Isifo baby: oonobangela, iimpawu, unyango

isifo sentliziyo azalwa (isifo) - oku utshintsho yokwakheka wentliziyo, nempahla yaso kunye izivingco, nokuphuhlisa Esibelekweni. Ngokutsho manani, esi leengxaki kwenzeka 0.8-1.2% yazo zonke kubelekwa. Isifo kubantwana - enye ezingunobangela rhoqo ukufa kwabantwana ngaphantsi kunyaka-1.

Izinto ezibangela isifo kubantwana

Okwangoku, akukho ingcaciso esichazayo for iziganeko zezifo ezithile zentliziyo. Siyazi kuphela ukuba babuthathaka na umzimba ibalulekileyo Umbungu kwixesha ukusuka iiveki ezi-2 ukuya kwelesi-7 zokukhulelwa. Yaba ngeli xesha kukho tab zonke iindawo eziphambili wentliziyo, ukuyilwa kwezivalo zayo, neempahla yegazi enkulu. Nayiphi na impembelelo owenzeka ngeli thuba kunokukhokelela ekumisweni ngezifo. Njengomthetho jikelele, ukuze ufumanise ukuba ubulawe akwenzeki. Amaxesha amaninzi kukhokelela kuphuhliso isifo zinto ezilandelayo:

• ezenzeka kwiDNA;
• amagciwane, wabuguqulela mfazi ngexesha lokukhulelwa (umzekelo, rubella);
• ekstragenital'nye izifo kakhulu koomama (seswekile sinwenwa, systemic lupus zomzimba, njl);
• kakubi utywala ngethuba lokukhulelwa;
• ubudala koomama ezindala ngaphezu kweminyaka 35.

Ukuqulunqwa isifo xa umntwana kuchaphazele izithuko zokusingqongileyo, ukungakhuseleki imitha, kwaye imithi ezithile ngexesha lokukhulelwa. Umngcipheko yokuzalwa kosana kunye ngezifo ukunyuka efanayo xa umfazi sele kuthethiwe ngazo ngaphambili, regressing ukukhulelwa, ifile okanye ukufa kweentsana ngemihla yokuqala yobomi. Kusenokwenzeka ukuba unobangela ezi ngxaki baqalisa iziphene ngentliziyo akubonakali.

Musa ukulibala ukuba Upu akanakuba self-ngezifo, kodwa inxalenye yawo Alukho ngaphantsi ezoyikekayo. Umzekelo, e Down syndrome isifo sentliziyo eyafunyanwa-40% yamatyala. Xa umntwana ozalwa malformations emininzi umzimba omkhulu yaye amaninzi oko baya kuthatha inxaxheba kwinkqubo yezifo.

Iintlobo isifo kubantwana

Medicine neentlobo ezingaphezu kwama-100 ezahlukeneyo iziphene intliziyo. Ngasinye isikolo inikeza yokuhlelwa yinzululwazi, kodwa uninzi Upu yahlulwe 'blue' yaye 'imhlophe. " ukwahlukana okunjalo iziphene ezisekelwe iimpawu zangaphandle lokuhamba nabo, ukuba babe ngqo, kubungakanani umbala ulusu. Xa "blue" kwi umntwana waphawula cyanosis, ngoxa "white" isikhumba uba libunile kakhulu. Le ukhetho lokuqala obufunyenwe tetralogy ka Fallot, atresia yemiphunga, kunye nezinye izifo. Uhlobo lwesibini ekuso ngakumbi atrial isiphene kunye septal ventricular.

Kukho nenye indlela yokuzahlula isifo ebantwaneni. Classification kulo mzekelo ibandakanya imikhuba kwiqela kwiqela kanye ejikeleza miphungeni. Kukho ezintathu:

1. Upu kunye sindisa le kwegazi pulmonary:

• patent ductus arteriosus;
• septal atrial siphene (ASD);
• septal ventricular siphene (VSD);

2. Upu nge isangqa encinane athile:

• tetralogy of Fallot;
• stenosis pulmonary;
• transposition iimpahla ezinkulu.

3. Upu ngegazi flow zingatshintshi pulmonary:

• coarctation of the aorta;
• stenosis aortic.

