Masero uye nzvimbo inopindira yenhengo huru inodzora yenheyo yenheyo inogona kuunganidza mvura. Izvi zvinokonzera kukudzidzira kana kuputika kweuropi, izvo zvinoita kuti kuwedzerwa kwehuwandu hwacho uye kuwedzera kwekusagadzikana kwepfungwa . Ichi chiitiko chinonzi chiitiko chinotyisa zvikuru chinoda kurapwa nokukurumidza.
Edema wehuropi - marudzi
Kuenzanisa kwechirwere chinotaridzika kunobva pane nzira dzekubva kwayo nekuyerera kunotevera. Pano pane cerebral edema yemhando idzi:
- vasogenic;
- cytotoxic;
- interstitial;
- osmotic (filtration).
Uyezve, cerebral edema inogona kusiyanisa zvichienderana nezvikonzero zvekuumbwa kwayo:
- ronda;
- dambudziko;
- kupisa;
- toxic;
- postoperative;
- hypertensive;
- ischemic uye zvimwe zvakasiyana.
Vasogenic cerebral edema
Pakati pehutachiona uye hutachiona hwehutachiona hwepakati pane chipingamupinyi chepanyama - ropa reuropi-bongo (BBB). Nekubatsira kwayo, mvura inogadziriswa munzvimbo ye intercellular inotongwa. Sezvo kuora kweBBB kuwedzera, vasogenic brain edema inowanikwa. Izvo zvinowanzopikisana nechekuita kwekuputsa kwekutevera:
- cold trauma;
- matumbo;
- gesi uye microembolism yemidziyo yeropa;
- eclampsia;
- occlusion carotid arterium.
Cytotoxic edema yeuropi
Mitsara inogona kuve nehuipi inouraya (kunze kana mukati), tanga kuita zvisakarurama. Kusvibiswa kwavo uye kuperevedza kwemuviri kunoshanduka. Tisue inogadzirisa mvura uye inoita cytotoxic edema kana kuvhara. Iyi maitiro ehutano inowanzoonekwa mushure mekurohwa uye kudhakwa kwakanyanya, asi inodzokororwa mukati maawa matanhatu ekutanga.
Interstitial cerebral edema
Muchikamu chikuru chegadziriro yenyika, chirwere chemvura chinonzi cerebrospinal fluid kana cerebrospinal fluid inofamba nguva dzose, kunyanya mumhepo. Apo kushungurudzika mukati mavo kwakanyanyisa uye kunomuka zvakasimba, kune dema iri mukati meuropi. Mamiriro ezvinhu anorondedzerwa anokonzera kuregererwa kwemasukisi newedzerwa kudhakwa. Somugumisiro, masero anowedzera mumavhu uye anorema.
Osmotic cerebral edema
Chero chero mvura inenge ine zvinyorwa zvinoputika mairi. Nhamba yavo mu 1 kg yehutu hunonzi osmolarity. Kazhinji, chiratidzo ichi chemaplasma uye nhengo inodzora yenheyo yenheyo inenge yakafanana. Kana hyperosmolarity (yakakwirira kwazvo) ye "gorozi" inowanikwa, kufungidzirwa kwehupfungwa hwemauropi inotangwa. Nemhaka yekuwedzera kwehuwandu hwezvimwe zvikamu mumuchengetedzo wemvura, mavara acho anowanzoderedza kusungirirwa kwawo, uye inotora mvura kubva mu plasma. Utano hwakadaro hwehuropi hunonyorwa nehutachiona hunokwana encephalopathies. Inowanzokonzera hyperglycemia, renal uye hepatic insufficiency.
Cerebral edema - zvinokonzera
Chinhu chinonyanya kukosha chinokonzera kusagadzikana mubvunzo ndechekuti:
- kusimba kwehutachiona (strokes);
- kupindira kwekuvhiya;
- kudhakwa kwakakomba, kunosanganisira doro rinodhaka;
- vanaphylactic reactions pamusoro pemamiriro ekurwara.
Pane zvikonzero zvishoma zvakajairika zvinotsanangura zvinokonzera huropi huputika:
- zvironda zvekenza uye metastases;
- kuputsika kwemapfupa e-cranium uye nheyo;
- kubhadharwa renal, hepatic, heart failure;
- meningitis ;
- brain upusion ;
- post-traumatic intracranial hematomas;
- kuderedza axonal kukuvara;
- meningoencephalitis;
- toxoplasmosis ;
- subdural empyema.
