Kodi AV chipika? Atrioventricular chipika: Zoyambitsa, Zizindikiro, Matendawa ndi Chithandizo

Atrioventricular chipika - zokhudza thupi matenda zimafalitsa mitsempha zikhumbo mwa dongosolo mtima conduction ku atria kuti ventricles lapansi. Ndizovuta koyamba, dzina amachokera kwa Latin mawu atrium ndi ventriculus, omwe amasonyeza atrium ndi ventricle, motero.

Pa mtima, matabwa ake ndi dongosolo conductive

Mtima wa munthu, monga zolengedwa zina zambiri wamoyo, zolengedwa zoyamwitsa, imakhala lamanja ndi lamanzere mbali, aliyense amene ali ndi atrium ndi ventricle. Magazi onse pa thupi, womwe zokhudza zonse kufalitsidwa, kumabwera koyamba mu atrium Chabwino, tsopano mu ventricle Chabwino, ndiye - kudzera ziwiya m'mapapo. Mpweya magazi kufalitsa m'mapapo mwanga kwa mapapo amalowa atrium kumanzere imene imagwera mu ventricle kumanzere, ndipo kuchokera pa msempha ndi kunditumiza ku ziwalo ndipo zimakhala.

magazi mtima dongosolo ake conduction. Ndi kuthokoza kwa iye apo ndi lolondola kugunda - kuchepetsa yake ya atria ndi ventricles ndi nthenda yotaya magazi mwa iwo. Pamene chintchito mu kufala kwa zikhumbo za mitsempha pakati pa atria ndi ventricles otsiriza yafupika mochedwa kapena pang'onopang'ono - pa nthawi yaitali imeneyi pambuyo chidule matenda. Chifukwa, mphamvu ya magazi, palibe kutulutsidwa mu mitsempha ya magazi pa nthawi yoyenera, pali dontho kuwasangalatsa ndiponso kusintha ena akuluakulu mu dongosolo mtima.

Zolusa AV chipika?

Kusalekerera atrioventricular chipika zimadalira ukulu wake. mitundu ofatsa a kuvutika conduction kungakhale asymptomatic, chiwerengerochi - kukakamiza kudziwa zimayambitsa ndi mankhwala kupewa matenda a mtima. Pamene anatseka misewu wathunthu kumachitika imfa yomweyo kuchokera kumangidwa mtima. N'chifukwa chake kuphwanya conduction mitsempha mtima sitingakane, ngakhale pali pano palibe zizindikiro kwambiri matenda.

Gawo malinga chipika digiri AV

AV chipika mtima ndi wa mitundu yambiri ndi subtypes. Ndi yokoka wolemekezeka: AV chipika digiri choyamba, zambiri osati limodzi ndi chisokonezo kwina ndipo nthawi zambiri ali ponseponse, anatseka misewu ya mlingo wachiwiri, ndi lophatikizana ndi ubwamunalo linagawanika nayenso mu mitundu iwiri: choimira 1 (Mobitts 1 kapena anatseka misewu Wenckebach) ndi kutayipa 2 (Mobitts 2), ndipo anatseka misewu ya digiri - wathunthu amasiya kufala kwa zikhumbo za mitsempha ku ventricles atria.

1 digiri AV chipika

AV chipika cha digiri 1 akhoza kukhala zachibadwa zokhudza thupi chodabwitsa odwala achinyamata. Kawirikawiri matenda ndi zonse zamatsenga mpikisanowo, ndipo Komanso ankaona ponseponse. Ndi anatseka misewu choterechi kwa anthu amakhala popanda zizindikiro noticeable omwe akusonyeza mavuto mtima. AV chipika 1 digiri, pakalibe zizindikiro za matenda zambiri sikutanthauza chithandizo, koma kungakhale kofunika pamaso pa kuvutika zina za mtima. Komanso Pankhaniyi dokotala mobwerezabwereza ECG, ECG polojekiti ambulatory ndi maphunziro ingaperekedwe, monga echocardiography (ultrasound kwa mtima). An digiri electrocardiogram atrioventricular chipika 1 kukuonetsedwa kuchuluka kwa imeneyi pakati pa mano P ndi R, pamene onse mano P n'zabwinobwino, ndipo nthawi akutsatiridwa ndi QRS-maofesi.

