Asphyxia ntawm cov menyuam yug tshiab: qhov hnyav, ua rau, kho, qhov tshwm sim

2024 Tus sau: Priscilla Miln | [email protected]. Kawg hloov kho: 2024-02-18 01:51

Asphyxia yog ib qho mob hnyav uas tshwm sim hauv cov menyuam yug tshiab hauv thawj feeb ntawm lub neej (thawj) lossis hauv thawj ob peb hnub (thib ob) tom qab yug menyuam. Pathology yog tus cwj pwm los ntawm kev ua pa tsis ua haujlwm thiab kev loj hlob ntawm kev ua pa tsis ua haujlwm. Hauv kev xyaum kho mob, nws yog ib txwm ua kom faib cov asphyxia mus rau hauv nruab nrab thiab hnyav.

Ua rau yug asphyxia hauv cov menyuam mos

Qhov ua rau kev loj hlob ntawm cov kab mob pathological yog ncaj qha nyob ntawm hom asphyxia hauv tus menyuam. Yog li, thawj qhov kev loj hlob thaum yug menyuam. Tus mob no feem ntau yog tshwm sim los ntawm mob hnyav lossis mob ntev hauv lub tsev menyuam hauv plab fetal hypoxia. Tsis tas li ntawd, ua rau asphyxia hauv cov menyuam yug tshiab tuaj yeem yog:

• kev raug mob intracranial hauv tus menyuam uas nws tau txais thaum yug menyuam;
• malformations uas ua rau muaj kev nyuaj siab rau lub cev ua pa thiab ua pa nyuaj;
• immunological incompatibility ntawm niam thiab menyuam los ntawm pawg ntshav lossis Rh yam;
• thaiv tus menyuam txoj hlab pa nrog hnoos qeev lossis kua dej amniotic;
• tus poj niam muaj kab mob plawv thiab vascular, ntshav qab zib, iron deficiency anemia;
• preeclampsia (late toxicosis) nyob rau hauv leej niam, uas yog nrog los ntawm cov ntshav siab thiab o loj ntawm cov ceg;
• pathological qauv ntawm txoj hlab ntaws lossis qhov quav, nws qhov kev tshem tawm, txoj haujlwm tsis raug ntawm lub plab hauv plab, tso tawm ntxov ntawm cov kua dej amniotic.

Secondary tshwm sim nyob rau hauv teev lossis txawm hnub tom qab yug. Qhov ua rau asphyxia hauv tus menyuam yug tshiab hauv qhov no yuav yog:

• kev ua haujlwm tsis zoo hauv lub hlwb;
• kev puas tsuaj rau tus menyuam lub hauv nruab nrab lub paj hlwb;
• lub plawv tsis xws luag ntawm qhov hnyav;
• pneumopathies: hemorrhages hauv ntsws, txhaws ntawm txoj hlab pa nrog hnoos qeev, ua haujlwm tsis zoo ntawm cov txheej txheem metabolic.

Txhua yam xwm txheej no tuaj yeem pib txhim kho txawm tias lub sijhawm yug menyuam.

Qhov tshwm sim ntawm tus mob pathological

Nrog ntau qib ntawm asphyxia hauv cov menyuam yug tshiab, kev hloov pauv hauv cov txheej txheem metabolic hauv lub cev pib. Kev tshwm sim, qhov hnyav thiab lub sijhawm ntawm cov teeb meem no nyob ntawm qhov hnyav ntawm asphyxia. Yog hais tias tus mob tshwm sim thaum yug me nyuam, ces kuj muaj ib tug txo nyob rau hauv cov ntshav ntim, nws thickening thiab viscosity. Edema yog ua tau nyob rau hauv lub hlwb, ob lub raum thiab daim siab, lub plawv, hemorrhages yog tsis tshua muaj, uas tshwm sim vim tsis txaus oxygen. Pathology kuj ua rau txo qisBP ntawm tus menyuam mos, lub plawv dhia qis, kev ua haujlwm tsis zoo ntawm cov zis.

