So wo mogya mmoroso kɔ soro mpofirim? Momma yɛnka Hypertensive Crisis ho asɛm!

So woasusuw nea ɛbɛba ho pɛn sɛ wo mogya mmoroso, anaa "nhyɛso" sɛnea yɛn nyinaa nim no, kɔ soro dodo mpofirim? Ɛtɔ da bi a, wobɛte nka sɛ wo ho ayɛ wo yaw anaasɛ wobɛte nka sɛ biribi a ɛyɛ nwonwa wɔ wo moma so. Eyi ne tebea a yɛrebɛka ho asɛm nnɛ, a wɔfrɛ no hypertensive crisis. Eyi yɛ tebea a emu yɛ den, enti ɛho hia yiye sɛ yehu nea ɛsɛ sɛ yɛyɛ wɔ ho ankasa.

Dɛn ne mogya mmoroso ho haw? Momma yɛnhwehwɛ mu pɛpɛɛpɛ!

Sɛ yɛbɛka no tiawa a, mogya mmoroso ho haw ne bere a wo mogya mmoroso kɔ soro kɛse, kɛse mpofirim. Afei ebia worebisa sɛ, "Dɛn na ɛsɛ sɛ wo mogya mmoroso a ɛfata yɛ?" Momma yɛnhwɛ.

Ɛsɛ sɛ obi a ɔwɔ apɔwmuden mogya mmoroso a ɛfata yɛ nea edidi so yi:

• Dodow a ɛwɔ soro (systolic pressure) : ɛsɛ sɛ ennu mercury milimita 120 (mm Hg).
• Botae a ɛba fam (diastolic pressure) : Ɛsɛ sɛ mercury (mm Hg) nnu milimita 80.

Nanso, wɔ ``Hypertensive Crisis'' mu no, dodow yi kɔ soro a wontumi nsusuw ho:

• Ɔsoro anohyeto : 180 mm Hg anaa nea ɛboro saa, ne/anaasɛ
• Botae a ɛba fam : 120 mm Hg anaa nea ɛboro saa.

Eyi yɛ biribi a ɛsɛ sɛ yɛkae: Mogya mmoroso yɛ aduruyɛ mu asɛm a egye ntɛmpɛ. Eyi kyerɛ sɛ, sɛ wo mogya mmoroso du saa dodow yi a, ɛsɛ sɛ wokɔ ayaresabea dan a wɔhwɛ wɔn a wɔwɔ ayaresa a egye ntɛmpɛ mu ntɛm ara.

Mpɛn pii no, ntɛmpɛ a ɛte sɛɛ ba nnipa a wɔwɔ mogya mmoroso (hypertension) so. Eyi kyerɛ sɛ wɔn mogya mmoroso kɔ soro sen sɛnea ɛte daa bere nyinaa. Sɛnea abenfo kyerɛ no, nnipa a wɔwɔ mogya mmoroso no mu 1% kosi 2% betumi anya ``Hypertensive Crisis''. Nanso, nea ɛyɛ nwonwa no, saa tebea yi betumi aba obi a onnyaa mogya mmoroso ho haw bi da mpo mu.

Eyi ahorow atitiriw abien na ɛwɔ hɔ, ɛnte saa? Dɛn ne wɔn?

Yiw, saa `(Hypertensive Crisis)` yi ahorow atitiriw abien na ɛwɔ hɔ. Momma yɛnka saa asɛm no ho asɛm nkɔ akyiri kakra .

1. Ntɛmntɛm a ɛma mogya mmoroso:

Eyi ne bere a wo mogya mmoroso kɔ soro dodo, kodu 180/120 mm Hg anaa nea ɛboro saa a yɛadi kan aka ho asɛm no. Nanso, nea ɛho hia sen biara no, biribiara nsɛe wo mu akwaa ahorow. Nnuruyɛfo binom frɛ eyi ``nhyɛso a wontumi nni so'' sen sɛ wɔbɛfrɛ no ``Hypertensive Urgency''. Enti, ɛmfa ho din biara a wɔde frɛ no no, ade titiriw a ɛwɔ ha ne sɛ wobɛsan de wo nhyɛso no aba tebea a ɛfata mu ntɛm ara.

