Congenital Diaphragmatic Hernias: Kuongororwa, Kuvhiya uye Kudzorerwa

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Chii Chinonzi Congenital Diaphragmatic (Bochdalek) Hernia?

Chirwere chemawere chinokonzera kufema, kana Bochdalek hernia, chinoitika muchizvaro uye chinoratidzwa panguva yekuzvitakura kana muchecheche. Izvo zvinoitika kana pane utera mukati mutsvuku, mutsara unoparadzanisa chifuva chechifu kubva mudumbu remuviri. Mukuwedzera pakuparadzanisa nhengo dzechifuva kubva munhengo dzemuviri, iyo diaphragm inobatsirawo mapapu azere ne oksijeni. (Kufamba kwedumbu iro iwe unoona kana uchifema ndiko kufamba kwechirafu.)

Nhengo yakakura yeharura inogona kubvumira nhengo yose kana nhengo kuti dzipinde mukati mechifuva, kuburikidza nehuni kana chirema. Mune zviitiko zvakawanda, hutachiona hunoputika hutsva, hunoda kurapwa nokukurumidza. Izvi ndezvokuti moyo nemapapu zvinonetsa kuzadza nekupa muviri muviri weokisijeni nekuda kwekukwira kwechifuva chechifu. Mwana achangoberekwa ane chirwere ichi chinogona kunge ane miromo inenge iine bluish, nekuda kwekushayikwa kweokisijeni.

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Zvinokonzera uye Zviitiko Zvengozi

Zvinokonzerwa neChenital Diaphragmatic Hernia

Hapana chakavanzika chinozivikanwa chechimiro chinoputika . Utera huri mumutsipa hunovapo pakuberekwa, unonziwo "congenital defect." Hapana nzira yekudzivirira hupfumi hwenyika, sezvavanoita mutero, mwana asati aberekwa.

Ndiani Ari pangozi yeChenist Diaphragmatic Hernia?

Mishonga inoputika inowanikwa mune 1 kubva pane 2,000 kusvika kune 5 000 kuberekwa. Ikoko inoratidzika seine chimiro chakabatanidzwa chinosanganiswa nemhando iyi yemhando, sezvo mwana angave ane ngozi yakawanda yekuva nemhando iyi yemuviri kana mukoma kana mubereki ane chirwere chacho. Vakomana vane ngozi yakanyanya kudarika vasikana.

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Kuziva

Nhengo yeharura inenge isina chimiro haifaniri kutaridzika nechepasi pasi peganda sezvinongoita mamwe maruva. Muzviitiko zvakawanda, hapana zviratidzo zvinoratidzika kuti mwana achangoberekwa ane rudzi urwu rwemunda. Ichaonekwa kuti ine ultrasound mwana asati aberekwa, kana mushure mokuberekwa apo dumbu rinonzwa rinoshungurudzwa "risina chinhu" apo kuongorora kwemuviri kuchiitwa. Mune zvimwe zviitiko, hutachiona hunogona kuwanikwa apo vanachiremba vari kutsvaga tsanangudzo yekuoma kwekufema kwechecheche iri kuitika.

Musha wake unofadza unowanzoitika kakawanda pamucheto wechecheche wechecheche, zvichiita kuti zvive nyore kuti mudumbu udzike mukati mechirema. Mune mamiriro mashoma, apo chete mudumbu inobatanidzwa, mwana angangoratidzira zviratidzo zvekuoma kwekudya nekurutsa.

Miedzo inogona kurairwa kuti ione nhengo dzipi dziri kuchinjwa nedambudziko. Mutsara unogona kurairwa kuti uongorore basa romwoyo; chest x-ray, CT scan kana MRI ingashandiswa kuongorora nhengo dzakawedzerwa. Kuongorora ropa kunogonawo kurairwa kuti uone kuti okisijeni inosvika kupi kuwedzerwa ropa pane kuwedzera kwebasa rebasa.

