Hauv kev kho mob, muaj cov xwm txheej thaum tus neeg lub plawv dhia ntau zaus, thiab yog vim li cas rau qhov tshwm sim no tsis yog nyob rau hauv qhov xwm txheej ntxhov siab, tab sis nyob rau hauv ib qho kev mus tas li ntawm atrial fibrillation. Hauv cov ntaub ntawv keeb kwm, cov kab mob no tau qhia los ntawm code I 48, raws li ICD ntawm qhov kev hloov kho thib kaum. Qhov no anomaly yog suav tias yog kev hem thawj rau lub neej, txij li nyob rau hauv li ntawm peb caug feem pua ntawm cov neeg mob nws ua rau tsis ua hauj lwm ntawm cerebral ncig, piv txwv li, mob stroke. Nyob rau tib lub sijhawm, ntau thiab ntau tus neeg mob tau sau npe txhua xyoo. Qhov no yog vim qhov nce hauv lub neej expectancy, suav nrog cov neeg laus nrog qhov kev kuaj mob.
Atrial flutter thiab fibrillation: Dab tsi yog qhov txawv?
Kev tsis ua haujlwm ntawm lub plawv dhia, uas cov nqaij fibers cog lus chaotically thiab ntawm qhov ntau zaus, nce mus txog rau pua tus neeg ntaus ib feeb, hu ua atrial fibrillation. Sab nraud, cov txheej txheem no tau tshwm simnquag pulse, tab sis nws nyuaj heev rau kev soj ntsuam. Nws zoo li flickering. Ua tsaug rau qhov kev sib piv txawv txawv no, tus kab mob tau txais lub npe thib ob - atrial fibrillation.
Flutter yog suav tias yog qhov hloov pauv me me ntawm arrhythmia. Nyob rau hauv cov ntaub ntawv no, lub plawv dhia mus txog plaub puas neeg ntaus ib feeb, tab sis lub plawv dhia ntawm ib ntus.
Ntau zaus, ob qhov kev cuam tshuam ntawm kev sib tw no tau txheeb xyuas, tab sis qhov no tsis tuaj yeem ua tiav, vim tias qhov tshwm sim thiab qhov tshwm sim ntawm cov kev ua tsis tiav no txawv, uas yuav tsum tau xav txog hauv cov ntaub ntawv keeb kwm. Atrial fibrillation yog ib qho random contraction ntawm lub plawv cov leeg nqaij ntawm lub sij hawm tsis tu ncua, nrog rau muaj ntau foci uas nyob rau hauv sab laug atrium thiab xa tawm txawv txawv txawv txawv. Lub fluttering yog nqa tawm ntawm ib ntus vim yog kev sib koom ua ke ntawm cov leeg, vim tias cov impulses los ntawm ib qho kev tsom xam xwb.
Kev faib tawm ntawm atrial fibrillation
Cia peb xav txog cov txheej txheem siv los ntawm kev xyaum kws kho mob. Daim ntawv ntawm atrial fibrillation tau muab faib ua:
- Thawj zaug pom - tam sim no kuaj mob thiab tsis hais ntxiv txog nws qhov kev tshawb pom. Hom no yog asymptomatic thiab symptomatic, paroxysmal lossis persistent.
- Tsis tu ncua - fibrillation kav ntev tshaj li ib lub lim tiam. Nws yog qhov nyuaj heev rau kev sib txawv qhov no thiab daim ntawv paroxysmal hauv kev xyaum.
- Ntev mus ntev, lossis tseem hu ua ruaj khov, txhawj xeeb tus neeg mob hauvrau ib xyoos lossis ntau dua. Daim duab qhia pom tau pom tsuas yog thaum lub cev tawm dag zog.
- Daim ntawv paroxysmal ntawm atrial fibrillation hauv cov ntaub ntawv keeb kwm qhia nws qhov tshwm sim tam sim ntawd thiab ploj mus tsis pub dhau ob hnub. Yog tias qhov kev tawm tsam ntev txog xya hnub, lawv kuj raug xa mus rau daim ntawv no ntawm tus kab mob. Tus neeg mob hnov mob tsis ua haujlwm nyob rau lub sijhawm ua haujlwm ntawm lub plawv, uas yog nrog los ntawm kev qaug zog, poob siab, ua tsis taus pa, kiv taub hau thiab mob retrosternal. Muaj tsawg zaus, lub xeev qaug zog tshwm sim.
