Kuyini AV block? block Atrioventricular: Izimbangela, Izimpawu, Sifo Nokuselapha

block Atrioventricular - bokuphila disorder sokudlulisa ezinzwa amaza ngokusebenzisa inhliziyo conduction uhlelo kusukela Atria kuya ventricles. Iyinkimbinkimbi Uma unganakile, igama livela lesiLatin elithi ATRIUM futhi ventriculus, okuyinto ukhombise ATRIUM futhi ventricle, ngokulandelana.

On inhliziyo, isimo sawo futhi uhlelo conductive

Inhliziyo yomuntu, njengoba kwezinye izidalwa eziningi eziphilayo, mammalian, sinemacala sokunene nesobunxele, ngamunye okuyinto ine ATRIUM futhi ventricle. Igazi wonke umzimba, okungukuthi kwegazi, uza kuqala lo ATRIUM kwesokudla, bese ku-ventricle yangakwesokudla ke - ngokusebenzisa izitsha emaphashini. igazi elinomoya-mpilo kusuka yokujikeleza kwegazi eliya emaphashini ovela emaphashini agelezela ATRIUM kwesokunxele kusuka kulo iwela i-ventricle engakwesobunxele, futhi kusukela ku-aorta udluliselwa kwezitho nezicubu.

Igazi ligeleze inhliziyo usebenza uhlelo lwayo conduction. Kuyinto ngenxa yakhe kukhona ukushaya kwenhliziyo lesifanele - nokwehla ngesikhathi esifanele Atria futhi ventricles futhi enomopho ngabo. Lapho ngenela ukudluliselwa nerve amaza phakathi Atria futhi ventricles zokugcina encishisiwe ngasekupheleni noma kancane kakhulu - phezu eside isikhawu ngemuva ukusikwa atrial. Ngenxa yalokho, ngamandla ukugeleza kwegazi, akukho ukukhululwa kwawo imithambo yegazi ngesikhathi esifanele, kukhona ukwehla ingcindezi, kanye nezinye izinguquko ezinkulu yisimiso senhliziyo nemithambo yegazi.

I esiyingozi AV block?

Ubucayi block atrioventricular incike namandla aso. amafomu Ezintsha ka conduction kwezinso kungenzeka asymptomatic, ngokwesilinganiso - zonke ukuthi zifune ukuqondiswa ukunquma izimbangela kanye nokwelashwa kwe-nokuvimbela yokumelwa yinhliziyo. Lapho ukuvinjelwa ephelele kungenzeka ukufa osheshayo kusukela ukuboshwa inhliziyo. Yingakho ukuhlukumeza Izinzwa conduction enhliziyweni akunakugwenywa, ngisho noma okwamanje ayikho izimpawu sina zesifo.

Ukwahlukanisa ngokuvumelana block degree AV

AV inhliziyo block kuyinto ngezinhlobo eziningi futhi subtypes. Amandla adonsela phansi zihlukaniswa: AV block idigri yokuqala, ngokuvamile hhayi sihambisane nanoma yimiphi thuthuva yangaphandle futhi ezimweni eziningi kuyinsakavukela khona, ukuvinjelwa besigaba sesibili, wehlukaniswa iziqephu e kukufake ezimbili: uhlobo 1 (Mobitts 1 noma ukuvinjelwa Wenckebach) futhi thayipha 2 (Mobitts 2), futhi nokuvinjelwa degree - ephelele stop ukudluliselwa nerve amaza kusukela ventricles Atria.

degree 1st AV block

AV block 1 degree kungaba evamile bokuphila mkhuba ngenxa seziguli ezisencane. Ngokuvamile ukuhlolelwa lesi sifo futhi njalo abaqhuba abasubathi, futhi nabo kubhekwe kuyinsakavukela. With ukuvinjelwa anjalo abantu ngokuvamile azikho izimpawu lubonakale ezibonisa nezinkinga zenhliziyo. AV block 1 degree ngokungabi bikho izimpawu zesifo ngokuvamile akudingi ukwelashwa, kodwa kungase kudingeke ebukhoneni nezinye kwezinso zenhliziyo. Futhi kulokhu udokotela okuphindaphindiwe ECG, ambulatory ukuqapha ECG kanye izifundo ezengeziwe ingase yabelwe, ezifana echocardiography (ultrasound inhliziyo). Kuvele degree electrocardiogram atrioventricular block 1 kuboniswa ukwanda kwe-isikhawu phakathi kwamazinyo aso P R, kuyilapho bonke P namazinyo bayizakhamuzi ezivamile, futhi njalo kulandelwa QRS-izakhiwo.

