Zizindikiro za shuga mwa akhanda - muyenera kudziwa

Nthawi zina kuzindikira kwa matenda ashuga kumaperekedwa kwa akhanda. Izi zosowa zamatsenga zimayambitsidwa osati chifukwa chakugwira ntchito bwino kwa chitetezo cha mthupi, koma ndi chilema cha jini chomwe chimayang'anira magwiridwe antchito a ma cell a pancreatic beta. Matendawa ndi osowa kwambiri, amodzi mwa ana 200-500,000 akhanda. Matendawa amatchedwa "neonatal" ndipo amapezeka mwa ana miyezi 6 yoyambirira ya moyo.

Zizindikiro za Neonatalabetes

Onaninso shuga mwana wakhanda pazifukwa zingapo:

• Mwanayo amayamwa mwaulesi ndipo kwenikweni salemera.
• Mwana amakodza pafupipafupi komanso kwambiri.
• Kusunthika kwa asidi-maziko olimbitsa thupi kuloza mbali ya acid, kapena acidosis, yomwe imadziwonetsera kulephera kupuma, mtima ndi kununkhira kwa maapulo wowawasa kuchokera mkamwa.
• Kuchepa kwa thupi la mwana, komwe kumatha kukayikiridwa ndi khungu lotayirira, kufooka kwa mucous membal, kufooka, kupuma mofulumira komanso palpitation.
• Mu kuyesedwa kwa magazi - kuchuluka kwa glucose mpaka 9 mmol / l musanadye, ndi 11 mmol / l - pambuyo, kukhalapo kwa matupi a ketone.
• Mukuyesedwa kwa mkodzo - kukhalapo kwa shuga, ndipo, kawirikawiri, matupi a ketone.

Zomwe zimayambitsa matendawa

Matenda a shuga a neonatal amatha chifukwa cha kusintha kwa majini komanso kusokonezeka kwa ma kanyumba kamwana komwe kamayambitsa ma virus: rubella, chikuku, mumps, chikuku, cytomegalovirus, kachilombo ka Coxsackie.

Maselo a pancreatic beta amakhalanso ndi zovuta pa mankhwala monga vaccor, streptozocin, alloxanpentamidine, diazoxide, β-adrenergic agonists, thiazides, dilantin, ndi interferon-alpha, omwe amatengedwa panthawi yapakati.

Zizindikiro

Matenda a neonatal sanadziwike m'mbuyomu, akuti mtundu uliwonse wa matenda ashuga ndiwo mtundu 1. Tsopano imakhazikitsidwa modalirika osati kokha pazithunzi zamankhwala, komanso kafukufuku wamtundu. Nthawi zambiri, mtundu uwu wa matenda a shuga umapezeka mwa ana osabadwa, omwe kubadwa kwawo kunali koyambirira kwa milungu 30.

Kuzindikira kwamtsogolo kwa mwana yemwe ali ndi neonatal matenda a shuga

Matendawa nthawi zambiri amagawika m'magulu awiri:

1) Kusakhalitsa (kwaposachedwa) - kumachitika pafupifupi theka la milandu, kumadutsa kwathunthu ndi miyezi 12. Zizindikiro zimatha pang'onopang'ono kapena zokha. Komabe, pamakhala chiopsezo chakuti matendawa adzabweranso muunyamata ndikukalamba.

2) Chokhazikika (chokhazikika), chofuna mankhwala osokoneza bongo kwa moyo wonse.

Masiku ano, mankhwala amakono samatha kuneneratu mukapanga matenda ngati padzakhala nthawi yokwanira komanso kwanthawi yayitali bwanji.

Chithandizo cha matenda a neonatal shuga mwa akhanda

Theka la milandu yonse, ana omwe ali ndi neonatal shuga safuna insulin. Nthawi zambiri, amapatsidwa mankhwala omwe amakhala ndi shuga m'magazi. Nthawi zambiri Glibenclamide kapena Sewero la Urea.

Muyenera kuwunika bwino momwe ndalamazi zimathandizira aliyense payekhapayekha. Ndi chisankho choyenera cha mankhwala ndi Mlingo, zovuta za matenda ashuga monga kufulumira kwa kukula ndi vuto la mitsempha zimatha kupewedwa.

Ndi mtundu wosakhalitsa wa matenda a neonatal shuga, odwala nthawi zambiri safuna insulin, kapena jakisoni amachitika ndi kuchepetsedwa kwa mlingo mpaka mankhwala atatheratu. Nthawi zambiri pofika miyezi itatu, mwana amasiya kufunafuna insulin yotengedwa kunja.

Ana omwe ali ndi matenda osatha a shuga amakhazikika amadalira insulin. Amakhala kuti alibe matendawa. Mlingo wa tsiku lililonse wa insulin yoyenera nthawi zambiri umakhala wochepa kwambiri ndipo ndimagulu atatu pa thupi limodzi la makilogalamu obadwa kumene.

Mankhwalawa a neonatal shuga, kukonza mankhwalawa kumachitika kuti matenda a electrolyte ndi acid azikhala bwino. Ma pancreatic enzymes amadziwikanso ngati mankhwala othandizira. Ana omwe akudwala matenda a neonatal shuga amafunika kuwunika pafupipafupi shuga, potaziyamu, calcium, sodium.

Zambiri

Neonatalabetes mellitus (NSD) ndi gulu la heterogeneous pathologies a neonatology ndi ana omwe amadziwika ndi hyperglycemia komanso kuchepa kwa insulin kapena kuchepa kwa insulin chifukwa cha β-cell kukanika kwa endocrine kapamba. Kistel adalongosola koyamba za matenda ashuga mwana wakhanda mu 1852. Kufalikira kwa izi ndi 1: 300-400 zikwi zatsopano. Mu milandu ya 55-60%, fomu yochepa imayamba. NSD yokhazikika ndiyofala, ndipo, monga lamulo, ndi gawo la ma syndromological pathologies. Pafupifupi, anyamata ndi atsikana amadwala pafupipafupi, koma ma syndromes ena (mwachitsanzo, IPEX syndrome) amapezeka kwambiri kwa amuna. Mtundu wa cholowa cha mitundu ina ya matenda a neonatal shuga umatanthauzanso mtundu wina wachilengedwe ndipo ukhoza kukhala wolamulira kwambiri (chilema cha GK) kapena kudziwitsidwa kwa autosomal recessive (KCNJ11).

