Atrial fibrillation paroxysm (ICD 10: I49) yog hais txog ib daim ntawv tshwj xeeb ntawm atrial fibrillation, uas qhov kev tawm tsam ntawm lub plawv dhia tsis zoo yuav kav ntev li 7 hnub. Nws yog tus cwj pwm los ntawm chaotic twitching ntawm atrial nqaij fibers thiab impaired conduction ntawm hluav taws xob impulses nyob rau hauv lub myocardium. Vim lub plawv atherosclerosis cuam tshuam rau hauv cov kab mob no, lawv tuaj yeem hloov pauv ntawm 200-300 tus neeg ntaus ntau li ob peb teev lossis ib hnub.
Atrial fibrillation paroxysm feem ntau tshwm sim hauv cov neeg laus thiab cov neeg laus thiab tsis tshua muaj tshwm sim hauv cov menyuam yaus thiab cov tub ntxhais hluas uas muaj qhov tsis zoo ntawm lub plawv cov leeg.
Tus kab mob
Atrial fibrillation paroxysm (ICD code 10 - I49) yog ib yam mob uas muaj nrog rau mob plawv arrhythmia. Feem ntau qhov ua rau nws tshwm sim yog ischemia, uas tsis kho raws sijhawm.
Atrial fibrillation paroxysm yog tus cwj pwm los ntawm qhov tseeb tias nws pib sai sai thiab xatsis xis nyob. Lub sijhawm ntawm ib qho kev tawm tsam no yog kwv yees li 5-7 feeb. Xws li cov kab mob yog qhov mob hnyav ntawm tachycardia, thaum lub sijhawm tus neeg tuaj yeem ntsib ntau dua 140 lub plawv dhia ib feeb, uas yog qhov txaus ntshai heev rau nws txoj kev noj qab haus huv.
Kev faib tawm tseem ceeb
Nyob ntawm tus naj npawb ntawm lub plawv dhia ib feeb, cov hom kab mob no txawv li flutter nrog ntau zaus txog 200 tus neeg ntaus thiab flickering los ntawm 200 neeg ntaus. Txij li thaum, tawm tsam keeb kwm ntawm arrhythmia, ventricles pib cog lus nyob rau hauv ib qho kev txhim kho, ces, raws li kev faib tawm, cov ntaub ntawv hauv qab no ntawm tus kab mob no txawv:
- tachysystolic;
- bradysystolic;
- normosystolic.
Lwm qhov kev faib tawm ntawm arrhythmias faib cov kab mob rau hauv cov ntaub ntawv xws li:
- ventricular, nrog mob plawv arrhythmias;
- atrial, nrog rau kev hloov pauv hauv kev coj ua ntawm Nws pob;
- mixed, nrog rau kev sib xyaw ntawm ob daim ntawv no.
Thawj qhov kev tawm tsam yuav tsum raug cais tawm ntawm paroxysm ntawm atrial fibrillation, uas cov kab mob tshwm sim ib ntus rov zoo dua thiab kav ntev txog 7 hnub. Nrog rau kev ua kom tsis zoo ntawm arrhythmia, peb tuaj yeem tham txog hom kab mob rov tshwm sim.
Raws li cov cim muaj, pathology tau muab faib ua ob peb chav kawm. Ntawm thawj daim duab kho mob yuav luag tag. Qhov thib ob, lub neej zoo tsis raug kev txom nyem, tab sis muaj cov cim qhia me ntsis ntawm cov kab mob. Qhov thib peb degree yog tus cwj pwm los ntawm qhov tseeb tias muaj ntau qhov kev tsis txaus siab thiab ib tus neeg yuav tsum txwv nws tus kheej. Ntawm plaub- daim duab kho mob tau hais tawm, thiab cov teeb meem tseem tuaj yeem pom, mus txog qhov tsis taus.
