UtanoZvirwere uye Conditions

Chii AV misa? Atrioventricular misa: Zvinokonzera, Zviratidzo, kuongorora chirwere neMarapirwo

Atrioventricular misa - vasiri nyonganyonga zvinoparadzira tsinga nomunhu kuburikidza cardiac conduction hurongwa kubva atria kusvika ventricles. Kuoma Pakutanga, zita rinobva muchiLatin shoko atrium uye ventriculus, izvo inoratidza atrium uye ventricle, ukuwo.

On mwoyo, ayo mamiriro uye conductive hurongwa

Mwoyo womunhu, sezvinoitwa nezvimwe zvizhinji zvipenyu, mammalian, chinosanganisira kurudyi nekuruboshwe mativi, chimwe nechimwe chine atrium uye ventricle. Ropa rose pamusoro muviri, dzinova systemic riparadzirwe, pokutanga zvakanaka atrium, uye ipapo kupinda zvakanaka ventricle, ipapo - kuburikidza midziyo mumapapu. Oxygenated ropa kubva pulmonary kuparadzirwa kubva mumapapu runoyerera kupinda atrium kuruboshwe kubva iyo achawira ventricle kuruboshwe, uye kubva pamusoro yeropa iri kune mapazi uye munyama.

Blood kuyerera mwoyo unoshanda ayo conduction hurongwa. Zviri nekuvongwa naye pane akarurama kwemwoyo - vachinyatsoziva rutapudzo pamusoro atria uye ventricles uye chokubuda ropa kuburikidza navo. Kana midziyo yaishandiswa nokubata etsinga nomunhu pakati atria uye ventricles ekupedzisira kuderedzwa kunonoka kana kunonoka - pamusoro refu chinguva pashure atrial marwadzo. Somugumisiro, simba ropa kuyerera, hapana kusunungurwa payo kupinda ropa midziyo panguva, pane kumanikidzwa donhwe, uye vamwe kuchinja zvikuru kumwoyo.

The ngozi AV misa?

Nekuomarara atrioventricular misa zvinobva kwayo zvakaoma. Nyoro siyana conduction abnormalities angava asymptomatic, paavhareji - zvinoda kuona zvinokonzera uye kurapwa kuti kudzivirira mwoyo kukundikana. Kana blockade zvakakwana kunogona kuitika rufu pakarepo kubva cardiac kusungwa. Ndokusaka kutyora etsinga conduction mumwoyo hazvigoni kungotariswa, kunyange kana pari zvino hakuna zviratidzo chakakura chirwere.

Kupatsanura maererano dhigirii AV chinhu chinogumbura

AV mwoyo nechigumbuso iri pakubhadhara anoverengeka uye subtypes. Nekuomarara anokudzwa: AV nechigumbuso wokutanga dhigirii, kazhinji haana achiperekedzwa chero zvokunze vachivavhiringidza uye kazhinji kacho vari ndozvakajairwa, iyo blockade dzeboka rechipiri, inokamukana, akavapindurawo, kupinda subtypes maviri: mhando 1 (Mobitts 1, kana nechigumbuso Wenckebach) uye kutaipa 2 (Mobitts 2), uye blockade kuti dhigirii - yakakwana vanorega kupararira tsinga nomunhu kubva atria ventricles.

1st dhigirii AV misa

AV block 1 dhigirii kunogona hwandaiva vasiri chakajairika revechiduku varwere. Kazhinji chirwere uye nguva dzose anoita vatambi, uye vave vaiona vasingambooni chakaipa nazvo. Yakadaro blockade muvanhu kazhinji hapana kuoneka zviratidzo kuti anoratidza matambudziko mwoyo. AV nechigumbuso 1 dhigirii pasina zviratidzo chirwere kazhinji haatarisiri kurapwa, asi zvingava zvakakodzera pamberi mamwe abnormalities zvomwoyo. Uyewo pane izvi kana chiremba akadzokorora ECG, ambulatory ECG zvichiongororwa uye mamwe zveBhaibheri vangaendeswa, akadai echocardiography (Ultrasound mwoyo). Unonzi, electrocardiograph dhigirii atrioventricular misa 1 kunoratidzwa Zvakawanikwa penguva pakati pameno P uye R, apo vose mazino P hwemazuva, uye vari nguva dzose achiteverwa QRS-zvivako.

