Maopopo iaʻu ke paʻakikī o ka haʻi ʻia ʻana e ke kauka i kahi makua he kīnā puʻuwai hānau ko kāu pēpē hānau hou. I ka manawa e like me kēia, ke lohe ʻoe e pili ana i ka 'BTT shunt', nui paha kāu mau nīnau e pili ana i ke ʻano o ia mea, no ke aha i hana ʻia ai, e hōʻeha anei i ka pēpē, a aia kekahi mau pilikia. Mai hopohopo. I kēia lā, e kamaʻilio mākou e pili ana i nā mea āpau me ka maopopo a me ka maʻalahi.
I ka ʻōlelo maʻalahi, he aha kēia BTT Shunt?
ʻO ka BTT shunt, a i ʻole Blalock-Taussig-Thomas shunt, he ʻoki kūikawā i hana ʻia e kōkua i nā pēpē i loaʻa ʻole ka oxygen lawa i ko lākou kino. Hoʻokumu ʻia kēia maʻi e kahi maʻi puʻuwai hānau .
E noʻonoʻo e pili ana i ia mea, loaʻa i ko mākou kino ka oxygen mai ka ea a mākou e hanu ai i loko o ko mākou mau māmā. Pono e hoʻohui ʻia kēia oxygen i ke koko a lawe ʻia ma ke kino holoʻokoʻa. Eia nō naʻe, i kekahi mau pēpē me ka maʻi puʻuwai, ʻaʻole lawa ke koko i loko o ke kīʻaha koko nui e lawe ana i ke koko mai ka puʻuwai a i nā māmā , ʻo ia hoʻi ke aʻa pulmonary . A laila, ʻaʻole lawa ke koko i ke kino.
No laila, ʻo ka hana a ka BTT shunt , ʻo ia ke hana i kahi ala hou ma ka hoʻokomo ʻana i kahi ʻōmole hana liʻiliʻi (shunt a i ʻole graft) mai ke kīʻaha koko nui e lawe ana i ke koko mai ka puʻuwai a i ke kino a i nā māmā. Ua like ia me ke alanui bypass liʻiliʻi e kāpae ana i kahi alanui paʻahana. Hoʻonui kēia i ka nui o ke koko e hele ana i nā māmā, a loaʻa i ke kino ka oxygen maikaʻi aʻe.
ʻO ka mea nui, he hopena manawa pōkole kēia. Ke ʻelemakule iki a ikaika aʻe ka pēpē, hana ʻia kahi ʻoki kino nui e hoʻoponopono piha i ka pilikia puʻuwai mua. I loko o kēlā ʻoki kino, wehe ʻia ka BTT shunt. Eia naʻe, he mea kakaikahi loa, pono paha i kekahi mau pēpē ke loaʻa kēia shunt ma ke ʻano he hopena lōʻihi.
He aha nā ʻano maʻi puʻuwai e pono ai ke ʻoki ʻana o BTT Shunt?
He mea pono kēia ʻoki kino no kekahi mau maʻi puʻuwai hānau e hōʻemi ana i ke kahe koko i nā māmā.
| Nā kūlana puʻuwai hānau |
|---|
| ʻO ka maʻi puʻuwai hema Hypoplastic |
| ʻO ke Tetralogy o Fallot (TOF) |
| ʻO Truncus arteriosus |
| ʻO ke ʻano ʻē o Ebstein |
| ʻO ka atresia pulmonary |
| ʻO ka atresia Tricuspid |
| ʻO kekahi mau ʻano o ka hoʻololi ʻana o nā aʻa nui |
He aha ka mea e hana ʻia ma mua o ke ʻoki kino?
