Zokuma: zokuqala (iSystolic), le yesibini (ukuzala) - nanjengokwesimo kwaye kwegazi

phonendoscopes Okokuqala agobe ityhubhu sheets okanye izinti uqalo ezibuhlazarha, yaye oogqirha abaninzi basebenzisa kuphela ezindlebeni zabo. Kodwa bonke babefuna ukuva oko kwenzekayo ngaphakathi emzimbeni womntu, ingakumbi xa kufikwa kwiqumrhu ezibalulekileyo ezifana intliziyo.

Heart izandi - izandi ziveliswa inkqubo yokunciphisa eludongeni engabalulekanga. Ngokuqhelekileyo, umntu onempilo unalo ithowuni-mbini, nto leyo ikhatshwe izandi ezongezelelweyo ngokuxhomekeke kuhlobo inkqubo zophendlo lwezifo luphuhla. Ugqirha na okukhethekile kufuneka akwazi ukuva ezi izandi ulityhilayo.

umjikelezo intliziyo

Intliziyo beats kumaza of ukusuka amathandathu ukuya asibhozo ibetha ngomzuzu kwi. Kakade ke, ixabiso, kodwa alithoba ekhulwini abantu kuwa emhlabeni phantsi kwawo, nto leyo ethetha ukuba njengoko eqhelekileyo uyithabathe. idubule nganye inamacandelo amabini alandelelanayo: systole kunye diastole. isandi intliziyo iSystolic, yena, yahlulahlulwe atrial kunye ventricular. Ngexesha kuthatha imizuzwana 0.8, kodwa intliziyo ixesha lokuba nesivumelwano ukhululeke.

systole

Njengoko kukhankanyiwe ngasentla, amacandelo amabini ubandakanyekile. Ekuqaleni, kukho systole atrial: iindonga contract zabo, igazi phantsi koxinzelelo ongena ventricles, iivelufa kunye nemivalo slam. Yaba isandi ngokuvala iivelufa kunye weva kwi yeSkrini. Le nkqubo yonke ithatha imizuzwana 0.1.

Kwandule ke ukubakho systole ventricular, nto leyo ukusebenza kakhulu ezimbaxa kunokuba kunjalo imithambo. Okokuqala, siphawula ukuba inkqubo ithatha izihlandlo ezithathu elide - imizuzwana 0,33.

Isigaba sokuqala - voltage le ventricles. Oku kuquka phase olungenangqamaniso kunye kwamathumbu ulwandiso. Yonke lento iqala nesibakala sokuba ubume eclectic Ukhuthaza ecaleni myocardium, yena Iyandonwabisa imicu kwezihlunu ngamnye ebangela ukuba angosulelwa ngokuzenzekelayo. Ngenxa yoko, ukuba utshintsha imilo kwentliziyo. Ngenxa kwemithambo atrioventricular asondelelene, ukwanda koxinzelelo. Ngoko kukho yindibanisela elinqatyisiweyo ventricles, kunye negazi ungena aorta okanye pulmonary. Ezi izigaba ezibini kugqiboezakuthatah 0.08 kunye imizuzwana 0.25 eliseleyo igazi engena izinto eziphambili.

diastole

Apha, kakhulu, ukuba akukho ilula ukuze oko kusenokubonakala xa efika kuqala. kuthanjiswa Ventricular ithatha imizuzwana 0.37 kwaye kwenzeka ngokwezigaba ezintathu:

1. Protodiastolic: emva igazi ngasekhohlo intliziyo, xi kwisisu yalo lifinyele yaye ivelufa, okukhokelela izitya ezinkulu, zivaliwe.
2. kuthanjiswa ulwandiso: imisipha kuyaqhubeka, xi iwela ngakumbi zangqinelana atrial. Kule valve atrioventricular evulekileyo, negazi ukusuka imithambo ukuya ventricles uyawa.
3. Ukuzaliswa kwezi ventricles: i ithambeka xi ecaleni kulwelo igcwalisa asezantsi kumagumbi intliziyo. Xa xi equalized, ithombo legazi ngcembe uyehla kwaye ke ime.

Lo mjikelo ngoko kuphindwa kwakhona, eqala nge systole. njalo ubude balo iyafana, kodwa diastole unako iyanqanyulwa okanye elide ngokuxhomekeke izinga intliziyo.

