Kutarisirwa Kwevana Vane Preeclampsia Yakanyanya
Pendauluan
Preeclampsia yakanyanya idambudziko rinogona kuisa upenyu pamwana pamuviri paamai nemwana ari mudumbu. Dambudziko iri rinowanzoonekwa mushure memavhiki makumi maviri ekuzvitakura uye rinoratidzwa neBP inoperekedzwa nezviratidzo zvekukuvadzwa kwenhengo dzemuviri, zvakaita sekutadza kushanda zvakanaka kweitsvo, chiropa, hematological, kana central nervous system. Mukurapa kwekuzvitakura, preeclampsia yakanyanya inoda rubatsiro rwekukurumidza, rwakarongeka, uye rwekushandira pamwe nekuti inogona kufambira mberi ku eclampsia, HELLP syndrome, pulmonary edema, stroke, uye kunyange kufa kwaamai. Nokudaro, vananyamukuta vanoita basa rakakosha mukuona mwana nekukurumidza, kugadzikana kwemwana nekukurumidza, kutarisa kwakanyatsojeka, kudzidziswa, uye kutumira mwana kuchipatara nenguva.
Tsanangudzo uye Zvinodiwa zvePreeclampsia Yakanyanya
Mukurapa, preeclampsia yakanyanya inotsanangurwa se preeclampsia ine BP yakanyanya kana zviratidzo zvekunyevera. Zvinonyanya kushandiswa zvinosanganisira BP ≥160/110 mmHg kaviri, thrombocytopenia, ma enzymes echiropa akakwira, kurwadziwa kwe epigastric/right upper quadrant, kusashanda zvakanaka kweitsvo (creatinine yakakwira kana oliguria), kuzvimba kwemapapu, uye zvirwere zvetsinga zvakaita semusoro wakanyanya, matambudziko ekuona, uye kusaziva kwakaderera. Proteinuria inogona kunge iripo kana kusavapo; humbowo hwekuti nhengo dzemuviri hadzina kushanda zvakanaka hunosimbiswa. Kuziva izvi zvakakosha sehwaro hwekutarisirwa kwevananyamukuta zvichibva pakuisa kuchengetedzeka kweamai nemwana ari mudumbu pakutanga.
Etiology uye Zvinhu Zvinokonzera Njodzi
Chikonzero chaicho che preeclampsia hachinzwisiswi zvizere, asi chinobatanidzwa nekusagadzikana kweplacenta, kusashanda zvakanaka kwe endothelial, uye kuzvimba kwemuviri kunokonzera kupwanya kweropa uye kusashanda zvakanaka kwenhengo. Zvinhu zvine njodzi zvinosanganisira pamuviri wekutanga, makore ari pasi pemakore makumi maviri kana anopfuura makumi matatu nemashanu, nhoroondo ye preeclampsia, BP isingaperi, chirwere cheshuga, kufuta, chirwere cheitsvo, pamuviri kakawanda, uye kuvapo kwezvirwere zve autoimmune. Vananyamukuta vanofanira kuongorora zvinhu zvine njodzi pakushanya kwemwana asati aberekwa kuti vaone kuti kuongororwa kwacho kwakasimba uye kudiwa kwekutumira tsamba kuchipatara.
Zviratidzo Nezviratidzo Zvekuchenjerera
Mu preeclampsia yakanyanya, vanaamai vanogona kunyunyuta nemusoro wakanyanya, kuona zvisizvo, kutya kutsvuka, kuda kurutsa, kurutsa, kurwadziwa mudumbu, kufema kushoma, uye kuzvimba kuri kuwedzera. Zviratidzo zvechinangwa zvinosanganisira BP yakakwira, hyperreflexia, kudzikira kwemvura inobuda, kuwedzera uremu kamwe kamwe, uye zviratidzo zvekushungurudzika kwemwana ari mudumbu zvakaita sekudzikira kwekufamba kwemwana ari mudumbu. Vananyamukuta vanofanira kutanga kuona zviratidzo zvine njodzi, sezvo kunonoka kurapwa kunogona kukonzera matambudziko akakomba.
Nheyo dzeKutarisira Vananyamukuta paPreeclampsia Yakakomba
Kutarisirwa kwevananyamukuta kana paine preeclampsia yakanyanya kunotarisa pane zvinotevera: (1) kugadzikana kweamai, (2) kudzivirira pfari, (3) kudzora BP, (4) kutarisa hutano hwemwana ari mudumbu, (5) kuona matambudziko nekukurumidza, uye (6) kugadzirira kusununguka kana kutumira mwana kuchipatara. Pfungwa huru yekurangarira ndeyekuti mushonga chaiwo we preeclampsia kubvisa pamuviri kana amai vagadzikana, tichifunga nezvezera repamuviri uye mamiriro emwana ari mudumbu.
