Subarachnoid hemorrhage yog ib yam mob uas tshwm sim los ntawm cov ntshav cerebral, thaum cov ntshav pib nkag mus rau hauv qhov chaw subarachnoid ntawm lub paj hlwb. Cov kab mob no yog tus cwj pwm los ntawm qhov mob hnyav thiab ntse hauv lub taub hau, tsis nco qab lub sijhawm luv, nws tsis meej pem, uas tuaj yeem ua ke nrog hyperthermia thiab cov tsos mob ntawm meningeal complex. Txheeb xyuas cov ntshav subarachnoid raws li CT cov ntaub ntawv thiab angiography ntawm lub hlwb. Yog tias nws tsis tuaj yeem ua tiav cov kev tshawb fawb no, pathology tau lees paub los ntawm kev muaj ntshav hauv cov kua dej cerebrospinal. Lub hauv paus ntawm kev kho mob ib txwm nyob rau hauv cov ntaub ntawv no yog kev kho mob ntawm angiospasm, nrog rau kev tshem tawm ntawm lub paj hlwb aneurysm los ntawm cov hlab ntsha system, uas yog ua los ntawm kev phais.
yam ntxwv tsos mob
mob taub hau mob hnyav heev nrog subarachnoid hemorrhage nce mus txog nws qhov siab tshaj plaws hauv ob peb feeb xwb. Thaum ib qho aneurysm ruptures los yog tam sim ntawd tom qab nws, lub sij hawm luv luv ntawm kev nco qab tuaj yeem pom. Hauv qee kis, qhov no tsuas yog tshwm sim tom qab qee lub sijhawm dhau mus. Cov neeg mob zoo li tsis xis nyob heev thiab tej zaum yuav qaug dab peg. Qee lub sij hawm cov tsos mob ntawm neuralgia koom nrog cov duab kho mob ntawm tus mob no, uas feem ntau dhau los ua qhov hloov tsis tau hauv ob peb teev lossis txawm tias feeb tom qab qhov kev sib tsoo ntawm qhov txhab.
Txoj kev piav qhia ntawm subarachnoid hemorrhage (ICD 10 I60) yog muab hauv qab no.
Hauv thawj teev, thaum tsis muaj qhov mob hnyav thiab mob herniation ntawm tonsils ntawm cerebellum, kev txav ntawm caj dab cov leeg tsis tau hais. Txawm li cas los xij, thaum thawj hnub, kev txhim kho ntawm cov kab mob chemical meningitis pib, thiab cov tsos mob ntawm kev khaus ntawm cov meninges nce. Nyob rau hauv cov ntaub ntawv no, nruab nrab los yog pronounced soj ntsuam cov tsos mob ntawm meningism tshwm sim, ntuav tshwm sim, ob sab pathological plantar reflex, ib tug hloov nyob rau hauv lub mem tes thiab cov txheej txheem ntawm ua pa ua pa. Hauv thawj 5-7 hnub, qhov kub thiab txias yuav nce, uas yog nrog los ntawm kev mob taub hau ntev thiab tsis meej pem.
Secondary hydrocephalus yuav ua rau mob taub hau, stupor thiab lub cev muaj zog cuam tshuam uas tshwm sim rau ib hlis. Cov ntshav rov tshwm sim tuaj yeem ua rau hnyav duaCov tsos mob uas twb muaj lawm.
Yuav ua li cas
Subarachnoid hemorrhage tshwm sim sai, mob heev, thaum tsis muaj dab tsi ua rau pom qhov xwm txheej zoo li no, yog tus cwj pwm, raws li txoj cai, los ntawm qhov tshwm sim ntawm qhov tshwm sim ntawm qhov tshwm sim ntawm qhov mob taub hau ntawm "ntaus" hom, uas feem ntau nrog xeev siab thiab ntuav. Ib yam hauv qhov xwm txheej no yog kev qaug zog luv luv thiab kev txhim kho ntawm meningeal syndrome. Kev tsis nco qab ntev ntev qhia txog cov mob hnyav heev, thaum muaj cov ntshav tawm mus rau hauv cov hlab ntsha, uas muaj cov tsos mob tshwm sim sai. Qhov no qhia tau hais tias ib qho subarachnoid-parenchymal hemorrhage nyob rau hauv lub hlwb.
