Yokusiza umuntu ukuba aphefumule Newborn: izinkomba, izinhlobo, izigaba, nemithi

Ngokwezibalo, njalo osanda kuzalwa yeshumi sihlinzeke usizo lwezempilo egumbini ukulethwa, futhi 1% kubo bonke abazalwa edinga uhla egcwele CPR. Izinga eliphezulu abaqeqeshwayo yezokwelapha kungandisa amathuba lempilo futhi kunciphise yezinkinga kungenzeka. yokusiza umuntu ukuba aphefumule lokwenele futsi Esifike Ngesikhathi ngayo lapho usana - isinyathelo sokuqala ukunciphisa inani lokufa nokuthuthukiswa isifo.

imiqondo eyisisekelo

Uyini umuntu ukuba aphefumule ezisanda kubelethwa? Lolu chungechunge izinyathelo ezihlose ekuvuseleleni isidumbu sengane kanye nokubuyiselwa imisebenzi elahlekile. Kuhlanganisa:

• yokusiza umuntu ukuba aphefumule cardiopulmonary;
• izindlela labagula kakhulu;
• ukusebenzisa ukupholisa ngemishini;
• pacemaker kanye nezinye ukufakwa.

Eside Okugcwele izinsana angadingi yokusiza umuntu ukuba aphefumule izinyathelo. Bezalwa asebenzayo, Memezani ngezwi elikhulu, ishayela nokushaya kwenhliziyo bayizakhamuzi ezivamile, isikhumba has a color pink, ingane iyaphendula kahle ezintweni ezenzeka ngaphandle. Lezi zingane ngokushesha ibekwe kamama esiswini kanye nendawo yokuhlala efudumele, inabukeni ezomile. Zokuphefumula lwamafinyila okuqukethwe aspirated ukubuyisela patency yabo.

Kuphethe yokusiza umuntu ukuba aphefumule cardiopulmonary kubhekwa oluphuthumayo. Kunenkolelo esimweni engasayi okumelwe uphefumule futhi ukhulume inhliziyo umsebenzi. Ngemva kokuthi i-sokungenela uma kwenzeka yalokho evumayo, ukusebenzisa izinto eziyisisekelo esegumbini labagula kakhulu. Ukuphathwa kanjalo is okuhloswe ngalo ukuqeda yezinkinga kungenzeka kokuma izitho ezibalulekile.

Uma isiguli singenakukwazi ngokuzimela silondoloze homeostasis, le yokusiza umuntu ukuba aphefumule ngayo lapho usana zihlanganisa ukupholisa mechanical (ALV) noma ukubeka elingenalo iwashi lenhliziyo.

Yini edingekayo ukuze umuntu ukuba aphefumule egumbini ukulethwa?

Uma isidingo nokuhlinzekwa izenzakalo ezinjalo uphansi, udinga bayifeze ngumuntu oyedwa. Esikhathini Ngaphakathi mo of khulelwa ezinzima nokulindelwe uhla eligcwele CPR e ukulethwa ongoti ezimbili.

Yokusiza umuntu ukuba aphefumule ngayo lapho usana egumbini ukulethwa kudinga ukulungiselelwa ngokucophelela. Ngaphambi inqubo bokubeletha, hlola ukutholakala zonke ezidingekayo futhi uqiniseke imishini zisesimweni ukusebenza.

1. Udinga ukuxhuma umthombo ukushisa ukuze itafula yokusiza umuntu ukuba aphefumule futhi namanabukeni kwabathinta, roll inabukeni ngesimo roller.
2. Hlola ukuthi isistimu kahle efakwe umoya-mpilo umncane. Kumele kube isamba ezanele oxygen ulungise kahle ingcindezi kanye flow rate.
3. Kuyadingeka ukuba uhlole ukulungela imishini ukuthi iyadingeka ukuze isizinda okuqukethwe ipheshana zokuphefumula.
4. Lungiselela amathuluzi ukuze kususwe lokuqukethwe esiswini uma kwenzeka nenshisekelo (uphenyo, isipetu, sikelo, impahla ukulungisa), meconium aspirator.
5. Lungiselela futhi uhlole ubuqotho isikhwama futhi imaski yokusiza umuntu ukuba aphefumule futhi intubation ungakuphi.

