Angina pectoris yog kab mob plawv ischemic uas tsim los ntawm atherosclerosis ntawm cov hlab ntsha uas pub lub plawv. Raws li lawv cov lumen txo qis, myocardial cov ntshav tau inhibited, thiab ischemia tshwm sim. Kev tawm tsam ntawm angina pectoris yog qhov tshwm sim ntawm lub ischemia luv luv hauv lub plawv cov leeg, tom qab ntawd cov ntshav rov qab tag nrho. Tus mob no muaj keeb kwm tshwm sim nrog myocardial infarction, tab sis, tsis zoo li yav tas los, thrombus tsis tsim nyob rau hauv cov hlab ntsha, thiab thaj tsam ntawm necrosis tsis tsim nyob rau hauv cov leeg. Txhua tus neeg mob yuav tsum paub yuav ua li cas nws tshwm sim nws tus kheej thiab yuav ua li cas txo qhov kev tawm tsam ntawm angina pectoris.
Cov ntawv ntawm angina pectoris
Raws li cov kev faib tawm uas feem ntau lees paub, ruaj khov angina (HF) yog qhov txawv, pom los ntawm qhov tshwm sim ntawm qhov mob luv luv, zoo nres los ntawm nitrates, tsis ruaj khov (NS), kev vam meej, variant thiab vasospastic. Tsis ruaj khov angina yog lub plawv nres ntev tshaj 30 feeb yam tsis muaj tsos mob.plawv nres ntawm cardiogram thiab thaum tsis muaj qhov nce ntxiv hauv cardiospecific enzymes.
Ib qho spasm ntawm cov hlab ntsha ntawm lub plawv yog qhov txawv ntawm vasospastic nres ntawm angina pectoris, uas ua rau nws muaj peev xwm txhim kho yam tsis muaj ischemic vascular puas. Tsis zoo li vasospastic, variant angina tsim nyob rau hauv lub xub ntiag ntawm atherosclerosis ntawm cov hlab ntsha coronary. Txawm li cas los xij, nws zoo ib yam li vasospastic nyob rau hauv uas nws tsim vim spasm ntawm coronary hlab ntsha.
Progressive angina (PS) yog ib hom tshwj xeeb ntawm kev ruaj khov angina, uas qhov zaus ntawm qhov mob anginal nce, kev tawm dag zog ua rau txo qis, thiab lub sij hawm nyem nce ntxiv. Raws li kev tawm tsam angina zuj zus, cov tsos mob thiab kev kho mob xwm txheej ceev yog tib yam li rau ib txwm mob ntawm qhov mob anginal. Txawm li cas los xij, nyob rau hauv rooj plaub ntawm kev qaug dab peg, mus pw hauv tsev kho mob thiab kev daws teeb meem ntawm angiography tau qhia.
Yog vim li cas rau kev hloov pauv ntawm exertional angina mus rau hauv kev loj hlob angina yog qhov nce ntawm qhov loj ntawm atherosclerotic plaque. Qhov no ua rau muaj kev pheej hmoo ntawm kev tsim myocardial infarction. Lub hom phiaj ntawm kev mus pw hauv tsev kho mob rau PS thiab NS yog los tiv thaiv nws, thaum lub sij hawm exertional angina qhov kev pheej hmoo tsawg dua.
Cov tsos mob ntawm angina pectoris
Kev lig kev cai, ib ntus ntawm angina pectoris tsim nyob rau hauv cov xwm txheej ntawm kev tawm dag zog lub cev lossis nrog kev siv nyiaj ntau ntawm lub zog substrate hauv plawv. Qhov tshwm sim no tshwm sim thaum lub sijhawm ua haujlwm ntawm kev ua haujlwm, hauv qee cov neeg mob nws tsuas yog thaumtaug kev los yog kev zoo siab. Feem ntau qhov mob angina tshwm sim thaum hmo ntuj thiab ua ntej sawv. Qhov no tshwm sim vim kev loj hlob ntawm tachycardia nyob rau theem ntawm REM pw tsaug zog, thaum lub plawv mob nyob rau hauv zoo.
thawj thiab feem ntau cov tsos mob ntawm angina yog mob angina. Nws yog manifested los ntawm ib qho kev xav ntawm muaj zog squeezing qab lub sternum ncaj qha thaum taug kev los yog nrog excitement, ib tug kub hnyiab nyob rau hauv lub plawv. Qee zaum mob tshwm sim nyob rau sab laug hypochondrium, tab sis qhov kub hnyiab tseem nyob hauv thaj tsam ntawm lub plawv. Kev mob anginal feem ntau kis mus rau thaj tsam hauv qab lub puab tsaig, mus rau caj dab, mus rau thaj tsam interscapular thiab hauv qab lub xub pwg hniav sab laug, tsawg zaus mus rau thaj tsam ntawm sab laug xub pwg.
