Umothuko wokusasazeka komqolo: 'umothuko' kwiyeza kubhekiselele kwisifo, okt iseti yeempawu kunye neempawu, ezibangelwa kukuncitshiswa kokuphola kwinqanaba lenkqubo kunye nokungalingani phakathi kokufumaneka kweoksijini kunye nemfuno yayo kwinqanaba lethishu.

Umothuko uhlelwa ngokwamaqela amabini amakhulu

• ukunciphisa ukothuka kwentliziyo: i-cardiogenic, obstructive, hemorrhagic hypovolaemic kunye ne-non-haemorrhagic hypovolaemic;
• Umothuko osasazekileyo (ukusuka ekuncipheni kokumelana ne-peripheral epheleleyo): i-septic, i-allergic ('i-anaphylactic shock'), i-neurogenic kunye Umgudu.

Umothuko wokusabalalisa umqolo

Ukutshatyalaliswa kokusabalalisa luhlobo lokutshatyalaliswa okubangelwa ukungafani phakathi kwebhedi ye-vascular, ehlanjululwa ngokungaqhelekanga, kunye nomthamo wegazi ojikelezayo, othi-nangona ungancitshiswanga ngokupheleleyo - uba ungonelanga ngenxa ye-vasodilation eyenziwe.

Ukutshatyalaliswa komgogodla luhlobo olunqabileyo lokutshatyalaliswa kokusabalalisa apho i-peripheral vasodilation ibangelwa ukulimala kwintambo yomgogodla equlethwe umqolo womgcini.

Le fomu akufanele idideke kunye nenye efanayo, i-neurogenic shock.

Kwiimibhalo ezininzi, iintlobo ezimbini zokothuka zidibene, kodwa kwimeko yokutshatyalaliswa komgogodla, ukulahlekelwa kwe-spinal cord-mediated reflexes kubonwa.

Ukothuka kudla ngokuba luphawu lokuqala lokwenzakala komqolo.

UQEQESHO KUNCEDO LOKUQALA? TYELELA I-DMC DINAS MEDICAL CONSULTANTS BOOTH KWI-EXPO EXPO.

Kolu hlobo lokothuka komqolo kukho, ukwenza lula, oku kulandelelana kweziganeko:

• umonakalo we-nerve ubangela ukuhla kweendlela ze-nerve ezilawula ukujikeleza kwegazi;
• kwenzeka i-vasodilatation ye-peripheral;
• i-vasodilatation ye-peripheral ikhokelela kwi-hypotension ye-arterial;
• i-arterial hypotension ikhokelela kwi-hypoperfusion yezicubu;
• i-tissue hypoperfusion ikhokelela kwi-anoxia yezicubu;
• ischemic Ndezelo kukhokelela kwi-necrosis (ukufa) kwezicubu, eziyeka ukusebenza.

Iimpawu kunye neempawu zokutshatyalaliswa komgogodla

Ezi mpawu zilandelayo zeklinikhi kunye neempawu zinokubonwa kolu hlobo lomothuko:

• i-arterial hypotension
• ukudinwa;
• isantya sokuphefumla esitshintshileyo;
• i-bradycardia okanye i-tachycardia (ukunciphisa okanye ukunyuka kwentliziyo);
• iimpawu kunye neempawu zokungasebenzi kakuhle kwamalungu amaninzi;
• ukuwa koxinzelelo lwegazi;
• ukubanjwa kwe-cardiac;
• ukubanjwa kwemiphunga;
• ukunciphisa kakhulu kwinqanaba lengqondo;
• isiqaqa
• ukufa.

Ezi mpawu kunye neempawu kufuneka kwakhona inxulunyaniswe nezinye iimpawu kunye neempawu ezibangelwa yimeko enyukayo kunye/okanye izifo ezibangele ukothuka, okufana noxinzelelo lwe-spinal cord, olunokuthi lukhokelele ekuswelekeni kwemoto (umz. ukukhubazeka kwemilenze engezantsi okanye imilenze ephezulu kwimeko yokulimala kwe-vertebra yomlomo wesibeleko) kunye neentsilelo zoluvo.

Ukulahlekelwa yimvakalelo kunye nokunyakaza kwenzeka ngaphantsi kwendawo yokulimala, ngoko ke ukuphakama kokulimala (umzekelo, ukuphuka kwe-vertebra yomlomo wesibeleko), umonakalo uya kuba mkhulu.