Setha i-intubation siqukethe amashubhu endotracheal nge babashayeli, nge ezahlukene laryngoscope izindwani namabhethri aseceleni, isikelo amagilavu.

Kuyini impumelelo izinyathelo?

yokusiza umuntu ukuba aphefumule ezisanda kubelethwa egumbini ukulethwa kusekelwe izimiso elandelayo yempumelelo:

• ukutholakala ukunakekelwa amaqembu olunzulu - ku zonke izinhlobo yokusiza umuntu ukuba aphefumule kufanele khona;
• umsebenzi ehlelekile - Ithimba kufanele nesebenzelana iphelelisane nomunye njengenye indlela enkulu;
• kwabasebenzi abaqeqeshiwe - yokusiza umuntu ukuba aphefumule ngamunye kufanele abe ezingeni eliphezulu lolwazi namakhono okusebenzayo;
• umsebenzi, ikhumbula ukuphendula lesiguli - CPR kumele kuqale ngokushesha nge ukubukeka isidingo sabo, izinyathelo ezinqala abazenzi, kuye ngokuthi basabela kanjani umzimba wesiguli;
• ukuseviswa of imishini - imishini ukuze yokusiza umuntu ukuba aphefumule kufanele kube serviceable futhi kufinyeleleke nganoma yisiphi isikhathi.

Izizathu isidingo isenzo

Ngu izici etiological zokucindezela ka inhliziyo, amaphaphu nezinye izitho ezibalulekile ngayo lapho usana zihlanganisa ukuthuthukiswa asphyxia, ukulimala lapho umuntu ezalwa, ukuthuthukiswa kwezinso azalwa naso, ezithathelwanayo umsuka toxemia nezinye amacala omsakazo engaziwa.

yokusiza umuntu ukuba aphefumule Wezingane ezisanda kubelethwa kanye nesidingo ngoba lingahunyushwa wabikezela ngisho esikhathini abantwana. Ezimweni ezinjalo, iqembu yokusiza umuntu ukuba aphefumule hlalani nilungele, ukuze kweso ukusiza ingane yakho.

Isidingo sokuba izenzakalo ezifana singenzeka ngaphansi kwale mibandela elandelayo:

• yehlukene noma oligohydramnios;
• perenashivanie;
• umama sikashukela;
• nomfutho wegazi ophezulu;
• isilulu samafayela;
• ukungondleki kwengane.

Futhi, kukhona izinto ezimbalwa ukuthi kakade kuphakama bokubeletha. Endabeni nesenzakalo yabo kungalindeleka ukuthi umnotho wawo kudingeke yokusiza umuntu ukuba aphefumule. izici ezinjalo zihlanganisa bradycardia umntwana, section caesarean, wazalwa kungakabi isikhathi futhi ngokushesha, previa noma abruption esinomhlapho, lesizalo hypertonus.

asphyxia

Ukuthuthukiswa iziyaluyalu zokuphefumula nge hypoxia izinqubo kubangela ukubukeka umzimba ngeziyaluyalu we kwegazi ohlelweni, umzimba kanye microcirculation. Okulandelayo kukhona ukuphazamiseka izinso, inhliziyo, izindlala adrenal, ubuchopho.

Asphyxia edinga ngokushesha ukuze kuncishiswe amathuba okuba ukuxakeka. Izimbangela kuphazamiseka zokuphefumula:

• hypoxia;
• ukwephulwa umgudu (nenshisekelo wegazi, isikhwehlela, meconium);
• organic okulimala ebuchosheni CNS umsebenzi;
• kombungu;
• surfactant enganele.

Ukuxilonga kudingeka yokusiza umuntu ukuba aphefumule ukungenelela eyenziwa ngemva nokuhlolwa ingane Apgar.

