I-BPD ezinsana ezingakabiphi - kuyini?

I-bronchopulmonary dysplasia (i-BPD) ezinsana ezingakabonakali ziqala ngemuva kokuvezwa isikhathi eside kuze kube yilapho ukucindezela okuphezulu kwe-oksijeni okwenziwa yizixhobo zokuphefumula. Ukuqeda lesi sifo, umntwana udinga ukwelashwa okhethekile okuhloswe ukugcina impilo yakhe. Ake sicabangele ngokuningiliziwe ukuthi yiziphi lezi, izimbangela, izimpawu kanye nezimpawu eziphawulekayo zokwelashwa komzimba.

I-BPD ezinsana ezingakabiphi - kuyini?

Amantombazane azalwa eminyakeni eminingana ngaphambi kokuba usuku olufanele luvezwe ezifweni ezihlukahlukene ngenxa yokuthuthukiswa ngokwanele kwezitho zangaphakathi. Ngokuvamile zonke izingane ezinjalo zineziphambeko ezinkulu emsebenzini wokuphefumula. Ukugcina izinga elidingekayo le-oksijeni, ingane ixhunywe kwi- apparatus ye-ventilation yokufakelwa. Lena imishini yesimanje elawula umswakama, izinga lokushisa kanye nejubane lenhlanganisela yegesi yokuphefumula. Ukucindezeleka okuvamile ngemva kwalesi nqubo i-dysplasia ye-bronchopulmonary.

I-BPD ezinsana ezingakabiphi isikhathi ziqala ngaphansi kwethonya lokugxila kwe-oxygen isikhathi eside. Uma ingane isesimweni sokuphuza umoya izinsuku ezingaphezu kwezingu-28, ingozi yokubukeka kwe-pathology yanda kakhulu. Ngokuvamile isifo sibonakala ezinganeni ezizalwa ngesikhathi, ngemuva kokugula izifo ezinzima ze-bronchial and lung.

Njengamanje, amacala omuthi omusha we-BPD avame ukurekhodwa, lapho amaphaphu wengane ane-alveolarization encane, okungenayo i-lesion yesimiso sokuphefumula kanye nemikhumbi yamapulmoni. Uma kuqhathaniswa ne-classical "dysplasia" ye-bronchopulmonary, isimo "sobumnene" sesifo kulula kakhulu ukudlulisa.

Izimbangela ze-BPD

Amacala e-dysplasia ye-bronchopulmonary eyenzeka ngemva kokuba ingane ixhunyiwe kusuka ekuphuculeni umoya. Ochwepheshe bathi isifo se-pathological sivela ngenxa yomphumela we-oksijeni ehlanzekile ezingxenyeni ezingapheli zamaphaphu athuthukile. Izinto eziyinhloko ezingozini zokuthuthukiswa kwe-BPD zihlanganisa okulandelayo:

• Ukungena ohlelweni lwe-bronchopulmonary lwe-agent ephathekayo;
• Ukwethulwa okungalungile kwe-surfactant;
• Ukucindezeleka komfutho wegazi okubangelwa isifo senhliziyo;
• Ukulimala kwamathishu emaphaphu uma uxhunywe ku-ventilator;
• I-edema yepulmonary;
• Hypovitaminosis.

Okuvamile ikakhulukazi i-BPD ezinsana ezincane ezingakafiki. Lesi sigaba sibandakanya izinsana ezizalwa ngaphambi kuka-29 futhi zilinganiselwa ngaphansi kuka-1500 g. Uhlelo lwe-surfactant alukhulumi ngokuphelele kubo. Lokhu kuholele ekutheni ngesikhathi sokuphefumula i-alveoli yamaphaphu iqala ukunamathela ndawonye futhi yonakaliswe, okwenza kube nzima ukushintshaniswa kwegesi. Ukuvimbela imiphumela engathandeki, ingane ixhunywe ku-ventilator.

