Pachimake mtima kulephera: zizindikiro asanafe thandizo

Chaka chilichonse, matenda a dongosolo mtima wopita ku imfa ya anthu oposa 17 miliyoni padziko lonse. % 10 okha pathologies ngati muli obadwa nawo. Ambiri limati matenda limapezeka pa maziko a nkhawa ndi moyo osauka wa munthu masiku ano. M'nkhani ino Ife timayang'ana pa zomwe ndi congestive mtima kulephera.

Zizindikiro za imfa ndi mavuto amene amakhalapo chifukwa kudwala, njira ya matenda ndi mankhwala a matenda, mitundu ndi mawonekedwe a matenda - zambiri pa nkhani zonse izi zimaonekera zipangizo za taphunzira. Komanso, nkhani ikufotokoza malamulo, zomwe zingakhale zothandiza kwa aliyense wa ife. Luso zinthu mwadzidzidzi amapereka nthawi zambiri, kuteteza moyo wa munthu. Choncho, munthu ayenera kudziwa zimene thandizo kulephera pachimake mtima.

Lingaliro la mtima kukanika

Mtima kulephera (HF) - kudwala, imene mtima ikutha kupereka zofunika kuchuluka kwa thupi minofu ya magazi. Ndi zotsatira za chakhungu luso minofu mtima (myocardium) kuti kuotcha. CH zambiri kumabweretsa aakulu mawonetseredwe matenda, kuphatikizapo edema m'mapapo mwanga, infarction, cardiogenic mantha.

Disease atengeke amuna ndi akazi, koma chomalizachi akuvutika ndi matenda zambiri. Imfa ndi mkulu okwanira pa kudwala lapansi. Kuopsa kwa anthu ndi aliyense wa mawonetseredwe chifukwa cha matenda monga kulephera congestive mtima. Zizindikiro asanafe, amatchedwa mankhwala mwadzidzidzi, ndi yosiyanasiyana. Akudalira pa zimene mtundu wa matenda kumachitika. Ndi chikhalidwe cha chiyambi cha matenda a mtima amadziŵika:

• M'mnyewa wamtima mtima kulephera - ndi kudwala kuti chifukwa cha kuwonongeka mwachindunji kwa minofu mtima chifukwa kuphwanya kagayidwe mphamvu. Mtundu wa matenda a mtima kumabweretsa kukanika ya chidule ndi zosangalatsa za mtima.
• Zimamuchulukira mtima kulephera - ndi kudwala kuti akufotokozera chifukwa cha katundu chachikulu pa mtima. Mtundu zina kukhala pa maziko a matenda a mtima.
• Tikaphatikiza mtima kulephera - mawonekedwe a kudwala, chomwe chili ndi awiri zifukwa tatchulawa.

Makalasi kulephera mtima

Pakali pano, pali muyezo yosiyanasiyana yomwe matenda lagawidwa mitundu yosiyanasiyana. Medicine, pali zingapo machitidwe gulu (Russian, European, American), koma kachitidwe wotchuka kwambiri ndi bungwe cardiologists US. Mogwirizana ndi njira imeneyi ndi makalasi anayi a matenda:

• Kalasi 1, mmene wodwalayo ukapezeka dyspnea yogwira zoyenda Mwachitsanzo, njira kuuka kwa mlingo pamwamba phaka lachitatu.
• Kalasi 2, mmene kumeneko dyspnea ngakhale pa katundu wochepa - pamene kutukula pansi woyamba kapena wachiwiri. Iwo amatchuka utachepa zolimbitsa thupi la munthu.
• Kalasi 3, mmene kulephera mtima ndi noticeable pa katundu wochepa, mwachitsanzo poyenda, koma matenda quiescent zizindikiro zikawoneka.
• Kalasi 4, yomwe zizindikiro zimachitika ngakhale pa mpumulo, ndi masewera olimbitsa thupi laling'ono kumabweretsa kuswa mtima ndi lonse mtima dongosolo lonse.

Gawo CH

Kudwala akhoza wachinsinsi monga muyezo angapo. Malinga ndi chithunzi matenda a mankhwala matenda, zodziwika pachimake ndi aakulu mtima kulephera.

Pachimake mtima kulephera (AHF) - matenda imene zizindikiro pathological mofulumira (pasanathe maola). Monga ulamuliro, ndi maziko a matenda ena a dongosolo mtima ndi kuli pachimake mtima kulephera.

