Nā ʻenehana mālama hānai ma nā hihia Lupus
Pendahuluan
ʻO Lupus, ʻoiai ʻo Systemic Lupus Erythematosus (SLE), he maʻi autoimmune mau loa ia e hiki ke hoʻopilikia i nā ʻano kino like ʻole e like me ka ʻili, nā hono, nā puʻupaʻa, ke koko, nā māmā, a me ka ʻōnaehana nerve. I nā wahine o ka makahiki hānau, he mea hopohopo nui ka lupus no ka mea hiki ke hoʻopilikia i ka momona, ka hāpai ʻana, a me ka palekana o ka makuahine a me ka fetus. Ma ke ʻano o ka obstetrics, pono nā hihia lupus i nā ʻano mālama piha a hoʻomau e pili ana i ka laulima ʻana ma waena o nā ʻoihana. He kuleana ko nā kahu hānai i ka ʻike mua ʻana i ka pilikia, ka nānā ʻana i ka makuahine-fetal, ka hoʻonaʻauao olakino, a me ka hōʻoia ʻana i nā kuhikuhi kūpono i ka wā e kū mai ai nā pilikia.
Nā Manaʻo Kumu o Lupus i ka Hāpai Keiki
ʻO ka hāpai ʻana i nā wahine me ka lupus ua manaʻo ʻia he hāpai kiʻekiʻe. Hiki i ka Lupus ke paʻa (remission) a i ʻole ka hana (flare). Pili ka hāpai ʻana i ka wā lupus hana me ka hoʻonui ʻia o ka pilikia o nā pilikia: preeclampsia, preterm labor, intrauterine growth restriction (IUGR), nā pilikia puʻupaʻa, thrombosis, anemia, thrombocytopenia, a me ka make ʻana o ka fetal. Eia kekahi, ʻo ke alo o kekahi mau antibodies, e like me anti-Ro/SSA a me anti-La/SSB, e hoʻonui i ka pilikia o ka neonatal lupus a me ka congenital heart block i loko o ka fetus. No laila, ʻo ke kumu nui ka hoʻolālā ʻana i ka hāpai ʻana i ka wā e paʻa ai ka lupus no ka liʻiliʻi he 6 mau mahina a e nānā pono i ka wā hāpai a me ka postpartum.
Nā Pahuhopu o ka Mālama ʻana i nā Hānau ma nā Maʻi Lupus
ʻO nā ʻano hana mālama kahu hānai no nā makuahine me ka lupus e manaʻo nei:
1. E mālama i ke kūpaʻa o ka maʻi a pale i ka hoʻi hou ʻana mai.
2. Ka ʻike mua ʻana i nā pilikia o ka makuahine e like me ka preeclampsia, nā maʻi puʻupaʻa, a me ka thromboembolism.
3. E nānā mau i ka ulu ʻana a me ka hoʻomohala ʻana o ka fetal a me ke olakino o ka fetal.
4. E hāʻawi i ka hoʻonaʻauao a me ke kākoʻo noʻonoʻo i hiki i nā makuahine ke mālama ponoʻī.
5. E hōʻoia i ka hoʻonohonoho ʻana o nā kuhikuhi a me ka laulima ʻana me nā loea i ka obstetrics, ka lāʻau lapaʻau kūloko/rheumatology, nephrology, a me pediatrics.
Ka Loiloi ʻana ma ka Mālama ʻana i nā Keiki Hānau
Pono ka loiloi no ka lupus i nā kikoʻī hou aku ma mua o ka hāpai ʻana maʻamau. Pono ka wahine hānai e hōʻiliʻili i kēia mau ʻikepili:
– Ka mōʻaukala o ka maʻi Lupus: i ka wā i ʻike ʻia ai, nā ʻōpū i pili (ʻoi aku hoʻi nā puʻupaʻa), ka alapine (pinepine) o ka lapalapa ʻana, a me ka mōʻaukala o ka hoʻokomo ʻia ʻana i ka haukapila.
