ʻO ka hōʻeha lolo lolo

ʻO ka ʻehaʻeha traumatic (TBI) kahi pūʻulu o nā ʻeha pili o nā kino palupalu o ke poʻo, nā iwi o ka iwi poʻo, ka mea o ka lolo a me nā membrane, kahi kūlike i ka manawa a me hoʻokahi ʻano hana o ka hoʻokumu. ʻO nā ulia pōpilikia (trauma inertial) kahi kumu maʻamau. ʻOi iki ka pinepine, ʻo kahi ʻeha ka hopena o ka home, nā haʻuki a i ʻole nā ​​ʻeha ʻoihana. Hiki i ka TBI ke hoʻololi i kekahi hanana o ka ʻōnaehana waena: keʻokeʻo a me ka hina o ka lolo, nā aʻa a me nā kīʻaha koko, nā paia o nā ventricle a me nā ala wai cerebrospinal, e hoʻoholo ana i nā ʻano o nā ʻōuli e hōʻike iā ia.

Nā Diagnostics

Hoʻokumu ʻia ka hōʻailona ma muli o ka hōʻiliʻili o anamnesis (hōʻoia i ka ʻoiaʻiʻo o ka ʻeha), nā hopena o kahi noi neurological a me ka ʻikepili o nā ʻikepili mai nā hana noiʻi instrumental (MRI a me CT).

Hoʻokaʻina

No ka loiloi i ke koʻikoʻi o ka leona, hoʻohana ʻia ka Glasgow Coma Scale, i hoʻokumu ʻia i ka nānā ʻana i nā ʻōuli neurological. Loiloi ʻia ka pālākiō i nā helu, ʻokoʻa ka helu o 3 a 15. Ma muli o ka helu o nā helu, hoʻokaʻawale ʻia ka TBI e nā kekelē.

• maʻalahi - 13-15;
• awelika - 9-12;
• kaumaha - 3-8.

© guas - stock.adobe.com

E pili ana i ka pālākiō o ka hopena traumatic o TBI, hiki iā ia ke:

• kaʻawale;
• hui ʻia (me ka poino o nā mea ʻē aʻe);
• hui ʻia (me ka hopena ma ke kino o ke kanaka o nā ʻano traumatic like ʻole); hopena paha mai ka hoʻohana ʻana i nā mea kaua o ka luku nui.

I ke alo o ka poino i nāʻaʻa palupalu (kaʻili, aponeurosis, dura mater), ʻo kaʻeha:

• pani ʻia (CCMT) - ʻaʻohe mea e ʻike ʻia nā pōʻino.
• hāmama (TBI) - hōʻino ʻia nā ʻāpana palupalu o ke poʻo, i kekahi manawa me ka aponeurosis (hiki ke hele pū me nā haki o nā iwi o ka waihona a i ʻole ke kumu o ka iwi poʻo; ma ke kumu, e kī pū a i ʻole nā ​​pū ʻole);
• TBI o kahi ʻano penetrating - hana hewa ʻia ka pono o ka dura mater.

He mea weliweli kahi ʻeha craniocerebral paʻa no ka mea ʻo ka mea maʻi me ka ʻole o ka pohō ʻike ʻia keʻimi iki nei i ke kauka, me ka manaʻo kuhihewa "e maikaʻi nā mea āpau." ʻO kāna wahi ma ka ʻāpana ʻoi aku ka weliweli ma muli o ka wānana ʻia o ka wānana ma ka hope cranial fossa.

Mai ke kuhi o ke kaʻina manawa mai TBI, no ka maʻalahi o ka hoʻomohala ʻana i nā hana lapaʻau, he mea mau ke hoʻokaʻawale i ka pōʻino i nā wā (i nā mahina).

• huʻi - a i ka 2.5;
• waena - mai 2.5 a 6;
• mamao - mai 6 a 24.

