Kev Tswj Xyuas Kev Saib Xyuas Kev Yug Me Nyuam hauv Cov Neeg Mob Ntshav Qab Zib Hom 1
Pendahuluuan
Kab mob ntshav qab zib hom 1 (T1DM) yog ib yam kab mob autoimmune uas ua rau lub pancreas tsis tsim cov insulin txaus. Feem ntau cov mob no pib thaum yau lossis thaum hluas, tab sis ntau tus poj niam uas muaj T1DM tuaj yeem xeeb tub thiab yug menyuam tau zoo nrog kev saib xyuas kev yug menyuam kom zoo. Hauv kev yug menyuam, T1DM yog ib yam mob uas muaj kev pheej hmoo siab vim nws tuaj yeem cuam tshuam rau kev noj qab haus huv ntawm leej niam thiab tus menyuam hauv plab, ob qho tib si thaum cev xeeb tub, yug menyuam, thiab tom qab yug menyuam. Yog li ntawd, cov kws yug menyuam ua lub luag haujlwm tseem ceeb hauv kev kuaj pom thaum ntxov, kev saib xyuas, kev kawm, kev koom tes ntawm cov kws tshaj lij, thiab kev txhawb nqa kev puas siab puas ntsws kom ua tiav cov hom phiaj tswj glycemic thiab tiv thaiv cov teeb meem.
Cov Ntsiab Lus Tseem Ceeb ntawm Hom Kab Mob Ntshav Qab Zib 1 thaum cev xeeb tub
Kab mob ntshav qab zib hom 1 yog tus yam ntxwv los ntawm qhov tsis muaj insulin kiag li, uas yuav tsum tau kho insulin tas mus li. Thaum cev xeeb tub, kev hloov pauv ntawm cov tshuaj hormones hauv cov theem ntawm tib neeg placental lactogen (hPL), progesterone, cortisol, thiab placental growth hormone tuaj yeem ua rau muaj kev tiv thaiv insulin ntau ntxiv, tshwj xeeb tshaj yog nyob rau hauv lub trimester thib ob thiab thib peb. Yog li ntawd, qhov xav tau insulin tuaj yeem hloov pauv: lawv feem ntau txo qis hauv thawj trimester vim yog xeev siab thiab ntuav thiab muaj kev nkag siab ntau ntxiv rau insulin, tab sis nce ntxiv sai heev hauv trimester tom ntej. Cov qib qabzib tsis tswj tau tuaj yeem ua rau muaj kev pheej hmoo ntawm cov teeb meem xws li hypoglycemia hnyav, diabetic ketoacidosis (DKA), preeclampsia, kev kis kab mob, polyhydramnios, yug ntxov ntxov, thiab cov teeb meem ntawm tus menyuam hauv plab xws li macrosomia, neonatal hypoglycemia, thiab kev ua pa nyuaj.
Lub Hom Phiaj ntawm Kev Tswj Xyuas Kev Pab Yug Me Nyuam
Lub hom phiaj tseem ceeb ntawm kev saib xyuas cov poj niam uas muaj ntshav qab zib hom 1 yog kom tswj tau cov ntshav qab zib kom zoo, tiv thaiv cov teeb meem mob hnyav thiab mob ntev, xyuas kom cov menyuam hauv plab loj hlob zoo, thiab npaj rau kev yug menyuam thiab lub sijhawm tom qab yug menyuam kom muaj kev nyab xeeb. Tsis tas li ntawd, kev saib xyuas yog tsom mus rau kev txhim kho kev ua raws li kev kho mob insulin, kev noj zaub mov, kev ua ub no kom zoo, thiab leej niam lub peev xwm los paub txog cov cim qhia txog kev phom sij xws li hypoglycemia thiab ketoacidosis.
