Maʻi maʻi naʻau Cyanotic

ʻO ka maʻi puʻuwai cyanotic e pili ana i kahi hui o nā puʻuwai puʻuwai like ʻole i loaʻa i ka wā hānau (congenital). Loaʻa lākou i kahi pae oxygen haʻahaʻa. ʻO Cyanosis e pili ana i kahi kala bluish o ka ʻili a me nā membrane mucous.

ʻO ka maʻamau, hoʻi ke koko mai ke kino a kahe i loko o ka puʻuwai a me nā akemāmā.

• ʻO ke koko i haʻahaʻa i ka oxygen (ke koko polū) hoʻi mai ke kino a i ka ʻaoʻao ʻākau o ka puʻuwai.
• ʻO ka ʻaoʻao ʻākau o ka puʻuwai e pīpī i ke koko i nā ake māmā, kahi e ʻohi ai i ka nui o ka oxygen a lilo i ʻulaʻula.
• Hoʻi ke koko waiwai oxygen mai ka māmā a ka ʻaoʻao hema o ka puʻuwai. Mai laila mai, puhi ʻia i ke koena o ke kino.

Hiki i nā kīnā ʻole o ka naʻau ke hānau ke keiki ke hoʻololi i ke kahe o ke koko ma loko o ka puʻuwai a me nā māmā. Hiki i kēia mau kīnā ke hoʻoemi i ke kahe o ke koko i nā akemāmā. Hiki iā lākou ke hopena i ka hui pū ʻana o ka uliuli a me ka ʻulaʻula. ʻO kēia ke kumu e hoʻokuʻu ʻia i ke koko oxygenated maikaʻi ʻole i ke kino. Ma ka hopena:

• ʻO ke koko e hoʻokahe ʻia i ke kino ma lalo o ka oxygen.
• Hiki i ka oxygen liʻiliʻi i hāʻawi ʻia i ke kino ke hana i ka ʻili i polū (cyanosis).

Pili kekahi o kēia mau kīnā ʻole i ka nohona o nā puʻuwai. Koikoʻi kēia mau kīnā i ke koko polū e hui pū me ke koko ʻulaʻula ma o nā kahawai puʻuwai maʻamau. Loaʻa nā valves puʻuwai ma waena o ka puʻuwai a me nā kīʻaha koko nui e lawe i ke koko a mai ka puʻuwai. Wehe ʻia kēia mau vaʻa no ke kahe o ke koko. A laila pani lākou, mālama i ke kahe o ke koko i hope.

Nā kīnā o ka puʻuwai puʻuwai e hiki ke kumu i ka cyanosis.

• ʻO ke kiwikā Tricuspid (ke kiwikā ma waena o nā keʻena 2 ma ka ʻaoʻao ʻākau o ka puʻuwai) e ʻike ʻole a hiki ʻole paha ke wehe ākea.
• Pulseary Valve (ka nohona ma waena o ka puʻuwai a me nā akemāmā) e ʻike ʻole a hiki ʻole paha ke wehe ākea.
• ʻAʻole hiki i ke kiwikā Aortic (ke kolo ma waena o ka puʻuwai a me ke kīʻaha koko i ke koena o ke kino) ke wehe ākea.

Hiki i nā kīnā o ka puʻuwai ke komo pū me nā mea kūpono ʻole i ka hoʻomohala kiwikā a i ʻole ka wahi a me nā pilina ma waena o nā kīʻaha koko. Aia kekahi mau laʻana:

• Coarctation a i ʻole hoʻopau piha o ka aorta
• ʻO Ebstein anomaly
• Hypoplastic hema puʻuwai maʻi
• ʻO Tetralogy o Fallot
• Hoʻi ka huakaʻi anomaly pulmonary venous
• Transposition o nā aʻa nui
• Truncus arteriosus

Hiki i kekahi mau kūlana olakino i ka makuahine ke hoʻonui i ka makaʻu o kekahi mau maʻi puʻuwai cyanotic i ka pēpē. Aia kekahi mau laʻana:

• Hōʻike kemikala
• ʻO nā genetic a me nā chromosomal syndrome, e like me Down Syndrome, trisomy 13, Turner Syndrome, Marfan Syndrome, a me Noonan Syndrome.
• Nā maʻi (e like me rubella) i ka wā hāpai
• Ka pae kō kō kō ʻole maikaʻi ʻia i nā wahine i loaʻa i ka maʻi kō i ka wā hāpai
• Nā lāʻau i kuhikuhi ʻia e kāu kahu mālama ola a i kūʻai ʻia paha iā ʻoe iho a hoʻohana ʻia i ka wā hāpai
• Ua hoʻohana ʻia nā lāʻau o ke alanui i ka wā hāpai

ʻO kekahi mau kīnā o ka naʻau ke kumu o nā pilikia nui ma hope pono o ka hānau ʻana.

