So woate sɛ obi a n’akyi berɛmo apirapira no anya
mogya mmoroso , ne ti yɛ no yaw kɛse, ne sɛnkyerɛnne afoforo mpofirim pɛn? Eyi ne tebea a yɛrebɛka ho asɛm nnɛ, a wɔfrɛ no Autonomic Dysreflexia, anaa AD tiawa. Mma ɛnhaw wo, sɛ wunim eyi a, wubetumi adi so.
Dɛn ne AD?
Sɛ yɛbɛka no tiawa a, Autonomic Dysreflexia (AD) yɛ adeyɛ a ɛnteɛ, a emu yɛ den wɔ ntini mu a ɛhwɛ wo nipadua no dwumadi ahorow bi a ɛba ara kwa so (yɛfrɛ eyi Autonomic
Nervous System ). Ɛte sɛ ahodwiriw kɛse ma biribi ketewaa bi.
Wɔtaa hu eyi wɔ nnipa a wɔasɛe akyi berɛmo, ntini a ɛwɔ akyi berɛmo no mu no mu . Saa asiane yi yɛ kɛse sɛ sɛe koko a ɛwɔ soro no a, yɛka sɛ T6 dodow (Sixth Thoracic Vertebrae) anaa nea ɛboro saa. Afei ebia woresusuw nea ɛyɛ akyi berɛmo a ɛwɔ akyi berɛmo yi ho. Ɛne sɛ, yɛn akyi berɛmo no mfinimfini fã. Eyi ne ɔfã a ɛware sen biara fi kɔn no so kosi mpampam no awiei. Ɛwɔ akyi berɛmo 12, T1 kosi T12. AD ho sɛnkyerɛnne titiriw ne
mogya mmoroso a ɛkɔ soro mpofirim ( mogya mmoroso ) . Nea ɛka eyi ho no, tiyɛ a emu yɛ den nso yɛ sɛnkyerɛnne titiriw. AD taa di kan da adi wɔ asram abien kosi abiɛsa akyi bere a obi apira akyi berɛmo na ahodwiriw a efi mu ba (Spinal Shock, Neurogenic Shock) no ano abrɛ ase. Nnipa pii betumi anya saa tebea yi mpɛn pii wɔ wɔn asetra mu. Wɔkyerɛ sɛ nnipa binom, titiriw wɔn a wɔasɛe no boro T6 dodow no, nya bi kodu mpɛn 40 da biara. Wɔsan frɛ saa AD yi din afoforo pii, na wo duruyɛfo nso betumi afrɛ no saa din ahorow yi mu biako: Autonomic Hyperreflexia, Hypertensive
Autonomic Crisis, Sympathetic Hyperreflexia.
Momma yensua yɛn Autonomic Nervous System no ho ade kakra.
Okay, afei momma yɛnhwɛ nea saa Autonomic Nervous System yi yɛ. Eyi ne yɛn nipadua no fã a ɛhwɛ nneɛma pii so a yensusuw ho. Nneɛma te sɛ ɔhome,
koma bɔ ,
mogya mmoroso , ne aduan a wɔyam. Eyi te sɛ yɛn nipadua nhyehyɛe a ɛyɛ adwuma ankasa no. Afã atitiriw abiɛsa na ɛwɔ saa autonomic nervous system yi mu:
- Sympathetic Nervous System (SNS): Eyi na esiesie yɛn ma tebea horow a egye ntɛmpɛ ne asiane ahorow. Ɛyɛ nhyehyɛe a ɛkanyan ‘ɔko anaa guankɔbea’ mmuae no.
- Parasympathetic Nervous System (PNS): Eyi yɛ nea ɛne nea sympathetic no yɛ bɔ abira. Ɛne sɛ, ɛma nipadua no dwo na ɛboa ma ‘home na ɛyam’.
- Enteric Nervous System (ENS): Eyi ne ade titiriw a ɛhwɛ yɛn aduan mu.
