Kev faib cov mob stroke yog nyob ntawm ntau yam. Ua ntej ntawm tag nrho cov, lawv yog raws li seb puas muaj ib tug blockage ntawm cov hlab ntsha los yog lawv rupture. Hauv qhov no, ischemic thiab hemorrhagic strokes txawv, raws li. Muaj coob tus neeg raug kev txom nyem los ntawm no pathology ntawm lub paj hlwb. Kab lus yuav xav txog kev mob stroke: kev faib tawm, etiology thiab chaw kho mob.
Lub tswvyim ntawm ischemic pathology
Kev faib tawm ntawm cov mob stroke yuav tsum pib kawm los ntawm daim ntawv uas tshwm sim los ntawm kev txhaws ntawm cov hlab ntsha hauv hlwb. Nws feem ntau kuaj pom hauv cov neeg mob laus uas muaj cov kab mob hauv qab no:
- mob ntshav qab zib mellitus;
- kev coj ua thiab lub plawv dhia tsis zoo;
- kab mob rheumatic mob plawv;
- myocardial infarction;
- mob ntawm cov hlab ntsha loj;
- hormonal contraception;
- IHD;
- unilateral migraine;
- kev ua txhaum ntawm cov khoom rheological ntawm cov ntshav.
Ib tug mob stroke tshwm sim thaum cov hlab ntsha uas pub rau lub hlwb cov ntaub so ntswg ua blocked los yog nqaim. Nws cov hlwb pib tuag yog tias lawv tsis tau txais cov as-ham thiab oxygen.
Lwm lub npe rau ischemic stroke yog cerebral infarction. Cov ntaub so ntswg hauv cov kab mob no tau raug rhuav tshem maj mam, cov txheej txheem tsis nres txawm tias tom qab kho cov ntshav ntws ib txwm muaj. Yog li ntawd, yuav tsum tau kho mob ceev rau tus neeg mob.
Kev faib tawm ntawm ischemic stroke los ntawm pathogenesis
Cov kab mob no yuav yog qhov tshwm sim ntawm kev txhim kho ntawm cov kab mob plawv. Kev faib tawm ntawm ischemic stroke yog ua raws li ntau tus qauv, ntawm cov txheej txheem pathogenesis yog ib qho ntawm cov thawj coj.
Cov hom hauv qab no yog qhov txawv:
- lacunar, uas tshwm sim vim occlusion ntawm cov hlab ntsha me me;
- atherothrombotic - tshwm sim los ntawm atherosclerosis ntawm cov hlab ntsha loj, ua rau arterio-arterial embolism;
- cardioembolic vim myocardial infarction, valvular heart disease lossis arrhythmia;
- mob ischemic cuam tshuam nrog qhov ua rau tsis tshua muaj: tsis yog-atherosclerotic vasculopathies, kev txiav ntawm phab ntsa hlab ntsha, ntshav hypercoagulability;
- pathology ntawm qhov tsis paub etiology, uas qhov ua rau tsis tsim, lossis yuav muaj ntau yam ntawm lawv.
Qhov kev faib tawm TOAST ntawm kev mob stroke yog qhov ntau tshaj.
Ischemic stroke cov tsos mob
Lawv tau pom los ntawm cov neeg txheeb ze thiab cov phooj ywg los ntawm lawv cov tshuaj tiv thaiv kev khaus thiab cov tsos mob ntawm tus neeg mob:
- ntuav thiab mob taub hau;
- mob rhiab heev, lub suab thiab lub cev muaj zog ua haujlwm poob lossis txo;
- kev nco qab ntxhov siab.
Nyob ntawm qhov mob hnyav thiab thaj chaw cuam tshuam, cov cim hauv qab no ntawm cov kab mob no txawv:
- kev tsis sib haum xeeb hauv qhov chaw thiab kev xav tsis thoob;
- mob qhov muag, tshwj xeeb tshaj yog thaum txav pob qhov muag;
- tsis nco qab nrog luv luv convulsions;
- mob taub hau.
Daim duab hauv qab no yog qhov raug rau sab xis ntawm ischemic stroke:
- kev nyuaj siab thiab qaug zog;
- tuag tes tuag taw thiab desensitization ntawm lub ntsej muag nqaij ntawm sab laug ntawm lub ntsej muag;
- mob thiab tuag tes tuag taw ntawm lub cev sab laug;
- kev ua txhaum cai.
Lub paj hlwb sab laug yog lub luag haujlwm rau kev hais lus, yog li nws tuaj yeem nyob li qub.