Kev tshwm sim
Atrial fibrillation paroxysm (ICD 10: I49) yog hais txog cov kab mob nyuaj, cov laj thawj tseem ceeb ntawm cov no yog:
- mob plawv tsis ua hauj lwm;
- cardiomyopathy;
- mob ntshav siab nrog lub plawv loj;
- Yischemia;
- cov txheej txheem inflammatory hauv myocardium;
- mob plawv tsis xws luag.
Tsis tas li ntawd, muaj qee yam kev xav tau uas yuav tsum raug ntaus nqi xws li:
- haus luam yeeb thiab haus cawv;
- mob tsis muaj magnesium thiab potassium;
- cov txheej txheem kis mob hnyav;
- kab mob endocrine;
- mob ntshav qab zib;
- noj tshuaj.
Yog tias qhov ua rau tus kabmob tseem tsis tau tsim, ces daim ntawv no hu ua idiopathic. Qhov mob no feem ntau tshwm sim hauv cov neeg mob hluas.
Ua ntej pib kho, nws yog ib qho tseem ceeb heev uas yuav tau txiav txim siab qhov ua rau muaj kev cuam tshuam. Qhov no yuav pab tus kws kho mob xaiv txoj kev kho kom raug thiab txo qhov kev pheej hmoo ntawm cov teeb meem txaus ntshai, suav nrog kev tiv thaiv kev rov tshwm sim dua.
Cov tsos mob tseem ceeb
Paroxysm ntawm atrial fibrillation (ICD code 10: I49) yog tus cwj pwm los ntawm qhov nyuaj ntawm kev ntws. Qhov xwm txheej ntawm cov kab mob pathology feem ntau yog nyob ntawm qhov zaus ntawm ventricularCov ntawv luv. Nws yog tsim nyog sau cia tias me me deviations los ntawm tus qauv yuav tsis tshwm sim lawv tus kheej kiag li. Nyob rau tib lub sijhawm, kev txo qis ntawm 120 strokes lossis ntau dua yog feem ntau nrog cov cim xws li:
- tsis muaj cua;
- tawm hws ntau dhau;
- panic tawm tsam;
- mob siab;
- ua tsis taus pa;
- pulse tsis sib xws;
- tsis muaj zog;
- tshee tshee
- kiv taub hau.
Thaum ib tug neeg muaj kev ua txhaum loj ntawm lub plawv contractions, ib tug deterioration ntawm cerebral ncig yog pom. Tus neeg mob tej zaum yuav qaug zog. Tsis tas li ntawd, qee zaum muaj qhov ua tsis taus pa ua tiav. Tus mob no xav tau kev kho mob sai.
Kev kub ntxhov
Kev saib xyuas xwm txheej kub ntxhov tseem ceeb heev rau paroxysmal atrial fibrillation. Lub algorithm ntawm kev ua nyob rau hauv cov ntaub ntawv no yuav tsum tau meej thiab kev sib koom tes. Yog tias muaj arrhythmia nres, lub luag haujlwm tseem ceeb yog nrhiav kev pab kho mob hauv 48 teev. Tom qab 2 hnub, muaj qhov tshwm sim ntawm cov ntshav txhaws hauv lub plawv thiab kev loj hlob ntawm lub plawv nres thiab mob stroke. Kev ntsuas ceev rau paroxysm ntawm atrial fibrillation yuav tsum mus raws li hauv qab no:
- Muab tus neeg mob tso rau ntawm lub txaj, rooj zaum lossis hauv pem teb;
- qhib qhov rai kom huab cua ntshiab;
- Tus neeg raug tsim txom yuav tsum ua pa tob.
Tom qab ntawd, nws raug nquahu kom muab tus neeg "Warfarin" lossis lwm yam tshuaj tiv thaiv kab mob uas tau muab los ntawm kws kho mob yav dhau los. Qhov no yuav pab tau zoo heevtxo cov ntshav txhaws. Thaum ua cov kev ntsuas ceev rau paroxysm ntawm atrial fibrillation, nyob rau hauv parallel nrog qhov no, ib pab neeg mob ceev yuav tsum tau hu. Kev kho mob tom ntej yuav tsum tau ua los ntawm tus kws kho mob nkaus xwb uas xaiv cov tshuaj nyob ntawm qhov mob hnyav.
