Izinkinga ze-SAH kanye Nendlela Odokotela Abaphatha Ngayo
I-SAH) isifo esisongelayo futhi esingaba sengozini yokuphila lapho igazi liphuma emthonjeni ebuchosheni futhi livuza phakathi kwe- cerebrospinal fluid (CSF).
Ngaphandle kwesithathu kwesiguli se-SAH sinomphumela "omuhle" ngemuva kokwelashwa. Njengokungathi lokhu akukwanele, ukubola kwesimiso sokungena kwempahla kungasusa ukuhlaselwa kwezinye izinkinga.
Ukulondeka ngalezi zinkinga eziqhubekayo, izisulu zokuqeda ukubola kwesimiso esinqunyiwe zibhekwa ezingxenyeni zokunakekela kakhulu ngemuva kokuba zingene esibhedlela kuqala.
Kukhona izinkinga ezinkulu ezine ekumenikeleni kwegazi eliphansi. Lezo zinkinga ziyi-vasospasm, i-hydrocephalus, i-seizures, ne-rebleing.
I-Vasospasm Ngemuva kweHemorrhage ye-Subarachnoid
I-vasospasm yezwi lisho ukuthi imithwalo yegazi ebuchosheni "i-spasm" futhi iyancipha, ukunciphisa futhi ngezinye izikhathi ngisho nokuvimba ukugeleza kwegazi zibe izingxenye zobuchopho. Umphumela uyingozi.
I-Vasospasm ngokuvamile ivela ezinsukwini eziyisikhombisa kuya kweyishumi emva kokuphuma kwegazi. Ngenxa yokuthi i-vasospasm inzima ukuphatha uma kwenzeka, ukugcizelela ukunakekelwa esibhedlela kuyisivikelo. Imithi ye-blood pressure i-nimodipine iboniswe ukunciphisa amathuba okuba nemiphumela embi emva kwe-vasospasm (nakuba kungabonakali ukwehlisa ingozi yokuthuthukisa i-vasospasm endaweni yokuqala). Igazi elincanyana kakhulu emzimbeni liye laboniswa ukuthi lihambisana nengozi ye-vasospasm, ngakho-ke isiguli sinikezwa amanzi okwanele ngu-IV ukugcina ivolumu yegazi endaweni ethile (hhayi okuningi, hhayi kakhulu).
Amanye amasu okuhlola okuvimbela ama-vasospasm afaka phakathi ukunikeza imithi ye-statin .
Abantu abane-SAH baqaphelisiswa izibonakaliso ze-vasospasm ngezivivinyo eziphindaphindiwe ze-neurological. Uma kukhona umphumela wokuhlola ophuthumayo, kungase kusho ukuthi i-vasospasm iyenzeka. Ukusetshenziswa kwamasu afana ne- transcranial Doppler nakho kungabonisa ukuthi othile uthuthukisa i-vasospasm.
Ngokuphathelene nokwelapha i-vasospasm, ukucindezelwa kwegazi kugcinwe kakhulu (ukucindezeleka okukhulu) ngaphandle kweziguli ezine-high blood pressure noma ezinye izinkinga zenhliziyo eziphikisana nalolu hlelo.
Uma i-vasospasm iphikelela naphezu kokwelapha okunegazi, izinketho eziningi ezingavamile, njenge- angioplasty (ukuvula isitsha segazi ngendwangu esetshenziselwa emithanjeni yegazi) noma ukusebenzisa i-catheter ukujova imithi ngokuqondile endaweni elincane, kungenziwa ukuzama.
I-Hydrocephalus Ngemuva kweHemorrhage ye-Subarachnoid
Ngezinye izikhathi i-clot yegazi esuka ekuqhumeni kwe-subarachnoid ingafakwa kwenye yezindawo ezibalulekile zokugeleza kwemvelo ye-cerebrospinal fluid (CSF). Ngokuvamile, i-CSF ikhiqizwa ezingxenyeni ze-brain. I-ke ihamba ngezingxoxo ezincane ezibizwa ngokuthi i-foramina. Uma lezi zivule zivaliwe, i-CSF isakhiqizwa kodwa ayikho indawo yokuya kuyo. Umphumela wukunyuka kwengcindezi ngaphakathi kwe-ventricles yobuchopho, eyaziwa ngokuthi i-hydrocephalus. Ingcindezi isakazeka ebuchosheni nasekhanda.
Ukunyuka kwengcindezi engathandwayo kungaholela ekunciphiseni ulwazi kanye ne-coma. Uma kushiywe kungalashwa, ubuchopho bungadluliselwa ezindaweni eziqinile ezifana nokuvula esisekelweni se-skull, okuholela ekufeni.
Ukuze uvimbele lokhu kukhishwa kwengcindezi, ama-neurosurgeons angenza i-lumbar puncture noma i-shunt ibe yi-skull ukuze kukhishwe ama-CSF angaphezu kwalokho.