degree 2nd

AV ukuvinjelwa kuyinto 2 degrees, njengoba iye echazwe ngenhla, uhlobo lokuqala nelesibili. Lapho ngesikhathi samuntu 1st (Mobitts 1) kungenzeka asymptomatic futhi asidingi ukwelashwa. Kulokhu, okuvela kuyo ngesisekelo bokuphila block ngokuvamile inkinga engeyokuqala atrioventricular. AV-block uhlobo besigaba sesibili Mobitts 2 - ngokuvamile phetho isifo kule aphansi Umqhubi uhlelo (wa- Purkinje). Ngokuvamile kwenzeka nge izimpawu ezisobala futhi zidinga uphethwe eyengeziwe kanye Ukuqalwa okusheshayo ukwelashwa ukuvimbela ukuthuthukiswa ukuvaleka ephelele ukuboshwa inhliziyo.

AV block on ECG (idigri yesibili ohlobo 1) 'zinezikhathi ukukhuphuka Kancane kancane PR isikhawu, ngemva kwalokho kukhona ukulahleka QRS-eziyinkimbinkimbi nokuningi - eduze ukubuyisela isigqi evamile. Khona-ke konke iyaphindwa. Lokhu PERIODICITY ubizwa ngokuthi nakomagazini Samoilova-Wenckebach. Uhlobo lwesibili ka-AV block ngezinga wesibili ECG libhekene kwezulu njalo noma okuzenzakalelayo QRS-eziyinkimbinkimbi kuyilapho PR isikhawu prolongation, njengoba kuhlobo 1 Mobitts ingekho.

degree Okwesithathu

AV-block 3 degrees kuyinto isegazini futhi kuluthola. Elinesimo sokungabi nhlobo pulses esukela Atria kuya ventricles, futhi ngenxa yalokho okukhulunywe ukuvinjelwa njengoba ephelele. Njengoba amaza ngokusebenzisa inhliziyo engeyokuqala atrioventricular ayakhumuka ukuze asekele inhliziyo babe abashayeli asebenzayo izinga lesibili-oda okungavamile, t. E. ventricle usebenza isigqi yayo, engahlangene isigqi Atria. Konke lokhu kubangela thuthuva ezinzima ekusebenzeni inhliziyo futhi yisimiso senhliziyo nemithambo yegazi. Nokuvinjelwa ngezinga lwesithathu kudinga Ukuqalwa okusheshayo ukwelashwa, t. Ukuze. Can ekufeni isiguli.

Izinga ECG block lwesithathu simiswe ngalendlela lelandzelako: isixhumanisi olahlekile ngokuphelele phakathi wave P kanye QRS eziyinkimbinkimbi. Zilotshwe ngesikhathi okungalungile futhi amaza ezahlukene, ie, itholiwe isigqi ezimbili engahlobene eyodwa - .. atrial, elinye - ventricular.

Izimbangela AV block

I yezimbangela ezivame kakhulu kwezinso ezifana AV block bayanda ithoni we emsipheni vagus e abasubathi, sclerosis ne-cystic we inhliziyo conduction uhlelo, zokugula we valve inhliziyo, myocarditis, isilethikusebenza, electrolyte isiphithiphithi uphazamise nezimoto ukusetshenziswa kwezidakamizwa ezithile, njenge glycosides inhliziyo ( "Digoxin" "Korglikon", "Strofantin"), calcium channel blocker ( "Amlodipine" "verapamil" "Diltiazem" "Nifedipine" "Cinnarizine"), i-beta-blocker ( "bisoprolol" "Atenolol" "Carvedilol" ). Qedela ukuvaleka kungaba azalwa nako. Lokhu zokugula ngokuvamile ezilotshwe izingane zomama uhlushwa omzimba izicubu erythematosus. Enye imbangela nokuvinjelwa ngezinga lwesithathu ibizwa ngokuthi isifo saseLyme, noma borreliosis.

