Kodi ndichifukwa chiyani kuyesedwa kwa glucose pakubala?

Yasinthidwa komaliza 03/09/2018

Kukhala ndi pakati kumakhala kovuta kwambiri m'thupi la mkazi, mosaganizira zaka. Hormonal dongosolo, kagayidwe ka mayi wapakati amakumana ndi zinthu zosadziwika. Ichi ndichifukwa chake ndikofunikira nthawi zonse kuwunikira momwe mayi amakhalira nthawi imeneyi podutsa mayeso osiyanasiyana. Ngakhale mayi atawona kuti amadya nthawi yayitali, azimayi oyembekezera amatha kupitilizidwa ndi matenda ashuga.

Zomwe zimachitika ndi matenda ashuga mwa amayi apakati

Matenda a shuga apakati ndikuphwanya kukonzanso kwa glucose, komwe m'mbuyomu sikunali kotheka kwa mayi woyembekezera ndipo adawonekera koyamba pokhapokha panthawi yopanga pakati. Vutoli ndilofala kwambiri - kutengera gulu lomwe lasankhidwa phunziroli, pafupifupi, azimayi 7 mwa 100 aliwonse omwe ali ndi matenda ashuga mwa amayi apakati. Chithunzithunzi cha matenda ashuga oterowo sichimangobwereza mwachindunji mtundu wamavuto omwe ali nawo mwa anthu omwe si oyembekezera, koma samachepetsa chiopsezo chawo kwa mayi woyembekezera ndipo ndi vuto lalikulu lomwe limabweretsa chiwopsezo chachikulu kwa mayi ndi wam'ng'ono mkati mwake. Amayi omwe ali ndi matenda a shuga, omwe amapezeka woyamba ali ndi pakati, ali pachiwopsezo chachikulu chotenga matenda obwera ndi matenda a insulin mtsogolo.

Pa nthawi yoyembekezera, thupi limasintha pamavuto omwe limayenera kukhalapo kwa miyezi ingapo yotsatira, ndipo kuwonjezereka kwa insulin kukhudzana ndi zochitika panthawiyi, zomwe zimadziwika ndi kuwonjezeka kwa insulini komanso kuchuluka kwa zomwe zili m'magazi. Mpaka pakati pa trimester yachiwiri, kuchuluka kwa glucose m'magazi a mayi wapakati kumakhala kocheperapo kuposa kwa mkazi yemwe alibe, ngati kuwunika kumachitika pamimba yopanda kanthu. Pathology nthawi zambiri imakhazikika mu theka lachiwiri la trimester yachiwiri ndipo pambuyo pake imangokulira. Cholinga chake ndikuti placenta iyenera kupereka mwana wosabadwayo mokwanira ndi glucose yofunikira pakukula kwake. Chifukwa chake, placenta pachifukwa ichi imayamba kupanga mahomoni, omwe amakhudza chikhalidwe cha mayi. Ngati mayi ali ndi matenda ashuga azimayi apakati, kupangika kwa mahomoni amenewo kumathina ndipo insulin imakana ndipo kapangidwe kake kamakhala kovuta.

Kusanthula g lucosolerance mayeso

Kuyeserera kwa glucose kumafunikira kuti mupeze vuto la kusamba kwakanthawi ndikuthandizira popanda kupewa zovuta zowopsa kwa mayi woyembekezera ndi mwana wosabadwayo. Dzinalo lolondola ndi mayeso a glucose kulolerana poyeserera (PGTT). Zotsatira zake zimapangitsa kuti azitha kuzindikira ndikuchotsa panthawi yake zovuta za carbohydrate metabolism mwa mayi wapakati. Mimba ndimakutu kwa ziwalo zonse ndi machitidwe a thupi la mkazi, chifukwa chake ndikofunikira kuti musaphonye ndikuwona kuwonjezeka kwa shuga m'magazi.

Matenda a shuga mwa amayi apakati amawonetsedwa makamaka mwa azimayi panthawi yomwe akuyembekezera mwana. Ngati vutolo likuyang'aniridwa, ndiye kuti, monga zilonda zambiri zosasangalatsa zomwe zimatuluka nthawi ya pakati, matenda ashuga adzazimiririka okha atabereka. Komabe, ngati kuphwanya kumeneku sikuwongoleredwa ndikusiyidwa mwamwayi, kumatha kukhalabe ndi kusokoneza moyo wanu pambuyo pobadwa kwa mwana yemwe akuyembekezeredwa kwa nthawi yayitali, kumabweretsa ndizoletsa zambiri komanso zovuta zaumoyo kwa mayi wachichepere, zomwe zimayenda naye moyo wake wonse.

Mayi woyembekezera amatha kumayikirira yekha matenda ashuga, poyang'anira kusintha kwa thupi lake. Ndi chitukuko cha matenda ashuga mwa amayi apakati, Zizindikiro sizimasiyana ndi matenda a shuga, omwe samadalira insulin: mzimayi amatha kumverera chikhumbo chowonjezereka cha kumwa, kulakalaka kudya, kapena, m'malo mwake, kupezeka kwake kwathunthu. Pakhoza kukhala chisokonezo pamene kukodza komanso kuchuluka kwa mkodzo mchimbudzi kuch kuchuluka. Ngakhale masomphenya amatha kukula, kusokonezeka! Kodi tinganenenji za kuthamanga kwa magazi? Ndi chitukuko cha matenda ashuga, kupanikizika kumatha kuchuluka kwambiri, komwe kumabweretsa chisokonezo osati cha amayi okha, komanso cha mwana wosabadwayo, ndipo chitha kukhala ndikuwopseza kuthetsedwe kwa kutenga pakati kapena kubereka. Ngati mukumva chimodzi mwazizindikirozi, onetsetsani kuti mwamuuza dokotala za izi ndikupempha kuti akutumizireni kuti muphunzire shuga ndikupatula shuga.

