Ukulimala ekhanda: ngezigaba. Shona ukulimala: izimpawu, usizo lokuqala kanye nokwelashwa

Ukulimala ekhanda, imiphumela okuyinto engase ihluke kakhulu (kuhlanganise nokufa) ingenye yimbangela ejwayelekile kakhulu abakhubazekile esemncane phakathi. Cishe ingxenye yabo bonke amacala kuhlasimulise nokulimala engqondweni. Ngokwezibalo, mayelana 25-30% azo zonke ukulimala akhawunti ukulimala kobuchopho. Ndawonye, akhawunti Kulezi zimo kwaphela isikhathi esingaphezu kwengxenye we nokufa. Kamuva esihlokweni kuyinto Ukwahlukaniswa ukulimala, incazelo ezinye zazo.

Uhlolojikelele

Obungapheli okulimala ebuchosheni libizwa umonakalo owenziwe amathambo skull noma izicubu zomzimba ezithambile. Lesi sakamuva, isibonelo, faka meninges, ekupholiseni izinzwa, imithambo yegazi kanye nezinye. Ukulimala ekhanda zihlukaniswe amaqembu amaningana. Ake sicabangele ezinye zazo ngokuningiliziwe.

Ukwahlukaniswa ukulimala

Umonakalo ungase uvuleke. Kulokhu, kubalulekile aponeurosis olimele futhi isikhumba. Njengoba phansi izenzo isilonda ithambo noma izicubu, okuyinto amanga kakhulu. Ifinyelela inhliziyo ukuhlukumezeka ukulimala libhekene laseDura. Njengoba udaba angabhekwa otlikvorreya ngenxa lapho eqondisa ithambo eliphukile ku isizinda Yekhanda. Kungenzeka futhi avaliwe ukulimala ekhanda. Kulokhu, isikhumba seyonakele, kanye fascia azigcina ubuqotho bayo. Futhi, kukhona amaqembu ezilandelayo:

• Ukundindizela. Lokhu ukuhlukumezeka ikhanda, okuyinto azinazo lezi zimpawu kwezinso ziphikelele ubuchopho. Zonke izenzo nesimo kwesikhathi (ngokuvamile izinsuku ezimbalwa) zinyamalale bebodwa. A izimpawu aphikelela iqhubeka, kukhona kakhulu ikhanda ukuhlukumezeka nge ukulimala kobuchopho kungenzeka. Lezi zindlela esiyinhloko Kuhlolwa kwesimo izenzo isikhathi uthuthumele (kusukela imizuzwana amahora) nokuba isimo nokujula kamuva beka ukulahlekelwa amandla okukhumbula kanye nokulahlekelwa ukwazi. Phakathi izimpawu ze-non-eqondile kufanele ukuhlanza, isicanucanu, ukuphazamiseka umsebenzi inhliziyo, blanching kwesikhumba kuphawulwe.
• Kokucindezela kwemizi okulimala ebuchosheni, emoyeni, nomzimba angaphandle, hematoma.
• ukopha Subarachnoid.
• Ekubhebhetselisa umonakalo axonal.

Ngo umkhuba, eqoshiwe eziningi ezimweni kuhlanganiswe. Kuhlanganiswe, isibonelo, kokucindezelwa kungaba hematoma futhi contusion contusion ne ukopha subarachnoid futhi kokucindezelwa, umonakalo ehlasela umzimba kanye nokulimala kwabanye. umonakalo ngokuvamile zenzeka ngenxa ukulimala ebusweni.

ubuchopho contusion

Kwenzeka ku isizinda wathola ukulimala ekhanda. Alimazayo kungukuphula ubuqotho ubuchopho izidakamizwa endaweni ethile elinganiselwe. Njengoba ungalindela, le esifundeni kwenzeka endaweni phoqelela uhlelo lokusebenza. Nokho, zikhona izimo lapho yayiyolimaza livela ngakolunye uhlangothi (kusuka protivoudara). On ngemuva kwalesi isimo ehlala ingxenye izicubu ubuchopho, imithambo yegazi, i-histological cell Abathandana ukwakheka alandelayo edema esibuhlungu. Le ndawo lezi izilonda kuyahlukahluka. Ikakhulukazi iyingozi kuyinto lokho kulimala ikhanda e ingane.

