Kukondoweza kwa ubongo

Kukondoweza kwakuzama kwa ubongo (DBS) imagwiritsa ntchito chida chotchedwa neurostimulator kuti chitsogolere magetsi kumadera aubongo omwe amayendetsa kayendedwe, kupweteka, kusinthasintha, kulemera, malingaliro okakamiza, ndikudzuka chikomokere.

Dongosolo la DBS limakhala ndi magawo anayi:

• Chingwe chimodzi kapena zingapo, zotchinga zotchedwa lead, kapena maelekitirodi, zomwe zimayikidwa muubongo
• Anangula kukonza zotsogolera ku chigaza
  
• Neurostimulator, yomwe imatulutsa mphamvu yamagetsi. Chotsitsimutsacho chimakhala chofanana ndi chomenyera mtima. Nthawi zambiri amaikidwa pansi pa khungu pafupi ndi kolala, koma amatha kuyikidwa kwina kulikonse m'thupi
• Mwa anthu ena waya wina wocheperako, wotsekedwa wotchedwa chowonjezera amawonjezeredwa kuti alumikizane ndi zotsogolera ku neurostimulator

Opaleshoni yachitika kuyika gawo lirilonse la dongosolo la neurostimulator. Kwa akulu, makinawa amatha kuyikidwa mu 1 kapena 2 magawo (maopaleshoni awiri osiyana).

Gawo 1 nthawi zambiri limachitidwa pansi pa anesthesia yakomweko, kutanthauza kuti ndinu ogalamuka, koma opanda ululu. (Kwa ana, anesthesia ambiri amaperekedwa.)

• Tsitsi limodzi pamutu panu limametedwa.
• Mutu wanu umayikidwa mu chimango chapadera pogwiritsa ntchito zikuluzikulu zazing'ono kuti muzisunga pochita izi. Mankhwala osungunula amagwiritsidwa ntchito pomwe zomangira zimalumikizana ndi khungu. Nthawi zina, njirayi imachitika mu makina a MRI ndipo chimango chimakhala pamwamba pamutu panu osati mozungulira mutu wanu.
• Mankhwala ochotsa mankhwala amagwiritsidwa ntchito pamutu panu pomwe dotoloyu amatsegula khungu, kenako kuboola kabowo pang'ono ndi kuyika kutsogolera kudera linalake laubongo.
• Ngati mbali zonse ziwiri zaubongo wanu zikuthandizidwa, dokotalayo amatsegula mbali iliyonse ya chigaza, ndipo amalowetsapo njira ziwiri.
• Zofunikira zamagetsi zimafunikira kutumizidwa kudzera kutsogola kuti zitsimikizike kuti zimalumikizidwa ndi ubongo zomwe zimayambitsa matenda anu.
• Mutha kufunsidwa mafunso, kuwerenga makadi, kapena kufotokoza zithunzi. Muthanso kufunsidwa kuti musunthire miyendo kapena mikono yanu. Izi zikuyenera kuwonetsetsa kuti ma elekitirodi ali pamalo oyenera ndipo zomwe akuyembekeza zakwaniritsidwa.
  

Gawo 2 limachitika pansi pa anesthesia, kutanthauza kuti mukugona komanso simumva kupweteka. Nthawi yomwe gawoli limachitika limadalira komwe ubongo uyikidwire.

• Dokotalayo amatsegula kabowo kakang'ono (kagawo kakang'ono), nthawi zambiri kamakhala pansi pa kolala ndipo amaikapo minyewa. (Nthawi zina amaikidwa pansi pa khungu pachifuwa chapansi kapena m'mimba.)
• Chingwe chowonjezera chimakonzedwa pansi pa khungu la mutu, khosi, ndi phewa ndipo chimalumikizidwa ndi neurostimulator.
• Kutumbuka kwatsekedwa. Chipangizocho ndi mawaya sizimawoneka kunja kwa thupi.

Akalumikizidwa, magetsi amagetsi amayenda kuchokera ku neurostimulator, kudzera pa waya wowonjezera, kupita patsogolo, ndikulowa muubongo. Tinthu ting'onoting'ono timeneti timasokoneza ndikuletsa chizindikiro chamagetsi chomwe chimayambitsa zizindikiro za matenda ena.

