Ukulimala Head: yokuhlela. ukulimala Head: iimpawu, uncedo lokuqala kunye nonyango

ukonzakala entloko, imiphumo apho inokuba nomahluko kakhulu (kuquka nokufa) yenye nobangela uqhelekileyo ukukhubazeka ebudaleni abatsha ophakathi. Malunga nesiqingatha zonke iimeko yokwenzakala kwengqondo esibuhlungu. Ngokutsho manani, malunga 25-30% yazo zonke ukwenzakala akhawunti ngenxa yomonakalo engqondweni. Kunye, ezi meko akhawunti ukuba ngaphezu kwesiqingatha yokufa. Kamva kweli nqaku kucalulo yokwenzakala, inkcazelo ezinye zazo.

Overview

nokulimala engqondweni traumatic ibizwa umonakalo ithambo ukakayi okanye inyama ithambile. Le yokugqibela, umzekelo, kuquka meninges, imizwa, imithambo yegazi kunye nezinye. ukulimala bohlulwa babe ngamaqela eziliqela. Makhe sihlolisise ezinye zazo ngokweenkcukacha.

ngezigaba yokulimala

Umonakalo kungaba avulekile. Kulo mzekelo, oko aponeurosis owenzakeleyo nesikhumba. Njengoko emazantsi izenzo inxeba njengoko ithambo okanye izihlunu, leyo ibuthe ngaphezulu kakhulu. Gaze ukwenzakala labagula ebonakala laseDura. Njengoko kwimeko ethile kungathathwa otlikvorreya ngenxa thambo ezophukileyo Amaza. Ngamana ukwenzeka ezivaliweyo ekhanda. Kulo mzekelo, nesikhumba nokuba yonakele, kwaye ifascia kugcina ingqibelelo yayo. Kwakhona, kukho la maqela alandelayo:

• UJohn. Le uhlukunyezwe intloko, nto leyo zimpawu ukungaqheleki gqolo apha ebuchotsheni. Zonke zokubonisa karhulumente kwixesha elizayo (ngokuqhelekileyo iintsuku eziliqela) nyamalala ngokwabo. A Iimpawu ezithe iqhubeka, kukho intloko labagula kakhulu ngakumbi nomonakalo ubuchopho senzeka. Indlela emisiweyo uvavanyo urhulumente wenza izothuso ubude bexesha (kwisekhondi ukuya kwi yure) yaye kamva umbuso ubunzulu ukubeka kunesifo kunye nelahleko seengcamango. Olunye lweempawu non-ezithile kufuneka kuqatshelwe ukugabha, isicaphucaphu, ukuphazamiseka kumsebenzi kwentliziyo, blanching kwesikhumba.
• ukwenzakala ucinezelo Iziko engqondweni, emoyeni, umzimba amazwe, hematoma.
• yokopha Subarachnoid.
• Kuyenye yeendlela umonakalo axonal.

Ukuziqhelisa, oko kubhalwe amaninzi lwamatyala zidityanisiwe. Ludityanisiwe, umzekelo, ucinezelo nga hematoma kunye contusion contusion kunye legazi subarachnoid kunye ucinezelo, umonakalo ehlasela kunye ukwenzakala kunye nabanye. umonakalo kaninzi kwenzeka ngenxa yokulimala ebusweni.

contusion ubuchopho

Oku kwenzeka phezu imvelaphi ukulimala entloko. Ukulinyazwa kukwaphula ingqibelelo wenkqu ingqondo kwindawo ethile. Ngokuqhelekileyo, lo mmandla kwenzeka kwindawo isicelo amandla. Nangona kunjalo, kukho iimeko apho Ukwaphuka livela kwelinye icala (ukusuka protivoudara). Kwisiqalo yale meko siyabutyaka yinxalenye isicwili sobuchopho, imithambo yegazi, izitropu iseli histological kunye kumiswa kweziveliso ze-nokudumba esibuhlungu. Le ndawo yezi izilonda lohlukile. Ngakumbi eyingozi enjalo ukonzakala entloko emntwaneni.