– Ka mōʻaukala lāʻau lapaʻau: ka hoʻohana ʻana i nā corticosteroids, hydroxychloroquine, azathioprine, nā lāʻau antihypertensive, a i ʻole nā anticoagulants. He mea nui e loiloi i ka mālama ʻana a me nā hopena ʻaoʻao.
– Mōʻaukala hānau keiki: hoʻopau pinepine ʻana i ka hāpai ʻana, hānau mua ʻana, nā pēpē kaumaha haʻahaʻa i ka wā hānau, make ʻana o ka fetal, a me ka preeclampsia ma mua.
– Nā hōʻailona o ka hoʻi hou ʻana: ʻeha nui o nā hono, ka ʻulaʻula maʻi ʻōpū, nā ʻeha waha, ke kuni me ka ʻike ʻole ʻia o ka maʻi, ka pehu ʻana, ka emi ʻana o ka mimi i hoʻopuka ʻia, ka pōkole o ka hanu, a me ka luhi nui.
– Nā hōʻailona weliweli o ka hāpai ʻana: ʻeha poʻo nui, ʻike maka pohihihi, ʻeha epigastric, edema koke, kahe koko, a i ʻole ka emi ʻana o ka neʻe ʻana o ka fetal.
E kālele ana ka hoʻokolohua kino i ke koko, ka edema, nā hōʻailona o ka anemia, ka hoʻokolokolo ʻili, a me ke kūlana hanu. ʻO nā hoʻokolohua kōkua pili e pili ana i ka urinalysis no ka protein, ka hana o nā puʻupaʻa, ka helu koko piha, a me ka loiloi ulu ʻana o ka fetal ma o ka ultrasound (ma muli o ka mana o ka lawelawe a me ke ala kuhikuhi).
Ka ʻike ʻana a me ka ʻike ʻana i ka pilikia
Ma hope o ka loiloi ʻana, hana ke kahu maʻi i kahi hōʻailona obstetric a me nā pilikia e hiki mai ana, no ka laʻana:
– Hāpai kino kiʻekiʻe me ka lupus.
– Ka pilikia o ka preeclampsia/gestational hypertension.
– Ka pilikia o ka IUGR a me ka hānau mua ʻana.
- Ka pilikia o ka thromboembolism, ʻoiai inā he antiphospholipid syndrome.
– Nā pono hoʻonaʻauao e pili ana i ka mālama ʻana i ka lāʻau lapaʻau, nā ʻano hoʻomaha, ka meaʻai, a me nā hōʻailona pōpilikia.
I ka hana maoli, pono nō hoʻi nā pale keiki e hoʻokaʻawale i nā hōʻailona o ka lupus flares mai nā pilikia obstetric e like me ka preeclampsia, no ka mea, hiki ke like nā mea ʻelua (e.g., proteinuria a me ke koko kiʻekiʻe). I ia mau kūlana, he mea nui ka kuhikuhi koke ʻana a me ka laulima ʻana i ka mālama ʻana.
Hoʻolālā Mālama
Hoʻokumu ʻia ka hoʻolālā ma ke kūlana o ka makuahine, ka makahiki hāpai, a me ke kūpaʻa o ka lupus. ʻO nā mea nui e komo pū ana me:
1. ʻOi aku ka pinepine o nā kipa ANC ma mua o nā hāpai maʻamau, e nānā i ke koko, ka edema, a me ke kūlana maʻamau.
2. Ka nānā mau ʻana i ka ʻōpū, me ke kiʻekiʻe o ka fundal uterine, ka neʻe ʻana o ka ʻōpū, a me nā kuhikuhi ultrasound serial e loiloi i ka ulu ʻana a me ka wai amniotic.
3. Hoʻolālā kuhikuhi i hoʻonohonoho pono ʻia inā ʻike ʻia nā hōʻailona o ka lapalapa ʻana, ka hoʻonui ʻia o ka proteinuria, ke koko kiʻekiʻe, ka emi ʻana o ka hana o nā puʻupaʻa, a i ʻole nā hopena nānā ʻana i ka fetal maikaʻi ʻole.
