Letsoalo la lefu la tsoekere moimana

Morero oa thuto e ne e le ho sekaseka mathata le lipatlisiso tsa bokhachane ho basali ba nang le lefu la tsoekere la mofets'e la GstM. Liphetho le mathata a ho ima li ile tsa ithutoa ho basali ba 50 baimana ba nang le lefu la tsoekere la sethoathoa, tšusumetso ea GDM ho lesea. Karolelano ea basali ba baimana e ne e le lilemo tse (33,7 ± 5.7). Ka GDM e lefelletsoeng, monyetla oa gestosis le ho se lekane hoa placental e ne e le 84%, polyhydramnios 36%, fetopathy ea fetal 48%. Ho tsamaisoa ka nako ho etsahetse ho 96% ea linyeoe, khafetsa ea liphoso tsa fetal e tsamaellanang le matšoao a kakaretso ea baahi. Ho fumanoe hore mellitus ea lefu la tsoekere la mmele e ama nts'etsopele ea gestosis le ho se lekane hoa placental, le ha puseletso ea metabolism ea carbohydrate e fumaneha ho tloha nakong ea ho sibolloa ha eona.

METSOALLE LE LITLHOHONOLOFATSO TSA BOTSOALLE BOPHELO BA MAHALA

Morero oa thuto e ne e le ho sekaseka mathata le ho hlahloba sephetho sa bokhachane ho basali ba nang le lefu la tsoekere le lefshoang. Re ithutile liphetho le mathata a bokhachane ho basali baimana ba 50 ba nang le lefu la tsoekere la lefu la sethoathoa, litlamorao tsa lefu la sethoathoa ho masea. Karolelano ea lilemo tsa basali ba baimana e ne e le (33,7 ± 5.7) lilemo. Keketseho ea gestoses le ho haella ha placental ho lefu la tsoekere la mofets'e e ne e le 84%, polyhydramnios 36%, fetopathy ea "fetus" Tsoalo ka nako e etsahetse ho 96% ea linyeoe, khafetsa ea liphoso tsa fetal e lumellanang le lipontšo tse thehiloeng ho baahi. Mellitus ea lefu la tsoekere la gestational e ama nts'etsopele ea boemo ba gestosis le fetoplacental, esita le ha puseletso ea metabolism ea carbohydrate ka mor'a ho sibolloa ha lefu la tsoekere la gestational mellitus.

Sengoloa sa mosebetsi oa mahlale ka sehlooho "Liphephetso le liphetho tsa bokhachane ho" mellitus "

LITLHAKU TSE KHOLO TSA PUSO EA LINTHO TSE LING TSA TLHALOSO TSA BOPHELO

METSOALLE LE LITLHOHONOLOFATSO TSA BOTSOALLE BOPHELO BA MAHALA

Bondar I.A., Malysheva A.S.

Novosibirsk State Medical University, Novosibirsk

Morero oa thuto e ne e le ho sekaseka mathata le lipatlisiso tsa bokhachane ho basali ba nang le lefu la tsoekere la mofets'e la GstM.

Liphetho le mathata a ho ima li ile tsa ithutoa ho basali ba 50 baimana ba nang le lefu la tsoekere la sethoathoa, tšusumetso ea GDM ho lesea.

Karolelano ea basali ba baimana e ne e le lilemo tse (33,7 ± 5.7). Ka GDM e lefelletsoeng, monyetla oa gestosis le ho hloka chelete ea placental e ne e le 84%, polyhydramnios - 36%, fetopathy ea fetal - 48%. Ho tsamaisoa ka nako ho etsahetse ho 96% ea linyeoe, khafetsa ea liphoso tsa fetal e tsamaellanang le matšoao a kakaretso ea baahi.

Ho fumanoe hore mellitus ea lefu la tsoekere la mmele e ama nts'etsopele ea gestosis le ho se lekane hoa placental, le ha puseletso ea metabolism ea carbohydrate e fumaneha ho tloha nakong ea ho sibolloa ha eona.

LIHLOOHO: lefu la tsoekere la sethoathoa, litlamorao tsa boimana, gestosis, fetopathy ea fetal.

Boitokisetso ba pregravid bakeng sa boimana, taolo e sa lekanang ea metabolism ea carbohydrate pele le nakong ea eona.

Lefu la tsoekere mellitus (DM) le ama tsela ea kemaro, ho hlahisa sephetho sa lona se sebe. Lefu la tsoekere ho basali ba baimana le thusa ho ntlafala ha mathata a methapo ea methapo, ho lebisa kholong ea khafetsa ea hypoglycemia, ketoacidosis, polyhydramnios, lefu la methapo ea methapo kapa gestosis, ho tsoa lipakeng tsa mpa kapa ho ntša mpa, le ho ntša mpa ka boomo, ho senyeha ha masea le ho pepa. forceps, vacuum extraction ea lesea), tsoalo pele ho nako 2, 3.

Gestationalabetes mellitus (GDM) ke lefu le tšoauoang ke hyperglycemia, le fumanoeng ka lekhetlo la pele nakong ea kemaro, empa le sa fihlelle litekanyetso tsa lefu la tsoekere. Khafetsa ea GDM ho bongata ka kakaretso e 7%. GDM e eketsa maqhubu a sephetho sa boimana se sa batleheng ho mme le ho hlokahala hoa lesea, ke ntho e kotsing ea ho holisa botenya, mofuta oa lefu la tsoekere la 2 le mafu a pelo ho mme le ho bana nakong e tlang.

Ho na le khokahano e tobileng lipakeng tsa matšeliso a lefu la tsoekere la sethoathoa le ho hlaha ha lefu la tsoekere, tsoelo-pele ea mathata a amang bokhachane le lefu la lefu la masea, le lefu la khatello ea methapo ea 4, 5. Mathata a hlahang nakong ea kemolo hangata a bakoa ke ho haella ha moralo le lefu la tsoekere.

