Xyaum txhua tus neeg mob ntawm tus kws kho plawv tau ntsib ib txoj hauv kev los yog lwm yam nrog ntau hom arrhythmias. Tam sim no, kev lag luam kws tshuaj muaj ntau yam tshuaj antiarrhythmic. Lawv cov kev faib thiab cov yam ntxwv yuav raug txiav txim siab hauv kab lus no.
Txoj kev muaj hwj chim
tshuaj Antiarrhythmic raug tshuaj los tshem tawm ectopic plawv atherosclerosis. Cov txheej txheem ntawm kev ua ntawm cov tshuaj no yog tsom rau cov khoom siv hluav taws xob ntawm kev ua haujlwm myocardial hlwb:
- Txo qhov nrawm ntawm qhov ua tau zoo, uas pab ua kom qeeb ntawm kev ua kom zoo siab.
- Tsawg myocardial excitability.
- Ua kom lub sij hawm luv luv ntawm cov txheeb ze refractoriness, uas ua rau lub sijhawm luv thaum lub zog tsis txaus ntseeg tuaj yeem ua rau lub plawv dhia.
- Nyob rau lub sij hawm ntawm kev ua tau zoo refractoriness, uas yog ib qho tseem ceeb rau tachycardias thiab tshem tawm impulses uas tshwm sim ib ntus luv luv tom qab qhov pom kev contraction.
- Kev nrawm nrawm, uas ua rauhomogenization thiab tiv thaiv qhov tshwm sim ntawm rov nkag ("rov nkag").
- Inhibition ntawm lub hom phiaj ntawm ectopic automatism, uas yog txuam nrog lub sijhawm ntev ntawm diastolic depolarization.
- Tshem tawm qhov sib txawv ntawm tus nqi conduction thiab refractoriness.
- Txo lub plawv rhiab heev rau hluav taws xob poob siab thiab kev pheej hmoo ntawm ventricular fibrillation.
Kev faib tawm ntawm cov tshuaj tiv thaiv arrhythmic
Txhua yam tshuaj hauv pab pawg no tau muab faib ua plaub chav kawm. Tsis tas li ntawd, thawj chav kawm tau muab faib ua peb pawg ntxiv. Qhov kev faib tawm no yog nyob ntawm qib uas cov tshuaj cuam tshuam rau lub peev xwm ntawm lub plawv hlwb los tsim thiab ua cov cim hluav taws xob. Cov chav sib txawv ntawm cov tshuaj antiarrhythmic muaj ntau txoj hauv kev ntawm kev ua, yog li lawv cov txiaj ntsig yuav txawv rau ntau hom arrhythmia.
Thawj chav kawm suav nrog cov blockers ntawm cov kab nrawm nrawm. Subclass IA suav nrog cov tshuaj xws li Quinidine, Disopyramide, Novocainamide, Gilurithmal. Subclass IB muaj xws li Pyromecaine, Tocainide, Difenin, Lidocaine, Aprindine, Trimecaine, Mexiletine. IC subclass yog tsim los ntawm cov neeg sawv cev xws li Etmozin, Ritmonorm (Propafenon), Allapinin, Etacizin, Flecainide, Indecainide, Bonnecor, Lorcainide.
chav kawm thib ob muaj beta-blockers (Metoprolol, Nadolol, Alprenolol, Kordanum, Propranolol, Acebutalol, Pindolol, Trazikor, Esmolol).
Chav kawm thib peb suav nrog cov tshuaj potassium channel blockers:Bretylium Tosylate, Amiodarone, Sotalol.
chav kawm plaub suav nrog cov blockers ntawm qeeb calcium channel (piv txwv li, "Verapamil").
Cov npe tshuaj tiv thaiv tsis tau xaus rau ntawd. Cardiac glycosides, potassium chloride, sodium adenosine triphosphate, magnesium sulfate kuj raug cais tawm.
tshuaj thawj zaug
Blockers ntawm ceev ceev sodium channel nres qhov nkag ntawm sodium mus rau hauv lub hlwb, uas ua rau qeeb ntawm kev nkag mus ntawm excitation nthwv dej los ntawm myocardium. Ua tsaug rau qhov no, cov xwm txheej rau kev nrawm nrawm ntawm cov paib pathological hauv lub plawv nres, thiab arrhythmia raug tshem tawm. Cia peb xav paub ntxiv txog cov pab pawg ntawm cov tshuaj antiarrhythmic uas yog thawj chav kawm.
IA class Medicines
Cov tshuaj tiv thaiv kev mob arrhythmic no tau muab rau cov tshuaj extrasystoles (ventricular thiab supraventricular), nrog rau txhawm rau kho qhov ntswg qhov ntswg thaum muaj atrial fibrillation (atrial fibrillation). Tsis tas li ntawd, lawv tau siv los tiv thaiv kev tawm tsam rov tshwm sim.
