Yamitsempha yamagazi septal chilema. VSD mu mwana wosabadwayo: zimayambitsa, matenda ndi mavuto

Yamitsempha yamagazi septal chilema (VSD) - bowo, amene ali pakhoma kuti chimalisiyanitsanso ndi cavities a ufulu ndi ventricles kumanzere.

mwachidule

chikhalidwe ichi kumabweretsa nthenda kusanganikirana (shunting) ya magazi. Zochita chotero mtima chilema - ambiri kobadwa nako matenda a mtima. Tili chikhalidwe pa pafupipafupi VSD kukhala peresenti makumi awiri ndi chimodzi. Mofanana, zikamera wa chilema phunziro kwa ana, amuna ndi akazi.

VSD wosabadwa akhoza olekanitsidwa (i.e. okha anomaly panopa mu thupi) kapena monga mbali ya zopindika zovuta (trehstverchatogo vavu atresia, mtima transposition wamba makungwa wolumikizira, tetralogy wa Fallot).

Mu zina septum palibe kwathunthu, chilema otchedwa umodzi ventricle za mtima.

VSD chipatala

Symptomatology yamitsempha yamagazi septal chilema kawirikawiri akuwonetseredwa mu masiku oyambirira kapena miyezi pambuyo pa kubadwa kwa mwana.

Mawonetseredwe ambiri chilema monga:

• kufupika kwa mpweya;
• cyanosis wa khungu (makamaka mosavuta ndi milomo);
• kusafuna kudya;
• palpitations mtima;
• kutopa;
• kutupa mu pamimba, mapazi ndi miyendo.

VSD pobadwa kungakhale asymptomatic, ngati chilemacho laling'ono mokwanira, ndipo ngakhale zimachitika zapambuyo pake (zaka zisanu kapena kuposerapo). Symptomatology mwachindunji amadalira ukulu wa chilema (dzenje), koma kuchenjeza dokotala ayenera phokoso amamva pa auscultation.

VSD mu mwana wosabadwayo: Zoyambitsa

Aliyense olumala mtima ndi chifukwa chisokonezo chitukuko cha thupi magawo oyambirira embryogenesis. Yofunika kwambiri apa wa zinthu zina zachilengedwe ndi chibadwa.

Pamene VSD yoopsa kumatanthauza kutsegula pakati kumanzere ndi ventricles bwino. Kumanzere yamitsempha yamagazi minofu wosanjikiza ndi zambiri olemera kuposa kumanja, ndipo chotero magazi, olemera ndi mpweya kuchokera ventricle kumanzere mu lamanja Chifalikira M'mimbamo ndi zimasakanikirana ndi magazi mpweya-zatha. Chifukwa, ziwalo ndi zimakhala umaperekedwa zochepa mpweya umene n'kukumana ndi aakulu hypoxia thupi (hypoxia). Poyankha, pamaso pa zina buku magazi ventricle lamanja kumatanthauza dilation ake (Ntchito yomangayi), m'mnyewa wamtima hypertrophy, ndi chifukwa zimenezi, a mtima kulephera pomwe yamitsempha yamagazi ndi matenda oopsa m'mapapo mwanga.

Zina mwa zifukwa

Chifukwa lenileni la VSD mu mwana wosabadwayo sakudziwika, koma chinthu chofunika kwambiri ndi mbiri banja (ie, pamaso pa yopanda chilema mu achibale).

Komanso, ntchito yaikulu ankaimba ndi zinthu zina zimene pano pa mimba:

• Chikuku. Ndi matenda enaake. Ngati mimba zikusinthira (makamaka trimester), mkazi zowawa chikuku, ngozi za ziwalo kuvutika zosiyanasiyana (kuphatikizapo VSD) wa mwana wosabadwayo ndi mkulu.
• Mowa ndi mankhwala ena. Kuvomereza mankhwala awa ndi mowa (makamaka milungu yoyambirira ya mimba) kwambiri kumaonjezera ngozi ya osauka zosiyanasiyana kuvutika mu mwana wosabadwayo.
• chithandizo kuchepa kwa shuga. Uncorrected shuga mimba zimayambitsa yoopsa hyperglycemia, zomwe pamapeto pake kungayambitse zosiyanasiyana anomalies kobadwa nako.

