Meconium aspiration syndrome

Meconium aspiration syndrome (MAS) yog hais txog cov teeb meem ua pa uas ib tug menyuam mosliab muaj thaum:

• Tsis muaj lwm yam ua, thiab
• Tus menyuam tau tso quav meconium (quav) mus rau hauv cov kua dej thaum lub sijhawm mob plab lossis xa menyuam tawm

MAS kuj yuav tshwm sim tau yog tias tus menyuam nqus pa (nqus) cov kua dej no rau hauv lub ntsws.

Meconium yog qhov tso quav ntxov los ntawm ib tus menyuam mos tom qab yug menyuam, ua ntej tus menyuam pib pub mis thiab zom mis lossis cov mis.

Muaj qee kis, tus menyuam kis tau tus mob meconium thaum tseem nyob sab hauv lub tsev menyuam. Qhov no tuaj yeem tshwm sim thaum cov menyuam mos "nyob hauv kev ntxhov siab" vim tias txo qis hauv cov ntshav thiab cov pa oxygen. Qhov no feem ntau yog vim muaj teeb meem nrog tus txiv neej lossis txoj hlab ntaws ntshav.

Thaum tus menyuam kis tau tus mob meconium rau hauv cov kua dej ib puag ncig, lawv nqus tau nws mus rau hauv lub ntsws. Qhov no yuav tshwm sim:

• Thaum tus menyuam tseem nyob hauv tsev menyuam
• Lub sijhawm khoom xa tuaj
• Tom qab yug me nyuam tas

Lub meconium tseem tuaj yeem thaiv cov menyuam txoj hlab pa txoj cai tom qab yug. Nws tuaj yeem ua rau muaj teeb meem ua pa vim yog o (mob) hauv tus menyuam lub ntsws tom qab yug.

Yam txaus ntshai uas yuav ua rau ntxhov siab rau tus menyuam ua ntej yug menyuam yog suav nrog:

• "Kev laus" ntawm cov txiv neej yog tias lub cev xeeb tub mus deb dhau hnub vim li cas
• Txo cov pa oxygen rau tus menyuam thaum tseem nyob hauv lub tsev menyuam
• Mob ntshav qab zib hauv niam cev xeeb tub
• Nyuaj yug menyuam los yog lub zog ntev
• Ntshav siab hauv cov niam cev xeeb tub

Feem ntau ntawm cov menyuam yaus uas kis tau meconium rau hauv cov kua tshuaj tsis nqus nws cov pa mus rau hauv lawv lub ntsws lub sijhawm lawv yug menyuam thiab yug menyuam. Lawv tsis zoo li yuav muaj cov tsos mob lossis teeb meem.

Cov menyuam mos ua pa ntawm cov kua dej no yuav muaj cov hauv qab no:

• Cov tawv nqaij daj xiav (cyanosis) hauv tus menyuam
• Ua haujlwm hnyav rau kev ua pa (ua pa nrov, ntxhaws, siv cov leeg kom ua pa, ua pa sai)
• Tsis ua pa (tsis muaj pa ua pa, lossis hawb pob)
• Limpness thaum yug

Ua ntej yug, tus menyuam hauv plab yuav pom lub plawv dhia qeeb. Thaum yug menyuam lossis thaum yug, meconium tuaj yeem pom hauv cov kua dej amniotic thiab rau ntawm tus menyuam mos.

Tus menyuam yuav xav tau kev pab ua pa lossis plawv dhia sai tom qab yug. Tej zaum lawv yuav tau qhab nia Apgar qis.

Pab neeg kho mob yuav mloog zoo rau tus menyuam lub hauv siab nrog lub ntsej muag tsom qhov muag. Qhov no tej zaum yuav qhia cov suab txawv txav, tshwj xeeb yog ntxhib, suab nrov.

Ntshav roj tsom yuav qhia:

• Tsawg (acidic) ntshav pH
• Txo cov pa oxygen
• Txhawb nqa carbon dioxide ntau dua

Kev xoo duab ntawm lub hauv siab yuav qhia pom thaj chaw lossis thaj chaw uas nyob hauv tus menyuam lub ntsws.

Pab pawg neeg tshwj xeeb yuav tsum muaj nyob rau thaum tus menyuam yug los yog tias pom muaj dab ntawm meconium hauv cov kua dej amniotic. Qhov no tshwm sim hauv ntau dua 10% ntawm cev xeeb tub ib txwm muaj. Yog tias tus me nyuam nquag thiab quaj, tsis tas yuav kho mob ntxiv.

