Cov cim qhia ntawm rickets hauv cov menyuam mos. Kev tiv thaiv thiab kho rickets

2024 Tus sau: Curtis Blomfield | [email protected]. Kawg hloov kho: 2023-12-16 21:10

Zaj lus yuav piav txog thawj cov cim qhia ntawm rickets.

Muaj qee cov kab mob uas tau ntev los ua "cov kab mob ntawm ib puas xyoo dhau los", tab sis raws li kev kho mob qhia, lawv tsis tshua muaj niaj hnub no, thiab tej zaum yuav tsis nyob ntawm tus qauv kev ua neej, kev saib xyuas me nyuam thiab kev noj haus. Cov kab mob no suav nrog rickets hauv cov menyuam mos.

Cov tsos mob ntawm rickets yuav tsum paub rau txhua tus niam txiv.

Kev txhim kho kab mob

Tsuas muaj ob yam uas yuav tsum tau ua ua ntej rau kev loj hlob ntawm rickets hauv menyuam yaus - kev noj zaub mov tsis txaus thiab tsis muaj vitamin D (calciferols) hauv lub cev, uas koom nrog ntau cov txheej txheem metabolic tseem ceeb, thiab qhov no, dhau los, dhau los ua qhov tseem ceeb ntawm kev loj hlob ntawm rickets hauv cov pob txha. Cov vitamin no muaj nyob hauv ntau yam khoom noj thiab tuaj yeem tsim tawm hauv daim tawv nqaij los ntawm kev raug tshav ntuj.

Yog tias tus menyuam noj zaub mov tsis zoo hauv cov khoom noj uas muaj vitamin D, thiab tus menyuam nws tus kheej tsis tshua mus taug kev hauv huab cua hnub ci, ces pathologicalphenomena nyob rau hauv cov pob txha, hauv nruab nrog cev thiab cov nqaij ntshiv yog inevitable rau nws.

Txawm li cas los xij, cov laj thawj zoo li no tau yooj yim tshem tawm. Nws yog txaus los kho tus menyuam txoj kev noj haus los ntawm kev ntxiv mis nyuj, butter, ntses roj, nqaij nyuj los yog nqaij qaib daim siab rau nws. Kev taug kev tsis tu ncua kuj yog qhov yuav tsum tau ua ua ntej.

Cov kab mob sab hauv thiab caj ces txawv txav raws li qhov ua rau rickets

Qhov xwm txheej nyuaj dua rau cov menyuam yaus uas muaj qee qhov pathologies ntawm cov kabmob hauv nruab nrog cev thaum yug los: hnyuv, siab, raum.

Impaired plab hnyuv nqus ntawm cov as-ham, cuam tshuam ntawm biliary ib ntsuj av, qee cov kab mob caj ces uas tiv thaiv kev nqus ntawm vitamin D - tag nrho cov no ua rau qhov pib ntawm thawj cov tsos mob ntawm rickets hauv cov me nyuam mos, thiab cov kab mob no nrog cov kab mob sib kis. kho kho siab heev.

Cov tsos mob thiab cov tsos mob ntawm rickets yog qhov tseem ceeb kom paub txog thaum ntxov.

Lwm yam ua rau rickets

Kev pub mis thiab ua ntej yug menyuam yog ob yam tseem ceeb sib npaug uas cuam tshuam rau cov txheej txheem metabolic hauv tus menyuam lub cev thiab kev nqus ntawm cov khoom noj.

Piv txwv li, hauv tus menyuam mos ntxov ntxov, qhov kev xav tau ntawm cov vitamin D yog qhov siab dua li cov menyuam yaus uas yug los raws sijhawm, yog li feem ntau cov khoom noj khoom haus tsis them rau qhov tsis txaus ntawm cov vitamin no, thiab rickets tsuas yog zuj zus yog tias nws. tsis tau pom raws lub sijhawm qhia thiab tsis txhob hloov qhov kev pub mis.

