Isikhathi eside, isifo sikashukela sasiyimbangela yokulimala okuphezulu nokushona komama, kanye nokushona kwengqondo. Kuze kube sekutholakaleni kwe-insulin (ngonyaka ka 1921), abesifazane kwakuqabukela besinda baye eminyakeni yokuzala, futhi yi-5% kuphela yabo ekhulelwa.
Esimweni sokukhulelwa, odokotela babevame ukumcebisa ukuthi akhiphe isisu, ngoba ebeka engcupheni enkulu impilo yowesifazane. Njengamanje, ukulawulwa kwezifo kwenziwa ngcono kakhulu futhi kube nokwehla okukhulu ekufeni kwabantu ababelethisa.
Kepha ngasikhathi sinye, ukungahambi kahle kokuzalwa ezinganeni ezizalwa omama abanesifo sikashukela kuvela 2 kuya ku-15% wamacala. Kusuka kuma-30 kuye kwangama-50% azo zonke izigameko zokufa okuphathelene nokuhlukunyezwa okuvela kokungalungi okwenzeka kulezi zingane ezisanda kuzalwa.
Omama besikhathi esizayo abanesifo sikashukela sohlobo lokuqala bangamathuba aphindwe kahlanu okuba nokuzalwa futhi nokufa phakathi kwezingane ezisanda kuzalwa. Ngaphezu kwalokho, ezinganeni ezivele kwabesifazane abanjalo, ukushona kwezinsana kuphindeke kathathu, futhi kweze-neonatal ku-15.
Izingane ezinomama abanesifo sikashukela sohlobo lokuqala zinamathuba aphindeke kathathu okuzalwa zisebenzisa isigaba sokakhokho, zinokulimala okuphindwe kabili kunesidingo esikhudlwana sokukhathalela kakhulu.
Kuyini isifo sikashukela?
Isifo sikashukela ngesifo sikashukela yisimo sengane esibelethweni futhi sizalwa ngowesifazane onesifo sikashukela, lapho kwenzeka khona into ethile ekhethekile ekukhuleni kwengane. Baqala ngemuva kwe-trimester yokuqala uma isifo sikashukela sikamama sisenkingeni noma sinxephezelwe kahle.
Isimo se-fetus sihlolwa ngisho nangesikhathi sokukhulelwa, uketshezi lwe-amniotic lufundwa isilinganiso se-lecithin ne-sphingomyelin, kuhlolwa amagwebu, kuhlaziywa amasiko, kanye negreyidi le-Gram. Izingane ezisanda kuzalwa zikalwe esikalini se-Apgar.
Izingane ezizalwe omama abanesifo sikashukela zingaba nezinguquko ezilandelayo ezinobuntu:
- ukuphazamiseka kokuphefumula;
- i-hypoglycemia;
- i-gigantism noma ukungondleki;
- hypocalcemia;
- i-hypomagnesemia;
- i-polycythemia ne-hyperbilirubinemia;
- ukungasebenzi kahle.
Izingane ezivela kwabesifazane abanesifo sikashukela zinokubambezeleka ekwakhekeni kwezicubu zamaphaphu ngenxa yokuvinjwa kokuvuthwa kokuvuthwa kwamaphaphu ngaphansi kwesenzo se-cortisol ngenxa ye-hyperinsulinemia.
Ama-4% ezinsana ezisanda kuzalwa anokuhlukumezeka emaphashini, i-1% ihlakulela i-hypertrophic cardiomyopathy, polycythemia ne-tachypnea yesikhashana yosana olusanda kuzalwa.
Ngokusho komqondo kaPederson, isifo sikashukela, i-gigantism ne-hypoglycemia kukhula ngokulandela lesi simiso esilandelayo: "fetus hyperinsulinism - hyperglycemia kamama." Imvamisa, ukungalungi emntwaneni kuvela ngenxa yokulawulwa okungalungile kokuxineka koshukela egazini likamama ezinyangeni ezintathu zokuqala zokukhulelwa.
Uma owesifazane enesifo sikashukela sohlobo loku-1, khona-ke kufanele alawulwe i-conceptual glycemic control futhi ahlele ngokucophelela ukukhulelwa kwakhe ukuvimbela ukukhubazeka kokuzala ezalweni zesibeletho.
I-Hyperglycemia yowesifazane
I-Hyperglycemia yowesifazane ngesikhathi sokukhulelwa sekwephuzile kungaholela ekuzalweni kwengane enesisindo esiningi, ukuphazamiseka kwe-dyselectrolyte ne-cardiomegaly.
