Mukati
Chii chinonzi pfari?
pfari chirwere chakajairika cheurouropsychiatric chine chisingaperi chinyararire chimiro chekosi. Pasinei neizvi, kuitika kwekuerekana kwepfari kubatwa nechirwere. Izvo zvinokonzerwa nekuonekwa kweakawanda foci yezvinongoerekana zvaitika (nerve dischages) mune dzimwe nzvimbo dzehuropi.
Kliniki, kubatwa kwakadaro kunoratidzwa nekukanganisika kwenguva pfupi kwekunzwa, mota, pfungwa uye autonomic mabasa.
Kuwanda kwekuonekwa kwechirwere ichi paavhareji 8-11% (classic yakawedzera kurwisa) pakati pehuwandu hwehuwandu hwehuwandu hwenyika chero ipi zvayo, zvisinei nenzvimbo yemamiriro ekunze uye kukura kwehupfumi. Muchokwadi, munhu wechi12 wega wega dzimwe nguva anosangana nezvimwe kana zvimwe zviratidzo zvepfari.
Ruzhinji zvikuru rwavanhu runodavira kuti hosha yepfari hairapiki, uye rudzi rwe“chirango choumwari.” Asi mishonga yemazuva ano inoramba zvachose mafungiro akadaro. Mishonga yeAntiepileptic inobatsira kudzvinyirira chirwere mu63% yevarwere, uye mu18% kuderedza zvakanyanya kuratidzwa kwayo kwekiriniki.
Mushonga mukuru ndeyekugara kwenguva refu, nguva dzose uye yekusingaperi mishonga yemishonga ine mararamiro ane hutano.
Zvinokonzera pfari zvakasiyana, WHO yakazvibatanidza mumapoka anotevera:
Idiopathic - izvi zviitiko apo chirwere chinogarwa nhaka, kazhinji kuburikidza nemazana ezvizvarwa. Organic, uropi hahuna kukuvadzwa, asi pane chaiyo maitiro eeuroni. Iyi fomu haina kuenderana, uye pfari inoitika pasina chikonzero chakajeka;
Symptomatic - pane nguva dzose chikonzero chekugadzirwa kwefoci yezvipembenene zvepathological. Izvi zvinogona kuva migumisiro yekutambudzika, kudhakwa, kuputika kana cysts, kukanganisa, etc. Iyi ndiyo nzira "isingatarisirwi" yepfari, sezvo kurwiswa kunogona kukonzerwa nekugumburwa kuduku, zvakadai sekutya, kuneta kana kupisa;
Cryptogenic - hazvibviri kunyatsogadzirisa chikonzero chechokwadi chekuitika kweuncharacteristic (isingasviki) impulse foci.
Ko pfari inoitika riini?
Kubata muzviitiko zvakawanda kunoonekwa muvana vachangozvarwa vane tembiricha yemuviri. Asi izvi hazvirevi kuti mune ramangwana munhu achava nepfari. Chirwere ichi chinogona kukura kune chero munhu uye chero zera. Zvisinei, inowanzoitika pakati pevana nevechiri kuyaruka.
Chikamu che75% chevanhu vane pfari vanhu vari pasi pemakore makumi maviri. Kana vari vanhu vanopfuura makumi maviri, marudzi akasiyana-siyana ekukuvadzwa kana sitiroko anowanzo kuve nemhosva. Boka renjodzi - vanhu vanopfuura makore makumi matanhatu.
Epilepsy zviratidzo
Zviratidzo zvepfari zvinogona kusiyana kubva kumurwere nemurwere. Chokutanga pane zvose, zviratidzo zvinoenderana nenzvimbo idzo dzehuropi umo kubuda kwepathological kunoitika uye kupararira. Muchiitiko ichi, zviratidzo zvichange zvakabatana zvakananga nemabasa ezvikamu zvakakanganiswa zveuropi. Panogona kunge paine kusagadzikana kwekufamba, kusagadzikana kwekutaura, kuwedzera kana kuderera kwetsandanyama toni, kusagadzikana kwemaitiro epfungwa, zviri zviviri mukuzviparadzanisa nevamwe uye mumasanganiswa akasiyana.
Kuoma uye kurongwa kwezviratidzo kuchaenderanawo nemhando chaiyo yepfari.
