Nzira Yokurapa Yakawanda uye Yakakosha Tachycardia muMunda
Tachycardia (kukurumidza kwepfungwa yemwoyo) ndeimwe yezvinonyanya kuoma dysrhythmias kurapa nokuti ine mharidzo dzakawanda uye zvinokonzera zvakawanda. Ichi chinyorwa chinonyanya kutaura nezvekurapa kwema-tachycardia yakasimba-yakabatana mumamiriro ezvinhu ekukurumidzira nevanosangana nehutungamiri vehutori.
Kakawanda, kusarudzwa kwekurapa mumunda kwakakosha kana kuchienzaniswa nedhipatimendi rekukurumidzira.
Nehutano hwakanaka hwehutano, zvisinei, vazhinji vanobatsira varapiriniki vane zvose zvavanoda kuti varambe vakagadzirisa varwere uye vanovaendesa kugadziriro yakakwana kuchipatara.
Pulses kana No Pulses
Ichi chinyorwa chakanaka kune tachycardia mune varwere vane kupisa. Varwere vasina kukwanisa kuputika kana pasina zviratidzo zvekupararira (kufema, kufambisa chinangwa) kunofanirwa kuonekwa sevari mumoyo kusungwa uye kubatwa, kutanga naCPR .
Kutsanya Kunokurumidza Kukuru Sei?
Tachycardia inowanzotsanangurwa sechinhu chinokurumidza kupfuura 100 kurova paminiti (bpm) paunenge uchizorora, asi kwete tachycardias yose inonyanya kukosha. Pasina maziso eEGG, mutemo wakanaka wegunwe unofanirwa kufunganya kana murwere ane chirwere chakakura kupfuura 140 bpm, kana kana kupisa kwemhepo kusina kusimba, kusimba, kana kusipo.
Pane zvakawanda zvinokonzera kukurumidza kwepfungwa yemwoyo izvo zvisina kufanana nemoyo usingabatsiri. Nemwoyo yepakati pakati pe100-140 bpm, mikana haisi yehupenyu-hukama.
Inokurumidza kupfuura 140 bpm, zvinokosha kutarisa zvinokonzera mwoyo pamwe nemamiriro ezvinhu asina mwoyo. Zvinosuruvarisa, uyu haisi mutemo wakaoma uye wakakurumidza, saka usakanganwa zvinokonzera mwoyo mukati chete nekuti murefu we mwoyo unononoka.
Chiremba chinorehwa nehutano hwemwoyo chinoshanduka zvichienderana nemhando ye tachycardia.
Kukura kwechikamu ichi hakwanisi kuverenga kududzirwa kweEGG , asi kukwanisa kwomutarisiri kukwanisa kududzira mapeji eCGG kunofungidzirwa. Pasi apa, tichakurukurirana zvishoma nezvishoma uye zvakaoma-tashycardia yakaoma, asi ikozvino, ingoziva kuti tachycardia yakazara yakaoma inoshungurudza kana inokurumidza kupfuura 140 bpm. Imwe tachycardia yakaoma-tara inogona kunge ichikurumidza zvishoma, asi funga nezvayo kana inopfuura 160 bpm.
Yakasimbiswa kana yakasimba Tachycardia
Kuziva kugadzikana kwekliniki kunoenderana nechikonzero che tachycardia. Vamwe vanoti zviratidzo zvine chokuita nemwoyo (chironda chemapfupa, kufema kwepfufu, nezvimwewo) zvinoratidza zviratidzo zvetachycardia isingachinji. Izvozvo zvinowedzera kuitika munzvimbo yezvipatara kupfuura mumunda, nekuda kwemhando dzakasiyana-siyana dzokurapa.
Kunze kwechipatara, funga nezvekwaniso yemwoyo yekuenderera mberi kuputira ropa nekukodzera kwakakwana kuti uende kuuropi. Izvozvo zvinonzi humodynamic stability . Hachodynamically tachycardia isina kugadzikana haipei makamuri emwoyo nguva yakakwana yekuzadza neropa pakati pezvipikiso.
