Maitiro Ekuchengetedza Vananyamukuta muLupus Cases
Pendauluan
Lupus, kunyanya Systemic Lupus Erythematosus (SLE), chirwere chisingaperi che autoimmune chinogona kukanganisa nhengo dzakasiyana-siyana dzakadai seganda, majoini, itsvo, ropa, mapapu, uye tsinga. Muvakadzi vari pazera rekubereka, lupus inonyanya kushungurudza nekuti inogona kukanganisa kubereka, pamuviri, uye kuchengetedzeka kwaamai nemwana ari mudumbu. Panyaya yekuzvitakura, nyaya dze lupus dzinoda nzira dzakakwana dzekutarisira dzinobva pakubatsirana kwevashandi. Vananyamukuta vanoita basa rekuona njodzi nekukurumidza, kutarisana nemwana ari mudumbu, dzidzo yehutano, uye kuona kuti vanotumirwa panguva yakakodzera kana paine njodzi.
Pfungwa huru dzeLupus mukuzvitakura
Kubata pamuviri kwevakadzi vane lupus kunoonekwa sepamuviri une njodzi huru. Lupus inogona kuva yakasimba (remission) kana kuti inoshanda (flare). Kubata pamuviri panguva ye active lupus kunobatanidzwa nekuwedzera kwenjodzi yezvinetso: preeclampsia, preterm labor, intrauterine growth restriction (IUGR), matambudziko eitsvo, thrombosis, anemia, thrombocytopenia, uye kunyange kufa kwemwana asati aberekwa. Uyezve, kuvapo kwemamwe ma antibodies, akadai se anti-Ro/SSA uye anti-La/SSB, kunowedzera njodzi ye neonatal lupus uye congenital heart block mumwana asati aberekwa. Saka, musimboti mukuru ndewokuronga pamuviri kana lupus yagara kwenguva refu kwemwedzi mitanhatu uye kunyatsotarisa panguva yekuzvitakura nepashure pekusununguka.
Zvinangwa zveKutarisirwa kweVananyamukuta muLupus Cases
Nzira dzekutarisira vanaamai vane lupus dzinovavarira:
1. Kuchengetedza chirwere chakagadzikana uye kudzivirira kudzoka kwacho.
2. Kukurumidza kuona matambudziko anokonzerwa nekuzvimba kwechibereko akadai se preeclampsia, matambudziko eitsvo, uye thromboembolism.
3. Tarisa kukura nekukura kwemwana ari mudumbu pamwe nekugara zvakanaka kwemwana ari mudumbu nguva dzose.
4. Ipai dzidzo nerutsigiro rwepfungwa kuitira kuti vanaamai vakwanise kuzviriritira.
5. Iva nechokwadi chekuti pane kubatana pakati pevanotumirwa kuchipatara uye kushanda pamwe chete nenyanzvi dzezvekubereka, mishonga yemukati/rheumatology, nephrology, uye pediatrics.
Kuongorora Kutarisirwa Kwevana Vakwegura
Kuongororwa kwe lupus kunoda ruzivo rwakadzama kupfuura pamuviri wakajairika. Nyamukuta anofanira kuunganidza ruzivo runotevera:
– Nhoroondo yechirwere cheLupus: kana chaonekwa, nhengo dzemuviri dzakabatanidzwa (kunyanya itsvo), kuwanda kwekuputika kweropa, uye nhoroondo yekuiswa muchipatara.
– Nhoroondo yemishonga: kushandiswa kwe corticosteroids, hydroxychloroquine, azathioprine, mishonga yekuderedza BP, kana mishonga yekudzivirira ropa kubva muropa. Zvakakosha kuongorora kutevedzera mitemo uye migumisiro yemishonga iyi.
– Nhoroondo yekusununguka: kubvisa pamuviri nguva nenguva, nguva isati yakwana, vana vanoberekwa vaine huremu hushoma, kufa kwemwana ari mudumbu, uye preeclampsia yekare.
– Zviratidzo zvekudzokera shure: kurwadziwa kwakanyanya kwemajoini, mapundu emudumbu, maronda emuromo, fivha isina hutachiona huri pachena, kuzvimba, kudzikira kwemvura inobuda, kushaya mweya, uye kuneta kwakanyanya.
– Zviratidzo zvengozi zvepamuviri: musoro wakanyanya, kuona zvisipo, kurwadziwa mudumbu, kuzvimba kamwe kamwe, kubuda ropa, kana kusafamba zvakanaka kwemwana ari mudumbu.
