Ib qho ntawm cov kab mob sib haum xeeb ntawm lub paj hlwb hauv nruab nrab yog vertebrobasilar insufficiency. Tus mob no yog tus cwj pwm los ntawm ntau cov tsos mob tsis zoo. Yuav kom txoj kev kho kom zoo raws li qhov ua tau, nws yog ib qho tsim nyog yuav tsum tau ua kom txoj kev daws teeb meem ntawm qhov nyuaj. Ib tus kws kho mob uas paub txog yuav sau cov kev kho mob uas tsim nyog tom qab cov txheej txheem kuaj mob. Tus kab mob no yog dab tsi, nws yog vim li cas, tshwm sim thiab txoj kev kho mob yuav tham ntxiv.
Kev piav qhia dav dav
Basilar insufficiency raws li ICD-10 hais txog chav kawm 5 "Vascular kab mob ntawm lub paj hlwb" thiab muaj cai G45. Hauv daim ntawv no, tus kab mob hu ua "Vertebrobasilar Arterial System Syndrome".
Tus kab mob yog ib qho kev ua haujlwm ntawm lub hlwb tsis zoo uas thim rov qab. Cov mob no yog tshwm sim los ntawm kev txo qis ntawm cov ntshav ncig hauv qee yamthaj tsam ntawm lub hlwb uas tau noj los ntawm cov hlab ntsha cuam tshuam (vertebral thiab basilar).
Vertebrobasilar insufficiency yog tshwm sim los ntawm cov tsos mob tshwj xeeb. Qhov no qhia txog kev mob ischemia ntawm lub paj hlwb hauv cov cheeb tsam uas txiav txim siab vascularization ntawm cov hlab ntsha loj thiab vertebral. Qee qhov kev hloov pauv hauv daim duab pathological tuaj yeem kuaj pom hauv cov neeg mob tom qab kev tso tseg ntawm ischemic nres.
Kev tshwm sim ntawm tus kab mob no muaj ntau yam. Ob peb cov tsos mob tshwm sim. Qee lub sij hawm nws tsis yooj yim sua kom tshem tawm qhov tseem ceeb. Kawm txog cov tsos mob ntawm tus mob basilar insufficiency, kws kho mob tau txheeb xyuas ob pawg ntawm qhov tshwm sim ntawm tus kab mob:
- Paraximal - syndromes tshwm sim thaum pib ntawm ischemic nres.
- Permanent - tus yam ntxwv los ntawm qhov tshwm sim ntev, pom nyob rau hauv tus neeg mob lub sijhawm ntawm kev tawm tsam.
Nyob rau hauv cov hlab ntsha ntawm lub vertebrobasilar system, ob qho tib si ischemic transient attacks thiab ischemic strokes ntawm txawv degrees ntawm kev siv yuav tshwm sim. Xws li lawv tuaj yeem ua lacunar.
Vim txoj kev loj hlob
Basilar insufficiency syndrome tuaj yeem tsim rau ntau yam laj thawj. Qhov loj tshaj plaws yog ntau yam mob ntawm cov hlab ntsha vertebral. Lawv yog cov sib txawv. Tsis tas li, kev hloov pauv pathological tuaj yeem txiav txim siab hauv cov kab mob subclavian thiab cov hlab ntsha tsis muaj npe.
Cov tsos mob zoo li no tau piav qhia los ntawm kev txhim kho stenosis, uas yog tus yam ntxwv ntawm atherosclerotic xwm. Nws yuav tsum tau muab sau tseg tias heevFeem ntau muaj vertebrobasilar insufficiency tawm tsam keeb kwm ntawm lub ncauj tsev menyuam osteochondrosis. Muaj compression ntawm cov hlab ntsha vertebral, uas yog compressed los ntawm lub vertebrae. Cov tom kawg, vim yog cov yam ntxwv ntawm tus kab mob, muaj kev hloov kho. Qhov no, piv txwv li, tuaj yeem yog osteophytes lossis spondylosis. Compression tshwm sim los ntawm cov xwm txheej zoo li no tuaj yeem suav tias yog qhov ua rau muaj kev ywj pheej ntawm kev loj hlob ntawm vertebrobasilar insufficiency.