Iimpawu iziphene senhliziyo azalwa ebantwaneni

Uxilongo "isifo" umntwana ibekwe ngokusekelwe eziliqela iimpawu. Kwiimeko kakhulu, utshintsho kuba zibonakale ngoko nangoko emva kokuzalwa. An ugqirha onamava Akukho nzima ukwenza sele isifo preliminary kwigumbi wokuziswa kweencwadi, nokulungelelanisa izenzo zabo ngokungqinelana nale meko. Kwezinye iimeko, ubukho abazali yesifo sentliziyo abazi iminyaka emininzi de isifo ibe nqanaba decompensation. Izifo ezininzi zichongwa kuphela nje elivisayo kwesinye uxilongo lwezonyango rhoqo. Kubantu abatsha, isifo sivame ukuxilongwa ngexesha elingaphesheya ikhomishini emkhosini.

Yintoni unika ugqirha lubonisa umntwana isifo cwaka kwigumbi wokuziswa kweencwadi? Okokuqala, kucelwa uthathele ingqalelo ukuba kombala Nedlac yesikhumba kuzalwa. Mu kuya kwa nshita umntwana abantwana kamnandi-Interface kunye nesifo sentliziyo libunile okanye oluhlaza (ngokuxhomekeke kuhlobo sisilonda esidumbileyoesingaphakathi ejikelezayo pulmonary). Isikhumba epholileyo neyomileyo ukuya ngaphandle kwebala. Cyanosis utshisa umzimba uphela okanye limited unxantathu nasolabial ngokuxhomekeke ubukhali isiphako.

Xa ukuphulaphula lokuqala neethowuni intliziyo isaziso ugqirha ingxolo ezingaqhelekanga iingongoma ezibalulekileyo auscultation. Unobangela zezi zinguquko ukuhamba kwegazi engalunganga nge iimpahla. Kulo mzekelo, usebenzisa ugqirha yeSkrini uva ukomeleza okanye buthathaka entliziyweni izandi, okanye ukubona ingxolo ezingaqhelekanga, nekufuneka ukuba umntwana ophilileyo. Konke oku kuhlanganiswa kwenza neonatologist ukuba ukrokrela ubukho yesifo sentliziyo naso nokuyalela itakane kwi uxilongo abalibona.

Olusanda kuzalwa kunye PRT ethile zithande ukuba siziphathe Ndigungqagungqiswa, yaye ngokufuthi ngokungenangqiqo ekhala. Abanye abantwana, kwelinye icala, abantu njengembi kakhulu. Abayi uthabathe incum, inkunkuma iibhotile kunye ulale kakuhle. Kungenzeka ukuba imbonakalo dyspnea kunye tachycardia (yomntanakhe rapid)

Xa kunjalo, ukuba uxilongo isifo kwi umntwana kunikelwa kwiminyaka kamva, uyakwazi ukuphuhlisa ezingaqhelekanga kuphuhliso engqondweni nasemzimbeni. abantwana abanjalo ekhula kancinci, hayi sifumane ubunzima, liyasilela esikolweni, abe engayigcini up noontanga esempilweni kunye esebenzayo. Azikwazi ukumelana umthwalo esikolweni, lingaphumi, Azitywine kwiiklasi physical education, zigula. Kwezinye iimeko, isifo sentliziyo iba ukufunyanwa ngengozi kwinqanaba elilandelayo kweemviwo zonyango.

Kwiimeko kakhulu, ukusilela intliziyo ezinganyangekiyo luphuhla. Kubonakala dyspnea kwi umthwalo nje. imilenze kalanga, isibindi eyonyukileyo kunye udakada, utshintsho kwenzeka kwegazi miphungeni. Xa engekho unonophelo abanezakhono isimo iphela ukukhubazeka okanye ukufa umntwana.

Zonke ezi mpawu uvumela ithile enoba kukancinane okanye, ukuqinisekisa ubukho isifo ebantwaneni. Iimpawu zisenokwahluka kwiimeko ezahlukeneyo. Ukusetyenziswa iindlela zale mihla diagnostic kusetyenziselwa ukungqinisisa sifo kunye nonyango olufanelekileyo ngexesha.

sigaba sophuhliso Upu

Kungakhathaliseki uhlobo kunye nobukhali zonke iziphene amabakala eziliqela. Inqanaba lokuqala kuthiwa lithathelwe. Ngeli xesha, umzimba umntwana wayethimb iimeko ezintsha ubukho, ukulungelelanisa umsebenzi zonke ii-arhente phantsi utshintsho ezininzi kwentliziyo. Ngenxa yokuba zonke iinkqubo kufuneka ukuba basebenze ngeli xesha ukunxiba, kunokwenzeka uphuhliso ukusilela kwentliziyo ludlule, ukungaphumeleli yonke eziphilayo.