omnene

ukulimala ekhanda enjalo ebonakala nokunqamula ukwazi isikhathi esifishane - kuze kube amashumi amaningana of imizuzu. Ngemva kokuqedwa kwalo kukhona izikhalazo ejwayelekile ka isicanucanu. Futhi, ubuhlungu nesineke futhi isiyezi. Kungase kube ukuhlanza, kwezinye izimo ngokuphindaphindiwe. Kwezinye izimo, kukhona bradycardia ngokulinganisela - ukwehlisa izinga inhliziyo kuya ku-60 futhi esingaphansi komzuzu. Isiguli kungaba okuhlushwa, ukulahlekelwa amandla okukhumbula retro- futhi anterograde - inkumbulo ukungakhuli ngendlela ukulahlekelwa ikhono ukusindisa kanye nokudlala yolwazi atholwe ngaphambili. Ngemva omnene ukulimala ekhanda imakwe tachycardia (kwenyuke kwenhliziyo 90 bpm. / Min). Ezinye iziguli zingase ziphakamise ingcindezi. Kulokhu lokushisa lomzimba nokuphefumula kwezimila, ngokuvamile zihlala zinjalo. Ngokuqondene izimpawu zokungasebenzi kahle kwemizwa, izimpawu ngokuvamile umlingiswa lula. Ngokwesibonelo, isiguli bangezwa ubuthakathaka, ukozela, nystagmus clonic (biphasic Rhythmic ukunyakaza okungalindelekile of emehlweni). Kukhona anisocoria ezincane, izimpawu meningeal, pyramidal esingamahlalakhona. Lezi izimpawu zivame abaphindela ku ngesonto 2-3 emva wathola ukulimala ekhanda.

Izimpawu ukwephulwa

On ngemuva yokulimala itholwa microscopically kulimaze medulla ikhipha engazinzile. It kubonakala njengoba izindawo ukuvuvukala zendawo, ukulimaza iphuzu cortical, cishe ngokuhlanganyela elinganiselwe ukopha subarachnoid. It yena, kubangelwa ukudabuka izitsha pial. ukopha Subarachnoid lapho igazi lingena arachnoid futhi sisakazeka imithombo basal uqhekeke futhi imisele ingqondo. Kungaba wendawo noma ugcwalisa isikhala lonke lapho kumiswa amahlule. Isimo eba ngempela oyingozi. kungazelelwe Isiguli uzizwa 'sishaye ekhanda ", ngokushesha livela photophobia, ukuhlanza, ubuhlungu bekhanda kakhulu. Cishe okuphindaphindiwe Ukudlikizela generalized. Ngokuvamile lesi simo ngeke ephelezelwa ukukhubazeka. Nokho, izimpawu okungenzeka meningeal. Ikakhulukazi, kungaba khona imisipha Intamo yayo iqina (i-ukuthambekela ikhanda akamthinti lesiguli sternum kwesilevu) futhi ukuhlelwa uphawu (ayikwazi ukwenza ngendlela qondanisa bend amadolo kuwo futhi hip umlenze). Uma kukhona izimpawu yokucasuka meningeal kwenzeka meninges kusakazwe igazi.

