Kua pāngia koe e te mamae upoko ohorere, kino rawa atu, me te mea he uira e pā ana ki tōu mahunga? He tokomaha e kī ana ko "te mamae upoko kino rawa atu kua pā ki a koe." Kaua rawa e whakahaweatia te mamae upoko ohorere, kino rawa atu pēnei. He tohu pea tēnei o te toto nui i roto i te roro. I tēnei rā, ka kōrero tātou mō tētahi o aua āhuatanga ohorere hauora, arā, te totohu subarachnoid (SAH).
He aha te Subarachnoid Hemorrhage (SAH)?
Āe, tera pea he ahua uaua tēnei ingoa, engari kia māmā noa iho. Kāore tō roro e noho noa ana i muri i tō mahunga. He mea tiaki e te hipoki kiko e toru ngā paparanga. I roto i ngā kupu hauora, ka kiia tēnei ko ngā meninges.
Whakaarohia he rite ki te riki. He kiri angiangi kei roto i te riki, ā, koinei te āhua o ēnei kiriuhi e karapoti ana i te roro.
1. Dura mater: Koinei te kiriuhi kaha, te mea o waho rawa e takoto ana i raro noa i te angaanga.
2. Ārākiō: Koinei te kiriuhi angiangi, rite ki te tukutuku pungawerewere i waenganui.
3. Pia mater: Koinei te kiriuhi o roto rawa e piri ana ki te kiko o te roro.
Nā, ko te wāhi i waenganui i te kiriuhi arachnoid i waenganui me te pia mater i te paparanga o roto rawa e kiia ana ko te 'wāhi Subarachnoid'. Ko te tikanga o te 'Sub' ko "i raro". Nō reira, e pā ana tēnei ki te wāhi i raro i te kiriuhi arachnoid. Mēnā he take, ka puta he toto ki roto i tēnei wāhi, koia te mea e kiia nei e tātou ko te Subarachnoid Hemorrhage (SAH) .
He āhuatanga ohorere hauora tino kino tēnei, he mea morearea ki te ora. Mēnā ka pāngia koe e ēnei tohu, me haere tonu koe ki te Tari Ohorere o te hōhipera (ETU).
He aha te rerekētanga i waenga i te SAH me te Subdural Hematoma?
Kua rongo pea koe i tētahi āhuatanga e kiia nei ko te 'Subdural Hematoma'. Ko ngā mea e rua he toto kei te rohe o te roro. Engari ko te rerekētanga kei te wāhi e puta ai te toto. Me whakamārama mārama tātou i tēnei.
| Āhuatanga | Te Toto o te Subarachnoid (SAH) | Hematoma o raro i te dural |
|---|---|---|
| Te pūwāhi toto | I raro i te kiriuhi arachnoid (i roto i te wāhi subarachnoid) | I raro i te dura mater (i te wāhi subdural) |
| Tohu matua | Te ānini o te whatitiri | Tērā pea ka piki haere te mamae o te upoko, ka pōhēhē, ka ngoikore pea. |
| He maha ngā wā ko te take | He pakaru o te aneurysm roro, he whara rānei o te upoko. | He uaua pakaru, e pā ana ki te whara o te upoko i te nuinga o te wā. |
He rite tonu ngā tohu o ngā āhuatanga e rua i ētahi wā. Ā, he āhuatanga ohorere ēnei e rua ka pā kino ki te roro. Nō reira, he mea nui kia rapu tohutohu hauora i te wā tonu ka puta mai ngā tohu.
Ko wai te mea tino tūpono ka pāngia e tēnei mate? He aha ngā āhuatanga mōrearea?
Ahakoa ka taea e te tangata katoa te pāngia e te toto toto iti i roto i te uaua ngākau (SUBARACHD), he mea tino noa tēnei i waenga i te hunga 40 me te 60 tau te pakeke .
Ko te SAH te mea tino puta mai i te whara o te upoko i roto i te hunga kaumātua. Ka puta pea tēnei ina hinga, ka pā te upoko. Mō te hunga rangatahi, ko ngā aituā waka te tino take.
Hei tāpiritanga, he maha atu anō ngā āhuatanga e whakanui ake ana i te mōrearea o te whakawhanake i te SAH. Kia titiro tātou he aha ēnei.