Infarction, myocarditis ndi matenda ena akhoza kukhala choyambitsa inati matenda, chifukwa pansi pathologies awa, maselo mtima minofu kufa chifukwa matenda wamba magazi. OCH amathanso n'chiyani wovulala kumanzere yamitsempha yamagazi khoma, pachimake kulephera kuli nthambi (ndi kung'ambika ndi mitral). Nthawi zina, kudwala akufotokozera popanda kuyan'anila isanafike.

OCH - matenda sioneka ndithu chifukwa zingayambitse chikhalidwe chowawa machitidwe ena a thupi. Zovuta kulephera pachimake mtima nthawi zambiri zimakhudza osati mtima komanso dongosolo kupuma, kuchititsa edema m'mapapo mwanga, mphumu mtima, cardiogenic mantha.

Matenda mtima kulephera - matenda amene kudwala ndi aumbike pang'onopang'ono, milungu, miyezi kapena zaka. Kumachitika ndi maziko a matenda a mtima, matenda oopsa kapena yaitali magazi m'thupi.

Mitundu ya DOS mtundu wa hemodynamics

Malinga mtundu wa hemodynamic khalidwe kutanthauzira wa kudwala, pali mitundu zotsatirazi kulephera pachimake mtima:

• DOS ndi hemodynamics congestive.
• DOS ndi hemodynamics hypokinetic.

Hemodynamics - ndi nthenda yotaya magazi kudzera ziwiya, chimene chinapangitsa pampanipani m'madera osiyanasiyana m'thupi. Amadziwika kuti chimachititsa magazi kuchokera kudera la kuthamanga apamwamba kwa m'munsi.

Kuthamanga zimadalira kukhuthala magazi, ndi kukana kwa Mitsempha pambuyo pake. DOS ndi hemodynamics congestive zingakhudze lamanja kapena lamanzere ventricle za mtima. Malinga ndi kusiyana izi:

• Pachimake bwino yamitsempha yamagazi kulephera, imene stasis venous zimawonedwa ku bwalo lalikulu la magazi, mwachitsanzo. E. umakhudza onse ziwalo ndipo zimakhala.
• Pachimake kumanzere kulephera yamitsempha yamagazi, imene stasis venous akupezeka otaya m'mapapo mwanga magazi. Kudwala yosemphana kuwombola mpweya mu mapapo ndi kumabweretsa chitukuko cha edema m'mapapo mwanga kapena mphumu mtima. Choncho, ndi maziko a zoterozo kuphwanya ndi amapezeka pachimake m'mapapo mwanga matenda a mtima.

DOS ndi hemodynamics hypokinetic

Pachimake matenda a mtima pa hypokinetic hemodynamics - ndi kudwala chifukwa cha mantha cardiogenic - kufooka lakuthwa mu luso la myocardium kuti mgwirizano, chifukwa mu kusokonezeka kwa kotunga magazi zimakhala thupi.

kusiyanitsa:

• Arrhythmic mantha, omwe chifukwa cha matenda mtima mungoli.
• Reflex Shock - zimachitika kuti ululu.
• N'zoona cardiogenic mantha - pathological chikhalidwe umene umachitika zotupa la kumanzere yamitsempha yamagazi minofu, ndi malo chotupa ndi osachepera 50%. Violation, monga ulamuliro, ndi sitichedwa anthu oposa zaka 60 zakubadwa; anthu omwe anali wachiwiri mtima; odwala matenda oopsa ndipo shuga.

Chofunika, cardiogenic mantha amakhala ndi ululu, mwadzidzidzi magazi kuchepa kwa mfundo osachepera (pansi 0), filiform zimachitika, wotumbululuka khungu. Kudwala mwina patapita kusamukira edema m'mapapo mwanga kapena n'chiyani kulephera aimpso.

Zinthu achititsa kuti zikamera wa OCH

Chitukuko cha matenda a mtima ndi njira pachimake, wodwala akhoza yoyamba kale anakumana matenda a mtima dongosolo. zinthu zimenezi ndi monga:

• matenda a mtima chifukwa cha kuwonongeka kwa minofu mtima, zikubweretsa kuchepa lakuthwa luso myocardium kutenga;
• aakulu mtima kulephera, amene akuswa pamene yachibadwa kotunga magazi ziwalo ndipo zimakhala;
• kuwononga umphumphu wa mavavu mtima ndi machubu;
• kudzikundikira madzimadzi mu pericardium, amene akutitsogolera kuti kuphwanya mlingo woyenerera wa mtima chifukwa kuthamanga ankachititsa pa M'mimbamo za mtima (kudwala iyi akutchedwa mtima tamponade);
• thickening mpanda wa mtima - m'mnyewa wamtima hypertrophy;
• hypertensive mavuto - amalembedwa magazi chosayenerera.

