Neurogenic zais zis tsis ua haujlwm yog ua txhaum ntawm kev ua haujlwm ntawm lub cev. Pathology yog dav heev. Hauv urology thiab pediatrics, kwv yees li 10% ntawm tag nrho cov kab mob ntawm cov zis yog nyob ntawm tus kab mob no. Nyob rau tib lub sijhawm, qhov kev pheej hmoo ntawm kev hloov pauv hauv lub cev ntawm lub cev ntawm cov hom thib ob yog nce. Kev tso zis tsis zoo yog tshwm sim los ntawm kev ua txhaum ntawm cov kev cai ntawm lub paj hlwb ntawm lub peripheral lossis hauv nruab nrab theem. Tom ntej no, xav txog dab tsi ua rau lub zais zis neurogenic tsis ua haujlwm ntawm lub hnub nyoog yau.
cov ntaub ntawv dav dav
Neurogenic zais zis hauv cov poj niam yog tshwm sim los ntawm kev yug me nyuam nyuaj, kev phais kev cuam tshuam ntawm gynecological xwm, nrog rau cov kab mob ntev ntawm cov plab hnyuv siab raum. Tus kab mob yuav tshwm sim sai sai los yog maj mam nce. Neurogenic zais zis hauv cov txiv neej feem ntau tshwm sim tawm tsam keeb kwm ntawm prostate adenoma, nrog rau tom qab ua haujlwm ntev uas cuam tshuam nrog kev nqa qhov hnyav. Nyob rau hauv pathology, ib tug neeg soj ntsuam cov zis tso zis los ntawm kev poob thiab tsis muaj peev xwm ua kom nws nyob rau hauv cov xwm txheej ntxhov siab. Lub zais zis neurogenic hauv tus menyuam tuaj yeem muaj hom thawj. Nyob rau hauv tas li ntawd, hereditary paj hlwb pathologies ua raws li ib tug provoking yam. Kev tso zis thaum muaj hnub nyoog yau tuaj yeem yog qhov thib ob. Hauv qhov no, kev tsim ntawm pathology tshwm sim nyob rau hauv kev cuam tshuam ntawm exogenous lossis endogenous yam.
Reflex formation
Ib tug me nyuam muaj kev tswj qhov tso zis tag nrho thaum muaj hnub nyoog 3-4 xyoos. Lub kaw lus mus dhau ntau theem ntawm txoj kev loj hlob - los ntawm tus txha caj qaum unconditioned reflex mus rau kev yeem reflex act. Cov kev cai ntawm cov kua paug muaj xws li subcortical thiab cortical hlwb chaw zov me nyuam, aav ntawm tus txha caj qaum innervation nyob rau hauv lub lumbosacral qaum qaum, thiab peripheral paj hlwb plexuses. Neurogenic zais zis nyob rau hauv ib tug me nyuam yog nrog los ntawm kev mob ntawm innervation thiab reserve-vacuum processes. Pathology yuav provoke ib tug xov tooj ntawm cov kab mob loj. Cov no suav nrog, tshwj xeeb, mob raum tsis ua haujlwm, pyelonephritis, cystitis, hydronephrosis, megaurethra, vesicoureteral reflux.
