ʻOhi Cerebrospinal fluid (CSF) hōʻiliʻili

ʻO ka hōʻiliʻili Cerebrospinal fluid (CSF) kahi hoʻāʻo e nānā i ka wai e hoʻopuni i ka lolo a me ka iwi kuamoʻo.

Hana ʻo CSF ​​ma ke ʻano he cushion, pale ʻana i ka lolo a me ka iwi ʻāʻī mai ka ʻeha. Maʻemaʻe maʻamau ka wai. He like like kona ʻano me ka wai. Hoʻohana ʻia ka hoʻokolohua e ana i ka kaomi i ka wai o ka iwi.

Aia nā ala like ʻole e kiʻi i kahi hāpana o CSF. Lumbar puncture (spinal tap) ʻo ia ka hana maʻamau.

E loaʻa i ka hōʻike:

• E moe ʻoe ma kou ʻaoʻao me kou mau kuli i huki ʻia i ka umauma, a kau ka chin i lalo. I kekahi manawa ua pau ka hoʻāʻo e noho ana i luna, akā kūlou i mua.
• Ma hope o ka hoʻomaʻemaʻe o ka hope, e hoʻopili ka mea mālama ola i kahi lāʻau numbing kūloko (anesthetic) i ka iwi kuamoʻo o lalo.
• E hoʻokomo ʻia kahi kui kuamoʻo.
• Lawe ʻia kahi kaomi hoʻomaka i kekahi manawa. Hiki i kahi kaomi maʻamau ke kuhikuhi i kahi maʻi a i ʻole nā ​​pilikia ʻē aʻe.
  
• Ke kū nei ke kui kele, ana ʻia ka puʻuwai CSF a hōʻiliʻili ʻia kahi laʻana o 1 a 10 mau milliliter (mL) o CSF ​​i nā ipu he 4.
• Wehe ʻia ka nila, hoʻomaʻemaʻe ʻia ka wahi, a hoʻonoho ʻia kahi kaula ma luna o ka pūnaewele nila. E noi paha ʻoe e moe i lalo no kahi manawa pōkole ma hope o ka hoʻāʻo.

I kekahi mau hihia, hoʻohana ʻia nā kukuna x kūikawā e kōkua i ke alakaʻi ʻana i ka nila. Kapa ʻia kēia fluoroscopy.

ʻO ka lumbar puncture me ka hōʻiliʻili wai ka ʻāpana o nā kaʻina hana ʻē aʻe e like me ka x-ray a i ʻole CT scan ma hope o ka hoʻokomo ʻia ʻana o ka kala i ka CSF.

Kākaʻikahi ka hoʻohana ʻia o nā ʻano ʻē aʻe o ka hōʻiliʻili CSF.

• Hoʻohana ʻo Cisternal puncture i kahi nila i hoʻonoho ʻia ma lalo o ka iwi hope (hope o ka iwi poʻo). Hiki ke weliweli no ka mea pili ia i ke kumu o ka lolo. Hana mau ʻia me ka fluoroscopy.
• Hoʻokomo ʻia paha ka punricure Ventricular i ka poʻe me ka herniation lolo hiki. Kēia mea he kākaʻikahi hoʻohana hana. Hana pinepine ʻia ia i loko o ka lumi lumi. Hoʻokomo ʻia kahi lua i ka iwi poʻo, a hoʻokomo ʻia kahi nila i loko o kekahi o nā ventricle o ka lolo.

Hiki ke hōʻiliʻili ʻia ʻo CSF ​​mai kahi ʻōmole i hoʻonoho ʻia i loko o ka wai, e like me kahi shunt a i ʻole kahi ʻauwai ventricular.

Pono ʻoe e hāʻawi i ka hui mālama ola i kou ʻae ma mua o ka hoʻāʻo. E haʻi i kāu mea hāʻawi inā ʻoe ma kahi aspirin a i ʻole nā ​​lāʻau hoʻomāliʻi koko.

Ma hope o ke kaʻina hana, pono ʻoe e hoʻolālā e hoʻomaha no kekahi mau hola, ʻoiai inā maikaʻi ʻoe. Pale aku kēia i ka hoʻokahe ʻana o ka wai a puni ka pūnaewele o ka puncture. ʻAʻole pono ʻoe e moe pālahalaha i kou kua i ka manawa holoʻokoʻa. Inā hoʻomohala ʻoe i kahi ʻeha o ke poʻo, pono paha e inu i nā mea inu caffeine e like me ke kope, tī a soda paha.

He ʻoluʻolu ʻole paha ke noho ma ke kūlana no ka hoʻāʻo. He mea nui ka noho mālie ʻana no ka mea hiki i ka neʻe ke alakaʻi i ka ʻeha o ka iwi kuamoʻo.

