Wake wezwa ngomuntu olimale umgogodla ngokuzumayo eba
nomfutho wegazi ophakeme, ikhanda elibuhlungu elinzima, nezinye izimpawu? Lesi yisimo esizokhuluma ngaso namuhla, esibizwa ngokuthi i-Autonomic Dysreflexia, noma i-AD ngamafuphi. Ungakhathazeki, uma ukwazi lokhu, ungakwazi ukukulawula.
Kuyini i-AD?
Kalula nje, i-Autonomic Dysreflexia (AD) iyindlela engavamile, enzima kakhulu ohlelweni lwezinzwa olulawula eminye yemisebenzi ezenzakalelayo yomzimba wakho (sikubiza ngokuthi i-Autonomic
Nervous System ). Kufana nokushaqeka okukhulu entweni encane. Lokhu
kuvame ukubonakala kubantu abaye balimala emgogodleni, emgogodleni ngaphakathi komgogodla . Le ngozi iphakeme uma kukhona umonakalo esifubeni esingaphezulu, sithi izinga le-T6 (i-Sixth Thoracic Vertebrae) noma ngaphezulu. Manje ungase uzibuze ukuthi lo mgogodla wesifuba uyini. Okungukuthi, ingxenye ephakathi yomgogodla wethu. Lena yingxenye ende kakhulu kusukela entanyeni kuya ekugcineni kwezimbambo. Inama-vertebrae angu-12, T1 kuya ku-T12. Uphawu oluyinhloko lwe-AD
ukwanda okungazelelwe komfutho wegazi ( umfutho wegazi ophakeme ) . Kanye nalokhu, ikhanda elibuhlungu elibi nalo liyisibonakaliso esikhulu. I-AD ivame ukuvela okokuqala ezinyangeni ezimbili kuya kwezintathu ngemuva kokulimala komgogodla futhi ukushaqeka okubangelwa yiyo (Spinal Shock, Neurogenic Shock) sekuphelile. Abantu abaningi bangabhekana nalesi simo izikhathi eziningana empilweni yabo. Abanye abantu, ikakhulukazi labo abanomonakalo ongaphezu kwezinga le-T6, kuthiwa babhekana nakho izikhathi ezifika kwezingama-40 ngosuku. Le AD ibizwa nangamanye amagama amaningana, futhi udokotela wakho angase ayibize ngelinye lala magama: I-Autonomic Hyperreflexia, I-Hypertensive
Autonomic Crisis, i-Sympathetic Hyperreflexia.
Ake sifunde kancane ngeSistimu yethu Yezinzwa Ezimele.
Kulungile, manje ake sibheke ukuthi iyini le-Autonomic Nervous System. Lena yingxenye yomzimba wethu elawula izinto eziningi ngaphandle kokuthi sicabange ngazo. Izinto ezifana nokuphefumula,
ukushaya kwenhliziyo ,
umfutho wegazi , kanye nokugaya ukudla. Lokhu kufana nesistimu yomzimba wethu ezenzakalelayo. Kunezingxenye ezintathu eziyinhloko zale sistimu yezinzwa ezizimele:
- Uhlelo Lwezinzwa Oluzwelanayo (SNS): Yilokhu okusilungiselela izimo eziphuthumayo nezingozi. Luhlelo oluqala impendulo 'yokulwa noma ukubaleka'.
- Isistimu Yezinzwa Ene-Parasympathetic (PNS): Lokhu kwenza okuphambene nalokho okwenziwa yi-sympathetic. Okusho ukuthi, kuthulisa umzimba futhi kusiza ngenqubo 'yokuphumula nokugaya'.
- Isistimu Yezinzwa Yamathumbu (ENS): Yilokhu okulawula ngokuyinhloko inqubo yethu yokugaya ukudla.
I-AD ikhula kanjani?