Nws yog ib qho tsim nyog sau cia tias cov tsos mob ntawm tus kab mob no tsis yog ib txwm tshwm sim los ntawm kev ua tsis zoo ntawm cov hlab ntsha vertebral. Feem ntau ua rau txo cov ntshav ncig hauv cheeb tsam no, ntxiv rau cov uas twb tau hais lawm, yog:
- Cervical disc herniation.
- Spasm ntawm cov leeg hauv caj dab.
- Subluxations ntawm lub ncauj tsev menyuam vertebrae.
- Txiv neej, keeb kwm kev loj hlob anomalies.
Ntxiv rau, qee zaum, qhov ua rau basilar insufficiency tuaj yeem ua rau caj dab raug mob ntawm qhov sib txawv.
Kev kho mob tshwm sim
Tus mob vertebrobasilar tsis txaus tuaj yeem tshwm sim nrog ntau yam tsos mob. Lawv tuaj yeem ua tau (sensitive, pyramidal), vestibular, pom. Kev ua haujlwm ntawm cov hlab ntsha cranial kuj tuaj yeem ua tsis taus. Nyob ntawm qhov hnyav thiab kev sib xyaw ua ke ntawm cov tsos mob ntawm basilar insufficiency, qhov loj ntawm thaj chaw cuam tshuam los ntawm ischemia thiab nws qhov chaw nyob yog txiav txim siab.
Cov ntshav muab rau lub paj hlwb thiab cerebellum tuaj yeem sib txawv me ntsis ntawm ib tus neeg mus rau lwm tus. Yog li ntawd, tus piavclassic neurological manifestations nyob rau hauv kev muaj tiag yuav luag tsis tshwm sim nyob rau hauv lawv daim ntawv ntshiab. Nrog rau qhov rov ua dua, sab ntawm kev hnov lus thiab lub cev muaj zog sib txawv thiab kev tsis sib haum xeeb tuaj yeem hloov pauv.
Ib qho ntawm cov tsos mob feem ntau yog kev ua haujlwm tsis zoo ntawm lub cev muaj zog. Cov neeg mob yuav muaj paresis, kev sib koom tes tsis zoo. Dynamic ataxia yog ua ke nyob rau hauv cov ceg ceg nrog txhob txwm tremor. Gait tuaj yeem cuam tshuam lossis cov leeg nqaij yuav txo qis asymmetrically.
Kev hnov mob feem ntau tshwm sim los ntawm kev siv tshuaj loog tag nrho lossis ib nrab ntawm cov ceg, ib nrab ntawm lub cev. Paresthesia tuaj yeem tshwm sim. Hauv 25% ntawm cov neeg mob, muaj qhov tsis txaus ntseeg lossis tob tob ntawm kev nkag siab.
Nws yog ib qho tsim nyog sau cia tias nws tsis yog ib txwm ua tau los txiav txim siab kev koom tes hauv cov txheej txheem pathological ntawm qee qhov chaw ntawm cov ntshav ntawm cov hlab ntsha vertebral, cov hlab ntsha carotid los ntawm kev kho mob tshwm sim. Yog li ntawd, thaum kuaj mob, nws tsis tuaj yeem ua yam tsis muaj cov txheej txheem neuroimaging.
pom kev cuam tshuam, kiv taub hau
Ntawm cov tsos mob ntawm basilar insufficiency, ib qho ntawm feem ntau tshwm sim yog qhov muag tsis pom kev. Xws li kev sib txawv tuaj yeem tshwm sim los ntawm kev poob ntawm thaj chaw. Photopsies yuav tshwm sim.
Thaum lub circulatory system ntawm lub paj hlwb raug cuam tshuam, kev cuam tshuam tshwm sim nyob rau hauv qhov chaw ntawm cov hlab ntsha ntawm lub cranium. Tej zaum yuav muaj teeb meem ntawm hom oculomotor. Qhov no yuav yog, piv txwv li, strabismus, ntsug sib cais ntawm lub qhov muag, thiab lwm yam. Cov kab mob no kuj suav nrog peripheral paresis ntawm cov leeg ntawm lub ntsej muag thiab bulbar syndrome.
