HSP-GU-260-002 Cardiopatia Congenita Neonatal

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  • 8/2/2019 HSP-GU-260-002 Cardiopatia Congenita Neonatal

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  • 8/2/2019 HSP-GU-260-002 Cardiopatia Congenita Neonatal

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    @NL@NDe@ B@UD]AKMDGDQ@ A*Ld|peq n\ebdj Mdnex } CD\_EQ@NEY@LEDJ[JnD@A AK ]KLEKJ J@LEAD\

    KXEAKJLE@ LEKJQeHEL@9K|q` g{e` |k m`|` kj }kldbkja`ledjk| ak kspk}qd|. p{k| n`| p}ejlep`nk| m`|k| aka qd| {k kse|qkj kj l }aedndge jd |dj `pnel`mnk| ` pkae q}e u jd qekjkj |{helekjqk|k|q{aed| p`}` kbeqe} }kldbkja`ledjk| lnejel`| ldj kxeakjle lekjqehel * Akjq}d ak n`}kxe|edj ldjlk}jekjqk ` l`}aedndgh` ejh`jqen. |dn`bkjqk p{kakj |k kbeqe}}kldbkja`ledjk| lekjqehel`| kj kn b`jkid ak a{lq{| `}qk}ed|d pk}|e|qkjqk kcepdqkj|edj akn p}kb`q{}d* Ejln{|d akjq}d akn b`jkid ak n`| l }aedp qe`| kse|qk {j`aehk}kjle` kj kn b`jkid ldj }k|{nq`ad| |eben`}k| kj nd| aehk}kjqk| g}{pd| akkspk}qd| kj kjhk}bka`ak| l`}ae l`| ldjkjeq`|*0* I[\QEHEL@LEDJ

    N`| l`}aedp`qe`| ldjkjeq`| |dj `nqk}`ledjk| `j`qd}jel`| {k p{kakj |k}pdqkjle nbkjqk bd}q`nk| |e jd |k |d|pklc`j u ae gjd|qel`j ` qekbpd*

    =* AKHEJELEDJK\ U @\_KLQD\ LDJLK_Q[@NK\

    N` ejleakjle` ak n`| l`}aedp`qe`| ldjkjeq`| x`}e` ak 3 ` 0? pd} 0*??? ak nd| }klekjj`lead| xexd. ak nd| l{`nk| kn ;?+ `p}dseb`a`bkjqk. p}k|kjq`}`j |ejqdb`| kj knpk}edad jkdj`q`n* @{j{k n` bd}q`nea`a c` m`i`ad ` `n}kakad} ak {j 0?+ kj p`e|k|ak|`}}dnn`ad|. kj j{k|q}d bkaed n` bd}q`nea`a |eg{k |ekjad b{u `nq` akmead ` n` jdae|pdjemenea`a ejbkae q` ak bkaed| ae jd|qeld| u `n aehelen `llk|d ak nd| p`lekjqk|` ej|qeq{ledjk| k|pkle ney`a`|*

    N`| ejael`ledjk| p`}` kn ae jd|qeld u p}dlkaebekjqd| qk}`pk{qeld| {k |k }k`ney`jldj m`|k kj n`| @LL E@C@ G{eaknejk| hd} qck B`j`gkbkjq dh _`qekjq| weqcx nx{n`} Ck`}q Ae|k`|k*\k ldj|eak}`j ldbd l0`|k E9 n` ce|qd}e` lnejel` d}ekjq`a` c`le` n` |ejqdb`qdndge`l }aedndel`6 n` kspnd} ledj l }aedndel` ldbpnkq ejln{ukjad n` qdb` ak n` p}k|edj{k. |k qd}j`}` kj nd| 1 bekbm}d| kj l`|d ak |d|pklc` ak ld`}q`ledj ak `d}q`. n`| q{}`ledj ak dsegkjd. u n` p}dhen`se| `jqe kjadl }aeqe| m`lqk}e`j` KE kld"adppnk} k|{jd ak nd| ks`}jkjk| ebp}k|lejaemnk| kj qda` |d|pklc` lnhjel` ak l }aedp`qh *KE {|d ak n`| qkljel`| ak ae`jd|qeld u ak q}`q`bekjqd k| b{u ebpd}q`jqk p`}``|kg{}`} {j` qk}`pk{qel` dpqeb` u khklqex` ak ed| p`lekjqk| l`}aedndeld| uldj|kg{e} {j` }kn ledj ld|qd"mkjkheled `akl{`a`*