Txoj kev sib cav
Neurogenic zais zis ua haujlwm tsis zoo tshwm sim los ntawm ntau yam kev puas hlwb. Lawv ua rau txo qis hauv kev sib koom tes ntawm kev ua haujlwm ntawm sab nraud sphincter lossis detrusor thaum lub sij hawm sib sau thiab tso tawm cov kua dej. Neurogenic zais zis hauv tus menyuam tuaj yeem txhim khotiv thaiv keeb kwm yav dhau ntawm CNS qhov txhab ntawm qhov xwm txheej. Lawv, nyob rau hauv lem, yuav tshwm sim los ntawm kev raug mob, inflammatory-degenerative thiab neoplastic pathologies ntawm tus txha caj qaum, congenital malformations, kab mob ntawm tus txha caj qaum thiab lub hlwb. Cov kab mob tawm tsam uas lub zais zis neurogenic tsim nyob rau hauv ib tug me nyuam muaj xws li spinal hernias, yug me nyuam raug mob, dysgenesis thiab agenesis ntawm coccyx thiab sacrum, cerebral palsy thiab lwm yam. Lawv ua kom tiav los yog ib nrab dissociation ntawm tus txha caj qaum thiab supraspinal paj hlwb chaw thiab lub cev. Feem ntau, pathology pom nyob rau hauv cov ntxhais. Qhov no yog vim muaj cov tshuaj estrogen saturation, uas ua rau kom qhov rhiab heev ntawm detrusor receptors.
Kev faib tawm
Raws li kev hloov pauv hauv lub zais zis reflex, muaj ntau hom kab mob. Nrog rau lub zais zis hyperreflex, lub xeev spastic tshwm sim nyob rau hauv theem ntawm cov kua tsub zuj zuj. Hom hyporeflex ntawm pathology yog nrog los ntawm detrusor hypotension nyob rau theem tso tawm. Nws yog tus cwj pwm los ntawm qhov tshwm sim ntawm reflex rau tso zis nrog lub ntim ua haujlwm ntawm lub zais zis, loj dua li qub rau hnub nyoog. Nrog hyperreflexia, qhov tshwm sim ntawm cov tshuaj tiv thaiv tau sau tseg ntev ua ntej kev sib sau ntawm cov kua dej tau sau tseg. Hom reflex ntawm pathology yog suav tias yog qhov hnyav tshaj plaws. Nws yog nrog los ntawm impossibility ntawm ywj siab contraction ntawm ib tug overflowing thiab tag nrho cov zais zis, raws li zoo raws li ib tug involuntary act of emptying. Pathology tseem raug cais raws li qib ntawm kev hloov pauv ntawm tus detrusor mus rau qhov nce ntim ntawm cov kua. Yog li, cov npuas neurogenic tuaj yeem ua tauunadapted (tsis-inhibited) thiab yoog. Kuj tseem muaj ntau hom kab mob. Tshwj xeeb, nrog rau daim ntawv me me, tus neeg mob spontaneously empties lub zais zis thaum muaj kev ntxhov siab. Cov tsos mob ntawm daim ntawv hnyav yog kev loj hlob ntawm Hinman's syndromes - detrusor-sphincter dyssenergy, Ochoa - urofacial pathology. Nyob rau hauv cov ntaub ntawv nruab nrab, instability ntawm lub cev kev ua ub no tau sau tseg.
daim duab kho mob ntawm hyperreflexia
Yuav ua li cas thaum lub zais zis tsis ruaj khov? Cov tsos mob ntawm pathology yog manifested nyob rau hauv kev ua txhaum ntawm kev ua ntawm lub plab khoob. Lawv qhov hnyav thiab zaus ntawm qhov tshwm sim yog txiav txim siab raws li qib ntawm cov hlab ntsha puas. Neurogenic hyperactivity feem ntau predominates hauv cov menyuam yaus. Nyob rau hauv cov ntaub ntawv no, nquag nqus (txog yim zaug ib hnub twg) ntawm cov ntim me me, qhov tseem ceeb (kho) urges, enuresis, thiab incontinence. Postural neurogenic zais zis, cov tsos mob tshwm sim thaum lub cev hloov pauv ntawm kab rov tav mus rau ntsug, nrog rau nruab hnub pollakiuria, nrog rau tsis muaj kev cuam tshuam ntawm cov zis thaum hmo ntuj nrog rau ib qho thaum sawv ntxov. Stress incontinence yog tus cwj pwm los ntawm qhov poob ntawm cov kua dej me me. Qhov tshwm sim no tuaj yeem tshwm sim thaum lub cev tawm dag zog. Tawm tsam keeb kwm yav dhau los ntawm detrusor-sphincter dyssenergy, muaj qhov ncua sij hawm los yog ua tsis tiav, nrog rau micturition (tso zis) thaum straining.
