Keiki Resuscitation: nāʻikepili, ano, kahua o ka hoʻonaʻauao, lāʻau

Wahi a ka 'ikepili helu, o kela mea keia umi keiki i ola mālama i loko o ka haawi lumi, a me ka 1% o nā mea a pau i hānau i loko o pono o ka piha huahelu o ka CPR. Ka nui kiʻekiʻe o ke aʻo o ka 'inikua nā limahana e hoomahuahua i ka manawa o ke ola, a emi hiki complications. Kūpono a me ka 'eleu resuscitation o ke keiki - ka mua ka anu u, e emi i ka helu o ka make a me ka maʻi? Acaeoey.

walaʻauʻana manaÿo

He aha ka neonatal resuscitation? Kēia moʻo o ana nona ma revitalizing i ke kino o ke keiki, a me ka hoihoi hou ia ana o ka nalowale hana. It nā:

• cardiopulmonary resuscitation;
• ki ina hana like o ka mālama nui malama;
• hana o mechanical e hoʻokomo ea;
• pacemaker a me nā mea hoʻonoho.

Full-manawa kamalii uuku mai, mai koi resuscitation ana. Ua hanauʻeleu, hooho nui, ka lāʻau ikiʻai a me ka naau i kela mea maʻamau, kaʻili i ke kala a pau a pink, ke pane pono i ke keiki i ka mawaho stimuli. Mau keiki i koke kau ma luna o ka makuwahine o ka abdomen a me ka malumalu mahana, maloo diaper. Naehana mucous aspirated Contents, e hoihoi mai i ko lakou patency.

Lawe ana mai cardiopulmonary resuscitation ka mea, ua manaoia pilikia kōkua. Ua ua paʻa i loko o ka hihia o ka cessation o ka hanu a me ka papa naʻau. Ma hope o ia ka piʻiʻana i loko o ka hanana o ka maikaʻi hopena, pili i ka hoʻokumu paʻaʻana o ka mālama nui malama. Oia lapaʻau ua pahuna ma ke kāpaeʻana hiki complications noho i ka nui nā loko.

Inā ka hoʻomanawanui hiki ole kū kaʻawale malama i homeostasis, ka resuscitation o ke keiki nā mechanical e hoʻokomo ea (ALV) a hoonoho iho la i ka pacemaker.

He aha ka mea i pono ai no ka resuscitation i loko o ka haawi lumi?

Inā i ka pono no ka hoʻolako 'ana o ia mau hanana mea haʻahaʻa, e pono e lawe ia mai e kekahi kanaka. Ma ka hihia o ka loa hāpai keiki, a 'upu' ana o ka piha huahelu o CPR i loko o ka haawi i mau hoʻomalu.

Resuscitation o ke keiki i loko o ka haawi lumi koi akahele hoʻomākaukau. Ma mua o ke kaʻina hana o ka nahunahu hanau, kaha ka loaʻa nui o nā mea a pau e pono ai, a e hōʻoia i ka ipu i loko o ka hana ke ano.

1. Oe Pono e hoʻohui i lalana ana ia ia i ka wela kahi i ka resuscitation papa a me diapers, he diaper owili i loko o ka palapala o ka lole wili.
2. Hōʻoia inā i ka'ōnaehana ua pono hoʻouka kekahi ka oxygen lako. Pono ia i ka lawa o ka nui o oxygen e pono hoʻomaʻa i ka manaʻo koikoi, a kahe kōmi.
3. He pono, e kaha i ka mākaukau o ka ipu i ua koi 'ia no ka pōʻalo o ka naehana'āpana Contents.
4. E hoomakaukau hana no ka hoopau ana o gastric Contents i loko o ka hanana o ka wehena (ʻimi, 'ohe,'ūpā, hoʻopunipuniʻia), meconium aspirator.
5. E hoʻomākaukau a e kaha i ka pono o ke eke, a ea paha resuscitation a me ka intubation kini puʻe wale.