ʻ belelo ʻia paha ʻoe e hoʻopololei i kou kūlana ma hope o ke kuʻi ʻana ma kahi. ʻO kēia e kōkua i ke ana ʻana i ka kaomi CSF.

E kuʻi a puhi paha ka mea anesthetic i ka manawa o ka injected mua. E loaʻa kahi puʻuwai paʻakikī ke hoʻokomo ʻia ka nila. ʻO ka pinepine, aia kekahi ʻeha pōkole ke hele ka nila i waena o nā mea e pili ana i ka iwi kuamoʻo. E kū kēia ʻeha i kekona kekona.

I ka hapanui o nā hihia, lawe ke kaʻina hana ma kahi o 30 mau minuke. ʻO nā ana kaomi maoli a me ka hōʻiliʻili CSF e lawe i kekahi mau minuke.

Hana ʻia kēia hōʻike e ana i nā kaomi ma loko o ka CSF a e hōʻiliʻili i kahi laʻana o ka wai no ka hoʻāʻo hou.

Hiki ke hoʻohana ʻia ka anamanaʻo CSF ​​e hōʻoia i kekahi mau maʻi neurologic. Hoʻopili paha kēia i nā maʻi (e like me ka meningitis) a me ka lolo a i ʻole nā ​​ʻino o ke kuamoʻo. Hiki ke hana ʻia i kahi kuʻikuʻi e hoʻokumu i ka hōʻailona o ka hydrocephalus kaomi maʻamau.

Loaʻa nā helu maʻamau i penei:

• Kaomi: 70 a 180 mm H₂ʻ
• Helehelena: maopopo, kala ʻole
• CSF huina protein: 15 a 60 mg / 100 mL
• Gamma globulin: 3% a 12% o ka huina protein
• ʻO ka glucose CSF: 50 a 80 mg / 100 ML (a i ʻoi aku paha ma mua o ʻelua hapakolu o ka pae kō kō)
• Helu huahelu CSF: 0 a 5 mau pūnaewele koko keʻokeʻo (nā mononuclear āpau), a ʻaʻohe ʻulaʻula koko
• Chloride: 110 a 125 mEq / L

Hiki ke loli iki nā pae waiwai maʻamau i waena o nā hale hana ʻokoʻa. E kamaʻilio i kāu mea hāʻawi e pili ana i ke ʻano o kāu mau hopena hōʻike.

Hōʻike nā hiʻohiʻona ma luna i nā ana maʻamau no nā hopena no kēia mau hoʻāʻo. Hoʻohana kekahi mau keʻena hoʻokolohua i nā ana like ʻole a i ʻole hoʻokolohua i nā hoʻohālikelike like ʻole.

Inā nānā ke CSF i ke ao, hiki ke manaʻo ia aia kekahi maʻi a i ʻole ke kūkulu ʻia ʻana o nā hunaola keokeo a i ʻole protein.

Inā he koko a ʻulaʻula paha ka CSF, he hōʻailona paha ia o ke kahe ʻana a i ʻole ke keakea ʻia o ka iwi kuamoʻo. Inā ʻeleʻele ia, ʻalani, a melemele paha, he hōʻailona paha ia o ka hoʻonui ʻia o ka protein CSF a i ʻole ke kahe ʻana o ka wā ma mua (ʻoi aku ma mua o 3 mau lā i hala). Aia paha he koko i loko o ka laʻana i hiki mai ka piʻo ʻōiwi ʻo ia iho. He mea paʻakikī kēia e unuhi i nā hopena hōʻike.

PAIKAI CSF

• Hoʻonui ʻia paha ke kaomi ʻo CSF ​​ma muli o ka hoʻonui ʻia o ke kaomi intracranial (kaomi i loko o ka iwi poʻo).
• ʻO ke kaomi ʻana o ka CSF i hōʻemi ʻia ma muli o ka poli o ke kuamoʻo, ka maloʻo, ka maʻule ʻana, a me ka liu ʻana o CSF.

CSF PROTEIN

• ʻO ka hoʻonui ʻia o ka protein CSF ma muli o ke koko i ka CSF, diabetes, polyneuritis, tumo, ʻeha, a i ʻole kekahi maʻi ʻeha a infectious paha.
• ʻO ka protein hōʻemi kahi hōʻailona o ka hana wikiwiki CSF.

ʻO CSF GLUCOSE

• ʻO ka hoʻonui ʻia o ka CSF glucose he hōʻailona o ke kō kō kiʻekiʻe.
• ʻO ka emi ʻana o ka glucose CSF ma muli o ka hypoglycemia (ke kō kō liʻiliʻi), ka maʻi bacteria a fungal paha (e like me ka meningitis), tuberculosis, a me kekahi ʻano meningitis ʻē aʻe.

