Kutarisirwa Kwevana Vari Kuyamwisa Muzviitiko Zvekushaya Kwemwoyo
Kukundikana kwemoyo chirwere chinokonzerwa nekuti mwoyo haugone kupomba ropa zvinobudirira kuti ugutse zvinodiwa nemuviri. Mukurapa kwevana vanozvara, kukundikana kwemoyo kunopa dambudziko guru nekuti pamuviri pachawo unokonzera shanduko dzemuviri dzinowedzera basa remwoyo. Nokudaro, kutarisira vakadzi vane pamuviri, vanozvara, vanozvara mushure mekusununguka, uye vanoyamwisa vane kukundikana kwemoyo kunofanira kunge kwakazara, kwakarongwa, uye kunoshanda pamwe chete, navanachiremba vezvekuzvara nevanachiremba vemwoyo. Chinyorwa chino chinokurukura misimboti, matanho ekutarisira, uye chinangwa chekutarisira chinofanira kushandiswa kuona kuchengetedzeka kwaamai nemwana ari mudumbu.
1. Nhoroondo: Kubata Pamuviri uye Mutoro weMwoyo
Munguva yekuzvitakura, huwandu hweropa hunowedzera, kurova kwemoyo kunowedzera, uye kubuda kwemoyo kunowedzera zvakanyanya. Kuchinja uku kwakajairika, asi kuvakadzi vane chirwere chemwoyo kana kusashanda zvakanaka kwepombi, nzira dzekugadzirisa dzinogona kutadza, zvichikonzera zviratidzo zvekushaya simba kwemoyo. Dambudziko iri rinogona kuipa, kunyanya mumwedzi mitatu yechipiri neyechitatu, panguva yekusununguka (nekuda kwekurwadziwa, kushushikana, uye kuchinja kweropa), uye pakutanga kwenguva yekusununguka nekuda kwe "autotransfusion" kubva muchibereko chinogumbura uye kuchinja kwehuwandu hwemvura.
Kukundikana kwemoyo panguva yekuzvitakura kunogona kukonzerwa nechirwere chemwoyo chekuzvarwa nacho, kusagadzikana kwemavharuvhu (senge mitral stenosis), cardiomyopathy mushure mekusununguka, BP isingaperi, preeclampsia yakanyanya, anemia yakanyanya, kana hutachiona. Kuzvitakura kunoita basa rakakosha mukuona nekukurumidza, kudzidzisa, kutarisa zvakanyanya, uye kutumira varwere kuchipatara nenguva.
2. Zvinangwa zveKutarisirwa kweVananyamukuta
Kutarisirwa kwevanamukoti kana paine kutadza kwemoyo kunonangana ne:
1. Kurumidza kuona zviratidzo zvengozi uye kudzivirira kuderedzwa kwemari.
2. Kuchengetedza kugadzikana kweropa raamai uye oxygen yakakwana.
3. Kuvandudza kukura kwemwana ari mudumbu uye kugara zvakanaka kwake.
4. Kuronga kusununguka kwakachengeteka zvichienderana nemamiriro ekurapa.
5. Kudzivirira matambudziko epamuviri mushure mekusununguka akadai sekuputika kwemapapu, thromboembolism, uye hutachiona.
6. Kupa mazano pamusoro pekuyamwisa, kuronga mhuri, uye kuronga pamuviri unotevera.
3. Kuongororwa kweKubereka
Ongororo yacho inofanira kunge yakazara, kusanganisira anamnesis, kuongororwa kwemuviri, uye kuongororwa kwezvinhu zvine njodzi.
a. Kuongororwa kwenhoroondo yehupenyu
Nyamukuta anofanira kubvunza kuti:
– Kunyunyuta nezvekupererwa nemweya (kunyanya panguva yekushanda, pakurara pasi/orthopnea, kana paroxysmal nocturnal dyspnea).
- Kuneta zviri nyore, kurova kwemoyo, kurwadziwa muchipfuva, dzungu kana kufenda.
– Kukosora, kunyanya husiku, kufemereka, kana kukosora furo rinobuda (chiratidzo chekuzvimba kwemapapu).
– Kuzvimba kwemakumbo, kuwedzera uremu nekukurumidza, kudzikira kwemvura inobuda mumuviri.
– Nhoroondo yechirwere chemwoyo/BP, kushandiswa kwemishonga yemwoyo, nhoroondo yekurara muchipatara.
– Nhoroondo yekuzvitakura: preeclampsia, kubuda ropa, anemia, matambudziko akamboitika.
b. Kuongororwa kwemuviri
Tarisa pane:
– Zviratidzo zvinokosha: kumanikidzwa kweropa, kurova kwemoyo, kufema, oxygen saturation, tembiricha.
– Zviratidzo zvekushaya simba kwemoyo: kuzvimba kweropa, kuwedzera kweJVP (mutsinga wejugular), kunyorova kwemapapu, hepatomegaly, cyanosis.
– Kuongororwa kwemamiriro emvura: kuenzana kwezvinobuda nezvinopinzwa, turgor, mwero wekuzvimba.