E kau no ka intubation ninoieo o endotracheal paipu a me na conductors, a me kekahi laryngoscope kōmi 'ana a me ka hoʻokuʻu iuo aaoa?,'ūpā a me Loan.

He aha ka i ka pomaikai o na ana?

neonatal resuscitation i loko o ka haawi lumi ua muli ma luna o ka loina kēia no ka pomaikai:

• loaʻa nui o ka mālama nui malama mau kime maika - ma luna o nā mea a pau la, kela waina resuscitation e e ike;
• wahi hana - hui e hana harmoniously complementing kekahi i kekahi, e like me hoʻokahi nuiʻano papa hana;
• palapala hōʻoia no nā limahana - kēlā resuscitation E i ke kiʻekiʻe kiʻekiʻe o ka ike, a me ka mea hiki ke kūlana mākaukau maoli;
• hana, e lawe i ka mooolelo o ka hoʻomanawanui ka naoh - CPR e hoʻomaka koke i ka helehelena o ko lākou nele, ua haliia mai la mawaho hou ana, ke kaumaha ma muli o ka pane ana o ka hoomanawanui ka kino;
• serviceability o? ieaoa - lako a pan no ka resuscitation e e ka pomaikai a me ka ole i kekahi manawa.

Ke kumu no ka hemahema no ka hana

Ma etiological aʻe o ka hoʻoluhi hewa o ka naau, maʻiʻaʻai a me nā pōʻino nā loko o ke keiki nā i ka hooulu ana o ka asphyxia, hānau nā palapū, ulu o congenital abnormalities, infectious ka molekumu o toxemia a me nā hihia o ike etiology.

Children ka neonatal resuscitation, a me ka nele no ka mea, hiki ke wānana a hiki i ka wā o ka hanau keiki ana. Ma ia mau hihia, pono e ka resuscitation hui makaukau, e loaa ia kōkua i kāu keiki.

Ke kupono o ia mau hanana ke'ākoʻakoʻa ma lalo o ke ana ma lalo nei:

• multi- ole oligohydramnios;
• perenashivanie;
• mimikō makuwahine;
• hypertension;
• infectious maʻi;
• Fetal malnutrition.

No hoi, eia kekahi mau aʻe i i ala mai kāinoa mua i hānau. Ma ka hihia o kā lākou hanana hiki ke manao ia e pono ai resuscitation. Oia aʻe nā bradycardia i loko o ke keiki, he caesarean pauku, premature hanau a me ka kokololio, previa a placental abruption, uterine hypertonus.

asphyxia

Ka hooulu ana o naehana kāna hana me ka hypoxia keʻano o ka hanaʻana kumu i ke ano o ke kino ma kāna hana o ka circulatory'ōnaehana, metabolic a me ka microcirculation. Next ka mea, he kāna hana no nā puʻupaʻa, naau, adrenal glands, lolo.

Asphyxia pono koke 'uao i ka mea e emi i ka manawa kūpono o complications. Kumu o naehana kāna hana:

• hypoxia;
• 'aʻe' airway (wehena o ke koko, mucus, meconium);
• ke aloha lolo ino a me CNS hana;
• malformations;
• lawa surfactant.

Lapaʻau 'Pono resuscitation uao ai' lawe mai ma hope o ka auhau o ke keiki Apgar.

oaeuiinoe ia	0 puan	1 wahi	2 points
naehana ano	No	Pathological, spasmodic	Leo kahea ana, rhythmic
HR	No	Emi iho malalo o 100 kui iho oe a no minuke	More ma mua o 100 kui iho oe a no minuke
ili ka waihoʻoluʻu	cyanosis	Pink ili, mau lala bluish	a pink
Kūlana o ka Muscle leo	No	Lala i kānaka manao, i ka leo o ka poe ikaika ole	ʻeleu neʻeʻana, maikaʻi leo
Ke naoh i ka ae hookaawale kumumea	No	weakly hoikeia	pono hoikeia

Ka auhau o ka moku'āina i ka 3 puan Hōʻike i ka hooulu ana o ka loa asphyxia, mai ka 4 a hiki i 6 - asphyxia lōpū oolea. Resuscitation o keiki asphyxia ia lŘlŘ koke ma hope o ka loiloi 'ia' ana o kona nohona ma ke ano.

