Ụmụ iji tụtee mmadụ: na-egosi, ụdị, nkebi, ọgwụ

Dị ka ọnụ ọgụgụ, ọ bụla iri ọhụrụ na-enye nlekọta ahụ ike na na nnyefe ụlọ, na 1% niile mụrụ bụ mkpa nke a na nso nke atụtụ aka. The elu nke ọzụzụ nke n'ụlọ ọgwụ nwere ike dịkwuo Ohere nke ndụ ma belata na o kwere omume nsogbu. Ọma na Bịara n'Ezi Oge iji tụtee mmadụ nke nwa ọhụrụ - nzọụkwụ mbụ iji belata ọnụ ọgụgụ nke ọnwụ na ọrịa development.

isi banye n'eluigwe,

Gịnị bụ neonatal iji tụtee mmadụ? Nke a usoro nke jikoro iji na revitalizing aru nke nwa na mweghachi nke furu efu ọrụ. Ọ na-agụnye:

• cardiopulmonary iji tụtee mmadụ;
• ụzọ nke ọzụzụ kpụ ọkụ n'ọnụ na-elekọta;
• iji nke n'ibu ventilashion;
• pacemaker na ndị ọzọ na echichi.

Full-okwu ụmụ ọhụrụ anaghị achọ iji tụtee mmadụ jikoro. Ha na-amụ ọrụ, na-eti mkpu n'oké olu, usu na obi ọnụego bụ nkịtị, na akpụkpọ nwere a pink agba, nwa-emegharị nke ọma mpụga stimuli. Ụmụaka ndị a na-ozugbo etinye na nne afo na ndo na-ekpo ọkụ, akọrọ metụ akwa. Akụkụ okuku ume na mucous aspirated ọdịnaya iji weghachi ha patency.

Arụ cardiopulmonary iji tụtee mmadụ ọ na-atụle mberede enyemaka. Ọ ẹkenịmde ke ikpe cessation nke iku ume na obi ọrụ. Mgbe ihe dị otú ahụ aka na ihe omume nke a mma N'ihi ya, na-etinye isi nke kpụ ọkụ n'ọnụ na-elekọta. Ọgwụgwọ dị otú ahụ a bụ ịkwụsị omume nsogbu ịkwụsị dị oké mkpa akụkụ.

Ọ bụrụ na onye ọrịa nwere ike bụghị onwe ha ịnọgide na-enwe homeostasis, na iji tụtee mmadụ nke nwa ọhụrụ na-agụnye n'ibu ventilashion (ALV) ma ọ bụ mwube nke pacemaker.

Gịnị dị mkpa iji tụtee mmadụ na nnyefe ụlọ?

Ọ bụrụ na ọ dị mkpa maka ndokwa nke dị otú ahụ ihe bụ ala, i kwesịrị imezu ha site otu onye. Na ikpe nke oké ime na-atụ anya nke na nso nke atụtụ na nnyefe abụọ ọkachamara.

Iji tụtee mmadụ nke nwa ọhụrụ na nnyefe ụlọ na-achọ ịkpachara anya nkwadebe. Tupu usoro nke na-amụ nwa, lelee nnweta niile dị mkpa na-eme ka n'aka na ngwá na-arụ ọrụ ọnọdụ.

1. Ị mkpa jikọọ a okpomọkụ isi iyi na-a tụtee mmadụ table na ákwà nhicha e ụtọ, a metụ akwa mpịakọta n'ụdị a ala.
2. Lelee ma usoro a na n'ụzọ kwesịrị ekwesị na arụnyere oxygen ọkọnọ. Ga-a zuru ezu ego nke oxygen kwesịrị ekwesị na kpatụ nsogbu na igba ọnụego.
3. Ọ dị mkpa iji chọpụta na ịdị njikere nke ngwá na a chọrọ maka mmịpụta nke akụkụ okuku ume tract ọdịnaya.
4. Kwadebe ngwaọrụ nke mwepụ nke gastric ọdịnaya na ihe omume nke ọchịchọ (nyocha, ntụtụ, mkpa, gwara ihe), meconium aspirator.
5. Kwadebe na lelee ike n'ezi ihe nke akpa na nkpuchi iji tụtee mmadụ na intubation gaa.

