An Acute Confusional State
Mavuto aakulu, omwe amadziwikanso kuti delirium kapena encephalopathy, amavomereza m'zipatala zomwe zimawoneka ngati chizoloŵezi cha ogwira ntchito m'chipatala ambiri. Pakati pa 14 mpaka 56 peresenti ya odwala onse opititsidwa kuchipatala amayamba kusokonezeka. Odwala omwe ali m'gulu la anthu odwala kwambiri amakhala ndi chiŵerengero chachikulu kwambiri, pafupifupi 82 peresenti.
Ngakhale kuti delirium ndi ozoloŵera kwambiri kwa ogwira ntchito kuchipatala, zimakhala zovuta kwambiri komanso zovuta kwa abwenzi ndi achibale.
Wokondedwa wawo, wodwala, sangathe kuwazindikira. Nthawi zina, wodwalayo anganene ngakhale achibale kapena anzake omwe amachita zinthu zovuta kwambiri monga kuyesa kumangidwa kapena kumupha. Zingamveke ngati munthu wodwala maganizo akudwala thupi lake.
Delirium kawirikawiri imakhala yopitirira ndipo imakula pamene wodwalayo achiritsa matenda awo. Komabe, izo sizikutanthauza kuti delirium ndi yabwino. Delirium imagwirizanitsidwa ndi kuwonjezeka kwawiri kwa miyezi 12, ngakhale atasintha chifukwa cha matenda aakulu. Amagwirizananso ndi maulendo a nthawi yayitali komanso chiopsezo chowonjezereka chotenga matenda a dementia .
Zizindikiro za Deliriamu
Odwala omwe akuvutika ndi delirium sangadziwe kumene ali kapena kudziwa chaka chomwe chiri. Iwo akhoza kulakwitsa anthu omwe amadziwika bwino omwe amabwera kudzawachezera. Zilonda zowonjezereka ndizofala. Chimodzi mwa zizindikiro zazikulu kwambiri za dziko lovuta kwambiri ndizovuta kumvetsera kanthu kalikonse kwa nthawi yaitali.
Nthawi zina delirium ikhoza kuyambitsa wina kukwiya, pamene iwo akhoza kufuula kapena kuyesetsa kuti achoke pabedi. Okhumudwawo odwala angayesenso kuchotsa mitsempha kapena mavitamini IV omwe amapereka mankhwala opulumutsa moyo. Mwamwayi, pafupifupi 10 peresenti ya odwala odyera ndi omwe amachitcha kuti "hyperactive" subtype.
Nthaŵi zambiri, delirium sichidziŵika bwino ndipo odwala akhoza kungogona kogona pabedi, koma popanda lingaliro lenileni la zomwe zikuchitika kuzungulira iwo. Anthu awa akhoza kukhala ovuta kapena osamvera. Izi zimatchedwa "hypoactive" delirium, ndipo pafupifupi 40 peresenti ya odwala opatsa adzakhala ndi mtundu uwu. Otsalira 50 peresenti ya odwala omwe ali ndi delirium ndi "osakanikirana," osakayika akudwala matenda osokoneza bongo.
Kusinthasintha kwa chidziwitso mozama ndi chizindikiro cha delirium. Mphindi imodzi wodwala angawoneke ngati momwe amadzikondera okha, ndipo miniti yotsatira akhoza kuchita ngati wina aliyense. Kusinthasintha kumeneku kungathenso kukhala maola ambiri. Delirium kaŵirikaŵiri imaipiraipira panthaŵi imene wodwala amatha kugona, chodabwitsa chomwe chimadziwika muzipatala monga "sundowning."
Zifukwa za Deliriamu
Njira yeniyeni yoganizira za delirium ndi yakuti munthu akhoza kukhala ndi zifukwa zobweretsa chisokonezo, zomwe zikhoza kuthetsa delirium. Mwachitsanzo, wodwala wachikulire akhoza kukhala ndi vuto lodziŵa kulingalira , koma kenaka ndikumayambitsa matenda a mkodzo omwe amachititsa kuti pakhale chisokonezo chachikulu. Mowa umagwiritsa ntchito, kuvutika maganizo, kusoŵa zakudya m'thupi, mankhwala ena, ndi kuwonongeka kwa masomphenya ndi kumva kungapangitsenso munthu kulunjika.
Pali mndandanda wautali kwambiri wa zinthu zomwe zingayambitse munthu yemwe ali ndi chiopsezo chachikulu kuti awonongeke mosavuta. Zingakhale zothandiza kudalira mndandanda "delirium" kukumbukira zina mwazifukwa zomwe zimayambitsa:
D - Mankhwala: Ichi ndicho chifukwa chofala kwambiri cha delirium. Kuonjezera mankhwala atatu atsopano kuchipatala kumaonjezera chiopsezo cha kupatsa katatu odwala okalamba. Ambiri omwe amachimwayo ndi mankhwala ophera anticholinergic monga ambiri omwe amagwiritsidwa ntchito pochita chithandizo chamakono. Benzodiazepines ndi opiates amakhalanso achifwamba. Komabe, mndandanda wa mankhwala ena omwe angapangitse delirium kumaphatikizapo antihistamines , antiepileptics , steroids, mankhwala ena opha tizilombo, ndi ena ambiri.