I-Seizure Ngemuva kweHemorrhage ye-Subarachnoid
Igazi lingamcasula i-cortex ye-cerebral futhi ibangele ukuthunjwa . Kodwa-ke, amaphesenti amancane kuphela weziguli ezine-SAH ziyaqhubeka nesifo sokuwa nesifo (isifo sokugula). Odokotela bangase bacabange ukusebenzisa ama-anti-epileptics okuvimbela esikhathini esilandelayo ngemva kokushisa kwesisu. Kodwa ukusetshenziswa kwesikhathi eside sokulwa nesithuthwane akunconywa (ngokuhlukile ngaphandle kokusekelwe ezinkingeni zomuntu ngamunye), ngenxa yobungozi bemiphumela emibi.
Ukukhipha kabusha emva kokufa kwe-Subarachnoid Hemorrhage
Ngemuva kwe-SAH, ingozi yokukhishwa kabusha ingamaphesenti angaba ngu-3 kuya ku-13 phakathi kwamahora angu-24 okuqala, ngokusho kwe-athikili ka-2012 eStroke .
Ukuhlola njalo kwezinzwa zezinzwa kanye nokuhlolwa kwekhanda ngezikhathi ezithile, ikakhulukazi esikhathini esifushane ngemuva kokuphuma kwegazi, kungasiza ekutholeni ukuphuma uma kwenzeka.
Ukuze uvimbele ukuphuma kwegazi, ama-aneurysms aphezulu kakhulu ebuchosheni afakwe uphawu. Lokhu kungenziwa ngokusebenzisa uhlobo oluyisisekelo sokudla okuyisiqeshana sokuqhafaza i-aneurysm kusuka kuyo yonke into yomthamo, noma ngokufaka umcengezi emithanjeni kuze kufike ku-aneurysm nokufaka izinsimbi zensimbi noma isakhi se-sealant ukuze ubeke uphawu lwe-aneurysm. Iyiphi inqubo engcono isinqumo esiyinkimbinkimbi esivela kumuntu kuya komuntu futhi sidinga ingxoxo ngokucophelela neqembu lezokwelapha.
Ngaphansi
Ngenkathi izinkinga ezine eziyinhloko zesifo somzimba esincane kungase kubonakale sengathi zingaphezu kokwanele, ngeshwa, kunezingozi eziningana ezingase zivele ngenxa yokugula okunzima okwanele okudingayo ukunakekelwa ekamelweni lokunakekelwa okukhulu. Ukucindezeleka okujulile kwemilenze, hyponatremia kanye nezifo ezitholakale esibhedlela kufanele futhi ziqashwe. Ukusinda kokuphuma kwegazi kuqala yingxenye yenkinga yokumiswa kwemithwalo yangaphansi kwe-subarachnoid. Ukusinda kokunye kuzodinga ukusebenzisana eduze neqembu labachwepheshe bezokwelapha.
Imithombo:
U-Bederson, uJB, et al. (2009). Izinkombandlela zokuphathwa kwe-aneurysmal subarchnoid hemorrhage: isitatimende sabasebenzi bezempilo abavela eqenjini elikhethekile lokubhala iStroke Council, i-American Heart Association. Isihlungu , 40: 994.
Buczacki, SJ, Kirkpatrick, PJ, Seeley, HM, & Hutchinson, PJ (2004). Isithuthwane esilandelayo emva kokuhlinzwa okuvulekile kwe-aneurysmal ye-hemorrhage engaphansi komhlaba. J yethu yen Neurology, Neurosurgery, & Psychiatry , 75: 1620.
U-Connolly, ES et al. (2012). Izinkombandlela zokuphathwa kwe-aneurysmal subarchnoid hemorrhage: isitatimende sabasebenzi bezempilo abavela eqenjini elikhethekile lokubhala iStroke Council, i-American Heart Association. Isisu, 43 (6): 1711-37.
Kassell, NF, Sasaki, T., Colohan, AR, Nazar, G. (1985). I-vasospasm ye-cerebral elandela ukubola kwe-suburchmay aneurysmal. Isisu, 16: 562.
Tidswell, P., et al. (1995). Umphumela wokucabangela ngemuva kokuhlukana kwe-aneurysm: ubudlelwane nesitifiketi esine-aneurysm kanye nezinkinga ze-perioperative. I-Neurology, 45: 875.
QAPHELA: Ulwazi olukulesi sayithi lunguzinhloso zemfundo kuphela. Akufanele isetshenziswe njengengxenye yokunakekelwa ngumuntu udokotela olayisenisi. Sicela ubheke udokotela wakho ukuze ahlolwe futhi aphathwe noma yiziphi izimpawu noma isimo sezokwelapha .