Zisonyezero za matenda amiseche

Mtsikana woyembekezera akabwera kudzalembetsedwa, adokotala amakhala ndi nthawi yomufufuzira kuti adziwe kuti izi zikuchitika mpaka sabata la 24 la mimba: muyenera kumutumiza kuti akafufuze kuchuluka kwa shuga m'magazi ndi / kapena kuchuluka kwa hemoglobin ya glycated. Ngati pali shuga wodziwika bwino, glucose wothamanga adzakhala pamwamba pa 7 mmol / lita (kapena pamwamba pa 11 mmol / lita pamene amapereka magazi osakhazikika), ndipo mulingo wa hemoglobin woposa 6,5 ​​peresenti. Kuphatikiza apo, ndizomveka kuwonjezera mayi wam'tsogolo m'gulu lowopsa ngati ali ndi shuga yoposa 5.1 mmol / lita imodzi m'mawa asanadye, koma osaposa 7 mmol / lita.

Asanathe milungu 24, kuyezetsa koteroko kuyenera kuchitidwa kokha kwa amayi omwe ali ndi chiyembekezo chakukula kwa amayi apakati, koma omwe ali ndimagazi a shuga m'magazi abwinobwino. Kodi ndi ndani amene ali pachiwopsezo chotenga matendawa? Choyamba, awa ndi azimayi onenepa - ngati BMI yawo imaposa 30 kg pa mita imodzi. Kachiwiri, awa ndi azimayi omwe abale awo adadwala matenda ashuga. Kenako pakubwera azimayi omwe apanga izi pamasiku apakati oyembekezera, ngakhale shuga wawo wamagazi anawonjezereka kapena malingaliro a shuga anali operewera. Chachinayi, azimayi omwe adakweza shuga mkodzo wawo. Amayi ena onse omwe alibe matendawa amayenera kukhala otetezeka ndikumayezetsa magazi kwa milungu 24-28. Mwambiri, kusanthula uku kukhoza kuchitika mpaka milungu 32 ya mimba. Pambuyo pake mayeserowa ndi osatetezeka kwa mwana wosabadwa!

Kodi zimachitika bwanji kuti nthawi yosangalala kwambiri kwa mkazi (nthawi yobala mwana wake), mkhalidwe woopsa monga matenda ashuga azimayi apakati amakula? Chowonadi ndi chakuti kapamba amachititsa insulin yomwe ili m'magazi, yomwe imayikiridwa ndi katundu wamkulu panthawi yapakati. Ngati kapamba sakugwirizana ndi kupanga kwa insulin, ndiye kuti kuphwanya kumachitika. Insulin ndi yomwe imapangitsa kuti shuga azikhala mthupi lathu. Ndipo mkazi akanyamula mwana, thupi lake limagwira ntchito kwa awiri, amafunika insulin yambiri. Ndipo, ngati sikokwanira kukonzanso kwazokha shuga, ndiye kuti kuchuluka kwa glucose kumakulanso.

Kodi matenda ashuga apakati ndi owopsa kwa mwana wosabadwa?

Mosakayikira! Kuti muteteze mimba, ndikofunikira kuti placenta ipange cortisol, estrogen ndi lactogen. Mwanjira yodekha, kupangika kwa mahomoni awa sikusokoneza. Komabe, kuphwanya kapangidwe ka insulin, mahomoni awa ayenera kuteteza ufulu wawo kukhalapo! Pomenya nkhondo kuti akhalebe mulingo wawo, zimatha kukhudza kugwira ntchito koyenera kwa kapamba, komwe kumakhudza osati mayi wapakati, komanso khanda mkati mwake.

Ngati matenda ashuga adawoneka wachiwiri patatha sabata la makumi awiri, ndiye kuti sizowopsa kwa mwana wosabadwayo ndipo sizingayambitse kukula kwamtsogolo kwa munthu wam'tsogolo. Koma pali chiyembekezo choti chitukuko cha fetal fetal chimayenderana ndi kukhalapo kwa matenda ashuga - omwe amatchedwa kudyetsa mwana wosabadwayo, kuchuluka kwake, komwe, monga kulemera kwambiri mwa munthu wamkulu, kumatha kutsogolera kukula kwa ziwalo ndi machitidwe a mwana. Mwanayo amakula kwambiri kulemera kwake komanso kutalika kwake chifukwa choti shuga wambiri amabwera kwa iye. Mwanayo sanakonzekere kwathunthu kapamba, yemwe sangathe kuthana ndi kuchuluka kwa shuga ndikuwusandutsa minofu ya adipose. Zotsatira zake, pali kuchuluka kwa lamba la phewa, ziwalo zamkati: mtima, chiwindi. Zosanjikiza zamafuta zimachuluka.

Chimawoneka ngati choyipa chachikulu? Amayi amasangalala ndi kukula kwa ana awo, kubadwa kwa bootuz koteroko. Koma zili choncho ngati kubadwa kunachitika popanda zovuta. Khanda lalikulu limakhala pachiwopsezo chakubereka kwa nthawi yayitali - chifukwa cha lamba wamkulu wam'mapewa, zimavuta kuti mwana adutse mumsewu wa amayi. Kutenga nthawi yayitali kumatha kubweretsa hypoxia, osanenapo za kubadwa kwa zowawa. Ntchito yovuta imatha kuwononga ziwalo zamkati mwa mayi. Ngati mwana mkati mwa chiberekero ndi wokulirapo, ndiye kuti izi zitha kuchititsa kuti mwana abadwe asanabadwe, ndipo mwana sangakhale ndi nthawi yakukula mpaka kumapeto.