Tus yam ntxwv ntawm qhov mob anginal
mob plab muaj qhov mob siab tas mus li thiab nrog xeev siab hauv 5-10%, ua tsis taus pa hauv 10-20% thiab tsis txaus siab tsis txaus ntseeg hauv 30-50%. Qhov no tsis tau txhais hais tias nrog kev tawm tsam ntawm angina pectoris, cov tsos mob ntawm kev ua pa luv yog qhov tshwj xeeb. Ua tsis taus pa luv qhia cov tsos mob ntawm sab laug ventricular tsis ua haujlwm hauv lub plawv nres. Tab sis nrog angina pectoris, tshwj xeeb tshaj yog thaum tsis muaj lub plawv tsis ua haujlwm, nws yog qhov ua tau zoo. Nws yog qhov tsis txaus siab ntawm qhov ua tsis taus pa uas tshwm, txawm hais tias qhov ua pa tsis nce.
Ntxiv rau qhov mob anginal tshwj xeeb, thawj cov cim qhia ntawm qhov mob angina tuaj yeem ua raws li hauv qab no: qhov pom ntawm qhov tsis muaj zog, kev xav ntawm constriction thiab nruj ntawm lub hauv siab thiab lub plawv, tawm hws thiab ua pa ntawm lub ntsej muag. Feem ntauKev mob taub hau tshwm sim nyob rau hauv thaj av parietal thiab occipital, uas yog ib qho cim qhia ntawm arterial hypertension.
Ib qho tseem ceeb tshwj xeeb ntawm qhov mob anginal hauv angina pectoris yog lawv tshem tawm sai (3-4 feeb) tom qab tshem tawm ntawm lub cev, noj nitroglycerin npaj lossis normalizing ntshav siab tom qab muaj teeb meem. Qhov tsis tuaj yeem txwv tsis pub cov tsos mob ntawm angina pectoris kav ntev dua 20-30 feeb tom qab 2 zaug ntawm kev siv nitroglycerin txhua 7 feeb yog ib qho teeb meem uas tus neeg mob yuav tsum tau mus rau EMS vim tias muaj kev pheej hmoo ntawm kev tsim kab mob plawv.
Angina hauv ntshav qab zib
Nyob rau hauv cov ntawv nyeem saum toj no, cov ntaub ntawv tau muab hais tias ib txwm mob anginal yog ib qho cim tshwj xeeb ntawm angina pectoris. Qhov no tsis yog ib txwm muaj, vim tias ntau cov receptors cuam tshuam rau cov ntshav qab zib neuropathy, suav nrog qhov mob receptors hauv lub plawv cov leeg. Vim li no, nrog ntshav qab zib, qhov mob yuav tsis hnov los ntawm tus neeg mob, thiab nrog rau kev tawm tsam ntawm angina pectoris, lwm yam cim tshwm sim: qaug zog, ua pa luv, tsis xis nyob hauv siab. Nyob rau tib lub sijhawm, nws tsis tuaj yeem hais lus ntseeg tau txog angina pectoris yam tsis muaj Holter ECG saib xyuas thiab txheeb xyuas ntawm ischemia. Kev kuaj treadmill thiab lub tsheb kauj vab ergometer kuaj kuj zoo rau kev kuaj mob. Cov tsos mob ntawm cov tsos mob ntawm ischemia ntawm ECG thaum lub sij hawm qoj ib ce yog qhov kev ntseeg siab tshaj plaws rau kev kuaj mob angina pectoris.
