Pathology, nyob rau hauv uas lub plawv dhia ntau zaus, txawm tias qhov tseeb tias qhov ntsuas ntawm qhov kawg nyob ruaj khov, hu ua atrial flutter. Qhov kev ua txhaum cai no hais txog cov qauv ntawm atrial fibrillation. Fibrillation thiab atrial flutter ntawm hom pathologies no feem ntau tshwm sim, thiab lawv tuaj yeem hloov pauv. Qhov sib txawv tseem ceeb ntawm thawj yog nrog nws cov haujlwm ntawm atria yog chaotic.
Txoj kev xav
Cov kab mob hauv qab kev xav ua rau ua txhaum ntawm txoj kev xav ntawm lub siab nyob rau hauv lub plawv raws atrial conduction system. Nws pib ncig nyob rau hauv ib lub voj voog nyob rau hauv txoj cai atrium. Qhov no ua rau muaj kev rov ua kom rov zoo dua ntawm myocardium, uas ua rau muaj kev sib kis loj heev.
Tib lub sijhawm, tus nqi ventricular yuav nyob li qub lossis nce siab, tab sis tsis ntau npaum li qhov atrial. Qhov no yog vim lub fact tias lub atrioventricular node tsis tuaj yeem ua ib qho impulse ntau zaus. Ib qho kev zam rau qhov no yog cov neeg mob nrogWPW-sydrome, nyob rau hauv lub plawv uas muaj ib pob ntawm Kent, uas ua ib tug impulse ntawm lub atrium mus rau lub ventricle ntawm ib tug ceev ceev piv rau lub atrioventricular node. Hauv qhov no, cov neeg mob zoo li no kuj tuaj yeem hnov qhov ventricular flutter.
Pathology feem ntau tshwm sim rau cov txiv neej tshaj 60.
Lub sijhawm nws yuav siv rau kev tawm tsam kom dhau yog hu ua flutter paroxysm.
Etiology ntawm tus kab mob
Qhov tshwm sim ntawm atrial flutter yog cuam tshuam los ntawm ob qho xwm txheej cuam tshuam nrog cov hlab plawv, thiab cov uas tshwm sim los ntawm kev cuam tshuam ntawm cov kab mob hauv nruab nrog cev thiab lwm lub cev.
Thawj yog vim li cas:
- qauv txawv ntawm lub siab;
- hypertrophy ntawm nws chav;
- cardiomyopathy ntawm qhov sib txawv hnyav thiab cov ntawv;
- ntshav siab;
- muaj kev nyiam ua cov ntshav txhaws;
- kab mob ischemic;
- mob tom qab phais.
Indirect ua rau muaj xws li hauv qab no:
- kab mob endocrine;
- pulmonary embolism;
- emphysema ntawm lub cev.
Cov yam tseem ceeb ua rau kev txhim kho ntawm cov kab mob no yog raws li hauv qab no:
- yeeb tshuaj;
- kos npe ntawm pw tsaug zog apnea;
- mob ntshav qab zib mellitus;
- kab mob plawv hauv cov txheeb ze;
- kev ntxhov siab thiab kev ntxhov siab;
- kev tawm dag zog ntau dhau;
- tsis muaj kev lees paub ntawm cov nyiaj uas muajcaffeine;
- tus cwj pwm phem.
Nrog mob plawv, daim duab kho mob tej zaum yuav tsis nthuav tawm thiab muaj nyob hauv ntau cov kab mob plawv. Lawv tuaj yeem yuam kev rau cov cim qhia ntawm kev sib kis:
- oxygen deficiency thaum lub sijhawm ua haujlwm;
- txo qis hauv lub cev muaj zog;
- kev nyuaj siab;
- pab siab;
- faus;
- ua tsis taus pa.
Cov neeg muaj kev pheej hmoo yuav tsum tau mus kuaj mob raws sij hawm los ntawm kws kho plawv, vim yog tias qhov pathology no tshwm sim thiab kev kho mob tsis pib raws sijhawm, kev tuag yog ua tau.
Kev faib tawm ntawm atrial flutter
Nws yog ua raws li qhov xwm txheej ntawm kev txhim kho thiab kev kho mob ntawm pathology.
Raws li thawj lub cim, cov qauv hauv qab no ntawm atrial flutter yog qhov txawv:
Hom (classic) - flutter zaus ib feeb yog 240-340 neeg ntaus. Lub nthwv dej ntawm excitations circulates nyob rau hauv ib tug raug lub voj voog nyob rau hauv txoj cai atrium.