me me asphyxia: tus mob yug tshiab

Primary asphyxia ntawm cov menyuam yug tshiab tshwm sim thawj feeb ntawm lub neej. Qhov xwm txheej ntawm tus menyuam raug ntsuas ntawm Apgar nplai. Nrog rau daim ntawv me me ntawm kev ua pa tsis ua haujlwm, tus menyuam tus mob yog kwv yees li ntawm 6-7 ntsiab lus. Nyob rau tib lub sijhawm, thawj feeb ntawm lub neej, tus menyuam yug tshiab ntawm nws tus kheej siv thawj qhov ua tsis taus pa, tab sis tom qab ntawd nws ua pa tsis sib xws, tsis muaj zog. Cov leeg nqaij feem ntau txo qis, thiab daim duab peb sab nasolabial ua xiav.

Cov tsos mob ntawm asphyxia hauv cov menyuam yug tshiab

Cov tsos mob ntawm pathology (nyob rau hauv ib qho kev tshwm sim me ntsis, uas yog, ib hom mob hnyav) yog lethargy, ib qho kev xav luv luv quaj, nquag regurgitation, spontaneous txav, tsis muaj zog tshuaj tiv thaiv rau irritating yam thiab kuaj, bluish xim ntawm lub daim tawv nqaij, tsis muaj zog tshwm sim ntawm physiological reflexes.

Tus mob ntawm tus menyuam mos feem ntau yog ntsuas nruab nrab, Apgar qhab nia yog 4-5. Nyob rau tib lub sijhawm, lub plawv dhia ib feeb tsawg dua 100 (hauv cov menyuam yaus noj qab haus huv - 100 lossis ntau dua), muaj qee qhov flexion ntawm cov ceg tawv (hauv cov menyuam mos uas muaj tus qhab nia ntawm 2, kev ua haujlwm nquag tau sau tseg), ua pa tsis sib xws, a grimace ntawm lub ntsej muag (cov me nyuam noj qab nyob zoo qw, hnoos, txham), xim liab ntawm lub cev thiab xiav - libs.

Cov tsos mob ntawm asphyxia hnyav rau cov menyuam yaus

mob asphyxia ntawm tus menyuam yug tshiab yog tshwm sim los ntawm cov cim hauv qab no:

• mob hnyav lossis mob hnyav thaum yug;
• yuav ua tiavtsis muaj physiological reflexes;
• muffled lub plawv suab thaum mloog, systolic yws;
• muaj peev xwm hemorrhagic shock, uas tus menyuam lub qhov muag kaw, ua pa tsis muaj zog thiab tsis muaj tshuaj tiv thaiv qhov mob.

Qhov phem tshaj plaws, tej zaum yuav muaj kev cuam tshuam hauv kev ua haujlwm ntawm ntau lub cev thiab lub cev, tsis muaj cov lus teb rau lub teeb. Tus kws kho mob neonatologist nrog cov tsos mob zoo li no yuav ntsuas 1-3 cov ntsiab lus ntawm Apgar nplai. Nyob rau hauv rooj plaub no, tej zaum yuav tsis muaj lub plawv dhia, ko taw dai, ua pa thiab reflexes tsis tuaj, cov tawv nqaij xim daj ntseg, tej zaum yuav muaj cyanosis.

Clinical death: Apgar 0

Daim ntawv hnyav tshaj plaws ntawm asphyxia yog tus cwj pwm los ntawm kev kho mob ntawm tus menyuam mos tuag. Txhawm rau cawm tus menyuam txoj sia hauv qhov xwm txheej no, cov kws kho mob pib ua haujlwm tam sim ntawd.

Cov cim tseem ceeb ntawm asphyxia theem nrab

Secondary asphyxia ntawm cov menyuam mos yug tshiab ob peb teev tom qab yug los lossis thawj ob peb hnub. Tus mob yog cim los ntawm tib cov tsos mob. Tus me nyuam ua tsis taus pa, ua pa tsis muaj zog lossis ploj mus, cov leeg nqaij qis qis, thiab yuav tsis teb rau lwm qhov stimuli. Cov tawv nqaij tib lub sijhawm tau txais cov xim xiav nyob rau hauv thaj tsam ntawm nasolabial daim duab peb sab.

ntxov thiab lig teeb meem ntawm asphyxia

Cov teeb meem thaum ntxov ntawm kev ua pa tsis ua haujlwm (piv txwv li cov tshwm sim hauv thawj hnub ntawm lub neej) suav nrog:

• pulmonary hypertension;
• necrosis ntawm lub paj hlwb;
• cerebral edema;
• intracranial hemorrhage;
• mob lub raum necrosis;
• thrombosis ntawm lub raum hlab ntsha;
• convulsive syndrome;
• pathology ntawm hematopoietic hlwb hauv cov pob txha pob txha.

