Kuthamangitsidwa kwa Aortic kumachitika pamene khoma la aorta (mitsempha yaikulu ya thupi) imabuka misozi, yomwe imalola kuti magazi alowe m'ngalawa, kusokoneza (kapena kupasula) zigawo za khoma. Kusokonezeka kwa Aortic kungayambitse kuvulaza kwa ziwalo zosiyanasiyana ndi kufa mofulumira, ndipo nthawi zonse ziyenera kuonedwa kuti ndizochitika mwachipatala.
Zimayambitsa
Kusokonezeka kwa Aortic kumachitika pamene chipinda chakunja cha khoma la aortic chimafooketsa, kuti misozi ikhale yopanga.
Kufooka uku kumayanjanitsidwa kwambiri ndi matenda oopsa . Zitha kuonanso ndi matenda omwe amagwiritsidwa ntchito monga scleroderma ndi Marfan syndrome , matenda a Turner, matenda a Ehlers-Danlos , kuvulazidwa koopsa (monga momwe zinachitika ndi Princess Princess), komanso kutupa kwa mitsempha ya magazi. Kusokonezeka kwa Aortic kumayambitsanso ntchito ya cocaine.
Kusokonezeka kwa Aortic kumawonekera kwambiri pakati pa anthu a zaka za pakati pa 50 ndi 70 ndipo amapezeka nthawi zambiri mwa amuna kusiyana ndi akazi.
Chimachitika ndi Aortic Dissection
Pamene kutuluka kwa aortic kumachitika, magazi akuyenda pansi pa kukakamizidwa kwakukulu kukhala makoma a aorta, kupasula zigawo za khoma. Magazi aakulu kwambiri amatha kulowa mu khoma la aortic, ndipo magazi awa amatayika kuti azitha kufalikira - ngati kuti magazi akutuluka kwambiri. Magazi a dissecting akhoza kuyenda pamtunda wa aorta, kuyika mitsempha ya magazi yomwe imachokera ku aorta ndi kuwononga ziwalo zomwe zimaperekedwa ndi mitsempha ya magazi.
Kusokonezeka kwa aortic kungachititse kuti aortic ayambe kubwezeretsedwa , kuwonongeka kwa mthupi , matenda a myocardial , matenda a neurologic, impso kulephera , ndi m'mimba magazi . Komanso, aortic dissection ikhoza kuthetsa aorta kwathunthu, zomwe zimayambitsa kuuluka kwakukulu mkati.
Pazifukwa zonsezi, imfa ya aortic dissection, ngakhale mofulumira komanso mwaukali, ikukula kwambiri.
Zizindikiro
Kawirikawiri, kupweteka kwa aortic kumayambitsa modzidzidzimutsa kwambiri, "kupundula" ululu mu chifuwa kapena kumbuyo, umene nthawi zambiri umatuluka pamimba. Kupweteka kungaperekedwe ndi syncope (kutaya chidziwitso), mwa mpweya wochepa kwambiri, kapena ndi zizindikiro za kupweteka . Kawirikawiri, zizindikiro za aortic dissection ndizoopsa komanso zoopsa kwambiri moti palibe funso lochepa mu malingaliro a wovutitsidwayo ngati chithandizo chamankhwala chofunika chokha chikufunika.
Chithandizo
Kuchiza kumadalira gawo lina la aorta lomwe likukhudzidwa, ndipo pa mkhalidwe wa wodwalayo.
Nthawi zonse, odwala a disorction aortic amabweretsedwa kuchipatala chachikulu ndipo nthawi yomweyo amaikidwa mankhwala osokoneza bongo (kawirikawiri ndi nitroprusside ) pofuna kuchepetsa kwambiri magazi awo. Kuchepetsa kuthamanga kwa magazi kukhoza kuchepetsa kupitirira kwa denga la aorta.