Izimpawu ze-AV block

1 degree block atrioventricular, kanye nokuvinjelwa 2 degrees yohlobo lokuqala, ngokuvamile hhayi sihambisane nanoma yimiphi izimpawu. Nokho, nokuvinjelwa uhlobo Moritz 1 kwezinye izimo, kukhona isiyezi nokuquleka. Uhlobo degree yesibili wabonakaliswa izimpawu ezifanayo, kanye ingaphazamisi ukwazi, ubuhlungu enhliziyweni umuzwa kokuma ke, yokufikelwa eside. Izimpawu ephelele atrioventricular block - ukwehla kwenhliziyo, ubuthakathaka ezinzima, ukujikeleza ikhanda, singagqunqi kwamehlo, Ukudlikizela, nokulahlekelwa ukwazi. Kungase kwenzeke ngci wenhliziyo nge umphumela ebulalayo.

Ukuxilongwa AV block

Ukuxilongwa block atrioventricular Kwenziwa usebenzisa electrocardiography. Ngokuvamile block AV 2 ngamadigrizi (efanayo 1-D) itholwa ngesikhathi ingozi ECG asikhali ngalutho phakathi ngihlolwa izifo. Kwezinye izimo, uphethwe wenziwa khona noma yimuphi izimpawu ukuthi kungahle kubangelwe izinkinga ohlelweni conduction wenhliziyo emsipheni amaza, njengokuba nesiyezi, ubuthakathaka, ugesi, yokufikelwa.

Uma isiguli sekutholakele ukuthi sine- ngu ECG AV block, futhi kunezinkomba zokuthi ukuhlola okunzulu, wenhliziyo ngokuvamile uncoma nsuku zonke ukuqapha ECG. Kunenkolelo esebenzisa Holter qapha, it is ngenxa yalokho nako kuvame ukubizwa ngokuthi ukuqapha Holter. Phakathi namahora angu-24 kukhona njalo okuqhubekayo ECG ukurekhoda, kuyilapho umuntu ejwayelene futhi eziyizici yokuphila kwakhe - ezihambayo, ukudla, ukulala. I noninvasive cwaningo futhi akabubangeli cishe akukho kabi.

Ngemva kokuloba idatha ECG kusukela qapha ziyahlaziywa iziphetho ezifanele. Plus le ndlela ukuxilongwa, uma kuqhathaniswa evamile iDemo ECG ukuqoshwa ezingeke ukuthola indlela ngokuvamile kwenzeke ukuvinjelwa, kulokho nkathi yesikhathi sosuku alotshwe njalo kakhulu futhi nalokho ezingeni lokuzivivinya nesineke.

ukwelashwa

Hhayi ngaso sonke isikhathi atrioventricular ukuvimba idigri yokuqala, kanye yesibili edinga wezokwelapha. Ekuqaleni e imisebenzi yezokwelapha, njengoba umthetho, asikho isidingo. Futhi ngaleso 2 nd yohlobo yokuqala (Moritz 1) yokwelapha ongavamile kwenziwe, nakuba kungase kwenziwe ucwaningo olunzulu ukuze kutholakale izinkinga inhliziyo ezihambisana Kunconywa.

Ukwelashwa AV block kudingekile besigaba sesibili Moritz uhlobo 2 kanye nokuvinjelwa esinqunyiwe noma ephelele ngezinga lwesithathu, isb. K. Ngakho abalulekile conduction thuthuva kungaholela ngokufa okuzumayo. Indlela eyisisekelo kokulungisa inhliziyo efanele iyona ukufakwa pacemaker nesineke (ECS) okwesikhashana noma unomphela. esimisiwe kahle futhi ethize yokwelapha izidakamizwa - "Atropine" nezinye izidakamizwa. Imithi abakwazi ukwelapha umuntu nalesi sifo futhi ngokuvamile asetshenziselwa ngaphambi pacemaker yenzeka.

Ilungiselela ukufaka ECS

Ukulungiselela i-pacemaker yenzeka kuhlanganisa, ngaphezu electrocardiography, echocardiography - ultrasound zenhliziyo. Echocardiography ivumela ngeso lengqondo odongeni umgodi futhi odongeni inhliziyo futhi ihlonze noma yibuphi isifo eyinhloko ukuthi angabangela AV block, ezifana nesifo valve. Uma wenhliziyo ku ultrasound Kutholwe izinkinga zenhliziyo, ukwelashwa concomitant iqhutshwa parallel ekwelapheni block atrioventricular. Lokhu kubalulekile ikakhulukazi ezimweni lapho lezi zifo imbangela conduction kwezinso. Futhi aqokwe ejwayelekile ucwaningo lwezempilo - ukuhlolwa kwegazi kanye nomchamo. Uma isiguli sine-isifo ezinye kwezitho izinhlelo esikhathini preoperative kungase izinyathelo zokuxilonga ezifanele Kunconywa.

