VULA: yintoni na? ONMIK ngohlobo lwe-ischemic. Irejista yezemfundo yezigulane ezine-ONMK

Abaninzi bayabuza umbuzo malunga ne-ONMK kwaye yintoni imiphumo emva kwayo. Kule nqaku, izizathu eziphambili zokubonakaliswa kwe-CNMK kunye nemiphumo iya kuphazamiseka.

VULA - yintoni na?

Abantu abaninzi abangenanto yokwenza ngamachiza, mhlawumbi abazi ukuba i-ONMK. Ngoko, ukuphazamiseka okukhulu kwendlela yokujikeleza kwegazi kwingqondo yinto ephazamisayo, ebangela ukulimala nokufa kweeseli zobuchopho. Isizathu salesi sifo kukubunjwa kwe-thrombus kwimithambo yegazi yengqondo okanye ukuphuka kwemithambo ethile yegazi, obangela ukufa kweenombolo ezinkulu zeeseli kunye neeseli zegazi. Ngokwezibalo, yi-ONMC eyokuqala phakathi kwezifo ezibangelwa ukufa komntu. Ngonyaka kwihlabathi lonke, njengoko kuboniswe yiRejista yegulane yezigulane ezine-ONMC, abantu aba-14% bafa kwesi sifo, kunye ne-16 ezivela kwezinye iintlobo zesifo se-circulatory system.

Izizathu zokuba i-MMS ingabonakala

Ukuze ukhusele ukubonakala kwesi sifo, kuyimfuneko ukuhlawula ingqalelo yokuphila kwakho ukususela kumncinane. Umzekelo, umsebenzi oqhubekayo wezemidlalo unokunciphisa kakhulu amathuba okubonakaliswa kwe-ONM. Yintoni na, sele uyazi, ezinye izizathu zokuqala kwesi sifo ziya kuxoxwa ngokuqhubekayo.

Njengomthetho, esi sifo asifizi ngokukhawuleza, ngokuqhelekileyo ukuxilongwa "kwe-ONMC" kungasungulwa ngenxa yezifo ezithile. Ngokuqhelekileyo imbangela yale meko ingaba:

• U xinzelelo;
• Ukunyaniseka kwesona sizathu esiqhelekileyo esiboniswe yiRejista ye-federal yesigulane kunye ne-UNMIK;
• Isifo sikashukela;
• Cholesterol ephezulu;
• Isifo senhliziyo;
• Utywala kunye nokutshaya;
• Iindidi ezahlukahlukeneyo zamachiza;
• Umgangatho ophezulu we-hemoglobin;
• Njengoko irejista ye-federal ye-ONM iqinisekisa, esinye isizathu sineminyaka yobudala;
• I-Craniocerebral trauma;
• I-Genetic predisposition kunye njalo.

Ngoku kuyacaca oko ku-ONMK. Le yimiphumo yokuphila okungalunganga. Ngoko ke kubaluleke kakhulu ukujonga imeko yakho yempilo kunye nempilo.

I-Ischemic ONMK

I-ONMC ye-Ischemic yinto ephazamisayo eyenziwa ngumonakalo kwiisisu zengqondo kunye nokuphazamiseka kwegazi ukuhamba komnye kumnye amasebe ayo.

Ininzi yezigulane ezine-ONMIK, izifo eziqhelekileyo zenkqubo ye-cardiovascular zifunyenwe kwintlobo ye-ischemic. Ezi zifo zingabandakanya i-arteriosclerosis, isifo senhliziyo (i-arrhythmia, i-rheumatic fever), isifo sikashukela.

Ukuze i-ONM yelo hlobo ibonakaliswe ngokubonakaliswa ngokukhawuleza nangokuqhelekileyo kweentlungu, umphumo wokuba ukwanda kwegazi kwi-cortex ye-cerebral. Njengomthetho, ukuhlaselwa okunjalo kunokunika ulwazi malunga nabo ngamaxesha amaninzi ngeyure kwaye kudlulileyo iiyure ezingama-24.