Ke kaʻina o ke kālailaiʻana i ke kūlana o

1. Ua kauʻia ke keiki ma lalo o ka wela kumu, o kona ili maloo pumehana diaper. Mai ka nasal lua, a me ka waha ua omo ai Contents. Paa tactile stimulation.
2. Assesses ha. Ma ka hihia o ka maʻamau pāpana a me ke alo o ka leo uwe, puka mai a hiki i ka mea e hiki mai ana ka anu u. I ka spasmodic ha me mechanical hoʻokomo ea me ka o oxygen no 15-20 minuke.
3. Ka loiloi 'ana o ka naau kōmi. Inā ka naau kōmi ma luna 100 kui iho oe a no minuke, neʻe maila i ka aʻe pae o ka nana. Ma ka hihia o ka naau kōmi ma lalo 100 kui iho oe a lawe ventilator. A laila, Loiloi i ka laulā o ka uao ai '.
   • Lāʻau ikiʻai wale ma lalo 60 -ʻauhau'ēʻaʻe naau lomilomi + ventilator.
   • Lāʻau ikiʻai wale mai ka 60 a hiki i 100 - ventilator.
   • Ka lāʻau ikiʻai ma luna 100 - ka ventilator ma ka hihia o ka ole hanu.
   • Ma hope o 30 kekona, ka ineffectiveness o ka pahu compressions me ka hoʻokomo ea, e halihaliia oia iwaho lāʻau Inc.
4. Nānā i ka ili waihoʻoluʻu. Pink kala like 'ole' o ia hoʻi ka maʻamau ana o ke keiki. Inā cyanosis a akrozianoz Pono, e haawi aku i oxygen, a malama i ke ano o ke keiki.

Pehea e lawe mai resuscitation?

Koi holoi, a kamaʻilio me antiseptic lima, kapa sterile Loan. I ka hanau ana o ke keiki ua paa, ma hope o ka mea ana - hoʻopaʻa pepa paʻi kiʻi. Keiki hoonoho iho ma lalo o ka wela kumu, he mehana maloo ua wahiia diaper.

ka airway e hoihoi, hiki ke kuu iho la ke poo o hopena, a kau aku i ke keiki ma kaʻaoʻao hema. Kēia, e pau ana i ke kaʻina hana o ka wehena, a, e wehe i kahi o ka waha a me ka ihu. Pono aspirated Contents, me ka io i ka walaau ole hoike aspirator.

Inā mau ana mai i ke kōkua, keiki resuscitation ua hoomau ma ka tracheal suctioning ka hoʻohana 'ana i ka laryngoscope. Ma hope iho o ka helehelena o ka hanu, akā, i ka wa e kaawale aku o kona pāpana, ua hoololiia ke keiki a hiki i ka ventilator.

Mālama nui malama pa alima keiki kamaiki i ma hope o ka loiloi mua resuscitation no hou kōkua a me ka mālama 'ana i ka nui i hana'.

hoʻokomo ea

Neonatal Resuscitation mau kapuwaʻi ma ka lolouila e mālama nei i hoʻokomo ea. Nāʻikepili no ka hoʻokomo ea ana:

• wa e kaawale aku o ka hanu a me naehana helehelena o convulsive neʻe;
• lāʻau ikiʻai wale ka emi o 100 mau manawa o ka minuke, nānā 'ole o ka moku'āina o ka hanu;
• paakiki cyanosis ma maʻamau ana o ka ÷ naehana hanu a me ka mea'ōnaehana mānowai koko nenoai.

