Mob Hluav Taws Xob Hluav Taws Xob Ua Ntej Hauv Cov Tsiaj

2024 Tus sau: Daisy Haig | [email protected]. Kawg hloov kho: 2023-12-17 03:09

Sinus Ntes thiab Sinoatrial Thaiv

Kev mob ntshav siab ntev uas tsis yog vim kev siv yeeb tshuaj yog feem ntau qhia tias muaj kev mob ntsws pob txha (SSS) - qhov tsis zoo ntawm lub plawv hluav taws xob tsim nyob rau hauv qhov ntswg ntshav. Lub tshuab ntshav (SA Node, lossis SAN), tseem hu ua qhov ntswg ntshav, yog tus pib ua hluav taws xob nyob hauv plawv, ua rau lub siab ntaus, lossis sib cog lus, los ntawm kev tua hluav taws xob. Kev raug mob Sinus yog qhov tsis txaus siab ntawm lub plawv dhia ua kom lub zog tsim los ntawm kev ua kom qeeb los yog txiav qhov tshwm sim ntawm qhov ntswg qhov ntswg qhov tsis txaus siab - lub cwj pwm tsis zoo ntawm cov ntaub so ntswg uas teeb tsa lub plawv rau lub plawv atherosclerosis. Nws yog qhov tsis ua haujlwm ntawm qhov ua txhaum (SA) node los pib qhov lub siab thaum lub sijhawm xav kom coj mus rau qhov ntswg ntes.

Sinoatrial thaiv yog qhov cuam tshuam ntawm impulse conduction. Qhov no yog thaum lub siab ua nyob rau hauv qhov ntswg ntshav tsis ua haujlwm los ntawm atria (sab hauv lub plawv), lossis thaum nws tau ncua hauv kev ua. Ntau zaus, qhov yooj yim ntawm lub ntsej muag ntawm lub qhov ntswg ntshav tsis cuam tshuam thaum lub impulses tsis ua zoo.

Cov tsos mob thiab Hom

• Feem ntau asymptomatic (tsis muaj mob)
• Neeg tsis muaj zog
• Tsaus muag
• Cov pos hniav daj
• Lub plawv dhia qeeb heev, tej zaum yuav kuaj tau

Sinoatrial block tau muab faib ua thawj, thib ob, thiab qib peb lub SA SA (zoo ib yam li cov qib ntawm atrioventricular [AV] block). Nws yog qhov nyuaj rau kev kuaj mob ua ntej thiab qib peb-qib SA thaiv los ntawm ib qho electrocardiogram (ECG) nyeem ntawv nkaus xwb.

Qhov thib ob-degree SA block yog hom ntau ntawm SA block, thiab tsuas yog qib degree uas tuaj yeem lees paub rau ntawm thaj chaw ECG. Tsis tas li ntawd, muaj ob hom qib ob-qib SA block: Mobitz hom I (tseem hu ua Wenckebach periodicity) thiab Mobitz hom II.

First-degree sinoatrial thaiv

Kev ua haujlwm qeeb

Thib ob-degree sinoatrial thaiv

• Ua tsis tiav kev coj ua ntu zus
• Ob hom ob-degree SA thaiv tshwm sim:
• Mobitz hom I / Wenckebach periodicity - nrawm ntawm conduction qeeb qeeb kom txog thaum tsis ua tiav ntawm impulses mus txog lub atria tshwm sim
• Mobitz hom II - thaiv yog txhua, lossis tsis muaj, kom txog thaum ua tiav qhov kev ua tiav tsis tiav
• Qhov ob hom no tsis tuaj yeem sib txawv nyob rau sab npoo ECG

