<胎兒心律不整 - bradycardia>
才讀完台兒通訊上期的雙月刊,門診就來了一個意外發現有房室傳導阻斷寶寶。
在診間聽心跳的時候,聽半天覺得心跳怎麼這麼慢? 到處都再確定一下又跟媽媽的脈搏相比不同,所以應該也不是聽到媽媽的動脈血流聲,因此帶她去超音波室一照,發現果不其然胎兒的心跳量起來只有70-80下。
立馬安排了比較詳細的心臟超音波,還有抽血來做更進一步的檢查。
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寶寶的心跳正常來說是在110-160下/分鐘之間,超過160下是心搏過快,太低則是心搏過慢。
心律不整是一個大課題,今天先從 #心博過慢這個族群來講起。
完整內容請看部落格文章
https://drjessicakang.blogspot.com/2021/07/blog-post.html
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胎兒心搏過緩要考慮幾個鑑別診斷:
1. 竇性心搏過慢 Sinus bradycardia
(Transient, fetal distress, sinus node dysfunction, Long QT syndrome...)
2. 緩慢性的心律不整 Bradyarrhythmia -> 房室傳導阻斷 AV block
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1. #竇性心搏過慢
表示胎兒心跳是規則的慢,並不是心房心室的傳導出問題,一個A對一個V。
(1) 暫時性的/胎兒窘迫:
待產時候常見的因為胎頭壓迫所造成的心跳過慢,還有心跳一去不復返的胎兒窘迫。
要考慮的可能是超音波做太久探頭壓迫的影響,或是注意媽媽有沒有低體溫的症狀?
如果以上都沒有,但是心跳還是很慢,就要認真考慮是不是其他的問題了。
(2) 竇房結異常:
竇房結出現問題,就會影響到心律,有些結構上的問題可能會影響到竇房結的位置,像是heterotaxy(異位症),interrupted IVC,或是單一心室的結構。
(3) Long QT syndrome:
如果心臟結構沒有問題,也排除了第二點的房室傳導阻斷,就要考慮是否為long QT syndrome (我對這個疾病的認識要遙想當年在中榮心臟內科當intern被電的時期阿)
但是Long QT這個疾病也通常只能在出生之後用心電圖來確認。
2. #房室傳導阻斷
大概1/15000-20000,大約40%合併心臟結構問題,其他60%若無心臟結構問題,要考慮跟免疫相關(特別是anti-Ro/SSA or anti-La/SSB抗體)
再來就是難到爆的分類 (沒錯就是跟以前CV學的Mobitz type 1漸行漸遠甚麼碗糕的)
基本上分類和大人一模一樣 (這樣是可以不用介紹的意思嗎??)
要量測PR interval還有對照A-V的比例 (認真覺得這期台兒通訊錄介紹的很淺顯易懂而且是中文版,有興趣的人可以去參考看看)
(#詳細說明請看部落格文章)
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***如果是懷疑AV block的胎兒,建議媽媽要抽anti-Ro/SSA, anti-La/SSB抗體,來確認免疫部分有沒有問題。
對於確定有anti-Ro/SSA或是anti-La/SSB抗體的媽媽,以前的印象總是要使用類固醇 (fluorinated corticosteroids),像是betamethasone or dexamethasone來治療,但是最近有些文獻指出,使用類固醇治療與否對於胎兒預後或是新生兒的預後其實沒有顯著的差別。要加快胎兒心跳,也有人使用salbutamol, b-agonist來治療,但是都沒有定論;另外也有使用IVIG的例子。
對於大家最常使用的 #類固醇,文獻中主要提到有幾點需要注意:
1. #影響胎兒預後的因子: 發現時間點<20週,ventricular rate<50 bpm,胎兒水腫,左心室功能受影響 ->預後差
2. 使用類固醇,主要對於"#預防"胎兒變成最嚴重的3度房室傳導阻斷有用;但是對於已經是完全房室傳導阻斷的胎兒,效用就沒有那麼好
3. 如果出現胎兒水腫,使用類固醇有時候可以 #改善水腫嚴重程度
4. 長期使用類固醇,對於胎兒還是會有一些影響,如 #羊水過少,#胎兒生長遲滯等,因此要衡量一下利弊
5. anti-Ro/SSA, anti-La/SSB抗體陽性的個案,AVBII沒有辦法自發性地回復到正常,但是如果有使用類固醇,就有機會會回復
參考資料:
Michael et al. Eur J Obstet Gynecol Reprod Biol X. 2019 Jun 16;4:100072
Eliasson et al. Circulation 2011 Nov 1;124(18):1919-26
#胎兒異常
#胎兒心律不整
#產前診斷
#產前超音波
distress意思 在 EZ Talk Facebook 的最佳解答
#EZTALK #你不知道的美國大小事 #武漢肺炎
The Wuhan Coronavirus 武漢肺炎
本週的【美國大小事】升級為【全球大小事】,來談談全球目前最關心的時事:
Q1. 什麼是武漢肺炎病毒?跟 SARS 有關係嗎?
