CHD ma loko o kahi keiki: nā kumu, nā hō'ailona, ​​ka ma'i

Congenital naau maʻi (CHD) - keia anatomical loli ana o ka naau, kona oihana a pau a me ka nohona kiwikā o, ka ulu 'ana ma utero. Wahi a ka 'ikepili helu, keia pathology ia lŘlŘ i 0.8-1.2% o nā pēpē i. CHD i keiki - kekahi o ka loa pinepine kumu o ka make i loko o na keiki ma lalo o 1 makahiki.

Nā kumu o ka CHD i keiki

Ma ka manawa, aole mea i definitive hoakaka no ka hanana o kekahi naau mai. Mākou wale ike i ka loa kūlana o ka nui loa kino o ka fetus i loko o ka manawa mai ka 2 a hiki i 7 pule o ka hāpai keiki. Ka mea, ua i keia manawa he mea he uku pila a pau i ke kumu nui loa o ka naau, ke kahua o kona kiwikā a me ka nui o na moku i ke koko. Kekahi hopena e mai ai i kēia wā ke alakai i ke kahua o ka pathology. E like me he mau rula, e loaʻa mai i ka kiko'ī kumu mea,ʻaʻole hiki. More pinepine ma mua i alakai i ke kūpono 'ana o ke CHD kēia mau kumumea:

• aaiaoe mutations;
• mea hoʻomaʻi nā mea palahēhē, hoololiia i ka wahine hāpai keiki i (e like, rubella);
• ekstragenital'nye loa maternal maʻi (mimikō mellitus, systemic lupus erythematosus, etc.);
• Alcohol hainā i hāpai keiki;
• maternal makahiki mua ma mua o 35 makahiki.

I ka ho okumu ana o CHD i loko o ke keiki hiki no hoi lakou aloha ia? Aneie hoinoia, pāhawewe waiū, a me ka lawe ana i kekahi mau lapaʻauʻia i hāpai keiki. Ka pilikia o ka hanau ana o ke keiki me ka like pathology piʻina ina i ka wahine i mua, ua kaulana i loko o ka hala, regressing hāpai keiki, stillbirth a me ke keiki a ka make i loko o nā lā mua o ke ola. He hiki i hoomaka ai i ke kumu o keia mau pilikia i undiagnosed naʻau mā.

Mai poina i ka UPU hiki ole e pakiko-pathology, akā, kekahi o ia mea i emi weliweli moku'āina. No ka laʻana, ma Down maʻi pale naau maʻi i loaʻa i loko o 40% o ka hihia. Ka wā e hānauʻia ke keiki me ka mau malformations o ka papa kuhikuhiE kino a me ka loa pinepine ia e e komo i loko o ka pathological kaʻina.

Ano o ka CHD i keiki

Medicine, ua oi aku mamua o 100ʻano o ka naau mā. Kela a me keia kula e kaumaha ana kona 'epekema Mea Maluna, akā, ka hapanui o ka UPU e māheleʻia i loko o "uliuli" a me "keʻokeʻo." Oia kaawale mā ka nānā 'ana ma luna o mawaho hoailona pu ia, a he oiaio, ma ka nui o ka' ia nā pōpō o ka ili. Ma ka "uliuli" i loko o ke keiki malama cyanosis, oiai "keʻokeʻo" ili i loa haikea. Ke koho mua ua pilikia ma ka tetralogy o Fallot, pulmonary atresia, a me nā maʻi. Ka lua oʻano Ua oi typical no ke kina atrial a me ventricular septal.

Aia i kekahiʻaoʻao o ke kaawale ana o ka CHD i loko o nā keiki. Mea Maluna o keia hihia komo ai pooling hewa i loko o ka pae like o ka pulmonary holo. Aia i ekolu koho:

1. UPU me ka overload o ka pulmonary holo:

• iaoaioa ductus arteriosus;
• atrial septal kina (ASD);
• ventricular septal kina (VSD);

2. UPU me ka uuku kaiapili o impoverishment:

• tetralogy o Fallot;
• pulmonary stenosis;
• transposition o na moku nui.

3. UPU me ka ua hoʻololiʻia koko i loko o ka pulmonary:

• coarctation o ka aorta;
• aortic stenosis.

