Vasovagal (Neurocardiogenic) Syncope

Chifukwa Chosavuta Kwambiri Cha Kutaya

Syncope - yomwe imatchedwa kutaya mtima - ndiyo nthawi yachipatala yowonongeka kwa kanthaŵi kochepa. Nkhani iliyonse ya syncope ndi yofunikira pazifukwa ziwiri. Choyamba, syncope ikhoza kuvulaza, kotero ndikofunika kuyesetsa kuti izi zisabwererenso. Ndipo chachiwiri, syncope nthawi zina ingakhale chizindikiro cha vuto lalikulu lachipatala. Ngakhale kuti matenda ambiri angayambitse syncope, mtundu wochuluka kwambiri wa syncope ndi vasovagal syncope.

• Werengani za zifukwa zambiri za syncope.

Chidule cha Vasovagal Syncope

Vasovagal syncope (yomwe imatchedwanso neurocardiogenic syncope ) ndi kuperewera kwadzidzidzi kwadzidzidzi komwe kumayambitsa matenda a ubongo omwe amachititsa mitsempha ya mitsempha mwazidzidzidzi, kapena kuthamanga kwa mtima kwambiri (bradycardia), kapena onse awiri.

Vasovagal syncope amawerengera zoposa theka la magawo onse a syncope. Ngakhale madokotala nthawi zambiri amatchula kuti "chosowa chophweka," njira ya vasovagal syncope kwenikweni si zonse zophweka. Ndipo osamvetsetsa momwe vasovagal syncope ntchito imayendetsera mavuto kuti apange chithandizo choyenera kapena posankha chithandizo chokwanira.

Zifukwa za Vasovagal Syncope

Vasovagal syncope imachitika pamene chinachake chimayambitsa vasovagal reflex , kuchititsa kuti mitsempha ya magazi iwonongeke mwadzidzidzi. Kusinthasintha kwa mitsempha ya mthupi kumapangitsa kuti magazi ambiri azigwedeza miyendo. Kugwiritsira ntchito magazi nthawi zambiri kumaphatikizapo kuchepa kwa mtima.

Zotsatira zake, kuthamanga kwa magazi mwadzidzidzi kumagwa. Ngati kugwa kwachisokonezo kumapangitsa kuti ubongo udziwe magazi, kuwonongeka kumachitika.

Vasovagal reflex ikugwira ntchito monga iyi: Choyamba, munthu amatha kukhumudwa kwambiri (monga kupweteka kwa singano m'chindunji) chomwe chimayambitsa kuganiza.

Chochititsa chidwicho chimayambitsa mitsempha ina (yomwe imamva kupweteka kwa chala), yomwe imatumiza chizindikiro cha magetsi kuchipatala cha vasomotor mu ubongo wa ubongo, gawo la ubongo lomwe limatulutsa mitsempha ya thupi (magazi chotengera). Pakatikatikati pa zivomezi, poyankha, amatumiza zizindikiro kumitsinje ya magazi, zomwe zimawapangitsa kuti azichepetse. Izi zimayambitsa kukhazikitsa magazi, zomwe zimabweretsa syncope. Kukopa komweko kwa ubongo kungatumizenso zizindikiro kumtima (kupyolera mu mitsempha ya vagus ) kuti ikhale ndi dontho la mtima.

Kwa anthu ambiri omwe ali ndi vasovagal syncope, kutuluka kwa mitsempha ya magazi kumawoneka kuti ndi chinthu chachikulu chomwe chimayambitsa imfa ya chidziwitso. Komabe, mwa anthu ena, kuchepa kwa mtima kumatengera mbali yaikulu.

Kodi chingayambitse vasovagal syncope? "Choyambitsa" chimene chimayambitsa vasovagal reflex chingakhale chilichonse cha zinthu zosiyanasiyana. Zowonongeka kaŵirikaŵiri ndi izi:

• Ululu, ululu womwe umakhala wovuta pachiyambi.
• Kukhala ndi magazi anu atakokedwa.
• Kukhala pamaso pakuwona magazi, kapena kuzinthu zina zoopsa.
• Kukhala ndi vuto lovuta kukonza kapena kutetezedwa.
• Kuthamanga kwakukulu kokopa.
• Kumeza kowawa.
• Kulandira uthenga wokhumudwitsa kapena wochititsa mantha.
• Kuwopa mwadzidzidzi.
• Kuima mosalekeza kwa nthawi yaitali. (Ichi ndichifukwa chake asilikali akuyimirira pamsasa, kapena oimba muyimba, nthawi zina amalephera.)