zimayambitsa noncardiac

Kuwonjezera pa mavuto ndi mtima zikamera wa limati matenda akhoza zikutanthauza kuti imapha mu kudwala kugwirizana ndi kuthamanga kwa magazi mu otaya m'mapapo mwanga magazi. Matenda kuti kukhala ndi matenda a "Kulephera pachimake mtima":

• Chilonda - kuphwanya makope ubongo, amene amakwiya minofu yake zowonongeka ndi okwana ubongo ntchito matenda;

• thromboembolism mtsempha wamagazi ya phapo (matenda kumachitika chifukwa cha blockage wa mtsempha wamagazi m'mapapo mwanga, komanso njira yake magazi kuundana (thrombi), ambiri amangoti magazi kuundana zimachitika akuluakulu m'chiuno ndipo m'munsi mitsempha nthambi);
• matenda a m'mapapo - kutukusira kwa bronchi ndi (matenda), kutupa kwa m'mapapo minofu (pneumonitis);
• dysrhythmia kugunda kwa mtima (mathamangitsidwe kapena deceleration) - tachyarrhythmia, bradyarrhythmia;
• matenda oyamba ndi tizilombo toyambitsa matenda osiyanasiyana.

Pali zifukwa wopita ku chitukuko cha matenda a mtima, koma osati kusonyeza matenda kachitidwe aliyense limba. Njirazi ndi monga:

• opaleshoni;
• choipa ndi ubongo choipa;
• kuukira poizoni pa minofu mtima - mowa, aukali kukhudzana mankhwala;
• mtima m'mapapo makina, ntchito imbaenda mavuto ena;
• electrotrauma - zimakhudzanso thupi la magetsi inawadutsa;
• psycho-athupi kapena yaikulu.

Matendawa kulephera pachimake mtima

Kupeza Vuto mtima ayi kwenikweni kwa mtima wa zimayambitsa zimene zinachititsa kuti chitukuko cha kudwala. Pamaso wozengereza mayesero zasayansi ndi mwai ntchito zipangizo zachipatala, dokotala adzaona kudzera kukambirana ndi mtima pamaso kapena kusapezeka mu moyo wake wa zinthu zosiyanasiyana zimathandiza kuti chitukuko cha matenda monga kulephera pachimake mtima. Zizindikiro za imfa (mwadzidzidzi) amapezeka mkati mwa maola 24 zimakhala ofooka, ndi ntchito katswiri - kuti asataye nthawi ndi kutenga nkhani madandaulo onse wodwala posachedwapa kukhazikitsa matenda zolondola.

Kufufuza njira yaikulu ntchito mu matenda a AHF, monga:

• ndi electrocardiogram;
• echocardiogram;

• pachifuwa X-ray;
• ambiri ndi zapamwamba magazi;
• Nthawi zina ntchito matenda OCH cardiovisor - chipangizo mfundo ya ntchito si losiyana kwa electrocardiograph lapansi.

i matenda

The zazikulu kwambiri kutchulidwa chizindikiro cha pachimake mtima kulephera panopa angatchedwe nkusani tachycardia - kupanga tachyarrhythmias supraventricular, umene khalidwe ndi inapita patsogolo nkusani mungoli - pafupipafupi contractions wa mtima wa munthu wamkulu kwambiri kuposa mphindi 100. Graphic tionetse ntchito mtima chikusonyeza kumatheka ulamuliro malire lamanja kapena lamanzere. Komanso pamwamba pa kapena pamwamba pa xiphoid ndondomeko lachitatu kamvekedwe akuwonekera.

Pachimake congestive lamanja mtima kulephera kumaonekera mbali zingapo:

• mtsempha khomo lachiberekero ndi mitsempha kwa chiwindi ndi pathupi ndi pathupi;
• mkulu venous kuthamanga;

• kuwonjezeka chiwindi, mapepala matenda a chikasu ndiyo;
• Ziwalo kutupa;
• cyanosis zala maso (khutu, chibwano, mphuno);
• wodwalayo kupweteka kwambiri nusu lake lamanja chapamwamba;
• ECG nkhani mtima mwadzidzidzi zimamuchulukira wa ventricle lamanja ndi atrium, kumene munthu amasonyeza mwa mano mkulu zisonga.