Symptoms o congenital naau mā i loko o na keiki

ʻike, "CHD" ke keiki ua kau ma luna o ke kumu o ka helu ana o symptoms. I loa hoopii, nā hoʻololi e e hiki koke mai ma hope o ka hanau ana. An inā pilikia ka haumāna kumu ao hoi i hiki ole i ka hana i ka muaʻike ia i loko o ka haawi lumi, a me kahi kūlike o kā lākou mau hana ma e like me ke kulana. Ma nā hihia, i ke alo o ka naau maʻi makua i ka ike ole no na makahiki a hiki i ka maʻi hele i loko o ke kahua o ka decompensation. maʻi he nui i hōʻike 'wale me he teenager i kekahi o ka ahakanaka ku' inikua examinations. I keiki kanaka, CHD pinepine diagnosed i ka hooholo ana o ke Komisina i loko o ke koa.

He aha e hāʻawi mai ai i ke kauka paipai CHD child nō i loko o ka haawi keena? Mua o nā mea a pau, hoʻolohe ua unuhi i atypical coloration o keiki ili. Akä naÿe i ka rosy-papalina keiki keiki me ka naau maʻi ka haikea a me ka uliuli (ke kaumaha ma muli o ka 'ano o ka lesion ma pulmonary holo). Skin me a me ka maloo ana i ka hoʻopā. Cyanosis hiki palahalaha ae i ke kino a pau, aole hoi i kaupalena 'nasolabial triangle ke kaumaha ma muli o ka oolea o ke kina.

I ka mea mua e hoolohe ana i ka naau kani Dr. hoolaha'āno'ē leo i loko o ka nui nui o ka auscultation. Ke kumu o kēia mau loli o ka hewa koko ma na ipu. Ma keia hihia, ka hoʻohana 'ana i ka stethoscope kauka lohe e hooikaika ai i mea hoʻonāwaliwali maoli o ka naau kani, a huai ae hana ino, a e ole e ke ola i ke keiki. A pau i kēia huiʻo ia ka mea e hiki neonatologist e manao i ke alo o ka congenital naʻau maʻi, a, e kuhikuhi mai i ke kao keiki ma ka sightingʻike.

Keiki me ka kekahi PRT kamaʻilioʻana, e hele restlessly, a me ka pinepine holomua 'hea ana. keiki kekahi, ma ka kekahi lima, ua ikaika sluggish. Lakou e i lawe i ka umauma, hoole hue hou, a hiamoe poorly. He hiki i keʻano o ka dyspnea a me ka tachycardia (kokololio Heartbeat)

Ma ia hihia, ina o kaʻike, o CHD i loko o ke keiki i haawiia ma ka hope makahiki, hiki hoʻomōhala abnormalities i loko o ka noʻonoʻo a me ka physical? Acaeoey. Oia na keiki ulu lohi, e ho onui ana ke kaupaonaʻana, haule iho la ia mahope, ma ke kula, aole ia e malama i me ka ola a me kaʻeleu na¯. Ka mea hiki ole Makuakane me ka haawe ana ma ke kula, 'aʻole e alohi mai iloko o physical hoʻonaʻauao papa, pinepine kiʻi maʻi. Ma kekahi mau hihia, naau maʻi i ka accidental loaʻa ma ka pili o ka 'inikua examinations.

I loa wahi, i hiki, maʻi naʻau ole e hoʻomōhala ai. Eia kahi mea akaka dyspnea ma luna o ka mea iki e haawe. Pehu wāwae, mahuahua ake a me ka spleen, loli ana i loko o ka pulmonary holo. I ka wa e kaawale aku o akamai malama o ka moku'āina welau kīnā o ke kino a me ka make ana o ke keiki.

A pau kēia mau hiʻona ae he nui a uuku loa, e hoʻokūpaʻa i ke alo o ka CHD i loko o nā keiki. Symptoms ke oko a ma kekahi hihia. Ke hoʻohana i kēia PalekanaEND_LINK ki ina hana like i hoʻohana e hōʻoia i ka maʻi, a kūpono lapaʻau i ka manawa.

UPU ulu ke kahua

Nānā 'ole o keʻano a me ka oolea o nā mā i kekahi mau kahua o ka hoʻonaʻauao. Ke kahua mua ua kapaia ka hoʻololiʻana. I keia manawa, kino ke keiki ka ke hakuloli i na olelo hou o ke ola, ka hōʻoiaʻana i ka hana o nā keʻena ma lalo nei ma lalo o kekahi mau loli o ka naau. Aie i ka mea i pau nenoai i e hana i keia manawa, e komo ai, he mea hiki i ka hooulu ana o ka huʻi naʻau ole, ke ole o ka mea a pau meaola.