Inqanaba lesibini - kwisigaba imbuyekezo isalamane. Ulwakhiwo olutshintshayo intliziyo inika umntwana ngaphezulu okanye ngaphantsi eziqhelekileyo, ukwenza yonke imisebenzi yayo kwinqanaba elifanelekileyo. Eli nqanaba unokuthatha iminyaka, akakafiki kungakhokelela yokusilela zonke iinkqubo omzimba kunye nophuhliso decompensation. Inqanaba lesithathu Upu umntwana kuthiwa terminal kwaye zibandakanya utshintsho emzimbeni. Intliziyo andisakwazi ukumelana umsebenzi wayo. Ukuphuhlisa utshintsho sisiba mandundu kwi myocardium, ekugqibeleni eziphela ekufeni.

siphene Atrial septal

Cinga omnye yeentlobo isifo sentliziyo. siphene Atrial septal ebantwaneni - yenye iziphene intliziyo ixhaphakileyo, ifumaneka abantwana abangaphezu kweminyaka engama emithathu. Xa esi sifo umntwana lowo umngxuma omncinane phakathi ekunene kunye nomthambo ekhohlo. Ngenxa yoko, kukho igazi Ukuphosa rhoqo ukusuka ekhohlo ukuya ekunene, nto leyo ekhokelela ngendalo ephuphumayo ejikeleza miphungeni. Zonke iimpawu ukuphuhlisa kule ngezifo, ezinxulumene waphula ukusebenza okuqhelekileyo wentliziyo iimeko zatshintsha.

Ngokwesiqhelo, le umngxuma phakathi imithambo kukho olungekazalwa aze azalwe. Libizwa ngokuba window mbhoxo, kudla kuphetha ngomoya yokuqala usana. Kwezinye iimeko, una ihlala ivulekile ebomini, kodwa le isiphako lincinane kakhulu ukuba umntu akazi nokuba bayazi ngayo. Hemodynamic anayenza kule lwalo. Patent foramen ovale, akuthethi ukuba umntwana waziva inokuba ngobekuphandwa random ngexesha uphando ultrasound intliziyo.

Ngokwahlukileyo koko, i atrial isiphako lokwenyaniso septal yingxaki kakhulu enzulu. kuvuleka zinkulu ngobukhulu kwaye zibekwe umbindi imithambo kunye kungqameko. uhlobo Upu (siphene septal atrial abantwana, njengoko natshoyo, yeyona common kakhulu) uzakugqiba indlela unyango okhethwe yingcali ngokususela kwidatha ultrasound kunye nezinye iindlela zophando.

iimpawu ASD

Anikezele primary kunye ekudibaneni lesibini sinesiphene interatrial. Ahluke phakathi kwabo features emngxunyeni indawo eludongeni kwentliziyo. Xa siphene zaseprayimari ASD ibonakele kwinxalenye asezantsi ulwahlulo. Uxilongo "Upu lesibini siphene septal atrial" ebantwaneni kudandalaza kwimeko apho emngxunyeni sibekwe kufutshane umbindi. Esi siphaku kumalungu kulula kakhulu ukuba balungise, kuba kwicandelo hlulo olusezantsi kancinci esiqwini, siyivumele ukuvala ngokupheleleyo siphene.

Kwiimeko ezininzi, abantwana abancinane kunye ASD akukho kwahluka noontanga babo. Bakhula nokuphuhlisa ngokungqinelana nobudala. A onesimo njengomkhuhlane rhoqo ngaphandle sihlandlo sikhethekileyo. Ngenxa ekubunjweni rhoqo wegazi ukusuka ekhohlo ukuya ekunene, kwaye ephuphumayo izifo bronchopulmonary osemiphungeni abantwana bako, kuquka inyumoniya kakhulu.

Le cyanosis okuncinane kuphela unxantathu nasolabial inokubonakalisa iminyaka emininzi yobomi xa abantwana abane ASD. Phuhlisa phezu kwexesha eluswini libunile, ukuphelelwa umoya ne amandla nje kancinane emzimbeni, ukhohlokhohlo. Ukuba lunganyangwa, umntwana eqalisa ukuba barhuqe emva kuphuhliso ngokwasemzimbeni, akusekho ukumelana neprogram yesikolo rhoqo.

