WPW phenomenon: oonobangela, iimpawu, isifo kwaye afumane unyango

WPW syndrome kuthiwa ngezifo kwi the luvo lwe imisipha intliziyo ebangela ukuxhuzula kunye tachycardia ngenxa elingaphesheya excitation kwe ngokwentshukumisa luvo kwi umendo owongezelelweyo mfutshane ukuba akukho mntu ungathembekanga entliziyweni esempilweni.

I okuqala

Ngowe-1930, oosonzululwazi zonyango Wolff Parkinson White kunye ngowokuqala bachaze iimpawu ezibonisa indlela syndrome, apho kamva wanikwa igama le SVC syndrome (WPW). Kukho ikho into WPW-senzeko. Sikwathathela nengqalelo ngayo kweli nqaku.

Ngokwesiqhelo, imicu entliziyweni, luvo excitation conductive ukubetha ukwenza kwindlela ethile, enika iyunifom kunye nokusasazwa ngokuthe ngcembe oluqhubekekayo. Isizukulwana uphawu iqala kwi sinus node kwi intendelezo ekunene egqitha esiludumbo AV (node atrioventricular) kwindawo atrioventricular, ngoko ke imilenze bundle Wakhe Purkinje Imicu excitation ezidluliselwa zonke Imicu kwezihlunu ezi ventricles intliziyo, yaye indlela elide inikeze yindibanisela eququzelelweyo yolunye imisipha yenhliziyo yonke.

Oonobangela kunye neempawu

Ukuba WPW syndrome luvo angxamele excitation ukusuka imithambo ukuya ventricles udlulisela indlela emfutshane loo nto ibizwa ngokuba yinkqubela-umqadi Kent, ngokudlula atrioventricular (AV) node. Oko kukuthi, igagasi excitation ngokukhawuleza kakhulu ngakumbi kwisingqi okuqhelekileyo nokubetha kwentliziyo, yaye kutheni kukho incoordination le kunciphiso izihlunu intliziyo, kunye neendidi ezahlukeneyo arrhythmia.

Leyo yindlela eyaphukileyo Intliziyo ukubetha.

mgaqweni ezifanayo isakhiwo entliziyweni naso kwaye kwasekwa kuphela ngenxa ungenxa uhlobo gene okanye uphantsi kweempembelelo kwezinye izinto, echaphazela ngokungalunganga uphuhliso ndiseyimbumba kwentliziyo yomntu.

Mbungu ring atrioventricular ekhona ezongezelelweyo kunye zomzimba, kwiveki 20-22-th ka ukubhitya kwaye shwaka ngokupheleleyo. Ukuba imicu agcinwe, kukho iimeko yokwakheka WPW syndrome. Ifomu lale WPW-syndrome iphawulwa linani elikhulu kokufakelwa AV, ukukhubazeka kunye mgaqweni kulwakhiwo kwentliziyo. Noko ke, kuphela omdala zingenzeka nangona ezingaqhelekanga iziphene yokwakheka, iimpawu yokuqala WPW-syndrome. Kuzo zonke iimeko, ubukho-70% ye-sifo banesifo kumadoda.

iimpawu zokugula

Ezi mpawu zixhaphakileyo lobukho kunokwenzeka ka WPW syndrome zezi zilandelayo:

1. Ukuziva iyangongoza olomeleleyo rhoqo, apho abantwana umnxeba "ukutsiba okanye iyagquma intliziyo."
2. nesiyezi ngesiquphe.
3. syncope kwenja, ingakumbi esakhula.
4. Ubuhlungu entliziyweni, ukuntlontlozela nokusika ubuhlungu xa ukusezela.
5. Imvakalelo ukutsarhwa, ukuphelelwa kakhulu ngumphefumlo eselula.
6. Kubelekwa uya kwala ukondla kunokwenzeka ukubila lweenkcukacha, rhoqo ubuthathaka, ukwanda izinga intliziyo ezithile ukuze ibetha 200-300 ngomzuzu.

Indlela yokubona izifo?

Abantu abaninzi abaye babe okuzenzela ezingaqhelekanga kakhulu esihlunwini kwentliziyo, le WPW syndrome banesifo kuphela xa zenziwa echocardiography intliziyo. Ziqonde ukuba ziya kunika isiphumo.

