ʻO ka hāpaiʻana i ka maʻi diabetes > Hoʻopiʻi nā maʻi maʻi

Nā ʻano hiʻohiʻona o ka pēpē:
- koʻikoʻi nui kino (4-6 kg),
- he pale uliuli-cyanotic o ke kino,
- ʻO ka hapaha petechial (i ke ʻano o nā wahi he hemorrhages hypodermic) ma ka ʻili,
- ka nui o ke kīwī-like e like me ka lubricant (keʻokeʻo-ʻalani-hina) o ka ʻili,
- huehue a ʻāʻī a me ke ʻano palu.
- Puffy (swollen) alo,
- ʻōpū nui (hoʻonui ʻia i ka momona subcutaneous)
- ka pūhā nui poʻohiwi,
- puʻupuʻu pōkole.
ʻO ka hopohopo hōʻeha i ka pēpē hou (ma muli o ka nele o ka synthes o kekahi mau mea i loko o ka pūpū (surfactant), e kōkua ana iā lākou e hoʻoponopono me ka hanu mua), ka pōkole o ka hanu a paʻa paha i ka hopu ʻana he hiki i nā hola mua o ke ola.
Jaundice (yellowness o ka ʻili a me nā sclera (nā protein) i nā maka). ʻAʻole pono e hilahila kēia ʻano me ka jaundice physiological, kahi maʻamau maʻamau i nā pēpē hou e pili ana me ka wehe ʻana o ka hemoglobin fetal (kahi pūnaehana hao kīpē o nā sela koko ʻōleʻa e pili ana i ka hana hanu) me ka hemoglobin makua. E hele pū me ka ʻili o ka ʻili, ka sclera (nā protein) o nā maka, i hōʻike iā ia iho ma ka lā 3-4 o ke ola a kūʻokoʻa iho i ka lā 7-8th. I loko o ka maʻi embryo-fetopathy maʻi, ʻo ka jaundice kahi hōʻailona o nā loli pathological i loko o ke kao a pono ai i nā mea hoʻohālike.
Hiki nō hoʻi i nā maʻi neurological ke hōʻola i nā hola mua o ke ola.
- hōʻemi i ka kani mele
- ka ʻauhau ʻana o ka ʻōpū piha,
- ka hana i hoʻemi ʻia, kahi i ka hoʻololi ʻia e ka maʻi hyper-excitability (hopohopo, ke hiamoe hiamoe, haʻalulu (haʻalulu) o nā wāwae).

ʻO ka maʻi diabetes mellitus a i kahi mua mua o kahi maʻi diabetes (kahi palena palena ma waena o ka maʻi diabetes a me ka hana maʻamau no nā pancreas) i ka makuahine. I ka ʻāina prediabetic, ʻo ka ʻenehana (hana) o ka insulin (ʻo ka pancreatic hormone e kuleana ai no ka hoʻohana ʻana i ka glucose) a i hōʻemi paha a i ʻole ka automatism o kēia hoʻoulu ʻana i ka hormone (maʻamau, hoʻoili ʻia ka insulin i ka pane ʻana i ka intake glucose no kona hoʻohana hou ʻana).
Hoʻoulu ʻia ka embryofetopathy Diabetic e like me kēia: ua hāʻawi ʻia ka nui o ka glucose (gula) i ka pēpē ma o ka plasenta a ka makuahine, ma muli o ia pancreas o ka pūpū e hua nui ai ka insulin. ʻO ka nui o ke kōpaʻa ma lalo o ka hana a ka insulin i hoʻololi ʻia i ka momona, ke alakaʻi nei i ka wikiwiki o ka ulu ʻana o ka fetal, e hoʻonāukiuki i ka momona o ka subcutaneous.
ʻO kahi maʻi maʻi gestational Maternal (a i ʻole ka maʻi hānau makua) he ʻano i ʻole e hiki ai i ka pancreas ke hoʻohua hou i ka insulin (me ka nānā ʻana i nā pono o ka pēpē), ka hopena o ka hoʻonui nui o ke kō i ka makuahine. Ma ke kānāwai, ulu kēia kūlana i ka hapalua o ka hapai.

