Iiseli kunye nesithuba esiphezulu segqeba elilawulayo le-nervous system lingagcina i-liquid. Oku kubangela ukuvuvukala okanye ukuvuvukala kwengqondo, okubangela ukwanda kwendleko yayo kunye nokwanda kweengcinezelo ezingenakunyango . Le meko ithathwa njengesifo esiyingozi kakhulu ekufuna unyango lwangoko.
I-Edema yeentlobo zeengqondo
Ukuhlelwa kwesifo esicatshulwayo kusekelwe kwiindlela zokuvela kwayo kunye nokuhamba kwexesha elizayo. Kukhona i-edema ye-cerebral yale ntlobo:
- vasogenic;
- i-cytotoxic;
- phakathi;
- osmotic (ukucoca).
Ukongezelela, i-edema ye-cerebral ingahlula ngokuxhomekeka kwizizathu zokubunjwa kwayo:
- isisu;
- buhlungu;
- u kuvutha;
- inetyhefu;
- emva kokusebenza;
- xhe lekile;
- nezinye izinto ezahlukahlukeneyo.
IVasogenic cerebral edema
Phakathi kwenkqubo ye-nervous and central nervous there is a obstacle of physiological - i-blood-brain obstruction (BBB). Ngoncedo lwaso, umxholo wamanzi kwisithuba se-intercellular ulawulwa. Njengoko ukunyuka kweBBB kwanda, i-edema yengqondo ye-vasogenic ivela. Kwenzeka ngokuchasene nemvelaphi yezophulo ezilandelayo:
- ukukhathazeka okubandayo;
- iimvumba;
- igesi kunye ne-microembolism yemithambo yegazi;
- eclampsia;
- ukufakwa kwamatriyridi e-carotid.
I-edema ye-cytotoxic yengqondo
Amaseli afumaneke kwisiphumo esinetyhefu (yangaphandle okanye yangaphakathi), qala ukusebenza ngokungalunganga. Ukuxilongwa kwazo kunye nokubonakala kweembrane kuyashintsha. Iifisi ziqokelela amanzi kwaye zivelisa i-edema ye-cytotoxic okanye ukuvuvukala. Le ndlela ye-pathology isoloko ifunyaniswa emva kokubethelwa kunye nokuxhatshazwa kakhulu, kodwa ibuyiswa emva kweeyure zokuqala ezingama-6-8.
I-edema yecerebral cerebral
Kwiqumrhu eliphambili le-nervous system, i-cerebrospinal fluid okanye i-cerebrospinal fluid ijikeleza rhoqo, ikakhulukazi kuma-ventricles. Xa uxinzelelo luba lukhuni kwaye lukhupha ngamandla, kukho i-edem ye-interstiti yengqondo. Imeko ichazwe ibangela ukuba ukungeniswa kwamathambo kubekho kunye notywala obuninzi. Ngenxa yoko, iiseli zanda kwivolumu kwaye zivule.
I-osmotic cerebral edema
Naliphi na umbane uqulethe iincinci eziphelile kuyo. Ubuninzi babo kwi-1 kg yobumanzi bubizwa ngokuba yi-osmolarity. Ngokuqhelekileyo, esi sibonakaliso se-plasma kunye nebhunga elilawulayo leenkqubo zentlungu liphantse lifana. Ukuba i-hyperosmolarity (ephakamileyo kakhulu) ye "grey matter" iyabonwa, ukuxilongwa kwe-brain edema kuqalisiwe. Ngenxa yokwanda kwenani leengqungquthela kwi-cerebrospinal fluid, izicubu zivame ukunciphisa uxinzelelo lwazo, kwaye zithatha umbane kwi-plasma. Ukuvuvukala kwengqondo kubhalwe nge-type encephalopathies. Ngokuqhelekileyo kubangela i-hyperglycemia, i-renal ne-hepatic insufficiency.
I-edema ye-cerebral - ibangela
Izinto eziqhelekileyo ezibangela ukuba inkxalabo ibuzwe ngayo:
- iziphazamiso ezijikelezayo ezijikelezayo (imivimbo);
- ukungenelela;
- utywala obukhulu, kuquka ukutyhelwa kotywala;
- ukuphendula kwe-anaphylactic ngokumalunga nemvelaphi yokugula.
Kukho izizathu eziqhelekileyo ezicacisa oko kubangela ukukhukhula kwengqondo:
- izicubu zomhlaza kunye nezidumbu;
- ukuphuka kwamathambo e-krano kunye nesiseko;
- ukuxhatshazwa kwenkunzi, ukuxhamla, ukuhluleka kwentliziyo;
- i-meningitis ;
- ukuphikiswa kwengqondo ;
- Iimpawu ze-hematomas ezingapheliyo;
- ukulimala kwe-axonal;
- meningoencephalitis;
- i-toxoplasmosis ;
- zendalo.
