Ukuphuka Kwe-Subarachnoid: Izimpawu, Izimbangela, Nokwelapha

Ukuphuka kwe-subarachnoid kukhona ukuphuka kwegazi okwenzeka endaweni phakathi kwengqondo yakho namafutha amncane asembozayo. Le ndawo, ebizwa ngokuthi yi-subarachnoid space, ngokuvamile iqukethe i-cerebrospinal fluid evikela futhi ivikela ingqondo yakho.

Uma igazi lingena kule ndawo evikela, lingadala ukucindezela okungozi kumafutha engqondo yakho. Nakuba lesi simo sikubi futhi sidinga ukunakekelwa ngokushesha kwezokwelapha, ukuqonda ukuthi kwenzekani kungakusiza ukuthi uqaphele izimpawu zokuqala futhi ufune ukunakekelwa ngokushesha.

Iyini i-subarachnoid hemorrhage?

I-Subarachnoid hemorrhage iyenzeka lapho i-artery eduze komphetho wengqondo yakho iqhuma futhi iphukele endaweni ye-subarachnoid. Cabanga ngakho njengokuqhekeka kwemibhobho eduze nesistimu yokukhosela evikela ingqondo yakho.

Lokhu kuphuka kwegazi kuphazamisa ukugeleza okuvamile kwe-cerebrospinal fluid futhi kungandisa ukucindezela ngaphakathi kwendlu yengqondo yakho. Lesi simo sithinta abantu abacishe babe ngu-10 kuya ku-15 ngabantu abangu-100,000 unyaka ngamunye, okwenza kube yinto engavamile kodwa edinga ukwelashwa ngokushesha uma kwenzeka.

Kunezinhlobo ezimbili eziyinhloko: i-traumatic subarachnoid hemorrhage evela ekulimaleni kwekhanda, ne-spontaneous subarachnoid hemorrhage eyenzeka ngaphandle kokulimalala. Iningi lamacala angapheliyo liphuma ekuqhekekeni kwe-aneurysm yengqondo.

Ziyini izimpawu ze-subarachnoid hemorrhage?

Isimpawu esiyinhloko yikhanda elibuhlungu kakhulu eliqala ngokuzumayo. Abantu bavame ukubiza lokhu ngokuthi "ukhanda olubuhlungu kunazo zonke empilweni yami" noma njengokuthi "ubhajwe yisibane."

Lokhu khanda elibuhlungu ngokuvamile kufinyelela epeak ngamasekhondi kuya emizuzu, okuhlukile kwezinye izinhlobo zokhanda eziqala kancane kancane. Ubuhlungu ngokuvamile buyahamba ezinweleni zakho futhi bungaba ne-nausea nokuhlanza.

Ezinye izimpawu ezivamile ongazihlangabezana nazo zihlanganisa:

• Ukuqina nobuhlungu benweleni ngokuzumayo
• Ukukhanya okukhulu
• I-Nausea nokuhlanza
• Ukuphazamiseka noma isimo sengqondo esiguqukile
• Ukulala noma ukulahlekelwa yikwazi
• Ukuhlanza
• Ubuthakathaka noma ukungabi namandla ezingxenyeni zomzimba wakho

Abanye abantu bahlangabezana nezimpawu zokuqala izinsuku noma amasonto ngaphambi kokopha okukhulu. Lezi zimpawu zokuqala, ebizwa ngokuthi yi-sentinel headaches, zingase zihlanganise ukhanda oluvamile, ubuhlungu benweleni, noma iziqephu ezifushane zokuphazamiseka.

Kwezinye izikhathi, ungase ube nezinkinga zobuso, ubunzima bokukhuluma, noma ukuguquka kokuziphatha ngokuzumayo. Lezi zimpawu zingase zihluke kuye ngokuthi yisiphi isigaba sengqondo yakho esithintekile ngokopha.

Yini ebangela i-subarachnoid hemorrhage?

Imbangela evamile ye-spontaneous subarachnoid hemorrhage yi-aneurysm yengqondo eqhekekile. I-aneurysm yindawo ebuthakathaka, ephumile odongeni lwe-artery engase iqhuma ngaphansi kokucindezela.

Cishe u-85% we-spontaneous subarachnoid hemorrhages ivela ekuqhekekeni kwe-aneurysms. Lezi aneurysms ngokuvamile zithuthukela ezindaweni zamagatsha lapho ama-arteries ahlukaniswa khona, ikakhulukazi encwadini ye-Willis ephansi kwengqondo yakho.