Edema yeuropi mushure mekurohwa
Kuvhiringidzwa kweropa kupararira mukati memutumbi wepakati yenheyo inotanga nekuvhara kwechikepe ne thrombus. Zvishoma nezvishoma, mishonga yacho inogamuchira oxygen shoma, ndicho chikonzero yavo yenzara yenzara inowedzera. Maseji anofa uye achinyatsopinza mhepo ipi zvayo, pane ischemic edema yeuropi. Mune zvimwe zviitiko, chirwere chemagetsi chinowedzera pamberi pe-thrombus chinogona kuputsa masvingo. Ichi chinoshamisa chinowedzera cerebral edema muchirwere, nokuti mishonga mushure mokunge hemorrhage inowedzera kunyanya kunyorova. Izvi zvakasiyana-siyana zvekudzivirira kwekamuri zvinonzi ndezvakaipa zvikuru.
Edema yeuropi mushure mekuvhiyiwa
Pathology nguva dzose inofambidzana nekupindira kwokuvhiya munzvimbo yehenya. Muzviitiko zvisingawanzopikisana uye zvakasangana nemamwe maitiro, pane cerebral edema - kushanda kwakaitwa uchishandisa epidural anesthesia, kana kuwedzerwa kushandiswa kwe hypotonic uye saline solutions mukati. Dzimwe nguva kubwinya kwemasero kunoitika nekuda kwezvinetso zvekupindira kwekuvhiya:
- kurasikirwa kukuru kweropa;
- Kusina kujeka kwekutsvaga kwetrachea kwekudzivirira mafomu;
- kuramba kwenguva refu uye kutumidzwa kuderera kweropa;
- zvisina kururama kuverengwa anesthesia.
Inodhaka yeodema yeuropi
Kuwedzerwa kwehuwandu ethyl doro mumuviri kunotungamirira kuhutu hwakaipa. Zvinodhaka zvinowanzoonekwa kuti zvine cerebral edema - zvikonzero ndezvekudhakwa kwemasero kwenguva yakareba, nekuda kwezvisingabvumirwi kushandiswa kwemagetsi uye kushanda. Zvinhu zvinokuvadza zvinopisa unyoro, zvichiita kuti kuve nokudzika uye kuwedzera. Uropi hwekudzimba hunoitawo hunhu hwehupfu hwemwe zvinhu:
- inouraya makemikari akabatanidzwa;
- zvinodhaka;
- gasi dzine chepfu;
- mishonga.
Edema wehuropi hwemagetsi
Kupindura kwakakwana kwemuviri wezvirwere mumuviri kunokanganisa kune vamwe vanhu kunosangana nevanaphylactic shock. Mumamiriro ezvinhu akadaro, icho chinokonzera uropi hwemauropi isinganzwisisiki. Mukurwisana nechekupedzisira kwe hypersensitivity, kuwedzera kweropa kunopera mumuviri wose kunoderera zvakanyanya, kuwedzera kweropa kunowedzera kuderera uye kuparara kunowedzera. Nokuda kwekushayikwa kweropa rakakwana kune zvivako zvakakosha, gorofu masero masero anonwisa mvura uye anozvimba.
Kukurira kweuropi - zviratidzo
Chirwere chemakiriniki chinorondedzerwa chirwere chinogara chichienderana uye hachibvi pamigumisiro yaro kana pane nzira dzekusimudzira. Kune ma 3 mapoka ezviratidzo zvinoratidza uropi hwemhemberero - zviratidzo zvinogoverwa mumhando dzinotevera:
- Syndrome of intracranial hypertension. Pamusana pokuputika kwemasumbu, huwandu hwavo hunowedzera. Kusviba kwakanyanya mujecha kunounza kuwedzera kwakasimba mukumanikidza. Izvi zvinokonzera kushungurudzika, chisimba uye chisingaregi musoro musoro, kushambidzika kusingabviri. Kana kuvhara kweuropi kuchienderera kwenguva yakareba, pane kuwedzera kwekuziva.
