Amaseli kanye nesikhala sokungenelela esakhiweni esilawulayo se-system central wezinzwa singagcina uketshezi. Lokhu kubangela ukuvuvukala noma ukuvuvukala kobuchopho, okwenyuka ukwanda komthamo wayo kanye nokwanda komfutho wokucindezeleka . Lesi simo kubhekwa njengesifo esiyingozi kakhulu esidinga ukwelashwa ngokushesha.
I-Edema yezinhlobo zobuchopho
Ukuhlukaniswa kwesifo esibhekwayo kuncike ezindleleni zokuvela kwayo kanye nokugeleza okulandelayo. Kukhona i-edema ye-cerebral yalezi zinhlobo:
- i-vasogenic;
- i-cytotoxic;
- ukusebenzisana;
- osmotic (ukuhlunga).
Ukwengeza, i-edema ye-cerebral ingahlukanisa kuye ngezimbangela zokubunjwa kwayo:
- isisu;
- i-traumatic;
- ukuvuvukala;
- i-toxic;
- i-postoperative;
- i-hypertensive;
- ischemic nezinye izinhlobonhlobo.
I-edema ye-cerebral e-vasogenic
Phakathi kwesistimu ye-nervous and central central kukhona isithiyo somzimba - isithiyo segazi-i-brain (BBB). Ngesizo salo, okuqukethwe kwamanzi esikhaleni se-intercellular kulawulwa. Njengoba ukunyuka kwe-BBB kwanda, i-edema yobuchopho be-vasogenic ivela. Kwenzeka ngokumelene nesizinda sokwephulwa okulandelayo:
- ukukhathazeka okubandayo;
- izicubu;
- igesi kanye ne-microembolism yemithambo yegazi;
- i-eclampsia;
- ukutholakala kwemithambo ye-carotid.
I-edema ye-cytotoxic yobuchopho
Amaseli athola umphumela onobuthi (wangaphandle noma wangaphakathi), qala ukusebenza ngokungalungile. Ukugcoba umzimba nokuguqulwa kwezibungu kuyashintsha. Izicubu ziqoqa uketshezi futhi zakha i-edema ye-cytotoxic noma ukuvuvukala. Leli fomu le-pathology livame ukutholakala ngemuva kokushaya kanye nokudakwa ngokweqile, kodwa kubuyeke emuva emahoreni ayisithupha kuya kwangu-8.
I-edema ye-cerebral edema
Engxenyeni esemqoka yesimiso sezinzwa, i-cerebrospinal fluid noma i-cerebrospinal fluid ijikeleza njalo, ikakhulukazi ema-ventricles. Lapho ingcindezi ekhulayo futhi iphakama ngokuqinile, kukhona i-edema yangaphakathi yobuchopho. Isimo esichazwe sibangela ukufakelwa kwezicubu ngokweqile ngokweqile. Ngenxa yalokho, amangqamuzana akhula ngevolumu futhi avule.
I-osmotic cerebral edema
Noma yiluphi uketshezi luqukethe izinhlayiya eziqukethe kuwo. Ubuningi babo ku-1 kg we-umswakama kuthiwa i-osmolarity. Ngokujwayelekile, lesi sakhi se-plasma nesigungu esilawulayo sesimiso sezinzwa cishe sifana. Uma i-hyperosmolarity (ephakame kakhulu) 'yezindaba ezimpunga' ibonakala, kutholakala ukuthi kutholakala ukuhlolwa kwengqondo yobuchopho. Ngenxa yokwanda kwamanani ezinhlayiyana ku-cerebrospinal fluid, izicubu zivame ukunciphisa ukuhlushwa kwazo, futhi zithatha uketshezi olusuka ku-plasma. Ukuvuvukala okunjalo kobuchopho kubhalwe nge-type encephalopathies. Ngokuvamile kubangelwa i-hyperglycemia, u-renal no-hepatic insufficiency.
I-cerebral edema - izimbangela
Izici ezivame kakhulu ezibangela ukuhlukumezeka okukhulunywe ngazo:
- ukuphazamiseka okukhulu kwe-circulatory (strokes);
- ukungenelela kokuhlinzwa;
- ukuphuza ngokweqile, kuhlanganise nokudla utshwala;
- ukusabela kwe-anaphylactic ngokumelene nesimo semvelo.
Kunezizathu ezingavamile ezichaza ukuthi yini ebangela ukukhukhumeza kobuchopho:
- izicubu zesifo somdlavuza kanye nama-metastases;
- amaqabunga amathambo we-cranium nesisekelo;
- ukuxoshwa kwenkohlakalo, ukwehluleka kwenhliziyo, ukwehluleka kwenhliziyo;
- i-meningitis ;
- ukuphazamiseka kwengqondo ;
- I-hematomas ehamba phambili ehamba phambili;
- ukulimala kwe-axonal;
- i-meningoencephalitis;
- i-toxoplasmosis ;
- i-subdural empyema.
