Senhliziyo: owokuqala (systole), wesibili (i-diastolic) - kuyinsakavukela pathology

phonendoscopes Okokuqala abangu eligoqiwe tube amashidi noma eziyize bamboo izinduku, zaba odokotela abaningi zisebenzisa ezindlebeni zazo siqu kuphela. Kodwa zonke zafuna ukuzwa ukuthi kwenzekani ngaphakathi emzimbeni womuntu, ikakhulu uma kuziwa i umzimba ebalulekile efana inhliziyo.

Inhliziyo umsindo - imisindo akhiqizwa inqubo yokunciphisa odongeni esivimba amanzi. Ngokuvamile, umuntu enempilo has a-ithoni ezimbili, okuyinto kungase kuhambisane imisindo ezengeziwe kuye ngokuthi hlobo luni inqubo sokugembula eba. Udokotela kunoma iyiphi okukhethekile kufanele bakwazi ukukuzwa lezi imisindo ukuzichaza.

umjikelezo inhliziyo

Inhliziyo ishaya ngesikhathi imvamisa amabhithi ngeminithi kusukela ayisithupha amashumi ayisishiyagalombili. Yiqiniso, inani eliyisilinganiso, kodwa amaphesenti angu-ayisishiyagalolunye abantu emhlabeni ukuwa ngaphansi kwaso, okusho ukuthi ngeke ukwazi ukuthatha ke njengento enhle. shot ngasinye siqukethe izingxenye ezimbili ezilandelanayo: systole futhi diastole. Systole inhliziyo umsindo yena, ihlukaniswe atrial futhi ventricular. Ngu isikhathi kuthatha imizuzwana 0.8, kodwa inhliziyo has isikhathi ungenwa futhi uphumule.

systole

Njengoba kushiwo ngenhla, yezingxenye ezimbili ezihilelekile. Ekuqaleni, kukhona systole atrial: izindonga inkontileka yabo, igazi ngaphansi kwengcindezi engena ventricles, ama-valve futhi amafasitela slam. Kwakuwusuku umsindo ukuvala valve futhi wezwa IselulekoSesihenqo. Yonke le nqubo ithatha 0.1 imizuzwana.

Bese kufika systole ventricular, okuyinto kakhulu ukusebenza inkimbinkimbi njengamanye ama kunjalo ne Atria. Ukuze uqale, siphawula ukuthi inqubo ithatha isikhathi eside kathathu - 0.33 imizuzwana.

Okokuqala isikhathi - voltage we ventricles. Kuhlanganisa isigaba indlela futhi Kufinyeta icwecwe eliqophayo. Konke kuqala nge yokuthi i-pulse eclectic Ukhuthaza kanye myocardium, lapho ekujabulisayo muntu imisipha zemicu ebangela ukuba angesabi inkontileka. Ngenxa yalokhu, kuba siyashintsha ukuma inhliziyo. Ngenxa valve atrioventricular zivaliwe uvalwe, senyusa izinga lomfutho womoya. Khona-ke kukhona ukusikwa okunamandla ventricles, futhi igazi lingena elikuyi-aorta noma Umthambo yamaphaphu. Lezi zigaba ezimbili ukuthatha 0.08 imizuzwana namasekhondi 0.25 ezisele igazi lingena izitsha main.

diastole

Nalapha futsi, akunjalo elula njengoba kungase kubonakale efika kuqala. ukuphumula Ventricular ihlala imizuzwana 0,37 futhi kuthatha indawo ngezigaba ezintathu:

1. Protodiastolic: emva igazi kwesokunxele inhliziyo, ukugandeleleka ingaphakathi layo sinciphile valve, okuholela imikhumbi emikhulu, zivaliwe.
2. ukuphumula icwecwe eliqophayo: imisipha uyaqhubeka, ingcindezi uwela okwengeziwe futhi ahambisana atrial. Kule valve atrioventricular evulekile, futhi igazi kusukela Atria kuya ventricles uwela.
3. I ukugcwaliswa we ventricles: le umyela ingcindezi kanye uketshezi igcwalisa aphansi emakamelweni inhliziyo. Lapho sicindezelwa equalized, ukugeleza kwegazi kancane kancane kubambezela bese iyama.

