Koj tus menyuam mos puas muaj teeb meem ua pa? Cia peb kawm txog PPHN (Persistent Pulmonary Hypertension of the Newborn)!

Ib tug menyuam mos yog ib qho kev xyiv fab tshaj plaws hauv lub neej, puas yog? Tab sis nws kuj yog ib txwm muaj kev ntshai thiab ntxhov siab me ntsis, tshwj xeeb tshaj yog txog kev noj qab haus huv ntawm tus menyuam. Qee zaum, cov menyuam mos muaj teeb meem ua pa. Qhov ntawd yog ib qho mob hnyav, tab sis yog ib qho uas peb txhua tus tuaj yeem tswj tau zoo yog tias peb txhua tus paub txog. Cia peb tham txog nws yooj yim hnub no.

PPHN yog dab tsi? Nws yog dab tsi tiag?

Hais yooj yim xwb, PPHN yog ib qho teeb meem ua pa loj heev uas tshwm sim rau cov menyuam mos. Nws tshwm sim thaum koj tus menyuam tawm hauv koj lub tsev menyuam thiab pib ua pa rau sab nraud, thiab lawv lub cev ncig tsis hloov kho kom zoo.

Xav txog nws li no. Thaum koj tus menyuam nyob hauv koj lub tsev menyuam, nws tau txais nws cov pa oxygen los ntawm txoj hlab ntaws, los ntawm lub placenta. Lub sijhawm ntawd, tsis muaj ntshav ntau mus rau nws lub ntsws. Qhov no yog vim tias cov hlab ntsha hauv lub ntsws (cov hlab ntsha hauv lub ntsws) feem ntau raug thaiv thiab nqaim. Qee cov ntshav hla lub ntsws thiab mus ncaj qha rau lwm qhov ntawm lub cev. Nws zoo li taug txoj kev sib txawv thaum txoj kev raug thaiv.

Txawm li cas los xij, yuav tsum muaj kev hloov pauv loj thaum tus menyuam yug los thiab ua pa thawj zaug . Tom qab ntawd, cov hlab ntsha hauv lub ntsws uas tau kaw lawm yuav tsum qhib ('(nthuav dav)'). Thaum ntawd cov pa oxygen nkag mus rau hauv lub ntsws nrog rau huab cua. Tom qab ntawd, cov ntshav mus rau lub ntsws los ntawm cov hlab ntsha uas tau qhib no, khaws cov pa oxygen, thiab faib cov ntshav uas muaj pa oxygen ntawd mus rau tag nrho lub cev, tshwj xeeb tshaj yog rau lub hlwb, lub plawv, thiab lub raum.

Hauv ib qho mob hu ua PPHN, cov hlab ntsha hauv tus menyuam lub ntsws tsis qhib zoo, lossis tsis txaus. Tom qab ntawd yuav ua li cas? Ntshav siab hauv lub ntsws (pulmonary hypertension). Qhov no txwv tsis pub cov pa oxygen uas mus txog tus menyuam lub hlwb thiab lwm yam kabmob tseem ceeb. Qhov no yog ib qho xwm txheej ceev uas txaus ntshai rau lub neej thiab yuav tsum tau pib kho tam sim ntawd.

Tus mob no hu ua PPHN ntau npaum li cas?

PPHN tshwm sim li ntawm 2 ntawm txhua 1,000 tus menyuam yug los muaj sia. Nws feem ntau tshwm sim rau cov menyuam mos uas yug thaum lub sijhawm teem tseg (ntawm 37 thiab 42 lub lis piam) thiab rau cov menyuam mos uas yug lig dua hnub yug (tom qab 42 lub lis piam). Txawm li cas los xij, nws tsis tshua muaj tshwm sim rau cov menyuam mos uas yug puv sijhawm.

Cov tsos mob ntawm PPHN yog dab tsi? Peb yuav paub nws li cas?

Yog koj tus menyuam muaj PPHN, lawv yuav muaj cov tsos mob xws li:

• Ua pa nyuaj: ua pa sai dhau los yog qeeb dhau, ua suab nrov thaum ua pa, thiab xav tias koj lub hauv siab tab tom nqes mus rau hauv ('(retractions)').
• Lub plawv dhia ceev heev ('(Lub plawv dhia ceev)').
• Daim tawv nqaij ntawm tus menyuam yuav zoo li xiav (cyanosis), tshwj xeeb tshaj yog nyob rau thaj chaw xws li daim di ncauj, tus nplaig, thiab cov ntiv tes.
• Ntshav siab qis (hypotension).
• Hauv cov ntshavCov pa oxygen hauv cov ntshav qis .
• Hnov cov suab ntxiv lossis txawv txawv (`(lub plawv suab nrov)`) thaum mloog lub plawv.

