Muaj ntau cov txheej txheem txaus ntshai uas tshwm sim hauv tib neeg lub cev uas tuaj yeem ua rau muaj kev puas tsuaj loj. Tab sis qee zaum kev kuaj mob hnyav tau muab zais tom qab qhov tsis nco qab, uas yuav pib zoo li qhov tshwm sim ntawm kev qaug zog lossis qaug zog. Qhov tseeb, muaj ntau lwm yam txaus ntshai uas tuaj yeem ua rau muaj qhov tshwm sim zoo sib xws.
Orthostatic collapse
Tus mob no kuj txhais tau tias yog orthostatic hypotension. Xws li kev kuaj mob yog siv los qhia txog cov ntshav tsis txaus ntawm lub hlwb, uas yog qhov tshwm sim ntawm kev hloov pauv ntawm lub cev. Cov tshuaj tiv thaiv zoo sib xws ntawm lub cev tuaj yeem pom nyob rau hauv rooj plaub thaum tus neeg sawv cev ntev. Tus mob no yog pab txhawb los ntawm lethargy ntawm phab ntsa ntawm cov hlab ntsha lossis ntshav siab.
Feem ntau qhov teeb meem no tshwm sim hauv cov neeg uas nws lub suab nrov tsis muaj zog. Feem ntau qhov kev kuaj mob no tau tsim rau cov neeg uas muaj hnub nyoog laus dua, txij li lub sijhawm no txoj kev loj hlob ntawm cov hlab ntsha poob qis dua qhov kev xav tau ntawm lub cev.
Cov tsos mob zoo li cas
Muaj ntau yam cim qhia txog qhov teeb meem no,zoo li orthostatic collapse. Cov tsos mob ntsig txog qhov kev kuaj mob no yog raws li hauv qab no:
- kiv taub hau;
- tsis nco qab;
- kev xav ntawm qhov khoob lossis hnyav hauv lub taub hau;
- tsis muaj zog tam sim;
- daim ntaub thaiv ntawm lub qhov muag lossis flickering yoov;
- ntuav ntawm lub hauv paus hauv paus los yog xeev siab;
- yog tias nws yog ib qho mob hnyav, ces tso zis tsis txaus thiab kev loj hlob ntawm tus mob convulsive tau.
Cov teeb meem zoo li no los ntawm orthostatic vau tuaj yeem tsim tawm tsam keeb kwm ntawm cov ntshav tsis txaus tsis yog rau lub hlwb xwb. Hauv qhov no, koj yuav tsum ua tib zoo saib xyuas cov tsos mob xws li angina pectoris (cov cim qhia ntawm myocardial ischemia), mob hauv caj dab cov leeg thiab hloov ua pa.
Qhov tshwm sim ntawm cov tsos mob no tuaj yeem ua tau ob qho tib si nrog kev nyob ntev hauv txoj haujlwm ncaj ncees, thiab nyob rau hauv rooj plaub ntawm kev hloov pauv ntawm lub cev. Kev ua kom lub cev muaj zog thiab nrawm tuaj yeem ua rau qaug zog. Qee zaum, cov tsos mob ntawm hypotension kuj tuaj yeem tshwm sim tom qab noj zaub mov ntau. Qhov no tau piav qhia los ntawm kev ua kom lub paj hlwb vagus.
Orthostatic collapse: ua rau
Ntau zaus, thaum tawm ntawm txaj, rov faib cov ntshav pib, vim nws qhov tseem ceeb yog concentrated nyob rau hauv cov hlab ntsha uas nyob rau hauv qis extremities. Cov txheej txheem no yog qhov tshwm sim ntawm kev nqus ntawm cov ntshav.
Venous rov qab mus rau lub plawv txo qis, uas ua rau muaj kev poob qis tom qab. Baroreceptors nyob rau hauv carotidsinuses thiab aortic arch, teb rau cov txheej txheem saum toj no thiab qhib lub autonomic paj hlwb.
Vim li ntawd, muaj qhov nce hauv vascular tone thiab rov qab los ntawm lub siab thiab lub plawv dhia mus rau qhov qub.
nyob rau hauv ib txwm muaj. Thiab tuaj yeem muaj ntau qhov laj thawj rau qhov no, qee zaum mob hnyav heev.
kab mob dab tsi tuaj yeem ua rau tawg
Lub xeev ntawm cov hlab ntsha uas tau hais los saum toj no tuaj yeem cuam tshuam los ntawm qee yam kab mob thiab cov txheej txheem:
- nervous strain and stress;
- kab mob kis kab mob;
- poob ntshav tseem ceeb;
- kab mob cuam tshuam nrog endocrine system;
- intoxication ntawm lub cev, uas manifests nws tus kheej nyob rau hauv daim ntawv ntawm hws ntau dhau, ntuav los yog raws plab;
- Kev tsim txom kev noj zaub mov tsis zoo;
- Kev siv tshuaj tiv thaiv hypertensive, vasodilator thiab diuretic tshuaj raws li kev kho mob ntshav siab ntau xyoo.