Jacksonian pfari
Saka, panguva yeJacksonian sezures, pathological irritation inovhara imwe nzvimbo yeuropi, pasina kupararira kune vavakidzani, uye naizvozvo zviratidzo zvinonyanya kutsanangurwa mapoka emasumbu. Kazhinji psychomotor kusagadzikana ndeyenguva pfupi, munhu anoziva, asi inoratidzirwa nekuvhiringidzika uye kurasikirwa kwekusangana nevamwe. Murwere haazive nezvekusashanda uye anoramba kuedza kubatsira. Pashure pemaminitsi mashomanana, mamiriro acho ezvinhu akajairika.
Kugwinha gwinha kana kuita chiveve kunotanga muruwoko, mutsoka, kana mugumbo rezasi, asi anogona kupararira kusvika pahafu yemuviri wese kana kushanduka kuita dzungu hombe. Muchiitiko chekupedzisira, vanotaura nezvekubatwa kwechipiri.
Grand mal seizure ine zvikamu zvinotevera:
Vakafanotangira - maawa mashomanana kusati kwatanga kurwisa, murwere anobatwa nehurumende inotyisa, inoratidzirwa nekuwedzera kwekutya kwekutya. Iko kutarisisa kwekuita kwepathological muuropi kunowedzera zvishoma nezvishoma, kufukidza ese madhipatimendi matsva;
tonic convulsions - mhasuru dzose dzakasimba zvakasimba, musoro unokanda shure, murwere anowira, achirova pasi, muviri wake wakadzivirirwa uye wakabatwa munzvimbo iyi. Chiso chinoshanduka kuva bhuruu nekuda kwekumira kwekufema. Chikamu chipfupi, anenge masekonzi makumi matatu, kashoma - kusvika kuminiti;
Clonic convulsions - mhasuru dzese dzemuviri dziri kukurumidza kuita rhythmically. Kuwedzera salivation, iyo inoita sefuro kubva mumuromo. Nguva - kusvika kumaminitsi mashanu, mushure mokunge kufema kunodzorerwa zvishoma nezvishoma, cyanosis inonyangarika kubva pachiso;
Stupor - mukutarisa kwemaitiro emagetsi emagetsi, inhibition yakasimba inotanga, misumbu yese yemurwere inozorora, kubuda kusingaite kweweti uye tsvina inogoneka. Murwere anorasikirwa nekuziva, reflexes haisipo. Chikamu chinotora kusvika kumaminitsi makumi matatu;
rota.
Mushure mokumutsa murwere kune mamwe mazuva 2-3, misoro, kushaya simba, uye kukanganisa kwemotokari kunogona kutambudza.
Kurwiswa kudiki
Kurwiswa kudiki kunoenderera zvishoma. Panogona kunge paine nhevedzano yematsimba etsandanyama dzechiso, kudonha kwakapinza kwetsandanyama (somugumisiro wekuti munhu anodonha) kana, zvakasiyana, kushushikana mumasumbu ese apo murwere anotonhora mune imwe nzvimbo. Kuziva kunochengetedzwa. Zvichida "kusavapo" kwechinguva - kusavapo. Murwere anotonhora kwemasekonzi mashoma, anogona kutenderedza maziso ake. Mushure mekurwiswa, haayeuki zvakaitika. Kubatwa kudiki kunowanzotanga mumakore ekutanga.
Mamiriro epilepticus
Status epilepticus nhevedzano yepfari inotevedzana. Mukati menguva dziri pakati pavo, murwere haadzokeri kuziva, akaderedza inzwi remasuru uye kushaya reflexes. Vadzidzi vake vanogona kudhirowa, kudzvanywa kana hukuru hwakasiyana, kupuruzira kunokurumidza kana kunetsa kunzwa. Ichi chiitiko chinoda kurapwa nekukurumidza, sezvo inoratidzirwa nekuwedzera hypoxia yeuropi uye edema yayo. Kushaikwa kwekupindira kwekurapa panguva yakakodzera kunotungamirira kumigumisiro isingagadziriswi uye rufu.
Kubatwa nepfari kwese kunongoerekana kwaitika uye kunopera zvega.
Zvinokonzera pfari
Hapana chinokonzera pfari chinogona kutsanangura kuitika kwacho. Pfari haisi hosha inogarwa nhaka mupfungwa chaiyoiyo, asi zvakadaro mune dzimwe mhuri umo mumwe wehama akatambura nechirwere ichi, mukana wehosha yacho wakakura. Chikamu che40% chevarwere vane pfari vane hama dzepedyo dzine chirwere ichi.
