Raunin ƙwaƙwalwar ƙwaƙwalwa

Raunin ƙwaƙwalwar ƙwaƙwalwa (TBI) saitin rauni ne na tuntuɓi na laushin laushin kai, ƙasusuwa na ƙwanƙolin kai, abin da ke cikin kwakwalwa da membranes ɗinta, wanda ya dace daidai da lokaci kuma yake da tsari guda ɗaya na samuwar. Haɗarin zirga-zirga (inertial trauma) sanadin kowa ne. Mafi sau da yawa ƙasa, rauni shine sakamakon iyali, wasanni ko raunin masana'antu. TBI na iya shafar kowane tsari na tsarin juyayi na tsakiya: fari da launin toka na ƙwaƙwalwa, kututtukan jijiyoyi da jijiyoyin jini, bangon ɗakunan jirgi da hanyoyin ruwan sha, wanda ke tantance ire-iren alamun da ke nuna shi.

Diagnostics

Ana yin binciken ne bisa tsarin anamnesis (tabbatar da gaskiyar rauni), sakamakon binciken jijiyoyi da kuma nazarin bayanai daga hanyoyin bincike na kayan aiki (MRI da CT).

Rabawa

Don kimanta tsananin raunin, ana amfani da sikelin Glasgow Coma Scale, wanda ya dogara da ƙididdigar alamun cututtukan jijiyoyi. Ana kimanta sikelin a cikin maki, wanda yawansu ya bambanta daga 3 zuwa 15. Bisa ga yawan maki, TBI ana rarraba ta da digiri:

• sauki - 13-15;
• matsakaici - 9-12;
• nauyi - 3-8.

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Dangane da girman tasirin tasirin TBI, zai iya zama:

• ware;
• haɗuwa (tare da lalata wasu gabobin);
• haɗuwa (tare da tasiri akan jikin mutum na abubuwa daban-daban masu rauni); na iya haifar da amfani da makaman kare dangi.

Ta hanyar lalacewar kayan kyallen takarda (fata, aponeurosis, dura mater), rauni shine:

• rufaffen (CCMT) - babu lalacewar da ke bayyane;
• bude (TBI) - lalacewar kyallen takarda mai laushi na kai, wani lokacin tare da aponeurosis (na iya kasancewa tare da karayar kasusuwa na taska ko tushe na kwanyar; ta asali, zama harbin bindiga ko mara harbi);
• TBI na dabi'a mai ratsa jiki - an keta mutuncin dorewar abin.

Cikakken rauni na craniocerebral yana da haɗari saboda mai haƙuri ba tare da lalacewar da ke bayyane ba da wuya ya nemi likita, yana kuskuren gaskata cewa "komai zai zama daidai." Musamman ma haɗari shi ne yadda ake sarrafa shi a cikin yanki saboda gaskiyar cewa hangen nesa na zubar jini a cikin fossa na baya shine mafi kyau.

Daga mahangar lokacin tazara tun daga TBI, don dacewar haɓaka dabarun magani, al'ada ce a raba lalacewar zuwa lokaci (a cikin watanni):

• m - har zuwa 2.5;
• matsakaici - daga 2.5 zuwa 6;
• nesa - daga 6 zuwa 24.

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A cikin aikin asibiti

An tabbatar da raunin kwakwalwa don:

Maƙarƙashiya (rikicewa)

Kwayar cutar yawanci warware cikin kwanaki 14. Lalacewa na iya kasancewa tare da farkon aiki tare daga secondsan dakikoki zuwa mintuna 6 (wani lokacin ana nuna aƙalla lokacin mintuna 15-20), sannan antegrade, congrade, ko retrosgrade amnesia. Wataƙila baƙin ciki na sani (har zuwa stupor) Cutar rikice-rikice na iya kasancewa tare da rikicewar tsarin juyayi na jiki: tashin zuciya, amai, pallor na buɗe ƙwayoyin mucous da fata, rikicewar tsarin zuciya da jijiyoyin jini (gajeren lokaci a cikin NPV da hawan jini). Ciwon kai da jiri, raunin jiki gaba ɗaya, zufa mai ƙyalli, da tinnitus na iya faruwa.