Ɔkwan bɛn so na AD nyin?
Afei ma yɛnhwɛ nea ɛba bere a woanya AD no. Sɛ w’akyi berɛmo sɛe, wɔ baabi a woapira no ase a, wo sympathetic nervous system (SNS) no yɛ adwuma. Te sɛ nea SNS no reyɛ ho biribi sɛ wowɔ asiane mu. Ne saa nti, mogya ntini a ɛwɔ wo nipadua a ɛwɔ fam (te sɛ wo nan, wo yafunu) no twetwe (wɔfrɛ eyi vasoconstriction). Eyi ma wo mogya mmoroso kɔ soro mpofirim. Mpɛn pii no, sɛ wo mogya mmoroso kɔ soro saa a, wo parasympathetic nervous system (PNS) no yɛ adwuma, na ɛtrɛw mogya ntini no mu (wɔfrɛ eyi vasodilation), na ɛma wo mogya mmoroso san ba sɛnea na ɛte kan no. Yɛfrɛ saa adeyɛ yi baroreflex. Nanso, wɔ obi a wapira wɔ n’akyi berɛmo fam fam no, saa nkrasɛm a ɛyɛ parasympathetic yi ntumi nkɔ fam mfi baabi a wapira no. Enti, nea ɛba ne sɛ mogya ntini no trɛw wɔ nipadua no fã a ɛwɔ soro (wɔ opira no atifi) nkutoo. Eyi nti na esiane sɛ mogya ntini a ɛwɔ nipadua no fã a ɛwɔ fam no kɔ so twetwe (esiane SNS no dwumadi nti) nti, mogya mmoroso no kɔ so yɛ kɛse wɔ ɔkwan a ɛyɛ hu so.
Ɛho hia sɛ yɛte eyi ase: Eyi nti na obi a ɔwɔ AD betumi anya sɛnkyerɛnne ahorow wɔ ne nipadua afã horow bere koro mu no. Sɛ nhwɛso no, honam ani a ɛboro akuru no so (te sɛ anim, kɔn, ne abasa) no betumi ayɛ kɔkɔɔ na fifiri ayɛ no. Nanso, honam ani a ɛwɔ akuru no ase (te sɛ yafunu ne nan ase) betumi ayɛ fitaa, ayɛ nwini, na ayɛ nwunu.
Hena na ɛda adi sɛ obenya AD?
Sɛ wohwɛ nea onya AD kɛse a, ɛyɛ wɔn a wɔn akyi berɛmo asɛe
wɔ T6 dodow (ahurututu mu akyi berɛmo a ɛto so asia) anaasɛ ɛboro saa . Nanso ɛnyɛ obiara na onya. Wunim, yɛn akyi berɛmo no te sɛ ɔkwan bi a ɛde nkrasɛm a efi amemene no mu kɔ nipadua no nyinaa mu. Ɛyɛ akyi berɛmo (akyi nnompe) na ɛbɔ ho ban. Mpɛn pii no, akyi berɛmo mu opira ba wɔ akwanhyia mu, bere a wɔde ɔhwe a ano yɛ den bubu akyi berɛmo yi. Afei nnompe a abubu no mia akyi berɛmo no, na ɛsɛe ntini a ɛwɔ saa beae no.
Asiane a ɛwɔ hɔ sɛ obi benya AD no kɔ soro bere a akyi berɛmo no sɛe ne sɛnea ɔsɛe no mu yɛ den (te sɛ nea ɛpaapae koraa) no. Wɔbu akontaa sɛ nnipa a wɔapirapira wɔn akyi berɛmo mu wɔ awotwaa mu akyi berɛmo anaa akyi berɛmo a ɛkɔ soro no mu bɛyɛ 90% benya AD. Bio nso, mmea a wɔyem a wɔapirapira wɔn akyi berɛmo mu wɔ T6 anaa nea ɛboro saa no wɔ asiane titiriw mu sɛ wobenya AD bere a wɔrewo no. Enti, ɛsɛ sɛ wosusuw eyi nso ho. Dɛn ne AD ho sɛnkyerɛnne ahorow?
