Syncope yog lub sijhawm luv luv ntawm kev tsis nco qab vim vascular thiab lwm yam teeb meem hauv lub hlwb. Vim muaj qhov teeb meem no tshwm sim ntawm cov pej xeem, qhov teeb meem no yuav tsum tau txiav txim siab kom ntxaws ntxiv txhawm rau txheeb xyuas qhov tshwm sim feem ntau, piav qhia txog kev pab thiab kev tiv thaiv.
Definition of concept
Syncope yog lub npe rau kev qaug zog los ntawm Latin lo lus syncope. Kev qaug zog tuaj yeem tshwm sim hauv cov neeg ntawm txhua lub hnub nyoog. Yog tias peb txheeb xyuas cov txheeb cais thiab kev xaiv tsa, ces kwv yees li ib feem peb ntawm cov neeg poob qis tsawg kawg ib zaug hauv lawv lub neej. Kev qaug dab peg thiab qaug zog yuav tsum raug cais nruj me ntsis, vim cov kab mob no xav tau ntau hom kev kho mob.
Feem ntau ntawm cov kab mob no tshwm sim vim qhov tsis txaus ntseeg hauv kev ua haujlwm ntawm lub paj hlwb, uas yog lub luag haujlwm tswj kev ua haujlwm ntawm cov nruab nrog cev thiab cov hlab ntsha. Yog li ntawd, syncope feem ntau tshwm sim thaum overloads, kev ntxhov siab, kev ua haujlwm tsis zoo.thiab tsis xis nyob hauv lub cev.
Kev loj hlob ntawm kev qaug zog tshwm sim nyob rau nruab nrab vim qhov txo qis hauv cov ntshav mus rau lub hlwb los ntawm 30% lossis ntau dua, uas ua rau oxygen tshaib plab thiab tsis nco qab. Cov hauv qab no tuaj yeem cuam tshuam cov ntshav ntws mus rau lub hlwb: qhov txo qis hauv cov suab nrov ntawm cov phab ntsa vascular, txo cov ntshav siab thiab lub plawv dhia, txo qis hauv cov zis tawm, kev hloov pauv hauv cov hlab ntsha ntawm lub taub hau thiab caj dab, ntse. txo cov ntshav qabzib.
Hmoov tsis zoo, yuav luag ib nrab ntawm cov xwm txheej, qhov tshwm sim hauv qab ntawm kev qaug zog tsis tuaj yeem txiav txim siab vim qhov hloov pauv luv luv ntawm cov hlab ntsha thiab lub paj hlwb.
Encoding
Syncope raws li ICD-10 yog xaiv R55. Qhov kev faib tawm no yog thoob ntiaj teb thiab yog siv los lis cov kab mob hauv cov ntaub ntawv kho mob thiab cov ntawv kho mob hauv cov kab uas tsim nyog. Syncope raws li ICD-9 tsis tau encrypted nyob rau hauv Lavxias teb sab Federation txij li thaum 1999 tom qab lub thib kaum kev kho dua tshiab ntawm kev faib tawm los rau hauv siv. Cov ciphers no feem ntau siv los ntawm neurologists, tab sis cov kws kho mob ntawm lwm yam tshwj xeeb yuav tsum tau paub txog lawv. Lub syncope code ntawm kev so mob tsuas yog zoo li R55, thiab tag nrho lwm cov rubrics raug cais tawm ntawm ntu no, vim lawv twb muaj feem cuam tshuam rau lwm cov txheej txheem pathological.
Ua tsaug rau
Qhov ua rau ntawm syncope muaj ntau sab, tab sis lawv tuaj yeem ua tau zoo:
- Lub sijhawm luv luv circulatory disorders cuam tshuam nrog kev hloov pauv hauv kev ua haujlwm ntawm lub cev thiabtshuab. Qhov no yog ua tau nrog nce kev ua haujlwm ntawm lub paj hlwb parasympathetic, uas yog, qhov tseem ceeb ntawm kev cuam tshuam ntawm cov hlab ntsha vagus ntawm lub plawv thiab cov hlab ntsha. Hauv qhov no, tus naj npawb ntawm lub plawv dhia qeeb, cov hlab ntsha dilate, ntshav siab poob, yog li cov hlab plawv tsis tuaj yeem muab cov pa oxygen thiab cov as-ham uas tsim nyog rau lub hlwb, thiab nws tig tawm.
- Qhov tseem ceeb preponderance rau parasympathetics tuaj yeem tshwm sim nrog kev zoo siab, kev ntxhov siab, ntshai, pom ntshav, hauv chaw kho hniav.
