ERTA YOSHLI BOLALARDA O‘TKIR ZOTILJAM KASALLIGINI MARKAZIY ASAB TIZIMINING PERINATAL SHIKASTLANISHI FONIDA GEMOSTAZ TIZIMI XUSUSIYATLARI
Abstrakt
Kirish. Erta yoshli bolalarda uchraydigan o‘tkir zotiljam (pnevmoniya) hozirgi kunda pediatriya amaliyotidagi eng dolzarb muammolardan biri hisoblanadi. Xalqaro statistik ma’lumotlarga ko‘ra, 5 yoshgacha bo‘lgan bolalarda o‘lim holatlarining 15–18 foizi aynan pnevmoniya bilan bog‘liq. Ayniqsa, markaziy asab tizimining perinatal shikastlanishi (gipoksik-ishemik ensefalopatiya, asfiksiya, intranatal ishemiya) mavjud bo‘lgan bolalarda bu kasallik og‘irroq kechadi va ko‘pincha uzoq davom etuvchi hipoksik, yallig‘lanish va trombogemorragik sindromlar bilan kechади. So‘nggi yillarda olib borilgan klinik va eksperimental tadqiqotlar gemostaz tizimidagi o‘zgarishlar pnevmoniyaning patogenezida muhim o‘rin tutishini ko‘rsatmoqda. Shu sababli, perinatal shikastlanish fonida kechuvchi zotiljamda gemostaz tizimining buzilishi, uning immun-yallig‘lanish mexanizmlari bilan o‘zaro ta’sirini aniqlash dolzarb ilmiy vazifa hisoblanadi. Maqsad. Erta yoshli bolalarda markaziy asab tizimi perinatal shikastlanishi fonida kechuvchi o‘tkir zotiljamda gemostaz tizimining o‘zgarishlarini aniqlash, ularning kasallik og‘irligi, yallig‘lanish darajasi va klinik kechish bilan bog‘liqligini baholash. Materiallar va usullar. Ushbu maqolada 2015–2024 yillar oralig‘ida chop etilgan 40 ta xorijiy va mahalliy ilmiy tadqiqotlar tahlil qilindi. Tadqiqotlarda fibrinogen, D-dimer, APTT, PT, antitrombin III, protein C va S ko‘rsatkichlari, shuningdek, yallig‘lanish mediatorlari – IL-6 va TNF-α darajalari o‘rganilgan. Klinik kuzatuvlarda esa perinatal gipoksiya bilan tug‘ilgan va pnevmoniya bilan og‘rigan bolalarda gemostaz ko‘rsatkichlari solishtirildi. Statistik tahlilda korrelyatsiya va variatsion usullar (p < 0,05) qo‘llanildi. Natijalar. Tahlil natijalariga ko‘ra, perinatal shikastlanish fonida kechuvchi zotiljamda giperkogulyatsiya belgilari aniqlangan. Fibrinogen va D-dimer miqdori 1,5–2 marta oshgan, APTT va PT qisqargan, antitrombin III faolligi 25–30 foizga pasaygan. IL-6 va TNF-α darajalari yuqori bo‘lgan bolalarda D-dimer bilan kuchli ijobiy korrelyatsiya (r = 0,62; p < 0,01) qayd etilgan. Bu holatlar “yallig‘lanish–koagulyatsiya doirasi” mexanizmining mavjudligini isbotlaydi. Bunday bolalarda klinik kechish og‘ir, intoksikatsiya uzoq, antibiotik terapiyaga javob sekin bo‘lgan. Profilaktik antikoagulyant terapiya (mikrodazali geparin, dipiridamol) qo‘llanilgan guruhlarda tromboembolik asoratlar soni 3–4 marta kamaygan. Olingan natijalar ko‘rsatadiki, gemostaz tizimining disbalansi perinatal gipoksiya fonida kechuvchi o‘tkir zotiljamning asosiy patogenetik bo‘g‘inidir. Endotelial shikastlanish, trombosit faolligining ortishi va fibrinoliz susayishi mikrotsirkulyatsiyani buzadi, bu esa o‘pka to‘qimasida gaz almashinuvi yetishmovchiligiga olib keladi. Gemostaz tizimining doimiy monitoringi va o‘z vaqtida antikoagulyant terapiya tayinlanishi pnevmoniyaning og‘ir kechishini yengillashtiradi. Xulosa. Pnevmoniya perinatal shikastlanish bilan kechuvchi bolalarda gemostaz buzilishlari klinik holatning og‘irlashuvi, uzoq reabilitatsiya va asoratlar rivojlanishining muhim sababi hisoblanadi. Kompleks davolashda gemostaz nazorati, IL-6 va TNF-α ko‘rsatkichlarini aniqlash hamda antikoagulyant vositalar qo‘llash tavsiya etiladi.
Nashr sanasi
Mualliflar haqida
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