Nemhaka yokuti chirwere chinowanzojairika mune zvehutano, hazvishamisi kuti 3 - 8 muzana yehutano hwose hunobatanidza kuongororwa kweAsthma.
Kusiyana nedzimwe mamiriro ezvinhu apo iwe unogona kumira mishonga panguva yekuzvitakura kana panguva yekutanga yekubata panguva yekuwana dambudziko guru rematogogenic effects, asthmatics inoda kutora mishonga yavo kuti ichengete zvakanaka.
Izvi zvinotungamirira kumibvunzo yakawanda yemibvunzo yakabatana nekuchengetedzwa kwemishonga yekushaya chirwere panguva yekudzivirira, kukanganisa kwepamuviri pahutachiona hwehutachiona hwako, uye huchaita kuti chirwere chiite mungozi yakakura kana kukonzera kukuvadza kumwana kana yo iwe here?
Kudzora Pora Pakati Pamuviri
Kudzora nyuchi pakuita pamuviri kunogona kufungidzirwa nemitemo yezvitatu-chimwe chetatu chekudzivirira asthmatics chakagadziriswa kudzora, chechitatu chinoratidza kusachinja, uye chechitatu chekupedzisira inowedzera kuwedzera kwezviratidzo. Muzhinji, kushushikana kwako kwepimma usati wava nepamuviri kunobatana neukama hwako hwepifu panguva yekuzvitakura.
Kunyange mumwe angafungidzira kuti sezvo girth yako yemimba inowedzera kuti kutapisa kwechifu kunowedzera kuipa, asi kunosvika pakuve kwakasiyana uye hombodo haina kunyanya kuoma mumavhiki ekupedzisira ekudzivirira. Apo chirwere chekudzivirira chikafu chikavandudza zvakaratidzika kuzviita zvishoma nezvishoma pamusoro pematambudziko ekudzivirira. Madzimai avo vane hutachiona hwakaipisisa, kuwedzera kwakanyanya kwaive pakati pevhiki 29-36 yekuzvitakura.
Zviratidzo zvinokonzerwa nehutachiona hazvijairika panguva yekushanda uye kubereka. Kuvhiringidzika kweputi kwakaita sokuti kunowanzoitika kakawanda munguva yechipiri neyechitatu mitatu. Pakupedzisira, dzidzo yepmma panguva yekuzvitakura inowanzozvidzokorora pamubhedha unotevera. Kana uhwu uhwu huchivandudza munguva yehutumbi hunowedzera kuvandudza nekurara kwekuzouya uye pamwe chete.
The Impact Of Asthma on Pregnancy
Kunyanya kutaridzika asthma kunogona kutungamirira kune zvinetso zvose zvinotevera:
- Rufu rwemucheche
- Preterm kutumira
- Kuderedza kuberekwa
- Kusununguka
- Kubvumira zvose pamberi uye shure kwekubereka
- Kuora mwoyo
- Preeclampsia kana kuti pamuviri-inokonzerwa nehutachiona
- Ropa rinovhara kana mapurmoni embolism
- Congenital malformations
- Hyperemesis, chirwere chokurutsa
- Basa rakaoma
Izvi zvinetso zvinogona kukonzerwa nekuderera kweakisijeni mazinga. Kuderedza oksijeni maitiro mumama kunogona kutungamirira kuderera kwemajini okwana wako uye kuderera kweropa kuyerera kusvika kune placenta. Panewo zvinogona kuitika zvinokonzerwa nemishonga yekurapa.
Hapana chimwe cheizvi chekuchinja kunobatana nekudzivirira kwechimusi kana kukanganisa kwechirwere pakuberekwa kunofanira kutorwa kunoreva kuti asthmatics haifaniri kutora pamuviri. Kurapa kwakanaka uye kudzora kunoderedza uye kuderedza ngozi yezvinetso izvi.
Izvo zvakanyanya kuoma mweya wako, zvinowanzoita kuti uve nechirwere chemafi.
Chirwere Chirwere Muhutano
Kurapa kwako kwepamu pakuberekwa hakusi zvose zvakasiyana nekurapa kwako mune zvisiri mimba. Iwe unoda chirongwa chechirwere cheputi , unoda kugara uchitarisa zviratidzo zvako zvechirwere , uye edza kudzivisa zvinokonzera. Chimwe chezvinhu zvinoita kuti kuongorora zvishoma zvive nyore pakuzvitakura ndiko kunzwa kwekupfupika kwemhepo vakawanda varwere vane pamuviri vanowana, kunyanya gare gare pakuve nepamuviri.
