Aortic stenosis yog qhov nqaim ntawm lub aortic qhib hauv thaj chaw valve, uas cuam tshuam cov ntshav tawm ntawm sab laug ventricle. Ntawm chav kawm, qhov no pathology entails qhov tshwm sim. Thiab yog hais tias nws tsis quav ntsej, kev tuag yog inevitable.
Tab sis vim li cas thiaj tshwm sim? Dab tsi tuaj yeem yog qhov tseem ceeb tshaj plaws? Cov tsos mob dab tsi qhia tau hais tias muaj cov kab mob no? Thiab kev kho mob li cas? Qhov no thiab ntau lwm yam yuav tau tham tam sim no.
yam ntxwv thiab hom kab mob
Aortic valve stenosis yog ib hom kab mob plawv heev ntawm cov neeg laus. Pathology yog congenital (kwv yees li 3-5.5% ntawm cov neeg mob) thiab kis tau.
Cov hom stenosis hauv qab no yog qhov txawv:
- Valved. Nws tshwm sim hauv 60% ntawm cov neeg mob. Feem ntau lub plawv tsis xws luag. Nyob rau hauv tag nrho, nws tshwm sim nyob rau hauv 0.4-2% ntawm lub ntiaj teb no cov pej xeem. Nws yog tus cwj pwm los ntawm lub valve deformity, feem ntau ua ke nrog coarctation ntawm lub aorta thiab patent ductus arteriosus.
- Subvalve. Nws tshwm sim hauv 30% ntawm cov neeg mob. Nws yog tus cwj pwm los ntawm polymorphic subvalvular nqaim ntawm cov dej ntws tawm ntawm sab laug ventricle. Kab mob plawv no yog congenital,tab sis tsis tshua muaj nyob rau hauv cov me nyuam mos. Pathology ua rau nws xav tau thoob plaws lub neej.
- Supravalvular. Nws tshwm sim hauv 10% ntawm cov neeg mob. Nrog rau qhov no pathology, diffuse los yog hauv zos nqaim ntawm lub lumen ntawm ascending aorta yog pom. Nws tuaj yeem tshwm sim saum thaj tsam sinotubular, lossis ntawm nws qib. Cov kab mob no txaus ntshai vim tias nws cuam tshuam rau tag nrho cov hlab ntsha loj - plab, pulmonary, brachiocephalic thiab aorta.
Qhov hnyav ntawm qhov nqaim kuj yog nyob ntawm systolic siab gradient ntawm sab laug ventricle thiab aorta, thiab tseem nyob rau thaj tsam ntawm lub valvular orifice. Feem ntau, nws yuav tsum yog 2.5-3.5 cm². Tab sis nyob rau hauv cov neeg uas muaj aortic stenosis, thaj tsam ntawm qhov qhib yog ntau dua. Hauv cov xwm txheej hnyav tshwj xeeb - txog 0.74 cm².
theem kab mob
Aortic stenosis nce mus txog tsib theem:
Thawj (tag nrho them nyiaj). Pathology tuaj yeem kuaj pom tsuas yog auscultatively, los ntawm kev mloog suab phenomena. Lub aorta nyob rau hauv cov ntaub ntawv no yog nqaim me ntsis. Txhawm rau zam kev txhim kho pathology, tus neeg mob yuav tsum tau saib xyuas los ntawm kws kho plawv thiab ua raws nws cov lus pom zoo.
Second (zais plawv tsis ua hauj lwm). Cov tsos mob hauv qab no tshwm sim: qaug zog, kiv taub hau, ua tsis taus pa txawm tias me ntsis kev tawm dag zog lub cev. Qhov thib ob theem tso cai rau koj los txiav txim qhov kev coj ua ntawm radiography thiab ECG. Muaj lub siab gradient nyob rau hauv thaj tsam ntawm 36 txog 65 mm Hg. Art. Qhov no dhau los ua qhov qhia rau kev ua haujlwm los kho qhov tsis xws luag.
Third (tus txheeb ze coronary insufficiency). Ua tsis taus paintensifies, angina pectoris tshwm sim, nquag tawm tsam ntawm fainting. Lub siab gradient yog tshaj 65 mm Hg. Art. Nyob rau theem peb, kev kho mob phais yog tsim nyog.
