WPW Fani: zvinokonzera, zviratidzo, kuongorora chirwere uye kurapwa

WPW chirwere inonzi zvokurwara mu etsinga fibers nomwoyo tsandanyama hunokonzera pfari uye tachycardia nokuda ndima excitation ane tsinga zvairatidza pane mamwe mapfupi munzira dzisina mumwoyo utano.

Wokutanga kutaurwa

Muna 1930, masayendisiti vezvokurapa Wolff Parkinson White uye vokutanga kurondedzera zviratidzo uye zvinoratidza chirwere mashandiro, iyo gare gare akapiwa zita kubva KWD syndrome (WPW). Pane here chinonzi WPW-chinonakidza. Nesuwo funga izvozvo munyaya ino.

Kazhinji fibers mumwoyo, huta conductive excitation kupomba kuumba dzakananga nzira, iyo inopa yunifomu uye zvishoma nezvishoma kugovera tichimhanya. Chiratidzo kuchizvarwa kunotangira sinus raiva pedyo nebundu zvakarurama atrium zvasvika AV raiva pedyo nebundu (atrioventricular raiva pedyo nebundu) ari atrioventricular vematunhu, ipapo makumbo tsapo kwake kuburikidza Purkinje fibers excitation iri chinopfuudzwa dzose tsandanyama fibers zvomwoyo ventricles, uye yakareba zvakadaro nzira inopa kwakarongeka uye synchronous marwadzo rose mwoyo tsandanyama.

Zvinokonzera uye zviratidzo

Kana WPW chirwere tsinga zvairatidza excitation kubva atria kusvika ventricles rinokoka pfupi nzira kune inonzi danda Kent, pavaigona kutora chikepe chaienda ari atrioventricular (AV) raiva pedyo nebundu. Kureva sefungu excitation riri nokukurumidza zvikuru kupfuura dzose mutinhimira ari kurova kwehana, uye nei ikoko incoordination pamusoro rutapudzo mumoyo tsandanyama, uye-siyana arrhythmia.

Ndizvo Nzira wakaputsika mwoyo kufamba kweropa.

Similar anomalies marongerwo komoyo vachiberekwa uye kuumbwa kungotaurwa nokuda nhaka kugozha Gene kana pasi pokudzora zvimwe zvinhu, kwakakanganisa rinobaya kukura embryo kwevanhu mwoyo.

Fetus nguva dzose aripo mamwe atrioventricular mhete uye fibers, izvo 20-22-fung vhiki wakawondereiko kudai mazuva ose uye kupera zvachose. Kana fibers akadaro akachengetwa, pane anatomical ezvinhu WPW syndrome. A nhaka chimiro WPW-chirwere kunoratidzwa vakawanda AV kubatana, zvikanganiso uye anomalies marongerwo mwoyo. Zvisinei, chete vakura kunogona kuitika pasinei vachiberekwa anatomical abnormalities, zviratidzo WPW-urwere wokutanga. Vose nyaya, kuvapo 70% of chirwere kunokwanisa kuonekwa nevanhu.

Zviratidzo zvokurwara

Vakawanda zviratidzo zvechirwere inobvira kuvapo WPW chirwere ndedzinotevera:

1. Achinzwa simba uye kakawanda palpitations, izvo vana vanogona kudana "kusvetuka kana nokugogodza mwoyo."
2. Sudden dzungu.
3. Sezvisingatsananguriki syncope, kunyanya vaduku uye kuyaruka.
4. Kupfuurira marwadzo mumoyo, tingling vakatema marwadzo kana Kufema.
5. Kunzwa kutadza kufema, zvikuru kupfupika kufema pane muduku.
6. Vachangoberekwa anogona kuramba zvokudya zvichiita kunonyengedza vangadikitira, kugara simba, vakawedzera kwemwoyo nenguva kuti 200-300 anorova paminiti.

How kuziva chirwere?

