Nyob rau hauv phau ntawv nto moo los ntawm Jerome K. Jerome "Peb nyob hauv ib lub nkoj, tsis suav tus dev" tus phab ej pom txhua yam tshwj tsis yog menyuam yaus ua npaws. Nws yog dab tsi? Cia peb xav txog hauv kab lus no.
Ib pawg kab mob tshwm sim los ntawm kev kis tus kab mob ntawm cov poj niam thaum cev xeeb tub yog hu ua postpartum sepsis, lossis, raws li lawv tau hais, puerperal fever (fever).
cov ntaub ntawv dav dav
Tus poj niam ua npaws tau tshwm sim hauv Nrab Hnub nyoog. Hippocrates yog ib qho ntawm thawj zaug piav qhia txog tus kab mob no. Txog thaum qhib lub tsev kho mob thawj tus me nyuam hauv xyoo pua 17th, cov neeg mob uas muaj tus kab mob npaws puerperal tau kis tus kab mob.
Nyob rau hauv nruab nrab ntawm lub xyoo pua 19th, Hungarian obstetrician Ignaz Semmelweis tau ua ib tug xov tooj ntawm kev xav txog cov ua rau puerperal kub taub hau. Nws yog thawj tus taw qhia qhov yuav tsum tau siv cov tshuaj tua kab mob thaum yug menyuam. Txawm li cas los xij, lawv cov kev siv dav dav hauv kev kho menyuam yaus pib siv tsuas yog thaum kawg ntawm lub xyoo pua 19th.
Raws li kev txheeb cais, niaj hnub no tsuas yog 0.2-0.3% ntawm cov neeg mob ntawm tag nrho cov teeb meem obstetric yog sepsis, uas tshwm sim tawm tsam keeb kwm ntawm endometritis hauv 90% ntawm cov poj niam hauv kev ua haujlwm.
Tus mob npaws puerperal hais nyob rau hauv cov phau ntawv classic feem ntau tau piav raws likab mob txaus ntshai thiab kho tsis tau. Kev siv aseptics, tshuaj tua kab mob hauv cov tshuaj niaj hnub no, kev siv tshuaj tua kab mob ua rau qhov tseeb tias tom qab yug me nyuam sepsis tau kho tau zoo.
Hom kab mob tom qab yug me nyuam muaj xws li:
- YEndometritis - mob ntawm lub tsev menyuam.
- Seam phua ntawm crotch tom qab phais.
- Suture divergence after caesarean section.
- YMastitis.
Paternity Fever: Ua rau
Dab tsi ua rau kub taub hau tom qab yug?
- Raws li txoj cai, kev kis kab mob ntawm tus poj niam lub cev tshwm sim thaum tsis pom cov tshuaj tua kab mob thaum yug menyuam.
- Cov kab mob tshwm sim feem ntau tshwm sim nrog "tsev kho mob" kab mob ntawm cov kab mob, tus yam ntxwv los ntawm kev tiv thaiv tshuaj ntxiv.
- Vim lub cev tsis muaj zog tiv thaiv kab mob tshwm sim los ntawm kev ntxhov siab thaum yug menyuam, tus poj niam tus kheej muaj peev xwm tuaj yeem ua rau hauv lub cev thiab ua rau muaj kev sib kis.
About kab mob
Cov kab mob ua rau muaj tus kab mob tom qab yug menyuam yog:
- bacteroids;
- proteus;
- YStaphylococcus aureus;
- gonococcus;
- E. coli;
- Klebsiella;
- Yhemolytic streptococcus;
- YPeptostreptococci thiab lwm yam.
Tab sis yeej tsis yog dev mub ua npaws hauv menyuam. Qhov no tsis yog kab mob, tab sis tsuas yog lub npe ntawm ib qho ntxoov ntxoo, thiab tsis muaj dab tsi ua rau tus kab mob.
Feem ntau, postpartum sepsis yog kab mob polymicrobial tshwm sim los ntawmntau hom kab mob.
Cov ntsiab lus nkag kab mob kab mob yog:
- kua muag ntawm qhov chaw mos, ncauj tsev menyuam thiab perineum.
- Tshaj tawm ntawm qhov chaw tso quav rau hauv lub uterine kab noj hniav.
Kev kis kab mob, raws li txoj cai, tshwm sim los ntawm kev sib cuag, sib cuag nrog lub qhov txhab ntawm tes qias neeg thiab cov cuab yeej tsis muaj menyuam. Tom qab ntawd cov kab mob kis tau los ntawm cov qog ntshav thiab cov hlab ntsha.
Risk factors
Risk factors for postpartum sepsis:
- mob hnyav thiab mob ntev ntawm cov poj niam - extragenital, xws li cystitis thiab pyelonephritis, thiab gynecological, xws li endometritis, colpitis thiab vulvitis;
- siv txoj kev tshawb fawb perinatal invasive;
- ncaj qha fetal electrocardiography;
- daim ntawv thov kev phais kho rau qhov tsis txaus ntawm lub ncauj tsev menyuam thiab isthmus;
- siv ntau zaus kuaj qhov chaw mos thaum yug menyuam;
- uterine los ntshav.
- thaum dej tawg;
- Ua haujlwm obstetric xws li kev sib hloov ntawm fetal, cervical dilatation siv forceps.
Puupital fever tshwm sim ntau zaus hauv primiparas dua li thaum yug zaum ob.
