I-Syncope (isono-co-pee) yilahleko yokulahleka kwengqondo, ebizwa ngokuqhelekileyo njengokuphazamiseka, okanye ukudlula. Ingumcimbi oqhelekileyo-uninzi lwabantu luphuma ngaphandle ubuncinane kanye ebudeni babo. Sekunjalo, i-syncope isoloko ingabangela ingxaki enkulu, zombini kuba ingabonakalisa ingxaki ebalulekileyo, kwaye kuba nayiphi na ilahleko yokuqonda ingabangela ukulimala.
Ngoko ke, ukuba unesiqhelo se syncope, kufuneka uhlolwe ngugqirha wakho ukuze ubone isizathu.
Ukunyaniseka
I-Syncope iyenzeka xa ukuphuma kwegazi ukuya kwingqondo kuyancitshiswa ngokukodwa, kuba imbalwa nje imizuzu emihlanu okanye emithandathu. Ukuphuma kwegazi kwengqondo kungaphazanyiswa ngenxa yezizathu ezahlukeneyo. Ngethamsanqa, kwiimeko ezininzi, i-syncope yimeko engapheliyo engabangelwa yinkinga enkulu yonyango. Ngenxa yoko, kwiimeko ezininzi, nje kuphela ukuba isiqephu se syncopal ngokwawo asizange sibangele ukulimala kakhulu, isiganeko asiyi kuba nexesha elide.
Nangona kunjalo, ngamanye amaxesha i-syncope yimiqondiso yokuba inobungozi okanye nokuba isongela ubomi phantsi kwimeko yonyango ingaba khona. Kungenxa yoko, ukuba unesiqhelo se syncope, kubalulekile ukuba uqhagamshelane nodokotela wakho.
Iimeko ezidibeneyo
I-Syncope inokubangelwa kwiindidi ezininzi zezokwelapha. Enyanisweni, inani elincinci lamathuba anokukwenza uvavanyo lwe syncope lube lukhuni olunzima kunye nosongelo loogqirha abangayifaki ingxaki kwinkqubo ngendlela ehlelekile.
Oogqirha abanobuchule bokuvavanya i-syncope ngokuqhelekileyo bahlula izizathu ezinokubakho kwiindidi eziqhelekileyo-i-syncope ngenxa yesifo senhliziyo, kunye ne-synncope ngenxa yezizathu ezingezizo zomzimba. Phantse zonke iintlobo ezisongela ubomi be syncope zikwimeko yesifo. Ngethamsanqa, iinjongo zesifo se-syncope zihlala zilula ukuba zichonge ngokuphonononga ngokuqhelekileyo-ngokukodwa, ngokuthatha imbali yonyango kunye nokwenza uvavanyo olusemgangathweni.
Kwaye xa unesifo somoya sinqunywe ngaphandle, wena kunye nodokotela wakho unokuqiniseka ngokuqinisekileyo ukuba nayiphi na isizathu esibangela ukuba, akunakwenzeka ukuba unesimo esisongela ubomi - kwaye intsalela yokuvavanya kwakho ingaqhutywa ngaphandle ingqiqo yokukhawuleza.
Izizathu
Izizathu zeCardiac
Phantse omnye kubantu abane abane-syncope baya kubangela ukuba banesifo senhliziyo. Iintlobo ezimbini ezibini zeengxaki zentliziyo zinokuvelisa iingxaki zentliziyo ye-syncope ezinokuthi zithintele ukuhamba kwegazi ngentliziyo, kunye ne- cardiac arrhythmias .