Gawo

Pali zingapo zimene mungachite kuti malo a VSD:

• Konoventrikulyarny, membranous, perimembranozny VSD mu mwana wosabadwayo. Ndi ambiri chilema malo ndi pafupifupi makumi asanu ndi atatu peresenti makhalidwe zonsezi. Detects chilema mbali membranous wa septum pakati pa ventricles ndi kufala zotheka wa linanena bungwe, ndi Kulowetsa septal m'madipatimenti ake; pansi valavu kung'ambika ndi valavu tricuspid (septal khumudwitsidwa ake). Nthawi zambiri uka aneurysm mu gawo membranous wa kuzunguza mitu, chifukwa cha zimene kenako zimachitika kutsekedwa (zonse kapena tsankho) chilema.
• Trabecular akulu VSDs mu mwana wosabadwayo. Umapezeka 15-20% milandu zonsezi. Chilema kwathunthu atazungulira minofu ndipo akhoza inali ku mbali ina ya minofu mbali septum pakati ventricles lapansi. Chotero mabowo pathological Tingaone ochepa. Nthawi zambiri, awa DZHMP wa mwana wosabadwayo zokha anatseka zokha.
• Podlegochnye, podarterialnye, infundibulyarnye, nagrebnevye outflow thirakiti mabowo zimapanga pafupifupi 5% milandu zonsezi. Isanafalikire chilema ndi mavavu (semilunar) linanena bungwe kapena conical kuzunguza mitu zigawo. Nthawi zambiri, ndi VSD chifukwa prolapse wa lamanja timapepala ta vavu kung'ambika pamodzi insufficiency kung'ambika;
• Zopindika kubweretsa thirakiti. Kodi benga kugawa malo athandizira khadi, ndipo pa malo za ubwenzi wa valavu yamitsempha yamagazi-matenda. Nthawi zambiri zimathera kudwala wa syndrome Down.

The kaŵirikaŵiri anapeza zopindika umodzi, koma pali zolakwika zambiri kugawa. VSD akhoza nawo kuphatikiza vuto mtima, monga tetralogy wa Fallot, transposition ziwiya ndi ena.

Malinga ndi kukula kwa ziwonongeke ndi zotsatirazi:

• yaing'ono (zizindikiro sasonyeza mmene);
• pafupifupi (chipatala uko mu miyezi pambuyo pa kubadwa);
• chachikulu (more dekompensirovnnye, ndi zizindikiro owala, aakulu ndi mavuto amene angathe kukhala oopsa).

VSD zosokonezeka

Ndi miyeso ka chilema sangakhale mawonetseredwe matenda zambiri zimachitika zokha kapena mipata akhoza otsekedwa nthawi yomweyo pambuyo pa kubadwa.

Pamene zilema zazikulu zotsatirazi mavuto aakulu angayambe:

• Eisenmenger syndrome. Yodziwika ndi chitukuko cha inasinthiratu mu mapapo chifukwa mu oopsa m'mapapo mwanga. mavuto amenewa akhoza kukhala ngati wamng'ono ndi ana okulirapo. Pa boma la upita magazi ndi ufulu ventricle kumanzere mwa dzenje septum, monga chifukwa cha m'mnyewa wamtima hypertrophy wa ventricle bwino ndi "wamphamvu" wa kumanzere. Chifukwa ziwalo ndipo zimakhala za mathithi magazi, mpweya-zatha, ndipo chotero, akufotokozera hypoxia aakulu, anasonyeza kulocha bluish (cyanosis) phalanges msomali, milomo ndi khungu zambiri.
• Mtima kulephera.
• Endocarditis.
• Sitiroko. Amatha pa ziwonongeke yaikulu ya kugawa chifukwa otaya chipwirikiti magazi. Mwina mapangidwe magazi kuundana kuti akhoza kenako kuononga zotengera za ubongo.
• Other matenda a mtima. Mukhoza kuona arrhythmias ndi valavu pathologies.

VSD mu mwana wosabadwayo: Kodi kuchita?

Nthawi zambiri zilema awa mtima wapezeka pa lachiwiri yokonzedweratu ultrasound. Komabe, musati mantha.

• M'pofunika kukhala moyo wabwino ndi kukhala wamanjenje.
• Dokotala nawo ayenera kuwunika mimba.
• Ngati chilema ndi wapezeka pa chachiwiri chizolowezi ultrasound, adokotala amalangiza kudikirira kafukufuku wachitatu (mu masabata 30-34).
• Ngati chilema ndi wapezeka pa ultrasound lachitatu, kusankha anayendera wina pamaso yobereka.
• Chabwino (mwachitsanzo, 1 mamilimita VSD wosabadwa) mipata akhoza kutseka zokha patsogolo kapena pambuyo pa kubadwa.
• Mukhoza kufunsa neonatologist ndi kuchititsa yoopsa Echo.

diagnostics

Akuganiza pamaso pa wachiwiri akhoza auscultation wa mtima ndipo anayendera mwana. Komabe, nthawi zambiri makolo tiphunzira za kukhalapo chotero chilema pamaso mwana wabadwa, pa kafukufuku nthawi ultrasound. Mokwanira zopindika lalikulu (mwachitsanzo, 4 mamilimita VSD wosabadwa) ali wapezeka, kawirikawiri wachiwiri kapena wachitatu trimester. Small n'zothekanso kudziwa pambuyo ngozi ya kubadwa kapena maonekedwe zizindikiro matenda.

