Ukwehluleka oyingozi inhliziyo: izimpawu ngaphambi kokuba afe futhi usizo lokuqala

Minyaka yonke, isifo esimiso senhliziyo nemithambo yegazi okuholela ekufeni kwabantu abangaphezu kwezigidi ezingu-17 emhlabeni wonke. 10% kuphela pathologies abanjalo bangabaphostoli azalwa nako. Iningi isifo uthi kwenzeka on isizinda yokucindezeleka yokuphila abampofu yomuntu yesimanje. Kulesi sihloko sibheka ukuthi yini congestive yokumelwa yinhliziyo.

Izimpawu sokufa kanye nezinkinga eziba umphumela zokugula, izindlela ukuxilongwa nokwelashwa kwezifo kungakephuzi, izinhlobo kanye namafomu zesifo - ulwazi kuzo zonke lezi zinkinga kuyobonakala mathiriyeli ukubuyekeza kwethu. Ngaphezu kwalokho, lesi sihloko sidingida imithetho yokuziphatha, okungaba wusizo kunoma ubani kithi. Ikhono isinyathelo esimweni esiphuthumayo inikeza ezimweni eziningi, kulondolozwe ukuphila komuntu. Ngakho, umuntu kufanele azi ukuthi usizo lokuqala for ukwehluleka oyingozi inhliziyo.

Umqondo ephethwe yisifo senhliziyo

ukuhluleka Inhliziyo (hf) - zokugula, lapho inhliziyo iyeke ukuphakela lemali edingekile of izicubu emzimbeni igazi. It is phetho ikhono kahle we imisipha yenhliziyo (myocardium) ukuncipha. CH ngokuvamile kuholela ukubonakaliswa okukhulu emitholampilo, kuhlanganise edema yamaphaphu, infarction, ukushaqeka cardiogenic.

Izifo ukungenwa kokubili amadoda nabesifazane, kodwa lona okugcinwe abahlushwa yilesi sifo njalo. Nokufa siphakeme ngokwanele kwi egunjini lokuhlolwa kwezifo. Ingozi ukuze ukuphila komuntu noma yiziphi izenzo kubangelwa izifo ezifana congestive yokumelwa yinhliziyo. Izimpawu ngaphambi kokufa kwakhe, ngesiHeberu ebizwa ngokuthi imithi okungazelelwe, zahlukahlukene kakhulu. Bathembele okuyifomu lesi sifo kwenzeka. Ngu ubunjalo imvelaphi yinhliziyo ababonakali ngezikhundla:

• Esivimba amanzi inhliziyo ukuhluleka - a zokugula ukuthi kuwumphumela umonakalo ngqo imisipha yenhliziyo ngenxa yokwephula energy umzimba. Lolu hlobo ukuhluleka kwenhliziyo kuholela ukungasebenzi kwekhono ukusikwa futhi aziphumulele zenhliziyo.
• Ngokweqile inhliziyo ukuhluleka - a zokugula esakheka ngenxa umthwalo omkhulu phezu kwenhliziyo. Lolu hlobo kwezinye izimo ukuthuthukisa ku ngemuva yesifo senhliziyo.
• Kuhlanganiswe inhliziyo ukuhluleka - uhlobo zokugula, elihlanganisa izizathu ezimbili ngenhla.

Amakilasi ephethwe yisifo senhliziyo

Kuze kube manje, kukhona criteria ehlukahlukene lapho isifo ihlukaniswe izinhlobo noma amafomu. Medicine, kukhona ngezigaba izinhlelo eziningana (isiRashiya, European, American), kodwa uhlelo ezithandwa kakhulu ehlongozwayo ngu US nangodokotela bababhekene nezifo zenhliziyo. Ngokuhambisana le ndlela kukhona amakilasi ezine isifo:

• EGreyidini yoku-1, lapho kuphakama isiguli dyspnea ezinyakazayo asebenzayo, isibonelo, izinyathelo ifike ezingeni ngenhla esitezi sesithathu.
• EBangeni 2, wherein nanso dyspnea ngisho at umthwalo ongaphakeme - nawuphakamisa esitezi sokuqala noma sesibili. Kuyaqapheleka kwehle umsebenzi ezingokomzimba.
• Ebangeni le-3, lapho inhliziyo ukwehluleka ephawuleka at imithwalo ongaphakeme, isibonelo uma uhamba, kodwa isifo quiescent izimpawu zinyamalale.
• EBangeni 4, lapho izimpawu zenzeka ngisho uphumule, futhi umsebenzi ezincane kuholela nokwephula ezisekujuleni kwenhliziyo futhi lonke uhlelo senhliziyo nemithambo yegazi iyonke.

