Fibrillation - yintoni na le nto? fibrillation paroxysmal atrial

Ngaba wakha nto ithile xa yaqala ezibetha chaotically intliziyo? Okanye, phezu koko, umzimba osezantsi? Oku kubanga imvakalelo yokoyika ixhala, yenza sicinge malunga ngeenyawo ukuya esibhedlele. Oogqirha kufuneka inkcazelo yokuba imele ezobuRhulumente, kubandakanywa ukulungiselela le njongo. Fibrillation - yinto uhlobo arrhythmias inhliziyo. Ekusebenzeni zentliziyo Kwiimeko ezinjalo akuqhelekanga, ngoko ngazo siya sithethe namhlanje.

Inkcazo kunye nokwanda

Kukho inkcazelo ukuziphatha okunjalo intliziyo zenzululwazi. Fibrillation - it tachyarrhythmia, nto leyo kudityaniswe ngamaza ombane ingalawuleki lomsebenzi atrial. esasidla yabo ingaba ukufikelela ibetha amakhulu asixhenxe ngomzuzu, kwaye ngeqondo ukuncitshiswa elungelelanisiweyo kube nzima.

fibrillation Atrial yenye yeentlobo ezininzi yandayo arrhythmias. Ngokuthembekileyo oko kumiselwa kuphela iziphumo electrocardiography. Kukho iimpawu uphawu: akukho Isingqisho sinus, imbonakalo f-ngumtshangatshangiso (enomoya atrial). Izifinyezo frequency kuxhomekeke iimpawu esiludumbo atrioventricular, kwaye umsebenzi yenkqubo yawo nervous xa zidityaniswe kunye iziyobisi.

Iingcali bathi esi sifo amanxeba somgquba izihlunu zentliziyo. zokurhwaqela ingalawuleki intliziyo akhokelela iingxaki yegazi kunye nengozi yokuba okuvela emboli. Le meko inxulunyaniswa yokufa kwesi sifo.

ngezigaba

Kukho ezi fom zilandelayo fibrillation atrial:

1. Okokuqala kutyhilwa. Loo isifo senziwa, ukuba isigulane alikhange ngaphambili wafuna uncedo lwezonyango fibrillation atrial.
2. Paroxysmal. Attack enomoya awutsali ngaphezu kweveki (ngokuqhelekileyo iintsuku ezimbini) kwaye isebenza ngokuzimeleyo.
3. Ukuphikelela. Ukuhlaselwa waqhubeka ngaphezu kweentsuku ezisixhenxe.
4. Long sizingise. Uhlaselo ihlala ezilishumi - iinyanga ezilishumi elinambini, kodwa oogqirha ukuba ayihlaziye isingqisho.
5. Abasisigxina. fibrillation Atrial kwenzeka ngalo lonke ixesha, kodwa isingqi wokubuyisela usaqala singàphunyezwa, kwaye ke ngoko wajika angasebenzi.

Ngokutsho ubungqongqo iimpawu fibrillation atrial yahlulwa ibe ziindidi ezine:

1. Nazimpawu.
2. kuyaphela Mild ngaphandle kokuphazamisa umsebenzi.
3. Iimpawu kakhulu echaphazela intuthuzelo ophilayo.
4. Lokukhubazeka. Kulo mzekelo, isigulana asikwazi ukuthatha unonophelo yena ukuba.

Kuxhomekeka rhoqo koogqirha ukubetha bokwahlula tachy, kunye nefomu normo bradisistolicheskuyu kwesi sifo.

ubungozi

fibrillation intliziyo kuvela kwizigulana ekufuneka yofuzo kulo. Usenokuba lwandulelwe ziingxaki ezahlukahlukeneyo inhliziyo:

- BP;
- ukusilela intliziyo;
- ezifunyenwe valve mitral;
- malformations bekhubazekile ze etiologies ezahlukeneyo.

Indima ebalulekileyo edlalwa yi- cardiomyopathy inimba, isifo kwemithambo, izifo ezondeleyo yokukrala inwebu intliziyo, kwakunye ngamathumba. fibrillation Paroxysmal atrial abantu abangaphantsi kweminyaka iminyaka emashumi mane, ukuze kuthi bodwa kwezinye izifo.

