Fibrillation - ndi chiyani ichi? paroxysmal matenda fibrillation

Kodi inu munayamba ndi mphindi pamene mtima unayamba kugunda chaotically? Kapena, pa mwake, mochedwa? Izo zimayambitsa kumverera mantha ndi nkhawa, amatichititsa kuganiza za kukwera ku chipatala. Madokotala ndi tanthauzo la boma lililonse kuonjezerapo kwa cholinga ichi. Fibrillation - ndi mtundu wa arrhythmias mtima. Mu cardiology mchitidwe Zikatero si zachilendo, kotero izo ziri za iwo tikambirana lero.

Tanthauzo ndi kuchuluka

Pali tanthauzo sayansi khalidwe la mtima. Fibrillation - izo tachyarrhythmia, amene pamodzi ndi zikhumbo wachisokonezo magetsi a ntchito matenda. pafupipafupi awo akhoza kufika kumenyedwa mazana asanu pa mphindi, ndipo pa mlingo mgwirizano kuchepetsa kumakhala kovuta.

Matenda fibrillation ndi imodzi mwa mitundu kwambiri ambiri arrhythmias. Molondola izo zingadziŵike okha chifukwa cha electrocardiography. Pali khalidwe zizindikiro: palibe mungoli nkusani, maonekedwe f-yoweyula (matenda flutter). Achidule pafupipafupi zimadalira katundu wa mfundo atrioventricular, ndi ntchito ya mantha dongosolo autonomic limodzi ndi mankhwala.

Akatswiri amanena mliri zotupa organic a minofu mtima. contractions wachisokonezo wa kutsogolera mtima kuti mavuto magazi ndi chiopsezo zosayembekezereka wa emboli. zodabwitsazi amagwirizana ndi imfa mkulu wa matenda.

Gawo

Pali mitundu zotsatirazi wa fibrillation matenda:

1. Anaulula choyamba. Chotero matenda anapangidwa, ngati wodwalayo m'mbuyomu anafuna chithandizo chamankhwala fibrillation matenda.
2. Paroxysmal. Kuukira flutter kumatenga zosaposa sabata (zambiri masiku awiri) ndi kuthamangira paokha.
3. Lekeza. Kuukira anapitiriza masiku opitirira asanu ndi awiri.
4. Long chosatha. kuukira kumatenga khumi - miyezi khumi, koma madokotala anaganiza kuti abwezeretse mungoli lapansi.
5. Okhazikika. Matenda fibrillation kumachitika nthawi zonse, koma kayendedwe ka kubwezeretsedwa mu magawo oyambirira si wonyamulidwa, ndiyeno anatembenuka operewera.

Malinga ndi zovuta zizindikiro matenda fibrillation agawidwa m'magulu anayi:

1. Asymptomatic.
2. Wofatsa kusapeza popanda kusokoneza ntchito.
3. matenda amene amakhudza chitonthozo moyo.
4. Kulemala. Pankhaniyi, wodwala kusamalira yekha kwa.

Malinga pafupipafupi adzionere madokotala kusiyanitsa tachy, ndi mawonekedwe normo bradisistolicheskuyu matendawa.

Zina mwa zifukwa

mtima fibrillation limapezeka odwala amene ali ndi kutengera za izo. Iye akhoza yoyamba mavuto osiyanasiyana mtima:

- matenda oopsa;
- mtima kulephera;
- anapeza vavu mitral;
- kobadwa nako malformations wa etiologies zosiyanasiyana.

Yofunika kwambiri ndi ankaimba ndi cardiomyopathy dilated, inatsekeratu matenda mtsempha wamagazi, aakulu yotupa matenda a nembanemba mtima, komanso zotupa. Paroxysmal matenda fibrillation anthu pansi zaka makumi kumachitika mobisika ndi matenda ena.