ʻO ke Obstetrician-gynecologist e kōkua i ka mālamaʻana i ka maʻi

Hoʻomaopopo i ka maʻi Fetopathy Diabetic

ʻO ka hapalua hola ma hope o ka hānau ʻana, ua pū ʻia ke keiki me ka glucose (5% hoʻonā), a laila e kuhikuhi ʻia nā minuke ʻelua mau umauma. Inā ʻaʻohe waiū a ka makuahine, a laila hiki ke mālama i ka waiū i nā wāhine ʻē aʻe i ka hana. Pono kēia hana e pale ai i ka hoʻomohala ʻana o ka hypoglycemia (kahi hōʻemi koʻikoʻi i ka glucose koko). Hoʻokumu ka hypoglycemia ma muli o ka hiki o ka hoʻomohala ʻana i ka hoʻohuihui makuahine i loko o ke koko o ka pēpē (ma hope o ka huki ʻana i ka kaula umbilical), aʻo ka pancreas o ka pēpē hou e hoʻomohala i ka insulin (ka hone i hana ʻia e ka pancreas, nona ke hoʻohana ʻana i ka glucose). He hōʻeha nui ka hoʻomohala ʻia o ka hypoglycemia a hiki i ka make o ka wahine hānau keiki hou.
No ka hoʻihoʻi ʻana i ka hana hanu, hoʻohana ʻia ka pono o ka ʻōpū mākeke (i kekahi mau haukapila, mālama ʻia ka puna - he ʻano pono ia no ka hanu mua, e kōkua i ka māmā o ka pūʻai a hoʻomaka i ka hanu). I nā pēpē me nā maʻi fetopathy maʻi, ʻaʻole i hoʻoulu ʻia ka surfactant i nā nui nui.
No nā pilikia neurological, e mālama ʻia ka calcium a me ka magnesium.
No ka mālamaʻana i ka jaundice (hana i ke kōpaʻa hana lēwa, i hele pū me ka yellowness o ka ʻili a me ka sclera (protein) o nā maka), ua ʻōlelo ʻia nā kaʻina UV. Hoʻokomo ʻia ke keiki ma lalo o hoʻokahi kukui a i ʻole ʻoi aku ka nui o nā kukui ultraviolet, aʻo ka maka ke uhi ʻia ʻana me kahi uhi pale kūikawā. Hoʻoponopono ke kauka i ka lōʻihi o ke kaʻina (e pale i nā kuni).

Nā hopena a me nā hopena

ʻO ka hoʻololi ʻana o ka maʻi fetopathy maʻi maʻi i loko o ka maʻi mellitus neonatal (maʻi o ka pēpē).
Neonatal hypoxia (kahi kūlana i ʻike ʻia e ka lawa ʻole o ka oxygen i ke koko a me nā kaila o ka pūpū a me ke keiki hou.
ʻO ka maʻi kaumaha o ka hanu o ka pēpē - ʻo kēia maʻi ka mea maʻamau ke kumu o ka make i waena o nā keiki i hānau me ka phenopathy maʻi maʻi.
Hypoglycemia (kahi kahe nui o ka hoʻokahe o ke koko). Hiki i ke ʻano ke hiki i ke ʻano o ka hōʻeha nui o ka glucose maternal i loko o ke koko o ka pēpē (ma hope o ka hoʻopaʻa ʻana i ke kaula umbilical) e pili ana i ke ʻano o ka huna ʻana o ka insulin (ka hone i hana ʻia e ka pancreas, nona ka hoʻohana ʻana i ka glucose) e ka pancreas o ke pēpē. He hōʻeha nui ka hoʻomohala ʻia o ka hypoglycemia a hiki nō hoʻi i ke kumu o ka make ʻana o ka wahine hānau keiki hou.
ʻO ka hoʻopauʻana o ka metabolism mineral i ka pēpē hou (hapa o ka calcium a me ka magnesium) e hoʻopilikia i ka hana o ka ʻoihana sentral. I ka wā e hiki mai ana, hiki i kēia mau keiki ke hala ma hope o ka hoʻomohala a me ka noʻonoʻo.
Haki ka huehu o ka puuwai
ʻO ka wānana a ke keiki e hoʻohiki i ka maʻi diabetes 2.
Nā ʻilima

ʻO ka maʻi maʻi gestational

Hoʻohui ia ma hope o 20 mau pule o ka hāpai ʻana. Hoʻokomo ka plasenta i ka lactosomatotropin, he hormone e hōʻemi ana i ka hoʻoweliweli ʻana o nā io o peripheral i insulin. ʻO nā wahine me ka momona a loaʻa ke kaumaha nui paha ma ka wā hāpai. He mea nui hoʻi ka moʻomeheu Burded.

ʻO nā maʻi fetopathy hāpai i nā wahine hāpai me ka maʻi gestational diabetes mellitus e loaʻa ana i 25% o nā hihia. ʻAʻole paʻa iki ke ʻano o ka pēpē.

ʻO nā hopena o ka hāpai a me ka hānau ʻana me ka maʻi diabetes

He mea nui ka nānā ʻana mau.

ka holomua o nā hoʻopiʻi o ka maʻi mellitus (nephropathy, retinopathy),
kolohe maoli,
hōʻeha nui,
hypertension (pinepine e alakaʻi i preeclampsia a me ka eclampsia),
polyhydramnios
ʻOluepo maʻi hypoxia o ka huaʻala,
ʻo ka maʻi ʻōpiopio me ka hoʻemi ʻana i ka hana make (colpitis, pyelonephritis),
nā pōʻino hānau i kahi keiki hou (ma muli o ke kaumaha nui o ke pēpē),
ka pilikia nui o ka hoʻokele ʻana (cesarean section) a me nā hoʻopiʻi postoperative,
kaonaaa, malform,
Loaʻa nā hānau hānau ma mua.