Kēia 'ia paha o nā hana ua lawe mai ka hoʻohana' ana i ka ea paha a eke. Keiki poo iki hoʻi a me Ka Wailele O hoʻi i ka maka ea paha ua noi ia. Kona hoopaa i kou manamana nui a me ka forefinger. Ka 'ē hiki aku ai i ke keiki i ka iwi.

Ke ea paha e ia ma luna o ka chin, ihu a me ka waha. Nui ia e ventilate na maʻiʻaʻai me ke alapine (frequency) o 30 a hiki i 50 manawa no 1 minuke. Hoʻokomo ea ma kaʻeke hiki i ka lewa komo i ka gastric lua. Mai laila aku oe mai ke wehe ia ka hoʻohana 'ana i ka'ōpū Tube.

E kanaka hoʻoponopono i ka laulā o ka manaʻo, ka mea, he pono nō ia e lohe i ke ala hou ana o ka pahu, a me ka loli ma ka naau kōmi. Ke keiki hoʻomau kilo a piha ke ola ana o ka hanu a me ka naau kōmi.

No ke aha la, a pehea e intubate?

Neonatal resuscitation pū mai nā 'intubation o ka trachea, ma ka hihia o ka ole o ka me mechanical hoʻokomo ea no 1 minuke. I ka akau, i waeʻia no ka intubation şarkı - kekahi o na o ka Naauao. Ua ua i ke kaumaha ma muli ke kaupaonaʻana i ke keiki a me ka ka gestational makahiki.

Intubation ua i mālama 'ia i loko o ka kēia hihia.

• ka pono e wehe aspirated meconium mai ka trachea;
• alakaʻi ana hoʻokomo ea;
• e pono ai e lawelawe ana resuscitation;
• epinephrine;
• loa premature.

At laryngoscopy nā kau iho, a lawe i loko o ka lima hema. Lima'ākau, hoopaa ke poo o ke keiki ka. Ke kōmi 'Ua hookomoia i loko o ka waha a me ka paa ana i ka waihona ipu'ōlelo. Hookiekie ana i ka maka i ke kumu o ka laryngoscope, resuscitation ike i ka glottis. Endotracheal Tube ua hoʻolauna ma kaʻaoʻao'ākau ma ka moʻolelo o ka lua, a ua laweia aku la oia ma na kaula vocal i ka manawa o ka puka. Ua lŘlŘ ma ka hoʻoulu. Ke Tube Ua malamaia oia, a me ka haʻalele 'wahi.

Laryngoscope weheʻia, a laila, - ke alakaʻi mele. Pono o kéu i hoʻolaunaʻia ma Tube compressing i ka hanu eke. Air komo ka ia maʻiʻaʻai a me ke kumu no ka hele ana o ka pahu. Next, hoʻohui i ka i oxygen lako nenoaiu.

umauma compressions

Resuscitation o ke keiki i loko o ka haawi lumi maupaʻa hana umauma compressions, paa ana i ua hōʻike ma ka naau i kela emi o 80 kui iho oe a no minuke.

Aia he mau aoao o ka umauma compressions. E ho ohana i ka mua, puʻe ma luna o ka pahu hoʻokō ka hoʻohana 'ana i ka' inideka, a waenakonu manamana o kekahi lima. Ma kekahiʻano, ka lomilomi ua lawe mai nā manamana nui a me nā manamana lima i komo i loko o ke kākoʻo kua. Resuscitator neonatolog-alakaʻi ua e ma waena o ka waena a me ka haahaa hapakolu o ka breastbone, thorax proginalas i 1.5 knm hahau ana alapine (frequency) -. 90 min.

