Hypertensive (hypertensive) encephalopathy (HE) yog kev ua txhaum ntawm lub hlwb ua haujlwm tawm tsam keeb kwm ntawm malignant hypertension. Raws li ICD-10, mob hypertensive encephalopathy yog coded li I67.4. Lub sij hawm tau qhia nyob rau hauv 1928 los ntawm Oppenheimer hauv kev koom tes nrog Fishberg los piav txog qhov tshwj xeeb ntawm encephalopathy. Txawm hais tias qhov xwm txheej zoo li no tuaj yeem tshwm sim hauv ntau yam kab mob (nrog eclampsia, nce siab sai, kub siab uas twb muaj lawm, mob nephritis, qog adrenal, thiab lwm yam), qhov txaus ntshai tshaj plaws los ntawm kev kub ntxhov. Nws ua rau cov tsos mob hnyav nrog kev paub tsis meej thiab cov ntaub so ntswg necrosis.
Kev mob ntshav siab cuam tshuam rau lub hlwb li cas?
Txawm tias dhia ib zaug rau lub hlwb tsis dhau yam tsis muaj kab. Cov kev cai ntawm lub suab ntawm venules thiab arterioles yog impaired. Lub hom phiaj tsis yog xwblub hlwb, tab sis kuj lub plawv thiab ob lub raum. Nrog me ntsis nce siab, kev tiv thaiv spasm ntawm cov hlab ntsha me ua ntej pib. Qhov no yog ua los ntawm lub cev txhawm rau tiv thaiv lawv qhov tawg thiab siab.
Yog tias lub siab tseem nce siab rau lub sijhawm ntev, cov leeg nqaij ntawm cov hlab ntsha pib hypertrophy. Qhov tshwm sim yog qhov nqaim ntawm lumen ntawm cov hlab ntsha thiab txo qis hauv cov ntshav perfusion. Hypoxia tshwm sim rau qhov sib txawv. Qhov siab tshaj plaws rau hypoxia yog lub hlwb. Uas ua rau cov tsos mob neurological.
Yog li, nrog HE ntawm txhua daim ntawv, hemodynamics ntawm lub hlwb raug cuam tshuam, thiab cov ntaub so ntswg hlwb puas mus txog rau necrosis. Tag nrho cov no los tawm tsam keeb kwm yav dhau los ntawm kev kub siab mus ntev, uas nyuaj rau tswj.
Mob ntshav siab encephalopathy raws li ICD yog qhov txawv ntawm ib hom kev mob ntshav siab uas tshwm sim nrog cov tsos mob ntshav siab. Thaum xub thawj, cov hlab ntsha me me feem ntau cuam tshuam, tab sis cov kab mob sai sai pib ua ke nrog kev koom tes ntawm lwm cov calibers. Daim ntawv no feem ntau tshwm sim nws tus kheej tawm tsam keeb kwm ntawm kev kub ntxhov siab. Raws li ICD-10, mob hypertensive encephalopathy muaj cov cai hauv qab no - I67.4. Nyob rau tib lub sijhawm, qib siab yuav txawv ntawm cov neeg mob hypo- thiab hypertensive.
Rau cov neeg mob ntshav siab, cov lej txaus ntshai yog li ntawm 180-190 mm Hg. Art., thiab hauv cov neeg mob hypotensive - hauv 140/90. Txawm li cas los xij, peb tab tom tham txog kev tsa tus qauv.
Cov kws tshaj lij hu rau lub xeev ntawm hypertensive encephalopathy ib yam ntawm qhov tshwm sim ntawm kev kub ntxhov siab. Daim ntawv mob ntev ntawm pathology yog ntau dua.
GE in acute form
Acute GE yog qhov xwm txheej ceev thiab yuav tsum tau txais kev pab tam sim. Txwv tsis pub, cov teeb meem yuav tsum muaj nyob rau hauv daim ntawv ntawm cerebral edema, hemorrhagic stroke, plawv nres, tuag.
Acute hypertensive encephalopathy raws li ICD-10 muaj code I67.4. Discirculatory vascular hypertensive encephalopathy yog suav tias yog ib qho kev tshwm sim. Nws ua tau nyob rau txhua lub hnub nyoog.
Pathology tshwm sim tawm tsam keeb kwm ntawm kev kub siab - kev kub ntxhov. Ib qho exacerbation tawm tsam lawv keeb kwm yav dhau los ntawm GE yog cov saw hlau zoo li no. Nws txoj kev loj hlob sai dua li lwm hom dyscirculatory encephalopathy.
