Hwakadzika huropi hunosimudzira

Hwakadzika huropi kukurudzira (DBS) inoshandisa chishandiso chinonzi neurostimulator kuendesa magetsi emagetsi kunzvimbo dzehuropi dzinodzora kufamba, kurwadziwa, kushushikana, uremu, kufunga-kwekumanikidza pfungwa, uye kumuka kubva pakoma.

Iyo DBS system ine zvikamu zvina:

• Imwe kana dzinopfuura, waya dzakadzivirirwa dzinodaidzwa kuti lead, kana ma electrode, anoiswa muuropi
• Anchors kugadzirisa zvinotungamira kune dehenya
  
• Iyo neurostimulator, iyo inoburitsa magetsi magetsi. Iyo inosimudzira yakafanana neyemwoyo pacemaker. Inowanzoiswa pasi peganda padyo nekora, asi inogona kuiswa kumwe kunhu mumuviri
• Mune vamwe vanhu imwe yakaonda, yakasungirirwa waya inonzi yekuwedzera inowedzerwa kubatanidza iyo inotungamira kune iyo neurostimulator

Kuvhiya kunoitwa kuisa yega yega chikamu cheiyo neurostimulator system. Muvanhu vakuru, hurongwa hwese hunogona kuiswa muzvikamu 1 kana zviviri (kuvhiya kwakaparadzana).

Chikamu 1 chinowanzoitwa pasi peanesthesia yemuno, zvichireva kuti wakamuka, asi hauna kurwadziwa. (Muvana, general anesthesia inopihwa.)

• Kamwe bvudzi mumusoro wako rinogona kuveurwa.
• Musoro wako unoiswa mune yakakosha furemu uchishandisa zvidiki zvidiki kuti uzvichengetedze panguva yekuita. Unyanzvi hwenhengo hunoiswa panotenderedzwa screws nemusoro. Dzimwe nguva, maitiro acho anoitwa mumushini weMRI uye furemu iri pamusoro pemusoro wako pane kutenderedza musoro wako.
• Unoverengera mushonga unoshandiswa kune yako ganda rekumusoro panzvimbo iyo chiremba anovhura ganda, wozochera buri diki muhenya uye woisa kutungamira mune yakatarwa nzvimbo yeuropi.
• Kana mativi ese ehuropi hwako ari kurapwa, chiremba anovhiya anoita kuvhura kune rumwe rutivi rwehenya, uye maviri anotungamira anoiswa.
• Simba remagetsi rinogona kuda kutumirwa kuburikidza nekutungamira kuti rive nechokwadi chekuti rakabatana nenzvimbo yeuropi inoitisa zviratidzo zvako.
• Iwe unogona kubvunzwa mibvunzo, kuverenga makadhi, kana kutsanangura mifananidzo. Iwe unogona zvakare kubvunzwa kufambisa makumbo ako kana maoko. Izvi ndezvekuve nechokwadi chekuti ma electrode ari munzvimbo chaidzo uye mhedzisiro inotarisirwa inowanikwa.
  

Chikamu chechipiri chinoitwa pasi peanesthesia, zvichireva kuti wakarara uye hauna kurwadziwa. Nguva yedanho rino rekuvhiya zvinoenderana nekuti uropi hunowanikwa kupi muuropi.

• Chiremba anovhiya anoita diki kuvhura (incision), kazhinji pazasi peiyo kora uye inodyara iyo neurostimulator. (Dzimwe nguva inoiswa pasi peganda mubhokisi repazasi kana padumbu.)
• Iyo yekuwedzera waya inoiswa pasi peganda remusoro, mutsipa, nepafudzi uye yakabatana neiyo neurostimulator.
• Iyo incision yakavharwa. Chigadzirwa newaya hazvigone kuoneka kunze kwemuviri.

Pane imwe nguva yakabatana, magetsi emagetsi anofamba kubva kune neurostimulator, pamwe chete netambo yekuwedzera, kutungamira, uye kupinda muuropi. Aya mapuru madiki anopindirana uye anovharira iwo magetsi emagetsi anokonzeresa zvimwe zviratidzo.

