Ejection sulusi da murabba'i na zuciya: kullum da kuma Pathology

Yau, a cikin shekaru da fasaha, ci gaban da cututtukan zuciya da shi ne quite tsanani damuwa ba kawai ga ma'aikatan kiwon lafiya cibiyoyin, amma kuma a cikin sama da matakan gwamnati. Wannan shi ne dalilin da ya sa more kuma mafi kuma mafi sabon dabarun don rage cutar a tambaya, rayayye a] en gudanar da bincike da kuma ci gaba, wanda zai ba da damar a nan gaba don cimma wadannan manufofi.

Daya daga cikin halin da magani na marasa lafiya da zuciya da jijiyoyin jini cututtuka - shi ne yin rigakafi da magani daga cutar zuciya. Idan ba za ka iya samu nasarar yi wa a wannan yanki wasu daga cikin cututtuka, yayin da wasu har yanzu suna "baro" saboda rashin kayayyakin aiki, da kuma sauran muhimman aka gyara na dace magani. Kamar yadda shi ne halin yanzu labarin ya tattauna da manufar serdechenogo watsi, ta dokoki da kuma hanyoyin da magani, cardiac ejection sulusi da murabba'i (na kullum a yara da manya).

yanzu halin da ake ciki

A dangane da karuwa a tsawon rayuwar tsakanin tsofaffi a cikin wannan kungiya ta ƙara ruwan dare cututtukan zuciya, musamman tare da mai illa ejection sulusi da murabba'i. Recent shekaru ɓullo da tabbatar da hanyoyin da magani da kuma yin amfani da cardiac resynchronization na'urorin, cardioverter defibrillator-cewa tsawanta rayuwa, inganta ingancin marasa lafiya tare da wannan Pathology.

Duk da haka, ba gano hanyoyin magani da cututtukan zuciya da na al'ada sulusi da murabba'i, magani da wannan cuta ne empirical. Akwai kuma wani tabbatar da magani daga m cardiac decompensation (na huhu edema). Har yanzu, babban kwayoyi da su bi wannan yanayin ne diuretics, oxygen, da kuma nitropreparatov. Ejection sulusi da murabba'i, zuciya rate, ta Pathology, bukatar wani tsanani tsarin kula da matsalar.

Ganin zuciya tsoka, kuma su gane aikin ɗakunan ajiya na zuciya (atria, ventricles) Hanyar iya Doppler cardiography. Don gane yadda zuciya aiki, binciko da ikon yi mu'ãmalar (systolic aiki) da kuma shakatawa (diastolic aiki) infarction.

A dabi'u na sulusi da murabba'i

Ejection sulusi da murabba'i na zuciya, wanda aka dauke a kasa na kullum - babban kayan aiki da nuna alama wadda characterizes da ƙarfin zuciya tsoka.

A dabi'u na ejection sulusi da murabba'i, samu da Doppler cardiography:

• Al'ada matakan - fi ko daidai to 55%.
• Kadan sabawa - 45-54%.
• Matsakaici sabawa - 30-44%.
• Bayyana sabawa - kasa da 30%.

Idan wannan nuna alama ne kasa da 40% - "ikon da zuciya" da aka rage. Al'ada dabi'u - sama da 50%, "ikon da zuciya" ne mai kyau. Ware wani "m zone" na 40-50%.

Zuciya rashin cin nasara - da wani sa na asibiti manifestations, biochemical alamomi, daga wadannan karatu (electrocardiography, Doppler zuciya, kirji X-ray) cewa faruwa a ƙananan karfi na zuciya.

Rarrabe tsakanin symptomatic da asymptomatic, systolic da diastolic zuciya rashin cin nasara.

The gaggawa na matsalar

A cikin shekaru 20 da ya faru na zuciya rashin cin nasara tsakanin Turawa da aka rage. Amma an kara yawan lokuta a tsakiyar da kuma babba segments na yawan saboda ya karu rayuwar jama'a.

Kamar yadda Turai nazarin (gudanar da echocardiography), da aka samu don rage a ejection sulusi da murabba'i, rabin na marasa lafiya da symptomatic zuciya gazawar da kuma rabin asymptomatic marasa lafiya.

Marasa lafiya da zuciya rashin cin nasara ne kasa iya aiki, suna da wata rage ingancin rayuwa da kuma ta duration.

Jiyya na wadannan marasa lafiya ne mafi tsada a gare su, kuma don a jihar. Saboda haka, za ta zauna ita da gaggawa search for hanyoyin hana abin da ya faru, farkon ganewar asali da kuma tasiri magani na cutar zuciya.

Da za'ayi a cikin 'yan shekarun nan, karatu sun tabbatar da tasiri na a yawan kungiyoyin da kwayoyi don inganta hangen nesa, rage mace-mace a cikin marasa lafiya da low cardiac ƙungiya:

• adenozinprevraschayuschego enzyme hanawa ( "Enalapril");
• angiotensin II antagonists ( "valsartan");
• Beta-blockers ( "Carvedilol");
• aldosterone blockers ( "spironolactone");
• Diuretics ( "Torasemide");
• "Digoxin".

A Sanadin zuciya rashin cin nasara

Zuciya rashin cin nasara - da ciwo, wanda aka kafa saboda rushewa daga cikin tsarin ko aiki na myocardium. A Pathology na cardiac kari ko madugu, kumburi, rigakafi, endocrine, na rayuwa, kwayoyin, neoplastic tafiyar matakai, ciki iya zama wani dalili na wani rauni da zuciya tare da mai illa ejection sulusi da murabba'i ko ba tare da.

A Sanadin zuciya kasawa:

- jijiyoyin zuciya da cututtukan zuciya da (yawanci bayan fama da bugun zuciya).

- hauhawar jini.

- mai hade da CHD da hauhawar jini.