Kev kuaj mob ntawm "dyscirculatory hypertensive encephalopathy" yog ua nrog kev puas tsuaj rau cov ntaub so ntswg ntawm lub hlwb vim cov ntshav tsis txaus. Nws txoj kev loj hlob yog maj mam thiab vam meej. Nrog rau kev hloov pauv morphological hauv cov ntaub so ntswg hauv hlwb, kev ua haujlwm tsis zoo thiab tuaj yeem ua rau dementia, tsis muaj peev xwm thiab kev tsis taus.
Cas ntawm teeb meem
Qhov ua rau HE (hypertensive encephalopathy raws li ICD yog coded I67.4) yog ib daim ntawv tsis quav ntsej txog ntshav siab. Hauv qhov no, nws tuaj yeem yog thawj thiab theem nrab, uas yog, tawm tsam keeb kwm yav dhau los ntawm lwm yam kab mob nrog rau lub siab surges: lub raum puas (ntoo pyelonephritis, glomerulonephritis, hydronephrosis), hyperthyroidism.
Y Pathologies ntawm cov qog adrenal thiab pituitary - pheochromocytoma, ua haujlwm ntau dhau ntawm adrenal cortex lossis hauv thaj chaw glomerular - aldosterone, aorticatherosclerosis.
Rau cov neeg mob ntshav siab, kev tswj tsis tau ntshav siab yog qhov txaus ntshai, kev hloov pauv sai heev thaum cov tshuaj tiv thaiv hypertensive raug tso tseg. Rov qab muaj kev kub ntxhov ntawm cov hlab ntsha, uas cov hlab ntsha tuaj sai sai thiab ua nyias. Lawv permeability nce thiab muaj cov hemorrhagic impregnation sai ntawm cov ntaub so ntswg hlwb. Kuj tseem muaj qhov hloov pauv tau tsom mus rau normalizing siab, hypotension nrog qeeb ntshav khiav. Nocturnal hypertension feem ntau latent.
siab mem tes siab yog lwm qhov tseem ceeb. Yog tias qhov sib txawv ntawm qhov siab thiab qis qis tshaj 40 mm Hg. Art. - Cov kab mob vascular yog exacerbated. Xws li lub siab tsis tu ncua cuam tshuam rau phab ntsa vascular thiab ua rau lub nra ntawm cov leeg nqaij ntawm phab ntsa vascular.
Risk Factor
Cov yam pheej hmoo suav nrog:
- Kev sib txawv ntawm kev ua haujlwm ntawm cov hlab ntsha thiab lub plawv uas tsis kuaj tau raws sijhawm.
- Kab mob raum (congenital lossis kis tau) thiab lub hlwb.
- Lub xeev tsis ruaj khov ntawm cov hlab ntsha. Overexertion ntawm txhua yam - lub cev thiab lub hlwb.
- Kev kho mob tsis raug lossis tsis xwm yeem ntawm kev kub siab.
- Kev noj zaub mov tsis zoo thiab lub cev tsis ua haujlwm, tus cwj pwm tsis zoo.
Hypertensive encephalopathy (hypertensive encephalopathy raws li ICD-10 code I67.4) kuj tuaj yeem ua rau:
- rog, laus, ntshav qab zib;
- tsis kam lossis hloov mus rau lwm yam tshuaj tiv thaiv ntshav siab yam tsis tau sab laj nrog kws kho mob;
- eclampsia nrog edema,ntshav siab thiab proteinuria;
- qog adrenal;
- kev quav tshuaj rau qee yam tshuaj - steroids, caffeine, kev ua si nawv;
- kev ntxhov siab tawm tsam keeb kwm yav dhau los ntawm cov teeb meem uas twb muaj lawm nrog cov hlab ntsha;
- ecology phem tuaj yeem ua rau muaj kev cuam tshuam rau cov nkoj;
- systematic hypothermia ntawm lub cev.
Raws li qee yam xwm txheej, kev kuaj mob ntshav siab encephalopathy (ICD code I67.4) tuaj yeem ua rau txhua tus.
Pathogenesis
Thaum muaj kev tsis txaus ntawm cov khoom noj khoom haus xa mus rau cov hlab ntsha, kev hloov pauv tshwm sim hauv lawv cov phab ntsa hauv daim ntawv ntawm kev txo qis hauv lawv lub suab. Tom qab ntawd los ntawm thickening ntawm cov leeg ntawm phab ntsa ntawm cov hlab ntsha thiab lawv cov lumen nqaim. Hypoxia mob zuj zus. Qhov no, nyob rau hauv lem, ua phem rau cov mob ntawm lub paj hlwb.
