Kutarisirwa Kwekuchengetedzwa Kwevana Vane Chirwere Cheshuga Cherudzi rwe1
Pendauluan
Chirwere cheshuga cherudzi rwekutanga (Type 1 diabetes mellitus (T1DM) chirwere chisingaperi chinokonzerwa ne autoimmune chinokonzera kuti pancreas itadze kugadzira insulin yakakwana. Chirwere ichi chinowanzotanga muhudiki kana kuyaruka, asi vakadzi vazhinji vane T1DM vanogona kubata pamuviri nekubereka zvakachengeteka nekutarisirwa kwakakodzera kwepamuviri. Panyaya yekuzvitakura, T1DM chirwere chinowanzoonekwa. njodzi huru nekuti zvinogona kukanganisa hutano hwaamai nemwana ari mudumbu, panguva yekuzvitakura, pakusununguka, uye mushure mekusununguka. Nokudaro, vananyamukuta vanoita basa rakakosha mukuona nekukurumidza, kutarisa, kudzidzisa, kushandira pamwe kwevashandi pamwe chete, uye kutsigirana kwepfungwa kuti vasvike pazvinangwa zvekudzora glycemic uye kudzivirira matambudziko.
Pfungwa Dzekutanga dzeChirwere Cheshuga Cherudzi rwe1 muPamuviri
Chirwere cheshuga cherudzi rwekutanga chinoratidzwa nekushaikwa kweinsulin zvachose, chinoda kurapwa kwe insulin kwehupenyu hwese. Munguva yekuzvitakura, shanduko dzemahormone muhuwandu hwe lactogen ye placental (hPL), progesterone, cortisol, uye placental growth hormone inogona kuwedzera kuramba insulin, kunyanya mu trimester yechipiri neyechitatu. Nekuda kweizvozvo, zvinodiwa zve insulin zvinogona kuchinja-chinja: zvinowanzo kudzikira mu trimester yekutanga nekuda kwekusvotwa nekurutsa uye kuwedzera kwe insulin sensitivity, asi zvinowedzera zvakanyanya mu trimester dzinotevera. Mazinga e glucose asingadzoreki anogona kuwedzera njodzi yezvinetso zvakaita se hypoglycemia yakanyanya, diabetic ketoacidosis (DKA), preeclampsia, hutachiona, polyhydramnios, preterm pakusununguka, uye matambudziko e fetus akadai se macrosomia, neonatal hypoglycemia, uye kufema kunetseka.
Zvinangwa zveKutarisira Kuchengetwa Kwevana Vakwegura
Chinangwa chikuru chekutarisira vakadzi vane chirwere cheshuga cherudzi rwekutanga kuburikidza nekubatsira vana vanozvara ndechekuchengetedza huwandu hweshuga muropa hwakanaka, kudzivirira matambudziko akanyanya uye asingaperi, kuona kuti mwana ari kukura zvakanaka, uye kugadzirira kusununguka kwakachengeteka uye nguva yekusununguka. Uyezve, kutarisira kwacho kwakanangana nekuvandudza kutevedzera kwaamai kurapwa ne insulin, kudya, kurovedza muviri kwakakodzera, uye kugona kwaamai kuona zviratidzo zvengozi zvakaita se hypoglycemia ne ketoacidosis.
Kuongororwa kweKubereka
Dzidza nezve amai vane pamuviri Varwere vane chirwere cheshuga cherudzi rwekutanga vanofanirwa kuongororwa zvizere. Vananyamukuta vanofanira kuunganidza ruzivo nezvenhoroondo yavo yezvekurapa (nguva yechirwere cheshuga, regimen ye insulin, kuwanda kwehypoglycemia, nhoroondo yeDKA), matambudziko (nephropathy, retinopathy, neuropathy), nhoroondo yekusununguka (kubva pamuviri, kusununguka nguva isati yakwana, mwana akakura), uye mararamiro (kudya, kuita, uye kutevedzera kuongororwa nachiremba). Kuongororwa kwemuviri zvinosanganisira BP, huremu hwemuviri, kunyorova kwemvura mumuviri, zviratidzo zvehutachiona, uye kuongororwa kwepamuviri zvichienderana nemakore ekuzvitakura.
Pamusoro pezvo, kuzviongorora wega kweglucose muropa (SMBG) kwakakosha. Vananyamukuta vanofanira kuongorora kana amai vari kuita bvunzo nemazvo, kangani, uye maitiro emhedzisiro (kutsanya/hyperglycemia mushure mekudya, shanduko, kana hypoglycemia yeusiku). Ruzivo rwemurabhoritari rwakadai seHbA1c, mashandiro eitsvo, uye bvunzo dzeweti (proteinuria, ketonuria) runofanirawo kutariswa pamwe chete nachiremba. Kutariswa kwemwana ari mudumbu kunoitwa nekuyera kukwirira kwechibereko, kufamba kwemwana ari mudumbu, uye kutumira kune serial ultrasounds kuti vaongorore kukura, huwandu hwemvura yeamniotic, uye mamiriro eplacenta.