- Reflex irritation ntawm carotid sinuses tuaj yeem tshwm sim nrog hnoos, txham, nqos, thaum lub sijhawm ua haujlwm hnyav, ntaus twj paj nruag.
- Pab txhawb rau hom kev faus no tuaj yeem hnav cov dab tshos nruj, khi, phuam qhwv caj dab, nrog rau kev nyob ntsug ntev hauv chav tsis muaj qhov cua kom ntev.
- Orthostatic genesis ntawm syncope yog txuam nrog kev hloov pauv ntawm lub cev tam sim ntawd. Feem ntau qhov no tshwm sim thaum ib tug neeg sawv tom qab pw tsaug zog ntev, pw tsaug zog. Hauv qhov no, muaj cov ntshav txaus rau lub hlwb tsis txaus vim yog vim li cas ntau yam ntshav tsis muaj sijhawm nkag mus rau lub hlwb sai npaum li lub cev xav tau tam sim no.
- Tus mob no yuav tsum tau kuaj xyuas tshwj xeeb kom txiav tawm cov kab mob loj: Parkinson's disease, ntshav qab zib neuropathy, amyloidosis neuropathy, Addison tus kab mob, ntau yam kab mob atrophy.
- Cov syncope no kuj tshwm sim vim qhov txo qis hauv ntimcirculating ntshav vim los ntshav ntawm ntau yam xwm los yog lub cev qhuav dej los ntawm raws plab los yog ntuav.
- Qee cov tshuaj tuaj yeem ua rau syncope (tshuaj rau cov ntshav siab, nrog rau cov tshuaj diuretics, nrog rau nitrates rau kev kho mob ntawm angina pectoris, tshuaj levodopa).
- Faints, tshwm sim los ntawm lub plawv tsis ua haujlwm, tshwm sim li ntawm ib feem tsib ntawm cov neeg uas muaj kev tsaus muag.
- Kev ua txhaum ntawm cov ntshav thiab oxygen rau lub hlwb hauv qhov no yog txuam nrog kev mob plawv, tshwm sim hauv daim ntawv ntawm arrhythmias ntawm ntau yam xwm txheej, blockades, tachycardia, bradycardia, kev ua haujlwm tsis zoo ntawm cov pacemakers, thiab kev siv. ntawm cov tshuaj antiarrhythmic.
- Kab mob cuam tshuam rau lub plawv li qub (stenosis, insufficiency) ua rau nws nyuaj rau xa oxygen mus rau lub hlwb hlwb, uas tuaj yeem ua rau cardiogenic syncope.
- Tib yam ua rau qaug zog hauv lwm cov kab mob hauv lub plawv thiab cov hlab ntsha (angina pectoris, plawv nres, cardiomyopathy, aneurysm, qog, pericarditis, myocarditis, pulmonary embolism).
- Syncope hauv neurology tuaj yeem yog qhov xwm txheej cerebrovascular. Nyob rau hauv kev xyaum neurological, muaj lub tswv yim ntawm vertebrobasilar insufficiency, uas muaj xws li pathology ntawm cov hlab ntsha ntawm lub vertebral thiab cerebral basilar hlab ntsha vim osteochondrosis ntawm lub ncauj tsev menyuam nqaj qaum. Nyob rau hauv rooj plaub no, cov neeg mob txhawj xeeb txog kiv taub hau, thiab nrog kev tsis zoo ntawm cov ntshav mus rau lub hlwb, ib qho syncope yog ua tau.
- Ntseeg syndrome tuaj yeemtshwm sim nrog pathological nqaim los yog txhaws ntawm cov hlab ntsha subclavian, uas, ntxiv rau kiv taub hau thiab ob lub zeem muag, tuaj yeem ua rau qaug zog.
- Cov neeg laus laus tuaj yeem ua rau qaug zog vim kev sib tsoo ntawm lub paj hlwb cuam tshuam nrog spasms, ua rau hypoxia.
- Qhov kev ua ntawm qhov kub siab (kub stroke) ua rau cov hlab ntsha ntawm lub cev, cov ntshav mus rau qhov chaw, uas ua rau cov hlwb tsis muaj zaub mov noj thiab kev loj hlob ntawm cerebrovascular syncope.
Kev faib tawm ntawm syncope
Kev qaug zog tuaj yeem raug cais raws li ntau yam. Feem ntau, hom syncope raug txiav txim siab nyob ntawm qhov ua rau lawv ua:
1. Reflex syncope:
- Vasomotor cuam tshuam nrog kev cuam tshuam vascular kev tswj hwm ntawm lub paj hlwb autonomic.
- Vagus, uas yog, vim yog qhov tseem ceeb ntawm cov hlab ntsha vagus ntawm lub cev.