Zomwe zimayambitsa matenda a Neonatal Shuga

The etiology ya neonatal matenda a shuga zimatengera mawonekedwe ake azachipatala. Kufupika kwakumapeto kwa NSD kumachitika chifukwa chosakwanira kwa β-maselo am'mphepete mwa ma pancreatic a Langerhans. Maselo osakhazikika bwino sangathe kuyankha mokwanira pakukula kwa glycemia. Potere, insulin plasma insulin ikhoza kukhala yabwinobwino. Nthawi zambiri, zamatsenga zimayamba mwa apo ndi apo. Chikhalidwe chobadwa nacho chokhudzana ndi zovuta zamtundu wamtundu wa chromosome VI chatsimikizidwanso. Kusintha kwa mtundu wa ABCC8 ndi KCNJ11 mwina ndi chifukwa cha matenda osakhalitsa a neonatalabetes mellitus, komabe, zolakwika zamtundu womwewo nthawi zina zimapangitsa kukula kwa mawonekedwe osatha.

Kulumikizana kwamphamvu kwa matenda a neonatal matenda a shuga kumachitika chifukwa cha kupunduka kwa maselo a β-cell, gland yonse, kapena insulini palokha, chifukwa chake kuperewera kwathunthu kumayamba. Monga lamulo, awa ndi cholowa chobadwa nacho cha majini osiyanasiyana. Mitundu yotchuka kwambiri ndi kusintha kwa heterozygous kwa mtundu wa ABCC8 ndi KCNJ11. Nthawi zambiri pamakhala zosankha zotsatirazi zomwe zimayambitsa kukula kwa NSD: IPF-1 - hypo- kapena aplasia ya kapamba, GK - kusowa koyankha ndi glucose wamagazi, EIF2FK3 (Walcott-Rallison syndrome) - kuphwanya kapangidwe ka insulin, FOXR3 (IPEX-syndrome) - autoimmune kuwonongeka kwa tiziwalo tamatumbo. Fomu yosatha ikhoza kukhala chiwonetsero cha mitochondrial pathologies. Nthawi zina, matenda a enterovirus, omwe mayi adakumana nawo nthawi yoyamba ya mimba, angayambitse matenda a shuga.

Kugawika ndi zizindikiro za matenda a neonatalabetes mellitus

Matenda a Neonatal ali ndi mitundu iwiri yayikulu yazachipatala:

• Osachedwa kapena Osakhalitsa NSD. Njira zambiri zofala. Mosasamala kanthu za mankhwalawa, Zizindikiro zimatha pang'onopang'ono asanakwanitse miyezi itatu. Chikhululukiro chonse chimachitika pakati pa miyezi isanu ndi umodzi ndi chaka chimodzi. Zodzidzimutsa mu ukalamba ndizotheka.
• NSD Yokhazikika kapena Yokhazikika. Nthawi zambiri amaphatikizidwa ndi mapangidwe a syndromic malformations. Pamafunika insulin yonse.

Mawonetsedwe azachipatala a kanthawi kochepa komanso osatha a neonatal matenda osokoneza bongo pakalibe zovuta zina za syndromic ali ofanana. Ndi trardent tardia, kukula kwa intrauterine nthawi zambiri kumawonedwa - ana amabadwa ndi thupi lolemera kwambiri poyerekeza ndi masiku onse (pansipa 3 peresenti) pazaka zawo zamkati. Mkhalidwe wapakati wa mwana wokhala ndi mawonekedwe osakhalitsa amasokonezeka pang'ono - wodwalayo sagwira ntchito, amapha thupi, amakhala ndi chidwi chofuna kudya. Coma ndi uncharacteristic. Ngakhale motsutsana ndi maziko azakudya zabwino, mwana amawonjezera pang'onopang'ono kulemera kwa thupi. Chizindikiro china cha matenda a shuga ochedwa neonatalabetes mellitus chimatchedwa polyuria ndi madzi am'mimba, nthawi zambiri fungo loipa la acetone kuchokera mkamwa.

Mwa mawonekedwe okhazikika a neonatal shuga mellitus, zizindikiro zonse pamwambazi ndi zikhalidwe, koma mwamphamvu kwambiri. Ngakhale izi, kukula kwa intrauterine sikutchulidwa. Zizindikiro zina zomwe zimatheka zimatengera ngati NSD ili gawo lamapangidwe amisala. Ndi chitukuko cha IPEX-syndrome, hyperglycemia imaphatikizidwa ndi matenda ena amtundu wa endocrine komanso chitetezo cha m'mimba komanso celiac negative enteropathy. Makamaka, izi zimawonetsedwa ndi chikanga, kutsekula m'mimba, autoimmune chithokomiro, kuchepa kwa magazi. Walcott-Rallison Syndrome, kuwonjezera pa matenda a shuga a neonatal, amaphatikizanso kulephera kwa impso, kufooka kwa luntha, hepatomegaly ndi spondyloepiphyseal dysplasia.

