CHD umntwana: izimbangela, izimpawu, ukwelashwa

Isifo senhliziyo esiphundu (CHD) singuquko ezenzakalelayo enhliziyweni, izitsha zalo namagagasi akhula ngo-utero. Ngokwezibalo, i-pathology efanayo ivela ku-0.8-1.2% yazo zonke izinsana. I-CHD yengane ingenye yezimbangela ezivame kakhulu zokufa ngaphambi kweminyaka engu-1.

Izimbangela ze-CHD ezinganeni

Okwamanje asikho incazelo ecacile yokuthi kwenzeke ezinye izinkinga zenhliziyo. Kuyaziwa ukuthi isitho esibaluleke kunazo zonke emfubeni yilabo abasengozini kunazo zonke esikhathini esingamaviki amabili kuya kwangu-7 okukhulelwa. Ngalesi sikhathi ukuthi zonke izingxenye ezinkulu zenhliziyo zibekiwe, ukwakheka kwamagagasi alo nezitsha ezinkulu. Noma yimuphi umthelela okwenzekile phakathi nalesi sikhathi kungabangela ekubunjweni kwezilwane. Njengomthetho, akunakwenzeka ukuthola isizathu esiqondile. Ngokuvamile, izici ezilandelayo zifaka isandla ekuthuthukiseni i-UPU:

• Izinguquko zomzimba;
• Ukutheleleka ngegciwane lesandulela ngculaza kudluliselwa owesifazane ngesikhathi sokukhulelwa (ikakhulukazi, i-rubella);
• Izifo ezithathelwanayo zomama (isifo sikashukela, ama-systemic lupus erythematosus nabanye);
• Ukuphuza utshwala ngesikhathi sokukhulelwa;
• Unyaka womama uneminyaka engaphezu kwengu-35.

Ukwakhiwa kwe-CHD kwengane nakho kungathinteka yizimo ezimbi zemvelo, ukuvezwa kwemisebe kanye nokudla kwemithi ethile ngesikhathi sokukhulelwa. Ingozi yokuzalwa komntwana ene-pathology efanayo iyakhula uma owesifazane esevele ehlangene nokukhulelwa kokubeletha esikhathini esedlule, ukufa komntwana noma ukufa kwezinsana ezinsukwini zokuqala zokuphila. Kungenzeka ukuthi imbangela yalezi zinkinga yayingenakubalwa kwezinhliziyo zenhliziyo.

Ungakhohlwa ukuthi i-UPU ayikwazi ukuba yisifo sokuzimela esizimele, kodwa ingxenye yeso simo esingenasabekayo. Isibonelo, ku- Down's syndrome, isifo senhliziyo senzeke kumacala angu-40%. Ekuzalweni kwengane enezinkinga eziningi, isitho esibaluleke kunazo zonke siyovame ukubandakanyeka nenqubo yokwelapha.

Izinhlobo ze-UPU ezinganeni

Imithi iyayazi izinhlobo ezingaphezu kwezingu-100 zezifo ezihlukahlukene zenhliziyo. Isikole ngasinye sihlinzeka ngezigaba zayo, kodwa ngokuvamile u-UPU uhlukaniswe "ohlaza okwesibhakabhaka" nokuthi "umhlophe". Ukwehlukaniswa okunjalo kweziphambeko kusekelwe ezimpawu zangaphandle, ukuhamba kwazo, ukucaca ngokwengeziwe, ngokuqina kombala wesikhumba. Ngengane "eluhlaza okwesibhakabhaka" ingane ine-cyanosis, futhi nge "mhlophe" isikhumba siba sebala kakhulu. Ukuhluka okuqala kwenzeka ku-tetralogy ye-Fallot, i-atresia ye-artery yamathambo nezinye izifo. Uhlobo lwesibili luyinto ejwayelekile kakhulu yeziphambeko ze-septa yangaphakathi ne-interventricular.

