Ukhathalelo olukhawulezileyo lokutshatyalaliswa kwemizimba: i-algorithm yesenzo. Iqela eliphuthumayo iqela

Ukungaphumeleli komzimba kukubhekiselele kwiimeko zokusongela ubomi. Ngendlela yokuphuhlisa, ikwahlula kwi-OCH. Bobabini le miqathango ibangelwa ukufa. Ukuze ulondoloze umntu, i-ambulensi kufuneka iqale ukuhlaziywa kwakhona.

Uninzi lwamaxesha amaninzi kukho ukusilela kwintliziyo eshiyekileyo. Ngokuqhelekileyo ilandele i-myocardial infarction, ukuphazamiseka kwengqungquthela kunye nezinye iimeko eziyingozi. Kwiintlobo ze-OSS zibandakanya ukutshatyalaliswa kwegazi. Yibangelwa zizilonda ezinzima zomzimba, apho intliziyo ayikwazi ukupompa igazi kwindawo eqhelekileyo.

Intsingiselo yokutshatyalaliswa kwemizimba

Ukunyamekela ngokukhawulezileyo ukutshatyalaliswa kwemizimba kuyimfuneko kwimimiselo yokuqala yophuhliso lwayo. Kufuneka kukhunjulwe ukuba le ngxaki ayiyi kudlula ngokwayo. Kwaye kungabikho unyango olukhawulezayo kuya kubangela ukufa. Ukutshatyalaliswa kwe-Cardiogenic isifo apho i-cardiac output isinciphisa. Nangona ukwanda kwenyameko ekumanyeni kwe-vascular, umzimba awukwazi ukuhlangabezana nale nkcenkcesha ngaphandle koonogqirha.

Ukubonakaliswa kwayo okubalulekileyo kubandakanya ukunciphisa uxinzelelo lwe-arterial and pulse, i- diuresis, ukulahlekelwa ngqalelo. Ukuba uncedo lungafumaneki ngexesha, ukufa ngenxa yokuphazamiseka kwemizimba kwenzeka emva kweeyure ezimbalwa emva kokuphuhliswa kwesi sifo. Eli rhulumente alangazimeli ngokwakhe. Usoloko elandelwa yintsholongwane enzima yenkqubo ye-cardiovascular system.

Ziziphi izizathu ezibangela ukutshatyalaliswa kwemizimba?

Izizathu zokutshatyalaliswa kwentliziyo ziquka izifo ezahlukeneyo zesifo kunye neengculazi. Into eqhelekileyo ye-etiological yi-infyoction ye-myocardial. Ngaloo xesha, ukutshatyalaliswa kwentsholongwane kuvela kuphela nge- necrosis yamathambo amakhulu kunye nokungabi ncediso lokuqala. Kwakhona, ngenxa yezizathu eziqhelekileyo zeziganeko zalo, i-arrhythmias ezisongela ubomi zifakiwe. Bangayikhathaza umntu iminyaka emininzi. Kodwa ngokunyuka kwabo kunye nokunciphisa, le miqathango inzima kakhulu.

Kwezinye iimeko, ukuphuhliswa kwentliziyo yesifo esibi kukuphulaphula i-tilecular tone. Oku kwenzeka ngegazi elikhulu, intlungu yesifo, i-arthritis. Kufuneka kukhunjulwe ukuba ukuphazamiseka kwemizimba kungekhona isifo esizimeleyo, kodwa inkxalabo ye-pathology engundoqo. Ngoko ke, oogqirha kufuneka benze konke ukukhusela ukuphuhliswa kwayo.

