Lethathamo la lithethefatsi antiarrhythmic le tlhophiso bona

Hoo e ka bang bakuli bohle ba nang le phihlelo tsela cardiologist kapa e mong le mefuta e fapaneng ya arrhythmias. Jwale, indasteri ea meriana e fana ka tse ngata tse mahlahana antiarrhythmic. tlhophiso bona le lintho tse khethollang tšohliloeng sehloohong sena.

tsela ea ho pepesehela

Ho rarolla ectopic arrhythmias cardiac, mahlahana antiarrhythmic abetsoe. The mochine ea nkang khato ea lithethefatsi tse joalo o ikemiseditse ho sebetsa myocardial electrophysiological thepa ea lisele:

• Fokotsa lebelo la monyetla oa ho nka khato, ka tsela eo slowing conduction ba nyakallo.
• The fokotseha ka excitability tsa myocardium ena.
• Fokotsa nako eo ba refractory mong ka bona, ho fellang ka khutsufatsa ba karohano, ha e tšusumetso e tsoang ho sa tloaelehang ka mo lakalisa cardiac honyele.
• Elongation e atlehang refractory nako, e leng bohlokoa ha tachycardias le bakeng sa ho felisa linaoa tseo etsahala ka mor'a nako e fokolang haholo ka mor'a phokotsong Optimum.
• sekhahla bokgoni ba nyakallo bo khothalletsang homogenization le thibela ketsahalo ya botjha kena ( «botjha ho kena").
• Thibelo ea ectopic automatism kamoreng eo e amana le karolo ea nako ea depolarization diastolic.
• Ho felisa ho se tšoane ka tekanyo ea nyakallo le litsupa refractivity.
• Fokotswa cardiac nahanela ho tebelwa motlakase le kotsing ea ho fibrillation ventricular.

Classification ea lithethefatsi antiarrhythmic

le meriana eohle ea ka sehlopha sena li arotsoe ka litlelase tse 'nè. Ho phaella moo, sehlopha sa pele e arotsoe ho eketsehileng subclasses tse tharo. tlhophiso ena e thehiloe isa tekanyong ea e le hantle ea lithethefatsi ka bokhoni ba lisele tsa pelo ho phethahatsa tlhahiso le conduction ea ka matshwao a medumo tsa motlakase. litlelase e fapaneng ya lithethefatsi antiarrhythmic na litsela tsa bona tsa ho pepesehela, kahoo ka mefuta e fapaneng ya arrhythmias katleho ea bona e tla ba ba fapaneng.

Sehlopha sa pele se akarelletsa ho itima lijo sodium le kanaleng blockers. IA sehlopha sa akarelletsa ho lithethefatsi tse kang "quinidine" "Dizopiramid", "novokainamid", "Giluritmal". Ke IB sehlotshwana koahela "Piromekain", "tocainide", "Difenin" "Lidocaine", "aprindine", "Trimekain", "Mexiletine." Sehlotshwana edy eaba ba etsa lisebelisoa tse kang "Etmozin", "Ritmonorm" ( "Propafenone"), "VFS" "Etatsizin", "Flecainide", "Indekainid", "Bonnekor", "Lorkainid".

Sehlopha sa bobeli e na le beta-blockers ( "metoprolol", "nadolol," "alprenolol," "Kordanum", "Propranolol", "acebutolol", "Pindolol", "Trazikor", "Esmolol").

Sehlopha sa boraro se akarelletsa potassium le kanaleng blockers "bretylium tosylate", "Amiodarone", "Sotalol".

Sehlopha sa bone se akarelletsa blockers k'halsiamo le kanaleng lieha (mohlala, "Verapamil").

Lethathamo la lithethefatsi-ba khahlanong le arrhythmic ha fella moo. Tokisetso e nang le tsona glycosides cardiac, chloride potassium, sodium diphosphate, magnesium sulfate.

Meriana Class Pele

Sodium le kanaleng blockers pelehi ho itima lijo e ile a khaotsa ho ka seleng ea sodium, e bakang kholofalo ea temana ea myocardium nyakallo wavelength. Ka hona cropped maemo bakeng sa ajoa ka potlako e ka pelong ea ka matshwao a medumo pathological, le arrhythmia phehella. A re hlahlobeng sehlopha sa lithethefatsi antiarrhythmic bao e leng sehlopha sa pele.

