Ugusohoka amaraso mu bwonko, Ugusohoka kw’amaraso ku bikoresho bigabanya amaraso, n’uguhindura amaraso¶

Ugusohoka amaraso mu bwonko (ICH) ni ikibazo gikomeye cane c’ugubagwa kw’ubwonko n’ugutera ubwonko, aho umutsi ufise umukazo uca uca mu bwonko (parenchyme), ugasuka amaraso mu gipfukisho c’igihanga gikomeye. Naho indwara y’umutima iterwa n’amaraso itera hafi 15 gushika ku 20 kw’ijana vy’indwara zose z’umutima, iratuma hafi ica kabiri c’abantu bose bapfa kubera indwara y’umutima kandi iragwira ningoga kandi mu buryo buteye akaga mu masaha 1 canke 3 ya mbere inyuma y’aho itanguriye. Iyo umuntu afise ibimenyetso vy’indwara y’imitsi bitunguranye (ugutemba mu maso, ukuboko gugoyagoya, canke ukubura amajambo) biherekejwe n’ugufatwa n’umutwe cane, uguruka, umuvuduko w’amaraso uteye akaga, canke ukugabanuka ningoga kw’uburinzi, hamagara uwo mu karere iwanyu . inomero z'ivyihutirwa ubwo nyene. Mu gihe murindiriye abaganga, musubiremwo amategeko ajanye n’ivyihutirwa kw’igenekerezo rya 10.00. kwemera indwara y'umutima (FAST), amaraso ava munsi y'umutwe n'umutwe ubabazwa n'inkuba, na gusubira inyuma kw'imiti igabanya amaraso n'indwara zo kuva amaraso.

Kubera ko militiro yose y’amaraso yinjira mu bwonko imenagura amamiliyoni y’imitsi y’ubwonko kandi igatuma umuvuduko wo mu bwonko ushika ku gusenyuka kw’ubwonko, kurokoka imbere y’uko umuntu aja mu bitaro bivana n’ibintu bitatu bihambaye: kutigera utanga aspirine canke ikintu cose co gutuma amaraso agenda neza imbere y’uko umuntu akora CT scan y’ibitaro, gukingira inzira y’impwemu y’umutwe w’umuntu. kandi ubwo nyene ukabwira abaganga n’umugwi w’abaganga b’ibitaro vyihutirwa izina nyaryo n’igihe ca nyuma co gufata umuti uwo ari wo wose wo gukingira amaraso (warfarin, apixaban, rivaroxaban, edoxaban, canke dabigatran) kugira ngo imiti yo gusubiza amaraso mu mitsi ishobore gutegurwa imbere y’uko imodoka itwara abarwayi ishika.

