonekedwe a polyuria ndi ludzu nthawi yayitali kapena itangotha kumene (craniopharyngioma, glioma, germinoma, ndi zina zotere) zimawonetsa chitukuko cha insipidus yapakati pa matenda ashuga ndipo sikutanthauza njira zapamwamba zodziwira matendawa.

Ngati ND yapakati idapezeka, kufufuza kwina kumafunikira kuti mudziwe matenda a etiology.

Kuchita maginito a ubongo, makamaka gawo la masisitere, kumakupatsani mwayi wopezeka ndi chotupa, zovuta za tsinde / chofukizira cha tinthu tambiri, zovuta za anatomical. Nthawi zambiri, pazithunzi za sagittal T1, ma neurohypophysis amawonetsedwa ngati chizindikiro champhamvu kwambiri. Kusowa kwa chizindikiro kuchokera ku neurohypophysis ndi chizindikiro cha matenda a hypothalamic-neurohypophysial, ndipo kungawonetse kukhalapo kwa gawo loyambirira la chotupa.

Pamaso pa kukulira kwa pituitary stalk kapena makina opitilira 6 mm, kutsimikiza kwa zotupa (β-hCG, α-fetoprotein) kukuwonetsedwa kupatula chotupa cha cell germ. Pakakhala kuwonjezeka kwa zotupa, ma MRI obwereza (komanso kukonzanso chikhazikitso cha chotupa) amayenera kuchitika pakadutsa nthawi 1 m'miyezi 6 (kapena pakawoneka zatsopano) kwa zaka zitatu, ndiye kuti nthawi imodzi m'miyezi 12 kwa zaka 3-4. Kupezeka pa MRI ya zizindikiro za kukula kwa thunthu kapena chimbudzi cha nthito kungakhale chizindikiro cha kukula kwa matenda opatsirana (makamaka hertiocytosis ochokera ku maselo a Langerhans) kapena germoma, ndi kukhalanso kwa pituitary gland / infundibulitis ndikuthekanso. Zikatero, ndikofunikanso kuyesa kupima kwakanthawi kwa mahomoni kuti muwone momwe matenthedwe amagwirira ntchito. Nthawi zambiri, zizindikiro za kuchepa kwapang'onopang'ono necrosis zimawonekera zaka zingapo asanafike pamitsempha ndi mawonekedwe ena a germinoma kapena hetiocytosis.

Chithandizo cha matenda apakati a shuga a insipidus

Cholinga chachikulu chakuchizira matenda a shuga kwa ana ndikuchepetsa mkodzo wowonjezera ndipo (nthawi zambiri) amachepetsa ludzu, lomwe, limapangitsa mwana kukhalabe ndi moyo wabwino. Chithandizo chamankhwala odwala matenda a shuga chikutsalira pa matenda a matendawa.

Kuti muthane ndi mavuto awa, muyenera:

kuonetsetsa kuti mwana azitha kupeza madzi momasuka
kukhathamiritsa kwa chakudya kuti muchepetse kuchuluka kwa madzi omwe amatulutsidwa (makamaka mwa ana omwe ali ndi NID)
zochizira chapakati mantha dongosolo - ntchito vasopressin analog - desmopressin
zochizira NND - kugwiritsa ntchito mankhwala omwe amathandizanso kubwezeretsa madzi impso
Chithandizo cha matenda oyambitsidwa.

Ana omwe ali ndi ND nthawi zonse azikhala ndi mwayi wopeza madzi. Nthawi yomweyo, kumwa kwambiri madzi ambiri kumatha kuyambitsa biliary dyskinesia, kufalikira kwam'mimba, kukulira kwa matumbo osavomerezeka, komanso kukula kwa hydronephrosis.

Pakadali pano, mankhwalawa a necrosis otsika kwambiri, mankhwalawa amasankhidwa ndi desmopressin (1-desamino-8-D-argininvazopressin DDAVP). Desmopressin ndi analogue yopanga mahomoni antidiuretic momwe 1-cysteine imayipitsidwa ndipo mu gawo la 8 L-isomer of arginine imasinthidwa ndi D-isomer. Chifukwa cha izi, desmopressin ili ndi kutchulidwa kotsimikizika, ili ndi nthawi yayitali poyerekeza ndi ADH. Nthawi yomweyo, mphamvu ya vasopressor ya desmopressin ndi 2000-3000 nthawi yochepera kuposa vasopressin.