Kotsi ea lefu la fetus ho GDM ke 3-6%, mme ha lefu la tsoekere le le sieo - 1-2%, empa lefu la tsoekere le lefshoang ha le eketse menyetla ea lefu la fetal ka lebaka la mathata a ho ima. Hape, ka GDM, ho na le keketseho ea letšoao la mafu a ho hema - trachthache tachypnea, asphyxia ea intrauterine, lefu la khatello ea maikutlo.

'Me Malysheva Anna Sergeevna, tel. 8-913-740-5541, lengolo-tsoibila: [email protected]

Ka "fetus", "frequopitis" ea "lefu la tsoekere" e tloha ho 27 ho isa ho 62% ha e bapisoa le 10%

bathong ba phetseng hantle, ho ea ka bangoli ba bang, khafetsa ea li-macrosomia e fapana ho tloha 20% bakeng sa lefu la tsoekere la moimana ho isa ho 35% bakeng sa lefu la tsoekere le qalileng pele ho ima.

Morero oa thuto e ne e le ho sekaseka mathata le lipatlisiso tsa bokhachane ho basali ba nang le lefu la tsoekere le lefutso.

Lintho tse bonahalang le mekhoa

Ho ile ha etsoa tlhahlobo ea basali ba 50 baimana ba lilemo tse 20 ho isa ho tse 42 (lilemo tse pakeng tsa 34.0 ± 5.7) ka tlhahlobo e fumanoeng ea GDM ka linako tse fapaneng tsa boikoetliso.

Litekanyetso tsa ho khetholloa thutong e ne e le: mofuta oa 2 le mofuta oa 1 lefu la tsoekere le fumanoeng nakong ea kemolo, ho hlohlona ho hoholo ha methapo ea mali, ho hlohlona ha qoqotho kapa mafu a tšoaetsang a tšoaetsanoang nakong ea libeke tse 2 pele ho kenyelletsoa thupelong.

Tlhahlobo ea nalane ea bongaka, datha ea nalane ea bokhachane le lefu la botšehali (tloaelo e sa senyeheng, ho ntša mpa ka mokhoa o sa reroang, lefu le sa hlalosoang la setho sa botona kapa bokhachane bo ntlafalitsoeng, "fetus" e kholo, mefuta e matla ea festosis, mpa ea nako le nako ea ho ruruha, ts'oaetso ea phepelo ea moroto hangata, ho ima hangata le ho ima nakong e fetileng le tse ngata nakong ea sena le sena. ) Ho ba teng ha mojaro oa lefutso la lefu la tsoekere, GDM, glucosuria, ho ile ha senoloa nalane ea metabolism ea carbohydrate. Lenane la boima ba 'mele (BMI) pele ho kemaro le keketseho ea boima ba' mele nakong ea kemaro, tekanyo ea glycemia nakong ea ts'oaetso, le kalafo e ntseng e theoha ea tsoekere ea glucose e hakanyetsoa. Kameho ea GDM ho lesea le sa tsoa emoloa (thuto ea bokhachane, ho lemala ha lesea) e ile ea ithutoa. Bakeng sa ts'oaetso ea gestosis, sehlahisoa sa ICD-10 se sebelisitsoe, botebo bo ile ba khethoa ho latela sekhahla sa Goeeke phetohong ea G.M. Savelyeva. Bakeng sa tlhahlobo ea lefu la GDM, ho ile ha sebelisoa mekhoa ea ho tsebahatsa litaba tsa "National GensMus National Consensus" (Diagnosis, Treatment, Postpartum Monitoring ”(2012)).

Tlhahlobo ea lipalo tsa liphetho e entsoe ho sebelisoa lenaneo Statistica 6.0 bakeng sa Windows, ho nka mekhoa ea likhakanyo e khothalletsoang bakeng sa biology le bongaka. Lits'oants'o tsa bohlokoa li hlahisoa e le M ± s, moo M e leng boleng bo bohareng, 'me s ke kheloho e tloaelehileng. Ho ikopanya ho ne ho ikemiselitsoe ho sebelisa tlhahlobo ea Spearman r, bakeng sa lintho tse fapaneng tseo re neng re li sebelisa

Lenaneo la Chuprov's CN le ithutetse. Phapang e ne e nkuoa e le bohlokoa ka lipalo ho p i Ha ke fumane seo u se hlokang? Leka ts'ebeletso ea khetho ea lingoliloeng.

± 0.9) mmol / L, 13:00 - (5.4 ± 1.1) mmol / L, 17:00 - (5.4 ± 0.9) mmol / L, 21:00 - (6, 1 ± 2.6) mmol / l, ka 02:00 - (4.7 ± 1.6) mmol / l.

Bakuli ba 34 (68%) ba ne ba e-na le botenya pele ho ima, 8 (16%) e ne e le boima bo feteletseng (ka kakaretso BMI - (28.4 ± 1.5) kg / m2), 8 (16%) - boima ba 'mele bo tloaelehileng, 4 ( 8%) - khaello ea boima ba 'mele (ka karolelano BMI - (17.8 ± 1.2) kg / m2). BMI e tloaelehileng ho bakuli ba nang le botenya pele ho ima e ne e le (34.3 ± 3.9) kg / m2. Ho nona ha degree ea 1 ho bonoe ho bakuli ba 20 (40%), 2nd - 10 (20%), degree ea 3 - 4 (8%). Ho latela bangoli ba bang, khafetsa khafetsa ho basali ba baimana e tloha ho 12 ho isa ho 28% mme ha e na mokhoa oa ho fokotseha 13, 14. Phaello ea boima ba bokhachane e ne e tloha ho 3 ho isa ho 20 kg, ka karolelano (11.9 ± 5.3) kg .