Kune marudzi akawanda epfari. Kuoma kwavo kwakasiyana. Kurwiswa uko kune chikamu chimwe chete cheuropi chine mhosva kunonzi kurwisa kwechidimbu kana kuti kwakananga. Kana uropi hwese hukabatwa, saka kurwisa kwakadaro kunonzi generalized. Kune kurwiswa kwakasanganiswa: vanotanga nechikamu chimwe cheuropi, gare gare vanovhara nhengo yese.
Zvinosuruvarisa, mumakumi manomwe muzana ematambudziko, chikonzero chechirwere chinoramba chisina kujeka.
Zvikonzero zvinotevera zvechirwere zvinowanzowanikwa: kukuvara kwehuropi, sitiroko, mapundu europi, kushaikwa kweokisijeni neropa pakuzvarwa, kusagadzikana kwemaitiro ehuropi (kukanganisa), meningitis, zvirwere zvehutachiona uye parasitic, abscess yeuropi.
Ko pfari inogarwa nhaka here?
Pasina mubvunzo, kuvapo kwehuputi hwehuropi mumadzitateguru kunotungamirira kune mukana mukuru wekutapurirwa kwehutano hwose hwechirwere kune vazukuru - izvi zvine kusiyana kweidiopathic. Uyezve, kana paine genetic predisposition yeCNS masero kune hyperreactivity, pfari ine mukana mukuru wekuratidzwa muvana.
Panguva imwecheteyo, pane sarudzo mbiri - symptomatic. Chinhu chinogadzirisa pano ndiko kusimba kweiyo genetic kutapurirana kweiyo organic chimiro cheuropi neurons (iyo pfuma yekunakidzwa) uye kuramba kwavo kusimba remuviri. Semuenzaniso, kana munhu ane genetics yakajairika anogona "kutsungirira" imwe mhando yekurova mumusoro, saka imwe, ine predisposition, ichaita pairi nekubatwa kwepfari.
Kana iri fomu ye cryptogenic, haina kudzidza zvishoma, uye zvikonzero zvekukura kwayo hazvinzwisisike.
Ndinganwa ndine pfari here?
Mhinduro isina mubvunzo ndeyokuti aiwa! Nepfari, chero zvakadaro, haugone kunwa zvinwiwa zvinodhaka, zvikasadaro, uine 77% garandi, unogona kutsamwisa generalized convulsive pfari, inogona kuve yekupedzisira muhupenyu hwako!
Pfari chirwere chakakomba chetsinga! Zvichienderana nekurudziro dzese uye mararamiro "akarurama", vanhu vanogona kugara murunyararo. Asi kana kutyora chirongwa chekurapa kana kuregeredza zvinorambidzwa (doro, zvinodhaka), mamiriro anogona kutsamwiswa anotyisidzira zvakananga hutano!
Ndeapi bvunzo anodiwa?
Kuti aongorore chirwere chacho, chiremba anoongorora anamnesis emurwere pachake, pamwe chete nehama dzake. Zvakaoma zvikuru kuita ongororo yakarurama. Chiremba anoita basa rakawanda pamberi peizvi: anotarisa zviratidzo, kuwanda kwekugumburwa, kubatwa kunotsanangurwa zvakadzama - izvi zvinobatsira kuziva kukura kwayo, nokuti munhu akabatwa nehope haayeuki chero chinhu. Mune ramangwana, ita electroencephalography. Maitiro haakonzere kurwadziwa - iko kurekodha kwekuita kwehuropi hwako. Matekiniki akadai secomputed tomography, positron emission uye magnetic resonance imaging anogonawo kushandiswa.
Chii chiri chirevo?
Kana pfari ikarapwa zvakanaka, zvino mumakumi masere muzana ezviitiko vanhu vane chirwere ichi vanorarama pasina kubatwa uye pasina zvirambidzo mukuita.
Vanhu vazhinji vanofanirwa kutora mishonga inorwisa zvipfari kweupenyu hwavo hwese kudzivirira kubatwa nepfari. Muzviitiko zvisingawanzoitiki, chiremba anogona kurega kutora mishonga kana munhu asina kubatwa nepfari kwemakore akawanda. Pfari ine ngozi nekuti mamiriro akaita sekushaya kufema (izvo zvinogona kuitika kana munhu akawira pasi negotsi papiro, nezvimwewo) kana kupunzika kunokonzeresa kukuvara kana kufa. Mukuwedzera, kuputika kwepfari kunogona kuitika mukutevedzana kwenguva pfupi, izvo zvinogona kukonzera kusungwa kwekufema.
