Transmural infarction yog ib yam kab mob uas tshwm sim thiab txaus ntshai heev, uas yog nrog los ntawm necrosis ntawm cov leeg plawv. Nws yog tsim nyog sau cia tias kev tuag nyob rau hauv cov ntaub ntawv ntawm kev loj hlob zoo li ib tug pathology yog siab heev, tshwj xeeb tshaj yog yog hais tias cov cim ntawm lub plawv puas tsis pom nyob rau hauv lub sij hawm, thiab tus neeg mob tsis tau txais kev kho mob tsim nyog. Yog vim li ntawd nws thiaj tseem ceeb kom paub tias daim ntawv mob plawv no tshwm sim nws tus kheej li cas thiab qhov kev pab twg uas tus neeg mob xav tau.
Transmural myocardial infarction: yog dab tsi?
Ua ntej tshaj, nws tsim nyog nkag siab lub ntsiab lus ntawm lo lus. Muaj tseeb ntau tus neeg paub tias kev mob plawv yog nrog kev tuag ntawm cov leeg ntawm lub plawv. Qhov no tshwm sim vim muaj qhov tsis txaus ntawm cov ntshav ntws mus rau lub plawv, vim tias cov ntaub so ntswg tsis tau txais cov pa oxygen thiab cov as-ham tsim nyog rau lub neej.
Raws li koj paub, phab ntsa ntawm lub siab muaj peb txheej - qhov noepicardium (txheej txheej), mural leeg txheej thiab endocardium (sab hauv ntawm cov leeg). Nyob rau hauv daim ntawv intramural ntawm tus kab mob, necrosis cuam tshuam tsuas yog ib txheej. Mob transmural infarction yog pathology nyob rau hauv uas cov txheej txheem necrotic tau pom nyob rau hauv txhua txheej ntawm lub plawv. Nws tsim nyog hais tias qhov no yog hom kab mob txaus ntshai tshaj plaws.
Hauv cov tshuaj niaj hnub no, pathology tau muab cais raws li thaj chaw ntawm foci ntawm necrosis. Feem ntau pom transmural infarction ntawm phab ntsa anterior ntawm myocardium, uas yog sab laug ventricle. Tsuas yog hauv ib qho ntawm tsib tus neeg mob, necrosis tseem cuam tshuam rau phab ntsa ntawm txoj cai ventricle. Hauv kwv yees li ib feem peb ntawm cov neeg mob, cov phab ntsa ntawm atria kuj koom nrog.
Kev txhim kho kab mob
Nyob rau hauv yuav luag txhua kis, transmural infarction yog tshwm sim los ntawm kab mob plawv. Raws li twb tau hais lawm, nrog tsis txaus oxygen thiab cov as-ham, cov leeg nqaij pib tuag - qhov no yog li cas necrosis tsim. Raws li kev txheeb cais, hauv 90% ntawm cov neeg mob yog atherosclerosis ntawm cov hlab ntsha, uas muab cov ntshav ntws mus rau myocardium.
Ib lub npe hu ua atherosclerotic plaque yog tsim rau ntawm phab ntsa hlab ntsha. Raws li kev cuam tshuam ntawm qee yam, ib feem ntawm cov quav hniav tawg tawm ntawm phab ntsa thiab thaiv cov lumen ntawm cov hlab ntsha. Mob transmural infarction, raws li txoj cai, kev loj hlob sai nyob rau hauv cov xwm txheej uas myocardial oxygen xav tau nce siab - qhov no tuaj yeem tshwm sim, piv txwv li, nrog kev tawm dag zog lub cev, ua npaws, muaj zog.kev nyuaj siab.
Tus mob kis mus rau myocardial infarction: cov khoom pheej hmoo
Raws li koj tuaj yeem pom, cov kab mob necrotic ntawm lub plawv tsis yog ib qho kev ywj pheej. Feem ntau, lawv tsim tawm tsam keeb kwm ntawm ischemia thiab atherosclerosis uas twb muaj lawm. Yog li ntawd, ntau yam kev pheej hmoo tuaj yeem txheeb xyuas:
- caj ces predisposition ntawm tus neeg mob, uas yog txuam nrog tej yam anatomical nta thiab hereditary kab mob.
- Tseem muaj hnub nyoog. Transmural infarction feem ntau kuaj pom hauv cov neeg laus dua 45 xyoo, thiab cov txiv neej feem ntau ua rau cov kab mob no.
- nce qib ntawm cov roj cholesterol hauv cov ntshav (nws yog vim qhov no uas cov plaques tsim rau ntawm phab ntsa ntawm cov hlab ntsha, uas tom qab thaiv cov ntshav ntws).
- kev noj zaub mov tsis raug (kev noj zaub mov muaj rog thiab kib ua rau muaj kev pheej hmoo ntawm kev tsim atherosclerosis).