Ivyo ubikore ubu¶

1. Hamagara inomero y’ivyihutirwa yo mu karere kawe ubwo nyene maze ukoreshe Stroke Alert. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu Bumwe bw’Uburayi bwose, 999 mu Bwongereza, 000 muri Australiya, canke urabe ububiko bwacu bwa inomero z'ivyihutirwa. Bwira uwurungitse neza: "Ikekwa ko ari indwara y'amaraso: gusenyuka bukwi na bukwi no kuvuga nabi n'umutwe n'uguruka."
2. NTUKIGEZE utanga aspirine, clopidogrel, ibuprofen, canke ikindi kintu cose co gutuma amaraso agenda neza. Bitandukanye n’indwara y’umutima aho umuntu asabwa gutagura aspirine, ntushobora kumenya ata gukeka 100 kw’ijana i muhira nimba indwara y’umutima iterwa n’ugutera amaraso (ischeturemorhacr) canke indwara y’umutima). Guha mbere n’urugero rumwe rw’imiti yitwa aspirine umurwayi afise amaraso ava mu bwonko, biratuma utugingo ngengabuzima two mu bwonko tudakora ubudasiba, kandi bikaba vyihuta kwaguka kw’amaraso yica imbere mu bwonko.
3. Menya umuti wose ugabanya amaraso (ugabanya amaraso canke ugabanya amaraso) umurwayi afata n’isaha nyayo y’imiti ya nyuma. Suzuma amacupa y’imiti canke imiringa y’imburi y’ubuvuzi ko ata warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (**Xarelto), rivaroxaban (**Xarelto), dabigatran (Pradaxa), enoksaparini (urukundo/ikileksane), canke klopidogreli (plavix). Ha abaganga bavuge izina nyaryo ry’umuti n’isaha ya nyuma y’imiti ku bitaro biwufata imbere y’uko ushika kugira ngo ivuriro rishobore kuvanga umuti wihariye wo gusubiza inyuma umuti (**Igitera Prothrombine y’Ibintu 4 [4F-PCC], Andexanet alfa, canke Idarucizumab in"de)
4. Ushire umurwayi umutwe n’umubiri wo hejuru biduzwe degre 30, ugumize izosi rigororotse mu murongo wo hagati (canke uzunguruke ku ruhande rwiwe iyo ariko araruha canke ataco azi). Iyo umuntu ari maso kandi akingira inzira y’impwemu yiwe, ushire umutwe wiwe n’ibitugu vyiwe hejuru ku **30-degree facing angle to siste, for the kinks the jugular veins) ikoresha ububasha bw’isi kugira ngo ifashe amaraso yo mu mitsi gusohoka mu gihanga no kugabanya umuvuduko wo mu gihanga. Ariko iyo uwo muntu atanguye gukorora canke akabura ubwenge, uce umuzunguruka ubwo nyene mu position de recovery lateral ku ruhande rwiwe kugira ngo urusenga ntirushobore guhumekera mu mahaha.
5. Suzuma igikoresho co gupima umuvuduko w’amaraso mu rugo nimba gica kiboneka, ariko NTUKIGEZE utanga imiti y’umuvuduko w’amaraso yo mu rugo y’inyongera munsi y’ururimi canke mu kanwa. Bwira abaganga igiharuro c’umuvuduko w’amaraso. Naho umuvuduko w’amaraso systolic kenshi ushika hejuru ya 180 gushika kuri 220 mmHg mu gihe umuntu ariko arasohoka amaraso mu bwonko, kumira imiti yo mu rugo yo gupima umuvuduko w’amaraso mu rugo biratuma umuntu arwaye indwara y’umutima agira ingorane zikomeye zo kuniha kandi bikaba bituma umuvuduko w’amaraso wo mu bwonko ugwa ataco ugenzura kandi udasanzwe. Abaganga bafasha abarwayi n’abaganga bafasha abarwayi bihutirwa bakoresha imiti ikora igihe gito, ikaba ifise ubushobozi bwo guterwa mu mutsi (nk’imiti yitwa nicardipine, clevidipine canke labetalol) kugira ngo umuvuduko w’amaraso ugabanuke neza gushika ku rugero rwa 130 gushika kuri 150 mmHg.
6. Ugume umurwayi ataco arya, ntaco yonywa canke yomira) kandi wibuke igihe ca "Last Known Well". Ntuhe amazi, umutobe, canke imiti yo mu kanwa. Andika umunota nyawo ibimenyetso vyatanguye (canke igihe ca nyuma uwo muntu yabonywe ari umuntu asanzwe).

Igiti c'ingingo: indwara y'umutima ikomeye ikekwa ko iva amaraso mu bwonko canke gukoresha imiti igabanya amaraso¶

flowchart TD
    Start["Igihombo c’imitsi gitunguranye (FAST: Mu maso hacitse intege, Ukuboko gugoyagoya, gutakaza amajambo) CANKE Umutwe ukaze utunguranye, Gutakara, Gutera urujijo, canke Coma"] --> CallEMS["1. Hamagara abajejwe ivy’ubutabazi (911 / 112 / 999) Ubwo nyene: Gukoresha imburi y’indwara y’umutima"]

    CallEMS --> NoAspirin["2. ITEGEKO RIKOMEYE: NTUKIGERE UHA Aspirine, Ibuprofen canke Umuti Uwundi Wose wo mu Kanwa"]

    NoAspirin --> AirwayCheck{"3. Umurwayi yoba ariko araruha, ariko arasesa amazi, canke ariko arasinzira canke akabura ubwenge?"}

    AirwayCheck -->|"EGO: Guruka canke Kugabanya Ubumenyi (GCS iri munsi ya 9)"| Recovery["Ubwo nyene ushire mu kibanza co gukira (umutwe ushigikiwe): Kura akanwa k’ibirungo, kurekura urukoba, kugenzura neza guhema ku bijanye n’ubutatu bwa Cushing"]

    AirwayCheck -->|"OYA: Nimuvyuke, mube maso, kandi ntimuvyure iseseme"| Elevate30["Gushira hejuru umutwe n’umubiri wo hejuru ku rugero rwa degre 30: Gumana umutwe n’izosi bigororotse cane mu murongo wo hagati (ntimupfuke imitsi y’izosi)"]

    Recovery --> BloodThinner{"4. Umurwayi yoba afata umuti wose wo gutuma amaraso agenda neza (anticoagulant)?"}
    Elevate30 --> BloodThinner

