Agbasa axonal mmerụ: Mgbaàmà, ihe ịrịba ama na nchoputa

cranial trauma pụrụ ịkpata oké mmebi nke ụbụrụ, isi awọ okwu. Ha, n'aka, nwere ike ime ka mmepe nke oké na mgbe irreversible ọrịa na ize ndụ mmadụ. Ọzọ, tụlee otu n'ime ndị a pụta - asị ibe axonal ọjọọ, ihe ọ bụ, ka ihe ize ndụ nke dị otú ahụ a na steeti.

Isi

Mbụ anyị mkpa enye obere nhazi ọkwa nke nkebi nke okpokoro isi unan:

• Easy. Nke a mmerụ na-esonyere a nta mmerụ ahụ na a uburu mgbaka.
• Nkezi. Na nke a, ogo unan ji dị ka agafeghị oke.
• Arọ. Mgbe a na ogbo, na-akpata na asị ibe axonal mmerụ ahụ n'ụbụrụ. Injury mgbe yi ihe inertial agwa.

nkọwa

Asị ibe axonal mmerụ (WCT) bụ a oke mbibi Filiks nke akwara mkpụrụ ndụ na kpagburuibe obere hemorrhages. Dị ka adakarị, enweghị nchịkwa na-elekwasị anya na-kpụrụ na ókè-ala nke isi awọ na-acha ọcha okwu. Asị ibe axonal mmerụ (WCT) budata ebelata àgwà nke ndụ na nke uche ọrụ nke aja. Ọrịa na-arịa, obi abụọ adịghị, nwere ike na-ewere oké. Nke a bụ tumadi n'ihi na eziokwu na e nwere a dị oké njọ n'ihe ize ndụ ndụ ya. Mgbe mmerụ emee ichihịa, ọkọ amalite, e nwere a subdural hygroma. Nsogbu n'obi CSF outflow si ventricular mpaghara, mgbe mgbe, ahụrụ dara mbà n'obi mgbaji ọkpụkpụ. Ndị a phenomena ime tupu emepe asị ibe axonal n'ụbụrụ. Mmerụ ndị na-emekarị nnọọ egwu nke na ọ bụghị mgbe nile na ọ bụ ike iji weghachi ahu ochie ọrụ. The aja bụ adịkarịghị, dị ka omume na-egosi, ọ na-alaghachikwuru ya gara aga kwesịrị ikwu. Mgbe ọgwụgwọ na ghara ịgbanwe nke ọrịa na asị ibe axonal ụbụrụ unan mkpa ịhụ dọkịta gị mgbe nile. Nyocha dị mkpa ịchịkwa ahụ ọnọdụ na n'oge nchọpụta nke na-arịa ọrịa.

Agbasa axonal mmerụ: mgbaàmà, ihe ịrịba ama, nchoputa

Olee otú a enweghị nchịkwa ọnọdụ? Ọtụtụ mmerụ ahụ n'ụbụrụ, asị ibe axonal mmerụ akpan akpan, Bilie ruo ogologo oge amaghị onwe ya. Nke a ọnọdụ pụtara na oge nke mmerụ ahụ okpokoro isi. Ke adianade do, e nwere a ịrịba mgbanwe Akwara ụda. Agbasa axonal mmerụ syndrome so meningeal, oké ngosipụta esiwe na. Ọ nọwo na a nkọ ọnụ ke nsogbu na ida. Onye ọrịa kwụsịrị omume nke niile duziri. Amaghị onwe pụrụ nnọọ ogologo, na-adakarị prognosis na ọnọdụ dị otú ahụ, dị ka a na-achị, ọ bụghị nnọọ mma. E nwere a-ekwe omume na ọrịa nwere ike ịnwụ, na-enweghị nwetaghachiri. Na ọzọ dịruru ná njọ, onye ọrịa ejisie pụọ nke Coma, ma mgbe a zuru ezu ogologo oge. Amagh onwe nwere ike adịru 2-3 izu. Amaghị onwe nwere ike so mgbanwe ụbụrụ ammamihe nke ụbụrụ ọrụ. Na nke a, ọrịa nwere ndị e ji mara mgbu.

