Lub tswvyim ntawm "perinatal encephalopathy" yog paub rau ntau tus niam txiv, txij li hnub no nws tau pom nyob rau hauv ntau yam versions ntawm yuav luag ib nrab ntawm cov menyuam cov ntaub ntawv kho mob nrog rau kev kuaj mob neurological. Qhov no pathology yog to taub raws li ib tug teeb meem ntawm lub paj hlwb nyob rau hauv lub cuam tshuam ntawm hypoxia, raug mob, kis kab mob uas cuam tshuam rau lub fetus hlwb thaum cev xeeb tub los yog thaum lub sij hawm yug me nyuam. Qhov tshwm sim ntawm qhov kev cuam tshuam no los ntawm kev ua haujlwm tsawg ntawm lub hlwb mus rau qhov tshwm sim loj heev hauv daim ntawv ntawm cerebral palsy, hydrocephalus thiab epileptic syndrome.
tshawb fawb cov ntaub ntawv
Ntau tus tsis paub yuav ua li cas teb rau kev kuaj mob ntawm perinatal encephalopathy syndrome, tshwj xeeb tshaj yog thaum tus menyuam zoo li noj qab haus huv thiab loj hlob raws li nws lub hnub nyoog. Tsis xav tsis thoob, vim tias qhov pathology no tsis nyob hauv kev faib thoob ntiaj teb.
Raws li ntau tus kws tshawb fawb tshawb fawb, cov xwm txheej tiagencephalopathy ntawm hypoxic thiab ischemic genesis tshwm sim tsuas yog hauv 4% ntawm cov menyuam mos, txawm li cas los xij, tsawg kawg ib nrab ntawm cov menyuam yaus raug kuaj pom hauv polyclinics.
Ntshai lub paj hlwb thawj xyoo ntawm ib tug neeg lub neej yog fickle heev. Nws yog kev txhim kho sai thiab loj hlob sai, raws li qhov tshwm sim ntawm ob qho tib si kev cuam tshuam rau lub ntiaj teb sab nraud thiab tus cwj pwm ntawm tus me nyuam hloov, yog li nws yog ib qho nyuaj heev rau systematize cov kev hloov pauv uas tau tshwm sim rau hauv ib qho kev cai, txawm li cas los xij, cov kws tshaj lij tau sim ua. ua qhov no.
Muaj ntau yam uas cuam tshuam kev loj hlob. Yog li ntawd, nws feem ntau tshwm sim hais tias nyob rau hauv cov me nyuam noj qab nyob zoo ib yam ntawm cov tsis mus dhau qhov ib txwm muaj. Los ntawm qhov no los cov ntaub ntawv hais txog qhov zaus ntawm kev kuaj mob ntawm perinatal mob. Txawm tias thaum tus me nyuam quaj ntev heev los yog nws lub puab tsaig tshee hnyo, los yog nws burps ob peb zaug, cov niam txiv maj nrawm mus rau tus kws tshaj lij, thiab nws tsis yig los txiav txim siab txog lub hlwb tsis ua haujlwm thiab kuaj xyuas "perinatal encephalopathy."
Kev kho mob thaum muaj hnub nyoog ntxov feem ntau tsis yog qhov tsim nyog xwb, tab sis kuj tsim kev puas tsuaj rau tus menyuam thaum qhov kev kuaj mob tsis tau lees paub los ntawm ntau qhov kev kuaj mob, uas feem ntau tshwm sim hauv cov chaw kho mob niaj hnub no.
Ntawm, nws tsis yog qhov tsis ncaj ncees lawm tsis lees paub qhov muaj lub hlwb perinatal puas tsuaj, tab sis qhov kev kuaj mob no yuav tsum tau kho kom zoo kom tsis txhob muaj kev kho tsis tsim nyog.
Qhov laj thawj tseem ceeb ntawm ischemic mob hlwb
Perinatal encephalopathy ntawm hypoxic lossis ischemic keeb kwm tuaj yeem tshwm sim los ntawm qee yam tsis zooyam uas cuam tshuam rau tus menyuam hauv plab thaum cev xeeb tub, nrog rau qee qhov xwm txheej ntawm kev yug menyuam thiab lub sijhawm ntxov tom qab lawv. Cov xwm txheej no feem ntau suav nrog:
- Cov kab mob ntev ntawm tus poj niam cev xeeb tub uas tuaj yeem cuam tshuam cov ntshav ncig thiab pauv hauv cov placenta, xws li lub plawv tsis ua haujlwm nrog lub plawv tsis xws luag, anemia, ntsws pathology, hypothyroidism, thiab lwm yam.