Q2. 感染症狀與途徑是什麼?
Q3. 該如何預防?
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As people return to work after the Lunar New Year holiday, the word on everybody’s lips is “coronavirus.” And no wonder—the outbreak, which began in Wuhan, capital of Hubei Province, has already killed over one thousand patients, and spread as far as Europe and the United States.
隨著春節過後返回工作崗位,大家也開始談起「冠狀病毒」這個字。這也難怪,在湖北省省會武漢爆發的疫情,至今已經讓超過 1,000 名病患喪生,而且擴散遠達歐美。
Coronaviruses are a group of viruses that cause diseases in mammals and birds. “Corona” means “crown” in Greek, and the name was given because the proteins on surface of these viruses make them look similar to crowns. In humans, most coronaviruses cause mild respiratory infections like the common cold. But rarer forms, like the viruses that cause SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) can be deadly.
冠狀病毒是會在哺乳類與鳥類中致病的一種病毒群。corona 是希臘文的「皇冠」之意,有此命名是因為這類病毒表面的蛋白質讓它們看起來像皇冠。多數冠狀病毒在人體中會引發類似感冒的輕微呼吸道感染。不過有些較罕見的冠狀病毒則是會致命,如引起 SARS(全名:嚴重急性呼吸道症候群)以及 MERS(全名:中東呼吸道症候群)的病毒。
The Wuhan coronavirus, which was discovered in Wuhan when patients developed pneumonia that didn’t respond to existing vaccines and treatments, is believed to have come from bats. The main symptoms of the virus include fever, fatigue, coughing and respiratory distress.
武漢新型冠狀病毒於武漢發現時,有病患產生肺炎症狀,但現行疫苗與醫療皆無法治癒,此病毒被認為起源於蝙蝠。這種病毒引發的主要症狀有發燒、疲累、咳嗽與呼吸困難。
How can you avoid contracting the coronavirus? Transmission usually occurs when people come into contact with droplets from coughs and sneezes (droplet transmission) and when people touch a surface with droplets and then touch their face (contact transmission). So the best way to keep the virus from spreading is to wear a mask when out in public, wash your hands frequently, and avoid touching your face—especially your eyes, nose and mouth. Oh, and it’s probably best to stay away from bat soup!
我們該如何避免感染冠狀病毒呢?傳染途徑是透過人體咳嗽打噴嚏的口沫(飛沫傳染),或者接觸到附有口沫的物體表面,再碰到自己的臉(接觸傳染)。所以避免病毒傳播最好的方法是外出時戴口罩,經常洗手,避免摸臉,尤其是口眼鼻。噢,最好別喝蝙蝠湯了!
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【✍重點單字】
1. coronavirus「冠狀病毒」:為corona「皇冠」+ virus「病毒」。
2. spread「傳播,擴散,蔓延」:可當動詞與名詞。
3. mammal「哺乳類」
4. respiratory infection「呼吸道感染」:respiratory指「呼吸的」。
5. acute「(病狀)急性的,十分嚴重的」
6. syndrome「症候群」:某疾病所導致的一連串相關症狀的總稱。
7. pneumonia「肺炎」
8. vaccine「疫苗」
9. treatment「治療方法」
10. fatigue「疲倦」:當名詞。
11. respiratory distress「呼吸困難」:distress可指「痛苦」。
12. contract「患上,感染(疾病)」:這裡當動詞,另一個常見意思是「合約」,此時做名詞用。
13. transmission「傳播(方式或途徑)」:動詞為transmit。
14. droplet「飛沫」:指小滴液體。
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🔔 按下「搶先看」,每週五【美國大小事】,由 Judd 編審分享最即時美國新鮮事!想知道更多美國文化,請看 👉 http://bit.ly/EZTalk嚴選
distress意思 在 玳瑚師父 Master Dai Hu Facebook 的最讚貼文
(English version below)
八字殿堂深又廣,
無限訊息當中藏,
一般衹向俗課談,
豈知佛魔亦可探。
八字是我們過去世,功過的因果密碼。就因爲是密碼,所以眞知者,根本就不會太多。除非,這個人願意投入,其大量的生命時光,專注且不停的鑽研及驗證,再加上其天賦,才能學上手。要不然,就會誤己誤人,嚇己嚇人,這一世消業不成,反添新業障啊!
