Rhesus-kunetsana mai uye mudumbu panguva pamuviri: a tafura. Immune kunetsana amai uye mudumbu

On pamuviri kukanganiswa zvinhu zvakawanda. High njodzi kutakura mai kusapindirana kweropa-kupesana uye mudumbu. Zvisinei, haasi munhu wose anonzwisisa zvikonzero Fani iyi, izvo zvinokonzera kutya zvisingazivikanwi. Saka, kuziva sei nengozi kuti kusapindirana kweropa chinhu uye kana paine kusawirirana kweropa raamai-kurwisana "mai-mudumbu" vanosungirwa mai ose pamuviri.

Rhesus kunetsana - chii?

Kuti tinzwisise hunhu dambudziko, zvakakosha kutanga kunzwisisa sei chinokosha kusapindirana kweropa chikonzero. Zviri chairo mapuroteni, riri pamusoro erythrocyte pamusoro. mapuroteni ichi aripo muropa 85% vanhu vose, uye vamwe chisipo. Naizvozvo, midziyo yokuisira vavo kutanga vanoonekwa zvakanaka Rhesus chinhu uye yechipiri kunaka.

Saka anosarudza mashoko immunological zvechadenga Muviri zvachose hapana zvazvinoita utano hwevanhu. Kusapindirana kweropa chinhu chinogona akasarudzwa kusapindirana kweropa + uye Rh-. Kokutanga ino izwi rakatangwa 1940 nemasayendisiti uye Aleksandrom Vinerom Karlom Landshteynerom. Kusapindirana kweropa kunetsana mai uye mudumbu ndiro immunological kusapindirana ropa kusapindirana kweropa kuna kana mai akaipa uye mudumbu zvakanaka. The ngozi Rhesus-kupesana iri pakuti zvinogona kukonzera fetus rufu, kubereka mwana akafa, kubva kwepamuviri. Fani iyi kuonekwe amai ramangwana kusapindirana kweropa negative mu nedanho gestation uye panguva basa. mai Immune uye mudumbu vachinetsana kunoratidza pachayo kana mudumbu nhaka kusapindirana kweropa + kubvira baba vake.

Zvinokonzera kusapindirana kweropa-kunetsana mai uye mudumbu

Nokuti muviri mai yemberi kuti ropa mwana pamwe kusapindirana kweropa + ndiye nengozi, saka inobereka antibodies kuti vakaitei kuna fetus masero matsvuku eropa uye kuvaparadza. Rhesus-kunetsana mai uye mudumbu akatsanangura transplantsentarnym kupinda masero fetus matsvuku uine kusapindirana kweropa chakaita neropa vanevana zvakaipa chakarurama.

Immunological vachinetsana kunonyanya kukonzerwa zvaitika wokutanga pamuviri. Panguva gestation Rhesus-kupesana zvingava zvakafanira kuwedzerwa ropa umo kusapindirana kweropa chinhu isina kucherechedzwa, zvapfuura pamuviri, kupfupfudzika. Uyewo kusapindirana kweropa kuchipesana ropa anogona kupinda mwana ari raamai pakusununguka, saka muviri raamai rinova kubatwa zvisina kunaka kusapindirana kweropa chinhu, uye mukana wokuti kusapindirana kweropa-kupesana panguva yechipiri pamuviri wakawedzera. It kunowedzera ngozi yokubatwa isoimmunization panguva caesarean chikamu. ropa kusapindirana inogona Penina ropa panguva nepamuviri uye pakusununguka somugumisiro kuvadza placenta.

The ndingangokuvara kusapindirana kweropa boka ropa kunetsana

Kusapindirana kweropa chikonzero ndechokunyanya majini vakatsunga uye kuzivikanwa nhaka unhu. Kana amai ane kunaka kusapindirana kweropa, uye baba vake kana homozygosity riri zvakanaka, mwana nguva dzose anowana kusapindirana kweropa +. Panyaya iyi, mukana rokurwisana boka ropa chaizvo. Zvino zvakaitika baba heterozygosity mukana wokuti Kupfuudzwa kuti mudumbu kusapindirana kweropa kunaka kana zvakanaka Isometric.