- Carotid, tshwm sim los ntawm kev cuam tshuam ncaj qha lossis tsis ncaj rau ntawm cov kab mob carotid rhiab heev.
2. Orthostatic syncope:
- Primary (nyob rau hauv cov kab mob ntawm lub paj hlwb xws li Parkinson's).
- Secondary (nrog rau cov kab mob hauv nruab nrog cev uas cuam tshuam rau peripheral paj hlwb, xws li ntshav qab zib neuropathy).
- Syncope tom qab hloov lub cev txoj haujlwm thiab thauj khoom.
- Zoo tom qab noj.
- Fainness tom qab noj qee yam tshuaj (blockers, diuretics, nitrates).
- Syncope tom qab nojcawv.
- Fooning vim txo cov ntshav ntim.
3. Cardiogenic Syncope:
- Txoj kev cuam tshuam nrog lub plawv dhia.
- Txoj kev ua haujlwm tsis zoo.
- Thaum lub pacemaker malfunctions.
- Vim cov tshuaj muaj txiaj ntsig ntawm cov tshuaj antiarrhythmic.
- Failing vim kab mob valvular.
- Syncope tom qab lossis thaum lub plawv nres.
- Fooning vim cov kab mob hauv lub plawv (myocarditis, myocardial dystrophy, myxoma, angina pectoris).
- Paroxysmal syncope vim kev puas tsuaj rau cov hlab ntsha loj (aortic aneurysm, pulmonary embolism).
4. Cerebrovascular Syncope:
- Nrog vertebrobasilar insufficiency.
- Fainting with steal syndrome.
- Nrog dyscirculatory encephalopathy ntawm vascular keeb kwm.
- Rau qhov kub hnyiab.
Kev kho mob tshwm sim hauv cov neeg laus
Tus mob syncope kho mob mus txog peb theem:
- theem pre-syncope yog tus cwj pwm los ntawm kev qaug zog, malaise, xeev siab, mob plab, darkening ntawm lub qhov muag. Daim tawv nqaij tig daj ntseg, tawm hws nce. Cov neeg mob feem ntau txhawj xeeb txog kiv taub hau, mob taub hau, tsis xis nyob hauv cheeb tsam ntawm lub plawv, xav tias tsis muaj cua txaus, palpitations. Tus mob no tsis tas yuav tshwm sim ua ntej faus thiab tuaj yeem kav ntev li ob peb feeb. Lub sijhawm no tus neeg yogNco ntsoov thiab nco ntsoov tias muaj dab tsi tshwm sim rau nws.
- Syncope nyob nruab nrab ntawm 20 vib nas this. Tsis muaj kev nco qab. Tag nrho cov nqaij ntawm lub cev so, cov menyuam kawm ntawv dilate, daim tawv nqaij yuav daj ntseg thiab ntub nrog hws, los yog tej zaum yuav qhuav.
- Lub sijhawm tom qab kev ntxhov siab yog qhov tshwm sim los ntawm kev rov qab los ntawm kev nco qab. Tus neeg tuaj yeem qaug zog thiab qaug zog. Feem ntau nws cuam tshuam los ntawm kev mob taub hau, tsis meej pem ntawm kev xav, kiv taub hau, tsis muaj zog, tsis xis nyob hauv siab. Lub xeev tom qab syncope feem ntau kav tsis ntev tshaj li ib nrab teev.
Nyob rau me nyuam
Syncope hauv cov menyuam yaus thiab cov tub ntxhais hluas yog qhov teeb meem loj heev thiab tshwm sim hauv 15% ntawm cov neeg qis dua 18.
Feem ntau hauv cov menyuam yaus muaj qhov cuam tshuam ntawm kev cuam tshuam nrog cov xwm txheej tsis zoo rau cov menyuam yaus, stimulation ntawm carotid sinus, vagal hyperfunction. Cardiogenic syncope tuaj yeem cuam tshuam nrog lub plawv tsis xws luag, arrhythmias (kwv yees li 11%).
Nws yog ib qho tseem ceeb kom sib txawv syncope los ntawm kev qaug dab peg. Thaum nug tus menyuam, nws tseem yuav tsum tau xam phaj cov pov thawj ntawm qhov tsis nco qab, kom paub meej tias cov tsos mob ua ntej nws li cas, txhua txoj haujlwm tau rov qab sai npaum li cas.