I-Edema yobuchopho ngemva kokushaywa yisifo
Ukuphazamiseka kokujikeleza kwegazi engxenyeni eyinhloko yesimiso sezinzwa ezisemaphakathi kuqala ngokugubha umkhumbi nge-thrombus. Kancane kancane, izicubu zithola umoya ophansi, yingakho indlala yabo ye-oksijeni iqala. Amaseli afa futhi acindezele ngandlela-thile umswakama, kukhona i-ischemic edema yobuchopho. Kwezinye izimo, uketshezi oluphilayo oluqoqa phambi kwe-thrombus lungaphula izindonga zomkhumbi. Lesi simo sandisa i-edema ye-cerebral ngokushaya, ngoba amathishu emva kokuqeda imithwalo yegazi ishaya umswakama ngisho nangaphezulu. Lokhu okuhlukile kokuvuvukala kweseli kubhekwa njengengozi kakhulu.
I-Edema yobuchopho ngemva kokuhlinzwa
I-pathology cishe ihambisana nokuhlinzeka okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa okuhlinzekwa ukuhlinzekwa okuhlinzekwa okuhlinzekwa ukuhlinzekwa okuhlinzekwa okuhlinzekwa ukuhlinzekwa okuhlinzekwa ukuhlinzekwa oku Ezimweni ezingavamile futhi ngokumelene nesimiso sezinye izinqubo, kukhona i-cerebral edema - umsebenzi owenziwe usebenzisa i-anesthesia ye-epidural, noma ukuphathwa ngokweqile kwe-hypotonic ne-saline solutions solutions. Ngezinye izikhathi ukuvuvukala kwamaseli kwenzeka ngenxa yezinkinga zokungenela okuhlinzayo:
- ukulahlekelwa kwegazi elikhulu;
- Ukungeniswa okungalungile kwe-trachea ye-ventilation yokufakelwa;
- isikhathi eside futhi sisho ukuncipha kwegazi;
- i-anesthesia ibalwa ngokungalungile.
I-edema enobudlova obuchopho
Inani eliningi ngokweqile le-ethyl utshwala emzimbeni liholela ebuhlungu obunobuthi. Izidakamizwa zivame ukutholakala ukuthi zine-cerebral edema - izizathu ziwukudakwa okwedlule kwamangqamuzana, ngenxa yalokho okungenakuqondakala ukuthi umzimba wabo usebenza kanjani. Izicubu ezonakalisiwe zithola umswakama, zenza ukuvuvukala nokwandisa. Ukuvuvukala okunjalo kobuchopho kuyisici sokuthi ubuthi ngezinye izinto:
- amakhemikhali anobuthi anobuthi;
- izidakamizwa;
- amagesi anobuthi;
- imithi.
I-Edema yobuchopho besifo somzimba
Ukusabela okungenele kwamasosha omzimba ukuvimbela abanye abantu kuhambisana nokushaqeka kwe-anaphylactic. Ezimweni ezinjalo, isici esenza ukuba ubuchopho bube yingqondo yokungezwani. Ngokweqile kwe-hypersensitivity, amandla okugeleza kwegazi emzimbeni wonke ancipha kakhulu, ukucindezeleka kwegazi kunciphise kakhulu futhi ukuwa kuqhubeka. Ngenxa yokungabi khona kwegazi okwanele ezinhlobonhlobo ezibalulekile, amangqamuzana aphuzi abomvu athatha amanzi futhi avule.
Ukuvuvukala kobuchopho - izimpawu
Umfanekiso wesitholampilo we-pathology echazwe njalo ufana futhi awuxhomeki kwizimbangela zawo noma ezindleleni zokuthuthukiswa. Kunezinhlobo ezingu-3 zezimpawu ezibonisa i-edema yobuchopho - izimpawu zihlukaniswe izinhlobo ezilandelayo:
- I-Syndrome ye-intracranial hypertension. Ngenxa yokuvuvukala kwezicubu, ivolumu yabo iyanda kakhulu. Uketshezi okwedlulele ku-skull kuholela ekwandeni okunamandla kwengcindezi. Lokhu kususa isicashu, ukuhlukunyezwa okungenakubekezeleka, nokuhlanza okungenakulungiswa. Uma ukuvuvukala kobuchopho kuqhubeka isikhathi eside, kukhona ukuwohloka kokuqaphela.
