Isifo sentliziyo kwizinja kunye neekati

"Inja yam inento entliziyweni yayo" yinto osoloko uyiva, ngakumbi xa isilwanyana sisidala. Kodwa imalunga nantoni? ugqirha wezilwanyana uDkt Sebastian Goßmann-Jonigkeit unika ingqiqo kwiimpawu zesifo senhliziyo kwizinja kunye neekati kwaye ubonisa unyango olunokwenzeka.

Isifo Sentliziyo… Ithetha ukuthini Le nto?

Nalu utyelelo olubhabhayo kwi-cardiology - isayensi yentliziyo.
Intliziyo inomsebenzi ofanayo kuzo zonke izilwanyana: impompa igazi emzimbeni. Oku kuqinisekisa ukuba ioksijini ebotshelelwe kwiiseli ezibomvu zegazi iyafumaneka kwiseli nganye emzimbeni ngobuninzi obaneleyo. Imfuno inokwahluka ukusuka ezantsi ukuya phezulu ngexesha lokuzibhokoxa ngokwasemzimbeni xa uphumle-ukubuyisela oku kwakhona kuwela kwindawo yentliziyo yoxanduva.

Isakhiwo sentliziyo

Ngaphandle kwezinto ezimbalwa kwizilwanyana, intliziyo yesakhiwo ifana kakhulu nelungu elisebenzayo elingenanto. Macaleni omabini kukho i-ventricle enkulu ezantsi kweatrium encinci, eyohlulwe ngokucacileyo omnye komnye sisivalo sentliziyo esisebenza njengevalve yendlela enye ukuze igazi liqukuqele kwicala elinye kuphela. Igazi ligcinwa lijikeleza rhoqo ngexesha lenkqubo yokumpompa ngenkqubo eyinkimbinkimbi yoxinzelelo lwemisipha kunye nokunyakaza kwevalve.
I-oksijini ephantsi, igeleza ngaphakathi kwi-organ nge-afferent posterior vena cava. Ingena kwi-ventricle elungileyo ukusuka kwi-atrium yasekunene nge-valve ebizwa ngokuba yi-tricuspid. Ukusuka apho nge-pulmonary artery ukuya kwinkqubo yemithambo yemiphunga, apho iiseli ezibomvu zegazi zilayishwa ngeoksijini entsha. I-pulmonary vein ikhokelela igazi kwi-atrium yasekhohlo, nge-valve ebizwa ngokuba yi-bicuspid kwi-ventricle yasekhohlo, kwaye ikhutshwe apho nge-aorta ukuya kwi-systemic circulation, ecebile kwi-oksijini.

Umgca Wokuvuselela

Ukuze ukuhamba kwegazi kusebenze kanye ngolu hlobo, ukucutheka kwemisipha yentliziyo kufuneka kulawulwe ngokuchanekileyo. I-node ebizwa ngokuba yi-sinus node ibeka isantya sale nto - ithumela impembelelo yombane efikelela kwiiseli ze-muscle zentliziyo ngendlela echanekileyo ukwenzela ukuba zivumelane ngokuchanekileyo ngokuhambelana nomsebenzi wokupompa. Oku kuphuma kombane kunokuboniswa ngokusebenzisa i-electrocardiogram (ECG) kwaye ibonisa ukuqhuba kwe-stimulus kwi-heart muscle. Isetyenziselwa ukufumanisa i-arrhythmias enokwenzeka (umzekelo, ixesha elichanekileyo okanye ukuqhuba okungalunganga) okunokuthi, kungabonakali, kunokukhokelela ekuhambeni kwegazi okungonelanga. Yingakho ukujonga intliziyo ngexesha le-anesthesia kubaluleke kakhulu.