Kev tshwm sim ntawm hyporeflexia
Tawm tsam keeb kwm ntawm hom kab mob no, tsis tshua muaj lossistsis tso zis nrog lub zais zis ntau dhau los yog tag nrho. Npua tej zaum kuj yuav sluggish, nrog nro nyob rau hauv lub peritoneal phab ntsa. Feem ntau muaj kev xav tias tso zis tsis tiav. Qhov no yog vim lub ntim loj ntawm cov residue (txog 400 ml). Hauv qee cov menyuam yaus, paradoxical ischuria zoo li, nrog rau cov zis uas tswj tsis tau. Qhov no yog vim lub gaping ntawm sab nraud sphincter, uas yog stretched nyob rau hauv lub siab ntawm ib tug neeg lub cev. Nrog rau lub zais zis tub nkeeg, tsis tshua tso zis tau sau tseg, ua ke nrog incontinence, kab mob hauv lub cev, thiab cem quav. Nyob rau hauv cov theem siab ntawm pathology, muaj kev pheej hmoo ntawm kev tsim mob, ua tsis taus ntshav khiav hauv ob lub raum, caws pliav ntawm parenchyma thiab tsim ntawm ob lub raum shrinkage, mob tsis txaus thiab nephrosclerosis..
Diagnosis
Thaum muaj kev tso zis tshwm sim, nws yog ib qho tsim nyog yuav tsum tau kuaj xyuas. Nws yuav tsum koom nrog cov kws kho mob xws li kws kho menyuam yaus, kws kho mob hlwb, kws kho mob hlwb, nephrologist, urologist. Kev kuaj mob suav nrog kev noj anamnesis. Ib tsev neeg predisposition rau txoj kev loj hlob ntawm pathology yog qhia, seb puas muaj kev raug mob, kab mob ntawm lub paj hlwb, thiab hais txog. Cov txiaj ntsig ntawm cov cuab yeej thiab cov kev tshawb fawb soj ntsuam kuj raug soj ntsuam. Txhawm rau kuaj pom tus kab mob thiab lub raum ua haujlwm tsis zoo tiv thaiv keeb kwm yav dhau los ntawm pathology, kev tshuaj xyuas biochemical ntawm cov ntshav thiab zis, kev sim raws li Nechiporenko, Zemnitsky, nrog rau kev tshuaj xyuas kab mob bacteriological. Kev kuaj urological muaj xws li ultrasound. Lub raum thiab zais zis raug tshuaj xyuas nrog kev txiav txim siab ntawm qhov seem seem. kuj nyob rau hauvkev ntsuam xyuas suav nrog X-ray diagnostic method. Ua excretory thiab tshuaj xyuas urography, voiding cytography. CT thiab MRI ntawm lub raum system, endoscopy, radioisotope scanning kuj tau ua. Kev ntsuam xyuas ntawm lub xeev ntawm lub zais zis yog ua los ntawm kev saib xyuas cov ntim txhua hnub thiab kev sib hloov ntawm cov zis tso zis nyob rau hauv ib txwm kub thiab haus dej haus. Kev ntsuam xyuas urodynamic ntawm lub xeev kev ua haujlwm ntawm qhov qis ntawm qhov system, uroflowmetry, ntsuas lub siab sab hauv thaum lub caij ntuj no sau, electromyography, profilometry, cystometry (retrograde) yog qhov tseem ceeb hauv kev txheeb xyuas tus kab mob. Echo-EG, EEG, MRI ntawm lub hlwb, X-ray ntawm tus txha nqaj qaum thiab pob txha taub hau kuj tau ua rau qhov xav tias lub zais zis neurogenic hauv cov menyuam yaus. Komarovsky nyob rau hauv ib qho ntawm nws cov lus piav qhia txog kev tshuaj ntsuam xyuas (CAM) kom meej.
