Xiisad wadnaha: calaamadaha intuusan dhiman iyo gargaarka degdegga ah

Sannad kasta, cudurka nidaamka wadnaha taasoo keentay in dhimashada in ka badan 17 milyan oo qof oo dunida oo dhan. % Ka mid ah heley sida Kaliya 10 waa lagu dhasho. Inta badan dalalka cudurka dhacdaa on asalka ah ee walbahaarka iyo qaab nololeedka dadka saboolka ah ee nin casriga ah. In this article aynu eegno waxa gabsiiya wadnaha.

Calaamadaha dhimashada iyo dhibaatooyinka ka dhasha cudurada, hababka ogaanshaha iyo daaweynta cudurka, noocyada iyo qaababka cudurka - macluumaad ku saabsan arrimaha oo dhan laga arki doono qalabka of our dib u eegis. Intaa waxaa dheer, article waxay ka hadlaysaa xeerarka ku dhaqanka, kaas oo noqon kara mid waxtar leh, waayo, wax kasta oo inaga mid ah. Awoodda in ay u dhaqmaan xaalad degdeg ah ka bixisaa xaaladaha inta ugu badan, ilaalinta ee nolosha aadanaha. Iyadoo la raacayo, mid ka mid ah uu leeyahay in la ogaado waxa gargaarka koowaad ee wadnaha ba'an.

Fikradda ah wadnaha oo shaqadiisa gaba

Heart failure (HF) - cudurada, taas oo qalbiga ku jireyso siiyo lacagta loo baahan yahay ee unugyada jirka ee dhiigga. Waa natiijo ah oo awoodda daciif ah ee muruqa wadnaha (myocardium) si loo yareeyo. CH inta badan keenta in daliilka aad u daran clinical, oo ay ku jiraan barar sambabada, Wadnaxanuun, shock cardiogenic.

Cudurka nugul rag iyo dumar, laakiin ugu dambaysta ee la ildaran cudurka this marar badan. Dhimashada Waa sare oo ku filan cudurada ka. Khatarta in nolosha aadanaha ayaa mid ka mid ah daliilka uu keeno cudurada sida gabsiiya wadnaha. Astaamaha ka hor geeridiisa, loo yaqaan ee daawo lama filaan ah, waa mid aad u kala duwan. Waxay ku xiran tahay nooca cudurka dhacdaa. By dabiiciga ah ee asalka ah ee wadnaha waa distinguished:

• Myocardial infarction wadnaha - cudurada in uu yahay natiijada waxyeelo toos ah muruqa wadnaha ay sabab u tahay xadgudub ka dhan ah shiid tamarta. Noocan ah wadnaha oo shaqadiisa gaba keenaysaa in cillad ee foosha iyo nasashada ee wadnaha.
• Dollar wadnaha oo shaqadiisa gaba - cudurada ah in uu yeesho iyadoo ay sabab u load badan oo ku saabsan waxyaalaha qalbiga ku jira. Noocan mararka qaar waxay yeeshaan ku saabsan asalka ah ee cudurka wadnaha.
• Isugeynta wadnaha - nooc ka mid ah cudurada, kaas oo isku daraa labada sababaha kor ku xusan.

Fasallada wadnaha oo istaagay

Si aad u taariikhda, waxaa jira shuruudo kala duwan by kaas oo cudurka u qaybsan yahay nooc ama noocyo. Medicine, waxaa jira dhowr nidaamka qoondaynta (Ruush, Yurub, Mareykanka), laakiin habka ugu caansan waa la soo jeediyay by wadnaha Maraykanka. Iyadoo la tixraacayo habkan jira afar fasalo cudurka:

• Fasalka 1, kuna waari dhexdeeda bukaanka baxdo dyspnea mooshin firfircoon, tusaale ahaan, tallaabooyinka kici heer ka sarreeya dabaqa saddexaad.
• Fasalka 2, badanu ku jiraan dyspnea xitaa at load yar yahay - marka u qaadaya dabaqa koowaad ama labaad. Waxaa la xusay hoos u dhaqdhaqaaqa jirka qofka.
• Grade 3, kuna waari dhexdeeda wadnaha waa dareemi at xamuulka yar yahay, tusaale ahaan marka socda, laakiin cudurka quiescent calaamadaha baaba'aan.
• Fasalka 4, taas oo calaamadaha dhici xitaa nasan, iyo jimicsi yar oo keenta in xadgudubyo halis ah ee wadnaha iyo nidaamka oo dhan wadnaha oo dhan.

