Sinoatrial blockade yog ib yam mob uas muaj nrog los ntawm kev ua txhaum ntawm lub plawv dhia. Qhov chaw ntawm myocardium cog lus asynchronously, ua rau lub asystole ib ntus. Lawm, xws li kev ua txhaum cai yog txaus ntshai. Ntau tus neeg mob nrhiav cov ntaub ntawv ntxiv txog qhov no pathology. Vim li cas txoj kev thaiv kev txhim kho? Puas muaj cov tsos mob sab nraud? Cov kev kho mob niaj hnub no muaj li cas? Cov lus teb rau cov lus nug no yuav txaus siab rau ntau tus nyeem.
sinoatrial block yog dab tsi?
txhawm rau piav qhia lub ntsiab lus ntawm pathology, koj yuav tsum xub ua tib zoo saib xyuas lub cev thiab lub cev ntawm tib neeg myocardium. Raws li koj paub, lub plawv yog ib feem ntawm lub cev. Nws qhov contraction yog muab los ntawm kev ua haujlwm ntawm cov hlab ntsha tshwj xeeb uas ua rau cov hlab ntsha impulses.
Ib feem tseem ceeb ntawm cov pacemakers yog lub sinus node. Nws nyob nruab nrab ntawm txoj cai auriclethiab qhib lub superior vena cava, nyob rau hauv lub phab ntsa ntawm txoj cai atrium. Kev sib txuas ntawm sinoatrial muaj ob peb ceg, nrog rau cov pob khoom ntawm Torel, Bachmann, Wenckebach - lawv ua impulses rau phab ntsa ntawm ob qho tib si atria. Kev ua txhaum ntawm kev coj ua ib txwm ua ntawm cov hlab ntsha impulse nyob rau hauv cheeb tsam no yog hu ua blockade ntawm lub sinoatrial node.
Yog li, tawm tsam keeb kwm ntawm pathology nyob rau hauv lub atherosclerosis ntawm lub plawv, tsis ua hauj lwm tshwm sim, uas ua rau asystole, uas, ntawm chav kawm, yog heev txaus ntshai. Nws yog tsim nyog hais tias qhov no yog ib qho tsis tshua muaj pathology - nws tau kuaj pom hauv 0.16% ntawm cov neeg mob hauv lub plawv plawv. Thiab raws li kev tshawb fawb txheeb cais, cov txiv neej tshaj li tsib caug xyoo feem ntau raug kev txom nyem los ntawm qhov teeb meem. Hauv cov poj niam cov neeg sawv cev, qhov kev sib txawv no tsawg dua.
Nws muaj peev xwm txhim kho kev thaiv thaum menyuam yaus, tab sis qhov no feem ntau tshwm sim tawm tsam keeb kwm ntawm cov kab mob hauv nruab nrog cev ntawm myocardium.
Qhov laj thawj tseem ceeb ntawm pathology
Nws yuav tsum nkag siab tias SA-kev thaiv tsis yog kab mob ywj pheej. Nws yog ib qho cim ntawm lwm yam pathologies. Yuav luag 60% ntawm cov neeg mob blockade raug kev txom nyem los ntawm kab mob plawv. Tsis tas li ntawd, pathology feem ntau tshwm sim tawm tsam keeb kwm yav dhau los lossis tom qab myocardial infarction.
Dhau li ntawm qhov no, muaj lwm yam laj thawj uas tuaj yeem ua rau muaj kev cuam tshuam ntawm lub plawv dhia. Kev pheej hmoo muaj xws li kab mob thiab kab mob myocarditis, nrog rau myocardial cardiosclerosis, calcification ntawm lub plawv cov leeg, thiab congenital cov ntaub ntawv ntawm cardiomegaly. Qee lub sij hawm SA block tsim rau cov neeg mob rheumatism.
Txhob Cia Siabsinoatrial node tuaj yeem tshwm sim los ntawm kev siv tshuaj ntau dhau ntawm lub plawv glycosides, beta-blockers, quinidines thiab lwm yam tshuaj. Qhov ntau ntawm cov poov tshuaj hauv cov ntshav feem ntau ua rau kev txhim kho ntawm pathology. Txij li thaum kev ua haujlwm ntawm lub plawv raug tswj hwm los ntawm cov hlab ntsha vagus, qhov nce hauv nws lub suab kuj tuaj yeem ua rau muaj kev cuam tshuam ntawm kev sib dhos (ib lub tshuab ua rau lub hauv siab raug mob, qee qhov kev ntsuam xyuas reflex uas ua rau cov hlab ntsha xaus).
Yog vim li cas suav nrog lwm yam mob, suav nrog lub plawv valve tsis xws luag, muaj qog nqaij hlav hauv hlwb, ua haujlwm tsis zoo ntawm cov thyroid caj pas, mob ntshav siab, mob meningitis, encephalitis, leukemia, pathology ntawm cerebral hlab ntsha. Raws li koj tuaj yeem pom, muaj ntau qhov xwm txheej txaus ntshai.
