 Wysłany: Pon 2:31, 16 Kwi 2007 Temat postu: |
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| Wysłany: Wto 1:38, 10 Kwi 2007 Temat postu: |
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| Wysłany: Sob 16:05, 07 Kwi 2007 Temat postu: |
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| Wysłany: Czw 1:16, 05 Kwi 2007 Temat postu: wlbpsx |
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| Wysłany: Wto 4:21, 03 Kwi 2007 Temat postu: swmhufi |
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| Wysłany: Pią 10:37, 30 Mar 2007 Temat postu: tokibmi |
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| Wysłany: Sob 15:51, 17 Mar 2007 Temat postu: usmlnii |
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| Wysłany: Sob 15:51, 17 Mar 2007 Temat postu: qyxmxdm |
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| Wysłany: Śro 9:39, 14 Mar 2007 Temat postu: |
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| Wysłany: Pon 7:40, 05 Mar 2007 Temat postu: thfmvl |
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| Wysłany: Pon 16:57, 10 Lip 2006 Temat postu: Profilaktyka zawałów serca i udarów mózgu |
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| Neurorehabilitacja
RATUJ SIĘ KTO CHCE I MOŻE !!! Zanim będzie za poźno. Rocznie zapada i umiera z powodu chorób cywilizacyjnych w USA i Europie miliony ludzi. Najbardziej smutny jest fakt, że aby nabawić się tych chorób i pozbawić ich skutków ludzie płacą podwójnie - aby się "żle prowadzić" i aby "się z tego wyleczyć". Stosując niezdrowy tryb życia i odżywiania w pogoni za posadami, ze stresem zapracowujemy się wydając pieniądze na powsyanie swojej miażdzycy, cukrzycy regulacyjnej etc.. Pracujemy tylko teoretycznie z myślą o swojej rodzinie ale tak naprawde w efekcie przeciw nieje bo nasza rodzina i dzieci nic z nas nie mają. A na koniec jesteśmy śmiertelnie chorzy i okazuje sie, że nikt nie wie co z nami począć - bo wsszyscy maja wazniejsze sprawy w zdobywaniu własnej maiżdzycy paradoksal;nie w tym samym procesie. Może warto zasatanowic się jak przeprogramować swoje życie i jak uniknąć stresu i błedów odżywiania jednocześnie pracując skutecznie na rzecz swojej rodziny. Żyjemy w ultra-nowoczesnym świecie i taka zmiana jest możliwa dzisiaj w dobie rozwoju quantum computing i diety kongresowej Orlando - ale o tym sposobie powiemy przy sposobności spotkania z naszym zespołem Neurorehabilitacji w Centrum Warszawy. Zawał serca i udar mózgu są skutkami szkodliwego trybu życia. Definicje: Zawał mięśnia sercowego (łac. Infarctus myocardii), ostra, groźna choroba serca w której powstaje obszar martwicy mięśnia sercowego w wyniku jego niedotlenienia. Zawał mięśnia sercowego jest postacią choroby niedokrwiennej mięśnia sercowego (obok: nagłej śmierci sercowej, dławicy sercowej, przewlekłej choroby niedokrwiennej serca czyli tzw. "kardiomiopatii" niedokrwiennej). Przyczyny Do zawału mięśnia sercowego najczęściej dochodzi na tle miażdżycy tętnic wieńcowych w przebiegu choroby wieńcowej (często utożsamianej z chorobą niedokrwienną serca). Ognisko miażdżycy w ścianie tętnicy wieńcowej nazywane jest blaszką miażdżycową. Powoduje ona zwężenie światła tego naczynia i ograniczenie przepływu krwi - często w tych przypadkach pacjent odczuwa objawy dławicy piersiowej przy wysiłku czy