Ukongeza, kukho uluhlu ezimbi, nto leyo echaphazela ngokulinganayo lubandakanywe nezenzo fibrillation atrial, kodwa azikho onxulumene umsebenzi yegazi:

- ukutyeba;
- diabetes;
- ezingapheliyo sisifo obstructive pulmonary;
- umsebenzi eyandisiweyo le ndlala lengqula.

Ukuba isigulane kuncipha imbali yosapho, oko kukuthi, phakathi kwezalamane ezisondeleyo, kukho abantu fibrillation atrial, amathuba ukuba isifo izakuvela kwi proband, landa ngo amathathu ekhulwini.

Pathogenesis

Fibrillation - kuba twitching umbhodamo kwemisipha, kule meko intliziyo. isifo Organic igalelo utshintsho kumaziko ezakhiwe yentliziyo kwaye ibangele yaphula Uhanjiso neemvakalelo zombane. Oku kungenxa yokwanda izixa yezihlunu nokuqina kunye abanesigulo elandelayo. Le nkqubo iqhubeka, udityaniso luvo dissociation ngoko fibrillation isaqhubeka.

Oogqirha ingqalelo yeengcinga eziliqela malunga nendlela uhlobo kukho paroxysmal kwesi sifo. Avamise kakhulu imfundiso nakujoliso olutsha kunye namaza ezininzi. Ezinye izazinzulu bakhetha zizidibanise zombini iinguqulelo, ekubeni akunakwenzeka ukwahlula ekupheleni unobangela kuphela esi sifo.

Ngokutsho ingcamango lokuqala (yinqontsonqa) kwi myocardium kwenzeka nobuninzi nakujoliso olutsha lomsebenzi zombane, ezithi zibekwe kufutshane iimpahla ezinkulu nodonga atrial umva. Ekuhambeni kwexesha, zisebenza kummandla iphela imithambo. Le mbono yesibini postulates ukuba fibrillation zibangelwa ezizenzekelayo elikhulu inani umbhodamo of excitation wave encinane.

Iimpawu kunye Iingxaki

fibrillation Paroxysmal atrial inokuba nazimpawu ukuba ukuphazamiseka hemodynamic ingahlawulwa ngokwaneleyo. Ngokuqhelekileyo, izigulane ezikhala kwimvakalelo iyangongoza rhoqo, iintlungu esifubeni okanye kabi kule ndawo.

Phantsi kwale mvelaphi, ukusilela inhliziyo okuqhubekayo, nto leyo ngokwezonyango wabonakalaliswa isiyezi, niphele kwakunye nokubamba-bamba umphefumlo. Maxa wambi, kukho xa kuhlasela kubaguli yokubakho qho ukuchama. Iingcali bathi oku kwanda kwamanani protein natriydiureticheskogo.

Elibanzi, kusenokubakho ukubetha kusilela, xa inani izinga lentliziyo likhulu kune nani kwamaza ukubetha leyo ukusasaza ukuya kwimida ethile. Ukuba uhlobo nazimpawu lwe fibrillation le "intsimbi" wokuqala kunokuba istroke.

Long elibaleka fibrillation atrial nzima ukusilela intliziyo, thrombosis iinqanawa ezinkulu nezincinane intliziyo okanye ingqondo.

ekuxilongweni

fibrillation Atrial - unciphiso rhoqo ngokungakhethi of cardiomyocytes. Ekuqaleni, ugqirha uqokelela imbali sifo kunye nobomi, uyeva umhla hlaselo lokuqala, ubukho ubungozi, kwakunye bafunde amayeza isigulane kuthatha ngalo mzuzu. Izigulane musa ukukhalaza, ngoko kubonisa le ngezifo usebenzisa iindlela instrumental. Ezi ziquka ultrasound, Holter ECG esweni yonke imihla. Fibrillation Ubonakala iimpawu ezithile zilandelayo:

- ukungabi lencinibakazi P (akukho isingqi sinus);
- ukuvela f-amaza fibrillation atrial;
- kumathuba olungalinganiyo phakathi kwamazinyo R.

