Thrombosis ntawm lub paj hlwb sinuses yog ib qho pathology tsawg heev, cov paj hlwb thiab kev kho mob tshwm sim uas tuaj yeem muaj ntau haiv neeg. Hmoov tsis zoo, tam sim no, cov kws kho mob muaj cov ntaub ntawv tsis txaus hais txog qhov yuav tshwm sim ntawm tus kab mob no thaum muaj lwm yam kab mob. Los ntawm txoj kev, nyob rau hauv peb lub teb chaws tsis tau muaj ib qho kev kawm loj txog qhov teeb meem no. Tias yog vim li cas nyob rau hauv feem ntau cov neeg mob sinus thrombosis ntawm lub paj hlwb raug kuaj xyuas lig, feem ntau twb thaum tus kab mob nyob rau theem siab, uas tsis tuaj yeem tab sis cuam tshuam rau lub sijhawm ntawm kev kho mob thiab kev kwv yees. Hauv qhov no, cov kws kho mob thiab cov kws kho mob neurologists pom zoo hu rau lub tsev kho mob yog tias muaj kev ceeb toom tshwm sim. Tsuas yog nyob rau hauv lub hauv paus ntawm cov txiaj ntsig ntawm kev kuaj mob nyuaj, ib tus tuaj yeem xav tias muaj cov kab mob sinus thrombosis thiabua txhua yam kev ntsuas tsim nyog raws sijhawm.
Pathogenesis
Ntau zaus koj hnov tias ua rau tus neeg tuag yog ntshav txhaws. Lo lus no yog hais txog ib qho kua nplaum ntawm cov ntaub so ntswg, qhov tsim ntawm uas tshwm sim hauv cov hlab ntsha. Thrombus muaj cov proteins, feem ntau yog fibrin. Nws tuaj yeem yog obturating lossis parietal. Nyob rau hauv thawj rooj plaub, nws yog kev cai hais tias lub thrombus kiag li thaiv lub lumen ntawm cov hlab ntsha, nyob rau hauv lub thib ob - ib feem.
Qhov tsim ntawm cov kua nplaum sib txuas tshwm sim rau ntau yam. Feem ntau nws yog:
- Impaired ntshav outflow.
- Hloov hauv phab ntsa.
- Ntau viscosity ntawm cov kua dej txuas ntxiv.
Lub hauv paus ntawm cov kab mob pathogenesis yog kev ua txhaum ntawm cov ntshav mus rau lub hlwb, nrog rau kev tsim cov ntshav txhaws. Hauv qhov no, qhov kawg tuaj yeem tsim ntawm ib feem ntawm lub cev. Raws li kev txheeb cais cov ntaub ntawv, thrombosis ntawm superior sagittal sinus yog feem ntau kuaj tau. Nws suav rau 60-98% ntawm tus neeg mob. Nyob rau sab nraud, cov ntshav txhaws ncaj qha thiab cavernous pom tsawg dua. Tsis tas li ntawd, cov kab mob tuaj yeem ua rau thaj tsam hauv cov hlab ntsha cortical thiab tob.
Etiology
Txawm hais tias tus kab mob no tsis nkag siab zoo, cov tshuaj paub qhov ua rau sinus thrombosis ntawm lub hlwb. Lawv tuaj yeem kis tau thiab tsis kis kab mob.
Nyob rau hauv thawj rooj plaub, qhov ua rau sinus thrombosis yog raws li nram no:
- Septic raug mob.
- Subdural empyema.
- Abscess.
- Meningitis.
- YSinusitis.
- Tit.
- Stomatitis.
- Tonsillitis.
- Septicemia.
- tuberculosis.
- Endocarditis.
- Hepatitis.
- tus kab mob Herpes.
- HIV
- Cytomegalovirus.
- Malaria.
- Toxoplasmosis.
- YTrichinosis.
- Cryptococcosis.
Aspergillosis Aspergillosis
Tsis yog kab mob ua rau mob sinus thrombosis:
- Ntau yam mob taub hau.
- Zoo tom qab kev cuam tshuam txog kev phais mob tsis ntev los no.
- Meningioma.
- Cholesteatoma.
- YMetastatic neoplasms.
- Kev cuam tshuam ntawm cov hlab ntsha hauv lub cev.
- Zoo tom qab kev kho mob phais.
- Kev cev xeeb tub.
- Kev siv tshuaj tiv thaiv qhov ncauj.
- Nephrotic Syndrome.
- Lub plawv tsis ua hauj lwm.
- Dehydration. Nws etiology tuaj yeem yog ib qho.
