Lub cev tib neeg lub cev yog qhov tshwj xeeb. Txawm li cas los xij, qee zaum muaj xwm txheej thaum qee lub cev tsis ua tiav nws txoj haujlwm. Nws yog qhov tseeb xws li kev ua txhaum ntawm cov qauv - tsis txaus ntawm lub aortic valve - lub ntsiab lus ntawm kab lus no.
Terminology
Thawj pib, koj yuav tsum nkag siab cov ntsiab lus uas yuav siv rau hauv kab lus nthuav tawm. Yog li dab tsi yog aortic valve insufficiency? Qhov no yog kev ua txhaum ntawm kev ua haujlwm ntawm lub cev no, vim tias nws cov li qub tsis tau kaw nruj nreem. Qhov no ua rau muaj teeb meem xws li reflux ntawm cov ntshav los ntawm lub aorta rov qab mus rau sab laug lub plawv ventricle. Qhov no tshwm sim thaum lub sij hawm diastole - tus txheej txheem ntawm sau lub plawv nrog ntshav. Qhov kev pheej hmoo yog dab tsi? Yog li ntawd, tib neeg lub cev tsis tau txais cov ntshav txaus tsim nyog rau kev ua haujlwm ib txwm muaj. Raws li qhov tshwm sim, lub nra ntawm lub plawv nce ntxiv txhawm rau txhawm rau them nyiaj rau qhov tsis txaus no.
Feem ntau hais lus, thaum xub thawj, thaum lub cev tseem hluas thiab muaj zog, aortic valve insufficiency feem ntau tsis ua.coj tsis muaj teeb meem. Qhov tsuas yog qhov uas lub plawv yuav nce me ntsis hauv qhov loj me thiaj li yuav tau them nyiaj rau qhov tsis muaj ntshav. Cov tsos mob tshwm sim thaum pib tshwm sim, thiab tus neeg mob yuav tsis paub txog qhov muaj teeb meem. Tom qab ntawd, ua tsis taus pa luv, nce qaug zog pib tshwm sim. Txhawm rau tiv thaiv tus kab mob no, tus neeg mob yuav raug xa mus rau qhov kev phais hloov kho aortic.
Qhov teeb meem yog tus lej
Cov kws tshawb fawb sau tseg tias nws yog cov txiv neej uas feem ntau raug kev txom nyem los ntawm qhov teeb meem xws li aortic valve insufficiency. Yog hais tias peb xav txog cov feem pua, ces tus naj npawb ntawm cov neeg tuag los ntawm no pathology, nyob rau hauv cov ntaub ntawv ntawm tag nrho cov neeg tuag nrog ntau yam teeb meem plawv, yog hais txog 14%. Yog tias peb xav txog cov kab mob tshwj xeeb no, tom qab ntawd kwv yees li 4% ntawm cov neeg mob, aortic valve insufficiency tau pom nyob rau hauv nws daim ntawv ntshiab, thiab hauv 10.3% ntawm cov neeg mob - nrog rau lwm yam kab mob plawv.
Yog vim li cas
Feem ntau hais lus, qhov ua rau kev txhim kho ntawm qhov teeb meem no hauv 2/3 ntawm cov neeg mob yog qhov tseeb ntawm qhov mob rheumatic ntawm li qub. Tsawg dua, tus kab mob ua rau mob endocarditis. Cov kws tshawb fawb kuj paub qhov txawv ntawm ob pawg ntawm cov laj thawj, uas tau muab faib ua mob ntev thiab mob.
Cas of Chronic Deficiency
Hauv qhov no, cov kws kho mob txheeb xyuas ob peb lub laj thawj tseem ceeb uas tuaj yeem ua rau cov txheej txheem mob ntev:
- Lub plawv tsis xws luag. Cov menyuam yaus tuaj yeem yug los nrog ib lossis ob lub li qub, uas ua rau muaj ntau yam teeb meem thiab teeb meem.thaum lub plawv dhia ntshav.
- txheej txheem kev laus. Ntawd yog, lub aortic valve tuaj yeem hnav dhau sijhawm, hnav tawm.