onomoya

limala olunjalo luphawulwa zokuqhawula ezingqondweni ixesha elifutshane - ukuya amashumi ezininzi imizuzu. Emva kokugqitywa yayo izikhalazo ngumntu isicaphucaphu. Kwakhona, intlungu nomonde Uyagula. Kusenokubakho uyagabha, kwezinye iimeko ngokuphindaphindiweyo. Kwezinye iimeko, kukho bradycardia eliphakathi - ukuthoba izinga intliziyo 60 ngaphantsi komzuzu. Isigulane inokuba ingqondo, kunesifo retro- kunye anterograde - memory eng- ngohlobo zokulahleka ukukwazi ukugcina kunye ukudlalwa ulwazi ngaphambili. Emva enomoya ukwenzakala entloko ophawulwe tachycardia (ukwanda izinga intliziyo 90 BPM. / Min). Ezinye izigulane ekukhuliseni uxinzelelo. Kulo mzekelo iqondo lobushushu emzimbeni kunye yokuphefumla, ngokuqhelekileyo kuhlala ingatshintshanga. Njengoko kuba iimpawu luvo, iimpawu ngokuqhelekileyo uphawu lula. Umzekelo, isigulane bangase ubuthathaka, ukozela, nystagmus clonic (biphasic ezinesingqi iintshukumo ngokuzenzekelayo ye kwamehlo). Kukho kwakhona anisocoria encinane, iimpawu meningeal, pyramidal insufficiency. Ezi mpawu zikholisa umva phantsi kwiveki 2-3 emva ukwenzakala entloko.

Iimpawu zokuphula

Kwisiqalo yokwenzakala eshiyekileyo ifunyanwa microscopically umonakalo Medulla ezakheke ezingazinzanga. Oku kubonakala njengeendawo kokudumba zasekuhlaleni, amaYiputa abephathe iingono ingongoma cortical, mhlawumbi ihambisana ukopha umda subarachnoid. Ngoko, ke, sibangelwa komsipha iimpahla pial. yokopha Subarachnoid xa igazi ingena arachnoid kwaye isasazeka phezu amaqula carcinomas, amathanda Nemiqela ingqondo. Kunokuba lengingqi okanye avale isithuba lonke kunye nokusekwa egazi. Simo kakhulu abukhali. Isigulana ngequbuliso uziva i "igalelo intloko", ngokukhawuleza ivela photophobia, ukugabha, yintloko ebuhlungu kakhulu. Kusenokwenzeka ngokuphindaphindiweyo yombono jikelele. Ngokuqhelekileyo le meko ezingahambi ukukhubazeka. Nakuba kunjalo, iimpawu amathuba meningeal. Ngokukodwa, kungakhona izihlunu lukhuni intamo (kwi-utyekelo intloko akakwazi bachukumise kwentamo kaYehoyakin yomguli) kunye uphawu kerning (ayikwazi ukuqondisa bend idolo ngayo kunye hip umlenze). Ukuba kukho iimpawu aphazamiseke meningeal lwenzeka meninges mngcelele igazi.

ukukhubazeka wathobeka

Le limala ebonakala ngokucima elide lokuqonda (iiyure eziliqela). Isigulana umntu kunesifo gqitha. Kukho kwakhona iimpawu yokwenzakala entloko ilandelayo: yintloko ebuhlungu, ukugabha ngokuphindaphindiweyo, ukuphazamiseka kwengqondo. ukuphazamiseka ezidlulayo mhlawumbi imisebenzi ebalulekileyo. Ngokukodwa, oko kuphawulwa bradycardia okanye tachycardia, ubunzima obungakumbi, tachypnea (ukuphefumla rapid iindlela kuyaphi ngaphandle rate kunye permeability phula), icesina ephantsi-grade (ubushushu umzimba landile ukuya 37-37.9 amaqo.). Qho le isiqu kunye iqokobhe iimpawu dissociation of ikhaliphe umsipha kwezihlunu, ibonwa zophendlo lwezifo abambiseneyo. Ngaba iimpawu ngokwaneleyo ngokucacileyo focal. ubhalo lwakhe ibangelwa kwasendaweni wokwenzakala. Kufunyenwe oculomotor kunye pupillary ukuphazamiseka, ukuphazamiseka intetho, novakalelo, paresis kweqondo kunye nezinye. Ezi mpawu zingadlulanga iiveki ezintathu ukuya ezintlanu, ngokuthe ngcembe egudise, njengoko umthetho. Noko ke, kwezinye iimeko, wachaza umfanekiso lwezonyango igcinwa elide ngokwaneleyo. Xa ukulimala sandla mayimodareyithe amaninzi zifumaneka ukwaphula amathambo isiseko kunye calvarium, legazi emikhulu subarachnoid. CT utshintsho focal elibhaqiweyo njengoko inclusions ezintle okanye uqhagamshelwano lwetshiphu emsebenzi-mninzi yohlobo olunye ngcathu ukwanda mninzi. Oku lihambisana ukopha kancinane kummandla yokwenzakala okanye ukopha ukumitha esiqwini ingqondo ngaphandle kokujongelwa gross.

