ʻO ke koko kiʻekiʻe i nā pēpē

ʻO ke koko kiʻekiʻe (hypertension) kahi hoʻonui i ka ikaika o ke koko e kūʻē i nā aʻa i loko o ke kino. Kuhi kēia ʻatikala i ke kaomi koko kiʻekiʻe i loko o nā pēpē.

Hoʻopili ke kaomi koko i ka hana o ka puʻuwai, a pehea ke olakino o nā aʻa. Aia he helu ʻelua i kēlā me kēia ana o ke koko.

• ʻO ka helu mua (luna) ka systolic pressure pressure, ka mea e ana i ka ikaika o ke koko i hoʻokuʻu ʻia ke kuʻi ka puʻuwai.
• ʻO ka lua (lalo) ka helu kaomi diastolic, kahi e ana ai i ke kaomi i nā aʻa ke hoʻomaha ka puʻuwai.

Kākau ʻia nā ana kaomi koko i kēia ala: 120/80. Hiki ke kiʻekiʻe a hoʻokahi a ʻelua paha o kēia mau helu.

Hiki i kekahi mau mea ke hoʻololi i ke koko, me:

• Hormones
• Ke olakino o ka naʻau a me nā kīʻaha koko
• Ke olakino o nā puʻupaʻa

ʻO ke kiʻekiʻe o ke koko kiʻekiʻe i nā pēpē ma muli paha o ka kidney a me ka maʻi puʻuwai e kū nei i ka wā hānau (congenital). ʻO nā laʻana maʻamau e pili pū me:

• ʻO ka Coarctation o ke aorta (ka ʻiki ʻana o ka kīʻaha koko nui o ka puʻuwai i kapa ʻia ʻo aorta
• Patent ductus arteriosus (ke kīʻaha koko ma waena o nā aorta a me nā aʻa pulmonary e pani ma hope o ka hānau ʻana, akā hāmama mau)
• ʻO ka displasia Bronchopulmonary (ke ʻano o ka lolo e pili i nā pēpē hou i kau ʻia i ka mīkini hanu ma hope o ka hānau ʻana a i hānau mua ʻia paha)
• ʻO ka maʻi kīwī e pili ana i ka nāʻaʻa puʻupaʻa
• Renal stenosis (hōʻemi ʻia o nā kīʻaha koko nui o ka puʻupaʻa)

I nā pēpē pēpē hou, hoʻokumu pinepine ʻia ke koko kiʻekiʻe e kahi kōkō koko i loko o kahi kīʻaha koko puʻuwai, kahi pilikia o ka loaʻa ʻana o ka pahu umbilical artery.

ʻO nā kumu ʻē aʻe o ke kahe kiʻekiʻe i loko o nā pēpē e komo pū paha:

• Nā lāʻau lapaʻau kekahi
• Hōʻike i nā lāʻau lapaʻau kūpono ʻole e like me ka cocaine
• ʻO kekahi mau tumors
• Nā kūlana hoʻoilina (nā pilikia e holo i loko o nā ʻohana)
• Nā pilikia thyroid

Piʻi ke koko i ka ulu ʻana o ka pēpē. ʻO ke kaumaha o ke koko i loko o kahi hānau hou ʻo 64/41. ʻO ke kaumaha o ke koko ma ke keiki i hoʻokahi mahina ma o 2 mau makahiki ʻo 95/58. He maʻamau no ka helu ʻana o kēia mau helu.

ʻO ka hapa nui o nā pēpē me ke koko kiʻekiʻe ʻaʻole e loaʻa nā ʻōuli. Akā, pili paha nā ʻōuli i ke ʻano o ke kaomi kiʻekiʻe. Pākuʻi ʻia paha kēia mau ʻōuli:

• ʻIli polū
• ʻAʻole e ulu a loaʻa ka kaumaha
• ʻO nā maʻi maʻi urinary pinepine
• ʻO kaʻili pale (pallor)
• Hanu wikiwiki

Nā ʻōuli e ʻike ʻia inā he kiʻekiʻe ke koko kiʻekiʻe o ka pēpē.

• Huhū
• Ka hopu ʻana i nā maʻi
• Hī pilikia
• ʻO ka luaʻi

I ka hapanui o nā hihia, ʻo ka hōʻailona o ke kaomi kiʻekiʻe wale nō ke ana o ke koko.

