Usizo oluphuthumayo ukushaqeka cardiogenic: algorithm yezenzo. yokusiza umuntu ukuba aphefumule-ambulensi

Ukwehluleka oyingozi inhliziyo ibhekisela esimweni okuyisimo esisongela ukuphila. On the indlela yentuthuko, ihlukaniswe yaba sokunene nesobunxele ventricular och. ngokuvamile Zombili lezi zimo ziyabulala. Ukugcina umuntu, udokotela ambulensi kufanele ngokushesha saqala yokusiza umuntu ukuba aphefumule.

Okuvame kakhulu ventricular kwesokunxele inhliziyo ukwehluleka. Kujwayele kulandela isilethikusebenza, arrhythmias ezinzima nakwezinye izimo eziyingozi. Izinhlobonhlobo zihlanganisa och acute ukushaqeka cardiogenic. Sibangelwa izilonda ezinzima emzimbeni lapho inhliziyo ayikwazi ukumpompa igazi ngokuvamile.

Umqondo ukushaqeka cardiogenic

usizo oluphuthumayo ukushaqeka cardiogenic kuyadingeka ngemaminithi ekucala sokuthuthuka. Kufanele kukhunjulwe ukuthi le inkinga ngeke adlule bebodwa. Futhi ngenxa yokuntuleka kwezinhlelo ezibanzi ukwelashwa esiphuthumayo kuzoholela ukufa. ukushaqeka Cardiogenic - a syndrome lapho kukhona ukwehla okukhipha inhliziyo. Naphezu ukwanda compensatory e ukumelana semithambo, umzimba awukwazi ukubhekana nalesi inkinga, ngaphandle kosizo odokotela.

Ngu zako eziyisisekelo lwemithambo nokwehlisa ahlobene e ishayela ingcindezi, umchamo okukhipha, nokulahlekelwa ukwazi. Uma usizo singanikezwanga ngesikhathi, inani labantu ukushaqeka cardiogenic kwenzeka emahoreni ambalwa ngemva ukuqala lesi sifo. Lesi simo ingekho bebodwa. Ngaso sonke isikhathi kwandulelwe izifo okukhulu uhlelo senhliziyo nemithambo yegazi.

Yini ebangela asihole ukushaqeka cardiogenic?

Izimbangela ukushaqeka inhliziyo zihlanganisa izifo ezihlukahlukene zenhliziyo semithambo. Okuvame kakhulu isici etiologic kuyinto isilethikusebenza. Kulokhu, ukushaqeka cardiogenic eba kuphela omkhulu izicubu necrosis , futhi akukho-ambulensi. Kukhona isizathu njalo ngoba ivela khona zihlanganisa arrhythmias ezisongela ukuphila. Abakwazi ukuphazamisa umuntu iminyaka eminingi. Kodwa isimo sabo exacerbation kanye decompensation nzima ukushaqeka.

Kwezinye izimo, isici ukuthuthukiswa ukwehluleka oyingozi inhliziyo ubhekwa ukuhlukumeza ithoni semithambo. Lokhu kwenzeka uma ukopha okukhulu, ubuhlungu syndrome, ukwehluleka oyingozi kwezinso. Kumele kukhunjulwe ukuthi ukushaqeka cardiogenic - lena akuyona isifo ezimele, isimo zokugula ecashile. Ngakho-ke, odokotela badinga ukwenza konke ukuvimbela ukuthuthukiswa yayo.

Shock Cardiogenic: Ukwahlukaniswa izifo

Kuye imbangela kanye pathogenesis ukuhlonza izinhlobo eziningana ukushaqeka cardiogenic. Ngamunye wabo indlela yayo yentuthuko. Nokho, zonke izinketho kuholele izimpawu ezifanayo. Kungakhathaliseki nezimbangela zayo, usizo lokuqala ukushaqeka cardiogenic kuyadingeka kunoma isiphi isimo. Njengoba lokhu isimo njalo kuyingozi ngokulinganayo. Lezi zinhlobo ezilandelayo yezinkinga:

1. Iqiniso ukushaqeka cardiogenic. Kutfutfukisa lizinga lapho lilimele izicubu inhliziyo. Ezimweni eziningi, leli fomu kungenxa transmural necrosis esivimba amanzi.
2. ukushaqeka Arrhythmic. izimbangela zalo zakhiwa kulokolokoza futhi flutter ventricular arrhythmias, bradycardia esindayo. Ngaphezu arrhythmias, ukuba ukushaqeka kungadala kuphula umthetho we conduction inhliziyo.
3. Reflex ukushaqeka cardiogenic. Ngaphansi le ndlela, ukungasebenzi inhliziyo akuyona kwandulelwe inkinga. Kujwayele eba omkhulu ukopha, nokwehluleka ukusebenza kwezinso.
4. ukushaqeka Ukungasabeli. Kuyinto inketho esiyingozi kakhulu. Kwakuthinta behlukaniswe iqembu ahlukene, njengoba cishe njalo siyabulala futhi asilapheki.

