Kuphatikizidwa koopsya kwambiri kwa matenda a atrial ndi stroke . Mu mafinya a atrial, atria ya mtima sagunda bwino, zomwe zimalola kuti magazi "asunge" mkati mwa zipindazi.
Zotsatira zake, ndi thrombus yodwala (magazi clot). Potsirizira pake, thrombus yodwalayo ikhoza kumangiriza-ndiko kuti, ikhoza kumasuka ndikuyenda kupyola mitsempha.
Nthawi zambiri, izi zimakhala mu ubongo, ndipo zotsatira zake ndi stroke.
Choncho ngati muli ndi matenda a atrial, dokotala wanu ayenera kulingalira za chiopsezo chanu chowopsya, ndipo ngati chiopsezocho chiri chokwanira, muyenera kuikidwa kuchipatala kuti mupewe magazi kuti asapangidwe, ndipo motero, kuteteza kudwala.
Kuwona Ngozi Yanu
Kuwonetsa chiopsezo chanu chowopsa ngati muli ndi matenda a atrial amafunika kulingalira za msinkhu wanu, kugonana, ndi matenda ena omwe mungakhale nawo. Choyamba, ngati muli ndi matenda a mtima otchedwa valvular, kuphatikizapo matenda opatsirana pogonana, mufunikira chithandizo kuti muteteze magazi, popeza kuti chiwopsezo chanu chapwetekedwa kwambiri.
Ngati mulibe matenda a valve mtima, dokotala wanu angagwiritse ntchito chiwerengero choopsa, chotchedwa chiwerengero cha CHA2DS2-VASc, kuti muone ngati muli ndi vuto lopweteka. Kwa anthu okhala ndi atrial fibrillation, kukwera kwa chiwerengero cha CHA2DS2-VASc, kumakhala koopsa kwambiri.
Mapepala a CHA2DS2-VASc mabala kuchokera ku zero kufika pazinthu zisanu ndi zinayi ndipo amawerengedwa motere:
- Kusweka mtima kwa mtima = gawo limodzi
- Kuthamanga kwa magazi = chinthu chimodzi
- Zaka 75 kapena kuposa = zigawo ziwiri
- Shuga = chinthu chimodzi
- Pambuyo pa kupweteka kapena TIA = mfundo ziwiri
- Mtheradi wamatenda matenda = mfundo imodzi
- Zaka pakati pa 64 ndi 74 = mfundo imodzi
- Kugonana kwachikazi = mfundo imodzi
Pamwamba pa chiwerengero cha CHA2DS2-VASc, chiopsezo cha pachaka cha kupwetekedwa. Choncho, ngati malipiro anu ali ndi zero, chiopsezo chanu cha kupwetekedwa ndi 0.2 peresenti pa chaka, chomwe chiri chochepa. Ngati malipiro anu ali awiri, chiwopsezo chaka ndi chaka ndi 2.2 peresenti, ndipo chikukwera mofulumira kuchokera pamenepo. Mapira asanu ndi anayi amachititsa ngozi ya pachaka ya 12.2 peresenti. (Poyerekeza, kwa anthu 100 aliwonse oposa zaka 65 osakhala ndi mafilimu a atrial, pafupifupi chaka chimodzi adzakhala ndi stroke.)
Kuchepetsa Mliri wa Stroke
Kugwiritsiridwa ntchito kwa mankhwala a antiticoagulant kungachepetse kwambiri chiopsezo kuti chiwalo chochokera kumanzere a atrium chidzachititsa kuti munthu asagwidwe ndi matenda odwala matenda a atrial fibrillation. Komabe, mankhwalawa amakhala ndi chiopsezo chotulutsa kachilombo koyambitsa magazi, kuphatikizapo kupwetekedwa kwa magazi (ubongo mu ubongo). Akuti chiĊµerengero cha pachaka cha matenda omwe amayamba chifukwa cha anticoagulants ndi 0,4 peresenti.
Izi zikutanthawuza kuti kugwiritsa ntchito mankhwala osokoneza bongo kumakhala kosavuta ngati chiopsezo cha kudwala matenda opatsirana pogonana ndi chachikulu kwambiri kusiyana ndi chiopsezo cha kugwidwa ndi mankhwala. Madokotala amavomereza, makamaka, kuti odwala omwe ali ndi matenda osokoneza bongo omwe alibe chidziwitso cha CHA2DS2-VASc ndi zero, zisagwiritsidwe ntchito. Kwa maola awiri kapena apamwamba, mankhwala a antiticoagulant ayenera nthawizonse kugwiritsidwa ntchito.
Ndipo chifukwa cha zambiri, chithandizo chiyenera kukhala payekhapayekha kwa wodwala aliyense.
M'mbuyomu, madokotala amaganiza kuti ngati atagwiritsa ntchito " rhythm control therapy " chifukwa cha matenda a atrial fibrillation (ndiko kuti, chithandizo chofuna kupha tizilombo toyambitsa matenda komanso kukhala ndi mtima wamba), chiopsezo chotenga sitiroko chidzagwa. Komabe, umboni wamakono mpaka pano walephereka kusonyeza kuti maseĊµera olimbitsa thupi amachepetsa chiopsezo cha kupwetekedwa. Choncho ngakhale inu ndi dokotala wanu mutapatsidwa chithandizo chamagetsi, muyenera kuchiritsidwa kuti musatengere sitiroko ngati mpikisano wa CHA2DS2-VASc uli wokwanira.
Kodi Ndi Mankhwala Otani Oyenera Kugwiritsa Ntchito?