Chithandizo cha matenda a neonatal shuga

Malangizo achire a mitundu yokhazikika komanso yosakhalitsa ya neonatal shuga mellitus ndi osiyana kwambiri. Kwa ana omwe ali ndi NSD yokhazikika, chithandizo cha insulin m'malo mwake chimasonyezedwa, chomwe chimathandizidwa ndi zakudya zapamwamba kwambiri zopatsa mphamvu. Njira zochizira zimasankhidwa payekha kwa mwana aliyense potengera insulin sensitivity ndi glucose wamagazi. Monga lamulo, ma insulin a zonse zazifupi ndi zazitali amagwiritsidwa ntchito. Kutengera ndi syndromic pathology ya neonatal shuga mellitus, kukonza koyenera kumachitika. Mwachitsanzo, ndi FOXR3 gene mutation, cytostatics imalembedwa, kufalikira kwa mafupa kumachitika, ndipo ndi chilema cha KCNJ11, sulfanylureas imagwiritsidwa ntchito m'malo mwa insulin. M'malo insulin mankhwala akusonyezedwa moyo wonse.

Odwala omwe ali ndi kanthawi kochepa ka matenda a neonatal matenda a shuga, mankhwalawa amagwiritsidwa ntchito pokhapokha glycemia, exicosis, kusokonezeka kwakukulu ponseponse, kuchepa thupi komanso kugwiritsidwa ntchito pang'onopang'ono. M'miyezi isanu ndi umodzi yoyamba ija, kufunika kwa mankhwala ochepetsa shuga kumachepa, kenako nkukazimira - kuchotsedwa kwathunthu kumachitika. Kuwunikira kuchuluka kwa shuga m'magazi ndikusintha kwa mankhwalawa kutengera mphamvu za NSD zitha kuchitika masiku 7 aliwonse kapena 1 mwezi uliwonse ndi endocrinologist ndi dotolo wa ana kapena mabanja.

Kuneneratu komanso kupewa matenda a neonatal shuga

Kuzindikira kwakanthawi kwakanthawi kwamatenda a neonatal ndi abwino. Monga lamulo, kuyambira wazaka 6 mpaka chaka chimodzi, kuchotsedwa kwathunthu kwachipatala kumachitika. Ana ena pambuyo pake amatha kuwona kulephera kwa glucose. Palinso chiopsezo chotenga matenda a shuga a autoimmune pakati pa zaka 20-30. Momwe matendawa amachira ndi mtundu wokhazikika wa matenda a neonatal shuga ndi osavomerezeka. Mosasamala kanthu za pathologies omwe alipo, mwana amakakamizidwa kumwa insulini moyo wonse. Matenda amoyo ndi mtundu uwu wa NSD ndiwokayikitsa. Zotsatira zake zimadalira kukhalapo kwa zovuta zina za chibadwa. Ndi IPEX syndrome, ana ambiri amamwalira asanakwanitse chaka chimodzi kuchokera ku mitundu yayikulu ya sepsis.

Kupewera kwina kwamatenda a neonatal sikunayambike. Njira zodzitetezera zopanda pake zimaphatikizapo upangiri wamtundu kwa maanja omwe akuwunika kuti akhale ndi mwana wokhala ndi matenda opatsirana. Pa chiwopsezo chachikulu cha kubadwa kwa NSD mwa mwana wosabadwa, amniocentesis akhoza kuchitika motsatiridwa ndi karyotyping.

Kodi matenda a neonatal shuga ndi ati

Kukula kwa nthenda yayikulu imeneyi kwa ana osakwana chaka chimodzi ndi vuto limodzi mwa ana 200,000, koma matendawa ndi odziwika chifukwa cha zovuta zake komanso kuopsa kwa moyo. Kuphatikiza apo, mu makanda, kuchuluka kwa shuga kwa magazi kwakanthawi, matenda a neonatal shuga amapeza maphunziro ovuta ndipo pambuyo pake amatha kuyambitsa kuchepa kwa masomphenya kapena kutayika kwathunthu, kusokonezeka kwamphamvu kwakuthupi ndi m'maganizo kwa mwana, kulephera kwa impso, matenda am'mimba komanso khunyu.

Pali mitundu iwiri yamatendawa mu makanda:

• wamtali - mwa 50% ya milandu, matenda obwera chifukwa cha matenda ashuga amatha milungu isanu ndi iwiri, ndipo ana safuna mankhwala owonjezera,
• mawonekedwe osasunthika, yomwe nthawi zambiri imasinthidwa kukhala mtundu woyamba wa shuga.

Koma ndikofunikira kukumbukira kuti ngakhale mawonekedwe osakhalitsa ndiwotheka kwambiri obwereza matenda ashuga kusukulu kapena unyamata, komanso atatha zaka 20, makamaka ndi katundu wobadwa nawo, kuwonekeratu pazovuta za ma cell a pancreatic (ma virus, kuledzera, zinthu "zoyipa") , mankhwala), kupsinjika, kugwira ntchito mopitirira muyeso. Chisamaliro chikuyenera kutengedwa kuti athe kuwunika momwe mwana akusinthira kapena momwe alili, makamaka ana omwe ali pachiwopsezo.

Zizindikiro zamatenda a khanda

Zizindikiro ndizofanana m'mitundu yonse iwiri, motero zimaphatikizidwa.

Zizindikiro zake zazikulu ndi:

• kukula kwa intrauterine, komwe kumadziwonetsera kuchepa thupi,
• ulesi ndi zochita za mwana,
• kudya kwakachepa kapena kwabwinobwino, koma mwana sakukula bwino
• kukodza pafupipafupi komanso kopatsa chidwi,
• kusowa kwamadzi, kuwonekera pakhungu lotupa, kufooka kwa mwana, ziwalo zoluma zamkati komanso mtima wamkati,
• acidosis, ndiye kuti, kusuntha kwa mulingo wa asidi acid kupita kumbali ya asidi, ndikosavuta kuzindikira kafungo ka acetone kamwa,
• kuyesa kwa magazi ndi mkodzo kumakhala ndi kuchuluka kwa shuga, ndipo matupi a ketone amatha kupezeka mumkodzo.

Ndi mawonekedwe osasunthika, zizindikiro zonse zimawoneka zowala, zomwe zimapangitsa kuti azindikire mwachangu. Zowonekera zamankhwala zimawonekera sabata yoyamba ya moyo wa mwana.