zdenerwowaniu. Mechanizmem, który bezpośrednio prowadzi do zawału jest pęknięcie lub krwotok do blaszki miażdżycowej albo narastanie zakrzepu na jej powierzchni. Jeśli średnica naczynia zostanie zwężona powyżej 2/3 - 3/4 jego średnicy (krytyczne zwężenie tętnicy wieńcowej) wówczas zwykle dokonuje się zawał mięśnia sercowego w obszarze zaopatrywanym przez dane naczynie (mięsień sercowy ulega niedokrwieniu i w ciągu kilku-kilkunastu minut rozpoczyna się jego nieodwracalne uszkodzenie, które w wypadku nieprzywrócenia dopływu krwi prowadzi do powstania ogniska martwicy tego fragmentu mięśnia sercowego). Krytyczne zwężenie światła (powyżej 2/3 średnicy) prawej tętnicy wieńcowej powoduje: * zawał ściany dolnej * zawał tylnej lewej komory serca * zawał tylnej części przegrody międzykomorowej. Krytyczne zwężenie światła gałęzi okalającej lewej tętnicy wieńcowej powoduje: * zawał ściany przedniej * zawał ściany bocznej zwężenie gałęzi międzykomorowej przedniej powoduje: * zawał w przedniej części przegrody * zawał ściany przedniej lewej komory serca. W rzadkich przypadkach przyczyną zawału może być zator tętnicy wieńcowej, zmiany zapalne tętnic wieńcowych (np. w kile) lub neuropochodne zaburzenia w regulacji przepływu krwi przez układ naczyń wieńcowych. Ogniskowa martwica mięśnia sercowego może pojawić się także w przebiegu wstrząsu i przy dużym przeroście mięśnia sercowego. Czynniki ryzyka Zawał mięśnia sercowego występuje na ogół po 40 roku życia, częściej u mężczyzn niż u kobiet, zwłaszcza u osób otyłych i z nadciśnieniem tętniczym. Do czynników ryzyka należą: * starzenie się * płeć męska * palenie tytoniu * nadciśnienie tętnicze i inne przyczyny przerostu lewej komory serca * wysoki poziom cholesterolu * brak aktywności fizycznej * osobowość typu A Osobowość typu A, WZA (wzór zachowania A), zachowanie typu A to typ osobowości, charakteryzującej się wysokim poziomem stresu, wywołanym presją czasu, tendencją do zachowań rywalizacyjnych, wysokim poziomem ambicji, agresywnością i wrogością wobec innych. Osoba z WZA postrzega otoczenie jako zagrażające i żyje w nieustannej reakcji alarmowej (fazie stresu). W kategoriach psychologicznych konstruktów teoretycznych WZA charakteryzuje neurotyczna ekstrawersja (EPQ-R) i niski poziom ugodowości (NEO-FFI). Hipoteza o występowaniu osobowości typu A, została po raz pierwszy postawiona przez Oslera. Opiera się na założeniu, że istnieje związek osobowości człowieka z występujacymi u niego chorobami układu krążenia. Amerykańscy kardiolodzy, Meyer Friedman i Ray Rosenman prowadzili badania, które dowiodły, że zapadalność na choroby serca jest dwukrotnie częstsza u osób nastawionych na dążenie do perfekcji i żyjących w ciągłym pośpiechu. Prowadzono wiele badań podłużnych poświęconych osobowości typu A i ryzyku zachorowania na CWS: * Western Collaborative Study (1960-1975) - prześledzono stan zdrowia 3200 robotników, CWS wystąpiła 2,2 raza częściej u osób zaklasyfikowanych do WZA * Framingham Heart Study - badania 1600 kobiet i mężczyzn przez 8 lat, CWS wystąpiła 3 razy częściej u osób zaklasyfikowanych do WZA * The Belgian Heart Disease Prevention Trial - badania 2000 kobiet i mężczyzn, CWS wystąpiła 1,9 raza częściej u osób zaklasyfikowanych do WZA WZA jest przeciwieństwem WZB, typu osobowości zdrowej somatycznie. Można