Bilirubin Direct kuchuluka: Zoyambitsa ndi Chithandizo. Kodi ngati chinawonjezeka bilirubin mwachindunji mwana?

Chifukwa cha kugwa kwa maselo ofiira pali chinthu chapadera - bilirubin. Limatchedwanso chikasu zofiira pigment, ali mmodzi wa zosakaniza waukulu ya ndulu. Mu seramu magazi kumachitika m'njira ziwiri: mwachindunji (zokhudzana) kapena mozungulira (mfulu).

matenda a matenda

Kupeza chomwe izo zikutanthauza kulongosola bilirubin, Sikutheka ngati simukudziwa zimene muyenera kuphunzira. M'pofunika kuwunika ntchito chiwindi ndi matenda ambiri a matenda a m'mimba thirakiti. kupatuka chilichonse ponseponse index zimenezi zimasonyeza kuti thupi walephera.

Ngati bilirubin mwachindunji ndi kukwezeka, ndiye dotolo ali ndi zifukwa ndikukhulupirira kuti wodwalayo ali pachimake kapena aakulu chiwindi matenda kapena gallstones. Ngati kupatuka chilichonse ponseponse wa chizindikiro ichi ndi zofunika kuchita kupenda wodwala, molondola oterewa ndi kuyamba kulandira chithandizo mwamsanga. Kawirikawiri, kuchuluka kwambiri ndi mlingo wa bilirubin akhoza matenda popanda MAGAZI. Pajatu amasonkhana mwana wa m'diso la, zikopa zotanuka, khungu ndi aipatsa kum'chitira chikasu.

Zimayambitsa chinawonjezeka bilirubin

Nthawi zambiri, ndikofunika molondola kudziwa zimene zinachititsa kuti kuwonongeka kwa ntchito chiwindi. Pakuti nkofunika tonse timvetsetse kuti mwachindunji bilirubin ali okwera imeneyi si choncho. Choncho, popanda liwulo matenda, zimene zinachititsa kuti boma, ndi kuika chithandizo chokwanira, iye sanagwe.

Kusintha mlingo wa bilirubin ingayambe ndi zifukwa zingapo. Ali:

1. Kuwonjezera mphamvu ya hemolysis maselo a magazi.
2. Kupondelezedwa kwa chiwindi chifukwa zotupa za parenchyma, motero chatsika ndi Kugawilidwa kwanthaka ntchito ya bilirubin.
3. Kuphwanya outflow wa ya ndulu mu intestine lapansi.
4. Kuchepa kwa Ngopambana zofunika amachititsa biosynthesis wa bilirubin.
5. The kuwonongeka ndondomeko ya katulutsidwe mwachindunji mu tuzigawo twa ya ndulu.

Komanso, vutoli chifukwa cha magazi m'thupi hemolytic. Chifukwa china akhoza kukhala ndi malungo, vitamini B12 akusowa, ndi zina, mavuto zochepa kwambiri.

The vuto limene bilirubin mwachindunji ndi kuchuluka, palinso chifukwa chakuti chifukwa amapangidwa chifukwa cha kumatheka hemolysis. Pa nthawi yomweyo kuphwanya chiwindi amatsogolera chakuti si kupirira ndi kupanga kuchuluka chiwerengero cha glucuronides amene ali koyenera kuti thupi.

diagnoses woopsawo

Musapereke, ngati dokotala anu akuonetsa kuti aletse chiwindi ndi kukutumizani inu kuti anayesedwa. Direct bilirubin angathandize oterewa angapo ndithu lalikulu matenda.

Choncho mlingo wake udzakhala wautali ngati:

- chiwindi (onse tizilombo ndi poizoni etiology);

- cytomegalovirus, zomwe zinachititsa kuti matenda a chiwindi;

- sekondale kapena ukachenjede chindoko ;

- cholecystitis;

- neonatal hypothyroidism;

- matenda a chikasu ndiyo mimba.

Ngati bilirubin n'komwe mwachindunji kukwezeka, ndiye adokotala akhoza kuganiza a chiwindi, ndi matenda ena ambiri. Wodwalayo mwina ndi khansa chiwindi, ndi matenda enaake chachikulu, cholelithiasis. Komanso kupatuka zizindikiro mwakale akhoza kukhala ndi vuto la poizoni, mankhwala kapena mowa poyizoni chamoyo.