Kuongorora/Kuziva Matambudziko Ekusununguka
Matambudziko ekusununguka anowanzoonekwa navanaamai vane chirwere cherudzi rwekutanga cheDM anosanganisira: njodzi yekusawirirana kweshuga muropa, njodzi yepreeclampsia, njodzi yekutapukirwa (kunyanya nzira yeweti), njodzi ye polyhydramnios, uye njodzi yekudzikamiswa kwekukura kwemwana ari mudumbu (macrosomia kana kudzikiswa kwekukura kana paine matambudziko etsinga dzeropa). Mupfungwa, vanaamai vanogona kunetseka nezvekuchengetedzeka kwemwana ari mudumbu, mutoro wekurapwa ne insulin, uye kutya hypoglycemia. Vananyamukuta vanofanira kuziva zvinhu zvinokonzera chirwere ichi zvakaita sekudya zvisina kurongeka, kupihwa insulin zvisina kunaka, kana kushaya rutsigiro rwemhuri.
Kuronga Kutarisirwa Kwevana Vachizvara
Kuronga kutarisirwa kwevana kunotarisa pakutarisa zvakanyanya, kudzidzisa, uye kushanda pamwe chete. Zvimwe zvikamu zvakakosha pakuronga zvinosanganisira:
1. Kudzora glycemic kwakanangana
Vananyamukuta vanobatsira kuona kuti vanaamai vanonzwisisa zvinangwa zveshuga inokurudzirwa nevashandi vezvehutano, kukosha kwekudya nguva dzose, uye nguva yekupa insulin. Dzidzo pamusoro pekushandiswa kweinsulin, nzira dzekubaya, kuchengetwa kweinsulin, uye nzvimbo dzekupa jekiseni dzinotenderedzwa zvakakoshawo.
2. Kudya kunovaka muviri uye dzidzo yemararamiro
Kudya zvine makabhohaidhiretsi akarongwa, huwandu hwakaringana hwezvikafu, uye purogiramu dzekudya nguva dzose zvinofanira kusimbiswa. Vananyamukuta vanogona kutungamira vanaamai mukugadzira hurongwa hwekudya huri nyore, hwechokwadi hwakakodzera tsika nehupfumi. Kurovedza muviri kuri nyore kusvika kune mwero kunogona kukurudzirwa kana pasina zvinorambidzwa pakusununguka.
3. Kudzivirira uye kuona matambudziko
Hurongwa hwekutarisa BP, zviratidzo zve preeclampsia (musoro wakanyanya, kuona zvisizvo, kuzvimba), zviratidzo zve hypoglycemia (kudedera, kudikitira, dzungu), uye zviratidzo zveDKA (kuda kurutsa nekurutsa, kurwadziwa mudumbu, kufema nekukurumidza, ketone breath) zvinofanira kutsanangurwa. Amai vanofanirawo kudzidziswa nguva yekuenda kuchipatara nekukurumidza.
4. Kutarisa kukura kwemwana ari mudumbu uye kugara zvakanaka kwake
Vananyamukuta vanovabatsira kuti vaende kunoona ANC kakawanda. Kushanda pamwe chete pakuongororwa kweultrasound, kuongorora mvura yeamniotic, uye bvunzo dzekugara zvakanaka kwemwana asati aberekwa dzakadai sekuongorora kusinganetseki (NST) kunoitwa sezvakaratidzwa.
5. Kugadzirira kubereka mwana
Kuzvara kunofanira kurongwa, tichifunga nezvemamiriro emwana ari mudumbu. Vananyamukuta vanoshanda navanachiremba kuti vaone nguva uye nzira yekusununguka, kunyanya kana paine macrosomia, preeclampsia, kana mamwe matambudziko. Kuronga kunosanganisira kugadzirira vana vacheche, sezvo vacheche vari panjodzi yekubatwa nehypoglycemia mushure mekuzvarwa.
Kuitwa kweKutarisirwa kweVananyamukuta
Munguva yekuvhiyiwa, nyamukuta anogara achitarisa zviratidzo zvinokosha, mhedzisiro yeSMBG, uye zvichemo zvaamai. Mazano anopiwa kakawanda kuti ave nechokwadi chekuti amai vanoramba vachitevedzera kurapwa kwe insulin uye kudya kwavo. Kana amai vakasangana nehypoglycemia, nyamukuta vanofanira kupa rubatsiro rwekutanga zvichienderana nemvumo yavo, zvakaita sekupa glucose inokurumidza kana amai vaziva, uye kutumira kune mumwe munhu kana chirwere chacho chakanyanya kuipa kana kuti kana pfungwa dzavo dzisina kugadzikana.