- Tus kab mob kis tau yooj yim lossis ua rau muaj kev mob hnyav zuj zus thaum cev xeeb tub.
- Kev noj yuam kev, haus cawv thiab haus luam yeeb.
- Nyob los yog muaj hnub nyoog ntawm tus poj niam cev xeeb tub.
- Hereditary pathologies thiab metabolic disorders.
- Preeclampsia, kev hem thawj ntawm kev nchuav menyuam, nrog rau cov kab mob fetoplacental ntev.
- Pathology ntawm kev ua haujlwm xws li qaug zog hauv kev ua haujlwm, kev siv quab yuam, kev ua haujlwm nrawm, lossis nqus tawm ntawm tus menyuam hauv plab.
- Intoxication, raug hluav taws xob, cuam tshuam ntawm qee yam tshuaj thaum cev xeeb tub.
- tus mob me nyuam mos ua ntej.
Yog li, txhua yam tsis xav tau ntawm lub cev ntawm tus poj niam cev xeeb tub, suav nrog kev ntxhov siab ntau zaus, tuaj yeem cuam tshuam kev loj hlob ntawm tus menyuam hauv plab, ua rau fetoplacental insufficiency thiab perinatal encephalopathy. ICD-10 code encrypts tus kab mob no raws li G 93.4 (unspecified encephalopathy). Feem ntau cov kws kho mob tsis pom qhov sib txuas ntawm tus kab mob thiab ib qho tsis zoo.
Apgar score
Ntsuas qhov tob ntawm lub hlwb puaspab, raws li txoj cai, Apgar nplai, uas yuav siv sij hawm mus rau hauv tus account cov kev ua ub no, reflexes ntawm cov me nyuam mos, cov xim ntawm lawv cov tawv nqaij thiab cov kev ua ntawm lub cev xws li lub plawv, lub ntsws, thiab lwm yam. Raws li cov ntaub ntawv no, peb tuaj yeem xaus tias qhov Qhov hnyav ntawm cov tsos mob ntawm hypoxia, thiab qhov ntsuas siab dua ntawm qhov ntsuas no, tus me nyuam noj qab nyob zoo, thiab tus nqi ntawm 3 cov ntsiab lus los yog tsawg dua qhia tau tias muaj kev pheej hmoo siab heev ntawm perinatal lesions ntawm lub paj hlwb, uas yog tshwm sim los ntawm kev sib sib zog nqus hypoxia. Yog li ntawd, tus me nyuam xav tau kev pab xwm txheej ceev.
Hypoxia
Lub ntsiab ua rau perinatal encephalopathy yog intrauterine hypoxia. Nyob rau tib lub sijhawm, cov qhab nia siab ntawm qhov ntsuas tau hais tseg tsis tau lees paub txog kev noj qab haus huv, txij li cov tsos mob ntawm tus kab mob tuaj yeem tshwm sim tom qab qee lub sijhawm. Kev pab raws sij hawm los ntawm cov kws kho mob thiab lub peev xwm siab ntawm tus me nyuam lub hlwb kom hloov tau qhov txiaj ntsig zoo ntawm cov teeb meem zoo li no thiab tsis muaj txhua yam kev puas hlwb hauv cov menyuam yaus.
Symptomatics
Perinatal hypoxic-ischemic encephalopathy feem ntau tuaj yeem tshwm sim hauv ntau theem, uas txawv ntawm cov tsos mob ntawm kev kho mob, qhov hnyav ntawm lawv cov chav kawm thiab cov txiaj ntsig sib txawv:
- Acute - thawj lub hlis ntawm lub neej.
- Kev rov qab mus txog rau ib xyoos hauv tus menyuam puv sijhawm thiab mus txog ob xyoos hauv tus menyuam ntxov ntxov.
- Residual hloov pauv.
Feem ntau feem ntau muaj kev sib txuas ntawm ntau qhov kev ua haujlwm ntawm lub hlwb tsis zoo, uas tuaj yeem qhia tau rau ntau qib, thiab rau txhua tus ntawm lawv tau tsim muaj kev kho mob tshwj xeeb.thiab kwv yees kom rov zoo.
Nyob rau hauv lub sijhawm mob ntawm perinatal encephalopathy ntawm ischemic-hypoxic genesis, lub hlwb kev nyuaj siab tuaj yeem pom, uas coma, nce kev xav thiab lub paj hlwb excitability, convulsions, cov tsos mob ntawm intracranial siab vim hnyav hydrocephalus.
