yog dab tsi - myocardial ischemia, tsis yog txhua tus paub. Lo lus no yog siv los txhais cov xwm txheej uas lub cev lossis ib feem ntawm lub cev tau txais oxygen tsis txaus. Yog li ntawd, oxygen tshaib plab tshwm sim.
Ischemia tuaj yeem tshwm sim rau ntau yam, nws tuaj yeem yog cov tsos mob ntawm cov mob hnyav heev, tshwj xeeb, xws li mob plawv. Nrog rau kev kawm ntev, nws dhau mus ntev thiab xav tau kev kho mob hnyav.
Ntxhais kab mob
Txawm hais tias cov leeg nqaij hauv lub plawv tsis tu ncua nrog cov ntshav, nws tsis tau txais oxygen thiab cov as-ham los ntawm nws. Qhov no tuaj yeem tshwm sim los ntawm qhov tseeb tias lub plawv tau npog sab hauv los ntawm endocardium, uas yog, cov ntaub so ntswg sab hauv uas tiv thaiv kev nqus ntawm cov ntshav mus rau hauv lub plawv.
Myocardium ua haujlwm ib puag ncig lub sijhawm, thiab xav tau cov khoom siv hluav taws xob thiab nws yog qhov siab heev. Cov hlab ntsha coronary, uas qhwv lub cev los ntawm txhua sab, muab cov khoom noj thiab cov pa oxygen rau lub plawv cov leeg. Lawv tus nqi yog qhov zoo heev, txij li los ntawm ib txwm muajKev ua haujlwm ntawm lub plawv nyob ntawm kev noj qab haus huv ntawm tag nrho cov kab mob. Yog li ntawd, thaum lub sijhawm muaj tus kabmob, kev ua haujlwm ntawm cov kabmob hauv nruab nrog cev yuav raug cuam tshuam.
Ntau tus neeg xav txog nws yog dab tsi - myocardial ischemia, vim li cas tus kab mob tshwm sim, nws muaj dab tsi tshwm sim. Qhov no yog ib qho mob uas muaj cov pa oxygen tshaib plab ntawm lub plawv cov leeg. Nws tshwm sim rau ntau yam laj thawj thiab tuaj yeem ua rau muaj teeb meem loj rau lub sijhawm.
Ntau heev yog mob myocardial ischemia (ICD-10 - I25.6), uas yuav luag asymptomatic, tab sis tuaj yeem ua rau muaj teeb meem loj. Muaj kev sib raug zoo ntawm qhov tshwm sim thiab hnub nyoog ntawm tus neeg mob. Qhov siab tshaj plaws yog pom nyob rau hauv tib neeg tom qab 50 xyoo.
Cov poj niam feem ntau ntsib kev mob ischemia, thaum mob ischemia feem ntau tshwm sim hauv cov txiv neej. Rau cov poj niam, qhov kev pheej hmoo tseem ceeb ntawm qhov pib ntawm tus kab mob yog qhov pib ntawm lub cev tsis muaj zog, thaum lub sij hawm muaj kev nce qib ntawm cov roj (cholesterol) thiab nyiam ua kom siab.
Type of ischemia
Nws yog ib qho tseem ceeb tsis tsuas yog kom paub tias myocardial ischemia yog dab tsi, tab sis kuj muaj hom kab mob dab tsi. Cov no suav nrog cov hauv qab no:
- painless;
- mob plawv tuag;
- angina;
- cardiosclerosis;
- myocardial infarction.
Painless form - ib hom kab mob plawv ischemic, uas muaj cov yam ntxwv tshwm sim hauv kev ntsuas los yog kuaj lub plawv. Qhov txawvIb qho tshwj xeeb yog qhov tsis muaj mob lossis lwm yam cim ntawm ischemia. Tsis tas li ntawd, hom kab mob no tshwm sim rau cov neeg mob uas tsis muaj qhov mob rhiab heev lossis hauv cov neeg uas tau mob plawv yav dhau los.