Iqiniso ukushaqeka cardiogenic: indlela yentuthuko

Kweqiniso enhliziyweni ukushaqeka kwenzeka kaningi kunabo. Kwenzeka lapho ehlaselwa ingxenye enkulu myocardium (50% noma ngaphezulu). Kulokhu, necrosis ubabonisa hhayi kuphela ngaphesheya imisipha mkhulu, kodwa futhi ithatha indawo enkulu. Ngaphezu isifo senhliziyo, ukushaqeka kweqiniso kungabangela nezinye izifo. Phakathi kwabo: .. endocarditis Amagcikwane, uzwakalise isifo senhliziyo, decompensated sokuwohloka kwemisipha, njll Kukhona ukuphazamiseka okukhulu okuthinta inhliziyo ukubangela i-hyperthyroidism acute, ezinye izifo zofuzo.

Ngenxa yalokho, necrosis of izicubu zenhliziyo contractility kuyehla kakhulu. Ngakho-ke, umzimba awukwazi ukusebenza at zigcwele nokuqinisekisa imithambo yegazi. ivolumu Minute kuyehla, futhi. Ngakho lapho luyanda ukumelana semithambo. Naphezu kwakho konke lokhu, inhliziyo namanje akakwazi ukubhekana nomsebenzi wabo. Imiphumela iba yinhlanganisela yokukhandleka okhathazekile liningi igazi kuzo zonke kwezitho nezicubu.

Pathogenesis arrhythmic ukushaqeka cardiogenic

Ngesisekelo lolu hlobo sifo lezi zinkinga kwenhliziyo isigqi conduction. Abakwazi zenzeka angesabi (ngenxa isilethikusebenza) nokuthuthukisa kancane kancane. Ngokuvamile, isiguli arrhythmia ukhathazekile iminyaka eminingi. Kuyefana nasendleleni conduction kwezinso. Noma kunjalo, isimo esisongela ukuphila eba phezu isikhathi esifushane. Sikhuluma amahora ngisho imizuzu. Ngokuvamile, ukushaqeka cardiogenic, arrhythmias ka ventricular phambili uhlamvu. Phakathi kwabo: tachycardia, kuphenduke fibrillation, futhi flutter atrial. Ngaphezu kwalokho, lezi zinhlelo kungaholela njalo amabhithi iqembu.

Esinye isimo engaholela ukushaqeka, kuyinto bradycardia itheku. Encishisiwe kwenhliziyo ngokuvamile libhekene conduction thuthuva. Ngaphansi ngokuvamile kuholela cardiogenic ukushaqeka fibrilloflutter. Ngenxa yalokho, Kufinyeta okungafanele foci ethunjini e myocardium (amabhithi) inhliziyo ayikwazi ukwenza umsebenzi walo. Ngakho-ke, ukuncipha sohlangothi ngomzuzu ivolumu, ukuwa kokushaya ingcindezi BP. Ngaphansi le ndlela, udokotela eziphuthumayo Into yokuqala ukubopha fibrillation, defibrillation, noma ukuchitha i yokufakelwa inhliziyo massage.

Kuyini shock reflex?

Leli fomu ukushaqeka kukhulisa ngenxa yezizathu ekuqaleni elihlobene ne ukulimala imisipha yenhliziyo. Trigger yezinkinga okunjalo kungaba sebuhlungwini obunzima noma ukopha. Ngesikhathi esifanayo, lezi zimpawu kuyaqabukela nenhliziyo. Ngokuvamile, shock esinjalo sitholakale ngemuva kwengozi, ukwehluleka oyingozi kwezinso.

Le ndlela Izibikezelo ukuzenza athandeke. usizo oluphuthumayo e cardiogenic ukushaqeka reflex uhlamvu kufanele okuhloswe ngalo ukubhekana nezimbangela zayo - ubuhlungu, kanye ukuze kunqandwe ukopha. Ngenxa lezi zici, ukulawulwa ithoni semithambo kuyaphazamiseka. Ngenxa yalokhu, igazi stagnates e emithanjeni yegazi, futhi esikhaleni interstitial uketshezi exuded, ukwakha edema. Konke lokhu kuholela ukwehla nokugeleza emithambo yegazi ukuze inhliziyo. Okulandelayo, lo mshini kuyafana nezinye izinhlobo.

Izimbangela pathogenesis ukushaqeka Ukungasabeli

Ukungasabeli ukushaqeka cardiogenic kwenzeka uma ehlaselwa lonke myocardium. Lokhu kwenzeka uma reinfarction. Futhi, ngesizathu kungaba tamponade inhliziyo. Kulokhu, kukhona uketshezi pericardial okuyinto licindezele umzimba, ekuvimbeleni ke sivuke. Kwezinye izimo, tamponade kungaholela ukudabuka zenhliziyo. Lesi simo siholela ekufeni. Ngeshwa, ukusiza isiguli kuleli cala akunakwenzeka. Mshini ukushaqeka ephathelene ne-ukumisa okuphelele inhliziyo, ngokungafani nezinye izinhlobo lapho ngomzuzu ivolumu sinciphile. Nokufa kusukela kule inkinga eduze 100%.