Qoondaynta CH

Pathology loo kala saari karaa sida ay dhowr shuruudaha. Iyada oo ku xidhan sawirka caafimaad ee dawada cudurka loo yaqaan ba'an iyo chronic wadnaha ah.

wadnaha Ba'an (AHF) - disorder ah oo calaamado cudur si degdeg ah (saacadood gudahood). Sida caadiga ah, ka dhanka ah asalka ah oo ah cudurrada kale ee nidaamka vascular oo halkaas waa wadnaha ba'an.

Wadnaxanuun, myocarditis iyo cudurrada kale ee ay noqon karaan kicin karta dalalka cudurka, maxaa yeelay, hoos heley kuwan, unugyada muruqa wadnaha dhiman sabab u ah xanuunada wareegga dhiigga maxaliga ah. OCH sidoo kale ku keeni karta jab derbiga ventricular bidix, failure ba'an ee filtarka (ku aortic iyo mitral). Xaaladaha qaarkood, cudurada yeesho oo aan xadgudubyada ka hor.

OCH - cudurka arrin uga hornimaadno maxaa yeelay waxa ay keeni kartaa xaalad xanuun badan oo ka mid ah hababka kale ee jirka. Dhibaatooyinka wadnaha ba'an badanaa ku dhaca ma aha oo kaliya wadnaha, laakiin sidoo kale nidaamka neef-mareenka, taasoo keenta barar sambabada, neefta wadnaha, shock cardiogenic.

Chronic wadnaha - disorder ah oo cudurada ah waxaa si tartiib ah sameeyay, in ka badan toddobaad, bilo ama xataa sanado. Waxay dhacdaa dhanka ah asalka ah oo ah cudurka wadnaha, dhiig-karka ama anemia sii dheeraaday.

Noocyada DOS nooca hemodynamics

Iyada oo ku xidhan nooca deegaamaynta hemodynamic caan cudurada, waxaa jira foomamka soo socda ee wadnaha ba'an:

• DOS la hemodynamics gabsiiya.
• DOS la hemodynamics hypokinetic.

Hemodynamics - waa socodka dhiigga iyada oo weelashii, oo ka dhigay in cadaadis weyn qaybaha kala duwan ee nidaamka wareegga dhiigga. Waxaa la og yahay in dhiig qaadista iyo ka gobolka a of cadaadis sarreeya oo si hoose.

Cadaadiska ay ku xiran tahay nafwaayay dhiigga, iyo iska caabin ah oo ka mid ah derbiyada marinnada dhiigga geysto. DOS la hemodynamics gabsiiya laga yaabaa in saameyn midig ama ventricle bidix ee wadnaha. Iyadoo la tixraacayo kala soocin this:

• Xiisad failure ventricular midig, taas oo Stasis ee arooriyaha lagu arkay goobo badan oo ah socodka dhiigga, ie. E. Saameyn ku dhowaad dhammaan xubnaha iyo unugyada.
• Xiisad ka tagay failure ventricular, taas oo Stasis ee arooriyaha dhacdaa socodka dhiigga pulmonary. Pathology dhibsadayoo sarrifka gaaska ee sanbabada ayaa waxaa ka iyo keenaysaa in horumarka barar sambabada ama neefta wadnaha. Sayidka, ka dhanka ah asalka ah oo ah xadgudub noocan oo kale ah wuxuu dhacaa ba'an cudurka wadnaha sambabada.