digiri 2

AV anatseka misewu ndi madigiri 2, monga wakhala tafotokozazi, mtundu woyamba ndi wachiwiri. Pamene pa chimake 1 (Mobitts 1) kungakhale asymptomatic ndipo popanda mankhwala. Pankhaniyi, pakutchulidwa ya maziko thupi la chipika zambiri vuto mu mfundo atrioventricular. AV-chipika mtundu digiri yachiwiri Mobitts 2 - ambiri chifukwa cha matenda a m'munsi kuchititsa system (His- Purkinje). Kawirikawiri amapezeka ndi waledzera ndi amafuna matenda zina ndi mwambo mofulumira mankhwala kupewa chitukuko cha blockage wathunthu kumangidwa mtima.

AV chipika pa ECG (digiri yachiwiri ya mtundu 1) yodziwika ndi kuwonjezeka mwapang'onopang'ono ndi imeneyi taphunzira, pambuyo pake imfa ya QRS-zovuta zambiri - pafupi kubwezeretsa mungoli yachibadwa. Kenako zonse akubwerezedwa. periodicity Izi dzina lake periodicals Samoilova-Wenckebach. Mtundu wachiwiri wa chipika AV ndi digiri yachiwiri ECG a amakhala ndi zonse kapena mowiriza mpweya wa QRS-zovuta pamene taphunzira imeneyi prolongation, monga mwa mtundu 1 Mobitts zimachokeradi.

digiri Chachitatu

AV-chipika madigiri 3 ndi titadziwa ndi zinazake. Yodziwika ndi anasiya nyemba anakafika ku atria kuti ventricles, ndipo chotero anatchula anatseka misewu monga wathunthu. Popeza zikhumbo mwa atrioventricular mtima mfundo sanaimbidwe thandizo zodabwitsa mtima timagwira ntchito madalaivala a mlingo wachiwiri kuti, T. E. Ventricle ukugwira ntchito pa mungoli yake, osalumikidwa ndi kayendedwe ka atria lapansi. Zonsezi zimayambitsa chisokonezo kwambiri kugwira ntchito kwa mtima ndi dongosolo mtima. Anatseka misewu ya digiri wachitatu amafuna mwambo mofulumira chithandizo, T. Kwa. Kungachititse kuti imfa ya wodwala.

The ECG chipika digiri lachitatu ndi ili: kugwirizana kwathunthu chosowacho pakati pa P yoweyula ndi QRS zovuta. Iwo analembedwa pa nthawi zosayenera ndi mafurikwense osiyana, mwachitsanzo, wapezeka awiri zifukwa mungoli chimodzi - .. matenda, wina - yamitsempha yamagazi.

Zimayambitsa chipika AV

The zimakonda kuvutika monga chipika AV ndi kuchuluka kamvekedwe ya mitsempha vagus mu mpikisanowo, ofoola ziwalo ndi fibrosis ya mtima dongosolo conduction, ndi kudwala kuli nthambi mtima, myocarditis, m'mnyewa wamtima infarction, zipolowe electrolyte ndi kugwiritsa ntchito mankhwala ena, monga glycosides mtima ( "Digoxin" "Korglikon", "Strofantin"), calcium njira blockers ( "Amlodipine" "verapamil" "Diltiazem" "Nifedipine" "Cinnarizine"), beta-blockers ( "bisoprolol" "Atenolol" "Carvedilol" ). Complete blockage kungakhale kobadwa nako. kudwala Kawirikawiri zimenezi zinalembedwa ana amene amayi amadwala zokhudza zonse lupus erythematosus. Chinthu china wa anatseka misewu ya digiri wachitatu amatchedwa Lyme matenda, kapena borreliosis.