Yog tias tus me nyuam tsis nquag thiab quaj tam sim tom qab xa khoom tas, pab pawg yuav:

• Ua kom sov thiab tswj hwm qhov kub thiab txias
• Qhuav thiab txhawb nqa tus menyuam

Yog hais tias tus menyuam tsis ua tsis taus pa lossis muaj lub plawv dhia qis:

• Pab neeg no yuav pab tus menyuam ua pa siv lub npog ntsej muag txuas nrog lub hnab uas muab cov pa oxygen sib xyaw ua ke kom ua rau tus menyuam lub ntsws.
• Yuav muab tus me nyuam tso rau hauv cov chaw saib xyuas tshwj xeeb lossis cov chaw zov menyuam tshiab kom lawv tau saib ze.

Lwm yam kev kho mob suav nrog:

• Tshuaj tua kab mob los kho tus mob tau.
• Lub tshuab ua pa (lub tshuab ua pa) yog hais tias tus menyuam mos ua tsis taus pa ntawm lawv tus kheej lossis xav tau cov pa ntxiv rau.
• Oxygen los ua kom ntshav nce nyob li qhov qub.
• Kev noj zaub mov raws leeg (IV) - khoom noj khoom haus los ntawm txoj leeg - yog tias muaj teeb meem ua pa ua kom menyuam tuaj yeem noj ntawm qhov ncauj.
  
• Tshav kub lub zog ua kom lub cev kub.
• Surfactant los pab cov ntsws sib pauv pa oxygen. Qhov no tsuas yog siv nyob rau hauv ntau dua mob hnyav.
• Nitric oxide (tseem hu ua NO, ib lub pa nqus pa) kom pab cov ntshav khiav thiab oxygen pauv hauv cov ntsws. Qhov no tsuas yog siv hauv cov mob hnyav.
• ECMO (kev ua kom tsis txhob muaj cov pa oxygen tshwj xeeb) yog ib hom kev mob plawv / mob ntsws. Nws yuav raug siv nyob rau hauv ntau qhov xwm txheej loj.

Feem ntau ntawm cov kua dej meconium, qhov kev pom kev ua tau zoo heev thiab tsis muaj kev cuam tshuam kev noj qab haus huv mus ntev.

• Tsuas yog li ib nrab ntawm cov menyuam yaus uas muaj kua nplaum meconium yuav muaj kev ua pa thiab tsuas yog txog 5% yuav muaj MAS.
• Qee tus menyuam yuav xav tau kev pab ntxiv nrog kev ua pa thiab khoom noj khoom haus rau qee kis. Qhov kev xav tau no feem ntau yuav ploj mus hauv 2 rau 4 hnub. Txawm li cas los xij, cov pa ceev ceev tuaj yeem txuas ntxiv rau ob peb hnub.
• MAS feem ntau ua rau mob ntsws tas mus li.

MAS tuaj yeem pom nrog kev daws teeb meem loj nrog cov ntshav ntws mus rau hauv thiab los ntawm cov ntsws. Qhov no yog hu ua kev mob ntsws ntsig txog cov ntshav yug tus me nyuam tshiab (PPHN).

Txhawm rau tiv thaiv cov teeb meem uas ua rau meconium nyob nrog, kom noj qab haus huv thaum cev xeeb tub thiab ua raws li koj tus kws kho mob qhia.

Koj tus kws kho mob yuav xav npaj kom tau meconium nyob rau thaum yug yog tias:

• Koj cov dej tawg hauv tsev thiab cov kua dej ntshiab lossis paug nrog cov khoom ntsuab lossis xim av.
• Ib qho kev sim twg thaum koj cev xeeb tub qhia tias tej zaum yuav muaj teeb meem.
• Kev soj ntsuam menyuam hauv plab yog cov pom tias muaj menyuam hauv plab.

MAS; Meconium pneumonitis (mob rau hauv lub ntsws); Kev Ua Haujlwm - meconium; Kev Xa - meconium; Neonatal - meconium; Kev saib xyuas me nyuam mos - meconium

• Meconium

Ahlfeld SK. Kev ua pa ntawm lub cev tsis taus. Hauv: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Phau Ntawv ntawm PediatricsCov. 21st ed. Philadelphia, PA: Elsevier; 2020: cha 122.

Qhua MA. Neonatal ua pa nyuaj. Hauv: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff thiab Martin's Neonatal-Perinatal Tshuaj: Cov kab mob ntawm lub plab thiab menyuam mosCov. 11th ed. Philadelphia, PA: Elsevier; 2020: cha 66.

Wyckoff MH, Aziz K, Escobedo MB, li al. Tshooj 13: Kev thim rov qab rau lub cev: 2015 Lub Koom Haum Asmeskas lub plawv cov lus qhia hloov tshiab rau kev kho plawv thiab kev kho plawv plawv thaum muaj xwm ceev. Kev ncigCov. 2015; 132 (18 Tus Pab Khoom Siv 2): S543-S560. PMID: 26473001 pubmed.ncbi.nlm.nih.gov/26473001/.