YPathogeny ntawm angina pectoris
Ib yam mob angina tshwm sim nyob rau hauv cov xwm txheej ntawm qhov tsis sib xws ntawm kev siv cov ntshav hauvmyocardium thiab nws lub zog xav tau. Qhov ntawd yog, nyob rau hauv ib qho xwm txheej uas lub load ntawm lub plawv cov leeg nce, thiab cov ntshav ntws tsis nce, ischemia thiab hypoxia tshwm sim hauv lub plawv. Qhov no episodic coronary insufficiency underlies txoj kev loj hlob ntawm angina pectoris rov. Ib qho xwm txheej tsim nyog rau kev txo qis ntawm cov ntshav ntws los ntawm cov hlab ntsha ntawm lub plawv yog coronary spasm. Nws tshwm sim thaum ua pa cua txias lossis thaum muaj kev ntxhov siab, kev tawm dag zog thiab haus luam yeeb.
Tam sim ntawd tom qab kev txhim kho ntawm angina nres vim cov ntaub so ntswg hauv zos (vasodilators), kev sim ua kom muaj kev siv cov ntshav mus rau cov leeg ischemic los ntawm dilating cov hlab ntsha. Nyob rau hauv cov ntaub ntawv ntawm coronary spasm, qhov no yog ua tiav nyob rau hauv 5-7 feeb. Tab sis nrog txoj kev loj hlob ntawm atherosclerosis ntawm cov hlab ntsha coronary thiab calcification, lawv nthuav dav thiaj li yuav ua rau kom muaj kev nkag mus tsis tau. Yog li ntawd, nyob rau hauv cov xwm txheej ntawm kev ua haujlwm siab dua ntawm lub plawv cov leeg thiab lub zog tshaib plab, episodic ischemia tsim. Tom qab noj nitrates, qhov mob no nres hauv 5-7 feeb. Nws kuj tseem tuaj yeem nres ntawm nws tus kheej tom qab so luv luv.
Kev ua rau mob anginal
Qhov tshwm sim ntawm qhov mob anginal yog cov tsos mob uas paub zoo rau txhua tus neeg mob uas muaj kev ruaj ntseg angina. Lawv hnov nws thaum lub cev tawm dag zog, nce ntaiv lossis tsuas yog taug kev, nrog kev kub ntxhov siab thiab kev ntxhov siab hnyav. Nws yog ib qho nyuaj rau confuse nws nrog mob plab los yogmob pob txha nrog thoracalgia, intercostal neuralgia. Yog li ntawd, cov neeg mob uas muaj kev kuaj mob tam sim ntawd nkag siab tias lawv tab tom txhim kho angina nres, uas yuav tsum tau nres los ntawm kev noj nitroglycerin. Lawv paub zoo tias so thiab tso tseg txoj haujlwm tso cai rau koj kom nres qhov kev tawm tsam sai dua.
tsam kev tawm tsam
Pab nrog kev tawm tsam ntawm angina yog kev so thiab kev siv cov tshuaj nitroglycerin npaj. Tam sim no muaj cov tshuaj ntsiav tshuaj thiab tshuaj tsuag. Tag nrho cov ntawm lawv yog siv sublingually: 1 ntsiav tshuaj ntawm nitroglycerin 0.5 mg los yog 1 tshuaj tsuag nyob rau hauv tus nplaig. Ib qho xwm txheej ntawm qhov mob anginal tom qab ntawd nres tsis pub dhau 2-4 feeb vim qhov txo qis hauv preload, thiab, yog li ntawd, kev poob qis hauv kev noj cov pa oxygen thiab lub zog substrates hauv myocardium.
Yog tias qhov kev tawm tsam ntawm angina tsis raug tshem tawm tom qab ib koob tshuaj nitrates sai sai, tom qab 5 feeb lawv tuaj yeem noj dua. Qhov no tau tso cai nrog cov ntshav siab lossis ntshav siab. Tab sis yog tias ntshav siab tsawg dua 90 / 60 mmHg, koj yuav tsum hu rau SMP thiab tsis kam siv nitroglycerin vim qhov txo qis ntxiv. Yog tias kev nyeem ntshav siab siab dua 100\60 mmHg, ces tuaj yeem noj nitroglycerin dua.