Mavuto mimba

Ena amayi oyembekezera mu trimester otsiriza mungaone kuti iwo alibe zotsatira zabwino kwambiri za kufufuza. Inde, ena angakhale bilirubin lachindunji kukwezeka mimba. chikhalidwe ichi amafuna kuvomerezedwa Kupenda zina. Ndithudi, kuwonjezeka index amasonyeza kuyan'anila mu ndondomeko ya outflow wa ya ndulu mu chiwindi. Matenda amatchedwa "intrahepatic cholestasis mimba."

Komanso, sitingathe kukusalani angapo matenda monga a chiwindi tizilombo, cholecystitis, hemolytic magazi m'thupi. Nkofunika oterewa iwo mu nthawi kupewa mavuto zotheka.

Nkofunika kudziwa kuti ngati kuchuluka bilirubin mwachindunji mankhwala Mugaŵireni motsimikizika. Ndipotu boma ungathe kusokoneza onse njira yachibadwa mimbayo, ndi moyo wa mwana wosabadwa. Zimenezi zingachititse kuti mawonekedwe edematous matenda hemolytic wa mwana wosabadwayo, pamene pali Mwina mkulu wa kubadwa msanga ndi imfa ya mwana m'mimba kapena maola woyamba atabadwa.

Zizindikiro za hyperbilirubinemia

Nthawi zambiri kufunika nkhani limatuluka pambuyo zimene munthuyo kapena dokotala anayendera mavuto akuganiza. Kotero kuti bilirubin n'komwe mwachindunji okwera, zingasonyeze zizindikiro monga:

- matenda a chikasu ndiyo ya sclera maso, zikopa mucous, khungu;

- malungo;

- kukulitsa a ndulu, kodi zingasonyeze kusapeza mu hypochondrium kumanzere;

- kunachita mdima wa mkodzo, zikhoza kukhala bulauni mdima kapena wakuda;

- ulesi, kutopa, palpitations, litsipa - zizindikiro izi zikusonyeza kuti zimakhala kukhala zochepa mpweya otaya.

zizindikiro izi ziri mwa magazi m'thupi hemolytic. Tikumbukenso kuti kusintha mu mtundu wa mkodzo kumachitika nthawi zonse. Kungakhale kuwonongedwa kwa maselo ofiira a magazi mkati ziwiya mwabata, ndipo izo zimachitika okha matenda ena, monga matenda Marchiafawa Michele.

Koma hemolytic magazi m'thupi - si chinthu chokha chimene chimatsogolera ku chakuti bilirubin lachindunji m'mwamba. Zifukwa komanso kugona mu kuyan'anila za chiwindi. Kukambirana za mavuto amenewa monga zotheka ngati wodwalayo:

- nseru, kusapeza mutadya owawa belching;

- Ndikumva chisoni mu hypochondrium kulondola, ukapezeka chifukwa ponso chiwindi;

- ntchito kuchepa, ndi kufooka.

Nthawi zina Tingaone kunachita mdima wa mkodzo mtundu wa mowa kapena tiyi amphamvu. Pamene chiwindi tizilombo ndi zambiri malungo.

chithandizo

Pofuna kuthana ndi mfundo, zomwe ziyenera kuperekedwa mankhwala, ngakhale bilirubin lachindunji pang'ono kukwezeka, sikutheka. Ndipotu n'zosatheka kuchotsa vuto mpaka chifukwa anatsimikiza.

M'pofunikanso zochita detoxification. Zina mwa zakudya zapadera, umalimbana kuchepetsa katundu pa hepatocytes ndi michere udindo Kupha poizoni. M'chipatala zambiri amathera kulowetsedwa-kuika mankhwala. Chinali cholinga kusintha kapangidwe ndi buku la magazi, okhudza maselo ambiri ndi madzimadzi intercellular. Sankhani njira zimene tikubweretsazi m'nsinga, angakhoze kokha dokotala. Mu zina ingaperekedwe ndi shuga njira, zosakaniza kwa amino asidi, saline ndi wothandizila ena.

Nthawi zina kumafunika kuchita phototherapy, lomwe limathandiza kuti kuwonongedwa kwa bilirubin poizoni. Kuchepetsa kawopsedwe madokotala amakonda kulemba adamulowetsa makala ndi angakhale angelo cholinga kuchotsa poizoni Mwachitsanzo, amatanthauza "Enterosgel".