zdiagnozować osobowość typu A lub B za pomocą standardowego wywiadu dotyczącego stresu lub wypełnienie poniższego kwestionariusza: Test typu osobowości A 1. Czy twój współmałżonek, lub przyjaciel mówił ci kiedykolwiek, że jesz za szybko? * Tak, często (Typ A) * Tak, raz lub dwa (Typ B) * Nie (Typ B) 2. Jak Twój współmałżonek (lub przyjaciel) ocenia twój ogólny poziom aktywności? * Jestem zbyt aktywny, powinienem zwolnić tempo (Typ A) * Jestem zbyt powolny, powinienem być bardziej aktywny (Typ B) 3. Czy kiedykolwiek wyznaczasz sobie terminy ukończenia jakiegoś zadania lub zadań do wykonania w pracy lub w domu? * Tak, raz w tygodniu lub częściej (Typ A) * Tylko czasami (Typ B) * Nie (Typ B) 4. Kiedy jesteś zajęty pracą i ktoś (nie twój szef) ci przerywa, to jak się czujesz? * Czuję się naprawdę zirytowany, gdyż większość takich przerw jest zbędna (Typ A) * Czuję się dobrze, po przerwie czuję się lepiej (Typ B) Objawy Podmiotowe (subiektywne) * bardzo silny ból w klatce piersiowej, nieustępujący po odpoczynku i po nitratach (nitrogliceryna), piekący, dławiący, rozpierający, promieniujący do żuchwy, lewej kończyny górnej (lub obu) * lęk przed śmiercią * duszność Przedmiotowe (obiektywne) * bladość * lepki pot * spadek ciśnienia tętniczego * tachykardia - wzrost częstości akcji serca, lub inne zaburzenia tętna * pobudzenie ruchowe W badaniach dodatkowych * zmiany elektrokardiograficzne (badanie decyzyjne przy rozpoznawaniu zawału) * obecność markerów zawału we krwi (badanie decyzyjne przy rozpoznawaniu zawału) * podwyższony poziom glukozy we krwi * przyspieszone opadanie krwinek (OB) * wzrost liczby leukocytów we krwi obwodowej (zwiększona leukocytoza) Postacie kliniczne zawału * bólowa * obrzękowa (występują objawy obrzęku płuca) * wstrząsowa (objawy wstrząsu kardiogennego) * arytmiczna (zaburzenia rytmu lub przewodnictwa) * brzuszna (gastryczna, gdy dotyczy ściany tylnej) * neurologiczna (objawy niedowładu, dezorientacja i zaburzenia świadomości) * bezbólowa * bezobjawowa Podział kliniczny zawału (ostre zespoły wieńcowe) Z punktu widzenia praktycznego, obecnie ostre niedokrwienie mięśnia sercowego nazywa się ostrym zespołem wieńcowym (OZW) (ang. ACS - Acute Coronary Syndromes) i dzieli się na następujące jednostki kliniczne, gdyż implikuje to sposób postępowania leczniczego: * niestabilna choroba wieńcowa (ang. UA - Unstable Angina) * zawał mięśnia sercowego o bez uniesienia odcinka ST elektrokardiogramu (ang. NSTEMI - Non ST-elevation Myocardial Infarction) o z uniesieniem odcinka ST elektrokardiogramu - (ang. STEMI - ST-Elevation Myocardial Infarction) * nagły zgon sercowy Niestabilną chorobą wieńcową (UA) oraz zawał serca bez uniesienia ST (NSTEMI) zalicza się jednej grupy, gdyż oba te stany chorobowe powstają z podobnej przyczyny - pęknięcia blaszki miażdżycowej z następowym narastaniem zakrzepu płytkowego, co doprowadza do zwężenia, ale nie do całkowitego zamknięcia światła naczynia. W przypadku całkowitego zamknięcia naczynia dochodzi do zawału mięśnia sercowego z uniesieniem odcinka ST (STEMI) lub bardziej morfologicznie rzecz ujmując - zawału pełnościennego lub w szczególnie dramatycznych wypadkach - nagłego zgonu sercowego. Kody Międzynarodowej Statystycznej Klasyfikacji Chorób i Problemów Zdrowotnych ICD-10 dotyczące zawału serca: (I21) Ostry zawał serca (I22) Ponowny zawał serca ("dorzut") (I23) Powikłania występujące w czasie ostrego zawału serca (krwiak osierdzia, ubytek przegrody międzyprzedsionkowej lub międzykomorowej, pęknięcie ściany serca, strun ścięgnistych, mięśnia brodawkowatego, skrzeplina przedsionka, uszka przedsionka i komory) Rozpoznanie Według aktualnych zaleceń WHO, zawał można rozpoznać tylko i wyłącznie na podstawie przekroczenia norm stężeń biochemicznych markerów uszkodzenia mięśnia sercowego we krwi. Najwcześniej do normy dochodzi fala Pardeego. Załamek T normalizuje się w ciągu kilku miesięcy, a dziura elektryczna może pozostać na stałe w zapisie EKG jako ślad po przebytym zawale. W zapisie EKG różnicować można kolejne warstwy ogniska zawałowego w ścianie mięśnia sercowego (od "wewnątrz"): * strefa martwicy - patologiczny załamek Q (dłuższy niż 0,1 ms oraz wyższy niż 25% załamka R) * strefa uszkodzenia - fala Pardeego, uniesiony odcinek ST * strefa niedotlenienia - ujemny załamek T Powyższe 3 strefy i ich obraz w EKG są charakterystycznymi cechami zawału serca w elektrokardiografii. W zależności od lokalizacji zawału poszukujemy ich w różnych odprowadzeniach, a na tej podstawie wysuwamy wnioski na temat lokalizacji zawału: * zawał przedniej ściany serca (łac. infarctus myocardii parietis anterioris) - odprowadzenia V3, V4 * zawał przednio-boczny (łac. infarctus myocardii anterolateralis) - odprowadzenia V3-V6, I, aVL * zawał przednio-przegrodowy (łac. infarctus myocardii anteroseptalis) - odprowadzenia V1, V2 * zawał rozległy przedni (łac. infarctus myocardii parietis anterioris externus) - odprowadzenia V1-V6, I, aVL * zawał dolnej ściany serca (łac. infarctus myocardii parietis inferioris) - odprowadzenia II, III, aVF * zawał tylnej ściany serca (łac. infarctus myocardii parietis posterioris) - odprowadzenia V1, V2 (UWAGA! "Efekt lustra", tzn. załamek T dodatni, zamiast ujemnego czy wysoki załamek R zamiast patologicznego załamka Q) Enzymy wskaźnikowe w zawale serca Diagnostyka biochemiczna zawału mieśnia sercowego opiera się na oznaczaniu w surowicy krwi enzymów i innych białek uwalnianych do krwi w wyniku martwicy kardiomiocytów. W zależności od metod oznaczania tych białek, wartości referencyjne i wartości odcięcia mogą się znacznie różnić pomiędzy poszczególnymi ośrodkami. Enzymy wczesne: * Sercowe białko wiążące kwasy tłuszczowe czyli h-FABP (heart-fatty acids binding protein) - pojawia się w osoczu już po 30-210 min. od wystąpienia objawów, szczyt stężenia osiąga po ok. 6 godzinach i po 24 godzinach powraca do wartości wyjściowych * Mioglobina pojawia się 2-3 godziny od początku objawów, osiąga szczyt po 12 godzinach i powraca do wartości wyjściowych po 18-24 godzina * cTnT i cTnI (izoformy troponin swoiste dla mięśnia sercowego) - stężenie podnosi się od 6 godziny po zawale, osiagając szczyt po ok. 12 godz, normalizuje się pomiędzy 6 a 10 dniem * CPK lub CK (kinaza kreatynowa) - poziom wzrasta 2-5 godzin po zawale, szczyt osiąga 24 godziny po zawale, a normalizuje się w 2-3 dobie * CK-MB - frakcja CPK z dimerami M i B, specyficzna dla mięśnia sercowego * AspAt (aminotransferaza asparaginianowa) - podnosi się w pierwszej dobie, szczyt osiąga 24-72 godzin, normalizuje się po 5-7 dniach * AlAt (aminotransferaza alaninowa) - podnosi się w 2-3 