Kiyasta lokacin karantawa: 10 minti daya
Table of Contents
- Abubuwan da za a yi la'akari da su yayin Ƙimar Ƙaddamarwa
- Gudanar da Rashin aikin Systolic
- Ma'aunai da Zaɓin Na'urar a cikin Rufewa
- Amfani da TTE da TEE
- Ƙimar Bayan Yin aiki (Bayan Rufe PDA)
- Canje-canje na Hemodynamic
- Matsayin asibiti na Mara lafiya
- Jiyya da Bibiya
- Ragowar Ruwa da Gudanarwa
- Matsalolin Bayan tiyata
BruceBlaus, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, ta hanyar Wikimedia Commons
Maganin magani yana da jin daɗi kuma yakamata a yi amfani da shi kawai don daidaita majinyata alamomin kafin gyara ko a cikin marasa lafiya da ke da tawaya mai tsanani a cikin lokacin bayan aikin. Dangane da tsanani da nau'in pathophysiology, diuretics, vasodilators, inotropic inotropic jamiái, da antiarrhythmics ya kamata a yi amfani da a cikin wadannan yanayi.
Tabbataccen magani na PDA, ƙulli na ductus arteriosusAna nuna wannan hanya a cikin duk dabbobin da ke da mahimmancin hemodynamically hagu-da-dama shunt. Shekaru da yawa, aikin tiyata shine kawai zaɓi don rufe PDA. Lokacin da ƙwararrun likitocin suka yi, aikin tiyata yana da babban nasara. kuma yawan rikitarwarsa kadan ne. Ana amfani da wannan fasaha har yanzu a cikin cibiyoyin da ba su da kayan aiki da ƙwarewar da ake bukata don rufewa, da kuma a cikin ƙananan karnuka da kuliyoyi da marasa lafiya da nau'in 3 PDA ba tare da ciwon huhu ba (sharuɗɗan da ba su ba da izinin daidaitawar na'urar ba).
PDA ta percutaneous ƙulli na daya Amplatz canine ductal occluder (ACDO) a halin yanzu ana amfani ita ce hanyar farko da aka fi so An yi amfani da wannan hanya sosai a duk duniya tsawon shekaru. Lokacin da ƙwararrun likitocin tiyata suka yi, hanyar tana da sauri, inganci, da aminci.
Iyaka na hanyar percutaneous kaɗan ne kuma suna da alaƙa da farko ga girman haƙuri. Ga yawancin karnuka masu nauyin kasa da 2 kg, Jijiya na mata yana da ƙananan ƙananan don ba da damar sanya na'urar samun damar jijiya da ake bukata don hanya.
Ligin tiyata bai dace ba a cikin ƙananan karnuka da kuliyoyi, ƙananan jijiyoyi ko Yin amfani da "Label-Label" na coils-saki mai sarrafawa Wasu ƙananan hanyoyin shiga tsakani suna yiwuwa, kamar: Mai ikon wucewa ta hanyar catheter 4 Fr bayarwa An tsara shi ta wannan hanya.
Abubuwan da za a yi la'akari da su yayin Ƙimar Ƙaddamarwa
1. Matsayin asibiti na Mara lafiya:
• Matsayin lafiyar majiyyaci gabaɗaya da kuma ko tsarin jininsa ya tabbata.
• Pathophysiological mataki ve digiri na gyaran jiki da aikin gyaran ventricle na hagu (LV) ya kamata a yi nazari.
2. Halin da ke Bukatar Tsayawa:
• ciwon zuciya,
• Rashin aiki na systolic (rauni na karfin bugun zuciya),
• Arrhythmias (Atrial fibrillation ko tachyarrhythmias).
A cikin waɗannan lokuta, yanayin mai haƙuri dole ne a daidaita shi kafin aikin. Ana iya samun wannan tare da maganin miyagun ƙwayoyi (diuretics, inotropic agents, magungunan antiarrhythmic).
3. Mahimman Hoto da Gwaje-gwajen Bincike:
• kirji x-ray: Ana duba kasancewar haɓakar zuciya (cardiomegaly) da edema na huhu.
• Electrocardiogram (ECG): Ana amfani dashi don gano cututtukan bugun zuciya.
• Transthoracic echocardiography (TTE): Wajibi ne don ƙayyade tsarin gaba ɗaya na zuciya, girman PDA da matakin shunt.
