I-Syncope (isono-co-pee) ukulahlekelwa okwesikhashana kwesikhashana, okubhekwa ngokuthi ukudikibala, noma ukuphuma. Kuyinto evamile kakhulu - iningi labantu lidlula okungenani kanye empilweni yabo. Noma kunjalo, i-syncope ihlale ingaba yinkinga enkulu, kokubili ngoba ingase ikhombise inkinga ebalulekile, futhi ngoba noma yikuphi ukulahlekelwa yocwaningo kungaveza ukulimala.
Ngakho-ke, uma unesiqephu se-syncope, kufanele uhlolwe udokotela wakho ukucacisa imbangela yaso.
Ukukhuthazela
Ukuvumelanisa kwe-syncope kwenzeka lapho igazi ligeleza ebuchosheni liyehliswa ngokuphawulekayo, ngoba kunambalwa amaminithi amahlanu noma ayisithupha. Ukugeleza kwegazi kwengqondo kungaphazamiseka ngenxa yezizathu ezahlukene. Ngenhlanhla, ezimweni eziningi, i-syncope yisimiso esincane esingabangelwa inkinga enkulu yokwelapha. Ngakho-ke ezimweni eziningi, uma nje isiqephu se-syncopal ngokwazo singabangeli ukulimala okukhulu, lo mcimbi ngeke ube nokubaluleka kwesikhathi eside.
Kodwa-ke, ngezinye izikhathi i-syncope iyisibonakaliso sokuthi isimo sezokwelapha esiyingozi noma esesongela impilo singase sibe khona. Yingakho, uma unesiqephu se-syncope, kubalulekile ukuthi uthintane nodokotela wakho.
Izimo ezihlanganisiwe
I-syncope ingabangela ukuhlukahluka kwemibandela yezokwelapha. Eqinisweni, inani elikhulu lemisebenzi lingenza ukuhlolwa kwe-syncope kube yinto enzima futhi yesabisa odokotela abangahambi nale nkinga ngendlela ehleliwe, ehlelekile.
Odokotela abahlakaniphile ekuhloleni i-syncope ngokuvamile bahlukanisa izimbangela ezingaba yizigaba ezimbili jikelele - i-syncope ngenxa yesifo senhliziyo, kanye ne-syncope ngenxa yezizathu ezingezona zomzimba. Cishe zonke izinhlobo ezingasongela impilo ye-syncope zisesigaba senhliziyo. Ngenhlanhla, izimbangela ze-heart syncope zivame ukubonakala ngokuhlola okujwayelekile ngokucophelela - ngokuyinhloko, ngokuthatha umlando omuhle wezokwelapha nokwenza ucwaningo olunempilo.
Futhi uma isifo senhliziyo sinqunywe ngaphandle, wena nodokotela wakho ungaqinisekiswa ukuthi kungakhathaliseki ukuthi imbangela ivelaphi, awunakwenzeka ukuthi ube nesimo esisongela ukuphila - kanti okunye okusele kokuhlolwa kwakho kungenziwa ngaphandle kwanoma yikuphi umqondo wokuphuthuma ngokweqile.
Izimbangela
Izifo zenhliziyo
Cishe umuntu oyedwa kwabayisine abane-syncope uzoba nomphumela wezinhliziyo. Izinhlobo ezimbili ezijwayelekile zezinkinga zenhliziyo zingabangela izinkinga ze-syncope - zenhliziyo ezingaphazamisa kancane ukugeleza kwegazi ngenhliziyo, kanye nokuhlelwa kwe-cardiac arrhythmias .
