Kung'ambika vavu 1, 2, madigiri 3: zizindikiro, zizindikiro, matenda, mankhwalawa

La munthu wapadera kwambiri. Komabe, nthawi zina pamakhala zinthu pamene chiwalo zina zolakwika amagwira ntchito yake. Ndi kuphwanya dongosolo la - ndi kung'ambika vavu - mutu wa nkhaniyi.

terminology

Poyamba, tiyenera kumvetsa mawu zidzagwiritsidwanso ntchito m'nkhani pano. Choncho, kodi Kulephera kwa vavu kung'ambika? kusokonezeka uyu wa thupi, moti kukupiza kwathunthu musati kutseka mwamphamvu. Zimenezi zimabweretsa vuto monga magazi msempha kuponyera mmbuyo mu kumanzere mtima ventricle. Izi zidzachitika diastole - kudzazidwa ndi mtima ndi magazi. Kuposa ana amakumana? Popeza thupi la munthu alandira osachepera chofunika ntchito yachibadwa buku magazi. Chifukwa, izo kumawonjezera katundu pa mtima, kuti zoperewerazo vuto limeneli.

Kunena zoona, poyamba, mpaka thupi ndi achinyamata mphamvu, kung'ambika vavu insufficiency zambiri musati kubweretsa mavuto. Only, ndi mtima pang'ono kuwonjezera kukula kukhala wokhoza zoperewerazo kuchepa kwa magazi. Symptomatology ndi poyamba kwina, ndi wodwala ngakhale ndikulingalira pa kuli vuto. Kenako akuyamba kulankhula kufupika kwa mpweya, kutopa. Kupirira matenda, wodwala akhoza anatumiza opaleshoni kuti kung'ambika vavu m'malo.

The vuto manambala

Asayansi dziwani kuti mavuto monga insufficiency wa valavu kung'ambika, zimakhudza zambiri oimira aamuna. Ngati tikambirana kuchuluka, chiwerengero cha anthu omwalira chifukwa matenda, mu nkhani ya onse amene amafa ndi mavuto osiyanasiyana mtima, pafupifupi 14%. Ngati timaona matenda, ndi za 4% a milandu kung'ambika vavu insufficiency amapezeka mu maonekedwe ake angwiro, ndi 10,3% milandu - osakaniza ndi matenda ena mtima.

zifukwa

Kunena zoona, chifukwa cha vutoli, mu 2/3 la milandu ndi enaake ophwanya mavavu. Pasanathe ambiri, matenda amachititsa infective endocarditis. Asayansi amadziwikanso magulu awiri a zifukwa, zomwe anawagawa pachimake ndi aakulu zikuchitika.

The zimayambitsa matenda aakulu

Pankhaniyi, madokotala apeza zifukwa zingapo zofunika, yomwe INGATHE kuyambitsa ndondomeko aakulu:

• Kobadwa nako matenda a mtima. Ana akhoza anabadwa yekha ndi zitseko imodzi kapena ziwiri, zomwe zimabweretsa mavuto ambiri ndi mavuto ikukoka magazi ndi mtima.
• Okalamba ndondomeko. Ndiko kuti, valavu kung'ambika kuvala, kuvala kuchokera pa nthawi.
• Enaake ophwanya malungo, zomwe zimabweretsa amamuyambitsa timabala wa timapepala ta valavu, zomwe zimawalepheretsa mokwanira chatsekedwa.
• njira opatsirana mu mtima, pamene nyengo kukula (ndi madera lonse mabakiteriya), "kudya" valavu kutseka kuti uchiwo usatuluke, kapena kungoti kudziunjikira pa mavavu ndi, kuteteza iwo kuchokera kutseka bwino.
• Kuwonjezeka msempha pamene babu ake lidakali kuti kuli nthambi sangakhoze basi kwathunthu tsekani.
• Chithandizo cha mavuto osiyanasiyana, zimenezi zingachititse kulephera kwa valavu kung'ambika. Mwachitsanzo, mankhwala cheza kapena kugwiritsa ntchito "fentamini" - mankhwala kwa kuwonda, amene anali kudzipatula kwa ntchito cha m'ma 20 mochedwa. Malinga ndi kafukufuku ndi akatswiri, ntchito ungamuphe mavuto osiyanasiyana mtima, kuphatikizapo kung'ambika vavu regurgitation.