Sab laug-sab mob stroke yog tus yam ntxwv ntawm cov hauv qab no:
- kev hais lus tsis meej;
- kev sib koom tes ntawm kev txav thiab kev nkag siab ntawm kev sib npaug;
- tsis hnov tsw, hnov lus, tsis pom kev, thaum mob hnyav, qhov teeb meem txuas mus rau ob sab;
- kev txom nyem ntawm sab xis ntawm lub cev nrog nws cov tuag tes tuag taw ntawm qhov sib txawv.
Yog li, muaj kev faib tawm ntawm cov hlab ntsha tawg raws li kev mob hlwb.
Qhov no pathology tuaj yeem ua tau los ntawm:
- qhov pib mob hnyav, uas muaj cov tsos mob tshwm sim sai sai, yog qhov zoo rau cov neeg mob atrial fibrillation;
- undulating, thaum cov tsos mob maj mam nce;
- qog zoo li, uas qhov nce hauv ischemia tshwm sim nyob rau lub sijhawm ntev, uas ua rau muaj kev puas tsuaj loj rau lub hlwb.
Tus yam ntxwv ntawm tus kab mob yog qhov tsis muaj peev xwm luag thiab qhov tseeb tias tus nplaig, thaum tawm ntawm lub qhov ncauj, deviates ntawm nruab nrab mus rau sab.
Views by defeat
Kev faib tawm ntawm ischemic stroke raws li neurology paub qhov txawv ntawm cov kab mob hauv qab no:
- kev tawm tsam ischemic, nyob rau hauv uas cov kab mob neurological yog focal nyob rau hauv cov xwm, regressing nyob rau hauv ib hnub tom qab lawv tshwm sim;
- mob stroke me - kho cov haujlwm ntawm lub paj hlwb yog ua tiav hauv 2-21 hnub;
- nce qib - cov tsos mob ntawm lub paj hlwb thiab cov tsos mob tshwm sim ntau dua li ob peb teev lossis hnub nrog kev rov ua haujlwm tsis tiav tom qab;
- ua tiav stroke - regression yuav tsis tshwm sim los yog tsis tag.
Ntau hom tsiaj nyob hauv ntiaj teb
Kev faib cov mob stroke tsis yog nyob hauv peb lub tebchaws xwb. Thaum sau cov kev kuaj mob, muaj ib qho system (ICD-10), uas txhua tus kab mob tau muab nws tus kheej cov cai. Kev faib tawm ntawm WHO ntawm mob stroke yog nyob ntawm qhov kawg. Raws li nws, hom kab mob hauv qab no yog qhov txawv:
- cerebral infarctionhlwb;
- subarachnoid hemorrhage;
- cerebral hemorrhage;
- tsis tau txhais.
hom thib ob thiab thib peb yog hais txog hemorrhagic stroke.
Hom ischemic pathology los ntawm lub sijhawm
Nyob ntawm seb cov kab mob pathology thiab lub sijhawm tom qab nws txoj kev, cov kev faib tawm hauv qab no los ntawm lub sijhawm mob stroke yog siv:
- Sharpest - thawj peb hnub. Nyob rau tib lub sijhawm, peb teev tom qab qhov pib ntawm qhov kev loj hlob ntawm tus kab mob hu ua "kev kho qhov rai", uas cov tshuaj thrombolytic tuaj yeem siv tau. Kev thim rov qab tuaj yeem tshwm sim thawj hnub.
- Lub sijhawm mob mus txog 4 lub lis piam.
- Lub sijhawm rov ua haujlwm ntxov - mus txog 6 lub hlis.
- Zoo lig - mus txog 2 xyoos.
- Lub sijhawm ntawm cov teebmeem seem yog tom qab lub sijhawm no.
Yog li, kev faib tawm ntawm ischemic strokes yog ua raws li ntau yam ntawm ntau yam.
Ua rau cerebral hemorrhage
Raws li tau hais dhau los, cov kab mob hauv cov lus nug tuaj yeem tshwm sim tsis yog vim kev txhaws, tab sis kuj yog vim cov hlab ntsha tawg. Yog li, raws li kev faib tawm ntawm cerebral strokes, tsis tsuas yog nws cov ischemic ntau yam txawv, tab sis kuj hemorrhagic.
Qhov ua rau muaj tus kab mob no yog raws li hauv qab no:
- los ntshav mus rau hauv lub hlwb qog;
- cirrhosis ntawm daim siab, ua rau ua txhaum ntawm cov ntshav txhaws thiab txo cov platelets, ua rau hemorrhages;
- teem sijhawmCov tshuaj fibrinolytic, tshuaj antiplatelet, anticoagulants;
- pathologies nrog los ntshav: hemophilia, thrombocytopenia;
- dystrophic thiab inflammatory dynamics ntawm phab ntsa hlab ntsha: amyloid angiopathy, vasculitis;
- arterio-venous malformations;
- vascular aneuryms;
- hlab ntshav siab.