DBS imachitika kawirikawiri kwa anthu omwe ali ndi matenda a Parkinson pomwe zizindikirazo sizingayang'aniridwe ndi mankhwala. DBS siyichiza matenda a Parkinson, koma itha kuthandiza kuchepetsa zizindikilo monga:

• Kugwedezeka
• Kukhala okhwima
• Kuuma
• Kusuntha pang'ono
• Mavuto oyenda

DBS itha kugwiritsidwanso ntchito kuthana ndi izi:

• Kukhumudwa kwakukulu komwe sikukuyankha bwino mankhwala
• Matenda osokoneza bongo
• Ululu wosatha (ululu wosatha)
• Kunenepa kwambiri
• Kugwedeza kayendedwe komwe sikungayang'aniridwe ndipo chifukwa chake sichidziwika (kunjenjemera kofunikira)
• Matenda a Tourette (nthawi zambiri)
• Kuyenda kosalamulirika kapena kochedwa (dystonia)

DBS imawerengedwa kuti ndiyotetezeka komanso yothandiza ikachitika mwa anthu abwino.

Zowopsa zakukhazikitsidwa kwa DBS zitha kuphatikizira izi:

• Matupi awo sagwirizana ndi magawo a DBS
• Vuto lakukhazikika
• Chizungulire
• Matenda
• Kutulutsa kwa madzimadzi a cerebrospinal, komwe kumatha kubweretsa mutu kapena meninjaitisi
• Kutayika bwino, kuchepa kwa mgwirizano, kapena kutayika pang'ono
• Zomverera ngati zowopsa
• Mavuto olankhula kapena masomphenya
• Kupweteka kwakanthawi kapena kutupa pamalo pomwe chida chidayikidwapo
• Kulira pang'ono pankhope, mikono, kapena miyendo
• Kutuluka magazi muubongo

Mavuto amathanso kupezeka ngati mbali zina za dongosolo la DBS zitha kapena kusuntha. Izi zikuphatikiza:

• Chipangizo, lead, kapena waya zimaduka, zomwe zimatha kubweretsa kuchitanso opareshoni ina m'malo mwa gawo losweka
• Batri ikulephera, zomwe zingapangitse kuti chipangizocho chisiye kugwira ntchito moyenera (batiri lozolowereka limakhala zaka 3 mpaka 5, pomwe batire loyambiranso limatha zaka 9)
• Waya womwe umalumikiza chopatsa mphamvu kutsogolera muubongo umaduka pakhungu
• Gawo la chipangizocho lomwe limayikidwa muubongo limatha kusiya kapena kusamukira kumalo ena muubongo (izi ndizochepa)

Zowopsa zomwe zingachitike pakuchita opaleshoni yaubongo ndi izi:

• Kuundana kwamagazi kapena kutuluka magazi muubongo
• Kutupa kwa ubongo
• Coma
• Chisokonezo, nthawi zambiri chimangokhala kwamasiku kapena milungu yambiri
• Matenda mu ubongo, bala, kapena chigaza
• Mavuto polankhula, kukumbukira, kufooka kwa minofu, kusamala, masomphenya, kulumikizana, ndi ntchito zina, zomwe zitha kukhala zazifupi kapena zosatha
• Kugwidwa
• Sitiroko

Zowopsa za aneshesia ndi:

• Zomwe zimachitika ndi mankhwala
• Mavuto kupuma

Muyesedwa kwathunthu.

Dokotala wanu adzaitanitsa mayeso ambiri a labotale ndi kujambula, kuphatikiza CT kapena MRI scan. Mayesowa amachitika kuti athandize dokotalayo kudziwa gawo lenileni la ubongo lomwe limayambitsa zizindikirazo. Zithunzizo zimagwiritsidwa ntchito kuthandiza dokotalayo kutsogolera ubongo mu opaleshoni.

Muyenera kuwona akatswiri angapo, monga katswiri wamaubongo, neurosurgeon, kapena psychologist, kuti muwonetsetse kuti njirayi ndi yoyenera kwa inu ndipo ili ndi mwayi wopambana.