那位想去泰國會見,其萍水相逢女子的男子,用個新手機號碼,致電於吾說想向吾學佛。談話中,他說他有聽取吾建議,沒去泰國見那女子,不過他有去找另外一位女子。吾聽了,再一次的讚嘆我們祖先,留給我們的智慧遺產,玄學。
這位男子若不是視力差,就是呆子了。因爲,吾已慈悲他多次,讓他來吾舉辦的餐會,不下五次,並當面拆穿他八字裡,及其心裡的魔,他應清楚不過,吾是何等人物才是呀!更何況,他其实有在悄悄的學,可惜六毒不除,魔在頭上啊!
從一個人的八字,是可以知道她他的喜、怒、哀、樂、狂的發生時間與地點,甚至何人會使她他這樣。同樣也可以通過八字來把脈,後對症下藥。比如近年幼孩的剋星,令父母傷心的川奇症或冰淇症。對不起,好像沒有冰淇症是嗎?是是是,是沒有。是吾喜歡八寶冰,不好意思,不好意思,希望沒嚇着大家。一笑。
吾想說的是,玄學的高手,一看川奇症,立馬就知曉對治方法。若妳你想知道,更想對治妳你所面對的魔,歡迎拜訪。
.......................
Bazi is the karmic secret code of the merits and faults from our past lives. Because it is a secret code, there are not many people who truly comprehend it.
If this person is willing to invest an enormous amount of his/her lifetime, is focused, carries out studies and verification tests of this subject matter, and has the gift for it, then he/she will be able to master it.
Otherwise, apart from himself/herself, the person will also mislead and frighten others. This will increase the karmic obstacles in this lifetime, instead of reducing them.
There was this gentleman who had wanted to go Thailand to see a lady he met by chance. He called me with a new mobile number, expressing his interest to learn Buddhism from me.
In our conversation, he said he heeded my advice not to fly to Thailand to meet that lady. However, he went to look for another lady instead. After hearing his words, I was once again in praises of our ancestors, for leaving us with this wisdom heritage - Chinese Metaphysics.
If this gentleman does not have poor vision, he must be a fool. Because I, out of compassion, have allowed him to come for my learning sessions and dissected his Bazi, telling him what his inner demons were. He should know what kind of person I am.
Moreover, he had been learning secretly. It was a pity he could not eradicate his six poisons, and Mara was sitting right on top of him!
From a person's Bazi, I can tell the times and locations that will elicit his/her happiness, anger, sadness, joy, madness, and even the people that caused such emotions in him/her. Similarly, I can use Bazi to take the pulse and prescribe the right medicine for the illnesses. For example, in recent years, there is this bane of an illness that strikes young children, causing distress in many parents - the Kawasaki Disease, or the Ice Disease. Oh, sorry, there seems to be no Ice Disease, right? Yes yes yes, indeed there is not. It is me who like Eight Treasures Shaved Ice. Sorry, sorry, I hope I did not scare you. *laughs*
What I wish to say is, as an expert in Chinese Metaphysics, it only takes a look to know the antidote for Kawasaki Disease. If you wish to know, and have a stronger desire to cure the demons you face, you are welcome to visit me.
distress意思 在 奧升英國小學集美分校- 0519 Kids News class - Facebook 的推薦與評價
0519 Kids News class: Bermuda Triangle Vocabulary 新聞英語課程提供給G4-G6班的小朋友們~ 學習要訣: 請跟著老師一起大聲唸單字,並且把它們的 意思 ... ... <看更多>