narushenie metabolizma glyukozi u novorojdennix

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pēdējā laikā gūtās atziņas... narushenie metabolizma glyukozi u novorojdennix irena zaxare gemostaz glyukozi ploda transport glyukozi proisxodit cherez platsentu ot materi plodu i dostigaet 60- 80% urovnya glyukozi materi insulin, glyukagon i gormoni rosta ne proxodyat cherez platsentu u ploda postoyanno proisxodyat protsessi glikoliza i glikogenogeneza glyukoza ploda yavlyaetsya substratom dlya obrazovaniya rezervov uglevodorodov i jira insulin ploda deystvuet kak faktor rosta: visokiy uroven insulina vizivaet chrezmerniy rost ploda nizkiy uroven insulina vizivaet zaderjku rosta ploda insulin sposobstvuet obrazovaniyu glyukogona, jira, mishechnoy tkani insulin ugnetaet glyukogenez, lipoliz, glyukoneogenez narusheniya metabolizma glyukozi u materi ili disfunktsiya platsenti, vizivayut narusheniya usvoeniya glyukozi u novorojdennogo deti ot materey s diabetom malovesnie deti perenoshennie deti narusheniya razvitiya ploda giperglikemiya u materi znachitelno vliyaet na razvitie ploda zamedlennoe sozrevanie surfaktanta tselesoobrazno opredelit ego kolichestvo v lyogochnoy jidkosti dlya togo, chtobi ubeditsya v funktsionalnoy sposobnosti lyogkix zaderjka lyogochnoy jidkosti v dixatelnix putyax, nespetsificheskaya odishka gipertroficheskaya kardiomiopatiya …

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ix daje ot kratkovremennix epizodov gipoglikemii ogranicheni rezervi dlya glyukoneogeneza nedonoshenniy rebyonok rebyonok s narusheniem vnutriutrobnogo rosta rebyonok rojdyonniy v asfiksii giperinsulinizm rebyonou ot materi stradayushey diabetom opuxoli podjeludochnoy jelezi optimalniy uroven glyukozi dlya normalnoy jiznedeyatelnosti organizma, uroven glyukozi krovi doljen bit ne menee 50 mg/dl (2.8 mmol/l) ili minimalnaya potrebnost 6 mg/kg/min minimalnaya potrebnost dlya bolnix detey i novorojdennix, nujdayushixsya v spetsialnom uxode, mojet bit vishe gipoglikemiya ponijenniy uroven glyukozi v krovi dlitelnaya gipoglikemiya neblagopriyatno vliyaet na mozg novorojdennogo (osobenno nedonoshennogo) priemlemiy uroven glyukozi 0-3 chasa jizni >35mg/dl (2.0 mmol/l) 4-24 chasa jizni >40mg/dl (2.2 mmol/l) > 24 chasa jizni >45mg/dl (2.5 mmol/l) vozmojni pogreshnosti v izmereniyax glyukozi uroven saxara v plazme na 10-15% vishe chem v krovi dlitelnoe xranenie materiala snijaet uroven glyukozi gipoglikemiya, gruppa riska malovesnie deti, nedonoshennie deti ot materey, stradayushix diabetom, krupnie deti,opuxol podjeludochnoy jelezi, mat poluchayushaya simpatomim. medikamenti, vistseromegaliya deti s nedostatochnim pitaniem bolnie …

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a obespechit v/v dostup dlya: normalizatsii urovnya glyukozi v krovi ispolzovaniya v/v dostupa dlya neotlojnoy pomoshi lechenie gipoglikemii uroven saxara 40 (2.2 mmol/l) 50 (2.8 mmol/l) esli uroven glyukozi ne povishaetsya, skorost vvedeniya uvelichit >8 mg/kg/min v vide 12,5% rastvora lechenie osobennosti nedonoshennix detey: ogranicheni vozmojnosti glikoliza i lipoliza gipoglikemiya mojet vizvat ili usugubit nevrologicheskie narusheniya neobxodimo predupredit gipoksiyu nedostatochnost krovoobrasheniya gipotermiyu profilaktika gipoglikemii rannee enteralnoe pitanie nachalo v/v infuzii 10% glyukozi 3ml/kg/chas, ili 5mg/kg/min. postepenniy perexod ot parenteralnogo k enteralnomu pitaniyu lechenie osobennosti malovesnix (gipotrofichnix) detey: prichini gipoglikemii: nedostachniy rezerv glikogena, ogranichen glyukoneogenez, giperinsulinizm, ponijena tolerantnost k enteralnomu pitaniyu rannee enteralnoe pitanie isxodno v/v struyno vvesti 2 ml/kg 10% rastvora glyukozi dlya korrektsii gipoglikemii nachinat vvedenie 10%glyukozi, so skorostyu 3mg/kg/chas kontrolirovat uroven glyukozi kajdiy chas, poka pokazateli dostignut > 50mg% (2.8 mmol/l) postepenno perexodit k enteralnomu pitaniyu, vojmojna neperenosimost pishi esli uroven glyukozi ne uvelichivaetsya, skorost vvedeniya povisit do …

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obxodima prodoljitelnaya (bolee 1 nedeli) infuziya glyukozi esli uroven saxara ne uvelichivaetsya, povisit skorost vvedeniya do >8 mg/kg/min v vide 12,5% rastvora lechenie osobennosti detey, rojdennix ot materey, stradayushix diabetom: xarakteren otnositelniy giperinsulinizm vremenniy gipoparatireoidizm politsitemiya, giperbilirubinemiya vozmojna neobxodimost vvedenie gipertonicheskix rastvorov glyukozi postepenno perexodit k enteralnomu pitaniyu dopolnitelnoe vvesti sa lechit politsitemiyu lechit giperbilirubinemiyu dopolnitelnie obsledovaniya pri gipoglikemii pri stoykoy gipoglikemii 150 (8.3 mmol/l) snijenie skorosti vvedeniya glyukozi do 1- 0,5 mg/kg/min. snijenie kontsenratsii rastvorov glyukozi do 5% - 2,5% naznachenie insulina- nachalnaya doza 0,02-0,1 ed/kg/chas, provodya regulyarnoe opredelenie urovnya glyukozi krovi

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pēdējā laikā gūtās atziņas... narushenie metabolizma glyukozi u novorojdennix irena zaxare gemostaz glyukozi ploda transport glyukozi proisxodit cherez platsentu ot materi plodu i dostigaet 60- 80% urovnya glyukozi materi insulin, glyukagon i gormoni rosta ne proxodyat cherez platsentu u ploda postoyanno proisxodyat protsessi glikoliza i glikogenogeneza glyukoza ploda yavlyaetsya substratom dlya obrazovaniya rezervov uglevodorodov i jira insulin ploda deystvuet kak faktor rosta: visokiy uroven insulina vizivaet chrezmerniy rost ploda nizkiy uroven insulina vizivaet zaderjku rosta ploda insulin sposobstvuet obrazovaniyu glyukogona, jira, mishechnoy tkani insulin ugnetaet glyukogenez, lipoliz, glyukoneogenez narusheniya metabolizma glyukozi u materi ili disfunktsiya platsenti, vizivayut naru...

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