Neurogenic shock: chii, nzira yekuiongorora uye nzira yekurapa murwere

By Cristiano Antonino On Jan 31, 2023

Muneurogenic shock, vasodilation inoitika semugumisiro wekurasikirwa kwekuenzanisa pakati peparasympathetic uye kunzwira tsitsi kukurudzira.

Chii chinonzi Neurogenic Shock?

Neurogenic shock imhando yekugovera yekuvhunduka.

Irwo rudzi rwekuvhunduka (chirwere chinotyisa chehupenyu umo pasina kukwana kweropa kuyerera mumuviri wose) iyo inokonzerwa nekurasikirwa kamwe kamwe kwezviratidzo kubva kune tsitsi dzetsinga dzinochengetedza mutsara wemazuva ose mumadziro emidziyo yeropa.

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Murwere anoona zvinotevera zvinoguma neurogenic shock:

Kukurudzira. Kukurudzira kunzwira tsitsi kunoita kuti tsandanyama yakatsetseka isungirire, uye parasympathetic stimulation inokonzera vascular smooth tsandanyama kuti isununguke kana kureruka.
Vasodilation. Murwere anosangana nekukurudzira kweparasympathetic kunokonzera vasodilation inogara kwenguva yakareba, zvichiita kuti iite hypovolemic state.
Hypotension. Uwandu hweropa hwakakwana, nokuti vasculature yakawedzera; huwandu hweropa hunobviswa, huchigadzira hypotensive (yakaderera BP) mamiriro.
Kuchinja kwemwoyo. Iyo yakanyanya parasympathetic stimulation inoitika neurogenic shock inokonzera kuderera kwakanyanya kwemurwere systemic vascular resistance uye bradycardia.
Kusakwana perfusion. Kusakwana kweBP kunoguma nekusakwana kupfachura kwematishu nemaseru izvo zvinowanzoitika kumatunhu ese ekuvhunduka.

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Neurogenic shock inogona kukonzerwa nezvinotevera:

Mumhara kukuvara kwetambo. Spinal cord kukuvara (SCI) inozivikanwa kukonzera hypotension uye bradycardia (neurogenic shock).
Spinal anesthesia. Spinal anesthesia - jekiseni reanesthetic munzvimbo yakatenderedza musana - kana kupatsanurwa kwepinal cord kunokonzera kudonha kweBP nekuda kwekureruka kwetsinga yeropa muchikamu chezasi chemuviri uye mhedzisiro yekuderera kwekudzoka kwe venous. mwoyo.
Kuora mwoyo chiito chemishonga. Kuora mwoyo kuita kwemishonga uye kushayikwa kweglucose kunogona kukonzera kuvhunduka kweneurogenic.

Makiriniki ekuratidzwa kweneurogenic shock zviratidzo zveparasympathetic stimulation

Dry, ganda rinodziya. Panzvimbo peganda rinotonhorera, rakanyorova, murwere anosangana neganda rakaoma, rinodziya nekuda kwevasodilation uye kusakwanisa kuvasoconstrict.
Hypotension. Hypotension inoitika nekuda kwekamwe kamwe, kuwedzera kukuru.
Bradycardia. Panzvimbo pekutora tachycardia, murwere anonzwa bradycardia.
Diaphragmatic breathing. Kana kukuvadzwa kuri pasi pe5th cervical vertebra, murwere acharatidza kufema kwe diaphragmatic nekuda kwekurasikirwa kwekutya kwehutano hwe intercostal muscles (iyo inodiwa pakufema kwe thoracic).
Kusungwa kwekufema. Kana kukuvadzwa kuri pamusoro pe 3rd cervical vertebra, murwere achapinda mukusungwa kwekufema pakarepo mushure mekukuvadzwa, nekuda kwekurasikirwa kwekutya kwekutya kwe diaphragm.

