Achangoberekwa nokumutswa: zvairatidza, mifananidzo, nzendo, mishonga

Maererano nenhamba, achangoberekwa ose wegumi kutarisira utano mune pakukurukura mukamuri, uye 1% vose vakaberekwa ari kuda uzere zvakawanda CPR. Yakakwirira pamwero kurovedza navanachiremba vanogona kuwedzera mikana upenyu uye kuderedza zvinobvira matambudziko. Zvakakwana uye Panguva Chaiyo nokumutswa achangozvarwa - danho rokutanga kuti kuderedza nhamba yevanofa uye chirwere kukura.

zvinhu pfungwa

Chii neonatal nokumutswa? dzakatevedzana ichi zviyero zvainanga unotipa simba muviri mwana uye kudzorerwa vakarasika mashandiro. Zvinosanganisira:

• nokungovafemera;
• nzira yevanorwara zvikuru;
• Kushandisa zvokuimba kufefetedza;
• pacemaker nezvimwe kugadzwa.

Full-rokuti vacheche regai zvinoda nokumutswa matanho. Ivo tinoberekwa kushingaira, Danidzirai nenzwi guru, kupomba uye mwoyo zvazvingava zviri dzose, ganda ane vaaleanpunainen ruvara, mwana anopindura zvakanaka zviwane. vana ava vari pakarepo kuiswa raamai dumbu uye pokugara kudziya, yakaoma mutambo. Respiratoria mucous aspirated mukati kudzorera patency yavo.

Patinoita nokungovafemera riri kuonekwa nechimbichimbi rubatsiro. It rakaitirwa nyaya kumira kufema uye mwoyo ushande. Mushure izvozvo Kupindira iri zvinoitirwawo yakanaka mugumisiro, shandisa zvinokosha yevanorwara zvikuru. kurapwa kwakadaro nechinangwa kubvisa zvichibvira yematambudziko zvokurega zvinokosha zvomukati.

Kana murwere haagoni vakazvimiririra kuramba homeostasis, nokumutswa achangozvarwa zvinosanganisira zvokuimba kufefetedza (ALV) kana kuisa pasi pacemaker.

Chii chinodiwa kuti nokumutswa mu kukurukura mukamuri?

Kana kudiwa urongwa zviitiko zvakadaro pasi, unofanira kuita zvaunenge mumwe munhu. Kana chakakomba pamuviri uye netarisiro hwenguva-siyana CPR ari pakukurukura vebazi maviri.

Nokumutswa kuti richangoberekwa kukurukura mukamuri zvinoda kunyatsogadzirira. Pamberi muitiro ekubereka, tarisa Kuwanikwa zvose zvakafanira uye nechokwadi zvokushandisa kushanda ezvinhu.

1. Unofanira batanidza munhu kupisa kunobva kuna tafura nokumutswa uye manapukeni vakanga kudziyirwa, mumwe mutambo mupumburu muchimiro chinotenderera.
2. Ongorora kuti hurongwa zvakakodzera iiswe yakachena zvitengeswa. Inofanira kuva kwakakwana okisijeni kuti zvakakodzera kuchinja kufurirwa uye ichayerera zvazvingava.
3. Zvakakodzera kutarisa unoda midziyo kuti zvinodiwa dzokubudisa ari kufema turakiti mukati.
4. Gadzirirai zvokushandisa nokuti kubviswa gastric zviri mu zvinoitirwawo chido (vachiongorora, sirinji, chigero, vachigadzira zvinhu), meconium aspirator.
5. Gadzirai motsvaka kuvimbika bhegi uye chifukidzo nokumutswa uye intubation Kit.

Set nokuti intubation chinosanganisira endotracheal sepombi pamwe conductors, nedzimwe laryngoscope mashizha uye kupembedza mabhatiri, chigero uye magiravhusi.

Chii kubudirira zviyero?

neonatal nokumutswa mu kukurukura kamuri anobva zvinotevera misimboti kuti ubudirire:

• Kuwanikwa yevanorwara zvikuru zvikwata - pamusoro vemarudzi ose nokumutswa zvinofanira kuvapo;
• kwakarongeka basa - chikwata vanofanira kushanda noruyanano kureva mumwe mumwe mashandiro guru;
• mudonzvo vanonyatsokwanisa - mumwe nokumutswa anofanira kuva mukuru azvipire ruzivo uye unyanzvi hunobatsira;
• basa, kufungisisa murwere akakutsamwira - CPR vanofanira kutanga pakarepo nechitarisiko chavo chokunamata, mamwe matanho yaitwa, zvichienderana kwaiita muviri zvomurwere;
• serviceability zvokushandisa - zvokushandisa nokumutswa kunofanira basa uye nyore chero nguva.