pacemaker yenzeka

Ukufakwa umshini wokulawula ukushaya kwenhliziyo uma kokutshelwa ngokukhubazeka kwengane, AV block, - ukuhlinzwa kobuholi. Kungaba kwenziwe kokubili ngaphansi izinzwa jikelele futhi izinzwa wendawo. Udokotela ngokusebenzisa vein subclavian ezikebheni kokuqhuba bubheke electrode inhliziyo ezilotshwe khona. Iyunithi ngokwayo isu elikhethekile ithungwe ngaphansi kwesikhumba. Isilonda ivaliwe ngemithungo.

ECS kuyinto esikhundleni yokufakelwa ngoba umshini wokulawula ukushaya kwenhliziyo, eqhuba amaza kusukela Atria kuya ventricles, futhi kuholela ukushaya kwenhliziyo okuvamile. Ngenxa ukushukuma ngakanye namkha njalo, inkontileka ikhamera ngendlela efanele kanye nezikhawu lesifanele, inhliziyo oyenza ngokugcwele ukudonsa yayo umsebenzi. Ngo isimiso sokujikeleza kwegazi, akukho yokujama tsi futhi ngokuphazima kweso lapho ingcindezi, kanye ingozi izimpawu njengokuba nesiyezi, yokufikelwa, nezinye evame nazo iziguli ukuthi nginesifo AV block, is kakhulu ziyancipha, kanye ingozi ngokufa okuzumayo kusukela inhliziyo umsebenzi inhliziyo.

postoperatively

isikhathi postoperative, uma kungekho ezinye nzima ke ezinkingeni zempilo, ngokuvamile hhayi sihambisane nanoma yimiphi imikhawulo abalulekile. isiguli ikhishwe ekhaya izinsuku 1-7, ngemuva kokwenza ucwaningo. ukunakekelwa isilonda emkhakheni implantable kudivayisi izindlu Kwenziwa ngudokotela wakho. Suture ukususwa kuyadingeka uma eziphoqelelwe suture impahla, okuyinto ayixazululi bebodwa. Uma ngesikhathi ukufakwa isilonda pacemaker ivaliwe umphetho yezimonyo, alidingi zisuswe.

Emavikini ekucala ngemva yenzeka we pacemaker Kunconywa ukugwema ukuzivocavoca, kanye nokuvikela endaweni weld (ezemidlalo, uma kungekho contraindications, ungaqala, njalo ngokubonisana udokotela e izinyanga ezimbalwa). 1 inyanga emva inqubo inikezwe kokubonisana ukulawula nezenhliziyo. Khona-ke isheke wenziwa ngemuva kwezinyanga eziyisithupha kanye futhi ngonyaka owodwa kusukela osukwini yenzeka, bese - minyaka yonke.

EX umsebenzi isikhathi kuxhomeke ezicini eziningi. Ngokwesilinganiso, le nkathi iminyaka 7-10, futhi izingane ngokuvamile mancane kakhulu kunalawo ukuthi ngenxa, phakathi kokunye, ngekukhula umzimba wengane. Ukulawula ivuselela, futhi izinhlelo zayo ukuba nesineke oluthize waya kudokotela wezokwelapha. Hlola iyunithi is obusebenzayo ngempela kwenziwe ngendlela esifike ngesikhathi. Futhi alungisa futhi uhlelo uma kudingekile - setha yokusebenza nemingcele. Lokhu kungase kudingeke uma pacemaker akagcwalisi imisebenzi eyabelwe yona: ukushaya kwenhliziyo liphansi kakhulu noma okusezingeni eliphezulu kanye / noma isimo lesiguli abampofu impilo. Ezinye izilungiselelo lingasethwa ngokushintsha indlela udokotela wokuphila kanye nokuntuleka ukushukuma ezifana nemidlalo asebenzayo.

Isizathu esiyinhloko ukwehluleka we pacemaker ukunciphisa umthamo sebhetri - ke zichithe. Ezimweni ezinjalo, lolu cingo kufanele indawo entsha bese bakudinga babonisana wenhliziyo. I electrode futhi etholakala ngaphakathi komgodi inhliziyo, ivame ukuhlala impilo kanye nokusebenza lesifanele ayidingi ukushintshwa, uvumela umuntu ukuba siphile ukuphila okwanelisayo naphezu kwezinkinga inhliziyo.