Mtima: woyamba (systolic), wachiwiri (diastolic) - wakudziko ndi kudwala

Choyamba phonendoscopes anali apangidwe chubu mapepala kapena dzenje nsungwi nkhuni, madokotala ambiri ntchito kokha kumva zawo. Koma iwo onse ankafuna kumva zimene zinali kuchitika m'kati mwa thupi, makamaka pankhani thupi ofunika kwambiri monga mtima.

Mtima zikumveka - phokoso kuti amapangidwa m'kati kuchepetsa m'mnyewa wamtima khoma. Mwachibadwa, munthu wathanzi ali awiri kamvekedwe, kumene limodzi ndi phokoso zina kutengera mtundu wa ndondomeko pathological akufotokozera. Dokotala zapaderazi aliyense ayenera kutha kumva awa ndi kuwamasulira iwo.

mkombero mtima

The mtima ukugunda pa pafupipafupi kumenyedwa kwa makumi asanu ndi eyite pa mphindi. Izi, kumene, mtengo wamba, koma nainte ya anthu pa dziko kugwa pansi, kutanthauza kuti angathe kutenga monga mwakale. Aliyense kuwombera tichipeza zigawo ziwiri motsatizana: systole ndi diastole. Systolic phokoso mtima, nayenso, lagawidwa matenda ndi yamitsempha yamagazi. Ndi nthawi zimatengera masekondi 0,8, koma mtima ali nthawi kutenga ndi kumasuka.

systole

Monga tanena, zigawo zikuluzikulu ziwiri zedi. Poyamba, pali matenda systole: makoma a pangano lawo, magazi opanikizika akulowa ventricles, mavavu ndi mawindo zikumenyetsedwa. Ilo linali phokoso la kutseka mavavu ndi kumva mu stethoscope lapansi. Izi ndondomeko lonse amatenga masekondi 0,1.

Ndiye pakubwera yamitsempha yamagazi systole, zomwe ndi zovuta zambiri ntchito kuposa momwe zilili ndi atria lapansi. Kuyamba, tiona kuti ndondomeko amatenga katatu yaitali - masekondi 0,33.

Choyamba nthawi - ndi voteji wa ventricles lapansi. Pamafunikanso gawo asynchronous ndi contractions isometric. Izo zonse akuyamba ndi chakuti zimachitika Akasakaniza propagates pamodzi myocardium, Amasonkhezera munthu ulusi minofu imawachititsa zokha mgwirizano. Chifukwa cha ichi, amasintha mawonekedwe a mtima. Chifukwa mavavu atrioventricular atsekedwa mwamphamvu, amayamba kuthamanga ndi. Ndiye pali chidule amphamvu ventricles, ndipo magazi akulowa msempha kapena mtsempha wamagazi m'mapapo mwanga. magawo awiri awa kutenga masekondi 0,08 ndi masekondi 0,25 otsala magazi akulowa ziwiya chachikulu.

diastole

Apanso, si mophweka monga Zingaoneke koyamba. Yamitsempha yamagazi zosangalatsa kumatenga masekondi 0,37 ndi chikuchitika mu magawo atatu:

1. Protodiastolic: pambuyo magazi anasiya mtima, kuthamanga mu M'mimbamo ake yafupika ndi valavu, zikubweretsa ziwiya lalikulu, tatseka.
2. Isometric yosangalala: kumasuka minofu akupitiriza anzawo imagwera motalikira limagwirizana ndi matenda. Kuyambira mavavu izi atrioventricular lotseguka, ndipo magazi ochokera atria kuti ventricles ukugwa.
3. The kudzazidwa ventricles kuti: kuthamanga masinthidwe amtundu pamodzi madzimadzi chimadzaza m'munsi zipinda za mtima. Atamupanikiza ndi equalized, otaya magazi pang'onopang'ono kubweza kenako kuima.

The mkombero ndiye linabwerezedwanso, kuyambira systole. anakhala yofanana, koma diastole akhoza adzafupikitsidwa kapena lengthened malingana ndi kugunda kwa mtima.