I-Macrosomy (gigantism) itholakala uma ukuphakama kwesisindo somzimba noma komzimba kuphambuka ngaphezu kwamasenti angama-90 okuhlobene nobudala bokuthinta umzimba. I-Macrosomia ibonwa ku-26% yezingane ezizalwa abesifazane abanesifo sikashukela, nasezinganeni eziqhamuka ejwayelekile ngamaphesenti ayi-10.
Ngenxa yesisindo somzimba esikhulu se-fetus nosanda kuzalwa, ingozi yokuthola izinkinga zempilo efana ne-dystopia yamahlombe e-fetus, i-asphyxia, ukuqunjelwa kwamathambo nokulimala kwe-pleachi ye-brachial ngesikhathi sokubeletha kukhula.
Zonke izingane ezine-gigantism kufanele zihlolwe ukuthi zingaba yini i-hypoglycemia. Lokhu kubaluleke kakhulu lapho owesifazane ethola inani elikhulu le-glucose solution ngesikhathi sokubeletha.
Uma isisindo somzimba nokuphakama kwengane esanda kuzalwa inezinkomba ezingaphansi kwamasenti ayi-10 okuhlobene nobudala bawo bokukhulelwa, khona-ke basho ngokubuyiselwa emuva kokukhula kwe-intrauterine.
Ngaphezu kwalokho, ukukhula kwe-morphofunctional kungamaviki amabili noma ngaphezulu ngemuva kweminyaka yobudala bokukhulelwa. Ukubuyiselwa emuva kokukhula kwe-intrauterine kubonakala ku-20% yezingane kwabesifazane abanesifo sikashukela kanye ne-10% yezingane kulo lonke inani labantu. Lokhu kungenxa yokuvela kwezinkinga ezinkulu zokuvuselelwa kwengqondo kumama.
Emahoreni okuqala empilo yengane, i-hypoglycemia ihlala yenzeka. Kubonakala nge-hypotension yemisipha, ukulungela okwengeziwe kokuqina, ukuguga, ukumunca okubabayo, ukukhala okubuthakathaka.
Ngokuyisisekelo, i-hypoglycemia enjalo ayinazibonakaliso zomtholampilo. Ukuphikelela kwalesi simo kwenzeka ngeviki lokuqala lempilo yengane.
Ukuthuthukiswa kwe-hypoglycemia ezinganeni ezisanda kuzalwa kuqala ngenxa ye-hyperinsulinism. Kuhlotshaniswa ne-hyperplasia yamaseli we-pancreatic beta wengane njengendlela yokusabela kuzinga elikhulayo loshukela egazini likamama. Lapho intambo ye-umbilical ligated, ukudla ushukela kusuka kumama kuye kungazelelwe, futhi ukukhiqizwa kwe-insulin kuyaqhubeka ngobuningi obukhulu, obubangela i-hypoglycemia. Indima eyengeziwe ekuthuthukisweni kwalesi simo futhi idlalwa ngokucindezela kwe-perinatal, lapho izinga le-catecholamines likhuphuka.
Izinyathelo zokuqala
I-fetopathy yesifo sikashukela idinga izinyathelo ezilandelayo ezingxenyeni zokuqala ngemuva kokuzalwa kwengane:
- Ukugcina ukuhlangana okujwayelekile koshukela egazini.
- Ukugcina ukushisa komzimba kosanda kuzalwa kusuka kuma-degree angama-36,5 kuya kwangama-37,5.
Uma ushukela wegazi wehla ngaphansi kuka-2 mmol / ilitha, khona-ke udinga ukufaka umjovo ushukela endaweni yesimo lapho izinga le-glycemia ngemuva kokondla ingane lingakhuphuki, noma i-hypoglycemia ibe nokubonakaliswa kwemitholampilo.
Uma ushukela wegazi wehla ngaphansi kwe-1.1 mmol / ilitha, kufanele ufake ijubane solution ka-10% kashukela ngokulethela ku-2,5-3 mmol / ilitha. Ukufeza lo mgomo, umthamo we-10% ushukela ubalwa enanini le-2 ml / kg bese ulawulwa imizuzu emi-5 kuye kweli-10. Ukuze ulondoloze i-euglycemia, kuthathwa isixazululo esisodwa se-bolus solution ye-10% ushukela ngokuqina kwe-6-7 mg / kg ngomzuzu. Ngemuva kokuthola i-euglycemia, isilinganiso sokuphatha kufanele sibe yi-2 mg / kg ngomzuzu.