Munguva yekusununguka, kuongororwa kweglucose kakawanda kunodiwa nekuti maitiro ekusununguka anogona kukanganisa zvinodiwa neinsulin. Mamwe maitiro anoshandisa madhiripi einsulin uye kuiswa kweglucose muzvipatara, saka vananyamukuta vanofanira kunzwisisa misimboti uye kutarisa zviratidzo zvehypoglycemia/hyperglycemia panguva yekusununguka. Kuongororwa kwakanyatsoitwa kwemoyo wemwana ari mudumbu (FHR) kunoitwa kuti vaone kutambudzika kwemwana ari mudumbu.
Kuongorora
Ongororo iyi inosanganisira kana zvinangwa zvekudzora glycemic zviri kuzadzikiswa, kana amai vachinzwisisa uye vachikwanisa kuzvitarisira vega, uye kana paine zviratidzo zvematambudziko. Ongororo iyi inosanganisirawo mhedzisiro yekutarisa mwana ari mudumbu, kuwedzera huremu hwaamai, BP, uye kutevedzera kutarisirwa kwevana vasati vaberekwa. Kana matambudziko akadai sekudzora glycemic zvisina kunaka kana zviratidzo zve preeclampsia zvikaonekwa, hurongwa hwekutarisira hunofanira kugadziriswa uye kutumirwa kune mumwe munhu.
Kutarisirwa kweVana Vari Kusununguka uye Kuyamwisa
Masa mushure mekusununguka mumadzimai Varwere vane chirwere cheshuga cherudzi rwekutanga vanodawo kutarisirwa kwakakosha. Mushure mekunge placenta yaburitswa, insulin resistance inoderera, saka zvinodiwa ne insulin zvinowanzoderera zvakanyanya. Vanaamai vanofanirwa kutarisa shuga yavo muropa kudzivirira hypoglycemia, kunyanya panguva yekuyamwisa, izvo zvinogona kuderedza huwandu hweglucose. Kuyamwisa mwana kuchiri kukurudzirwa nekuti kunobatsira amai nemwana., asi vanaamai vanoda kudya macalorie akakwana uye purogiramu yakanaka yekudya.
Vana vacheche vanoberekwa naamai vane chirwere cheshuga cherudzi rwekutanga vari panjodzi yekubatwa nehypoglycemia mushure mekusununguka, zvichireva kuti vanoda kuongororwa kweshuga muropa nechikwata chevacheche vanoberekwa. Vananyamukuta vanoita basa rekutsigira kutanga kuyamwisa vachiri vadiki, kudzidzisa vanaamai nezvezviratidzo zvehypoglycemia mucheche (kuneta, kunetseka kuyamwisa, pfari), uye kuona kuti vanotevera mushure mekubuda muchipatara.
Kushandira pamwe uye Kutumira Vamwe
Kurapwa kwechirwere cheshuga cherudzi rwekutanga panguva yekuzvitakura hakugone kubatwa chete nevananyamukuta. Kushanda pamwe chete navanachiremba vezvekubereka nevanachiremba vezvirwere zvemazamu, vanachiremba vezvekurapa/vanachiremba veendocrine, nyanzvi dzezvekudya, uye timu yevana vacheche kwakakosha. Vananyamukuta vanoshanda semubatsiri, vachiona kuti rubatsiro runoramba ruchienderera mberi, kutevedzera mitemo yevabereki, uye kutaurirana panguva yakakodzera kana paine matambudziko.
Mhedziso
Kutarisirwa kwekuchengetedzwa kwevana vane chirwere cheshuga cherudzi rwekutanga kunoda nzira yakazara inosanganisira kuongororwa kwakasimba, kutariswa kweshuga yeropa, dzidzo inoenderera mberi, kuona matambudziko, uye kushanda pamwe chete nevashandi. Nekutarisirwa kwakarongwa uye kwakarongeka kwevana vanozvara, vakadzi vane chirwere cheshuga cherudzi rwekutanga vane mukana wakakura wekuva nepamuviri pakanaka, kusununguka zvakachengeteka, uye kuzvarwa kwemwana ari mumamiriro akanaka. Basa revana vanozvara rakakosha semubatsiri waamai mukutarisira zuva nezuva, kupa dzidzo, uye kuona kuchengetedzeka kwaamai nemwana ari mudumbu kuburikidza nekutarisa kwakakodzera uye kutumira varwere.