Kulinganiselwa ukuthi	0 amaphuzu	1 iphuzu	2 amaphuzu
isimo zokuphefumula	Ayikho	Sokugembula, spasmodic	wamemeza ngezwi elikhulu, Rhythmic
HR	Ayikho	amabhithi Ngaphansi kuka 100 ngomzuzu	amabhithi Bangaphezu kuka-100 ngomzuzu
ibala lesikhumba	cyanosis	isikhumba Pink, nemilenze bluish	pink
Isimo imisipha ithoni	Ayikho	Nemilenze kukhona kancane bent, ithoni ababuthaka	ukunyakaza Active, ithoni omuhle
I yokusabela kuya izici ukucasuka	Ayikho	wavuma uzwakalise	waveza kahle

Kuhlola isimo kuze 3 amaphuzu kubonisa ukuthuthukiswa asphyxia ezinzima, kusukela 4 kuya 6 - asphyxia kobukhulu ngokulinganisela. Yokusiza umuntu ukuba aphefumule ka asphyxia osanda kuzalwa kwenzeka ngokushesha ngemva kokuba nokuhlola isimo yayo jikelele.

Kulandzelana kwalokucuketfwe lokuhleliwe ekuhloleni isimo

1. Ingane ibekwa ngaphansi umthombo ukushisa, isikhumba sakhe omisiwe inabukeni efudumele. Kusukela ngalo ingaphakathi acinene nomlomo is ukusivumela okuqukethwe. Labetibambile ukushukuma ethintekayo.
2. Uhlaziya ukuphefumula. Endabeni isigqi evamile futhi khona ngezwi elikhulu, wabe esinyathelweni esilandelayo. Lapho spasmodic ukuphefumula ukupholisa mechanical yomoya-mpilo engasetshenziswa imizuzu 15-20.
3. Ukulinganiswa ukushaya kwenhliziyo. Uma ukushaya kwenhliziyo ngenhla amabhithi 100 ngomzuzu, ukuthuthela esigabeni esilandelayo ukuhlolwa. Endabeni ka kwenhliziyo ngezansi amabhithi 100 eyenziwa womoya-mpilo. Khona-ke ukuhlola imphumelelo yekungenelela.
   • Pulse ngezansi 60 - engaqondile inhliziyo massage + womoya-mpilo.
   • Pulse kusuka 60 kuya ku-100 - mpilo.
   • Pulse ngenhla 100 - i-mpilo uma ukuphefumula okungajwayelekile.
   • Ngemva kwemizuzwana engu-30, ukwehluleka esifubeni compressions umoya, ukwelashwa kufanele kwenziwe.
4. Hlola umbala kwesikhumba. umbala Pink kusho isimo evamile ingane. Uma cyanosis noma akrozianoz kuye kudingeke ukuba banikeze umoya-mpilo bese bagcine isimo somntwana.

Kanjani ukufeza yokusiza umuntu ukuba aphefumule?

Kuyadingeka wageza futhi ziphathwe isandla isinqandakuvunda, gqoka amagilavu oyinyumba. Ukuzalwa kwengane iqinile, emva izinyathelo ezidingekayo - bodokotela. Newborn ibekwe ngaphansi umthombo ukushisa, inabukeni ezomile, ezifudumele zihambisana.

Ukubuyisela umgudu, kungenziwa kwehlisa ikhanda ekupheleni wafaka umntwana ohlangothini lwesobunxele. Lokhu kuzomisa inqubo nenshisekelo futhi kuzosusa okuqukethwe umlomo nekhala. aspirated okuqukethwe ngokucophelela, ngaphandle asebenzise esinamandla isingeniso aspirator.

Uma lezi zinyathelo musa asize, yokusiza umuntu ukuba aphefumule olusanda kuzalwa baqhubeka tracheal suctioning usebenzisa laryngoscope. Ngemva ukubonakala umoya, kodwa ukungabi khona nesigqi somqondo, ingane is adluliselwe ku-mpilo.

