Chenjera mwoyo kutadza: Zviratidzo asati afa uye rwekutanga

Gore negore, hosha kumwoyo inotisvitsa rufu vanhu vanopfuura mamiriyoni 17 munyika yose. 10 chete% kubva pathologies dzakadaro vachiberekwa. Ruzhinji chirwere inoti rinooneka riri yaitwa mupfungwa uye murombo mararamiro womunhu ano. Munyaya ino tinotarisa zviri kukundikana mwoyo congestive.

Zviratidzo rufu uye yematambudziko kuti zvinobva zvokurwara, nzira nechirwere uye kurapwa kwezvirwere, mhando uye siyana chirwere - mashoko panyaya dzose idzi achabudiswa mumatauriro zvinhu zviri kwataita. Uyezve, nyaya inokurukura nemitemo yomufambiro, izvo zvinogona kubatsira chero wedu. Kugona kuita pakaita anogovera kakawanda, ndichengetedze upenyu hwevanhu. Saka, munhu anofanira kuziva kuti vabatsirwe nokuda rikwanise mwoyo kukundikana wokutanga.

Pfungwa mwoyo kutadza

Heart kutadza (Zvakanaka hf) - zvokurwara, umo mwoyo hunoguma kuwanisa zvakakodzera chitsama muviri rinenge ropa. Zviri migumisiro vasingadzoreki mano pomwoyo (myocardium) kuti ndizvipete. CH Kazhinji kunounza zvakakomba zvekuchipatara kuratidzwa, kusanganisira pulmonary edema, infarction, cardiogenic kuvhunduka.

Chirwere kubatwa varume nevakadzi, asi vapedzisira vanorwiswa chirwere ichi kakawanda. Rufu kumusoro zvakakwana pamusoro zvokurwara. Ngozi upenyu hwevanhu ane mumwe kuratidzwa zvinokonzerwa zvirwere zvakadai congestive mwoyo kukundikana. Zviratidzo asati afa, akadana mushonga kamwe, muri-siyana chaizvo. Ivo vanovimba iro chimiro chirwere kunoitika. By yezvakaita kwakabva mwoyo nokukundikana Munokudzwa:

• Myocardial mwoyo kutadza - mumwe zvokurwara kuti mugumisiro zvakananga kuvadza pomwoyo nokuda kutyora simba muviri. Izvi mhando mwoyo kukundikana kunotungamirira dysfunction kuti marwadzo uye kutandara mwoyo.
• Zadzisa mwoyo kutadza - a zvokurwara inoita kuti somugumisiro guru mutoro pamwoyo. Izvi mhando mune zvimwe zviitiko kuva pamusoro pakanyorwa mwoyo chirwere.
• Combined mwoyo kutadza - mufananidzo zvokurwara, iro rinobatanidza maviri pamusoro-dzataurwa zvikonzero.

Makirasi mwoyo kutadza

To musi, pane nzira dzakasiyana-siyana idzo chirwere rakakamurwa mhando kana nzira. Medicine, pane dzakawanda kupatsanura mugadziriro (Russian, European, American), asi zvikuru nevanhu vari ezvinhu wakatangwa na US cardiologists. Maererano nzira iyi makirasi mana chirwere:

• Grade 1, sezvamakaropafadzwa murwere ichibudira dyspnea vanoshingaira inofamba Somuenzaniso, matanho kumuka kune pamwero pamusoro uriri rechitatu.
• Grade 2, zvine dyspnea kunyange panguva yakaderera mutoro - apo nokusimudza rokutanga kana repiri paburiro. It rinozivikanwa ungaderedza basa munhu chaiko.
• Grade 3, sezvamakaropafadzwa mwoyo kukundikana kuoneka panguva yakaderera mitoro, somuenzaniso kana achifamba, asi quiescent chirwere zviratidzo apere.
• Grade 4, umo zviratidzo kuitika kunyange zororo, uye vashoma muviri kunoita kuti zvakakomba kutyorwa mwoyo yose kumwoyo yose.

kupatsanura CH

Zvokurwara zvinogona Classified maererano akawanda zvinodiwa. Zvichienderana kunotoda mufananidzo mushonga chirwere anozivikanwa chakasimba uye chirwere chemwoyo.

Chenjera mwoyo kutadza (AHF) - kukanganisika umo pathological zviratidzo nokukurumidza (mumaawa). Kazhinji, tikafunga zvimwe zvirwere zviri vascular emuviri uye pane kukundikana mwoyo chakasimba.

