Newborn kuwatsitsimula: zizindikiro, mitundu, masiteji, mankhwala

Malinga ndi kafukufuku, makanda chakhumi asamalire thanzi mu chipinda yobereka, ndi 1% ya onse obadwa akufunikira ndi uthunthu wonse wa CPR. The mkulu mlingo wa kuphunzitsa ogwira ntchito kuchipatala mukhoza kuwonjezera mwayi wakuti moyo ndi kuchepetsa mavuto zotheka. Mokwanira yake kuwatsitsimula wa ana akhanda - sitepe yoyamba kuchepetsa chiwerengero cha imfa ndi chitukuko matenda.

mfundo zofunika

Kodi neonatal kuwatsitsimula? Nkhani miyeso umalimbana utipatse mphamvu m'thupi la mwana ndi kubwezeretsa ntchito otaika. Pamafunikanso:

• mouzirira kuwatsitsimula;
• njira odwala mwakayakaya;
• ntchito mpweya mawotchi;
• pacemaker ndi unsembe ena.

makanda Full-akuti chiyani popanda miyeso kuwatsitsimula. Obadwa yogwira, kufuula mokweza, zimachitika ndi kugunda kwa mtima ndi zabwinobwino, khungu mtundu pinki, mwana Yankho bwino zikuchitika kunja. ana awa yomweyo anaikidwa pa pamimba ndi pogona ofunda mayi, youma thewera. Kupuma mucous zili aspirated kubwezeretsa patency awo.

Pogwira mouzirira kuwatsitsimula amaona chithandizo mwadzidzidzi. Amakhulupirira pa nkhani ya kutha kwa kupuma ndi ntchito mtima. Pambuyo aziloŵerera pa mwambo chifukwa yabwino, ntchito ndizosowa odwala mwakayakaya. mankhwala amenewa akupita kuthetsa mavuto zotheka wotseka ziwalo zofunika kwambiri.

Ngati wodwala paokha kukhala homeostasis, ndi kuwatsitsimula wa ana akhanda monga makina mpweya (ALV) kapena kuika pacemaker.

Kodi zofunika kuwatsitsimula mu chipinda yobereka?

Ngati kufunika makonzedwe a zinthu zimenezi ndi otsika, muyenera kuzikwaniritsa ndi munthu mmodzi. Pankhani ya mimba kwambiri ndi zoyembezereka za uthunthu wonse wa CPR mu yobereka ndi akatswiri awiri.

Kuwatsitsimula wa wakhanda mu chipinda yobereka amafuna kukonzekera bwino. Pamaso pa ndondomeko za pobereka, onani kupezeka kwa zonse zofunikira ndipo onetsetsani zipangizo za chikhalidwe ntchito.

1. Muyenera kugwirizana ndi gwero la kutenthako kwa tebulo kuwatsitsimula ndi matewera anasangalala, ndi thewera mpukutu mu mawonekedwe a wodzigudubuza a.
2. Onani ngati dongosolo moyenerera anaika kotunga mpweya. Ayenera kukhala okwanira kuchuluka kwa mpweya bwino kusintha zoipazi ikuyenda mlingo.
3. M'pofunika onani chivomerezocho zida zimene zimafunika kuti m'zigawo za nkhani thirakiti kupuma.
4. Konzani zida kuchotsa nkhani muzituluka mu mwambo kukhumba (kafukufuku, syringe, lumo, kukonza zinthu), meconium aspirator.
5. Konzani ndipo fufuzani umphumphu wa thumba ndi chigoba kuwatsitsimula ndi intubation zida.

Anasiyira intubation tichipeza machubu endotracheal ndi ochititsa, ndi masamba osiyana laryngoscope ndi mabatire yopuma, lumo ndi magolovesi.

ndi bwino miyeso chiyani?

neonatal kuwatsitsimula mu chipinda yobereka zachokera mfundo zotsatirazi bwino:

• kupezeka kwa magulu akayakaya - pa onse kuwatsitsimula ayenera kupezeka;
• ntchito yolongosoka - gulu ayenera kugwira ntchito mogwirizana complementing mnzake limagwirira limodzi lalikulu;
• ndodo oyenerera - lililonse kuwatsitsimula ayenera mkulu mlingo wa nzeru ndi luso yothandiza;
• ntchito, kutenga nkhani zimene wodwalayo - CPR ayenera kuyamba pomwepo ndi maonekedwe zosowa zawo, mitsuko zina akutsatiridwa, malinga ndi zimene thupi wodwalayo;
• Kutukula zida - zipangizo kuwatsitsimula ayenera ntchito ndi Kufikika nthawi iliyonse.