Kuchema uye kuputika, zvisinei, hazvirevi zviratidzo zvekudzivirira uye zvinogona kuva chiratidzo chekushaya masimba ekudzivirira. Somugumisiro, kutarisa asthma nepamusoro pekuyerera kana FEV1 inogona kuva yakanyanya kuvimbika kune murwere ane pamuviri. Kuyerera kweimwe yei izvi kunogona kuratidza kuwedzera kwehuputi.
Kufanana nemurwere asina kuberekwa , kurega kusvuta kunokosha kune chiremera chepamuviri. Kwete kusvuta kunowedzera mukana wekuwedzera kwekusimudzira mweya , asi kunogona kuita kuti uwandu hwemhepo yakadzika huwedzere uye hunogona kuwedzera dambudziko rekuona chimwe chezvinetso zvakambotaurwa kare. Saizvozvowo, kudzivisa zvimwe zvinokanganisa zvakadai seguruva, dander , uye guruva mite chikamu chinokosha cheurongwa hwako hwekuita.
Mishonga Panguva Yokudzivirira
Zvine chokuita nekurapwa kwechirwere pakuberekwa, mibvunzo miviri inowanzobuda yakabatana nemishonga.
1. Mishonga yekurapa inokonzera matambudziko kune mwana anobudirira here?
2. Kuberekwa kunoshandisa kubudirira kwemumwe mishonga kana uchienzanisa nekubudirira kwahwo mune zvisiri mimba here?
Mishonga yeApmma panguva yekuzvitakura yakabatanidzwa nemigumisiro yakakomba yakaipa yakadai seyi:
- Kusununguka
- Rufu
- Congenital malformations
- Kupera kukura mu-utero
- Kubudirira kusimba
- Kupera kweropa kunopfuurira kusvika kune placenta
- Kuwedzera kwengozi yekugadzirira kutangira
Zvisinei, munhu anofanira kunge achiziva zvose izvi zvinowanzokonzera zvinowanzoonekwa mukudzivirira, kunyange mumadzimai ane pamuviri asina chirwere. Semuenzaniso, congenital anomalies inowanikwa mu3% yevanhu vakaberekwa kurarama uye kusapererwa 10-15% yekuzvitakura. Hapana mishonga inonzi asthma iripo ikozvino inonzi Chikamu A neUnited States Food and Drug Administration. Izvi zvingave zvinodhaka zvinotungamirira zvidzidzo zvekutsvaga mumadzimai ane pamuviri zvakakundikana kuratidzira njodzi kumucheche muhutumbi hwepakutanga uye pasina uchapupu hwehutambudziro mushure mekuita pamuviri. Zvizhinji zvinodhaka zvechirwere zviri mukirasi B kana kirasi. Chirwere chechikoro B chinoreva kuti zvidzidzo zvemhuka hazvina kuratidza chero dambudziko rekurera mwana, asi hapana dzidzo dzinochengetedzwa mumadzimai ane pamuviri. Inogonawo kureva kuti pane imwe njodzi inowanikwa muzvidzidzo zvemhuka izvo zvisingasati zvatsigirwa mune zvidzidzo zvevakadzi mumwedzi wekutanga wekuita pamuviri uye pasina uchapupu hwehutambudziro mushure mekuita pamuviri. Mungozi yeChikoro C haikwanise kubudiswa kunze uye kushandiswa kunofanirwa kungofungidzirwa chete kana zvikomborero kune fetus zvisingaiti njodzi. Mukirasi D kune uchapupu hunofadza hwehutambudziro, asi kushandiswa kwechirwere kunogona kugamuchirwa pasinei nechinetso.
Nenzira yakawanda, inofungidzirwa kuti kushandiswa kwakasimba kunoramba kwakanaka kutora masimba uye kudzivirira kuwedzera kunowedzera zvinowanzoita nengozi dzese dzinowanzoshandiswa mishonga yekurapa chirwere. Albuterol, beclomethasone, uye budesonide zvose zvakashandiswa mukutsvakurudza kwevakadzi vane mimba yekudzivirira uye zvidzidzo zvose zvaive nemigumisiro inokurudzira. Kune rumwe rutivi, zvidzidzo nemuromo we prednisone hazvina kumbosimbisa. Iko kunewo mishonga yemishonga ine uwandu hushoma hwevanhu mune varwere vane pamuviri.