I-ONM ifakiwe kwi-classification yezizwe ngezizwe 10 ukuhlaziywa

Iikhowudi ze-ONMK (ICD 10):

1. I63.0. I-infrection yoluntu ye-cerebral ngenxa ye-thrombosis ye-artery arteries.
2. I63.1. Ubundlobongela bentliziyo yomntu emva kokugqitywa kwemithambo yegazi yangaphambili.
3. I63.2. I-infraction ye-cerebral ngenxa ye-stenosis yeemitha zegazi zangaphambili okanye ukuvinjwa okungalawulwayo kwemibhobho ye-cerebral.
4. I63.3. MSEKILE ngenxa ye-thrombosis ye-artery arteries.
5. I63.4. I-ONMI ngenxa yokugqithiswa kwemithambo yegazi.
6. I63.5. I-CABG njengesiphumo se-stenosis yeemithana yegazi okanye ukukhutshwa kwabo okungabonakaliyo.
7. I63.6. Ukungena kwe-piogenic cerebral infarction ngenxa ye-thrombosis yeethambo zegazi zeengqondo.
8. I63.8. I-infraction ye-cerebral kwezinye izizathu.
9. I63.9. ONMK engagqibekanga.
10. I64.0. I-ONMC engagqibekanga, ebonakalisa njengesisindo somzimba okanye i-infarction.

Iikhowudi ze-ONM (i-ICD 10) avumela oogqirha ukuba bazise ngokukhawuleza ukuhlelwa kwesifo, isizathu esinyani sokubonakala kwayo kunye nokuchonga unyango oluyimfuneko. Ngenxa yoko, olu luhlu luyinhloko kwisandla segqirha, okuvumela ukugcina ubomi komntu omnye okanye omnye.

Iimbangela ze-ischemic stroke ye-ONM

Isizathu esiyinhloko sokubonakaliswa kwe-ONMI kwintlobo ye-ischemic kuyancipha ekuphumeni kwegazi kwingqondo. Ngokuqhelekileyo, yeso sizathu sokufa komntu sisifo soqhinga.

Ngoko, sifunde iimpawu ze-ONMC ye-ischemic, yintoni na kwaye ziphi iimpawu zayo.

Oku kuvame ukuba ngumonakalo kwimpahla yentamo kunye nemithambo ethile yeengqondo ngendlela yesilonda kunye ne-stenosis.

Masifunde izizathu eziphambili zokuvela kwayo. Izinto eziphambili ezinokuchaphazela ukunciphisa ukuhamba kwegazi, zibandakanya oku kulandelayo:

1. Ukuzibandakanya kunye nokugqithwa kwemibhobho ephezulu yengqondo kunye neempahla zentamo.

2. I-thrombotic ifakwe kwi-platetic atherosclerotic.

3. I-cardiogenic embolism, eyenzekayo phambi kweemvenge ezenziwayo entliziyweni yomntu.

4. Ukuqulunqwa kwemibhobho emikhulu yommandla wesibeleko.

5. I-Hyalinosis yamathambo amancinci, okubangela ukuphuhliswa kwe-microangiopathy, ekhokelela ekuvelweni kwe-lacunar infarction yengqondo yomntu.

6. Izinguqulelo ze-Haemorheological ekubunjweni kwegazi, ezenzeka kwi-vasculitis, kunye ne-coagulopathies.

Kunqabile kakhulu, imbangela yokubonakalisa kwesi sifo kungabangela ukulimala kwangaphandle kweetriyari ze-carotid kunye neenkqubo ezahlukeneyo ezivuthayo ezinokunyanya kakhulu ukunyuka kwegazi ngeempahla.

Kananjalo ngokuqhelekileyo imbangela ebalulekileyo ye-ONM yengqondo ingaba yi-osteochondrosis yomlenze wesibeletho, ngexesha apho imithwalo yegazi iminyene, ekhokelela ekunciphiseni ukuhamba kwegazi. Izigulane nge-osteochondrosis zihlala zikhuthazwa ukuba zihlaziye umlenze wesibeleko kwaye zisebenzise ngamachiza atshisayo ahlukahlukeneyo anokunciphisa kakhulu imithana yegazi kunye nokuphucula umjikelezo wegazi.

Iimpawu zeMMS

Izibonakaliso zesi sifo kaninzi zibonakalisa ngokukhawuleza okanye ngokunyuka ngokunyuka. Njengomthetho, iimpawu eziphambili zesi sifo ziquka intetho nengxaki yombono kwisigulane, ukuphulwa kweengcamango ezahlukahlukeneyo, ukulungelelaniswa kwentshukumo, intloko, ukuphazamiseka kokulala, intloko yesandi, ukukhubazeka kwememori, ukukhubazeka komzimba, ulwimi, ukungabikho komfutho wezitho ezithile. Ngaphezulu.