Cov menyuam yaus ntawm cov khoom noj khoom haus muaj kev txom nyem los ntawm rickets vim qhov tseeb tias nyob rau hauv tshis thiab nyuj mis nyuj, nrog rau hauvCov khoom sib xyaw ua ke ua txhaum qhov kev faib ua feem ntawm phosphorus thiab calcium - cov ntsiab lus tseem ceeb tshaj plaws rau kev tsim cov pob txha.

Cov niam txiv uas tsis pub mis rau menyuam yaus yuav tsum paub tias cov khoom siv dag zog zoo tshaj plaws tsis muaj nyob rau niaj hnub no, yog li ntawd, kev noj zaub mov ntawm cov menyuam yaus yuav tsum tau npaj kom tsis muaj vitamin D, phosphorus thiab calcium. tas li them cov zaub mov ntxiv.

Cov cim qhia ntawm rickets hauv cov menyuam mos yuav qhia hauv qab no.

Kev faib kab mob

Kev faib tawm ntawm rickets uas muaj nyob rau hauv niaj hnub pediatrics, cuam tshuam nrog kev ua haujlwm ntawm kev kho mob nrog calciferols. Hauv qhov no, cov kab mob hauv qab no yog qhov txawv:

1. Feem ntau yog classic D-deficient rickets.
2. Secondary.
3. Vitamin D resistant.
4. Vitamin D nyob ntawm.

hom classic ntawm rickets kuj tseem raug faib raws li kev hloov pauv hauv cov ntsiab lus ntawm phosphorus thiab calcium hauv cov ntshav, yog li muaj phosphopenic thiab calciumpenic ntau yam ntawm nws, uas qhia txog qhov tsis txaus ntawm cov ntsiab lus no. Qee lub sij hawm daim ntawv classic ntawm rickets tshwm sim nrog cov ntsiab lus ntawm phosphorus thiab calcium.

Cov chav kawm ntawm D-tsis muaj daim ntawv ntawm rickets yog mob, rov tshwm sim thiab subacute. Tus kab mob no dhau los ntawm ob peb theem: theem pib, qhov siab ntawm tus kab mob, rov qab los, theem ntawm cov teebmeem seem.

Daim ntawv mob tau pom hauv cov menyuam mos noj qab haus huv: lawv loj hlob zoo, nce hnyav,Txawm li cas los xij, lawv tseem raug kev txom nyem los ntawm xws li pathology. Nws tshwm sim vim tsis muaj calciferols nyob rau hauv ib tug monotonous carbohydrate noj zaub mov thiab yog yus muaj los ntawm kaj, nruj tsos mob los ntawm lub paj hlwb thiab autonomic paj hlwb, raws li zoo raws li pronounced hloov nyob rau hauv cov pob txha cov ntaub so ntswg.

Nyob rau hauv daim ntawv subacute, cov tsos mob ntawm rickets yog ntau smoothed thiab qhia me ntsis. Qhov txawv ntawm tus kab mob no tau pom nyob rau hauv cov menyuam yaus uas yav tas los tau txais kev tiv thaiv tshwj xeeb nrog cov khoom sib xyaw uas muaj vitamin D.

Thaum daim ntawv rov tshwm sim, uas yog lub sijhawm ntawm exacerbations thiab remissions ntawm rickets, feem ntau pom nyob rau hauv cov menyuam yaus los ntawm cov tsev neeg tsis ua haujlwm, thaum tsis muaj kev saib xyuas zoo, noj kom zoo thiab raug huab cua txaus.

Secondary rickets tshwm sim vim qhov tsis txaus ntawm cov vitamin D hauv cov hnyuv, nrog rau kev cuam tshuam ntawm cov ducts, kab mob hauv lub raum, uas cuam tshuam nrog cov kab mob metabolic. Nws kuj tshwm sim nyob rau hauv cov menyuam yaus uas noj tshuaj anticonvulsant, diuretics thiab cov tshuaj hormones ntev. Muaj kev muaj peev xwm ntawm cov rickets thib ob hauv cov menyuam yaus uas tau noj niam txiv hauv tsev kho mob.

