Mitral stenosis yog kab mob hauv lub plawv uas tshwm sim los ntawm qhov nqaim ntawm qhov qhib ntawm sab laug ventricle thiab atrium. Xws li kev hloov pauv hauv cov qauv ntawm lub plawv ua rau muaj kev ua txhaum ntawm cov ntshav ncig thiab, raws li, cuam tshuam rau kev ua haujlwm ntawm txhua lub cev.
Tau kawg, cov neeg uas ntsib teeb meem zoo sib xws tab tom nrhiav cov ntaub ntawv ntxiv. Vim li cas pathology tshwm sim? Dab tsi yog thawj cov cim qhia ntawm mitral stenosis? Puas muaj kev kho mob zoo? Tus neeg mob yuav tsum xav li cas? Cov lus teb rau cov lus nug no tseem ceeb rau ntau tus nyeem.
Vim li cas thiaj tsim tau tus kab mob
Mitral stenosis ntawm lub plawv yog ib yam kab mob kis tau. Cov kws tshawb fawb txheeb xyuas ntau qhov laj thawj tseem ceeb rau kev txhim kho cov kab mob zoo li no.
- Raws li kev txheeb cais, kwv yees li 80% ntawm cov neeg mob, mitral stenosis yog tshwm sim los ntawm rheumatism - ib pab pawg ntawm cov kab mob uas muaj nrog cov ntaub so ntswg puas. Nyob rau hauv lem, lingering tonsillitis los yog mob tonsillitis feem ntau ua rau rheumatism.
- rau yamkev pheej hmoo kuj suav nrog cov kab mob sib kis uas cuam tshuam rau cov ntaub so ntswg ntawm lub plawv (piv txwv li, endocarditis).
- Ntxoov (stenosis) ntawm mitral valve tuaj yeem ua rau mob atherosclerosis, nrog rau kev tsim cov ntshav txhaws hauv plawv.
- Tus kab mob tuaj yeem tawm tsam keeb kwm ntawm kev raug mob plawv (nrog rau tom qab kev phais, xws li hloov lub mitral valve).
- Lwm yam muaj feem yuav muaj xws li mob syphilis, mitral valve cov ntaub so ntswg calcification, thiab aortic insufficiency.
Mitral stenosis: hemodynamics thiab nws cov yam ntxwv
Nquag, thaj tsam ntawm qhov qhib ntawm sab laug atrium thiab ventricle yog 4 txog 6 square centimeters. Tawm tsam keeb kwm yav dhau los ntawm nws txoj kev nqaim, hemodynamic cuam tshuam loj tuaj, vim tias cov txheej txheem ntawm cov ntshav los ntawm sab laug atrium mus rau hauv lub ventricle yuav nyuaj. Lub siab nyob rau hauv lub atrial kab noj hniav nce mus rau 20-25 mm Hg. Art. (feem ntau daim duab no yog 5). Kev nce hauv siab ua rau maj mam hypertrophy ntawm qhov no ntawm myocardium. Cov txheej txheem them nyiaj no pab ua kom lub plawv ua haujlwm, tab sis hmoov tsis zoo qhov stenosis nce.
Raws li tus kab mob no zuj zus, muaj qhov nce siab hauv cov hlab ntsws pulmonary, uas ua rau kev loj hlob ntawm pulmonary hypertension. Lub load ntawm sab xis ntawm lub plawv nce. Maj mam, cov txheej txheem dystrophic thiab sclerotic pib hauv myocardium, uas ua rau txo qis hauv kev ua haujlwm ntawm lub plawv.
Cov qauv thiab theem ntawm kev loj hlob ntawm pathology
Yog koj xav txogthaj tsam ntawm qhov qis ntawm atrioventricular orifice, tom qab ntawd plaub qib ntawm mitral stenosis tuaj yeem paub qhov txawv.
- First degree - nqaim me ntsis, thaj tsam ntawm lub qhov yog 3 square centimeters.