– Kuongororwa kwechibereko: kureba kwedumbu, kubuda kwemwana ari mudumbu, DJJ, kufamba kwemwana ari mudumbu, zviratidzo zvekusununguka.
c. Kutsigira bvunzo (kubatsirana)
Vananyamukuta vanobatsira pakutumirwa/kubatsirana kwe:
– ECG, echocardiography, chest X-ray kana zvichidikanwa (tichifunga nezvepamuviri), BNP kana iripo.
– Kuongororwa kweHb (kushayiwa ropa kunowedzera kutadza kwemoyo), kushanda kweitsvo, ma electrolytes.
– Ultrasound yekuzvitakura, ichitarisa kukura kwemwana ari mudumbu uye mvura yemudumbu.
4. Kuongorora Utachiona Hwepamuviri uye Matambudziko Angangoitika
Panyaya yekuzvitakura, matambudziko anowanzoitika anosanganisira:
– Njodzi yekudzikira kwesimba remwoyo inokanganisa kuyerera kweropa mudumbu.
– Kusakwanisa kuita zvinhu nekuda kwekusawirirana pakati pekuwanikwa kweokisijeni nekudiwa kwayo.
– Njodzi yekukanganisa kuchinjana kwemagasi (pulmonary edema).
– Njodzi yekuwanda kwemvura mumuviri/kuzvimba.
- Kunetseka uye kushaya ruzivo nezvezvirwere, mishonga, uye zvirongwa zvekusununguka.
– Njodzi yekuzvarwa nguva isati yakwana kana kuti kudziviswa kwekukura kwemwana muchibereko (IUGR) nekuda kwekudzikira kweropa rinoyerera.
5. Kuronga uye Kupindira Kwekuchengetedzwa Kwevana Vachizvara
a. Kuchinja kwedzidzo nemararamiro
Vananyamukuta vanopa mazano anoshanda:
– Zorora zvakakwana, rara nerutivi rwako rweruboshwe kuti ropa ridzoke zvakanaka.
- Deredza mabasa anorema; kurudzira mabasa akareruka sezvinobvumidzwa.
- Kudya kwakaringana, kuderedza munyu kana zvichikurudzirwa nachiremba, uye kutarisa kuwedzera kwehuremu.
– Dzivisa fodya, doro, uye mishonga isingapihwe mushonga nachiremba.
– Ziva zviratidzo zvengozi: kufema nekukurumidza, kukosora kunenge kune furo, kurwadziwa pachipfuva, kupera simba, kuzvimba nekukurumidza, kudzikira kwekufamba kwemwana ari mudumbu.
b. Kunyatsoongorora pamuviri
- Kushanya kakawanda uchiongorora zviratidzo zvakakosha.
- Tarisa huremu hwemuviri, kuzvimba, uye diuresis.
– Tarisa hutano hwemwana ari mudumbu: FHR, kufamba kwemwana ari mudumbu, fundus yechibereko; tumirai kunoitwa serial ultrasound kana zvichidikanwa.
– Iva nechokwadi chekutevedzera mishonga (diuretics, beta-blockers, mamwe maanticoagulants, nezvimwewo) sezvakarairwa nachiremba wako. Vananyamukuta vanofanira kukuyeuchidza kuti mimwe mishonga yemwoyo haina njodzi panguva yekuzvitakura, saka mishonga yese inofanira kunyorerwa nachiremba.
c. Kushandira pamwe nekutumira vamwe
Nyaya dzekukundikana kwemoyo panguva yekuzvitakura dzinowanzoonekwa sedzine njodzi huru. Vananyamukuta vanofanira:
– Enda kunzvimbo ine rubatsiro rwekubatsirwa kwepamuviri nekubatsirwa neICU kana zvichidikanwa.
- Batanai pamwe chete kuti muone mhando yemabasa (semuenzaniso NYHA), pamwe chete nehurongwa hwemunhu mumwe nemumwe hwekupa zvinhu.
- Iva nechokwadi chekuti ropa ragadzirira, mishonga yekukurumidzira, uye kuti vanhu vanowana rubatsiro nekukurumidza.
d. Kudzivirira matambudziko
– Kudzivirira anemia: kuwedzera iron, folate, uye kutarisira anemia kwakajairika.
– Kudzivirira hutachiona: dzidzo yehutsanana, kuona nekukurumidza hutachiona hwekufema/hweweti hunogona kukonzera kucheneswa kwemari.
– Kudzivirira thromboembolism: kufamba zvishoma nezvishoma, kunyoroveswa kwemvura mumuviri, kushandisa masokisi ekudzvanya kana zvichikurudzirwa, uye kutevedzera mishonga inorwisa ropa kana yakapihwa.
6. Kutarisirwa Kwemwana Mukati Mekusununguka (Panguva Yekusununguka)
Kusununguka kwemwana kuvakadzi vane chirwere chemwoyo kunofanira kurongwa. Chinangwa chikuru ndechekuderedza kushushikana, marwadzo, uye kuchinja kweropa kamwe kamwe.