Nystagmus mai yuwuwa tare da kamewar ƙwallan ƙafa sosai, rashin daidaito na alamun jijiya da alamun meningeal waɗanda suka tsaya cikin kwanaki 7. Nazarin kayan aiki (MRI) tare da rikicewa ba ya bayyana canje-canje na cuta. Canje-canje a cikin tsarin ɗabi'a, raunin hankali da rage zurfin bacci ana iya kiyaye su tsawon watanni.

Rikitarwa (rikicewa)

Sau da yawa yakan bayyana kansa a cikin yanayin girgiza-girgiza-girgiza (tare da saurin hanzari da hana motsi na kwakwalwa saboda tasirin waje). Ana gano alamun bayyanar asibiti ta wurin wurin rauni kuma sun haɗa da canje-canje a cikin yanayin ƙwaƙwalwa. Morphologically tabbatar da intraparenchymal zubar jini da kuma edema na gida. Raba zuwa:

• Da sauki. Yana yawanci tare da asarar sani na tsawon mintuna da yawa. Babban alamun cututtukan ƙwaƙwalwa sun fi bayyana fiye da rikicewa. Hali ne na cututtukan ciyayi a cikin yanayin hawa da sauka a cikin bugun zuciya da haɓaka hawan jini. An tsayar da hadaddun alamun cutar tsakanin kwanaki 14-20.
• Tsakiyar. Cutar kayan lambu suna haɗuwa da yanayin tachypnea da yanayin subfebrile. Bayyanar da alamun bayyanar cututtuka: oculomotor da rikicewar upan makaranta, bugun gabbai, dysarthria da dysesthesia. Sau da yawa ana lura da damuwa bayan kwanaki 35.
• Tã nauyi A wasu lokuta, yana tare da karayar kasusuwan kwanyar da zubar jini ta intracranial. Rushewar kasusuwa na kasusuwa yawanci layi ne. Tsawan lokaci aiki tare ya fito daga awanni da yawa zuwa makonni 1-2. Ana bayyana saurin rikicewar kai a cikin sifar canjin yanayi a cikin karfin jini, bugun zuciya, yanayin numfashi da hauhawar jini Alamun tushe sun mamaye. Sukuwa zasu yiwu. Saukewa yana ɗaukar lokaci mai tsawo. A mafi yawan lokuta, bai cika ba. Rikici a cikin motar da ɓangarorin tunani, waɗanda ke haifar da nakasa, galibi suna ci gaba.

Yada rauni na axonal

Rauni ga farin abu saboda ƙarfin shearing.

Yana halin halin matsakaici zuwa zurfin suma. An bayyana mahimmancin bayyanar cututtukan cututtuka da rikice-rikicen ikon kansa. Sau da yawa yakan ƙare da yaudara tare da ci gaban cututtukan zuciya. Ilimin halittar jiki, gwargwadon sakamakon MRI, an ƙaddara ƙaruwar ƙwayar ƙwayar kwakwalwa tare da alamun matsawa na ventricles na uku da na gefe, sararin samaniya mai sassaucin ra'ayi da rami. Hoananan cututtukan cututtukan jini na Pathognomonic a cikin farin kwayar halittar hemispheres, corpus callosum, subcortical da stem Tsarin.

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Matsawa

Yawanci yakan haifar da saurin ɓarkewar jijiyoyin ƙwaƙwalwa da / ko mahimmin jini na intracranial. Saurin ƙaruwa cikin matsin cikin intracranial yana tare da saurin haɓaka mai da hankali, ƙwaƙwalwar ƙwaƙwalwa da alamun kwakwalwa. Yana dauke ne da "alamar almakashi" - karuwa a tsarin karfin jini bisa tsarin karuwar bugun zuciya. A gaban zub da jini na ciki, yana iya kasancewa tare da mydriasis mai kama da juna. "Alamar almakashi" ita ce tushen cutar craniotomy domin rage kwakwalwa. Zubar da jini ta ciki ta hanyar wuri zai iya zama:

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

Dangane da nau'in jirgin ruwan da ya lalace, suna da jijiyoyin jini da jijiyoyin jini. Babban haɗari shine zubar jini ta cikin jini. Zubar da jini yana da kyau a gani akan CT. CT karkace yana ba ka damar kimanta ƙarar hematoma intracranial.

