Isikhokelo sakho esigqibeleleyo kwiiNICU zixhobo
Mhlawumbi inxalenye ebesisongelayo yokuba nomntwana kwiNICU yiyo zonke izixhobo ezingaqhelekanga kunye neenkqubo kwinkqubo yokunakekela abantwana abanomdla. Ukubona umntwana wakho enamathele kumashishini kunye nokugqithwa ngeencitshe kunokwesabisa, kodwa zonke izixhobo zikhona ukuze uncede umntwana wakho aphile.
Izixhobo ze-NICU zinokusebenza ezininzi ngeenjongo ezahlukeneyo ekujongeni impilo yakho kunye neenjini zokuxhasa ukuphefumla.
Enye yezona zinto zifunwa ngokubanzi malunga nezixhobo yi-ECMO, ngoko ngaphambi kokuba sijonge ezinye iimpahla kunye neenkqubo ze-NICU, masiqale sijonge kwi-ECMO.
Yintoni i-ECMO?
I-ECMO isisigxina esibhekisele kwi-membrane e-oxygenation. Umshini we-ECMO ngumshini othabatha igazi emzimbeni, owenza i-oxygen usebenzisa umphunga wengwenya aze awuphanyele emzimbeni usebenzisa intliziyo yokufakelwa. I-ECMO ifana nomshini wenhliziyo / umphunga ogqithisiweyo osetyenziswe ekuvuyweni kwentliziyo evulekile kodwa unokusetyenziswa ixesha elide.
Ngokukodwa, i-ECMO igxotha igazi nge-oksijini kwaye isusa i-carbon dioxide, umonakalo wokuphefumula. Ukongezelela, i-ECMO inokuxhasa uxinzelelo lwegazi. Nangona oomatshini bokuxhasa i-cardiopulmonary okanye i-"heart-lung" matshini angasetyenziselwa iiyure ezimbalwa kwigumbi lokusebenza, i-ECMO ingasetyenziselwa ixesha elide kwiisetyenzisi ngaphandle kwendawo yokusebenza njengeNICU.
Nazi izixhobo ze-ECMO:
- Iibhola zesiphaluka
- I-membrane oxygenator
- Amacangethi athile abuyisela igazi kwiinkqubo ze-venous okanye inkqubo ye-arterial
- Ipompo ye-Centrifugal okanye i-roller
- Umchithisi wokufudumeza
Ngubani ofuna i-ECMO?
I-ECMO yinkqubo enzima, ngoko isetyenziselwa kuphela iintsana ezigula kakhulu kwaye mhlawumbi ziya kufa ngaphandle kwayo. I-ECMO ingaqwalaselwa kwiintsana ezi:
- I-Meconium aspiration syndrome
- I-pulmonary persistant yengxowankulu yintsana (PPHN)
- Eyona ntsholongwane yokuphefumula
- Ubhubhane obusongela ubomi okanye i-pneumonia
I-ECMO ingasetyenziselwa nayiphi na imeko ebalulekileyo eyenza intliziyo yomntwana okanye imiphunga ukuba ayeke ukusebenza kakuhle. Ngenxa yokuba i-ECMO ingasetyenziselwa kuphela kwiiveki ezimbalwa, isetyenziselwa kuphela izigulane ezilindeleke ukuba ziphinde zibuye emva kokunyanga okanye ukuhlinzwa.
I-ECMO isebenza njani?
Ukuqala unyango lwe-ECMO, oogqirha baya kufaka iipilisi ezininzi ezibizwa ngokuthi i-catheters kwimithambo yegazi yomntwana. Ama-catheter angangena nge-incision encinci entanyeni yentsana okanye e-groin aze ahambe kwiinqanawa ezinkulu kufuphi nentliziyo yomntwana.
Xa ama-catheters ekhona, oogqirha baya kubakhonkxa kwi-tubing machine ye-ECMO, eya kuza kuzaliswa ngegazi lomnikelo. Xa umatshini we-ECMO uvuliwe, uya kugawula igazi ukusuka kwintsana, ukupompoza kwi-membrane eyongeza i-oksijini kwaye isuse i-carbon dioxide ize iphinde ibuyisele igazi le-oksijini kumntwana.
Ziziphi iingozi ze-ECMO?