Atypical - qhov zaus yog 340-440 neeg ntaus, tsis raug sau tseg daim ntawv raug. Ib nthwv dej ntawm kev zoo siab ncig ib qho chaw, tab sis tsis nyob hauv ib lub voj voog.
Raws li qhov xwm txheej ntawm chav kawm, pathology tau muab faib ua cov ntaub ntawv hauv qab no:
- thawj tsim;
- persistent;
- paroxysmal;
- constant.
Daim duab kho mob hauv daim ntawv ntawm cov kab mob yuav luag zoo ib yam, yog li ntawd, nws tuaj yeem tsim kom muaj kev ua txhaum cai dab tsi tsuas yog ua los ntawm kev ntsuas tshwj xeeb kuaj.
Paroxysmal atrial flutter kav ntev txog ib lub lis piam, nres ntawm nws tus kheej, tsis tu ncua - ntau dua li lub sijhawm no, sinus atherosclerosis tsis zoo ntawm nws tus kheej. Kev mus tas li tshwm sim thaum qhov kev siv tshuaj kho tsis tuaj yeem ua tiav qhov kev xav tau lossis thaum nws tsis ua tiav.
Tahisistology ua ntej mus rau diastolic thiab tom qab ntawd mus rau systolic dysfunction ntawm sab laug ventricular myocardium, nrog rau cov tsos ntawm lub plawv tsis ua hauj lwm. Nrog rau cov kab mob no, cov ntshav coronary txo qis mus txog 60%.
Symptoms of disease
Qee zaum, nws yog asymptomatic, uas tsis suav nrog qhov pib ntawm kev tuag. Muaj cov cim qhia hauv qab no ntawm atrial flutter:
- mob siab nyob rau hauv thaj tsam hauv siab;
- faus thiab tsis nco qab;
- mob taub hau thiab kiv taub hau;
- xav qaug zog;
- hyperhidrosis;
- pallor ntawm epithelial integuments;
- ua pa hnyav, ntiav;
- mob plawv dhia;
- ua tsis taus pa.
Cov yam hauv qab no tuaj yeem ua rau muaj qhov tshwm sim:
- cuam tshuam ntawm lub plab zom mov;
- haus dej ntau, suav nrog cawv;
- hloov kev siab ntsws overstrain;
- txuas ntxiv raug cua sov lossis chav tsev txias;
- kev tawm dag zog ntau dhau.
Kev tawm tsam tuaj yeem tshwm sim los ntawm ob peb lub lis piam mus rau 1-2 ib xyoos thiab txiav txim siab los ntawm tus kheej tus yam ntxwvkab mob.
Diagnosis
txhawm rau txheeb xyuas tus kabmob, cov haujlwm hauv qab no tau ua:
- kev tshawb fawb plawv electrophysiological;
- txiav txim siab ntawm electrolytes;
- kuaj mob rheumatological;
- txhais cov thyroid hormones;
- biochemical thiab suav ntshav kom tiav;
- MRI thiab CT;
- transesophageal echocardiography txhawm rau txheeb xyuas cov ntshav txhaws hauv atria;
- ECG;
- Keeb kwm thiab tshuaj xyuas lub cev ntawm tus neeg mob.
Atrial flutter ntawm ECG qhia:
- dynamic zaus thiab lub sijhawm ntawm paroxysms;
- pom ntawm F-atrial nthwv dej;
- wrong rhythm.
Raws li kev kuaj mob, nws paub meej tias tus kab mob no tshwm sim li cas thiab yuav tsum kho li cas.
Nrog atrial flutter, kuaj pom cov mem tes nrawm thiab nrawm. Nrog rau qhov sib piv ntawm 4: 1, cov mem tes tuaj yeem yog 75-85 tus neeg ntaus ib feeb, nrog rau qhov tsis tu ncua ntawm cov coefficient, qhov sib dhos ua tsis zoo. Nrog rau cov kab mob no, muaj ntau zaus thiab lub suab sib luag ntawm lub ncauj tsev menyuam cov hlab ntsha, uas dhau ntawm cov hlab ntsha ntawm lub plawv los ntawm 2 zaug lossis ntau dua thiab sib haum rau atrial atherosclerosis.
Nrog rau atrial flutter, 12-lead ECG qhia tau hais tias atrial sawtooth F nthwv dej, lub plab zom mov tsis tu ncua, tsis muaj P nthwv dej. ventricular complexes tsis hloov, ua ntej los ntawm atrial nthwv dej. Thaum zaws lub carotid sinus, qhov tom kawg tau nthuav tawm ntau dua vim yog nce AV-blockade.
