CHD mwana: zimayambitsa, zizindikiro, chithandizo

matenda obadwa nawo a mtima (CHD) - uyu kusintha anatomical mtima, ziwiya zake ndi mavavu, osauka utero. Malinga ndi kafukufuku, kudwala izi zimachitika mu 0.8-1.2% ya ana onse. CHD ana - chimodzi mwa zinthu zambiri za imfa ana pansi 1 chaka.

Zimayambitsa CHD ana

Pa nthawi, palibe kufotokoza okhazikika chifukwa pakutchulidwa matenda ena mtima. Koma tikudziwa kuti pachiopsezo kwambiri ndi thupi lofunika kwambiri la mwana wosabadwayo mu nyengo ya milungu 2 ndi 7 cha mimba. Inali pa nthawi iyi pali tsamba ziwalo zonse zazikulu za mtima, mapangidwe kuli nthambi zake ndi ziwiya lalikulu magazi. zimakhudza aliyense zimene zinachitika pa nthawi imeneyi kungachititse kuti mapangidwe kudwala. Tinganene, kuti mudziwe chifukwa enieni sizingatheke. Nthawi zambiri kungathandize kuti apange wa CHD zifukwa zotsatirazi:

• masinthidwe majini;
• matenda tizilombo, anasamutsira mkazi ali woyembekezera (mwachitsanzo, chikuku);
• ekstragenital'nye aakulu akuchikazi matenda (shuga, zokhudza zonse lupus erythematosus, etc.);
• Kumwa mowa pa mimba;
• zaka akuchikazi wamkulu kuposa zaka 35.

Mapangidwe CHD mwana akhoza kusokoneza chipongwe zachilengedwe, cheza padzuwa, ndi mukumwa mankhwala pa mimba. Chiopsezo mwana akabadwa ndi ofanana kudwala umachuluka ngati mkazi kale taonera kale, regressing mimba, nthayo kapena imfa khanda m'masiku oyambirira a moyo. N'zotheka kuti chifukwa cha mavuto amenewa anayamba zopindika undiagnosed mtima.

Musaiwale kuti UPU sangakhale kudziletsa kudwala, koma gawo la izo palibe boma zochepa zoopsa. Mwachitsanzo, mu ozerezeka matenda a mtima opezeka 40% ya milandu. Pamene mwana wabadwa ndi malformations angapo a thupi waukulu ndipo nthawi zambiri adzakhala nawo pa ndondomeko pathological.

Mitundu ya CHD ana

Medicine ndife oposa 100 mitundu yosiyanasiyana ya zopindika mtima. Lililonse sukulu amapereka gulu lake la sayansi, koma ambiri UPU anawagawa "buluu" ndi "woyera." Chotero kulekana zopindika zochokera zizindikiro kunja nawo limodzi, kapena m'malo pa mphamvu ya mitundu ya pakhungu. Mu "buluu" mwana anati cyanosis, pamene "woyera" khungu amakhala wotumbululuka kwambiri. Njira yoyamba nawo pa tetralogy wa Fallot, atresia m'mapapo mwanga, ndi matenda ena. Mtundu wachiwiri ndi zina zambiri chilema matenda ndi septal yamitsempha yamagazi.

Pali njira ina yolekanitsa CHD ana. Gulu Pankhaniyi kumaphatikizapo makhalidwe kuchotsa mu gulu monga wa kufalitsa m'mapapo mwanga. Pali zinthu zitatu:

1. UPU ndi zimamuchulukira wa kufalitsa m'mapapo mwanga:

• setifiketi ductus arteriosus;
• matenda (ASD);
• yamitsempha yamagazi septal chilema (VSD);

2. UPU ndi yaing'ono bwalo la impoverishment:

• tetralogy wa Fallot;
• stenosis m'mapapo mwanga;
• transposition ziwiya kwambiri.

3. UPU ndi nthenda yotaya zikutsatiridwa magazi m'mapapo mwanga kuti:

• coarctation kwa msempha;
• kung'ambika stenosis.

