Transmural infarction: zimayambitsa ndi madokotala ananena zawo

Transmural infarction - wamba ndi woopsa kwambiri matenda, amene anatsagana ndi necrosis a minofu mtima. Tikumbukenso kuti amafa likhoza kudwala ofanana ndi mkulu, makamaka ngati zizindikiro za matenda mtima sanali anawona nthawi, ndipo wodwalayo sanalandire chisamaliro zofunika mankhwala. Choncho n'kofunika kudziwa kusonyeza mawonekedwe amtima ndi thandizo chofunika n'chiyani kuti munthu odwala.

Transmural m'mnyewa wamtima infarction: ndichiyani?

Choyamba, tiyeni kuthana ndi mawu akuti. Ndithudi ambiri a inu mukudziwa kuti zinthu infarct ali limodzi ndi lifotabe zigawo za minofu mtima. Izi zimachitika chifukwa cha kutha mwadzidzidzi wa magazi mtima, chifukwa mu minofu simulandira koyenera kuti moyo mpweya ndi zakudya.

Monga amadziwika, mtima khoma tichipeza zigawo zitatu - ndi epicardium (kunja wosanjikiza), mural wosanjikiza minofu ndi endocardium (mbali mkati minofu). Pamene intramural mawonekedwe necrosis matenda amakhudza okha wosanjikiza umodzi. Pachimake transmural m'mnyewa wamtima - kudwala, kumene njira necrotic zingaoneke mu zigawo zonse za mtima. Akuti izi mawonekedwe owopsa za matenda.

Mu mankhwala amakono, kudwala zimagawidwa zochokera kutanthauzira kwa foci wa necrosis. The kaŵirikaŵiri anati transmural m'mnyewa wamtima infarction kutsogolo khoma, womwe ventricle kumanzere. munthu mmodzi yekha pa milandu asanu, necrosis ndi amakhudza bwino ventricle khoma. Pafupifupi hafu ya odwala nawo mbali ndipo makoma a atria lapansi.

Zimayambitsa matenda

Pafupifupi nkhani iliyonse, chifukwa cha transmural m'mnyewa wamtima matenda ischemic mtima. Monga tanenera kale, ndi mpweya osakwanira ndi zakudya minofu maselo anayamba kufa - kotero osauka necrosis. Malinga ndi kafukufuku, 90% ya milandu chifukwa ndi atherosclerosis a zotengera inatsekeratu, moti otaya magazi kwa myocardium lapansi.

Pa khoma chombocho aumbike mwa otchedwa atherosclerotic zolengeza. Mothandizidwa ndi zinthu zina mipukutuyi gawo akuswa kutali khoma ndipo atseka wa lumen wa mtsempha wamagazi ndi inatsekeratu. Pachimake transmural m'mnyewa wamtima zambiri amakula mwamsanga mu zochitika pamene m'mnyewa wamtima mpweya ankafuna ukuwonjezeka zikuchepa - izi zikhoza kuchitika, mwachitsanzo, ndi amphamvu thupi yaikulu, malungo, aakulu maganizo nkhawa.

Pachimake transmural m'mnyewa wamtima infarction: Zifukwa

Monga mukuonera, zotupa necrotic mtima si matenda palokha. Nthawi zambiri, kukhala pa maziko a atherosclerosis kale ndi ischemia. Choncho n'zotheka kupeza ndi zifukwa zingapo chiopsezo:

• The kutengera za kumtundu wa wodwalayo kuti amagwirizana ndi mbali zina anatomical ndi matenda akatengela apabanja.
• Izo zikuchitika ndi chinthu zaka. Transmural m'mnyewa wamtima zambiri anapezeka ku anthu 45, ndi anthu sitichedwa matenda.
• Kuchuluka mlingo wa mafuta m'thupi m'magazi (chifukwa cha mawonekedwe mipukutuyi pa Mitsempha, amene kenako kuphimba m'magazi).
• Kusagwiritsa zakudya (kudya mafuta ndi zakudya yokazinga kumachititsa kukhala atherosclerosis).
• Kunenepa (zomwe nthawi zambiri amagwirizana ndi zakudya osauka ndi kunenepa kumawonjezera katundu pa mtima).
• Wongokhala (amangokhala moyo kumabweretsa kufooka mwapang'onopang'ono minofu mtima, myocardium kenako zovuta kupirira zinthu zilizonse thupi).
• Zonse nkhawa, amatopa, maganizo kumabweretsa kusintha m'thupi zimene zimakhudza dongosolo mtima.
• Kusuta (malingana ndi kuwerengera, 35% ya milandu m'mnyewa wamtima necrosis kugwirizana ndi chizolowezi zoipa).

Zizindikiro Main: mmene tingadziwire vuto la mtima?

Zizindikiro za necrosis angakhale osiyana - izo zidalira pa mlingo wa kuwonongeka, m'badwo munthu, pamaso pa matenda concomitant, etc. Pali milandu asymptomatic m'mnyewa wamtima otaya ... Komabe, zizindikiro zina zazikulu ndi:

• Nthawi zambiri, munthu anadandaula za aakulu compressive ululu kumbuyo breastbone - izo bwino amapatsa kumanzere phewa, nkono, nsagwada, makutu ndipo ngakhale mano.
• Ululu wavy ndi yaitali - kuukira Mungathe kubwereza patangotha maola ochepa mwinanso masiku.
• Mpatuko tachycardia, wodwalayo zambiri akuona bwinobwino pafupipafupi ndipo ngakhale chowawa heartbeats.
• Palinso mphamvu ya yochepa kutha mtima.
• Pali zizindikiro kunja ndi matenda a mtima - khungu ndi nembanemba mucous wa munthu mwadzidzidzi wotumbululuka.
• Against maziko a necrosis pafupipafupi kukhala mtima mphumu - wodwala anati kufupika amphamvu mpweya, mwadzidzidzi matenda breathlessness.

miyeso matenda

Pamene kuphwanya choyamba ayenera kunyamulidwa yomweyo munthu wodwalayo mu kuchipatala kuchipatala, komwe matenda zoyenera ndi mankhwala ikuchitika. Waukulu matenda njira necrosis m'mnyewa wamtima ndi electrocardiography, chifukwa pamene ngati ndondomeko n'zotheka kuti akonze Zoyenereza magetsi mu mbali zosiyana za mtima.

Molondola ikuchitika, ndi decrypted electrocardiogram amalola dokotala kudziwa kutanthauzira kwa necrosis (mwachitsanzo, m'munsi transmural mtima), mlingo wa kufala kwa ndondomeko pathological ndi kuya chotupa, nthawi ya matenda.

Komanso, muyenera atayezetsa. M'mnyewa wamtima ananena kuwonjezeka erythrocyte mlingo sedimentation, kuchuluka chiwerengero cha leukocytes mu mwazi wa michere yeniyeni ndi mankhwala omwe si mwa selo m'mnyewa wamtima.

Terms of thandizo

Pachimake transmural m'mnyewa wamtima infarction kutsogolo khoma - ndi kudwala kuti akufotokozera mofulumira kwambiri. zizindikiro zake angayambe nthawi ina iliyonse, choncho muyenera mutidziwe bwino malamulo a thandizo kwa wodwala. Kumene, poyamba pa zonse tiyenera itanani ambulansi.

Kudikira madokotala, munthu ayenera kugona pansi. Zosiyana ndi vuto kumene kufupika amphamvu mpweya ndi wheezing pamene kupuma osiyana - zimene zinachitikira wodwalayo bwino mpando, tucked pansi kumbuyo kwa pilo kapena khushoni. Ndi bwino kuchita aspirin. Muyeneranso kupereka munthu nitroglycerin - woyamba mankhwala, ndipo ngati ululu sukupita kwina, ndiye mphindi zisanu kenako wina (koma palibe zoposa zitatu).