Isifo somoya:
Ukuphazamiseka kwigazi eligeleza entliziyweni kunokubangela ukuhla kwexabiso legazi intliziyo igxobhoza, ngaloo ndlela ukuphanga ingqondo ngokuhamba kwegazi okwaneleyo. Iintlungu ezininzi zeentliziyo zingabinqanda ngokukhawuleza ukuhamba kwegazi ngeentliziyo . Ezi ziquka:
- Isifo se-valve Heart eyenza i-stenosis, ngakumbi i- aortic stenosis kunye ne- mitral stenosis
- I-hypertrophic cardiomyopathy , leyo, ngezinye iimeko, inokunciphisa ukuhamba kwegazi kwi-valve ye-aortic
- Ukuphazamiseka kwisitya esikhulu segazi kufuphi nentliziyo (njengokuba i- pulmary pulmonary embolus )
- Iimvumba ze-cardiac (ezifana ne-myxoma yase-atrial, isisu esinobungozi esinokuphazamisa i-mitral valve)
Iinqununu zomzimba:
Iimpawu ze-cardiac ziyizona zizathu eziqhelekileyo ze syncope kunezimo eziphazamisayo zengqondo. Ngelishwa, phantse nayiphi na i-arrhythmia enokubangela ukuba i-syncope ingabangela nokufa ngokukhawuleza, ukuba i-arrhythmia iyaqhubeka imizuzu emininzi.
I-Arrhythmias inokunciphisa ukusebenza komzimba ngezindlela ezimbini ezahlukeneyo - ngokwenza intliziyo yephule kakhulu, okanye ngokuyenza ngokukhawuleza.
I-slowly arrhythmias (ebizwa ngokuba yi-bradycardia) inokuvelisa i-syncope nje ngokubangela ukuba intliziyo ibetha ngokukhawuleza kangangokuba ingqondo ayifumana ukuhamba kwegazi okwaneleyo. Ukuba i-bradycardia ifunyenwe yimbangela ye syncope, kwaye ukuba i-bradycardia icingelwa ukuba iyakwazi ukubuyela kwakhona, unyango olululo lunokunikwa ngokufaka i- pacemaker ye- cardiac.
I- sinus bradycardia okanye ibhloko yeentliziyo inokuvelisa i-bradycardia ebalulekileyo.
Intliziyo ye-arrhythmias ebizwa ngokukhawuleza (ebizwa ngokuba yi-tachycardia) inokubangela ukuba i-syncope ngokwenza intliziyo ibethe ngokukhawuleza kangangokuthi ayikwazi ukupompa ngokufanelekileyo. Nangona kukho iintlobo ezahlukeneyo ze-tachycardia, ezo zivame ukudala i-syncope yi- ventricular tachycardia kunye ne- fibrillation ye-ventricular . Ezi i-arrhythmias zibeka ubomi besongelo kwaye zivame ukuvelisa ukufa ngokukhawuleza .
Imbali yonyango ngokucophelela kunye nokuhlolwa komzimba - kunye ne- electrocardiogram (ECG) - kufuneka unike ugqirha wakho ngokwaneleyo ukuba ugwebe ukuba nayiphi na imeko yezimo zengqondo yimeko ebangela ukuba i-syncope yakho. Yaye ukuba iimeko zentliziyo kucingelwa ukuba ziyimfuneko, uvavanyo oluphambili lwengqondo, olufunekayo, olubandakanya i- echocardiogram , uvavanyo loxinzelelo , okanye enye inkqubo yokuxilonga. Ugqirha wakho unokwenza isigqibo sokuba kufuneka ube esibhedlele ukwenzela ukhuseleko kuze kube yilapho ukuxilongwa kugonywe phantsi, kwaye unyango olufanelekileyo lunikwa.
Ngethamsanqa, nangona kunjalo, kwininzi lamatyala, uhlolo olululo lokuqala lwezokwelapha lulawula imbangela yesifo se-syncope. Ugqirha wakho angaphendukela ingqalelo kwizinto ezingezizo zomzimba.
Izizathu ezingekho kwiCardiac
Kukho iintlobo zintathu eziqhelekileyo zezifo ezingenayo inhliziyo eyenza i-syncope - iinjongo ze-neurological, izizathu zesisombululo kunye nezizathu ze-vasomotor.
