Ua lohe paha ʻoe i kekahi kanaka me ka ʻeha o ke kaula kuamoʻo e ulu koke ana i
ke koko kiʻekiʻe, nā ʻeha poʻo nui, a me nā hōʻailona ʻē aʻe? ʻO kēia ke kūlana a mākou e kamaʻilio ai i kēia lā, i kapa ʻia ʻo Autonomic Dysreflexia, a i ʻole AD no ka pōkole. Mai hopohopo, inā ʻike ʻoe i kēia, hiki iā ʻoe ke kaohi iā ia.
He aha ka AD?
I ka ʻōlelo maʻalahi, ʻo Autonomic Dysreflexia (AD) kahi hopena maʻamau ʻole a koʻikoʻi i loko o ka ʻōnaehana nerve e kāohi ana i kekahi o nā hana aunoa o kou kino (kapa mākou i kēia ʻo Autonomic
Nervous System ). Ua like ia me kahi haʻalulu nui i kahi mea liʻiliʻi.
ʻIke pinepine ʻia kēia i nā poʻe i hōʻino ʻia i ke kaula spinal, ke kaula nerve i loko o ka iwi kuamoʻo . ʻOi aku ke kiʻekiʻe o kēia pilikia inā he hōʻino i ka umauma o luna, ʻōlelo mākou T6 level (Sixth Thoracic Vertebrae) a i ʻole ma luna. I kēia manawa ke noʻonoʻo nei paha ʻoe i ke ʻano o kēia iwi kuamoʻo thoracic. ʻO ia hoʻi, ka ʻāpana waena o ko mākou iwi kuamoʻo. ʻO kēia ka ʻāpana lōʻihi loa mai ka ʻāʻī a hiki i ka hopena o nā iwi ʻaoʻao. He 12 vertebrae kona, T1 a T12. ʻO ka hōʻailona nui o AD
ka piʻi koke ʻana o ke koko ( hypertension ) . Me kēia, he hōʻailona nui nō hoʻi ka ʻeha poʻo nui. ʻIke pinepine ʻia ʻo AD i ʻelua a ʻekolu mahina ma hope o ka ʻeha o ka iwi kuamoʻo a ua emi iho ka haʻalulu hopena (Spinal Shock, Neurogenic Shock). Hiki i nā poʻe he nui ke ʻike i kēia ʻano i nā manawa he nui i ko lākou ola. Ua ʻōlelo ʻia kekahi poʻe, ʻoiai ka poʻe i loaʻa ka pōʻino ma luna o ka pae T6, ua ʻike lākou iā ia a hiki i 40 mau manawa i ka lā. Ua kapa ʻia kēia AD i kekahi mau inoa ʻē aʻe, a hiki i kāu kauka ke kapa iā ia i kekahi o kēia mau inoa: Autonomic Hyperreflexia, Hypertensive
Autonomic Crisis, Sympathetic Hyperreflexia.
E aʻo iki kākou e pili ana i kā kākou ʻōnaehana nerve ponoʻī.
ʻAe, e nānā kākou i kēia ʻōnaehana nerve autonomic. ʻO kēia ka ʻāpana o ko kākou kino e kāohi ana i nā mea he nui me ka ʻole o ko kākou noʻonoʻo ʻana iā lākou. Nā mea e like me ka hanu ʻana,
ka helu o ka puʻuwai ,
ke koko , a me ka ʻai ʻana. Ua like kēia me ka ʻōnaehana aunoa o ko kākou kino. ʻEkolu mau ʻāpana nui o kēia ʻōnaehana nerve autonomic:
- ʻŌnaehana Aʻalolo Aloha (SNS): ʻO kēia ka mea e hoʻomākaukau ai iā mākou no nā pilikia a me nā pōʻino. ʻO ia ka ʻōnaehana e hoʻoulu ai i ka pane 'hakakā a lele paha'.