Musi vhiki rechisere fetus pakukura pane ropa, umo masero matsvuku eropa rurefu mwero mukana rinogona kubatwa ari raamai. In kudzivirira ichi yenzendo zvirwere navanaamai fetus antigen anonzi mutorwa. Naizvozvo, muviri kunobereka pamuviri kusapindirana kweropa antibodies, iro rinoita kuti kusapindirana kweropa kunetsana mai uye mudumbu. Mukana immunological kunetsana ishoma zvakakwana panguva gestation uye 0,8 chete%, asi kune ngozi chaizvo, uye saka zvinoda chinokosha kudzidza uye kutarisirwa. Kuzivisa pamusoro asati aberekwa mwana kusapindirana kweropa ropa bvunzo boka vabereki achitirega kufungidzira kusapindirana kweropa-kunetsana pamuviri. Tafura zvakajeka zvinoratidza mukana ropa neremwana.

Consequences uye kutyisidzira pamwe rhesus kunetsana panguva pamuviri

mai Immune uye mudumbu vachinetsana hwakazara mutsekwende mwana. The maantigen zvinoberekwa mai muviri, kuwana yokumwe muviri haawirirani kusapindirana kweropa chinokonzera zvinopfuura fetus ropa riyerere kuburikidza mechidziro gematoplatsentarny kuvhiringidza hematopoiesis mwana rikurumidze, zvichivhiringidza paumbwe masero matsvuku eropa.

Izvi antibodies maitiro zvinogona kukonzera mamiriro zvikuru ngozi nokuda mudumbu, kutyisidzira upenyu mwana, iyo inozivikanwa nokuva acidosis, hypoxia, kupererwa neropa. In muviri mwana rinoungana yakawandisa Urume uye kutyora zvinenge zvose nhengo uye hurongwa. Pakadaro, kana matanho hadzina kubatwa nenguva nenzira, pane chakakomba ngozi yokubva pamuviri yakakura, fetus rufu, kubereka mwana akafa, kuberekwa mwana hemolytic chirwere kuti acharamba mberi nokuda kuunganidza mumuviri mwana antirhesus antibody Kugadzirwa izvo zvakakonzera amai kurwisana uye mudumbu panguva pamuviri . Kunogona kukonzera pave nezvirwere, varehwa nenzira kunyanya kuwedzera zvomukati, pfungwa, mwoyo, hunokachidza lesion zvomusoro tsinga.

zviratidzo

Kusapindirana kweropa kunetsana mai uye mudumbu panguva pamuviri asina zvekuchipatara zviratidzo uye yakananga zviratidzo. Possible kuziva dambudziko chete kuburikidza Murabhoritari kuongorora ropa, izvo zvinoratidza kuvapo antibodies kuna kusapindirana kweropa negative.

In fetus ropa kusapindirana kunooneka pacharo kukura hemolytic chirwere pamusoro zvomukati uye mugadziriro muviri, izvo zvingaita kuti kuparadzwa kwayo munguva kubva vhiki 20-30 pamuviri, uyewo kuti chidzoke kubva pamuviri, kubereka mwana akafa, kukurumidza pakukurukura.

Uyezve, mwana renguva izwi zvingaita edematous, icteric uye neta neta chimiro hemolytic chirwere. Rhesus-kunetsana iri mudumbu muropa pakuonekwa saibva matsvuku eropa pathologies kuti nhengo dzomukati. Symptomatology anokonzerwa uwandu antibodies zvinoberekwa mai muviri. In chakakomba chimiro chirwere kunoitika apo mumatenhere mudumbu - pane kuwedzera kukura zvomukati, panowanikwa ascites kuwedzera placenta uye Líquido uwandu hwemvura. uremu mwana inogona zvakawedzera kusvika kaviri, chirwere kunowanzoguma edema.

tsvakurudzo rabhoritari

Rhesus-kurwisana "mai-mudumbu" panguva yepamuviri vanokwanisa kudzivisa mangwanani nechirwere, kunyanya muchimiro kuona baba kusapindirana kweropa chinhu uye amai pamberi chinotevera pamuviri kana kwokutanga mazwi ayo.