dobie, normalizuje się w 3-7 dobie Enzymy późne: * LDH (dehydrogenaza mleczanowa) - osiąga szczyt ok. czwartego dnia, a normalizuje się od 8 - 14 dni * GGTP (gammaglutamylotranspeptydaza) - wzrasta w czwartej dobie, szczyt osiąga w 2-3 tygodniu, a normalizuje się po ok. 5-6 tygodniach. Powikłania Wczesne * zgon, najczęściej w wyniku nagłego zatrzymania krążenia w mechaniźmie migotania komór * wstrząs kardiogenny * poszerzenie sie ogniska zawałowego (najczęściej w wyniku poszerzenia sie obszaru uskodzenia reperfuzyjnego lub wstecznego narastania zakrzepicy w zajętej tętnicy wieńcowej) * zaburzenia rytmu i przewodnictwa * ostra niewydolność krążenia z obrzękiem płuc * ostra dyskineza mięśnia sercowego (ostry tętniak serca) * pęknięcie ściany serca (tamponada serca) lub przegrody międzykomorowej * pęknięcie mięśnia brodawkowatego i ostra niewydolność zastawki mitralnej Późne * zakrzepica przyścienna w komorze nad obszarem zawału i inne powikłania zatorowo-zakrzepowe * pozawałowe zapalenie nasierdzia (łac. pericarditis epistenocardiaca) * przewlekły tętniak serca * przewlekła niewydolność krążenia * zespół ramię-ręka * zespół pozawałowy Dresslera Postępowanie przy zawale Pomoc przedlekarska sprowadza się do ułożenia chorego w pozycji półsiedzącej (o ile jest przytomny) lub bocznej ustalonej (jeśli jest nieprzytomny), wezwaniu fachowej pomocy medycznej i kontroli tętna i oddechu (jeśli ustanie praca serca i oddech należy rozpocząć resuscytację krążeniowo-oddechową). Lekarz, jeżeli istnieje podejrzenie zawału, dokonuje pomiarów tętna, ciśnienia krwi oraz podłącza chorego do stałego monitoringu. Wykonuje EKG oraz zapewnia stały dostęp do żyły poprzez założenie wenflonu lub w cięższych przypadkach wkłucia centralnego. Podaje tlen, który powinien być nawilżony i podawany z prędkością 2-4 litrów na minutę. Powinien pobrać krew do badań oraz walczyć z bólem. Walka z bólem Stosuje się mieszanki przeciwbólowe: * lityczna, która składa się z: o 100 mg Dolarganu o 50 mg Dipherganu o 50 mg Fenactilu o uzupełnia się 0,9% roztworem NaCl do 20 ml * NLA, która składa się z: o 0,1 mg Fentanylu o 5 mg dihydrobenzperidolu o uzupełnia się 0,9% roztworem NaCl do 10 ml * MCP, która składa się z: o 50 mg morfiny o 50 mg Fenactilu o 50 mg Dipherganu o 500 ml 5% glukozy Pierwszym lekiem przeciwbólowym podawanym pacjentowi jest morfina, podawana dożylnie. Początkowo 5 mg w ciągu 2 min., a następnie 2 mg co 5 min. Maksymalna dawka wynosi 30 mg. Postępowanie przeciwpłytkowe i przeciwzakrzepowe Podczas zawału serca nie można dopuścić do stworzenia się zakrzepów, dlatego podaje się na samym początku kwas acetylosalicylowy (aspiryna) w dawce co najmniej 300 mg (aktualnie podanie aspiryny traktowane jest jako rutynowe postępowanie przedszpitalne) oraz heparynę w dawce 40-70 j.m./kg. Płytki krwi, które powodują powstawanie zakrzepów, można dodatkowo zablokować, stosując tienopirydyny (klopidogrel) w dawce nasycającej 600 mg. Optymalną metodą leczenia świeżego zawału serca (do 12 godz od początku bólu) jest angioplastyka wieńcowa pod warunkiem, że jest wykonywana w ośrodku pełniącym 24-godzinny dyżur zawałowy przez doświadczonych operatorów w ciągu 90 minut od pierwszego kontaktu z lekarzem (pierwotna angioplastyka wieńcowa). W sytuacji, gdy istnieje możliwość wykonania pierwotnej