Yintoni AV block? ibloko Atrioventricular: Oonobangela, Iimpawu, diagnosis and Treatment

ibloko Atrioventricular - zizimvo komzimba disorder ayidlulisele luvo ngenkqubo Uhanjiso wentliziyo imithambo ukuya ventricles. Nzima xa uqala, lo gama livela intendelezo igama Latin kunye ventriculus, abonisa intendelezo ventricle, ngokulandelelana kwazo.

Entliziyweni, isakhiwo sayo kunye nenkqubo conductive

Intliziyo yomntu, njengoko kwezinye izidalwa ezininzi eziphilayo, mammalian, iqulathe kumacala ngasekunene nangasekhohlo, nganye eneyazo intendelezo ventricle. Igazi lonke phezu umzimba, ezizezi kwegazi, eza kuqala kwi intendelezo ekunene, uze kungena ventricle ekunene, ngoko - ngokusebenzisa iimpahla emiphungeni. Mpilo igazi kuye kwasasazwa pulmonary ukusuka emiphungeni lungena ngokukhululekileyo intendelezo ekhohlo ukusuka apho iwele ventricle lasekhohlo, kwaye kuwo phezu aorta idluliselwa ukuba amalungu kunye namalaphu.

Kwegazi liya intliziyo isebenza inkqubo yayo Uhanjiso. Kuyinto ngenxa kuye kukho uVuyo echanekileyo - ukuncitshiswa kwangethuba imithambo kunye ventricles kunye ithombo legazi ngabo. Xa yokuwisa ekudluliseni neemvakalelo-luvo phakathi imithambo kunye ventricles yokugqibela wancipha emva kwexesha okanye ngokucotha kakhulu - emva kwexesha lekhefu elide emva ucutheko atrial. Ngenxa yoko, amandla yokumpompoza kwegazi, akukho ukukhululwa kwawo ube imithambo yegazi ngexesha elifanelekileyo, kukho ukuhla koxinzelelo, kunye nezinye iinguqulelo ezininzinzi kweli nemithambo yegazi.

I-AV block eyingozi?

ibloko ubungqongo atrioventricular ixhomekeke namandla aso. iintlobo mnene ezingaqhelekanga Uhanjiso inokuba nazimpawu, avareji - befuna ukufumanisa oonobangela kwaye unyango nokuthintela ukusilela kwentliziyo. Xa ukuvimba epheleleyo Inokwenzeka ukufa nangoko ukusuka zokuma. Kungenxa yoko le nto nokuhluthwa luvo Uhanjiso ezintliziyweni azinakho ukutyeshelwa, nokuba kukho nto okwangoku akukho zimpawu kakhulu zesi sifo.

Classification ngokutsho block AV degree

AV block intliziyo kukuba lweendidi eziliqela iintlobo zeHPV zingonobangela. Ngu bekukubi avelele: AV block isidanga sokuqala, ngokufuthi ezingahambi naziphi na ukuphazamiseka angaphandle kwaye kwiimeko ezininzi eqhelekileyo, kuvalwe iindlela ngokuzalana, nohlulwe leyo ngeentlobo ezimbini: type 1 (Mobitts 1 okanye kwafa Wenckebach) kunye uhlobo 2 (Mobitts 2), kwaye kuvalwe iindlela isidanga - a transmission yokuma neemvakalelo-luvo evela ventricles imithambo.

degree 1 AV block

AV block of 1 kungaba into eqhelekileyo komzimba ukuba izigulane abaselula. Kudla ngoxilongo kunye nokwenza rhoqo iimbaleki, kwaye baye bacinga eqhelekileyo. Ekubeni kwafa elolo hlobo abantu badla akukho zimpawu lubonakale abonisa iingxaki intliziyo. AV block 1 isidanga kungekho kweempawu zesi sifo ngokuqhelekileyo akafuni kufuna unyango, kodwa kusenokuba yimfuneko phambi kwezinye ukungaqheleki zentliziyo. Kwakhona kulo mzekelo ugqirha ngokuphindaphindiweyo ECG, iliso ECG ambulatory kunye nezifundo ezongezelelweyo zomsebenzi awuphathisiweyo, ezifana echocardiography (ultrasound zentliziyo). An isidanga electrocardiogram ibloko atrioventricular 1 kuboniswa ukunyuswa lokuphumla phakathi kwamazinyo P kunye R, lo gama zonke P amazinyo eziqhelekileyo, kwaye isoloko elandelwa QRS-nezakhiwo.