Uma izinga lijwayelekile emahoreni ayishumi nambili, khona-ke ukumakwa kufanele kuqhubeke ngesilinganiso se-1-2 mg / kg ngomzuzu.
Ukulungiswa kokuhlushwa kwe-glucose kwenziwa ngokumelene nesizinda sokudla okungenamsoco.
Ngokusekelwa kokuphefumula, kusetshenziswa izindlela ezahlukahlukene zokwelapha i-oxygen, ezivumela ukugcina izinga lokugcwala komoya-mpilo egazini le-venous ngaphezulu kwe-90%. Ezinganeni ezizalwe ngaphambi kwamaviki angama-34 wokukhulelwa, amalungiselelo ezinto ezinikezwa ekugcineni.
Izinkinga zenhliziyo zelashwa ngendlela efanayo nama-pathologies afanayo kwezinye izingane. Uma kunesifo sokuxhuzula okuncane ngokuthikamezwa kwendlela okuphuma kuyo i-ventricle yangakwesobunxele, kuyabe kunqunywa i-propranolol (umuthi ovela eqenjini le-beta-blocker). Imiphumela yayo incike kumthamo:
- Ukusuka ku-0,5 kuye ku-4 μg / kg ngomzuzu - lapho kukhishwa khona ama-dopamine receptors, i-vasodilation (ukugcwala, i-coronary, i-mesenteric), ukunwetshwa kwemithambo ye-renal kanye nokwehla kokuphelele kokumelana kwemithambo yegazi.
- I-5-10 mcg / kg ngomzuzu - ithuthukisa ukukhishwa kwe-norepinephrine (ngenxa yokukhishwa kwe-B 1 ne-B 2 adrenergic receptors), ivuselela ukuphuma kwenhliziyo nokukhipha inhliziyo.
- I-10-15 mcg / kg ngomzuzu - ibangela i-vasoconstriction ne-tachycardia (ngenxa yokucaphuka kwe-B 1 -adrenoreceptors).
I-Propranolol iyi-blocker engakhethi ye-B-adrenergic receptors futhi ilawulwa ngethamo le-0,25 mg / kg ngosuku ngomlomo. Uma kudingekile, ngokuzayo, umthamo ungandiswa, kepha ungabi ngaphezu kuka-3.5 mg / kg njalo emahoreni ayisithupha. Ukulawulwa okuhamba kancane kwe-intravenous (kungakapheli imizuzu eyi-10), kusetshenziswa umthamo we-0,01 mg / kg njalo emahoreni ayi-6.
Uma umsebenzi osebenzayo we-myocardium ungancishisiwe futhi ukuthikamezwa kwephepha lokuphuma le-ventricle yangakwesobunto kungabonwa, khona-ke izidakamizwa ze-inotropic zisetshenziswa ezinganeni ezisanda kuzalwa:
- dopamine (intropin)
- i-dobutrex (dobutamine).
I-Dopamine ivuselela ama-adrenergic ne-dopamine receptors, futhi i-dobutamine, ngokungafani nayo, ayenzi kusebenze ama-delta receptors, futhi ngenxa yalokho ayithinti ukuhamba kwegazi okuphelele.
Umphumela walezi zidakamizwa ku-hemodynamics uncike kumthamo. Ukubala kahle umthamo wezidakamizwa ezi-inotropic ngokuya ngesisindo sengane esanda kuzalwa futhi unaka ubudala obuhlukile bokukhulelwa, kusetshenziswa amatafula akhethekile.
Ukulungiswa kweziphazamiso esele kuma-electrolyte.
Okokuqala, udinga ukuguqula okuqukethwe kwe-magnesium esegazini. Ukuze wenze lokhu, faka isisombululo esingu-25% se-magnesium sulfate ngesilinganiso se-0,5 ml kilo ngayinye yesisindo.
I-Hypocalcemia ayivezi kubonakala emtholampilo, futhi ilungiswa ngesisombululo esiyi-10% se-calcium gluconate emthanjeni we-2 ml kilo nganye yesisindo somzimba. Umuthi uphathwa ngaphakathi kokudonsa noma ukusakazeka kwemizuzu engu-5
I-Phototherapy isetshenziselwa ukwelapha i-jaundice.