Ho bakuli ba 2 (4%) ba neng ba e-na le botenya ba 2nd pele ho ima, ho ne ho se na keketseho ea boima ba 'mele nakong ea kemaro ka lebaka la lijo. Phallo ea boima ba 'mele ea ho kula e tlalehiloe maemong a 16 (32%): maemong a 10 (20%) ho basali ba nang le botenya le khatello e tšoanang (makhetlo a 2 ka' ngoe)

Patlisiso ea mantlha ea bongaka

ho basali ba nang le maemo a tloaelehileng, ba boima bo feteletseng le ba boima bo tlase pele ba ima. Katleho ea boima ba 'mele e tlalehiloe ho bakuli ba 16 ho ba 50 le ba karolelitsoeng (16.7 ± 1.8) kg.

Ke karolo ea 6 (12%) feela ea barupeluoa e neng e se na nalane ea boimana, bakuli ba 10 (20%) ba neng ba e-na le nalane ea boimana, ba 12 (24%) - baimana ba 2, 22 (44%) - 3 kapa ho feta. Boholo ba basali (52%) ba nang le GDM ba ne ba e-na le nalane e thata ea thibelo ea bokhachane.

Khatello e atileng haholo ea nako ea boimana ba 'nete le GDM e bile tsoelo-pele ea gestosis - 84% ea linyeoe. Mest gestosis ea mefuta e fapaneng e fumanoe ho basali baimana ba 76%: edema le proteinuria ntle le khatello ea mali e bakoang ke ho ima - linyeoe tse 4 (8%), khatello ea mali ntle le proteinuria ea bohlokoa - 8 (16%), edema - 6 (12%), 2 ( 4%) - khatello ea maikutlo e neng e le teng pele ho khatello ea methapo ea kutlo e emisang pele ho nako, 18 (36%) - khatello ea maikutlo e bakiloeng ke bokhachane e nang le protheine ea bohlokoa. Ke feela 4% ea linyeoe tse nang le khatello ea mali tse ileng tsa bakoa ke ho ima tse nang le protheine e matla le edema e bonolo. Kamano e fokolang e ile ea senoloa pakeng tsa nts'etsopele ea gestosis le boemo ba glycemia boteng ba GDM (CN = 0.29, p = 0.002) (ka glycemia e nyane ea 5.2 mmol / L ka mpeng e se nang letho). Hape o fumane khokahano e nepahetseng lipakeng tsa nts'etsopele ea gestosis le botenya ba li-degrees tse fapaneng pele ho ima (g = 0.4, p = 0.03) boima ba pathological (g = 0.4, p = 0.005) nakong ea kemaro. Ntshetsopele ea gestosis e ne e tsamaisana le ho ba teng ha methapo ea methapo ea mafu (AH) ho basali baimana ba 26 (52%) (g = 0.48, p = 0.0004). Kamano pakeng tsa botenya pele ho ima le nts'etsopele ea khatello ea mali (g = 0.4, p = 0.003) nakong ea kemolo e ile ea senoloa. Pyelonephritis e sa foleng e ile ea bonoa maemong a 14 (28%). Tekanyo e tloaelehileng ea proteinuria tlhahlobisong e akaretsang ea moroto ho bakuli bana e ne e le (0.05 ± 0.04) g / l, proteinuria ea letsatsi le leng le le leng (0.16 ± 0.14) g / l.

Ho bonolo ho khaola khaello ea methapo ea methapo ea mali le maemo a thata a bokhachane nakong ea linyeoe tse 22 (44%), boemo bo tloaelehileng ba hemoglobin e ne e le (105.6 ± 18.8) g / l. Maemong a 6 ho a 50, boimana bo ne bo tsamaisana le hemato native thrombophilia le thrombocytopenia.

Tlhahlobo ea sephetho sa bokhachane e bonts'a hore pelehi e hlahile ho 96% ea basali baimana, basali ba 2 ba tsoetsoe pele ho nako, e tsamaellanang le

Bulletin ea mahe a linotsi a Siberia

E tsamaisana le matšoao a kakaretso ea baahi ho basali ba baimana ntle le mathata a carbohydrate metabolism (tafoleng).

Ho latela lipatlisiso, maemong a 76%, lesea le ne le le kahara puo ea hlooho.

Sephetho n% Correlation

Tšohanyetso COP 6 12

Monyetla oa COP 24 48 o hlophisitsoeng pele o ima

Ho tsamaisoa ka 20 40

canal ea tlhaho ea tlhaho

E Qobelletse ho Potlaka 2 4

Bofokoli ba ho sebetsa;

r = 0.74, p = 0.02

Hlokomela KS - Karolo ea Cesarean.

Ho bakuli ba 42 (84%), boimana bo ne bo tsamaisana le ho ba le mathata a sa foleng a placental (FPF), e leng semelo se atisitsoeng hangata - 26 (52%), ho 16 (32%) - se lefelletsoeng. Nts'etsopele ea FPI ho basali ba 24 (48%) e ne e tsamaisana le tlhekefetso ea phallo ea mali ea utero-placental (1st degree - 4 (8%), degree ea 1 - 14 (28%), degree ea 1 - 4 (8%), degree ea 2 - 2 ( 4%)), ho ba teng ha methapo ea methapo ea methapo (r = 0.41, p = 0.003) le ts'oaetso ea intrauterine (r = 0.36, p = 0.02). Ho latela tlhahlobo ea ultrasound, bakuli ba 2 (4%) ba ne ba e-na le sebopeho sa placenta esale pele, 10 (20%) e ne e na le bothata bo tlase, 'me e le' ngoe feela ea "cell" ea "cell" e fumanoang ho 2 (4%). Maemong a 20 (40%), boimana bo ne bo tsamaisana le ho ba teng ha ts'oaetso ea intrauterine le ts'oaetso e sa foleng ea urogenital (8%).

