Ukwelashwa Kwezokwelapha Nezihlinzeko ze-High Skull Pressure
Uma ingcindezi ku-skull ikwakhiwa, kungakhathaliseki ukuvuvukala, i-bleed, i- tumor , noma enye inkinga, ukucindezelwa kwezicubu zobuchopho kungaholela ekulimaleni okungapheli. Ukucindezela okuphezulu okuphezulu (ICP) kubhekwa njengesimo esiphuthumayo se-neurological futhi kudinga ukuxazululwa ngokushesha ngangokunokwenzeka.
Ukuthola i-ICP ephezulu
Indlela yokuqala yokuthola i-ICP ephakeme ukulalela izimpawu zomuntu.
Umbono ophuphuthekayo, ukukhanda ikhanda , noma izinguquko ekucabangeni kungabonisa ukuthi ukucindezela komuntu othile okuphezulu kungaphezulu kakhulu. Ngokuvamile, izimpawu zimbi nakakhulu uma zibeka flat.
Nokho, ngezinye izikhathi, umuntu ulahlekelwa ukuqonda, lapho kwenzeka khona ezinye izinkomba ezidingekayo. I-Fundoscopy , lapho udokotela ebuka ngemuva kweso ngenkathi ekhanyisa ukukhanya okukhanyayo, angabonisa izinguquko ku-nertic optic ngenxa ye-ICP ephakeme. Lezi zinguquko azihlali ngaso sonke isikhathi, ngakho-ke, ngezinye izikhathi ezinye izindlela zokuphenya ukucindezela okungahambi kahle ziyadingeka uma odokotela besola ukuthi ukucindezeleka okungahambi kahle kungase kugibele.
Enye yezindlela ezinokwethenjelwa kakhulu zokulinganisa i-ICP ukubeka i- monitor ngaphansi kwegazi. Lokhu kunenzuzo eyengeziwe yokukwazi ukukala i-ICP njalo kunokuba nje uthole isilinganiso esisodwa, ngakho izinguquko ku-ICP zingathathwa. Lokhu kubaluleke kakhulu ezimweni lapho umuntu angakwazi ukubikezela ukuthi i-ICP izoba yimbi kakhulu, njengokuthumba ngemuva kokuhlukunyezwa kwengqondo .
Ukubeka isimiso esinjalo kuyinkqubo evumayo, noma kunjalo. Ngenkathi zivame ukuphephile, laba baqaphi bangabangela ukutheleleka noma ukuphuma. Zibekwe kuphela lapho kunesidingo esicacile sokuqapha okufutshane kwe-ICP.
Ukuphathwa Kwezokwelapha kwe-ICP ephezulu
Lapho izinzwa ze-neurologists zizwa i-ICP ephakeme, izinyathelo zithathwa ukuze zinciphise leyo ngcindezi.
Kunezinto ezintathu eziyinhloko ezingxenyeni ezingaphansi kwe-skull: igazi, ubuchopho, kanye ne- cerebrospinal fluid (CSF) . Uma ukucindezelwa kwakha, ukunciphisa ivolumu yegazi noma i-CSF kungenza indawo engaphezulu yobuchopho ukuvimbela ukucindezeleka nokulimala okuphakade.
Ivolumu ye-CSF ingancishiswa ngokunciphisa ukukhiqizwa kwayo ngaphakathi kwezingxenyeni zobuchopho. Ezinye imithi efana ne-acetazolamide inganciphisa ukukhiqizwa kwe-CSF kanye ne-ICP ephansi njengomphumela. Noma kunjalo, amandla alo mphumela awunamandla kakhulu, futhi i-acetazolamide inemiphumela emibi njengokushintsha i-asidi yegazi.