Kana iri generalized tonic-clonic seizures, inogona kuuraya. Vanhu vanorwiswa uku vanoda kugara vachitarisirwa, kunyanya kubva kuhama dzavo.
Migumisiro ipi?
Varwere vane pfari vanowanzoona kuti pfari dzavo dzinotyisa vamwe vanhu. Vana vangatambura nokurambwa nevanodzidza navo. Uyewo, vana vaduku vane chirwere chakadaro havazokwanisi kutora chikamu mumitambo yemitambo nemakwikwi. Kunyangwe kusarudzwa kwakaringana kweantiepileptic therapy, hyperactive maitiro uye matambudziko ekudzidza anogona kuitika.
Munhu angave achifanira kudziviswa mune zvimwe zviitiko - somuenzaniso, kutyaira motokari. Vanhu vanorwara zvakanyanya nepfari vanofanira kutarisa mamiriro avo epfungwa, izvo zvisingaparadzanisiki nechirwere.
Nzira yekurapa pfari?
Pasinei nekukomba uye ngozi yechirwere, nekuongororwa panguva uye kurapwa kwakakodzera, pfari inorapika muhafu yezviitiko. Kuregererwa kwakagadzikana kunogona kuwanikwa mune inenge 80% yevarwere. Kana kuongororwa kukaitwa kekutanga, uye nzira yekurapa zvinodhaka inoitwa nekukurumidza, ipapo muzvikamu zviviri muzvitatu zvevarwere vane pfari, pfari haidzokeri zvachose muhupenyu hwavo, kana kupera kwemakore akati wandei.
Kurapa kwepfari, zvichienderana nerudzi rwechirwere, chimiro, zviratidzo uye zera remurwere, rinoitwa nekuvhiya kana kuchengetedza nzira. Kazhinji kazhinji vanotendeukira kune ekupedzisira, sezvo kutora antiepileptic mishonga inopa yakagadzikana mhedzisiro yakanaka munenge 90% yevarwere.
Kurapa kwechirwere chepfari kunosanganisira matanho makuru akati wandei:
Differential diagnostics - inokubvumira kuti uone chimiro chechirwere uye rudzi rwekugumburwa kuitira kuti usarudze mushonga wakakodzera;
Kugadzira zvikonzero - muchiratidzo (chinowanzojairika) chimiro chepfari, kunyatsoongorora kwehuropi kunofanirwa kuvepo kwekukanganisa kwemaitiro: aneurysms, benign kana yakaipa neoplasms;
Kubata Kudzivirira - zvinodikanwa kusabvisa zvachose zvinhu zvine njodzi: kushanda zvakanyanya, kushaya hope, kushushikana, hypothermia, kunwa doro;
Relief of status epilepticus kana single pfari - inoitwa nekupa rubatsiro rwechimbichimbi uye kutsanangura imwe anticonvulsant mushonga kana seti yemishonga.
Zvinonyanya kukosha kuzivisa nzvimbo yepedyo pamusoro pekuongororwa uye maitiro akakodzera panguva yekubatwa, kuitira kuti vanhu vazive kudzivirira murwere ane pfari kubva mukukuvadzwa panguva yekudonha uye kuzununguka, kudzivirira kunyura uye kuruma rurimi uye kurega kufema.
Kurapa kwechirwere chepfari
Kugara uchitora mishonga inorayirwa inokubvumira kuvimba nechivimbo pahupenyu hwakanyarara husina kubatwa. Mamiriro ezvinhu apo murwere anotanga kunwa mishonga chete kana epileptic aura inooneka haigamuchirwi. Kana mapiritsi akanga atorwa nenguva, zviratidzo zvekurwisa kunouya, zvichida, zvingadai zvisina kuitika.
Munguva yekurapa kwechirwere chepfari, murwere anofanira kutevedzera mitemo inotevera:
Nyatsocherechedza purogiramu yekutora zvinodhaka uye usashandura dosage;
Hazvina mhosva iwe unofanirwa kupa mimwe mishonga iwe pachako pane mazano eshamwari kana mufesi wemishonga;
Kana pane chido chekushandura kune analogue yemishonga inotarwa nekuda kwekushayikwa kwayo mu pharmacy network kana yakawandisa mutengo, zivisa chiremba anouya uye uwane mazano ekusarudza imwe nzvimbo yakakodzera;
Usamira kurapwa paunosvika yakagadzikana yakanaka dynamics pasina mvumo yeneurologist yako;
Zivisa chiremba panguva yakakodzera yezviratidzo zvese zvisina kujairika, shanduko yakanaka kana yakaipa mumamiriro ezvinhu, mafungiro uye kugara zvakanaka.