Kev mob plawv tuag yog myocardial ischemia, uas ua rau lub plawv nres thiab tuag ntawm tus neeg mob. Ib qho kev ua txhaum zoo sib xws tshwm sim thaum cov hlab ntsha tseem ceeb raug thaiv. Angina pectoris yog ib qho myocardial ischemia rov tshwm sim, qhov kev tawm tsam uas yog nrog los ntawm qhov mob hnyav heev tom qab lub sternum, hnov qhov kub, ua tsis taus pa thiab ua kom lub plawv dhia.
Myocardial infarction yog ib qho mob ischemia uas ua rau tuag ntawm ib feem ntawm cov leeg nqaij thiab kev ua haujlwm tsis zoo. Cardiosclerosis yog ib daim ntawv nyuaj ntawm tus kab mob, thaum, raws li qhov tshwm sim ntawm oxygen tshaib plab, ib feem ntawm lub plawv cov leeg tau hloov los ntawm cov ntaub so ntswg uas tsis tuaj yeem ua nws txoj haujlwm ib txwm.
Painless ischemia
Dab tsi yog myocardial ischemia? Cov tsos mob thiab kev kho mob ntawm tus kab mob no tseem ceeb heev uas yuav tsum paub rau cov neeg uas tau kuaj pom tus kab mob no. Heev feem ntau muaj ib daim ntawv mob ntawm tus kab mob. Kev kuaj mob kom raug tsuas yog ua nrog cov cuab yeej siv ntxiv xwb.
Rau qhov mob myocardial ischemia, tag nrho cov txheej txheem ntawm kev loj hlob zoo ib yam yog nyob rau hauv lwm cov ntaub ntawv kho mob, nrog rau qhov sib txawv tsuas yog tias lawv yog episodic thiab tsis nrog rau kev loj hlob ntawm cov yam ntxwv kho mob daim duab.
Daim ntawv tsis mob ntawm myocardial ischemia tuaj yeem tshwm sim sib npaug feem ntau hauv cov tib neeg uas tsis muaj kev kuaj mob yav dhau los, thiab hauv cov neeg mob uas raug kev txom nyem los ntawm lwm cov ntaub ntawv kho mob ntev.pathology, xws li angina pectoris.
Qhov tshwm sim ntawm qhov tsis mob ischemia yog txhawb los ntawm kev txo qis ntawm qhov mob tag nrho rau ntau yam stimuli. Lub hauv paus pathogenetic yog qhov xav tau ntawm lub plawv cov leeg rau oxygen.
Yuav kom kuaj mob, yuav tsum muaj kev tshuaj ntsuam xyuas uas siv cov cuab yeej cuab tam.
Kev tshwm sim
Ntawm cov laj thawj tseem ceeb ntawm myocardial ischemia, nws yog ib qho tsim nyog los qhia txog cov hauv qab no:
- tsis muaj poov tshuaj;
- spasm ntawm cov hlab ntsha coronary;
- thaiv cov hlab ntsha;
- overweight;
- kab mob ntawm endocrine system;
- kev ua neej nyob.
Txhua cov hlab ntsha pub ib feem ntawm lub plawv cov leeg, yog li thaum ib qho ntawm cov hlab ntsha raug thaiv, lawv nyob twj ywm tsis muaj zaub mov. Nrog hypokalemia, muaj ntau ntau cov kua thiab sodium, uas ua rau cov ntaub so ntswg edema. Lub cell edematous tsis tuaj yeem nqus cov as-ham thiab ua haujlwm ib txwm muaj.
Cov tsos mob tseem ceeb
Cov tsos mob ntawm myocardial ischemia hauv txhua kis tuaj yeem tshwm sim lawv tus kheej hauv ntau txoj kev sib txawv. Txawm li cas los xij, muaj ntau cov tsos mob uas yog tus yam ntxwv ntawm yuav luag txhua hom kab mob coronary artery. Ntawm cov paib sab nraud, nws yog ib qho tsim nyog yuav tsum tau qhia xws li:
- pom qhov kub hnyiab, mob paroxysmal tom qab lub sternum;
- xav qaug zog;
- yuav muaj qee zaus xeev siab;
- tus neeg mob yws tias ua tsis taus pa lossis ua tsis taus pa thaum so.