Le ndlela inye ukubona comorbidities kwentliziyo :. iposi engabalulekanga, arrhythmia, njl iimviwo ultrasound yenzelwa ukuchonga kwaye uqinisekise ukuba isifo sentliziyo eziphilayo, kunye nemilinganiselo udonga ubukhulu engabalulekanga, umthamo we imithambo kunye ventricles. Ukongeza, nesisitheliso kakuhle thrombi Parietal abonakale nezihluma phezu kwemithambo.

Ukongeza, emva kwaloo nto yokuqala ugqirha fibrillation atrial ubeka uvavanyo kumanqanaba ihomoni ukwahlula ukungahlaliseki yakhe.

anticoagulation

Kweli nqanaba umfundi unalo ufifi lokuba yintoni nendlela kukho fibrillation atrial. Unyango ngqo ukupheliswa zayo, okanye izinto etiological, okanye iimpawu intlungu okuyo.

Anticoagulants, okt igazi ukuxozwa amayeza, kuboniswe ngenxa ekuthinteleni egazi igazi ngenxa yoko icala kunye isifo sentliziyo. Avamise kakhulu azipilisi phakathi - i "Warfarin" yaye "aspirin". Ekuqeshweni eli qela iziyobisi ugqirha iqwalasela olungaka lomguli ukuya thrombosis, umngcipheko ischemia kwixa elizayo, nokuba Izimo umguli kule hlobo unyango.

Kubalulekile ukukhumbula ukuba ukusetyenziswa anticoagulants kuyimfuneko ukuba esweni rhoqo le INR (ratio nganye ezinga malungu abantu ngamazwe). Oku kuvumela ixesha elaneleyo ukumisa ichiza nokucutha umngcipheko ukopha.

control rhythm

Fibrillation wentliziyo Kumaxesha amaninzi imeko ingathityazwa. Ukuba ukususela ekuqaleni isehlakalo ixesha elincinane, ugqirha ukubuyisela sinus isingqisho eqhelekileyo. Oku kungenziwa inomlaza zokukhomba kwamachiza zombane yangoku okanye antiarrhythmic.

Ekuqaleni, lo izinga intliziyo zancitshiswa okanye wakhulela nekhulu ibetha ngomzuzu. Ngoko ke kufuneka ukuba uthathe ingqalelo umngcipheko thromboembolism, ngoko iiveki ezintathu phambi kokuba inkqubo, kwaye inyanga emva kokuba isigulane ufumana unyango anticoagulant. yonke le nto, kodwa kuyimfuneko kuphela xa kuthe kokuhlaselwa fibrillation atrial sisaqhubeka ngaphezu kweentsuku ezimbini okanye ixesha ayikwazi kusekwa ngayo. Ukuba kwakusazeka ukuba ukususela ekuqalekeni izishunqulelo umbhodamo wentliziyo ngaphantsi kweeyure ezingamashumi amane anesibhozo ngaphezulu, okanye isigulane iye kakhulu ukungazinzi hemodynamic, unciphiso izinga yenziwa ngokukhawuleza, elawulwa phantsi ezinto lweeHedfowuni weight.

1. cardioversion Electrical. Le nkqubo kunokuba buhlungu ukuba ufuna emanzini kwiphupha yezonyango yesigulane. Xa defibrillators mihla ndiyenza yolunye kunye R-yomtshangatshangiso kwi ECG. Oku kuthintela ngengozi ventricular fibrillation. Qala ngokuqhelekileyo nekhulu ziijowule, yaye ukuba kuyimfuneko ukubhobhoza nganye ezilandelayo wavuswa mahlanu ziijowule. Le modeli kwisigaba-mbini. -Phase Single ekubhobhozeni nangoko wenza amakhulu amabini ziijowule, kwelona nqanaba liphezulu ngo-ezine.
2. Drug cardioversion. Kuba iziyobisi kuchaphazela isingqisho intliziyo, iquka "Procainamide", "Amiodarone", "Nibentan" yaye "Propafenone".

