Ntawm cov neeg uas muaj kab mob plawv thiab mob plawv, ib qho ntawm cov laj thawj tseem ceeb ntawm kev tuag ntau ntxiv yog suav tias yog mob plawv. Qhov tshwm sim tsis yog tus qauv ntawm tus kab mob, uas yog, thaum ib tus neeg hnov mob hnyav hauv plab, qhov no yog qhov mob plab ntawm myocardial infarction. Daim duab classic yog mob hauv siab uas tshwm sim tam sim ntawd thiab tawg mus rau thaj tsam scapular ntawm sab xis, caj dab thiab lub xub pwg sib koom. Tus neeg mob ua pa nyuaj thiab xav tias ntshai.
cov ntaub ntawv dav dav
Cov tib neeg muaj mob ntev ntawm txoj hnyuv, mob plab, quav quav, xeev siab tsis ua rau muaj kev txhawj xeeb, vim lawv suav tias cov xwm txheej no yog qhov ntuj tsim, muab cov kab mob uas twb muaj lawm. Txawm li cas los xij, cov tsos mob zoo li no yuav qhia tau tias mob plab myocardial infarction. Feem ntau gastralgichom tshwm sim nrog lub plawv nres diaphragmatic. Nws yog qhov raug rau cov txiv neej. Qhov txaus ntshai yog tias cov tsos mob zoo ib yam li intoxication, uas yog, nrog lub chaw kho mob atypical rau lub plawv nres. Tsis zoo li lwm cov ntaub ntawv, lub plab ib leeg mus txog tsuas yog ob theem - qhov mob hnyav tshaj plaws (ntev tsis pub ntau tshaj ob teev), nws yog tus cwj pwm los ntawm kev hais tawm necrosis ntawm lub plawv cov leeg, thiab mob hnyav (hauv lub sijhawm nws kav tsis ntev tshaj kaum ob teev), thaum qhov mob hnyav zuj zus lawm.
Lub ntsiab mob ntawm lub plab daim ntawv ntawm mob myocardial infarction yog qhov mob hnyav tshaj plaws hauv:
- cheeb tsam epigastric;
- txoj cai hypochondrium;
- plab plab.
Nyob ntawm qhov xwm txheej, nws kub hnyiab, ntse thiab tsis tawm tom qab noj nitroglycerin.
Kev txhim kho tsis zoo ntawm myocardial infarction
Qhov nce ntawm tus naj npawb ntawm cov kab mob tshwm sim feem ntau cuam tshuam nrog kev hloov pauv ntawm cov hnub nyoog ntawm cov neeg mob. Ntawm ib sab, lub plawv nres feem ntau cuam tshuam rau cov pej xeem hluas, thiab ntawm qhov tod tes, nws tau pom ntau dua hauv cov neeg laus. Nyob rau hauv cov ntaub ntawv no, nws yog feem ntau rov qab thiab tsim tawm tsam keeb kwm ntawm ntau yam concomitant pathologies. Qhov kawg cuam tshuam rau chav kawm thiab chaw kho mob ntawm tus kab mob. Txhua yam kev hloov pauv ntawm lub plawv nres uas muaj qhov pib tsis zoo yog qhov ua tau muab faib ua tsis mob thiab tsis mob. Atypical myocardial infarction ntawm lub plab daim ntawv hais txog qhov mob. Qhov tshwm sim no ua rau qee qhov teeb meem hauv kev kuaj mob, txij li qhov chaw ntawm qhov mob syndrome yog atypical. Mob feem ntau yog hnov los ntawm tus neeg nyob rau hauv lub epigastric, iliac, umbilical (umbilical)cheeb tsam, raws li zoo raws li nyob rau hauv lub cheeb tsam ntawm lub hypochondria. Yog li ntawd, ib tug neeg paub tseeb tias qhov mob yog tshwm sim los ntawm cov teeb meem ntawm lub plab zom mov. Muaj ntau zaus thaum lub plawv nres ntawm daim ntawv no provoked ib tug exacerbation ntawm mob pancreatitis, cholecystitis, appendicitis thiab lwm yam kab mob. Rau kev kuaj mob raws sij hawm thiab txhim khu kev qha ntawm daim ntawv gastralgic infarction, nws yuav tsum raug coj mus rau hauv tus account tias qhov tseem ceeb hauv cheeb tsam ntawm qhov mob syndrome nyob rau hauv cov neeg mob no yog thaj tsam plab. Lub plab daim ntawv ntawm myocardial infarction, nrog rau lwm yam kev hloov pauv nrog qhov pib atypical, feem ntau yog cov neeg laus cov neeg laus uas muaj cov tsos mob ntawm atherosclerosis thiab hereditary predisposition.