Njira zochizira

Popeza matendawa amayambitsidwa makamaka ndi kupatuka kwa ntchito ya majini, sangathe kuchiritsidwa kwathunthu. Kwa ana omwe ali ndi vuto losatha la matenda, mankhwala a insulin amakhala. Poterepa, gawo lililonse la mahomoni limakhala pafupifupi magawo atatu pa kilogalamu imodzi ya kuchuluka kwa mwana.

Ndi mawonekedwe osakhalitsa kapena aubwino, insulin siikulamulidwa. Zoyambira zamankhwala ndi mankhwala omwe amathandiza kuchepetsa magazi a shuga, monga urea sulfate kapena glibenclamide, amathandizira kupanga kwa insulin.

Mlingo umayikidwa mbali iliyonse ndipo umasinthidwa pafupipafupi ndi adokotala.

Nthawi zina, mapiritsi a insulin amapatsidwa mankhwala, omwe pang'onopang'ono amayamba kuchepa ndi miyezi itatu. Zomwezo zimagwiranso ntchito kwa mankhwala a hypoglycemic, kudya kwawo kumasiya pakatha miyezi isanu ndi umodzi ndi umodzi.

Mofananamo, chithandizo chimagwiritsidwa ntchito pochotsa zizindikiro za matenda omwe amasokoneza magwiridwe antchito amthupi. Amakhala ndi acid yokhala ndi acid komanso yokhazikika mthupi. Mankhwala okhala ndi potaziyamu, sodium ndi calcium, yankho la sodium chloride angagwiritsidwe ntchito. Ma enzymes a pancreatic nthawi zina amalimbikitsidwa.

Kukula kwa matendawo kumadalira mtundu wake komanso nthawi yodziwira bwino matenda. Chifukwa chake, ndi mawonekedwe osalekeza, mwana adzagwiritsa ntchito kukonzekera insulin moyo wake wonse.

Adzalembetsa kuchipatala ndikulandila mankhwala kwaulere. Komabe, matendawa amakhudza thupi, akuipiraipira mphamvu.Mavuto monga kuchepa kwa masomphenya, kuchiritsa mabala pang'ono komanso kuchira kwa nthawi yayitali kumazunza mwana moyo wake wonse.

Ndi matenda osakhalitsa, Zizindikiro zimatha pang'ono pang'ono ndipo mankhwalawo amaleka. Koma mwana amakhalabe wokhazikika pang'onopang'ono ndipo amapitidwa mayeso pafupipafupi, izi zimachitika chifukwa chakuyambiranso kwa matendawa muubwana kapena munthu wamkulu. Sizothekera kulosera kutalika kwa chikhululukiro ndi kuthekera kwa kuchira kwathunthu.

Wodwala amalimbikitsidwa kuti azitsatira njira zodzitetezera:

• gwiritsitsani chakudya chopatsa thanzi chokhala ndi zopatsa mphamvu zambiri zamafuta ndi mafuta,
• kutsatira moyo wabwino wokhala ndi masewera olimbitsa thupi pafupipafupi komanso kusakhala ndi zizolowezi zoyipa,
• pewani kunenepa kwambiri
• Ngati muli ndi matenda ena, yesani kuwathetsa m'nthawi yochepa.
• magazi magazi.

Amaganiziridwa kuti amatha kutalikitsa nthawi yachikhululukiro ndikuchedwa kuthandizanso kukonzanso matendawa kwa nthawi yayitali.

Ndikofunika kudziwa kuti chidwi cha matenda m'thupi la mwana ndi champhamvu kwambiri, ndipo mwachangu chithandizo chake chikaperekedwa, ndiye kuti sichingawonekere. Pafupifupi 20 peresenti ya milandu, pali kuchedwa kwa chitukuko.

Chifukwa chake, mu zovuta za minyewa ya ana zimadziwika: kupuma pakulankhula ndi kuyendetsa galimoto, khunyu, kufooka kwa minofu, zovuta zovuta kuphunzira. Kulipirira kumakhala kovuta.

Ndizothekanso kukhudza ziwalo zina: matenda a impso ndi chiwindi kulephera, kusokonezeka kwa malingaliro.

Pokhudzana ndi machitidwe amomwe matendawa amachokera, kupewa kwake ndikovuta kupanga. Choyamba, zimaphatikizapo kukhala ndi moyo wathanzi ndi makolo onse musanakonzekere kukhala ndi pakati.

Nthawi imeneyi iyenera kukhala osachepera miyezi isanu ndi umodzi. Kukadandaula ku chithandizo chachipatala ndi ma genetic kungathandizenso, izi ndizofunikira kwambiri ngati njira zina zofananira kapena zobadwa nawo zinaonedwa m'banjamo. Akatswiri amathandizira kukonzekera njira yopanga pakati ndikupereka malingaliro ofunikira.

Kanema kochokera kwa Dr. Komarovsky:

Mkhalidwe wofunikira ndi thanzi la mayi nthawi yapakati komanso kupewa kuwonetsedwa pazinthu zovulaza. Pachikhalidwe, azimayi amalangizidwa kuti apewe malo omwe angatenge kachilombo ka HIV, matenda omwe ali ndi amayi omwe akuyembekezeredwa, mankhwala amalembedwa wocheperako, ambiri amagwiritsidwa ntchito pokhapokha ngati chiwopsezo cha mkazi chimakhala chachikulu kuposa cha mwana.

Inde, zinthu zoyipa monga kumwa mowa, fodya, ndi zinthu zokhudzana ndi psychotropic ziyenera kupewedwa panthawiyi. Ndikosatheka kuneneratu za matenda, koma ndichowona kukhala otetezeka ku izo.