Cov teeb meem uas yuav tshwm sim nyob rau ob peb hnub tom ntej no yog tias tsis muaj kev kho mob txaus thiab kev kho mob ntawm tus menyuam mos asphyxia yog:

• meningitis - mob ntawm meninges;
• sepsis - kab mob dav dav nrog cov kab mob pathogenic uas tau nkag mus rau hauv cov hlab ntsha;
• pneumonia - mob ntsws;
• hydrocephalic syndrome - ntau dhau kev sib txuas ntawm cerebrospinal kua.

Kev kho mob asphyxia hauv tus menyuam

Cov theem ntawm kev rov ua kom rov zoo dua thaum asphyxia ntawm tus menyuam yug tshiab tau ua haujlwm rau hauv ib qho kev ua haujlwm hauv Tebchaws Meskas. Lub kaw lus hu ua ABC-steps. Ua ntej, neonatologists yuav tsum xyuas kom meej lub patency ntawm lub pa ib ntsuj av tau ntawm cov me nyuam mos, qhov thib ob, cov txheej txheem ntawm lub ntuj ua pa yuav tsum tau stimulated, thiab thib peb, nws yog tsim nyog los txhawb lub circulatory system.

Thaum tus menyuam muaj cov tsos mob ntawm asphyxia yug los, cov kws kho mob ntxig ib qho tshuaj ntsuam xyuas tshwj xeeb rau hauv nws lub qhov ntswg thiab qhov ncauj. Feem ntau qhov kev txiav txim no tau ua txawm tias thaum lub taub hau ntawm tus menyuam tshwm los ntawm tus kwj dej yug ntawm tus poj niam. Nrog kev pab los ntawm kev sojntsuam, cov kua qaub uas seem thiab cov kua amniotic, uas tuaj yeem cuam tshuam rau kev ua pa ib txwm muaj, raug tshem tawm ntawm tus menyuam txoj kev ua pa.

Tom qab raug tshem tawm ntawm tus kwj dej yug los, cov kws kho mob txiav tus menyuam mos txoj hlab ntaws. Tom qab ntawd, nws yuav raug muab tso rau ntawm lub rooj resuscitation, qhov twg cov ntsiab lus ntawm nasopharynx yuav rov ua dua. Lub sijhawm nontxuav lub plab. Hauv qhov no, koj tsis tuaj yeem kov lub nraub qaum ntawm lub pharynx, thiaj li tsis ua rau muaj kev ntxhov siab ntawm lub paj hlwb thiab bradycardia.

Tus menyuam yaus nqa hauv lub tshuab hluav taws xob infrared, nws daim tawv nqaij yog blotted nrog daim ntaub huv. Txhawm rau kom ntseeg tau qhov siab tshaj plaws ntawm txoj hlab cua, cov kws kho mob nteg tawm tus menyuam mos raws li hauv qab no: nyob rau sab nraub qaum, ib tug menyuam hauv qab lub xub pwg nyom, lub taub hau yog nruab nrab. Yog tias tsis muaj kev ua pa txhua, ces kev txhawb nqa yog nqa tawm: maj mam nplawm tus menyuam ntawm pob taws, ib leeg, rub daim tawv nqaij raws tus txha nraub qaum.

Yuav tsis muaj peev xwm muab cov pa oxygen rau menyuam yaus thaum lub ntsej muag asphyxia, nchuav lossis nchuav dej rau nws, nyem nws lub hauv siab lossis ntaus pob tw.

Cov dej num uas tau piav saum toj no yuav tsum tau ua sai sai, nyob rau hauv nees nkaum vib nas this. Tom qab resuscitation ntawm tus me nyuam mos nrog asphyxia, nws tus mob tau rov ntsuas dua, saib xyuas lub plawv dhia, ua pa thiab tawv nqaij.