Zvikonzero kudiwa chiito

By etiological zvinhu kudzvinyirira zvomwoyo, mapapu uye dzimwe nhengo dzose achangoberekwa inokosha inosanganisira kukura asphyxia, kuberekwa kukuvara, pave vachiberekwa abnormalities, kutapuriranwa kwakabva toxemia uye zvimwe zviitiko zvisingazivikanwi etiology.

Chevana neonatal nokumutswa uye kudiwa rinogona rakafanotaura kunyange munguva rokubereka vana. Muzviitiko zvakadaro, nokumutswa chikwata garai makagadzirira, kuti pakarepo kubatsira mwana wako.

Kudiwa zviitiko zvakadaro zvinogona kuitika pasi zvinotevera ezvinhu:

• multi- kana oligohydramnios;
• perenashivanie;
• chirwere cheshuga mai;
• neBP;
• zvirwere;
• Fetal zvokudya.

Uyewo, pane zvinoverengeka kuti kare simuka pakusununguka. Kana chiitiko ravo zvinogona kutarisirwa vanoda nokumutswa. Zvinhu zvakadai zvinosanganisira bradycardia ari mwana, mumwe caesarean chikamu, kukurumidza kuberekwa uye kukurumidza, previa kana placental abruption, uterine hypertonus.

asphyxia

Kukura kufema zvirwere vane hypoxia pezvakaitwa hunokonzera chitarisiko muviri kusagadzikana kweropa ino, metabolic uye microcirculation. Next pane kukanganisika itsvo, mwoyo, adrenal omumuviri, uropi.

Asphyxia kunoda pakarepo kupindira kuitira kuderedza mukana yematambudziko. Zvinokonzera kufema zvirwere:

• hypoxia;
• kutyora yemweya (chido ropa, madzihwa, meconium);
• Organic kukuvara uropi uye CNS basa;
• malformations;
• kukwana surfactant.

Diagnostics vanoda nokumutswa kupindira kunze pashure tinyatsonzwisisa mwana Apgar.

Zvinofungidzirwa kuti	0 pfungwa	1 pfungwa	2 pfungwa
kufema ezvinhu	kwete	Pathological, spasmodic	Danidzira nenzwi, mutinhimira
HR	kwete	anorova Asingasviki 100 paminiti	anorova anopfuura 100 paminiti
ganda ruvara	cyanosis	Pink ganda, maoko nemakumbo rinokwanisa kucheneruka	pingi
Status kuti tsandanyama matauriro	kwete	Mbabvu vari zvishoma hwakakungwa, mataurire simba	Active kufamba, matauriro akanaka
Zvakaitwa kuti bundu zvinhu	kwete	zvakaneta akaratidza	zvakanaka akaratidza

Tinyatsonzwisisa ehurumende anosvika 3 pfungwa inoratidza kukura kwazvo asphyxia, kubvira 4 kusvika 6 - asphyxia mwero nekuomarara. Nokumutswa achangoberekwa asphyxia kunoitika pakarepo mushure kunyatsoongorora ayo kunopindirana ezvinhu.

The kutevedzana kwezviitiko dzinoongorora mamiriro

1. Mwana anoiswa pasi kupisa kupi, ganda rake yaoma inodziya mutambo. Kubva nasal mhango uye muromo wacho vakanwa mukati. Held tactile dzishande.
2. Anoongorora kufema. Kana kwomuzvarirwo mutinhimira uye kuvapo mhere, anoenderera padanho rinotevera. Kana spasmodic kufema zvokuimba kufefetedza pamwe okisijeni kwemaminitsi 15-20.
3. An kunyatsoongorora mwoyo unodiwa. Kana mwoyo mwero kupfuura anorova 100 paminiti, kutamira kune chinotevera chokutambudzika kuongorora. Kana moyo exchange pazasi 100 anorova vakatakura ventilator. Zvadaro kuongorora kubudirira kupindira.
   • Pulse pazasi 60 - kunanga mwoyo masaja + ventilator.
   • Pulse kubvira 60 kusvika 100 - ventilator.
   • Pulse pamusoro 100 - the ventilator pakuparwa kutadza kufema.
   • Mushure masekondi 30, ineffectiveness kuti kudzvinya pachipfuva pamwe kufefetedza, zvinodhaka kurapa yaifanira.
4. Kundotarira rweganda. Pink ruvara zvinoreva dzose mamiriro ezvinhu mwana. Kana cyanosis kana akrozianoz vanofanira kupa okisijeni uye kuchengeta mamiriro ezvinhu mwana.

