Zimene Madokotala ndi Aamwino Amayang'anira
Odwala omwe ali ndi matenda a ubongo amasiyana ndi odwala ena. Chifukwa chakuti vuto lawo limakhudza dongosolo lawo lamatenda, amatha kukhala ndi mavuto ena. Ubwino wa khungu la ICU ndikuti madokotala ndi anamwino amaphunzitsidwa zapadera zomwe zimawathandiza kuti azindikire bwino komanso kuthetsa mavuto ngati akuwuka.
Hyponatremia
Matenda a ubongo angachititse kutulutsa mahomoni omwe amasintha kwambiri sodium m'magazi, omwe amadziwika kuti hyponatremia . Izi ndizovuta chifukwa chiwerengero chochepa cha m'magazi chikhoza kuyambitsa madzi kulowa mu minofu ya ubongo ndi kuwonongeka kwa edema ndi kutupa. Pali njira zikuluzikulu ziwiri zomwe zimawonongera ubongo kum hyphonatremia: matenda a hormone osayenera a hypersecretion (SIADH) ndi cerebral salt akuwononga syndrome (CSWS).
SIADH imakhala yokhudzana ndi madzi ochuluka kwambiri m'thupi, ndipo CSWS imapangitsa kuti thupi likhale lochepa kwambiri. Mwa kuyankhula kwina, pamene mavuto awiriwo angapangitse ma laberi ofanana, iwo ali osiyana kwambiri ndipo amafuna mankhwala osiyana.
Mdima Wozama Kwambiri Thrombosis
Pali zifukwa zitatu zoopsa zomwe zimayambitsa magazi: stasis, kupweteka kwa thupi, ndi hypercoagulability.
Stasis amangotanthauza kuti simusunthera kwambiri.
Ndicho chifukwa chake ndege zimalimbikitsa anthu kuti adzuke nthawi ndi nthawi paulendo wautali ndikuyenda kuzungulira nyumbayo. Kukhalabe motalika kwambiri kungayambitse magazi m'mitsempha ya miyendo yanu. Ngati zotchingazi zimachoka pamilendo, zimatha kuyandama mpaka m'mapapo ndikupanga mapulmasi owopsya.
Kuwonongeka kwa khoma la mthunzi wa magazi kungapangitsenso kuti mapulaneti apangidwe, monga momwe zilili ndi kuthamanga kwa magazi . Potsirizira pake, anthu ena ali ndi magazi omwe amatha kupanga mapuloteni ndipo amakhala pachiopsezo chachikulu cha mitsempha ya thrombosis ndi pulmonary embolism.
Odwala m'maganizo a ICU amatha kuika magazi. Chifukwa cha matenda awo, anthu omwe ali olumala kapena osokonezeka sakuyenda. Kuwonjezera pamenepo, anthu ena amene anadwala sitiroko anali ndi sitiroko chifukwa chakuti ali ndi magazi omwe amatha kupanga mapepala. Anthu omwe amavutika ndi vutoli amatha kuwonongeka kwambiri ku zitsulo zamagazi.
Kupitiliza kumvetsa nkhaniyi ndi funso la choti achite ngati wina apanga magazi pokhapokha ali ku ICU kuti awononge magazi. Mwachitsanzo, kuchepetsa kutaya kwa magazi kumagwirizanitsidwa ndi chiopsezo chachikulu cha mitsempha yambiri ya mitsempha. Mankhwala amagazi amatetezedwa kawirikawiri powapatsa ochepa magazi monga heparin, koma mankhwalawa akhoza kuwononga kwambiri magazi. Mmene mungayendetsere zovuta zotsutsanazi zingakhale zovuta.
Kutentha
Mukakumana ndi zovuta, madokotala amaphunzitsidwa kuyang'ana pa ABCs - kuyendayenda, kupuma, ndi kufalitsa. Chofunika kwambiri pa zinthu izi ndiwayendedwe.
Pokhapokha ndime zomwe zimatilola kupuma zili zotseguka, palibe kanthu kena kalikonse. Ngakhale kugwidwa mtima kumakhala kofunika kwambiri msanga. Kuwongolera chinachake m'mapapu omwe sichikutanthauza kukhalapo amadziwika ngati aspiration , ndipo amatha kuyambitsa wina matenda aakulu.
Ambiri a ife timachita zinthu zazing'ono pa ola lililonse kuti tiwone kuti kuyenda kwathu kumakhala kotseguka. Chinthu chosavuta kudziwa chomeza makola, mwachitsanzo, kumatsimikizira kuti mabakiteriya ochokera m'milomo mwathu samalowa m'mapapu athu ndikuyamba kukhala chibayo . Timadandaula nthawi zina kuti tisawononge madera aang'ono m'mapapu athu. Ngati tikumva tizilombo kumbuyo kwa mmero, timakhala chifuwa.