Ka lua o ke kahua - i ka pae o ka pili uku. Ka hoʻololi 'ole o ka naʻau hoʻolako i ke keiki i oi a emi maʻamau ke ola, ae hana i na mea a pau o kona oihana ma ka pae kūpono. Kēia kahua hiki hope no ka makahiki, i ole i alakai i ka holo pono o nā nenoai o ke kino a me ka hooulu ana o ka decompensation. Ke kolu o ka pae ana o ka UPU ke keiki ua kapaia ka maʻi, a ua wehewehe aku ma ka mea hou i loko o ke kino. Ka naʻau ke Makuakane ole hou me kona kuleana pili i. Ulu ka degenerative loli ma ka myocardium, e ho'ōla pau i loko o ka make.

Atrial septal kina

E noonoo i kekahi o nā 'ano o ka CHD. Atrial septal hewa i loko o na keiki - o kekahi o ka loa e like me ka naʻau mā, ua loaʻa i loko o nā keiki ma luna o ka makahiki o nā makahikiʻekolu. A pau keia maʻi ke keiki la, he uuku puka ma waena o ka pono a me ka haʻalele atria. E like me ka hopena, aia no he mau upena koko, mai haʻalele i ka akau, i maoli ai hele aku ai i hoʻohālana o pulmonary holo. Nā mea a pau o ka symptoms i aʻoʻia i loko o kēia pathology, hou pili i ka 'aʻe' ana o ka maʻamau functioning o ka naau i ka wehewehe ana oia i ana.

Maʻamau, i ka puka ma waena o ka atria he mea he fetus a hiki i ka hanau ana. Ua kapaʻia ka'ololaha puka aniani, a i hookuu pani ia me ka hanu mua o ke keiki. Ma kekahi mau hihia, i ka puka koe hamama no i ka wa e ola ana, akā, i kēia kina mea ai uuku i kekahi kanaka, aole ia i ike, a hiki no ia. Hemodynamic i mālama i loko o kēiaʻano. Palapala Sila Nui foramen ovale, 'aʻole i i ke kamaiki kekahi discomfort hiki e huikau ka mea i hoʻoholo' loko o ka ultrasound study o ka naau.

Akä naÿe, i ka oiaio atrial septal kina mea he oi nui pilikia. Oia i ka weheʻana i nui ma ka nui a me ka hiki ke kai piha ma ke kikowaena hapa o ka atria, a ma luna o nā kihi. UPU palapala (atrial septal hewa i loko o na keiki, e like me mākou i mai la, o ka loa, he pono ole), e ho oholo i ka iapaau ana hana i kohoʻia ma ke akamai ma muli o ka ultrasoundʻikepili a me nā anamanaʻo ki ina hana like.

symptoms o ASD

Līkaia no i kekahi, iniiaiie, a me ka kiʻekiʻe hemahema interatrial septum. Ka mea, oko lakou iho no ano lua wahi i loko o ka naʻau paia. Ma ka iniiaiie kina ASD ia akulla 'i loko o ka hapa malalo o ka paku. ʻike, "UPU kiʻekiʻe atrial septal kina" i loko o nā keikiʻana i loko o ka hihia ma ka puka kahi kokoke i ke kikowaena hapa. Kēia flaw ka nui maʻalahi e hooponopono, no ka mea, i loko o ka mea haʻahaʻa paku pauku o kona wahi o ka naau'aʻaʻa, hiki e pani i ka kina loa.

Ma ka hapanui o na, mea i okoa mai kā lākou na¯ kahi mau keiki liilii me ASD. Ko lakou ulu ana, a hoʻomōhala i kulike ai me ka elemakule. A ana i ka pinepine i anu, he kupaianaha i ka manawa maopopo ole. Aie i ka ikaika hooleiia'na o ke koko, mai haʻalele i ka akau, a me ka hoʻohālana o ka pulmonary holo keiki i hooleiiaʻi mawaho bronchopulmonary maʻi, a me ka loa pneumonia.

Na wale hōʻemi iki cyanosis i loko o ka nasolabial triangle hiki ke malama no na makahiki o ke ola i loko o na keiki me ASD. E hoʻomōhala ana i ma manawa haikea ili, pokole o ka hanu me ka uuku physical exertion, cough. Inā untreated, ke keiki hoʻomaka e lag hope ma physical kūpono 'ana, i hou Makuakane me ke kula maʻamau.

I ka naʻau o nā mea maʻi opiopio no ka lōʻihi manawa hiki ke ku imua o ka mahuahua haawe ana. Hoopii aku la tachycardia a me ka ole naau pāpana ana hou ma waena o nā makahiki o 12-15 makahiki. Inā ke keiki mea,ʻaʻole ma lalo o ka hooponopono ana o kauka a me ka ia, aole hana echocardiography, i kaʻike, "ka UPU, ASD," i e hoopuka ia i ke keiki wale nō i loko o adolescence.

