Shugaban raunin: rarrabuwa. Shugaban rauni: cututtuka, da taimako na farko da kuma magani

Shugaban rauni, sakamakon wanda zai iya zama quite daban-daban (ciki har da mutuwa) yana daya daga cikin mafi kowa hanyar tawaya a cikin matasa da kuma magidanci. Game da rabin dukkan lokuta na traumatic kwakwalwa rauni. Bisa kididdigar da, game da 25-30% na dukkan raunin asusu na kwakwalwa lalacewa. Tare, wadannan lokuta asusu na fiye da rabin na mutuwar. Daga baya a cikin labarin ne rarrabuwa na raunin da ya faru, mai bayanin wasu daga cikinsu.

Overview

Traumatic kwakwalwa rauni ne da ake kira lalacewar da kwanyar kashi ko taushi nama. A karshen, misali, hada da meninges, jijiyoyi, jini da kuma sauran. Shugaban raunin kasu kashi da dama kungiyoyin. Bari mu bincika wasu cikin su daki-daki.

rarrabuwa na raunin da ya faru

Damage iya zama a bude. A wannan yanayin, shi ne suka ji rauni aponeurosis da kuma fata. Kamar yadda kasa na ciwo ayyukan matsayin wani kashi ko nama, wanda karya mafi warai. Iya shiga rauni rauni halin Dura. Kamar yadda wani batu za a iya daukan otlikvorreya saboda karayar kashi a gindi daga cikin kwanyar. Na iya faruwa, kuma rufaffiyar shugaban rauni. A wannan yanayin, da fata za su iya lalacewa, da kuma fascia rike da mutunci. Har ila yau, akwai da wadannan kungiyoyin:

• Tremors. Wannan rauni da kai, wanda ba a halin da naci munanan a cikin kwakwalwa. All manifestations na jihar daga baya lokacin (yawanci kwanaki da dama) bace a kan nasu. A mafi m bayyanar cututtuka dage, akwai wani mafi tsanani shugaban rauni tare da m kwakwalwa lalacewa. Babban sharudda ga kima na jihar abubuwa tsawon tunkaro (daga seconds to hours) da kuma ciwon zurfin jihar baya sanya ɓacin hankali da asarar sani. Daga cikin wadanda ba takamaiman cututtuka kamata a lura da amai, tashin zuciya, disturbances a cardiac aiki, blanching na fata.
• Matsawa hearth kwakwalwa rauni, iska, kasashen waje jiki, hematoma.
• Subarachnoid hemorrhage.
• Yaxuwa axonal lalacewa.

A yi, rubuta shi ne da yawa lokuta a hade. Hada, misali, matsawa iya hematoma da contusion contusion da subarachnoid hemorrhage da kuma matsawa, yaxuwa lalacewa da kuma rauni da sauransu. lalacewar sau da yawa faruwa a sakamakon raunin da fuska.

kwakwalwa contusion

Yana auku a kan bango na ji rauni a kansa. Bruising a take da mutuncin kwakwalwa abu a wani iyaka yanki. Yawanci, wannan yankin ya auku a batu na karfi aikace-aikace. Duk da haka, akwai lokuta inda kurma ya bayyana a gaban gefe (daga protivoudara). A kan bango na wannan jiha ya rushe bangaren kwakwalwa nama, jini, da histological cell shaidu da m samuwar traumatic edema. A fannin wadannan raunuka dabam. Musamman m ne irin ji rauni a kansa a cikin wani yaro.