Ngati chiwonongeko chotsatira chikutsatira zochitika izi, vasovagal syncope ndithudi ndi chifukwa.

Zizindikiro Zomwe Zimaphatikizapo Kapena Zimathandiza Vasovagal Syncope

Ngakhale kutaya chidziwitso ndi vasovagal syncope kungakhale mwadzidzidzi, mochuluka kwambiri mwachikondi kumayambitsidwa ndi masekondi angapo kapena zizindikiro zochepa zachenjezo . Zizindikirozi zowonetsera nthawi zina zimatchedwa "prodrome" ya syncope.

Zizindikiro izi zimaphatikizapo:

• Lightheadedness.
• Kulira kapena kugwedeza m'makutu.
• Kusokonezeka kwazithunzi, monga masomphenya owonetsa kapena masomphenya masomphenya.
• Kutuluka thudzidzidzi.
• Kusowa mwadzidzidzi.

Zizindikiro zowonjezerazi zimatsatiridwa ndi "kumva," kenako potaya chidziwitso.

Nthawi pakati pa kuyambira kwa zizindikiro za prodromal ndi kudutsa kunja kungakhale mphindi pang'ono, kapena yachiwiri kapena ziwiri.

Syncope palokha imakhalanso ndi zizindikiro zosiyanasiyana:

• Vasovagal syncope nthawi zambiri imapezeka pamene wogwidwayo akuima, kapena amakhala wokhazikika (pamene magazi akuyendetsa miyendo angakhoze kuchitika), ndipo sizikuchitika konse pamene wagona.
• Anthu omwe ali ndi vasovagal syncope kawirikawiri amadziwanso pambuyo pa masekondi pang'ono, kamodzi atagwa (kapena, ngati ali ndi mwayi, amathandizidwa) pansi. Izi zili choncho chifukwa kamodzi kake pansi, mphamvu yokoka siimayambitsa magazi kuti ayambe kusambira m'milingo ndipo kuthamanga kwa magazi kumawonekera nthawi yomweyo.
• Koma, ngati wogwidwayo akugwiridwa moyenera ndi woyang'ana bwino, chidziwitso chingakhoze kukhala chochuluka kwambiri. Izi zikhoza kukhala zoopsa, chifukwa malinga ngati wolumidwayo ali wolunjika ndi wosadziŵa, ubongo wake sungapangidwe bwino ndi magazi.

Chofunika kwambiri ndi chakuti ngati muwona wina akufooka, muyenera kuwathandiza kuti ayambe kutsitsa ndikukweza miyendo yawo. Kuwagwira pa malo owongoka - ngakhale ngati muwonjezera "mankhwala" owonjezereka a kufuula m'makutu mwawo kapena kuwamenya - sizothandiza, ndipo zingakhale zovulaza.

"Zizindikiro" zowonjezera. Pambuyo panthawi ya vasovagal syncope, anthu ambiri amamva zowawa kwa maola pang'ono kapena ngakhale masiku angapo otsatira, kapena ataliatali. Panthawi imeneyi, nthawi zambiri amakhala otopa kwambiri, kunyowa, chizungulire komanso kusowa kwa njala.

Ndikofunika kwambiri kuzindikira kuti, mpaka izi zowonongeka (ndi zowopsya) zizindikiro zowonongeka zimatha, anthu amatha kukhumudwa - choncho amafunika kukhala osamala chifukwa cha zizindikiro zomwe zingasonyeze kuti chiwonetsero cha syncope chili pafupi.

Anthu omwe kale anali ndi vasovagal syncope. Anthu omwe ali ndi magawo awiri kapena awiri a vasovagal syncope nthawi zambiri amatha kuzindikira machenjezo, kotero adziwa nthawi yomwe yatsala pang'ono kuchitika. Chofunika kwambiri, ngati amadziwa zizindikiro zowonetsera, amatha kuteteza mdimawu mwa kungokhala pansi ndi kukweza miyendo yawo. (Kusiya chochitika sizingatheke ndi mitundu yambiri ya syncope.) Komanso, ngati atha kupeŵa kuzima, nthawi zambiri amapewa nthawi yotsatizana yomwe imachitika nthawi zambiri.