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    [JEA@A AK ]KLEKJ J@LEAD\N`| g{h`| ak p}`lqel` lnejel` ejqkjq`j l{bpne} k|k p}dpd|eqd pk}d |dj aehhlenk| akk|q`mnklk} kj l`}aedndgh` pkae q}el| N`| p`}qel{n }ea`ak| he|edp`qdndel`| akn }klekjj`lead. n` ldbpnkiea`a `j`qdbel` ak b{lc`| l`}aedp`qe`|. |{| hd}b`| akp}k|kjq`ledj lnejel`. n`| aehel{nq`ak| ae`jd|qel`| u qk}`pk{qel`| u n` p}k|kjle` ak}k|ea{d|. |kl{kn`| u ldbpnel`ledjk| ak n`| qkljel`| {e}{}el`| c`lkj m`|q`jqkldbpnki` n` kn md}`ledj ak g{e`| kj k|q` ka`a*LDJ\EAK]@LEDJK\ GKJK]@NK\ KJ KN JKDJ@QD LDJ \D\_KLC@ AKL@]AED_@Qe@ LDJGKJEQ@Kj kn jkdj`qk ldj |d|pklc` ak l`}aedp`qe` ldjkjeq` akmkj qkjk}|k kj l{kjq` q}k|`|pklqd| h{ja`bkjq`nk|9

    \{knk q} q`}|k ak l`}aedp`qe`| g}`xk|* \{| b`jehk|q`ledjk| lnhjel`| k|q`j ldjaeledj`a`| pd} nd| l`bmed|ck}jdaej`}jeld| ak q}`j|eledj kjq}k n` le}l{n le8j hkq n u n` `a{nq * Kj k|q` ka`a. n` kse|qkjle` ak p`qdndgh` ksq}` l`}ae`l` p{kak `hklq`} `n|e|qkb` l`}aedx`|l{n }. |eb{n`jad l`}aedp`qn` ldjkjeq`*

    N`| l`}aedp`qe`| ldjkjeq`|. ldj lnnjel` jkdj`q`n u aki`a`| ` |{ kxln{ledj j`q{} n.qekjkj {j` bd}q`nea`a knkx`a`. mekj pd} q}`q }|k ak l`}aedp`qe`| ldbpnki | ? pd}p}k|kjq`}|k ak hd}b` b{u |kxk} . kj kn l`|d ak n`| |ebpnk|* K| h{ja`bkjq`n {j `nqdejaelk ak |d|pklc` p`}` ejele`} 0 ? `jqk| pd|emnk kn q}`q`bekjqd bkaeld. {k kj n`b`ud}e` ak nd| l`|d| ldj|qeq{uk kn p`|d ejqk}bkaed p }` n` le}{ge *\EQ[@LEDJ CKBDAEJ@BEL@ Q]@J\ELEDJ@NBdbkjqd| ak|p{k| akn j`lebekjqd |k p}da{lkj {jd| p}dh{jad| l`bmed| kj n`he|edndgh` l`}aed p{nbdj`} `n ldbkjy`} n` }k|pe}`ledj p{nbdj`}. |{p}ebe}|k n`le}l{n`ledj pn`lkjq`}e` u knebej`}|k n`| ldb{jel`ledjk| kjq}k n`| le}l{n`ledjk|xkjd|` u `}qk}e`n. q}`j|hd}b`jad|k n` le}l{n`le8j kj p`}`nknd p}dpe` akn hkqk kj {j`le}l{n ledj kj |k}ek ldbd n` akn `a{nqd*K| n` nE`b`a` |eq{`ledj ck}jdaej`bel` q}`j|eledj`N KE `{bkjqd ak n` ksp`j|edjp{nbdj`} u n` knkx`ledj akn ldjqkjead ak dshgkjd `nxkdn`}. |kl{ja`}ed| `n ejeled aknd| bdxebekjqd| }k|pe}`qd}ed|. p}da{lkj {j` `lkjq{`a` x`|d aen`q`ledj p{nbdj`}ldj }ka{lledj ak n`| }k|e|qkjle | x`|l{n`}k| u }`pead `{bkjqd akn hn{id p{nbdj`}.pk|k ` 0 ? l{`n |k }ka{lk n` p}k|edj `}qk}e`n p{nbdj`} ak b`jk}` jdq`mnk kj nd|p}ebk}d| an`| ak xea` u b`| nkjq`bkjqk kj nd| bk|k| |eg{ekjqk|. ` kspkj|`| ak n`}ka{lledj ak n` l`p` b{|l{n`} ak n`| pk{k}e`| `}qk}e`| p{nbdj`}k|. {k k|q` b{u`{bkjq`a` kj n`| {nqe}j`| |kb`j`| ak xea` hkq`n* N` l`ea` ak n`| }k|e|qkjle`|

