Cov leeg nqaij, raws li koj paub, ua haujlwm ntawm ib hom twj tso kua mis hauv peb lub cev. Yog tias cov cuab yeej no rau qee qhov laj thawj tsis tiv nrog nws txoj haujlwm ncaj qha, muaj lub plawv tsis ua haujlwm. Txhua xyoo tus kab mob no tsuas yog hluas, thiab tsis ntev los no nws tau nce zuj zus.
mob plawv tsis ua hauj lwm. Dab tsi yog?
mob plawv tsis ua hauj lwm yog ib qho kev poob qis hauv kev ua haujlwm ntawm lub plawv, ua rau nws dhau thiab ua rau lub ntsws tsis zoo. Tus kab mob tuaj yeem tshwm sim ob qho tib si tawm tsam keeb kwm yav dhau los ntawm cov kab mob uas twb muaj lawm ntawm lub plawv, thiab tsis muaj mob plawv yav dhau los. Feem ntau, nws raug kuaj pom tias muaj myocardial infarction, thaum lub cell tuag tshwm sim vim muaj qhov tsis zoo ntawm cov ntshav ncig hauv cheeb tsam no.
Raws li qhov ntau dhau ntawm cov leeg nqaij ntawm tib neeg lub cev, muaj ob hom kab mob tseem ceeb: txoj cai ventricular thiab sab laug ventricularua tsis tiav. Peb yuav tham txog yav tas los kom ntxaws ntxiv hauv kab lus no.
Pathogenesis ntawm tus kab mob
Ib lub sijhawm tseem ceeb ntawm cov kab mob hauv kev txhim kho ntawm sab laug ventricular tsis ua haujlwm yog qhov nce hauv hydrostatic siab hauv cov hlab ntsha thiab cov hlab ntsha ntawm cov hlab ntsws. Hauv pulmonary interstitium, cov kua dej maj mam sib sau ua ke ntau dhau, uas ua rau txo qis elasticity ntawm lub cev. Lub ntsws ua "nruj dua", kev txwv tsis pub muaj tshwm sim. Tom qab ntawd cov kua dej edematous nkag mus rau hauv alveoli, vim tias lawv tsis koom nrog kev sib pauv roj.
Nws txuas ntxiv mus rau hauv lub ntsws serous thiab bronchial trunks. Muaj infiltration ntawm perivascular thiab peribronchial qhov chaw nrog serous kua, uas yog reflected nyob rau hauv lawv direct resistance, deterioration ntawm metabolic mob.
Nyob hauv sab laug atrium, cov ntshav los ntawm qhov tsis muaj cua alveoli sib xyaw nrog cov khoom siv oxygenated. Qhov no ua rau txo qis ntawm tag nrho cov hlab ntsha ib feem ntawm cov pa oxygen, kev loj hlob ntawm hypoxemia. Nyob rau hauv thawj theem, lub tom kawg yog circulatory nyob rau hauv xwm.
Sab laug ventricular tsis ua hauj lwm feem ntau yog tshwm sim los ntawm hnyav dhau los lossis kev puas tsuaj rau cov khoom siv ntawm lub plawv. Xws li ib tug kab mob entails ib tug deterioration ntawm cov ntshav ncig. Nws yuav tsum tsis tsuas yog kuaj xyuas raws sijhawm, tab sis kuj muaj peev xwm kho tau. Nrog rau kev sib xyaw ua ke ntawm pathology nrog rau sab xis-sab plawv tsis ua haujlwm, qhov tshwm sim ntawm kev tuag ntawm tus neeg mob nce.
Tus kab mob tseem ceeb
- Y Cardiomyopathy.
- IHD.
- mob plawv mob plawv.
- Cardiogenic pulmonary edema.
- Symptomatic arterial hypertension.
- Mitral stenosis.
- Kev phais loj.
- mob hlwb.
- Kab mob sib kis.
- Cov tshuaj lom ntawm myocardium (tshuaj, cawv).
mob sab laug ventricular tsis ua haujlwm thiab myocardial infarction
Tus kab mob no feem ntau tsim tawm tsam keeb kwm ntawm myocardial infarction. Nws feem ntau yog vim muaj kev ua haujlwm tsis zoo diastolic thiab tuaj yeem tshwm sim nrog ib qho ejection feem. Mitral regurgitation plays lub luag haujlwm tseem ceeb hauv kev txhim kho lub plawv tsis ua haujlwm hauv qhov no. Nws yog vim papillary leeg ischemia lossis poob ntawm myocardial loj.