Limagwirira la mapangidwe Ine kamvekedwe

Monga zachilendo mmene zingamvekere, 1 kamvekedwe ka mtima tichipeza zigawo zinayi:

1. Vavu - izo zikubweretsa maphunziro phokoso. Ndipotu, fluctuation atrioventricular timapepala ta vavu kumapeto kwa systole yamitsempha yamagazi.
2. Minofu - oscillatory zoyenda wa ventricles pa chidule.
3. Mtima - anatambasula waukulu chotengera makoma pa nthawi imene magazi awo kugwa.
4. Matenda - matenda systole. Izi chiyambi atangochimwa phula choyamba.

Limagwirira mapangidwe II kamvekedwe ndi malankhulidwe zina

Choncho, 2 kamvekedwe mtima zikuphatikizapo zigawo ziwiri zokha: a valavu ndi mtima. Choyamba - ichi ndi phokoso amachokera kumenyedwa magazi paluso valavu ndi thunthu m'mapapo mwanga pa nthawi imene iwo adakali kutsekedwa. Chachiwiri, lili ndi mtima chigawo chimodzi - gulu ziwiya chachikulu makoma, pamene kutseka kuti uchiwo usatuluke ali kutsegulidwa pomaliza.

Kuwonjezera pa kuwiri, koma kusiyanitsa malankhulidwe 3 ndi 4.

Chachitatu kamvekedwe - ndi fluctuation wa myocardium yamitsempha yamagazi pa diastole, pamene magazi umayenda ankangokhala mu malo mochedwerako.

kamvekedwe chachinayi limapezeka kumapeto kwa systole ndipo amagwirizana ndi mapeto a athamangitsidwe magazi atria lapansi.

Khalidwe Ine kamvekedwe

Mtima zimadalira zinthu zambiri, onse intra- ndi extracardiac. 1 sonority kamvekedwe zimadalira boma cholinga cha myocardium lapansi. Motero, buku loyamba amaperekedwa ndi kutsekedwa zolimba kuli nthambi mtima ndi mlingo pa zimene ventricles ali yafupika. Akuti mbali yachiwiri monga kachulukidwe kutseka kuti uchiwo usatuluke kuli nthambi atrioventricular komanso udindo wawo M'mimbamo mtima.

Ndi bwino kumvetsera kwa mtima phokoso woyamba pamwamba pa izo - mu 4-5 intercostal danga yatsala sternum lapansi. Pakuti zolondola amayang'anira zofunika percussion a chifuwa m'dera limeneli ndi bwino chimatanthauza malire a afiira mtima.

Khalidwe phula II

Kodi kumumvera, m'pofunika kuika belu stethoscope pa m'munsi mtima. pathera pang'ono lamanja la ndondomeko xiphoid wa sternum lapansi.

Buku kumva za kamvekedwe chachiwiri ndi amadalira mmene mwamphamvu mavavu amakhala otseka, okha tsopano semilunar. Komanso, liwiro la ntchito yawo, kuti amatseka ndi malekezero ufulu wa oscillation amakhudza kubwezeretsa phokoso. Ndipo katundu zina ndi osalimba a nyumba zonse mu mapangidwe kamvekedwe, komanso malo a mavavu pa athamangitsidwe magazi kuchokera mumtima.

Malamulo auscultation mawu mtima

Phokoso la mtima mwina pansi anthuwo kwambiri mu dziko, pambuyo phokoso woyera. Asayansi hypothesized kuti anali mwana kumva utero. Koma kuti azindikire kuwonongeka kwa mtima, monga kumva mmene ukugunda, sikokwanira.

Makamaka zikugwira auscultation muyenera wabata ndi ofunda malo. The aima wa munthu kumatengera mtundu valavu muyenera kumvetsera mwatcheru kwambiri. Izi zikhoza kukhala malo a atagona kumbali yake ya kumanzere, vertically, koma nyumba patsogolo anapambutsa kumanja, ndi zina zotero. D.