m

Irin shugaban rauni halin da disconnecting sani ga wani ajali na - har zuwa dama dubun minti. Bayan ta kammala ne na hali gunaguni na tashin zuciya. Har ila yau, da mãsu haƙuri zafi da jiri. Akwai iya zama amai, a wasu lokuta akai-akai. A wasu lokuta, akwai wata matsakaici bradycardia - ragewan da zuciya rate zuwa 60 da kuma kasa da minti daya. A haƙuri iya zama wani taro, retro- da anterograde ɓacin hankali - memory hanawa a cikin nau'i na asarar ikon ajiye da kuma sake kunnawa na baya ilimin da suka samu. Bayan m shugaban rauni alama tachycardia (ya karu da zuciya rate zuwa 90 bpm. / Min). Wasu marasa lafiya na iya tada matsa lamba. A wannan yanayin da jiki zafin jiki da kuma numfasawa, yawanci kasance canzawa. Amma ga neurological bayyanar cututtuka, da cututtuka su ne yawanci sauki hali. Alal misali, a haƙuri iya samun rauni, drowsiness, nystagmus clonic (biphasic rhythmic involuntary ƙungiyoyi na da idanu). Akwai kuma kananan anisocoria, meningeal bayyanar cututtuka, pyramidal insufficiency. Wadannan cututtuka yawanci ci baya a kan 2-3 mako bayan ji rauni a kansa.

Halaye na take hakki

A kan bango na rauni da aka gano microscopically lalata da fasali m medulla. Yana bayyana kanta a matsayin yankunan da gida kumburi, bruising cortical ma'ana, mai yiwuwa a tare da tare da wata iyaka subarachnoid hemorrhage. Yana, bi da bi, ne ya sa ta katsewa na pial tasoshin. Subarachnoid hemorrhage lokacin da jini ratsa cikin arachnoid da kuma shimfidawa a kan muhimmi tafkunan ruwa, fasa da kuma furrows kwakwalwa. Yana iya zama na gida, ko ciko da dukan sararin samaniya tare da samuwar clots. Yanayin tasowa quite m. A haƙuri ba zato ba tsammani ji wani "busa ga shugaban", da sauri bayyana photophobia, amai, mai tsanani da ciwon kai. M maimaita kowa yana da convulsions. Yawancin lokaci da yanayin da aka ba tare da inna. Duk da haka, da yiwuwar meningeal bayyanar cututtuka. Musamman ma, akwai na iya zama wani m wuyansa tsokoki (a karkata daga kansa ba zai iya shãfe haƙuri da sternum Chin) da kuma kerning alama (ba zai iya daidaita gwiwa lanƙwasa a shi da kuma hip kafar). Idan akwai alamun meningeal hangula auku meninges streamed jini.

bruising tsakaita

Wannan shugaban rauni halin da shafe tsawon kashewa na sani (dama hours). A haƙuri yana da wani alama ɓacin hankali. Akwai kuma ãyõyin ji rauni a kansa wadannan: mai tsanani da ciwon kai, da maimaita amai, shafi tunanin mutum cuta. M dõgẽwa disturbances a harshen damo. A musamman, shi za a iya alama bradycardia ko tachycardia, ta ƙara matsa lamba, tachypnea (m numfashi m hanyoyi ba tare da keta kudi da kuma permeability), low-sa zazzabi (jiki zafin jiki ne ya karu zuwa 37-37.9 deg.). M ne tushe da kuma harsashi bayyanar cututtuka na dissociation na jijiya reflexes da tsoka sautin, dangantakar pathological manifestations. Shin isasshe sarari mai da hankali bayyanar cututtuka. Ta halin ne ya sa ta sarrafawa daga rauni. Found oculomotor da pupillary cuta, jawabin cuta, ji na ƙwarai, paresis na extremities da sauran. Wadannan cututtuka a cikin uku zuwa biyar makonni, hankali smoothed fitar, kamar yadda mai mulkin. Duk da haka, a wasu lokuta, ya bayyana asibiti hoto da aka ajiye dogon isa. Lokacin da rauni na matsakaici mai tsanani sau da yawa samu samu karaya a cikin ƙasusuwansa daga cikin tushe da kuma calvarium, m subarachnoid hemorrhage. CT mai da hankali canje-canje gano a matsayin lafiya inclusions ko high-yawa kama matsakaici karuwa yawa. Wannan yayi dace da kadan zub da jini a yankin na rauni ko hemorrhagic impregnation na kwakwalwa nama ba tare da babban ƙasƙanci.