ukulimala ekhanda

Kulo mzekelo, hematoma intracerebral waphawula kuzo zombini isithinzi ngokungqalileyo njengoko kulinganiselwe boxinzelelo igazi izilonda ezahlukeneyo nemithambo komsipha. Oku kwenza kwikhavithi equlathe igazi ngobubende okanye ulwelo. Mbi kakhulu luphawulwa ngokucima okunyanzelweyo elide lokuqonda (iiveki eziliqela). Amaxesha amaninzi esingenayo excitation gqitha. Kwakhona ephawulwe ukuphazamiseka kwemisebenzi ebaluleke kakhulu apha emzimbeni. Nangona kunjalo, xa kuthelekiswa ne wononophelo heavy, ukuba ucaca ngakumbi. Umzekelo, kukho ukuphazamiseka komsebenzi nokuphefumla besaphula yemizila isingqisho kunye nesimo sendawo. Isigulane emsebenzini eDayalayo, izinga lokuqaqamba stem zaseprayimari mpawu luvo. Ngokukodwa, ezichongwe yokuginya yokudla, kwakudada intshukumo yamehlo, ptosis, okanye mydriasis, paresis yaza yabonisa, ngqongqo decerebrate, intshukumo, ukukhula okanye inhibition of ikhaliphe, inwebu yangaphakathi, ulusu, imisipha njalo njalo. Iimpawu luvo kwixesha lokuqala (ngethuba leeyure yokuqala okanye iintsuku) ilawula iimpawu hemispheric focal. Isigulane okungakanani yalityatya paresis, ukuphazamiseka subcortical ithoni kwezihlunu, njalo-njalo. Kwezinye iimeko, kusenokwenzeka ukuba kugxile okanye ngokubanzi ukuxhuzula. Ukuhlehla obubonakala focal kwenzeka kancinci ngokwaneleyo. Ingozi enjalo ukwenzakala entloko? Imiphumo inokuba emibi kakhulu. Ngokufuthi kukho ziphawulwe iziphumo eyintsalela, ikakhulu endle ngengqondo kunye motor.

Iimpawu CT

Xa yokulimala kwi isahlulo sesithathu amatyala ingxelo evela amanxeba bamalungelo ezesini ebuchotsheni ngohlobo non-uniform kwiindawo ezixineneyo kwandisa. Kulo mzekelo, kukho alternation lwemimandla. iindawo lunikezelwa ezixineneyo nezisezantsi. Kule imeko ngokuqatha intshabalalo wayalela Medulla kwaye ukufikelela nzulu kwinkqubo ventricular kunye nuclei subcortical. okuhambisa kokuma kubonisa ukwehla kancinane kwimimandla ngokulitywina, fusion kunye yenguqu ibe enobunzima eyohlobo olulodwa. It iza iiyure 8 okanye 10 emva kweso sehlo. Ukuhlehla effect yezifo zeendawana bayawarhawula elicothayo, ebonisa ubukho egazi moto non-resorbed kunye zomzimba kwagxilwa yokwenzakala. Kweli nqanaba, baba kakhulu ravnoplotnymi ezingqonge kweziyobisi kwengqondo edematous. Zanyamalala emva kweentsuku 30-40. ukusebenza volume ibonisa resorption kunye nokusekwa kwe-zeendawana endaweni iindawo yoma okanye ukuqanda esinganyangekiyo.

Umonakalo ngomva fossa izakhiwo

Le sisilonda esidumbileyoesingaphakathi ithathwa ukuba ngokuqatha konke ukulimala entloko. Kuba urhulumente luphawulwa mpawu zilandelayo: uxinezeleko sezingqondweni ukuhlanganiswa esiqwini, cerebellar, ebuchotsheni kunye neempawu meningeal ngenxa ngokukhawuleza ucinezelo kunye ejikelezayo utywala ukuphazamiseka.

amanyathelo elapha xa ukwenzakala

Kungakhathaliseki ngobungakanani ukonzakala, ukhathalelo lwempilo isigulane kufuneka lubonelelwe. Xa kukho umdlali olimeleyo intloko ixhoba ukuba zikwazi ukuya esibhedlele ngokukhawuleza kangangoko kunokwenzeka. Ukuxilongwa ibonisa X-ray kunye CT. Isigulana kufuneka alale. ubude bayo abangeva - iintsuku 7-10, kunye umlinganiselo -. iintsuku ezili-14. Kwimeko ezinzima yokwenzakala kwengqondo traumatic kufuneka kuthathwe yokurhaxwa. Baqala kwasekuqaleni nexesha pre-esibhedlele yaye baqhubeka iimeko ngokuthe-karhulumente. Bunjani uphefumlayo kuyimfuneko ukuze kuqinisekiswe free cross-lizwe kwisiqwenga eliphezulu wokuphefumla - kubakhulula yencindi, igazi, ukumgabhisa. It wazisa umoya bile, a tracheostomy luyenziwa (inyama asike kunye nofakelo cannula noqhoqhoqho okanye ukucinga imingxuma eziqhubekayo - stoma). Kwakhona wasebenzisa inhalation usebenzisa umxube oxy-moya. Ukuba kuyimfuneko, sebenzisa umoya ngomatshini.