- Imibukiso yemitholampilo ekhonjisiwe. Ukuvuvukala kwezicubu ezingxenyeni ezithile zesimiso sokulawula uhlelo lwezinzwa kubangela ukwephulwa kwemisebenzi ethile. Ngenxa yalokho, kubonakala ukuthi ukukhubazeka, ukubonwa, ukuphazamiseka kwenkulumo, ukusebenzisana nokukhubazeka. Ngezinye izikhathi isiguli asinakukwazi ukwenza umsebenzi ophakeme wezinzwa futhi sisesimweni esingenalutho.
- Izimpawu zesitembu. Ukuzikhukhumeza kobuchopho kungabangela ukuthuthwa kwezakhi ezithile zegciwane, ukucindezela izinqwaba zezicubu zokuphela kwezidakamizwa kanye nemithambo yegazi. Ngokumelene nalokhu kulandela lezi zenzakalo kukhona ukwephulwa komzimba nomzimba wokuphefumula, ukuwohloka kwegazi ukuqhuma, ukucindezelwa kwe-pupillary reaction kanye nezinye izifo ezisongela ukuphila.
I-cerebral edema - ukwelashwa
I-degree evezwe kabi yalesisifo, isibonelo, emva kokuhlukunyezwa noma ukulimala okuncane, akudingi ukwelashwa okukhethekile. Izinhlobonhlobo zokuvuvukala kwezicubu zidlula ngokuzimela izinsuku ezingu-2-4. Ukwakhiwa kwezibhedlela kuyadingeka uma i-edema ye-cerebral iqhubeka - ukwelashwa kwezinhlobo eziyinkimbinkimbi nezingozi ze-pathology kwenziwa kuphela e-unit yokunakekelwa okukhulu.
Umgomo oyinhloko wokwelashwa yi-normalization ye-cerebral perfusion pressure (CPD). Kungenxa yokuhlinzeka ngegazi, ukunikezwa kwe-oksijini kanye nezakhi ezakhiweni ze-neurons. I-CPR yiyona nhlobo phakathi kokuphazamiseka okushoyo kanye nesamba sokucindezeleka kwe-veous ne-central central. Ezinye imisebenzi yokwelashwa:
- ukuqeda ukuxubana nokuhamba ngokweqile;
- ukugcina ukushisa komzimba okujwayelekile;
- ukubuyiselwa kwamaphaphu nesenzo senhliziyo;
- ukujwayelekile komqondo owonakele;
- ukususwa kwezizathu ezivimbela ukuphuma kwegazi elibi kakhulu emgodini we-cranial;
- ukukhululeka nokuvimbela isifo sobuhlungu;
- ukuqeda uketshezi okweqile kwamathemikhali.
I-Edema yobuchopho - usizo oluphuthumayo
Iziguli ezinalesi sifo esibucayi kufanele zihanjiswe ngokushesha.
Ukunakekelwa kokuqala kokudokotela:
- Ngemva kokuthola izimpawu ze-edema ye-cerebral, ngokushesha shayela iqembu labodokotela.
- Beka isisulu endaweni enezingqimba.
- Nikeza umoya omusha.
- Uma kukhona ukuhlanza, vula ikhanda lomuntu eceleni.
- Vula noma ususe izingubo zokucindezela.
- Uma kwenzeka ukugubha, cindezela ngokucophelela ikhanda nezinyathelo zesiguli, ukuvimbela ukusetshenziswa kwezikhwama nokulimala.
I-Edema yobuchopho - izidakamizwa
Ukwelashwa kwe-dehydration isetshenziselwa ukususa uketshezi okweqile kusuka kwamangqamuzana kanye nezicubu ze-cerebral. Uma i-edema enkulu ye-cerebral itholakale kubantu abadala, ukuphathwa ngokubambisana kwe-osmotic diuretics kuqala kukhonjiswe ngosizo lwe-dropper - i-Mannitol, i-albin kanye ne-analogues. Ngemuva kokukhululeka kwesimo esibi sesiguli sidluliselwa ku-dioptic loop:
- I-Torasemide;
- I-Furosemide ;
- I-Toradiv;
- I-Lasix;
- I-Toraz;
- I-Britomar;
- I-Trigrim;
- I-SutrilNEO;
- I-Torsid;
- I-Diver;
- I-Trifas nabanye.
Uma ingcindezi yokugxilisa ingculazi iphezulu kakhulu futhi akunakwenzeka ukuqeda i-cerebral edema ngezidakamizwa ezibalwe, kuphakanyiswa i-ventriculostomy. Lokhu kungenelela okuhlinzekwayo okukuvumela ukuba ususe uketshezi okweqile kusuka ezicukwaneni. Inqubo yukwethulwa kwe-cannula (isaliti esingenalutho elingenalutho) kwenye yezinguquko zebuchopho ukuze kutholakale amanzi. Ukuphathwa okunjalo kunikeza ukusimama okusheshayo kokucindezela nokuphuma kwamanzi amaningi.
