I-Vasovagal (i-Neurocardiogenic) i-Syncope

by URichard N. Fogoros, MD, ugqirha oqinisekisiweyo webhodi

Isizathu Esiqhelekileyo Sokwehla

I-Syncope - ebizwa ngokuba yi-fainting - iyigama lonyango lokulahlekelwa kwexesha elifutshane. Naliphi na isiqhelo se syncope kubalulekile ubuncinane ezibini izizathu. Okokuqala, i-syncope inokubangela ukulimala, ngoko kubalulekile ukuzama ukukhusela ukuphindaphinda. Okwesibini, i-syncope ngamanye amaxesha ingabonakalisa ingxaki ebalulekileyo yonyango. Nangona iimeko ezininzi zonyango zingakhokelela kwi syncope, ngohlobo oluqhelekileyo lwe syncope yi-vasovagal syncope.

Funda ngezizathu ezininzi ze syncope.

Ubume be-Vasovagal Syncope

I-syncope yeVasovagal (ebizwa ngokuba yi- neurocardiogenic syncope ) yilahleko yokulahleka kwengqondo ebangelwa yintsholongwane ye-neurological eyenza ukuxutywa ngokukhawuleza kwemijelo yegazi emilenzeni, okanye inqanaba lentliziyo elincinci (bradycardia), okanye zombini.

I-akhawunti yeVasovagal syncope engaphezulu kwesigama sazo zonke iziqephu ze syncope. Nangona oogqirha badla ngokubhekisela kulo "njengento elula yokuphelelwa amandla," indlela yokusebenzisa i-vasovagal syncope ngokwenene ayikho into elula. Ukungaqondi kakuhle indlela i-vasovagal syncope isebenza ngayo ingabangela iingxaki ekwenzeni ukuxilongwa ngokuchanekileyo okanye ekukhetheni unyango olwaneleyo.

Iimbangela zeVasovagal Syncope

I-syncope yeVasovagal ivela xa kukho into eyenza i- reflex vasovagal , ebangela ukuba imivenge yegazi ihluthe ngokukhawuleza. Ukuxilwa kwemithambo yegazi kubangela ukuba inani elincinane legazi legazi lidibanise kwimilenze. Ukuxakeka kwegazi ngokuqhelekileyo kuhamba kunye nokunciphisa izinga lentliziyo.

Ngenxa yoko, uxinzelelo lwegazi ngokukhawuleza luhla. Ukuba ukuwa kweengcinezelo zondlobongela kunele ukuphanga ingqondo yegazi, ukuphelelwa yintlungu kwenzeka.

I-reflex ye-vasovagal isebenza njengale: Okokuqala, umntu ukhangeleke kwi-stimulus enobungozi (njengenaliti ebuhlungu eminwe) eyenza i-reflex.

Isiganeko esishukumisayo sivuselela iimbilini ezithile (iintlungu zomnyo), ezithumela umqondiso wombane kwisikhululo se-vasomotor kwi-brainstem, isabelo sengqondo esenza isigxina somzimba (isitya segazi). Isikhungo se-vasomotor, ngokuphendula, sithumela iimpawu kwiimitha zegazi, ezibangela ukuba zihluthe. Oku kuvelisa ukuxhamla kwegazi, okukhokelela kwi-synncope. Ukukhuthazwa okufanayo kwe-brainstem kungathumela intetho kwi ntliziyo (ngokusebenzisa i- vagus nererve ) ukuvelisa ukuhla kwezinga lentliziyo.

Kulo maninzi abantu abane-syncope ye-vasovagal, ukukhutshwa kwemithambo yegazi kubonakala kubangelwa yiyona nto ibangela ukulahlekelwa kwengqondo. Kwabanye abantu, nangona kunjalo, ukunciphisa intlawulo yenhliziyo kuthatha indima enkulu.

Yintoni enokubangela i-vasovagal syncope? "Intambo" eqala i-reflex vasovagal ingaba nayiphi na yezinto ezahlukeneyo. Iziphumo eziqhelekileyo ziquka:

Ubuhlungu, ngakumbi intlungu enzima ekuqaleni.
Ukuba negazi lakho litsalwe.
Ukubonakaliswa kwimbono yegazi, okanye kwezinye izinto ezinobungozi.
Ukuba nobunzima bokuchama okanye ukuchaswa.
Ukuphefumula okukhulu kokukhwehlela.
Ukugwinya okubuhlungu.
Ukufumana iindaba eziphazamisayo okanye ezothusayo.
Soyika ngokukhawuleza.
Ukunyamezela ixesha elide. (Kungenxa yoko amajoni amele ukuphumla, okanye iimvumi kwipyara, ngamanye amaxesha uya kuphelelwa amandla.)