Ukutshatyalaliswa kwe-Cardiogenic: ukuhlelwa kwesifo

Ngokuxhomekeka kwimbangela kunye ne-pathogenesis, iintlobo ezininzi zeentshukumo zomzimba ziyahluka. Ngamnye wabo unendlela yokuphuhlisa. Nangona kunjalo, zonke iindidi zikhokelela kwimpawu ezifanayo. Kungakhathaliseki ukuba yintoni imbangela yokubonakala kwayo, ukunakekelwa kwimeko engxamisekileyo yokukhathazeka kwimizimba kuyimfuneko kunoma yintoni na. Ekubeni eli lizwe lisoloko liyingozi. Kukho iindidi ezilandelayo:

1. Ukutshatyalaliswa kwenhliziyo. Ivela xa izicubu zentliziyo zonakaliswe. Kwimeko ezininzi le fomu ibangelwa yi-transmural myocardial necrosis.
2. Ukutshitshiswa kwama-Arrhythmic. Kwizizathu zayo zibandakanya i-fibrillation kunye ne- flutter ye-ventricles, i- extrasystole, i-bradycardia enamandla. Ukongeza kwi-arrhythmias, ukutshitshiswa kunokukhokelela ekuphulaphuleni kwentliziyo.
3. Ukuxhatshazwa kwe-cardioxygen. Kule ndlela ehlukileyo, ukuphulwa kwemisebenzi yentliziyo ayiyi kuqala phambi kwengxaki. Ngokuqhelekileyo ikhula ngokulahleka kwegazi, ukungaphumeleli kwezintso.
4. INTSHINTSHO. Ngaba yindlela enobungozi kakhulu. Ikwahlukileyo kwiqela elihlukeneyo, kuba liphantse likhokelela ekufeni kwaye ayiphenduli unyango.

Ukutshatyalaliswa kwezinto ezinokwenyama: indlela yokuphuhlisa

Ukutshatyalaliswa kwentliziyo kuqhelekileyo. Kwenzeka ukuba uninzi lwe-myocardium luchaphazelekayo (ukusuka kuma-50% okanye ngaphezulu). Kule meko, i-necrosis ayidluli nje kuphela kwi-muscle thickness, kodwa iphinda ihlala kwindawo enkulu. Ukongezelela ekuhlaselweni kwentliziyo, ezinye izifo zingakhokelela ekutshatyeleni okwenyaniso. Phakathi kwabo: i-endocarditis ye-septic, iintsilelo ezinzima zeentliziyo, i-myodystrophy, i-myodystrophy, kunye nokunye.

Njengomphumo we-necrosis yeethambo zentliziyo, isivumelwano sehla sinciphisa kakhulu. Ngoko ke, umzimba awukwazi ukusebenza ngamandla ngokupheleleyo kwaye unikeze imithwalo yegazi. Umthamo wemizuzu uyancipha. Oku kwandisa ukunyanzelwa kwemithambo yegazi. Nangona kunjalo, intliziyo isengqinelani nomsebenzi wabo. Isiphumo kukunikezelwa kwegazi kwizinto zonke kunye nezicubu.

I-Pathogenesis yokutshatyalaliswa kwe-cardiogenic arrhythmic

Kwintliziyo yale fomu yesifo kukuphulwa kokuqhutywa kunye neshyenti yentliziyo. Bangakwazi ukuphakama ngokukhawuleza (njengesiphumo se-myocardial infarction), kunye nokuphuhlisa kancane. Ngokuqhelekileyo, i-arrhythmias ingxaki yesigulane iminyaka emininzi. Kuyafana nokusebenza kwezifo zokuziphatha. Nangona kunjalo, iimeko zokusongela ubomi zikhula ngexesha elifutshane. Ku malunga neeyure kunye nemizuzu. Uninzi lwamaxesha amaninzi, ukuphazamiseka kwemizimba kubangelwa ukuphulwa komyinge wendalo. Phakathi kwabo: i-tachycardia, iphendulela kwi-fibrillation, kunye ne-flutter. Ukongezelela, ezi nkqubo zingakhokelela kwizihlandlo zamaqela e-extrasystoles.