Polyhydramnios e ile ea bonoa maemong a 18 (36%), oligohydramnios ha ea ka ea fumanoa. Amniotomy e entsoe ho basali ba 4 (8%). Phallo ea pelehi ea amniotic fluid e hlahile ho basali baimana ba 8 (16%) ba nang le GDM. Mokelikeli o tloaelehileng oa mokelikeli oa amniotic e ne e le 660 ml, ho 6 (12%) ho ne ho e-na le phetoho ea boleng ba moroallo oa amniotic (fluid amniotic fluid).

Boima ba 'mele ba masea a macha bo ne bo tloha ho 2 500 ho isa ho 4,750 g, boima ba' mele bo ne bo le (3,862.1 ± 24.1) g, bophahamo bo boholo e ne e le lisenthimithara tse 53.4 4 1.6. %) ea masea a macha, ka karolelano boima ba 'mele - (4 365 ± 237) g. Ho basali ba baimana ba nang le mokoloto oa GDS ho trimester ea 1st, ho fumanoe fetopathy ea fetal ho 100% ea linyeoe, ha boima ba' mele ba masea bo bocha bo ne bo phahame ho feta ho basali ba nang le bothata ba GDS ho Li-trimesters tsa 2 le 3 ((4525.0 ± 259.8) le (3828.0 ± 429.8 g, ka ho latellana). Ho latela ultrasound (ultrasound), ho 8

s, 2014, moqolo 13, No. 2, leq. 5-9 7

linyeoe (16%) li senole "hypoxia" ea "fetus" e sa feleng ea masea, maemong a 2 (4%) - ka bobeli ka tlung ea mpa. Lintlha tsa rona li tsamaisana le thuto ea V.F. Ordynsky, moo khafetsa ea "fetopathy" e fihlelang ho 49% (ka ultrasound).

Ha ho lekola sekhahla sa Apgar, ho ile ha fumaneha hore tekanyetso ea pele e ne e tsoa ho lintlha tse 6 (1 kesi) ho ea ho 8. Tekanyetso ea bobeli e ne e tloha ho lintlha tse 7 ho isa ho tse 9.

Ho masea a 2 (4%), ho senyeha hoa litho tsa mpa, ho ile ha senoloa, hoo ka nako ea tsoalo ho ileng ha bontšoa ke boemo bo matla ba sistimi ea phefumoloho le matšoao a methapo. Nako ea mosebetsi e ne e thatafalloa ke ho tsoaloa ha mahetla

2 (4%), bothata ba ho tlosa mahetla - 2 (4%), nts'etsopele ea pelvis e moqotetsane ea bongaka - 2 (4%).

Placenta e ile ea lokolloa e le mong maemong a 24 (48%), ho basali ba 20 (40%) ba baimeng, placenta e ile ea aroloa ka letsoho. Boima bo boholo ba placenta e ne e le (760.3 ± 180.2) g. Maemong a mabeli feela (4%) e ne e le edema ea sebaka sa ngoana. Bolelele ba khoele ea umbilical bo ne bo fapana ho tloha ho 30 ho isa ho 96 cm, ka karolelano - (65,5 ± 13.0) cm. Twinelement entanglement e ile ea bonoa ho ba 12 (24%) ba sa tsoa tsoaloa.

Liphetho tse fumanoeng li bonts'a tšusumetso ea GDM holima nts'etsopele ea gestosis le ho se lekane hoa maemo ho 84% ea linyeoe, esita le ka tlhahlobo e fumanehang ea nako le puseletso ea GDM. Sethaleng sa GDM

ho trimester ea 1, nts'etsopele ea "fetopathy" e fumanoe maemong a 100% khahlanong le semelo sa matšeliso bakeng sa metabolism ea carbohydrate.

Ka hona, hyperglycemia botong ba GDM, botenya le boima ba methapo ea methapo bo eketsa menyetla ea mathata le liphetho tse mpe tsa boimana ho bo mme le lesea, leha le ka tseba ka GDM ka nako le puseletso bakeng sa metabolism ea carbohydrate.

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2. Hod M., Carrapato M. Lefu la Tsoekere le Tlhatlhobo ea Bopaki ba Boimana le Tataiso (Sehlopha se sebetsang sa lefu la tsoekere le ho ima). Prague, 2006.

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Dova, G.A. Melnichenko. M.: GEOTAR-Media, 2012.S. 156-157.

4. Jovanovic L., Knopp R. H., Kim H. et al. Phokotso ea bokhachane bo phahameng ka ho fetisisa le tlase le tlase la tsoekere ea bokhachane mathoalong a tloaelehileng le a lefu la tsoekere: bopaki ba ho ikamahanya le maemo ho ts'ireletso ea lefu la tsoekere // Lefu la Tsoekere. 2005. V. 5. P. 11131117.

5.Demidova I.Yu., Arbatskaya N.Yu., Melnikova E.P. Mathata a sebele a ho putsa lefu la tsoekere nakong ea kemolo // Lefu la tsoekere. 2009. Che. 4. P. 32-36.

6. Yesayan R.M., Grigoryan O.R., Pekareva E.V. Karolo ea matšeliso bakeng sa metabolism ea carbohydrate ho basali ba baimana ba nang le lefu la tsoekere la 1 ho nts'etsopele ea mathata a letsoalo le lefu la tsoekere. 2009. Che 4. P. 23-27.