Komanso, pali mndandanda wa pathologies, amene mofanana bwanji zosayembekezereka wa fibrillation matenda, koma sikuti chokhudzana ndi ntchito ya dongosolo mtima:

- kunenepa;
- shuga;
- aakulu obstructive m'mapapo mwanga matenda;
- kuchuluka ntchito ya chithokomiro England.

Ngati wodwala kusweka mbiri banja, ndiye, mwa achibale, pali anthu ndi fibrillation matenda, mwayi kuti matenda chidzaonekera proband ndi, peresenti makumi atatu.

pathogenesis

Fibrillation - ndi wachisokonezo kukokana kwa minofu, mu nkhani iyi mtima. matenda Organic zimathandiza kuti kusintha structural mu thunthu la mtima ndi chifukwa kuphwanya conduction kwa zikhumbo za magetsi. Ichi ndi chifukwa cha kuchuluka kwa minofu connective ndi wotsatira fibrosis. Zimenezi m'kati, Kuwonjezera pa vuto dissociation mitsempha ulusi Choncho fibrillation mwawo.

Madokotala kuganizira malingaliro angapo za mmene pali mtundu paroxysmal za matenda. Ambiri ndi chiphunzitso cha foci ndi mafunde angapo. Asayansi ena amakonda kuphatikiza Mabaibulo onse, chifukwa n'zosatheka kusiyanitsa mapeto a chifukwa chokhacho cha matenda.

Malinga ndi chiphunzitso choyamba (mogwirizana) mu myocardium kumachitika kuchuluka kwa foci wa ntchito magetsi, zomwe zili pafupi ziwiya lalikulu matenda kumbuyo khoma. M'kupita kwa nthawi, iwo ntchito ku dera lonse la atria lapansi. The Ofufuza postulates kuti fibrillation ndizo zotsatira za wachisokonezo padera ndi yaikulu chiwerengero cha funde malemeredwe yaing'ono.

Zizindikiro ndi Zovuta

Paroxysmal matenda fibrillation kungakhale asymptomatic ngati chisokonezo hemodynamic kulipidwa mokwanira. Childs, odwala amadandaula kudzikayikira palpitations kawirikawiri chifuwa ululu kapena kusamva m'deralo.

Against maziko awa, mwapang'onopang'ono kulephera mtima, amene kukomoka akuwonetseredwa chizungulire, akukomoka ndi kupuma movutikira. Nthawi zina, pamene pali kuukira odwala kuchuluka pafupipafupi pokodza. Akatswiri amanena izi kwa kuchuluka kwa mapuloteni natriydiureticheskogo.

Mwachikulu, pangakhale zimachitika kuchepekedwa, pamene chiwerengero cha kugunda kwa mtima kuposa chiwerengero cha mafunde zimachitika zomwe kufalitsa kwa periphery lapansi. Ngati maonekedwe asymptomatic wa fibrillation wa loyamba "belu" kungakhale sitiroko.

Long loyenda matenda fibrillation kobvuta ndi matenda a mtima, thrombosis ziwiya yaikuluikulu ya mtima kapena ubongo.

diagnostics

Matenda fibrillation - mowirikiza chosaneneka kuchepetsa cardiomyocytes. Poyamba, dokotala likamva mbiri ya matenda ndi moyo, amaona kuchokera tsiku woyamba kuukira, pamaso pa mfundo zoopsa, komanso kuphunzira za mankhwala amene wodwalayo zimatengera pa mphindi. Odwala si kudandaula, kotero kusonyeza kudwala pogwiritsa ntchito njira malangizo. Zikuphatikizapo ultrasound, Holter ECG ndi polojekiti tsiku. Fibrillation akuwonetseredwa ndi nkhani yeniyeni:

- pakalibe P yoweyula (palibe mungoli nkusani);
- maonekedwe f-mafunde a fibrillation matenda;
- intervals wosiyana pakati pa mano R.

