Atropine kana Pacing?
Muhurongwa hwehutano hwehutano husinganzwisisiki hwehutano hwakapoteredza United States, kune maviri ezvokuda kurapwa kwechirwere chema bradycardia chinowanikwa kune vakwegura : transcutaneous pacing (TCP) kana kutengesa kwetropine yeatropine sulfate. Mune masangano akawanda, pane nharo pamusoro pekuti kurapwa kwemaitiro kunoshandiswa sei. Uyu muenzaniso wakanaka wekuti nzira yehupupuriro inopupurirwa inopesana pakati pemishonga kune dzimwe mamiriro ezvinhu zvichibva pamurwi we data iyo inovaka kune rumwe rutivi rwegakava kana imwe.
Symptomatic Bradycardia
Bradycardia (slow heart rate) inowanzotsanangurwa sehuwandu hwemhepo inotapisa pasi pe50 kurohwa paminiti (BPM). Tinoshushikana kana murwere ane bradycardia ane zviratidzo zvingave zvichikonzerwa nekuderera kwekukurumidza-kana-murwere ane zviratidzo zvinokonzerwa nechimwe chinhu chinokonzera bradycardia. Chero nzira, murwere anonzi ane chiratidzo chebrascardia. Zviratidzo zvinosangana neBradycardia uye zvinonzi zvinokosha zvinosanganisira:
- Hypotension (kuderera kwemuviri weropa)
- Chipfuva chepfu
- Kupfupika kwemhepo
- Chizutu
- Syncope
- Kusanganiswa
Vamwe vanhu, kunyanya vatambi vemoyo, vanogona kuva nemwoyo wekuzorora mitezo inononoka kudarika 50 BPM uye apo iyo inonyanya kuve bradycardia, inouya pasina zviratidzo (asymptomatic).
Kusasimbiswa kana Simba Chiratidzo cheBradycardia
Zviratidzo izvi zvinogona kuparadzaniswa kuita zvikamu zviviri: hemodynamically isina kugadzikana nekuenzanisa humodynamine yakasimba. Hemodynamically husina kusimbiswa bradycardias inoreva kune izvo zvinotungamirira pakurasikirwa kwemafuta uye zvinoperekedzwa ne hypotension kana zviratidzo zvinoratidza kusava nehupenzi hwehuroyi (chizuru, syncope, nekuvhiringidzika).
Kazhinji, zviratidzo izvi zvinokonzerwa ne bradycardia, saka kugadzirisa bradycardia kunogona kugadzirisa zviratidzo.
Kuora kwepfupa nekupfupika kwefema kunogona kuenderera mberi kana kuti yakagadzikana yakasimba kana kuti isina kubatika bradycardia. Mukusagadzika bradycardia, kusava nekunyengedzera kunogona kukonzera kurwadziwa kwepfupa kana dyspnea.
Muchigadziro bradycardia, mamwe mamiriro emwoyo angave ari kutungamirira kune zvose zviratidzo uye bradycardia. Dzimwe hurongwa hwehutano hwezvehutano hwekukurumidzira dzinofunga kuti bradycardia yakagadzikana kana ihwo chete inofambisa zviratidzo inorwadza chepfuva kana kupererwa kwemhepo. Mamwe maitiro anotarisa kuti haana kugadzikana. Paramedics dzinofanira kugara dzichitevera mirairo yavo yepasi.
Atrioventricular Block (AVB)
Dzimwe bradycardia inogona kuva mugumisiro wekushaya maitiro kuburikidza neatrioventricular (AV) node , iyo inoshandura pfungwa yekuudza mwoyo kuti iite chibvumirano kubva kuAria (makamuri maviri akapamusoro) kusvika kumakamuri maviri (pasi pedzimba mbiri). Iyo nhamba yeAV inopa pfupa pfupi pakutevedza kwekutsvaga kupa nguva yokuti ropa rinomanikidzwa kubva kuAria uye zvizadza zvizere zvinyorwa. Mushure mokunge pause, pfungwa yacho inotumirwa pasi yeBundle yaYe uye kusvika kuPurkinje fibers , iyo inokonzera kuti mhepo inobhururuka iwirirane uye inokanda ropa muyeri (iyo pulse). Mwoyo inodzivirira (rimwe shoko reVVB) rinouya mumadhigiri matatu.
Yokutanga digiti AVB inongowedzera pause pemazuva iyo iyo node yeVV inofanirwa kuumba. Dhigirii yekutanga AVB haina zvakawanda, kana zviripo, zvinokonzera kushaya kwemoyo. Mutengo uri munyaya ino unenge uchigadziriswa node ye sinus iri munzvimbo yakasara inrium.
Nhamba yepamusoro yega yega yega digest inonzi yakashata.
