Symptomatic Bradycardia mu Munda

Atropine kapena Pacing?

M'madongosolo ambiri okhudza thandizo lachipatala omwe amapezeka ku United States, amatha kusankha njira zothandizira odwala matenda opatsirana pogonana : transcutaneous pacing (TCP) kapena atropine sulphate. Mu machitidwe ambiri, pamakhala kutsutsana payekha momwe chithandizo chamankhwala chikufunira. Ichi ndi chitsanzo chabwino cha momwe mankhwala opatsirana ndi umboni amalepheretsa pakati pa mankhwala pa zifukwa zina zochokera pa mulu wa deta yomwe imamanga mbali imodzi ya mkangano kapena ina.

Symptomatic Bradycardia

Bradycardia ( yopitirira mu mtima) imatanthauzidwa ngati kupweteka kwa kupitirira 50 kugunda pa mphindi (BPM). Timadera nkhaŵa pamene wodwala ali ndi bradycardia ali ndi zizindikiro zomwe zingayambitsedwe ndi pang'onopang'ono kwambiri-kapena-wodwala ali ndi zizindikiro zomwe zimayambitsidwa ndi chinthu chomwecho chomwe chimachititsa bradycardia. Mwanjira iliyonse, wodwalayo akuti ali ndi bradycardia yodabwitsa. Zizindikiro zomwe zimaphatikizana ndi bradycardia ndipo zimatengedwa kuti ndizofunika monga:

• Kusamvana (kutsika kwa magazi)
• Kupweteka pachifuwa
• Kupuma pang'ono
• Chizungulire
• Syncope
• Kusokonezeka

Anthu ena, makamaka ochita masewera olimbitsa thupi, akhoza kukhala ndi mtima wopuma wokhala ndi pang'onopang'ono kusiyana ndi 50 BPM ndipo pamene iwo alidi a bradycardia, amadza popanda zizindikiro (asymptomatic).

Kusakhazikika Kapena Kolimba Symptomatic Bradycardia

Zizindikirozi zingagawanike m'magulu awiri: zamoyo zosagwedezeka zotsutsana. Bradycardias osakhazikika mwachilengedwe imatanthawuza zomwe zimatsogolera kuperewera kwa mafuta ndipo zimatsatiridwa ndi hypotension kapena zizindikiro zomwe zimasonyeza kusowa kwa ubongo (ubongo, syncope, ndi chisokonezo).

Kawirikawiri, zizindikiro izi zimachokera ku bradycardia, kotero kukonzekera bradycardia kukathetsa zizindikiro.

Kupweteka mchifuwa ndi kupuma pang'ono kungaperekenso ndizitsulo zokhazikika kapena zosakhazikika za bradycardia. Muzitsulo zosasunthika, kusowa zoperewera kungakhale chifukwa cha kupweteka pachifuwa kapena dyspnea.

Mu khola la bradycardia, zinthu zina za mtima zimatha kutsogolera zizindikiro zonse ndi bradycardia. Machitidwe ena opatsirana azachipatala amalingalira kuti bradycardia imakhala yokhazikika ngati zizindikiro zokhazokha ndizopweteka pamtima kapena kupuma pang'ono. Machitidwe ena amaona kuti ndi osakhazikika. Ma Paramedics ayenera nthawi zonse kutsata ndondomeko yawo.

Atrioventricular Block (AVB)

Ena a bradycardia amatha kukhala operewera chifukwa cha vuto la atrioventricular (AV) , lomwe limapangitsa kuti mtimawu ugwire ntchito kuchokera ku atria (pamwamba pa zipinda ziwiri) kupita ku zinyumba ziwiri (pansi pa zipinda ziwiri). Vuto la AV limapereka mphindi zochepa poyendetsa mwatsatanetsatane kuti apereke nthawi kuti magazi asakanikizidwe kuchokera ku atria ndi kudzaza zinyama. Pambuyo pa pause, chikoka chimatumizidwa pansi pa thumba lake ndikupita ku zipika za Purkinje , kumene zimapangitsa kuti tizilombo toyambitsa matenda tizilumikizana ndikukankhira magazi m'mitsempha (pulse). Mitengo yamtima (wina mawu a AVB) amabwera mu madigiri atatu.

Mbali yoyamba AVB imangowonjezera kupuma kwachilengedwe kotero kuti kachilombo ka AV kamayenera kulenga. Degresi yoyamba AVB ilibe zotsatira zambiri, ngati zilipo, pamitima ya mtima. Mpikisano mu nkhani iyi ndiyikidwabe ndi mfundo ya sinus yomwe ili kumbali ya kumanzere.

Makina oyambirira a digiri amayamba kukhala opanda vuto.