DOS la hemodynamics hypokinetic

failure Xiisad wadnaha lagu jiro hemodynamics a hypokinetic - cudurada uu keeno lama filaan ah cardiogenic - hoos u dhac af ee awoodda myocardium ah qandaraas, taasoo keentay in carqalad ah ee dhiigga oo dhan unugyada jidhka.

kala saaro:

• lama filaan ah Arrhythmic, taas oo sabab u ah xanuunada garaaca wadnaha.
• Shoogga reflex - cadaanyo xanuunka.
• lama filaan ah cardiogenic True - xaalad cudur oo waxay dhacdaa marka lesions ah unugyada ee ventricular bidix, iyo meesha dhaawaca ugu yaraan waa 50%. Ku xadgudubka, sida caadiga ah, waxay u badan u nugul dadka ka weyn 60 sano jir; dadka ayaa weerar wadnaha labaad; bukaanka qaba dhiig-karka iyo macaanka mellitus.

Muhiimsan, si lama filaan ah cardiogenic waxa lagu gartaa xanuun, lama filaan ah hoos u dhac cadaadiska dhiigga in qiimaha ugu yar (hoos si 0), garaaca wadnaha filiform, jirka oo caddaado. Pathology laga yaabaa in markii danbe ku biiro barar sambabada ama keeni ka renal failure.

Sababaha ka qeyb ah ee OCH

Horumarinta ee wadnaha oo shaqadiisa gaba koorso ba'an, bukaanka la Horeeyey laga yaabaa by a hore kala kulantay cudurada of vascular ee nidaamka. Xaaladaha noocan oo kale ah waxaa ka mid ah:

• cudurka wadnaha keenta waxyeello muruqa wadnaha, taasoo keentay in hoos u dhac af ee awoodda myocardium qandaraas;
• wadnaha chronic, oo jebiyo marka sahayda dhiigga caadiga ah in xubnaha iyo unugyada,
• dhaawac daacadnimada filtarka wadnaha iyo tuubooyinka,
• raasamaal ah ee dareeraha ah ee pericardium ah, taas oo horseedaysa in ay xadgudub ku ah heerka wadnaha xaq u sabab u tahay cadaadiska iyo cunfiga on saabka waxyaalaha qalbiga ku jira (pathology tani waxaa la yiraahdaa tamponade wadnaha);
• dhagid darbiyada waxaa qalbiga ka soo - hypertrophy myocardial;
• dhibaatooyinka hypertensive - calaamadeeyay aan caadi ahayn dhiig karka.

sababaha noncardiac

Waxa intaa dheer in dhibaatooyin qalbiga oo si bixitaanka wadamada cudur la lug laga yaabaa in cudurada la xiriira cadaadis dhiig oo sareeya ee socodka dhiigga pulmonary. Cudurada oo keeni ogaanshaha "wadnaha ba'an":

• stroke - xadgudub wareegga maskaxda, taas oo dhirfinaya ay unugyada dhaawacan iyo guud ahaan disorder shaqada maskaxda;

• halbowlaha thromboembolism ee sambabada (cudurka ku dhacaa sabab u ah xannibaad ah halbowlaha pulmonary, iyo sidoo kale sida loo xinjiro dhiig (thrombi) ay, inta badan xinjiro dhiig oo ka dhaca xididdada addinka miskaha iyo hoose waaweyn);
• cudurada sanbabada - barar ku dhaca bronkie (bronchitis), barar unugyada sambabada (pneumonitis);
• Heerka dysrhythmia wadnaha (xawaaraha ama deceleration) - tachyarrhythmia, bradyarrhythmia;
• caabuqa sababa wareer kala duwan.

Waxaa sidoo kale jira arrimo taasoo keentay in horumarinta wadnaha oo shaqadiisa gaba, laakiin aan muuqan cudurada qaababka xubnaha kasta. Kuwaas waxaa ka mid ah:

• qalliinka;
• dhaawac iyo maskaxda dhaawac;
• weerarkii sunta on muruqa wadnaha - khamriga, daroogada gaadhista dagaal;
• mishiinka wadnaha-sanbabka, isticmaalka taas oo horseedaysa cawaaqib gaar ah;
• electrotrauma - saamayn on jirka ah ee hadda korontada,
• dirqin psycho-niyadeed ama jireed.