Matendawa "DZHMP" akhanda kapena wachikulire mwana kapena munthu wamkulu akhoza adzaikidwa, zochokera:

• mtima madandaulo. kudwala Izi limodzi ndi kufupika kwa mpweya, kufooka, kupweteka mtima, khungu pallor.
• Mbiri ya matenda (nthawi ya isanayambike zizindikiro ndi wachibale wawo kuti katundu).
• Mbiri Moyo (mbiri banja, matenda akuchikazi pa mimba ndi zina zotero).
• General Kupenda (kulemera, kutalika, mzere wa msinkhu, khungu, etc.).
• Auscultation (phokoso) ndi percussion (kukulitsa wa malire mtima).
• Kuphunzira magazi ndi mkodzo.
• deta ECG (zizindikiro za hypertrophy yamitsempha yamagazi, nthenda conduction ndi mungoli).
• phunziro Rengenologicheskogo (a kusinthidwa mawonekedwe a mtima).
• Vetrikulografii ndi angiography.
• Echocardiography (ultrasound kwa mtima). Phunziro ili ndi kudziwa malo ndi kukula kwa chilema, ndipo pamene doplerometrii (omwe angathe kuchitidwa mu utero) - kuchuluka ndi malangizo a magazi kudzera ukutsegulira (ngakhale AMS - VSD mu wosabadwa 2 mm m'mimba mwake).
• Mtima catheterization cavities. I.e. mayikidwe a catheter ndi mtima mothandizidwa ndi ziwiya kuthamanga ndipo cavities mtima. Choncho, malinga ndi zochita pa kasamalidwe tsogolo la odwala.
• MR. Kuikidwa pa nthawi imene echocardiography uninformative.

chithandizo

Pa kudziwika mwana wosabadwa VSD kutsatira maso wodikira, chifukwa chilema mulole zokha pafupi asanabadwe kapena nthawi yomweyo pambuyo pa kubadwa. Kenako, pokhalabe chidziwitso cha matenda a wodwalayo nawo cardiologists.

Ngati chilema si kusokoneza magazi ndi mkhalidwe wonse wa wodwalayo, kenako basi kumangomuyang'ana. Pakuti mabowo lalikulu, kuswa khalidwe la moyo, kusankha kuti opaleshoni.

Maopaleshoni pa VSD angakhale mitundu iwiri: palliative (kuchepetsa m'mapapo mwanga magazi pamaso pa kugwirizana malformations) ndi kwakukulu (zonse kutsegula kutseka).

Njira ya opaleshoni:

• opaleshoni Open mtima (mwachitsanzo, tetralogy wa Fallot).
• Mtima catheterization ndi kulamulidwa imposition wa chigamba pa chilema.

Kupewa yamitsempha yamagazi septal chilema

Specific zodzitetezera VSD mu mwana wosabadwayo si Komabe, pofuna kupewa CHD, muyenera:

• Kupeza thandizo antenatal kwa masabata khumi ndi mimba.
• Amapita LCD: kamodzi pa mwezi pa miyezi itatu, kamodzi pa masabata atatu mu trimester yachiwiri, ndiyeno kamodzi pa masiku khumi wachitatu.
• Kusunga mode ndi kutsatira zakudya zoyenerera.
• Kuchepetsa zotsatira za zinthu zoipa.
• Kuthetsa fodya ndi mowa.
• Tengani mankhwala mosamalitsa zotchulidwa dokotala.
• Ikani katemera chikuku miyezi osachepera asanu ndi limodzi asanafike mimba anakonza.
• Pamene mbiri banja mosamala kuwunika chipatsocho kudziwika onse poyamba CHD kungakhale.

kaonedwe

Pamene VSD yoopsa yaing'ono (2 mm kapena zochepa), yabwino madokotala ananena zawo, monga mabowo izi kawirikawiri pafupi zokha. Ngati pali zopindika lalikulu madokotala ananena zawo zimadalira malo awo ndi pamaso pa osakaniza malformations ena.