angioplastyki wieńcowej podawanie leków fibrynolitycznych (alteplaza, reteplaza, streptokinaza) powinno być stosowane w wyjątkowych sytuacjach. KIG To tzw. mieszanka polaryzująca, która poprawia metabolizm niedokrwionych komórek mięśnia sercowego. Składa się z: * K - potasu ok. 40mEq * I - insuliny ok. 6 j.m. insuliny krótkodziałającej np. Actrapid * G - glukozy 250ml 10% na KIG mały lub 500ml 5% na KIG duży Podczas podawania leku należy zwrócić uwagę na szybkość podawania, ponieważ zbyt szybkie może spowodować asystolię. W kontrolowanych badaniach klinicznych nie stwierdzono korzystnego wpływu podawanie KIG w zawale mięśnia sercowego, wobec powyższego nie powinno być ono stosowane i ma raczej znaczenie historyczne. Rehabilitacja Rehabilitację rozpoczyna się po ustąpieniu bólu zawałowego, zmniejszeniu aktywności enzymów i obniżeniu temperatury. Faza I Model A - stosuje się dla chorych z pełnościennym, niepowikłanym zawałem. 1° - ćwiczenia bierne i sadzanie po 2-3 dobach 2° - ćwiczenia czynne i pionizacja po 4-5 dobach 3° - wolne spacery oraz chodzenie po schodach po ok. 6-10 dniach Model B - dla chorych z powikłanym zawałem i trwa powyżej 21 dni W pierwszej fazie obciążenie nie powinno przekraczać 1,5-3 MET'ów Faza I zazwyczaj kończy się wypisaniem chorego ze szpitala. W pierwszym okresie zawału bardzo istotne jest zapewnienie lekkostrawnej diety, tak aby chory nie miał trudności z wypróżnianiem się. Defekacja jest dość dużym wysiłkiem, wymagającym napięcia tłoczni brzusznej, powodując odruchową tachykardię w celu zwiększenia rzutu sercowego. Skutkiem tego wysiłku może być "śmierć na sedesie" - dość typowa u chorych w pierwszych dwóch tygodniach choroby, czasami nawet z pęknięciem ściany serca. Faza II Odbywa się w pomieszczeniach odpowiednio przystosowanych tzn. zapewniających ciągły monitoring chorego, posiadających ruchome bieżnie lub cykloergometry. Wszystkie te zabiegi odbywają się pod nadzorem lekarza i rehabilitantów. Proste ćwiczenia chory powinien wykonywać w domu. Faza III Trwa co najmniej 6 miesięcy. Jest realizowana w ośrodkach przyszpitalnych i w domu. Obejmuje ćwiczenia kondycyjne, rekreacyjne i edukację przeciwzawałową. Celem jest osiągnięcie przez chorego wydolności co najmniej 8 MET'ów. Faza IV Rozpoczyna się ok. 1 rok po zawale. Polega na ćwiczeniach grupowych i indywidualnych w celu utrzymania chorego w jak najlepszej kondycji fizycznej i psychicznej oraz zapobiegania nawrotom choroby. Historia odkrycia zawału mieśnia sercowego Pojęcie zawału w odniesieniu do mięśnia sercowego nazwę wprowadził w 1896 r. franc. lek. René Marie (1868-1952), a wg innych niem. patolog Carl Weigert (1845-1902) w 1880 r. W 1910 r. ros. lekarze Wasilij Parmenowicz Obrazcow (1849-1920) i Nikołaj Dymitriewicz Strażesko (1876-1952) jako pierwsi opisali pod względem klinicznym trzy przypadki zawału serca, a jednoznaczny związek przyczynowy pomiędzy zakrzepicą tętnic wieńcowych a zawałem serca ustalił amer. lekarz James Bryan Herrick (1861-1954) w 1912 r. Przedtem zmiany narządowe o tym charakterze nazywano rozmaitymi nazwami łacińskimi, najczęściej „apoplexia” (udar), „infiltratio” (nacieczenie), „hepatisatio” (zwątrobienie), „myomalatio” (rozmiękanie) i in. Uznawano bowiem, że przyczyną zawału są niekreślone zmiany zwyrodnieniowe lub zmiany zapalne. Udar