Ukwahlukanisa CH

Pathology kungenziwa labizwa ngokuvumelana nezimfuno eziningi. Kuye isithombe emitholampilo ye imithi isifo eyaziwa oyingozi futhi ezingalapheki yokumelwa yinhliziyo.

Acute inhliziyo ukwehluleka (AHF) - ukuphazamiseka lapho izimpawu sokugembula ngokushesha (kungakapheli amahora). Njengomthetho, ngokumelene zasemuva zezinye izifo isimiso semithambo yegazi futhi kukhona ukwehluleka inhliziyo oyingozi.

Infarction, myocarditis kanye nezinye izifo bangalindela abe okwabangela isifo uthi, ngoba ngaphansi kwale pathologies, senhliziyo esilimele amangqamuzana efa ngenxa iziyaluyalu kwegazi wendawo. Och kungase futhi kuholele kusukela ukwa kwesokunxele ventricular odongeni, ukwehluleka okukhulu valve (the yomthambo i-aorta ne-mitral). Kwezinye izimo, zokugula eba ngaphandle ukwephula ngaphambi.

Och - isifo ngempela esikhohlisayo ngoba lokho kungase kubangele isimo okubuhlungu nezinye izinhlelo zomzimba. Izinkinga of ukwehluleka oyingozi inhliziyo kanengi ayithinti kwaphela inhliziyo kodwa futhi umgudu wokuphefumula, okubangela edema yamaphaphu, isifuba somoya inhliziyo, ukushaqeka cardiogenic.

Okungalapheki inhliziyo ukuhluleka - ukuphazamiseka kwakhiwa lapho zokugula kancane kancane, amasonto, izinyanga noma ngisho neminyaka. Kwenzeka ngokumelene ingemuva yesifo senhliziyo, umfutho wegazi ophakeme noma unenkinga yegazi eliphansi isikhathi eside.

Izinhlobo DOS ngohlobo hemodynamics

Kuye uhlobo hemodynamic kwasendaweni nobuntu zokugula, kukhona amafomu alandelayo ka ukwehluleka oyingozi inhliziyo:

• DOS nge hemodynamics congestive.
• DOS nge hemodynamics hypokinetic.

Hemodynamics - iyona enomopho ngokusebenzisa izitsha, okwabangela kokucindezeleka okukhulu ezindaweni ezahlukene isimiso sokujikeleza kwegazi. Kuyaziwa ukuthi uhamba igazi kusuka esifundeni ingcindezi ephakeme ukuze aphansi ezaziwayo.

Ingcindezi incike viscosity igazi, kanye ukumelana we Imithambo yegazi nomfula. DOS nge hemodynamics congestive kungathinta kwesokudla noma i-ventricle engakwesobunxele senhliziyo. Ngaphakathi accordance nga lo mahluko:

• Acute kwesokudla ventricular ukwehluleka, lapho stasis emithambo yegazi siyenzeka kumbuthano enkulu ukugeleza kwegazi, isb. E. Ithinta cishe yonke kwezitho nezicubu.
• Acute kwesokunxele ukwehluleka ventricular, lapho stasis emithambo yegazi kwenzeka yamaphaphu ukugeleza kwegazi. Pathology ephazamisa exchange igesi emaphashini futhi kuholela ukuthuthukiswa edema yamaphaphu noma somoya inhliziyo. Ngakho, sinombono ukuhlukumeza okunjalo kwenzeka acute yamaphaphu isifo senhliziyo.

