I-algorithm yokunakekelwa okuphuthumayo yesifo se-hypertensive

Inkambo ye-hypertension ye-arterial ngokuhamba kwesikhathi ingafakwa yinkimbinkimbi yenkinga ye-hypertgency - ukukhuphuka okungalindelekile kokucindezela kwe-systolic kanye / noma kwe-diastolic kusuka kokukhuphuka noma okukhuphukile. Inkinga ihlala ihambisana nokuqalwa noma ukuqina kwezimpawu ezivela ezithweni ezihlosiwe (inhliziyo, izinso, ubuchopho).

Izinkomba zomfutho wegazi wale nkimbinkimbi zingezomuntu ngamunye - kwi-hypotension inkinga ingaba yi-130/90, kanti esigulini esine-hypertension kwingcindezi yokusebenza kwe-150/90, i-180-200 / 100 iba yinkinga.

Izinkinga ziyahlukahluka ngenxa yokuvela kwezinkinga, futhi zihlukaniswe zaba yinkimbinkimbi futhi azinzima.

Izinkinga zingaba yilezo zimo:

• ohlangothini lobuchopho - ingozi ye-cerebrovascular - stroke, ukuhlaselwa kwesikhashana kwe-ischemic;
• ukushaya kwenhliziyo - ukushaya kwenhliziyo, ukwehluleka okukhulu kwesobunxele be-ventricular (pulmonary edema), i-paroxysmal tachycardia, i-ventricular extrasystole;
• izinso - ukwehluleka kwezinso; imikhumbi - i-aneurysm ye-aortic.

Uhlobo lwesibili luhlukaniswe:

1. Inkinga ye-Cerebral.
2. Izinkinga ze-Hypothalamic noma zezitshalo.
3. Inkinga yenhliziyo.

Ngaphezu kwalokho, lokhu kufaka phakathi ukukhuphuka okukhulu kwengcindezi esikhathini ngemuva kokuhlinzwa kanye nokwenyuka okungafaniyo kokucindezela kwegazi kwe-systolic kuya kumamilimitha angama-250 we-zebaki noma i-diastolic kuya kumamilimitha angama-150.

Ngokwamagama, inkambo yezinkinga ihlukaniswe ngamafomu - ama-neurovegetative, edematous futhi aqinisekisayo.

Izimbangela nezimpawu ze-HA

Kumele kuqashelwe ukuthi kubantu abaningi i-hypertension yi-asymptomatic, futhi inkinga kungaba ukubonakaliswa kwayo kokuqala.

Ezimweni ezinjalo, ukutholwa okusheshayo kwengxaki nokwelashwa ngokushesha kubaluleke kakhulu.

Isizathu sokuqala futhi esivame ukuba isizathu esiyinhloko ukuphathwa ngokungafanele noma okungalungile - ukuqedwa okubukhali kwezidakamizwa ze-antihypertensive, umuthi ongafanele esigulini noma kumthamo wakhe.

Kukhona nezinye izizathu:

• Ukuzivocavoca okukhulu komzimba, ezemidlalo.
• Ukuqina ngokweqile kwemizwelo, ukucindezela okukhulu.
• Ukuya esikhathini kubantu besifazane.
• Izimo zesimo sezulu.
• Ukuphuza utshwala obuningi noma ukweqa isidlo.

Ukuxilongwa okufika ngesikhathi kwezinhlekelele, kubalulekile ukuba ungabhekiseli ezingeni lokucindezela, kepha izikhalazo nezimpawu ezivelayo. Azidingi ukwaziwa hhayi kodokotela kuphela, kodwa kuwo wonke umuntu onomfutho wegazi ophakeme noma wegazi ophakeme othandekayo.

Izimpawu zezinkinga ezinkulu kakhulu:

1. I-Tachycardia - ukwanda kwesilinganiso senhliziyo esingaphezu kwama-90 ngomzuzu.
2. Ikhanda elibukhali, i-tinnitus, isiyezi, ukuqunjelwa.
3. Umuzwa wokushisa, ukujuluka, ubomvu bobuso nentamo.
4. I-Angina pectoris - Ubuhlungu emuva kwe-sternum yesimo esicindezelayo nesicindezelayo.
5. Ukulimazeka okubukwayo - Izimpukane eziqhakaza phambi kwamehlo, ukulahleka kwezindawo ezibukwayo.
6. Umlomo owomile, isicanucanu, ukuhlanza.
7. Ubunzima bokuphefumula, ukufushane komoya.
8. Izimpawu ze-Neurological - Ukuqhaqhazela kwesandla, ukukhuluma nokukhubazeka, ukudideka, ukozela, ukulahleka kwekhono lokuzula eskhathini nangesikhathi.
9. I-Epistaxis.