Ngemuva kokuvuvukala kwe-cerebral, i-hypoxia ivame ukuvela. Ukwelashwa kwe-oksijeni kusetshenziselwa ukumisa ukulala kwesimo se-oxygen nokubuyisela umsebenzi wokuphefumula. Ukuhluka okulula kuwukusetshenziswa komaski okhethekile ngokunikezwa kwegesi eligxilile. Ezitholampilo zanamuhla ze-oxigenobarotherapy zenziwa - ukubeka isiguli esimweni esikhethekile somoya ngokunyuka kwengcindezi ye-oxygen. Ezimweni ezimbi, umoya wokuphuza umoya owenziwayo wenziwa ngokuphuthumayo.
Ukuze uthuthukise imithi ye-cerebral futhi uvuselele imisebenzi yamaseli obuchopho, ukupholisa kwendawo yekhanda kanye nokuphathwa kwezixazululo zezidakamizwa ezisebenzayo izinqubo zokusebenzisa umzimba:
- Cortexin;
- I-Armadine;
- I-Mexidol;
- I-Citicoline;
- I-Antifront;
- Elfoon;
- I-Mexiprim;
- I-Venocor;
- I-Nikomex;
- I-Mexmidol;
- I-Dinar;
- Ixutshwe;
- I-Neurotropin-Mexibel.
Ukuvuvukala kobuchopho kuhambisane nokukhishwa kwamagundane esitokisini nokubuthakathaka kwezindonga zamasongo. Ukubhekana nalezi zinkinga kusiza ama-hormone glucocorticosteroid:
- I-Hydrocortisone ;
- I-Depos;
- I-Prednisolone;
- Celeston;
- I-Betaspan;
- I-Diprospan;
- Lauracort;
- I-Betamethasone;
- U-Flosteron nabanye.
Ukuqiniswa kwengcindezi yegazi kumiswa:
- I-Dibazol;
- Eufillin ;
- I-Pentamine;
- Azamethonium;
- I-Papaverine ne-analogues.
Iziguli eziningi zidinga ukuphathwa kwe-psychomotor agitation. Ngalokhu, lokhu okulandelayo kusebenza:
- I-Droperidol;
- i-oxybutyrate ye-sodium;
- Diazepam.
Ukubuyiselwa kwesimiso sezinzwa zomphakathi kunikezwa ama-angioprotectors, i-hemostatics, i-antiginoxants, i-proteolytic enzyme inhibitors namanye amaqembu omuthi, okufaka okulandelayo:
- Dicycin;
- I-Actovegin ;
- I-Piracetam;
- i-glutamic acid;
- I-Tracerol;
- I-Contrikal;
- i-cytochrome C.
Ngezinye izikhathi kuyadingeka ukusebenzisa ama-antibiotics, ikakhulukazi ama-cephalosporins anezinyathelo eziningi:
- I-Cefepime;
- I-Cefuroxime;
- Cefazolin;
- Cefadroxil;
- I-Ceftriaxone ne-analogues.
Imiphumela ye-Cerebral edema - imiphumela
Ezimweni ezingavamile, odokotela bakwazi ukuqeda ngokuphelele ukuthumba kwezicubu. I-edema yobuchopho ivame ukulukhuni - imiphumela:
- ukuphazamiseka kwengqondo;
- ukukhubazeka kwengqondo;
- ukukhubazeka kanye neparresis;
- ukukhubazeka (kuxhomeke ezingxenyeni ezithintekile zobuchopho);
- ukuphazamisa;
- ukuphazamiseka kokulala;
- ukucindezeleka;
- izinkinga zememori;
- ikhanda elibuhlungu;
- ukunyuka kwengcindezi yokungena emzimbeni;
- ukukhubazeka komsebenzi wemoto.
I-Edema yobuchopho - ukubikezelwa kokuphila
I-pathology ehlolwayo iqhubekela phambili ngokushesha, kungenzeka ukuyiyeka ngaphandle kwezinkinga kuphela ngokuthumba kwezicubu ezinobuthi kubantu abasha nabaphilile. Kwezinye izimo, kunemiphumela ngemuva kwe-edema ye-cerebral yobunzima obuhlukahlukene. Isibikezelo sincike ekutheni izinga lomonakalo wendikimba, iminyango ethintekile kanye nobukhulu bezinkinga ezithintekayo. Ezimweni eziningi, ukuvuvukala kobuchopho kubangela izinkinga ezingenakuguquka, ngezinye izikhathi ukuvuvukala kuholela ekufeni komuntu.