Nyob rau theem rov qab los ntawm tus kab mob, cov tsos mob no tseem muaj, txawm tias lawv qhov hnyav txo qis los ntawm kev kho. Ntau yam kab mob visceral thiab autonomic, lag hauv psychomotor kev loj hlob, thiab lwm yam tshwm sim.
Thaum lub sijhawm hloov pauv, muaj kev ncua sijhawm ntawm kev hais lus, kev ua siab loj, neurasthenia, vegetative dysfunctions, thiab nyob rau hauv cov xwm txheej hnyav muaj convulsive syndrome, hydrocephalus nws tus kheej tsis daws. Qhov tshwm sim txaus ntshai heev nyob rau lub sijhawm no yog mob hlwb palsy.
daim duab kho mob
Daim duab kho mob ntawm perinatal encephalopathy (ICD-10: G93.4) thiab neuroreflex excitability syndrome tau qhia los ntawm cov yam ntxwv hauv qab no:
- Ua kom muaj kev txav ntawm tus kheej, nrog rau qhov kev xav ntawm lub cev.
- Kev ntxhov siab, quaj, pw tsaug zog thiab luv luv.
- Nyob tsaug zog thiab teeb meem pw tsaug zog.
- Kev hloov pauv ntawm cov leeg nqaij, tshee ntawm lub puab tsaig, ceg lossis caj npab ntawm tus menyuam.
Cov menyuam mos ntxov ntxov uas muaj tus mob no feem ntau yuav muaj qaug dab peg uas tshwm sim thaum raug rau qee yam ua rau khaus, xws li nce ntxivkub. Nrog rau qhov nyuaj ntawm tus kab mob, dhau sij hawm, tus me nyuam tuaj yeem tsim mob vwm.
Ntsuag
Kev qaug dab peg yog lwm qhov cim tshwj xeeb ntawm encephalopathy. Lawv tuaj yeem tshwm sim tsis hais hnub nyoog li cas thiab muaj ntau haiv neeg - los ntawm kev tawm tsam ntawm lub taub hau qaij nrog lub suab nrov ntawm cov ceg thiab shudders mus rau qhov tshwm sim dav dav nrog kev tsis nco qab.
Hypertension-hydrocephalic syndromes tshwm sim vim cov kua cerebrospinal ntau dhau, uas ua rau muaj kev nce siab hauv intracranial. Qhov tshwm sim no tuaj yeem tshwm sim los ntawm o thiab pulsation ntawm fontanel, kev loj hlob ntawm tus menyuam lub taub hau, uas qee zaum tsis sib haum rau lub hnub nyoog. Cov menyuam yaus uas muaj hydrocephalus zoo siab heev, pw tsaug zog tsis zoo thiab ntuav ntau zaus.
Txawm li cas los xij, nws yuav tsum paub tias lub taub hau loj tuaj yeem yog txoj cai lij choj ntawm ib tus menyuam yaus, thiab feem ntau pom muaj regurgitation thiab tsis xis nyob hauv plab hnyuv. Lub fontanel tsis loj hlob mus ntev nrog rickets, yog li koj yuav tsum tsis txhob kuaj koj tus kheej.
Coma
Coma yog ib qho mob hnyav heev ntawm lub paj hlwb pathology, uas ua rau cov kab mob sib sib zog nqus hypoxic ntawm cov neurons. Hauv cov menyuam yaus hauv qhov xwm txheej no, kev qaug zog ntawm kev txav los yog lawv tsis tuaj, inhibition ntawm kev ua pa reflex, bradycardia, txo qis nqus thiab nqos reflexes, thiab convulsive qaug dab peg tshwm sim. Tus mob no xav tau kev kho mob xwm txheej ceev, nrog rau cov khoom noj khoom haus parenteral thiab saib xyuas kom zoo. Tej zaum lub coma yuav kav ntev li ob lub lis piam.
Kev ua haujlwm tsis raug cai thiab tsis meej pem ntawm visceral innervation hauv hypertensive-hydrocephalic syndrome thiab cov teeb meem zoo sib xws pib li ntawm ob lub hlis. Lawv muaj cov tsos mob xws li regurgitation, tsis txaus qhov hnyav nce, pathologies ntawm lub plawv atherosclerosis thiab ua pa, impaired thermoregulation thiab digestion. Nrog rau tus mob no, enteritis thiab colitis feem ntau tshwm sim nrog quav quav.
motor ntshawv siab
Cov kab mob hauv lub cev hauv cov kab mob no pom tau pom nyob rau thawj lub lis piam tom qab yug me nyuam. Cov leeg nqaij tuaj yeem ua rau siab lossis, hloov pauv, txo qis, thiab txav mus los qeeb lossis ua kom hnyav. Cov tsos mob no tuaj yeem nrog los ntawm kev lag luam hauv psychomotor kev loj hlob, kev hais lus qeeb, thiab txo qis hauv kev txawj ntse. Tsis tas li ntawd, cov yam ntxwv ntawm lub ntsej muag tsis muaj zog, kev cuam tshuam qeeb rau kev hnov lus thiab qhov muag pom kev, belated mastery ntawm kev ua ntawm zaum, taug kev thiab nkag.