2. Ntɛmntɛm a ɛma mogya mmoroso:

Eyi ne ɔkwan a asiane wom sen biara. Wo mogya mmoroso nso kɔ soro kɛse, nanso ɛsan nso sɛe wo nipadua akwaa foforo, anaasɛ ɛma nneɛma a asɛe dedaw no yɛ kɛse.Susuw ho hwɛ, eyi betumi asɛe akwaa a ɛho hia te sɛ wo koma, wo aorta, w’ani, w’amemene, ne w’asaabo. Tebea horow te sɛ preeclampsia a emu yɛ den ne eclampsia a ɛba ɛnanom a wɔyem mu mpo hyɛ saa ``Hypertensive Emergency'' yi mu.

Ebia woate asɛmfua "Malignant Hypertension." Nokwarem no, ɛyɛ asɛmfua dedaw bi a wɔde dii dwuma wɔ afeha a ɛto so 20 mfiase. Ná ɛkyerɛ sɛ mogya mmoroso a ɛkɔ soro mpofirim a ɛma asaabo ne aniwa sɛee. Nnuruyɛfo binom da so ara de asɛmfua "Hypertensive Emergency" di dwuma bere a wɔreka "Hypertensive Emergency" ho asɛm no. Nanso, nnuruyɛfo a wɔwɔ hɔ nnɛ pɛ sɛ wɔde asɛmfua "Hypertensive Emergency" di dwuma efisɛ ɛwɔ nkyerɛase pɔtee bi nnɛ.

Dɛn ne sɛnkyerɛnne ahorow a ebetumi aba? Woyɛ dɛn hu no?

``Hypertensive Crisis'' ho sɛnkyerɛnne gyina sɛ ebia akwaa no asɛe anaasɛ ɛnsɛee, sɛnea yɛadi kan aka no.

Hypertensive Urgency (a ɛkyerɛ sɛ, bere a nhyɛso no yɛ kɛse dodo a akwaa no nsɛee) ntaa mfa sɛnkyerɛnne biara mma. Ɔkwan biako pɛ a wobɛfa so ahu sɛ wo mogya mmoroso dodo ne sɛ wobɛma wɔasusuw. Nanso, ɛtɔ mmere bi a, sɛnkyerɛnne ahorow te sɛ:

• Te a wote nka sɛ wo ho nyɛ wo dɛ na wosuro (Adwennwene) .
• Ti a ɛyɛ yaw kakra.
• Mogya a ɛretu fi hwene mu
• Ɔhome a ɛyɛ den kakra

Nsɛnkyerɛnne a ɛwɔ mogya mmoroso a egye ntɛmpɛ mu (kyerɛ sɛ, bere a nhyɛso no ma akwaa sɛe) no mu yɛ den kɛse na nea ɛka ho ne:

• Nsakrae a ɛba adwene mu tebea mu (dadwen, adwene mu naayɛ) .
• Koko mu yaw
• Adwene a ɛyɛ basaa (vertigo) .
• Nipadua mu a ɛho ahonhon (Edema) .
• Koma a ɛbɔ denneennen
• Nsu a ɛba kakraa bi sen sɛnea ɛte daa
• Convulsions (akisikuru tebea, te sɛ nea ɛyɛ akisikuru) .
• Tiyɛ a emu yɛ den.
• Nsɛnkyerɛnne a ɛkyerɛ sɛ obi ayɛ obubuafo (sɛ nhwɛso no, anim fã biako a ɛtɔ mpofirim, ɛyɛ den sɛ ɔbɛkasa, abasa ne/anaa ne nan a ɛyɛ mmerɛw mpofirim) .
• Nsakrae a ɛba aniwa so (te sɛ aniwa mu yaw, aniwa a ɛyera, aniwa a ɛyɛ mmerɛw mpofirim) .

Sɛ oduruyɛfo hwehwɛ wo mu a, ebia wubehu sɛnkyerɛnne te sɛ eyinom wɔ ``Hypertensive Emergency'' mu:

• Jugular venous a ɛtrɛw
• Nnyigyei a ɛyɛ krak bere a woretie ahurututu no
• Koma mu nnyigyei a ɛnteɛ a na enni hɔ kan (koma mu nwiinwii) .
• Nsɛnkyerɛnne a ɛkyerɛ sɛ mogya ntini a ɛwɔ aniwa no akyi no asɛe
• Mmerewa a ɛyɛ soronko, a ɛnyɛ pɛpɛɛpɛ a ɛyɛ adwenem naayɛ sɛ tebea bi a ɛma obi mmubu

Dɛn nti na tebea yi ba? Dɛn ne nea enti a ɛte saa?