Umthamo wegazi ebuchosheni ungancishiswa ngokubeka ikhanda ukuze ukhuthaze umvuthwandaba wekhanda ukuba ubuyele igazi ngokushesha enhliziyweni. Uma isiguli sivuliwe ( sinombhobho ophefumulayo), izinga lokuphefumula lingakhuphuka ukuze lishintshe i-acidity yegazi lesiguli. Lokhu kungabangela imishanguzo ebuchosheni ukunciphisa, ukunciphisa ukugeleza kwegazi nokunikeza ubuchopho igumbi elincane kakhulu-noma kunjalo, lesi yisisombululo sesikhashana nje kuphela.
Ngezinye izikhathi ubuchopho buvuvukala ngenxa ye-edema, lapho ukuphuma kwamanzi kuphuma khona emithanjeni yegazi kanye nasezikhungweni zobuchopho. Amanye ama-substrate afana ne-mannitol, noma ngisho ne-saline, angakhuthaza ukuthi uketshezi ukuthi ubuyele ebuchosheni ukuya emithanjeni yegazi lapho kungabangela ukulimala okuncane.
I-steroids efana ne-dexamethasone ingasiza ekunciphiseni ukuvuvukala kobuchopho.
Ukuphathwa kokuhlinzwa kwe-ICP ephezulu
Uma ukuphathwa kwezokwelapha kunganele, ngezinye izikhathi izinyathelo ezinonya ezimbi zibizwa, njengokuhlinzwa.
Uma ubuchopho bucindezelwa into ekhanda engeyona eyakhe, njenge- abscess noma i-tumor, ngezinye izikhathi kungenzeka ukususa inkinga. Nokho, ezinye izikhathi, lokhu akunakwenzeka, kungenxa yokuthi ingozi yokuhlinzwa inkulu kakhulu, noma ngenxa yokuthi inkinga ayisuswa kalula.
Isibonelo, uma inkinga enkulu ukuthi ubuchopho buvuvukala ngenxa yokuvuvukala, kusobala ukuthi ngeke kube yisisombululo esihle kakhulu sokususa ingxenye yengqondo ngokwayo.
Kule nkinga, ikamelo elithile kufanele lenziwe ngandlela-thile ukuze kuvunyelwe ikamelo lokuvuvukala.
Ngaphandle kwemithi efana ne-acetazolamide, i-CSF ingasuswa ngokuyiqeda ngokusebenzisa i- shunt . Lokhu kuhilela ithubhu ibekwe ezingxenyeni zengqondo zokukhipha i-CSF. Uma i-ICP iqapha isele ivele ivele, i-CSF ingase isetshenziswe ngaleyo qapha ukuze igcine ingcindezi emgomweni othile.
Noma kunjalo, kunemiphumela emibi yokugwema. Ngaphandle kwezingozi zokutheleleka nokuphuma kwegazi okuvela ekufakeni okuthile emzimbeni, kukhona ingozi yokuthi i-CSF kakhulu izosuswa ezindaweni ezingalungile, okuholela ekushintsheni kwezingcindezi eziholela ekusenizeni - ukunyakaza kwengxenye yengqondo lapho kungenjalo.
Enye yokwelapha okungenzeka ukuthi kwenzeke ubuchopho bube bukhulu kakhulu. Odokotela benza lokhu ngokwenza i- craniectomy , lapho ingxenye ye-skull isuswe khona ukuze kuvunyelwe indawo engaphezulu yobuchopho ukuba ivule.
Ngenkathi ingxenye ye-skull isusiwe, izicubu ezizungezile ubuchopho zisalokhu zigcinwe njengezinzile futhi zihlanzekile ngangokunokwenzeka ukuvimbela ukutheleleka. Nakuba izifo nezinye izinkinga zingase zenzeke, ngenkathi i-craniectomy ibizwa, kunezinye izinketho ezimbalwa. I-craniectomy iyinkimbinkimbi enkulu ngezinye izingozi ezinkulu, kepha kungasiza kakhulu ezimweni ezinkulu.
Imithombo:
Allan, H., et al. Ukunakekelwa Okujulile Neurological and Neurosurgical, Edition Four, Lippicott Williams & Wilkins, 2004
I-Braunwald E, Fauci ES, et al. Izimiso zikaHarrison zeMithi yangaphakathi. 16th ed. 2005.