Hnub no peb caw koj los tham txog dab tsi atrial tachycardia yog. Tsis tas li ntawd, peb yuav txheeb xyuas ntau yam teeb meem: kev faib tawm, ua rau, cov tsos mob, kev kuaj mob, kev kho mob, thiab lwm yam.
Ua ntej peb mus txog lub plawv ntawm qhov teeb meem, kuv xav kom nco ntsoov qhov tseeb hauv qab no: PT (atrial tachycardia) tau pom nyob rau hauv cov neeg muaj teeb meem plawv, tab sis feem ntau cov kab mob no tau pom nyob rau hauv cov neeg noj qab haus huv kiag li.
Txawm hais tias feem ntau tus kab mob me me, cov tsos mob tsis zoo yuav tsum tau siv tshuaj kho mob (peb kuj tseem yuav tham txog qhov no tom qab).
Raws li lub npe cuam tshuam (atrial tachycardia), qhov chaw ntawm tus kab mob yog lub atrium. Qhov ua rau tus kab mob no muaj ntau heev: los ntawm kev haus luam yeeb thiab rog dhau mus rau kev phais atrial thiab cov kab mob ntev ntawm lub ntsws thiab cov hlab plawv.
Qhov no yog dab tsi?
Cia peb pib nrog qhov tseebatrial tachycardia muaj qhov ua kom pom tseeb (qhov chaw me me uas muaj tus kab mob tshwm sim). Nws yog nyob rau hauv kev tsom xam tias stimulation ntawm ceev contractions ntawm lub plawv tshwm sim los ntawm generating hluav taws xob impulses. Yog li ntawd lub plawv dhia ntawm ib tug neeg sai.
Raws li txoj cai, tiam ntawm cov pulses no tsis tas li, lawv tsis tshwm sim ntau zaus. Hauv qhov no, tus kab mob hu ua "paroxysmal atrial tachycardia." Txawm li cas los xij, muaj cov xwm txheej thaum qhov no tshwm sim tas li rau ob peb hnub lossis ntau hli. Nws yog ib nqi sau cia hais tias tej zaum yuav muaj ntau tshaj ib tug tsom xam, uas yog pom nyob rau hauv cov neeg laus los yog cov neeg uas muaj lub plawv tsis ua hauj lwm.
Dhau li ntawm qhov no, peb yuav nco ntsoov atrial tachycardia nrog AV block, qhov no yog ib qho mob hnyav heev, uas yog hom arrhythmia. Localization - atrium. Tus kab mob no yuav tsis tshwm sim nws tus kheej rau lub sij hawm ntev heev, tab sis tom qab ntawd nws cov tsos mob tshwm sim heev thiab ruaj khov. Kab mob plawv yog ib qho kev tso dag tsis zoo, piv txwv li, qhov teeb meem no tuaj yeem ua rau tuag tam sim lossis syncope. Peb yuav qhia tam sim ntawd ib qho kev piav qhia ntawm lub sij hawm kawg - lub sij hawm luv luv fainting xeev. Pom qhov kev tawm tsam yog qhov yooj yim heev - lub plawv pib nrawm dua, ntawm 140 txog 190 neeg ntaus ib feeb.
Qhov tshwm sim tas li ntawm kev ua haujlwm ntawm lub plawv dhia nrawm yog qhov laj thawj loj uas tuaj ntsib kws kho plawv, vim tias tus kab mob ua rau koj lub plawv tsis txaus.
Views
Muaj peb hom atrial tachycardia:
- Nrog thaiv.
- Monofocal (ntawm 100 txog 250 lub plawv cov leeg mob ib feeb nrog lub suab tsis tu ncua).
- Multifocal (ib qho tshwj xeeb yog qhov tsis sib xws).
Dhau li ntawm qhov no, nws tsim nyog sau cia tias atrial tachycardia tuaj yeem muaj ib qho lossis ob peb. Raws li qhov no, txhua hom tuaj yeem muab faib:
- on monofocus (ib tsom);
- multifocal (ntau foci).
Kev faib tawm
Tam sim no peb yuav faib tus kab mob no raws li ntau yam. Thawj qhov yog qhov localization ntawm qhov chaw ntawm impulse tsim. Muaj peb hom nyob rau hauv tag nrho:
- sinoatrial reciprocal (localization - thaj chaw sinoatrial);
- reciprocal (localization - atrial myocardium);
- polymorphic atrial tachycardia (tej zaum yuav muaj ib lossis ntau qhov foci).