Choncho, ngati chifukwa cha chiwonongeko kwambiri maselo magazi anapezeka kuti kuchuluka bilirubin mwachindunji, chifukwa hemolysis imeneyi iyenera kukhazikitsidwa ndithu. Sitepe yoyamba ndi kumvetsa zimene zinachititsa kuti izi. Pambuyo mankhwala si zotsatira zofunika ndiponso chifukwa hemolysis. Kuchita izi, ntchito mahomoni glucocorticoid, monga preparatat "Prednisolone". Pambuyo kuchotsa chifukwa milingo bilirubin kugwa payokha.

Ngati zinachititsa kuphwanya mavuto a ndondomeko outflow wa ya ndulu, silingachite popanda mankhwala. Madokotala ku Zikatero mankhwala chakudya, awa angathe kukhala njira monga "Ursosan", "Febihol", "Tseruglan", "Ermital", "Papazol", "Gepabene", "Analgin". Therapy umalimbana zolimbikitsa phunzirani kutulutsa ya ndulu, analgesia. Koma si koyenera kugwiritsira ntchito mankhwala popanda chilolezo cha dokotala. Inde, zina, amafuna mankhwala mankhwala kapena antiparasitic.

Nthawi zambiri chifukwa cha matenda a chikasu ndiyo ndi chiwindi. Zikatere m'pofunika kuchitira chiwindi. Kuti zimenezi zitheke, mankhwala zotsatirazi mwina mankhwala, "Essentiale", "Methionine", "Geptral".

malamulo okhazikika

Kaya zaka wodwala (kupatula ana) zizindikiro akhale malire zinalembedwa. Choncho, okwana miyezo bilirubin ranged kuchokera 3.4 17,1 mmol / l, ndi bilirubin mwachindunji mu magazi ayenera osapitirira 4.3 mol / l. Izi malamulo sasintha, iwo chomveka akuluakulu a iliyonse msinkhu, ndi kwa ana. Mlingo wa tuzigawo twa mozungulira atsimikiziridwa payokha, ndi masamu monga kusiyana kwa zotsatira kusanthula pakati kuchuluka kwa n'komwe mwachindunji bilirubin. Sitiyenera upambana 13.7 .mu.mol / l. Chodziwa mozungulira bilirubin ndi matenda a chikasu ndiyo neonatal hemolytic ndi zoipa magazi m'thupi syndromes ozungulira, Gilbert, Crigler-Najjar.

Vutolo ndi yosiyana ndi ana osakwana zaka 1 mwezi. Pa tsiku loyamba la moyo nyenyeswa bilirubin kungakhale mu osiyanasiyana kuchokera 24 mpaka 149 pmol / l. Pa tsiku lachiwiri la moyo mlingo uli mkati 58-197. Pa tsiku 3-5 bilirubin kungakhale kwa 26 205 pmol / l. Makanda akuti, chithunzi ichi kawirikawiri dekhetsa ziwiri sabata (nthawi zina mwezi) zakubadwa.

Zimayambitsa hyperbilirubinemia makanda

Onse obadwa kumene nyenyeswa kuchuluka m'magazi a pigment lachikasu wofiira kwambiri. Ichi ndi chifukwa ana makeke kuti inatuluka kuwala, sanachite zinthu ngati achikulire. Iwo sangakhoze kupirira bilirubin, ndipo amasonkhana mu thupi. Ndicho chifukwa ana ambiri mlingo chodziwa.

Musati mantha, izi ndi zinthu zachilendo, pokhapokha, ndithudi, zizindikiro musalumphe choperekedwa kwa ana a m'badwo uno mfundo. Mwachibadwa, chiwindi ndi ankamangidwanso ndipo akuyamba liziyenda bwinobwino kale mu sabata chachiwiri cha moyo, ndi mlingo wa bilirubin mwakale paokha.

Pamene dokotala akuganiza kuti pangakhale mavuto, zikhoza kuchititsa kufufuza wapadera. Ngati bilirubin lachindunji wokwezeka pa ana owonjezera mwakale, nthawi zambiri akulimbikitsidwa kuchita chithandizo kuchipatala. Kukana mankhwala osavomerezeka ndi osafunika, chifukwa matenda a chikasu ndiyo akhanda si otetezedwa momwe makolo ambiri amaganizira.