Umjikelezo is Wabe esephinda futhi, eziqala systole. ubude bayo ihlale ifana, kodwa diastole kungenziwa mfushane noma yinde kuye ukushaya kwenhliziyo.

Lo mshini kumiswa mina ithoni

Njengabangaqondakali kungase kuzwakale, 1 ithoni inhliziyo siqukethe izingxenye ezine:

1. Valve - it is okuholela imfundo umsindo. Empeleni, lokhu ukuguquguquka atrioventricular umphini amapheshana ekupheleni ventricular systole.
2. Muscle - ezinyakazayo oscillatory we ventricles ngesikhathi ukusikwa.
3. Umhlinzi - esisuka main isitsha izindonga ngesikhathi lapho wegazi ophansi uwela.
4. Atrial - systole atrial. Lokhu ekuqaleni ngokushesha first pitch.

Mshini kumiswa II ithoni bese amathoni ezengeziwe

Ngakho, 2 ithoni inhliziyo kuhlanganisa tincenye letimbili kuphela: valve futhi semithambo. Okokuqala - lokhu umsindo ukuthi livela amabhithi igazi kwezobuciko valve futhi isiqu yamaphaphu ngesikhathi lapho Namanje ivaliwe. Okwesibili, it has a ingxenye semithambo - a ukunyakaza imikhumbi emikhulu izindonga, lapho enezinto zivulwa ekugcineni.

Ngaphandle ezinkulu, kodwa ukuhlukanisa amathoni ezimbili 3 no-4.

ithoni Okwesithathu - a ukuguquguquka of ventricular myocardium ngesikhathi diastole, lapho igazi ageleza zibukele endaweni yokucindezelwa ongaphakeme.

ithoni Okwesine livela ekupheleni systole futhi lihlotshaniswa ekupheleni ukuxoshwa igazi kusukela Atria.

Isici mina ithoni

Senhliziyo kuzoncika ezintweni eziningi, kokubili intra- futhi extracardiac. 1 sonority ithoni incike esimweni umgomo we myocardium. Ngakho, ngo-umqulu wokuqala inikezwa yi Ukuvalwa Friend of valve inhliziyo futhi izinga lapho ventricles ziyancipha. Kubhekwe izici yesibili ezifana enezinto kwabantu valve atrioventricular kanye zikuphi ingaphakathi inhliziyo.

Kungcono ukulalela kuqala inhliziyo umsindo phezu kwalo - esikhaleni 4-5 intercostal kwesokunxele sternum. Ukuze esinembile uhlela ezidingekayo eshaywayo kwesifuba kule ndawo futhi ukuchaza ngokucacile imingcele onokuqundeka inhliziyo.

Isici iphimbo II

Yini ukumlalela, kubalulekile ukubeka IselulekoSesihenqo insimbi phezu isizinda inhliziyo. Leli phuzu kancane ngakwesokudla yenqubo xiphoid we sternum.

Ubukhulu nokuzwakala ngokucacile we ithoni yesibili kubuye sincike kangakanani uvalwe valve zivaliwe, manje kuphela semilunar. Ngaphezu kwalokho, ijubane umsebenzi wabo, ukuthi ukuvala nemikhawulo yomhlaba sesihle oscillation kuthinta ukudlala umsindo. Futhi izakhiwo ezingeziwe kwabantu bonke izakhiwo ezihilelekile ekwakhekeni ithoni, kanye nesikhundla we valve ngesikhathi ukuxoshwa igazi lisuka enhliziyweni.

Imithetho auscultation kwenhliziyo imisindo

Umsindo inhliziyo cishe ukuzola kakhulu emhlabeni, emva umsindo elimhlophe. Ososayensi baye hypothesized ukuthi wayewukuphela kwengane yakhe nakuzwayo utero. Kodwa ukuze sithole ukulimala inhliziyo, nje ukuzwa ishaya kanjani, akwanele.

Ngokuyinhloko wahlanganyela auscultation kudingeka endaweni ethule futhi efudumele. Ukumisa komuntu kuncike onjani umphini udinga ukulalela ngokucophelela. Lokhu kungaba isikhundla ngohlangothi sakhe sokhohlo, zibheka, kodwa izindlu bayichezukisa phambili ohlangothini lwesokudla, nokunye. D.