Yog vim li cas
Gastralgic daim ntawv tshwm sim nyob rau hauv cov ntaub ntawv ntawm pathological vasoconstriction raws li lawv yeej los ntawm ib tug sib tov ntawm cov rog, piv txwv li, atherosclerotic plaques. Ib daim duab kho mob tshwj xeeb yog vim qhov sib thooj ntawm qhov chaw tuag mus rau lub diaphragm. Ntxiv nrog rau atherosclerosis, qhov ua rau lub plawv nres yog:
- kev quav cawv;
- haus luam yeeb;
- obesity;
- angina;
- pericarditis;
- mob ntshav qab zib mellitus;
Circulatory tsis ua hauj lwm hauv IHD pab tsim cov necrosis hauv plawv cov leeg. Thaum mob hnyav ntawm cov txheej txheem no, ib qho mob tshwm sim, uas yog hu ua mob plawv. Lub anterior phab ntsa ntawm sab laug ventricle feem ntau cuam tshuam. Tab sis lub plab daim ntawv ntawm myocardial infarction yog tus yam ntxwv ntawm necrosis nyob rau hauv lub nraub qaum phab ntsa ntawm cov leeg ntawm lub ntsiab tib neeg lub cev, uas yog heev ze rau.diaphragm. Qhov tshwj xeeb ntawm cov kab mob no yog tias tus neeg mob cuam tshuam los ntawm qhov mob hauv qhov chaw atypical - hauv thaj tsam epigastric (epigastric) thiab hauv qab tav ntawm sab laug. Hmoov tsis zoo, daim duab qhov muag plooj lossis tsis meej yog qhov laj thawj rau qhov ua yuam kev hauv kev kuaj pom thawj zaug.
ntsuas ntsuas
Rau lub hom phiaj ntawm kev kuaj mob sib txawv, kev kuaj troponin yog ua nyob rau theem prehospital. Nws qhia tau hais tias muaj nyob rau hauv cov ntshav ntawm cov ntsiab lus ntawm kev puas tsuaj ntawm myocardiocytes. Tom qab theem ntawm lub plawv nres, C-reactive protein, nruab nrab leukocytosis raug kuaj pom. Thiab cov cim qhia ntawm kev ua haujlwm ntawm daim siab hlwb tau hloov pauv ob qho tib si hauv pancreatitis thiab kab mob siab, thiab hauv daim ntawv mob plab ntawm myocardial infarction. Yog li, qhov ntau yam no yuav luag ib txwm ua rau muaj teeb meem hauv kev kuaj mob sib txawv.
Qhov chaw kho mob tseem ceeb yog mob hauv plab, lossis theej, hauv thaj tsam epigastric lossis sab laug hypochondrium. Feem ntau muaj kev kuaj mob tsis tseeb ntawm pancreatitis. Mob plab yog yam ntxwv ntawm posterior localization ntawm infarction. Tib lub sijhawm, cov leeg diaphragmatic yog ib feem ntawm cov txheej txheem.
Differential diagnosis of plab myocardial infarction
Vim cov paib atypical, nws tau ua nrog pathologies xws li:
- mob plab;
- perforated ulcer;
- cholecystitis;
- kab mob zaub mov lom;
- plab hnyuv;
- Ypancreatitis.
Tom qab sau ib qho anamnesis ntawm tag nrho tsev neeg, kev tsis txaus siab ntawm tus kheej thiab nws qhov kev xeem, lawv muab tso rauKev kuaj mob ua ntej, thiab muaj tseeb - tsuas yog tom qab kuaj thiab ntsuas cov hom kev xeem. Hauv kev kuaj mob sib txawv, qhov tshwm sim ntawm ECG coj hauv thawj feeb ntawm qhov pib ntawm qhov mob thiab cov lus nug ntawm tus neeg yog qhov tseem ceeb.
