Ngokusho kwezikhungo zezinhliziyo, ukuhlaselwa kwenhliziyo ejulile kubhekisela kuma-pathologies avamile adinga ukunakekelwa okuphuthumayo kwezokwelapha. Ukufa okuphezulu ngenxa yalesi sifo kungenxa yokungabi nolwazi mayelana nokubonakaliswa okuyinhloko kwesifo. Cabanga ngabo, ubiza izimbangela ze-pathology, i-algorithm yosizo lokuqala.
I-infarction enkulu ye-myocardial
Igama elithi "infarction enkulu ye-cardiac (i-myocardium)" ebizwa ngokuthi i-cardiology ngokuvamile ibizwa ngokuthi ukwephulwa, lapho kukhona ukuguqulwa kokugeleza kwegazi, kuhambisana nokwehla kwenkomba ye-oksijeni, eholela ku-necrosis ye-muscle yenhliziyo. Ingxenye yamaseli afa ngokuphelele. Endaweni yabo, lobunzima lwakhiwa ngokuhamba kwesikhathi. Kuye indawo yesilonda, indawo yendawo ye-necrosis, ukuhlukanisa:
- i-infarction yodonga lwangaphakathi;
- i-infarction ye-myocardial.
Uhlobo lokuqala lokuphulwa kukhona umonakalo kumshini wesokunxele. I-lumen yayo igqoke ngokuphelele, okuvimbela ukugeleza okuvamile kwegazi enhliziyweni. Uma udonga olungemva komzimba luthinteka, umcibisholo oqondile we-coronary uvele. Phakathi kwezimbangela zokugula, odokotela bafaka phambili ischemia (amacala angu-98%). Kulesi simo, imishanguzo ye-coronary iyakwazi ukulimala - izinguquko ze-atherosclerotic. Ngaphezu kwalokho, i-heart attack enkulu ingenzeka ngenxa yokuthi:
- i-coronary artery thrombosis ;
- ukulimazeka kwemithambo ye-coronary;
- ukuvinjelwa kwemithambo yegazi emikhulu ngezingxenye ze-neoplasms;
- inqubo yokuvuvukala ephazamisa imishanguzo ye-coronary;
- ukuklanywa komnyango we-aortic okhuphuka kanye nemfundo emva kwe-hematoma;
- ukusetshenziswa kwezidakamizwa, okubangela ukuphazamiseka kwemithambo ye-coronary (coke, amphetamine);
- ukulimala okumangalisa, ukwethuka kwamandla kagesi;
- imiphumela yokuhlinzwa kwenhliziyo.
Ukuhlasela okukhulu kwenhliziyo - izimpawu, izimpawu zokuqala
Izimpawu zokuhlaselwa kwenhliziyo eningi zibizwa. Into yokuqala ekhonjiswe yiziguli ziwumvuthwandaba oqinile, ovame ukuphuza engxenyeni engakwesokunxele yesifuba noma ngemuva kwesifuba, esiya esikhwameni, emhlathini ongaphansi, nasesikhaleni sokudla kwesokunxele. Kukhona izimo ezibuhlungu okungenani imizuzu engu-30. Isici esiyingqayizivele sesiyaluyalu ukungabi nomphumela wokwelapha we- Nitroglycerin .
Ngemva kwesikhashana, ukuzwa kokuntuleka komoya kuphawulwe, isiguli sigxuma ngalokho okukuyo. Ngaphezu kwalokho, okulandelayo kungabhalwa:
- ukujula okubandayo;
- ukuhlanza;
- isicasuli;
- ukwehliswa kwengcindezi yegazi.
I-infarction ejulile ibhekisela kulawo ma-pathologies lapho isiteleka sezimpawu sinobuciko. Kunezigaba ezingu-5:
- Isikhathi se-prodrome (preinfarction). Kubonakala ukwanda kwenani leziqephu zokuhlaselwa kwe-angina.
- Isikhathi esibukhali kakhulu. Ukuhlala isikhathi samahora angu-0.5-2. Izimo ezibuhlungu ezibuhlungu, ukujuluka, izinguquko ezinqoleni zenhliziyo, ukucindezeleka kwegazi.
- Isikhathi esibukhali. Isikhathi sithatha izinsuku ezingu-2-10. Kubonakala ngenqubo yokwakhiwa kwesayithi le-necrosis emisipha yomzimba. Ubuhlungu buyadlula, kepha isigqi senhliziyo siphukile, izinga lokushisa lomzimba likhuphuka.