Kufembera Rhesus kukonana kwakavakirwa Data dzokutambura kuwedzerwa ropa, kubuda uye mugumisiro wokutanga pamuviri, Kuwanikwa pamuviri, zvinoguma nokupfupfudzika, rufu fetus mukati mudumbu ramai vake, hemolytic chirwere mwana, zvichiita yakavimbika nemazvo kuziva ndingangokuvara pangozi isoimmunization.

miedzo Laboratory ropa kuti asarudze antirhesus miviri uye mazita dzinoitirwa vakadzi vose vane vanofungidzirwa kusapindirana kweropa-kunetsana pamuviri. Analyses vanofanira kutora uye baba vomwana. Kana mukana wokuti kusapindirana kweropa-kunetsana zvakakwirira, vakadzi vane pamuviri zvinofanira kuongororwa mwedzi wose. On the 32 fung vhiki Murabhoritari nemiedzo yaitwa kaviri pamwedzi, nezuva 36th - vhiki ose kusvikira pakusununguka. Kana kuona kusapindirana kweropa-kupesana pamuviri, muchidzidza achasarudza zviri antibodies mumuviri waamai. Kwokutanga chirwere zvokurwara, rezasi ngozi yematambudziko, sezvo migumisiro kusapindirana kweropa-kunetsana rinoungana pamusoro nguva.

Ultrassom uye invasive nzira ngozi tinyatsonzwisisa kuti mudumbu

Rokuongorora immunological kunetsana amai uye mudumbu zvose, akatakurwa Ultrasound nguva dzinenge ina kubva 20 kusvika 36 vhiki pamuviri uye napamberi pakusununguka. Ultrassom unokubvumira chamber zvechadenga mudumbu, uyewo kuziva kuvapo abnormalities.

Kudzidza Anoongororawo mamiriro uye kukura placenta, fetus abdominal vhoriyamu, Líquido fluid achiine rukuvhute tambo mutsinga.

Zvokuwedzera dzinoshandiswa unonzi, electrocardiograph, cardiotocography, phonocardiography kuti kubvumira mudumbu kuona padanho hypoxia mune rhesus kunetsana. Zvokuzobatsira mashoko invasive kupima - kudzidza Líquido mvura nokuda amniocentesis uye achiine rukuvhute tambo neropa cordocentesis. Chirwere pakati Líquido mvura kuti aone titer antirhesus miviri, bonde ari mwana, fetus zvemapapu kukura yacho. Chaiwo mwero chirwere chirwere ne kardotsentoza ropa boka uye kusapindirana kweropa chinhu fetus tambo ropa. Uyezve, ongororo dzinoratidza kuvapo whey mapuroteni, Chizenga, bilirubin, reticulocytes, antibodies, wakaiswa pamusoro erythrocytes.

mabatiro

Kana kukonana dzakaonekwa mai uye boka ropa fetus, anoita chete zvinobudirira pakurapa ropa riri fetus kuburikidza achiine rukuvhute tsinga mukati mudumbu. The nzira rinoitwa kudzorwa Ultrasound. chiyero Izvi zvinobvumira kuderedza ezvinhu mudumbu, achawedzera pamuviri, kuderedza zviratidzo kupererwa, hypoxia.

Kuderedza migumisiro kusapindirana kweropa kunetsana okisijeni ARV kuitwawo basa zvazvingava nonspecific kurapa, izvo zvinosanganisira mavhitaminzi, kugadzirira ane kugutsikana yamatare, calcium, antihistamines. Kana mwana asati azvarwa kuchengetwa chakakomba ezvinhu, mashoko Caesarean chikamu rinoitwa vhiki 37-38 akazvitakura. Uyewo, vakadzi vane pamuviri dzakabatwa plasmapheresis, izvo zvinoderedza zviri antibodies muropa kuti ropa masero matsvuku ari mudumbu.