Musanachite opaleshoni, uzani dokotala wanu kuti:

• Ngati mungakhale ndi pakati
• Ndi mankhwala ati omwe mukumwa, kuphatikiza zitsamba, zowonjezera mavitamini, kapena mavitamini omwe mudagula pa-counter popanda mankhwala
• Ngati mwakhala mukumwa mowa wambiri

M'masiku asanachitike opareshoni:

• Wothandizira zaumoyo wanu akhoza kukuwuzani kuti musiye kumwa magazi pang'ono. Izi zikuphatikizapo warfarin (Coumadin, Jantoven), dabigatran (Pradaxa), rivaroxaban powder (Xarelto), apixaban (Eliquis), clopidogrel (Plavix), aspirin, ibuprofen, naproxen, ndi ma NSAID ena.
• Ngati mukumwa mankhwala ena, funsani omwe akukuthandizani ngati zili bwino kumwa tsiku lomwelo kapena masiku asanakwane opaleshoni.
• Ngati mumasuta, yesetsani kusiya. Funsani omwe akukuthandizani kuti akuthandizeni.

Usiku usanachitike komanso tsiku la opareshoni, tsatirani malangizo awa:

• Osamwa kapena kudya chilichonse kwa maola 8 mpaka 12 asanachite opareshoni.
• Kusamba tsitsi lanu ndi shampu yapadera.
• Tengani mankhwala omwe wothandizirayo adakuwuzani kuti mutenge ndi madzi pang'ono.
• Kufika kuchipatala nthawi yake.

Mungafunike kukhala mchipatala kwa masiku atatu.

Dokotala amatha kupereka mankhwala opha tizilombo kuti apewe matenda.

Mudzabwerera ku ofesi ya dokotala tsiku lina pambuyo pa opaleshoni. Paulendowu, yotsegulira imatsegulidwa ndipo kuchuluka kwa kukondoweza kumasinthidwa. Kuchita opaleshoni sikofunikira. Izi zimatchedwanso kuti pulogalamu.

Lumikizanani ndi dokotala ngati mukupanga zotsatirazi pambuyo pa opaleshoni ya DBS:

• Malungo
• Mutu
• Kuyabwa kapena ming'oma
• Minofu kufooka
• Nseru ndi kusanza
• Dzanzi kapena kumva kulasalasa mbali imodzi ya thupi
• Ululu
• Kufiira, kutupa, kapena kukwiya pamalo aliwonse opangira ma opaleshoni
• Kulephera kuyankhula
• Mavuto masomphenya

Anthu omwe ali ndi DBS nthawi zambiri amachita bwino panthawi yochita opaleshoniyi. Anthu ambiri amasintha kwambiri pazizindikiro zawo komanso moyo wawo. Anthu ambiri amafunikirabe kumwa mankhwala, koma pamlingo wochepa.

Kuchita opaleshoniyi, komanso kuchitidwa opaleshoniyi, ndiwowopsa kwa anthu azaka zopitilira 70 komanso omwe ali ndi matenda monga kuthamanga kwa magazi ndi matenda omwe amakhudza mitsempha yamaubongo. Inu ndi dokotala muyenera kulingalira mosamala phindu la opaleshoniyi motsutsana ndi zoopsa zake.

Njira za DBS zitha kusinthidwa, ngati zingafunike.

Kukondoweza kwa Globus pallidus kwambiri; Kukondoweza kwambiri muubongo; Kukondoweza kwa ubongo wa Thalamic; DBS; Ubongo wokhudzidwa ndi ubongo

Johnson LA, Vitek JL. Kukondoweza kwakuya kwamaubongo: njira zogwirira ntchito. Mu: Winn HR, mkonzi. Opaleshoni ya Youmans ndi Winn Neurological. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2017: chap 91.

Lozano AM, Lipsman N, Bergman H, ndi al. Kukondoweza kwakuya kwamaubongo: zovuta zapano ndi mayendedwe amtsogolo. Nat Rev Neurol. 2019; 15 (3): 148-160 (Pamasamba) PMID: 30683913 pubmed.ncbi.nlm.nih.gov/30683913/.

Rundle-Gonzalez V, Peng-Chen Z, Kumar A, Okun MS. Kukondoweza kwa ubongo. Mu: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, olemba. Neurology ya Bradley mu Kuchita Zachipatala. Wachisanu ndi chiwiri. Philadelphia, PA: Elsevier; 2016: chap 37.