    BloodThinner -->|"EGO: Warfarini, Apixaban, Rivaroxaban, Edoxaban, Dabigatran canke Heparine"| CodeICH["IBITARO VY’IMBERE Y’IBIMENYETSO VY’IBIMENYETSO VY’IBIMENYETSO VYA CODE ICH ANTICOAGULANT REVERSAL: Raporo izina nyaryo ry’umuti, inkomezi za miligarama, n’isaha nyayo y’isaha y’imiti ya nyuma"]

    BloodThinner -->|"OYA canke ntibizwi"| HospitalCT["5. Gutwara vuba ku kigo c’abarwayi b’indwara y’umutima kugira ngo bakore CT y’umutwe idakoreshwa n’ibindi bihimba: Gukurikirana BP, gusuzuma isukari mu maraso y’urutoke, kuguma ufise NPO"]

    CodeICH --> Antidotes["Igitabu c’ibitaro Mu minota 30 gushika kuri 60 umuntu ashitse ku muryango: Warfarin ironka 4F-PCC + IV Vitamine K; Apixaban/Rivaroxaban ironka umuti witwa Andexanet alfa canke 4F-PCC; Dabigatrani ironka umuti witwa Idarucizumab; 130-150 mmHg"]

Pathophysiology: ingene amaraso ava mu bwonko yaguka agamenagura ubwonko¶

Mu buryo butandukanye n’indwara y’umutima (aho amaraso apfutse umutsi wo mu bwonko maze agatuma utugingo ngengabuzima two mu bwonko tuja munsi y’ubwonko tugira umwuka w’ikirere) canke indwara y’umutima . amaraso ava munsi y'umutwe (aho umutsi w’amaraso (saccular aneurysm) uca mu kibanza cuzuye amazi gikikuje hanze y’ubwonko), ugusohoka kw’amaraso mu bwonko (ICH) bishika iyo umutsi w’amaraso utobora ufise umuvuduko munini uca uwuca mu kintu gikomeye (parenchyme) co mu bwonko.

1. Kubera iki imitsi y’ubwonko iri imbere cane imeneka: Imitsi mito mito ya Charcot-Bouchard n’indwara y’imitsi y’ubwonko yitwa amyloïde¶

Ingwara zibiri zitandukanye ziri mu mitsi y’amaraso ni zo zituma amaraso arenga 80 kw’ijana ava mu bwonko yihuta:

• Indwara y’umuvuduko w’amaraso idakira (Microangiopathy y’umuvuduko munini w’amaraso): Imyaka y’umuvuduko munini w’amaraso udashobora gucungerwa itera imitsi mito mitoyi, y’ubwoya (amashami y’amaso, y’amaso y’amaso, n’amashami y’amaso y’imbere) igororotse iva ku mitsi minini y’amaraso y’umuvuduko munini cane. imiterere y’ubwonko. Uko igihe kigenda kirarenga, inkuta z’imitsi y’izo nzira zitoyi cane zirasenyuka (lipohyalinose) zigaca zihinduka imitsi mito mitoyi ya Charcot-Bouchard. Mu gihe umuvuduko w’amaraso wiyongera bukwi na bukwi, kimwe muri ivyo bihimba vy’umubiri bikomeye cane kirasaduka imbere mu imitsi y’imbere (putamen), thalamus, ubwonko buto, canke pons.
• Indwara y’imitsi y’ubwonko (CAA - Lobar Bleeds in Older Adults): Mu bantu bakuze barengeje imyaka 60 gushika kuri 65 (mbere n’abafise umuvuduko w’amaraso usanzwe), poroteyine ya beta-amyloïde irabika imbere mu bihome vy’imitsi mito n’iyiringaniye mu mitsi y’inyuma y’ubwonko nk’igihimba c’umubiri c’inyuma c’ubwonko nk’igihimba c’umubiri c’inyuma c’ubwonko. Iyo izo nzira zo hejuru zisadutse, zituma haba amaraso manini manini y’ibihimba vy’umubiri mu bihimba vy’imbere, vy’imbere, vy’igihe canke vy’inyuma.

2. Inyigisho ya Monro-Kellie n’akarorero k’ugukura kw’amaraso¶

Igihanga c’umuntu akuze ni igihimba c’amagufa gipfutse kandi gikomeye, gifise uburemere buhoraho bw’imbere bugera kuri militiro 1.400 gushika kuri 1.700, kigabanywemwo ibice bitatu bidashobora gufatwa: imitsi y’ubwonko (80 kw’ijana), **amazi yo mu bwonko (**10 kw’ijana)va. Dushingiye ku nyigisho ya Monro-Kellie, kubera ko igihanga kidashobora kwaguka, ikintu gishasha cose congerewe imbere mu gihanga (nk’ikidengeri c’amaraso yo mu mitsi kigenda kirakura) kigomba guca gikuraho amazi yo mu bwonko n’amaraso yo mu mitsi; iyo utwo dukoko dutoduto tumaze guhera (mu bisanzwe inyuma y’imililitiro 50 gushika kuri 80 y’uburemere bw’amaraso, n’imililitiro 20 gushika kuri 30 mu gice c’inyuma gikomeye gifise ubwonko buto), umuvuduko wo mu mutwe (ICP) uraduga cane.