- Kev rog dhau (feem ntau nws cuam tshuam nrog kev noj zaub mov tsis txaus, thiab qhov hnyav nce ntxiv rau lub plawv).
- Kev tsis ua haujlwm (kev ua neej nyob tsis muaj zog ua rau cov leeg mob plawv tsis muaj zog, tom qab ntawd nws nyuaj heev rau myocardium tiv thaiv txhua yam kev tawm dag zog lub cev).
- Kev ntxhov siab tsis tu ncua, ntxhov siab, ntxhov siab, kev ntxhov siab ua rau muaj kev hloov pauv hauv cov tshuaj hormones, uas cuam tshuam rau kev ua haujlwm ntawm cov hlab plawv.
- Kev haus luam yeeb (raws li kev txheeb cais, hauv 35% ntawm cov neeg mob necrosis ntawm cov leeg plawv yog txuam nrog tus cwj pwm phem no).
Cov tsos mob tseem ceeb: yuav ua li castxheeb xyuas lub plawv nres?
Cov tsos mob ntawm necrosis tuaj yeem sib txawv - txhua yam nyob ntawm qhov kev puas tsuaj, hnub nyoog ntawm tus neeg, muaj cov kab mob sib kis, thiab lwm yam. Muaj cov neeg paub txog asymptomatic infarction. Txawm li cas los xij, qee cov tsos mob tseem ceeb tuaj yeem txheeb xyuas:
- Feem ntau, ib tug neeg yws yws ntawm qhov mob hnyav tom qab lub sternum - nws pom meej meej mus rau sab laug lub xub pwg hniav, caj npab, sab puab tsaig, pob ntseg thiab txawm cov hniav.
- Tus mob yog undulating thiab ntev - kev tawm tsam tuaj yeem rov qab tau ntau teev lossis ib hnub.
- Tachycardia tsim, thiab tus neeg mob, raws li txoj cai, pom meej meej hnov ntau zaus thiab txawm mob plawv.
- Tseem muaj lub siab luv luv ntawm lub siab.
- Tseem muaj lwm yam cim qhia ntawm lub plawv nres - daim tawv nqaij thiab mucous daim nyias nyias ntawm ib tug neeg tig daj ntseg sharply.
- Tawm tsam keeb kwm ntawm necrosis, mob ntsws asthma feem ntau tshwm sim - tus neeg mob sau ntawv ua tsis taus pa hnyav, ua rau tsis taus pa.
ntsuas ntsuas
Thaum thawj qhov kev ua txhaum cai tshwm sim, nws tsim nyog xa tus neeg mob tam sim ntawd mus rau lub tuam tsev kho mob, qhov kev kuaj mob thiab kev kho mob tsim nyog. Txoj kev kuaj mob tseem ceeb rau myocardial necrosis yog electrocardiography, vim hais tias nrog cov txheej txheem no nws muaj peev xwm sau cov hluav taws xob muaj peev xwm nyob rau ntau qhov chaw ntawm lub plawv.
Ua tau zoo thiab txiav txim siabelectrocardiogram tso cai rau tus kws kho mob los txiav txim qhov chaw ntawm necrosis (piv txwv li, qis transmural infarction), qhov twg ntawm cov txheej txheem pathological thiab qhov tob ntawm qhov txhab, lub sijhawm ntawm tus kab mob.
Ntxiv mus, yuav tsum tau kuaj ntshav. Nrog lub plawv nres, muaj qhov nce hauv erythrocyte sedimentation tus nqi, nce ntawm cov leukocytes, cov tsos mob hauv cov ntshav ntawm cov enzymes tshwj xeeb thiab cov tebchaw uas ib txwm pom hauv cov hlwb myocardial.
Txoj Cai Pab Ua Ntej
Tus mob transmural infarction ntawm phab ntsa anterior ntawm myocardium yog ib qho pathology uas tsim sai heev. Nws cov tsos mob tuaj yeem tshwm sim yuav luag txhua lub sijhawm, yog li koj yuav tsum paub koj tus kheej nrog cov cai los pab tus neeg mob. Lawm, ua ntej ntawm tag nrho cov, koj yuav tsum hu rau lub tsheb thauj neeg mob.
Tau cov kws kho mob, tus neeg yuav tsum tau pw. Ib qho kev zam yog qhov xwm txheej uas ua tsis taus pa hnyav thiab hawb pob thaum ua pa - qhov no, nws yog qhov zoo dua los zaum tus neeg mob los ntawm kev tso lub hauv ncoo lossis cov menyuam hauv qab nws nraub qaum. Nws raug nquahu kom noj tshuaj aspirin ntsiav tshuaj. Koj kuj yuav tsum tau muab tus neeg nitroglycerin - thawj ib ntsiav tshuaj, thiab yog tias qhov mob tsis ploj mus, tom qab tsib feeb ntxiv ib zaug (tab sis tsis ntau tshaj peb).