Labagula usana ithatha emva yokusiza umuntu ukuba aphefumule lokuqala olunye usizo kanye nokugcinwa imisebenzi ebalulekile.

ukupholisa

Neonatal yokusiza umuntu ukuba aphefumule izinyathelo zibandakanya kokuqhuba ukupholisa. Izimpawu I-ukupholisa eliyifa:

• ukungabi khona ukuphefumula noma ukubukeka zokuphefumula ukunyakaza convulsive;
• ishayela kuyizikhathi esingaphansi 100 ngomzuzu, kungakhathaliseki isimo ukuphefumula;
• cyanosis eziphikelelayo ngesikhathi operation evamile amasistimu zokuphefumula futhi senhliziyo.

Lokhu iqoqo imisebenzi wenziwa usebenzisa buso noma esikhwameni. ikhanda Newborn kancane emuva aliphonse emuva isifonyo sisetshenziswa. Wakhe ubambe isithupha sakho ne forefinger. Enye kuholela emhlathini wengane.

The Mask kufanele kube esilevwini, imphumulo kanye umlomo. Engingakusho nje pholisa emaphashini nge imvamisa izikhathi 30 kuya 50 iminithi elingu-1. Ukupholisa ngokusebenzisa isikhwama kungabangela emoyeni ngokufaka ingaphakathi esiswini. Kusuka lapho ungayisusa usebenzisa tube esiswini.

Ukuze ukusebenza kokusebenza, kubalulekile ukuba banake ukuvelela esifubeni kanye ushintsho kwenhliziyo. Ingane baqhubeka observation kuze ephelele yokutakula izinga emishinini yokuphefumula nokushaya kwenhliziyo.

Kungani futhi kanjani intubate?

yokusiza umuntu ukuba aphefumule ezisanda kubelethwa sihlanganisa intubation we kuqhoqhoqho, endabeni ukwehluleka of ukupholisa mechanical iminithi elingu-1. I choice esifanele intubation tube - esinye sezenzakalo ezivelele. Wenziwe kuye isisindo sengane kanye nobudala sokukhulelwa.

Intubation is bawenza kulezi zimo ezilandelayo:

• isidingo ukususa meconium aspirated kusukela kuqhoqhoqho;
• kokuqhuba ukupholisa okuqhubekayo;
• lula yokusingatha yokusiza umuntu ukuba aphefumule;
• epinephrine;
• ngaphambi kwesikhathi kakhulu.

Ngezinye laryngoscopy zihlanganisa ukukhanyisa amukele esandleni sobunxele. Isandla sokunene, ubambe ikhanda usana sika. Ikhaba ufakwa umlomo futhi ayebambelele ulimi isizinda. Ukuphakamisa ikhaba maqondana isibambo laryngoscope, yokusiza umuntu ukuba aphefumule ubona glottis. tube Endotracheal yethulwa ngakwesokudla ku ngalo ingaphakathi ngomlomo futhi yenziwa ngokusebenzisa iphimbo ngesikhathi kuvulwa. Lokhu kwenzeka ku-ugqozi. I tube laphenya kwaze kwaba iphuzu okuhleliwe.

Laryngoscope isuswe ke - umqhubi. Ngokunemba kokuhlola ethula tube ukugxisha isikhwama ukuphefumula. Air ingena amaphaphu kubangela uhambo kwesifuba. Okulandelayo, xhuma ohlelweni umoya-mpilo umncane.

Chest compressions

Yokusiza umuntu ukuba aphefumule ngayo lapho usana egumbini ukulethwa yakhiwa kokwenza esifubeni compressions, ubambe zazo kuboniswa ngesilinganiso inhliziyo esingaphansi 80 amabhithi ngeminithi.

Kunezindlela ezimbili esifubeni compressions. Ukusebenzisa lokuqala, ingcindezi phezu kwesifuba kusetshenziswa inkomba futhi umunwe phakathi ngesandla esisodwa. Kwesinye samuntu, massage Kwenziwa kokubili izithupha kanye nezinye iminwe zinengxenye imihlane ukwesekwa. Resuscitator neonatolog-kokuqhuba ngokucindezela phakathi phakathi nawesithathu engezansi breastbone, thorax proginalas 1.5 cm imivimbo imvamisa -. 90 imiz.

