Wavulala kwambiri m'mutu: gulu. Mutu choipa: zizindikiro, thandizo ndi mankhwala

Mutu choipa, zotsatira zimene zingakhale zosiyana kwambiri (kuphatikizapo imfa) ndi mmodzi wa chifukwa ambiri olumala mu wamng'ono ndi pakati. Pafupifupi theka la milandu onse a choipa ubongo zoopsa. Malinga ndi ziwerengero za 25-30% kuvulala onse chifukwa cha kuwonongeka kwa bongo. Pamodzi, milandu chifukwa cha oposa theka la imfa. Kenako m'nkhani ndi gulu la kuvulala, ikulongosola za ena a iwo.

mwachidule

Mantha ubongo choipa amatchedwa kuwonongeka kwa chigaza fupa kapena minofu zofewa. Yotsirizira Mwachitsanzo, monga meninges ndi, mitsempha Mitsempha ndi zina. kuvulala mutu anawagawa m'magulu angapo. Tiyeni tione ena mwa iwo mwatsatanetsatane.

gulu la kuvulala

Kuwononga akhoza kukhala omasuka. Pankhaniyi, ndi wovulala aponeurosis ndi khungu. Monga pansi pa zochita bala ngati fupa kapena minofu, omwe amanama kwambiri. Ozama zoopsa choipa yodziwika Dura. Monga nkhani zosiyanasiyana tinganene kuti otlikvorreya chifukwa mafupa othyoka mu m'munsi a Chigaza lapansi. Kumachitika ndi kuvulala chatsekedwa mutu. Pankhaniyi, khungu akhoza imawonongeka, ndi fascia akuzisunga kukhulupirika kwake. Komanso, pali magulu otsatirawa:

• Kenaka utentha mamba. zoopsa izi kwa mutu, amene si yodziwika ndi kuvutika kulimbikira ubongo. Onse maonekedwe a boma nthawi (zambiri masiku angapo) kutha paokha. A zizindikiro zambiri kulimbikira kulimbikira, pali kwambiri mutu zoopsa ndi kuwonongeka Nkosatheka ubongo. I chachikulu ziyenera a boma amachita zodabwitsa nthawi (kwa masekondi maola) ndi kukhala boma kuya kenako ikani amnesia ndi imfa ya chikumbumtima. Mwa zizindikiro si yeniyeni tisaiwale kusanza, chisokonezo pa ntchito mtima, blanching wa khungu.
• Psinjika moto ubongo choipa, mpweya, thupi yachilendo, hematoma.
• Subarachnoid kukha magazi.
• Akakufunsani kuwonongeka axonal.

Zochita izo zinalembedwa kwambiri milandu pamodzi. Tikaphatikiza Mwachitsanzo, psinjika akhoza hematoma ndi contusion contusion ndi kukha mwazi subarachnoid ndi psinjika, kuwonongeka akakufunsani ndi kuvulala ndi ena. kuwonongeka amayambira chifukwa cha kuvulala kwa nkhope.

ubongo contusion

Zimachitika pa maziko a choipa mutu. Kufinya ndi kuphwanya umphumphu wa ubongo mankhwala pa malo ena zochepa. Childs, dera limeneli limapezeka pa nsonga ya mphamvu ntchito. Komabe, pali milandu kumene yotupa amapezeka mbali ina (kuchokera protivoudara). Pa maziko a boma n'kugwa mbali ya minofu ubongo, mitsempha ya magazi, ndi histological nsinga selo ndi mapangidwe wotsatira wa edema zoopsa. M'dera la zotupa izi zimasiyanasiyana. Makamaka oopsa amenewa mutu choipa mwana.

wofatsa

Chotero choipa mutu yodziwika ndi disconnecting kutsitsimuka kwa nyengo yaifupi - mpaka makumi angapo Mphindi. Nditamaliza ake ndi madandaulo ankaikira nseru. Komanso, kupweteka mtima ndi chizungulire. Pangakhale kusanza, nthawi zina mobwerezabwereza. Nthawi zina, pali zolimbitsa bradycardia - kutsitsa mtengo mtima 60 ndi mphindi imodzi yokha. Wodwalayo mwina ndende, retro- ndi anterograde amnesia - kuwonongeka kukumbukira mu mawonekedwe a Amalephera kupulumutsa ndi kubwezeretsa chidziwitso cha kale anagula. Pambuyo wofatsa choipa mutu amalembedwa tachycardia (chinawonjezeka kugunda kwa mtima 90 bpm. / Min). Odwala ena angafunse zoipazi. Pankhaniyi kutentha thupi ndi kupuma, kawirikawiri kukhala sichinasinthe. Koma zizindikiro za minyewa, matendawo amakhala zosavuta khalidwe. Mwachitsanzo, wodwala akhoza kuona kufooka, kugona, nystagmus clonic (biphasic rhythmic kayendedwe musanaganizire wa maso). Palinso anisocoria yaing'ono, zizindikiro meningeal, pyramidal insufficiency. zizindikiro zambiri amayambiranso pa sabata 2-3 pambuyo choipa mutu.