Zimayambitsa kutupikana pachimake

Madokotala amapha wa kung'ambika vavu insufficiency komanso secrete matenda monga endocarditis (matenda kuwonongeka limba), kung'ambika kung'ambika (umene magazi umayenda mwa mipata anapanga). Nthawi zina odwala pambuyo likufa opaleshoni m'malo valavu kung'ambika amadziwikanso osauka linalephera. zimayambitsa pachimake vuto ikugwilizirana ndi zoopsa za chifuwa (mwachitsanzo, pamene kugunda galimoto pamene munthu swipes chifuwa galasi lakutsogolo). Kawirikawiri komanso amatsogolera n'kuwononga kuti valavu kung'ambika.

mavuto symptomatology

ndi zizindikiro za kung'ambika vavu regurgitation, amene angathe kudziwa pamaso pa vuto chiyani? Monga tanenera kale pamwambapa, poyamba zizindikiro akhoza kukhala. Kuti, wodwalayo mwina angaone kuti mavuto ena. Komabe, kwa zaka zambiri, zinthu zikusintha. Mtima ntchito kumufotokozera kukwaniritsa chosowa magazi. Motero, ndi ventricle kumanzere kumawonjezera pang'ono, ndi mtima yokha wayamba kufooka. Apa Ikuonetsanso lokha anamva vavu kung'ambika. Zizindikiro, amene Pankhaniyi angakhalepo:

• Zonse kutopa, kufooka thupi lonse.
• Wodwalayo kupuma movutikira. Amakulitsa izo pa zolimbitsa thupi.
• Anatinso arrhythmias mwachitsanzo nthenda mtima mungoli.
• Wodwala angadandaule za kugunda mofulumira.
• Ndi katundu angayambe ululu pachifuwa (angina).
• Kawirikawiri odwala zowawa ndi imfa ya chikumbumtima.

Ngati wodwalayo ndi kulephera pachimake, ndiye zizindikiro zonse amaoneka mwadzidzidzi, mphamvu zawo zambiri, iwo amaoneka m'tsogolo. Pankhaniyi, odwala zambiri amafuna thandizo mwadzidzidzi, kuti apulumutse moyo.

Za digiri osakwanira wa

Komanso ali ndi vuto monga valavu kung'ambika, mlingo wa chitukuko. Iwo amasiyana kutalika kwa ndege, amene jekeseni kubwerera ventricle mwa kutseka kuti uchiwo usatuluke bwino chatsekedwa. Malinga amakhala atatu: choyamba, lachiwiri ndi lachitatu.

digiri yoyamba

Kodi wapadera za kung'ambika vavu regurgitation 1 digiri? Mu nkhani iyi, ndege si upambana 5 mm m'litali kuchokera timapepala ta kung'ambika. Choncho, vuto limeneli akhoza kutchedwa mwana. Ndipotu, magazi Akusonkhanitsa pafupifupi pakhomo kwambiri popanda kuchititsa mavuto alionse. Kung'ambika vavu 1 digiri sayambitsa kuwonjezeka yokulirapo mu ventricle kulamanzere, Pankhaniyi tikhoza kukhala ndi miyeso ochiritsira.

digiri yachiwiri

Kung'ambika vavu madigiri 2 ndi wapadera mu ndege yaitali iyi ndi kuchuluka kwa 10 mm. Ndiko kuti, magazi "splatters" mtunda wa pafupifupi 10 mm kuchokera timapepala ta valavu. Mu nkhani iyi, kwakusiyana imakhala kutseka kuti uchiwo usatuluke wa valavu mitral, amene kwambiri worsens zinthu. Kung'ambika vavu regurgitation kalasi 2 kumawonjezera pulsation mu mitsempha ya carotid ndi mtima, anachoka ventricle ukuwonjezeka. Awa onse mophweka pa echocardiogram ndi.

digiri lachitatu

Kung'ambika vavu kalasi 3 yodziwika kuti magazi ndi jekeseni mmbuyo ndi mtunda umene uli woposa 10 mm. Mu nkhani iyi, kwakusiyana intersects valavu mitral, ndipo akhoza kufika pamwamba pa ventricle kumanzere. Pankhaniyi, mitima ya malire chinawonjezeka ndi masentimita oposa 2, ECG kungakhale "anaona" kumanzere yamitsempha yamagazi hypertrophy.