Ongororo Yakakwana
Nyamukuta anoita ongororo nekukurumidza uye zvakanangana. Ruzivo rwemunhu anoona nezvemwana runosanganisira chichemo chikuru, nhoroondo yekuzvitakura, nhoroondo yekurapwa, kudya, zviito, uye kutevedzera zvinodiwa neongororo. Ruzivo rwechinangwa runosanganisira zviratidzo zvinokosha (BP, pulse, kufema, tembiricha), mamiriro etsinga, patellar reflex, kuzvimba, uye kuongororwa kwekufema kwemwana kuti aone zviratidzo zvekuzvimba kwemapapu. Kuongororwa kwepamuviri kwakadai sekukwirira kwedumbu, kuratidzwa kwemwana ari mudumbu, kurova kwemoyo kwemwana ari mudumbu, uye kuongororwa kwekufamba kwemwana ari mudumbu zvakakoshawo.
Pamusoro pezvo, vananyamukuta vanobatana pakutsigira kuongororwa: mapuroteni emuweti, huwandu hweropa rakazara (kunyanya maplatelet), mashandiro eitsvo (urea, creatinine), mashandiro echiropa (AST/ALT), uye, kana zvichidikanwa, zvidzidzo zvekuvhara ropa. Kana zviripo, kuongororwa kwemwana ari mudumbu kuburikidza ne ultrasound (kukura, huwandu hwemvura yeamniotic) uye Doppler zvinogona kubatsira kuona mamiriro eplacenta uye kuyerera kweropa.
Kuongorora Mimba uye Matambudziko Anogona Kuitika
Zvichibva pamhedzisiro yeongororo, nyamukuta anoona kuongororwa kwemwana ari mudumbu, semuenzaniso: "Kukanganiswa kweropa munyama kunokonzerwa nekuputika kweropa mu preeclampsia yakanyanya" kana "Njodzi huru yekubatwa nepfari (eclampsia)." Matambudziko angangoitika anofanirwa kutarisirwa anosanganisira eclampsia, kubuda ropa muuropi, kuzvimba kwemapapu, kutadza kweitsvo zvakanyanya, kuvharika kweplacenta, uye kushushikana kwemwana ari mudumbu. Kuziva matambudziko angangoitika kunobatsira kugadzira hurongwa hwekudzivirira uye hwekugadzirisa matambudziko.
Kupindira Kukuru: Kudzikamisa uye Kudzivirira Kubatwa
Danho rekutanga nderekuona kuti mweya unobuda, kufema, uye kutenderera kweropa (ABCs). Amai vanoiswa kuruboshwe rwavo kuti vawedzere kubuda kweropa mudumbu uye vaderedze kumanikidzwa kwevena cava. Nzvimbo yacho inochengetwa yakadzikama uye isinganyanyi kukurudzira kuderedza njodzi yekubatwa nepfari. Kumanikidzwa kweropa kunoongororwa nguva nenguva, kazhinji maminetsi gumi nemashanu kusvika makumi matatu panguva yechirwere ichi.
Kudzivirira pfari ndiko kunonyanya kukosha. Magnesium sulfate ndiyo mushonga unosarudzwa kudzivirira pfari uye kurapwa muvanhu vane preeclampsia yakanyanya. Vananyamukuta vanofanira kutarisa zviratidzo zve magnesium chepfu, zvakaita sekudzikira kwe patellar reflex, kufema kushoma, uye kudzikira kwekuziva, uye kuona kuti calcium gluconate inorapwa zvichienderana nemutemo wechipatara. Uyezve, kutarisa diuresis kwakakosha nekuti magnesium inoburitswa kuburikidza neitsvo; oliguria inowedzera njodzi yekukuvadzwa.
Kudzora Kumanikidzwa Kweropa uye Kutarisira Mvura
Kuwedzerwa kweropa kwakanyanya kunofanira kuderedzwa kudzivirira sitiroko, asi kudzikira kwacho hakufanirwe kunge kwakanyanya, sezvo kuchigona kukanganisa kubuda kweropa mudumbu. Kurapa kweropa kunoderedza BP (semuenzaniso, nifedipine, labetalol, kana hydralazine, zvichienderana nemutemo wekiriniki) kunopihwa pamwe chete. Basa ranyamukuta nderekuona kuti mishonga inopihwa zvakakodzera, kutarisa migumisiro, kuona BP nguva dzose, uye kunyora maitiro aamai.
Kutarisirwa kwemvura kunoda kunyatsotarisirwa. Preeclampsia yakanyanya ine njodzi yekubuda kwemvura mumapapu, izvo zvinogona kukonzera kuzvimba kwemapapu kana paine mvura yakawanda. Vananyamukuta vanoongorora kunwa kwemvura uye kubuda kwayo, vanoisa catheter yeweti kana zvichidikanwa kuti vayere kubuda kwayo, uye vanotaura nezve kudzikira kwemvura inobuda. Weti inobuda kazhinji inenge iri 30 ml/awa, asi maitiro emunharaunda anofanira kugadziriswa nguva dzose.