KEKAHI KOKO MA CSF

• ʻO ka hoʻonui ʻia o nā hunaola keokeo i ka CSF he hōʻailona paha ia no ka meningitis, maʻi ʻaʻai nui, e hoʻomaka ana i kahi maʻi wā lōʻihi (mau), ka maʻi tumo, abscess, a i ʻole demyelinating maʻi (e like me sclerosis he nui)
• ʻO nā hunaola ʻulaʻula i ka hāpana CSF kahi hōʻailona o ke kahe ʻana o ke kahe i loko o ka wai o ka iwi āpau a i ʻole ka hopena o kahi pūpū lumbar traumatic.

NA HUAOLELO CSF

• Ma muli paha o nā maʻi e like me nā sclerosis, neurosyphilis, a me Guillain-Barré Syndrome paha ka hoʻonui ʻia o ka pae gamma globulin CSF.

Nā kūlana hou aʻe e hana ʻia ai ka hōʻike:

• ʻO ka polyneuropathy hoʻouluulu maʻi
• ʻO Dementia ma muli o nā kumu hana metabolic
• ʻO Encephalitis
• Epilepsy
• ʻO ka hopu ʻana ʻo Fepile (keiki)
• Ka hopu ʻana i ka tonic-clonic laulā
• ʻO Hydrocephalus
• Anthrax hoʻohenehene
• ʻO ka hydrocephalus kaomi maʻamau (NPH)
• Tumo pituitary
• Reye maʻi maʻi

Nā pilikia o ka lumbar puncture e komo pū:

• Kahe i loko o ka canal spinal a i ʻole ka lolo (subdural hematomas).
• Ka hōʻoluʻolu ʻole i ka wā o ka hoʻāʻo.
• Headache ma hope o ka hoʻāʻo e hiki ke hala i kekahi mau hola a i ʻole mau lā. He mea kōkua paha ke inu i nā mea inu caffeine e like me ke kope, tī a i ʻole soda e kōkua ai e hōʻoluʻolu i ka ʻeha o ke poʻo. Inā ʻoi aku ka nui o nā poʻo o ke poʻo ma mua o kekahi mau lā (keu paha i kou noho ʻana, kū a hele wāwae paha) loaʻa paha iā ʻoe kahi kulu CSF. Pono ʻoe e kamaʻilio me kāu kauka inā kū kēia.
• Hypersensitivity (allergic) ka hopena i ka anesthetic.
• ʻO ka maʻi i hoʻolauna ʻia e ka nila kuʻi i ka ʻili.

Hiki i ka herniation lolo ke hana ʻia kēia hoʻokolohua ma luna o kahi kanaka me ka nui i ka lolo (e like me ka tumo a i ʻole abscess). Hiki i kēia ke hopena i ka hōʻino o ka lolo a i ʻole ka make. ʻAʻole hana ʻia kēia hōʻike inā hōʻike kahi hōʻike a hōʻike paha i nā hōʻailona o ka nui o ka lolo.

Hiki ke hōʻino i nā aʻa i ka iwi kuamoʻo, ke ʻano neʻe ke kanaka i ka wā o ka hoʻāʻo.

Lawe ka puncture Cisternal a i ʻole puncture ventricular i nā mea hou aʻe o ka lolo a me nā ʻino o ke kuamoʻo a me ke kahe ʻana o ka lolo i loko o ka lolo.

ʻOi aku ka weliweli o kēia hōʻike no ka poʻe me:

• ʻO kahi tumo i ka hope o ka lolo e kaomi ana i ka lolo
• Nā pilikia pili koko
• Helu platelet haʻahaʻa (thrombositopenia)
• ʻO nā kānaka e lawe ana i ka lahilahi o ke koko, aspirin, clopidogrel, a i ʻole nā ​​lāʻau like ʻē aʻe e hōʻemi ai i ke kūkulu ʻia ʻana o nā clots koko.

Paina iwi kuamoʻo; Pahu Ventricular; Pahu Lumbar; Puku Cisternal; ʻO ka moʻomeheu wai Cerebrospinal

• Kemika CSF
• Lumbar vertebrae

ʻO Deluca GC, ʻo Griggs RC. Hele i ka mea maʻi me ka maʻi neurologic. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 368.

Euerle BD. ʻO ka puncture a me ka nānā ʻana i ka wai cerebrospinal. I: Roberts JR, Custalow CB, Thomsen TW, eds. ʻO Roberts a me Hedges 'Nā Kauka Lapaʻau i ka Medicine Emergency a me ka Care Acute. ʻEpekema 7 Piladelapia, PA: Elsevier; 2019: chap 60.

ʻO Rosenberg GA. ʻO ka edema lolo a me nā maʻi o ka holo ʻana o ka wai cerebrospinal. I: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. ʻO Bradley's Neurology i ka hana lapaʻau. ʻEpekema 7 Piladelapia, PA: Elsevier; 2016: chap 88.