- Yog hais tias peb tab tom tham txog qib thib ob ntawm stenosis, ces qhov loj ntawm lub qhov yog 2.3-2.9 square meters. saib
- Qib thib peb twb tau hais tawm stenosis, nrog rau qhov nqaim ntawm lub qhov mus rau 1, 7-2, 2 square meters. saib
- Qib plaub yog hu ua daim ntawv tseem ceeb ntawm mitral stenosis. Qhov chaw ntawm qhov qhib ntawm lub ventricle thiab lub atrium nqaim mus rau 1-1.6 square meters. saib
Nws tsim nyog sau cia tias mitral stenosis tshwm sim nyob rau hauv tsib theem, txhua tus uas muaj cov tsos mob tshwj xeeb thiab teeb meem.
- Thawj theem hu ua lub sijhawm them nyiaj tag nrho. Qhov nqaim ntawm atrioventricular lumen me me, thiab lub plawv tseem ua haujlwm nrog nws cov haujlwm yooj yim heev. Cov neeg mob tsis qhia qhov tsis txaus siab. Yog hais tias tus pathology raug kuaj nyob rau theem no, ces nws yog kiag li kev huam yuaj.
- Qhov thib ob yog theem ntawm kev txheeb ze ntawm cov hlab ntshav tsis ua haujlwm. Lub qhov nqaim, sab laug ntawm myocardium pib nce. Nyob rau theem no, qee cov tsos mob twb tshwm sim - venous siab nce me ntsis, tus neeg yws yws ntawm kev ua tsis taus pa hnyav uas tshwm sim thaum lub cev ua si.
- theem peb yog qhov pib ntawm kev txhim kho ntawm cov hlab ntshav tsis ua haujlwm. Nyob rau theem no, muaj stagnation ntawm cov ntshav ob leeg nyob rau hauv me me thiab nyob rau hauv lub systemic ncig. Lub plawv loj heev. Thaum lub sijhawm tshuaj xyuas, koj tuaj yeem pommuaj zog nce hauv venous siab. Vim cov ntshav khiav tsis zoo, qhov nce hauv siab tau pom.
- Nyob rau theem plaub, circulatory tsis ua hauj lwm twb pronounced. Nyob rau hauv ib lub voj voog loj, cov ntshav stagnation tshwm sim, uas ua rau tsim edema, kev loj hlob ntawm ascites. Nyob rau theem no, ntu ntawm atrial fibrillation feem ntau pom.
- Thaum theem tsib, thaj tsam ntawm lub qhov tsis pub tshaj 1 square centimeter. Lub plawv loj heev, venous siab yog nce. Ua tsis taus pa cuam tshuam tus neeg mob txawm tias thaum so. Cov neeg mob kuj raug kev txom nyem los ntawm pronounced edema. Ntau thiab ntau cov kua dawb accumulates nyob rau hauv lub plab kab noj hniav. Kev kho mob yuav luag tsis muaj txiaj ntsig.
Mitral stenosis cov tsos mob
theem pib ntawm kev loj hlob ntawm tus kab mob yog feem ntau asymptomatic. Cov cim qhia pom tseeb ntawm mitral stenosis tshwm sim yog tias qhov qhib atrioventricular raug txo mus rau 2 square centimeters. Cov neeg mob raug kev txom nyem los ntawm qhov ua tsis taus pa tsis tu ncua. Thiab yog tias thaum xub thawj ua tsis taus pa tshwm sim tsuas yog thaum lub sijhawm ua haujlwm ntawm lub cev, ces yav tom ntej lawv cuam tshuam tus neeg mob txawm tias so. Cov npe ntawm cov tsos mob kuj suav nrog hnoos hnyav, uas qee zaum nrog cov hnoos qeev nrog cov ntshav streaks.
Hmo ntuj, cov neeg mob raug mob hawb pob. Muaj cov leeg tsis muaj zog, qaug zog tas li, nce qaug zog. Cov neeg raug kev txom nyem los ntawm insomnia, thiab qhov no tsis tuaj yeem tab sis cuam tshuam rau lawv lub siab lub ntsws. Cov tsos mob ntawm tus neeg mob kuj hloov - daim di ncauj thiab lub qhov ntswgua bluish, thiab purplish-bluish me ntsis nrog cov npoo ntshiab tshwm rau ntawm lub puab tsaig (ib yam ntawm "tus menyuam roj hmab blush").
