Hauv cov neeg mob uas muaj ntshav qab zib, txhua txoj kev tswj kom tsis txhob muaj menyuam yog siv. Haum hauv qhov loj me tuaj yeem siv. Tub rogmuaj tooj liab. Tsis txhob tso tus "kav hlau txais xov" ntawm IUD uas dai ntawm lub ncauj tsev menyuam, vim lawv tuaj yeem dhau los ua tus neeg nqa kab mob. IUDs hauv cov neeg mob ntshav qab zib ua rau muaj kev nyuaj ntau tsis ntau dua li cov poj niam noj qab haus huv.

Kev txwv tsis pub muaj ntsiav tshuaj npaj, qhov sib hu ua COCs (sib xyaw ua ke ntawm lub qhov ncauj), tuaj yeem siv, thiab nws raug nquahu kom siv cov tshuaj tiv thaiv qis qis peb-theem muaj me nyuam. Qee zaum, qhov no, nws yog qhov tsim nyog yuav tau nce lub koob tshuaj insulin. Hauv cov neeg mob nrogvascular cov teeb meem ntshav qab zib, tshuaj tiv thaiv tsis pub mis yuav tsum tsis txhob siv.Thaum GDMkev ploj lawm tom qab yug menyuam tsuas yog siv tau progestins (femoden, exluton, thiab lwm yam).

Daim ntawv thov tsis raug cais tawm txoj hauv kev thaiv txoj kev pov thaivli qub kom tsis muaj menyuam, uas tuaj yeem ua nrog kev phais mob lossis laparoscopically tsis muaj ntxov dua 6-8 lub lis piam. tom qab yug menyuam.

4.3. Kev tshuaj xyuas tus kheej rau cov pojniam xeeb tub uas muaj ntshav qab zib

Nws yog ib qho tsim nyog los tham nrog tus neeg mob thiab nws tus khub ntawm cov phiaj xwm ntsuas ntawm glycemia thaum cev xeeb tub, lub luag haujlwm ntawm kev ntsuas tus kheej thiab kev tshawb fawb tsis tu ncua ntawm HbA1c, kev pheej hmoo rau leej niam thiab tus menyuam. Lawv yuav tsum tau nquahu kom mus kawm lub Tsev Kawm Ntawv Cev Xeeb Tub thiab Mob Ntshav Qab Zib, txawm tias ib tug pojniam nyuam qhuav mus kawm ntawv rau cov neeg mob ntshav qab zib. Lub sijhawm cev xeeb tub, kev hloov pauv hauv tus pojniam lub cev tas li tshwm sim tas li, xav tau kev paub tshwj xeeb los hloov kho kom haum rau txhua qhov kev paub ntawm tus kabmob, txij li thaum Qhov kev pheej hmoo tseem ceeb rau txhua tus cev xeeb tub tsis yog lub sijhawm mob ntshav qab zib, thiab qhov zoo ntawm nws cov nyiaj tau los ntawm xeeb mus rau kev yug menyuam. Tus txij nkawm tuaj yeem muab kev pab ncaj qha rau hauv kev tswj hwm cov nyiaj them rau kev mob ntshav qab zib, yog li kev pom zoo kev kawm paub.

Ntxiv rau kev qhia theoretical, nws yog qhov yuav tsum tau kuaj xyuas tus neeg mob tus kheej kev tswj tus kheej, ntsuas lub ntsej muag glucometer, ntsuas seb tus neeg mob tau kho cov tshuaj insulin kho mob li cas, thiab kuaj cov txheej txheem rau kev txais neeg thiab tswj cov tshuaj insulin. Nws tseem yuav tsum tham txog cov hauv kev niaj hnub ntawm kev siv tshuaj insulin: koob txhaj - koob tshuaj, koob txhaj tshuaj insulin (innovo nrog cov cim xeeb tsim), insulin twj tso kua mis (medtronic). Nyiaj txiag qhov teeb meem ntawm cov teeb meem yuav tsum tau daws. Rov ua dua txhua hnub ntsuas ntawm glycemia, acetonuria, kev sim ntxiv rau cov poj niam cev xeeb tub uas muaj ntshav qab zib yuav tsum muaj qee yam nqi khoom, uas tseem yuav tsum tau coj mus rau hauv qhov kev npaj thaum npaj yuav xeeb tub (Cov lus 2).

Intrauterine tshuab.

