Indlela Yokuphatha I-Tachycardia Emide Neyindlala Emkhakheni
I-Tachycardia (isilinganiso senhliziyo esisheshayo) ingenye yezinkinga eziyinkimbinkimbi kakhulu zokuphatha ngoba kunezethulo eziningi kakhulu nezimbangela eziningi kangaka. Lesi sihloko sigxile ekwelapheni kwe-tachycardia ehlobene nenhliziyo ehlobene nenhliziyo esimweni esiphuthumayo abaqeqeshi be-prehospital.
Ngokuvamile, izinketho zokwelapha endle zilinganiselwe uma kuqhathaniswa nomnyango ophuthumayo.
Kodwa ngamakhono amakhono okuhlola, noma kunjalo, iningi labasizo lwezeMpilo linalo konke okudingayo ukuze kuqiniswe iziguli futhi kubenze ekwelapheni okuqondile esibhedlela.
Izimpondo noma Azikho izimpondo
Lesi sihloko sisho ngqo ku-tachycardia ezigulini ezine-pulse. Iziguli ezingenayo iziphazamisi ezingenakunyakaziswa noma ngaphandle kwempawu yokujikeleza (ukuphefumula, ukunyakaza okunenjongo) kufanele kubhekwe njengokuboshwa kwenhliziyo nokuphathwa, ngokuqala nge- CPR .
Kanjani Ukusheshisa Kakhulu?
I-Tachycardia ngokuvamile ichazwa njengento esheshayo kunamaphesenti angu-100 ngomzuzu (bpm) uma iphumula, kodwa akuwona wonke ama-tachycardias abalulekile emtholampilo. Ngaphandle kwe-monitor ye-ECG, kufanele kube nomthetho omuhle wesiguli uma isiguli sinesisindo esingaphezu kwe-140 bpm, noma uma ukushayela komsindo kungavamile, kunobuthakathaka, noma kungekho.
Kunezimbangela eziningi zokushaya kwenhliziyo okusheshayo ezingahlobene nenhliziyo engasebenzi. Ngamazinga enhliziyo phakathi kuka-100-140 bpm, amathuba akuyona into ehlobene nenhliziyo.
Ngokushesha kunama-140 bpm, kubalulekile ukucabangela izimbangela zenhliziyo kanye nezimo ezingezona zomzimba. Ngeshwa, lokhu akuwona umthetho onzima futhi okusheshayo, ngakho-ke ungayinaki izimbangela zenhliziyo ngoba nje izinga lenhliziyo lincane kancane.
Ukubaluleka komtholampilo wezinga lenhliziyo kushintshana kuye ngokuthi uhlobo lwe-tachycardia.
Ububanzi balesi sihloko abukwazi ukumboza ukuhumusha kwe-ECG , kodwa ikhono lomnakekeli lokuhumusha amaphuzu e-ECG kucatshangwa. Ngezansi, sizoxoxa nge-tachycardia encane kakhulu-eyinkimbinkimbi kakhulu, kodwa okwamanje, wazi ukuthi i-tachycardia ehlukahlukene ibuhlungu uma ihamba ngokushesha kunama-140 bpm. I-tachycardia encane eyinkimbinkimbi ingaba esheshayo kancane, kodwa cabanga ngokuphathelene naphezu kuka-160 bpm.
I-Tachycardia engazinzile noma eqinile
Ukuthola ukuqina komtholampilo kuxhomeke ekubambeni kwe-tachycardia. Abanye bathi izimpawu ezihlobene nenhliziyo (ubuhlungu besifuba, ukuphefumula, njll) yizinkomba ezibalulekile ze-tachycardia engaqiniseki. Lokhu kuyiqiniso nakakhulu esimweni sesibhedlela kunasensimini, ngenxa yezinhlobo eziningi zokwelapha.
Ngaphandle kwesibhedlela, gxila emandleni enhliziyo ukuqhubeka nokupompa igazi ngokucindezela okwanele ukuwuthola ebuchosheni. Lokho kubizwa ngokuthi ukuqina kwe-hemodynamic . I-tachycardia engazinzile ye-Hemodynam isinikezi amakamelo enhliziyo okwanele isikhathi sokugcwalisa igazi phakathi kwezingqinamba.