Ngenxa yokuphazamiseka okukhulu komjikelezo we-cerebral, iziphumo ezilandelayo zifana: ukuphazamiseka kwengqondo, ukusabalaliswa kwegazi kwi-cortex ngexesha lokubunjwa kwamacandelo egazi kwiinqanawa kunye nemigqaliselo yegazi ephezulu, njalo njalo.

Ngeempawu zokuphazamiseka okukhulu komjikelezo we-cerebral, ophelileyo ngaphezu kweentsuku, kuphazamiseka isifo. Kwisigaba sokuqala sesi sifo, ikhanda elibi, inxantathu, isicupunu, ukuhlanza ukucatshulwa kunye nokunjalo kungabonakaliswa. Ukuba awuyi kukhawulezi ngokukhawuleza kule mibonakalo, kunokubangela ukufa komntu.

Ngokwerejista yezigulane nge-ONM, ngokwemibare, imbangela ebalulekileyo yale mibonakalo ingabangela uxinzelelo ophezulu, ongabonwa ngokuzikhandla ngokomzimba. Ukwanda okwexinzelelo lwegazi kungabangela ukutshabalalisa kweenqwelo ze-cerebral, emva koko kuya kuba negazi kunye ne-hematoma yangaphakathi ye-cerebral.

Kwiimeko ezininzi, iimpawu ezibalwe apha ngasentla zigcinwa phambi kwe-ischemia. Njengolawulo, banokuhlala iiyure eziliqela okanye imizuzu emininzi. Njengomthetho, ngokubonakaliswa kwe-ONMK uhlobo lwe-ischemic, iimpawu zihlala zisebenza ngokuthe rhoqo. Ngokweengcali, ngokubonakaliswa kwezi zimpawu, abaninzi abantu badidekile, ukuze umntu alahleke ukuphaphama, ukulungelelaniswa kweminyango kuyanda, ngoko izigulane ezininzi zilele. Njengoko iifomati zithi, iipesenti ezingama-75 zokuhlaselwa kwelo hlobo lwe-ischemic lwenzeka kwiphupha.

Ukufumanisa ingozi yengozi enkulu ye-cerebrovascular uhlobo lwe-ischemic

Ukufumanisa ingxaki, kuyimfuneko ukuphumeza uphando kunye nezifundo ezahlukeneyo kwi-ICD system. Oogqirha be-ONMIK baya kukwazi ukuxilonga emva kweenkqubo ezilandelayo:

• Uvavanyo lwegazi lwe-electrolytes, i-glucose, i-hemostasis, i- lipid spectrum, i- antiphospholipid antibodies.
• I-Electrocardiography yenguqu kwixinzelelo lwegazi.
• Ikhompyutheni yekhompyutheni ye-cortex ye-cerebral, ukuze ukwazi ukubona kalula iindawo ezichaphazelekayo zobuchopho kwaye wenze ama-hematomas ngaphandle kweengxaki.
• I-cerebral angiography njalonjalo.

Unyango lokukhubazeka okukrakra kwe-cerebral circulation kwinhlobo ye-ischemic

Isizathu esona siqhelekileyo sokufa ngokuchanekileyo i-ONMI. Ngoko ke unyango kufuneka lwenzeke phantsi kolawulo lwagqirha abanolwazi. Esi sifo le nonyango lulandelayo lwenziwa:

1. Ukugcina imisebenzi ebalulekileyo yomzimba womntu. Isigulane sifanele sisebenzise iziyobisi ezingekho emzimbeni, kwimeko apho uxinzelelo lwegazi emzimbeni luyi-200 ukuya kwi-120 mm. Gt; Ubugcisa. Kwakhona kusetyenziswe i-anticoagulants (esetyenziselwa i-pathologies edibeneyo kwaye isetyenziswe ixesha elide emva kokumiselwa kwemimiselo), izidakamizwa ezingenayo i-vasoactive, i-antigregregants, i-decongestants, i-neuroprotectors njalonjalo.
2. Iiseti ezahlukeneyo zokuzilolonga ziqhutywa - unyango lwentetho kunye nokuphefumula.
3. Umba we-thrombolysis uqwalaselwa xa isigulane singena kwiziko lezonyango kwixesha leeyure ezingama-3 ukuya ku-6 ukusuka kwimeko yokubonakalisa kwesi sifo.
4. Iprophylaxis yesibini yesi sifo.
5. Amanyathelo amaninzi okuvuselela ayenziwa njalo njalo.

