Ka-noqoshada Matoorka Intrathecal Baclofen vs Xad-dhaafka: Cuncun, Dib-u-soo-kabashada Bakhtiyaa-nasiibka, iyo Hyperthermia¶

Baclofen intrathecal (ITB) oo la geliyey (sida Medtronic SynchroMed II ama SynchroMed III system) waxay si toos ah u keentaa qiyaasaha microgram ee dareeraha baclofen dareeraha cerebrospinal (CSF) ee ku wareegsan xudunta laf dhabarta si loo xakameeyo bararka daran ee curyaanka maskaxda, sclerosis badan, dhaawaca laf dhabarta, ama dhaawac maskaxeed. Sababtoo ah dhalmada intrathecal waxay xoogga saartaa daawada receptors GABA-B 100 jeer awoodda kiniinnada la liqay, hakad kasta oo degdeg ah ee socodka bamka (laga bilaabo kaydka madhan, ballan buuxinta oo seegay, rotor bamka oo fadhiistay, batteri yaraaday, ama kateetarka laf-dhabarka ee kinked / go'ay) kicinta ** 1 saac gudahooda Taa beddelkeeda, khaladka barnaamijka ama cirbadeynta jeebka inta lagu jiro dib-u-buuxinta waxay sababi kartaa ** qaadashada baclofen intrathecal ba'an **, taasoo u horseedda kacsanaan kor u kac ah, neefsashada oo xirma, iyo miyir-beel. Haddii bukaanka bamka baclofen la rakibay uu si lama filaan ah u yeesho cuncun jidhka oo dhan oo aan la garanayn, muruq qallafsanaan, qandho sare, ama hurdo aan caadi ahayn, wac degaankaaga nambarada degdega ah isla markiiba. Xaaladaha degdega ah ee neerfaha iyo kulaylka ee la xidhiidha, la tasho serotonin syndrome iyo neuroleptic malignant syndrome, autonomic dysreflexia ee dhaawaca laf dhabartaiyo dhaawac kelyo oo degdeg ah iyo rhabdomyolysis.

Ka-noqoshada baclofen intrathecal-ka degdega ah ayaa inta badan si khaldan loogu gartaa waaxyaha xaaladaha degdegga ah sida bakteeriyada meningitis, sepsis, neuroleptic malignant syndrome, ama dysreflexia madax-bannaan. Aqoonsiga calaamadda digniinta ugu horayso ee caadiga ah (** cuncun guud oo daran oo aan firiiric lahayn ***), dhegeysiga qaylo-dhaanta qaylo-dhaanta gudaha ee bamka, bixinta badbaadinta afka baclofen iyo benzodiazepines haddii bukaanku si ammaan ah u liqi karo, iyo u yaacidda cusbitaal awood u leh su'aalo weydiinta bamka degdegga ah iyo dib u soo celinta CSF ee lumbar waxay badbaadisaa nolosha.

Hadda samee tan¶

1. ** Isla markiiba wac lambarkaaga deg-degga ah.** Wac 911 gudaha Mareykanka iyo Kanada, 112 gudaha Midowga Yurub, 999 gudaha Boqortooyada Midowday, 000 gudaha Australia, ama kala tasho buug-tilmaameedkayaga nambarada degdega ah. Si cad ugu sheeg diraha: " Gurmadka degdega ah ee baclofen intrathecal intrathecal: looga shakisan yahay ka bixitaanka baclofen ba'an (ama xad dhaaf) oo u baahan gaadiid isbitaal degdeg ah."
2. ** Isla markiiba go'aanso in bukaanku ku jiro KA- BAXA (adag, gariir, kulayl, cuncun) ama xad-dhaaf ah (lunsan, hurdo, neefsasho tartiib ah, qabow).**
3. Calamadaha ka-noqoshada: cuncun jidhka oo dhan ah oo daran (pruritus• aan lahayn finan maqaarka ah**, soo laabashada murqaha rabshadaha wata iyo qallafsanaanta guddiga, goosebumps, wadnaha tartanka, dhiig karka, kacsanaanta ama dhalanteed, iyo qandho si degdeg ah u koraysa (badanaa ka badan 40 ilaa 41 darajo Celsius [104 ilaa 105.8 darajo Fahrenheit]).
4. Calamadaha xad dhaafka ah: lulmo aad u daran (somnolence) kooma, murqaha "rag-doll" oo faleebo (floppy)flaccid hypotonia, luminta falcelinta seedaha qoto dheer, hadalka qallafsan, qulqulaya, neefsasho gacmeed gaabanrespiratory depression), cadaadis dhiig oo hooseeya, iyo garaaca wadnaha oo gaabis ah.
5. **Haddii bukaanku ku jiro DIB-QABSIGAN oo uu si buuxda u soo jeedo oo uu awoodo inuu si badbaado leh u liqo, bixi qiyaasta gurmadka degdega ah ee afka ee baclofen (iyo diazepam/lorazepam) isla markiiba. Iyadoo baclofen afka kaligiis ah ** aysan si buuxda u joojin karin ka-baxa xiidmaha ee daran sababtoo ah waxay ka gudubtaa xannibaadda dhiigga-maskaxda si tartiib tartiib ah, iyadoo siinaya qadar sare oo afka ah isla markiiba oo ay weheliso benzodiazepine loo qoraydiazepam ama lorazepam) iibsada wakhtiga muhiimka ah marka loo qaadayo cisbitaalka.
6. **Hadduu bukaanku qandho sare leeyahay iyo muruqyo qallafsan (ka-baxsan), billow qaboojin dibadda ah oo firfircoon kana ilaali dhaawac. Weligaa jir ahaan ha is-xakameyn bukaanka leh dib-u-soo-kabashada ba'an, maadaama la dagaalanka xakameynta ay soo dedejiso burburka muruqa iyo heerkul sare.
7. *Hadduu bukaanku ku jiro DOQON KA BADAN ( dhutin, kacsi la'aan, ama si tartiib tartiib ah u neefsanaya ), taageer marin hawomadeedka una diyaari inaad neefsato samatabbixin ah. CPR dadka waaweyn haddii neefsashadu istaagto ama ay hoos u dhacdo 8 neefsasho daqiiqadii.
8. ** Hel Kaadhka Aqoonsiga Qalabka Bukaan-socodka oo keen barnaamijka bukaan-socodka dibadda (haddii loo qoondeeyo) isbitaalka. taariikhda buuxinta u dambaysa.

