Uhlu izidakamizwa antiarrhythmic kanye ngezigaba zabo

Cishe zonke iziguli wazibonela indlela wenhliziyo noma elinye nge izinhlobo ezahlukene arrhythmias. Okwamanje, abekho embonini yokwenziwa kwemithi inikeza ezihlukahlukene ejenti antiarrhythmic. ngezigaba izici zabo futhi okuxoxwe ngazo kulesi sihloko.

umzila yokuchayeka

Ukuxazulula ethunjini arrhythmias inhliziyo, ejenti antiarrhythmic abelwa. Lo mshini wezenzo izidakamizwa ezifana kuhloswe ukusebenza izakhiwo esivimba amanzi electrophysiological amaseli:

• Ukunciphisa ijubane isenzo ezingaba, kanjalo okwehlisa conduction ka excitation.
• Ukwehla excitability we myocardium.
• Ukunciphisa isikhathi refractory isihlobo, okuholela kokunciphisa isikhathi, lapho inhliziyo yakho okungavamile kungase kubangele ukusikwa inhliziyo.
• Ukunwebeka ngempumelelo isikhathi refractory, okuyinto ebaluleke lapho tachycardias futhi ekuqedeni pulses okuyinto zenzeka emva isikhathi esincane kakhulu ngemva ukunciphisa elikhulu.
• Umthamo ngesilinganiso excitation okukhuthaza homogenization iphinde ivimbele lo mkhuba kabusha entry ( «kabusha entry").
• Okusithiyayo of ethunjini automatism ekamelweni ehlangene isandiso kwenkathi depolarization diastolic.
• Ukuyeka umehluko ngesilinganiso excitation kanye nezinkomba refractivity.
• Encishisiwe ukuzwela inhliziyo ukuba osenyameni kagesi kanye ingozi ventricular fibrillation.

Ukwahlukanisa izidakamizwa antiarrhythmic

Zonke imithi kuleli qembu zihlukaniswe amakilasi amane. Ngaphezu kwalokho, esigabeni sokuqala phambili ihlukaniswe subclasses ezintathu. Lokhu kuhlukaniswa kusekelwe kube sezingeni izidakamizwa nomthelela ikhono amaseli inhliziyo lokufeza zokukhiqiza conduction ka yezinzwa. amakilasi elehlukile lemithi antiarrhythmic babe ziyaphi yokuchayeka, ngakho ezinhlobeni ezihlukene arrhythmias ukusebenza kwabo zizohluka.

Ikilasi lokuqala lihlanganisa okusheshayo sodium channel blocker. IA ekilasini kuhlanganisa izidakamizwa ezifana "quinidine" "Dizopiramid", "novokainamid", "Giluritmal". Ngu IB subclass ihlanganisa "Piromekain", "tocainide", "Difenin" "Lidocaine", "aprindine", "Trimekain", "Mexiletine." Subclass IC amathuluzi ezifana "Etmozin" obumba, "Ritmonorm" ( "Propafenone"), "VFS" "Etatsizin", "Flecainide", "Indekainid", "Bonnekor", "Lorkainid".

Ikilasi wesibili siqukethe beta-blocker ( "metoprolol", "nadolol," "alprenolol," "Kordanum", "Propranolol", "acebutolol", "Pindolol", "Trazikor", "Esmolol").

Ekilasini lesithathu kuhlanganisa potassium channel blocker "bretylium tosylate", "Amiodarone", "Sotalol".

Ekilasini lesine kuhlanganisa blocker-calcium channel kancane (isb, "Verapamil").

Uhlu kwemishanguzo elwa arrhythmic akugcini lapho. Ukuhlinzekwa has futhi glycosides inhliziyo, potassium chloride, i-sodium triphosphate, magnesium sulfate.

Imithi First Class

Sodium channel blocker ukulethwa fast kuyekwa kuseli sodium, elibangela retardation ukudlula nombono myocardium excitation. Ngalesi ukunqampunwa nemibandela ukuzungeza okusheshayo e inhliziyo amasignali sokugembula, futhi arrhythmia iqhubeka. Ake sicabangele iqembu izidakamizwa antiarrhythmic okuqondene ekilasini lokuqala.