- ʻŌnaehana Nervous Parasympathetic (PNS): Hana kēia i ka mea kū'ē i ka hana a ka sympathetic. ʻO ia hoʻi, hoʻomālielie ia i ke kino a kōkua i ke kaʻina hana o ka 'hoʻomaha a me ka hoʻoheheʻe ʻana'.
- ʻŌnaehana Nervous Enteric (ENS): ʻO kēia ka mea nui e hoʻokele i kā mākou kaʻina hana hoʻoheheʻe.
Pehea e ulu ai ʻo AD?
I kēia manawa, e nānā kākou i ka mea e hana ʻia ke loaʻa iā ʻoe ka AD. Ke hōʻino ʻia kou iwi kuamoʻo, ma lalo o kahi o ka ʻeha, hoʻāla ʻia kāu ʻōnaehana nerve sympathetic (SNS). Me he mea lā e pane mai ana ka SNS ua pilikia ʻoe. ʻO ka hopena, ʻūlū nā kīʻaha koko i loko o kou kino haʻahaʻa (e like me kou mau wāwae, ʻōpū) (ua kapa ʻia kēia he vasoconstriction). ʻO kēia ke kumu e piʻi koke ai kou koko. ʻO ka maʻamau, ke piʻi aʻe kou koko e like me kēia, hoʻāla ʻia kāu ʻōnaehana nerve parasympathetic (PNS), e hoʻonui ana i nā kīʻaha koko (ua kapa ʻia kēia he vasodilation), e hoʻihoʻi ana i kou koko i ka maʻamau. Kāhea mākou i kēia kaʻina hana ʻo ka baroreflex. Eia naʻe, no kekahi me ka ʻeha o ka iwi kuamoʻo, ʻaʻole hiki i kēia leka parasympathetic ke hele i lalo mai kahi o ka ʻeha. No laila, ʻo ka mea e hana ʻia, ʻūlū wale nā kīʻaha koko ma ka ʻaoʻao o luna o ke kino (ma luna o ka ʻeha). ʻO ia ke kumu, no ka mea, ke hoʻomau nei nā kīʻaha koko ma ka ʻaoʻao haʻahaʻa o ke kino e ʻūlū (ma muli o ka hana a ka SNS), noho mau ke koko kiʻekiʻe loa.
He mea nui e hoʻomaopopo i kēia: ʻO ia ke kumu e ʻike ai ke kanaka me AD i nā hōʻailona like ʻole ma nā ʻāpana like ʻole o ko lākou kino i ka manawa like. No ka laʻana, ʻulaʻula a hou paha ka ʻili ma luna o ka pae o ka lesion (e like me ka maka, ka ʻāʻī, a me nā lima). Eia nō naʻe, ʻeleʻele, anu, a maloʻo paha ka ʻili ma lalo o ka lesion (e like me ka ʻōpū haʻahaʻa a me nā wāwae).
ʻO wai ka mea i ʻoi aku ka paʻakikī o ka loaʻa ʻana o AD?
Inā ʻoe e nānā i ka mea i loaʻa nui iā AD, ʻo ia ka poʻe i hōʻino ʻia ke kaula spinal
ma ka pae T6 a i ʻole ma luna o ka pae (ka ʻeono o ka thoracic vertebra) . Akā, ʻaʻole i loaʻa i nā kānaka a pau. Ua ʻike ʻoe, ua like ko kākou kaula spinal me ke ala e lawe ana i nā leka mai ka lolo a puni ke kino. Ua pale ʻia e nā vertebrae (nā iwi hope). ʻO ka hapa pinepine, loaʻa nā ʻeha o ka spinal i kahi ulia, i ka wā e haki ai kēia iwi spine e kahi hahau ikaika. A laila e ʻomi nā iwi haki i ke kaula spinal, e hōʻino ana i nā aʻalolo ma ia wahi.