Garashada wadnaha ba'an

Soo ogaanshaha wadnaha ugu horayn waxa la faray in ay go'aan ka soo baxay sababaha keentay in horumarinta cudurada. Ka hor inta fulinta baaritaan sheybaar iyo manipulations iyadoo la isticmaalayo qalab caafimaad, dhakhtarka ayaa go'aamin doona iyada oo loo marayo wada hadal la bukaanka joogitaanka ama maqnaanshaha in uu naftiisa arrimo kala duwan oo qayb ka ah horumarinta cudurada sida wadnaha ba'an. Calaamadaha dhimashada (kedis ah) wuxuu dhacaa 24 saacadood gudahood, ayaa laga yaabaa inuu daciif ah, iyo hawl takhasus - in aan lumin waqtiga, iyo iyada oo la tixgelinayo dhammaan cabashooyinka bukaanka sida ugu dhakhsaha badan si loo ogaado cudurka saxda ah.

Hababka cilmi weyn ee loo isticmaalo in cudurka of AHF, waxaa ka mid ah:

• electrocardiogram ah;
• echocardiogram;

• xabadka X-rays;
• baaritaanka dhiigga guud iyo heerka sare,
• Waxaa mararka qaarkood loo isticmaalo cardiovisor OCH ogaanshaha - Mabda 'qalab hawlgalka jiro kala duwan oo ka electrocardiograph ah.

shuruudaha lagu ogaanayo

calaamad ugu weyn oo ugu fahmayaan of ba'an wadnaha oo shaqadiisa gaba hadda la odhan karaa tachycardia sanka - sameeyaan tachyarrhythmias supraventricular, kaas oo sifo la degdegsiimada laxanka sanka - inta jeer ee foosha qalbiga qof weyn waa in ka badan 100 halkii daqiiqo. bandhigay Graphic dhaqdhaqaaqa qalbigiisa ku muujinayaa soohdintu waxay amar wanaajiyey bidix ama midig. Intaa waxaa dheer, on top of ama kor ku xusan nidaamka xiphoid midab saddexaad muuqataa.

Xiisad gabsiiya wadnaha xaq u muuqato in muuqaalada kala duwan:

• xididka dhuunta ilmo-galeenka iyo xididdada cagaarshowga bararin oo barara,
• cadaadiska arooriyaha sare;

• sii kordhaya beerka, go'yaal joonis;
• Addinka barar,
• Farahaaga ku taqasuusay wajihi (dhegta, garka, sanka);
• bukaan-socodka uu leeyahay xanuun aad u daran ee uu Rubuca sare midig,
• ECG Qori wadnaha dollar si kadis ah ventricle midigta iyo Atrium ah, taasoo ku muuqata by ilkaha sare wadno.

Calaamadaha xaq u wadnaha waxaa si cad shaaca ka qaaday by X-ray iyo wadnaha. heerka ugu dambeeya ee noocan ah ee cudurka wadnaha keenaysaa in daaqa ee jirka, yareeyo heerka protein dhiigga iyo qas ah dheelitirka cusbo ee jidhka ku jira.

Calaamadaha ventricular bidix failure iyo shoog cardiogenic

Taa baddalkeeda, joogitaanka ba'an failure ventricular bidix la hemodynamics gabsiiya cadaynaysay tiro ka mid ah sifooyinka soo socda:

• neefta oo ku qabata, mararka qaarkood jeestay galay neefta,
• qufac qalalan paroxysmal, expectoration mararka frothy, kaas oo la sii daayay afka ama sanka ka;
• joogitaanka crackling qoyan kuwaas oo maqlay dushiisa oo dhan xabadka.

Waxaa jira tiro ka mid ah calaamadaha caan ku filaan ah cardiogenic, kuwaas oo:

• Cadaadiska dhiigga ee bukaanka ugu dhaco, si qiyamka 90-80 mm Hg. Art. iyo xataa ka yar. Haddii qof xanuunka dhiig-karka, waa calaamad ka mid lama filaan ah hoos u dhici doonto 30 mm Hg. Art. ka heer shakhsi maalin kasta.
• hoos u cadaadiska wadnaha - in ka yar 25-20 mm Hg. Art.
• Tuhun of shock cardiogenic waa keeni midabka maqaarka iyo ay jilcid. daliilka waxay muujinaysaa xadgudub ku ah microcirculation ee unugyada jidhka.

