Emergency kubatsirwa cardiogenic kuvhunduka: ane algorithm yezviito. nokumutswa amburenzi

Chenjera mwoyo kutadza rinoreva mamiriro upenyu pangozi. Musi mashandiro okukura, rakakamurwa rworudyi uye rworuboshwe ventricular akurumidza. Zvose izvi ezvinhu kakawanda zvinouraya. Kuti aponese murume, amburenzi chiremba vanofanira kutanga pakarepo nokumutswa.

Rakajairika rworuboshwe ventricular mwoyo kukundikana. Kazhinji zvichifambirana myocardial infarction, zvikuru arrhythmias uye zvimwe zvirwere ngozi. Akasiyana-siyana vanosanganisira naArioki chakasimba cardiogenic kuvhunduka. It kunokonzerwa kwazvo maronda kuti muviri umo mwoyo havagoni kupomba ropa kupengereka.

Pfungwa cardiogenic kuvhunduka

Emergency kubatsirwa cardiogenic kuvhunduka inomuda maminitsi waro kukura rokutanga. Zvinofanira kurangarirwa kuti kuomesa ichi haangafambi hwavo. Uye pasina kukurumidza kurapwa kuchaita kuti rufu. Cardiogenic kuvhunduka - munhu chirwere umo pane kuderera cardiac goho. Pasinei compensatory kuwedzera vascular nemishonga, muviri havagoni kukurira kuomesa ichi, pasina kubatsirwa navanachiremba.

By yayo inokosha kuratidzirwa arterial ndokurondedzera zvinoderedza kupomba nevezera, weti goho, kurasikirwa chavanoziva. Kana rubatsiro haina inopiwa nguva, nzufu cardiogenic kuvhunduka kunoitika mukati akawanda maawa pashure pakatanga chirwere. mamiriro Izvi hariwanikwi hwavo. Aigara pakurukurwa chakasimba zvirwere kumwoyo.

Chii chinokonzera zvinotungamirira cardiogenic kuvhunduka?

Zvinokonzera cardiac kuvhunduka zvinosanganisira siyana cardiac uye vascular zvirwere. Rakajairika etiologic chinhu ndechokuti myocardial infarction. Muchiitiko chino, cardiogenic kuvhunduka hwapedyo chete muhombe zvinyama necrosis , uye hapana amburenzi. Panewo kakawanda chikonzero parinowanika zvinosanganisira arrhythmias zvinouraya. Vanogona kuvhiringidza munhu kwemakore akawanda. Asi avo exacerbation uye decompensation mamiriro rakaoma nokuda kuvhunduka.

Mune zvimwe zviitiko, chinhu pamusoro pokumuka rikwanise mwoyo kukundikana anoonekwa kuti kutyora vascular matauriro. Izvi zvinoitika kana muhombe ropa, marwadzo chirwere, chenjera renal kukundikana. Zvinofanira kurangarirwa kuti cardiogenic kuvhunduka - ichi hachisi yakazvimirira chirwere, pakava kuti pane zvokurwara. Saka, vanachiremba vanofanira kuita zvose kudzivirira kukura kwayo.

Cardiogenic Shock: kupatsanura zvirwere

Zvichienderana chikonzero uye pathogenesis kuziva zvakawanda siyana cardiogenic kuvhunduka. Mumwe nomumwe wavo ane yayo mashandiro okukura. Zvisinei, nzira dzose kutungamirira chete zviratidzo. Pasinei ayo zvinokonzera, rubatsiro rwekutanga cardiogenic kuvhunduka kunodikanwa kuzvidzosera. Sezvo mamiriro iri nguva dzose zvakafanana ngozi. Marudzi anotevera yematambudziko:

1. Ichokwadi cardiogenic kuvhunduka. Inokudziridza kana akakanganisa mwoyo tishu. Kazhinji, chimiro ichi imhaka transmural myocardial necrosis.
2. Arrhythmic kuvhunduka. Its zvikonzero zvinosanganisira kudzima uye flutter ventricular arrhythmias, bradycardia rinorema. Kuwedzera arrhythmias, kuti kuvhunduka kungaita kutyora cardiac conduction.
3. Reflex cardiogenic kuvhunduka. Pasi pfungwa iyi, cardiac dysfunction hakuna pashure kuomesa. Kazhinji ikabuda muhombe nokurasikirwa neropa, itsvo kukundikana.
4. Kusateerera kuvhunduka. Ndicho chisarudzo kupfuura nengozi. It oga ari oga boka, sezvo ari inenge nguva zvinouraya uye kwete rinorapika.