- Mob mob ntev - mob atrial fibrillation. Cov ntaub ntawv kho mob sau tseg ib qho kev txiav txim siab (tus kws kho mob thiab tus neeg mob) tias tsis muaj kev sim ua kom rov zoo li qub sinus atherosclerosis. Nrog rau kev tso cai ntawm tus neeg, uas yog, thaum nws hloov siab, kev ntsuas raug coj los tswj lub suab nrov. Nyob rau hauv rooj plaub no, lub arrhythmia rov ua ib tug protracted.
Kev faib tawm hauv tsev kho mob lossis yog vim li cas. Raws li qhov systematization no, atrial fibrillation yog qhov txawv ntawm cov kab mob sib kis lossis cov xwm txheej uas ua rau muaj kev pheej hmoo ntawm arrhythmia. Xav txog hom fibrillations:
- Secondary - provocateurs is heart disease.
- Focal - muaj nyob rau hauv cov neeg mob hluas, tshwj xeeb tshaj yog cov neeg uas muaj keeb kwm ntawm atrial tachycardia lossis lub sijhawm luv luv ntawm fibrillation.
- Polygenic - tsim tawm tsam keeb kwm yav dhau los ntawm ntau cov noob hloov pauv thaum muaj hnub nyoog ntxov.
- Monogenic - tshwm sim nrog ib tus noob hloov pauv.
- Postoperative - qhib lub plawv phais ua tus provocateur.
- Nyob rau hauv cov kws ncaws pob - tshwm sim hauv paroxysms thiab nyob ntawm kev ua haujlwm hnyav thiab ntev.
- Nyob rau hauv cov neeg mob uas muaj valvular anomalies - tsim tom qab kev khiav hauj lwm los kho lub valvular apparatus, raws li zoo raws li nrog mitral stenosis.
Raws li qhov hnyav. EAPC nplai, nws yog siv los ntsuas lub neej zoo:
- 1 - tsis muaj tsos mob ntawm tus kab mob.
- 2a - qhov tshwm sim me me, tsis muaj kev hem thawj rau tus kheej.
- 2b - Ua pa nyuaj thiab ua pa luv, tab sis lub peev xwm ua haujlwm txhua hnub tsis ploj.
- 3 - cov cim qhia ntawm arrhythmia: qaug zog, palpitations, ua tsis taus pa.
- 4 - lub peev xwm los pab tus kheej poob.
Kev sib tw. Genetic Aspects
Raws li kev soj ntsuam ntawm cov ntaub ntawv kho mob, lossis qhov tseeb, cov ntaub ntawv keeb kwm, kab mob plawv thiab tachysystolic atrial fibrillation tshwm sim hauv cov tib neeg los ntawm nees nkaum xyoo thiab laus dua, piv txwv li, kwv yees li peb feem pua ntawm cov neeg laus. Cov lus piav qhia txog qhov tseeb yog raws li hauv qab no:
- early detection;
- qhov tshwm sim ntawm cov kab mob sib xyaw ua ke uas ua rau cov tsos mob ntawm atrial fibrillation;
- nce lub neej expectancy.
Ntxiv mus, nws tau pom tias qhov kev pheej hmoo ntawm kev mob yog siab dua rau cov txiv neej, tab sis kev sib deev ncaj ncees yog qhov ua rau mob stroke ntau dua, vim tias lawv muaj ntau yam sib txawv thiab pom cov duab pom ntawm lub plawv tsis ua haujlwm.
Ua pov thawj tias lub hauv paus ntawm tus kab mob yog kev hloov pauvCov noob caj noob ces, piv txwv li, ib tus neeg, txawm tias tsis muaj kev pheej hmoo ntawm cov hlab plawv, muaj kev pheej hmoo loj ntawm kev tsim atrial fibrillation. Cov kws kho mob paub txog kaum plaub qhov sib txawv ntawm cov kev hloov pauv hauv cov genotype uas ua rau lub cev tsis ua haujlwm.
Diagnosis
Ua ntej kuaj mob atrial fibrillation, tus kws kho mob nkag mus rau anamnesis rau hauv keeb kwm kho mob, qhov twg cov ntaub ntawv hauv qab no yuav yog cov ntaub ntawv tseem ceeb:
- muaj qhov txawv txav ntawm cov thyroid caj pas, plab hnyuv, ntsws thiab lwm yam;
- muaj cov txheeb ze tau zoo ib yam arrhythmias;
- poj niam muaj kev mob ntshav qab zib;
- yog tias tus neeg mob nws tus kheej pom tias muaj kev cuam tshuam ntawm lub suab nrov, tus kws kho mob yuav xav tias lawv nyob ntev npaum li cas.