4. Ka hana lapaʻau hui pū ʻana, e hōʻoia ana e loaʻa ana i ka makuahine ka lāʻau lapaʻau palekana no ka hāpai ʻana a ʻaʻole e hoʻōki wale i ka lāʻau lapaʻau.
5. Ka hoʻonaʻauao koʻikoʻi a me ke aʻo ʻana, me ka hoʻolālā hānau ʻana ma kahi hale kuhikuhi i loaʻa ka mana e lawelawe i nā pilikia kiʻekiʻe.
Ka Hoʻokō ʻana (Nā Hana) o ka Mālama ʻana i nā Keiki Hānau
1. Mālama Ma mua o ka Hānau ʻana
ʻO nā ʻano hana antenatal no nā makuahine me ka lupus:
– Ke nānā ʻana i nā hōʻailona koʻikoʻi a me nā hōʻailona lapaʻau i kēlā me kēia kipa: ke koko, ka piʻi ʻana o ke kaumaha, ka edema, nā hoʻopiʻi no ka ʻeha a me ka ʻulaʻula o nā hono.
– Ke nānā ʻana no nā hōʻailona o ka preeclampsia: ʻeha poʻo, ʻike maka pohihihi, ʻeha puʻuwai, proteinuria (inā loaʻa), a me nā reflexes.
– Hoʻonaʻauao olakino: ke koʻikoʻi o ka hoʻomaha lawa, ka pale ʻana i ke kaumaha nui, ka mālama ʻana i ka hydration, a me ka kaupalena ʻana i ka nui o ka lā inā hoʻoulu ia i kahi ʻulaʻula.
– Kākoʻo meaʻai: kahi ʻai kaulike i waiwai i ka protein maikaʻi, ka hao, ka folate, ka calcium, a me ka palena paʻakai inā he hypertension/edema.
– Ke mālama nei i nā lāʻau lapaʻau: Ke kuhikuhi nei nā pale keiki e hoʻomau ʻia kekahi mau lāʻau lapaʻau, e like me ka hydroxychloroquine, e like me ke kuhikuhi a ke kauka no ka mea kōkua lākou i ka hoʻopau ʻana i nā lapalapa a hoʻomaikaʻi i nā hopena hāpai.
– Ke aʻo ʻana i nā hōʻailona pōpilikia: pono nā makuahine a me nā ʻohana e hoʻomaopopo i ka wā e hele koke ai i kahi kikowaena olakino.
2. Mālama Intranatal (Hānau ʻana)
ʻO ka mea maikaʻi loa, ʻo ka hānau ʻana o nā makuahine me ka lupus e hana ʻia ma kahi hale e hiki ai ke mālama i nā pilikia. ʻO nā ʻano hana intranatal:
– Ke kiaʻi pono ʻana i ke koko, ke kahe ʻana o ke koko, a me nā hōʻailona o ka pilikia.
– Ka mālama ʻana i ka ʻeha a me ka luhi me ke ʻano kākoʻo, no ka mea, ʻo nā makuahine me ka lupus he maʻalahi lākou i ka luhi.
- E manaʻo i nā pilikia e like me ka preeclampsia, ka placental abruption, a i ʻole ke kahe koko postpartum inā haʻahaʻa nā platelets.
– Ka laulima ʻana i nā kaʻina hana lapaʻau inā pono ka hoʻokomo ʻana, ka ʻoki caesarean, a i ʻole ka lawelawe ʻana i kekahi mau lāʻau lapaʻau.
Hoʻopaʻa ka pale keiki i ka palapala partograph, loiloi i ka holomua o ka hānau ʻana, a kuhikuhi koke inā he mau ʻokoʻa.