Infarction, myocarditis nezvimwe zvirwere zvinogona kuva chikungiso kuti chirwere rinoti, nekuti pasi pathologies izvi, mwoyo tsandanyama masero afe nokuda omunharaunda kweropa zvirwere. NaArioki zvinogona kuitika kubva pakakuvara kuruboshwe ventricular rusvingo, rikwanise kukundikana mavharuvhu (the kutsemuka uye mitral). Mune zvimwe zviitiko, zvokurwara hwapedyo pasina risati kutyorwa.

NaArioki - zvikuru achinyengera chirwere nokuti kunogona kukonzera chinorwadza mwoyo dzimwe gadziriro muviri. Matambudziko chenjera mwoyo kutadza kazhinji kukanganisa mwoyo asiwo kufema hurongwa, zvichikonzera pulmonary edema, cardiac asima, cardiogenic kuvhunduka.

Chirwere mwoyo kutadza - kukanganisika umo zvokurwara aumbwa zvishoma nezvishoma, pamusoro mavhiki, mwedzi kana kunyange kwemakore. It kunoitika pamusoro mamiriro chemwoyo, neBP kana mazhinji kupererwa neropa.

Mhando Dos pamusoro mhando hemodynamics

Zvichienderana rudzi hemodynamic unhu localization pamusoro zvokurwara, pane zvinotevera siyana rikwanise mwoyo kutadza:

• Dos pamwe congestive hemodynamics.
• Dos pamwe hypokinetic hemodynamics.

Hemodynamics - ndiro chokubuda ropa kuburikidza midziyo, izvo zvakakonzera zvikuru munzvimbo dzakasiyana nzvimbo kweropa hurongwa. Zvinozivikanwa kuti ropa inofamba kubva kunzvimbo yakakwirira kumanikidzwa kuti yakaderera.

The kufurira kunobva viscosity ropa, uye kurwisa kwemasvingo midziyo ropa nomurwizi. Dos pamwe congestive hemodynamics zvingaita kurudyi kana kuruboshwe ventricle mwoyo. Maererano musiyano uyu:

• Chenjera kurudyi ventricular akundikana, umo venous stasis iri kuchengetwa guru denderedzwa ropa kuyerera, kureva. E. Kwainoita anenge zvose nhengo uye munyama.
• Chenjera akasiya ventricular kukundikana, umo venous stasis rinowanikwa muropa chekubuda pulmonary. Zvokurwara zvinokunetsa gasi mukutsinhana mumapapu uye zvinotungamirira chitange pulmonary edema kana cardiac asima. Saka, tikafunga kutyorwa kwakadaro kunoitika chakasimba pulmonary mwoyo chirwere.

Dos pamwe hypokinetic hemodynamics

Chenjera mwoyo kukundikana panguva hypokinetic hemodynamics - mumwe zvokurwara kunokonzerwa cardiogenic kuvhunduka - rakapinza kuderera nekugona myocardium kuti chibvumirano, zvichiguma nokuvhiringidzirwa ropa wedzerai zvose nyama dzomuviri.

kusiyanisa:

• Arrhythmic kuvhunduka, inova nemhaka cardiac mutinhimira zvirwere.
• Reflex Shock - maitiro kune marwadzo.
• True cardiogenic kuvhunduka - pathological ezvinhu kunoitika apo maronda ari kuruboshwe ventricular rinenge uye lesion nzvimbo iri zvinenge 50%. Kukanganisa, sezvo mutemo, ndivo tichikurumidza vanhu makore 60 zera; vanhu vakambova mwoyo kurwisa wechipiri; varwere neBP uye chirwere cheshuga mellitus.

Pazvese, cardiogenic kuvhunduka kunoratidzwa marwadzo, kungoerekana BP kuderera kusvikira shoma tsika (pasi 0), filiform kupomba, ganda akacheneruka. Zvokurwara anogona vakazoroorwa kune pulmonary edema kana zvinovapo renal kukundikana.

