Umphumela we-Increased Intracranial Pressure eBrain
Kusho ukuthini ngempela uma umuntu ekhuphuke ingcindezi yokungasebenzi? Ziyini izimpawu zengcindezi ephakeme yokunyuka kwengcindezi, yini eyabangela, futhi iphathwa kanjani? Yini engenzeka ebuchosheni uma ingcindezi ekhanda ihlala iphezulu kakhulu?
Ukucindezela Okuphezulu Kwezingcingo - Incazelo
Ukucindezelwa kokuxoshwa komzimba kuyisilinganiso sokucindezela ebuchosheni nasezindaweni ezizungezile zomswakama we-cerebrospinal fluid.
Uma lokhu kucindezela kwanda ngesizathu esithile-kungakhathaliseki ukuthi kuphuma igazi ebuchosheni (ukulimala), ukutheleleka, noma ukulimala kwekhanda-ubuchopho bungase buhlupheke kakhulu. Eqinisweni, ingcindezi ephakeme yokucindezeleka ingenye yezinkinga ezesabekayo zokulimala kwengqondo ebuhlungu. Ake sichaze ukuthi kungani.
I-Brain, i-Cerebrospinal Fluid, ne-Intracranial Pressure
I-skull, lapho ucabanga ngakho, ayikho enkulu kakhulu. Kulezo zimbalwa eziyisentimitha eziyisithupha zamathambo angenalutho yizinto zonke ozikhumbulayo, zonke izici zobuntu, zonke zamakhono akho akhethekile noma amathalenta, konke okubanjwe ngamaphilisi ambalwa obuciko obuchopho.
Njengoba encane njengalesi sikhala, ubuchopho kufanele bubelane ngakho. I-Cerebrospinal fluid (CSF) iyakhela ubuchopho, igxume futhi ivikele ubuchopho ekushayeleni ngokumelene ne-skull nazo zonke i-jolt yekhanda lakho. Igazi ligeleza kulowo mkhakha wokungena emzimbeni, futhi unikeze ubuchopho ngomoya owufunayo futhi ulahle ubuchopho ngabakhiqizi be-toxic.
Ezinye izingxenye zomzimba kufanele zabelane ngezikhala, kepha lezo zindawo azihlanganisiwe ngokuqinile kakhulu njengengqondo. Kukhona ukuvuleka okumbalwa okuphuma kulolo skull lapho izinzwa nezinsika zomgogodla zihamba ngayo. Okunye ngaphandle kwalokho, ayikho indlela yokuphuma noma yokuphuma kwaleso sikhala sokungena.
Konke lokhu kuhle ngokwanele ekuphileni kwansuku zonke.
Kuyinto enhle ukuthi ubuchopho bethu buvikelwe kahle ngalolu hlobo lwesigqoko semvelo, noma ngabe sithandwa yizo zonke izinhlobo zokulimala komqondo. Kodwa-ke, izinkinga ziphakama lapho enye yezingxenye ezintathu eziyinhloko zesikhala esingahambi kahle idinga indawo engaphezulu. Lezi zici zihlanganisa:
- I-blood tract
- Izicubu ze-Brain
- I-Cerebrospinal fluid
Uma okuthile kudinga isikhala esengeziwe, kukhona okunye okumelwe ukunikeze. Ekuqaleni, izenzo zokukhokha zenzeka phakathi kwalezi zigaba ezintathu. Uma lokhu kungasenakwenzeka, noma kunjalo, njengoba lokhu kwenzeka enqenqemeni oluqinile lwe-skull, ukucindezela okungahambi kahle kuqala ukukhula ngokushesha.
Yini Ebangela Ukucindezela Okuphezulu Kwe-Intracranial?
Kunezinqubo ezimbalwa ezihlukene nezinqubo ezingaholela ekukhuphukeni kokucindezela okungahambi kahle.
