Ukungaphumeleli intliziyo Acute: iimpawu phambi kokufa kwakhe noncedo lokuqala

Qho ngonyaka, isifo nemithambo yegazi ekhokelela ekufeni ngaphezulu kwezigidi-17 zabantu ehlabathini lonke. 10% nje kuphela ezimbi ezinjalo bekhubazekile. Uninzi sifo ithi kwenzeka kwisiqalo loxinzelelo kunye yokuphila ihlwempu womntu mihla. Kweli nqaku sijonga into ukusilela intliziyo congestive.

Iimpawu yokufa kunye nezigulo ezibangelwa ngezifo, iindlela isifo kwaye afumane unyango izifo, iintlobo kunye neentlobo kwesifo - kubonwe ingcaciso ngemiba yonke le miba iya kubonakala izinto ngokutsha wethu. Ukongeza, eli nqaku lixoxa imigaqo yokuziphatha, oluno kubaluncedo ukuba nabani na kuthi. Ukukwazi ukwenza kaxakeka ubonelela kwiimeko ezininzi, ukulondolozwa ubomi babantu. Ngako oko, umntu kufuneka azi ukuba uncedo lokuqala ngokusilela intliziyo oyingozi.

Ingcamango senhliziyo

Ukungaphumeleli Heart (HF) - ngezifo, apho intliziyo uyayeka ukuba unikeze isixa eyimfuneko umzimba inyama igazi. Kuyinto ngenxa ekukwazini imisipha yenhliziyo kakuhle (myocardium) ukuba nciphisa. CH kukhokelela obubonakala kakhulu kwezonyango, kuquka nokudumba yemiphunga, iposi, ukothuka cardiogenic.

Isifo basengozini amadoda kunye nabafazi, kodwa zifunwaEzokugqibela zidweliselwe nokubandezeleka kulo sifo kaninzi. Lokufa phezulu ngokwaneleyo phezu ngezifo. Ubungozi kubomi babantu awunazo ezi mpawu ezibangelwa zizifo ezifana ukusilela intliziyo congestive. Iimpawu phambi kokufa kwakhe, ebizwa amayeza ngesiquphe, zahlukahlukene kakhulu. Baxhomekeke apho kwenzeka uhlobo esi sifo. Ngu uhlobo ngemvelaphi ukusilela intliziyo ahluka:

• Ukungaphumeleli intliziyo engabalulekanga - a ngezifo oko ngenxa yomonakalo ngqo imisipha intliziyo ngenxa kukwaphula ukutya amandla. Olu hlobo ukusilela kwentliziyo kukhokelela kwekhono of ucutheko nokuphumla kwentliziyo.
• Ukuxinana ukusilela intliziyo - a ngezifo ukuvela ngenxa yokuba umthwalo omkhulu entliziyweni. Olu hlobo kwezinye iimeko ukuphuhlisa kwisiqalo yesifo sentliziyo.
• Ukungaphumeleli intliziyo Ludityanisiwe - luhlobo oluthile ngezifo, okuhlanganisa izizathu ezibini ikhankanywe apha ngentla.

Iiklasi ukuhluleka intliziyo

Ukuza kuthi ga ngoku, kukho iindlela ezahlukeneyo apho esi sifo zohlulwa ngokwendidi okanye iifom. Medicine, kukho iinkqubo zokuhlela ezininzi (Russian, eYurophu, eMelika), kodwa inkqubo ithandwayo ecetywayo yi cardiologists US. Ngokungqinelana nale ndlela iiklasi ezine izifo:

• Grade 1, apho isigulane kuvela dyspnea motion esebenzayo, umzekelo, amanyathelo banyukele kwinqanaba ngentla kumgangatho wesithathu.
• KwiBanga lesi-2, apho dyspnea kukho nkqu umthwalo eliphantsi - xa ephakamisa kumgangatho wokuqala okanye wesibini. Ziphawuleka yehle umsebenzi wezandla zomntu.
• zesifo Grade 3, apho ukusilela intliziyo oqaphelekayo xa imithwalo ephantsi, umzekelo xa uhamba, kodwa isifo quiescent shwaka.
• BeBanga lesi-4, apho iimpawu kwenzeka nangona ukuphumla, kunye umthambo encinane ikhokelela yanyhashwa intliziyo kunye nemithambo yegazi lonke luphela.