Meningeal syndrome yog qhov tseem ceeb sib txawv ntawm kev kuaj mob ntawm cov kab mob no. Nyob ntawm qhov loj ntawm subarachnoid hemorrhage (ICD code - 10 I60), cov tsos mob tuaj yeem tshwm sim hauv ntau txoj kev thiab pheej nyob ib hnub mus rau 4 lub lis piam.
Nrog rau qhov tshwm sim ntawm cov tsos mob ntawm lub paj hlwb hnyav, xws li hemorrhage tuaj yeem nrog qee qhov kev hloov pauv viscero-vegetative.
Ntau zaus thaum lub sijhawm subarachnoid hemorrhage hauv lub hlwb muaj qhov nce ntshav siab. Cov tsos mob no yog suav hais tias yog lub cev cov lus teb rau qhov xwm txheej ntxhov siab, uas kuj yog qhov ua tau zoo, txij li nws tswj hwm lub paj hlwb perfusion siab nyob rau hauv cov xwm txheej ntawm mob intracranial siab thaum lub sij hawm hemorrhage. Ntshav siab, tshwj xeeb tshaj yog nyob rau hauv cov neeg mobleej twg raug kev txom nyem los ntawm kev mob ntshav siab feem ntau ua rau tus mob hnyav no raug kuaj pom tsis raug raws li kev kub ntxhov siab.
Thaum muaj mob hnyav subarachnoid hemorrhage, mob hnyav ntawm lub plawv thiab cov kab mob ua pa tuaj yeem tshwm sim.
Nyob rau lub sijhawm mob hnyav ntawm cov txheej txheem pathological, feem ntau muaj qhov kub thiab txias mus rau subfebrile cov duab thiab kev loj hlob ntawm leukocytosis. Cov tsos mob no tseem tuaj yeem txhais tsis raug raws li cov cim qhia ntawm kis kab mob.
Qhov hnyav ntawm tus neeg mob tus mob thaum lub sijhawm hemorrhage thiab cov txheej txheem tom ntej ntawm cov txheej txheem pathological nyob ntawm nws qhov loj thiab etiology. Nws pib nyuaj heev, raws li txoj cai, nws tshwm sim thaum aneurysm ntawm cerebral hlab ntsha tawg.
Qhov ua rau subarachnoid hemorrhage yuav tau tham hauv qab no.
Ua rau kev loj hlob ntawm pathology
Spontaneous los yog, raws li nws yog feem ntau hu ua nyob rau hauv kev kho mob terminology, thawj, hemorrhage (SAH) tshwm sim, raws li txoj cai, vim rupture ntawm ib tug aneurysm ntawm tej yam superficial hlab ntsha. Qee zaum tsawg dua, nws tau pom nrog kev tawg ntawm atherosclerotic lossis mycotic aneurysms, arteriovenous malformation, lossis hemorrhagic diathesis. Subarachnoid hemorrhage ntawm lub hlwb kuj muaj ntau heev nyob rau hauv kev raug mob lub hlwb raug mob.
Kwv yees li ib nrab ntawm cov mob intracranial hemorrhage yog tshwm sim los ntawm aneurysms ntawm cov hlab ntsha nyob rau hauv lub hlwb. Cov kab mob pathological no tuaj yeem ua tauyuav congenital los yog tau. Visually, aneurysm yog ib qho kev tsim saccular ntawm phab ntsa hlab ntsha, uas lub caj dab, lub cev thiab hauv qab yog qhov txawv. Txoj kab uas hla ntawm lub hnab vascular, raws li txoj cai, yog li ntawm ob peb millimeters mus rau ob peb centimeters. Aneurysms loj dua 2 cm inch yog suav tias yog loj heev. Subarachnoid hemorrhage (ICD code I60) tshwm sim sib npaug ntawm cov txiv neej thiab poj niam, thiab feem ntau yog los ntawm keeb kwm.
