Ejection ingxenyana inhliziyo: kuyinsakavukela pathology

Namuhla, nkathi yobuchwepheshe, ukuthuthukiswa izifo zenhliziyo nemithambo yegazi Uyinto kuyindaba ebalulekile nje kuphela abasebenzi ezikhungweni zezempilo, kodwa futhi amazinga engenhla uhulumeni. Yingakho amasu amasha ngokwengeziwe futhi ngaphezulu ukwehlisa lesi sifo umbuzo, ucwaningo uxhaso ngenkuthalo nokuthuthuka, okuyokwenza esikhathini esizayo ukuze afeze lezi zinhloso.

Omunye izitayela nokwelashwa kweziguli izifo zenhliziyo nemithambo yegazi - iyona nokwelashwa isifo senhliziyo. Uma ungakwazi ngempumelelo aphathe kule ndawo ezinye izifo, kanti abanye namanje "Ezingalapheki" ngenxa yokuntuleka amathuluzi kanye nezinye izingxenye ebalulekile ukwelashwa okufanelekile. Njengoba isihloko wamanje acoce nomqondo serdechenogo emkhathini, imithetho yayo nezindlela zokwelashwa, inhliziyo ejection ingxenyenamba (kuyinsakavukela ezinganeni nakubantu abadala).

Isimo yamanje

Mayelana nokwanda sokuphila kwabantu asebekhulile kuleli qembu anda yokudlanga kokuxhashazwa isifo senhliziyo, ikakhulukazi nge kahle ejection ingxenyenamba. Eminyakeni yamuva nje kuye nezindlela bokuthi ukwelashwa ukusetshenziswa resynchronization amadivayisi inhliziyo, cardioverter-ovuselela ukuthi baphile isikhathi eside, ngcono ikhwalithi iziguli nale egunjini lokuhlolwa kwezifo.

Nokho, izindlela abaziwa ukwelapha isifo senhliziyo kanye ingxenyenamba evamile, ukwelapha lesi sifo enokwehla. Kukhona futhi akukho ukwelashwa efakazelwe of acute decompensation inhliziyo (edema yamaphaphu). Kuze kube manje, lo izidakamizwa main ukuba aphathe lesi simo kukhona isisu, womoya-mpilo nitropreparatov. Ejection ingxenyenamba, kwenhliziyo, zokugula yayo, zidinga kalula inkinga.

Ake usibone ngeso lengqondo imisipha yenhliziyo nemithambo ukuhlonza umsebenzi emakamelweni inhliziyo (Atria, ventricles) indlela kungaba Doppler cardiography. Ukuze uqonde ukuthi inhliziyo isebenza, ukuhlola ikhono layo ungenwa (systole umsebenzi) futhi okuphumuzayo (umsebenzi diastolic) infarction.

Amanani kokulingana

Ejection ingxenyenamba kwenhliziyo, okuyinto kubhekwa ngezansi kuyinsakavukela - main ithuluzi inkomba okuyinto ephawula ngamandla imisipha yenhliziyo.

Amanani we ingxenyenamba ejection, etholwe Doppler cardiography:

• amazinga Okuvamile - okungaphezulu kophawu noma elilingana 55%.
• Iya kancane ukuphambuka - 45-54%.
• ukuphambuka Maphakathi - 30-44%.
• ukuphambuka Sikuveze - engaphansi kuka-30%.

Uma le nkomba lingaphansi kuka-40% - "amandla inhliziyo" sinciphile. Amanani Okuvamile - ngenhla 50%, "amandla inhliziyo" muhle. Ukwaba "grey zone" ka 40-50%.

Inhliziyo ukuhluleka - iqoqo ukubonakaliswa emitholampilo, izimpawu kwamakhemikhali, yalezizifundo (electrocardiography, Doppler inhliziyo, esifubeni X-ray) ukuthi kwenzeke amandla engezansi inhliziyo.

Hlukanisa emkhatsini lingaze futhi asymptomatic, systolic futhi diastolic yokumelwa yinhliziyo.

Ukuphuthuma inkinga

Kule minyaka engu-20 edlule izigameko ephethwe yisifo senhliziyo phakathi baseYurophu sinciphile. Kodwa inani elandayo labantu amacala e kumasegmenti maphakathi kanye engenhla sabantu ngenxa lenyuka bempilo.