- Malignant neoplasms.
- Thrombophilia (feem ntau hu ua kab mob congenital).
- Cov kab mob coagulation.
- Crohn's disease.
- Cirrhosis.
- Ulcerative colitis.
- Sarcoidosis.
- siv sijhawm ntev ntawm cov tshuaj, tshwj xeeb yog glucocorticosteroids, L-asparginase thiab aminocaproic acid.
Vasculitis
Tsis tas li ntawd, qhov kev pheej hmoo ntawm sinus thrombosis nce tom qab txha caj qaum thiab epidural tshuaj loog, nrog rau tom qab lumbarntaus.
Symptoms
Daim duab kho mob ntawm tus kab mob tuaj yeem muaj ntau haiv neeg. Cov tsos mob ntawm sinus thrombosis thiab lawv qhov kev siv ncaj qha nyob ntawm tus nqi ntawm occlusion ntawm cov hlab ntsha.
Qhov pib ntawm tus kab mob tuaj yeem yog:
- Ntxhais. Hauv qhov no, cov tsos mob tshwm sim sai heev, tsawg dua 48 teev.
- Subacute. Cov tsos mob tshwm sim tuaj yeem maj mam nce ntau hnub thiab txawm tias ib hlis.
- Ntawm. Hauv qhov no, qhov mob hnyav zuj zus ntxiv rau ntau tshaj 30 hnub.
Headache yog lub ntsiab lus ceeb toom. Nrog sinus thrombosis, nws pib subacutely. Qhov nce hauv nws qhov kev siv zog tshwm sim hauv ob peb hnub. Thaum lub sij hawm no, mob taub hau ua resistant rau qhov kev txiav txim ntawm analgesics. Cov neeg mob nco ntsoov tias thaum hmo ntuj nws tsis tuaj yeem tiv taus, uas ua rau muaj kev ntxhov siab pw tsaug zog.
Kev hnov mob tsis tshua muaj tshwm sim tam sim ntawd, feem ntau lawv tshwm sim thiab tshwm sim thaum nruab hnub. Lawv qhov kev siv zog yog ib txwm siab dua thaum lub cev tawm dag zog. Tsis tas li ntawd, qhov mob taub hau nce ntxiv thaum tus neeg nyob hauv txoj hauj lwm kab rov tav. Nws feem ntau nrog cov tsos mob ntawm lub paj hlwb.
Thaum lub sij hawm sib tham nrog kws kho mob, cov neeg mob yws tsis tsuas yog mob taub hau, tab sis kuj tsis xis nyob hauv qhov muag (nws tshwm sim vim qhov o ntawm lub taub hau optic), nrog rau muaj kev tawm tsam ntawm convulsive, impaired nco qab, sensory thiab lub cev muaj zog deficit.
Diagnosis
Yog tias muaj cov cim ceeb toom tshwm sim (feem ntau nws yog mob taub hau hnyav uas tiv taus qhov kev ua ntawm tshuaj loog), koj yuav tsum hu rau tus kws kho mob lossis kws kho mob hlwb. Tus kws kho mob tshwj xeeb yuav ua ib qho anamnesis, kuaj lub cev thiab xa daim ntawv xa mus rau kev tshuaj ntsuam xyuas.
Thaum kuaj pom tus kab mob, cov ntaub ntawv kho mob yuav tsum tau lees paub los ntawm cov txheej txheem neuroimaging. Feem ntau, cov kws kho mob pom zoo tias cov neeg mob tau txais MRI ntawm lub taub hau thiab paj hlwb thiab CT scan. Txawm li cas los xij, tus nqi kuaj mob ntawm cov txheej txheem no ncaj qha nyob ntawm seb tus kab mob tau tshwm sim ntev npaum li cas. Piv txwv li, nyob rau theem pib ntawm kev txhim kho pathology, MRI ntawm lub taub hau thiab lub paj hlwb yuav tsis qhia. Hauv qhov no, txoj kev kuaj mob tseem ceeb yog CT.
Nrog kev pab los ntawm kev suav tomography, nws tuaj yeem tsis tsuas yog kuaj pom cov kab mob txawm tias nyob rau theem ntxov tshaj plaws, tab sis kuj tseem ua kom lawv sib txawv ntawm lwm yam mob uas muaj cov duab kho mob zoo sib xws (piv txwv li intracranial hematoma, abscess, hlwb. qog, etc.).
Nyob rau theem mob hnyav, cov kev tshawb fawb tshaj plaws yog MRI thiab CT venography. Nyob rau tib lub sijhawm, cov txheej txheem tom kawg yog qhov tshwj xeeb dua thiab muaj qib siab dua.