Hoʻonui ka pilikia o ka loaʻa ʻana o AD me ka nui o ka hōʻino ʻia o ke kaula kuamoʻo a me ke koʻikoʻi o ka hōʻino (e like me ka haki piha ʻana). Ua manaʻo ʻia ma kahi o 90% o ka poʻe me nā ʻeha kaula kuamoʻo ma ka iwi kuamoʻo cervical a i ʻole ka iwi kuamoʻo kiʻekiʻe-thoracic e loaʻa iā AD. Eia kekahi, ʻo nā wahine hāpai me nā ʻeha iwi kuamoʻo ma T6 a i ʻole ma luna e loaʻa iā lākou ka pilikia nui o ka loaʻa ʻana o AD i ka wā hānau. No laila, pono e noʻonoʻo ʻia kēia. He aha nā hōʻailona o AD?
Hiki ke ʻokoʻa iki nā hōʻailona o AD mai kēlā kanaka a i kēia kanaka, akā hiki pinepine mai lākou me ka koke. ʻO ka hōʻailona nui mua he ʻeha poʻo nui a ʻūlū. Hoʻokumu ʻia kēia e ka piʻi koke ʻana o ke koko. Eia kekahi, hiki iā AD ke hana i kēia mau hōʻailona:- Ka hou nui ʻana ma luna o ka pae o ka ʻeha hope.
- ʻO ka wikiwiki o ka puʻuwai ma mua o ka maʻamau (ua kapa ʻia kēia ʻo bradycardia).
- ʻUlaʻula o ka ʻili ma luna o ka ʻeha ma ke kua a me ka ʻili maloʻo a keʻokeʻo ma lalo o ka ʻeha.
- ʻEhaʻeha ke kino ma muli o ke kua.
- ʻIli anu.
- Paʻa ka ihu.
- Ka luaʻi, ka luaʻi.
- ʻIke pōwehiwehi.
- Ka manaʻo o ka hopohopo nui a me ka makaʻu.
Mea nui: Inā ʻike ʻoe i kēia mau hōʻailona, he mea nui loa ia e ʻimi koke i ke kōkua lapaʻau. He pilikia paha kēia.
He aha nā kumu o AD?
ʻO ke kumu nui o AD ka ʻeha o ke kaula kuamoʻo a mākou i kūkākūkā mua ai. ʻO ka ʻōnaehana nerve autonomic o ka poʻe me AD he pane nui loa ia i kekahi mau stimuli. ʻO ka maʻamau, ke ʻike ke kino i kahi stimulus noxious ma lalo o ka pae o ka ʻeha o ke kaula kuamoʻo, hoʻāla nui ʻia ka ʻōnaehana nerve sympathetic, e hana ana i ka nui o nā kīʻaha koko e ʻaelike (vasoconstriction). ʻO kēia 'noxious stimulus' kekahi mea e hōʻino maoli i ka ʻiʻo a hiki ke hōʻeha, akā i kekahi manawa ʻaʻole ʻike ʻia ka ʻeha. Hiki ke lilo i kekahi mea mai ka maneʻo hiki ʻole iā ʻoe ke kahakaha a hiki i ka ʻōpū piha. Ma waho aʻe o nā ʻeha o ke kaula kuamoʻo, aia kekahi mau kūlana ʻē aʻe e hiki ai ke hoʻoulu iā AD, akā he mea kākaʻikahi loa lākou:- ʻO ka Astrocytoma Intramedullary - He maʻi ʻaʻai o ka ʻōnaehana nerve waena.
- ʻO ka Sclerosis lehulehu (MS).
- ʻO ka maʻi Guillain-Barré.
- Nā hopena ʻaoʻao o kekahi mau lāʻau lapaʻau.
- Nā ʻeha poʻo koʻikoʻi a me nā maʻi lolo ʻē aʻe.
- Ke kahe koko ʻana o ka lolo (Subarachnoid Hemorrhage - SAH) - ke kahe koko ʻana i loko o ka lolo.
- Ka hoʻohana ʻana i nā lāʻau hoʻouluulu ʻole e like me ka cocaine a me nā amphetamines.