Thib peb-degree sinoatrial thaiv

Ua tsis tiav kev ua

Ua rau

Kws kho lub cev

• Vagal stimulation (i.e., stimulation ntawm lub paum ntawm lub qhov ntswg ntawm lub pharynx), tshwm sim los ntawm hnoos, thiab voos ntawm pharynx (rov qab ntawm lub qhov ncauj / pib ntawm lub qa)
• Kev ntsuas ntshav siab hauv qhov muag, lossis carotid leeg ntshav hlab ntsha (nqa ntshav los ntawm lub siab mus rau lub hlwb)
• Kev phais tawm siv

Kev kawm txog Pathologic

• Degenerative mob plawv: lub plawv hlob zoo dua thiab tsis yoog raws
• Dilatory heart disease: mob plawv, thiab ua tsis tiav
• Cia li mob lub plawv tuaj
• Mob cancer hauv lub plawv
• Mob sinus syndrome (SSS): sib quas ntus sai thiab qeeb supraventricular arrhythmias
• Kev voos ntawm pojniam lub paum, ob lub caj dab lossis hauv siab mob ntsws
• Kev ntsuas hluav taws xob tsis txaus: ntau ntau cov poov tshuaj nyob hauv cov ntshav
• Siv tshuaj muaj yees (piv txwv, digoxin)

Kev kuaj mob

Koj tus kws kho tsiaj yuav kuaj ib ce ntawm koj tus dev, muaj ntshav qhia txog tshuaj lom neeg ntshav, kuaj ntshav tag, kuaj ntshav thiab tso zis. Lub vaj huam sib luag electrolyte tuaj yeem qhia hyperkalemia, tsis txawv txav ntawm cov poov tshuaj nyob rau hauv cov ntshav, uas tuaj yeem ua rau arrhythmias. Koj yuav tsum tau muab keeb kwm keeb kwm ntawm koj tus dev noj qab haus huv, suav nrog keeb kwm ntawm cov tsos mob, thiab lawv pib.

Thoracic (lub hauv siab) xoo duab hluav taws xob thiab / lossis duab tsom lub plawv ultrasound yuav raug coj los ntawm tus kws kho tsiaj kom paub meej lossis txiav txim siab cov kab mob hauv lub plawv thiab cov nqaij tsis ua haujlwm loj (neoplasia).

Kev sim cov tawv nqaij ntawm cov tawv nqaij (provocative atropine response test) yuav ua tiav los soj ntsuam qhov ntswg ntshav ntawm lub luag haujlwm. Qhov kev kuaj no siv cov tshuaj atropine los txhawb qhov kev tua hluav taws ntawm SA Node. Cov dev nrog SSS feem ntau yuav tsis muaj lus teb, lossis yuav muaj qhov teb tsis tiav rau atropine.

Kev Kho Mob

Feem ntau cov dev tuaj yeem kho tau rau tus mob sab nrauv. Tsuas yog cov neeg mob uas qhia tias cov muaj mob yuav tsum tau mus pw hauv tsev kho mob. Kev kho mob npaws yuav muab rau cov neeg mob uas xav tau. Yog tias koj tus dev mob cov neeg mob heev thiab tsis tau teb nrog rau kev kho mob tej zaum yuav xav tau kev cog hniav cuav, thiab yuav tau pw tsev kho mob ua ntej kev phais mob hauv kev npaj nws. Yog tias koj tus dev ua tsis tau ntau dhau, lossis tab tom qhia tias nws tsis nco qab, lossis tsaus muag, nws yuav tsum muaj nws cov haujlwm kev txwv.

Nyob thiab Tswj

Tom qab kev saib xyuas yuav nyob ntawm seb koj tus dev puas muaj tus kab mob, nrog rau SA qhov thaiv. Tus kws kho tsiaj yuav teem caij rov qab mus ntsib raws li qhov tsim nyog, thiab kev nyeem ntawv ECG yuav tau ua rau txhua zaus koj mus ntsib koj tus dev kev nce qib. Yog tias koj tus dev tsis muaj zog, los sis tsis nco qab lawm, hu rau tus kws kho tsiaj tam sim kom nws tawm tswv yim.