Vitamin D-dependent daim ntawv ntawm rickets yog ob hom thiab feem ntau tshwm sim los ntawm qhov tsis xws luag hauv kev sib txuas ntawm calciferols hauv lub raum thiab tsis txaus ntawm cov receptors uas yog lub luag haujlwm rau lawv qhov nqus.

Vitamin D-resistant rickets tshwm sim tawm tsam keeb kwm ntawm orphan pathologies ntawm lub cev xeeb tub - nrog Debret-Fanconi syndrome, phosphate diabetes, hypophosphatasia - ua txhaum ntawm pob txha mineralization, thiab lwm yam.e.

Cov kab mob no tsis tshua muaj heev thiab feem ntau nrog rau ntau yam kev hloov pauv loj hauv kev loj hlob ntawm lub hlwb thiab lub cev.

Cov cim tseem ceeb ntawm rickets

Tus kab mob no muaj peb theem:

1. Thawj theem yog tus yam ntxwv los ntawm qhov pib tshwm sim ntawm tus kab mob nrog cov tsos mob me me.
2. theem ob yog ib qho kev mob nruab nrab ntawm tus kab mob.
3. theem thib peb yog rickets hnyav, uas muaj kev hloov pauv ntawm lub cev thiab kev lag luam hauv kev puas siab puas ntsws.

Thawj theem ntawm rickets

Cov niam txiv, ua ntej ntawm tag nrho, yuav tsum ceeb toom cov cim qhia ntawm rickets hauv tus menyuam, uas suav nrog:

1. muaj kev tawm hws nrog kua qaub tsw ntxhiab tsw.
2. Alopecia tom qab ntawm lub taub hau, feem ntau nrog khaus khaus.
3. pib ntawm prickly tshav kub (me me pob khaus).
4. Nyob rau hauv plab zom mov thaum tswj kev haus ib txwm haus.

Cov cim qhia ntxiv ntawm rickets suav nrog cov hauv qab no:

1. Spontaneous leeg twitches.
2. Ntshai qhov kaj.
3. Nco tus me nyuam chim.
4. Zoo pw tsaug zog.
5. Kev qab los noj mov.

Rickets ntawm thawj qib hauv cov menyuam mos feem ntau pib hauv lub hlis thib peb, thiab hauv cov menyuam mos ntxov ntxov ntxov.

theem ob

Cov chav kawm ntxiv ntawm cov kab mob no nyuaj los ntawm qhov tshwm sim ntawm cov cim tshiab. RicketsCov me nyuam mos uas tsis tau txais kev kho mob rau tus kab mob no nyob rau hauv thawj theem yuav loj hlob raws li hauv qab no:

1. Nyob ntawm cov pob txha cranial hauv thaj chaw fontanelle - craniotabes.
2. Hloov zoo li lub nraub qaum ntawm lub taub hau - flattening ntawm nws cov pob txha.
3. Teem ib qho kev qhia pom ntawm rickets hauv cov menyuam mos thaum 3 lub hlis yog lub hauv siab deformity - "cobbler lub hauv siab", yog tias nws nyuaj siab me ntsis, los yog "mis qaib", yog tias nws yog protruded.
4. Curvature ntawm tubular pob txha: "X"-puab lossis "O"-puab ceg.
5. Pom ntawm dab teg ntawm tshwj xeeb "cov hlaws" ntawm rickets.
6. pib ntawm kev cuam tshuam hauv kev ua haujlwm ntawm lub cev hauv nruab nrog cev.
7. Late fontanel kaw.
8. Ntev teething.

Nws yooj yim pom cov cim qhia ntawm rickets hauv cov menyuam mos thaum 3 hlis.

Rickets ntawm qib thib ob hauv cov menyuam mos feem ntau yog nrog kev nce ntxiv ntawm cov tsos mob ntawm tus kheej thiab cov paj hlwb - lethargy, tsaug zog, qaug zog ntau dhau, tawm hws hnyav, tshwj xeeb tshaj yog thaum qw thiab lwm yam kev ntxhov siab. Cov me nyuam yaus no qab heev rau lawv cov phooj ywg tsis yog hauv kev loj hlob ntawm lub cev, tab sis kuj nyob rau hauv psychomotor thiab kev loj hlob hlwb.