Mwana akangobadwa kumene amakhala chimtolo chachikulu m'mapapu a mwana. Mpaka nthawi yayitali, mapapu sakhala okonzeka kupuma mpweya woyamba - satulutsa mpweya wokwanira (chinthu chomwe chimathandizira mwana kupuma). Pankhaniyi, mwana atabadwa adzaikidwa mu chipangizo chapadera - chofungatira chothandizira kupuma.

Ngati kuyeserera kwa glucose sikungachitike

1. Ndi toxosis woyamba trimester, limodzi ndi kusanza ndi mseru.
2. Ndi kuchepa kwa mota ntchito za amayi apakati pamaso pogona.
3. Mukadwala kapena matenda opatsirana.
4. Ngati pali mbiri yodwala kapamba kapena kale m'mimba.

Ngati magazi asanatuluke kuchokera pachala sichinawonetsere kuchuluka kwa shuga m'magazi - palibe chifukwa choyeserera ndipo magazi amayesedwa shuga kuchokera m'mitsempha kuti asatuluke matenda ashuga.

Kodi mayeso ololera a glucose ali bwanji?

Kwa mphindi zisanu mkazi amamwa kapu yotsekemera ya madzi osakhalitsa okhala ndi magalamu 75 a shuga wowonjezera pamwamba pa kutentha kwa thupi. Pa kuyezetsa kumeneku, magazi a venous amafunikira katatu: choyamba pamimba yopanda kanthu, kenako ola limodzi ndi maola awiri mutatenga tambala. Ndikothekanso kugwiritsa ntchito madzi a m'magazi pakufufuza. Pereka magazi mosamala m'mimba yopanda kanthu m'mawa. Izi zisanachitike, musadye usiku wonse, makamaka maola 14 musanapereke magazi. Popanda malangizo a dokotala wina, mayesowo amachitika pa 6 mwezi wa 6 woyembekezera mothandizidwa ndi dokotala - chikhumbo chosavomerezeka cha wodwala chochita GTT sichovomerezeka.

Kukonzekera mayeso

Masiku atatu kumayeso, musadalire maswiti, onetsetsani kuchuluka kwamadzimadzi, osagwiritsa ntchito kwambiri masewera olimbitsa thupi osapatula poizoni. Kuphatikiza apo, simungagwiritse ntchito mankhwala omwe angakhudze zotsatira za phunziroli - mapiritsi othandizira kubereka, salicylates, mahomoni, mavitamini. Ngati mukufuna kumwa mankhwalawa, mayi woyembekezera amatha kuyambiranso kumwa pambuyo poyeserera. Kuchoka kwa mankhwala pokonzekera mayeso kuyenera kuchitika moyang'aniridwa ndi adokotala. Madzulo a mayeso, simungamwe mowa. Patsiku la mayeso, simuyenera kuchita zinthu mopitirira muyeso, koma izi sizitanthauza kuti muyenera kugona nthawi zonse.

Mayeso a kulolera a glucose

Pankhani yoyesedwa kwa maola awiri ndi katundu komanso kuyezetsa magazi kawiri, matenda osokoneza bongo amatha kupezeka ngati chizindikiro chimodzi cha shuga chili pamwamba pa 7 mmol / lita imodzi pamimba yopanda kumwa madzi okoma ndi 7.8 mmol / lita imodzi atatha kumwa maola awiri madzi okoma.

Izi zidaganiziridwa m'mbuyomu, koma malamulo atsopanowa amafuna kukonzanso. Pakadali pano, World Health Organization imatsatira miyezo ina, yomwe imagwirizana ndi akatswiri a Association of Obstetrician-Gynecologists of Russia.

Panthawi yovomerezeka Zizindikiro izi zikuyenera kukhala:

1. Asanadye pamimba yopanda kanthu, shuga wamagazi sayenera kupitirira 5.1 mmol / lita.
2. Ola limodzi mutatenga madzi okoma - osaposa 10,0 mmol / lita.
3. Maola awiri mutamwa chakumwa chokoma, shuga wamagazi sayenera kupitirira 8.5 mmol / lita.

Kusiyanitsa kusiyanasiyana kwa matenda ashuga apakati komanso shuga yayikulu

Ndi chitukuko cha matenda a shuga Zizindikiro zidzakhala motere:

1. shuga wamagazi akayesedwa m'mimba yopanda kanthu kuchokera pa 5.1 mpaka 6.9 mmol / lita.
2. patatha ola limodzi mutatenga madzi okoma - oposa 10,0mmol / lita.
3. patatha maola awiri mutamwa mankhwalawa - kuyambira 8.5 mpaka 11.0 mmol / lita.

Pamaso pa shuga timapeza manambala awa:

1. shuga m'magazi popereka zinthu pamimba yopanda kanthu - zoposa 7.0 mmol / lita.
2. ola limodzi mutatha kuchita masewera olimbitsa thupi, kuchuluka kwa glucose m'magazi kulibe miyezo ina.
3. patatha maola awiri mutamwa madzi okoma, shuga m'magazi azidutsa 11.1 mmol / lita.

Ngati mwapambana mayeso a GTT, ndipo zotsatira zake sizinakusangalatseni, pitani kuchipatala mwachangu! Osamadzichitira nokha mankhwala mulimonse!