Zochita za kuyan'anila

Pa maziko a choipa ndi wapezeka microscopically kuwononga amapanga wosakhazikika medulla. Izo kumaonekera monga madera a kutupa m'deralo, nuchoka yokhudza kotekisi mfundo, mwina molumikizana ndi zochepa subarachnoid kukha magazi. Izo, nawonso, amayamba ndi chophukacho wa ziwiya pial. Subarachnoid kukha mwazi pamene magazi likulowerera arachnoid ndi kufalikira pa zitsime woyambira ming'alu ndi mizere ubongo. Zimakhala m'deralo kapena kudzaza danga lonse ndi mapangidwe kuundana. Ulili akufotokozera pachimake ndithu. Wodwala mwadzidzidzi akumverera "kuwomba kwa mutu", mwamsanga limapezeka photophobia, kusanza, kupweteka kwambiri. N'kutheka mobwerezabwereza zopweteka zowombetsa mkota. Kawirikawiri chikhalidwe si limodzi ndi ziwalo. Komabe, zizindikiro Mwina meningeal. Makamaka, pangakhale ouma khosi minofu (pa maganizo pa mutu sangakhoze kukhudza wodwalayo sternum chibwano) ndi kerning chizindikiro (simungakhoze kuwongola bondo unakhota ndi m'chiuno mwendo). Ngati pali zizindikiro za kukhumudwa meningeal amapezeka meninges akukhamukira magazi.

nuchoka zolimbitsa

Izi choipa mutu yodziwika ndi shutdown yaitali chikumbumtima (maola angapo). Wodwalayo amnesia n'kuchiumba. Palinso zizindikiro za kuvulala mutu zotsatirazi: woopsa mutu, kusanza mobwerezabwereza, mavuto a m'maganizo. N'kutheka chosakhalitsa chisokonezo ntchito kwambiri. Kwenikweni, akhoza kudzakhala bradycardia kapena tachycardia, kuthamanga, tachypnea (mofulumira kupuma osaya njira osalakwika mlingo ndi permeability), malungo otsika kalasi (kutentha thupi kuchuluka kwa 37-37.9 deg.). Pafupipafupi ndi tsinde ndi chipolopolo zizindikiro za dissociation ya bongo tendon ndi minofu kamvekedwe, amgwirizano pathological mawonetseredwe. Ndi zizindikiro mokwanira bwino mogwirizana. khalidwe lake amayamba ndi kutanthauzira zoipa. Anapeza oculomotor ndi pupillary matenda, matenda kulankhula, tilinazo, paresis wa malekezero ndi zina. zizindikiro zimenezi mwa masabata atatu kapena asanu, pang'onopang'ono ankawachotsera kunja, monga ulamuliro. Komabe, nthawi zina, anafotokoza chithunzi matenda wapulumutsidwa motalika kokwanira. Pamene choipa cha kuwuma zolimbitsa Nthawi zambiri fractures mu mafupa a m'munsi ndi calvarium, yaikulu subarachnoid kukha magazi. CT kusintha mogwirizana wapezeka monga inclusions chabwino kapena mkulu-kachulukidwe homogeneous zolimbitsa kuchuluka osalimba. Izi limafanana ndi magazi pang'ono m'dera la kuvulala kapena hemorrhagic impregnation ubongo minofu popanda kudzitsitsa aakulu.