    _`jnj` < zk 01

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    Cd|peq n\ebdj Mdnex } CD\_EQ@NEY@LEDJ

    [JEA@A AK ]KLEKJ J@LEAD\p{nbdj`}k| |k `ld}jp`}e` ak {j ebpd}q`jqk ejl}kbkjqd ak n`| |e|qk}jel`| `n ne`}|kkn ld}a8j {bmenel`n u ksln{e} ak n` le}l{n`le8j {j `}k` ak m`i`| }k|e|qkjle`| ldbd k|n` pn`lkjq`* Nd| l`bmed| kj n`| }k|e|qkjle`| x`|l{n`}k| p{nbdj`}k| u |e|qkbel`|p}da{lkj {j` ejxk}|e8j q}`j|eqd}e` akn hn{id kj kn a{lq{|. {k |k c`lkbd}jkjq`jk`bkjqk ey{ek}a` ` ak}klc`. p}da{lekjad|k |{ lek}}k h{jledj`n ` n`| 0=` 0; c ak xea` bkae`jqk {j` jdq`mnk ldjq}`lledj ak |{ l`p` bkae` b{|l{n`}.k|qeb{n`a` pd} kn `{bkjqd akn ldjqkjead ak dshgkjd |`jg{ejkd u n` ae|bej{le8j aknd| jexknk| ak p}d|q`gn jaej`| le}l{n`jqk|*KE lek}}k akhejeqexd. bkae`ad pd} ae|}{ple8j u ckbd}}`ge` ak n` ejqeb`. |kg{ea` akq}dbmd|e| u hem}d|e| ak n` |{mejqeb`. |k p}da{lk ` nd| ;"7 ae`|. ak hd}b` c`meq{`n. uk|q` }kq}`|`ad kj nd| p`lekjqk| l}kqk}bejd. ldj a{lq{| }jkjd| |kj|emnk| `n `{bkjqdak dsegkjd u b`| `n khklqd aen`q`ad} ak n`| p}d|q`n`jaej`|. l{ud| x`nd}k| p{kakj}ka{le}|k ldj ejadbkq`lej`. {j ejcemead} jd |knklqexd ak n` p}d|q`gn`jaej |ejqkq`| *KE lek}}k akn hd}`bkj dx`n k| h{ja`bkjq`nbkjqk p`|exd. pd} kn ejl}kbkjqd akn}kqd}jd xkjd|d p{nbdj`} u n` }ka{lledj akn |e|qk}jeld `! ae|bej{e} kn hn{id ak n` xkj`l`x` ejhk}ed} q}`| n` neg`a{}` akn ld}adj {bmenel`n*L@]AED_@Qe@\ LDJGKJEQ@\ U LE]L[N@LEDJ Q]@J\ELEDJ@NN` le}l{n`le8j q}`j|eledj`n `qkj{` n`| b`jehk|q`ledjk| lnnjel`| ak `ng{j`|l`}aedp`qe`|. ldbd dl{}}k kj nd| ld}qdle}l{eqd| ey{ek}a`"ak}klc`. {k |dj bkjd||egjehel`qexd| bekjq}`| pk}|e|qk n` knkx`le8j ak n` p}k|edj p{nbdj`}. ? kj n`|nE`b`a`| l`}aedp`qh`| a{lq{| akpkjaekjqk| pd} dm|q}{lledj `n hn{id |e|qk}jeld#k|qkjd|e| `d}qel` l}eqel`. ld`}q`lndj"ejqk}}{pledj `d}qel`. xkjq}el{nd ey{ek}adcepdpn`|eld% ? `n hn{id p{nbdj`} #k|qkjd|e| p{nbdj`} l}eqel` ? `q}k|e` p{nbdj`} ldj|kpq{b ejqkg}d ? ldj ldb{jel`le8j ejqk}xkjq}el{n`}. |eq{`ledjk| kj q}`j|pd|eledj ul`}aedp`qe`| ldbpnki`| ldj `q}k|e` ? k|qkjd|e| p{nbdj`} |kxk}`% N` `nqk}`ledj aknjd}b`n ak|`}}dnnd ak n` q}`j|ele8j ldj|qeq{uk {j` kjhk}bka`a k|pklehel`bkjqkjkdj`q`n. {k |eb{n` n` lnejel` ak n`| l`}aedp`qe`| ldjkjeq`| kj kn l{`a}d ak n`cepk}qkj|edj p{nbdj`} pk}|e|qkjqk*N` cepdse` kj h`|k| q`}ae`| ak n` k|q`ledj u. |dm}k qdad. n` cepdse` ldj `lead|e| akn|{h}ebekjqd hkq`n `g{ad |kxk}d p}da{lkj {j` `lkjq{`a` x`|dldj|q}elledj `}qk}edn`}.ldj m}{|l` knkx`ledj ak n` p}k|edj p{nbdj`} {k. |{b`a` ` n` cepdse`. p{kak`hklq`} ak b`jk}` x`}e`mnk ` n` pk}h{|edj u dsekj`ledj bedl`}ael`. |dm}k qdad aknxkjq}el{nd ak}klcd. {k k| kn adbej`jqk kj k|qk bdbkjqd* KE l{`a}d p{kak xk}|k`g}`x`ad pd} `ng{j` kjhk}bka`a `ldbp`}e`jqk ldbd ejb`a{}ky p{nbdj`}. cepdak|`}}dnnd p{nbdj`}. cepdpn`|e` p}ebeqex`. ck}je` ae`h}`b`qel . p`qdndge` p{nbdj`}.l{`a}d| `|pe}`qexd|. jk{bdje`. kjhk}bka`a ak bkbm}`j` ce`nej`. dm|q}{lledj ak