Thaum ua ECG thaum nruab hnub, tus nqi mem tes yog ntsuas ntawm lub sijhawm sib txawv thiab paroxysms ntawm pathology tau txiav txim siab.
ICD atrial flutter
Tom qab kev hloov pauv mus rau ICD-10, raws li cov lus pom zoo ntawm European Association of Cardiology, lo lus "atrial fibrillation" tau muab los ntawm cov lus hais. Hloov chaw, cov ntsiab lus ntawm "fibrillation" thiab "atrial flutter" pib siv. Nws yog nyob rau hauv no ua ke uas lawv tau sau nyob rau hauv lub thoob ntiaj teb classifier ntawm cov kab mob ntawm lub 10th revision. Lawv tus lej yog I48.
kev kho mob
Kev kho mob xwm txheej ceev yog muab los ntawm kev siv hluav taws xob qis. Nyob rau tib lub sijhawm, tshuaj tiv thaiv kab mob.
Kev kho mob rau atrial flutter suav nrog cov tshuaj hauv qab no:
- tshuaj tiv thaiv kab mob;
- potash;
- mob plawv glycosides;
- beta-blockers
- tshuaj tiv thaiv kab mob;
- calcium channel blockers.
Thaum qhov kev tawm tsam tsis ntev tshaj 2 hnub, siv hluav taws xob pacing nrog cov tshuaj hauv qab no:
- "Amiodarone";
- "Quinidine" thiab "Verapomil";
- "Propafenone";
- YProcainamide.
Anticoagulants yog tswj hwm los tiv thaiv thromboembolism.
Tib lub sijhawm, cov haujlwm hauv qab no kuj tau ua:
- Pacemaker installation;
- radiofrequency ablation.
Txhob hnov qab yog kho nrog cov ntshav nyias.
CourseKev kho tshuaj kuj raug sau tseg tom qab ua haujlwm.
Atrial flutter yuav tsum tau kho sai li sai tau thaum thawj cov tsos mob tshwm sim. Txawm li cas los, tam sim no nws yog tsis yooj yim sua kom tshem tawm tag nrho cov pathology. Tsuas yog qhov tshwm sim ntawm lawv qhov tshwm sim tsawg kawg yog tias tus neeg mob noj tag nrho cov tshuaj uas kws kho mob tau sau tseg.
Cov lus pom zoo thoob ntiaj teb
Cov kws tshaj lij hauv ntiaj teb tau hais qhia siv cov tshuaj hauv qab no rau kev kho mob antithrombotic, nyob ntawm theem ntawm kev pheej hmoo ntawm cov teeb meem thromboembolic:
- yog tias muaj thrombus nyob rau hauv lub atrium, keeb kwm ntawm thromboembolism, dag lub plawv li qub, mitral stenosis, arterial hypertension, thyrotoxicosis, plawv tsis ua hauj lwm, hnub nyoog 75 xyoo thiab laus dua, muaj kab mob plawv thiab ntshav qab zib mellitus - los ntawm 60 xyoo - qhov ncauj anticoagulants;
- yog tias koj muaj hnub nyoog qis dua 60 xyoo thiab muaj kab mob plawv uas tsis qhia tias muaj lub plawv tsis ua haujlwm, ntshav siab - "Aspirin" (325 mg / hnub);
- rau tib lub hnub nyoog thaum tsis muaj mob plawv - cov tshuaj tib yam hauv tib koob tshuaj lossis tsis kho.
Cov lus pom zoo rau atrial flutter suav nrog kev saib xyuas nrog cov coagulants indirect coagulants thaum pib kho - los ntawm ib zaug ib lim piam thiab ntau zaus yog tias tsim nyog, tom qab ntawd - ib hlis ib zaug.
Muaj peev xwm kho hluav taws xob tam sim no thaum sivdefibrillator. Feem ntau, muaj kev ruaj khov ntawm lub plawv dhia thiab txhim kho kev noj qab haus huv ntawm cov neeg mob. Qee lub sij hawm txoj kev kho mob zoo li no tsis tuaj yeem ua rau cov txiaj ntsig xav tau, lub suab sib dhos tau tawg dua tom qab ib ntus.
Ntxiv rau, cov txheej txheem no tuaj yeem ua rau muaj kev mob stroke, yog li ua ntej nws ua tiav, yog tias ua tau, cov tshuaj txhaj rau hauv cov hlab ntsha thiab subcutaneous tau muab rau cov ntshav nyias.