Manje ake sibheke ukuthi kwenzekani uma uba ne-AD. Uma umgogodla wakho wonakele, ngaphansi kwendawo yokulimala, uhlelo lwakho lwezinzwa oluhambisana nozwela (SNS) luyasebenza. Njengokungathi i-SNS iphendula ngokuthi usengozini. Ngenxa yalokho, imithambo yegazi emzimbeni wakho ongezansi (njengemilenze yakho, isisu) iyancipha (lokhu kubizwa ngokuthi i-vasoconstriction). Lokhu kubangela ukuthi umfutho wegazi wakho ukhuphuke ngokuzumayo. Ngokuvamile, lapho umfutho wegazi wakho ukhuphuka kanje, uhlelo lwakho lwezinzwa oluhambisana nozwela (PNS) luyasebenza, lukhulise imithambo yegazi (lokhu kubizwa ngokuthi i-vasodilation), lubuyisele umfutho wegazi wakho esimweni esijwayelekile. Sibiza le nqubo ngokuthi i-baroreflex. Kodwa-ke, kumuntu olimale umgogodla, lo myalezo we-parasympathetic awukwazi ukuhamba wehle usuka endaweni yokulimala. Ngakho-ke, okwenzekayo ukuthi imithambo yegazi ikhula kuphela engxenyeni engenhla yomzimba (ngaphezu kwendawo yokulimala). Yingakho, ngenxa yokuthi imithambo yegazi engxenyeni engezansi yomzimba iyaqhubeka nokuncipha (ngenxa yesenzo se-SNS), umfutho wegazi uhlala uphezulu ngendlela eyingozi.
Kubalulekile ukuqonda lokhu: Yingakho umuntu one-AD engase abe nezimpawu ezahlukene ezingxenyeni ezahlukene zomzimba wakhe ngesikhathi esisodwa. Isibonelo, isikhumba esingaphezu kwezinga lesilonda (njengobuso, intamo, nezingalo) singase sibe bomvu futhi sijuluke. Kodwa-ke, isikhumba esingaphansi kwesilonda (njengesisu esingezansi nemilenze) singase sibe mhlophe, sibande, futhi somile.
Ubani onamathuba amaningi okuthola i-AD?
Uma ubheka ukuthi obani abathola i-AD kakhulu, yilabo abanomonakalo womgogodla
ezingeni le-T6 noma ngaphezulu kwalo (i-vertebra yesithupha yesifuba) . Kodwa akubona bonke abantu abawutholayo. Uyazi, umgogodla wethu ufana nendlela ethwala imiyalezo evela ebuchosheni kuwo wonke umzimba. Ivikelwe amathambo omgogodla (amathambo angemuva). Ngokuvamile, ukulimala komgogodla kwenzeka engozini, lapho lomgogodla uphulwa ukushaywa okunamandla. Khona-ke amathambo aphukile acindezela umgogodla, onakalise imizwa kuleyo ndawo.
Ingozi yokuthola i-AD iyanda ngokwezinga lomonakalo womgogodla kanye nokuthi umonakalo unzima kangakanani (njengokuqhekeka ngokuphelele). Kulinganiselwa ukuthi cishe abantu abangu-90% abanokulimala komgogodla emgogodleni wesibeletho noma emgogodleni ophakeme wesifuba bazoba ne-AD. Ngaphezu kwalokho, abesifazane abakhulelwe abanokulimala komgogodla ku-T6 noma ngaphezulu basengozini enkulu yokuthola i-AD ngesikhathi sokubeletha. Ngakho-ke, lokhu kufanele kucatshangelwe. Ziyini izimpawu ze-AD?
Izimpawu ze-AD zingahluka kancane kumuntu nomuntu, kodwa zivame ukuvela ngokuzumayo. Uphawu lokuqala olukhulu ikhanda elibuhlungu elibuhlungu kakhulu. Lokhu kubangelwa ukwenyuka okukhulu kwengcindezi yegazi ngokuzumayo. Ngaphezu kwalokho, i-AD ingadala nezimpawu ezilandelayo:- Ukujuluka ngokweqile okungaphezu kwezinga lobuhlungu emhlane.
- Ukushaya kwenhliziyo okuhamba kancane kunokujwayelekile (lokhu kubizwa ngokuthi i-bradycardia).
- Ukubomvu kwesikhumba ngaphezu kwesilonda emhlane kanye nesikhumba esikhanyayo, esomile ngaphansi kwesilonda.