I-Edema yengqondo emva kwesifo
Ukuphazamiseka kokujikeleza kwegazi kwinqanaba eliphambili le-nervous system liqala ngokucima iinqanawa nge-thrombus. Kancinci, iifomsi zithola i-oksijini encinci, yingakho i-oksijeni yindlala ikhula. Iiseli ziyafa kwaye zifumene nantoni na ukunyamezela, kukho i-edemicemic edema yengqondo. Kwezinye iimeko, i-fluid fluid eqokelela phambi kwe-thrombus inokudiliza iindonga zeenqanawa. Lo mzekelo ukwandisa i-edema ye-cerebral ngokuphazamiseka, ngenxa yokuba izicubu emva kokuvutha kwamanzi zifumanisa ubuninzi obuninzi. Olu hlobo lovulo lweseli lubonwa njengona yingozi.
I-Edema yengqondo emva kokuhlinzwa
I-Pathology ihlala ihamba kunye neendlela zokungenelela ezikwindawo yengqayi. Kwiimeko ezinqabileyo kunye nangemvelaphi yezinye iinkqubo, kukho i-edema ye-cerebral - umsebenzi owenziwe ngokusebenzisa i-anesthesia ye-epidural, okanye ukuphathwa ngokugqithisileyo kwe-hypotonic kunye ne-saline solutions solutions. Ngamanye amaxesha ukuvuvukala kweeseli kwenzeka ngenxa yeengxaki zokungenelela ngoncedo:
- ukulahlekelwa kwegazi elikhulu;
- Ukungeniswa okungahambiyo kwe-trachea ye-air venting;
- ixesha elide kunye nelizwi linciphile kwixinzelelo legazi;
- i-anesthesia ibalwa ngokungalunganga.
I-edema enxilisayo yengqondo
Inani elithwala ngokweqile le-ethyl yotywala emzimbeni lukhokelela ekutyhefu. Utywala zivame ukuxilongwa nge-edema ye-cerebral - izizathu zixakeka kakhulu kweeseli, ngenxa yento engavumelekiyo ukuba i-metabolism kunye nokusebenza kwayo. Izicubu ezonakalisiweyo zithatha umswakama, zenza ukuvuvukala nokwandisa. Ukukhukhumeza okunjalo kubonisa ukuba utyhefu nezinye izinto:
- izixhobo zamachiza ezinobuthi;
- machiza;
- gesi ezinobuthi;
- mayeza.
I-Edema yengqondo ngokunyamezela
Ukusabela okungonelanga kwamasosha omzimba okwenzela abanye abantu kuhambelana nokutshatyalaliswa kwe-anaphylactic. Kwiimeko ezinjalo, into ebangela ukuba ubuchopho be-brain bubuhlungu. Ngokuchasene nokudlulela kwe-hypersensitivity, ukunyuka kwegazi kuhamba umzimba wonke kunciphisa kakhulu, uxinzelelo lwegazi luyancitshiswa kakhulu kwaye ukuwa kwehla kuyaqhubeka. Ngenxa yokungabikho kwegazi elaneleyo kwizakhiwo ezibalulekileyo, iifom zegrey zifaka umbane kwaye zivule.
Ukuvuvukala kwengqondo - iimpawu
Umfanekiso wekliniki we-pathology echazwe rhoqo ufana kwaye awuxhomekeke kwizizathu zakhe okanye kwiindlela zokuphuhlisa. Kukho amaqela eempawu ezi-3 ezibonakalisa i-edema yengqondo - iimpawu zahlula iindidi ezilandelayo:
- I-Syndrome ye-intracranial yomshurensi. Ngenxa yokuvuvukala kwezicubu, ukukhula kwabo kwanda kakhulu. Umkhuhlane ogqithiseleyo kwisikakrawu kubangela ukwanda okunamandla kwingcinezelo. Oku kuphazamisa isicaphulo, intlungu enobudlova kunye nengenakubandezeleka, ukuhlanza okungenakulungiswa. Ukuba ukuvuvukala kwengqondo kuqhubeka ixesha elide, kukho ukunyuka kokuqonda.