Yog tias koj pom ib lossis ntau yam ntawm cov tsos mob no tam sim ntawd tom qab tus menyuam yug los, lossis hauv ob peb teev, nws yog ib qho tseem ceeb heev uas yuav tsum qhia rau cov kws kho mob tam sim ntawd.

Cov yam tseem ceeb uas ua rau muaj kev loj hlob ntawm PPHN yog dab tsi?

Cov kws tshawb nrhiav tseem tsis tau paub tseeb tias yog dab tsi ua rau muaj PPHN, tab sis nws xav tias yog vim tus menyuam lub ntsws tsis loj hlob zoo lossis tsis tuaj yeem hloov kho (qhib) rau qhov chaw sab nraud tom qab lawv tawm hauv tsev menyuam.

Muaj tej yam dab tsi ua rau muaj kev pheej hmoo ntawm PPHN?

Txawm hais tias qhov ua rau muaj qhov no tsis paub meej los xij, muaj tej yam uas ua rau tus menyuam muaj feem yuav mob PPHN ntau ntxiv. Cia peb saib seb lawv yog dab tsi:

• ' Kev nqus cov quav meconium': Qhov no yog thaum tus menyuam thawj zaug quav (peb hu ua '(Meconium)', uas tuab thiab nplaum me ntsis) nkag mus rau hauv nws txoj kev ua pa thaum nws tseem nyob hauv plab.
• Kev kis kab mob: Kev kis kab mob ntsws, xws li mob ntsws ntsws, lossis kev kis kab mob hauv cov ntshav.
• Kab mob ua pa nyuaj siab (RDS): Qhov no feem ntau pom muaj rau cov menyuam mos uas yug tsis tau lub hlis uas lawv lub ntsws tsis tau loj hlob tag.
• Kev ua tsis taus pa thaum yug los: Tus menyuam mos tsis tau txais oxygen txaus ua ntej lossis thaum lub sijhawm yug los.
• Kab mob diaphragmatic hernia: Qhov no tshwm sim thaum muaj ib lub qhov hauv cov leeg nqaij uas cais tus menyuam lub hauv siab thiab lub plab (hu ua diaphragm). Qhov no tso cai rau qee cov kabmob hauv plab thawb los ntawm lub qhov mus rau hauv lub hauv siab.
• Lwm yam teeb meem ntawm lub plawv lossis lub ntsws uas yug los: Piv txwv li, lub ntsws me me lossis lub plawv qhib tsis tau.
• Siv qee yam tshuaj thaum cev xeeb tub: Muaj lus qhia tias kev siv cov tshuaj hu ua "NSAIDs" (cov tshuaj nonsteroidal anti-inflammatory drugs) thiab "SSRIs" (selective serotonin reuptake inhibitors), tshwj xeeb tshaj yog thaum cev xeeb tub lig, kuj yuav raug cuam tshuam. Yog li ntawd, yog tias koj noj tshuaj thaum cev xeeb tub, nws yog ib qho tseem ceeb heev uas yuav tsum tham nrog koj tus kws kho mob txog nws.

Cov teebmeem mus sij hawm ntev ntawm PPHN yog dab tsi?

Kwv yees li ib ntawm plaub (1 ntawm 4) tus menyuam mos uas muaj sia nyob PPHN muaj qee qib kev tsis taus vim tsis muaj oxygen mus rau lub hlwb. Cov teeb meem no suav nrog:

• Kev loj hlob qeeb .
• Tej zaum yuav muaj teeb meem hnov ​​lus tsis zoo, qee zaum txawm tias lag ntseg.
• Kev tsis taus kawm .
• Txo qis peev xwm ua ub ua no .

Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum tau saib xyuas cov menyuam mos uas tau zoo los ntawm PPHN thiab saib xyuas lawv txoj kev loj hlob.

Yuav kuaj mob PPHN li cas?

Koj tus menyuam tus kws kho mob tuaj yeem ua ntau yam kev kuaj mob kom paub tseeb tias koj tus menyuam puas muaj PPHN. Qee qhov ntawm cov no suav nrog:

• Kev suav cov ntshav tag nrho (CBC): Qhov no ntsuas tus naj npawb ntawm cov qe ntshav dawb, cov qe ntshav liab, thiab cov platelets hauv cov ntshav ntawm tus menyuam.
• Kev ntsuas pa oxygen hauv tus menyuam (pulse ox): Qhov no yog ib txoj kev yooj yim, tsis muaj kev phais los ntsuas qib oxygen hauv cov ntshav ntawm tus menyuam.
• Cov pa roj ntshav hauv cov hlab ntsha (ABG): Qhov no ntsuas seb lub cev ntawm tus menyuam tau txais oxygen zoo npaum li cas thiab nws tshem tawm cov pa roj carbon dioxide zoo npaum li cas.
• X-ray hauv siab: Qhov no pab pom seb tus menyuam lub plawv puas loj dua lossis yog tias muaj tej yam mob ntsws.
• Echocardiogram (echo): Qhov no yog kev ntsuas ultrasound kom ntxaws ntawm lub plawv ntawm tus menyuam. Nws ntsuas seb cov ntshav ntws mus rau lub plawv thiab lub ntsws li cas.
• Kev kuaj mob ultrasound ntawm lub taub hau: Qhov no pab kuaj xyuas seb puas muaj ntshav hauv lub hlwb ntawm tus menyuam.
• Kev kuaj electrolyte hauv cov ntshav: Cov kev kuaj no yog siv los xyuas qhov sib npaug ntawm cov minerals hauv cov ntshav ntawm tus menyuam.
• Kev tho qhov ntawm lub duav (qhov tho qhov txha caj qaum): Qhov kev kuaj no tej zaum yuav ua los xyuas seb tus menyuam puas muaj kab mob.

Tsis tas yuav ua tag nrho cov kev kuaj no; cov kws kho mob yuav txiav txim siab seb yuav ua qhov kev kuaj twg raws li tus menyuam tus mob.

Yuav kho tus mob PPHN li cas?

Lub hom phiaj tseem ceeb ntawm kev kho mob PPHN yog kom ua kom cov pa oxygen ntws mus rau cov kab mob ntawm tus menyuam thiab tiv thaiv cov teeb meem loj. Muaj ntau txoj kev kho rau qhov no:

• Cov Pa oxygen: Tus menyuam mos tuaj yeem tau txais 100% oxygen los ntawm cov cannula hauv qhov ntswg, cov prongs hauv qhov ntswg, lossis lub npog ntsej muag.
• Kev siv tshuab ua pa: Tus kws kho mob muab ib lub raj tso rau hauv tus menyuam lub raj cua (trachea) thiab siv lub tshuab ua pa los pab tus menyuam ua pa.
• Tswj ntshav siab: Tus menyuam yuav tau txais tshuaj los tswj ntshav siab los ntawm txoj hlab ntsha (IV).
• Nitric oxide: Nitric oxide yog ib qho roj uas pab qhib (nthuav) cov hlab ntsha hauv koj tus menyuam lub ntsws, txhim kho cov ntshav ntws mus rau lub ntsws.
• Kev ua pa tawm uas siv zaus siab heev: Qhov no kuj yog ib hom kev ua pa tshwj xeeb. Nws tuaj yeem pab txhim kho cov pa oxygen hauv cov ntshav ntawm tus menyuam.
• Kev siv tshuab ua pa oxygen sab nraud lub cev (ECMO): Lub tshuab no siv thaum lub plawv lossis lub ntsws ntawm tus menyuam tsis muaj zog txaus los tswj hwm los ntawm lwm yam kev kho mob. Nws siv cov ntshav los ntawm lub cev ntawm tus menyuam ib ntus, ntxiv cov pa oxygen rau nws, thiab xa rov qab mus rau lub cev, muab cov pa oxygen rau lub hlwb thiab lwm qhov ntawm lub cev. Nws ua haujlwm zoo li lub ntsws cuav.

Peb puas tuaj yeem tiv thaiv PPHN tau?

Raws li peb tau tham ua ntej lawm, tsis muaj ib txoj hauv kev twg los tiv thaiv tau PPHN tag nrho vim peb tsis paub meej tias yog dab tsi ua rau nws . Txawm li cas los xij, kev zam qee yam tshuaj thaum cev xeeb tub tuaj yeem pab txo koj qhov kev pheej hmoo. Yog li, yog tias koj cev xeeb tub, nco ntsoov tham nrog koj tus kws kho mob ua ntej noj tshuaj kom paub tseeb tias nws muaj kev nyab xeeb thaum cev xeeb tub.

Yuav siv sijhawm ntev npaum li cas los kho tus mob PPHN?

Feem ntau cov menyuam mos rov zoo los ntawm PPHN hauv ib lossis ob lub lis piam . Txawm li cas los xij, qee tus menyuam mos yuav siv sijhawm ntev dua, qee zaum ntau lub hlis, kom rov zoo tag nrho. Txawm tias tom qab koj tus menyuam rov zoo lawm, nws yog ib qho tseem ceeb kom tiv thaiv lawv ntawm mob khaub thuas, mob ntsws, thiab lwm yam kab mob sib kis. Qhov no tuaj yeem ua tiav los ntawm kev ntxuav koj txhais tes ntau zaus, txwv koj tus menyuam txoj kev raug rau cov neeg coob coob, thiab ua kom koj tus menyuam nyob deb ntawm cov neeg mob. Nws tseem yog ib lub tswv yim zoo rau txhua tus neeg hauv koj tsev neeg kom tau txais tshuaj tiv thaiv mob ntsws txhua xyoo.