Mai tsananin shugaban rauni

A wannan yanayin, intracerebral hematoma lura a duka biyu frontal lobes matsayin iyakance jini yawa a daban-daban jijiyoyin bugun gini raunuka katsewa. Wannan Forms rami cewa ya ƙunshi coagulated jini ko ruwa. Rauni a mai tsanani ne halin da tsawo kashewa na sani (makonni da dama). Sau da yawa wani alama motor zumudi. Har ila yau, alama cuta na da harshen damo a cikin jiki. Duk da haka, a kwatanta da wani talakawan mataki a cikin nauyi, su ne mafi pronounced. Alal misali, akwai wani rashin lafiya na numfashi aiki a take hakkin da kari waƙoƙi da ƙasa. A haƙuri an kiyaye pyrexia, dominance na farko kara neurological bayyanar cututtuka. A musamman, gano hadiya cuta, iyo ƙungiyoyi daga cikin idanu, ptosis, ko mydriasis, paresis ganinsu, decerebrate rigidity, motsi, ci gaban ko hanawa na reflexes, mucous membranes, fata, tendons da sauransu. Neurological cututtuka a cikin na farko lokaci (lokacin farko da sa'o'i ko kwana) mamaye da mai da hankali hemispheric bayyanar cututtuka. A haƙuri iya samun reshe paresis, subcortical cuta da tsoka sautin, da sauransu. A wasu lokuta, m mai da hankali ko kowa yana da seizures. Komawa da baya mai da hankali bayyananen faruwa sannu a hankali isa. A hatsarin da irin wannan shugaban rauni? A sakamakon na iya zama quite tsanani. Sau da yawa akwai suna alama saura effects, yafi a cikin filin da shafi tunanin mutum da kuma mota.

Manuniya CT

A tsanani rauni a sulusin daga cikin lokuta ana ruwaito daga mai da hankali raunuka a kwakwalwa a cikin nau'i na ba-uniform yawa yankunan kara. A wannan yanayin, akwai wani canzawar zones. Kasaftawa yankunan da high da kuma low yawa. A mafi tsanani yanayin halaka directed medulla kuma zai iya kai zurfi a cikin na ramin zuciya tsarin da subcortical nuclei. kuzarin kawo cikas lura nuna a hankali a hankali ƙi a cikin sealing yankuna, su fe da kuma canji a cikin wani taro yi kama. Ya zo tare da 8 ko 10 hours bayan da ya faru. Komawa da baya pathological substrate kewaya sakamako ne a hankali, na nuna gaban maras resorbed fasa clots da kuma nama a mayar da hankali da rauni. A wannan gaba, suka zama gwada ravnoplotnymi kewaye edematous kwakwalwa abu. The bacewar bayan 30-40 kwanaki. girma sakamako ya nuna resorption da kuma samuwar substrate maimakon yankunan atrophy ko cystic cavities.

Lalacewar da na baya fossa Tsarin

Wannan rauni aka dauke su mafi tsanani daga duk shugaban raunin. Domin jihar ne halin da wadannan cututtuka: ciki na sani da kuma hade da kara, cerebellar, cerebral da meningeal cututtuka saboda da m matsawa da kuma sayar da giya wurare dabam dabam cuta.

Warkewa matakan lokacin da rauni

Ko da kuwa da har na rauni, da mãsu haƙuri kiwon lafiya da ya kamata a bayar. A hali na rauni da wanda aka azabtar ya kai da za a hawa zuwa asibiti maza maza. Ga wani cikakken ganewar asali ya nuna da X-ray, kuma CT. A haƙuri bukatar gado sauran. Its tsawon tare da m - 7-10 kwana, da wani talakawan -. 14 days. A cikin hali na tsanani traumatic kwakwalwa rauni ya kamata a dauka domin farfado da. Sun fara da farkon a matsayin pre-asibiti lokaci da kuma ci gaba kwari-jihar yanayi. Don normalize da numfashi ne zama dole don tabbatar da free giciye-kasa a cikin sama numfashi fili - yantar da su daga gamsai, jini, aman. Yana gabatar da iska bututu, a tracheostomy aka yi (nama dissection kuma trachea cannula shigarwa ko kafa m ramukan - stoma). Har ila yau, amfani da inhalation amfani oxy-iska cakuda. Idan dole, nema inji iska.

