Imiqathango ekufuneka idibene nayo ngaphambi kokuba i-diagnostic ingenziwa
Kukho okungakumbi ekulahlekelweni kwengqondo kunokungavuki. Ukulala kunye ne-coma, umzekelo, nganye iquka ukulahlekelwa kwengqondo kwaye ichazwe ngokubanzi ngelixesha elifunekayo ukubuyela kwi-consciousness. Nokuba umntu ohlala kwimeko yezilwanyana eziqhubekayo (PVS ) unakho, nokuba uncinane, ukuvuka.
Ubomi beBongo buhluke . Njengoko eli gama libonisa, ukufa kwengqondo kubonisa ukuba akukho misebenzi yengqondo kwaye, ngenxa yoko, akukho nethemba lokubuyisela.
Ukuthetha ngomlomo, ukufa kwengqondo kukuxilongwa ngokucacileyo kokufa .
Ukuqonda Ubomi Bokufa
Ngokungafani nezinye iifomu zokulahlekelwa kwengqondo, ukufa kwengqondo kubandakanya ukulahlekelwa ngokupheleleyo kwe-brainstem function. Oko kuthetha ukuthini ukuba inkqubo yokusebenza ebonakalayo -inethiwekhi ehambayo yentsholongwane yokudibanisa intambo yomgogodla kunye nengqondo-ibonakaliswe ngokungenakonakala. Kwakhona kubonisa ukuba iinxalenye zesingqondo ezilawula ukuphefumula kunye nomsebenzi wentliziyo ziye zachithwa ngokungenakulungiswa.
Ukufa kweBongo kungaba yinto yokuba abanye bayakufumana nzima ukuyiqonda. Ngenxa yokuba sihlolisana ngokufa kunye nentliziyo eyeke ukubetha, sihlala siqaphele into yokuba ingqondo isindisa imiphumo "egijima" intliziyo.
Ngelixa izixhobo zokuxhasa ubomi zingasetyenziswa ukugcina ukuphefumla kunye nokujikeleza, akukho sikhombi esinokugcina ingqondo iqhuba. Ekugqibeleni, ukuba ingqondo iyafa, wonke umzimba uya kulandela.
Ukuchonga Ubomi Bokufa
Kukho inani lemiqathango ekufuneka idibeneyo ukuze i-brain death ivakaliswe. Nangona imithetho yommandla okanye yendawo ingadinga iintshukumo ezongezelelweyo, ukwakheka koxilongo kuye kwamukelwa njengento ecacileyo. Ngamafutshane, ukuvakalisa umntu ophefumula ngengqondo:
- I-coma kufuneka ingenakucinganiswa nayiphi na into eyaziwayo okanye esondeleyo.
- Umntu akumele abe neengcamango zeengqondo.
- Umntu akanakho umsebenzi wokuphefumula.
Zonke iimeko ezintathu kufuneka zanelisekile ekufeni kweengqondo ukuba zivakaliswe.
Ukusungula ukungavumeleki kunye Nesizathu seComa
Ngaphambi kokuba ugqirha anqume ukuba i-coma ayinakuphikiswa, kufuneka afumane ukuba kukho nayiphi na indlela yokuyijika. Ukuze wenze njalo, iqela lezokwelapha kufuneka liqale lichaze isizathu (okanye ininzi ibangela) ye-coma.
Ngaphezu koko, iqela kufuneka libandakanye nayiphi na imeko efuna ukulinganisa ukufa kwengqondo, njengokwenza i- hypothermia , ukuxutywa kweziyobisi okanye ukutyhefuza, ukungaqhelekanga kwemithi, okanye i-neuromuscular agents ezinokubangela ukuba "ukufa" kufane nokukhubazeka. Zonke ezi, ngokuchithwa kwee-degrees, ziyakwazi ukuguqulwa.
Ukuseka ukungafihli kwe-coma kufuna ukuba ugqirha alinde inani elifanelekileyo lexesha-ngokusekelwe kwisizathu esaziwayo okanye esikufutshane. Ukuzimisela okumele kuhlangane kunye nemigangatho yonyango kunye nemithetho. Ukususela kulo mbono, igama elithi "kufuphi" libonisa ukuba isizathu sifanele siseke ngokufanelekileyo kwaye sixhaswe ukuba akusaziwa.
Ukuseka ukungabikho kwe-Brainstem Reflexes
I-Brainstem reflexes ziphendule ngokuzenzekelayo ezingafaniyo neemvavanyo zamadolo ezinikezelwa kwiofisi yegqirha.
Zizinto ezenza izinto ezintle zibonisa ukuba imisebenzi yomntu yintsholongwane iqhelekile, ayiqhelekanga, okanye ayikho.
Umntu uthathwa njengengqondo-efile ukuba akakwazi ukuphendula kuzo zonke ezilandelayo:
- Ukungabikho kwe-pupillary reflex kuthetha ukuba abafundi bomntu abaphenduli ngandlela-thile xa kukhanya kubo. Ukuba umntu wayephila, abafundi baya kuba bancinci.