Peb qhov laj thawj kawg yog qhov ntau tshaj.
Raws li kev faib tawm ntawm cov hlab ntsha tawg, uas muab rau lawv faib rau hauv hemorrhagic thiab ischemic, tsuas yog 15% ntawm tag nrho cov kab mob tau muab cais ua thawj.
Clinic of cerebral hemorrhage
Nws yog txiav txim los ntawm qhov loj thiab qhov chaw ntawm qhov txhab. Cov cim qhia ntawm lub hlwb tsis ua haujlwm nyob ntawm seb cov qauv ntawm lub hlwb puas lawm. Kev hais lus, kev xav thiab lub cev muaj zog feem ntau cuam tshuam. Yog hais tias qhov hemorrhage nyob rau hauv lub hlwb qia, ces lub vasomotor thiab cov chaw ua pa yuav raug puas tsuaj, uas tuaj yeem ua rau tuag sai.
Cov tsos mob ntawm cerebral hemorrhage
Rau hemorrhagic stroke, tib cov tsos mob yog cov yam ntxwv ntawm ischemic stroke, tshwj xeeb tshaj yog, ib tug neeg tsis tuaj yeem tsa ob txhais tes tib lub sijhawm, luag nyav, lo tawm nws tus nplaig hauv txoj hauj lwm ncaj nraim, cuam tshuam rau thaj tsam ntawm lub cev rov qab mus rau qhov cuam tshuam hemisphere. Tsis tas li ntawd, nrog rau hom kab mob no, cov pob muag tig mus rau qhov hemorrhage.
Yog tias lub cerebellum raug cuam tshuam, ces kev hais lus zoo tshwm sim, qhov tsis muaj peev xwm sawv ntsug, ua txhaum caitaug kev, kiv taub hau, ntuav, mob taub hau occipital. Yog hais tias hemorrhages nyob rau hauv lub hlwb no loj, ces edema sai sai, uas wedges mus rau hauv lub occipital foramen, uas ua rau tuag.
Thaum hemorrhages nyob rau hauv hemispheres, cov ntshav nkag mus rau hauv lub ventricles ntawm lub hlwb. Nyob rau hauv tas li ntawd, ib tug neeg poob rau hauv lub coma, los yog nws tsis nco qab lawm, uas yog ib qho kev hem thawj rau lub neej.
Subarachnoid hemorrhage tej zaum yuav nrog mob taub hau hnyav thiab lwm yam tsos mob ntawm tus mob stroke nrog coma.
Nrog rau cov ntshav hauv lub hlwb qia, ob leeg tuag tes tuag taw tsim, cov hlab plawv thiab cov hlab ntsws raug cuam tshuam, muaj qhov tsis nco qab, kev loj hlob sai ntawm coma, nqos tau thiab rhiab heev raug cuam tshuam. Qhov tshwm sim ntawm kev tuag nce mus txog 90%.
Hmoov hemorrhagic strokes
Lawv txawv nyob ntawm cov qauv kev ua haujlwm thiab qhov chaw nyob hauv lub hlwb. Raws li qhov no, cov nram qab no hom hemorrhages yog txawv nyob rau hauv kev faib ntawm hemorrhagic stroke:
- sub- thiab epidural;
- intraventricular;
- parenchymal;
- subarachnoid.
thawj cov uas feem ntau raug mob thiab raug kho los ntawm cov kws kho mob hlwb.
Intraventricular hemorrhages tuaj yeem tshwm sim vim kev tawg ntawm choroid plexuses, tab sis ntau zaus cov ntshav nkag mus rau qhov ntawd vim muaj cov hemispheric hematomas loj. Tib lub sijhawm, cov cawv txoj kev raug kawntshav, cov dej tawm ntawm cerebrospinal los ntawm pob txha taub hau raug cuam tshuam, vim tias hydrocephalus tsim, cerebral edema nce. Txoj kev ciaj sia nyob rau hauv cov ntaub ntawv no yog tsawg heev. Raws li txoj cai, cov neeg mob tuag nyob rau hauv thawj ob hnub tom qab cov ntshav nkag mus rau hauv lub ventricles.
Parenchymal hemorrhage yog hom hemorrhagic stroke tshaj plaws. Hauv qhov no, cov ntshav nkag mus rau hauv lub hlwb heev. Parenchymal hemorrhages, nyob rau hauv lem, muab faib ua ob hom:
- hematoma;
- hemorrhagic impregnation.