mózgu dawniej także apopleksja (łac. apoplexia cerebri, insultus cerebri ang. cerebro-vasculari accident - CVA) to nagłe wystąpienie mniej lub bardziej nasilonych objawów uszkodzenia mózgu w wyniku zaburzeń krążenia mózgowego. Epidemiologia Udary mózgu wystepują przede wszystkim u ludzi starszych, aczkolwiek w 25% dotyczą osób poniżej 55 roku życia. Według statystyki częstość ich określa się na 100-300 przypadków na 100 000 na rok. Stanowią one co najmniej połowę ostrych chorób neurologicznych, wymagających hospitalizacji. Udar mózgu możemy podzielić na: * udar krwotoczny * udar niedokrwienny (zawał mózgu) Czynniki ryzyka udaru * wiek - ryzyko zwiększa się 2-krotnie co 10 lat * płeć męska * nadciśnienie tętnicze * choroby serca * cukrzyca * palenie papierosów * alkoholizm * otyłość * hipercholesterolemia * hiperhomocysteinemia * mała aktywność fizyczna * niewłaściwy sposób odżywiania Udar krwotoczny Polega na nagłym wylewie krwi z pękniętego naczynia, który niszczy utkanie mózgu. Najczestszą przyczyną jest nadciśnienie krwionośne. Stanowi ok. 15-20% wszystkich udarów. Przyczyny Podstawowymi przyczynami udarów mózgu są: * nadciśnienie tętnicze * tętniaki * skazy krwotoczne * przedawkowanie leków przeciwkrzepliwych Objawy * nagły, bardzo silny ból głowy * utrata przytomności * niedowład lub paraliż po stronie przeciwnej do uszkodzonej pólkuli mózgu * osłabienie lub zniesienie czucia po jednej stronie ciała, * zaburzenia mowy * zaburzenia widzenia Udar niedokrwienny Spowodowany gwałtownym zatrzymaniem dopływu krwi do mózgu jako wynik zwężenia lub całkowitego zamknięcia światła naczyń tętniczych. Stanowi 85-90% wszystkich udarów. Przyczyny * zmiany miażdżycowe * niedrożność tętnic zaopatrujących mózg (zakrzep) * wady zastawek * ostry zawał serca * zaburzenia rytmu serca * zaburzenia krzepnięcia * zmiany zapalne naczyń Objawy * wkrótce po wstawaniu z łóżka, czasem chory budzi się z niedowładem lub paraliżem * przytomność zachowana * osłabienie lub zniesienie czucia po stronie ciała zgodnej z miejscem zawału * brak odczuwania bólu * w przypadku zakrzepu - brak drgawek * w przypadku zatoru - nagłe drgawki Leczenie Pod koniec lat 90-tych w USA, na wzór leczenia ostrego zawału serca, wprowadzono do leczenia udaru niedokrwiennego mózgu leki trombolityczne. Są to leki "rozpuszczające" skrzep będący przyczyną niedokrwienia mózgu. W Polsce, od roku 2003, na podstawie wytycznych Narodowego Programu Profilaktyki i Leczenia Chorób Sercowo-Naczyniowych POLKARD 2003-2005, prowadzone jest leczenie trombolitycze w udarze niedokrwiennym w specjalnie przygotowanych do tego Oddziałach Udarowych. Leczenie trombolityczne może być przeprowadzone tylko w czasie pierwszych 3 godzin od wystąpienia udaru, ponieważ po tym czasie nie przynosi spodziewanych rezultatów i może prowadzić do poważnych powikłań. Aktualnie nie ma leków, które skutecznie leczą udary po tym czasie, jednak w niektórych przypadkach leczenie trombolityczne odnosi skutek w czasie do 4,5 godziny od udaru, a nawet do 6 godzin, jednak zależy to od indywidualengo przypadku chorego. W dalszym etapie leczenia kompleksowe zajęcie się chorym, jego monitoring i zwalczanie na bieżąco wszystkich dysfunkcji organizmu może przynieść dobre wyniki w leczeniu udarów. |
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