Geedka go'aanka: kala soocidda degdegga ah ee baklofen intrathecal¶

flowchart TD
    A["Bukaanka lagu beeray bamka Baclofen (ITB)."] --> B{"Hubi codka murqaha, feejignaanta, iyo digniinta bamka"}
    B -->|"Cuncun aan lahayn finan, barar adag, qandho, tachycardia, ama qaylo dhaanta"| C["CUNTADA CUNTADA CUNTADA AH EE KALA-BIXIDDA SYNDROME"]
    C --> D{"Bukaanku ma soo jeedaan oo ma awoodo inuu si ammaan ah wax u liqo?"}
    D -->|"Haa"| E["Sii samatabbixin qoran afka baclofen + afka/malawadka benzodiazepine isla markaaba"]
    D -->|"Maya (lulo, suuxdin, ama neef-qabatin)"| F["Si adag u ilaali NPO; sii samatabbixinta malawadka/gudaha sanka ee benzodiazepine haddii laguu qoro"]
    E --> G["Bukaanka qabooji si firfircoon oo baraf ah qoorta/axillae/ gumaarka oo wac EMS hadda"]
    F --> G
    B -->|"Muruqyo qallafsan/muruqsan, lulmo aad u daran, neefsashada oo gaabis ah, ama dib-u-buuxin ka dib"| H["XUMO XANUUN AH ITB (Buux jeebka, khaladka barnaamijka, ama bolus)"]
    H --> I["Marin-haweedka fur, dhig booska soo kabashada dhinac-jiif, si dhow ula soco neefsashada"]
    I --> J["Bilow neefsashada samatabbixinta/CPR haddii neefsashadu hoos u dhacdo ama joogsato; isla markiiba wac EMS"]
    B -->|"Casaan, barar, kiish dareere ah, ama malax dushiisa bamka caloosha ama jeexitaan dhabarka"| K["Caabuqa jeebka bamka AMA CSF HYGROMA: Ha damcin guriga; tag ER"]

Sida habka baclofen intrathecal u shaqeeyo iyo sababta uu u guuldareysto¶

Nidaamka baclofen intrathecal wuxuu ka kooban yahay laba qaybood oo la rakibay:

1. ** Saxanka bamka ee la baran karo:** Kaydka xeegada xeegada xeegada xeegada ee titanium iyo batari ku shaqeeya batari (qiyaastii 8.5 sentimitir [3.3 inji] balac ah iyo 2 sentimitir [0.8 inji) dhumucdiisuna waa 2 sentimitir [0.8 inji] Bartamaha bamka ayaa leh caag silikoon ah oo iskii isku xiraya ** septum dib-u-buuxinta kaydka *, cidhifka matoorku wuxuu leeyahay meel yar oo ** kateetarka gelitaanka (CAP) taasoo si toos ah u sii gelisa kateetarka laf-dhabarka ee ka gudbaya habka bamka.
2. Kateetarka intrathecal: Silikoon dhuuban, dabacsan ama tuubo polyurethane ah oo ku xiran dhinaca bamka kaas oo tunnel-ka hoostiisa ku wareegsan garbaha ilaa dhabarka hoose (lumbar spine), wuxuu ka galaa kanaalka laf-dhabarka isagoo dhex mara dura mater, oo uu kor ugu sii shubo dareeraha maskaxda (cerbrospinal fluid).subarachnoid space) xudunta laf-dhabarta ee dhuunta ama afka ilmagaleenka.