Ezinye izimbangela ezingadala lo mlobo wokuphuka kwegazi zihlanganisa:

• Ama-Arteriovenous malformations (ukuxubana okungalungile kwamagatsha egazi)
• Ukuvuvukala noma ukutheleleka kwamagatsha egazi
• Izifo zegazi noma imithi yokuncipha kwegazi
• Ezinye izifo zengqondo
• Ukusetshenziswa kwe-cocaine noma ezinye izidakamizwa ezishukumisayo
• Ukulimala kwekhanda okukhulu okuvela ezingozi noma ekuwa

Kwezinye izikhathi, ukuphuka kwegazi kungase kuphumelele esimweni esingu-reversible cerebral vasoconstriction syndrome, lapho ama-arteries engqondo ecindezela ngokuzumayo bese ebuyela esimweni sayo.

Nini okufanele ubheke udokotela nge-subarachnoid hemorrhage?

Kufanele ufune ukunakekelwa kwezokwelapha ngokushesha uma uhlangabezana nokhanda olukhulu oluzumayo olungakaze ube nalo ngaphambili. Lokhu kubaluleke kakhulu uma ukhanda olukhulu lufinyelela ezingeni eliphezulu ngamasekhondi noma imizuzu.

Shaya u-911 ngokushesha uma wena noma omunye umuntu unekhanda elibuhlungu kakhulu kanye nokuqina kwenweleni, ukuhlanza, ukuphazamiseka, noma ukulahlekelwa yikwazi. Lezi zici zezimpawu zidinga ukuhlolwa ngokushesha.

Ungalindi noma uzama "ukukhuthazelela" uma uhlangabezana nezimpawu zokuqala njengokhanda oluvamile, iziqephu ezifushane zokuphazamiseka, noma ukuguquka ngokuzumayo kobuso noma inkulumo. Ngisho noma izimpawu zibonakala zithuthuka, zingase zibonise ukuphuka okuncane okungase kuholele kokukhulu.

Ziyini izici ezikhulu ze-subarachnoid hemorrhage?

Izici eziningi zingandisa amathuba akho okukhula lesi simo. Iminyaka idlala indima, ngamacala amaningi eyenzeka kubantu abaneminyaka engama-40 kuya kwengu-60, yize ingase ienzeke kunoma iyiphi iminyaka.

Abesifazane banezingozi eziphakeme kunemadoda, ikakhulukazi ngemuva kwe-menopause. Lokhu kungase kuhlobene nezinguquko ze-hormonal ezithinta odonga lwamagatsha egazi ngokuhamba kwesikhathi.

Isitayela sokuphila nezici zezokwelapha ezandisa ingozi yakho zihlanganisa:

• Ukucindezeleka kwegazi okuphezulu
• Ukubhema utshaba
• Ukusetshenziswa okukhulu kotshwala
• Umlando womndeni we-aneurysms yengqondo
• Izimo ezithile ze-genetic njenge-polycystic kidney disease
• Ukulimala kwekhanda kwangaphambili
• Ukusetshenziswa kwezidakamizwa ezishukumisayo njenge-cocaine

Ezinye izimo ze-genetic ezingavamile zingase futhi zande ingozi yakho, kuhlanganise i-Ehlers-Danlos syndrome, i-Marfan syndrome, ne-neurofibromatosis type 1. Ukuba nelungu lomndeni eline-aneurysm yengqondo kungase kudinge ukuxoxisana ngokuhlola nodokotela wakho.

Ziyini izinhlanganisela ezingase zenzeke ze-subarachnoid hemorrhage?

I-Subarachnoid hemorrhage ingase iholele ezinhlanganisela eziningi ezinkulu ezidinga ukulandelelwa nokwelashwa ngokucophelela. Ukukhathazeka okukhulu kakhulu ukwanda kokucindezela ngaphakathi kwendlu yengqondo yakho ngenxa yokuphuka kwegazi.

Ukuphuka kabusha kuyinhlanganisela engozi kakhulu ekuqaleni, eyenzeka cishe ku-20% yamacala phakathi kwamasonto amabili okuqala uma i-aneurysm ingalashwanga. Lokhu kuphuka kwesibili ngokuvamile kubona kakhulu kunokuqala.