Set maka intubation mejupụtara endotracheal akpa na-eduzi, na dị iche iche laryngoscope pupụtara na mapụtara batrị, mkpa na uwe.

Gịnị bụ ịga nke ọma nke jikoro?

neonatal iji tụtee mmadụ na nnyefe ụlọ dabeere na-esonụ ụkpụrụ maka ihe ịga nke ọma:

• nnweta kpụ ọkụ n'ọnụ na-elekọta ìgwè - na ụdị nile iji tụtee mmadụ ga-adị ugbu a;
• achikota ọrụ - otu ga na-arụ ọrụ n'otu complementing onye ọ bụla ọzọ dị ka otu nnukwu usoro;
• ruru eru mkpara - ọ bụla iji tụtee mmadụ kwesịrị nwere a elu larịị nke ihe ọmụma na bara uru nkà;
• ọrụ, na-ewere n'ime akaụntụ ọrịa mmeghachi omume - atụtụ aka ga na-amalite ozugbo na onye ahụ nke ha mkpa, ozokwa jikoro na-rụrụ, dabere na omume nke onye ọrịa ahụ;
• serviceability ngwá - ngwá maka iji tụtee mmadụ kwesịrị serviceable na inweta n'oge ọ bụla.

Ihe mere na ọ dị mkpa maka ime ihe

Site etiological ihe nke mmegbu nke obi, akpa ume na ndị ọzọ dị oké mkpa akụkụ nke nwa ọhụrụ na-agụnye mmepe nke asphyxia, ọmụmụ unan, mmepe nke congenital abnormalities, na-efe efe si toxemia na ndị ọzọ na ikpe nke na-amaghị etiology.

Ụmụaka neonatal iji tụtee mmadụ na mkpa n'ihi na ọ nwere ike buru amụma ọbụna oge ịmụ nwa, nwa. N'ọnọdụ dị otú ahụ, na iji tụtee mmadụ otu ga-adị njikere, ka kama inyere nwa gị aka.

The mkpa nke dị otú ahụ ihe nwere ike ime n'okpuru ndị na-esonụ ọnọdụ:

• multi- ma ọ bụ oligohydramnios;
• perenashivanie;
• -arịa ọrịa shuga na nne;
• ọbara mgbali;
• na-efe efe ọrịa;
• Nwa ebu n'afọ na erighị.

Ọzọkwa, e nwere ọtụtụ ihe na-ama na-enwe n'oge na-amụ nwa. N'ihe banyere ha na omume nwere ike na-atụ anya ka mkpa iji tụtee mmadụ. Ihe ndị dị na-agụnye bradycardia na nwa, a caesarean ngalaba, akaghi ọmụmụ na ngwa ngwa, previa ma ọ bụ placental abruption, eriri akpa nwa hypertonus.

asphyxia

Mmepe nke akụkụ okuku ume na ọrịa na hypoxia Filiks na-eme ka ọdịdị nke ahu site na ọrịa nke ọbara usoro, metabolic na microcirculation. Next e a aghara nke akụrụ, obi, adrenal glands, ụbụrụ.

Asphyxia achọ ozugbo aka iji belata ohere nke nsogbu. Akpata akụkụ okuku ume na ọrịa:

• hypoxia;
• mebiri airway (ọchịchọ nke ọbara, imi, meconium);
• organic ụbụrụ mmerụ ahụ na CNS ọrụ;
• malformations;
• ezughi oke surfactant.