Statistics
Ruptures of aneuryms tshwm sim feem ntau ntawm cov hnub nyoog ntawm 30 thiab 50, thiab tshwm sim nyob rau hauv yuav luag 90% ntawm cov neeg mob. Cov kab mob tsis sib haum xeeb ntawm qhov xwm txheej no tshwm sim hauv kwv yees li 6-7%, thiab cov kab mob asymptomatic - hauv 0.5% ntawm cov neeg mob. Kev tawg ntawm aneurysms yuav luag ib txwm tshwm sim hauv thaj av ntawm lawv cov hauv qab, qhov twg nyob rau hauv lub tshuab tsom iav feem ntau tuaj yeem pom cov pinholes me me uas muaj cov kab mob thrombotic. Ib qho chaw hauv cheeb tsam ntawm aneurysms yog nyob rau hauv qhov chaw ntawm cov hlab ntsha ntawm qhov kev txiav txim I thiab II. Lawv feem ntau nyob hauv cheeb tsam yog pom nyob rau hauv supraclinoid seem ntawm cov hlab ntsha carotid sab hauv (40% ntawm cov neeg mob), nyob rau hauv lub cerebral anterior thiab anterior sib txuas cov hlab ntsha (30% ntawm cov neeg), nyob rau hauv nruab nrab cerebral hlab ntsha (20%), nyob rau hauv lub vertebrobasilar. qhov system (10%). Ntau qhov aneurysms feem ntau tsis tshua muaj thiab tshwm sim li ntawm 15% ntawm cov neeg mob.
Nrog subarachnoid hemorrhages vim lub sijhawm ntev spasms ntawm cov hlab ntsha loj, diffuse ischemia ntawm lub cev no tsim nyob rau hauv lub hauv paus ntawm lub hlwb, uas yog ntau zaus.txhua yam ua rau kev hloov pauv tom qab hemorrhagic hauv kev paub txog kev ua haujlwm, piv txwv li, lethargy, dementia. Tseem muaj qhov nce hauv intracranial siab.
Txoj Kev Kho Mob
Qhov tshwm sim ntawm subarachnoid hemorrhage yuav tsum tau kho sai sai. Cov neeg mob hauv qhov xwm txheej no raug mus pw hauv tsev kho mob xwm txheej ceev hauv chav kho mob neurosurgical ntawm lub tsev kho mob.
Tam sim no, ntshav siab tau kho, ntshav siab normalized, siv tshuaj tiv thaiv thiab tshuaj tua kab mob. Nyob rau hauv rooj plaub uas tus neeg mob tsis nco qab, tag nrho cov dej num saum toj no yog ua tawm tsam keeb kwm ntawm cov tshuab ua pa.
Txhawm rau tshem tawm vasospasm hauv lub hlwb, cov neeg mob tau muab tshuaj Nimodipine (Nimotop). Vim lub fact tias, los ntawm parenteral kev tswj hwm, cov tshuaj no tuaj yeem ua rau cov hlab ntsha hypotension, uas tuaj yeem ua rau lub paj hlwb ischemic puas tsuaj, nws raug nquahu kom noj nws qhov ncauj txhua 4 teev. Hauv cov xwm txheej tsis nco qab, cov tshuaj tau muab tshuaj, raws li txoj cai, los ntawm kev sojntsuam. Cov ntsiav tshuaj yuav tsum tsis txhob noj cov kua txiv hmab txiv ntoo vim qhov no yuav ua rau muaj kev cuam tshuam metabolic.
