Spinal shock: zvikonzero, zviratidzo, njodzi, kuongororwa, kurapwa, kufungidzira, kufa

By Cristiano Antonino On Dai 15, 2022

Spinal distribution shock: 'kuvhunduka' mukurapa kunoreva chirwere, kureva seti yezviratidzo nezviratidzo, zvinokonzerwa nekuderedzwa kweperfusion padanho rehurongwa nekusaenzana pakati pekuwanikwa kweokisijeni uye kudiwa kwayo padanho retishu.

Kuvhunduka kunokamurwa kuita mapoka makuru maviri

kuderera kwekutya kwemwoyo: cardiogenic, obstructive, haemorrhagic hypovolaemic uye isiri-hemorrhagic hypovolaemic;
distributive shock (kubva mukuderera kwese kwese kweperipheral resistance): septic, allergic ('anaphylactic shock'), neurogenic uye Musipinha.

Spinal distributive shock

Distributive shock rudzi rwekuvhundutsa kunokonzerwa nekusawirirana pakati pemubhedha wevascular, iyo yakanyanyisa kuderedzwa, uye ropa rinotenderera, iro - kunyange risina kuderedzwa zvachose - rinova risina kukwana nekuda kwevasodilation yakagadzirwa.

Spinal shock imhando isingawanzo ye distributive shock umo peripheral vasodilation inokonzerwa nekukuvadzwa kumusana wemusana urimo. spinal column.

Iyi fomu haifaniri kuvhiringidzwa neyakafanana, neurogenic shock.

Mune magwaro akawanda, marudzi maviri ekuvhundutsa akabatanidzwa, asi munyaya yekuvhunduka kwemusana, kurasikirwa kwepinal cord-mediated reflexes kunoonekwa.

Kuvhunduka kunowanzova chiratidzo chekutanga chekukuvara kwemusana.

KUDZIDZWA MURUBATSIRO RWEKUTANGA? SHANYIRA DMC DINAS MEDICAL CONSULTANTS BOOTH PAEMERGENCY EXPO

Murudzi urwu rwekuvhunduka kwemusana pane, kurerutsa, iyi inotevedzana yezviitiko:

kukuvara kwetsinga kunoguma nekuderera kwemaitiro etsinga anodzora kutenderera kweropa;
peripheral vasodilatation inoitika;
peripheral vasodilatation inotungamirira kune arterial hypotension;
arterial hypotension inotungamira kune tishu hypoperfusion;
tishu hypoperfusion inotungamirira kune tishu anoxia;
ischemic pakutambudzika kunotungamirira kune necrosis (kufa) kwezvinyama, izvo zvinomira kushanda.

Zviratidzo uye zviratidzo zvekuvhunduka kwemusana

Izvi zvinotevera zviratidzo zvekiriniki uye zviratidzo zvinogona kuonekwa mumhando iyi yekuvhunduka:

arterial hypotension
kuneta;
kuchinjwa kwekufema;
bradycardia kana tachycardia (kuderera kana kuwedzera kwemwoyo);
zviratidzo uye zviratidzo zve-multi-organ dysfunction;
kudonha kweropa;
kusungwa kwemoyo;
kusungwa kwepulmonary;
kuderera kwakanyanya muzinga rekuziva;
kudya;
rufu.

Izvi zviratidzo nezviratidzo zvinofanirawo kubatanidzwa nezvimwe zviratidzo nezviratidzo zvinokonzerwa nemamiriro ekumusoro kwemvura uye / kana pathology yakakonzera kuvhunduka, seyayo yekutsikirira kwepinal cord, izvo zvinogona kukonzera kukanganisa kwemotokari (semuenzaniso kuoma mitezo yezasi kana kunyange mitezo yepamusoro munyaya yekukuvara kwekervical vertebra) uye kukanganisa kwekunzwa.

Kurasikirwa kwekunzwa uye kufamba kunoitika pazasi penzvimbo yekukuvara, saka iyo yakakwirira kukuvara (semuenzaniso cervical vertebra fracture), iyo yakanyanya kukuvadza kukuvara kunowanzo kuve.