Vanhu vazhinji vane zvakawanda kanganisika fibers ari cardiac tsandanyama, kuti WPW chirwere kunokwanisa kuonekwa chete kana akaita cardiac echocardiography. Achiongorora zvaive chokwadi agopa mugumisiro.

Kwakadaro vatakuri chirwere havatamburi kubva tichibatwa tachycardia kana fibrillation, uye kuti angatova vasingazivi pamberi abnormalities mumwoyo.

asymptomatic ichi kuchengetwa 35-40% vose akaratidza vatakuri syndrome. Munyoro aibuda WPW chirwere kunoratidzwa idzokororo pfupi-rokuti tachycardia kana fibrillation, iyo inokurumidza anopfuura pasina rubatsiro. Kubvisa pfari zvakadyiwa svikiro regiravhiti WPW chirwere zvinoda zvinodhaka antiarrhythmic kana mamwe blockers ose cardiac excitation.

Kana mazhinji pfari kuti regai haina kunyanya kubviswa mukurapa yakaoma uye disordered sunga zvomwoyo tsandanyama uye atrial flutter chirwere chakakomba mwero chirwere uye inokurudzirwa kuvhiyiwa.

urwere mhando

WPW chirwere uye mwoyo dzinoiswa maererano kakawanda uye zvikurukuru chidzoke-siyana zvekuchipatara zviratidzo uye vari akakamurwa marudzi anotevera:

• Kuratidza kana unonzi, electrocardiograph aripo Delta chinozunguzirwa nguva dzose, uye MAD-tachycardia uye sinus mutinhimira kuonekwa pano neapo.
• Inopera - kunoratidzwa zvinopfuura ventricular pre-excitation.
• Yakavanzwa - rinorondedzera episodic AVR-tachycardia, uye vachingotya zororo haina chirwere.

Sei munhu anogona kuziva zviri chirwere?

Pasina unonzi, electrocardiograph rokuongorora zvinobvira WPW-chirwere zvinogoneka nokuteerera mwoyo ichirira, izvo zvichava chikamu okuti arrhythmic zvakasikwa, uyewo kwemashifiti kurova kwehana.

Mukuwedzera ECG chirwere pamusoro WPW chirwere zvinoongororwa kushandisa chaiyo inotakurika mudziyo pamwe electrodes, kubudikidza Ultrasound uye echocardiography, pakatanga masero electrodes kupinda yegurokuro pamwe nekutambira decoding nemigumisiro magetsi nomunhu, uyewo kunzwisisa electrophysiological kuongororwa, aunopiwa yakarurama zvikuru muenzaniso zvinowanikwa munzvimbo cardiac mhasuro Kent matanda uye anotibvumira varumbidze kumwe kana kuvhiya kurapwa.

WPW-Fani

Apo kuongorora kuvapo WPW chirwere inodarika 30% of vanozivikanwa vatakuri chirwere chero zvichemo pamwoyo utano vasingapiwi kusangana. Nokuda vakawanda vakadai asymptomatic, muna 1980, WHO yakabudiswa kutevedzera inoganhura WPW chirwere ane chaiwo kunotoda mufananidzo, uye WPW-chinonakidza.

About Fani iyi, zvinonzi akagumisa kuti musi unonzi, electrocardiograph mwoyo sinus mutinhimira une zviratidzo vakurumidze ventricular excitation, asi nyaya havasi pathological inoti uye atrioventricular tachycardia vakanga kuchengetwa.

Pasinei neizvi, kana Chiitiko WPW nengozi yematambudziko chaizvo, Nokumukira chero matambudziko - mumuviri kana mupfungwa, doro, kufamba mu kujairika nenzvimbo dzinodengenyeka - zvinogona kukonzera kuratidzwa rwakashata zviratidzo WPW syndrome. Ari mukuru hwevanhu muna 0.3% kubva Muzviitiko WPW-Chiitiko rakaipa, vakaongorora vana akaratidza navanachiremba vafa muna 2% nyaya.

