Mmene Mungachitire Tachycardia Yambiri Ndi Yophuka M'munda
Tachycardia (kuthamanga kwa mtima mofulumira) ndi imodzi mwa zovuta kwambiri kuti dokotala azichiza chifukwa zimakhala ndi zochitika zambiri komanso zifukwa zambiri. Nkhaniyi ikukhudzana ndi chithandizo cha tachycardia zosagwirizana ndi mtima m'maganizo mwa aphunzitsi omwe amatha kusokoneza maganizo.
Kawirikawiri, zosankha zamankhwala m'munda ndizochepa poyerekeza ndi dipatimenti yosavuta.
Koma ali ndi luso labwino, odwala opaleshoni ambiri ali ndi zonse zomwe akufunikira kuti athetsere odwala ndi kuwafikitsa kuchipatala.
Mphungu kapena Mipira
Nkhaniyi ndi yeniyeni ya tachycardia odwala omwe ali ndi matenda. Odwala omwe alibe mapepala osakanikirana kapena opanda zizindikiro za kusindikizidwa (kupuma, kuthamanga mwachidwi) ayenera kuonedwa kuti ali mu mtima womangidwa ndi mankhwala, kuyambira ndi CPR .
Kodi Mwamsanga N'kulakwa Motani?
Kawirikawiri Tachycardia imatchulidwa kuti imakhala yofulumira kuposa 100 kugunda pamphindi (bpm) pamene mukupumula, koma sikuti tachycardias onse ndi ofunika kwambiri. Popanda kuyang'anira ECG, malamulo abwino a thumb ayenera kukhala okhudzidwa ngati wodwalayo ali ndi vuto lalikulu kuposa 140 bpm, kapena ngati kutentha kwapakati kulibe, kofooka, kapena kulibe.
Pali zifukwa zambiri za kuthamanga kwa mtima mwamsanga zomwe sizikugwirizana ndi mtima wosagwira ntchito. Ndili ndi mtima wa pakati pa 100-140 bpm, mwayi siwokhudzana ndi mtima.
Mofulumira kuposa 140 bpm, ndikofunikira kulingalira zifukwa za mtima komanso zosakhala za mtima. Mwamwayi, iyi si lamulo lolimba komanso lachangu, kotero musanyalanyaze chifukwa cha mtima chifukwa chakuti kuthamanga kwa mtima kuli pang'onopang'ono.
Chofunika chachipatala cha kusintha kwa mtima kumasintha malinga ndi mtundu wa tachcarcardia.
Chiwerengero cha nkhaniyi sichikhoza kutanthauzira kutanthauzira kwa ECG , koma mphamvu ya wosamalira kutanthauzira zolemba za ECG imaganiziridwa. Pansipa, tikambirana za tachycardia zosavuta komanso zovuta, koma pakalipano, dziwani kuti tachycardia yambiri imakhala yoopsa ngati ikufulumira kwambiri kuposa 140 bpm. Tachycardia yochepa kwambiri ikhoza kukhala yofulumira pang'ono, koma taganizirani izi ngati zoposa 160 bpm.
Tachycardia yosakhazikika kapena yolimba
Kudziwa kukhazikika kwa kliniki kumadalira chifukwa cha tachycardia. Ena amanena kuti zizindikiro zokhudzana ndi mtima (kupweteka kwa chifuwa, kupuma pang'ono, ndi zina zotero) ndi zizindikiro zazikulu za tachycardia yosakhazikika. Izi ziri zowona kwambiri mu malo ochipatala kuposa mmunda, chifukwa cha njira zosiyanasiyana zochiritsira.
Kunja kwa chipatala, yang'anani pa kuthekera kwa mtima kuti apitirize kupopera magazi ndi kukakamizidwa mokwanira kuti apite ku ubongo. Izo zimatchedwa bata la hemodynamic . Tachycardia yosasunthika ya majeremusi sakupatsani zipinda za mtima nthawi yokwanira kuti azidzaza ndi magazi pakati pa zotsutsana.
Wodwala wopanda zizindikiro zosadziwika za kusagwirizana kwa magazi ( kuchepa kwa magazi , kutentha kapena kutaya mphamvu, kusintha kwaseri , etc.) akhoza kutengedwera kupita kuchipatala popanda kuyesa kutulutsa tachycardia.
Kuwonjezera apo, odwala omwe alibe zizindikiro za kusagwirizana kwa magazi amatha kupulumutsidwa chifukwa cha zizindikiro zina zokhudzana ndi mtima.
Odwala osasunthika omwe ali ndi tachycardia mofulumira kuposa 140-160 bpm angapindule chifukwa chokhala ndi mtima womwe umasinthidwa. Amenewa ndiwo odwala omwe tikuwatsatira nkhaniyi.
Nzere kapena Wamtunda
Tachcarcardia yamtengo wapatali imakhala m'magulu awiri ofunika: zochepa kapena zovuta. Izi zikutanthauza QRS complex pa kufufuza ECG. Pamene QRS ndi yopitirira 120 milliseconds (timabokosi tating'ono tating'ono ta ECG) zimasonyeza kuti mtima wa magetsi unayambira pa atria ndipo anayenda pansi kupyolera mu nambala ya AVrioventricular (AV) kupita ku zilembo za Iye ndi ulusi wa Purkinje. ili m'makontomba.
Iyi ndiyo njira yoyenera yoperekera njira, ndipo njira yokhayo QRS ingakhalire yopapatiza ndiyo ngati kuyendayenda kumayenda moyenera. Chifukwa chiyero chiyenera kuyambira pamwamba pa zamoyo zam'mlengalenga mu tachycardia yopapatiza, imadziwikanso kuti supraventricular tachycardia (SVT).
