Ukulimala kwengqondo okubuhlungu

Ukulimala kwengqondo okubuhlungu (i-TBI) kuyisethi yokulimala kokuthintana kwezicubu ezithambile zekhanda, amathambo ogebhezi, into yobuchopho nolwelwesi lwawo, oluhlangana ngesikhathi futhi olunendlela eyodwa yokwakheka. Izingozi zethrafikhi (ukuhlukumezeka ngaphakathi) kuyimbangela ejwayelekile. Kaningi, ukulimala kungumphumela wokulimala kwasendlini, kwezemidlalo noma kwezezimboni. I-TBI ingathinta noma yikuphi ukwakheka kwesistimu yezinzwa emaphakathi: udaba olumhlophe nolimpunga lobuchopho, iziqu zemithambo yegazi nemithambo yegazi, izindonga zama-ventricles nezindlela ze-cerebrospinal fluid, ezinquma izinhlobonhlobo zezimpawu ezikuvezayo.

Ukuxilongwa

Ukuxilongwa kwenziwa ngesisekelo seqoqo le-anamnesis (ukuqinisekiswa kweqiniso lokulimala), imiphumela yokuhlolwa kwemizwa nokuhlaziywa kwedatha evela ezindleleni zocwaningo lwezinsimbi (i-MRI ne-CT).

Ukwahlukanisa

Ukuhlola ubukhulu besilonda, i-Glasgow Coma Scale iyasetshenziswa, egxile ekuhlolweni kwezimpawu zemizwa. Isikali sihlolwa ngamaphoyinti, inani lakhona elihluka kusuka ku-3 kuye ku-15 Ngokuya ngenombolo yamaphoyinti, i-TBI ihlukaniswa ngamazinga:

• kulula - 13-15;
• isilinganiso - 9-12;
• esindayo - 3-8.

© guas - stock.adobe.com

Ngokwesilinganiso somphumela obuhlungu we-TBI, kungaba:

• isizungu;
• kuhlangene (kanye nokulimala kwezinye izitho);
• kuhlangene (kanye nomphumela emzimbeni womuntu wezinto ezahlukahlukene ezihlukumezayo); kungavela ekusetshenzisweni kwezikhali zokubhubhisa okukhulu.

Ngokutholakala kokulimala kwezicubu ezithambile (isikhumba, i-aponeurosis, i-dura mater), ukulimala yilokhu:

• kuvaliwe (i-CCMT) - akukho monakalo obonakalayo;
• evulekile (i-TBI) - izicubu zekhanda ezithambile ezilimele, kwesinye isikhathi zihambisana ne-aponeurosis (ingahle ihambisane nokuqhekeka kwamathambo e-vault noma isisekelo sogebhezi; ngomsuka, kube ukuqhuma kwesibhamu noma ukungadubuli);
• Ukungena kwe-TBI - ubuqotho besikhathi eside buyaphulwa.

Ukuhlukumezeka okuvaliwe kwe-craniocerebral kuyingozi ngoba isiguli esingenamonakalo obonakalayo asivamile ukufuna udokotela, ngephutha sikholelwa ukuthi "konke kuzolunga." Ukuhlaliswa kwayo endaweni ye-occiput kuyingozi ikakhulukazi ngenxa yokuthi ukubikezelwa kwegazi emgodini we-posterior cranial fossa kuyinto enhle kakhulu.

Ngokombono wesikhawu sesikhathi kusukela i-TBI, ukuze kube lula ukwakha amaqhinga okwelashwa, umonakalo uvame ukuhlukaniswa ngezikhathi (ngezinyanga):

• acute - kufika ku-2,5;
• Lesisemkhatsini - kusuka 2.5 kuya 6;
• kude - kusuka ku-6 kuye ku-24.

© bilderzwerg - stock.adobe.com

Ekusebenzeni komtholampilo

Ukulimala kobuchopho kuqinisekiswa nge:

Impi (ukuxubana)

Izimpawu zivame ukuxazululwa zingakapheli izinsuku eziyi-14. Ukulimala kungahambisana nokuqala kwe-syncope kusuka kumasekhondi ambalwa kuya kumizuzu engu-6 (kwesinye isikhathi kukhonjiswa isikhathi esiphezulu semizuzu eyi-15-20), kulandelwe i-antegrade, congrade, noma i-retrograde amnesia. Mhlawumbe ukucindezelwa kokwazi (kuze kube sekufeni). Ukuxubana kungahambisana nokuphazamiseka kwesistimu yezinzwa ezizimele: isicanucanu, ukuhlanza, ukubola kolwelwesi lwamafinyila kanye nesikhumba, ukuphazamiseka kwezinhlelo zenhliziyo nemithambo yokuphefumula (ukushintshashintsha kwesikhashana ku-NPV nomfutho wegazi). Ungase ube nekhanda nesiyezi, ubuthakathaka obujwayelekile, umjuluko we-clammy, nokuzwa kwe-tinnitus.

