Bazamile Newborn: ezibonisa, iintlobo, izigaba, amayeza

Ngokutsho manani, zonke iintsana yeshumi ukunika ukhathalelo lwempilo kwigumbi wokuziswa kweencwadi,-1% yabo bonke abazalelwe ufuna uluhlu olupheleleyo CPR. Inqanaba eliphezulu nokuqeqesha abasebenzi bezonyango nga kwandisa amathuba obomi kunye nokunciphisa iingxaki kunokwenzeka. bazamile olwaneleyo Ngexesha le usana - inyathelo lokuqala ukunciphisa inani ukusweleka kunye nophuhliso izifo.

nezimaphambili ezingundoqo

Yintoni bazamile lweentsana? Olu thotho amanyathelo ejolise ekuvuseleleni umzimba umntwana kunye nokubuyiselwa imisebenzi ezilahlekileyo. Oku kuquka:

• bazamile;
• iindlela labagula kakhulu;
• sebenzisa of yomatshini;
• pacemaker kunye nezinye ufakelo.

iintsana Full-term musa ukufuna amanyathelo yokurhaxwa. Bona wazalwa esebenzayo, enze ingxolo, ukubetha kwentliziyo kunye nezinga intliziyo eziqhelekileyo, isikhumba umbala epinki, umntwana iphendula kakuhle kwizinto ngaphandle. Ezi abantwana nangoko obekwe kwi esisu kunye nekhusi lifudumeleyo sikanina, ilweyile owomileyo. Nokuphefumla imixholo yangaphakathi aspirated ukubuyisela patency zabo.

Ukufeza bazamile kucingwa uncedo olungxamisekileyo. Kukholelwa kwimeko engasayi zokuphefumla umsebenzi intliziyo. Emva ukungenela okunjalo xa kuthe yoko kakuhle, sebenzisa iziseko labagula kakhulu. unyango sijoliswe ukuphelisa iingxaki kunokwenzeka ukuyeka amalungu abalulekileyo.

Ukuba isigulana akakwazi ngokuzimeleyo ukugcina homeostasis, ukuba bazamile usana ziquka yomatshini (ALV) okanye ukubeka-ntliziyo.

Yintoni efunekayo ukuze bazamile kwigumbi wokuziswa kweencwadi?

Ukuba imfuno amalungiselelo iziganeko ezinjalo esezantsi, kufuneka ukuba uzenze ngumntu omnye. Kwimeko ukukhulelwa kakhulu kunye nokulindelwe uluhlu olupheleleyo CPR ekuziseni iinkonzo abaziingcali ezimbini.

Bazamile usana kwigumbi wokuziswa kweencwadi kufuna ukulungiselela ngenyameko. Phambi kokuba inkqubo zokubeleka khangela ukufumaneka zonke eziyimfuneko ukwenza zikwimeko yuokusebenza ukuqinisekisa ukuba izixhobo.

1. Kufuneka ukuqhagamshela umthombo nobushushu itafile ngokumphefumlela ukucupha, Akazifudumeza, incwadi esongwayo ilweyile ngokohlobo irola.
2. Khangela ukuba inkqubo ifakwe kakuhle mpilo. Kufuneka ibe imali eyaneleyo ioksijini ukuze ulungise kakuhle uxinzelelo kwaye izinga ukuqukuqela.
3. Kuyimfuneko ukukhangela ukulungela kwezixhobo elifunekayo ukuze nezokukhupha imixholo phecana sokuphefumla.
4. Lungisa izixhobo zokususa imixholo esiswini xa kuthe wolangazelelo (uphenyo, isirinji, izikere, izinto ukulungisa), meconium aspirator.
5. Lungisa uze uhlole ukuthembeka wengxowa kunye imaski ngokumphefumlela ekumfakeni nekhithi.

Iseti for ekumfakeni iqulathe ngemibhobho endotracheal kunye izinikezeli, kunye iincakuba ezahlukeneyo laryngoscope neebhetri nanceba, izikere neeglavu.

Yintoni na impumelelo manyathelo?

bazamile ezisanda kuzalwa kwigumbi wokuziswa kweencwadi isekelwe phezu kwale mithetho-siseko ilandelayo sempumelelo:

• ukufumaneka Amaqela labagula kakhulu - kuzo zonke iintlobo bazamile kufuneka abe khona;
• umsebenzi olulungelelanisiweyo - iqela kufuneka basebenze kakuhle ukuncedisana omnye njengoko inkqubo enye enkulu;
• abasebenzi abaqeqeshiweyo - bazamile nganye kufuneka banamanqanaba aphezulu olwazi kunye nezakhono bobuqili;
• umsebenzi, kuthathelwa ingqalelo indlela yomguli - CPR kufuneka uqale ngoko nangoko kunye ukubonakala intswelo yabo, amanyathelo iyenziwa, kuxhomekeke impendulo emzimbeni wesigulane;
• serviceability kwezixhobo - izixhobo bazamile kufuneka ziyalungiswa kwaye zifikeleleka nangaliphi na ixesha.