E - Epilepsy: Ngakhale kuti kugwidwa kwachizoloŵezi kwapangidwe kukhala kovuta chifukwa cha kusintha kwa maganizo, kafukufuku waposachedwapa awonetsa kuti ochuluka a odwala, makamaka ku ICUs, akuvutika ndi matenda a khunyu , zomwe zikutanthauza kuti nthawi zonse amadwala popanda kusuntha kwa miyendo yowopsya.
L - Mapungulo: Okosijeni yaing'ono kapena kwambiri carbon dioxide chifukwa cha kupuma kovuta kungachititse kuti zikhale zovuta kwambiri. Kupewa kugona tulo ndi vuto lalikulu.
I-Kutengera: Malingana ndi momwe munthu wina amadziwira kuti ali ndi vuto lovuta kwambiri, pafupifupi matenda aliwonse angathe kuwatsitsira pamphepete mwa delirium, kuphatikizapo matenda ochepa a tizilombo. Kawirikawiri, matenda a mkodzo, chibayo, kapena matenda a khungu ndiwo chifukwa.
R - Kutsekedwa: Izi zikhoza kutanthauza kusungidwa kwa mkodzo kapena sitolo. Kumangika kumawathandiza kupititsa patsogolo.
I-Kutupa: Ichi ndi gulu lodziwika mwachangu popeza zinthu zambiri m'thupi zimapangitsa kuti anthu ayambe kuvuta. N'kutheka kuti pali njira yothetsera vutoli. Kuchita opaleshoni kumaphatikizapo kupereka kwa delirium. Kulepheretsa kuchepetsa thupi kapena kupweteka kwa thupi kungathe kuchita izi.
U - wosakhazikika: Zowonongeka kwambiri zikhoza kukhala chizindikiro chochenjeza kuti wodwala akudwala kwambiri. Kupanikizika kwa magazi komwe kumakhala kochepa kwambiri kapena kotsika kwambiri kungayambitse matenda osokoneza bongo, monga momwe matenda a mtima amatha kukhalira. Kukwapulika sikungapangitse kuti delirium popanda chizindikiro china cha stroke , monga kufooka kwa mkono kapena mwendo, koma nthawi zambiri zimangopangitsa chisokonezo.
M - Zamagetsi: Izi zimaphatikizapo mavuto a chithokomiro komanso shuga, zomwe zingayambitse shuga ya magazi yomwe ili yochepa kwambiri ( hypoglycemia ) kapena mkulu (hyperglycemia). Mahomoni ena monga cortisol angapangitsenso kusintha kwa kuganiza. Kuperewera kwa zakudya m'thupi komanso kuperewera kwa chiwerewere kungaphatikizidwepo m'gululi.
Monga mukuonera, pali zifukwa zambiri zomwe wodwalayo angasokonezedwe kuchipatala. Ambiri amasokonezeka odwala ali ndi chiopsezo chotere cha delirium. Mndandanda umene uli pamwambawu suphatikizapo zina zomwe zimagwiritsidwa ntchito mobwerezabwereza monga kupuma, catheterizations, ndi njira zambiri zomwe zimapezeka mzipatala. Nthaŵi zina madokotala amayenera kuyenda kuyenda bwino mu management management. Mwachitsanzo, pamene ululu ukhoza kuyambitsa delirium, chomwechonso chimatha kupweteka kwambiri mankhwala. Ngakhale kuti nthawi zina zimakhala zolepheretsa kuti munthu wodwala asokonezeke kuchotsa mizere ndi ma tubes, zoletsa zakuthupi zimapangitsanso kuti zikhale zovuta kwambiri.
Mwamwayi, pali njira zowonjezera zomwe ochipatala ndi achibale angatenge kuti athandize kupeletsa delirium kuti asatuluke pamene mavuto akukonzedwa. Deliriamu amawopseza, koma pafupifupi osakhalitsa. Chisamaliro choyenera cha wodwalayo chingathandize kuti aliyense athandizidwe ndi zovuta zomwe zingatheke.
Zotsatira:
Dubois MJ et al. Delerium mu ICU, kufufuza zoopsa zachithandizo Mankhwala Ochepetsa Mankhwala. 2001 27 1297-1304
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Peterson JF, Delerium ndi motoric subtypes, J am. Geriat. Soc 54 (3) 479-484, 2006.
Vanja C. Douglas, A. Andrew Josephson, Delirium. Kupitiriza: Kuphunzira moyo wanga wonse Neurol 2010; 16 (2) 120-134