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AFGONA

1200px-ranunculus_abortivusAFGONA (Praematurus, abortivus), fagona, chala, kudaki norasida, tifle, ki pesh az muhlat, yane dar haftahoi az 28 to 37-umi homilagi (vazn – az 1000 to 2500 g; qad – az 35 to 45 sm) ba dunyo omadaast. Pesh az in muhlatho tavallud yoftani tifl, bacha aftondan yo kudak vayron kardan nomida meshavad. Vale bazan chunin kudakon niz dar surati khub ba roh mondani nigohubin qobili hayot meboshand; agar kudak dar muddati 168 soat (yak hafta) nafavtad, pas uro tifli zinda ba dunyo omada mehisoband. Baroi kudakoni vaznashon 500 – 999 g shubahoi makhsusi nigohubin vujud dorand.
Sababi ba guruhi alohida judo kardani chunin navzodon in ast, ki A. bo vujudi muvofiqi sinni khud mutadil inkishof yoftan, baroi mustaqil vujud doshtan nagz mutobiq nest va nigohubini jiddi mekhohad. Az in ru ba A. haftahoi avvali badi tavallud faqat dar shubahoi makhsusi bemorkhonaho va zeri nazorati doimii dukhtur nigohubin kardan mumkin ast (in sharti zarurii minbaad durust inkishof yoftani kudak meboshad).
CHala ba dunyo omadani kudak sababhoi gunogun dorad, mas., nihoyat javon (az 20-sola khurd) budani modar; bo nojuriho jarayon giriftani davrai haml (bemorihoi tifl, toksikozhoi homilagon, dugoniku segonikho va g.); bemorihoi az sar guzaronidai zani homila, isqoti qabli; nomuvofiqii rezus-omil va guruhi khuni modar va kudak; osebhoi jismoni va ravonii modar; zahroludi az mashrubot, tamoku va g.
Dar in bobat sharoiti zindagii zani homila niz maqomi kalon dorad. Osebi asabiyu ruhi va jismoni, sharoiti vaznini mehnat (ziyoni kasbi, mas., dar sharoiti istehsoloti khimiyavi kor kardan), vaziyati nokhush dar oila niz sababi tavalludi barmahal shuda metavonad.
Alomoti anatomiyu fiziologii afgona. Afgonagi (norasidi) darajahoi gunogun dorad: darajai I – vazni kudak hangomi tavallud 2500 – 2001 g ast; darajai II – vazni tifl 2000 – 1501 g meboshad; darajai III – vazni tifl 1500 – 1001 g ast; darajai IV – vazni tifl az 1000 g kam meboshad. Kudakoni vaznashon 1500 va kamtar az onro kudakoni norasidai amiq menomand. Vobasta ba muvofiqat kardan yo nakardani vaznu qad ba sinni gestatsiyavi (muhlati haml dar vaqti tavalludi tifl) A.-ho 2 guruh meshavand: kudakoni rushdi jismoniashon ba muhlati gestatsiya muvofiq va kudakoni inkishofi jismoniashon ba muhlati gestatsiya nomuvofiq. Dar A.-ho nishonahoi norasidi ba mushohida merasand: tanosubi vazn nisbat ba qad 25 – 50 ast, hol on ki dar kudaoni rasida on barobari 60 – 80 meboshad; darozii sar 1/2 hissai darozii tanro tashkil medihad (dar kudakoni rasida – 1/4); poyho nisbatan kutoh, pust surkhi jilodor, sermuy, tunuk va purchin ast; sufrai gush narm buda, ba sar chaspida meistad; nof khele poyon joy giriftaast; nokhunho va azoi tanosul inkishof nayoftaand – dar pisarchaho tukhm ba khoya nafaromadaast, dar dukhtarchaho boshad, labhoi kaloni farj labhoi khurdi onro faro namegirand; faoliyati reflekshoi fiziologi zaif ast (hatto mumkin reflekshoi makish va furu burdan vujud nadoshta boshand); ovozi kudak past va sathi, nafas nomurattab meboshad. Najosati A. az sababi nomukamalii medayu ruda aksar vaqt sabzrang buda, gurushahoi safed dorad. Gurdaho niz nomukammal kor mekunand.