Iimpawu zesifo senhliziyo kwizinja kunye neekati

Zonke iimpawu zokungaphumeleli kwentliziyo zinokuchazwa ngokungasebenzi kakuhle kwentliziyo. Esinye sezizathu eziphambili zedinga ngexesha lokubonisana kukwehla okubonakalayo ekusebenzeni - oku kudla ngokuqala ukubonakala xa amaqondo obushushu angaphandle ephezulu ekuqaleni kwehlobo. Kuba intliziyo enesiphene sevalvu yentliziyo enxulumene nobudala inokugquma kuphela imfuno yeoksijini kumzimba, isigulana sihlala sishukuma kancinci okanye sicotha kunesiqhelo. Ngokunyuka kwamaqondo okushisa angaphandle, inkqubo ye-cardiovascular igxininiswe ngakumbi, ekubeni inxalenye enkulu yamandla omzimba igeleza kulawulo lobushushu kunye nokunikezelwa kwe-oksijini encinci kuzo zonke izitho (ibaluleke kakhulu kwingqondo) ayiqinisekiswanga ngamaxesha onke. Le meko ibangela ukuwa kwesigulane sentliziyo esingaqatshelwanga okanye esinganyangwanga ngokwaneleyo ngeentsuku ezishushu zasehlotyeni.

Olunye uphawu lunokuba bubluish (cyanotic) inwebu ezijike umbala (umzekelo, i-conjunctiva esesweni okanye iintsini ezingenabala), ezibangelwa kukungabikho kweoksijini egazini.
Kumanqanaba ahambele phambili, into ebizwa ngokuba 'lukhohlokhohlo lwentliziyo' ikholisa ukwenzeka – le yi-pulmonary edema, ethi isigulana sizame ukukhohlela okanye ukuminxa. Kwenzeka xa igazi elisuka kwi-atrium esekhohlo libuyela emiphungeni kwaye ulwelo olusegazini lucinezelwe luphume kwi-vascular system ukuya kwizikhewu phakathi kwe-bronchi - ukuba ayinyangwanga, izilwanyana 'zinokurhaxwa' okanye 'zifuthaniseleke'.

Ukuqondwa

Zininzi iindlela zokuxilonga intliziyo. Eyona nto ilula kukuphulaphula nge-stethoscope - into ebizwa ngokuba yi-auscultation. Kule nkqubo, ingxolo yesibini yentliziyo (ukubetha, ukugobhoza, njl. njl.) inokumiselwa ngeevalvu zentliziyo ezinesiphako. Ngelo xesha, umntu unokubala ukubetha kwentliziyo kwaye mhlawumbi uve i-arrhythmia.

Kwimeko ye-X-ray yenhliziyo (ngokuqhelekileyo inokwenzeka ngaphandle kwe-sedation), imilinganiselo ethe tyaba kunye nethe nkqo ye-organ ibekwe ngokumalunga nobukhulu be-thoracic vertebrae ukuze ibone ukuba ikhulisiwe. Ukuba ilinganisa ngaphezu kwemizimba ye-10.5 ye-vertebral inja, oku kubhekiselwa kuyo njengokwandiswa kwentliziyo efuna unyango - le ndlela yokubala ibizwa ngokuba yi-VHS X-rays (i-Vertebral Heart Score).

Ukuze ukwazi ukuvavanya ukusebenza kweevalve ngaphandle kwamathandabuzo, i-Doppler ultrasound izibonakalise ngokwayo. Ukongeza kwimilinganiselo yeevalvu zentliziyo, nayiphi na i-backflow yegazi ngenxa yeziphene inokuboniswa ngombala.

I-DCM vs HCM

Xa ukusilela kwentliziyo kwenzeka ebudaleni, umzimba wezinja kunye neekati uhlala usabela ngendlela eyahlukileyo. Ekubeni ukuhamba kwegazi kuphazanyiswa yi-valve yentliziyo ephosakeleyo kwaye inokuncitshiswa kwezinye iindawo, intliziyo njengesikhululo sokumpompa esiphakathi kufuneka sakhiwe ngokutsha kwaye silungelelaniswe ngokufanelekileyo.