Izinhlanganisela ezivamile ongazihlangabezana nazo zihlanganisa:

• I-Vasospasm (ukunciphisa kwama-arteries engqondo okuholela e-stroke)
• I-Hydrocephalus (ukwakheka kwe-fluid ebuchosheni)
• Ukuhlanza
• Ama-Blood clots kwezinye izingxenye zomzimba wakho
• Izinkinga zokubetha kwenhliziyo
• Izinkinga ze-lung
• Ukungahambisani kwe-electrolyte

I-Vasospasm ngokuvamile iyenzeka ezinsukwini eziyi-3 kuya kweziyi-14 ngemuva kokopha okuqala futhi ingase iholele ezimpawu ezifana ne-stroke. I-Hydrocephalus ingase ithuthuke lapho igazi livinja ukugeleza okuvamile kwe-cerebrospinal fluid.

Izinhlanganisela zesikhathi eside zingase zihlanganise ukuguquka kwengqondo, izinkinga zokukhumbula, ubunzima bokuhlangana, ukuguquka kwesimo sengqondo, nasezinye izikhathi, ukungasebenzi okungapheli komzimba. Noma kunjalo, abantu abaningi bayaphila kahle ngokwelashwa okufanele nokubuyiselwa.

I-Subarachnoid hemorrhage ihlonishwa kanjani?

Ukuhlolwa ngokuvamile kuqala nge-CT scan yekhanda lakho, engase ithole ukuphuka kwegazi cishe ku-95% yamacala uma kwenziwa phakathi namahora angu-24 ngemuva kokuthi izimpawu ziqale. Le scan esheshayo iyasiza odokotela ukuqinisekisa ukuba khona kwegazi endaweni ye-subarachnoid.

Uma i-CT scan ingabonisi ukuphuka kwegazi kodwa izimpawu zakho zikhomba kakhulu i-subarachnoid hemorrhage, udokotela wakho angase enze i-lumbar puncture (spinal tap). Lokhu kuhilela ukuthatha isampula encane ye-cerebrospinal fluid ukuhlola amaseli egazi.

Uma ukuphuka kwegazi kuqinisekiswe, ukuhlolwa okwengeziwe kuzosiza ukuthola imbangela:

• I-CT angiography ukuze ubone amagatsha egazi
• I-MRI ne-MRA (magnetic resonance angiography)
• I-Cerebral angiography (indlela engcono kakhulu yokubona amagatsha egazi ngemininingwane)
• I-Digital subtraction angiography

Iqembu lakho lezokwelapha lizobuye lenze ukuhlolwa kwe-neurological ukuhlola isimo sengqondo yakho, ama-reflexes, nokusebenza komzimba. Bazolandelela izimpawu zakho zokuphila eduze futhi bangase basebenzise izikali ezifana ne-Glasgow Coma Scale ukulandelela isimo sakho.

Iyini indlela yokwelapha i-subarachnoid hemorrhage?

Ukwelashwa kuqala ngokushesha ngokuqinisekisa isimo sakho nokuvimbela izinhlanganisela. Cishe uzokwamukelwa e-neurological intensive care unit ukuze uqapha eduze futhi unakekelwe ngokukhethekile.

Inhloso ephambili ukumisa ukuphuka kwegazi nokuvimbela ukuphuka kabusha. Nge-aneurysms, lokhu ngokuvamile kuhilela ukunqunywa kokuhlinzwa noma i-endovascular coiling, kokubili okuvala i-aneurysm ukuvimbela ukuphuka kwegazi okwengeziwe.

Uhlelo lwakho lokwelashwa lungase luhlanganise:

• Imithi yokuvimbela i-vasospasm
• Ukuphathwa kokucindezeleka kwegazi
• Ukulawulwa kobuhlungu
• Imithi yokulwa nokuhlanza uma kudingeka
• Ukwelashwa kwe-hydrocephalus ngezinqubo zokukhipha
• Ukukhathalela okusekela umsebenzi wenhliziyo ne-lung

Ukunqunywa kokuhlinzwa kuhilela ukufaka i-clip encane yensimbi ebusweni be-aneurysm ngesikhathi sokuhlinzwa kwengqondo evulekile. I-Endovascular coiling isebenzisa i-catheter ukufaka ama-coils amancane ngaphakathi kwe-aneurysm, okubangela ukuthi ihlanganiswe futhi ivalwe.

