I-Bilirubin iphakanyiswe ngokuqondile: izimbangela kanye nokwelashwa. Yini okufanele uyenze uma ukwandisa i-bilirubin ngokuqondile enganeni?

Ngenxa yokuhlukaniswa kwamaseli abomvu wegazi, into ekhethekile ivela egazini - i-bilirubin. Ubizwa nangokuthi i-pigment ephuzi obomvu, ingenye yezingxenye eziyinhloko ze-bile. Ku-serum, kwenzeka ngezindlela ezimbili: okuqondile (okuboshwe) noma okungaqondile (mahhala).

Ukuhlonza izifo

Akunakwenzeka ukuthola ukuthi yikuphi okuqondile okushoyo yi-bilirubin, uma umuntu engazi ukuthi lolu cwaningo luni. Kuyadingeka ukuthi kuhlolwe ukusebenza kwesibindi nokuxilongwa kwezifo eziningana zomuthi wamathunjini. Noma yikuphi ukuphambuka kwalesi sibonakaliso kusuka kwendabuko kubonisa ukuthi umzimba uhlulekile.

Uma i- bilirubin iphakanyisiwe ngokuqondile , odokotela banesizathu sokukholelwa ukuthi isiguli sinesifo esiyinhlanzi noma esingapheli kwesibindi noma i- cholelithiasis. Uma kunoma yikuphi ukuphambuka kwalesi sibonakaliso kusuka kwendabuko, kubalulekile ukuhlola ukulandelwa kwesiguli ukuze uhlolisise kahle futhi uqale ukwelashwa okufika ngesikhathi. Ngokujwayelekile izinga eliphakeme kakhulu le-bilirubin lingatholakala ngaphandle kokuhlolwa kwegazi. Phela, ihlanganisa ebusweni be-eye, izibilini ezinwebekayo, isikhumba futhi zinikeza umthunzi ophuzi.

Izimbangela zokukhula kwe-bilirubin

Ezimweni eziningi kubalulekile ukunquma ngokuthembekile ukuthi yini eyabangela isibindi ukuba sibi kakhulu. Ngenxa yalokhu kubalulekile ukuqonda ukuthi i-bilirubin ephezulu ephezulu ayikwazi ukufana naleyo. Ngakho-ke, ngaphandle kokunquma isifo esiholela kule nkinga, nokuqokwa kokwelashwa okwanele, ngeke kunciphise.

Ukushintsha izinga le-bilirubin kungabangelwa izizathu eziningana. Lezi yizi:

1. Ukwandisa ukuqina kwe-hemolysis ye-erythrocytes.
2. Ukuphazanyiswa kwesibindi okubangelwa ukulimala kwe-parenchyma, kuyilapho umsebenzi wokukhululwa kwe-bilirubin ukhula.
3. Ukuphazanyiswa kwenqubo yokuphuma kwe-bile kuya emathunjini.
4. Ukulahlekelwa kwesixhumanisi esibalulekile esithinta i-biosynthesis ye-bilirubin.
5. Ukuwohloka kwenqubo yokwehliswa kwengxenyana eqondile ibe yi-bile.

Futhi, izinkinga zingabangelwa i-hemolytic anemia. Esinye isizathu singase sibe ne-malaria, ukutholakala kwe-vitamin B12 nezinye izinkinga ezilinganayo.

Isimo lapho i-bilirubin iphakanyiswa ngokuqondile, ibuye ivele ngenxa yokuthi ikhiqizwa ngenxa ye-hemolysis ethuthukisiwe. Ngesikhathi esifanayo, ukwephulwa kwesibindi kuholela ekwenzeni ukuthi akukwazi ukubhekana nokwenza inombolo yokwanda ye-glucuronides, okudingeka kakhulu emzimbeni.

Ukuxilongwa okuyingozi

Ungayeki uma udokotela ekhuthaza ukuhlola isibindi futhi akuthumele ukuba uhlole. I-Bilirubin ngqo ingasiza ukuxilonga inani lezifo ezibi kakhulu.