Classification CH

Pathology ukuba zihlelwe ngokwemimiselo eziliqela. Kuxhomekeka umfanekiso bezonyango amayeza sifo nowaziwayo kwaye ezingapheliyo sisifo sentliziyo.

Ukungaphumeleli intliziyo Acute (AHF) - kuphazamiseka apho iimpawu zophendlo lwezifo ngokukhawuleza (kwisithuba seeyure). Njengoko umthetho, kwimvelaphi nezinye izifo olujikeleza kwaye kukho ukusilela intliziyo yayiyazi.

Iqhosha, myocarditis kunye nezinye izifo ube umnyele isifo ithi, ngenxa yokuba phantsi kwezi ezimbi, iiseli intliziyo kwezihlunu kufa ngenxa ukuphazamiseka kwegazi yasekuhlaleni. Och isenokukhokelela ukusuka ukwaphuka le ventricular eludongeni ngasekhohlo, ukusilela etsolo semigudu (i aortic kunye mitral). Kwezinye iimeko, ngezifo iphuhlisa ngaphandle kwalawo ngaphambili.

Och - isifo kakhulu singanyangekiyo kuba kunokubangela imeko kubuhlungu ezinye iinkqubo zomzimba. Iingxaki ukusilela kwentliziyo etsolo ngokufuthi asichaphazeli nje kuphela intliziyo kodwa inkqubo yokuphefumla, ibangela nokudumba yemiphunga, isifuba kwentliziyo, ukothuka cardiogenic.

Ukungaphumeleli intliziyo Chronic - kuphazamiseka apho ngezifo yenziwe ngokuthe ngcembe, iiveki, iinyanga okanye iminyaka. Oku kwenzeka ngokuchasene nentsukaphi isifo sentliziyo, lwegazi okanye anaemia kuyoluka.

Iintlobo DOS kuhlobo hemodynamics

Ngokuxhomekeka kuhlobo eyendawo hemodynamic uphawu ngezifo, kukho iintlobo zilandelayo ukusilela intliziyo ludlule:

• DOS ne hemodynamics congestive.
• DOS ne hemodynamics hypokinetic.

Hemodynamics - ke ithombo legazi ngokusebenzisa ezityeni, nto leyo ebangela uxinzelelo olukhulu kwiindawo ezahlukeneyo kwegazi. Yinto eyaziwayo oshukunyiswa igazi kummandla ndinyanzelekile ngaphezulu yesimo.

Uxinzelelo kuxhomekeke viscosity kwegazi, kwaye kweelana iindonga imithambo yegazi kwindawo engezantsi. DOS ne hemodynamics congestive kungachaphazela ekunene okanye ventricle ngasekhohlo kwentliziyo. Ngokuhambelana kunye nale mahluko:

• Ukungaphumeleli ventricular Acute ekunene, apho stasis lwemithambo uyaqapheleka isangqa esikhulu yokumpompoza kwegazi, okt. E. Busichaphazela phantse onke amalungu kunye namalaphu.
• Acute washiya ukusilela ventricular, apho stasis lwemithambo lwenzeka kwi ukuhamba kwegazi miphungeni. Pathology ephazamisana exchange igesi emiphungeni kwaye ikhokelela kuphuhliso nokudumba yemiphunga okanye asthma intliziyo. Ngoko ke, malunga nemvelaphi ukugxojwa okunjalo kwenzeka yondele nesifo sentliziyo miphungeni.