Pono Pono e hahai i ka mea e hanu a me ka ua e ma luna o ka pahu ua i lawe mai ka poʻe. Ma ka ihola ma waena o koikoi ala iā, e hiki ole lawe i kou mau lima mai ka ili o ka sternum. Ke kaomi 'ana i ke eke kala hana ma hope o kēlā ekolu compressions. No ka mea, 2 kekona mea pono e paa 1 a me 3 ua e hoʻokomo ea.

Hana ka wā meconium mea hoʻohaumia o ka wai

Hiʻona nā neonatal resuscitation kōkua no ka i hookohu aku i o ka amniotic loli meconium a me ka loiloi 'ana o ke keiki ka Apgar heluʻai o ka emi o 6 wahi.

1. Ma ka nahunahu hanau ma hope o ke ano o ke poo o ka hanau Canal koke aspirating kahi o ka ihu a me ka waha.
2. i ka hanau ana o ke keiki, a me ka lumi no ke kumu o ka wela ma hope, ma mua o ka hanu mua, ka mea mea kupono e lawe mai intubation şarkı nui hiki nui e extract kahi o ka trachea a me ka bronchi.
3. Inā 'oe hiki ole wehe i ka maʻiʻo, a me ka mea, mai ka admixture o meconium, ia mea pono e reintubirovat keiki kekahi kelepona paʻa lima.
4. Hoʻokomo ea ua like wale nō ma hope o nā mea a pau maʻiʻo i ua wehe.

ka lapaʻauʻia

Children ka neonatal resuscitation ua me ka nānā 'ole wale ma luna o ka hooko ana mai e manual a lako e' uao, akā, no hoi ma o ka hoʻohana o ka ai '. Ma ka hihia o mechanical e hoʻokomo ea a me ka umauma compressions, i ka wa a ka hana e mana no ka oi mamua o 30 kekona ole, e hoʻohana ai '.

neonatal resuscitation komo ai i ka hoʻohana 'ana o ka adrenaline,' o ia hoʻi no ka hoihoi hou ana i ke koko buke, paʻakai hydrogencarbonate, naloxone, dopamine.

Adrenaline ua hookomoia ma ka endotracheal şarkı i loko o ka trachea, a bolus aa koko. I ka lehulehu o ka lāʻau - 1:10 000 lāʻau hoʻohana e hoʻonui i ka ikaika o ka naau a me ka ho'ēmi i ka naau kōmi hoʻonui. Ma hope o intratracheal aaieieno? Hoomauia ma paʻi hoʻokomo ea, no laila, i ka lāʻau hiki ke haawi kōā kaulike. Inā pono, o ka hope ua lawelawe iho la no 5 minuke ma hope.

I ka ho omaulia ana o ka mahele lāʻau ke kaumaha ma muli o ka keiki ka kaumaha:

• 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.

I ka koko poho ole ka, e hoʻopiha i ka buke o ke hoʻolahaʻia ke koko albumin pono ua hoʻohana ', physiological paʻakai koloriside pāʻoihana a me Ringer ka pāʻoihana. Ai 'ka lawelaweia ana i loko o ke aa koko o ka piko mokulele hēkī (10 ml no 1 kg kino paona) lohi no 10 minuke. Introduction vospolniteley BCC ke hoonui ke koko, ho'ēmi i acidosis, a me normalize i ka lāʻau ikiʻai wale ana, no ka hoʻoikaika 'ana i'aʻaʻa pūnao.

neonatal resuscitation, i ukali ia e akemāmā hoʻokomo ea mana, pono ka hoike o ka paʻakai hydrogen kalepona i loko o ka umbilical aa koko e ho'ēmi i na hoailona o ka acidosis. Ka lāʻau 'E ole e hoʻohana like loa me ke keiki i ole, ua hookupaaia akemāmā kūpono hoʻokomo ea.

Dopamine ua hoʻohana 'ia e hoʻomāhuahua cardiac' inideka, a glomerular kānana. Ka lāʻau 'maoli heʻaʻa puʻuwai paʻakai na moku, a maoli heʻae ma ka hoʻohana' ana i infusion Inc. Intravenously microfluidic ma lalo o ke ana ka mālamaʻana o ke koko, a me ka naau kōmi.