Plaub (lub plawv tsis ua hauj lwm hnyav). Ua tsis taus pa thab txawm thaum so, tawm tsam ntawm mob hawb pob feem ntau tshwm sim thaum hmo ntuj. Nyob rau theem no, kev ua haujlwm tsis suav nrog. Qee zaum, kev kho phais tuaj yeem ua tau, tab sis tsis tshua muaj txiaj ntsig.
Thib tsib (terminal). Nws yog tus cwj pwm los ntawm kev nce qib ntawm lub plawv tsis ua haujlwm, edematous syndrome tshwm. Kev ua haujlwm yog contraindicated nyob rau theem no, thiab noj tshuaj tsuas yog txhim kho tus neeg mob rau lub sijhawm luv luv.
Yog vim li cas
Acquired aortic stenosis tshwm sim vim rheumatic puas rau cov nplooj ntawv valve. Qhov no ua rau deformation ntawm lawv cov teeb meem, vim hais tias lawv loj hlob ua ke, ua nruj thiab ntom. Vim li ntawd, lub nplhaib valve nqaim.
Tsis tas li, qhov ua rau ntawm kev loj hlob ntawm aortic stenosis yog cov hauv qab no pathologies thiab tej yam kev mob:
- Cov calcium ntau hauv lub aortic valve (calcification, calcification).
- Cov kab mob endocarditis.
- Atherosclerosis ntawm aorta.
- Paget tus kab mob, uas tshwm sim nws tus kheej hauv kev ua txhaum ntawm cov txheej txheem ntawm kev puas tsuaj thiab kho cov pob txha.
- Terminal raum tsis ua haujlwm.
- YSystemic lupus erythematosus.
- Rheumatoid mob caj dab.
Congenital pathology tau soj ntsuam nrog bicuspid aortic valve (qhov no yog anomaly) lossis nrognqaim ntawm lub qhov ncauj ntawm lub aorta, uas ib tug neeg muaj los ntawm yug.
Tus kab mob ntawm daim ntawv no ua rau nws tus kheej hnov ua ntej hnub nyoog 30 xyoo. Tau stenosis tshwm tom qab hnub nyoog 60.
Nws yuav tsum raug sau tseg tias muaj kev pheej hmoo yog cov neeg mob ntshav siab thiab hypercholesterolemia, nrog rau cov neeg haus luam yeeb.
Kev tshwm sim ntawm tus kab mob
Cov tsos mob ntawm aortic stenosis (hauv ICD-10 tus kab mob tau teev nyob rau hauv txoj cai I35 "Non-rheumatic lesions ntawm aortic valve"), raws li tau hais ua ntej, ntev ntev tsis pom meej meej. Tab sis koj yuav tsum ceev faj yog tias koj tau sau cov cim hauv qab no:
- Nyob.
- Ua tsis taus pa hnyav dhau ntawm kev tawm dag zog.
- Muscle tsis muaj zog.
- Nkauj kho siab.
- kiv taub hau.
Ntxiv mus, raws li tus kab mob loj zuj zus tuaj, cov tsos mob no tau koom nrog los ntawm kev qaug zog vim qhov hloov pauv sai ntawm lub cev, angina tawm tsam, ua tsis taus pa nocturnal.
Ntau heev yog mob hawb pob. Qhov no yog ib tug kho mob syndrome uas tshwm sim nws tus kheej nyob rau hauv lub ntse tawm tsam ntawm inspiratory dyspnea, uas yog tsim rau suffocation. Nws tshwm sim vim congestion nyob rau hauv lub pulmonary ncig thiab interstitial pulmonary edema. Feem ntau, vim mob hawb pob, alveolar pulmonary edema pib tsim, uas, raws li txoj cai, xaus rau kev tuag.
Aortic valve stenosis kuj feem ntau txhim kho txoj cai ventricular tsis ua haujlwm. Yog tias nws tshwm sim, edema tshwm, qhov kev xav hnyav ntawm txoj cai hypochondrium.