© bilderzwerg - stock.adobe.com

I ka hoʻomaʻamaʻa kino

Hōʻoia ʻia nā hōʻeha lolo no:

Concussion (concussion)

Hoʻoholo pinepine nā ʻōuli ma waena o 14 mau lā. Hiki ke hele pū me ka pohō me ka hoʻomaka ʻana o kahi syncope mai kekona kekona a i 6 mau minuke (i kekahi manawa hōʻike ʻia ka manawa keu o 15-20 mau minuke), ukali ʻia e ka antegrade, congrade, a me retrograde amnesia. Maliʻa paha o ke kaumaha o ka naʻau (a i ʻole stupor). Hiki ke hele pū me ka concussion me nā maʻi o ka ʻōnaehana autonomic: nausea, luaʻi, pallor o nā membrane mucous hāmama a me nā ʻili, nā maʻi o nā ʻōnaehana puʻuwai puʻuwai a me nā ʻōnaehana hanu (nā loli pōkole i ka NPV a me ke kaomi koko). Hiki paha iā ʻoe ke ʻeha i ke poʻo a me ka puʻupuʻu, nāwaliwali maʻamau, ka hou clammy, a me kahi ʻano tinnitus.

Hiki i ka nystagmus me ka lawe ʻino ʻana i nā maka maka, asymmetry o nā tendon reflexes a me nā hōʻailona meningeal e kū ana i loko o 7 mau lā. ʻO nā haʻawina instrumental (MRI) me ka concussion ʻaʻole hōʻike i nā loli pathological. Hiki ke ʻike ʻia nā hoʻololi i nā lauana o ka lawena, ka hoʻohaʻahaʻa ʻike ʻana a me ka hōʻemi ʻana i ka hohonu o ka hiamoe no kekahi mau mahina.

Contusion (contusion)

Hōʻike pinepine ia iā ia iho e ka ʻōnaehana shock-counter-shock (me ka wikiwiki a me ka pāpā ʻana i ka neʻe ʻana o ka lolo ma muli o nā hopena kūwaho). Hoʻoholo ʻia nā hōʻailona maʻi e ka wahi o ka ʻeha a komo pū me nā loli noʻonoʻo. Hōʻoia ʻia ka Morphologically e nā hemorrhages intraparenchymal a me ka edema kūloko. Mahele ʻia i:

• Maʻalahi Hele pinepine ʻia me ka nalo o ka ʻike e mau ana i nā mau minuke he ʻumi. ʻOi aku ka nui o nā ʻōuli o ka cerebral ma mua o ka concussion. Hoʻohālikelike ʻia e nā maʻi vegetative i ke ʻano o ka fluctuations i ka helu o ka puʻuwai a hoʻonui i ke kahe o ke koko. Hoʻopau ʻia ka ʻōuli ʻōuli ma waena o 14-20 mau lā.
• Waena. Hoʻohui ʻia nā maʻi Vegetative e tachypnea a me ke ʻano subfebrile. Hōʻike i nā ʻōuli kikoʻī: oculomotor a me nā maʻi pupillary, paresis o nā ʻāʻī, dysarthria a me disesthesia. Hoʻomaopopo pinepine ʻia ka hoʻihoʻi hope ʻana ma hope o 35 mau lā.
• Kaumaha. I kekahi mau hihia, hele pū me nā haʻi o nā iwi o ka iwi poʻo a me nā hemorrhages intracranial. Māhele maʻamau nā haki o nā iwi fornix. ʻO ka lōʻihi o ka syncope mai nā hola he nui a i 1-2 mau pule. Hōʻike nui ʻia nā haunaele autonomic i ke ʻano o ka fluctuations nui i ke kahe o ke koko, ka puʻuwai, ka hanu a me ka hyperthermia. ʻOi aku ka nui o nā ʻōiwi. Hiki i nā ʻāpana. Lōʻihi ka hoʻōla ʻana. I ka hapanui o nā hihia, ʻaʻole piha ia. ʻO nā maʻi i loko o nā kaʻa a me nā ʻepekema noʻonoʻo, ʻo ia ke kumu o ke kīnā ʻole, hoʻomau mau.

Hoʻonui i ka ʻeha axonal

ʻO ka hōʻino i ka mea keʻokeʻo ma muli o ka ikaika hoʻopaʻa.