Statistics WPW Fani muvana

WPW-chirwere anopindura nzvimbo vaitungamirira pakati zvinhu kukonzera tachycardia uye arrhythmia muvana. Zviri pachena hwaro humwe nokuvhiringidzirwa mwoyo mutinhimira, uye kunyange kusavapo zvichemo hakurevi yekuzvidzivirira zvirwere zvakadaro. Chero mumuviri zadzisa, zvikuru muviri, mupfungwa zvinhu kungamutsawo kukundikana zvekufungidzira mwoyo kufara uye kunyange kutungamirira kurufu nechirwere chemwoyo.

Long-rokuti zvichiongororwa kwemakore anoda kusvika 20 makore hombe boka revana vari panoonekwa mwoyo WPW chirwere, mazera mucheche makore 18, akaratidza zvinotevera results:

• 8% vana rwakaona kamwe kutanga ABP-tachycardia;
• 8.2% nyaya akambosanganawo zvinopfuura chakajairika kuchinja WPW chirwere;
• 8.5% kubva zvinopfuura nokurasikirwa pfungwa kwakaitika;
• 2% yevana panguva yokutanga kuongorora zvakatoparara vakatambura zvekuchipatara rufu;
• 1.2% - chete vakomana - pakarepo akafa Ongororo kumwedzi;
• 9 chete% vana vane WPW Fani yakashuma kunyangarika zviratidzo mashoko.

How ngozi chaiyo WPW?

Kubva nhamba idzi zviri pachena sei kuvapo kunyange zvine ngozi WPW kutanga. Izvi vakawanda vanotanga yaivhuvhuta zviratidzo uye pathologies muuduku anopa chikonzero kuti tisafunge kuti pasina nyasha mumuviri uye mupfungwa, pasina kwegadziriro zvichiongororwa uye dzokurapwa nezviyero nezera uye chikamu ichi chinotyisidzira kuupenyu chete kuwedzera.

Vana vane WPW Fani havafaniri kuita mitambo kwounyanzvi, uye pasi tinyanye kunetseka zvinhu. Zvokungwarira zvinofanira kuendeswa chimbichimbi okunze panofamba kana zviitiko, inokonzera zvikuru mupfungwa kwehasha. Zvose izvi zvinhu zvingava zvikuru zvichida kuti varware kana kufa chakakomba. Persons vanenge akasimbisa kuvapo WPW urwere kana Fani, kwete kunzi muchiuto.

Treatment uye kuzorodzwa of urwere

Zviratidzo uye kurapwa kazhinji zvinodyidzana. Kune mishonga yakawanda kuti uderedze mwoyo kurwiswa anokonzerwa WPW urwere, uye kuderedza nekuratidzwa zviratidzo zvayo.

blocker zvinodhaka boka normalizes kakawanda pakati sunga zvomwoyo tsandanyama. Zvisinei, kubudirira nzira dzakadaro kunoratidzwa chete pachiyero 50-60% uye hazvigoni kushandiswa pane kugara hypotension uye asima.

Antiarrhythmics yakatsiga zvikuru yakasvikawo kurwisa AVR-tachycardia, normalize mwoyo mwero 80% wevarwere, asi vanewo anoverengeka contraindications zvakadyiwa hypotension, chomwoyo uye vamwe mwoyo chirwere, uduku uye kuyaruka. Vamwe karusiyamu blockers zvachose contraindicated muna WPW urwere, sezvo mufananidzo shure akavandudzika kupararira tsinga zvairatidza, vari kukundikana ari atria, ine zvakakomba uye kusingarapiki yakaipa.

Uyewo, dzimwe nguva, kushandisa zvinodhaka ATP boka vakachengeta inokanganisa pamusoro atrial marwadzo. Panewo vasiri zvinodhaka nzira ruyamuro zviratidzo.