- Subacute. Ukulala amasonto angu-4-5. Ngalesi sikhathi, kutholakala isikhala esakhiweni sezicubu ezifile. Umsindo wenhliziyo ubuyiselwa, isifo sobuhlungu siyanyamalala ngokuphelele, ingcindezi ijwayelekile.
- I-Postinfarction. Isikhathi sithatha izinyanga ezingu-3-6. On odokotela izinhliziyo babhalisa, ngosizo ultrasound, ukwanda ubukhulu we izicubu scar. Umzimba kancane kancane usetshenziselwa izimo ezintsha.
Usizo lokuqala lokuhlasela kwenhliziyo
Lesi sifo sidinga ukunakekelwa okuphuthumayo esibhedlela. Usizo lokuqala lwe-infarction ye-myocardial kufanele lunikezwe kusayithi. I-algorithm yezenzo zabahlobo noma izihlobo kufanele ibe nokulandelana okulandelayo:
- Layisa, ukhulule izingubo eziqinile-zokugqoka, ikhola.
- Uma kunokwenzeka, khuthaza isiguli.
- Nika izidakamizwa ezivimbela ubuhlungu: i-Nitroglycerin, i-Aspirin.
- Shayela i-ambulensi.
Ukuhlasela okukhulu kwenhliziyo - imiphumela, amathuba okuphila
Ngokuphulwa okunjalo njengokuhlasela kwenhliziyo okujulile, imiphumela, amathuba okuba nomphumela ophumelelayo kuxhomeke esikhathini sokuqala ukwelashwa. Ngokusho kwezibalo, iziguli ezingu-40 kwabangu-100 ziyafa esigabeni sokuqala. Ngaphezu kwalokho, lapho ukubikezela odokotela bacabangela indawo yendawo ethintekile, okuthinta ngqo umphumela. Izici ezikhudlwana kulezi zifo ziwukuthi:
- ukuguga;
- isifo somfutho wegazi ophezulu e-anamnesis;
- ukutholakala kwezibonakaliso zokwehluleka kwenhliziyo kwangempela.
I-infarction enkulu ye-myocardial
I-pathology ngokwayo inamathuba aphezulu okufa. Ngenxa yalokhu, izibhedlela kufanele zenziwe zingakapheli imizuzu engama-30 ekuqaleni kwezimpawu zokuqala. Kulokhu kuyadingeka ukuthi ukwazi ukunquma ngokunembile ukuhlaselwa kwenhliziyo, imiphumela okungaba kanje:
- Ukuphakama kwemisipha yenhliziyo. Kuholela ekufeni. Iyenzeka phakathi nosuku olulodwa lwe-infarction. Kulokhu, udonga lwe-ventricle kwesokunxele luthinta ngqo.
- Ukuphazamiseka kwe-cardiogenic. Kubonakala njengesizathu se-infarction egcwele lapho isilonda sodonga lwangaphakathi (imizimba ye-coronary arteries) yenzeka khona. Iqala uma i-necrosis isungulwa ngaphezu kuka-40% wendawo ye-myocardium. Ngenxa yokwethuka kwe-cardiogenic kwangempela , ukubulala kwabantu kufinyelela ku-90%.
- I-edema yepulmonary. I-infarction ngokungabikho kosizo kungaholela edemaolar edema. Ukuhlukunyezwa okunjalo kubonakala ukuphefumula, ukuphefumula okubuthakathaka, ukuqhuma okumanzi, ukukhwehlela nge-foamy sputum ye-pink hue (ukuhlaselwa kwenhliziyo elula).
Ezigulini eziye zaphulwa ngokweqile ezinyangeni zokuqala zokuphumula, izinkinga nazo kungenzeka:
- ukungakwazi ukusebenza kwamandla (ku-25-50% weziguli);
- i-aneurysm ye-ventricle kwesokunxele (10-15%);
- i-thromboembolism (10%);
- inhliziyo isigqi disorder;
- i-fibrillation ye-atrial.
I-infarction enkulu ye-myocardial - imiphumela
Leli fomu lezinkinga ngokuvamile liba nezimpawu ezinzima kakhulu. Ngenxa yalokhu, iziguli azikholelwa ngisho nokuhlaselwa kwenhliziyo enkulu, imiphumela efana nalezo ezibalwe ngenhla. Kumele kuqashelwe ukuthi lolu hlobo lwe-pathology lubonakala ngesifungo sokuhleleka - izinga lokusinda uma kwenzeka ukubandakanya udonga lwama-posterior luphakeme. Phakathi kwemiphumela engaba yingozi yokuphula umthetho yilokhu:
- I-Dressler's syndrome;
- ukuphazamiseka kwesigqi;
- i-thromboembolism;
- ukuphazamiseka kwe-cardiogenic.