Ngokocwaningo olwenziwa European (kokuqhuba echocardiography), watholakala ehle ejection ingxenyenamba, kwesigamu iziguli nge lingaze inhliziyo ukwehluleka kanye nengxenye iziguli asymptomatic.

Iziguli senhliziyo mancane uyakwazi ukusebenza, banalo izinga encishisiwe zokuphila futhi ubude bayo.

Ukwelashwa salezi ziguli kuyinto eqolo ngabo, futhi isimo. Ngakho-ke, njengoba kubasalele yokusesha esiphuthumayo izindlela zokunqanda okuvela, ekuhlonzweni nasekwelashweni ngempumelelo yokuba nesifo senhliziyo.

Kwenziwe emashumini eminyaka amuva, izifundo zikufakazela ukusebenza yenombolo amaqembu izidakamizwa ukuthuthukisa Izibikezelo, sehlise ukushona in iziguli ongaphakeme iqembu inhliziyo:

• adenozinprevraschayuschego enzyme inhibitor ( "Enalapril");
• angiotensin II abamelene ( "valsartan");
• Beta-blocker ( "Carvedilol");
• aldosterone blocker ( "spironolactone");
• Isisu ( "Torasemide");
• "Digoxin".

Izimbangela ephethwe yisifo senhliziyo

Inhliziyo ukuhluleka - a syndrome, kwakheka ngenxa ukuphazamiseka isakhiwo noma umsebenzi myocardium okuyinto. I zokugula isigqi inhliziyo noma conduction, ukuvuvukala, mzimba, endocrine, umzimba, zofuzo, izinqubo neoplastic, ukukhulelwa kuphazamisa yisimangaliso yobuthakathaka inhliziyo nge kahle ejection ingxenyenamba noma ngaphandle.

Izimbangela ephethwe yisifo senhliziyo:

- i-coronary isifo senhliziyo (ngokuvamile ngemuva kokushaywa yisifo senhliziyo);

- nomfutho wegazi ophezulu;

- inhlanganisela CHD kanye nomfutho wegazi ophezulu;

- zenhliziyo idiopathic;

- fibrillation atrial;

- isifo valve (rheumatism, sclerotic).

ukuhluleka Inhliziyo:

- systole (inhliziyo ejection ingxenyenamba - ngaphansi kuka-40% kuyinsakavukela);

- diastolic (ejection ingxenyenamba 45-50%).

Ukuxilongwa systolic senhliziyo

Ukuxilongwa systolic senhliziyo kuhlanganisa:

1. senhliziyo ejection ingxenyenamba - ngaphansi kuka-40% kuyinsakavukela;

2. yokujama tsi kumibuthano ukuzungeza;

3. izinguquko inhliziyo isakhiwo (nezibazi, cystic izilonda, njll).

Izimpawu ukuminyana:

- ukukhathala;

- dyspnea (iphika), kuhlanganise orthopnea, paroxysmal dyspnea ebusuku - isifuba somoya inhliziyo;

- ukuvuvukala;

- hepatomegaly;

- ukunwetshwa ngemithambo jugular;

- crackles e iphaphu noma effusion pleural;

- Msindo ku auscultation kwenhliziyo, cardiomegaly.

Inhlanganisela eziningana izimpawu ngenhla, ukutholakala kolwazi mayelana nesifo senhliziyo kusiza ukusungula ukumelwa inhliziyo, kodwa kubalulekile ebambe inhliziyo Doppler nge kwencazelo izinguquko ezihlelekile kanye nokuhlola esivimba amanzi ejection ingxenyenamba. Kulokhu, kuzoba kubalulekile inhliziyo ejection ingxenyenamba, izinga ngemva kokushaywa yinhliziyo okuyinto nakanjani omunye.

zindlela zokuxilonga

Indlela uphethwe yisifo senhliziyo nge ingxenyenamba evamile:

- ejection ingxenyenamba wenhliziyo - ngesilinganiso 45-50%;

- yokujama tsi kumbuthano ezincane (dyspnea, iphaphu crepitation, isifuba somoya inhliziyo);

- ukwephulwa zokuzilibazisa noma ukwenyuka ukuqina we myocardium.