- Rheumatic kub taub hau, uas ua rau caws pliav ntawm cov nplooj ntawv valve, tiv thaiv lawv los ntawm kev kaw kom zoo.
- Cov txheej txheem kis mob hauv lub siab, thaum cov nroj tsuag (tag nrho cov kab mob hauv cheeb tsam) "noj los ntawm" cov nplooj ntawv valve, lossis, yooj yim accumulating ntawm li qub, tiv thaiv lawv los ntawm kev kaw ib txwm.
- Kev loj ntawm lub aorta, thaum nws qhov muag tau ncab ntau heev uas cov li qub tsuas kaw tsis tau kiag li.
- Kho ntau yam teeb meem uas tuaj yeem ua rau aortic valve tsis txaus. Piv txwv li, kev kho hluav taws xob lossis kev siv Phentermine, ib qho tshuaj poob phaus uas tau tshem tawm ntawm kev siv thaum kawg ntawm lub xyoo pua 20th. Raws li cov kws tshawb fawb, nws siv tuaj yeem ua rau muaj teeb meem ntau lub plawv, suav nrog aortic valve insufficiency.
Ua rau mob tsis txaus
Ntawm qhov ua rau aortic valve tsis txaus, cov kws kho mob kuj paub qhov txawv ntawm cov kab mob xws li endocarditis (kev kis kab mob ntawm lub cev), aortic dissection (vim cov ntshav ntws los ntawm qhov khoob). Qee lub sij hawm, cov neeg mob uas tau txais kev phais aortic valve hloov pauv kuj tsim lub valve tsis txaus. Qhov ua rau mob hnyav ntawm qhov teeb meem no kuj muaj xws li mob hauv siab (piv txwv li, thaum lub tsheb sib tsoo, thaum tus neeg ntaus nws lub hauv siab hnyav ntawm lub dashboard). Qhov no feem ntau kuj ua rau muaj kev puas tsuaj rau lub aortic valve.
Cov tsos mob ntawm qhov teeb meem
Dab tsi yog cov cim qhia ntawm aortic valve insufficiency, uas koj tuaj yeem txiav txim siab qhov muaj teeb meem? Raws li tau sau tseg saum toj no, thawj zaug yuav tsis muaj cov tsos mob. Qhov ntawd yog, tus neeg mob yuav tsis xav tias nws muaj teeb meem tshwj xeeb. Txawm li cas los xij, qhov xwm txheej tau hloov pauv ntau xyoo. Lub plawv ua haujlwm hnyav dua los them rau qhov tsis muaj ntshav. Yog li ntawd, sab laug ventricle nce me ntsis, thiab lub plawv nws tus kheej yuav qaug zog. Qhov no yog qhov uas aortic valve insufficiency ua rau nws tus kheej xav. Cov tsos mob uas yuav tshwm sim hauv qhov no:
- Kev qaug zog tas mus li, tsis muaj zog thoob plaws lub cev.
- Tus neeg mob ua tsis taus pa. Nws nce ntxiv thaum lub sijhawm ua si lub cev.
- Tseem muaj arrhythmias, uas yog, lub plawv dhia tsis zoo.
- Tus neeg mob tuaj yeem yws ntawm lub plawv dhia nrawm.
- mob hauv siab (angina pectoris) tuaj yeem tshwm sim thaum lub sijhawm ua haujlwm.
- Ntau heev, cov neeg mob kuj raug kev txom nyem los ntawm tsis nco qab.
Yog tias tus neeg mob muaj qhov tsis txaus, ces txhua yam tsos mob tshwm sim tam sim ntawd, lawv lub zog loj dua, lawv pom lawv tus kheej meej dua. Hauv qhov no, cov neeg mob feem ntau xav tau tsheb thauj neeg mob xwm txheej ceev, mus txog kev cawm neeg txoj sia.