- Te whai i tētahi aneurysm kāore anō kia pakaru i roto i te roro, i tētahi atu wāhi rānei o te tinana: Ko te aneurysm he ngoikore o te pakitara o tētahi uaua toto e pupuhi ana pērā i te poihau. Ka taea tēnei te pakū i ngā wā katoa.
- He hītori o te pakaru o te aneurysm roro o mua.
- Te Momi hikareti: Ka tino kino te momi hikareti ki ngā uaua toto.
- Te toto toto tiketike (Total Pressure): Ka taea e te toto toto tiketike kāore e whakahaeretia te kino i ngā oko toto, ka piki ake te mōrearea o te hanganga me te pahūtanga o ngā aneurysms.
- Ētahi āhuatanga ira: Ngā mate e pā ana ki te kiko honohono, pērā i te Fibromuscular Dysplasia (FMD) me te Ehlers-Danlos syndrome.
- He mate tākihi polycystic tō tōu.
- Te whakamahinga o ngā raau taero: Ina koa ko ngā raau taero whakaohooho pēnei i te kōkaini me te methamphetamine.
- Te inu nui rawa o te waipiro.
- Te whakamahinga o ngā rongoā whakaiti toto: Hei tauira, Warfarin.
- He nui te hītori whānau o ngā aneurysms.
He aha ngā tohu o te SAH?
E ai ki tā tātou i kōrero ai i mua ake nei, ko te tohu matua me te tohu tino wawe ko te ānini ohorere, te mamae nui e kiia nei ko te "Ānini o te Whatu." Ka tino mamae tēnei i roto i ētahi hēkona ruarua.
Whakaarohia, kei te mahi koe i tāu mahi noa. Kāore he whakatūpato, kātahi ka pā mai he mamae nui ki tōu mahunga, me te mea kua pahū he poma i roto i a koe, kua whiua rānei koe e tetahi ki te hama. Koinei te āhua o tēnei.
Mena kei a koe tētahi, ētahi rānei o ngā tohu e whai ake nei me te mamae o te upoko pēnei, haere tonu ki te Tari Whawhati Tata o te hōhipera (ETU). Ehara tēnei i te mea e taea e koe te tatari noa i te kāinga.
| Kāwai tohu | Whakaahuatanga |
|---|---|
| Ngā raruraru e pā ana ki te hinengaro | Te hekenga o te hinengaro, te hiamoe, te ngaro o te aro ki ngā mea e tupu ana, te ngaro o te hinengaro. |
| Ngā āhuatanga ā-tinana | Whakapairuaki me te ruaki, te pakari o te kaki (te uaua ki te piko i te kaki), te ngoikore ohorere, te ngoikore o tetahi wāhanga o te tinana. |
| Ngā huringa hinengaro me ngā whanonga | Ngā huringa o te wairua me te tuakiri, te riri ohorere, me te ngaronga o te mahara. |
| Ngā raruraru tirohanga | Te aro nui ki te mārama kanapa (photophobia), te tirohanga takirua, ngā ira pango o te tirohanga, te ngaronga o te tirohanga mō te wā poto o te kanohi kotahi. |
| Ētahi atu āhuatanga | Pōuriuri, mamae uaua (ina koa ki te kaki me ngā pakihiwi), ngā haurangi. |
He aha ngā tino take o te SAH?
Kia titiro tātou ki ngā tino take o tēnei āhuatanga mōrearea.
- Ngā whara nui o te upoko: Ko te tino take o te SAH he whiu nui ki te upoko, pērā i te hinganga kino, i te aituā motuka rānei.
- Pakaru o te aneurysm: Koinei te take o te 85% o ngā SAH ka puta kāore he aituā. Ka pupuhi te wāhi ngoikore o te uaua toto i roto i te roro, pērā i te poihau, ā, ka pakū ohorere. Kātahi ka turuturu te toto ki te wāhi subarachnoid i raro i te pēhanga teitei.
- Ngā rerekētanga o ngā oko toto: Ka puta hoki te toto nā ngā āhuatanga e rarau ana ngā oko toto, pērā i te arteriovenous malformation (AVM).
- Ngā mate toto: Ngā āhuatanga e kore ai e ngawari te toto ki te toto.