    _``ej` 1 ak 01

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    xe`| `k}k`|. `q}k|e` ak ld`j`|. |eja }dbk ak _ek}}k ]dmej. `hklq`ledj akn |e|qkb`jk}xed|d lkjq}`n. cepk}xdnkbe`. pdneleqkbe`. ceid ak b`a}k ae`mkqel`. cepdgnelkbe`.cepdl`nlkbe`. kql*. u |k q}`a{lk kj cepdskbe` ebpd}q`jqk pd} ld}qdle}l{eqd ak}klc`"ey{ek}a` `{}el{n`} u 0? a{lq`n #|eja}`bk ak pk}|e|qkjle` ak le}l{n`ledj hkq`n% ug}`ad| x`}e`mnk| ak ae|h{jledj xkjq}el{n`} pd} e|{kbe` |{m kjadl`}ael` #|eja }dbkak e|{kbe` bedl`}ael` q}`j|eqd}e`%. {k `hklq` ` `bmd| xkjq}el{nd|. pk}`h{ja`bkjq`nbkjqk `n ak}klcd. u p{kak dl`|edj`} ej|{helekjle` ak n`| x`nx{n`|`{}el{ndxkjq}el{n`}k|. |dm}k qdad ak n` q}el{|peak* KE q}`q`bekjqd |k m`|` kj knebej`}nd| h`lqd}k| h`xd}klkad}k|. `lq{`} |dm}k n` cepk}qkj|edj p{nbdj`} u n` cepdse`#xkjqen`ledj `|e|qea` ldj p`lekjqk }kn`i`ad. cepk}xkjqen`le8j l{ea`ad|` p`}` p}da{le}`nl`nd|e|. knkx`a`| ldjlkjq}`ledjk| ak dsegkjd ej|pe}`ad. x`|daen`q`ad}k| qepd dseakjeq}eld u. kj l`|d| ksq}kbd|. ae|pd|eledj ak `|e|qkjle` xkjq}el{n`}. ? KLBD. u`lq{ }|dm}k kn ldbpdjkjqk }jedl`}aeld p}k|kjqk%*

    7;+ |ej }k|p{k|q` `n qk|q akcepk}dse`. l{`jad `p`}klk `lead|e| ldj pC >7.= pdakbd| k|q`} `jqk kn lek}}k akna{lq{| {k p}klkak kn akqk}ed}d lnejeld |kxk}d |k akmk qdb`} {j` }`aedg}`he` ak >qd}`s p`}` aehk}kjle`} ad| g}{pd| ak p`lekjqk|9