The tsandanyama tsinga nomunhu nomunyika tsitsi uye parasympathetic fibers. The mhando fibers rokutanga zvaanopa simba mwoyo, kuti DZEMUNHU DZINODZORA mwoyo mwero mutsa wechipiri, sezvo rudzi vagus tsinga nervus vagus, uye anonziwo vagal dzepanguva. Iyo activation ine hunenge chaizvo mhando iyi vachapa zvakakonzerwa Kudzikamiswa mwoyo. Nzira nyore Activate vagal nomunhu ndiwo unonzi dzepanguva Aschner izvo wakatsamwisa 20-30-wechipiri zvinyoronyoro pamusoro eyeballs uye kazhinji kunobatsira kumisa tachycardia.

Uyewo, kuti vagus etsinga zvakanaka kusashanda ne mweya-kunhaka uye voltage abdominal tsandanyama, zvokuti Chiitiko pamusoro WPW urwere kana anobatsira kuita kuti yoga uye kufema kurovedza.

Kutanga nzira serakaoma chiratidzo kuburikidza electrode rakapinzwa yegurokuro, zvinobudirira kwazvo anodzivira rinorema refu tachycardia, asi dzimwe nguva zvichitungamirira fibrillation mwoyo, saka kuitwa chaihwo makabhati nepokuongorora defibrillator.

Defibrillation rinoitwa chete kwazvo nguva apo zvikuru upenyu, asi kakawanda kunobatsira kubvisa kunowanzotangira yokumwe nomunhu ngozi mune cardiac zvinyama uye normalize mwoyo mutinhimira basa.

Kushanda kurapwa WPW chirwere uye avo faniro

Kana kuona Fani WPW ECG operative nzira kubviswa rinoshandisirwa chete aakatipa ezvinhu, pamwe kakawanda uye kwenguva refu tachycardia, zvisingagone kubviswa pamwe mishonga, uyewo yakasimbiswa zviitiko kungoerekana cardiac rufu, hama murwere kana nezvikonzero nyanzvi.

Kuvhiya kurapwa inokurudzirwa chete nokuda misoro uye kwakakwana kuongororwa, aunopiwa yakarurama kupfuura mufananidzo pamusoro pathological zvinyama hurongwa mwoyo. Naizvozvo, unofanira kufunga kana kuti kushanda pamwe chinonakidza WPW.

The oparesheni rinoitwa kushandisa chaiyo electrode, akaiswa kubudikidza femoral tsinga kuti mwoyo tsandanyama kubudikidza X-ray zvaakazvionera uye mune dzimwe nzvimbo unobereka radioprizhiganie kana ablation, tsinga fibers.

Rinogonawo kriorazrushenie pathological tsinga fibers. Uye chokwadi, muna vacho oparesheni kunyatsoshanda rinosvika 95%. Kusvutazve nokuda kuparadzwa kukwana vari wakaiswa foci, uye pamberi zvinowanikwa zvinosanganisira masangano nedzimwe Neural munyama. Roga, kuvhiyiwa kunogona kuitwa pasi omunzvimbo yokutindivadza, anenge ropa, haakonzeri matambudziko, ane pfupi chaizvo kupora nguva uye zvinogona saka kuitwa chero zera.

Cardiac nzvimbo muMoscow

Institute of Surgery. A. V. Vishnevskogo - Kuzvikudza wechipfuwo mushonga, ane zvivako ano kuti kurapwa uye zvokuongorora, anoitisa tsvakurudzo, hwakasiyana-siyana yepamusorosoro Diagnostics uye nemamwe cardiac kuvhiyiwa. FGBU "NNP Centre zvemwoyo Surgery pavo. A. N. Bakuleva "anoita zvokurapa, zvesayenzi uye dzidzo mabasa chirongwa" zvemwoyo Surgery. "

Russian Cardiology Research uye Production Complex inoitisa kuongorora uye kurapwa chemwoyo mu yepamusorosoro nyika yakati chechetere. In "cardoid" pakati unogona achindireverera zvakakwana cardiac wakatarwa, vanogamuchira unhu yokurapwa pamusoro outpatient hwaro. Emwoyo Center muMoscow akashanda zvakanaka, saka kana uine kudiwa kuvhiya apindire kurapa, imi hamugoni kuzengurira.