Fibrillation - Iyini? paroxysmal fibrillation atrial

Ingabe wake wazithola zikhathi lapho inhliziyo yaqala ukushaya chaotically? Noma, kunalokho, yona ehlile? Kubangela umuzwa ukwesaba nokukhathazeka, lisenza sicabange ngayo ukushaywa esibhedlela. Odokotela babe definition nganoma yisiphi isimo, kuhlanganise le njongo. Fibrillation - ke kuwuhlobo arrhythmias inhliziyo. Ngo nezenhliziyo umkhuba Ezimweni ezinjalo akukhona okungavamile ukuba likhithike, ngakho-ke imayelana kubo sizoxoxa namuhla.

Incazelo nekwenteka

Kukhona definition yesayensi ukuziphatha okunjalo kwenhliziyo. Fibrillation - ke tachyarrhythmia, okuyinto kuhlangene amaza kunezinxushunxushu kagesi womsebenzi atrial. imvamisa yabo bangase bafinyelele amabhithi anamakhulu asixhenxe ngomzuzu, futhi ngesilinganiso esingafani ukunciphisa esihlelwe kusuka kube nzima.

fibrillation atrial ingenye amafomu okwandile iningi arrhythmias. Thembeke ke kungaba azimisele kuphela imiphumela electrocardiography. Zikhona izimpawu sici: akukho isigqi itheku, ukubukeka f-wave (flutter atrial). Izifinyezo imvamisa incike izakhiwo engeyokuqala atrioventricular, futhi umsebenzi autonomic nervous system lihambisana izidakamizwa.

Ochwepheshe bathi lesi sifo izilonda eziphilayo imisipha yenhliziyo. Kufinyeta esingalawuleki phambili inhliziyo izinkinga kwegazi futhi ingozi okuvela emboli. Lesi simo esiyingqayizivele sibangelwa lihlotshaniswa ngokwempilo yangenyama okusezingeni eliphezulu lesi sifo.

ngezigaba

Kukhona amafomu alandelayo ka fibrillation atrial:

1. Okokuqala kwembulwe. kokutshelwa ngokukhubazeka kwengane, uma isiguli ayizange ngaphambili wafuna usizo lwezokwelapha ngenxa fibrillation atrial.
2. Paroxysmal. Ukuhlasela flutter ihlala akukho kuka ngesonto (ngokuvamile kwezinsuku ezimbili) futhi ugijimela ngokuzimela.
3. Eziphikelelayo. Ukuhlaselwa kwaqhubeka izinsuku ezingaphezu kweziyisikhombisa.
4. Long eziphikelelayo. Ukuhlaselwa ihlala eziyishumi - izinyanga eziyishumi nambili, kodwa odokotela banquma ukuthi ukubuyisela isigqi.
5. Permanent. fibrillation atrial kwenzeka ngaso sonke isikhathi, kodwa isigqi sokubuyiselwa kusaqalwa akuyona kwenziwe, bese-ke waphenduka ayizwakali.

Ngokusho kobukhulu atrial izimpawu fibrillation zihlukaniswe amakilasi amane:

1. Asymptomatic.
2. ukungakhululeki Ezintsha ngaphandle kokuphazamisa umsebenzi.
3. izimpawu ezinamandla ezithinta induduzo eziphilayo.
4. Ukukhubazeka. Kulokhu, lo isiguli singenakukwazi anakekele yena okwesikhathi.

Kuye ukuvama odokotela ishayela ukuhlukanisa tachy, futhi normo bradisistolicheskuyu uhlobo lesi sifo.

engcupheni

inhliziyo fibrillation livela ezigulini abe nezici ezithile kuso. Angase kwandulelwe izinkinga ezihlukahlukene inhliziyo:

- nomfutho wegazi ophezulu;
- inhliziyo ukwehluleka;
- atholwe valve mitral;
- kombungu esizalweni of etiologies ehlukahlukene.

Indima ebalulekile udlalwa ngu zenhliziyo osuke usuvulekile, yenhliziyo Umthambo isifo, izifo ukuvuvukala we ulwelwesi inhliziyo, kanye izimila. Paroxysmal fibrillation atrial e abangaphansi kweminyaka engu kweminyaka engamashumi amane kungenzeka todvwa esivela nezinye izifo.