Hoʻohālikelike ʻia ia e ke koma kaulike a hohonu. Hōʻike nui ʻia ka maʻi ʻōiwi a me nā maʻi autonomic. Hoʻopau pinepine me ka decerebration me ka hoʻomohala ʻana o ka apallic syndrome. Morphologically, e like me nā hopena o MRI, hoʻoholo ʻia ka hoʻonui ʻana i ka nui o ka waiwai o ka lolo me nā ʻōuli o ke kaomi ʻana o ke kolu a me nā ʻaoʻao ʻaoʻao, subarachnoid convexital space a me nā ʻauwaha kumu. ʻO nā hemorrhages liʻiliʻi liʻiliʻi o Pathognomonic i ka mea keʻokeʻo o nā hemispheres, ke kupapaʻu callosum, nā subcortical a me nā ʻōiwi.

© motortion - stock.adobe.com

Kaohi ʻana

Hoʻokumu pinepine ʻia e ka hoʻomohala wikiwiki ʻana i ka edema cerebral a me / a i ʻole ke kahe nui intracranial. ʻO ka piʻi wikiwiki o ka kaomi intracranial me ka piʻi wikiwiki o ka focal, ka lolo a me nā hōʻailona cerebral. Hoʻohālikelike ʻia ia e ka "ʻāpana ʻūlū" - kahi piʻi o ke kaomi koko ʻōnaehana e kūʻē i ke kumu o ka emi o ka helu o ka puʻuwai. I ke alo o ke kahe intracranial, hiki ke hele pū me mydriasis homolateral. ʻO ka "scissors symptom" ke kumu o ka craniotomy pōpilikia i mea e hōʻemi ai i ka lolo. Hiki i ka hemorrhage intracranial e:

• epidural;
• subdural;
• subarachnoid;
• intracerebral;
• ventricular.

Kaukaʻi ʻia i ke ʻano o ka moku i hōʻino ʻia, he arterial a me ka venous lākou. ʻO ka weliweli nui loa ke kahe ʻana o ka aracial intracranial. ʻIke maikaʻi loa nā hemorrhages ma CT. Hāʻawi ka Spiral CT iā ʻoe e nānā i ka nui o ka hematoma intracranial.

I ka manawa like, hiki ke hoʻohui ʻia nā ʻano ʻeha like ʻole, no ka laʻana, contusion a me ka hemorrhage ventricular, a i ʻole nā ​​hōʻino hou i ka lolo i nā hana o ka meninges. Hoʻohui ʻia, hiki i ka ʻōnaehana kikowaena ke ʻike i ke koʻikoʻi i hōʻeha ʻia e ka trauma, haʻalulu CSF.

ʻElima kūlana o ka poʻe maʻi

I ka neurotraumatology, ʻelima mau kūlana o nā mea maʻi me TBI e ʻike ʻia.

Kōkua mua

Inā hōʻike ʻia kahi ʻāpana o ka nalowale o ka ʻike, pono i ka mea i hōʻeha ʻia i ka halihali pōpilikia i kahi haukapila, ʻoiai e hoʻopiha ʻia ka syncope me nā pilikia e weliweli no ke kino. Ke nānā nei i ka mea i hōʻino ʻia, pono ʻoe e hoʻolohe i:

• ke kū o ke kahe ʻana a i ʻole ka lama ʻino mai ka ihu a pepeiao paha (kahi ʻōuli o ka haki o ke kumu o ka iwi poʻo);
• ke kūlana o nā maka maka a me ka laulā o nā haumāna (myilriasis unilateral i hopena ʻia mai ka hemorrhage intracranial homolateral);
• nā palena kino (e hoʻāʻo e hoʻopaʻa i nā mea kuhikuhi i hiki):
  • ʻili o ka ʻili;
  • NPV (helu hanu);
  • Umi puʻuwai (puʻuwai puʻuwai);
  • HELE;
  • wela o ke kino.