Zizindikiro za matenda a mtima lamanja momveka bwino ndi X-ray ndi electrocardiogram. Mapeto a mtundu wa matenda a mtima kumabweretsa zikutha m'mayiko thupi, kuchepetsa mlingo wa mapuloteni mu magazi ndi chisokonezo a muyezo mchere m'thupi.

Zizindikiro kulephera kumanzere yamitsempha yamagazi ndi cardiogenic mantha

Poyankha, pamaso pa pachimake kulephera kumanzere yamitsempha yamagazi ndi hemodynamics congestive umboni ndi chiwerengero cha zinthu zotsatirazi:

• kufupika kwa mpweya, nthawi zina kutembenukira mu mphumu;
• paroxysmal youma chifuwa, expectoration zina frothy, amene anamasulidwa pakamwa kapena mphuno;
• pamaso pa rales yonyowa amene anamva pamwamba lonse la pachifuwa.

Pali zizindikiro khalidwe la mantha cardiogenic, akuti:

• The magazi a wodwalayo akutsikira khalidwe 90-80 mamilimita Hg. Art. ndipo ngakhale zochepa. Ngati munthu amadwala matenda oopsa, ndi chizindikiro cha wodwalayo kuchepa ndi 30 mamilimita Hg. Art. kuchokera pa tsiku payekha.
• utachepa zimachitika kuthamanga - osachepera 25-20 mamilimita Hg. Art.
• Kukayikirana kakasi cardiogenic chiyenera kupangitsa paleness wa khungu komanso kuzizira kwa uzimu wake. mawonetseredwe amenewa amasonyeza kuphwanya microcirculation mu zimakhala za thupi.

Ndi munthu amene anapeza zizindikiro pamwamba wa kudwala, payenera kukhala zingapo isanafike akatswiri. (. Kufa ziwalo, matenda a mtima, etc.) thandizo kulephera pachimake mtima ayenera kupita kuonetsetsa kuti:

• kukonza kupeza mpweya wabwino;
• kuonetsetsa malo yopingasa wodwalayo (ngati alibe zizindikiro kulephera kumanzere yamitsempha yamagazi);
• kugwira zotsatira analgesic.

Chithandizo kulephera pachimake mtima

Chithandizo cha matenda a mtima - kuipidwa mankhwala umalimbana, Choyamba, kuonetsetsa kuti:

• kuthetsa zimamuchulukira mtima minofu - muyeso izi zimatheka pogwiritsa ntchito mankhwala kuchepetsa magazi ndiponso kugunda kwa mtima;
• kudzagwira matenda a (miyeso achire kudzadalira pa matenda mawonetseredwe mawonetseredwe).

Ngati DOS ali kusanduka chifukwa cha infarction m'mnyewa wamtima, m'pofunika posachedwapa kubwezeretsa inatsekeratu mtsempha wamagazi magazi. Childs, chikhalidwe amachititsa infarct thrombosis mtsempha wamagazi, chakudya mtima. Mankhwala amathandiza magazi aumirira kwathunthu kubwezeretsa patency wa magazi chotengera ndi ziziyenda alili.

The njira wotchuka kwambiri mu nkhani iyi akuti thrombolysis, koma ndondomeko ayenera kuchitika posachedwapa pambuyo isanayambike infarction mpaka aumirira akadali "watsopano". thandizo kulephera pachimake mtima zimaphatikizapo kugwiritsa ntchito mankhwala (thrombolytics), amene kanthu umalimbana ndi kuvunda kwa magazi kuundana. Medicaments kutumikiridwa m'nsinga, mlingo wawo wa malowedwe mu chamoyo ndi malamulo okhwima okhudza.

Chithandizo kulephera pachimake (yamitsempha yamagazi kumanja) ndi hemodynamics congestive kumafuna kuchotsa amachititsa zinapangitsa, - .. Momwe asthmaticus, magazi kuundana mu mitsempha m'mapapo mwanga, etc. Kuyambira mankhwala kopita mtima "nitroglycerin" kapena "Furosemide" pamene ophatikizana kudwala cardiogenic mantha ntchito inotropic amatanthauza. Mothandizana ndi miyezo ya pamwamba ikuchitika ndi mpweya inhalation kudzera catheter lapansi.

Psychomotor mukubwadamuka amalimbikira analgesics chomwa mankhwalawa, monga "morphine", omwe amachepetsa ntchito za minofu kupuma ndipo kumachepetsa nkhawa pa mtima.