Cov neeg mob nco ntsoov lub plawv dhia tsis tu ncua. Qee lub sij hawm muaj kev mob hauv cheeb tsam ntawm lub siab.
Thaum nws nce mus, lwm cov tsos mob tshwm sim. Mitral stenosis yog tshwm sim los ntawm cov tsos mob ntawm peripheral edema. Koj tuaj yeem soj ntsuam qhov o ntawm tus neeg mob lub caj dab cov leeg - cov hlab ntsha tau pom meej hauv qab ntawm daim tawv nqaij txawm tias so. Muaj peev xwm tsub zuj zuj ntawm cov kua nyob rau hauv lub plab kab noj hniav, nrog rau ntawm cov nplooj ntawv ntawm lub pleura ntawm lub ntsws (ib tug pronounced circulatory disorder feem ntau ua rau pulmonary edema).
Cov teeb meem dab tsi ua rau pathology ua rau?
Mitral stenosis yuav tsum tsis txhob ignored. Qhov tseeb yog tias thaum tsis muaj kev kho mob, tus kab mob ua rau muaj teeb meem txaus ntshai heev.
- Qee tus neeg mob tsim sab laug ventricular tsis ua haujlwm, feem ntau hu ua mob ntsws asthma, vim yog tus kab mob. Cov neeg mob raug kev txom nyem los ntawm kev ua tsis taus pa ib ntus, uas tshwm sim ob qho tib si thaum lub sijhawm ua haujlwm lub cev thiab so.
- Nyob hauv cov hlab ntsha pulmonary, lub siab nce siab, uas yog nrog los ntawm kev tsis xis nyob tom qab lub sternum, nrog rau ua tsis taus pa hnyav. Nyob rau hauv lub zog ntawm lub siab, phab ntsa ntawm lub hlab ntsha tuaj yeem nthuav dav, ua rau muaj qhov tsis txaus ntseeg. Nrog xws li pathology, qhov kev pheej hmoo ntawm kev tawg ntawm cov hlab ntsha yog siab, uas ua rau tus neeg mob tuag.
- Qee lub sij hawm muaj ntau yam kev cuam tshuam lub plawv dhia, tshwj xeeb atrial fibrillation thiab flutter.
- Thromboembolism - ntauib qho txaus ntshai tshwm sim ntawm mitral stenosis. Cov hlab ntsha tawg tuaj yeem thaiv cov hlab ntsha, tshwj xeeb tshaj yog cov hlab ntsha pulmonary, uas, thaum tsis muaj kev kho mob tam sim, tuaj yeem ua rau tuag taus.
- Tawm tsam keeb kwm yav dhau los ntawm tus kab mob, sab laug ib nrab ntawm lub plawv nce qhov loj me thiab qee zaum ua rau cov hlab ntsha thiab cov hlab ntsha nyob ze.
ntsuas ntsuas
Thaum qhov ua txhaum me me tshwm sim, koj yuav tsum sab laj nrog kws kho mob tas li. Kev kuaj mob ntawm mitral stenosis yog txheej txheem nyuaj uas suav nrog ntau cov txheej txheem. Nws yog ib qho tseem ceeb tsis yog tsuas yog kom paub meej tias muaj qhov nqaim ntawm atrioventricular orifice, tab sis kuj txiav txim siab theem thiab qib ntawm stenosis, txhawm rau txheeb xyuas cov teeb meem cuam tshuam nrog pathology, txheeb xyuas qhov ua rau.
- Ua ntej koj yuav tsum sau keeb kwm tiav. Tus kws kho mob yuav nug cov tsos mob dab tsi thab tus neeg, thaum twg thiab qhov tshwm sim ntawm qhov tshwm sim. Nws tseem yog ib qho tseem ceeb kom paub seb tus neeg mob puas mob caj pas thaum yau, seb puas muaj tonsillitis ntev, seb tus menyuam puas tau sau npe nrog kws kho mob. Ntawm chav kawm, tus kws kho mob tshwj xeeb xav paub txog cov ntaub ntawv hais txog kev ua neej, piv txwv li, tus neeg mob lub cev ua haujlwm, kev noj zaub mov zoo, muaj tus cwj pwm tsis zoo. Tag nrho cov ntaub ntawv no tseem ceeb hauv kev kuaj mob xws li mitral stenosis.
