Zvirwere Zvokurapa uye Zvokuvhiya nokuda kweKeedhead Pressure
Kana kushungurudzwa mucheka kunowedzera, zvichida nekuda kwekudzima, kubuda ropa, chirwere , kana chimwe chinetso, kuwedzera kwehutachi tissue kunogona kutungamirira kukuvadzwa zvachose. Kukwidziridzwa kwepakamanikidzi (ICP) inonzi inofungidzirwa neurological emergency uye inoda kurongedzwa nokukurumidza sezvinobvira.
Kuona High ICP
Nzira yekutanga yekuona ICP yakakwirira ndeyekuteerera kune zviratidzo zveumwe munhu.
Kuvhiringidza maziso, kuora musoro , kana kuchinja mukufunga kunogona kuratidza kuti kune umwe munhu anokonzera kushungurudzika kwakanyanya. Pakati pese, zviratidzo zvinowedzera apo pazvigadzikana.
Dzimwe nguva, kunyange zvakadaro, munhu wacho anorasikirwa, mune imwe nguva zvimwe zviratidzo zvinodiwa. Fundoscopy , uko chiremba anotarisa kumashure kweziso apo achipenyera chiedza chakajeka, anokwanisa kuratidza kuchinja mumagetsi e-optic nemhaka yeCP yakakwirira. Iko kushanduka hakuiti nguva dzose, asi dzimwe nguva dzimwe nzira dzekutsvaga kusagadzikana kusingadikanwi dzinofanirwa kana vanachiremba vachifungira kuti kusagadzikana kwemaitiro kungave kukwira.
Imwe yenzira dzakavimbika dzekuyera ICP ndeyekuisa ganda pasi pehenya. Izvi zvinowedzera rubatsiro rwekukwanisa kuongorora ICP nguva dzose pane kungova kuwana imwe chete, saka kuchinja ku ICP kunogona kutorwa. Izvi zvinonyanya kukosha mumamiriro ezvinhu apo munhu anogona kufanotaura kuti ICP inowedzera kuwedzera, yakadai sekuputika shure kwekutambudzika kwehupi .
Kuisa kuongorora kwakadaro inzira inoparadza, zvisinei. Nepo vachiwanzochengeteka, vatariri ava vanogona kutungamirira kuhutachiona kana kubuda ropa. Zvinongowanikwa apo pane chikonzero chakajeka chekutarisana kweCPP.
Medical Management yepamusoro ICP
Apo mapurogiramu eurologist anonzwa ICP yakakwirira, matanho anotorwa kuti aderedze kudzvinyirira.
Iko kune zvikamu zvitatu zvinokonzera nzvimbo inoshandiswa pasi pehenya: ropa, uropi, uye cerebrospinal fluid (CSF) . Kana kuwedzerwa kuri kuvaka, kuderedza kuwanda kweropa kana CSF kunogona kuita nzvimbo yakawanda yeuropi kudzivirira kukonzerwa nekukuvara kusingaperi.
CSF volume inogona kuderedzwa nekuderedza kushandiswa kwayo mukati memhepo inobva muuropi. Mimwe mishonga yakafanana neyamacetazolamide inogona kuderedza CSF kukwidzika uye yakaderera ICP semugumisiro. Zvisinei, simba reizvi haisi rakasimba kwazvo, uye acetazolamide ine migumisiro yakadai sekushandura acidity yeropa.
Ropa iro muuropi rinogona kuderedzwa nekuisa musoro kumusoro kuti kukurudzira mitsetse yemusoro kudzorera ropa nokukurumidza kumwoyo. Kana murwere akabatwa (ane futi inoputika mukati), kufema kunogona kuwedzerwa kushandura acidity yeropa romurwere. Izvi zvinogona kuita kuti mitsetse iri muuropi iwedzere, kuderedza kubuda kweropa nekupa uropi zvishoma nzvimbo yakawanda - zvisinei, iyi inongogadzirisa pfupi kwenguva pfupi.
Dzimwe nguva uropi huputika nekuda kwedema, uko kusviba kunoputika kubva mumidyo yeropa uye muhutano tissue. Mimwe micheche yakadai se mannitol, kana kunyange saline, inogona kukurudzira kuti mvura inodzoka kubva muuropi ichipinda mumidziyo yeropa uko inokonzera kuderedza kuora.
Steroid seDexamethasone inogonawo kubatsira kuderedza uropi kuputika.
Surgical Management of High ICP
Apo kurapwa kwechiremba hakukwanisi, dzimwe nguva mamwe matanho ane utsinye anoshevedzwa, sekuvhiyiwa.
Kana uropi huri kumanikidzirwa nechimwe chinhu chiri mucheka chisiri cheko, kufanana nevhavha kana tumarara, dzimwe nguva zvinogona kubvisa dambudziko. Dzimwe nguva, zvisinei, izvi hazvibviri, zvimwe nokuti dambudziko rekuvhiyiwa rakawandisa, kana kuti dambudziko harisi nyore kubviswa.
Semuenzaniso, kana dambudziko guru nderekuti uropi huputika nekuda kwekuputika, zvingatove pachena kuti haisi mhinduro yakanakisisa yekubvisa chikamu cheropi pachayo.
Muchiitiko ichi, pane imwe nzvimbo pane imwe nzira inofanira kuitwa kuitira kuti zvibvumire nzvimbo yekudzivirira.
Kunze kwemishonga yakadai seacetazolamide, CSF inogona kubviswa nekuidhonza kuburikidza ne shunt . Izvi zvinosanganisira chikwata chinoiswa mumhepo inotenderera yeuropi kuti ibudise CSF. Kana kuongorora kwe ICP kwave kuchiiswa kare, CSF inogona kuderedzwa kuburikidza neyochengeti kuitira kuchengetedza kushanda pane imwe chinangwa.
Zvisinei, kune mimwe migumisiro yekudzivirira. Mukuwedzera kune njodzi dzehutachiona uye kubuda ropa kunobva pakuisa chimwe chinhu mumuviri, kunewo njodzi yokuti CSF yakawanda ichabviswa panzvimbo dzisina kunaka, zvichiita kuti kudii kushandiswa kunotungamirira mukudzivirira-kufamba kwechikamu cheuropi kunzvimbo iyo haisi yake.
Chimwe chiitiko chinogona kurapwa ndechokuti uropi huve nzvimbo huru. Vanachiremba vanoita izvi kuburikidza nekuita kristaniectomy , iyo chikamu chedehenya chinobviswa kuitira kuti zvibvumira nzvimbo yakawanda yeuropi kuti irere.
Nepo chikamu chedehenya chiri kubviswa, mavara akakomberedza uropi achiri kuchengetwa seasina kuchena uye akachenesa sezvinobvira kudzivirira utachiona. Kunyange zvazvo zvirwere uye zvimwe zvinetso zvinogona kuitika, nenguva iyo craniectomy inodanwa, pane zvimwe zvingasarudzwa. A craniectomy chirongwa chakakura nemimwe ngozi yakakomba, asi inogona kunge yakakosha mumamiriro ezvinhu akaoma.
Sources:
Allan, H., et al. Neurological uye Neurosurgical Care Intensive, Fourth Edition, Lippicott Williams & Wilkins, 2004
Braunwald E, Fauci ES, et al. Harrison's Principles of Internal Medicine. 16th ed. 2005.