Iingxaki ze-SAH kunye nendlela oogqirha abazilawula ngayo
I-SAH) isifo esisongelayo kunye nesifo esinokubangela ukuba igazi liphule kwi-artery ebuchosheni kunye nokuvuza kwi- cerebrospinal fluid (CSF).
Kuphela malunga nesithathu kwezigulane ezine-SAH zinomphumo "omhle" emva kokunyanga. Njengokuba oko kwakungekho okwaneleyo, ukubola kweempahia ezinokutshatyalaliswa kwamanzi kungasusa i-cascade yezinye iingxaki.
Ukukhusela kulezi zixazululo eziqhubekayo, amaxhoba enqabileyo ye-subarachnoid ihlolwe kwiyunithi yonyango emva kokuqala ukungena esibhedlele.
Kukho iingxaki ezine eziphambili kwiimpazamo ezithintekayo. Ezi ngxaki ziyi-vasospasm, i-hydrocephalus, i-seizures, kunye ne-rebleing.
I-Vasospasm Emva kweHemorrhage ye-Subarachnoid
Igama elithi vasospasm lithetha ukuba imithwalo yegazi kwingqondo "igaqa" kwaye iyancipha, ukunciphisa kwaye ngamanye amaxesha nokuyeka ukuphuma kwegazi kwiindawo zobuchopho. Isiphumo sisifo.
I-Vasospasm ibonakala ivela kwiintsuku ezisixhenxe ukuya kwelishumi emva kokuphuma kwegazi. Ngenxa yokuba i-vasospasm kunzima ukunyanga ukuba kwenzeka, ukugxininiswa kwenkathalo yesibhedlele kukukhusela. Iipilisi zengcinezelo yegazi i-nimodipine iboniswe ukunciphisa amathuba okufumana imiphumo embi emva kwe-vasospasm (nangona kungabonakali ukunciphisa ingozi yokuphuhlisa i-vasospasm kwindawo yokuqala). Igazi elincinci kakhulu emzimbeni liye laboniswa ukuba lilungelelanise nengozi ye-vasospasm, kwaye ngoko isigulane sinikezwa ngamanzi aneleyo yi-IV ukugcina umthamo wegazi kwimeko yelizwe (kungekhona kakhulu, kungekhona kakhulu).
Ezinye iindlela zokuzama ukukhusela i-vasospasm ziquka ukunika amayeza omzimba .
Abantu abane-SAH bajongwa ngokugqithiseleyo iimpawu ze-vasospasm kunye neemviwo eziphindaphindiweyo ze-neurological. Ukuba kukho umphumo wokuvavanya ngokukhawuleza, kunokuthi i-vasospasm iyenzeka. Ukusetyenziswa kweendlela ezifana ne- transcranial Doppler kunokubanceda ukuba umntu uphuhliso lwevasospasm.
Ngokwonyango lwe-vasospasm, uxinzelelo lwegazi lugcinwa lukhulu (lukhusele ingozi yecembelelo) ngaphandle kwezigulane ezineengcinezelo zengcinezelo okanye ezinye iingxaki zentliziyo ezichasene nesi sicwangciso.
Ukuba i-vasospasm iyaqhubeka nangona unyango oluphezulu, ezinye iindlela ezinokungena, ezifana ne- angioplasty (ukuvula isitya segazi kunye ne-catheter efakwe kwimithambo yegazi) okanye ukusebenzisa i-catheter ukufaka imithi ngqo kwiindawo ezinqamlekileyo, unokuzama.
I-Hydrocephalus Emva kweHemorchnoid Hemorrhage
Ngamanye amaxesha i-clot yegazi esuka kwi-sarachnoid hemorrhage ingeniswa kwenye yezona ndawo ezibalulekileyo zendawo yokuhambisa amanzi yendalo ye-cerebrospinal fluid (CSF). Ngokuqhelekileyo, i-CSF ikhiqizwa kwii- ventricles zeengqondo. Emva koko uhamba ngeemvula ezincinane ezibizwa ngokuba yi-foramina. Ukuba ezi zivulo zivaliwe, i-CSF isacaciswa kodwa ayikho ndawo eya kuyo. Isiphumo sinyuka kwixinzelelo ngaphakathi kweengcambu zengqondo, eyaziwayo njenge-hydrocephalus. Uxinzelelo lusasazeka kwingqondo nangengqayi.
Ukunyuswa kwengcinezelo engaphantsi kungakhokelela ekunciphiseni ingqondo kunye ne-coma. Ukuba ishiywe ingakhange ithatyathwe, ingqondo ingaqhutyelwa kwimimandla eqinile njengesivulo kwisiseko seskull, okubangelwa ukufa.