Zizindikiro za chipika AV

1 digiri atrioventricular chipika, komanso anatseka misewu madigiri 2 mtundu woyamba, zambiri osati limodzi ndi zizindikiro zilizonse. Komabe, anatseka misewu ya mtundu Moritz 1 zina, pali chizungulire komanso kukomoka. Mtundu wachiwiri wa digiri yachiwiri chidawoneka zizindikiro zomwezo, komanso clouding chikugwirabe, ululu mu mtima ndi maganizo choti izo, kukomoka yaitali. Zizindikiro wathunthu atrioventricular chipika - kuchepa kugunda kwa mtima, kufooka kwambiri, kukuzungulira mutu, kunachita mdima wa maso, zopweteka, imfa ya chikumbumtima. Iwo zingachitikenso kuletsa zonse za mtima ndi zotsatira amapha.

Matenda a chipika AV

Matenda a chipika atrioventricular ikuchitika ntchito electrocardiography. Nthawi zambiri AV chipika madigiri 2 (mofanana 1-D) ndi wapezeka pa ngozi ECG kudandaula ayi pa Kupenda podziteteza. Nthawi zina matenda ikuchitika pamaso pa zizindikiro zilizonse zimene ingayambe ndi mavuto mu dongosolo conduction wa mtima mitsempha zikhumbo, monga chizungulire, kufooka, mdima, kukomoka.

Ngati wodwala matenda ndi ECG AV chipika, ndipo zikuoneka kuti kupenda, cardiologist zambiri akuonetsa ECG polojekiti tsiku. Amakhulupirira kudzera Holter polojekiti, ndi choncho nthawi zambiri amatchedwa Holter polojekiti. Patangopita maola 24 pali nthawi zonse mosalekeza ECG kujambula, pamene munthu ali bwino ndi osamvetseka kwa moyo wake - kusuntha, kudya, kugona. Phunziro lochita ndipo sayambitsa pafupifupi palibe nkhawa.

Atalemba deta ECG kwa polojekiti ndi kusanthula ndi mfundo yoyenera. Plus njira ya matenda, poyerekeza ndi alipidwa lalifupi ECG kujambula kuti simungathe kulingalira mmene zambiri kuchitika anatseka misewu, m'nyengo iti nthawi ya tsiku olembedwa kaŵirikaŵiri ndi zimene mlingo wa ntchito wodwalayo.

chithandizo

Osati nthawi zonse atrioventricular ndigwire digiri loyamba, komanso yachiwiri amafuna alowererepo zachipatala. Poyamba ntchito zachipatala, monga ulamuliro, palibe. Komanso pa 2 na- a mtundu woyamba (Moritz 1) mankhwala kawirikawiri si wonyamulidwa, ngakhale kafukufuku zina kuzindikira mavuto a mtima wodwala.

Chithandizo AV chipika chofunika mlingo wachiwiri Moritz mtundu 2 komanso tsankho kapena wathunthu anatseka misewu ya digiri wachitatu, mwachitsanzo. K. Choncho kwambiri conduction chisokonezo kungachititse kuti imfa yadzidzidzi. The njira zoyambirira kuchitapo malfunctioning mtima ndi unsembe wa pacemaker mtima (ECS) zosakhalitsa kapena okhazikika. Chabwino zoikika ndi yeniyeni mankhwala mankhwala - "atropine" ndi mankhwala ena. Mankhwala sangathe kuchiza munthu ndi matenda ndipo kawirikawiri ntchito isanafike pacemaker implantation.

Kukonzekera kukhazikitsa ECS

Kukonzekera pacemaker implantation zikuphatikizapo, kuwonjezera electrocardiography, echocardiography - ultrasound za mtima. Echocardiography amalola kuti muzione mpanda wa M'mimbamo ndi khoma mtima ndi kudziwa matenda alionse choyambirira chimene chingachititse AV chipika, monga matenda valavu. Ngati cardiologist pa ultrasound wapezeka mavuto mtima, mankhwala concomitant wochititsidwa limodzi ndi mankhwala a chipika atrioventricular. Zimenezi n'zofunika kwambiri makamaka pa nthawi imene matenda amenewa ndi chifukwa kuvutika conduction. Komanso akusankhidwa ndi muyezo kafukufuku matenda - MAGAZI ndi mkodzo. Ngati wodwala ali ndi matenda a ziwalo zina ndi kachitidwe mu nthawi preoperative n'koyenera miyeso matenda mwina wodwala.

