So woate sɛ obi mogya mmoroso paa mpofirim na wɔde no kɔ ayaresabea ntɛm ara pɛn? Anaasɛ woanya osuahu a ɛte saa ara? Eyi ne nea yɛfrɛ no aduruyɛ mu sɛ mogya mmoroso ho haw anaa ``Hypertensive Crisis''. Eyi nyɛ ade a ɛsɛ sɛ wobu no adewa, efisɛ ebetumi de nkwa ato asiane mu. Enti, momma yɛnka eyi ho asɛm wɔ ɔkwan a ɛyɛ tẽẽ so.
Dɛn ne mogya mmoroso ho haw yi?
Sɛ yɛbɛka no tiawa a, eyi kyerɛ sɛ mpofirim ara wo mogya mmoroso kɔ soro paa. Afei, ma yɛnhwɛ sɛnea ɛsɛ sɛ obi a ɔwɔ apɔwmuden mogya mmoroso yɛ:
- Botae a ɛwɔ soro (systolic pressure) : mercury a ennu milimita 120 (120 mm Hg) .
- Botae a ɛba fam (diastolic pressure) : mercury a ennu milimita 80 (80 mm Hg) .
Nanso, wɔ mogya mmoroso ho haw yi mu no, wo mogya mmoroso bɛyɛ sɛ eyi:
- Botae a ɛwɔ soro : 180 mm Hg anaa nea ɛboro saa, ne/anaasɛ
- Botae a ɛba fam : 120 mm Hg anaa nea ɛboro saa.
Eyi yɛ aduruyɛ mu asɛm a egye ntɛmpɛ ! Sɛ wo mogya mmoroso du saa dodow yi a, ɛsɛ sɛ wokɔ baabi a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ (ER) ntɛm ara.
Mpɛn pii no, ɔhaw a ɛte sɛɛ ba nnipa a wɔwɔ mogya mmoroso (hypertension) dedaw so. Ɛne sɛ, wɔn nhyɛso no korɔn sen sɛnea ɛte daa wɔ da biara da asetra mu mpo. Sɛnea abenfo kyerɛ no, nnipa a wɔwɔ mogya mmoroso no mu 1% kosi 2% betumi anya ɔhaw a ɛte sɛɛ. Nanso, ɛho hia sɛ yɛkae sɛ saa tebea yi betumi aba nnipa a wonnyaa nhyɛso ho haw da nso so.
Eyi ahorow atitiriw abien na ɛwɔ hɔ.
Wobetumi akyekyɛ mogya mmoroso ho haw ahorow mu atitiriw abien:
1. Hypertensive urgency : Wɔ eyi mu no, wo mogya mmoroso yɛ kɛse yiye, nanso sɛnkyerɛnne biara nni hɔ a ɛkyerɛ sɛ wo mu akwaa (te sɛ w’akoma, w’amemene, anaa w’asaabo) asɛe. Nnuruyɛfo binom nso frɛ eyi sɛ “mogya mmoroso a wontumi nni so.” Ɛmfa ho edin biara a wɔde frɛ no no, nea ɛho hia sen biara ne sɛ wobɛma wo mogya mmoroso asan ayɛ nea ɛfata ntɛm ara sɛnea wubetumi.
2. Hypertensive emergency : Eyi ne tebea a ɛyɛ hu sen biara. Ɛha yi, wo mogya mmoroso kɔ soro araa ma ɛsɛe wo mu akwaa foforo, anaasɛ ɛma nneɛma a asɛe dedaw no yɛ kɛse. Sɛ nhwɛso no, akwaa te sɛ koma, aorta, aniwa, amemene, ne asaabo betumi asɛe. Preeclampsia a emu yɛ den ne eclampsia a ɛba mmea a wɔyem mu nso ka saa kuw yi ho.
Ebia woate asɛmfua "malignant hypertension." Ná ɛyɛ asɛmfua a wɔde dii dwuma wɔ afeha a ɛto so 20 mfiase. Ná ɛkyerɛ sɛ mogya mmoroso a ɛba mpofirim no sɛe asaabo ne aniwa no. Nnuruyɛfo binom da so ara de saa asɛmfua yi di dwuma bere a wɔreka “asɛm a egye ntɛmpɛ a ɛma mogya mmoroso” ho asɛm no. Nanso seesei, wɔtaa de "hypertensive emergency" di dwuma efisɛ ɛwɔ nkyerɛase a emu da hɔ.