Kev Ntsuam Xyuas Kev Pab Yug Me Nyuam
Kev ntsuam xyuas tag nrho ntawm cov poj niam cev xeeb tub uas muaj hom ntshav qab zib 1 (DM) yog qhov tseem ceeb. Cov kws pab yug menyuam yuav tsum sau cov ntaub ntawv txog lawv keeb kwm kev kho mob (lub sijhawm ntawm DM, kev siv tshuaj insulin, zaus ntawm hypoglycemia, keeb kwm ntawm DKA), teeb meem (nephropathy, retinopathy, neuropathy), keeb kwm yug menyuam (rho menyuam, yug ntxov, menyuam loj), thiab tus cwj pwm kev ua neej (kev noj zaub mov, kev ua ub no, kev ua raws li kev kuaj mob). Kev kuaj lub cev yuav tsum suav nrog ntshav siab, qhov hnyav, dej haus, cov cim ntawm kev kis kab mob, thiab kev kuaj cev xeeb tub uas tsim nyog rau lub hnub nyoog cev xeeb tub.
Tsis tas li ntawd xwb, kev saib xyuas tus kheej ntawm cov ntshav qab zib (SMBG) yog qhov tseem ceeb heev. Cov kws pab yug menyuam yuav tsum tau soj ntsuam seb leej niam puas ua qhov kev kuaj no kom raug, ua ntau zaus npaum li cas, thiab cov qauv ntawm cov txiaj ntsig (kev yoo mov/tom qab noj ntshav qab zib, kev hloov pauv, lossis kev yoo mov ntshav qab zib). Cov ntaub ntawv hauv chaw kuaj mob xws li HbA1c, kev ua haujlwm ntawm lub raum, thiab kev kuaj zis (proteinuria, ketonuria) kuj yuav tsum tau saib xyuas ua ke nrog tus kws kho mob. Kev saib xyuas tus menyuam hauv plab yog ua los ntawm kev ntsuas qhov siab ntawm lub tsev menyuam, kev txav ntawm tus menyuam hauv plab, thiab xa mus rau kev kuaj ultrasound ntau zaus los ntsuas kev loj hlob, qhov ntim ntawm cov kua amniotic, thiab qhov xwm txheej ntawm lub placental.
Kev Kuaj Mob/Kev Txheeb Xyuas Cov Teeb Meem Kev Yug Me Nyuam
Cov teeb meem kev yug menyuam uas feem ntau tshwm sim rau cov niam uas muaj ntshav qab zib hom 1 suav nrog: kev pheej hmoo ntawm kev tsis sib npaug ntawm cov ntshav qab zib, kev pheej hmoo ntawm preeclampsia, kev pheej hmoo ntawm kev kis kab mob (tshwj xeeb tshaj yog txoj hlab zis), kev pheej hmoo ntawm polyhydramnios, thiab kev pheej hmoo ntawm kev txwv kev loj hlob ntawm tus menyuam hauv plab (macrosomia lossis kev txwv kev loj hlob hauv cov xwm txheej ntawm cov hlab ntsha). Hauv kev puas siab puas ntsws, cov niam yuav muaj kev ntxhov siab txog kev nyab xeeb ntawm tus menyuam hauv plab, lub nra hnyav ntawm kev kho mob insulin, thiab kev ntshai ntawm hypoglycemia. Cov kws pab yug menyuam yuav tsum txheeb xyuas cov yam ntxwv ua rau muaj kev kub ntxhov xws li kev noj zaub mov tsis tu ncua, kev noj tshuaj insulin tsis raug, lossis tsis muaj kev txhawb nqa los ntawm tsev neeg.
Kev Npaj Saib Xyuas Kev Yug Me Nyuam
Kev npaj saib xyuas mob nkeeg tsom mus rau kev saib xyuas zoo, kev kawm, thiab kev koom tes. Qee qhov tseem ceeb ntawm kev npaj muaj xws li:
1. Kev tswj hwm glycemic raws li lub hom phiaj
Cov kws pab yug menyuam pab kom cov niam to taub cov hom phiaj ntshav qab zib uas cov kws kho mob pom zoo, qhov tseem ceeb ntawm kev noj mov tsis tu ncua, thiab lub sijhawm txhaj tshuaj insulin. Kev qhia txog kev siv insulin, cov txheej txheem txhaj tshuaj, kev khaws cia insulin, thiab kev hloov pauv qhov chaw txhaj tshuaj kuj tseem ceeb heev.