Chiwembu Chithandizo cha m'mnyewa wamtima

Malinga ndi zotsatira tinasonkhanitsa pa matenda dokotala n'kukulemberani chithandizo. chithandizo koyamba zambiri imakhala zigawo zitatu zikuluzikulu:

• Kuvomereza othetsa ululu pochepetsa alili. Nthawi zambiri, ululu n'zotheka kusiya kokha ndi thandizo la mankhwala amphamvu, kuphatikizapo "Promedol" ndi "Morphine". Maonekedwe zizindikiro ndi matenda a "m'mnyewa wamtima infarction" ndi nkhawa kwa munthu, ndi chisangalalo ndi mantha kumawonjezera yekha katundu pa mtima - wodwala Kwalamulidwa mankhwala.
• Malamulo pazikhalanso kulandira feteleza komanso beta-blockers, amene amathandiza kuthetsa arrhythmia ndi kubwezeretsa mtima kayendedwe.
• Pamene transmural m'mnyewa wamtima mkulu Mwina wa magazi kuundana, amene ana amakumana ndi necrosis ziwalo zina ndi ndondomeko inafikira pa malo moyandikana wa myocardium ndi zotupa mantha dongosolo ndipo ngakhale imfa. Choncho, polimbana thrombosis ayenera kuyamba maola oyambirira chiyambire matendawa. Chifukwa chaichi, ntchito yokonzekera vasospasm amene ali heparin ndi fibrinolysin. Mwachibadwa, pamene mukumwa mankhwala zambiri kukha mwazi chachikulu chifukwa magazi aumirira mabasi, kotero ndikofunika mosamala kuwunika alili.

Chithandizocho kwenikweni anakhala m'chipatala - wodwala padziko koloko akhale pansi chisamaliro dokotala.

Zotsatira ndi mavuto a matenda

Transmural infarction - kwambiri zovuta ndi zoopsa mawonekedwe necrosis m'mnyewa wamtima, makamaka pankhani lalikulu focal necrosis. Matendawo zinadzala ndi zotsatira - chitukuko cha edema m'mapapo mwanga, ziwalo za miyendo lokhudza kulankhula. Nthawi zina m'mnyewa wamtima kumatanthauza kudwala zina za dongosolo mtima, monga sitiroko.

Zotsatira za matenda mulinso thromboembolism, fibrillation yamitsempha yamagazi, kuthetsedwa kwa ntchito za mabungwe osiyana ndi ngakhale kachitidwe kawo. Zikatero amakhala mu imfa, ngakhale wodwalayo thandizo kuchipatala anapereka. moyo pachiswe wina zosokonezeka - mtima. Ngati kuchepetsa amphamvu myocardium ndi kuonjezera kuthamanga mu ventricles ndi atria chiopsezo kunyengerera kukhulupirika kwa minofu m'dera la necrosis.

Konzanso ndi Zoneneratu

Mwatsoka, Zoneneratu pa zinthu zimenezi mankhwala si yabwino kwambiri - pafupifupi 50% ya milandu (makamaka pankhani achikulire) aphedwe. Ngati Komabe, pali anakwanitsa kubwezeretsa yachibadwa magazi, pali chiopsezo mavuto m'tsogolo, kuyambira zasintha minofu m'mnyewa wamtima.

Ndicho chifukwa chake ndi chofunika ndi nthawi konzanso. Odwala analimbikitsa ndi zakudya yosavuta, zosavuta, ndi mkulu-kalori. Komanso, n'kofunika pang'onopang'ono atengenso ntchito locomotor, monga wongokhala ndi zinadzala ndi manja a minofu ndi patsogolo mu mapapo. Kumene ntchito zonse zokhudzana ndi zolimbitsa thupi, ayenera mosamalitsa ankalamulira katswiri.

mankhwala wothandiza ndi polojekiti nthawi kuti dokotala ndikofunikira pamaso mapeto a moyo. Ndithudi, odwala amafunika kudya zakudya, kupewa maganizo ndi masewera olimbitsa thupi kwambiri, kupewa amphamvu kuthamanga kuwonjezeka magazi ndiponso kusiya kusuta.