Kev ua rau qaug dab peg
Kev kho mob qhia txog kev ua tiav ntawm angina pectoris rov. Tab sis yog tias tom qab 4-5 feeb ntawm kev rov ua haujlwm ntawm qhov mob anginal tsis nres, koj yuav tsum hu rau SMP rau kev kuaj mob ntawm tus mob coronary syndrome: nce qib.los yog tsis ruaj tsis khov angina, myocardial infarction. Nws kuj tseem muaj peev xwm hais tias tus neeg mob nws tus kheej txhais nws qhov mob tsis raug thiab txhais qhov mob los ntawm lwm qhov los ntawm kev tawm tsam angina.
Qhov tseeb, vim qhov peculiarities ntawm innervation ntawm lub plab kab mob, qhov mob zoo ib yam li mob anginal tuaj yeem yog cov tsos mob ntawm lub plab rwj lossis gastritis, kab mob reflux thiab esophagitis, cholecystitis thiab pancreatitis, appendicitis, adnexitis, ectopic. cev xeeb tub, qog nqaij hlav hauv nruab nrab lossis plab kab noj hniav, aortic aneurysm thiab pulmonary embolism.
Txhua yam mob no xav tau kev kuaj mob thiab kho tshwj xeeb hauv lub sijhawm luv. Tab sis qhov no tsis tau txhais hais tias yog tias qhov kev pab muab thaum lub sij hawm tawm tsam ntawm angina pectoris tsis muaj kev cuam tshuam, ces tus kab mob loj heev yuav tsum tsim. Qhov no tsuas yog qhia txog qhov yuav tsum tau sab laj nrog cov kws tshaj lij (cov neeg ua haujlwm ntawm lub tsheb thauj neeg mob lossis kws kho mob hauv chav kho mob xwm txheej ceev) kom tsis suav nrog lub plawv nres, mob hnyav ntawm lub plab hnyuv, qog.
Tom qab ntawd, ua ntej lub tsheb thauj neeg mob tuaj txog, koj yuav tsum tau ua qhov chaw xis nyob (sab lossis pw), tsis txhob haus dej haus, noj zaub mov thiab tshuaj, thiab haus luam yeeb. EMS cov neeg ua haujlwm yuav tsum qhia cov ntsiab lus ntawm qhov tsis zoo hauv kev noj qab haus huv uas tau tshwm sim hauv ib daim ntawv tshwj xeeb thiab lub hom phiaj. Thaum piav qhia txog koj tus mob, koj yuav tsum tau tso tseg cov ntsiab lus tseeb, qhia lub sijhawm pib ntawm kev mob angina, muab cov ntaub ntawv kho mob, cov ntawv rho tawm thiab cov ntaub ntawv ntawm cov tsev kho mob, cardiograms.
Thawj angina pectoris
Raws li cov txiaj ntsig ntawm Framingham txoj kev tshawb fawb, cov cim qhia ntawm kev tawm tsam ntawm angina pectoris yog thawj qhov tshwm sim ntawm tus kab mob coronary hauv 40.7% ntawm cov txiv neej, thiab hauv 56.5% ntawm cov poj niam. Qhov no txhais tau hais tias ua ntej qhov pib ntawm qhov mob anginal, cov neeg mob yuav tsis xyuam xim rau qhov txo qis hauv kev ua haujlwm siab ntev. Tab sis thaum muaj mob kub hnyiab hauv lub siab, nws yuav lig dhau los tsis quav ntsej. Txawm li cas los xij, qhov kev kuaj mob ntawm tus kab mob coronary ntev qeeb, thiab kev kho mob pib tom qab. Raws li qhov tshwm sim, nws qhov kev ua tau zoo tseem tsis txaus, thiab yog li ntawd lub plawv tsis ua haujlwm ntev sai dua.
Yog tias qhov mob anginal tshwm sim thawj zaug thiab tsis tshwm sim ua ntej, koj yuav tsum ua raws li cov lus qhia saum toj no. Ntawd yog, nres nws nrog nitroglycerin npaj, noj Metoprolol 25 mg lossis Anaprilin 40 mg nrog lub plawv dhia, txo cov ntshav siab nrog Captopril yog tias nws siab thaum lub sijhawm pib mob. "Nifedipine" yuav tsum tsis txhob siv rau angina pectoris, vim hais tias nws yuav ua rau kom mob vim kev loj hlob ntawm "nyem" syndrome.