Nyob rau hauv rooj plaub uas angiospasm tshwm sim tawm tsam keeb kwm yav dhau los ntawm cov ntshav siab los yog nruab nrab, kev txiav tawm ntawm qhov aneurysm yuav tsum tau ua. Nws kuj tseem pom tau tias tsim nyog txhawm rau nce siab nrog kev pab ntawm "Dopamine" lossis lwm yam txhais tau tias.
Txhim kho lub hlwb edema hauv subarachnoid hemorrhage (ICD 10), Dexamethasone, Mannitol, Glycerol yog siv intravenously. Thaum hyponatremia tshwm sim,Raws li txoj cai, nws txaus los txo cov kua isotonic txhaj rau hauv cov ntshav. Thaum hypovolemia tshwm sim, cov tshuaj isotonic saline daws los yog Ringer cov tshuaj yog siv los tshem tawm nws. Nyob rau hauv cov ntaub ntawv ntawm kev tshawb pom ntawm tsis txaus ADH ntau lawm, txwv tsis pub noj kua thiab siv Furosemide tom qab subarachnoid hemorrhage raug qhia.
Non-occlusive hydrocephalus yog txo los ntawm rov lumbar puncture.
Kev ntsuas dav dav hauv cov kab mob no zoo ib yam li cov uas tau ua hauv ischemic stroke. Nyob rau tib lub sijhawm, tus neeg mob tau pom lub txaj so, nws raug tso cai kom sawv ntawm 4 lub lis piam tom qab hemorrhages, thiab ua ntej ntawd, nws lub cev muaj zog maj mam nce.
Yuav daws qhov teeb meem ntawm kev kho mob phais, tag nrho angiography ntawm cerebral hlab ntsha yog ua.
Thaum tus neeg mob tus mob tso cai, qhov mob aneurysm raug txiav hauv thawj ob hnub tom qab nws tawg. Hauv qhov xwm txheej hnyav heev, thaum nws los cawm tib neeg txoj sia, kev cuam tshuam endovasal yog ua. Ib cov txheej txheem zoo sib xws kuj tseem siv rau cov neeg mob uas muaj mob aneurysms ntawm kev pheej hmoo phais mob siab, nrog rau thaum muaj cov kab mob aneurysms nrog lub caj dab nqaim heev.
Kev kho mob ntawm subarachnoid hemorrhage yuav tsum tau raws sijhawm.
Nyob rau hauv rooj plaub uas tsis tuaj yeem ua haujlwm ceev, nws tau ua raws li kev npaj kwv yees li 2 lub lis piam tom qab hemorrhage (thaum lub sijhawm "lub caij txias"). Qee zaum, piv txwv li, nrog hematomas ntawm lub ntsej muag lobe,Kev phais mob xwm txheej ceev yuav tsum tau ua, uas yog txhawm rau kho tus mob uas ua rau muaj kev phom sij rau lub neej, txawm tias lub luag haujlwm tseem ceeb, uas yog qhov kev txiav tawm ntawm qhov aneurysm, tsis yooj yim sua.
Kev pheej hmoo ntawm kev tuag thaum phais yog kwv yees li 6%, thiab qhov kev pheej hmoo ntawm kev tsim cov ntaub ntawv loj ntawm cov paj hlwb tsis txaus yog kwv yees li 13%.
Kev kuaj mob rau cov tsos mob ntawm subarachnoid hemorrhage yog dab tsi?
Kev kuaj mob hemorrhage
Cov kab mob no tau kuaj pom tias muaj lub lumbar puncture, thaum kuaj pom cov kua cerebrospinal, uas ntws tawm hauv qhov siab.