Txhawm rau nres qhov paroxysm ntawm atrial fibrillation, tus kws kho mob txhaj tshuaj glycoside mob plawv, tshwj xeeb yog "Strophanthin", "Korglikon" lossis tshuaj "Novocainomide". Hauv cov xwm txheej hnyav tshwj xeeb, lub plawv defibrillation tau ua.
Diagnostics
Tom qab muab kev saib xyuas xwm txheej ceev rau paroxysm ntawm atrial fibrillation, kev kuaj mob yog qhov yuav tsum tau ua. Kom paub meej tias muaj teeb meem, lub plawv dhia yog hnov. Kev kuaj pom tseeb yog ua tau nrog flutter thaum lub sij hawm thib ob lossis thib plaub contraction.
Ntxiv thiab, tus kws kho mob tau sau tshuaj electrocardiography. Cov txheej txheem no yuav pab txiav txim siab qhov muaj cov kab mob pathological hauv lub plawv. Kev kuaj mob yog nyob ntawm qib ntawm atrial loj thiab valve hnav. Cov txiaj ntsig tau txais kev cuam tshuam loj rau kev kho mob.
Txoj kev kho mob
Kev kho mob ntawm paroxysmal atrial fibrillation raug xaiv cais rau txhua tus neeg mob. Ntxiv nrog rau kev sau tshuaj, nws tseem ceeb heev kom ua raws li kev noj haus, tsis suav nrog kev tawm dag zog lub cev hnyav, thiab tseem ua rau muaj kev noj qab haus huv. Nws yog ib qho tseem ceeb heev los tsim kom muaj lub hauv paus ua rau pathology thiab ua rau nws.
Thaum xaumob me tuaj yeem kho tau ntawm tus neeg mob sab nraud. Cov lus qhia tseem ceeb rau kev mus pw hauv tsev kho mob yog raws li hauv qab no:
- thawj zaug tawm tsam;
- lub plawv dhia ntau dua 200 tus neeg ntaus ib feeb;
- kev poob siab;
- cim qhia ntawm lub plawv tsis ua hauj lwm;
- clot formation.
Lub hom phiaj tseem ceeb ntawm kev saib xyuas kev kho mob yog los kho lub plawv dhia. Nws yog ib qho tseem ceeb kom tshem tawm cov tsos mob uas twb muaj lawm sai li sai tau, txo qhov kev pheej hmoo ntawm thrombosis thiab tiv thaiv qhov tshwm sim ntawm cov teeb meem.
Thaum xub thawj, tus kws kho mob tau sau tshuaj tiv thaiv kab mob thiab tshuaj tiv thaiv kab mob. Yog hais tias ib tug neeg muaj hnub nyoog qis dua 60 xyoo thiab tsis muaj cov organic myocardial puas tsuaj, kev kho tshuaj yuav tsum suav nrog kev noj cov acetylsalicylic acid tas li. Nyob rau hauv lub xub ntiag ntawm ischemia thiab lwm yam kab mob, "Warfarin" yog qhia nrog kev kuaj tsis tu ncua. Hauv cov xwm txheej tshwj xeeb, qhov hnyav molecular hnyav heparins tau raug sau tseg, tab sis nws tsim nyog nco ntsoov tias lawv tuaj yeem noj hauv chav kawm luv xwb.
Txhawm rau rov ua kom lub plawv dhia zoo li qub, cardioversion tau sau tseg, uas tuaj yeem kho mob lossis ntsuas. Muaj ntau cov tshuaj antiarrhythmic uas tiv thaiv qhov tshwm sim ntawm kev tawm tsam ntawm paroxysmal fibrillation. Cov no suav nrog xws li "Propafenone", "Sotaleks", "Kordaron", "Amiodarone".
