the Professor G.N.Chumakova, senior lecturer T.L.Shirjaeva, senior lecturer A.A.Usynina Kafedra neonatologii and perinatologii Northern state medical universiteta

SYNDROME ASPIRATSII MEKONIJA (R 24.0) meets more often at perenoshennyh and donoshennyh children. Prichiny: ante - and-or intranatalnaja gipoksija; obvitie umbilical cords round a neck, sdavlenie umbilical cords even at absence asfiksii Displays 1. The general signs. Rebenok is born, as a rule, in asfiksii. The skin, nails, an umbilical cord perenoshennogo novorozhdennogo the child are painted over mekoniem (in green or yellow colour). Presence mekonija in okoloplodnyh waters. 2. There are 2 variants of a clinical current. 1 a variant. Heavy respiratory insufficiency since a birth, attacks secondary asfiksii, a short wind, prituplenie a pulmonary sound, increase rigidnosti chest kletki, plentiful mixed damp rattles in lungs. 2 a variant. Presence of a light interval after a birth, then clinic SDR of II type (a short wind, an emphysema). In some hours weight SDR, the phenomena dyhatelnoj insufficiency, participation of auxiliary muscles in the breath certificate, obilie rattles in lungs accrues. 3. Clinic persistirujushchej a pulmonary hypertensia. 4. Infectious defeats of lungs (traheobronhit, a pneumonia) 5. A syndrome " air leaks " (pnevmotoraks, etc.) . Rentgenograficheski: Chrezmernoe a stretching of lungs (emphysema) and uploshchenie diaphragms in the beginning. Rough infiltraty with rough contours with impregnations emfizematoznyh areas. At obilnoj aspiratsii - a symptom " a snow storm " and kardiomegalija, pnevmotoraks or pnevmomediastinum. Inspection: Objazatelnoe: - Monitoring of key parametres of ability to live (a body temperature, chistota breath, CHSS, an electrocardiogram, the HELL, saturatsija) with conducting sheet dynamic nabljudenija - the General analysis of blood + gematokrit, the general analysis of urine - glucose Level in blood, PLAITS of blood, the basic electrolits; blood gases - in dinamike - Rentgenografija a thorax Dopolnitelnoe: - Blood on crops (in 3 days of antibacterial therapy for the question decision tselesoobraznosti further antibiotikoterapii. - Crops of a bronchial secret - Bronhoskopija under indications Tactics 1. At presence mekonija in okoloplodnyh waters at a head birth - sanitation rotovoj cavities (a pear, kateter with elektrootsosom). 2. To place the child under a source of radiant heat on warm diapers in position s lowered on 15-30 0 head end. 3. Laringoskopija, if necessary - intubatsija tracheas and otsasyvanie mekonija from nizhnih respiratory ways through intubatsionnuju a tube. 4. To remove stomach contents in a patrimonial room (the prevention aspiratsii after srygivany). 5. After removal mekonija - kislorodoterapija or IVL under indications. 6. At carrying out IVL - lavazh traheobronhialnogo a tree (instilljatsija 1-2 ml sterilnogo an isotonic solution of sodium of chloride with the subsequent sanitation) on pokazanijam each 30 minutes at the first 2 o`clock with use posturalnogo drenazha. 7. Antibiotics (semisynthetic penicillin + aminoglikozidy or tsefalosporiny 2 generations + aminoglikozidy). 8. Under indications - infuzionnaja therapy for liquidation atsidoza, gipoglikemii, gipovolemii. 9. Therapy ekzogennym surfaktantom is possible.

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