Hoʻolohe Pono ʻoe e hoʻomākaukau no ka lawe ʻana i kahi keiki ma mua o ka mua! Inā hoʻopaʻa ʻoe i ke koko koko i ka papa hoʻolālā o ka hāpai ʻana, hiki iā ʻoe ke pale i nā ʻōnaehana koʻikoʻi loa.

Nā koho Fetopathy

Aia i ka kiʻekiʻe o ka hōʻino, ua hōʻike ka pathological syndrome iā ia iho ma nā ʻano like ʻole.

Hoʻokumu ka paʻakikī o nā hōʻike kulekele i ke ʻano o ka maʻi a ka makuahine a me ka piʻi ʻana o ka uku o kona kūlana i ka manawa hāpai. ʻO ka maʻi maʻi ʻōpala 1 ka mea nui loa.

ʻO ke koho hypoplastic. ʻO ia ka hiʻohiʻona o ka maʻi mellitus maʻi maʻamau me nā hoʻopiʻi vascular (nephropathy, retinopathy). ʻO kahi hopena o ka nalowale o nā moku liʻiliʻi o ka plasenta, e alakaʻi ana i ka pōʻino. I ka manawa pinepine he make intralterine make fetn, malnutruction, congenital malformations.

Nā hopena o ka hypoxia

ʻO ke koho Hypertrophic. Hoʻokumu kū i ke kiʻi o ka hyperglycemia kiʻekiʻe, akā me ka ʻole o ka hoʻopiʻi vascular koi. Hānau ʻia kahi pēpē nui me kahi paona nui.

Nā hōʻailona hōʻailona

Macrosomy

ʻO ke kaumaha nui o ke kino o ke keiki (ma luna o 4 kg i loko o kahi hoʻohiki piha.

Ka hoʻonui ʻia ʻana o ka nui o ka kiko subcutaneous. Ke hōʻike ʻia nei e ka hoʻokumu ʻana ʻana i nā momona momona ma ka ʻāʻī, kahi ʻōpala a me nā poʻomanaʻo.

ʻO ka pinepine, ʻo ka paona o kahi pēpē i hiki aku i ka 5 kg a i ʻole (ʻoi aku ka wahine hānau).

Nohea Nā hiʻohiʻonaʻikeE pili ana kēia:

helehelena kahelole o ka mahina (e like me nā poʻe maʻi i loaʻa i ka glucocorticoids no ka manawa lōʻihi),
ʻāʻī pōkole
"ʻEleʻele" nā maka
kuʻe ʻana i nā hoʻohālikelike: ke kino lōʻihi, nā poʻohiwi ākea, nā wāwae pōkole.

Hōʻano kikoHōʻike ʻia ka maʻi fetopati maʻi i nā pēpē hou e ka hemphological a me ka hana hemoleleNā hōʻailona maʻi:

haua
hāneʻa me ka kala ʻula ʻoi
hypertrichosis
ho'ēmi i ka kani musia a me ka pulu physiological.

ʻOkoʻa kala ʻōniʻoniʻo

Lauoho lauohoHōʻeha ka puʻuwai kaumahaHana ʻia ia ma muli o ka hala o ka hoʻokumu ʻana o ka surfactant.

ʻaʻano pōkole
komo i ka hana o nā ea hanu laupili ("hoʻokani" ʻo nā ʻēheu o ka ihu, ka hoʻihoʻi mai o ka intercostal space a me sternum),
cyanosis.

I kekahi manawa hana ulu ka hanu hanu.

X-ray kiʻi o ka māmā ʻO ka hoʻohaʻahaʻa ʻana i ke kō kokoʻO ka hypoglycemia i kahi keiki hou kahi emi o ke kaila koko ma lalo o 3 mmol / L. ʻO ka pae koʻikoʻi ma mua o ka 2.2 mmol / L.

Hōʻike ʻia i nā hola mua o ke ola. Hoʻākāka ʻia e ka nui o ka insulin i ka pūpū.

nystagmus, "holo" ʻana i ka ʻōpū o ka ʻeneke,
haʻalulu (haʻalulu) o nā wāwae,
kahi hoihoi hou o ka keiki i ka lethargy,
nā koholā o ke cyanosis, apnea,
e loaʻa paha nā kau.

He mea nui loa ka mālama ʻana i kou koko koko!