Insufficiency ana

Payokha kuiganizira kung'ambika vavu insufficiency ana. Kodi pali kusiyana kulikonse pakati wamkulu ndi mwana? Choncho, pang'ono kudzakhala zizindikiro zosiyana. Pankhaniyi, ana nthawi zambiri anati pallor, pulsation ya mitsempha mu malekezero akhoza kukhala chizindikiro Musset (mwanayo kugwedeza mutu wake kumbali, malingana kugunda kwa mtima). Monga zochizira ndi matenda a mavuto, ndi ana ndi akulu, njirayi adzakhala yemweyo.

diagnostics

Matenda kuyambirira "kung'ambika vavu" mukhoza kuika dokotala pambuyo kumvetsera (auscultation) uncharacteristic phokoso mu mtima (diastolic kudandaula ndi zachilendo). Komabe, izi akadali yekha kukhala akungonena mawu Opeka. Kenako, dokotala ndikufunsani za zizindikiro zimene zingasonyeze pamaso pa vutolo, sonkhanitsani anamnesis zonse. Kenako, dokotala adzatumiza wodwalayo maphunziro kuti adzatsimikizira kapena kutsutsa matenda a chisanadze anakonza.

• Palpation. Pankhaniyi munthu akhoza kudziwa jitter pa tsinde la mtima mwa akufufuza mpata. Izi zimachitika chifukwa amasulidwe buku lalikulu kwambiri magazi. Komanso, "pali" percussion, pamene malire a mtima "pitani" lamanzere.
• ECG. njirayi limachititsa kudziwa kuchuluka kwa kukula kwa ventricle kumanzere kwa mtima.
• Echocardiography. Ndondomeko zili mode ziwiri ooneka enieni limasonyeza kumanzere yamitsempha yamagazi hypertrophy. Mu umodzi azithunzi omwe tikunena - amatha kusiyanitsa matenda mitral vavu chifukwa ozama mu ndege ya.
• Doppler amapereka mwayi kudziwa mlingo wa insufficiency wa valavu kung'ambika - kumasonyeza utali wa mtsinje wa magazi ku kubayidwa.
• X-ray. Ngati valavu kung'ambika umaonetseredwa, njirayi limachititsa "kuona" akuchuluka mu kukula mtima, calcification wa timapepala ta lapansi.
• Kuonjezera kudziwika kuthamanga intracardiac angathe kuperekedwa mtima catheterization ndondomeko cavities. Pankhaniyi, madokotala madigiri anayi kung'ambika vavu insufficiency malinga voliyumu ya jekeseni magazi kumbuyo. Mlingo woyamba pafupifupi 15%, pamene lachiwiri - kuchokera 15 mpaka 30%, wachitatu - kuchokera 30 mpaka 50%, pamene wachinayi - oposa 50%.

Ngati wodwala kale matenda monga "kung'ambika vavu" matenda vuto si vuto ikuchitika mothandizidwa ndi njira zonse izi. Choncho, dokotala wasankha yekha wodwalayo panthawi imeneyi n'kofunika. Tikumbukenso kuti kuwonjezera pa njira pamwamba matenda, nthawi zina akugwiritsabe ntchito ndi inatsekeratu angiography, sipangakhalenso anatumizidwa kuti adziwe ngati ku stenosis kung'ambika.

mankhwala

Ngati wodwala matenda "kung'ambika vavu" chithandizo kumatengera ndi matenda wodwalayo. Choncho, cangu kugwiritsa ntchito mankhwala ena kapena mankhwala chilamulira chikhalidwe ndi zovuta mawonetseredwe a zizindikiro. Ngati mtundu wa matenda - aakulu, mwina achire mankhwala.