Kune marudzi maviri echipiri degree AVB:
- Dhigirii yechipiri Type I (inozivikanwawo seWenckebach ) kuenderera mberi kunonoka kwekutengesa kuburikidza neNode yeAV kusvikira kushushikana kusingaiti kuburikidza neAria kusvika kumhepo. Kana izvozvo zvikaitika, kutengesa kunotanga nokukurumidza uye zvishoma nezvishoma zvinoderera zvakare. Kana maitiro akaderera achiitika nguva yakawanda, anogona kuderedza BPM kusvika pasi pe50. Somuenzaniso, kana murwere ane rudzi rwechipiri chechipiri AVB uye yechitatu yehondo inorohwa hazviitiki asi node ye sinus iri kutumira pfungwa makumi manomwe neminiti, iyo inokonzerwa nekupisa inenge iri 46 neminiti.
- Chikoro chechipiri Type II haisi kufambira mberi seChirungu I, asi chichiri kuita kuti mamwe mafungiro asaitwa kuburikidza neAV node uye kurohwa kusina. Nharo dzisina kuitika dzinogona kuitika mune purogiramu kana nenzira dzisina njodzi. Chero nzira, kurasikirwa kwemakumbo akakwana paminiti kunogona kukonzera kupisa kuva pasi peBPM 50 uye ingadai inonzi bradycardia.
Chechitatu chekare AVB (inonziwo AVB yakakwana kana kuti yakazara mwoyo block ) inoitika apo mafungiro asingaoneki kuti aite kuburikidza neAV node zvachose. Muchiitiko ichi, theria inorohwa kumudonzvo wechitendero chechivi asi zvivako zvichange zvichita ivo pachavo. Izvo zvinyorwa zvisingashandisi, zvinenge zvisingakurumidze kuputika pacemaker kutevera, zvinorohwa pane imwe nguva pakati pe20-40 BPM, yakawandisa zvishoma kuti inonzi bradycardia. Pasinei nokuti kunzi "block block", panguva yechitatu yeAVB pane zvingave zvichiri kuve nekuitisa maitiro kuburikidza neAV node. Kana kuitisa kunonoka, zvivako hazvingamiri kuona kana chimwe chinhu chiri kuuya uye chichaita nenzira imwechete iyo yaizodai kana kudzidzira kwadziviswa zvachose. Iyi nuance inonyanya kukosha painopikisana kana kwete kuedza atropine zvachose nokuda kwekuvhara mwoyo mwoyo.
Kurapa kwechiratidzo cheBydycardia
Stable bradycardia inotaridzirwa nekurapa chinokonzera chikonzero che bradycardia. Kana iyo yakabatana nechirwere chemyocardial infarction (AMI), kurapa AMI kunofanira kuva nemagumisiro akanaka pa bradycardia. Kana iine mishonga yakabatana, kubvisa kana kuchinja mishonga inofanira kubatsira.
Bradycardia isina kusimba inofanira kurapwa zvakananga. Kuruboshwe kusina kutenderwa, bradycardia isina kugadzikana yehemodynam inogona kubuda kunze kwekudzora-kusakosha kwekuwedzera kunogona kuwedzera kukanganisa kweropa rekubuda. Kupera kuperesa muuropi kunogona kutungamirira kune kurohwa, chizungu, kana kuvhiringidzika.
Pane nzira nhatu dzokubata nadzo kusagadzikana kwechiratidzo cheBradycardia: kuwedzera ropa (uye naizvozvo kupisa) nekuwedzera kwemvura inotenderera mukati memwoyo yematambudziko, kuvhara mishonga yeropa dzese kuisa ropa kuzvikamu zvakakosha, kana kukura kwemwoyo. Kunyanya kurapa kwakabudirira kunoshandisa kusanganiswa kwezvinhu zvitatu.
Chirwere che IV chinoshandiswa chinogona kuwedzera kukura kweropa uye kunatsiridza kupisa. Sympathomimetic zvinodhaka, zvakadai sedopamine, zvinogona kubatsira kubvisa ropa kubva kune imwe nzvimbo uye kuisa pfungwa kumhanyi, kunyanya uropi nemoyo. Zvirwere zvinonzi Sympathomimetic zvinogona kubatsirawo kuwedzera kukurumidza kwemwoyo, iyo ndiyo inonyanya kurapa inogona kuitika. Muzviitiko zvakawanda, kuwedzerwa kukuru kwehutano hwemwoyo kunongobva chete kana kutonga atropine sulfate kana kuti kurapwa kwemaitiro.
Uye zvino, iyo nharo.
Atropine kana Transcutaneous Pacing
IAmerican Heart Association inokurudzira atropine sulfate seyokutanga yerapa yehutachiona hwechirwerecardia, pasinei nokuti inokonzerwa neAVB kana kwete. Ikoko ndiko kunonzi nuance yemwoyo yakavhara mabloki inouya. Inowanzofungidzirwa kuti nepo atropine inovandudza hutungamiri kuburikidza neNode yeAV, haizoiti chero chinhu chechokwadi chekuvhara mwoyo mwoyo.