Qhov kev kho mob tshwm sim hauv cov menyuam yaus zoo ib yam li qhov tshwm sim nrog kev qaug zog hauv cov neeg laus. Ua ntej syncope, tus me nyuam yuav yws yws ntawm qhov tsis muaj zog, tsis muaj cua, suab nrov hauv pob ntseg, tsaus muag ntawm qhov muag, xeev siab, loog ntawm caj npab thiab txhais ceg. Nyob rau lub sij hawm tom qab-syncope, tus me nyuam yuav ntshai heev thiab pib quaj. Tsim nyogsoo thiab piav qhia rau tus menyuam tias muaj dab tsi tshwm sim.
Kev kuaj mob ntawm syncope
Yuav kom kuaj tau qhov tseeb, tus kws kho mob yuav tsum nug kom meej txog txhua qhov kev tsis nco qab, dab tsi ua ntej lawv, cov ntu no mus li cas, tus neeg mob tuaj txog thiab rov zoo li cas hauv lub sijhawm tom qab lub sijhawm.. Txhawm rau ua qhov no, nws yog ib qho tsim nyog yuav tsum tau ua ib qho kev soj ntsuam ntawm ib tug tim khawv ntawm lub xeev syncopal, txij li tus neeg mob nws tus kheej muaj lub tswv yim tsuas yog ib feem ntawm nws ua ntej thiab lub sij hawm tom qab rov pib nco qab.
Ntshav siab yog ntsuas siv lub tonometer nyob rau hauv lub xeev siab nyob rau hauv lub supine thiab sawv ntsug. Nws yog qhov zoo dua los ntsuas peb zaug.
Electrocardiography yuav pab ntsuas qhov kev sib tw ntawm lub plawv dhia, qhov tsis muaj qhov thaiv, kev tshwm sim ischemic, thiab mem tes.
Thaum kuaj pom qhov sib txawv, kev soj ntsuam txhua hnub ntawm lub plawv yog qhia siv lub tshuab ECG txuas nrog tus neeg uas yuav tsum ua tag nrho nws cov dej num ib txwm muaj thiab thauj khoom.
Yog tias muaj qhov sib txawv hauv kev saib xyuas txhua hnub lossis xav tias muaj cov kab mob hauv lub plawv, yuav tsum kuaj ultrasound.
CBC tuaj yeem kuaj pom ntshav qab zib, uas tuaj yeem ua rau qaug zog.
Txhawm rau tshem tawm lossis lees paub qhov tshwm sim ntawm kev qaug zog, cov neeg muaj hnub nyoog qis dua 40 xyoo tuaj yeem kuaj nrog carotid sinus massage nyob rau hauv lub supine txoj hauj lwm raws li kev tswj ntawm ECG thiab ntsuas ntshav siab. Qhov no yog qhov chaw hauv caj dab uas cov hlab ntsha carotid sib faib uasab hauv thiab sab nraud, muaj qhov sib txuam loj ntawm receptor hlwb lub luag haujlwm rau innervation ntawm cov hlab ntsha thiab lub plawv. Lawv qhov khaus ua rau kev ua kom lub paj hlwb parasympathetic, ua rau lub plawv dhia qeeb thiab poob ntawm cov ntshav siab. Cov tib neeg uas teb rau kev zaws nrog qhov txo qis hauv ob qho kev ntsuas (kev poob qis hauv systolic siab tsawg dua 50 mm Hg thiab tsis muaj lub ventricular contractions rau peb lub vib nas this) muaj qhov tsis txaus siab ntawm cov node, uas tuaj yeem ua rau reflex syncope, piv txwv li, nrog nruj. dab tshos los yog khi.
Kev kuaj Orthostatic tau ua nyob rau hauv cov xwm txheej uas xav tias syncope cuam tshuam nrog kev hloov hauv lub cev. Kev hloov pauv hloov pauv hloov pauv ntawm supine mus rau sawv ntsug tab tom ua tiav.
Differential Diagnosis
Differentiate fainting nrog rau cov xwm txheej hauv qab no:
- Cov teeb meem metabolic uas ua rau tsis nco qab, mus txog qhov tsis nco qab (hypo- thiab hyperglycemia, hypoxia, hypercapnia, hyperventilation).
- Txoj kev cuam tshuam ntawm ntau yam tshuaj.
- Kev tawm tsam ischemic.
- Cataplexy.
- Pseudo syncope hauv psychosis.
- Hysterical "faint".
- Panic tawm tsam.
Txhawm rau kom paub meej lossis tsis suav nrog cov tsos mob saum toj no, kev tshuaj xyuas yuav tsum tau ua kom tob. Kev kuaj ultrasound ntawm cov hlab ntsha ntawm lub caj dab, rheoencephalography yog ua los kawm txog cov ntshav cerebral. Electroencephalography tso cai rau kom tshem tawm qhov tshwm sim ntawm tus kab mob. Kev suav tomography lossis magnetic resonance imaging ntawm lub hlwb qhia tau hais tias nws cov qauv, vascular mob nyob rau hauv lub medulla, kuaj cov qog thiab cysts, nrog rau kev loj hlob anomalies.