Tus kab mob hauv thawj teev hauv cov neeg mob uas muaj myocardial infarction yog tus cwj pwm los ntawm kev txo qis hauv cov ntshav ntim, kev hloov pauv hauv lub plawv thiab cov tshuaj sodium tsawg hauv lub cev.
daim duab kho mob
Raws li koj paub, yuav luag txhua yam kab mob ntawm lub plawv muaj cov tsos mob tshwm sim, uas yog, lawv tau qhia los ntawm qhov mob hauv cheeb tsam ntawm lub plawv. Nws tuaj yeem muab rau lub luj tshib, caj dab lossis lub xub pwg hniav. Qhov tshwm sim no feem ntau pom muaj kab mob xws li sab laug ventricular tsis ua haujlwm. Cov tsos mob yog ua npaws, ua tsis taus pa, ntsesiab surges thiab kub ua txhaum.
Qhov xwm txheej thiab kev siv ntawm cov cim qhia ntawm pathology ncaj qha nyob ntawm seb qhov twg ntawm lub plawv cov leeg puas. Rau sab laug ventricular daim ntawv, ntxiv rau cov tsos mob tseem ceeb, qhov tsos ntawm fainting, tawm tsam ntawm arrhythmia, kiv taub hau, o ntawm cov ceg, thiab qhov nce ntawm cov leeg jugular yog yam ntxwv.
Maj mam, tag nrho cov cim qhia ntawm sab laug ventricular insufficiency intensify, tam sim no tshwm tsis tau tsuas yog nyob rau hauv lub active theem, tab sis kuj nyob rau hauv so. Yog tias koj tsis teb cov teeb meem no raws sijhawm, qhov tshwm sim tuag tsis raug txiav tawm.
kab mob daim ntawv
Pathology tuaj yeem tshwm sim hauv ntau hom.
- Nrog congestive hom hemodynamics. Manifested nyob rau hauv daim ntawv ntawm mob hawb pob (kev tawm tsam ntawm suffocation) thiab pulmonary edema.
- Hypokinetic hom hemodynamics:
- Arrhythmic shock. Txhim kho raws li cov lus teb rau kev ua txhaum ntawm lub plawv dhia.
- Reflex shock. Zoo li qhov tshwm sim rau qhov mob.
- True cardiogenic shock. tshwm sim nrog kev puas tsuaj loj (tshaj 50% ntawm qhov loj ntawm myocardium ntawm sab laug ventricle).
Kev mob hnyav zuj zus ntawm qhov kuaj pom tias lub plawv tsis ua haujlwm (cov leeg tsis muab cov ntshav txaus rau cov kev xav tau ntawm lub cev)
Diagnosis
Ntau yam pathologies ntawm lub plawv mob yog tus cwj pwm los ntawm kev loj hlob sai, thiab mob sab laug ventricular tsis muaj qhov tshwj xeeb hauv qhov teeb meem no. Yog tias tus kws kho mob xav tias qhov kev kuaj mob no, thawj qhov yuav tsum ua yog uatshuaj xyuas tus neeg mob. Txawm li cas los xij, kev kuaj lub cev tsis txaus los ntsuas cov duab kho mob tag nrho. Yog li ntawd, tus neeg mob tau muab ntau txoj kev kuaj mob, suav nrog ECG, ultrasound ntawm lub plawv, X-ray ntawm lub sternum, radioisotope ventriculography thiab PET.
Raws li cov txiaj ntsig tau txais, tus kws kho mob tuaj yeem lees paub qhov kev kuaj mob thiab sau ntawv kho kom muaj peev xwm.
mob sab laug ventricular tsis ua haujlwm: kev saib xyuas xwm txheej ceev
Thaum muaj kev tawm tsam, nws tseem ceeb heev rau tus neeg mob yuav tsum muab kev pab tsim nyog raws sijhawm ua ntej cov kws kho mob tuaj txog. Ua ntej tshaj plaws, nws yuav tsum tau muab tso rau ntawm lub txaj (nws yog txwv tsis pub pw), muab cua ntws, pib kho cov pa oxygen.