Pulmonary edema dace kafin shiga tsakani ko hanyoyin tiyata a cikin marasa lafiya da aka gano kwanciyar hankali tare da maganin diuretic dole ne a bayar. Atrial fibrillation ko tachyarrhythmia a gaban PDA kafin rufewa bugun zuciya da sarrafa kari dole ne a bayar.
Gudanar da Rashin aikin Systolic
Marasa lafiya tare da tabarbarewar systolic suna buƙatar kulawa ta musamman saboda dalilai masu zuwa:
• Inotropic goyon baya (ƙarar ƙarfin bugun zuciya),
• Vasodilator kwayoyi (rage matsi akan zuciya),
• Intraoperative da perioperative saka idanu (ci gaba da sa ido a lokacin da kuma bayan tiyata).
A cikin wadannan marasa lafiya, Ƙarar ventricular na hagu (LV). kuma musamman karshen-systolic girma yawanci babba ne. Juzu'in fitarwa yana raguwa. S' kalaman yana da ƙananan gudu kuma nakasar tsayin daka (damuwa) da raguwar adadin kuzariyana tabbatar da kasancewar rashin aiki na systolic.
A cikin Karnuka masu Ayyukan Systolic na Al'ada:
• Lokacin da akwai PDA da kiyaye aikin systolic, VTI (lokacin saurin gudu) ve aortic ganiya gudu yana ƙaruwa daidai da ƙarar shunt.
Alamomin rashin aikin systolic:
• Ƙara ƙarar ƙarshen-systolic,
• VTI da mafi girman saurin aortic sun kasance ƙasa da na al'ada ko na al'ada.
Ma'aunai da Zaɓin Na'urar a cikin Rufewa
wani Amplatz canine ductus occluder (ACDO) Idan an rufe PDA tare da:
• MDD (Ƙaramar Ductus Diamita): Wannan diamita, ducts Ana auna wannan tsarin ne kawai a matakin Echocardiography transthoracic (TTE) Ile bincike mai inganci za a iya nunawa daidai ta amfani da .
• Distal ampulla distal: Wannan diamita ya zama dole don zaɓar daidai girman na'urar ɓoye.
Amfani da TTE da TEE
Echocardiography transthoracic (TTE):
Ana amfani da TTE don ingantacciyar ma'auni na MDD (ƙananan diamita na bututu).
• An yi shi tare da manyan gwaje-gwajen ƙididdiga kuma don auna daidai taga acoustic ya dace Bukatar.
Echocardiography transesophageal (TEE):
• Rufe PDA tare da ACDO Hoton TEE yana da matukar mahimmanci yayin
• Ana amfani da TEE don auna daidai girman ductus da jagorantar hanya.
• Real-lokaci 3D TEE, ductus en-face view of pulmonary ostium Wannan yana ba da ƙarin ma'auni daidai don zaɓin na'urar.
Amfanin TEE kawai:
• Lokacin da hotunan TEE suka yi kyau, ba tare da amfani da fluoroscopy (x-ray ba) TEE ne kawai zai iya jagorantar hanya.
• Duk da haka, Haɗuwa da 3D TEE da fluoroscopyshine mafi aminci kuma mafi inganci zaɓi.
Hanyar rufe PDAana iya yin ta ta hanyoyi biyu na tiyata da na percutaneous. Matsakaicin rufe ACDOHanya ce da aka fi so saboda yawan nasarar sa da ƙananan haɗarin rikitarwa. Kafin wannan hanya, yanayin mai haƙuri ya kamata a daidaita shi. X-ray, ECG, da transthoracic echocardiography (TTE) Yakamata ayi. Rashin aiki na systolic Taimakon inotropic da saka idanu na ciki suna da mahimmanci a cikin marasa lafiya tare da TTE da TEE Ya kamata a ɗauki ma'auni daidai, kuma ya kamata a ƙayyade na'urar da aka zaɓa daidai. Wannan hanya gabaɗaya ta yi nasara a cikin karnuka masu nauyin fiye da 2 kg.