AD ho sɛnkyerɛnne betumi ayɛ soronko kakra wɔ onipa biara ho, nanso ɛtaa ba mpofirim. Nsɛnkyerɛnne titiriw a edi kan ne tiyɛ a emu yɛ den a ɛbɔ denneennen. Eyi fi mogya mmoroso a ɛkɔ soro mpofirim kɛse. Nea ɛka ho no, AD nso betumi de sɛnkyerɛnne ahorow a edidi so yi aba:- Fifiri a ɛboro so a ɛboro akyi yaw so.
- Koma a ɛbɔ brɛoo sen sɛnea ɛte daa (wɔfrɛ eyi bradycardia).
- Wora a ɛyɛ kɔkɔɔ a ɛwɔ akuru no atifi wɔ akyi ne honam ani a ɛyɛ mmerɛw na ɛyɛ mmerɛw wɔ akuru no ase.
- Goosebumps wɔ nipadua no so esiane akyi yaw nti.
- Wora a ɛyɛ nwini.
- Anom a ɛyɛ mmerɛw.
- Akisikuru, ɔfe.
- Anisoadehu a ɛyɛ kusuu.
- Dadwen ne ehu a emu yɛ den a wɔte nka.
Nea ɛho hia: Sɛ wuhu saa sɛnkyerɛnne ahorow yi a, ɛho hia yiye sɛ wohwehwɛ aduruyɛ mu afotu ntɛm ara sɛnea wubetumi. Eyi betumi ayɛ tebea a egye ntɛmpɛ.
Dɛn na ɛde AD ba?
Nea ɛde AD ba titiriw ne akyi berɛmo mu opira a yɛaka ho asɛm dedaw no. Nnipa a wɔwɔ AD no ntini a ɛhwɛ ne ho so no yɛ nea ɛboro so wɔ nneɛma bi a ɛkanyan wɔn ho. Mpɛn pii no, sɛ nipadua no nya biribi a ɛyɛ hu a ɛkanyan no a ɛba fam sen akyi berɛmo a wɔapirapira no a, tema ntini no yɛ adwuma kɛse, na ɛma mogya ntini pii twetwe (vasoconstriction). Saa ‘nkate a ɛyɛ hu’ yi yɛ biribiara a ɛsɛe ntini ankasa na ebetumi de ɛyaw aba, nanso ɛtɔ mmere bi a, wɔnte ɛyaw no nka. Ebetumi ayɛ biribiara fi ɛyaw a wuntumi nsɛe so kosi akisikuru a ɛyɛ ma so. Sɛ akyi berɛmo mu opira da nkyɛn a, tebea afoforo bi wɔ hɔ a ebetumi de AD aba, nanso ɛntaa nsi koraa:- Intramedullary Astrocytoma - Kokoram a ɛwɔ ntini a ɛwɔ mfinimfini no mu.
- Ntini a Ɛyɛ Fɛ (MS).
- Guillain-Barré Nyarewa a Ɛyare no.
- Nnuru bi mu nsunsuanso bɔne.
- Ti a wopirapira kɛse ne amemene mu nyarewa afoforo.
- Subarachnoid Hemorrhage (SAH) - mogya a ɛtɔ wɔ amemene no mu.
- Nnuru a ɛkanyan obi a mmara mma ho kwan te sɛ cocaine ne amphetamines a wɔde di dwuma.
Nneɛma a ɛkanyan AD
Sɛ wowɔ asiane mu sɛ wubenya AD a, ɛho hia sɛ wuhu nneɛma a ebetumi akanyan tebea yi. Saa kwan yi so no, wubetumi akwati wɔn na sɛ AD ho sɛnkyerɛnne da adi a, woasa wɔn yare ntɛm. Mpɛn pii no, ɔhaw ahorow a ɛfa:- Akisikuru.