Zviratidzo zveHelen Diaphragmatic

• Kukurumidza kwepfungwa yemoyo (mwoyo unotsvaga kuti uwane oxygen mumuviri)
• Kufema kwekukurumidza kufema (mapapu ari kuedza zvakaoma kuwana oxygen mumuviri)
• Cyanosis (blue lips and fingernail beds)
• Matambudziko asina kufanira, asina kufema
• Kuongororwa kwekunyanyisa amniotic fluid panguva yekuzvitakura
• Kuongororwa kwepapu yakaputsika
• Rimwe rutivi rwechipfuva rinonyanya kukura kupfuura rimwe
• Zvinetso zvakakomba kudya kana kuchengeta zvokudya pasi
• Bhokisi re x-ray rinoratidza kusagadzikana mubhokisi

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Ndeipi Iri Rakabatana Remazuva Ano Hernia Inokurumidza?

Nzvimbo yakashata inogona kunge iri dambudziko kune zvikonzero zvakawanda. Mwana anogona kunge akaoma kufema, sezvo nhengo dzomuviri muchipfuva dzinoita kuti zvive zvakaoma kuti mapapu awedzere. Izvi ndezvechokwadi pamwoyo; zvinogona kuva zvakaoma kuti mwoyo uzadze neropa nekuda kwekuwedzera kwebhokisi.

Mukuwedzera, kune ngozi yekudzima kwezvikamu zviri kuomesera muchipfuva, zvinoreva kuti nhengo dzakatamira muchipfuva dziri kuregererwa ropa. Izvi zvinogona kukonzera rufu rwechigunwe uye nhengo dzinenge dzichikurira kuburikidza nemunda.

Vacheche vanoberekerwa nemakumbo anonzi diaphragmatic hernias vanowanzochengetwa mune chimwe chikwata chekuchengetedza zvakanyanya nekuda kwezvinetso zvakakomba zvinowanzovapo. Pasinei nokuti vana vanoberekwa vane chirwere chinoputika vanorwara zvikuru, kuvhiyiwa kunogona kuchinonoka kusvikira mapapu ese akatsigiswa, sezvo izvi zvingavandudza mikana yekupona chirwere.

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Congenital Diaphragmatic Hernia Surgery

Kuvhiyiwa kwemajeri inonzi diaphragmatic inowanzoitwa kuburikidza nekushandisa aneshehesia yakawanda uye inoitwa pane chirwere chepfungwa . Inogona kuitika nokukurumidza, pakarepo mushure mekuberekwa kwomwana, kana pakarepo mwana wacho akasimba zvakakwana kuti abvumirire kuvhiyiwa. Mune zvimwe zviitiko, pangava nechido chekusimudza kufema kwomwana kana kuti mwoyo mushure mekuvhiyiwa kunogona kuitwa. Munzvimbo dzisinganzwisisiki, kuvhiyiwa muUtero kunogona kufungwa, nzira iyo chirwere chinoshandiswa pamucheche apo amai vane pamuviri. Iyo fetus inobvumidzwa kuramba ichingokura apo kuberekwa kunopfuurira, kunyange zvazvo kubata kunowedzera ngozi.

Kuvhiyiwa, kana kuchiitwa pachecheche, kunoitwa nechiremba mukuru wezvechiremba, asi zvinogona kubatsirwa nevamwe vanachiremba, sachiremba wechirdidiracic kana kuti nyanzvi yekoloni-rectal mumatambudziko makuru. Zvichienderana nezvikamu zvakakanganiswa, vakasiyana-siyana kana vamwe vanovhiya vanowedzera vane unyanzvi hwakasiyana vanogona kutora chikamu pakuvhiyiwa.

Kuvhiyiwa kunowanzoitwa nenzira yakasununguka kushandiswa kwekushandiswa kwemazinga pasi pechibhakera chembambo, kwete pane nzira shoma inoparadzanisa laparoscopic . Izvi zvinokonzerwa nokuoma kwechinetso ichi pamwe chete nehukuru hukuru hwomurwere.