Cov kev tshwm sim uas tau teev tseg tuaj yeem pom hauv kev sib txawv. Tsis tshua muaj, tsuas yog ib qho syndrome tshwm sim. Cov kab mob tuaj yeem tshwm sim los ntawm kev sib xyaw ua ke ntawm cov hlab ntsha hauv cov hlab ntsha vertebral thiab carotid.
Lwm cov tsos mob ntawm vertebrosobasilar insufficiency yog kiv taub hau. Lub xeev no tuaj yeem kav ntev li ob peb feeb, tab sis qee zaum nws tuaj yeem ncav cuag ob peb teev. Qhov no yog vim lub morphological thiab functional yam ntxwv ntawm tib neeg circulatory system, siab rhiab heev rau ischemia.
kiv taub hau tuaj yeem muaj ntau hom. Qee zaum muaj kev ua txhaum cai ntawm lub vestibular apparatus. Tab sis kuj muaj qhov sib xyaw ua ke ntawm kiv taub hau. Qhov no yog tshwm sim los ntawm qhov kev xav ntawm kev sib hloov lossis txav mus rau hauv txoj kab ncaj nraim ntawm cov khoom nyob ib puag ncig tus neeg mob, nrog rau nws lub cev. Qhov no feem ntau ua rau xeev siab, thiab qee zaum ntuav. Tus neeg mob muaj hyperhidrosis, nce lub plawv dhia, hloov ntshav siab.
Lub sijhawm dhau mus, qhov kev siv ntawm qhov tsis xis nyob yuav txo qis. Tab sis cov tsos mob focal, xws li ataxia, yuav tshwm sim. Lawv txawj hais lus ntau, ua siab ntev, mus tas li.
tsis hnov lus
Kawm cov tsos mob thiab kev kho mob ntawm vertebrobasilar insufficiency, nws tsim nyog sau cia lwm qhov tshwm sim ntawm pathology. Cov no yog kev tsis hnov lus. Nws tuaj yeem pom qhov txo qis, suab nrov tshwm hauv pob ntseg. Tej zaum kuj yuav muaj kev xav ntawm congestion. Cov tsos mob zoo sib xws feem ntau tshwm sim thaum ischemia cuam tshuam rau thaj tsam ntawm cov hlab ntsha sab hauv sab hauv.cerebellum. Nws muab cov ntshav mus rau qhov chaw dorsolateral ntawm lub paj hlwb, nrog rau lub cerebellar peduncle. Cov hlab ntsha no kuj pub rau pob ntseg sab hauv, cov hlab ntsha cochlear.
Kev hnov lus thiab vestibular teeb meem, tshwm sim hauv lub cev, feem ntau nrog rau lwm yam kev mob hlwb. Qhov no qhia txog pathology ntawm kev noj haus ntawm cerebellum thiab lub hlwb qia.
Ntau zaus tsawg dua, tus neeg mob tsim muaj kab mob sib cais ntawm hom ischemic ntawm pob ntseg sab hauv lossis paj hlwb. Hauv qhov no, tus neeg mob muaj qhov mob tsis hnov lus, nrog rau kiv taub hau. Tsis muaj teeb meem neurological. Ib qho xwm txheej zoo sib xws tshwm sim vim qhov txo qis ntawm patency ntawm cov hlab ntsha ntawm lub auditory, uas yog lub hauv paus ceg ntawm inferior anterior cerebellar artery. Tsis muaj anastomoses ntawm no.
Kev ua txhaum cai cais tsis tshua muaj heev. Yuav tsum muaj kev kuaj mob dav dav, vim tias qhov tshwm sim no qee zaum qhia txog qhov pib ntawm kev txhim kho ntawm tus mob stroke, uas yog nrog los ntawm qhov tsis txaus ntawm cov paj hlwb.