Signs
Cov tsos mob ntawm lub plab daim ntawv ntawm myocardial infarction tshwm sim thawj zaug ntawm tus kab mob. Mob (mob), uas tshwm sim poob nthav tawm tsam keeb kwm ntawm kev xav lossis lub cev muaj zog, yog suav tias yog cov tsos mob tseem ceeb. Feem ntau ib tug neeg tsis tuaj yeem piav qhia txog qhov mob ntawm qhov mob, vim tias tsis muaj qhov pom tseeb ntawm nws, thiab kev siv zog tsis muaj zog tom qab noj Drotaverine lossis Nitroglycerin. Thiab hloov txoj hauj lwm ntawm lub cev tsis muaj zog rau nws.
hws txias, ntshav siab, pallor ntawm lub dermis - cov no yog txhua tus khub ntawm kev mob plab. Tsis tas li ntawd, tus neeg muaj daim duab kho mob hauv qab no:
- bloating;
- xeev siab thiab ntuav;
- dermis ntub thiab txias;
- quav quav;
- lub plawv dhia hloov pauv;
- lub suab plawv yog muffled, systolic yws thiab ntxiv suab nrov tshwm;
- mob ntsws asthma;
Thaum muaj kev tawm tsam, tus neeg mob ntshai tsam tuag.
Cov tsos mob ntawm lub plab ntawm myocardial infarction feem ntau tshwm sim tom qab noj mov. Qhov tshwm sim no cuam tshuam nrog cov ntshav tsis zoo rau cov leeg ntawm lub plawv thaum ua haujlwm ntawm lub plab zom mov. Thaum kuaj lub plab, tsis muaj qhov nro. Qhov kub nyob rau hauv lub sij hawm mob hnyav kuj tsis tau pom. Tom qab ob peb teev, qhov mob syndrome txav mushauv siab.
Daim ntawv plab ntawm myocardial infarction: thawj pab
Cov tib neeg uas muaj chaw kho mob plab hnyav, uas yog atypical rau daim duab ntawm "mob plab", tau mus pw hauv tsev kho mob hauv plawv plawv kom paub meej qhov kev kuaj mob zaum kawg. Txog thaum cov kws kho mob tuaj txog:
- Tus neeg mob muab tso rau hauv txoj kab rov tav.
- Nws xav tau huab cua ntshiab.
- Yog ua tau, ntsuas qhov siab. Nrog tus lej siab, nws tso cai muab cov tshuaj uas tus neeg mob tau noj ua ntej.
Txhawm rau tsis suav nrog kev mus pw hauv tsev kho mob yuam kev hauv lub tsev kho mob kis mob lossis phais mob, tus neeg mob tau txais ECG ua ntej nws mus pw hauv tsev kho mob. Hauv daim ntawv gastralgic, cov txiaj ntsig tau txais tom qab sau npe ntawm kev ua haujlwm plawv cuam tshuam nrog qis (posterior) infarction.
Tom qab kuaj mob (thaum tsis muaj kev txwv thiab contraindications), thrombolysis raug tso cai nyob rau theem prehospital. Tsis tas li ntawd, Heparin, cov tshuaj antiplatelet yuav tsum tau noj. Hauv kev poob siab cardiogenic, infusions ntawm infusion daws tau qhia.
Tom qab analgesia, tus neeg raug coj mus rau hauv lub supine txoj hauj lwm mus rau ntau lub tsev kho mob-hom chaw kho mob. Qhov chaw kuaj mob ntxiv thiab cov cuab yeej siv tshuaj ntsuam xyuas. Kev xaiv txoj kev kho mob - angioplasty, bypass, stenting ntawm coronary hlab ntsha - yog txiav txim los ntawm tus kws kho mob.
Qhov chaw thiab qhov xwm txheej ntawm qhov mob
Nyob rau hauv plab daim ntawv ntawm myocardial infarction, qhov mob yog nyob rau hauv lub Upper ib nrab ntawm lub plab mog. Txawm li cas los xij, cov neeg mob xav tias nws nyob hauv thaj tsam ntawm lub plawv thiab tom qab lub sternum. Nrog rau lub plawv nres thib ob, qhov xwm txheej ntawm qhov mob thiab nws cov irradiation hloov. Yog li ntawd, yam uas ua rau nws yuav tsum sib txawv.
Feem ntau qhov mob tshwm sim tom qab kev ntxhov siab lossis lub cev thiab tuaj yeem ua ke nrog kev noj mov. Nws hlob zuj zus, dhau los ua qhov muaj zog tshaj plaws tom qab peb caug mus rau rau caum feeb los ntawm qhov pib ntawm kev tawm tsam. Feem ntau tus neeg raug ntes nrog kev ntshai, thiab nws xav tias ntshai kev tuag. Kev txais tos ntawm "Nitroglycerin" pab txhawb nws rau ib lub sijhawm. Qhov mob nrog xeev siab, ntuav tsis tshua muaj.