Zoyambitsa ndi Zoopsa

Kukula kwa izi mwa ana makanda nthawi zambiri kumakhala kovuta chifukwa cha chibadwidwe cha majini ndipo amachokera kwa makolo

Matenda a shuga m'makanda amayamba chifukwa cha kusintha kwa jini komwe kumayambitsa maselo opanga insulin. Chifukwa chake, chisamaliro chapadera chimaperekedwa kwa makanda ochokera ku banja lomwe kholo limodzi lili ndi matenda ashuga. Koma nthawi yomweyo, kupezeka kwa matendawa kwa ana akhanda ndi makanda nthawi zambiri kumalumikizidwa ndi zifukwa zina ndipo amafunikiranso kudziwika.

Zowopsa izi zimaphatikizira othandizira omwe amasokoneza kuyika ndi kusiyanasiyana kwa kapangidwe ka kapamba ka chiberekero ndikumayambitsa kusokonezeka kwa gawo la insulin.

Izi zikuphatikiza:

• ma virus (chikuku, chikuku, cytomegalovirus, rubella, mumps, ma virus a Coxsackie),
• kumwa mankhwala (Streptozocin, Vacor, Diazoxide, Alloxanpentamidine, β-adrenergic agonists, α-interferon, Thiazides, antidepressants),
• kusuta fodya, kugwiritsa ntchito mankhwala osokoneza bongo kapena mowa, makamaka munthawi yoyambirira ya mimba,
• prematurity ndi kulimbikira morphofunctional kusakhazikika kwa kapamba.

Ngati pali mbiri yokhudza ngozi imodzi kapena zingapo, ndikofunikira kuyang'anira kuchuluka kwa shuga kwa mwana

Makolo ayenera kukumbukira kuti chitukuko cha matenda osokoneza bongo mu makanda chimatha kuyambitsidwa osati ndi zinthu zovulaza munthawi ya kukula kwa intrauterine, komanso pambuyo pobadwa kwa mwana.

Matenda a shuga m'makanda amatha chifukwa:

• matenda oopsa a virus kapena bacteria,
• Kugwiritsa ntchito mankhwala kwa nthawi yayitali komwe kumakhudzanso kapamba (maantibayotiki, mankhwala osokoneza bongo a sulfa):
• Kupanikizika: Kulira kwa nthawi yayitali komanso kukwiya pafupipafupi kwamitsempha yamagetsi (mawu ofuula, kuwaluka kwa nyali) kumayambitsa chitukuko cha ana mu chiwopsezo,
• kudyetsa kosayenera: makonzedwe oyambilira a mafuta, zakudya yokazinga, chimanga osakwanitsa miyezi 3, shuga, mkaka wonse wokhala ndi mafuta ambiri.

Kodi matenda ashuga a neonatal amakaikiridwa liti?

Nthawi zambiri, zizindikiro zowoneka zamakanda zatsopano zimawonekera ndi shuga wambiri m'matenda awa komanso zovuta kuzindikiritsa matendawa panthawi yake.

Zizindikiro za matenda a shuga m'makanda:

• kusapeza chakudya chokwanira komanso kusadya bwino, ndikofunikira kudziwa kuti mwana amafunikira kudyetsedwa nthawi zonse,
• kuda nkhawa kosalekeza komanso kusangalala popanda zifukwa zomveka,
• mkodzo wambiri patsiku (oposa malita 2),
• kulimbirana kukhuthala kukhuthala, kutupa ndi kupweteka kwa khungu m'deralo gluteal komanso kumaliseche, zomwe ndizovuta kuchiza,
• matenda obwera pustular,
• Nthawi zina, mwana amakhala woopsa ndipo amasiya kukhala ndi chidwi ndi zinthu zomwe zimamuzungulira,
• khungu lowuma, kuchepa kwa turgor wake, fontanel yayikulu imamira,
• mkodzo umakhala womata ndipo umasiyira zoyeretsa pama diap.

Chizindikiro chimodzi cha matenda ovuta kwambiri ndi ludzu losatha: Khanda limakhala losakhalitsa ndipo limakhazikika pakumwa kanthawi kochepa.

Ndi kuchuluka kwa nthawi yayitali m'magazi a shuga, Zizindikiro za matenda osokoneza bongo kwa ana osakwana chaka chimodzi zimakulitsidwa - kusanza kwambiri kumachitika (popanda chifukwa), kutsegula m'mimba, kukonzekera kapena kutsimikiza, kusiya kuzindikira. Panthawi imeneyi, kugonekedwa kuchipatala kwa mwana kuchipatala, kufotokozera za matendawo ndi chithandizo chofunikira ndikofunikira.

Mu matenda ashuga, makanda mpaka chaka chimodzi amakhala ndi zizindikiro za metabolic ndi kuchepa thupi zomwe zingayambitse zovuta zaumoyo. Chithandizo cha matenda ali wakhanda zimatengera mtundu wa matenda: kanthawi kochepa matenda a neonatal kapena mtundu wowonjezereka wa matendawa.

Kuti mupeze chithandizo choyenera cha matenda awa, ndikofunikira kudziwa mtundu wa matendawa akhanda

Matenda a shuga ndi matenda oopsa komanso ovuta omwe amafuna kuti munthu azizindikira msanga komanso kulandira chithandizo chanthawi iliyonse. Kukula kwa matenda a shuga a mtundu wa ana kumafuna kuwunikira nthawi zonse za momwe khanda limakhalira komanso kukhala maso kwa makolo ndi akatswiri.

Ngati ndi kotheka, ndikofunikira kuteteza mwana ku zotsatira zoyipa ndi mbiri yosavomerezeka yabanja. Ana omwe ali ndi vuto lalikulu la matenda ashuga ayenera kulandira chisamaliro chachikulu komanso chisamaliro pang'onopang'ono kuti athe kuwongolera mkhalidwe wa mwana wawo.

Pokhala ndi zakudya zoyenera, chithandizo komanso moyo wabwino, mutha kupewa kukula kwa matenda ashuga kapena kuonetsetsa kuti mwana ali ndi matenda ashuga, ngati matendawa amathandizidwa.