Ukuthintela uhlaselo nezolo of fibrillation atrial emva cardioversion oqeshwe ziziyobisi antiarrhythmic, leyo isigulane kufuneka athathe iinyanga, okanye iminyaka.

ulawulo ukubetha

Zonke iifom eyaziwayo fibrillation atrial zibandakanya yaphula izinga kwentliziyo. Ngoko ke, oogqirha belicinga unyango ukuphelisa uphawu. Lisebenzisa iziyobisi ukunciphisa izinga intliziyo. Ezi ziquka:

- beta-blocker;
- blocker calcium channel.

Ngenxa kwawo kula mayeza ezilawulwa maqela "Amiodarone" okanye "Dronedarone". unyango olunjalo ukunciphisa iimpawu arrhythmia, kodwa uyisuse ngokupheleleyo alukwazi.

Ukuba unyango kuphumelele, maxa wambi oogqirha ukubhenela catheter ablation. Ukuze ukugcina isingqisho sinus, zonke iziza yimincili kufuneka iqwalaselwe. Nge radiofrequency Uphenyo kwentliziyo ugqirha aqala intsimi Ozahlulayo enye kwenye, ukunqanda ukusasazeka kwamaza zombane.

Kukho nenye indlela apho kutshabalalisa ganglion phakathi intendelezo ventricle. Oku kudala ezinqamlezayo block intliziyo okwethutyana. Emva koko lo isigulane isixhobo introducer ngumntu kwesingqisho, elawula inani zisaphila. Umgangatho wobomi isigulane baphucuka ngendlela engathethekiyo, kodwa ubude ubomi bakhe ayiphazamiseki.

fibrillation Atrial emva kotyando intliziyo

Paroxysm of fibrillation atrial kangangoko kunokwenzeka emva kotyando entliziyweni. Le yenye iingxaki osetyenziswe nazo emva imisebenzi enjalo. Le pathophysiology yale meko yahlukile eyenzeka ngo izigulane eqhelekileyo fibrillation atrial.

Ukongezelela ubungozi eqhelekileyo, isigulane ke dissociation ionic, oko kukuthi ukuhla kumanqanaba potassium, sinciphise umthamo wegazi, ukwenzakala yokugaya inwebu intliziyo, iindumbisa imithambo. Konke oku kuphakamisa ukusebenza sifo ngohlobo abasabela inkqubo ngumphelelisi ayo. Ivela ukukhululwa yabalamli ukudumba, ukukhuthazwa kwenkqubo onovelwano luvo, kwakunye igcwala ubundlobongela basabela. Konke oku ngumba umnyele ekuqaleni fibrillation atrial.

Ngoko ke, unyango yeengxaki post-operative uqale ulungiso zonke ezi ngxaki zichazwe ngentla apha. Ukulungiselela le njongo, beta-blocker, "Amiodarone", steroids and non-steroidal amachiza-ukudumba.

Wezulu kunye neziphakamiso

Umntu ukuthintela isifo esinobungozi kakhulu, njengoko "fibrillation atrial". Iingcebiso koogqirha ulula nengafihliyo. Kuyimfuneko ukuba baphile ubomi obusempilweni, ukutya, kuphephe uxinzelelo lwegazi oluphezulu ngaphezu ikhulu elinamanci mane. Ezi zenzo ayinzima kuphela ukuthintela ukwenzeka fibrillation atrial, kodwa ukunceda ukuthintela nezinye izifo zentliziyo.

Kakade ke, sicebisa ukuyeka ukutshaya kunye nokunciphisa ukusetyenziswa kotywala. Ukuze ukomeleza nezitsha, cardiologists wacela ukufumana imali eyaneleyo yokutya asidi kubalulekile ezinamanqatha, okanye uthabathe njengezingxobo ne-fish oil.

Unyango lwezifo iintsholongwane kwaye wentsholongwane egazini ukulandela ngayo, nokuba wena subjectively uzive okulungileyo.

Amathuba okuba nestroke kubantu kunye nokunyuka fibrillation atrial ukuya kwiminyaka engamashumi amahlanu anesihlanu ekhulwini, asibhozo - mabini. Omnye ezintandathu ingxelo icala kwi emhlabeni elifana neli izigulane uxilongo "fibrillation atrial".