Chaka chilichonse, chithandizo cha matenda a shuga chikuyenda bwino. Izi zimakupatsani mwayi wopewa zovuta zamtundu wa mtima kapena kuchedwetsa nthawi yowonekera kwawo. Chifukwa chake, kwa azimayi omwe ali ndi matenda ashuga, kutalika kwa nthawi yobereka kumakula.
Matenda a shuga amatha kupanga zovuta kusankha njira zoyenera zakulera.
Nthawi yomweyo, azimayi onse omwe ali ndi matenda ashuga amafunika kukonzekera mwanzeru pakakhala ndi pakati. Mutha kuyamba kukhala ndi pakati pomwe shuga yanu yayandikira kwambiri, ndiye kuti kubwezeretsedwa bwino kwa shuga.
Mimba yosakonzekera yomwe imayambitsa matenda ashuga imawopseza mayi ndi mwana wake wamtsogolo. Izi zikutanthauza kuti nkhani yoletsa kubereka m'matenda a shuga ndiyofunika kwambiri. Amalandira chidwi ndi madokotala komanso odwala omwe ali ndi matenda ashuga.
Kusankha njira zoyenera kwambiri zakulera ndi ntchito yovuta. Nkhaniyi imasankhidwa payokha kwa mayi aliyense. Ngati ali ndi matenda a shuga, ndiye kuti mungam'patsa zina. M'nkhani ya lero, muphunzira zonse zomwe muyenera, limodzi ndi dokotala, kudziwa kulera kwa matenda ashuga.
Otsatirawa akufotokozera njira zamakono zothandizira kulera. Ndizoyenera azimayi omwe ali ndi matenda ashuga, kutengera mtundu wawo. Sitikambirana za njira yopyapyala, zosokoneza zokhudzana ndi kugonana, kugwa ndi njira zina zosadalirika.
Kuvomerezeka kwa njira zakulera kwa amayi omwe ali ndi matenda ashuga
| Mkhalidwe | COC | Zingwe | Mphete ya mphete | Bye | Zofikira | Cu-IUD | LNG-Navy |
|---|---|---|---|---|---|---|---|
| Pakhala pali matenda ashuga | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Palibe zotupa za mtima | 2 | 2 | 2 | 2 | 2 | 1 | 2 |
| Pali zovuta za matenda ashuga: nephropathy, retinopathy, neuropathy | 3/4 | 3/4 | 3/4 | 2 | 2 | 1 | 2 |
| Mavuto akulu a mtima kapena kutalika kwa shuga kwa zaka zopitilira 20 | 3/4 | 3/4 | 3/4 | 2 | 2 | 1 | 2 |
Kodi manambala akutanthauza chiyani:
- 1 - kugwiritsa ntchito njirayi kumaloledwa;
- 2 - nthawi zambiri palibe zotsutsana ndi kugwiritsa ntchito njira;
- 3 - Kugwiritsa ntchito njirayi sikulimbikitsidwa pokhapokha ngati njira zoletsa moyenera kapena kugwiritsa ntchito kwake sizivomerezeka;
- 4 - Kugwiritsa ntchito njirayi kumatsutsana kwathunthu.
Maudindo:
- Ma COC - mapiritsi ophatikizira kubereka ophatikizira omwe ali ndi mahomoni kuchokera kuzinthu zama estrogens ndi progestin;
- POC - mapiritsi oletsa kubereka omwe ali ndi progestogen yokha;
- Cu-IUD - chipangizo cha intrauterine chomwe chili ndi mkuwa;
- LNG-IUD ndi chipangizo cha intrauterine chokhala ndi levonorgestrel (Mirena).
Kusankha njira yolerera yolerera
| Mkhalidwe waumoyo wa mayi yemwe ali ndi matenda ashuga | Njira yakulera | |
|---|---|---|
| Mapiritsi | Makina, am'deralo, opaleshoni | |
| Odwala a shuga a Type 1 omwe amatha kuwongolera shuga lawo lamwazi, osatchulira mavuto a mtima |
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| Odwala odwala matenda ashuga a 2 omwe akwaniritsa zolinga zawo payekha malinga ndi shuga, mwachitsanzo, onetsetsani matendawa |
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| Odwala a shuga a Type 2 omwe ali ndi magazi okwera triglycerides ndi chiwindi chodwala | Sikuwonetsedwa |
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| Odwala a shuga 1 amtundu wa shuga omwe samayendetsa bwino shuga wawo wamagazi ndi / kapena omwe ali ndi vuto lalikulu la mtima | Sikuwonetsedwa |
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| Lemberani odwala matenda ashuga 1 omwe ali ndi matenda oopsa komanso / kapena omwe kale ali ndi ana awiri kapena kupitilira apo | Sikuwonetsedwa |
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Gwero lazidziwitso: malangizo azachipatala "Ma Algorithms a chithandizo chapadera cha odwala omwe ali ndi matenda a shuga", okonzedwa ndi II. Dedova, M.V. Shestakova, kope 6, 2013.