Ukuba isiqhelo esipheleleyo silandela nayiphi na imimangaliso, i-vasovagal syncope ngokuqinisekileyo iyibangela.

Iimpawu ezihambelanayo okanye zenza iVasovagal Syncope

Nangona ukulahleka kwesaziso kunye ne-vasovagal syncope inokukhawuleza, ngokuphindaphindiweyo kulandelwa imizuzwana embalwa okanye imizuzu embalwa yezilumkiso . Ngezinye iinkalo iimpawu ezilumkiso zibizwa ngokuba yi "prodrome" ye syncope.

Ezi zibonakaliso iimpawu ziquka rhoqo:

Lightheadedness.
Ukubetha okanye ukuguqula ezindlebeni.
Ukuphazamiseka kokubonakalayo, njengombono otyhafazayo okanye umbono we-tunnel.
Ukuthuthumela ngokukhawuleza.
Izaziso ezinokukhawuleza.

Ezi zimpawu ezihamba phambili zilandelwa livakalelo "lokugqitywa," ekugqibeleni ukulahlekelwa yintliziyo.

Ixesha eliphakathi kokuqala kweempawu zeprodromal kwaye ngokugqithiseleyo ukudlula kungaba yimaminithi embalwa, okanye nje kweyesibini okanye ezimbini.

I syncope ngokwayo inezixhobo ezinobuninzi:

I-syncope yeVasovagal isoloko ivela xa ixhoba limi, okanye lihleli lixhomekeke (xa ukugawula igazi kusemilenzeni kuya kwenzeka), kwaye akunakuze kwenzeke ngoxa ulele phantsi.
Abantu abanayo i-vasovagal syncope bahlala beqaphela emva kwemizuzwana embalwa, xa bewile (okanye, ukuba banenhlanhla, bancedwa) kumhlaba. Oku kungenxa yokuba kanye emhlabathini, amandla adonsela amandla awabangela ukuba igazi lidibanise emilenzeni kwaye uxinzelelo lwegazi luphucula phantse.
Ngakolunye uhlangothi, ukuba ixhoba ligcinwe lithe tye ngummeli onentsingiselo, ukungabi nalwazi kunokuba luninzi. Le yimeko enobungozi, kuba nje nje ixhoba lithe tye kwaye lingenanto, ingqondo yakhe ayinakulungiswa ngokufanelekileyo ngegazi.

Umgca wenyani kukuba ukuba ubona umntu ephelile, kufuneka abancede bahlawule intloko baze baphakamise imilenze yabo. Ukubamba kwindawo ebonakalayo - nokuba ungeze "unyango" olongezelelweyo lokumemeza ezindlebeni zabo okanye ukubetha-akuncedi, kwaye lunokuba lunobungozi.

Iimpawu ze "Postdromal". Emva kwesiganeko se-syncope ye-vasovagal, abantu abaninzi baya kuziva bexakeka kwiiyure ezimbalwa okanye kwimihla embalwa ezayo, okanye nangaphezulu. Ngexesha le "postdromal" ixesha abavame ukufumana ukukhathala okukhulu, isicathulo, isisu kunye nokulahleka kwesidlo.

Kubaluleke kakhulu ukuba uqaphele ukuba, kude kube yilapho izibonakaliso ezidlulayo (kunye nezixhalabisayo) ziphela, abantu banokuphelelwa amandla ngenxa yoko-ke kufuneka baqaphele ngokuphawulekayo iimpawu zokulumkisa ezingabonisa ukuba isiqhelo se syncope sisondele.

Abantu ababenayo i-vasovagal syncope. Abantu ababenayo enye okanye amabini episodes ye-syncope ye-vasovagal bahlala bekwazi ukuqonda iimpawu zokulumkisa, ngoko baya kukwazi xa esinye isiganeko siza kwenzeka. Okubaluleke ngakumbi, ukuba bayayibona impawu zokulumkisa, banokuthintela ukuphela komntu ngokulala nokuphakamisa imilenze yabo. (Ukuyeka isiqendu akunakwenzeka ngezinye iindidi ze syncope.) Ngaphezu koko, ukuba banokuphepheza ngokwenene bamnyama, banokuthi baphinde baphephe ixesha eliphumayo le-post-vagal elandelwa rhoqo.