Kumbali ina, kuyesera "kumenyana" ndi nthawi yotsatira ya vasovagal syncope mwa kudzikakamiza kuti mukhalebe wolunjika ndipo mukudzikonda nokha kuti musataye ngakhale kuti sizikuyenda bwinobwino.

Anthu achikulire omwe ali ndi vasovagal syncope amakhala ndi zizindikiro zowoneka bwino. Syncope yawo ikhoza kuchitika popanda chidziwitso chodziwikiratu, ndipo popanda zizindikiro zowonetsera. Kupanga matenda oyenerera m'mabuku amenewa kungabweretse vuto lalikulu kwa dokotala.

Kawirikawiri, vasovagal syncope siyo yomwe imayambitsa moyo - koma kuvulala kumene kumabwera chifukwa cha kugwa kungakhale. Ndipo ngati magulu ambiri amapezeka mobwerezabwereza, matendawa akhoza kukhala osokoneza moyo wamba.

Ndani Amakhudzidwa?

Zomwe zimayambitsa vasovagal syncope zikhoza kuchitika kwa aliyense, kotero pafupifupi aliyense akhoza kukhala ndi vasovagal chochitika ngati chochitika chokwanira chokwanira chikuchitika. Inde, zikutheka kuti anthu ambiri adzakhala ndi vuto lothawa nthawi zina m'miyoyo yawo.

Vasovagal syncope ikhoza kuchitika pa zaka zirizonse, koma zimakhala zofala kwambiri kwa achinyamata ndi achinyamata kusiyana ndi anthu akuluakulu.

Anthu ena amakonda kwambiri vasovagal, ndipo akhoza kufooka ngakhale ndi zochitika zosautsa. Anthu awa amakonda kukhala ndi zigawo zowonjezereka za syncope, kuyambira muunyamata. Nthawi zambiri amamva syncope akutsatira zochitika zosiyanasiyana zokopa.

Mwa anthu omwe sali ochepa, vasovagal syncope nthawi zambiri ndi zovuta kuchiza kuti zimakhala zolephereka nazo. Anthuwa amakhala ndi mawonekedwe a dysautonomia (kusamvetseka kwa kayendedwe kabwino ka mantha) komwe kumawapangitsa kukhala ofanana kwambiri ndi vasovagal reflex yomwe imayambitsa vutoli. Nthawi zambiri amakhalanso ndi zizindikiro zina zomwe zimakhalapo nthawi zambiri zomwe zimayambitsa matendawa, monga kupweteka m'mimba kapena kutsekula m'mimba, kutsekula m'mimba, kudzimbidwa, kutopa kwambiri komanso zowawa zosiyanasiyana.

Kuzindikira Vasovagal Syncope

Madokotala omwe ali ndi luso lomvetsa vasovagal syncope amadziwa kuti vutoli ndilokhazikika nthawi zonse. Vasovagal syncope makamaka ikutheka kuchitika pambuyo pa matenda a chiwindi, atatha kuchita masewera olimbitsa thupi, atatha kusamba kapena kutentha m'mawa - mwa kuyankhula kwina, nthawi iliyonse yokhudzana ndi kuchepa kwa madzi imakhalapo. (Pamene mwataya madzi, kutsitsa mitsempha ya magazi m'milingo kumakhala kovuta kwambiri kuti muchepetse magazi anu.)

Chifukwa cha zikhalidwe izi ndi maonekedwe a chikhalidwe ichi, madokotala ayenera athe kupeza matenda oyenera odwala ambiri pokhapokha pofunsa mafunso abwino ndi kumvetsera mwatcheru ku mayankho. Mwatsoka, madokotala ambiri amalephera kutenga mbiri yoyenera yachipatala; Zotsatira zake, amatha kuyesa zosavuta ndi njira zosavuta kufunafuna matenda a mtima kapena a ubongo.