The njira yomweyo amatha kudziwa mtima comorbidities :. m'mnyewa wamtima infarction, arrhythmia, etc. ultrasound Kupenda imagwiridwa kudziwa komanso kutsimikizira za organic matenda a mtima, ndi m'mnyewa wamtima miyezo khoma makulidwe, buku la atria ndi ventricles. Komanso, nsalu yotchinga bwino looneka parietal thrombi ndi zomera pa mavavu lapansi.

Ndiponso, yomwe akutchulidwa choyamba cha matenda fibrillation dokotala n'kukulemberani mayeso za mulingo chithokomiro timadzi kuti achotse ofuntha ake.

anticoagulation

Pa nthawi imeneyi wowerenga ali chithunzithunzi cha mmene nanga pali matenda fibrillation. Chithandizo walangizidwa Kupha ake, kapena zinthu etiological, kapena kusalaza zizindikiro.

Anticoagulants, mwachitsanzo magazi kupatulira mankhwala, akusonyeza kuti kupewa magazi kuundana ndipo potsatira sitiroko ndi matenda a mtima. Ambiri mwa mawonekedwe piritsi - ndi "Warfarin" ndi "Aspirin". Poika gulu la mankhwala dokotala amaziona propensity wodwalayo kuti thrombosis, ngozi za ischemia posachedwapa, ndipo ngati contraindications wodwalayo mtundu uwu wa mankhwala.

Nkofunika kukumbukira kuti pa ntchito anticoagulants m'pofunika zonse kuyan'ana INR (mayiko dekhetsa chiŵerengero). Zimenezi zimathandiza nthawi yokwanira kuti asiye mankhwala ndi kuchepetsa kufala kwa magazi.

mungoli ulamuliro

Fibrillation za mtima nthawi zambiri chikhalidwe ndi kusintha. Ngati kuyambira chiyambi cha kuukira anatenga nthawi pang'ono, dokotala angathe kubwezeretsa yachibadwa nkusani mungoli. Izi zikhoza kutheka ndi kumaliseche mbali ya mankhwala magetsi inawadutsa kapena antiarrhythmic.

Poyamba, kugunda kwa mtima yafupika kapena anamuukitsa kwa kumenyedwa zana pa mphindi. Ndiye muyenera kuganizira chiopsezo thromboembolism, kotero kwa masabata atatu isanafike ndondomeko, ndi mwezi kuchokera wodwala alandira chithandizo anticoagulant. Koma zonsezi Ndikofunikira kukachitika kuti kuukira kwa fibrillation matenda kumatenga masiku oposa awiri kapena nthawi ya izo sizingakhoze adzakhazikika. Ngati amadziwika kuti kuyambira chiyambi cha contractions wachisokonezo za mtima maola forte-eyiti kwambiri, kapena odwala aakulu hemodynamic Kusakhazikika, kuchepetsa mlingo ikuchitika mwachangu, kutumikiridwa heparin otsika maselo kulemera.

1. Magetsi cardioversion. Iyi ndi ndondomeko m'malo opweteka amene amafuna kumizidwa mu maloto kuchipatala wodwalayo. Mu defibrillators makono zimatulutsa synchronous ndi R-yoweyula pa ECG lapansi. Izi amapewa mwangozi yamitsempha yamagazi fibrillation. Yambani kawirikawiri ndi joules zana, ndipo ngati n'koyenera lililonse kumaliseche wotsatira anaukitsidwa kwa Joules makumi asanu. Izi chitsanzo ziwiri gawo. Single-gawo kumaliseche yomweyo joules mazana awiri, mlingo wokweretsa zinayi.
2. Mankhwala cardioversion. Pakuti mankhwala kungakhudze mtima kayendedwe, monga "Procainamide", "Amiodarone", "Nibentan" ndi "Propafenone".