Chifukwa chiyani kuyesedwa kwa glucose ndikofunikira?

Matenda a gestational ndi matenda omwe amakhudza azimayi oyembekezera okha. M'mikhalidwe imeneyi, kuchuluka kwa shuga mumagazi kumawonedwa. Matenda a gestational amakhudza 14% ya amayi apakati.

Kodi nchiyani chinayambitsa izi? Kuti mutenge shuga, timadzi tating'onoting'ono timene timapangidwa ndi kapamba, timafunika. Pa nthawi yoyembekezera, kapamba wa mkazi amayenera kudzipangira yekha, komanso mwana. Chifukwa chake, kupanga insulin panthawi yapakati kumachuluka. Komabe, nthawi zina kuwonjezeka kumeneku sikungakhale kokwanira, kenako shuga wowonjezera amapangidwa m'magazi.

Kuchuluka kwa shuga pa nthawi ya mimba kumachitika ndi:

• kuwonjezeka kwa kulemera kwa thupi la wakhanda komanso zovuta zokhudzana ndi kubadwa komanso kubadwa,
• Zoyipa pakati pa mimba, pathupi,
• zolakwika pakukula kwa fetal,
• diabetic fetopathy mu wakhanda.

Ngakhale mwana wodwala matenda ashuga akangobadwa alibe mavuto ndipo ali ndi thanzi, komabe pamakhala chiwopsezo chachikulu choti pambuyo pake adzadwala matenda a shuga a mtundu wachiwiri.

Ichi ndichifukwa chake madokotala amatenga matenda ashuga kwambiri. Matendawa ndi osakhalitsa m'chilengedwe, ndipo nthawi zambiri amadutsa popanda kufufuza pambuyo pobadwa kwa mwana.

Kuyeserera kochita masewera olimbitsa thupi kumachitika pofuna kuthana ndi matendawa. Kupatula apo, Zizindikiro za matenda ashuga panthawi yomwe ali ndi pakati sizolunjika kwambiri, ndipo sizotheka kuzindikiritsa nthendayi mosazindikira. Nthawi zina mzimayi yemwe akuvutika ndi GDM amatha kumva kufooka kapena chizungulire, kusintha kusowa kudya, ludzu lalikulu. Koma mu 99% yamilandu, zizindikiro zonsezi zimadziwika chifukwa choyipa chomwe chimapangitsa kuti pakhale mimba.

Kuyesedwa nthawi zambiri kumakonzedwa kwa masabata 14-16. M'mbuyomu, sizikupanga nzeru kuyesa, chifukwa m'nthawi zoyambirira, kupatuka kwa shuga komwe kumachitika chifukwa cha pakati nthawi zambiri sikumawonedwa. Chokhacho kupezeka kwa kupezeka kwa shuga m'magazi a wodwalayo pakuwunika kwamankhwala am'thupi. Pankhaniyi, kuyesedwa kutha kuchitika kuyambira milungu 12.

GTT ina yoyeserera ikhoza kutumikiridwa, koma kumayambiriro kwa trimester yachitatu (masabata 24-28). Komabe, pakatha milungu 32, kuyezetsa kumayesedwa, chifukwa kumatha kuvulaza mwana wosabadwa.

Nthawi zina, madotolo amapereka njira yopititsira kuyezetsa amayi onse apakati, pofuna kukhala otetezeka. Komabe, nthawi zambiri, malangizowo amaperekedwa kwa azimayi omwe ali pachiwopsezo:

• kunenepa kwambiri (index of body over 30),
• kukhala ndi abale apamtima odwala matenda ashuga
• mbiri yodwala matenda ashuga,
• kubereka ana owonjezera thupi (makilogalamu oposa 4),
• omwe apezeka ali ndi shuga posanthula mkodzo,
• kukhala ndi shuga wambiri (woposa 5.1) poyesa magazi:
• wokhala ndi mbiri ya ovary ya polycystic,
• zaka zopitilira 35
• omwe ali ndi pakati oyamba ndipo ali ndi zaka zopitilira 30.

Madokotala ena amapatsa mayeso okhudzana ndi glucose mu trimester yachiwiri yokha ya amayi okha omwe ali pachiwopsezo, komanso kumayambiriro kwa trimester yachitatu kwa wina aliyense.

Njira zowonera kagayidwe kazakudya

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Kuchuluka kwa matenda ashuga pakati pa azimayi oyembekezera ndi avareji ya 4,5% ku Russia m'chiwerengero chawo.Mu 2012, boma la Russia National Consensus lidatanthauzira GDM ndikulimbikitsa njira zatsopano zothandizira kudziwa matenda ake, komanso chithandizo ndi kuwunikira.

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Matenda a shuga oyembekezera ndi matenda omwe amadziwika ndi shuga wambiri, yemwe amapezeka kwa nthawi yoyamba, koma samakwaniritsa njira zomwe zimapezeka chifukwa cha matenda omwe angopezedwa kumene. Izi ndi izi:

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• kuthamanga shuga ndi wamkulu kuposa 7.0 mmol / l (apa mayina omwewo a mayunitsi) kapena wofanana ndi mtengo wake,
• glycemia, yotsimikiziridwa mu kusanthula mobwerezabwereza, komwe nthawi iliyonse tsiku lonse komanso osasamala chakudyacho ndi chofanana kapena chachikulu kuposa 11.1.