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Ezinye iimpawu ezikhawulezayo zinokubandakanya:

• intlungu kwindawo yokulimala
• i-spasticity yemisipha;
• ukubetha kunye nokuba ndindisholo emilenzeni;
• ipriapism emadodeni;
• i-dyspnea;
• ukusilela ekuphefumuleni;
• i-arrhythmia yentliziyo;
• ukulahleka komsebenzi wesinyi;
• ukulahleka komsebenzi wamathumbu.

Imiphumo ehlala ixesha elide ye-spinal trauma iyahluka ngokuxhomekeke kwindawo kunye nobukhulu bokulimala: njengoko sele kukhankanyiwe, umonakalo omkhulu kumqolo, unzima kakhulu, ngokubanzi, iimpawu.

Ngokomzekelo, ukulimala kumqolo wesibeleko kuya kuchaphazela zonke izitho ezine, kunye nezihlunu ezilawula ukuphefumla kunye neminye imisebenzi ebalulekileyo.

Ukulimala kwi-lumbar spine, ngakolunye uhlangothi, kuya kuchaphazela imilenze ephantsi (kungekhona imilenze ephezulu) kunye nomsebenzi wesisu kunye ne-bladder, kodwa ngokuqhelekileyo ayichaphazeli ezinye izitho okanye iinkqubo.

Gqibezela phezulu entanyeni ukwenzakala nokwenzakala okuntsonkothileyo kunokubangela ukufa kwangoko okanye kubangele ukonakala okukhulu kokuzimela, ekugqibeleni kufuna uncedo olupheleleyo kubo bonke ubomi besigulane.

Amanqanaba othuso lomqolo

Olu hlobo lomothuko lwahlulahlulwe lwazizigaba ezine ezahlukeneyo ngokusekwe kwikhosi ye-reflexes:

• isigaba 1 ukulahleka kwe-reflexes (areflexia);
• isigaba 2 emva kweentsuku ezimbini inxalenye ye-reflexes ifunyenwe;
• isigaba 3 hyperreflexia yenzeka;
• isigaba 4 isigaba se-spastic.

Ngokutsho kwabanye ababhali, ukothuka komqolo kunokohlulwa kube ngamanqanaba amabini:

- isigaba esibukhali

• i-areflexia
• ukugcinwa kweendlela zokuphuma;
• ivasoparalysis;
• i-hypothermia yolusu;
• ukukhubazeka;
• hypotonia yemisipha;

-Inqanaba elingapheliyo:

• hyperflexia;
• i-spasticism;
• automatism yomqolo.

Ezi zigaba ngokubanzi ziquka ubude bexesha leeveki ezintathu ukuya kwezintandathu; kwezinye iimeko ixesha elipheleleyo lezi zigaba libe ziinyanga eziliqela.

Kwithuba ngokukhawuleza emva kokwenzakala (iiyure ezingapheliyo okanye iintsuku), ukothuka komqolo kubonakaliswa yi-flaccidity, ukulahleka kwemisebenzi yokuzimela kunye ne-anesthesia epheleleyo engaphantsi kokwenzakala, ehlala ixesha elide ukwenzakala ngokwalo kwindawo ephezulu yomqolo; Lo mfanekiso uphumelela ngokuqhubekayo yi-spasticity.

Izizathu kunye nemingcipheko yokutshatyalaliswa komgogodla

I-Pathologies kunye neemeko ezivame ukubangela kunye / okanye ukukhuthaza ukutshatyalaliswa kwe-neurogenic kukulimala kwentambo yomgogodla kunye ne-quadriplegia okanye i-paraplegia.

Ukuxhatshazwa rhoqo kukuphuka kwe-vertebra kunye / okanye ukuchithwa kwayo, okubangelwa ukunyanzeliswa kunye / okanye ukulimala kwentambo yomgogodla.

Iintlobo ezinjalo zentlungu zihlala zivela kwiingozi zezithuthi okanye zezemidlalo, okanye ekuwa okanye ukulimala okubangelwa yimipu.

Ukwenzakala kwentambo yomqolo kunokuba

• ngqo (ivaliwe okanye ingena);
• ehambelana nokugqithiswa kwemida yokunyakaza enikezelwa kwintambo yomgogodla ngaphakathi komgudu womgogodla (i-hyperextension egqithisileyo, i-hyperflexion okanye i-torsion).

Ukothuka komqolo ngamanye amaxesha kuba sisiphumo samathumba omqolo okanye ukungaqhelekanga okunokuthi kwenzeke emva kokuzalwa ngenxa yeziganeko ezinxulumene noxinzelelo.