Sababaha farsamada ee caadiga ah ee kateetarka shaqada (sababta 70% guuldarrooyinka ay u aamusan yihiin)¶

Halka kombuyuutarka bamka titanium la farsameeyay inuu socdo 6.5 ilaa 7 sano ka hor beddelka baytariyada la doortay, tuubada laf dhabarta ee dhuuban ee dhuuban waxaa la mariyaa kumanaan foorar, leexasho, iyo xoog leh mar kasta oo bukaanku ka soo wareejiyo sariirta una wareego kursiga curyaanka, hore u foorarsado, ama korayo dhererka xilliga qaan-gaarka. Dhibaatooyinka kateetarka makaanikada waxaa ka mid ah:

• Kateetarka oo kiciya ama xirid: Qallooc fiiqan halka kateetarka uu ka soo baxo isku xiraha bamka aan suture-ka lahayn ee caloosha ama halka ay xagal u sii marto thoracolumbar fascia ee dhabarka hoose.
• Jajab ama xiirid: Cadaadiska tuubada kateetarka ee u dhaxaysa laba hab oo laf dhabarta ah ama lafaha lamina ee dhabarka hoose, kateetarka badhkeed si ay daawadu ugu daadato muruqyada paraspinal (subcutaneous CSF hygroma).
• Kateeter-ka-baxa / ka guurista bannaanka gudaha ee xididka: caarada kateetarka ayaa dib uga soo baxda daloolka daba-dheeraada ee dufanka epidural'ka ama unug ka hooseeya, inta badan ka dib daawaynta jirka ee xoogga leh, ka dhicida kursiga curyaanka, qalliinka fiyuuska laf-dhabarta, ama korriinka degdegga ah ee ilmaha.
• Granuloma catheter-cathecal intrathecal: Barar barar ah oo makrophages ah iyo unug nabar ah oo ka sameysan agagaarka caarada catheter gudaha kanaalka laf-dhabarka (oo aad ugu badan inta badan morphine-ka intrathecal ama bambooyinka hydromorphone, laakiin mararka qaarkood waxaa lagu soo warramey baclofen-sare), kaas oo xannibaya faafitaanka daroogada wuxuuna cadaadin karaa laf-dhabarta lafteeda cusub, taasoo keenta curyaannimo cusub.

Infekshanka jeebka ee bamka, qoorgooyaha, iyo dheecaanka CSF ee lumbar ("pseudomeningocele")¶

Laba xaalad degdeg ah oo goobta qaliinka ah ayaa dhici karta 2 ilaa 8da toddobaad ee ugu horreeya ka dib marka bamka la geliyo, beddelka batteriga, ama dib-u-buuxinta percutaneous:

1. Infekshanka jeebka iyo kor u kaca qoorgooyaha bakteeriyada: Haddii casaan, diirimaad, barar bogsasho ah, dheecaan dheecaan ah, ama nabar-baxa (tolmo furan si ay u soo bandhigaan birta titanium) ay ka soo baxaan jeebka bamka caloosha ama jeexitaan hoose ee dhabarka, bakteeriyada (* Staphylococcus aureus * ama * Staphylococcus waxay si toos ah u sii marin kartaa tuubada godka ee tube). dareeraha maskaxda ee maskaxda, oo keenaya fulminant ** bakteeriyada qoorgooyaha** (qandho, qoor adag, sawir-qaadis, jahawareer) oo ay weheliso bamka oo xumaada. ** Weligaa ha isku dayin inaad ka daadiso ama ka tuujin dareeraha jeebka bamka ee guriga dhexdiisa ah**; Isla markiiba u tag qolka xaaladaha degdegga ah ee dhaqamada dhiigga, falanqaynta CSF, iyo vancomycin faleebada ah iyo cefepime/ceftriaxone.
2. Lumbar CSF dillaaca iyo hygroma subcutaneous: Haddii dheecaanka maskaxdu uu ka soo daadanayo agagaarka goobta daloolinta dabaasha ee dhabarka hoose, waxay abuuri kartaa jilicsanaan, dareere codeyn karo oo maqaarka dambe hoostiisa ah (pseudomeningoceleoo sababa madax-xanuun daran oo dabada kadib** (madax-xanuun daran oo si aad ah uga sii dara marka uu si toos ah u fadhiyo oo soo roonaado daqiiqado gudahood markaad si buuxda u jiifsato, oo ay weheliso lalabo iyo qoorta oo adkaan).

Qiyaasta 100-ilaa-1 ee awoodda u dhaxaysa intrathecal iyo baclofen afka¶

Baclofen waa analooga qaab dhismeedka gamma-aminobutyric acid (GABA), habdhiska dhexe ee neerfaha ee bini'aadamka ee xakameynaya neurotransmitter. Waxay si xushmad leh ugu xidhaa ** presynaptic iyo postsynaptic GABA-B reseptors ** ee geeska dorsal ee xudunta laf-dhabarta, xannibaadda qulqulka kaalshiyamka iyo joojinta sii-deynta neurotransmitters kacsan (glutamate iyo aspartate) kuwaas oo kicinaya murqaha spastic.

Marka bukaanku liqo kiniinka baclofen ee afka ah (sida caadiga ah 40 ilaa 80 milligaraam [40,000 ilaa 80,000 micrograms] maalintii), daawadu waxay si liidata u nuugtaa xannibaadda dhiigga-maskaxda, taasoo keenaysa uruurin yar oo CSF ​​ah oo yar oo ka yar 12 ilaa 95 nanograms halkii millilitir ee maskaxda. Taas bedelkeeda, bamka intrathecal-ga ah ee ku shubaya kaliya ** 300 ilaa 800 micrograms maalintii *** si toos ah CSF-gu wuxuu gaaraa uruurinta laf-dhabarka laf-dhabarka ** afar ilaa toban jeer ka sarreeya qiyaasta ugu badan ee afka iyadoo la isticmaalayo 1/100^th wadarta qaddarka milligaraam.