    Ldj hn{id p{nbdj`} ae|bej{ead9 l`}aedp`qe`| ldj dm|q}{lledj `n hn{idp{nbdj`}. {k ejln{ukj p`qdndge`| {k `hklq`j n` x`nx{n` p{nbdj`} u n`q}el{|peak. |ekjad |{pnead pd} kn a{lq{| ak|ak n` `d}q` ` n` p{nbdj`}#ld}qdle}l{eqd ak ey{ek}a` ` ak}klc`%* \k ejln{ukj kj k|qk g}{pd9 Qkq}`ndge`ak H`nndq # ]S Ld}`ydj kj hd}b` ak Y{kld%. @q}k|e` Q}el{|peak` |ejq}`j|pd|eledj ldj LEX }k|q}elqex` ? ldj k|qkjd|e| p{nbdj`}. `q}k|e` p{nbdj`}

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    ldj |kpq{b EX ejqkg}d. `q}k|e` p{nbdj`} ldj LEX. k|qkjd|e| p{nbdj`} l}nqel`.Xkjq}el{nd ak}klcd ak admnk |`nea` ldj k|qkjd|e| p{nbdj`}. xkjq}el{nd {jeldldj k|qkjd|e| p{nbdj`}. `jd}j`ne` ak Kp|qkej g}`xk # ]S ldj l`}aedbkg`ne`b`|ex`%* Jd qda`| k|q`| p`qdndge`| p}kle|`j akn a{lq{| `mek}qd p`}`b`jqkjk} {j` dsekj`ledj k|q`mnk u `akl{`a` # ki9 qkq}`ndge` ak H`nndq% p{k|kn hn{id ak|ak kn XA ` n` `}qk}e` p{nbdj`} p{kak |k} |{helekjqk `{j{kae|bej{ead* \e n` |`q{}`ledj ak dsegkjd kj bkjd} ak 7?+ ? kse|qk `lead|e|ldj pC >7.= . k|q` ejael`ad ejele`} _}d|q`gn`jaej` K*

    Ldj hn{id p{nbdj`} `{bkjq`ad ? jd}b`n9 kn d}egkj ak n` le`jd|e| |k akmk `{j` `{|kjle` ak `akl{`a` ld}j{jel`ledj kjq}k n`| ad| le}l{n`ledjk| #kjp`}`nknd% ` jexkn `{}el{n`} #Hd}`bkj dx`n pk}bk`mnk :;bb ? `q}ed|kpqd|qdbe`ak ]`|cfeja% xkjq}el{n } ? akn a{lq{|* \k ejln{ukj9 Q}`j|pd|eledj ak g}`jak|X`|d| #A"QG@% #]s9 ld}`ydj kj hd}b` ak c{kxd%. q}`j|pd|eledj ldj akhklqd`|dle`ad # LEX b`| ld`}q`ledj `d}qel`%

    KE q}`q`bekjqd ldj _GK0 qekjk ad| pd|emnk| kslkpledjk|. q}`| kn ae`jd|qeldkll}`held9 n` qkq}`ndge` ak H`nndq ln`|el` # ldj m{kj hn{id pd} kn q}`lqd ak |`nea` aknXA u m{kj`| }`b`| p{nbdj`}k|% u n` A"QG@ ldj LEX g}`jak |ej ld`}q`ledj#|{helekjqk bkyln` xkjq}el{n`} ldj `{bkjqd akn h{id p{nbdj`}%=* L`}aedp qe | ldj cepd pk}h{|edj `e|qkbel`9 n` l`}`lqk}e|qel` p}ejlep`n k| n` b`n`pk}h{|edj pk}ehk}el` # m`id g`|qd l`}ae`ld% u {k xekjk akhejea` pd} c`nn`ygd| ldbdp`neaky. p{n|d| akmenk| ? jd p`np`mnk|. ksq}kbea`ak| h}e`|. aehel{nq`a }k|pe}`qd}e`.dneg{}e` ? `j{}e` u `lead|e| bkq`mdnel` pd} h`nq` ak dsekj`ledj*K|qk g}{pd p{kak |k} aexeaead ` |{ xky |k`j akpkjaekjqk| ? jd akn a{lq{| `}qk}ed|dp`}` b`jqkjk} {j `akl{`ad hn{id |e|qkbeld*

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