Nneɛma pii betumi ama ``Hypertensive Crisis`` te sɛ eyi betumi aba. Momma yɛnhwɛ emu atitiriw no:

• Nea ɛtaa ba ne sɛ worenom wo mogya mmoroso aduru no yiye na sɛnea wɔakyerɛw ama wo no. Sɛ biribi nti wopa wo dose no a, wowɔ asiane mu sɛ eyi bɛba.
• Nnuru a wɔde sa mogya mmoroso a wogyae mpofirim.
• Nnuru a ɛne nnuru afoforo a worenom di nkitaho.
• Asaabo mu yare.
• Nsɛm a ɛfa endocrine ho.
• Preeclampsia anaa eclampsia bere a nyinsɛn no.
• Nnuru bi a ɛma obi yɛ ade tra so a wɔde di dwuma.
• Ti a ɛyɛ mmerɛw (ti a opira).
• Amemene mu akisikuru.
• Nnuru bi a wonom ma tebea afoforo.

Nnuru a ebetumi de ``Hypertensive Crisis'' aba no bi ne:

• Steroid Ahorow a Wɔde Di Dwuma
• Nnuru bi a wɔde sa adwenemhaw
• Cyclosporine a wɔde di dwuma
• Pseudoephedrine, a ɛwɔ atiridii ne atiridii nnuru bi mu

Henanom na wɔwɔ asiane kɛse mu? (Nneɛma a Ɛma Asiane) .

Nnipa binom wɔ asiane mu kɛse sɛ wobenya ``Hypertensive Crisis'' sen afoforo. Ma yɛnhwɛ nnipa ko a wɔyɛ:

• Wɔn a wɔayɛ kɛse mmoroso no fam.
• Wɔ mmarima fam.
• Wɔ abibifo fam (ebia eyi gyina awosu ne asetra mu sikasɛm so).
• Aduru a wɔde ma mogya mmoroso no fata ma wɔn a wɔmfa nni dwuma daa no.
• Wɔ wɔn a wɔde nnuru a ɛkanyan adwene di dwuma a oduruyɛfo nkyerɛw wɔn ma wɔn no fam.

Nsɛnnennen a asiane wom bɛn na eyi betumi de aba?

Sɛ nhyɛso no kɔ soro kodu baabi a asiane wom yi a, ebetumi de nsɛnnennen a emu yɛ den aba. Eyinom bi ne:

• Koma no dwumadi a ɛyɛ mmerɛw mpofirim ntɛmntɛm (koma a entumi nyɛ adwuma yiye).
• Nsu a ɛboaboa ano mpofirim wɔ ahurututu mu (acute pulmonary edema).
• Asaabo no dwumadi a ɛyera mpofirim (asaabo a entumi nyɛ adwuma yiye).
• Aortic dissection yɛ mogya ntini kɛse a ɛwɔ wo nipadua mu, aorta, a ɛtetew mu.
• Mogya a ɛtɔ wɔ amemene no mu (mogya a ɛba amemene no mu).
• Mogya a ɛkɔ koma no mu a ɛso tew na ɛde komayare ba.
• Akisikuru a mogya a ɛkɔ amemene no mu a ɛso tew (`ischemic stroke`) na ɛde ba.
• Amemene no dwumadi a ɛyɛ mmerɛw bere tiaa bi (`hypertensive encephalopathy`).

Susuw sɛnea eyinom nyinaa yɛ aniberesɛm no ho. Ɛno nti na ɛho hia sɛ wohwɛ wo mogya so na wohwehwɛ ayaresa ntɛm sɛ ``Hypertensive Crisis'' ba a.

Ɔkwan bɛn so na nnuruyɛfo hu eyi pɛpɛɛpɛ?

Oduruyɛfo bedi kan asusuw wo mogya mmoroso wɔ wo nsa abien no nyinaa mu. Afei, wobebisa w’ayaresa ho abakɔsɛm, aka wo sɛnkyerɛnne ahorow ho asɛm, na wɔayɛ wo nipadua mu nhwehwɛmu. Ebia ɛho behia nso sɛ wɔyɛ nhwehwɛmu ahorow bi de boa ma wohu nea ɛde wo tebea no ba.