Indlela ye-neurovegetative yenkinga ivame ukwenzeka ngemuva kokugcwala okukhulu ngokomzwelo, ukucindezela. Ezigulini ezinjalo, i-adrenaline kanye nabanye abalamuli bembumbulu badedelwa egazini, okukhombisa ukwanda kwengcindezi, i-tachycardia, ukwethuka komzimba, umlomo owomile nokukhathazeka. Esikhathini esiningi, lolu hlobo alubeki ingozi empilweni futhi luphela ngemuva kwamahora angu-1 - 5 nge-polyuria enomchamo okhanyayo, ukoma nokudonsa.

Ukwelashwa okungcono kakhulu kulezi ziguli ukulala kahle nezidakamizwa eziqeda amakhambi.

Izimbangela zokuphazamiseka

Ifomu le-Edematous livela kakhulu kubantu abanokweqile kanye nomfutho wegazi ophezulu. Izimbangela zalesi simo ukusebenza okungekuhle kohlelo lwe-renin - angiotensin - aldosterone. Ngenxa yalokhu, ukuhlunga nokubuyiselwa komchamo ezinso kuwohloka, umthamo wegazi elijikelezayo uyanda, kanti ibhalansi kasawoti wamanzi iyaphazamiseka. Iziguli ziphuzi, zinokuvuvukala noma ukuqina kwezinyawo, imilenze, izandla. Inhlekelele ingadlulisela i-arrhythmias, ubuthakathaka bemisipha, i-oliguria. I-prognosis yosizo lokuqala olunikezwe ngokwanele futhi ukwelashwa kuyinto enhle.

Okuyingozi kakhulu kukho konke kuyinkinga ethokomelekayo, ngoba kungenzeka ukuthi ihlanganiswe yinkimbinkimbi yokushaywa yi-stroke, i-hemorrhage ebuchosheni, i-ventricular cavity noma i-subarachnoid, i-edema yamakhemikhali, i-paresis noma ukukhubazeka kwemikhawulo. Isikhathi - kusuka emahoreni ambalwa kuya ezinsukwini ezi-3. Ukunakekelwa okuphuthumayo kufanele kunikezwe ngokushesha futhi ngokugcwele. Isikhathi sokuhlasela ngemuva kweziguli eziningi saziwa yi-amnesia enengxenye.

Noma ngabe unjani uhlobo lwenkinga, nezimpawu zemizwa ezinjengekhanda elibukhali elibukhali, ukuhlanza okungalethi impumuzo, ukukhuluma kabi, ukudideka, ukunyakaza okungenampilo, ukunakekelwa okuphuthumayo ngesimo sokwehla kwengcindezi kumele kunikezwe kungakapheli ihora ukusuka kokuqala kokuhlaselwa.

I-Diagnosis iyinhlanganisela yesithombe somtholampilo kanye nomfutho wegazi ophakeme. Izindlela ezingeziwe zokuhlola ziyisifiso senhliziyo namaphaphu, i-electrocardiography.

Kepha kufanele ukhumbule ukuthi isikhathi esincane sizosetshenziswa ekuxilongeni, okuthe kakhulu kuzohlala ekwelashweni.

Ungayinikeza kanjani usizo lokuqala nokwelashwa?

Usizo lwezokwelapha uma kwenzeka kuba nenkinga ye-hypertensive lunikezwa odokotela bezimo eziphuthumayo zama-ambulensi, khona-ke ukunakekelwa okufanele kunikezwa odokotela bezenhliziyo ezibhedlela zesifunda nezezifunda.

Ukufika kodokotela kuzoqoqa ama-anamnesis alesi sifo, ukukala umfutho wegazi nokushaya ngamandla, ukuthatha i-electrocardiogram bese uqhubeka nokuphathwa kwezidakamizwa ezinciphisa umfutho wegazi.

I-algorithm yokunakekelwa okuphuthumayo yesifo se-hypertensive ifaka ukunakekelwa kwangaphambi kwezokwelapha nokukhethekile. Esigabeni saphambi kokuba abezokwelapha, isiguli uqobo kanye nalabo abasondelene nabo bangazisiza.

Ungahlukanisa lezi zinyathelo zokwelashwa ngaphambi kokufika kwe-ambulensi noma udokotela:

• Shayela i-ambulensi, udokotela wakho noma uqale ukuthutha isiguli esibhedlela ngokwakho.
• Ukuqinisekisa isiguli, dala umoya othule, susa okucasulayo kwangaphandle.
• Kungcono ukuthi isiguli sihlale phansi bese sehlise imilenze yaso phansi, sokwembesa izembatho eziqinile.
• Vula amafasitela, ungene egumbini.
• Linganisa umfutho wegazi futhi, sebenzisa i-tonometer ukukala umfutho.
• Buza isiguli ngenkambo ye-hypertension, izidakamizwa ezithathiwe. Kuyadingeka ukuthola ukuthi umuntu ubuphuza utshwala, noma ngabe wayenokwethuka ngokomzwelo noma ukuzivocavoca okukhulu ngokomzimba. Lolu lwazi luzoba wusizo kodokotela ukuthola isifo kanye nokwelashwa.
• Nikeza isiguli imishanguzo yakhe ye-antihypertensive uma ingaliphuthi iphilisi ngesikhathi esifanele.
• Esikhundleni salokho, unganikeza izidakamizwa ezisebenza ngokushesha - i-Captopril, uCorffar, i-Pharmadipine, iNifedipine, ezisetshenziswa ngaphansi kolimi.
• Ukuhlisa umoya unganikeza izidakamizwa - valerian, mamawort.
• Nge-tachycardia ebalulekile, umphumela wokwelapha une-massage ye-carotid sinus. Inqubo yokuqanjwa kwalolu hlobo iqukethe ukugcoba indawo eseceleni kwentamo esifundeni sokudonsa umthambo we-carotid okwemizuzu engu-10-15. Esimweni lapho ukushaya kwenhliziyo kunganciphi, ukusetshenziswa kwemithi kuyadingeka.

