Isifo seMeconium aspiration

I-Meconium aspiration syndrome (MAS) ibhekisa kwiingxaki zokuphefumla anokuba nalo usana olusandul 'ukuzalwa xa:

• Azikho ezinye izizathu, kwaye
• Usana ludlulise i-meconium (ilindle) kwi-amniotic fluid ngexesha lokubeleka okanye ukubeleka

I-MAS inokwenzeka ukuba umntwana uphefumla (aspirates) olu lwelo luye emiphungeni.

I-Meconium sisihlalo sokuqala esidluliswa lusana olusandula kuzalwa emva kokuzalwa, ngaphambi kokuba umntwana aqale ukondla kunye nokwetyisa ubisi okanye ubisi olungumgubo.

Kwezinye iimeko, umntwana udlula i-meconium ngelixa esesibelekweni. Oku kunokwenzeka xa abantwana "bephantsi koxinzelelo" ngenxa yokwehla kwegazi kunye neoksijini. Oku kuhlala kubangelwa ziiplacenta okanye umbilical cord.

Nje ukuba umntwana adlulise i-meconium iye kwi-amniotic fluid engqongileyo, banokuyiphefumlela kwimiphunga. Oku kunokwenzeka:

• Ngelixa umntwana esesibelekweni
• Ngexesha lokuhanjiswa
• Ngokukhawuleza emva kokuzalwa

I-meconium inokuthintela neendlela zomoya zosana kanye emva kokuzalwa. Ingabangela iingxaki zokuphefumla ngenxa yokudumba (ukudumba) kwimiphunga yosana emva kokuzalwa.

Izinto ezinobungozi ezinokubangela uxinzelelo emntwaneni ngaphambi kokuzalwa zibandakanya:

• "Ukwaluphala" kwepasenta xa ukukhulelwa kudlula kude kumhla obekiweyo
• Ukunciphisa ioksijini kusana ngelixa lisesibelekweni
• Iswekile kumama okhulelweyo
• Ukuhanjiswa nzima okanye ukusebenza ixesha elide
• Uxinzelelo lwegazi oluphezulu kumama okhulelweyo

Uninzi lweentsana ezidlulise i-meconium kwi-amniotic fluid ayiphefumli kwimiphunga yazo ngexesha lokubeleka kunye nokuhanjiswa. Akunakulindeleka ukuba babe naziphi na iimpawu okanye iingxaki.

Iintsana eziphefumla oku kulwelo zinokuba noku kulandelayo:

• Umbala wesikhumba esimnyama (cyanosis) elusaneni
• Ukusebenza nzima ukuphefumla (ukuphefumla okunengxolo, ukukrokra, ukusebenzisa izihlunu ezongezelelweyo ukuphefumla, ukuphefumla ngokukhawuleza)
• Akukho kuphefumla (ukungabikho komgudu wokuphefumula, okanye i-apnea)
• Ukuqhwalela ekuzalweni

Ngaphambi kokuzalwa, ukubekwa kweliso lomntwana kungabonisa ukubetha kwentliziyo kancinci. Ngexesha lokuhambisa okanye ekuzalweni, i-meconium inokubonwa kulwelo olunamniotic nakusana.

Usana lusenokufuna uncedo ngokuphefumla okanye ukubetha kwentliziyo kanye emva kokuzalwa. Banokuba namanqaku asezantsi e-Apgar.

Iqela lokhathalelo lwempilo liza kuphulaphula isifuba sentsana nge-stethoscope. Oku kunokuveza izandi zokuphefumla ezingaqhelekanga, ngakumbi izandi ezirhabaxa, nezingavakaliyo.

Uhlalutyo lwegesi yegazi luya kubonisa:

• IPH ephantsi (eneasidi) yegazi pH
• Ukunciphisa ioksijini
• Ukwanda kwekharbon diokside

I-x-ray yesifuba inokubonisa iindawo ezinamachaphaza okanye ezinemigca emiphungeni yosana.

Iqela lokhathalelo olukhethekileyo kufuneka libekhona xa umntwana ezalwa ukuba imizila ye-meconium ifunyenwe kulwelo lwe-amniotic. Oku kwenzeka ngaphezulu kwe-10% yokukhulelwa okuqhelekileyo. Ukuba umntwana uyasebenza kwaye uyakhala, akukho lunyango luyafuneka.