Kuita nokumutswa?

Kunodiwa kushambidzwa uye kubatwa akambozvishandisa kuuraya utachiona ruoko, vanopfeka chena magiravhusi. Kuberekwa mwana wakaiswa, pashure anodiwa matanho - rakanyorwawo. Achangobva akaisa pasi kupisa kupi noushamwari yakaoma rakaputirwa mutambo.

Kudzorera yemweya, anogona kudzikiswa musoro magumo uye akaisa mwana kurutivi rworuboshwe. Izvi zvichaita kumisa chirongwa chido uye achabvisa zviri muromo uye mhuno. Achingwarira aspirated mukati, pasina kushandisa zvikuru sumo aspirator.

Kana nezviyero izvi regai kubatsira, achangoberekwa nokumutswa iri mberi nokuda tracheal suctioning uchishandisa laryngoscope. Mushure pakuonekwa mweya, asi pasina ayo mutinhimira, mwana hwakatamisirwa ventilator.

Yevanenge achangoberekwa zvinotora pashure kwokutanga nokumutswa nokuda rumwe rubatsiro uye dzigadziridzwe anokosha.

kufefetedza

Neonatal nokumutswa matanho anosanganisira kudzidzisa kufefetedza. Zvairatidza kuti kufefetedza kunhaka:

• kusavapo kufema kana kufema chimiro convulsive masangano;
• kupomba idukusa ka100 paminiti, zvisinei mamiriro kufema;
• Kuramba cyanosis panguva dzose nokushanda kufema uye zvemwoyo nehurongwa.

Wakaisa ichi mabasa rinoitwa kushandisa masiki kana bhegi. Achangoberekwa musoro zvishoma musana uye runodzingira kudzokera kumeso rikashandiswa. Her abate thumbs wako uye forefinger. Mumwe anotungamirira mwana shaya.

The chifukidzo chinofanira pamusoro chirebvu, mhuno uye muromo. Zvakakwana fefetedza mumapapu ane kakawanda 30 kusvika 50 nguva 1 miniti. Kufefetedza kuburikidza bhegi anogona kukonzera mhepo kupinda gastric mhango. Kubva ipapo unogona kubvisa nayo vachishandisa kwomudumbu chubhu.

Kuongorora kubudirira Implementation, zvakafanira kuti kuteerera kuwedzera chipfuva uye kuchinja kwemwoyo. Mwana akaramba pakuongorora kusvikira zvakakwana kupora yevanhu afemeruke uye kwemwoyo.

Sei uye sei kuti intubate?

Neonatal nokumutswa rinewo intubation zviri trachea, panyaya kukundikana zvokuimba kufefetedza nokuda 1 miniti. Chisarudzo kuti intubation chubhu - mumwe huru. Wakaitwa zvichienderana uremu hwomwana uye gestational zera.

Intubation iri kuitwa mu zvinotevera nyaya:

• kudikanwa kubvisa aspirated meconium kubva trachea;
• kuitisa kuramba kufefetedza;
• pakugonesa kubata nokumutswa;
• epinephrine;
• zvikuru rokusamhanyira.

At laryngoscopy zvinosanganisira chiedza uye tora noruoko rworuboshwe. ruoko rworudyi, abate musoro mucheche wacho. Chipande akaiswa mumuromo uye wakanamatira mutauro chawo. Nokusimudza chipande kurutivi mubato iri laryngoscope, nokumutswa anoona glottis. Endotracheal chubhu kutaurwa kurudyi iri nemumuromo mhango uye achaendeswa kuburikidza pahuro zvinokonzera panguva yokutanga. Izvi zvinoitika pasi kufuridzirwa. The chubhu iri rakaitirwa kusvikira yakarongwa pfungwa.