Intliziyo izigulane abatsha ixesha elide unako ukumelana umthwalo ukwanda. Izikhalazo ngokuchasene tachycardia kwaye engaphumi intliziyo isingqisho ngesiqhelo phakathi kweminyaka eli-12-15. Ukuba umntwana phantsi kweliso oogqirha yaye akazange enze echocardiography, uxilongo "i Upu, ASD," umntwana inokukhutshwa kuphela elivisayo.

Uxilongo kunye nonyango lwe ASD

Ngosuku loviwo, le cardiologist uthi nokuqiniswa luyambombozela zentliziyo iingongoma ezibalulekileyo auscultation. Oku kungenxa yokuba xa igazi udlula kwemithambo iingqameko aveza asakhasayo, apho ugqirha ukuva ngalo yeSkrini. flow Igazi ngokusebenzisa isiphene kwi ekudibaneni nayiphi na ingxolo Akukhathaliseki.

Ngoxa uphulaphule imiphunga kungabonwa crackles ezinxulumene ekuma negazi kwegazi miphungeni. Xa emgama (Isifuba prostukivanii) lubonise ukwanda imida ngentliziyo ngokunxibelelene hypertrophy yayo.

Kuphononongo lwe electrocardiogram ezi ngokucacileyo iimpawu ezibonakalayo ukucima kombane intliziyo elungileyo. On echocardiography lwabonisa unesiphene ekudibaneni atrial. X-ray emiphungeni sikuvumela ukuba ubone iimpawu ekuma igazi ngemithambo miphungeni.

Ngokungafaniyo ventricular septal isiphako ASD zange luvalwe ngokuzenzekelayo. Olona nyango kuphela le isiphako yotyando. Olu tyando lwenziwa eneminyaka engama 3-6 de kuphuhliswa decompensation intliziyo. ungenelelo Surgical sihlelwe. Olu tyando lwenziwa uqhaqho open-intliziyo bypass cardiopulmonary. Ugqirha yenza kuvalwe unesiphako, okanye ukuba hole kuba inkulu kakhulu, babugubungela isiziba, kukho basinqumla khona pericardium (neehempe ngentliziyo). Kufuneka kuqatshelwe ukuba ukusebenza kunye ASD wayengomnye utyando lokuqala intliziyo kwiminyaka engaphezu kwama-50 eyadlulayo.

Kwezinye iimeko, endaweni suturing yemveli usebenzisa indlela endovascular. Kulo mzekelo, kwi vein okuhlatywa femoral yenziwe, yaye intliziyo lweHo- occluder lesitofu (isixhobo ezizodwa, apho isiphene ivaliwe). olu khetho uthathwa ukuba buhlungu ngaphantsi nekhuselekileyo ngakumbi, njengoko ngaphandle kokuvula i esifubeni. Emva msebenzi kakhulu ngokukhawuleza ngakumbi abantwana wachacha. Ngelishwa, asiyiyo yonke amatyala enokusetyenziswa indlela endovascular. Ngamanye amaxesha indawo le mingxuma, ubudala bomntwana, kwakunye neminye imiba enxulumene musa ukuvumela kuphazamiseka.

siphene Ventricular septal

Makhe sithethe olunye uhlobo isifo sentliziyo. VSD ebantwaneni - nesifo sentliziyo zixhaphakileyo yesibini kweminyaka iminyaka emithathu. Kulo mzekelo, umngxuma eshiyekileyo ifunyanwa ngawo ekudibaneni kwemingxuma ventricles ekunene nasekhohlo. Kukho igazi Ukuphosa rhoqo ukusuka ekhohlo ukuya ekunene, yaye, njengoko kunjalo nge ASD kuphuhlisa sindisa le ejikeleza miphungeni.

Isimo izigulane abaselula zingahluka ngokuxhomekeke kubungakanani siphene. Nomntwana umngxuma omncinane akakwazi ukwenza naziphi na izikhalazo, kwaye ingxolo auscultation - into kuphela eziya kumphazamisa abazali. Ngowe-70% amatyala iziphene ezincinane ventricular septal ivaliwe phambi kweminyaka yobudala engama-5.