Makamaka, ngati mkazi ali ndi kudya kwa venous plasma shuga wochepera 5.1, komanso kuyeserera pakamwa glucose, osakwana 10.0 pambuyo pa ola limodzi atachita masewera olimbitsa thupi, osakwana 8.5 pambuyo pa maola awiri, koma oposa 7.5 Izi ndi njira zoyenera kwa mayi woyembekezera. Nthawi yomweyo, kwa amayi omwe sanali oyembekezera, zotsatirazi zikuwonetsa kuphwanya kwa kagayidwe kazakudya.

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Kodi kuyeserera kwa glucose kumatenga nthawi yayitali bwanji mukakhala ndi pakati?

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Kuzindikiritsa kagayidwe kazakudya kumachitika m'magawo:

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1. Kulemba Gawo I ndikofunikira. Amawonetsedwa paulendo woyamba wa dokotala wa mbiri iliyonse ndi mzimayi mpaka masabata 24.
2. Pa gawo lachiwiri, kuyezetsa magazi m'magazi kumachitika ndi magalamu 75 a shuga kwa masabata 24-28 oyembekezera (kwathunthu - masabata 24-26). Nthawi zina (onani pansipa), kuwerengera kotereku kumatha mpaka masabata 32, pamaso pa chiwopsezo chachikulu - kuyambira masabata 16, ngati shuga wapezeka mukuyesedwa kwamkodzo - kuyambira masabata 12.

Gawo I ndimakhala ndi kafukufuku wa labotale wosala kudya madzi am'madzi atatha kudya kwa maola 8 (pafupifupi). Kuyesedwa kwa magazi ndikothekanso komanso mosasamala zakudya. Ngati miyambo imakhala yopitilira, koma kuchuluka kwa shuga m'magazi ndi ochepera 11.1, ndiye ichi ndichizindikiro chobwereza kafukufuku pamimba yopanda kanthu.

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Zotsatira zoyesedwa zikakwaniritsa zomwe zimayambitsa matenda oyamba kudwala (kuwonetsa) shuga, mayiyo amatumizidwa kwa endocrinologist kuti awonenso ndi kulandira chithandizo choyenera. Pankhani ya kudya mwachangu pamwamba pa 5.1, koma osakwana 7.0 mmol / L, GDM imapezeka.

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Njira Yoyesera

Mayeserowa amakonzekera m'mawa kwambiri (kuyambira maora 8 mpaka 11). Musanayesedwe, muyenera kuphunzitsidwa - osadya chilichonse kwa maola 8 mpaka 14 (monga adokotala akunenera). Simungathe kumwa mankhwala ngati chakudya chamagulu ali ndi kapangidwe kake. Mankhwala osokoneza bongo a diuretic, glucocorticosteroids, mavitamini, kukonzekera kwazitsulo ndizoletsedwa. Saloledwa kumwa mowa, utsi, kumwa khofi. Amaloledwa kumwa madzi okha osakhala ndi kaboni. Komabe, madzi amathanso kuledzera m'miyeso yaying'ono ndipo osati yomweyo mayeso asanachitike.

Mutha kumwa madzi musanayesedwe.

Ndikofunika kuzindikira mkhalidwe wina - zakudya m'masiku atatu omalizira GTT isanakhale yabwinobwino, popanda choletsa chokwanira chamafuta.

Mutha kuda nkhawa kwambiri, kuchita masewera olimbitsa thupi.

GTT imatenga nthawi yayitali kwambiri - maola 2,5 mpaka 3,5. Mkazi akabwera ku labotale, amapatsidwa mwayi wokhala pansi ndikupumula. Pakatha mphindi 20-30, sampuli ya magazi imatengedwa kuchokera kwa iye. Maselo onse amwazi amatengedwa kuchokera mu mtsempha. Izi magazi magazi. Kenako, mtengo wa glucose m'magazi umayezedwa. Ngati shuga ali mkati moyenera, kuyezetsa kwinanso kumachitika, apo ayi, ngati shuga ndiwokwera kwambiri, matenda osokoneza bongo kapena apezanso shuga wowona wapezeka.

Kenako mayiyo amapatsidwa kapu ya chakumwa (250 ml) yamadzi ofunda (+ 37-40 ° C), pomwe 75 g ya shuga imasungunuka. Njira yothetsera vutoli iyenera kukhala yoledzera pasanathe mphindi 5. Njira yothetsera vutoli ndi yabwino kwambiri, kotero ngati mkazi amakhala ndi mseru pafupipafupi, mwachitsanzo, chifukwa cha toxicosis yokhala ndi pakati, ndiye kuti kuyezetsa kumayikidwa.

75 g shuga wa mayeso a GDM

Kutalika kotsatira, kapu itatha kumwa, mkazi ayenera kupuma. Ndikwabwino kungokhala kapena kugona (monga dokotala wanena).

Patatha ola limodzi atamwa shuga, mayi amatenga wina magazi, ndipo atatha maola 2 - wina. Zingwezizi zikufufuzidwanso, ndipo malinga ndi zotsatira za kafukufukuyu, madokotala amapanga zigamulo zawo. Ngati zotsatira zake zili zabwino, zitsanzo zachitatu zimatha kuchitika, pambuyo pa maola 3. Mpaka kuyezetsa magazi komaliza, mayi wapakati saloledwa kudya kapena kumwa. Musachite masewera olimbitsa thupi kapena kuyenda.

Kuchulukitsa kwa magazi kuchokera m'mitsempha panthawi yoyesa

Pofuna kukayikira kukhalapo kwa GDM mwa mkazi, ndikofunikira kuti pama sampu ziwiri zamagazi mtengo ukadakhala wopitilira muyeso wamba.