Zvakanaka nenguva iyo transcutaneous pacing (kukwanisa kushandisa kwenguva pfupi magetsi pacemaker kunze kushandisa mashizha ekubatanidza pamapfupa uye / kana kumashure) yakavapo kune vakwegura vanoita musango, kushandiswa kweatropine kwakatanga kupikiswa. Pane zvikonzero zvakawanda zvakapiwa. Chikonzero chinowanzoitika ndechekuti atropine inowedzera okisijeni kushandiswa mumutsipa wemwoyo, izvo zvinogona kukuvadza AMI. Chikonzero chechipiri chinowanzopiwa ndechokuti atropine haina kukanganisa zvizere zvemwoyo.
Hapana chimwe chezvikonzero izvozvo chinongoramba chichiongororwa, zvakadaro. Hapana humwe huchapupu hunoratidza kuti atropine, iyo inoshandiswa nokuda kwechirwere chebrascardia, inowedzera myocardial infarction. Uyewo, kuzadza AVB ndiyo inonyanya kushandiswa iyo iri nyore nyore kuziva kuburikidza neEECG. Kunyange kana chikamu chechitatu cheVVB chisingazivikanwi kana kuti hachizivikanwi uye atropine inotarisirwa, pane zvakanyanya kusina kuchinja kune mwoyo wepamusoro uye pane zvakanakisisa, pachava nekuvandudza.
Kuvhiringidza kushandisa atropine kunowedzera kuwedzera nekutenda kuti kutenderera mberi kwekutengesa kwakajeka kushandiswa muhutungamiri hwe prehospital uye kuti hutachiona hunoita zvirwere zvishoma. Mukuita, TCP inowanzoshandiswa zvisina kufanira nevarapi vemapurisa uye varwere havakwanisi kuva nemigumisiro yakanaka kunyange kana chirwere ichi chichifunga kuti pacemaker iri "kutora" (zvichiita kuti ventricular contraction uye mhepo yega yega inofungidzira). Kushandisa TCP inyanzvi yepamusoro-hutsika, yakadzika yepamusoro-soro ine simba rakakosha yekushanda kusina kunaka.
Pasi Pasi: Mishonga Pamberi Edison
Mune nhepfenyuro yakaoma mundima yemabasa ekurapa kwekukurumidzira, nhaurirano iyi inowanzoputirwa sekuti ingashandise Edison (magetsi) kana mushonga (atropine) mukurapa bhardycardia isina kugadzikana. Kukurukurirana kwakafanana-kunze kwekukakavadzana chikamu-chiripo kana kuti kushandisa Edison kana mushonga we tachycardia isingachinji.
Chinhu chakanakisisa chokuyeuka ndechokutevera American Heart Association uye kupa atropine kuedza. Uchapupu hunoratidza kuti hahuzokuvadza murwere. Kana atropine ichizoshanda, inowanzoshanda mukati memaminiti ekutungamirira. Kana, miviri miviri nemaminetsi maviri gare gare, atropine asina kuita tsvina, saka ndiyo nguva yekuenderera mberi kuTCP.
> Sources:
> Brady WJ Jr, Harrigan RA. Kuongororwa uye kutungamirirwa kwebrascarcardia uye atrioventricular block inobatanidza neacute coronary ischemia. Emerg Med Clin North Am . 2001 May; 19 (2): 371-84, xi-xii. Kudzokorora.
> Brady WJ, Swart G, DeBehnke DJ, Ma OJ, Aufderheide TP. Kubudirira kweatropine mukurapa kwesimba rakasimbiswa bradycardia uye atrioventricular block: prehospital uye dhipatimendi rekufungidzira dhipatimendi. Kudzorerazve . 1999 Jun; 41 (1): 47-55.
> Marrison LJ, Long J, Vermeulen M, Schwartz B, Sawadsky B, Frank J, Cameron B, Burgess R, Shield J, Bagley P, Mausz V, Brewer JE, Dorian P. Chiitiko chinongororwa chine simba chinogona kuenzaniswa nekudzivirira uye kubudirira kwe prehospital pacing zvichienderana nekugadzirwa kwechirwere: 'PrePACE'. Kudzorerazve . 2008 Mar; 76 (3): 341-9. Epub 2007 Nov 22.
> Sherbino J, Verbeek PR, MacDonald RD, Sawadsky BV, McDonald AC, Morrison LJ. Prehospital transcutaneous cardiac pacing yechirwere chekare bradycardia kana kuti bradyasystolic mwoyo kusungwa: kuongorora kurongwa. Kudzorerazve . 2006 Aug; 70 (2): 193-200. Epub 2006 Jun 30. Ongorora.
> Swart G, Brady WJ Jr, DeBehnke DJ, MA OJ, Aufderheide TP. Acute myocardial infarction yakakomberedzwa nehumodynamically isina kugadzikana bradyarrhythmia: prehospital uye ED chirwere neatropine. Am J Emerg Med . 1999 Nov; 17 (7): 647-52.