Njengomzali, ndiyaqonda ukuba uziva unzima kwaye woyika kangakanani xa ugqirha wakho ekuxelela ukuba umntwana wakho osandul’ ukuzalwa unesiphene sentliziyo esibizwa ngokuba yiHypoplastic Left Heart Syndrome (HLHS). Kumelwe ukuba kwavakala ngathi lonke ihlabathi lakho liwile ngequbuliso. Kodwa ungakhathazeki. Namhlanje, isayensi yezonyango ihambele phambili kakhulu. Inkqubo yeNorwood linyathelo lokuqala elibaluleke kakhulu ekunikeni ubomi kwiintsana ezinjalo. Namhlanje, siza kuthetha ngale nto ngendlela elula onokuyiqonda, ukuze unciphise uloyiko lwakho.
Iyintoni iNkqubo yaseNorwood?
Ngamafutshane, inkqubo yeNorwood lutyando lwentliziyo olukhethekileyo olwenziwa kwiintsana ezineengxaki zentliziyo ezizalwa nazo ezibizwa ngokuba yiHypoplastic Left Heart Syndrome (HLHS) .
Cinga ngayo njengendlu encinci enamagumbi amane. Inamacandelo amabini, icala lasekunene necala lasekhohlo. Ngokwesiqhelo, icala lasekhohlo lentliziyo limpompa igazi elicocekileyo nelinomoya-mpilo emzimbeni wonke. Icala lasekunene limpompa igazi elingenawo umoya-mpilo lisuka emzimbeni libuyele emiphungeni ukuze lifakwe umoya-mpilo.
Nangona kunjalo, icala lasekhohlo lentliziyo yomntwana one-HLHS alikhuli kakuhle . Oko kuthetha ukuba elo cala lincinci kakhulu kwaye libuthathaka. Ngoko ke elo cala alikwazi ukupompa igazi emzimbeni. Le yeyona ngxaki inkulu.
Inkqubo yaseNorwood yenza into emangalisayo. Oogqirha benza iindlela ezintsha zokuhamba kwegazi entliziyweni. Oko kukuthi, baqondisa umsebenzi omele wenziwe licala lasekhohlo lentliziyo uye kwicala lasekunene, elisebenza kakuhle . Emva kotyando, i-ventricle yasekunene yomntwana iqala ukupompa igazi elineoksijini emzimbeni wonke, kunye nokuthumela igazi emiphungeni.
Olu asilonyango olupheleleyo. Nangona kunjalo, linyathelo lokuqala elibalulekileyo ekusindiseni ubomi bomntwana. Oku kunceda ekulawuleni ukuhamba kwegazi ukuze iiseli zomntwana zifumane umlinganiselo ofunekayo weoksijini.
Ngubani odinga olu tyando?
Olu tyando lufuneka kakhulu kwiintsana ezineHypoplastic Left Heart Syndrome (HLHS) . Kufuneka benze olu tyando kwiiveki ezimbini zokuqala emva kokuzalwa.
Ekuzalweni, umntwana ngamnye unonxibelelwano oluncinci phakathi kwemithambo yegazi emibini ephambili entliziyweni (i-aorta kunye nomthambo we-pulmonary). Oku kubizwa ngokuba yi-'patent ductus arteriosus'. Oku kuvumela umntwana one-HLHS ukuba afumane igazi emzimbeni wakhe kwiintsuku zokuqala ezimbalwa. Nangona kunjalo, olu nxibelelwano luya kuvala emva kweentsuku ezimbalwa. Ukuba oku kuyenzeka, umntwana akayi kuba nendlela yokufumana igazi emzimbeni wakhe, nto leyo eyingozi kakhulu.
Ngoko ke, into yokuqala eyenziwa ngoogqirha kukunika iyeza elikhethekileyo (elibizwa ngokuba yi-'Prostaglandin') ukuze kuthintelwe ukuvalwa komthambo wegazi. Kodwa oko kungokwexeshana. Utyando lwaseNorwood lwenziwa njengesisombululo esihlala sihleli.