2. Kev kawm txog kev noj haus thiab kev ua neej
Yuav tsum tau noj zaub mov uas muaj cov carbohydrates uas tswj tau, noj kom sib npaug, thiab noj tsis tu ncua. Cov kws pab yug menyuam tuaj yeem qhia cov niam tsev kom lawv npaj cov zaub mov yooj yim thiab ua tau raws li lawv lub neej thiab kev coj noj coj ua. Yog tias tsis muaj kev txwv tsis pub cev xeeb tub, yuav tsum txhawb kom lawv ua si me me mus rau nruab nrab.
3. Kev tiv thaiv thiab kev kuaj pom cov teeb meem
Yuav tsum piav qhia txog txoj kev npaj rau kev saib xyuas ntshav siab, cov cim ntawm preeclampsia (mob taub hau hnyav, pom tsis meej, o), cov cim ntawm hypoglycemia (tshee hnyo, hws, kiv taub hau), thiab cov cim ntawm DKA (xeev siab thiab ntuav, mob plab, ua pa sai, ua pa ketone). Tus niam kuj yuav tsum tau qhia thaum twg yuav tsum nrhiav kev kho mob tam sim ntawd.
4. Saib xyuas kev loj hlob thiab kev noj qab haus huv ntawm tus menyuam hauv plab
Cov kws pab yug menyuam pab kom muaj kev mus ntsib ANC ntau zaus dua. Kev koom tes rau kev kuaj mob ultrasound ntau zaus, kev ntsuam xyuas cov kua dej amniotic, thiab kev kuaj mob ntawm tus menyuam hauv plab xws li kev kuaj mob tsis ntxhov siab (NST) yog ua raws li tau qhia.
5. Kev npaj rau kev yug menyuam
Yuav tsum tau npaj yug menyuam, xav txog qhov xwm txheej ntawm niam thiab tus menyuam hauv plab. Cov kws pab yug menyuam ua haujlwm nrog cov kws kho mob los txiav txim siab lub sijhawm thiab txoj kev yug menyuam, tshwj xeeb tshaj yog tias muaj menyuam loj dua, mob ntshav qab zib ua ntej yug, lossis lwm yam teeb meem. Kev npaj suav nrog kev npaj rau cov menyuam mos, vim tias cov menyuam mos muaj feem yuav muaj ntshav qab zib qis tom qab yug los.
Kev Siv Kev Saib Xyuas Kev Yug Me Nyuam
Thaum lub sijhawm ua cov txheej txheem, tus kws pab yug menyuam yuav saib xyuas cov cim tseem ceeb, cov txiaj ntsig ntawm SMBG, thiab leej niam cov lus tsis txaus siab. Muaj kev qhia ntau zaus kom ntseeg tau tias leej niam ua raws li kev kho mob insulin thiab kev noj zaub mov. Yog tias leej niam muaj ntshav qab zib qis, tus kws pab yug menyuam yuav tsum muab kev pab thawj zaug raws li nws lub hwj chim, xws li muab cov piam thaj sai sai yog tias leej niam tseem nco qab, thiab xa mus rau lwm tus yog tias tus mob hnyav lossis yog tias tsis nco qab.
Thaum lub sijhawm yug menyuam, yuav tsum tau saib xyuas cov piam thaj ntau zaus vim tias cov txheej txheem yug menyuam tuaj yeem cuam tshuam rau qhov xav tau insulin. Qee cov txheej txheem siv cov insulin drips thiab glucose infusions hauv tsev kho mob, yog li cov kws pab yug menyuam yuav tsum nkag siab txog cov ntsiab cai thiab saib xyuas cov cim ntawm hypoglycemia / hyperglycemia thaum lub sijhawm yug menyuam. Kev saib xyuas ze ntawm lub plawv dhia ntawm tus menyuam hauv plab (FHR) yog ua kom pom kev ntxhov siab ntawm tus menyuam hauv plab.