Nheyo dzekutarisira mwana panguva yekusununguka:
– Kuzvara mwana kunofanira kuitwa muchipatara chevanopa rubatsiro rwechiremba vane timu yevanachiremba vane hunyanzvi hwakasiyana-siyana.
- Kuramba uchitarisa zviratidzo zvehupenyu, kuwanda kweropa, uye mamiriro emapapu.
- Kurerekera kuruboshwe/kusendama zvishoma kuti uderedze mutoro pamoyo.
– Kutarisirwa kwemvura zvakanyanya: dzivisa mvura yakawanda inopinzwa mutsinga.
- Kuderedza marwadzo zvakakwana kuderedza kushushikana (kushanda pamwe chete neanesthesia).
– Danho rechipiri rinopfupikiswa kana zvichidikanwa (semuenzaniso nekubvisa vacuum/forceps sezvakaratidzwa nachiremba) kuitira kuti amai vasazosundidzira kwenguva yakareba.
– Dzivisa mishonga inogona kuwedzera matambudziko emwoyo pasina zviratidzo zvakasimba; kushandiswa kwemudumbu kunofanirawo kuitwa nekungwarira uye zvichienderana nemutemo wachiremba.
Sarudzo maererano nenzira yekusununguka (yekubereka nepamuviri kana yekuvhiyiwa) inobva pamamiriro emwoyo wemurwere, zera repamuviri, uye zviratidzo zvekusununguka. Zviitiko zvakawanda zvinobvumira kusununguka nepamuviri nekutarisirwa kwakakodzera, asi zvimwe zvirwere zvinoda kuvhiyiwa.
7. Kutarisirwa Kwemwana Mushure mekusununguka uye Kuyamwisa
Nguva yekusununguka, kunyanya maawa ekutanga 24-72, inguva yakakosha nekuti kuchinja nekukurumidza kwemvura kunogona kukonzera kuzvimba kwemapapu. Kutarisirwa kwemwana mushure mekusununguka kunosanganisira:
- Kunyatso tarisa zviratidzo zvehupenyu, kuwanda kwemuviri, zviratidzo zvekupererwa nemhepo, uye ruzha rwekufema.
- Kutarisa kuenzana kwemvura uye diuresis.
- Tsigira kuzorora, zvirambidzo zvekuita, uye nzvimbo dzakagadzikana.
– Kudzivirira kubuda ropa mushure mekusununguka (izvo zvinogona kuwedzera mamiriro eropa) ukuwo uchiri kungwarira kuchengetedzeka kwemishonga yemudumbu.
– Mazano ekuyamwisa: Vanaamai vazhinji vanogona kuyamwisa, asi sarudzo yacho inoenderana nekugadzikana kwekiriniki uye mishonga inoshandiswa (mimwe mishonga inogona kupinda mumukaka wezamu). Vananyamukuta vanofanira kukurudzira kubvunza chiremba kuti vaone kuti kuyamwisa kwakachengeteka.
8. Mazano Ekugadzirisa Kuronga Mhuri Nekuronga Kubata Pamuviri
Vananyamukuta vane basa guru mukupa mazano ekuronga mhuri mushure mekusununguka. Kubata pamuviri kunotevera kunofanira kurongwa nokungwarira sezvo kunogona kuwedzera kutadza kwemoyo. Nzira dzekudzivirira pamuviri dzinofanira kusarudzwa zvichienderana nemamiriro emurwere uye mazano achiremba. Mune dzimwe nguva dzakakomba, kubata pamuviri zvakare kunogona kuva nengozi huru, zvichida mazano akadzama maererano nekushandisa nzira dzekudzivirira pamuviri kwenguva refu.
9. Magwaro uye Kuenderera Mberi Kwekutarisira
Magwaro akazara anosanganisira zviratidzo, zviratidzo zvinokosha, mhedzisiro yekutarisa, kurapwa kwakapihwa, dzidzo, kutumira varwere kuchipatara, uye mhinduro dzevarwere. Kuramba uchitarisirwa kwakakosha: vananyamukuta vanoona kuti vanotevera nguva yakatarwa, vanotevedzera kuongororwa, uye kutaurirana kwakanaka pakati penzvimbo dzehutano.
Mhedziso
Kutarisirwa kwevana vane kutadza kwemoyo nekuda kwekusununguka kunoda kungwarira kwakanyanya, kuongororwa kwakazara, kutariswa kwakanyatsojeka, kudzidziswa kunoramba kuripo, uye kushanda pamwe chete mumabasa akasiyana-siyana. Chinangwa chikuru ndechekudzivirira kuputsika kwemwoyo, kuchengetedza kubuda kweropa mudumbu, kuronga kusununguka kwakachengeteka, uye kutarisira nguva yakakosha yekusununguka. Nekutarisirwa kwakakodzera uye kutumirwa kune vanhu vakakodzera, njodzi yematambudziko inogona kuderedzwa, zvichikonzera hutano hwakanaka kuna amai nemwana.
Kana muchida, ndinogona kugadzirisa chinyorwa chino kuita pepa resainzi (rizere nesumo-nzira-hurukuro-mhedziso) kana kuwedzera bhuku remabhuku nemagwaro ekurapa.