Ob peb teev tom qab hemorrhage, cov kua dej no tau txais xim xanthochromic vim hemolysis ntawm erythrocytes. Lub xub ntiag ntawm cov ntshav nyob rau hauv cheeb tsam subarachnoid tuaj yeem kuaj pom los ntawm CT ntawm lub taub hau. Txawm li cas los xij, lumbar punctures yuav muaj txiaj ntsig tsis yog rau kev kuaj mob nkaus xwb tab sis kuj rau kev kho mob. Yog tias kev txhim kho ntawm kev rov ua dua subarachnoid hemorrhage tsis tau pom, ces cov kua cerebrospinal pib maj mam meej, thiab nws cov ntsiab lus thaum kawg normalizes los ntawm lub lim tiam thib 3.
mob hemorrhage qee zaum zoo li myocardial infarction, thiab lub xeev tsis nco qab thiab ECG hloov pauv tuaj yeem ua rau qhov no. Nrog rau kev loj hlob ntawm focal neurological manifestations, qhov pathology no yuav tsum tau sib txawv ntawm parenchymal hemorrhage.
Angiography thiab xam tomography kuj yuav tsum tau uanpaj kev phais txoj kev kho mob. Nws yog ib qho tsim nyog los kawm tag nrho cov hlab ntsha tseem ceeb ntawm lub taub hau, vim ntau qhov aneurysms tuaj yeem tshwm sim ib txhij.
Computer tomography tuaj yeem kuaj pom qhov aneurysm yog tias nws loj dua 5 hli. Thaum lub sij hawm hemorrhagic, basal hemorrhage tuaj yeem pom, uas qee zaum ua ke nrog intracerebral lossis intraventricular hemorrhage. Xav txog qhov tshwm sim ntawm subarachnoid hemorrhage ntawm lub hlwb.
Qhov tshwm sim ntawm subarachnoid los ntshav
Qhov tseem ceeb tsis zoo rau qhov tshwm sim ntawm cov kab mob pathological no yog qhov tsis nco qab, muaj cov ntshav nyob hauv qhov chaw subarachnoid, lub hnub nyoog ntawm tus neeg mob thiab muaj vascular aneurysms nyob rau hauv lub vertebrobasilar phiab.
Nyob rau qee cov neeg mob uas muaj ntshav me me, kev tuag yuav yog vim lub sijhawm ntev ntawm lub paj hlwb ischemia thaum pib tus kabmob. Nyob rau hauv tas li ntawd, lub siab ntawm cov kua nyob rau hauv tus txha caj qaum nce mus rau theem siab nyob rau hauv cov hlab ntsha ntawm lub paj hlwb thiab muaj ib tug circulatory ntes.
Hypertension tom qab subarachnoid hemorrhage yog suav tias yog qhov nyiaj them rov qab, yog li cov tshuaj tiv thaiv hypertensive siv nrog cov cim zoo li no tuaj yeem ua rau lub hlwb perfusion. Qee cov kws tshaj lij tau hais tias yog tias tsis siv cov tshuaj tiv thaiv kab mob siab ua ke nrog cov dej ntim dej, qhov no tuaj yeem txo qhov kev pheej hmoo ntawm kev tsim cov hlab ntsha hlwb. Arterial hypertension nyob rau lub sijhawm mob hnyav ntawm subarachnoid hemorrhage yuav tsis raug khocov xwm txheej uas tsis muaj cov cim qhia ntawm lub cev puas tsuaj.
Hyponatremia yog tus cwj pwm los ntawm kev poob ntawm sodium los ntawm cov ntaub so ntswg hauv hlwb, thiab tsis yog qhov tshwm sim ntawm hemodilution vim tsis muaj qhov tso tawm ntawm ADH. Nws yuav tsum tau kho, raws li nws muaj peev xwm provoke kev loj hlob ntawm cerebral ischemia.
Cov tshuaj Antifibrinolytic tuaj yeem tiv thaiv kom tsis txhob rov los ntshav tshwm sim los ntawm kev sib tsoo aneurysm, txawm li cas los xij, ua rau muaj kev pheej hmoo ntawm cerebral ischemia thiab, vim li ntawd, tsis cuam tshuam rau qhov tshwm sim ntawm pathological hemorrhage.