Nā mea hoʻoulu o AD
Inā ʻoe e pilikia ana i ka loaʻa ʻana o AD, he mea nui e makaʻala i nā mea e hiki ai ke hoʻoulu i kēia kūlana. Ma kēia ʻano, hiki iā ʻoe ke pale aku iā lākou a mālama koke iā lākou inā ʻike ʻia nā hōʻailona AD. Hoʻoulu pinepine ʻia ʻo AD e nā pilikia e pili ana i:- ʻŌpū mimi.
- ʻōpū (ʻo ia hoʻi nā ʻōpū).
- ʻIli.
Nā kumu e pili ana i ka ʻōpū mimi
ʻO nā pilikia o ka ʻōpū mimi ke kumu nui o AD - ʻo ia ka 85% o nā hihia AD. ʻO ka hapa nui, ʻo ke kumu he ālai ʻia i ke ala e kahe ai kou mimi, e hoʻopiha nui ai kou ʻōpū mimi (Bladder Distension). Hiki ke hana ʻia kēia e:- Inā hoʻokomo ʻia kahi catheter Foley, hiki ke kinked a ālai ʻia paha.
- Nā ʻūmiʻi o ka ʻōpū mimi.
- Nā pōhaku ʻōpū.
- Nā Maʻi ʻAla Mimi (UTI).
I kekahi manawa, hiki i nā hoʻokolohua e like me ka cystoscopy a i ʻole ka hoʻāʻo urodynamic ke hoʻoulu i ka AD. Nā kumu e pili ana i ka ʻōpū nui
ʻO ka ʻōpū nui, a i ʻole ka ʻōpū, ka lua o ke kumu maʻamau o AD. Hiki ke loaʻa ka AD ke kīkoʻo nui ʻia nā ʻōpū. ʻO nā kumu no kēia:- Ka pā ʻana o ka ʻōpū.
- Ka paʻa ʻana o ka ʻōpū.
- ʻŌpū, ʻōpū.
- Nā ʻEnema.
- Ka hoʻokahe lima ʻana.
A me nā maʻi lele ʻē aʻe i loko o nā ʻōpū, no ka laʻana:- Ka maʻi pākī.
- ʻO ka diverticulitis.
- ʻO ka maʻi o Crohn.
- Nā māwae anal.
- Nā ʻōpū hemorrhoids.
Hiki i nā mea e like me kēia ke hoʻoulu i ka AD. Nā kumu e pili ana i ka ʻili
ʻO nā pilikia ʻili ke kolu o ke kumu maʻamau o AD. Aia kekahi mau kumu hiki ke loaʻa:- ʻEha kaomi / ʻeha moe.
- Nā ʻoki, nā palapū.
- Nā ʻūhū ʻili.
- Ke paʻa nei nā lole, ke pipili nei, a ke nui loa nei.
- He maneʻo i hiki ʻole ke hoʻopā ʻia a i ʻole ke kahakaha ʻia.
- Nā kui wāwae i ulu i loko.
Pehea ʻoe e ʻike ai inā loaʻa iā ʻoe ʻo AD?
ʻAʻohe hoʻokolohua hoʻokahi e hiki ke hōʻoia maopopo iā AD. No laila, e hoʻokumu nui nā kauka a me ka poʻe e mālama iā ʻoe i kā lākou hōʻailona ma luna o kēia mau mea:- ʻO kou mōʻaukala olakino , ʻoiai ka ʻike e pili ana i kahi ʻeha kua.
- ʻO kou kaomi koko o kēia manawa i hoʻohālikelike ʻia me kou kaomi koko maʻamau. Ma ke ʻano laulā, inā ʻoi aku kou kaomi koko systolic ma mua o 150 mmHg, a i ʻole ma kahi o 40 mmHg kiʻekiʻe aʻe ma mua o kou pae maʻamau, ua manaʻo ʻia he hōʻailona ia o AD.
- Nā hōʻailona , ʻoiai hoʻi nā ʻeha poʻo nui.