Nā ʻōnaehana pinepine

Loaʻa pū i nā keiki me ka embryofetopathy maʻi maʻi:

ʻO nā mea hoʻoili maikaʻi ʻana. ʻO ka mea maʻamau nui: nā puʻuwai naʻau (interventricular septal defect, transposition o nā moku nui, wehe aortic duct), kūnaehana nūnaila (anencephaly), nā lehelehe lip a me ka palate, nā hana hewa o nā keiki.
Hoʻemi ka nui o ke koko o ka calcium a me ka konane. Ke alakaʻi ia i ka nui o ka excitability, nā pilikia hanu. Hiki i nā mea ʻaihue.
ʻO Polycythemia kahi ala pathological i hōʻike ʻia e ka hoʻonui nui o nā pūpū koko a me ka hemoglobin. Hoʻākāka ia e ka hoʻonui nui ʻana o nā ʻōpū koko kalaʻula i ka pane ʻana i ke kaumaha koʻikoʻi. Ka hōʻike ʻia e ka maʻi maʻi ʻulaʻula, cardiovascular a me nā hanu.
Jaundice Me ka polycythemia, ʻo ka haʻalulu o "kahe" nui o nā toto koko ke alakaʻi i ka piʻi nui o ka pae o bilirubin i ke koko. ʻO ka nele o ka hana excretory o ka ate ma muli o ka morphofunctional immaturity he mea nui hoʻi. Hoʻopili ʻo Bilirubin i loko o ka ʻili. I nā kīʻaha kiʻekiʻe i ke koko, hiki iā ia ke komo i ka pā o ka lolo-lolo a hoʻopaʻa i ka pōʻino o ka lolo.
Hōʻeha ka hānau ʻana (cephalohematomas, fractures collarbone). ʻO ka hopena e pili ana i ka nui o ke kōpana. ʻO ka hānauʻana o kahi keiki ke kau nei ma mua o 5 kg e hoʻomau ana i nā pilikia me ka hoʻokau ʻana.
ʻO kaʻino Perinatal i ka ʻōnaehana sentral. Hōʻike pinepine ʻia ia e ka lohi i ka hoʻokumu ʻana i nā mākau motika.
Hoʻoulu nui i ka pīpī a me ka nī.

Hoʻolaha ka Icteric i ka ʻili

Hoʻolālā Mahele Hoʻōkohu Hāpai

Kōkua i ka pale ʻana i nā hoʻopiʻi weliweli ʻana i ke ola.

ʻO ka nānā a me ka loiloi o ke kino kūʻokoʻa (ke kaupaona ʻana a me ke ana ʻana i ka ulu ʻana).
ʻO ka helu koko piha, ka hoʻoholo ʻana o ka hemoglobin a me ka hematocrit.
E mālama i ka helu o kou naʻau a me ka hanu.
ʻO ka loiloi o nā kahe koko (e kōkua i ke nānā ʻana i nā pilikia o ka hanu ʻana i ka wā mua).
Biochemistry: bilirubin, electrolytes.
Kaʻai koko i kēlā me kēia mau hola ʻelua mai ka hānau ʻana.
ʻO ka pōkole o ka puʻuwai a me nā ʻōpū.
I kahi hihia o nā mea hanu, hōʻike ʻia ka umauma x-ray.

ʻO ka nānā ʻana i kahi pēpē mai kahi makuahine me ka maʻi maʻi e hana mau ʻia me ka wikiwiki! No kēia, lawe ʻia ke keiki i kahi keʻena loea.

Ke kiaʻi no ka liʻiliʻi

Pehea e kōkua ai i ka pēpē?

Pono nā maʻi hānau maʻi i ke keiki hou hou ma hope o ka hānau ʻana.

Ke kūpono o ke kūlana. ʻO nā keiki āpau me kēia pilikia e mālama i ka wela ma muli o ka lohiʻana o nā mīkini thermoregulation. I kekahi manawa pono kahi incubator.
I ka hihia o nā ʻōpū hanu, hoʻohana ʻia ka therapy oxygen. Ma kahi hana hoʻopiʻi koʻikoʻi, koi ʻia ka hoʻokūkū uila.
Hoʻohāluulu i ke kōpala koko. Inā nui ka maʻi mellitus o ka makuahine, hoʻomaka kahi infusion o 10% glucose ma hope o ka hānau ʻana, me ke kali ʻana no ka hopena o kahi hōʻike koko.
Ke hoʻoponopono ʻana i nā hana hoʻonā electrolyte. ^ E Ha yM. Hoʻopuka ʻia nā maʻi infusion me ka mālama pono ʻana i kēlā me kēia lā i ka calcium a me ka magnesium, a me ko lākou nele i kēia maʻi maʻi.
Hoʻohana ʻia ka Phototherapy e mālama i ka Jaundice.
Ma kahi o ka ʻae ʻana o nā malenation congenital, hana ʻia kā lākou hoʻoponopono ʻana. ma hope o ka hoʻomau ʻana o ka pēpē.