Zvinhu muve kwaita naArioki

Kukura mwoyo kukundikana pamwe rikwanise Chokwadi, murwere anogona kuitwa pashure kare vakasangana zvirwere vascular hurongwa. ezvinhu akadaro dzinosanganisira:

• mwoyo chirwere anokonzerwa kuvadza mwoyo tsandanyama, zvichiita kuti unopinza kuderera myocardium kukwanisa kubata;
• chisingaperi mwoyo kukundikana, iyo inotanga kana chakaipa ropa wedzerai mapazi uye munyama;
• kuvadza kuvimbika mwoyo mavharuvhu uye sepombi;
• kuunganidza Urume ari pericardium, iyo inosvitsa kutyorwa mwoyo yakarurama mwero nokuda kumanikidza kunoitwa pamusoro mhango mwoyo (zvokurwara ichi anonzi cardiac tamponade);
• thickening kwemasvingo mwoyo - myocardial hypertrophy;
• vane chirwere cheBP dambudziko - akacherekedza BP abnormality.

noncardiac zvikonzero

Kuwedzera matambudziko nomoyo kuti chidzoke zvirwere rinoti anogona honzeri iri zvokurwara chokuita cheBP muropa chekubuda pulmonary. Zvirwere kuti kukonzera chirwere kuti "rikwanise mwoyo kutadza":

• Kurohwa - kutyora uropi kuparadzirwa, iyo chinokurwadzai zvayo tagovera zvinyama uye zvachose pfungwa shanda nyonganyonga;

• thromboembolism tsinga of zvemapapu (hosha kunoitika pamusana blockage of pulmonary tsinga, uyewo yaro dzinotsanagura clots ropa (thrombi), anowanzodanwa clots ropa munguva zvikuru pelvic uchingodzikira muzvidimbu mutsinga);
• zvirwere zvemapapu - ane kuzvimba principales (bronchitis), kuzvimba zvemapapu rinenge (pneumonitis);
• dysrhythmia kwemwoyo (kumhanyisa kana deceleration) - tachyarrhythmia, bradyarrhythmia;
• Zvirwere zvinokonzerwa utachiona siyana.

Panewo zvikonzero inoenda kukura mwoyo kukundikana, asi kwete kuratidzwa zvirwere chero nenhengo dzawo. Idzi dzinosanganisira:

• kuvhiya;
• kukuvara pfungwa zvinokuvadza;
• hunokachidza kurwisa pomwoyo - doro, hasha zvinodhaka ekisiposha;
• mwoyo-zvemapapu muchina, kushandiswa iyo inosvitsa nemimwe migumisiro;
• electrotrauma - zvainoita mutumbi Magetsi;
• psycho-mupfungwa kana mumuviri nesimba.

Chirwere kuti rikwanise mwoyo kutadza

Diagnosing mwoyo kukundikana anonyanya kutungamirirwa kutsunga zvinokonzera zvakazoita kuti kukura zvokurwara. Asati kuita rabhoritari nemiedzo uye manipulations nokushandiswa zvokurapa midziyo, chiremba achasarudza kuburikidza kutaura murwere kuvapo kana kusavapo muupenyu hwake-siyana zvinoita kuti pave kwezvirwere zvakadai rikwanise mwoyo kukundikana. Zviratidzo rufu (kamwe) rinowanika mumaawa 24, zvingaita simba, uye nyanzvi basa - kwete kurasikirwa nguva, uye kufungisisa zvose zvichemo murwere nekukurumidza kumisa zvakarurama zvawanikwa.

Huru ongororo nzira inoshandiswa nechirwere pamusoro AHF, zvinosanganisira:

• unonzi, electrocardiograph;
• echocardiogram;

• bhokisi maekisirei;
• mukuru uye yemhando bvunzo ropa;
• dzimwe nguva rinoshandiswa kureva chirwere naArioki cardiovisor - mudziyo musimboti kushanda hapana chakasiyana electrocardiograph.

chirwere zvinodiwa

Chikuru uye kupfuura raidudzwa chiratidzo rikwanise mwoyo kutadza kuitika anganzi sinus tachycardia - kuumba supraventricular tachyarrhythmias, nokuti idzo hunhu iri nokukurumidza sinus mutinhimira - kakawanda pakati sunga kwemoyo mukuru kunopfuura 100 paminiti. Graphic kuratidza mwoyo kwebasa zvinoratidza kunowedzera simba muganhu akasiya kana kurudyi. Uyezve, pamusoro kana pamusoro xiphoid muitiro rechitatu inzwi anooneka.

Chenjera congestive rworudyi mwoyo kukundikana kunooneka pacharo mune dzakawanda zvinhu:

• remuromo tsinga uye hepatic mutsinga kuti achazvimba uye kuzvimba;
• yakakwirira venous kumanikidzwa;

• kuwedzera chiropa, jaundice machira;
• nhengo bundu;
• cyanosis minwe vanotarisana (nzeve, chirebvu, mhino);
• murwere ane kurwadziwa kwake rworudyi yepamusoro quadrant;
• ECG anonyora mwoyo pakarepo zadzisa rworudyi ventricle uye atrium, izvo zvinoratidzwa kumusoro zvakajeka mazino.