Kukhona enye indlela yokuhlukanisa i-CHD ezinganeni. Ukuhlukaniswa kulokhu kuhilela ukubumbana kwezinto ezimbi emaqenjini ngokusho kwesimo se-pulmonary circulation. Kunezinketho ezintathu:

I-UPU ene-overload yomjikelezo omncane wokusabalalisa:

• Vula umzila wokuguqula;
• I-Atrial septal defect (ASD);
• Umthetheli we-septum ye-interventricular (DMF);

2. I-EPS enokunciphisa umbuthano omncane:

• I-Tetrad of Fallot;
• Isisu se-artery yamapayipi;
• Ukudluliselwa kwezitsha ezinkulu.

3. I-CHD enegazi elingaguqukiyo lokugeleza embuthaneni omncane:

• Ukuhlanganiswa kwe-aorta;
• Ukuqina kwesimo se-aorta.

Izimpawu zesifo senhliziyo esibangelwa abantwana

Ukuxilongwa kwe "CHD" kwengane kusekelwe ezinkomba eziningi. Ezimweni ezimbi, izinguquko zizobonakala ngokushesha ngemva kokuzalwa. Udokotela onolwazi angasifaka kalula ukuhlolwa kokuqala ekuqaleni ekamelweni lokulethwa futhi aqondise izenzo zabo ngokuhambisana nesimo samanje. Kwezinye izimo, abazali abasoli ukuthi kukhona isifo senhliziyo iminyaka eminingi kuze kube yilapho lesi sifo singena esiteji sokukhokha imali. Amathambo amaningi atholakala kuphela ekukhuleni kwesinye sezivivinyo ezivamile zezokwelapha. Kubantu abasha, i-UPU ivame ukutholakala ukuthi idlulisela ikhomishana ekubhalweni kwezempi nokubhalisa ihhovisi.

Yini enikeza udokotela isizathu sokugqoka i-CHD yengane esesendlini yokulethwa? Okokuqala, ukunakwa kugxila embala wombala wesikhumba wengane esanda kuzalwa. Ngokungafani nezingane ezinama-pink-cheeked, ingane enesici senhliziyo iyoba yikhanyane noma eluhlaza okwesibhakabhaka (kuye ngokuthi uhlobo lomonakalo wokujikeleza kwe-pulmonary). Isikhumba siphelile futhi somile kuya kuthinta. I-Cyanosis ingasakazeka kuwo wonke umzimba noma inqunywe kunxantathu ye-nasolabial, kuye ngobukhulu besici.

Ekuzweni kokuqala kwenhliziyo umsindo, udokotela uzobona imisindo yezintambo emaphuzu abalulekile ekuhlaleni. Isizathu salolo shintsho ukugeleza kwegazi okungalungile ngokusebenzisa izitsha. Kulesi simo, ngosizo lwe-phonendoscope, udokotela uzozwa ukukhuliswa noma ukwehliswa kwamathoni enhliziyo noma uzobona imisindo ye-atypical engafanele ibe khona emntwaneni onempilo. Konke lokhu kuyinkimbinkimbi kuvumela ukuthi i-neonatologist icabange ukuthi kukhona khona isifo senhliziyo esiswini futhi iqondise ingane ekuxilongweni okuhlosiwe.

Izingane ezisanda kuzalwa nge-UPU ethile, njengombuso, ziziphatha ngokungapheli, ngokuvamile futhi ngaphandle kwesizathu, ziyakhala. Ezinye izingane, ngokuphambene nalokho, zilukhuni kakhulu. Abathathi isifuba, benqabe ibhodlela bese balala kabi. Kungase kube khona ukuphefumula kanye ne-tachycardia (ukushaya kwenhliziyo okusheshayo)

Uma kwenzeka ukuthi ukutholakala kwe-CHD enganeni kwenziwe esikhathini esizayo, ukuthuthukiswa kokungajwayelekile ekuthuthukiseni kwengqondo nangokwenyama kungenzeka. Lezi zingane zikhula kancane kancane, zithole isisindo esingahle, zivele ngemuva kwezifundo, zingabi nokuhambisana neontanga enempilo futhi esebenzayo. Ababhekane nokucindezeleka esikoleni, abakhanyeli emakilasini emfundo engokwenyama, bavame ukugula. Kwezinye izimo, isifo senhliziyo sibe yinto yokuthola ngengozi ekulandeni kokuhlolwa kwezokwelapha.