Imithi Class IA

izidakamizwa Antiarrhythmic enjalo baqokwa extrasystole (ventricular futhi supraventricular) kanye ukubuyisela itheku isigqi uma fibrillation atrial (fibrillation atrial). Ngaphezu kwalokho, asetshenziselwa ukuvimbela ukuhlaselwa yansukuzonke.

"Procainamide" futhi "quinidine" - imithi eminye esebenza ngempumelelo antiarrhythmic nge tachycardia. Sizokwenza bakutshele okwengeziwe ngabo.

"Quinidine"

Lo muthi isetshenziswa uma paroxysmal tachycardia supraventricular, kanye paroxysms ka fibrillation atrial ukuze itheku isigqi. Ngokuvamile, imithi yaphathwa ngendlela amaphilisi.

Ubuthi izidakamizwa antiarrhythmic kuyaqabukela kwenzeka, kodwa lapho ithola "Quinidine" kungenzeka komzimba okufana thuthuva wokugaya ukudla (ukuhlanza, ukukhishwa isisu), nekhanda. Ngaphezu kwalokho, ukusetshenziswa kwezidakamizwa uyakwazi zinciphisa amazinga egazi platelet, intracardiac conduction okwehlisa, ekunciphiseni contractility esivimba amanzi. I esiyingozi kakhulu side effect - ukuthuthukiswa ventricular tachycardia, ifomu okhethekile, okungase kubangele ukufa okuzumayo isiguli. Yingakho ukwelashwa "quinidine" kufanele sigcwaliswe kuphela ukulawula ECG kanye ngaphansi kokuqondisa onguchwepheshe.

Umuthi is contraindicated ku block intraventricular futhi atrioventricular, inhliziyo glycoside ukudakwa, thrombocytopenia, hypotension, congestive ukuhluleka kwenhliziyo, ukukhulelwa.

"Procainamide"

Lesi sidakamizwa has izimpawu ezifanayo ukuba lisetshenziswe njengesifanekiselo 'quinidine ". Kaningi-ke ezinqunyiwe ngenjongo esiqoshiwe paroxysmal fibrillation atrial. Lapho umjovo emthanjeni "novokainamid" kungenzeka ukunciphisa abukhali wegazi ngakho-ke kuyadingeka ukuba ukwethula ikhambi kwaba kancane esiphezulu.

Phakathi imiphumela emibi ukuhlukanisa isicanucanu, ukuhlanza, izinguquko egazini, iziyaluyalu isimiso sezinzwa ngesimo isiyezi, ubuhlungu bekhanda, ezimweni ezingavamile, ukudideka. Uma ukusetshenziswa njalo izidakamizwa, angagcina lupus-like syndrome (serozity, samathambo, imfiva), ukutheleleka microbial ku ngalo ingaphakathi ngomlomo, ephelezelwa kancane ukuphulukiswa amanxeba kanye nezilonda nokopha izinsini. Ngaphezu kwalokho, "novokainamid" kungaba kuvuse ukusabela iguliswa, kulesi simo siyoba yini isibonakaliso wokuqala okwenziwe buthakathaka kwezicubu ekusebenziseni izidakamizwa.

Sebenzisa imithi akuvunyelwe lapho block atrioventricular, ezinzima ukwehluleka kwezinso futhi inhliziyo, hypotension futhi ukushaqeka cardiogenic.

IB ekilasini

izidakamizwa ezinjalo awakuthinti phezu itheku node, uxhumano atrioventricular futhi ATRIUM, ayizwakali ngakho endabeni arrhythmias supraventricular. Aqokwe idatha izidakamizwa antiarrhythmic nge arrhythmia, tachycardia paroxysmal, okungukuthi, ukwelapha ventricular arrhythmias. Babuye asetshenziselwa ukwelapha arrhythmias, okuyinto libangelwa ukweqisa izidakamizwa of glycosides inhliziyo.

Uhlu izidakamizwa antiarrhythmic kule sigaba ngempela ebanzi, kodwa lisho ukuthi "lidocaine" elisetshenziswe kaningi. Ngokuvamile, iqondiswa ngemithambo yegazi uma ezinzima ventricular arrhythmias e t. H. Ngo isilethikusebenza.

