Kua rongo kē koe mō tētahi tangata kua whara te taurakira, ā, ka pāngia e
te toto toto tiketike, te mamae nui o te upoko, me ētahi atu tohu? Koinei te mate ka kōrerohia e tātou i tēnei rā, e kiia nei ko te Autonomic Dysreflexia, ko te AD rānei te whakarapopototanga. Kaua e manukanuka, ki te mōhio koe ki tēnei, ka taea e koe te whakahaere.
He aha te AD?
Ki te whakarapopoto, ko te Autonomic Dysreflexia (AD) he tauhohenga kino, he rerekē i roto i te pūnaha io e whakahaere ana i ētahi o ngā mahi aunoa o tō tinana (e kiia ana tēnei ko te
Pūnaha Io Aunoa). He rite ki te ru nui ki tētahi mea iti.
Ka kitea pinepine tēnei i roto i te hunga kua pakaru te taurakira, te taura io i roto i te tuaiwi . Ka nui ake tēnei mōrearea mēnā he pakaru te uma o runga, e kīia ana ko te taumata T6 (Sixth Thoracic Vertebrae) neke atu rānei. Inaianei kei te whakaaro pea koe he aha tēnei tuaiwi thoracic. Arā, ko te wāhanga waenga o tō tātou tuaiwi. Koinei te wāhanga roa rawa atu mai i te kaki ki te pito o ngā rara. E 12 ōna vertebrae, T1 ki te T12. Ko te tohu matua o te AD ko
te pikinga ohorere o te toto toto ( hypertension ) . Haunga tēnei, he tohu nui anō hoki te ānini nui. He maha ngā wā ka puta tuatahi te AD i muri i te rua ki te toru marama i te whara o te tuaiwi, ā, kua memeha te ru i puta mai (Spinal Shock, Neurogenic Shock). He maha ngā tāngata ka pāngia e tēnei āhuatanga i ētahi wā i roto i ō rātou oranga. E kiia ana ka pāngia ētahi tāngata, inā koa ko te hunga he kino kei runga ake i te taumata T6, tae atu ki te 40 ngā wā i te rā. He maha atu anō ngā ingoa e karangatia ana mō tēnei AD, ā, ka karangatia pea e tō tākuta tētahi o ēnei ingoa: Autonomic Hyperreflexia, Hypertensive
Autonomic Crisis, Sympathetic Hyperreflexia.
Kia ako tātou mō tā tātou Pūnaha Io Ā-Whaiaro.
Āe, me titiro tātou ki te āhua o tēnei Pūnaha Io Motuhake. Koinei te wāhanga o tō tātou tinana e whakahaere ana i ngā mea maha, kāore tātou e whakaaro ki aua mea. Ngā mea pēnei i te manawa,
te tere o te manawa ,
te toto toto , me te nakunaku. He rite tēnei ki te pūnaha aunoa o tō tātou tinana. E toru ngā wāhanga matua o tēnei pūnaha io motuhake:
- Pūnaha Io Aroha (SNS): Koinei te mea e whakarite ana i a tātou mō ngā āhuatanga ohorere me ngā tūponotanga. Koinei te pūnaha e whakaoho ana i te urupare 'pakanga, rere rānei'.
- Pūnaha Io Parasympathetic (PNS): He rerekē te mahi a tēnei i tā te pūnaha io sympathetic. Arā, ka whakamarie i te tinana, ka āwhina hoki i te tukanga 'okioki me te nakunaku'.
- Pūnaha Io Puku (ENS): Koinei te mea matua e whakahaere ana i tā tātou tukanga nakunaku.
Me pēhea te whanaketanga o te AD?
Nā, me titiro tātou ki ngā mea ka puta ina pāngia koe e te AD. Ina pakaru tō tuaiwi, i raro i te wāhi whara, ka whakahohehia tō pūnaha io sympathetic (SNS). Me te mea kei te whakautu te SNS kei roto koe i te mōrearea. Nō reira, ka whakawhāitihia ngā oko toto i roto i tō tinana o raro (pērā i ō waewae, puku) (ka kiia tēnei ko te vasoconstriction). Ka piki ohorere tō toto toto. I te nuinga o te wā, ina piki ake tō toto toto pēnei, ka whakahohehia tō pūnaha io parasympathetic (PNS), ka whakawhānui i ngā oko toto (ka kiia tēnei ko te vasodilation), ka whakahokia tō toto toto ki te noa. Ka kiia tēnei tukanga ko te baroreflex. Heoi, mō te tangata kua whara te tuaiwi, kāore e taea e tēnei karere parasympathetic te haere ki raro mai i te wāhi whara. Nō reira, ko te mea ka tupu ko te whakawhānui noa i ngā oko toto i te taha o runga o te tinana (i runga ake i te whara). Koinei te take, nā te mea ka haere tonu te whakawhāiti i ngā oko toto i te taha o raro o te tinana (nā te mahi a te SNS), ka noho tonu te toto toto ki te tino teitei.