Ntxiv rau, raws li kev kho mob cov lus qhia, sinus thrombosis yog ib qho pathology, thaum lub sijhawm kuaj mob, nws yog ib qho tsim nyog yuav tsum tau ua tiav cov ntshav suav, kuaj cov pob nyiaj thiab kev kawm txog cov kua dej cerebrospinal. Cov keeb kwm noj yuav tsum tau meej heev.
Kev kho mob
Cov kev kho mob ncaj qha nyob ntawm qhov ua rau ua rau muaj kev loj hlob ntawm sinus thrombosis. Kev kho mob ntawm tus kab mob sib kis yuav tsum tau noj cov tshuaj tua kab mob dav dav, cov khoom siv uas muaj peev xwm nkag mus rau hauv cov hlab ntsha hauv hlwb. Tsis tas li ntawd, kev kho dua tshiab ntawm kev ua kom pom tseeb ntawm pathology los ntawm txoj kev phais yog qhia.
Tshuaj tua kab mob yog muab empirically kom txog thaum kuaj pom muaj. Nws yog ib qho tsim nyog sau cia tias feem ntau qhov ua rau muaj kev loj hlob ntawm tus kab mob yog cov haujlwm tseem ceeb ntawm streptococci thiab staphylococci..
Raws li ib feem ntawm kev kho tshuaj tua kab mob thawj zaug, cov tshuaj hauv qab no tuaj yeem raug sau:
- III tiam cephalosporins (Cefotaxime, Ceftriaxone, Ceftazidime), IV tiam (Cefpirome, Cefmetazole).
- tshuaj tua kab mob beta-lactam. Feem ntau, cov kws kho mob muab tshuaj Meropenem.
- Glycopeptides (xws li Vancomycin).
- Lwm yam tshuaj. Cov kws tshaj lij nyiam aminoglycosides thiab penicillins.
Thaum kuaj pom tias tsis muaj kab mob sinus thrombosis, kev sib ntaus tawm tsam thrombosis los ua ntej. Tam sim no, cov tshuaj zoo tshaj plaws yog Heparin. Nws raug siv kom txog thaum tus neeg mob pom cov kev hloov pauv zoo. Feem ntau, kev kho heparin yog ua tiav hauv 1 lub lis piam.
Raws li ib feem ntawm kev tawm tsam thrombosis, "Kurantil" feem ntau tau sau tseg. Qhov no yog ib tug antiplatelet tus neeg sawv cev, lub active ingredient ntawm uas yog dipyridamole raws li cov lus qhia rau kev siv. Tus nqi ntawm "Kurantil" yogtxog 700 rubles, uas ua rau nws pheej yig rau cov neeg mob feem ntau.
Cov tshuaj noj ntau npaum li cas yog txiav txim los ntawm tus kws kho mob tuaj koom ntawm tus kheej. Tshwj tsis yog tus kws tshaj lij tau qhia lwm yam, nws yuav tsum tau coj cov ntaub ntawv cuam tshuam hauv cov lus piav qhia ua lub hauv paus. 225 mg yog koob tshuaj ntau tshaj raws li cov lus qhia rau kev siv.
Tus nqi ntawm "Kurantil" yog qhov ncaj ncees. Raws li cov kws kho mob cov tshuaj xyuas, cov tshuaj no zoo heev tiv thaiv pathologies ntawm lub paj hlwb thiab cov hlab plawv system txuam nrog thrombosis thiab circulatory disorders.
Kev kho tus kab mob kuj muaj kev noj tshuaj kom txo cov ntshav. Qhov no yog vim lub fact tias cov kua tuab connective cov ntaub so ntswg tsis tuaj yeem ua tiav nws lub luag haujlwm, uas tsuas yog ua rau cov txheej txheem ntawm cov kab mob hnyav dua. Thaum kho, cov ntshav txhaws kuj liquefy. Lawm, qhov no muaj txiaj ntsig zoo rau lub sijhawm ntawm tus kabmob thiab ua rau qhov kev cia siab zoo dua.
Cov tshuaj uas nquag tshaj plaws yog cov tshuaj tua kab mob Cardiopyrin, Aspirin, Lamifiban, Magnecard. Tag nrho cov tshuaj raug xaiv ib tus zuj zus raws li keeb kwm kev kho mob thiab kev kuaj mob.