DOS nge hemodynamics hypokinetic

Acute inhliziyo ukwehluleka ngesikhathi hemodynamics hypokinetic - a zokugula kubangelwa ukushaqeka cardiogenic - nokwehla elibukhali ikhono myocardium ungenwa, kuphumele ukuphazamiseka igazi eligciniwe bonke ezicutshini zomzimba.

ukuhlukanisa:

• ukushaqeka Arrhythmic, okuyinto ngenxa inhliziyo isigqi iziyaluyalu.
• Shock Reflex - yokusabela kuya ubuhlungu.
• Iqiniso ukushaqeka cardiogenic - isimo sokugembula okwenzeka lapho izilonda kwesokunxele ventricular izicubu, futhi endaweni lesion okungenani u-50%. Ukwephulwa, njengoba umthetho, nivame abantu engaphezu kuka-60 ubudala; abantu abaye ngamelwa yinhliziyo yesibili; iziguli sikashukela mellitus nomfutho wegazi ophezulu kanye.

Okubalulekile, ukushaqeka cardiogenic libhekene ubuhlungu, okungazelelwe blood pressure ukwehla ukuze amagugu ubuncane (phansi 0), filiform ishayela, isikhumba ugodo. Pathology angase kamuva ukuthuthela edema yamaphaphu noma umphumela wokuhluleka kwezinso.

Kunomthelela ukuvela och

Ukuthuthukiswa yinhliziyo nge Yiqiniso acute, isiguli singase kwandulelwe ngaphambilini ihlangabezane yezifo semithambo uhlelo. Izimo ezinjalo zihlanganisa:

• isifo senhliziyo kubangelwa ukulimala imisipha yenhliziyo, okuholela ukwehla elibukhali myocardium ikhono ungenwa;
• ukuhluleka kwenhliziyo okungamahlalakhona, okuyinto ephula lapho liningi igazi evamile kwezitho nezicubu;
• ukulimala ubuqotho valve inhliziyo futhi amashubhu;
• ukunqwabelana oketshezini pericardium, okuholela ukwephulwa kwelungelo kwenhliziyo ngenxa ukucindezela kwendikimba phezu komgodi wenhliziyo (lokhu zokugula libizwa tamponade inhliziyo);
• ukuqina ezindongeni inhliziyo - hypertrophy esivimba amanzi;
• abanomfutho wegazi ophakeme crisis - imakwe blood pressure okungavamile.

izimbangela noncardiac

Ngaphezu kwalokhu kwakunenkinga ngenhliziyo ukuvela isifo uthi kungenzeka ongumsolwa kuleli cala zokugula okuhlobene ne-high blood pressure ku yamaphaphu ukugeleza kwegazi. Izifo eziholela ekuxilongelweni "acute inhliziyo ukwehluleka":

• unhlangothi - ukwephulwa ubuchopho kwegazi, okuyinto kuphakamisa izicubu zawo alimele Imininingwane ubuchopho umsebenzi disorder;

• thromboembolism Umthambo yamaphaphu (isifo kwenzeka ngenxa ukuvaleka Umthambo yamaphaphu, kanye izinqubo zayo amahlule (thrombi), ngokuvamile amahlule igazi lifika kule ezinkulu okhalo futhi aphansi esitho emithanjeni);
• wamaphaphu nesifo - yisishiso bronchi (ukucinana kwemigudu yokuphefumula), ukuvuvukala izicubu wamaphaphu (pneumonitis);
• dysrhythmia kwenhliziyo (ukusheshisa noma deceleration) - tachyarrhythmia, bradyarrhythmia;
• izifo zibangelwa Amagciwane ahlukahlukene.

Kukhona futhi izici okuholela ukuthuthukiswa ephethwe yisifo senhliziyo, kodwa hhayi ibonakalisa izifo kwanoma iyiphi izinhlelo isitho. Lezi zihlanganisa:

• ukuhlinzwa;
• ukulimala kanye nobuchopho ukulimala;
• ukuhlaselwa anobuthi ku imisipha yenhliziyo - utshwala, nolaka izidakamizwa ukuchayeka;
• umshini heart-lung, ukusetshenziswa okuholela nemiphumela ethile;
• electrotrauma - nomthelela emzimbeni kagesi;
• ukuzikhandla psycho-ngokomzwelo noma ngokomzimba.