Izizathu Zegazi:
Izimo ze-neurological zifikelela kwisizathu esingaqhelekanga se syncope, ukubalwa kwee-1% zeepisodes ze syncopal. Kukho iimeko ezintathu ze-neurological ezingaba zivelise i syncope:
- Ukuhlaselwa kwe-ischemic ephantsi (i-TIAs) , ngokuqhelekileyo iquka i- vertebrobasilar arteries . Imithambo ye-vertebrobasilar yimizila yegazi emqaleni kwentamo, ecaleni kwintambo yomgogodla, enika i-brainstem - inxalenye yengqondo, phakathi kwezinye izinto, ixanduva lokugcina ingqalelo. Ukukhutshwa kwegazi ku-artebrobasilar arteries kungenza i syncope.
- I-Subclavian iba nesifo
- Uxinzelelo oluqhelekileyo i-hydrocephalus (NPH)
Isimo sengqondo esivame ukudideka kunye ne syncope isifo sokuhlutha . Ukudideka kubangelwa kukuba ukuhluthwa kwesithuthwane, njenge syncope, kubangela ukulahlekelwa kwexesha elide. Kodwa ukuxhatshazwa ngokuqhelekileyo akubangelwa ukuphazamiseka kokuphuma kwegazi kwingqondo - kunoko, kubangelwa ngumsebenzi ongaqhelekanga kumbilini. Ugqirha ngokuqhelekileyo uyakrokrela ukuba ukuphazamiseka kwengxaki yesohlwayo yimbangela yokulahleka kwengqondo xa iqela lihamba kunye nokunyakaza okungazibandakanyeki ngokuqhelekileyo kwenzeka ngokubanjwa. Ukuxilongwa ngokuqinisekileyo kokuhluthwa kungasigcinwa yi- electroencephalogram (i-EEG) - uvavanyo olurekhoda umbane wombane. Kubalulekile ukwenza uvavanyo oluyimfuneko kwaye ufumane okokuxilongwa ngokufanelekileyo, kuba unyango lweengxaki zokuthintela ngokuhlukileyo luhluke kakhulu kunyango lwe syncope. Ngelishwa, abantu abaneendlela ezinobungozi be-syncope (ngokuqhelekileyo abantu abancinci) bahlala bexilongwa ngokungathandabuzekiyo njengengxaki yokutshatyalaliswa.
Iziphumo zeMetabolic:
Ngaphantsi kwe-1% yabantu abane syncope bafumana iziganeko zokuxilisa njengesizathu. Izizathu ze-metabolic ze syncope ziquka i- hypoxia (iyanciphisa i-oksijini egazini, ephantse ibhekiselele emaphaphaza kunye nesifo senhliziyo ekhoyo); ukuxhatshazwa kwegazi , okwenzeka kwiimeko ezinzima zokuxhalaba okanye ukuhlaselwa ngumsindo ; kunye ne- hypoglycemia enobukhulu (ishukela ephantsi kwegazi), okumele ikhankanywe kwi-diabetics, ngakumbi abo bathabatha i- insulin .
Izizathu zeVasomotor:
Ngenxa yobuninzi babantu abanama-Syncope, yilapho imali ikhona. I-Vasomotor syncope iyenzeka xa iinkqubo zomzimba eziyinkimbinkimbi ezigcina uxinzelelo lwegazi oluqhelekileyo lusehluleka (mhlawumbi ngokukhawuleza okanye ngokungapheliyo), okukhokelela ekuhlahleni kwexinzelelo lwegazi , okuza kubamba ingqondo yegazi.
Kukho ezimbini iintlobo eziqhelekileyo ze-vasomotor syncope- orthostatic hypotension kunye ne- vasovagal (okanye i-cardioneurogenic) syncope .