Far ga girgizawa

Idan aka ƙaddara cewa haƙuri yana ji rauni a kansa, da magani ya kamata a yi a cikin neurosurgical asibiti. Lokacin da girgizawa nuna biyar gado sauran. A babu rikitarwa da haƙuri iya dakatar a kan rana ta 7-10. Yana da ake sa da outpatient magani, tsowon lokacin da - har zuwa kwanaki 14. Magani ga girgizawa ne da nufin tabbatar da dorewar aikin jiha na kwakwalwa, zafi management, rashin barci, tashin hankali. Yawanci, magunguna wajabta kewayon hada hypnotics, sedatives da analgesics. Kamar yadda analgesics amfani da kwayoyi kamar "Baralgin" "Pentalgin" maksigan "" sedalgin Reglan "da sauransu. Yana nufin iya sanya wa juwa." "Don na sedatives hada da irin magunguna a matsayin" Valocordin "" Corvalol " da kuma sauran dauke da phenobarbital. Aiwatar da na ganye infusions (motherwort, valerian).

Nagari kamar yadda tranquilizers. Wadannan sun hada da, misali, hada da irin jamiái matsayin "Rudotel", "Nozepam", "Phenazepam", "Sibazon", "elenium" da sauransu. Bugu da kari ga symptomatic magani nada Course na rayuwa da kuma jijiyoyin bugun gini magani. Yana taimaka wa mai mafi m da kuma cikakken maido da gaji da damuwa da kwakwalwa aiki, ya hana daban-daban postkommotsionnye bayyanar cututtuka. Ganawa tserebrotropnoy da vasotropic far iya zama bayan 5-7 kwanaki bayan rauni. Advantageously hade nootropic (kwayoyi "Pikamilon" "aminolone", da dai sauransu) da kuma vasotropic (magunguna "Teonikol" stugeron "" Cavinton ") tana nufin shawo kan asthenic bayyananen marasa lafiya an sanya bitamin gidaje." Centrum "" Complivit "" Vitrum "da sauransu. Nagari tonics: Schisandra 'ya'yan tsantsa Eleutherococcus, ginseng tushen. ya kamata a lura da cewa shake ba ya bayyana wani kwayoyin rauni. Idan akwai wani canje-canje a kan MRI ko CT scan, shi wajibi ne don magana game da mafi tsanani a raunuka - kwakwalwa rauni.

gudanar da sa baki

Inji raunin bukatar tiyata. Surgery aka nuna a cikin hali na murkushe rauni tare da kwakwalwa nama. Yawanci, irin wannan inji raunin da faruwa a cikin boko iyakacin duniya da kuma yankin na frontal lobes. Kamar yadda wani m hanya hidima osteoplastic trepanation. The aiki ne ta samar da ramuka a cikin kashi don shiga cikin kogo da kuma detritus leaching bayani daga sodium chloride (0.9%).

Outlook

M lalacewar yawanci quite m sakamako (ga yarda da shawarwari da haƙuri game da magani da kuma far). A matsakaici yanayin shi ne sau da yawa yiwu a cimma cikakkar dawo da kuma maido da zaman jama'a da kuma aiki aiki na shafa. Wasu marasa lafiya na iya fuskanci meningitis da hydrocephalus tsokani asthenia, jijiyoyin bugun gini tabarbarewa, zafi, cuta da daidaituwa, a tsaye da kuma sauran neurological bayyanar cututtuka. A kan backdrop mai tsanani rauni a 30-50% na lokuta mutuwa ya auku. Daga cikin wadanda suka tsira ne sosai na kowa tawaya, wanda suke da babban Sanadin shafi tunanin mutum da cuta, danye magana da kuma mota disturbances, seizures. A bude shugaban raunin ne m kumburi rikitarwa. A musamman, da babban hadarin da bunkasa mai kwakwalwa ƙurji, ventriculitis, encephalitis, meningitis. Har ila yau, m liquorrhea wakiltar outflow na cerebrospinal ruwa (CSF) daga halitta ko ramukan kafa saboda daban-daban dalilai a cikin kasusuwa na kashin baya da kuma kwanyar. Rabin da mummunar a kai rauni lissafta (RTA) hatsarori a kan hanyoyi.