vegetative ala

Agbasa axonal mmerụ nke ụbụrụ ji mgbanwe dị ngwa na-adakarị picture. Ya mere, amaghị onwe nwere ike na-aga n'ime a vegetative obodo ma ọ bụ transistor. Clinically, asị ibe axonal ụbụrụ mmebi gosi na ụzọ dị iche iche. Ezie na ụfọdụ ndị ọzọ ọzọ egosikwa na a zuru ezu elu ike ọsọ. Vegetative obodo e ji a ọtọ disconnection nọ n'ógbè nke ụbụrụ ammamihe. Ọ nwere ike na-anọgidesi ike ruo ọtụtụ ọnwa. Na a vegetative ala, e nwere ihe ịrịba ama nke ọtọ impairment na subcortical-azuokokoosisi owuwu nke ụbụrụ. Ọrịa na mkpa Filiks na-akpalite anya bulbar, pupillary na ndị ọzọ yiri ngosipụta. Mgbe na-agbanwe agbanwe Akwara ụda pozdnotonicheskie ime na aghọta na-echebe omume. A na-agụnye, akpan akpan, na-agụnye cramps na elu ma na ala ụkwụ, amụba njupụta nke mmegharị hulata isi ya ehulata, aka ịma jijiji, mgbagwoju kpee nke ahu. Dị ka e kwuru n'elu, na-adakarị ngosipụta ịdị iche iche ngwa ngwa. Ruo otu awa, n'ihi na ihe atụ, nwere ike na-enwe dị iche iche -enweghị nchịkwa na-aghọ nkọ. Na-akọwapụta mgbanwe vegetative ala ọrịa na-egosi dyskinesia, ataxic gait, e nwere okwu na ọrịa uche. Otu n'ime ihe ndị ikpeazụ, ọ bụ uru na-arịba ama aspontannost, obi nchefu, omume gwụrụ.

The n'ihu N'ezie nke enweghị nchịkwa usoro

Agbasa axonal mmerụ ahụ n'ụbụrụ dị iche iche ezi uche mgbanwe site a ogologo amaghị onwe na a persistent vegetative ala-akwụsị akwụsị. Nke a na-egosi site ọhụrụ ngosipụta, nke adịghị adị n'ihu. Dị ka ihe atụ, onye ọrịa nwere ike n'ụzọ gabigara ókè na-elekwasị anya ilekiri filika ma ọ bụ na-eme ka mpụga stimuli. Ọ bụrụ na ndị vegetative ala na-aga n'ihu n'ihi na a ogologo oge, o kpughere ọhụrụ ịrịba ama nke ọrịa. Karịsịa, e nwere bụ erighị carpal muscle fibrillation N'ịdị mọzụlụ. Na nke a, e nwere a ngwa ngwa na-enwe ọganihu paroxysmal ekwu. Ha ọkọnọ tachycardia, flushing, ọbara mgbali elu, na ndị ọzọ na ndiiche mgbaàmà. Ekemende akara arịa ọrịa. Asị ibe axonal mmerụ na-now so site muscle stiffness, discoordination, gipomimiya, oligofaziey, bradykinesia, discoordination, ataxia. Ọ bụ ugboro ugboro n'ihi ọrịa na-isi ọwụwa. Amalite ịzụlite emetic syndrome, e nwere ihe isi ike na tilt nke isi na ụkwụ extensions, e ikwesi olu ike uru. Ọtụtụ ndị ọrịa ji hyperthermia (cortical strok hụrụ si a zuru ezu nkọ na-abawanye na okpomọkụ) ptyalism, mụbara sweating. N'ihi ya, anyị nwere ike ikwubi na asị ibe axonal mmerụ akpalite irreversible enweghị nchịkwa Filiks ke idem.

nyochaa onye ọrịa

Asị ibe axonal mmerụ achọpụtara nanị site CT na MRI. A usoro ekwe ka ọmụmụ visual chọpụtara nke ndiiche na-abawanye na ahu hyperemia ma ọ bụ edema n'ihi mkpakọ nke ventricles. Dere na ndị ọzọ na aggravated mgbaàmà. Site n'enyemaka nke CT ọkachamara nwere ohere iji chọpụta ihe ndị na-adakarị picture na-eme ka a tentetivu amụma maka ọdịnihu. MRI egosi niile enweghị nchịkwa na mgbanwe, iwe na ele mmadụ anya n'ihu ma ọ bụ na ọtụtụ ọbara ọgbụgba na-eso asị ibe axonal mmerụ. N'ókè nke a enweghị nchịkwa ọnọdụ kpebisiri ike na-na ndabere nke magnetik resonance tomographic agụ. The results ekwe ịhọrọ ezigbo ọgwụ n'ihi ọrịa. Ọma chọpụta ihe na-adabere lumbar mgbapu. Nke a na usoro dị oké mkpa nke oge mbụ nchọpụta nke subarachnoid hemorrhage. Na nke a na mgbapu na-atụ aro predominance elu intracranial nsogbu. Nke a na usoro a na-contraindicated na ọrịa na intracranial olu Filiks na-eme ka ụbụrụ na eze.