Zizindikiro za olumala mtima ana

Matendawa "CHD" mwana aikidwa pa maziko a angapo zizindikiro. Zikavuta, kusintha adzakhala kuonekera yomweyo pambuyo pa kubadwa. An dokotala wodziwa sikovuta kupanga matenda kuyambirira kale mu chipinda yobereka, ndi ntchito zochita zawo mogwirizana ndi vutolo. Nthawi zina, pamaso pa makolo matenda a mtima sadziwa kwa zaka zambiri mpaka matenda amapita ku siteji ya decompensation. Matenda ambiri amadziwika monga mwana pa umodzi mwa mayeso zonse zachipatala. Mu achinyamata, CHD zambiri anapezeka pa ndime ya lamuloli usilikali.

Kodi amapereka dokotala zikusonyeza CHD mwana akadali mu chipinda yobereka? Choyamba, chidwi limachokera kwa atypical coloration wa khungu akhanda. Mosiyana ndi duwa-cheeked ana mwana ndi matenda a mtima ndi wotumbululuka kapena buluu (malingana ndi mtundu wa chotupa kupezeka m'mapapo mwanga). Khungu ozizira ndi youma ndi kukhudza. Cyanosis ingafalire kwa thupi lonse kapena zochepa nasolabial makona malingana ndi kuopsa kwa chilema.

Pa kumvetsera oyamba mtima zikumveka Dr. zindikirani nthenda phokoso mu mfundo yaikulu ya auscultation. Chifukwa cha kusintha ndi cholakwika magazi kudzera ziwiya. Pankhaniyi, ntchito stethoscope dokotala amamva kulimbikitsa kapena kufooka kwa mtima zikumveka, kapena kudziwa phokoso zachilendo, amene ayenera kukhala mwana wathanzi. Zonsezi ophatikizana limachititsa neonatologist kuganiza pamaso pa matenda obadwa nawo a mtima ndi kutsogolera mwana pa matenda pati.

Atabadwa ndi makamaka PRT amakonda kuchita zinthu restlessly, ndipo nthawi zambiri alakwitsa kulira. Ana ena, mbali inayi, kwambiri waulesi. Sangachitire bere, amakana mabotolo ndi kugona bwino. N'zotheka kuoneka dyspnea ndi tachycardia (mofulumira kugunda)

Zikatero, ngati matenda a CHD mwana anaperekedwa pa zaka ina angathe kuvutika mu chitukuko maganizo ndi thupi. Ana otere kukula pang'onopang'ono, osati kupeza kulemera, kugwa kumbuyo sukulu, sasunga ndi anzawo wathanzi ndi akuchitachita. Iwo sangathe kulimbana ndi katundu kusukulu, sumanyezimira mu makalasi maphunziro thupi, zambiri kudwala. Nthawi zina, matenda a mtima wobwezera anapeza mwangozi pa otsatira a mayeso a zachipatala.

Zinthu zitafika povuta kwambiri, aakulu mtima kulephera akufotokozera. Zikuoneka dyspnea pa katundu pang'ono. miyendo kutupa, kuchuluka chiwindi ndi ndulu, kusintha kumachitika mu makope m'mapapo mwanga. Popeza chisamaliro waluso boma umatha kulumala kapena imfa ya mwana.

mbali zonse izi kulola mmene wamkulu kapena wamng'ono, kutsimikiza pamaso pa CHD ana. Zizindikiro zingasiyane milandu yosiyanasiyana. Kugwiritsa ntchito njira zamakono matenda ntchito pofuna kutsimikizira matenda ndi chithandizo choyenera nthawi.

siteji chitukuko UPU

Kaya mtundu komanso kusalekerera vuto onse magawo angapo. Gawo loyamba wotchedwa anatengera. Panthawi imeneyi, thupi la mwanayo Amasintha mikhalidwe yatsopano chiripo, kusintha ntchito ya magulu onse pansi tikusintha mtima. Chifukwa chakuti machitidwe onse ali kugwira ntchito pa nthawi ino kuvala, n'zotheka chitukuko cha kulephera pachimake mtima, kulephera kwa lake lonse.