Dɛn ne mogya mmoroso ho haw yi ho sɛnkyerɛnne?
Nsɛnkyerɛnne no gyina sɛ ebia akwaa a ɛwɔ nipadua no mu no asɛe anaasɛ ɛnsɛee no so.
Hypertensive urgency (mogya mmoroso a ɛkɔ soro a akwaa nsɛee) .
Mpɛn pii no, yare no ho sɛnkyerɛnne atitiriw biara nni hɔ. Ɔkwan biako pɛ a wobɛfa so ahu sɛ wo mogya mmoroso dodo ne sɛ wobɛma wɔasusuw. Nanso, ɛtɔ mmere bi a, wubetumi anya yare no ho sɛnkyerɛnne te sɛ:
- Ehu ne ahotɔ a wɔte nka (Adwennwene) .
- Ti a ɛyɛ yaw kakra
- Mogya a ɛba hwene mu kakra
- Ɔhome a ɛyɛ den kakra
Hypertensive emergency (mogya mmoroso a ɛkɔ soro a akwaa a ɛsɛe) .
Wɔ eyi mu no, sɛnkyerɛnne ahorow no mu yɛ den efisɛ akwaa a ɛwɔ nipadua no mu no asɛe.
- Adwene mu tebea a ɛsakra , te nka sɛ n’adwene atu afra
- Koko mu yaw anaasɛ te nka sɛ wo koko mu ayɛ den
- Adwene a ɛyɛ basaa
- Ɛhohoro, titiriw wɔ nan mu (edema) .
- Koma a ɛbɔ denneennen
- Nsu a ɛba kakraa bi sen sɛnea ɛte daa
- Akisikuru a ɛma obi ho kyere no
- Tiyɛ a emu yɛ den a wontumi nnyina ano
- Nsɛnkyerɛnne a ɛkyerɛ sɛ obi anya ɔyare a ɛma obi hwe ase : Sɛ nhwɛso no, n’anim fã biako a ɛkɔ fam mpofirim, kasa a ɛyɛ mmerɛw, anaasɛ tumi a ɛyera mpofirim wɔ nsa anaa nan bi so (ɔfã biako).
- Aniwa a ɛsakra : Aniwa yɛ yaw, ɛyera mpofirim, anaasɛ nhu ade yiye.
Sɛ oduruyɛfo bi hwehwɛ wo mu a, ebia wɔbɛhwehwɛ nsɛnkyerɛnne te sɛ eyinom nso:
- Jugular venous a ɛtrɛw
- Nnyigyei a ɛnteɛ (crackling) a wɔte bere a woretie ahurututu no
- Koma mu nnyigyei foforo a ɛyɛ soronko a na enni hɔ kan (koma mu nwiinwii) .
- Mogya ntini a ɛwɔ aniwa no mu (retinal membrane) a ɛsɛe .
- Mmerewa a ɛyɛ soronko, a ɛnyɛ pɛpɛɛpɛ a ɛma wogye adwenem naayɛ sɛ obi anya ɔyare a ɛma obi hwe ase
Dɛn na ɛde mogya mmoroso ho haw yi ba?
Nneɛma pii nti na ɛte saa:
- Nea ɛtaa ba ne sɛ worenom wo mogya mmoroso aduru no yiye, sɛnea wo duruyɛfo akyerɛ wo no, na worenom bere ano. Eyi betumi asi esiane nneɛma dodow biara nti (wo werɛ fi, nnuru a sa, nea wɔhyɛ da nnom).
- Mogya mmoroso nnuru a wobegyae mpofirim.
- Aduru biako a wobɛnom betumi ne aduru foforo adi nkitaho (nnuru a ɛne ne ho di nkitaho).
- Asaabo mu yare.
- Endocrine nsɛm (hormone nsɛm).
- Preeclampsia anaa eclampsia yɛ mogya mmoroso a ɛba bere a wɔyem.
- Nneɛma bi a ɛma obi yɛ ade tra so (nnubɔne) a wɔde di dwuma.
