Ukunakekelwa Kwababelethisi Ezimweni Zokwehluleka Kwenhliziyo
Ukwehluleka kwenhliziyo yisimo lapho inhliziyo ingakwazi ukupompa igazi ngempumelelo ukuze ihlangabezane nezidingo zomzimba. Emsebenzini wokubeletha, ukwehluleka kwenhliziyo kuletha inselele enkulu ngoba ukukhulelwa ngokwako kubangela izinguquko zomzimba ezandisa umthwalo womsebenzi wenhliziyo. Ngakho-ke, ukunakekelwa kwababelethisi kwabesifazane abakhulelwe, ababelethayo, abakhulelwe, nabancelisayo abanezinkinga zenhliziyo kumele kube okuphelele, kuhlelwe, futhi kubambisane, nodokotela bezifo zokubeletha kanye nodokotela bezifo zenhliziyo. Lesi sihloko sixoxa ngezimiso, izinyathelo zokunakekela, kanye nokugxila kokuqapha okumele kusetshenziswe ukuqinisekisa ukuphepha kukamama nomntwana osanda kuzalwa.
1. Isizinda: Ukukhulelwa kanye Nomthwalo Wenhliziyo Nemithambo Yegazi
Ngesikhathi sokukhulelwa, umthamo wegazi uyanda, izinga lokushaya kwenhliziyo liyakhula, kanye nokukhishwa kwenhliziyo kuyanda kakhulu. Lezi zinguquko zivamile, kodwa kwabesifazane abanesifo senhliziyo noma ukusebenza kahle kwephampu, izindlela zokubuyisela zingahluleka, okuholela ezimpawini zokwehluleka kwenhliziyo. Lesi simo singaba sibi kakhulu, ikakhulukazi ezinyangeni zesibili nezesithathu, ngesikhathi sokubeletha (ngenxa yobuhlungu, ukucindezeleka, kanye nezinguquko ze-hemodynamic), kanye nasesikhathini sokuqala sokuzala ngenxa "yokufakelwa igazi ngokuzenzakalelayo" esibelethweni esinciphile kanye nezinguquko kumthamo woketshezi.
Ukwehluleka kwenhliziyo ekukhulelweni kungabangelwa yisifo senhliziyo sokuzalwa, ukukhubazeka kwe-valve (njenge-mitral stenosis), i-cardiomyopathy ngemuva kokubeletha, umfutho wegazi ophakeme ongapheli, i-preeclampsia enzima, i-anemia enzima, noma ukutheleleka. I-Obstetrics idlala indima ebalulekile ekutholakaleni kusenesikhathi, ekufundisweni, ekuqapheni eduze, kanye nokudluliselwa ngesikhathi esifanele.
2. Izinhloso Zokunakekelwa Kwababelethisi
Ukunakekelwa kwababelethisi ezimweni zokwehluleka kwenhliziyo kuhlose:
1. Thola izimpawu zengozi kusenesikhathi futhi uvimbele ukubola kwesikweletu.
2. Gcina ukuqina kwe-hemodynamic kukamama kanye nokunikezwa komoya-mpilo okwanele.
3. Lungiselela ukukhula kanye nenhlalakahle yengane esanda kuzalwa.
4. Ukuhlela ukubeletha okuphephile ngokwezimo zezokwelapha.
5. Vimbela izinkinga zangemva kokubeletha ezifana nokuvuvukala kwamaphaphu, i-thromboembolism, kanye nokutheleleka.
6. Nikeza iseluleko ngokuncelisa, ukuhlela umndeni, kanye nokuhlela ukukhulelwa okulandelayo.
3. Ukuhlolwa Kokubelethisa
Ukuhlolwa kumele kube okuphelele, okuhlanganisa umlando, ukuhlolwa ngokomzimba, kanye nokuhlolwa kwezinto eziyingozi.
a. Umlando oqondisiwe
Umbelethisi udinga ukubuza:
– Izikhalazo zokuphelelwa umoya (ikakhulukazi ngesikhathi somsebenzi, lapho ulele phansi/ukuphazamiseka kwe-orthopnea, noma ukuphazamiseka kokuphefumula ebusuku okubangelwa yi-paroxysmal).
