Zovuta za SAH ndi momwe madokotala amazigwiritsira ntchito
Kuwonongeka kochepa kwa thupi (SAH) ndi matenda owopsya komanso omwe angawopsyeze moyo umene magazi amachokera ku mitsempha ya ubongo ndi kulowa mu cerebrospinal fluid (CSF).
Pafupifupi theka la odwala omwe ali ndi SAH amakhala ndi "zotsatira zabwino" pambuyo pa chithandizo. Monga ngati izi sizingakwanire, kutaya kwapaschnoid kusokoneza mavuto ena.
Kuti atetezedwe ku mavuto enawa, odwala matenda otaya magazi amatha kuyang'anitsitsa mu chipatala chachikulu kwambiri atangoyamba kulowa kuchipatala.
Pali mavuto akuluakulu anayi omwe amachititsa kuti magazi asasokonezeke. Mavuto amenewa ndi vasospasm, hydrocephalus, kugwidwa, ndi kubwezeretsedwa.
Vasospasm Pambuyo pa Kutaya Kwambiri kwa Chinsomba
Liwu lakuti vasospasm limatanthauza kuti mitsempha ya magazi mu ubongo "imathamanga" ndi kumira pansi, kuchepetsa ndi nthawizina ngakhale kuimitsa magazi ku mbali zina za ubongo. Zotsatira zake ndi stroke.
Vasospasm kawirikawiri imachitika masiku asanu ndi awiri kapena khumi mutatha magazi. Chifukwa vasospasm ndi zovuta kuchiza ngati zikuchitika, kutsindika kwa chipatala ndiko kupewa. Mankhwala opatsirana magazi amachititsa kuchepetsa vuto lopweteka pambuyo pa vasospasm (ngakhale sizikuwoneka kuchepetsa chiopsezo choyamba kukhala ndi malo oyamba). Magazi aang'ono kwambiri m'thupi amasonyezanso kuti akugwirizana ndi vuto la vasospasm, kotero kuti wodwala amapatsidwa madzi okwanira ndi IV kuti asunge magazi pamtundu womwewo (osati kwambiri, osati pang'ono).
Njira zowonjezera zowonongeka za vasospasm zikuphatikizapo kupereka mankhwala a statin .
Anthu omwe ali ndi SAH amayang'anitsitsa mosamala zizindikiro za vasospasm ndi mayesero obwerezabwereza. Ngati pali zotsatira zowonjezera kuyesa, zingatanthawuze kuti vasospasm ikuchitika. Kugwiritsa ntchito njira monga transcranial Doppler kungatanthauzenso kuti wina akukula vasospasm.
Pofuna kuthana ndi matendawa, kuthamanga kwa magazi kumakhala kochepa kwambiri (kupangitsidwa ndi matenda oopsa kwambiri) kupatula odwala omwe ali ndi vuto lachiwopsezo chachikulu kapena mavuto ena a mtima omwe amatsutsana ndi njirayi.
Ngati vasospasm ikupitirizabe ngakhale mukudwala kwambiri, njira zina zosautsa, monga angioplasty (kutsegula mitsuko yamagazi ndi catheter yotsekedwa kudzera m'mitsempha ya mitsempha) kapena kugwiritsa ntchito catheter kuti imwe mankhwala mwachindunji pamalo ochepa, akhoza kuyesedwa.
Hydrocephalus Pambuyo pa Kutaya Kwambiri kwa Nthendayi
Nthaŵi zina magazi amachokera ku subarachnoid kutaya magazi amatha kupezeka m'modzi mwa malo ofunikira oteteza zachilengedwe za cerebrospinal fluid (CSF). Kawirikawiri, CSF imapangidwa m'magulu a ubongo. Kenako amapita kudzera m'mabwalo ang'onoang'ono otchedwa foramina. Ngati malowa atsekedwa, CSF ikupangidwanso koma ilibe ponseponse. Zotsatira zake ndi kuwonjezeka kwa chipsyinjo mkati mwa zinyama za ubongo, zomwe zimadziwika kuti hydrocephalus. Kupsyinjika kumafalikira ku ubongo ndi chigaza.
Kuwonjezereka kwapachilendo kungachititse kuchepa ndi kuzindikira. Ngati sitingathe kuchitapo kanthu, ubongo ukhoza kukankhidwa kumadera otetezeka ngati kutseguka pamunsi pa chigaza, zomwe zimachititsa kuti munthu afe.