SABAs . Maawa mashoma-acting beta agonist anopa zororo rinokurumidza zviratidzo zvechirwere zvakadai se:
Nepo kunyanya kukwirira kwemaSABAs kwakaratidza zvinokonzerwa netatogenic mumhuka, hapana dhiyabhorosi inoratidza zvakajeka kuti matatogenic effects muvanhu. Zvidzidzo zvakaratidza zvakaratidzwa zvishomanana kana matambudziko ane albuterol. Zvisinei, zvimwe zvidzidzo zvishomanana zvakaratidza gastroschisis kana urema hunoberekwa iyo mwana akaberekerwa ane zvimwe kana matumbu ake ose kunze kwemuviri nekuda kwekuzarura kwemuviri masvingo. Imwe dambudziko nemamwe emigumisiro yemigumisiro inoratidza kuve nekukuvadza ndeyokuti kushandiswa kweSABA kunobatanidzwa nehutachiona husingaitirwi hutsika hunogona kutungamirira kune dzakawanda zvinorondedzerwa zvinoratidzika.
Systemic beta-adrenergic agonists dzimwe nguva inoshandiswa kudzivirira basa risina nguva. Panzvimbo pokurambidza mishonga iyi inopiwa kuburikidza ne IV. Zvipembenene zvinowanzoonekwa zvakajeka nenzira iyi yekutungamirira i hyperglycemia kana yakasviba ropa sutu. Apo vacheche vanoberekwa dzimwe nguva vane mwoyo yakakwirira, kutengesa, uye nechepasi shuga yeropa semugumisiro wekubata pamuviri. Zvose izvi zvinokonzerwa nematambudziko muchechecheche zvinorapwa uye kazhinji, zvinodzokorora nokukurumidza saka hazvisi izvo zvinopesana.
LABAs . Chiitiko neLABAs uye kubata hazvisi zvishoma kudarika kune vaSABA. Kubva pane izvo zvinoitika ruzivo rwakakosha runosanganisira zvidzidzo zvevanhu uye zvezvipfuwo, hazviratidzi kuti salmeterol kana formoterol inowedzera dambudziko rekuberekwa kusina kunaka. Pane humwe hutano hwakakwana hwevanhu ne salmeterol. Somugumisiro, zvinonzwisisika kana mukadzi akazvitakura kuti arambe aine LABA iyo yaidiwa kuti uite chirwere cheputi mumamiriro ekutanga asati aberekwa. Ngozi yekuberekwa kusagadzikana nehana yakasanganiswa yeLABA / steroid inhaled inoratidzika kunge yakafanana nesirivha kana yakakwirira yeCIS monotherapy.
Epinephrine. Nemhaka yehutachiwana hwekuderera kweropa kunopinda kune placenta, Gira rekushanda pamusoro peKubata uye Asthma rinokurudzira ichi chirwere chinoshandiswa chete mukugadzirisa vanaphylaxis.
Oral steroids. Oral steroids inowanzoshandiswa pakuberekwa kwemhando dzakasiyana siyana kunze kwechirwere. Zvimwe zvekunetseka pamusoro pekushandisa kwavo zvinosanganisira kuwedzera njodzi yekusarura, kuberekwa kunokonzera (kunyanya cleft palate), kubata pamuviri-kunokonzerwa nehutachiona, gestational chirwere cheshuga, kuberekwa kunorema, uye neonatal adrenal kusakwana. Pane mhinduro shomanana dzisarudzo. Somuenzaniso, zvimwe zvidzidzo zvakaratidza dambudziko rinowedzera rekucheka palate uye vamwe havana. Uchapupu hunoratidza kukurumidza kusununguka pakati pevakadzi vanogamuchira steroid munguva yose yekuzvitakura hauna simba. Pakupedzisira, huwandu hwehutachiona uye mazinga ehutukidzi akakwirira anozivikanwa kusangana uye saka, hazvishamisi. Saka zvinonyatsouya kune ngozi. Pane ngozi yakawanda kuna amai uye fetus inobatana nehutachiona hwekusimudzira mweya. Ngozi dzehupenzi husingadzorwi dzingaita sokuti dzinodarika zvinokonzera njodzi dze steroid kune vakawanda varwere.
Inhaled steroids. Nhoroondo yekuchengetedzwa kweakaroti inhaled panguva yekuzvitakura, saizvozvowo kune vasiri vasikana vane pamuviri, zvinonyanya kukurudzira. A registry study ye inhaled steroid budesonide muSweden vakadzi vakaratidza kuti hapana kuwedzera kwengozi yekusagadzikana kuenzaniswa nehuwandu hwevanhu. Chidzidzo chacho hachina kuratidza kusawirirana kwakabatana nekukura kwekuberekwa, kufa, kana kupera. Kubva pazviwanikwa izvi ndiyo chete inoderedzwa steroids iye zvino ine chirongwa cheB B. Mune imwe nheyo ye database yakafanana nekudzidza, fluticasone yakaratidza kuti hapana kuwedzera kwekuberekwa kusina kufanana nekuenzaniswa nedzimwe steroid inoputika. Miedzo miviri yakarongedzwa yakarongeka yakaratidza mapapu ekuvandudza basa uye kuderera kwemari yekuverenga.