ukulimaza ngokulinganisela

Lokhu ukulimala ekhanda elinesimo ukuvala shaqa isikhathi eside ukwazi (amahora ambalwa). Isiguli has a ukulahlekelwa amandla okukhumbula emakiwe. Kukhona futhi izimpawu wathola ukulimala ekhanda ezilandelayo: ubuhlungu bekhanda ukuhlanza okuphindaphindiwe, okuthile engqondweni. Cishe thuthuva lezivakashi e imisebenzi ebalulekile. Ikakhulukazi, kungaba imakwe bradycardia noma tachycardia, yokucindezeleka okwandayo, tachypnea (ukuphefumula okusheshayo izindlela engajulile ngaphandle yokwephula rate permeability), ongaphakeme-ebangeni imfiva (lokushisa lomzimba luyanda 37-37.9 deg.). Njalo kukhona stem igobolondo izimpawu of dissociation ka ikhaliphe umsipha imisipha ithoni, zamazwe amabili ukubonakaliswa sokugembula. Ingabe izimpawu ngokwanele ecacile eqondile. uhlamvu wakhe kubangelwa kwasendaweni umbhalo wokulinyazwa. Found oculomotor futhi pupillary neziyaluyalu, inkulumo neziyaluyalu, ukuzwela, paresis wemikhawulo nezinye. Lezi izimpawu ngaphakathi emavikini amathathu noma amahlanu, kancane kancane esehlelembe, njengoba umthetho. Nokho, kwezinye izimo, echazwe isithombe emtholampilo igcinwa isikhathi eside ngokwanele. Lapho ukulimala kobukhulu ngokulinganisela ngokuvamile atholakala waphuka e amathambo base futhi calvarium, ukopha olunzulu subarachnoid. CT izinguquko ebalulekile itholwa njenge inclusions emihle noma Isidlulisilwazi eyohlobo ngokulinganisela ukwanda kwabantu. Lokhu kulingana ukopha okuncane endaweni yokulimala noma oluhambisana impregnation kwezicubu ingqondo ngaphandle nokucekelwa okwedlulele.

Sinzima ukulimala ekhanda

Kulokhu, hematoma intracerebral ebonwe kokubili iyizingxenye engaphelele njengoba kungagcini igazi lokuhlala at izilonda ahlukahlukene semithambo ukudabuka. Loku umgodi equkethe igazi coagulated noma uketshezi. Ukulimala e ezinzima libhekene ukuvala shaqa nokunwetshiwe ukwazi (amasonto ambalwa). Ngokuvamile wawubona motor excitation. Futhi imakwe iziyaluyalu imisebenzi ebalulekile emzimbeni. Nokho, uma iqhathaniswa nayo ngezinga isilinganiso in esindayo, zingabantu evelele. Ngokwesibonelo, kukhona ukuphazamiseka umsebenzi zokuphefumula ephula amathrekhi isigqi sezwe. Isiguli is baphawula pyrexia, ukubusa stem oyinhloko izimpawu zokungasebenzi kahle kwemizwa. Ikakhulukazi, akhonjwe nokugwinya neziyaluyalu, ukunyakaza kwamehlo, ptosis, noma mydriasis, paresis amehlo, rigidity decerebrate, ukunyakaza, ukukhula noma okusithiyayo of ingqondo, nolwelwesi lwamafinyila, isikhumba, imisipha nokunye elintantayo. izimpawu zokungasebenzi kahle kwemizwa esikhathini sokuqala (phakathi kwamahora wokuqala noma izinsuku) obusa izimpawu ebalulekile hemispheric. Isiguli bangezwa esitho paresis, iziyaluyalu subcortical kwemisipha ithoni, nokunye. Kwezinye izimo, kungenzeka Focal noma generalized nokuquleka. Regression ukubonakaliswa ebalulekile zenzeka kancane ngokwanele. Ngengozi onjalo ukulimala ekhanda? Imiphumela ingase ibe mibi kakhulu. Ngokuvamile lapho ibhalwe imiphumela asalile, ikakhulukazi emkhakheni engqondo motor.