Yog tias ib tug neeg tau pom cov tsos mob ntawm aortic stenosis, nws yuav tsum tau teem caij nrog kws kho plawv tam sim ntawd. Tsis quav ntsej tus kab mob yog fraught nrog rau txim. Thiab nyob rau hauv 5-10% ntawm cov neeg mob nrog cov kab mob no, lub plawv tuag sai sai tshwm sim.
Diagnosis
Qhov muaj aortic stenosis feem ntau tuaj yeem txiav txim siab txawm tias tus neeg mob zoo li cas. Tus neeg zoo li daj ntseg, nws muaj vasoconstriction, thiab nyob rau theem tom qab muaj cyanosis ntawm daim tawv nqaij thiab peripheral edema.
Thaum lub sijhawm percussion, nws tuaj yeem txiav txim siab qhov nthuav dav ntawm ciam teb ntawm lub plawv nqes mus rau sab laug, thiab palpation nthuav tawm qhov txav ntawm apex tuav thiab tshee hnyo nyob rau hauv lub jugular fossa ntawm ib tug systolic xwm.
Kuj nrog rau cov kab mob no, tus kws kho mob kuaj pom qhov ntxhib systolic yws ntawm lub mitral valve thiab aorta.
Txhua qhov kev tshwm sim saum toj no tuaj yeem kuaj pom los ntawm phonocardiography - hom no yog tsim tshwj xeeb los sau cov lus yws thiab lub siab lub suab siv lub phonocardiograph.
Tus neeg mob tseem yuav tau txais ECG, vim cov ntaub ntawv tau txais thaum lub sijhawm txheej txheem no yuav pab txheeb xyuas cov tsos mob ntawm arrhythmia, sab laug ventricular hypertrophy thiab blockade.
Dhau li ntawm qhov no, yuav tsum tau ua x-ray. Cov duab tshwm sim qhia pom cov tsos mob ntawm pulmonary hypertension, nthuav dav ntawm sab laug ventricular duab ntxoov ntxoo, tom qab stenotic dilatation ntawm lub aorta, thiab cov yam ntxwv aortic configuration ntawm lub plawv.
Koj yuav tsum tau mus rau echocardiography txhawm rau tsim qhov kev kuaj mob. Nws yuav pab txheeb xyuas seb puas muaj hypertrophy ntawm phab ntsa ntawm sab laug ventriclethiab thickening ntawm lub valve flaps, raws li zoo raws li kom paub yuav ua li cas txwv lub amplitude ntawm txav ntawm lub valve flaps nyob rau hauv systole.
Yuav ntsuas qhov siab gradient, tus neeg mob raug qhia kom soj ntsuam lub plawv kab noj hniav. Raws li cov txiaj ntsig ntawm cov txheej txheem no, cov lus xaus tuaj yeem kos txog qib ntawm kev loj hlob ntawm pathology.
Los ntawm ventriculography, mitral concomitant insufficiency tuaj yeem kuaj pom, thiab coronography thiab aortography tso cai rau kev kuaj mob sib txawv ntawm aortic stenosis nrog cov kab mob coronary artery thiab aneurysm ntawm ascending aorta.
Kev ua haujlwm
Yog tias qib ntawm aortic stenosis tso cai rau kev phais, tus kws kho plawv feem ntau yuav pom zoo kom hloov lub valve. Qhov kev ua haujlwm no tuaj yeem txhim kho tus neeg mob lub neej zoo thiab ua kom nws ntev.
Hauv qhov no, lawv siv txoj hauv kev ntawm kev phais me me. Thaum lub sijhawm ua haujlwm, lub valve puas raug muab tshem tawm thiab hloov nrog ib qho khoom siv - biological lossis mechanical.
Qee zaum, lub ntsws ntsws yog siv los ua cov khoom siv tes ua, uas nyob nruab nrab ntawm qhov qhib ntawm cov hlab ntsha pulmonary thiab sab xis chamber. Thiab nws, nyob rau hauv lem, yog hloov los ntawm ib tug dag. Txoj haujlwm no siv tau, tab sis tsuas yog tsim nyog rau cov neeg qis dua 25.
