I-Bilirubin iyi -pigment ye- blu -brown enombala ophuzi eyakhiwa ukubhujiswa kwe-hemoglobin namanye amaprotheni wegazi futhi iqukethe iplasma. Umkhuba we-bilirubin egazini lomuntu omdala nosana olusanda kuzalwa luyahlukahluka. Kubantu abadala kanye nezingane ezineminyaka engaphezu kwenyanga eyodwa, okuqukethwe kwayo kuyahluka phakathi kuka-8.5 no-20.5 μmol / l. Ezinganeni, izinga le-bilirubin linganyuka libe ngu-205 μmol / l noma ngaphezulu.
Amanani aphakeme kangaka e-bilirubin ezinsana aqondakalayo. Ngesikhathi umntwana esesiswini, akaphefumuli wodwa. I-oksijeni ifaka izicubu zayo ngosizo lwe-erythrocytes equkethe i-fetal hemoglobin (fetal hemoglobin). Ngemva kokubeletha, leli hemoglobin libhujiswa, njengoba lingasadingeki. Ngenxa yalokho, i-bilirubin entsha ingabonwa enganeni. Lokhu kungabonakali (mahhala) i-bilirubin, engenayo i-insoluble, ayikwazi ukudonswa izinso futhi izojikeleza egazini lomntwana kuze kufike izinhlelo zayo ze-enzyme zivuthwe ngokuphelele. Ngemva kwesikhashana, lapho lezi zinhlelo ezisanda kuzalwa zingasebenza ngokusebenzayo, i-birectubin engaqondile izophendulwa ngokuqondile futhi isuswe emzimbeni.
I-jaundice yezingane ezisanda kuzalwa
Ukwandisa i-bilirubin ngaphezu kwendabuko kubangela ukubonakala kwe-jaundice ezinsana, okungaba:
- i-physiological;
- i-pathological.
I-jaundice yemvelo
Kwenzeka cishe ku-70% kuzo zonke izingane, zivela ezinsukwini ezingu-3-4 futhi ekugcineni zilahleka ngaphandle komkhondo ngaphandle kokulimaza umzimba. Izinga lokukhuphuka kwe-bilirubin egazini lezingane ezisanda kuzalwa lixhomeke ezingeni lokuvuthwa kwe-fetus, kanye nendlela ukukhulelwa nomama: kungakhathaliseki ukuthi kunezifo noma ezinye izinkinga. Ngokuvamile ukutholakala kwe-jaundice kususa i-intrauterine fetal hypoxia, i-asphyxia, isifo sikashukela sikashukela sikashukela.
I-icterus ye-pathological
Ngokunyuka okuphawulekayo kwe-bilirubin egazini ezinganeni ezisanda kuzalwa ziqala i-jaundice ye-pathological, izimbangela zazo ezingaba:
- ukungalingani komama nengane ngamaqembu egazi noma i-Rh factor;
- ukubhujiswa okwenziwa ngokofuzo kwama-erythrocyte;
- izilonda zesibindi ezithathelwanayo;
- i-jaundice yomshini;
- ukuvimbela emathunjini;
- I-Gilbert's syndrome (ukungasebenzi kahle kwe-constitutional hepatic);
- ukuphazamiseka kwe-hormonal, njll.
Njengoba sibona, kunezizathu eziningi, futhi kuphela ochwepheshe ongaziqonda.
Indlela ebalulekile yokuxilongwa yisifundo sokuhlaziywa kwegazi ezinganeni ezisanda kuzalwa ze-bilirubin kanye nezingxenyana zayo. Ngokusekelwe kulokhu kanye nezinye izivivinyo nokuhlolwa, udokotela uzozihlola futhi anikeze ukwelashwa okudingekayo.
Ingozi yezinga eliphakeme kakhulu le-bilirubin ekusanda kuzalwa liwukuthi alikwazi ukuvinjelwa ngokuphelele nge-albinini yegazi futhi ingene ohlelweni lwezinzwa, luveze emiphumeleni enobuthi. Lokhu kuyingozi ebuchosheni nasezikhungweni ezibalulekile zezinzwa. Lesi simo sibizwa ngokuthi "i-bilirubin (nuclear) encephalopathy" futhi sibonakala emahoreni angu-24 okuqala ngemva kokuzalwa ngesimo sezimpawu ezilandelayo:
- ubuthongo obunzima;
- ukunciphisa i-reflex yokusondla;
- ukuphazamiseka nokukhathazeka okukhulu;
- ukwehliswa kwengcindezi yegazi;
- ukwandiswa kwesibindi nesipere.
Ngenkathi eneminyaka eyisithupha, ingane ingase izwe ukulahlekelwa ukuzwa, ukuphuza kwengqondo, ukukhubazeka. Ngakho-ke, izinga eliphakeme le-bilirubin ezinsana lidinga ukwelashwa okungathí sina, futhi esikhathini esizayo, ukubonwa kwemibandela evela kwesazi sezinzwa.
Indlela yokunciphisa i-bilirubin enganeni esanda kuzalwa?
Nge-jaundice engokwenyama, indlela ephumelela kakhulu yokunciphisa i-bilirubin ephezulu iyindlela yokwelapha elula (phototherapy). Ngaphansi komthelela wokukhanya okungaqondile, i-bilirubin iguqulwa ibe "i-lumirubin" engeyona inxushunxushu futhi idonswa ngaphakathi kwamahora angu-12 ngemifino kanye nomchamo. Kodwa i-phototherapy ingaba nemiphumela emibi: isikhumba sikhumba, izihlalo ezikhululekile, ezidlula ukuphela kokuphulukiswa. Ukuvimbela nokuphathwa kahle kwe-jaundice yezinto eziphilayo kuyisicelo sokuqala esifubeni kanye nokudla njalo. I-colostrum ikhuthaza ukuphuma kwe-meconium (izinhlanzi zangempela) kanye ne-bilirubin.
E-jaundice ye-pathological, ngaphezu kwe-phototherapy nokudla njalo ngobisi lwebele, ukwelashwa kuyadingeka kucabangela imbangela yalesi sifo. Le ukwelashwa kwenziwa esibhedlela sezingane yi-neonatologists.
Ungakhohlwa, i-bilirubin ephezulu entsheni ihlala njalo isetshenziswe ngokucophelela nokubona okunamandla.