Inā ʻike ʻole ka mea maʻi, i mea e hōʻoki ai i ka retraction o ke alelo a pale i nā pilikia hanu hiki. Inā loaʻa iā ʻoe nā mākau, hiki iā ʻoe ke hoʻolei i ka iwi ā lalo i mua, kau i kou mau manamana lima ma hope o kona mau kihi, a humuhumu i kou alelo me ka wili a hoʻopaʻa iā ia i ke pihi pālule.

Nā hopena a me nā pilikia

Hoʻokaʻawale ʻia nā pilikia mai ke kikowaena waena:

• maʻi lele:
  • meningoencephalitis;
  • encephalitis;
  • lolo abscess;
• maʻi lele:
  • aneurysms arterial;
  • malformations arteriovenous;
  • episyndrome;
  • hydrocephalus;
  • maʻi pale apallic.

Hiki ke kūlohelohe a paʻa paha nā hopena maʻi. Hoʻoholo ʻia e ka leo a me kahi o ka hoʻololi. Pākuʻi ʻia kēia mau mea:

• Nā hōʻailona cerebral nui - nā poʻo hina a me ka puʻupuʻu - i hoʻokumu ʻia e ka hōʻeha o ka loko o ka dura mater, ka hoʻololi ʻana o ka lole vestibular a i ʻole nā ​​kūkulu cerebellar, kahi piʻi mau o ka intracranial a me / a i ʻole ke kaomi koko ʻōnaehana.
• Ke kū ʻana o nā pathological dominants (overactivity o neurons) i loko o ka kikowaena nūnaehana ʻōnaehana, i hiki ke hōʻike he convulsive ka hopu ʻana (post-traumatic episodes of syndrome) a i ʻole nā ​​loli i nā ʻano hana.
• Nā ʻōuli i hoʻokumu ʻia e ka hōʻino ʻana i nā wahi e pili ana i ka motika, nā ʻano sensory a me ka noʻonoʻo.
  • nalo hoʻomanaʻo, disorientation i ka manawa a me ka hakahaka;
  • nā loli o ka noʻonoʻo a me ka hoʻolohi manaʻo;
  • nā ʻano maʻi like ʻole i ka hana a nā kānaka kālailai (e laʻa me, olfactory, ʻike a i ʻole auditory);
  • nā loli i ka ʻike o ka ʻike o ka ʻili (disesthesia) ʻokoʻa i ka wahi;
  • nā maʻi kūlike, hoʻemi i ka ikaika a me ke ʻano o ka neʻe, nalo o nā mākau ʻoihana i loaʻa, disphagia, ʻano like ʻole o ka disarthria (haʻi maʻi).

Hōʻike ʻia nā maʻi i ka hana o ka ʻōnaehana locomotor e ka paresis o nā ʻāʻī, ʻoi aku ka liʻiliʻi o ka plegias, me ka loli, ka hōʻemi a me ka nalo ʻana o ka ʻike.

Ma waho aʻe o nā pilikia i hoʻokumu ʻia e nā haunaele i ka hana o ka lolo, hiki i nā loli pathological ke ʻano somatic a hoʻopili i ka hana o nā mea kūloko ma muli o ka ʻaihue o ka loko. No laila, inā paʻakikī ka ale ʻana, hiki i ka meaʻai ke komo i loko o ka trachea, i hoʻopiha ʻia me ka ulu ʻana o ka pneumonia aspiration. ʻO ka hōʻino i ka nuklei o ke aʻa liʻiliʻi e alakaʻi i ka hoʻohaunaele o ka naʻau parasympathetic o ka puʻuwai, nā ʻōnaehana digestive a me nā gland endocrine, kahi e hopena maikaʻi ʻole i kā lākou hana.

Hoʻoulu hou

ʻO kahi kūpono kūpono o nā hana hoʻoponopono e hoʻopili pololei i nā hopena o ka mālama ʻana a me ke koʻikoʻi o ka deficit neurological post-traumatic. Lawe ʻia ka hoʻoponopono hou ʻana ma lalo o ka nānā ʻana a ke kauka e hele nei a me kahi hui o nā loea loea. ʻO ka maʻamau lākou: he neurologist, kahi therapist rehabilitation, a physiotherapist, an occupational therapist, a speech therapist a me kahi neuropsychologist.