KUnunura RADIO MUNYIKA? SHANYIRA EMS RADIO BOOTH PAEMERGENCY EXPO

Zvimwe zviratidzo zvekukurumidza zvinogona kusanganisira:

kurwadziwa munzvimbo yekukuvara
tsandanyama spasticity;
kurira uye chiveve mumakumbo;
priapism muvarume;
dyspnea;
kutadza kufema;
cardiac arrhythmia;
kurasikirwa kwebasa redundira;
kurasikirwa kwebasa rehutano.

Migumisiro yenguva refu yekukuvara kwepelinha inosiyana zvichienderana nenzvimbo uye kuoma kwekukuvara: sezvatotaurwa, iyo yakakwirira kukuvadza mumusana, zvakanyanya, kazhinji, zviratidzo.

Semuenzaniso, kukuvadzwa kumusana wekervical kunokanganisa makumbo mana ose, pamwe chete nemisungo inodzora kufema uye mamwe mabasa anokosha.

Kukuvara kune lumbar spine, kune rumwe rutivi, kuchakanganisa makumbo ezasi (kwete mazamu epamusoro) uye ura uye bladder basa, asi kazhinji haaiti dzimwe nhengo kana zvirongwa.

Complete high mutsipa kukuvara uye kukuvadzwa kwakaomeswa nekumwe kukuvara kwakakomba kunogona kukonzera kufa nekukurumidza kana kukonzera kukanganisa kwakanyanya kwekuzvimiririra, zvichizoda rubatsiro rwakakwana kwehupenyu hwese hwemurwere.

Matanho ekuvhunduka kwemusana

Rudzi urwu rwekuvhundutsa runosiyaniswa muzvikamu zvina zvakasiyana zvichienderana nekufamba kweiyo reflexes:

chikamu 1 kurasikirwa kwemafungiro (areflexia);
chikamu 2 mushure memazuva maviri chikamu chepfungwa chinowanikwa;
chikamu 3 hyperreflexia inoitika;
chikamu 4 spastic phase.

Maererano nevamwe vanyori, spinal shock inogona kukamurwa kuita zvikamu zviviri:

- acute phase

areflexia;
kuchengetedza nzira dzekubuda;
vasoparalysis;
ganda hypothermia;
paraplegia;
muscular hypotonia;

- chisingaperi chikamu:

hyperflexia;
spasticism;
spinal automatism.

Zvikamu izvi zvinowanzobatanidza nguva yakareba yemavhiki matatu kusvika matanhatu; mune zvimwe zviitiko nguva yose yezvikamu izvi yave iri mwedzi yakawanda.

Munguva inongotevera kukuvara (maawa anogara kana mazuva), kuvhunduka kwemusana kunoratidzwa nekuputika, kurasikirwa kwemabasa ekuzvimirira uye anesthesia yakakwana pasi pekukuvadzwa, iyo inopedza nguva yakareba kukuvara pachayo kune chikamu chepamusoro chemuzongoza; mufananidzo uyu unobudirira zvishoma nezvishoma ne spasticity.

Zvikonzero uye njodzi zvinhu zvekuvhunduka kwemusana

Pathologies nemamiriro ezvinhu anowanzo kukonzera uye/kana kukurudzira neurogenic shock kukuvara kwemusana nequadriplegia kana paraplegia.

Kushungurudzika kunowanzoita kuputsika kwe vertebra uye / kana kusununguka kwayo, zvichiita kuti kumanikidzika uye / kana kukuvara kwemusana.

Mhando dzakadaro dzekukuvadzwa dzinowanzoitika mumotokari kana mutsaona dzemitambo, kana mukudonha kana kukuvara kunokonzerwa nepfuti.

Spinal cord trauma inogona kuva

yakananga (yakavharwa kana kupinda mukati);
yakabatana nekudarika miganhu yekufamba kunopiwa kumutsipa wepelinha mukati memugero wepelinha (yakanyanyisa hyperextension, hyperflexion kana torsion).

Spinal shock zvakare dzimwe nguva mhedzisiro yemamota emusana kana kusagadzikana kunogona kuitika mushure mekuzvarwa nekuda kwezviitiko zvine chekuita nekushushikana.