Los ntawm txoj kev, nws tau hais ua ntej tias kev phais yog contraindicated nyob rau hauv loj pathology. Tab sis ntau tus kws tshaj lij tau sib cav tias kev ncua sijhawm ua haujlwm hauv cov xwm txheej zoo li no yog qhov kev txiav txim siab pheej hmoo dua li ua nws. Yog tias tsis hloov lub valve, kev tuag yog lav tsis pub dhau 2.5 xyoo tom ntej.
Kev phais yog nruj me ntsis txwv tsis pub tsuas yog tus neeg mob muaj qhov qis qis hauv cheeb tsam ejection feem thiab ua haujlwm tsis zoo ntawm sab laug ventricle. Tab sis txawm li ntawd los, ntau tus neeg tau txais kev pheej hmoo, thiab nws tau dhau los ua qhov tsim nyog.
Ntau zaus ua ntej kev ua haujlwm, tus kws kho plawv tau tshaj tawm txoj hauv kev ntawm coronary angiogram lossis coronary catheterization. Cov txiaj ntsig ntawm cov kev tshawb fawb no tso cai rau koj los txiav txim seb tus neeg puas muaj cov hlab ntsha hauv cov hlab ntsha los yog tsis. Yog tias muaj, thiab qhov teeb meem loj heev, tus neeg mob yuav tau txais kev phais mob coronary bypass, uas yog ua ke nrog kev hloov lub valve.
Drug therapy
Kev kho mob ntawm aortic stenosis, tau kawg, tsuas yog kws kho plawv tau sau tseg. Kev kho tshuaj yog tsom rau kev ruaj khov hemodynamics, thiab rau lub hom phiaj no, cov neeg mob tau muab tshuaj diuretic thiab inotropic agents. Tsis tas li ntawd, kev kho qhov ua pa tsis txaus thiab kev tsis haum ntawm ASC feem ntau ua tiav.
Txawm hais tias qhov kev kho mob ntawm aortic stenosis tsis yog qhov tshwj xeeb, nws yog txwv tsis pub sau tshuaj ntawm koj tus kheej. Thiab koj kuj yuav tsum paub tias kev noj cov nyiaj no tuaj yeem ua rau muaj teeb meem loj:
- Peripheral vasodilators. Lawv dilate cov leeg thiab cov hlab ntsha me, cuam tshuam rau lawv cov leeg nqaij. Tej zaum yuav ua rau dyspepsia thiab txo cov ntshav siab.
- Nitrates. Lawv qhov kev noj haus tuaj yeem ua rau tachycardia, kev sib tsoo orthostatic, nce intraocular siab, nrog rau kev txhim kho cov hlab ntsha ntawm cov hlab ntsha ntawm lub plawv.kev ua ntawm nitrates.
- Calcium channel blockers. Lawv ua rau mob taub hau, nce plawv dhia thiab paradoxical pro-ischemic teebmeem (provoke angina tawm tsam).
- Beta-blockers. Lawv txo lub plawv dhia thiab ua rau metabolic thiab pulmonary teeb meem.
- Alpha-beta blockers. Lub ntsiab contraindication rau lawv siv yog teeb meem plawv thiab insufficiency, yog li ntawd lawv yuav tsum tsis txhob noj nyob rau hauv txhua rooj plaub.
- Mob plawv glycosides. Lawv ua kom lub plawv dhia, txo cov conduction, nce excitability thiab nce ntshav siab.
Txawm li cas los xij, dua, txhua yam yog tus kheej nkaus xwb. Yog hais tias ib tug neeg tsim atrial fibrillation nrog aortic valve stenosis, kev kho mob yuav tsum tau ntxiv nrog rau kev noj cov tshuaj tsis zoo glycosides (Digoxin, piv txwv li), vim tias lawv tsuas tuaj yeem tiv tau tus kab mob no.
Tab sis feem ntau, nrog kev saib xyuas kev kho mob, kev saib xyuas tshwj xeeb yog them rau kev rov ua kom cov ntshav ntws ib txwm muaj thiab ua kom tsis muaj qhov cuam tshuam ntawm arrhythmia.
kev kho neeg zoo
Ua ntej siv lawv, koj yuav tsum sab laj nrog kws kho plawv. Muaj ntau cov zaub mov txawv, thiab ntawm no yog cov nyiam tshaj plaws:
- Y Hauv qhov sib npaug, sib tov cov tincture ntawm peony, motherwort, hawthorn, valerian thiab Corvalol. Haus 1 tsp. tav su thiab yav tsaus ntuj, diluted hauv 1/3 khob dej.