Yog tias cov txheej txheem ntawm kev kho mob tsis zoo, tus kws kho mob txiav txim siab txog qhov tsim nyog ntawm kev phais. Muaj ntau ntau txoj kev kho mob phais, tab sis tam sim no bypass phais tseem yog qhov nrov tshaj plaws. Lub ntsiab ntawm txoj kev yog los tsim ib txoj kev dag nyob ib ncig ntawm lub nkoj cuam tshuam. Thaum lub sijhawm ua haujlwm, qhib kev nkag tau siv, nrog rau qhov twgkev cuam tshuam yog ua raws li kev tshuaj loog.
Ntawm ntawm pathology hauv menyuam yaus
Kev tsis txaus ntshav rau lub hlwb yog qhov teeb meem ceev tsis yog ntawm cov neeg laus xwb. Raws li kev txheeb cais, thrombosis ntawm cerebral sinuses raug kuaj pom hauv 2 ntawm 100,000 tus menyuam yaus ib xyoos ib zaug. Ntxiv mus, superior sagittal sinus feem ntau cuam tshuam. Me ntsis thrombosis ntawm lateral.
Cov kab mob tseem ceeb hauv cov menyuam yaus:
- Zaj caj ces.
- Bacterial sepsis.
- kab mob khaub thuas
- Purulent meningitis.
- Lub cev qhuav dej hnyav.
- Kab mob hauv lub plawv.
- kab mob siab.
Kev kho mob tshwm sim ntawm tus kab mob ncaj qha nyob ntawm lub hnub nyoog ntawm tus menyuam. Nyob rau tib lub sijhawm, lawv tuaj yeem raug nthuav tawm ob qho tib si tsis muaj zog (drowsiness, excitability, qab los noj mov) thiab muaj zog (coma). Hauv cov menyuam mos, qhov sinus thrombosis feem ntau tshwm sim los ntawm kev nqhis dej, kev nyuaj siab thiab kub taub hau.
Thaum hnub nyoog laus, cov tsos mob hauv qab no tshwm sim:
- Headache.
- Vim.
- Congestion in the fundus.
Kev kho mob ntawm cov menyuam yaus nrog kev noj tshuaj tiv thaiv kab mob, thrombolytics thiab tshuaj tiv thaiv kab mob.
Tus kab mob ntawm cov poj niam cev xeeb tub thiab cov poj niam hauv kev ua haujlwm
Raws li kev txheeb cais, qhov mob thrombosis tau kuaj pom nyob hauv kwv yees li 1-4 tus neeg mob ntawm 10,000 yug. Hauv qhov no, tus kab mob no feem ntau kuaj pom hauv cov poj niam hluas thiab hnub nyoog nruab nrab.
Qhov laj thawj tseem ceeb ntawm kev txhim kho tus kab mob hauv cov poj niam cev xeeb tub thiab cov poj niam thaum yug menyuam:
- Cov txheej txheem mob hauv lub qhov txhab, pob ntseg, ntsej muag.
- Neoplasms ntawm ob qho tib si benign thiab malignant xwm.
- Hereditary mutations (xws li Leiden factor).
- Leukemia.
- YPolycythemia.
- Behçet's disease.
- YAntiphospholipid Syndrome.
thawj tus tsos mob yog mob taub hau. Thaum lub sij hawm, xeev siab, ntuav, convulsive qaug dab peg koom nrog nws. Tej zaum muaj kev cuam tshuam ntawm kev nco qab, tshwj xeeb yog coma.
Kev kho mob ntawm cov poj niam cev xeeb tub thiab cov poj niam hauv kev yug menyuam muaj kev saib xyuas hnyav nrog kev pab ntawm cov tshuaj saum toj no. Tsis tas li ntawd, kev ntsuas tau raug coj los kho intracranial siab thiab txo qis qaug dab peg.
Khoom noj khoom haus
Txhua tus neeg mob tom qab kev kho mob yuav tsum paub tias cov zaub mov twg tiv thaiv cov ntshav txhaws. Tsis tas li ntawd, kev hloov pauv kev noj haus tuaj yeem suav tias yog kev tiv thaiv tus kabmob tseem ceeb.
Cov ntawv qhia zaub mov yuav tsum muaj cov khoom noj uas txhawb nqa cov ntshav thinning thiab tiv thaiv kev tsim cov hlab ntsha ntawm cov kua dej sib txuas.
Cov no suav nrog:
- Zaub thiab txiv hmab txiv ntoo uas muaj vitamin C (citrus txiv hmab txiv ntoo, txiv hmab txiv ntoo, txiv apples qaub, lingonberries, blueberries, plums, cherries, apricots, txiv duaj, qej, dos).