degree 2

AV ukuvimba Iqondo lobushushu lihle laya-2, njengoko ichazwe ngasentla, uhlobo yokuqala neyesibini. Xa ngexesha ngobuwena 1 (Mobitts 1) kusenokuba nazimpawu kwaye musa ukuba unyango. Kulo mzekelo, kokuvela isiseko komzimba kwibloko mali ingxaki kwi esiludumbo atrioventricular. uhlobo AV-block Mobitts bolwesibini udidi 2 - ngokuqhelekileyo ngenxa yesifo kwinkqubo nokuqhutywa ephantsi (wama- Purkinje). Ngokuqhelekileyo kwenzeka iimpawu ezicacileyo kwaye zifuna sifo ezongezelelweyo kunye lokwaluka ngokukhawuleza unyango ukuthintela uphuhliso ukuvaleka ngokupheleleyo zokuma.

AV block on ECG (ngokuzalana type 1) luphawulwa ukunyuka okuqhubekekayo PR lekhefu, emva koko kukho ilahleko QRS-complex nangaphezulu - kufutshane ukubuyisela isingqisho yesiqhelo. Ke konke iyaphindwa. Le periodicity ibizwa ngegama oolindixesha Samoilova-Wenckebach. Uhlobo lwesibini AV block abanesidanga sesibini ECG luphawulwa imvula rhoqo okanye yezizwe QRS-complex lo gama i-PR lekhefu isongezo, njengoko kuhlobo 1 Mobitts lungenzeki.

degree Third

AV-block degrees 3 isegazini kunye abazifumene. Lubonakala ngokuba ukungabikho epheleleyo pulses osusela imithambo ukuya ventricles, ngoko ke wabhekisela kwafa ephelele. Ekubeni eyenza ngenxa atrioventricular esiludumbo intliziyo hayi zigcinelwe inkxaso enkulu kwentliziyo ibe abaqhubi esebenzayo yereyithi yesibini-order, t. E. Ventricle iMisebenzi isingqi sayo, hayi onxulumene kwisingqi imithambo. Konke oku kubangela ukuphazamiseka kakhulu ekusebenzeni wentliziyo kunye nemithambo yegazi. Kuvalwe iindlela kumlinganiselo wesithathu kufuna lokwaluka ngokukhawuleza unyango, t. To. Ngaba kukhokelela ukufa isigulane.

Le ECG block degree wesithathu ngolu hlobo lulandelayo: link ezilahlekileyo ngokupheleleyo phakathi yomtshangatshangiso P kunye QRS ezintsonkothileyo. Bona ebhalwe ngexesha elingafanelekanga kunye ezitsho ezahlukeneyo, oko kukuthi, bekubona ezimbini isingqisho ezingazalaniyo omnye - .. Atrial, omnye - ventricular.

Izinto ezibangela AV block

Iimbangi uqhelekileyo ezingaqhelekanga ezifana AV block ukuba ilizwi ukwanda kwe-luvo vagus e leembaleki, sclerosis kunye abanesigulo yenkqubo Uhanjiso kwentliziyo, le ngezifo semigudu intliziyo, myocarditis, iposi engabalulekanga, nokuphazamiseka electrolyte kunye nokusebenzisa iziyobisi ezithile, ezifana glycosides kwentliziyo ( "digoxin" "Korglikon", "Strofantin"), blocker calcium channel ( "Amlodipine" "verapamil" "Diltiazem" "Nifedipine" "Cinnarizine"), beta-blocker ( "bisoprolol" "Atenolol" "Carvedilol" ). Zalisa ukuvaleka kungaba bekhubazekile. Le ngezifo kubhalwa ngokufuthi abantwana oomama ubunzima ukusuka systemic lupus zomzimba. Enye imbangela kuvalwe iindlela kumlinganiselo wesithathu kuthiwa isifo Lyme, okanye borreliosis.