Ukuxilongwa ukwehluleka oyingozi inhliziyo

Ukuhlonza Ukugula senhliziyo is ngokuyinhloko zibhekiswe ukuzimisela izimbangela ukuthi kwaholela ekwakhekeni zokugula. Ngaphambi kokwenza ukuhlolwa laboratory futhi manipulations nokusetshenziswa kwemishini yokwelapha, udokotela wakho izocacisa ngokusebenzisa ingxoxo isiguli ukuba khona noma ukungabi ekuphileni kwakhe yezici ezihlukahlukene ekuthuthukisweni izifo ezifana ukwehluleka oyingozi inhliziyo. Izimpawu sokufa (okungazelelwe) kwenzeka phakathi namahora angu-24, kungase kubonakale ubuthakathaka, umsebenzi Uchwepheshe - hhayi ukulahlekelwa isikhathi, futhi ikhumbula zonke izikhalazo isiguli ngokushesha ngangokunokwenzeka ukusungula uphethwe yini.

Izindlela zocwaningo main esetshenziswa sitholakele AHF, zihlanganisa:

• i electrocardiogram;
• echocardiogram;

• esifubeni X-ray;
• jikelele sezihambile ukuhlolwa igazi;
• Ngezinye izikhathi isetshenziselwa uphethwe och cardiovisor - kudivayisi Umgomo we operation akuhlukile electrocardiograph.

zindlela zokuxilonga

Isibonakaliso ezinkulu evelele kakhulu ukwehluleka oyingozi inhliziyo zamanje kungenziwa ngokuthi itheku tachycardia - yakha tachyarrhythmias supraventricular, okuyiwona isici yanda itheku isigqi - ukuvama Kufinyeta kwenhliziyo omdala ingaphezu 100 ngomzuzu. isibonisi Graphic umsebenzi inhliziyo sibonisa igunya umngcele sithuthukiswe kwesokunxele noma kwesokudla. Ngaphezu kwalokho, phezu noma ngaphezu inqubo xiphoid ithoni lwesithathu livela.

Acute congestive kwesokudla senhliziyo kuzibonakalisa izici eziningana:

• umthambo wesibeletho kanye emithanjeni hepatic ukuba sikhukhumale zigcwala;
• wegazi ophezulu emithambo yegazi;

• okwandisa isibindi, jaundice amashidi;
• ilungu ukuvuvukala;
• cyanosis iminwe nazo (indlebe, kwesilevu, ekhaleni);
• isiguli nobuhlungu obukhulu quadrant kwakhe kwesokudla;
• ECG ilandisa inhliziyo sindisa ngokuzumayo i-ventricle yangakwesokudla kanye ATRIUM, okuyinto kuvezwa okusezingeni eliphezulu amazinyo ezicijile.

Izimpawu kwesokudla senhliziyo is ngokucacile bambulwa-X-ray kanye electrocardiogram. Isigaba sokugcina salolu hlobo isifo senhliziyo kuletha Ukuwohloka umzimba, ukunciphisa izinga iphrotheni esegazini futhi ukuphazamiseka ibhalansi usawoti emzimbeni.

Izimpawu kwesokunxele ventricular ukwehluleka futhi ukushaqeka cardiogenic

Ngakwelinye ihlangothi, khona-acute ventricular kwesokunxele nokwehluleka hemodynamics congestive kufakazelwa eziningi izici ezilandelayo:

• iphika, ngezinye izikhathi kuphenduke somoya;
• ukukhwehlela paroxysmal ezomile, expectoration ngezinye izikhathi frothy, okuyinto ukhululeka umlomo noma ikhala;
• khona rales ezimanzi zazo wezwa phezu bonke ubuso esifubeni.