- Auscultation thiab kuaj lub cev tseem ceeb sib npaug. Tus kws kho mob tuaj yeem mloog lub siab lub suab, pom tias muaj kev hloov pauv pathological, qhov tsos ntawm cov tsis zoo li diastolic yws. Tus kws kho mob tshwj xeeb kuj txiav txim seb hom lub cev, tshuaj xyuas daim tawv nqaij.
- kuaj ntshav thiab zis yog qhov yuav tsum tau ua. Cov kev tshawb fawb no pab txiav txim seb muaj cov txheej txheem inflammatory hauv lub cev.
- Cov ntaub ntawv zoo heev yog kuaj ntshav biochemical. Thaum lub sij hawm soj ntsuam kuaj, kev saib xyuas feem ntau yog them rau qib ntawm cov roj (cholesterol) - nws nce nyob rau hauv lub xub ntiag ntawm atherosclerosis. Cov ntshav tseem raug kuaj xyuas kom pom muaj cov tshuaj antistreptolysin-O - qhov no yog ib yam khoom tshwj xeeb uas tau tsim tom qab raug tus kab mob streptococcal, xws li tonsillitis, tonsillitis. Yog tias C-reactive protein muaj nyob rau hauv tus neeg mob cov ntshav kuaj, qhov no qhia tau hais tias muaj ib tug mob inflammatory txheej txheem.
- Cov npe ntawm cov txheej txheem kuaj mob suav nrog coagulogram. Txoj kev tshawb no ua rau nws muaj peev xwm ntsuas qhov kev pheej hmoo ntawm cov ntshav txhaws thiab, yog tias tsim nyog, kho cov txheej txheem kho mob.
- Electrocardiography tseem yuav tsum tau ua. Qhov no yog ib txoj kev kawm yooj yim thiab pheej yig uas tso cai rau koj los txiav txim siab qhov nce ntawm sab laug thiab sab xis ventricles, txhawm rau txheeb xyuas qee lub plawv arrhythmias. Xav paub ntau ntxiv yog kev soj ntsuam ECG txhua hnub.
- Echocardiography yog ib qho kev kuaj ultrasound uas tso cai rau koj los tshuaj xyuas cov nplooj ntawv ntawm lub mitral valve, kuaj pom muaj cov kab mob, thiab txiav txim siab qhov loj ntawm atrioventricular orifice. Tsis tas li ntawd, thaum lub sijhawm ua haujlwm, tus kws tshaj lij tuaj yeem tshawb pom cov ntshav txhaws, neoplasms, tsub zuj zuj ntawm cov calcifications ntawm cov nplooj ntawv valve.
- X-ray tso cai rau koj kuaj mob pulmonary edema. Ntawm cov duab koj tuaj yeem pom tias tus neeg mob lub siab tau loj tuaj.
- Transesophageal echocardiography tso cai ntau duatshuaj xyuas lub plawv, qhib thiab li qub kom ntxaws. Ib qho ultrasound sojntsuam yog ntxig los ntawm txoj hlab pas. Phab ntsa ntawm lub cev no nyob ze ntawm lub plawv, yog li tus kws kho mob tuaj yeem tau txais cov duab tseeb.
- Qee zaum tus neeg mob raug xa mus rau kev sab laj nrog kws kho mob plawv, nrog rau tus kws kho mob rheumatologist.
Kev tshawb fawb tau tsuas yog kawm thiab txiav txim siab los ntawm tus kws kho mob.
Tshuaj kho thiab nws cov yam ntxwv
Tom qab kuaj tau tiav lawm, tus kws kho mob yuav tuaj yeem tsim kho cov txheej txheem kho tau zoo.