Spasm ntawm cerebral arterioles ua rau hypoxia thiab khoom noj khoom haus tsis txaus rau lub hlwb, mob cerebral ischemia. Tsis tas li ntawd, kev hloov pauv degenerative tshwm sim hauv cov txheej txheem cerebral. Yog tias muaj atherosclerosis, nws tsuas yog ua rau qhov xwm txheej hnyav dua.
Cov medulla dawb yog cuam tshuam ntxov dua li lwm tus, lacunar infarcts tsim ntawm no thiab demyelination ntawm paj hlwb tshwm sim.
Cov kev hloov pauv no tau nthuav dav thiab cuam tshuam rau ob lub hemispheres symmetrically. Cov kab mob thawj zaug tshwm sim raws lub ventricles, ces lawv nthuav lawv qhov chaw - lawv kis periventricularly.
Ntawm qhov tseem ceeb ntawm txoj kev loj hlob ntawm OGE yog qhov ntau dhau ntawm cov hlab ntsha me me uas nkag mus rau hauv cov hlab ntsha, lawv cov permeability nce thiab tuag tes tuag taw.daim ntawv mob ntawm GE.
ntse zoo
Hypertensive crisis nrog ntshav siab tshaj 180-190 mm Hg. Art. ua rau, raws li txoj cai, kev hloov pauv loj hauv cov ntaub so ntswg ntawm cov hlab ntsha. Qhov twg? Thaum muaj kev cuam tshuam rau nws txoj kev txav mus los, uas yog: lub lumen nqaim ntawm cov hlab ntsha lossis cov plaques ntawm cov phab ntsa, cov ntshav ua rau qhov no los ntawm qhov pom ntawm hemorrhages raws phab ntsa ntawm cov hlab ntsha. Lub suab ntawm cov leeg ntawm cov leeg nqaij mos hloov pauv thiab intracranial siab nce. Nws ua rau cov tsos mob ntawm neurological tsos mob. Mob hypertensive encephalopathy - qhov tshwm sim ntawm kev kub ntxhov siab; tab sis nws kuj dhau los ua ib qho harbinger ntawm strokes nrog kev loj hlob ntawm kev tsis taus thiab kev tuag. 16% ntawm qhov teeb meem ntawm kev kub ntxhov yog qhov tseeb ntawm OGE.
Symptomatics
Lub tsev kho mob ntawm tus mob hypertensive encephalopathy suav nrog:
- Ntsia mob taub hau.
- Ua ntej lawv nyob hauv qab ntawm lub taub hau, ces lawv ua nchuav, i.e. loj hlob.
- Mob tsis tau daws los ntawm kev mob plab. Feem ntau qhov no yog nrog xeev siab thiab ntuav yam tsis muaj kev pab. Mob hypertensive encephalopathy tshwm sim nws tus kheej feem ntau thaum muaj kev kub ntxhov.
- Kev pom kev pom tshwm sim sai sai vim qhov o ntawm lub qhov muag pom, cov yoov tsaus nti thiab me ntsis tshwm rau ntawm lub qhov muag.
- kiv taub hau. hnoos thiab txham thiab lwm yam nro hauv caj dab cov leeg ua rau tus mob hnyav dua.
- Hnub tsis hnov lus - suab nrov thiab tinnitus tshwm.
- Convulsions thiab meningeal tsos mob tshwm sim yam tsis muaj o (meningismus).
- Nto rhiab heev pibnce.
Feem ntau, cov no yog cov tsos mob ntawm kev kub ntxhov, tab sis nrog kev koom tes ntawm lub hlwb tsis ua haujlwm. Thaum tsis muaj kev kho kom raug, kev tuag loj ntawm cov neurons thiab cov tsos ntawm ischemic foci tshiab tshwm sim.
Cov tsos mob tseem ceeb ntawm lub tsev kho mob ntawm tus mob hypertensive encephalopathy kuj suav nrog:
- stupefaction xeev ua ntej los ntawm kev zoo siab dhau mus rau paresis;
- slow heart rate;
- mob taub hau ntawm tus nplaig, ntiv tes, kev taw qhia hauv qhov chaw cuam tshuam;
- gait ua tsis ruaj khov.
Lub cev kub tuaj yeem nce. Kev tawm tsam tuaj yeem siv sijhawm ob peb teev lossis ntev txog 2 hnub. Tsis tas li ntawd, mob stroke hemorrhagic tsim, cerebral edema thiab tuag yog tias tsis muaj kev pab.
