Ingabe ingane yakho kufanele yenze i-Norwood Procedure? Ake sixoxe ngayo kalula.

Kumelwe ukuba wazizwa wesaba futhi washaqeka kangakanani lapho odokotela bekutshela ukuthi ingane yakho encane inesifo senhliziyo esiyinkimbinkimbi sokuzalwa? Lapho bekutshela ukuthi udinga ukwenza 'iNqubo kaNorwood', cishe awuzange uyiqonde ngisho negama. Kuvamile kakhulu. Ngesikhathi esinjengalesi, kufika imibuzo eyinkulungwane engqondweni. Ungakhathazeki, sizoxoxa ngalokhu kalula, ngendlela ongayiqonda.

Iyini inqubo yeNorwood?

Kalula nje, inqubo yeNorwood iwukuhlinzwa kokuqala nokukhulu kakhulu okwenziwa ukusindisa izimpilo zezingane ezizalwa zinesici senhliziyo esiyinkimbinkimbi kakhulu. Lokhu sikubiza ngokuthi yi -Hypoplastic Left Heart Syndrome (HLHS) .

Bheka manje, inhliziyo enempilo inamakamelo amane amakhulu. Uhlangothi lwesokudla lunesibopho sokuthumela igazi lomzimba elingenawo umoya-mpilo emaphashini. Igazi elinomoya-mpilo elivela emaphashini liza ohlangothini lwesobunxele lwenhliziyo. Uhlangothi lwesobunxele lunesibopho sokupompa leli gazi elinomoya-mpilo, elihlanzekile emzimbeni wonke.

Kodwa-ke, uhlangothi lwesobunxele lwenhliziyo yengane ene-HLHS alukakhuli ngokugcwele. Lokhu kusho ukuthi ingxenye eyinhloko epompa igazi elihlanzekile emzimbeni ayisebenzi. Ngakho-ke kunzima ngomntwana onjalo ukusinda.

Yilapho odokotela benza inqubo yeNorwood. Le nqubo ivumela uhlangothi lwesokudla lwenhliziyo yengane, oluvele lusebenza kahle, ukuthi lwenze umsebenzi okufanele wenziwe uhlangothi lwesobunxele. Okusho ukuthi, ukugeleza kwegazi lenhliziyo kuyashintsha ukuze i-ventricle yesokudla ipompe igazi liye emaphashini, kuyilapho ngesikhathi esifanayo ipompe igazi elinomoya-mpilo liye kuwo wonke umzimba.

Ubani odinga lokhu kuhlinzwa?

Lokhu kuhlinzwa kuyadingeka kakhulu ezinganeni ezinesimo se-HLHS esikhulume ngaso ekuqaleni. Lezi zingane zidinga lokhu kuhlinzwa zingakapheli amasonto amabili okuqala zizelwe.

Cabanga nje, lapho umntwana esesiswini, lobu buthakathaka benhliziyo abuyona inkinga ngoba buthola umoya-mpilo ovela entanjeni yesisu. Ngisho nangemva kokuzalwa, ezinsukwini ezimbalwa zokuqala, ingxenye encane yenhliziyo efana nethubhu phakathi kwemithambo yegazi eyinhloko (i-aorta kanye nomthambo wamaphaphu) (i-patent ductus arteriosus) ihlala ivulekile. Lokhu kuvumela igazi elithile ukuthi ligeleze liye emzimbeni.

Kodwa-ke, leli payipi liyavaleka ngokwemvelo ezinsukwini ezimbalwa. Yilapho umntwana eba nobunzima bokuphefumula, futhi impilo yakhe isengozini enkulu. Ngakho-ke, odokotela bamnika umuthi okhethekile wokuvimbela ipayipi ukuthi lingavali. Okwamanje, umntwana ulungele lokhu kuhlinzwa kweNorwood.

Ngezinye izikhathi, ezinganeni ezizalwa ngaphambi kwesikhathi, ezinesisindo esiphansi, noma ezinezinye izinkinga zempilo ezinkulu, lokhu kuhlinzwa kungase kungenzeki ngesikhathi esisodwa. Ezimweni ezinjalo, odokotela bangase basebenzise ezinye izindlela zesikhashana.

Kwenzekani ngesikhathi sokuhlinzwa?

Lokhu ukuhlinzwa okuyinkimbinkimbi kakhulu okuthatha amahora amaningana, ngezinye izikhathi ngisho nosuku. Nakhu udokotela akwenzayo ngamazwi alula:

1. Ukwandisa imbobo phakathi kwamakamelo aphezulu (i-atria) enhliziyo: Lokhu kusiza igazi elinomoya-mpilo elivela emaphashini ukuthi ligeleze kalula liye ohlangothini lwesokudla lwenhliziyo.

2. Ukwakhiwa kabusha komthambo oyinhloko (i-aorta): I-aorta encane, engakakhuli kahle yengane ixhunywe kumthambo wamaphaphu, umthambo othwala igazi emaphashini, bese kufakwa i-patch ekhethekile ukuze kudalwe umthambo wegazi owodwa, omkhulu, oqinile.

3. Ukuxhuma umthambo omusha ne-ventricle yesokudla: Manje le-aorta enkulu esanda kudalwa ixhunywe ne-ventricle yesokudla, okuwukuphela kwengxenye esebenzayo yenhliziyo. Manje uhlangothi lwesokudla lungapompa igazi liye emzimbeni wonke.

