Uma udokotela wakho ekutshela ukuthi ingane yakho encane idinga ukuhlinzwa kweFontan ngenxa yesimo senhliziyo esizalwa naso, ungase uzizwe ukwesaba okukhulu nokwesaba. Imibuzo eyinkulungwane ingase ifike engqondweni ngokuzumayo. Kuvamile ukucabanga izinto ezinjengokuthi, "Luhlobo luni lokuhlinzwa?", "Kungani ingane yami idlula kulokhu?", "Ingabe izophila ngemva kwalokhu?" Ungakhathazeki. Ake sixoxe ngalokhu ngokuthula nangokucacile. Kulesi sihloko, ngizozama ukuphendula imibuzo yakho ngalokhu ngendlela elula.
Kalula nje, iyini inqubo yeFontan?
Ukuze siqonde lokhu, ake siqale sikhumbule kancane ngendlela inhliziyo yethu esebenza ngayo. Inhliziyo enempilo inamakamelo amane amakhulu. Amabili phezulu namabili phansi. Siwabiza ngokuthi amakamelo amabili amakhulu, aqinile ngaphansi kwala ma-ventricle . Elinye igumbi liqoqa igazi "elingcolile" lomzimba elingenawo umoya-mpilo bese lilipompa emaphashini ukuze lithole umoya-mpilo. Elinye igumbi liqoqa igazi "elihlanzekile" eligcwele umoya-mpilo emaphashini bese lilipompa liye kuwo wonke umzimba. Lawa amabili asebenza njengezimoto ezimbili zamanzi.
Kodwa-ke, lapho kuzalwa abanye abantwana, elinye lala maseli amabili alikakhuli ngokugcwele. Bese kuba yileli seli elihle kuphela okufanele lenze yomibili le misebenzi. Okusho ukuthi, kufanele lipompe igazi emaphashini nasemzimbeni wonke. Cabanga ukuthi leyo moto izizwa isisindo esingakanani uma kufanele ipompe amanzi ezindlini ezimbili ngemoto eyodwa. Ngakho-ke, leli seli elilodwa kufanele lisebenze ngaphansi komthwalo osindayo.
Nakhu okwenziwa inqubo yeFontan : Odokotela abahlinzayo bakha "indlela emfushane" encane eya enhliziyweni. Lokhu kuvumela igazi elingenawo umoya-mpilo elivela emzimbeni ongezansi ukuthi ligeleze ngqo emaphashini, lidlule inhliziyo. Empeleni lidlula ezinye zezimoto ezithwala kakhulu inhliziyo.
Ngokudala indlela emfushane kanje, umthwalo kulelo seli elilodwa elalisebenza kanzima kangaka uncishiswa kakhulu. Ngemuva kwalokho, lelo seli lingasebenzisa amandla alo aphelele futhi limpompe igazi elihlanzekile, elinomoya-mpilo emzimbeni kuphela. Lokhu kwandisa inani lomoya-mpilo elitholwa ngumzimba wengane, futhi izizwa ikhululekile kakhudlwana.
Lolu hlobo lokuhlinzwa lwenziwa kubantwana abanjani?
Ukuhlinzwa kweFontan akuyona inqubo eyenzeka kanye kuphela. Ngokuvamile kwenziwa njengesinyathelo sesithathu nesokugcina ochungechungeni lokuhlinzwa kwengane enesifo senhliziyo esinegumbi elilodwa. Ngaphambi kwalokho, kungase kudingeke ukuhlinzwa okukodwa noma ngaphezulu, kuye ngeminyaka nesimo sengane.