- Berries (raspberries, blackberries, strawberries, blueberries, currants). Lawv tuaj yeem noj tshiab lossis ua rau hauv cov kua txiv hmab txiv ntoo thiab smoothies.
- Seedlings of legumes and cereals (peas, oats, buckwheat,nplej qus). Tawm tsam keeb kwm yav dhau los ntawm lawv cov kev siv tsis tu ncua, cov hlab ntsha raug ntxuav.
- txiv lws suav.
- Bulgarian kua txob.
- zaub ntsuab.
- Cabbage Dawb.
- Slightly s alted dib.
- Carrot.
- Ntau cov khoom lag luam, tshwj xeeb yog zib ntab.
- Ginger.
- Dill.
- -parsley.
- Fuck.
- Cinnamon.
- zaub roj.
Rau lub sijhawm noj zaub mov, koj yuav tsum tso tseg cov khoom noj uas tsis zoo rau cov ntshav ncig, ua rau cov platelet loj hlob thiab ua rau muaj kev pheej hmoo ntawm cov ntshav txhaws.
Cov khoom hauv qab no yuav tsum raug cais tawm ntawm cov ntawv qhia zaub mov:
- Nuts.
- High-fat cheeses.
- Bananas.
- qos.
- dej qab zib.
- Tshuaj yej.
- Marinades.
- khoom noj kaus poom.
- Nyob.
- Muaj.
- Cawv.
Huab cua
Qhov tshwm sim ntawm tus kab mob ncaj qha nyob ntawm qhov hnyav ntawm tus neeg mob tus mob, lub sijhawm ntawm kev kuaj mob thiab kev kho mob.
Cov cim qhia hauv qab no tsis zoo:
- Kev nyuaj siab ntawm kev nco qab.
- Deep coma.
- Sepsis.
- mob qaug dab peg uas nyuaj heev los nres.
- Hemorrhagic heart attacks.
- YPulmonary embolism.
Raws li cov ntaub ntawv muaj, kev rov ua tiav tiav tshwm sim hauv kwv yees li 50-75% ntawm cov neeg mob. Cov teebmeem seem raug kuaj pom hauv kwv yees li 29% ntawm cov neeg mob. tuagCov txiaj ntsig tshwm sim hauv 5-33% ntawm cov neeg mob.
Nrog rau kev kuaj mob lig thiab kev kho tsis tau ntev, kev pheej hmoo ntawm kev tsim cov teeb meem hauv qab no nce ntxiv:
- Nyob rau hauv lub hlwb.
- Venous infarction.
- Purulent meningitis.
- YRetinal vein thrombophlebitis.
- Metastatic ntsws abscesses.
- Brain abscess.
- Septic pneumonia.
Txhawm rau tiv thaiv qhov tshwm sim tsis zoo uas ua rau muaj kev phom sij tsis yog rau lub neej nkaus xwb, tab sis kuj rau kev noj qab haus huv, nws yuav tsum tau hu rau lub tsev kho mob sai li sai tau thaum thawj cov tsos mob ceeb toom tshwm sim. Kev mob taub hau tsis tu ncua thiab mob hnyav, uas nyuaj rau kev tso tseg nrog tshuaj tua kab mob lossis tiv taus lawv, yuav tsum ceeb toom tshwj xeeb.
Ntxiv rau, ua ib feem ntawm kev tiv thaiv tus kabmob tseem ceeb, nws raug nquahu kom ua lub neej noj qab haus huv, uas cuam tshuam txog kev ua lub cev tsis tu ncua. Kev ua lub cev tiv thaiv kev tsim cov ntshav txhaws. Nws tseem yog ib qho tseem ceeb uas yuav tau hloov kho cov zaub mov, cov ntawv qhia zaub mov yuav tsum sib npaug.
Nyob hauv kaw
Sinus thrombosis yog ib hom kab mob uas tsis tshua muaj tshwm sim hauv cov hlab ntsha hauv lub hlwb, cov chav kawm uas yog nrog los ntawm kev tsis zoo ntawm cov kua dej txuas nrog cov ntaub so ntswg vim kev txhaws ntawm cov hlab ntsha los ntawm cov ntshav txhaws. Cov tsos mob tseem ceeb ntawm tus kab mob yog mob taub hau. Nws tuaj yeem tshwm sim hnyav lossis nce ntxiv hauv lub sijhawm. Yuav kom kuaj tau qhov tseeb, nws yog ib qho tsim nyog yuav tsum tau mus rau qhov kev ntsuam xyuas dav dav. Tam sim no, CT yog cov txheej txheem tseem ceeb tshaj plaws hauv kev kho mob ntawm cov ntaub ntawv.