Ngakho, izinga layo liyokwanda uma:

- I-Hepatitis (kokubili i-etiology ye-viral neyenobuthi);

- i-cytomegalovirus, eyabangela ukulimala kwesibindi esithathelwanayo;

- syphilis yesibili noma ephakeme ;

- cholecystitis;

- hypothyroidism izinsana;

- i-jaundice yabesifazane abakhulelwe.

Uma i-bilirubin iyinhloko futhi iqondile, udokotela angasolwa kokubili kwesifo sofuba nesinye sezifo. Isiguli singaba nomdlavuza wesibindi, i-cirrhosis eyinhloko, i-cholelithiasis. Futhi, ukuphambuka kwezinkomba ezivela esimweni esivamile kungenziwa uma kunobuthi obuyingozi, obudakamizwa noma obudakayo bomzimba.

Izinkinga kwabesifazane abakhulelwe

Abanye omama esikhathini esizayo emithathu yokugcina bangathola ukuthi abanawo imiphumela emihle yokuhlolwa. Phela, abanye bangaba ne-bilirubin eqondile ekukhulelwe. Lesi simo sidinga ukulandelwa okuphoqelekile. Ngemuva kokukhuphuka kwalesi sibonakaliso kubonisa ukwephulwa kwenqubo yokuphuma kwebhili esibindi. Lesi simo sibizwa ngokuthi "i- cholestasis ye- intrahepatic yabesifazane abakhulelwe."

Futhi, izifo eziningi azikwazi ukukhishwa, njenge-hepatitis ye-viral, i-cholecystitis, i-hemolytic anemia. Kubalulekile ukuwaxilonga ngesikhathi sokuvimbela izinkinga ezingenzeka.

Kubalulekile ukuqonda: uma i-bilirubin ephezulu iphakanyisiwe, ukwelashwa kufanele kumiswe ngempela. Phela, lesi simo singasongela inkambo evamile yokukhulelwa ngokwawo kanye nokuphila komntwana ongakazalwa. Kungabangela uhlobo oluvuvukala lwezifo ze-hemolytic ze-fetus, futhi kunamathuba aphezulu okuzalwa ngaphambi kwesikhathi sokuzalwa nokufa kwengane ngaphakathi kwesibeletho noma emahoreni wokuqala ngemva kokuzalwa.

Izimpawu ze-hyperbilirubinemia

Ngokuvamile, umbuzo wesidingo sokuhlaziywa uphakanyiswa emva kokuthi umuntu noma udokotela ekuhlolweni uyobe esolula inkinga. Ngakho, ukuthi i-bilirubin ejwayelekile futhi eqondiswayo iphakanyisiwe, ingaboniswa yizibonakaliso ezinjengalezi:

- i-icterus sclera yamehlo, izitho zangasese, isikhumba;

- izinga lokushisa lokushisa;

- Ukwandiswa kwengubo, engakhuluma ngokungahambi kahle esifundeni se hypochondrium kwesokunxele;

- ukumnyama komchamo, kungaba mnyama noma kumnyama;

- ukuzithemba, ukukhathala okwedlulele, ukukhathala, ikhanda - lezi zibonakaliso zibonisa ukuthi i-oksijeni iye yaba yimbi kakhulu kwezicubu.

Izimpawu ezinjalo ziqukethe i-hemolytic anemia. Kubalulekile ukuphawula ukuthi ushintsho lombala womchamo awuhlangatshezi ngaso sonke isikhathi. Kungaba ukubhujiswa kwamangqamuzana egazi abomvu ngisho nasezikhungweni, futhi lokhu kwenzeka kuphela ngezifo ezithile, isibonelo, nge-Marciafawa-Mikeli syndrome.