Meriana Class IA

lithethefatsi Antiarrhythmic joalo e behiloeng ka extrasystole (ventricular le supraventricular) le ho tsosolosa sinus morethetho tabeng ea atrial fibrillation (atrial fibrillation). Ho phaella moo, ba li sebelisetsoa ho thibela litlhaselo tse iphetang.

"Procainamide" le "quinidine" - e atlehang antiarrhythmic lithethefatsi le tachycardia. Re tla u bolella haholoanyane ka tsona.

"Quinidine"

meriana ena e sebelisoa ka tabeng ea paroxysmal supraventricular tachycardia, hammoho le ka paroxysms tsa fibrillation atrial ho sinus morethetho. Hangata ka ho fetisisa, meriana tsamaisoa ka mokgwa wa matlapa.

Chefo lithethefatsi antiarrhythmic seoelo etsahala, empa ha ho amohela "Quinidine" litla khoneha lehlakoreng kang meferefere tshilong ya dijo (ho hlatsa, letshollo), 'me hlooho. Ho feta moo, ho sebelisa lithethefatsi le ea ka khonang ho etsa hore ea fokotseha ka maling platelet, intracardiac conduction slowing, fokotsa myocardial contractility. The kotsi ka ho fetisisa ditlamorao - ntshetsopele ya tachycardia ventricular, e leng mofuta o khethehileng, e leng ho ka etsa hore lefu la tšohanyetso la mokuli. Ke ka lebaka leo kalafo "quinidine" lokela ho ho phethahatsoa feela ka taolo ea ECG le tlas'a bookameli ba setsebi sa.

moriana o contraindicated ka intraventricular le atrioventricular le literata, cardiac glycoside botahoa, thrombocytopenia, hypotension, congestive ha pelo, ho ima.

"Procainamide"

lithethefatsi ena o na le matšoao a tšoanang le bakeng sa ho sebelisoa e le "quinidine". hangata e ba laela hore morero oa liphallelo esita le ka tsa paroxysmal atrial fibrillation. Ha intravenous ente "novokainamid" khoneha bohale ho fokotseha ha khatello ea mali e le hore ke ho hlokahala hore ho hlahisa tharollo ne butle palo e kahodimodimo.

Har'a litla-morao khetholla ho nyekoa ke pelo, ho hlatsa, liphetoho tse maling, mafu a ea tsamaiso ea methapo ea kutlo ka sebōpeho sa ho tsekela, hlooho e opang, maemong a sa tloaelehang, pherekano. Haeba ho sebelisoa ha ea kamehla ea lithethefatsi, a ka hlahisa lupus-joaloka lefu (serozity, ramatiki, feberu), tse sa bonahaleng tse tshwaetso ka cavity molomo, a tsamaea le ba le pholiso maqeba lieha le liso tsa ka maleng le ho tsoa mali marenene. Ho phaella moo, "novokainamid" ka qholotsa e itsoara joang alejiki, tabeng ena e tla ba letšoao la pele la ketsahalo e ea bofokoli mesifa ka taolo ea lithethefatsi.

Sebetsa meriana e thibetsoe ha atrioventricular le literata, matla renal le pelo ea hloleha, hypotension le cardiogenic makala.

IB sehlopha sa

lithethefatsi tse joalo na le phello e fokolang ho ea sinus noute, mabapi atrioventricular le atrium, kahoo thuso tabeng ea arrhythmias supraventricular. Khethiloeng ke ya data lithethefatsi antiarrhythmic le arrhythmia, paroxysmal tachycardia, ke hore,, bakeng sa kalafo ya arrhythmias ventricular. Ba ne ba boetse ba sebelisetsoa ho alafa arrhythmias, tse bakoa ke e overdose ea glycosides cardiac.

Lethathamo la lithethefatsi antiarrhythmic ka sehlopha sena ke a pharaletseng a haholo, empa ho bolela "lidocaine" le sebelisitsoe hangata ka ho fetisisa. Ka tloaelo ho, e laolwa entoe ka tabeng ea arrhythmias haholo ventricular ka sa t. H. Ka infarction myocardial.