mavuto ana akhanda

Chifukwa chakuti ana a chiwindi si lizigwira akuluakulu awo bilirubin mwachindunji kapena kudzera m'njira zina akhoza zochuluka. Izi zikhoza kukhala chifukwa cha zifukwa zotsatirazi. Mu ndondomeko ya azingokhala maselo a magazi anapanga hemoglobin poizoni - heme, limene limayamba kupesa thupi ndipo anayamba bilirubin. Mu ichi mozungulira kachigawo ake si kupasuka mu madzi, choncho sangathe anachokera ku mkodzo. Pambuyo kulumikiza izo ndi zinthu zosiyana ndi kusamutsidwa kwa chiwindi kumene n'kukhala bilirubin mwachindunji ndipo amayendayenda mu ndulu ya. Ana, ndondomeko kusintha masabata ochepa pambuyo pa kubadwa. Choncho, matenda a chikasu ndiyo thupi ndi zabwinobwino.

Koma pali zochitika pamene mlingo bilirubin kuposa malire. Ichi ndi m'malo mavuto chifukwa cha kuchuluka ake aakulu angakhale chopinga chitukuko yachibadwa ubongo, kuyambitsa matenda osiyanasiyana maganizo amene amayambitsa kumva, kuona, kapena ngakhale retardation maganizo. Ichi ndi chifukwa chakuti mopambanitsa bilirubin, albumin siikutchinga zotsatira zake poizoni. Ndipo zimenezi zimapangitsa chakuti mantha dongosolo akuvutika.

chithandizo cha ana

Mwauchidakwa kuchuluka bilirubin mwachindunji mu magazi zambiri chifukwa chakuti mwanayo anayamba kuchitira m'chipatala kapena kuchipatala ana. Mfundo zikuluzikulu njira amati phototherapy. Izi mwana younikira kuwala wapadera, zomwe limatha kusintha bilirubin poizoni mu njira zabwinobwino. Iwo anachokera ku thupi maola 12 ndowe ndi mkodzo. njira zimenezi zimakhudza zake zam'mbali, koma atangokhala njira ya mankhwala udzatha. Choncho, mwanayo amayamba khungu pang'ono ndi chikopa, kutsegula m'mimba ndipo amaoneka hypersomnia.

Koma nthawi zina thupi mofulumira achire wa bilirubin amafuna thandizo zina. Pankhaniyi chilengedwe chipatala amapatsidwa dropper ndi shuga, mankhwala cholagogue ntchito, ascorbic acid.

The njira yaikulu kuteteza neonatal zheltushki otchedwa yoyamwitsa. Kuti a colostrum ali mankhwala ofewetsa tuvi tolimba tingati pa wakhanda ndipo amathandiza kuonetsetsa kuti chodziwa mwachindunji bilirubin mu magazi pang'onopang'ono kubwerera mwakale. Koma pali zochitika zina pamene vuto akulimba mkaka anthu. Pankhaniyi, izo tikulimbikitsidwa kuti m'malo oyamwitsa osakaniza kwa masiku angapo. Ngati milingo bilirubin anayamba kutha, choncho matenda a chikasu ndiyo chifukwa cha izo ndi mkaka wa m'mawere. Koma uwu si chifukwa si yoyamwitsa. Childs, normalization wa nyenyeswa yokwanira 3 masiku a kudyetsa chisakanizo, kenako mukhoza kachiwiri anamuyika mwana bere.

Mavuto ana

Koma kuchuluka kwa pigment chikasu ndi ofiira ndi osati ongobadwa kumene. Komabe, ngati chinawonjezeka bilirubin mwachindunji mwana, ndiye n'kofunika kwambiri kuti bwinobwino. Ngati mwanayo ali kale kunja kwa zaka ana akhanda, zimayambitsa matenda a chikasu ndiyo palibe zosiyana ndi zimene zimabweretsa mavuto akuluakulu.

Ngakhale kudziwa matenda kutsogozedwa ndi kuwonjezeka bilirubin, n'kofunika kuti mwana anatsatira zakudya bwino. Ndi kuthandiza chiwindi pokonza bilirubin ndi poizoni ndi kusandutsa mu ufulu madzi sungunuka nusu. Choncho, zakudya kuti achotse onse mafuta ndi zakudya yokazinga, mankhwala tsabola, enaake zakumwa. Komanso, makolo ayenera kudziwa kuti m'njira imeneyi kuchuluka bilirubin mwachindunji mwana, mowonekera kudwala. Choncho, detoxification ntchito umalimbana kuyeretsa thupi ku poizoni mwana tuzigawo twa ayenera kuyamba mwamsanga.