Ventricular flutter yog ventricular tachyarrhythmia uas muaj qhov tsis tu ncua, nrawm nrawm (kwv yees li 200-300 neeg ntaus ib feeb). Feem ntau, qhov mob yuav ua tau nrog kev txo qis hauv cov ntshav siab. Tsis nco qab, pallor, diffuse cyanosis ntawm daim tawv nqaij, ua tsis taus pa, convulsions, dilated cov menyuam kawm ntawv yuav tsis txiav tawm.
Ntxiv rau, nws tuaj yeem ua rau tuag sai sai. Kev kuaj mob ntawm xws li pathology yog ua los ntawm kev tshawb fawb electrocardiographic thiab cov ntaub ntawv kho mob. Kev saib xyuas thaum muaj xwm txheej ceev rau ventricular flutter suav nrog kev defibrillation tam sim ntawd thiab cardiopulmonary resuscitation.
ventricular flutter yog dab tsi?
Ib qho tshwm sim zoo sib xws yog kev ua haujlwm hluav taws xob tsis zoo ntawm myocardium, uas yog tus cwj pwm los ntawm kev sib txuas ntawm cov ventricles. Qhov zaus ntawm cov contractions no tshaj 200 neeg ntaus ib feeb. Nws tuaj yeem tig mus rau hauv fibrillation (flickering), uasyuav nthuav tawm nrog ntau zaus, txog li 500 tus neeg ntaus, tab sis tsis xwm yeem thiab tsis ua haujlwm ventricular.
Hauv chav kho mob plawv, cov kws tshaj lij tau faib cov fibrillation thiab flutter ua hom txaus ntshai ntawm arrhythmia uas tuaj yeem ua rau tsis muaj peev xwm hemodynamics. Tsis tas li ntawd, lawv yog cov feem ntau ua rau arrhythmic tuag. Raws li cov ntaub ntawv kis mob, fibrillation thiab flutter feem ntau tshwm sim hauv cov tib neeg uas muaj hnub nyoog li ntawm 47 txog 75 xyoo. Ib tug yam ntxwv feature yog hais tias nyob rau hauv cov txiv neej lawv tshwm sim peb zaug ntau dua li cov poj niam. Hauv 70-80% ntawm cov neeg mob, kev tuag sai yog tshwm sim los ntawm ventricular fibrillation.
Caus ntawm pathology?
Ventricular flutter tuaj yeem tshwm sim tawm tsam keeb kwm yav dhau los ntawm ntau yam kab mob hauv lub plawv, nyob rau hauv muaj ntau yam ntawm cov kab mob extracardiac. Feem ntau, cov organic myocardial puas tsuaj uas tshwm sim tawm tsam keeb kwm ntawm IHD tuaj yeem ua rau muaj kev nyuaj siab los ntawm ventricular fibrillation thiab flutter. Tsis tas li ntawd, qhov no pathology nrog cov kab mob hauv qab no:
- postinfarction cardiosclerosis;
- lub plawv aneurysm;
- mob myocardial infarction;
- myocarditis;
- hypertrophic cardiomyopathy;
- Ydilated cardiomyopathy;
- Hma-Parkinson-White syndrome;
- kab mob plawv plawv (aortic stenosis, mitral valve prolapse).
Lwm yam yog vim li cas
Tsis tshua muaj, kev txhim kho ntawm qhov teeb meem no tuaj yeem tshwm sim vim kev qaug cawvplawv glycosides, electrolyte imbalances, siab ntshav siab ntawm catecholamines, hluav taws xob raug mob, mob hauv siab, mob plawv, hypoxia, acidosis, hypothermia. Tsis tas li ntawd, ventricular tachycardia tuaj yeem tshwm sim los ntawm qee yam tshuaj, piv txwv li, sympathomimetics, barbiturates, narcotic analgesics, antiarrhythmics.
Lwm qhov ua rau flutter yog cov txheej txheem phais plawv. Cov no muaj xws li coronary angiography, hluav taws xob cardioversion, defibrillation nyob rau hauv cardiology department.
Pathogenesis ntawm ventricular flutter
Txoj kev loj hlob ntawm tus kab mob no ncaj qha cuam tshuam nrog kev rov nkag mus, uas muaj qhov xwm txheej ntawm kev ncig ntawm lub zog excitation nthwv dej dhau los ntawm ventricular myocardium. Nws ua rau cov ventricles sib cog lus ntau zaus thiab sib dhos, thiab tsis muaj lub sijhawm diastolic. Lub voj rov nkag tuaj yeem nyob ntawm thaj tsam ntawm tag nrho thaj tsam infarction, los yog qhov chaw ntawm lub ventricular aneurysm. Cov lus ntsuas lub plawv ib txwm muaj raws li hnub nyoog yuav qhia hauv qab no.