Ukuze ususe senhliziyo Eminyakeni yamuva ukunquma nakomaka yemvelo: atrial peptide natriuretic (ukwehluleka oyingozi inhliziyo - engaphezu kuka-300-pg / ml, ezingamahlalakhona phezu 125 pg / ml). amazinga peptide kuzosiza ekunqumeni Izibikezelo lesi sifo, kukhethwa yokwelapha elilungile.

Iziguli ezigcinwe ingxenyenamba inhliziyo ngokuvamile amadala, futhi ngokuvamile abesifazane. Sinenkosi comorbidities eziningi, kuhlanganise nomfutho wegazi ophezulu. Kulezi iziguli, amazinga plasma natriuretic peptide uhlobo B lingaphansi kunalokhu ukuthi iziguli ingxenyenamba ongaphakeme, kodwa kunakunoma abantu enempilo.

Izinkinga lodokotela ekwelapheni iziguli

Imigomo nokwelashwa kweziguli ukuhluleka kwenhliziyo, lapho inhliziyo ejection ingxenyenamba ngenhla kuyinsakavukela:

- emizamweni yokunciphisa izimpawu zesifo;

- Ukuncishiswa amacala readmission;

- nokuvinjelwa ukufa kungakabi isikhathi.

Isinyathelo sokuqala kokulungisa yinhliziyo kuyinto ukuphathwa non-izidakamizwa:

- komkhawulo lokuzivivinya;

- eyamukelayo izivimbelo usawoti;

- uketshezi izivimbelo;

- kwesisindo.

Ukwelashwa kweziguli enciphile EF

Isinyathelo 1: I isisu ( "Torasemide") + inhibitor ka angiotensin ukuguqulela enzayimu ( "Enalapril") yokwamukela blocker noma angiotensin II ( "valsartan") ulapha nge ukwenyuka kancane esimweni esitebeleni + beta-blocker ( "Carvedilol").

Uma izimpawu eziphikelelayo - Isinyathelo 2: Engeza i-omelene aldosterone ( "Veroshpiron") noma yokwamukela angiotensin P.

Uma ziphikelela, kungenzeka ukuze ungeze ekwelapheni "Digoxin", "Hydralazine" nitroprepaty ( "Kardiket") kanye / noma ukuqhuba kokungenela koda (ukubeka amadivaysi resynchronization cardioverter-ovuselela, inhliziyo ukufakelwa), ukwenza i-ultrasound wachitha ngaphambilini zenhliziyo. Ejection ingxenyenamba, ngesilinganiso elichazwa ngenhla, lokukhulunywa ngako kulendzaba kusho kunqunywa ultrasonography.

Amaqhinga Modern yokwelashwa yinhliziyo angiotensin ukuguqulela enzyme inhibitor, angiotensin yokwamukela blocker II, beta-blocker, aldosterone blocker, isisu, nitrate, hydralazine, digoxin, Omacor, uma kunesidingo, faka idivayisi resynchronization futhi cardioverter-defibrillators e Emashumini amabili eminyaka adlule kuye kwaholela nokwanda okuphawulekayo okusinda iziguli amafomu ukuphela kwalesi sifo. Lokhu lunikeza inselele lodokotela kanye nabacwaningi.

It uhlala izindlela ezifanele yosesho esikhundleni isibanda izicubu we myocardium.

isiphetho

Ngakho, kusukela izihloko okufakiwe ungabona SIZUZISA ngofaka odokotela imikhuba. Ejection ingxenyenamba wenhliziyo (kuyinsakavukela pathology) is akukaqondakali ngokugcwele. Nakuba imithi manje isikhathi ukubhekana nalokhu zokugula akuyona ephelele, kubalulekile ukuba nethemba, futhi ukutshala imali eyanele utshalomali ekuthuthukiseni kanye nokuthuthukiswa ucwaningo lwesayensi kule ndawo. Phela, kusukela ososayensi ikakhulu incike ukuthuthukiswa imboni kwezempilo. Ngakho-ke, iziphathimandla zikahulumeni kufanele asekele zonke izikhungo zokwelapha zesayense, ezama ukufakazisa aphule kwangqingetshe phezu udaba kuxoxwa.