- May zib mu (200 ml) tov nrog tws dos (1 khob) thiab xa mus rau infuse rau ib lub lim tiam nyob rau hauv ib qho chaw tsaus. Nyob rau hauv lub khob,Piv txwv li. Tom qab ntawd muab cov sib tov tso rau hauv lub tub yees rau 14 hnub. Tom qab lub sijhawm dhau mus, koj tuaj yeem siv - 3 tbsp. l. ib hnub rau ib nrab ib teev ua ntej noj mov rau ob lub hlis.
- Crushed coltsfoot (1 tsp) ncuav boiling dej (200 ml) thiab cia nws brew rau 20 feeb. Ces lim. Haus 0.5 khob infusion ib hnub.
- Hawthorn berries (1 kg) ncuav dej (300 ml) thiab tawm hmo ntuj. Tshem tawm cov kua thaum sawv ntxov. Lub berries yuav tsum tau crushed. Tom qab ntawd lawv yuav tsum tau sprinkled nrog qab zib thiab xa mus rau qhov hluav taws kub rau 5 feeb kom boil. Tom qab ntawd cov sib tov yuav tsum tau tso cai kom txias thiab xa mus rau ib lub thawv. Muaj 1 tsp txhua hnub. ntawm lub plab khoob rau ib lub lim tiam.
Ntxiv rau qhov saum toj no, koj tuaj yeem ua tshuaj ntsuab da dej, zaws thiab qoj ib ce kho mob. Tab sis tag nrho cov no yuav siv tau tsuas yog thaum pib ntawm tus kab mob.
Kev nyuaj siab
Ntau tau hais saum toj no txog qhov ua rau, cov tsos mob thiab kev faib tawm ntawm aortic stenosis. Tam sim no nws tsim nyog tham txog dab tsi feem ntau yog qhov tshwm sim yog tias ib tus neeg tsis quav ntsej txog qhov tshwm sim ntawm tus mob no.
Raws li tus kab mob loj tuaj, sab laug ventricle thickens thiab loj hlob tuaj, vim hais tias nrog lub qhov nqaim, nws txoj hauj lwm nyuaj - nws yuav tsum thawb cov ntshav ntau rau hauv lub aorta.
Thaum xub thawj, cov kev hloov pauv no hloov tau. Lawv pab rau sab laug ventricle los tso ntshav nrog lub zog ntau dua. Tab sis thaum kawg, sab laug ventricle tsis muaj zog, thiab qab nws lub siab tag nrho.
khoom noj kom raug
Nrog aorticstenosis, tus kws kho mob cov lus pom zoo yuav tsum ua raws. Thiab ib qho ntawm lawv yog kev hloov mus rau kev noj zaub mov tshwj xeeb. Koj yuav tsum tsis kam lees cov khoom no:
- Cawv.
- Khaub, cocoa, tshuaj yej muaj zog.
- dej qab zib.
- Cheese nrog pwm (thiab qhov tseeb tag nrho cov khoom lag luam stale).
- ntsim, muaj rog, ntsev, haus luam yeeb.
- Cov khoom muaj E codes, carcinogens thiab additives.
- dej qab zib.
- Fast food.
Txhua yam saum toj no provokes qhov tshwm sim ntawm cov ntshav txhaws, qog nqaij hlav cancer, kab mob ntawm cov pob txha, plab thiab lub plawv. Nws raug pom zoo kom haus cov ntses uas tsis muaj rog thiab nqaij, khoom noj siv mis, zaub thiab txiv hmab txiv ntoo, cereals thiab kua txiv hmab txiv ntoo.
noj qab nyob zoo yuav tsis tsuas yog pab txhawb kev ua haujlwm ntawm lub cev thiab tag nrho nws cov kab ke, tab sis kuj nce kev tiv thaiv kab mob.