Zviratidzo zvakanaka mwoyo kukundikana zvakajeka pachena X-ray uye unonzi, electrocardiograph. Chokupedzisira pavaipfuura ichi mhando chemwoyo kunotungamirira Kuparadzwa mumuviri, kuderedza mwero mapuroteni muropa uye kuvhiringidza munyu zvakanakanaka mumuviri.

Zviratidzo rworuboshwe ventricular kukundikana uye cardiogenic kuvhunduka

Zvadaro, pamberi chakasimba rworuboshwe ventricular kukundikana pamwe congestive hemodynamics runoratidzwa anoverengeka anotevera zvinhu:

• kupfupika mweya, dzimwe nguva akatendeukira kupinda asima;
• paroxysmal chikosoro yakaoma, expectoration dzimwe nguva frothy, iyo anosunungurwa kubva muromo kana mhuno;
• kuvapo nyoro rales izvo vakanzwa pamusoro pepasi pechipfuva.

Kune akawanda anozivikanwa zviratidzo cardiogenic nehana, zvinoti:

• The BP murwere anodonhedza kuti tsika 90-80 mm HG. Art. uye kunyange zvishoma. Kana munhu anotambura BP, chiratidzo nehana kuchaita kutsauka nokuda 30 mm HG. Art. kubva zuva mumwe chechetere.
• ungaderedza kupomba kumanikidzwa - asingasviki 25-20 mm HG. Art.
• Nokufungirana pamusoro cardiogenic kuvhunduka akonzera paleness ganda rayo pasava noushamwari. kuratidzwa izvi zvinoratidza kutyora microcirculation munyama muviri.

With murume akawana pamusoro zviratidzo zvokurwara, panofanira kuva kakawanda asati asvika unyanzvi. (. Sitiroko, chemwoyo, etc.) rubatsiro kuti rikwanise mwoyo nokukundikana First inofanira kuendeswa nechokwadi kuti:

• ronga kuwana mhepo yakachena;
• nechokwadi chinjikira nzvimbo murwere (kana asina zviratidzo rworuboshwe ventricular kutadza);
• bata unonyaradza marwadzo kushanda.

Mabatirwo chenjera mwoyo kutadza

Mabatirwo mwoyo nokukundikana - kunzwisisa kurapa kunangidzirwa, pakutanga, kuti ave nechokwadi chokuti:

• kubvisa zadzisa cardiac tsandanyama - ichi chiyero kunokwanisika nokushandisa zvinodhaka kuti kudzikisa BP uye kwemwoyo;
• kusunga zviratidzo chirwere (kuchirapa matanho achaenderana chirwere kuratidzwa kuratidzwa).

Kana Dos akaita rakavapo pamusana myocardial infarction, zvakakodzera nekukurumidza kudzorera coronary tsinga ropa riyerere. Kazhinji, mamiriro ezvinhu anoita infarct tsinga thrombosis, vachisimbisa mwoyo. Mushonga kunobatsira ropa clot nokudzosa patency ngarava ropa zvakakwana uye kudzikamisa murwere ezvinhu.

Nzira rakakurumbira ichi nyaya runoonekwa kuti thrombolysis, asi vanofanira kusvikira clot richiri "itsva" muitiro kuitwa nekukurumidza mushure kutanga infarction. chinobatsira kuti rikwanise mwoyo kukundikana First kunosanganisira kushandisa zvinodhaka (thrombolytics), uyo chiito nechinangwa pokufa ropa. Medicaments raitongwa nomutsinga, mwero wavo kupinda mukati nhengo iri zvachose inodzorwa.

Mabatirwo chenjera kukundikana (kurudyi ventricular) pamwe congestive hemodynamics kunoda kubviswa zvikonzero, yakakonzera - chinzvimbo asthmaticus, ropa clots ari pulmonary tsinga, uye zvichingodaro D. Kutanga kurapa nechinangwa murwere "nitroglycerin" kana "Furosemide" ane mubatanidzwa zvokurwara pamwe cardiogenic kuvhunduka aishandisa inotropic. zvinoreva. Rakabatanidzwa pamusoro matanho ari kuitwa okisijeni inhalation kubudikidza anobudisa mushonga zvishoma nezvishoma.

Psychomotor kugadzikana zvikaramba marwadzo analgesics, akadai "morphine", iro rinoita basa kufema tsandanyama uye kunoderedza kushushikana pamusoro mwoyo.