He mea nui kia mārama ki tēnei: Koinei te take ka pāngia ai te tangata whai AD e ngā tohu rerekē i ngā wāhanga rerekē o tōna tinana i te wā kotahi. Hei tauira, ko te kiri i runga ake i te taumata o te whara (pērā i te mata, te kaki, me ngā ringa) ka whero, ka werawera. Heoi, ko te kiri i raro i te whara (pērā i te puku o raro me ngā waewae) ka mā, ka makariri, ka maroke.
Ko wai te mea ka nui ake te tūponotanga ka pāngia e te AD?
Ki te tirohia ko wai te hunga e tino pāngia ana e te AD, ko te hunga e whara ana te taurakira
i te taumata T6, i runga ake rānei (te tuaono o ngā tuaiwi o te uma) . Engari kāore e pāngia te katoa. Kei te mōhio koe, he rite tō tātou taurakira ki te ara e kawe ana i ngā karere mai i te roro puta noa i te tinana. Kei te tiakina e ngā tuaiwi (ngā wheua o muri). I te nuinga o te wā, ka puta ngā whara o te tuaiwi i roto i tētahi aituā, ina whati tēnei tuaiwi i te whiu kaha. Kātahi ka pēhia e ngā wheua whati te taurakira, ka pakaru ngā io i taua wāhi.
Ka piki ake te mōrearea o te whakawhanake i te AD me te nui o te kino o te taurakira me te kaha o te kino (pēnei i te pakaru katoa). E kiia ana tata ki te 90% o te hunga kua whara te taurakira i te tuaiwi kaki, i te tuaiwi uma-teitei rānei ka pāngia e te AD. Hei tāpiri, ko ngā wāhine hapu kua whara te tuaiwi i te T6, neke atu rānei, he tino mōrearea ki te whakawhanake i te AD i te wā e whānau ana. Nō reira, me whai whakaaro anō hoki ki tēnei. He aha ngā tohu o te AD?
Ka rerekē pea ngā tohu o te AD i ia tangata, i ia tangata, engari he maha ngā wā ka puta ohorere mai. Ko te tohu nui tuatahi ko te ānini nui, te mamae o te upoko. Ka puta tēnei i te pikinga ohorere, nui o te toto toto. Hei tāpiri, ka taea hoki e te AD te whakaputa i ēnei tohu e whai ake nei:- Te werawera nui rawa atu i te taumata o te mamae tuara.
- He tere o te manawa e pōturi ake ana i te noa (e kiia ana tēnei ko te bradycardia).
- Te whero o te kiri i runga ake i te whara i te tuara, me te kiri mā, maroke i raro i te whara.
- Ngā kōroke o te tinana nā te mamae o te tuara.
- Kiri makariri.
- Te pupuhi o te ihu.
- Whakapairuaki, ruaki.
- Te tirohanga pōuri.
- Te ahua o te manukanuka nui me te wehi.
He mea nui: Ki te pāngia koe e ēnei tohu, he mea nui kia rapu tohutohu hauora i te wā e taea ai. He āhuatanga ohorere pea tēnei.
He aha ngā pūtake o te AD?
Ko te tino take o te AD ko te whara o te taurakira kua kōrerohia kētia e tātou. Ka nui rawa te aro o te pūnaha io ā-roto o te hunga whai AD ki ētahi whakaohooho. I te nuinga o te wā, ina pāngia te tinana e te whakaohooho kino i raro iho i te taumata o te whara o te taurakira, ka tino whakahohehia te pūnaha io atawhai, ka meinga te maha o ngā oko toto kia kōpiri (vasoconstriction). Ko tēnei 'whakaohooho kino' he mea e kino ana te kiko, ā, ka mamae pea, engari i ētahi wā kāore e rangona te mamae. Tērā pea he mea mai i te mākūkū e kore e taea te waru ki te pūkahukahu kī tonu. Haunga ngā whara o te taurakira, tera atu ētahi atu āhuatanga ka puta ai te AD, engari he tino onge:- Ko te Astrocytoma Intramedullary - He mate pukupuku o te pūnaha io matua.
- Te Mate Pukupuku Maha (MS).
- Te Mate Guillain-Barré.
- Ngā pānga taha o ētahi rongoā.
- Ngā whara nui o te upoko me ētahi atu mate o te roro.
- Te toto o raro i te roro (Subarachnoid Hemorrhage - te toto i roto i te roro).
- Te whakamahi i ngā raau taero whakaoho turekore pērā i te kōkaini me te amphetamines.