Nā lāʻau mālama Hōʻailona hoʻoiho Hāʻawi ka polokalamu i ka wikiwiki i makemake ʻia i ka hoʻokele intravenous ʻAulike

Hoʻolohe Inā he makua maʻi ka manaʻakeʻa, pono nō e lawe ʻia ka ʻōkuhi o nā keʻena makua kiʻekiʻe, kahi i loaʻa nā mea āpau e mālama ai.

Pākuʻi ʻia nā hana kūpono i ka mālama ʻana i kahi wahine hāpai, mālama a ʻike i ka maʻi maʻi.

Pehea ka lōʻihi o ka mālama ʻana?

Aloha awakea Ua hānau maoli kaʻu wahine. Aia nā pilikia me ke keiki. Wahi a lākou ua maʻi kāna wahine. Ua lawe koke ʻia ke keiki iā ia me ka makaʻala. ʻAʻohe e makemake e haʻi mai iaʻu i kona mau lā? ʻO ka ʻoiaʻiʻo ʻo wau e pono i kahi huakaʻi hele. ʻAʻole wau ʻike inā paha wau i ka manawa e hoʻokuʻu ai? E haʻi mai iaʻu, pehea ka lōʻihi e hana ai i ka pēpē hou mai ka maʻi hānau hānai?

Aloha Pili ka manawa o ka mālama ʻana i ka hōʻeha o ke ʻano o ke keiki a me ka loaʻa ʻana o nā hoʻopiʻi. Ke kono aku nei au e kamaʻilio pū me kāu kauka.

Hiki i kahi wahine me ka maʻi hānai ke hānau i kahi pēpē maikaʻi?

Aloha Loaʻa iaʻu i kahi makahiki gestational o 25 pule. ʻO kēia manawa ua hoʻi hou au mai ke kauka i ka waimaka: ʻ theylelo lākou ua loaʻa iaʻu ka maʻi gestational. Ua noa nā ho'āʻo āpau a pau. Heluhelu wau i nā mea weliweli a makaʻu loa wau i ke pēpē. He aha e hana ʻia iā ia i kēia manawa?

Aloha awakea Mai hopohopo, nā fetopathy fetal i nā wahine hāpai me ka maʻi maʻi gestational e hele wale i ka 25% o nā keiki hou. He maikaʻi ia e hoʻomaʻamaʻa ʻia ka maʻi maʻi i ka manawa, e kōkua kēia i ka pale ʻana i ka hoʻopiʻi ʻana.

ʻO nā kumu o ka maʻi pokiopika:

Hoʻokomo nā wahine me ka maʻi diabetes a me kā lākou mau keiki hou i ka hoʻomohala ʻana i nā hoʻopiʻi obstetric a me neonatal. Pili ka pili o nā pilikia ʻelua o ka maʻi maʻi i mua o ka hāpai ʻana a me ke ʻano maʻi gestational. ʻO ka maʻi maʻi i ka wā hāpai a labile, he nui ka hoʻoneʻe o ka decompensation, e holomua ka maʻi ʻōpiopio vascular. ʻAʻole nui ka mea iʻike i ka prognosis no ka makuahine a me ka wā hāpai i ka lōʻihi o ka maʻi, akā ma ke ʻano o kāna uku i mua o ka wā e hāpai ana i ka wā hāpai, nā hoʻopiʻi mua a me kā lākou holomua ʻana.

Wahi a nā helu helu nūhou, & nbsp & nbsp o ka ulu ʻana o ka maʻi maʻamau ma waena o nā wahine hāpai i ka Russian Federation no nā makahiki he 10 i hala iho nei ua hoʻonui ʻia ka 20%.

ʻO ka maʻi diabetes gestational, ma ke ʻano he kānāwai, e ulu i hope o ka 20 mau pule o ka hapai, i ka wā i hoʻomaka ai ka plasenta i ka hana ikaika - he kelipi endocrine hou e hana ana i ka chorionic lactosomatotropin, kahi i kokoke i kāna waiwai kūlohelohe i ka hormone somatotropic. Paipai kēia hormon i ka hoʻolālā ʻana o ka kūleʻa o ka insulin i nā kōpili peripheral, hoʻōla i ka gluconeogenesis i loko o ka ate, a ma laila e hoʻonui ai i ka pono o ka insulin. Loaʻa ka hopena nui i ka hoʻomohala ʻana i kēia mākeke i nā wahine o nā makahiki makua (ʻoi aku ma mua o 25 mau makahiki) me ka momona a me / a me ka nui o ka hoʻonui ʻana i ke kaumaha o ke kino i ka wā hāpai, me nā hoahānau pili me ka maʻi mellitus.Hoʻonui ka puʻuwai a inā i hāpai pū ʻia nā ʻōpū ma mua o nā maʻi gestational a i ʻole ka hānau ʻana o ke keiki me ka paona kino i ʻoi aku ma mua o 4000 g, a ma kēia wā hāpai ʻia, ua loaʻa nā macrosomia me polyhydramnios.