Kuvhiya kunotanga nekuwana chirema mukati memharafu uye mhuka yakasimudzira munzvimbo yechifuva. Mhuka uye nhengo, kana dziripo, dzinoiswa mudumbu. Kana kamwechete mazamu acho adzorerwa kunzvimbo yavo yakakodzera, gomba riri muvharasi rakavharwa. Izvi zvinoitwa kudzivirira mimba dzemaviri kuti dzisafambidzana zvakare kumapfupa emapfupa. Kana chiremera chiri mumarara chiri chakakomba zvikuru, chinyorwa chinogona kugadzirwa kubva pakugadzirisa zvinhu.

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Kuwana kubva kuDiaphragmatic Hernia Surgery

Vazhinji vese varwere vanorwara zvakanyanya pamagumo ekuvhiya uye vachaendeswa kuNeonatal Intensive Care Unit (NICU) kuti iwanezve. Kune varwere vashoma vanogona kufema pachavo pfupi mushure mekuvhiyiwa, tarisira mwana akangwara asinganzwisisi uye pane dzimwe nguva, zvakaoma kunyaradza.

Kana mapapu emucheche asati achinjwa kana kuti matambudziko ekufema anoramba achitsvaga mushure mekuvhiyiwa, vhizimusi inogona kudiwa panguva yekudzoka. Mune zvimwe zviitiko zvakanyanya, ventilator haina kukwana kupa oxygen yakakwana kumuviri. Muzviitiko izvi ECLS / ECMO (Extracorporeal Life Support / Extracorporeal Membrane Oxygenation) inogona kushandiswa, mishonga inobatsira kukonzera ropa apo mapapu nemwoyo zvisingagoni kuita kudaro. Iro kurapwa kunongoshandiswa chete kune vanorwara zvikuru, avo vanozofa vasina kuwedzerwa oksijeni vachiendeswa kumuviri.

Nguva yakareba mwana inopinda muI ICU inonyanya kuvimba nezvakaoma zvakadai semunda wake, kana pane nhengo chero ipi zvayo yakanganisa uye kuti yakagadziridzwa sei nhengo.

Zvinosuruvarisa, iyi mamiriro acho akaoma uye vamwe vana havabvumiri kuvhiyiwa. Vamwe vana vanozviita kuburikidza nekuvhiyiwa, asi kusanganiswa kwekuvhiyiwa, nhengo dzisina kusimbiswa kana nhengo dzomumigumisiro dzinoguma murufu. Inofungidzirwa kuti 80 muzana yevarwere vanopona kuvhiyiwa uye kupora.

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Migumisiro Yenguva Dzakawanda dzeHajapragmatic Hernias

Nhengo inotapira inogona kukonzera zvinetso mwana asati aberekwa. Mapapu nemwoyo wemwana zvinogona kunge zvisina kukura zvakakwana, nekuda kwekumanikidzwa kunokonzerwa nemamwe maviri mubhokisi. Zvisikwa kana nhengo dzinopinda muchipfuva zvinogonawo kukuvara kana kukundikana kukura zvakanaka nekuda kwekushayikwa kweropa. Izvi zvinogona kuguma mukuenderera mberi kwekunetseka kwepfungwa, matambudziko emwoyo uye nenyaya dzekudya.

Vaya varwere vanowanzoona kunonoka kukura, izvo zvingaderera kudarika nguva. Mune dzimwe nguva, kukundikana kwekukurumidza kuongororwa kunoenda kunogara kwenguva refu kusagona kuwana oxygen yakakwana kumuviri.

Mamwe Mashoko: Zvose Pamusoro paHernias

_Sources:

_{Congenital Diaphragmatic Hernia. University of Michigan Health System. http://surgery.med.umich.edu/pediatric/clinical/physician_content/am/congenital_diaphragmatic.shtml}

_{Diaphragmatic Hernias. The Lucile Packard Children's Hospital iri kuStanford http://www.lpch.org/diseasehealthinfo/healthlibrary/digest/diaphrag.html}