Nchọpụta nsogbu mkpa iji tụtee mmadụ adọ rụrụ mgbe ntule nke nwa Apgar.

atụmatụ na	0 ihe	1 ebe	2 ihe
akụkụ okuku ume na ọnọdụ	No	Enweghị nchịkwa, spasmodic	Tie nkpu, rhythmic
Ọrụ Nchịkwa	No	Erughị 100 gafere kwa nkeji	Ihe karịrị 100 gafere kwa nkeji
ụcha akpụkpọ	cyanosis	Pink anụ ahụ, aka na ụkwụ bluish	pink
Status of Akwara ụda	No	Aka na ụkwụ na-ubé kpebisiri, ụda olu nke na-adịghị ike	Active ije, ezi ụda
The mmeghachi omume na iyatesịt ihe	No	weakly kwuru	kwupụtara nnọọ nke ọma

Assessment nke ala ruo 3 ihe na-egosi na mmepe nke oké asphyxia, si 4 6 - asphyxia agafeghị oke ntaramahụhụ. Iji tụtee mmadụ nke nwa ọhụrụ asphyxia emee ozugbo nwale nke ya n'ozuzu ọnọdụ.

The usoro nke adabere na ọnọdụ nke

1. The nwa-etinye n'okpuru okpomọkụ iyi, akpụkpọ ahụ ya mịrị amị na-ekpo ọkụ metụ akwa. Si gọzie gị uji eze na ọnụ na-aracha ya aracha ọdịnaya. N'ịbụ tactile mmalite.
2. Atụlekwa eku ume. N'ihe banyere nkịtị n'afọ iri na ụma na ọnụnọ nke tie nkpu, gaa nzọụkwụ ọzọ. Mgbe spasmodic iku ume n'ibu ventilashion na oxygen maka 15-20 nkeji.
3. Ihe nwale nke obi ọnụego. Ọ bụrụ na obi ọnụego n'elu 100 gafere kwa nkeji, na-akpụ akpụ na-esote na-adọ nke nnyocha. N'ihe banyere nke obi ọnụego n'okpuru 100 gafere rụrụ ventilator. Mgbe ahụ amata irè nke adọ.
   • Usu n'okpuru 60 - anọ obi ịhịa aka n'ahụ + ventilator.
   • Usu 60 ruo 100 - ventilator.
   • Usu n'elu 100 - na ventilator bụrụ na nke oge ufodu iku ume.
   • Mgbe 30 sekọnd, adịghị ike nke obi compressions na ventilashion, usoro ọgwụ ga-rụrụ.
4. Inyocha na-acha. Pink agba pụtara nkịtị ọnọdụ nke nwa. Ọ bụrụ na cyanosis ma ọ bụ akrozianoz mkpa ka i oxygen na-edebe ọnọdụ nke nwa.

Olee otú na-ebu iji tụtee mmadụ?

Chọrọ saa na-emeso ya na antiseptik n'aka, eyi akpali mmasị uwe. The ọmụmụ nke a na nwa bụ ofu, mgbe mkpa jikoro - akwukwo. Ụmụ enịm n'okpuru okpomọkụ iyi, a na-ekpo ọkụ akọrọ ọbọp metụ akwa.

Iji weghachite airway, nwere ike zie isi njedebe na-etinye na nwa na n'aka ekpe. Nke a ga-akwụsị na usoro nke ọchịchọ na ga-ewepụ ọdịnaya nke ọnụ na imi. Jiri nlezianya na-aspirated ọdịnaya, n'ejighị a ikop iwebata aspirator.

Ọ bụrụ na ndị a jikoro adịghị aka, nwa ọhụrụ iji tụtee mmadụ na-aga n'ihu site tracheal suctioning eji a laryngoscope. Mgbe ọdịdị nke ume, ma na-anọghị nke ya n'afọ iri na ụma, na nwa na-agafere na ventilator.

Kpụ ọkụ n'ọnụ na-elekọta unit mụrụ ọhụrụ na-ewe mgbe mbụ iji tụtee mmadụ maka inwekwu aka ma na mmezi nke dị mkpa ọrụ.

ventilashion

Neonatal iji tụtee mmadụ nzọụkwụ na-agụnye na-eduzi ventilashion. Egosi maka ventilashion nketa:

• enweghị ume ma ọ bụ akụkụ okuku ume na ọdịdị convulsive mmegharị;
• usu bụ ihe na-erughị 100 ugboro a nkeji, n'agbanyeghị nke ala nke na-eku ume;
• persistent cyanosis n'oge kwesịrị ime ihe nke akụkụ okuku ume na obi usoro.