Ngezinye izikhathi, into ekhona ekhanda okungadingeki kube khona. Izibonelo zihlanganisa isisu sobuchopho , igazi ngenxa yokulimaza ebuchosheni. Ngezinye izikhathi ukutheleleka noma ukuvuvukala kubangela ukuvuvukala futhi kugubha ebuchosheni.
Ngezinye izikhathi, indlela evamile yokuphuma kwamanzi iphuma futhi iphuma esikhaleni esingenakunyakaziswa iphazamisekile. Isibonelo, i-CSF ivame ukugeleza kusuka kuma-ventricles maphakathi nobuchopho ngokusebenzisa ukuvuleka okuncane okubizwa ngokuthi i-foramina. Uma lokhu kugeleza kwe-CSF kuvinjelwe ngandlela-thile, futhi i-CSF iyaqhubeka nokwenziwa, ukucindezela kuyakha.
Ezinye izici ezingozini zokucindezela okuphezulu okugxilwe kuyo zihlanganisa:
- Ukuhlukunyezwa kwekhanda
- Izicubu ezinjengama-tumors obuchopho noma ama-metastase ebuchosheni obuvela kwezinye izicubu
- Ukushisa okwegazi, ukubola kwesisu noma i- subarchnoid hemorrhage
- Isihlungu sakwa-Ischemic
- Hydrocephalus
- Izifo ezifana ne- meningitis ne-encephalitis
Ngezinye izikhathi kukhona ukwanda kokucindezela okungahambi kahle ngenxa yezizathu ezingaziwa. Lokhu kubizwa ngokuthi "idiopathic" ingcindezi ephakeme yokungasebenzi.
Yiziphi Izimpawu Nezibonakaliso Zokucindezela Okuphakeme Kwezingcingo?
Ukucindezela okujwayelekile okungahambi kahle kunendawo ethile phakathi kwamamitha angu-8 ukuya kwangu-20 we-mercury (mm Hg). Okungaphezu kwalokhu kanye nezakhiwo ezibuchosheni zingase ziqale ukuthinteka.
Enye yezinhlaka zokuqala ukuzwa ukuhlukunyezwa yizicubu ezibizwa ngokuthi i-meninges ezungeze ubuchopho. Nakuba ubuchopho ngokwayo buhluleka ukuthola ama-receptors, ama-meninges angavutha imiyalezo ebuhlungu eholela enhlokweni ebuhlungu.
Ukucindezelwa okuphezulu okuvame ukudala ukucindezeleka okuvamile noma ukucindezeleka ekhanda uma ulele phansi; ngoba ingcindezi ephezulu yokungasebenzi iyathuthukiswa ngokuma futhi ibuhlungu ngokulala phansi. Ukuma kuvumela ezinye izingcindezi ukuba zehla emgqeni wamagogasi, kuyilapho zibeka phansi isisindo soguquko, okuholela ekucindezelweni okuphakeme okuzungeze ubuchopho.
Esinye isakhiwo okumelwe sithinteke ngokushesha nje lapho kuphuma ukucindezelwa kwengcindezi yizimbilini ze-optic, izinzwa ezisuka ngemuva kweso (i-retina) endaweni yengqondo lapho umbono uhunyushwa khona (i-occipital lobes). Abantu abane-ICP ephezulu bangase baqale ukukhononda ngokufiphaza kombono wabo njengoba izinzwa ze-optic zonakalisiwe. Ngaphandle kokulahlekelwa okubukwayo, ngokuvamile kutholakala ukulahlekelwa kwensimu futhi udokotela angakwazi ukuphawula i-papilledema ekuhlolweni kwe-fundoscopic-uma udokotela esebenzisa ithuluzi eceleni kwesithuluzi esibheka ezindlebeni zakho ukubheka i-retina-yamehlo. Uma ingcindezi yokungasebenzi ingakapheli isikhathi esilinganiselwe, ukulahleka kombono okungapheli kungaholela.