"Lidocaine o" khona ho senya ea ka tšebetso ea tsamaiso ea methapo, e leng e bontšoa ho tsekela, sethoathoa, mathata a ka puo le Pono mafu a ea kelo-hloko. Ha re hlahisa lithethefatsi tekanyetso e phahameng, e ka fokotsa ho otla ha pelo, fokotseha cardiac contractility. Hape, kulisa ka etsahala ya ho theha angioedema, urticaria, pruritus.

"Lidocaine" e contraindicated ka le literata atrioventricular, kula sinus lefu. Meriana e sa ho bontšitsoe tabeng ea matla arrhythmias supraventricular ka lebaka la kotsi ya fibrillation atrial eketseha.

sehlopha sa edy

Lithethefatsi bao e leng sehlopha sa ena, eketsa intracardiac conduction, haholo-holo ka ea tsamaiso ea hae e-Purkinje. Ba na le matla arrhythmogenic thepa, kahoo hona joale ho sebelisa ha bona e lekanyelitsoe.

Lethathamo la lithethefatsi antiarrhythmic tsa sehlopha sena ho fanoeng ka lona holimo, empa ka kakaretso feela sebelisoa "Propafenone" ( "Ritmonorm"). E o ile a bontša ho arrhythmias supraventricular le ventricular, ka lefu H. Tlas'a SVC Vol.. Kaha ho na le kotsi ea ho ba le liphello arrhythmogenic, meriana e lokela ho sebelisoa ka tlas'a ngaka tlhokomelo.

Ho phaella ho arrhythmia, lithethefatsi ena ho ka etsa hore letotong la hloleha pelo le a ntseng a mpefala tsa contractility cardiac. Har'a lehlakoreng liphello e ka ba hlaheletseng ponahalo ea metallic tatso ka molomo, ho nyekoa ke pelo le ho hlatsa. Ho e sa thoko litla joalo mpe, tse kang Pono thothofatsang, liphetoho tse ka teko ea mali, ho tsekela, lefu la ho hlobaela, ho tepella maikutlo.

Beta-blockers

Ha eketsa molumo oa tsamaiso ea methapo le kutloelo-bohloko, ho etsa mohlala, tabeng ea ho imeloa kelellong, kgatelelo ya madi, mafu autonomic, ischemia, ka mali, ho na le ba bangata ba catecholamines, ho akarelletsa le adrenaline. dintho tsena sebetsa ka receptors beta-adrenergic tsa myocardium e isang cardiac se tsitse ha motlakase le ponahalo ea arrhythmias.

Beta-blockers thibela tlhotlheletso ka tsela e feteletseng ea receptors me ka tsela eo sireletsa myocardium. Ho phaella moo, ba fokotsa excitability tsa lisele tsa tsamaiso conduction, leng isang pelo morethetho lieha.

Meriana tsa sehlopha sena li sebediswa ea ho phekola ba flutter atrial le atrial fibrillation bakeng sa ho thibela le Setšoantšo sa arrhythmias supraventricular. Ho phaella moo, li thusa ho hlōla sinus tachycardia.

Nkoa lithethefatsi thuso antiarrhythmic bakeng fibrillation atrial, ntle la linyeoe moo bolwetse e bakoang ke e fetang e potoloha catecholamines.

"Metoprolol" le "Inderal" ba atisa ho sebediswa bakeng sa kalafo ya arrhythmias. lithethefatsi tsena li ka ba le liphello tse kang slowing ho otla ha pelo, fokotsa myocardial contractility, ponahalo atrioventricular le literata. meriana tsena se ka mo lakalisa lipheletsong batang le a ntseng a mpefala la phallo ea mali pheriferale. Ho phaella moo, lithethefatsi ama tsamaiso ea methapo, a etsa hore ho otsela, ho tsekela, ho tepella maikutlo, khopolong ea kholofalo. le bona ba fetoha ka conductivity ea methapo ea kutlo le mesifa, e leng e bontšoa ke mokhathala le bofokoli.