Iimpawu AV block

1 degree block atrioventricular, kwakunye kuvalwe iindlela degrees 2 uhlobo lokuqala, ngokubanzi ezingahambi naziphi na iimpawu. Noko ke, ukuqapha lohlobo Moritz 1 kwezinye iimeko, kukho isiyezi kunye waphela. Uhlobo lwesibini isidanga sesibini wabonisa iimpawu ezifanayo, kwakunye clouding osezingqondweni, iintlungu entliziyweni kunye nokuziva ukusimisa, niphele elide. Iimpawu epheleleyo atrioventricular block - izinga nciphisa intliziyo, buthathaka kakhulu, aluzunguleza intloko, lifathul yamehlo, unditsho, ilahleko lokuqonda. Kusenokwenzeka kwakhona kwenzeka isingxi bentliziyo kunye esibulalayo.

Uxilongo lwe AV block

Uxilongo of block atrioventricular yenziwa usebenzisa electrocardiography. Amaxesha amaninzi ibloko AV degrees-2 (enye 1-D) eshiyekileyo ifunyanwa ngexesha ingozi ECG akukho zikhalazo ngethuba loviwo unyango lothintelo. Kwezinye iimeko, uxilongo oluqhutywa phambi naziphi na iimpawu unokubangwa iingxaki kwinkqubo Uhanjiso yentliziyo inhliziyo luvo, ezifana nesiyezi, buthathaka, blackout, niphele.

Ukuba isigulane axilonge ECG AV block, kwaye kukho iimpawu ezibonisa ukuba iphinde iphononongwe, cardiologist jikelele ikhuthaza esweni ECG ngemihla. Kukholelwa esebenzisa Holter monitor, oko ke ke udla ngokubizwa ngokuba esweni Holter. Zingaphelanga iiyure ezingama-24 kukho ECG eqhubekayo rhoqo zokurekhoda, lo gama umntu uqhelene kwaye eziziimpawu indlela yakhe yokuphila - uhambisa, ukutya, elele. Le ayiphazamisi sifundo kwaye akubangeli phantse akukho uqeqeshwa.

Emva ukurekhoda data ECG evela esweni zihlahlelwe kunye izigqibo ezifanelekileyo. Plus le ndlela sifo, xa kuthelekiswa ne yesiqhelo mfutshane ECG recording ukuba akakwazi bana phandle indlela kaninzi kwenzeka yaye kuvalwe, ziziphi ixesha ixesha lemini kokuba zibhalwe qho yaye nenqanaba lomsebenzi nomonde.

unyango

Akusoloko atrioventricular ukuvimba isidanga sokuqala, kwakunye owesibini kufuna ungenelelo lonyango. Ekuqaleni kwimisebenzi zonyango, njengoko umthetho, akukho mfuneko. Kwakhona kwi-2 nd lohlobo lokuqala (Moritz 1) uthomalaliso ngokuqhelekileyo singàphunyezwa, nangona uphando olongezelelweyo ukuqaphela iingxaki intliziyo ezinxulumene ukuze kucetyiswa.

Unyango AV block kuyimfuneko yesibini isidanga Moritz uhlobo 2 kwakunye kwafa buso okanye epheleleyo kumlinganiselo wesithathu, okt. K. nokuphazamiseka Uhanjiso Ngoko ezibalulekileyo kunokukhokelela ekufeni ngesiquphe. Indlela ezisisiseko yokulungisa intliziyo kakuhle i ufakelo yomguli ipacemaker (ECS) yethutyana okanye esisigxina. wamisa kakuhle kwaye ethile therapy iziyobisi - "Atropine" kunye nezinye iziyobisi. Imithi abakwazi ukuba aphilise umntu sifo yaye bakholisa kusetyenziswa phambi pacemaker umzila.

Ilungiselela ukufakela ECS

Ukulungiselela pacemaker umzila ibandakanya, ukongezelela electrocardiography, echocardiography - ultrasound kwentliziyo. Echocardiography ivumela ukuba nomfanekiso udonga lweHo- kunye nodonga entliziyweni ukubona nasiphi na isifo singundoqo kunokubangela AV block, ezifana nesifo vana. Ukuba cardiologist kwi ultrasound bekubona iingxaki intliziyo, unyango elimi kuqhutywa ngaxeshanye kunye unyango lwe block atrioventricular. Oku kubaluleke ngakumbi kwiimeko apho ezi zifo unobangela ukungaqheleki Uhanjiso. Wanyulwa nokunyulwa ngawo uphando lwezonyango standard - igazi nomchamo uvavanyo. Ukuba isigulana umntu ngesifo namanye amalungu kunye neenkqubo kwixesha ipreoperative ngayo amanyathelo afanelekileyo diagnostic ukuze kucetyiswa.

pacemaker umzila

pacemaker yoFakelo xa isigulo eso, AV block, - utyando ekunokukhethwa kulo. Oko kwenziwe ngaphandle zombini phantsi zomzimba jikelele kunye Ukubulawa yasekuhlaleni. Ugqirha nge Kwangamoya subclavian ezitsheni eqhuba ngayo i electrode intliziyo, apho kukho ezirekhodiweyo. Le yunithi ngokwawo njengobuchule olulodwa athungwe phantsi kwesikhumba. Eli nxeba avalwa yaseZimbabwe.