Ngamanye amaxesha, olu tyando lusenokungenzeki kwiintsana ezizelwe ngaphambi kwexesha, ezizelwe zinobunzima obuphantsi, okanye ezinezinye iingxaki. Kwiimeko ezinjalo, oogqirha basebenzisa ezinye iindlela, ezifana neebhanti zemithambo yegazi yemiphunga.
Kwenzeka ntoni ngexesha nasemva kotyando?
Ngaphambi nangexesha lotyando
Ngaphambi kotyando, umntwana ukwigumbi lokhathalelo olunzulu (ICU). Njengoko bekutshiwo ngaphambili, baya kuqhubeka nokunika amayeza okugcina umthambo wegazi okhethekileyo uvulekile. Kungafuneka ukwandisa umngxuma phakathi kwamagumbi amabini aphezulu entliziyo (i-'septostomy').
Inkqubo yaseNorwood inzima kakhulu, ithatha iiyure ezininzi (ngesiqhelo ithatha iiyure ezisi-8-10). Iqela loogqirha lenza oku kulandelayo ngononophelo:
- Kwenziwa umngxuma phakathi kwamagumbi amabini aphezulu (i-atria) entliziyo ukuvumela igazi ukuba lihambe.
- I-aorta encinci iqhagamshelwe kumthambo omkhulu wemiphunga, kwaye kufakwa i-patch ekhethekileyo ukuze kudalwe i-aorta entsha, enkulu.
- Le aorta intsha iqhagamshelwe kwi-ventricle yasekunene esebenzayo.
- Okulandelayo, kufakwa 'i-shunt' , ityhubhu encinci yokwenziwa, ukuthumela igazi emiphungeni. Oku kungaba ukusuka kwi-aorta ukuya emiphungeni (i-Blalock-Taussig shunt) okanye ukusuka kwi-ventricle yasekunene ukuya emiphungeni (i-Sano shunt).
Kulo lonke olu tyando, umntwana uqhagamshelwe kumatshini we-cardiopulmonary bypass . Oku kuthetha ukuba intliziyo kunye nemiphunga yomntwana zisebenza okwethutyana ngulo matshini.
Emva kotyando
Emva kotyando, umntwana ubuyiselwa kwigumbi lokhathalelo olunzulu (ICU). Xa usiya kubona umntwana, uza kubona iityhubhu ezininzi, iingcingo, kunye noomatshini. Musa ukoyika xa uzibona. Zonke zilapho ngenxa yempilo-ntle yomntwana, ukunceda umntwana . Uza kubona ibhandishi egquma inxeba lotyando embindini wesifuba.
Kwanasemva kolu tyando, ulusu lomntwana lusenokuba nombala oluhlaza okwesibhakabhaka (i-cyanosis) . Oku kungenxa yokuba igazi elithile elingenaoksijini kunye negazi elineoksijini lisaxubana ngaphakathi entliziyweni. Oku kuqhelekile kweli nqanaba.
Emva kweveki ekwigumbi lokunyamekela abagula kakhulu, umntwana uza kudluliselwa kwigumbi eliqhelekileyo. Kuya kufuneka uhlale esibhedlele malunga neeveki ezi-2-3 ukuze uphile ngokupheleleyo. Emva kokuba ubuyele ekhaya, oogqirha kunye nabongikazi baza kukunika imiyalelo eneenkcukacha malunga nendlela yokunyamekela umntwana, indlela yokumnika amayeza, kunye nendlela yokujonga amanqanaba akhe eoksijini.
Uthotho lweenkqubo zotyando ze-HLHS
I-HLHS ayipheli ngotyando olunye kuphela. Luluhlu lweenkqubo zotyando olunezigaba ezintathu . I-Norwood linqanaba lokuqala nje.
| Iqonga | Igama lotyando | Idla ngokwenziwa xa umntu emdala |
|---|---|---|
| Utyando lokuqala | Inkqubo yaseNorwood | Kwiiveki ezimbini emva kokuzalwa |
| Utyando lwesibini | Inkqubo kaGlenn | Phakathi kweenyanga ezi-4 ukuya kwezi-8 |
| Utyando lwesithathu | Inkqubo yeFontan | Phakathi kweminyaka eyi-1.5 ukuya kweye-5 |
Zithini iingenelo kunye neengozi?