Cov tsos mob tseem ceeb ntawm myocardial ischemia yuav nyob deb, thaum tsis xis nyob tshwm sim thiab tom qab ntawd ploj mus ntawm nws tus kheej. Qhov no ua rau tus neeg xav tias nws tsuas yog malaise lossis nkees.
Ntxiv rau, nrog qee hom myocardial ischemia, tsis muaj qhov cim qhia kiag li. Nyob rau hauv cov ntaub ntawv no, lub pathology tsuas yog kuaj thaum lub sij hawm echocardiography los yog ECG.
Diagnostics
Nws yog ib qho tseem ceeb heev rau kev kuaj mob myocardial ischemia thiab kho nws raws sijhawm los tiv thaiv kev txhim kho ntawm cov teeb meem. Qee zaum, nws tshwm sim tias sab nraud cov cim qhia ntawm pathology yog qhov tsis tuaj. Diagnosis implies:
- kev tshuaj xyuas tus neeg mob;
- sau thiab tshuaj xyuas ntawm anamnesis;
- kev ntsuas ntsuas thiab ntsuas ntsuas.
Instrumental txoj kev tshawb fawb tseem ua tau zoo tshaj plaws, tshwj xeeb, xws li:
- electrocardiography;
- kab mob plawv;
- echocardiography;
- tomography;
- kuaj mob ultrasound;
- dopplerography ntawm cov hlab ntsha;
- angiography;
- intraesophageal electrocardiography;
- Holter saib xyuas.
Tsis tas li ntawd, kev kuaj mob hauv chaw kuaj mob tseem ceeb heev rau kev kuaj pom tus kab mob, vim tias ischemia yog tus cwj pwm los ntawm kev hloov pauv hauv cov ntsuas xws li:
- troponins;
- Ycreatine phosphokinase;
- myoglobin;
- aminotransferase.
Tam sim no, feem ntauECG yog suav tias yog ib txoj hauv kev los kuaj pom cov kab mob no. Nws yog ib qho kev kawm tsis ncaj uas ua rau nws muaj peev xwm txheeb xyuas cov kev hloov pauv hauv kev ua haujlwm ntawm myocardium. Txhua txoj kev kuaj mob siv tau tso cai rau peb los ntsuas qhov xwm txheej ntawm cov kab mob thiab xaiv cov kev kho uas xav tau.
Txoj kev kho mob
Kev kho mob yog sau raws li cov txiaj ntsig ntawm kev kuaj mob. Txhua tus neeg mob uas muaj cov tsos mob ntawm cov ntshav tsis txaus yuav tsum tso tus cwj pwm phem, ua kom lawv cov zaub mov zoo, thiab txo qis kev ntxhov siab.
txhawm rau txhawm rau ua haujlwm ntawm cov hlab plawv thiab cov hlab plawv, cov neeg mob tau muab cov tshuaj xws li:
- ACE inhibitors;
- tshuaj tiv thaiv kab mob;
- statins;
- beta blockers;
- Ydiuretics;
- antiarrhythmics;
- Yorganic nitrates.
Kev xaiv tshuaj thiab nws qhov ntau npaum li cas yog txiav txim siab nyias rau txhua tus neeg mob. Nyob rau tib lub sijhawm, kev kuaj mob ntawm pathology thiab muaj contraindications rau cov tshuaj xaiv yog qhov tseem ceeb heev. Qee zaum, ntu ntawm myocardial ischemia yog qhov tsawg heev thiab yuav luag asymptomatic, yog li tus kab mob tuaj yeem kuaj pom tau nyob rau theem siab.