ʻike, a me ka lapaʻau o ASD

Ma hookolokolo, ka cardiologist olelo hooikaika ana o ka naau ohumu mai ai me ka nui o ka heluʻai auscultation. O ke kumu ho i ka mea i ka wā i ke koko hala ae ma ka nohona kiwikā hou ulu swirls, a Kauka lohe ma ka stethoscope. Koko ma ka kina i loko o ka septum o kekahi walaau, aole ia i mea.

Oiai hoʻolohe i nā maʻiʻaʻai hiki ke 'akomi i crackles me stagnation o ke koko i loko o ka pulmonary holo pili. I ka percussion (prostukivanii thorax) hoikeia mai i ka mahuahua ma ka naau palena ma ka pili me kona hypertrophy.

Ma ka like ana o ka electrocardiogram i maopopo hiki hoailona o overload o ka naau pololei. Ma echocardiography hoikeia mai he kina ma ka atrial septum. X-Ray o na maʻiʻaʻai e leie aku oe e ike i ka symptoms o stagnation o ke koko i loko o ka pulmonary aa koko.

Haʻalele ventricular septal kina ASD aole loa e pani paha. Ke wale lapaʻau no keia kina meaʻoki lāʻau lapaʻau. Ke hana ua hana ma ka makahiki o ka 3-6 makahiki a ia? Ac? Cardiac decompensation. ʻoki lāʻau lapaʻau 'uao ua? Oaony. Ke hana ua hana hamama-naauʻoki kino me ka cardiopulmonary holo alaʻokoʻa. Ke Kauka i ka panina o ka kina, a ina o ka puka mea, ua nui, e uhi i ke one, he oki o ka pericardium (naau pālule,). It E e hoʻomaopopo i ka hana me ka ASD i kekahi o kaʻoki kino mua ma luna o ka naʻau no ka oi ma mua o 50 makahiki aku nei.

Ma kekahi mau hihia, kahi o ka kuʻuna suturing ka hoʻohana 'ana i ka endovascular kokoke loa i kahi. Ma keia hihia, i loko o ka femoral aa koko puncture ua i, a ma ka naau lua injected occluder (kūikawā ka manaʻo, ma i kina ua paa). Kēia AOAIAaOO ua manaoia e e emi traumatic a me ka maluhia, e like me ka hana me ka weheʻana o ka pahu. Ma hope o ia he hana nui aku koke na keiki i loaa hou ai. Eia naʻe,ʻaʻole i nā hihia a hiki ke hoopili endovascular hana. I kekahi manawa, i ka wahi o ka puka, i ka makahiki o ke keiki, e like me nā nā aʻe mai e ae ke 'ākeʻakeʻa.

Ventricular septal kina

E ka kamailio e pili ana i kekahi ano o ka CHD. VSD i keiki - i ka lua o ka loa e like me ka naʻau o nā maʻi i loko o ka makahiki o ka makahikiʻekolu. Ma keia hihia, he puka ua 'akomi i loko o ka septum hookaawale ana i ka ventricles akau a me ka hema. Aia ka he mau upena koko, mai haʻalele i ka akau, a, e like me ka ka ina me ASD e hoʻomōhala ana i ka overload o ka pulmonary holo.

Ka moku'āina o ka opiopio e hoomanawanui i ke oko a nui ke kaumaha ma muli o ka nui o ke kina. Me ka uuku puka keiki hiki ole e kekahi hoopii, a me ka halulu i auscultation - ka wale nō mea e, e hoopilikia makua. I ka 70% o ka hihia o ka poe liilii, ventricular septal mā Hoopaa iho la lakou ia lakou iho ma mua o ka makahiki o 5 makahiki.

A pau loa ia kekahi kiʻi mńlie ka wā o ka mana oi nui o ka UPU. VSD i na keiki i kekahi manawa, hiki nui nui like 'ole. Ma keia hihia, no ka pahiki o ka ulu pulmonary hypertension - hanahana loa complications o ke kina. Initially a pau kino nenoai ke hakuloli i ka hou keia, e hoohauhee ana i ke koko mai o ka ventricle a hiki i kekahi, a e pili ana i ka loa puʻe i loko o nā ipu pulmonary. Ma neia hope aku e hoʻomōhala ana i decompensation, ma i ka naʻau hiki ole hou Makuakane me kona kuleana pili i. Ho'ā hou venous koko 'ole e hana, e accumulates ma ka ventricle, a loko o ka systemic holo. High ke koko, i loko o nā maʻiʻaʻai Aʻole 'ae' ia ka naʻauʻoki kino, a me kēia nā mea maʻi pinepine make mai complications. I mea no ke aha la ia i nā manaʻoi hoʻokoe 'huai ae i kēia kina, a hoʻohuli i ke keiki no kaʻoki lāʻau lapaʻau kanaka mea nui.

