Sinoauricular lossis sinoarterial blockade yog ib hom kab mob intracardiac conduction disorder. Cov mob no yog tus cwj pwm los ntawm kev qeeb qeeb lossis ua tiav ntawm lub plawv impulse mus rau atria los ntawm qhov sinus node. Muaj kev cuam tshuam los yog lub plawv dhia, kev qaug zog, kiv taub hau luv luv.
Muaj ntau yam laj thawj vim li cas lub qhov txhab nres. Qhov no yuav tsum tau kuaj tag nrho lub plawv, vim tias qhov tsis ua haujlwm ntawm lub atherosclerosis tsis yog tshwm sim xwb. Nws yog qhov ua rau txiav txim siab txog kev kho mob ntxiv thiab qhov tshwm sim ntawm tus kab mob.
Nyob rau hauv qee cov neeg mob, lub plawv ua haujlwm nyob rau hauv lub atherosclerosis ntawm atrioventricular hlws ris los yog atrial atherosclerosis thoob plaws lub neej. Cov chaw khaws cia no muab kev ua haujlwm txaus ntawm lub siab. Yog tias lawv tsis tuaj yeem tiv nrog qhov no, ces tsuas muaj ib txoj hauv kev tawm - kev cog cov pacemaker.
Kev piav qhia tus kab mob
Sinoauricular blockade yog ib qho mob uas muaj qhov tsis muaj zogsinus node. Kev ua ntawm hluav taws xob impulse yog thaiv ntawm qhov sinus node thiab atria. Nrog rau qhov teeb meem no, ib ntus atrial asystole tau pom thaum ib lossis ntau tshaj ib lub ventricular complex ntog.
Kev tshwm sim ntawm kev thaiv kab mob sinauricular tsis tshua muaj, thiab yog tias lawv loj hlob, feem ntau ntawm cov txiv neej ib nrab ntawm cov pejxeem (hauv 65% ntawm cov neeg mob). Tus kab mob no raug txiav txim thaum twg los tau.
Dab tsi yog qhov thaiv ntawm 1, 2, 3 degrees thiab hom? Xav paub ntau ntxiv tom qab.
Qib thiab hom kab mob
Tus kab mob tuaj yeem faib raws li qhov hnyav. Nws los nyob rau hauv thawj, thib ob thiab thib peb qib:
Thawj qib yog qhov nyuaj los txiav txim siab txog electrocardiogram. Muaj qhov tshwm sim tsis tshua muaj tshwm sim ntawm lub plawv impulses uas ncav cuag atria. Blockade tej zaum yuav qhia tau los ntawm lub xub ntiag ntawm sinus bradycardia
- Tab sis qib thib ob tuaj yeem txiav txim siab los ntawm ECG. Nws muab faib ua 2 hom. Sinoauricular blockade ntawm 2nd degree (hom 1) - blockade ntawm lub plawv maj mam nce, muaj tam sim ntawd lub sij hawm ntawm tag nrho cov impulses. SA blockade ntawm 2nd degree (hom 2) - lub plawv impulses poob tawm tsis tu ncua, muaj episodic thiab ib ntus ua tiav blockades ntawm conduction. Qee qhov impulses tsis ncav cuag lub ventricles thiab atria. Samoilov-Wenkerbach lub sij hawm tshwm sim ntawm daim cardiogram. Qhov no qhia tau hais tias ib tug sinauricular blockade ntawm 2nd degree 2: 1. Ib lub voj voog ntawm lub plawv poob tawm, thaum lub sijhawm nce R-R yog sib npaug rau ob lub sijhawm tseem ceeb. Qee qhov xwm txheej, txhua tus mem tes thib ob raug thaiv,uas ua raws li ib txwm contractions. Qhov no txhais tau tias allorhythmia.
- Nrog rau qib thib peb (ua tiav) sinoauricular blockade ntawm ECG, daim duab yog raws li nram no - tag nrho cov impulses los ntawm qhov sinus node raug thaiv. Qhov no feem ntau ua rau asystole thiab tuag. Tus tsav tsheb yog lub atrioventricular node, cov kab ke ntawm lub atria thiab ventricles.
Dab tsi ua rau muaj kev thaiv?
Sinoauricular blockade tshwm sim thaum:
- organic myocardial puas;
- nraug vagal tone;
- sinus node lesion.
Tus kab mob no feem ntau tshwm sim rau tus neeg uas raug kev txom nyem los ntawm cov kab mob hauv qab no:
- mob plawv;
- IHD (ua rau lub plawv nres, atherosclerosis);
- myocarditis.
Cia lub npe qee qhov laj thawj ntxiv rau kev txhim kho ntawm kev thaiv:
- Adrenoblockers, mob plawv glycosides, tshuaj K, quinidine, uas ua rau qaug rau lub cev.
- Defibrillation.
- Reflex-increased tone ntawm vagus paj hlwb.