"Novocainamide" thiab "Quinidine" yog cov tshuaj tiv thaiv arrhythmic rau tachycardia. Wb tham txog lawv ntau yam ntxiv.
Quinidine
Cov tshuaj no yog siv rau hauv cov xwm txheej ntawm paroxysmal supraventricular tachycardia, nrog rau paroxysms ntawm atrial fibrillation, txhawm rau kho qhov mob ntawm qhov ntswg. Feem ntau, cov tshuaj tau sau rau hauv daim ntawv ntawm cov ntsiav tshuaj.
Tshuaj lom nrog cov tshuaj tiv thaiv kab mob tsis tshua muaj, tab sis thaum noj Quinidine, cov kev mob tshwm sim hauv daim ntawv ntawm kev tsis sib haum xeeb tuaj yeem ua tau.plab zom mov (ntuav, quav quav) thiab mob taub hau. Tsis tas li ntawd, kev siv cov tshuaj no tuaj yeem ua rau txo qis ntawm platelets hauv cov ntshav, txo qis hauv intracardiac conduction, thiab txo qis hauv myocardial contractility. Qhov tshwm sim txaus ntshai tshaj plaws yog kev txhim kho ntawm daim ntawv tshwj xeeb ntawm ventricular tachycardia, uas tuaj yeem ua rau tus neeg mob tuag sai. Yog vim li cas Quinidine kho yuav tsum tau ua tsuas yog nrog kev tswj ntawm electrocardiogram thiab nyob rau hauv kev saib xyuas ntawm ib tug kws tshwj xeeb.
Cov tshuaj yog contraindicated nyob rau hauv intraventricular thiab atrioventricular blockade, intoxication nrog cardiac glycosides, thrombocytopenia, arterial hypotension, plawv tsis ua hauj lwm, cev xeeb tub.
Novocainamide
Cov tshuaj no muaj tib cov lus qhia rau kev siv xws li Quinidine. Feem ntau nws raug sau tseg rau lub hom phiaj ntawm kev nres paroxysms ntawm atrial fibrillation. Nrog rau kev txhaj tshuaj ntawm Novocainamide hauv txoj hlab ntshav, qhov txo qis hauv cov ntshav siab yog qhov ua tau, vim li ntawd, nws yog qhov tsim nyog los tswj cov tshuaj kom maj mam li sai tau.
Ntawm cov kev mob tshwm sim yog xeev siab, ntuav, hloov pauv hauv cov ntshav muaj pes tsawg leeg, kev cuam tshuam ntawm lub paj hlwb hauv daim ntawv kiv taub hau, mob taub hau, tsis tshua muaj neeg tsis meej pem. Yog tias koj siv cov tshuaj tas li, cov kab mob zoo li lupus (serositis, mob caj dab, ua npaws), kab mob microbial nyob rau hauv qhov ncauj kab noj hniav, nrog rau kev kho mob qeeb ntawm qhov txhab thiab mob thiab cov pos hniav los ntshav, tuaj yeem txhim kho. Tsis tas li ntawd, Novocainamide tuaj yeem ua rau muaj kev fab tshuajcov tshuaj tiv thaiv, nyob rau hauv cov ntaub ntawv no tus thawj kos npe yuav yog cov tsos mob ntawm cov leeg tsis muaj zog thaum noj tshuaj.
Nws yog txwv tsis pub siv tshuaj rau atrioventricular blockade, mob raum thiab lub plawv tsis ua haujlwm, arterial hypotension thiab cardiogenic shock.
IB class
Cov tshuaj no muaj kev cuam tshuam me ntsis ntawm lub qhov txhab ntawm lub qhov txhab, lub atrioventricular junction, thiab atria, thiab yog li ntawd tsis muaj txiaj ntsig zoo rau cov mob supraventricular arrhythmias. Cov tshuaj antiarrhythmic no tau sau tseg rau extrasystole, paroxysmal tachycardia, uas yog, rau kev kho mob ntawm ventricular arrhythmias. Lawv kuj tau siv los kho arrhythmias uas tshwm sim los ntawm kev noj ntau dhau ntawm lub plawv glycosides.
Daim ntawv teev cov tshuaj antiarrhythmic ntawm chav kawm no yog qhov dav heev, tab sis feem ntau siv tshuaj yog Lidocaine. Raws li txoj cai, nws tau muab tso rau hauv cov hlab ntsha thaum muaj mob hnyav ventricular arrhythmias, suav nrog myocardial infarction.
