Izimbangela, Ukwelapha, Nebunzima Besimo Epilepticus
Isimo sokuphefumula isimo, noma 'isimo' yisimo esiphuthumayo sezokwelapha esidinga ukunakwa okusheshayo - eqinisweni, ukunakekelwa kwezempilo okusheshayo kungagcina impilo.
Qaphela : Uma ukhathazekile ukuthi umuntu unesimo se-epilepticus ubiza u-911. Izinyathelo eziphuthumayo zokwelashwa eziphuthumayo zakwa-2016 ziphawulwe ngezansi ngaphansi kokunakekelwa okuphuthumayo.
Ukuthunjwa kuyinto engavamile, engalungile umsebenzi kagesi okwenzeka ngaphakathi kobuchopho.
Uma umuntu enesifo esiphuthumayo, ukuxilongwa kwesithuthwane kwenziwa ngokusekelwe ezifundweni zegazi, umlando ophelele wezokwelapha, nokunye ukuvivinywa, njenge-EEG, ithempini yomgogodla , noma izifundo zokucabanga. Kule ndawo lapho umhlinzeki wakho wezempilo uyokunika imithi efanele ezolawula isimo sakho.
Nge-epilepsy, uzothola ukuthi ukugunjwa okukhulu kungadlulela emaminithini ambalwa . Kwezinye izimo ezingavamile, zingase zihlale isikhathi eside futhi zingase zivele zingaboni nakancane. Lokhu kubizwa ngokuthi yisimo se-epilepticus. Kulinganiselwa ukuthi abantu abangaba ngu-50 000 kuya ku-150 000 e-United States baphathwe isimo se-epilepticus minyaka yonke.
Yini Isimo Epilepticus?
Ngenkathi isimo se-epilepticus, umuntu onesithuthwane uyoba nokuqonda okungafaneleki nokucindezeleka okuphikelela noma okuphindaphindiwe. Ukuzikhandla okujwayelekile kuzohlala imizuzu embalwa nje. Kodwa-ke, lapho ukuthunjwa kudlula imizuzu engu-5 kuya kwezingama-30 ngaphandle kokuthola ulwazi, lowo muntu uzotholakala enesimo sokuhlushwa kwesimo se-epilepticus.
Isimo esiphuthumayo isifo esiphuthumayo esidinga ukwelashwa okusheshayo nokucophelela futhi singabulala uma kungakhulumi ngaso leso sikhathi. Izinkinga ezingase zivele esimweni se-epilepticus zibandakanya ukungasebenzi kwenhliziyo noma amaphaphu, ushintsho lwe-metabolic, ukwanda kokushisa komzimba, futhi ekugcineni, ukulimala kwengqondo okungapheli.
Isimo sokuhlukumeza isimo singahle sibekwe ngokuthi sixhumane noma asixhunyiwe. Ukuxubha kusho ukuthi umuntu unesiqephu esicacile sokuthuthumela. I-epilepticus engaxhunyiwe ibhekisela esimweni sokudideka nokungazi kahle. Abantu abasesimweni esingaboni ngaso sonke isikhathi ngeke babonakale behlushwa ngokusobala, kodwa basenayo i-misfirings kagesi ebuchosheni obuhambisana nokuthunjwa. Ngemuva kokuqothulwa komkhuhlane futhi umuntfu engakaze aphinde aqaphele emva kwesikhathi, umhlinzeki wezempilo uyobheka ukwenza i-EEG ukuqinisekisa ukuthi umuntu akasiyo isimo esingenasibindi.
Yini Ebangela Isimo Epilepticus?
Isimo sokuhlukumezeka yisimo esibucayi nesisongela impilo esidinga ukwelashwa okusheshayo nokuphuthumayo ukuze kuvinjelwe ukucindezeleka okuqhubekayo nokugcina ukusebenza kobuchopho. Isimo sokuhlukunyezwa kwesimo singathinta noma yiliphi iqembu lobudala, nakuba ezinye izici zingase zidale isimo ezinganeni nakwabanye abantu abavamile kubantu abadala. Lezi zici zihlanganisa:
- Ukutheleleka kwesimiso (izifo ezithinta izingxenye ezinkulu zomzimba)
- Febrile (izifo ezihlobene nomkhuhlane)
- Ukuhlukunyezwa kwekhanda
- Isibungu
- Amanye khansa
- Ukuhoxiswa okungahambi kahle kwemithi ye- anticonvulsant (anti-seizure)
- Ukuphuza ngokweqile utshwala noma izidakamizwa ezingekho emthethweni
- Izinkinga zemetaboliki (i-sodium ephansi, i-calcium ephansi, ushukela ophansi noma ophezulu wegazi)
- Ukuhlushwa okuphansi kwesidakamizwa se-antiepileptic egazini
Ukunakekelwa Okuphuthumayo Kwesimo Epilepticus
Ukwelashwa kokuqala kuqala ngemithetho ye-ABC: Qinisekisa ukuthi umoya womuntu ngamunye ucacile, umuntu uphefumula futhi abuyisele umthamo womzimba.