Iqembu lakho lezokwelapha lizobuye ligxile ekuvimbeleni nasekwelapheni izinhlanganisela ezifana ne-vasospasm ngemithi efana ne-nimodipine, esiza ukugcina ama-arteries engqondo evulekile futhi igcine ukugeleza kwegazi.

Indlela yokuphatha ukubuyiselwa kwe-subarachnoid hemorrhage?

Ukubuyiselwa kwe-subarachnoid hemorrhage ngokuvamile inqubo ehamba kancane edinga isineke nokunakekelwa okubanzi. Iqembu lakho lezokwelapha lizokwakha uhlelo lokuvuselelwa oluqondene nezidingo zakho ezithile nobunzima banoma yiziphi izinhlanganisela.

I-Physical therapy ingakusiza ukubuyisela amandla nokuxhumanisa uma uhlangabezane nobuthakathaka noma izinkinga zokulinganisela. I-Occupational therapy igxile ekufundeni kabusha imisebenzi yansuku zonke nokwenza izinguquko kunoma yiziphi izinguquko ezihlala zikhona emisebenzini.

Phakathi nokubuyiselwa kwakho, ungasekela ukuphulukisa kwakho ngokuthi:

• Ulandela wonke amashejuli wemithi ngokuqondile njengoba kunqunyiwe
• Uya kuwo wonke ama-follow-up appointments
• Uhlanganyela ngokusebenzayo eziprogrameni zokubuyiselwa
• Uthole ukuphumula okwanele nokulala
• Udla ukudla okunempilo, okulinganiselayo
• Ukuvimbela ukubhema nokusetshenziswa okukhulu kotshwala
• Ukulawula ukucindezeleka ngezindlela zokupumula

Abantu abaningi bahlangabezana nokuphumula, ukhanda, noma ubunzima bokuhlangana ngesikhathi sokubuyiselwa. Lezi zimpawu ngokuvamile ziyathuthuka ngokuhamba kwesikhathi, kodwa kubalulekile ukuxhumana neqembu lakho lezokwelapha mayelana nanoma yikuphi ukukhathazeka.

Ukusekelwa ngokomzwelo kubalulekile ngesikhathi sokubuyiselwa. Cabanga ngokujoyina amaqembu okusekela noma ukusebenza nabacebisi abaqonda izinselele zokubuyiselwa ekulimaleni kwengqondo.

Kufanele ulungiselele kanjani i-appointment yakho nodokotela?

Uma uhlela i-follow-up appointment ngemuva kokwelashwa, ukulungiselela kungakusiza ukwenza kakhulu isikhathi sakho nomhlinzeki wakho wezokwelapha. Bhala phansi noma yiziphi izimpawu ozibonile kusukela ekuhambeleni kwakho kokugcina, kuhlanganise ukhanda, ukuguquka kokucinga, noma izimpawu zomzimba.

Letha uhlu oluphelele lwemithi yonke oyithathayo, kuhlanganise ne-dosages nokuthi uyayithatha kangakanani. Faka imithi yokuthengwa ngaphandle komthetho, izongezelelo, nanoma iyiphi imithi yemifino.

Cabanga ngokuletha ilungu lomndeni noma umngani ukukusiza ukukhumbula ulwazi nokubuza imibuzo. Bangase futhi banikeze ukubona okuyigugu mayelana nezinguquko esimweni sakho noma ekuziphatheni.

Lungiselela imibuzo ethile mayelana nokuthuthuka kokubuyiselwa kwakho, ukumisa imisebenzi, izimpawu zokuqala okumele uzibheke, nokuthi ungase ubuyele nini emsebenzini noma emisebenzini evamile. Unganqikazi ukubuza mayelana nanoma yini ekukhathazayo.

Iyini into ebaluleke kakhulu mayelana ne-subarachnoid hemorrhage?

I-Subarachnoid hemorrhage yisimo esibi sezempilo esidinga ukwelashwa ngokushesha, kodwa ngokunakekelwa okusheshayo, abantu abaningi bangaphila kahle. Okubalulekile ukuqaphela izimpawu zokuqala nokufuna usizo ngokushesha.

Khumbula ukuthi ukhanda olukhulu oluzumayo olungakaze ube nalo ngaphambili kufanele luhlale lukhuthaza ukunakekelwa kwezokwelapha ngokushesha. Ukwelashwa okusheshayo kuyaqina kakhulu imiphumela futhi kunciphisa ingozi yezinhlanganisela.