Wodwala ayenera kukhala kawirikawiri ndi osaya kupuma, ndipo malinga ndi pempho dokotala kugwira mpweya wanu. Kuti bwinobwino kumene systole ndi diastole dokotala ayenera ikufanana ndi kumvetsera palpate ndi carotid mtsempha wamagazi zimachitika zomwe chikugwirizana kwathunthu ndi gawo systolic.

Dongosolo la auscultation mtima

Patapita mtima kuyambirira wa Mtheradi ndi wachibale mtima afiira dokotala amamvetsera mtima zikumveka. Umayamba, monga ulamuliro, ndi thupi pamwamba. Chabwino pali valavu mitral ndi lomveka. Pite ku mavavu ya mitsempha lalikulu. Choyamba kung'ambika kwa - lachiwiri intercostal danga kuti lamanja la sternum, ndiye kuti mtsempha wamagazi ndi m'mapapo mwanga - pa mlingo yemweyo, basi lamanzere.

Mfundo yachinayi kwa kumvetsera - izi ndi maziko a mtima. Malowa ali pamtunda m'tsinde mwa ndondomeko xiphoid, koma akhoza ankatembenukira pambali. Kotero kuti dokotala ayenera fufuzani mtundu zimene mtima ndi olamulira magetsi molondola kumvetsera vavu tricuspid.

Nazo auscultation pa Botkin-Erba. Inu mukhoza kumva valavu kung'ambika. Ndi mu wachinayi intercostal danga kumanzere kwa sternum lapansi.

malankhulidwe zina

mtima phokoso si nthawi zonse akukumbutsa kudina rhythmic. Nthawi zina, nthawi zambiri kuposa adzakhala zofunika, pamafunika mitundu chodabwitsa. Ena mwa madokotala izi aphunzira kuzindikira ndi kumvera. Njirazi ndi monga:

- Dinani valavu mitral. Iye angamvele pafupi pachimake pa mtima, amagwirizanitsidwa ndi kusintha organic wa timapepala ta valavu ndi imapezeka pamene zopindika anapeza mtima.

- Systolic pitani. mtundu wina wa vavu mitral. Mu nkhani iyi, kutseka kuti uchiwo usatuluke atsekedwa mwamphamvu ngati anatembenuka mkati ndi kunja pa systole.

- Perekardton. Anapeza pamene pericarditis zomatira. Kugwirizana ndi dilation kwambiri a ventricles chifukwa anapanga mkati mzere mooring.

- The kayendedwe ka zinziri. Pali mitral stenosis, zimaonekera kuwongola wa kamvekedwe choyamba, chachiwiri kamvekedwe motsindika mtsempha wamagazi m'mapapo mwanga ndi mitral vavu pitani.

- gallop. Chifukwa pakuwonekera kwake ndi kuchepetsa m'mnyewa wamtima kamvekedwe, chimaoneka pa maziko tachycardia.

Extracardiac amachititsa amveke ndi attenuation malankhulidwe

The mtima ukugunda mu thupi ndi moyo, popanda kupuma ndi maholide. Ndiye, amavala uko, mpandawo phokoso la ntchito zake kuonekera extraneous. Chifukwa izi zikhoza kukhala mwina zogwirizana kuwononga mtima, ndipo Musati muzidalira pa izo.

malankhulidwe zimathandiza kulimbikitsa:

- cachexia, anorexia, woonda pachifuwa pakhoma;

- atelectasis m'mapapo mwanga kapena mbali zake;

- kutupa mu zapambuyo mediastinum, kusuntha mosavuta;

- kusalola wa lobes m'munsi ya mapapu anu;

- zidindo zadothi mu mapapo.

The chifooke mtima zikumveka:

- kulemera kwambiri;

- kukula kwa minofu ya khoma pachifuwa;

- subcutaneous ndiko kumayambitsa;

- pamaso pa madzimadzi mu M'mimbamo thoracic;

- exudative pericarditis.

zifukwa Intracardiac kwa mtima ndi chifooke malankhulidwe mtima

Mtima bwino, rhythmic pamene munthuyo ali pa mpumulo kapena akagona. Ngati udasokonezeka, mwachitsanzo, iye anakwera masitepe ku ofesi ya adokotala, zingayambitse mtima zokwezera. Komanso, mathamangitsidwe wa kugunda kwa mtima ingayambe ndi magazi m'thupi, matenda endocrine, etc.