Tab sis yog tias koj ib leeg tawm qhov tseem ceeb ntawm cov tsos mob tseem ceeb uas ua rau orthostatic vau, xws li tsis nco qab, ces koj yuav tsum tau xyuam xim rau ischemic anoxia. Nws yog nyob ntawm ntau yam mechanismstsim nyog hais.
Ua ntej tshaj, qhov no yog qhov tsis muaj peev xwm ntawm myocardium los ua kom lub plawv tsim nyog. Lub plawv arrhythmias kuj tuaj yeem ua rau lub cev qhuav dej, tiv thaiv kom tsis txhob muaj hlwb txaus.
Nws tsis tuaj yeem tsis quav ntsej txog qhov txo qis hauv cov ntshav siab vim yog lub zog peripheral vasodilation. Qhov tshwm sim ntawm cov txheej txheem no yog cov ntshav tsis txaus rau lub hlwb.
Qhov cuam tshuam ntawm ntau yam tshuaj
Ntxiv rau qhov cuam tshuam ntawm ntau yam kab mob, nws tsim nyog xav txog qhov tseeb tias qee cov tshuaj kuj tuaj yeem ua rau poob ntawm cov hlab ntsha thiab tsis yog xwb.
Cov tshuaj uas ua rau lub cev tsis muaj zog yuav tsum tau txiav txim los ntawm tus kws kho mob ntawm tus kheej, tom qab ntawd lawv yuav tsum tsis txhob siv lossis txo cov koob tshuaj kom raug. Cov no tuaj yeem yog ntau yam inhibitors, nitrate blockers, vasodilators, diuretics thiab lwm yam tshuaj tiv thaiv.
Yog li ntawd, nws yuav tsum nco ntsoov tias Dibazol thiab lwm yam tshuaj zoo sib xws tuaj yeem ua rau orthostatic collapse.
Yam koj yuav tsum paub txog ganglioblockers
Thaum pib, cov tshuaj uas muaj nyob hauv pab pawg no yog tsim los cuam tshuam kev coj ua ntawm impulses los ntawm kev tswj hwm tus kab mob autonomic ganglia. Cov nyhuv no yog xav tau los txo cov suab nrov ntawm cov leeg ntawm arterioles, venules thiab precapillary sphincters.
Qhov tshwm sim ntawm cov txheej txheem no yog kev txhim kho microcirculation hauv cov ntaub so ntswg, uas yog qhov tseem ceeb heev thaum kho ntau yam poj ntsuam ntawm kev poob siab, kab mob kub hnyiab, kis kab mob toxicosis, mob ntsws thiab lwm yam kab mob.
Sivganglioblockers, nws muaj peev xwm nce qib ntawm cov ntshav tsub zuj zuj hauv cov leeg thiab yog li txo nws cov rov qab mus rau lub plawv, thiab yog li txo nws cov preload. Hauv lwm lo lus, muaj kev txhim kho hauv kev ua haujlwm ntawm lub siab.
Tab sis muaj yoov nyob rau hauv cov tshuaj pleev rau hauv lub thoob ntawm zib mu, uas yog, orthostatic collapse thaum siv ganglionic blockers. Qhov no yog ib qho ntawm qhov tshwm sim ntawm kev siv cov tshuaj no. Cov teeb meem zoo li no tau pom hauv qee pawg neeg mob. Yog vim li cas rau xws li ib tug tshwm sim ntawm lub cev yog inhibition ntawm impulses nyob rau hauv lub sympathetic txoj kev mus rau cov leeg.
Cov teeb meem xws li tso zis tso tseg, cem quav atonic thiab txo cov kua qaub ntawm cov kua qaub hauv plab kuj ua tau.
Qhov kev xeem twg tuaj yeem suav tias cuam tshuam
Yog tias cov cim qhia tus yam ntxwv ntawm orthostatic hypotension tau sau tseg, nws yuav tsum tau palpate lub cev. Nws tseem yog ib qho tseem ceeb los xyuas koj cov ntshav siab. Ib qho kev kuaj orthostatic kuj tseem tsim nyog. Nws cov ntsiab lus kub siab rau qhov tseeb tias tus neeg mob tau sawv, thiab tus kws kho mob lub sijhawm no soj ntsuam cov hemodynamic adaptation ntawm cov leeg.
Daim ntawv xeem dhau los kuj ua tau. Nws yuav tsum tau nqa tawm ntawm lub rooj tig, thaum cov leeg yuav tsis ua haujlwm.
Nyob rau hauv cov txheej txheem ntawm kev kuaj mob, keeb kwm kuj tau kawm, kev tshawb fawb ntawm cov tshuaj uas tau sau tseg yav dhau los thiab tuaj yeem ua rau muaj qhov tsis zoo. Nrog rau qhov no, lwm yam cuam tshuam tau raug txheeb xyuas, kev tshuaj xyuas tau ua, nrog rauthiab kev kawm txog cov kab ke thiab cov kabmob ntawm tus neeg mob. Rau cov hom phiaj no, percussion, palpation, auscultation thiab lwm yam kev kuaj mob yuav siv tau.
