Kobadwa nako diaphragmatic chophukacho kukonza

Kukonzekera kwa chiberekero cha chiberekero (CDH) chobadwa ndi opaleshoni kukonza chitseko kapena malo mu chotupa cha mwana. Kutsegula uku kumatchedwa kuti hernia. Ndi mtundu wosowa wobadwa nawo. Kubadwa kumatanthauza kuti vuto limakhalapo pakubadwa.

Opaleshoniyo isanachitike, pafupifupi makanda onse amafunika kupuma kuti athetse mpweya wabwino.

Kuchita opareshoni kumachitika pomwe mwana wanu ali pansi pa anesthesia (akugona komanso osamva kupweteka). Dokotalayo amadula (cheka) m'mimba pansi pa nthiti. Izi zimathandiza kuti ziwalo zam'deralo zifikire. Dokotalayo amakokera ziwalozi m'malo mwake kudzera pachitseko cha m'mimba ndi m'mimba.

Pazovuta zochepa, opaleshoniyi imatha kugwiritsidwa ntchito pang'onong'ono pachifuwa. Kamera yaying'ono yamakanema yotchedwa thoracoscope imayikidwa kudzera pachimodzi mwazinthuzi. Izi zimathandiza dokotalayo kuti aone mkati mwa chifuwa. Zida zokonzera dzenje lakalezo zimayikidwa kudzera pazinthu zina.

Mwa mtundu uliwonse wa opareshoni, dokotalayo amakonza bowo lakulendalo. Ngati dzenjelo ndi laling'ono, limatha kukonzedwa ndi ulusi. Kapenanso, chidutswa cha pulasitiki chimagwiritsidwa ntchito kuphimba dzenjelo.

Chizindikiro ndi minofu. Ndikofunika kupuma. Imalekanitsa chifuwa (pomwe pamakhala mtima ndi mapapo) kuchokera kumimba.

Mwa mwana yemwe ali ndi CDH, minofu ya diaphragm sinapangidwe kwathunthu. Kutseguka kwa CDH kumalola ziwalo kuchokera m'mimba (m'mimba, ndulu, chiwindi, ndi matumbo) kupita mchimake pachifuwa pomwe pali mapapo. Mapapu samakula bwinobwino ndipo amakhala ochepa kwambiri kuti ana azipuma paokha akabadwa. Mitsempha yamagazi m'mapapu imakhalanso yachilendo. Izi zimapangitsa kuti mpweya wosakwanira usalowe m'thupi la mwana.

Hnia yotsekemera imatha kukhala pangozi ndipo ana ambiri omwe ali ndi CDH amadwala kwambiri. Kuchita opaleshoni yokonza CDH kuyenera kuchitika msanga mwana atabadwa.

Zowopsa za opaleshoniyi ndi izi:

• Mavuto apuma, omwe atha kukhala owopsa
• Magazi
• Mapapu atagwa
• Mavuto am'mapapo omwe samatha
• Matenda
• Zomwe zimachitika ndi mankhwala

Ana obadwa ndi CDH amaloledwa kupita kuchipatala cha NICU. Zitha kukhala masiku kapena milungu mwana asanakhazikike mokwanira kuti achite opaleshoni. Chifukwa vutoli ndi loopsa ndipo kunyamula mwana wakhanda wodwala kwambiri ndiwowopsa, makanda omwe amadziwika kuti ali ndi CDH ayenera kuperekedwa kuchipatala ndi madotolo a ana ndi neonatologists.

• Mu NICU, mwana wanu angafunikire makina opumira (makina opumira) asanamuchite opaleshoni. Izi zimathandiza mwana kupuma.
• Ngati mwana wanu akudwala kwambiri, makina opumira pamtima (extracorporeal membrane oxygenator, kapena ECMO) angafunike kuchita ntchito yamtima ndi mapapo.
• Asanachite opaleshoni, mwana wanu amakhala ndi ma x-ray komanso kuyezetsa magazi pafupipafupi kuti awone momwe mapapo akugwirira ntchito. Chojambulira chowala (chotchedwa pulse oximeter) chimagwidwa pakhungu la khanda kuti liwone kuchuluka kwa mpweya m'magazi.
• Mwana wanu atha kupatsidwa mankhwala ochepetsa kuthamanga kwa magazi ndikukhala omasuka.