Ikibi kuruta, ukuva amaraso mu bwonko si ikintu kimwe gusa kiba mu segonda imwe. Ivyigwa vyerekeye ubuhinga bwo gupima ubwonko vyerekana ko ukwaguka kw'amaraso kuba mu masaha ya mbere 1 gushika ku masaha 6 (kandi gushika ku masaha 24 ku barwayi bafata imiti igabanya amaraso) biciye ku Fisher "avalanche" effect: nk'uko umuyaga w'intango w'amaraso y'umuvuduko munini ucagura biciye mu bihimba vy'ubwonko vyoroshe, imitsi mitoyi cane ikikuje urubibi rw'igihimba c'umubiri, bigatuma habaho uruhererekane rw'imitsi y'amaraso (iboneka ku bipimo vya CT nk'ikimenyetso c'Ibara"**). Igihe cose ukwiyongera kw’ibice 10 kw’ijana kw’umubare w’amaraso, bituma umuntu ashobora gupfa canke akagira ubumuga bukomeye budahera.

3. Ugusenyuka kw’ubwonko n’ubutatu bwa Cushing¶

Uko amaraso agenda aragwira n’ibivyimba bikikije (perihematomal edema) bisunika igice c’ubwonko gifashwe ku ruhande kijabuka umurongo wo hagati (uguhinduka kw’umurongo wo hagati) kikaja hasi biciye mu nzira ndende y’imbere y’igihanga (uncal or transtentorial herniation), igihimba c’ubwonko kiramenagurika. Rondera ibimenyetso bibi vy’ubuvuzi vy’ugusenyuka kw’ubwonko:

1. Umunyeshure "apfutse" (Unilateral mydriasis): Igipfunsi c'amaraso gikomeza kwaguka gifatanya igihimba c'umubiri c'imbere (uncus) ku umutsi wa gatatu w'umutwe (oculomotor nerve), bigatuma umunyeshure uri ku ruhande rumwe n'ubwonko ruva amaraso** ugafunguka cane iyo umuco w'ibirenge ugaca uhagarara.
2. The Cushing Triad (Terminal intracranial pressure reflex): Iyo umuvuduko uriko uraduga imbere mu gihanga uhagaze amaraso aja mu gice c’ubwonko, igihimba c’ubwonko kiratera umuvuduko w’impuhwe wihebuye kugira ngo uhagarike amaraso mu mutwe, bigatuma habaho amahinduka atatu asanzwe mu mubiri:
3. Ukwaguka cane kw’umuvuduko w’amaraso n’ugutera imbere cane kw’umuvuduko w’amaraso (nk’akarorero, umuvuduko w’amaraso usimbuka ukagera kuri 240/90 mmHg).
4. Reflex bradycardia (umutima utera buhoro cane, ugaca utera 40 gushika kuri 50 ku munota naho hari ingorane).
5. Uguhema kudasanzwe, guhema, canke guhagarika (uguhema kwa Cheyne-Stokes canke Biot).
6. Guhagarara neza canke guca ubwonko: Gupfukama kudasanzwe kw’amaboko yerekeza ku gikiriza (decorticate) canke gugororoka bikomeye no guhindukiza imbere kw’amaboko n’amaguru yompi afise izosi ry’umugongo (decerebrate).

Gutandukanya indwara y’umutima y’amaraso (ICH), indwara y’umutima y’amaraso, n’indwara y’amaraso y’umutima¶

Naho CT scan yo mu bitaro yonyene ishobora gutandukanya neza indwara y’amaraso n’indwara y’amaraso, ibimenyetso vyinshi vy’ubuvuzi biri iruhande y’igitanda vyerekana cane ko amaraso ava mu bwonko kandi bikakugabisha ko umurwayi ashobora gusenyuka akaja mu coma mu minota mikeyi:

Imikono yihariye: ibibanza 5 vya kera vy'umubiri vy'amaraso ava mu bwonko¶

Abaganga b’ibihe vyihutirwa hamwe n’abahinga mu vy’imitsi barashobora kenshi gutahura umutsi nyawo wimbitse wacitse imbere y’uko umurwayi yinjira mu gikoresho co gupima amaso mu kwihweza inzira amaso ariko araba n’ingene umubiri winyiganza:

Ugusohoka amaraso mu bwonko bifitaniye isano n'imiti igabanya amaraso ("Code ICH" ihinduka ry'ugutoranya)¶

Nk’ibice 15 gushika kuri 20 kw’ijana vy’amaraso yose ava mu bwonko bishika ku barwayi bafata imiti yo mu kanwa kubera ububabare bw’umutima, ububabare bw’imitsi y’amaraso, ububabare bw’amaraso mu mahaha, canke ububabare bw’umutima bukoreshwa n’ubuhinga. Mu gihe amaraso yo mu bwonko yihuta ku murwayi afise ugutera kw’amaraso mu buryo busanzwe akenshi ahagarika kwaguka inyuma y’amasaha 3 gushika ku 6, amaraso yo mu bwonko akoresheje warfarin, apixaban, revaroxaban, edoxaban, canke dabigatran abandanya gusuka amaraso mu bwonko mu kiringo c’amasaha 12 gushika ku 24 kw’ijana, atwara ra**te kugeza kuri 60d. mu minota 30 gushika kuri 60 umuntu ashitse mu bitaro:

Ugucungera umuvuduko w'amaraso mu gusohoka amaraso mu bwonko: kuki kugabanya umuvuduko w'amaraso mu buryo bubereye bishobora gukiza ubuzima¶

Abarwayi barenga 75 kw’ijana bafise amaraso akomeye cane mu bwonko bafise umuvuduko w’amaraso uri hejuru ya 180 gushika kuri 240 mmHg. Naho umuvuduko w’amaraso (systole) uguma ari mwinshi gutyo, uwo mutsi wacitse utuma amaraso menshi yinjira mu mwobo w’amaraso. Igerageza ry’ubuvuzi ry’agaciro (IBIMENYETSO2, ATACH-2, na BIMENYETSO3) n’Ingingo ngenderwako za AHA/ASA zo mu 2022 bishinga amategeko atatu nyamukuru:

1. Ntukigere utanga imiti y’umuvuduko w’amaraso mu kanwa canke mu rurimi muhira: Ntukigere utanga imiti y’inyongera y’umuvuduko w’amaraso wo mu rugo, amlodipine, lisinopril, metoprolol, clonidine, canke nifedipine yo mu rurimi. Ica kabiri c’abarwayi bose ba ICH barafise ubumuga bwo kumira (dysphagie) canke bwo gukorora, bikaba bishobora gutuma umuntu ahita aniha canke ashobora guhumeka, kandi imiti yo mu kanwa irashobora gutuma umuvuduko w’amaraso ugwa ataco ugenzura, ivyo bikaba bituma ubwonko bupfa inzara bukikuje igihimba c’umubiri.
2. Iciyumviro c’ibitaro ku ICH yoroshe canke iri hagati (igaragaza SBP 150 gushika kuri 220 mmHg): Abaganga batangura gutera umuti w’imitsi y’amaraso (nicardipine, clevidipine, labetalol, canke urapidil) udasiba, ukora igihe gito cane (nicardipine, clevidipine, labetalol, canke urapidil) mu masaha 1 y’amaraso n’intumbero ya 140 mmHg (urugero rw’umutekano 130 gushika ku 150 mmHg)**.
3. Irinde kugabanya umuvuduko w’amaraso systolic munsi ya 130 mmHg: Igerageza rya ATACH-2 ryerekanye ko gusunika umuvuduko w’amaraso systolic munsi ya 130 mmHg bidatuma amaraso arushiriza kugabanya kandi bikongera ugukomeretswa kw’amafyigo n’ugucika intege kw’amaraso mu bwonko.

Intambwe ku yindi kwitaho umuntu imbere y'uko aja mu bitaro mu gihe arindiriye imodoka itwara abarwayi¶

1. Gushira umutwe ahantu (itegeko rya degre 30 n’aho umuntu ashobora gukira): Nimba umurwayi ari maso kandi ATARUKA, ushire umugongo wiwe wo hejuru n’umutwe wiwe hejuru ku incline ya degre 30 umutwe n’izosi bigororotse cane mu murongo wo hagati hanyuma urekure amaboko akomeye (uguhindura imitsi y’izosi n’imitsi y’izosi). Niba umurwayi ariko araruka, ariko araboroga, canke ariko arasinzira/ataco azi, uce umuzunguruka ubwo nyene ku ruhande rwiwe mu position de recovery lateral kugira ngo arutse asohoke mu kanwa.
2. Gukingira Valsalva guhagarika umutima no gucungera indwara y’ibicurane: Gumana ivyumba bitekanye kandi bicereje. Amaraso ava mu gice c’umubiri citwa cortical (lobar) atuma umuntu agira indwara y’ibicurane rusangi iyo atanguye ku barwayi 8 gushika ku 15 kw’ijana; iyo umuntu afashwe n’indwara y’umusonga, ushire umutwe, utere uwo muntu ku ruhande rwiwe (raba gufatwa n'intandara ubutabazi bwambere), kandi ntukigere ushiramwo ibintu mu kanwa.
3. Kwirinda umuriro no gusuzuma isukari mu maraso: Igihe cose ubushuhe buzamutse ku rugero rwa degre 1 Celsius (degre 1,8 Fahrenheit) bituma ubwonko buvyimba cane, rero ukureho ibitambaro biremerera. Abaganga bazoca basuzuma isukari mu maraso y’urutoke kugira ngo ntihagire umuntu afise isukari mu maraso (<3.3 mmol/L canke 60 mg/dL).