Nws yog ib txwm tsim nyog nco ntsoov tias orthostatic vau tuaj yeem ua rau qee yam teeb meem, txij li qee kis nws yog qhov tshwm sim ntawm cov kab mob loj (cardiomyopathy, aortic stenosis, arrhythmia, myocardial infarction). Qhov no txhais tau tias muaj cov cim qhia pom tseeb ntawm qhov teeb meem no, koj yuav tsum hu rau tus kws kho mob.
Yuav ua li cas cov menyuam yaus ntsib kev tawg
Orthostatic hypotension thaum muaj hnub nyoog ntxov yog qhov nyuaj dua li cov neeg laus. Qhov laj thawj rau qhov kev kuaj mob no tuaj yeem yog ntau yam kab mob pathological. Piv txwv suav nrog kev tshaib plab, lub cev qhuav dej, pom tseeb lossis tsis pom kev poob ntshav, thiab cov kua dej hauv lub plab thiab pleural kab noj hniav.
Hauv cov menyuam yaus, kev sib tsoo feem ntau ua rau nws tus kheej tiv thaiv keeb kwm ntawm kev kis kab mob thiab toxicosis, thiab ntau dua li cov neeg laus. Tus mob no nrog raws plab, ntuav thiab kub taub hau.
Raws li cov ntshav tsis txaus nyob hauv lub hlwb thiab txo cov ntshav siab, hauv tus menyuam lub cev lawv tshwm sim nrog qhov pom tseeb ntawm hypoxia, nrog rau convulsions thiab tsis nco qab.
Txoj Kev Kho Mob
Yuav kom kov yeej orthostatic vau, kev kho mob yuav tsum tau ua kom muaj peev xwm thiab nrog kev koom tes ntawm tus kws tshaj lij. Feem ntau, txoj hauv kev cuam tshuam qhov teeb meem no tuaj yeem muaj ob lub ntsiab lus qhia: kev hloov pauv hauv kev ua neej thiab kev siv tshuaj kho mob.
Yog tias peb tham txog cov txheej txheem rov qab los, ces lawv suav nrog cov haujlwm hauv qab no:
- noj me me;
- nyob luv luv hauv qhov chaw kub;
- shaping thaum pw tsaug zog nrog kev pab ntawm toj hauv ncoo hauv qab taw;
- siv isotonic loads rau tag nrho cov leeg nqaij;
- nquag taug kev hauv huab cua ntshiab;
- yog tias muaj xwm txheej xav tau, compression hosiery yog siv los pab tswj lub suab ntawm cov leeg nyob rau hauv qis extremities;
- kev tiv thaiv los ntawm kev nce siab ntawm lub txaj lossis lub rooj zaum (thawj koj yuav tsum tau txo koj ob txhais ceg thiab tsuas yog tom qab ntawd ua txoj haujlwm ntsug).
Erythropoietin, vasopressin analogues ("Vazomirin", "Minimirin"), mineralocorticoids ("Desoxycorton", "Florinef"), cholinesterase inhibitors ("Galantomine", "Prozerin"), thiab lwm yam. yog siv rau kev kho tshuaj. Tab sis ib txwm nws yuav tsum nco ntsoov tias kev sib tsoo orthostatic tuaj yeem tshwm sim los ntawm cov tshuaj uas tau siv yam tsis suav nrog contraindications nyob rau hauv rooj plaub ntawm tus neeg mob tshwj xeeb lossis nrog cov tshuaj tsis raug.
Tsis txhob hnov qab txog tus kab mob hauv qab, uas tej zaum yuav ua rau lub cev qhuav dej. Yog tsis muaj nws txoj kev kho mob, nws tsis zoo li yuav ua tiav cov txiaj ntsig tseem ceeb.
Results
Yog li, yog tias orthostatic hypotension tau sau tseg, tsis tas yuav tsum ntshai, qhov teeb meem no tau kov yeej. Yog li ntawd tom qab kev kho mob tiav, lub cev qhuav dej tsis ua rau nws tus kheej xavdua, nws ua rau kev nkag siab zoo kom nco ntsoov qee qhov kev tiv thaiv.
Cov no suav nrog cov lus hais saum toj no tas li taug kev ntawm txoj kev, tswj cov tshuaj tiv thaiv kab mob siab, noj zaub mov kom raug thiab, tau kawg, txoj kev noj qab haus huv. Nws yog ib qho tseem ceeb uas yuav tsum tau kuaj xyuas yam tsis muaj ncua sij hawm ntawm thawj cov cim qhia ntawm qhov teeb meem no, vim tias qhov ua rau qaug zog tuaj yeem yog tus kab mob hnyav, tsis quav ntsej txog qhov uas muaj teeb meem loj.