Nakanjani kudingeka ulandele ukuze umoya bese ucindezela phezu kwesifuba akuyona kwenziwe kanyekanye. Ngo ikhefu phakathi pressings, awukwazi ukuthatha izandla zakho off ebusweni sternum. Ukuchofoza isikhwama ukwenza njalo emva compressions ezintathu. Ukuze njalo ngemizuzwana 2 kudingeke baqhube 1 no-3 ngokucindezela ukupholisa.

Izenzo lapho meconium ukungcoliswa kwamanzi

Izici zifaka ezisanda kubelethwa yokusiza umuntu ukuba aphefumule aid for staining we amniotic meconium uketshezi kanye nokuhlola Apgar isikolo wengane engaphansi kuka 6 amaphuzu.

1. Ngesikhathi sokubeletha emva ukubukeka lwekhanda emgudwini wokuzala ngokushesha aspirating okuqukethwe ekhaleni nomlomo.
2. Emva kokuzalwa kwengane yakho futhi indawo umthombo ukushisa, ngaphambi umoya wokuqala, kuyinto efiselekayo lokufeza intubation tube ngobukhulu usayizi kungenzeka kukhishwe okuqukethwe kuqhoqhoqho kanye bronchi.
3. Uma ungeke ukwazi ukususa okuqukethwe, futhi kukhona i-admixture we meconium, kubalulekile ukuba reintubirovat ewusana olusanda kuzalwa enye kwihendisethi.
4. Ukupholisa is kushintshwe kuphela emva konke okuqukethwe sisusiwe.

imithi

yokusiza umuntu ukuba aphefumule Wezingane ezisanda kubelethwa kusekelwe hhayi kuphela ekufezeni ibhukwana noma kokungenela hardware, kodwa futhi ku ukusetshenziswa kwezidakamizwa. Endabeni ukupholisa mechanical nasesifubeni compressions, lapho imisebenzi akuzona eliphumelelayo ngemizuzwana engaphezu kwengu-30, zisebenzisa izidakamizwa.

yokusiza umuntu ukuba aphefumule ezisanda kubelethwa kuhilela ukusetshenziswa adrenalin, kusho sokubuyisela umthamo wegazi, i-sodium hydrogencarbonate, naloxone, Dopamine.

Adrenaline is eyayifakwa tube endotracheal kuqhoqhoqho, noma bolus emthanjeni. I lokuhlushwa izidakamizwa - 1:10 000 izidakamizwa esetshenziswa ukwandisa ngamandla inhliziyo futhi ukunciphisa kwenhliziyo ukushesha. Ngemva kokuphathwa intratracheal baqhubeka ukupholisa mechanical, ukuze izidakamizwa kungenziwa basakaza ngokulinganayo. Uma kudingeka, i-ejenti iqondiswa kamuva imizuzu 5.

Ukubalwa umthamo kuye isisindo sengane:

• 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.

Lapho ukopha noma isidingo ukugcwalisa ivolumu afundwa igazi albumin isetshenziswa, bokuphila isixazululo sodium chloride noma solution, Ringer sika. Izidakamizwa iphathwa ku vein ye enkabeni intambo jet (10 ml ngayinye esisindo 1 kg) kancane imizuzu engaphezu 10. Isingeniso vospolniteley BCC kungenyusa umfutho wegazi, ukunciphisa lactic, futhi kujwayeleke izinga ishayela ukuthuthukisa izicubu umzimba.

yokusiza umuntu ukuba aphefumule ezisanda kubelethwa, kulandele wamaphaphu ukupholisa ngempumelelo, kudinga ukwethulwa sodium hydrogen carbonate ku vein enkabeni ukunciphisa izimpawu lactic. Umuthi akufanele isetshenziswe njengoba nje ingane engakaze isungulwe wamaphaphu komoya ohlanzekile okwanele.

Dopamine isetshenziswa ukwandisa Inkomba zenhliziyo filtration glomerular. Umuthi kwandisa izitsha sodium kwezinso futhi kwandisa imvume ngokusebenzisa ukwelashwa ukumnika. Ngemithambo yegazi microfluidic ngaphansi ukuqapha okuqhubekayo wegazi nokushaya kwenhliziyo.

