Ke hana nei ka puʻuwai o kāu pēpē i kahi leo kūikawā? E kamaʻilio kākou e pili ana i ka PDA (Patent Ductus Arteriosus)

Hiki i kahi makuahine a makua kāne paha me kahi pēpē hānau hou ke makaʻu loa ʻoiai inā ʻike lākou i kahi loli liʻiliʻi i kā lākou pēpē. No laila, pehea kou hopohopo inā nānā ke kauka i ka pēpē a ʻōlelo, "Aia kahi murmur puʻuwai liʻiliʻi"? Akā, mai makaʻu. I kēia lā, ke kamaʻilio nei mākou e pili ana i kahi maʻi puʻuwai i ʻike pinepine ʻia i nā pēpē hānau hou a hiki ke mālama maʻalahi ʻia. Ua kapa ʻia kēia ʻo Patent Ductus Arteriosus, a i ʻole PDA e like me ka mea i kapa ʻia i waena o nā kauka no ka pōkole.

I ka ʻōlelo maʻalahi, he aha kēia PDA?

I mea e hoʻomaopopo ai i kēia, e hoʻi kākou i ka wā i loko o ka ʻōpū o ka makuahine ke pēpē. E noʻonoʻo, ʻaʻole hanu ka pēpē i loko o ka ʻōpū. Loaʻa i ka pēpē ka oxygen e pono ai ma o ke kaula umbilical o ka makuahine. No laila, ʻaʻole hana nā māmā o ka pēpē i kēlā manawa. No laila, aia kahi ala liʻiliʻi, e like me ka pilina 'bypass', ma waena o ke aʻa nui e lawe ana i ke koko mai ka puʻuwai a i ke kino (aorta) a me ke aʻa e lawe ana i ke koko i nā māmā (pulmonary artery). ʻO kēia ka mea a mākou e kapa nei i ka lāʻau lapaʻau `(ductus arteriosus)`. ʻO kāna hana, ʻo ia ke kāpae i nā māmā, ka mea e hana ʻole ana, a hoʻouna i ke koko i ke koena o ke kino.

Ma hope o ka hānau ʻana o ka pēpē a lawe i kona hanu mua, hoʻomaka ka hana ʻana o nā māmā. A laila, ʻaʻohe pono no kēlā ala 'bypass'. No laila, i loko o nā lā mua ma hope o ka hānau ʻana o ka pēpē, e emi ana kēia kīʻaha koko a pani iā ​​ia iho.

Akā i kekahi mau pēpē, ʻaʻole pani pono kēia kīʻaha koko i kapa ʻia ʻo "ductus arteriosus". Waiho ia i kahi lua liʻiliʻi. ʻO ia ke kumu i kapa ʻia ai ʻo Patent Ductus Arteriosus (PDA) .

Pehea ka hopena o kēia kūlana PDA i ka pēpē?

I kēia manawa, he aha ka mea e hana ʻia ke ʻole e pani ʻia kēlā ala hele? Kiʻekiʻe ke kaomi koko ma ke aʻa nui e lawe ana i ke koko i ke kino, ʻo ia hoʻi ka aorta. Haʻahaʻa ke kaomi ma ke aʻa e lawe ana i ke koko i nā māmā, ʻo ia hoʻi ke aʻa pulmonary. No laila, ma o kēia lua, kahe ka nui o ke koko mai kahi kiʻekiʻe o ke kaomi i kahi haʻahaʻa o ke kaomi, ʻo ia hoʻi, i nā māmā.

Hoʻopilikia kēia i ʻelua mau pilikia nui:

1. ʻOi aku ka hana no ka puʻuwai a me nā māmā: Pono ka puʻuwai a me nā māmā o ka pēpē e hana ikaika aʻe e pamu i kēia koko keu a pau.

2. Ka hōʻino ʻana o ka māmā: Inā hoʻomau kēia ʻano me ka ʻole o ka mālama ʻia, hiki ke piʻi aʻe ke koko i loko o nā māmā, e alakaʻi ana i kahi ʻano i kapa ʻia ʻo ka hypertension pulmonary. Hiki i kēia ke hōʻino i nā kīʻaha koko i loko o nā māmā.

ʻO wai ka mea i ʻoi aku ka nui o ka pilikia o ka hoʻomohala ʻana i kēia PDA?

ʻOiai hiki ke loaʻa kēia ʻano i kekahi pēpē, ʻoi aku ka nui o ka pilikia o kekahi mau pēpē.

• Nā pēpē hānau mua ʻole:ʻO kēia ka hui pilikia nui. ʻO ka liʻiliʻi o nā pule i hānau ʻia ai kahi pēpē, ʻo ka nui o ka loaʻa ʻana o ka PDA. Ma kahi o 80% o nā pēpē i hānau ʻia ma mua o 28 mau pule hiki ke ʻike i kēia maʻi.
• Nā pēpē wahine: ʻOi aku ka maʻamau o kēia ʻano i waena o nā pēpē wahine ma mua o nā pēpē kāne.
• Nā kumu hoʻoilina: Hiki ke hana ʻia ka PDA me kekahi mau syndromes genetic.
• ʻO ka maʻi Rubella i ka makuahine i ka wā hāpai: Inā loaʻa ka makuahine i ka maʻi ʻōpala Kelemania i ka wā hāpai, ua piʻi aʻe ka pilikia o ka pēpē i ka loaʻa ʻana o ka PDA.

He aha nā hōʻailona o PDA?