Indlela of ukubunjwa I ithoni

Uyinqaba njengoko kuvakala unakho, 1 ilizwi entliziyweni siquka namacandelo amane:

1. Ivelufa - oko kukhokelela imfundo eyiyo. Enyanisweni, oku kukuhla kunyuka amaphetshana vana atrioventricular ekupheleni ventricular systole.
2. Muscle - isiphakamiso oscillatory le ventricles ngexesha ukusikwa.
3. Olujikeleza - esisuka iindonga eziphambili inqanawa ngexesha uxinzelelo lwegazi sabo siwela.
4. Atrial - systole atrial. Oku kuqaleka ekhawulezileyo pitch yokuqala.

Indlela wesiseko II ithoni neethowuni ezongezelelweyo

Ngoko ke, 2 ithoni intliziyo lubandakanya amacandelo amabini kuphela: i nokufakelwa yegazi. Okokuqala - oku isandi oluvela ibetha igazi kwezobugcisa nokufakelwa buti pulmonary ngexesha xa nangoku ivaliwe. Okwesibini, esinecandelo nemithambo - intshukumo iinqanawa ezinkulu iindonga, xa beziya zivulwe ekugqibeleni.

Ngaphandle ezinkulu, kodwa ukwahlula iithowuni ezimbini 3 no-4.

ithoni sesithathu - a kunyuka ventricular myocardium ngexesha diastole, xa igazi sihamba nje endaweni xi eliphantsi.

ithoni Okwesine livela ekupheleni systole kwaye unxulunyaniswa ekupheleni ukugxothwa igazi imithambo.

ithoni I uphawu

Wentliziyo zixhomekeke kwizinto ezininzi, zombini obuvakalayo extracardiac. 1 ithoni sonority kuxhomekeke kwimeko injongo yale myocardium. Ngoko ke, incwadi yokuqala inikwa ukuvalwa olwandeleyo kwemithambo yenhliziyo kwaye izinga apho ventricles ziyancipha. Izincomo iimpawu zasesekondari ezifana beziya lexinene semigudu atrioventricular kwakunye nezikhundla zabo em- entliziyweni.

Kungcono ukuba umamele isandi sokuqala intliziyo ngaphezu kwayo - kwisithuba 4-5 intercostal iseleyo kwentamo. Kuba elungile ilungelelanise kuyimfuneko zibuphekhashini ye esifubeni kule ndawo kwaye ukuchaza ngokucacileyo imida anozizi intliziyo.

pitch uphawu II

Yintoni ukumphulaphula kuye, kuyimfuneko ukubeka yeSkrini intsimbi phezu kwesiseko intliziyo. Le ngongoma kancinane ukuya ekunene inkqubo xiphoid kwentamo.

Umthamo kunye nokucaca sethowuni yesibini kwakhona ixhomekeke nendlela ibihleli ivaliwe kwemithambo, kodwa ngoku semilunar. Ukongeza, isantya yomsebenzi wabo, ukuba yokuvala kunye neziphelo sesisa oscillation echaphazela isandi ukudlala. Kunye neempawu ezongezelelweyo ezi lexinene onke amaqela achaphazelekayo ukuyilwa ithoni, kwakunye indawo kwemithambo ngexesha ukugxothwa igazi entliziyweni.

Imithetho auscultation izandi intliziyo

Isandi intliziyo mhlawumbi yeyona uzole ehlabathini, emva ingxolo emhlophe. Izazinzulu ziye hypothesized ukuba umntwana wakhe esiva Esibelekweni. Kodwa ukuze ukubona umonakalo entliziyweni, nje ukuva ukuba ibetha ngayo, akwanelanga.

Ubukhulu becala benza auscultation kufuneka indawo ezolileyo kwaye kufudumele. Le pose lwabantu kuxhomekeke kuhlobo vana kufuneka baphulaphule ngenyameko ngakumbi. Lo isenokuba indawo silele ngecala lasekhohlo, nkqo, kodwa izindlu yakuthobela phambili kwicala ngasekunene, njalo njalo. D.