Lub tshuab hluav taws xob (IUD) yog lub kaw lus intrauterine, uas yog cov cuab yeej me me ua los ntawm cov yas nrog tooj liab uas tiv thaiv kev txav ntawm cov phev nkag mus rau hauv lub tsev menyuam kab noj hniav, tiv thaiv cov qe thiab phev los ntawm kev sib ntsib, thiab tseem tiv thaiv lub qe ua qe los txuas rau phab ntsa uterine. Raws li kev txheeb cais, 1 ntawm 100 tus poj niam nrog hom kev xeeb tub no yuav xeeb tub. Cov tshuaj hormones progesterone los ntawm cov kab ke no tau tso tawm qeeb, tab sis tas li, pab txhawb rau cov txheej txheem ntawm sab hauv ntawm lub tsev menyuam (ntu ntawm endometrium), uas txwv tsis pub lub qe nkag mus rau lub tsev menyuam phab ntsa, thiab tseem ua rau lub tsev me lossis cov hnoos qeev ua ntau dua (qhov no ua rau nws nyuaj rau cov phev nkag mus rau lub tsev menyuam kab noj hniav, qhov chaw uas lawv tuaj yeem fertilize ib lub qe). Qhov zoo ntawm cov qauv no muaj txiaj ntsig kev tiv thaiv zoo, tsis muaj qhov xav tau kom nquag mus noj mov, zoo ib yam li ntsiav tshuaj. Lub kauv yog teem rau 5 xyoos. Qhov tsis zoo yog qhov pheej hmoo ua teeb meem xws li kis kab mob, thiab ntau ntxiv thiab muaj kev mob lub sijhawm. IUDs feem ntau tau tsim rau cov poj niam uas tau yug menyuam. Cov ntaub ntawv uas twb muaj lawm qhia tib cov kev taw qhia rau nruab ib lub twj tso kua mis rau cov poj niam yam tsis muaj ntshav qab zib. Hom no tsawg kawg cuam tshuam rau kev tswj ntshav qab zib.

Kev cog hniav sib cais.

Qhov cog hniav yog tso subcutaneously, thiab nws cov nyhuv ua tiav los ntawm kev zes qe menyuam (qhov tawm ntawm lub qe los ntawm lub zes qe menyuam). Thaum siv nws, 1 ntawm 100 tus poj niam tuaj yeem cev xeeb tub. Nws tau nruab nrog siv cov tshuaj loog hauv zos rau 3 xyoos. Qhov zoo yog pom tseeb - high efficiency, installation ib zaug rau 3 xyoos. Qhov tsis zoo yog qhov feem ntau ntawm kev pom pom thiab kev phiv me uas feem ntau tshwm sim hauv thawj ob peb lub hlis.

Kev phais ntshav me me kuj tseem muaj kev nyab xeeb rau cov neeg mob ntshav qab zib. Raws li kev tshawb fawb, cov tshuaj no tsis cuam tshuam rau theem ntawm glycated hemoglobin thiab tsis ua rau muaj kev vam meej ntawm cov kev mob ntshav qab zib. Qhov laj thawj feem ntau ntawm kev tso lawv tseg yog raug sau tseg.

Rau tsev tiv thaiv tsis ntev suav nrog qhov ncauj ua kom lub ntsej muag zoo li lub ntsej muag tshuaj tiv thaiv. Cov no yog cov tshuaj tiv thaiv kom muaj feem ntau. Txawm li cas los xij, 1 xyoo tom qab pib siv tus qauv, tsuas yog 68% ntawm cov poj niam txuas ntxiv lawv txoj kev noj mov yav tom ntej, vim tias cov ntsiav tshuaj yuav tsum noj txhua hnub, thaj ua rau thaj hloov pauv txhua asthiv, thiab ncig txhua hli. Nyob rau hauv muaj ntawm hom 1 mob ntshav qab zib mellitus yam tsis muaj kev mob vascular, cov txiaj ntsig ntawm qhov kev kho no dhau nws qhov txaus ntshai.

Tshuaj tiv thaiv tsis pub siv ncauj lossis tshuaj noj kom tsis muaj me nyuam.