- Iimbonakaliso zeklinikhi ezijoliswe kuzo. Ukuvuvuka kwezicubu kwiindawo ezithile ze-central central nerve system control unit kubangela ukuphulwa kwemisebenzi ethile. Ngenxa yoko, ukuphazamiseka, ukubonakala, ukuphazamiseka kwentetho, ukungahambi kakuhle kokuhamba kwamanye amazwe. Ngamanye amaxesha isigulane asikwazi ngokupheleleyo ukwenza umsebenzi ophezulu weentlonelo kwaye unesimo esingenalwazi.
- Sitshixo Ukukhukhuma kwengqondo kungakhokelela ekuhambeni kwezakhiwo ezithile zegungu, ukucima ukunyuka kwamazinga omzimba wee-tissu zeendawo ezisondeleyo zeentsholongwane kunye nemithambo yegazi. Ngokuchasene neziganeko ezinjalo kukho ukuphulwa komzimba kunye nomoya wokuphefumula, ukunyuka kwegazi, ukunyanzelwa kweempendulo kunye nezinye izifo ezisongela ubomi.
I-cerebral edema - unyango
Ukutshatyalaliswa ngokwemvavanyo kwisigulane sesifo, umzekelo, emva komngcipheko okanye ukulimala okwenzakala, akudingeki unyango olukhethekileyo. Ezihlukeneyo zokuvuvukala kwezicubu zidlula ngokuzimeleyo iintsuku ezi-2-4. Izibhedlele ziyimfuneko xa i-edema ye-cerebral iqhubeka-unyango lwezinto ezinzima kunye neyingozi ze-pathology lwenziwa kuphela kwiyunithi yokunyamekela.
Injongo ephambili yonyango ngumgangatho wokunyanzeliswa kwe-cerebral perfusion (CPD). Inoxanduva lokunikezelwa kwegazi, ukunikezelwa kwe-oksijini kunye nezondlo kwi-neurons. I-CPR yohlukwano phakathi kwesigqibo sentsholongwane kunye nesibalo somngcipheko weengcinezelo kunye nomphakathi. Ezinye imisebenzi zonyango:
- ukupheliswa kwexinzelelo kunye nokuqhutyelwa kwempahla;
- ukugcina ubushushu bomzimba obuqhelekileyo;
- Ukubuyiselwa kwemiphunga kunye nomsebenzi wentliziyo;
- ukuqheleka kwengqondo ewonakalisiweyo;
- ukususwa kwezizathu zokuthintela ukuphuma kwegazi legazi elivela kwisigxina;
- ukukhulula nokukhusela isifo sesifo;
- ukupheliswa kwamanzi angaphezulu kwamaqhosha.
I-Edema yengqondo - uncedo olungxamisekileyo
Izigulane ezinezifo ezixilisayo kufuneka zifakwe esibhedlele ngokukhawuleza.
Ukuqala unyango lokuqala:
- Emva kokuba ufumene iimpawu ze-edema ye-cerebral, khawuleza ubizele iqela loogqirha.
- Faka ixhoba kwindawo ephezulu.
- Ukubonelela ngomoya omtsha.
- Ukuba kukho ukuhlanza, vula intloko yomntu kwicala.
- Unganqakraza okanye ususe iimpahla zokucima.
- Xa kunokubanjwa, gcina ngokuthe ngcembe intloko kunye nemilenze yesigulane, ukukhusela ukusetyenziswa kwemivimbo kunye nokulimala.
I-Edema yengqondo - iziyobisi
Ulwaphulo lwe-dehydration usetyenziselwa ukususa umthamo ogqithiseleyo kwiiseli kunye nezicubu ze-cerebral. Ukuba i-edema ye-cerebral ephezulu ifunyanwe kubantu abadala, ukulawulwa kwe-osmotic diuretics kuqala kukuncediswa ngoncedo lwe-dropper - iMannitol, i-Albumin kunye ne-analogues. Emva kokukhululeka kwesimo esibi isigulane sidluliselwa kwi-loop diuretics:
- Torasemide;
- Furosemide ;
- Toradiv;
- Lasix;
- Toraz;
- Britomar;
- Trigrim;
- SutrilNEO;
- Torsid;
- Diver;
- Trifas nabanye.
Xa uxinzelelo lwe-intracranial luphezulu kwaye akunakwenzeka ukuphelisa i-edema ye-cerebral kunye nezidakamizwa ezidweliswe, u-ventriculostomy uyaphakanyiswa. Oku kungenelelo lokukhusela okukuvumela ukuba ususe umthamo ogqithiseleyo kwiishubhu. Inkqubo yukuqaliswa kwe-cannula (inaliti ephihlileyo engenalutho) kwenye yee-ventricles yengqondo ukwenzela ukudala umjelo. Ukuphathwa okunjalo kubonelela ngokukhawuleza kwenkxalabo kunye nokuphuma kwamanzi amaninzi.