Faqat az rui vazn va qad qazovat kardan dar borai kudak chala durust nest, khususan dar surate, ki agar muqarrar namudani muhlati haml dushvor boshad. Zero kudakone niz duchor meoyand, ki qadu basti onho raso ast, vale khud chala meboshand. Baroi durust oshkor sokhtani norasidi boyad muhlati haml va majmui alomathoi zikryofta ba etibor girifta shavand.
Davrai navzodii A.-ho ba darajai balogati fiziologi vobasta ast. Dar chunin kudakon eritemai muqarrari (katari fiziologii pust) nisbatan vozeh ba nazar rasida, nisbat ba eritemai kudakoni digar beshtar – to 2 hafta mahfuz memonad. Zafarmai fiziologi, odatan, der rukh namuda, to haftai 3 – 4-umi badi tavallud davom mekunad. Nofi A.-ho gafsu «sershira» ast va der (bisyor vaqt badi 8 – 14 ruz) meaftad. Dar bisyor A.-ho dar haftai 1 – 2 varam (asosan dar shikam va poyho) ba mushohida merasad. Tanzimi harorat dar onho nomukammal buda, kudaki belibos zud khunuk mekhurad, harorati badan mumkin az 36° poyon faroyad; hangomi baland shudani harorati muhit u zud tasf mekunad («tablarzai kuvezi»).
Talafi fiziologii vazn, odatan, dar haftai 2 – 3 barqaror meshavad. Binobar sababhoi nomusoide, ki boisi chala ba dunyo omadani kudak shudaand, A. dar mohi avvali hayot nisbatan kam – az 100 to 500 g vazn megirad. Kudakoni chalai darajai IV, ki giriftori bemorihoi jismi meboshand, dar mohi yakum mumkin umuman vazn nagirand (onho faqat talafi fiziologii vaznro barqaror mekunandu khalos).
Basomadi nafas nomuntazam buda, hangomi harakat dar 1 daq. ba 60 – 80 merasad; dar holati oromi va khob nafas nisbatan bomarom, goho hatto qat (dar vaqti gizodihi) megardad. Vobasta ba sharoiti muhit va holati kudak basomadi kori dil tagyir meyobad (120 – 160). Dar surati bezobitagi va baland gashtani harorati muhit, basomadi kori dil metavonad dar 1 daq. ba 200 zarba barobar shavad.
Dar navzodhoi chala bisyor vaqt asfiksiya va khunshorii dokhili kosakhonai sar ba vujud meoyad; onho zud-zud giriftori pnevmoniya va sepsis meshavand (sababi on sust budani aksulamali mutobiqat nisbat ba sharoiti muhit ast). Nishondodhoi immuniteti khos va nomakhsus dar A.-ho nisbat ba kudakoni hamsinni raso past meboshand. Dar mohhoi 2 – 3, vaqte ki kudak bojadal vazn paydo mekunad, dar A.-ho anemiyai barmahal paydo meshavad (on khususiyati normokhromi dorad). Dar mavridi durust nigohubin kardan, anemiya tadrijan raf meshavad. Az 83 g/l past faromadani gemoglobin muolijaro taqozo menamoyad. Badi 3-mohagi rukh namudani anemiya (anemiyai takhirnok) dar A.-ho bisyor vaqt khususiyati kamohani doshta, bo doruhoi ohandor tabobat karda meshavad.
Sabzishu inkishofi A.-i az 1-moha bolo ba vazi salomati va darajai norasi vobasta ast. A.-hoi salomatiashon khub zudtar rushdu inkishof meyoband. Onho, odatan, az mohi 2-yum sar karda, vazn megirand; dar okhiri soli avval vazni onho 4 – 10 marotiba meafzoyad. Vobasta ba darajai norasi qadu basti A.-ho dar nimsolai yakum har moh 2,5 – 5,5 sm, dar nimsolai duyum 0,5 – 3 sm mesabzad. Dar muddati yak sol qadi onho 25 – 44 sm afzuda, okhiri sol ba 70 – 75 sm merasad. Qati nazar az on ki afzoishi qadu bast va vazni A.-ho nisbat ba kudakoni digar teztar ast, in nishondodho dar 3-solagi, dar kudakoni norasidagii darajai IV, hamchunin dar A.-hoi mariz va vaznashon kam boshad, soli 7 – 8-um qiyos karda meshavand. Ehtimol dorad, ki dar davrai balogati jinsi rushdu sabzishi A. az digar kohish yobad. A.-ho der meshinand, der roh meravand, der dandon mebarorand va der mustaqilona gizo mekhurand.
