Transmural infarction: izimbangela futhi Izibikezelo

infarction Transmural - isifo ovamile futhi iyingozi kakhulu, okuyinto kuhambisana necrosis of imisipha yenhliziyo. Kufanele kuqashelwe ukuthi izinga lokufa uma kwenzeka zokugula efanayo kakhulu, ikakhulukazi uma izimpawu zezifo zenhliziyo zazingabonakali ngesikhathi, kanti isiguli ayitholanga ukwelashwa ezidingekayo. Ngakho-ke kubalulekile ukwazi ukuthi ukuze abonise ukuthi leli fomu ukuhlaselwa isifo senhliziyo futhi iluphi usizo liyadingeka ogulayo.

Transmural isilethikusebenza: kuyini?

Okokuqala, ake ukubhekana ne lisho ukuthini igama elithi. Ngokuqinisekile iningi wazi ukuthi izimo infarct ahambisana le lilokhu libuna izingxenye imisipha yenhliziyo. Lokhu kwenzeka ngenxa ukumisa ngokushesha igazi ligeleze liye enhliziyweni, umphumela waba izicubu ungamukeli kudingekile ngenxa yokuphila mpilo nezakhi.

Njengoba yaziwa, inhliziyo odongeni siqukethe izingqimba ezintathu - a epicardium (olwelwesini), mural ungqimba kwemisipha kanye endocardium (engxenyeni engaphakathi imisipha). Lapho intramural ifomu necrosis sifo kuphela isendlalelo esisodwa. Acute esivimba amanzi transmural - zokugula, lapho izinqubo necrotic kungabonakala nasemkhakheni zonke zamatshe inhliziyo. Kuthiwa lena uhlobo oluvame kakhulu lesi sifo.

Ngo inqubo yokwelapha yesimanje, zokugula libhekwa esekelwe kwasendaweni foci of necrosis. The njalo kunazo waphawula transmural esivimba amanzi infarction phambi odongeni, okungukuthi i-ventricle engakwesobunxele. eyodwa kuphela kuzo amacala ayisihlanu, necrosis futhi sithinta ilungelo ventricle udonga. Cishe ingxenye eyodwa kwezintathu iziguli abahilelekile futhi izindonga Atria.

Izimbangela zesifo

Cishe kuyo yonke kunjalo, umphumela transmural esivimba amanzi ischemic isifo senhliziyo. Njengoba sekushiwo, ne umoya-mpilo owanele futhi izakhamzimba imisipha amaseli baqala ukufa - ngakho ekuthuthukiseni necrosis. Ngokwezibalo, u-90% amacala imbangela atherosclerosis izitsha-coronary, eyisa uvumele igazi ligeleze myocardium.

Phezu kodonga bomkhumbi Kumiswa by the okuthiwa i-plaque atherosclerotic. Ngaphansi kwethonya izici ezithile zingcwecwe ingxenye iphula ogangeni futhi ivale mafutha anciphisa isikhala esingaphakathi we ukuxhumelela imithambo yenhliziyo. Acute esivimba amanzi transmural ngokuvamile iqhubeka ngokushesha kulezo zimo lapho esivimba amanzi nomoya-mpilo funa inyuka ngokucijile - lokhu kungase kwenzeke, isibonelo, nge ukuzikhandla eqinile emzimbeni, imfiva, ukucindezeleka okukhulu ngokomzwelo.

Acute transmural isilethikusebenza: ingozi

Njengoba ubona, izilonda necrotic wenhliziyo Awuyena isifo ezimele. Ezimweni eziningi, ziba ku isizinda atherosclerosis ekhona kakade futhi ischemia. Ngakho-ke kungenzeka ukwehlukanisa izinto ezimbalwa ingozi:

• I yofuzo isiguli ukuthi lihlotshaniswa izici ezithile yokwakheka nezifo ngofuzo.
• Kuthatha ndawo engu isici. esivimba amanzi Transmural ngokuvamile kutholakala abantu phezu 45, futhi amadoda bethambekele ekubeni lesi sifo.
• Ukwandiswa ezingeni cholesterol egazini (ngenxa leli fomu zingcwecwe phezu Imithambo yegazi, kamuva ukumboza egazini).
• Ukudla okungafanele (ukudla okunamafutha kanye nokudla okuthosiwe kwandisa amathuba asathuthuka atherosclerosis).
• Ukukhuluphala (okuyinto ezimweni eziningi lihlotshaniswa ukudla okungenamsoco futhi kwesisindo kwandisa umthwalo phezu kwenhliziyo).
• Ukungawuvivinyi umzimba (yokuphila umzimba kuholela lube buthaka kancane kancane imisipha yenhliziyo, myocardium ngemva kwalokho kunzima kakhulu ukubekezelela noma yimuphi umsebenzi ngokomzimba).
• ukucindezeleka njalo, nokutubeka, ukucindezeleka ngokomzwelo kuholela ukushintsha kwama-hormone ezithinta uhlelo senhliziyo nemithambo yegazi.
• Ukubhema (ngokusho izibalo, 35% of amacala necrosis esivimba amanzi ezihlobene nale mkhuba omubi).

izimpawu Main: indlela yokubona yinhliziyo?

Izimpawu necrosis zingahluka - konke kuncike izinga lomonakalo, ubudala lomuntu, khona izifo concomitant, njll Kukhona amacala asymptomatic ukugeleza esivimba amanzi ... Noma kunjalo, ezinye izimpawu eziyinhloko:

• Ezimweni eziningi, umuntu ekhononda severe ubuhlungu compressive ngemuva breastbone - ngokucacile unika kwesobunxele ehlombe, ingalo, umhlathi, indlebe ngisho namazinyo.
• Ubuhlungu mihlobiso futhi eside - ukuhlaselwa kungaba liphindwe kungakapheli amahora ambalwa noma ngisho kwezinsuku.
• Utfutfukisa tachycardia, isiguli ngokuvamile azizwa zisaphila ngokugqamile njalo futhi kumzwise ngisho nobuhlungu.
• Kukhona umqondo short-term wokudamba inhliziyo.
• Kukhona izimpawu kwangaphandle ngemuva kokuhlaselwa yisifo senhliziyo - isikhumba kanye nolwelwesi lwamafinyila yomuntu evele okhanyayo.
• Against isizinda necrosis njalo ukuthuthukisa somoya inhliziyo - nesineke baphawula kufushane enamandla umoya, ukuhlaselwa ngokuzumayo Ukuphelelwa.

izinyathelo zokuxilonga

Lapho ukuhlukumeza lokuqala kufanele uyiswe ngokushesha kumuntu ogulayo egunjini lasesibhedlela, lapho uphethwe ezifanele kanye nokwelashwa wenziwa. The main indlela inkinga necrosis esivimba amanzi kuyinto electrocardiography, ngoba lapho inqubo enjalo kungenzeka ukulungisa nekhono kagesi ezingxenyeni ezahlukene inhliziyo.

Kahle kwenziwe, futhi electrocardiogram uguqulwa ivumela udokotela ukucacisa kwasendaweni necrosis (isib aphansi transmural senhliziyo), izinga ukusabalala inqubo sokugembula kanye lesion ukujula, ubude lesi sifo.

Ngaphezu kwalokho, udinga ukuhlolwa igazi. Esivimba amanzi waphawula ukwanda erythrocyte sedimentation isilinganiso, kwenani labafana leukocyte kokuvela egazini enzyme ethile futhi compounds okuyizinto ngokuvamile ngaphakathi kwengqamuzana esivimba amanzi.

Imigomo usizo lokuqala

Acute transmural isilethikusebenza phambi udonga - a zokugula esakheka ngokushesha okukhulu. Izimpawu zayo kungenzeka cishe noma nini, ngakho kufanele uzijwayeze imithetho usizo esigulini. Yiqiniso, okokuqala kudingeka ukubiza i-ambulensi.

Ilinde odokotela, umuntu kudingeka ukuba ulale. Okungabalulwa isimo lapho kukhona kufushane enamandla umoya futhi kwesifuba lapho ukuphefumula abahlukene - kuleso simo isiguli esihlalweni kangcono, esakhiwe ngaphansi ngemuva umcamelo noma isiguqo. Kunconywa ukuthatha i-aspirin. Udinga ukunikeza umuntu nitroglycerin - lokuqala iphilisi elilodwa, futhi uma ubuhlungu akusho hamba ke kamuva imizuzu emihlanu omunye (kepha hhayi ngaphezulu kuka ezintathu).