Tom ntej yog kev kuaj lub cev. Nrog nws cov kev pab, tus kws kho mob kuj ua qhov kev kuaj mob sib txawv nrog kev tshee. Thaum mloog, lub plawv dhia yuav txawv ntawm lub plawv dhia ntawm lub dab teg. Qhov kev txiav txim siab txog qhov tsis tu ncua ntawm lub atherosclerosis yog ua raws li cov txiaj ntsig ntawm ECG, uas yog suav tias yog ib qho kev qhia tshwj xeeb rau kev kuaj mob. Tag nrho cov ntaub ntawv tau txais kuj raug kaw rau hauv keeb kwm kho mob. Thaum kuaj cov neeg laus, ib qho electrocardiogram yuav tsum tau qhia. Qhov kev ntsuas no txo tus naj npawb ntawm cov neeg mob uas tom qab mob plawv tsis ua haujlwm thiab ischemic stroke, nrog rau txhim kho kev kuaj mob asymptomatic thiab paroxysmal cov ntaub ntawv ntawm fibrillation. Txhawm rau kuaj xyuas qhov kawg, nws yog qhov zoo tshaj plaws los mus saib xyuas Holter puag ncig.
Tam sim no muaj txoj hauv kev tshiab los ntawm cov tib neeg tuaj yeem txheeb xyuas qhov ua txhaum cai. Txawm li cas los xij, nyob rau hauv cov ntsiab lus ntawm cov ntaub ntawv, lawv muaj qis dua rau daim cardiogram.
ntsuas ntsuas
Tom qab kev kuaj mob ntawm atrial fibrillation tau ua tiav, kev kho mob nyuaj. Qhov no siv rau hauv tus account yam xws li:
- mob;
- tus lej ntshav siab;
- lub plawv dhia;
- kev phom sij ntawm lub paj hlwb;
- probability ntawm sinus atherosclerosis;
- muaj kev sib koom ua ke ntawm pathology ua rau muaj kev cuam tshuam ntawm arrhythmia.
Tom qab ntsuas tus neeg mob tus mob, tus kws kho mob txiav txim siab txog kev tswj hwm nws tus kheej.
Kev tiv thaiv kab mob stroke yog qhia:
- YWarfarin;
- Dabigatran, Apixaban.
Txhawm rau tswj lub plawv dhia, cov tswv yim hauv qab no tau ua raws:
- tswj lub plawv dhia;
- resuming natural sinus rhythm.
Tau kawg, kev xaiv cov tswv yim rau kev kho mob ntawm atrial fibrillation nyob ntawm ntau yam - qhov no yog kev paub txog kab mob, qhov hnyav ntawm cov tsos mob, muaj cov kab mob loj heev, hnub nyoog, thiab ntau dua. Hauv cov neeg mob laus, thawj lub tswv yim feem ntau yog siv. Ua tsaug rau txoj hauv kev no, qhov tshwm sim ntawm tus kab mob tau txo qis, thiab kev ua haujlwm ntawm cov neeg mob hauv lub neej niaj hnub txhim kho.
Verapamil, Diltiazem thiab Bisoprolol yog cov tshuaj xaiv kom txo tau lub plawv dhia sai. Thaum arrhythmia ua ke nrog plawvInsufficiency qhia kev sib txuas ntawm beta-blockers nrog digitalis derivatives - Digoxin. Rau cov tib neeg uas muaj ntshav siab tsis ruaj khov, kev tswj hwm ntawm Amiodarone tau pom zoo.
Siv rau kev txais tos mus tas li:
- Beta-blockers - Carvedilol, Metoprolol, Nebivolol. Lawv zam txim tau zoo tsis hais hnub nyoog li cas.
- "Digoxin". Nws yog ib qho tseem ceeb uas yuav tau xaiv cov koob tshuaj kom raug vim muaj tshuaj lom.
- Reserve tshuaj - Amiodarone.
Yog li, nyob rau hauv rooj plaub ntawm tus kab mob - atrial fibrillation - kom ua tiav cov hom phiaj (110 neeg ntaus ib feeb) ntawm lub plawv dhia, kev xaiv tshuaj yog nqa tawm ib tus zuj zus. Thaum pib, qhov tsawg kawg nkaus koob tshuaj tau pom zoo, uas yog maj mam nce mus txog thaum tau txais cov txiaj ntsig kho mob.