mankhwala amene wodwalayo angafunike kuti:

1. Okodzetsa. Cholinga chachikulu cha mankhwala Pankhaniyi - linanena bungwe madzimadzi owonjezera m'thupi, kutsitsa magazi.
2. Mankhwala. Mwina kuperekedwa ngati prophylaxis matenda opatsirana njira opaleshoni kapena mano.
3. Ndipo anaikidwa kukhala blockers kashiamu njira (makamaka mankhwala "Nifedipine") ndi cholinga chachikulu - kuchepetsa magazi kutayikira. Tikumbukenso kuti nthawi zina kugwiritsira ntchito mankhwala awa akhoza kukhala wabwino njira opaleshoni.
4. Angagwiritsidwenso anatumizidwa ndi mankhwala ena monga Ace zoletsa kapena angiotensin cholandilira blockers.

Tiyeneranso anati odwala ndi vutoli, ngakhale pano mu mawonekedwe aakulu, ayenera mayina ndi dokotala. Nthaŵi kukaonana ndi dokotala. miyeso kwakukulu mu nkhani iyi si nthawi zonse anasonyeza.

alowererepo opaleshoni

Ngati matenda yakula, pali kufunika alowererepo mwamsanga pa opaleshoni. Mwamsanga munthu afika kwa dokotala, ndi apamwamba mwayi kukhala ndi moyo. Ngakhale amafa ndi otsika mu nkhani iyi, kunena za madokotala kuchedwa akhoza ndalama wodwala ngakhale moyo.

Komanso, opaleshoni imaonekera mu Odwala amene wautali zapitazo anapezeka ndi "kung'ambika vavu". Ngati wodwala zachitika zizindikiro, ngakhale poyamba wofatsa, anasiya ventricle contractility wotaya - ndi zizindikiro zonse opaleshoni kung'ambika vavu m'malo.

Buku tisaiwale kuti lero, opaleshoni zambiri malekezero abwino komanso kumabweretsa kufunika zotsatira mtima. opaleshoni yoyamba chidachitika kumbuyo mu 1960 ndi Dr. Harkenom kuti apulasitiki mikanda msempha pulasitiki ndi mphanga zitsulo. Pa gawo la Soviet Union, ntchito koyamba anachita mu 1964, wopambana. Kuyambira nthawi imeneyo, dokotala anayamba njira zambiri ndi njira kuchita opaleshoni khalidwe pazipita komanso zothandiza.

kupulumuka

Ngati wodwalayo zolimbitsa kapena wodekha mtima kulephera, 10 chaka mlingo kupulumuka ndi mkulu ndipo chimachititsa pafupifupi 90% odwala onse. Ngati madandaulo ayamba kutuluka, pali zizindikiro, zinthu lingasanduke mofulumira. Pankhaniyi, ngati inu sachita opaleshoni, imfa angayambe za 2-5 zaka, malingana ndi chitukuko cha matenda ena.

Ngati matenda kwathunthu asymptomatic, kuti madokotala ananena zawo zabwino kwambiri. Zikatero, alowererepo ntchito chofunika% 4 okha milandu. Pa nthawi yomweyo, madandaulo kumachitika odwala pa zaka zisanu - 20% odwala, zaka zisanu ndi ziwiri - pafupifupi 25% ya odwala. Ngati pachimake kulephera, kwambiri, mwina oopsa ngati fibrillation yamitsempha yamagazi. Ngati nthawi kuchita opaleshoni, chitukuko izi zikhoza kupewedwa.

kupewa

miyeso kuteteza anthu osati kuti apeze matenda, palibe. Pankhaniyi, zakudya kapena njira zina za moyo sangathe kuthandiza. Koma pano pali odwala amene ali pa chiopsezo angathe kudziteteza. Choncho, iwo nthawi zambiri pochitika mayeso pa dokotala, kupanga ndondomeko kusankhidwa. Sankhani ndi kafukufuku angakhale osiyana, koma simungathe kukaonana ndi adokotala anu zochepa zambiri kuposa 1 nthawi pachaka.