Vanopfuura hafu yevarwere mushure mekutanga kuongororwa uye kunyorerwa kweimwe antiepileptic mushonga vanorarama vasina kubatwa kwemakore mazhinji, vachiramba vachiomerera kune yakasarudzwa monotherapy. Basa guru reuropathologist nderekusarudza iyo yakakwana dosage. Tanga kurapa pfari nemishonga nediki, ukuwo mamiriro emurwere achinyatsotariswa. Kana kubatwa kusingagoni kumiswa pakarepo, muyero wacho unowedzera zvishoma nezvishoma kusvikira kuregererwa kwakagadzikana kuchiitika.
Varwere vane chikamu chepfari pfari vanonyorerwa mapoka anotevera emishonga:
Carboxamide - Carbamazepine (40 rubles pasuru yemapiritsi makumi mashanu), Finlepsin (50 rubles pasuru yemapiritsi makumi mashanu), Actinerval, Timonil, Zeptol, Karbasan, Targetol (260-50 rubles pasuru yemapiritsi makumi mashanu);
Valproates - Depakin Chrono (580 rubles pakiti yemapiritsi makumi matatu), Enkorat Chrono (30 rubles papakiti yemapiritsi makumi matatu), Konvuleks (mumadonhwe - 130 rubles, musyrup - 30 rubles), Convulex Retard (180-130 rubles papakiti ye 300 -600 mapiritsi), Valparin Retard (30-60-380 rubles pakiti yemapiritsi 600-900-30);
Phenytoins - Difenin (40-50 rubles pakiti yemapiritsi makumi maviri);
Phenobarbital - kugadzirwa kwemukati - 10-20 rubles pakiti yemapiritsi makumi maviri, analogue yekunze Luminal - 20-5000 rubles.
Mishonga yekutanga mukurapa pfari inosanganisira valproates uye carboxamides, inopa hutano hwakanaka hwekurapa uye inokonzera kushomeka kwemhedzisiro. Murwere anorayirwa 600-1200 mg yeCarbamazepine kana 1000-2500 mg yeDepakine pazuva, zvichienderana nekuoma kwechirwere. Chiyero chakakamurwa kuva 2-3 doses mukati mezuva.
Phenobarbital uye phenytoin zvinodhaka zvinoonekwa sezvisina basa nhasi, zvinopa zvakawanda zvine njodzi mhedzisiro, inodzvinyirira hurongwa hwetsinga uye inogona kupindwa muropa, saka vemazuva ano neuropathologists vanoramba.
Iyo yakanyanya nyore kushandisa ndeyekurebesa mafomu emavalproates (Depakin Chrono, Encorat Chrono) uye carboxamides (Finlepsin Retard, Targetol PC). Zvakakwana kutora mishonga iyi 1-2 kanomwe pazuva.
Zvichienderana nerudzi rwekubatwa nepfari, pfari inorapwa nemishonga inotevera:
Generalized seizures - yakaoma yevalproates neCarbamazepine;
Idiopathic fomu - valproates;
Kusavapo - Ethosuximide;
Myoclonic seizures - chete valproate, phenytoin uye carbamazepine haina mhedzisiro.
Izvo zvitsva zvitsva pakati pemishonga yeantiepileptic - mishonga Tiagabine neLamotrigine - yakazviratidza mukuita, saka kana chiremba achikurudzira uye mari ichibvumira, zviri nani kuvasarudza.
Kurega kurapwa kwezvinodhaka kunogona kutariswa mushure memakore mashanu ekuregererwa kwakagadzikana. Kurapa kwepfari kunopedzwa nekuderedza zvishoma nezvishoma chiyero chemushonga kusvikira kukundikana zvachose mukati memwedzi mitanhatu.
Kubviswa kwechimiro epilepticus
Kana murwere ari mumamiriro epfari (kurwiswa kunotora maawa akawanda kana kunyange mazuva), anobayiwa intravenous nechero ipi yemishonga yeboka resibazon (Diazepam, Seduxen) pachiyero che10 mg pa20 ml yeglucose. mhinduro. Mushure memaminitsi 10-15, unogona kudzokorora jekiseni kana chirwere chepfari chikaramba chiripo.