Enye imeko engakhokelela ekutshitshiseni, yiyona sinus bradycardia. Ukuhla kwezinga lentliziyo ngokuqhelekileyo kubonakala ngokukhathazeka kokuqhuba. Ngaphantsi kwexesha, ukutshatyalaliswa kwemizimba kukukhokelela kwi-fibrillation kunye ne-flutter ye-atrial. Ngenxa yokuchaswa kwezilwanyana kunye ne-ectopic foci kwi-myocardium (i-extrasystoles), intliziyo ayikwazi ukwenza umsebenzi wayo. Ngenxa yoko, kukho ukuhla kwefuthe kunye nomthamo wemizuzu, ukuwa kwexinzelelo lwe-pulse, uxinzelelo lwegazi. Ngolu khetho, into yokuqala yokugcina i-ambulensi ukumisa i-arrhythmia ngokuchithwa kwe-defibrillation okanye i-heart massage.

Kuyintoni ukutshatyalaza ngokucacileyo?

Le ndlela yokutshitshiswa ivela ngenxa yezizathu ezingenakunxulumene nokutshatyalaliswa kweentliziyo zomzimba. Indlela yokubangela inkxalabo enjalo ingaba yintlungu yesifo okanye igazi. Nangona kunjalo, ezi zimpawu aziqhathaniswa nxamnye nentliziyo. Ngokuqhelekileyo ukuphazamiseka okunjalo kufunyaniswa emva kwengozi, ukungaphumeleli kwe-renal.

Olu khetho lunolwazi oluhle kakhulu. Ukunyamekela kwimeko engxamisekileyo yokuphazamiseka kwengqondo yomntu omele ulungelelaniswe kufuneka kujoliswe ekupheliseni imbangela yesifo sesifo, kunye nokuyeka ukuphuma kwegazi. Ngenxa yale miba, ukulawulwa kwetoni ye-vascular kuyingozi. Ngenxa yalokhu, igazi lixhamla kwiimvini kunye neetriyeri, kwaye umlambo ungena kwisithuba sendawo, ukwenza i-edema. Konke oku kukukhokelela ekunciphiseni kwintsipheko entle. Ukuqhubela phambili, le ndlela ifana nezinye iifom.

Iibangela kunye ne-pathogenesis yokutshatyalaliswa kwamathambo

Ukuphazamiseka komzimba kwenzeka xa yonke i-myocardium ichaphazelekayo. Oku kwenzeka ngokuhlaselwa kwentliziyo. I-Tamponade yentliziyo nayo ingabangela. Kule meko, utywala lubonakala kwi-pericardium, ephikisana nequmrhu, ekuthintela ukuba ingayinayo. Kwezinye iimeko, i-tamponade ingakhokelela ekuphukeni kwentliziyo. Le meko ibangela ukufa. Ngelishwa, isiguli asikwazi ukuncedwa kulolu hlobo. Inkqubo yokuphuhliswa kokutshatyalaliswa kuhambelana nokupheliswa ngokupheleleyo komsebenzi wentliziyo, ngokungafani nezinye iifom ezithintekayo. Ukufa kwale nkcenkceshi kukufutshane ne-100%.

Iimpawu zokutshitshiswa kwemizimba

Umfanekiso weklinikhi ufana, kungakhathaliseki ukuba yintoni imbangela yokutshatyalaliswa kwegazi. Iimpawu zoxinzelelo zilandelayo: ukuwa kwexinzelelo lwe-arterial and pulse, tachycardia, oliguria (i-diuresis yehla). Ngokuxhomekeke kwixabiso lexinzelelo legazi kunye nedatha yekliniki, i-degrees of gravity iyahlukana. Xa uhlolisisa isigulane, unokwazi ukubona ezinye iimpawu zokuphazamiseka kwemizimba. Ezi ziquka:

1. Ijubane elibandayo kunye elinomzimba.
2. Uloyiko lokufa okanye ukungabi nalwazi.
3. I-Cyanosis - cyanosis yolusu.
4. Impawu zobuso zesigulane zingatsholwa, ukubonakaliswa kwesibonakalo - ukubandezeleka.
5. Umbala wesikhumba kwiqondo elibi ufumana i-gray tinge.

Indlela yokufumanisa ukutshitshiswa?