Nov yog ib qho ntawm kev siv feem ntau ntawm kev tswj kom tsis txhob muaj menyuam. Muaj ntau ntau pawg kev tswj tsis pub muaj menyuam: cov tshuaj ua ke (muaj 2 cov tshuaj hormones - estrogen thiab progesterone) thiab xwb progesterone - muaj tshuaj. Ua ntej tshaj plaws, cov tshuaj hormones no ua rau lub zes qe menyuam, thaiv kev tawm ntawm lub qe (ovulation nres). Tsis tas li ntawd, cov tshuaj hormones no ua rau lub ncauj tsev menyuam hnoos qeev, ua rau endometrium thinner, uas tiv thaiv kev txuas ntawm lub qe qe rau lub uterine phab ntsa. Peb sib tham txhua ntawm cov pab pawg.

Kev tshawb mob kis mob hlwb tau qhia tias kev noj ua ke sib xyaw ntawm qhov ncauj txuam nrog kev pheej hmoo siab ntawm kab mob vascular. Yog lawm, noj cov tshuaj no tuaj yeem ua lub luag haujlwm tseem ceeb ntsig txog ntshav qab zib. Ib qho ntxiv, ua ntej lawv teem caij, nws yog qhov yuav tsum tau los ntsuas qhov ntsuas ntawm cov ntshav coagulation system, txij li qhov kev pheej hmoo ntawm kev tsim cov ntshav txhaws (ntshav txhaws) nce.

Yog li, cov tshuaj tiv thaiv kev xeeb tub no tsim nyog yog tias koj muaj hnub nyoog qis dua 35 xyoo thiab koj tsis muaj teeb meem voos voos thiab cov kev pheej hmoo xws li mob ntshav siab, rog rog, haus luam yeeb thiab muaj cov ntshav liab yav dhau los.

Ua ke ntawm kev tiv thaiv kab mob hauv qhov ncauj, thaum noj ntau dua, cuam tshuam qhov xav tau ntawm insulin, nce nws, thiab hauv cov koob tshuaj me me cov nyhuv no tseem tsawg heev.

Raws li kev txheeb cais, 1 ntawm 100 tus poj niam uas tau noj tshuaj tsis tu ncua cev xeeb tub. Lawv cov txiaj ntsig yog qhov ua tau zoo, qhov tsawg ntawm cov kev mob tshwm sim, thiab lawv kuj siv rau qhov mob hnyav thiab hnyav. Thiab qhov tsis zoo yog qhov kev pheej hmoo los ntshav tsis txaus (ntshav txhaws), qhov yuav tsum tau nkag mus tsis tu ncua yam tsis muaj qhov khoob, sib kis rau qee yam kabmob.

Cov tshuaj progesterone muaj.

Kev npaj tos tsuas muaj progesterone lossis dej haus me me (uas yog, "cov ntsiav tshuaj tsawg kawg") tau zoo rau cov poj niam uas muaj ntshav qab zib hom 1, vim tias lawv tsis cuam tshuam txog kev tswj ntshav qab zib lossis muaj feem ua rau muaj mob ntshav qab zib. Raws li kev txheeb cais, 1 ntawm 100 tus poj niam uas tau noj tshuaj tsis tu ncua cev xeeb tub. Qhov tsis zoo ntawm hom kev tswj kom tsis txhob muaj menyuam yog qhov muaj peev xwm ua tsis xwm yeem ntawm lub cev ntas thiab qhov tseeb uas lawv yuav tsum tau ntsuas lub sijhawm nruj me ntsis. Lawv ua vim qhov tshwm sim ntawm qhov ntom ntawm cov hnoos qeev hauv lub ncauj tsev menyuam, txhaws ntawm lub plab hnyuv, thiab tseem thaiv cov ovulation. Ntxiv rau, cov tshuaj no feem ntau siv los ntawm lactating poj niam, poj niam hnub nyoog 35 xyoo rov hauv, thiab haus luam yeeb.

Koj yuav tsum siv lawv raws li txoj cai ntawm kev pub nkag mus rau kev tiv thaiv kev tiv thaiv kev xeeb tub. Cov teeb meem tshwm sim feem ntau ntawm kev tswj tsis ua hauj lwm thaum noj tshuaj txwv tsis pub noj yog noj tshuaj, noj tshuaj, lossis cov xwm txheej uas cuam tshuam rau kev ua haujlwm zoo (piv txwv li kev siv tshuaj tua kab mob, ntuav, lossis raws plab).

Thaj kev tiv thaiv.