DOS ne hemodynamics hypokinetic

ukusilela Acute intliziyo ngexesha hemodynamics hypokinetic - a ngezifo okubangelwa ukothuka cardiogenic - ukwehla okukhulu ekukwazini myocardium ukuba osulelwe, ebangela ukuphazamiseka igazi ubonelelo zonke izicwili umzimba.

ahluke:

• mothuko Arrhythmic, nto leyo ngenxa yokuba ukuphazamiseka rhythm intliziyo.
• Umothuko reflex - kubangelwa iintlungu.
• True mothuko cardiogenic - imeko zophendlo lwezifo olwenzeka xa izitshanguba le ventricular inyama lasekhohlo, kwaye indawo sisilonda esidumbileyoesingaphakathi ubuncinane 50%. KumaLungelo oQoqosho, njengokuba umthetho, sonke siyazenza ngakumbi kubantu abangaphezulu kweminyaka engama-60 ubudala; abantu abaye baba ndamelwa yintliziyo yesibini; izigulane lwegazi kunye seswekile sinwenwa.

Okubalulekileyo, ukothuka cardiogenic luphawulwa ziintlungu, ngesiquphe uxinzelelo lwegazi nokuhla amaxabiso zisezantsi (iye ku-0), filiform ukubetha, isikhumba luthuthu. Pathology ukuze emva koko ukuya nokudumba yemiphunga okanye enokubangelwa ukusilela kwezintso.

Imiba igalelo ukuvela och

Uphuhliso ukusilela intliziyo Kakade etsolo, isigulane kufuneka lwandulelwe nazo ngaphambili izifo olujikeleza nkqubo. iimeko ezinjalo ziquka:

• isifo sentliziyo zibangelwa ngumonakalo imisipha intliziyo, ekhokelela ukuhla elibukhali kumandla myocardium ukuba ungenwe;
• ukusilela intliziyo ezingapheliyo, leyo waphula xa igazi unikezelo eqhelekileyo Amalungu nezihlunu;
• umonakalo ngengqibelelo kwemithambo intliziyo neetyhubhu;
• ukuqokelelana ulwelo kwi pericardium, nto leyo ekhokelela ukugxojwa ekunene izinga intliziyo ngenxa uxinzelelo ezwi kwi em- intliziyo (oku ngezifo kuthiwa tamponade intliziyo);
• ukuqina iindonga intliziyo - hypertrophy engabalulekanga;
• unesifo crisis - ukungaqheleki uxinzelelo lwegazi amakishiweyo.

ezibangela noncardiac

Ukongezelela kwiingxaki kunye intliziyo ukuvela sifo ithi ukuze abachaphazelekayo ngezifo ezinxulumene kwegazi eliphezulu kwi ukuhamba kwegazi miphungeni. Izifo ezikhokelela ukuba une "ukusilela intliziyo etsolo":

• ngesibetho - ukujikeleza ubuchopho ukungathobeli, apho bekuhleli izicwili yayo onakeleyo ngokupheleleyo umsebenzi kwengqondo;

• thromboembolism Umthambo kwemiphunga (sifo kwenzeka ngenxa ukuvaleka kwemithambo pulmonary, kwakunye neenkqubo zalo amahlwili egazi (thrombi), uninzi ngokuqhelekileyo amahlwili egazi kwenzeka ngemithambo ezinkulu umlenze zangasese nolusezantsi);
• isifo semiphunga - kukukrala bronchi (nephika), ukudumba inwebu semiphunga (pneumonitis);
• izinga dysrhythmia intliziyo (lunikezelo okanye deceleration) - tachyarrhythmia, bradyarrhythmia;
• izifo ezibangelwa ngamagciwane ezahlukeneyo.

Kukho izizathu ezikhokelela kuphuhliso sisifo sentliziyo, kodwa awubonisi izifo naziphi na iinkqubo omzimba. Ezi ziquka:

• utyando;
• nokulimala kobuchopho okubi;
• kuhlaselwa yityhefu kwi imisipha intliziyo - utywala, ukuvuleleka iziyobisi silwe;
• umatshini intliziyo-lung, ukusetyenziswa leyo ekhokelela kwiziphumo ezithile;
• electrotrauma - ukusebenza ngomhla umzimba yangoku zombane;
• amandla yengqondo-ngokweemvakalelo okanye ngokwasemzimbeni.