7. Dedov I.I., Krasnopolsky V.I., SukhikhG.T. Lebitsong la sehlopha se sebetsang. Russia National Consensus "Lefu la tsoekere la Mofets'e: Lefu la Ts'oaetso, Pheko, Monitoring ea Postpartum" // Lefu la tsoekere. 2012. Che. 4. S. 4-10.

8.Andreeva E.V., Dobrokhotova Yu.E., Yushina M.V., Heyder L.A., Boyar E.A., Filatova L.A., Shikhmirzaeva E.Sh. Litšobotsi tse ling tsa tšebetso ea mofuta oa tšoelesa ea qoqotho ho masea a sa tsoa hlaha a tsoang ho bo-'mè ba nang le lefu la lefu la tsoekere mellitus // Mathata a ho ikatisa. 2008. Che. S. S. 56-58.

9. Peters-Harmel E., Matur R. lefu la tsoekere la lefu la tsoekere le kalafo / ed. translate N.A. Fedorova. M .: Ho ikoetlisa, 2008.S. 329-369.

10. Cherif A. et al. Preeclampsia e eketsa kotsi ea lefu la membrane ea hualine ho masea a tlang pele ho nako: thuto e laoloang ea morao-rao // J. Gynecol. Obstet Biol. Ho ikatisa. 2008. V. 37 (6). P. 597-601.

11. Gabbe S.G., mabitla C. Tsamaiso ea lefu la tsoekere le phekola lefu la tsoekere // Obstet. Gynecol. 2003. V. 102. P. 857-868.

12. Carrapato M.R., Marcelino F. Lesea la mme oa lefu la tsoekere: Lifensetere tsa bohlokoa tsa nts'etsopele // Pelehi ea Pelehi. 2001. Che 5. R. 57.

13. Bellver J., Melo M.A., Bosch E. Botenya le sephetho se fosahetseng sa ho tsoala: karolo e ka bang teng ea endometrium // Fertil Steril. 2007. V. 88.P. 446.

14. Chen A., Feresu S.A., Fernandez C. Ho tepella maikutlo ho bakhachane le kotsi ea lefu la masea United States. Epidemiology 2009, 20:74. Dashe J.S., McIntire D.D., Twickler D.M. Liphetoho tsa botona ba botona ba botšehali ho ho pepesetsoa ha "li-" "fetus" tse sa utloahaleng / Obstet Gynecol. 2009.V. 113.P. 1001.

15. Ordynsky V.F. Likarolo tsa liphetoho mo sebopeho sa placenta ho basali baimana ba nang le lefu la tsoekere ho latela liphetho tsa tlhahlobo ea tlhahlobo ea "ultrasound". 2005. Che 5. P. 21-22.

E amohetse ka la 24 Tšitoe 2013; E amohetsoe ho phatlalatsoa ka la 20 Hlakubele 2014

Bondar Irina Arkadevna - Dr. Dr. mahlale, moprofesa, hlooho Lefapha la Endocrinology, Novosibirsk State Medical University (Novosibirsk). 8 Bulletin of Siberian Medicine, 2014, Buka ea 13, No. 2, leq. 5-9

Patlisiso ea mantlha ea mantlha ea bongaka Malysheva Anna Sergeevna (I) - seithuti se tsoang sekolong sa Lefapha la Endocrinology, Novosibirsk State Medical University (Novosibirsk). 'Me Malysheva Anna Sergeevna, tel. 8-913-740-5541, lengolo-tsoibila: [email protected]

METSOALLE LE LITLHOHONOLOFATSO TSA BOTSOALLE BOPHELO BA MAHALA

Bondar I.A., Malysheva A.S.

Novosibirsk State Medical University, Novosibirsk, Russia Federation ABSTRACT

Morero oa thuto e ne e le ho sekaseka mathata le ho hlahloba sephetho sa bokhachane ho basali ba nang le lefu la tsoekere le lefshoang.

Re ithutile liphetho le mathata a bokhachane ho basali baimana ba 50 ba nang le lefu la tsoekere la lefu la sethoathoa, litlamorao tsa lefu la sethoathoa ho masea.

Karolelano ea lilemo tsa basali ba baimana e ne e le (33,7 ± 5.7) lilemo. Keketseho ea gestoses le ho haella hoa placental ho lefu la tsoekere le lefu la tsoekere e ne e le 84%, polyhydramnios - 36%, fetopathy ea "fetus" - 48% ea linyeoe. Tsoalo ka nako e etsahetse ho 96% ea linyeoe, khafetsa ea liphoso tsa fetal e lumellanang le lipontšo tse thehiloeng ho baahi.

Mellitus ea lefu la tsoekere la gestational e ama nts'etsopele ea boemo ba gestosis le fetoplacental, esita le ha puseletso ea metabolism ea carbohydrate ka mor'a ho sibolloa ha lefu la tsoekere la gestational mellitus.

MANTSOE A MOTSOALLE: lefu la lefu la tsoekere mellitus, sephetho sa boimana, gestoses, fetopathy ea fetus.

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Bondar Irina A., Novosibirsk State Medical University, Novosibirsk, Russian Federation. Malysheva Anna S. (H), Novosibirsk State Medical University, Novosibirsk, Russian Federation.

