CHF: kupatsanura. Chirwere chemwoyo kurapwa

Chirwere mwoyo kukundikana, zviratidzo izvo zvichashandiswa kurondedzerwa hereinafter, ari zvokurwara, zviratidzo zviri chokuita kweropa nenyonganyonga. State pana zororo uye panguva mupfungwa uye ari pamwe chete kunonoka mumuviri Urume. Treatment kuti zvemwoyo chirwere dzakawanda pakurapa uye comprehensively akaita. Panguva Chaiyo kuwana chiremba rinokurudzira kuva nokukurumidza kuzoita ropa kuyerera uye kubvisa chirwere. Next, isu funga mashoko chii chinoumba CHF. The kupatsanura pakati chirwere, zviratidzo uye dzokurapwa kupindira zvicharehwawo kurondedzerwa munyaya.

tsananguro

CHF, riri zvikuru rakakura kupatsanura anobva rutapudzo kwomuviri kukwanisa kupomba ropa kusvikira Kuburitswa mu kana zvinodiwa. Ichi chirwere kunokonzerwa, pakutanga kwezvose, tsandanyama lesion. Zvinokoshawo ndezvokuti ndiye kusaenzana kwezvinhu hurongwa kukanganisa zvemwoyo basa.

zvekuchipatara mufananidzo

Sezvo akaratidza chisingaperi mwoyo nokukundikana? Zviratidzo zvinotevera zvirwere:

• Kupfupika mweya - kudzika nokutsanya kufema.
• Kuneta - kuderedza portability pamusoro kwakajairika muviri.
• Peripheral edema. Kakawanda aonekwa makumbo uye netsoka, pamusoro kwenguva, simuka kumusoro, kuripa yehudyu rusvingo pamberi peritoneum, muchiuno uye zvichingodaro.
• cardiopalmus
• Chikosoro. At kutanga matanho zvaoma, uye ipapo anotanga vaparadzane sparse sputum. Naizvozvo, anogona kuonekwa ne ropa activation.
• Position orthopnea. Murwere zvinovawo zvakakodzera kuti avate musoro wako akakwidziridza (pamakusheni Somuenzaniso). Mune sandara chinjikira nzvimbo vanotanga kukura pfupi kufema uye chikosoro.

pathological chimiro

Pasinei kunhaka pamusoro kuchirapa kupindira, murwere nemamiriro anogona kuipa. Panyaya iyi, kudiwa kwazvo chirwere chemwoyo uye kweropa hurongwa. akatsvakurudza zvakadzama ichafukura yakavanzika ude. CHF ega matanho anotevera:

• Wokutanga (kwokutanga). Panguva iyi, hapana CHF kweropa zvirwere. Kana echocardiography akaratidza dysfunction mu ventricle kuruboshwe yakavanzika.
• A wechipiri (symptomatic). State kunoratidzwa vasingadzoreki hemodynamics (ropa kufamba) mumwe madenderedzwa.
• The B wechipiri (kwazvo). Danho iri kunoratidzwa hemodynamic kusagadzikana mune zvose madenderedzwa. Uyewo zvakanga akaona kukundwa muviri zvivako uye makwara ropa.
• Wechipiri (wokupedzisira). State achabatsirwa vasingadzoreki hemodynamics kududzwa. Heavy kazhinji kusingarapiki zvachinja sechivako kubaya nhengo uyewo anowanzoramba kuti chimiro ichi komoyo kukundikana.

zvokurwara kupatsanura zvinogona kuitwa maererano dzichipfekeka mhando. All zvina.

dzichipfekeka marudzi

Sezvaiitwa yapfuura kupesana, kuchinja vangava yakananga kuvandudzika uye kudzikira, kunyange tikafunga yaipfuurira kuchirapa kupindira kuti chirwere chemwoyo dzakaonekwa. Kupatsanura maererano basa mhando sezvinotevera:

• Wokutanga mhando kunoratidzwa kusavapo kukamurwa kurovedza muviri. Ziendamberi kurovedza muviri muviri murwere anogona kushivirira pasina kuratidza chirwere. Slow kupora mamiriro kana dyspnea zvingaitika kana mumwe overvoltage.
• Nokuti chechipiri mhando kunoratidzwa ne Kurambidzwa kwebasa muduku pamwero. Zvokurwara hakuiti unooneka pa zororo. Zvatinosiita, nemamejasitiriti muviri kurovedza akashivirira nevarwere vane kupfupika kufema, kurukutika, kana rokumuka mutinhimira. Panguva iyi, varumbidzwa chaizvo cardiac Diagnostics.
• In rechitatu mhando pane zvikuru basa kukamurwa. Kusagadzikana mune murwere pa zororo zvisipo. Zvishoma zvikuru kupfuura dzose mumuviri nesimba iri pamwe nekuratidza zviratidzo zvokurwara.
• Kana chechina mhando ipi basa murwere pamwe zvisingafadzi nezvekufadza. Zviratidzo zvokurwara kwakacherechedzwa murwere pa zororo, amplifying pamwe shoma mumuviri nesimba.

kuzara mapazi

Zvichienderana zvaunoda localization kuti zvinetso, murwere anogona ringazivikanwa:

• Right ventricular kukundikana. Panyaya iyi, kuti kurega kunotanga vakachengeta ari pulmonary - pulmonary ropa makwara.
• Kusiyiwa ventricular kukundikana. Muchiitiko chino, vemunyika kuzara guru denderedzwa - muropa migero yemvura nhengo dzose kunze mumapapu.
• Dvuhzheludochkovaya (biventricular) kukundikana. kurega kunotanga ropa iri nyaya iri kuchengetwa vaitenderera maviri panguva kamwe.

danho

Mabatirwo zvemwoyo chirwere anosarudzwa maererano kunotoda mufananidzo. The kuratidzwa kuvimba localization pamusoro pathologies zvirwere uye precipitating zvinhu. Zvakafanana zvinokosha kusarudzwa mishonga ine nhoroondo chirwere. CHF anogona chokuita havachanyatsogoni diastolic kana / uye systole. Saizvozvowo, ziva zvakawanda pathologies maitikiro. Zvikurukuru pane:

• Systolic mwoyo kutadza. Rinobatanidzwa ne chirwere systole - nguva ventricular marwadzo.
• Diastolic kukundikana. danho iri kuti mitemo diastole - ventricular kuzvivaraidza nguva.
• Mixed chimiro. Muchiitiko chino, pane kutyorwa diastole uye systole.

zvikonzero

Pakusarudza kuchirapa nzira kuti kubvisa CHF dhigirii danho uye chimiro dzinokosha. Zvisinei, chinokosha ndiko kuziva zvinokonzera uye zvokurwara. Chirwere mwoyo kutadza zvinogona kukonzerwa:

• Myocardial infarction. In ichi pane kuparadzwa pomwoyo, Rinobatanidzwa ne kumira ropa riyerere kwairi.
• CHD tisina myocardial infarction.
• NeBP - kuwedzera kwakuri nevezera.
• Mishonga. Kunyanya, zvokurwara angatanga nokuda pakushandisa anticancer zvinodhaka uye medicaments nokuda pakupora unodiwa.
• Cardiomyopathy - pomwoyo zvinokuvadza pasina abnormalities zviri arteries pachavo muviri wayo vharafu maronda, uyewo neBP.
• Diabetes.
• Thyroid maronda.
• Zvirwere zviri adrenal basa.
• Kufutisa.
• Cachexia.
• Kushaya vakawanda aitodada zvinhu uye mavhitaminzi.
• Amyloidosis.
• Sarcoidosis.
• HIV.
• Inouraya renal insufficiency.
• Atrial fibrillation.
• Heart nechigumbuso.
• Dry uye exudative pericarditis.
• Vachiberekwa uye vawana mwoyo kuremara.

Kuziva zvokurwara

Chirwere "CHF" anoiswa pachishandiswa kuongorora kuti zvichemo anamnesis. Mubvunzurudzo pamwe chiremba kuudza murwere kana paine zviratidzo zvokurwara uye chii richibatanidza navo vanorwara. Zvinoitawo sokuti dzimwe zvirwere vakanga murume uye nemhuri yake. Nyanzvi anofanira kuziva zvose mishonga rakatorwa murwere. On kuongororwa mumuviri, vakafunga ganda ruvara, kuvapo edema. Kana kuteerera mwoyo akatsunga kana ruzha chipo. Akazivisawo kuvapo kuzara mumapapu. Sezvo zvaida zvidzidzo basa weti uye miedzo ropa. Research anogona kuona comorbidities kuti vatingakurudzira nzira CHF. Treatment hazvisi yakaoma, zvainanga kubvisa zvirwere background. Kugadzwa sezvo nokukanganisika ropa. Maererano zvabuda pakutsvaga wevasungwa kuti remafuta akawandisa uye ayo zvikamu zviduku, urea, creatinine, shuga, potassium. The Kuongororwa pamusoro thyroid mahormone. Mazvikokota anogona vanonyorera immunological kudzidza. Panguva chinoitwa pakutsvaga pachiyero antibodies mumwoyo rinenge uye zvigare.

Studies kushandisa midziyo

ECG anobvumira rokuongorora mutinhimira kubva heartbeats, ziva arrhythmias, muviri saizi madhipatimendi, uyewo kuziva ventricular scarring. Kuongorora ruzha inoshandiswa phonocardiogram. Achibatsirwa ane fungidziro pakati vharuvhu pakutsvaga pamberi systolic kana diastolic ruzha. Kuongorora Zvivako mapapu uye mwoyo inoshandiswa bani radiography yacho sternum. Kudzidza uku ndiko kuona kukura uye Vhoriyamu nhengo, kupomba ropa kuona pamberi kurega kunotanga. Echocardiography inoshandiswa kuongorora kunzvimbo dzose mwoyo. Panguva nzira kurondedzerwa parusvingo ukobvu zvikamu uye mavharuvhu. Uyewo, achishandisa echocardiography anogona kuonekwa sezvo varehwa kuwedzera nevezera mune pulmonary midziyo. Analysis ropa kuyerera anoitwa panguva dopplerEhoKG. Chiremba wenyu anogona mishonga nezvimwe tsvakurudzo, kuwedzera kune ivavo.