| Izinhlobo zokuhlinzwa kwangaphambilini | Kalula nje, kwenzekani? |
|---|---|
| Inqubo yaseNorwood | Uhlangothi lwesokudla lwenhliziyo lusiza ekupompeni igazi liye emzimbeni nasemaphashini. Lokhu kuvame ukwenziwa emasontweni ambalwa okuqala ngemva kokuzalwa komntwana. |
| Inqubo kaGlenn | Igazi elingenawo umoya-mpilo emzimbeni ongaphezulu liqondiswa ngqo emaphashini. Lesi ngokuvamile yisigaba sesibili. |
| I-BTT shunt (i-Blalock-Taussig-Thomas shunt) | Kusetshenziswa ipayipi lokwenziwa ukwandisa inani legazi eliya emaphashini. |
| Ibhendi yomthambo wamaphaphu | Ilawula ukugeleza kwegazi emaphashini futhi ivumela igazi eliningi ukuthi ligeleze kwezinye izingxenye zomzimba. |
Izimo eziyinhloko ezidinga ukuhlinzwa kweFontan
Lokhu kuhlinzwa kuyadingeka kakhulu ezimweni ezimbalwa lapho inhliziyo ingakhekanga kahle ngesikhathi sokuzalwa. Lezi yizi:
- I-Hypoplastic left heart syndrome: Lena yimbangela evame kakhulu. Kulesi simo, uhlangothi lwesobunxele lwenhliziyo alukhuli kahle.
- I-Hypoplastic right heart syndrome: Kulesi simo, uhlangothi lwesokudla lwenhliziyo alukhuli kahle.
- I-Tricuspid atresia: I-valve engakwesokunene senhliziyo ayakheki kahle.
- I-Pulmonary atresia: I-valve ethwala igazi emaphashini ivaliwe.
- I-ventricle yesobunxele engene kabili: Igazi elivela emakamelweni aphezulu enhliziyo lingena kuphela kwi-ventricle yesobunxele.
- Ezinye izimo eziningana zenhliziyo eziyinkimbinkimbi zokuzalwa nazo.
La magama angakwenza uzizwe wesaba kakhulu. Kodwa lawa amagama nje asetshenziswa odokotela ukukuhlonza. Into ebalulekile ukuthi kuzo zonke lezi zimo, ivalvu eyodwa yenhliziyo ingaphansi kokucindezeleka okukhulu. Inqubo yeFontan izama ukuqeda lokho kucindezeleka.
Kwenzekani ngaphambi kokuhlinzwa?
Ukuhlinzwa kwe-Fontan kuvame ukwenziwa ezinganeni.Phakathi kweminyaka engu-2 no-5. Ngezinye izikhathi lokhu kungabambezeleka kuze kube yiminyaka engaba ngu-15 ubudala. Kodwa lokhu kuhlinzwa akukwazi ukwenziwa yiwo wonke umuntu. Odokotela bazokwenza izivivinyo kuqala ukuze babone ukuthi ingane yakho ifanelekile yini kulokhu kuhlinzwa.
Isibonelo, iseli elilodwa elisebenzayo lomntwana kumele libe namandla ngokwanele ukupompa kahle. Futhi, amaphaphu kumele abe nempilo ngokwanele ukwamukela igazi elingenayo ngqo ngaphandle kosizo lwenhliziyo.
Ukuhlolwa okulandelayo kwenziwa ngaphambi kokuhlinzwa:
- I-Transthoracic echocardiogram (TTE): Lokhu kufana nokuskena kwenhliziyo. Kungabona ngokucacile amakamelo enhliziyo, ama-valve, kanye nokugeleza kwegazi.
- I-Electrocardiogram (EKG): Lokhu kuhlola ukusebenza kukagesi kwenhliziyo, okungukuthi, iphethini yokushaya kwenhliziyo.
- Ukufakwa kwe-catheter enhliziyweni: Ipayipi elincane kakhulu (i-catheter) lidluliselwa emthanjeni wegazi osemlenzeni noma engalweni liye enhliziyweni, bese kulinganiswa amazinga okucindezela kanye nomoya-mpilo ngaphakathi enhliziyweni. Lokhu kunganikeza isithombe esinembile kakhulu sesimo senhliziyo ngaphambi kokuhlinzwa.
- Ukuhlola amazinga okuphefumula kanye nomoya-mpilo.
- Ngezinye izikhathi i-CT noma i-MRI scan.