Komabe, mawu omaliza sangakhale omaliza. Ngati zotsatira zake zili za mtengo wamalire, ndipo sitinganene kuti mayi woyembekezera ali ndi GDS, kapena mukukayikira kuti wodwalayo adatsata malamulo onse pokonzekera mayeso, adotolo atha kukulemberani zovomerezeka. Nthawi zambiri amachitika 2 milungu itatha yoyamba yobereka.

Komanso, musanapange matenda, ndikofunikira kupatula ntchito yowonjezera ya adrenal gland kapena chithokomiro, komanso kumwa mankhwala a corticosteroid.

Ndi zinthu ziti zomwe zingayambitse zosokoneza pazotsatira:

• kusowa kwa magnesium ndi potaziyamu,
• matenda achilengedwe komanso endocrine,
• kupsinjika
• zolimbitsa thupi musanayambe kuyesa komanso mkati mwa mayeso,
• kumwa mankhwala ena (corticosteroids, beta-blockers).

Kuyeserera kwa glucose pakamwa sikungavulaze mayi wapakati kapena mwana wake, pokhapokha ataperekedwa.

Zotsatira za kuyeserera kwa glucose:

• matenda oopsa a toxosis,
• matenda a chiwindi
• pachimake kapamba kapena cholecystitis,
• zilonda zam'mimba
• Matenda a Crohn
• kutaya matenda (kudya kwathamanga kwambiri kuchokera m'mimba kupita m'matumbo),
• matenda otupa a pachimake
• ARI kapena ARVI (muyenera kuyembekezera kuchira),
• kusala shuga pamwamba 7 mmol / l,
• kupweteka kwam'mimba kwa etiology yosadziwika,
• Mimba yayitali masabata 32.

Simungathe kuyesa mayeso a glucose ngakhale mayi atayikidwa kuti apumule pakama.

Nthawi zina, kuyesa kwa makolo kungachitike m'malo mwa kuyeseza pakamwa. Potsatira mayeso amenewa, glucose amalowa m'mitsempha.

Zotsatira zakuyesa.

Zotsatira zoyesa kuposa zomwe zaperekedwa pagomezi zikuwonetsa HDM. Ngati muyeso woyamba udawonetsa zoposa 7 mmol / L kapena muyezo wachitatu - woposa 11 mmol / L, matenda a shuga awonekera.

Mayeso a kulolerana ndi gluyose

Momwe mungapangire mayeso okhudzana ndi glucose panthawi yomwe muli ndi pakati

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Kuyesa kwa kulolera kwa glucose kumachitika kwa akazi onse milandu:

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1. Kusakhalapo kwa kupatuka kwazomwe zikuchitika pazotsatira zoyambirira za mayeso koyambirira kwa mayeso.
2. Kukhalapo kwa chimodzi mwazizindikiro za chiwopsezo chachikulu cha GDM, zizindikiro za ultrasound zamatenda a metabolism mu fetus kapena kukula kwina kwa fetal. Pankhaniyi, mayesowa atheka kuphatikiza sabata la 32.

Zizindikiro zoopsa kwambiri zikuphatikiza:

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• kunenepa kwambiri: Mloza wam'mimba ndi 30 kg / m 2 ndi pamwamba,
• kukhalapo kwa matenda ashuga oyandikira kwambiri (m'badwo woyamba) abale,
• The kukhalapo m'mbuyomu gestational shuga mellitus kapena kagayidwe kachakudya matenda, mu nkhani iyi, kuyezetsa kumachitika paulendo woyamba wa madokotala (kuyambira 16 milungu).

Kodi mayeso ololera wama glucose ndi owopsa panthawi yomwe ali ndi pakati?

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Phunziroli lilibe vuto kwa mayi ndi mwana wosabadwa mpaka milungu 32. Kuchita pambuyo pa nthawi yovumbulutsidwa kumakhala koopsa kwa mwana wosabadwayo.

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Kuyesedwa sikuchitika:

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• poyizoni koyambirira kwa amayi apakati,
• pogona,
• kukhalapo kwa matenda am'mimba opaka,
• kukhalapo kwa cholecystopancreatitis aakulu pachimake siteji,
• kukhalapo kwa matenda opatsirana oyipa kwambiri kapena otupa.

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Zochitika zathupi

Mu kapamba kaumunthu, mahomoni awiri akuluakulu amapangidwa omwe amawongolera kagayidwe kazakudya - insulin ndi glucagon. Mphindi 5 mpaka 10 mutatha kudya chakudya, ndende ya magazi imadzuka. Poyankha izi, insulin imamasulidwa. Hormayo imalimbikitsa kuyamwa kwa shuga ndi minofu ndikuchepa kwake ku plasma.

Glucagon ndi wokonda mahomoni wa insulin. Panjala, kumapangitsa kuti shuga atulutsidwe m'magazi ndikuwonjezera kuchuluka kwa shuga m'madzi a m'magazi.

Nthawi zambiri, munthu alibe magawo a hyperglycemia - kuchuluka kwa shuga m'magazi kuposa kwazonse. Insulin imapereka kuyamwa mwachangu ndi ziwalo. Ndi kuchepa kwa kaphatikizidwe ka timadzi tating'onoting'ono kapena kuphwanya kwamphamvu kwa izo, ma pathologies a carbohydrate metabolism amachitika.

Mimba imakhala pachiwopsezo cha metabolic metabolologies. Pakatikati mwa nyengo yachiwiri ya nthawi ya bere, kuchepa kwamphamvu kwa thupi kumawonedwa. Ichi ndichifukwa chake pofika nthawi imeneyi, azimayi ena oyembekezera amayambanso kudwala matenda ashuga.