"Lidocaine" uyakwazi ukuphazamisa ukusebenza isimiso sezinzwa, okuyinto kubonakala isiyezi, ukuquleka, nenkinga ngenkulumo kanye umbono iziyaluyalu ukwazi. Uma sethula izidakamizwa ebulilini, kungase kukwenze wephuze ukushaya kwenhliziyo, kwehle contractility inhliziyo. Futhi, nokungezwani komzimba nezinto kungenzeka ukwakha angioedema, urticaria, pruritus.

"Lidocaine" is contraindicated ku block atrioventricular, ogulayo itheku syndrome. Imithi aluboniswa uma arrhythmias ezinzima supraventricular ngenxa kwengozi fibrillation atrial.

ekilasini IC

Izidakamizwa fanele kuze lo ekilasini, ukunweba conduction intracardiac, ikakhulukazi uhlelo lakhe-Purkinje. Sinenkosi izakhiwo eziqinile arrhythmogenic, ngakho manje ukusetshenziswa lawo lilinganiselwe.

Uhlu izidakamizwa antiarrhythmic alesi sigaba elinikwe ngenhla, kodwa ngokuvamile isetshenziswa kuphela "Propafenone" ( "Ritmonorm"). It is kuboniswe ngoba arrhythmias supraventricular futhi ventricular, e Umq. H. Ngaphansi SVC syndrome. Njengoba kukhona ingozi nemiphumela arrhythmogenic, imithi kumele isetshenziswe ngaphansi udokotela kwabaqaphi.

Ngaphezu arrhythmia, lokhu izidakamizwa kungabangela inchubekelembili yinhliziyo naqhubeka ka contractility inhliziyo. Phakathi ohlangothini Kungadala ovelele ukubukeka metallic ukunambitheka emlonyeni, isicanucanu nokuhlanza. It is hhayi ngaphandle imiphumela emibi, efana angaboni kahle, izinguquko ukuhlolwa igazi, isiyezi, ukuqwasha, ukucindezeleka.

Beta-blocker

Lapho kwandisa ithoni nozwela isimiso sezinzwa, isibonelo, endabeni ukucindezeleka, umfutho wegazi ophakeme, iziyaluyalu autonomic, ischemia, egazini, kukhona abaningi catecholamines, kuhlanganise i-adrenaline. Lezi izinto isinyathelo receptor beta-adrenergic we myocardium eholela inhliziyo ukuntengantenga kagesi kanye ukubukeka arrhythmias.

Beta-blocker ukuvimbela ukushukuma ngokweqile receptor futhi ngaleyo ndlela ukuvikela myocardium. Ngaphezu kwalokho, ukwehlisa excitability kwamaseli kohlelo conduction, okuholela kancane inhliziyo beat.

Imithi alesi sigaba asetshenziswa ukwelapha flutter atrial futhi fibrillation atrial zokuvikela kanye losizo arrhythmias supraventricular. Ngaphezu kwalokho, baba usizo lokunqoba itheku tachycardia.

Kubhekwe izidakamizwa ayizwakali antiarrhythmic ngoba fibrillation atrial, ngaphandle emacaleni lapho zokugula kubangelwa ngokweqile afundwa catecholamines.

"Metoprolol" futhi "Inderal" avame ukusetshenziswa for ekwelapheni arrhythmias. Lezi imithi inemiphumela ethile engemihle ezifana okwehlisa izinga lokushaya kwenhliziyo, ukunciphisa contractility esivimba amanzi, ukubukeka block atrioventricular. Lezi imithi emikhawulweni abandayo kuvuse naqhubeka ka-peripheral ukugeleza kwegazi. Ngaphezu kwalokho, izidakamizwa ezithinta isimiso sezinzwa, okubangela ukozela, isiyezi, ukucindezeleka, inkumbulo ukungakhuli. bona futhi ushintshe e conductivity we izinzwa nemisipha, okuyinto livezwa ukukhathala noma ukuba buthakathaka.