Desmopressin amagwiritsidwa ntchito ngati kutsanulira kapena kutsitsa kwa mkati, mapiritsi amkamwa ndi mapiritsi okhala ndi chidetso cha lyophilized (Sungunulani) pakugwiritsira ntchito kwamkati. The intranasal mawonekedwe a mankhwalawa amagwiritsidwa ntchito nthawi zambiri ntchito, pambuyo pa ntchito, ngati mwana ali ndi mseru komanso / kapena kusanza, kutchulidwa kusayanjana ndi mapiritsi. Ubwino wa piritsi wamtundu wa mankhwalawa ndi kuyamwa bwino, mwayi wosintha ndikusankha mulingo woyenera wa mankhwalawa, nthawi zambiri - kutsata kwa wodwala kumawathandiza. Kuphatikiza apo, kutha kupereka desmopressin pamapiritsi ang'onoang'ono (mpaka 0,025 mg / mlingo) kumachepetsa chiopsezo cha mankhwala osokoneza bongo kwa ana osaposa zaka 3-5 ndi odwala omwe amafunikira chithandizo chamankhwala. Gome 2 imapereka mitundu yotulutsira ya desmopressin, avareji Mlingo womwe amagwiritsidwa ntchito komanso kuchuluka kwa makonzedwe awo.

Tiyenera kukumbukira kuti kutalika kwa nthawi ndi mphamvu ya mankhwalawa zimatha kusiyanasiyana, kotero kuchuluka kwa kayendetsedwe kake ndi mlingo wake amasankhidwa payekha. Mwa ana osaposa zaka 3, mankhwalawa apakati pa ND sagwiritsidwa ntchito nthawi zambiri chifukwa chowopsa cha desmopressin ndi chitukuko cha hyponatremia. Hyponatremia imabweretsa hypoosmolality of extracellular fluid ndi kudutsa kwamadzi m'maselo, kuphatikiza ma cell aubongo. Zotsatira zake, kukula kopanikizika koopsa ndikotheka - matenda a edema.

Mwa ana aang'ono, ndizovuta kwambiri kuwongolera kuchuluka kwa mkodzo wothira, motero ndikofunika kuyang'ana kuchuluka kwa madzi omwe amwedwa ndi / kapena kuchuluka kwa sodium mu seramu yamagazi. Ngati zizindikiro za matenda a shuga insipidus zikufotokozedwa bwino, kuchuluka kwa ludzu komanso kusokonekera pafupipafupi kumabweretsa chitukuko ndi momwe mwana wakhanda alili, ndizotheka kugwiritsa ntchito desmopressin kukonzekera mosamala kwambiri motsogozedwa ndi seramu sodium ndi / kapena osmolality. Ndikofunika kugwiritsa ntchito desmopressin mu mawonekedwe a kutsitsi lamkati, pomwe mankhwalawa amathandizidwa ndi saline mu chiyerekezo cha 1:10. Kukonzekera kuchepetsedwa kumaperekedwa kudzera mkamwa kawiri pa tsiku.

Mwa ana omwe ali ndi vuto lamanjenje lopitirira zaka 3, mankhwala a desmopressin amayamba ndi Mlingo wochepa, pang'onopang'ono ukuwonjezeka ngati pakufunika.Kuphatikiza apo, pakusankha koyamba kwa mankhwala, mlingo uliwonse wotsatira wa mankhwalawa umalimbikitsidwa kuti ugwiritsidwa ntchito pambuyo pa maola awiri a maola awiri a diuresis m'munsi osakwana ml / kg / ola, i.e. kukodza kochepa kukachitika mwa wodwala kwakanthawi, mkodzo umakhala wopepuka. Izi zimathandizira kuchotsa mkodzo waulere wopanda magazi ndikulepheretsa kukula kwa hyponatremia.

Mukamapereka mankhwala a desmopressin, kuwerengera kosamalitsa kwa tsiku ndi tsiku ndikuwerengera kuchuluka kwa zakumwa zoledzera ndi zotulutsa kumachitika, tsiku lililonse kutsimikiza kwa kuchuluka kwa ma electrolyte (sodium, potaziyamu) mu seramu yamagazi, ndi kuchuluka / kuchepa kwa sodium, kutsimikiza kumachitika kangapo patsiku (nthawi zambiri 2-3), wodwalayo kulemera tsiku lililonse kuti azitha kuyendetsa bwino madzi. Ntchito zonsezi zimachitika mpaka boma litakhazikika. Pambuyo pake, kutsimikiza kwa ma elekitirodi ndi kuchuluka kwa madzimadzi kumachitika kamodzi pakadutsa miyezi 3-6. Ndikofunikira kufotokozera odwala ndi makolo awo kufunika kopewa kuthamanga kwamadzimadzi. Pofuna kupewa mankhwala ochuluka osokoneza bongo, mankhwalawa desmopressin azitha kulandira mankhwala osokoneza bongo kwa nthawi yayitali ayenera kusankhidwa kuti kuchuluka kwa madzimadzi omwe amatulutsidwa tsiku ndi tsiku kumaposa zomwe zimachitika tsiku ndi tsiku. (Nthawi zambiri, kuchuluka kwa mkodzo wowonjezera ndi 15-30 ml / kg patsiku). Pafupifupi, masiku onse diuresis mwa ana omwe ali ndi vuto lochepa kwa magazi osakwana zaka 4-5 sayenera kukhala osakwana 1000 ml, osakwana zaka 10 - 1200-1500 ml, mwa ana okulirapo - 1800-2000 ml.