Kev ua kom cov ntshav ncig hauv qhov no tsis tuaj yeem ua tiav los ntawm kev siv cov kev kho mob nkaus xwb. Nrog rau cov kab mob zoo li no, tus neeg mob tau pom zoo kom kho mob kho mob ntawm cov kev hloov pauv tshwm sim hauv cov hlab ntsha coronary. Qhov no yuav tsum tau phais radical thiab endovascular. Kev xaiv ntawm txoj kev cardiocorrectionraug txiav txim nruj ib leeg nyob ntawm txhua rooj plaub.
Yog tias nws muaj peev xwm los kho cov ntshav ncig hauv thaj tsam ntawm ischemia, xws li kev cuam tshuam tsawg kawg nkaus li angioplasty nrog stenting tuaj yeem ua tau. Nrog rau qhov mob loj heev, kev ua haujlwm loj dua tau ua tiav.
Tshuaj
Nyob rau hauv mob thiab mob myocardial ischemia, yuav tsum tau noj tshuaj. Kev xaiv ntawm qee yam txhais tau tias yog txiav txim siab rau txhua tus neeg mob sib cais, nyob ntawm qhov kev tshawb nrhiav kev kuaj mob.
Yeej, cov kws kho mob tau sau cov tshuaj tiv thaiv kab mob, tshwj xeeb, xws li Cardiomagnyl, Aspirin cardio, Thrombo ass. Lawv normalize cov txheej txheem ntawm cov ntshav ncig, thiab txo cov load ntawm myocardium.
Beta-blockers xws li Nebivolol, Carvedilol thiab Bisoprolol yuav pab txo qis lub plawv dhia thiab myocardial oxygen xav tau. Statins thiab fibrates txo qis cov roj cholesterol thiab tiv thaiv kev loj hlob ntawm atherosclerosis. Cov tshuaj no suav nrog cov nyiam Lovastatin thiab Fenofibrate.
ACE inhibitors xws li "Captopril" thiab "Enap" normalize ntshav siab thiab tshem tawm cov hlab ntsha ntawm cov hlab ntsha. Diuretics yuav tsum tau tshem tawm cov kua dej ntau dhau, uas ua rau muaj kev ntxhov siab ntxiv rau lub plawv. Cov tshuaj no suav nrog Lasix, Indapamide.
Tshuaj tua kab mob yuav tsum tau kuaj xyuas arrhythmias. Feem ntau, cov kws kho mob tau sau Amiadron thiab Kordaron. Organic nitrates, tshwj xeeb,xws li "Izoket" thiab "Nitroglycerin", yog siv rau qhov mob hauv lub plawv. Nrog ischemia thiab myocardial infarction, tus kws kho mob tuaj yeem sau lwm yam tshuaj.
Kev ua haujlwm
Kev kho mob myocardial ischemia ntawm theem siab yog ua nrog kev phais, vim tias tsuas yog noj tshuaj tsis txaus. Kev phais plawv tej zaum yuav tsum tau ua kom rov qab kho cov hlab ntsha.
Raws li qhov xwm txheej ntawm cov kab mob vascular, kev ua haujlwm siv cov kev cuam tshuam endovascular lossis kev cuam tshuam radical tuaj yeem ua kom tshem tawm cov kab mob. Nrog me ntsis qhov txhab ntawm cov hlab ntsha, lub zais pa angioplasty tuaj yeem ua tau, ua raws li kev teeb tsa ntawm cov hlau stent. Cov txheej txheem zoo sib xws muaj nyob rau hauv kev qhia lub zais pa ua los ntawm cov khoom siv polymer rau hauv lub lumen ntawm lub nkoj cuam tshuam. Nyob rau hauv X-ray tswj, nws yog inflated nyob rau hauv qhov yuav tsum tau, ib tug tshwj xeeb cylindrical hlau ncej yog ntsia nyob rau hauv lub cheeb tsam ntawm vasoconstriction, uas yuav tswj lub nkoj nyob rau hauv ib tug nthuav lub xeev. Yog li ntawd, myocardial ischemia raug tshem tawm hauv thaj chaw cuam tshuam.