Sababtoo ah soo-dhoweeyayaasha GABA-B ee xudunta laf dhabarta ayaa si joogto ah loogu qubeeyaa baclofen xoog leh 24 saacadood maalintii, neerfayaasha laf-dhabarka waxay la qabsadaan ** hoos-u-dejinta (saarida) reseptors GABA-B iyaga u gaar ah ** iyo kordhinta dareenka xiisaha leh.

Maxaa ka dhacaya gudaha xudunta laf dhabarta marka socodka bamka uu istaago¶

Nolosha nuska noolaha ee baclofen gudaha dareeraha maskaxda ee bini'aadamka waa **1.5 ilaa 5 saacadood ***. Marka bamka uu qallalo ama kateetarka uu go'o:

• 4 ilaa 8 saacadood gudahood, Heerarka Baclofen ee CSF waxa ay hoos ugu dhacayaan eber.
• Ka-hortagga GABA-B iyo la'aanta cufnaanta caadiga ah ee soo-dhoweynta, xudunta laf-dhabarka ee alfa iyo gamma neurons neurons, neurons preganglionic u naxariista, iyo cuncun interneurons ayaa ka dillaacay ** aan la tartamin, toogasho joogto ah.
• Muruq kasta oo lafaha ah ee jirridda iyo cidhifyada waxay xiraan foosha teetanada, taasoo dhalinaysa kulayl weyn oo dheef-shiid kiimikaad ah (** thermogenesis in ka badan 41 darajo Celsius [105.8 darajo Fahrenheit]) iyo jeexjeexa fiilooyinka murqaha ( rhabdomyolysis ***), halka nidaamka dareenka dareenka uu daadiyo qulqulka dhiigga iyo eaurepinephrine.

Aqoonsiga afarta marxaladood ee ka bixitaanka baclofen intrathecal¶

Ka-noqoshada intrathecal baclofen waxay daba socotaa wakhti la saadaalin karo, oo si degdeg ah u kordhaya. Aqoonsiga Marxaladda 1 ka hor inta aysan bilaaban qandhada iyo hawlgabka xubnaha waa muhiim.

Heerka 1: Prodrome hore (6 ilaa 18 saacadood kadib socodka socodka)¶

• ** cuncun daran, guud ahaanneuropathic pruritusIYADOO AAN LAGU JIRIN finan maqaarka ah oo muuqda, cuncun, ama casaan:** Tani waa calaamadda ugu horaysa ee gaarka ah ee ka bixitaanka intrathecal baclofen, oo ku dhacda 40 ilaa 70 boqolkiiba bukaanada sababtoo ah daaweeyayaasha GABA-B ee laf-dhabarka waxay caadi ahaan joojiyaan dariiqyada cuncunka dorsal-geeska (GRP/Bhlhb5 interneurons). Qoysaska iyo takhaatiirta daryeelka degdega ah waxay inta badan ku qaldamaan fal-celinta xasaasiyadda waxayna siiyaan antihistamines (diphenhydramine), kuwaas oo aan waxba samayn oo dhab ahaantii ka sii daraya delirium.
• ** Soo noqoshada gunta hoose iyo cidhiidhiga muruqa:** Lugaha, gacmaha, ama jirida bukaanka waxay dareemaan adkaansho marka la wareejinayo ama labisanayo, oo ay weheliso bararka bilawga ah ee soo noqnoqda, xinjirowga canqowga (cagaha garaaca laxanka), iyo walaac aan xasilloonayn ama hurdo la'aan.
• ** Dysesthesia iyo paresthesia:** Dareemaha maqaarka oo xiira, gubasho, ama "biinanka iyo irbadaha"diaphoresis), iyo goosebumps (piloerection).

Marxaladda 2: Dib-u-soo-kabashada degdega ah iyo duufaan madax-bannaan (18 ilaa 36 saacadood)¶

• ** Rabshado badan, xanuun badan, muruq xanuun joogto ah iyo qallafsanaan:** Opisthotonus daran (dhabarka dhabarka iyo qoorta), jilbaha iyo miskaha qufulan, iyo laxanka myoclonic ee joogtada ah ee cirridka.
• Xasilooni la'aanta 'Hyperadrenergic autonomic': Tartanka garaaca wadnaha ee nasashada inta u dhaxaysa 120 iyo 170 garaac daqiiqaddii, isbeddel duurjoogta ah oo dhiig karka ah ( dhiigkarka daran oo beddela hypotension), neefsasho degdeg ah (tachypnea), iyo dhididka qulqulaya.
• Xummada xudunta u ah oo sii kordheysa: Heerkulka jidhku wuu dhaafay 38.5 ilaa 40.0 darajo Celsius (101.3 ilaa 104.0 darajo Fahrenheit) - oo ay wadato gabi ahaanba muruq lafo-lafo oo aan kala joogsi lahayn iyo habacsanaan hypothalamic, ma aha caabuq.
• ** Isbeddellada maskaxeed iyo garashada:** Kacsi daran, miyir-beel, muuqaal iyo muuqaal maqal, jaahwareer, iyo delirium.