Njira yosamalitsa mosamala kwambiri pakusankhidwa ndi kusankha kwa mankhwala othandizira omwe ali ndi desmopressin amafunikira kwa odwala omwe amachitidwa opaleshoni chifukwa cha chotupa cha hypothalamic-pituitary dera kapena kuwonongeka kwa ubongo. Muzochitika izi, ND ikhoza kukhala ndi zosankha zingapo zachitukuko.

Postoperative shuga insipidus imatha kuyamba ndendende ndi polyuria, ndikungosintha mosavomerezeka kwa masiku angapo. Kuwonongeka kwambiri kwa intraoperative kapena kuvulala kwambiri kungapangitse kukulira kwa ND. Matenda a shuga atha kukhala ndi "magawo atatu": gawo loyamba la polyuria, lomwe limayambitsidwa ndi kuwonongeka kwa dera la hypothalamic-pituitary komanso kuchepa kwa chitetezo cha ADH, kumatha maola angapo (maola 12 mpaka 65) mpaka masiku angapo. Kenako pakubwera gawo lachiwiri, kuyambira 2 mpaka 14 masiku, otchedwa Gawo la "Antidiuretic", limodzi ndi kutulutsidwa kosalamulirika kwa ADH kuchokera ku ma neurons owonongeka. Kenako gawo lachitatu limatsata - gawo la polyuria. Mchigawo chachiwiri, ndikofunikira kuti musamayese kuthamanga kwa magazi mu wodwala, komwe kumayambira kumbuyo kwa chitetezo chokwanira cha ADH kumabweretsa chitukuko cha hyponatremia. Odwala omwe adachita kulowererapo kwa vuto la neurosuction, mosasamala kanthu za momwe mayendedwe apanthawi ya opaleshoni yotsika (atapatsidwa chithandizo chokwanira cha kulowetsedwa ndipo desmopressin imayendetsedwa), kuchuluka kwa seramu ya 145 mmol / l nthawi zambiri kumayambitsa kuzimiririka kwazizindikiro za ND (kawirikawiri pambuyo pa 3 - miyezi 6 atachitidwa opaleshoni). Ngati odwala omwe ali mu postoperative nthawi amakhala ndi seramu sodium ya 145 mmol / L, mwayi wokhala ndi ND yokhazikika ndiwambiri. Izi monga maphunziridwe a LPD mu nthawi ya postoperative, ndikofunikira kuganizira posankha mtundu wa desmopressin. Ndikofunika kuchenjeza odwala ndi / kapena makolo awo za kufunika kolamulira zakumwa zoledzera kapena zotulutsa, kusiya mankhwalawo ngati edema iwoneka komanso / kapena kusintha mawonekedwe amadzimadzi, kutsatiridwa ndi kukambirana ndi endocrinologist.

Nthawi zina, atachitidwa opaleshoni yama volumetric chifukwa cha chotupa cha hypothalamic-pituitary odwala, komanso polyuria yoyambitsidwa ndi kukula kwa kukakamizidwa kwa neural syndrome, oligo- kapena adipsia imawonedwa. Kuphatikizidwa kwa polyuria ndi madzi osakwanira amkati m'thupi kumabweretsa chitukuko champhamvu cha hypernatremia ndi boma la hyperosmolar.Popewa zovuta zotere, odwala oterewa amakhala okakamizidwa (nthawi zambiri, koma m'magawo ochepa a 50-100 ml), mlingo wa desmopressin umasankhidwa nthawi yomweyo, ndipo ngati pakufunika kuthandizidwa, mankhwalawa amayenera kuchitidwa. Cholinga cha mankhwalawa ndikuti akwaniritse dziko komanso kusintha momwe mulili wa sodium m'madzi am'magazi. Mu gululi la odwala, m'miyezi isanu ndi umodzi yoyamba atachitidwa opaleshoni, ndikofunikira kudziwa kuchuluka kwa sodium komanso / kapena osmolity ya magazi nthawi 1 m'masiku 10-14, ndikusintha kwa mlingo woyenera wa desmopressin.

Mutha kuthandizira tsambali ndalama - izi sizingothandiza kulipira kuchititsa tsambalo, kapangidwe ndi chitukuko cha tsambalo, komanso kuti musalole kuti muzitsitsa tsambalo ndi zotsatsa zokhumudwitsa. Chifukwa chake, simudzangothandiza tsambalo, komanso kuti muthandize nokha komanso ogwiritsa ntchito ena kulandira zambiri zodalirika pamutu wakuti "Matenda a shuga, matenda ogwirizana ndi kusokonezeka kwa magetsi amagetsi."!
Ndipo, mogwirizana, anthu ambiri adzalandira chidziwitso chomwe moyo wawo ungadalire.Mukamalipira mudzawongolera patsamba kuti mukalanditse zikalata zofunikira.