Kubviswa rworuboshwe ventricular kukundikana zviratidzo

Kurega kunotanga ropa iri pulmonary kazhinji kunotungamirira zvikuru nemigumisiro zvakadai pulmonary edema. Kana hadzina kufambiswa zvakanaka zvakadaro varwere ushandiswe kutungamirira "nitroglycerin" nomutsinga.

Kana chenjera rworuboshwe ventricular kukundikana pamwe congestive hemodynamics nezvaaiitawo cardiogenic kuvhunduka, akarayira kuunzwa "dobutamine" kana "noradrenaline" nomutsinga. Pane zviitiko apo zvinodhaka izvi ikashandiswa ari kunzwisisa.

Anopupuma yakasvikawo Via zvinoreva kupa furo akawisa.

Kana hemodynamics pazvakagadzikana, asi zvemapapu edema zviratidzo zvikaramba, murwere dzakabatwa glucocorticoids. Muchiitiko chino, rubatsiro rwekutanga rikwanise mwoyo kutadza kuchabatsira kuti kuderedza permeability pamusoro membranes.

Zvipatara pamwe cardiogenic kuvhunduka anotanga kuwedzera cardiac goho, pasina ari kuratidzwa congestive mwoyo nokukundikana kwayo unotora yachengetwa plasma. nzira iyi rinoitwa chete kutongwa kwemwoyo, BP uye afemeruke. Kana asati panowanikwa rikwanise mwoyo chirwere rwakaitika kurasikirwa kukuru emura, yavaibvisa chloride inoshandiswa.

Kubviswa zviratidzo chirwere Chokwadi, zvikurukuru chokuita nokushandiswa kwezvinodhaka, asi kana atora matanho haanamati zvinozoita, unogona kushandisa nzira - kuita hemodynamic vachidzikisa kuburikidza tourniquet pamusoro gumbo mutsinga.

Muzviitiko apo mushonga kuchinja zviri simba kushandisa kuvhiyiwa. Data kubudikidza yakapedza matambudziko chokuita occlusion pamusoro arteries, dzokutsiva mwoyo mavharuvhu. Kudzikamisa kwemwoyo kunobatsira hwokugadza chinodzora kurova kana defibrillator.

dziviriro

Nzira yakanakisisa yokudzivirira kukura chirwere - ndiko kuti zvinoenderana nyore mitemo - kureva, kutungamirira mararamiro utano, kusvuta uye vorega kushandiswa kunyanyisa doro, kuita nguva nenguva richiona kuti zviripo chisingaperi zvirwere. Zvisinei, mune zviitiko apo hosha vachiri kwakaratidzwa pacharo, vanofanira kutevera chairo hurumende muupenyu hwezuva nezuva.

Varwere congestive mwoyo nokukundikana vanofanira kunyatsotevera kuongorora kwavo uremu. Extra kilos vanotsamwisa kuwedzera ropa shuga uye paumbwe remafuta akawandisa plaques nemidziyo ropa, iro rinoita cheBP. An chinokosha zvimiso tiine kwomuviri ezvinhu kazhinji ndiyo pasi inokosha kudya zvokudya. Zvakakodzera mukanyatsochengeta waidzora yaunodya munyu, zvakawandisa izvo zvakaipa utano - Chinokonzera Urume chengetedzo, edema inotungamirwa, vakawedzera mutoro pamusoro mwoyo.

Zvinobatsira kuita muviri, kupa mutoro kune tsandanyama uye mapfundo, asi makirasi mitambo havafaniri kukonzera zadzisa muviri. A seti kurovedza kuti akabvumirana nachiremba. Zvakakosha kuti kakawanda kushanyira pakachena mhepo, kurara, kudzivisa kuneta mupfungwa uye nesimba rokufunga.

Aunganidze pamwe, zvinogona kucherechedzwa kuti rikwanise mwoyo kutadza - mumwe zvokurwara kuti kazhinji zvinouraya. Kazhinji The chirwere ikabuda pakanyorwa dzimwe chirwere in kumwoyo uye kunotungamirira matambudziko akasiyana-siyana, kusanganisira sitiroko, cardiogenic kuvhunduka, pulmonary edema, uye zvichingodaro.

Pane zviratidzo, icho chirwere rikwanise mwoyo kukundikana. Zviratidzo rufu anogona zvakakwana kwakaratidzwa, zviri saka chinokosha basa nyanzvi chinyorwa vose murwere zvichemo uye nokukurumidza kuongorora.