Gawo lachiwiri - gawo la malipiro wachibale. The kusintha kapangidwe ka mtima zimathandiza mwana kwambiri kapena zochepa moyo wabwinobwino, kuchita ntchito zake zonse pa mlingo yoyenera. Mbali imeneyi akhoza mzaka, sanabadwe kutsogolera kulephera kwa machitidwe onse a thupi ndi chitukuko cha decompensation. Gawo lachitatu la UPU mwana wotchedwa osachiritsika ndipo amakhala ndi kusintha kwakukulu mu thupi. The mtima sangathenso kupirira ntchito yake. Mukhale kusintha osachiritsika mu myocardium, patapita nthawi mu imfa.

Matenda

Taganizirani za mtundu wina wa CHD. Matenda ana - ndi imodzi ya zopindika ambiri mtima, opezeka mu ana oposa zaka zitatu. Pamene matenda mwanayo ali ndi bowo laling'ono pakati pa chabwino ndi atria kumanzere. Chifukwa, pali nthawi zonse kuponya magazi kuchokera kumanzere, yomwe mwachibadwa kumabweretsa kusefukira kwa makope m'mapapo mwanga. zizindikiro zonse kukhala kudwala ichi, amagwirizana ndi kuphwanya uziyenda yachibadwa ya mtima mu zinthu zinasintha.

Mwachibadwa, una pakati atria pali mwana wosabadwayo mpaka kubadwa. Limatchedwa zenera chowulungika ndi zambiri atseka ndi mpweya woyamba wa ana akhanda. Nthawi zina, una wotseguka kwa moyo, koma chilema izi ndi ang'onoang'ono kwambiri motero kuti munthu samadziwa nkomwe za izo. Hemodynamic silinkachitidwa chimake izi. Maluso foramen ovale, sayambitsa mwana kusapeza aliyense akhoza kukhala mwachisawawa kupeza nthawi kuphunzira ultrasound za mtima.

Koma zoona matenda ndi vuto lalikulu kwambiri. mipata amenewa lalikulu kukula ndipo akhoza ili m'chigawo chapakati cha atria ndi pa konsekonse. UPU mawonekedwe (matenda ana, monga tanena kale, ndi ambiri) adzaona njira mankhwala osankhidwa ndi katswiri zochokera deta ultrasound ndi njira zina kafukufuku.

zizindikiro za ASD

Kuonetsetsa chachikulu ndi sekondale zosalongosoka interatrial septum. Akusiyana pakati pawo makhalidwe dzenje malo mpanda mtima. Mu chilema chachikulu ASD wapezeka mu gawo m'munsi mwa kugawa. Matendawa "UPU sekondale matenda" ana poyera ngati kumene mdzenje ili pafupi ndi chigawo chapakati. chilema Ichi ndi zosavuta kukonza, chifukwa mu kugawa gawo m'munsi ndi pang'ono minofu mtima, kulola kutseka chilema kwathunthu.

Nthawi zambiri, ana aang'ono ndi ASD sali osiyana ndi anzawo. Iwo amakula ndi kukhala malinga ndi msinkhu. Kuchotsedwa kwa chimfine pafupipafupi popanda chochitika chapadera. Chifukwa kuponyera zonse magazi kuchokera kumanzere kupita kumanja, ndi Kusefukira kwa m'mapapo mwanga matenda kufalitsidwa ana poyera bronchopulmonary, kuphatikizapo chibayo kwambiri.

Yekha pang'ono cyanosis mu makona nasolabial zingaoneke kwa zaka zambiri ana ndi ASD. Zimatenga nthawi khungu wotumbululuka, kufupika kwa mpweya ndi pang'ono zofuna kukhetsa thukuta, chifuwa. Ngati Popanda kuchitapo kanthu, mwana wayamba kwanthawi kumbuyo mu kukula, salinso kulimbana ndi pulogalamu sukulu.

Mtima wa achinyamata amene akudwala kwa nthawi yaitali kupirira katundu chinawonjezeka. Madandaulo tachycardia ndi osasamba mtima mungoli zimakhala zaka zapakati pa zaka 12-15. Ngati mwana si kuyang'aniridwa ndi madokotala ndipo sanachitepo opaleshoni echocardiography, matenda ndi "UPU, ASD," mwana akhoza chikalata yekha mu unyamata.