Kev kuaj ntshav biochemical qhia txog qhov ntsuas ntawm cov metabolism. Kev tshawb fawb txog qib ntawm cov tshuaj hormones hauv cov ntshav pab txhawm rau txheeb xyuas cov kab mob endocrine.
Thaum dhau txhua qhov kev kuaj mob thiab pom qhov ua rau nyuaj, tus neeg mob yuav tsum raug xa mus rau tus kws kho mob hlwb lossis kws kho hlwb.
Kev kho thiab tiv thaiv
Syncope yog qhov laj thawj pom tus kws tshaj lij. Kev kho mob tuaj yeem nrog lossis tsis muaj tshuaj.
Hauv syncope, cov lus pom zoo rau kev coj tus cwj pwm ntxiv ntawm cov neeg mob yuav nyob ntawm qhov ua rau syncope.
Hloov pauv hauv kev ua neej nyob rau lub sijhawm reflex genesis, cuam tshuam nrog kev zam cov xwm txheej uas ua rau muaj kev cuam tshuam, yuav pab txo lawv cov lej kom tsawg. Koj yuav tsum tau tsawg dua hauv cov chav tsis muaj zog, tsis tuaj yeem ua pa rau lawv, hnav cov khaub ncaws xoob uas tsis txhawb nqa qhov chaw carotid ntawm caj dab.
Rau qhov nquag nquag ua haujlwm, uas ua rau cov neeg mob ua rau lub neej tsis zoo lossis tiv thaiv lawv los ntawm kev coj lub neej lawv xav tau (tsav tsheb, ua haujlwm siab, ua haujlwm kis las), lawv yuav tsum tau kho.
Kev qoj ib ce hla caj npab thiab txhais ceg tuaj yeem ua rau ntshav siab ntxiv rau ib ntus kom zamsyncope.
Muaj txoj hauv kev ntawm lub cev ntawm kev cob qhia cov neeg mob nrog orthostatic syncope kom nce lub sij hawm siv nyob rau hauv txoj hauj lwm ncaj ncees (kev qhia npe). Cov kev cob qhia no tau ua tiav maj mam dhau lub sijhawm ntev.
Cov tshuaj kho kom ruaj khov rau lub paj hlwb, suav nrog cov tshuaj tiv thaiv kev ntxhov siab, muab cov txiaj ntsig ib ntus thiab tsis sib haum. Siv tau rau hauv cov kab mob neurotic concomitant, suav nrog phobias thiab ceeb ntshai.
Cardiogenic syncope tau kho nrog rau qhov ua rau hauv qab. Nws yuav tsim nyog hu rau qhov chaw ntawm syncope thiab cardiac arrhythmias. Kev kho tshuaj yog ua tiav, nrog rau kev siv cov txheej txheem pacing.
Cov lus pom zoo kho mob rau syncope hauv cov neeg laus raug txo qis rau kev kho mob txhawm rau txhawm rau ua rau syncope. Feem ntau cov ua rau yog orthostatic, carotid thiab arrhythmic yam, nrog rau vascular pathology. Nws tshwm sim tias ntau qhov kev hem thawj ua rau tib tus neeg. Cov tshuaj noj los ntawm tus neeg mob no yuav tsum tau tshuaj xyuas txhawm rau txhawb kev pheej hmoo ntawm kev tsim cov syncope.
Txoj kev noj qab haus huv nrog kev noj zaub mov kom raug, zam kev tiv thaiv kev phom sij, kev tawm dag zog tsis tu ncua thiab kev ua si sab nraum zoov yuav pab tau zoo hauv kev kho mob qaug dab peg ntawm ib qho etiology.
Kev nyuaj siab
Vim tias syncope yog ib qho teeb meem hauv kev ua haujlwm ntawm lub paj hlwb cuam tshuamNrog rau ntau yam ua rau, ces lawv cov teeb meem yuav txawv nyob rau hauv cov nqe lus ntawm kev txaus ntshai rau lub neej thiab kev koom tes ntawm lub cev thiab lub cev.
Teeb meem ntawm fainting yog:
- Ntshai raug mob.
- Cardiac death syndrome (lub plawv nres).
- Asphyxia vim kev thim tus nplaig.
- Impaired nco thiab xav cov txheej txheem nrog nquag syncope vim txo cov ntshav perfusion hauv hlwb (tshwj xeeb tshaj yog cov neeg laus).