Ukuxilongwa kwe-cardiogenic shock ngokuqhelekileyo kusekelwe kwidatha yeklinikhi kunye nokubuza izihlobo zesigulane. Njengoko kubalulekile ukwenza ngokukhawuleza, oogqirha bavavanya uxinzelelo lwegazi, imeko yesikhumba, impendulo yabafundi, izinga lentliziyo kunye neqondo lokuphefumula. Ukuba isigulane sinempawu yokutshatyalaliswa, uncedo olukhawulezayo lufumaneka ngokukhawuleza.

Ekubeni kubasebenzi bezonyango behhala, i-anamnesis yesi sifo ibonakala. Ugqirha ubuza: ngaba isigulane sasihlushwa yi-arrhythmia, i-angina pectoris, mhlawumbi, yafumana i-infyoction ye-myocardial ngaphambili? Ukuba inkcenkceshela iqala ekhaya okanye kwisitrato, ngoko ukuxilongwa kwe-ambulance oogqirha uphela apha. Xa isigulane sigcinwe kwiyunithi yokunyamekela kakhulu, ngaphezu koko, uxinzelelo lwe-pulse, ukumelana ne-vascular, i-diuresis iyalinganiswa. Ukwenziwa kwegesi yegazi kuphandwa kwakhona.

Ukuxhatshazwa kwe-Cardiogenic: uncedo lokuqala, i-algorithm yezenzo

Kufanelekile ukuba sikhumbule ukuba ubomi besigulane kuxhomekeke ekukhawulezeni kunye nekhwalithi kunceda. Ngemiqondiso yale nkcenkceshe, oogqirha baqala ukuthatha inyathelo ngokukhawuleza. Ukuba wenza yonke into ngexesha, unako ukutshatyalaliswa kwentswelo yomzimba. Uncedo olungxamisekileyo - i-algorithm yezenzo zilandelayo:

1. Beka isigulane kwindawo ephakamileyo kunye nokuphela kweenyawo eziphakamileyo. Ukongezelela, kubalulekile ukubonelela ukufikelela emoyeni (ukuvala izambatho, vula iwindi).
2. Ukunikezelwa kweoksijini. Inokuthi iqhutywe ngeemaski ezikhethekileyo okanye i-cathter.
3. Anesthesia. Nge-infarction ye-myocardial kunye nokutshitshiswa kwe-reflex, izidakamizwa zonyango zisetyenziselwa oku. Ngokuqhelekileyo, isilwanyana "uMorphine" sisetyenzisiweyo. Uzalwe kwi-saline ye-physiological kwaye injected / ngokukhawuleza.
4. Ukubuyiswa kwe-BCC kunye nokuhamba kwegazi. Ngenxa yale njongo, isisombululo sithi "Reopoliglyukin".
5. Ukuba akukho miphumo, kuyimfuneko ukuphakamisa uxinzelelo lwegazi ngoncedo lweziyobisi "Atropine" 0.1%. Ngena kwisixa semali 0.5-1 ml.

Ukongezelela, kubalulekile ukuqeda imbangela yokutshatyalaliswa. Nge-infarction ye-myocardial, unyango lwe-thrombolytic kunye ne-antiplatelet lwenziwa (ukulungiselela u-Alteplase, Clopidogrel, Aspirin). Kwakhona ukuhlaziywa kwegazi kusetyenziswa isisombululo se "Heparin". Ngenxa yokuphazamiseka kwesigxina, iyeza "uLidocaine" lilawulwa. Kwezinye iimeko, i-defibrillation iyimfuneko.

Unonophelo olungxamisekileyo esibhedlele

Ukunyamekela ngokukhawulezileyo ukutshatyalaliswa kwenhliziyo kuyaqhubeka kwiyunithi yokunyamekela. Kukho unyango olunzulu, ukuhlolwa rhoqo kwezibonakaliso, izizathu zeengxaki zicaciswa. Nge-infarction ye-myocardial, unyango ogqityiweyo lwenziwe - ngokugqithisa iirriyiti, ukuseka i-stent. Kwakhona, kufuneka unyango olwenziwe ngophando olunee-arrhythmia kunye neengxaki zokuqhuba. Ngethuba elifanayo, i-pacemaker yokufakelwa iifakwe eyenza umsebenzi onentsebenziswano yentliziyo.