Kodwa i-hemolytic anemia akuyona into kuphela eholela eqinisweni lokuthi i-bilirubin iphakanyisiwe ngokuqondile. Izimbangela nazo zitholakala ukwephulwa kwesibindi. Khuluma ngezinkinga ezinjalo kungaba, uma isiguli:

- isicashu, ukunganaki ngemva kokudla, ukukhwehlela okubabayo;

- umuzwa wokudabuka e-hypochondrium elungile, kubangelwa ukwanda kwesibindi;

- ukwehlisa ukusebenza kahle, ubuthakathaka.

Ngezinye izikhathi kungase kube nokukhanya komchamo kumbala webhiya noma itiye eliqinile. Lapho i-hepatitis ye-viral ibuye iphinde ibonwe ukuphakama kokushisa.

Ukwelapha

Ukuzama ukuthola ukuthi ngabe ukwelashwa kufanele kwenziwe kanjani, ngisho noma i-bilirubin iphakanyisiwe kancane, akunakwenzeka. Ngemuva kwalokho, awukwazi ukususa inkinga kuze kube yilapho umgomo wayo uzimisele.

Kubalulekile futhi ukuqhuba imisebenzi yokuxoshwa kwe-detoxification. Zihlanganisa nokudla okhethekile okuhloswe ukunciphisa umthwalo kuma-hepatocytes kanye nama-enzyme aphethwe ukukhipha ubuthi. Esendaweni yesibhedlela, ukwelashwa kwe-infusion-transfusion ngokuvamile kuyenziwa. Yenzelwe ukushintsha ukubunjwa nevolumu yegazi, i-intracellular kanye ne-intercellular fluid. Ungakhetha isixazululo esizojova ngaphakathi, kuphela udokotela kuphela. Kwezinye izimo, isisombululo se-glucose, ama-amino acids, u-saline nezinye izidakamizwa zingahle zenziwe.

Ngezinye izikhathi kunconywa ukwenza i-phototherapy, okusiza ukubhubhisa i-bilirubin enobuthi. Ukunciphisa odokotela abadakayo kuvame ukunikeza i-activated carbon and gels, eyenzelwe ukususa i-toxins, isibonelo, i-agent Enterosgel.

Ngakho-ke, uma ngenxa yokubhujiswa okujulile kwamangqamuzana egazi kwacaca ukuthi i-bilirubin iphakanyisiwe ngokuqondile, izizathu ze-hemolysis kufanele zenziwe ngaphandle kokuhluleka. Okokuqala, kubalulekile ukuqonda ukuthi yini eyayiholela kulokhu. Ngemuva kwalokho, kuzodingeka ukuthi ungaphatheli imiphumela, kodwa imbangela ye-hemolysis. Kulokhu, ama-hormone e-glucocorticoid asetshenziswa, isibonelo, umuthi "Prednisolone". Ngemva kokuqeda imbangela, izinga le-bilirubin lizokwehla ngokwalo.

Uma izinkinga ezibangelwa ukuphulwa kokuphuma kwe-bile, ukungenelela kwezidakamizwa akunakwenzeka. Odokotela ezimweni ezinjalo banquma imithi yokwelashwa, engabandakanya izindlela ezifana ne "Ursosan", "Febihol", "Ceruglan", "Hermitage", "Papazol", "Gepabene", "Analgin". Ukwelapha kuhloswe ekugqugquzeleni ukuphuma kwe-bile, i-anesthesia. Kodwa akufanelekile ukusebenzisa izidakamizwa ngaphandle kokubonisana nodokotela. Phela, ezimweni eziningi, ukwelashwa okulwa negciwane noma antiparasitic kuyadingeka.

Ngokuvamile imbangela ye-jaundice yi-hepatitis. Kulesi simo, kubalulekile ukuphatha isibindi. Ngenxa yalokhu, izidakamizwa ezilandelayo zingahle zenziwe: Essentiale, Methionine, Heptral.