Isiguli esingenazo izibonakaliso ezicacile zokungazinzi kwe-hemodynamic ( ukucindezelwa kwegazi okuphansi , ukushayeka kwegazi noma ukuguqulwa kwamandla, izinguquko zangemva kwesimo , njll.) Kungenzeka ukuthi zithunyelwe esibhedlela ngaphandle kokuzama ukuphatha i-tachycardia.
Ngaphezu kwalokho, iziguli ezingenakho ukungazinzi kwe-hemodynamic zingaphathwa ngokuphepha kwezinye izimpawu ezihlobene nenhliziyo.
Iziguli ezingenakuzivikela ezinama-tachycardia ngokushesha kunama-140-160 bpm zingazuzisa ngokuba nesilinganiso senhliziyo esilungiselwe emuva evamile. Lezo yiziguli esizigxile kulokhu kulesi sihloko.
Okumfushane noma Okude
I-tachycardia ephawulekayo emitholampilo iwela ezinhlokweni ezimbili eziyisisekelo: okuncane noma okubanzi. Lokhu kubhekisela enkingeni ye-QRS ekulandeleni kwe-ECG. Lapho i-QRS encane kunezingamamitha angu-120 (amabhokisi amathathu amancane emgqeni we-ECG) ibonisa ukuthi umfutho wegesi we-electricial uvela e-atria futhi wehla ngaphansi kwe-node atrioventricular (AV) kuya ezinxenyeni ze-HIS nama-Purkinje fibers, etholakala kuma-ventricles.
Lena yindlela ejwayelekile yokuqhuba, futhi indlela kuphela i-QRS enganciphisa ngayo uma ngabe ukucindezela kuhamba kahle. Ngoba umfutho kufanele uqale ngenhla kwezinguquko ezise-tachycardia encane, eyaziwa ngokuthi i-tachycardia ephakeme (SVT).
I-QRS eyinkimbinkimbi eyinkimbinkimbi kunama-milisecond angu-120 evame ukuhlotshaniswa ne-ventricular tachycardia (VT) -ukuthi umfutho uvela emabhokisini, ngaphansi kwesimo se-atrioventricular. Akusi njalo njalo, noma kunjalo. Uma kuncane, kufanele kube yi-SVT. Uma ivulekile, ingaba i-VT noma kungenzeka ukuthi isisusa esivela ngaphezu kwe-ventricles asiqhutshwa nge-node ye-AV. Iphelelwe inkambo futhi ishayela indlela yayo, okwenza kube lula. Lokhu kuvame ukubizwa ngokuthi i-block block, i-AV block, noma i-block block yegatsha, kuncike lapho i-block ivela khona.
Ukumba impela futhi ukukhomba i-tachycardia kudinga i-ECG yokuhola i-12 ehola phambili. Kwezinye izilungiselelo ezingaphandle kwesibhedlela, i-ECG ehamba phambili engu-12 ayitholakali. Isizathu esisodwa sokuthi singaphatheki i-tachycardia ngaphandle uma kungenakulinganiswa kwegazi ngenxa yokuthi kungenzeka ukuthi ukwelapha i-tachycardia eyinkimbinkimbi njenge-tricycardia ye-ventricular uma kungenjalo. Ukuthatha lelo thuba lapho isiguli sisengozini enkulu yokuboshwa komzimba kuyamukeleka. Ukwelapha ngokucophelela i-tachycardia eningi kakhulu uma isiguli sinamathele emzimbeni akufanelekile ingozi.
Indawo yenhliziyo lapho umfutho uvela khona uyaziwa ngokuthi i-pacemaker ngoba noma yikuphi indawo edala umfutho futhi ibeka ijubane lokushaya kwenhliziyo. I-node ye-sinus itholakala ku-atrium kwesokunxele. I-pacemaker evamile. I-node ye-sinus ivame ukugijima phakathi kuka-60-100 bpm. Njengoba sihamba phansi enhliziyweni, amazinga azalwa ahamba kancane. Izimo ezivela ku-node ye-AV zihamba cishe ngo-40-60 bpm. Ku-ventricles, ku-20-40 bpm. Yingakho i-tachycardia ehlanganisiwe kakhulu emtholampilo ephawulekayo ngesilinganiso esincane kancane.