Isiguli kufanele kube ukuphefumula ngendlela engavamile futhi kukhona engajulile, futhi ngokusho isicelo udokotela ukubamba umoya wakho. Ukuze uzwisise ngokucacile lapho systole futhi diastole lapho udokotela kufanele zifana ngokulalela palpate ishayela carotid Umthambo okuyinto ezokwenzeka ngokuphelele nge esigabeni systolic.

I-oda we auscultation inhliziyo

Ngemva ukuzimisela owandulelayo udokotela onokuqundeka inhliziyo ngokuphelele futhi isihlobo ulalela inhliziyo umsindo. Iqala, njengoba umthetho, ne umzimba phezulu. Well kukhona valve mitral kuyinto ezwakalayo. Khona-ke ukuthuthela valve kwemithambo emikhulu yenhliziyo. Okokuqala kuya yomthambo i-aorta - lesibili intercostal isikhala ngakwesokudla sternum, kwase kuba kwabayishumi Umthambo yamaphaphu - ezingeni elifanayo, ukuze nje kwesokunxele.

Iphuzu lesine ukulalelwa - lena phansi inhliziyo. Itholakala ngasesinqeni se inqubo xiphoid, kodwa kungenziwa wawugxilisa ohlangothini. Ngakho ukuthi udokotela kufanele uhlole ukuthi yini oluthile lwesifo senhliziyo-eksisi kagesi ukulalela ngokunembile valve tricuspid.

Ukuqoqa auscultation at Botkin-Erba. Ungezwa valve yomthambo i-aorta. Kuyinto yesine intercostal isikhala at kwesokunxele sternum.

amathoni engeziwe

inhliziyo umsindo akuyona njalo ukhumbuza ukuchofoza onesigqi. Ngezinye izikhathi, kaningi kunakuqala kungafiseleka, kuthatha amafomu yinqaba. Ezinye zalezi odokotela baye bafunda ukuhlonza nje ngokulalela. Lezi zihlanganisa:

- Chofoza valve mitral. Yena ungezwakala eduze sokudlondlobala inhliziyo, ihlobene izinguquko eziphilayo amapheshana valve futhi ibonakala kuphela uma kuluthola inhliziyo yayo yayinezinkinga ezicini.

- systole ngokuchofoza. Olunye uhlobo valve mitral. Kulokhu, it enezinto zivaliwe uvalwe, sengathi waphenduka ngaphakathi ngaphandle ngesikhathi systole.

- Perekardton. Found lapho pericarditis ingcina. Iphathelene Ukuvuleka komlomo ngokweqile ventricles ngenxa kwakheka ngaphakathi umugqa mooring.

- I isigqi izigwaca. Kube stenosis mitral, ngcono okusobala kwezinto ithoni kokuthoma, kwesibili ithoni okugcizelela Umthambo yamaphaphu kanye mitral valve ngokuchofoza.

- gallop. Isizathu sokuba ivela khona ukunciphisa ithoni esivimba amanzi, livela tachycardia ngemuva.

Extracardiac kubangela okhulisa kanye attenuation amathoni

Inhliziyo ishaya emzimbeni impilo, ngaphandle kokuthatha ikhefu namaholide. Ngakho, uma ugqoke phandle, umsindo elinganisiwe yemisebenzi yakhe avele nezingahlobene nendaba. Izizathu zalokhu kungenzeka ngokuqondile exhumene kulimaze inhliziyo yowesifazane, futhi musa encike kuyo.

amathoni neqhaza ekuqiniseni:

- cachexia, sokuzincisha ukudla, esifubeni mncane udonga;

- atelectasis yamaphaphu noma ingxenye yalo;

- nokuvuvukala mediastinum posterior, uhambe kalula;

- kokuziphatha we iyizingxenye engezansi yamaphaphu;

- bulla emaphashini.

Mandle inhliziyo umsindo:

- isisindo ngokweqile;

- ukuthuthukiswa imisipha odongeni esifubeni;

- emphysema ongama;

- khona uketshezi ingaphakathi thoracic;

- pericarditis exudative.