Nakuba lesi simo singesaba, ukuthuthuka ekunakekelweni kwezokwelapha kuye kwathuthukisa amazinga okusinda kanye nemiphumela yokubuyiselwa. Iqembu lakho lezokwelapha lizohlangana nawe ukukunikeza ukunakekelwa okuhle kakhulu nokusekela phakathi nohambo lwakho lokubuyiselwa.

Gxilisa ukulandela uhlelo lwakho lokwelashwa, ukuhlanganyela ekubuyiselweni, nokugcina ukuxhumana okuvulekile neqembu lakho lezokwelapha. Ngokunakekelwa okufanele nesikhathi, abantu abaningi bayaqhubeka bephila impilo ezele ngemuva kokubhekana ne-subarachnoid hemorrhage.

Imibuzo evamile mayelana ne-subarachnoid hemorrhage

Ungaphila kahle ngokuphelele ngemuva kwe-subarachnoid hemorrhage?

Abantu abaningi bayaphila kahle ngemuva kwe-subarachnoid hemorrhage, ikakhulukazi uma bethola ukwelashwa okusheshayo. Ukubuyiselwa kuncike ezintweni ezifana nobunzima bokuphuka kwegazi, iminyaka yakho, impilo yonke, nokuthi ukwelashwa kuqalile nini. Abanye abantu bayabuya emisebenzini yabo evamile, kanti abanye bangase babe nemiphumela ethile ehlala isikhathi eside engaphathwa ngokubuyiselwa nokusekelwa.

Isikhathi esingakanani sokubuyiselwa kwe-subarachnoid hemorrhage?

Isikhathi sokubuyiselwa sihluke kakhulu kumuntu ngamunye. Ukulala esibhedlela ngokuvamile kuhlala amasonto angu-1-3, kodwa ukubuyiselwa okuphelele kungathatha izinyanga kuya eminyakeni. Ukuthuthuka okuningi kwenzeka ezinyangeni eziyisithupha zokuqala, yize abanye abantu beqhubeka bebona ukuthuthuka kuze kube eminyakeni emibili. Iqembu lakho lezokwelapha lizokusiza ukusetha ithemba elifanele ngokuya ngesimo sakho esithile.

Ukhanda lwe-subarachnoid hemorrhage luzwakala kanjani?

Ukhanda oluvela e-subarachnoid hemorrhage ngokuvamile luchazwa njengoluzumayo, olukhulu, futhi olungakaze ube nalo ngaphambili. Abantu bavame ukusho ukuthi luzwakala njengokuthi "ubhajwe yisibane" noma "ubhajwe yibhola lebhola." Lufinyelela ezingeni eliphezulu ngamasekhondi kuya emizuzu futhi ngokuvamile luhambisana nokuqina kwenweleni, i-nausea, nokukhanya okukhulu.

Ingabe kunezimo zokuqala ngaphambi kwe-subarachnoid hemorrhage?

Abanye abantu bahlangabezana nezimpawu zokuqala izinsuku noma amasonto ngaphambi kokopha okukhulu, okuthiwa yi-sentinel headaches. Lezi zingase zihlanganise ukhanda oluvamile oluhlukile kwiphethini yakho evamile, ubuhlungu benweleni, iziqephu ezifushane zokuphazamiseka, noma ukuguquka ngokuzumayo kobuso. Noma kunjalo, iningi le-subarachnoid hemorrhages liyenzeka ngaphandle kwanoma yiziphi izimpawu zokuqala.

Ziyiphi izinguquko zesitayela sokuphila okufanele uzisenze ngemuva kwe-subarachnoid hemorrhage?

Izingozi zesitayela sokuphila zihlanganisa ukushiya ukubhema ngokuphelele, ukulinganisela ukusetshenziswa kotshwala, ukulawula ukucindezeleka kwegazi ngokudla nemithi, ukuzivocavoca njengoba kunqunyiwe udokotela wakho, ukulawula ukucindezeleka, nokuthatha yonke imithi enqunyiwe ngokuqondile njengoba kunqunyiwe. Ukulandelelwa okuvamile nokuqapha kubalulekile futhi ekuvimbeleni izinhlanganisela zesikhathi esizayo.