Izizathu imfuneko amanyathelo

Zimeko etiological of yokubhuqwa intliziyo, imiphunga kunye namanye amalungu ebalulekileyo usana ziquka uphuhliso zizalwa, ukwenzakala ukuzalwa, ukuphuhliswa ezingaqhelekanga iziphene, esosulelayo imvelaphi toxemia kunye namanye amatyala umyalezo ezingaziwayo.

bazamile ezisanda kuzalwa abantwana kunye nemfuneko kuba linakho ukuqikelelwa kwanaxa ixesha lokuzala. Kwiimeko ezinjalo, iqela ngokumphefumlela kufuneka sikulungele, ukuze nangoko kumnceda umntwana wakho.

Imfuneko iziganeko ezinjalo kunokwenzeka phantsi kwale miqathango ilandelayo:

• ezininzi okanye oligohydramnios;
• perenashivanie;
• iswekile unina;
• wegazi;
• isifo esosulelayo;
• ukungondleki Fetal.

Kwakhona, kukho izinto ezininzi ezivela sele ngethuba lokubeleka. Kwimeko kwazo kulindeleke ukuba udinga yokurhaxwa. Ezo zinto ziquka bradycardia umntwana, a ngoqhaqho, ukuzalwa ngaphambi kwexesha okukhawulezayo, previa okanye abruption placental, zesibeleko hypertonus.

zizalwa

Uphuhliso ukuphazamiseka nokuphefumla kunye neenkqubo hypoxia ebangela imbonakalo umzimba ukuphazamiseka kwenkqubo yokujikeleza kwegazi, yokucolwa kunye microcirculation. Okulandelayo kukho ukuphazamiseka le izintso, intliziyo, adrenal, ingqondo.

Zizalwa ufuna ukungenelela ukwenzela ukunciphisa amathuba iingxaki. Izinto ezibangela izifo zemigudu:

• hypoxia;
• ukuhlukunyezwa umgudu (ngeminqweno igazi, yencindi, meconium);
• ukwenzakala ebuchotsheni organic kunye nomsebenzi CNS;
• malformations;
• lunezinto ayonelanga.

Uxilongo kufuneka ungenelelo bazamile eqhutywa emva kovavanyo umntwana Apgar.

Kuqikelelwa ukuba	0 amanqaku	1 indawo	amanqaku ama-2
isimo zemigudu	ayikho	Yezifo, spasmodic	ngezwi elikhulu, ezinesingqi
HR	ayikho	Ngaphantsi kwe 100 ibetha ngomzuzu	Ngaphezu kwe 100 ibetha ngomzuzu
ibala	cyanosis	isikhumba pink, imilenze esiluhlaza	pink
Isimo se kwezihlunu	ayikho	Imilenze baphikele kancinane, ithowuni kweentsizana	intshukumo Active, imvakalozwi elungileyo
Zasabela imiba ukuluma	ayikho	okwanamhlanje waveza	wabonisa kakuhle

Uvavanyo karhulumente ukuya amanqaku 3 ibonisa uphuhliso zizalwa kakhulu, ukususela-4 ukuya kwezi-6 - zizalwa ubungnqongqo ngomlinganiselo. Bazamile of zizalwa usana kwenzeka ngokukhawuleza emva kokuba uvavanyo imeko yayo yonke.

Ulandelelwano yokuhlola nemeko

1. Umntwana ibekwe phantsi nobushushu, nesikhumba sayo eyomileyo ilweyile efudumeleyo. Ukususela lweHo- ngeempumlo kunye Umlomo owawanyayo imixholo. Kubanjwe ukuvuselela lafaka.
2. Uhlaziya ukuphefumla. Kwimeko kwesingqisho eqhelekileyo phambi kokukhala elikhulu, uyaqhubeka kwinyathelo elilandelayo. Xa spasmodic ukuphefumla yomatshini mpilo imizuzu eli-15-20.
3. Uvavanyo izinga kwentliziyo. Ukuba izinga intliziyo ngaphezu ibetha 100 ngomzuzu, ukufudukela kwisigaba esilandelayo lokuhlolwa. Kwimeko ireyithi intliziyo ngezantsi 100 ibetha kwenziwa mpilo. Koko ukuhlola ukusebenza zongenelelo.
   • Pulse ngaphantsi kwe-60 - ngqo yokuthanjiswa intliziyo + mpilo.
   • Sazi ukusuka 60 ukuya ku-100 - mpilo.
   • Pulse ngaphezu kwe-100 - le mpilo xa iphefumla engagunyaziswanga.
   • Emva kwemizuzwana 30, lo kwawo of compressions esifubeni umoya, unyango ngamachiza kufuneka kwenziwe.
4. Hlola umbala lolusu. umbala Pink kuthetha imeko eqhelekileyo umntwana. Ukuba cyanosis okanye akrozianoz kufuneka ukunika ioksijini ize nizigcine imeko wosana.