Ezinye izimpawu zengcindezi yokunyuka kwengcindezi ingase ihlanganise ukunxanxathela nokuhlanza, izinguquko zokuziphatha, kanye nokuqothulwa. Ukuguquka kwesimo sengqondo, njengokungathembeki futhi ekugcineni i-coma kuyisibonakaliso esibi.
Ezinganeni, isibonakaliso sokunyuka kwengcindezi yokunyuka kwengcindezi siyi-fontanelle (indawo esithambile) futhi ngezinye izikhathi ukuhlukaniswa kwe-sutures (emaphethelweni ekhanda lomntwana.)
Izinkinga Zokucindezela Okuphezulu Kwezingcingo
Okunye okuphathelene nokulimala kwe-optic nerve (nokulimala okubangelwa embonweni) ukuthi i-ICP ingathinta kanjani ubuchopho ngokwayo. Lapho izingcindezi ziphakama ngaphakathi kwengxenye ye-skull, ubuchopho bungaphakanyiswa endaweni engaphansi kwengcindezi. I-lobes yobuchopho ihlukaniswe iziqephu ezinzima zezicubu. Isibonelo, i-hemisphere engakwesobunxele ihlukaniswe ukusuka e-hemisphere kwesokudla phezulu kobuchopho ngamathambo okuthiwa i-falx cerebri. Uma i-bleed in the hemisphere engakwesokunxele yenza ukucindezeleka okwanele, ingashukumisa ubuchopho bendawo engakwesobunxele ngaphansi kwe-falx cerebri, ukuchoboza izicubu zobuchopho nokuvimbela imithwalo yegazi. Ukulimala kwengqondo kanye nokushaya isifo kungaholela.
Ngokufanayo, i-cerebellum ihlukaniswe nobuchopho bonke ngengqamuzana. Uma ingcindezi ikhiphe ngaphezu kwalolu membrane, izicubu zobuchopho zingasuswa phansi ngokusebenzisa ukuvulwa okuncane eduze kwe-brainstem, okwenza kube nomonakalo ongenakuhlukaniswa kobuchopho. Lokhu kungabangela ukukhubazeka, i- coma, nokufa.
Ukuqaphela ukucindezela okuphezulu kwe-Intracranial
Ukucindezela okuphezulu okuphakanyisiwe kungaxilongwa ngezindlela eziningi ezahlukene. Izimpawu ezibalwe ngenhla zingase ziphakamise ukuthi ukucindezelwa kuphakanyisiwe. Ukuhlola i-fundoscopic iso kungabonisa i-papilledema. Umshini womgogodla ungaphinde unikeze ulwazi mayelana nokucindezela okungahambi kahle, nakuba lokhu kungaba yingozi uma ukucindezeleka kuphezulu kakhulu.
Indlela enokwethenjelwa kakhulu yokulinganisa ukucindezeleka okungahambi kahle ngokufaka i-monitor ngaphansi kwegazi. Le nqubo inikeza ukufundwa okuqhubekayo kokucindezela okungahambi kahle. Ngezinye izindlela zokuhlinza ngobuchopho noma ukulimala kokwehluleka kwengqondo ukuqapha kwengcindezi engaphelele kuvame ukufakwa ngokushesha.
Izinketho zokwelashwa zokwenyuka kwengcindezi yokucindezela
Kumele kube manje ukuthi kucace ukuthi ukucindezeleka okuphezulu okuphezulu kungaba yingozi. Kodwa-ke, izazi ze-neurologists zinekhono kakhulu ekuhloleni futhi ngokuvamile ukuphatha lesi simo, okuyinkimbinkimbi evamile yezinzwa eziguli ezigula kakhulu.
Esikhathini esiningi, ukucindezela okungekho emthethweni ngaphezu kuka-20 kuya ku-25 kuphathwa kabi.