Symptoms
1-2 hnub tom qab yug me nyuam, cov tsos mob ntawm postpartum sepsis yuav tshwm sim:
- kub kub thiab txias;
- tachycardia;
- kev tsis zoo tag nrho, lwm yam tsos mob ntawm kev qaug cawv;
- nqhis dej, poob qisqab los;
- mob plab tag nrho, tsis yog hauv qab;
- fetid, nrog impurities ntawm cov kua paug tawm (lochia) los ntawm qhov chaw yug me nyuam, qee zaum tsis muaj paug;
- nrog mastitis, ua kom tiav lossis txo lactation.
Dhau li ntawm tus mob npaws puerperal, lwm yam mob tshwm sim.
Ua ntej, cov txheej txheem inflammatory tsis kis tshaj qhov txhab yug. Tom qab ntawd, nyob ntawm qhov mob, qhov tshwm sim tshwj xeeb ntawm tus mob ua npaws tshwm sim:
- puerperal ulcers - qhov txhab nrog greyish hauv qab, nrog edematous thiab hyperemic npoo, nyob rau ntawm lub ncauj tsev menyuam, qhov chaw mos phab ntsa, perineum;
- puerperal colpitis yog ib qho mob ntawm qhov chaw mos mucosa.
Cov cim qhia thib ob ntawm tus kab mob koom nrog kev sib kis ntawm cov txheej txheem inflammatory:
- endometritis cuam tshuam rau cov mucous ntawm lub tsev menyuam;
- parametritis cuam tshuam rau cov ntaub so ntswg periuterine;
- adnexitis, txwv tsis pub o ntawm uterine appendages;
- pelvioperitonitis - swb ntawm lub plab peritoneum;
- metrothrombophlebitis - mob ntawm cov leeg ntawm lub tsev menyuam;
- thrombophlebitis - mob ntawm cov leeg ntawm lub plab thiab sab qis.
theem thib peb ntawm tus kab mob yog tus cwj pwm los ntawm cov tsos mob ntawm cov kab mob sepsis thiab cov tsos mob ntawm peritonitis. Puerperal fever kuaj tau li cas?
Diagnosis
Kev kuaj mob ntawm "puerperal sepsis" yog tsim los ntawm cov tsos mob tam sim no, tom qab kuaj gynecological thiab kuaj ntshav.
Kev kho mob
Kev kho mob rau cov kab mob puerperal sepsis yog nyob ntawm qhov mob hnyav. Qhov chaw tseem ceeb:
- Muab rau hauv tus account qhov rhiab heev rau cov tshuaj tua kab mob, tshuaj tua kab mob yog nqa tawm. Cov tshuaj tau sau tseg rau kev pub niam mis, thaum muaj mob hnyav, kev noj zaub mov raug tso tseg.
- Immunostimulating tshuaj (anti-staphylococcal immunoglobulin, T-activin, plasma transfusion qhia, toxoid tswj).
- Kev kho cov dej cawv yuav tsum tau txo qis kev qaug cawv thiab rov qab los ntawm cov dej ntsev (alkaline daws, hemodez, proteins thiab reopoliglyukin).
- Antihistamines raug tshuaj ("Suprastin", "Tavegil").
- Taw qhia ntawm cov enzymes proteolytic (trypsin) yog qhia.
Nyob rau hauv daim ntawv dav dav ntawm sepsis, glucocorticoids thiab cov tshuaj hormones anabolic raug tshuaj.
Nws muaj peev xwm ua tau cov txheej txheem kho lub cev:
- hluav taws xob stimulation ntawm lub tsev menyuam;
- UHF;
- YUV irradiation;
- Ymicrowaves;
- ultrasound.
Kev kho mob ntawm tus kab mob:
- ntxuav rwj nrog sodium chloride tov thiab hydrogen peroxide, rau cov qhov txhab loj - txiav cov npoo nrog suturing;
- nrog endometritis, thaum cov ntshav khaws cia hauv tsev menyuam, tshem tawm cov placenta uas tseem tshuav thiab kho kho ntawm lub tsev menyuam kab noj hniav.
Nrog peritonitis, uas yog, thaum mob hnyav, extirpation yog ua - tshem tawm ntawm lub tsev menyuam nrog rau cov khoom ntxiv.
Huab cua
Qhov tshwm sim ntawm tus kab mob nrog kev yug menyuamnyob ntawm ntau yam:
lub sijhawm pib kho, thiab tiv thaiv tus poj niam hauv kev ua haujlwm;
degrees ntawm pathogenicity ntawm cov kab mob
Yog tias cov txheej txheem o tsuas yog txwv rau qhov txhab, qhov rov zoo feem ntau ua tiav thiab tsis muaj qhov tshwm sim. Nrog rau daim ntawv dav dav ntawm sepsis, kev tuag nce mus txog 65%.
Kev Tiv Thaiv
Txhawm rau tiv thaiv tus mob npaws puerperal, yuav tsum ntsuas cov hauv qab no:
- kev noj qab haus huv ntawm tus mob thiab mob ntev inflammatory extragenital thiab gynecological kab mob;
- thaum yug me nyuam, tiv thaiv kev tawg ntawm cov ntaub so ntswg ntawm tus kwj dej yug;
- nruj ua raws li cov cai ntawm asepsis thiab antisepsis.
Tus phab ej ntawm phau ntawv, pom meej, paub cov tsos mob ntawm tus kab mob no, vim nws pom txhua yam kab mob hauv nws, tsuas yog ua npaws puerperal. Noj qab nyob zoo!