ʻOkoʻa nā hōʻailona ma muli o ka nui o ka PDA. ʻAʻole paha e hōʻike kahi PDA liʻiliʻi loa i kekahi mau hōʻailona . He leo haʻalulu puʻuwai wale nō paha e hiki i ke kauka ke lohe me ka stethoscope. Eia nō naʻe, inā he PDA waena a nui paha kāu, e ʻike paha ʻoe i kēia mau hōʻailona.

Pehea ʻoe e ʻike ai i kēia, e Kauka?

Inā ʻike ʻoe i kekahi o kēia mau hōʻailona i kāu pēpē, e haʻi koke i kāu kauka. ʻO ka maʻamau, i ka nānā ʻana i kāu pēpē, hiki i ke kauka ke lohe i kahi "mīkini murmur" i loko o ka puʻuwai. ʻO kēia ka manawa e kānalua ʻia ai kahi PDA.

A laila, no ka hōʻoia ʻana i kēia, e hoʻouna ʻia ʻoe i kahi Pediatric Cardiologist . Hiki iā ia ke hana i nā hoʻokolohua aʻe:

• ʻEchocardiogram (Echo): ʻO kēia ka hoʻāʻo koʻikoʻi a pololei loa . Ua like ia me ke scan o ka puʻuwai. Hiki iā ia ke ʻike maopopo i nā mea āpau e like me ka loaʻa ʻana o ka PDA, pehea kona nui, a me ka nui o ke koko e kahe ana ma o ia mea. ʻAʻole kēia he hoʻāʻo ʻeha.
• X-ray o ka umauma: Hiki i kahi X-ray o ka umauma ke nānā inā ua hoʻonui ʻia ka puʻuwai a inā paha he nui loa ke koko e kahe ana i loko o nā māmā.
• Electrocardiogram (ECG): Ma ka nānā ʻana i ka hana uila o ka puʻuwai, hiki ke hoʻoholo ʻia inā ua kaumaha nui ka puʻuwai.

He aha nā lāʻau lapaʻau no PDA?

Hoʻoholo ʻia ka lāʻau lapaʻau e ka makahiki o ke pēpē, ke kaumaha, ke kūlana olakino, a me ka nui o ka PDA. ʻAʻole mālama ʻia nā PDA āpau i ka manawa like.

1. Ke Kali Makaʻala

Inā he PDA liʻiliʻi loa ia, a ʻaʻole ia e hōʻeha i ka pēpē, e hoʻoholo paha ke kauka e kali iki. No ka mea, pani kekahi o lākou iā lākou iho. Akā, he mea nui e hoʻomau i ke kipa ʻana i ke keʻena lapaʻau o ke kauka no nā nānā ʻana i kēia manawa.

2. Ka mālama ʻana me ka lāʻau lapaʻau

ʻOi aku hoʻi no nā pēpē i hānau mua ʻia , hāʻawi ʻia kekahi mau lāʻau lapaʻau (e laʻa me Ibuprofen, Indomethacin) ma o nā inikini e hoʻāʻo e pani i kēia PDA. Kōkua kēia mau lāʻau lapaʻau i ke kīʻaha koko e ʻaelike a pani. He holomua wale nō kēia i nā pule mua ma hope o ka hānau ʻana o ke pēpē.

3. Hoʻokomo ʻana i ka catheter o ka puʻuwai

ʻAʻole kēia he ʻoki kino. Hoʻopau piha ʻia ka pēpē i ka anesthetized, a hoʻokomo ʻia kahi paipu lahilahi loa (catheter) ma o kahi kīʻaha koko ma ka ʻūhā a alakaʻi ʻia i ka puʻuwai. A laila, hoʻokomo ʻia kahi mea liʻiliʻi (a i ʻole coil) ma o ka paipu a pani ʻia ka lua PDA. Hana pinepine ʻia kēia no nā pēpē momona iki i kekahi mau mahina. ʻO ka pōmaikaʻi o kēia ʻano hana, ʻaʻole pono e kāʻei ʻia ka pēpē, i hiki i ka pēpē ke hoʻōla koke a hoʻi i ka home.

4. ʻoki kino

I kekahi mau hihia, ʻoi aku hoʻi no nā pēpē i kūpono ʻole no ka catheterization a inā nui loa ka PDA, pono paha ke ʻoki ʻana. I kēia hihia, hana ke kauka ʻoki i kahi ʻoki liʻiliʻi ma ka ʻaoʻao o ka umauma, ma lalo o ka ʻāʻī, a pani i ka PDA me nā humuhumu a i ʻole kahi clip metala liʻiliʻi.

He aha ka mea e hana ʻia ma hope o ka lāʻau lapaʻau?

Ma hope o ka mālama ʻana a me ka pani ʻana o ka PDA, hoʻi ke kahe koko o ka pēpē i ka maʻamau. Nalo mālie nā hōʻailona.

Ma hope o ka lāʻau lapaʻau, e haʻi aku ke kauka iā ʻoe e lawe i nā lāʻau antibiotic no kahi o 6 mau mahina e pale aku ai i ka maʻi puʻuwai (endocarditis). He mea nui loa hoʻi e hele i ke keʻena lapaʻau i ka manawa kūpono a hōʻike i ka pēpē.

I ka manawa e ʻimi koke ai i ke aʻo lapaʻau

Inā ʻike ʻoe he PDA kāu pēpē, e kāhea koke aku i kāu kauka inā loaʻa kekahi mau hōʻailona hou (e laʻa, ka emi ʻana o ka lawe ʻana i ka waiū, ka paʻakikī o ka hanu ʻana).

Inā paʻakikī koke kāu pēpē i ka hanu ʻana a i ʻole e polū kona mau lehelehe, e lawe koke iā ia i ka ʻOihana Pilikia (ETU) o ka haukapila kokoke loa.