Nke a set nke omume rụrụ iji a nkpuchi ma ọ bụ akpa. Ụmụ isi ubé azụ na-achụpụ azụ na ihu nkpuchi na-etinyere. Ya jide gị isi mkpịsị aka na forefinger. The ọzọ na-eduga ná agbà nwatakịrị ahụ.

The nkpuchi kwesịrị na agba, imi na ọnụ. Ịpụta ihe ọ na ventilet ngụgụ na a ugboro ole nke 30 na 50 ugboro maka 1 nkeji. Ventilashion site akpa nwere ike ime ka ikuku na-abanye gastric oghere. Site n'ebe ahụ i nwere ike wepu ya na-eji a na afo tube.

Nyochaa irè nke mmejuputa iwu, ọ dị mkpa ka ntị ka ịrị elu nke obi na mgbanwe obi ọnụego. Nwa ahụ nọ chọpụtara ruo mgbe zuru ezu na mgbake ọnụego nke respiration na obi ọnụego.

Gịnị mere na otú e si intubate?

Neonatal iji tụtee mmadụ na-agụnye intubation nke oghere eji ekunye ume, na ihe banyere ọdịda nke n'ibu ventilashion maka 1 nkeji. The nhọrọ ziri ezi n'ihi intubation tube - onye nke ẹkenemede. Ọ na-mere dabere na ịdị arọ nwatakịrị na gestational afọ.

Intubation na-arụkwa na-esonụ mgbe:

• mkpa iji wepụ aspirated meconium si oghere eji ekunye ume;
• na-eduzi na-aga n'ihu ventilashion;
• Ọrụ ejizi iji tụtee mmadụ;
• epinephrine;
• oké akaghi.

Na laryngoscopy gụnyere ọkụ ma na-na aka ekpe. N'aka nri, jide nwa ọhụrụ isi. Agụba na-etinyere n'ime ọnụ na ẹkenịmde isi asụsụ. Eweli agụba kwupụta ahụ nke laryngoscope, iji tụtee mmadụ ahụ glottis. Endotracheal tube na ẹkenam n'akụkụ aka nri na-edeghị ede oghere na-rụrụ site na akwara ụda olu na oge nke oghere. Nke a emee na n'ike mmụọ nsọ. The tube ẹkenịmde ruo mgbe ndokwa ebe.

Laryngoscope wepụrụ, mgbe ahụ, - na-eduzi. Correctness ịlele ewebata tube compressing na-eku ume akpa. Air abatakwa ngụgụ na-akpata njem mmụta nke obi. Next, jikọọ oxygen tụkwasị usoro.

obi compressions

Iji tụtee mmadụ nke nwa ọhụrụ na nnyefe ụlọ mejupụtara n'ịrụ obi compressions, na-ejide nke nke na-egosi na a obi ọnụego erughị 80 gafere kwa nkeji.

E nwere ụzọ abụọ nke obi compressions. Iji mbụ, nsogbu na obi rụrụ iji index na n'etiti mkpịsị aka nke otu aka. Na ọzọ n'onwe, na ịhịa aka n'ahụ na-rụrụ ma isi mkpịsị aka na ndị ọzọ na mkpịsị aka na-aka ná nkwado azu. Resuscitator neonatolog-eduzi ịpị n'etiti n'etiti na ala atọ nke breastbone, ǹgụ proginalas 1.5 cm strok ugboro -. 90 min.

Mkpa na-eso iji ume na ịpị na obi na-adịghị rụrụ n'out oge. Na kwusi n'etiti pressings, ị na-apụghị iri gị aka n'elu nke sternum. Na ịpị bag-eme mgbe ọ bụla atọ compressions. N'ihi na ọ bụla 2 sekọnd dị mkpa iji jide 1 na 3 ịpị ventilashion.