Uxilongo ukungaphumeleli kwentliziyo ahlekise

Uxilongo ukusilela intliziyo ikakhulu mayibhekiswe nokuzimisela oonobangela ukuba kukhokelele kuphuhliso ngezifo. Phambi zokwenza uvavanyo elebhu kunye zazo kunye nokusetyenziswa kwezixhobo zonyango, ugqirha uza kuqinisekisa ngokusebenzisa incoko kunye isigulane ubukho okanye ukungabikho ebomini bakhe imiba eyahlukeneyo igalelo kuphuhliso kwezifo ezifana ukusilela intliziyo oyingozi. Iimpawu yokufa (ngesiquphe) yenzeka kwisithuba seeyure ezingama-24, ukuze abonakale babuthathaka, yaye umsebenzi specialist - ukuba ningethi ixesha, kwaye kuthathelwe ingqalelo zonke izikhalazo yesigulana ngokukhawuleza kangangoko kunokwenzeka ukuseka uxilongo echanekileyo.

Iindlela zophando lusetyenziswayo xa une AHF, ziquka:

• i electrocardiogram;
• echocardiogram;

• esifubeni X-reyi;
• uvavanyo lwegazi jikelele kunye eliphezulu;
• Ngamanye amaxesha isetyenziswa moshilongo och cardiovisor - isixhobo Umgaqo yokusebenza akukho ezahlukeneyo ukusuka electrocardiograph.

criteria zokuxilonga

Uphawu enkulu kwaye iqapheleka ahlekise ukusilela kwentliziyo yangoku ingabizwa sinus tachycardia - ukwenza tachyarrhythmias supraventricular, apho iimpawu kwandiswa sinus isingqisho - nezihlandlo izishunqulelo zeentliziyo umntu omdala ngaphezu ngomzuzu 100. ukubonisa ngemizobo yomsebenzi intliziyo ibonisa umda oluphuma igunya ekhohlo okanye ekunene. Ukongeza, ngaphezulu okanye ngaphezu inkqubo xiphoid ilizwi wesithathu ibonakala.

Acute congestive Ukungaphumeleli intliziyo elungileyo esizibonakalisa iimpawu ezininzi:

• ndlela wesibeleko ngemithambo hepatic ukudumba kunye nelikhulu;
• koxinzelelo lwemithambo phezulu;

• ukwandisa kwesibindi, senyongo sheets;
• omzimba ukudumba;
• iminwe cyanosis nobuso (indlebe, isilevu, impumlo);
• isigulane uyaxhalaba kakhulu xa ikota yesangqa sakhe sokunene eliphezulu;
• ECG ubhala intliziyo omninzi ngequbuliso loo ventricle ekunene kwaye intendelezo, lokubonakala yi amazinyo aphezulu etsolo.

Iimpawu ukusilela intliziyo elungileyo kutyhilwa ngokucacileyo X-ray kunye electrocardiogram. Inqanaba lokugqibela le hlobo nesifo sentliziyo kukhokelela zokuncipha umzimba, ukunciphisa izinga iiprothini egazini kunye ukuphazamiseka eseleyo ityuwa emzimbeni.

Iimpawu ze ukusilela ventricular yasekhohlo kunye nokothuka cardiogenic

Ngenxa yoko, phambi ahlekise ukusilela ventricular ekhohlo hemodynamics congestive sinokungqinelwa eziliqela ezi mpawu zilandelayo:

• ukuphelelwa umoya, maxa wambi ajike abe somoya;
• ukhohlokhohlo paroxysmal owomileyo, expectoration maxa wambi amagwebu, ephuma emlonyeni okanye impumlo;
• ubukho rales zimanzi leyo weva phezu bonke ubuso esifubeni.