Indlela yokwenza bazamile?

Kufuneka wageza siphathwe ngesandla kubola, anxibe iiglavu nokuphepha. Ukuzalwa komntwana Iqinisekile, emva kokuba amanyathelo ayimfuneko - elixwebhu. Newborn obekwe phantsi nobushushu, a ilweyile eyomileyo efudumeleyo isongiwe.

Ukubuyisela ngokuma, ibe bewuhlisele ekupheleni entloko, wamfaka kuwo umntwana kwicala lasekhohlo. Oku kuya kumisa inkqubo yokulangazelela ndisishenxise imixholo umlomo kunye nempumlo. Ngononophelo aspirated contents, ngaphandle kokubhenela kwi intshayelelo aspirator kakhulu.

Ukuba la manyathelo ongenelelo ndokusindisa, bazamile kuzalwa baqhubeka tracheal suctioning ngokusebenzisa laryngoscope. Emva kokuba imbonakalo umoya, kodwa ukungabi kho isingqi sayo, umntwana egqithiselwe mpilo.

Ngokunzulu labagula usana olusanda kuzalwa ithatha emva bazamile okokuqala uncedo olungaphezulu kunye nokugcinwa kwemisebenzi ebalulekileyo.

umoya

amanyathelo bazamile ezisanda kuzalwa ziquka siqhuba umoya. Ubungqina obubonakalayo buxela ukuba umoya eziphethe:

• ukungabikho zokuphefumla okanye imbonakalo yokuphefumla zeentshukumo convulsive;
• kwamaza amaxesha ngaphantsi kwe-100 ngomzuzu, kungakhathaliseki ukuba imeko ukuphefumla;
• cyanosis ezingisayo ngexesha lokusebenza okuqhelekileyo iinkqubo bokuphefumla sentliziyo.

Le uluhlu lwemisebenzi lwenziwa usebenzisa isigqumathelo okanye ibhegi. intloko emva kancinane abaphose emva ubuso imaski uyasetyenziswa. Yakhe ibamba ubhontsi wakho Uvalo. Eyesibini kukhokelela umhlathi lomntwana.

Isigqumathelo kufuneka kusesilevini, impumlo kunye nomlomo. Kwanele ukuba pholisa imiphunga kunye kumaza izihlandlo ezingama-30 ukusa kwengama-50 ngomzuzu 1. Umoya ngokusebenzisa ingxowa kungabangela umoya ungena kwisisu esiswini. Ukusuka apho uyakwazi ukususa usebenzisa umbhobho isisu.

Ukubeka iliso impumelelo ukuphunyezwa, kuyimfuneko ukuba banikele ingqalelo ngokuvela esifubeni kunye utshintsho kwiqondo entliziyweni. Umntwana waqhubeka mkhanya de izinga recovery olupheleleyo nokuphefumla kunye nezinga intliziyo.

Kwakutheni ukuze intubate njani?

bazamile ezisanda kuzalwa kwakhona kubandakanya ekumfakeni ye uqhoqhoqho, kwimeko ukusilela yomatshini ukuze umzuzu 1. Choice esifanele ekumfakeni ityhubhu - yenye yezinto eziphume phambili. Yenziwe kuxhomekeke ubunzima komntwana kunye nobudala sokukhulelwa.

Ekumfakeni nalo kuqhutywa kwezi meko zilandelayo:

• imfuneko ukususa meconium aspirated ukusuka uqhoqhoqho;
• liqhuba umoya okuqhubekayo;
• lula ukusingatha bazamile;
• epinephrine;
• kakhulu kwexesha.

Xa laryngoscopy ziquka ukukhanyisa uthabathe esandleni sasekhohlo. ngesandla sokunene, ukuba intloko wosana. I-blade lifakwa emlonyeni yaqhubeka ulwimi kwisiseko. Ukuphakamisa ibe likhaba ukuya isiphatho laryngoscope, bazamile ubona glottis. tube Endotracheal yaziswa kwicala lasekunene kwi kwisisu ngomlomo ufuduswe ngokusebenzisa imisipha ngexesha lokuvula. Oku kwenzeka phezu iphefumlelwe. Ityhubhu ubanjwa de ngongoma ebimiselwe yona.