Ngenxa yokuba kukho ubuninzi beengozi ezinxulumene ne-ECMO, isetyenziselwa kuphela kwiintsana ezigulayo kangangokuthi ziya kufa ngaphandle kokonyango. Iingozi ziquka:
- Ukuhlambalaza: I- Heparin, igazi elincinci, lisetyenziselwa ukukhusela ama-blood clots ngethuba le-ECMO. I-Heparin inokubangela ukuphuma kumanzi apho iibhulo zifakwe khona okanye kwezinye iindawo zomzimba.
- Usulelo: naliphi na ixesha into engaphandle, njenge-cmeterter ye-ECMO, ifakwa emzimbeni, inokubangela ukusuleleka.
- I-hemorrhage (IVH): I- bleeding in brain is a complication serious of ECMO unyango.
- Amacwecwe egazi: Amancinci egazi amancinci angabumba kwi-ECMO tubing. La macwecwe angatyelela ngegazi kunye nokubangela ukulimala okanye ukufa.
- Ukumpontshelwa ngegazi: Ukufelwa igazi rhoqo kunokufuneka xa umntwana e-ECMO. Nangona igazi linikezelwa ngokukhuselekileyo, kukho rhoqo umngcipheko wesifo esivela kwigazi lomnikelo.
Ezinye izixhobo zokuphefumula kwi-NICU
Ukongeza kwi-ECMO, unokuhlangabezana nezinye izixhobo zokuphefumula kwi-NICU.
Iintsana kwi-NICU zingadinga uncedo lokuphefumula okanye ukugcina igazi labo li-oxygen. Izixhobo zokuphefumula kwi-NICU zingaquka:
- Iingqungquthela ze- nasal : I- cannula yamanqa isethi yamancinci amancinci amancinci angabangela ukuxinwa okuphezulu kwe-oksijini kune-air room. Baya kunika umoya wokulala endaweni ephezulu, eyanceda ukugcina umoya uvule kwaye ukhuthaze iintsana ukuba ziphefumle ngokwazo.
- I-CPAP: Uxinzelelo oluqhubekayo lwe-airway, okanye i- CPAP , i-mask okanye isethi esikhethekileyo se-nasal prongs ezigxininiswe ekhaleni lomntwana ukuze ziqhube umoya. Uxinzelelo oluqhubekayo lukhuthaza i-airways evulekile kwaye ukhumbuze iintsana zokuphefumula, kwaye iindawo eziphezulu ze-oksijini zingasetyenziswa.
- Iintsholongwane: Ukuba umntwana ufakwa kwi- ventilator , inkqubo ebizwa ngokuba yi-intubation iya kusetyenziswa ukubeka ityhubhu ekhethekileyo ebizwa ngokuba yi-tube endotracheal kwi-airway ngomlomo okanye ekhaleni. Umqhubi, okanye umphefumli, ngumshini ohambisa impumulo ezinganeni ezingenakuphefumula ngokwazo okanye ezingaphefumli kakuhle.
Izixhobo zoKuqwalasela kwiiNtshaba
Ukongeza kwizixhobo zokuphefumula, iintsana ezinonophelo ezizodwa zonyango ziqhubeka zihlolwe ukuqinisekisa ukuba ziphilile. Iindlebe eziqhelekileyo ezisetyenziswa ziquka:
- Abahloli bee-cardiac: Ezi zinto zisebenzisa izikhonkwane kwisifuba esixhunyiwe kwiinkambo (ezibizwa ngokuba zikhokelo) ezixhomekeke kwisebe ukuqinisekisa ukuba intliziyo yomntwana ibetha ngesivinini esifanelekileyo kunye nesigqi esifanelekileyo.
- Abaqapheli bokuphefumula: Ngokuqhelekileyo inxalenye yabameli be-cardiac, ezi zinto zikhokelela ekujongeni izinga lokuphefumula umntwana kunye nomzekelo.
- I-oximeters ye-Pulse: Ezi zizungeze isalathisi somntwana okanye unyawo lwakho kwaye zibe nombane obomvu ohlola i-oxygen egazini.