ʻO ka hōʻailona nui he cyanosis kahi kala bluish o nā lehelehe, nā manamana lima, a me nā manamana wāwae i hoʻokumu ʻia e ka haʻahaʻa oxygen ma loko o ke koko. Hiki paha i ka wā e hoʻomaha ana ke keiki a i ʻole ke hana ke keiki.

Loaʻa i kekahi mau keiki i nā pilikia hanu (dispnea). Hiki iā lākou ke komo i kahi kūlana squatting ma hope o ka hoʻoikaika kino e hōʻoluʻolu i ka hanu ʻole.

ʻO nā mea ʻē aʻe he kilokilo, kahi i pōloli ʻole ai ko lākou kino i ka oxygen. I loko o kēia mau ʻanuʻu, hiki ke hoʻopili ʻia nā ʻōuli:

• Hopohopo
• Ka hanu wikiwiki ʻana (hyperventilation)
• Hoʻonui piʻi i ke kala bluish i ka ʻili

Luhi a palu paha nā pēpē i ka wā e hānai ana a loaʻa ʻole paha ke kaumaha e like me ka mea e pono ai.

Hiki paha ke palu (sinkope) a me ka ʻeha o ka umauma.

ʻO nā ʻōuli ʻē aʻe e pili ana i ke ʻano o ka maʻi puʻuwai cyanotic, a komo pū paha me:

• Hānai i nā pilikia a hoʻēmi paha i ka makemake, e alakaʻi ana i ka ulu maikaʻi ʻole
• ʻIli hina hina
• Nā maka a i ʻole ke alo
• Luhi i nā manawa āpau

Hōʻoia ka nānā kino ʻana i ka cyanosis. Loaʻa paha i nā kamaliʻi makua i nā manamana lima paʻa.

E hoʻolohe ke kauka i ka puʻuwai a me nā māmā me kahi stethoscope. Kani nā naʻau maʻamau, ʻōhumu ka puʻuwai, a lohe ʻia paha nā ʻūlū māmā.

E loli nā hoʻokolohua ma muli o ke kumu, akā hiki ke hoʻopili ʻia:

• Pākuʻi x-ray
• Ke nānā nei i ka pae o ka oxygen i loko o ke koko e hoʻohana ana i kahi hoʻokolohua kinoea koko arterial a i ʻole ke nānā ʻana iā ia ma o ka ʻili me kahi oximeter pulse
• Helu piha koko (CBC)
• ECG (electrocardiogram)
• Ke nānā nei i ke ʻano o ka naʻau a me nā kīʻaha koko e hoʻohana ana i ka echocardiogram a i ʻole MRI o ka puʻuwai
• Ke hele nei i kahi paipu hikiwawe (catheter) i ka ʻaoʻao ʻākau a hema paha o ka puʻuwai, maʻamau mai ke aʻa (catheterization cardiac)
• Transcutane oxygen oxygen monitor (pulse oximeter)
• Echo-Doppler

Pono paha kekahi mau pēpē e noho i ka haukapila ma hope o ka hānau ʻana i hiki ai iā lākou ke loaʻa ka oxygen a kau ʻia i ka mīkini hanu. Hiki iā lākou ke loaʻa nā lāʻau i:

• E hoʻopau i nā wai keu
• Kōkua i ka puʻuwai puʻuwai paʻakikī
• E wehe i kekahi mau kīʻaha koko
• E mālama i nā kuʻi puʻuwai a i ʻole nā ​​mele

ʻO ka mālama ʻana i ke koho no nā maʻi puʻuwai congenital he ʻoki kino e hoʻoponopono hou i ka hemahema. Nui a hewahewa nā ʻano o ke kaha ʻana, kaukaʻi ʻia i ke ʻano o ka hānau hānau. Pono paha ke ʻoki ma hope koke iho o ka hānau ʻana, a i lohi paha no kekahi mau mahina a i ʻole mau makahiki. Hoʻokumu ʻia paha kekahi mau kaha ʻoki ke ulu aʻe ke keiki.