Lub luag haujlwm tseem ceeb hauv kev tsim cov kab mob ventricular fibrillation yog ua los ntawm ntau yam random rov nkag nthwv dej, uas ua rau muaj kev sib cog lus ntawm tus kheej myocardial fibers thaum tsis muaj ventricular contractions. Qhov tshwm sim no yog vim lub electrophysiological heterogeneity ntawm myocardium: tib lub sijhawm, qhov sib txawv ntawm cov ventricles tuaj yeem nyob rau lub sijhawm ntawm repolarization thiab nyob rau lub sijhawm depolarization.
Nws tso dab tsi?
Ventricular fibrillation thiab flutter, raws li txoj cai, pibventricular thiab supraventricular extrasystole. Cov txheej txheem rov qab tuaj yeem tuaj yeem pib ua rau ventricular thiab atrial tachycardia, Wolff-Parkinson-White syndrome, atrial fibrillation, thiab tom qab ntawd txhawb lawv.
Nyob rau hauv tus txheej txheem ntawm kev tsim flutters thiab flickering, lub stroke ntim ntawm lub plawv sai sai txo, thiab ces ua xoom. Yog li ntawd, cov ntshav ncig nres tam sim ntawd. Paroxysmal flutter thiab ventricular fibrillation yeej ib txwm nrog syncope, thiab ib daim ntawv ruaj khov ntawm tachyarrhythmia entails thawj qhov chaw kho mob thiab tom qab ntawd lom tuag.
Kev faib tawm ntawm ventricular flutter
Nyob rau hauv txoj kev loj hlob, kab mob plawv xws li ventricular fibrillation thiab flutter mus txog plaub theem:
Thawj yog theem tachysystolic ntawm ventricular flutter. Lub sijhawm ntawm theem no yog qhov siab tshaj plaws ntawm ob vib nas this. Nws yog tus cwj pwm los ntawm kev sib koom ua ke ntawm lub plawv dhia. Ntawm ECG, theem no sib raug mus rau 3-6 lub ventricular complexes nrog ib tug ntse high-amplitude oscillation.
theem ob yog convulsive ventricular tachyarrhythmia. Nws lub sijhawm yog los ntawm 15 mus rau 50 vib nas this. Nws yog tus cwj pwm los ntawm nquag, hauv zos contractions ntawm myocardium ntawm qhov xwm txheej tsis xwm yeem. ECG qhia txog theem no nyob rau hauv daim ntawv ntawm high-voltage nthwv dej ntawm qhov sib txawv thiab amplitude.
theem peb yog theem ntawm ventricular fibrillation. Lub sijhawm ntawm lub sijhawm no yog 2-3 feeb. Nws yog nrog los ntawm ntau yam tsis xwm yeem ntawm ib qho chaw ntawm myocardium,muaj ntau zaus.
theem plaub yog atony. Cov theem no tshwm sim kwv yees li 2-5 feeb tom qab pib ntawm ventricular fibrillation. Qhov thib plaub theem yog tus cwj pwm los ntawm me me, tsis xwm yeem tsis sib xws ntawm kev cog lus, muaj ntau qhov chaw uas tau cog lus tseg. Ntawm ECG, lawv tau pom nyob rau hauv daim ntawv ntawm kev tsis sib haum xeeb, lub amplitude uas maj mam txo.
Cov kws kho plawv paub qhov txawv ntawm ventricular fibrillation thiab flutter raws li qhov txawv ntawm lawv qhov kev kho mob. Yog li, muaj cov ntaub ntawv ruaj khov thiab paroxysmal. Nyob rau tib lub sijhawm, fluttering ntawm daim ntawv thib ob tuaj yeem tshwm sim hauv qhov xwm txheej, uas yog, nws tuaj yeem rov ua dua ob peb zaug thaum nruab hnub.
Symptoms
Kab mob plawv - ventricular fibrillation thiab flutter, qhov tseeb, sib raug rau kev kho mob tuag. Yog hais tias flutter tshwm sim, ces rau ib lub sij hawm luv luv, nws muaj peev xwm tswj tau lub plawv qis, tsis nco qab thiab arterial hypotension. Tsis tshua muaj, ventricular flutter tej zaum yuav ua rau qhov mob ntawm qhov ntswg-hom atherosclerosis. Feem ntau, xws li ib qho kev tsis ruaj khov hloov mus rau hauv ventricular fibrillation.
Flutter thiab ventricular fibrillation nrog cov tsos mob hauv qab no:
- ncig raug kaw;
- tsis nco qab;
- ploj ntawm cov mem tes ntawm cov hlab ntsha femoral thiab carotid;
- ua pa nyuaj;
- ntse pallor;
- pupil dilation;
- diffuse cyanosis ntawm daim tawv nqaij;
- tsis muaj kev cuam tshuam rau lub teeb;
- tsis txhob xavtso zis thiab tso zis;
- tonic spasms.