Laryngoscope isusiwe, ngoko - umqhubi. Lulungiswe ekuhloleni ityhubhu ukungenisa ngokuveza ingxowa uphefumlayo. Air engena imiphunga kunye eyenza i uhambo kwesifuba. Okulandelayo, qhagamshela inkqubo oxygen yonikezelo.

compressions zesifuba

Bazamile usana kwigumbi wokuziswa kweencwadi iquka ukwenza compressions isifuba, lokubanjwa oboniswe ngeqondo intliziyo ibetha ngaphantsi kwe-80 ngomzuzu.

Kukho iindlela ezimbini compressions esifubeni. Usebenzisa yokuqala, uxinzelelo phezu kwesifuba ngokusebenzisa isalathisi umnwe phakathi ngesandla esinye. Kwenye ngobuwena, lo yokuthanjiswa ikhutshwa phandle bobabini ubhontsi kunye nezinye Iminwe inxaxheba umhlana inkxaso. Resuscitator neonatolog-liqhuba ngokucofa phakathi phakathi neyesithathu esezantsi breastbone, proginalas Isifuba ku 1.5 cm imivumbo rhoqo - imiz. 90.

Ukuba kufuneka ulandele ukuze umoya akwenziwanga ngokucinezela phezu kwesifuba ngaphandle ngaxeshanye. In ikhefu phakathi pressings, awukwazi ukuthatha izandla zakho phezu kwentamo. Ukunqakraza kwi ingxowa ntoni emva compressions emithathu. Kuba zonke imizuzwana-2 kuyimfuneko ukuba baqhube-1 no-3 ngokucinezela umoya.

Iintshukumo xa meconium kungcoliseko lwamanzi

Zibandakanya uncedo ngokumphefumlela lweentsana ukuba amabala le meconium .Kuma cerebrospinal kunye novavanyo Apgar inqaku komntwana amanqaku ngaphantsi kwama-6.

1. Ngexesha ukuzala emva kokuvela yentloko emjelweni lokuzalwa ngoko nangoko aspirating umpakati impumlo kunye nomlomo.
2. Emva kokuzalwa kosana kunye nendawo umthombo ubushushu, phambi kokuba umoya yokuqala, kungakuhle ukuba aphumeze ekumfakeni ityhubhu inkulu ubungakanani bazakukwazi ukuyikhupha imixholo uqhoqhoqho kunye bronchi.
3. Ukuba awukwazi ukususa umxholo, kwaye kukho admixture of meconium, kuyimfuneko ukuba reintubirovat kuzalwa omnye nefoni.
4. Komoya siyahlengahlengiswa kuphela emva kokuba onke umxholo sele isusiwe.

amayeza

bazamile ezisanda kuzalwa yabantwana isekelwe kungekuphela ekwenzeni manual okanye ungenelelo yentsimbi, kodwa malunga nokusetyenziswa kweziyobisi. Kwimeko yomatshini kunye compressions zesifuba, xa imisebenzi engeyiyo olusebenzayo imizuzwana engaphezu kwama-30, sebenzisa iziyobisi.

bazamile ezisanda kuzalwa kubandakanya ukusetyenziswa iadrenaline, ithetha ukuba ukubuyisela umthamo wegazi, isodiyam hydrogencarbonate, naloxone, dopamine.

Iadrenaline kufakwa ngokusebenzisa ityhubhu endotracheal kwi uqhoqhoqho, okanye bolus umthambo. Uyondelelwano lwee- ichiza - 1:10 000 iziyobisi kusetyenziselwa ukwandisa amandla yentliziyo kunye nokunciphisa izinga intliziyo lunikezelo. Emva ulawulo intratracheal yaqhubeka yomatshini, ukuze ichiza Inokuinikezwa ngokulinganayo. Ukuba kuyimfuneko, i-arhente ilawulwa imizuzu emi-5 kamva.

Ukubalwa ithamo ngokuxhomekeke ubunzima komntwana:

• 1 kg - 0.1-0.3 ml;
• 2 kg - 0.2-0.6 ml;
• 3 kg - 0.3-0.9 ml;
• 4 kg - 0.4-1.2 ml.