Lub cim tom ntej ntawm kev faib tawm yog cov kab mob. Kom yooj yim dua, peb tau muab lub rooj.
| Variety | Kev mob nkeeg |
| Atrial tachycardia paroxysm | Ib qho tshwj xeeb yog muaj qaug dab peg uas pib thiab nres tam sim ntawd. Kev tawm tsam tuaj yeem sib txawv raws sijhawm, tab sis koj tuaj yeem pom qhov tsis tu ncua ntawm kev sib dhos hauv lawv |
| Non-paroxysmal tachycardia |
Ntau yam no muaj subspecies:
Nws tseem ceeb heev kom paub tias tsis yog-paroxysmal tachycardia yog qhov tsawg heev |
Lub cim kawg ntawm kev faib tawm yog cov txheej txheem uas cuam tshuamtsos ntawm ib qho impulse. Raws li nyob rau hauv lub dhau los version, ib lub rooj yog muab rau yooj yim.
| Variety | Yog vim li cas |
| Kev sib tw |
Muaj ntau qhov laj thawj rau qhov no:
Tib lub sijhawm, lub plawv dhia sib txawv ntawm 90-120 neeg ntaus ib feeb |
| Automatic | Ntau zaus pom cov hluas. Qhov ua rau tsis siv neeg atrial tachycardia yog lub cev overexertion. Hom no tsis xav tau kev kho mob |
| Tsim |
Ntawm no peb pom daim duab rov qab. Ua rau tachycardia ntau dua hauv cov neeg laus. Qhov laj thawj yog:
|
| polytopic | Qhov ntau yam no tuaj yeem tshwm sim los ntawm kev mob ntsws hnyav. Tsis tas li ntawd, polytopic tachycardia tuaj yeem nrog cov kab mob hu ua lub plawv tsis ua haujlwm |
Yog vim li cas
Cia sim tshuaj xyuas qhov ua rau atrial tachycardia. Tus kab mob no tuaj yeem tshwm sim rau ntau yam, suav nrog kab mob plawv, valve txawv txav, lub plawv puas lossis qaug zog. Qhov ua rau ntawm qhov kawg yuav yog lub plawv nres lossis mob yav dhau los.
Tsis tas li ntawd, muaj kev pheej hmoo - cov neeg quav yeeb tshuaj thiab haus cawv, cov neeg uas muaj cov kab mob metabolic. Qhov tom kawg tuaj yeem ua tau yog tias cov haujlwm ntawm cov thyroid caj pas lossis cov qog adrenal tau nce.
Tam sim ntawd nws tsim nyog hais: hauv cov neeg mob feem ntau, qhov tseeb ntawm tus kab mob tsis tau tsim. Yog tias tus kws kho mob xav tias atrial tachycardia, ces nws yuav twv yuav raug sau ntau yam kev tshawb fawb:
- kuaj ntshav;
- electrocardiogram ntawm lub plawv (yooj yim - ECG);
- tshawb nrhiav hluav taws xob.
Qhov no yog txhua yam koj yuav tsum paub txog qhov ua rau tachycardia. Tab sis nws tsim nyog teev koj tus kheej ua ntej tias qhov tseeb ntawm tus kab mob yuav tsis raug tsim kom muaj tseeb. Qhov no tshwj xeeb tshaj yog rau cov neeg laus. Attacks ntawm atrial tachycardia nyob rau hauv lawv yog ib tug nquag tshwm sim. Yog li nws tau txais los xav txog qhov no twb yog tus qauv.
Yog li, cia peb sau ob peb yam ua rau atrial tachycardia:
- hnyav dhau, uas yog qhov chaw ntawm ntau yam kab mob (tshwj xeeb yog tib neeg cov hlab plawv);
- ntshav siab;
- kab mob ntawm endocrine system;
- kab mob ntsws chronic;
- noj qee yam tshuaj thiab lwm yam.
Symptoms
Cov tsos mob muaj xws li:
- nrawm nrawm ntawm cov leeg nqaij;
- dyspnea;
- kiv taub hau;
- mob plab;
- pom kev ntxhov siab thiab ntshai;
- muag qhov muag;
- zooua tsis taus pa.
Peb ceeb toom tam sim ntawd tias tsis yog txhua tus muaj cov tsos mob zoo ib yam, ib tus neeg tuaj yeem hnov txog tag nrho cov txheej txheem saum toj no, thiab ib tus neeg yuav tsis pom tias qhov kev tawm tsam yuav dhau mus li cas. Feem ntau tsis muaj tsos mob lossis tsuas pom lub plawv dhia ceev xwb.
Nws yog ib qho tsim nyog yuav tsum xyuam xim rau qhov tseeb tias cov tub ntxhais hluas tuaj yeem pom cov cim ntau dua li cov neeg laus, txij li thaum kawg, kev nce hauv cov leeg nqaij hauv plawv, raws li txoj cai, mus tsis pom.
Diagnosis
Yog tias koj pom cov tsos mob ntawm atrial tachycardia, koj yuav tsum hu rau tus kws kho plawv. Tus kws kho mob yuav tsum xa koj mus rau ntau qhov kev tshawb fawb:
- UAC;
- OAM;
- tshuaj ntsuam biochemical;
- ECG (Holter);
- Echocardiography;
- ultrasound ntawm lub siab;
- kuaj ntshav rau cov tshuaj hormones.
