Kuberekwa diaphragmatic hernia kugadzirisa

Congenital diaphragmatic hernia (CDH) kugadzirisa ndiko kuvhiya kugadzirisa kuvhura kana nzvimbo mune diaphragm yemwana. Uku kuvhura kunonzi hernia. Icho chisingawanzo rudzi rwehurema hwekuzvarwa. Kuberekwa zvinoreva kuti dambudziko riripo pakuzvarwa.

Kuvhiya kwacho kusati kwaitwa, vangangoita vese vacheche vanoda mweya wekufema kuvandudza iwo oxygen mazinga avo.

Kuvhiya kunoitwa apo mwana wako ari pasi peanesthesia (akarara uye asingakwanise kunzwa kurwadziwa). Chiremba anovhiya anowanzo cheka (kucheka) mudumbu pasi pemabvu ekumusoro. Izvi zvinobvumira kuti nhengo dziri munzvimbo iyi dzisvike. Chiremba anovhiya zvinyoro nyoro nhengo idzi pasi munzvimbo dzacho kuburikidza nekuvhurika mudhiramu uye mudumbu.

Muzviitiko zvishoma zvakanyanya, kuvhiyiwa kunogona kuitwa uchishandisa zvidiki zvidiki mubhokisi. Kamera kadiki vhidhiyo inonzi thoracoscope inoiswa kuburikidza nechimwe chezviitiko. Izvi zvinobvumira chiremba anovhiya kuti aone mukati mechipfuva. Midziyo yekugadzirisa gomba mudhiramu inoiswa kuburikidza nezvimwe zvinoitwa.

Mune chero mhando rekuvhiya, chiremba anovhiya anogadzirisa gomba riri mudhiramu. Kana gomba iri diki, rinogona kugadziriswa nemastitch. Kana, chimedu chepurasitiki chigamba chinoshandiswa kuvhara gomba.

Iyo diaphragm imhasuru. Zvakakosha pakufema. Iyo inoparadzanisa chipfuva (pane moyo nemapapu) kubva mudumbu nzvimbo.

Mune mwana ane CDH, diaphragm mhasuru haina kunyatsoumbwa. Kuvhurwa kweCDH kunotendera nhengo kubva mudumbu (mudumbu, spleen, chiropa, uye ura) kuenda kumusoro muchipfuva mune mapapu. Mapapu haakure zvakajairika uye anoramba ari madiki zvakanyanya kuti vana vazvifemere vega kana vazvarwa. Tsinga dzeropa mumapapu dzinokurawo zvisina kujairika. Izvi zvinoita kuti okisijeni isakwanise kupinda mumuviri wemwana.

Iyo diaphragmatic hernia inogona kutyisidzira hupenyu uye vazhinji vacheche vane CDH vanorwara zvakanyanya. Kuvhiya kwekugadzirisa CDH kunofanirwa kuitwa nekukurumidza sezvinobvira mushure mekunge mwana azvarwa.

Ngozi dzekuvhiya uku dzinosanganisira:

• Matambudziko ekufema, angave akaomarara
• Kubuda ropa
• Mapapu akadonha
• Mapapu matambudziko asingaendi
• Utachiona
• Zviitiko kumishonga

Vacheche vanozvarwa vaine CDH vanobvumidzwa kuchipatara chekubereka chakanyanya (NICU). Zvinogona kuve mazuva kana vhiki mwana asati agadzikana zvakakwana kuti avhiyiwe. Nekuti mamiriro acho ari kutyisidzira hupenyu uye kutakura mwana achangozvarwa anorwara kune njodzi, vacheche vanozivikanwa kuti vane CDH vanofanirwa kuendeswa munzvimbo ine vana chiremba vanovhiya uye neonatologists.

• MuNICU, mwana wako angangoda muchina wekufema (mechanical ventilator) usati wavhiyiwa. Izvi zvinobatsira mwana kufema.
• Kana mwana wako achirwara zvakanyanya, moyo-mapapu wekupfuura muchina (extracorporeal membrane oxygenator, kana ECMO) inogona kudikanwa kuti uite basa remwoyo nemapapu.
• Usati wavhiyiwa, mwana wako anozoita x-ray uye kuongororwa kweropa nguva nenguva kuti aone mashandiro ari kuita mapapu. Chiedza chechiedza (chinonzi pulse oximeter) chinoiswa paganda remucheche kuti chiongorore muyero weokisijeni muropa.
• Mwana wako anogona kupihwa mishonga yekudzora BP uye kugara wakasununguka.