Aakulu choipa mutu

Pankhaniyi, intracerebral hematoma anati mu lobes onse mazunzo monga okha woipa magazi zotupa zosiyanasiyana mtima chophukacho. Izi ndipamene M'mimbamo kuti muli magazi uŵende kapena madzi. Ngozi mu aakulu amakhala ndi yaitali shutdown wa chikumbu (masabata angapo). Nthawi zambiri, n'kuchiumba galimoto malemeredwe. Komanso amalembedwa matenda a ntchito yofunika m'thupi. Komabe, poyerekeza ndi digiri ambiri olemera, iwo ali yapadera kwambiri. Mwachitsanzo, pali matenda ntchito kupuma kuphwanya mayendedwe kayendedwe ndi mtunda. Wodwala zimawonedwa pyrexia, ulamuliro wa chachikulu tsinde zizindikiro ubongo. Makamaka, kuzindikiridwa Pomeza matenda, kayendedwe ka maso, ptosis, kapena mydriasis, paresis maso, decerebrate chinthu chimodzimodzi, kayendedwe, kukula kapena chopinga wa bongo, zikopa mucous, khungu, tendons ndi zina zotero akuyandama. Zizindikiro ubongo mu nthawi koyamba (nthawi yoyamba kapena masiku) ukulamulira zizindikiro focal hemispheric. Wodwala akhoza kuona nthambi paresis, matenda subcortical minofu kamvekedwe, ndi zina zotero. Nthawi zina, mwina mogwirizana kapena zowombetsa mkota khunyu. Mgwirizano focal mawonetseredwe zimachitika mosathamanga. Kuopsa kwa choipa chotero mutu? Zotsatira zake zikhoza kukhala zoopsa kwambiri. Nthawi zambiri pali amalembedwa zotsatira yotsalira, makamaka m'munda wa maganizo ndi galimoto.

zizindikiro CT

Mu kuvulala kwambiri ndi magawo atatu la milandu zinalembedwa ku zotupa focal mu ubongo mawonekedwe a si yunifolomu kachulukidwe m'madera kuonjezera. Pankhaniyi, pali kusinthana kwa mabacteria. m'madera allocated ndi osalimba mkulu ndi otsika. Mu chikhalidwe aakulu chiwonongeko imatsogoleredwa medulla ndi angafikire kwambiri mu dongosolo yamitsempha yamagazi ndi mtima subcortical. mphamvu kuzipenya kusonyeza kutha kwapang'onopang'ono m'madera wosindikiza, maphatikizidwe awo ndipo kusinthika mu misa homogeneous. Iwo akubwera ndi 8 kapena 10 Patapita maola nkhaniyi. Mgwirizano pathological gawo lapansi akuzinga zotsatira msanga, kusonyeza pamaso sanali resorbed kuundana ukali ndi minofu cholinga cha kuvulala. Pa nthawi imeneyi, iwo kukhala ndi ravnoplotnymi ozungulira edematous ubongo mankhwala. Mofulumira pambuyo masiku 30-40. buku zotsatira limasonyeza resorption ndi mapangidwe gawo lapansi m'malo madera manja kapena cavities enaake.

Kuwonongeka kwa zapambuyo pa fossa nyumba

chotupa ichi imatengedwa kuti ndi ovuta kwambiri kuvulala onse mutu. Boma amakhala ndi zizindikiro zotsatirazi: maganizo a chikumbumtima ndipo mitundu tsinde, cerebellar oziziritsa ndi zizindikiro meningeal chifukwa psinjika ndi mowa kufalitsidwa matenda mwamsanga.

Achire miyeso pamene kuvulala

Mosalingalira zoipa, ndi zaumoyo wodwala ayenera kupatsidwa. Mu nkhani ya choipa mutu wovulalayo kuti kuwapititsa ku chipatala posachedwapa. Kuti matenda zolondola zikusonyeza X-ray ndi CT. Wodwala ayenera bedi zina. Kutalika kwake ndi wofatsa - masiku 7-10, ndi avareji -. masiku 14. Pankhani ya aakulu zoopsa choipa ubongo ayenera kumwedwa kuwatsitsimula. Iwo anayamba mwamsanga nthawi chisanadze kuchipatala ndipo anapitiriza zinthu azilandira boma. Kuti matenda kupuma pofuna mfulu mtanda dziko mu kapepala chapamwamba kupuma - asiye ntchofu, magazi, masanzi. Iwo anayamba mpweya ritsa, ndi tracheostomy imagwiridwa (minofu kung'ambika ndi trachea cannula unsembe kapena kupanga mosalekeza mabowo - stoma). Komanso ntchito inhalation ntchito oxy mpweya osakaniza. Ngati ndi kotheka, ntchito makina mpweya wabwino.