Ngaphezu kwalokho, kukhona uhlu pathologies, okuyinto ngokulinganayo kuthinte okuvela fibrillation atrial, kodwa engahlangene umsebenzi yisimiso senhliziyo nemithambo yegazi:

- ukukhuluphala;
- sikashukela;
- ezingamahlalakhona obstructive isifo samaphaphu;
- Umsebenzi okwandisiwe indlala yegilo.

Uma isiguli ebucayini umlando womndeni, okungukuthi, phakathi kwezihlobo eziseduze, kukhona abantu fibrillation atrial, amathuba ukuthi isifo izovela proband, landa ngamaphesenti angu amathathu.

pathogenesis

Fibrillation - kuba ukudikiza esingalawuleki imisipha, kulesi simo inhliziyo. isifo Organic neqhaza tingucuko tekuhleleka anatomy ezisekujuleni kwenhliziyo futhi kubangele kokunikezwa kwe-conduction ka amaza kagesi. Lokhu kungenxa okwandisa amanani sezicubu zezinzwa futhi cystic okwalandela. Le nqubo iqhubeka, ezihlanganisiwe dissociation yezinzwa ke fibrillation iqhubeka.

Odokotela cabangela imibono eyayisinesikhathi eziningana mayelana nendlela khona ifomu paroxysmal yalesi sifo. I ezivamile imfundiso yokuziphendukela foci namagagasi amaningi. Abanye ososayensi bakhetha ukuhlanganisa zombili izinguqulo, ngenxa yokuthi kunzima ukuhlukanisa ekupheleni imbangela yedwa lesi sifo.

Ngokwe-theory lokuqala (ebalulekile) e myocardium kwenzeka sebuningini foci womsebenzi kagesi, okuyinto etholakala eduze imikhumbi emikhulu futhi atrial udonga emuva. Ngokuhamba kwesikhathi, zisebenza kunoma yonke indawo ye Atria. Imfundiso yesibili postulates ukuthi fibrillation zibangelwa inombolo kunezinxushunxushu okuvele enkulu encane wave excitation.

Izimpawu kanye Izinkinga

Paroxysmal fibrillation atrial kungenzeka asymptomatic uma thuthuva hemodynamic ihlawulelwa ngokwanele. Ngokuvamile, iziguli esekhala umuzwa palpitations njalo, ubuhlungu besifuba noma ukungaphatheki endaweni.

Ngenxa yalokhu, lesichubekako ukumelwa inhliziyo, okuyinto emtholampilo wabonakaliswa isiyezi, yokufikelwa kanye iphika. Ngezinye izikhathi, lapho kuhlasela ezigulini kukhuphuke imvamisa ukuchama. Ochwepheshe bathi lokhu kubangwa ukwanda kwenani amaprotheni natriydiureticheskogo.

Ngomqondo ovulekile, kungase kube ishayela kusilela, lapho inani kwenhliziyo idlula isibalo amagagasi ishayela lapho lwande kuwo azungeze. Uma ifomu asymptomatic ka fibrillation we "insimbi" yokuqala kungaba yisifo sohlangothi.

Long egeleza fibrillation atrial nzima ngokwehluleka inhliziyo, thrombosis imithambo ezinkulu nezincane wenhliziyo noma ubuchopho.

ukuhlola

fibrillation atrial - ukuncipha njalo ngokungakhethi of cardiomyocytes. Ekuqaleni, lo dokotela iqoqa umlando sifo ukuphila, uthola usuku Ekuqaleni kuhlaselwa, khona engcupheni, kanye ufunde mayelana imithi ukuthi isiguli kuthatha okwamanje. Iziguli ungenawo akhononde, ngakho ubonise lo zokugula usebenzisa izindlela wezinsimbi. Lezi zihlanganisa i-ultrasound, Holter ECG kanye nokuqapha nsuku zonke. Fibrillation livezwa izici ezithile ezilandelayo:

- ukungabi khona igagasi P (akukho isigqi itheku);
- ukubukeka f-amaza fibrillation atrial;
- ngezikhawu ukungalingani phakathi kwamazinyo R.