Ƙimar Bayan Yin aiki (Bayan Rufe PDA)
Rufe PDA yana bawa mara lafiya damar canje-canje kwatsam a cikin ma'aunin hemodynamic haddasawa. Tsarin tsarin yana ƙaruwa tare da rufewar shunt da wannan hali, reflex bradycardia ta hanyar ƙarfafa baroreceptors (alamar Nicoladoni-Branham) Wannan sakamako yakan haifar da samuwar a cikin manyan magudanan ruwa ya zama sananne kuma yana iya wucewa na sa'o'i. Musamman manyan magudanan ruwa ve rashin aiki na systolic A cikin marasa lafiya tare da bradycardia, ana iya ƙara yawan fitarwar zuciya.
Canje-canje na Hemodynamic
• Hagu ventricular (LV) bayan lodi yana ƙaruwa, kwararar huhu da shigar LV sun daidaita.
• Kafin a cikin ventricle, wanda aka haɓaka kuma an daidaita shi zuwa babban ƙarar cikawa. Yana kashe tasirin Starling.
• Wannan, Diastolic da systolic kundin LV yana haifar da raguwa da raguwa mai yawa a cikin juzu'in fitarwa (EF) yana faruwa.
• A cikin matasa karnuka ve a cikin ƙananan nau'o'i, Girman ventricular na hagu yana komawa al'ada da sauri. Duk da haka, a cikin manyan karnuka ko a cikin wadanda aka yi wa tiyata tun balagagge, gyaran gyare-gyare yana faruwa a hankali a hankali kuma adadin LV ya kasance mai girma na tsawon lokaci na iya kasancewa ya fi na al'ada girma.
Matsayin asibiti na Mara lafiya
• Marasa lafiya tare da kiyaye aikin systolic, gabaɗaya waɗannan canje-canjen an jure su da kyau.
• A cikin marasa lafiya da rashin aikin systolic Idan haɗin ventricle-jijiya na hagu ya rushe, haɗin ventricle-jijiya na hagu na iya rushewa. Wannan na iya haifar da rikice-rikice masu zuwa:
• m arrhythmias,
• Electromechanical dissociation (rashin aikin wutar lantarki na zuciya don fassarawa zuwa matsewa).
A irin waɗannan marasa lafiya, yanayin yana ci gaba ta hanyoyi biyu:
1. Tsayawa tare da matsakaicin rashin aiki: mara lafiya, kyakkyawan yanayin rayuwa da tsawon rai iya samu.
2. Ƙarin lalacewa: A cikin wannan hali. alamomin gazawar zuciya, tsanani ventricular arrhythmias ve mutuwa kwatsam haɗarin yana ƙaruwa.
Jiyya da Bibiya
• Vasodilators da inotropic kwayoyi masu kyau, biyu a lokacin tiyata, da kuma a cikin kulawa mai tsanani bayan tiyata ve a cikin dogon lokaci magani ya kamata a yi amfani da shi.
Ya kamata a ci gaba da kula da marasa lafiya da ke da tabarbarewar systolic kuma a tallafa musu da waɗannan magunguna.
Ragowar Ruwa da Gudanarwa
• Ragowar kwararaHar yanzu akwai ƙaramin adadin jini ta hanyar ductus bayan an rufe PDA.
• Doppler duban dan tayi ana kula da shi.
• Idan Adadin LV baya komawa baya bayan aikin ko idan yana son karuwa, Wannan, kasancewar shunt mai mahimmancin hemodynamically A wannan yanayin, tsoma baki na biyu na iya zama dole.
Zaɓuɓɓukan Jiyya:
• Rufe shiga tsakani (Amfani da Amplatz canine ductus occluder (ACDO) ko coil)
• Maganin tiyata (Musamman Fasaha ta Jackson-Henderson tare da)
Ragowar kwarara ya fi kowa a cikin PDAs da aka rufe da coils yayin da ake gani, A cikin rufewa da aka yi tare da ACDO Yawancin kwararar ruwa yana faruwa ne ta hanyar:
• Matsayin na'urar ba daidai ba (Wannan yana ƙara haɗarin na'urar ta ɓace daga baya).
• Na'urar tana da girma (A wannan yanayin, ruwan yakan tsaya akan lokaci).
• PDA rufehanya ce da ke haifar da canje-canjen hemodynamic.
• Marasa lafiya tare da tabarbarewar systolicna iya fuskantar matsaloli masu tsanani kamar arrhythmias da rage fitar da bugun zuciya.