izinkomba CT

Ngo yokulimala e okwesithathu amacala ezibikwa kusukela izilonda ebalulekile ebuchosheni ngesimo non-iyunifomu kwabantu ezindaweni ukwandisa. Kulokhu, kukhona ngaphakathi alternation of esishintshashintshayo. izindawo abelwe nge high density futhi ongaphakeme. Esikhathini isimo esibi kakhulu ekubhujisweni iqondiswe medulla futhi ingafinyelela ezijulile ohlelweni ventricular kanye nuclei subcortical. Dynamics kokuma ubonise ukwehla kancane kancane ezindaweni uphawu, Fusion yabo kanye nenguquko ibe mass homogeneous. Senziwa 8 noma 10 amahora ngemuva kwesigameko. Regression sokugembula substrate ozungezayo umphumela kancane, okubonisa khona-non-resorbed amahlule sephulwe asesibelethweni focus yokulimala. Kuleli qophelo, ziba kuqhathaniswa ravnoplotnymi ezizungezile edematous ubuchopho izidakamizwa. Ukunyamalala emva kwezinsuku 30-40. ivolumu umphumela kubonisa resorption kanye kumiswa substrate esikhundleni izindawo yoma noma izimbotshana fibrosis.

Ukulimala posterior fossa izakhiwo

Lokhu lesion ubhekwa the ezinzima kunazo zonke ukulimala ekhanda. Ukuze isimo libhekene zimpawu ezilandelayo: ukucindezeleka ukwazi futhi inhlanganisela yalokhu stem, cerebellar, palsy futhi izimpawu meningeal ngenxa okusheshayo kokucindezelwa nophuzo kwegazi iziyaluyalu.

izinyathelo zokwelapha lapho ukulimala

Kungakhathaliseki ubukhulu ukulimala, ukunakekelwa kwezempilo nesineke kumele inikezwe. Uma kwenzeka yokulimala ekhanda lohlaselwayo uyiswe esibhedlela ngokushesha ngangokunokwenzeka. Ukuze uthole ukusazi ngokunembile isifo esikuphethe libonisa ze-X ray nakuma-CT. Isiguli kudingeka embhedeni ukuphumula. ubude bayo ne omnene - izinsuku 7-10, nge-avareji -. ezingu-14. Endabeni ezinzima kuhlasimulise nokulimala engqondweni kufanele kuthathwe yokusiza umuntu ukuba aphefumule. Baqala emuva kwesikhathi nemibandela engaguquki-state baqhubeka zangaphambi esibhedlela. Ukuze kulesetayelekile ukuphefumula kuyadingeka ukuqinisekisa khulula unqamule izwe phezulu ipheshana zokuphefumula - ukukhulula nabo kusuka isikhwehlela, igazi, ebuhlanzweni. Sethula uvule imbobo emoyeni, a tracheostomy wenziwa (izicubu asike izidumbu zabantu kanye kuqhoqhoqho ukufakwa cannula noma ukwakha izimbobo okuqhubekayo - stoma). Futhi esetshenziswa ephefumula usebenzisa Oxy emoyeni ingxube. Uma kudingekile, faka i-ukupholisa lokukhanda.

Ukwelashwa ukuxukuzeka

Uma kunqunywa ukuthi isiguli wathola ukulimala ekhanda, ukwelapha kufanele kwenziwe esibhedlela neurosurgical. Lapho ukuxukuzeka libonisa ezinhlanu embhedeni ukuphumula. In the ukungabikho yezinkinga kungenzeka isiguli angakhishwa ngosuku 7-10. It inikezwa ukuphathwa sinenkonzo yokunakekela iziguli emakhaya, isikhathi lapho - kufikela kuzinsuku ezingu-14. lokwelashwa ukuxukuzeka kuhloswe ezibangela ukuzinza isimo sokusebenza kobuchopho, ubuhlungu ukuphathwa, ukuqwasha, ukukhathazeka. Ngokuvamile, imithi ibanga kuhlanganisa hypnotics, sedatives futhi analgesics. Njengoba analgesics wasebenzisa izidakamizwa ezifana "Baralgin" "Pentalgin" maksigan "" sedalgin Reglan "nabanye. Kusho ingase yabelwe ngoba isiyezi." "Ukuze sedatives zihlanganisa imithi efana" Valocordin "" Corvalol " kanye nezinye phenobarbital equkethe. Sebenzisa infusions herbal (motherwort, valerian).