Percutaneous catheter ablation tau raug pov thawj tias muaj txiaj ntsig zoo hauv kev kho mob atrial fibrillation, thiab tshwj xeeb tshaj yog txo cov tsos mob. Kev siv cov qauv no, ua ke nrog cov tshuaj anticoagulants tshiab thiab cov tshuaj antiarrhythmic tiam tshiab, ua rau muaj txiaj ntsig zoo dua. Kev kho rau atrial fibrillation yog:
- noj cov tshuaj tiv thaiv coagulants;
- kho cov kab mob plawv;
- mob nyem.
Raws li cov txheej txheem kho mob tshiab kawg, kev kho mob ntawm atrial fibrillation yog raws li txoj hauv kev tshiab rau kev kho mob ntshav qab zib. Txhawm rau txo qhov zaus ntawm atrial fibrillation lossis txwv nws qhov tshwm sim, ntau yam kev cuam tshuam tsis yog tshuaj siv tau nquag siv.
Kev mob xwm txheej ceev
Nyob rau hauv lwm txoj kev, nws tseem hu ua electropulse therapy - qhov no yog ib tug manipulation uas nws muaj peev xwm rov qab tau cov atherosclerosis ntawm lub plawv contractions los ntawm raug hluav taws xob tawm. Lub hauv paus ntawm hluav taws xob impulses yog lub sinus node, uas muab ib tug uniform contraction ntawm lub myocardium, nws yog nyob rau hauv lub phab ntsa ntawm lub plawv. Cardioversion yog subdivided rau hauv:
- Pharmacological - sinus atherosclerosis normalizes li tsib caug feem pua ntawm cov neeg mob thaum siv Amiodarone, Flecainide, Propafenone thiab lwm yam hauv kev kho mob ntawm paroxysmal atrial fibrillation. Nws muab qhov txiaj ntsig zoo tshaj plaws yog tias nws pib tsis pub dhau plaub caug yim teev tom qab qhov pib tawm tsam. Nyob rau hauv rooj plaub no, tsis tas yuav tsum tau npaj kev ntsuas, sib piv rau cov txheej txheem kho vajtse. Tsis tas li ntawd, muaj ib txoj hauv kev los normalize lub plawv dhia hauv tsev. Nws yog hu ua "pill in your pocket". Lawv siv "Propafenone", "Flecainide" rau qhov no.
- Hluav taws xob - hom kev cardioversion no tau qhia rau cov tib neeg uas muaj cov hlab ntshav tsis zoo nyob rau hauv qhov ua rau paroxysm ntawm atrial fibrillation.
Cia peb xav txog ib rooj plaub los ntawm kev xyaum. Raws li kev kho mob keeb kwm, paroxysmal atrial fibrillation yog ib qho kev kuaj mob ua ntej uas tau ua rau tus neeg mob hnub nyoog 25 xyoo. Nws tau hais lus tsis txaus siab hauv qab no:
- tsis tau ua pa tob;
- heartbeat;
- xov tsis ua pa;
- kev qaug zog;
Tus tub hluas tau koom nrog kev txhawb nqa lub zog thiab tsis nco qab thaum mus txog tom ntej. Atrial fibrillation tau kuaj pom hauv tus neeg mob niam thiab pog. Ntawm kev kuaj lub cev:
- pallor ntawm dermis;
- ua tsis taus pa thaum so;
- txo qhov siab, qhov txwv sab saud yog 90, thiab qis qis yog 60 hli. ua rt. Art.;
- nrog auscultation, lub plawv dhia yog 400 neeg ntaus ib feeb, thawj lub suab nrov nrov dua li qub;
- tsis sib xws ntawm cov hlab ntsha radial;
- lub plawv dhia 250 neeg ntaus ib feeb.
Kev kuaj ntxiv raug txiav txim kom pom tseeb qhov kev kuaj mob.
Thaum lub sijhawm kho mob hauv tsev kho mob, kev saib xyuas ECG 24-teev tau ua tiav, paroxysms ntawm atrial fibrillation tsis tau sau npe hauv keeb kwm kho mob, piv txwv li lawv tsis tau pom. Tus neeg mob tau txais kev kho mob cardioversion nrog dofetilide. Yog li ntawd, sinus atherosclerosis rov pib dua. Tus tub hluas raug qhia kom txwv tsis pub ua lub cev.