"Lidocaine" tuaj yeem cuam tshuam kev ua haujlwm ntawm lub paj hlwb, uas tshwm sim los ntawm kiv taub hau, convulsions, teeb meem nrog kev hais lus thiab tsis pom kev, tsis nco qab. Yog hais tias koj nkag mus rau hauv cov tshuaj nyob rau hauv ib tug loj koob tshuaj, nws muaj peev xwm ua rau kom lub plawv dhia qeeb, txo cov contractility ntawm lub plawv. Tsis tas li ntawd, kev tsis haum tshuaj yuav tshwm sim hauv daim ntawv ntawm Quincke's edema, urticaria, khaus tawv nqaij.
"Lidocaine" yog contraindicated nyob rau hauv atrioventricular blockade, mob sinus syndrome. Cov tshuaj tsis raug sau tseg thaum muaj mob hnyav supraventricular arrhythmia, raws li kev pheej hmoo ntawm atrial fibrillation nce.
IC chav kawm
Cov tshuaj muaj nyob rau hauv chav kawm no ua kom ntev intracardiac conduction, tshwj xeeb tshaj yog nyob rau hauv His-Purkinje system. Lawv tau tshaj tawm cov khoom arrhythmogenic, yog li tam sim no lawv tau siv rau qhov tsawg.
Daim ntawv teev cov tshuaj antiarrhythmic ntawm chav kawm no tau muab los saum toj no, tab sis ntawm cov no, tsuas yog siv Propafenone (Ritmonorm) nkaus xwb. Nws raug sau tseg rau supraventricular thiab ventricular arrhythmias, nrog rau ERW syndrome. Txij li thaum muaj kev pheej hmoo ntawm cov nyhuv arrhythmogenic, cov tshuaj yuav tsum tau siv nyob rau hauv kev saib xyuas ntawm kws kho mob.
Ntxiv rau qhov arrhythmias, cov tshuaj no tuaj yeem ua rau lub plawv tsis ua haujlwm thiab ua rau lub plawv dhia tsis zoo. Cov kev mob tshwm sim muaj xws li xim hlau saj hauv qhov ncauj, xeev siab thiab ntuav. Cov teebmeem tsis zoo xws li kev cuam tshuam txog kev pom, kev hloov pauv hauv kev kuaj ntshav, kiv taub hau, pw tsaug zog, thiab kev nyuaj siab tsis suav nrog.
Beta-blockers
Thaum lub suab ntawm lub paj hlwb nce ntxiv, piv txwv li, thaum muaj kev ntxhov siab, kub siab, kev tsis haum xeeb, ischemia, ntau cov catecholamines tshwm sim hauv cov ntshav, suav nrog adrenaline. Cov tshuaj no ua rau myocardial beta-adrenergic receptors, uas ua rau hluav taws xob plawv tsis muaj zog thiab cov tsos mob ntawm arrhythmias.
Beta-blockers tiv thaiv kev tawm dag zog ntau dhau ntawm receptors thiab yog li tiv thaiv myocardium. Tsis tas li ntawd, lawv txo cov excitability ntawm cov hlwb ntawm cov conduction system, uas ua rauqeeb lub plawv dhia.
Cov tshuaj ntawm cov chav kawm no yog siv los kho atrial flutter thiab fibrillation, rau kev tiv thaiv thiab kho ntawm supraventricular arrhythmias. Tsis tas li ntawd, lawv pab kom kov yeej sinus tachycardia.
Tsis muaj txiaj ntsig suav tias yog cov tshuaj tiv thaiv kab mob rau atrial fibrillation, tshwj tsis yog nyob rau hauv cov xwm txheej uas cov kab mob tshwm sim los ntawm ntau dhau ntawm catecholamine hauv cov ntshav.
Metoprolol thiab Anaprilin feem ntau yog siv rau kev kho mob ntawm cov hlab ntsha tawg. Cov tshuaj no muaj kev phiv nyob rau hauv daim ntawv ntawm ib tug qeeb ntawm cov mem tes, txo qis hauv myocardial contractility, thiab tshwm sim ntawm atrioventricular blockade. Cov tshuaj no tuaj yeem ua rau mob khaub thuas thiab ua rau cov ntshav ntws tsis zoo. Tsis tas li ntawd, cov tshuaj cuam tshuam rau lub paj hlwb, ua rau qaug zog, kiv taub hau, kev nyuaj siab, thiab kev nco tsis zoo. Lawv kuj hloov cov kev coj ua hauv cov hlab ntsha thiab cov leeg, ua rau qaug zog thiab qaug zog.
Beta-blockers raug txwv tsis pub siv rau hauv kev poob siab cardiogenic, pulmonary edema, insulin-dependent diabetes mellitus, bronchial hawb pob. Tsis tas li ntawd, contraindications yog atrioventricular thaiv ntawm qhov thib ob degree, sinus bradycardia.