A eyahlukileyo ngokupheleleyo umfanekiso siyavela xa luguqulello ozimiseleyo Upu. VSD kubantwana maxa wambi ukufikelela ubungakanani ezinkulu. Kulo mzekelo, amathuba yokuphuhlisa lwegazi yemiphunga - iingxaki kakhulu engasebenzi. Ekuqaleni zonke iinkqubo zomzimba ukuqhelana iimeko ezintsha, igazi uqhuba ngaphandle ventricle ukuya kwenye kunye nokudala uxinzelelo bhetele nasezimpahleni miphungeni. Kungekudala emva iphuhlisa decompensation, apho intliziyo asinakukwazi ukuphinda ukumelana umsebenzi wayo. igazi Hlela lwemithambo kungenzeki, oko oluhlala kwi ventricle kwaye kungena kwegazi. kwegazi eliphezulu emiphungeni awukuvumeli ukuba uqhaqho lwentliziyo, yaye ezi izigulane basweleka ngenxa iingxaki. Yiyo loo nto kubalulekile ukuba babone ngexesha kule isiphene, ukuze adlulisele umntwana unyango ngotyando.

Kwimeko apho VSD ayikho amvalele ngokwakho ukuba kwiminyaka 3-5, okanye mkhulu kakhulu, utyando yenzelwa ukubuyisela isidima zekhala interventricular. Njengoko kunjalo kunye ASD, ukuvulwa oku sutured okanye yavalwa isiziba, ukucuthelwa evela pericardium. Unga ukuvala isiphene kunye endovascular iindlela, ukuba iimeko zemvume.

Unyango leziphene senhliziyo azalwa

ndlela kuhlinzwa kuyinto kuphela ukujongana izifo ezifana na ubudala. Kuxhomekeka ebukhulwini isifo kwi kunyango abantwana kwenziwe kwithuba lweentsana, yaye kwiminyaka kamva. Kukho amatyala zotyando kwentliziyo kwi kwimveku esibelekweni. Ngelo xesha abafazi nje akwazi ukunxibelelana ngokukhuselekileyo ukhulelwe elide, kodwa ukuba nomntwana ophile kakhulu engadingi ukuba labagula kakhulu kwi kwiiyure yokuqala yobomi.

Iintlobo nobungakanani unyango kwimeko nganye uzimisele ngamnye. Wentliziyo ngokususela kwidatha uhlolo kunye neendlela zoviwo isisixhobo, indlela ukhetha kwaye yayimisela imisebenzi kunokwenzeka. Lonke eli xesha umntwana phantsi kweliso eengcali, ukulawula imeko yakhe. Ukulungiselela ukusebenza umntwana ufumana iyeza kuyimfuneko, nto leyo evumela ukuba kupheliswe iimpawu ezingemnandi kangangoko kunokwenzeka.

Ukukhubazeka kwi isifo kwi umntwana ngokuxhomekeke unyango kwangethuba iphuhlise kunqabile. Kwiimeko ezininzi, utyando Asikwazi ukuluphepha ukufa kuphela, kodwa ukudala iimeko zokuphila eziqhelekileyo ngaphandle anemiqathango.

Uthintelo ngenhliziyo ukukhubazeka naso

Ngelishwa, inqanaba lophuhliso yamayeza ayikho nokungenelela kuphuhliso Esibelekweni yosana olungekazalwa , kwaye ngandlela kuchaphazela ibhukmakhi intliziyo. Prevention of isifo kubantwana lubandakanya ngokucokisekileyo uviwo yabazali phambi kokuba ocwangcisiweyo ukukhulelwa. Umama okhulelweyo phambi kwesisu womntwana kufuneka unikeze imikhuba emibi, ukutshintsha umsebenzi kumsebenzi enobungozi kweminye imisebenzi. La manyathelo aya ukunciphisa ingozi yokuba umntwana ngezifo inkqubo sentliziyo.

ugonyo lwarhoqo rubella, oluqhutywa onke amantombazana, ukunqanda ukuvela Upu ngenxa yale usuleleko yingozi. Ukongeza, oomama abakhulelweyo ukuba kufuneka ukuba baye ultrasound yovavanyo ngexesha kwisakhelo sokukhulelwa. Le ndlela ivumela ixesha ukuchonga iziphene usana uthabathe amanyathelo ayimfuneko. Ukuzalwa komntwana uya kuba phantsi kweliso cardiologists abanamava kunye noogqirha. Ukuba kuyimfuneko, ekunene ukusuka kwigumbi esibhedlele usana izakuthathwa neyunithi specialist ukusebenza ngoko nangoko uze uvumele ukuba aphile.

I-ALS sokuphuhlisa yesifo sentliziyo naso kuxhomekeke kwizinto ezininzi. I ngaphambili esi sifo elibhaqiweyo, kokukhona ithuba ukuphepha imeko decompensation. unyango Ngexesha yotyando kuphela usindisa ubomi lezigulane abatsha, kodwa likuvumela ukuba baphile ngaphandle anemiqathango ngezizathu zempilo.