I-Hematoma engaphansi kwegazi iphuma ngaphansi kwengqikithi yobuchopho
Uma ikhanda lithola iphutha ngesikhathi sengozi, imithwalo yegazi ingonakaliswa bese iqala ukungena ngaphakathi nangaphakathi kobuchopho. Njengoba i-skull ye-bony ezungeze ubuchopho nayo ibizwa nangokuthi i-cranium, ochwepheshe bezokwelapha babhekisela kulolu hlobo lomcimbi wokugaya igazi "njengesifo sokuqeda igazi". Lokhu kusho ukusuka ngaphakathi kwe-cranium.
Uhlobo olulodwa lwe-hemorrhage yokungena emzimbeni lubizwa ngokuthi "iHematoma ye-Subdural".
I-hematoma ye-subdural iyenzeka lapho imithanjeni ikhona ngaphansi kwenkathi yokugcina , uhlaka lwamathishu oluhlanganisa ubuchopho, lonakaliswe futhi luqala ukuphuma. Njengoba igazi liqoqa bese liphenduka i-clot, kuba into ebizwa ngokuthi "hematoma".
Ukuhlukaniswa Nezimpawu
I-hematomas engezansi (SDH) ihlelwa ngezigaba ezintathu. Umuntu onesifo esibucayi se-SDH uzoletha ngokuphaphaza cishe kwezinsuku ezingu-1-2 ngemuva kokuhlukunyezwa kokuqala. I-SDH ye-subacute ibonisa cishe ngezinsuku ezingu-3-14 emva kokulimala kwekhanda. Ekugcineni, i-SDH engapheli izoletha izinsuku ezingaphezu kwezingu-15 emva kokuhlukunyezwa kwekhanda.
Uma othile enesimo esibucayi se-SDH, izimpawu zivame ukubonakala. Isibonelo, abangaba ngu-50% wabantu abanesifo se-SDH esivela nge-coma, noma ezinye izimpawu ze-neurologic ezibonakala ngokucacile ezibonisa ukuthi kunezingcindezi eziningi ngaphakathi kobuchopho.
Ama-hematomas angama-subacute futhi angapheli angase abe nzima nakakhulu ukuwabona. Izimpawu zifaka ukunganaki, ukulala nokushintsha kwengqondo.
Izimbangela Nezinhlekelele
Abantu abaningi abakha i-SDH benza kanjalo ngemuva kwengozi yemoto. Ukuhlaselwa nokuwa yizinto ezilandelayo ezibangelwa ukuphuma kwamanzi endaweni engaphansi komhlaba ezungeze ubuchopho.
Abantu abasemikhiqizo ye-blood thinning efana neCoumadin / warfarin basengozini yokuphuma kwegazi.
Lokhu kuyiqiniso ngisho noma ukulimala kwekhanda kunomusa kakhulu. I-Micro-izinyembezi eziya emithanjeni yegazi ezungeze futhi ebuchosheni zingabangela ukuvuza okungapheli kwegazi okungayeki ukuphela.
Ukuphefumula kwegazi okwenziwe ngegazi kujwayelekile kuvamile asebekhulile abavame ukuthatha lolu hlobo lwemithi, ngakho-ke kufanele kunakekelwe ukunakekelwa okwengeziwe ukuze kugwemeke ngisho nokuhlukunyezwa kwekhanda elincane kule ndawo.
Ukuxilongwa
I-SDH ivame ukutholakala nge-CT scan . Uma isithwebuli se-CT sitholakala ngokushesha ngemva kokuhlukunyezwa kwekhanda, ekuqaleni kungase kungabonisi ukuthi kukhona ukuphuma kwegazi. Kodwa-ke, uma uphinda ngokuphindaphindiwe esikhathini esithile kamuva kungase kuvele kunomsoco we-hematoma. Lokhu kungenxa yokuthi kuthatha isikhathi ukuze igazi liqoqe futhi liphawulwe esifundweni sokucabanga. Izinto ezibalulekile ezifunwa ku-CT scan zifaka:
- Ubukhulu be-clot yegazi
- Ukuba khona kokucindezeleka kobuchopho
- Ukuba khona kokucindezela okwanele kubangele ukuguqulwa kwe- midline yobuchopho
Ukuhlolwa kwe-CT ukulandela ukuthi ngabe i-clot yegazi iqhubeka ikhula, uma kukhona izinkinga ezintsha noma uma iqala ukuxazulula.
Ukwelapha
Ezinye iziguli zingase zidinge ukuhlinzwa ukuze zimise ukuphuma kwegazi futhi zisuse igazi elakhiwe nxazonke zobuchopho. Esikhathini esingazelelwe se-SDH, odokotela bavame ukuthatha isinqumo sokuthatha isiguli ukuhlinzwa uma i-clot yegazi ingaphezu kwamamitha ayi-10, noma uma kune-shift midline ye-5-millimeter, kungakhathaliseki ukuthi ivukile noma ixwayise kanjani isiguli.
Kodwa-ke, igazi elincane lingadinga ukwelapha okuhlinzekwayo. Isinqumo sokuya ekuhlinzekeni singase sibe nolaka uma isiguli sithandana noma sibonisa ukwehlisa amandla abo okucabanga, ukukhuluma nokukhumbula izenzakalo
Uma i-SDH yesiguli ikhona isikhathi eside futhi ayikho izimpawu, ukuhlinzwa kungase kungadingeki. Icala ngalinye lizodinga ukuhlolwa ngesisekelo somuntu ngamunye futhi ukwelashwa, njenge-steroids, kungase kulandelwe.
Uhlobo lokuhlinzeka oludingekayo lusekelwe nobukhulu be-clot yegazi, kanye nezimo zezokwelapha ezingaphansi kwesiguli. Ukugoba kwe- Burr ne-craniotomy yizinhlinzeko ezivame kakhulu ukukhipha igazi elakhiwe.
Kwezinye izimo, kungadingeka ukuthi i- craniectomy ilawule ukucindezela okwandayo.
Indlela engcono kakhulu ukukhuluma neurosurgeon mayelana nazo zonke izinketho, futhi yikuphi okukhethwa kukho okungcono kakhulu kwemiphumela emihle.
Imithombo:
UHerou, E., Romner, B., & Tomasevic, G. (2015). Isihloko Sokuqala: Ukulimala Okubuhlungu KwamaBrain Okumangalisayo: Ukufa Kwabadala. I-World Neurosurgery , 83 996-1001. i-doi: 10.1016 / j.wneu.2015.02.023
Walcott, BP, Khanna, A., Kwon, C., Phillips, HW, Nahed, BV, & Coumans, J. (2014). Ucwaningo lwezokwelapha: Isikhathi sesikhathi sokuhlinzwa kanye nemiphumela ngokulandela ukwelashwa okuhlinzekwa kwe-hematoma engaphansi kwe-subdural hematoma. Journal Of Neuroscience Clinic , 21 2107-2111. doi: 10.1016 / j.jocn.2014.05.016