Murwere asina zviratidzo zvakajeka zvehutodynamic kusagadzikana ( kuderera kwemuviri wega, kutora kana kushaya simba, postural changes , nezvimwewo) zvinogona kunge zvakatakurwa zvakanaka kuenda kuchipatara pasina kuedza kubata tachycardia.
Kunyanya, varwere vasina zviratidzo zvekudzikama kwehemodynamic vanogona kutarisirwa zvakachengeteka kune dzimwe zviratidzo zvine chokuita nemwoyo.
Hemodynamically vasingagadzikani varwere vane tachycardia nokukurumidza kudarika 140-160 bpm vanogona kubatsirwa nokuva nemwoyo wekutengesa kunyorerwa kumashure. Vaya ndivo varwere vatinenge tichifunga nezvechikamu ichi.
Yakadzika kana Yakawanda
Chirwere chekare chinonzi tachycardia chinowira muzvikamu zviviri zvinokosha: zvishoma-kana zvakakura-zvakaoma. Izvi zvinoreva chimiro che QRS pamusana pekutengesa kweEECG. Apo QRS iri shoma kupfuura milliseconds 120 (matatu mabhokisi mashomanana eEGG strip) inoratidza kuti mafungiro emagetsi emagetsi akabva muAria uye akafamba pasi kuburikidza neodhini ye-atrioventricular (AV) kune zvimedu zveHIS uye Purkinje fibers, iyo iri iri mumhepo.
Iyi ndiyo nzira inowanzoitwa yekugadzirisa nzira, uye nzira chete iyo QRS inogona kuderedza ndeye kana kushushikana kunofamba nayo nenzira yakakodzera. Nokuti chikonzero chinotanga kutangira pamusoro pemhepo inobata tachycardia yakaoma, inonziwo supraventricular tachycardia (SVT).
Nhengo yakawanda yeQRS yakawanda kupfuura 120 miliseconds inowanzobatanidzwa ne ventricular tachycardia (VT) -kunyengedza mhepo inobva mumhepo, pasi peiyo inrioventricular node. Haisi nguva dzose, zvakadaro. Kana iri shoma, inofanirwa kuva SVT. Kana iri yakafara, inogona kuva VT kana zvingava kuti kuedza kunobva pamusoro pemhepo inenge isiri kutungamirirwa kuburikidza neAV node. Icho chiri kunze kwedzidzo uye ichienzanisa nzira yayo, iyo inoita kuti iwedzere. Izvi zvinowanzozonzi senhengo yemwoyo, yeAV block, kana bundle branch block, zvichienderana nepo nzvimbo yacho inowanikwa.
Kunyatsochera mukati uye kuziva kuti tachycardia inoda 12-inotungamirira kuongorora ECG. Mune zvimwe zvirongwa kunze kwechipatara, mutungamiri we-ECG ane gumi nembiri haawaniki. Chimwe chikonzero chekusaitira tachycardia kunze kwekuti inenge isina simba rakawanda ndeyekuti pane mikana yekurapa tachycardia yakazara-soro sematricyria tachycardia kana isiri. Kutora mukana iwoyo kana murwere ari muhutano hukuru hwekusungwa kwemwoyo kunogamuchirwa. Kurapa zvishoma nezvishoma tachycardia yakawanda-shanduka apo murwere ane hutodynamine hwakasimba hazvifananidzi njodzi.
Nzvimbo yemoyo iyo pfungwa inotangira inozivikanwa se pacemaker nokuti chero nzvimbo inokonzera kushushikana inogadzirisawo kufamba kwepfungwa. Node ye sinus iri muruboshwe rwenharaunda. Ndiyo yakakwana pacemaker. Node ye sinus inowanzosvika pakati pe 60-100 bpm. Sezvatinofamba zvakaderera pamwoyo, maitiro ehupenyu anotora zvishoma. Mhedzisiro inotangira mumusana weAV inotanga kusvika 40-60 bpm. Muchivhura, iri 20-40 bpm. Ndicho chikonzero nei tashycardia yakazara-yakawanda iri muchipatara ichikosha pane zvishoma zvishoma.