Isifo senhliziyo esivimbelayo:
Ukuvinjelwa egazini eligeleza ngenhliziyo kungabangela ukwehla kwenani legazi inhliziyo ishaya, ngaleyo ndlela iphanga ubuchopho ngokugeleza kwegazi okwanele. Izinkinga eziningana zenhliziyo zingavimbela kancane ukugeleza kwegazi ngenhliziyo . Lokhu kufaka:
- Isifo se-valve senhliziyo esenza i-stenosis, ikakhulukazi i- aortic stenosis kanye ne- mitral stenosis
- I-cardiomyopathy ye-hypertrophic , okuyinto, kwezinye izimo, inganciphisa ukugeleza kwegazi ngaphesheya kwe-valve ye-aortic
- Ukuvimbela isitsha esikhulu segazi esiseduze nenhliziyo (njenge- pulmonary mass embolus )
- Izicubu ze-cardiac (njenge-myxoma ye-atrial, isisu esinamandla esingavimbela i-valve valve)
I-arrhythmias ye-cardiac:
I-arrhythmias ye-cardiac iyimbangela evamile kakhulu ye-syncope kunezimo ezivimbela inhliziyo. Ngeshwa, cishe noma iyiphi i-arrhythmia engabangela i-syncope ingabangela nokufa okungazelelwe, uma i-arrhythmia iqhubeka imizuzu eminingana.
I-Arrhythmias inganciphisa ukusebenza komzimba ngezindlela ezimbili ezahlukene - ngokwenza izinga lenhliziyo liphuze kakhulu, noma ngokwenza ngokushesha kakhulu.
I-slowly arrhythmias (ebizwa ngokuthi i-bradycardia) ingaveza i-syncope ngokumenza inhliziyo ishaye kancane kangangokuthi ingqondo ayitholi ukugeleza kwegazi okwanele. Uma i-bradycardia itholakala ukuthi iyimbangela ye-syncope, futhi uma i-bradycardia kucatshangwa ukuthi kungenzeka ibuyele, ukwelashwa okuphumelelayo kunganikezwa ngokufaka i- pacemaker yenhliziyo.
Noma i- sinus bradycardia noma i- block block ingaveza ibradycardia ebalulekile.
I-arridthmias yenhliziyo esheshayo (ebizwa ngokuthi i-tachycardia) ingabangela futhi i-syncope ngokwenza inhliziyo ishaye ngokushesha kangangokuthi ayikwazi ukupompa ngempumelelo. Nakuba kunezinhlobo eziningi ze-tachycardia, lezo ezivame ukubangela i-syncope yi- ventricular tachycardia ne- fibrication ye-ventricular . Lawa ma-arrhythmias athile asongela ukuphila futhi avame ukukhiqiza ukufa okungazelelwe .
Umlando wezokwelapha ngokucophelela nokuhlolwa ngokomzimba - kanye ne- electrocardiogram (ECG) - kufanele unikeze udokotela wakho izinkomba zokwanela ukuthi yikuphi okunye kwezimo zenhliziyo kuyimbangela ye syncope yakho. Futhi uma isimo senhliziyo sicatshangwa ukuthi kungenzeka, ukuhlolwa kwenhliziyo okusheshayo, okugcizelele kuyadingeka, okungabandakanya i- echocardiogram , ukuhlolwa kokucindezeleka , noma ezinye izinqubo zokuxilonga. Udokotela wakho angase anqume nokuthi kufanele uhanjiswe esibhedlela ukuze uvikeleke kuze kube yilapho ukuxilongwa kugonywe phansi, futhi ukwelashwa okufanelekile kunikezwa.
Ngenhlanhla, kodwa kuningi lamacala, ukuhlolwa okuhle kokuqala kwezokwelapha kuveza imbangela yesifo se-syncope. Udokotela wakho angabe esebheka ukunakekelwa kwezinto ezingezona zomzimba.
Izizathu ezingezona ze-Cardiac
Kunezigaba ezintathu ezijwayelekile zezinkinga ezingezona zomzimba ezibangelwa i-syncope - izimbangela zezinzwa, izimbangela ze-metabolic, nezimbangela ze-vasomotor.