Yog tias ua pa tsis muaj lossis tsis txaus, ces tus menyuam yuav tsum ua pa tawm. Kev pab nrog asphyxia ntawm cov menyuam yug tshiab muaj kev qhia txog tshuaj. Ntawm cov tshuaj resuscitation agents, ib qho kev daws teeb meem adrenaline yog siv tau, uas tau muab tshuaj sai sai. Ib qho kev daws ntawm sodium chloride kuj yog siv rau hauv daim ntawv ntawm lub dropper rau 5-10 feeb. Yog tias tsim nyog, ntawm 40-50 feeb ntawm tus me nyuam lub neej, kev teem caij kho mob pib pib.

Kev saib xyuas tus menyuam mos tom qab asphyxia

Tom qab muaj mob hnyav xws li asphyxia, nws yog qhov tsim nyogzov menyuam tshwj xeeb. Nws yuav tsum tau so kom tiav. Lub taub hau yuav tsum nyob rau hauv qhov chaw siab. Feem ntau, cov kws kho mob - neonatologists thiab kws kho mob menyuam yaus - sau tshuaj kho cov pa oxygen rau cov neeg mob me. Lub sijhawm ntawm kev kho mob no txawv ntawm txhua tus neeg thiab nyob ntawm tus menyuam tus mob. Tom qab asphyxia, tus menyuam yug tshiab tau muab tso rau hauv pawg ntseeg uas muaj cov pa oxygen siab.

Nco ntsoov saib xyuas tus menyuam uas ua tsis taus pa thaum yug menyuam. Nws yog ib qho tsim nyog los ntsuas lub cev kub, tswj diuresis thiab kev ua haujlwm ntawm plab hnyuv. Feem ntau, tus me nyuam yuav tsum tau rov ntxuav cov pa ntawm txawv teb chaws.

Thawj qhov pub mis rau tus menyuam mos lossis ua pa tsis ua haujlwm tshwm sim tau kaum rau teev tom qab yug menyuam. Yog tias tus me nyuam mob hnyav, ces thawj zaug pub mis tsuas yog tom qab ib hnub thiab nrog kev pab los ntawm kev sojntsuam tshwj xeeb. Lub sij hawm pib pub mis niam yog txiav txim los ntawm rooj plaub.

Tom qab tso tawm hauv tsev kho mob maternity, tus menyuam yuav tsum nyob rau hauv kev saib xyuas ntawm tus kws kho mob thiab kws kho mob hlwb. Lub hom phiaj tseem ceeb ntawm txhua txoj kev kho mob yog kom zam (lossis txo qis, yog tias tshem tawm tag nrho tsis tuaj yeem ua tau) cov teeb meem ntawm lub paj hlwb.

Kev soj ntsuam ntawm cov kws kho mob thiab qhov tshwm sim ntawm asphyxia

Qhov kev tshwm sim thiab qhov tshwm sim ntawm asphyxia hauv cov menyuam yug tshiab yog nyob ntawm qhov hnyav ntawm cov kab mob, qhov txaus ntawm cov kws kho mob ua haujlwm thiab lub sijhawm ntawm kev pib kho. Qhov kev kwv yees ncaj qha nyob ntawm qhov kev ntsuas thib ob ntawm nws txoj kev noj qab haus huv ntawm Apgar nplai. Qhov kev ntsuam xyuas thib ob yog ua los ntawm tus kws kho mob neonatologist tsib feeb tom qab tus menyuam yug los. Yog tias qhov kwv yees thib ob siab dua thawj zaug, ces qhov kev kwv yees zoo li yuav muaj txiaj ntsig zoo.