ʻO nā huaʻōlelo penei o ka hapai a me ka hānau ʻana i nā wahine me ka maʻi maʻi:
ka hoʻēmi ʻana o ka maʻi mellitus me ka maʻi hypoglycemic alternating a me ka ketoacidosis,
ka ulu ʻana o ka nephropathy, retinopathy a me nā hoʻopiʻi ʻē aʻe
maʻi mellitus maʻiʻi
ka haʻalele ʻana i ka spontanally, ka mea, i nā manawa mua (ma ka 30% o nā wahine hāpai, ʻoi aku ka 4 mau manawa ma mua o ka lehulehu
kahi maʻi maʻi koʻikoʻi, kahi mea i ʻike ʻia ma ka aneane 50% o nā wahine hāpai me ka maʻi mellitus (ma ka laulā nui - 3-5%),
hypertension hapalua a me ka hopena o ka hopena, a he hopena hoʻonui nui ʻia o ka preeclampsia a me ka eclampsia (4 mau manawa i ʻoi aku ma mua o ka heluna)
polyhydramnios
humopopacental incufficiency a humoplu hypoxia,
ʻO ka maʻi a me ka vulvovaginitis me ka hoʻēmi ʻana i ka pale kaua nonspecific o ke kino,
pilikia i ka wā hānau keiki ma muli o ka wahine hāpai,
mahuahua i hōʻeha o ka hoʻoweliweli (cesarean pauku), ka hoʻopiʻi a me ka hoʻopiʻi postoperative
kaumaha nui ka hānau keiki preterm (nānā i 24% o nā hihia i hoʻohālikelike ʻia me 6% o ka heluna kanaka),
nā hana maikaʻi a me ka maikaʻi o ke keiki (ma 10 - 12%).

Nā hōʻailona o ka maʻi fetopathy maʻi:

ʻO ka hana ʻino maʻamau i nā keiki nāna e maʻi nei nā makuahine me ka maʻi maʻi ʻoihana caudal dyskinesia syndrome, ʻo ka waiho ʻole a me ka hypoplasia o ka sacrum, tailbone, i kekahi manawa lumbar vertebrae, a me ka lalo o ka femur. Ua wehewehe pū ʻia lākou i ka mahuahua o ka ulu ʻana o nā kīnā o ka lolo (anencephaly), nā pēpē (aplasia), ka hoʻolalelale ʻana o nā ureter, nā puʻuwai naʻau, a me ka wahi hoʻi o nā ʻōpū.

Pono e hoʻomanaʻo ʻia o ka hala ʻana o nā hoʻopiʻi o perinatal ma muli o ka paʻakikī a me ka pae o ka uku no ka maʻi maʻi. I kēia mea, pono ia e ʻimi i ka uku hoʻāno no ka maʻi diabetes inā ʻo ka wahine e hoʻolālā ana i ka hāpai ʻana. Pili ka pahuhopu like i ka manawa gestational.

I ka wā hapai, e pili ana i ke kua o ka maʻi mellitus, ma 90-100% o nā hihia ke hoʻohālikelike ʻia ka mea maʻi i kahi maʻi i kapa ʻia ʻo fetopathy maʻi maʻi. ʻO ka make hanal Perinatal ma ka maʻi fetopathy maʻi 2-5 mau manawa ma mua o ka nui o ka lehulehu.

Hoʻokumu ʻia ka fetopathy Diabetic i kekahi mau mea: ka nele o ka placental, hana pūpale hana hormonal, hyperglycemia maternal.
ʻO ka Hyperglycemia o ka makuahine e alakaʻi i ka hyperglycemia i ke kaʻe o ka puni o ke keiki. Hoʻomoʻu wale ʻia ʻo Glucose i ka plasenta a hoʻomau mau i ka lolo i ke koko o ka makuahine. ʻO ka lawe hou ʻana o nā waikawa amino a me ka hoʻoneʻe ʻana i nā kino ketone i ka fetus e hele pū nō hoʻi. Ma ka hoʻohālikelike ʻana, nā insulin, glucagon, a me nā momona momona ʻo ka māmā e komo i loko o ke koko fetal. I nā 9-12 mau pule mua o ka manawa hāpai, ʻaʻole i hoʻopuka ke pancreas o kāna iho ponoʻī. Pili kēia manawa i ka manawa o ka organogenesis fetal, i ka manawa, me ka mau ʻana i ka hyperglycemia maternal, & nbsp & nbsp, ʻoi ka naʻau, spine, spinal cord a me nā ʻeha gastrointestinal form i loko o ia mea.

