Keywords
Abstract
Tug‘ma yurak nuqsonlari bo‘lgan bolalarda o‘pka qon aylanishining ortiqcha yuklanishi dastlab sezilarsiz kechishi, keyinchalik esa o‘pka tomirlari qarshiligining oshishi va o‘ng qorincha faoliyatining buzilishiga olib kelishi mumkin. Xavfni erta aniqlashda yurakdagi anatomik nuqson, qon oqimining yo‘nalishi, kislorod bilan to‘yinganlik va exokardiografik o‘zgarishlar birgalikda baholanishi zarur. Faqat bitta bosim ko‘rsatkichiga tayanish bolaning umumiy holatini to‘liq tavsiflamaydi [1], [2]. Ushbu maqolada klinik hamda laborator belgilar yordamida o‘pka tomirlaridagi o‘zgarishlarni tizimli talqin qilish masalalari yoritiladi. Chop etilgan klinik materialda tug‘ma yurak nuqsoni bo‘lgan 139 bola ko‘rib chiqilgan; ulardan 94 nafarida o‘pka gipertenziyasi belgisi aniqlangan, 45 nafarida esa bunday belgi bo‘lmagan. Ayrim kichik guruhlarda o‘pka arteriyasidagi o‘rtacha bosimning oshishi qonda kislorod bilan to‘yinganlikning pasayishi bilan birga kuzatilgan. Endotelin-1, endoteliy o‘sish omili, interleykin-1 va natriyuretik peptid kabi markerlar kasallikning fiziologik mexanizmlarini tushunishda qo‘shimcha ma’lumot berishi mumkin [3], [4]. Biroq ular invaziv gemodinamik tekshiruvning zarur bo‘lgan holatlardagi o‘rnini avtomatik ravishda bosa olmaydi. Bolaning yoshi, nuqson turi, shunt hajmi va ko‘rik paytidagi klinik barqarorlik xavfni baholashda alohida ahamiyatga ega. Exokardiografiya ko‘p hollarda dastlabki tanlov usuli bo‘lib, murakkab vaziyatlarda maxsus markazda kengaytirilgan tekshiruv talab etiladi. Maqolada ko‘rsatkichlarni takroran o‘lchash, bir necha belgi o‘rtasidagi moslikni tekshirish va natijalarni mutaxassislar kengashida muhokama qilish prinsiplari asoslanadi. Matn yangi klinik sinov sifatida emas, mavjud kuzatuvlar va amaldagi tavsiyalarning tahliliy sharhi sifatida taqdim etiladi. Muayyan laborator chegara qiymatini barcha yosh guruhlariga qo‘llash diagnostik xatoga olib kelishi mumkin. Shu sababli qo‘llanilgan test usuli, bolaning tana yuzasi va umumiy klinik holati nazoratning tarkibiy qismlari deb qaraladi. Xavf belgilarining ketma-ket paydo bo‘lishi ham bir martalik ko‘rsatkichdan ko‘ra muhimroq bo‘lishi mumkin. Sifatli kuzatuvning maqsadi to‘liq tasdiqlanmagan xulosani erta e’lon qilish emas, zarur paytda to‘g‘ri tekshiruvni tanlashdir.
References
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