Ezimweni ezinzima, ukwehluleka kwenhliziyo okungapheli kukhula. Kubonakala kufushane kokuphefumula ngomthwalo omncane kakhulu. Imilenze, isibindi nesipelingi ukuvuvukala, izinguquko zenzeka emjikelezweni omncane wegazi. Ngaphandle kokunakekelwa okufanelekayo, lesi simo sibangela ukukhubazeka noma ngisho nokufa kwengane.

Zonke lezi zibonakaliso zivumela ukuqinisekiswa okungaphezulu noma okuncane kokubakhona kwe-CHD ezinganeni. Izimpawu zingahluka ezimweni ezehlukene. Ukusetshenziswa kwezindlela zokuhlaziya zanamuhla kukuvumela ukuba uqinisekise lesi sifo futhi ngesikhathi sokunikeza ukwelashwa okudingekayo.

Izinyathelo zokuthuthukiswa kwe-UPU

Kungakhathaliseki ukuthi luhlobo luni nobukhulu bokweqile, zonke iziphambelelo zidlula ngezigaba eziningana. Isigaba sokuqala sibizwa ngokuthi i-adaptive. Ngalesi sikhathi, umzimba womntwana uvumelanisa nezimo ezintsha zokuphila, ukulungisa umsebenzi wazo zonke izitho ngenhliziyo eguquliwe kancane. Ngenxa yokuthi zonke izinhlelo kufanele zisebenze ngalesi sikhathi sokugqoka nokudiliza, ukuthuthukiswa kwehluleka kwenhliziyo nokuhluleka emsebenzini wonke umzimba akukhishwa.

Isigaba sesibili yisigaba sesinxephezelo esihambisana naso. Izinguquko zezinhliziyo zinikeza ingane impilo ejwayelekile noma engavamile, yenza yonke imisebenzi yayo ezingeni elifanele. Lesi sigaba singadlulela iminyaka, kuze kube yilapho sekuholela ekuhlulekeni kwazo zonke izinhlelo zomzimba kanye nokuthuthukiswa kwe-decompensation. Isigaba sesithathu se-CHD enganeni libizwa ngokuthi liphela futhi libhekene nezinguquko ezinzima emzimbeni wonke. Inhliziyo ayisakwazi ukubhekana nomsebenzi wayo. Izinguquko eziguquguqukayo ekuthuthukiseni kwe-myocardium, ngokushesha noma kamuva ziphela ngomphumela obulalayo.

I-septrial septal defect

Cabangela enye yezinhlobo ze-AMS. I-DMPP ezinganeni ingenye yeziphambeko zenhliziyo ezivame kakhulu, ezitholakala ezinganeni ezingaphezu kweminyaka emithathu. Kulesi sifo, ingane inokuvula encane emkhatsini we-atria engakwesokudla nangakwesokunxele. Ngenxa yalokho, kukhona ukuwa kwegazi okuqhubekayo kusuka kwesobunxele kuya kwesokudla, okuyinto ngokwemvelo kuholela ekuchichimeni kokujikeleza kwepulmonary. Zonke izimpawu ezithuthuka kulezi zifo zihlobene nokuphulwa komsebenzi ovamile wenhliziyo ezimweni eziguquliwe.

Ngokuvamile, imbobo ephakathi kwe-atria ikhona ebusweni kuze kube sekuzalweni. Ibizwa ngokuthi iwindi elingu-oval futhi, njengomthetho, ivala nge-inhalation yokuqala yokuzalwa okusha. Kwezinye izimo, imbobo ihlala ivulekile impilo, kodwa lesi siphene sincane kangangokuthi umuntu akakwazi ngisho naso ngakho. Akukho ukuphulwa kwe-hemodynamics ngalokhu okuhlukile. Ifasitela elivulekile elingavumelani nanoma yikuphi ukunganaki kwengane ingaba ukutholakala ngengozi ngesikhathi sokuhlolwa kwe-ultrasound yenhliziyo.