2nd dhigirii

AV blockade iri 2 madhigirii, sezvo yave pamusoro apa, rokutanga uye rechipiri mhando. Kana munguva 1st musimboti (Mobitts 1) zvingava asymptomatic uye regai zvinoda kurapwa. Panyaya iyi, panowanikwa vasiri hwaro chinogumbura Kazhinji dambudziko iri atrioventricular raiva pedyo nebundu. AV-chinogumbura mhando rechipiri dhigirii Mobitts 2 - yemanyorero migumisiro chirwere panzvimbo dzapasi achitungamirira gadziriro (His- Purkinje). Kazhinji kunoitika nezviratidzo pachena uye zvinoda humwe chirwere uye kukurumidza mharuro kurapwa kudzivirira kukura zvakakwana blockage ose cardiac kusungwa.

AV nechigumbuso musi ECG (mwero mhando 1 wechipiri) vari dzinoratidzwa mberi kuwedzera penguva PR, pashure paine kurasikirwa QRS-kunzwisisa uye zvakawanda - pedyo kudzorera chakaipa mutinhimira. Zvadaro zvose inodzokororwa. periodicity iyi ainzi periodicals Samoilova-Wenckebach. The mhando chechipiri AV nechigumbuso nedhigirii rimwe ECG yechipiri kunoratidzwa rusingaperi kana vaingoerekana kunayisa pamusoro QRS-zvakaoma ukuwo PR penguva prolongation, sapamazuva mhando 1 Mobitts zvikasaitika.

Third dhigirii

AV-block 3 madhigirii ndiyo chokuziva uye vawana. Dzinoratidzwa kusavapo pulses pakukoka kubva atria kusvika ventricles rakakwana, uye saka akataura blockade sezvo wakakwana. Sezvo zvinodiwa kuburikidza atrioventricular raiva pedyo nebundu mwoyo havasi vachengeterwe yemaguta kutsigirwa mwoyo kuva vatyairi vanoshingaira wechipiri-kuitira zvazvingava, t. E. Ventricle unoshanda panguva yayo mutinhimira, kwete chokuita mutinhimira yacho atria. izvi zvose kunokonzera kwazvo kuvhiringidzika kushanda mwoyo uye kumwoyo. Blockade kuti dhigirii rechitatu kunoda nokukurumidza mharuro kurapwa, t. To. Inogona kukonzera rufu nomurwere.

The ECG chinogumbura dhigirii wechitatu sezvinotevera: zvachose vasisina kubatana pakati P chinozunguzirwa uye QRS dzakaoma. Zvinonyorwa panguva kukodzera uye nedzimwe frequencies, kureva, kubva dzakaonekwa maviri chokuita mutinhimira rimwe - .. Atrial, mumwe - ventricular.

The zvinokonzera AV misa

Vakawanda zvinokonzera abnormalities zvakadai AV nechigumbuso vowanda mataurire of vagus etsinga mu vatambi, sclerosis fibrosis pamusoro cardiac conduction hurongwa, kuti zvokurwara moyo mavharuvhu, myocarditis, myocardial infarction, electrolyte nenyonganiso uye kushandisa zvimwe zvinodhaka, zvakadai cardiac glycosides ( "Digoxin" "Korglikon", "Strofantin"), karusiyamu gwara blockers ( "Amlodipine" "verapamil" "Diltiazem" "Nifedipine" "Cinnarizine"), Beta-blockers ( "bisoprolol" "Atenolol" "Carvedilol" ). Complete blockage kunogona vachiberekwa. zvokurwara iri kazhinji wakanyorwa vana vevanaamai vanotambura chinonzi systemic lupus erythematosus. Chimwe chikonzero blockade kuti dhigirii rechitatu anonzi chirwere cheLyme, kana borreliosis.