Beta-blockers ba thibetsoe ho tloha ho sebedisa ba makala cardiogenic, edema methapo, ka insulin e itšetlehileng ka lefu la tsoekere, le asma. Hape contraindications protrude atrioventricular le literata tsa lengolo la bobeli, sinus bradycardia.

blockers potassium le kanaleng

Lenane la lithethefatsi antiarrhythmic sehlopheng sena ke mokhoa oa retarding dithulaganyo motlakase me ka tsela eo thibela metjha e potassium liseleng cardiac. Ka ho fetisisa tummeng tsa sehlopha sena sa meriana - "Amiodarone" ( "Kordaron"). Har'a lintho tse ling, ho nka khato ka receptors M-holino- le adrenergic.

"Kordaron" e sebediswa bakeng sa kalafo le thibelo ea ventricular, atrial le arrhythmias supraventricular, pelo ea morethetho meferefere ka semelo sa lefu SVC. moriana o ka o boetse o laolwa e le hore ho thibela ho beha bophelo kotsing ventricular arrhythmias ka bakuli ba myocardial hlobaetsang. Ho phaella moo, e sebediswa ho fokotsa lebelo leo pelo ka kamehla atrial fibrillation.

Haeba u sebelisa sesebelisoa ka nako e telele ka 'na ba interstitial matšoafo fibrosis, phetoho ea' mala oa letlalo (ponahalo ea ka 'mala o pherese). Maemong a mang, ho tšoaroa ke hlooho, robala maloetse, karete ya memori le Pono. Baeti ba fihlelang ho "Amiodarone" e ka ba sesosa sa sinus bradycardia, pipitlelano, ho nyekoa ke pelo le ho hlatsa.

U se ke ua laela meriana a sa le bradycardia lekhetlo la pele, QT prolongation, tlōlo ea conduction intracardiac, lefu thyroid, ea bohlokoa hypotension, ho ima, le asma.

K'halsiamo le kanaleng blockers lieha

lithethefatsi tsena li ka etsa loko lieha k'halsiamo jwale, ka tsela eo hatella ea foci ectopic ka atria le decreases sinus noute automaticity. Lenane la lithethefatsi antiarrhythmic sehlopheng sena akarelletsa "Verapamil," e leng se ka abeloa ho thibela le phomolo ea paroxysmal supraventricular tachycardia, supraventricular arrhythmia phekolo. "Verapamil" ke thuso tabeng ea arrhythmias ventricular.

litla-morao kenyeletsa atrioventricular le literata, sinus bradycardia, hypotension, le maemong a mang - ho fokotsa contractile bokhoni ba pelo.

glycosides cardiac

Classification ea lithethefatsi antiarrhythmic ne e ke ke ka ho feletseng ntle le bua ka chelete ena. Tsena li akarelletsa lithethefatsi tse kang "Tselanid", "Korglikon", "Digitoxin", "Digoxin" le ba bang. Ba ne ba li sebelisetsoa ho tsosolosa sinus morethetho, supraventricular tachycardia, phokotso ea sekhahla ventricular tabeng ea fibrillation atrial. Ha u sebelisa glycosides cardiac lokela ho hlokomela boemo ba hao. Lipontšo tsa digitalis botahoa o talima ka eona mpeng bohloko, ho nyekoa ke pelo le ho hlatsa, ho tšoaroa ke hlooho, ho se bone thothofatsang le toro, tsoa mali ho tswa ho nko.

E thibetsoe ho sebelisa lithethefatsi tsena li ka antiarrhythmic nakong bradycardia lefu ERW intracardiac thibela likepe. Ha ba ha khethoa ha tachycardia paroxysmal ventricular.

motswako antiarrhythmics

Ha re utloa morethetho ectopic ikatisetsa tlelenike, ba bang ba motsoako oa lithethefatsi sebediswa. Kahoo, "Quinidine" e ka sebediswa hammoho le glycosides cardiac ho phekola phehellang arrhythmia. Le beta-blockers "quinidine" ka abeloa ho ea liphallelo e ba arrhythmias ventricular refractory ho mekhoa ea phekolo e tse ling. Tshebediso a ikopantseng a beta-blockers le glycosides cardiac fana le phello e ntle ka ventricular le arrhythmias supraventricular, hammoho le thusa ho thibela ho boipheto tsa tachycardia ectopic le tachyarrhythmia.