Ngokuphambene nalokho, iphutha langempela le-atrial septal yinkinga enkulu kakhulu. Ukuvula okunjalo kunkulu futhi kungatholakala kokubili engxenyeni eyinhloko ye-atria nasemaphethelweni. Uhlobo lwe-CHD (ASD ezinganeni, njengoba sishilo, luvame kakhulu) luzokwenza indlela yokwelapha ekhethwe yikhulu esekelwe kwi-ultrasound nezinye izindlela zokuhlola.

Izimpawu ze-ASD

Hlukana neziphambeko eziyinhloko nezesibili ze-septum ye-interatrial. Zihlukana phakathi kwazo ngokwazo eziqakathekile zendawo yomgodi odongeni lwenhliziyo. Ekuqaleni kwe-DMPP isici sitholakala engxenyeni engezansi ye-septum. Ukuxilongwa kwe "CHD, ASD yesibili" ezinganeni kusethwe lapho umgodi usondelene nendawo ephakathi. I-vice enjalo isetshenziswa kakhulu ekulungiseni, ngoba engxenyeni engezansi ye-septum kukhona izinhlanzi ezincane zenhliziyo, okuvumela ukuvala isici ngokuphelele.

Ezimweni eziningi, izingane ezincane ezine-ASD azifani neontanga. Akhula futhi athuthuke ngokusho kweminyaka. Kukhona ukuthambekela kokushisa okuvamile ngaphandle kwesizathu esikhethekile. Ngenxa yokumiswa kwegazi okuqhubekayo kusuka kwesobunxele kuya kwesokudla nokuchichima kwengxenyana encane yokujikeleza kwegazi, izingane zibhekene nezifo ze-bronchopulmonary, kuhlanganise ne-pneumonia enamandla.

Iminyaka eminingi yokuphila ezinganeni ezine-ASD kungaba kuphela i-cyanosis encane kunxantathu ye-nasolabial. Ngokuhamba kwesikhathi, isikhumba sesikhumba siphuthuma, i-dyspnea enomzimba omncane, ukukhwehlela okumanzi. Uma kungekho ukwelashwa, ingane iqala ukuguga emva kokuthuthukiswa ngokomzimba, ihluleka ukubhekana nokufunda esikoleni esijwayelekile.

Inhliziyo yeziguli ezincane isikhathi eside esibhekene nokubhekana nokucindezeleka kakhudlwana. Izikhalo mayelana ne-tachycardia ne-arrhythmiya yenhliziyo zivame ukuvela eneminyaka engu-12-15. Uma ngabe ingane ingaphansi kokuqondiswa kwezokwelapha futhi i-Echocardiography ayingakaze yenziwe, ukuxilongwa "kwe-CHD, i-DMPP" enganeni kungabonakala kuphela ekukhuleni.

Ukuxilongwa nokuphathwa kwe-ASD

Lapho ehlolwa, isazi se-cardiologist sikhombisa ukwenyuka kwenhliziyo ekhononda ngamaphuzu avela kakhulu. Lokhu kungenxa yokuthi uma igazi lidlula emagodini aphethwe, ama-vortices athuthuka lapho udokotela ezwa khona nge-stethoscope. Igazi eligeleza ngephutha endaweni ye-septum ayibangeli umsindo.

Ngesikhathi ulalela amaphaphu, umuntu angathola ukushaya kwesondo okumanzi okuhlotshaniswa nokuqhuma kwegazi emjikelezweni omncane wegazi. Nge-percussion (ukushaya kwesifuba), ukwanda kwemingcele yenhliziyo kubonakala ngokuphathelene ne-hypertrophy yayo.

Uma ihlolwe kwi-electrocardiogram, izibonakaliso zokugqithisa kwenhliziyo efanele zibonakala ngokucacile. I-Echocardiography ibonisa iphutha esifundeni se-septum yezokuxhumana. I-X-ray yemaphaphu ikuvumela ukuba ubone izimpawu zegazi elihlaselwa emithanjeni yamapulmonari.