Atrial fibrillation: kho
Cia peb xav txog cov kev kho mob uas siv ntau cov ntaub ntawv keeb kwm tseeb ua piv txwv:
- IHD, paroxysmal atrial fibrillation, lub plawv tsis ua haujlwm - qhov kev kuaj mob tau tsim los ntawm keeb kwm, kev kuaj xyuas, kev tshawb fawb. Tus neeg mob N., 70 xyoo, tau mus pw hauv tsev kho mob nrog kev tsis txaus siab ntawm qhov mob hnyav hauv cheeb tsam retrosternal, uas tshwm sim thaum lub sij hawm qoj ib ce, palpitations, ua tsis taus pa luv thiab hnov qhov hnyav tom qab lub sternum. Tom qab noj nitroglycerin, qhov mob mob tau nres tom qab tsib mus rau kaum feeb. Tus neeg mobIHD tau kuaj pom ib xyoos dhau los. Tsis tau txais kev kho mob. Thaum nkag mus, lub dermis yog daj ntseg, ciam teb ntawm lub plawv yog tsiv mus rau sab laug. Muffled lub plawv suab, tachyarrhythmia, systolic yws, ib puas thiab nees nkaum neeg ntaus ib feeb lub plawv dhia. Cov kev kho mob hauv qab no tau raug sau tseg hauv cov chaw kho mob: Anaprilin, Kordaron, Celanide, Nitroglycerin thiab intravenous infusion of glucose.
- Tom ntej piv txwv ntawm cov ntaub ntawv keeb kwm. IHD, paroxysmal atrial fibrillation, ventricular extrasystole, mob plawv tsis ua hauj lwm. Tus neeg mob T., 60 xyoo, nyob rau hnub tuaj txog ntawm tsev kho mob, yws txog cov kev tsis txaus siab xws li kev cuam tshuam hauv kev ua haujlwm ntawm lub plawv (ntev rau ib hnub), tshwm sim feem ntau thaum nruab hnub nrog kev puas siab puas ntsws thiab lub cev ua si, ua tsis taus pa, nquag plawv dhia, tsis muaj zog. Nres hauv kev ua haujlwm ntawm lub cev tseem ceeb tau pib xav txog kaum plaub xyoos dhau los, kev ua tsis tiav raws li hom paroxysmal atrial fibrillation thiab ventricular extrasystole tau kuaj pom ib hlis ua ntej mus pw hauv tsev kho mob. Tom qab kev ntsuam xyuas ntxiv, nws tau tshwm sim: qhov tsis xwm yeem thiab tsis xwm yeem ntawm sinus atherosclerosis, rau caum-rau lub plawv dhia, manifestations ntawm sab laug ventricular hypertrophy, lub plawv dhia tsis ua hauj lwm los ntawm hom paroxysmal atrial fibrillation. Cov kev kho mob hauv qab no tau teev tseg hauv keeb kwm kho mob: pw so, statins - Atorvastatin, anticoagulants - Clexane, tom qab ntawd Warfarin, Aspirin cardio, Clopidogrel, Asparkam, Prestarium, Betaloc ZOK, intravenously "Sodium chloride".
- Sick K, 70 xyoo, raug lees paubtsev kho mob nrog kev tsis txaus siab ntawm ua tsis taus pa luv, nkees, mob me me retrosternal, palpitations thaum lub sij hawm qoj ib ce. Nws tau mob ob xyoos dhau los (palpitations, tsis muaj zog, ua tsis taus pa, mob hauv cheeb tsam ntawm lub plawv, tawg mus rau sab laug ceg thiab lub xub pwg hniav) mam li nco dheev tshwm sim, thawj zaug tshwm sim, thaum lub sij hawm nws tsis nco qab. Nws tsis nco qab tias nws tau txais kev kho mob dab tsi thiab kuaj mob dab tsi. Thaum nkag mus, lub mem tes yog non-rhythmic synchronous, yim caum-rau neeg ntaus ib feeb. Tom qab tau txais cov txiaj ntsig ntawm kev tshuaj xyuas ntxiv thiab cov ntaub ntawv kuaj mob, nrog rau keeb kwm ntawm kev txhim kho ntawm tus kab mob, kev kuaj mob tau ua tiav: diffuse cardiosclerosis, kab mob coronary artery, atrial fibrillation. Cov phiaj xwm kho mob hauv qab no tau qhia hauv cov ntaub ntawv keeb kwm: nyob rau hauv rooj plaub ntawm kev tawm tsam rov qab, tsim cov xwm txheej kom ntseeg tau tias huab cua ntshiab, lub rooj zaum thiab ua kom tus neeg mob siab. Intravenously txhaj tshuaj sodium chloride, Kordaron, Isoptin, Novocainamide. Siv lub plawv glycosides, beta-blockers.