About degrees of insufficiency
Kuj muaj qhov teeb meem xws li aortic valve insufficiency, degree ntawm kev loj hlob. Lawv txawv ntawm qhov ntev ntawm lub dav hlau uas tau txhaj rov qab rau hauv lub ventricle los ntawm qhov tsis zoo kaw cusps. Nyob ntawm qhov no, lawv txawv los ntawm peb:thawj, thib ob thiab thib peb.
First degree
Dab tsi tshwj xeeb txog qib 1 aortic valve insufficiency? Nyob rau hauv cov ntaub ntawv no, lub dav hlau tsis tshaj ib tug ntev ntawm 5 mm los ntawm lub aortic cusps. Yog li, qhov teeb meem no tseem tuaj yeem hu ua qhov tsis tseem ceeb. Tom qab tag nrho, cov ntshav tau sau kwv yees li hauv qab li qub, tsis muaj teeb meem tshwj xeeb. Aortic valve insufficiency ntawm qib 1 tsis ua rau muaj kev nce ntxiv ntawm sab laug ventricle, nyob rau hauv rooj plaub no nws tuaj yeem ua rau tag nrho-fledged ib txwm loj.
Second degree
Aortic valve tsis txaus ntawm 2nd degree yog tshwj xeeb hauv qhov ntev ntawm lub dav hlau nyob rau hauv rooj plaub no nce mus rau 10 hli. Ntawd yog, cov ntshav "txhaj" ntawm qhov deb li ntawm 10 mm los ntawm cov nplooj ntawv valve. Nyob rau hauv cov ntaub ntawv no, lub dav hlau tuaj yeem ncav cuag cov nplooj ntawv ntawm lub mitral valve, uas ua rau qhov teeb meem loj dua. Aortic valve insufficiency ntawm 2nd degree tsub kom lub pulsation nyob rau hauv lub carotid hlab ntsha thiab lub plawv, sab laug ventricle nce. Nov yog txhua yam yooj yim pom ntawm echocardiogram.
Third degree
Aortic valve insufficiency ntawm 3rd degree yog tus cwj pwm los ntawm qhov tseeb tias cov ntshav txhaj rov qab mus rau qhov deb tshaj 10 hli. Hauv qhov no, lub dav hlau hla lub mitral valve thiab tuaj yeem ncav cuag lub apex ntawm sab laug ventricle. Hauv qhov no, ciam teb ntawm lub plawv nce ntau dua 2 cm, sab laug ventricular hypertrophy tuaj yeem "pom" ntawm ECG.
Me nyuam Deficiency
Cais, Kuv xav xav txog qhov aortic valve insufficiency hauv cov menyuam yaus. Puas yuav muaj qhov sib txawvlaus thiab me nyuam? Yog li, cov tsos mob yuav txawv me ntsis. Nyob rau hauv cov ntaub ntawv no, cov me nyuam feem ntau muaj pallor ntawm daim tawv nqaij, pulsation ntawm cov hlab ntsha nyob rau hauv cov ceg, Musset cov tsos mob yuav loj hlob (tus me nyuam yuav co taub hau rau ob sab, nyob ntawm seb lub atherosclerosis ntawm lub plawv dhia). Raws li kev kho mob thiab kev kuaj mob ntawm qhov teeb meem, cov txheej txheem no yuav zoo ib yam rau cov menyuam yaus thiab cov neeg laus.
Diagnosis
Kev kuaj mob ua ntej ntawm "aortic valve insufficiency" tuaj yeem ua los ntawm tus kws kho mob tom qab mloog (auscultation) ntawm lub plawv tsis zoo (yuav muaj qhov tsis txaus ntseeg diastolic yws). Txawm li cas los xij, qhov no tsuas yog kev kwv yees rau tam sim no. Tom ntej no, tus kws kho mob yuav nug txog cov tsos mob uas yuav qhia tau tias muaj qhov teeb meem no, sau keeb kwm tag nrho. Tsis tas li ntawd, tus kws kho mob yuav xa tus neeg mob mus rau kev tshawb fawb ntxiv uas yuav lees paub lossis tsis lees paub qhov kev kuaj mob yav dhau los.