Pashure pakaberekwa mwana akatakura ropa chinotsiva kutsiva wakaputsika erythrocytes uye taurira hemolytic chirwere - dropper inobuda zvine chepfu kubva mumuviri uye kunoderedza erythrocyte kuora, irradiation pamwe ultraviolet mwaranzi. Treatment kunoda kosi yokurapa, vachiongorora neonatologists, dzimwe nguva mwana ukaiswa muimba yevanenge. Zvokudya mwana ari pazamu mukaka haana yakarumbidza panguva 2 weeks okutanga pashure pokuberekwa panyaya hemolytic chirwere.

Genera pamwe Rhesus kunetsana

Kakawanda magumisiro pamuviri pamberi kusapindirana kweropa-kunetsana - rokusamhanyira pakuberekwa. Saka, basa vanachiremba ndiko kuwedzera nokubereka vana, nzwisisika richiona waro pakukura kwacho. Nokuti nechirwere munguva yose nguva pamuviri vakatakura Ultrasound, Doppler, CTG. Kana zvimwe kuva nengozi kuti mudumbu, chisarudzo musi pakuzvarwa vakamhanyira.

Kazhinji, kana mukubereka vana Rhesus hondo yapera caesarean chikamu. Kubereka muropa hadziwanzowaniki chaizvo uye chete kana fetus ezvinhu ari dzinogutsa uye mwana wavo upenyu hausi panjodzi. Caesarean chikamu ichaongororwa kupfuura vakachengeteka uye munyoro kune azvarwa. Pakusununguka kunoda kuvapo neonatologists kuita nokumutswa kana zvakakodzera. Kuzvarwa zvinofanira kuitwa munyika vakanyatsoshongedzwa ose anodiwa wezvokurapa michina uye kwakavakirwa pasi pokudzora vanachiremba zvikuru vaikodzera.

matanho

Makakatanwa "mai-mudumbu" panguva pamuviri kunogona kukonzera mutsekwende mwana. Naizvozvo, kukosha matanho makuru zvainanga kudzivisa kusapindirana kweropa-kurwisana uye kukura isoimmunization. Kana kuwedzerwa ropa kunokosha kufunga kugarisana pamwe nomupi zvakakodzera kuponesa wokutanga pamuviri chete, asi kudzivirira pamuviri. Zvinokoshawo ndezvokuti ndiye nokungwarira kuronga pamusoro pamuviri. Kudzidza mapoka ropa, kusawirirana kweropa raamai chinhu chichaita kuti kusapindirana kweropa-kunetsana pamuviri. Table boka ropa kugarisana kudzivisa matambudziko ramangwana. Zvinofanira ngadziteerere nzira pamuviri. Sezvo prophylaxis vaishandisa intramuscular jekiseni kusapindirana kweropa immunoglobulin kubva ropa anyatsoronga vakadzi kusapindirana kweropa negative uye kwakawedzera susceptibility kune zvakanaka antigen. gadziriro iyi anoparadza masero matsvuku eropa akanga akanaka kubva mutakuri kusapindirana kweropa chinhu, nokudaro kuderedza ngozi isoimmunization uye kusapindirana kweropa kunetsana.

The majekiseni vakatakudzwa kubva pashure kugumiswa pamuviri, zvinoguma nokupfupfudzika, intrauterine kuvhiya kudzivirira pamuviri. Uyewo, kusawirirana kweropa raamai masoja globulin, chinotarisirwa kuti vakadzi vane pamuviri weboka racho ngozi panguva vhiki 28 uye zvakare pa 34 kuderedza mukana wokuti pave hemolytic chirwere azvarwa. Uyewo jekiseni chinotarisirwa mumazuva 2-3 aberekwa, nokudaro kuderedza ngozi Rhesus-kupesana tevera pamuviri. Immunoglobulin chinotarisirwa nomumwe pamuviri, kana mukana wokuva mwana uine kusapindirana kweropa chinhu.

Nokudaro, kusawirirana kweropa raamai-kupesana mai uye mudumbu haasi chikonzero kugumiswa pamuviri. Mukana wokuti dzichiri Rhesus kunetsana kuri diki chaizvo, saka hapana chikonzero mwoyo. Nemhaka nokufambira mberi immunology ano pane nguva dzose kukwanisa kushandisa simba uye utano mwana a.