Yog li, ntau yam tuaj yeem ua rau muaj kev cuam tshuam ntawm impulses hauv lub qhov txhab, uas feem ntau cuam tshuam nrog qhov tseeb tias kev ua haujlwm plawv tsis zoo. Yog li, kev loj hlob ntawm tus kab mob no tshwm sim thaum:
- cov txheej txheem inflammatory hauv txoj cai atrium;
- metabolic-dystrophic teeb meem tshwm sim hauv atria;
- myocardial infarction;
- kev phais plawv.
Symptomatics
Sinoauricular blockade ntawm qib 1 yog qhov nyuaj heev los txheeb xyuas, vim nws tsis tshwm sim nws tus kheej hauv txhua txoj kev. Nws tsuas yog txiav txim siab thaum tsis muaj lub plawv dhia tom qab 2-3 lub voj voog ib txwm.
Sinus ntaus zaus muaj kev cuam tshuam rau cov tsos mob ntawm qhov kev ntsuas thib ob. Yog tias tsis tshua muaj mob plawv, ces tus neeg mob yuav raug kev txom nyem:
- dizzy;
- plab tsis xis nyob;
- kev qaug zog;
- ua tsis taus pa.
Cov tsos mob ntawm qhov thaiv, uas yog tus cwj pwm los ntawm qee qhov tsis muaj lub plawv dhia, yuav ua raws li hauv qab no:
- lub plawv nres;
- tinnitus;
- bradycardia.
Thaum ib qho mob nrog cov organic puas rau myocardium, lub plawv tsis ua haujlwm raug tsim.
Asystole ua rau kev txhim kho ntawm Morgagni-Adams-Stokes syndrome hauv cov neeg mob. Nyob rau hauv rooj plaub no, muaj pallor ntawm daim tawv nqaij, tsis xav txog kiv taub hau, flashing ntsiab lus ua ntej lub qhov muag, convulsions, tsis nco qab, ringing nyob rau hauv pob ntseg.
Yog li, peb tuaj yeem xaus tias theem thib ob thiab thib peb tshwm sim:
- plab tsis xis nyob;
- bout kiv taub hau;
- ua tsis taus pa;
- kev qaug zog;
- poob siab;
- nrog ua pa;
- tawv nqaij;
- tinnitus;
xav
Txoj Kevdiagnostics
Yuav ua li cas txheeb xyuas tus kab mob no? Nws yog lub npe hu tias sinoauricular blockade ntawm ECG manifests nws tus kheej. Puas yog?
Cov kev xeem tseem ceeb suav nrog:
- electrocardiography (ECG), txij li cov blockade sinoauricular pom meej ntawm nws;
- kuaj lub plawv (ultrasound).
Raws li cov txiaj ntsig ntawm ECG, qhov muaj thiab qhov hnyav ntawm SA tau txiav txim siab. Nrog 1, yuav luag tsis muaj qhov tshwm sim - tsuas yog sinus bradycardia tau sau tseg, uas ntau tus neeg muaj thiab suav tias yog qhov txawv ntawm cov qauv.
Thawj hom 2nd degree blockade ntawm ECG tau nthuav tawm raws li hauv qab no - lub sijhawm tsis zoo ntawm lub plawv dhia (poob ntawm P-P nthwv dej lossis tag nrho PQRST complex). Nyob rau hauv hom thib ob - uas tsis yog-rhythmic thiab rov prolapse ntawm P-P yoj, PQRST complexes, thaum 2 los yog ntau tshaj lub plawv mus ploj, pathological ntshav ncig yog tsim.
Yog li, electrocardiography tau ua, tab sis nws yog ib qho tseem ceeb kom paub qhov txawv ntawm qhov sib txawv ntawm qhov sib txawv ntawm sinus bradycardia thiab arrhythmia, nrog rau atrial premature beats, thib ob-degree atrioventricular block.
Yog tias qhov sinus bradycardia tau lees paub, ces kev kuaj nrog atropine raug tshuaj. Tom qab ntawd, hauv cov neeg mob, lub plawv dhia ob npaug, thiab tom qab ntawd kuj poob qis los ntawm ib nrab. Qhov no provokes ib tug blockade. Thiab nyob rau hauv cov ntaub ntawv ntawm ib txwm ua hauj lwm ntawm lub sinus node, lub atherosclerosis yuav maj mam ua ntau zaus. Dab tsi yog kev kho mob rau kev kuaj mob ntawm sinauricular blockade?
Kev kho yog dab tsi?
Yog tias pom pom thawj-degree sinoauricular block nyob rau hauv ib tug neeg, ces tsis tas yuav kho. RauKev kho kom rov zoo li qub ntawm lub plawv, nws yog ib qho tsim nyog los kho cov kab mob hauv qab los yog tsis kam noj cov tshuaj uas ua rau ua txhaum cai.