– Ukukhathala kalula, ukushaya kwenhliziyo, ubuhlungu besifuba, isiyezi noma ukuquleka.
– Ukukhwehlela, ikakhulukazi ebusuku, ukukhwehlela, noma ukukhwehlela i-phlegm enamagwebu (uphawu lokuvuvukala kwamaphaphu).
– Ukuvuvukala kwemilenze, ukukhuluphala okusheshayo, ukwehla kokukhishwa komchamo.
– Umlando wesifo senhliziyo/umfutho wegazi ophakeme, ukusetshenziswa kwemithi yenhliziyo, umlando wokulaliswa esibhedlela.
– Umlando wokubeletha: i-preeclampsia, ukopha, i-anemia, izinkinga zangaphambilini.
b. Ukuhlolwa komzimba
Gxila ku:
– Izimpawu ezibalulekile: umfutho wegazi, ukushaya kwenhliziyo, izinga lokuphefumula, ukugcwala komoya-mpilo, izinga lokushisa.
– Izimpawu zokwehluleka kwenhliziyo: ukuvuvukala kwangaphakathi, ukwanda kwe-JVP (umthambo we-jugular), ukumanzi kwamaphaphu, i-hepatomegaly, i-cyanosis.
– Ukuhlolwa kwesimo soketshezi: ibhalansi yokufaka nokukhipha, i-turgor, izinga lokuvuvukala.
– Ukuhlolwa kwesibeletho: ukuphakama kwe-fundal, ukuvezwa kwengane, i-DJJ, ukunyakaza kwengane, izimpawu zokubeletha.
c. Ukusekela izivivinyo (ngokubambisana)
Ababelethisi basiza ekudluliseleni/ekubambisaneni kwalokhu okulandelayo:
– I-ECG, i-echocardiography, i-X-ray yesifuba uma kudingeka (kucatshangelwa ukukhulelwa), i-BNP uma ikhona.
– Ukuhlolwa kwe-Hb (i-anemia yenza ukwehluleka kwenhliziyo kube kubi kakhulu), ukusebenza kwezinso, ama-electrolyte.
– I-ultrasound yokukhulelwa, eqapha ukukhula kombungu kanye noketshezi lwe-amniotic.
4. Ukuxilongwa Kwezinkinga Zokukhulelwa Nezinkinga Ezingaba Khona
Uma kukhulunywa ngokubeletha, izinkinga ezivame ukuvela zifaka:
– Ingozi yokwehla kokuphuma kwenhliziyo okuthinta ukugeleza kwegazi e-uteroplacental.
– Ukungabekezelelani umsebenzi ngenxa yokungalingani phakathi kokunikezwa komoya-mpilo kanye nesidingo.
– Ingozi yokuphazamiseka kokushintshana kwegesi (i-pulmonary edema).
– Ingozi yobuningi/ukuvuvukala koketshezi okweqile.
– Ukukhathazeka nokuntuleka kolwazi mayelana nezimo, imithi, kanye nezinhlelo zokubeletha.
– Ingozi yokuzalwa ngaphambi kwesikhathi noma ukuvinjelwa kokukhula kwangaphakathi kwesibeletho (IUGR) ngenxa yokuncipha kokuphuma kwegazi.
5. Ukuhlela Nokungenelela Kokunakekelwa Kwababelethisi
a. Imfundo kanye nezinguquko zendlela yokuphila
Ababelethisi banikeza iseluleko esiwusizo:
– Phumula ngokwanele, lala ngohlangothi lwakho lwesobunxele ukuze ukhuphule ukubuya kwemithambo yegazi.
- Nciphisa imisebenzi enzima; khuthaza imisebenzi elula njengoba kuvunyelwe.
– Ukudla okunomsoco, ukunciphisa usawoti uma kunconywa udokotela, kanye nokuqapha ukukhuluphala.
– Gwema ugwayi, utshwala, kanye nemithi engagunyaziwe ngudokotela.