Pono paha kāu keiki e inu i nā wai wai (diuretics) a me nā lāʻau puʻuwai ʻē aʻe ma mua a ma hope paha o ke kaha ʻana. E mālama pono i nā ana pololei. He mea nui ka ukali maʻamau me ka mea hāʻawi.

ʻO nā keiki he nui i loaʻa i ka puʻuwai puʻuwai e pono e lawe i nā lāʻau ʻaloʻalo ma mua, a i kekahi manawa ma hope o ka loaʻa ʻana o kekahi hana niho a i ʻole nā ​​kaʻina lāʻau. E ʻike pono i kāu mau kuhikuhi akāka mai ka puʻuwai puʻuwai mai o kāu keiki.

E noi i ka mea hāʻawi i kāu keiki ma mua o ka loaʻa ʻana o nā lāʻau āpau. Hiki i ka hapanui o nā kamaliʻi ke ukali i nā ʻōkuhi i paipai ʻia no nā lāʻau ʻōpio.

Aia ka nānā i ka maʻi kikoʻī a me kona koʻikoʻi.

Nā pilikia o ka maʻi puʻuwai cyanotic:

• Nā ritme naʻau maʻamau a me ka make koke
• Lōʻihi (wā lōʻihi) ke koko kiʻekiʻe i nā kīʻaha koko o ka akemāmā
• Hewa puʻuwai
• ʻO ka maʻi i loko o ka puʻuwai
• Hahau
• Make

Kāhea i kāu mea hāʻawi inā loaʻa kāu pēpē i:

• ʻO ka ʻili polū (cyanosis) a i ʻole ka ʻili hina
• Pilikia hanu
• ʻEha ʻeha a ʻeha ʻeha ʻē aʻe
• Pōpō, maʻule, a palpitations puʻuwai paha
• Hānai i nā pilikia a hoʻēmi paha i ka makemake
• Fever, nausea, a i ʻole ka luaʻi
• Nā maka a i ʻole ke alo
• Luhi i nā manawa āpau

Pono nā wahine hāpai e mālama i ka mālama prenatal maikaʻi.

• Hōʻalo i ka hoʻohana ʻana i ka waiʻona a me nā lāʻau i ka wā hāpai.
• E haʻi i kāu kauka ua hāpai ʻoe ma mua o ka lawe ʻana i nā lāʻau i kuhikuhi ʻia.
• E kiʻi i kahi hōʻoia koko i ka wanaʻao e ʻike inā pale aku ʻoe i ka rubella. Inā ʻaʻole ʻoe e pale aku, pono ʻoe e hōʻalo i ka hōʻike ʻana i ka rubella a pono e pale ākea ʻia ma hope pono o ka hānau ʻana.
• Pono nā wahine hāpai me ka maʻi diabetes e hoʻāʻo e loaʻa i ka kaohi maikaʻi ma luna o kā lākou pae kō kō.

Hiki i kekahi mau mea hoʻoilina ke hoʻokau i ka maʻi puʻuwai congenital. Pilikia paha nā lālā ʻohana he nui. Inā ʻoe e hoʻolālā ana e hāpai, e kamaʻilio me kāu mea hoʻolako e pili ana i ka kānana ʻana no nā maʻi maʻi.

Shunt cardiac ʻākau-hema; Shunt puni ʻākau a hema

• Puʻuwai - ʻāpana ma waena o ka waena
• ʻO ka catheterization Cardiac
• Puʻuwai - ʻike mua
• ʻO Tetralogy o Fallot
• Pāʻālua
• Maʻi maʻi naʻau Cyanotic

ʻO Bernstein D. Cyanotic maʻi puʻuwai congenital: loiloi i ka neonate maʻi nui me ka cyanosis a me ka hanu hanu. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, MBBS, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2019: chap 456.

Lange RA, Hillis LD. Maʻi maʻi ʻōpū. I: Bope ET, Kellerman RD, eds. ʻO Conn's Current Therapy 2018. Piladelapia, PA: Elsevier; 2018: 106-111.

Webb GD, Smallhorn JF, Therrien J, Redington AN. ʻO ka maʻi puʻuwai Congenital i ke kanaka makua a me ka mea maʻi pediatric. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 75.