Chifukwa kufunika kanthu

Ndi zinthu etiological wa kupondereza mtima, mapapo ndi ziwalo zina zofunika kwa ana akhanda monga chitukuko cha asphyxia, kuvulala pobadwa, chitukuko cha kuvutika kobadwa nako, matenda chiyambi toxemia ndi zina za etiology osadziwika.

Ana neonatal kuwatsitsimula ndi kufunika akhoza ananeneratu ngakhale mu nthawi ya kubereka ana. Mu Zikatero, kuwatsitsimula gulu tiyenera kukhala okonzeka, ndi yomweyo kuthandiza mwana wanu.

Kufunika zinthu ngati angayambe pansi zinthu zotsatirazi:

• multi- kapena oligohydramnios;
• perenashivanie;
• shuga amayi;
• oopsa;
• nthenda;
• kutupikana yoopsa.

Komanso, pali zinthu zingapo zimene kale uka pobereka. Pankhani ya asayembekezere kungayembekezereke muyenera kuwatsitsimula. Zinthu monga bradycardia mwana, gawo la Kaisara, kubadwa azionera mofulumira, previa kapena placental abruption, uterine hypertonus.

asphyxia

Chitukuko cha matenda kupuma njira hypoxia amachititsa maonekedwe a thupi ndi matenda a magazi dongosolo, kagayidwe kachakudya ndi microcirculation. Kenako pali matenda a impso, mtima, zopangitsa adrenal, ubongo.

Asphyxia amafuna alowererepo mwamsanga kuti kuchepetsa kuthekera matendawo. Zimayambitsa matenda kupuma:

• hypoxia;
• kuphwanya airway (kukhumba magazi, mamina, meconium);
• organic ubongo choipa ndi CNS ntchito;
• malformations;
• osakwanira surfactant.

Diagnostics muyenera zikunena kuwatsitsimula ikuchitika pambuyo ziyenera a mwanayo Apgar.

Akuti	0 mfundo	1 mfundo	2 mfundo
chikhalidwe kupuma	No	Pathological, spasmodic	Mokweza kulira, rhythmic
HR	No	Pasanathe 100 kumenyedwa pamphindi	Zoposa 100 kumenyedwa pamphindi
khungu	cyanosis	Pinki khungu, miyendo bluish	pinki
Mayendedwe a minofu kamvekedwe	No	Miyendo ndi pang'ono wopindidwa, kamvekedwe ka ofooka	Yogwira kayendedwe, kamvekedwe wabwino
The anachita zinthu kuyabwa	No	ofooka anafotokoza	ofotokozedwa bwino

Kafukufuku boma kuti mfundo 3 akuti chitukuko cha asphyxia kwambiri, kuyambira 4 mpaka 6 - asphyxia zolimbitsa mwamphamvu. Kuwatsitsimula wa asphyxia akhanda kukuwonekera mwamsanga kufufuza chikhalidwe wonse.

The ndondomeko ya poona udindo wa

1. mwana aikidwa pansi gwero kutentha, khungu lake zouma thewera ofunda. Kuchokera m'mphuno ndi m'kamwa ndi mawere nkhani. Unachitikira chogwirika kukondoweza.
2. Amaweruza kupuma. Pankhani ya mungoli wabwinobwino ndi kukhalapo kwa kulira mokweza, atuluka zotsatirazi. Pamene spasmodic kupuma makina mpweya ndi mpweya kwa mphindi 15-20.
3. An kufufuza kugunda kwa mtima. Ngati kugunda kwa mtima pamwamba kumenyedwa 100 pa mphindi, kusamukira ku gawo lotsatira loyang'anira. Pankhani ya kugunda kwa mtima pansipa kumenyedwa 100 anagwira othandizira. Ndiye kuwunika mphamvu ya zikunena.
   • Kugunda pansipa 60 - mozungulira kutikita mtima + othandizira.
   • Kugunda kwa 60 100 - othandizira.
   • Kugunda pamwamba 100 - pa othandizira pa nkhani ya kupuma osasamba.
   • Pambuyo masekondi 30, kupanda compressions pachifuwa ndi mpweya wabwino, mankhwala ayenera kuchitidwa.
4. Kuyendera khungu. Pinki mtundu zikutanthauza chikhalidwe yachibadwa mwanayo. Ngati cyanosis kapena akrozianoz amafunika kupereka mpweya ndi kusunga chikhalidwe cha mwanayo.