Yog tias kev tswj lub plawv dhia tsis tau tshem tawm arrhythmia, ces beta-blockers raug tshuaj, nrog rau calcium channel blockers.
Ntxiv ntxiv tuaj yeem raug muabhluav taws xob cardioversion, uas cuam tshuam nrog kev coj lub plawv dhia rov qab los ntawm kev siv hluav taws xob tam sim no. Vim qhov kev mob siab heev, cov txheej txheem yog ua raws li tshuaj loog. Lub defibrillator nrog electrodes yog ntsia nyob rau hauv txoj cai collarbone, uas xa impulses mus rau lub plawv thiab "reboots" ua hauj lwm ntawm lub cev.
Cardioversion ua tiav thaum muaj xwm txheej ceev lossis xaiv xaiv. Yog tias cov txheej txheem tau npaj, tom qab ntawd hauv ib hlis ua ntej thiab tom qab nws, tus neeg yuav tsum tau noj Warfarin. Ua ntej muaj xwm txheej ceev, tus neeg mob tau txhaj tshuaj Heparin sai.
Thaum daim ntawv rov tshwm sim ntawm tus kab mob tshwm sim thiab lwm txoj hauv kev ua tsis tiav, kev ua haujlwm tau qhia, uas yog radiofrequency catheter ablation. Nws yog qhov kev cuam tshuam tsawg kawg nkaus. Cov electrode yog ntxig los ntawm cov hlab ntsha femoral mus rau hauv lub plawv, thiab tom qab ntawd pathological foci ntawm excitation raug rhuav tshem nrog kev pab los ntawm hluav taws xob poob siab.
Yog tias tsim nyog los rhuav tshem nws cov pob khoom, ces thaum lub sijhawm ua haujlwm yuav tsum muaj lub tshuab pacemaker. Nyob rau hauv ib daim ntawv loj heev ntawm to, lub installation ntawm ib tug defibrillator yog qhia kom tshem tawm qhov tshwm sim tshwm sim.
Atrial fibrillation paroxysm yog qhov txaus ntshai heev rau tus neeg mob lub neej, yog li kev kho mob yuav tsum tau ua nyob rau hauv kev saib xyuas ntawm kws kho mob nkaus xwb. Folk kev kho mob tsuas yog siv los tiv thaiv cov leeg nqaij. Rau qhov no, nws raug pom zoo kom noj rosehip thiab hawthorn infusions, haus txiv qaub nrog zib mu, thiab ntxiv zaub roj rau zaub mov.
Muaj Teeb Meem
Atrial fibrillation paroxysmarrhythmias (ICD code 10: I49) yog hais txog cov kab mob loj thiab txaus ntshai uas, yog tias tsis kho thiab kho tsis raws sijhawm, tuaj yeem ua rau muaj teeb meem txaus ntshai. Yog tias tsis tau txais kev pab, ces qhov kev hloov ntawm cov ntshav ntws tuaj yeem ua tau. Qhov no ua rau muaj kev pheej hmoo ntawm atrial embolism. Raws li qhov teeb meem, tej zaum yuav muaj xws li:
- pulmonary edema vim mob tsis ua haujlwm;
- hypoxic shock, nrog rau kev txo qis hauv siab;
- fainting;
- mob plawv;
- pathological hloov pauv hauv cov ntshav ntws.
Qhov teeb meem hnyav tshaj plaws yog thromboembolism. Qhov tshwm sim ntawm nws qhov tshwm sim yuav nce ntxiv yog tias ntau tshaj ob hnub dhau los txij li qhov kev tawm tsam tsis muaj kev kho mob tsim nyog. Lub sijhawm no txaus rau kev tsim cov ntshav txhaws loj hauv lub atria.