- Palpation. Hauv qhov no, tus kws kho mob tshwj xeeb tuaj yeem, los ntawm kev xav, txiav txim siab qhov tshee ntawm lub hauv paus ntawm lub plawv. Qhov no yog vim qhov tso tawm ntawm cov ntshav ntau heev. Percussion kuj tseem "pom" thaum ciam teb ntawm lub siab "mus" rau sab laug.
- EKG. Cov txheej txheem no ua rau nws muaj peev xwm txiav txim siab qhov loj ntawm sab laug ventricle ntawm lub plawv.
- EchoCG. Cov txheej txheem no nyob rau hauv ob-dimensional hom qhia sab laug ventricular hypertrophy. Nyob rau hauv ib-dimensional hom, nws muaj peev xwm paub qhov txawv flutter ntawm lub mitral valve leaflet vim lub dav hlau nkag mus rau nws.
- Dopplerography muablub peev xwm los txiav txim siab txog qib ntawm aortic valve insufficiency - qhia qhov ntev ntawm lub dav hlau ntawm cov ntshav pov tseg rov qab.
- X-ray. Yog tias aortic valve insufficiency hnyav heev, cov txheej txheem no ua rau nws muaj peev xwm "pom" qhov loj ntawm lub plawv, calcification ntawm nplooj ntawv.
- txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau lub plawv, cov txheej txheem catheterization plawv yuav raug sau tseg. Hauv qhov no, cov kws kho mob paub qhov txawv plaub qib ntawm aortic valve insufficiency raws li qhov ntim ntawm cov ntshav txhaj rov qab. Nrog rau thawj degree, nws yog hais txog 15%, nrog rau qhov thib ob - los ntawm 15 mus rau 30%, nrog rau qhov thib peb - los ntawm 30 mus rau 50%, nrog rau lub thib plaub - ntau tshaj 50%.
Yog tias tus neeg mob tau kuaj pom yav dhau los nrog aortic valve insufficiency, qhov teeb meem yuav tsis tas kuaj tau siv tag nrho cov txheej txheem no. Yog li, tus kws kho mob txiav txim siab rau nws tus kheej seb tus neeg mob xav tau dab tsi nyob rau theem no. Nws yuav tsum tau muab sau tseg tias, ntxiv rau cov kev kuaj mob saum toj no, qee zaum coronary angiography kuj tseem siv tau, uas tuaj yeem muab tshuaj rau tib qho kev qhia xws li aortic stenosis.
kho mob
Yog tias tus neeg mob tau kuaj pom tias muaj aortic valve insufficiency, kev kho mob yuav nyob ntawm seb tus neeg mob tus kab mob li cas. Yog li, qhov ceev ntawm kev siv qee yam tshuaj lossis cov txheej txheem cuam tshuam nrog qhov hnyav ntawm qhov tshwm sim ntawm ntau yam tsos mob. Yog tias daim ntawv ntawm tus kab mob no ntev, kev kho mob yog ua tau.
Tshuaj uas tus neeg mob yuav xav tau:
- Diuretics. Lub hom phiaj tseem ceeb ntawm cov tshuaj no yog tshem tawm cov kua dej ntau dhau ntawm lub cev, txo cov ntshav siab.
- Tshuaj tua kab mob. Muaj peev xwm muab tau raws li kev tiv thaiv kab mob sib kis thaum phais lossis kho hniav.
- Calcium channel blockers kuj tau sau tseg (tsuas yog cov tshuaj "Nifedipine"), lub hom phiaj tseem ceeb ntawm kev txo cov ntshav tawm. Nws yuav tsum raug sau tseg tias qee zaum, kev siv cov tshuaj no tuaj yeem yog lwm txoj hauv kev zoo rau kev phais.
- Lwm cov tshuaj kuj yuav raug sau tseg, xws li ACE inhibitors lossis angiotensin receptor blockers.
Nws tseem yuav tsum tau muab sau tseg tias cov neeg mob uas muaj qhov teeb meem no, txawm tias tam sim no nyob rau hauv daim ntawv ntev, yuav tsum tau sau npe nrog kws kho mob. Lawv yuav tau mus ntsib kws kho mob ib ntus. Kev ntsuas radical hauv qhov no tsis yog ib txwm qhia.