Kev kho mob
Kev kho mob plab ntawm myocardial infarction yog ua nyob rau hauv ib lub tsev kho mob ib ncig ntawm 25-35 hnub. Qhov no yog qhov tsim nyog rau kev saib xyuas tas li ntawm lub xeev ntawm tus neeg. Tus neeg mob yuav tsum tau saib xyuas lub txaj so thiab tsis suav nrog txhua qhov xwm txheej uas tuaj yeem ua rau muaj kev tawm dag zog ntau dhau. Pharmacotherapy yog tsom rau kev tshem tawm cov tsos mob thiab tiv thaiv kev txhim kho ntawm cov teeb meem. Cov kws kho mob pom zoo kom noj cov tshuaj uas muaj nyob hauv pawg kws tshuaj hauv qab no:
- ACE inhibitors;
- calcium blockers;
- nitrates;
- sedative;
- tshuaj tua kab mob;
- thrombolytics;
- beta blockers;
- tsis sib haum;
- tshuaj tiv thaiv kab mob.
Hauv daim ntawv plab, cov tsos mob tau pom zoo ib yam li kev ua haujlwm tsis zoo hauv plab hnyuv, yog li tus neeg mob tau pom cov tshuaj tiv thaiv cov kua tsib, txo cov kua qaub, thiab ua kom cov hnyuv ua haujlwm tau zoo.
Yog muaj teeb meem thiabCov kab mob sib kis, tso cai rau kev teem sijhawm ntawm lwm yam tshuaj.
Thaum tus neeg mob nyob hauv tsev kho mob, tus neeg mob yuav tsum ua ib ce tshwj xeeb los kho lub cev yav dhau los. Cov chav kawm ntawm kev kho lub cev yog tsim los rau tag nrho lub sijhawm rov zoo, piv txwv li los ntawm rau rau mus rau kaum ob lub hlis.
Ntxiv rau, kev noj zaub mov yog tsim nyog, txij li cov txheej txheem txawv txav yog nrog los ntawm dyspeptic manifestations.
Surgery
Kev phais yog tsim nyog thaum tus neeg mob mob hnyav. Feem ntau qhov no tshwm sim nrog kev kuaj mob tsis tu ncua. Cov kev phais hauv qab no yog siv:
- Aortocoronary bypass phais - tso cai rau koj los kho cov ntshav ntws hla qhov chaw tuag.
- Coronary angioplasty - lub raj hlau yog ntxig rau hauv qhov nqaim tshaj plaws ntawm lub nkoj, ua tsaug rau cov ntshav ntws zoo li qub.
ntsuas kev tiv thaiv
Yuav kom txiav tawm lub plawv nres thib ob, kws kho mob qhia:
- keep active;
- muab luam yeeb thiab cawv;
- mus ntsib kws kho plawv txhua xyoo;
- tswj ntshav siab thiab qib roj cholesterol;
- dhau qhov kev xeem tsim nyog, suav nrog angiography ntawm cov hlab ntsha ntawm lub plawv, ECG thiab lwm yam;
- kho cov khoom noj - tsis suav nrog cov khoom noj kib thiab rog, ntxiv rau cov zaub mov thiab legumes, ntses, txiv ntseej, zaub, nqaij ntshiv;
- sib ua raws li niaj hnub ua;
- sau npe rau lub pas dej lossis cardio workout;
- noj cov tshuaj uas kws kho mob sau tseg - angioprotectors, beta-blockers, anticoagulants, calcium antagonists, sedatives;
- kho mob sib kis.
Tsis ua raws li cov lus qhia saum toj no yog fraught nrog relapses.
Kev nyuaj siab
Lub plab daim ntawv ntawm myocardial infarction, lub tsev kho mob uas tau piav qhia hauv tsab xov xwm, nrog kev kuaj mob tsis raug thiab kev kho mob nyuaj los ntawm cov kab mob hauv qab no:
- rupture ntawm lub plawv cov ntaub so ntswg;
- mob plawv tsis ua hauj lwm;
- pericarditis;
- postinfarction syndrome;
- thrombosis;
- arrhythmias;
- neurotrophic ntshawv siab;
- aneurysms.
Sudden coronary death overtakes ib tug neeg yog tsis muab kev pab raws sij hawm. Tsis tas li ntawd xwb, koj yuav tsum tau mus rau hauv chav kawm kho kom rov zoo.
Huab cua
Nws yog qhov nyuaj los ntawm qhov tseeb tias nyob rau theem ntawm kev kuaj mob no pathology tsis tau lees paub tam sim, uas yog qhov txaus ntshai nrog qhov tshwm sim loj. Hauv qhov chaw nyob ruaj khov, qhov txiaj ntsig tuag tau qis heev thiab muaj txog li nees nkaum feem pua. Kwv yees li yim feem pua tuag hauv ib xyoos ntawm kev mob plawv.