Pali mitundu iwiri ya digiri yachiwiri AVB:

1. Dipatimenti yachiwiri ya mtundu I (yotchedwanso Wenckebach ) ndi kupititsa patsogolo kupititsa patsogolo kudzera mu vutolo la AV mpaka chidziwitso sichitha kupyola kuchokera ku atria kupita ku ventricles. Izi zikachitika, kafukufuku amayamba mofulumira ndipo kenako amachepetsanso pang'onopang'ono. Ngati zokhudzana ndi zofuna zimapezeka nthawi zambiri, zingathe kuchepetsa BPM kukhala zosakwana 50. Mwachitsanzo, ngati wodwalayo ali ndi mtundu wachiwiri wa digiri ya AVB ndi kupweteka kwa mtima kwachitatu sikuchitika koma nthenda ya sinus imatumiza maganizo 70 pa miniti, Zotsatira zake zimakhala 46 panthawi imodzi.

1. Gawo lachiwiri lachiwiri sichikupita patsogolo monga mtundu wa I, komabe chimachititsa kuti maganizo ena asakwaniritsidwe kudzera mu chithunzi cha AV komanso kuposedwa kopanda. Mabomba omwe amasowa akhoza kuchitika mu dongosolo kapena mwa njira yopanda phindu. Mulimonsemo, kutayika kwa mimba mokwanira pa miniti kungayambitse kutentha kwapakati pa 50 BPM ndipo ingatengedwe ngati bradycardia.

Vuto la AVB (lomwe limatchedwanso AVB lathunthu kapena chikwama cha mtima wathunthu ) kumachitika pamene zizindikiro siziwoneka kuti zimadutsa muzithunzi za AV nkomwe. Pachifukwa ichi, ma atria adzamenyana ndi drum ya sinus koma ziphuphu zidzachita zomwezo. Mpweya wothamanga, wosathamanga mofulumira, udzamenyana pakati pa 20 ndi 40 BPM, wochulukirapo mochulukira kuti uziwoneka ngati bradycardia. Ngakhale kuti amatchedwa "block block", pa digrii yachitatu AVB pangakhalebe kupititsa patsogolo kupyolera mu vesi la AV. Ngati kupititsa patsogolo kuli pang'onopang'ono, zintchito sizidzadikirira kuti ziwone ngati chirichonse chikubwera ndipo chidzachita mofanana momwe zikanakhalira ngati kafukufuku atatsekedwa kwathunthu. Izi zimakhala zofunikira kwambiri pakutsutsana ngati mukuyesa kapena kuti musayese pamtima mitima yanu.

Kuchiza kwa Symptomatic Bradycardia

Stable bradycardia imayankhidwa mwa kuchiza chomwe chimayambitsa chifukwa cha bradycardia. Ngati ikugwirizana ndi matenda oopsa a myocardial infirction (AMI), kuchiza AMI kuyenera kukhala ndi zotsatira zabwino pa bradycardia. Ngati ndizogwirizana ndi mankhwala, kuchotsa kapena kusintha mankhwala ayenera kuthandizidwa.

Bladdycardia yosakhazikika iyenera kuperekedwa mwachindunji. Kuchokera kumalo osatulutsidwa, bradycardia yosasunthika mwachisawawa imatha kutuluka mwadzidzidzi-kupanda phindu kungapangitse kuti thupi liziyenda magazi. Kuchepetsa kuchepa kwa ubongo kungayambitse kukwapula, chizungulire, kapena chisokonezo.

Pali njira zitatu zochizira matenda osokonezeka omwe ali ndi matendawa: kuonjezera kuthamanga kwa magazi (komanso kupuma kwa magazi) poonjezera kuthamanga kwa madzi m'thupi, kuyimitsa mitsempha ya mitsempha yowonjezera kukhetsa magazi ku ziwalo zofunika, kapena kuwonjezeka kwa mtima. Chithandizo chabwino kwambiri chimagwiritsira ntchito kuphatikiza zonse zitatu.

Mankhwala a IV omwe amalowetsedwa amathandizira kuonjezera kuthamanga kwa magazi ndikupangitsanso kukonzanso. Mankhwala a sympathomimetic, monga dopamine, angathandize kuteteza magazi kutali ndi phokoso ndi kuika maganizo pamtima, makamaka ubongo ndi mtima. Mankhwala osokoneza bongo angathandizenso kuwonjezera kuchuluka kwa mtima, chomwe ndi chithandizo chowonekera kwambiri. Nthaŵi zambiri, kuwonjezeka kwakukulu kwa muyeso wa mtima kumangobwera kuchokera poyang'anira atropine sulphate kapena kuchizira.

Ndipo tsopano, mtsutsano.

Atropine kapena Transcutaneous Pacing

American Heart Association imalimbikitsa atropine sulphate monga mzere woyamba wa chithandizo cha chizindikiro cha bradycardia, mosasamala kanthu kuti ndi chifukwa cha AVB kapena ayi. Apa ndipamene pamakhala timabuku ta mitima yathunthu. Ambiri amaganiza kuti ngakhale atropine ikuthandizira kupititsa patsogolo kudzera mu chidziwitso cha AV, sichidzachita kalikonse pamutu wokwanira wa mtima.