Uma isiguli sinobuhlungu besifuba, ukufupheka ngaphambi kokufika kukadokotela, kuvunyelwe ukuthatha isibhebhe se-nitroglycerin ku-0,5 mg. Lo muthi ungcono kakhulu ekuvimbeleni infarction ye-myocardial.

Ngaphambi kokufika kwe-ambulensi, kuvunyelwe ukuthatha amaphilisi afinyelela kwayi-3 ngezikhathi zesigamu sehora nge-nitroglycerin ngaphansi kolimi. Qiniseka ukuthi ulungisa isikhathi sokuthatha umuthi.

Yini okufanele ikhunjulwe ngesikhathi sokwelashwa?

Omunye wemithetho eyinhloko yokwelashwa ukwehla kancane kwengcindezi, ngoba ukwelashwa okuqine kakhulu, ikakhulukazi kwasebegugile, kungaholela ekwephulweni kokuhlinzekelwa kwegazi ezithweni zezitho zomzimba.

Ngakho-ke, umkhawulo ofanelekile wehla ngamaphesenti angama-25 wezinga lokuqala lamahora angama-24 kuye kwangama-48.

Kwezinkinga ezingelula, ukwelashwa kuhlanganisa ukusetshenziswa komjovo we-intravenous kanye nokuphathwa kwezidakamizwa ngomlomo, okuyinkimbinkimbi - ukuphathwa kwe-intravenous kuphela.

Le mithi elandelayo isetshenziselwa ukwelapha ubunzima:

1. I-Lasix noma i-Furosemide iyi-diuretic, isetshenziswa ngokungenamsoco ukunciphisa inani lokujikeleza kwegazi nokunciphisa ingcindezi.
2. I-Nifedipine noma i-Captopril nayo iyabhalwa, inikezwe izidakamizwa ezaziphuzwe ngaphambili.
3. Ungaphinda ukuphinda kwethulwe i-Nitroglycerin ngomzimba ngenkathi ugcina izinhlungu ezibuyela emuva.

Kusetshenziswe nezidakamizwa ezifana neMagnesium sulfate, Dibazole, Papaverine, Eufillin.

Ngobuhlungu obukhulu, iDroperidol, iNitroxoline nayo ingasetshenziswa. Ngokukhula kwesifo sokukhohlisa, kungakuhle ukwethula i-Seduxen, Magnesium sulfate. I-tachycardia ebalulekile ingamiswa nge-beta - blockers, isibonelo, Propranolol, Atenolol.

Ukwelashwa kwenkinga eyinkimbinkimbi kuya ngohlobo lwenkimbinkimbi. Nge-hypertensive encephalopathy, i-sodium nitroprusside, i-labetalol, i-nimodipine iyabhalwa. Ngokuthuthukiswa kwesifo sohlangothi, ukusetshenziswa kweNimodipine, i-Enalaprilat, i-sodium nitroprusside kuyaphoqelelwa.

Ngemuva kokususa izimpawu nokuqinisa isimo sesiguli, ukwelashwa kufanele kuqhubeke ekhaya. Ukwelashwa okuqhubekayo komfutho wegazi ophakeme kuyadingeka ukuvimbela izingqinamba ezizayo. Izindlela zokwelapha:

• ukuguqulwa kwendlela yokuphila - ukuyeka ukubhema, ukusetshenziswa kabi kotshwala;
• Ukudla - ngaphandle kwamafutha, okuthosiwe, ukudla okunosawoti, okuthandayo ngezithelo, imifino, okusanhlamvu.

Okubaluleke ngokulinganisela ukuzivocavoca okulinganiselayo okulinganiselwe.

Ukwelashwa kwezidakamizwa kuyakhonjiswa. Ama-inhibitors e-ACE, ama-blockers wesiteshi se-calcium, ama-beta blockers nama-angiotensin receptor antagonists asetshenziswa kakhulu. Ama-diuretics kwesinye isikhathi anqunyelwa isifo sikashukela sohlobo 2, kepha le mishanguzo ingadala ukuthi kube noshukela egazini.

Ungayinikeza kanjani usizo lokuqala lesimo se-hypertgency echazwe kuvidiyo kule ngxenye.