Mmene angagwirire kuwatsitsimula?

Amafuna kuchapa ndi mankhwala dzanja antiseptic, kuvala magulovu wosabala. Kubadwa kwa mwana chili, pambuyo miyeso zofunika - zalembedwa. Newborn wakumvera gwero kutentha, ndi thewera ofunda youma atakulungidwa.

Kubwezeretsa airway, akhoza adatchithisira mutu kumapeto ndipo anaika mwana kumanzere. Izi kulepheretsanso wa chiyembekezo adzachotsa nkhani za mkamwa ndi mphuno. Mosamala aspirated nkhani, popanda kuwaika kwambiri oyamba aspirator.

Ngati zimenezi sizipangitsa kuthandiza, kuwatsitsimula akhanda ikupitirira ndi tracheal suctioning ntchito laryngoscope. Pambuyo kuoneka mpweya, koma pakalibe mungoli ake, mwana kunditumiza ku othandizira lapansi.

Akayakaya wagawo mwana wakhanda amatenga pambuyo kuwatsitsimula koyamba thandizo zina ndi kukonzanso ntchito kwambiri.

magawanidwe

masitepe Neonatal kuwatsitsimula monga kuchititsa mpweya wabwino. Zikuonetsa kwa mpweya wabwino kumalo:

• pakalibe kupuma kapena maonekedwe kupuma kayendedwe convulsive;
• Kugunda ndi zosakwana 100 nthawi yokha, kaya boma kupuma;
• kulimbikira cyanosis pa ntchito yachibadwa a dongosolo la kupuma ndipo mtima.

akonzedwa izi za ntchito ikuchitika ntchito chigoba kapena thumba. mutu Newborn pang'ono kumbuyo ndi kuponyera kubwerera ku nkhope chigoba umagwiritsidwa ntchito. Ake kugwira chala chanu ndi mkombaphala. The zina zimabweretsa pachibwano mwanayo.

The chigoba akhale pa chibwano, mphuno ndi mkamwa. Wokwanira ventilate mapapo ndi pafupipafupi nthawi 30 50 kuti 1 miniti. Mpweya wabwino kupyolera thumba angachititse mpweya kulowa M'mimbamo muzituluka. Kuyambira apo inu owachotsa ntchito m'mimba chubu.

Kuwayang'anira mphamvu ya kukhazikitsa, m'pofunika kulabadira kuwuka kwa chifuwa ndi kusintha kugunda kwa mtima. The mwana anapitiriza kuonerera mpaka mlingo wathunthu ayambe kupuma ndiponso kugunda kwa mtima.

Chifukwa ndi momwe intubate?

Neonatal kuwatsitsimula mulinso intubation wa trachea, mu nkhani ya kulephera kwa mpweya wabwino mawotchi kwa miniti 1. Kusankha koyenera kwa intubation chubu - chimodzi mwa zochitika. Linapangidwa malinga ndi kulemera kwa mwanayo ndi zaka gestational.

Intubation amadziwikanso amachitika milandu zotsatirazi:

• kufunika kwa kuchotsa aspirated meconium ku trachea ndi;
• akuchititsa mosalekeza mpweya wabwino;
• mutsogolo wolunjika kuwatsitsimula;
• Epinephrine;
• msanga kwambiri.

Pa laryngoscopy monga kuunikira ndi kutenga ku dzanja lamanzere. dzanja lamanja, anayimitsa mutu khanda a. Tsamba ndi anaikapo m'kamwa ndi unachitikira ku chinenero m'munsi. Kukweza tsamba kwa chogwirira cha laryngoscope ndi, kuwatsitsimula amaona glottis. Endotracheal chubu umayamba kumanja mu M'mimbamo m'kamwa ndi ikuchitika kudzera zingwe amapilira pa nthawi ya kutsegula. Izi zimachitika pa kudzoza. chubu umachitika mpaka kufika yokonzedweratu.