Ngati mayi yemwe ali ndi matenda ashuga ali ndi zotsutsana kwathunthu pazamankhwala oyembekezera, ndiye kuti lingalirani ndikuchita opaleshoni yodzifunira. Zomwezo ngati "mwathetsa kale ntchito yanu yobala."
Kuphatikiza kulera kwamlomo
Njira zophatikiza zakulera za pakamwa (COC) ndi mapiritsi oteteza kubala omwe ali ndi mitundu iwiri ya mahomoni: estrogens ndi progestins. Estrogen monga gawo la mapiritsi oteteza kubala amadzaza kuperewera kwa estradiol, kapangidwe kazachilengedwe komwe kumapanikizidwa m'thupi. Chifukwa chake, kuyang'anira kusamba kumasungidwa. Ndipo progestin (progestogen) imaperekanso njira zolerera za ma COC.
Musanagwiritse ntchito njira yolerera ya mahomoni, kaonaneni ndi dokotala ndikukuwunika. Awa ndi mayeso am magazi a ntchito ya platelet, AT III, factor VII ndi ena. Ngati mayeserowa atakhala oyipa - njira yoletsa kubereka siyabwino kwa inu, chifukwa pali chiwopsezo cha venous thrombosis.
Pakadali pano, kuphatikiza kwa kulera kwamlomo ndi kotchuka kwambiri padziko lonse lapansi, komanso mwa azimayi omwe ali ndi matenda ashuga. Zifukwa zake:
- Ma COC amateteza modziteteza ku mimba zosafunikira;
- nthawi zambiri amaloledwa ndi akazi;
- atayimitsa mapiritsi, azimayi ambiri amatenga pakati pakatha miyezi 1 mpaka 12;
- kumwa mapiritsi ndikosavuta kuposa kumangoyala, kupanga jakisoni, ndi zina zambiri.
- njira yolerera ya kubala imakhala ndi zowonjezera zowonjezera zowonjezera zowonjezera komanso prophylactic.
Contraindative kugwiritsa ntchito limodzi pakamwa kulera azimayi omwe ali ndi matenda ashuga:
- matenda a shuga salipidwa, i.e., shuga wamagazi amakhala okwera kwambiri;
- kuthamanga kwa magazi pamtunda wa 160/100 mm RT. st.;
- dongosolo la heestatic limaphwanyidwa (kutaya magazi kwambiri kapena kuwonjeza magazi);
- zovuta zamatenda a shuga atapangidwa kale - proliferative retinopathy (2 zimayambira), matenda ashuga nephropathy pa gawo la microalbuminuria;
- wodwala alibe luso lokwanira kudziletsa.
Contraindative ku estrogen kudya ngati mbali yapakati ya pakamwa:
- chiopsezo chowonjezeka cha magazi ndi kufinya kwa mitsempha yamagazi (pimani mayeso ndikuwunika!);
- wapeza cerebrovascular ngozi, migraine;
- matenda a chiwindi (hepatitis, Rotor, Dabin-Johnson, Gilbert syndromes, cirrhosis, matenda ena omwe amayenda ndi chiwindi kulephera);
- magazi ochokera kumimba, zomwe zimayambitsa sizimadziwika;
- zotupa zodalira mahomoni.
Zinthu zomwe zimawonjezera chiopsezo cha mavuto a estrogen:
- kusuta
- zolimbitsa ochepa matenda oopsa;
- zaka zopitilira 35;
- kunenepa kwambiri kuposa madigiri 2;
- cholowa chovuta mu matenda amtima, mwachitsanzo, pakhala pali matenda amtima kapena matenda a sitiroko m'mabanja, makamaka asanakwanitse zaka 50;
- mkaka wa m'mawere (yoyamwitsa).
Kwa azimayi omwe ali ndi matenda ashuga, njira yotsika ndi yaying'ono ya pakamwa ndi yoyenera.
Ma COC ochepera - okhala ndi zochepa za 35 μg za estrogen. Izi zikuphatikiza:
- monophasic: "Marvelon", "Femoden", "Regulon", "Belara", "Jeanine", "Yarina", "Chloe";
- Gawo lachitatu: "Tri-Regol", "atatu-Merci", "Trikvilar", "Milan".
Ma COC osakanizidwa - amakhala ndi 20 mcg kapena kuchepera kwa gawo la estrogen. Izi zikuphatikiza kukonzekera monophasic "Lindinet", "Logest", "Novinet", "Mercilon", "Mirell", "Jacks" ndi ena.