Matenda a shuga ndi zofanana mwa ana akhanda

Mavuto a kagayidwe kazakudya kwa ana akhanda, owonetsedwa ndi hyperglycemia ndi glucosuria, mosakayikira ndizofala kuposa zomwe zimapezeka. Kusanthula kwa zofalitsa ndi zomwe tawona zikutsimikizira kuti izi ndi zoyambira kale, zimasiyana mosiyanasiyana ndipo zimakhala ndi zotsatira zosiyana.

Malingaliro akufotokozedwa pakakhala zenizeni zenizeni za chibadwa komanso matenda obwera chifukwa cha matenda ashuga, omwe amafotokozedwa m'malo osiyanasiyana pansi pa dzina loti "pseudo-kishuga cha mwana wakhanda," ndi "neonatalabetes mellitus syndrome"

Mwa zina zomwe zimapangitsa kuti kupezeka kwa matenda osokoneza bongo a neonatal matenda ashuga, zizindikiridwe poyamba chifukwa cha zovuta za carbohydrate metabolism zimachitika mchikhalidwe cha magwiridwe antchito a endocrine, chifukwa chomwe kusakwanira kwa zida zapakompyuta sikumapezeka kokhako komanso kufiira ndi zina.

Nthawi zina, zovuta za carbohydrate metabolism zimangokhala chiwonetsero chazovuta za vuto lakubadwa kwa craniocerebral, matenda a impso, matenda a cytomegaly, hemolytic matenda obadwa kumene, komanso kubereka toxoplasmosis.

Pepala ili likuwonetsa kuwonetsedwa kwa 4 kwa zovuta za kagayidwe kazakudya kwa ana akhanda.

Matenda azachipatala, kobadwa nako shuga mellitus mu gawo la kuwonongeka. Mavuto: staphylococcal sepsis (mawonekedwe a septic-pemic), nthawi yayitali, pachimake, staphylococcal enterocolitis, kuperewera kwa zakudya m'thupi, matenda a magazi.

Wodwalayo adamufotokozera mbali ziwiri za jakisoni wa insulin, ndipo kenako magawo atatu musanadye. Nthawi yomweyo, sepsis ndi enterocolitis adathandizidwa. Pang'onopang'ono, glycemia inayamba kukhala yabwinobwino, shuga mumkodzo sanapezekenso. Pambuyo pake, mnyamatayo adapatsidwa ICC yamagulu 6 kamodzi pa tsiku 9 koloko m'mawa.

Kuyang'aniridwa kwa wodwala kwa sabata lathunthu kunatsimikizira kuti mankhwalawo ndi okwanira, ndipo adamuchotsa kunyumba mankhwala osokoneza bongo. Mwezi wakukhala ku chipatalako, kulemera kwa thupi kumawonjezeka ndi 1000 g, mwana adayamba kugwira ntchito, kupukusira kwa kabala komanso zotupa pakhungu zidasowa, chopondapo ndi kukodzetsa chidabwerera mwakale. Mkhalidwe pambuyo pakuchotsedwa umakhalabe wokhutiritsa. Woyamwitsa, amalandira chithandizo.

Ana ochepa omwe ali ndi matenda obadwa nawo a shuga amadziwika mu ntchito zina. Monga chimodzi mwazomwe zimayambitsa prenatal hypotrophy mwa odwala otere, kuchepa kwa insulin ndende m'magazi a mwana wosabadwayo kumalimbikitsidwa. Kusintha kwa thupi komwe kumachitika mwa mwana kumatiwona ngati vuto la matenda ashuga.

Wodwalayo adapangidwa kuti akonze kulowetsedwa mankhwala, magawo anayi a crystalline insulin adalowetsedwa m'mitsempha, kenako kuchuluka chomwecho pansi pa khungu. Sodium ascorbate, cocarboxylase, ndi madzi a m'magazi adalowetsedwa kudzera m'matumbo. Pambuyo pa maola 2, kuchuluka kwa shuga m'magazi kunatsikira ku 28.9 mmol / L, pHmet 7.115, pH 7.044 BE -16.5 mmol / L. Mankhwalawa anapitilizidwa, komabe, sizinali zotheka kuti achotse wodwalayo pamalo ovuta.

Pathologic matenda a hypoplasia a kapamba, adrenal tiziwalo tambiri, thymus dysplasia, mitral valve angiomatosis. Zovuta: purulent bronchitis, amoyo wam'madzi am'kati mothandizidwa ndi mapapo (Staphylococcus aureus olekanitsidwa ndi mapapu), foci ya emphysema ndi atelectasis, catarrhal enterocolitis, kupweteka kwa diaper, thrush, chiwindi chamafuta, myocardial granular dystrophy, carbohydrate dystrophy.

Powona izi, chomwe chimayambitsa matenda ashuga chinali chobadwa nako pancreatic hypoplasia ndikusowa kwathunthu kwa insulin. Mpaka 1 1/2, mtsikanayo anakula wathanzi. Kuwonongeka kwakuthwa kwakumachitika pokhudzana ndi kusamutsidwa kwake kwa kudya kwaposachedwa mu nyengo ya SARS. Mwana adayamba kukhala ndi chikomokere cha hyperglycemic, chomwe sichimapezeka m'magawo am'mbuyomu, ndipo chithandizo cha pathogenetic chinayambika mochedwa.

Titha kumaganiza kuti ngakhale mtsikanayo amalandira mkaka wa m'mawere, kagayidwe kake pansi pamankhwala ambiri a chakudya amaperekedwa ndi amayi a insulin. Zinthu zamagetsi zomwe zimakhala zochepa mkaka wa m'mawere, zikuoneka kuti, sizimagwira ntchito yayikulu, chifukwa maselo amtundu wa wakhanda ali ndi zolandilira zomvera kwambiri za insulin ndipo amatha kutanthauzira kwambiri insulin, kuthekera kwake ndi 24.3% mwa akhanda ndipo 4,7% mwa akulu.