Matendawa ndi mankhwala a ASD

Kuzionetsetsa, ndi cardiologist akuti kulimbitsa la kung'ung'udza mtima mfundo zofunika auscultation. Ichi ndi chifukwa chakuti pamene magazi umadutsa mavavu ndi mwapang'ono osauka swirls, zomwe dokotala mumva kupyolera stethoscope lapansi. magazi kudzera chilema mu septum phokoso uliwonse zilibe kanthu.

Ngakhale kumvetsera m'mapapo angathe kuonedwa crackles kugwirizana ndi stagnation magazi mu makope m'mapapo mwanga. Pamene percussion (prostukivanii thorax) anaulula ponso m'malire mtima mogwirizana ndi hypertrophy ake.

Mu kuphunzira electrocardiogram ndi bwino zizindikiro zosonyeza wa zimamuchulukira wa mtima wabwino. Pa echocardiography anavumbula chilema mu septum matenda. X-ray a m'mapapo limakupatsani kuona zizindikiro za stagnation magazi mu misempha m'mapapo mwanga.

Mosiyana yamitsempha yamagazi septal chilema ASD konse atseka basi. Mankhwalawa okha chilema izi opaleshoni. opaleshoni amachitidwa pa zaka 3-6 mpaka Kutacha mtima decompensation. Opaleshoni alowererepo zakonzedwa. amachita opaleshoni yotsegula mtima ndi kulambalala mouzirira. dokotala zimapangitsa kutsekedwa kwa chilema, kapena ngati dzenje lalikulu kwambiri, limafotokoza chigamba, kagawo wa pericardium (malaya mtima). Tikumbukenso kuti ntchito ndi ASD anali mmodzi wa opaleshoni woyamba pa mtima zaka zoposa 50 zapitazo.

Nthawi zina, mmalo mwa suturing miyambo ispolzuetsya endovascular njira. Pankhaniyi, mu femoral mtsempha puncture anapangidwa, ndi mwa mtima M'mimbamo jekeseni occluder (chipangizo wapadera umene chilema chatsekedwa). njirayi akuti ndi zochepa zoopsa ndi otetezeka, monga popanda kutsegula pachifuwa. Pambuyo opareshoni ngati mofulumira kwambiri ana anachira. Mwatsoka, Nthawi zonse ungagwiritsidwe endovascular njira. Nthawi zina malo m'maenje, m'badwo wa mwanayo, komanso zinthu zina salola kusokonezedwa amenewa.

Yamitsempha yamagazi septal chilema

Tiyeni tikambirane njira yina CHD. VSD ana - wachiwiri ambiri matenda a mtima mu zaka zitatu. Pankhaniyi, dzenje ndi wapezeka mu septum kulekanitsa lamanja ndi lamanzere ventricles. Pali nthawi zonse kuponya magazi kuchokera kumanzere, ndipo, ngati ndi choncho ndi ASD akufotokozera ndi zimamuchulukira wa kufalitsa m'mapapo mwanga.

Boma la achinyamata amene akudwala akhoza zimasiyana kwambiri malinga ndi kukula kwa chilema. Ndi mwana wamng'ono dzenje simungakhoze kupanga madandaulo uliwonse, ndi phokoso pa auscultation - chinthu lokhalo limene kusokoneza makolo. Mu 70% ya milandu yaing'ono zopindika yamitsempha yamagazi septal anatseka okha pamaso zaka 5.