Tus neeg mob yuav tsum tau muab "Nitroglycerin" hauv qab tus nplaig, nkag mus rau subcutaneously 1% "Morphine". Nrog rau kev loj hlob ntawm pulmonary edema vim qhov txo qis hauv cov ntshav siab, "Prednisolone" tau muab tso rau hauv cov hlab ntsha (3-5 ml).
Thaum tsis muaj cov tshuaj tsim nyog, tus neeg mob yuav tsum siv cov tshuaj tourniquets rau lub duav thiab lub xub pwg nyom kom txo qis qhov ntim ntawm cov ntshav ncig. Koj tuaj yeem nkag mus rau qhov sib xyaw tshwj xeeb hauv cov hlab ntsha. Ua li no, kos 3 ml ntawm 96% ethyl cawv rau hauv 10 ml syringe, thiab tom qab ntawd ntxiv dej rau kev txhaj tshuaj. Nws yog ib qho tseem ceeb uas tag nrho cov ntim puv. Cov tshuaj no muaj cov nyhuv defoaming. Tus neeg mob yuav tsum hu rau pab neeg kho mob plawv. Tom qab tshem tawm ntawm pulmonary edema, tag nrho cov neeg mob uas kuaj mob sab laug ventricular plawv tsis ua hauj lwm yuav tsum tau mus pw hauv tsev kho mob yam tsis poob. Kev thauj mus los feem ntaunqa tawm ntawm lub stretcher nyob rau hauv ib qho chaw zaum.
Cov ntsiab cai tseem ceeb ntawm kev kho mob
Tus kab mob no hem tus neeg mob lub neej thiab ib txwm xav tau kev kho mob xwm txheej ceev.
- Yog tias qhov ua rau tus kab mob yog qhov hloov pauv ntawm lub plawv dhia, txhawm rau txhim kho hemodynamics thiab tus neeg mob tus mob, nws yuav tsum tau kho lub plawv dhia.
- Yog tias qhov ua rau yog myocardial infarction yav dhau los, txhawm rau tiv thaiv tus kab mob, nws yog qhov yuav tsum tau ua kom cov ntshav txaus kom sai li sai tau. Hauv kev saib xyuas ua ntej hauv tsev kho mob, qhov no tuaj yeem ua tau los ntawm cov kab mob thrombolysis, uas yog, kev tswj hwm cov tshuaj tshwj xeeb rau cov ntshav txhaws.
- Yog tias sab laug ventricular tsis ua haujlwm yog qhov tshwm sim ntawm qhov muaj nyob hauv intracardiac haemodynamic cuam tshuam vim yog myocardial rupture lossis raug mob, qhia mus pw hauv tsev kho mob tam sim.
Drug therapy
Kev kho tus kab mob, feem ntau, txhais tau hais tias kev sib koom ua ke (ua tiav so, tsis muaj kev tawm dag zog lub cev hnyav, ua raws li kev noj zaub mov zoo). Txawm li cas los xij, cov no yog cov kev tiv thaiv ntau dua, uas qee zaum tsis tuaj yeem nres qhov mob mob uas nrog tus kab mob - mob sab laug ventricular tsis ua haujlwm. Kev kho tshuaj tsuas yog qhov no los cawm.
Lub hom phiaj tseem ceeb ntawm kev kho tshuaj muaj npe hauv qab no:
- Normalization ntawm myocardial contractility.
- Tshuaj cov tsos mob ntawm sinus tachycardia.
- Tiv thaiv cov ntshav txhaws thiab occlusion ntawm cov hlab ntsha.
- txheej txheem normalizationtshem tawm cov kua los ntawm lub cev.
- Nyob ntev ntawm kev zam txim.
Ua ntej ntawm tag nrho, txhua tus neeg mob, yam tsis muaj kev zam, tau txais kev kho mob oxygen. Txhawm rau tiv thaiv cov kua dej ntau hauv lub cev, nws raug nquahu kom noj cov tshuaj diuretics ("Furosemide", "Uregit") thiab kev txwv nruj ntawm kev haus cawv. Txhawm rau txo cov hlab plawv thiab tib lub sijhawm txhim kho cov ntshav ncig, vasodilators thiab antiplatelet cov neeg ua haujlwm (Tiklid, Plavix) tau sau tseg. Txhawm rau txhim kho myocardial contractility, cardiac glycosides thiab cov tshuaj cardiotonic tau sau tseg.