Fludrocortisone muaj cov haujlwm mineralocorticoid, thiab tseem rov nqus sodium hauv cov tubules ntawm ob lub raum, uas txhais tau hais tias nws tuaj yeem tiv thaiv qhov tshwm sim ntawm qhov tsis zoo sodium tshuav, qhov tshwm sim ntawm ischemic thiab hypovolemia. Txhua tus neeg yuav tsum paub qhov ua rau thiab qhov tshwm sim ntawm subarachnoid hemorrhage.
Huab cua
Kev ntsuas kev kho mob feem ntau yog nyob ntawm qhov hnyav ntawm qhov kev tawm tsam pom hauv txhua tus neeg mob. Yog tias muaj kev kho mob tsis tu ncua, qhov tshwm sim ntawm cov ntshav rov qab tom qab kev cuam tshuam ntawm neurosurgical yog siab heev thiab, vim li ntawd, tus neeg mob tuag. Kev rov qab los tom qab hemorrhage yuav siv sij hawm tsawg kawg yog rau lub hlis thiab yog lub sijhawm nyuaj heev ntawm kev kho mob. Kev noj tshuaj txhua hnub, saib xyuas qhov xwm txheej, mus ntsib kws kho mob tsis tu ncua - qhov no yog qhov tseem ceeb rau kev kho mob zoo li no. Tsis tas li ntawd, tus neeg mob uas tau muaj kev tawm tsam ntawm lub paj hlwb los ntshav yuav tsumMuab cov cwj pwm phem thiab pib coj txoj kev ua neej nyob rau hauv kev ntsuas kom tsis txhob muaj qhov tshwm sim ntawm subarachnoid hemorrhage.
Pathology hauv cov menyuam yug tshiab
Subarachnoid hemorrhage hauv cov menyuam mos tuaj yeem cuam tshuam nrog kev yug menyuam, muaj cov tsos mob xws li meningeal thiab hydrocephalic syndrome, nrog rau cov tsos mob focal uas nyob ntawm qhov chaw ntawm qhov hemorrhage, tshwm sim tam sim tom qab yug me nyuam.
Mob ntshav siab nyob rau hauv cov menyuam mos feem ntau yuav luag asymptomatically lossis tuaj yeem kuaj pom hnub ob. Cov tsos mob ntawm cerebral hemorrhage nyob rau hauv cov me nyuam mos tshwm sim li:
- Kuv muaj kev txhawj xeeb heev thiab kev sib cav sib ceg.
- Npaj qw.
- Txhawj xeeb.
- Puag inversions.
- Txhim kho lub cev muaj zog.
- Ntxhais nqaij tawv.
- Hyperesthesia.
- Jaundice.
- Txoj kev ntawm lub fontanel.
Kev kuaj mob kom raug thiab kho raws sijhawm pab txo qis kev pheej hmoo ntawm kev tsim cov kab mob hauv lub hlwb, pab txhawb lawv txoj kev kho kom rov zoo sai thiab txo qis cov teebmeem ntawm lub hauv nruab nrab paj hlwb uas ua rau muaj kev loj hlob ntawm cerebral palsy hauv cov menyuam yaus.
Taumatic subarachnoid hemorrhage
Cov kab mob no tshwm sim los ntawm kev raug mob ntawm lub taub hau nrog lub zog tawg rau lub taub hau thiab nrog kev tawg ntawm cov hlab ntsha pial, uas nyob hauv qhov chaw subarachnoid. Feem ntau, cov kev mob tshwm sim ntawm xws li hemorrhage tshwm sim nyob rau hauv ib tug hluashnub nyoog, nyob rau hauv cov tub ntxhais hluas thiab cov me nyuam uas ntog los ntawm qhov siab, kev ua si los yog kev raug mob ntawm txoj kev, thiab nyob rau hauv kev sib tsoo.
Qhov tshwm sim ntawm kev raug mob subarachnoid hemorrhage (ICD 10 I60) nyob ntawm seb hom hlab ntsha thiab los ntshav loj, lub hnub nyoog ntawm tus neeg mob, lub sijhawm kuaj mob thiab mus pw hauv tsev kho mob.