Heart attack regimen
Nyob ntawm cov txiaj ntsig tau txais thaum kuaj mob, tus kws kho mob sau ntawv kho mob. Kev kho thawj zaug feem ntau muaj peb qhov tseem ceeb:
- noj tshuaj kho mob kom txo tau tus neeg mob. Feem ntau, qhov mob tuaj yeem nres nrognrog kev pab ntawm cov tshuaj muaj zog, suav nrog Promedol thiab Morphine. Cov tsos mob ntawm cov tsos mob thiab kev kuaj mob ntawm "myocardial infarction" yog kev ntxhov siab rau ib tug neeg, thiab kev zoo siab thiab kev ntshai tsuas yog ua rau lub plawv dhia - tus neeg mob tau muab tshuaj sedative.
- Cov kev kho mob suav nrog nitrates thiab beta-blockers, uas pab tshem tawm arrhythmia thiab kho lub plawv dhia.
- Nrog transmural infarction, muaj qhov tshwm sim ntau ntawm kev tsim cov thrombus, uas yog fraught nrog necrosis ntawm lwm yam kabmob thiab kev sib kis ntawm cov txheej txheem mus rau cov chaw nyob sib ze ntawm myocardium, kev puas tsuaj rau lub paj hlwb thiab txawm tuag. Yog li ntawd, kev sib ntaus tawm tsam thrombosis yuav tsum tau pib nyob rau hauv thawj teev tom qab pib cov tsos mob. Rau lub hom phiaj no, thinning npaj yog siv uas muaj heparin thiab fibrinolysin. Lawm, thaum noj cov tshuaj no, muaj peev xwm ua rau mob hnyav heev, vim tias cov ntshav nres tsis khov, yog li nws tseem ceeb heev uas yuav tsum ua tib zoo saib xyuas tus neeg mob.
Kev kho mob yuav tsum tau ua hauv tsev kho mob - tus neeg mob yuav tsum nyob rau hauv kev saib xyuas ntawm tus kws kho mob ib ncig.
Qhov tshwm sim thiab teeb meem ntawm tus kab mob
Transmural infarction yog qhov nyuaj tshaj plaws thiab txaus ntshai daim ntawv ntawm myocardial necrosis, tshwj xeeb tshaj yog thaum nws los txog rau macrofocal necrosis. Tus kab mob yog fraught nrog rau txim - kev loj hlob ntawm pulmonary edema, tuag tes tuag taw, hais lus tsis meej. Qee lub sij hawm lub plawv nres ua rau muaj cov kab mob ntxiv ntawm cov hlab ntsha, tshwj xeeb yog mob stroke.
Rau qhov tshwm sim ntawm cov kab mob no kujsuav nrog thromboembolism, ventricular fibrillation, kev ua haujlwm ntawm ntau yam kabmob thiab txawm tias lawv lub cev. Cov xwm txheej zoo li no feem ntau xaus rau hauv kev tuag, txawm tias tus neeg mob tau txais kev kho mob. Lwm qhov ua rau tuag taus yog lub plawv tsis ua haujlwm. Nrog rau kev cog lus muaj zog ntawm myocardium thiab nce siab hauv ventricles thiab atria, muaj kev pheej hmoo ntawm kev ua txhaum ntawm kev ncaj ncees ntawm cov leeg nqaij hauv thaj tsam ntawm necrosis.
Rehabilitation thiab prognosis
Hmoov tsis zoo, qhov kev cia siab rau tus kab mob no tsis zoo heev - txog li 50% ntawm cov neeg mob (tshwj xeeb tshaj yog thaum nws los txog rau cov neeg laus) tuag. Yog tias, txawm li cas los xij, nws tuaj yeem rov ua kom cov ntshav zoo li qub, tseem muaj kev pheej hmoo ntawm cov teeb meem yav tom ntej, txij li kev hloov pauv hauv cov ntaub so ntswg myocardial tau tshwm sim.
Yog vim li cas lub sijhawm kho kom rov zoo li qub tseem ceeb heev. Cov neeg mob tau qhia kom noj zaub mov yooj yim, lub teeb thiab muaj calorie ntau ntau. Nws tseem yog ib qho tseem ceeb kom maj mam rov qab mus rau lub cev ua si, txij li kev tsis ua haujlwm yog fraught nrog cov leeg nqaij atrophy thiab congestion nyob rau hauv lub ntsws. Tau kawg, txhua yam kev ua ub no cuam tshuam nrog kev ua lub cev yuav tsum tau tswj hwm los ntawm tus kws tshaj lij.
Kev txhawb nqa thiab saib xyuas kev kho mob tas li yog qhov tseem ceeb rau koj lub neej. Tau kawg, cov neeg mob yuav tsum tau saib xyuas cov khoom noj khoom haus, tsis txhob muaj kev ntxhov siab thiab kev tawm dag zog lub cev, tiv thaiv kev nce siab hauv cov ntshav siab thiab tsis txhob haus luam yeeb.