Kubata Wide-Complex Tachycardia
Nechinangwa chekurapa kwekukurumidzira kwechirwere chisina kugadzikana chinogadzikana mumunda, chimbofunga mamiriro ose emakamuri akazara tachycardia seV VT. Kana murwere anoratidza zviratidzo zvekukurumidza ngozi (systolic blood pressure pasi pe 90 mm / Hg, kurasikirwa kweruzivo, kuvhiringidzika, kana kungokwanisa kuwana tsvina ye carotid), kuwirirana kwevhutima kunoratidzwa. Inokurudzirwa kuwedzerwa kazhinji 50 Joules.
Kana panguva ipi zvayo murwere akarasikirwa uye anorega kufema, kana kuti hazvibviri kuwana karotid pulse, defibrillation (isina kushamwaridzana kunotyisa) inoratidzwa pa 200 Joules kutanga. Mushure mekudzivirira chimwe chinhu (kana kana chipfuridziri chisina kuwanika) tanga CPR, kutanga nemapfupa emapfupa.
Kurapa Nyore-Yakakomba Tachycardia
Tachycardias yakareba-yakakomba yakanyanya kuoma pane yakakura-yakakura arrhythmias. Muchiitiko ichi, kugara kwechirongwa kunokosha. Nokuda kwemakemikirwo akaoma-soro anonyatsosimbiswa (systolic yeropa rezasi pasi pe 90 mm / Hg, kurasikirwa kwekuziva, kuvhiringidzika, kana kungokwanisa kuwana carotid pulse), chirwere chinogadziriswa chinoratidzika chinoratidzwa pa 100 Joules.
Varwere vasina ropa rekudzivirira-asi vane zvimwe zviratidzo (chirwere, chirwere chemwoyo) -chimwe chinogona kurapwa nemishonga kana madhiragi, kunyanya adenosine. Fluid ndiyo danho guru rekutanga kune tachycardia kana kana mvura isisina mvura.
Adenosine inofanira kupiwa kuburikidza nekukurumidza kuvhara IV. Chirwere chekutanga chiri 6 mg, asi kana izvozvo zvisingaiti, chirwere chekutevera che 12 mg chinogona kuedzwa. Adenosine inoshanda zvakafanana zvakafanana nemagetsi emhepo, zvichiita kuti kuora mwoyo kuve kwemafupa emwoyo uye kubvumira kuti sinus node isarudzo zvakare.
Kana adenosine isingashandisi, iyo inowanzoita kana tachycardia isiri iyo, mamwe mapoka maviri emishonga anogona kuedzwa. Calcium channel blockers inononoka kuderedza kufamba kwe calcium kudarika mwoyo wemasero cell membranes. Inokonzera kuti mutambo wose uite zvishoma. Beta blockers inofadza nzira iyo epinephrine inoshanda pamusana wemwoyo.
Kuchengetedza rakasimba tachycardia inoshandiswa mumunda haifaniri kuitwa kunze kwekumire mirairo kana kubvunzurudza nyanzvi kuburikidza nekurapa kwekurapa kwekurapa nemukuru wezvokurapa akakodzera.
> Sources:
> Abarbanell NR, Marcotte MA, Schaible BA, Aldinger GE. Prehospital management of friction atrial fibrillation: mazano emitambo yekurapa. Am J Emerg Med . 2001 Jan; 19 (1): 6-9. doi: 10.1053 / ajem.2001.18124
> Garner, JB., & M Miller, J. (2013). Yakazara Complex Tachycardia - Ventricular Tachycardia kana kuti kwete Ventricular Tachycardia, Iyo Inogara Mubvunzo. Arrhythmia & Electrophysiology Review , 2 (1), 23-29. http://doi.org/10.15420/aer.2013.2.1.23
Peji, R., Joglar, J., Caldwell, M., Calkins, H., Conti, J., & Deal, B. et al. (2015). 2015 ACC / AHA / HRS Nhungamiro yekutungamirirwa kwevarwere vakura ne Supraventricular Tachycardia. Kurwisana , 133 (14), e506-e574. doi: 10.1161 / cir.0000000000000311