True cardiogenic kuvhunduka: mashandiro okukura

Wechokwadi mwoyo kuvhunduka kunoitika kakawanda. It kunoitika apo akauraya neboka guru chikamu myocardium (50% kana kupfuura). Muchiitiko chino, necrosis kunosvika kwete chete mhiri mukobvu tsandanyama, asi ane nzvimbo nzvimbo huru. Kuwedzera chemwoyo, kuti kuvhunduka wechokwadi anogona kukonzera zvirwere. Pakati pavo: .. Utachiwana endocarditis, akaratidza mwoyo chirwere, decompensated chinonzi dystrophy, etc. Panewo zvikuru cardiac rebipolar kunokonzera rikwanise hyperthyroidism, zvimwe zvirwere magene.

Somugumisiro, necrosis mwoyo rinenge contractility ipfupi yekudyidzana. Naizvozvo, muviri haugoni anoshanda zvizere kugona uye inonzi tsinga. Minute vhoriyamu ipfupi, zvakare. Saka pane ichiwedzerwa vascular nemishonga. Pasinei neizvi, mwoyo zvakadaro havagoni kukurira basa ravo. Zvinoguma hwakakanganisika ropa rive zvomukati zvose uye nyama.

Pathogenesis arrhythmic cardiogenic kuvhunduka

Hwaro chimiro ichi chirwere muri kusagadzikana mwoyo mutinhimira uye conduction. Vanogona zvaitika (somugumisiro myocardial infarction) uye kutanga zvishoma nezvishoma. Kakawanda, imwe arrhythmia murwere hanya kwemakore akawanda. Izvi zvinoshandawo conduction abnormalities. Kunyange zvakadaro, upenyu chirwere kukura pamusoro pfupi. Tiri kutaura maawa uye kunyange maminitsi. Kakawanda, cardiogenic kuvhunduka, arrhythmias ose ventricular kutungamirira hunhu. Pakati pavo: tachycardia vanoshandura kupinda fibrillation, uye atrial flutter. Uyezve, azvaiitwa zvinogona kuguma kakawanda boka anorova.

Chimwe chirwere chinogona kukonzera nehana, ndiye sinus bradycardia. Akaderedza kwemwoyo inowanzopiwa hwokuratidza conduction vachivavhiringidza. Zvishoma zvinowanzoita kuti cardiogenic kuvhunduka fibrilloflutter. Somugumisiro, kanganisika sunga uye ectopic foci ari myocardium (anorova) mwoyo haakwanisi kuita ayo ushande. Naizvozvo, zvinoderedza sitiroko uye miniti vhoriyamu, kuwa muna kupomba nevezera BP. Pasi pfungwa iyi nechimbichimbi chiremba chokutanga ndechokuti kusunga fibrillation, defibrillation, kana kushandisa rakagadzirwa nevanhu mwoyo masaja.

Chii dzepanguva kuvhunduka?

chimiro ichi nehana hwapedyo nokuda kwezvikonzero kwete pakutanga chokuita kuvadza pomwoyo. Rukungiso yematambudziko akadaro kunogona kuva kurwadziwa kana ropa. Panguva iyoyowo, Zviratidzo izvi kashoma nechokuita nomwoyo. Kazhinji, kwakadaro kuvhunduka kunokwanisa kuonekwa mushure metsaona, chenjera renal kukundikana.

pfungwa iyi ine kupfuura zvakanaka fungidziro. Emergency kubatsirwa cardiogenic kuvhunduka dzepanguva hunhu zvinofanira zvainanga kugadzirisa ayo chinokonzera - marwadzo, uyewo kurega ropa. Nokuda izvi zvinhu, mutemo vascular matauriro akashatirwa. Nokuda kwaizvozvi, ropa stagnates ari mutsinga uye arteries, uye mune interstitial nzvimbo imwe mvura exuded, pova edema. izvi zvose zvinotungamirira vasanyanye venous chokubuda pamwoyo. Zvadaro, mashandiro akangofanana mune dzimwe nzira.

Zvinokonzera pathogenesis nehana Kusateerera

Kusateerera cardiogenic kuvhunduka kunoitika apo yakarohwa yose myocardium. Izvi zvinoitika kana reinfarction. Uyewo, chikonzero kunogona cardiac tamponade. Muchiitiko chino, pane pericardial mvura iyo anorumanya muviri, kudzivirira kubva kuderera. Mune zvimwe zviitiko, tamponade kungaita kuti atsamwira mwoyo. Izvi ezvinhu chinourayisa. Zvinosuruvarisa, kubatsira murwere hazvisi zvisingaiti. The mashandiro nehana kusonganirana kumbomira wakakwana mumwoyo, mukusiyana kune dzimwe siyana umo rwakapetwa miniti ipfupi. Rufu kubva kuomesa ichi pedyo 100%.