Izinja zihlala zivelisa into eyaziwa ngokuba yi-dilated cardiomyopathy (DCM). Oku kukwandiswa kwelungu elinokuthi libonwe ngokulula kwi-X-reyi. Umthamo wawo omabini amagumbi ubonakala unyuke kakhulu ukuze isixa esikhulu segazi sishukunyiswe ngokubetha kwentliziyo nganye. Ingxaki yolu hlengahlengiso kukuba isihlunu sentliziyo siba mxinwa kakhulu kwindawo yamagumbi - asinawo amandla okusebenzela ilungu elandisiweyo ngokufanelekileyo.

Iikati, kwelinye icala, ziphuhlisa i-hypertrophic cardiomyopathy (HCM) phantse kuphela ebudaleni ukuba kukho iziphene zevalvu ezihambelanayo. Ngolu hlobo lwembuyekezo, imisipha yentliziyo igxininiswe kakhulu ngokunciphisa okubalulekileyo kubukhulu bamagumbi entliziyo. Ngoko ke, kuphela inani elincinane legazi elinokumpontshwa ngokubetha kwentliziyo nganye kwaye intliziyo kufuneka ibethe rhoqo ukuze ikwazi ukuthutha elona nani lincinane legazi.

unyango

Kungekudala xa iimpawu zesifo senhliziyo ezichazwe ngasentla zivela kwizinja kunye neekati, ugqirha wezilwanyana kufuneka adibane ngokukhawuleza ukuze ahlolwe intliziyo.

Kuba iivalvu zentliziyo zihamba kancinci ngokukhula, uninzi lwazo zonke izinja kunye neekati ziya kuthi kungekudala ziphuhlise iimpawu ezihambelanayo kwaye zifune unyango. Ukuze kuhlawulwe ngenxa yokungaphumeleli kwentliziyo, iyeza lanamhlanje lezilwanyana lisebenzisa iintsika ezine zentliziyo (amayeza entliziyo):

1. Ukwehlisa umthwalo osemva nge-ACE inhibitors (ngokwandisa imithambo yegazi, kuba lula ukuba intliziyo impompe ngokuchasene noxinzelelo lwegazi olukhoyo)
2. Ukunciphisa okanye ukuguqula inkqubo yokuguqulwa okwenzekayo kwi-dilated or hypertrophic cardiomyopathy
3. Ukomelezwa kokuqina kwentliziyo ye-muscular ngokusebenzisa isithako esisebenzayo 'pimobendan' ezinjeni.
4. Ukukhupha imiphunga ngokuvula ukusebenza kwezintso kunye nezithako ezisebenzayo 'Furosemide' okanye 'Torasemide' xa kukho i-pulmonary edema.

Ukongeza, iiarhente ezikhuthaza ukujikeleza kwegazi ezifana nepropentofylline zinokusetyenziswa kwindawo yeendlela zokuhamba zesiphelo.

Yeyiphi into esebenzayo esetyenziswayo apho isigulane kufuneka sigqitywe ngesiseko seziphumo ezikhoyo kunye neempawu. Ukudibanisa ngokubanzi akunakwenzeka.

isiphelo

Kwiminyaka embalwa edlulileyo, isifo senhliziyo kwizinja kunye neekati, ngakumbi iimeko ezinxulumene neminyaka, zazibhekwa njengobunzima kakhulu. Kwelinye icala, ngenxa yokuba ukhetho lwamayeza lwalunqongophele kakhulu kwaye, kwelinye icala, iyeza ekwakunzima ukulenza (umz. ityhefu ye-foxglove ebomvu) lalikhona.

Ngokukodwa, ukomeleza isiphumo se-pimobendan kuzise inkqubela phambili enkulu kunyango lwezinja ezinesifo sentliziyo kwiminyaka yakutshanje.
Namhlanje, ubomi obulindelekileyo besigulana sentliziyo esilungelelaniswe kakuhle kwaye sibekwe iliso ngokufanelekileyo sinokuba phezulu kanye njengeso sigulana esisempilweni – ukuba kuthathwe amanyathelo kwangethuba.