Setha imigomo

Kungakhathaliseki ukuthi yisiguli (ngaphandle kwawasana), izinkomba kufanele zibe ngaphansi kwemingcele ebekiwe. Ngakho-ke, ngoba inani lama-bilirubin amazinga avela ku-3.4 kuya ku-17.1 μmol / l, ne-bilirubin eqondile egazini akufanele ibe ngaphezu kuka-4.3 μmol / l. Lezi zimiso azishintshi, zivumelekile kubantu abadala nganoma isiphi isikhathi, kanye nezingane. Kulesi simo, izinga lezingxenyana ezingaqondile alinqunywe ngokwehlukana, kubalwa njengokungathi umehluko emiphumeleni yokuhlaziywa phakathi kwenani le-bilirubin eliphelele futhi eliqondile. Akufanele kudlule i-13.7 μmol / l. Ukwandisa i-bilirubin engacacile uma kwenzeka i-jaundice esanda kuzalwa, i-hemolytic ne- pernicious anemia, Rotor, Gilbert, Kriegler-Nayar syndrome.

Isimo sihlukile nezingane ezineminyaka engaphansi kwenyanga eyodwa. Ngosuku lokuqala lokuphila, i-bilirubin emahlathini ingaba kusuka ku-24 kuya ku-149 μmol / l. Ngosuku lwesibili lokuphila umkhuba osezingeni eliphakathi kuka-58-197. Ngosuku lwesithathu 3-5, i-bilirubin ingaba kusuka ku-26 kuya kuma-205 μmol / l. Ezinganeni zesikhathi esigcwele, lesi sibonakaliso sivame ukujwayelekile kuya kweviki ezimbili (ngezinye izikhathi kuze kube nonyaka).

Izimbangela ze-Hyperbilirubinemia kwabantwana abancane

Kuzo zonke izinsana ezisanda kuzalwa, inani le-pigment eliphuzi elibomvu egazini livuliwe. Lokhu kungenxa yokuthi isibindi sezingane esanda kuzalwa asisebenzi njengabantu abadala. Akakwazi ukubhekana ne-bilirubin, futhi iqoqa emzimbeni. Yingakho izingane eziningi zandisa izinga.

Ungesabi, lokhu kuyimeko evamile, uma-ke, izinkomba azidluli izinga elisungulwe izingane zale minyaka. Ngokuvamile, isibindi sakhiwa kabusha futhi siqala ukusebenza ngokujwayelekile ngesonto lesibili lokuphila, futhi izinga le-bilirubin lizimela ngokwakho.

Uma udokotela esho ukuthi izinkinga kungenzeka, angaqhuba isifundo esikhethekile. Uma i-bilirubin ikhuphuka ngokuqondile ezinganeni ezisencane ngaphezu kwesilinganiso esimisiwe, kuvame ukuphakanyiswa ukuba ukhethe ukwelashwa esibhedlela. Ukwenqaba ukwelashwa okunconywayo akuyona efiselekayo, ngoba i-jelly yengane ayiyona ephephile abazali abaningi bacabanga.

Izinkinga ezingenzeka ezinganeni

Ngenxa yokuthi isibindi sezingane ezisanda kuzalwa asisebenzi njengabantu abadala, bangaba ne-bilirubin eqondile nangeyona eqondile. Lokhu kungenxa yezizathu ezilandelayo. Phakathi nokubola kwamaseli egazi, i-hemoglobin - heme enobuthi, eqala ukuvuthwa ngomzimba iphinduka ibe yi-bilirubin, isakhiwe. Ngesikhathi esifanayo, ingxenyana yayo engacacile ayifuni kulokhu oketshezi, ngakho-ke ayikwazi ukudonswa emcinini. Emva kokuxhuma ngezinto ezihlukahlukene, ihanjiswa esibindi, lapho iguqulwa khona ukuze iqondise i-bilirubin iphinde ihambise ku-gallbladder. Ezinganeni le nqubo isungulwa amasonto ambalwa emva kokuzalwa. Ngakho-ke, i-jaundice yokuphila iyinto evamile.