- Te whakamahinga o ngā rongoā whakaheke toto.
- Te whakamahinga o ngā raau taero: Ka taea e ngā raau taero pēnei i te kōkaine te whakanui ake i te toto toto me te pakaru o ngā uaua toto.
Me pēhea te tautuhi a ngā tākuta i tēnei mate?
Ina haere koe ki te hōhipera me ēnei tohu, ka whakaarohia e ngā tākuta he āhuatanga ohorere, ā, ka tere te whakahaere i ngā whakamātautau.
1. Matawai CT (Matawai Tomography Rorohiko): Koinei te whakamātautau tuatahi, ā, ko te mea nui rawa atu. Ka tangohia ngā whakaahua o roto o te upoko, ā, ka kitea mārama mēnā he toto kei te taha o te roro. I ētahi wā ka mahia he matawai motuhake e kiia nei ko te CT Angiography (CTA). I roto i tēnei, ka werohia he tae ki roto i te uaua hei tirotiro i te āhua o ngā oko toto.
2. Te Werohanga o te Lumbar: I ētahi wā, kāore pea e kitea he toto iti noa iho i roto i te matawai CT. I ēnei wā, ka mahia tēnei whakamātautau e ngā tākuta. I roto i tēnei, ka werohia he ngira angiangi rawa ki roto i te tuara o raro, ā, ka tangohia he wai cerebrospinal (CSF) iti mai i te rohe huri noa i te roro me te taurakira. Ka tirohia te wai mō ngā toto whero, te xanthochromia rānei (te kōwhai). Ka huri te wai nei hei kōwhai i muri i te wā poto o te toto.
3. Matawai MRI (Whakaahua Āhua Aukume): Mena kei te whakapaehia he toto i puta tata nei, ka taea e tēnei whakamātautau te kite.
Kia whakaūtia te mate, ka taea te whakahaere i ētahi atu whakamātautau, pērā i te angiogram roro, hei whakatau i te tino pūtake o te toto.
Me pēhea te rongoā?
Nā te mea he mate mōrearea te SAH, ka whakaurua te tūroro ki te wāhanga tiaki nui (ICU) o te hōhipera, ā, ka rongoatia e te tīma tākuta he tohunga ki ngā mate pūnaha io. Ko ngā whāinga matua o te maimoatanga ko:
- Te whakaora i te ora o te tūroro.
- Whakatikahia te pūtake o te toto.
- Te whakahaere i ngā tohu.
- Te ārai i ngā raruraru (hei tauira, te vasospasm, te hydrocephalus).
Ngā maimoatanga hei whakaora i te ora me te whakahaere i ngā tohu:
- Te whakarato tautoko ora.
- Te whakauru i tētahi ngongo whakaheke toto hei whakaiti i te pēhanga i roto i te roro.
- Te mahi i ngā mahi hei tiaki i te ara manawa.
- Te hoatu rongoā IV (i roto i ngā uaua) hei whakahaere i te toto toto tiketike.
- Te hoatu rongoā hei ārai i te whakawhāititanga o ngā oko toto (vasospasm).
- Te hoatu i ngā rongoā whakamamae mamae me ngā rongoā ārai-manukanuka mō te ānini nui.
- Te hoatu rongoā hei ārai, hei whakahaere rānei i ngā haurangi.
Te rongoā i te pūtake o te toto:
- Mena kua pakaru te aneurysm: Ka mahia he pokanga hei whakatika. Ka taea tēnei mā te whakamahi i ngā tikanga pēnei i te 'Surgical Clipping' (te kati i te kaki o te aneurysm ki te topenga) te 'Endovascular Coiling' rānei (te kati i te aneurysm ki te koiri waea mā roto i te uaua toto).
- Mena kua kohia te toto nā tētahi aituā: Tērā pea me pokanga hei whakaiti i te pēhanga ki te roro, hei tango hoki i te toto kua kohia.
I te nuinga o te wā, me noho pea te tangata whai SAH ki te hōhipera mō te 10 ki te 20 rā, neke atu rānei, i runga i te āhua me ngā hiahia whakaora.
He aha ngā pānga me ngā raruraru mō te wā roa o tēnei mate?