- Focal kliniki zviratidzo. Kuvhurika kwemashuini mune dzimwe nhengo dzenheyo yenheyo yenhengo yekudzora kunokonzera kukanganisa kwemabasa avo chaiwo. Somugumisiro, kuora mitezo, kuonekwa, kutadza kutaura, kutadza kuwirirana kwekutama kunoonekwa. Dzimwe nguva murwere haakwanisi kuita zvakanyanya basa rekutya uye ari mukutadza kuziva.
- Simba zviratidzo. Kuzvimba-kuputika kweuropi kunogona kutungamirira kushanduka kwezvimwe zvivako zvenhengo, kufambisa kuwedzera kwezviviri zvemasukisi emunharaunda iri pedyo nekuguma nemidziyo yeropa. Mukurwisana kwezvakaitika zvezviitiko zvakadaro kune kuputsa kwemwoyo uye kupumha kwemaitiro, kuwedzera kwekupararira kweropa, kudzvinyirirwa kwepupillary reaction uye zvimwe zvirwere zvinopisa upenyu.
Cerebral edema - kurapwa
Zvisina kumira zvakajekesa chirwere chechirwere, somuenzaniso, mushure mekugunun'una kana kukuvara kwechidiki, hachidi kurapwa kwakakosha. Zvimwe zvakasiyana-siyana zvekudzimba kwemashupu zvinopfuurira zvakasununguka kwemazuva 2-4. Hospitalization inofanirwa kana chirwere chedema chichifambira mberi - kurapwa kwezvinhu zvakakomba uye zvinotyisa zvehutano zvinowanikwa muchengeti rekuchengetedza.
Icho chinangwa chikuru cherapi ndiyo yekusimudzirwa kweperebral perfusion pressure (CPD). Inokonzerwa neropa, kugoverwa kweokisijeni nemuviri kunyanzvi. CPR ndiyo musiyano pakati pezvinoreva kushandiswa uye chiyero chekushanda uye chepakati pezvinokonzera mhepo. Zvimwe zvekuita mabasa:
- kubvisa kukanganiswa uye motokari kuwedzerwa;
- kuchengetedza kutonhora kwemuviri;
- Kudzorerwa kwemapapu uye moyo wemabasa;
- kumira kwehuropi hwakaora;
- kubviswa kwezvikonzero zvinodzivisa kuputika kweropa rinobva mumugwagwa wakaoma;
- kurasikirwa nekudzivirira zvirwere zvinorwadza;
- kubviswa kwehuwandu hwehutachiona kubva mumatumbu.
Edema yeuropi - rubatsiro rwekukurumidzira
Varwere vane chirwere ichi chinonyanya kuonekwa vanofanira kupedzisira vasunungurwa.
Kutanga pre-kuchirapa:
- Kana uchinge wawana zviratidzo zvehutachiona edema, pakarepo udane boka rechiremba.
- Isai munhu akabatwa panzvimbo yakanyanyisa.
- Ipa mweya wakachena.
- Kana pane kurutsira, dzorera musoro wemunhu kudivi.
- Usasunungura kana kubvisa kubvisa nguo.
- Kana ukakunda, nyatsobata musoro nemakumbo omurwere, kudzivirira kushandiswa kwepakuvadzwa nekukuvadzwa.
Edema wehuropi - zvinodhaka
Kurapa kwemahydration kunoshandiswa kubvisa kuwedzera kwechirwere kubva mumasero uye muhutu hutachiona. Kana chirwere chakakomba chinonzi cerebral edema chinowanikwa kune vanhu vakuru, kushandiswa kwemasimusi ye osmotic diuretics inotanga kunyorwa nerubatsiro rwechidonho - Mannitol, Albumin uye zvakafanana. Mushure mokuzorodzwa kwemamiriro akaoma omurwere anotumirwa ku loop diuretics:
- Torasemide;
- Furosemide ;
- Toradiv;
- Lasix;
- Toraz;
- Britomar;
- Trigrim;
- SutrilNEO;
- Torsid;
- Diver;
- Trifas uye vamwe.
Kana kupindira kwepachirwere kuchikwirira uye hazvibviri kubvisa cerebral edema nemishonga yakanyorwa, ventriculostomy inokurudzirwa. Iyi inopindira yekuvhiya iyo inokubvumira kuti ubvise zvinodhaka zvakanyanya kubva mumatumbu. Nzira iyi ndiyo kuiswa kwe cannula (hollow thick needle) mune imwe yevhirikiri yeuropi kuitira kugadzira mvura. Kutarisa kwakadaro kunopa hurumende yekusimudzirwa kwekumanikidza uye kubuda kwemvura yakawandisa.