Leukotriene modifiers. Kufanana neLABAs, boka iri rechirwere rine chirwere chiduku chechipatara kusvikira nhasi, asi data ne montelukast iri kukura. Nyaya dzisina kubudiswa kubva kuMareck Pregnancy Registry uye chiitiko chinotarisirwa, chinotungamirirwa chinoratidza kuti kuwanda kwekuzvarwa kwekusagadzikana hakuratiki kwakasiyana nehuwandu hwevanhu. Somugumisiro, varwere vanoda ruzha rweucotriene vangashandirwa zviri nani ne montelukast kusvikira mamwe mashoko aripo kubva kune vamwe vashandi.
Anti-immunoglobulin E. Monoclonal anti-immunoglobulin E anorinki kana omalizumab inogamuchirwa kune varwere vane chirwere chisina kunaka chetachiona uye vane mazinga akawandisa eGE pasinei nekushandisa steroid inhaled. Kunyange zvazvo isina kuongororwa zvakananga mune zvidzidzo zvekliniki, maitiro ezvinetso zvakadai sokupererwa kwepamuviri, kutanga kwepabonde, vaduku-zve-gestational-age yevana, uye congenital anomalies inoita kunge yakafanana nedzimwe ongororo dzekudzivirira asthmatics. Iko hakusi ikozvino zvakakwana deta kuti ipe kukurudzira kwekushandisa kwayo pakuzvitakura.
Methylxanthines. Iko kune chiitiko chakakura chemakiriniki ne theophylline uye aminophylline pakuzvitakura. Kunyange zvazvo mishonga iyi iri mumakiriniki akachengeteka, simba ravo rekugadzirisa muviri rinoshandurwa zvikuru mukudzivirira uye mazinga anofanira kuongororwa. Nzira yakakosha yokurapa inokosha zvikuru iyo inoita kuti kurapwa mune varwere vasiri vasikana kuome. Uyezve, sezvinoitwa nevasiri ivo vane pamuviri, steroid inharedzwa inoshanda zvakanyanya pakugadzirisa mweya. Somugumisiro, mishonga iyi inofungidzirwa zvakanakisisa sekuwedzera-kune vashandi kana kutadza kusingakwanisi kuwanika ne-steroid inhaled.
Immunotherapy. Kunyange zvazvo zvisiri kukurudzirwa kuti utange immunotherapy panguva yekuzvitakura, hazvioneki kuti mishonga iyi inowedzera ngozi kune amai kana fetus kuitira kuti ienderere mberi pakuberekwa.
> Sources
> Tata LJ, Lewis SA, McKeever TM, et al. Migumisiro yehutachiona hwemamai, kuwedzera uye mishonga yekurapa inoshandiswa pamusana pekusangana kusagadzikana muvana: kuongororwa kwevanhu vemuUK. Tora 2008; 63: 981.
> Blais L, Kukanganisa A. Kuwedzera kwehupombwe mukati mekutanga kwekutanga kwekuita pamuviri uye pangozi yekuberekwa kusagadzikana pakati pevakadzi vechikadzi. J Allergy Clin Immunol 2008; 121: 1379.
> Dombrowski MP, Schatz M, ACOG Komiti yeKubatsira Bulletins-Obstetrics. ACOG inoshandiswa nhaurirano: kliniki yekufambisa mirayiridzo yezvipatara-gynecologists nhamba 90, February 2008: asthma mukuzvitakura. Obstet Gynecol 2008; 111: 457.
> Eltonsy S, Forget A, Beauchesne MF, Blais L. Dambudziko rekuzvarwa kusina kumira>>> Vakadzi vane pamuviri vane chiremera vachishandisa nguva yakareba β₂-agonist uye inhaled corticosteroid kusangana pamwe nepamusoro-dose inhaled corticosteroid monotherapy. J Allergy Clin Immunol 2015; 135: 123.
> Namazy JA, Murphy VE, Powell H, et al. Migumisiro yekutsamwa kwemafi, kuwedzera uye muromo wekorticosteroids pamigumisiro yepinatal. Eur Respir J 2013; 41: 1082.
> Dombrowski MP, Schatz M, Wise R, et al. Nyeredzi panguva yekuzvitakura. Obstet Gynecol 2004; 103: 5.