Naloxone ngemithambo yegazi injected ngesilinganiso 0.1 ml ngayinye esisindo 1 kg. Kusho, 'eyasetshenziswa endabeni lapho umbala kwesikhumba uhlanganise ijwayelekile, kodwa kukhona izimpawu zokucindezeleka zokuphefumula. Naloxone ayikwazi iqondiswa owayesanda kuzalwa ngesikhathi unina isebenzisa izidakamizwa kwezidakamizwa noma ukwelashwa ubhekene usebenzisa analgesics kwezidakamizwa.

Lapho ukumisa yokusiza umuntu ukuba aphefumule?

IVL uyaqhubeka nje ingane ingavumi sithathe 6 amaphoyinti Apgar. Lokhu kokuhlaziywa Kwenziwa njalo ngemva kwemizuzu engu-5 no-ihlala kuze kube isigamu sehora. Uma emva kwalesi sikhathi usana Lunezikhombo ezingaphansi kwezingu-6, wabe sidluliselwe ICU esibhedlela lapho ukuqhuba yokusiza umuntu ukuba aphefumule okwengeziwe, ukwelashwa olunzulu kwezinsana.

Uma ukusebenza kwe yokusiza umuntu ukuba aphefumule engekho ngokuphelele futhi kukhona asystole futhi cyanosis, umcimbi uyaqhubeka kuze kube amaminithi angu-20. Uma ubona ngisho izimpawu kancane ngempumelelo, ubude kwandisa sonke isikhathi, kuze izinyathelo akhayo.

Neonatal labagula olunzulu

Ngemva kokubuyiselwa ngempumelelo amaphaphu inhliziyo ngayo lapho usana udluliselwa labagula iyunithi. Kukhona odokotela umsebenzi uvimbela yezinkinga kungenzeka.

Ewusana olusanda kuzalwa ngemva yokusiza umuntu ukuba aphefumule abadinga nokuvinjelwa okuvela ukuvuvukala kobuchopho noma ezinye CNS neziyaluyalu, nomsebenzi wokuvuselela umhlaba ngemva kwe-izinso umsebenzi excretory yomzimba, ukuzinza kwegazi.

Ingane ingase ibonakale iziyaluyalu umzimba ngendlela lactic, lactic acidosis, okuyinto kubangelwa iziyaluyalu we microcirculation neuropathy. On the ingxenye yobuchopho kungadala sokuwa ukopha, infarction palsy, edema, ukuthuthukiswa ikhoma. Ungase wamukele ukungasebenzi we ventricles kwenhliziyo, ukwehluleka oyingozi so-renal, atony esinyeni, esingamahlalakhona adrenal kanye nezinye izitho endocrine.

Kuye isimo ingane ibekwe endaweni incubator noma umoya-mpilo etendeni. Ochwepheshe engamele umsebenzi wazo zonke izinhlaka futhi izinhlelo. Okuphakelayo avumele ingane kuphela ngemuva kwamahora angu-12, ezimweni eziningi - ngokusebenzisa ngamapayipi nasogastric.

Amaphutha esikuvimbela kungavunyelwe

It is nhlobo ukuze bafeze imisebenzi ezingenziwanga efakazelwe ephephile:

• uthele amanzi umntwana;
• cindezela esifubeni;
• ushaya ezinqeni;
• ngqo ebusweni umoya-mpilo Jets kanye nokunye okufana nalokho.

isixazululo albumin akumele zisetshenziswe ukwandisa bcc kokuqala, ngoba kwandisa ingozi ebulalayo umphumela ezisanda kubelethwa.

Yokusiza umuntu ukuba aphefumule akusho ukuthi ingane oyoba kwezinso noma izinkinga. Abazali abaningi balindele ukubonakaliswa sokugembula emva eyayisanda kuzalwa egunjini labagula kakhulu. Izibuyekezo lezi zimo ibonisa ukuthi izingane esikhathini esizayo ube ukuthuthukiswa efanayo ontanga yabo.