Kutarisa Hutano hweMwana Ari Mudumbu uye Kugadzirira Kuzvara
Vana vacheche vane preeclampsia yakanyanya vari panjodzi yekudzora kukura kwemwana mukati mechibereko (IUGR) uye kutambudzika kwemwana nekuda kwekudzikira kweropa rinobuda muchibereko. Vananyamukuta vanoongorora kurova kwemoyo kwemwana, kufamba kwemwana, uye zviratidzo zvekubuda kwemwana mudumbu, zvakaita sekurwadziwa kwemudumbu nekubuda ropa kamwe kamwe. Kunzvimbo dzinotumirwa vana, kuongororwa kweCTG neultrasound kunobatsira kuona nguva uye nzira yekusununguka.
Kubereka mwana ndiyo nzira chaiyo yekurapa. Kana pamuviri pacho pakazara kana kuti mamiriro emwana ari mudumbu akanyanya kuipa, kubvisa pamuviri nekukurumidza ndiyo nzira inowanzo shandiswa. Vananyamukuta vanoita basa rekugadzirira kusununguka, kusanganisira kupa mwana mvura inobuda mutsinga dzeropa sezvinodiwa, kugadzirira mishonga yekukurumidzira, kugadzirira kumutswa kwemwana achangoberekwa, uye kupa rutsigiro rwepfungwa kuna amai nemhuri. Nzira yekusununguka (kubereka nepanhengo yechikadzi kana yekubvisa pamuviri) inosarudzwa nachiremba zvichibva pazviratidzo zvekusununguka uye mamiriro ekurapa.
Dzidzo, Rutsigiro, uye Kutumira Vamwe
Dzidzo kuna amai nemhuri inosanganisira tsananguro ye preeclampsia, zviratidzo zvinonyevera (musoro wakanyanya, kuona zvisizvo, chirungurira, kushaya mweya, pfari), kukosha kwekuzorora, kutevedzera mishonga, uye purogiramu yekutevera zvakanyatsonaka. Vananyamukuta vanopawo rutsigiro rwepfungwa, sezvo kuongororwa uku kunowanzo kukonzera kuzvidya mwoyo.
Kutumirwa kwechiremba kunofanirwa kuitwa kana nzvimbo yacho isingakwanise kupa rubatsiro rwakakwana. Nheyo yekutumira chiremba kune preeclampsia yakanyanya ndeyekuti "kutumira chiremba mushure mekugadzikana kwekutanga," kusanganisira kuona kuti mweya uri kufamba zvakanaka, kugadziriswa/kudziviswa kwepfari, kudzora BP, kuwanikwa kwenzira yekupinda mutsinga, uye magwaro akazara ekutumira chiremba. Panguva yekutumira chiremba, rutsigiro kubva kunyanzvi yehutano nekutarisa vanaamai kwakakosha kudzivirira kuora kwechirwere munzira.
Kutarisirwa Kwemwana Mushure mekusununguka uye Kudzivirira Kudzokorora
Preeclampsia inogona kuwedzera kana kuoneka kekutanga panguva yekusununguka. Nokudaro, kutarisa BP uye zviratidzo zvekunyevera zvinoenderera mberi mushure mekusununguka. Magnesium sulfate inowanzo enderera mberi zvichienderana nemutemo wekudzivirira pfari mushure mekusununguka. Vananyamukuta vanoongorora kubuda ropa, kubuda kwemvura mumuviri, mamiriro etsinga, uye zviratidzo zvekuputika kwemapapu. Mazano ekuronga mhuri akakoshawo; sarudzo yenzira inogadziriswa zvichienderana nemamiriro eamai uye BP.
Mukufamba kwenguva, vanaamai vane nhoroondo ye preeclampsia vane njodzi yakakura yekurwara neBP uye chirwere chemwoyo. Vananyamukuta vanogona kukurudzira kuongororwa hutano nguva dzose, mararamiro ane hutano, uye dzidzo nezvenjodzi dziripo pakubata pamuviri mune ramangwana, kusanganisira mazano ekurapwa kwemwana asati aberekwa (ANC) nekukurumidza uye kakawanda.
Mhedziso
Kutarisirwa kwevananyamukuta vane preeclampsia yakanyanya kunoda kuongororwa kwakazara, kugadziriswa nekukurumidza, kutariswa kwakanyatsojeka, uye kushanda pamwe chete nechikwata chekurapa. Chinangwa chikuru ndechekudzivirira matambudziko akakomba akadai se eclampsia nestroke, kuchengetedza hutano hwemwana ari mudumbu, uye kugadzirira kubvisa pamuviri nenguva. Nekuonekwa nekukurumidza, nzira dzakakodzera dzekurapa, dzidzo yakakodzera, uye kutumira vanhu nekukurumidza kana zvichidikanwa, vananyamukuta vanogona kubatsira zvakanyanya mukuderedza kurwara kwevanaamai nevacheche pamwe nekufa nekuda kwe preeclampsia yakanyanya.