- Ti a wopirapira kɛse (Ti a ɛyɛ mmerɛw).
- Amemene mu akisikuru.
- Nnuru bi a wonom ma nyarewa afoforo.
Nnuru ahorow pii wɔ hɔ a ebetumi ama obi anya mogya mmoroso:
- Steroid Ahorow a Wɔde Di Dwuma
- Nnuru bi a wɔde sa adwenemhaw
- Cyclosporine a wɔde di dwuma
- Pseudoephedrine, atiridii ne atiridii nnuru bi fã
Hena na ɔwɔ asiane kɛse mu sɛ obenya eyi?
Ebia wobɛkɔ asiane kɛse mu sɛ wubenya saa tebea yi sɛ:
- Sɛ wo nipadua mu duru dɔɔso a, ɛkyerɛ sɛ woayɛ kɛse mmoroso .
- Sɛ woyɛ ɔbarima a .
- Amanaman ntam nhwehwɛmu ahorow bi ada no adi sɛ nnipa a wofi Afrika wɔ asiane mu kakra. Nanso kae sɛ, saa tebea yi betumi aka obiara, a ofi abusuakuw biara mu.
- Sɛ woyɛ obi a ɔmfa wo mogya mmoroso nnuru no bere ano a .
- Sɛ wode nnuru a ɛkanyan adwene (e.g. cocaine, amphetamines) a oduruyɛfo nkyerɛw maa wo redi dwuma a.
Nsɛnnennen a asiane wom bɛn na eyi betumi de aba?
Sɛ nhyɛso no kɔ soro wɔ ɔkwan a ɛyɛ hu so wɔ saa kwan yi so a, ebetumi de nsɛnnennen a emu yɛ den te sɛ:
- Koma a ɛyɛ mmerɛw mpofirim, ɛyɛ mmerɛw (acute heart failure) .
- Nsu a wɔde hyɛ ahurututu mu ma mpofirim (acute pulmonary edema) .
- Asaabo no dwumadi a ɛyera mpofirim (asaabo a entumi nyɛ adwuma yiye) .
- Mogya ntini kɛse a ɛwɔ wo nipadua mu a ɛtetew anaasɛ ɛpae (aorta) (aortic dissection) .
- Mogya a ɛtɔ kɔ amemene no mu (mogya a ɛba amemene no mu) .
- Komayare ba esiane mogya a ɛkɔ koma no mu a ɛso tew nti.
- Ischemic stroke ba esiane mogya a ɛkɔ amemene no mu a ɛso tew nti.
- Amemene a entumi nyɛ adwuma yiye bere tiaa bi (amemene mu yare a ɛma mogya tu) .
Saa nneɛma yi nyinaa betumi de nkwa ato asiane mu. Ɛno nti na yɛka sɛ hwɛ yiye wɔ wo mogya mmoroso ho no.
Ɔkwan bɛn so na nnuruyɛfo hu saa tebea yi?
Oduruyɛfo bedi kan asusuw wo mogya mmoroso wɔ wo nsa abien no nyinaa mu de ahu sɛ ebia wowɔ mogya mmoroso ho haw anaa. Bio nso, obebisa w’ayaresa ho abakɔsɛm nyinaa (te sɛ nyarewa a woadi kan anya ne nnuru a wonom), ɔne wo bɛkasa afa wo sɛnkyerɛnne ahorow ho, na wayɛ wo nipadua mu nhwehwɛmu a edi mũ. Ebia ɛho behia sɛ wɔyɛ nhwehwɛmu afoforo pii na ama wɔahu nea ɛde ba.
Sɔhwɛ ahorow a wobetumi ayɛ:
- Mogya mu nhwehwɛmu (de hwɛ nneɛma te sɛ asaabo dwumadi ne nkyene dodow) .
- Nsu mu nhwehwɛmu
- ``EKG/ECG'' strip a ɛhwɛ anyinam ahoɔden dwumadi a ɛwɔ koma no mu
- Fundoscopic nhwehwɛmu (de hwɛ sɛ mogya ntini a ɛwɔ aniwa no mu no asɛe anaa) .
- Ntini mu nhwehwɛmu
- Ultrasound scan a wɔde hwɛ koma no (`Transthoracic echocardiogram`) .