Inā loaʻa iā ʻoe nā hōʻailona o AD akā ʻaʻole ʻoe e manaʻo he ʻeha kou iwi kuamoʻo, makemake paha kāu kauka e hana i kahi hoʻokolokolo piha o kāu ʻōnaehana nerve a hana i nā hoʻokolohua ʻē aʻe e ʻike ai i ke kumu o kāu mau hōʻailona. Hiki i kēia mau mea ke komo pū me:- Nā hoʻāʻo koko a me ka mimi.
- ʻO ke scan CT (CT - Computed Tomography scan) a i ʻole MRI scan (MRI - Magnetic Resonance Imaging scan).
- ECG (Electrocardiogram - EKG).
- ʻŌkuʻi iwi kuamoʻo / Puʻu lumbar.
- Hoʻāʻo papa hoʻohiolo.
- Nā hoʻāʻo lāʻau lapaʻau.
- Nā kukuna X.
Pehea e mālama ʻia ai ʻo AD?
ʻO ka hana mua i ka mālama ʻana iā AD, ʻo ia ke moe i lalo ka mea maʻi, hoʻohaʻahaʻa i ko lākou mau wāwae, a wehe i nā lole paʻa. Kōkua kēia i ka hoʻohaʻahaʻa ʻana i ke koko. I ka hapanui o nā hihia, nalowale ʻo AD ke wehe ʻia ke kumu. No laila, ʻo ka hana aʻe, ʻo ia ka ʻike a me ka hoʻopau ʻana i ke kumu, inā hiki, ma mua o ka hāʻawi ʻana i ka lāʻau. No ka laʻana, eia kekahi mau mea hiki i kāu kauka a mea mālama paha ke hana e ʻike a hoʻoponopono i ke kumu:- Ke nānā nei inā ke kahe pono nei ka mimi, a i ʻole ke hoʻoponopono nei.
- Inā he catheter Foley ko kekahi, e nānā iā ia no nā mea e ālai ana a i ʻole nā hemahema a hoʻoponopono iā lākou.
- Ke hoʻāʻo ʻana i kahi hāpana mimi e ʻike ai inā he maʻi ʻaʻai mimi (UTI), a inā pēlā, e hāʻawi i nā lāʻau antibiotic.
- E nānā i ka rectum e ʻike ai inā he impaction fecal, a inā pēlā, e wehe i ka ʻōpala.
Ua ʻike maopopo ka poʻe he nui i loaʻa ka ʻike me AD i kēia a ua mākaukau e hoʻokō i kahi hoʻolālā lapaʻau. I kahi pilikia: Inā ʻaʻole hiki ke loaʻa ke kumu, a ʻaʻole hoʻohaʻahaʻa nā hana maʻamau i ke koko, pono ka mālama ʻana i ka pilikia e hoʻohaʻahaʻa i ke koko. I ia hihia, e kelepona i ka 119 (a i ʻole ka helu pilikia pili), a i ʻole e ʻimi koke i ke kōkua lapaʻau.
A laila e hāʻawi ʻia iā ʻoe nā lāʻau lapaʻau hana wikiwiki e like me nitrates, hydralazine, labetalol, a i ʻole nifedipine e hoʻohaʻahaʻa i kou koko. I ka wā o ka mālama ʻana, e nānā kāu hui lapaʻau i kāu mau hōʻailona koʻikoʻi a nānā pinepine i kou koko. Hiki ke pale ʻia ka AD?
ʻAʻole hiki ke pale aku i ka AD i nā manawa a pau. Eia nō naʻe, inā loaʻa iā ʻoe kahi ʻeha o ka iwi kuamoʻo, ʻoi aku hoʻi ma luna o ka pae T6, hiki i kēia mau mea ke kōkua i ka pale ʻana i ka AD:- E hoʻokahe pinepine i ka ʻōpū mimi a mālama pono ʻaʻole e hoʻopiha.
- Ka mālama ʻana i ka ʻeha.
- He mea nui ka mālama ʻana i kou ʻōpū no ka pale ʻana i ka paʻa ʻana o ka ʻōpala a me ka constipation.
- He mea nui ka mālama pono ʻana i kou ʻili no ka pale ʻana i nā ʻeha moe a me nā maʻi ʻili.