Nzira yekuvhunduka kwemusana

Zvikamu zvitatu zvakasiyana zvinogona kuonekwa mukuvhunduka:

chikamu chekutanga chekubhadhara: kuora mwoyo kwemoyo kunowedzera uye muviri unotanga nzira dzekubhadhara dzinopindirana netsitsi dzetsitsi, catecholamines uye kugadzirwa kwezvinhu zvemunharaunda zvakadai sema cytokines. Danho rekutanga rinorapika zviri nyore. Kukurumidza kuongororwa kunotungamirira kune fungidziro iri nani, zvisinei iyo inowanzooma sezvo zviratidzo nezviratidzo zvingave zvakasvibiswa kana kuti zvisiri izvo pane iyi nhanho;
kufambira mberi kwechikamu: nzira dzekubhadhara dzinove dzisingabatsiri uye kupera kweperfusion kune nhengo dzinokosha kunowedzera nekukurumidza, zvichiita kuti pathophysiological kusaenzana kwakanyanya ne ischaemia, kukuvara kwemasero uye kuunganidza zvinhu zvevasoactive. Vasodilation nekuwedzera kwematishu permeability inogona kutungamirira mukuparadzirwa intravascular coagulation.
irreversibility phase: ichi ndicho chikamu chakanyanya kuomarara, apo zviratidzo nezviratidzo zvinogonesa kuongororwa, izvo, zvisinei, zvinoitwa panguva ino, kazhinji zvinotungamira mukusashanda kwekurapa uye kutadza kufungidzira. Irreversible coma uye kuderedza kushanda kwemwoyo kunogona kuitika, kusvika kumwoyo kusungwa uye kufa kwemurwere.

Kuongororwa kwekuvhunduka kwemusana

Kuongororwa kwekuvhunduka kunobva pane akasiyana maturusi, anosanganisira:

anamnesis;
kuongorora kwechinangwa;
ma laboratory tests;
haemochrome;
haemogasanalysis;
CT SCAN;
coronarography;
pulmonary angiography;
electrocardiogram;
X-ray yechipfuva;
echocardiogram ine colordoppler.

Ongororo dzinonyanya kushandiswa pakuongorora kwakasiyana iCT scan, echocardiography, cardiac catheterisation, abdominal ultrasound, pamwe nerabhoritari bvunzo kuti pasave nekubuda kweropa uye coagulation kusagadzikana.

Anamnesis uye kuongororwa kwechinangwa kwakakosha uye kunofanirwa kuitwa nekukurumidza.

Muchiitiko chemurwere asina ruzivo, nhoroondo inogona kutorwa nekubatsirwa kwevemhuri kana shamwari, kana iripo.

Pakuongororwa kwechinangwa, chidzidzo chekuvhunduka chinowanzo ratidza kucheneruka, nekutonhora, ganda rakanyorova, tachycardic, nekudzikira kwecarotid pulse, kusagadzikana renal basa (oliguria) uye kusaziva.

Panguva yekuongororwa, zvichave zvakakosha kuti ive nechokwadi chekuti airway patency muvarwere vane ruzivo rwakaremara, isa nyaya yacho munzvimbo ye-anti-shock (supine), kuvhara munhu anenge akuvara, pasina kumuita ziya, kudzivirira lipotimia uye nekudaro kuwedzera kuwedzera kweiyo nyika. kuvhunduka.

Nezvekuongororwa murabhoritari, chakakosha pakuonekwa kwekuvhunduka i arterial kana venous haemogasanalysis, kuongorora acid-base balance yemuviri.

Sezvineiwo, kuvhunduka kunoperekedzwa nemufananidzo wemetabolism acidemia ine yakawedzera lactates uye base kushomeka.

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CT uye MRI scans yemuzongoza yakakosha kuona kukuvara kwemusana

Kuongororwa uye kutungamirirwa kwekukuvara kwepelinha kunogona kuva kwakaoma uye kukuvadzwa kusina kuonekwa nokukurumidza kunogona kukonzera matambudziko makuru.

Kana kukuvara kwepelinha kuchifungidzirwa, musana unofanirwa kuchengetedzwa uye kusagadzikana nguva dzese panguva yekuongorora uye kuongororwa.