Kukho eziliqela iimpawu uphawu bothukile cardiogenic, ezizezi:

• Uxinzelelo lwegazi ze isigulane kusithwa amaxabiso ka 90-80 mm HG. Art. yaye ngaphantsi. Ukuba umntu unesifo lwegazi, luphawu bothukile lingaya lisehla ngokwehla yi-30 mm HG. Art. ukusuka kwinqanaba ngalinye yonke imihla.
• kunciphisa umfutho ukubetha - ngaphantsi kwe 25-20 mm HG. Art.
• Ukusola ethukile cardiogenic akhubekise isiyezi yesikhumba kunye silwa yayo. Ezi mpawu ibonisa yaphula microcirculation kwi kwizihlunu zomzimba.

Le ndoda owafumana mpawu zingasentla ngezifo, kufuneka kubekho uthotho lweziganeko phambi kokufika ziingcali. (. Stroke, isifo sentliziyo, njl) uncedo lokuqala ngokusilela intliziyo etsolo kufuneka ibhekiswe ukuqinisekisa ukuba:

• amalungiselelo ukufikelela umoya;
• ukuqinisekisa imeko tyaba isigulane (ukuba unalo akukho zimpawu ukusilela ventricular ekhohlo);
• ubambe ukusebenza iintlungu.

Unyango ukungaphumeleli kwentliziyo ahlekise

Unyango ukwehluleka intliziyo - kwanonyango ezintsonkothileyo ejolise, kuqala, ukuze kuqinisekiswe ukuba:

• ukuphelisa omninzi imisipha kwentliziyo - le ndlela yokulinganisa kwenziwa ngokusebenzisa iziyobisi kuthoba uxinzelelo lwegazi kunye izinga intliziyo;
• abophe iimpawu zesifo (amanyathelo zonyango ziya kuxhomekeka wabonakala sifo kubonakaliswa).

Ukuba DOS iye yakhula ngenxa iposi engabalulekanga, kuyimfuneko ngokukhawuleza kangangoko kunokwenzeka ukubuyisela coronary ukuhamba kwegazi umthambo. Ngokuqhelekileyo, imeko ebangela infarct Umthambo thrombosis, lokondla intliziyo. Elisebenzayo kunceda ihlwili legazi ukubuyisela ngokupheleleyo patency isitya igazi nokugcina imeko yesigulane.

Eyona ndlela yaziwa kakhulu kule meko kuthathwa thrombolysis, kodwa nkqubo kufuneka kwenziwa ngokukhawuleza kangangoko kunokwenzeka emva kokuba kuqala iqhosha de ihlwili usenguye "entsha". uncedo lokuqala ngokusilela intliziyo etsolo kuquka ukusetyenziswa kweziyobisi (thrombolytics), isenzo sakhe ejoliswe ngokuchithwa egazi. Imithi ezilawulwa yegazi, izinga elalana kulo ephilayo kulawulwa ngokungqongqo.

Unyango ukusilela etsolo (ventricular ekunene) kunye hemodynamics congestive kubandakanya ukususwa ebangela yabangela, - .. Status asthmaticus, igazi egazi kwi imithambo pulmonary, njl Iqala nomonde therapy ekuyiwa kuyo "Nitroglycerin" okanye "Furosemide" xa ngezifo zidibene mothuko cardiogenic kusetyenziswa inotropic ithetha. Basenze kunye namanyathelo ngasentla ikhutshwa phandle oksijini inhalation ngokusebenzisa catheter.

Lengqondo ukuphazamiseka isaqhubeka analgesics ezidakumbisayo, ezifana "icaffeine", nto leyo kunciphisa umsebenzi izihlunu bokuphefumla kunciphisa uxinezeleko entliziyweni.

Ukuphelisa iimpawu ukusilela ventricular lasekhohlo

Mihla le nangenxa yokudodobala igazi kwi-pulmonary kukhokelela imiphumo ebuhlungu ezifana nokudumba miphungeni. Xa ezinjalo Izitenxo izigulane emiselweyo alawula "Nitroglycerin" yegazi.

Ukuba etsolo ukusilela ventricular yasekhohlo kunye hemodynamics congestive edityaniswe ngokothuka cardiogenic, amisele ukuqaliswa "dobutamine" okanye "noradrenaline" yegazi. Kukho iimeko xa ezi amachiza ezihlanganiswe entsonkothileyo.