Marxaladda 3: Heerkul sare oo buuxa, xaalad suuxdin, iyo rhabdomyolysis (36 ilaa 72 saacadood)¶

• Hyperpyrexia aad u daran: Heerkulka xudunta ahi waxa uu dhaafaa 40.5 ilaa 42.0 darajo Celsius (104.9 ilaa 107.6 darajo Fahrenheit), taasoo ka saaraysa enzymes-ka gacanta ee maskaxda, beerka, iyo wadnaha.
• ** Suuxdin guud oo tonic-clonic ah iyo xaaladda suuxdintu:** Ka-noqoshada Cortical GABA-B waxay kicisaa suuxdin joogto ah oo aan joogsanayn iyada oo aan la helin qiyaas sare oo xididada benzodiazepines, propofol, ama barbiturates.
• ** Rhabdomyolysis wayn iyo kaadi madow "Coca-Cola"

Marxaladda 4: Hawlgabka xubnaha nidaamka kala duwan iyo burburka wadnaha iyo xididdada dhiigga¶

• ** Xididdada xididdada xididdada dhiigga ee la faafiyay (DIC):** Xinjirro aan la xakameynin iyo dhiig-bax iskiis ah oo ka yimaada ciridka, goobaha IV, iyo mareenka caloosha iyo mindhicirka.
• ** Cagaarshow ba'an, dhaawac kelyo oo ba'an, ARDS, iyo shoog wadnaha.

Fahamka Medtronic SynchroMed bamka alaarmiga maqalka ah¶

Matoorada Medtronic SynchroMed II iyo III ee la geliyey waxay ka kooban yihiin beddelka codka-dhaliyaha piezoelectric kaas oo siidaaya dhawaaqyo maqal oo kala duwan oo aad maqli karto markaad bukaanka u dhowdahay ama aad dhegta u dhigayso calooshooda u dhow:

Kala soocida ka bixitaanka ITB ee xaaladaha degdega ah ee isku eg¶

Sababtoo ah bukaanada qaba curyaanka maskaxda, dhaawacyada laf-dhabarka, ama sclerosis badan ayaa sidoo kale u nugul sepsis kaadi mareenka, ventriculoperitoneal (VP) caabuqyada shunt, dysreflexia autonomic, iyo falcelinta daawada, dhakhaatiirta degdega ah waxay isticmaalaan sifooyinka kiliinikada ee soo socda si ay u kala saaraan ka-noqoshada baclofen ba'an:

Baclofen intrathecal ba'an oo xad dhaaf ah: "jeebka buuxa" iyo khaladaadka barnaamijka¶

Iyadoo ay ka yar tahay ka-noqoshada, ** qaadashada baklofen intrathecal degdega ah** waa marin-haweed degdeg ah iyo xaalad degdeg ah oo neefsasho ah. Qaadashada xad dhaafka ah waxay ku dhacdaa laba goobood oo waaweyn:

1. ** Buuxinta jeebka ee shilalka ah inta lagu jiro bamka caadiga ah ee buuxinta (Khatarta ugu badan):** Marka takhtarka takhtarka dib u buuxiyo bamka 2 ilaa 6 biloodba mar, waxay irbad ka geliyaan maqaarka caloosha silikoonka dhexe ee septum si ay isugu duraan baclofen xoog leh (oo laga yaabo inay ka koobnaato **10,000 ilaa 40,000 oo ah maandooriye) 50 jeer qiyaasta dilaaga ah ee intrathecal). Haddi irbaddu ka siibto ama ay dhaafto septum xitaa wax yar, qayb ka mid ah qiyaastaas aadka u weyn ayaa si toos ah loogu duraa jeebka dufanka hoose ee ku wareegsan bamka. 30 daqiiqo ilaa 4 saacadood ee soo socda, baclofen-ta xooga leh waxay si degdeg ah u nuugtaa dhiiga habaysan, taasoo keenta xad-dhaaf nafta halis galinaya oo degdeg ah (maalmo is-khilaafsan ayaa daba socday ka-noqosho daran sababtoo ah kaydka bamka laftiisa ayaa faaruq ah).
2. Barnaamijka ama qaladka-fiirsashada-isku-dheeli-tirnaan la'aanta: Diyaarinta 2,000 mcg/mL dib u buuxinta sida haddii ay tahay 500 mcg/mL, ama xisaabin khaldan kateetarka priming bolus ka dib dib u eegis qaliinka.

Calaamadaha xad-dhaafka baclofen ba'an (kor u kaca rostral)¶

Marka baclofen xad-dhaaf ah uu kor u faafo (rostrallylaga bilaabo CSF lumbar ilaa lafaha maskaxda iyo kiliyaha maskaxda:

• 30 ilaa 90 daqiiqo ee hore: Si lama filaan ah oo lumay dhammaan lugaha caadiga ah iyo murqaha jirridda (** flaccidity qoto dheer / hypotonia**), dawakhaad, madax-furnaan, lallabbo, iyo fuuqbax xad-dhaaf ah (sialorrhea).
• 1 ilaa 4 saacadood: lulmo aad u daran (somnolence), hadal qaawan (dysarthriaataxia, hypothermia, garaaca wadnaha oo gaabis ah (bradycardia), iyo cadaadiska dhiigga oo hooseeya (hypotension).
• ** Sunta daran:** aan la kicin karin ** kooma**, luminta falcelinta iftiinka ardayga iyo falcelinta corneal (la ekaansho dhimashada maskaxda), suuxdin guud (oo ay sababto presynaptic GABA-B autoreceptor disinhibition ee kortex), iyo ** xirida neefsiga / apnea ***.