Pa nthawi yomwe transcutaneous pacing (yokhoza kugwiritsa ntchito kachiphamaker yamagetsi panthawiyi pogwiritsira ntchito zomatira pamatumbo ndi / kapena kumbuyo) inapezeka kwa othandizira opaleshoni m'munda, kugwiritsa ntchito atropine kunayamba kuyesedwa. Pali zifukwa zingapo zoperekedwa. Chifukwa chofala kwambiri ndi chakuti atropine imapangitsa kuti okosijeni azigwiritsa ntchito minofu ya mtima, zomwe zingawononge AMI. Chifukwa chachiŵiri chomwe chimaperekedwa ndichoti atropine sichikhudza zowononga mtima.

Zonse mwazifukwazi sizingaganizire, komabe. Palibe umboni wotchulidwa kuti atropine, pamene waperekedwa kwa chizindikiro cha bradycardia, amachititsa kuti matendawa asokonezeke. Komanso, AVB yodalirika ndizovuta kwambiri kuzidziwikiratu kudzera mwa ECG. Ngakhale kuti digri yachitatu AVB ndi yosadziwika kapena yosadziwika bwino komanso atropine ikuyendetsedwa, panthawi yomwe sipadzakhalanso kusintha kwa chiwombankhanza cha mtima ndipo padzakhala bwino.

Kulephera kugwiritsa ntchito atropine kumawonjezereka ndi chikhulupiliro chakuti transcutaneous pacing ndi yosavuta kuigwiritsa ntchito pachiyambi komanso kuti ndi mankhwala oopsa omwe ali ndi zotsatira zochepa. Mwachizoloŵezi, TCP nthawi zambiri imagwiritsidwa ntchito molakwika ndi odwala matenda opatsirana ndi odwala omwe alibe zotsatira zabwino ngakhale pamene opaleshoni ikukhulupirira kuti pacemaker "ikugwira" (zomwe zimachititsa kuti mchitidwe wogwidwa ndi chiwombankhanga ndi kugunda kwa mpweya uliwonse). Kugwiritsira ntchito TCP ndi luso lapamwamba kwambiri, luso lochepa lafupipafupi lomwe liri ndi mwayi waukulu wosagwiritsa ntchito.

Pansi: Mankhwala Musanayambe Edison

Mu gawo lolemera lachipatala, mndandanda uwu umagwiritsidwa ntchito ngati kuti agwiritse ntchito Edison (magetsi) kapena mankhwala (atropine) pochiza bradycardia yosakhazikika. Kukambitsirana kofanana-popanda mkangano wokhalapo-ulipo ngati mungagwiritse ntchito Edison kapena mankhwala kwa tachycardia yosakhazikika.

Chinthu chabwino kwambiri kukumbukira ndi kutsatira American Heart Association ndikupereka atropine. Umboni umasonyeza kuti izo sizidzavulaza wodwalayo. Ngati atropine ikugwira ntchito, imagwira ntchito mkati mwa miniti yoyang'anira. Ngati, miyezo iwiri ndi maminiti awiri kenako, atropine sanachite chinyengo, ndiye nthawi yoti mupite ku TCP.

> Zotsatira:

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> Banda WJ, Swart G, DeBehnke DJ, Ma OJ, Aufderheide TP. The efficacy of atropine pochiza matenda osadziwika a bradycardia ndi atrioventricular block. Kubwezeretsanso . 1999 Jun; 41 (1): 47-55.

> Morrison LJ, Long J, Vermeulen M, Schwartz B, Sawadsky B, Frank J, Cameron B, Burgess R, Shield J, Bagley P, Mausz V, Brewer JE, Dorian P. Kuyesedwa kosasinthika komwe kumachitika poyerekezera chitetezo ndi mphamvu Kupititsa patsogolo pathupi poyerekeza ndi mankhwala ochiritsira: 'PrePACE'. Kubwezeretsanso . 2008; 76 (3): 341-9. Epub 2007 Oct 22.

> Sherbino J, Verbeek PR, MacDonald RD, Sawadsky BV, McDonald AC, Morrison LJ. Kupititsa patsogolo maganizo kwa mtima kwa munthu amene akudwala matenda osokoneza bongo. Kubwezeretsanso . 2006 Aug, 70 (2): 193-200. Epub 2006 Jun 30. Onaninso.

> Swart G, Chikondi WJ Jr, Chikondi DeBehnke DJ, MA OJ, Aufderheide TP. Matenda a myocardial infarction akuphatikizidwa ndi mankhwala osakhazikika bradyarrhythmia: mankhwala a prehospital ndi ED ndi atropine. Am J Emerg Med . 1999 Nov; 17 (7): 647-52.