Intracardiac izizathu ukuqiniswa kanye buthakathaka amathoni inhliziyo

Senhliziyo ecacile, Rhythmic lapho umuntu uyaphumula noma ngesikhathi sokulala. Uma wanyakaza, isibonelo, yakhwela izitebhisi ukuze kwehhovisi likadokotela, lokho kungase kubangele inhliziyo okhulisa umsindo. Futhi, ukusheshisa kwenhliziyo kungase kubangelwe izinkinga kwegazi, izifo endocrine, njll

Izithulu inhliziyo umsindo yamlalela ngesikhulu izifo atholwe inhliziyo, ezifana mitral noma stenosis yomthambo i-aorta, esingamahlalakhona of valve. Igalelo lakhe kuletha stenosis yomthambo i-aorta eminyangweni ukuthi sekuseduze ukuba inhliziyo yakhe: ekuntweleni ingxenye arc, ukwehla ingxenye. inhliziyo muffled umsindo elihlobene ne okhushuliwe mass esivimba amanzi, kanye netifo sokuvuvukala imisipha yenhliziyo, okuholela ukonakala noma sclerosis.

inhliziyo Ibubula

Ngaphandle imibala, udokotela ungezwa neminye imisindo, okuthiwa umsindo. Basuke kwakhiwa kusukela omawala of ukugeleza kwegazi, okuyinto sidlula ingaphakathi zenhliziyo. Ngokuvamile, akufanele kube. Yonke imisindo zingahlukaniswa zibe organic futhi zisebenza kahle.

1. Organic avele lapho yokwakheka isitho zenzeka, izinguquko ezingenakuhlehliswa ohlelweni valve.
2. umsindo Functional elihlobene ne kahle ezinzwa ukunikezela noma imisipha amandla papillary, kwenhliziyo nokugeleza kwegazi isilinganiso, ukwehla viscosity yayo.

Noises ungakwazi ukuhamba umsindo inhliziyo, futhi kungaba ezimele wabo. Ngezinye izikhathi ngomshikisho pleural e Izifo ukuvuvukala is esikhulu inhliziyo, bese une ukubuza isiguli ukubamba umoya wakhe futhi wathi ukugoba waphinda ukubamba auscultation. Le nqubo elula kungasiza ukugwema amaphutha. Ngokuvamile, lapho ngilalele umsindo zama sokugembula ukucacisa lapho isigaba lomjikelezo inhliziyo zenzeka, indawo engcono yokuthola futhi iqoqe ukulalela umsindo izici: amandla, ubude kanye isiqondiso.

umsindo izakhiwo

Timbre kukhona izinhlobo eziningana umsindo:

- soft noma beshaya (ongavamile ukuhlotshaniswa zokugula, ngokuvamile izingane);

- emangelengele, nokususa kanye sawing;

- umculo.

Ukuze isikhathi zihlukaniswa:

- iDemo;

- eside;

Ngomthamo:

- uthule;

- elikhulu;

- ngincipha;

- ezikhulayo (ikakhulukazi ukuvaleka kwesokunxele orifice atrioventricular);

- olwengeziwe-ngincipha.

Ukushintsha ivolumu eqoshiwe ngesikhathi omunye izigaba umsebenzi inhliziyo.

Ukuphakama:

- okusezingeni eliphezulu (lapho yomthambo i-aorta stenosis);

- imvamisa ongaphakeme (stenosis mitral).

Kukhona ezinye amaphethini jikelele umsindo auscultation. Okokuqala, bakulalela kahle izindawo valve, ngenxa zokugula ngazo kwamiswa. Okwesibili, umsindo imbuthuma isiqondiso ukugeleza kwegazi, hhayi ngokumelene nalo. Okwesithathu, njengoba inhliziyo umsindo, imisindo normal kungcono wezwa lapho inhliziyo engamboziwe nge ukukhanya futhi uvalwe adherent esifubeni.

ikhononda systole kungcono ukulalela kule sikhundla lisalele, ngoba ukugeleza kwegazi kusukela ventricles kuba lula futhi ngokushesha, futhi diastolic - ehlezi, ngoba ngaphansi amandla adonsela phansi, uketshezi kusukela Atria kuya ventricles uwela ngokushesha.

Noise kungenziwa umahluko ngokuvumelana indawo yabo futhi inhliziyo umjikelezo isigaba. Uma umsindo endaweni efanayo livela systole futhi diastole, likhuluma izilonda elihlangene valve. Uma umsindo livela systole ngesinye isikhathi, futhi diastole - enye - isivele ukulahlekelwa elihlangene valve ezimbili.