Autonomic dysreflexia

Autonomic dysreflexia ndeye isina kujairika, kunyanyisa kweasingaite (autonomic) huta hurongwa hwekukurudzira. Izvi zvinogona kusanganisira:

• Chinja mukurova kwemoyo
• Kuwedzera kudikitira
• Kuwedzera kweropa
• Tsandanyama mhasuru
• Ruvara rweganda shanduko (kuchena, kutsvuka, bhuruu-grey ganda ganda)

Chikonzero chakanyanya kukonzera autonomic dysreflexia (AD) ndeye kukuvara kwemuzongoza. Tsinga yenzvimbo yevanhu vane AD inodarika-inopindura kumhando dzekusimudzira dzisinganetse vanhu vane hutano.

Zvimwe zvikonzero zvinosanganisira:

• Guillain-Barré syndrome (kusagadzikana uko immune system inorwisa zvisirizvo chikamu chehurongwa hwemitsipa)
• Zvimwe zvinokanganisa mimwe mishonga
• Yakanyanya musoro kushungurudzika uye kumwe kukuvara kwehuropi
• Subarachnoid hemorrhage (chimiro cheropa kubuda ropa)
• Kushandiswa kwemishonga isiri pamutemo inokurudzira yakadai secocaine uye amphetamines

Zviratidzo zvinogona kusanganisira chero zvinotevera:

• Kufunganya kana kunetseka
• Matambudziko edundira kana ura
• Chiono chisina kuona, chakawedzera (chakawedzerwa) vadzidzi
• Musoro wakareruka, dzungu, kana kupera simba
• Kupindwa nechando
• Goosebumps, yakatsvuka (tsvuku) ganda pamusoro pechikamu chekukuvara kwetambo yemuzongoza
• Kudikitira zvine simba
• Kuwedzera kweropa
• Kusarongeka kwemoyo, kurovera kana kukurumidza kurova
• Tsvina yemhasuru, kunyanya mushaya
• Kuzara kwemhino
• Kutema musoro

Dzimwe nguva panenge pasina zviratidzo, kunyangwe nekukwira zvine njodzi mukukwira kweropa.

Anopa hutano anozoita yakazara yetsinga system pamwe nekuongororwa kwechiremba. Udza mupiki nezveese mishonga yauri kutora izvozvi uye yawakatora kare. Izvi zvinobatsira kuona kuti ndeapi mabvunzo aunoda.

Miedzo inogona kusanganisira:

• Ropa uye weti kuongororwa
• CT kana MRI scan
• ECG (kuyerwa kwesimba remagetsi chiitiko)
• Lumbar kubaya
• Tilt-tafura kuyedzwa (kuyedzwa kweropa sezvo chinzvimbo chemuviri chinoshanduka)
• Toxicology kuongorora (kuyedza chero mishonga, kusanganisira mishonga, muropa rako)
• X-ray

Mimwe mamiriro anogovera zviratidzo zvakawanda neAD, asi ane chikonzero chakasiyana. Saka bvunzo uye kuyedzwa kunobatsira mupi kutonga kunze kweiyi mamwe mamiriro, kusanganisira:

• Carcinoid syndrome (mamota emukati mudumbu, colon, appendix, uye bronchial machubhu mumapapu)
• Neuroleptic malignant syndrome (mamiriro anokonzerwa nemimwe mishonga inotungamira kuomarara kwemhasuru, kupisa kwakanyanya, uye kukotsira)
• Pheochromocytoma (bundu readrenal gland)
• Serotonin syndrome (zvinodhaka zvinokonzeresa izvo zvinoita kuti muviri uve neyakawanda serotonin, kemikari inogadzirwa nemaseru maseru)
• Thyroid dutu (inotyisidzira hupenyu kubva kune yakanyanyisa utachiona)

AD iri kutyisidzira hupenyu, saka zvakakosha kuti uwane nekukurumidza kugadzirisa dambudziko.

Munhu ane zviratidzo zveAD anofanira:

• Garai musimudze musoro
• Bvisa zvipfeko zvakaomarara

Kurapa kwakakodzera kunoenderana nechikonzero. Kana mishonga kana zvinodhaka zvisiri pamutemo zvichikonzera zviratidzo, izvo zvinodhaka zvinofanirwa kumiswa. Chero chirwere chinoda kurapwa. Semuenzaniso, mupi anozotarisa yakavharidzirwa urineti catheter uye zviratidzo zvekudimburwa.

Kana kudzikira kwemoyo kuchikonzera AD, zvinodhaka zvinonzi anticholinergics (senge atropine) inogona kushandiswa.

Yakakwira yakakwira BP inoda kurapwa nekukasira asi zvine hungwaru, nekuti iro BP rinogona kudonha kamwe kamwe.

Iyo pacemaker inogona kudikanwa kune isina kugadzikana moyo mutinhimira.

Maonero anoenderana nechikonzero.

Vanhu vane AD nekuda kwemushonga vanowanzopora kana mushonga uya ukamiswa. Kana AD ichikonzerwa nezvimwe zvinhu, kupora kunoenderana nekuti chirwere ichi chingarapwa sei.

Matambudziko anogona kuitika nekuda kwemhedzisiro yemishonga inoshandiswa kurapa mamiriro acho. Yenguva refu, yakanyanya kukwirira kweropa kunogona kukonzera kugwinha, kubuda ropa mumaziso, sitiroko, kana kufa.

Fonera waunopa ipapo ipapo kana uine zviratidzo zveAD.

Kuchengetedza AD, usatore mishonga inokonzeresa mamiriro aya kana kuita kuti iwedzere.

Muvanhu vane kukuvara kwemuzongoza, zvinotevera zvinogona kubatsira kudzivirira AD:

• Usarega dundira rizere zvakanyanya
• Marwadzo anofanira kudzorwa
• Dzidzira kutarisirwa kwakakodzera kwembudzi kuti usabate chetsoka
• Dzidzira kuchengetedza ganda kwakakodzera kuti usadzivirire maronda uye hutachiona hweganda
• Kudzivirira chirwere chedundira

Autonomic hyperreflexia; Musana tambo kukuvara - kuzvimiririra dysreflexia; SCI - kuzvionera dysreflexia

• Central nervous system uye yekumusoro tsinga system

Cheshire WP. Autonomic matambudziko uye manejimendi avo. Mune: Goldman L, Schafer AI, eds. Goldman-Cecil Mushonga. 26th ed. Philadelphia, PA: Elsevier; 2020: chitsiko 390.

Cowan H. Autonomic dysreflexia mukukuvara kwemuzongoza. Mukoti Nguva. 2015; 111 (44): 22-24. PMID: 26665385 pubmed.ncbi.nlm.nih.gov/26665385/.

McDonagh DL, Barden CB. Autonomic dysreflexia. Mune: Fleisher LA, Rosenbaum SH, eds. Matambudziko muAnesthesia. 3rd ed. Philadelphia, PA: Elsevier; 2018: chits. 131.