- Sick V., 66 xyoo. Thaum lub sij hawm nkag mus, muaj kev tsis txaus siab ntawm nias qhov mob hauv cheeb tsam ntawm lub plawv, uas tshwm sim thaum lub sij hawm qoj ib ce. Hauv qhov no, qhov mob muab rau lub puab tsaig qis, sab laug lub xub pwg hniav thiab sab sauv. Tom qab noj nitrates, nws nres tom qab peb feeb. Thaum taug kev nrawm - ua pa luv. Tsis tas li ntawd, tus neeg sau ntawv cuam tshuam hauv kev ua haujlwm ntawm lub cev tseem ceeb, uas yog nrog lub plawv dhia ceev, kiv taub hau, thiab tsis muaj zog. Kuv thawj zaug hnov mob tsis zoo rau xyoo dhau los. Nws raug kho raws li tus neeg mob sab nraud thiab hauv tsev kho mob, noj nitroglycerin, Metoprolol, Veroshpiron, acetylsalicylic.kua qaub. Kev kuaj mob ua ntej, raws li keeb kwm kho mob: "CHD, atrial fibrillation, exertional angina". Tus neeg mob tau teem sijhawm rau kev soj ntsuam tom qab. Kev npaj kho mob tau tsim, suav nrog kev noj cov nitrates, beta-blockers, calcium ion antagonists. Thaum tsis muaj kev kho mob monotherapy nrog cov tshuaj los ntawm pawg kws tshuaj, kev kho mob ua ke.
Atrial fibrillation nyem
Rau txhua tus neeg mob uas muaj atrial fibrillation, ob txoj haujlwm los ntawm cov hauv qab no tau qhia hauv cov ntaub ntawv keeb kwm kev kho mob tib lub sijhawm:
- Rau txhua tus tib neeg - tiv thaiv cov kab mob thromboembolism. Qhov no yog lub luag haujlwm tseem ceeb ntawm cov kws kho mob. Rau cov laj thawj no, siv cov tshuaj tiv thaiv tsis ncaj ncees - Warfarin, Dabigatran etexilate, Rivaroxaban. Nyob rau hauv cov ntaub ntawv ntawm contraindications rau lawv siv, lawv yog siv - "Clopidogrel", "Tikagrelol", acetylsalicylic acid. Vim qhov tseeb tias kev siv cov tshuaj antithrombotic yog qhov txaus ntshai vim qhov tshwm sim los ntshav, lawv lub sijhawm teem rau cov neeg mob tau txiav txim siab ib tus zuj zus, suav nrog txhua qhov kev pheej hmoo.
- Nyob rau hauv daim ntawv tsis tu ncua - ntes ntawm arrhythmias thiab tiv thaiv kev rov qab los, piv txwv li kev tswj lub suab. Nrog rau hom atrial fibrillation hauv keeb kwm ntawm tus kab mob, cov tshuaj ntawm kev xaiv yog Amiodarone. Tsis tas li ntawd, cov txheej txheem kho mob kuj suav nrog cov tshuaj xws li Propafenone, Aymalin, Novocainamide, Dofetilide, Flecainide.
- Nrog rau daim ntawv tas mus li - kho lub plawv dhia. Rau qhov no, kev npaj nrog cov nyhuv nrawm tau qhia - "Metoprolol" lossis "Esmolol", uas tau muab tso rau hauv cov hlab ntsha, lossis sublingually "Propranolol". Yog nws ua tsis tauKev siv tshuaj kho mob lossis tsis muaj txiaj ntsig, ablation yog siv nrog kev cog qoob loo ib txhij ntawm lub pacemaker.
- Thaum muaj paroxysmal atrial fibrillation, txoj kev kho mob tau sau rau hauv keeb kwm kev kho mob los tiv thaiv cov ntu tshiab ntawm arrhythmia. Rau lub hom phiaj no, nws raug pom zoo kom tsis tu ncua noj tshuaj antiarrhythmic - Metoprolol, Bisoprolol, Propafenone, Sotalol, Amiodarone. Cov tshuaj uas tau teev tseg muaj cov kev mob tshwm sim tsawg, suav nrog kev pheej hmoo ntawm cov teeb meem hauv daim ntawv ntawm kev mob arrhythmias.