CT na-eweta nnukwu oge

Agbasa axonal ụbụrụ mmebi ji a nnọọ na-abawanye na ngwa ma ọ bụ agafeghị oke olu. Ọzọkwa, mmachi a hụrụ, na ụfọdụ zuru ezu mkpakọ III na mpụta ventricles, olulu mmiri convexital isi na subarachnoid oghere. Mgbanwe anụ ahụ njupụta, dị ka a na-achị, nwere normodensitivnym agwa, ma pụrụ hụrụ abawanye ma ọ bụ ọnụ. Na-acha ọcha okwu, corpus callosum, na esiwe na subcortical owuwu na-emekarị hụrụ obere Baịbụl hiwere isi n'ebe hemorrhages. Biko mara na CT picture onye ọrịa nwere ike ịnọgide na-ahụ afọ nso nke ụkpụrụ. Dynamics ndị ọrịa gosiri a asị ibe axonal mmerụ nke ụbụrụ, ji mmepe nke atrophic usoro. Karịsịa, ọ na-kwuru ventriculomegaly, mgbasa convexital basal na subarachnoid oghere. Na n'oge ikpeazụ mgbe mmerụ (mgbe banyere 3-4 izu) na-hụrụ ìgwè cerebrospinal ọmụmụ na frontal ebe, interhemispheric fissure (ya ihu akụkụ akpan akpan). Ọ nwere ike na-ewepụ na N'ezie nke stabilization nke uche na akwara ozi ọnọdụ. Nke a bụ anọ na-egosi na mgbake olu mgbe ụbụrụ mebiri. Akpasasị uche ụbụrụ mmerụ na ụmụaka ndị ọzọ na-na mma karịa ndị toworo eto na-enye na ọgwụ.

Nchoputa nke CT

Dị ụkpụrụ pụrụ ịbụ Olee ihe enyemaka na-ekpe ikpe n'iru ma ọ bụ enweghị intracranial ọbara mgbali. Ọ bụrụ na CT na-adịghị sụgharịrị tank isi na ventricle, ma ọ bụ ugbu a bụ ngosipụta nke ha oké mkpakọ nke elu puru ich. Nke a pụrụ ịbụ nnọọ ihe ezi uche echichi nyocha intracranial nsogbu na ya ụdi mgbazi. Ọ bụrụ na ndị CT bụ doro anya na anya CSF outflow tract, karịsịa nke ventricle na olulu mmiri, ICP, dịcha n'ime onu. Ọ bụ eleghi anya na nke jikoro iji na ya Mbelata, ga-bara uru n'ihi na aja. Ọrịa gosiri a ịrịba osmotic homeostasis aghara mere site a bụ isi ma ọ bụ nke abụọ mmebi azuokokoosisi na hypothalamic-pituitary owuwu. Na ọrịa na-agafeghị oke hyperosmolar ala hụrụ ihe mma esi, na ihe akpọ ukwuu mgbe ọnwụ emee.

pathogenesis

Macroscopic nnyocha na-ekpughe dịghị anụ ahụ na-ebibi mgbanwe basal na elu na-ebupụta. N'otu oge ahụ na -acha ọcha okwu e nwere ebe nke miri ọnya. Ha nwekwara ike ahụrụ obodo hemorrhages dị iche iche ebe nke ụbụrụ. Ọ ga na-na-enyocha histologically. Ọ nwere ike ịchọpụta ọnụnọ nke "axonal bọọlụ." A ọcha mejupụtara ebe nke discontinuity na akwara endings. Ke adianade do, histological ule mata mgbanwe cylinders ebibi agwa abụrụ varicose thickenings. A ọnwa mgbe ofufe nke bọọlụ mmerụ ahụ na proliferation nke macrophages na mgbanwe mpaghara. Ọzọkwa mgbanwe ime na myelin n'ọbọ, ịnọgide na-enweghị nchịkwa na Filiks ke akwara ozi nke elu akụkụ nke ụjọ usoro. Ọzọkwa ịzụlite akwara na ọgidigi azụ emep uta eri.