Ikhosi yokothuka komqolo

Izigaba ezithathu ezahlukeneyo zinokuchongwa ngokubanzi ngokothuka:

• Isigaba sokuqala sembuyekezo: ukudakumba kwe-cardiovascular kubi kwaye umzimba udala iindlela zembuyekezo ezilamlwa yinkqubo ye-nervous enovelwano, i-catecholamines kunye nokuveliswa kwezinto zendawo ezifana ne-cytokines. Inqanaba lokuqala linyangeka ngokulula. Ukuxilongwa kwangethuba kukhokelela kuxilongo olungcono, nangona kunjalo kudla ngokuba nzima njengoko iimpawu kunye neempawu zisenokungacacanga okanye zingacaciswanga kweli nqanaba;
• isigaba sokuqhubela phambili: iindlela zembuyekezo zingasebenzi kwaye i-perfusion deficit kwizitho ezibalulekileyo ziba zibi ngokukhawuleza, kubangela ukungalingani okukhulu kwe-pathophysiological kunye ne-ischemia, umonakalo weselula kunye nokuqokelela kwezinto ze-vasoactive. I-Vasodilation kunye nokunyuka kwe-tissue permeability kunokukhokelela ekuhanjisweni kwe-intravascular coagulation.
• Isigaba sokungaguquleki: esi sesona sigaba sibi kakhulu, apho iimpawu eziphawulweyo kunye neempawu ziququzelela ukuxilongwa, nangona kunjalo, okwenziwa kweli nqanaba, okuhlala kukhokelela kunyango olungasebenziyo kunye ne-prognosis embi. I-coma engaguqukiyo kunye nokunciphisa umsebenzi wentliziyo kunokwenzeka, ukuya kuthi ga ekubanjweni kwentliziyo kunye nokufa kwesigulane.

Ukuxilongwa kokutshatyalaliswa komgogodla

Ukuxilongwa komothuko kusekelwe kwizixhobo ezahlukeneyo, kuquka:

• i-anamnesis
• uviwo lwenjongo;
• iimvavanyo zaselabhoratri;
• haemochrome;
• i-haemogasanalysis;
• CT SCAN;
• i-coronarography;
• i-angiography ye-pulmonary;
• i-electrocardiogram;
• X-ray esifubeni;
• i-echocardiogram ene-colordoppler.

Olona vavanyo luxhaphakileyo lusetyenziselwa ukuxilongwa ngokwahlukileyo yi-CT scan, i-echocardiography, i-cardiac catheterization, i-abdominal ultrasound, kunye novavanyo lwaselabhorethri ukuthintela ukopha kunye nokuphazamiseka kwe-coagulation.

I-anamnesis kunye noviwo olunenjongo lubalulekile kwaye kufuneka lwenziwe ngokukhawuleza.

Kwimeko yesigulane esingenangqondo, imbali ingathathwa ngoncedo lwamalungu entsapho okanye abahlobo, ukuba bakhona.

Kuvavanyo lwenjongo, isifundo esothusayo sihlala siveza ulusu oluluthuthu, ngokubanda, ulusu oluthambileyo, i-tachycardic, kunye nokuncipha kwe-carotid pulse, ukungasebenzi kakuhle kwezintso (oliguria) kunye nokuphazamiseka kwengqondo.

Ngexesha lokuxilongwa, kuya kufuneka ukuba kuqinisekiswe i-patency yomoya kwizigulana ezinengqondo ephazamisekileyo, ubeke isifundo kwindawo yokulwa nomothuko (i-supine), sigqume umntu owenzakeleyo, ngaphandle kokumenza abile, ukuthintela i-lipotimia kwaye ngaloo ndlela ukuqhubela phambili kobume belizwe. umothuko.

Ngokumalunga novavanyo lwaselabhoratri, eyona nto ingundoqo ekufunyanisweni komothuko yi-arterial okanye i-venous haemogasanalysis, ukuvavanya ibhalansi yeasidi-siseko somzimba.

Ngokweempawu, ukothuka kukhatshwa ngumfanekiso we-acidemia ye-metabolic ngokunyuka kwe-lactates kunye nokusilela kwesiseko.

I-CT kunye ne-MRI scans zomqolo ziyimfuneko ekuboneni umonakalo wentambo yomgogodla

Ukuxilongwa kunye nokulawulwa kokulimala kwentambo yomgogodla kunokuba nzima kwaye ukulimala okungakhange kubonwe kwangoko kunokubangela iingxaki ezinzulu.

Ukuba intambo yomgogodla ikrokrelwa, umqolo kufuneka ukhuselwe kwaye ungashukumi ngamaxesha onke ngexesha lovavanyo kunye nokuxilongwa.

Uvavanyo lokuqala lubandakanya imbali yonyango, ukuhlolwa kweklinikhi kwaye ngaphezu kwayo yonke imifanekiso (i-X-ray, i-CT scan, i-MRI), ekufuneka ibandakanye umqolo wonke, kungekhona nje ummandla apho kukrokrelwa khona ukulimala.