Ma mua o ke ʻoki kino, e hōʻiliʻili ke kime lapaʻau o kāu pēpē i nā ʻike āpau e pono ai. E nānā pono lākou i kāu pēpē a nānā i kona mōʻaukala olakino mai kou hāpai ʻana. Hiki iā lākou ke hana i kekahi mau hoʻokolohua ʻaʻole invasive.
| Nā ʻano hoʻokolohua hiki ke hana ʻia |
|---|
| ʻO ke scan puʻuwai (Transthoracic echocardiogram) |
| Nā hoʻāʻo koko |
| X-ray umauma |
| Hoʻāʻo ECG (Electrocardiogram) |
| I kekahi manawa he angiogram a i ʻole CT angiogram (Coronary angiogram a i ʻole CT angiogram) |
E loaʻa nō hoʻi iā ʻoe nā ʻōlelo kuhikuhi no ka ʻauʻau ʻana i kāu pēpē ma mua o ke ʻoki ʻana a me ka wā e hoʻōki ai i ka ʻai ʻana a me ka hānai waiū.
He aha ka mea e hana ʻia i ka wā o ke ʻoki kino?
He mau hola ka lōʻihi o kēia hana a he akahele loa. ʻO ka mea nui e hana ai ke kauka ʻoki i kēia mau mea:
- ʻO ka iwi ma waenakonu o ka umauma o kahi pēpēLoaʻa ka puʻuwai ma ka ʻoki ʻana ma o ka sternum .
- I mea e hoʻokokoke aku ai i ka puʻuwai, ua wehe loa ʻia ka ʻōpū thymus ma kahi kokoke.
- E like me ka mea i ʻōlelo ʻia ma mua, ua hoʻopili ʻia kahi graft synthetic ma waena o kahi aʻa nui e hoʻolako ana i ke koko i ke kino (ke aʻa subclavian) a me ke aʻa e hoʻolako ana i ke koko i nā māmā (ke aʻa pulmonary).
- Nānā pono ʻia kēia pilina e ʻike inā e hana pono ana, inā he mau ʻūpā koko, a inā paha he kahe koko.
- Inā maikaʻi nā mea a pau, e pani hou ʻia ka umauma o ke pēpē.
He aha ka mea e hana ʻia ma hope o ke ʻoki kino?
Ma hope o ke ʻoki kino, e hoʻokomo ʻia kāu pēpē i ka keʻena mālama koʻikoʻi (ICU) .
Mai hopohopo i kēia. Hiki paha iā ʻoe ke manaʻo iki i ka ʻoluʻolu ʻole ke ʻike ʻoe i kāu pēpē ma hope o ke ʻoki ʻana. He nui nā paipu a me nā uea i hoʻopili ʻia i ka pēpē. Akā e hoʻomanaʻo, aia kēlā mau lako a pau e kōkua i ka pēpē e ho'ōla koke. No laila e noho ikaika.
Hāʻawi ʻia ka pēpē i kahi mea hoʻokahe koko, e like me ka heparin, e pale aku i nā ʻūpā koko. Hoʻomaka pū lākou i ka aspirin . Pono ka pēpē e lawe i kēia aspirin no ke koena o kona ola. He mea kākaʻikahi loa, pono paha kekahi mau pēpē i ke kōkua o kahi mīkini kākoʻo ola no ka manawa pōkole, e like me ka ECMO .
He aha nā pōmaikaʻi a me nā pilikia o kēia ʻoki kino?
ʻO ka pōmaikaʻi nui:
ʻO ka pōmaikaʻi nui o kēia ʻoki kino , ʻo ia ka hoʻonui ʻana i ka nui o ka oxygen e hiki aku ana i nā hunaola kino o ke pēpē. Hoʻemi kēia i ke kala polū (cyanosis) i ʻike ʻia ma ka ʻili, nā lehelehe, a me nā kui o kekahi mau pēpē ma muli o ka nele o ka oxygen. He alahaka maikaʻi kēia no ka pēpē e noho olakino a ikaika a hiki i ke ʻoki kino nui e hiki mai ana.
Nā pilikia a me nā pilikia:
E like me nā ʻoki kino āpau, aia kekahi mau pilikia. E wehewehe pono kāu kauka i kēia mau mea iā ʻoe. ʻO kekahi o nā pilikia e hiki mai ana:
- ʻOi aku ka nui o ke koko e kahe ana ma o ka shunt i nā māmā ma mua o ka mea e pono ai (pulmonary overcirculation).