Sɔhwɛ ahorow pii wɔ hɔ a wobetumi ayɛ:

• Mogya mu nhwehwɛmu
• Nsu mu nhwehwɛmu
• Electrocardiogram (EKG/ECG) nhwehwɛmu a ɛkyerɛw koma no bɔ
• Fundoscopic nhwehwɛmu (aniwa no mu nhwehwɛmu) .
• Ntini mu nhwehwɛmu
• Koma no mu nnyigyei a ɛyɛ hyew (Transthoracic echocardiogram) .
• ``Computed Tomography (CT) scan`` a wɔde yɛ koko ne ti

Sɛ wowɔ nsɛnkyerɛnneɛ a ɛkyerɛ sɛ akwaa foforɔ asɛe a, wo duruyɛfoɔ bɛhunu sɛ wowɔ ``Hypertensive Emergency''. Sɛ nsɛnkyerɛnne a ɛte saa nni hɔ a, wɔbɛhunu sɛ ɛyɛ ``Hypertensive Urgency''.

Ɔkwan bɛn so na wɔsa? So wobetumi asa no ntɛm?

Wɔsa ``Hypertensive Crisis'' bi 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 akwaa biara nsɛee (sɛ ɛba sɛ `Hypertensive Urgency`): Wubetumi akɔ fie da koro no ara (a wowɔ nnuru a wobɛnom wɔ fie).
• Nanso, sɛ wowɔ ``Hypertensive Emergency`` a: Ɛho behia sɛ wotra ayaresabea hɔ ayarehwɛ a emu yɛ den (ICU) nna kakraa bi. Ɛhɔ no, nnuruyɛfo bɛma wo nnuru tẽẽ akɔ ntini bi mu (``IV - intravenous`` kwan). Wɔbɛhwɛ wo mogya mmoroso nso bere nyinaa.

Wo nnuruyɛfo kuw no besi sɛnea wobɛtew wo mogya so ntɛm no ho gyinae, na wosusuw ayaresa tebea afoforo a wowɔ no ho. Wɔ tebea horow bi mu no, sɛ wobrɛ wo mogya so ntɛmntɛm dodo a, ebetumi ama wo akwaa ne wo ntini ahorow no nnya mogya a ɛdɔɔso. Enti, nnuruyɛfo betumi ama wo mogya so atew nkakrankakra, wɔ nnɔnhwerew 24 kosi 48 mu.

Nanso, sɛ wowɔ tebea horow te sɛ aortic dissection, severe preeclampsia, anaa eclampsia a, nnuruyɛfo bɛma wo mogya so atew ntɛmntɛm wɔ mogya mmoroso ho haw mu. 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 ma de sa yare

Nnuru a wɔde sa ``Hypertensive Crisis`` no bi ni:

• `Captopril`
• `Clevidipine a wɔde di dwuma`
• `Clonidine a wɔde di dwuma`
• `Esmolol`
• `Hydralazine a wɔde yɛ adwuma`
• `Labetalol`
• `Nicardipine a wɔde di dwuma`
• `Nifedipine a wɔde di dwuma`
• `Nitroglycerin a wɔde yɛ adwuma`
• `Nitroprusside`

Nnuruyɛfo bɛpaw aduru a ɛfata w’ahiade yiye. Wobesusuw w’ayaresa tebea afoforo ne nnuru afoforo a worenom nso ho. Enti, mma wo ho nnyɛ wo hu bere a wohu saa nnuru yi, ɛyɛ oduruyɛfo/awuraa no na obesi nea eye ma wo ho gyinae.

Bere bɛn na ɛsɛ sɛ mekɔ oduruyɛfo nkyɛn?

Sɛ wo mogya mmoroso yɛ 180/120 mm Hg anaa nea ɛboro saa a, frɛ 911 (1990 Suwaseriya Ambulance Service wɔ Sri Lanka) ntɛm ara, anaa kɔ ayaresabea a ɛbɛn wo no dan a wɔhwɛ ntɛmpɛ so. Wohia ayaresa a egye ntɛmpɛ!

Sɛ wɔsa wo ``Hypertensive Crisis'' wie a, kɔ wo duruyɛfoɔ a wotaa yɛ no nkyɛn. Ebia obesi gyinae sɛ ``ɔbɛyɛ nsakrae'' wɔ wo mogya mmoroso nnuru no mu. Ɔne wo bɛkasa nso afa nsakrae biara a ɛsɛ sɛ woyɛ wɔ wo da biara da asetra mu ho.

Sɛ nhwɛso no, ebia wobetu wo fo sɛ sesa nea wudi (di aduan te sɛ DASH aduan akyi) anaasɛ fa apɔw-mu-teɛteɛ pii ka wo nhyehyɛe ho.

So eyi bɛba me so bio? Dɛn na ɛsɛ sɛ mihu?

