Zvinokonzera, Kurapa, uye Kuoma Kwechiitiko Epilepticus
Mamiriro epilepticus, kana kuti 'chimiro' chirwere chekurapa chinoda kutarisirwa nokukurumidza - chaizvoizvo, kurapwa kwechimbichimbi kunogona kuchengetedza hupenyu.
Cherechedza : Kana iwe unonetseka kuti mumwe munhu ane chiremera chekudya chinonzi 911. Mutsva unofanirwa kuitika gore ra 2016 unorayira mishonga yekurapa inowanikwa pasi apa pasi pekuchengetedzwa kwekukurumidzira.
Kubatwa kwechibhakera hakusi kwemazuva ose, kusagadziriswa kwemagetsi basa rinoitika mukati meuropi.
Kana mumwe munhu akagara achigadzikana, kufungidzirwa kwekufa kwechifo kunogadziriswa kuburikidza nedzidzo dzeropa, nhoroondo yakazara yezvokurapa, nezvimwe zviedzo, zvakadai seEEG, kamupopu , kana kufungidzira. Ndiko panguva ino kuti mupi wako wehutano wehutano achakupa iwe mishonga yakakodzera ichagadzirisa mamiriro ako.
Nekuputika, uchaona kuti kunetseka kunogona kupera kusvika kumaminitsi mashomanana . Mune dzimwe nguva dzisingawanzoitiki, dzinogona kupedzisa nguva refu uye dzinogona, sezviri pachena, dzichiita sekuti dzisarega zvachose. Izvi zvinotumidzwa semamiriro epilepticus. Inofungidzirwa kuti vanenge 50 000 kusvika 150 000 vanhu muUnited States vanobatwa nehuwandu hwehupenyu gore negore.
Chii Chiripo Epilepticus?
Panguva yechirwere chekufa, munhu ane chirwere chekufa ane chiremera chekuziva uye anoramba achidzoka kana kuti akadzoka zvakare. Kazhinji kukanganisa kunogara kwenguva shomanana. Zvisinei, kana kubatwa kunopedza maminitsi mashanu kusvika kumakumi matatu asina ruzivo rwekuwanazve, munhu wacho achaonekwa ane chiremera chepile.
Mamiriro epilepticus chirwere chekurapa chinoda kukurumidza uye nekuchenjerera kurapwa uye chinogona kuuraya kana chisina kutaurwa. Zvinetso zvinogona kubuda kubva pane zvakagadziriswa zvinosanganisira kusagadzikana kwemwoyo kana mapapu, kuchinja kwemagetsi, kuwedzera kwekushisa kwemuviri, uye pakupedzisira, kusagadziriswa kwehupfungwa hwepfungwa.
Mamiriro epilepticus anogona kuenzanisirwa seanovhiringidza kana asingasviki. Kushungurudza kunoreva munhu ari kuve akajeka achizununguka (kuzununguka se) episode. Nonconvulsive epilepticus inoreva mamiriro ekuvhiringidzika uye kutadza kunzwisisa. Vanhu vari mune zvisingabatsiri havangaratidzi kuva nechisimba chiri pachena, asi vachiri nemagetsi emhepo ari muuropi ayo anowirirana nekutora. Mushure mokunge kushungurudzika kwakanyarara uye munhu wacho asina kudzoka shure mushure mechinguva, mutapi wehutano achafunga kuita EEG kuti ave nechokwadi chokuti munhu haasi mamiriro asina simba.
Chii Chinokonzera Chimiro Epilepticus?
Mamiriro epilepticus chirwere chinotyisa uye chinopisa upenyu chinoda kurapwa nekukurumidza kuchirapa kuitira kuti kudzivirira zvimwe zvinetso uye kuchengeta uropi hushanda. Mamiriro epilepticus anogona kukanganisa chero rimwe boka rezera, kunyange zvazvo zvimwe zvikonzero zvinowanzokonzera chimiro muvana uye nevamwe vanowanzoonekwa nevanhu vakuru. Izvi zvinogadzirisa zvinhu zvinosanganisira:
- Zvirwere zvirwere (zvirwere zvinokonzera zvikamu zvikuru zvemuviri)
- Huru (zvirwere zvine chokuita nefivha) zvirwere
- Head trauma
- Stroke
- Dzimwe kenza
- Kukurumidza kubvisa anticonvulsant (anti-seizure) mishonga
- Kukurumidza kubvisa doro kana zvinodhaka zvisina kukodzera
- Matambudziko emagetsi (low sodium, low calcium, tsukasi yakadzika kana yakasvibira)
- Kumanikidzwa kwakanyanya kwechirwere chinopesana nemaperembudzi muropa
Emergency Care of Status Epilepticus
Kurapa kwokutanga kunotanga nemitemo yeAAC: Iva nechokwadi chokuti munhu wacho ari pachena, munhu ari kufema uye kudzorera muviri wemvura.