Ukuba umntwana akasebenzi kwaye uyakhala kanye emva kokubeleka, iqela liya:

• Ukufudumala nokugcina ubushushu obuqhelekileyo
• Yomile kwaye uvuselele umntwana

Ukuba umntwana akaphefumli okanye unentliziyo encinci:

• Iqela liza kunceda umntwana aphefumle esebenzisa imaski yobuso eqhotyoshelwe engxoweni ehambisa umxube weoksijini ukufakela imiphunga yosana.
• Usana lunokufakwa kwigumbi lokhathalelo olukhethekileyo okanye kwiyunithi yonyango olunzulu olusandul 'ukuzalwa ukuze lujongwe ngokusondeleyo.

Olunye unyango lunokubandakanya:

• Iintsholongwane zokunyanga usulelo olunokwenzeka.
• Umatshini wokuphefumla (umoya wokuphefumla) ukuba umntwana akakwazi ukuziphefumlela okanye ufuna isixa esikhulu seoksijini eyongezelelweyo.
• Ioksijini ukugcina amanqanaba egazi esiqhelekileyo.
• Ukutya ngaphakathi (IV) isondlo-isondlo ngemithambo-ukuba iingxaki zokuphefumla zigcina umntwana ekubeni akwazi ukondla ngomlomo.
  
• Ukufudumala okufudumeleyo ukugcina ubushushu bomzimba.
• Surfactant ukunceda imiphunga ukuba itshintshe ioksijini. Oku kusetyenziswa kuphela kwiimeko ezinzima kakhulu.
• I-nitric oxide (ekwabizwa ngokuba yi-NO, igesi engenayo) ukunceda ukuhamba kwegazi kunye nokutshintshana kweoksijini kwimiphunga. Oku kusetyenziswa kuphela kwiimeko ezinzima.
• I-ECMO (inwebu yangaphakathi yeoksijini yeoksijini) luhlobo lokudlula kwentliziyo / kwemiphunga. Ingasetyenziswa kwiimeko ezinzima kakhulu.

Kwiimeko ezininzi ze-meconium-stained fluid, umbono ubalaseleyo kwaye akukho ziphumo zexesha elide kwezempilo.

• Sisiqingatha kuphela seentsana ezine-meconium-stains fluid eya kuba neengxaki zokuphefumla kwaye yi-5% kuphela eya kuba ne-MAS.
• Iintsana zisenokufuna inkxaso eyongezelelweyo ngokuphefumla kunye nesondlo kwezinye iimeko. Esi sidingo sihlala sihamba kwiintsuku ezi-2 ukuya kwezi-4. Nangona kunjalo, ukuphefumla ngokukhawuleza kunokuqhubeka kangangeentsuku ezininzi.
• I-MAS kunqabile ikhokelela kumonakalo osisigxina wemiphunga.

I-MAS inokubonwa kunye nengxaki enkulu yokuhamba kwegazi ukuya nokubuya emiphungeni. Oku kubizwa ngokuba yi-pulmonary hypertension yentsana (PPHN).

Ukuthintela iingxaki ezikhokelela ekubeni i-meconium ibekhona, hlala usempilweni ngexesha lokukhulelwa kwaye ulandele iingcebiso zomboneleli wakho wezempilo.

Umboneleli wakho uya kufuna ukulungela i-meconium ukuba ikhona xa uzalwa ukuba:

• Amanzi akho aqhekekile ekhaya kwaye ulwelo lwalucacile okanye ludyojwe yinto eluhlaza okanye emdaka.
• Naluphi na uvavanyo olwenziwe ngexesha lokukhulelwa kwakho lubonisa ukuba kungakho iingxaki ezikhoyo.
• Ukubeka iliso kwimveku kubonisa naziphi na iimpawu zoxinzelelo lomntwana.

MAS; IMeconium pneumonitis (ukudumba kwemiphunga); Umsebenzi - meconium; Ukuhanjiswa - meconium; Neonatal - meconium; Unonophelo olusandul 'ukuzalwa - meconium

• Meconium

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