``Hypertensive Crisis'' yɛ kɔkɔbɔ sɛnkyerɛnne a ɛkyerɛ sɛ wo mogya mmoroso nyɛ nea ɛfata. Wo duruyɛfo betumi aboa wo ma wo mogya mmoroso so atew na ama ayɛ nea ɛfata. Ade a ɛho hia sen biara ne sɛ wobɛkɔ so ayɛ nhyehyɛe a wode bedi w’akyi no so na woanom wo nnuru sɛnea wo duruyɛfo ka kyerɛ wo no pɛpɛɛpɛ.

Ɛyɛ ade a ɛfata sɛ obiara bɛte ehu nka bere a ɔte asɛmfua "Ɔhaw" no. Ebia wubesusuw sɛ, "Oo, so me mogya mmoroso bɛkɔ soro saa bio?" Sɛ wo nsa ka sɛ wowɔ ``Hypertensive Crisis,'' a, ebia wobɛsan nso asusuw sɛnea ɛbɛka w'akwahosan ne daakye ho.

Nanso kae sɛ nneɛma pii betumi ama wo mogya mmoroso ayɛ kɛse saa. Wɔatete nnuruyɛfo ma wɔahu nea ɛde ba a ɛyɛ soronko wɔ onipa biara ho. Sɛ wuhu nea ɛde ba wie a, wubetumi ayɛ nneɛma bi de atew asiane a ɛwɔ hɔ sɛ ɛbɛsan asi bio no so.

Ebia nea ɛka eyi ho ne nkaebɔ ahorow a wode besi hɔ sɛ wobɛnom w’aduru no. Anaasɛ, ebetumi akyerɛ sɛ wo ne wo duruyɛfo bɛkasa afa nnuru a wonom esiane nneɛma afoforo nti na woayɛ nsakrae wɔ mu. Anamɔn biara a wobɛyɛ de ahyɛ wo mogya mmoroso so mprempren no bɛboa ma woabɔ wo ho ban afi ɔhaw ahorow a anibere wom ho daakye.

Nneɛma a ɛho hia paa a ɛsɛ sɛ yɛkae fi eyi mu (Take-Home Message) .

Okay, enti, so yɛbɛsan akae wo nneɛma a ɛho hia sen biara a yɛaka ho asɛm a ɛsɛ sɛ wode sie w’adwene mu?

• Mogya mmoroso ho haw ne bere a wo mogya mmoroso kɔ soro kodu 180/120 mm Hg anaa nea ɛboro saa. Eyi yɛ aduruyɛ mu asɛm a egye ntɛmpɛ.
• Eyi ahorow abien na ɛwɔ hɔ: `Hypertensive Urgency` a enni akwaa a ɛsɛe ne `Hypertensive Emergency` a akwaa asɛe.
• Ɛsono sɛnea yare no ho sɛnkyerɛnne. Ɛtɔ mmere bi a, ebia sɛnkyerɛnne biara nni hɔ koraa, anaasɛ nea ɛka ho ne tiyɛ a emu yɛ den, koko mu yaw, ne aniwa a ɛyɛ kusuu.
• Nea enti titiriw ne sɛ wɔrennom nnuru a wɔkyerɛw ama mogya mmoroso no yiye. Asaabo mu yare ne nnuru bi nso betumi de eyi aba.
• Sɛ nhyɛso no yɛ 180/120 mm Hg anaa nea ɛboro saa a, kɔ ayaresabea ntɛm ara.
• Nea ɛka ayaresa ho ne nnuru a wɔde ma mogya mmoroso so tew. Ebia ɛho behia nso sɛ wotra ayaresabea hɔ.
• Nea ɛbɛyɛ na eyi ansi bio no, di wo duruyɛfo akwankyerɛ akyi yiye, nom wo nnuru no yiye, na yɛ nsakrae a ɛho hia wɔ w’asetra mu.

Nea etwa to no, hwɛ wo mogya so. Hwɛ mu daa. Efisɛ, sɛ yɛbɛtra ase a ahoɔden wom a, ɛho hia yiye sɛ yɛn nyinaa hu saa "kumfo a ɔyɛ komm" yi. Sɛ wowɔ nsɛmmisa foforo bi a, nsuro sɛ wubebisa wo duruyɛfo anaa awogyefo. Wɔbɛboa wo!

` Hypertension, Hypertensive Crisis, Mogya Nhyɛso, Mogya Nhyɛso, Koma Yare, Nhyɛso, mogya mmoroso