Maareynta degdega ah ee baclofen xad dhaafka ah¶

1. ** marinka hawo-mareenka iyo neefsiga ayaa marka hore yimaada:** Ma jiro **ma jirto gabi ahaanba la isku halayn karo oo gaar ah oo ka hortagta reseptor-antagonist ** loogu talagalay xad-dhaafka baclofen (physostigmine waxaa taariikh ahaan la isku dayay natiijooyin aan iswaafaqayn iyo waxyeelooyinka halista ah ee cholinergic sida bradycardia, bronchospasm, iyo suuxdin; flumazenil kama beddelo qaataha GABA-B). Si kastaba ha ahaatee, si degdeg ah ** hawo-qaadista maaskarada iyo xuubka endotracheal **, ka badbaadada xitaa xad-dhaafka badan ee baclofen waxay ku dhowdahay 100 boqolkiiba marka dawadu nadiifiso 24 ilaa 72 saacadood.
2. ** Joogsiga bamka degdega ah ee isbitaalka iyo dheecaanka CSF:** Qolka gargaarka degdega ah, dhakhaatiirtu waxay isla markiiba su'aalo waydiiyaan bamka si ay u joojiyaan faleebada (ama u dejiso heerka ugu hooseeya) **, ka daadi daawada ka soo baxa kaydka bamka (iyo wax kasta oo dareere ah oo ku jira jeebka hoosta hoose haddii jeebka buuxsamo), oo ay sameeyaan ** lumbar jeexan iyada oo loo marayo bamka 3aad 40 ml oo dareere cerebrospinal baclofen ku raran ** (mararka qaarkood waxa lagu beddelaa milix caadi ah oo nadiif ah oo nadiif ah).

Sida isbitaalladu u daaweeyaan ka-noqoshada degdega ah ee ITB marka aad timaado¶

Ogaanshaha waxa ay u baahan tahay waaxda gargaarka degdega ah waxay ka caawisaa daryeel bixiyayaasha inay si cad ugu doodaan bukaanka marka ay imanayaan cusbitaal bulsheed halkaas oo shaqaaluhu ay dhif tahay inay arkaan bambooyinka gudaha:

1. Diyaas sare oo degdeg ah oo xididka GABA-A iyo GABA-B agonism:
2. Sababtoo ah baclofen afka si degdeg ah uma gaari karto xudunta laf dhabarta si aad u daran, dhakhaatiirta degdega ah waxay isla markiiba maamulaan ** benzodiazepines xididkalorazepam ama diazepam IV boluses iyo faleebo joogto ah)**, kuwaas oo dhaqaajiya **GABA-A reseptors *** hoos ee xudunta laf-dhabarta iyo maskaxda, iyagoo ka gudbaya dariiqa madhan ee GABA-B si loo joojiyo qalalka, nasiyo murqaha teetanada, iyo joojinta hyperthermia.
3. Haddii bukaanku wali ku qaadan karo dawooyinka afka, tuubada sanka, ama tuubada gastrostomy (PEG), qiyaasta sare enteral baclofen (sida caadiga ah 10 ilaa 20 mg 4 ilaa 6 saacadoodba) ayaa si isku mid ah loo bilaabaa, oo inta badan lagu kabo afka ** cyproheptadine ** (4 ilaa 8 mg 6 ilaa 8 saacadood kasta) iyo serotonin ka-noqoshada) ama dexmedetomidine/propofol faleebooyinka qaybta daryeelka degdega ah.
4. Dantrolene sodium (IV) waxaa loo isticmaali karaa isku-xidhaha murqaha lafaha lafaha ee naf-gooyada ah iyo hyperthermia haddii benzodiazepines aysan ku filneyn, inkastoo dib u soo celinta GABAergic ay weli tahay daaweynta aasaasiga ah.
5. ** Soo celinta degdega ah ee dhalmada baclofen ee xididdada xididdada:**
6. ** Haddii kaydka bamka uu si fudud u ordo ama uu istaago MRI ka dib:** Dhakhtarka neerfaha, physiatrist (Takhasuska PM&R), ama khabiir ku takhasusay kiliinikada ee soo saaraha ayaa su'aalo waydiiya bamka usha telemetry oo uu sameeyo kayd nadiif ah oo sariirta dhinaceeda ah buuxinta ama dib u bilaabo mootada.
7. Haddii kateetarka la lulo, la gooyo, ama la jabiyo oo qalliinka dib loo dhigo: Dhakhtarku wuxuu samayn karaa sariir dhinaceeda ah ** hal-dubbarid lumbar puncture cirbadeynta baclofen intrathecal-la'aanta ah (sida caadiga ah 50 ilaa 100 micrograms)**
8. ** Fuuqbaxa IV-ga ee daran ee rhabdomyolysis:** Dheecaannada xididada Isotonic (0.9% normal saline) si degdeg ah ayaa loo geliyo si loo ilaaliyo soosaarka kaadida oo sarreeya oo myoglobin laga saaro kelyaha, iyadoo la kormeerayo serum potassium, creatine kinase (CK), iyo xayndaabyada xinjirowga 4 ilaa 6 kasta.