- Ubuhlungu bomhlane bubangelwa yizinhlungu zomzimba.
- Isikhumba esibandayo.
- Ukuminyana kwamakhala.
- Isicanucanu, ukuhlanza.
- Umbono ofiphele.
- Ukuzizwa ukhathazekile kakhulu futhi wesaba.
Okubalulekile: Uma uhlangabezana nalezi zimpawu, kubaluleke kakhulu ukufuna iseluleko sezokwelapha ngokushesha okukhulu. Lokhu kungaba yisimo esiphuthumayo.
Ziyini izimbangela ze-AD?
Imbangela eyinhloko ye-AD ukulimala komgogodla esesixoxe ngakho. Uhlelo lwezinzwa oluzimele lwabantu abane-AD lusabela ngokweqile ezintweni ezithile. Ngokuvamile, lapho umzimba uzwa isikhuthazo esiyingozi ngaphansi kwezinga lokulimala komgogodla, uhlelo lwezinzwa oluzwelayo luba lusebenza kakhulu, okubangela inani elikhulu lemithambo yegazi ukuba linciphe (vasoconstriction). Lesi 'sikhuthazo esiyingozi' yinoma yini elimaza izicubu futhi ingabangela ubuhlungu, kodwa ngezinye izikhathi ubuhlungu abuzwakali. Kungaba yinoma yini kusukela ekulumeni ongakwazi ukuklwebha kuya esinyini esigcwele. Ngaphandle kokulimala komgogodla, kunezinye izimo ezingadala i-AD, kodwa azivamile kakhulu:- I-Intramedullary Astrocytoma - Umdlavuza wesimiso sezinzwa esiyinhloko.
- I-Multiple Sclerosis (MS).
- I-Guillain-Barré Syndrome.
- Imiphumela emibi yemithi ethile.
- Ukulimala okukhulu ekhanda kanye nezinye izinkinga zobuchopho.
- Ukopha kwegazi okungaphansi kwe-Subarachnoid (SAH) - ukopha ebuchosheni.
- Ukusetshenziswa kwezidakamizwa ezivuselelayo ezingekho emthethweni njenge-cocaine nama-amphetamine.
Izimbangela ze-AD
Uma usengozini yokuthola i-AD, kubalulekile ukuqaphela izinto ezingadala lesi simo. Ngale ndlela, ungazigwema futhi uzelaphe ngokushesha uma kuvela izimpawu ze-AD. I-AD ivame ukubangelwa izinkinga ezihlobene nalokhu:- Isinye.
- Amathumbu (lokho kusho amathumbu).
- Isikhumba.
Izimbangela ezihlobene nesinyi
Izinkinga zesinyi ziyimbangela ehamba phambili ye-AD - zibangela cishe u-85% wamacala e-AD. Ngokuvamile, imbangela iwukuvinjelwa kwendlela umchamo wakho ogeleza ngayo, okwenza isinyi sakho sigcwale kakhulu (Ukuvuleka kwesinyi). Lokhu kungabangelwa yi:- Uma ufake i-catheter ye-Foley, ingase iqhekezeke noma ivaleke.
- Ukuqaqamba kwesinyi.
- Amatshe esinyini.
- Ukutheleleka Kwendlela Yomchamo (UTIs).
Ngezinye izikhathi, ukuhlolwa okufana ne-cystoscopy noma ukuhlolwa kwe-urodynamic nakho kungabangela i-AD. Izimbangela ezihlobene nomathumbu amakhulu
Ithumbu elikhulu, noma amathumbu, liyimbangela yesibili evame kakhulu ye-AD. I-AD ingenzeka uma amathumbu enwebeka kakhulu. Izizathu zalokhu yilezi:- Ukushaywa yindle.
- Ukuqunjelwa.
- Ukuqunjelwa, ukuqunjelwa.
- Ama-enema.
- Ukuzikhulula ngesandla.
Nezinye izifo ezithelelanayo emathunjini, isibonelo:- Uhudo.
- I-Diverticulitis.
- Isifo sikaCrohn.
- Imifantu yendunu.
- Ama-hemorrhoids.