DBS inowanzoitirwa vanhu vane chirwere chePalinson apo zviratidzo zvisingakwanise kudzorwa nemishonga. DBS hairape chirwere chePasinson, asi inogona kubatsira kudzikisa zviratidzo zvakaita se:

• Kudengenyeka
• Rigidity
• Kuomarara
• Zvishoma nezvishoma kufamba
• Matambudziko ekufamba

DBS inogona zvakare kushandiswa kurapa anotevera mamiriro:

• Kuora mwoyo kukuru kusingapindure zvakanaka kumishonga
• Kutarisa-kumanikidza kusagadzikana
• Marwadzo asingaendi (kurwadziwa kusingaperi)
• Kunyanyisa kufutisa
• Kubvunda kufamba kusingakwanise kudzorwa uye chikonzero chacho hachizivikanwe (kudedera kwakakosha)
• Tourette syndrome (mune zvisingawanzoitika zviitiko)
• Kusadzora kana kunonoka kufamba (dystonia)

DBS inoonekwa seyakachengeteka uye inoshanda kana yaitwa mune vanhu chaivo.

Ngozi dzekuiswa kweDBS dzinogona kusanganisira:

• Allergic reaction kune iyo DBS zvikamu
• Dambudziko rekutarisa
• Dzungu
• Utachiona
• Kuvuza kwecebrospinal fluid, izvo zvinogona kutungamira kumusoro kana meningitis
• Kurasikirwa kwekuyera, kudzikisira kubatana, kana kushomeka kushoma kwekufamba
• Kushamisika-senge kunzwa
• Matambudziko ekutaura kana ekuona
• Kurwadziwa kwenguva pfupi kana kuzvimba panzvimbo iyo mudziyo waiswa
• Kwechinguva kurira kumeso, maoko, kana makumbo
• Kubuda ropa muuropi

Matambudziko anogona zvakare kuitika kana zvikamu zveiyo DBS system ikatyoka kana kufamba. Izvi zvinosanganisira:

• Mudziyo, lead, kana tambo dzinodambuka, izvo zvinogona kutungamira kune kumwe kuvhiyiwa kutsiva iyo yakaputsika chikamu
• Bhatiri rinokundikana, izvo zvinokonzeresa kuti mudziyo umire kushanda nemazvo (bhatiri rakajairwa kazhinji rinotora makore matatu kusvika mashanu, nepo bhatiri recharge rinogara makore angangoita mapfumbamwe)
• Waya inobatanidza inosimudzira kune inotungamira muhuropi inodambura nepaganda
• Chikamu chechigadzirwa chakaiswa muuropi chinogona kutyoka kana kuenda kune imwe nzvimbo muuropi (izvi hazviwanzoitika)

Njodzi dzinogona kuitika dzekuvhiyiwa kwehuropi ndeidzi:

• Ropa rakavhara kana kubuda ropa muuropi
• Kuzvimba kwehuropi
• Coma
• Kuvhiringidzika, kazhinji kunogara chete kwemazuva kana vhiki zvakanyanya
• Utachiona muuropi, muronda, kana mudehenya
• Zvinetso nekutaura, ndangariro, kushaya simba kwemhasuru, kuenzanisa, kuona, kubatana, uye mamwe mabasa, ayo anogona kunge ari epfupi-kana ekupedzisira
• Kufenda
• Kurohwa

Ngozi dzehuwandu hweanesthesia ndeidzi:

• Zviitiko kumishonga
• Matambudziko kufema

Iwe unenge uine bvunzo yakakwana yemuviri.

Chiremba wako anozoraira akawanda ma laboratory uye imaging bvunzo, kusanganisira CT kana MRI scan. Iyi bvunzo yekufungidzira inoitwa kubatsira chiremba anovhiya kunyatso tarisa chikamu chaicho chehuropi chinotarisira zviratidzo. Mifananidzo yacho inoshandiswa kubatsira chiremba anovhiya kuisa inotungamira muuropi panguva yekuvhiyiwa.

Iwe ungatofanira kuona anopfuura anopfuura imwe nyanzvi, senge chiremba wezveuropi, neurosurgeon, kana chiremba wepfungwa, kuti uve nechokwadi chekuti maitiro acho akakukodzera uye ane mukana wakanyanya wekubudirira.