Rushdi asabivu ruhi (tabassum kardan, gap zadan va g.)-i A.-ho niz sust ast, khosa dar kudakone, ki vazni kam doshtand. Baroi inkishofi nutqi A. tarbiya dar oila ahamiyati kalon dorad. Tadqiqotho sobit mekunand, ki dar surati mavjud nabudani osebi dokhilibatni yo illathoi digar, rushdi ruhiyu ravonii A.-ho dar davrai sinni tomaktabi az digar kudakoni hamsin farq nadorad. Kudakoni chalae, ki dar batni modar oseb yoftaand, odatan, giriftori ikhtiloli asab, sar, zafi ruhi meshavand. Gayr az in, ehtimol dorad, ki dar A.-ho dar solhoi minbadai hayot dilbehuzuri va beishtihoi ba mushohida rasand. Umuman, A.-ho hamchun odamoni komil ba voya merasand.
Nigohubini afgonaho. Nomukammalii kori organizmi A. nigohubini jiddi va faroham ovardani sharoiti musoid (khususan dar mohhoi avvali hayot)-ro taqozo dorad. Agar hamai in shartho rioya gardand, on goh A. dar inkishofi jismoni va fikri ba hamsoloni dar muhlati muqarrari tavalludyofta barobar meshavad va chun odami az har jihat komil ba kamol merasad.
A.-ero, ki vaznash 2300 g ast, vobasta ba vazi salomatii u va sharoiti khona bo ijozati dukhtur az tavalludkhona javob medihand. A.-i hangomi tavallud vaznash az 1500 g kamro dar kuvezhoi haroratu namnokiash mutadil va oksigendor joy medihand. Ba kuvezho inchunin kudakonero, ki vaznashon ziyod, ammo harorati badanashon tagyiryobanda ast, joygir mekunand. Agar vazni tifl ba 2500 g rasad, dukhtur ijozat medihad, ki uro ba khona barand.
Baroi dar sharoiti khona nigoh doshtani A. diqqati kalon va nigohubini jiddi zarur ast. Harorati khonai tifl boyad 22 – 24° boshad. Dar katcha ba tagi sar va kitfoni u bolini sakhti past meguzorand. Kudakro sakht parpech kardan joiz nest, uro dam ba dam az yak pahlu ba pahlui digar mekhobonand (vazi badanashro tagiyr doda meistand.)
Ba tifl libosi garmu narm pushonda, ba kampal mepechonand. Ba sar kulutai gushakdor (chepchik) pushonida, ruyashro kushoda memonand. Agar A. harorati badanashro durust nigoh doshta natavonad, ba poyoni poy va du pahluyash garmkunak meguzorand. Haror. obi garmkunak boyad taqr. 600 boshad. Garmkunakro ba sachoq yo parpech pechonda, dar masofai taqr. 10 sm az kudak meguzorand. Harorati badani kudak boyad 36,5 – 36,8,° harorati zeri kampal 28 – 33° boshad. Badi har 1 – 2 soat obi garmkunakhoro bo navbat ivaz mekunand. Hangomi garm shudan, rui kudak surkh gashta, harorati badan baland va khud noorom megardad. Dar in hol garmkunakhoro tamoman yo qisman megirand, agar lozim oyad, parpechro chand daqiqa kushoda memonand, ba kudak ob medihand. Dar surati khunuk khurdan rui kudak kabudcha shuda, khud behol megardad. Dar in asno ba boloi u boz yak kampali digar mepushonand yo 5 – 7 daq. dar daruni vannachai obash shirgarm (36 – 37°) nigoh medorand va bad boz garmkunakho meguzorand. Baroi peshgirii garm shudan yo khunuk khurdan harorati obi garmkunakro tavassuti kharoratsanj zud-zud sanjida istodan lozim ast.
A. nagz nafas kashida nametavonad. Binobar in dar ruzhoi avvali hayot ba u oksigeni namnok dodan lozim. Agar markazi tamini oksigen vujud nadoshta boshad, pas onro az bolini oksigeni ba vositai apparati Bobrov medihand. Vobasta ba behtar shudani holat va ba sharoiti navi hayot mutobiq gashtani kudak, ba garm kardanu oksigen dodan tadrijan khotima mebakhshand.