Njengomgaqo, iingongoma eziphambili zonyango ziya kunikwa kuphela ngugqirha, oya kuba nolwazi oluqhelekileyo nezifo zexhoba.

Kwimeko apho kukho izikhalazo zokungahambi kakuhle kwe-cerebral circulation, kuyimfuneko ukuphendukela kwiingcali ezifanelekileyo kakhulu kule ndawo yomsebenzi. Njengomthetho, kwindawo yokuqala kuyakufuneka ukuba ufake umfanekiso we-magnontic resonance, okwazi ukuchaneka ngokuchanekileyo yonke i-pathologies ye-cortex ye-cerebral. Ngaloo ndlela, kuya kubakho ukuthintela ukuba kunokwenzeka ukuba kube nzima ukukhupha eso sifo kwaye uqale unyango ngaphambi kokuba ubonakaliswe ngokupheleleyo. Isebe elikhethekileyo le-UNMIK, njengomthetho, kufuneka libe nezixhobo ezizodwa eziza kuphucula kakhulu unyango.

Izibalo zezifo phakathi kwamaqela abantu

Esi sifo sisoloko sixhalabele kuphela ngabantu asebekhulile, kodwa nangobutsha. Esi sifo sithatha ingqwalaselo yamashumi amawaka eenzululwazi ezivela kwihlabathi lonke, njengoko ihlala iphazamisa abantu bamaqela ahlukeneyo. Kwakubhalwe amaninzi amaninzi xa i-ONM iqalile ukuqhubela phambili kubantu abaselula, kwaye nakwiintsana. Iingcali zenzululwazi zikhankanya iinani, ezibonisa isibalo esilandelayo kwezifo kwi-100,000 yabantu kwiminyaka eyahlukileyo.

Inani lezigulane ezine-SWLD kwiminyaka eyahlukileyo ziboniswa etafileni.

	Ubuso bomfazi							Ubuso bendoda
Ubudala	60+	40-60	25-40	14-25	3-14	1-3	0-1	60+	40-60	25-40	14-25	3-14	1-3	0-1
Inani le Ezichaphazelekayo	253.2	16	52.3	52	0.5	0.1	0.01	266.5	184.9	61.5	61.4	0.5	0.1	0.01

Irejista yesigulana esidlangalaleni kunye ne-ONMK

Irejista ye-federal igcina iirekhodi kwinani lezigulane ngesifo esithile. Ufunda ukuqhubela phambili kwezifo ezithile kunye nezizathu zokuphuhliswa kwazo. I-ONMC isifo esiza kubhala. Le rejista inezo zonke iinkcukacha ngezigulane kunye nembali yazo.

Irejista ye-federal ithi ukufa ngenxa yezifo zesistim somzimba namhlanje kunokuqala. Ngokomthetho, ama-50 ekhulwini abantu abafa ngenxa yokuphazamiseka okukhulu kwe-cerebrovascular (CABG), oko kukuthi, imbangela ebalulekileyo yokufa iyingozi. Unyaka ngamnye kwiRashiya iRussia i-400-450 iimeko ze-ONMC zibhalisiwe, oko kukuthi, ngemizuzu elineshumi elinesihlanu umntu ubonakalisa esi sifo. Kwiphepha elipheleleyo lezigulane, malunga neepesenti ezingama-40 ziyafa.

Unyaka ngamnye inani lezigulane ezine-ONMC landa kakhulu. Ngaloo ndlela, ngokwe-register regeral yesebe le-MMM, ngo-1996 kwingingqi yaseMoscow, amaxhoba angama-16,000 abhalisiwe, kwaye ngo-2003 eli nani landa kwii-22,000 izigulane. Kule nto kunokugqitywa ukuba i-disorder disorder of circulation circulation to date isinye sezifo ezihamba phambili.