Yog tias cov tsos mob no tau pom thiab pom tau tias ventricular fibrillation thiab flutter tau tshwm sim, ces tus neeg mob xav tau kev kho mob sai. Lub hauv paus paj hlwb thiab lwm yam kabmob yuav raug puas ntsoog yog tias lub plawv dhia zoo li qub tsis rov qab los li ntawm 4-5 feeb.
Kev nyuaj siab
Kev tuag yog qhov tsis txaus siab tshaj plaws ntawm cov kev sib txawv no. Cov teeb meem hauv qab no tuaj yeem tshwm sim los ntawm kev kho mob plawv:
- aspiration pneumonia;
- pob txha pob txha ua raws li lub ntsws raug mob;
- hemothorax;
- pneumothorax;
- tawv nqaij hlawv;
- ntau yam arrhythmias;
- hypoxic, anoxic, ischemic encephalopathy;
- myocardial dysfunction vim reperfusion syndrome.
Kev kuaj mob ntawm ventricular flutter
Ventricular fibrillation thiab flutter tuaj yeem lees paub thiab kuaj tau siv cov ntaub ntawv kho mob thiab electrocardiographic. Yog tias muaj qhov sib txawv, tom qab ntawd ntawm txoj kev tshawb fawb electrocardiographic nws yuav tshwm sim nyob rau hauv daim ntawv ntawm cov tsis tu ncua, cov suab paj nruag uas yuav luag zoo ib yam thiab amplitude. Lawv zoo ib yam li sinusoidal hom nkhaus nrog lub oscillation zaus ntawm 200-300 ib feeb. Tsis tas li ntawm ECG tsis muaj isoelectric kab nruab nrab ntawm nthwv dej, P thiab T nthwv dej.
Yog tias muaj ventricular fibrillation, yuav muajnthwv dej nrog lub plawv dhia (lub plawv dhia) ntawm 300-400 oscillations ib feeb tau kaw, uas tsis tu ncua hloov lawv lub sijhawm, cov duab, kev taw qhia thiab qhov siab. Tsis muaj isoelectric kab nruab nrab ntawm nthwv dej.
Ventricular fibrillation thiab flutter yuav tsum sib txawv ntawm lub plawv tamponade, loj PE, supraventricular arrhythmia, paroxysmal ventricular tachycardia.
Cov lus ntawm lub plawv dhia yog ib txwm muaj raws li hnub nyoog yog muab hauv qab no.
Kev kho mob ventricular flutter
Thaum muaj ventricular flutter los yog fibrillation, tam sim ntawd resuscitation yuav tsum tau muab los kho sinus atherosclerosis. Kev kho thawj zaug yuav tsum suav nrog kev poob siab ua ntej lossis ua pa ua pa hauv tandem nrog rau hauv siab compressions. Tshwj xeeb cardiopulmonary resuscitation suav nrog cov tshuab ua pa thiab hluav taws xob defibrillation ntawm lub plawv.
Ib txhij nrog kev ntsuas kev ua kom rov zoo, kev daws teeb meem ntawm atropine, adrenaline, sodium bicarbonate, procainamide, lidocaine, amiodarone, magnesium sulfate yuav tsum tau txhaj tshuaj intravenously. Nyob rau hauv parallel nrog qhov no, rov ua electrodefibrillation yog yuav tsum tau. Nyob rau hauv cov ntaub ntawv no, nrog rau txhua series, lub zog yuav tsum tau nce los ntawm 200 mus rau 400 J. Yog hais tias muaj ib tug rov tshwm sim ntawm ventricular fibrillation thiab flutter, uas tshwm sim raws li ib tug tshwm sim ntawm tiav atrioventricular plawv block, ces nws yog tsim nyog rau resort mus rau ib ntus stimulation. ntawm lub plawv ventricles nrog lub atherosclerosis uas tshaj qhov zaus ntawm lawv tus kheejhesitation.
Cov lus qhia tshwj xeeb
Yog tias tus neeg mob tsis rov qab ua pa, ua pa ntawm lub plawv, kev nco qab tsis pub dhau 20 feeb, tsis muaj qhov cuam tshuam rau lub teeb ntawm cov menyuam kawm ntawv, kev ntsuas kev rov ua haujlwm yuav tsum raug tso tseg. Yog tias qhov resuscitation tau ua tiav, ces tus neeg mob raug xa mus rau ICU rau kev soj ntsuam ntxiv. Tom qab ntawd, tus kws kho mob plawv uas tuaj koom txiav txim siab seb nws puas tsim nyog los cog ib lub cardioverter-defibrillator lossis ob chav pacemaker.