Tus kws kho mob sau txhua yam tshuaj ib leeg rau txhua tus neeg mob. Yog li, nws yog ib qho tseem ceeb kom nkag siab tias kev kho tus kheej ntawm tus kheej tsuas tuaj yeem ua rau daim duab kho mob hnyav dua thiab tsis tuaj yeem nqa qhov xav tau.
Thaum twg yuav tsum tau phais?
Yog tias kev kho tshuaj tsis txo tus neeg mob tus mob, sab laug ventricular plawv tsis ua haujlwm tsuas yog ua rau nws tshwm sim, kev phais raug pom zoo. Tam sim no, ob hom kev ua haujlwm tau siv rau hauv kev kho mob: cardiomyoplasty thiab implantation ntawm cov cuab yeej tshwj xeeb los txhim kho cov ntshav ncig. Ob qho kev xaiv yog kev hem thawj rau lub neej, yog li lawv tsuas yog siv rau hauv qhov xwm txheej hnyav. Ntxiv mus, cov nyhuv postoperative yog pom tsuas yog 3-4 lub hlis tom qab ib tug ntev lub sij hawm rov qab. Ua ntej mus rau qhov kev ua haujlwm zoo li no, nws tsim nyog sab laj nrog koj tus kws kho mob thiab sib piv tag nrho nws cov txiaj ntsig thiab ua taushortcomings.
Kev nyuaj siab
Yog tias tus neeg mob tau kuaj pom tias muaj lub plawv tsis ua haujlwm sab laug, nws tsis quav ntsej txog nws tus kheej kev noj qab haus huv thiab kev kho mob qeeb, muaj feem ntau ntawm kev tuag ntxov.
ntsuas kev tiv thaiv
Nyob rau hauv lub xub ntiag ntawm cov kab mob ntawm cov hlab plawv system ntawm ib tug ntev lub sij hawm, tsis tu ncua saib xyuas los ntawm ib tug kws kho plawv thiab nruj ua raws li tag nrho nws cov tshuaj. Nws yog ib qho tseem ceeb heev kom txo qis qhov cuam tshuam ntawm qhov tsis zoo ntawm kev ua haujlwm ntawm tag nrho cov kab mob. Cov no suav nrog kev quav yeeb quav tshuaj (kev haus luam yeeb, cawv thiab siv yeeb tshuaj), kev puas siab puas ntsws ntau dhau thiab kev ntxhov siab ntau zaus, nrog rau kev rog dhau.
Raws li kev tiv thaiv kab mob xws li mob sab laug ventricular tsis ua haujlwm, cov laj thawj uas feem ntau muab zais rau hauv lub cev tsis ua haujlwm, pom zoo kom noj tshuaj noj. Qhov no tuaj yeem ua luam dej, taug kev sab nraud, skiing, mus rau lub gym lossis yoga. Ntshav siab yuav tsum tau saib xyuas tas li. Kev saib xyuas tshwj xeeb yuav tsum tau them rau kev noj haus. Kev noj zaub mov yuav tsum sib npaug li qhov ua tau, muaj fiber ntau. Nws yog qhov zoo dua tso cov khoom noj rog thiab kib, nrog rau cov khoom noj ntsim heev.
Cov kev tiv thaiv yooj yim no tuaj yeem tsis tsuas yog tiv thaiv kev txhim kho ntawm cov kab mob zoo li no txaus ntshai rau kev noj qab haus huv, tab sis kuj txhim kho lub neej zoo nyob rau hauv dav dav.
Zoo kawg
Nyob rau hauv tsab xov xwm no, peb tham txog dab tsi ua tus kab mob nyob rau hauvhu ua laug ventricular tsis ua hauj lwm. Cov laj thawj rau kev txhim kho ntawm cov kab mob no tuaj yeem sib txawv heev, pib nrog myocardial infarction thiab xaus nrog cov tshuaj lom hauv lub cev ntawm cov tshuaj. Kev kuaj mob raws sij hawm thiab kev kho mob muaj peev xwm tuaj yeem txo qhov kev pheej hmoo ntawm cov teeb meem, qhov txaus ntshai tshaj plaws yog kev tuag. Noj qab nyob zoo!