Ukwelapha i-Tachycardia e-Wide-Complex
Ngenhloso yokwelashwa okuphuthumayo kwesiguli esingenakuqina esasensimini, cabanga zonke izimo ze-tachycardia ehlukahlukene njenge-VT. Uma isiguli sibonisa izimpawu zengozi esheshayo (i-systolic blood pressure ngaphansi kuka 90 mm / Hg, ukulahlekelwa ulwazi, ukudideka, noma ukuthola kuphela ukushaywa kwe-carotid), i-cardioversion evumelanisiwe ibonisiwe. Isilinganiso esinconywe ngokuvamile siyi-50 Joules.
Uma noma nini isiguli silahlekelwa ukuqonda futhi siyeka ukuphefumula, noma akunakwenzeka ukuthola ukushaywa kwe-carotid, ukuguqulwa komzimba (ukushaqeka okungavumelanisiwe) kuboniswa ku-200 Joules ukuqala. Ngemuva kwe-defibrillation eyodwa (noma uma i-defibrillator ingatholakali) qalisa i-CPR, ngokuqala ngokucindezela kwesifuba.
Ukwelapha i-Tachycardia e-Narrow-Complex
I-tachycardias enezintambo eziyinkimbinkimbi yinkimbinkimbi kunama-arrhythmias amaningi. Kulesi simo, ukujwayela kwe-arrhythmia kubalulekile. Ukuze i-arrhythmias encane ene-hemodynamically engazinzile (i-systolic blood pressure ngaphansi kwe-90 mm / Hg, ukulahlekelwa kwengqondo, ukudideka, noma ukuthola kuphela ukushaywa kwe-carotid), i-cardioversion ehambisanayo ikhonjiswe kuma-100 Joules.
Iziguli ezingenawo umfutho wegazi ophansi-kodwa zinezinye izimpawu (isizungu, izinhliziyo zenhliziyo)-zingaphathwa nge-fluid noma izidakamizwa, ikakhulukazi i-adenosine. I-flu isisinyathelo esihle sokuqala se-tachycardia uma kwenzeka ukuphelelwa amandla kwemvelo kuyimbangela.
I-adenosine kumele inikwe nge-push push ngokushesha. Isilinganiso sokuqala singama-6 mg, kodwa uma lokho kungasebenzi, umthamo wokulandelela we-12 mg ungahlolwa. I-Adenosine isebenza ngendlela efanayo ngokuya kwe-cardioversion kagesi, okuholele ekuphuculeni kwenhliziyo yesisindo nokuvumela i-node yesode ukusetha kabusha.
Uma i-adenosine ingasebenzi, cishe kungenzeka uma i-tachycardia ingavamile, amanye amakilasi amabili emithi angahlolwa. Ama-blockers we-calcium amisa kancane ukuhamba kwe-calcium ngaphesheya kwenhliziyo ye-muscle cell membranes. Kubangela ukuthi umjikelezo wonke uhambe kancane. Abavimbela i-Beta kuthinta indlela i-epinephrine esebenza ngayo emasipha enhliziyo.
Ukwelapha i-tachycardia encane eyinkimbinkimbi emkhakheni akufanele kwenziwe ngaphandle kwemigomo emihle noma ukubonisana kochwepheshe ngokusebenzisa ukulawulwa kwezokwelapha ku-intanethi nomqondisi wezokwelapha okufanelekile.
> Imithombo:
> Abarbanell NR, uMarcotte MA, Schaible BA, Aldinger GE. Ukuphathwa kwe-Prehospital ye-fibrillation ngokushesha e-atrial: izincomo zokwelashwa kwezivumelwano. Am J Emerg Med . 2001 Jan; 19 (1): 6-9. doi: 10.1053 / ajem.2001.18124
> Garner, JB., & M Miller, J. (2013). I-Wide Complex Tachycardia - I-Tricycardia ye-Ventricular noma iTachycardia Engenayo Yenhloko, Ehlala Kuyo Umbuzo. Ukubuyekezwa kwe-Arrhythmia & Electrophysiology , 2 (1), 23-29. http://doi.org/10.15420/aer.2013.2.1.23
Ikhasi, R., Joglar, J., Caldwell, M., Calkins, H., Conti, J., & Deal, B. et al. (2015). Umhlahlandlela we-ACC / i-AHA / HRS we-Management of Patients Adult with Tachycardia Supraventricular. Ukujikeleza , 133 (14), e506-e574. i-doi: 10.1161 / isigaba00000000000311