Ngakolunye uhlangothi, uzama "ukulwa" nesiganeko esivelayo se-vasovagal syncope ngokuziphoqa ukuba uhlale ulungile kwaye uzilungele ukuba ungadangali phantse ungaze usebenze kakuhle.

Abantu abakhulileyo abane-vasovagal syncope banamathuba okuba "neempawu zengqondo". I-syncope yabo inokwenzeka ngaphandle kweyiphi into ebonakalayo, kwaye ingenayo nayiphi na impawu. Ukwenza ukuxilongwa ngokuchanekileyo kwezi meko kunokubonisa umngeni onzima kumgqirha.

Ngokubanzi, i-vasovagal syncope ayiyiyo ingozi yokuphila - kodwa ukulimala okubangelwa ukuwa kungenzeka. Kwaye ukuba iipasodes zihlala zihlala zifumaneke ngokwale nkalo ngokuqinisekileyo ziphazamisa ubomi obuqhelekileyo.

Ngubani ochaphazelekayo?

I-reflex ebangela i-vasovagal syncope inokuthi ibe yinto ethile kuwo wonke umntu, ngoko phantse nabani na umntu unokufumana isiganeko se-vasovagal xa kwenzeka isiganeko esinamandla esinokubangela. Enyanisweni, kunokwenzeka ukuba abaninzi abantu baya kuba nesiganeko esinyameko ngexesha elithile ebomini babo.

I-syncope yeVasovagal iyakwenzeka nanini na ubudala, kodwa ixhaphake kakhulu kwiintsholongwane kunye nabantu abadala kunabantu abadala.

Abanye abantu baxhomekeke kwiziqwenga ze-vasovagal, kwaye banokuphelelwa yintsiba kunye neziganeko ezinokubangela ukuba zenzeke. Aba bantu banamathenda aphindaphindiweyo episodes of syncope, ukususela ebusheni. Baza kufumana ama-syncope ngokulandela iintlobo ezininzi ezahlukahlukeneyo.

Kwizinto ezingaqhelekanga, i-vasovagal syncope injalo kwaye kunzima ukunyanga ukuba bayakhubazeka ngayo. Laba bantu baninzi banesimo se- dysautonomia (ukungalingani kwenkqubo ye-nervous autonomic system) eyenza ukuba bathambekele kakhulu kwi-reflex ye-vasovagal ebangela le meko. Kananjalo bahlala bekhona nezinye iimpawu eziqhubekayo ezibonakalisa i-dysautonomias, ezifana nokuqhaqha kwesisu okanye i-cramps, isifo sohudo, ukunqanda, ukukhathala okukhulu kunye neentlungu ezahlukeneyo.

Ukuchonga i-Vasovagal Syncope

Oogqirha abanezakhono ngokuchonga ngokufanelekileyo i-vasovagal syncope bayaqonda ukuba le meko ihlala ihlala isimo. I-syncope yeVasovagal iyakwenzeka ngokukodwa emva kokugula kwegciwane, emva kokuzivocavoca, emva kokutshiza okufudumele okanye kusasa - ngamanye amagama, nayiphi na ixesha ixesha lokungcoliswa kwemvelo likhoyo. (Xa uphelelwe amanzi, ukuhlanjululwa kwemithambo yegazi emilenzeni kunakho ukuvelisa ukuphahla okukhulu kwigazi lakho.)

Ukunikezelwa kwezi zixhobo kunye neemeko zesimo, oogqirha kufuneka bakwazi ukwenza ukuxilongwa ngokuchanekileyo kwininzi yezigulane nje ngokubuza imibuzo efanelekileyo nokuphulaphula ngokukhawuleza iimpendulo. Ngelishwa, oogqirha abaninzi banqabile ukuthabatha imbali yonyango ngokwaneleyo; ngenxa yoko, bagqiba ukwenza iimvavanyo ezingekho mfuneko kunye neenkqubo ezikhangela izifo zentliziyo okanye izifo zengqondo.