Ezo abathwali syndrome abaguli maxa tachycardia okanye fibrillation, kwaye zinokude akayiboni ubukho ezingaqhelekanga entliziyweni.

Le nazimpawu waphawula ngo-35-40% yabo bonke abathwali ivezwe onaso. flow mnene WPW syndrome luphawulwa tachycardia elifutshane nezolo okanye fibrillation, leyo ngokukhawuleza udlula ngaphandle koncedo. Ukuze ukuphelisa uhlaselwe kwimeko womxhuzulane medium WPW syndrome zifuna iziyobisi antiarrhythmic okanye iintlobo ezithile blocker of excitation intliziyo.

Kwimeko uxhuzula iyoluka ukuba musa kakhulu isuswe izishunqulelo ngokwezonyango nzima yaye uphazamisekile kwemisipha sentliziyo enomoya atrial kwafunyaniswa ukuba iqondo kakhulu of syndrome kunye notyando esicetyiswayo.

iintlobo syndrome

WPW syndrome nentliziyo zahlulwa ngokuvumelana rhoqo kwaye ingakumbi ukuvela kweempawu ezahlukeneyo lwezonyango yahlulwe ezi ndidi zilandelayo:

• Ukubonakalisa xa electrocardiogram uhlala Delta yomtshangatshangiso, yaye ATS-tachycardia kunye sinus isingqisho kuvela manqaphanqapha.
• Ihlala - luphawulwa ventricular zezomzuzwana pre-excitation.
• Efihliweyo - ichaza episodic AVR-tachycardia, kwaye imo yokuphumla akukho sifo.

ukwazi ukuhlola njani enye sifo?

Ngaphandle electrocardiogram ukuxilonga kunokwenzeka WPW-syndrome kunokwenzeka ngokuphulaphula ngentliziyo izandi, nto leyo eya kuba yinxalenye ibinzana arrhythmic kwindalo, kwakunye ukubetha kwentliziyo kakubi.

Ukongezelela ECG une WPW syndrome elibukhali usebenzisa isixhobo ekhethekileyo ephathekayo electrode, ultrasound kunye echocardiography, ukuqaliswa electrode ezakhayo emphinjeni kunye neziphumo ekufundeni elandelayo ngamaza ombane, kwakunye loviwo entsonkothileyo electrophysiological, enika imodeli echanekileyo ayifumaneki esihlunwini intliziyo Kent imiqadi kwaye ivumela ukuba bancome unyango endala okanye yotyando.

WPW-phenomenon

Xa ukuhlola ubukho WPW syndrome e ngaphezu kwe-30% ye abathwali syndrome ezichongiweyo naziphi na izikhalazo malunga nempilo intliziyo bangabikelwanga nazo. Ngenxa inani elikhulu enjalo nazimpawu, ngo-1980, WHO yapapashwa izindululo kwezinya WPW syndrome ukuba umfanekiso ethile lwezonyango, kunye WPW-senzeko.

Malunga nalo mba, kuphothulwe ukuba electrocardiogram intliziyo sinus rhythm iye iimpawu yokuya ventricular excitation, kodwa ke ezi zenziwayo izifundo zizifundo akukho States zophendlo lwezifo kunye tachycardia atrioventricular mbaleko.

Ngaphandle koku, xa isenzeko WPW esichengeni iingxaki liphezulu kakhulu, ukumqumbisa nayiphi impembelelo - uxinzelelo emzimbeni okanye emphefumlweni, utywala, ukuhamba kwimimandla ezingaqhelekanga geographical - kunokubangela ngokubonakala iimpawu ebuhlungu WPW syndrome. Xa abantu abadala ngo-0.3% amatyala WPW-ziyenzeka akubulali, abantwana baye bahlola wabonisa ukufa kwezonyango-2% yamatyala.