Thawj yog ib kab noj hniav uas muaj ntshav. Nyob rau hauv cov ntaub ntawv no, lub hlwb nyob rau hauv cov cheeb tsam cuam tshuam tuag, uas ua rau ib tug neurological tsis txaus thiab ua rau muaj kev hem thawj rau lub neej ntawm cov neeg mob. Txoj hauv kev uas yuav tau txais txiaj ntsig zoo yog qhov tsis txaus ntseeg.
Nyob rau hauv rooj plaub thib ob, cov ntshav nkag mus ntawm cov ntsiab lus ntawm lub paj hlwb, thaum loj-scale neuronal kev tuag tsis tshwm sim, zoo li thawj kis, yog li qhov kev mob tshwm sim zoo dua. Hom mob stroke no tuaj yeem tshwm sim los ntawm kev kho cov tshuaj tiv thaiv coagulants, thrombocytopenia, kub siab.
Nyob rau hauv subarachnoid hemorrhage, ntshav accumulates nyob rau hauv pia mater, uas muaj cov hlab ntsha thiab npog sab nraud ntawm lub hlwb. Hom no hu ua vascular malformations thiab aneurysms. Thaum cov hlab ntsha tawg, cov ntshav kis thoob plaws lub hlwb. Qee zaum muaj kev koom tes hauv cov txheej txheem pathological ntawm cov ntaub so ntswg hauv hlwb, qhov no lawv hais txog subarachnoid-parenchymal hemorrhage.
Kev nyuaj siab
Hauv ischemic stroke, cov hauv qab no ua tauqhov tshwm sim:
- mob vwm (nws tshwm sim hauv txhua kis thib tsib);
- Kuv muaj kev nyuaj siab, txob taus, hloov pauv ntsws;
- tshwm sim ntawm ntau yam mob mob;
- paralysis, qaug zog;
- lub cev muaj zog;
- kev tso zis thiab tso quav;
- cerebral edema;
- kev puas hlwb;
- pulmonary thromboembolism;
- dub vein thrombosis ntawm sab ceg;
- kab mob urinary, bedsores, mob ntsws thiab lwm yam pathologies.
Nrog rau sab laug-sab ischemia, tus neeg tsis tuaj yeem taug kev hauv lub sijhawm thiab qhov chaw, tso nws tus kheej ua tus neeg noj qab haus huv, tsis paub txog cov txheeb ze thiab phooj ywg.
Nyob rau hauv thawj lub lim tiam, kev tuag yuav tshwm sim vim yog theem nrab ischemia ntawm lub paj hlwb qia, uas tsim foci ntawm infarction. Tsis tas li ntawd, tus kab mob ischemic tuaj yeem hloov mus ua ib qho hemorrhagic nrog kev tsim cov hemorrhage thib ob. Cerebral edema kuj tshwm sim.
Nrog ntau yam hemorrhagic, myocardial infarction, arrhythmia, cardiac decompensation, kev loj hlob ntawm cov ntshav txhaws nrog muaj peev xwm tsim pulmonary thromboembolism, siab rwj, sepsis, congestive pneumonia, urinary tract infections
Qhov teeb meem txaus ntshai tshaj plaws hauv qhov no yog:
- ua haujlwm tsis zoo ntawm kev ua pa sab nraud thiab lub cev hemodynamics;
- kev txhim kho ntawm hydrocephalus;
- cerebral edema;
- ntshav nkag mus rau hauv lub qhov quav.
Ntxiv mus, cov teeb meem no tuaj yeem tshwm sim ob qho tib si hauv lub sijhawm mob hnyav ntawm kev loj hlob ntawm tus kab mob thiab tom qab.
Nyob hauv kaw
Muaj ntau qhov kev faib tawm ntawm cov hlab ntsha tawg raws li ntau yam. Los ntawm hom, nws muab faib ua ischemic thiab hemorrhagic. Nyob rau hauv kev sib raug zoo rau thawj, qhov kev faib yog dav dua. Muaj ntau yam raws li pathogenesis, raws li ICD-10, uas tau txais kev txhawb nqa los ntawm WHO, raws li kev kho mob hlwb, raws li lub sijhawm. Cov tsiaj sib txawv yog cov tsos mob zoo sib xws, tshwj xeeb tshaj yog nyob rau hauv cov nqe lus ntawm kev tuag tes tuag taw ntawm sab ntawm lub cev rov qab mus rau qhov cuam tshuam hemisphere, impossibility ntawm protruding tus nplaig, tsa caj npab. Qhov ua rau tuag taus hauv ischemic stroke yog 15-20%, thaum nyob rau hauv hemorrhagic stroke nws mus txog 80-90%.