I-nystagmus engenzeka ngokuthunjwa okwedlulele kwama-eyeballs, i-asymmetry ye-tendon reflexes kanye nezimpawu ze-meningeal ezima zingakapheli izinsuku eziyi-7. Izifundo ze-Instrumental (MRI) ezinokushayisana azivezi ushintsho lwe-pathological. Izinguquko emaphethini wokuziphatha, ukukhubazeka kwengqondo nokuncipha kokulala kungabonwa izinyanga ezimbalwa.

Ukuhlanganiswa (ukudideka)

Imvamisa izibonakalisa nge-shock-counter-shock mechanism (ngokusheshisa okubukhali nokuvimbela ukunyakaza kobuchopho ngenxa yamathonya angaphandle). Izimpawu zomtholampilo zinqunywa indawo yokulimala futhi zibandakanya ushintsho esimweni se-psyche. I-Morphologically iqinisekiswe yi-intraparenchymal hemorrhage ne-edema yendawo. Ihlukaniswe yaba:

• Kulula. Imvamisa kuhambisana nokulahleka kokwazi okuhlala amashumi emizuzu eminingana. Izimpawu ezijwayelekile zobuchopho zibonakala kakhulu kunokuxubana. Kubonakaliswa ukuphazamiseka kwemifino ngendlela yokuguquguquka kokushaya kwenhliziyo nokwenyuka kwengcindezi yegazi. Isakhiwo esiyinkimbinkimbi simisiwe kungakapheli izinsuku eziyi-14-20.
• Ephakathi. Ukuphazamiseka kwemifino kuhambisana ne-tachypnea nesimo se-subfebrile. Kubonisa izimpawu ezigxile: i-oculomotor ne-pupillary disorders, i-paresis yemikhawulo, i-dysarthria ne-dysesthesia. Ukuhlukumezeka kubonakala kaningi ngemuva kwezinsuku ezingama-35.
• Kuyasinda. Kwezinye izimo, kuhambisana nokuqhekeka kwamathambo ogebhezi nokopha okungaphakathi emzimbeni. Ukuphuka kwamathambo e-fornix kuvame ukulingana. Isikhathi se-syncope sisukela emahoreni amaningana kuya emavikini angu-1-2. Ukuphazamiseka kwe-Autonomic kuvezwa kabukhali ngendlela yokushintshashintsha okukhulu kwengcindezi yegazi, ukushaya kwenhliziyo, isilinganiso sokuphefumula kanye ne-hyperthermia. Izimpawu zesiqu ziyabusa. Iziqephu zingenzeka. Ukululama kuthatha isikhathi eside. Ezimweni eziningi, akuphelele. Ukuphazamiseka emikhakheni yezimoto neyengqondo, okuyimbangela yokukhubazeka, kuvame ukuqhubeka.

Ukusabalalisa ukulimala kwe-axonal

Ukulimala kwendaba emhlophe ngenxa yamandla okugunda.

Kubonakala nge-coma elinganiselayo kuya ekujuleni. Izimpawu eziyinkimbinkimbi zezimpawu zeziqu nezokuzimela zivezwa ngokucijile. Imvamisa kuphela ngokuqedwa nokukhula kwesifo se-apallic. Morphologically, ngokwemiphumela ye-MRI, ukwanda kwevolumu yento yobuchopho kunqunywa ngezimpawu zokucindezelwa kwe-ventricles yesithathu ne-lateral, isikhala se-subarachnoid convexital kanye nemithombo yamanzi. Ukopha okuncane okugxilwe yiPathognomonic odabeni olumhlophe lwama-hemispheres, i-corpus callosum, i-subcortical kanye ne-stem structure.

© ukuguquguquka - stock.adobe.com

Ukucindezela

Imvamisa kubangelwa i-edema ye-cerebral edema kanye / noma ukuphuma kwegazi okungatheni. Ukwanda okusheshayo kwengcindezi yokungasebenzi kuhambisana nokwanda okusheshayo kwezimpawu ezigxile, zeziqu nezobuchopho. Kubonakala ngokuthi "uphawu lwesikele" - ukwanda kwengcindezi yegazi elihlelekile ngokumelene nesizinda sokuncipha kwenhliziyo. Lapho kukhona ukuphuma kwegazi ngaphakathi, kungahle kuhambisane ne-mydriasis yekhaya. "Uphawu lwesikere" yisisekelo se-craniotomy ephuthumayo ukuze kusebenze ukucindezela kwengqondo. Ukopha ngaphakathi kwe-intracranial ngokwasendaweni kungaba:

• i-epidural;
• subdural;
• i-subarachnoid;
• i-intracerebral;
• i-ventricular.

