Ejection hautanga o te ngakau: täkupu me te māuiuitanga

I teie mahana, i roto i te tau o te hangarau, te whanaketanga o te mate Cardiovascular he āwangawanga rawa nui ki te kaimahi o ngā pūtahi hauora kore anake, engari ano hoki i roto i te taumata o runga o te kāwanatanga. Ko te aha ki te ake me te ake me te ake ngā rautaki hou whakaiti te mate i roto i te pātai, rangahau me te whanaketanga mātātoa pütea, e ka tukua i roto i te heke mai ki te whakatutuki i ēnei whāinga.

Ko tētahi o nga ngā i roto i te maimoatanga o te tūroro ki te mate Cardiovascular - ko te ārai me te maimoatanga o te mate ngakau. Ki te taea pai koe te hamani i roto i tenei rohe i te tahi o nga mate, etahi i he tonu "a tātau" no te mea o te kore o taputapu, me te tahi atu wāhanga faufaa o te maimoatanga tika. Ko rite matapaki tuhinga nāianei te ariā o te pira serdechenogo, ona ture me ngā tikanga o te maimoatanga, hautanga pana cardiac (te täkupu i roto i ngā tamariki me ngā pakeke).

Āhuatanga o nāianei

I roto i te hononga ki te hua i roto i te ora te tümanako i roto i te feia ruhiruhia i roto i tenei rōpū nui haere nuinga o te mate ngakau, rawa ki te hautanga ejection waimaero. tau tata nei whakawhanakehia tikanga kï o maimoatanga hauora me te whakamahi o ngā pūrere resynchronization cardiac, cardioverter-defibrillator e roa te ora, te whakapai ake i te kounga o te tūroro ki tenei māuiuitanga.

Heoi, e kore e tāutuhia tikanga o te maimoatanga o te mate ngakau ki hautanga noa, he tëtehi maimoatanga o tenei mate. Kahore he hoki kahore maimoatanga matauranga o te decompensation cardiac whakapeka (edema pūkahukahu). Mohoa noa nei, te raau taero matua ki te hamani tenei huru ko nga Diuretics, te hāora, me te nitropreparatov. Pana hautanga, auau ngakau, tona māuiuitanga, e rapu he huarahi nui ki te raruraru.

Sioloto te uaua ngakau me ki te tautuhi i te mahi ruma o te ngakau (atria, ventricles) taea tikanga Doppler cardiography. Ki te mārama me pēhea te mahi i te ngakau, te tūhura tona kaha ki te kirimana (systolic mahi), me te olungá (mahi diastolic) infarction.

Ko te uara o te hautanga

Ejection hautanga o te ngakau, whakaaro nei i raro i te täkupu - te tohu taputapu matua e faaite i te kaha o te uaua ngakau.

Ko te uara o te hautanga ejection, i whiwhi e Doppler cardiography:

• taumata Pūnoa - nui atu i rite ranei ki 55%.
• ine iti - 45-54%.
• ine He āhua - 30-44%.
• ine faaite - iti iho i te 30%.

Ki te ko tenei tohu iti iho i te 40% - "te mana o te ngakau" e iti. uara Pūnoa - i runga 50%, he pai "te mana o te ngakau". Tohatoha i te "rohe hina" o 40-50%.

rahunga Heart - he huinga o faaiteraa haumanu, tohu matüora, o enei akoranga (electrocardiography, ngakau Doppler, pouaka X-ray) e puta i kaha raro o te ngakau.

Wehewehe i waenganui i symptomatic me asymptomatic, systolic me te kore ngakau diastolic.

Ko te rūraa o te raruraru

I roto i te 20 tau whakamutunga iti te pā o te kore ngakau i roto i te Pākehā te. Ko te tokomaha piki o ngā take i roto i nga wāhanga o te taupori waenganui, me te runga e tika ana ki te tümanako ora nui haere.

E ai ki ngā akoranga Pākehā (whakahaere echocardiography), i kitea ki te iti haere i roto i te pana hautanga, hawhe o nga tūroro ki te kore te ngakau symptomatic me te hawhe o tūroro asymptomatic.

Tūroro ki te kore te ngakau e iti taea ki te mahi, to ratou he kounga iti o te ora, me tona roanga.

Maimoatanga o enei tūroro ko te utu tino mo ratou, a ka hoki te āhua. Na reira, tonu reira rapu akiaki mō huarahi ki te ārai i te tupu, te tātaritanga wawe me te maimoatanga whai hua o te mate ngakau.

Kawea atu i roto i ngā tekau tau tata nei, kua kï rangahau te whai huatanga o te maha o ngā rōpū o taero ki te whakapai ake i waitohunga, whakaiti tahuti i roto i te tūroro ki te iti totohe cardiac:

• inhibitors whākōkī adenozinprevraschayuschego ( "Enalapril");
• angiotensin II te raveraa ra ( "valsartan");
• Beta-blockers ( "Carvedilol");
• blockers aldosterone ( "spironolactone");
• Diuretics ( "Torasemide");
• "Digoxin".

Ko te take o te kore ngakau

rahunga Heart - he syndrome, i hanga nei e tika ana ki te rangirua o te hanganga whakahaere ranei o te myocardium. Ko te māuiuitanga o te manawataki cardiac ranei āriponga, inflammatory, ārai, endocrine, pūkoro tinana, ira, ngā tukanga neoplastic, kia meinga hapūtanga te take o te ngoikore o te ngakau ki te hautanga ejection waimaero, kahore ranei.