ECS yi endaweni yokwenziwa ukuba ipacemaker, eqhuba iminqweno ukusuka imithambo ukuya ventricles, kwaye ikhokelela uVuyo yesiqhelo. Ngenxa ukuvusa engenasiqabu okanye rhoqo, isivumelwano camera ngendlela echanekileyo kunye lekhefu ezichanekileyo, intliziyo lenza ngokupheleleyo umsebenzi wayo sokumpompa amanzi. Kwinkqubo yokujikeleza kwegazi, akukho ngxi kunye notshintsho ngesiquphe uxinzelelo, kunye nengozi yokuba iimpawu ezifana nesiyezi, niphele, kunye nezinye ngokuqhelekileyo nazo kwizigulane kwafunyaniswa AV block, yehliswe kakhulu, kwakunye ingozi yokufa ngesiquphe ukusuka inhliziyo umsebenzi intliziyo.

postoperatively

ixesha Postoperative, ukuba akukho ezinye nzima ngenxa iingxaki zempilo, ngokuqhelekileyo ezingahambi nayiphi anemiqathango. isigulane kukhululwa ekhaya iintsuku 1-7, emva kokuqhuba uphando. ukunakekela inxeba endle lwezindlu isixhobo implantable yenziwa ngugqirha wakho. ukususwa Suture kuyimfuneko xa ebekwe izinto suture, engaquki ukusombulula ngokwabo. Ukuba ngexesha lofakelo lenxeba ipacemaker luvaliwe ingenamthungo izithambiso, oko akukho mfuneko sisuswe.

Kwiiveki zokuqala emva umzila we-ntliziyo Kucetyiswa ukuba siphephe umthambo onzima, kwakunye nokukhusela indawo weld (ezemidlalo, ukuba akukho Izimo, ungaqalisa, njalo ngokubonisana ugqirha kwiinyanga ezimbalwa). ngenyanga 1 emva nkqubo yabelwa ibhunga lolawulo zentliziyo. Ngoko itshekhi yenziwa emva kweenyanga ezintandathu kwaye kwakhona kunyaka omnye ukususela kwimini umzila, uze emva koko - minyaka yonke.

ixesha umsebenzi EX kuxhomekeke kwizinto ezininzi. Kwi-avareji, eli xesha yiminyaka 7-10, kunye nabantwana ngokuqhelekileyo zincinane kakhulu ngaphezu koko ngenxa, phakathi kwezinye izinto, kunye nokukhula yomzimba yomntwana. Olawula ivuselela, kunye nokufakwa kweenkqubo zayo isigulana ingakumbi kugqirha. Khangela le yunithi esebenza ukuba yenziwe ngexesha elifanelekileyo. Kwakhona walungisa kunye nenkqubo xa kuyimfuneko - parameters ebekwe yokusebenza. Oku kube yimfuneko ukuba kwesincedisi- ongayiphumeziyo imisebenzi eyabelwe kuyo: izinga intliziyo iphantsi kakhulu okanye phezulu kunye / okanye imeko yomguli amahlwempu yempilo. Ezinye izicwangciso zingacwangciswa ngokutshintsha indlela kagqirha yobomi kunye nokungabikho ukukhuthazwa, ezifana nemidlalo esebenzayo.

Esona sizathu siphambili sokusilela kwesincedisi- kukunciphisa umthamo kwebhetri - it oluphumayo. Kwiimeko ezinjalo, esi sixhobo kufuneka kufakwe entsha yaye ngokuqinisekileyo kufuneka kudityanwe cardiologist. I electrode ame em- intliziyo, ngokuqhelekileyo ahlale ubomi kunye nokusebenza ngokuchanekileyo akuyomfuneko ukuba kutshintshwa, avumele umntu ukuba aphile ubomi ngokupheleleyo nangona iingxaki intliziyo.