Laryngoscope kuchotsedwa, ndiye - kondakitala. Kulondola afufuze kuyambitsa chubu compressing thumba kupuma. Air akulowa mapapo ndi amachititsa ulendo wa pachifuwa. Kenako, kulumikiza dongosolo mpweya okwanira.

pachifuwa compressions

Kuwatsitsimula wa wakhanda mu chipinda yobereka limapangidwa kuchita compressions pachifuwa, atagwira a chomwe chili pa mtengo mtima zosakwana 80 kumenyedwa pa mphindi.

Pali njira ziwiri za compressions pachifuwa. Kugwiritsa woyamba, kuthamanga pa chifuwa anachita ntchito index ndi chala chapakati cha dzanja limodzi. Mu chimake wina, kutikita ikuchitika likundikanikizira ndi zala ena amaphatikizidwa misana thandizo. Resuscitator neonatolog-kuchititsa kukanikiza pakati pakati ndi kutsikira wachitatu wa breastbone ndi, thorax proginalas kwa 1.5 masentimita zikwapu pafupipafupi -. Mphindi 90.

Kwenikweni muyenera kutsatira kuti mpweya ndi kukanikiza pa chifuwa si ikuchitika imodzi. Mu chete kwa pakati pressings, sungathe kuchitenga manja anu pamwamba pa sternum lapansi. Kuwonekera pa thumba kuchita iliyonse compressions atatu. Pakuti masekondi 2 ndikofunikira kugwira 1 ndi 3 kukanikiza mpweya wabwino.

Zochita pamene meconium kuipitsidwa kwa madzi

Features monga neonatal kuwatsitsimula chithandizo kwa kudetsa wa amniotic madzimadzi meconium ndi kufufuza mwanayo Apgar mphambu mfundo zosakwana 6.

1. Pobereka pambuyo kuoneka mutu wa ngalande kubadwa yomweyo aspirating nkhani za mphuno ndi mkamwa.
2. Atabadwa mwana ndi malo gwero la kutentha, pamaso mpweya woyamba, ndi zofunika kuchita intubation chubu waukulu zotheka kukula kuchotsa nkhani za trachea ndi bronchi.
3. Ngati inu simungakhoze kuchotsa, ndipo ali kusakanizikana kwa meconium, m'pofunika reintubirovat atabadwa pafoniyo wina.
4. Mpweya kusintha pokhapokha zili zonse chachotsedwa.

mankhwala

Ana kuwatsitsimula neonatal zachokera osati pa wozengereza Buku kapena hardware alowererepo, komanso kugwiritsa ntchito mankhwala osokoneza bongo. Pankhani ya mpweya makina ndi compressions pachifuwa, pamene zinthu sizili ochiza masekondi zoposa 30, ntchito mankhwala osokoneza bongo.

neonatal kuwatsitsimula zimaphatikizapo kugwiritsa ntchito zikuwonjezereka masiku ano, zikutanthauza kuti kubwezeretsa magazi buku, sodium hydrogencarbonate, naloxone, dopamine.

Zikuwonjezereka masiku ano ali anaikapo mwa endotracheal chubu mu trachea, kapena bolus mtsempha. Ndende ya mankhwala - 1:10 000 mankhwala ntchito kuonjezera mphamvu ya mtima ndi kuchepetsa mlingo mtima mathamangitsidwe. Pambuyo makonzedwe intratracheal anapitiriza makina mpweya, kotero kuti mankhwala akhoza anagawira wogawana. Ngati ndi kotheka, wothandizila ndi kutumikiridwa Mphindi 5 ina.

Mawerengedwe a mlingo malinga ndi kulemera kwa mwanayo:

• makilogalamu 1 - 0.1-0.3 ml ya;
• 2 makilogalamu - 0.2-0.6 ml ya;
• 3 kg - 0.3-0.9 ml ya;
• 4 makilogalamu - 0.4-1.2 ml.