Ngokungafani nenkinga ye-septum ye-interventricular, i-ASD ingakaze ivalwe yodwa. Indlela kuphela yokwelapha isici esinjalo ukuhlinzwa. Ukusebenza kwenziwa eneminyaka engu-3-6, kuze kube yilapho kuqhathaniswa umsebenzi wezinhliziyo. Ukungenelela kokuhlinzwa kuhlelwe. Ukusebenza kwenziwa ngenhliziyo evulekile ezimweni zokujikeleza okufakelwayo. Udokotela wenza i-suturing ye-defect noma, uma umgodi ukhulu kakhulu, uyifaka nge-patch cut from the pericardium (inhliziyo shroud). Kufanele kuqaphele ukuthi ukusebenza ne-ASD kwakungenye yezindlela zokuqala zokuhlinzwa ezinhliziyweni eminyakeni engaphezu kwengu-50 eyedlule.

Kwezinye izimo, esikhundleni se-suturing yendabuko, indlela yokugcina i-endovascular isetshenziswa. Kule nkinga, i-puncture yenziwa emgodini wesifazane, futhi kuyo yonke indawo (idivayisi ekhethekile evala isici) ifakwa enhliziyweni. Lolu khetho lubhekwa njengengcindezi encane futhi ephephile, ngoba lwenziwa ngaphandle kokuvula isifuba. Ngemuva kokusebenza okunjalo, izingane zilulama ngokushesha. Ngeshwa, akuzona zonke izimo ezingasebenzisa indlela yokugcina. Ngezinye izikhathi indawo yomgodi, ubudala wengane, nezinye izici ezihlobene azivumeli ukungenela okunjalo.

Ithempulethi ye-septum yangaphakathi

Ake sikhulume ngenye uhlobo lwe-UPU. I-VSD ezinganeni yinto yesibili yokuhluleka kwenhliziyo kubantu abangaphezu kweminyaka emithathu. Kulesi simo, ukuvula kutholakala ku-septum ehlukanisa ama-ventricle angakwesokudla nangakwesokunxele. Kukhona ukuwa kwegazi okuqhubekayo kusuka kwesobunxele kuya kwesokudla, futhi, njengoba kunjalo ne-ASD, ukuxilongwa kwe-circle encane yokujikeleza kukhula.

Isimo seziguli ezincane singahluka kakhulu kuye ngobukhulu besici. Ngomgodi omncane, ingane ayikwazi ukwenza izikhalazo, futhi umsindo ngesikhathi sokukhishwa kwezinto yinto kuphela ezokhathaza abazali. Ezingamaphesenti angama-70%, amaphutha amancane we-septum ehamba phambili azivala eseneminyaka engaba ngu-5.

Isithombe esivela ngokuphelele siphumelela ngenguqulo eyinkimbinkimbi ye-UPU. I-VSD ezinganeni ngezinye izikhathi ifinyelela usayizi omkhulu. Kulesi simo, amathuba okuthuthukisa umfutho wegazi ophezulu we-pulmonary is a complication serious of this defect. Ekuqaleni, zonke izinhlelo zomzimba zivumelane nezimo ezintsha, ukudlulisa igazi kusuka kwelinye i-ventricle kuya kwelinye futhi kudala ukucindezela okwenyuka emikhawulweni yombuthano omncane. Ngokuhamba kwesikhathi, i-décompensation iqala, lapho inhliziyo ingakwazi khona ukubhekana nomsebenzi wayo. Ukulahla kwegazi elingenayo i-venous, akubutheki ngaphakathi kwe-ventricle bese kungena emjikelezweni omkhulu wegazi. Ukucindezela okukhulu emaphashini akuvumeli ukuhlinzwa kwenhliziyo, futhi iziguli ezinjalo zivame ukufa ngenxa yezinkinga. Yingakho kubaluleke kakhulu ukukhomba lesi siphene ngesikhathi futhi ukuqondisa ingane ekwelapheni okuhlinzayo.

Uma kwenzeka ukuthi i-VAW ingavali ngokuzimela kuze kube yilapho ineminyaka engu-3-5 ubudala noma inkulu kakhulu, kwenziwa umsebenzi wokubuyiselwa ubuqotho be-septum ye-interventricular. Njengokwesimo se-ASD, imbobo i-sutured noma ihlanganiswe ngesikhuni se-patch esivela ku-pericardium. Ungavala indlela yokukhubazeka neyindlela yokugcina, uma izimo zivumela.