Therapy ngenxa yokulimala

Ukuba kufunyaniswa ukuba isigulana unalo ukonzakala entloko, unyango kufuneka lwenziwe esibhedlele neurosurgical. Xa mala ubonisa ukuphumla ezintlanu ebhedini. Xa engekho iingxaki isigulane angasuswa ngomhla ka 7-10. It unikwe unyango zezigulana, ixesha apho - ukuya kwiintsuku ezili-14. unyango ngenxa yokulimala ijolise uzinzo sokusebenza lobuchopho, ulawulo iintlungu, ubuthongo, ixhala. Ngokuqhelekileyo, amayeza emiselweyo lufaka hypnotics, nadlamkisayo kunye analgesics. Njengoko analgesics basebenzisa iziyobisi ezifana "Baralgin" "Pentalgin" maksigan "" sedalgin Reglan "kunye nabanye. Iindlela ukuze yabelwe ukuba nesiyezi." "Ukuze ke nadlamkisayo kuquka amayeza afana" Valocordin "" Corvalol " kunye nezinye equlethe phenobarbital. Faka infusions esintu (motherwort, valerian).

Akunconywa uxinezeleko. Ezi ziquka, umzekelo, kuquka izinto ezifana "Rudotel", "Nozepam", "Phenazepam", "Sibazon", "elenium" kunye nabanye. Ukongeza lingaze unyango elimisiweyo Ikhosi metabolic kunye nonyango nemithambo. Oku kwenza ukuba ngokubuyiselwa ngokukhawuleza kakhulu kwaye olupheleleyo nokusebenza kwengqondo aphazamiseka, kuthintela iimpawu postkommotsionnye ezahlukeneyo. Ukuqeshwa tserebrotropnoy kunye nonyango vasotropic inokuba emva kweentsuku 5-7 emva kokwenzakala. Advantageously udityaniso nootropic (iziyobisi "Pikamilon" "aminolone", njalo njalo) kunye vasotropic (amayeza "Teonikol" stugeron "" Cavinton ") kuthetha ukuba ukoyisa ibonwa asthenic izigulane ababelwe izakhiwo vitamin." Centrum "" Complivit "" . Vitrum "kunye nabanye ezicetyiswayo tonics: iziqhamo Schisandra isicatshulwa Eleutherococcus, . ginseng ingcambu kufanele kuqatshelwe ukuba abalindi alibonakali nayiphi sisilonda esidumbileyoesingaphakathi zomgquba ukuba kukho naluphi na utshintsho kwi MRI okanye CT scan, kuyimfuneko ukuthetha embi ngakumbi. kakubi - ukwenzakala ebuchotsheni.

ukungenelela operative

ukulimala oomatshini zifuna uqhaqho. Surgery iboniswe kwimeko yokwenzakala kuzityumza kunye isicwili sobuchopho. Ngokuqhelekileyo, ukonzakala mechanical ezinjalo kwenzeka kwipali zexeshana kunye indawo esithinzini ngokungqalileyo. Njengoko etyandwa ikhonza trepanation osteoplastic. Olu tyando ukwenza imingxuma ithambo ukungena kulo ukusetshwa detritus nesisombululo iziniki-sodium chloride (0.9%).

Outlook

umonakalo Mild ngokuqhelekileyo isiphumo kakhulu entle (lokuthobela kunye iingcebiso isigulane malunga unyango kunye nonyango). Xa imeko oluphakathi kunokwenzeka rhoqo ukuphumeza ukuphucuka ingundoqo kunye nokubuyiselwa msebenzi ekuhlaleni kunye yokwaphuka amaxhoba. Ezinye izigulane zinokuba meningitis kwaye hydrocephalus, asthenia ingqondo, kwekhono semithambo, iintlungu, ukuphazamiseka zoququzelelo, ndawonye kunye nezinye iimpawu luvo. Ulungelane njengokonzakala eziqatha malunga ne30-50% yamatyala kwenzeka ekufeni. Phakathi abasinde ukukhubazeka eqhelekileyo kakhulu, nto leyo ke ebangela ukuphazamiseka kwengqondo, intetho ekrwada kunye nokuphazamiseka iimoto, ukuxhuzula. Xa ukonzakala entloko evulekileyo kukho iingxaki kungenzeka arhabaxa. Ngokukodwa, ingozi enkulu yokuba kukho ithumba ebuchotsheni, ventriculitis, kobuchopho, meningitis. Kwakhona kusenokwenzeka liquorrhea emele yayikukuphuphuma ulwelo fluid (CSF) ukusuka zendalo okanye imingxunya benziwa ngenxa yeemeko ezahlukeneyo emathanjeni yomqolo kunye ukakayi. Isiqingatha abafa onokonzakalisa intloko accounted for (RTA) iingozi phezu ezindleleni.