Laryngoscope akabvisa, ipapo - muitisi. Yakarurama vachiongorora pave chubhu compressing ari kufema bhegi. Air anopinda mapapu uye anoita chinhu karwendo pechipfuva. Next, batanidza yakachena zvitengeswa hurongwa.

kudzvinya pachipfuva

Nokumutswa kuti richangoberekwa kukurukura mukamuri unotora kuita kudzvinya pachipfuva, vakabata iyo kunoratidzwa panguva kwemwoyo asingasviki 80 anorova paminiti.

Pane nzira mbiri kudzvinya pachipfuva. Uchishandisa wokutanga, kumanikidza chipfuva vaiita kushandisa indekisi uye pakati nomunwe ruoko mumwe. Mune imwe musimboti, kuti masaja rinoitwa zvose thumb nemamwe minwe zvinobatanidzwa nokutsigira pamisana. Resuscitator neonatolog-kuitisa kudzvanya pakati nepakati uye nechezasi chetatu breastbone, thorax proginalas kuti 1.5 masendimita shamhu maitikiro -. 90 min.

Hako kutevedzera kuti mweya uye chinokutsimbirirai chipfuva haana kuitwa panguva imwe chete. Vari kumbomira pakati pressings, haukwanise kutora maoko enyu nokupedzwa yacho sternum. Nekudzvanya pamusoro bhegi kuita pashure ose matatu kudzvinya. Nokuti mumwe 2 mumasekonzi zvakafanira kubata 1 uye 3 kudzvanya kufefetedza.

Zviito kana meconium kusvibiswa mvura

Features zvinosanganisira neonatal nokumutswa rubatsiro kuti staining of Líquido mvura meconium uye kunyatsoongorora vomwana Apgar mamakisi kuti asingasviki 6 points.

1. Pakusununguka pashure chitarisiko musoro yokuberekwa Canal pakarepo aspirating zviri mhino uye muromo.
2. Pashure pakaberekwa mwana uye nenzvimbo kunobva kupisa, kutangira mweya, ndiko kwakanaka kuita intubation chubhu rakakura zvinoita saizi dzokubvisa zviri trachea uye principales.
3. Kana iwe usingagoni kubvisa kugutsikana, uye ane admixture pamusoro meconium, zvakakodzera reintubirovat achangozvarwa mumwe handset.
4. Kufefetedza iri akagadzirisa chete pashure kugutsikana zvose chabviswa.

mishonga

Chevana neonatal nokumutswa kunobva kwete chete pane kuita Chinyorwa kana Hardware kupindira, asiwo nokushandisa zvinodhaka. Kana zvokuimba kufefetedza uye kudzvinya pachipfuva, kana mabasa havana zvakabatsirawo masekondi anopfuura 30, kushandisa zvinodhaka.

neonatal nokumutswa kunosanganisira kushandisa adrenaline, zvinoreva kuti vavezve vhoriyamu ropa, yavaibvisa hydrogencarbonate, naloxone, dopamine.

Adrenaline iri akaiswa kuburikidza endotracheal chubhu kupinda trachea, kana bolus tsinga. Wevasungwa zvinodhaka - 1:10 000. The mushonga chinoshandiswa kuwedzera simba mwoyo uye kuderedza kwemwoyo kumhanyisa. Pashure intratracheal Kutarisirwa akaramba zvokuimba kufefetedza, saka kuti mushonga inogona anoparadzirwa zvakaenzana. Kana zvakakodzera, pomutumwa chinotarisirwa 5 maminitsi pashure.

Kukarukureta of dose zvichienderana uremu wemwana:

• 1 kg - 0.1-0.3 Rine mamiririta;
• 2 makirogiramu - 0.2-0.6 Rine mamiririta;
• 3 makirogiramu - 0.3-0.9 Rine mamiririta;
• 4 makirogiramu - 0.4-1.2 Rine mamiririta.