Thawj qib thaiv thaiv thiab nws cov yam ntxwv
Hauv cov tshuaj niaj hnub no, nws yog ib txwm ua kom paub qhov txawv peb theem ntawm qhov mob hnyav ntawm cov kab mob no. Txhua tus ntawm lawv muaj nws tus yam ntxwv. Daim ntawv mildest yog suav tias yog thawj-degree sinoatrial block. Nrog xws li ib tug pathology, txhua impulse uas tshwm sim nyob rau hauv lub cheeb tsam ntawm lub sinus node mus txog lub atria. Tab sis nws qhov kev siv yuav tshwm sim nrog qee qhov qeeb.
Cov kab mob no tsis tuaj yeem pom ntawm electrocardiogram, thiab tsis muaj qhov tshwm sim sab nraud - rau feem ntau, cov neeg mob xav li qub. Koj tuaj yeem kuaj xyuas thawj qib ntawm kev thaiv thaum lub sij hawm intracardiac EPS.
Second degree blockade: piav qhia luv luv
Qhov kev loj hlob ntawm pathology tau txaismuab faib ua ob hom:
- Thaiv ntawm qib 2nd ntawm thawj hom yog nrog los ntawm kev maj mam txo qis hauv kev coj ua hauv thaj tsam ntawm qhov sinus node. Qhov kev ua txhaum cai no tuaj yeem kuaj pom ntawm ECG. Hais txog cov tsos mob sab nraud, cov neeg mob feem ntau yws yws ntawm kiv taub hau, tsis muaj zog. Raws li tus kab mob no tshwm sim, pre-syncope xeev, thiab qee zaum tsis nco qab lub sij hawm luv luv, provoked los ntawm kev siv lub cev muaj zog, hnoos hnyav, tig taub hau, thiab lwm yam, ua ib qho tshwm sim tsis tu ncua hauv tib neeg lub neej.
- 2nd degree blockade ntawm hom thib ob twb tau nrog los ntawm lub plawv arrhythmias uas tus neeg mob nws tus kheej tuaj yeem hnov. Piv txwv li, lub plawv dhia ua ntej nce ntxiv (ib tug neeg tuaj yeem hnov qhov contractions), tom qab ntawd nws nres sai sai, thiab tom qab ib ntus nws rov pib dua. Thaum lub sijhawm asystole, tus neeg mob hnov qhov tsis muaj zog, feem ntau tsis nco qab.
Cov tsos mob ntawm 3rd degree thaiv yog dab tsi?
Thib peb kab mob yog qhov ua tiav sinoatrial thaiv. Hauv qhov no, myocardium tsis tau txais impulses los ntawm sinus node kiag li. Lawm, pathology yog pom ntawm ECG, vim hais tias tiv thaiv keeb kwm yav dhau los ntawm kev thaiv tag nrho, tus neeg mob tsim asystole. Nyob rau tib lub sijhawm, ib qho ectopic atherosclerosis tshwm sim vim kev ua haujlwm ntawm cov neeg tsav tsheb thib peb. Thaum lub sij hawm electrocardiography, koj yuav pom tias tsis muaj PQRST complexes.
kev kho mob
Nws yuav tsum tau hais tam sim ntawd tias kev kho mob feem ntau nyob ntawmua rau pathology. Yog hais tias lub sinoatrial blockade yog ib feem thiab tsis yog ib qho kev hem thawj rau tus neeg mob lub neej, ces kev kho tshwj xeeb tej zaum yuav tsis tas yuav tsum tau - lub plawv atherosclerosis tuaj yeem normalize nws tus kheej.
Tseem xav kho tus kab mob thawj zaug. Piv txwv li, yog hais tias qhov blockade yog provoked los ntawm ib qho kev nce nyob rau hauv lub suab ntawm lub vagus paj, ces nws yog ib qho tseem ceeb uas yuav tsum tau muab Atropine rau tus neeg mob (tuaj yeem hloov nrog Ephedrine, Orciprepalin, Isoprenaline). Nyob rau hauv cov xwm txheej uas lub plawv tsis ua hauj lwm tshwm sim tawm tsam keeb kwm yav dhau los ntawm kev siv tshuaj ntau dhau, kev siv cov tshuaj uas muaj peev xwm txaus ntshai yuav tsum tau nres tam sim ntawd thiab yuav tsum tau ua kom tshem tawm cov khoom seem ntawm cov tshuaj los ntawm lub cev.
Hmoov tsis zoo, feem ntau qhov kev cuam tshuam zoo li no ua rau muaj kev hloov pauv fibrotic hauv myocardium. Nyob rau hauv tas li ntawd, ib txwm contraction ntawm lub plawv cov leeg yuav tsum tau ua kom ntseeg tau los ntawm tas li hluav taws xob stimulation.
pab thawj rau kev thaiv
Raws li twb tau hais lawm, feem ntau qhov kev thaiv yog ib feem thiab tsis ua rau muaj kev hem thawj rau tus neeg mob lub neej. Txawm li cas los xij, qee zaum, qhov ua tiav ntawm kev xa tawm ntawm hluav taws xob impulses ua rau lub plawv nres.
Yog tias muaj qhov tsis ua haujlwm loj hauv lub plawv dhia, mus txog qhov nres, tom qab ntawd atrial stimulation yog ua. Raws li kev ntsuas luv luv, koj tuaj yeem tso siab rau ntawm lub qhov muag (pab hloov lub plawv dhia). Hmoov tsis zoo, qee zaum tus neeg mob xav tau kev saib xyuas hnyav, zaws lub plawv thiab kev sib txuas nrog lub tshuab txhawb nqa lub neej.