Lisosa le Lintho Tse Kotsi

Etiopathogenesis ea lefu la tsoekere nakong ea boimana ha e utloisisoe ka botlalo. Ho nahanoa hore nts'etsopele ea eona e bakiloe ke ho thibeloa ha tlhahiso ea insulin e lekaneng ka lihormone tse ikarabellang bakeng sa kholo e nepahetseng le nts'etsopele ea "fetus" e ntseng e hola. Nakong ea kemolo, liphetoho tsa tlhaho ea 'mele le tsa tlhaho tsa mosali li ba teng' meleng oa mosali o amanang le ho rala, e leng lekunutu la chorionic gonadotropin, corticosteroids, estrogens, progesterone, le "lactogen" ea mali ho tsoa maling a 'm'a. Lihormone tsena li fokotsa kutloelo-bohloko ea lisele tse kaholimo ho insulin. Karabelo ea nts'etsopele ea metabolic ho insulin ea endo native e baka keketseho ea lipolysis, ha ts'ebeliso ea tsoekere ka linama tse nang le insulin e fokotseha, eo, haeba ho na le mabaka a kotsi, e ka bakang lefu la tsoekere.

Maloetse a Autoimmune a kenya letsoho kholisong ea lefu la tsoekere, moo ho senngoa makhopho, 'me ka lebaka leo, ho fokotsehang hoa tlhahiso ea insulin. Ho basali bao beng ka bona ba haufi ba nang le lefu la tsoekere, menyetla ea ho ba le lefu la tsoekere nakong ea boimana e imena habeli.

Lintlha tse ling tsa kotsi li kenyeletsa:

• phatsa ea tlhaho
• tšoaetso ea vaerase ea pele
• candidiasis tse tloaelehileng
• polycystic ovary syndrome,
• ho hlaha, tsoalo ea lesea le leholo, nalane ea polyhydramnios, lefu la tsoekere la sethoathoa moimana oa nakong e fetileng,
• khatello e phahameng ea mali
• ho nona haholo
• mekhoa e mebe
• khatello ya mmele kapa ya kelello
• lijo tse se nang moeli (haholoholo, tšebeliso ea palo e kholo ea lik'habohaedreite tse potlakisang lijo).

Bakeng sa ho thibela nts'etsopele ea mellitus ea lefu la tsoekere, ho khothalletsoa: ho ja ka mokhoa o leka-lekaneng, ho lahla mekhoa e mebe, ho ikoetlisa ka ho lekaneng.

Mefuta ea lefu lena

Lefu la tsoekere ho basali ba baimana le arohantsoe le lefu la tsoekere pele ho nako, moo lefu la metabolism la carbohydrate le hlahang ho mosali pele ho kemaro, le gestational, moo lefu le iponahatsang nakong ea kemolo.

Mellitus ea lefu la tsoekere la Gestational e arotsoe ka tefo ea phepo ea phepo mme e lefelloa ke kalafo ea insulin hammoho le lijo. Mellitus e lekantsoeng le e fokolitsoeng ea lefu la tsoekere e khetholloa ho latela tekanyo ea matšeliso a lefu lena.

Matšoao a lefu la tsoekere

Lefu la tsoekere la botona le botšehali ha le hlalose, matšoao a lona a itšetleha, ka nako e 'ngoe, ka nako ea kemaro. Maemong a mang, lefu lena ha le na lipontšo tsa bongaka tse ikhethang 'me le fumanoa feela nakong ea tlhahlobo ea laboratori, e etsoang e le karolo ea ho lekola bokhachane.

Letšoao le ka sehloohong la lefu la tsoekere nakong ea kemolo ke ho eketseha ha tsoekere maling maling a mosali oa moimana (hangata a fumanoang kamora beke ea 20), ho se na matšoao a lefu la tsoekere ho mosali pele a ima. Lipontšo tse ling tsa lefu la tsoekere la letsoalo le kenyelletsa ho nona haholo, ho ntša metsi khafetsa le ho fufuleloa, ho hlohlona letlalo, ho kenyelletsa ho hlohlona kahare ho mpa, molomo o omileng, lenyora le sa khaotseng, takatso e fokotsehileng, bofokoli le mokhathala.

Ts'oaetso

E le karolo ea ts'oaetso ea lefu la tsoekere ho basali baimana, ba bokella litletlebo le anamnesis, ba ela hloko ka ho khetheha boteng ba lefu la tsoekere nalaneng ea lelapa.

Mekhoa e meholo ke liteko tsa mali bakeng sa glucose le glycosylated hemoglobin, hammoho le tlhahlobo e akaretsang ea moroto ka boikemisetso ba 'mele ea glucose le ketone. Teko ea mamello ea glucose e u lumella ho bona mathata a metabolism ea carbohydrate methating e qalang ea kholo. Ka tloaelo, tlhahlobo e tloaelehileng ea tsoekere ea glucose e etsoa ka ho nka 75-100 g ea glucose ka molomo ebe o lekanya tsoekere ea mali. Haeba mokuli a e-na le hyperglycemia, tlhahlobo e emisitsoe.

Etiopathogenesis ea lefu la tsoekere nakong ea boimana ha e utloisisoe ka botlalo.

Phekolo ea lefu la tsoekere la letsoalo nakong ea boimana hangata e etsoa motheong oa kantle. Letsatsi le letsatsi ho hlokahala ho laola boemo ba tsoekere maling. Tekanyo ea letšoao lena e etsoa pele ka mpa e se nang letho, ebe hora e le ngoe ka mor'a lijo.

Pele ho tsohle, mokuli o khothalletsoa ho hlahloba lijo. Ntle le moo, ho khothalletsoa ho ikoetlisa ka tsela e leka-lekaneng ho ka thibelang ho eketsa boima ba 'mele haholo le ho boloka mmele o le boemong bo botle. Ntle le moo, nakong ea boikoetliso, mesifa e sa sebeliseng tsoekere e itšetlehileng ka insulin, e thusang ho fokotsa glycemia. Ho ikoetlisa ho ka kenyelletsa boikoetliso bakeng sa basali ba bakhachane, ho sesa, ho tsamaea. Tabeng ena, ho sisinyeha ka tšohanyetso, hammoho le boikoetliso bo reretsoeng ho sebetsa mesifa ea lebota la mpa ea ka ntle, ho tlameha ho qojoa. Boemo ba mojaro bo khethoa ke ngaka e etellang pele moimana, kapa ke setsebi ho tsa kalafo ea boikoetliso.