Izimpawu ukushaqeka cardiogenic

Isithombe sokucindezeleka okufanayo, kungakhathaliseki ukuthi isizathu okubangelwa ukushaqeka cardiogenic. Izimpawu yezinkinga ezilandelayo: ukuwa e wegazi nokushaya kwenhliziyo, tachycardia, oliguria (kwehle umchamo okukhipha). Kuye blood pressure kanye idatha emitholampilo, ukwaba 3 degrees. On luhlolo, isiguli bungabonakala, kanye nezinye izimpawu ukushaqeka cardiogenic. Lezi zihlanganisa:

1. izithukuthuku ebandayo futhi clammy.
2. Ukwesaba ukufa noma nokuquleka.
3. Cyanosis - blueness kwesikhumba.
4. Izici sobuso lesiguli kungenziwa iloliwe, isimo sobuso - ukholo.
5. Skin umbala degree ezinzima iba grey.

Indlela ukuxilonga ukushaqeka?

Ukuxilongwa ukushaqeka cardiogenic ngokuvamile kusekelwe idatha emitholampilo kanye imibuzo we izihlobo lesiguli. Njengoba kudingeka bathathe isinyathelo ngokushesha, odokotela hlola blood pressure, isimo isikhumba, pupillary impendulo, kwenhliziyo Izinga lokuphefumula. Uma isiguli izimpawu ukushaqeka, ngokushesha ukunikeza usizo oluphuthumayo.

Ephambi kwezinduna abasebenzi bezokwelapha khulula wathola umlando lesi sifo. Udokotela ucela uma isiguli uhlushwa arrhythmia, angina, cishe yisifo senhliziyo ngaphambi? Uma yezinkinga athuthukile ekhaya noma emgwaqeni, uphethwe ukushaqeka ambulensi odokotela akuphelelanga lapho. Lapho okuqukethwe isiguli in labagula imvelo, ngaphezu, isilinganiso ingcindezi ishayela, ukumelana semithambo, diuresis. Naye wafundelwa igazi amagesi.

ukushaqeka Cardiogenic: usizo lokuqala, i-algorithm yezenzo

Kubalulekile nokukhumbula ukuthi masinya kanjani basiza ukuphila lesiguli kuncike. Uma kukhona izimpawu yezinkinga enjalo, odokotela sebeqala nithatha isinyathelo ngokushesha. Uma ukhohlwa ukwenza lokho okudingekayo, kungenzeka ukunqoba ukushaqeka cardiogenic. Eziphuthumayo - ukulandelana izenzo simiswe ngalendlela lelandzelako:

1. Beka esigulini ngesimiso evundlile nge ephakanyiswe unyawo sekupheleni. Ngaphezu kwalokho, kubalulekile ukuqinisekisa ukufinyelela emoyeni (izingubo unbutton, ukuvula iwindi).
2. Umoya-mpilo umncane. It kungenziwa ngokusebenzisa buso ekhethekile noma cannula acinene.
3. Anesthesia. isilethikusebenza futhi ukushaqeka reflex ngoba ezisebenzisa izidakamizwa kwezidakamizwa. izidakamizwa "Morphine" lisetshenziswa kaningi. Wakhe buhlanjululwe in nosawoti bese injected / kancane.
4. Ukubuyiselwa ukugeleza kwegazi futhi BCC. Ukuze abaphathi lokhu isixazululo "Reopoligljukin".
5. Uma kungekho ukusebenza kuyadingeka ukukhulisa blood pressure nge "atropine" ukulungiselela 0.1%. Ingabe yaphathwa imali 0.5-1 ml.

Ngaphezu kwalokho, kubalulekile ukususa imbangela ukushaqeka. isilethikusebenza wenziwa thrombolytic futhi antiplatelet therapy (amalungiselelo "Alteplase" "clopidogrel", "aspirin"). Futhi usebenzisa thinners igazi "heparin" isixazululo. nomuthi "Lidocaine" Lapho iqondiswa ventricular isigqi thuthuva. Kwezinye izimo, defibrillation.

ukunakekelwa eziphuthumayo esibhedlela

usizo oluphuthumayo ukushaqeka cardiogenic uyaqhubeka e labagula. Kukhona olwenziwa yokwelapha olunzulu, ukuqapha okuqhubekayo izinkomba, ukuphenya yezinkinga imbangela. isilethikusebenza wenziwa ukuhlinzwa - dlula Umthambo stent ukubekwa. Futhi, ukunakekelwa kuhlinzwa kuyadingeka kwezinye izimo of arrhythmia futhi conduction kwezinso. Ngesikhathi esifanayo ukusungula i pacemaker yokufakelwa kokwenza umsebenzi contractile zenhliziyo.