Ngā mea whakaoho o te AD
Mena kei te tūpono koe ki te pāngia e te AD, he mea nui kia mōhio koe ki ngā mea ka puta ai tēnei mate. Mā tēnei, ka taea e koe te karo i ēnei āhuatanga, ā, ka taea hoki te rongoā wawe mēnā ka puta ngā tohu AD. He maha ngā wā ka puta te AD i ngā raruraru e pā ana ki:- Pūngāwerewere.
- Whekau (arā, ngā whekau).
- Kiri.
Ngā take e pā ana ki te pūkahukahu
Ko ngā raruraru pūkahukahu te tino take o te AD - tata ki te 85% o ngā take AD. I te nuinga o te wā, ko te take he aukati i te ara e rere ai tō mimi, ka kī rawa tō pūkahukahu (Bladder Distension). Ka puta pea tēnei i:- Mena kua whakauruhia he catheter Foley ki roto i tō poka, tera pea ka piko, ka aukati rānei.
- Ngā pupuhi o te pūkahukahu.
- Ngā kōhatu pūkahukahu.
- Ngā Mate Pukupuku o te Ara Mimi (UTI).
I ētahi wā, ka taea hoki e ngā whakamātautau pēnei i te cystoscopy me te whakamātautau urodynamic te whakaoho i te AD. Ngā take e pā ana ki te whekau nui
Ko te whekau nui, te whēkau rānei, te tuarua o ngā tino take o te AD. Ka puta te AD ina totoro rawa ngā whekau. Ko ngā take mō tēnei:- Te pānga o te paru.
- Te mate kōroke.
- Te pupuhi o te puku, te pupuhi o te puku.
- Ngā enema.
- Te tūtae ā-ringa.
Me ētahi atu mate pāwera i roto i ngā whekau, hei tauira:- Te korere.
- Te mate diverticulitis.
- Te mate a Crohn.
- Ngā matāra o te anal.
- Ngā pukupuku.
Ka taea hoki e ēnei mea te whakaoho i te AD. Ngā take e pā ana ki te kiri
Ko ngā raruraru kiri te tuatoru o ngā tino take o te AD. He maha ngā take pea:- Whara pēhanga / Tūkino moenga.
- Ngā motu, ngā marō.
- Ngā ponana kiri.
- Ka piri haere ngā kākahu, ka mau, ka rahi rawa.
- He mākati e kore e taea te pā, te rakuraku rānei.
- Ngā maikuku o roto.
Me pēhea koe e mōhio ai mēnā kei a koe te AD?
Kāore he whakamātautau kotahi e taea ai te tautuhi i te AD. Nō reira, ko ngā tākuta me te hunga e tiaki ana i a koe ka whakatakoto i tā rātou tautuhi i runga i ēnei e whai ake nei:- Tō hītori hauora , inā koa ngā mōhiohio e pā ana ki te whara o te tuara.
- Ko te whakataurite i tō toto toto o nāianei ki tō toto toto noa. I te nuinga o te wā, ki te neke atu tō toto toto systolic i te 150 mmHg, ki te 40 mmHg teitei ake rānei i tō taumata noa, ka kiia he tohu tēnei o te AD.
- Ngā tohu , inā koa te mamae nui o te upoko.
Mena kei a koe ngā tohu o te AD engari kāore koe e whakaaro he whara tō tuaiwi, ka hiahia pea tō tākuta ki te tirotiro i tō pūnaha io me te mahi i ētahi atu whakamātautau hei kimi i te pūtake o ō tohu. Kei roto i ēnei ko:- Ngā whakamātautau toto me te mimi.
- Matawai CT (CT - Matawai Tomography Rorohiko) matawai MRI rānei (MRI - Matawai Whakaahua Āhuatanga Ahokore).
- ECG (Electrocardiogram - EKG).
- Te pokanga tuaiwi / Te pokanga lumbar.
- Whakamātautau tēpu honga.
- Ngā whakamātautau tarukino.
- Ngā hihi-X.
Me pēhea te rongoā mō te AD?
Ko te taahiraa tuatahi ki te rongoā i te AD ko te takoto o te tūroro, te whakaheke i ōna waewae, me te tango i ngā kākahu piri. Ka āwhina tēnei ki te whakaheke i te toto toto. I te nuinga o te wā, ka ngaro te AD ina tangohia te pūtake. Nō reira, ko te taahiraa e whai ake nei ko te tautuhi me te whakakore i te pūtake, ki te taea, i mua i te hoatu rongoā. Hei tauira, anei ētahi mea ka taea e tō tākuta, e tō kaitiaki rānei te mahi hei tautuhi me te whakatika i te pūtake:- Te tirotiro mēnā kei te tika te rere o te mimi, te whakatika rānei.
- Mena he Foley catheter tā tetahi, tirohia mēnā he aukati, he hapa rānei, ka whakatika.
- Te whakamātautau i tētahi tauira mimi hei tirotiro mēnā he mate mimi (UTI), ā, mēnā he mate pāwera, me hoatu he rongoā paturopi.