Xa ukopha okanye imfuneko ukugcwalisa umthamo elijikeleza albumin igazi iyasetyenziswa, umxube sodium chloride ukusebenza komzimba okanye isisombululo Ukukhala kaThixo. Iziyobisi zilawulwa kungena umthambo ka intambo jet yosana (ml 10 1 kg ubunzima bomzimba ngalinye) kancinci ngaphezu kwemizuzu eli-10. Intshayelelo vospolniteley BCC kunganyusa uxinzelelo lwegazi, ukunciphisa asidi, yaye ukubuyisela izinga ukubetha ukuphucula inyama ukutya.

bazamile ezisanda kuzalwa, ilandelwe yi-lung umoya kakuhle, ifuna ukuqaliswa sodium hydrogen carbonate kwi Kusenjalo yosana ukunciphisa iimpawu-asidi eninzi. Ichiza akufuneki zisetyenziswe nje umntwana iye ayasekwa lung umoya ngokwaneleyo.

Dopamine isetyenziselwa ukwandisa isalathisi ezesifuba nama glomerular. Ichiza kwandisa iimpahla sodium kwezintso kwaye yandisa kugqitywe ngokusebenzisa unyango ukumnika. Yegazi microfluidic phantsi esweni rhoqo of wegazi kunye nezinga intliziyo.

Naloxone yegazi zifakwa ngomlinganiselo 0.1 ml 1 kg ubunzima bomzimba ngalinye. Iindlela, ezisetyenziswa kwimeko apho ibala lolusu kunye ukubetha eziqhelekileyo, kodwa kukho iimpawu zokudakumba sokuphefumla. Naloxone ayikwazi kwenziwa ukuba usana xa umama usebenzisa iziyobisi ezidakumbisayo okanye unyango nobunzi- usebenzisa analgesics ezidakumbisayo.

Xa ukuyeka bazamile?

IVL kuqhubeka nje umntwana uyichole amanqaku 6 phezu Apgar. Olu hlolo lwenziwa rhoqo kwimizuzu emi-5 kwaye ihlala ukuya sisiqingatha seyure. Ukuba emva kweli xesha usana une isalathisi engaphantsi kwe-6, ngoko watshintshelwa ICU esibhedlele apho ukuqhuba bazamile ngakumbi, unyango olumandla kubelekwa.

Ukuba impumelelo bazamile ongekhoyo ngokupheleleyo kwaye kukho asystole kunye cyanosis, isiganeko kuyaqhubeka de imizuzu engama-20. Xa ubona nkqu imiqondiso nakancinane ukusebenza, ubude kwandisa lonke ixesha, de amanyathelo HIV.

unit ePrince labagula kakhulu

Emva ekubuyiselweni ngempumelelo emiphungeni nentliziyo usana idluliselwa kwiyunithi labagula kakhulu. Kukho amagqirha umsebenzi ijonge ekuthinteleni iingxaki kunokwenzeka.

Kuzalwa emva bazamile abadinga yothintelo ingenzeka na ekweneni ubuchopho okanye ezinye ukuphazamiseka CNS, umsebenzi ngokubuyiselwa izintso umsebenzi excretory umzimba, kuqheleke nokuhamba kwegazi.

Umntwana kuvela iingxaki pathways ngohlobo lactic, lactic acidosis, nto leyo ibangwa ukuphazamiseka kweli microcirculation yoluvo. Ngomhla inxalenye ingqondo kungabangela ukuxhuzula, legazi, iposi ebuchotsheni, nokudumba, ukuphuhliswa isiqaqa. Ungafumana kananjalo kwekhono ke ventricles zentliziyo, ukusilela etsolo kwezintso, atony isinyi, insufficiency adrenal kunye nezinye izigqeba yonyango.

Kuxhomekeka kwimeko wosana ibekwe isifo okanye oksijini intente. Iingcali ukongamela umsebenzi onke amalungu kunye neenkqubo. Yalusa ukuvumela umntwana kuphela emva kweeyure ezili-12, kwiimeko ezininzi - ngokusebenzisa ityhubhu nasogastric.

Iimpazamo leyo abakukhusela aluvumelekanga

Akuvunyelwe ngokungqongqo ukuphumeza izinto na ubungqina bokuba ekhuselekileyo:

• kugalela baby amanzi;
• compress esifubeni sakhe;
• etshaya ezinqeni;
• ubuso ngqo Jets ioksijini kunye like.

solution albumin akufuneki zisetyenziswe ukunyusa BCC sokuqala, kuba oko konyusa ingozi yokuba esibulalayo lweentsana.

Bazamile akuthethi ukuba umntwana uza kuba nantoni na engaqhelekanga okanye iingxaki. Abazali abaninzi balindele ezibonisa zophendlo lwezifo emva kokuba usana labagula kakhulu. Izimvo ezi meko zibonisa ukuba abantwana elizayo uphuhliso elifanayo oontanga babo.