Indlela efanayo kungathola comorbidities inhliziyo :. isilethikusebenza, arrhythmia, njll ultrasound luhlolo wenziwa ukuhlonza futhi uqinisekise organic isifo senhliziyo, esivimba amanzi odongeni ukujiya izilinganiso, umthamo Atria futhi ventricles. Ngaphezu kwalokho, isikrini kahle ebonakalayo parietal thrombi kanye izimila valve.

Ngaphezu kwalokho, ngemva isiqephu sokuqala udokotela fibrillation atrial sinquma ukuhlolwa amazinga hormone yegilo ukubekela eceleni hyperactivity wakhe.

anticoagulation

Kuleli qophelo umfundi has umbono walokho nokuthi kukhona fibrillation atrial. Ukwelashwa iqondiswe ziqedwe yayo, noma izici etiological, noma izimpawu yokululama.

Anticoagulants, okungukuthi imithi thinning igazi, kuvezwa nokuvimbela amahlule futhi ngenxa yalokho, ayiphulule nokumelwa yinhliziyo. Okuvame kakhulu phakathi ifomu tablet - kuyinto "Warfarin" futhi "aspirin". Ekumisweni leli qembu izidakamizwa kudokotela uyazicabangela propensity lesiguli thrombosis, ingozi ischemia esikhathini esizayo esiseduze, futhi ngabe Izimo isiguli lolu hlobo yokwelapha.

Kubalulekile ukukhumbula ukuthi ngesikhathi ukusetshenziswa anticoagulants kuyadingeka ukuze sihlale njalo siqaphele INR (isilinganiso kwesejwayelekile international). Lokhu kuvumela isikhathi esanele ukuyeka izidakamizwa futhi kuncishiswe ingozi ebangela ukopha.

isilawuli isigqi

Fibrillation wenhliziyo ezimweni eziningi lesi simo emuva. Uma kusukela ekuqaleni sigameko senzeke isikhathi esincane, udokotela Ungayibuyisa evamile itheku isigqi. Lokhu kungenziwa olokugobhoza ohlangothini izidakamizwa kagesi wamanje noma antiarrhythmic.

Ekuqaleni, inhliziyo ishaya kuyehla noma ephakanyiswe eziyikhulu amabhithi ngeminithi. Khona-ke kudingeka acabangele ingozi thromboembolism, ngakho amasonto amathathu ngaphambi inqubo, futhi inyanga ngemva kokuba isiguli alashwe anticoagulant. Kodwa konke lokhu kuyadingeka kuphela uma kwenzeka ukuthi ngokuhlasela fibrillation atrial ihlala izinsuku ezingaphezu kwezimbili noma isikhathi ke angeke isungulwe. Uma kuyaziwa ukuthi kusukela ekuqaleni Kufinyeta kunezinxushunxushu wenhliziyo emahora langaphasi kulangu-amane nesishiyagalombili ngaphezulu, noma isiguli uye ezinzima ukuntengantenga hemodynamic, ukunciphisa izinga Kwenziwa ngokushesha, iqondiswa ongaphakeme yamangqamuzana isisindo heparin.

1. cardioversion kagesi. Lena inqubo kunalokho buhlungu lokho lusho ukucwiliswa ephusheni wezempilo wesiguli. Ngo defibrillators yesimanje zichithe zokuvumelanisa ne R-wave phezu ECG. Lokhu ugwema ngephutha ventricular fibrillation. Qala ngokuvamile eziyikhulu Joules, futhi uma kunesidingo osenyameni ngamunye okwalandela wavuselwa Joules amahlanu. Le modeli ezimbili isigaba. Single-isigaba osenyameni ngokushesha wenza Joules ezingamakhulu amabili, ezingeni eliphakeme kunawo wonke eminyakeni emine.
2. Izidakamizwa cardioversion. Ukuze izidakamizwa ezingathinta isigqi inhliziyo, zihlanganisa "Procainamide", "Amiodarone", "Nibentan" futhi "Propafenone".

Ukuvimbela ukuhlaselwa yansukuzonke ye fibrillation atrial ngemva cardioversion aqokwe izidakamizwa antiarrhythmic, okuyinto isiguli kumele kuthathe izinyanga, ngisho neminyaka.

isilawuli ishayela

Zonke izinhlobo ezaziwayo fibrillation atrial kuhilele ukwephulwa of ukushaya kwenhliziyo. Ngakho-ke, odokotela wayecabange yokwelapha ukuqeda uphawu. Isebenzisa izidakamizwa ukuthi kunganciphisa izinga inhliziyo. Lezi zihlanganisa:

- beta-blocker;
- calcium channel blocker.