- Tirohia te tōku kia kite ai mēnā he pānga o te paru, ā, ki te mea kei te pērā, tangohia te paru.
He tokomaha te hunga whai wheako ki te AD e mōhio ana ki tēnei, ā, kua rite rātou ki te whakatinana i tētahi mahere maimoatanga. I roto i tētahi āhuatanga ohorere: Ki te kore e kitea te pūtake, ā, kāore ngā mahi taketake e whakaheke i te toto toto, me whai maimoatanga ohorere hei whakaheke i te toto toto. I roto i tēnei āhuatanga, waea atu ki te 119 (te nama ohorere tika rānei), rapua tonutia rānei he awhina hauora.
Kātahi ka hoatu he rongoā tere te mahi ki a koe pērā i te nitrates, te hydralazine, te labetalol, te nifedipine rānei hei whakaheke i tō toto toto. I te wā e rongoatia ana, ka aroturukihia e tō tīma hauora ō tohu ora, ā, ka tirohia hoki tō toto toto i ngā wā katoa. Ka taea te ārai i te AD?
Kāore e taea te ārai i te AD i ngā wā katoa. Heoi, ki te mea he whara tō tuaiwi, ina koa kei runga ake i te taumata T6, ka āwhina pea ēnei mea ki te ārai i te AD:- Te whakawātea i te pūkahukahu i ia wā, me te tūpato kia kaua e kī.
- Te whakahaere i te mamae.
- He mea nui te tiaki i ō whekau hei ārai i te aukati o te paru me te mate kōroke.
- He mea nui te tiaki tika i tō kiri hei ārai i ngā mate kiri me ngā mate kiri.
- Te ārai i ngā mate urutā o te ara mimi (UTI).
Ka pēhea te āhua o te AD? (Outlook)
He pai te matapae mō te AD, engari mēnā ka puta ēnei mea:- Mena ka kite wawe koe, tō kaitiaki, tō tīma hauora rānei i tēnei.
- Mena ka tīmata wawe te maimoatanga whakatikatika ohorere.
- Mena kei te mōhio koe, me/ranei ō kaitiaki, ki ngā tohu me ngā mea e whakaoho ana i te AD.
- Mena ka tangohia e koe, e tō kaitiaki, e tō tīma hauora rānei ngā mahi ārai tika hei ārai i te AD.
Heoi, ko ngā mate kino o te AD kāore e rongoatia wawetia, ā, kāore hoki e tika ana te rongoā, ka pā mai pea he hua kino. Hei tauira:- Te pakaru o te roro nā te toto toto tiketike (Hypertensive Encephalopathy).
- Te whiu.
- Te hopukanga o te ngākau.
- Te hopuhopu.
- Te mate.
Waimarie, he tino onge ngā mate mai i te AD. Mena kei te mōrearea koe ki te pāngia e te AD, me aha koe?
Me whai wāhi koe me ō whanaunga ki te kite i ngā tohu o te AD. Ina tīmata koe ki te rongo i ngā tohu o te AD, noho ake ka tīmata te maimoatanga. Tērā pea ka hinga koe, ka whara koe, ka ngaro rānei te mārama, nō reira waea atu ki te āwhina. Ki te kore e kitea e koe te pūtake, ki te kore rānei te maimoatanga tika e āwhina, me waea atu tetahi ki te 119 (ki te nama ohorere tika rānei). He mea nui hoki kia mau tonu he Kete Maimoatanga Ohorere ki a koe, mēnā kua tohua e tō tākuta, me tētahi pepa kōrero kei roto ngā mōhiohio mō te AD. Ka āwhina tēnei ahakoa te hunga kāore i te mōhio ki te AD. Mēnā kua pāngia koe e ngā tohu o te AD i mua, me whakamōhio atu koe ki ō tākuta katoa, ki ō kaitiaki, me ō whanaunga mō tō āhua. Kia mōhio ai rātou mēnā ka puta anō, ahakoa kāore he wā ki te tono āwhina. Kia maumahara hei whakarāpopototanga
He āhuatanga mōrearea te autonomic dysreflexia (AD). Engari ko te rongo pai ka taea te rongoā – mā te tango, te whakarerekē rānei i te pūtake. Mena kei te mōrearea koe ki te whakawhanake i te AD, he mea nui kia ako koe me ō whanaunga i ngā mea katoa e taea ana e koe mōna. Kātahi ka taea e koe te mōhio ki ngā tohu me te whiwhi maimoatanga tere mō te AD. Kōrero ki tō rōpū hauora mō ngā huarahi hei karo i ngā pūtake. Kei te rite rātou ki te āwhina i a koe. Kia maumahara, ehara tēnei i te mea hei wehi, ko te mōhio te parenga nui rawa atu!
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