Iyadoo ninkii laga helay calaamadaha kor ku xusan ee cudurada, waa inuu jiraa taxane ah oo dhacdooyin ka hor inta ay ka imanayaan ku takhasusay. (. Stroke, wadno xanuun, iwm) Gargaarka degdegga ah ee loogu talagalay wadnaha ba'an waa in lagu hagaajiyaa si loo hubiyo in:

• diyaarin helaan hawo cusub;
• loo hubiyo booska siman ee bukaanka (haddii waxa uu leeyahay oo aan lahayn calaamadaha ventricular bidix failure);
• qaban saamayn xanuunka.

Daaweynta wadnaha ba'an

Daaweynta wadnaha oo shaqadiisa gaba - therapy adag loogu talagalay, ugu horrayn, in la hubiyo in:

• baabi'iyo dollar muruqa wadnaha - cabbirkan waxaa lagu gaarayaa by isticmaalka daroogada in hoos u cadaadiska dhiigga iyo garaaca wadnaha,
• qabtaan calaamadaha cudurka (tallaabooyin daweyn ku xirnaan doontaa daliilka daliilka cudur).

Haddii DOS ayaa waxaad fartaan Wannaagga iyadoo ay sabab u Wadnaxanuun myocardial, waxaa lagama maarmaan ah sida ugu dhaqsaha badan si loo soo celiyo socodka dhiigga halbowlaha wadnaha. Caadi ahaan, xaaladda sababa infarct thrombosis halbowlaha, qalbiga ku quudiyo. Daawaynta caawisaa xinjir dhiig si buuxda loo soo celiyo patency xidid dhiig oo lagu xasilinayo xaalada bukaanka.

Habka ugu caansan ay dhacdo in this waxaa loo arkaa inay thrombolysis, laakiin nidaamka waa in la sameeyaa sida ugu dhaqsaha badan ka dib bilawga Wadnaxanuun ilaa xinjir weli waa "cusub". Gargaarka degdegga ah ee loogu talagalay wadnaha ba'an ku lug leedahay isticmaalka daroogada (thrombolytics), kuwaas oo ficil loogu talagalay kala diridda ee xinjiro dhiig. Medicaments maamula intravenously, iyagoo heerka wax lays geliyey shaqeeyo si adag loo nidaamiyo.

Daaweynta failure ba'an (ventricular midig) oo la hemodynamics gabsiiya ku lug leedahay ka saarista oo sababa in ay sababtay, - .. Status asthmaticus, inotropic xinjiro dhiig ee halbowlayaasha pulmonary, iwm bilaabo bukaanka caga therapy "Nitroglycerin" ama "Furosemide" marka la isku daro lama filaan ah cudurada cardiogenic isticmaalo ka dhigan tahay. In lagu daro tallaabooyinka kor ku xusan waxaa lagu fuliyaa by neefsasho oxygen la marinayo tuubo.

cadhoodaan Psychomotor socoto analgesics maandooriyaha, sida "morphine", taas oo yaraynaysa shaqada oo ka mid ah murqaha-mareenka iyo yaraynaysaa stress on wadnaha.

Tirtiridda calaamadaha failure ventricular bidix

Fadhiidka ah ee dhiigga ee sambabada ah inta badan keenta in cawaaqib daran sida barar sambabada. Marka bukaanka khaladaad sida qoray maamulka "Nitroglycerin" intravenously.

Haddii ba'an failure ventricular bidix la hemodynamics gabsiiya weheliso lama filaan ah cardiogenic, qori hordhaca ah ee "dobutamine" ama "noradrenaliin" intravenously. Waxaa jira xaalado marka daawooyinkan lagu daro in a adag.

Xumbaynayso jaray via siyaabo bixinta burburkii xumbo.