I-Orthostatic hypotension
Ngokuqhelekileyo xa usukuma, imithwalo yegazi emilenzeni yakho iminyanzelo, eyanceda ukugcina igazi "ekuhlanganiseni" emilenzeni yakho, ngaloo ndlela ukugcina uxinzelelo lwegazi oluqhelekileyo. Kubantu abanesifo se- orthostatic hypotension , ngesinye sezizathu ezininzi, uxinzelelo lwegazi oluqhelekileyo alukwazi ukugcinwa xa lumile. Ukuba uxinzelelo lwayo lwegazi luyancipha ngokukhawuleza, banokuphelelwa ingqondo xa ba tye. I-Orthostatic hypotension idla ngokubonakalayo kubantu abadala, kwaye iqhelekileyo ibangelwa yimithi yonyango. Kodwa kunokubangelwa nesifo sikashukela, isifo sika-Parkinson, kunye nezinye izifo zonyango.
Iimeko ezinxulumene ne- postural orthostatic tachycardia syndrome, okanye i-POTS . I-POTS iyahluke kwi-hypotension ye-orthostatic ngokuthi: a) ibonwa ngokukodwa kubantu abaselula (ngokuqhelekileyo abantu abangaphantsi kweminyaka engama-45), kwaye b) ngelixa i-POTS inokuvelisa uxinzelelo lwegazi oluphantsi, ingxaki ephezulu yintliziyo esheshayo ngokukhawuleza phezu kokuma. Abantu abane-POTS bafumana iimpawu ezininzi xa bephakama, ngokuqhelekileyo kubandakanywa iipilpitations , ukungcola kunye nobuthathaka-kwaye phantse i-40% yazo iya kuba nama-syncope ubuncinane kanye.
Vasovagal (cardioneurogenic) syncope
I-syncope yeVasovagal (eyaziwa nangokuthi i-cardioneurogenic syncope) iyona nto ibangela kakhulu i syncope, mhlawumbi ibala ngaphezu kwama-80% yazo zonke iziqephu ze-synncopal. Kubangelwa ukuhluthwa ngokukhawuleza kwemithambo yegazi kwimilenze ngokuphendulela kwi-reflex ye-neurological exaggeration. Ukuba unayo i-syncope kwaye ingenayo imbali yesifo senhliziyo okanye ingozi ephakamileyo yesifo senhliziyo, iingxaki ziphezulu ukuba uya kuba ne-vasovagal syncope - apho kufuneka ufunde okuninzi ngale meko unako. Funda apha malunga nokuphatha i-vasovagal syncope .
Vavanyo
Ngoku ukuba sihlolisise imimandla ebanzi yezokwelapha ezinokubangela ukuba i-syncope, ukuba wena okanye othandekayo unayo i-syncope kuya kuba luncedo ukwazi ukuba oogqirha kufuneka bahlelwe njani kuzo zonke iimeko, kwaye bafumane ngokufanelekileyo ukuxilongwa ngokuchanekileyo.
Nayi nqaku exoxa ngendlela echanekileyo neyocwangco yokufikelela kuvavanyo lwe syncope .
> Imithombo:
> Costantino G, Casazza G, Reed M, et al. I-Syncope Risk Stratification Tools Izigwebo zeSiklinikhi: Ulwabiwo-mali oluPhezulu loLuntu. U-J Med 2014; 127: 1126.e13.
> Huff JS, Decker WW, Quinn JV, et al. Umgaqo-nkqubo weKlinikhi: iiNgxaki eziPhambili kwiVavanyo kunye nokuPhathwa kwabaPhathi abaPhezulu abaNika kwiSebe eliPhezulu ngeSyncope. U-Ann Emerg Med 2007; 49: 431.
> Strickberger SA, uBenson DW, Biaggioni I, et al. I-AHA / I-ACCF yeSitethi yeScientific on the Evaluation of Syncope: Ukusuka kwi-American Heart Association Councils kwiCliniological Cardiology, Unesi-Cardiovascular Nursing, Izifo Zengqondo Zase-Young, kunye ne-Stroke, kunye neMigangatho Yokunakekelwa kunye neZiphumo zoPhando lwaBasebenzi abaSebenzayo; kunye ne-American College of Cardiology Foundation: kwi-Collaboration ne-Heart Rhythm Society: Iyavunyelwa yi-American Autonomic Society. Uhambo luka-2006; 113: 316 .