Nge ukwehluleka lezi imithi iqondiswa amaqembu "Amiodarone" noma "Dronedarone". Ukwelapha okunjalo kungaba banciphise izimpawu eziwumphumela wokugula ka arrhythmia, kodwa isuse ngokuphelele alukwazi.

Uma uphathwa ingaphumeleli, odokotela ngezinye izikhathi iphendukele ipayipi ablation. Ukuze alondoloze isigqi itheku, wonke amasayithi ujabule kudingeka zixazululwe. Nge radiofrequency Uphenyo inhliziyo udokotela ohlinzayo inhlamvu ensimini lehlukanisa komunye nomunye, ekuvimbeleni ukusakazeka amagagasi kagesi.

Kukhona enye indlela lapho ukubhubhisa ganglion phakathi ATRIUM futhi ventricle. Lokhu kwakha yesikhashana transverse inhliziyo block. Khona-ke lo nesineke ezifakelwa introducer yokufakelwa isigqi, olawula inani zisaphila. Izinga lokuphila isiguli ngcono ngokuphawulekayo, kodwa ubude bokuphila kwakhe ayiphazamiseki.

fibrillation atrial emva kokuhlinzwa inhliziyo

Paroxysm ka fibrillation atrial ngangokunokwenzeka ngemva kokuhlinzwa kwakhe enhliziyweni. Lona omunye yezinkinga eyayivame kakhulu nazo ngemva misebenzi. I pathophysiology lesimo kuhlukile eyenzeka ngo iziguli evamile nge fibrillation atrial.

Ngaphezu ezivamile engcupheni, isiguli iyona dissociation ionic, okungukuthi ukwehla kwamazinga potassium, kwehle umthamo wegazi, ukulimala mechanical nezicubu inhliziyo, futhi ukuvuvukala Atria. Konke lokhu kuphakamisa ukusebenza ngumsebenzi ngesimo umphelelisi wendlale uhlelo ukusabela. Kuziwa ukukhululwa kwe balamuli ukuvuvukala, ukukhuthazwa nozwela isimiso sezinzwa, kanye namachibi ukuphendula enobudlova. Konke lokhu kuyisici okwabangela kuqale fibrillation atrial.

Ngakho-ke, ukwelashwa yezinkinga post-op siqale ukulungiswa zonke izinkinga ngenhla. Ngenxa yale njongo, beta-blocker, "Amiodarone", ama kanye non-steroidal izidakamizwa eqeda ukuvuvukala.

Isibikezelo kanye nezincomo

Umuntu ungagwema kokutshelwa ngokukhubazeka kwengane eziyingozi, njengoba "fibrillation atrial". Izincomo odokotela abasakwazi elula esobala. Kuyadingeka ukuba ahole indlela yokuphila enempilo, yokudla, gwema-high blood pressure ngaphezu izingalo eziyikhulu namashumi amane. Lezi zenzo ayinzima hhayi kuphela ukuvimbela okuvela kuyo fibrillation atrial, kodwa futhi ukusiza ukuvimbela ezinye izifo inhliziyo.

Yiqiniso, sincoma ukuyeka ukubhema futhi ukunciphisa utshwala. Ukuze aqinise ezitsheni, nangodokotela bababhekene nezifo zenhliziyo ebuzwa ukuthola imali eyanele yokudla kubalulekile fatty acid, noma ukuthatha amaphilisi namafutha kafishi.

Ukwelapha izifo ezibangelwa amagciwane kanye ezibangelwa amagciwane ukulandela ngokusebenzisa, ngisho noma wena ngokwakho subjectively beneme.

Ingozi yokushaywa unhlangothi kubantu abanegciwane atrial fibrillation inyuka yobudala engamashumi ayisihlanu nanhlanu per cent, anamanci osibhozo - amabili. Oyedwa eziyisithupha kubika unhlangothi emhlabeni siyenzeka in iziguli uphethwe "fibrillation atrial".