Ibitaro vy'ubuvuzi bw'imitsi n'ubuvuzi bw'imitsi¶

Igihe CT y’umutwe idakoresheje ubuhinga bwo gupima amaraso yemeza ko hari amaraso mu bwonko maze igapima ubunini bwayo (ikoresheje formule ABC/2: uburebure A incuro ubwaguke B incuro uburebure bw'igice C ugabanye na 2), umugwi w’abaganga babaga indwara y’umutima n’imitsi y’ubwonko utanguza Igikorwa co kwitwararika umuntu gishingiye ku ntumbero ya INTERACT3:

1. Guhindura imiti igabanya amaraso no kugabanya umuvuduko w’amaraso mu buryo bubereye mu minota 30 gushika kuri 60 umuntu ashitse.
2. Igisohoka c’inyuma c’umubiri (EVD) ku bijanye n’ugusohoka kw’amaraso mu mubiri (IVH): Iyo amaraso amenetse mu bihimba vy’umubiri vy’amazi agahagarika amazi yo mu bwonko (obstructive hydrocephalus), abaganga babaga imitsi barashiramwo igikoresho co gukura amaraso mu mubiri no kugenzura umuvuduko wo mu mutwe.
3. Gukuraho amaraso mu bwonko: Ubwo nyene Gukuraho umutwe wo munsi y’umutwe ni ugukiza ubuzima ku maraso ava mu bwonko arenga militiro 15 (canke umurongo >3 cm), mu gihe ugukura amaraso mu mubiri bikoresheje endoscope canke catheter (igerageza rya ENRICH) canke gukura amaraso mu gice c’umubiri bishobora gutuma umuntu ashobora kurokoka mu maraso manini manini yo mu gice c’umubiri (30 gushika kuri 80 mL).

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Abarwayi bakekwa ko bafise amaraso ava mu bwonko basaba gutwarwa n’imodoka itwara abarwayi mu kigo cemewe Comprehensive Stroke Center (CSC) canke mu bitaro bifise amasaha 24 y’ugupima CT, imiti igabanya amaraso, n’ubushobozi bwo kubaga ubwonko/ubwonko:

• Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911. Abaganga ba EMS bakoresha ibipimo vy’uburemere bw’indwara y’umutima imbere y’uko umuntu aja mu bitaro (nk’ivyo bita RACE, LAMS, canke C-STAT) kandi bakamenyesha imbere y’igihe ikigo c’indwara y’umutima kivyakira kugira ngo igikoresho co gupima CT gisukurwe imbere y’uko igikoresho co gutwara umuntu gishika.
• Ubwongereza: Hamagara 999. Mu Ingingo ngenderwako ya NHS na NICE NG128 (Igitero c'Indwara y'Umutima n'Igitero c'Imitsi y'Igihe gito mu myaka irenga 16) no mu Igitero c'Igihugu c'Indwara y'Imitsi (Integuro y'2023), abarwayi ba ICH bakomeye baronka "Ikigo c'Ivyitaho ABC" (Igitero c'Imitsi y'Umutima gikomeye, kugabanya kugera kuri 130-140 mmHg, na Cni inzira yo kubaga mu bwonko).
• Ubumwe bw'Uburaya: Hamagara 112. Kurikiza amabwirizwa y’ishirahamwe ry’Uburaya ryitaho indwara y’umutima (ESO)** mu kumenyesha imiti yose yo mu kanwa igabanya amaraso (VKAs canke DOACs) ubwo nyene ku bajejwe ivy’ubuvuzi vyihutirwa.
• Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Icungirwa hakurikijwe Ishirahamwe ry’indwara y’umutima (Australia/NZ) ry’amabwirizwa y’ubuvuzi y’ubuzima bwo kuvura indwara y’umutima.
• Ubuhindi na Aziya-Pasifike: Hamagara 112 (canke 108 mu Buhindi), 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Gusaba gutwara mu bitaro vy’amashure yisumbuye bifise amasaha 24 y’ugupima CT n’ugubaga imitsi.