Lambarada degdega ah ee gobolka iyo borotokoolka wakaalada¶

• Mareykanka iyo Kanada: Wac 911. Digniinta Sanduuqa Madow ee Maamulka Cuntada iyo Dawooyinka ee Mareykanka (FDA) ee loogu talagalay baclofen intrathecalLioresal Intrathecal / Gablofen) waxa uu amrayaa in degdeg loo dhigo cusbitaal deg-deg ah oo looga shakisan yahay ka bixitaan, taas oo muujinaysa in baclofen afka kaligiis aanu si la isku halleyn karo uga hortagi karin horumarka loo maro rhabdomyolysis, xubnaha habdhiska badan oo fashilma, iyo dhimasho. Dhakhaatiirtu waxay sidoo kale la xiriiri karaan 24-saac ee Adeegyada Farsamada ee Adeegyada Farsamada ee Degdegga ah (1-800-707-0933 gudaha Mareykanka) si ay bogga ugu qoraan injineerka bukaan-socodka deegaanka oo wata kiniin barnaamij ah waaxda gurmadka.
• United Kingdom: Wac 999. NHS England Xeerarka Komishanada Kiliinikada ee Intrathecal Baclofen Therapy iyo Tilmaamaha Spasticity NICE si toos ah ugu wareejinta neurosciences gobolka ama xarunta dhaawaca laf dhabarta, IV benzodiazepine titration, iyo su'aalo bamka degdega ah.
• Midowga Yurub: Wac 112. Akadeemiyada Yurub ee Neerfaha (EAN) iyo Hay'adda Dawooyinka Yurub (EMA) borotokoollada waxay xooga saarayaan qiyaasta sare ee IV benzodiazepines, qaboojinta firfircoon ee dibadda, iyo boluses samatabbixin degdeg ah oo gudaha ah iyada oo loo marayo daloolinta lumbar marka tuubada tuubada tuubada ay sababto bixitaan daran.
• Australia iyo New Zealand: Wac 000 gudaha Australia ama 111 gudaha New Zealand. Maamulka Alaabada Daawaynta (TGA) iyo digniinaha badbaadada neuromodulation ee ANZCA waxay amar ku bixinayaan qiimaynta degdega ah ee cusbitaalka alaarmiga bamka laba-tone ah ama cuncun/hypertonia oo aan la garanayn.
• Hindiya iyo Aasiya-Pacific:** Wac 112 gudaha Hindiya, 995 gudaha Singapore, 119 gudaha Japan iyo Kuuriyada Koonfureed, ama 999 gudaha Malaysia iyo Hong Kong. Waddamada kale, kala tasho buug-tusahayaga lambarada degdega ah ee caalamiga ah.

Su'aalaha soo noqnoqda¶

Waa maxay sababta ka-baxa baclofen intrathecal ay keento cuncun jidhka oo dhan ah oo daran oo aan lahayn finan?¶

Geeska dorsal ee xudunta lafdhabarta bini'aadamka, interneurons-ka-hortagga khaaska ah waxay isticmaalaan GABA-B reseptors si ay u ilaaliyaan calaamadaha cuncunka ee dariiqyada dareemayaasha xaaladaha caadiga ah. Marka bukaanku helo baclofen intrathecal joogto ah bilo ama sannado oo socodka si lama filaan ah u joogsado, kuwa qabayaasha laf-dhabarka ee GABA-B ayaa si buuxda looga tagaa, taasoo keenta in neerfayaasha cuncunka laf-dhabarta ay si kedis ah oo aan joogsi lahayn u gubaan. Sababtoo ah cuncunku wuxuu ka soo baxaa gudaha laf-dhabarka halkii uu ka soo saari lahaa histamine ee maqaarka, ma jiraan finan ama casaan, iyo antihistamines sida diphenhydramine (Benadryl) ma shaqeeyaan.

Ma ku siin karaa kiniinno dheeri ah oo afka laga qaato guriga dhexdiisa haddii matoorka baclofen ee ilmahaygu bilaabo dhawaaq ama uu dhammaado?¶

Haddii bukaanku si buuxda u soo jeedo oo uu si badbaado leh u liqo, waa inaad isla markiiba siisaa qiyaasta badbaadinta degdega ah ee afka laga qaato ee baclofen, laakiin waa inaad si toos ah u tagtaa waaxda gurmadka. Baclofen la liqay ayaa si aad u liidata uga gudubta xannibaadda dhiigga-maskaxda, taasoo gaadhaysa in ka yar boqol-meel gaadhka dareeraha laf-dhabarka halkii milligram marka la barbar dhigo faleebada gudaha. Ku-tiirsanaanta kiniinka baclofen ee afka kaligiis guriga waxay keentay dhimasho badan oo la diiwaan galiyay oo ka timid suuxdin la'aan, 41 C (106 F) hyperthermia, iyo xubno badan oo hawlgab ah.