Mob ntshav siab encephalopathy yog li nyob hauv txoj haujlwm nruab nrab ntawm kev kub ntxhov thiab mob stroke.
Qhov kev txiav txim siab yog tus lej ntawm lub siab: thaum muaj kev tawm tsam nws mus txog 250-300, qhov qis dua yog mus txog 130-170. Tab sis cov hlab ntsha dilate. Lawv tsis nqaim lawm, thiab lawv cov permeability nce. Nyob rau hauv cov ntaub so ntswg ntawm lub paj hlwb, cov ntshav khiav yog cuam tshuam, nrog ib tug tsis muaj peev xwm ntawm plasma, protein, thiab oxygen, nws edema tsim. Me foci ntawm necrosis tsim.
Mob ntshav siab encephalopathy kuj yog ib qho ntawm cov tsos mob thaum ntxov ntawm kev mob stroke, yog li tus neeg mob yuav tsum ua ntej ntawm txhua tus ceev faj thiab hu rau lub tsheb thauj neeg mob.
Diagnosis
Qhov kev kuaj mob algorithm suav nrog:
- Yuav tsum kuaj xyuas los ntawm tus kws kho mob hlwb. Nyob rau hauv thawj theem, cov xwm txheej yuav tsisua txhaum, tab sis anisoreflexia tshwm sim ntxov dua lwm tus. Kev ntsuam xyuas kev txawj ntse tshwj xeeb txiav txim siab mnestic, praxic thiab gnostic impairments ntawm txawv degrees.
- Kev sab laj nrog kws kho plawv yuav txheeb xyuas thiab paub meej tias muaj ntshav siab.
- Kev puas siab puas ntsws yog ntsuas los ntawm tus kws kho mob hlwb los ntawm kev sib tham, kev soj ntsuam thiab kev sim.
- Kev kuaj mob tuaj yeem nyuaj vim qhov zoo sib xws ntawm cov tsos mob ntawm kev raug mob hauv hlwb, yog li CT thiab MRI ntawm cov hlab ntsha hlwb yuav tsum tau ua. Nyob rau hauv cov ntaub ntawv no, focal hloov nyob rau hauv lub hlwb - cerebral edema. Nws kuj tseem tso cai rau txheeb xyuas qhov kev hloov pauv degenerative, foci ntawm yav dhau los lacunar infarcts hauv cov neeg mob nrog II-III theem ntawm HE, kom tsis suav nrog lwm cov kab mob hauv lub hlwb. Daim duab ntawm kev kuaj ntshav tsis yog qhia, tab sis qhov muaj ntawm hypercholesterolemia yog qhov tseem ceeb.
- Nyob ntawm tus kws kho qhov muag qhov kev sab laj - o ntawm lub qhov muag discs. Muaj qhov nce siab hauv pob txha taub hau.
- EEG - kev tsis sib haum xeeb ntawm lub suab nrov, tshwj xeeb tshaj yog nyob rau thaj tsam occipital. ECG - sab laug ventricular phab ntsa hypertrophy, dystrophic hloov hauv myocardium.
- Kev tshawb fawb ntawm cerebral hemodynamics: ultrasound ntawm lub ncauj tsev menyuam thiab cranial hlab ntsha. Txoj kev tshawb no qhia txog qib ntawm kev nqaim ntawm cov hlab ntsha, lawv thaj chaw thiab kev nthuav dav.
Kev nyuaj siab
OGE yog ib qho mob ceev uas, yog tias tsis kho, ua rau:
- muag;
- hlwb infarction;
- stroke;
- IM;
- cerebral edema,
- intracranial hemorrhage thiabtuag.
Kev kho mob
Tus neeg mob yuav tsum tau mus pw hauv tsev kho mob hauv chav saib xyuas mob hnyav thiab saib xyuas tag nrho pab pawg kws kho mob: resuscitator, neurologist, neurosurgeon, ophthalmologist, thiab lwm yam.
Kev kuaj mob OGE yuav tsum tau siv cov tshuaj ua haujlwm ntev.
Nws yog qhov yuav tsum tau sau tshuaj diuretics uas txo qhov o ntawm lub hlwb cov ntaub so ntswg - Furosemide, ethacrynic acid, Lasix, thiab lwm yam. Nws tseem ceeb heev rau kev tswj cov ntshav electrolytes kom tiv thaiv tag nrho lub hlwb ischemia.