Kuongororwa kwemuviri kuchatarisa BP, kuzvimba, zviratidzo zvekushaya ropa, kuongororwa kweganda, uye mamiriro ekufema. Miedzo yekuwedzera inosanganisira kuongororwa kweweti yeprotein, mashandiro eitsvo, huwandu hweropa rose, uye kuongororwa kwekukura kwemwana ari mudumbu kuburikidza neultrasound (zvichienderana nesimba remushandi uye nzira yekutumira mwana kuchipatara).
Kuongorora uye Kuziva Dambudziko
Mushure mekuongororwa, nyamukuta anogadzira kuongororwa kwemwana ane pamuviri pamwe nematambudziko angangoitika, semuenzaniso:
– Pamuviri une njodzi huru nekuda kwechirwere che lupus.
– Njodzi ye preeclampsia/gestational BP.
– Njodzi yeIUGR uye nguva isati yakwana.
– Njodzi ye thromboembolism, kunyanya kana paine antiphospholipid syndrome.
- Zvinodiwa pakudzidza zvine chekuita nekutevedzera marapirwo, maitiro ekuzorora, kudya kunovaka muviri, uye zviratidzo zvengozi.
Mukuita, vananyamukuta vanofanirawo kusiyanisa zviratidzo zve lupus flares nematambudziko ekusununguka akadai se preeclampsia, sezvo zviviri izvi zvichigona kufanana (semuenzaniso, proteinuria neBP). Mumamiriro ezvinhu akadaro, kutumira varwere nekukurumidza uye kushanda pamwe chete zvakakosha pakutarisira varwere.
Kuronga Kutarisira
Chirongwa ichi chakavakirwa pamamiriro emuviri waamai, zera repamuviri, uye kugadzikana kwe lupus. Zvinhu zvikuru zvinosanganisira:
1. Kuenda kuchipatara cheANC kunowanzoitwa kakawanda kupfuura panguva yekuzvitakura, kuti vaongorore BP, kuzvimba, uye mamiriro emuviri wese.
2. Kugara uchitarisa mwana ari mudumbu, kusanganisira kureba kwechibereko, kufamba kwemwana ari mudumbu, uye kutumirwa kunoongororwa neultrasound kuti vaone kukura uye mvura yemudumbu.
3. Hurongwa hwekutumira mwana kana zviratidzo zvekubuda ropa, kuwedzera kweproteinuria, BP, kusashanda zvakanaka kweitsvo, kana kusanyatso tarisa mwana ari mudumbu.
4. Kurapa pamwe chete, kuve nechokwadi chekuti amai vanowana kurapwa kwakachengeteka pamuviri uye kusingamisi mushonga wega wega.
5. Dzidzo yakadzama uye mazano, kusanganisira kuronga kubereka panzvimbo yekutumira vana ine simba rekugadzirisa njodzi huru.
Kuitwa (Maitiro) eKutarisirwa kweVananyamukuta
1. Kutarisirwa Kwevanhu Vasati Vazvarwa
Nzira dzekudzivirira pamuviri dzinoshandiswa navanaamai vane lupus dzinosanganisira:
– Kuongororwa kwezviratidzo zvinokosha uye zviratidzo zvekiriniki panguva imwe neimwe yekushanya: BP, kuwedzera huremu, kuzvimba, kunyunyuta kwekurwadziwa kwemajoini/mapundu/fivha.
– Kuongororwa kwezviratidzo zve preeclampsia: musoro, kuona zvisipo, chirungurira, proteinuria (kana iripo), uye reflexes.
– Dzidzo yehutano: kukosha kwekuzorora zvakakwana, kudzivirira kushushikana kwakanyanya, kuchengetedza mvura yakakwana mumuviri, uye kuderedza kupiswa nezuva zvakanyanya kana zvichikonzera mapundu.
– Rutsigiro rwezvekudya: kudya kwakaringana kwakapfuma muprotein, iron, folate, calcium, uye munyu kana paine BP/edema.
– Kutevedzera mishonga: Vananyamukuta vanosimbisa kuti mimwe mishonga, yakaita sehydroxychloroquine, inowanzo kurudzirwa kuti irambe ichishandiswa sezvakarairwa nachiremba nekuti inobatsira kudzikamisa kubuda kweropa uye kuvandudza mhedzisiro yekuzvitakura.
– Mazano ezviratidzo zvine njodzi: vanaamai nemhuri vanofanira kunzwisisa nguva yekuenda kuchipatara nekukurumidza.