Ukukhethwa kweendlela zokuxilonga kuyahluka ngokuxhomekeke kwisimo sengqondo sesigulane kunye nobukho bezinye iingozi.

Kumothuko wokusasazwa komqolo, le meko iyenzeka:

• ukulayisha kwangaphambili: kuyancipha/kuqhelekileyo
• emva kokulayishwa: kuncipha;
• contractility: eqhelekileyo;
• i-venous satO2 ephakathi: iyahluka; kwi-arteriovenous shunt kukho ukwanda;
• I-Hb concentration: eqhelekileyo;
• i-diuresis: eqhelekileyo / iyancipha;
• ukumelana ne-peripheral: yehla;
• inzwa: eqhelekileyo kwi-neurogenic kunye ne-spinal shock; ukubhideka/ukubhideka kumothuko we-septic kunye nokwalana.

Masikhumbule ukuba ukuphuma kwe-systolic kuxhomekeke kumthetho ka-Starling ekulayisheni kwangaphambili, emva kokulayishwa kunye nokucutha kwentliziyo, enokuthi ijongwe ngokwezonyango ngokungangqalanga ngeendlela ezahlukeneyo:

• ukulayisha kwangaphambili: ngokulinganisa uxinzelelo lwe-venous esembindini ngokusetyenziswa kwe-catheter ye-Swan-Ganz, ukhumbula ukuba olu tshintsho alukho kumgca wokusebenza kunye nokulayisha kwangaphambili, kodwa oku kuxhomekeke kubungqongqo beendonga ze-ventricle elungileyo;
• emva kokulayishwa: ngokulinganisa uxinzelelo lwemithambo (ingakumbi idiastolic, okt 'ubuncinane');
• contractility: nge echocardiogram okanye myocardial scintigraphy.

Ezinye iiparamitha ezibalulekileyo kwimeko yokothuka zijongwa ngolu hlobo:

• haemoglobin: nge haemochrome;
• ioksijini saturation: ngokusebenzisa imitha saturation yexabiso lenkqubo kunye nokuthatha isampuli ekhethekileyo evela i-catheter esembindini ukugcwala kwe-venous (umahluko kunye nexabiso le-arterial libonisa ukusetyenziswa kwe-oxygen ngamathishu)
• Uxinzelelo lwe-oxygen kwi-arterial: nge-haemogasanalysis
• diuresis: ngecatheter yesinyi.

Ngexesha lokuxilongwa, isigulane sijongwa ngokuqhubekayo, ukujonga ukuba imeko ivela njani, isoloko igcina 'ABC lawula' engqondweni, okt ukujonga

• ipatency yeendlela zomoya
• ubukho bokuphefumula;
• ubukho bokujikeleza.

Ezi zinto zintathu zibalulekile kubomi besigulane, kwaye kufuneka zilawulwe - kwaye ukuba kukho imfuneko zimiselwe kwakhona - ngolo hlobo.

unyango

Unyango luxhomekeke kunobangela wokothuka. Ukulawulwa kwe-oksijeni ngokuqhelekileyo kuqhutyelwa, kulandelwa ukulungiswa kwamanzi omntu ukubuyisela i-volaemia efanelekileyo: i-isotonic crystalloids isetyenziselwa le njongo; kwiimeko ezinzima kakhulu apho unyango oluqhelekileyo lubonakala lungaphumeleli, i-dopamine okanye i-noradrenaline isetyenziswa.

Ngokukodwa, unyango lubandakanya

• ukungasebenzi intloko, intamo kunye nomqolo;
• ukuphunyezwa kwamanyathelo athile anxulumene nesizathu esinyukayo somothuko, umz. unyango lwe-neurological kunye/okanye lwe-orthopedic utyando kwimeko yamathumba kunye / okanye ukwenzakala okubuhlungu kwi-vertebrae kunye nentambo yomgogodla;
• ukurhoxiswa kweziyobisi ze-vasodilator;
• Ukwandiswa kwe-volaemia: ukufakwa kwesisombululo se-ev crystalloid (ilitha eyi-1 ngaphezu kwemizuzu engama-20-30, kuqhubeka kude kube ngumbindi wexabiso loxinzelelo oluqhelekileyo). IiColloids zisenokusetyenziswa kolu hlobo lokothuka;
• iziyobisi ze-vasoconstrictor: ezi zichasene ne-peripheral vasodilation kunye ne-arterial hypotension. Ukulawulwa kwe-dopamine kwiidosi ze-15-20 mg / kg / iminithi okanye i-noradrenaline kwiidosi ze-0.02-0.1 mcg / kg / umzuzu luncedo (i-infusion kufuneka ilungiswe ukuze ingadluli i-100 mmHg uxinzelelo lwegazi lwe-systolic).