Zviratidzo AV misa

1 dhigirii atrioventricular mufurati, uyewo blockade 2 madhigirii wokutanga mhando, kazhinji haana achiperekedzwa chero zviratidzo. Zvisinei, kuti blockade ari mhando Moritz 1 dzimwe nguva, pane dzungu uye kufenda. Rudzi wechipiri dhigirii rechipiri akaratidza zviratidzo zvimwechete, uyewo dzisavhiringidza kuti pfungwa, marwadzo mumwoyo uye kunzwa kwekumira izvozvo, refu kufenda. Zviratidzo yakakwana atrioventricular misa - kuderera kwemwoyo, zvikuru simba, yodzoka musoro, achiipa kwemaziso, kugwinha, kurasikirwa chavanoziva. Zvinogona kuitika zvizere vanorega mumwoyo ane zvinouraya mugumisiro.

Chirwere kuti AV misa

Chirwere pamusoro atrioventricular misa rinoitwa kushandisa electrocardiography. Kazhinji AV misa 2 madhigirii (zvakafanana 1-D) ari kuona panguva tsaona ECG hapana zvichemo panguva chokudzivirira kuongorora zvokurapa. Mune zvimwe zviitiko, chirwere rinoitwa pamberi chero zviratidzo kuti anogona kukonzerwa nematambudziko ari conduction mamiriro mwoyo etsinga nomunhu, akadai dzungu, utera, kudzima magetsi, somuenzaniso, kufenda.

Kana murwere akanzi ne ECG AV misa, uye zvichiratidza kuti tichiongorora, cardiologist kazhinji rinorumbidza zuva ECG zvichiongororwa. Zvinonzi inoitwa achishandisa Holter tarisisa, zviri saka kakawanda vachinzi Holter zvichiongororwa. Mumaawa 24 pane chenguva chinoramba ECG kurekodha, apo munhu yaizivikanwa uye yaingowanikwa nemararamiro ake - ichifamba, vachidya, akarara. The yokudzidza noninvasive uye haakonzeri anenge asina kusanzwa.

Mushure achinyora ECG Data kubva tarisisa vari vakaongorora pamwe mhedziso akakodzera. Plus nzira iyi nechirwere, ichienzaniswa zvatinosiita pfupi ECG kurekodha isingagoni edza kazhinji sei kuitika blockade, chii nguva yezuva akanyorwa inonyanyoshandiswa uye chii pamwero murwere basa.

mabatiro

Kwete nguva dzose atrioventricular kuvhara wokutanga dhigirii, uyewo munhu wechipiri kunoda kurapwa kupindira. Pakutanga mune zvokurapa mabasa, sezvo mutemo, hapana chikonzero. Uyewo panguva 2 nd it rokutanga mhando (Moritz 1) kurapa inowanzopiwa haana kuitwa, kunyange zvazvo dzimwe tsvakurudzo kuziva nechokuita matambudziko mwoyo anogona inokurudzirwa.

Kurapa AV misa kunodikanwa rechipiri dhigirii Moritz mhando 2 uyewo kukwana kana kwakakwana blockade kuti dhigirii wechitatu, kureva. K. Saka chinokosha conduction vachivavhiringidza kungaita kuti kufirwa. Nzira inokosha chokururamisa malfunctioning Mwoyo kugadzwa pacemaker murwere (ECS) pfupi kana zvachose. Well yakatarwa uye yakananga zvinodhaka kurapa - "Atropine" uye zvimwe zvinodhaka. Mishonga havagoni kurapa munhu ane chirwere uye anowanzoshandurwa kushandiswa asati pacemaker muchibereko.

Kugadzirira yokugadza ECS

Kugadzirira pacemaker muchibereko zvinosanganisira, kunze electrocardiography, echocardiography - Ultrasound mwoyo. Echocardiography anobvumira kuona rusvingo mhango uye mwoyo rusvingo uye kuona chero chikuru chirwere aigona kukonzera AV mufurati, akadai vharafu chirwere. Kana cardiologist pamusoro Ultrasound padzakacherechedza matambudziko mwoyo, concomitant kurapa chiri kuitwa kufanana mishonga atrioventricular misa. Izvi zvinokosha zvikurukuru Muzviitiko apo zvirwere izvi ndizvo zvinokonzera conduction abnormalities. Also akagadzwa mureza kunotoda tsvakurudzo - ropa uye weti nemiedzo. Kana murwere ane chirwere nedzimwe nhengo uye enyika ari preoperative nguva nayo chirwere matanho akakodzera anogona inokurudzirwa.

