Yomthambo i-aorta ne-valve 1, 2, 3 degrees: izimpawu, izimpawu, uphethwe, ukuphathwa

Umzimba womuntu uhlukile. Nokho, ngezinye izikhathi kunezimo lapho isitho esithile unephutha wenza imisebenzi yawo ngokupheleleko. It kungukuphula isakhiwo - valve yomthambo i-aorta - isihloko lesi sihloko.

amagama

Ekuqaleni, kudingeka siqonde imigomo ezizosetshenziselwa esihlokweni samanje. Ngakho, liyini ukwehluleka of valve yomthambo i-aorta? Lokhu ukuphazamiseka umzimba, wabangela ukuba ichopho ngokuphelele ungavali uvalwe. Lokhu kuholela inkinga ezifana igazi elikuyi-aorta aphonse emuva ku kwesokunxele ventricle inhliziyo. Lokhu kwenzeka ngesikhathi diastole - ukugcwaliswa inhliziyo ngegazi. Than igcwele? Njengoba umzimba womuntu uthola esingaphansi adingekayo operation evamile umthamo wegazi. Ngenxa yalokho, it kwandisa umthwalo phezu kwenhliziyo, ukuze sivale lapho sisilela khona lokhu ligcwalise isikhala esasisele.

Ngokuvamile, owokuqala, kuze umzimba usemncane futhi zibe namandla, yomthambo i-aorta ne-valve esingamahlalakhona ngokuvamile Ungasingenisi izinkinga. Kuphela, inhliziyo kungase kwandise kancane ngosayizi bakwazi ukuzivumelanisa nalolu yokuntuleka kwegazi. Symptomatology ekuqaleni, nobujamo isiguli singenakukwazi ngisho ukuqagela khona inkinga. Kamuva iqala lifika iphika, ukukhathala. Ukuze ukubhekana nalesi sifo, isiguli ingase ithunyelwe uhlinzwe ukuze kwelashwe yomthambo i-aorta ne-valve esikhundleni.

Inkinga ku izinombolo

Ososayensi uqaphele ukuthi izinkinga ezifana esingamahlalakhona of valve yomthambo i-aorta, kuthinta kakhulu abamele besilisa. Uma sicabanga iphesenti, inani labantu ababulawa yilesi sifo, endabeni bonke abantu ababulawe yizifo nezinkinga ezihlukahlukene inhliziyo, cishe ngo-14%. Uma sicabanga ke isifo, imayelana 4% of amacala yomthambo i-aorta ne-valve esingamahlalakhona kwenzeka njengoba injalo emsulwa, futhi 10.3% of amacala - lihambisana namanye izifo zenhliziyo.

izizathu

Ngokuvamile, imbangela yale nkinga, ngo 2/3 amacala kuba valve rheumatism. Ngaphansi ngokuvamile, lesi sifo kubangela endocarditis infective. Lapho ososayensi befunda ukubona amaqembu amabili yezizathu, okuyinto zihlukaniswe oyingozi futhi ezingalapheki okwenzeka.

Izimbangela isifo esingelapheki

Kulokhu, odokotela baye baphawula ngenxa yezizathu eziningana ezibalulekile, okungase kubangele izinqubo okungamahlalakhona:

• Yesifo senhliziyo azalwa naso. Izingane angazalwa kuphela eyodwa noma ezimbili iminyango, elibangela eziningi izinkinga nezingcindezi uzotshala igazi enhliziyweni.
• Inqubo yokuguga. Okungukuthi, valve yomthambo i-aorta abagqoka, ukugqoka off ngokuhamba kwesikhathi.
• imfiva Rheumatic, elibangela nezibazi we amapheshana valve, okuyinto kubavikela avaliwe ngokugcwele.
• izinqubo ezithathelwanayo enhliziyweni, lapho yokukhula (lonke amakoloni amagciwane), "badle" the enezinto valve, noma umane buthelela ku valve, ukuvimbela nabo kusuka ukuvala kahle.
• Ukwanda aorta lapho isibani yayo sisalokhu ukuze valve awukwazi nje shaqa ngokuphelele.
• Ukwelashwa nokuvikelwa izinkinga ezihlukahlukene, okungabangela ukwehluleka valve yomthambo i-aorta. Ngokwesibonelo, ukwelashwa ngemisebe noma ukusetshenziswa "Phentermine" - isidakamizwa for kwesisindo, okuyinto likhishwa ukusetshenziswa ngasekupheleni kwekhulu lama-20. Ngokusho ucwaningo yizazi, ukusetshenziswa kwalo kungadala izinkinga ezihlukahlukene inhliziyo, kuhlanganise yomthambo i-aorta ne-valve regurgitation.