Naloxone intravenously injected i ka uku o 0,1 ml no 1 kg kino ke kaumaha. Mea, hoʻohana 'ia i loko o ka hihia ma ka ili waihoʻoluʻu a me ka lāʻau ikiʻai wale nō maʻamau, akā, he mau hoailona o naehana hanu kaumaha. Naloxone hiki ole ke lawelawe i ka keiki, i ka wa o ka makuahine hoʻohana narcotic ai 'ole undergoing lapaʻau ka hoʻohana' ana narcotic analgesics.

I ka wa e oki resuscitation?

IVL mau like loa me ke keiki, aole ia i lawe ia i 6 helu ma ka Apgar. Kēia loiloi Ua lawe mai kēlā kanaka kēia 5 minuke, a mau no i ka hapalua o ka hora. Inā ma hope o keia manawa i ke keiki i ka 'inideka o ka emi o 6, lailaʻo ia i laila' o ia i ka ICU o ka haukapila ma ka a, e hoʻomaka hou resuscitation, mālama nui Inc o nā pēpē.

Inā ka laulā o ka resuscitation ka loa ma kahi'ē, a he mea asystole a me cyanosis, ka hanana mau a 20 minuke. A hiki i ka iki na hoailona o ka hopenaʻoi loa oe i ike, lōʻihi like 'ole maoli a pau i ka manawa, a me nā ana i maikaʻi.

Neonatal mālama nui mālama pa alima

Ma hope o ka holomua hoihoi hou ia ana o na ia maʻiʻaʻai a me ka naau o ke keiki ua hoolilo i ka mālama nui malama pa alima. Ka I lapaau hana AIM e ole hiki complications.

Keiki ma hope o resuscitation ma ka pono o ka Kāohiʻana o ka hanana o ka nani o ka lolo a me 'ē aʻe CNS kāna hana, hoihoi hou hana o nā puʻupaʻa, a excretory hana o ke kino, normalization o ke koko holo.

Ke keiki ke ikea metabolic kāna hana i loko o ka palapala o ka acidosis, lactic acidosis, a ua kena ae la ma kāna hana o kaʻike ākea microcirculation. Ma ka hapa o ka lolo i i ke kāʻili 'ana, hemorrhage, cerebral infarction, edema, ulu o coma. E hiki no hoi loaa dysfunction o na ventricles o ka naau, huʻiʻaʻa puʻuwai e hemahema, atony bladder, adrenal insufficiency a me nā endocrine nā loko.

Ke kaumaha ma muli o ka ano o ke keiki ua waiho ia ma ka incubator a me ka oxygen halelewa. Hoʻomalu kiaʻi i ka hana o nā mea a pau nā loko, a nenoai. E hanai ae i ke keiki wale nō ma hope o 12 hora, ma ka hapanui o na hihia - ma ka nasogastric Tube.

Hewa e pale aku pāpā

Ua Ua pololei papaia e lawe mai hana i mea ole ai e ola:

• ninini i ka wai bebe;
• oOeEIAOO i kona umauma;
• pepehi i na lākou kīkala;
• kauoha helehelena o oxygen jets a me ka mea e like.

albumin pāʻoihana pono ole e hoʻohana 'e hoʻonui i ka loiloi mua bcc, no ka mea, ka mea maoli i ka pilikia o ka ona neonatal hoʻokūkū.

Resuscitation 'aʻole i manaʻo i ke kamaiki, e i kekahi abnormalities a complications. Ua nui na makua nui pathological hoike ana ma hope o ka keiki ua ma ka mālama nui mālama. Reviews o kēia mau hihia ka hōʻike i nā keiki i loko o ka wā e hiki mai i ka like 'ana me kā lākou mau na¯.