Kufufuza kwa anthu omwe ali ndi vasovagal syncope kawirikawiri kumakhala kovuta. Komabe, kufufuza kumathandiza kwambiri pakupeza mkhalidwe wofananako wa hypotension orthostatic syndrome (POTS) , ndipo zingakhale zothandiza pakukonza njira zomwe zingatheke.

Ngakhale kuti nthawi zambiri kufufuza kwa vasovagal syncope kuyenera kukhala kotheka mwa kutenga mbiri yachipatala ndikuyesa thupi, kuyesa nthawi zina kumathandiza. Makamaka, phunziro la patebulo lopindika lingakhale lothandiza ngati mbiri yakale yachipatala siyimene vasovagal syncope, kapena ngati n'zovuta kusiyanitsa pakati pa vasovagal syncope ndi hypotension orthostatic hypotension.

Kuchitira Vasovagal Syncope

Anthu omwe ali ndi kachilombo kamodzi kokha ka vasovagal syncope kawirikawiri safuna thandizo lililonse lachipatala.

Koma ngati mwakhala ndi zizindikiro zosawerengeka, mumakhala ndi zochitika zambiri pokhapokha ngati mukuchiritsidwa. Ndipo, monga aliyense amene ali ndi vasovagal syncope amadziwa, zigawo izi zowonongeka nthawi zambiri zimafika nthawi zovuta kapena zosatheka, ndipo zingasokoneze moyo wanu. Mwamwayi, mankhwala amathandiza kwambiri.

Pali mitundu iwiri ya mankhwala a vasovagal syncope: maphunziro, mankhwala, zochita masewera olimbitsa thupi komanso opanga mtendere. Mwa izi, maphunziro ndi othandiza kwambiri kwa anthu ambiri.

1) Kudziphunzitsa nokha za Vasovagal Syncope

Anthu omwe amakhala pafupi ndi vasovagal syncope ayenera kudziwa mfundo zisanu zofunika zokhudza matendawa, omwe tawafotokozera kale. Mwachidule, awa ndi awa:

1. Vasovagal syncope imapangidwa ndi reflex yomwe imayambitsa mitsempha ya mwazi mwadzidzidzi m'milingo, kuchititsa kuti damu ikhale pamadzi otsika.
2. Chikhalidwe chilichonse chimene chimayambitsa kuchepa kwa madzi (zomwe zimachepetsa mphamvu ya magazi) zidzakupangitsani kuti mukhale ndi chizolowezi cha syncopal.
3. Zizindikiro za Prodromal zimapereka machenjezo ofunika omwe syncope angakwaniritse kanthawi.
4. Ngati mugona pansi ndikukweza miyendo yanu mukakumana ndi prodrome, mungapewe chiwonetsero cha syncopal.
5. Nthawi zambiri anthu amakhala ndi masiku angapo kapena masabata omwe nthawi zambiri amakhala nawo pafupi ndi vasovagal. Izi zikhoza kuchitika, mwachitsanzo, atatha kudwala matenda a vutolo, kapena nthawi yothetsa nthawi yaitali kapena kuwonongeka kwa kugona. Muyenera kukhala osamala kwambiri pa zizindikiro zowonjezereka nthawi zina.

Njira yabwino yothetsera vasovagal syncope ndi kupewa zinthu zomwe zimapangitsa syncope. Ngati mumvetsetsa mfundo zisanu zomwe zatchulidwa, malangizo otsatirawa akuwoneka bwino.