Hoʻoikaika nā kauka e hana i nā kūlana maikaʻi no ka mea hoʻomanawanui e hoʻi i ke ola maʻamau a hoʻomaha i nā hōʻailona neurological. ʻO kahi laʻana, nā hana a ka mea hoʻoponopono ʻōlelo e hoʻoliʻiliʻi i ka hana haʻiʻōlelo.

Nā hana hoʻōla

• ʻO Bobath therapy - hoʻonāukiuki i ka hoʻoikaika kino ma muli o nā loli i ke kūlana o ke kino.
• Hoʻokumu ʻia ʻo Vojta therapy ma ka paipai ʻana i ka mea maʻi e hana i nā neʻe ʻana ma o ka hoʻoulu ʻana i kekahi mau ʻāpana o kona kino.
• ʻO ka Mulligan therapy kahi ʻano o ka manual therapy e kuhikuhi ana i ka hōʻemi ʻana i ka leo o nā mākala a me ka hoʻomaha ʻana i ka ʻeha.
• ʻO ka hoʻohana ʻana o ke kūkulu "Exart", kahi mea kaua i hoʻolālā ʻia e hoʻomohala i nā mākala hypotrophic.
• Ke hana nei i nā hana ma luna o nā pono hana cardiovascular a me kahi kahua paʻa i mea e hoʻomaikaʻi ai i ka hoʻohui ʻana o nā neʻe.
• ʻO ka hana ʻoihana kahi hoʻonohonoho o nā ʻenehana a me nā mākau e ʻae i ka mea maʻi e hoʻomaʻa i ka nohona kaiaulu.
• ʻO Kinesio taping kahi lālā o ka lāʻau haʻuki, i loko o ka hoʻopili ʻana o nā leki uila hoʻopili me nā olonā a me ka hoʻonui ʻana i ka maikaʻi o nā kuʻina muscle.
• Psychotherapy - pili i ka hoʻoponopono neuropsychological i ke kahua o ka hoʻoponopono hou.

Physiotherapy:

• lāʻau electrophoresis;
• laser therapy (loaʻa kahi hopena anti-inflammatory a regeneration-stimulate);
• ʻākehu.

Hoʻomaopopo-hoʻokumu lāʻau lapaʻau therapy:

• nā lāʻau nootropic (Picamilon, Phenotropil, Nimodipine) e hoʻomaikaʻi i nā hana metabolic i nā neurons;
• nā sedatives, hypnotics a me nā tranquilizers e normalize i ka psycho-ʻano kāʻei kua.

Wanana

Hoʻoholo ʻia e ka paʻakikī o TBI a me ka makahiki o ka mea maʻi. Loaʻa ka wānana maikaʻi o ka poʻe ʻōpio ma mua o ka poʻe kahiko. Hoʻonohonoho ʻike ʻia nā ʻeha.

• haʻahaʻa hoʻoweliweli:
  • ʻeha ʻeha ʻia;
  • haki nā iwi o ka iwi poʻo;
  • haʻalulu;
• kiʻekiʻe kamepiula:
  • kekahi ʻano o ke kahe intracranial;
  • kekahi ʻano o ka haʻi iwi poʻo;
  • poino ʻelua i ka waiwai o ka lolo;
  • poino me ka edema.

Hoʻoweliweli nā hōʻeha kūlana kiʻekiʻe ma ke komo ʻana o ka lolo (SHM) i ka foramen magnum me ka kaomi ʻana o nā kikowaena hanu a me nā vasomotor.

ʻO ka wānana no ka maʻi maʻa mau ka maikaʻi. Me ke kaulike a koʻikoʻi - loiloi ʻia e ka helu o nā helu ma ka Glasgow Coma Scale. ʻO nā kiko keu, ʻoi aku ka maikaʻi.

Me kahi kekelē koʻikoʻi, aneane mau ka deficit neurological, ʻo ia ke kumu o ke kīnā.

E nānā i ka wikiō: Lego Worlds - Rocket Ship Away! Worlds to explore. Part 1 KM+Gaming S01E30 (Nowemapa 2024).