4. Ukubeka i-shunt ukuze kuthunyelwe igazi emaphashini: Njengoba lonke igazi manje selidlula ku-aorta entsha liye emzimbeni, kudingeka kudalwe umzila ohlukile wokuthumela igazi emaphashini. Lokhu kwenziwa kusetshenziswa ithubhu elincane elibizwa ngokuthi i-shunt. Lokhu kuxhunywe kusuka ku-aorta entsha kuya emithanjeni yamaphaphu (i-Blalock-Taussig noma i-BT shunt) noma kusuka ku-ventricle yesokudla kuya emithanjeni yamaphaphu (i-Sano shunt).

Phakathi nalokhu kuhlinzwa konke, inhliziyo namaphaphu engane kusetshenziswa okwesikhashana umshini okhethekile obizwa ngokuthi i-cardiopulmonary bypass .

Kwenzekani ngemva kokuhlinzwa?

Ngemva kokuhlinzwa, ingane yakho izongeniswa e-Intensive Care Unit (ICU) , lapho odokotela nabahlengikazi abaqeqeshwe ngokukhethekile bezonakekela ingane amahora angama-24 ngosuku.

Uzobona ukuthi kunezimbobo eziningi nezintambo ezixhunywe emzimbeni womntwana. Zisetshenziselwa ukunikeza umntwana imithi edingekayo, umoya-mpilo, ukudla, futhi zilinganisa njalo imisebenzi yomzimba. Ungesabi ukuzibona , zonke zikhona ngenxa yenhlalakahle yomntwana.

Ngisho nangemva kokuhlinzwa, njengoba sixoxile ngaphambili, isikhumba nezindebe zomntwana zingase zibe nombala oluhlaza okwesibhakabhaka ngenxa yokuxubana kwegazi elinomoya-mpilo ophezulu kanye negazi elinomoya-mpilo ophansi. Lokhu kuvamile kulesi sigaba.

Ngemva kwesonto elilodwa egunjini lokunakekelwa okujulile, uma isimo somntwana sesingcono, uzodluliselwa egunjini elivamile. Ngaphambi kokuba uye ekhaya, odokotela nabahlengikazi bazokunikeza incazelo ephelele yokuthi ungayinakekela kanjani ingane yakho, ungayinika kanjani imithi, nokuthi yiziphi izimpawu okufanele uziqaphele.

Uchungechunge oluphelele lokuhlinzwa lwesimo se-HLHS

Inqubo yaseNorwood iyisinyathelo sokuqala kulolu hambo. Ukuze umntwana one-HLHS abe nokuphila okuvamile, kudingeka enze uchungechunge lwezinqubo ezintathu zokuhlinzwa.

Yiziphi izingozi nezinkinga ezingaba khona?

Njenganoma yikuphi ukuhlinzwa okukhulu, inqubo yeNorwood inezingozi ezithile. Udokotela wakho uzokuchazela lokhu. Izinkinga ezinkulu ezingaba khona yilezi:

• Ukuncishiswa kwemithambo yegazi: Ngemva kokuhlinzwa, i-aorta eyakhiwe kabusha noma umthambo othwala igazi emaphashini ungase uncishiswe (i-stenosis).
• Izinkinga ze-shunt: I-shunt ethumela igazi emaphashini ingase ivaleke noma ingasebenzi kahle.
• Ukushaya kwenhliziyo okungavamile: Isigqi senhliziyo singashintsha (arrhythmia).
• Ukusebenza kwenhliziyo okubuthakathaka: Ikhono lenhliziyo lokupompa noma ukusebenza kwama-valve ayo kungase kuphazamiseke.
• Ukulibaziseka kokukhula kwe-neuro: Kunethuba elincane lokuthi ukukhula kobuchopho kuzothinteka, okuholela ezinkingeni zokufunda noma zokuziphatha (ukulibaziseka kokukhula kwe-Neurodevelopmental).

Imiphumela kanye nokusinda kanjani?

Lona ngumbuzo omkhulu kunayo yonke umzali anawo. Iqiniso liwukuthi, ngaphambi kokuba kutholakale lokhu kuhlinzwa ngawo-1980, kwakungekho ukwelashwa kwezingane ezizalwa zine-HLHS. Inqubo yaseNorwood iyithuba lalezi zingane lokuphila.

Ngokwezibalo, amathuba okusinda esibhedlela ngemuva kwalokhu kuhlinzwa angama-90%.Izinga lokusinda kweminyaka emihlanu ngemva kokuhlinzwa liphakathi kuka-60% no-75%. Ngeshwa, ezinye izingane ziyafa ngokuzumayo ngaphambi kokufinyelela esigabeni sokuhlinzwa kwesibili.

Kodwa-ke, uma konke ukuhlinzwa okuthathu kuphumelela, laba bantwana bangakhula babe ngabantu abadala abasebasha. Bazoba nethuba lokuya esikoleni, badlale, futhi baphile impilo evamile.

Kufanele ngimbone nini udokotela?

Ngemva kokuletha ingane yakho ekhaya, unomthwalo wemfanelo omkhulu. Udinga ukuqaphela kakhulu ngezinto ezilandelayo. Uma ubona into efana nale, shayela udokotela wakho ngokushesha.

• Uma ingane ingakhuli kahle.
• Uma izinga lomoya-mpilo lomntwana wakho lehla ngaphansi kwezinga udokotela akutshele lona (uzobe unikezwe umshini wokukala umoya-mpilo ekhaya).
• Uma ingane ingasabeli kahle emithini enikezwe udokotela.
• Uma unemibuzo noma ukungabaza mayelana nendlela yokunakekela ingane yakho.

Ngenxa yokuthi i-HLHS iyisimo esingavamile, kubaluleke kakhulu ukukhetha udokotela onolwazi kanye nesibhedlela esenza lolu hlobo lokuhlinzwa njalo. Ungesabi noma ube namahloni okubuza udokotela wakho ngokuphindaphindiwe nganoma yini ongayiqondi.