Omume mgbe meconium ofufe nke mmiri

Atụmatụ na-agụnye neonatal iji tụtee mmadụ enyemaka maka staining nke mmiri ọmụmụ meconium na nwale nke nwa Apgar akara nke na-erughị 6 na-ekwu.

1. N'oge na-amụ nwa mgbe ọdịdị nke isi nke ọmụmụ kanaal ozugbo aspirating ọdịnaya nke imi na ọnụ.
2. Mgbe ọmụmụ nke nwa na ụlọ maka isi iyi nke okpomọkụ, n'ihu mbụ ume, ọ na-achọsi ike na-ebu intubation tube kasị ekwe omume size wepụ ọdịnaya nke oghere eji ekunye ume na bronchi.
3. Ọ bụrụ na ị nwere ike iwepu na ọdịnaya, na o nwere ihe admixture nke meconium, ọ dị mkpa ka reintubirovat mụrụ ọhụrụ ọzọ handset.
4. Ventilashion na-agbazi naanị mgbe ọdịnaya niile e wepụrụ.

ọgwụ

Ụmụaka neonatal iji tụtee mmadụ dabeere bụghị nanị na-arụ ntuziaka ma ọ bụ ngwaike aka, ma na-na ojiji nke ọgwụ ọjọọ. Na ikpe nke n'ibu ventilashion na obi compressions, mgbe na-eme ihe na-adịghị irè n'ihi na ihe karịrị 30 sekọnd, iji ọgwụ ọjọọ.

neonatal iji tụtee mmadụ na-agụnye iji adrenaline, pụtara n'ihi na Iweghachi ọbara olu, sodium hydrogencarbonate, naloxone, dopamine.

Adrenaline ịtinye site endotracheal tube n'ime oghere eji ekunye ume, ma ọ bụ bolus akwara. Ịta nke ọgwụ - 1:10 000 ọgwụ mee dịkwuo ike nke obi ma belata obi ọnụego osooso. Mgbe intratracheal ochichi iso n'ibu ventilashion, nke mere na ọgwụ ike ga-ekesa evenly. Ọ bụrụ na ọ dị mkpa, ndị gị n'ụlọnga na-ndinọ 5 nkeji mgbe e mesịrị.

Ngụkọta oge nke dose dabere na ịdị arọ nwatakịrị:

• 1 n'arọ - 0.1-0.3 ml;
• 2 n'arọ - 0.2-0.6 ml;
• 3 n'arọ - 0.3-0.9 ml;
• 4 n'arọ - 0.4-1.2 ml.

Mgbe ọbara na ọnwụ ma ọ bụ na mkpa, jupụta olu nke ekesa ọbara albumin na-eji, n'ahụ sodium chloride ngwọta ma ọ bụ Ringer si ngwọta. Ọgwụ ọjọọ na-ndinọ n'ime akwara nke eriri nwa ugboelu (10 ml kwa 1 n'arọ ahu arọ) nwayọọ nwayọọ n'elu 10 nkeji. Introduction vospolniteley Bcc pụrụ ịmụba ọbara mgbali, belata acidosis, na normalize usu ọnụego ka mma anụ ahụ metabolism.

neonatal iji tụtee mmadụ, ndị akpa ume ventilashion irè, na-achọ iwebata sodium hydrogen carbonate n'ime alọ akwara iji belata ihe ịrịba ama nke acidosis. The ọgwụ na-ekwesịghị-eji dị ka ogologo dị ka nwa na a guzosie ike akpa ume ezigbo ventilashion.

Dopamine na-eji na-amụba gbasara obi index na glomerular filtration. The ọgwụ enwekwu gbasara akụrụ sodium arịa na enwekwu nwechapụ site na iji infusion ọgwụ. Intravenously microfluidic n'okpuru na-aga n'ihu nlekota nke ọbara mgbali na obi ọnụego.