Haddii hemodynamics xasilin, laakiin calaamadaha bararka sambabka ku adkaystaan, bukaanka maamula glucocorticoids. Xaaladdan oo kale, gargaarka degdegga ah ee wadnaha ba'an caawin doonaa si loo yareeyo permeability ee xuubka.

Therapy lama filaan cardiogenic bilaabo si loo kordhiyo wax soo saarka wadnaha, ay ka maqan yihiin daliilka ee hawl gabsiiya wadnaha waxay ka kooban tahay maamulida expanders plasma. Habkani waxaa loo sameeyaa oo keliya gacanta ugu garaaca wadnaha, cadaadiska dhiigga iyo Neefta. Haddii ka hor inta dhacdo ee cudurada wadnaha ba'an ka dhacay khasaare weyn oo cabitaan ah, chloride sodium waxaa loo isticmaalaa.

Tirtiridda calaamadaha cudurka, dabcan, ugu horrayn la xiriira isticmaalka daroogada, laakiin haddii tallaabooyin qaaday ha noqonin mid horseeda in saamayn la doonayo, waxaad isticmaali kartaa sida saxda ah - si ay u qabtaan dejinta hemodynamic iyada oo iska fur a on xididdada addinka.

Mararka ay dhacdo daawo muxaafidka ah waa karayaan inay door biday in ay qaliin. Data by reebay dhibaatooyin la xiriira qabsamin of xididdada, iyo khaanadaha wadnaha bedelka. Negaanshaha heerka wadnaha ka caawisaa si loo soo dajiyo pacemaker ama defibrillator.

ka hortagga

Habka ugu wanaagsan ee looga hortago horumarinta cudurka - waa in ay u hoggaansamaan xeerarka fudud - kuwaas oo, si uu u hoggaamiyo hab nololeed caafimaad leh, joojinta sigaarka iyo quusan isticmaalka xad-dhaafka ah ee khamriga, si ay u fuliyaan kormeerka wareegsan cudurada raaga jira. Si kastaba ha ahaatee, mararka marka cudurka ayaa weli laftiisa muujiyey, waa inay raacaan nidaam gaar ah ee nolol maalmeedka.

Bukaanka qaba gabsiiya wadnaha waa in si dhow ula socdaan miisaankooda. kilo dheeraad ah ka cadhaysiinina kordhiyo sonkorta dhiigga iyo formation of dabar kolestaroolka in xididdada dhiigga, taasoo keenta cadaadis dhiig oo sareeya. xaalad muhiim u ah dayactirka xaalladda jireed si caadi ah ku xiran yahay cunto gaar ah cunto. Waxaa lagama maarmaan ah in ay si adag nidaaminaya qaadashada Cusbada, xad-dhaaf ah kaas oo u xun tahay caafimaadka - waxa sababa dareeraha, formation bararka, kor u load on wadnaha.

Waa waxtar leh in ay sameeyaan jimicsi, siin load a muruqyada iyo laabatooyinka, laakiin fasalada ciyaaraha waa in aan keeni dollar ee jirka. set A jimicsi in la isku raacay in la dhakhtarka. Waxaa muhiim ah in si joogta ah u booqan hawada u furan, seexan, iska ilaali stress iyo dadaalka badan maskaxda.

Isku soo duuboo, waxaa la ogaadaa laga yaabaa in wadnaha ba'an - cudurada in uu yahay inta badan lagu dhinto. Cudurku waxa uu caadi uu yeesho ee asalka ah ee dalalka cudur kale ee nidaamka wadnaha iyo keenaysaa in dhibaatooyin kala duwan, oo ay ku jiraan stroke, shock cardiogenic, barar sambabada, iyo wixii la mid ah.

Waxaa jira calaamado, oo waxaa lagu ogaada ayado wadnaha ba'an. Calaamadaha dhimashada dadban ka muuqato, waxaa sidaas daraaddeed hawl muhiim ah xirfadlayaasha waa diiwaanka dhammaan cabashooyinka bukaan-socodka iyo baaritaanka degdeg ah.