Mai ka wiki o 12 o ka ulu ʻana o ka pūpū, hoʻomaka ke pancreas o ka pūpū e synthesize i ka insulin a me ka reactive hypertrophy a me ka hyperplasia o cells-cell o nā pancreas o ka pūpū i hoʻomohala ʻia e pane i ka hyperglycemia. Ma muli o ka hyperinsulinemia, e ulu ka macrosomia o ka pūpū, a me ka hoʻokaʻawale ʻana i ka synthesis lecithin, e wehewehe ana i ka nui o ka maʻi kaumaha o ke alapine i nā pēpē hou. Eia kekahi, i ka pathogenesis macrosomia, ʻo ka nui o ka kōpana o ka glucose a me ka waikawa amino ma o ka plenta, a me ka hypercorticism kekahi mea nui loa. ʻO ka hapa o ka pae glucose i loko o ke koko o ka makuahine ka mea e hoʻoikaika i ka hana o ka kelima pituitary - ʻo ka cortex adrenal.

A ma muli o ka hyperplasia β-cell a me ka hyperinsulinemia, heʻano maʻamau i ka hypoglycemia koʻikoʻi a lōʻihi a lōʻihi nā manawa i nā keiki hou. I ka wā i hoʻokaʻawale ʻia ai ka plasenta, ka haʻalele koke o ka kahe o ka glucose i ka pūpū, akā ʻaʻole i emi ka hyperinsulinemia, ma muli o ke ʻano o ka hypoglycemia e hana i nā hola mua o ka hānau ʻana.

Nā maʻi kulekō a me ka maʻi diagnostic:
ka nui a me ka lōʻihi o ke kino i ka wā hānau (macrosomia),
ka palapula, hypertrichosis, kala kala-cyanotic o ke kino.
puʻu puʻu piha piha (e like me ka mālama ʻana o nā glucocorticoids),
kuʻi ʻana i ka hoʻoponopono ʻana o ka postnatal,
morpho hana hemolele,
nā maʻi lapaʻau o ka hypoglycemia,
ʻeha ka maʻi ʻehaʻeha no ka synta o ka syntactant hoʻopā,
cardiovegaly in 30% o nā hihia, nā puʻuwai naʻau kongenital,
nā mea hoʻāla ʻē aʻe
hepato-splenomegaly,
hiki paha i ka hypotrophy intrauterine, akā naʻe, pēlā ke mālama ʻia nā hiʻohiʻona o ka maʻi Cushoid
huahuʻi,
hypocalcemia a me hypomagnesemia.

Ua ʻōlelo ʻia ʻo Hypoglycemia o nā pēpē, inā ma ka mau hola 72 mua o ke ola, ʻo ka nui o ke kō koko koko i nā keiki piha piha ma lalo o ka 1.7 mmol / l, ma nā keiki hānau mua a me nā pēpē me ka hoʻomau hoʻomohala ʻana i emi iho ka 1,4 mmol / l. Ma kahi hana, akā, ua manaʻo ʻia inā inā he nui o ke kō koko koko i loko o ka mea hānau hou ma lalo o 2.2 mmol / l, a laila pono ke kau ʻia.

ʻO kahi hoʻomaʻamaʻa no ka hypoglycemia ma hope o nā hola 72 o ke ola he nui ka wai momona ma lalo o 2.2 mmol / L.

Pono e hoʻoluhi ʻia e hiki ke ulu i ka hypoglycemia me ka maʻi maʻi maʻi diabetes. Hiki ke hana ʻia kēia ʻano, no ka laʻana, ma ka maʻi gestosis a me Rh nā maʻi ma muli o ka hōʻino nui o ka metabolism fetoplacental a me ka hoʻohana nui o ka glucose endogenous e ka pūpū. Hiki ke manaʻo ʻia ka hypoglycemia me ka wā ma mua, ka hoʻōla kino o ka intrauterine, i loko o nā māhoe, me ka asphyxiation a me ka hypothermia i ka hānau keiki, nā hōʻeha hānau intracranial, SDR, GBN, nīnūnika. Inā me ka fetopathy maʻi maʻi, ua hoʻoholo ʻia ka hypoglycemia i nā hola 2-6 o ke ola mua (neonatal hypoglycemia awal), a laila ma nā kūlana ʻē aʻe ma hope o ka hānai ʻana o ka hola 12-36 ma hope o ka hānau ʻana, ʻoi aku ka pinepine o ka hopena o ka lā mua (neia neʻokeʻo hypoglycemia).

ʻO nā hōʻailona maʻi o ka hypoglycemia i loko o nā keiki hou he ʻokoʻa a me ka non-pathognomonic. E like me kā lākou hele ʻana, ua puʻunaue ʻia lākou penei: hoʻonui ulu ʻia, hoʻāla hou ʻana i nā reflexes, nunui, cyanosis, cramps, apnea attack, irritated scream, iki pinepine - inhibition, nāwaliwali o ka hānai, nystagmus. ʻO ka paʻakikī o ka maʻi maʻi ma nā pēpē i hōʻemi ʻia, nā hanana like like me ka normoglycemia. ʻO ka hōʻailona diagnostic decisive, ma kahi o ka hoʻoholo ʻana i ke kō koko, ke nalowale ʻana o nā hōʻailona ma hope o ka hoʻomalu ʻana o ka glucose.

