Chilakolako chothetsa mchitidwe wa thrombosis
Mapulogalamu atsopano a stent akuyenda mofulumira. Ngakhale akatswiri a cardiologists angakhale ndi vuto lolimbitsa zonse. Pano pali kuyambira kofulumira pa mitundu yatsopano ya mbola yomwe ikukula, ndipo chifukwa chake zimakhala zosafunika kwambiri.
Kodi Ndi Ziti Zomwe Zimayenera Kuchitidwa?
Cholinga chonse cha mbola ndi kuthandiza kuteteza kupumula mu mitsempha yamtundu wina (kapena chida chilichonse) pambuyo pa angioplasty ya chikhomo cha atherosclerotic .
Pogwiritsa ntchito angioplasty, kathetta ya buluni imadutsa kudera la chitetezo mu mitsempha, ndipo buluni imakhutitsidwa kuti iwononge chipikacho ndi kuchepetsa kutseka. Nthenda yamtengo wapatali yomwe imagwiritsidwa ntchito pa nthawi yamakono yotsika mtengo yomwe imapereka chithandizo, ndipo imathandiza kuti mitsempha yatsopano ikhale yotseguka.
Kusinthika Kwambiri Kwambiri kwa Zipangizo Zamakono
Pamene poyamba ankagwiritsidwa ntchito, anathandiza kuchepetsa chiopsezo cha kupuma kwa angioplasty ndi theka, kuyambira 20% mpaka 10 peresenti m'miyezi 12 mutatha njirayi. (Restenosis, ikachitika, kawirikawiri imapezeka mkati mwa chaka.)
Poyesera kuchepetsa kuchuluka kwa kupuma kwazomwekusowa, opanga mazonda anayamba kuyamba kuvala zitsulo zopanda kanthu ndi ma polima omwe ali ndi mankhwala omwe amayenera kuletsa kukula kwa minofu pamalo otsika. Zozizwitsa zimenezi zimatchedwa mankhwala osokoneza bongo, kapena DES. (Choyambirira, chosakhala ndi mankhwala ochotsera mankhwala, mosiyana, chinadziŵika ngati osalimba opanda zitsulo, kapena BMS.) DES akhala akupangidwa pogwiritsa ntchito mankhwala osiyanasiyana, makamaka paclitaxel, everolimus, kapena yotarolimus.
DES akhala atapambana pochepetsa kuchepa kwa 5 - 6% pachaka. Komabe, mkati mwa zaka zingapo za DES kukhala "muyezo wa golide" wa mankhwala opatsirana, vuto latsopano linafika poyera - mochedwa thrombosis.
Vuto la Kutha Kwambiri Kwambiri
Thrombosis yamtunduwu ndi mapangidwe amagazi a magazi mkati mwa mitsempha pamalo a stent.
Thrombosis ndi yosiyana ndi restenosis, yomwe ndi regrowth ya minofu. Restenosis ndizovuta, koma zikachitika zimakhala zochitika pang'onopang'ono kotero kuti kawirikawiri pali nthawi yochizira. Mosiyana ndi zimenezi, kupwetekedwa kwapakati kumachitika mwadzidzidzi, popanda chenjezo. Thrombosis yamtunduwu imayambitsa nthawi yambiri ya mitsempha, ndipo nthawi zambiri imayambitsa matenda a mtima kapena imfa yadzidzidzi .
Vuto la thrombosis oyambirira (mwazi wamagazi umachitika masiku amodzi pambuyo pa sabata) anazindikiridwa kumayambiriro koyambirira kwa kutupa, ndipo anachitidwa bwino mwa kupereka mankhwala amphamvu odana ndi mapuloteni kwa miyezi ingapo atatha. Pogwiritsa ntchito BMS, njirayi ikuwoneka yokwanira.
Komabe, patangopita zaka zowerengeka za kugwiritsidwa ntchito kwa DES, vuto la thrombosis lochedwa stent linapezeka - kutanthauza thrombosis mwadzidzidzi pamalo a stent omwe amapezeka chaka chimodzi kapena ziwiri mutatha. Matenda otha msinkhu amodzimodzi ndi oopsa kwambiri monga oyambirira a thrombosis. Pofuna kuchepetsa chiopsezo, akatswiri a cardiologist tsopano amapereka mankhwala oletsa mankhwalawa kwa zaka zosachepera chaka chitatha, ndipo ngati n'zotheka nthawi yaitali (mwina kwanthawizonse).
Chifukwa chakuti kugwiritsa ntchito mankhwala olimbana ndi mapuloteni olimbitsa thupi kumabweretsa ngozi, vuto la thrombosis lakumapeto kwapangitsa kuti oyambitsa stent ayesetse kupanga mtundu watsopano wa stent umene umathetsa kapena kuchepetsa vutoli.
Zatsopano Zamakono Zamakono
Chifukwa chotsogolera kuti DES ikhoza kuyambitsa thrombosis mochedwa (pamene zovuta sizingayambitse vutoli) zimayang'ana pa zokutira polima zomwe zimagwiritsidwa ntchito pazinthu izi. Cholinga cha kuvekedwa kwa polima ndiko kugwira mankhwalawo, ndikuwamasula pang'onopang'ono kwa masabata kapena miyezi kuti athetse minofu ndi kupuma. Koma mankhwalawa atatulutsidwa, komabe mankhwalawa sagwiranso ntchito.
Ofufuza tsopano akukhulupirira kuti zokutira mapuloteni pa DES kungakhale kukuwonjezereka kutupa ndi kuchepetsa machiritso pa malo a malo osungirako malo, motero kumayambitsa chiopsezo cha thrombosis.