Koj tsis tuaj yeem txo qhov siab uas twb muaj lawm, cov txheej txheem yuav tsum maj mam maj mam. Hauv thawj teev, qhov txo qis yuav tsum tsis pub tshaj 20% rau systolic thiab 15% rau diastolic, thiab hauv 24 teev tom ntej, lub siab yuav tsum tau ua kom zoo rau qhov kev kawm no. Diastolic siab yuav tsum tsis txhob poob qis dua 90 mmHg
Nrog lub zog ntse tsis txaus ntawm cov hlab ntsha hauv hlwb, qhov txo qis hauv systolic siab yuav tsum tau qeeb dua: lub siab tsis tshaj 15%, qhov qis dua yog 10% ntawm qhov qub.
Txhawm rau txhawm rau txhawm rau txhawm rau txo qis ntshav siab, sodium nitroprusside tau muab tso rau hauv txoj hlab ntshav (0.3-0.5 mcg / kg hauv 1 min.) - nws tso cai rau koj los tswj cov ntshav siab.
Tsis tas li, cov tshuaj ntawm cov haujlwm tseem ceeb ("Clonidine" thiab "Clonidine") yog siv rau hauv cov hlab ntsha hauv daim ntawv ntawm cov dej hauv saline lossis hauv kwj ntawm 1-2 ml.
Cov txiaj ntsig tau zoo yog muab los ntawm tus neeg saib xyuas ntshav siab - "Hypostat", nws normalizes siab li ntawm ob peb feeb.
Tom ntej no, koj tuaj yeem hloov mus rauntsiav tshuaj - adrenoblockers, calcium ion antagonists ("Nifedipine" - txhim kho cerebral ntshav txaus), ACE inhibitors ("Enalapril", "Captopril" - optimize vascular tone), diuretics thiab lwm yam tshuaj.
Prednisolone, Dexamethasone tau muab tshuaj los tiv thaiv cov edema tshiab thiab txo qhov uas twb muaj lawm.
Nyob rau hauv kev kho mob ntawm tus mob hypertensive encephalopathy nyob rau hauv lub xub ntiag ntawm ib tug convulsive syndrome, Relanium yog tshuaj.
"Magnesia", "Eufillin" kuj tseem yuav muaj cov nyhuv calming thiab sedative. Raws li kev ua txhaum ntawm cov txheej txheem lipid oxidation, cov tshuaj antioxidants tau sau tseg:
- droppers nrog "Mexidol" 400 mg;
- "Ceraxon" 1000 mg txhua;
- "Cytoflavin" 10 ml intravenously.
Nws yog qhov zoo heev los muab lawv nrog cov activators ntawm gluconeogenesis: mildronate 10-20 ml intravenously raws li ib tug dropper.
tshuaj tiv thaiv kab mob yog "Cavinton" thiab "Vinpocetine" rau 3 lub hlis. Hirudotherapy muaj txiaj ntsig zoo.
ntsuas kev tiv thaiv
Raws li cov laj thawj, peb tuaj yeem tsim cov npe meej ntawm kev ntsuas txaus:
- kev kho thiab kho raws sijhawm ntawm kev kub siab;
- kev kho mob ntawm cov kab mob sib kis ua rau mob ntshav qab zib - atherosclerosis, rog;
- txiav luam yeeb thiab haus dej;
- khoom noj khoom haus kom raug;
- antioxidant thiab angioprotective kev tiv thaiv.
Qhov kev ntsuas tseem ceeb yog tswj lub siab ntawm qhov zooqib. Qhov no yuav pab tiv thaiv kev loj hlob ntawm encephalopathy.
Vim tias kev loj hlob ntawm GB mus txog 3 theem, ntawm theem 3 encephalopathy muaj nyob hauv yuav luag txhua tus neeg mob. Yog li ntawd, nws yog ib qho tseem ceeb los tiv thaiv kev hloov pauv ntawm kev kub siab mus rau theem 3. Nws yog ib qho tseem ceeb uas yuav tsum tsis suav nrog kev dhia siab thaum hmo ntuj thiab cov kev hloov pauv ntawm cov keeb kwm yav dhau thaum nruab hnub. Nws yuav tsum nco ntsoov tias tsuas yog thawj theem ntawm kev ua txhaum cai yog thim rov qab. Nyob rau hauv lub neej yav tom ntej, txawm tias txoj kev kho kom raug tsis ua rau muaj txiaj ntsig ntawm kev txo qis kev puas siab puas ntsws thiab lub cev muaj zog.