Haddii bamka baclofen uusan dhawaaqin, taasi miyay caddaynaysaa in bukaanku aanu ka bixin baclofen?¶

Maya. In ka badan 70 boqolkiiba kiisaska ka bixitaanka baclofen intrathecal intrathecal waxay dhacaan iyada oo aan wax digniin ah laga maqlin bamka. Kumbuyuutarka gudaha ee bamka ayaa og oo kaliya in batarigu awood leeyahay iyo in kale, haddii kaydiyaha kaydka uu sheegay in dareeruhu hadhsan yihiin, iyo in rotor-ku rotor yahay; ma laha wax dareen ah gudaha tuubada kateetarka dabacsan ee u socota laf dhabarta. Haddii kateeterku qandho, dillaaco, ka go'o sanbabada tuubada, ama ka soo baxdo kanaalka laf-dhabarka oo galay baruurta dambe, bamka ayaa si aamusan u sii lulanaya halka daawadu eber gaarto xudunta laf dhabarta.

Maxay takhaatiirtu u siinayaan lorazepam xididka ama diazepam (Valium) si ay baclofen uga baxdo marka ay dawooyin kala duwan yihiin?¶

Baclofen waxay ka shaqeysaa soo-dhoweeyayaasha GABA-B, kuwaas oo si ba'an u yaraa oo aan loo dareemin inta lagu jiro daawaynta bamka intrathecal dabadheeraad ah. Benzodiazepines sida diazepam, lorazepam, iyo midazolam waxay si degdeg ah ugu gudbaan habka dhexe ee neerfayaasha marka xididada la siiyo oo waxay dhaqaajiyaan GABA-A reseptors ee isla isla maskaxda dareemayaasha laf-dhabarka iyo waddooyinka maskaxda. Tani waxay dib u soo celinaysaa kanaalka chloride-ka xannibaya ee nidaamka dareenka daqiiqado gudahood, joojinta muruqyada rabshadaha, suuxdinta, iyo hyperthermia inta ay dhakhaatiirtu hagaajinayaan bamka.

Waa maxay "buuxinta jeebka" inta lagu jiro ballan buuxinta bamka baclofen, maxayse yihiin calaamadaha digniinta?¶

Buuxinta jeebka waxay dhacdaa marka cirbadda dib-u-buuxinta ay simbiriirto ama ay ku guuldareysato inay dhex gasho septum-ka silikoonka dhexe ee bamka, si lama filaan ah ugu duri millilitir oo baclofen dareere ah oo aad u urursan oo ku jira unugyada jilicsan ee jilicsan ee maqaarka caloosha hoostiisa halkii ay ka ahaan lahayd gudaha taangiga titanium. Calaamadaha digniinta waxaa ka mid ah barar aan caadi ahayn ama barar aan caadi ahayn oo ka soo baxa bamka inta lagu jiro buuxinta, oo ay ku xigto 30 daqiiqo ilaa 4 saacadood gudahood muruqa muruqa oo qoto dheer, hurdo badan, hadal gariir, neefsasho gaaban, iyo miyir-beel. Qof kasta oo si aan caadi ahayn u lulo ama lulmo saacado gudahood marka bamka la buuxiyo wuxuu u baahan yahay ambalaas isla markiiba.

Ilaha iyo hanuuninta rasmiga ah¶

• ** Maamulka Cuntada iyo Dawooyinka ee Maraykanka (FDA) & Neuromodulation Medtronic:** *Qoritaanka Macluumaadka iyo Digniinta Sanduuqa ee Lioresal Intrathecal / Gablofen (Baclofen Injection) iyo SynchroMed II/III Nidaamyada Faleebo ee Barnaamijsan
• ** Coffey RJ iyo al. (* Kaydka Daawada Jirka iyo Dhaqancelinta*):**
• ** Saulino M et al. (Neuromodulation: Technology at the Neural Interface):**
• ** Adeegga Caafimaadka Qaranka (NHS England) & Machadka Qaranka ee Caafimaadka iyo Wanaagsanaanta Daryeelka (NICE, Boqortooyada Ingiriiska):** * Siyaasadda Komishinka Caafimaadka: Intrathecal Baclofen ee Baaxadda daran ee dadka waaweyn iyo carruurta*.
• ** Watve SV iyo al. (Xadhka Laf-dhabarta):** *Maaraynta Xad-dhaafka Ba'an iyo Xad-gudubka Baclofen ee Intrathecal: Lumbar Puncture CSF Drainage iyo ICU ee Xeerarka Daryeelka Taageerada *.

Tilmaamaha la xidhiidha¶

• Serotonin syndrome, neuroleptic malignant syndrome, iyo isdhexgalka daroogada
• Disreflexia iskeed u taagan ee dhaawaca laf dhabarta
• Xaaladda suuxdin, suuxdin dabadheeraad ah, iyo dawooyinka samatabbixinta
• Dhaawac kelyo oo ba'an, rhabdomyolysis, iyo kala soocida firfircoonida kaadida mugdiga ah
• Isticmaalka CPR ee dadka waaweyn iyo AED