Cov npe ntawm cov tshuaj antiarrhythmic thiab lawv cov kev faib tawm

Xyaum tag nrho cov neeg mob ntawm cov kws kho mob tau ntsib ib txoj kev los sis lwm yam uas muaj ntau hom mob arrhythmias. Tam sim no, cov kev lag luam pharmacological muaj ntau yam tshuaj anti-arrhythmic. Cov lus no thiab cov cwj pwm yuav raug muab xam rau hauv tsab xov xwm no.

Txoj kev ntawm kev cuam tshuam

Txhawm rau tshem tawm ectopic ntshawv siab ntawm lub plawv atherosclerosis, cov tshuaj antiarrhythmic tau sau tseg. Lub hom phiaj ntawm kev ua ntawm xws li cov yeeb tshuaj yog qhia nyob rau hauv lub electrophysiological thaj chaw ntawm lub hlwb ntawm ua hauj lwm myocardium:

• Tsawg dua nyob rau ntawm qhov kev nqis tes ntawm qhov kev nqis tes ua, uas pab txhawb qeeb lub txim.
• Txo qhov excitability ntawm myocardium.
• Txo cov sij hawm ntawm kev txhawj xeeb ntawm tus txheeb ze, uas ua rau kom luv ntawm lub caij nyoog, thaum ib qho txawv txav tsis muaj peev xwm ua rau lub siab ploj mus.
• Ua kom lub sijhawm zoo rau refractoriness, uas yog ib qho tseem ceeb rau tachycardias thiab tshem tawm impulses uas tshwm sim tom qab dhau luv me ntsis tom qab kev pom zoo.
• Ua rau kom ceev ceev, uas muaj kev txhawb homogenization thiab tiv thaiv qhov tshwm sim ntawm rov nkag ("rov nkag").
• Kev tsom xam ntawm kev ua kom pom tseeb ntawm ectopic automatism, uas yog txuam nrog ib qho kev loj hlob ntawm lub sij hawm ntawm diastolic depolarization.
• Tawm sib txawv ntawm qhov kev cia siab thiab kev tsis nyiam.
• Txo tus mob plawv kom txo tau hluav taws xob thiab kev pheej hmoo ntawm cov hlwv fibrillation.

Kev faib tawm ntawm cov tshuaj antiarrhythmic

Tag nrho cov tshuaj ntawm pawg neeg no tau muab faib ua plaub chav kawm. Tsis tas li ntawd, thawj chav kawm yog muab faib ua peb pawg. Qhov kev faib tawm no yog nyob ntawm seb cov tshuaj muaj txiaj ntsig zoo li cas ntawm lub peev xwm ntawm lub plawv hlwb kom tsim thiab ua hluav taws xob. Qee hom tshuaj antiarrhythmic tau muaj lawv txoj kev ua haujlwm, yog li ntawd rau ntau hom arrhythmia lawv cov kev ua haujlwm yuav txawv.

Thawj chav kawm muaj xws li blockers ntawm cov kev cai yoo mov sodium. Subclass IA muaj cov tshuaj xws li "Quinidine", "Dizopiramid", "Novokainamid", "Giluritmal." Tus khoos kas IB muaj xws li "Pyromecain", "Tokainid", "Diphenin", "Lidocaine", "Aprindin", "Trimekain", "Mexiletin". Subclass IC daim ntawv txhais tau hais tias "Etmozin", "Ritmonorm" ("Propafenon"), "Allapinin", "Etatsizin", "Flekainid", "Indecainid", "Bonnecor", "Lorcainid".

Cov chav kawm thib ob muaj beta-blockers (Metoprolol, Nadolol, Alprenolol, Kordanum, Propranolol, Acebutalol, Pindolol, Trazicore, Esmolol).

Chav kawm thib peb muaj cov kua qaub ntaws ntawm cov kab mob: Brethilia tosilate, Amiodarone, Sotalol.

Cov chav kawm plaub muaj xws li blockers hauv cov qev calcium uas qeeb (piv txwv, "Verapamil").

Daim ntawv ntawm cov tshuaj antiarrhythmic tsis xaus rau. Muab kuj mob glycosides, poov tshuaj tshuaj dawb, sodium triphosphate, magnesium sulfate.

Thawj Phaj Tshuaj

Cov neeg lim dej ntawm cov kab khiav ceev ceev nres qhov nkag mus rau hauv cov kua qaub hlwb, uas ua rau kom qeeb ntawm qhov kev sibtham hla raws lub myocardium. Vim qhov no, cov mob rau kev ua ntu zus nyob rau hauv plawv ntawm cov ntsig txog qeeb pathological yog txiav, thiab cov arrhythmia yog tshem tawm. Cia peb xav txog qhov tseeb cov pab pawg ntawm cov tshuaj antiarrhythmic uas yog mus rau thawj chav kawm.