Izimbangela Zezinzwa:
Izimo ze-neurological ziholela ekubambeni okungahambi kahle kwe-syncope, kubalwa kuphela okungu-1% kweziqephu ze-syncopal. Kukhona izimo ezintathu ze-neurological kuphela ezizokhiqiza i-syncope:
- Ukuhlaselwa kwe-Ischemic esheshayo (TIAs) , ngokuvamile okubandakanya imishanguzo ye-vertebrobasilar . Imishanguzo ye-vertebrobasilar iyimithwalo yegazi ngemuva kwetanyeni, eduze komgogodla, ohlinzeka ubuchopho - ingxenye yobuchopho, phakathi kwezinye izinto, obhekene nokugcina ulwazi. Ukuvinjelwa kokugeleza kwegazi emithambo ye-vertebrobasilar kungabangela i-syncope.
- I-subclavian steal syndrome
- Ingcindezi evamile i-hydrocephalus (i-NPH)
Isimo sengqondo esivame ukudideka nge-syncope yisifo sokuphuza . Ukuphazamiseka kuphakama ngoba ukuhlushwa kwesithuthwane, njengesi-syncope, kubangelwa ukulahlekelwa isikhathi eside. Kodwa izibhamu ngokuvamile azibangelwa ukuphazanyiswa kokugeleza kwegazi ebuchosheni - esikhundleni salokho, kubangelwa umsebenzi ongajwayelekile wesiko kagesi ebuchosheni. Udokotela uzovame ukusola ukuthi ukugula kwengculazi kuyimbangela yokulahlekelwa yilapho isiqephu sihambisana nokunyakaza okungavamile okuvame ukuvela ngokuthunjwa. Ukuxilongwa ngokuqinile kwesithuthwane kungavunyelwa yi- electroencephalogram (i-EEG) - ukuhlola okurekhoda komshini kagesi. Kubalulekile ukwenza ukuhlolwa okudingekile futhi uthole lokhu kuhlolisiswa kahle, ngoba ukwelashwa kwezifo zokuhlukunyezwa kuhluke kakhulu nokuphathwa kwe-syncope. Ngeshwa, abantu abanezinhlobo ezinobungozi ze-syncope (ngokuvamile abantu abasha) bavame ukubhekwa kabi ngokuthi bane-disorder seizure.
Izimbangela zeMetabolic:
Kubalwa kunabangu-1% abantu abane-syncope ababa nemibandela yemethamo njengesizathu. Izimbangela ze-metabolic ze-syncope zihlanganisa i- hypoxia (i-oksijini enciphise egazini, okusho njalo ukuthi kusho ukuphazamiseka okukhulu kwesifo nesifo senhliziyo); i-hyperventilation , eyenzeka ekuphenduleni okukhulu ukukhathazeka noma ukuhlaselwa ; kanye ne- hypoglycemia enamandla (ishukela ephansi egazini), okufanele kucatshangelwe kubantu abanesifo sikashukela, ikakhulukazi labo abathwala i- insulin .
I-Vasomotor Yenza:
Kubantu abaningi abano-syncope, yilapho imali ikhona khona. I-Vasomotor syncope iyenzeka lapho izinqubo eziyinkimbinkimbi zomzimba ezigcina ingcindezi yegazi evamile ihluleka (mhlawumbe ngokweqile noma engapheliyo), okuholela ekubeni kwehla ekucindezelekeni kwegazi , okwenza ukuthi ubuchopho bube negazi.
Kunezinhlobo ezimbili ezijwayelekile ze-vasomotor syncope - orthostatic hypotension kanye ne- vasovagal (noma i-sydioneurogenic) syncope .