Pofuna kupewa kupanikizika, mapuloteniwa amatha kupuma kapena malo omwe amachokera ku chigaza kuti athetse CSF.
Kuchetsa Pambuyo pa Kutaya Kwambiri Kwachitsulo
Magazi angakwiyitse khungu la ubongo ndipo amachititsa kugwidwa . Komabe, peresenti yokha ya odwala omwe ali ndi SAH amatha kukhala ndi khunyu (matenda opatsirana). Madokotala angaganizire kugwiritsa ntchito njira zothandizira odwala matenda a khunyu m'thupi mwamsanga pakapita nthawi. Koma nthawi yaitali mankhwala okhudzana ndi khunyu sali okonzedwa (ndi zina zosiyana chifukwa chazifukwa zina), chifukwa cha kuopsa kwa zotsatira.
Kubwezeretsanso kachiwiri Pambuyo pa Kuwonongeka Kwambiri kwa Subarachnoid
Pambuyo pa SAH, chiopsezo chothamanganso ndi pafupifupi 3 mpaka 13 peresenti mkati mwa maola 24 oyambirira, malinga ndi nkhani ya 2012 mu Stroke .
Kawirikawiri kafukufuku wam'thupi ndi mutu wa CT womwe umayang'ana, makamaka panthawi yomwe atangoyamba kutuluka magazi, ukhoza kuthandizira kuti azindikire ngati akupezeka.
Pofuna kupewa kuthamanganso magazi, ziwalo zoopsa za ubongo mu ubongo zimasindikizidwa. Izi zikhoza kuchitika pogwiritsira ntchito mtundu wa mankhwala opangira opaleshoni kuti muzitsulola anirysm kuchoka pamtsinje wonsewo, kapena kudula katheter kudzera m'mitsempha mpaka ku aneurysm ndi kuika zida zitsulo kapena chizindikiro chosindikizira kuti asindikize aneurysm. Ndi njira iti yomwe ili yabwino ndi chisankho chovuta chomwe chimasiyanasiyana kuchokera kwa munthu ndi munthu ndipo amafuna kukambirana mosamala ndi gulu lachipatala.
Pansi
Ngakhale zovuta zinayi zazikulu zowonongeka kwaparachnoid zingawoneke ngati zongowonjezera, mwatsoka, pali ngozi zingapo zomwe zingakhalepo chifukwa chodwala matenda okwanira omwe amafunikira chisamaliro ku chipatala chachikulu. Mavuto a mitsempha , hyponatremia ndi chipatala chomwe amapezedwa chiyenera kutetezedwanso. Kupulumuka kwa magazi oyambirira ndi mbali imodzi ya vuto la kuchepa kwa magazi. Kupulumuka kwa ena onse kumafuna kugwirizana kwambiri ndi gulu la akatswiri azachipatala.
Zotsatira:
Bederson, JB, et al. (2009). Malangizo othandizira kuyang'anira matenda a aneurysmal ocheperachepera: chiganizo cha akatswiri a zachipatala kuchokera ku gulu lapadera lolemba la Stroke Council, American Heart Association. Kukwapula , 40: 994.
Buczacki, SJ, Kirkpatrick, PJ, Seeley, HM, & Hutchinson, PJ (2004). Matenda a kanthawi kochepa atatha opaleshoni yotsegula kwa aneurysmal subarachnoid kuchepa kwa magazi. J wathu wa Neurology, Neurosurgery, & Psychiatry , 75: 1620.
Connolly, ES et al. (2012). Malangizo othandizira kuyang'anira matenda a aneurysmal ocheperachepera: chiganizo cha akatswiri a zachipatala kuchokera ku gulu lapadera lolemba la Stroke Council, American Heart Association. Kukwapulidwa, 43 (6): 1711-37.
Kassell, NF, Sasaki, T., Colohan, AR, Nazar, G. (1985). Cerebral vasospasm ikutsatira kuchepa kwa nayurysmal subarachnoid. Sitiroko, 16: 562.
Tidswell, P., et al. (1995). Zotsatira zamaganizo pambuyo pa kuchepa kwa anirysm: ubale ndi malo achimake ndi mavuto ovuta. Neurology, 45: 875.
KUDZIZIRANI: Zomwe zili pa tsamba ili ndi zolinga za maphunziro okha. Sitiyenera kugwiritsidwa ntchito ngati choloweza m'malo mwa chisamaliro cha munthu wodwala wovomerezeka. Chonde funsani dokotala wanu kuti apeze matenda ndi chithandizo cha chilichonse chokhudza zizindikiro kapena matenda .