Hoob I Cov Tshuaj

Antiarrhythmic tshuaj xws tsa ntawm extrasystole (ventricular thiab supraventricular) thiab los ntswg atherosclerosis nyob rau hauv cov ntaub ntawv ntawm atrial fibrillation (atrial fibrillation). Tsis tas li ntawd, lawv raug siv los tiv thaiv kom rov qab mob dua.

Novokainamid thiab Quinidine yog cov tshuaj tiv thaiv zoo heev nrog tachycardia. Cia tham txog lawv nyob hauv ntau yam.

"Quinidine"

Cov tshuaj no yog siv nyob rau hauv cov ntaub ntawv ntawm paroxysmal supraventricular tachycardia, raws li zoo raws li nyob rau hauv paroxysms ntawm atrial fibrillation rau qhov ntswg atherosclerosis. Feem ntau, cov tshuaj no yog siv rau hauv daim ntawv ntawm cov ntsiav tshuaj.

Tshuaj lom nrog cov tshuaj antiarrhythmic tsawg kawg, tab sis thaum noj cov tshuaj quinidine, cov kev mob tshwm sim muaj peev xwm ua tau rau daim digestive teeb meem (ntuav, quav quav) thiab mob taub hau. Tsis tas li ntawd, kev siv cov tshuaj no ua rau txo qis platelet nyob rau hauv cov ntshav, qeeb ntawm kev kho mob hlwb, kev txo qis ntawm kev mob plawv hauv lub cev. Qhov phom sij tshaj plaws yog qhov kev loj hlob ntawm ib txoj hlab ntsha ntawm cov kab mob qis dua, uas yuav ua rau muaj kev puas tsuaj ntawm tus neeg mob. Tias yog vim li cas txoj kev kho "Quinidine" yuav tsum tau nqa tawm nkaus xwb nrog kev tswj ntawm lub tshuab electrocardiogram thiab nyob rau hauv kev saib xyuas ntawm ib tus kws kho mob tshwj xeeb.

Cov tshuaj no yog contraindicated rau intraventricular thiab atrioventricular blockade, intoxication nrog plawv glycosides, thrombocytopenia, arterial hypotension, plawv tsis ua hauj lwm, cev xeeb tub.

Novokainamid

Cov tshuaj no muaj cov cim qhia tib yam li "quinidine". Feem ntau nws tau hais rau lub hom phiaj ntawm kev ntes cov kab mob hauv atrial fibrillation. Nrog rau cov tshuaj Novocainamide uas tso dej kom ntws ntws, ua rau cov ntshav siab tuaj yeem ua rau cov ntshav siab tuaj yeem ua tau, thiab yog li ntawd, nws yuav tsum txhaj tshuaj kom qis qeeb zog li sai tau.

Cov kev mob tshwm sim muaj xws li xeev siab, ntuav, hloov ntshav hauv cov ntshav, kev mob ntawm cov leeg hlwb hauv daim ntawv ntawm kiv taub hau, mob taub hau, thaum tsis tshua muaj kev ntxhov siab. Yog tias cov tshuaj siv tsis tu ncua, lupus-like syndrome (serositis, mob caj dab, kub cev), kab mob microbial hauv qhov ncauj qhuav, nrog kev kho mob ntawm qhov txhab thiab cov leeg thiab cov pos hniav tuaj yeem tsim muaj. Tsis tas li ntawd, Novokainamid tuaj yeem ua rau muaj kev fab tshuaj tsis haum, qhov no, thawj tus cwj pwm yog qhov pom ntawm cov leeg tsis muaj zog nrog kev tswj ntawm tshuaj.

Nws yog txwv tsis pub siv tshuaj nrog atrioventricular blockade, hom mob ntawm lub raum thiab lub plawv tsis ua hauj lwm, kev kho siab rau ntshav siab thiab kev sib tsoo cardiogenic.

Chav Kawm IB

Xws li cov tshuaj muaj ib qho kev qaug zog rau ntawm qhov ntswg, atrioventricular hlwv thiab atrial, yog li ntawd yog cov siv tsis tau rau hauv cov ntaub ntawv supraventricular arrhythmia. Antiarrhythmic tshuaj yog kws kho rau extrasystole, paroxysmal tachycardia, uas yog, rau txoj kev kho ntawm cov kev kho siab atherosclerosis. Lawv kuj siv los kho arrhythmias, uas yog txhais los ntawm kev tshaj li ntawm kev mob plawv glycosides.

Daim ntawv teev cov tshuaj antiarrhythmic ntawm cov chav kawm no yog qhov tseem ceeb, tab sis feem ntau yog siv cov tshuaj "Lidocaine". Raws li txoj cai, nws yog siv cov kab mob hauv lub cev thaum muaj kev sib tshuam ua rau mob plawv, nrog rau kev mob rau lub cev.