Yog kev kho mob tsis pab thiab arrhythmia rov tshwm sim, tus kws kho mob tau sau ntawv:
- radiofrequency ablation;
- cryoablation.
Lawv tau tuav nyob rau hauv kev sib raug zoo rau txoj hauv kev uas lub impulse tau ncig thaum muaj kev tawm tsam.
Thaum muaj ntau yam teeb meem thiab mob hnyav, kev ua haujlwm tau ua. Nws yog qhov tsim nyog thiaj li yuav:
- stabilize lub plawv dhia thiab lub plawv dhia;
- txhim kho tus mob ntawm tus neeg mob;
- suppress the focus of pathology.
Cov paroxysms raug kho nrog transesophageal pacing.
Huab cua
Tus kab mob no yog tus yam ntxwv los ntawm kev tiv thaiv kev kho mob tiv thaiv arrhythmia, nyiam rov qab los, ua tsis taus pa ntawm paroxysms.
Kev saib mus ntev tsis zoo. Hemodynamics cuam tshuam, kev ua haujlwm ntawm cov chav ua haujlwm tsis sib xws, cov zis ntawm lub plawv txo qis los ntawm 20% lossis ntau dua. Muaj qhov tsis sib xws ntawm lub peev xwm thiab kev xav tau ntawm lub cev rau kev siv cov txheej txheem metabolic, uas ua raumob circulatory tsis ua hauj lwm. Atrial flutter, uas muaj cov tsos mob tsis zoo, tuaj yeem ua rau nthuav dav ntawm cov kab noj hniav ntawm cov leeg plawv, uas tuaj yeem ua rau tuag.
Nyob rau hauv daim ntawv mob ntev ntawm tus kab mob, parietal ntshav txhaws tsim nyob rau hauv lub atria. Hauv qhov xwm txheej ntawm lawv txoj kev sib cais, kev puas tsuaj loj hauv cov hlab ntsha tuaj yeem pom. Cov txiaj ntsig ntawm tus kab mob tuaj yeem tshwm sim rau lawv tus kheej hauv cov hlab ntsws thiab cov hlab ntsha, ua rau lub plawv nres ntawm txoj hnyuv, spleen, ob lub raum, gangrene ntawm extremities, thiab strokes.
Kev nyuaj siab
Ntau hom atrial flutter tuaj yeem ua rau muaj teeb meem hauv qab no:
- lub plawv tsis ua hauj lwm;
- thromboembolism;
- myocardial infarction;
- stroke;
- ventricular tachyarrhythmias;
- ventricular fibrillation.
Txhua yam kab mob no tuaj yeem ua rau tuag.
Kev Tiv Thaiv
Tsis muaj kev tiv thaiv tshwj xeeb rau tus kab mob congenital. Cov niam txiv yuav tsum zam tus cwj pwm phem thiab tsim kev noj haus.
Cov lus qhia tiv thaiv dav dav suav nrog:
- kho raws sijhawm ntawm ntau yam mob txhawm rau tiv thaiv lawv txoj kev hloov mus rau hauv daim ntawv ntev;
- kev tawm dag zog;
- khoom noj muaj txiaj ntsig;
- muab tus cwj pwm phem.
Kev ua neej
Tsis suav nrog kev noj haus:
- yuav haus dej cawv;
- coffee;
- tea;
- sweet soda.
Cov kua dej tsawg tsawg, cov zaub mov yuav tsum loj, thaum nws tau noj me me. Koj tsis tuaj yeem noj cov zaub mov uas tuaj yeem ua rau flatulence thiab tsam plab. Kev noj haus yuav luag tsis muaj ntsev.
Tus neeg mob yuav tsum raug qhuab ntuas, noj tshuaj thiab zam kev cuam tshuam ntawm cov yam ntxwv uas tuaj yeem ua rau cov kab mob hnyav dua.
Nyob hauv kaw
Atrial flutter yog ib qho tachycardia nrog lub plawv dhia txawv txav. Yeej, nws yog cuam tshuam nyob rau hauv lub atria, tej zaum nws muaj zog yog pom nyob rau hauv lub ventricles. Tus kab mob no kho tsis tau kiag li. Nws tsuas yog ua tau kom txo qis qhov tshwm sim tsis zoo nrog kev siv tshuaj kho mob, siv ntau yam kev ntsuas, thiab, yog tias lawv tsis muaj txiaj ntsig, kev ua haujlwm.