Wogontha phokoso mtima kumvetsera matenda anapeza mtima, monga mitral kapena kung'ambika stenosis, insufficiency kuli nthambi. chopereka chake, kumabweretsa kung'ambika stenosis m'madipatimenti kuti ali pafupi ndi mtima wake: ndi kukwera mbali waku Arc, ndi atsikira gawo. mtima Muffled zikumveka kucheza ndi anthu m'mnyewa wamtima misa, komanso matenda yotupa kwa minofu mtima, wopita ku alibe kapena sclerosis.

mtima Lidandaula

Kuwonjezera mitundu, adokotala akhoza kumva ena, otchedwa phokoso. Iwo anapanga kuchokera kugwedezekagwedezeka a magazi, omwe umadutsa M'mimbamo za mtima. Bwinobwino, iwo ayenera kukhala. mawu onse akhoza kugawidwa mu organic ndi zinchito.

1. Organic kuonekera pamene limba anatomical zidzachitika, inasinthiratu mu dongosolo valavu.
2. Zinchito phokoso kugwirizana ndi mitsempha kotunga mkhutu kapena minofu mphamvu papillary, kuchuluka kugunda kwa mtima ndi mlingo magazi, kuchepa kukhuthala ake.

Siimva akhoza ayende phokoso mtima, ndipo akhoza kukhala osadalira pa iwo. Nthawi zina pleural mikangano matenda yotupa ndi superimposed pa mtima, ndiye muyenera wodwalayo kukoka mpweya wake ndipo anawerama pang'ono kamodzinso kugwira auscultation. Njira imeneyi yosavuta yomwe ingakuthandizeni kupewa zolakwa. Childs, pamene kumvetsera mkokomo wa pathological amayesetsa kudziwa zimene gawo la kuzungulira mtima zidzachitika, malo abwino kupeza ndi kusonkhanitsa kumvetsera phokoso makhalidwe: mphamvu, nthawi ndi malangizo.

katundu phokoso

Timbre muli mitundu yambiri ya phokoso:

- zofewa kapena kuwomba (zambiri kumphatikiza ndi kudwala, nthawi zambiri ana);

- zamwano, kuchipala ndi kumaliza;

- nyimbo.

Pakuti nthawi ya wolemekezeka:

- yochepa;

- yaitali;

Ndi buku:

- chete;

- mokweza;

- kucheperachepera;

- kukula (makamaka kuchepetsa wa kumanzere atrioventricular orifice);

- incrementally-ikuchepa.

Kusintha buku wolembedwa pa limodzi la magawo ntchito mtima.

msinkhu:

- mkulu (pamene kung'ambika stenosis);

- otsika pafupipafupi (mitral stenosis).

Pali ena dongosolo ambiri phokoso auscultation. Choyamba, iwo anamvetsera bwino ku malo a mavavu, chifukwa cha kudwala zimene zinapangidwa. Kachiwiri, phokoso yochokera akulowera magazi, osati motsutsa izo. Ndipo chachitatu, ngati mtima zikumveka, phokoso nthenda yabwino atamva mtima si yokutidwa ndi kuwala ndipo mwamphamvu adherent kuti chifuwa.

kung'ung'udza Systolic bwino kumvera mu malo supine, chifukwa otaya magazi ventricles ndi kumakhala kosavuta ndipo mofulumira, ndipo diastolic - atakhala, chifukwa pansi pa mphamvu yokoka, madzi kuchokera atria kuti ventricles ukugwa mofulumira.

Phokoso angathe kusiyanitsidwa monga malo awo ndi mtima mkombero gawo. Ngati phokoso mu malo omwewo limapezeka systole ndi diastole, limanena za zotupa kuphatikiza valavu. Ngati phokoso limapezeka systole pa nthawi ina, ndipo diastole - winayo - ndi kale imfa kuphatikiza kuli nthambi ziwiri.