• Poyamba, pewani kutaya madzi m'thupi . Kutaya madzi m'thupi (ndipo motero syncope) amapezeka kawirikawiri pambuyo pochita masewera olimbitsa thupi, pambuyo pa matenda aliwonse, ndi m'mawa kwambiri pambuyo pa kusala usiku wonse. Mankhwala a khofi, tiyi ndi diuretic angathenso kutulutsa thupi. Ngati muli pamtundu wotha kuchepa kwa madzi m'thupi, muyenera kumvetsa kupweteka kuti muthetse. Muyenera kumwa madzi ochulukirapo ambiri, koma ngati mukuganiza kuti mutha kutaya madzi, izi ndi zofunika kwambiri. Ndipo muyenera kupewa nthawi yayitali pamene mukusiya madzi.
• Samalani kwambiri ndi zizindikiro zilizonse zomwe mungakumane nazo. Zizindikiro za prodromal - zovuta zowonongeka, kuyang'ana m'makutu, kumutu, kutuluka thukuta, ndi / kapena nseru - zimakhala zosiyana ndi munthu. Koma anthu omwe adakumana ndi magulu a syncopal kawirikawiri ali ndi lingaliro labwino la zizindikiro zomwe zimayenera kuchitika.
• Ndikofunika kuzindikira zizindikiro zanu zoyipa, chifukwa ngati mutero, mungathe kupewa syncope mwa kugona ndi kukweza miyendo yanu. Koma, ngati musankha kunyalanyaza zizindikirozo, mumatha kudutsa mu zakudya zachisanu, ndipo woyang'anira sitolo amagwiritsa ntchito (chifukwa cha zifukwa zomveka) kuti mutumize ku ER mu ambulansi , komwe mungapangidwe ndi batri ya mayesero osafunika ndikukhala m'chipatala usiku wonse. Ubwino wina wopewa syncope weniweni ndi kugona pansi ndikuti pamene mutero, mudzapewa nthawi yochuluka ya matenda omwe amatha nthawi zambiri omwe amatsatira vasovagal.
• Anthu ena atha kuchotsa zochitika za vasovagal syncope (kapena mobwerezabwereza, kuchezetsani nthawi yaitali kuti mufike pamalo oyenera kuti mugone pansi) mwamsanga mukuchita masewera olimbitsa thupi . Zochita zimenezi zikuchepetsa kuchepa kwa mitsempha ya magazi ndikuwonjezera kuchuluka kwa magazi kubwezeretsedwa pamtima. Zochita zoterezi zimaphatikizapo kudumpha miyendo ndikukweza miyendo, m'mimba ndi m'mimba; Kuwombera manja ndi ziboda zovuta; mwendo wokumenya; kapena kupopera mipira ya mphira.
• Anthu omwe amakhala pafupi ndi vasovagal syncope angakhale ndi nthawi, masiku osatha kapena masabata, momwe syncope imakhala yovuta kuchitika. Nthawi "zovuta" zimenezi zimawoneka kuti sizichitika chifukwa chosadziŵika. Nthawi zina, amatha kukhala okhudzana ndi matenda a tizilombo, kumapeto kwa nthawi, nthawi yokhala wotopa kapena kuthamanga; kapena m'mimba, m'mitsempha kapena m'mimba. Ngati mwakhala ndi magawo awiri kapena awiri atsopano a syncopal, amafunika kukhala osamala makamaka pa zizindikiro zowonjezereka zomwe zingayambitse kachilendo kena. Zimaperekanso nthawiyi kuti azichita khama kwambiri kuti asunge madzi ambiri.

2) Mankhwala Osokoneza Bongo

Kwa anthu ena, vasovagal syncope imakhala ndi mafupipafupi osokonezeka ngakhale zitakhala zotetezedwa. Kwa anthuwa, mankhwalawa ndi othandiza.

Zakale zapitazo, mankhwala omwe amagwiritsidwa ntchito kwambiri pa vasovagal syncope anali oteteza beta , koma maphunziro angapo alephera kusonyeza phindu lililonse ndipo mankhwala awa sakulimbikitsidwa .

Mankhwala omwe asonyezedwa kuti ali ndi thandizo lina ndi awa: midodrine (mankhwala omwe amachepetsa kuchepa kwa mitsempha ya magazi), disopyramide (Norpace, mankhwala osokoneza bongo omwe ali ndi zida zina zotsekereza), serotonin kubwezeretsanso mankhwala (mankhwala m'gulu la Prozac) ndi theopylline (mankhwala omwe amagwiritsidwa ntchito kwambiri pochizira mphumu ).

Ngakhale mankhwala amodzi kapena angapo amathandiza kuchepetsa zigawo za syncope, kupeza "kulumikiza" mankhwala osokoneza bongo nthawi zambiri ndi vuto la kuyesera. Kuleza mtima kumafunika kwa dokotala ndi wodwalayo kuti apeze mankhwala abwino kwambiri.