Isigulana kufuneka uphefumla enqabileyo nzulu, kwaye isicelo kagqirha ukubamba umoya wakho. Ukuze aqonde ngokucacileyo apho systole kunye diastole apho ugqirha kufuneka acha- ukuphulaphula palpate ubume carotid kwemithambo eyenzeka ngexesha elinye ngokupheleleyo kwisigaba iSystolic.

Umyalelo we auscultation intliziyo

Emva ukuzimisela owandulelayo ugqirha anozizi intliziyo ngokugqibeleleyo xa kuthelekiswa umamela intliziyo izandi. Iqala, njengoko umthetho, kunye umzimba phezulu. Well apho umba mitral yi oluvakalayo. Ngoku yisa ku kwemithambo kwemithambo enkulu. Kuqala aortic - kwisithuba intercostal yesibini ukuya ekunene kwentamo, ngoko ukuya pulmonary - kwinqanaba elifanayo, nje ukuya ekhohlo.

Ingongoma sesine ukuphulaphula - oku isiseko kwentliziyo. Le ibekwe emazantsi inkqubo xiphoid, kodwa lutshintshelwe ecaleni. Ngoko ke, ukuba ugqirha kufuneka ukhangele ukuba uhlobo kwentliziyo kunye esqwini zombane ukuphulaphula kakuhle valve tricuspid.

Ukusondeza auscultation e Botkin-Erba. Unga ukuva vana aortic. Kungenxa kwisithuba intercostal yesine kwi ngasekhohlo kwentamo.

iithowuni ezongezelelweyo

sound intliziyo akusoloko ukhumbuza nokufuna ezinesingqi. Ngamanye amaxesha, amaxesha amaninzi singanqweneleka, kuthatha iintlobo engaqhelekanga. Ezinye zezi oogqirha baye bafunda ukuba ukuchonga nje ngokuphulaphula. Ezi ziquka:

- Cofa ivalve mitral. Uyakwazi ukuba weva kufuphi enkcochoyini wentliziyo, oko lu dityanisiwe utshintsho somgquba amaphetshana nokufakelwa livela xa iziphene intliziyo zifumaneka kuphela.

- iSystolic click. Olunye uhlobo valve mitral. Kulo mzekelo, ukuba beziya asondelelene, ngokungathi gu ngaphakathi ngaphandle ngexesha systole.

- Perekardton. Found xa pericarditis kwakuse. Ezinxulumene komlomo ngokugqithisileyo le ventricles ngenxa amiliswe ngaphakathi komgca mooring le.

- I kwisingqi lwezagwityi. Kukho stenosis mitral, ukwandiswa engumbonakalaliso ithoni yokuqala, yesibini ithowuni ugxininiso kwi-pulmonary yaye ivelufa nqakraza mitral.

- wokuphalisa. Isizathu sokuba livela kukuphungula ilizwi engabalulekanga, ivela kwi tachycardia kwisiqalo.

Extracardiac ibangela yokukhulisa kunye eziphango neethowuni

Intliziyo beats emzimbeni ubomi, ngaphandle breaks nangeeholide. Ngoko, xa unxiba phandle, isandi elilinganisiweyo yemisebenzi yakhe kubonakala nendaba. Izizathu oku nokuba inxulumene ngqo yomonakalo intliziyo, yaye musa buxhomekeke kulo.

kocingo negalelo ekomelezeni:

- cachexia, ukudla, udonga esifubeni obhityileyo;

- atelectasis pulmonary okanye inxalenye yayo;

- ukudumba kwi mediastinum ngomva, ukuhamba lula;

- afunxwe esithinzini umzantsi wemiphunga;

- bulla emiphungeni.

Ukwenziwa buthathaka entliziyweni izandi:

- ubunzima ngokugqithiseleyo;

- uphuhliso izihlunu zodonga esifubeni;

- emphysema ongama;

- ubukho ulwelo em- thoracic;

- pericarditis exudative.