Madeti

Akatswiri ambiri amalimbikitsa kuyesa pakati pa milungu 24 ndi 26 ya bere. Pofika nthawi imeneyi, kuchepa kwamphamvu kwa insulin kumachitika.

Ngati kuli kosatheka kuchita kusanthula panthawi yomwe ikunenedwa, kupatula milungu 28 kumaloledwa. Kuunikiridwa pambuyo pake pa tsiku lanyengo ya gestation ndikotheka kwa dokotala. Pakuyamba kwa trimester yachitatu, kuchepa kwambiri kwa insulin sensitivity kwalembedwa.

Sikoyenera kupereka mayeso mpaka masabata 24 mwa azimayi osayanjana ndi zoopsa. Kutsika kwakuthupi pakulekerera kwa insulini sikumawonedwa kawirikawiri m'chigawo choyamba cha mimba.

Komabe, pali magulu omwe ali pachiwopsezo cha kufooketsa kagayidwe kazakudya. Amayi otere amawonetsedwa mayeso ololera a glucose awiri. Kusanthula koyamba kumayikidwa kumayambiriro kwa trimester yachiwiri ya kutenga pakati - pakati pa 16 ndi 18 milungu. Kusanthula kwachiwiri kwa magazi kumachitika monga momwe anakonzera - kuyambira 24 mpaka 28 milungu. Nthawi zina azimayi amawonetsedwa kafukufuku wowonjezera mu nyengo yachitatu ya mimba.

Chiyeso chimodzi chamagazi chololera chimawonetsedwa kwa amayi onse oyembekezera. Kusanthula kumakupatsani mwayi kuti mupeze matenda osokoneza bongo ndikusankha chithandizo chamankhwala koyambirira.

Mkazi aliyense ali ndi ufulu wosankha funso lokhudza mayeso. Ngati mukukayika, mayi woyembekezera akhoza kusiya kuphunzira. Komabe, madokotala amalimbikitsa GTT yovomerezeka ya azimayi onse oyembekezera.

Milandu yambiri ya matenda a shuga a gestational is asymptomatic. Matendawa amawopseza kwambiri moyo ndi thanzi la mwana wosabadwa. Ndi mayeso ololera wa glucose omwe amakupatsani mwayi wopeza matenda musanayambike zizindikiro.

Pali magulu 7 oopsa omwe kuyesedwa kwa shuga kumawonetsedwa kawiri:

1. Amayi amtsogolo omwe ali ndi mbiri yodwala matenda ashuga.
   
2. Kukhalapo kwa kunenepa kwamkati - index yam'mimba pamtunda wa 30.
   
3. Ngati shuga adapezeka pakuyesa kwamikodzo mkodzo.
   
4. Kubadwa kwa mwana wokhala ndi misa yoposa 4000 gramu m'mbiri.
   
5. Mayi wamtsogolo ali ndi zaka zopitilira 35.
   
6. Mukamazindikira polyhydramnios pa ultrasound.
   
7. Kupezeka pakati pa abale odwala ndi kagayidwe kachakudya matenda.
   

Contraindication

Contraindication chifukwa chowunikirawo ndi vuto lalikulu lomwe mayi wapakati ali nalo. Ngati mukumva kusowa bwino patsiku lolemba, ndikulimbikitsidwa kusinthana ndi tsiku lina.

Kuyeserera kwa glucose sikulimbikitsidwa panthawi yopuma kwambiri kapena pakulimbana kwina. Glucose ndi malo osungiramo tizilombo tambiri, chifukwa chake kafukufukuyu amathandizira kuti vutoli likule.

Phunziroli silikulimbikitsidwa kwa anthu omwe ali ndi pathologies a gland a mkati. Matendawa amaphatikizapo acromegaly, pheochromocytoma, hyperthyroidism. Asanapereke kuwunika kwa odwala omwe ali ndi ma pathologies awa, endocrinologist ayenera kuthandizidwa.

Kuyeserera kwa glucose sikuyenera kuchitika mukamamwa glucocorticosteroids, hydrochlorothiazides, mankhwala a khunyu. Mankhwala amatha kupotoza zotsatira za kusanthula.

Ndi koletsedwa kuchititsa kafukufuku ndi matenda omwe amayamba chifukwa cha matenda osokoneza bongo - omwe adakhalapo asanakhale ndi pakati. Hyperglycemia yomwe imayamba chifukwa cha maziko ake ndiyowopsa kwa mwana wosabadwayo.

Sitikulimbikitsidwanso kuyeserera poyesa toxicosis ya amayi apakati. Pathology imathandizira zotsatira zoyesa zolakwika. Kusintha kwa mkaka kumathandizira kuchotsedwa kwa shuga mthupi.

Sizotheka kuchita kafukufuku potsatira kupumula kwa kama. Poyerekeza ndi maziko olimbitsa thupi ochepa, kuchepa kwa zochitika za pancreatic kumapangidwa.

Kuchitika

Kuyeserera kwa glucose kumachitika m'chipinda chachipatala kapena chipatala china. Njira yakuwunikiridwa imayikidwa ndi obstetrician-gynecologist wochititsa mayiyo. Magazi amatengedwa ndi namwino.

Gawo loyamba loyesa kulolera la glucose limaphatikizapo kutenga magazi kuchokera m'mimba yopanda kanthu. Mayi wamtsogolo amayika chopondera pamapewa, kenako singano imayikidwa mu chotengera cham'mbali chamapewa. Pambuyo pamankhwala ofotokozedwawo, magazi amatengedwa mu syringe.