- idiopathic cardiomyopathy.

- atrial fibrillation.

- bawul cuta (rheumatic, sclerotic).

Zuciya kasawa:

- systole (cardiac ejection sulusi da murabba'i - kasa da 40% na kullum).

- Diastolic (ejection sulusi da murabba'i 45-50%).

Ganewar asali systolic zuciya rashin cin nasara

Ganewar asali systolic zuciya rashin cin nasara ya hada da:

1. cardiac ejection sulusi da murabba'i - kasa da 40% na kullum.

2. stagnation a wurare dabam dabam da'irori.

3. canje-canje a cikin zuciya tsarin (scarring, fibrosis raunuka, da dai sauransu).

Ãyõyin cunkoso:

- gajiya.

- dyspnea (shortness na numfashi), ciki har da orthopnea, paroxysmal nocturnal dyspnea - cardiac fuka.

- kumburi.

- hepatomegaly.

- fadada daga cikin lakar jijiyoyinmu.

- crackles a cikin huhu ko pleural effusion.

- amo a kan auscultation na zuciya, cardiomegaly.

A hade da dama na sama bayyanar cututtuka, da samuwan bayanai game da cututtukan zuciya taimaka wajen kafa zuciya rashin cin nasara, amma yana da muhimmanci rike da zuciya Doppler tare da definition da tsarin canje-canje da kuma kimantawa na tsokar ejection sulusi da murabba'i. A wannan yanayin, shi zai zama da muhimmanci zuciya ejection sulusi da murabba'i, rabon bayan wani ciwon zuciya wanda shi ne haƙĩƙa wani.

diagnostic sharudda

Sharudda ga ganewar asali na zuciya rashin cin nasara tare da al'ada sulusi da murabba'i:

- ejection sulusi da murabba'i na zuciya - da kudi na 45-50%.

- stagnation a cikin wani karamin da'irar (dyspnea, huhu crepitation, cardiac asma).

- warwarewarsu shakatawa ko wani karuwa a cikin stiffness na myocardium.

Don ware zuciya gazawar 'yan shekarun nan ƙayyade nazarin halittu alamomi: atrial natriuretic peptide (m cardiac gazawar - a kan 300 shafi / ml, kullum a kan 125 shafi / ml). peptide matakan za su taimaka a kayyade da hangen nesa da cutar, zabi na mafi kyau duka far.

Marasa lafiya da kiyaye cardiac sulusi da murabba'i yawanci mazan, kuma shi ne mafi sau da yawa mata. Suna da yawa comorbidities, ciki har da hauhawar jini. A cikin wadannan marasa lafiya, jini matakan natriuretic peptide irin B ne m fiye da na marasa lafiya da low sulusi da murabba'i, amma mafi girma fiye da na lafiya mutane.

Matsaloli ga likitoci da magani na marasa lafiya

Goals na lura da marasa lafiya da zuciya rashin cin nasara, a lokacin da zuciya ejection sulusi da murabba'i sama na kullum:

- alleviating da bayyanar cututtuka da cutar.

- raguwa lokuta da readmission.

- rigakafin bai kai ba mutuwa.

A mataki na farko a gyara zuciya rashin cin nasara ne da ba-miyagun ƙwayoyi jiyya:

- ya rage mata jiki aiki.

- karɓa a ƙuntatawa gishiri.

- m ƙuntatawa.

- nauyi asara.

Jiyya na marasa lafiya tare da rage EF

Mataki 1: A diuretic ( "Torasemide") + hanawa na angiotensin tana mayar enzyme ( "Enalapril") tsoka mai amsa sigina shafi ko angiotensin II ( "valsartan") kashi da hankali karuwa zuwa barga jihar + beta-shafi ( "Carvedilol").

Idan m bayyanar cututtuka - Mataki 2: Add wani aldosterone antagonist ( "Veroshpiron") ko angiotensin tsoka mai amsa sigina P.

Idan cututtuka nace, yana yiwuwa ya kara da magani daga "Digoxin", "Hydralazine" nitroprepaty ( "Kardiket") da / ko gudanar cin zali baki (saitin resynchronization na'urorin cardioverter-defibrillator, zuciya dasawa), a baya ya ciyar duban dan tayi na zuciya. Ejection sulusi da murabba'i, da kudi na wanda aka bayyana a sama, a cikin wannan yanayin ne m da ultrasonography.

Modern magani dabara zuciya rashin cin nasara angiotensin tana mayar enzyme hanawa, angiotensin tsoka mai amsa sigina blockers P, beta-blockers, aldosterone blockers, diuretics, nitrates, hydralazine, digoxin, Omacor, idan ya cancanta sawa resynchronization na'urar da wani cardioverter-defibrillator a karshe biyu shekarun da suka gabata ya kai ga wani gagarumin karuwa a rayuwa marasa lafiya tare da m siffofin da cutar. Wannan babban sabon kalubale ga likitoci da masu bincike.

Ya zauna dacewa search maye hanyoyin da tabo nama na myocardium.

ƙarshe

Saboda haka, daga ƙaddamar articles za ka iya ganin m darajar Kanmu da likitoci ayyuka. Ejection sulusi da murabba'i na zuciya (kullum da kuma Pathology) ne ba tukuna cikakken gane. Ko da yake magani yanzu lokaci zuwa magance wannan Pathology ba m, shi wajibi ne don fatan, kuma su zuba jari isasshen adadin zuba jari a cikin ci gaba da kuma ci gaban kimiyya da bincike a wannan yanki. Bayan duk, daga masana kimiyya yafi dogara a kan ci gaban da kiwon lafiya masana'antu. Saboda haka, jama'a hukumomi kamata goyi bayan duk kimiyya likita cibiyoyin, kokarin warware kiki kan batun tattauna.