• Khalidwe losakhazikika la mwana,
• kupezeka kwa zizindikiro zomwe zikuwonetsa kuchepa thupi (kumva ludzu),
• Pamaso pa kudya, mwana sakhala wonenepa.
• mkodzo watsopano umakhala wowonda ndipo umasiyidwa pazovala kapena pa ma diapuleti (omwe amatchedwa "banga okhuthala"),
• kupezeka kwa zotupa ndi zotupa zamtundu uliwonse pakhungu,
• kukula kwa kutukusira kwa maliseche (mwa anyamata pamphumi, ndi mwa asungwana - vulvitis).

Chithunzi cha kuchipatala

Chizindikiro choyambirira cha matenda ashuga mwa ana ndi polyuria, chomwe mwa ana aang'ono chimawoneka ngati bedwetting, ndi polydipsia. Kupaka utoto kumatha kukhala kovuta, ngati kusokonekera. Mitsuko imayikidwamo kwambiri (malita 3-6 patsiku), kuchuluka kwake kumakhala kwakukulu (kupitirira 1020), mkodzo umakhala ndi shuga ndipo, nthawi zambiri, acetone.

Zizindikiro za ketosis ndi acidosis yowonjezereka ndikuwonjezera pakuzama kwa kupuma, kuwonjezeka kwa kugunda kwa mtima, komanso kutsika kwa kuthamanga kwa magazi.

Malinga ndi gulu lomwe lidayambika, ndichizolowezi kusiyanitsa magawo owopsa pachiwopsezo cha shuga pomwe magazi a magazi sapitilira zomwe zimakhazikika, kuyezetsa kwa galactose sikumawululanso zodetsa nkhawa chifukwa cha chibadwa chosagwirizana ndi matenda a shuga (kulemera kwakukulu kwa thupi pobadwa, mbiri ya kagayidwe kazakudya) ndi kukula kwa kunenepa.

Mu ana omwe ali ndi cholowa chatsopano, kukonzanso kwakuthupi panthawi yomwe akukula komanso kutha msinkhu, makamaka kusintha kwa neuroendocrine, amatha kukhala zinthu zomwe zikuthandizira kuwonekera kwa zovuta zamtundu wa metabolic komanso kukhazikitsa kwawo pamavuto a metabolic a mtundu wa matenda ashuga.

Mukamaphunzira kulekerera kwa glucose pogwiritsa ntchito njira yolekerera glucose komanso Stub - Traugott njira zowonjezera kawiri, mitundu yosiyanasiyana ya glycemic curve (hyperinsulinemic, dubious, hypoinsulinemic, prediabetesic ngakhalenso shuga) imatha kupezeka, kuwonetsa machitidwe komanso kuya kwa kulekerera kwa chakudya pakati pa ana omwe ali ndi matenda obadwa nawo a shuga.

Kuthekera kwakukulu kwa mitundu ya matenda ashuga pakati pa ana olemedwa kwambiri (shuga, kunenepa kwambiri) kumafunikira chisamaliro chapadera cha gulu ili la ana.

Munthawi yoyambirira ya matenda osokoneza bongo, kuchuluka kwa shuga m'magazi ndi mkodzo wa tsiku ndi tsiku mwa ana nthawi zambiri kumachulukitsidwa, chifukwa chake, kupezeka kwa mayeso a glucose (kuchuluka kwa glucose kwa 1.75 g / kg) kumatheka pokhapokha atatha kumvetsetsa bwino izi.

Chithandizo cha matenda osokoneza bongo a ana ndi chovuta kwambiri chifukwa cha kugwiritsa ntchito mankhwala a insulin ndi zakudya, osangothandiza kuchiza matenda okha, komanso kuonetsetsa kukula kwa thupi. Thanzi liyenera kutsatira miyezo ya zaka. Zakudya zowonjezera zimaphatikizidwa.

Kufunika kwa shuga kumaphimbidwa munthawi imeneyi chifukwa cha chakudya chamafuta omwe amakhala mkaka, zipatso ndi ndiwo zamasamba. Shuga wotsekemera bwino, maswiti ndi mafuta ziyenera kuchepetsedwa nthawi yakubwezera,

Pamaso pa ketosis yayikulu ndi acetonuria, kayendedwe ka mafuta kamayenera kukhala kochepa kwambiri, kwinaku kumakhalabe kwabwinobwino kapenanso kukulitsa chakudya. Tchizi wopanda mafuta kanyumba, chimanga, mbale zouma zanyama zimayikidwa. Muubwana, musagwiritse ntchito mankhwala opatsirana a antiidiabetes (sulfonylureas ndi biguanides).

Poterepa, ndikofunikira kuganizira kukhudzidwa kwa thupi la mwanayo kuti apange insulin. Jekeseni imachitika ndi nthawi ya maola 8, poganizira mawonekedwe a glucosuric: onjezani mlingo pambuyo pake mumatuluka shuga mu mkodzo, ndikuchepetsa Mlingo womwe umapangitsa kutsika kwa glucosuria kwakukulu.

Kukonzekera kwa insulin kwa nthawi yayitali sikuyenera kugwiritsidwa ntchito ngati akuganiza kuti akudwala matenda ashuga. Pofuna kupewa lipodystrophy, mawebusayiti a insulin ayenera kusinthidwa. Mukamalipiritsa odwala matenda a shuga, kuchita masewera olimbitsa thupi kumasonyezedwa, kusenda kumaloledwa, kuloleza kuyang'aniridwa ndi adokotala ndi makolo. Sizoletsedwa kuchita nawo masewera. Chithandizo cha matenda ashuga komanso hypoglycemic (onani. Coma).