Zviratidzo cardiogenic kuvhunduka

The kunotoda mufananidzo ndiro, pasinei chikonzero zvakakonzera cardiogenic kuvhunduka. Zviratidzo yematambudziko zvinotevera: kuwa BP uye kupomba, tachycardia, oliguria (ungaderedza weti goho). Zvichienderana BP uye kurapwa data, govera 3 inegumi. On kuongororwa, murwere vangazivikanwa, uye zvimwe zviratidzo cardiogenic kuvhunduka. Idzi dzinosanganisira:

1. Cold uye ndakatota ziya.
2. Kutya rufu kana kufenda.
3. Cyanosis - blueness ganda.
4. Features chiso murwere inogona wakarodzwa, chiso chedu - yakapondwa.
5. Skin ruvara kwazvo dhigirii kunova pfumbu.

How rokuongorora zvaitika?

Chirwere pamusoro cardiogenic kuvhunduka inowanzopiwa yakavakirwa kurapwa Data uye mibvunzo nehama murwere. Sezvo zvakakodzera kuita pakarepo, vanachiremba vanoongorora BP, mamiriro ezvinhu ganda, pupillary mhinduro, mwoyo mwero uye respiratoria. Kana murwere ane zviratidzo nehana, pakarepo kupa nechimbichimbi rubatsiro.

In pamberi mudonzvo vakasununguka wezvokurapa akawana nhoroondo chirwere. Chiremba anobvunza kana murwere ari kutambura kubva arrhythmia, angina, zvichida akatambura chemwoyo pamberi? Kana matambudziko yakatanga kumba kana mumugwagwa, nechirwere nehana amburenzi chiremba kugumira ipapo. Kana zviri murwere ari yevanenge zvakatipoteredza, mukuwedzera, nokuyerwa ndiye kupomba kufurirwa, vascular nemishonga, diuresis. Akadzidzawo ropa magasi.

Cardiogenic kuvhunduka: rwekutanga, algorithm yezviito

Zvinokosha kuyeuka kuti sei nokukurumidza uye zvakanaka vaibatsira upenyu murwere kunoenderana. Kana pane zviratidzo yematambudziko akadaro, vanachiremba vari kutanga kutora matanho pakarepo. Kana ukakanganwa kuita chii chinodiwa, zvinokwanisika kuti ndiwane cardiogenic kuvhunduka. Emergency - kutevedzana kwezviitiko zviito zviri sezvinotevera:

1. Isai murwere ari chinjikira nzvimbo ine vanomutswa rutsoka magumo. Uyezve, zvinokosha kuti tibu- kuwana mhepo (unbutton mbatya, svinudzai hwindo).
2. Okisijeni zvitengeswa. Zvinogona kuitwa kuburikidza rinokosha chifukidzo kana nasal cannula.
3. Yokutindivadza. Myocardial infarction uye nehana dzepanguva iyoyo kushandisa zvinodhaka marwadzo. zvinodhaka "Morphine" rinoshandiswa kakawanda. Ake rakasanganiswa mu sesaline uye jekiseni mu / kunonoka.
4. Kudzorerwa ropa kuyerera uye Nyorera mumwe zvisingaoneke. Nokuti Kutarisirwa mhinduro iyi "Reopoligljukin".
5. Kana pasina zvazvakabatsira zvinokosha kusimudza BP Via "atropine" gadziriro 0.1%. Chinotarisirwa munzvimbo chitsama 0.5-1 Rine mamiririta.

Uyezve, zvinokosha kuti kubvisa chikonzero nehana. Myocardial infarction rinoitwa thrombolytic uye antiplatelet kurapa (kugadzirira "Alteplase" "clopidogrel", "asipurini"). Uyewo kushandisa ropa thinners "heparin" mhinduro. medicament "Lidocaine" Kana achiita ventricular mutinhimira vachivavhiringidza. Mune zvimwe zviitiko, rimwe defibrillation.

Emergency hanya muchipatara

Emergency kubatsirwa cardiogenic kuvhunduka anoramba ari yevanenge. Pane chiri kuitwa ndichibvunza kurapa, chichiitwa richiona nezvezvabuda zviratidzo, kuongorora chikonzero matambudziko. Myocardial infarction rinoitwa kuvhiya - yokunzvenga tsinga stent placement. Uyewo, kuvhiya kungwarira mune zvimwe zviitiko arrhythmia uye conduction abnormalities. Panguva iyoyowo kumisa rakagadzirwa nevanhu pacemaker kuita contractile kushanda mwoyo.