Usati wavhiyiwa, udza chiremba wako kuti:

• Kana iwe uchigona kuve nepamuviri
• Ndeapi mishonga yauri kutora, kusanganisira mahebhu, zvinowedzerana, kana mavitamini awakatenga pamusoro-pekutengesa pasina mushonga
• Kana wanga uchinwa doro rakawanda

Munguva yemazuva asati avhiyiwa:

• Anokupa hutano anogona kukuudza kuti umbomira kutora vatete veropa. Izvi zvinosanganisira warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban powder (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), aspirin, ibuprofen, naproxen, nedzimwe NSAID.
• Kana iwe uri kutora mimwe mishonga, bvunza mupi wako kana zvakanaka kuti uitore pazuva kana kana mumazuva asati avhiyiwa.
• Ukasvuta, edza kurega. Kumbira mupiki wako kuti akubatsire.

Husiku hwakatangira uye nezuva rekuvhiyiwa, tevera rairo nezve:

• Kusanwa kana kudya chero chinhu kwemaawa masere kusvika gumi nemaviri asati avhiyiwa.
• Kugeza bvudzi rako neakasarudzika sipo.
• Tora mishonga yawakaudzwa nemupi wako kuti utore nekamwe kapfu kemvura.
• Kusvika kuchipatara nenguva.

Ungangoda kugara muchipatara kwemazuva matatu.

Chiremba anogona kupa mishonga inorwisa mabhakitiriya kudzivirira hutachiona.

Iwe uchadzokera kuhofisi yechiremba wako pane imwe nguva inotevera mushure mekuvhiyiwa. Munguva yekushanya uku, iyo inosimudzira inovhurwa uye huwandu hwekusimudzira hunogadziriswa. Kuvhiya hakudiwe. Maitiro aya anonzi zvakare chirongwa.

Bata chiremba wako kana iwe ukagadzira chero chinotevera mushure mekuvhiyiwa kweDBS:

• Kupindwa nechando
• Kutemwa nemusoro
• Itching kana mikoko
• Tsvina kushaya simba
• Kusvotwa uye kurutsa
• Unhu kana kugwinha kune rumwe rutivi rwemuviri
• Kurwadziwa
• Kutsvuka, kuzvimba, kana kutsamwa pane chero nzvimbo dzekuvhiya
• Kunetseka kutaura
• Matambudziko ekuona

Vanhu vane DBS vanowanzoita zvakanaka panguva yekuvhiyiwa. Vanhu vazhinji vane kuvandudzika kukuru muzviratidzo zvavo uye nemhando yehupenyu. Vazhinji vanhu vachiri kuda kutora mushonga, asi pane yakaderera muyero.

Uku kuvhiyiwa, uye kuvhiyiwa kazhinji, kune njodzi kune vanhu vanopfuura makore makumi manomwe uye avo vane mamiriro ehutano senge yakakwira BP uye zvirwere zvinokanganisa tsinga dzeropa muuropi. Iwe nachiremba wako munofanira kuyera zvakanakira kubatsirwa kwekuvhiya uku nenjodzi.

Maitiro eDBS anogona kudzoserwa, kana zvichidikanwa.

Globus pallidus yakadzika uropi kukurudzira; Subthalamic yakadzika huropi kukurudzira; Thalamic yakadzika huropi kukurudzira; DBS; Ubongo neurostimulation

Johnson LA, Vitek JL. Hwakadzika huropi kukurudzira: nzira dzekuita. Mune: Winn HR, ed. Youmans uye Winn Neurological Kuvhiya. 7th ed. Philadelphia, PA: Elsevier; 2017: chits. 91.

Lozano AM, Lipsman N, Bergman H, et al. Hwakadzika huropi hunosimudzira: zvazvino zvinetswa uye nezveramangwana mafambiro. Nat Rev Neurol. 2019; 15 (3): 148-160. PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Rundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Hwakadzika huropi hunosimudzira. Mune: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology muClinical Dzidzira. 7th ed. Philadelphia, PA: Elsevier; 2016: chits. 37.