Ukuhlolisisa ngokomzimba abantu abane-vasovagal syncope ngokuqhelekileyo kuqhelekileyo. Nangona kunjalo, uvavanyo luncedo kakhulu ekufumaneni iimeko ezifanayo ze -hypotension orthostatic okanye i- postural orthostatic tachycardia syndrome (i-POTS) , kwaye ingaba luncedo kakhulu ekuhleleni izinto ezinokwenzeka.

Nangona kunjalo kwiimeko ezininzi ukwenza ukuba ukuxilongwa kwe-vasovagal syncope kufanele kwenzeke ngokuthatha imbali yonyango nokwenza uvavanyo lomzimba, ngezinye amaxesha uvavanyo luncedo. Ngokukodwa, ukufundiswa kwetafile ye-tilt kunokuba luncedo ukuba imbali yonyango ayifani ukuba i-vasovagal syncope, okanye ukuba kunzima ukuhlukanisa phakathi kwe-vasovagal syncope kunye ne-hypotension ye-orthostatic.

Ukuphathwa kweVasovagal Syncope

Abantu abanesicatshulwa esisodwa, esicacileyo se-vasovagal syncope ngokubanzi abafunanga naluphi na unyango lweyeza.

Kodwa ukuba uye wafumana iziqwenga eziphindaphindiweyo, unakho ukufumana ezinye izipapawu ngaphandle kokuba uphathwa kakuhle. Kwaye, njengokuba nabani na i-vasovagal syncope bayazi, ezi ziqhelo eziphazamisayo zihlala zifika kwiimeko eziphazamisayo okanye ezingenakwenzeka, kwaye zinokuphazamisa ubomi bakho. Ngenhlanhla, unyango luba luncedo kakhulu.

Kukho ezine iindidi eziqhelekileyo zonyango kwi-vasovagal syncope: imfundo, amayeza, ukusetyenziswa kunye nabakhuthazi. Kule miba, imfundo iyona ndlela iphumelele kakhulu kuninzi lwabantu.

1) Uzifundisa Nge-Vasovagal Syncope

Abantu abaxhomekeke kwi-syncope ye-vasovagal kufuneka baqonde iinkcukacha ezi-5 ezibalulekileyo malunga nale meko, esele sithethe ngazo. Isishwankathelo, zezi zi:

I-Vasovagal syncope iveliswa ngumbonakalo obangela ukukhutshwa ngokukhawuleza kwemithambo yegazi emilenzeni, okwenza igazi lidibanise kwimida engaphantsi.
Nawuphi na umqathango obangela ukuchithwa kwamanzi (okunciphisa umthamo wegazi) kuya kwenza ukuba ulungele ukufumana isiqhelo se syncopal.
Iimpawu zeProdromal zinika isilumkiso esibalulekileyo ukuba i-syncope iyakwenzeka ngokukhawuleza.
Ukuba ulala kwaye uphakamise imilenze xa ufumana iprodrome, unokuthintela isiqephu se syncopal.
Abantu baya kudla ixesha elininzi lweentsuku okanye iiveki apho baxhomekeka khona kwiziqephu ze-vasovagal. Oku kungenzeka, umzekelo, emva kokugula kwegciwane, okanye emva kwexesha lokuxinzezeleka kwengcinezelo okanye ukulahlwa kokulala. Kufuneka uqikelele ngakumbi kwiimpawu zangaphambili ngexesha elinjalo.

Indlela efanelekileyo yokukhusela i-vasovagal syncope kukukhusela iimeko ezivelisa i syncope. Ukuba uqonda ezi zintlanu zibhalwe apha, izikhokelo zilandelayo zibonakala ngokukhawuleza.