Ukubuyisela kwisimo sangaphambili kumothuko womqolo:

Ukongeza kwiindlela zonyango ezidweliswe ngasentla, unyango lwe-physiotherapeutic rehabilitation ludibaniswe ngexesha lokubuyisela kangangoko kunokwenzeka i-sensor kunye / okanye i-motor function elahlekileyo ngenxa yokulimala kwentambo yomgogodla.

Unyango lomzimba, umsebenzi, intetho kunye nokubuyisela kwimeko yesiqhelo yinxalenye ebalulekileyo yenkqubo yokubuyisela ixesha elide.

Ukuvuselelwa kugxile ekukhuselweni kwe-atrophy ye-muscle kunye nekhontrakthi, inceda izigulane zifunde ukubuyisela ezinye izihlunu zabo ukuze zihlawule ukulahlekelwa kwabanye, kwaye zinokuphucula unxibelelwano kwisigulane esiye salahlekelwa ukukwazi ukuthetha nokuhamba.

Ngelishwa, unyango alusoloko luvelisa iziphumo umguli esinethemba lazo.

Ngokuxhomekeke kubunzima bokulimala, ukungenelela kwexesha elide kunokufuneka ukugcina imisebenzi yemihla ngemihla, umzekelo inokubandakanya:

• ukuphefumla ngoomatshini ukwenza lula ukuphefumla;
• i-catheter yesinyi ukukhupha isinyi;
• ityhubhu yokondla ukubonelela ngesondlo esongezelelweyo kunye neekhalori.

I-Evolution kunye ne-prognosis ye-spinal shock

Ukutshatyalaliswa okukhulu komgogodla okungaphathwa ngokukhawuleza kudla ngokuba ne-prognosis embi, ngakumbi kwimeko yokulimala kwe-vertebra yomlomo wesibeleko.

Kwanaxa ungenelelo lwezonyango lusexesheni, i-prognosis ngamanye amaxesha ayinabungozi.

Nje ukuba inkqubo ebangela i-syndrome iqale, i-hypoperfusion yezicubu ikhokelela kukungasebenzi kakuhle kwamalungu amaninzi, okonyusa kwaye kwenze mandundu imeko yomothuko: izinto ezahlukeneyo zigalelwa kumjelo wokujikeleza ukusuka kwi-vasoconstrictors efana ne-catecholamines, ukuya kwii-kinins ezahlukeneyo, i-histamine, i-serotonin, i-prostaglandins, i-radicals yamahhala, i-activation system complement kunye ne-tumor necrosis factor.

Zonke ezi zinto azenzi nto ngaphandle kokonakalisa amalungu abalulekileyo anjengezintso, intliziyo, isibindi, imiphunga, amathumbu, udakada nengqondo.

Umothuko onzima womqolo onganyangwanga ngexesha unesimo esibi, njengoko kunokukhokelela kumonakalo ongenakulungiseka wemoto kunye/okanye kwimithambo-luvo, isiqaqa nokufa kwesigulane.

Ukuhlala kwiiyure ezimbalwa ukuya kwiiveki ezimbalwa, ukothuka komgogodla kunokuncipha ngokuhamba kwexesha ukubonisa ubungakanani bokwenyani bomonakalo, nangona kunjalo, uhlala unzima kwaye awunakuguqulwa, kunye nempendulo encinci kunyango lokubuyisela.

Kwenziwe ntoni?

Ukuba ukrokrela ukuba kukho umntu owothukayo, qhagamshelana neNombolo yoNgxamiseko eNye.

Isifundo singenakushukunyiswa ukuqala ngentamo, evalwe ngentambo yentamo, emva koko umva, amalungu aphezulu, i-pelvis kunye nemilenze ephantsi ayishukumi.

Ngenxa yale njongo, iibhanti okanye iibhanti zingasetyenziselwa ukukhupha ukunyakaza kwesifundo.

Ukuba kunokwenzeka, beka isihloko kwindawo yokulwa nomothuko, okanye Isikhundla seTrendelenburg, ephunyezwayo ngokubeka ixhoba elele phantsi, i-supine, i-tilted 20-30 ° kunye nentloko phantsi ngaphandle komqamelo, kunye ne-pelvis iphakanyiswe kancane (umz. ngomqamelo) kunye nemilenze ephantsi iphakanyisiwe.

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umthombo:

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