I-Orthostatic hypotension
Ngokuvamile uma usukuma, imithwalo yegazi emilenzeni yakho iminyene, okusiza ukugcina igazi "lingene" emilenzeni yakho, kanjalo nokugcina umfutho wegazi ovamile. Kubantu abane- orthostatic hypotension , ngesinye sezizathu eziningana, umfutho wegazi ojwayelekile awukwazi ukugcinwa uma usukuma. Uma ukucindezeleka kwegazi kwehla kakhulu, bangakwazi ukulahlekelwa ulwazi uma beqondile. I-Orthostatic hypotension ivame ukubonwa kubantu abadala, futhi ngokuvamile ibangelwa yimithi kadokotela. Kodwa kungabangelwa isifo sikashukela, isifo sikaPasinson, kanye nezinye izifo eziningana zezokwelapha.
Isimo esilandelayo yi- postural orthostatic tachycardia syndrome, noma i-POTS . I-POTS ihlukile ku-hypotension ye-orthostatic ngokuthi: a) ibonakala cishe kuphela kubantu abasha (ngokuvamile abantu abangaphansi kweminyaka engama-45), futhi b) kuyilapho i-POTS ingaveza futhi ukucindezelwa kwegazi ephansi, inkinga enkulu iyinhliziyo enhle kakhulu phezu kokuma. Abantu abane-POTS bathola izimpawu eziningi uma bevuka, ngokuvamile kuhlanganisa ukupholisa , ukuzondeka nokubuthakathaka - futhi cishe 40% wabo bazobona syncope okungenani kanye.
Vasovagal (cardioneurogenic) syncope
I-syncope ye-Vasovagal (eyaziwa nangokuthi i-sydiope cardioneurogenic) iyimbangela evamile kakhulu ye-syncope, mhlawumbe ibheka ngaphezulu kuka-80% yazo zonke iziqephu ze-syncopal. Kubangelwa ukuthungulwa kwemithambo yegazi ngokungazelelwe emilenzeni ngokuphendukela kwengxenyeni eguquguqukayo yezinzwa ze-neurological. Uma une-syncope futhi ungenalo umlando wesifo senhliziyo noma ingozi ephakeme yesifo senhliziyo, ukunganaki kuphezulu ukuthi uzoba ne-vasovagal syncope - lapho kufanele ufunde okuningi ngalesi simo ngangokunokwenzeka. Funda lapha mayelana nokwelapha i-vasovagal syncope .
Ukuhlola
Manje ukuthi sesibukeze ububanzi obuningi bemibandela yezokwelapha ezingabangela i-syncope, uma wena noma othandekayo unayo i-syncope kungaba usizo ukwazi ukuthi odokotela kufanele bahlele kanjani kuzo zonke izindlela, futhi baphumelele ekutholeni ukuxilongwa okulungile.
Nasi isihloko esixoxa ngendlela ecacile futhi ehlelekile yokufinyelela ukuhlolwa kwe-syncope .
> Imithombo:
> Costantino G, Casazza G, Reed M, et al. Ama-Syncope Risk Stratification Tools vs Ukwahlulela Kwamtholampilo: Ukuhlaziywa Kwemininingwane Yokwelapha Yomuntu ngamunye. Am J Med 2014; 127: 1126.e13.
> Huff JS, Decker WW, Quinn JV, et al. Inqubomgomo Yomtholampilo: Izinkinga Ezibucayi Ukuhlolwa Nokuphathwa Kweziguli Ezikhulayo Zethula eMnyangweni Wezimo Eziphuthumayo nge-Syncope. U-Ann Emerg Med 2007; 49: 431.
> Strickberger SA, uBenson DW, Biaggioni I, et al. Isitatimende se-AHA / ACCF Scientific on the Evaluation of Syncope: Kusukela ku-American Heart Association Amakhomikhali Emitholampilo Yezokwelapha, Nursing Cardiovascular, Izifo Zenhliziyo Ezinganeni, ne-Stroke, kanye neQiniso Lokunakekelwa kanye Nemiphumela Yezokucwaninga Kwamaqembu Okusebenza; kanye ne-American College of Cardiology Foundation: ku-Collaboration ne-Heart Rhythm Society: Ivumela i-American Autonomic Society. Ukujikeleza kuka-2006; 113: 316 .