ʻO nā hōʻailona o ke kaomi koko kiʻekiʻe loa:

• Hewa puʻuwai
• Hewa ʻole nā ​​hakuʻala
• Pākuʻi wikiwiki

Ana ʻia ke koko i nā pēpē me kahi hāmeʻa.

Inā ʻo ka coarctation o ke aorta ke kumu, e hoʻemi ʻia paha nā pulus a i ʻole ke kaomi koko i nā wāwae. Lohe ʻia paha kahi kaomi inā kū kahi kōwikā aicic bicuspid me ka coarctation.

ʻO nā hoʻokolohua ʻē aʻe i nā pēpē me ke koko kiʻekiʻe e hoʻāʻo e ʻike i ke kumu o ka pilikia. ʻO ia mau hoʻāʻo e komo pū paha:

• Nā hoʻokolohua Laboratory, me nā hoʻāʻo koko a me ka mimi
• X-kukuna o ka umauma a i ʻole ka ʻōpū
• Ultrasounds, me kahi ultrasound o ka puʻuwai e hana ana (echocardiogram) a me nā puʻupaʻa
• MRI o nā kīʻaha koko
• ʻO kahi ʻano x-ray kūikawā e hoʻohana ai i ka pena e nānā ai i nā kīʻaha koko (angiography)

Pili ka lāʻau i ke kumu o ke koko kiʻekiʻe i loko o ka pēpē. Hiki ke hoʻopili i ka mālama ʻana:

• Dialysis e mālama pono ʻole ai ka hakuʻala
• ʻO nā lāʻau e hoʻohaʻahaʻa i ke koko a kōkua i ka puʻuwai puʻuwai maikaʻi
• ʻOki kino (me transplantationʻoki a me ka hana hou ana o ka coarctation)

Aia ka maikaʻi o ka pēpē i ke kumu o ke kahe kiʻekiʻe a me nā kumu ʻē aʻe e like me:

• Nā pilikia olakino ʻē aʻe i ka pēpē
• Inā ua hōʻino ʻia (e like me ka hōʻino ʻana o ka puʻupaʻa) ma ke ʻano he hopena o ke koko kiʻekiʻe

ʻAʻole hiki ke mālama ʻia, hiki i ke koko kiʻekiʻe ke alakaʻi iā:

• Hoka ʻole ka naʻau a i ʻole ka hakuʻala
• Poino o ke kino
• Ka hopu ʻana i nā maʻi

Kāhea i kāu kahu mālama ola inā kāu pēpē:

• ʻAʻole e ulu a loaʻa ke kaumaha
• He ʻili bluish kona
• Loaʻa pinepine i nā maʻi maʻi urinary
• ʻIke huhū
• Pākuʻi maʻalahi

Lawe i kāu pēpē i ke keʻena pilikia inā kāu pēpē:

• Loaʻa ka hopu ʻana
• ʻAʻole pane
• Ke luaʻi mau nei

ʻO kekahi mau kumu o ke kahe kiʻekiʻe e holo i loko o nā ʻohana. E kamaʻilio i kāu mea hāʻawi ma mua o kou hāpai ʻana inā he moʻolelo ʻohana kāu o:

• Maʻi maʻi ʻōpū
• Piʻi koko kiʻekiʻe
• ʻO ka maʻi kīwī

E kamaʻilio pū me kāu mea hāʻawi ma mua o ka hāpai ʻana inā ʻoe e lawe i ka lāʻau no kahi pilikia olakino. ʻO ka hōʻike ʻana i kekahi mau lāʻau i loko o ka ʻōpū e hoʻonui i ka makaʻu o kāu pēpē i ka hoʻomohala ʻana i nā pilikia e hiki ai ke piʻi i ke kiʻekiʻe o ke koko.

Hypertension - pēpē

• Pahu lulu uila
• Coarctation o ka aorta

Flynn JT. Hypertension neonatal. I: Gleason CA, Juul SE, eds. Nā maʻi o Avery o ke keiki hānau. 10 o ka lā. Piladelapia, PA: Elsevier; 2018: chap 93.

ʻO Macumber IR, ʻo Flynn JT. Ka piʻi kiʻekiʻe ʻōnaehana. I: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. ʻO Puka Textbook of Pediatrics ʻo Nelson. 21st ed. Piladelapia, PA: Elsevier; 2020: chap 472.

Sinha MD, Reid C. ʻōnaehana hypertension. I: Wernovsky G, Anderson RH, Kumar K, et al, eds. Ka Pediatric Cardiology o Anderson. ʻEhā ed. Piladelapia, PA: Elsevier; 2020: chap 60.