Tarzi gizodihiro vobasta ba darajai inkishofi kudak va mavjudiyati reflekshoi makish intikhob menamoyand. Ba kudakoni vaznashon ziyoda az 1800 g metavon sina makond. SHirmakonii A. dushvoriho dorad va mohhoi avval boyad zeri nazorati doimii dukhtur surat girad. SHiri zanhoi barmahal tavalludkarda dertar paydo meshavad. Bo vujudi in hangomi nigohubini A. faqat shiri modar natijai khub mebakhshad. Az in ru, A.-ro bo shiri modar tamin namudan zarur ast. Agar kudak sina makida natavonad, ba u dar avval tavassuti zond dar yak shaboruz 10 – 12 marotiba shir medihand. Bad tadrijan bo pistonak shir doda, minbad uro ba sinamaki odat mekunonand. Badi ba 2500 – 3000 g rasidani vazn gizodihi ba A. az kudaki dar muhlatash tavalludshuda kam farq mekunad, vale ba A. khuroki ilovagiro 2 – 4 hafta peshtar (bo ehtiyot va tadrijan) medihand. Ba kudakoni solim ruze 7 – 8, ba kudakoni mariz to 10 marotiba gizo dodan lozim ast. Badi ba 3500 – 4000 g rasidani vazn (odatan dar 2 – 3-mohagi) ba A.-ho ruze 6 marotiba gizo medihand. Miqdori gizoro dukhtur vobasta ba darajai chalagi, vazi salomati va nerui hozimai kudakon intikhob menamoyad. Ba onho badi 15-ruzagi obi meva dodan mumkin ast. Behtarash in korro az obi limu (3 – 5 chakra) ogoz kard. Dar 1-mohagi metavon pyurei sebi dod; az 15-ruzagi bahri bo safeda qone gardondani talabot shirtuppa (tvorog) yo kefir medihand; az 4-mohagi pyurei sabzavoti, az 5-mohagi shavla, az 6-mohagi gizoi gushti, az 7-mohagi bulyon dodan mumkin.
A.-ro hamchun tifli raso obbozi medorand. Kudakoni vaznashon 1500 g va ziyodtarro badi 7 – 10 ruz boyad obbozi dorond. Dar vaqti obbozi A.-ro az khunuk khurdan nihoyat ehtiyot kardan lozim ast; haror. havo boyad az 250 past naboshad, parpechro pesh az pechonidani kudak garm boyad kard.
Ba A. dar havoi toza sayrugasht namudan mufid va zarur ast, vale in korro boehtiyot boyad guzarond. CHunin sayrugasht ba kudakoni vaznashon az 2500 g ziyod tavsiya meshavad. Zimiston ba sayrugashti kudakone ijozat medihand, ki vazni onho 3000 g va ziyodtar ast; agar vazni kudak az 3000 g kam yo haror. havo az –8 –100S past boshad, uro dar khonai bodkhonash kushoda boyad nigoh dosht. Sayrugashtro az chand daqiqa sar karda, muhlati onro tadrijan meafzoyand.
Tavallud shudani A.-ro hanuz to homilagi peshgiri kardan lozim ast. Agar zan giriftori bemorihoi gunoguni muzmin boshad, pas boyad khudro sari vaqt tabobat namuda, qoidahoi gigienai shakhsi va gigienai aloqai jinsiro rioya kunad. Tadbirhoi peshgirii haml niz zarurand, chunki aksar vaqt sababi tavalludi A. isqot ast.
Dar surati paydo shudani alomathoi avvalini haml zan baroi giriftani tavsiyahoi zaruri (to in ki hangomi homilagi chi tavr raftor kunad) boyad ba dukhtur murojiat namoyad. Zani homila boyad ba iztirob naoyad, durust khurad, nushokihoi spirtdorro istemol nakunad, tamoku nakashad. Dar asnoi paydo shudani avvalin alomathoi toksikoz boyad favran ba dukhtur murojiat kunad.
Badi az bemorkhona baromadan, A.-horo dar darmongoh zeri mushohida megirand.
M. F. Dodkhoeva.

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