Ma ka hihia ma ka VSD ua e pani oe ia oe iho i ke 3-5 makahiki, a me ka nui nui,ʻoki kino ua hana i ka pono o ka interventricular septum e hoʻihoʻi aku. E like me ka mea i ka manawa a me ASD, i ka puka ua sutured a paa hou mai la ma ke one, he oki mai ka pericardium. Oe ke pani i ke kina a me endovascular mea, ina ana ae.

Lapaʻau o congenital naʻau mā

ʻoki lāʻau lapaʻau 'ana i kūpono ia hoʻi ka mea wale nō i kekahi i ka helu wahi o ka poe mai, ma kekahi mau makahiki. Ke kaumaha ma muli o ka oolea o CHD ma ka iapaau ana o na keiki ke e hana i loko o ka neonatal manawa, a ma ka hope makahiki. A ua noho hihia o cardiacʻoki kino i loko o ka fetus i loko o ka opu. I ka Ia manawa wahine ole wale, ua hiki ke kamaʻilio maluhia hāpai keiki i ka makahiki, akā, no hoi ia i ke keiki kŘpa a ola ia, aole ia e koi mālama nui mālama i loko o ka hora mua o ke ola.

Ano a me ka lōʻihi like 'ole o ka hana i loko o kēlā me kēia hihia manao pākahi. Cardiac nānā 'ana i ka nanaʻikepili a me vocal ninaninau epekema, ka iaoiaeii Nāna e koho i a designates ana hiki. I keia manawa i ke keiki mea ma lalo o ka hooponopono ana o hoʻomalu, ke kaōhiʻana i kona kulana. I ka wa hoomakaukau ia no ka ka mea hana i ka bebe lawelawe 'ia me ka mea e pono ai ka lapaʻauʻia, a E ho oku ui, e hoʻopau i kaʻawaʻawa loa symptoms like ka nui me ka hiki.

Kīnā i loko o CHD i loko o ke keiki malalo o ia i ka 'eleu kanaka e hoʻomōhala ana i kākaʻikahi. Ma ka hapanui o hoopii,ʻoki kino hiki ole loaʻa wale nō ka make, akā, no hoi e hana maʻamau ka noho me ka nui kapu.

Kāohiʻana o congenital naʻau mā

Eia naʻe, i ka nui o ka? Acaeoey o ka lapaau mea,ʻaʻole e intervene ma utero kūpono 'ana o ke fetus , a somehow pili i ka naau lepe puke. Kāohiʻana o ka CHD i loko o na keiki komo ai i ka hoʻokolokolo pono ninaninau o nā mākua ma mua o ka n ieaie? Hāpai keiki. Expectant makuahine mua hapai ana i ke keiki i ka hoi e haawi mai inoʻano, e hoʻololi i ka 'oihana i loko o hoʻopōʻino hana ma nā hana. Mau ana, e emi na ka pilikia o ka ke keiki me ka pathology o ka mea'ōnaehana mānowai koko nenoaiu.

Oaeouee vaccination ku rubella, a ua lawe mai ia i na kaikamahine, e pale aku i ka helehelena o UPU like me ka hopena o keia noho pilikia maʻiʻaʻai. Eia hou kekahi, expectant makuwahine E e koi 'ia e undergo ultrasound loiloi i loko o ka manawa maoli o ka gestation. Kēia papa hana apono 'manawa, e kuhikuhi mā ma ke kamaiki, a lawe i ka mea ana. I ka hanau ana o ia i ke keiki, e ia ma lalo o ka hooponopono ana o ka hoao ana i cardiologists a me surgeons. Inā pono, pono, mai ka haukapila keena o ke keiki, e e lawe ana i ka hoʻomalu pa alima e hana koke ia, a ae aku la ia ia, e ola ia.

Ke prognosis no ka hooulu ana o ka congenital naau maʻi hilinaʻi nui ma luna o na mea he nui aʻe. Ka mua i ka maʻi ua 'akomi i, i ka nui o ka manawa, e pale i ka moku'āina o decompensation. 'Āwīwīʻoki lāʻau lapaʻau lapaʻau ole wale ho'ōla ola o ka opiopio hoʻomanawanui iki mai, akā, no hoi e leie aku ia lakou, e noho me kekahiʻiʻo kapu i ola kai.