Phekolo ea boikoetliso ba 'mele, haeba ho hlokahala, e ka kenyelletsa meriana ea litlama (flaxseed, motso oa burdock, makhasi a blueberry, jj), lithethefatsi tsa hepatopoietic le angioprotective.

Ha ho na le phello e ntle ea lijo, hammoho le sehlopha sa boikoetliso ba physiotherapy, ho hlahisoa liente tsa insulin. Lithethefatsi tse ling tsa hypoglycemic bakeng sa lefu la tsoekere la mmele le hanyetsoa ka lebaka la litlamorao tse ka bang teng tsa teratogenic.

Nako ea pelehi e thehiloe ho nahanela ho teba ha lefu lena, boemo ba lesea le ho hlaha ha mathata a ho beleha. Nako e nepahetseng ke beke ea 38 ea boimana, hobane matšoafo a fetal a se a holile mme ha ho na kotsi ea ho ba le mathata a ho hema.

Ho lefu la tsoekere le matla la mmele le / kapa nts'etsopele ea mathata, ho khothaletsoa ho pepisoa kapele, nako e nepahetseng eo e leng beke ea bo 37 ea moimana.

Ka boholo bo tloaelehileng ba pelvis ea mosali, ho khothalletsoa boholo bo bonyenyane ba popelo le ponaletso ea eona kahare, ho tsamaisoa ka kotara ea tlhaho. Ho tlisoa ke karolo ea Caesarean hangata ho etsoa haeba ho na le mathata, hammoho le ka boholo ba lesea.

Lefu lena le kotsi bakeng sa hore lesea le emele ho nts'etsapele "hyperinsulinemia", 'me le eona e ka lebisa ho phefumoloha ho ts'ebetsong.

Lijo tsa lefu la tsoekere nakong ea boimana

Lijo tsa lefu la tsoekere nakong ea boimana li hlile li reretsoe ho fokotsa litekanyetso tsa tsoekere ea mali. Ho khothalletsoa lijo tse nang le lik'habohaedreite tse 40-45% le mafura a 20-25%. Palo ea lijo tsa protheine e baloa ho latela karolelano ea 2 g ea protheine ho 1 kg ea boima. Meroho e halikiloeng, confectionery, lijo tse mafura le tse halikiloeng, sebete, mahe a linotsi, mahe, lijo tse tsoang hang-hang, mayonnaise le lisosa tse ling tsa indasteri li kenyelletsoa lijong. Litholoana le monokotsoai li lokela ho jeoa ka tekano, li sa rate monate haholo (li-currants, li-gooseberries, liapole tse tala, li-cherries, likhalase). Ho khothalletsoa ho kenyelletsa nama e nang le mafura a tlase, tlhapi le chisi, lijo-thollo, pasta ea mefuta e thata, k'habeche, li-mushroom, zucchini, pepere ea bell, legumes, meroho lijong. Bakuli ba nang le lefu la tsoekere la letsoele nakong ea kemolo ba tlameha ho netefatsa ho kenella ha livithamini le liminerale tse hlokahalang bakeng sa nts'etsopele ea lesea.

Lijo li lokela ho ba li-fractional (lijo tse 6-8 ka letsatsi ka likarolo tse nyane). Ho khethoa ho lokela ho fuoa lijana tse phehiloeng, tse phehiloeng le tse besitsoeng, hammoho le li-salate tse ncha tsa meroho. Ntle le moo, ho khothalletsoa ho sebelisa bonyane lilithara tse 1,5 tsa mokelikeli ka letsatsi.

Mokuli ea nang le lefu la tsoekere la letsoalo kamora ho ima o khothalletsoa ho latela mokhoa oa ho ja nako e itseng le ho lekola maemo a tsoekere ea mali ho fokotsa kotsi ea lefu la tsoekere la mofuta oa 2. Matšoao a metabolism ea carbohydrate, joalo ka molao, a tloaelehile nakong ea khoeli ea pele kamora ho beleha.

Ho ka ba le mathata le litlamorao

Mellitus ea lefu la tsoekere la setho sa botšehali e eketsa kotsi ea mathata le sephetho se sebe ho baimana le ba lesea. Lefu lena le kotsi bakeng sa hore lesea le emele ho nts'etsapele "hyperinsulinemia", 'me le eona e ka lebisa ho phefumoloha ho ts'ebetsong. Hape, ts'ebetso ea pathological e ka fetoha sesosa sa lefu la tsoekere, le hlahisoang ke macrosomia, e hlokang karolo ea cesarean. Ntle le moo, lefu la tsoekere la sethoathoa le eketsa kotsi ea ho hlaha kapa ho shoa ha lesea le sa tsoa hlaha matsatsing a pele a pelehi.

Ho bakuli ba nang le lefu la tsoekere nakong ea bokhachane, mafu a tšoaetsanoang a "urogenital", "preeclampia", eclampsia, ho pepeseha ka nakoana ea metsi a amniotic, ho tsoaloa pele ho nako, ho hema ka morao le mathata a mang a bokhachane a atile.

Ka tlhahlobo e tlang ka nako le kalafo e lekaneng, kholo ea lefu la tsoekere e loketseng mosali le moimana ea sa tsoaloang.

Thibelo

Bakeng sa ho thibela nts'etsopele ea "mellitus" ea lefu la tsoekere,

• Ho hlokomela boemo ba mosali nakong ea kemolo,
• khalemelo ea boima ba 'mele,
• phepo e nepahetseng
• tlohela mekhoa e mebe,
• ho ikoetlisa ka ho lekaneng.