Potassium channel blockers
Daim ntawv teev cov tshuaj antiarrhythmic ntawm pab pawg no suav nrog cov tshuaj uas ua rau cov txheej txheem hluav taws xob qeeb hauv cov hlwb ntawm lub plawv thiab yog li thaiv cov kab mob potassium. Cov tshuaj nto moo tshaj plaws ntawm chav kawm no yog Amiodarone (Cordarone). Ntawm lwm yam, nwsua rau M-cholinergic thiab adrenergic receptors.
"Kordaron" yog siv rau kev kho mob thiab tiv thaiv ventricular, atrial thiab supraventricular arrhythmia, lub plawv atherosclerosis cuam tshuam rau keeb kwm ntawm ERW syndrome. Cov tshuaj no kuj raug sau tseg los tiv thaiv kev ua rau lub neej ventricular arrhythmia nyob rau hauv cov neeg mob uas mob plawv nres. Tsis tas li ntawd, nws yog siv los txo lub plawv dhia nyob rau hauv persistent atrial fibrillation.
Yog tias koj siv cov khoom siv ntev, cov kab mob pulmonary interstitial pulmonary fibrosis tuaj yeem txhim kho, cov tawv nqaij xim tuaj yeem hloov pauv (qhov tsos ntawm cov xim liab qab). Qee zaum, muaj mob taub hau, pw tsaug zog cuam tshuam, nco, tsis pom kev. Kev noj Amiodarone tuaj yeem ua rau mob sinus bradycardia, cem quav, xeev siab thiab ntuav.
Tsis txhob muab tshuaj rau thawj zaug bradycardia, ncua sijhawm Q-T lub sijhawm, kev ua haujlwm tsis zoo ntawm lub plawv, cov thyroid kab mob, arterial hypotension, cev xeeb tub, bronchial hawb pob.
Slow calcium channel blockers
Cov tshuaj no thaiv qhov qeeb ntawm calcium, yog li inhibiting ectopic foci nyob rau hauv atria thiab txo cov automatism ntawm lub sinus node. Cov npe ntawm cov tshuaj antiarrhythmic nyob rau hauv pab pawg no suav nrog "Verapamil", uas tau sau tseg rau kev tiv thaiv thiab kev kho mob ntawm paroxysms ntawm supraventricular tachycardia, rau kev kho mob ntawm supraventricular extrasystoles. Verapamil tsis muaj txiaj ntsig thaum muaj ventricular arrhythmias.
Cov kev mob tshwm sim suav nrogatrioventricular blockade, sinus bradycardia, arterial hypotension, thiab qee zaum - txo qis hauv plawv contractility.
Kheev glycosides
Kev faib cov tshuaj tiv thaiv kab mob yuav tsis ua tiav yam tsis tau hais txog cov tshuaj no. Cov no suav nrog cov tshuaj xws li Celanide, Korglikon, Digitoxin, Digoxin, thiab lwm yam. Lawv tau siv los kho cov kab mob hauv lub cev, nres supraventricular tachycardia, thiab txo qhov zaus ntawm ventricular contractions nyob rau hauv cov ntaub ntawv ntawm atrial fibrillation. Thaum siv cardiac glycosides, koj yuav tsum tau saib xyuas koj tus mob. Cov cim qhia ntawm cov tshuaj lom neeg muaj xws li mob plab, xeev siab thiab ntuav, mob taub hau, pom thiab pw tsaug zog, thiab ntshav ntswg.
Nws yog txwv tsis pub siv cov tshuaj tiv thaiv arrhythmic rau bradycardia, SVC syndrome, intracardiac blockades. Lawv tsis raug sau rau hauv cov ntaub ntawv ntawm paroxysmal ventricular tachycardia.
Kev sib xyaw ntawm cov tshuaj tiv thaiv arrhythmic
Nrog ectopic rhythms, qee qhov kev sib xyaw ntawm cov tshuaj siv hauv kev kho mob. Yog li, "Quinidine" tuaj yeem siv ua ke nrog lub plawv glycosides rau kev kho mob ntawm extrasystole. Nrog rau cov tshuaj beta-blockers, Quinidine tuaj yeem raug sau tseg kom tsis txhob muaj cov kab mob ventricular arrhythmias uas tsis haum rau lwm yam kev kho mob. Kev siv ua ke ntawm beta-blockers thiab cardiac glycosides muab cov txiaj ntsig zoo ntawm ventricular thiab supraventricular extrasystoles, thiab tseem pab tiv thaiv kev rov tshwm sim ntawm tachyarrhythmias thiab ectopic tachycardias.