- Yog tias tus neeg mob muaj daim ntawv mus tas li ntawm atrial fibrillation, nrog rau kev txo qis hauv kev cog lus ntawm txoj cai ventricle, ces cov kws kho mob tau sau cov tshuaj plawv glycosides, tshwj xeeb tshaj yog Strofantin, Korglikon.
- Beta-blockers yog siv los ua kom lub plawv dhia zoo li qub. "Bisoprolol", "Carvedilol" yog suav tias yog siv tau.
- Diuretics pab txo qhov o, tshem tawm cov kab mob hauv lub ntsws. Raws li txoj cai, cov tshuaj xws li Furosemide, Veroshpiron yog siv.
- Cov kev kho mob tseem suav nrog cov tshuaj tiv thaiv kab mob uas tiv thaiv lub plawv ntawm kev puas tsuaj ("Ramipril", "Captopril").
- Nitrates yog siv los nthuav cov hlab ntsha thiab txo cov ntshav siab, tshwj xeeb yog Nitrosorbide, Nitroglycerin.
- "Heparin", "Aspirin", "Tromboass" yog siv los txo cov ntshav. Qhov no yuav txo tau cov ntshav txhaws, kev loj hlob ntawm thromboembolism.
- Thaum lub sijhawm mob rheumatism, nws yuav tsum tau noj tshuaj tiv thaiv kab mob ("Diclofenac", "Ibuprofen", "Nimesulide"). Kuj sivtshuaj tua kab mob penicillin.
Nws yuav tsum nkag siab tias kev kho mob ntawm mitral stenosis tsis tuaj yeem cawm tib neeg los ntawm tus kab mob no. Cov tshuaj tsuas yog siv los txo cov tsos mob thiab ua rau qeeb zuj zus ntxiv ntawm tus kab mob.
kev kho mob phais
Kev kho mob ntawm mitral stenosis tam sim no tsuas yog txoj hauv kev zoo los ua kom lub plawv zoo li qub thiab tiv thaiv kev txhim kho ntxiv ntawm tus kab mob.
- Qee lub sij hawm ib qho percutaneous commissurotomy tau ua. Cov txheej txheem yog ua tsis tau qhib lub hauv siab. Lawv nkag mus rau hauv lub plawv los ntawm cov hlab ntsha femoral. Nrog kev pab los ntawm ib tug tshwj xeeb saj zawg zog hollow raj, tus kws kho mob dissects qhov chaw ntawm lub acretion ntawm lub qhov. Cov txheej txheem no tso cai rau koj ua ob npaug ntawm nws thaj chaw.
- Kaw mitral commissurotomy cuam tshuam nrog kev phais hauv siab. Muaj tseeb, lub plawv tsis qhib thiab lub plawv- ntsws tshuab tsis siv. Tus kws kho mob nkag mus rau hauv lub plawv los ntawm sab laug atrial appendage thiab tshem tawm cov fusion nrog nws tus ntiv tes.
- Qee zaum nws yuav tsum tau txiav cov nplooj ntawv fused ntawm lub mitral valve. Qhov no yog kev ua haujlwm puv ntoob, suav nrog kev siv cov khoom siv dag zog thiab kev phais hauv lub plawv, ua raws li suturing.
- Yog hais tias muaj qhov hais tawm deformation ntawm lub valve, ces mitral valve hloov yog ua.
Kev phais yuav tsis ua rau thawj theem ntawm kev loj hlob. Nyob rau hauv lub neej yav tom ntej, tsis muaj kev pab los ntawm kws phais neeg, nws tsis zoo lituaj yeem xa nrog.
Tau kawg, cov txheej txheem zoo li no cuam tshuam nrog qee qhov teeb meem. Piv txwv li, ib txwm muaj kev pheej hmoo ntawm cov ntaub so ntswg nrog kev txhim kho ntxiv ntawm qhov mob. Kev ua haujlwm feem ntau ua rau cov ntshav txhaws. Raws li rau cov khoom siv dag zog, qee zaum cov khoom siv ntawm cov pob qij txha pib tawg - qhov no yuav tsum tau tshem tawm cov seem ntawm lub valve thiab rov ua cov khoom siv ntxiv.