No ka manawa kūpono o ka hypoglycemia i nā keiki hou me ka fetopathy maʻi maʻi, e hoʻoholo pono ʻia ka pae o ke kō ma ke koko capillary ma hope o ka hānau ʻana a ma hope o 1-2 mau hola. Ma hope iho, ua hoʻoholo ʻia ka pae ʻaina ma kēlā me kēia mau hola 3-4 no 2 mau lā, a ma kēlā me kēia mau hola 6-8 no kahi 2 mau lā. Ke ulu ikaika nei ka honi ma ka lā 6-7th.

Ka mālama ʻana o ka maʻi hānau ʻana o ka maʻi diabetes:

ʻO nā loiloi o ka hānai ʻana i nā pēpē hou aʻe i nā makuahine me ka mellitus o ka maʻi diabetes:
ka mālama pono ʻana o nā kūlana kūpono,
hānai ʻaʻai
pono ke kahua o ka oxygen
ka pale a me ka hoʻoponopono ʻana i ka hypoglycemia a me nā pilikia ʻē aʻe o ka homeostasis,
ka hoʻohana ʻana i nā antioxidants,
hopena maʻi hōʻailona i ʻike ʻia.

Hoʻopili ʻia ka pale a me ke hoʻoponopono ʻana i ka hana hoʻohālikelike o ka hypoglycemia a me ka electrolyte e like me ka ʻōlelo ʻana. Manaʻo nā keiki āpau i ka 15-20 mau minuke ma hope o ka hānau ʻana e nā mea o ka ʻōpū a, inā pono, holoi ʻia me ka paʻakai. A laila, ke kuhikuhiʻia ka lawelawe waha o ka wai momona 5% i ka nui o 30-40 ml / kg i kēlā me kēia lā. 2 mau hola ma hope o ka hānau ʻana, hiki iā ʻoe ke hoʻomaka i ka mālama umauma a i ʻole ka hōʻike umauma waiū. I ka lā mua, e hānai ʻia ka hānai i kēlā me kēia 2 mau hola.

Inā ʻo ka waiwai glycemia he 1.65-2.2 mmol / L 1-2 mau hola ma hope o ka hānau ʻana, pono nō e hoʻomau i ka hoʻokele o ka glucose ma ke ala waha. Me ka hoʻomohala ʻana o ka hypoglycemia, ua hōʻeha ʻia kahi hopena o ka glucose 10% i ka intravenously ma ke ʻano o ka wai o 2 ml / kg (no nā mea hoʻonaninani - a hiki i 10 ml / kg a i ʻole 20-25% hopena o ka glucose 4-5 ml / kg). Ma hope aku, huli lākou i ka hoʻokele dropwise o ka hopena o ka glucose i ka 10% i ka awelika o 0.1 ml / kg i hoʻokahi minuke (ʻo ka nui o kēlā me kēia lā ʻaʻole ma mua o 80 ml / kg). ʻAʻole ʻōlelo ʻia nā hopena glucose neʻe hou ʻia, no ka mea, he kumu hou kēia i ka pae o ka insulin a hoʻonāukiuki i ka hoʻomohala ʻana o ka hypoglycemia lua. Hoʻoholo ʻia ke kōhi koko i kēlā me kēia mau hola 1-2 a hiki i kona hoʻonui ʻia i ka 2.2 mmol / L. A hiki i kēia pae, ua hoʻemi ʻia ka lawelawe intravenous glucose i ka ulu nui, me ka hoʻohui pū me ia me ka hoʻokele waha o ka glucose. ʻO ka honi koko ke nānā i kēlā me kēia 4-6 mau hola.

Inā ʻaʻole maikaʻi ka mālama ʻana i ka glucose, hoʻohana nā hydrocortisone ma kahi pae like o 2.5 mg / kg i kēlā me kēia mau hola 12 a i ʻole ka prednisone 1 mg / kg i kēlā me kēia lā, glucagon 0.3-0.5 mg intramuscularly.

Hoʻololi ʻia ka hypypcemia e ka hoʻokō intravenous o kahi hopena o 10% o ka calcium gluconate (1-2 ml no kēlā me kēia 50 ml o ka glucose a i ʻole 0.3 ml / kg i kēlā me kēia lā), ke hoʻoponopono ʻia nā hypomagnesemia e ka hoʻokō intravenous o kahi hopena o 15% o ka magnesium sulfate ma kahi maʻa o 0.3 ml / kg (paha intramuscular ka hoʻolauna ʻana i kahi hopena o 25% o 0.2-0.4 ml / kg i kēlā me kēia lā).