pacemaker muchibereko

Installation pacemaker kana chirwere chakadaro, AV nechigumbuso, - zvokuwedzera kuvhiya. Rinogona kuitwa zvose pasi vakawanda yokutindivadza uye nemakanzuru yokutindivadza. Chiremba kuburikidza subclavian tsinga pamidziyo kuitisa kurutivi mwoyo electrodes, izvo pane zvakanyorwa. The chikwata pacharo pedyo rinokosha nzira iri vasonanidza pasi peganda. The ronda akavharwa pamwe stitches.

ECS chinhu hazvizivi chinotsiva chinodzora kurova, kuitisa nomunhu kubva atria kusvika ventricles, uye kunoita kuti chakaipa kurova kwehana. Nokuda inoratidza kana kugara dzishande, kamera chibvumirano muna nenhevedzano uye yakarurama chinguva, mwoyo zvakazara anoita ayo kupomba chaitika. In kweropa hurongwa, hapana kurega kunotanga uye kuchinja kamwe kamwe ari kufurirwa, uye ngozi zviratidzo zvakadai dzungu, kufenda, uye vamwe rinowanzogamuchirwa vasangana Varwere nechirwere AV mufurati, zviri akaderedza, uyewo mukana kufirwa kubva cardiac cardiac basa.

postoperatively

Postoperative kumwedzi, kana pasina dzimwe complicating kuti zvoutano, kazhinji haana achiperekedzwa chero chinokosha kurambidzwa. murwere asunungurwa kumba mazuva 1-7, pashure kuitisa tsvakurudzo. Ronda kutarisirwa mumunda implantable mudziyo pokugara riri kuitwa nachiremba wako. Suture Kubviswa chinodiwa kana vari zvavakatemerwa suture zvinhu, chisingazivi kugadzirisa voga. Kana panguva kugadzwa pacemaker ronda akavhara musono zvizorwa, izvozvo havafaniri kubviswa.

Mavhiki rokutanga pashure muchibereko pamusoro pacemaker inokurudzirwa kudzivisa rinonetesa muviri, uyewo kudzivirira weld nharaunda (mitambo, kana kusina contraindications, unogona kutanga, nguva dzose pane zano chiremba mashoma months). 1 mwedzi pashure nzira iri kupiwa kudzora cardiology kubvunza. Ipapo cheki rinoitwa pashure pemwedzi mitanhatu uye zvakare rimwe gore kubva pazuva muchibereko, uye ipapo - ose gore.

EKS basa nguva inotsamira zvinhu zvakawanda. Paavhareji, iyi ndiyo makore 7-10, uye vana kazhinji chiduku zvikuru pane kuti zvakafanira, Inter Alia, pamwe kukura muviri wemwana. Kudzora rinodhaka, uye ayo zvirongwa kuti imwe murwere nokuda chiremba. Ongorora hadzisisina dzichipfekeka hazvo kuitwa nenguva nenzira. Also akaruramisa uye chirongwa kana zvakafanira - akaisa uchishandisa parameters. Izvi zvinogona zvakakodzera kana pacemaker asingadi kuzadzisa mabasa basa nayo: mwoyo mwero iri pasi kana mukuru uye / kana murwere murombo ezvinhu utano. Other Kurongwa anogona akazviisa kuchinja nzira chiremba woupenyu uye kushayikwa dzishande, akadai zvinoshingaira mitambo.

Chikuru Chikonzero kukundikana pacemaker ndiko kuderedza vachikwanisa of bhatiri - nayo tiite. Muzviitiko zvakadaro, mudziyo inofanira kutsiviwa itsva uye zvechokwadi vanoda cardiologist kubvunza. The electrodes dziri riri mumwoyo mhango, kazhinji kuramba upenyu uye zvakarurama oparesheni usingafaniri kutsiviwa, vachibvumira munhu kurarama upenyu huzere pasinei nematambudziko mwoyo.

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