• Vasodilator da inotropic far, wajibi ne don daidaitawar irin waɗannan marasa lafiya.
• Ragowar kwarara yana faruwa, ana iya buƙatar hanya ta biyu.
• Rage kwarara a cikin hanyoyin coil ya fi kowa, A rufe tare da ACDO wannan hadarin ya ragu.
Wannan kimantawa, Yana da matukar mahimmanci don tabbatarwa da kuma kula da kwanciyar hankali na mai haƙuri bayan tiyata..
Matsalolin Bayan tiyata
Rufe PDA, ko na fiɗa ko na ɗan lokaci, yawanci hanya ce mai aminci da inganciMatsalolin rikitarwa ba su da yawa, amma a wasu lokuta, matsaloli masu mahimmanci na iya faruwa.
1. Sepsis (kamuwa da cuta)
• Sepsis bayan tiyata yana da wuya.
• Sepsis, a wurin rufewa na iya faruwa kuma wannan yanayin na iya faruwa, a cikin yankin ligation ko a yankin da aka sanya na'urar rufewa na iya haifar da kamuwa da cuta.
2. Ƙarfafawa (Rashin Na'urar)
• Ƙaddamar da na'urorin Amplatz canine ductus occluder (ACDO). Yana da wuya sosai.
An ga wannan rikitarwa a ƙasa da 1% na lokuta a cikin kwarewar marubucin.
• ƘunƙwasawaWannan yana nufin cewa na'urar ta fita daga cikin ductus zuwa cikin tsarin jini. A wannan yanayin, hanyar shiga tsakani na iya zama sau da yawa dole.
3. Ruptus (Tear)
• Ruptus na ductus, biyu a lokacin aikin tiyata kuma da kyar na iya faruwa a lokacin hanyoyin da ake bi.
• Hatsarin tsagewa, musamman a cikin ducts tare da ampullae mai zurfi ko aneurysmal ya fi girma.
• Rupture a lokacin tiyata ligation, Gabaɗaya a gefen dama na ductus yana faruwa. Wannan yawanci yana faruwa lokacin shigar dinki Yana auku.
Tsokaci Kan Matsalar Ruptus Ductus
• Tsayawa zubar jiniKwararrun likitocin suna amfani da dabarun tiyata don dakatar da zubar jini Suna amfani da hemoclip ( cliped-stopper clip).
• Rufe ragowar ductus na haƙƙin mallakaA wannan yanayin, idan har yanzu ductus yana buɗewa, na'urar rufewa (misali. ACDO) ana iya rufe shi da .
•Saboda, Fasaha ta Jackson-Henderson ko tsarin shiga tsakani na percutaneous, a cikin irin wannan tsarin jiki sune hanyoyin da aka fi so.
4. Mugunyar Maganin Aortic
• Wannan rikitarwa ba kasafai ba ne, amma yanayi ne mai barazana ga rayuwa.
• Rarraba aorticna iya faruwa bayan rufe ductus kuma yana iya haifar da sakamako mai mutuwa.
Rufe PDA hanya ce mai aminci tare da ƙarancin rikitarwa. Duk da haka, ya kamata a yi la'akari da matsaloli masu zuwa:
• Kamuwa da cuta (sepsis): Yana da wuya kuma yawanci yana tasowa a wurin ligation ko wurin rufewa.
• Embolisation (harshe na'urar): Ana ganinsa a ƙasa da 1%.
• Fashewar Ductus: Yana iya faruwa musamman a cikin ducts na aneurysmal da lokacin aikin tiyata da lokacin wucewar sutures. A wannan yanayin, hemoclip aikace-aikace ve Rufewa tare da ACDO ana yin shisshigi da hanyoyin kamar.
• M aortic dissection: Yana da wuya amma mai yuwuwar rikitarwa.
Mafi yawan waɗannan matsalolin, ƙwararrun likitocin fiɗa da ƙwararrun masu shiga tsakani za a iya sarrafa su yadda ya kamata. Musamman Fasaha ta Jackson-Henderson ve hanyoyin rufe percutaneous, tsaya a matsayin mafi aminci zažužžukan a cikin marasa lafiya tare da babban hadarin rupture ductal.
Wasu Labarun Kuna iya Sha'awarsu
"Farin ciki shine kawai abin da ke karuwa idan aka raba."
Albert Schweitzer