Kunezindlela eziningana izimpawu nobuntu ukushaqeka cardiogenic, okuyilezi:

• Wegazi isiguli lehla abakuzuzile 90-80 mm HG. Art. ngisho kancane. Uma umuntu uhlushwa umfutho ophezulu wegazi, kuwuphawu ukushaqeka izoyenqaba ngo-30 mm HG. Art. kusukela ezingeni ngabanye nsuku zonke.
• kwehle ishayela ingcindezi - esingaphansi 25-20 mm HG. Art.
• Izinsolo ukushaqeka cardiogenic kufanele ubangele paleness zesikhumba coldness yayo. Lezi kubonakaliswa kwembule kokunikezwa kwe-microcirculation kwezicubu zomzimba.

Nge yomuntu othola izimpawu ngenhla zokugula, kufanele kube uchungechunge lwezenzakalo ngaphambi kokufika Ochwepheshe. (. Stroke, isifo senhliziyo, njll) Usizo lokuqala for acute inhliziyo ukwehluleka kufanele iqondiswe ukuqinisekisa ukuthi:

• uhlele ukufinyelela umoya ohlanzekile;
• ukuqinisekisa evundlile isiguli (Uma engenabo izimpawu kwesokunxele ukwehluleka ventricular);
• ubambe umphumela analgesic.

Ukwelashwa nokuvikelwa ukwehluleka oyingozi inhliziyo

Ukwelashwa ephethwe yisifo senhliziyo - yokwelapha eziyinkimbinkimbi okuhloswe ngokuyinhloko, ukuqinisekisa ukuthi:

• ukuqeda sindisa imisipha inhliziyo - lesi sinyathelo kufezwa ngokusebenzisa izidakamizwa ukuthi kunciphise umfutho wegazi nokushaya kwenhliziyo;
• abophe ngezimpawu zesifo (izinyathelo zokwelapha kuzoncika isifo ukubonakaliswa ukubonakaliswa).

Uma DOS uye savela ngenxa isilethikusebenza, kubalulekile ngokushesha ngangokunokwenzeka ukuze ubuyisele yenhliziyo Umthambo ukugeleza kwegazi. Ngokuvamile, isimo kubangela infarct Umthambo thrombosis, okunomsoco inhliziyo. Ikhambi kusiza igazi ihlule ukubuyisela ngokuphelele patency bomkhumbi igazi futhi ekulinganiseni isimo lesiguli.

Indlela ethandwa kakhulu kuleli cala ubhekwa thrombolysis kodwa kunemidanti kufanele kwenziwe ngokushesha ngangokunokwenzeka lapho kuqala infarction kuze clot namanje "fresh". Usizo lokuqala for ukwehluleka oyingozi inhliziyo kuhilela ukusetshenziswa kwezidakamizwa (thrombolytics), ogama senzo ihlose kuqedwa amahlule. Ukuthaka imithi iqondiswa ngemithambo yegazi, isilinganiso sabo Ukungena ku umzimba akuvunyelwe ezilawulwayo.

Ukwelashwa nokuvikelwa ukwehluleka oyingozi (ventricular kwesokudla) ne hemodynamics congestive kuhilela ukususwa kubangela yavusa, - .. Isimo asthmaticus, amahlule e imithambo yamaphaphu, njll Ukuqala yokwelapha uya khona nesineke "nitroglycerin" noma "Furosemide" lapho zokugula kuhlanganiswe ukushaqeka cardiogenic esetshenziswa inotropic kusho. Lihambisana ezingenhla Kwenziwa-mpilo ephefumula ngokusebenzisa ipayipi.

Lengqondo ukuyaluza iqhubeka analgesics kwezidakamizwa, ezifana "morphine", okuyinto kunciphisa umsebenzi imisipha zokuphefumula futhi enciphisa ukucindezeleka phezu kwenhliziyo.

Ukuqedwa ventricular kwesokunxele izimpawu ukwehluleka

Yokujama tsi igazi yamaphaphu ngokuvamile kuholela nemiphumela enqala ezifana edema yamaphaphu. Lapho semfene anjalo iziguli ebekiwe esasikhipha "nitroglycerin" ngemithambo yegazi.

Uma acute kwesokunxele ventricular ukwehluleka nge hemodynamics congestive kuhlangene ukushaqeka cardiogenic, libeke ukwethulwa "dobutamine" noma "noradrenaline" ngemithambo yegazi. Kukhona amacala lapho lezi imithi ezihlanganiswe eziyinkimbinkimbi.