Naloxone intravenously agbara na ọnụego nke 0,1 ml kwa 1 n'arọ ahu aro. N'aka, na-eji na ikpe ebe acha na usu bụ nkịtị, ma e nwere ihe ịrịba ama nke akụkụ okuku ume na ịda mbà n'obi. Naloxone ike ga-ndinọ nwa ọhụrụ ahụ mgbe nne na-eji narcotic ọgwụ ọjọọ ma ọ bụ na emume ha Ọrịa iji narcotic analgesics.

Mgbe iji kwụsị iji tụtee mmadụ?

IVL na-aga n'ihu dị ka ogologo dị ka nwatakịrị na-adịghị bulie 6 na-ekwu na Apgar. Nke a nwale a rụrụ 5 ọ bụla nkeji na-ekwupụtakwa ruo ọkara otu awa. Ọ bụrụ na mgbe a mụrụ nwa ọhụrụ nwere ihe index erughị 6, mgbe a kpọfere ya na ICU nke ụlọ ọgwụ dị na nke na-eduzi ihe ọzọ iji tụtee mmadụ, kpụ ọkụ n'ọnụ ọgwụ nke mụrụ ọhụrụ.

Ọ bụrụ na irè nke iji tụtee mmadụ bụ kpam kpam na-anọghị na e asystole na cyanosis, ihe omume na-aga n'ihu ruo mgbe 20 nkeji. Mgbe ị na-ahụ ọbụna ndị nwetụrụ ihe ịrịba ama nke nrụpụta, oge enwekwu oge niile, ruo mgbe jikoro bụ mma.

Neonatal nlekọta kpụ ọkụ n'ọnụ

Mgbe ihe ịga nke ọma mweghachi nke ngụgụ na n'obi nke nwa ọhụrụ na-agafere nlekọta kpụ ọkụ n'ọnụ. E nwere ihe dọkịta ọrụ Aims iji gbochie ekwe omume nsogbu.

Nwa ọhụrụ mgbe iji tụtee mmadụ mkpa nke mgbochi nke omume nke ọzịza nke ụbụrụ ma ọ bụ ndị ọzọ CNS ọrịa, n'ọrụ mweghachi nke akụrụ na excretory ọrụ nke ahụ, normalisation ọbara ekesa.

Nwa ahụ nwere ike ịpụta metabolic ọrịa n'ụdị acidosis, lactic acidosis, nke e mere site ọrịa nke elu microcirculation. Na akụkụ nke ụbụrụ nwere ike ime ka ihe ọdịdọ, hemorrhage, ọrịa ụbụrụ infarction, edema, mmepe nke amaghị onwe ya. Ị nwekwara ike inweta dysfunction nke ventricles obi, nnukwu gbasara akụrụ odida, atony eriri afo, adrenal insufficiency na ndị ọzọ na endocrine akụkụ.

Dabere na ọnọdụ nke nwa na-enịm ke a incubator ma ọ bụ oxygen tent. Ọkachamara ilekọta ọrụ niile akụkụ na usoro. Nri ikwe ka nwa naanị mgbe 12 awa, ọtụtụ mgbe - site a nasogastric tube.

Njehie na gbochie machibidoro

Ọ na-machibidoro mepụta ihe omume ndị na-adịghị pụtara mma:

• wụsa mmiri nwa;
• mpikota onu ya obi;
• abia na ike;
• kpọmkwem ihu oxygen jets na dị ka.

albumin ngwọta ga-eji na-amụba mbụ Bcc, n'ihi na ọ na-enwekwu ihe ize ndụ nke na-egbu egbu neonatal pụta.

Iji tụtee mmadụ apụtaghị na nwa ga-nwere ihe ọ bụla abnormalities ma ọ bụ nsogbu. Ọtụtụ ndị nne na nna na-atụ anya enweghị nchịkwa ngosipụta mgbe a mụrụ nwa ọhụrụ bụ na kpụ ọkụ n'ọnụ na-elekọta. Nyocha nke ndị a na-egosi na ụmụaka na-eme n'ọdịnihu nwere otu mmepe dị ka ndị ọgbọ ha.