Kodwa kunezimo lapho izinga le-bilirubin livaliwe. Lesi simo esiyingozi kakhulu, ngoba ukwanda okungapheli kuyo kungaphazamisa ukuthuthukiswa okuvamile kwengqondo, kuholele ekuhluphekeni okuhlukahlukene kwengqondo, kubangele ukulahlekelwa kokuzwa, umbono, noma ukuphuza kwengqondo. Lokhu kungenxa yokuthi ukugqokisa ngokweqile i-bilirubin akuvumeli i-albin ukuthi ivimbele umphumela wayo onobuthi. Futhi lokhu kuholela eqinisweni lokuthi uhlelo lwezinzwa luhlupheka.

Ukwelashwa kwezingane

Ukwehlisa ngokweqile i-bilirubin eqondile egazini ngokuvamile kubangela ukuba ingane ilashwe esesibhedlela noma idluliselwe esibhedlela sabantwana. Indlela eyinhloko i-phototherapy. Lona ukukhanya komntwana onokukhanya okhethekile okukwazi ukuguqula i-bilirubin enobuthi ibe amafomu angenabungozi. Baxoshwa emzimbeni amahora angu-12 ngemifino kanye nomchamo. Le ndlela inemiphumela yaso emibi, kepha idlula ngokushesha nje uma inkambo yokwelashwa iphelile. Ngakho-ke, ingane ingase iqale ukuba nekhanda elincane lesikhumba, izihlalo ezixekethile futhi zivele zilele.

Kodwa kwezinye izimo, umzimba udinga usizo olwengeziwe ukusheshisa ukuhoxiswa kwe-bilirubin. Kulokhu, endaweni yokubhedlela, ama-droppers ane-glucose ayalelwe, amalungiselelo e-cholagogue, ase-ascorbic acid asetshenziswa.

Indlela esemqoka yokuvimbela izingane ze-jaundice kuthiwa ibelesa. I-colostrum ene-laxative emnene emntwaneni osanda kuzalwa futhi ikhuthaza ukuthi ukwandisa i-bilirubin ngokuqondile egazini kancane kancane. Kodwa kunezimo lapho izinkinga zilele ubisi lomama. Kulesi simo, kunconywa ukuthatha indawo yokubeletha ngengxube izinsuku ezimbalwa. Uma izinga le-bilirubin liqala ukwehla, kusho ukuthi i-jaundice ibangelwa ubisi lwebele. Kodwa lesi akusona isizathu sokwenqaba ukuncelisa. Ngokuvame ukuba ukujwayelekile kombuso wezimpumputhe izinsuku ezintathu zokudla ngengxube kwanele, emva kwalokho kungenzeka ukuthi usebenzise ingane futhi esifubeni.

Izinkinga ezinganeni

Kodwa ukwanda kwe-pigment ephuzi obomvu egazini akukhona kuphela ezinganeni ezisanda kuzalwa. Kodwa-ke, uma i-bilirubin eqondile yanda kumntwana, kumele ihlolwe ngokucophelela. Uma umntwana usuvele eshiye iminyaka yobudala, izimbangela ze-icterus azifani nalabo abangela izinkinga kubantu abadala.

Ngisho nangaphambi kokuthola izimbangela ezenza ukwanda kwe-bilirubin, kubalulekile ukuthi ingane ibone ukudla okufanele. Iyakwazi ukusiza isibindi ukucubungula i-bilirubin enobuthi bese iguqule ibe yingxenyana engenawo amanzi enomswakama. Ngakho, ukudla kuhilela ukukhipha konke ukudla okunamafutha nokuthosiwe, imikhiqizo ye-pepper, iziphuzo ze-carbonated. Futhi abazali kufanele bazi ukuthi esimweni lapho ingane ikhuphuka khona ngokuqondile, isimo sakhe sempilo siyehla kakhulu. Ngakho-ke, izinyathelo zokuxoshwa komzimba ezihlose ukuhlanza ingane ezinxenyeni ezinobuthi kufanele ziqaliswe ngokushesha ngangokunokwenzeka.