Odwalawa amaperekanso mavitamini otchedwa betra (propranolol kapena labetalol) kuti achepetse kuthamanga kwa mtima, komanso kuchepetsa mphamvu ya mtundu uliwonse. Khwerero iyi ikufunikanso kuchepetsa kusokoneza kwina.
Pomwe wodwalayo ali ndi zizindikiro zofunika kwambiri, kafukufuku (omwe nthawi zambiri amapezeka ndi CT kapena MRI ) amafotokozedwa kuti ndi gawo liti la aorta.
Malingana ndi malo ake, dissection imatchedwa mtundu wa A kapena mtundu B.
Lembani A Kusokonezeka. Lembani chisokonezo cha A chiwonetsedwe m'mwamba (mbali yoyamba ya aorta yomwe imapereka magazi kumtima, ubongo, ndi mikono). Lembani kusokonezeka kwa A nthawi zambiri amachiritsidwa ndi kukonza opaleshoni, yomwe kawirikawiri imaphatikizapo kuchotsa mbali yowonongeka ya aorta ndi kuikamo ndi kulembera. Popanda opaleshoni, odwalawa ali pangozi yaikulu ya aortic kubwerera, myocardial infarction kapena stroke, ndipo kawirikawiri amafa ndi mavuto ngati amenewa. Opaleshoni ndi yovuta komanso yovuta, komabe, komanso ngozi yofa ndi opaleshoni ndi yaikulu kwambiri kuposa 35%.
Opaleshoni imalimbikitsidwa chifukwa cha kusiyana kwa mtundu wa A chifukwa chiwerengero cha anthu akufa ndipamwamba kwambiri ndi mankhwala okha.
Sungani Zosokoneza B. Mu mtundu B, kuthamangitsidwa kumangokhala kumsika kwa aorta (gawo la aorta lomwe liri patsogolo pa msana ndikupereka magazi ku ziwalo za m'mimba ndi miyendo). M'mayesero amenewa, imfa si yabwino kwambiri - ndipo ikhoza kukhala yopambana - ndi opaleshoni kusiyana ndi kuchipatala. Kotero mankhwala ambiri kawirikawiri amakhala ndi chithandizo chamankhwala chopitilira, ndiko kuti, kupitirizabe kuthamanga kwa magazi ndi beta blockers. Ngati umboni umayambitsa impso, m'matumbo, kapena m'munsi , komabe opaleshoni ikhoza kukhala yofunikira.
Kuchokera ku Aortic Dissection
Pambuyo pa kupweteka kwa aortic kuchipatala, wodwalayo akuyenera kukhalabe pa beta kwa moyo wake wonse, ndipo kuyendetsa bwino kwa magazi ndikoyenera. Kubwereza majekiti a MRI amachitika asanafike kuchipatala, nthawi zingapo pa chaka chotsatira, ndi zaka ziwiri mpaka zitatha. Kuwunika kumeneku n'kofunikira chifukwa, mwatsoka, pafupifupi 25% opulumuka a disticction dissection adzafuna opaleshoni yowonjezereka kwa kusokonezeka kwatsopano kwa zaka zingapo zotsatira.
Chifukwa kusokonezeka kwa aortic kumakhala kusintha moyo kosakhala wosapha, ndibwino kuti muteteze kusiyana ndi kuchiza. Mungathe kuchepetsa vuto lanu lokhala ndi matenda a aortic mwa kuonetsetsa kuti mumayambitsa matenda a mtima , makamaka kuwonjezera pa matenda oopsa, komanso kugwira ntchito mwaukali kuti musinthe maonekedwe anu.
> Zotsatira:
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> LeMaire SA, Russell L. Epidemiology ya Thoracic Aortic Dissection. Nat Rev Cardiol 2011; 8: 103.
> Melvinsdottir IH, Lund SH, Agnarsson BA, ndi al. Kuwonjezeka ndi Kufa Kwachidziwitso Chochuluka cha Thoracic Aortic: Zotsatira Zophunzira Padziko Lonse. Eur J Cardiothorac Surgery 2016; 50: 1111.