IV Equipment for Prevers
Unokuba uqhelana ne-IVs, okanye amathambo amancinci angena emithanjeni ukuvumela abasebenzi ukuba bafake amanzi okanye amayeza ngqo kwiimvini. Njengenxalenye yeenkqubo zeNICU eziqhelekileyo, iintsana kwi-NICU zinokuba neendidi ezininzi ze-IV imigca:
- I-Peripheral IVs: Lezi "ziqhelekileyo" ii-IV eziya emthanjeni kwimithi okanye kumanzi. I-Peripheral IVs ingaba seenyawo, izandla, iingalo, okanye i-scalps yeintsana ezingaphambi kwexesha . Nangona i-scalp IV ibukeka ibangelwa kubazali, ixhaphake kakhulu kwi-NICU ukususela kwintsana engenakusasa ihlala isineemifuno emihle ye-IV ezandleni zabo nasezinyaweni.
- Imigca yePICC : Ngaphandle kokungeniswa kwamacangethi amakhulu, okanye imigca yePICC imfutshane, ibonakala njenge-IV rhoqo. Banama-catheters angaphezulu, okanye ama-tubes, ngaphezu kwe-IV rhoqo, kwaye bahamba nge-vein kwiimvumba ezinkulu ezingenanto entliziyweni. Ukufakwa kwezi migaqo ngenye yeenkqubo zeNICU iintsana zihlala ziphantsi.
- I-caribbean ye-Umbilical: Ezi zifakwe kwisigxina sekhanda kunye nokuhamba kwiimvumba ezinkulu kunye nemithambo emfutshane entliziyweni. Imigca ye-umbilical ingeniswa kwintambo emgqeni, umgca kwintambo yesibindi, okanye zombini, ukuvumela ukulawulwa kwamanzi kunye neyeza, ukunyanzeliswa kwegazi, isampuli yegazi kunye nezinye iinkqubo.
Ezinye izixhobo kwiNICU
Ngexesha le-NICU, umntwana wakho unokufuna iimpahla ezongezelelweyo ngokunjalo.
- Iipilisi zokutya : I- tube yokutya isuka emlonyeni (orogastric- ebizwa ngokuba yi-OG) okanye kwimpumlo (i-nasogastric ebizwa nge-NG) kwisisu. Iintsana ezigula kakhulu okanye ezibuthathaka ukususela kwibele okanye kwibhotile zithola ukutya kula maphubhu. Ukufaka ii-tubes nokunikezela ngokutya kuzo ziqhelekileyo iinkqubo phakathi kweentsana ezingekafiki.
- Ama-Incubators: Iintsana ezisengaphambili zizinzima ukuzigcina zifudumele, ngoko-ke i- incubators isetyenziselwa ukubonelela indawo efudumeleyo ukuze umntwana aphumle. I-skin probes ilinganisa rhoqo ukushisa komntwana, ngoko akafumani kakhulu okanye ashushu.
- I-Phototherapy: Iintshaba ziyakwazi ukuba neengxaki ezivela kwi-jaundice. Izibane ze-Phototherapy, ezibizwa ngokuba zibane zezibane, zibane zizodwa eziza kubangela ukuba umzimba womntwana uqhekeza i-bilirubin , ikhemikhali ebangela i- jaundice .
Imithombo:
I-American Academy yePediatrics. "Amanqanaba okuNakekelwa kweNonatal" Iingcali zonyango 2004 114: 1341-1347. > http://pediatrics.aappublications.org/content/114/5/1341.
Isibhedlele sabantwana sasePittsburgh. "Iinkqubo kunye nezixhobo kwiNICU."
Isibhedlele sabantwana baseNtshona. "Abasebenzi bethu beNICU abanakekelayo." 2008. https://www.mhs.net/locations/memorial-west/neonatal/staff.
Izingane zeCincinnati. Izinketho zokuphanda: I-Membrane ye-Extracorporeal Oxygenation (ECMO). Https://www.cincinnatichildrens.org/health/e/ecmo.
Matshi weDimes. "Iiglosari: Iimpahla eziqhelekileyo zeNICU." Oktobha 2008.
Nemours Foundation. "Xa umntwana wakho e-NICU."
IStanford School of Medicine uLane Library Library. "Intshayelelo ye-ECMO yabazali" http://lane.stanford.edu/portals/cvicu/HCP_CV_Tab_1/ecmo_for_parents.pdf.