Diagnosis
Txhawm rau sau cov txheej txheem kev kho mob kom zoo rau kev tsis txaus basilar, tus kws kho mob tau sau ntawv tshuaj ntsuam xyuas. Txog niaj hnub no, ib txoj hauv kev zoo tshaj plaws ntawm neuroimaging yog MRI. Nrog kev pab los ntawm cov txheej txheem no, nws tuaj yeem txheeb xyuas txawm tias me me foci ntawm pathology.
Yog tias nws yuav tsum ua kom sib txawv ntawm qhov mob stroke, CT yog siv. Tab sis qhov txheej txheem no yuav tsis tshua paub,yog tias koj yuav tsum kawm cov qauv ntawm cov qauv ntawm cranial posterior fossa. Niaj hnub no, nws tuaj yeem tshawb xyuas lub txaj vascular siv magnetic resonance angiography. Txawm li cas los xij, radiopaque angiography yog qhov zoo tshaj rau cov txheej txheem no nyob rau hauv cov ntsiab lus ntawm cov ntaub ntawv.
Yog tias tus neeg mob muaj cov tsos mob ntawm kev puas tsuaj rau cov hlab ntsha loj, tsuas yog cov txheej txheem ntawm cerebral selective angiography yuav qhia tau. Yog tias qhov nqaim ntawm phab ntsa thiab qhov txo qis hauv vascular patency yog tshwm sim los ntawm atherosclerosis, tshwj xeeb tshaj yog nyob rau hauv cov kab mob vertebral, digital angiography ntawm cov hlab ntsha yog cov txheej txheem qhia ncaj ncees. Txoj kev txhaj tshuaj zoo sib xws yuav tsis qhia txog qhov no.
Txawm li cas los xij, nws tsim nyog nco ntsoov tias kev tshawb fawb angiographic ua rau muaj kev pheej hmoo mob stroke. Yog li ntawd, lawv tau muab tshuaj kom ceev faj heev.
Nyob rau hauv chav kawm ntawm tus cwj pwm ntawm ultrasound niaj hnub no, kev teeb tsa Doppler thiab lub tshuab ntsuas triplex tau siv. Qhov no tso cai rau koj kom pom qhov zoo ntawm cov lus hais thiab tsis zoo intracranial ntawm cov hlab ntsha. Nws yog ib txoj kev uas tsis yog-tus yam ntxwv uas tsis mob thiab tsis muaj kev phiv.
txoj kev kho
Kev kho mob ntawm basilar insufficiency yog ua los ntawm kev coj mus rau hauv tus account tus yam ntxwv ntawm tus neeg mob lub cev, nrog rau kev kho mob tshwm sim. Tom qab kev kuaj mob tiav, tus kws kho mob tuaj yeem sau tshuaj kho tau zoo. Thaum kho, nws yog ib qho tseem ceeb kom tswj cov ntshav siab.
Tom ntej no, muaj kev noj zaub mov tshwj xeeb. Nws muaj ib tug complex ntawm cov vitamins thiab minerals. Nws yog ib qho tseem ceeb tshwj xeeb rau kev noj zaub mov ntxivCov vitamins C thiab R. Qab Zib, cov zaub mov muaj roj thiab ntsev tsis suav nrog. Nws yog txwv tsis pub haus cawv thiab haus luam yeeb. Yog tias tus neeg mob tus mob zoo txaus, kev kho mob tsis siv tshuaj yuav kav li 2-3 lub hlis.
Tus neeg mob tau txais kev tawm dag zog lub cev, suav nrog rau lub tshuab vestibular. Nws yog qhov zoo tshaj los ua lawv sab nraum zoov. Nws tseem ceeb heev uas yuav tau taug kev txhua hnub, mus pw raws sijhawm, thiab so kom txaus. Hauv qhov no, yuav tsis tas yuav tshuaj.
Yog tias tus neeg mob tus mob tsis ruaj khov, kev tawm tsam tshwm sim ntau zaus thiab siv zog heev, yuav tsum tau kho mob. Nws yuav tsum tau ua ke nrog kev noj zaub mov zoo thiab kev ua kom lub cev kom zoo. Hauv qhov no, kev kho mob yuav ua tau zoo.