Izimpawu ze-BPD

Ukubonakaliswa kokuqala kwalesi sifo kunqunywa ngemuva kokuba ingane ixhunyiwe kusuka ekuphefumuleni. Ngokushesha kungase kubonakale sengathi ingane inezandla ezinamandla, kodwa ngemva kwesikhathi kunamashikali ayingozi. Okokuqala, abazali kufanele banakekele ukuphefumula ngokushesha. Uma umntwana enza ukuphefumula kuka-60 ngomzuzu, amaphiko ekhaleni avuvuka, futhi isifuba sinokubukeka okufana nomgqomo, udinga ukuthola usizo lwezokwelapha ngokushesha.

Ukuphefumula okumnandi, ukuqhuma emaphashini, ukuphumula okwesikhashana, ukubhula okwesibhakabhaka kwesikhumba - izimpawu ezivamile ze-BPD ezinsana ezingakabiphi. Iyini le ngukugula kanye nendlela yokunciphisa isimo somntwana? Ukwelashwa kukhethwe kuphela udokotela, kuye ngokuthi ubuhlungu besimo somntwana. Izenzo zokuhlola zokuqala zenziwa: ukuhlolwa kwangaphandle, i-ultrasound yenhliziyo, i-X ray. Ngaphezu kwalokho, ukuvivinya kwelabhoratori, ukubonisana kwe-pulmonologist kungabekwa.

Ukwelashwa kwe-BPD

Ezinganeni ezingakabiphi, ukukhubazeka kuphathwa ngendlela efanele. Umsebenzi oyinhloko yokwelapha okunjalo ukuyeka izimpawu zesifo nokujwayelekile ukuphefumula. Isikhathi sokwelashwa - kusukela emavikini ambalwa kuya ezinyangeni ezingu-2-3.

Kunezinhlobo ezilula, eziphakathi nezindayo ze-dysplasia ye-bronchopulmonary. Phakathi nenkathi yesifo, kunezinyathelo zokucindezela nokukhululwa. Ukwelashwa kwezidakamizwa kusho ukusetshenziswa kwe-glucocorticoids, izidakamizwa, ama-antibiotics (uma kunesidingo), ama-bronchodilators, ama-surfactants.

Kudingeka izidakamizwa zokulwa ne-antibacterial ukuvimbela ukuthuthukiswa kwenqubo yokuvuvukala. Izidakamizwa ezibonakalayo zibhekwa njengezivela eqenjini lama-macrolide, alwa ngokuphumelelayo nemithambo eminingi yama-pathogenic.

Izici zokwelapha

Naphezu kokuthi lesi sifo senza ukuba umoya we-amplification wokufakelwa kwamapayipi, okwelapha oksijini kuyadingeka ngenkathi ukwelashwa. Ukuxhuma ingane kudivayisi kuyadingeka ukuze unikeze uhlelo lokuphefumula nazo zonke izicubu ezine-oxygen eyanele. Ngesikhathi esifanayo, ukuxubana kwenhlanganisela yegesi kanye nokucindezelwa kulezi zixhobo kuncishisiwe. Kuzophinde kudingeke ukuba kuqashwe njalo inani le-oksijini egazini lomntwana.

Nge-BPD, izinsana zokuqala zidinga ukudla. Kubalulekile ukuhlinzeka umzimba womntwana ngesamba samaprotheni okwanele futhi ngesikhathi esifanayo ugweme uketshezi okwedlulele. Uma isimo somntwana sinzima, ingxube yomsoco ijojowe nge-probe. Umthamo woketshezi uyancipha ube ngu-110 ml ngegesi yesisindo ngosuku ukuvimbela ukuthuthukiswa kwe-edema ye-pulmona.

Ukusetshenziswa kwezidakamizwa ze-hormonal

Ukwelashwa kwama-hormone kuyadingeka ukuqeda inqubo yokuvuvukala emphefumulweni wokuphefumula, okwenzeka ngokumelene nesizinda se-dysplasia ye-bronchopulmonary. I-glucocorticoids yesimiso inqunywe kusukela ezinsukwini zokuqala zokuphila lapho ingane isenomoya wokuphuza umoya. Lokhu kunciphisa ingozi ye-pathologies enkulu yokuphefumula.