IHD kev kho mob
Txhawm rau pom qhov kev kuaj mob no, nws daim ntawv kho mob tau tsim kom tiav. Myocardial infarction lossis angina pectoris yog qhov tshwm sim thiab feem ntau tshwm sim. Lwm cov tsos mob tshwm sim tsis tshua muaj sau tseg. Tom qab txheeb xyuas ntau txhiab tus ntaub ntawv keeb kwm, kab mob coronary artery, arrhythmic variant ntawm atrial fibrillation tau ntsib nyob rau hauv cov xwm txheej cais. Daim ntawv no manifests nws tus kheej nyob rau hauv daim ntawv ntawm pulmonary edema, tawm tsam ntawm mob hawb pob, ua tsis taus pa luv. Nws qhov kev kuaj mob yog qhov nyuaj. Qhov kev kuaj mob zaum kawg yog tsim los ntawm cov txiaj ntsig ntawm kev soj ntsuam thiab cov ntaub ntawv los ntawm kev xaiv coronary angiography lossis electrocardiographic cov kev tshawb fawb hauv kev ntsuas kev tawm dag zog. Kev kho tshwj xeeb nyob ntawm daim ntawv kho mob. Kev kho mob dav dav suav nrog:
- Kev txwv kev ua lub cev.
- khoom noj khoom haus.
- Pharmacotherapy - cov tshuaj tiv thaiv kab mob, beta-blockers, fibrates thiab statins, nitrates, lipid-lowering thiab antiarrhythmic tshuaj, anticoagulants, diuretics, ACE inhibitors.
- YEndovascular coronary angioplasty.
- Surgery.
- Kev kho tsis yog tshuaj - qia hlwb, hirudotherapy, shock yoj thiab quantum therapy.
Qhov kev cia siab ntawm pathology yog qhov tsis zoo, txij li kev kho mob nres lossis ua haujlwm qeeb, tab sis tsis muab kev kho kom tiav. Tus kab mob no mob ntev heev.
Txoj kev sib txawv rau kev kho mob atrial fibrillation mus tas li. Case keeb kwm
Nyob rau hauv cov tib neeg feem ntau, atrial fibrillation loj hlob mus rau hauv ib daim ntawv mus tas li los yog tsis tu ncua, uas ua rau cov kev mob tshwm sim.
Hauv qhov no, lub hom phiaj ntawm normalizing sinus atherosclerosis yog qhov pib tsis tsim nyog. Txawm li cas los xij, nyob rau theem tsis yooj yim ntawm tus kab mob, cov kws kho mob qee zaum sim ua kom lub qhov ntswg ua haujlwm zoo siv tshuaj kho mob lossis cardioversion. Hauv lwm qhov xwm txheej, lub hom phiaj yog ua kom tsis muaj ntau tshaj yim caum strokes ntawm so thiab ib puas thiab nees nkaum hauv qab load. Tsis tas li ntawd, nws yog ib qho tsim nyog los txo qhov kev pheej hmoo ntawm thromboembolism. Nws yog txwv tsis pub rov kho qhov mob hauv qhov ntswg yog tias, nrog rau daim ntawv mus tas li ntawm atrial fibrillation, hauv keeb kwm kho mob muaj cov ntaub ntawv hais txog qhov muaj tus neeg:
- lub plawv tsis xws luag yuav tsum tau phais;
- Ythyrotoxicosis;
- left ventricular aneuryms;
- kab mob rheumatic;
- mob plawv tsis ua haujlwm thib peb;
- intracardiac thrombi;
- mob ntshav siab ntshav siab;
- Ydilated cardiomyopathy;
- nquag bouts ntawm arrhythmias;
- sinus node tsis muaj zog thiab bradycardiaCov ntaub ntawv ntawm atrial fibrillation thiab txo qis hauv lub plawv dhia.
Nrog rau qhov fibrillation tas li, cov txiaj ntsig ntawm kev siv cov tshuaj siv los kho qhov kev sib dhos yog nyob rau plaub caug feem pua. Yog hais tias tus mob tsis ntev tshaj li ob xyoos, ces kev siv hluav taws xob impulse kho yuav ua rau kom muaj kev vam meej los ntawm cuaj caum feem pua. Thaum tsis ua hauj lwm ntawm lub atherosclerosis nyob rau lub sij hawm ntev, thiab tsis yog tus kws kho mob los yog tus neeg mob ua ib qho kev sim kho nws, ces qhov laj thawj ntawm tus cwj pwm no yog vim muaj kev tsis ntseeg txog kev tswj xyuas qhov sinus atherosclerosis rau lub sijhawm ntev nrog kev kuaj mob atrial fibrillation..