Izinto ezinjengalezi zingase zibangele i-AD. Izimbangela ezihlobene nesikhumba
Izinkinga zesikhumba ziyimbangela yesithathu evame kakhulu ye-AD. Kunezimbangela eziningana ezingaba khona:- Ukulimala kwengcindezi / i-Bedsore.
- Ukusikeka, imihuzuko.
- Ukuqubuka kwesikhumba.
- Izingubo ziyaqina, ziyabamba, ziba zinkulu kakhulu.
- Ukulunywa okungenakuzwakala noma ukuklwebheka.
- Izinzipho zezinyawo ezikhule ngaphakathi.
Wazi kanjani ukuthi une-AD?
Akukho ukuhlolwa okukodwa okungahlonza i-AD ngokuphelele. Ngakho-ke, odokotela nalabo abakunakekelayo bazosekela ukuxilongwa kwabo kulokhu okulandelayo:- Umlando wakho wezokwelapha , ikakhulukazi ulwazi mayelana nokulimala emhlane.
- Umfutho wegazi wakho wamanje uqhathaniswa nomfutho wegazi wakho ojwayelekile. Ngokuvamile, uma umfutho wegazi wakho we-systolic ungaphezu kuka-150 mmHg, noma cishe u-40 mmHg uphakeme kunezinga lakho elijwayelekile, kubhekwa njengophawu lwe-AD.
- Izimpawu , ikakhulukazi ikhanda elibuhlungu kakhulu.
Uma unezimpawu ze-AD kodwa ucabanga ukuthi awunalo ukulimala komgogodla, udokotela wakho angase afune ukwenza ukuhlolwa okugcwele kwesimiso sakho sezinzwa futhi enze ezinye izivivinyo ukuthola imbangela yezimpawu zakho. Lokhu kungafaka:- Ukuhlolwa kwegazi nomchamo.
- I-CT scan (CT - I-Computed Tomography scan) noma i-MRI scan (MRI - I-Magnetic Resonance Imaging scan).
- I-ECG (i-Electrocardiogram - i-EKG).
- Ukubhoboza umgogodla/umgogodla.
- Ukuhlolwa kwetafula elithambekile.
- Ukuhlolwa kwezidakamizwa.
- Ama-X-ray.
Iphathwa kanjani i-AD?
Isinyathelo sokuqala ekwelapheni i-AD ukuba isiguli silale phansi, sehlise imilenze yaso, futhi sikhiphe noma yiziphi izingubo ezisibambayo. Lokhu kusiza ukwehlisa umfutho wegazi. Ezimweni eziningi, i-AD iyaphela uma i-trigger isusiwe. Ngakho-ke, isinyathelo esilandelayo ukuhlonza nokususa i-trigger, uma kungenzeka, ngaphambi kokunikeza imithi. Isibonelo, nazi ezinye izinto udokotela wakho noma umnakekeli angayenza ukuze ahlonze futhi alungise i-trigger:- Ukuhlola ukuthi umchamo ugeleza kahle yini, noma ukuwulungisa.
- Uma othile ene-catheter ye-Foley, hlola noma yikuphi ukuvinjelwa noma amaphutha bese uwalungisa.
- Ukuhlola isampula yomchamo ukuze kubonakale ukuthi kukhona yini ukutheleleka komgudu womchamo (i-UTI), futhi uma kunjalo, ukunikeza ama-antibiotic.
- Hlola i-rectum ukuze ubone ukuthi kukhona yini ukushaywa yindle, futhi uma kunjalo, susa indle.
Abantu abaningi abanolwazi nge-AD bayazi kahle lokhu futhi bakulungele ukusebenzisa uhlelo lokwelashwa. Esimweni esiphuthumayo: Uma imbangela ingatholakali, futhi izinyathelo eziyisisekelo zingawehlisi umfutho wegazi, ukwelashwa okuphuthumayo kuyadingeka ukuze kwehliswe umfutho wegazi. Esimweni esinjalo, shayela ku-119 (noma inombolo ephuthumayo efanele), noma ufune usizo lwezokwelapha ngokushesha.