- Bowel (ɛno kyerɛ dwensɔtwaa).
- Wedeɛ.
Nneɛma a ɛde ba a ɛfa akisikuru ho
Akisikuru ho haw ne ade titiriw a ɛde AD ba - ɛyɛ bɛyɛ 85% wɔ AD nsɛm mu. Mpɛn pii no, nea ɛde ba ne ɔkwan a wo nsu fa mu no siw, na ɛma wo akisikuru no yɛ ma dodo (Bladder Distension). Eyi betumi afi:- Sɛ wode Foley catheter ahyɛ mu a, ebetumi ayɛ kinked anaasɛ asiw.
- Akisikuru a ɛyɛ mmerɛw.
- Abo a ɛwɔ akisikuru mu.
- Nsuo mu Nyarewa (UTIs).
Ɛtɔ da bi a, nhwehwɛmu te sɛ cystoscopy anaa urodynamic testing nso betumi akanyan AD. Nneɛma a ɛde ba a ɛfa dwensɔtwaa kɛse no ho
Dwotwaa kɛse anaa dwensɔtwaa ne ade a ɛto so abien a ɛtaa de AD ba. AD betumi aba bere a dwensɔtwaa no mu ayɛ den dodo no. Nea enti a ɛte saa ne:- Fecal impaction a ɛkɔ nipadua no mu.
- Ayamtim.
- Flatulence, akisikuru a ɛyɛ mmerɛw.
- Enemas a ɛyɛ den.
- Nsa a wɔde gu nsu mu.
Na tebea afoforo a ɛde ɔyare mmoawa ba wɔ dwensɔtwaa mu, sɛ nhwɛso no:- Ayamtuo.
- Diverticulitis a ɛma obi ho yɛ hyew.
- Crohn yare no.
- Anal mu mpaapaemu.
- Akisikuru a ɛma obi ho yɛ hyew.
Nneɛma a ɛte sɛɛ nso betumi akanyan AD. Nneɛma a ɛde ba a ɛfa honam ani
Honam ani haw ne ade a ɛto so abiɛsa a ɛtaa de AD ba. Nneɛma pii wɔ hɔ a ebetumi de aba:- Nhyɛso mu opira / Mpa mu akisikuru.
- Ntwitwiridii, akuru.
- Honam ani akisikuru.
- Ntade a ɛyɛ den, ɛyɛ snagging, ɛyɛ kɛse dodo.
- Ɛyaw a wontumi nte nka anaasɛ wontumi nwene.
- Nnadewa a anyin wɔ mu.
Wobɛyɛ dɛn ahu sɛ wowɔ AD?
Nhwehwɛmu biako biara nni hɔ a ebetumi ahu AD koraa. Enti, nnuruyɛfo ne wɔn a wɔhwɛ wo no begyina nea edidi so yi so titiriw na wɔahu:- Wo aduruyɛ ho abakɔsɛm , titiriw nsɛm a ɛfa akyi opira ho.
- Sɛ wode wo mogya mmoroso a ɛwɔ hɔ mprempren no toto wo mogya mmoroso a ɛfata ho a. Mpɛn pii no, sɛ wo mogya mmoroso a ɛwɔ systolic no mu boro 150 mmHg, anaasɛ ɛboro wo dodow a ɛfata so bɛyɛ mmHg 40 a, wobu no sɛ ɛyɛ AD ho sɛnkyerɛnne.
- Nsɛnkyerɛnne , titiriw tiyɛ a emu yɛ den.
Sɛ wowɔ AD ho sɛnkyerɛnne nanso wunsusuw sɛ woapira w’akyi berɛmo mu a, ebia wo duruyɛfo bɛpɛ sɛ ɔyɛ wo ntini mu nhwehwɛmu a edi mũ na ɔyɛ nhwehwɛmu afoforo de hu nea ɛde wo sɛnkyerɛnne ahorow no ba. Ebia eyinom bi ne:- Mogya ne nsu mu nhwehwɛmu.