Cov teeb meem feem ntau yog tshwm sim los ntawm cov kab mob hauv lub cev lossis vim muaj cov ntshav txhaws. Ib qho ntawm cov txiaj ntsig txaus ntshai tshaj plaws ntawm paroxysm yog kev poob siab, uas lub siab poob qis thiab cov txheej txheem ntawm kev muab cov ntaub so ntswg thiab lub cev nrog oxygen cuam tshuam. Qhov teeb meem no tuaj yeem tshwm sim vim qhov siab lossis qis qis.
Nrog lub plawv tsis ua hauj lwm, pulmonary edema feem ntau tshwm sim. Thaum muaj kev tawm tsam, tej zaum yuav tsis nco qab, uas yog provoked los ntawm impaired ntshav mov mus rau lub hlwb. Qhov tshwm sim tsis zoo tuaj yeem ua rau lub plawv nres, mob stroke lossis gangrene.
Huab cua
Kev Ntsuas rau paroxysmal atrial fibrillation yog tus kheej rau txhua tus neeg mob. Nws nyob hauvFeem ntau nyob ntawm keeb kwm ntawm tus kab mob, qhov ua rau ntawm nws tshwm sim, daim ntawv ntawm cov chav kawm thiab kev kho mob raws sij hawm. Tsis tas li ntawd, qhov hnyav ntawm tus neeg mob, nws lub hnub nyoog, nrog rau lub xub ntiag ntawm concomitant pathologies ua lub luag haujlwm tseem ceeb.
Feem ntau, qhov kev cia siab rau tus kab mob no zoo heev. Kev kho mob raws sij hawm tso cai rau koj kom muaj kev noj qab haus huv ib txwm muaj, tiv thaiv qhov tshwm sim ntawm qaug dab peg. Nws yog ib qho tsim nyog sau cia tias nrog kev ua raws li tag nrho cov ntawv kho mob, tus neeg tuaj yeem ua lub neej ib txwm muaj, tshwj tsis yog qee qhov kev txwv ntawm kev noj zaub mov thiab kev tawm dag zog lub cev.
Qhov tseem ceeb tshaj plaws yog mus ntsib kws kho mob kom raws sijhawm thiab tsis yog tshuaj rau tus kheej. Tsis tas li ntawd, qhov normalization ntawm lub plawv dhia yog ib qho tseem ceeb, uas yuav tsum tau rov qab rau thawj hnub, kom txog thaum muaj teeb meem txaus ntshai tshwm sim.
prophylaxis
Atrial fibrillation paroxysm (ICD 10: I49) yog ib qho mob txaus ntshai, vim li ntawd nws yog qhov zoo tshaj plaws los tiv thaiv qhov pib ntawm kev tawm tsam ntau dua li kho nws ntev. Txhawm rau txo qhov kev pheej hmoo ntawm atrial fibrillation, nws yog ib qho tseem ceeb kom ua raws li cov lus pom zoo hauv qab no:
- muab tus cwj pwm phem;
- kev tiv thaiv rog;
- noj qab nyob zoo;
- kho raws sijhawm ntawm txhua yam kab mob myocardial.
Ntxiv rau, koj yuav tsum ua kom koj cov zaub mov muaj cov zaub mov muaj calcium, ua raws li kev teem sijhawm los ntawm kws kho plawv txhua 6 lub hlis. Nws yog ib qho tseem ceeb kom zam tag nrhokev ntxhov siab, kev nyuaj siab thiab kev ntxhov siab. Nco ntsoov faib sijhawm rau pw tsaug zog zoo thiab so.
Tsis tu ncua yuav tsum tau saib xyuas cov mem tes thiab siab nrog lub ntsuas ntshav hauv tsev. Kev pom zoo electrocardiogram tsawg kawg ib xyoos ib zaug. Nrog kev kho kom raug thiab ua raws li tag nrho cov cai ntawm kev tiv thaiv, cov txiaj ntsig tau zoo tuaj yeem ua tiav.
Nrog rau qhov kev kuaj mob no, ob peb tus neeg nyob rau lub hnub nyoog laus, tab sis nws yuav tsum ua raws li txhua daim ntawv tshuaj kho mob.