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Kuongorora uye Diagnostic Zviwanikwa

Kuongororwa kweurogenic shock kunogoneka kuburikidza nekutevera bvunzo:

Computerized tomography (CT) scan. A CT scan inogona kupa kutarisa kuri nani pane zvisiri izvo zvinoonekwa paX-ray.
Xrays. Vashandi vekurapa vanowanzo raira bvunzo idzi kune vanhu vanofungidzirwa kuve nekukuvara kwemusana mushure mekushungurudzika.
Magnetic resonance imaging (MRI). MRI inoshandisa simba remagineti uye masaisai eredhiyo kugadzira mifananidzo inogadzirwa nekombuta.

Medical Management

Kurapa neurogenic shock kunosanganisira:

Kudzoreredza inzwi rekunzwira tsitsi. Zvingava kuburikidza nekudzikamisa kwekukuvara kwemusana kana, muchiitiko chepinal anesthesia, nekuisa murwere zvakakodzera.
Immobilization. Kana murwere ane mhosva inofungidzirwa yekukuvara kwepelinha, traction inogona kudiwa kuti igadzikane musana kuti uuye nayo pakurongeka kwakakodzera.
IV zvinwiwa. Kudzorwa kwezvinwiwa zveIV kunoitwa kudzikamisa BP yemurwere.

Pharmacologic Therapy

Mishonga inopihwa kumurwere ari kubatwa neurogenic shock ndeiyi:

Inotropic agents. Inotropic agents senge dopamine inogona kuisirwa kuti fluid resuscitation.
Atropine. Atropine inopiwa intravenously kugadzirisa bradycardia yakaoma.
Steroids. Mwoyo murefu ane hutachiona hwehutachiona hunogona kupiwa IV steroids, yakadai semethylprednisolone muhupamhi hwepamusoro, mukati maawa masere ekutanga kweurogenic shock.
Heparin. Kudzora kweheparin kana yakaderera molecular-weight heparin sekurairwa kunogona kudzivirira thrombus kuumbwa.

Nursing management yemurwere ane neuroogenic shock inosanganisira:

Nursing Assessment

Kuongororwa kwemurwere ane neurogenic shock inofanira kusanganisira:

ABC kuongorora. Mupi weprehospital anofanirwa kutevera nzira yekutanga yemhepo, kufema, kutenderera kune murwere wekutambudzika apo achidzivirira musana kubva kune imwezve kufamba.
Neurologic assessment. Neurologic deficits uye chiyero chepamusoro pakatanga kusagadzikana kunofanira kuonekwa.

Kuongororwa kweUchiremba

Kubva pane data rekuongorora, kuongororwa kwehukoti kune murwere ane neuroogenic shock ndeiyi:

Ngozi yekutadza kufema maitiro ane chekuita nekukanganiswa kweiyo innervation ye diaphragm (maronda ari kana pamusoro peC-5).
Ngozi yekukuvara ine chekuita nekushaya simba kwechinguvana / kusagadzikana kwe spinal column.
Kusakanganiswa kwekufamba kwemuviri kunoenderana neuromuscular impairment.
Kuvhiringidzika kwekuona kwekunzwa kwakabatana nekuparadzwa kwematurakiti ekunzwa ane kuchinjwa kwekugamuchira kwekunzwa, kutapurirana, uye kubatanidzwa.
Kurwadza kwakanyanya kunoenderana nekubatanidzwa kweropa yechipiri kune thrombus kuumbwa.

Nursing Care Planning & Zvinangwa

Zvinangwa zvikuru zvemurwere zvinosanganisira:

Chengetedza mhepo yakakwana sezvinoratidzwa nekusavapo kwe mweya wekufema uye ABGs mukati memiganhu inogamuchirwa
Ratidza maitiro akakodzera kutsigira kuedza kwekufema.
Chengetedza kurongeka kwakaringana kwemusana pasina kumwe kukuvadzwa kwemusana.
Chengetedza nzvimbo yebasa sezvinoratidzwa nekusavapo kwezvibvumirano, kudonha kwetsoka.
Wedzera simba renhengo dzemuviri dzisina kukanganiswa / dzinobhadhara.
Ratidza maitiro/maitiro anogonesa kutangisazve basa.
Ziva kukanganiswa kwekunzwa.
Ziva maitiro ekutsiva kukanganisa.
Verbalize kuziva zvinodiwa zvekunzwa uye mukana wekunyima / kuwandisa.