- CT scan (CT - Computed Tomography scan) anaa MRI scan (MRI - Magnetic Resonance Imaging scan) a wɔde yɛ nhwehwɛmu.
- ECG (Ɛlektrɔnik koma ho mfonini - EKG).
- Akyi berɛmo mu tap / Lumbar puncture.
- Tilt-table sɔhwɛ.
- Nnuru ho nhwehwɛmu.
- X-ray a wɔde yɛ adwuma.
Ɔkwan bɛn so na wɔsa AD?
Ade a edi kan a ɛsɛ sɛ wɔyɛ de sa AD ne sɛ wɔbɛma ɔyarefo no ada fam, abrɛ ne nan ase, na wɔayi ntade biara a ɛyɛ den afi hɔ. Eyi boa ma mogya mmoroso so tew. Mpɛn pii no, AD kɔ bere a wɔayi nea ɛkanyan no afi hɔ no. Enti, ade a edi hɔ ne sɛ wubehu nea ɛkanyan no na woayi afi hɔ, sɛ ɛbɛyɛ yiye a, ansa na wode nnuru ama. Sɛ nhwɛso no, nneɛma bi a wo duruyɛfo anaa nea ɔhwɛ wo no betumi ayɛ de ahu nea ɛkanyan wo na wasiesie no ni:- Hwɛ sɛ ebia nsu resen yiye, anaasɛ wosiesie.
- Sɛ obi wɔ Foley catheter a, hwɛ sɛ ebia asiw anaasɛ sintɔ bi na siesie.
- Nsu a wɔde yɛ nhwehwɛmu a wɔbɛsɔ ahwɛ sɛ ebia nsu mu yare (UTI) bi wɔ hɔ anaa, na sɛ ɛte saa a, nnuru a ekum ɔyare mmoawa a wɔde ma.
- Hwɛ akyi berɛmo no mu hwɛ sɛ nsuo a ɛretu no wɔ hɔ anaa, na sɛ ɛte saa a, yi nsuo no.
Nnipa pii a wɔwɔ AD ho osuahu nim eyi yiye na wɔasiesie wɔn ho sɛ wɔde ayaresa nhyehyɛe bi bedi dwuma. Wɔ tebea a egye ntɛmpɛ mu: Sɛ wɔantumi anhu nea ɛkanyan no, na nneɛma atitiriw a wɔyɛ no mma mogya mmoroso no nkɔ fam a, ɛho hia sɛ wɔsa yare ntɛm na ama mogya mmoroso no so atew. Sɛ ɛba saa a, frɛ 119 (anaasɛ nɔma a ɛfata a wɔde ma ntɛm ara), anaa hwehwɛ aduruyɛ mu mmoa ntɛm ara.
Afei wɔbɛma wo nnuru a ɛyɛ adwuma ntɛmntɛm te sɛ nitrates, hydralazine, labetalol, anaa nifedipine na ama wo mogya mmoroso so atew. Bere a wɔreyɛ ayaresa no, w’aduruyɛfo kuw no bɛhwɛ wo sɛnkyerɛnne ahorow a ɛho hia no so na wɔahwɛ wo mogya mmoroso mpɛn pii. So wobetumi asiw AD ano?
Ɛnyɛ bere nyinaa na wobetumi asiw AD ano. Nanso, sɛ woapira w’akyi berɛmo mu, titiriw nea ɛboro T6 dodow so a, nneɛma yi betumi aboa ma woasiw AD ano:- Akisikuru a wobɛma ada mpan daa na woahwɛ yiye na amma anhyɛ mu ma.
- Ɛyaw a wobedi ho dwuma.
- Wo dwensɔtwaa a wobɛhwɛ so yiye no ho hia na ama woasiw nsu a ɛbɛsiw ne akisikuru ano.