- Koko ne ti CT scan
Sɛ sɛnkyerɛnne bi wɔ hɔ a ɛkyerɛ sɛ wo mu akwaa foforo asɛe a, oduruyɛfo no bɛfrɛ no ``hypertensive emergency'', na sɛ sɛnkyerɛnne biara nni hɔ a ɛte saa a, ɛbɛyɛ ``hypertensive urgency.''
Ɔkwan bɛn so na wɔsa mogya mmoroso ho haw yi?
Wɔsa eyi wɔ ayaresabea dan a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ mu . Nnuruyɛfo bɛma wo nnuru na wɔama wo mogya mmoroso akɔ fam akodu baabi a asiane biara nni ho.
- Sɛ wunni sɛnkyerɛnne biara a ɛkyerɛ sɛ akwaa a ɛwɔ wo mu no asɛe (i.e., hypertensive urgency) a, ebia wubetumi akɔ fie da koro no ara. Nanso wɔde nnuru bi bɛkɔ fie a wobɛnom wɔ fie.
- Nanso, sɛ wowɔ ``hypertensive emergency`` (organ damage) a, ɛho behia sɛ wotra ayaresabea hɔ intensive care unit (ICU) nna kakraa bi. Ɛhɔ no, nnuruyɛfo bɛma wo nnuru a wɔde fa ntini mu (IV) na wɔbɛkɔ so ahwɛ wo mogya mmoroso.
Wo nnuruyɛfo kuw no besi sɛnea ɛsɛ sɛ wɔtew wo mogya so ntɛmntɛm no ho gyinae. Ebegyina aduruyɛ mu tebea afoforo a wowɔ no so. Kae sɛ ɛtɔ mmere bi a, sɛ wo mogya so tew ntɛmntɛm dodo a, ebetumi ama wo akwaa ne wo ntini ahorow no ahwere mogya. Enti, mpɛn pii no egye nnɔnhwerew 24 kosi 48 ansa na wo mogya so atew.
Nanso, sɛ wowɔ tebea soronko bi te sɛ aortic dissection, preeclampsia a emu yɛ den, anaa eclampsia a, nnuruyɛfo bɛma wo mogya so atew ntɛm. Wɔ tebea horow a ɛtete saa mu no, mfaso a ɛwɔ so sɛ wobɛtew wo mogya mmoroso so ntɛmntɛm no boro asiane nketenkete a ɛwɔ mu no so koraa.
Nnuru a wɔde yɛ eyi no bi ne `(Captopril)`, `(Clevidipine)`, `(Clonidine)`, `(Esmolol)`, `(Hydralazine)`, `(Labetalol)`, `(Nicardipine)`, `(Nifedipine)`, `(Nitroglycerin)` ne `(Nitroprusside)`. Wo duruyɛfo no begyina wo tebea, nnuru afoforo a worenom, ne w’akwahosan nyinaa so apaw nnuru a eye ma wo.
Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?
Sɛ wo mogya mmoroso yɛ 180/120 mm Hg anaa nea ɛboro saa a, frɛ 1990 (nɔma a egye ntɛmpɛ) ntɛm ara, anaa kɔ dan a ɛbɛn wo a wɔhwɛ wɔn a wɔwɔ yare a egye ntɛmpɛ mu. Wohia ayaresa a egye ntɛmpɛ!
Bere a wɔasa wo mogya mmoroso ho haw te sɛ eyi akyi no, kɔ w’abusua oduruyɛfo a wotaa yɛ no nkyɛn. Ebia obesi gyinae sɛ ɔbɛsesa wo mogya mmoroso aduru no dodow anaasɛ ɔde aduru foforo bɛka ho. Ɔne wo bɛkasa nso afa nsakraeɛ a ɛsɛ sɛ woyɛ wɔ wo da biara da asetena mu (te sɛ aduane ne apɔmuden). Sɛ nhwɛso no, ebia wobetu wo fo sɛ di aduan a nkyene nnim na nnuaba ne nhabannuru pii wom (te sɛ `DASH aduan`) na teɛteɛ w’apɔw mu da biara da.
Sɛ tebea yi sɔre a, dɛn na ɛsɛ sɛ mehwɛ kwan?