Ngokwe-register federal ye-UNMIK, kwilizwe lethu kukho abantu abayizigidi abaye basinda kwesi sifo, kufuneka kuqatshelwe ukuba inxalenye yabasetyhini ngabantu abaneminyaka yobudala. Emva kwesi sifo phakathi kwabantu bale minyaka kuphela ama-25% amaxhoba angabuyela emsebenzini. Ngokusekelwe kwezi nkcukacha, kunokwenziwa ukuba i-ONMI yenye yezona zifo ezihamba phambili neziyingozi.

Irejista yesigqeba yezigulane ezine-ONMC igcwaliswa imihla ngemihla ngeeninzi zezigulane, kodwa inani lamatyala alinakuguqulwa. Oku kuchanekileyo kukuba ubude bomi emva kokuba isifo sinciphise kakhulu. Ngoko ke, kukufanelekile ukubeka iliso impilo yakho rhoqo ukuze ukhusele ukubonakaliswa kwesi sifo.

Iziphumo zengozi ephazamisayo

Imiphumo icala yahluke kakhulu - ukusuka ngokobunzima bazo. rhoqo emva yayiyazi iingozi cerebrovascular abantu neziphumo ezilandelayo:

• Ukulahleka koluvo ukusuka kwindawo komzimba. Kakhulu ziye zilahleke ubuntununtunu imilenze izandla, iminwe, ekunene okanye ekhohlo icala lomzimba, izihlunu ebusweni, ulwimi, njalo-njalo.
• Ukutyhafa okanye ukushwabana ngokupheleleyo ingalo okanye iingalo, imilenze, okanye iinyawo, amalungu omzimba, ekunene okanye ekhohlo icala lomzimba.
• Amaxesha amaninzi, amaxhoba balahlekelwe ukuva, umbono, incasa, uvakalelo of kwalapho ezithile zemithambo-luvo imilenze zomzimba.
• Amaxesha amaninzi emva izigulane stroke amava nesiyezi, umbono kabini, ikhalisa intloko, njalo-njalo.
• intetho edidayo.
• Le ubunzima yokubiza amagama xa uthetha.
• Ukungabikho Ukukwazi ukuqaphela amalungu omzimba.
• echama ngokuzenzekelayo.
• Ukungakwazi ukuhamba.
• Ukungabikho kuqhelaniswa isithuba kunye nelahleko eseleyo.
• niphele Nethuba njalo njalo.

Branch lezigulane CVA kunye abasisigxina kuqhutywa imithambo kwisimo. Njengoko umthetho, phantsi kweliso booogqirha benamava kuqwalasela iimpembelelo kunye nokubuyiselwa ngokupheleleyo uvakalelo lomzimba. Emva kwexesha elithile emva kukuvela yokuhlaselwa kobuchopho okanye nobetho, umntu abuyele ngokupheleleyo ubomi obuqhelekileyo. Kubangel 'umdla ukwazi ukuba ekuthiwa- kobuchopho ingahlala ixesha elide. Ukuba kwenzeka ebudeni bemini, oko kuya kukhokelela kwiimeko ezininzi ngesibetho ngokupheleleyo. Kananjalo kwenzeka emva kwexesha elithile. Ngoko ke, ezi mpawu kwezinye abantu kuvela izihlandlo eziliqela ngonyaka. Kwaye emva kokuba kubonisa zonke kufuna ixesha elithile yesiqhelo.

Imiphumo icala yahluke kakhulu, njengoko ummandla izitshanguba ingqondo zinokuba nomahluko.

uncedo lokuqala for ngesibetho

Into yokuqala ekufuneka uyenzile xa sibona iimpawu zesi sifo - kukuba ubize inqwelo yezigulana. Nomonde ngexesha ekuqaleni iimpawu zesi sifo nayiphi na imeko ayikwazi bangaphazamiseki ngaphandle kwesizathu, ngoko, ngoko nangoko emva kokuba imiqondiso yokuqala kuyimfuneko ayivalele.

Kulo inyathelo elilandelayo, zonke izigulane ekutyhwakrazeni kufuneka amanga ukuze umntla eliphezulu kunye nentloko navuswa, kuyimfuneko kwakhona ukucola kwindawo ikhola umzimba, ukwenzela ukuba kube lula isigulane ukuphefumla. Kuyimfuneko ukuqinisekisa ukuba igumbi apho abagulayo, umoya omtsha (window ezivulekileyo, ucango, njalo njalo).