Izimbangela ukungondleki acute

Odokotela ehola imbangela yomthambo i-aorta ne-valve esingamahlalakhona futhi secrete izifo ezifana endocarditis (ukutheleleka umonakalo isitho), asike izidumbu zabantu yomthambo i-aorta (lapho igazi odabula kulesi izikhala kwakhiwa). Ngezinye izikhathi iziguli emva othola ukuhlinzwa ukuze esikhundleni valve yomthambo i-aorta nalo ekuthuthukiseni ukuhluleka kwawo. izimbangela olunamandla yenkinga uyalandisa ngaphezulu kanye nokwethuka kwesifuba (isibonelo, phakathi imoto ukushayisana uma umuntu okungu a webele kuyi-dashboard). Lokhu ngokuvamile kuholela kulimaze ukuze valve yomthambo i-aorta.

izinkinga symptomatology

Yiziphi izimpawu yomthambo i-aorta ne-valve regurgitation, okungase ukucacisa khona inkinga? Njengoba sekushiwo ngenhla, ekuqaleni izimpawu kungase kungabi. Lokho, isiguli singase ngisho uzizwe anakho nezinkinga ezithile. Nokho, eminyakeni edlule, isimo uyashintsha. Inhliziyo ukusebenza izikhandle kakhudlwana ekufuneni isinxephezeliso yokuntuleka kwegazi. Ngenxa yalokho, i-ventricle engakwesobunxele kwandisa kancane, futhi inhliziyo ngokwayo ekubeni buthaka. Lapha ibuye izenze wazizwa valve yomthambo i-aorta. Izimpawu, lokukhulunywa ngako kulendzaba ezingase ziphakame:

• ukukhathala njalo, ubuthaka umzimba wonke.
• Isiguli sinelungelo iphika. Icacisa ngesikhathi umzimba.
• arrhythmias Futhi waphawula okungukuthi normal inhliziyo isigqi.
• Isiguli kungase esekhala ukushaya kwenhliziyo okusheshayo.
• With imithwalo singenzeka ubuhlungu besifuba (angina).
• Akuvamile, iziguli futhi balahlekelwa umuzwa ngiqaphele.

Uma isiguli iphutha acute ke zonke izimpawu zavele, amandla abo ngaphezulu, zivela licace. Kulokhu, iziguli kaningi zidinga usizo lokuqala eziphuthumayo, ukuze basindise impilo.

Mayelana degree enganele

Futhi inenkinga ezifana valve yomthambo i-aorta, degree of ukuthuthukiswa. Ahluke ubude jet, okuyinto injected emuva ku-i-ventricle ngokusebenzisa enezinto kahle evaliwe. Kuye lokhu, ezintathu: esokuqala, wesibili nowesithathu.

idigri yokuqala

Yini ekhethekile ngale yomthambo i-aorta ne-valve regurgitation 1 degree? Kulokhu, jet ingeqi 5 mm ubude kusukela amapheshana yomthambo i-aorta. Ngakho, le nkinga angasahlelwa ngokuthi ingane. Phela, igazi eqoqwe cishe ngasemasangweni kakhulu ngaphandle kokudala izinkinga. Yomthambo i-aorta ne-valve 1 degree akakubangeli ukukhuphuka kwezinga-ventricle engakwesobunxele, kulesi simo kungaba egcwele Ubukhulu ezivamile.

besigaba sesibili

valve yomthambo i-aorta 2 degrees kuyinto ekhethekile ukuthi obuphelele jet kulokhu luyanda 10 mm. Okungukuthi, abangabantwana igazi "Splatters" ibanga-10 mm ukusuka amapheshana valve. Kulokhu, jet ngifinyelele enezinto of valve mitral, okuyinto kakhulu siba sibi isimo. valve yomthambo i-aorta regurgitation grade 2 kwandisa okusizwa ukushaya e imithambo carotid futhi inhliziyo, kwesokunxele ventricle iyakhula. Lezi wonke kubonakala kalula ku-echocardiogram.

degree wesithathu

Yomthambo i-aorta ne-valve grade 3 ungachazwa ukuthi igazi injected emuva ngu ibanga yikuphi okukhulu kuka-10 mm. Kulokhu, jet ephambana valve mitral, futhi angase afinyelele phezulu i-ventricle engakwesobunxele. Kulokhu, izinhliziyo emngceleni landa ngamaphesenti angaphezu kuka-2 cm, ECG kungaba "abukwe" ngakwesokunxele ventricular hypertrophy.