CHF kurapwa: audzwa

Chokutanga, murwere itungamirirwe chinokosha kudya. Zvokudya shoma yomunyu magiramu matatu emura kuti 1-1.2 litres pazuva. Products vanofanira nyore kugaya, kuva chaizvo mukuru-mafuta, vhitamini uye mapuroteni ari kunodiwa mari. Gara murwere anofanira kumushandisira yairema. kufuta anodarika 2 makirogiramu kwemazuva 1-3 zvinowanzoita anoratidza imba kunonoka mumuviri Urume uye decompensated mwoyo nokukundikana. Treatment Angasanganisira rubatsiro nepfungwa. It ndehwokuti mhanyisa murwere apore. rubatsiro Psychological inogona inopiwa nehama murwere. Varwere hazvinatsoita mapfumo chose mitoro. basa pamwero Akatsunga mumwe murwere nomumwe. Sarudzo dzinofanira kupiwa simba zvinorema.

The chikuru chinodhaka kurapa

Zvinodhaka kuti mwoyo nokukundikana vanokamurwa muzvikwata: chikuru, yechipiri uye ebetsero. Boka rokutanga zvinosanganisira:

• ACE FIs. Ivo pave kuderedza kuchinja kwezvirwere, kudzivirira mwoyo, itsvo, tsinga, kudzora BP.
• angiotensin Kanotokonya mhandu. zvishandiswa izvi pachii hypersensitive ACE FIs kana pamwe navo yakasanganiswa.
• Beta-blockers ( "Concor" zvinodhaka, "Inderal" uye vamwe). nzira izvi zvinopa simba pamusoro kumanikidzwa uye mwero reductions vane antiarrhythmic kushanda. Beta-blockers vari kutarisirwa pachiimbwa ACE FIs.
• Diuretics ( "amiloride" zvinodhaka "Furosemide" uye vamwe). nzira idzi kubatsira kubvisa pamuviri zvakawandisa zvinwiwa uye munyu.
• Cardiac glycosides. nzira aya advantageously raitongwa mune mishonga duku atrial arrhythmia.

okuwedzera mari

• Satin vakagadzwa chiitiko kuti mhaka mwoyo kukundikana vachida CHD.
• Anticoagulants zviri kunanga chiito. Kugadzirira veboka iri basa refu ndingangokuvara thromboembolism uye atrial fibrillation.

ancillary zvinodhaka

zvigadzirwa aya nezvaro chaiyo nguva kana vakaratidza matambudziko. Idzi dzinosanganisira:

• Nitrates. nevasori izvi kuvandudza kuerera uye dilates nemidziyo ropa. Medicines veboka iri anogadzwa nokuda angina.
• Karusiyamu mhandu. mishonga aya akaratidza abutment angina, BP (mabiko), yakakwirira BP iri pulmonary migero, kukundikana iziviswe mavharuvhu.
• Antiarrhythmics.
• Antiplatelet yomuchipatara. nevasori izvi anokwanisa zvinoshatisa coagulation zvichivhiringidza platelet agglutination. Medicaments veboka iri vanoonekwa vari yechipiri kudzivirira infarction.
• Neglikozidnye inotropic muviri. Mari idzi dzinoshandiswa mu waivapo kuderera BP uye mwoyo simba.

zvomusejari nzira

Pasina zvinodhaka dzokuteerera kushandisa kunyatsoshanda kushanda zvokuimba chipingaidzo. Kunyanya, murwere anogona kupiwa:

• Coronary tsinga yokunzvenga kusonanidzwa. Operation akaita pakunoratidzwa atherosclerotic vascular maronda.
• Kuvhiya nokururamiswa vharafu kuremara. The chipingaidzo rinoitwa panyaya zvikuru stenosis (aienda) kana vharafu kukundikana.
• Nhego transplantation. Transplantation kwomwoyo iwayo zvikuru kwazvo. Implementation Its kunosanganisira dzinoverengeka nematambudziko:
  
  - fungidzira nerokuzvidzwa;
  - kukwana Nhamba anyatsoronga nhengo;
  - ropa Mipata kukundwa of wakasimwa nhengo, zvishoma zvakaoma kurapa.

• Kushandiswa chakagadzirwa namano kuti vanopa kweropa rutsigiro. Ivo kuzozivisa zvakananga mukati murwere. Mushure ganda pamusoro vari chokuita bhatiri riri pamusoro bhandi murwere. Zvisinei, kushanda midziyo iri achiperekedzwa nematambudziko. Kunyanya, ndingangokuvara zvinotapuriranwa yematambudziko, thromboembolism uye thrombosis. Rinodzivirira kushandiswa zvikuru zvikuru motokari uye kudhura yavo.
• Uchishandisa kwakavharwa nenyama padandemutande kuumbwa. Ivo envelop mwoyo panguva dilated cardiomyopathy. chiyero Izvi zvinoita kunetesa kuwedzera kukura mumuviri, kuvandudza kushanda zvinodhaka dzokupisa, kuvandudza murwere ezvinhu.