Ib hom sib xyaw ua ke ntawm kev tswj kom tsis txhob muaj estrogen thiab progesterone. Cov kabmob no txuas rau ntawm daim tawv nqaij. Qhov zoo ntawm cov hom no yog qhov yooj yim ntawm kev siv, qhov ua tau zoo, nrog rau qhov ua kom tsis muaj qhov hnyav thiab tsis tshua muaj mob. Qhov tsis zoo yog qhov kev txwv ntawm kev siv qee yam ntawm tus neeg. Nws tsis pom zoo rau cov poj niam hnub nyoog tshaj 35 xyoo, haus luam yeeb, nrog rau cov poj niam lub cev nyhav dua 90 kg, vim tias cov tshuaj hormones yuav tsis txaus kom tsis txhob muaj menyuam.

Rau txoj kev tsis-hormonal suav nrog cov hnab yas looj, cov phuam qhwv caj dab, tshuaj tua kabmob phev, cov txheej txheem ntawm kev xeeb tub hauv ib txwm muaj. Thaum tus poj niam tsis npaj me nyuam ntxiv lawm, tuaj yeem siv txoj kev ua kom tsis taus menyuam.

Kev thaiv txoj kev.

Cov no suav nrog cov hnab yas looj (txiv neej, poj niam), daim ntaub qhwv caj dab. Lawv tiv thaiv cov phev los rau hauv lub tsev menyuam. Lawv cov hauj lwm zoo dua qis dua me ntsis. Thaum siv hnab looj cov txiv neej, 2 ntawm 100 tus poj niam tuaj yeem cev xeeb tub. Qhov zoo yog qhov tsis muaj mob, nrog rau kev mob tshwm sim. Ntxiv rau, nco ntsoov tias hnab looj tiv thaiv tiv thaiv kev sib kis los ntawm kev sib deev. Qhov tsis zoo yog qhov tsis txaus ntseeg ntawm tus qauv, qhov yuav tsum tau siv nws txhua zaus, nrog rau kev ua txhaum txoj cai kev ncaj ncees ntawm tus qauv.

Los ntawm cov txheej txheem kho mob, cov txheej txheem thaiv tau zoo rau txhua tus poj niam uas muaj ntshav qab zib hom 1 vim muaj qee qhov me tshwm sim thiab cuam tshuam rau kev tswj ntshav qab zib. Cov hnab looj, cov tshuaj tua kabmob (spermicides) thiab cov tshuaj tua kabmob ua kom tshem tawm tau zoo thaum siv kom raug thiab tsis tu ncua. Txawm li cas los xij, qhov kev ua tau zoo ntawm cov qauv no nyob ntawm koj qhov kev cog lus rau cov qauv no thiab siv tas li. Lawv yog qhov zoo tshaj plaws rau cov poj niam uas tsis xav noj tshuaj hormonal npaj npaj cev xeeb tub hauv 3-6 lub hlis tom ntej, thiab, muaj qee qhov xwm txheej tsis tshua muaj, cov poj niam uas tsis pom zoo siv lwm txoj kev tiv thaiv.

Thiab tseem, rau cov pojniam uas tsis muaj tus khub sib deev mus tas li, cov hnab looj yuav tsum siv los tiv thaiv kab mob sib kis. Nov yog tib txoj kev tiv thaiv kom muaj kev tiv thaiv cov kab mob no.

Thaum xaiv cov hau kev zoo li no, koj tus kws kho mob yuav tsum qhia koj txog kev tiv thaiv kev xeeb tub thaum muaj xwm txheej ceev. Cov hau kev siv tshuaj tiv thaiv thaum muaj xwm txheej ceev yog siv yog tias koj tsis xav tau cev xeeb tub: thaum sib deev tsis muaj kev tiv thaiv menyuam, yog tias lub hnab looj raug puas, yog tias koj ploj cov tshuaj tiv thaiv kev xeeb tub, lossis yog tias koj siv cov tshuaj tua kab mob uas txo cov tshuaj muaj txiaj ntsig.

Rau cov poj niam uas tsis xav kom cev xeeb tub ntxiv lawm, phais mob kom tsis muaj menyuam yog lwm qhov kev daws. Txawm li cas los xij, cov hau kev saum toj no tsis qis qis qis hauv kev ua kom tsis muaj menyuam thiab tsis yog phais. Poj niam kom tsis muaj menyuam yog ib txoj kev phais mob kom txhob muaj menyuam, uas yog ua raws li kev tsim cov nyom ntawm txoj hlab qe menyuam. Nws yog qhov yooj yim heev los nqa nws thaum lub sijhawm phais plab. Poj niam kom tsis muaj menyuam tsis hloov pauv keeb kwm yav dhau los. Koj tuaj yeem sib tham txog qhov teeb meem no nrog koj tus kws kho mob tas mus li thaum lub sijhawm ua haujlwm Sterilization ntawm tus txiv neej kuj ua tau - vasectomy, ib txoj kev phais mob hauv kev sib txuas lus uas tshem tawm lossis tshem tawm ib ntu ntawm vas deferens tau ua rau txiv neej. Nws tseem ceeb yog tias koj muaj kev sib deev tsis tu ncua.