Kuongorora kwekutanga kunosanganisira nhoroondo yezvokurapa, kuongororwa kwekliniki uye pamusoro pezvose zvekufungidzira (X-ray, CT scan, MRI), iyo inofanira kusanganisira yose musana, kwete nzvimbo iyo kukuvara kunofungidzirwa.

Kusarudzwa kwemaitiro ekuongorora kunosiyana zvichienderana nemamiriro ekuziva kwemurwere uye kuvapo kwezvimwe zvinokuvadza.

Mumusana wekuparadzirwa kuvhunduka, mamiriro aya anoitika:

preload: inoderera/yakajairika
afterload: inoderera;
contractility: zvakajairika;
pakati venous satO2: inosiyana; mu arteriovenous shunt kune kuwedzera;
Hb concentration: yakajairika;
diuresis: yakajairika / yakaderera;
peripheral resistance: yakaderera;
kunzwa: zvakajairika muurogenic uye spinal shock; kubvongodza/kuvhiringika mu septic uye allergic shock.

Ngatiyeukei kuti kubuda kwe systolic kunoenderana nemutemo waStarling pane preload, afterload uye contractility yemoyo, inogona kutariswa zvekiriniki zvisina kunanga nenzira dzakasiyana siyana:

preload: nekuyera iyo yepakati venous pressure kuburikidza nekushandiswa kweSwan-Ganz catheter, uchiyeuka kuti shanduko iyi haisi mumutsara wekushanda ne preload, asi izvi zvakare zvinoenderana nekuoma kwemadziro e ventricle yakarurama;
afterload: nekuyera systemic arterial pressure (kunyanya diastolic, kureva iyo 'minimum');
contractility: ne echocardiogram kana myocardial scintigraphy.

Mamwe ma parameter akakosha munyaya yekuvhunduka anotariswa ne:

hemoglobin: ne haemochrome;
oxygen saturation: kuburikidza nesaturation mita ye systemic kukosha uye nekutora yakakosha sampuli kubva ku nechepakati venous catheter ye venous saturation (musiyano neiyo arterial kukosha inoratidza kushandiswa kweokisijeni nematishu)
arterial oxygen pressure: kuburikidza nehemogasanalysis
diuresis: kuburikidza bladder catheter.

Panguva yekuongorora, murwere anocherechedzwa nguva dzose, kutarisa kuti mamiriro ezvinhu anoshanduka sei, nguva dzose kuchengetedza 'ABC kutonga' mupfungwa, kureva kutarisa

patency yenzira dzemhepo
kuvapo kwekufema;
kuvapo kwekutenderera.

Zvinhu zvitatu izvi zvakakosha pakurarama kwemurwere, uye zvinofanirwa kudzorwa - uye kana zvichidikanwa zvigadziriswe zvakare - nenzira iyoyo.

kurapa

Kurapa kunoenderana nepamusoro pechikonzero chekuvhunduka. Oxygen administration inowanzoitwa, inoteverwa nekugadziriswa kwemvura yemunhu kuti adzorere zvakakodzera volaemia: isotonic crystalloids inoshandiswa nokuda kwechinangwa ichi; mune dzimwe nguva dzakanyanya kuoma apo kurapwa kwemaitiro kunoratidzika kunge kusina kubudirira, dopamine kana noradrenaline inoshandiswa.

Kunyanya, kurapwa kunosanganisira

immobilisation yemusoro, mutsipa uye musana;
kushandiswa kwezviyero zvakananga zvine chekuita nekumusoro kwechikonzero chekuvhunduka, semuenzaniso tsinga uye / kana orthopedic kuvhiyiwa kurapa mumamiriro emamota uye / kana kukuvadzwa kwekukuvara kwevertebrae uye musana;
kubvisa vasodilator zvinodhaka;
kuwedzera kwevolaemia: infusion ye ev crystalloid solution (1 litre pamusoro pe20-30 maminetsi, ichienderera mberi kusvika pakati pevenous pressure values normalise). Colloids inogonawo kushandiswa mumhando iyi yekuvhunduka;
vasoconstrictor zvinodhaka: izvi zvinopesana neperipheral vasodilation uye arterial hypotension. Kutungamirirwa kwe dopamine mumatare e 15-20 mg / kg / miniti kana noradrenaline mumatareji e0.02-0.1 mcg / kg / miniti inobatsira (iyo infusion inofanira kugadziriswa kuitira kuti isapfuure 100 mmHg systolic blood pressure).