- Ke pale ʻana i nā maʻi ʻōpū mimi (UTIs).
Pehea lā ke ʻano o ke kūlana AD? (Outlook)
Ma keʻano laulā, maikaʻi ka wānana no AD, akā inā wale nō e hana ʻia kēia mau mea:- Inā ʻike ʻoe, kāu mea mālama, a i ʻole kāu hui lapaʻau i kēia i ka wā mua.
- Inā hoʻomaka koke ʻia ka lāʻau hoʻoponopono ulia pōpilikia.
- Inā ʻike maikaʻi ʻoe a/a i ʻole kou poʻe mālama e pili ana i nā hōʻailona a me nā mea hoʻoulu o AD.
- Inā ʻoe, kāu mea mālama, a i ʻole kāu hui lapaʻau e hana i nā hana palekana kūpono e pale aku ai iā AD.
Eia nō naʻe, ʻo nā kūlana AD koʻikoʻi i mālama ʻole ʻia me ka wikiwiki a me ke kūpono hiki ke loaʻa nā hopena koʻikoʻi. Eia kekahi laʻana:- Ka pōʻino o ka lolo ma muli o ke koko kiʻekiʻe (Hypertensive Encephalopathy).
- Hahau.
- Paʻa ka puʻuwai.
- Hoʻopaʻa ʻana.
- Ka make.
ʻO ka mea pōmaikaʻi, he mea kakaikahi loa nā make mai AD. Inā ʻoe i pilikia no AD, he aha kāu e hana ai?
Pono ʻoe a me kāu poʻe aloha e komo i ka ʻike ʻana i nā hōʻailona AD. I ka wā e hoʻomaka ai ʻoe e ʻike i nā hōʻailona o AD, e noho i luna a hoʻomaka i ka lāʻau lapaʻau. Hiki iā ʻoe ke hāʻule, hōʻeha iā ʻoe iho, a nalowale paha ka ʻike, no laila e kāhea no ke kōkua. Inā ʻaʻole hiki iā ʻoe ke loaʻa kahi mea hoʻonāukiuki, a inā ʻaʻole kōkua ka lāʻau lapaʻau kūpono, pono kekahi e kāhea iā 119 (a i ʻole ka helu pilikia kūpono). He mea nui hoʻi e mālama i kahi Emergency Treatment Pack me ʻoe, inā ua kuhikuhi kāu kauka iā ia, a me kahi pepa liʻiliʻi me ka ʻike e pili ana iā AD. E kōkua kēia i ka poʻe i ʻike ʻole e pili ana iā AD. Inā ua loaʻa iā ʻoe nā hōʻailona AD ma mua, pono ʻoe e hoʻomaopopo i kāu mau kauka āpau, nā mea mālama, a me nā mea aloha e pili ana i kou kūlana. I mea e hana hou ai, e ʻike lākou, ʻoiai inā ʻaʻohe ou manawa e noi ai i ke kōkua. E hoʻomanaʻo ma ke ʻano he hōʻuluʻulu manaʻo
ʻO ka autonomic dysreflexia (AD) kahi kūlana e hiki ke hoʻoweliweli i ke ola. Akā ʻo ka nūhou maikaʻi , hiki ke mālama ʻia - pinepine ma ka wehe ʻana a i ʻole ka hoʻololi ʻana i ke kumu. Inā ʻoe e pilikia ana i ka hoʻomohala ʻana iā AD, he mea nui iā ʻoe a me kāu poʻe aloha e aʻo i nā mea āpau e hiki ai iā ʻoe e pili ana i ia mea. A laila hiki iā ʻoe ke ʻike i nā hōʻailona a loaʻa koke ka lāʻau no AD. E kamaʻilio me kāu hui lapaʻau e pili ana i nā ala e pale aku ai i nā mea hoʻonāukiuki. Ua mākaukau lākou e kōkua iā ʻoe. E hoʻomanaʻo, ʻaʻohe mea e makaʻu ai kēia, ʻo ka ʻike ka pale nui loa!
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