Amagwebu isikiwe nge kuthetha ezinika amagwebu nciphisa.

Ukuba hemodynamics yazinza kodwa iimpawu umphunga nokudumba iqhubeka, isigulane elawulwa glucocorticoids. Kulo mzekelo, uncedo lokuqala ukusilela intliziyo etsolo kuya kunceda ekunciphiseni permeability of ngena kwiseli.

Therapy ngokothuka cardiogenic iqalisa ukwandisa imveliso kwentliziyo, xa engekho mpawu ukusilela kwentliziyo congestive Liquka kulawulo zegazi. Le nkqubo lwenziwa kuphela phantsi kolawulo izinga kwentliziyo, uxinzelelo lwegazi kunye nokuphefumla. Ukuba ngaphambi isenzeko nesifo sentliziyo etsolo kwenzeka ilahleko enkulu ulwelo, kusetyenziswa sodium chloride.

Ukuphelisa iimpawu zesifo, kakade, ezinxulumene ikakhulu kunye nokusetyenziswa kweziyobisi, kodwa ukuba amanyathelo athathwa musa kungakhokelela yifuna, ungasebenzisa indlela ekunene - ukwenza ukothula hemodynamic ngokuthi tourniquet kwi yegazi lomzimba.

Kwiimeko apho amayeza endala akanawo amandla ukubhenela uqhaqho. Idatha yi nya iingxaki ezinxulumene occlusion ezincinane, iivelufa replacement intliziyo. Uzinzo izinga intliziyo kunceda ukufaka ipacemaker okanye mshini.

ukuvimbela

Eyona ndlela ibhetele yokuthintela uphuhliso izifo - liyithobele na imithetho elula - oko kukuthi, ukuba baphile ubomi obusempilweni, wayeka ukutshaya nikuyeke ukusetyenziswa ngokugqithisileyo utywala, ukuba enze esweni ngamaxesha zizifo ezingapheliyo ezikhoyo. Nangona kunjalo, kwiimeko xa sifo nangoku lazibonakalisa, kufuneka lulandele yolawulo ethile kubomi bemihla ngemihla.

Izigulane ukusilela ngentliziyo congestive kufuneka ngokusondeleyo iliso ubunzima lwabo. wayedla ezongezelelweyo bawaphikise ukwanda iswekile egazini kwaye ukuyilwa umonakalo cholesterol imithambo yegazi, nto leyo ebangela uxinzelelo oluphezulu lwegazi. Yimeko ebalulekileyo ekugcineni impilo ngokuqhelekileyo kuxhomekeke ukutya ukutya ekhethekileyo. Kuyimfuneko ukuba akulawule ukuthathwa ityuwa, kwakuwo apho akuyilugelanga impilo - yenza ukugcinwa fluid, nokudumba ukwakheka, ukwanda umthwalo entliziyweni.

Kuluncedo ukwenza umthambo, ukunika abayithweleyo imisipha namalungu, kodwa iiklasi zemidlalo kufuneka ungabi sisizekabani ukucima kombane umzimba. Iseti umzimba ukuze ekuvunyelwene ngalo ngugqirha. Kubalulekile ukuba atyelele rhoqo enomoya, balale, xiphephana kunye amandla engqondo.

Ngamafuphi, ukuze kuqwalaselwe ukuba ukusilela intliziyo etsolo - a ngezifo evame ebulalayo. Le yokugula ngokuqhelekileyo senzeka ngasemva kwezinye izifo amazwe kwenkqubo sentliziyo kwaye ikhokelela iingxaki ezahlukeneyo, kuquka stroke, ukothuka cardiogenic, nokudumba yemiphunga, njalo-njalo.

Kukho imiqondiso, nto leyo banesifo ukusilela intliziyo oyingozi. Iimpawu olukukufa zawahlela wabonakalaliswa, oko ke umsebenzi obalulekileyo iingcali kukho irekhodi yazo zonke izikhalazo nomonde zokuhlola ngokukhawuleza.