Mwana wako achave nemachubhu akaiswa:

• Kubva pamuromo kana mumhino kusvika mudumbu kuchengetedza mweya kubuda mudumbu
• Mune tsinga yekutarisa kuwedzera kweropa
• Mutsinga kuendesa zvinovaka muviri uye mishonga

Mwana wako achange ari pamushini wekufema mushure mekuvhiyiwa uye achagara muchipatara kwemavhiki akati wandei. Paunenge wabviswa pamushini wekufema, mwana wako anogona achiri kuda okisijeni nemishonga kwechinguva.

Kudyisa kunotanga mushure mekunge ura hwemwana wako hwatanga kushanda. Kudyisa kunowanzo kupihwa kuburikidza nekadiki, yakapfava yekudyisa chubhu kubva mumuromo kana mumhino kupinda mudumbu kana mudumbu mudiki kusvikira mwana wako atora mukaka nemuromo.

Vanenge vese vacheche vane CDH vane reflux pavanodya. Izvi zvinoreva kuti chikafu kana asidhi mudumbu mavo inokwira ichipinda mudumbu ravo, chubhu inotungamira kubva pahuro kuenda mudumbu. Izvi zvinogona kusagadzikana. Izvo zvinotungamira mukugara uchipfira uye kurutsa, izvo zvinoita kuti kudyidzana kuome zvakanyanya kana mwana wako achitora chikafu nemuromo. Reflux inowedzera njodzi yemabayo kana vacheche vachifema mukaka mumapapu avo. Izvo zvinogona zvakare kuita kuti zvive zvinonetsa kuvacheche kutora macalorie akakwana kuti akure.

Vanamukoti uye nyanzvi dzekudyisa vachakudzidzisa nzira dzekubata nekudyisa mwana wako kudzivirira reflux. Vamwe vacheche vanofanirwa kunge vari pombi yekudyisa kwenguva yakareba kuti ivabatsire kuwana macalorie akakwana kuti akure.

Mhedzisiro yekuvhiya uku zvinoenderana nekuti mapapu emwana wako akasimba sei. Vamwe vacheche vane mamwe matambudziko ekurapa, kunyanya nemoyo, huropi, mhasuru, uye majoini, izvo zvinowanzo kukanganisa maitiro emwana.

Kazhinji maonero akanaka kune vacheche vane hutano hwakagadzirwa hwemapapu uye vasina mamwe matambudziko. Kunyangwe zvakadaro, vacheche vazhinji vanozvarwa vaine diaphragmatic hernia vanorwara zvakanyanya uye vanogara muchipatara kwenguva yakareba. Nekufambira mberi mune zvekurapa, maonero evana vacheche ava kuvandudza.

Vacheche vese vakagadziriswa CDH vanozoda kunyatso tariswa kuti vaone kuti gomba mudhiramu ravo harivhurike zvakare pavanokura.

Vacheche vaive nekuvhurika kukuru kana kuremara mudhayaphira, kana avo vaive nematambudziko akawanda nemapapu avo mushure mekuzvarwa, vanogona kunge vaine chirwere chemapapu mushure mekunge vabuda muchipatara. Ivo vangangoda okisijeni, mishonga, uye chubhu yekudyisa kwemwedzi kana makore.

Vamwe vacheche vanozove nezvinetso kukambaira, kufamba, kutaura, uye kudya. Vanozoda kuona vemuviri kana vezvekurapa varapi kuvabatsira kuvandudza mhasuru uye simba.

Diaphragmatic hernia - kuvhiyiwa

• Kuunza mwana wako kuti ashanyire hama inorwara zvakanyanya
• Kuchengeta ronda rekuvhiya - rakavhurika

• Diaphragmatic hernia kugadzirisa - akateedzana

Carlo WA, Ambalavanan N. Matambudziko ekufema. Mune: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Chinyorwa chePediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016: chits. 101.

Hollinger LE, Harting MT, Lally KP. Yenguva refu-yekutevera yekuberekerwa diaphragmatic hernia. Semin Pediatr Kuvhiya. 2017; 26 (3): 178-184. PMID: 28641757 www.ncbi.nlm.nih.gov/pubmed/28641757.

Keller BA, Hirose S, Murimi DL. Zvirwere zvekuvhiya zvechipfuva nemumhepo. Mune: Gleason CA, Juul SE, eds. Zvirwere zveAvery zveMucheche. 10th ed. Philadelphia, PA: Elsevier; 2018: chits. 49.

Tsao KJ, Lally KP. Congenital diaphragmatic hernia uye chiitiko. Mune: Holcomb GW, Murphy JP, Ostlie DJ, eds. Kuvhiya kwaAshcraft Kwevana. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014: chits.