Matšoao a mantlha a lefu la tsoekere la moimana

Letšoao le ka sehloohong la HD ke tsoekere e phahameng ea mali. Boloetse ka bobona bo na le thuto e sa reroang.

Mosali a ka ikutloa a nyoriloe, a khathetse kapele. Takatso ea lijo e tla ntlafala, empa ka nako e ts'oanang e tla fokola.

Mosali ha a na monyetla oa ho ela hloko matšoao a joalo, a lumela hore ona ke phello ea moimana. Mme ke lefeela. Ponahatso efe kapa efe ea ho hloka botsitso e lokela ho lemosa 'm'a ea lebelletsoeng mme o lokela ho tsebisa ngaka ka bona.

Matšoao a mofuta oa lefu lena

Haeba lefu le tsoela pele, matšoao a latelang a ka etsahala:

• molomo o sa feleng o omileng (ho sa tsotelehe hore metsi a mangata a noele),
• khafetsa ho ntša,
• ka ho eketsehileng ke batla ho phomola
• pono e ntse e mpefala
• takatso ea lijo ea eketseha, 'me le eona e na le li-kilogram tsa boima.

Nyorong le takatso e ntle ea lijo, ho thata ho lemoha matšoao a lefu la tsoekere, hobane ho mosali ea phetseng hantle, ha a emetse ngoana, litakatso tsena lia matlafala. Ka hona, ho hlakisa ts'oaetso, ngaka e laela 'm'a ea lebelletseng thutong e eketsehileng.

Phekolo ea bokhachane

Maemong a mangata haholo (ho fihlela 70%), lefu lena le fetoha le lijo. Mosali oa moimana o boetse o hloka ho khona ho laola glycemia ka boeona.

Phekolo ea lijo tsa HD bakeng sa HD e ipapisitse le melao-motheo e latelang:

• Lijo tsa ka mehla li reretsoe hore li kenyelletse liprotheine tse 40%, mafura a 40% le lik'habohaedreite tse 20%,
• ithute ho ja hanyane: makhetlo a 5-7 ka letsatsi le nako ea lihora tse 3,
• ka boima bo feteletseng, litaba tsa khalori le tsona li lokela ho baloa: eseng ho feta 25 kcal ka kilo e le ngoe. Haeba mosali a se na liponto tse eketsehileng - 35 kcal ka kilo. Fokotsa litaba tsa khalori ea lijo li lokela ho ba hlokolosi ebile li boreleli, ntle le mehato e thata,
• lipompong, hammoho le linate le lipeo, li qheletsoe ka thoko lijong. Haeba u hlile u batla ho ja lipompong, e fetisetse litholoana,
• se ke oa ja lijo tse halikiloeng (li-noodle, poroteine, litapole tse khotliloeng),
• fana ka likhetho tsa lijana tse phehiloeng le tse chesang,
• ho feta - likhalase tse 7,8 tsa mokelikeli ka letsatsi,
• nka li-complexes tsa vithamini le ngaka ea hau, kaha lithethefatsi tsena li na le tsoekere.
• leka ho fokotsa bongata ba mafura lijong, mme o fokotse liprotheine ho 1.5 g ka kg. Ntlafatsa lijo tsa hau ka meroho.

Hopola hore u ke ke ua lapa motho ea lebelletseng 'mele ka mokhoa o fapaneng, hobane tsoekere e ntse e hola ka lebaka la khaello ea lijo.

Haeba lijo li sa fane ka sephetho se lebelletsoeng, mme boemo ba tsoekere bo lula bo le holimo, kapa mokuli o na le tlhahlobo e mpe ea moroto ka tsoekere e tloaelehileng, kalafo ea insulin e laetsoe.

Tekanyetso le liphetoho tse ka bang teng kamora nako li khethoa ke ngaka feela ho latela boima ba mosali oa moimana le lilemo tsa boimana.

Ho entoa ho ka etsoa ka boikemelo, kaha o koetlisitsoe ke endocrinologist. Ka tloaelo, tekanyetso e arotsoe ka litekanyetso tse peli: hoseng (pele ho lijo tsa hoseng) le ka shoalane (ho fihlela lijo tsa ho qetela).

Ha ho na kalafo ea "insulin" e hlakolang lijo, e phehella nakong eohle ea kemolo.

Tlhahlobo ea kamoso

Lefu la tsoekere la botšehali le na le tšobotsi e le 'ngoe: ha le nyamele esita le kamora ho pepa.

Haeba mokhachane a bile le HD, menyetla ea ho tšoaroa ke lefu la tsoekere e tloaelehileng bakeng sa hae e eketseha ka makhetlo a 5.

Ena ke kotsi e kholo haholo. Ka hona, mosali o lula a bonoa ka mor'a ho beleha. Kahoo kamora likhoeli tse 1.5, o tlameha ho hlahloba metabolism ea carbohydrate.

Haeba sephetho se le setle, tlhaiso e tsoelang pele e etsoa lilemo tse ling le tse ling tse tharo. Empa haeba tlolo ea ts'ebetso ea mamello ea glucose e fumanoa, lijo tse khethehileng li nts'etsopele, 'me ho shebella ho eketseha ho fihlela nako e le' ngoe ka selemo.

Boimana bohle ba morao nakong ena bo lokela ho reroa, hobane lefu la tsoekere (hangata mefuta e 'meli) e ka ba le lilemo tse' maloa kamora ho hlaha. Ho ikoetlisa ho lokela ho eketsoa.

Bana ba sa tsoa hlaha ho bo-'mè ba nang le HD ba fuoa feela sehlopha sa batho ba kotsing ea ho shoa ha masea mme ba beiloe leihlo le sa hlokeng bongaka.