Txhua qhov tshwm sim ntawm asphyxia ntawm cov menyuam yug tshiab thaum muaj hnub nyoog laus tsis tshua tshwm sim yog tias cov kws kho mob pom zoo. Raws li txoj cai, yog tias tus menyuam tau ntsib kev ua pa tsis ua haujlwm thaum yug menyuam, tab sis cov kws kho mob tau tswj hwm nws tus mob thiab tsis txhob muaj teeb meem, tom qab ntawd thaum muaj hnub nyoog laus dua yuav tsis muaj lwm yam tshwm sim ntawm tus mob txaus ntshai.

ntsuas kev tiv thaiv tseem ceeb

Qhov tshwm sim ntawm asphyxia hauv cov menyuam yug tshiab yog qhov hnyav heev, tab sis lawv tuaj yeem zam tau. Muaj kev tiv thaiv kev tiv thaiv, uas, ntawm chav kawm, tsis yog tag nrho 100% qhov tshwm sim yuav zam kev ua pa tsis ua haujlwm hauv tus menyuam hauv plab, tab sis muab qhov tshwm sim li ntawm 40% ntawm cov neeg mob. Ib qho ntawm cov ua rau asphyxia, piv txwv li, tej zaum yuav yog intrauterine fetal hypoxia. Txhawm rau zam qhov no, tus poj niam cev xeeb tub yuav tsum mus ntsib nws tus kws kho mob tsis tu ncua.

Tsis tas li, cov xwm txheej txaus ntshai uas tuaj yeem ua rau ua pa tsis ua pa hauv tus menyuam hauv plab yog:

• niam hnub nyoog tshaj 35;
• muaj tus cwj pwm phem hauv tus poj niam cev xeeb tub;
• kev nyuaj siab thaum cev xeeb tub;
• cuam tshuam ntawm leej niam lub cev endocrine;
• hloov pauv hauv keeb kwm hormonal ntawm tus poj niam;
• kis kab mob thiab lwm yam kab mob uas cuam tshuam rau tus menyuam hauv plab.

Ib qho ua rau asphyxia kuj yogplacental abruption los yog pathology ntawm nws txoj kev loj hlob. Hauv kev tshem tawm qhov xwm txheej no, kev saib xyuas tsis tu ncua los ntawm tus kws tshaj lij yog qhov tseem ceeb. Tus kws kho mob tuaj yeem txheeb xyuas cov xwm txheej txaus ntshai thiab pib kho raws sijhawm kom tsis muaj dab tsi cuam tshuam rau tus txiv neej lub neej thiab kev noj qab haus huv.

Ntawm no yog qee cov lus qhia dav dav los ntawm gynecologists rau tus poj niam cev xeeb tub uas yuav txo qhov kev pheej hmoo ntawm tus menyuam hauv plab ua pa tsis ua haujlwm:

1. Ntau qhov kev ua si sab nraum zoov. Tus poj niam lub cev yog saturated nrog qhov tsim nyog cov pa oxygen, uas yog tom qab ntawd hloov mus rau fetus, uas xav tau lub caij no.
2. Noj cov vitamins raws li kws kho mob gynecologist. Ob tus poj niam cev xeeb tub thiab tus me nyuam, leej twg tseem tab tom tsim kev sib raug zoo nrog leej niam lub cev, xav tau cov vitamins thiab cov as-ham.
3. Saib kev tswj hwm hnub. Thaum tsaus ntuj, tus niam uas xav pw yuav tsum tau pw tsawg kawg yog cuaj teev, thaum nruab hnub nws tseem pom zoo kom tso ob peb teev kom pw tsaug zog lossis tav su so (tsis yog ntawm lub computer screen).
4. Ua kom koj lub siab kaj lug thiab tus cwj pwm zoo. Kev xeeb tub yog lub sijhawm tsis nco qab hauv lub neej ntawm txhua tus poj niam, tab sis nws kuj cuam tshuam nrog kev ntxhov siab thiab kev xav. Rau kev noj qab haus huv ntawm tus menyuam yaus thiab tus poj niam nws tus kheej, yuav tsum txhawj xeeb tsawg dua, kawm ua siab ntev tiv thaiv kev tsis sib haum xeeb ntawm lub neej, siv sijhawm ntau los tham nrog cov neeg zoo.

Nws tsim nyog hais tias ua pa tsis ua haujlwm, uas yog, asphyxia, yog ib qho mob hnyav. Tab sis ua tsaug rau cov tshuaj niaj hnub thiab kev ua haujlwm ntawm cov neeg ua haujlwm kho mob, lub neejCov menyuam mos feem ntau tau txais kev cawmdim thiab tshem tawm qhov tshwm sim ntawm pathology.