Pamusoro penhepfenyuro yekudzimba, hypoxia inowanzoitika. Oxygen therapy inoshandiswa kumisa oksijeni nenzara uye kudzorera basa rokufema. Kusiyana kwakanyanyisa ndiko kushandiswa kwemasikisi chaiwo nehuwandu hwegesi yakawanda. Mumakiriniki emazuva ano oxigenobarotherapy inoshandiswa - kuisa murwere mune imwe nzvimbo yepamhepo yemhepo yakawedzera oksijeni yezvinokonzera. Muzviitiko zvakakomba, kuputika kwemajini kunoitwa nokukurumidza.
Kuvandudza hutachiona hwemagetsi uye kusimbisa mabasa emasero europi, kugadzirisa kwemukati kwekudzivirira uye kushandiswa kwezvinodhaka zvinogadzirisa zvinoshandisa zvirongwa zvemagetsi zvinoshandiswa:
- Cortexin;
- Armadine;
- Mexidol;
- Citicoline;
- Antifront;
- Elfoon;
- Mexiprim;
- Venocor;
- Nikomex;
- Mexmidol;
- Dinari;
- Mixed;
- Neurotropin-Mexibel.
Kuzvimba-kuputika kweuropi kunofambidzana nekugadzirisa kwemasero memasero uye kuderera kwemasvingo emasisita. Kutsungirira nezvinetso izvi kubatsira glucocorticosteroid hormones:
- Hydrocortisone ;
- Depos;
- Prednisolone;
- Celeston;
- Betaspan;
- Diprospan;
- Lauracort;
- Betamethasone;
- Flosteron nevamwe.
Kuti kugadzikana kwehutano hweropa kunogadzwa:
- Dibazol;
- Eufillin ;
- Pentamine;
- Azamethonium;
- Papaverine uye zvakafanana.
Varwere vazhinji vanoda hutungamiri hwehutano hwepfungwa. Nechinangwa ichi, zvinotevera zvinoshanda:
- Droperidol;
- sodium oxybutyrate;
- Diazepam.
Kudzorerwa kwehutachiona hwehutano hunoendeswa neangioprotectors, hemostatics, antiginoxants, proteolytic enzyme inhibitors nemamwe mapoka emishonga, anosanganisira zvinotevera:
- Dicycin;
- Actovegin ;
- Piracetam;
- glutamic acid;
- Tracerol;
- Contrikal;
- cytochrome C.
Dzimwe nguva zvakakosha kushandisa antibiotics, kunyanya cephalosporins ine maitiro akawanda:
- Cefepime;
- Cefuroxime;
- Cefazolin;
- Cefadroxil;
- Ceftriaxone uye zvakafanana.
Cerebral edema - migumisiro
Muzviitiko zvisingawanzoitiki, vanachiremba vanogona kubvisa zvachose kubwinya kwemasukisi. Uropi hutema hunowanzoomerwa - mhinduro:
- kukanganisika kwepfungwa;
- kusanganisa kugadzirisa;
- kupora muviri uye paresis;
- kuremara (kunobva pane zvikamu zvakakanganiswa zveuropi);
- kudodzwa;
- kushushikana kwehope;
- kuora mwoyo;
- zvinetso zvekuyeuka;
- asingagumi musoro;
- kuwedzera kusagadzikana uye kuwedzera kwepfungwa;
- kukanganiswa kwemajini.
Edema yehuropi - chirevo chehupenyu
Iyo yakaongororwa chirwere ichi inokura zvakakurumidza, zvinogona kuidzikisa pasina zvinetso chete nehupfu hwekudzivirira kwemasumbu mune vanhu vaduku uye vane utano. Mune dzimwe mamiriro ezvinhu, pane zviitiko pashure pekushaya cerebral edema yekusiyana kwakanyanya. Izvo zvinotaridzika zvinoenderana nehuwandu hwenhengo inoparadza, madhipatimendi akabatwa uye kuoma kwematambudziko anokonzera. Mune mamiriro ezvinhu akawanda, kuzvimba kweuropi kunokonzera matambudziko asingagadziriswi, dzimwe nguva kupfugama kunotungamirira kurufu rwemunhu.