Yesivini ukunqampunwa nge izindlela ukuhlinzeka igwebu wokugoqa.

Uma hemodynamics walulama, kodwa izimpawu wamaphaphu edema iqhubeka, isiguli iqondiswa glucocorticoids. Kulokhu, usizo lokuqala e ukwehluleka oyingozi inhliziyo kuzosiza ukunciphisa permeability of ulwelwesi.

Ukwelashwa nge ukushaqeka cardiogenic iqala ukwandisa okukhipha inhliziyo, ngokungabi bikho izenzo congestive yinhliziyo Yakhiwe esasikhipha zegazi. Le nqubo wenziwa kuphela ngaphansi kokulawula kwenhliziyo, umfutho wegazi nokuphefumula kwezimila. Uma ngaphambi okuvela acute isifo senhliziyo kwenzeka ukulahlekelwa okukhulu okusamanzi, i-sodium chloride isetshenziswa.

Ukuqedwa ngezimpawu zesifo Yiqiniso, ngokuyinhloko ezihlobene nokusetshenziswa kwezidakamizwa, kodwa uma izinyathelo ezithathwe akuvezi umphumela oyifunayo, ungasebenzisa indlela efanele - ukwenza athula hemodynamic ngokusebenzisa tourniquet ku ngemithambo zomzimba.

Ezimweni lapho imithi olandelanayo akanamandla iphendukele ukuhlinzwa. Idatha ye-iqedwe lapho umuntu enezinkinga ezihambisana occlusion lemithambo valve esikhundleni inhliziyo. Misa ukushaya kwenhliziyo kusiza ukufaka umshini wokulawula ukushaya kwenhliziyo noma ovuselela.

zokuvimbela

Indlela engcono ukuvimbela ukuthuthukiswa isifo - kuba ukuthobela imithetho elula - okungukuthi, ahole indlela yokuphila enempilo, wayeka nokubhema, give up utshwala ngokweqile, ukuze afeze ukuqapha ngezikhathi izifo ekhona. Nokho, ezimweni lapho isifo namanje ukuvela, kufanele ulandele umbuso ezithile zokuphila kwansuku zonke.

Iziguli congestive senhliziyo kumele eduze ukuqapha isisindo sabo. ngamakhilogremu Extra avuse ukwanda kashukela futhi kumiswa cholesterol zingcwecwe e imithambo yegazi, elibangela-high blood pressure. Isimo esihle sokulondoloza isimo somzimba ngokuvamile kungaphansi Ukudla ukudla okukhethekile. Kuyadingeka ukuba ngokuqinile alawule ukuthathwa usawoti, the ngokweqile of okuyinto embi empilweni - kudala nokugcinwa uketshezi, edema ekwakhekeni, kukhuphuke umthwalo inhliziyo.

Kuyasiza ukwenza ukuvivinya umzimba, ukunikeza load emisipheni nasemalungeni, kodwa amakilasi ezemidlalo akufanele kusenze sindisa umzimba. Isethi umzimba ukuba kuvunyelwane ngakho udokotela. Kubalulekile njalo ukuvakashela evulekile, ukulala, ukugwema ukuhlala ucindezelekile futhi ukuzikhandla ngokwengqondo.

Ngamafuphi, kungase kuqashelwe ukuthi sibi isifo senhliziyo - a zokugula ukuthi luvame ukubulala. Ukugula ngokuvamile ikhulela zasemuva zezinye izinhlelo uthi isifo esimiso senhliziyo nemithambo yegazi kanye kuholela yezinkinga ezihlukahlukene, kuhlanganise nokufa, ukushaqeka cardiogenic, edema yamaphaphu, nokunye.

Zikhona izimpawu, okuyinto sitholakale ukwehluleka oyingozi inhliziyo. Izimpawu sokufa kungase ngokuphelele ubonakalisiwe, it is ke umsebenzi obalulekile ochwepheshe yirekhodi azo zonke izikhalazo nesineke futhi ukuhlolwa ngokushesha.