Beta-blocker banqatshelwe usebenzisa ukushaqeka cardiogenic, edema yamaphaphu, insulini sikashukela engaphansi, isifuba somoya. Futhi Izimo aphume ashone block atrioventricular besigaba sesibili, itheku bradycardia.

blocker potassium isiteshi

Uhlu izidakamizwa antiarrhythmic kuleli qembu kukhona izindlela retarding izinqubo kagesi kanjalo ivimbela iziteshi potassium amaseli inhliziyo. Isenzakalo esidume kunazo zonke sale ekilasini imithi - "Amiodarone" ( "Kordaron"). Phakathi kwezinye izinto, ke enza la mangqamuzana M-holino- futhi adrenergic.

"Kordaron" isetshenziselwa ukwelapha nokuvimbela ventricular, atrial futhi arrhythmias supraventricular, inhliziyo isigqi thuthuva ku isizinda SVC syndrome. I nomuthi nayo iqondiswa ukuze kuvinjelwe esisongela ukuphila ventricular arrhythmias in iziguli esivimba amanzi oyingozi. Ngaphezu kwalokho, isetshenziswa ukunciphisa kwenhliziyo njalo ngaso fibrillation atrial.

Uma usebenzisa ithuluzi isikhathi eside zingase ukuthuthukisa interstitial wamaphaphu cystic, ushintsho ibala (ukubukeka abe luhlaza onsomi). Kwezinye izimo, ubuhlungu bekhanda, ukulala neziyaluyalu, inkumbulo futhi umbono. Reception "Amiodarone" kungase kube imbangela itheku bradycardia, ukuqunjelwa, ukucanuzela kwenhliziyo nokuhlanza.

Musa akunikeze imithi i-bradycardia kokuqala, qt prolongation, ukwephulwa kwamalungelo conduction intracardiac, abanale nkinga, hypotension lwemithambo, ukukhulelwa, isifuba somoya.

Calcium channel blocker kancane

Le mithi athwale Ilokhi calcium kancane zamanje, kanjalo wacindezela foci ethunjini e Atria futhi itheku node automaticity encishisiwe. Uhlu izidakamizwa antiarrhythmic kuleli qembu zihlanganisa "Verapamil," okuyinto okwabelwe lelo ezivimbayo futhi esiqoshiwe paroxysmal tachycardia supraventricular, supraventricular yokwelapha arrhythmia. "Verapamil" kuyinto ayizwakali esimweni ventricular arrhythmias.

Imiphumela engemihle zihlanganisa block atrioventricular, itheku bradycardia, hypotension, futhi kwezinye izimo - ukunciphisa ikhono contractile zenhliziyo.

glycosides inhliziyo

Ukwahlukanisa izidakamizwa antiarrhythmic ngeke ibe ephelele ngaphandle ukuzisho ngokwenu lezi zimali. Lezi zihlanganisa izidakamizwa ezifana "Tselanid", "Korglikon", "Digitoxin", "Digoxin" nabanye. Zisetshenziswa ukubuyisela itheku isigqi, tachycardia supraventricular, ukuncishiswa ventricular izinga esimweni fibrillation atrial. Lapho usebenzisa i-glycosides inhliziyo kufanele ukuqapha isimo sakho. Izimpawu digitalis ukudakwa owabonakaliswa ubuhlungu besisu, isicanucanu nokuhlanza, ukuphathwa ikhanda, angaboni kahle futhi iphupho, ngopha emakhaleni.

Akuvunyelwe ukusebenzisa lezi izidakamizwa antiarrhythmic ngesikhathi bradycardia syndrome ERW intracardiac ukuvinjelwa. Basuke hhayi oqokwe esimweni paroxysmal ventricular tachycardia.

inhlanganisela antiarrhythmics

Uma isigqi ethunjini e umkhuba emtholampilo, abanye inhlanganisela yemithi esetshenziswa. Ngakho, "Quinidine" lingasetshenziswa ngokuhlanganyela glycosides inhliziyo ekwelapheni arrhythmia eziphikelelayo. Nge-beta-blocker "quinidine" kungenziwa esiwabelwe esiqoshiwe ventricular arrhythmias refractory ukuze yingaba yini engakusiza. Ukusetshenziswa ahlangene we-beta-blocker futhi glycosides inhliziyo kunikeza nomphumela omuhle kuleli ventricular futhi arrhythmias supraventricular, kanye kusiza ukuvimbela ukuphinda tachycardia ethunjini futhi tachyarrhythmia.