Ukuthintela lo xinzelelo lwe-build-up, i-neurosurgeons inokwenza i-lumbar puncture okanye ifake i-crane kwi-gace ukuze ikhuphe ngaphandle kwe-CSF.
Ukuhluma emva kweHemorrhage ye-Subarachnoid
Igazi liyakucasula i-cortex ye-cerebral kwaye ibangele ukuthatha . Nangona kunjalo, kuphela ipesenteji ezincinci zezigulane ezine-SAH ziya kuhluthwa (ukuphazamiseka kwengxaki). Oogqirha banokuqwalasela ukusebenzisa i-anti-epileptics ekhuselekileyo ngexesha elifutshane emva kwexesha lokufa kwesisu. Kodwa ukusetyenziswa kwexesha elide lokulwa nesisu akucebiswanga (ngaphandle kwezinye izinto ezisekelwe kumngcipheko ngamnye), ngenxa yemingcipheko yeziphumo ezibi.
Ukubuyiselwa kwakhona emva kweMimiselo yeHemorrhage
Emva kwe-SAH, umngcipheko wokuhlaziya kwakhona ngowama-3 ukuya kuma-13 ekhulwini kwiiyure ezingama-24 zokuqala, ngokubhekiselele kwinqaku le-2012 kwiStroke .
Ukuhlolwa rhoqo kweengxaki zegazi kunye neentloko zeT CT, ngokukodwa kwithuba emva nje kokuphuma kwegazi, kunokukunceda ukuva kwakhona xa kuvela.
Ukuthintela ukuphuma kwegazi, ii-aneurysms ezinobungozi obuphezulu engqondweni zivalwa. Oku kunokwenziwa ngokusebenzisa uhlobo lwesitrafti sokuqhawula ukutshintshela i-aneurysm kuyo yonke into yomthamo, okanye ngokufaka intambo yecatter ngokusebenzisa iirriyiti ukuya kwi-aneurysm kunye nokufaka iipilisi zensimbi okanye isicatshulwa esityinwe ukutywina i-aneurysm. Yiyiphi inkqubo engcono isigqibo esiyinkimbinkimbi esahlukileyo ukusuka kumntu ukuya kumntu kwaye sidinga ingxoxo ngokucokisekileyo kunye neqela lezonyango.
Okukwintsusa
Nangona ezine iingxaki eziphambili ze-subarachnoid ukubola kwegazi zingabonakala zininzi ngokwaneleyo, ngelishwa, zikhona ezinye izingozi ezinokuthi zivela ekubeni nezifo ezikhuselekileyo zokufuna unyango kwiyunithi yokunyamekela. Ubundlobongela obunzulu bemilenze, i-hyponatremia kunye nezifo ezifunyenwe esibhedlele nazo maziqaphele. Ukusukela ekuphumeni kwegazi kuyingxenye yomngeni we-starachnoid i-hemorrhage. Ukusinda kwabo bonke baya kufuna ukubambisana okufutshane kunye neqela leengcali zonyango.
Imithombo:
Bederson, JB, et al. (2009). Izikhokelo zolawulo lwe-aneurysmal yesitrato esisemthethweni: isitatimenti seengcali zokunakekelwa kwezempilo kwiqela elibhaliweyo lokubhala iStroke Council, i-American Heart Association. Isibetho , 40: 994.
Buczacki, SJ, Kirkpatrick, PJ, Seeley, HM, & Hutchinson, PJ (2004). Ukuhluthwa ngokukhawuleza emva kokuhlinzwa okuvulekileyo kwi-aneurysmal ye-hemorrhage ekhoyo. J yethu ye-Neurology, i-Neurosurgery, ne-Psychiatry , 75: 1620.
Connolly, ES et al. (2012). Izikhokelo zolawulo lwe-aneurysmal yesitrato esisemthethweni: isitatimenti seengcali zokunakekelwa kwezempilo kwiqela elibhaliweyo lokubhala iStroke Council, i-American Heart Association. I-Stroke, 43 (6): 1711-37.
Kassell, NF, Sasaki, T., Colohan, AR, Nazar, G. (1985). I-cerebral vasospasm ilandela i-aneurysmal subarachnoid. Stroke, 16: 562.
Tidswell, P., et al. (1995). Isiphumo sengqondo emva kokuphelelwa kwe-aneurysm: ulwalamano nesayithi ye-aneurysm kunye neengxaki zexesha. I-Neurology, 45: 875.
INKCAZELO: Ulwazi olukule ndawo lusezinjongo zemfundo kuphela. Akufanele isetyenziswe njengendawo yokunyamekelwa ngumntu ogqirha. Nceda ubone ugqirha wakho ukuze ufumane unyango kunye nonyango malunga nayiphi na impawu okanye imeko yonyango .