Kwimeko apho inkantsi emhlanzweni nomonde kwenzeka, kuyimfuneko ukuba ukujika intloko yakhe kwicala lasekhohlo usule umlomo kunye igozi okanye ngelaphu elicocekileyo. Oku kwenziwa ukuze kuthintelwe ithuba lokufumana netuwa emhlanzweni kungena emiphungeni ngexesha ukuphefumla, nto leyo inokukhokelela kwiingxaki ezongezelelweyo.

Enye uphawu iqhelekileyo kokubetha i kufanelekile unesathuthwane - umntu ulahlekelwa ezingqondweni emva kwemizuzwana embalwa, umzimba ucanda nokulatyuza uxhuzula ukuba unokuthatha imizuzu embalwa. Kananjalo kubalulekile ukuba siqaphele ukuba ukuhlasela ezinjalo kuphindwa izihlandlo eziliqela.

Nabani na ukubuza umbuzo ekufuneka kwenziwe kule meko. Isigulane kufuneka wajika waya ecaleni, wabeka nomluko woboya phantsi kwentloko yakhe. Ingabamba intloko yakho, kufuneka ukosula rhoqo yokuzahlula emlonyeni wakhe, ukuba zaye zabandakanywa isixokelelwano sokuphefumla. Ukuba isigulane ukuba usatya ulwimi wakhe emlonyeni kuyimfuneko ufake naliphi na ikama okanye wand. Kubalulekile ukuphawula ukuba naphantsi kwazo naziphi na iimeko akukho mfuneko yokuba cinezela iingalo kunye nemilenze kumguli okanye bakholosa ngaye lonke. Izenzo ezinjalo kwandisa ngokubalulekileyo uhlaselwe okanye abangele iintlobo ezahlukeneyo yokwenzakala - komsipha, waphuka. Kufuneka nje kancinci ukubamba umlenze yomguli ukuze akakwazi azenzakalise okanye abanye. Musa ukusebenzisa ammonia, njengoko kunokubangela ukusilela yokuphefumla xa isigulane.

Ukuba, emva kokuhlaselwa yintliziyo yexhoba ayeke ukubetha, okanye ngokupheleleyo ukuyeka ukuphefumla, kukho imfuno engxamisekileyo ukwenza umyalezo intliziyo ngqo kunye umlomo-to-emlonyeni okanye umlomo nempumlo.

Ngoku uyazi imisebenzi esisiseko kunye nemigangatho nobetho, nto leyo eya kuba nako ukusindisa ubomi umntu ahlaselwe.

Indlela ukuthintela ukwenzeka lwesifo stroke

Ngokusekelwe kwi-manani angentla, kucacile ukuba esi sifo kubonakala nkqu ebantwaneni. Asinto nzima ukuba baqashele ukuba bonke abantu nyaka abaphethwe kwesi sifo, kuya kusiba ngakumbi nangakumbi. Konke oku kungenxa yokuba ukungatyi ukutya okunesondlo, yokuphila luyeke ukusebenza uze ntshikilelo eliphezulu engqondweni.

Ukuba umntu akanayo kukhokelela yokuphila asebenzayo kwaye usoloko uchitha ixesha kwi computer, yena amathuba omkhulu wokufumana esi sifo. Ukutyeba kuthiwa - esona sizathu sokuba esi sifo, nto leyo esisizathu sokuba ukugcinwa qethe namhlanje kubaluleke kakhulu kubantu abaselula.

umthwalo elirhabaxa nalo rhoqo yimvelaphi le ngxaki, kuba uxinzelelo lwegazi kwandisa umngcipheko komsipha ezincinane igazi ngemithambo, nayo leyo enokukhokelela istroke. Ngoko ke, imfuneko inxaxheba rhoqo kwezemidlalo, yokuphila esebenzayo, ukutya ekunene - kwaye amathuba okuba nestroke lancipha kakhulu.

Esi sifo kakhulu ezibulalayo ezoyikekayo ixesha lethu kanye ngokubethwa. Yintoni na yaye kungeso sizathu kwenzeka esi sifo, usenokuba sele uyazi, ngoko kuyimfuneko ukuba zilandele ngqo ezi iingcebiso ngasentla, ukwenzela ukuthintela isifo kwixesha elizayo.