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Kupindira Kwevakoti

Kupindira kwavanamukoti kunonangidzirwa pakutsigira moyo wemoyo uye neurologic basa kusvika iyo inowanzo chinguva chidiki chiitiko cheneurogenic shock chagadziriswa.
Simudza musoro wemubhedha. Kukwidziridzwa kwemusoro kunobatsira kudzivirira kupararira kweanesthetic agent kumusoro kwemutsipa wepelinha apo murwere anogamuchira musana kana epidural anesthesia.
Kupindira kwepasi. Kuisa anti-embolism masokisi uye kusimudza tsoka yemubhedha kunogona kubatsira kuderedza kuungana kweropa mumakumbo uye kudzivirira thrombus kuumbwa.
Exercise. Passive huwandu hwekufamba kweiyo immobile migumo inobatsira kusimudzira kutenderera.
Airway patency. Chengetedza patent airway: chengeta musoro usina kwawakarerekera, simudza musoro wemubhedha zvishoma kana ukatenderwa, shandisa nzira yekufambisa mhepo sezvakaratidzwa.
Okisijeni. Gadzira okisijeni nenzira yakakodzera (nasal prongs, mask, intubation, ventilator).
Mabasa. Ronga zviitwa kuti upe nguva yekuzorora isina kukanganiswa uye kukurudzira kubatanidzwa mukati mekushivirira kwemunhu uye kugona.
BP monitoring. Yera uye tarisa BP pamberi uye mushure mekuita muzvikamu zvakakomba kana kusvika yakagadzikana.
Deredza kufunganya. Batsira murwere kuti azive uye adzorere kuchinjwa kwekunzwa.

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Evaluation

Migumisiro inotarisirwa yemurwere ndeiyi:

Kuchengetedza mhepo yakakwana.
Akaratidza maitiro akakodzera kutsigira kuedza kwekufema.
Kuchengetedza kurongeka kwakaringana kwemusana pasina kumwe kukuvadzwa kwemusana.
Yakachengetwa nzvimbo yebasa.
Kuwedzera simba rezvikamu zvemuviri zvisina kukanganiswa / zvinoripira.
Akaratidza maitiro/maitiro anogonesa kutangisazve basa.
Kuzivikanwa kukanganisa kwekunzwa.
Kuzivikanwa maitiro ekutsiva kukanganisa.
Verbalized kuziva kwezvido zvekunzwa uye mukana wekunyima / kuwandisa.

Zvinyorwa Zvinyorwa

Chinangwa chezvinyorwa ndezvi:

Yakakodzera nhoroondo yedambudziko.
Maitiro ekufema, manzwi ekufema, kushandiswa kwemhasuru dzekuwedzera.
Laboratory values.
Nhoroondo yekare uye yemazuva ano yekukuvara, kuziva nezvekuchengetedza zvinodiwa.
Kushandisa kuchengeteka midziyo kana maitiro.
Zvinetso zvezvakatipoteredza, nyaya dzekuchengetedza.
Chiyero chebasa, kugona kutora chikamu mune zvakati kana zvinodiwa zviitiko.
Tsananguro yemutengi yekupindura kumarwadzo, zvakananga zvekurwadziwa kwekutsvaga, zvinotarisirwa zvekugadzirisa marwadzo, uye chiyero chinogamuchirwa chemarwadzo.
Usati washandisa mishonga.
Urongwa hwekutarisira, kupindira kwakananga, uye ndiani anobatanidzwa mukuronga.
Chirongwa chekudzidzisa.
Mhinduro kune kupindira, kudzidzisa, zviito zvakaitwa, uye chirongwa chekurapa.
Kuwana kana kufambira mberi kune zvinodiwa.
Kugadziriswa kurongwa hwekutarisira.