Kana kurasikirwa neropa kana kudiwa kuzadza bhuku achiparadzira ropa sealbumin rinoshandiswa, vasiri yavaibvisa chloride mhinduro kana Ringer anogadzirisa. Zvinodhaka zviri kutarisirwa kupinda tsinga dzose achiine rukuvhute tambo ndege (10 Rine mamiririta pa 1 kg muviri uremu) zvishoma nezvishoma pamusoro maminitsi 10. Nhanganyaya vospolniteley Nyorera mumwe zvisingaoneke kungawedzera BP, kuderedza acidosis, uye kuti normalize kurova kwemwoyo mwero kuvandudza tishu muviri.

neonatal nokumutswa, zvichiteverwa zvemapapu kufefetedza kunobudirira, zvinoda pakatanga yavaibvisa rehydrogen carbonate kupinda achiine rukuvhute tsinga kuderedza zviratidzo acidosis. The mushonga harifaniri kushandiswa sokuvapo mwana haana dzatangwa zvemapapu zvakakwana kufefetedza.

Dopamine inoshandiswa kuwedzera cardiac indekisi uye glomerular filtration. The mushonga kunowedzera renal yavaibvisa midziyo uye anowedzera Clearance nokushandisa aizomupa mishonga. Nomutsinga microfluidic pasi kuramba richiona nezvezvabuda BP uye kwemwoyo.

Naloxone nomutsinga jekiseni pa mwero 0.1 Rine mamiririta por 1 kg muviri uremu. Zvinoreva, kushandiswa panyaya apo ganda ruvara uye kupomba hwemazuva, asi pane zviratidzo kufema mwoyo. Naloxone haagoni kupiwa kuna achangoberekwa apo amai anoshandisa zvinodhaka marwadzo kana uchishushikana kurapwa pachishandiswa marwadzo analgesics.

Kana kumisa nokumutswa?

IVL anoramba sokuvapo mwana asingadi atore 6 pfungwa pamusoro Apgar. Kukoshesa ichi rinoitwa ose 5 maminitsi uye kunotora kusvika hafu yeawa. Kana pashure nguva ino achangoberekwa ane indekisi kuti asingasviki 6, akabva hwakatamisirwa ICU muchipatara umo kuita kumwe nokumutswa, ndichibvunza marapirwo ose vachangoberekwa.

Kana kubudirira nokumutswa iri zvachose vasipo uye pane asystole uye cyanosis, chiitiko panoberekwa maminitsi 20. Paunoona napaduku zviratidzo efficacy, nguva kunowedzera nguva dzose, kusvikira akaenzaniswa akanaka.

Neonatal yevanenge

Mushure anobudirira kudzorerwa mapapu uye mumwoyo achangoberekwa zvaitambidzwa yevanenge. Pane vanachiremba basa ndehwokuti kudzivirira zvinobvira matambudziko.

Achangobva pashure nokumutswa vachida kudzivirira panowanikwa mumatenhere uropi kana zvimwe CNS zvinetso, basa kudzorerwa itsvo excretory kushanda kwemuviri, normalization ropa kutenderera.

Mwana anogona kuonekwa metabolic nepfungwa muchimiro acidosis, lactic acidosis, izvo zviri kukonzerwa zvinetso zviri peripheral microcirculation. Pamusoro kuuropi kungaita nezvipusha, ropa, chepfungwa infarction, edema, kukura pakoma. Unogona kugamuchira dysfunction pamusoro ventricles kwomwoyo, chenjera renal kukundikana, atony dundira, adrenal insufficiency nezvimwe kwemakemikari anobudiswa nhengo.

Zvichienderana ezvinhu mwana anoiswa mune mazai chenguva duku kana yakachena tende. Nyanzvi atungamirire basa zvomukati zvose uye hurongwa. Fudzai kubvumira mwana chete pashure pemaawa 12, kazhinji - kuburikidza munhu nasogastric chubhu.

Zvikanganiso kuti kutadzisa wairambidza

Zvinonzi zvaisambobvumirwa kuita zvinhu zvisina nekusimba yakachengeteka:

• dira mvura mwana;
• tsonyera pachipfuva;
• anorova pamusoro magaro;
• yakananga chiso okisijeni jets uye zvakafanana.

sealbumin mhinduro haafaniri kushandiswa kuwedzera kwokutanga Nyorera mumwe zvisingaoneke, nokuti inowedzera mikana dzinouraya neonatal mugumisiro.

Nokumutswa hazvirevi kuti mwana achava chero abnormalities kana matambudziko. Vabereki vakawanda vanotarisira pathological zvinoratidza mushure achangoberekwa rakanga yevanorwara zvikuru. Reviews dzenyaya idzi dzinoratidza kuti vana mune ramangwana vane kukura zvakafanana vezera ravo.