- Nā ʻūpā koko.
- Ka hōʻino ʻana i kahi aʻalolo kokoke i kahi ʻoki (ʻoi aku hoʻi ke aʻalolo e hoʻopilikia ai i ka hohonu o ka leo o ka pēpē).
- Nā ʻano ʻino o ka puʻuwai (Arrhythmia).
- Paʻa ka puʻuwai.
He haʻahaʻa loa kēia mau pilikia, a ke hana nei ke kime lapaʻau i ka mea maikaʻi loa e pale aku i nā mea e like me kēia.
ʻEhia ka lōʻihi e hoʻōla ai a i ka manawa hea e pono ai iaʻu ke ʻike i ke kauka?
ʻO ka maʻamau, e noho ka pēpē ma ka haukapila no ʻelua pule. ʻO ka pule mua a i ʻole e hoʻolilo ʻia ma ka ʻāpana mālama koʻikoʻi (ICU). ʻOiai ma hope o kou hoʻi ʻana i ka home, pono ʻoe e lawe i kāu pēpē no nā nānā maʻamau. ʻO ka kipa mua ʻana maʻamau i loko o hoʻokahi a ʻelua paha pule o ka hoʻi ʻana i ka home.
Ma hope o ka hoʻi ʻana i ka home, inā ʻike ʻoe i nā hōʻailona aʻe, pono ʻoe e kāhea koke i kāu kauka.
| Nā hōʻailona hōʻike e makaʻala ai |
|---|
| Ka pehu ʻana ma kahi i hana ʻia ai ke ʻoki a ma kahi ʻē aʻe paha o ke kino |
| ʻUlaʻula a puni ka ʻeha ʻoki |
| Inā ʻike hou ʻia ka ʻili a me nā lehelehe he uliuli |
| Inā ʻike ʻia ka pēpē ua luhi loa a palaualelo paha |
| Inā loaʻa iā ʻoe ke kuni |
| Inā e kahe ana ka wai mai ka ʻeha ʻoki |
Ma ke ʻano he makua, ʻike mākou makemake ʻoe e hāʻawi i kāu pēpē i ka mea maikaʻi loa hiki iā ʻoe. ʻO ka mea maikaʻi loa hiki iā ʻoe ke hana i kēia manawa, ʻo ia ke nīnau i ka hui lapaʻau i nā nīnau āu e loaʻa ai. E kamaʻilio maopopo e pili ana i ke kūlana o kāu pēpē, ke ʻoki kino, a me ka wā e hiki mai ana. ʻO ke koho ʻana i kahi haukapila a me nā kauka i loaʻa ka ʻike nui i ia mau ʻoki kino e lawe mai iā ʻoe i ka maluhia nui o ka noʻonoʻo.
Leka Lawe-Home
- ʻO ka BTT Shunt kahi ʻoki kino i hana ʻia ma nā pēpē me ka maʻi puʻuwai hānau e hoʻonui i ka nui o ke koko e kahe ana i nā māmā a hāʻawi i ka oxygen i ke kino.
- He hopena manawa pōkole kēia. Ke ulu ka pēpē, pono kekahi hana ʻoki kino e hoʻoponopono ai i ke kūlana puʻuwai.
- Ma hope o ke ʻoki ʻana, pono ka pēpē i ka mālama koʻikoʻi a pono paha e lawe i nā lāʻau lapaʻau e like me ka aspirin no ke koena o kona ola.
- E like me nā ʻoki kino āpau, aia nā pilikia. E kamaʻilio ākea me kāu kauka e pili ana iā lākou.
- Ma hope o kou hoʻi ʻana i ka home, e makaʻala pono i ke ʻano o kāu pēpē, ke kala o ka ʻili, ke kuni, a pēlā aku. Inā ʻike ʻoe i kekahi mau loli, e ʻimi koke i ke kōkua lapaʻau.
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