Iqoqo le-Cerebrospinal fluid (CSF)

Iqoqo le-Cerebrospinal fluid (CSF) isivivinyo sokubheka uketshezi oluzungeze ubuchopho nomgogodla.

I-CSF isebenza njengomqamelo, ivikela ubuchopho nomgogodla ekulimaleni. Uketshezi kuvame ukucaca. Inokufana okufanayo namanzi. Isivivinyo sisetshenziselwa ukukala ingcindezi kulwelo lomgogodla.

Kunezindlela ezahlukahlukene zokuthola isampula le-CSF. Ukubhoboza i-Lumbar (umpompi womgogodla) kuyindlela ejwayelekile kakhulu.

Ukuhlolwa:

• Uzolala ngohlangothi ngamadolo akho adonswe abheke esifubeni, bese kuthi isilevu sibheke phansi. Kwesinye isikhathi isivivinyo senziwa sihleli, kepha sigobele phambili.
• Ngemuva kokuhlanzwa kwangemuva, umhlinzeki wezokunakekelwa kwempilo uzojova umuthi wendawo obandayo (izinzwa) emgogodleni ongezansi.
• Kuzofakwa inaliti yomgogodla.
• Ukucindezelwa kokuvula kwesinye isikhathi kuyathathwa. Ukucindezela okungavamile kungasikisela ukutheleleka noma enye inkinga.
  
• Lapho inaliti isimile, ingcindezi ye-CSF iyalinganiswa bese kuthi isampula le-1 kuye kwayi-10 milliliters (mL) le-CSF liqoqwe ngezimbiza ezine.
• Inaliti iyasuswa, indawo iyahlanzwa, kubekwe nebhandishi ngaphezu kwendawo yesinaliti. Ungacelwa ukuthi uhlale ulele phansi isikhashana ngemuva kokuhlolwa.

Kwezinye izimo, ama-x-ray akhethekile asetshenziselwa ukusiza ukuqondisa inaliti endaweni. Lokhu kubizwa nge-fluoroscopy.

Ukubhoboza i-lumbar ngokuqoqwa kuketshezi nakho kungaba yingxenye yezinye izinqubo ezifana ne-x-ray noma i-CT scan ngemuva kokuthi kufakwe idayi ku-CSF.

Imvamisa, ezinye izindlela zokuqoqwa kwe-CSF zingasetshenziswa.

• Ukubhoboza emgodini kusebenza inaliti ebekwe ngaphansi kwethambo le-occipital (emuva kogebhezi). Kungaba yingozi ngoba kuseduze kakhulu nesiqu sobuchopho. Kwenziwa njalo nge-fluoroscopy.
• Ukuphonswa kwe-ventricular kunganconywa kubantu abane-herniation yobuchopho engenzeka. Le yindlela engasetshenziswa kakhulu. Kuvame ukwenziwa egumbini lokuhlinza. Kubhobozwa imbobo ogebhezini, bese kufakwa inaliti ngqo komunye wemiphetho yobuchopho.

I-CSF nayo ingaqoqwa kusuka kushubhu esivele ibekiwe oketshezini, njenge-shunt noma i-ventricular drain.

Uzodinga ukunika ithimba lezempilo imvume yakho ngaphambi kokuhlolwa. Tshela umhlinzeki wakho uma ukuyo noma iyiphi i-aspirin noma yimuphi omunye umuthi wokunciphisa igazi.

Ngemuva kwenqubo, kufanele uhlele ukuphumula amahora amaningana, noma ngabe uzizwa uphilile. Lokhu kwenzelwa ukuvimbela uketshezi ekuvuzeni eduze kwesiza sokubhoboza. Awudingi ukulala phansi emhlane wakho sonke isikhathi. Uma uba nekhanda, kungasiza ukuphuza iziphuzo ezine-caffeine ezifana nekhofi, itiye noma isoda.

Kungaba ukungakhululeki ukuhlala usesimweni sokuhlolwa. Ukuhlala unganyakazi kubalulekile ngoba ukunyakaza kungaholela ekulimaleni komgogodla.

Ungatshelwa ukuthi ulungise ukuma kwakho kancane ngemuva kokuthi inaliti isendaweni. Lokhu ukusiza ukukala ingcindezi ye-CSF.