A lokaci guda, ana iya haɗuwa da nau'ikan lalacewa daban-daban, misali, rikicewa da zubar jini ta kwakwalwa, ko ƙarin lalacewar al'amarin kwakwalwa akan matakan meninges. Bugu da ƙari, tsarin mai juyayi na tsakiya zai iya fuskantar damuwa da lalacewa ta haifar, tashin hankali CSF.

Yanayi biyar na marasa lafiya

A cikin neurotraumatology, yanayi biyar na marasa lafiya tare da TBI an bambanta:

Taimako na farko

Idan aka nuna wani ɓangare na rashin sani, wanda aka azabtar yana buƙatar jigilar gaggawa zuwa asibiti, tun da syncope yana cike da rikitarwa waɗanda ke da haɗari ga jiki. Lokacin bincika wanda aka azabtar, ya kamata ku kula da:

• kasancewar zubar jini ko liquorrhea daga hanci ko kunnuwa (alama ce ta karaya daga gindin kwanya);
• matsayin ƙwallan ido da faɗin ɗalibai (mydriasis ɗai-ɗai na iya haifar da zubar jini ta haɗi)
• sigogi na zahiri (yi ƙoƙarin yin rikodin alamun da yawa yadda ya kamata):
  • launin fata;
  • NPV (yanayin numfashi);
  • Bugun zuciya (bugun zuciya);
  • JAHANNAMA;
  • zafin jiki.

Idan mara lafiya ya sume, don kebe raunin harshe da hana yiwuwar numfashi matsaloli. Idan kuna da ƙwarewar, zaku iya tura ƙananan muƙamuƙin gaba, sa yatsunku a bayan sasanninta, sa'annan ku ɗinke harshenku da zare ku ɗaura shi da maɓallin riga.

Sakamakon da rikitarwa

Rarraba daga tsarin juyayi ya kasu kashi biyu:

• mai yaduwa:
  • cutar sankarau;
  • ƙwaƙwalwar ƙwaƙwalwa;
  • ƙwaƙwalwar ƙwaƙwalwa;
• mara yaduwa:
  • jijiyoyin jini;
  • nakasawar nakasa;
  • cututtukan episyndrome;
  • hydrocephalus;
  • cututtukan zuciya.

Sakamakon asibiti na iya zama na ɗan lokaci ko na dindindin. Ayyade da ƙarar da wurin canjin. Wadannan sun hada da:

• Babban alamun cututtukan ƙwaƙwalwa - ciwon kai da rashin kuzari - wanda ya samo asali daga take hakkin abin da ke cikin yanayin, sauya kayan masarufi ko kayan kwalliyar, ci gaba da ƙaruwa cikin jini da / ko tsarin jini.
• Bayyanar masu rinjaye masu cuta (yawan aiki na jijiyoyi) a cikin tsarin juyayi na tsakiya, wanda zai iya bayyana azaman kamuwa da rikicewar rikicewa (cututtukan cututtukan post-traumatic na ciwo) ko canje-canje a cikin halayen ɗabi'a.
• Kwayar cututtukan cututtukan da lalacewar yankunan da ke hade da motar, ƙirar hankali da ƙwarewa:
  • asarar ƙwaƙwalwa, rikicewa a cikin lokaci da sarari;
  • canjin tunani da raunin hankali;
  • rikice-rikice daban-daban a cikin aikin masu nazari (misali, ƙamshi, gani ko sauraro);
  • canje-canje a cikin fahimtar ƙwarewar fata (dysesthesia) daban a cikin yanki;
  • rikicewar daidaituwa, rage ƙarfi da kewayon motsi, asarar ƙwarewar ƙwarewar da aka samu, dysphagia, nau'ikan dysarthria (maganganun maganganu).

Rikice-rikice a cikin aikin tsarin locomotor ana bayyanar da shi ta hanyar rikicewar tsauraran matakai, da yawa sau da yawa ta hanyar roƙo, sau da yawa tare da canji, raguwa ko rashin hasara na ƙoshin lafiya.