"Lidocaine" muaj peev xwm cuam tshuam kev ua haujlwm ntawm lub paj hlwb, uas yog tshwm sim los ntawm kiv taub hau, kev sib ceg, teeb meem nrog kev hais lus thiab kev pom kev, thiab kev tsis meej ntawm kev xav. Yog tias koj nkag mus rau hauv cov tshuaj hauv ib lub loj loj, nws yog ib qhov ua tau kom qeeb tus plawv dhia, txo qis contractility. Tsis tas li ntawd, kev txhaum fab hnyav yog ua rau hauv Quincke txoj kev ntshaus, khaus khaus, khaus.

"Lidocaine" yog ib qho contraindicated nyob rau hauv cov ntaub ntawv ntawm atrioventricular blockade, tsis muaj zog syndrome ntawm qhov ntswg. Cov tshuaj no tsis tau sau rau ntawm qhov kev ua txhaum loj heev, vim qhov kev pheej hmoo ntawm atrial fibrillation nce.

Class IC

Cov tshuaj muaj feem rau hauv chav kawm no txuas mus rau kev kho mob, tshwj xeeb tshaj yog nyob rau hauv nws qhov System. Lawv tau hais cov khoom lag luam arrhythmogenic, yog li ntawm tam sim no lawv siv nyob rau hauv ib txoj kev txwv.

Ib daim ntawv teev cov tshuaj antiarrhythmic ntawm cov hoob kawm no tau muab los saum no, tab sis tsuas yog "Propafenone" ("Ritmonorm") yog siv. Nws tau sau tseg rau kev supraventrikular thiab cov hlab ntsha hauv plab, xws li ERW syndrome. Txij li thaum muaj kev phom sij ntawm arrhythmogenic, cov tshuaj yuav tsum raug siv los ntawm kev saib xyuas ntawm tus kws kho mob.

Ntxiv rau arrhythmias, cov tshuaj no tuaj yeem ua rau lub plawv tsis ua hauj lwm thiab ua rau lub plawv mob plawv. Ntawm cov kev mob tshwm sim tuaj yeem txheeb xyuas tau qhov pom ntawm nws lub cev ntawm lub qhov ncauj, xeev siab thiab ntuav. Tsis txhob tshem tej yam tsis zoo xws li kev pom tsis zoo, kev hloov hauv ntshav, kiv taub hau, kev nyuaj siab, kev nyuaj siab.

Beta-blockers

Thaum lub suab ntawm kev mob siab khov kho hauv lub cev, piv txwv, thaum muaj kev nyuab siab, mob ntshav siab, mob tsis zoo, qog nqaij hlav, ntau cov catecholamines tshwm nyob rau hauv cov ntshav, nrog rau cov adrenaline. Cov tshuaj no cuam tshuam rau cov beta-adrenoreceptors ntawm myocardium, uas ua rau hluav taws xob tsis muaj zog thiab qhov tshwm sim ntawm arrhythmias.

Beta-adrenoblockers tiv thaiv kom txhob ntev li ntawm kev kho mob ntawm lub cev thiab ua li tiv thaiv lub myocardium. Tsis tas li ntawd, lawv txo cov kev cia siab ntawm cov hlwb hauv txoj kev ua, uas ua rau qeeb ntawm lub plawv dhia.

Cov tshuaj ntawm cov chav kawm no yog siv los kho cov atrial flutter thiab atrial fibrillation, rau kev tiv thaiv thiab kev tua ntawm kev supraventricular arrhythmia. Tsis tas li ntawd, lawv pab txo kom txhob muaj sinus tachycardia.

Tsuas siv tshuaj antiarrhythmic tsawg hauv kev saib xyuas hauv atrial fibrillation, tshwj tsis yog rau cov neeg mob thaum pathology yog los ntawm qhov ntau heev hauv cov ntshav ntawm catecholamine.

Metaprolol thiab Anaprilin feem ntau siv los kho cov teebmeem hauv plawv. Cov tshuaj no muaj cov kev mob tshwm sim hauv kev ua kom tsis txhob poob siab, txo qhov kev mob plawv hauv lub cev, qhov tshwm sim ntawm qhov atrioventricular blockade. Cov tshuaj no tuaj yeem ua rau muaj mob pob txha thiab ua rau neeg plab hnyuv. Tsis tas li ntawd, yeeb tshuaj cuam tshuam rau lub paj hlwb, ua rau nkees nkees, kiv taub hau, kev nyuab siab, nco tsis zoo. Lawv kuj hloov cov lus nug nyob rau hauv qab haus huv thiab cov leeg, uas yog tshwm sim los ntawm qaug zog thiab tsis muaj zog.