Kev ua neej zoo
Tau kawg, tshuaj yog ib feem tseem ceeb ntawm kev kho. Tab sis muaj qee cov cai uas cov neeg mob mitral stenosis yuav tsum ua raws. Cov kws kho mob cov lus pom zoo yog raws li nram no:
- kev noj zaub mov yuav tsum sib npaug, nrog rau zaub mov lub cev yuav tsum tau txais tag nrho cov as-ham tsim nyog;
- koj yuav tsum tau saib xyuas kev haus dej haus cawv, txwv cov ntsev ntawm lub rooj - qhov no yuav pab tiv thaiv kev tsim cov edema thiab ntshav siab;
- nws yog ib qho tseem ceeb kom ua raws li kev ua haujlwm kom raug thiab so, tsis txhob ua haujlwm dhau, pw txaus;
- cov kws tshaj lij pom zoo kom tsis txhob ua kom lub cev muaj zog, tab sis ua kom haum (piv txwv li, taug kev ntev hauv huab cua ntshiab yuav pab tau);
- koj yuav tsum sim kom tsis txhob muaj kev ntxhov siab (cov kws kho mob qhia kom ua kev xav, vim lawv tso cai rau koj kom muaj kev sib npaug ntawm kev xav).
Kev Tiv Thaiv: tiv thaiv stenosis?
Kev tiv thaiv tshwj xeeb ntawm mitral stenosis, hmoov tsis, tsis muaj. Cov kws kho mob qhia kom tsis txhob kis tus kab mob.
keeb kwm ntawm kev txhim khontau yam kab mob yog lub cev tsis muaj zog, yog li nws yuav tsum tau ntxiv dag zog rau txhua txoj hauv kev. Nws yog ib qho tseem ceeb kom tswj tau lub cev zoo, noj kom raug, noj cov vitamin complexes ib ntus, siv sij hawm ntau sab nraum zoov, koom nrog kev ua si sab nraum zoov, thiab zam kev ntxhov siab.
Nws yog ib qho tseem ceeb los kho tonsillitis thiab tonsillitis hauv lub sijhawm. Yog tias tsis kho, cov kab mob no tuaj yeem ua tau ntev. qeeb tab sis tas li o hauv cov tonsils tuaj yeem ua rau muaj kev txhim kho ntawm rheumatism, uas ua rau muaj kev pheej hmoo ntawm mitral valve stenosis.
Tsis muaj teeb meem koj yuav tsum tsis kam mus kuaj mob. Tsawg kawg ib xyoos ib zaug, koj yuav tsum pub ntshav rau kev tsom xam (nws yog ib qho tseem ceeb rau kev kuaj mob rheumatic), ua electrocardiography. Cov neeg mob uas twb muaj mob rheumatism yuav tsum tau sau npe nrog tus kws kho mob rheumatologist thiab kws kho plawv, thiab mus kuaj mob tas li. Qhov kuaj pom tus kab mob sai dua, txoj hauv kev ua tiav ntau dua.
Kev ntsuas rau cov neeg mob
Mitral valve stenosis yog ib yam kab mob txaus ntshai. Thaum tsis muaj kev phais, kev muaj sia nyob tsib xyoos (los ntawm lub sijhawm kuaj mob) ntawm cov neeg mob yog kwv yees li 50%. Txawm hais tias muaj tus kab mob me me, noj cov tshuaj kom raug thiab ua lub neej zoo, tib neeg tsuas muaj hnub nyoog 45-50 xyoo xwb.
Txoj kev kho tau zoo niaj hnub no yog kev phais. Mitral stenosis tuaj yeem kov yeej, txawm li cas los xij, kwv yees li 30% ntawm cov neeg mob nyob rau 10 xyoo tom ntej, cov neeg mob tsim kho postoperative restenosis, uas yuav tsum tau rov ua dua.phais kev cuam tshuam. Nrog kev pab ntawm cov tshuaj niaj hnub no, nws muaj peev xwm ua kom lub neej ntev ntawm tus neeg mob, tshem tawm qhov tsis xis nyob thiab cov tsos mob.