Ibibazo bikunda kubazwa¶

Ni kuki ntashobora guha aspirine umuntu afise indwara y’umutima nk’uko wewe ubigira ku ndwara y’umutima?¶

Naho indwara y’umutima hafi imisi yose iterwa n’ugutera amaraso mu mutsi w’umutima, nk’ibice 15 gushika ku 20 kw’ijana vy’indwara zose z’umutima ni indwara z’amaraso ziterwa n’umutsi wacitse amaraso akaja mu bwonko ataco akora. Kubera ko indwara y’umutima (ischemie) n’indwara y’amaraso (hemorrhagic) itera ibimenyetso bisa n’ivyo mu maso nk’ugutemba mu maso, ukuremba kw’amaboko, n’ukuvuga nabi, ntibishoboka ko umuntu amenya neza 100 kw’ijana i muhira ubwoko buriko buraba. Guha aspirine umuntu afise indwara y’umutima iva amaraso birabuza ubudasiba utugingo ngengabuzima tudatera amaraso kandi bituma amaraso yihuta kuva imbere mu gihanga. Ntukigere utanga aspirine gushika CT scan y’ibitaro yerekanye ko ata maraso ava.

Wokeka gute ko indwara y’umutima yoba ari amaraso ava mu bwonko aho kuba amaraso atera?¶

Naho CT scan yo mu bitaro yonyene ishobora kwemeza ko umuntu arwaye, amaraso ava mu bwonko arashobora cane iyo ibimenyetso vy’indwara y’umutima bitunguranye (ubugoyagoye ku ruhande rumwe, ukubura amajambo, canke ukubura amaso) biherekejwe n’ugufatwa n’umutwe gukomeye gutunguranye, iseseme n’uguruka kw’ibisasu, umuvuduko w’amaraso urenga mm20). n’ugufatwa n’indwara y’ibicurane mu ntango, canke kugabanuka neza kandi vyihuta gushika aho umuntu asinzira, akagira urujijo canke akagira ububabare mu minota 15 gushika ku 60 ya mbere.

Ni kubera iki vyihutirwa cane kubwira abaganga izina nyaryo n’igihe ca nyuma umuntu afata umuti wo gutuma amaraso agenda neza?¶

Amaraso ava mu bwonko bw’abarwayi bafata imiti igabanya amaraso (warfarin, apixaban, rivaroxaban, edoxaban canke dabigatran) aragwira ningoga mu kiringo c’amasaha 12 gushika ku 24 kandi atwara urugero rw’urupfu rw’ibice 40 gushika ku bice 60 kw’ijana kiretse iyo umuntu ahise asubira inyuma. Ivyiyumviro bitandukanye vy’imiti igabanya amaraso bisaba imiti itandukanye cane yo gukingira amaraso mu bitaro (4-Factor PCC na Vitamine K ku miti yitwa warfarin; Andexanet alfa canke 4F-PCC ku miti yitwa apixaban na rivaroxaban; amasaha makeyi canke arenga 8 aheze. Gumenyesha ibitaro imbere y’igihe bituma ivuriro ritegura umuti imbere y’uko imodoka itwara abarwayi ishika.

Noba nshobora guha umurwayi w’indwara y’umutima umuti w’umuvuduko w’amaraso wo muhira iyo umuvuduko w’amaraso wiwe ari 210/110 mmHg?¶

Oya, ntukigere uha umuntu akekwaho ko afise indwara y’umutima imiti yo mu kanwa canke yo mu rurimi. Ica mbere, indwara y’umutima kenshi iratuma imitsi yo mu muhogo ikenewe kugira ngo umuntu ashobore kumira neza, ivyo bikaba bituma umuntu ahita aniha canke guhumekera iyo ntungamubiri mu mahaha. Ubwa kabiri, imiti umuntu afata mu kanwa iragabanya umuvuduko w’amaraso ata co yiteze kandi ntishobora kuzimwa iyo umuvuduko w’amaraso ugabanutse cane, ivyo bikaba bishobora gutuma ubwonko bwavyimvye bupfa inzara y’ugutembera kw’amaraso. Abaganga bo mu bitaro baragabanya umuvuduko w’amaraso ata ngorane gushika ku rugero rwa 130 gushika ku 150 mmHg bakoresheje imiti iguma itera kandi ikora igihe gito.