Zambiri za QRS zoposa 120 miliseconds nthawi zambiri zimagwirizana ndi ventricular tachycardia (VT) -kutanthauza chikoka chomwe chimachokera ku zinyama, pansi pa chidziwitso cha atrioventricular. Sikuti nthawi zonse zimakhala choncho. Ngati ndi yopapatiza, iyenera kukhala SVT. Ngati ndizitali, zikhoza kukhala VT kapena zikhoza kukhala kuti zochitika zomwe zimachokera pamwamba pa zinyama sizimayendetsedwa kudzera muzithunzi za AV. Icho chimachoka pa maphunziro ndi kujambula njira yake, zomwe zimapangitsa kuti pang'onopang'ono. Izi nthawi zambiri zimatchedwa mtima block, AV block, kapena bundle nthambi, malingana ndi kumene malowa amapezeka.
Kufuna kukumba ndi kuzindikira kuti tachycardia imafuna ECG yotsogolera 12. M'malo ena kunja kwa chipatala, ECG yotsogolera 12 siilipo. Chifukwa chimodzi chosachitira tiachycardia pokhapokha ngati sichingakhale chosasinthika chifukwa cha kuthekera kochizira tachycardia monga tricycardia yamagetsi ngati siili. Kugwiritsa ntchito mwayi umenewu pamene wodwalayo ali ndi ngozi yaikulu ya kumangidwa kwa mtima kumakhala kovomerezeka. Kugwiritsira ntchito tachycardia yochulukirapo mofulumira ngati wodwalayo ali ndi mphamvu yokhala ndi chilengedwe sichiyenera kukhala pangozi.
Chigawo cha mtima chomwe chikokacho chimayambira chimadziwika ngati pacemaker chifukwa malo alionse omwe amachititsa chidwi ndikuyambitsanso kuyenda kwa mtima. Node ya sinus ili mu atrium yamanzere. Ndilo pacemaker yachibadwa. Node ya sinus imayenda pakati pa 60-100 bpm. Pamene tikuyenda pansi pamtima, chiwerengero cha chikhalidwe chimayamba kuchepa. Zotsatira zomwe zimayambira muzithunzi za AV zimayenda pafupifupi 40-60 bpm. Muzitsulo, ndi 20-40 bpm. Ndicho chifukwa chake tachycardia imakhala yofunika kwambiri pang'onopang'ono.
Kuchitira Tachycardia Wopambana
Pofuna kuchiza mwamsanga munthu wodwalayo wosagwira ntchito m'munda, ganizirani zochitika zonse za tachycardia monga VT. Ngati wodwala amasonyeza zizindikiro za ngozi yomweyo (systolic blood pressure pansi pa 90 mm / Hg, kutaya chidziwitso, kusokonezeka, kapena kungopeza mpweya wa carotid), mtima wotsatizana umasonyezedwa. Ovomerezeka mlingo nthawi zambiri ndi 50 Joules.
Ngati panthawi iliyonse wodwalayo ataya mtima ndikusiya kupuma, kapena sitingathe kupeza carotid pulse, defibrillation (yosasinthika modabwitsa) imasonyezedwa pa 200 Joules kuyamba. Pambuyo pa kutsekemera kwapadera (kapena ngati osokoneza bongo sakupezeka) ayambani CPR, kuyambira kumapeto kwa chifuwa.
Kuchiza Tachycardia Yophazikika
Tachycardias zovuta kwambiri zimakhala zovuta kwambiri kusiyana ndi zovuta zambiri. Pankhaniyi, nthawi zonse zimakhala zofunikira. Pogwiritsa ntchito maselo omwe amachititsa kuti thupi lisasinthe (systolic blood pressure pansi pa 90 mm / Hg, kutaya chidziwitso, kusokonezeka, kapena kukwanitsa kupeza carotid pulse), mtima wogwirizanitsa umasonyezedwa pa 100 Joules.
Odwala omwe alibe kuponderezedwa kwa magazi-koma amakhala ndi zizindikiro zina (chizungulire, kutsekedwa kwa mtima) -chikhoza kuchitidwa ndi madzimadzi kapena mankhwala, makamaka adenosine. Madzi ndi gawo loyamba la tachycardia ngati vuto la kuchepa kwa madzi ndilo chifukwa.
Adenosine ayenera kuperekedwa kudzera mwachangu. Mlingo woyambirira ndi 6 mg, koma ngati izi sizigwira ntchito, mlingo wotsatira wa 12 mg ukhoza kuyesedwa. Adenosine imagwira ntchito mofananamo ndi magetsi a mtima, zomwe zimayambitsa kukhumudwa kwa minofu ya mtima ndikulola nambala ya sinus kukonzanso.
Ngati adenosine siigwira ntchito, ndizotheka ngati tachycardia ndi yosagwirizana, magulu ena awiri a mankhwala angathe kuyesedwa. Njira ya calcium imachepetsanso kayendedwe ka kashiamu pamtundu wa minofu. Zimayambitsa mkombero wonse kuti ufike pang'onopang'ono. Anthu oteteza mabeta amachititsa kuti epinephrine izigwira ntchito pamtima.
Kuchiza tachycardia yosavuta kumapanga m'munda sikuyenera kuchitidwa popanda maulamuliro ovomerezeka kapena kuyankhulana ndi akatswiri kupyolera mwa njira zachipatala zogwiritsa ntchito mankhwala ndi mkulu woyenera wa zachipatala.
> Zotsatira:
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> Garner, JB., & M Miller, J. (2013). Wakavuta Kwambiri Tachycardia - Tacycardia Yoyamba Kapena Yopanda Tachycardia, Yomwe Imakhalabe Funso. Arrhythmia & Electrophysiology Review , 2 (1), 23-29. http://doi.org/10.15420/aer.2013.2.1.23
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