Kev Ntsuam Xyuas
Qhov kev ntsuam xyuas suav nrog seb puas ua tiav cov hom phiaj tswj ntshav qab zib, seb leej niam puas nkag siab thiab puas muaj peev xwm tswj tus kheej, thiab seb puas muaj cov cim qhia tias muaj teeb meem. Qhov kev ntsuam xyuas kuj suav nrog cov txiaj ntsig ntawm kev saib xyuas menyuam hauv plab, qhov hnyav ntawm leej niam nce, ntshav siab, thiab kev ua raws li kev mus ntsib kws kho mob ua ntej yug menyuam. Yog tias pom muaj teeb meem xws li kev tswj ntshav qab zib tsis zoo lossis cov cim ntawm preeclampsia, yuav tsum tau kho dua txoj kev npaj kho mob thiab pib xa mus.
Kev Saib Xyuas Tom Qab Yug Me Nyuam Thiab Pub Mis
Lub sijhawm tom qab yug menyuam rau cov niam uas muaj ntshav qab zib hom 1 kuj xav tau kev saib xyuas tshwj xeeb. Tom qab lub placenta yug los, kev tiv thaiv insulin txo qis, yog li qhov xav tau insulin feem ntau txo qis heev. Cov niam yuav tsum saib xyuas lawv cov ntshav qab zib kom tiv thaiv hypoglycemia, tshwj xeeb tshaj yog thaum pub niam mis, uas tuaj yeem txo cov piam thaj. Kev pub niam mis tseem raug pom zoo vim nws cov txiaj ntsig rau ob leeg niam thiab tus menyuam, tab sis cov niam yuav tsum tswj kom muaj calorie txaus thiab noj zaub mov zoo.
Cov menyuam mos uas yug los ntawm cov niam uas muaj tus kab mob ntshav qab zib hom 1 muaj feem yuav mob ntshav qab zib qis hauv cov menyuam mos, uas yuav tsum tau muaj pab pawg menyuam mos saib xyuas cov ntshav qab zib. Cov kws pab yug menyuam ua lub luag haujlwm txhawb nqa kev pub niam mis thaum ntxov, qhia cov niam txog cov cim ntawm tus menyuam mos uas mob ntshav qab zib qis hauv cov menyuam mos (qaug zog, nyuaj rau pub niam mis, qaug dab peg), thiab xyuas kom muaj kev saib xyuas tom qab tawm hauv tsev kho mob.
Kev Koom Tes thiab Kev Xa Mus Rau Lwm Tus
Kev tswj tus kab mob ntshav qab zib hom 1 thaum cev xeeb tub tsis yog tsuas yog cov kws pab yug menyuam xwb. Kev koom tes nrog cov kws kho mob yug menyuam thiab kws kho mob poj niam, cov kws kho mob plab/kws kho mob endocrine, cov kws noj zaub mov zoo, thiab pab pawg menyuam mos yog qhov tseem ceeb heev. Cov kws pab yug menyuam ua haujlwm ua tus neeg sib txuas lus, xyuas kom muaj kev saib xyuas tas mus li, ua raws li cov niam txiv hais, thiab sib koom tes xa mus rau tus kws kho mob raws sijhawm yog tias muaj teeb meem.
Xaus
Kev tswj hwm kev saib xyuas tus poj niam cev xeeb tub rau hom ntshav qab zib 1 xav tau txoj hauv kev dav dav uas suav nrog kev ntsuam xyuas hnyav, kev saib xyuas glycemic, kev kawm txuas ntxiv, kev kuaj pom teeb meem, thiab kev koom tes ntawm cov kws tshaj lij. Nrog kev saib xyuas tus poj niam cev xeeb tub uas tau npaj tseg thiab tsis tu ncua, cov poj niam uas muaj hom ntshav qab zib 1 muaj feem ntau dua rau kev cev xeeb tub noj qab haus huv, kev yug me nyuam muaj kev nyab xeeb, thiab kev yug me nyuam hauv qhov xwm txheej zoo tshaj plaws. Lub luag haujlwm ntawm tus poj niam cev xeeb tub yog qhov tseem ceeb ua tus khub rau leej niam hauv kev tswj hwm txhua hnub, muab kev kawm, thiab ua kom muaj kev nyab xeeb ntawm leej niam thiab tus menyuam hauv plab los ntawm kev saib xyuas thiab xa mus rau qhov tsim nyog.