Thib peb ntawm rickets

Rickets ntawm theem peb feem ntau yog tshwm sim los ntawm qhov tsis muaj kev kho mob, thaum tus menyuam tsis muaj kev saib xyuas niam txiv thiab saib xyuas kev kho mob. Nyob rau hauv cov ntaub ntawv no, cov lus nug tseem tsis tshwm sim ntawm yuav ua li cas los txiav txim thawj cov cim qhia ntawm rickets nyob rau hauv xws li ib tug me nyuam - nws tsis saib xyuas cov tsos mob yog li hais thiab hnyav. Koj tuaj yeem pom cov kab mob hauv qab no:

1. Kev ua txhaum loj ntawm pob txha thiabcev nqaij daim tawv.
2. Tsis muaj zog ntawm ligamentous apparatus.
3. Kev ncua ntawm lub cev muaj zog.
4. Kev ua haujlwm hnyav heev ntawm cov kabmob hauv nruab nrog cev, nquag mob ntsws thiab mob ntsws.

Feem ntau, cov cim qhia ntawm rickets tshwm tom qab ib xyoos.

Nyob rau hauv txhua tus menyuam yaus uas tau muaj tus kabmob hnyav lossis nruab nrab ntawm tus kabmob no, kev hloov pauv ntawm cov pob txha tseem nyob, raws li txoj cai, rau lub neej:

• deformed libs;
• bulging or sunken hauv siab.

Cov ntxhais feem ntau muaj qhov tsis xws luag ntawm cov pob txha hauv plab. Nyob rau tib lub sijhawm, lub pelvis yuav tiaj tus, uas tom qab ntawd ua rau muaj ntau yam kev raug mob thaum yug me nyuam.

Cov cim qhia ntawm pathology hauv cov menyuam yaus hnub nyoog ib txog ob xyoos

Tus me nyuam tsis xis nyob, quaj qw, txaj muag - tom qab 2 xyoos cov tsos mob nce ntxiv. Lub innervation ntawm daim siab ua rau lub fact tias hepatocytes raug cuam tshuam, kev puas tsuaj ntawm daim siab cov ntaub so ntswg pib, thiab cov pathological foci ua overgrown nrog caws pliav ntaub so ntswg.

Cov tsos mob ntawm rickets hauv tus menyuam hnub nyoog 2 xyoos tuaj yeem ua rau niam txiv ntshai.

Cov kab mob tsis zoo tuaj yeem nrog cov tshuaj vasomotor. Yog tias koj khiav koj tus ntiv tes hla ntawm daim tawv nqaij, koj tuaj yeem pom cov kab liab liab. Vegetative-vascular teeb meem yuav muaj zog tom qab pub tus me nyuam. Liab vesicles tshwm nyob rau sab nraum qab ntawm lub taub hau ntawm daim tawv nqaij. Kev khaus hnyav tshwm sim.

Lwm qhov cim qhia ntawm rickets hauv tus menyuam hnub nyoog 2 xyoos yog hyperesthesia. Hypersensitivity ntawm daim tawv nqaij receptors irritates tus me nyuam.

Kab mob ntawm lub hauv nruab nrab paj hlwb nrog rau cov pathology ntawm reflexes nrog inhibition, lub cev muaj zog ua haujlwm. Ntawmrickets tshwm sim hloov hauv cov leeg.

Kev xoos ntawm cov pob qij txha, qhov nkhaus ntawm ob txhais ceg tshwm tom qab ib xyoos thaum tus menyuam kawm taug kev.

Peb tau tshuaj xyuas cov cim tseem ceeb ntawm rickets hauv cov menyuam yaus tom qab ib xyoos.