Pofuna kupewa kuukira kobwereza wa fibrillation matenda pambuyo cardioversion akusankhidwa ndi mankhwala antiarrhythmic, lomwe wodwalayo ayenera kutenga miyezi kapena zaka.

kulamulira kugunda

mitundu yonse odziwika fibrillation matenda kumafuna kuphwanya kugunda kwa mtima. Choncho, madokotala ankaganiza mankhwala kuthetsa chizindikiro. Iwo amagwiritsa mankhwala akhoza kuchepetsa mlingo mtima. Njirazi ndi monga:

- beta-blockers;
- kashiamu njira blockers.

Ndi kupanda mankhwala awa kutumikiridwa magulu "Amiodarone" kapena "Dronedarone". mankhwala amenewa akhoza kuchepetsa zizindikiro za arrhythmia, koma kuchotsa kwathunthu kuti sangathe.

Ngati mankhwala ndi operewera, madokotala nthawi zina amatsatira catheter ablation. Pofuna kukhala nkusani mungoli, malo yense ayenera kuzithetsa. Ndi radiofrequency kafukufuku mtima dokotala choyambitsa munda cholekanitsa Chrixitu, kuteteza kufala kwa mafunde magetsi.

Pali njira ina imene kuwononga ganglion pakati pa atrium ndi ventricle. Izi amalenga kanthawi yopingasa chipika mtima. Ndiye wodwala uyu anapatsa introducer yokumba wa mungoli, amene akulamulira chiwerengero cha heartbeats. Umaso wa wodwalayo ndinasintha, koma kutalika kwa moyo wake si bwanji.

Matenda fibrillation pambuyo opaleshoni ya mtima

Paroxysm wa fibrillation matenda monga kutheka pambuyo opaleshoni pa mtima. Ichi ndi chimodzi mwa mavuto zambiri anakumana pambuyo ntchito zimenezi. The pathophysiology a chikhalidwe ichi chosiyana ndi zimene anaona odwala wabwinobwino ndi fibrillation matenda.

Kuphatikiza pazifukwa ochiritsira chiopsezo, wodwalayo ndi dissociation amaayoni, ndicho kuchepa madzi a potassium utachepa magazi buku, makina kuvulala kwa minofu mtima, ndi kutupa atria lapansi. Zonsezi amakwiya kutsegula kwa chitetezo chokwanira mu mawonekedwe a dongosolo womuyenerera kugwa zosiyanasiyana. Iwo ubwera amasulidwe owayimira yotupa, kukondoweza wa mantha dongosolo wachifundo komanso wachiwawa makutidwe ndi okosijeni anachita. Zonsezi ndi choyambitsa chinthu cha chiyambi cha fibrillation matenda.

Choncho, chithandizo cha mavuto pambuyo ntchito kuyamba ndi malangizo mavuto onse a pamwamba. Chifukwa chaichi, beta-blockers, "Amiodarone", mankhwala ndi sanali steroidal odana ndi yotupa mankhwala.

Mapa ndi ayamikira

Munthu akhoza kupewa matenda oopsa otere, monga "matenda fibrillation". Ayamikira madokotala ndi wosavuta ndi poyela. M'pofunika kukhala moyo wathanzi, zakudya, kupewa BP pamwamba makumi zana limodzi. Zimene wopepuka osati kuteteza zosayembekezereka wa fibrillation matenda, komanso kupewa matenda ena mtima.

Kumene, Mpofunika kusiya kusuta ndi kuchepetsa mowa. Pofuna kulimbikitsa nsupa, cardiologists anapempha kuti alandire okwanira kuchuluka kwa zakudya zofunika mafuta zidulo, kapena kutenga makapisozi ndi mafuta nsomba.

Chithandizo cha matenda bakiteriya ndi tizilombo ndi kutsatira kudzera, ngakhale inuyo subjectively kumverera bwino.

Chiopsezo sitiroko anthu ndi ukuwonjezeka matenda fibrillation kwa zaka makumi asanu peresenti, ndi makumi asanu ndi atatu - makumi awiri. Mmodzi mwa asanu lipoti sitiroko pa dziko zimawonedwa odwala ndi matenda "matenda fibrillation".