Therapy kwa concussion

Ngati anatsimikiza kuti wodwalayo ali ndi choipa mutu, mankhwala ayenera kuchitidwa mu chipatala neurosurgical. Pamene concussion limasonyeza asanu bedi zina. Popeza mavuto wodwala akhoza m'chipatala pa tsiku la 7-10. Iwo anasankha outpatient chithandizo, nthawi imene - masiku 14. kuchipatala concussion umalimbana ofunika boma la ubongo, kasamalidwe ululu tulo, nkhawa zinchito. Childs, mankhwala osiyanasiyana zikuphatikizapo hypnotics, mankhwala ndi analgesics. Monga mankhwala analgesics ntchito monga "Baralgin" "Pentalgin" maksigan "" sedalgin Reglan "ndi ena. Njira ingaperekedwe chifukwa chizungulire." "Kuti mankhwala komanso mankhwala monga" Valocordin "" Corvalol " ndi ena okhala phenobarbital. Ikani infusions mankhwala (motherwort, valerian).

Analimbikitsa monga asamakhale ndi nkhawa. Zikuphatikizapo Mwachitsanzo, monga wothandizira monga "Rudotel", "Nozepam", "Phenazepam", "Sibazon", "elenium" ndi ena. Kuwonjezera symptomatic mankhwala yoikidwiratu Ndithudi kagayidwe kachakudya ndi chithandizo mtima. Imathandiza kuti mofulumira kwambiri ndi wathunthu kubwezeretsa kusokonezedwa ubongo ntchito, kumathandiza zizindikiro zosiyanasiyana postkommotsionnye. Pangano tserebrotropnoy ndi mankhwala vasotropic mwina patapita masiku 5-7 pambuyo zoipa. Advantageously kuphatikiza nootropic (mankhwala "Pikamilon" "aminolone", etc.) ndi vasotropic (mankhwala "Teonikol" stugeron "" Cavinton ") amatanthawuza kugonjetsa mawonetseredwe asthenic odwala amapatsidwa vitamini maofesi." Centrum "" Complivit "" . Vitrum "ndi Chakudya chopatsa thanzi ena analimbikitsa: zipatso za Schisandra, Siberia ginseng Tingafinye . ginseng muzu ayenera ananena kuti kugwedezeka sizimawoneka zotupa aliyense organic, tiyenera kulankhula zofunika kwambiri ngati pali kusintha kulikonse pa Kujambula kapena CT. mu kuvulala - ubongo choipa.

ntchito alowererepo

Mawotchi kuvulala opaleshoni. Opaleshoni imaonekera mu nkhani ya kugona tulo choipa ndi ubongo minofu. Childs, monga kuvulala makina zimachitika mzati kanthawi ndi dera la lobes mazunzo. Monga opaleshoni akutumikira osteoplastic trepanation. ntchito ndi kupanga mabowo fupa kudutsa mu M'mimbamo ndi detritus njira leaching wa sodium kolorayidi (0.9%).

kaonedwe

kuwonongeka wofatsa zambiri zotsatira zabwino ndithu (kuti litsatidwe malangizo a wodwalayo za chithandizo ndi mankhwala). Pa chikhalidwe zolimbitsa nthawi zambiri zotheka kukwaniritsa kuchira mtheradi ndi kukonzanso ntchito chikhalidwe ndi ntchito mwa anthu. Odwala ena kuona bongo ndi hydrocephalus, n'zothandiza asthenia, mtima kukanika, ululu, matenda a kugwirizana, malo amodzi ndi zizindikiro zina ubongo. Motsutsa likhale ndi kuvulala kwambiri 30-50% milandu munthu amafa. Pakati pa opulumuka sizachilendo chilema, ndiwo chikuchititsa mavuto matenda a m'maganizo, kulankhula zopanda pake ndi zipolowe galimoto, khunyu. Mu kuvulala lotseguka mutu mwachidziwikire mavuto yotupa. Makamaka, chiopsezo kukhala ubongo abscess, ventriculitis, encephalitis, meninjaitisi. Mwina liquorrhea woimira outflow wa madzimadzi cerebrospinal (CSF) kwa zachilengedwe kapena mabowo anapanga chifukwa zinthu zosiyanasiyana mu mafupa a msana ndipo mutu. Theka la amafa mu choipa mutu nkhani (RTA) ngozi pa msewu.