3. Mālama Ma hope o ka hānau ʻana
ʻO ka wā postpartum he manawa i maʻalahi i ka lupus flares. ʻO nā ʻano hana mālama postpartum e komo pū me:
– Ke nānā ʻana i nā hōʻailona o ka maʻi a me ke kahe ʻana o ke koko, me ka loiloi ʻana i ka involution o ka uterine a me ka lochia.
- E nānā i ke kahe koko a me nā hōʻailona o ka lapalapa, ʻoi aku hoʻi i nā pule mua.
– Kākoʻo hānai waiū: Hiki i ka hapa nui o nā wāhine me ka lupus ke hānai waiū, akā pono paha nā hoʻoponopono lāʻau. Hiki i nā pale keiki ke kōkua i nā makuahine e kūkākūkā i ka palekana o ka lāʻau me kā lākou mau kauka i ka wā hānai waiū.
– Ka hoʻokele luhi: paipai i ke kākoʻo ʻohana i hiki i ka makuahine ke loaʻa ka hoʻomaha lawa.
– Ke aʻo ʻana i ka hoʻolālā ʻohana: ke koho ʻana i kahi ʻano palekana e pili ana i kou kūlana (e laʻa, e noʻonoʻo ana i ka pilikia o ka thrombosis me kekahi mau ʻano hormonal a me nā kūlana antibody antiphospholipid). Pono e koho ʻia ka kaohi hānau ma o ke aʻo ʻana a me ka laulima ʻana me ke kauka.
Ka mālama ʻana i nā keiki hānau hou o nā makuahine me Lupus
Pono e nānā ʻia nā pēpē no ka hānau mua ʻana, ke kaumaha haʻahaʻa o ka hānau ʻana (LBW), a me nā hōʻailona o ka lupus neonatal (ka ʻōhūhū, nā maʻi koko, a i ʻole nā pilikia puʻuwai). Inā ʻike ʻia ka makuahine he mau antibodies anti-Ro/SSA a i ʻole anti-La/SSB, he mea nui ka nānā ʻana i ka puʻuwai fetal i ka wā hāpai a me ka loiloi postnatal. He kuleana ko nā pale keiki i ka ʻike mua ʻana i nā hōʻailona pōpilikia i nā pēpē hānau hou a me ka hōʻoia ʻana i ka kuhikuhi ʻana i kahi pediatrician inā pono.
Loiloi a me ka Palapala
Hana ʻia nā loiloi i kēlā me kēia manawa e hoʻoholo ai inā paʻa ka lupus, inā he mau pilikia obstetric, a me ke kūlana o ka ʻōpū/pēpē. Pono e piha nā palapala mālama: nā hopena loiloi, nā hoʻolālā, nā hana, ka hoʻonaʻauao, a me ka pane a ka makuahine. Hoʻoikaika ka palapala maikaʻi i ka hoʻomau ʻana o ka mālama ma waena o nā kahu hānai, nā kauka, a me nā hale kuhikuhi.
Ka hopena
Pono nā ʻano hana mālama kahu hānai no ka lupus i ka makaʻala nui a me kahi ʻano holoʻokoʻa. ʻO ke kuleana o ka kahu hānai e pili ana i ka loiloi hohonu, ka nānā pono ʻana, ka hoʻonaʻauao mau ʻana, ke kākoʻo noʻonoʻo, a me ka laulima ʻana ma waena o nā ʻoihana. Me ka hoʻolālā hāpai kūpono, ka nānā mau ʻana, a me ka kuhikuhi ʻana i ka manawa kūpono, hiki i nā wahine he nui me ka lupus ke loaʻa nā hāpai palekana a me nā hānau ʻana no ka makuahine a me ka pēpē.
Inā makemake ʻoe, hiki iaʻu ke hoʻololi i kēia ʻatikala i loko o kahi ʻano pepa (ʻikepili-hoʻonohonoho pilikia-kūkākūkā-hopena) a i ʻole e hoʻohui i kahi papa inoa e like me ke kaila APA/Vancouver.