He mate tino kino tēnei. E ai ki ngā tatauranga, tata ki te haurua o te hunga whai SAH ka mate ohorere. Mō te hunga e haere mai ana ki te hōhipera:
- Kotahi hautoru ka mate i te hōhipera.
- Kotahi i roto i te toru e ora ana me tētahi momo hauātanga.
- Kotahi hautoru te hokinga ki te oranga noa.
Ka taea e te SAH te whakararu i te roro, ka arahi pea ki ngā raruraru roa, tuturu rānei.
- Ngā raruraru tinana: Te ngenge tonu me te hiamoe, te ngoikore, te ngoikore rānei o ngā wāhanga o te tinana, te uaua ki te horomi, te ngaro o te taurite.
- Ngā raruraru hinengaro: ngā raruraru mahara, te uaua ki te arotahi, te uaua ki te whakamahere me te mahi i ngā mahi uaua.
- Ngā uauatanga ki te kōrero: te kōrero pōturi, te kōrero puhoi, te uaua ki te kimi i ngā kupu tika.
- Ngā raruraru hauora hinengaro: Nā te mea he whara nui tēnei i te ao, ka pā mai pea ngā āhuatanga pēnei i te pouri, te manukanuka whānui, me te mate ahotea muri i te whara (PTSD).
Hei whakahaere i ēnei raruraru mō te wā roa, ka taea e ngā maimoatanga pēnei i te whakaora tinana, te whakaora mahi, te whakaora kōrero, me te hinengaro whakaora te whakarato i te tino whakamarie.
He aha tā tātou e taea ai te whakaiti i te mōrearea?
I te mea ko ngā whara o te mahunga me te pakaru o te aneurysm ngā tino take o te SAH, he mea pai kia mahi i ngā mahi hei ārai i ēnei āhuatanga e rua.
Hei ārai i ngā whara o te upoko:
- Me mau tonu he potae i te wā e eke pahikara ana, e motopaika ana rānei, e takaro ana rānei i ngā hākinakina morearea.
- Kia haumaru te taraiwa, kia whai hoki i ngā ture huarahi.
- Ki te mea he maha āu hinganga, rapua he tohutohu mai i tētahi kaiwhakaora tinana, ā, akohia ngā huarahi hei ārai i ngā hinganga, hei whakarite hoki i tō kāinga kia haumaru ake.
Hei whakaiti i te mōrearea o te aneurysm:
- Whakahaerehia te toto toto tiketike. Tangohia tō rongoā kia rite ki te whakahau a tō tākuta. Hurihia te āhua noho (whakaitihia te tote, whakakori tinana).
- Kati rawa te momi hikareti.
- Whakakorikori tinana i ngā wā katoa, engari kaua e hiki i ngā mea taumaha i te wā kotahi, nā te mea ka pakaru pea te aneurysm i te nui rawa o te whakapau kaha.
- Kai i te kai taurite.
- Āta karohia te waipiro me te whakamahi i ngā raau taero, inā koa ngā mea whakaohooho pēnei i te kōkaini.
Mena kua kī atu tō tākuta he aneurysm tōu kāore anō kia pakaru, kōrero ki a ia mō ngā kōwhiringa maimoatanga me ngā tikanga whakahaere e wātea ana.
Karere Tangohia ki te Kāinga
- Ko te toto toto iti (subarachnoid hemorrhage - SAH) he toto e puta ana i waenganui i te roro me ngā kiriuhi e karapoti ana i te roro. He mate hauora tino kino tēnei, he mate ohorere.
- Ko te tohu matua he "mamae upoko pakū" ohorere, e kiia ana ko te mamae upoko kino rawa atu o tōku ao.
- Ki te pā mai ngā tohu pēnei i te whakapairuaki, te ruaki, te pakari o te kaki, me te ngaronga o te māramatanga me tēnei momo ānini, haere tonu ki te Tari Whawhati Tata o te hōhipera (ETU).
- Ko ngā tino take ko ngā whara o te mahunga me te pakaru o ngā aneurysms o te roro.
- Mā te whakahaere i te toto toto tiketike, te karo i te momi hikareti, me te karo i te whakamahi tarukino ka taea te whakaiti i te mōrearea.
- Mā te tautuhi wawe me te maimoatanga tika ka nui ake te tūponotanga o te whakaora ora me te whakaiti i ngā raruraru.
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