Dzimwe nguva Sibazon uye analogues ayo haashande, uye ipapo vanotendeukira kuPhenytoin, Gaxenal kana sodium thiopental. Mushonga we1-5% une 1 g yemushonga unopinzwa mutsinga, uchiita kumira kwemaminetsi matatu mushure me5-10 ml yega yega kuitira kudzivirira kuparara kunouraya muhemodynamics uye / kana kusungwa kwekufema.
Kana pasina majekiseni anobatsira kuburitsa murwere kubva pachimiro chepfari, zvinodikanwa kushandisa mushonga unofemerwa weokisijeni nenitrogen (1: 2), asi nzira iyi haishande kana paine kupfupika kwekufema, kudonha kana pakoma. .
Kuvhiya kurapwa kwepfari
Panyaya yechiratidzo chepfari chinokonzerwa neaneurysm, abscess, kana bundu remuuropi, vanachiremba vanofanirwa kuvhiya kuti vabvise chikonzero chepfari. Aya maitiro akaoma zvikuru, anowanzoitwa pasi peanesthesia yemunharaunda, kuitira kuti murwere arambe achiziva, uye maererano nemamiriro ake ezvinhu, zvinokwanisika kudzora kuvimbika kwenharaunda dzeuropi dzinoita mabasa anokosha zvikuru: motokari, kutaura, uye kuona.
Iyo inonzi temporal form yepfari inokweretesawo mukurapa kwekuvhiya. Panguva yekuvhiya, chiremba anovhiya anogona kuita resection yakakwana yenguva yehuropi, kana kubvisa chete amygdala uye / kana hippocampus. Kubudirira kwekupindira kwakadaro kwakanyanya kwazvo - kusvika ku90%.
Muzviitiko zvisingawanzoitiki, kureva, vana vane congenital hemiplegia (kuderera kweimwe yehemispheres yeuropi), hemispherectomy inoitwa, kureva kuti, chirwere chechirwere chinobviswa zvachose kuitira kudzivirira pasi rose pathologies yenheyo system, kusanganisira pfari. Kufungidzira kweramangwana revana vakadaro kwakanaka, sezvo simba rehuropi hwemunhu rakakura, uye imwe hemisphere yakakwana zvakakwana kune hupenyu hwakazara uye kufunga kwakajeka.
Nekutanga kuonekwa idiopathic fomu yepfari, kushanda kwecallosotomy (kucheka corpus callosum, iyo inopa kutaurirana pakati pemahemispheres maviri europi), inoshanda zvikuru. Kupindira uku kunodzivirira kudzoka kwepfari munenge 80% yevarwere.
Rubatsiro rwekutanga
Nzira yekubatsira munhu anorwara kana ane kurwisa? Saka, kana munhu akangoerekana adonha ndokutanga kubvongodza maoko nemakumbo zvisinganzwisisiki, achikanda musoro wake kumashure, tarisa uye ona kuti vadzidzi vanowedzera. Uku kubatwa nepfari.
Chekutanga, simuka kubva kumunhu zvinhu zvese zvaanogona kudonhedza paari panguva yekubatwa. Woitendeudzira parutivi wayo woisa chinhu chakapfava pasi pemusoro kudzivirira kukuvara. Kana munhu ari kurutsa, shandura musoro wavo kurutivi, munyaya iyi, izvi zvichabatsira kudzivirira kupinda kwerutsi mumhepo yekufema.
Panguva yekubatwa nepfari, usaedza kunwa murwere uye usaedza kumubata nesimba. Simba rako harisati rakwana. Kumbira vamwe kuti vashevedze chiremba.
Chekutanga, simuka kubva kumunhu zvinhu zvese zvaanogona kudonhedza paari panguva yekubatwa. Woitendeudzira parutivi wayo woisa chinhu chakapfava pasi pemusoro kudzivirira kukuvara. Kana munhu ari kurutsa, shandura musoro wake kune rumwe rutivi, munyaya iyi, izvi zvichabatsira kudzivirira marutsi kuti apinde mumugwagwa wekufema.
Panguva yekubatwa nepfari, usaedza kunwa murwere uye usaedza kumubata nesimba. Simba rako harisati rakwana. Kumbira vamwe kuti vashevedze chiremba.