Iingenelo
Eyona nzuzo inkulu nekuphela kwayo kukuba umntwana unethuba lokusinda . Ngaphambi kweminyaka yoo-1980, bekungekho nyango lweentsana ezizalwa zine-HLHS. Kodwa ukusukela oko kwaqanjwa inkqubo yeNorwood, ezi ntsana ziye zafumana ithuba lokusinda zize zibe ngabantwana nakwishumi elivisayo.
Iingozi kunye neengxaki
Njengalo naluphi na utyando olukhulu, kukho iingozi ezibandakanyekileyo. Kubalulekile ukuzazi ezi zinto.
- Ukuvaleka okanye ukungasebenzi kakuhle kwe-shunt: Umbhobho omncinci othwala igazi ukuya emiphungeni unokuvaleka.
- Ukuncitshiswa kwemithambo yegazi (iStenosis): I-aorta esusiweyo ngotyando okanye imithambo yegazi ekhokelela emiphungeni inokuba mxinwa.
- Ukungasebenzi kakuhle kwentliziyo (i-Arrhythmia): Isingqisho sentliziyo sisenokuba singaqhelekanga.
- Ukubuthathaka kokusebenza kwentliziyo: Njengoko i-ventricle yasekunene kufuneka ithwale ubunzima obungaphezulu, ukusebenza kwayo kusenokuba buthathaka.
- Ukulibaziseka kophuhliso lwe-neuro: Kunokubakho ukulibaziseka okuthile ekuphuhlisweni kwengqondo kunye nenkqubo yemithambo-luvo. Ngenxa yoko, ezinye iintsana zinokufuna uncedo olukhethekileyo kwizinto ezifana nokuthetha nokuhamba.
Izinga lokusinda esibhedlele emva kwenkqubo yaseNorwood liphezulu ukuya kuthi ga kwi-90%. Nangona kunjalo, kukho iimeko apho ezinye iintsana zingafiki kutyando lwesibini.
Ufanele uye nini kugqirha wakho?
Ufanele umnike ingqalelo enzulu umntwana wakho emva kokuba ufikile ekhaya. Ukuba uneengxaki, fowunela ugqirha wakho ngokukhawuleza.Lumka ngakumbi ngezi zinto:
- Ukuba unemibuzo malunga nokunyamekela umntwana wakho ekhaya.
- Ukuba umntwana akatyebi kakuhle.
- Ukuba inqanaba le-oksijini yomntwana liphantsi kunelo ugqirha athe lilindele.
- Ukuba umntwana akasabeli kakuhle kumayeza anikwe ngugqirha.
- Ukuba umntwana ulele kakhulu kunesiqhelo okanye uthatha ubisi oluncinci.
Khumbula, lo mntwana uya kufuna ulwalathiso kunye nokhathalelo lukagqirha wentliziyo ubomi bakhe bonke.
Umyalezo Wokuya Ekhaya
- I-Hypoplastic Left Heart Syndrome (HLHS) yimeko enzima kakhulu. Nangona kunjalo, inkqubo yeNorwood linyathelo lokuqala nelibaluleke kakhulu elinokusindisa ubomi bomntwana.
- Olu ayilonyango olupheleleyo. Emva koko kuza kufuneka utyando oluphindwe kabini (uGlenn noFontan).
- Olu tyando luyinkimbinkimbi kwaye luneengozi, kodwa ithuba lokusinda lifanelekile.
- Kubalulekile ukuba umntwana alandele imiyalelo kagqirha emva kokuba ebuyele ekhaya aze aye kwiikliniki ngemihla ebekiweyo.
- Njengabazali, kuyinto eqhelekileyo ukuziva usoyika kwaye uxhalabile. Musa ukoyika ukubuza ugqirha wakho nayiphi na imibuzo okanye iinkxalabo onokuba nazo. Awuwedwa.
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