Ukwehla okukhulu kwenhliziyo - ukwelashwa
Ukuhlukumeza kudinga ukunakekelwa esibhedlela nokunakekelwa okukhulu. Njengoba ukukhubazeka okunjengokuhlaselwa kwenhliziyo ejulile, amathuba okuphila ancike ngqo ekutheni kunakekelwa kanjani ukunakekelwa okusheshayo nokunakekelwa kwezimo eziphuthumayo. Ngokusho kochwepheshe bezokwelapha, uma isiguli sithathwa esibhedlela kungakapheli imizuzu engu-30 kusukela ekuqaleni kokuhlaselwa, ukubonakala kwezibonakaliso zokuqala, amathuba okuba nomphumela omuhle aphezulu. Kulesi simo, khetha:
- izidakamizwa zokuthuthukisa i-hemodynamics - iPrasugrel, Plavix, Clopidogrel;
- izidakamizwa ezinciphisa ubuhlungu - ama-analgesics, i-Nitroglycerin
- i-antiarrhythmic - i-Amiodarone;
- i-anticoagulants - i-Streptokinase, i-streptodeacase;
- i-thrombolytics - I-Heparin, i-Aspirin.
Ukuhlasela okukhulu kwenhliziyo - ukuhlinzwa kwenhliziyo
I-infarction enkulu ye-myocardial ehlehlisiwe ngokuvamile iba yinkomba yokungenela okuhlinzekwayo. Inqubo ephumelelayo kulokhu i-angioplasty - ukubuyiselwa ubuciko bemithambo ye-coronary ngokucindezela. Inikeza izitsha nemisipha ububanzi obudingekayo, obangela ukugeleza kwegazi kahle, kunciphisa umthwalo enhliziyweni.
Ukucindezela ngemva kokuhlaselwa kwenhliziyo enkulu
I-infarction enkulu ye-myocardial ehlehlisiwe, imiphumela exoxwa ngayo ngenhla, cishe njalo idinga ukubuyiselwa kobuciko bemikhumbi. Le ndlela yokugcina i-endovascular isenziwa esigabeni sezinthambo. Ukusebenza kudinga ukutholakala kwemishini efanele nabahlinzayo abaqeqeshiwe. I-stent ngokwayo iyishubhu eqinile, ububanzi bayo obuhambisana ngokuphelele nalokho komthambo.
Bangaki abaphila ngemva kokuhlaselwa kwenhliziyo enkulu?
Ngokuphulwa okunjalo njengokuhlasela kwenhliziyo okujulile, ukuphawula kwesikhashana kubangelwa ukuhlinzekwa kokunakekelwa kwezokwelapha, indawo ethintekile yisisindo senhliziyo. Kubalulekile ukukhumbula ukuthi i-pathology ngokwayo ihambisana no-angina pectoris. Uma kungenakwenzeka, iziguli ezingu-30% ziyafa izinyanga ezingu-1-3 ngemuva kokuhlaselwa. Ngokusho kwezibalo, phakathi kweziguli ezitholwa esibhedlela esikhulu, ukushona ku-10%.
Ukuphila emva kokuhlaselwa kwenhliziyo enkulu
Ukuhambisana nezincomo kanye nemiyalelo kadokotela - isisekelo sokuvuselelwa ngokuphumelelayo. Ukudla emva kokuhlaselwa kwenhliziyo ejulile kufanele kube nokulinganisela. Kusukela odokotela abadinga ukweluleka ukukhipha izitsha ezisawoti, okubabayo nokubhema. Izinsuku zokuqala ezingu-10 kufanele zihambisane nokudla okuphansi kwekhalori, unciphise ukudla okuketshezi. Isisekelo somsoco esiteji sokuqala sokuvuselelwa yizilimo ezinomsoco, izithelo, isobho elifihliwe, i-vegetable purees.
Ngemva kwenyanga, lapho uhlamvu luqala ukwakha, kunesidingo semikhiqizo equkethe i-potassium. Le microelement ngokuqondile kunciphisa ukukhukhumeza, okufaka isandla ekususeni uketshezi okweqile komzimba wabo, kwandisa isivumelwano sokungena kwenhliziyo. Iqukethe:
- amantongomane;
- ikholifulawa;
- ama-alimondi;
- i-walnut;
- umlimi.