Rehabilitation in spinal shock:

Mukuwedzera kune marapirwo akanyorwa pamusoro apa, physiotherapeutic rehabilitation treatments inosanganiswa nekufamba kwenguva kudzorera zvakanyanya sezvinobvira kunzwa uye / kana motokari basa rakarasika nekuda kwekukuvara kwepelinha.

Muviri, basa, kutaura uye rehabilitation therapy zvikamu zvakakosha zvenguva refu yekudzoreredza maitiro.

Rehabilitation inotarisa pakudzivirira kwemuscle atrophy uye contracture, inobatsira varwere kudzidza kudzorera mimwe yemisumbu yavo kubhadhara kurasikirwa kwevamwe, uye inogona kuvandudza kutaurirana kune murwere akarasikirwa nekukwanisa kutaura uye kufamba.

Sezvineiwo, marapiro haawanzopa miuyo iyo murwere anotarisira.

Zvichienderana nekuoma kwekukuvara, kupindira kwenguva refu kunogona kudiwa kuchengetedza mabasa ezuva nezuva, semuenzaniso anogona kusanganisira:

mechanical ventilation kufambisa kufema;
bladder catheter kubvisa dundira;
kudyisa chubhu kupa humwe hutano uye macalorie.

Evolution uye prognosis yekuvhunduka kwemusana

Kuvhunduka kwakanyanya kwepelinha kusingarapike nekukurumidza kazhinji kune hurombo husina kunaka, kunyanya muchiitiko chekukuvara kwekervical vertebra.

Kunyange kana kupindira kwezvokurapa kwakakodzera nguva, kufungidzira dzimwe nguva kunonyadzisa.

Kana iyo nzira inokonzeresa iyo syndrome yatanga, tishu hypoperfusion inotungamira kune yakawanda-organ dysfunction, iyo inowedzera uye inowedzera mamiriro ekuvhunduka: zvinhu zvakasiyana-siyana zvinodururwa mumhepo inotenderera kubva kune vasoconstrictors senge catecholamines, kune akasiyana kinins, histamine, serotonin, prostaglandin, mahara radicals, inoenderana system activation uye tumor necrosis factor.

Zvese izvi zvinhu zvinoita kunze kwekukuvadza nhengo dzinokosha dzakaita seitsvo, moyo, chiropa, mapapu, matumbu, rwatata neuropi.

Kuvhunduka kwakanyanya kwemusana kusingarapwe nenguva kune fungidziro yakaipa, sezvo inogona kutungamirira kumotokari isingagadziriswi uye / kana kukuvara kwetsinga, coma uye kufa kwemurwere.

Inogara kubva kumaawa mashomanana kusvika kumavhiki mashomanana, kuvhunduka kwemusana kunogona kupera nekufamba kwenguva kuratidza hukuru hwechokwadi hwekukuvara, iyo, zvisinei, inowanzova yakaoma uye isingagadziriswi, ine mhinduro shoma kune rehabilitation therapy.

Zvokuita?

Kana uchifungidzira kuti mumwe munhu ari kubatwa nekutya, bata Nhamba Yechimbichimbi Imwe.

Chidzidzo chacho hachina kufamba chichitanga nemutsipa, iyo yakavharwa nemutsipa wemutsipa, shure kweiyo musana, nhengo dzepamusoro, pelvis uye makumbo ezasi hazvina kufamba.

Nechinangwa ichi, tambo kana mabhandi anogona kushandiswa kumisa kufamba kwechinyorwa.

Kana zvichibvira, isa nyaya yacho munzvimbo yekurwisa kuvhundutsa, kana Trendelenburg chinzvimbo, iyo inowanikwa nekuisa munhu anenge akuvadzwa akarara pasi, supine, yakarereka 20-30 ° nemusoro pasi pasina piro, nechiuno chakakwirira zvishoma (semuenzaniso nepillow) uye makumbo ezasi akasimudzwa.