Esingamahlalakhona ezinganeni

Eceleni nicabangele yomthambo i-aorta ne-valve esingamahlalakhona ezinganeni. Ingabe kuzoba khona umehluko phakathi omdala kanye nengane? Ngakho, kancane kuyoba izimpawu ezahlukene. Kulokhu, ezinganeni uvame baphawula pallor, okusizwa ukushaya kwemithambo yegazi e emikhawulweni angagcina uphawu Musset (ingane bayonikina ikhanda lakhe eceleni, kuye kwenhliziyo). Njengoba for ekwelapheni kanye ukuxilongwa izinkinga, futhi izingane kanye nabantu abadala, le nqubo kuyoba okufanayo.

ukuhlola

Imiphumela yaloku kuhlola okungenhla kwangaphambilini "umphini yomthambo i-aorta" Ungabeka udokotela ngemva kokulalela (auscultation) uncharacteristic kunomsindo inhliziyo (nokububula diastolic kuyinto engavamile). Nokho, lokhu namanje kuphela ukuqagela. Okulandelayo, udokotela uzokubuza ngezimpawu ukuthi kungase kubonise khona inkinga, uqoqe anamnesis egcwele. Okulandelayo, udokotela uzothumela isiguli izifundo ezengeziwe izoqinisekisa noma ukuphikisa sitholakele pre-zavela.

• Palpation. Kulokhu omunye lungacacisa jitter ku kumila inhliziyo esebenzisa kumba. Lokhu kwenzeka ngenxa ukukhululwa yenqwaba kakhulu kwegazi. Futhi, "kukhona" eshaywayo, lapho imingcele inhliziyo "hamba" kwesobunxele.
• ECG. Le nqubo kwenza kube nokwenzeka ukuba anqume ukwanda Usayizi ventricle engakwesobunxele senhliziyo.
• Echocardiography. Le nqubo ikwimodi mgudumbili lembula kwesokunxele ventricular hypertrophy. Esikhathini eyodwa-ntathu - uyakwazi ukuhlukanisa atrial umphini mitral ngenxa engena phakathi jet.
• Doppler unikeza kungenzeka ukunquma degree of esingamahlalakhona of valve yomthambo i-aorta - kubonisa ubude ukusakaza igazi emuva injected.
• -X-ray. Uma valve yomthambo i-aorta sivezwe, le nqubo kwenza kube nokwenzeka ukuba "ukubona" nokwanda ngobukhulu inhliziyo, calcification of amapheshana.
• Ukuze wandise ukuthola ingcindezi intracardiac ingasatshenziswa catheterization inhliziyo inqubo izimbotshana. Kulokhu, odokotela kukhona degrees ezine yomthambo i-aorta ne-valve esingamahlalakhona ngokuvumelana umthamo injected igazi emuva. Izinga lokuqala cishe 15%, kanti eyesibili - kusuka 15 kuya 30%, wesithathu - kusuka 30 kuya 50%, kanti owesine - ezingaphezu kuka-50%.

Uma isiguli ngaphambili okwatholakala "umphini yomthambo i-aorta" inkinga uphethwe kungase kwenziwe ngosizo zonke lezi zindlela. Ngakho, lo dokotela uyazinqumela lokho ogulayo kulesigaba kubalulekile. Kufanele kuqashelwe ukuthi ngaphezu Kulezi zindlela ezingenhla, ukuxilongwa, ngezinye izikhathi isasetshenziswa futhi angiography yenhliziyo, okungase esiwabelwe izinkomba efanayo e stenosis yomthambo i-aorta.

ukwelashwa izidakamizwa

Uma isiguli sekutholakele ukuthi sine- ukwelashwa "umphini yomthambo i-aorta" kuzoncika isifo lesiguli. Ngakho, wokuphuthuma ukusetshenziswa kwezidakamizwa ezithile noma ukwelashwa kwehlisa ne kobukhulu ukubonakaliswa izimpawu. Uma uhlobo lesi sifo - a okungamahlalakhona, ukwelashwa cishe zokwelapha.

imithi ukuthi kungase kudingeke ukuba isiguli:

1. Isisu. Injongo eyinhloko yale izidakamizwa kuleli cala - okukhipha uketshezi okweqile kusukela umzimba, ukwehlisa wegazi.
2. Imithi elwa namagciwane. Kwangathi esizosingathwa njengoba prophylaxis kwezifo ezithathelwanayo ezinqubweni kuhlinzwa noma wamazinyo.
3. Futhi aqokwa njengelungu calcium channel blocker (ikakhulukazi izidakamizwa "Nifedipine") nge injongo eyinhloko - ukunciphisa igazi ukuvuza. Kufanele kuqashelwe ukuthi kwezinye izimo ukusetshenziswa kwalezi izidakamizwa kungaba enye esihle leso siguli.
4. Zingase futhi inikezwa nezinye izidakamizwa ezifana ACE inhibitor noma angiotensin yokwamukela blocker.

Kufanele kuphawulwe ukuthi iziguli nale nkinga, ngisho noma elikhona ngesimo okungamahlalakhona, kumele zibhaliswe ne udokotela. Bona njalo kufanele uvakashele udokotela. izinyathelo Radical kuleli cala ngaso sonke isikhathi siboniswa.

kokungenela kuhlinzwa

Uma lesi sifo ezinzima, kukhona isidingo kokungenela esiphuthumayo kuhlinzwa. Ukushesha umuntu uthola ukuthi lo dokotela, ayanda amathuba ukuze bahlale bephila. Nakuba izinga lokufa liphansi kuleli cala, ebhekisela ukubambezeleka odokotela kungadla isiguli ngisho nokuphila.

Futhi, ukuhlinzwa kuvezwa iziguli ngempela kudala ukuthi nginesifo "umphini yomthambo i-aorta". Uma isiguli isungule izimpawu, ngisho noma ekuqaleni omnene, washiya ventricle contractility ilahlekelwa - kungcono zonke izinkomba for kuhlinzwa yomthambo i-aorta ne-valve esikhundleni.

Ngenxa inkomba kufanele kuphawulwe ukuthi namuhla, ukuhlinzwa ngokuvamile semikhawulweni omuhle futhi kuletha wayefisa imiphumela ezigulini. ukusebenza kwakhe kuqala ezifana kwakwenziwa emuva ngo-1960 nguDkt Harkenom ukuthi wokufakelwa aorta plastic ubuhlalu futhi yezinyoni metal. On the eSoviet Union, lo msebenzi waba sokuqala esenziwa ngo-1964, kwaba yimpumelelo. Kusukela ngaleso sikhathi, udokotela asungula izindlela eziningi nezindlela ukwenza lokhu ukuhlinzwa izinga esiphezulu futhi ngempumelelo.

okusinda

Uma isiguli emaphakathi noma omnene ukumelwa inhliziyo, umsolwa oneminyaka engu-10 ngesilinganiso okusinda kakhulu futhi kufana cishe 90% yazo zonke iziguli. Uma izikhalazo, sekuqala ukuvela, zikhona izimpawu, isimo ukuwohloka ngokushesha. Kulokhu, uma aziphendukeli ukuhlinzwa, ukufa, zingaba khona ngemva kweminyaka engaba ngu 2-5, kuye ngokuthi ukuthuthukiswa izifo ezithile.

Uma lesi sifo asymptomatic ngokuphelele, onalesi sifo ukuzenza athandeke. Esimweni esinjalo, kokungenela op liyadingeka% 4 kuphela amacala. Ngesikhathi esifanayo, izikhalazo kungenzeka ezigulini Eminyakeni yokuqala emihlanu - 20% eziguli, iminyaka eyisikhombisa - mayelana 25% eziguli. Uma ukwehluleka oyingozi, ezinzima, mhlawumbe ebulalayo uma ventricular fibrillation. Uma isikhathi ukwenza ukuhlinzwa, le ntuthuko kungagwenywa.

zokuvimbela

izinyathelo zokuvikela hhayi ukuthola isifo, akukho. Kulokhu, ukudla noma ngendlela ethile yokuphila ngeke bakwazi ukusiza. Kodwa nakhu iziguli abasengozini ungakwazi ukuzivikela. Ngakho, benza njalo sidlule izivivinyo ngesikhathi udokotela, wenze inqubo aphoyintimenti. Hlela inhlolovo zingase zihluke, kodwa awukwazi yiya kudokotela wakho kancane kaningi kunanoma 1 isikhathi ngonyaka.