Ukuhlolwa kwezokwelapha kuzokwenziwa futhi ukuze uthole ukuthi kungani umuntu engena esimweni sokuqala kwesifo sofuba.
Ukuze ulawule ukuhlukunyezwa, imithi ethile izosetshenziswa. Iziqondiso ezintsha zenziwa ngo-2016 yi-American Epilepsy Society.
Imithi yokuqala neyakhethwa yi-IV benzodiazepines, ehlanganisa i-diazepam, i-lorazepam, ne-midazolam. I-Lorazepam ivame ukusetshenziswa ngenxa yesenzo sayo esisheshayo. Abantu abangaba ngu-55% bazophendula ngale ndlela yokuqala. Uma ingasebenzi, enye yalezi zidakamizwa ingahle iphindwe, kodwa uma ihluleka ukusebenza emva kwesilinganiso sesibili, sekuyisikhathi sokushintshela kwimithi ehlukile.
Izinketho zokwelapha izidakamizwa zesigaba sesibili zifaka i-IV fosphenytoin, i-valproic acid, noma i-levetiracetam. Uma lokhu kungasebenzi enye yalezi zidakamizwa kungasetshenziswa, noma phenobarbital inganikezwa.
Uma lesi sigaba sesibili sesigaba sezidakamizwa asisebenzi, sekuyisikhathi sokufaka isigaba esinobudlova nokusetshenziswa kokuqapha okuqhubekayo kwe-EEG . Imithi yesibili yokwelashwa ingabuyekezwa noma isiguli singaphathwa nge-anesthetic dose thiopental, midazolam, pentobarbital, noma propofol.
Ukubaluleka nokubikezelwa kwesimo se-Epilepticus
Isimo sokuhlukunyezwa kwesimo singaba nokubulala futhi akufanele sithathwe kalula. Ucwaningo oluthile luphawula ukuthi izinga lokushona labantu ababhekene nesifo sofuba laliphakeme kakhulu ngo-22%, ngesilinganiso sokufa kwezingane ezi-3% nabantwana abangu-26% kubantu abadala. Ngakho-ke, isinyathelo esisheshayo sibaluleke kakhulu.
Ukuvimbela Isimo Epilepticus
Ukuze kuvikelwe isimo se-epilepticus, abantu kufanele bahambisane nemithi yabo yokulwa ne-antiepileptic. Ukwengeza, ukuvakashelwa okujwayelekile kumhlinzeki wabo wezempilo kufanele kwenziwe ukuqinisekisa ukuthi imithi isebenza kahle, akukho minye imithi eyengeziwe eyanganciphisa ukuphumelela kwemithi yabo yokulwa nesifo sofuba, nokuhlola kwanoma yiziphi ezinye izimo (njengokudakwa ngokweqile, isifo sikashukela esingalawuleki , ukuphazanyiswa komzimba) okungaphazamisa ukulawula ukulawula.
Imithombo:
UBetjemann, J., noD. Lowenstein. Isimo se-epilepticus. I-Lancet Neurology . 2015. 14 (6): 615-624.
UDrislane, F. Ukuxilongwa kwesifo se-epilepticus kubantu abadala: Ukuhlukaniswa, izici zomtholampilo nokuxilongwa. Kusesikhathini. Kubuyekezwe 11/20/15. http://www.uptodate.com/contents/convulsive-status-epilepticus-in-adults-classification-clinical-features-and-diagnosis
I-Glauser, T., Shinnar, S., Gloss, D. Isiqondiso Esisekelwe Ebufakazi: Ukwelashwa Kwesimo Esixubileyo Epilepticus Ezinganeni Nabantu abadala: Umbiko weKhombandlela Ikomidi le-American Epilepsy Society. Iziqu ze-Epilepsy . 2016. 16 (1): 48-61.
I-Trinka, E., Cock, H., Hesdorffer. Et al. Incazelo kanye nokwahlukaniswa kwesimo se-epilepticus - Umbiko we-ILAE Task Force on Ukuhlukaniswa kwesimo se-Epilepticus. Epilepsia . 2015. 56 (10): 1515-23.