Beta-adrenoblockers tsis raug tso cai rau kev mob plawv, kev mob ntsig txog ntshav, kab mob ntshav qab zib mob ntshav qab zib, mob ntsws ntsws bronchial. Tsis tas li ntawd contraindications yog atrioventricular blockade ntawm qib ob, sinus bradycardia.

Potassium channel blockers

Daim ntawv teev cov tshuaj antiarrhythmic nyob rau hauv pab pawg no suav nrog cov neeg ua haujlwm uas txo qis hluav taws xob hauv lub plawv hlwb thiab li thaiv cov kua qaub. Cov tshuaj uas nto moo tshaj plaws ntawm hoob no yog Amiodarone (Cordarone). Ntawm lwm yam, nws cuam tshuam rau M-cholino- thiab adrenergic receptors.

"Cordarone" yog siv los kho thiab tiv thaiv cov hlab ntsha hauv plab, cov caj dab thiab supraventricular arrhythmias, lub plawv atherosclerosis tsis zoo rau cov keeb kwm ntawm ERW syndrome. Cov tshuaj no kuj tseem muaj kev tiv thaiv kom tsis txhob muaj qhov ua rau neeg mob hnyav hauv cov neeg mob uas muaj tus kab mob siab. Tsis tas li ntawd, nws yog siv los txo cov plawv dhia nrog qhov kev ua kom tsis muaj mob atrial fibrillation.

Yog hais tias koj siv lub cuab tam rau ib ntev lub sij hawm tej zaum yuav tsim interstitial ntsws fibrosis, kev hloov ntawm daim tawv nqaij xim (cov tsos ntawm ib cov ntshav Hawj txawm). Qee zaum, muaj mob taub hau, pw tsaug zog, nco, tsis pom kev. Kev txais tos ntawm Amiodarone tuaj yeem ua rau tus kab mob bradycardia, cem quav, xeev siab thiab ntuav.

Tsis txhob muab tshuaj rau thawj zaug kho tus mob bradycardia, qhov ntev ntawm QT qis, kev kho mob hauv hlwb tawg, thyroid kab mob, ntshav siab, kev mob ntsws, mob ntsws ntsws bronchial.

Blockers ntawm qeeb calcium raws

Cov tshuaj no thaiv cov qeeb qeeb ntawm cov poov hlau, yog li ua rau cov pob txha ectopic foci nyob hauv lub atria thiab txo cov automatism ntawm qhov ntswg. Daim ntawv teev cov tshuaj antiarrhythmic ntawm cov pab pawg no muaj xws li "Verapamil", uas tau sau tseg rau kev tiv thaiv thiab kev tswj ntawm cov tshuaj tiv thaiv ntawm supraventricular tachycardia, rau kev kho mob supraventrricular extrasstole. "Verapamil" tsis ua haujlwm yog thaum muaj teeb meem ntawm qhov ntswg.

Sab los muaj xws li atrioventricular thaiv, qhov ntswg bradycardia, hypotension, thiab nyob rau hauv tej rooj plaub - txo lub contractile muaj peev xwm ntawm lub plawv.

Kev mob glycosides

Kev faib tawm ntawm cov tshuaj antiarrhythmic yuav tsis ua tiav tsis hais txog cov nyiaj no. Cov no suav cov tshuaj xws li Celanide, Korglikon, Digitoxin, Digoxin, thiab lwm tus, lawv siv los kho qhov ntswg atherosclerosis, supraventricular tachycardias, txo cov zaus ntawm cov hlab ntsha hauv atrial fibrillation. Thaum siv cov tshuaj glycosides, koj yuav tau saib xyuas koj tus mob. Cov tsos mob ntawm kev quav yeeb quav tshuaj yog ua rau mob plab, xeev siab thiab ntuav, mob taub hau, ua kom pom kev thiab pw tsis tsaug zog, nosebleeds.

Nws yog txwv tsis pub siv cov tshuaj antiarrhythmic no rau bradycardia, VPW syndrome, intracardiac blockades. Lawv tsis tau sau rau hauv qhov teeb meem ntawm paroxysmal ventricular tachycardia.

Ua ke ntawm cov tshuaj antiarrhythmic

Nyob rau hauv ectopic rhythms, ib co kev sib txuas ntawm cov tshuaj yog siv nyob rau hauv kev kho mob xyaum. Yog li, "Quinidine" yuav siv tau nrog cov mob plawv glycosides los kho cov tshuaj tsis haum xeeb. Nrog beta-blockers, "Quinidine" tuaj yeem muab kho kom tsis txhob mob plab hlaub, uas yog tsis txaus ntseeg rau lwm txoj kev kho mob. Kev siv cov beta-blockers thiab kev mob plawv glycosides ua rau muaj kev ntxim ntxub rau cov hlab ntses thiab supraventricular extrasstoles, thiab tseem tiv thaiv kev mob hawb pob tachyarrhythmias thiab ectopic tachycardias.