Isikimu Ukwelashwa esivimba amanzi

Kuye imiphumela eyatholakala ngesikhathi uphethwe udokotela ekunika imithi yokwelashwa. ukwelashwa kokuqala ngokuvamile inezingxenye ezintathu eziyinhloko:

• Ukwemukelwa amaphilisi ezinhlungu ukuphungula isimo lesiguli. Kaningi, ubuhlungu kungenzeka ukuba ayeke kuphela ngosizo izidakamizwa ezinamandla, kuhlanganise "Promedol" futhi "Morphine". Ukubukeka ngezimpawu ukuxilongwa "isilethikusebenza" kuyinto ukucindezeleka komuntu, futhi injabulo nokwesaba kwandisa kuphela umthwalo inhliziyo - isiguli ezinqunyiwe sedatives.
• Isimiso kuzomele sifake nitrate kokuthola i-beta-blocker, esiza ukuqeda arrhythmia futhi abuyisele isigqi inhliziyo.
• Lapho transmural esivimba amanzi awokuthi amahlule, okuyinto igcwele necrosis ezinye kwezitho inqubo ukusabalala on ezindaweni ezakhelene we myocardium, isimiso sezinzwa izilonda ngisho nokufa. Ngakho-ke, ukulwa thrombosis kufanele kuqale amahora okuqala angu-lapho kuqala izimpawu. Ngenxa yale njongo, sebenzisa vasospasm amalungiselelo aqukethe heparin futhi fibrinolysin. Ngokuvamile, uma uthatha imithi enjalo kungenzeka kokopha kakhulu ngoba ihlule legazi zamabhasi, ngakho-ke kubalulekile ukuqapha ngokucophelela isimo lesiguli.

Treatment ngempela wachitha esibhedlela - nesineke anganqamuki kufanele kube ngaphansi ukunakekelwa kadokotela.

Imiphumela kanye nezinkinga lesi sifo

infarction Transmural - ifomu nzima kakhulu noyingozi necrosis esivimba amanzi, ikakhulukazi uma kuziwa ezinkulu necrosis ebalulekile. Ukugula igcwele nemiphumela - ukuthuthukiswa edema yamaphaphu, ukukhubazeka kwamalungu omzimba, inkulumo iziyaluyalu. Ngezinye izikhathi esivimba amanzi akuhileli zokugula ngokwengeziwe isimiso semithambo yegazi, njenge-stroke.

Imiphumela yalesi sifo futhi zihlanganisa thromboembolism, fibrillation ventricular ukuqedwa umsebenzi ejensi ehlukene ngisho izinhlelo zabo. Ezimweni ezinjalo ngokuvamile kugcine ekufeni, ngisho noma usizo lwezokwelapha nesineke elinikeziwe. Enye yezinkinga ezisongela ukuphila - yinhliziyo. Uma ukuncipha eqinile we myocardium futhi kwandise ingcindezi yokufuna ngaphakathi ventricles futhi Atria ingozi kokuyekethisa ubuqotho izicubu endaweni necrosis.

Ukuvuselelwa kanye izibikezelo

Ngeshwa, izibikezelo ku izimo zezokwelapha ezinjalo azibona evumayo kakhulu - cishe u-50% amacala (ikakhulukazi uma kuziwa asebekhulile) abulawe. Nokho, uma namanje ephethwe ukubuyisela evamile ukugeleza kwegazi, sisekhona ingozi yezinkinga esikhathini esizayo, njengoba kuye kwaba nezinguquko kwezicubu esivimba amanzi.

Yingakho kubalulekile kangaka isikhathi nokuvuselelwa. Iziguli Kunconywa ukuba abe ukudla elula, kulula, futhi okunama-kilojoule amaningi. Futhi, kubalulekile kancane kancane uphinde uthole umsebenzi locomotor, njengoba sokungasebenzi igcwele yoma imisipha futhi amile emaphashini. Yiqiniso, yonke imisebenzi ezihlobene umsebenzi ngokomzimba, kufanele kulawulwe onguchwepheshe.

ukwelashwa abasekelayo kanye nokuqapha okuqhubekayo okwenziwa udokotela kuyadingeka ngaphambi kokuphela ukuphila. Yiqiniso, iziguli kudingeka balandele yokudla, gwema ukucindezeleka futhi umsebenzi okukhulu, gwema eqinile ukwanda blood pressure, futhi ayeke ukubhema.