Mwana wanu adzakhala ndi machubu oyikidwa:

• Kuyambira mkamwa kapena mphuno mpaka m'mimba kuti mpweya usatuluke m'mimba
• Mitsempha yowunika kuthamanga kwa magazi
• Mitsempha yoperekera michere ndi mankhwala

Mwana wanu azikhala pa makina opumira pambuyo pa opareshoni ndipo azikhala mchipatala kwa milungu ingapo. Mukachotsedwa pamakina opumira, mwana wanu angafunikire mpweya ndi mankhwala kwakanthawi.

Kudyetsa kumayamba mwana wanu atayamba kugwira ntchito. Zakudya zimaperekedwa kudzera mu chubu chofewa chofewa kuchokera mkamwa kapena mphuno m'mimba kapena m'matumbo mpaka mwana wanu atenge mkaka pakamwa.

Pafupifupi makanda onse omwe ali ndi CDH amakhala ndi Reflux akamadya. Izi zikutanthauza kuti chakudya kapena asidi m'mimba mwawo amasunthira m'mimba mwawo, chubu chomwe chimachokera kukhosi mpaka m'mimba. Izi zitha kukhala zosasangalatsa. Zimabweretsanso kulavulira pafupipafupi ndi kusanza, zomwe zimapangitsa kudyetsa kumakhala kovuta mwana wanu akamamwa chakudya pakamwa. Reflux imawonjezera chiopsezo cha chibayo ngati ana alowetsa mkaka m'mapapu awo. Zingapangitsenso kuti zikhale zovuta kuti ana azidya ma calories okwanira kuti akule.

Anamwino ndi akatswiri odyetsa azikuphunzitsani njira zosungira ndikudyetsa mwana wanu kuti asatengeke. Ana ena amafunika kukhala pa chubu chodyetsera kwa nthawi yayitali kuti awathandize kupeza ma calories okwanira kuti akule.

Zotsatira za opaleshoniyi zimadalira momwe mapapu a mwana wanu amakulira bwino. Ana ena amakhala ndi mavuto ena azachipatala, makamaka ndi mtima, ubongo, minofu, ndi malo, zomwe nthawi zambiri zimakhudza momwe mwana amakhalira bwino.

Nthawi zambiri malingaliro amakhala abwino kwa makanda omwe ali ndi minofu yam'mapapo yomwe ili bwino ndipo alibe mavuto ena. Ngakhale zili choncho, ana ambiri omwe amabadwa ndi vuto lodziwika bwino la hernia amadwala kwambiri ndipo amakhala mchipatala kwanthawi yayitali. Ndi kupita patsogolo kwa zamankhwala, malingaliro a makanda awa akukhala bwino.

Ana onse omwe adakonzedwa ndi CDH adzafunika kuyang'anitsitsa kuti awonetsetse kuti dzenje lawolo silikutsegulanso akamakula.

Ana omwe anali ndi kutsegula kapena chilema chachikulu mu diaphragm, kapena omwe anali ndi mavuto ambiri m'mapapu awo atabadwa, atha kukhala ndi matenda am'mapapo atatuluka mchipatala. Angafune oxygen, mankhwala, ndi chubu chodyetsera kwa miyezi kapena zaka.

Ana ena amakhala ndi zovuta kukwawa, kuyenda, kulankhula, ndi kudya. Adzafunika kuwona othandizira pantchito kapena pantchito kuti awathandize kukulitsa minofu ndi nyonga.

Diaphragmatic chophukacho - opaleshoni

• Kubweretsa mwana wanu kuti adzachezere m'bale wanu wodwala kwambiri
• Chisamaliro cha bala la opaleshoni - chotseguka

• Diaphragmatic hernia kukonza - mndandanda

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Hollinger LE, Harting MT, Lally KP. Kutsata kwakanthawi kwakubadwa kwa hernia wobadwa nako. Semina Odwala Opaleshoni. 2017; 26 (3): 178-184. PMID: 28641757 www.ncbi.nlm.nih.gov/pubmed/28641757.

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Tsao KJ, Lally KP. Mpweya wobadwa nawo wobadwa nawo komanso zochitika. Mu: Holcomb GW, Murphy JP, Ostlie DJ, olemba. Opaleshoni ya Ana ya Ashcraft. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier Saunders; 2014: chap 24.