Mankhwala omwe ali othandiza kuchepetsa chiopsezo cha kukwapulidwa mu matenda opatsirana pogonana ndi mankhwala a antiticoagulant.
Izi ndizo mankhwala omwe amaletsa kuti magazi asamangidwe, ndipo amalepheretsa mapangidwe a magazi. Odwala omwe ali ndi matenda a atrial, amagwiritsira ntchito mankhwalawa kuti achepetse chiwopsezo chachikulu.
Mpaka zaka zingapo zapitazo, mankhwala okhaokha omwe amapezeka pamtunduwu anali warfarin ( Coumadin ), mankhwala omwe amaletsa vitamini K. (Vitamini K ndizofunikira kupanga zinthu zambiri zotchinga.) Kutenga Coumadin kumakhala kovuta ndipo nthawi zambiri zovuta, komabe. Nthawi zambiri kawirikawiri amayesedwa magazi kuti azindikire "kuchepa" kwa magazi ndikusintha mlingo wa Coumadin. Komanso, zakudya zoyenera kudya zimafunika chifukwa zakudya zambiri zimatha kusintha Coumadin. Ngati mlingo sungasinthidwe bwino kapena kawirikawiri, magazi akhoza kukhala "oonda kwambiri" kapena osaonda kwambiri, ndipo mwina akhoza kubweretsa mavuto aakulu.
M'zaka zingapo zapitazo, mankhwala ena atsopano omwe amachititsa kuti asatengere mavitamini K, koma m'malo mwake amaletsa zinthu zina. Izi zimatchedwa "buku lachilendo la antiticoagulant", kapena NOACs. NOACs omwe amavomerezedwa ku US tsopano ndi dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), ndi edoxaban (Savaysa).
Mankhwala awa onse ali ndi ubwino pa Coumadin. Amagwiritsira ntchito mlingo wa tsiku ndi tsiku, kotero kufunika koyezetsa magazi nthawi zambiri ndi kusintha kwazitsulo kumachotsedwa. Sichifuna zakudya zina. Ndipo kafukufuku wamaphunziro awonetsa kuti mankhwala atsopanowa ndi othandiza komanso otetezeka monga Coumadin.
Pali zovuta zina kwa NOACs, komabe. Iwo ndi okwera mtengo kwambiri kuposa Coumadin, ndipo mosiyana ndi Coumadin (zomwe zingasinthidwe mofulumira mwa kupereka vitamini K) zimakhala zovuta kubwezeretsa zotsatira zawo za antiticoagulant ngati vuto lalikulu lokha magazi liyenera kuchitika. (Kupatulapo komweko ndi Pradaxa, mankhwala otsutsana ndi mankhwalawa adavomerezedwa mu October 2015.)
Akatswiri ambiri tsopano amakonda kugwiritsa ntchito mankhwala osokoneza bongo a NOAC pa Coumadin odwala omwe ali ndi matenda a atrial fibrillation. Komabe, pali anthu omwe Coumadin akadali njira yosankhika. Coumadin ndibwino kusankha ngati mutenga Coumadin kale ndipo mwakhala mukulimba kwambiri pa mankhwalawa kapena ngati simufuna kumwa mapiritsi kawiri pa tsiku (zomwe zimafunika Pradaxa ndi Eliquis) kapena ngati simungakwanitse kupeza ndalama zamakono za mankhwala atsopano.
Mankhwala Njira
Chifukwa cha mavuto omwe amabwera chifukwa chogwiritsa ntchito mankhwala osokoneza bongo, amayesetsa kuti apange chithandizo chamankhwala pofuna kupewa matenda opatsirana pogwiritsa ntchito mankhwala opatsirana pogonana. Njirazi zakhala zikuthandizira kudzipatula kwachisawawa (a "thumba" la atrium lakumanzere lomwe latsala pa kukula kwa fetus). Zikuoneka kuti ma clot ambiri omwe amapanga kumanzere kumanzere kumatenda am'thupi amapezeka pamagazi a atrial.
Mankhwala operekera kumanzere amatha kupezeka pazogwiritsidwa ntchito pogwiritsira ntchito njira zopangira opaleshoni kapena poika chipangizo chapadera m'kati mwa catheter. Pamene amagwiritsa ntchito kuchipatala, njira zonsezi zimakhala ndi zovuta zazikuru, ndipo pakadali pano zimasungidwa ndi milandu yapadera.
Chidule
Sitiroko ndi yoopsya kwambiri, ndipo mwatsoka, yofala kwambiri, yokhudzana ndi matenda oopsa. Choncho kuchepetsa chiopsezo cha matenda a sitiroko ndi chinthu chomwe inu ndi dokotala muyenera kuchiganizira kwambiri. Mwamwayi, ngati inu ndi dokotala wanu mukuyandikira vutoli moyenera-kulingalira za chiopsezo chanu ndi kuchiza moyenera-zovuta zanu kuti muteteze nkhaniyi zidzasintha kwambiri.
Zotsatira:
Fuster, V, Ryden, LE, Cannom, DS, et al. ACC / AHA / ESC 2006 Malangizo Othandizira Odwala Odwala Matenda Aakulu Padziko Lonse Lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines ndi European Society ya Komiti Yokonza Maphunziro Otsogolera (Komiti Yolemba Kubwereza Malangizo a 2001 kwa Utsogoleri wa Odwala Amene Ali ndi Nthenda Yamatenda). J Am Coll Cardiol 2006; 48: e149.
Fang MC, Pitani AS, Chang Y, et al. Kuyerekezeranso zochitika zowononga masoka kuti tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda tizilombo toyambitsa matenda. J Am Coll Cardiol 2008; 51: 810.