Ib qho tshwm sim loj tshaj plaws ntawm cov kab mob ntawm lub cev muaj zog yog cerebral palsy, thaum lub cev muaj zog, kev hais lus raug cuam tshuam, muaj kev puas hlwb thiab strabismus.
Yuav kuaj pom perinatal posthypoxic encephalopathy li cas?
YKev kuaj mob ntawm pathology
Kev kuaj mob ntawm lub hlwb perinatal yog tsim los ntawm cov tsos mob, cov ntaub ntawv anamnesis ntawm lub sijhawm cev xeeb tub thiab yug menyuam, thaum gestosis, ntau yam kab mob, kev raug mob thaum yug, thiab lwm yam. Cov ntaub ntawv no muaj nyob rau hauv lub daim npav thiab rho tawm hauv tsev kho mob maternity.
Kev kuaj ntxiv ua kom yooj yim heevKev tshawb nrhiav thiab pab qhia meej txog qhov kev puas tsuaj rau lub paj hlwb, nrog rau kev taug qab cov kab mob thiab cov txiaj ntsig ntawm kev kho mob.
Instrumental txoj kev rau kev kuaj mob perinatal encephalopathy hauv cov menyuam yug tshiab hauv qhov no suav nrog:
- Neurosonography, uas muaj kev nyab xeeb heev thiab tso cai rau koj los soj ntsuam cov morphological thiab kev ua haujlwm ntawm lub hlwb, nrog rau CSF system. Siv txoj kev no, koj tuaj yeem txheeb xyuas qhov muaj kev puas tsuaj thiab lawv qib.
- Dopplerography, uas ntsuas cov ntshav ncig hauv cov hlab ntsha ntawm lub hlwb.
- Electroencephalography yog ib txoj hauv kev los kawm txog kev ua hluav taws xob ntawm cov neurons los ntawm kev tso npe ntawm cov peev txheej ntawm tes. Txoj kev tshawb no qhia txog kev loj hlob ntawm lub paj hlwb, kev loj hlob qeeb, asymmetry ntawm cerebral hemispheres, convulsive npaj.
- Kev soj ntsuam video, nrog kev pab los ntawm nws tuaj yeem txheeb xyuas qhov kev txav ntawm tus menyuam nyob rau hauv thiaj li yuav ntsuas qhov kev ntsuas ntawm kev ua ub ua no
- Electroneuromyography tso cai rau koj kuaj mob neuromuscular pathologies, congenital lossis kis tau.
- CT thiab MRI yog cov kev tshawb fawb uas qhia meej txog cov yam ntxwv ntawm cov qauv anatomical ntawm lub hlwb, tab sis muaj qhov tsis zoo, vim lawv tau ua raws li tshuaj loog.
- Positron emission tomography, uas qhia txog daim duab ntawm cov txheej txheem metabolic, nrog rau cov ntshav khiav ceev hauv qee qhov chaw ntawm lub hlwb.
Cov kev siv ntau tshaj plaws rau kev kuaj mob hypoxic perinatal encephalopathy yog neurosonography thiab EEG, uas yooj yim.yog rov tsim dua tshiab, nyab xeeb thiab tuaj yeem muab cov ntaub ntawv ntau heev.
Thaum muaj qhov mob hypoxic ntawm lub hlwb, kev sab laj nrog tus kws kho qhov muag yog qhov yuav tsum tau ua. Txoj kev tshawb fawb ntawm fundus pab txhawm rau txheeb xyuas cov kab mob caj ces, txheeb xyuas cov qib ntawm intracranial siab thiab qhov xwm txheej ntawm cov hlab ntsha ntawm optic.
Kev kho mob ntawm pathology
Kev kho mob ntawm perinatal encephalopathy (ICD code - G93.4) nyob rau theem nruab nrab thiab hnyav ntawm theem mob hnyav yog nqa tawm hauv tsev kho mob. Hauv cov kab mob me me, feem ntau, cov kws kho mob tshwj xeeb raug txwv rau cov haujlwm hauv qab no:
- Kho cov txheej txheem, teeb tsa ib tus zuj zus thiab nyob ntawm qhov xwm txheej ntawm lub cev muaj zog thiab qib ntawm kev ntxhov siab thiab kev xav ntawm tus menyuam.