Okokuqala kunye nokuphambili, thintela ukungcola . Ukuchithwa kwamanzi (kwaye ngoko i-syncope) ngokuqhelekileyo kwenzeka emva kokuzivocavoca ngamandla, emva kokuphi na uhlobo lokugula, kwaye kusasa kusasa emva kobusuku bokukhawuleza. Ikhofi, itiye kunye neziyobisi ezidakayo ziyakwazi ukuvelisa amanzi. Ukuba unesimo apho kunokungcola khona, kufuneka uthabathe intlungu ukuze uvuselele kwakhona. Kufuneka uphuze amanzi amaninzi ngokubanzi, kodwa ukuba ucinga ukuba unokudityaniswa oku kubaluleke kakhulu. Kwaye kufuneka ugweme ukuma ixesha elide ngelixa udibene.
Nika ingqwalasela esondeleyo kuyo nayiphina impawu ezinokuthi ungazifumana. Izimpawu ezihamba phambili - ngokuphazamiseka okubonakalayo, ukugqithisa ezindlebeni, ukukhanya okukhawulezileyo, ukujuluka, kunye / okanye i-nausea - ithambe ukuhluka kumntu kumntu. Kodwa abantu abaye bafumana ama-syncopal episodes bafumana ingcamango ecacileyo yeempawu ezifunekayo ekufuneka zizilindele.
Kubalulekile ukuqaphela iimpawu zakho zokuhamba, kuba ukuba uyenzayo, unokuphepha i syncope ngokulala nokuphakamisa imilenze yakho. Ngakolunye uhlangothi, ukuba ukhetha ukungayithobeli iimpawu zokulumkisa, unokuthi uphumelele kwicandelo lokutya eliqingqiweyo, kwaye umphathi wesitolo uya kugxininisa (ngenxa yezizathu ezisemthethweni ezisisiseko) ekuthumeleleleni kwi-ER kwi-ambulensi , apho uya kuba phantsi kwebhetri yeemvavanyo ezingadingekile kwaye mhlawumbi uhlala esibhedlele. Enye inzuzo yokuphepha i-syncope yangempela ngokulala phantsi kukuba xa usenzayo, uya kuphepheka ixesha elide lokugula emva kwesigxina esoloko kulandela isiqephu se-vasovagal.
Abanye abantu baye bakwazi ukukhupha isiqhelo se-vasovagal syncope (okanye ngokuphindaphindiweyo, ukulibaziseka ixesha elide ukufikelela kwindawo efanelekileyo yokulala) ngokukhawuleza ukubandakanyeka ekusebenziseni ama- muscle-exercens . Ezi zinto zibonakalisa ukunciphisa i-blood vessel dilation kunye nokwandisa inani legazi elibuyiselwa entliziyweni. Ukuzivocavoca okunjalo kunokubandakanya ukuwela umlenze ngelixa umva imilenze, indawo yesisu kunye namathambo; Ukucima iingalo ngeengqungquthela ezixinzekileyo; ukuqhuma komlenze; okanye ukucima iibhola zerabha.
Abantu abaxhomekeke kwi-vasovagal syncope banokufumana amaxesha, ixesha elide okanye iiveki, apho i-synncope iyakwenzeka ngokukodwa. Ezi zihlandlo "ezibucayi" zivame ukuba zenzeke ngenxa yezizathu ezingabonakaliyo. Ngamanye amaxesha, nangona kunjalo, banokuthi banxulumane nokugula kwintsholongwane, ukuya kwimizila yokuya esikhathini, ukuya kwixesha lokukhulelwa okanye ukuhla; okanye kwiingxaki zesisu, isisombululo okanye sesisu. Ukuba unesinye seziqephu ze-syncopal okanye esinye sesibini, uhlawulela ukuba uqaphele ngokukhethekileyo iimpawu ezibonakalayo ezinokumisela esinye isiqhelo. Ihlawulela ngeli xesha ukuba kwenziwe imizamo ekhethekileyo yokuhlala i-hydrated kakuhle ngokusela amaninzi.

2) Unyango lweziyobisi

Kwamanye abantu, i-syncope ye-vasovagal iyenzeka ngexesha eliphazamisayo nangona zonke izilumkiso ezifanelekileyo zithathwa. Kwaba bantu, unyango lwamayeza luncedo rhoqo.

Kwiminyaka edluleyo, izidakamizwa zisetyenziswa kakhulu kwi-vasovagal syncope ngababhengezi be- beta , kodwa izifundo eziliqela ziye zahluleka ukubonisa nayiphi na inzuzo kwaye la mayeza ayenganyanzelwanga.

Iziyobisi eziye zaboniswa ukuba ubuncinane uncedo luquka i-midodrine (isicinga esilulela ukunciphisa ukukhutshwa kwemithambo yegazi), i-disopyramide (i-Norpace, isixhobo esichaphazelekayo esinezixhobo ezithile zokuvimbela i-vagal), i-serotonin iphinda ifake i-inhibitors (iziyobisi kwiCraza Prozac) kunye ne -opylline (isilwanyana esasetyenziswa kakhulu ukuphatha i- asthma ).

