Unyango lwezoNyango kunye noPhephelo oluPhezulu lweSkull Press
Xa uxinzelelo kwikhayi lwakhula, nokuba ngenxa yokuvuvukala, i-bleed, i- tumor , okanye enye ingxaki, ukunyanzelwa kweengxube zeengqondo kunokukhokelela ekulimaleni ngonaphakade. Uxinzelelo oluphezulu lwe-intracranial (ICP) lubonwa njengengxamiseko yengqondo kwaye kufuneka luqwalaselwe ngokukhawuleza.
Ukujonga i-ICP ephezulu
Indlela yokuqala yokufumanisa i-ICP ephezulu kukunyamekela iimpawu zomntu.
Umbono ogqabileyo, intloko , okanye utshintsho ekucingeni konke kunokubonisa ukuba uxinzelelo lomntu luphezulu kakhulu. Ngokuqhelekileyo, iimpawu zibi nakakhulu xa zihlala zibala.
Ngamanye amaxesha, nangona kunjalo, umntu ulahlekelwa ingqalelo, kwimeko apho ezinye izikhombisi zifuneka. I-Fundoscopy , apho ugqirha ekhangele ngasemva kweso xa ekhanyisa ukukhanya okukhanyayo, angabonisa utshintsho kwiimbono ze-optic ngenxa ye-ICP ephakamileyo. Olu tshintsho alisoloko lwenzeka ngokukhawuleza, nangona kunjalo, ngamanye amaxesha ezinye iindlela zokuphanda uxinzelelo olungapheliyo ziyadingeka ukuba oogqirha bayakrokra ukuba ukunyanzeliswa kwengcinezelo kunokunyuka.
Enye yeendlela ezichanekileyo zokulinganisa i-ICP kukubeka iliso ngaphantsi kwekhayi. Oku kunenzuzo eyongezelelweyo yokukwazi ukulinganisa i-ICP rhoqo kunokuba ufumane umlinganiselo owodwa, ngoko utshintsho kwi-ICP lungabanjwa. Oku kubaluleke nakakhulu kwiimeko apho umntu angaqikelela ukuba i-ICP iya kuba nzima, njengokukhukhuma emva kokuxhatshazwa kwengqondo .
Ukubeka eso siqendu kuyinkqubo engenayo, nangona kunjalo. Ngoxa ziqhelekileyo zikhuselekileyo, aba bahloli bangakhokelela kwiintsholongwane okanye kuphuma igazi. Zibekwa kuphela xa kunesidingo esicacileyo sokubeka esweni i-ICP.
Ulawulo lweZonyango lwe-ICP ephezulu
Xa ama-neurologists evakalelwa yi-ICP ephakamileyo, amanyathelo athatyathwa ukunciphisa olo xinzelelo.
Kukho izicwangciso ezintathu kwiindawo ezingenakucala phantsi kwegazi: igazi, ubuchopho, kunye ne- cerebrospinal fluid (CSF) . Ukuba uxinzelelo lwakhiwo, ukunciphisa umthamo wegazi okanye i-CSF inokwenza indawo engakumbi yengqondo ukukhusela ukuxinzelela nokulimala ngokusisigxina.
Umthamo we-CSF ungancitshiswa ngokunciphisa ukuveliswa kwawo ngaphakathi kweengcambu zengqondo. Amanye amayeza afana ne-acetazolamide anganciphisa umkhiqizo we-CSF kunye ne-ICP ephantsi ngenxa yoko. Nangona kunjalo, amandla alo mphumo ayinamandla kakhulu, kwaye i-acetazolamide ineempembelelo ezifana nokutshintsha i-asidi yegazi.
Umthamo wegazi kwingqondo ingancitshiswa ngokubeka intloko ukukhuthaza iintlobo zeentloko ukubuyisela igazi ngokukhawuleza entliziyweni. Ukuba isigulane sithotywe ( sinombhobho ophefumulayo), izinga lokuphefumula linganyuswa ukutshintsha i-acidity yegazi legulane. Oku kunokubangela ukuba imirhobho ebuchosheni iyancitshiswe, iyanciphise ukuhamba kwegazi kwaye inika ingqondo igumbi elincinci - nangona kunjalo, esi sisisombululo sethutyana kuphela.