- kev pab qhia ntawv.
- massage and therapeutic exercises.
- Physiotherapy method.
Raws li kev kho tshuaj rau perinatal encephalopathy (ICD-10: G93.4), ntau yam tshuaj sedatives nrog tshuaj ntsuab cov khoom xyaw thiab diuretics tau sau.
Hypertensive-hydrocephalic disorders xav tau kev kho kom zoo:
- Lub taub hau ntawm lub txaj yog tsa 30 degrees.
- Phytotherapeutic kho mob me me - bearberry, horsetail thiab lwm yam nroj tsuag.
- Thaum tsis muaj cov nyhuv ntawm cov tshuaj ntsuab nyob rau hauv cov chav kawm hnyav thiab nruab nrab, cov tshuaj siv - "Diakarb", uas txo cov kua cerebrospinal thiab nce nws tawm ntawm pob txha taub hau, nrog rau."Mannitol".
- Kev kho phais (kev phais phais) yuav tsum tau yog tias kev kho mob tsis ua tiav.
Cov kab mob hauv lub cev muaj zog hauv perinatal hypoxic encephalopathy feem ntau kho tau zoo:
- kev tawm dag zog.
- massage.
- YPhysiotherapy - electrophoresis, amplipulse.
Kev pab kho mob
Nyob ntawm qhov tshwm sim ntawm qhov chaw kho mob, kev txhawb nqa tshuaj tau muab:
- "Dibazol", "Galantamine" - tshuaj los txhim kho cov hlab ntsha hauv lub cev nrog hypotension thiab paresis.
- "Mydocalm", "Baclofen" - thaum muaj hypertonicity, nrog rau spasms.
Cov tshuaj no yog noj hauv qhov ncauj, txhaj lossis los ntawm electrophoresis. Kev ceev faj thiab ceev faj yuav tsum tau kho cov tshuaj tiv thaiv kab mob ntawm cov menyuam yaus uas muaj mob vwm. Cov koob tshuaj thiab hom tshuaj tiv thaiv, nrog rau kev tswj hwm, raug txiav txim siab los ntawm qhov hnyav thiab chav kawm ntawm pathology, nrog rau lub hnub nyoog ntawm tus menyuam. Hauv qhov no, "Depakine", "Phenobarbital", "Diazepam" thiab lwm yam yog siv.
Hloov cov tshuaj yog ua tau nyob rau hauv kev saib xyuas ntawm tus kws kho mob hlwb, coj mus rau hauv tus account encephalogram.
Kev noj cov tshuaj tiv thaiv kab mob hauv hypoxic lossis ischemic genesis ntawm perinatal encephalopathy yog qee zaum nrog cov kev mob tshwm sim thiab cuam tshuam rau kev loj hlob ntawm tus menyuam. Lawv siv yuav tsum tau saib xyuas los ntawm kev kuaj ntshav thiab lub siab ua haujlwm ntsuas.
Lwm qhov tseeb tseem ceeb yog qhov zaws thiab kho lub cevcontraindicated nyob rau hauv cov me nyuam nrog epileptic syndrome. Kev ua luam dej, cua sov, ua haujlwm ntau dhau tuaj yeem ua rau qaug dab peg, yog li lawv yuav tsum raug cais tawm.
Nrog kev loj hlob qeeb, uas yuav luag nrog lub hlwb puas tsuaj, cov tshuaj siv los txhim kho lub hlwb kev ua haujlwm thiab cov ntshav ncig hauv nws, uas ua rau cov txheej txheem metabolic nce ntxiv thiab pab tsim kev sib txuas ntawm cov neurons.
Qhov tshwm sim ntawm perinatal encephalopathy
- rov qab tag nrho. Yog tias kuaj pom tus kab mob raws sijhawm thiab kev kho mob nyuaj, ces qhov kev xaiv no ua tau.
- Kev ncua ntawm kev txhim kho psychomotor. Nws txawv ntawm qhov hnyav. Tus me nyuam yuav tsis txwv txoj hauv kev loj heev.
- Hyperactivity thiab Attention Deficit.
- Hydrocephalus.
- Kev tshwm sim ntawm cov tshuaj tiv thaiv neurotic. Nws raug suav hais tias yog ib qho teeb meem loj dua uas yuav tsum tau ua raws li tus menyuam tas li.
- Vaj-visceral dysfunction.