Yog vagotonia coj mus rau hom 2 sinauricular blockade ntawm 2nd degree, ces kev siv atropine subcutaneously lossis intravenously yuav zoo:
- Txhawm rau ua kom lub cev tsis muaj zog ntawm lub qhov txhab, siv cov tshuaj sympathomimetic, xws li "Ephedrine", "Alupten", "Izadrina".
- txhawm rau txhim kho cov metabolism hauv lub plawv cov leeg, cocarboxylase, ribaxin, ATP raug tshuaj. Nyob rau hauv cov ntaub ntawv ntawm overdose ntawm cov tshuaj no, mob taub hau, xeev siab, insomnia, twitching ntawm ceg, thiab ntuav tej zaum yuav pib.
Kev noj cov plawv glycosides yog contraindicated rau cov neeg mob, nrog rau kev kho mob nrog beta-blockers, tshuaj antiarrhythmic ntawm quinidine series, K ntsev, cordarone, rauwolfia.
Thaum tus neeg mob uas muaj kev cuam tshuam ntawm sinauricular blockade muaj qhov cuam tshuam loj hauv kev noj qab haus huv, yog tias muaj kev tawm tsam asystole feem ntau tshwm sim, cov kws kho mob ua ib ntus lossis mus tas li stimulation ntawm atria nrog lub pacemaker.
Kev pabcuam thaum muaj xwm txheej ceev thaum muaj kev thaiv
Kev kho mob muaj nyob rau hauv kev tshem tawm qhov ua rau provoked sinoauricular blockade (xws li intoxication nrog cardiac glycosides, rheumatism, kab mob plawv, thiab lwm yam). Qee zaum kev coj ua tuaj yeem rov qab los tsuas yog tom qab kho cov kab mob hauv qab lossis tshem tawm cov tshuaj uas ua rau nws ua txhaum.
Nrog kiv taub hau thiabKev txo qis hauv lub plawv dhia yog qhia kom noj cov tshuaj atropine sulfate subcutaneously, intravenously lossis hauv tee. Qee zaum cov tshuaj adrenomimetic raug tshuaj - "Ephedrine" thiab kev npaj ntawm isopronyl norepinephrine.
"Ephedrine" yog noj ob zaug hauv ib hnub lossis subcutaneously raws li kev daws teeb meem.
"Orciprenaline" ("Alupent") yog siv maj mam intravenously, subcutaneously los yog intramuscularly los yog hais lus nyob rau hauv ntsiav tshuaj ob zaug ib hnub twg.
"Izadrin" ("Novodrin") yog ntsiav tshuaj. Nws raug sau tseg kom noj hauv qab tus nplaig (kom txog thaum yaj tag) ib nrab ib ntsiav tshuaj peb zaug ib hnub lossis ntau dua.
Kev noj ntau dhau ntawm cov tshuaj no ua rau mob taub hau, palpitations, tshee hnyo, tawm hws, insomnia, xeev siab, ntuav.
ntsuas kev tiv thaiv
Txhua yam kab mob plawv yuav tsum raug kuaj kom raws sijhawm. Xws li ib tug kab mob xws li sinauricular blockade yog tseem tsis to taub, nyob rau hauv kev twb kev txuas nrog rau qhov no, tsis muaj kev tiv thaiv zoo li no. Yeej, dab tsi yuav tsum tau ua yog mus koom rau kev tshem tawm ntawm qhov ua rau ntawm qhov kev hloov ntawm lub plawv conduction. Nws yuav tsum tau kuaj xyuas tsis tu ncua los ntawm kws kho plawv (los yog tus kws kho mob arrhythmologist). Tsis tas li ntawd, kev pheej hmoo siab ntawm lub plawv yog kub siab, rog, rog, noj tsis txaus, tus cwj pwm tsis zoo, uas suav nrog kev haus luam yeeb thiab haus cawv.
Qhov teeb meem no ua rau muaj dab tsi?
Lub xub ntiag ntawm qhov tsis zoo ntawm sinauricular blockade yog piav qhia los ntawm qhov qeeb qeeb vimorganic mob plawv. Cov kab mob uas peb feem ntau piav qhia ua rau lub plawv tsis ua haujlwm ntev lossis ua rau nws hnyav dua, yog tias nws twb muaj lawm, pab tsim cov ventricular thiab ectopic arrhythmias.
Yuav kwv yees yog dab tsi?
Kev tshwm sim ntxiv ntawm cov kab mob sinoauricular blockade yog nyob ntawm qhov ua rau, uas yog, ntawm tus kab mob hauv qab. Qib ntawm conduction thiab muaj lwm yam mob plawv arrhythmias kuj ua lub luag haujlwm tseem ceeb.
Tus kab mob uas tsis tshwm sim nws tus kheej hauv txhua txoj kev tsis ua rau muaj kev cuam tshuam hauv hemodynamics.
Thaum Morgagni-Adams-Stokes syndrome tshwm sim, qhov kev cia siab tsis zoo.