Kumele kukhunjulwe ukuthi ukwelashwa kwe-hormone kunezinkinga eziningi, okuyinhloko yazo imiphumela emibi ngesimo se-hyperglycemia, umfutho wegazi ophezulu, i-hypertrophic cardiomyopathy.

Okuthandwa kakhulu kuvame ukunikezwa nge-steroids engatholakali. Kudinga isilinganiso esincane kakhulu futhi sithinte kuphela izingxenye eziphansi zendlela yokuphefumula. Ngesikhathi esifanayo, ukwelashwa okunjalo kunomphumela omuhle wesikhashana ezimweni ezinzima.

"Dexamethasone" ingenye yezidakamizwa ezisebenza kahle futhi ezisheshayo ezivela eqenjini le-glucocorticoids. Unqunywe ezimweni eziphuthumayo ukususwa kwezimpawu ezibonakalayo ze-pathology. Futhi, izidakamizwa zivimbela ukutholakala kokushayeka okusha.

Ukwelashwa kwe-BPD ezinganeni ezingakabi isikhathi "I-Dexamethasone" ivumela ukucindezela isenzo se-interleukin - into ephilayo esebenzayo engena esifundeni se-bronchial futhi iqhaza ezinkambisweni zokuvuvukala. Isidakamizwa sivimbela ukuthuthukiswa kokuhluleka ukuphefumula futhi kuphephile ngokuphelele kwengane.

Dexamethasone: Incazelo yokulungiselela

Imithi iyinhlangano ehlakaniphile yokwenza uchungechunge lwe-glucocorticoid. Isenzo se- "Dexamethasone" senzelwe ukusimama kwamaprotheni, amaminerali kanye nesimiso semithamo ye-carbohydrate emzimbeni. Inezici ezinamandla zokulwa nokuvuvukala, okulwa ne-allergenic, antitoxic nokuphikisayo. Inqubo yokuvuvukala ingamiswa ngenxa yokunciphisa okukhulu ekuhlanganisweni kwamaseli amancane kanye nama-eosinophil, okukhiqiza abalamuleli abavuthayo.

Ukuze kusetshenziswe i-dysplasia ye-bronchopulmonary ezinganeni, isixazululo ku-ampoules sisetshenziswa. Isilinganiso sikhethwe kuphela ngesisekelo somuntu ngamunye. Kumele kukhunjulwe ukuthi ukusetshenziswa okwesikhashana kwalesi sidakamizwa kunomthelela wokuzivikela, kanti nangokwelashwa okuqhubekayo, ingozi yokutheleleka kwesibili iyanda.

I-Diuretics ku-BPD

Naphezu kokuncipha kokungenwa kwamanzi kwansuku zonke ezinsana ezisencane ezine-BPD, izidakamizwa zenziwa ukuba zivimbele ukuqala kwe-edema. Impumelelo yabo yokwelapha ihlose ukujwayelekile ukulinganisela kwe-acid-base nokunciphisa inani lamanzi ezicubu.

Phakathi kwezidakamizwa zesimiso, i-Furosemide isetshenziswa kakhulu. Inhloso yalesi sidakamizwa ukusheshisa ukubuyisela kabusha uketshezi kwamanzi emaphashini nokuthuthukisa imishini yamaphaphu ekuvuvukeni.

Izibikezelo kanye nemiphumela

I-dysplasia ye-bronchopulmonary yisifo esibi kakhulu futhi esiyingozi. Ngesimo esibi, lesi sifo siholela emphumela obulalayo kumacala angu-20%. Esikhathini sokukhanya nokulinganisela kwe-pathology, ukuthuthukiswa kwesimo somntwana kungafinyelelwa phakathi nezinyanga zokuqala zokuphila. Kwenzeke kaningi kangakanani imiphumela emibi emva kwe-BPD ezinsana ezingakabiphi? Ochwepheshe bathi izingane ezinjalo zihlushwa izifo ezithathelwanayo zesimiso sokuphefumula, umfutho wegazi ophakeme, i-anemia, nokuphuthuma ukuthuthukiswa ngokomzimba.