Ngamanye amaxesha ubuchopho buvuvukala ngenxa ye-edema, apho kuphuma umkhuhlane ngaphandle kwemithambo yegazi kunye neengxube zengqondo. Ezinye iimbonti ezifana ne-mannitol, okanye i-saline, ziyakhuthaza ukuba umbane ubuyele ebuchosheni ukuya emithanjeni yegazi apho kubangela umonakalo ongaphantsi.
I-Steroids efana ne-dexamethasone inokunceda ekunciphiseni ukuvuvukala kwengqondo.
Ulawulo loPhando oluPhakamileyo lwe-ICP
Xa ukulawulwa kwezokwelapha kungonelanga, ngamanye amaxesha amaninzi amanyathelo ahlaseleyo abizwayo, njengophando.
Ukuba ubuchopho buxinwa yinto ethile ekhreyini engabikho kuyo, njenge- abscess okanye i-tumor, ngamanye amaxesha kunokwenzeka ukususa ingxaki. Amanye amaxesha, nangona kunjalo, oku akunakwenzeka, nokuba mhlawumbi umngcipheko wobuchopho ukhulu kakhulu, okanye ngenxa yokuba ingxaki ingasuswa kalula.
Ngokomzekelo, ukuba ingxaki ebalulekileyo kukuba ubuchopho buvuvukala ngenxa yokuvuvukala, kuya kubonakala ukuba ayiyiyo isisombululo esiphezulu sokususa inxalenye yengqondo ngokwayo.
Kule meko, indawo eninzi kufuneka yenziwe ngenjongo yokuvumela indawo yokuvuvukala.
Ngaphandle kwamachiza afana ne-acetazolamide, i-CSF ingasuswa ngokuyifaka nge- shunt . Oku kubandakanya ityhubhu ibekwe kwii-ventricles zengqondo ukuze zikhuphe i-CSF. Ukuba i-monitor ye-ICP ifakiwe, i-CSF inokucinywa ngolu vavanyo ukugcina uxinzelelo kwindawo ethile.
Nangona kunjalo, kukho imiphumo emibi yokuyeka. Ukongeza kwimingcipheko yentsholongwane kunye nokuphuma kwegazi okuvela ekufakeni into emzimbeni, kukho ingozi yokuba i-CSF iyakususwa kwiindawo ezingafanelekanga, ezikhokelela ekutshintsheni kweengcinezelo ezikhokelela ekuhambiseni ukunyakaza-inxalenye yentliziyo yengqondo apho kungabikho.
Olunye unyango olunokuthi lwenze ingqondo ibe yindawo enkulu. Oogqirha benza oku ngokwenza i- craniectomy , apho inxalenye yengqayi isuswe ukuze ivumeleke indawo engakumbi ingqondo ukuba ivule.
Nangona inxalenye yengqayi isuswe, izicubu ezijikeleze ubuchopho zigcinwa zichanekile kwaye zicoceke ngokunokwenzeka ukuze kuthintela usulelo. Nangona ukusuleleka kunye nezinye iingxaki ezinokuthi zenzeke, ngexesha elibizwa ngokuba yi-craniectomy, kukho ezinye iindlela ezinokukhetha. I-craniectomy yindlela enkulu yokuhlinzwa kunye nemingcipheko enkulu, kodwa ingaba luncedo kwiimeko ezinzima.
Imithombo:
Allan, H., et al. Uncedo lwe-Neurological ne-Neurosurgical Care, Intetho yesine, uLippicott Williams noWilkins, ngo-2004
Braunwald E, Fauci ES, et al. Iinqununu zeHarrison zeMithi yoPhakathi. 16th. 2005.