Mogya mmoroso ho haw yɛ kɔkɔbɔ sɛnkyerɛnne a anibere wom a ɛkyerɛ sɛ wontumi nni wo mogya mmoroso so yiye. Wo duruyɛfo betumi aboa wo ma wo mogya mmoroso so atew na ama ayɛ nea ɛfata. Ade a ɛho hia sen biara ne sɛ wubedi wo bere a wɔahyɛ no so na woanom wo nnuru sɛnea wɔakyerɛw ama wo no pɛpɛɛpɛ.
Ɛyɛ ade a ɛfata sɛ wobɛte ehu ne dadwen nka bere a wote asɛmfua "ɔhaw" no. Ebia wubesusuw sɛ, "So me mogya mmoroso bɛkɔ soro saa bio da bi?" Anaasɛ, "Ɔkwan bɛn so na mogya mmoroso ho haw yi bɛka m'akwahosan ne me daakye?"
Susuw ho hwɛ, nneɛma pii nti na wo mogya mmoroso tumi kɔ soro saa. Nnuruyɛfo rebɔ mmɔden sɛ wobehu nea ɛde ba pɔtee ma onipa biara. Sɛ wuhu nea ɛde ba ankasa wie a, wubetumi ayɛ nneɛma bi de atew asiane a ɛwɔ hɔ sɛ ɔhaw a ɛte saa ara bɛsan asi bio no so.
Eyi betumi akyerɛ sɛ wode nkaebɔ bi besi wo fon so de akae wo sɛ fa w’aduru no. Anaasɛ, ebetumi akyerɛ sɛ wo ne wo duruyɛfo bɛkasa afa nnuru foforo biara a wobɛnom ho na sɛ ɛho hia a, woayɛ nsakrae wɔ mu. Kae sɛ, anammɔn ketewaa biara a wubetu de ahyɛ wo mogya mmoroso so mprempren no betumi aboa kɛse ma asiane a ɛwɔ hɔ sɛ wubenya akwahosan ho haw a emu yɛ den daakye no so atew.
Nea etwa to no, nneɛma a ɛho hia sen biara a ɛsɛ sɛ wokae (Take-Home Message) .
- Hu wo mogya mmoroso gyinapɛn ahorow: Dɛn ne wo mogya mmoroso a ɛfata? Hu nea ɛyɛ ntɛmpɛ (180/120 mm Hg anaa nea ɛboro saa) ankasa.
- Nom wo nnuru no yiye: Sɛ wo duruyɛfo akyerɛw wo nnuru a wode bedi dwuma ama wo mogya mmoroso a, hwɛ hu sɛ wobɛnom wɔ bere a ɛfata ne dodow a ɛfata mu. Mma nnhu da koro mpo.
- Hu kɔkɔbɔ nsɛnkyerɛnne no: Sɛ wuhu sɛnkyerɛnne ahorow te sɛ tiyɛ a emu yɛ den, wo koko mu yaw, ɛyɛ den sɛ wobɛhome, w’ani a wohu no sesa, wo kasa a ɛyɛ mmerɛw, anaasɛ wo nsa ne anan a ɛyera a, ebetumi ayɛ tebea a emu yɛ den.
- Hwehwɛ aduruyɛfo afotu ntɛm ara: Sɛ wuhu atifi hɔ sɛnkyerɛnne ahorow no bi, anaasɛ wo mogya mmoroso yɛ 180/120 mm Hg anaa nea ɛboro saa a, nsɛe bere na hwehwɛ aduruyɛfo afotu ntɛm ara. Kɔ ayaresabea anaa frɛ 1990.
- Asetra mu nsakrae: Aduan pa (a nkyene, ngo, ne asikre nnim), apɔw-mu-teɛteɛ daa , sigaretnom a wobɛkwati, ne nsa a wobɛnom ano hye betumi aboa kɛse ma woadi wo mogya mmoroso so.
Mewɔ anidaso sɛ saa nsɛm yi ho bɛba wo mfaso. Kae sɛ w’akwahosan wɔ wo nsam. Hwɛ so yiye!
` Mogya mmoroso, nhyɛso, ntɛmpɛ, mogya mmoroso ho haw, sɛnkyerɛnne, ayaresa, komayare
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