– Qaphela izimpawu zengozi: ukuphelelwa umoya ngokuzumayo, ukukhwehlela okunegwebu, ubuhlungu besifuba, ukuquleka, ukuvuvukala okusheshayo, ukuncipha kokunyakaza kombungu.
b. Ukuqapha okuqinile kwangaphambi kokubeletha
– Ukuvakashelwa kaningi nokuhlolwa kwezimpawu ezibalulekile.
– Qapha isisindo somzimba, ukuvuvukala, kanye nokukhishwa kwamanzi emzimbeni.
– Qapha impilo-ntle yengane: i-FHR, ukunyakaza kwengane, i-uterine fundus; thumela i-ultrasound elandelanayo uma kudingeka.
– Qinisekisa ukuthi unamathela emithini (i-diuretics, i-beta-blockers, ama-anticoagulant athile, njll.) njengoba kunqunywe udokotela wakho. Ababelethisi kufanele bakukhumbuze ukuthi eminye imithi yenhliziyo ayiphephile ngesikhathi sokukhulelwa, ngakho-ke konke ukwelashwa kufanele kunqunywe udokotela.
c. Ukubambisana kanye nokudluliselwa kwabanye
Amacala okwehluleka kwenhliziyo ngesikhathi sokukhulelwa ngokuvamile abhekwa njengayingozi kakhulu. Ababelethisi kufanele:
– Bheka isikhungo esinezinsizakalo zokubelethisa eziphuthumayo kanye nokusekelwa kwe-ICU uma kudingeka.
– Bambisana ukuze kunqunywe isigaba sokusebenza (isib. i-NYHA), kanye nezinhlelo zokulethwa komuntu ngamunye.
– Qinisekisa ukulungela kwegazi, imithi ephuthumayo, kanye nokufinyelela esinyathelweni esisheshayo.
d. Ukuvimbela izinkinga
– Ukuvimbela i-anemia: ukwengezwa kwensimbi, i-folate, kanye nokuphathwa kwe-anemia ejwayelekile.
– Ukuvimbela ukutheleleka: imfundo yokuhlanzeka, ukutholakala kusenesikhathi kwezifo zokuphefumula/zomchamo ezingabangela ukubola kwesisu.
– Ukuvimbela i-thromboembolism: ukuhamba kancane, ukudonsa amanzi okulawulwayo, ukusetshenziswa kwamasokisi okucindezela uma kunconywa, kanye nokunamathela kuma-anticoagulant uma kunqunywe.
6. Ukunakekelwa Kwangaphakathi Kokubeletha (Ngesikhathi Sokubeletha)
Ukubeletha kwabesifazane abanesifo senhliziyo kufanele kuhlelwe. Ukugxila okuyinhloko ukunciphisa ukucindezeleka, ubuhlungu, kanye nezinguquko ezisheshayo ze-hemodynamic.
Izimiso zokunakekelwa kwangaphambi kokubeletha:
– Ukubeletha kufanele kwenziwe esibhedlela sokudlulisela iziguli esinethimba elinolwazi oluhlukahlukene.
– Ukuqapha okuqhubekayo izimpawu ezibalulekile, ukugcwala, kanye nesimo samaphaphu.
– Ukuthambekela kwe-Semi-Fowler/kwesobunxele ukuze kuncishiswe umthwalo enhliziyweni.
– Ukuphathwa koketshezi okuqinile: gwema uketshezi oluningi olufakwa ngemithambo yegazi.
– Ukunciphisa ubuhlungu ngokwanele ukuze kuncishiswe impendulo yokucindezeleka (ukubambisana ne-anesthesia).
– Isigaba sesibili siyafinyezwa uma kudingeka (isibonelo ngokukhipha i-vacuum/i-forceps njengoba kuboniswe udokotela) ukuze umama angadingi ukusunduza isikhathi eside.
– Gwema imithi engenza izifo zenhliziyo zibe zimbi kakhulu ngaphandle kwezinkomba eziqinile; ukusetshenziswa kwe-uterotonic kufanele kwenziwe ngokucophelela nangokulandela inqubo kadokotela.