Zonke lezi zivivinyo zenziwa ukuze ukuhlinzwa kuphephe futhi kuphumelele ngangokunokwenzeka.
Kwenzekani ngesikhathi sokuhlinzwa?
Egumbini lokuhlinza, umntwana uqala ngokunikezwa i-anesthesia ukuze alale ukuze angazizwa ubuhlungu. Ngesikhathi sokuhlinzwa, kusetshenziswa umshini wenhliziyo namaphaphu ukwenza umsebenzi wenhliziyo namaphaphu okwesikhashana.
Udokotela ohlinzayo ube esexhuma i-vena cava engaphansi, umthambo wegazi oyinhloko othwala igazi elingenawo umoya-mpilo ovela emzimbeni ongezansi, uye emthanjeni wamaphaphu, othwala igazi uye emaphashini, esebenzisa umsele. Yile ndlela "indlela emfushane" esikhulume ngayo ngaphambili eyakhiwa ngayo.
Ngezinye izikhathi, ezinye izinto ezincane zokulungisa, njengokulungisa i-valve yenhliziyo, zingenziwa ngesikhathi esifanayo nalokhu kuhlinzwa.
Ukuhlinzwa konke kuvame ukuthatha amahora amane kuya kwamahlanu . Phakathi naleso sikhathi, ithimba lezokwelapha lizokhuluma nawe njalo futhi likunikeze izibuyekezo ngesimo sengane yakho.
Yiziphi izinzuzo nezingozi zokuhlinzwa?
Njenganoma yikuphi ukuhlinzwa, ukuhlinzwa kweFontan kunezinzuzo kanye nezingozi ezithile.
Inzuzo enkulu ukuthi kunciphisa umthwalo womsebenzi enhliziyweni, okwenza umsebenzi wayo ube lula kakhulu. Futhi, njengoba kuncane ukuxubana kwegazi elinomoya-mpilo kanye negazi elinomoya-mpilo ophansi, inani lomoya-mpilo elitholwa umzimba liyakhula. Izindebe nezinzipho zengane ziba luhlaza okwesibhakabhaka (cyanosis), futhi iba namandla engeziwe okusebenza kakhudlwana.
| Izinkinga ezingase zenzeke ngemva kokuhlinzwa | |
|---|---|
| Izinkinga zesikhashana | Izinkinga zesikhathi eside |
| Ukulimala kwezinso | I-enteropathy yokulahlekelwa amaprotheni (ubunzima bokumunca amaprotheni) |
| Ukwehluleka kwenhliziyo | Ukuqhekeka kwegazi (i-embolism) |
| Ukushaya kwenhliziyo okungajwayelekile | Isifo sesibindi (isifo sesibindi esihlobene ne-Fontan - FALD) |
| Imiphumela ekusebenzeni kwesibindi | Ukuvinjelwa kwemigudu yomoya yi-mucus ejiyile (i-plastic bronchitis) |
| Ukuqongelela koketshezi emaphashini (i-pleural effusions) | |
Lezi zinto zingase zesabe ukuzibona, kodwa khumbula, ithimba lezokwelapha liyazazi zonke lezi zingozi. Bahlala bekulungele ukuzivimbela nokuzilawula uma zenzeka.
Injani impilo ngemva kokuhlinzwa?
Ngemva kokuhlinzwa, ingane ingeniswa egunjini lokunakekelwa okujulile (ICU) futhi iqashwe ngokucophelela. Ngemva kwezinsuku ezimbalwa, lapho isimo siba ngcono, idluliselwa egunjini elijwayelekile. Ingane ingahlala esibhedlela izinsuku eziyi-7 kuya kweziyi-13 .
Ngaphambi kokuba uye ekhaya, odokotela kanye nabasebenzi abahlengikazi bazochaza ngokuningiliziwe ukuthi ungayinakekela kanjani ingane yakho, imithi okufanele uyinikezwe, kanye nezimpawu okufanele uziqaphele.
Kunini lapho udinga ukukhuluma nodokotela?