Ọgwụgwọ: Isi

Ọrịa ndị gosiri asị ibe axonal ọjọọ, ọgwụgwọ na-kenyere a mgbagwoju na-agụnye ọtụtụ ụzọ. Karịsịa, ndị ọrịa mkpa ka o duzie ruo ogologo oge n'ibu ventilashion (ventilashion) ke agafeghị oke hyperventilation mode. E Kenyere multimodality ọgwụ gụnyere iji vasoactive ọgwụ ọjọọ na nootropics, ịnọgide na-enwe nkwụsi ike na metabolic Filiks iji na nyocha (enteral) na parenteral oriri na-edozi. Ịwa ahụ aka na-emekarị bụghị kenyere n'ihi na e nweghị mkpụrụ, nke a ga-ewepụ. Ịwa mkpachapụ expedient nchọpụta nke ndị ọzọ abnormalities na-enwe ọganihu na-enye elu nsogbu na ụbụrụ na ya mmiri. Ruru akwa omume nke extracranial nsogbu (akpa ume na pyoinflammatory, ọkacha mma) esịne ke ọgwụgwọ N'ezie nke antibacterial ọgwụ ọjọọ na immunocorrecting eme.

Atụmatụ ọgwụgwọ adọ

Ọrịa na asị ibe axonal mmerụ ahụ n'ụbụrụ n'ụlọ ọgwụ na a ọgwụ. The oruru nke mgbagwoju nke jikoro nke ọgwụgwọ na rehabilitative okike. Na atụmatụ, akpan akpan, ọ na-agụnye:

• Ventilator ịnọgide na-enwe anụ ọrụ nke akụkụ okuku ume na usoro.
• Tube nri.
• Kpụ ọkụ n'ọnụ na-elekọta na nkà mmụta ọgwụ.
• Ịnọgide na-enwe nkịtị ọmụmụ na electrolyte itule.
• Mgbe ụfọdụ, na ojiji nke neurotransmitters, na biogenic-akpali akpali.
• Therapeutic omume, akwalite resumption nke kwesịrị ịrụ ọrụ nke aka na ụkwụ, mgbochi nke ọrịa nke nkwonkwo.
• Speech ọgwụ sessions maka olu ọrụ stabilization.

Mgbe ọrụ na-achọ ọ bụghị a ngwa ngwa mgbake oge mgbe ogologo oge ụlọ ọgwụ. Iji nụ Central ụjọ usoro, ụbụrụ chefuo mkpọchị ọrụ, mee ngwangwa ijeụkwụ nke ghara ịgbanwe kwesịrị nhọpụta nke vaskụla na neuroprotective mmadụ. O nwekwara ike na-achọ na ojiji nke biogenic stimulants, ọgwụ ọjọọ na-emetụta anụ ahụ metabolism na, dị ka ndị na-egosi, neurotransmitters (pụtara "Madopar", "L-Dopa," "Lac" na ndị ọzọ), na anticholinesterase ọgwụ ọjọọ. Ọ bụrụ na DAP ọ dịghị mkpa maka nhọpụta nke mmiri ọgwụ ọgwụ.

ele ihe anya

The puru nke na-agwọ ọrịa na WCT ga-adabere na ịdị ukwuu nke mmebi axons, ọnụnọ nke edema, ekwe omume nke isonyere-enweghị nchịkwa na Filiks extracranial. Na-arụ dị irè mgbagwoju ọgwụgwọ adọ ná mkpirikpi oge mma pụta bụ yikarịrị. Na aka iso ogologo oge amaghị onwe enwekwu ihe ize ndụ nke nsogbu. Mgbe inyịme ọ enwekwu ohere nke oghom ga esi, karị, belata na-ekwe omume nke mgbake. Dịkwa mkpa bụ ịdị omimi na amaghị onwe ya. The arọ ya bụ, njọ na ya pụta. The isi ike-atụle ekwe omume nke zuru ma ọ bụ ele mmadụ anya n'ihu mgbake nke furu efu nke uche na ọrụ na nlaghachi azụ nke akwara ozi ọrịa, ọbụna mgbe nke mmebi ebe ndidi mgbe ogologo amaghị onwe kpụrụ vegetative ọnọdụ na-adịgide adịgide si a izu ole na ole ka ọnwa. Nke a na onu nwere ike na-egosi a likelihood nke reversibility na ụgwọ ọgụgụ akwara mbufe ozi na bughi ọrịa na underlie persistent disturbances nke ọtọ na-eme ụbụrụ mgbe agbasa axonal mmerụ.