Cov ntaub ntawv keeb kwm, uas suav tias yog ib daim ntawv kho mob tseem ceeb, qhia txog tus neeg mob tus mob, lub tswv yim ntawm kev kuaj mob thiab kev kho mob, thiab kev kho mob ntawm tus kab mob. Keeb kwm tsis yog tsuas yog cov npe ntawm cov ntaub ntawv tau txais los ntawm tus neeg mob thiab cov kws kho mob tau qhia thaum lub sijhawm kuaj, nws yog cov ntaub ntawv dav dav uas tau nthuav tawm hauv daim ntawv qhia ntxaws ntxaws thiab muaj txiaj ntsig zoo. Qhov zoo ntawm cov ntaub ntawv no yog ncaj qha nyob ntawm theem ntawm kev paub ntawm tus kws kho mob. Tsis tas li ntawd, thaum nws ua tiav, yuav tsum tau ua raws li cov cai tshwj xeeb, kev ua raws li qhov yuav tsum tau ua kom tsis txhob muaj ntau yam yuam kev, suav nrog kev cai lij choj. Piv txwv li, thaum qhov kev kuaj mob tseem ceeb yog "CHD, atrial fibrillation, ib daim ntawv mus tas li", cov ntaub ntawv keeb kwm qhia tau zoo thiab nthuav dav: kev tsis txaus siab, anamnesis ntawm tus kab mob thiab lub neej, cov ntaub ntawv los ntawm lub hom phiaj thiab kev kuaj ntxiv, kev kho mob. Nyob rau hauv cov ntaub ntawv ntawm ib tug mus tas li variant ntawm arrhythmia, kev kho mob phais yog qhia -ablation thiab installation ntawm ib tug tshwj xeeb ntaus ntawv (pacemaker). Tom qab kev phais, qhov kev cia siab rau lub neej ntawm tus neeg yog qhov zoo.
Tshuaj kho mob keeb kwm: atrial fibrillation
Zaj dab neeg piav qhia meej txog cov hauv qab no anamnesis ntawm tus neeg: lub neej, keeb kwm, kev ua haujlwm, kws tshuaj, tshuaj tsis haum. Raws li cov ntaub ntawv ntawm kev tshuaj xyuas lub hom phiaj, cov txiaj ntsig ntawm cov cuab yeej siv thiab kev sim hauv kev tshawb fawb, qhov laj thawj rau kev kuaj mob sib txawv, lub hom phiaj thiab lub hom phiaj ntawm kev kho mob. Kev xaiv tsim nyog ntawm pawg kws tshuaj yog ua los kho tus neeg mob tshwj xeeb. Piv txwv li, cov lus qhia tseem ceeb tshaj plaws hauv kev kho mob ntawm atrial fibrillation yog tshem tawm ntawm arrhythmia ncaj qha thiab tiv thaiv qhov tshwm sim ntawm thromboembolic. Muaj ob txoj hauv kev los kho atrial fibrillation:
- Txhim kho thiab tu lub qhov ntswg atherosclerosis - cardioversion (pharmacological thiab hluav taws xob). Nrog nws, yeej ib txwm muaj kev pheej hmoo ntawm thromboembolism.
- Kev tswj lub siab lub ntsws thaum tswj hwm atrial fibrillation. Stabilization ntawm sinus atherosclerosis yog qhov yuav tsum tau ua rau mob atrial fibrillation. Nyob rau hauv cov ntaub ntawv keeb kwm ntawm cov neeg mob sib txawv, ob qho tib si hluav taws xob thiab pharmacological cardioversion tau ntsib. Tsis tas li ntawd, kev khaws cia ntawm sinus atherosclerosis kuj tseem tsim nyog rau cov neeg uas muaj paroxysmal daim ntawv ntawm atrial fibrillation. Cov tshuaj feem ntau siv rau lub hom phiaj no yog Disopyramide, Propafenone, Procainamide, Amiodarone.
Thaum xaiv tshuaj los ntawm ib pab pawg, tsis suav nrogtshuaj uas tuaj yeem ua rau tus neeg mob hnyav dua. Lawv piav qhia hauv cov ntaub ntawv keeb kwm ob qho tib si kev sib cuam tshuam ntawm cov tshuaj xaiv, thiab qhov tshwm sim tsis zoo uas yuav tshwm sim thaum lub sij hawm kho tshuaj. Cov hauv qab no piav qhia txog qhov ua tau zoo ntawm kev kho mob.