A chithunzi chosiyana ukuonekera pamene Baibulo yaikulu kwambiri ya UPU. VSD ana zina kukwaniritsa makulidwe lalikulu. Pankhaniyi, Mwina kukhala oopsa m'mapapo mwanga - mavuto aakulu a chirema. Poyamba machitidwe onse thupi azolowere zinthu zatsopano, galimoto magazi kuchokera ventricle kwa wina ndi kulenga kuthamanga bwino ziwiya m'mapapo mwanga. Posakhalitsa kapena kenako akufotokozera decompensation, imene mtima sangathenso kupirira ntchito yake. Yambitsaninso magazi venous sizichitika, izo amasonkhana ventricle ndi mu makope zokhudza zonse. Kuthamanga magazi mu mapapo salola opaleshoni ya mtima, ndi odwalawo zambiri amamwalira ndi zosokonezeka. N'chifukwa chake m'pofunika yake kudziwa chilema ichi ndi kumutsatira mwana mankhwala opaleshoni.

Ngati kumene VSD si anatseka nokha kwa zaka 3-5, kapena ndi chachikulu, opaleshoni imagwiridwa kubwezeretsa umphumphu wa septum interventricular. Monga momwe zilili ndi ASD, kutsegula ndi sutured kapena lotseka ndi chigamba, ndi odulidwa kuchokera pericardium lapansi. Mukhoza kutseka chilema ndi endovascular njira, ngati zinthu kuloleza.

Chithandizo cha olumala mtima

Opaleshoni njira yekha kuti akonze matenda pa msinkhu uliwonse. Malinga ndi kukula kwa CHD mankhwalawa ana angathe kuchitidwa mu nthawi neonatal, ndipo ali ina. Pakhala milandu opaleshoni ya mtima mu mwana wosabadwayo m'mimba. Pa nthawi yomweyo akazi osati kulankhula bwinobwino mimba mawu akuti, komanso kukhala ndi mwana ndi abwino sikutanthauza odwala mwakayakaya mu maola loyamba la moyo.

Mitundu ndi nthawi ya chithandizo pa nkhani iliyonse anatsimikiza payekha. Mtima zochokera deta anayendera ndi njira malangizo bwinobwino njira amasankha ndipo anam'patsa ntchito zotheka. nthawi yonseyi mwanayo kuyang'aniridwa ndi akatswiri kulamulira chikhalidwe chake. Pokonzekera opaleshoni mwanayo amalandira mankhwala zofunika, zimene zimathandiza kuthetsa zizindikiro zosasangalatsa ngati kuli kotheka.

Chilema mu CHD phunziro mwana mankhwalawa yake akufotokozera kawirikawiri. Nthawi zambiri, opaleshoni akhoza amapewa imfa, komanso kulenga zinthu zachilendo moyo popanda malamulo kwambiri.

Kupewa olumala mtima

Mwatsoka, mlingo wa chitukuko cha mankhwala si kanthu utero chitukuko cha mwana wosabadwayo , mwina bwanji mtima Bookmark. Kupewa CHD ana kumafuna bwinobwino za makolo pamaso mimba anakonza. Mayi woyembekezera pamaso lingaliro mwanayo ayenera kusiya zizolowezi zoipa, kusintha ntchito mu ntchito woopsawo pa zinthu zina. zonsezi kuchepetsa kuopsa kokhala ndi mwana ndi kudwala a dongosolo mtima.

Chizolowezi katemera ndi chikuku, yomwe ikuchitika atsikana onse, kuti asapanikize anthu UPU chifukwa cha matenda yoopsa. Komanso, amayi oyembekezera ayenera kuthi chokuchititsani ultrasound mosamala mu nthawi chimango cha gestation. Njira imeneyi zimathandiza nthawi kudziwa zopindika mwanayo ndi kutenga miyezo kutero. Kubadwa kwa mwana woteroyo adzakhala kuyang'aniridwa ndi cardiologists ndi madokotala odziwa. Ngati ndi kotheka, pa chipatala chipinda cha ana akhanda udzachotsedwa kwa unit katswiri ntchito yomweyo ndi kumulola iye kukhala pa.

Kuti madokotala ananena zawo pa chitukuko cha matenda obadwa nawo a mtima kumatengera zifukwa zambiri. The kale nthendayo wapezeka kwambiri, mwayi kupewa boma la decompensation. Panthawi yake chithandizo opaleshoni osati kumapulumutsa miyoyo ya achinyamata amene akudwala, komanso zimawathandiza kukhala wopanda malamulo alionse kwambiri pa malo thanzi.