Ngenhlanhla, izazi ze-neurologists zinezinhlobo eziningi zokuphatha i-ICP ephezulu uma isikhathi sesisisekelo. Ngenkathi kungekho lutho oluqinisekisiwe, ukungenelela okufike ngesikhathi kungavimbela ukukhungatheka okukhulu.
Umgomo wokuqala ukuqinisa isiguli, ukuhlinzekela nge-sedation uma kudingeka, futhi ukukhulula ubuhlungu. Uma ukwenyuka kuncane nje, izinyathelo ezilula ezifana nokuphakamisa ikhanda kunganciphisa ukucindezela okungahambisani nomuntu ngokwezinga eliphansi ngokuvumela igazi entanyeni ukuba libuyele enhliziyweni.
Isinyathelo esilandelayo ukukhulisa ikamelo ebuchosheni ngamathambo we-nerve sensitive. Izixazululo ezifana ne-mannitol noma i-hypertonic saline zivame ukunikezwa njengoba zidonsa amanzi egazini futhi zingekho ebuchosheni. I-steroids ingase futhi iyancipha ukuvuvukala ebuchosheni. Imithi efana ne-acetazolamide inganciphisa ukukhiqizwa kwamanzi kagesi. Uma isiguli sisesithombeni, izinga lokuphefumula livame ukwanda futhi. Izindlela ezintathu zokwelashwa zingase zihlanganise i-hypothermia, ukucindezelwa komzimba, noma i-craniectomy. I-craniectomy ihilela ukukhipha ingxenye ye-skull ukuze unikeze ubuchopho ithuba lokunyuka njengoba likhula.
Funda kabanzi mayelana nokuphathwa kwezokwelapha nokwelashwa kwengcindezi ephakeme yokunyakaza .
Ukubikezelwa kokucindezela okuphezulu kwe-Intracranial Pressure
Ukuchazwa kwemfutho ephakeme yokuxoshwa komzimba kungashintsha kakhulu, kuye ngokuthi imbangela eyimbangela, ukuthi ukuphakama kwengcindezi kuphakama kangakanani, nokuthi ingcindezi ihlala isikhathi eside kangakanani. Kuzophinde kuxhomeke ezinyangeni ezithize ezisetshenziswayo.
Ngezansi Kucindezelo Oluphezulu Lokuxubha Inhliziyo
Ukucindezela okuphezulu okuphakanyiswayo kuyinkimbinkimbi evamile futhi eyinkimbinkimbi yezimo eziningi ezithinta ubuchopho. Lokho kusho ukuthi ukuqashelwa kokuqala kanye nokwelashwa okunomthelela kungadala isikhathi eside ekunciphiseni izinkinga. Uma ubhekane nalesi sikhathazo nomuntu othandekayo, cela imibuzo. Noma yikuphi ukukhathazeka kwezokwelapha kungasabisa, kodwa lokho okuthinta ikhono lethu lokucabanga nokufunda nokuphupha kuthwala ukukhathazeka okungaphezu kwalokho. Ukuqonda okwenzekayo nokuthi yiziphi izinyathelo ezilandelayo ezingakusiza kungakusiza ukuthi ubhekane naso uma ubhekene nale nkinga enzima.
Imithombo
- UCzosnyka, M., Pickard, J., noL. Steiner. Izimiso Zokuqapha Nokucindezelwa Kwe-Intracranial Pressure. I-Handbook ye-Neurology yezokwelapha . 2017. 140: 67-89.
- de Oliveira Manoel, A., Goffi, A., Zampieri, F. et al. Ukuphathwa Okunakekelwa Okunakekelwa Kwemiphumela Yokuzivocavoca Okungajwayelekile: Ukubukeza Okuqhubekayo. Ukunakekelwa Okubalulekile . 2016. 20: 272.
- Kasper, uDennis L .., u-Anthony S. Fauci, noStephen L .. Hauser. Izimiso zikaHarrison zeMithi yangaphakathi. I-New York: Imfundo ye-Mc Graw-Hill, 2015. Phrinta.