pacemaker implantation

Unsembe pacemaker pamene ngati matenda, kuletsa AV, - kusankidwa opaleshoni. Iwo angathe kuchitidwa onse pogonekedwa ndi mankhwala ambiri ndi mankhwala oletsa ululu pamalopo. Dokotala kudzera m'mitsempha subclavian pa zotengera kuchititsa kwa maelekitirodi mtima, amene kumeneko analemba. Unit lokha ndi njira yapadera sewn pansi pa khungu. bala kutsekedwa ndi stitches.

ECS ndi wogwirizira yokumba kwa pacemaker ndi, kuchita zikhumbo ku atria kuti ventricles, ndipo zimabweretsa kugunda bwinobwino. Chifukwa kukondoweza likukulira kapena zonse, mgwirizanowo kamera m'ndondomeko ndi imeneyi cholondola, mtima kwathunthu amachita ikukoka ake ntchito. Mu m'thupi, palibe stagnation ndi kusintha mwadzidzidzi kuthamanga, ndi chiopsezo zizindikiro monga chizungulire, kukomoka, ndi ena ambiri nawo pa odwala matenda ndi chipika AV, ali kwambiri yafupika, komanso chiopsezo imfa yadzidzidzi kwa mtima mtima ntchito.

postoperatively

nthawi Postoperative, ngati palibe wina complicating kwa matenda, kumakhala limodzi ndi malamulo alionse kwambiri. wodwalayo adzamasulidwa kunyumba masiku 1-7, pambuyo kuchititsa kafukufuku. Bala chisamaliro m'munda wa implantable chipangizo nyumba ikuchitika ndi dokotala. Suture kuchotsa n'kofunika ngati woyikidwa suture chuma, zomwe si kuthetsa paokha. Ngati pa unsembe wa bala pacemaker anatseka zodzikongoletsera msoko, izo sayenera kuchotsedwa.

Masabata choyamba pambuyo implantation wa pacemaker ndi bwino kupewa kuchita masewera olimbitsa thupi yovuta, komanso kuteteza malo china chotulutsa (masewera, ngati palibe contraindications, mukhoza kuyamba, nthawi zonse mogwirizana ndi dokotala mu miyezi ingapo). 1 mwezi pambuyo ndondomeko amagwira ntchito ulamuliro cardiology azichiona. Ndiye cheke imachitidwa patapita miyezi isanu ndi kachiwiri chaka chimodzi kuchokera tsiku implantation, ndiyeno - chaka chilichonse.

EKS ntchito nthawi kumatengera zifukwa zambiri. Pafupifupi nyengo imeneyi zaka 7-10, ndi ana amakhala laling'ono kwambiri kuposa mmene Akumuopera Inter zina zotere, ndi kukula kwa thupi la mwanayo. Control wa stimulant, ndi mapulogalamu ake kwa wodwala makamaka ndi dokotala kuchipatala. Chongani unit ndi zinchito kwenikweni idzachitika m'nthawi yake. Anakonzanso ndi pulogalamu ngati n'koyenera - anapereka magawo opaleshoni. Izi zikhonza kukhala zofunika ngati pacemaker si kukwaniritsa ntchito anatumizidwa kuti: mlingo mtima ndi otsika kwambiri kapena mkulu ndi / kapena wodwala osauka ukupeza. Zokonda ena akhoza anapereka kusintha njira dokotala wa moyo komanso kusowa kukondoweza, monga masewera yogwira.

Chifukwa chachikulu kulephera kwa pacemaker ndi kuchepetsa mphamvu batire - izo zimatulutsa. Zikatero, chipangizo ayenera m'malo ndi atsopano ndi amafuna ndi cardiologist azichiona. maelekitirodi The amagwiritsidwa ili mu M'mimbamo mtima, kawirikawiri kukhala moyo ndi ntchito zolondola sayenera m'malo, kulola munthu kukhala moyo wonse ngakhale mavuto mtima.