Kev kho mob ntawm rickets thaum ntxov ntawm nws qhov tshwm sim

Kev kho mob ntawm rickets hauv cov menyuam mos yog ib txoj haujlwm ntev heev, txij li nws yuav siv sijhawm ntau lub hlis, thiab qee zaum txawm tias xyoo, los kho cov pob txha. Cov kev kho mob raug xaiv nyob ntawm qhov hnyav ntawm cov tsos mob thiab qhov hnyav ntawm tus kab mob.

Tsis yog kev kho mob tshwj xeeb suav nrog:

1. Tshem tawm lub suab nrov thiab lub teeb ci ntsa iab hauv tus menyuam chav.
2. Kev taug kev ntev txhua hnub, nrog rau hnub thiab da dej - raws caij nyoog.
3. hardening nyob rau hauv daim ntawv ntawm roog nrog txias thiab dej sov.
4. Coniferous thiab ntsev da dej los kho cov txheej txheem ntawm inhibition thiab excitation nyob rau hauv lub paj hlwb.
5. kho mob gymnastics thiab massages.
6. Kev noj haus.

Hais txog kev noj zaub mov yuav tsum tau hais cais: nws tseem yog qhov tseem ceeb rau kev rov zoo ntxiv. Kev kho mob ntawm rickets nyob rau theem pib yuav tsum tau kho dua ntawm cov khoom noj khoom haus ib txwm:

1. Hloov cov dej zoo tib yam nrog txiv hmab txiv ntoo thiab zaub broths.
2. Thaum ntxov qhia txog cov khoom noj muaj protein ntau hauv cov tsev cheese thiab qe qe.
3. Lub hom phiaj ntawm cov zaub mov ntxiv rau hauv daim ntawv ntawm cov zaub mashed stewed thiab boiled zaub, grated nyoos zaub.

Tom qab cov txheej txheem kuaj mob uas qhia txog qhov tsis txaus ntawm phosphorus thiab calcium, cov menyuam raug sau npe kawmcov vitamins C, A, B, thiab cov tshuaj calcium.

Txheeb xyuas qhov mob hnyav, tus kws kho mob tuaj yeem ntxiv cov ntsiab lus ntawm kev kho mob tshwj xeeb rau kev kho mob tshwj xeeb, uas suav nrog:

1. UV irradiation rau 20 hnub nrog kev xaiv ntawm tus kheej biodosage.
2. Roj, cawv lossis dej daws cov vitamin D - "Videhol", "Ergocalciferol", "Videin", "Cholecalciferol", "Aquadetrim", thiab lwm yam.

Cov tshuaj "Ergocalciferol" tau sau tseg, raws li txoj cai, rau txhua tus menyuam yaus, tsis hais txog qhov mob hnyav npaum li cas.

Txhawm rau kom tsis suav nrog qhov rov tshwm sim ntawm tus kab mob, cov menyuam mos uas muaj kev pheej hmoo feem ntau tau muab cov tshuaj uas muaj vitamin D rau 4 lub lis piam txhua hnub los tiv thaiv qhov pib ntawm cov tsos mob ntawm rickets. Komarovsky (tus kws kho menyuam yaus paub zoo) qhia txog kev tiv thaiv hauv qab no.

Kev tiv thaiv kab mob rickets

Kev tiv thaiv tus kab mob no hauv cov menyuam mos pib thaum lub sij hawm ntawm kev loj hlob hauv plab. Tib lub sijhawm, cov kws kho menyuam yaus pom zoo kom cov niam ua raws li cov cai hauv qab no:

1. Ib ntus, nyiam dua hauv cov chav kawm, muab rau tus menyuam tshwj xeeb multivitamin complexes.
2. Ua raws li kev noj zaub mov tshwj xeeb, uas yog, tus menyuam noj zaub mov uas yuav ua rau nws xav tau calcium thiab phosphorus.
3. Neeg taug kev hauv huab cua ntshiab thaum twg los xij.

Kev tiv thaiv tus kab mob no thaum cev xeeb tub yog ua los ntawm kev noj ib koob tshuaj vitamin D ntawm 200,000 IU ntawm lub hli xya ntawm cev xeeb tub.