Iwo atenga njira zitatu zothetsera vutoli, ndipo makampani angapo tsopano akupanga zatsopano zogwiritsa ntchito njira zitatu izi.
1) "Zabwino" ma polima otalika. DES tsopano akupezeka pogwiritsa ntchito makina opangidwa ndi polima. Ma polimawa atsopano amawoneka kuti amachititsa kuchepa pang'ono, ndipo amalola kuti machiritso apamwamba azichiritsidwa pa tsamba la mankhwala. Amakhulupirira kuti amachepetsa kwambiri chiopsezo chotchedwa thrombosis. Zozizwitsa izi - zomwe zimatchulidwa kuti "DZIWENI chachiwiri" - tsopano zikugwiritsidwa ntchito padziko lonse lapansi.
2) ma polima opangidwa ndi bioabsorbable. DES (zopangidwa ndi zopangidwa ku US) zakhala zikupezeka ku Ulaya kwa zaka zingapo zomwe zimagwiritsa ntchito mapuloteni omwe amawotchedwa (amatha) mkati mwa miyezi ingapo, osasiya zitsulo zopanda kanthu. M'mawu ena, mbola izi zimapereka ubwino wa DES kwa miyezi ingapo yoyambirira (pamene restenosis imapezeka), ndiyeno amakhala BMS, ndipo amakhala ndi mwayi wochepa wochedwa thrombosis. Mu October, 2015, Stent Syentgy (Boston Scientific) inakhala yoyamba ya bioabsorbable polima povomerezeka ku US.
Kafukufuku wambiri wapangidwa poyerekeza DES bioabsorbable-polymer DES ndi DES ndi mbadwo wachiwiri DES. Poyerekeza ndi zobadwa zatsopano za DES, kuchepa kwapakhosi kwafupika kumachepetsedwa ndi DES komanso chilengedwe cha bi-absorbable-polymer. Komabe, palibe chisonyezero panthawiyi kuti bioabsorbable-polymer DES amachita bwino kuposa mbadwo wachiwiri DES.
Komanso, mpaka tsopano, DES ndi mchimwene watsopano wa DES akufunikirabe mankhwala owonjezera ndi mankhwala osokoneza bongo.
3) mpweya wosasinthika. Mphuno imakhala pansi pa chitukuko chomwe chimapangidwira kwambiri - ndiko kuti, mbola yonse imabweretsanso ndipo kenako imatheratu palimodzi. Amakhulupirira kuti phindu limene limaperekedwa chifukwa cha kupweteketsa (sizowonjezereka) sikunkafunikiranso miyezi isanu ndi iwiri kapena khumi mutatha njirayi - mbola imatumikirabe cholinga china. Ndiye bwanji osazichotsa? Matembenuzidwe angapo a stos bioresorbable apangidwa, ndipo ali mu mayesero ogwira ntchito zachipatala.
Mfundo Yofunika Kwambiri
Zonse zochititsa chidwi zomwe tikuona zikuchitika lero mu teknoloji yolimba ndizochititsa chidwi, ndipo zikuwoneka kuti posachedwa kapena pang'onopang'ono zidzakhalapo zomwe zimadza pafupi kuthetsa kupuma ndi thrombosis. Koma tiyenera kusunga zinthu zingapo moyenera.
Choyamba, ntchito zonsezi ndi malonda onsewa mu teknoloji yolimba imayesetsani kuthana ndi mavuto awiri (restenosis ndi thrombosis yolimba) yomwe imayesedwa chifukwa cha kuyesa kuti tizilombo toyambitsa matenda (CAD) ndi angioplasty ndi stents. Ngati sitinafunikire kuchita njirayi poyamba, kuyesayesa kwakukulu sikungakhale kofunikira.
Ndipo kachiwiri, pamene akatswiri a cardiologists akhala akufulumira kulangiza chithandizo choopsa cha CAD, tiyenera kukumbukira kuti zochepa kwenikweni sizinawonetsedwe kuchepetsa kwambiri chiopsezo cha matenda a mtima kapena imfa mwa odwala ambiri okhala ndi CAD wodekha. Musanavomereze, muyenera kulankhula ndi dokotalayo ngati mbola ikhoza kukhala yothandiza m'tsogolomu, kapena ngati mungangowonjezera vuto latsopano la kasamalidwe pa zomwe muli nazo kale.
Zotsatira:
Bangalore S, Toklu B, Amoroso N, et al. Zikada zitsulo zokhala ndi zitsulo, zowonjezera polima mankhwala akuwombera poizoni, ndi biodegradable polima mankhwala akuwombera phokoso chifukwa cha mitsempha matenda: kusakaniza kophatikizira meta-analysis. BMJ 2013; 347: f6625.
Navarese EP, Tandjung K, Claessen B, ndi al. Zotsatira za chitetezo ndi zogwira mtima za mankhwala osokoneza bongo oyamba ndi achiwiri omwe amachititsa kuti pulogalamu yowonongeka yowonongeka yowonjezereka ikupangidwe. BMJ 2013; 347: f6530.
Stefanini GG, Byrne RA, Serruys PW, et al. Mankhwala osokoneza bongo amadzimadzi otsekemera amachepetsa chiopsezo cha kupweteka kwapakati pa zaka 4 kwa odwala omwe amatha kupititsa patsogolo: Kuwonetsedwanso kwadongosolo kwa deta ya munthu aliyense wochokera ku ISAR-Test Test 3, ISESTEST 4, ndi LEADERS mayesero osadziwika. Mtima; 33: 1214.