Nangona enye okanye ngaphezulu kwezi zonyango ziza kuncedisa ukunciphisa izigcawu ze syncope, ukufumana "ukulungelelanisa" ukusetyenziswa kweziyobisi ngokuqhelekileyo ngumcimbi wezilingo kunye nephutha. Ukunyamezela kuyadingeka kwicandelo loogqirha kunye nesigulane ukuze ufumane unyango olungcono.

3) Ukunyanga kwamayeza

Abantu abaninzi abane-dysautonomia babonisa ukutyekela ukuba ne-vasovagal syncope; Ngokwenene, kubonakala ngathi abantu abaninzi abahlala bevasovagal syncope (esikhundleni sezinto ezingabodwa, iziqendu ezihlukeneyo), ngokwenene banesimo se-dysautonomia. Ekubeni amanye ama-dysautonomiya ayaziwa ngokuphendula ngokufanelekileyo ukuqhuba uqeqesho (oluya kuphucula umsebenzi we-vascular "ukulungisa" inkqubo ye-nerveous autonomic), ezinye iingcali zicebise ukuba ukuxubusha kungabanceda abantu abane-vasovagal syncope. Kwaye, ingcaciso ekhoyo ekhoyo okwangoku ibonisa ukuba kunjalo. Ngoko ke, ukuba unayo i-syncope ye-vasovagal ephindaphindiweyo, kufuneka uxoxe ngokuqeqesha umzimba (njengokuhamba, ukugijima okanye ibhayisiki) kunye nogqirha wakho.

Funda malunga nokufumana umyalelo wokusebenza.

4) Ulwaphulo lwe-Pacemaker

Kwiminyaka emininzi edlulileyo kwakukho umxhelo omkhulu wokusebenzisa i- pacemakers ukuphatha i-syncope ye-vasovagal, kuba i-vasovagal syncope idla ngokuhamba ngokukhawuleza kwehla kwenhliziyo. Inzondelelo yonyango lwe-pacemaker yabuya ngokukhawuleza, nangona kunjalo, emva kokugqibeleni ekugqibeleni ukuba izigulane ezininzi ezine-vasovagal syncope ezafumana i-pacemakers zagqitywa-zazenza ngaphandle kwenani lentliziyo elincinci. Njengoko kuvela, kwiindawo ezininzi, ukuba kungekhona abantu abaninzi abane-syncope ye-vasovagal, kukuhlanganiswa kwegazi emilenzeni, kwaye kungekhona inqanaba lentliziyo elincinci, elivelisa i-syncope.

Sekunjalo, kwabanye abantu abane-syncope ye-vasovagal, ukuhla kwexabiso lentliziyo yisona sizathu esiphezulu sokudlula. Kula bantu, abanokukhubaza abanokunciphisa ubukhulu beepisodes ze syncope.

Okwangoku, abantu abanokunciphisa i-vasovagal syncope kuphela ukuba: a) ukuphuculwa okukhulu kwenani lentliziyo kubhalwe ngexesha leengqungquthela, mhlawumbi ngexesha lokuvavanya kwetafile okanye ngexesha lokuqwalasela i-ECG , kwaye b) ukuziphatha kokuphepha (oko kukuthi, ukuthatha Amanyathelo achazwe ngasentla ukuze agweme okanye akhuphe i-syncope ye-vasovagal ayiyiyo.

ILizwi

Vasovagal syncope yimeko eqhelekileyo. Ngethamsanqa, ngokuqhelekileyo kuvela kwiindawo ezinqabileyo, eziqhelekileyo okanye ngexesha elincinci. Uninzi lwabantu abane-vasovagal syncope lukhokela ubomi obuqhelekileyo.

Ukuba unayo i-vasovagal syncope - ingakumbi ngaphezu kwesiganeko esisodwa - kufuneka ufunde ngokubanzi njengoko unako malunga nale meko, kubandakanye ukuba zeziphi izinto eziyiphuthumayo, indlela yokuqonda iimpawu zokulumkisa kunye nendlela onokumisa ngayo isiqhelo.

Ukuba uneziqendu eziphindaphindiweyo ze syncope naphezu kokuba uthathe amanyathelo anjalo, kufuneka uxoxe nodokotela wakho malunga nokuba kukhona into engaphezulu nje "yonyango lokukhusela" olufunekayo.

> Imithombo:

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