Kev cuam tshuam kho mob
Lawv raug tshuaj raws li hom, qhov hnyav ntawm kev mob, comorbidities. Raws li txoj cai, sib txawv tactics yog siv. Ntau tus kws tshaj lij tau sau cov tshuaj homeopathic. Txawm li cas los xij, muaj qee tus kws kho mob uas tsis ntseeg cov tshuaj no. Piv txwv li, nws tsis pom zoo kom npaj homeopathic yog tias kuaj pom lub zais zis neurogenic hauv cov menyuam yaus, Komarovsky. Nws yuav tsum tau hais tias tus kws kho mob feem ntau tsis ntseeg txog hom kev kho no. Txawm li cas los xij, muaj ntau zaus hauv kev xyaum thaum homeopathy tau zoo heev. Kev kuaj mob raws sij hawm thiab xaiv txoj kev kho kom raug tso cai txaustshem tawm cov kab mob sai sai.
Tshuaj kho mob
Txhawm rau tshem tawm hypertonicity, cov neeg mob tau muab tshuaj M-cholinoblockers. Cov no suav nrog cov tshuaj xws li "Atropine", "Oxybutynin" (rau cov neeg mob txij li tsib xyoos). Kuj pom muaj tricyclic antidepressants (piv txwv li, Melipramine), Ca + antagonists (cov no suav nrog cov tshuaj Nifedipine, Terodilin), nootropics (ntawm lawv cov tshuaj Picamilon, Pantogam). Motherwort thiab valerian tinctures kuj pom zoo yog tias lub zais zis neurogenic raug kuaj pom hauv cov menyuam yaus. Kev kho mob nrog cov tshuaj pej xeem tso cai rau koj los txhim kho cov txiaj ntsig ntawm kev kho mob tseem ceeb, nrog rau kev txo qis ntawm qhov kev pheej hmoo tsawg tshaj plaws, vim nws muaj qhov tsawg kawg nkaus ntawm cov kev mob tshwm sim. Nyob rau hauv lub xub ntiag ntawm nocturnal enuresis, cov neeg mob uas muaj hnub nyoog tsib xyoos tuaj yeem muab tshuaj analogue ntawm antidiuretic steroid ntawm neurohypophysis - desmopressin. Txhawm rau tiv thaiv kev loj hlob ntawm tus kab mob, cov neeg mob tau pom zoo koob tshuaj me me ntawm uroseptics. Cov no suav nrog, tshwj xeeb, nitrofurans (Furagin tshuaj), oxyquinolones (5-NOC tshuaj), fluoroquinolones (nalidixic acid), Canephron tshuaj, immunocorrective effect (Taktivin, Levamisole tshuaj).
Extra
Txhawm rau txo qhov mob, tso zis tau teem sijhawm raws li lub sijhawm hauv 2-3 teev. Kuj pom tau tias yog catheterization tsis tu ncua, kev siv cholinomimetics, tshuaj anticholinesterase,adaptogens. da dej nrog tshuaj hiav txwv ntsev yog pom zoo.
Kev Ua Haujlwm
Thaum lub zais zis neurogenic, kev cuam tshuam endoscopic tau ua. Hauv particular, transurethral resection ntawm lub caj dab ntawm lub cev, implantation ntawm collagen nyob rau hauv lub qhov ncauj ntawm lub urethra, intraurethral thiab intradetrusive txhaj ntawm botulinum toxin yog ua. Kev cuam tshuam kuj tau ua rau ntawm cov hlab ntsha ganglia, uas yog lub luag haujlwm rau kev tso zis. Nrog kev pab ntawm plab hnyuv cystoplasty, qhov nce ntawm lub zais zis yog ua.