Ngokuya ngohlobo lwesikebhe esonakele, sinemithambo yegazi futhi sinobuthi. Ingozi enkulu ukuphuma kwegazi ngaphakathi. Ama-hemorrhages abonakala kahle ku-CT. I-Spiral CT ikuvumela ukuthi uhlole ivolumu ye-hematoma ye-intracranial.

Ngasikhathi sinye, izinhlobo ezahlukahlukene zomonakalo zingahlanganiswa, ngokwesibonelo, ukungqubuzana kanye nokopha kwe-ventricular, noma ukulimala okwengeziwe endabeni yobuchopho ezinqubweni zama-meninges. Ngaphezu kwalokho, uhlelo oluphakathi lwezinzwa lungathola ukucindezeleka okubangelwa ukuhlukumezeka, i-CSF jolt.

Izimo ezinhlanu zabagulayo

Ku-neurotraumatology, kunezimo ezinhlanu ezigulini ezine-TBI:

Insiza yezimo eziphuthumayo

Lapho kukhonjiswa isiqephu sokulahlekelwa ukwazi, isisulu sidinga ukuthuthwa okuphuthumayo siye esibhedlela, ngoba i-syncope igcwele izinkinga eziyingozi emzimbeni. Lapho uhlola isisulu, kufanele unake:

• ukutholakala kokuphuma kwegazi noma uketshezi oluvela emakhaleni noma ezindlebeni (uphawu lokuphuka kwesisekelo sogebhezi);
• isikhundla sezinhlamvu zamehlo nobubanzi babafundi (i-unilateral mydriasis ingahle ibangelwe ukopha okungaphakathi kokungasebenzi);
• amapharamitha womzimba (zama ukurekhoda izinkomba eziningi ngangokunokwenzeka):
  • umbala wesikhumba;
  • I-NPV (isilinganiso sokuphefumula);
  • Ukushaya kwenhliziyo (ukushaya kwenhliziyo);
  • ISIHOGO;
  • izinga lokushisa komzimba.

Uma isiguli singaqulekile, ukuze sikhiphe ukuhoxiswa kolimi futhi sivimbele ubunzima bokuphefumula. Uma unamakhono, ungadudula umhlathi ophansi uye phambili, ubeke iminwe yakho ngemuva kwamakhona ayo, bese uhlanganisa ulimi lwakho ngentambo bese ulubopha enkinobheni yehembe.

Imiphumela kanye nezinkinga

Izinkinga ezivela ohlelweni lwezinzwa oluphakathi zihlukaniswe zaba:

• ezithathelwanayo:
  • i-meningoencephalitis;
  • i-encephalitis;
  • ithumba lobuchopho;
• okungathathelani:
  • ama-arterial aneurysms;
  • ukungahambi kahle komzimba;
  • i-episyndrome;
  • i-hydrocephalus;
  • i-apallic syndrome.

Imiphumela yomtholampilo ingaba yesikhashana noma ehlala unomphela. Kunqunywa ivolumu nendawo lapho kuguqulwa khona. Lokhu kufaka phakathi:

• Izimpawu ezijwayelekile zobuchopho - ukuphathwa yikhanda nesiyezi - kubangelwa ukwephulwa kokubekwa kwesikhashana, ukuguqulwa kwezinto ezisetshenziswayo noma izakhiwo ze-cerebellar, ukwanda okuqhubekayo kwengcindezi yegazi kanye / noma yesistimu.
• Ukuvela kwamandla amakhulu we-pathological (overactivity of neurons) ohlelweni lwezinzwa oluphakathi, olungabonakalisa njengokuquleka okuxakayo (post-traumatic episodic syndrome) noma izinguquko emaphethini wokuziphatha.
• Izimpawu ezibangelwa ukulimala ezindaweni ezihambisana nemikhakha yemoto, yezinzwa neyokuqonda:
  • inkumbulo, ukudideka ngesikhathi nendawo;
  • izinguquko zengqondo nokukhubazeka kwengqondo;
  • iziyaluyalu ezahlukahlukene emsebenzini wabahlaziyi (ngokwesibonelo, olfactory, visual or auditory);
  • izinguquko ekubukeni kokuzwela kwesikhumba (i-dysesthesia) ehlukile endaweni;
  • ukuphazamiseka kokusebenzisana, ukwehla kwamandla nobubanzi bokuhamba, ukulahleka kwamakhono obuchwepheshe atholakele, i-dysphagia, izinhlobo ezahlukahlukene ze-dysarthria (ukuphazamiseka kwenkulumo).

Ukuphazamiseka emsebenzini wohlelo lwe-locomotor kuboniswa yi-paresis yamaphethelo, kakhulu kangako nge-plegias, evame ukuhambisana noshintsho, ukwehla noma ukulahleka okuphelele kobuzwe.