Qhov tseem ceeb, nws yog ib qho tseem ceeb uas yuav tsum coj koj tus menyuam mus kuaj mob tsis tu ncua thiab mus ntsib kws kho mob tshwj xeeb kom paub tseeb tias nws txoj kev loj hlob zoo.

Tus nqi ciaj sia thiab qhov kev cia siab rau PPHN yog dab tsi?

PPHN yog ib qho mob hnyav heev, thiab hmoov tsis zoo, ntawm 7% thiab 10% ntawm cov menyuam mos uas muaj tus mob no tuag los ntawm cov teeb meem. Ntawm cov menyuam mos uas muaj sia nyob, kwv yees li 25%, lossis kwv yees li ib ntawm plaub tus, yuav muaj cov teebmeem mus sij hawm ntev (xws li kev loj hlob qeeb, kev kawm tsis tau zoo, thiab kev hnov ​​​​lus tsis zoo) uas tshwm sim los ntawm qhov tsis muaj oxygen mus rau lub hlwb.

Thaum twg koj yuav tsum coj koj tus menyuam mus ntsib kws kho mob?

Tom qab koj tus menyuam rov zoo los ntawm PPHN, nco ntsoov coj koj tus menyuam mus rau txhua qhov kev teem caij rov qab . Qhov no yuav pab koj tus kws kho mob txuas ntxiv saib xyuas koj tus menyuam. Lub sijhawm no, nrhiav kev pab kho mob tam sim ntawd yog tias koj tus menyuam muaj cov tsos mob hauv qab no:

• Yog koj kub taub hau.
• Yog koj txo koj cov mis nyuj noj, lossis yog koj tsis haus mis nyuj li.
• Yog tias koj lub hauv siab nqes mus rau hauv thaum koj ua pa, lossis yog tias koj ua pa nrog koj lub qhov ntswg qhib dav.
• Yog koj ua suab nrov los yog nrov nrov thaum koj ua pa.
• Yog tias daim tawv nqaij pib tig xiav lossis grey.

Thaum koj pom tias koj tus menyuam mos muaj mob zoo li PPHN, nws yog ib qho ib txwm muaj kev tu siab, ntshai, npau taws, thiab tsis meej pem. Qhov ntawd yog ib txwm muaj. Kawm ntau li ntau tau txog PPHN los ntawm cov kws kho mob thiab cov kws tu mob uas kho koj tus menyuam. Lawv yuav qhia koj txhua yam koj ua tau txog koj tus menyuam tus mob, thiab koj yuav nplij thiab pab lawv li cas. Nyob rau lub sijhawm, koj yuav dhau los ua tus kws tshaj lij txog koj tus menyuam tus mob, thiab koj yuav muaj kev ntseeg siab los ua txhua yam koj ua tau rau koj tus menyuam.

Tej yam tseem ceeb uas yuav tsum nco ntsoov (Cov Lus Qhia Coj Mus Tsev)

• PPHN yog ib qho teeb meem ua pa loj heev rau cov menyuam mos. Hauv qhov xwm txheej no, cov hlab ntsha hauv lub ntsws tsis qhib zoo, ua rau lub cev tsis tau txais oxygen txaus.
• Txawm hais tias qhov ua rau qhov no tseem tsis tau paub meej , muaj cov yam ua rau muaj kev pheej hmoo xws li kev nqus meconium, kev kis kab mob, RDS, thiab kev tsis muaj pa oxygen thaum yug los.
• Yog koj muaj cov tsos mob xws li ua pa nyuaj, tawv nqaij xiav, lossis lub plawv dhia ceev, nrhiav kev pab kho mob tam sim ntawd.
• Kev kho mob suav nrog kev siv oxygen, kev pab txhawb nqa lub tshuab ua pa, nitric oxide, thiab ECMO.
• Txawm hais tias nws tsis yooj yim sua kom tiv thaiv tau tag nrho los xij , nws yog ib qho tseem ceeb uas yuav tsum noj cov tshuaj uas muaj kev nyab xeeb thaum cev xeeb tub raws li tus kws kho mob qhia.
• Kev saib xyuas kev kho mob mus sij hawm ntev thiab kev kuaj xyuas kev loj hlob yog qhov tseem ceeb tom qab rov zoo.
• Koj tsis yog tib leeg xwb lub sijhawm no. Nrhiav kev txhawb nqa los ntawm cov kws kho mob thiab tsev neeg. Muaj ntau yam koj ua tau rau koj tus menyuam.

PPHN , menyuam mos, kev ua pa nyuaj, ntshav siab hauv lub ntsws, oxygen, kev saib xyuas menyuam mos, cyanosis