I-anesthetic izoluma noma ishise lapho ijojowe okokuqala. Kuzoba nokuzwa kwengcindezi kanzima lapho inaliti ifakiwe. Imvamisa, kuba nobuhlungu obuthile lapho inaliti idlula kwezicubu ezizungeze umgogodla. Lobuhlungu kufanele bume ngemizuzwana embalwa.

Ezimweni eziningi, inqubo ithatha cishe imizuzu engama-30. Izilinganiso zangempela zengcindezi kanye nokuqoqwa kwe-CSF kuthatha imizuzu embalwa kuphela.

Lokhu kuhlolwa kwenziwa ukukala izingcindezi ngaphakathi kwe-CSF nokuqoqa isampula loketshezi ukuze liqhubeke nokuhlolwa.

Ukuhlaziywa kwe-CSF kungasetshenziselwa ukuxilonga ukuphazamiseka okuthile kwe-neurologic. Lokhu kungafaka ukutheleleka (okufana ne-meningitis) nomonakalo wobuchopho noma umgogodla. Umpompi womgogodla ungenziwa futhi ukuthola ukutholakala kwengcindezi ejwayelekile ye-hydrocephalus.

Amanani ajwayelekile ngokuvamile ahluka ngokulandelayo:

• Ingcindezi: 70 kuya ku-180 mm H₂O
• Ukubukeka: kucacile, akunambala
• Amaprotheni aphelele we-CSF: 15 kuye ku-60 mg / 100 mL
• IGamma globulin: 3% kuye ku-12% wamaprotheni esewonke
• I-CSF glucose: 50 kuya ku-80 mg / 100 mL (noma ngaphezulu kwezingxenye ezimbili kwezintathu zezinga likashukela egazini)
• Ukubalwa kwamaseli e-CSF: amaseli egazi amhlophe angama-0 kuye kwangama-5 (wonke ayingqamuzana lenyoni), futhi awekho amaseli abomvu egazi
• I-chloride: 110 kuya ku-125 mEq / L

Ububanzi bamanani ajwayelekile bungahluka kancane phakathi kwamalabhorethri ahlukene. Khuluma nomhlinzeki wakho mayelana nencazelo yemiphumela yakho ethile yokuhlolwa.

Izibonelo ezingenhla zibonisa izilinganiso ezivamile zemiphumela yalezi zivivinyo. Amanye ama-laboratories asebenzisa izilinganiso ezahlukahlukene noma angahlola izinhlobo ezahlukene.

Uma i-CSF ibukeka inamafu, kungasho ukuthi kukhona ukutheleleka noma inqwaba yamaseli amhlophe egazi noma amaprotheni.

Uma i-CSF ibukeka inegazi noma ibomvu, kungaba uphawu lokopha noma ukuvinjelwa kwentambo yomgogodla. Uma inombala onsundu, owolintshi, noma ophuzi, kungaba uphawu lokunyuka kweprotheni le-CSF noma ukopha kwangaphambilini (ngaphezulu kwezinsuku ezi-3 ezedlule). Kungaba negazi kusampula elivela empompini womgogodla uqobo. Lokhu kwenza kube nzima ukutolika imiphumela yokuhlolwa.

Ukucindezela kwe-CSF

• Ukwanda kwengcindezi ye-CSF kungabangelwa ukwanda kwengcindezi yangaphakathi (ingcindezi ngaphakathi kogebhezi).
• Ukwehla kwengcindezi ye-CSF kungahle kube ngenxa yokuvinjelwa komgogodla, ukuphela kwamanzi emzimbeni, ukuquleka, noma ukuvuza kwe-CSF.

I-CSF PROTEIN

• Ukwanda kwamaprotheni we-CSF kungahle kube ngenxa yegazi ku-CSF, isifo sikashukela, i-polyneuritis, isimila, ukulimala, noma yisiphi isimo sokuvuvukala noma esithathelwanayo.
• Ukwehla kwamaprotheni kuyisibonakaliso sokukhiqizwa okusheshayo kwe-CSF.

CSF GLUCOSE

• Ukwanda kwe-CSF glucose kuwuphawu lukashukela egazini.
• Ukwehla kwe-CSF glucose kungaba ngenxa ye-hypoglycemia (ushukela ophansi wegazi), ukutheleleka kwamagciwane noma isikhunta (njenge-meningitis), isifo sofuba, noma ezinye izinhlobo ezithile ze-meningitis.