Kupewa

Khazikitsani kuwunika kwa ana ochokera m'mabanja omwe muli odwala matenda ashuga. Nthawi ndi nthawi werengani za shuga m'magazi ndi mkodzo, kuchepetsa kugwiritsa ntchito maswiti. Poyang'aniridwa ndi ana ndi ana omwe amabadwa ndi kulemera kwakukulu kwa thupi (zoposa 4 kg). Mwa ana omwe ali ndi zizindikiro za prediabetes kuchokera pagulu langozi, ma glycemic curves okhala ndi katundu awiri amawunika.

• Mwanayo amayamwa mwaulesi ndipo kwenikweni salemera.
• Mwana amakodza pafupipafupi komanso kwambiri.
• Kusunthika kwa asidi-maziko olimbitsa thupi kuloza mbali ya acid, kapena acidosis, yomwe imadziwonetsera kulephera kupuma, mtima ndi kununkhira kwa maapulo wowawasa kuchokera mkamwa.
• Kuchepa kwa thupi la mwana, komwe kumatha kukayikiridwa ndi khungu lotayirira, kufooka kwa mucous membal, kufooka, kupuma mofulumira komanso palpitation.
• Mu kuyesedwa kwa magazi - kuchuluka kwa glucose mpaka 9 mmol / l musanadye, ndi 11 mmol / l - pambuyo, kukhalapo kwa matupi a ketone.
• Mukuyesedwa kwa mkodzo - kukhalapo kwa shuga, ndipo, kawirikawiri, matupi a ketone.

1. Mwana wakhanda asanabadwe amatha kukhala ndi ziphuphu zakukhazikika.
2. Cancreas wakhudzidwa ndi matenda omwe amapha ma cell omwe amapanga insulin.
3. Panali mankhwala omwe anali ndi poizoni pakudya.

• Kubetcha, kukodza pafupipafupi (kupaka malita a mkodzo 3-6 patsiku),
• Pambuyo pouma, ma diaper ndi nsalu zimakhala zolimba, ngati kuti sizowuma.
• Kununkhira kwa acetone kuchokera mkamwa
• Wocheperako
• Lethargy, nseru, kugona,
• Kuchepetsa kuthamanga kwa magazi, kuchuluka kwa mtima, kuchuluka kwa kupuma,
• Udzu wokhazikika
• Zotupa mwachangu, osachiritsika.
• Kuda nkhawa, kutulutsa madzi.

• Kumwa mankhwala ena mukakhala woyembekezera, monga mankhwala a antitumor,
• Kukhalapo kwa ma pathologies a chitukuko cha kapamba kapena kuwonongeka kwa ma virus a beta-cell,
• Pancreatic underdevelopment ndi prematurity,
• Makanda ochokera kwa amayi omwe ali ndi matenda ashuga amatenga kachilomboka.

Zofunikira

Matenda a shuga a neonatal amayamba chifukwa cha kusintha kwa jini komwe kumakhudza kupanga kwa insulin. Izi zikutanthauza kuti mulingo wa glucose m'magazi (shuga) m'thupi wakwera kwambiri. Chofunikira kwambiri cha matenda a neonatal matenda a shuga ndi kupezeka kwa matenda ashuga osakwana miyezi 6, ndipo umu ndi momwe zimasiyanirana ndi mtundu woyamba wa shuga, womwe sukukhudzika anthu osakwana miyezi isanu ndi umodzi.

Pafupifupi 20 peresenti ya anthu omwe ali ndi matenda ashuga tsopano ali ndi vuto lotukuka (monga kufooka kwa minofu, zovuta za kuphunzira) ndi khunyu. Matenda a shuga a neonatal ndi matenda osowa, mwachitsanzo, ku UK pakadali pano pali anthu ochepera 100 omwe amapezeka ndi matenda a neonatal shuga.

Pali mitundu iwiri ya matenda a neonatal shuga - osakhalitsa (osakhalitsa, osakhalitsa) komanso okhazikika (okhazikika, osasunthika). Monga momwe dzinali likusonyezera, matenda osokoneza bongo osakhalitsa mwa akhanda sakhala kwamuyaya ndipo nthawi zambiri amapita asanakwanitse miyezi 12. Koma matenda abwinobwino a shuga, monga lamulo, amakumbukiranso m'moyo, mwachizolowezi, mu unyamata.

Mwa njira, pomwe tikuwongolera kuchuluka kwa shuga m'magazi, glibenclamide ingathenso kusintha zizindikiro zakukula kwakanthawi. Ndikofunikira kudziwa ngati mwana wanu ali ndi matenda a shuga a neonatal kuti awonetsetse kuti akulandira chithandizo choyenera komanso upangiri (mwachitsanzo, kusiya insulin).

Kuyesa kwa ma genetic kuti mupeze matenda a neonatal matenda a shuga ndikofunikira kutero msanga, chifukwa kuyesedwa kwa majini ndikofunikira kuti mutsimikizire amtunduwo musanalingalire zakusintha kwina .Ngati mwana wanu wapezeka ndi matenda ashuga isanakwane miyezi isanu ndi umodzi, Funsani dokotala wanu kuti akuthandizeni mayeso a matenda a shuga.

Mavuto

Matendawa amakhala ndi zovuta komanso zotsatirapo zake. Ngati inyalanyazidwa kapena kuchitiridwa mosayenera, mavuto monga:

1. Coma yotsika kwambiri m'magazi a shuga ndi hypoglycemic.
2. Matenda a shuga a ketoacidosis ndikusintha kosalamulika kwamas shuga.
3. Kuwonongeka kwamaso, khungu.
4. Lag mu chitukuko.
5. Ischemia wamtima.
6. Zilonda zam'mimba za miyendo, phazi la matenda ashuga.
7. Kulephera kwina.
8. Kusokonezeka kwazungulira muubongo.
9. Lactic acidosis.

Zosintha zimatha kuchitika zomwe sizikugwirizana ndi matenda ashuga, koma chifukwa cha matenda omwe mwapeza: matenda a pakhungu ndi matenda a mucous membrane.