Ngaphezu kwezinkinga ezibangelwa ukuphazamiseka emsebenzini wobuchopho, izinguquko ze-pathological zingaba ngesimo somatic futhi zithinte umsebenzi wezitho zangaphakathi ngenxa yokwephulwa kwe-innervation. Ngakho-ke, uma ukugwinya kunzima, ukudla kungangena ku-trachea, okugcwele ukuthuthuka kwe-pneumonia yokufisa. Ukulimala kwe-nuclei ye-vagus nerve kuholela ekuphazanyisweni kwe-parasympathetic innervation yenhliziyo, izitho zokugaya kanye nezindlala ze-endocrine, ezithinta kabi umsebenzi wazo.

Ukuvuselelwa

Isakhiwo esanele sezinyathelo zokuvuselelwa sithinta ngqo imiphumela yokwelashwa nobukhulu bokushoda kwangemva kokuhlukumezeka kwemizwa. Ukuvuselelwa kwenziwa ngaphansi kokuqondisa kukadokotela obekhona kanye neqembu lochwepheshe abakhethekile. Imvamisa kuba yile: i-neurologist, i-rehabilitation therapist, i-physiotherapist, i-therapist therapist, i-Therapist Therapist kanye ne-neuropsychologist.

Odokotela balwela ukudala izimo ezithandekayo ukuze isiguli sibuyele empilweni ejwayelekile futhi sinciphise izimpawu zezinzwa. Isibonelo, imizamo yeselaphi sokukhuluma ihlose ukubuyisa ukusebenza kwenkulumo.

Izindlela zokuvuselela

• Ukwelashwa kukaBobath - kukhuthaza ukuvivinya umzimba ngokushintsha ukuma komzimba.
• Ukwelashwa kweVojta kusekelwe ekukhuthazeni isiguli ukuthi senze ukunyakaza kokuqondisa ngokuvuselela izindawo ezithile zomzimba waso.
• Ukwelashwa kwe-Mulligan uhlobo lwezokwelapha ezenzelwe ukunciphisa ithoni yemisipha nokudambisa izinhlungu.
• Kusetshenziswa idizayini ye- "Exart", okuyihhanisi elenzelwe ukuthuthukisa imisipha ye-hypotrophic.
• Ukwenza izivivinyo kumishini yenhliziyo nemsamo wokuqina ukuze kuthuthukiswe ukuhlangana kokuhamba.
• Ukwelashwa emsebenzini kuyisethi yamasu namakhono avumela isiguli ukuthi sivumelane nesimo senhlalo.
• I-Kinesio taping igatsha lomuthi wezemidlalo, oqukethe ukusetshenziswa kwamateyipu wokunamathisela okunwebeka ngokuhambisana nemicu yemisipha nokwandisa ukusebenza kahle kwezingcindezi zemisipha.
• I-Psychotherapy - ehlose ukulungiswa kwe-neuropsychological esigabeni sokuvuselelwa.

I-Physiotherapy:

• i-electrophoresis yezidakamizwa;
• i-laser therapy (inomphumela wokulwa nokuvuvukala nokuvuselela);
• ukutshopa.

Ukwelashwa kwezidakamizwa okungena ngaphakathi:

• izidakamizwa ze-nootropic (i-Picamilon, i-Phenotropil, i-Nimodipine) ezithuthukisa izinqubo ze-metabolic kuma-neurons;
• izidambisi, ama-hypnotics kanye ne-tranquilizers ukujwayeza isizinda se-psycho-emotional.

Isibikezelo

Kunqunywa ubunzima be-TBI nobudala besiguli. Abantu abasha banesibikezelo esihle kunabantu asebekhulile. Ukulimala kuhlukaniswa ngokujwayelekile:

• ingozi ephansi:
  • amanxeba aqothuliwe;
  • ukuphuka kwamathambo ogebhezi;
  • ukushayisana;
• ingozi enkulu:
  • noma yiluphi uhlobo lokopha okungaphakathi ngaphakathi;
  • ezinye izinhlobo zokuphuka kogebhezi;
  • ukulimala kwesibili ketshezi lobuchopho;
  • umonakalo ohambisana ne-edema.

Ukulimala okuyingozi kakhulu kuyingozi ngokungena kwe-brainstem (SCM) ku-foramen magnum ngokucindezela kwezikhungo zokuphefumula neze-vasomotor.

Isibikezelo sesifo esincane ngokuvamile sihle. Ngokulinganisela futhi okunzima - kuhlolwe ngenombolo yamaphoyinti ku-Glasgow Coma Scale. Amaphuzu amaningi, kulapho kuvumelana kangcono.

Ngezinga elinzima, ukusilela kwemizwa cishe kuqhubeka njalo, okuyimbangela yokukhubazeka.

Bukela ividiyo: God The Best (Novemba 2024).