Tab sis tseem, tib txoj hauv kev los kuaj tus kab mob yog ua ECG thaum lub sijhawm pib pib. Yog tias koj piav qhia cov tsos mob rau tus kws kho mob, tom qab ntawd nws tuaj yeem ua ECG siv txoj kev Holter (tshaj tus neeg mob lub siab rau 24 lossis 48 teev). Yog tias qhov kev xaiv no tsis tuaj yeem ua tau, ces tus kws kho plawv tuaj yeem ua rau muaj kev tawm tsam thaum lub sijhawm kev kawm ntawm electrophysiological.
Differential Diagnosis
Koj tuaj yeem pom dab tsi atrial tachycardia zoo li ntawm ECG hauv daim duab ntawm ntu ntawm kab lus no. Cov yam ntxwv tshwj xeeb:
- kho kom raug;
- mob siab;
- interval R-Rtsis zoo ib yam;
- P nthwv dej tsis zoo los yog tib theem T.
Nws yog qhov yuav tsum tau cais tawm:
- sinus tachycardia (cov yam ntxwv: lub plawv dhia mus txog 160 ib feeb, maj mam txhim kho thiab poob);
- sinus-atrial paroxysmal tachycardia (cov yam ntxwv: P configuration yog ib txwm, chav kawm yog me me, nws raug tso tseg los ntawm cov tshuaj antiarrhythmic).
Tus kab mob puas txaus ntshai?
Ua ntej peb mus rau kev kho mob ntawm atrial tachycardia, peb yuav pom tias nws ua rau muaj kev phom sij rau lub neej. Txawm hais tias muaj cov tsos mob tsis zoo ntawm tus kab mob no, tus kab mob no tsis ua rau muaj kev hem thawj rau lub neej.
Yog tias koj tsis muaj lub plawv dhia nrawm, ces lub plawv cov leeg tuaj yeem tiv thaiv tau yooj yim. Nws tseem ceeb heev uas yuav tsum nco ntsoov tias tib qho kev tawm tsam no tsis cuam tshuam lwm yam teeb meem plawv. Ib qho kev zam yog qhov muaj teeb meem (piv txwv li, angina pectoris). Raws li tau hais dhau los, qhov muaj qhov tsis tshua muaj tshwm sim tsis txaus ntshai, tab sis yuav ua li cas yog tias lub plawv raug yuam kom ua haujlwm ntev ntev (hnub lossis txawm lub lis piam)? Kev nrawm nrawm ntawm lub plawv cov leeg ua rau nws tsis muaj zog. Txhawm rau zam qhov no, xav tau kev kho mob.
Tsis muaj kev pheej hmoo ntawm cov ntshav txhaws lossis mob hlab ntsha tawg, yog li tsis tas yuav tsum noj cov ntshav thinners (anticoagulants). Tsuas yog tus kws kho mob pom zoo kom noj cov tshuaj Aspirin lossis cov tshuaj muaj zog dua, xws li Warfarin. Qhov yuav tsum tau noj cov tshuaj kawg yog thaum tus neeg mob muaj lwm yamteeb meem plawv (piv txwv li, atrial fibrillation, uas yog tus cwj pwm los ntawm lub plawv dhia tsis zoo).
Kev kho mob
Kev kho mob raug xaiv los ntawm tus kws paub txog kev paub txog ntawm tus kheej. Peb tuaj yeem hais tias kev xaiv cov tshuaj yog ua los ntawm kev sim thiab ua yuam kev. Raws li txoj cai, atrial tachycardia yog asymptomatic, yog li kev kho mob tsis tsim nyog ntawm no.
Kev kho mob lossis kev kho mob caterral ablation yog tsim nyog nyob rau hauv ob kis:
- muaj cov tsos mob tsis zoo;
- nquag qaug dab peg hem lub plawv loj.
Atrial tachycardia nrog AV thaiv yuav tsum tau tshem tawm sai sai ntawm glycosides (yog tias tus neeg mob noj lawv). Ib qho kev daws ntawm poov tshuaj chloride, los yog theej nws cov drip infusion, pab kom tsis txhob tawm tsam. Tsis tas li ntawd, phenytoin yog siv.
Huab cua thiab tiv thaiv
ntsuas kev tiv thaiv suav nrog:
- kev ua neej nyob;
- khoom noj kom raug;
- tsaug zog zoo (tsawg kawg 8 teev);
- tuav lub neej noj qab nyob zoo (tsis kam haus luam yeeb, cawv, tshuaj thiab lwm yam).
Nws yog ib qho tsim nyog kom tsis txhob muaj kev ua haujlwm ntau dhau thiab muaj kev ntxhov siab. Qhov kev cia siab rau tus kab mob no yog qhov zoo. Yog tias koj ua raws li tus kws kho mob cov lus pom zoo, ces atrial tachycardia tsis ua rau muaj kev phom sij loj rau tib neeg lub neej.