AMANGQAMUZANA EGAZI KU-CSF

• Ukwanda kwamaseli amhlophe egazi ku-CSF kungaba luphawu lwe-meningitis, ukutheleleka okunamandla, ukuqala kokugula okuhlala isikhathi eside (okungapheli), isimila, ithumba, noma isifo esidiliza (njenge-multiple sclerosis).
• Amaseli egazi abomvu kusampula le-CSF angaba wuphawu lokopha emthonjeni womgogodla noma umphumela wesigaxa esibuhlungu se-lumbar.

Eminye imiphumela ye-CSF

• Ukukhuphuka kwamazinga e-CSF gamma globulin kungahle kube ngenxa yezifo ezinjenge-multiple sclerosis, i-neurosyphilis, noma i-Guillain-Barré syndrome.

Izimo ezingeziwe lapho ukuhlolwa kungenziwa khona:

• I-polyneuropathy engapheli yokuvuvukala
• Ukuwohloka komqondo ngenxa yezimbangela ze-metabolic
• I-Encephalitis
• Isifo sokuwa
• Ukubanjwa kwe-Febrile (izingane)
• Ukubanjwa okujwayelekile kwe-tonic-clonic
• IHydrocephalus
• Ukuhogela i-anthrax
• Ingcindezi ejwayelekile i-hydrocephalus (NPH)
• Isimila sesibeletho
• I-Reye syndrome

Izingozi zokubhoboza i-lumbar zifaka:

• Ukopha emgodini womgogodla noma nxazonke zobuchopho (i-subdural hematomas).
• Ukungakhululeki ngesikhathi sokuhlolwa.
• Ukuphathwa yikhanda ngemuva kokuhlolwa okungathatha amahora noma izinsuku ezimbalwa. Kungasiza ukuphuza iziphuzo ezine-caffeine ezifana nekhofi, itiye noma i-soda ukusiza ukudambisa ikhanda. Uma ukuphathwa ikhanda kuhlala ngaphezu kwezinsuku ezimbalwa (ikakhulukazi lapho uhleli, ume noma uhamba ngezinyawo) ungahle ube nokuvuza kwe-CSF. Kufanele ukhulume nodokotela wakho uma lokhu kwenzeka.
• Impendulo ye-Hypersensitivity (allergen) ku-anesthetic.
• Ukutheleleka okwethulwa yinaliti edlula esikhunjeni.

Ukuqothulwa kobuchopho kungenzeka uma lokhu kuhlolwa kwenziwa kumuntu onesisindo ebuchosheni (njengesimila noma ithumba). Lokhu kungaholela ekulimaleni kwengqondo noma ekufeni. Lokhu kuhlolwa akwenziwa uma ukuhlolwa noma ukuhlolwa kuveza izimpawu zobunzima bobuchopho.

Ukulimala kwezinzwa ezisentanjeni yomgogodla kungenzeka, ikakhulukazi uma umuntu ehamba ngesikhathi sokuhlolwa.

Ukubhoboza komgogodla noma ukubhoboza i-ventricular kuthwala ubungozi obengeziwe bokulimala kobuchopho noma komgogodla nokopha ngaphakathi kobuchopho.

Lokhu kuhlolwa kuyingozi kakhulu kubantu abane:

• Isigaxa esingemuva kobuchopho esicindezela phansi ku-brainstem
• Izinkinga zokuvala igazi
• Inani eliphansi leplatelet (thrombocytopenia)
• Abantu abathatha izinciphisi zegazi, i-aspirin, i-clopidogrel, noma ezinye izidakamizwa ezifanayo ukunciphisa ukwakheka kwamahlule egazi.

Thepha umgogodla; Ukubhoboza umoya; Ukubhoboza i-lumbar; Ukubhoboza amanzi emgodini; Isiko le-Cerebrospinal fluid

• I-CSF chemistry
• Ama-vertebrae emilenzeni

UDeluca GC, uGriggs RC. Indlela eya esigulini esinesifo se-neurologic. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 368.

U-Euerle BD. Ukubhoboza umgogodla nokuhlolwa koketshezi lwe-cerebrospinal. Ku: Roberts JR, Custalow CB, Thomsen TW, ama-eds. Izinqubo Zomtholampilo zikaRoberts noHedges ku-Emergency Medicine kanye ne-Acute Care. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2019: isahluko 60.

IRosenberg GA. I-edema yobuchopho nokuphazamiseka kokujikeleza kwe-cerebrospinal fluid. Ku: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, ama-eds. I-Neurology kaBradley ekwenziweni kwemitholampilo. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 88.