Magazi osonkhanitsidwa amayesedwa kuchuluka kwa shuga. Ndi zotsatira zomwe zikugwirizana ndi chizolowezi, gawo lachiwiri likuwonetsedwa - kuyesedwa pakamwa. Mayi woyembekezera ayamwe kumwa shuga. Pakukonzekera kwake, magalamu 75 a shuga ndi ma millilitita 300 amadzi oyera ofunda amagwiritsidwa ntchito.

Hafu ya ola atatha kugwiritsa ntchito njirayi, mayi woyembekezera amaperekanso magazi kuchokera m'mitsempha. Mukalandira zotsatira zabwinobwino, mipanda yowonjezereka imawonetsedwa - pambuyo pa 60, 120 ndi maminiti a 180 kuchokera pakumwa shuga.

Pa kuyesedwa kwa kulolera kwa glucose, mayi woyembekezera amalangizidwa kuti aziyang'aniridwa ndi ogwira ntchito kuchipatala. Mayi woyembekezera amakhala nthawi yayitali pakati pa zitsanzo za magazi m'mbali mwa chipatala. Zachipatala zina zimakhala ndi maupangiri apadera, zikwatu, mabuku, ma TV.

Zoyenera kuchita ngati GTT yapeza matenda a shuga

Chithandizo cha matenda a shuga chimachitika ndi endocrinologist. Nthawi zambiri, kuchuluka kwa shuga pammimba kumatha kusungidwa m'njira yokhazikika pochita masewera olimbitsa thupi komanso zakudya. Zakudya zimaphatikizira kuletsa kwa chakudya chambiri (shuga, maswiti, chokoleti, zipatso zotsekemera ndi zakumwa), mbatata, pasitala. Njira zamankhwala izi zimachitika ngati shuga ya mayi woyembekezera siyikukwana kwambiri kuposa masiku onse.

Koma ngati njirazi sizikuthandizira, ndipo kuchuluka kwa shuga kukupitilira kukwera, kapena poyamba mayiyo amakhala ndi kuchuluka kwa shuga, ndiye kuti adokotala amatha kupatsa jakisoni wa insulin kwa wodwalayo. Kuphatikiza apo, kuwongolera kulemera kwa mwana wosabadwa kumachitika. Ngati matenda ashuga a gestational ayambitsa kuchuluka kwa fetal, ndiye kuti ndizotheka kuti gawo la caesarean lizichitika m'malo mwabwinobwino.

Miyezi 1-2 pambuyo pobadwa, kuyesanso kwina kumachitika. Ndikofunikira kuti zitsimikizike kuti shuga yayamba kukhala yabwinobwino, ndipo chithandizo china cha matenda ashuga sichofunikira. Kupanda kutero, zowonjezera zimachitika, ndipo mkazi amalembera chithandizo cha matenda amtundu 1 kapena matenda a shuga.

Mulingo wa kusanthula

Ndi kagayidwe kabwino ka chakudya, kuchuluka kwa shuga pambuyo pakusala kudya sikupitirira 5.1 mmol / L.Manambalawa akuwonetsa kugwira ntchito kwa kapamba - katemera woyambira woyambira.

Pambuyo poyesedwa pakamwa pachakudya chilichonse, shuga wa m'magazi nthawi zambiri sapitirira 7.8 mmol / L. Makhalidwe abwinobwino a kusanthula kumawonetsa chinsinsi chokwanira cha insulin komanso kumva bwino kwa minyewa.

Masiteji

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1. Kutenga magazi oyambira m'mitsempha ndikuwunika. Pomwe zotsatira zake zikuwonetsa kukhalapo kwa odwala omwe apezeka kumene kapena matenda a shuga, kafukufukuyu watha.
2. Kunyamula shuga ndi zotsatira zabwinobwino loyamba. Muli ndi wodwala omwe amatenga shuga wa 75 g osungunuka osungunuka mu madzi a 0.25 l otentha (37-40 ° C) madzi kwa mphindi 5.
3. Kutola ndi kusanthula kwa masampweya pafupipafupi kwa mphindi 60, kenako mphindi 120. Ngati zotsatira za kusanthula kwachiwiri zikuwonetsa kukhalapo kwa GDM, ndiye kuti gawo lachitatu la magazi litha.

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Kutanthauzira kwa zotsatira za mayeso a kulolera kwa glucose panthawi yapakati

Chifukwa chake, ngati pamimba yopanda kanthu kuchuluka kwa shuga m'magazi ndi ochepera 5.1 - izi ndiye zofunikira, pamwambapa 7.0 - kuwonetsa shuga, ngati aposa 5.1, koma nthawi yomweyo, m'munsimu 7.0, kapena mphindi 60 pambuyo glucose katundu - 10,0, kapena pambuyo pa mphindi 120 - 8.5 - iyi ndi GDM.

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Tab. 1 Malo osokoneza bongo a venous plasma glucose for diagnostic GDM

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Tab. 2 venous plasma glucose malo opezeka ndi matenda owonetsa matenda ashuga m'mimba

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Njira yolondola yodziwira ndi kuchiza matenda ashuga (ngati kuli kotheka) amachepetsa kuopsa kwa zovuta panthawi yomwe ali ndi pakati komanso pakubadwa kwa mwana wokha komanso kuchuluka kwa chiwopsezo chotenga matenda ashuga m'tsogolo kwambiri mwa azimayi omwe analingalira kale.