Isinqumo mayelana nendlela yokubeletha (ukuhlinzwa kwesitho sangasese sowesifazane noma sokubeletha) sisekelwe esimweni senhliziyo yesiguli, iminyaka yokukhulelwa, kanye nezimpawu zokubeletha. Amacala amaningi avumela ukubeletha kwesitho sangasese sowesifazane ngokuqapha nokuphathwa okufanele, kodwa ezinye izimo zidinga ukuhlinzwa.
7. Ukunakekelwa Kwangemva Kokubeletha Nokuncelisa
Isikhathi sangemva kokubeletha, ikakhulukazi amahora okuqala angu-24-72, siyisigaba esibucayi ngoba izinguquko ezisheshayo zoketshezi zingabangela ukuvuvukala kwamaphaphu. Ukunakekelwa kwangemva kokubeletha kuhlanganisa:
– Ukuqapha ngokucophelela izimpawu ezibalulekile, ukugcwala, izimpawu zokuphelelwa umoya, kanye nemisindo yokuphefumula.
- Ukuqapha ibhalansi yoketshezi kanye ne-diuresis.
- Sekela ukuphumula, imikhawulo yemisebenzi, kanye nezikhundla ezikhululekile.
– Ukuvimbela ukopha ngemva kokubeletha (okungadala izimo ze-hemodynamic ezimbi kakhulu) ngenkathi kusabhekwa ukuphepha kwemithi yokwehlisa umbungu.
– Ukwelulekwa ngokuncelisa: Omama abaningi basengancelisa, kodwa isinqumo sincike ekuzinzeni kwezokwelapha kanye nemithi esetshenziswayo (eminye imithi ingadlulela obisini lwebele). Ababelethisi kufanele batuse ukubonisana nodokotela ukuqinisekisa ukuphepha kokuncelisa.
8. Ukwelulekwa Kokuhlela Umndeni Nokuhlela Ukukhulelwa
Ababelethisi badlala indima ebalulekile ekuhlinzekeni ukwelulekwa kokuhlela umndeni ngemva kokubeletha. Ukukhulelwa okulandelayo kufanele kuhlelwe ngokucophelela njengoba kungenza ukwehluleka kwenhliziyo kube kubi kakhulu. Izindlela zokulawula ukubeletha kufanele zikhethwe ngokusekelwe esimweni sempilo sesiguli kanye nezincomo zikadokotela. Kwezinye izimo ezinzima, ukukhulelwa okuphindaphindiwe kungaba yingozi enkulu, okudinga ukwelulekwa okujulile mayelana nokuvimbela ukukhulelwa kwesikhathi eside.
9. Imibhalo kanye Nokuqhubeka Kokunakekelwa
Imibhalo ephelele ifaka phakathi izimpawu, izimpawu ezibalulekile, imiphumela yokuqapha, ukwelashwa okuhlinzekwayo, imfundo, ukudluliselwa, kanye nempendulo yesiguli. Ukuqhubeka kokunakekelwa kubalulekile: ababelethisi baqinisekisa ukulandelwa okuhleliwe, ukuhambisana nokuhlolwa, kanye nokuxhumana okuhle phakathi kwezikhungo zezempilo.
Isiphetho
Ukunakekelwa kokubeletha kokwehluleka kwenhliziyo kudinga ukuqapha okukhulu, ukuhlolwa okuphelele, ukuqapha okuseduze, imfundo eqhubekayo, kanye nokubambisana kwemikhakha eminingi. Ukugxila okuyinhloko ukuvimbela ukubola kwenhliziyo, ukugcina ukugeleza kwegazi esiswini, ukuhlela ukubeletha okuphephile, kanye nokulindela isikhathi esibucayi sangemva kokubeletha. Ngokunakekelwa okufanele kanye nokudluliselwa okufanele, ingozi yezinkinga ingancishiswa, okuholela emiphumeleni emihle yezempilo kumama kanye nomntwana.
Uma ufisa, ngingaguqula lesi sihloko sibe yifomethi yephepha lesayensi (ephelele ngesingeniso-izindlela-ingxoxo-iziphetho) noma ngengeze uhlu lwezincwadi kanye nezinkomba zemihlahlandlela yezokwelapha.