Mob ntshav qab zib kom paub meej

Kev noj qab haus huv ntawm tus poj niam muaj ntshav qab zib

Neeg kho tshuab, hauv zos, phais

Cov neeg mob ntshav qab zib 1 hauv lub xeev cov nyiaj them thiab subcompensation, yam tsis muaj suab vascular muaj teeb meem

• Peb-theem qhov ncauj kev tiv thaiv tsis zoo (OK) (Triquilar, Triziston, Peb-Tsho)

• Qhov chaw mos txwv tsis pub muaj kev tiv thaiv

Cov neeg mob ntshav qab zib 2 hauv lub xeev cov nyiaj them thiab subcompensation

• Qes qes ua ke OK OK muaj 20-30 micrograms ntawm ethinyl estradiol (Logest, Mercilon, Novinet) • Cov tshuaj tiv thaiv ntawm cov tub ntxhais tsim tshiab (Desogestrel, Norgestimat, Gestoden)

• Tshuaj Tiv Thaiv Intrauterine (“tsis pub muaj cov tooj liab ntawm cov khoom siv hluav taws xob (IUD)”)

Cov neeg mob uas muaj ntshav qab zib hom 2 nrog hypertrig-lyceridemia thiab lub siab ua haujlwm tsis zoo

• Txheeb ze hormonal nplhaib muaj steroids

Cov neeg mob uas muaj mob ntshav qab zib hom 1, ua rau lub cev qhuav thiab / lossis muaj cov leeg ntshav hnyav heev

• Gestagen-IUDs uas muaj • Neeg kho tshuab thiab tshuaj lom neeg (douching, pastes)

Cov neeg mob ntshav qab zib 1, nrog 2 lossis ntau tus menyuam yaus thiab / lossis cov chav kawm muaj mob hnyav

Yeem Kev phais mob kom zoo

Cov neeg mob ntshav qab zib tsis tau. Cov hauv qab no kev tiv thaiv kom paub zoo:

• progestogens (hauv cov neeg mob uas muaj ntshav qab zib hom 1),

• cov lus qhia sib dho uas tsis meej pem.

Qhov ntsuas kev qhia glycemic tswj hwm hauv cov menyuam yaus thiab cov hluas uas muaj ntshav qab zib hom 1 (ISPAD Consensus Gu>)

Kev siv txoj kev ua kom tsis muaj menyuam.

Qhov no suav nrog kev sib daj sib deev thiab kev sib deev nyob rau "nyab xeeb" hnub. Yog lawm, koj yuav tsum nkag siab tias cov hau kev no muaj qhov ua tau zoo tsawg. Txhawm rau txiav txim siab txog hnub "nyab xeeb", nws yog qhov tsim nyog rau 3-6 ntu ib txwm siv siv ntsuas xws li ntsuas lub cev, qhov paum ntawm qhov paum thiab kuaj tshwj xeeb los txiav txim hnub ovulation. Qhov zoo dua yog qhov tsis muaj cov kev mob tshwm sim, ntxiv rau qhov kev pheej hmoo siab ntawm cev xeeb tub.

Hauv kev xaus, Kuv xav nco ntsoov tias kev xeeb tub yuav tsum tsis yog qhov tsim nyog xwb, tab sis kuj tau npaj, yog li ntawd nws yog qhov yuav tsum tau mus cuag qhov teeb meem no tiag tiag. Tam sim no, muaj kev lag luam dav dav rau kev tswj kom tsis txhob muaj menyuam yaus, thiab, ua tsaug rau qhov no, koj tuaj yeem sib deev yam tsis muaj kev ntshai txog cev xeeb tub. Nyob ntawm koj cov phiaj xwm kev xeeb tub, koj cov kev nyiam, kev ua neej, thiab muaj cov mob ntshav qab zib, koj thiab koj tus kws kho mob yuav xaiv cov qauv zoo tshaj plaws ntawm kev tiv thaiv rau koj.