izizathu Intracardiac ukubomeleza buthathaka neethowuni zentliziyo

Wentliziyo ecacileyo, xa enesingqi umntu uphumle okanye ngexesha ubuthongo. Ukuba wasikwa, umzekelo, yakhwela kwizinyuko kwi-ofisi kagqirha, oko kunokubangela intliziyo yokukhulisa. Kwakhona, ukukhawulezisa ireyithi intliziyo kunokubangelwa kwegazi, izifo yonyango, njl

sound intliziyo abazizithulu waphulaphula kunye nezifo ngentliziyo ezifunyenwe, ezifana mitral okanye stenosis aortic, insufficiency semigudu. Igalelo lakhe kuzisa stenosis aortic kumasebe ukuba basondele intliziyo yakhe; ukwenyuka inxalenye arc, inxalenye ukwehla. Intliziyo umfutho izandi ezinxulumene okwandileyo mass engabalulekanga, ngokunjalo nezifo yokukrala imisipha intliziyo, ekhokelela ukonakala okanye sclerosis.

inhliziyo luyambombozela

Ngaphandle imibala, ugqirha uyakwazi ukuva ezinye izandi, ebizwa ngokuba yi-ingxolo. Bona wabumba esisiphithiphithi yokumpompoza kwegazi, nto leyo udlula em- intliziyo. Ngokuqhelekileyo, kufuneka sibe. Zonke izandi lungahlulwa-hlulwa zibe organic kwaye zisebenza.

1. Organic kuvela xa yokwakheka iqumrhu kwenzeka, utshintsho ayibuyiseki umva kwinkqubo vana.
2. yengxolo esebenzayo ezinxulumene nonikezelo kakuhle luvo okanye izihlunu amandla papillary, ukwanda izinga lentliziyo kunye nezinga flow igazi, ukuhla viscosity yayo.

Ingxolo nga kunye izandi ngentliziyo, kwaye bazimele geqe wabo. Ngamanye amaxesha ukukhuhlana pleural yezifo ukudumba yi enyanzeliswa phezu entliziyweni, kwaye ke kufuneka ucele isigulane ukubamba umoya wakhe waza wacinezela phambili kwakhona ukubamba auscultation. Le ndlela elula kunokusinceda siphephe iimpazamo. Ngokuqhelekileyo, xa ephulaphula isandi itrayi zophendlo lwezifo ukujonga apho sigaba somjikelo kwentliziyo ukuba kwenzeka, ayindawo engcono yokufumana kwaye aqokelele ukumamela iimpawu ingxolo: amandla, ixesha kunye nolwalathiso.

iipropati ingxolo

Ubume iintlobo ezininzi yengxolo:

- soft okanye ukuvuthela (ngokuqhelekileyo hayi ezinxulumene ngezifo, kaninzi abantwana);

- gadalala, ukukrwela kunye namarhela;

- umculo.

Kuba Ubude zizakubalulwa:

- elifutshane;

- elide;

Ngu umthamo:

- tu;

- elikhulu;

- siyehla;

- ekhulayo (ingakumbi licuthe le orifice atrioventricular ekhohlo);

- ukwandisa-ukuhla.

Ukutshintsha ivolyum lwashicilelwa ngexesha elinye izigaba umsebenzi intliziyo.

ubude:

- high (xa aortic stenosis);

- njalo (stenosis mitral).

Kukho ezinye iindlela jikelele ingxolo auscultation. Okokuqala, waphulaphula kakuhle iindawo semigudu, ngenxa ngezifo ezo benziwa. Okwesibini, ingxolo ibonakala ulwalathiso yokumpompoza kwegazi, hayi nayo. Kwaye wesithathu, njengoko intliziyo izandi, izandi okungaqhelekanga achotshelwa kakuhle apho intliziyo ithe wambu ukukhanya kuthinteleke unamathele esifubeni.

luyambombozela iSystolic Kulungile ukuphulaphula kwindawo lisalele, ngokuba ithombo legazi ukusuka ventricles kuba lula yaye ngokukhawuleza, kwaye iDiastolic - ehleli, kuba phantsi amandla womxhuzulane, ulwelo ukusuka imithambo ukuya ventricles uyawa ngokukhawuleza.

Ingxolo kwahlulwa kwindawo yabo kwaye isigaba kumjikelo intliziyo. Ukuba ingxolo kwindawo enye uvela systole kunye diastole, ithetha ezitshangubeni odityanisiweyo we vana. Ukuba ingxolo ivela systole ngaxa lithile, yaye diastole - enye - sele ilahleko odityanisiweyo semigudu ezimbini.