Surgery
Yog tus kab mob mob hnyav, yuav tsum tau muaj kev phais sai. Thaum ib tug neeg mus cuag kws kho mob sai, qhov muaj feem yuav muaj sia nyob ntau dua. Thiab txawm hais tias kev tuag hauv qhov no tsawg, qhov kev ncua mus rau cov kws kho mob tuaj yeem ua rau tus neeg mob ua rau nws txoj sia.
Tsis tas li, kev phais tau qhia rau cov neeg mob uas tau kuaj pom tias muaj aortic valve insufficiency ntev dhau los. Yog tias tus neeg mob twb muaj cov tsos mob, txawm tias thaum xub thawj mob me, sab laug ventricle poob contractility - cov no yog tag nrho cov qhia rau kev phais hloov lub aortic valve.
Raws li kev siv, nws yuav tsum tau muab sau tseg tias niaj hnub no kev phais feem ntau xaus zoo thiab coj cov txiaj ntsig xav tau rau tus neeg mob. Thawj qhov haujlwm no tau ua rov qab rau xyoo 1960 los ntawm Dr. Harken, uas tau hloov lub aorta nrog lub pob yas thiab lub tawb hlau. Nyob rau hauv ib ncig ntawm lub Soviet Union, xws li ib tug ua hauj lwm yog thawj zaug ua nyob rau hauv 1964, ua tiav. Txij thaum ntawd los, cov kws kho mob tau tsim ntau cov tswv yim thiab cov tswv yim los ua qhov kev cuam tshuam ntawm kev phais kom zoo thiab ua tau zoo raws li qhov ua tau.
Tus neeg muaj sia nyob
Yog tias tus neeg mob muaj lub plawv tsis ua haujlwm nruab nrab lossis mob me, qhov muaj sia nyob 10 xyoo yog siab heev, suav txog yuav luag 90% ntawm tag nrho cov neeg mob. Yog tias qhov kev tsis txaus siab pib tshwm sim, cov tsos mob tshwm sim, qhov xwm txheej tuaj yeem ua rau hnyav zuj zus. Nyob rau hauv cov ntaub ntawv no, yog hais tias koj tsis siv rau kev phais, kev tuag yuav tshwm sim nyob rau hauv li 2-5 xyoo, nyob ntawm seb txoj kev loj hlob ntawm lwm yam kab mob.
Yog hais tias tus kab mob no yog asymptomatic kiag li, qhov kev cia siab yuav zoo li qhov ua tau. Hauv qhov no, kev phais tsuas yog yuav tsum tau ua hauv 4% ntawm cov neeg mob. Nyob rau tib lub sijhawm, kev tsis txaus siab tuaj yeem tshwm sim hauv cov neeg mob thawj tsib xyoos - hauv 20% ntawm cov neeg mob, xya xyoo - txog 25% ntawm cov neeg mob. Yog tias qhov tsis txaus yog mob hnyav, mob hnyav, qhov tshwm sim ua rau tuag taus yog ua tau thaum muaj ventricular arrhythmia. Yog tias qhov haujlwm ua tiav raws sijhawm, kev txhim kho ntawm cov xwm txheej no tuaj yeem zam tau.
Kev Tiv Thaiv
Kev tiv thaiv kom tsis txhob kis tau li ntawdmob, tsis muaj. Hauv qhov no, kev noj zaub mov lossis kev ua neej nyob yuav tsis tuaj yeem pab tau. Tab sis cov neeg mob uas muaj kev pheej hmoo tuaj yeem cawm lawv tus kheej. Yog li, lawv tsis tu ncua yuav tsum tau mus kuaj nrog kws kho mob, ua cov txheej txheem. Lub sijhawm kuaj yuav txawv, tab sis koj yuav tsum tsis txhob mus ntsib koj tus kws kho mob tsawg dua ib xyoos ib zaug.