Anthu omwe awononga mitsempha yomwe imayendetsa khoma lawo, chifuwa, lilime kapena khosi zingakhale zovuta kuchita zinthu zophweka, zopanda kuzindikira. Wina wa ku coma sangathe kuchita zinthu izi. Mu chipatala chachikulu, zinthu izi zimachitidwa kwa iwo ndi akatswiri ndi anamwino omwe ali ndi njira monga kuyamwa, mankhwala opuma, komanso kukhwima.
Kutenga
Mankhwala osamalira kwambiri ndi omwe odwala kwambiri amasamalidwa. Izi zimatanthauzanso kuti ma ICU nthawi zambiri amapezeka mabakiteriya owopsa komanso owopsa kwambiri. Chifukwa cha kuchuluka kwa ma antibayotiki ku ICU, ena mwa mabakiteriyawa asintha kuti asamalandire maantibayotiki , kupangitsa matenda kukhala ovuta kwambiri.
Antchito azachipatala amaphunzitsidwa kugwiritsa ntchito njira iliyonse yopeŵera matenda, kuphatikizapo kusamba m'manja komanso nthawi zina zovala ndi masikiti. Komabe, palibe njira zodziwitsira zomwe zimagwira ntchito peresenti ya nthawi, ndipo nthawi zina matendawa amafalikirabe ngakhale izi zitetezedwa. Pachifukwa ichi, ogwira ntchito zachipatala amawona odwala omwe ali pafupi ndi zizindikiro za matenda. Komanso, kuyesayesa kumapangitsa kuti wodwalayo apite kumalo ochepa kwambiri, monga chipatala chodziwika bwino, mwamsanga mwamsanga.
Acute Confusional State
Mavuto aakulu, omwe amadziwikanso kuti delirium kapena encephalopathy, ndi chimodzi mwa zinthu zosokoneza kwambiri zomwe odwala kapena okondedwa awo amapeza kuchipatala. Tsoka ilo, ndilo chimodzi mwazofala kwambiri. Ambiri odwala 80% omwe ali ndi matendawa amapezeka mu chikhalidwe ichi. Munthuyo amasokonezeka ndi kumene ali, nthawi yake, ndi zomwe zikuchitika. Iwo sangadziwe abwenzi kapena achibale. Iwo akhoza kukonza, kapena kukhala chowopsya. Nthawi zina izi zimayesetsa kuthawa kuchipatala kapena kuchotsa zida ndi ma IV omwe amafuna kuti wodwalayo akhale ndi moyo.
Chithandizo cha vuto lovuta kwambiri likhoza kukhala lovuta kwambiri monga vutoli popeza lingaphatikizepo kupereka mankhwala osungirako mankhwala kapena kuletsa wodwalayo. Komabe, pali njira zochepa zomwe zingatengedwe kuti zisokoneze chisokonezo musanatuluke.
Matenda a m'magulu a Epilepticus
Pamene anthu ambiri amaganiza za kugwidwa, amawoneka ngati wina akugwedeza mwachiwawa. Pali mitundu yonyansa yowunkha, komabe, pamene wina sawoneka kuti akuchita zambiri, kapena angangowoneka akusokonezeka.
Komabe, anthuwa angapindule ndi mankhwala abwino. Kafukufuku wina wanena kuti anthu 10% mwa ICU angakhale ndi kugwidwa komwe nthawi zambiri kumakhala kosazindikiridwa, ndipo chiwerengerochi chikhoza kukhala chokwanira kwa odwala omwe ali ndi mavuto a ubongo.
Dysautonomia
Ndondomeko yamatope yodzidzimutsa imadziwa ndipo nthawi zambiri imayamikiridwa. Ichi ndi gawo la dongosolo la mitsempha lomwe limayang'anira kuthamanga kwa mtima, kupuma, kuthamanga kwa magazi, ndi zina zambiri. Monga momwe matenda a ubongo angasinthire ntchito zomwe timakonda kuganizira, monga kayendetsedwe ndi kayankhulidwe, mavuto ena angakhudze dongosolo lokhazikika la mantha.
Mavuto omwe tatchulidwa pamwambawa amapezeka m'magulu osiyanasiyana a matenda omwe amachititsa munthu ku ICU . Ngakhale kuti angapezedwe m'zinyamu zina zothandizira kwambiri, akatswiri ena sangadziwe kuti akudziŵa ndi kuthetsa mavuto osiyanasiyana. Pachifukwa ichi, maurosi-neuro-ICUs adatsimikizira kukhala ofunika pochiza anthu omwe ali ndi matenda aakulu a ubongo.
Zotsatira:
Allan H. Ropper, Daryl R. Gress, Michael. Diringer, Deborah M. Green, Stephan A. Mayer, Thomas P. Bleck, Matenda a Nkhono ndi Opaleshoni Zambiri, Gawo Lachinayi, Lippincott Williams & Wilkins, 2004
Braunwald E, Fauci ES, ndi al. Mfundo za Harrison za Mankhwala a M'kati. 16th ed. 2005.