- Ukungabikho kwe-reflex corneal kuthetha ukuba loo mntu akayi kukhanya kwaye unayo nayiphi na impendulo xa ugqirha uyichukumisa iliso nge-cotton swab okanye ukuwa kwamanzi.
- Ukungabi ne-oculocephalic reflex (eyaziwa nangokuthi "isohlwayo lombono") lithetha ukuba amehlo omntu akayi kukulungisa ubuso bomhloli xa ikhanda lakhe lishukunyiswa ngapha nangapha.
- Ukungabikho kwe-gag reflex kuthetha ukuba loo mntu akayi kuguqa, ukukhwehlela, okanye ukuphendula xa umva we-throat uthintwa nge-cotton swab okanye kwisixhobo sokutsala.
- Ukungabikho kwempendulo kwindlela yokucima i-caloric kuthetha ukuba loo mntu akayi kuphendula xa amanzi e-icele agxothwa kwindlebe. Ukuba umntu wayaphila, i-stimuli ibangela ukuba amehlo omntu ahambe kwindlela eyahlukileyo njengoko "ngokucokisekileyo" intloko yangaphakathi ekucingeni ukuba umntu uhamba.
Ukuseka ukungabikho komsebenzi wokuphefumula
Isinyathelo sokugqibela ekumiseni ingqondo yesifo kukuhlolwa kwe-apnea. I-Apnea ligama lonyango lokumisa ukuphefumla kwaye lisetyenziswe kulo mzekelo ukuqinisekisa ukuba ukumiswa kuyisigxina.
Ukwenza uvavanyo lwe-apnea, ugqirha uya kuthatha amanyathelo alandelayo:
- Umntu onomoya owenzela i-ventilator uza kufakwa kwi- pulse oximeter . Esi sixhobo esisetyenziselwa ukulinganisa ukufakelwa kwe-oksijini egazini.
- I-ventilator iya kukhishwa kwaye ibhubhe iya kufakwa kwi-trachea yomntu ukuhambisa i-100 pesenti ye-oksijini kwimiphunga. Oku kuqinisekisa ukuba umntu akasoze aphefumula i-oxygen xa ephendula.
- Uvavanyo lwegazi luya kwenziwa ngokukhawuleza ukulinganisa igazi zegazi ezisisiseko.
- Ugqirha wayeza kulinda imizuzu eyisibhozo ukuya kwe-10 ukuze abone ukuba kukho nayiphi na impendulo kwisigulane.
- Emva kwemizuzu eyisibhozo ukuya kwi-10, iigesi zegazi ziya kuphinda zihlolwe.
Ukuba akukho ntshukumo yokuphefumula kunye ne- PaCO2 (uxinzelelo lwe-carbon dioxide kwimithambo yegazi) liye landa ngaphezu kwama-60-lithetha ukuba akukho nto yatshintshiselana yomoya-mpilo kunye ne-carbon dioxide kwimiphunga-loo mntu uya kuthiwa u-brain-dead.
Ukuba ngakwelinye icala, ukunyakaza okuphefumulayo kubonwa, ngoko umntu akayi kuthathwa njengengqondo-efile. Kuphanda uphando olongezelelweyo luza kwenziwa ukwenzela ukuba, ukuba kukho nantoni na, enokuthi yenziwe ukuba iguqule imeko.
Uvavanyo olongezelelweyo
Ukuba uvavanyo olupheleleyo lweklinikhi lwenziwe (kubandakanywa iimvavanyo zesifo sengqondo kunye ne-apnea test) kunye nokufa kwengqondo kubhengezwa, akukho luvavanyo olongezelelweyo olufunekayo. Xa kuthethwa oko, ngenxa yendalo yengcwaba yokuxilongwa, ezininzi izibhedlele namhlanje zifuna ukuba uviwo oluqinisekisiweyo lwenziwe ngudokotela oqeqeshiweyo ohlukeneyo emva kwexesha elibiweyo.
Kwezinye iimeko, iimvavanyo ezongezelelweyo zingenziwa xa ukulimala komzimba, ukulimala komgudu, okanye ezinye izinto kwenza kube nzima ukugqiba uvavanyo oluqhelekileyo. Ezi mvavanyo ezongezelelweyo zinganika amalungu entsapho isiqiniseko esongezelelweyo sokuthi ukuxilongwa okuchanekileyo kwenziwa.
> Umthombo:
> Wijdiks, V .; Varela, P .; Gronseth, G. et al. Uhlaziyo olujoliswe ngumboniso: Uqaphela ukufa kwengqondo kubantu abadala - Ingxelo yeComitric Subcommittee ye-American Academy of Neurology. " Neurology. 2010; 74 (23). INGXELO: 10.1212 / WNL.0b013e3181e242a8.