Kwimvelaphi yokuvuvukala kwe-cerebral, i-hypoxia isoloko ivela. Ulwaphulo lwe-oksijeni lisetyenziselwa ukumisa i-oksijini yendlala kunye nokubuyisela umsebenzi wokuphefumula. Ukuhluka okulula kukusetyenziswa kweemaski ekhethekileyo kunye nokunikezelwa kwegesi egciniweyo. Kwiikliniki zanamuhla i-oxigenobarotherapy eyenziwa - ukubeka isigulane kwindawo ekhethekileyo yomoya kunye noxinzelelo lwe-oxygen. Kwiimeko ezinzima, umoya wokuphuphuma umoya wenziwa ngokukhawuleza.
Ukuphucula i-cerebral metabolism kunye nokubeka umgangatho kwimisebenzi yeeseli zobuchopho, ukupholisa kwendawo yentloko kunye nokulawulwa kwezicwangciso zonyango ezisebenzisayo iinkqubo zokusetyenziswa kwamanzi:
- Cortexin;
- Armadine;
- Mexidol;
- Citicoline;
- Antifront;
- Elfoon;
- Mexiprim;
- Venocor;
- Nikomex;
- Mexmidol;
- IDinari;
- Idibeneyo;
- Neurotropin-Mexibel.
Ukukhukhuma kwengqondo kuhamba kunye nokuphelela kweembrane kunye nokudakalisa kweendonga ze-vascular. Ukujongana nale ngxaki kukunceda i-hormone ye-glucocorticosteroid:
- Hydrocortisone ;
- Depos;
- Prednisolone;
- Celeston;
- Betaspan;
- Diprospan;
- Lauracort;
- I-Betamethasone;
- Flosteron nabanye.
Ukuzinzisa uxinzelelo lwegazi lonyulwe:
- Dibazol;
- Eufillin ;
- Pentamine;
- Azamethonium;
- Papaverine kunye neempawu.
Izigulane ezininzi zidinga ulawulo lwe-psychomotor agitation. Kule njongo, oku kulandelayo kusebenza:
- Droperidol;
- i-oxybutyrate ye-sodium;
- Diazepam.
Ukubuyiselwa kwenkqubo ye-nervous central kubonelelwa ngama-angioprotectors, i-hemostatics, i-antiginoxants, i-proteolytic enzyme inhibitors kunye namanye amaqela eyeza, eziquka oku kulandelayo:
- Dicycin;
- Actovegin ;
- Piracetam;
- i-glutamic acid;
- Tracerol;
- Iintlangano;
- cytochrome C.
Ngamanye amaxesha kuyimfuneko ukusebenzisa ama-antibiotiki, ikakhulukazi i-cephalosporins eninzi yezenzo:
- Cefepime;
- Cefuroxime;
- Cefazolin;
- Cefadroxil;
- Ceftriaxone kunye neempawu.
Imiphumo ye-cerebral edema
Kwiimeko ezinqabileyo, oogqirha banokuphelisa ngokupheleleyo ukuthunga kwezicubu. Ingqondo ye-edema isoloko iyanzima - iziphumo:
- ukuphazamiseka kwengqondo;
- ukukhubazeka kwengqondo;
- ukukhubazeka kunye neparresis;
- ukukhubazeka (kuxhomekeke kwiindawo ezichaphazelekayo zobuchopho);
- ukuphazamiseka;
- izifo zokulala;
- ukudandatheka;
- iingxaki zeememori;
- ikhanda;
- ukunyuka kwengcinezelo kunye neengcinezelo zobisi;
- ukuphazamiseka komsebenzi wemoto.
I-Edema yengqondo - isalathiso ebomini
Ukuhlolwa kwezilwanyana kuqhubela phambili ngokukhawuleza, kunokwenzeka ukuwuyeka ngaphandle koxinzelelo kuphela ngokuzikhukhumeza kweetcuksi kubantu abancinci nabasempilweni. Kwamanye amaxesha, kukho imiphumo emva kokuba i-edema ye-cerebral yomehluko. Ukuxhomekeka kwento kuxhomekeke kumlinganiselo womonakalo wequmrhu, amasebe achaphazelekayo kunye nokukhawulelana kwezifo ezinokubambisana. Kwiimeko ezininzi, ukuvuvukala kwengqondo kubangela iingxaki ezingapheliyo, ngamanye amaxesha ukuvuvukala kukukhokelela ekufeni komntu.