Ko te take o te kore ngakau:

- mate ngakau Coronary (te tikanga i muri i te mamae i te whakaeke ngakau);

- takawhita;

- he huinga o te CHD me takawhita;

- cardiomyopathy idiopathic;

- Atrial Fibrillation;

- mate piha (rūmātiki, sclerotic).

rahunga Heart:

- systole (hautanga ejection cardiac - iti iho i te 40% o te täkupu);

- Diastolic (ejection hautanga 45-50%).

Tātaritanga o te kore ngakau systolic

Tātaritanga o te kore ngakau systolic ngā:

1. hautanga ejection cardiac - iti iho i te 40% o te täkupu;

2. stagnation i roto i te porohita tohanga;

3. huringa i roto i te hanganga ngakau (scarring, pāpaka kakakīrehe, me ētahi atu).

Tohu o te popoketanga:

- rohirohi;

- dyspnea (hāhā o te manawa), tae atu ki orthopnea, paroxysmal dyspnea pō - huangō cardiac;

- ngawhatanga;

- hepatomegaly;

- roha o te uaua jugular;

- crackles i roto i te pūkahukahu effusion pleural ranei;

- haruru i runga i auscultation o te ngakau, cardiomegaly.

He huinga o te maha o nga tohu i runga ake, te wātea o te mōhiohio e pā ana ki te mate ngakau āwhina ki te whakatū i kore te ngakau, engari ko reira mahu'inga pupuri Doppler ngakau ki te whakamāramatanga o te huringa hanganga me te aro mātai o te hautanga ejection myocardial. I roto i tenei take, ka waiho reira mahu'inga hautanga pana ngakau, te auau i muri i te whakaeke ngakau i te mea tino tetahi.

paearu tātaritanga

Paearu mō te tātaritanga o te kore ngakau ki hautanga noa:

- pana hautanga o te ngakau - te tere o 45-50%;

- stagnation i roto i te porohita iti (dyspnea, pūkahukahu crepitation, huangō cardiac);

- pakaru o te whakangā ranei he hua i roto i te pakeke o te myocardium.

Hei tutakina kore ngakau tau tata whakatau tohu koiora: peptide natriuretic Atrial (whakapeka kore cardiac - i runga i 300 wh / ml, ma'i i runga i 125 wh / ml). ka tauturu i te taumata peptide i roto i te whakatau i te waitohunga o te mate, te whiriwhiri o te therapy tino arotau.

Tūroro ki tiaki hautanga cardiac te tikanga pakeke, a ko reira atu maha wahine. E ratou maha comorbidities, tae atu takawhita. I roto i enei tūroro, taumata wē o natriuretic peptide momo B he i raro i taua o te tūroro ki te hautanga iti, engari ki runga ake i taua o te iwi hauora.

Raruraru mō ngā rata i roto i te maimoatanga o te tūroro

Whāinga o te maimoatanga o te tūroro ki te kore te ngakau, ka te ngakau pana hautanga runga ake te täkupu:

- tamarыraa i nga tohu o te mate;

- Tuhinga o take o readmission;

- te ārai o te mate taimi halá,.

Te taahiraa matamua i roto i te whakatikatika kore ngakau ko te maimoatanga tarukino-kore:

- fakangatangata o mahi tinana;

- tangohanga rāhuitanga tote;

- inu here;

- mate taimaha.

Maimoatanga o te tūroro ki te iti EF

Hipanga 1: Ko te diuretic ( "Torasemide") + inhibitor o angiotensin tahuri paru ( "Enalapril") receptor pūārai angiotensin II ( "valsartan") horopeta ki te hua āta ki te āhua pūmau + beta-pūārai ( "Carvedilol") ranei.

Ki te tohu tamau - Hipanga 2: Tāpiri he enemi aldosterone ( "Veroshpiron") ranei receptor angiotensin P.

Ki te tohe tohu, he reira taea ki te tāpiri ki te maimoatanga o "Digoxin", "Hydralazine" nitroprepaty ( "Kardiket") me / ranei whakahaere wawaotanga urutomo (te whakatakoto whakaaro resynchronization tanuhia cardioverter-defibrillator, transplantation ngakau), ultrasound pau mua o te ngakau. whakaritea pana hautanga, te tere o nei whakaahuatia te runga ake, i roto i tenei take e ultrasonography.

Modern maimoatanga tātai ngakau kore angiotensin te tahuri paru inhibitors, angiotensin receptor blockers P, beta-blockers, aldosterone blockers, Diuretics, pūhau, hydralazine, digoxin, Omacor, ki te tika tāuta resynchronization pūrere me te cardioverter-defibrillator i te whakamutunga e rua tekau tau, kua arahina ki te tino hua i roto i te ora tūroro ki momo kāpeka o te mate. vĕvĕ tenei wero hou mō rata me kairangahau.

tonu te reira i tikanga rapu whakakapinga hāngai o te nawe kiko o te myocardium.

mutunga

Ko te kupu, i te tuhinga tukuna taea kite koe i te uara 'aonga whakahaeretia e te mahi rata. e kore e matau ano tino pana hautanga o te ngakau (täkupu me te māuiuitanga). Ahakoa rongoā Ko inaianei wa ki te mahi ki tenei māuiuitanga te kore e tino, he mea e tika ana ki te tumanako, me te ki te haumi nui rawaka o haumi i roto i te whanaketanga me te whanaketanga o te rangahau pūtaiao i roto i tenei rohe. I muri i te katoa, i kaiputaiao te nuinga tei runga i te whanaketanga o te ahumahi hauora. Na reira, kia tautoko i mana tūmatanui pūtahi hauora pūtaiao katoa, e ngana ana ki te wahi i te te pēnei ka mo te take kōrero.