Ngemva kokubuyela ekhaya, kufanele ushayele udokotela wakho ucingo ngokushesha uma ubona noma yiziphi zalezi zimpawu:
- Uma igazi noma olunye uketshezi luvuza enxebeni lokuhlinzwa.
- Uma unomkhuhlane noma ezinye izimpawu zokutheleleka (umkhuhlane, ukuvuvukala, ukubomvu).
- Uma ubunzima bokuphefumula bukhula.
Ingane eye yahlinzwa iFontan izodinga ukunakekelwa kwezokwelapha impilo yayo yonke. Ngokuvamile kuzodingeka ibone udokotela njalo ezinyangeni eziyi-6 kuya kweziyi-12 . Izodinga nokuhlolwa njalo ukuze kuhlolwe isimo senhliziyo nesibindi sayo.
Into ebalulekile ukuthi inqubo yeFontan akuyona "ikhambi." Iyindlela yokusiza inhliziyo yengane ukuthi isebenze kahle. Ngakho-ke, ukulandelwa kwesikhathi eside kubalulekile.
Ungathini ngokuphila kwesikhathi?
Lona umbuzo omkhulu kubazali abaningi. Isikhathi sokuphila ngemva kokuhlinzwa kweFontan sincike ebunzimeni besimo senhliziyo ingane eyayinaso.
Kodwa, namuhla, ezokwelapha sezithuthuke kakhulu. Iningi labantu liphila iminyaka eyi-10 ngemva kokuhlinzwa. Abantu abayisishiyagalombili kwabayishumi baphila iminyaka engama-30 noma ngaphezulu . Eqinisweni, abantu abaningi abaye bahlinzwa eFontan manje sebephila iminyaka engama-40 nangaphezulu.
Ngokuhamba kwesikhathi, ikhono lokupompa inhliziyo yabanye abantu lingase libe buthaka, noma isibindi singase sithinteke. Lokhu kubizwa ngokuthi "i-Fontan ehlulekile." Ezimweni ezinjalo , kungadingeka ukufakelwa inhliziyo . Kodwa akuwona wonke umuntu okudingayo lokhu.
Uma uthola ukuthi ingane yakho inesifo senhliziyo esibi kakhulu futhi isizohlinzwa, ungase uzizwe unemizwa eminingi. Ukwesaba, ukukhathazeka, nokungaqiniseki ngekusasa konke kuvamile. Kodwa into ebaluleke kakhulu okufanele uyazi ukuthi awuwedwa .
Ngemva kwalokhu kuhlinzwa, ingane yakho ingadlala, ifunde, ikhule, futhi ijabulele impilo njenganoma yimuphi omunye umntwana. Ingase ikhathale ngokushesha, noma ingadinga ukuhlolwa okwengeziwe kwezokwelapha. Kodwa, ngeseluleko esifanele sezokwelapha kanye nothando lwakho nokunakekelwa, ingaphila impilo egcwele nejabulisayo.
Umlayezo Wokuya Nawe Ekhaya
- Inqubo yeFontan iwukuhlinzwa kwenhliziyo okukhethekile okwenziwa ezinganeni ezizalwa zine-ventricle eyodwa kuphela esebenzayo.
- Lokhu kudala "indlela emfushane" yokugeleza kwegazi enhliziyweni, kunciphisa umthwalo womsebenzi esitokisini esisodwa esisebenzayo.
- Lesi ngokuvamile yisigaba sokugcina ochungechungeni lokuhlinzwa, futhi senzelwa ingane eneminyaka ephakathi kwemibili nemihlanu.
- Nakuba ukuhlinzwa kweFontan “kungasiqedi” ngokuphelele lesi sifo, kungasiza kakhulu ingane ukuba iphile impilo engcono nematasa.
- Ngemva kokuhlinzwa, ukulandelwa njalo ngudokotela kubalulekile impilo yakho yonke.
- Ngokuphathwa kahle kwezokwelapha nokunakekelwa, izingane eziningi ezenza lokhu kuhlinzwa ziphila impilo ephumelelayo negcwele.
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