Baya ga rikice-rikicen da rikice-rikice a cikin aikin kwakwalwa ke haifarwa, sauye-sauyen cututtukan cututtuka na iya zama na yanayi mai rikitarwa kuma yana iya shafar aikin gabobin ciki saboda ƙetawar aiki na ciki. Don haka, idan haɗiye yana da wahala, abinci na iya shiga trachea, wanda ke cike da ci gaban cutar huhu. Lalacewa ga tsakiya na jijiyar wuyan juji yana haifar da rushewar shigarwar zuciya ta zuciya, gabobin narkewar abinci da glandon endocrine, wanda ke shafar aikinsu ta mummunar hanya.

Gyarawa

Cikakken hadadden matakan gyarawa kai tsaye yana shafar sakamakon magani da kuma tsananin raunin jijiyoyin jiki bayan rauni. Ana yin gyaran gyare-gyare a ƙarƙashin kulawar likitan da ke halartar da kuma rukuni na kwararru na musamman. Yawancin lokaci su ne: likitan jijiyoyin jiki, mai ba da warkewa, likitan kwantar da hankali, mai warkarwa na aiki, mai ba da magana da kuma likitan ƙwaƙwalwa.

Doctors sunyi ƙoƙari don ƙirƙirar yanayi mai kyau don mai haƙuri ya koma rayuwarsa ta yau da kullun kuma ya sauƙaƙe alamun cututtukan jijiyoyi. Misali, kokarin likitan magana yana nufin dawo da aikin magana.

Hanyoyin gyarawa

• Boath far - yana motsa motsa jiki ta hanyar canza matsayin jiki.
• Maganin Vojta ya dogara ne akan ƙarfafa mai haƙuri don yin motsi na kwatance ta hanyar haɓaka wasu yankuna na jikinsa.
• Maganin Mulligan wani nau'in magani ne wanda ake amfani dashi don rage sautin tsoka da rage ciwo.
• Amfani da ginin "Fita", wanda kayan doki ne wanda aka tsara don haɓaka ƙwayoyin hypotrophic.
• Yin darasi akan kayan aiki na jijiyoyin jini da dandamalin daidaitawa domin inganta daidaituwa da motsi.
• Maganin aikin sana'a saiti ne na fasaha da ƙwarewa waɗanda ke bawa mai haƙuri damar daidaitawa da yanayin zamantakewar.
• Rubutun Kinesio wani reshe ne na maganin wasanni, wanda ya ƙunshi aikace-aikacen kaset masu ɗauka na roba tare da ƙwayoyin ƙwayoyin tsoka da haɓaka tasirin raunin tsoka.
• Thewararrun ƙwaƙwalwa - da nufin gyaran ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa a matakin gyarawa.

Jiki:

• magani electrophoresis;
• far laser (yana da anti-mai kumburi da farfadowa-stimulating sakamako);
• acupuncture.

M magani-tushen magani far:

• ƙwayoyin nootropic (Picamilon, Phenotropil, Nimodipine) waɗanda ke inganta hanyoyin tafiyar da rayuwa cikin ƙwayoyin cuta;
• masu kwantar da hankali, masu kwantar da hankali da kwantar da hankali don daidaita yanayin tunanin-tunani.

Hasashen

Eterayyade da tsananin TBI da shekarun mai haƙuri. Matasa suna da kyakkyawan hangen nesa fiye da tsofaffi. Raunin da aka saba rarrabe ne:

• ƙananan haɗari:
  • raunin raunuka;
  • karaya daga kasusuwa na kokon kai;
  • girgizawa;
• babban haɗari:
  • kowane irin jini na ciki;
  • wasu nau'ikan karayar kwanya;
  • lalacewa ta biyu ga abu mai kwakwalwa;
  • lalacewa tare da edema.

Raunin haɗari masu haɗari suna da haɗari ta hanyar kutsawa cikin ƙwaƙwalwar ƙwaƙwalwar ƙwaƙwalwa (SHM) a cikin babban fatar tare da matsawa na cibiyoyin numfashi da na vasomotor.

Hannun cutar rashin lafiya yawanci yana da kyau. Tare da matsakaici da mai tsanani - an tantance shi ta adadin maki akan Glasgow Coma Scale. Pointsarin maki, mafi dacewa shi ne.

Tare da matsanancin digiri, rashi na jijiyoyin jiki kusan koyaushe yana ci gaba, wanda shine dalilin rashin lafiya.

Kalli bidiyon: FRP作業必見FRP道具類ドブ付け洗浄点セット (Fabrairu 2025).