Ni kubera iki amaraso ava mu bwonko butoyi akenshi cane afatwa nabi ko ari ingorane yo mu gutwi kw’imbere canke ko ari ubumara bw’ibifungurwa?¶

Kubera ko ubwonko buto bugenzura uburinganire n’uguhuza ibintu aho kugenzura inkomezi z’ukuboko canke zo mu maso, iyo umuntu ava amaraso mu bwonko buto buto, agira igisenyi gitunguranye (vertigo), akagira iseseme nyinshi n’ugusesa amaraso, n’ugufatwa n’umutwe inyuma y’umutwe ataco bituma mu maso hacika intege canke ngo ukuboko gusenyuke. Ibendera ry’umutuku ry’ingenzi ritandukanya indwara y’umutima n’umugera wo mu gutwi kw’imbere ni truncal ataxia: umurwayi ntashobora rwose kwicara, guhagarara canke gutera intambwe imwe ataguye. Kumenya umuntu mu bitaro hakiri kare bituma umuntu abagwa, akamukurako igihimba c’umubiri gishobora kumukiza ubuzima, imbere y’uko ubwonko buto buvyimvye bumenagura ubwonko.

Ni kuki umutwe w’igitanda ukwiye kuduzwa degre 30 izosi rigororotse mu maraso yo mu bwonko?¶

Mu murwayi ari maso atariko araruha, gushigikira umutwe n’ibitugu hejuru mu mfuruka ya degre 30 umutwe uravye imbere bikoresha ububasha bw’isi kugira ngo bifashe amaraso ava mu gihanga aciye mu mitsi y’imbere y’igihanga, ivyo bikaba bigabanya umuvuduko wo mu gihanga ata kugabanya amaraso aja mu bwonko. Gutuma izosi riguma rigororotse biratuma imitsi y’izosi idatera. Ariko iyo umurwayi ariko araruha canke ata co azi, bategerezwa gushirwa ku ruhande mu kibanza co gukira kugira ngo bakingire inzira y’impwemu.

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry’umutima ryo muri Amerika / Ishirahamwe ry’abarwayi b’indwara y’umutima ryo muri Amerika (AHA/ASA, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako y’umwaka w’2022 ku bijanye no gufasha abarwayi bafise amaraso ava mu bwonko yibonekeza (Greenberg n’abandi, Indwara y’umutima, intumbero zo guhindura imiti igabanya amaraso, eBPg-g0va kugera kuri,503. kwirinda guterwa amaraso y’amaraso mu buryo busanzwe).
• Ishirahamwe ry’Uburayi ryitaho ivy’Indwara y’Imitsi (ESO, Europe): Ingingo ngenderwako z’Ishirahamwe ry’Uburayi ryitaho Indwara y’Imitsi ku bijanye no gucungera amaraso ava mu bwonko yihuta n’Amaraso ava mu bwonko aterwa n’imiti igabanya amaraso.
• Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE) & Ishirahamwe ry'Igihugu ry'Ibikorwa vy'Indwara y'Imitsi y'Imitsi (Ubwongereza): Indwara y'Imitsi y'Imitsi n'Imitsi y'Imitsi y'Igihugu mu myaka irenga 16: Gupima no kuyivura mu ntango (NG128)" na Ingingo ngenderwako y'Igihugu y'Imitsi y'Imitsi (CH0AIrlande) (CH0A2re) mu Bwongereza na IBC3).
• Abashakashatsi b’igerageza rya INTERACT3 (Ma L, Hu X, Song L, n’abandi, Ikinyamakuru, 2023): Igitabu ca gatatu c’ubuvuzi bukomeye n’ugugabanya umuvuduko w’amaraso mu kigeragezo c’ugusohoka kw’amaraso mu bwonko (INTERACT3).
• Ishirahamwe mpuzamakungu ry’umusaraba utukura n’ukwezi gutukura (IFRC) & Komite ya Australiya na Nouvelle-Zélande ijejwe gusubiza ubuzima mu buzima (ANZCOR): Ingingo ngenderwako mpuzamakungu zijanye n’ubutabazi bwa mbere, gusubiza ubuzima mu buzima, n’uburezi: Kwemera indwara y’umutima no kwitwararika imbere y’uko umuntu aja mu bitaro.

Inyobora zifitaniye isano¶

• Kumenya indwara y'umutima (FAST) no gutanga ubutabazi bwa mbere
• Ugusohoka amaraso munsi y'umutwe, umutwe utera nk'inkuba, n'umutsi wo mu bwonko ucitse
• Amaraso ashobora gutuma umuntu apfa ku miti igabanya amaraso canke mu ndwara y’amaraso .
• Igitero c'umutima c'igihe gito (TIA / mini-stroke) n'ingorane z'amasaha 24 y'umutima
• Indwara y’umuvuduko w’amaraso, umuvuduko w’amaraso mubi, n’umuvuduko w’amaraso urenga 180/120