Tshuaj
Rau kev kho mob ntawm basilar insufficiency, tus kws kho mob tau sau qee yam tshuaj. Koj tsis tuaj yeem kho tus kheej. Dab tsi ua haujlwm rau ib tus neeg mob yuav tsis ua haujlwm rau lwm tus. Hauv qhov no, ib tus neeg mus kom ze yog qhov tseem ceeb tshaj plaws.
txhawm rau txo cov ntshav siab, cov kws kho mob tau sau ACE inhibitors rau cov neeg mob, piv txwv li, nws tuaj yeem yog Enalapril. Calcium channel blockers kuj tseem yuav xav tau. Txhawm rau ua qhov no, koj yuav tsum tau txais kev kho mob nrog cov tshuaj xws li, piv txwv li, Felodipine lossis nws cov analogues. Cov tshuaj beta-blockers tuaj yeem raug sau tseg. Cov no suav nrog Bisoprolol, Nebivalol.
Qee zaum, kev kho mob tsis muab qhov xav tau. Yog li ntawd, tus neeg mob tus mob yuav tsum tau saib xyuas tas li los ntawm kws kho mob. Nws sau tau qhov noKev sib xyaw tshuaj, xws li kev sib xyaw ACE inhibitors nrog cov tshuaj diuretics.
Lwm yam tshuaj zoo
Ntxiv nrog rau cov tshuaj stabilizers, tus kws kho mob tuaj yeem sau qee yam tshuaj thaum kho basilar insufficiency. Yog tias tus neeg mob tau kuaj pom tias muaj cov kab mob atherosclerotic ntawm cov hlab ntsha, lub plawv valve lossis cov hlab ntsha peripheral, yuav tsum muaj kev kho mob antithrombotic. Rau qhov no, "Dipyridamole", "Acetylsalicylic acid", "Clopidogrel" yog sau.
Nco ntsoov muab tshuaj los txhim kho cerebral ncig. Qhov no, piv txwv li, tuaj yeem yog "Cinnarizine", "Piracetam", "Phezam". Qhov kawg ntawm cov tshuaj no yog ua ke ntawm thawj ob yam tshuaj.
Kho gymnastics yog qhov yuav tsum tau ua. Qhov no tso cai rau koj los txhim kho cov hlab ntsha, txhim kho cov ntshav ncig.
Gymnastics rau lub vestibular apparatus
Tshwj xeeb gymnastics ua lub luag haujlwm tseem ceeb hauv cov txheej txheem kho mob. Txhawm rau ntxiv dag zog rau lub vestibular apparatus, txhim kho cov kev mob ntawm tus neeg mob, koj yuav tsum ua ob peb yam yooj yim ce. Lawv tau ua txhua hnub thiab ua haujlwm zoo.
Ua ntej koj yuav tsum maj mam tig koj lub taub hau ntawm ib sab mus rau sab, nce thiab nqis. Lub ntsia yuav tsum txav nrog lub taub hau, thiab tom qab ntawd kho ntawm ib qho taw tes.
Tes muab tso rau saum lub taub hau, rub lub taub hau rov qab. Hauv qhov no, koj yuav tsum tau tawm tsam nrog koj txhais tes. Nyob rau hauv txoj hauj lwm no, lub taub hau yog tuav rau 3 vib nas this. Kev tawm dag zog yog ua 10 zaug. Cov txheej txheem tib yam yog ua los ntawm kev muab cov ntiv tes tso rau ntawm lub hauv pliaj, thiab tom qab ntawd hloov pauv ntawm cov tuam tsev.
Kev ua kom zoo sib npaug yog qhov kev coj ua ib leeg. Ua ntej koj yuav tsum qhib koj lub qhov muag, thiab tom qab ntawd kaw. Koj yuav tsum tau ua kev tawm dag zog ntawm qhov chaw mos.
Nws raug nquahu kom tawm ntawm txaj maj mam. Ua ntej, smoothly tig rau ntawm ib sab, thiab tom qab ntawd rau lwm qhov. Lub qhov muag yuav tsum qhib. Qhov no rov ua dua ob peb zaug. Tom qab ntawd koj tuaj yeem sawv.