Statistics WPW ngumkhuba abantwana

WPW-syndrome ithatha indawo akhokelayo phakathi izinto ezibangela le tachycardia kunye arrhythmia ebantwaneni. Oku sisiseko ngokucacileyo ukuba uphazamiseko ngakumbi isingqi intliziyo, kwakunye nokungabikho izikhalazo akuthethi ukunciphisa ingozi onokugula okunjalo. Nawuphi sindisa emzimbeni, umthambo olukhulu, izinto zengqondo engabangela ukungaphumeleli intliziyo wengqikelelo wonwabile kwaye kukhokelela ekufeni ngenxa yesifo sentliziyo.

esweni Long-term iminyaka phantse 20 iqela elikhulu labantwana abafunyenwe intliziyo WPW syndrome, abaneminyaka olusana ukuya kwiminyaka eli-18, wabonisa iziphumo zilandelayo:

• 8% yabantwana bafumana abaqala ngesiquphe ABP-tachycardia;
• 8.2% kwezi zifundo lifumanise zezomzuzwana ngumkhuba lenguqu WPW syndrome;
• 8.5% lokulahlekelwa otshintsho ezingqondweni yenzekile;
• 2% yabantwana ngexesha kwisaveyi yokuqala sele eve ukufa clinical;
• 1.2% - abafana kuphela - ngesiquphe waza wafa kwisithuba uhlolo;
• 9 kuphela% abantwana WPW nesenzeko ingxelo Ukunyamalala data iimpawu.

Njani yingozi phenomenon WPW?

Ukusuka kwezi manani kucacile ngayo phambi nokuba Kuyingozi WPW senzeko. Le pesenti eliphezulu iimpawu ezingalunganga kunye ezimbi ngexesha ebuntwaneni unika izizathu ukuba sicinge ukuba ungayekwa uxinzelelo emzimbeni nangokweemvakalelo, ngaphandle inkqubo esweni kunye namanyathelo zonyango kunye ubudala kwaye le pesenti isoyikiso kubomi uya kwandisa kuphela.

Abantwana WPW nesenzeko akufuneki benze lezemidlalo, ize ke inyanzeleke ukuba izinto ezibangela uxinezeleko rhoqo. Amanyathelo kufuneka athathwe kumaqela kwemozulu baxa okanye iziganeko, ebangela bekudla kakhulu emphefumlweni. Zonke ezi zinto ukuze kungahle kakhulu ukuba kungakhokelela ukugula okanye ukufa. Abantu abaye bazakhela ubukho syndrome WPW okanye nesenzeko, hayi abizelwe emkhosini.

Treatment kunye ukukhululeka syndrome

Iimpawu kunye unyango badla zihlobene. Kukho Amayeza amaninzi ukuba akhulule ukuhlaselwa yintliziyo zibangelwa yi-WPW syndrome, kwaye ziyakwehlisa ngokubonakalayo ngokubonakala iimpawu zayo.

iqela iziyobisi blocker normalizes nezihlandlo izishunqulelo kwemisipha kwentliziyo. Noko ke, impumelelo iindlela ezinjalo kuboniswe kuphela kwinqanaba 50-60% kwaye ayikwazi ingasetyenziswa hypotension rhoqo sombefu.

Antiarrhythmics kakhulu kuzinza isikiwe ukuhlaselwa AVR-tachycardia, bunjani izinga intliziyo ngo-80% yezigulane, kodwa babe eziliqela Izimo kwimeko hypotension, isifo sentliziyo kunye nezinye isifo sentliziyo, esakhula. Ezinye blocker calcium contraindicated ngokupheleleyo kwi WPW syndrome, njengoko umfanekiso ngasemva oluphuculweyo yokosulela kwe ngokwentshukumisa-luvo, nanzo busilele imithambo, leyo ineziphumo ezingababeka engxakini lakho.

Kwakhona, kwezinye iimeko, ukusetyenziswa kweziyobisi iqela ATP waphawula nefuthe elibi ucutheko atrial. Kukho iindlela ezingezo-drug isiqabu iimpawu.

Kwathi amaza kwezihlunu luvo ngokusebenzisa imicu novelwano kunye parasympathetic. Uhlobo lokuqala kwimicu iyazingenela intliziyo, uhlobo lwesibini imenza izinga intliziyo, njengokuba uhlobo vagus luvo nervus vagus, kwaye kananjalo ngokuba reflex vagal. Oko kukuthi, ukuba ipoti ye ikwayile hlobo ingqondo uya isiphumo nokuzinziswa intliziyo. Indlela elula ukuba wenze inkqubela vagal i ekuthiwa-reflex Aschner leyo Bamqumbisa 20-30-okwesibini ukuchukumisa ngobunono phezu amehlo kwaye usoloko kunceda ukuyeka tachycardia.