3) Mankhwala opatsirana

Anthu ambiri omwe ali ndi dysautonomia amasonyezanso chizoloŵezi chokhala ndi vasovagal syncope; Inde, zikuwoneka kuti anthu ambiri omwe nthawi zambiri amapezeka vasovagal syncope (mmalo mwa magawo amodzi, okhaokha), ali ndi mawonekedwe a dysautonomia. Popeza ma dysautonomias ena amadziwika kuti amayesetsa kuchita masewera olimbitsa thupi (omwe angasinthe machitidwe awo ndi "kusintha" kayendedwe ka mantha), akatswiri ena amanena kuti kuchita masewera olimbitsa thupi kungathandizenso anthu omwe ali ndi vasovagal syncope. Ndipo ndithudi, deta yochepa yomwe ilipo pano ikusonyeza kuti izi ndizochitika. Kotero, ngati mutakhala ndi vasovagal syncope, muyenera kukambirana za zochitika zolimbitsa thupi (monga kuyenda, kuthamanga kapena njinga) ndi dokotala wanu.

• Werengani za kutenga mankhwala oyenera.

4) Pacemaker Therapy

Zaka zingapo zapitazo panali chidwi chochuluka chogwiritsa ntchito opanga chipangizo kuti athetse vasovagal syncope, chifukwa vasovagal syncope nthawi zambiri imakhala ndi kuperewera kwa mtima mwadzidzidzi. Chidwi cha mankhwala opanga pacemaker chinachepa mofulumira, komabe patapita nthawi kuti odwala ambiri omwe ali ndi vasovagal syncope omwe analandira chipangizo chowombera amatha kupitilira - iwo amangopanga mosavuta mtima. Zomwe zikuwonekera, ambiri, ngati anthu ambiri omwe ali ndi vasovagal syncope, ndiko kugawana kwa magazi m'milingo, ndipo osati pang'onopang'ono pamtima, zomwe zimapangitsa syncope.

Komabe, mwa anthu ena omwe ali ndi vasovagal syncope, kugwa kwa mtima wamtima ndi chifukwa chachikulu chokhalira. Mwa anthuwa, opanga pachipatala akhoza kuchepetsa nthawi zambiri za syncope episodes.

Pakalipano, anthu omwe ali ndi vasovagal syncope amalimbikitsidwa ngati: a) kuchepetsa kutaya kwa mtima kumatchulidwa panthawiyi, mwina panthawi ya kuyesedwa kwa tebulo kapena pa kuyang'aniridwa kwa ECG , ndi b) kuchitapo kanthu Ndondomeko zomwe tazitchula pamwambapa kuti tipewe kapena kuzichotsa vasovagal syncope) sizothandiza.

Mawu Ochokera

Vasovagal syncope ndizofala kwambiri. Mwamwayi, kaŵirikaŵiri amapezeka m'zinthu zosaoneka, zapadera kapena panthawi yochepa. Anthu ambiri omwe ali ndi vasovagal syncope amatsogolera moyo weniweni.

Ngati mwakhalapo ndi vasovagal syncope - makamaka kuposa chiwerengero chimodzi - muyenera kuphunzira zambiri momwe mungathere pa vutoli, kuphatikizapo zinthu zomwe zimapangitsa kuti zizindikiritse, momwe mungazindikire zizindikiro zowonetsera ndi momwe mungasiyirepo chochitikacho.

Ngati mwabwereza magawo ambiri a syncope ngakhale mutayesetsa kuchita zimenezi, muyenera kuyankhula ndi dokotala wanu ngati palibenso chinthu china choposa "chithandizo chopewera".

> Zotsatira:

> Chen-Scarabelli C, Scarabelli TM. Syncope ya Neurocardiogenic. BMJ 2004; 329: 336.

> Sumner GL, Rose MS, Koshman ML, et al. Mbiri Yakale ya Vasovagal Syncope mu Werenganinso Wachiwerengero Chachiwerengero ndi Wowonjezera Wowonjezereka wa Syncope Wosakhalitsa kuposa Lifetime Syncope Burden. J Cardiovasc Electrophysiol 2010; 21: 1375

> Gulu la Task of Discoagnosis and Management of Syncope, European Society of Cardiology (ESC), European Heart Rhythm Association (EHRA), et al. Malangizo Othandizira Kuzindikira ndi Kusamalira Syncope (2009). Mtima; 30: 2631.