Pamene kutaya magazi kapena kufunika kudzaza buku la kufalitsidwa magazi albumin ntchito, zokhudza thupi njira sodium kolorayidi kapena njira Ringer a. Mankhwala kutumikiridwa mu mtsempha wa umbilical chingwe kwakusiyana (10 ml pa 1 makilogalamu thupi) pang'onopang'ono mphindi 10. Chiyambi vospolniteley Bcc angadwale magazi, kuchepetsa acidosis, ndi matenda a mtima umagunda mofulumira kusintha kagayidwe minofu.

neonatal kuwatsitsimula, kenako m'mapapo mpweya ogwira, liyenela kukhazikitsa carbonate ndi sodium wa hydrogen mu mtsempha umbilical kuchepetsa zizindikiro za acidosis. Mankhwala sayenera kugwiritsidwa ntchito malingana ngati mwana sichinayambe anakhazikitsa m'mapapo mpweya okwanira.

Dopamine ntchito kuonjezera mtima index ndi glomerular kusefera. Mankhwala kumawonjezera aimpso ziwiya soda ndi kumawonjezera chilolezo pogwiritsa ntchito kulowetsedwa mankhwala. M'nsinga microfluidic pansi polojekiti mosalekeza wa magazi ndiponso kugunda kwa mtima.

Naloxone m'nsinga jekeseni pa mlingo wa 0.1 ml ya pa 1 makilogalamu thupi. Njira, ntchito ngati kumene khungu ndi zimachitika ali bwinobwino, koma pali zizindikiro za maganizo kupuma. Naloxone sangathe kuperekedwa kwa ana akhanda pamene mayi amagwiritsa mankhwala chomwa mankhwalawa kapena mankhwala likufa ntchito analgesics chomwa mankhwalawa.

Polekera kuwatsitsimula?

IVL akupitiriza bola ngati mwanayo si kukatenga mfundo 6 pa Apgar. kuwunika Izi ikuchitika pa mphindi 5 ndi kumatenga kwa theka la ola. Ngati nthawi imeneyi wakhanda ali index wa osachepera 6, ndiye iye anasamutsidwa ku ICU za chipatala chimene kuchititsa kuwatsitsimula zina, tamaliza mankhwala a mwana.

Ngati mphamvu ya kuwatsitsimula palibe kwathunthu ndipo pali asystole ndi cyanosis, chochitika akupitiriza mpaka mphindi 20. Mukadzaona ngakhale zizindikiro pang'ono efficacy, nthawi kumawonjezera nthawi zonse, mpaka miyeso abwino.

Neonatal akayakaya wagawo

Pambuyo pa kubwezeretsedwa bwino mapapo ndi mtima wa ana akhanda ndi kunditumiza ku odwala mwakayakaya. Pali madokotala ntchito Cholinga kupewa mavuto zotheka.

Atabadwa kuwatsitsimula akufunika kupewa yatsoka a kutupa kwa ubongo kapena matenda ena CNS kubwezeretsa ntchito za impso ndi excretory ntchito za thupi, normalization wa magazi.

The mwana angaoneke matenda kagayidwe kachakudya mu mawonekedwe a acidosis, lactic acidosis, amene amayamba ndi matenda a microcirculation zotumphukira. Pa mbali ya ubongo zikhoza khunyu, kukha mwazi infarction oziziritsa, edema, chitukuko chikomokere. Mukhozanso kulandira kukanika kwa ventricles mtima, pachimake aimpso kulephera, atony chikhodzodzo, adrenal insufficiency ndi ziwalo zina endocrine.

Malinga ndi matenda a mwanayo aikidwa mu chofungatira kapena mpweya hema. Akatswiri amayang'anira ntchito ziwalo zonse ndi kachitidwe. Dyetsani kuti mwana pokhapokha maola 12, nthawi zambiri - kudzera chubu nasogastric.

Zolakwa kuti kuteteza ndikoletsedwa

Izo kutiletsa kuchita zinthu zomwe si kutsimikiziridwa otetezeka:

• madzi mwana;
• compress pamtima;
• angakaphe pa matako ndi;
• nkhope mwachindunji mpweya Jets ndi zina zotero.

albumin njira ayenera kugwiritsidwa ntchito kuonjezera koyamba Bcc, chifukwa kumaonjezera ngozi ya amapha neonatal zotsatira zake.

Kuwatsitsimula sizikutanthauza kuti mwanayo ndi kuvutika kapena mavuto. Makolo ambiri amayembekezera mawonetseredwe pathological pambuyo wakhanda anali mu odwala mwakayakaya. Reviews milandu amenewa akusonyeza kuti ana m'tsogolo chitukuko mofanana anzawo.