2. Kutarisirwa Kwemwana Pamuviri (Kusununguka)
Kusununguka kwevanaamai vane lupus kunofanira kuitwa munzvimbo inokwanisa kugadzirisa matambudziko. Nzira dzekudzivirira pamuviri dzinosanganisira:
- Kunyatso tarisa BP, kubuda ropa, uye zviratidzo zvekutambudzika.
- Kudzora marwadzo nekuneta nenzira yekutsigira, nekuti vanaamai vane lupus vanowanzo kuneta.
– Fambira matambudziko akadai se preeclampsia, placenta abruption, kana kubuda ropa mushure mekusununguka kana maplatelet ari mashoma.
– Kushanda pamwe chete mukurapa kana zvichidikanwa kuti mwana atange kuvhiyiwa, kuvhiyiwa kwemwana, kana kupa mimwe mishonga.
Nyamukuta anoona kuti panowanikwa gwaro reparrograph, anoongorora kufambira mberi kwekusununguka, uye anobva angotumira mashoko kana paine zvimwe zvinhu zvisina kunaka.
3. Kutarisirwa Kwemwana Mushure mekusununguka
Nguva yekusununguka inguva inowanzobatwa nechirwere che lupus flares. Nzira dzekuchengeta mwana mushure mekusununguka dzinosanganisira:
- Kutarisa zviratidzo zvehutachiona uye kubuda ropa, kusanganisira kuongorora kupararira kwechibereko uye lochia.
- Tarisa BP uye zviratidzo zvekubuda kweropa, kunyanya mumavhiki ekutanga.
– Rutsigiro rwekuyamwisa: Vakadzi vazhinji vane lupus vanogona kuyamwisa, asi kugadziriswa kwemishonga kunogona kudiwa. Vananyamukuta vanogona kubatsira vanaamai kukurukura nezvekuchengetedzwa kwemishonga navanachiremba vavo panguva yekuyamwisa.
– Kudzora kuneta: kurudzira rutsigiro rwemhuri kuitira kuti amai vawane zororo rakakwana.
– Mazano ekuronga mhuri: kusarudza nzira yakachengeteka zvichienderana nemamiriro ako ezvinhu (semuenzaniso, kufunga nezvengozi yekubuda ropa muropa uchishandisa dzimwe nzira dzemahormone uye mamiriro ekudzivirira phospholipid antibody). Sarudzo yenzira dzekudzivirira pamuviri inofanira kuitwa kuburikidza nekupa mazano uye kushanda pamwe chete nachiremba.
Kutarisira Vana Vacheche Vane Vanaamai Vane Lupus
Vacheche vanofanira kutariswa kuti vaone kana vacheche vasati vasvika nguva yekuzvarwa, vane huremu hushoma (LBW), uye zviratidzo zve lupus yevana vacheche (mapundu, zvirwere zveropa, kana matambudziko emwoyo). Kana amai vachizivikanwa kuti vane anti-Ro/SSA kana anti-La/SSB antibodies, kutarisa moyo wemwana ari mudumbu panguva yekuzvitakura uye kuongororwa mushure mekusununguka kwakakosha. Vananyamukuta vane basa rekuona zviratidzo zvengozi muvana vacheche uye kuona kuti vanotumirwa kuna chiremba wevana kana zvichidikanwa.
Kuongorora uye Zvinyorwa
Ongororo dzinoitwa nguva nenguva kuti vaone kana lupus ichiri yakasimba, kana paine matambudziko ekusununguka, uye mamiriro emwana ari mudumbu/mwana. Magwaro ekutarisira anofanira kunge akakwana: mhedzisiro yekuongorora, zvirongwa, zviito, dzidzo, uye mhinduro yaamai. Magwaro akanaka anosimbisa kuenderera mberi kwekutarisira pakati pevananyamukuta, vanachiremba, nenzvimbo dzinotumirwa kune vanorwara.
Mhedziso
Maitiro ekuchengetedza madzimai ane lupus anoda kungwarira kwakanyanya uye nzira yakakwana. Basa raamai vanoyamwisa rinosanganisira kuongorora zvakadzama, kutarisa kwakanyatsojeka, kudzidzisa nguva dzose, kutsigirana kwepfungwa, uye kushanda pamwe chete nevashandi. Nekuronga pamuviri zvakanaka, kutarisa nguva dzose, uye kutumira varwere panguva yakakodzera, vakadzi vazhinji vane lupus vanogona kuva nepamuviri pakachengeteka uye kusununguka kwakachengeteka kuna amai nemwana.
Kana muchida, ndinogona kugadzirisa chinyorwa ichi kuita pepa (background-problem formulation-discussion-conclusion) kana kuwedzera bibliography zvichienderana neAPA/Vancouver style.