Uzobe usunikezwa imithi esebenza ngokushesha njenge-nitrate, i-hydralazine, i-labetalol, noma i-nifedipine ukuze wehlise umfutho wegazi lakho. Ngesikhathi sokwelashwa, ithimba lakho lezokwelapha lizoqapha izimpawu zakho ezibalulekile futhi lihlole umfutho wegazi lakho njalo. Ingabe i-AD ingavinjelwa?
Akunakwenzeka njalo ukuvimbela i-AD. Kodwa-ke, uma unesifo somgogodla, ikakhulukazi esingaphezu kwezinga le-T6, lezi zinto zingasiza ukuvimbela i-AD:- Ukuthulula isinyi njalo nokuqaphela ukuthi singasivumeli sigcwale.
- Ukuphatha ubuhlungu.
- Ukunakekela amathumbu akho kubalulekile ekuvimbeleni ukuvaleka kwendle nokuqunjelwa.
- Ukunakekela isikhumba sakho ngendlela efanele kubalulekile ekuvimbeleni izilonda zombhede kanye nezifo zesikhumba.
- Ukuvimbela izifo zomgudu womchamo (UTIs).
Sizoba njani isimo se-AD? (Outlook)
Isibikezelo se-AD ngokuvamile sihle, kodwa kuphela uma lezi zinto zenzeka:- Uma wena, umnakekeli wakho, noma ithimba lakho lezokwelapha nikubona lokhu kusenesikhathi.
- Uma ukwelashwa okuphuthumayo kuqaliswa ngokushesha.
- Uma wena kanye/noma abanakekeli bakho ninolwazi oluhle ngezimpawu kanye nezimbangela ze-AD.
- Uma wena, umnakekeli wakho, noma ithimba lakho lezokwelapha nithatha izinyathelo ezifanele zokuvimbela i-AD.
Kodwa-ke, izimo ze-AD ezimbi kakhulu ezingelashwa ngokushesha nangendlela efanele zingaba nemiphumela emibi kakhulu. Isibonelo:- Ukulimala kobuchopho okubangelwa umfutho wegazi ophakeme (i-Hypertensive Encephalopathy).
- Isifo sohlangothi.
- Ukuboshwa kwenhliziyo.
- Ukuquleka.
- Ukufa.
Ngenhlanhla, ukufa okubangelwa yi-AD akuvamile kakhulu. Uma usengozini yokuthola i-AD, yini okufanele uyenze?
Wena nabathandekayo bakho kudingeka nihlanganyele ekuboneni izimpawu ze-AD. Uma nje uqala ukuzwa izimpawu ze-AD, hlala phansi bese uqala ukwelashwa. Ungase uwe, uzilimaze, noma ulahlekelwe ingqondo, ngakho shayela usizo. Uma ungakwazi ukuthola imbangela, noma uma ukwelashwa okufanele kungasizi, othile kufanele ashayele ku-119 (noma inombolo efanele yezimo eziphuthumayo). Kubalulekile futhi ukugcina i-Emergency Treatment Pack nawe, uma udokotela wakho ekunikezile, kanye nencwajana enolwazi mayelana ne-AD. Lokhu kuzosiza ngisho nalabo abangazi nge-AD. Uma uke waba nezimpawu ze-AD ngaphambili, kufanele wazise bonke odokotela bakho, abanakekeli, kanye nabathandekayo bakho ngesimo sakho. Ukuze uma kwenzeka futhi, bazi, noma ungenaso isikhathi sokucela usizo. Khumbula njengesifinyezo
I-Autonomic dysreflexia (AD) yisimo esingasongela impilo. Kodwa izindaba ezinhle ukuthi singelashwa - ngokuvamile ngokususa noma ngokushintsha i-trigger. Uma usengozini yokuthola i-AD, kubalulekile ukuthi wena nabathandekayo bakho nifunde konke eningakwenza ngayo. Ngemuva kwalokho ningakwazi ukubona izimpawu futhi nithole ukwelashwa kwe-AD ngokushesha. Khuluma nethimba lakho lezokwelapha ngezindlela zokugwema izimbangela. Bakulungele ukukusiza. Khumbula, lokhu akusikho okufanele ukwesabe, ukuqwashisa kuyisivikelo esikhulu kunazo zonke!
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