Kwakhona, i-luvo vagus iyasebenza kakuhle umoya-namphi ombane kwizihlunu esiswini, ukuze lo mkhuba WPW syndrome okanye luncedo ukuba senze yoga kunye imithambo ukuphefumla.

Ukuqalisa indlela uphawu kakhulu ngokusebenzisa i electrode lifakwa kuvuleke iminxunya, ngempumelelo kakhulu eyeka tachycardia nzima ixesha elide, kodwa ngamanye amaxesha ekhokelela fibrillation wentliziyo, ngoko kwenziwa nekhabhathi ezizodwa zixhotyiswe nge mshini.

Defibrillation lwenziwa kuphela kwiimeko ezinzima kakhulu, xa isoyikiso kakhulu ebomini, kodwa kuyanceda ukuphelisa kugquba eziyingozi neemvakalelo angaphandle inyama ezesifuba bunjani umsebenzi rhythm intliziyo.

Yentsebenziswano syndrome WPW unyango kunye nemfuneko yawo

Ukuba phenomenon Sithole WPW ECG indlela yokusebenza ukuphelisa lisetyenziswa kuphela kwiimeko ezizodwa, kunye tachycardia rhoqo kwaye elide, nto leyo ayisuseki ngamayeza, kwakunye kwiimeko emisiweyo ukufa kwentliziyo ngesiquphe, izihlobo isigulane okanye ngenxa yezizathu umsebenzi.

unyango Surgical kucetyiswa kuphela ngokusekelwe uviwo ebanzi ngokupheleleyo, nto leyo enika umfanekiso lichaneke izakhiwo zeethishu zophendlo lwezifo kwentliziyo. Ngoko ke, kufuneka ucinge ukuba ingaba ukwenza intsebenziswano kunye WPW nesenzeko.

Olu tyando lwenziwa ngokusebenzisa i electrode ekhethekileyo, eyafakwa nge kwemithambo femoral ukuya izihlunu intliziyo ngokubona X-reyi kwaye kwiindawo ezithile uvelisa radioprizhiganie okanye ablation, luvo.

Kananjalo kufuneka kriorazrushenie luvo yezifo. Yaye eneneni, kuzo zombini ezi meko ukwanela nokusebenza efikelela 95%. Likakade zenzeka ngenxa intshabalalo engaphelelanga ayinakutshintshwa nakujoliso olutsha, kwaye phambi kumaqumrhu wabo kwezinye iithishu zemithambo. Ngokwawo, lo msebenzi kufuneka wenziwe phantsi zomzimba zasekuhlaleni, phantse kwegazi, oko kunokubangela iingxaki, ixesha ekuphulukwene elifutshane kakhulu kwaye ngoko wenziwe na ubudala.

amaziko wentliziyo eMoscow

Institute of Surgery. A. V. Vishnevskogo - iqhayiya amayeza ekhaya, uye izibonelelo zale mihla ukuba unyango kunye isifo, uqhuba uphando, uxilongo ophezulu zobugcisa ezahlukeneyo kunye notyando unique inhliziyo. FGBU "NNP Centre of Lwentliziyo Surgery kubo. A. N. Bakuleva "lenza imisebenzi zonyango, ezobunzululwazi kunye nezemfundo yenkqubo" Utyando Lwentliziyo. "

Russian Uphando Cardiology neMveliso Complex liqhuba uphando kunye ukunyanga isifo sentliziyo komgangatho KWIHLABATHI-zobugcisa. In center "cardoid" ungakwazi bangenele uvavanyo olupheleleyo kwentliziyo, afumane unyango olusemgangathweni kwezonyango qho kwesibhedlele. Centre Cardiological eMoscow yasebenza kakuhle, ngoko ke ukuba une kwimfuneko yokungenelela ngoncedo ngotyando ukuphatha, awukwazi madolw 'anzima.