Nrog kev puas tsuaj ntau rau cov hlab ntsha, kev cuam tshuam me me yuav tsis ua haujlwm. Nyob rau hauv cov ntaub ntawv no, ib tug ntau radical ua hauj lwm, uas yog coronary artery bypass grafting, yog ua los mus tshem tawm circulatory tsis ua hauj lwm.
Kev cuam tshuam tuaj yeem ua rau ntawm lub siab qhib lossis nrog qhov cuam tshuam tsawg kawg nkaustxoj kev. Lub ntsiab lus ntawm qhov kev cuam tshuam no yog los tsim ib qho shunt los ntawm cov hlab ntsha transplanted uas ua kom cov ntshav ntws mus rau ib qho chaw ntawm myocardium. Raws li qhov tshwm sim, cov kab mob coronary ua rau tag nrho, thiab kev pheej hmoo ntawm myocardial infarction lossis kev tuag sai sai tau txo qis.
Muaj Teeb Meem
Yog tias mob myocardial ischemia tsis tau kuaj pom raws sijhawm, tus kab mob tuaj yeem ua rau tuag sai sai. Tsis tas li ntawd, nws tseem ceeb heev uas yuav tsum nco ntsoov tias qhov no yuav yog qhov laj thawj tseem ceeb ntawm myocardial infarction.
Nrog asymptomatic ischemia, tus neeg mob tuaj yeem ntsuas qhov tseeb ntawm nws tus mob rau lub sijhawm ntev thiab ntsuas qhov tsim nyog. Cov tsos mob pom tseeb ntawm myocardial necrosis nyob rau hauv cov neeg mob no feem ntau tau pom lawm thaum muaj kev puas tsuaj rau lub plawv mob, thiab kev pheej hmoo ntawm kev tuag nce ntau.
Huab cua
Kev ntsuas rau ischemia ib txwm tsis zoo. Thaum tsis muaj kev kho mob raws sij hawm, cov kab mob no tuaj yeem ua rau muaj kev tsis taus ntawm tus neeg mob thiab xaus nrog qhov pib ntawm kev tuag tam sim ntawd. Raws li kev txheeb cais, tsis mob ischemia ua rau muaj kev pheej hmoo ntawm kev mob plawv tsis ua haujlwm thiab arrhythmia los ntawm 2 zaug, thiab qhov tshwm sim ntawm kev tuag sai sai tuaj yeem nce 5 zaug.
Yog vim li cas qhov kev daws teeb meem ntawm qhov teeb meem no tseem cuam tshuam rau niaj hnub cardiology, kev tshawb pom raws sijhawm ntawm cov kab mob hauv lub cev thiab kev tiv thaiv yog qhov tseem ceeb heev. Myocardial ischemia tuaj yeem ua raukev loj hlob ntawm arrhythmia loj, angina pectoris, plawv tsis ua hauj lwm, myocardial infarction. Txhawm rau tiv thaiv qhov tshwm sim ntawm cov teeb meem zoo li no, koj yuav tsum tau kuaj xyuas kev tiv thaiv thiab ua raws li tag nrho cov lus pom zoo ntawm tus kws kho mob.
prophylaxis
Nws yog ib qho tseem ceeb tsis tsuas yog kom paub tias nws yog dab tsi - myocardial ischemia, thiab yuav ua li cas kho tau, tab sis kuj yuav ua li cas tiv thaiv qhov pib ntawm tus kab mob. Kev tiv thaiv tseem ceeb suav nrog:
- muab tus cwj pwm phem uas ua rau vasoconstriction;
- ua raws li kev noj zaub mov txwv cov roj cholesterol;
- kho cov kab mob sib kis (mob ntshav qab zib, ntshav siab, rog);
- kev tawm dag zog txaus;
- restoration ntawm ntxhia tshuav;
- ntshav nyias los tiv thaiv thrombosis.
Tus nqi ntawm lub cev yuav tsum raug xaiv los ntawm tus neeg mob qhov hnyav thiab ntsuas ntshav siab. Qee zaum kev tawm dag zog yog nruj me ntsis txwv tsis pub rau cov neeg rog rog.