Nws yog ib qho tsim nyog yuav tsum paub txog cov cim qhia ntawm rickets hauv cov menyuam mos ntawm 4 lub hlis. Txij thaum yug los ntawm ib tug me nyuam, nws yuav tsum tau ua tib zoo saib xyuas nws cov khoom noj thiab kev ua haujlwm txhua hnub. Nws yog ntshaw kom pub niam mis rau nws, vim tsuas yog cov kua mis muaj tag nrho cov khoom tsim nyog rau tus menyuam, uas tsis tuaj yeem hloov los ntawm cov khoom sib xyaw uas muaj niaj hnub no.

Dhau li ntawm qhov no, tus menyuam xav tau kev taug kev txhua hnub, thiab raws caij nyoog koj tuaj yeem ua kom tus menyuam liab qab rau qee lub sijhawm hauv qhov ntxoov ntxoo ntoo. Kev noj qab haus huv zaws kuj pom zoo rau 20 feeb ib hnub, nrog so. Yog tias tsim nyog, cov kws kho mob qhia cov niam txiv kom qhia cov zaub mov muaj protein thiab zaub thaum ntxov.

Nws tseem yuav tsim nyog siv cov citrate sib tov, uas yog raws li kev siv 2.1 g ntawm citric acid diluted hauv 100 ml dej. Cov tshuaj uas tshwm sim yuav tsum tau muab rau tus menyuam hauv ib lub teaspoon peb zaug hauv ib hnub rau 10 hnub, tom qab ntawd rov ua dua ntawm chav kawm hauv ib hlis.

Kev tiv thaiv tshwj xeeb ntawm cov kab mob no kuj tseem tsim nyog: cov menyuam noj qab haus huv tau sau npe rau chav kawm ntawm irradiation nrog lub teeb UV ntawm kaum zaug hauv lub caij ntuj no, caij nplooj zeeg lossis caij nplooj ntoos hlav. Nyob rau lub caij ntuj sov, xws li kev kho UV, raws li txoj cai, tsis tau ua. Tom qab lawv, cov tshuaj vitamin D raug tso tseg rau 2 lub hlis. Rau cov menyuam yaus uas muaj kev pheej hmoo, qhov kis tau tshwm sim txij li hnub nyoog ob lub lis piam.

Cov tshuaj npaj muaj vitamin D, rau kev siv cov tshuaj tiv thaiv tshwj xeeb rau cov menyuam yug los ntawm lub sijhawm, raug tshuaj, raws li txoj cai, ntawm qhov ntau npaum li cas ntawm 400 IU hauv daim ntawv oily lossis aqueous daws thaum lub sijhawm tag nrho thawj zaug.xyoo ntawm lub neej. Rau cov menyuam mos ntxov ntxov, qhov koob tshuaj zoo sib xws yog siab dua me ntsis thiab muaj txog 1000 IU.

Nws yuav tsum nco ntsoov tias cov tshuaj vitamin D tsis yog ib txwm pab tau. Kev siv lawv raug txwv nyob rau hauv cov xwm txheej hauv qab no:

1. Tom qab raug mob fetal hypoxia thaum cev xeeb tub.
2. After intracranial birth trauma.
3. Nrog me me ntawm fontanel loj.
4. Rau nuclear jaundice.

Nrog ceev faj, calciferols kuj tau muab rau cov menyuam yaus uas tau txais cov mis hloov pauv uas muaj vitamin D.

Taug kev nrog tus menyuam yuav tsum ua txhua hnub, thiab qhov no yuav tsum ua thaum huab cua. Yog tias nws txias thiab txias sab nraum, kev taug kev yuav tsum kav ntev li ib teev, tab sis yog tias nws yog tshav ntuj thiab sov, tsawg kawg 3-4 teev. Ib qho tshwj xeeb yog cua daj cua dub, txawm nyob rau lub caij sov, thaum nws txwv tsis pub coj menyuam mus rau sab nraud.