Chirongwa chekurapa chichaitwawo kuti uwane kuti nei munhu wacho akapinda muhupenyu epilepticus pakutanga.
Kuti uchengetedze kugumburwa, mamwe mishonga ichashandiswa. Nhungamiro mutsva yakaiswa muna 2016 neAmerican Epilepsy Society.
Mishonga yekutanga uye yakashandiswa ndeye IV benzodiazepines, inosanganisira diazepam, lorazepam, uye midazolam. Lorazepam inowanzoshandiswa nekuda kwekuita kwayo nokukurumidza. Vanenge 55% yevanhu vachabvuma kutendeuka kwekutanga. Kana iyo isiri kushanda, imwe yemishonga iyi inogona kudzokororwa, asi kana ikakundikana kushanda pashure pemiti yechipiri, inguva yekushandura kune mishonga yakasiyana.
Zvisarudzo zvechipiri chechiremba gadziriro yemishonga dzinosanganisira IV fosphenytoin, valproic acid, kana levetiracetam. Kana izvi zvisingashande imwe yemishonga iyi inogona kushandiswa, kana phenobarbital inogona kupiwa.
Kana iyi yechipiri sangano remagadzirirwo emishonga isingashandisi, inguva yekupinda muchikamu chinotyisa nekushandiswa kwekuenderera kweEEG kutarisa . Chirwere chechipiri chinodhaka chinogona kudzokororwa kana murwere aigona kurapwa neanesthetic dose thiopental, midazolam, pentobarbital, kana propofol.
Kukosha uye Kufanirwa kweMamiriro Emo Epilepticus
Mamiriro epilepticus anogona kuuraya uye haafaniri kutorwa zvishoma. Chimwe chiitiko chakacherechedza kuti chiyero chekufa kwevanhu vanoonekwa kuti vane hosha yakakura se 22%, nehuwandu hwevakafa hwe 3% muvana uye 26% muvanhu vakuru. Saka, chiito chinokurumidza chakakosha zvikuru.
Kuchengetedza Mamiriro Epilepticus
Kuti udzivirire chimiro chekuuraya, vanhu vanofanira kunge vachienderana nemishonga yavo yekurapa. Kuwedzerwa, nguva dzose kushanyira kune mutapi wavo wehutano kunofanirwa kuitwa kuti ave nechokwadi chokuti mushonga unoshanda zvakanaka, hapana mimwe mishonga yakawedzerwa iyo inogona kuderedza kushanda kwemishonga yavo yekurapa, uye kuongorora kune mamwe mamiriro ezvinhu (akadai sokudhakwa, chirwere cheshuga chisina kudzora , kushungurudzika kwemagetsi) izvo zvinogona kukanganisa kudzora kugadzirisa.
Sources:
Betjemann, J., uye D. Lowenstein. Mamiriro epilepticus. Lancet Neurology . 2015. 14 (6): 615-624.
Drislane, F. Kushungurudzika kwehutano hwevanhu vakuru: Kurongeka, zvipatara, uye kuongororwa. Kusvika pari zvino. Yakavandudzwa 11/20/15. http://www.uptodate.com/contents/convulsive-status-epilepticus-in-adults-classification-clinical-features-and-diagnosis
Glauser, T., Shinnar, S., Gloss, D. Zvinyorwa-Zvakatungamirirwa Nhungamiro: Kurapa Kwekushaya Mamiriro Epilepticus muvana nevakuru: Gwaro reMotungamiri Komiti yeAmerican Epilepsy Society. Kuora Kwemapapiro . 2016. 16 (1): 48-61.
Trinka, E., Cock, H., Hesdorffer. Et al. Tsanangudzo uye kusarudzwa kwemaitiro epilepticus - Mharidzo yeILAE Task Force paKutsanangurwa Kwechiitiko Epilepticus. Epilepsia . 2015. 56 (10): 1515-23.