Kev ua tom qab nyem thawj zaug angina pectoris
Thaum muaj kev saib xyuas xwm txheej ceev rau kev tawm tsam ntawm angina pectoris tau muab, kev kuaj mob yuav tsum tau ua kom paub meej txog theem ntawm tus kab mob ischemic. Tsis tas li ntawd, tom qab thawj qhov kev tawm tsam, vim tias muaj cov atherosclerotic plaques nyob rau hauv cov hlab ntsha nqaim, cov ntu tshiab ntawm qhov mob anginal yuav tshwm sim tas li. Qhov no yuav cuam tshuam rau tus neeg mob lub peev xwm ua haujlwm thiab txwv nwsmuaj peev xwm ua haujlwm.
Qhov muaj cov quav hniav nyob rau hauv cov hlab ntsha, qhov loj ntawm qhov twg thiab qhov degree ntawm occlusion tsis meej, yog qhov pheej hmoo rau kev loj hlob ntawm myocardial infarction. Lub plawv nres ua ntej lub plawv nres tuaj yeem ua tau zoo ib yam li kev mob angina. Cov tsos mob ntawm cov mob no zoo ib yam thaum xub thawj, raws li lawv muaj xws li mob anginal. Txawm li cas los xij, hauv lub plawv nres, lawv tuaj yeem ua rau hnyav dua, tsis txhob nres tag nrho los ntawm kev noj nitroglycerin, thiab feem ntau nrog ua pa luv vim yog sab laug ventricular tsis ua haujlwm.
Rau qhov sib piv: nyem qhov mob angina tshwm sim hauv 2-4 feeb tom qab noj nitrates lossis 5 feeb tom qab noj lawv dua. Infarction anginal mob tsis nres tom qab noj nitroglycerin, txawm tias lawv yuav tsis muaj zog me ntsis. Txhawm rau tiv thaiv kev txhim kho ntawm myocardial infarction, nrog rau txo tus naj npawb ntawm angina pectoris ntu, koj yuav tsum hu rau tus kws kho mob.
Kuj lub sijhawm uas cov chaw kho mob raug kaw, tus neeg mob uas muaj angina pectoris thawj zaug yuav tsum mus rau chav kho mob xwm txheej ceev ntawm lub tsev kho mob lossis mus rau EMS. Thawj zaug angina pectoris yog suav tias yog ib qho mob ua ntej myocardial infarction thiab tau kho nrog cov tshuaj tiv thaiv coagulants, antiplatelet agents, statins, beta-blockers thiab antihypertensives hauv tsev kho mob.
CV
Cov tsos mob tshwm sim thaum muaj kev tawm tsam ntawm angina pectoris yog thawj cov cim qhia tias muaj cov atherosclerotic plaque nyob rau hauv cov hlab ntsha ntawm lub plawv. Nrog psychophysical kev nyuaj siab,Thaum lub plawv xav tau lub zog ntau dua li ntawm so, ischemia tshwm sim hauv myocardium, uas yog nrog los ntawm qhov mob hauv lub plawv. Ischemia yog qhov tshwm sim thim rov qab, uas tuaj yeem ua kom ruaj khov los ntawm cov tshuaj uas nres qhov kev tawm tsam angina. Kev npaj: ntsiav tshuaj "Nitroglycerin 0.5 mg" - 1 ntsiav tshuaj nyob rau hauv tus nplaig los yog tshuaj tsuag, "Metoprolol 25 mg" los yog "Inderal 40 mg" - 1 ntsiav tshuaj nyob rau hauv, antihypertensives.
Tsuas yog "Nitroglycerin" yog qhov yuav tsum tau noj, thaum cov tshuaj "Metoprolol" thiab "Anaprilin" yuav tsum tau noj nrog lub plawv dhia siab (siab dua 90 toj ib feeb) thiab tsis muaj keeb kwm ntawm mob hawb pob bronchial. Captopril 25 mg tuaj yeem siv los ua ib txoj hauv kev los txo cov ntshav siab yog tias cov ntshav siab thaum muaj kev tawm tsam siab dua 150/80 mmHg. Yog tias tsis muaj kev cuam tshuam los ntawm kev rov ua haujlwm ntawm "Nitroglycerin 0.5 mg" lossis tshuaj tsuag, nrog rau tom qab kev kho mob angina thawj zaug, koj yuav tsum nrhiav kev pab kho mob.