Kucotsa zizindikiro kumanzere yamitsempha yamagazi kulephera

Stagnation kwa magazi m'mapapo mwanga ndi zambiri kumayambitsa mavuto aakulu monga edema m'mapapo mwanga. Amenewa monyanyira odwala Kwalamulidwa kugwiritsira "nitroglycerin" m'nsinga.

Ngati pachimake kumanzere yamitsempha yamagazi kulephera ndi hemodynamics congestive pamodzi ndi mantha cardiogenic, mankhwala oyamba a "dobutamine" kapena "noradrenaline" m'nsinga. Pali milandu pamene mankhwala amaphatikiza zovuta a.

Thobvu cropped kudzera njira kupereka thovu kugwa.

Ngati hemodynamics okhazikika, koma zizindikiro m'mapapo edema kulimbikira wodwala kutumikiridwa glucocorticoids. Pankhaniyi, thandizo zoopsa pachimake mtima ithandiza kuchepetsa permeability wa zimagwira ntchito zosiyanasiyana.

Therapy ndi mantha cardiogenic wayamba kuonjezera linanena bungwe mtima, pakalibe mawonetseredwe kulephera congestive mtima kuti limapangidwa kugwiritsira plasma zochulukitsira. Ndondomeko anachita okha m'manja mwa kugunda kwa mtima, kuthamanga kwa magazi ndi kupuma. Ngati isanafike pakutchulidwa matenda pachimake mtima zinachitika imfa waukulu wa madzi, sodium mankhwala enaake ntchito.

Kucotsa zizindikiro za matenda, ndithudi, makamaka kugwirizana ndi kugwiritsa ntchito mankhwala, koma akamwedwa miyeso sikumachititsa zotsatira anakhumba, mukhoza kugwiritsa ntchito njira yolondola - kuchita hemodynamic katundu kupyolera tourniquet pa mitsempha nthambi.

Nthawi kumene mankhwala ndiwofatsa ndi mphamvu amachita opaleshoni. Data ndi inathetsedwa mavuto kugwirizana ndi occlusion wa mitsempha, mavavu m'malo mtima. Ziziyenda mlingo mtima zimathandiza kukhazikitsa pacemaker kapena Makina amenewa.

kupewa

Njira yabwinno yogonjetsera chitukuko cha matenda - ndi kumvera malamulo yosavuta - ndicho, kukhala ndi moyo wathanzi, kusuta fodya ndi kusiya ntchito kwambiri mowa, kuchita nthawi kuwunika matenda aakulu alipo. Komabe, m'zochitika pamene matenda ukadali unaonekera ayenera kutsatira ulamuliro zenizeni tsiku ndi tsiku.

Odwala ndi kulephera congestive mtima ayenera kwambiri kuyan'ana kulemera. Owonjezera pogwiritsa imfayo kuwonjezeka mu shuga magazi ndi mapangidwe mafuta mipukutuyi mu zotengera magazi, kamene kamayambitsa matenda a kuthamanga magazi. Mkhalidwe zofunika kukhalabe thanzi bwinobwino umamumvera wapadera chakudya zakudya. M'pofunika mosamalitsa zonse zakudya za mchere, ndi muyeso umene zoipa thanzi - izo zimayambitsa posungira madzimadzi, edema mapangidwe, kuchuluka katundu pa mtima.

Imathandiza kuchita masewera olimbitsa thupi, kupereka katundu kwa minofu ndi mafupa, koma makalasi masewera si chifukwa zimamuchulukira za thupi. Zogwiritsira zokambirana kuti anagwirizana ndi dokotala. Nkofunika pafupipafupi pitani panja, kugona, kupewa maganizo ndi yaikulu maganizo.

Kulonga n'cigwagwa, mwina kudziŵika kuti mtima kulephera pachimake - ndi kudwala kuti nthawi zambiri amapha. matenda zambiri akufotokozera mu maziko a limati zina matenda a dongosolo mtima ndipo kumayambitsa mavuto osiyanasiyana, kuphatikizapo sitiroko, cardiogenic mantha, edema m'mapapo mwanga, ndi zina zotero.

Pali zizindikiro, amene amawapeza pachimake mtima kulephera. Zizindikiro za imfa wonse kuwonetseredwa, choncho ntchito zofunika akatswiri ndi mbiri yonena za madandaulo onse wodwala ndi mosamala mwamsanga.