Ukwelashwa kwesifo senhliziyo esiswini

Indlela yokuhlinzeka yedwa kuphela yokuqeda lesi sifo kunoma yikuphi ubudala. Ngokuya ngobunzima, ukwelashwa kwe-CHD ezinganeni kungenziwa kokubili ngesikhathi sezinsana nasebudala . Kunezimo zokuhlinzwa kwenhliziyo emntwaneni wesibeletho esibelethweni somama. Ngesikhathi esifanayo, abesifazane abazange bakwazi ukuletha ukukhulelwa ngempumelelo kuphela ngaphambi kosuku olufanele, kodwa futhi babelethe ingane enempilo enhle engadingi ukuvuselela ngesikhathi sokuqala sokuphila.

Izinhlobo kanye nemigomo yokwelapha esimweni ngasinye sinqunywa ngabanye. Udokotela ohlinzayo wezinhliziyo, ngokusekelwe kwedatha yokuhlola kanye nezindlela zokuhlola izinsimbi, ukhetha indlela yokusebenza futhi anikeze isikhathi esithile. Konke lokhu ingane ingaphansi kokuqondiswa kochwepheshe abalawula isimo sakhe. Lapho ilungiselela ukusebenza, ingane ithola imithi edingekayo, evumela ukuthi kuqedwe izimpawu ezingathandeki kakhulu.

Ukukhubazeka ku-CHD kwengane ngaphansi kwesimo sokwelashwa okufika ngesikhathi kukhula kakhulu. Ezimweni eziningi, ukuhlinzwa akuvumeli kuphela ukugwema ukufa, kodwa futhi ukudala izimo zokuphila ezivamile ngaphandle kwemingcele ebalulekile.

Ukuvimbela isifo senhliziyo esiswini

Ngeshwa, ezingeni yentuthuko emithi akuyona ukuba angenelele ukuthuthukiswa utero umbungu , futhi ngandlela-thile kuphazamise ibhukumaka inhliziyo. Ukuvimbela CHD ezinganeni kuhilela luhlolo loluphelele abazali ngaphambi sokukhulelwa okuhleliwe. umama okhulelwe ngaphambi nje ebamba isisu sengane futhi kufanele ithawula imikhuba emibi, ukushintsha umsebenzi eziyingozi nakweminye imisebenzi. Lezi zinyathelo zizoba zokunciphisa izingozi zokuba umntwana nge zokugula we esimiso senhliziyo nemithambo yegazi.

lokugoma Asebenza ngokumelene rubella, okuyinto eyenziwa kuwo wonke amantombazane, ukugwema ukubonakala Upu ngenxa yalesi ukutheleleka esiyingozi. Ngaphezu kwalokho, omama abakhulelwe kufanele kwakudingeka alandele inqubo ultrasound Ukuhlolwa saba sesimweni ngesikhathi sokukhulelwa. Le ndlela ivumela isikhathi ukuhlonza yokulimala ingane futhi sithathe izinyathelo ezidingekile. Ukuzalwa kwengane okunjalo kuyoba ngaphansi kokuqondisa nangodokotela bababhekene nezifo zenhliziyo abanolwazi futhi odokotela abahlinzayo. Uma kunesidingo, ukusuka lesibhedlela ngayo lapho usana iyothathwa iyunithi Uchwepheshe isebenze ngokushesha futhi umvumele ukuba bahlale kuwo.

Onalesi sifo sokuthuthukiswa yesifo senhliziyo azalwa naso kuxhomeke ezicini eziningi. I ngaphambili lesi sifo lutholwa, aba maningi amathuba okuba ukugwema isimo decompensation. ukwelashwa esifike ngesikhathi kuhlinzwa hhayi kuphela kusindisa ukuphila iziguli abasha, kodwa futhi ivumela ukuba baphile ngaphandle kwemingcele abalulekile ngezizathu zempilo.