Kwa amayi omwe ali ndi matenda ashuga, gawo latsopano pakubala kunali chitukuko cha KOK, chomwe chili ndi estradiol valerate ndi dienogest, yokhala ndi dosing regimen (Klayra) yamphamvu.
Njira zonse zophatikizira zakulera pakamwa zimakulitsa milingo ya triglyceride m'magazi. Koma ichi ndi chiopsezo chokhacho kwa azimayi omwe kale anali ndi hypertriglyceridemia asanamwe mapiritsi. Ngati mayi ali ndi dyslipidemia wolimbitsa thupi (kuchepa kwamafuta metabolism), ndiye kuti ma COC amakhala otetezeka. Koma pakudya kwawo, muyenera kumayesa magazi pafupipafupi kwa triglycerides.
Vaginal mahomoni mphete NovaRing
Njira yachikazi yogwiritsira ntchito mahomoni a steroid yoletsa kubereka, pazifukwa zambiri, ndibwino kuposa kumwa mapiritsi. Kutulutsa kwa mahomoni m'mwazi kumakhala kosasunthika. Zinthu zomwe sizikugwira zimawonekera pang'onopang'ono kudzera pachiwindi, monga momwe amalembera mapiritsi. Chifukwa chake, mukamagwiritsa ntchito njira zakulera zamkati za amayi, kuchuluka kwa mahomoni tsiku ndi tsiku kumatha kuchepetsedwa.
Mphete yam'mimba ya NovaRing imakhala yoletsa kubereka mwa mawonekedwe a mphete yowonekera, masentimita 54 mm ndi mainchesi 4 mm pamagawo a mtanda. Kuchokera pamenepa, ma microgram 15 a ethinyl estradiol ndi ma microphs a etonogestrel amatulutsidwa mu nyini tsiku lililonse, iyi ndi metabolite yogwira ya desogestrel.
Mzimayimayala payekhapayekha amaloza mphete yoletsa kubereka kudzera mu nyini, osagwira nawo ntchito zachipatala. Iyenera kuvalidwa masiku 21, ndiye yopuma masiku 7. Njira yolerera yolerera imakhudza kwambiri kagayidwe kazakudya zamafuta ndi mafuta, ofanana ndi microdosed ophatikizana am'kamwa.
Mphete yam'mimba ya NovaRing imasonyezedwa makamaka kuti imagwiritsidwa ntchito ndi azimayi omwe shuga imaphatikizidwa ndi kunenepa kwambiri, kukwezedwa kwa magazi kwa triglycerides kapena kuwonongeka kwa chiwindi. Malinga ndi kafukufuku wakunja, zizindikiro za ukazi sizimasintha pamenepa.
Kukhala kofunikira pano kukumbukira kuti azimayi omwe ali ndi kunenepa kwambiri komanso / kapena shuga wambiri chifukwa cha matenda ashuga amakonda kwambiri kuonetsa vervovaginitis. Izi zikutanthauza kuti ngati muli ndi thrush, ndiye kuti siyosavuta kugwiritsa ntchito njira yakulera ya NovaRing, koma yawuka pazifukwa zina.
Intrauterine kulera
Njira zakulera za intrauterine zimagwiritsidwa ntchito ndi 20% azimayi omwe ali ndi matenda ashuga. Chifukwa njira yolerera yodalirika komanso nthawi yomweyo imadziteteza kumatenda osakonzekera. Amayi amakhala omasuka kwambiri kuti safunikira kuyang'aniridwa mosamala tsiku lililonse, monga kumwa mapiritsi a kulera.
Zowonjezera za njira zakulera za intrauterine za matenda ashuga:
- Siziwononga chakudya ndi mafuta metabolism;
- musachulukitse mwayi wamagazi ndikutseka magazi.
Zoyipa zamtundu uwu wa kulera:
- azimayi nthawi zambiri amakhala ndi kusamba kwa msambo (hyperpolymenorrhea ndi dysmenorrhea)
- chiopsezo chowonjezereka cha mimba ya ectopic
- Nthawi zambiri matenda opatsirana a m'chiberekero amapezeka, makamaka ngati ali ndi matenda ashuga shuga wambiri amakhala wothamanga.
Amayi osabereka samalimbikitsidwa kugwiritsa ntchito intrauterine kulera.
Chifukwa chake, mwazindikira kuti ndi zifukwa ziti zosankhira njira imodzi kapena imodzi yolerera ya matenda ashuga. Mkazi wazaka zobereka azitha kusankha yekha njira yoyenera, onetsetsani kuti mukugwira ntchito ndi dokotala. Nthawi yomweyo khalani okonzeka kuyesa njira zingapo mpaka mutasankha njira yabwino kwambiri.