- Wo honam ani a wobɛhwɛ yiye no ho hia na ama woatumi asiw mpa so akuru ne honam ani yare ano.
- Nsuo mu yareɛ (UTIs) a wɔsiw ano.
AD tebea no bɛyɛ dɛn? (Nsusuwii) .
Mpɛn pii no, AD ho nkɔmhyɛ ye, nanso sɛ nneɛma yi si nkutoo a:- Sɛ wo, wo hwɛfo, anaa w’aduruyɛfo kuw no hu eyi ntɛm a.
- Sɛ wofi ase ntɛm ara siesie ayaresa a.
- Sɛ wo ne/anaasɛ wɔn a wɔhwɛ wo no nim AD ho sɛnkyerɛnne ne nea ɛkanyan wo no yiye a.
- Sɛ wo, wo hwɛfo, anaa w’aduruyɛfo kuw no yɛ ahwɛyiye a ɛfata de siw AD ano a.
Nanso, AD tebea horow a emu yɛ den a wɔansa no ntɛm na wɔansa no yiye no betumi de nea emu yɛ den aba. Nhwɛsoɔ:- Amemene a ɛsɛe esiane mogya mmoroso (Hypertensive Encephalopathy) nti.
- Nnwodwoɔ.
- Koma a ɛyɛ den.
- Gye no ɔhyɛ so.
- Owuo.
Nea eye ne sɛ, nnipa a AD wuwu no ho yɛ na koraa. Sɛ wowɔ asiane mu sɛ wubenya AD a, dɛn na ɛsɛ sɛ woyɛ?
Ɛsɛ sɛ wo ne w’adɔfo de mo ho hyɛ AD ho sɛnkyerɛnne ahorow a wobehu mu. Sɛ wufi ase te AD ho sɛnkyerɛnne nka ara pɛ a, sɔre tena ase na fi ase sa yare. Ebia wobɛhwe ase, apira wo ho, anaasɛ w’adwene bɛyera, enti frɛ mmoa. Sɛ woantumi anhu nea ɛkanyan wo, anaasɛ sɛ ayaresa a ɛfata no mmoa a, ɛsɛ sɛ obi frɛ 119 (anaasɛ nɔma a ɛfata a wɔde ma ntɛm ara). Ɛho hia nso sɛ wode Emergency Treatment Pack ka wo ho, sɛ wo duruyɛfoɔ akyerɛw ama wo a, ne kratawa a AD ho nsɛm wom. Eyi bɛboa wɔn a wonnim AD ho asɛm mpo. Sɛ woanya AD ho sɛnkyerɛnne pɛn a, ɛsɛ sɛ woma wo nnuruyɛfo, wɔn a wɔhwɛ wo, ne w’adɔfo nyinaa hu wo tebea no. Sɛnea ɛbɛyɛ a sɛ ɛba bio a, wobehu, sɛ wunnya bere srɛ mmoa mpo a. Kae sɛ nsɛm a wɔaboaboa ano
Autonomic dysreflexia (AD) yɛ tebea a ebetumi de obi nkwa ato asiane mu. Nanso asɛmpa no ne sɛ wobetumi ayɛ ho adwuma – mpɛn pii no denam nea ɛkanyan no a wobeyi anaasɛ wɔbɛsesa so. Sɛ wowɔ asiane mu sɛ wubenya AD a, ɛho hia sɛ wo ne w’adɔfo sua nea wubetumi nyinaa fa ho. Afei wubetumi ahu sɛnkyerɛnne ahorow no na woanya AD ayaresa ntɛm. Wo ne w’aduruyɛfo kuw no nkasa mfa akwan a wobɛfa so akwati nneɛma a ɛkanyan wo ho. Wɔasiesie wɔn ho sɛ wɔbɛboa wo. Kae sɛ eyi nyɛ biribiara a ɛsɛ sɛ wusuro, nhumu ne ahobammɔ kɛse!
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