Kunconywe njengoba zinhlungu. Lezi zihlanganisa, isibonelo, zihlanganisa ejenti ezifana "Rudotel", "Nozepam", "Phenazepam", "Sibazon", "elenium" nabanye. Ngaphezu lingaze ukwelashwa esimisiwe Course umzimba kanye nokwelashwa semithambo. Lokho kwenza ukubuyiselwa ngokushesha futhi ephelele siyabhubha ekusebenzeni kobuchopho, kuvimbela izimpawu ezihlukahlukene postkommotsionnye. Ukuqokwa tserebrotropnoy nokwelulekwa vasotropic kungenzeka emva kwezinsuku 5-7 emva ukulimala. Advantageously inhlanganisela nootropic (izidakamizwa "Pikamilon" "aminolone", njll) kanye vasotropic (imithi "Teonikol" stugeron "" Cavinton ") lisho ukuba banqobe ukubonakaliswa asthenic iziguli babelwa Vitamin izakhiwo." Centrum "" Complivit "" . Vitrum "nabanye Kunconywe tonics: Schisandra izithelo akhiphe Eleutherococcus, . ginseng impande kufanele kuphawulwe ukuthi Shake ayibonakali iyiphi lesion organic Uma kukhona izinguquko ku-MRI noma-CT scan, kubalulekile ukukhuluma mayelana sina ngokwengeziwe. e ukulimala - okulimala ebuchosheni.

kokungenela op

ukulimala Mechanical kudingeka uhlinzwe. Ukuhlinzwa kuvezwa esimweni wayichoboza ukulimala izicubu ingqondo. Ngokuvamile, ezifana ukulimala mechanical zenzeka isigxobo yesikhashana futhi endaweni iyizingxenye engaphelele. Njengoba inqubo yokuhlinza ukhonza trepanation osteoplastic. Lo msebenzi ukwakha emigodini ithambo ukungena ngalo ingaphakathi futhi detritus isixazululo leaching of sodium chloride (0.9%).

ukuba nombono ongafani ngeke

umonakalo Ezintsha ngokuvamile umphumela ngempela evumayo (ngoba kuhambisana nezincomo isiguli mayelana nokuphathwa kanye therapy). Ngezinye isimo ngokulinganisela ngokuvamile kungenzeka kute kuzuzwe kubuyela ngokuphelele kanye nokubuyiselwa umsebenzi social nomshikashika izisulu. Ezinye iziguli zingase zibhekane meningitis iphimbo, ingqondo asthenia, ukungasebenzi semithambo, ubuhlungu, izinkinga kokuxhumana, static nezinye izimpawu zokungasebenzi kahle kwemizwa. Against ngaphansi kwesimo yokulimala e 30-50% of amacala ukufa kwenzeka. Phakathi kwalabo abasinda kuyinto ukukhubazeka evame kakhulu, okuyizinto kwezimbangela eziyinhloko yezifo zengqondo, inkulumo ongahluziwe kanye motor thuthuva, nokuquleka. Ngo ukulimala evulekile ikhanda kukhona yezinkinga ukuvuvukala Cishe. Ikakhulukazi, ingozi enkulu yokuba a ithumba ubuchopho, ventriculitis, encephalitis, meningitis. Futhi kungenzeka liquorrhea emelela outflow ka cerebrospinal fluid (CSF) kusukela yemvelo noma izimbobo kwakheka ngenxa izici ezihlukahlukene emathanjeni yomgogodla ugebhezi. Half of the Abashona ekhanda ukulimala zaba (RTA) izingozi emigwaqweni.