Gawo la ST-Non-Myocardial Infarction

Bwanji ngakhale ngakhale "mtima wofatsa" umakhala chinthu chachikulu

Nkhalango yosagwira ntchito yopanda matenda ya ST (se-ST-segment infomction infarction) (NSTEMI) ndi ST-segment infomction infarction (STEMI) onse amadziwika kuti matenda a mtima. NSTEMI ndi yosavomerezeka kwambiri pa ziwirizi, ndikuwerengera pafupifupi 30 peresenti ya zowawa zonse za mtima.

NSTEMI, STEMI, ndi matenda achitatu omwe amatchedwa angina osakhazikika ndi mitundu yonse ya matenda oopsa a coronary syndrome (ACS) .

Mbali yake, ACS imatanthauzidwa ngati mkhalidwe uliwonse umene umabweretsa mwa kuchepetsa mwadzidzidzi kapena kutsekedwa kwa magazi m'mtima.

Kumvetsetsa Acute Coronary Syndrome

Mitundu yonse ya ACS imayambitsidwa chifukwa cha kuponyedwa kwa chipika mu mitsempha yowonongeka , zomwe zimapangitsa kuti zitsulo zikhale zochepa kapena zodzaza. Malingana ndi kupsinjika kwa chilepherero, ACS ikhoza kusankhidwa kukhala mitundu itatu:

• Angina wosasunthika ndi kupweteka pang'ono kwa mitsempha yomwe imayambitsa ululu wamphongo. Mosiyana ndi angina yokhazikika (yomwe imachitika mukamachita khama), angina yosakhazikika ikhoza kuchitika nthawi iliyonse ndipo imakhala yovuta kwambiri. Ngakhale zizindikirozi, angina wosakhazikika sizimapangitsa kuti mtima uwonongeke.
• STEMI imaonedwa kuti ndi "yovuta" ya matenda a mtima pomwe phokoso lopunthidwa kwathunthu kapena lapafupi limatseka mitsempha yayikulu yowonongeka, zomwe zimapangitsa kuti mtima uwonongeke kwambiri.
• NSTEMI imaonedwa kuti ndi "mawonekedwe apakati" a ACS omwe amachititsa kuti pakhale mitsempha yaing'ono yamakono kapena amachititsa kuti pang'onopang'ono zisokonezeko. Ngakhale zizindikiro zikhoza kukhala zofanana ndi STEMI, kuwonongeka kwa mtima kudzakhala kochepa kwambiri.

NSTEMI ndi angina osakhazikika nthawi zambiri amapita ku "kukwanira" matenda a mtima mkati mwa maola angapo kapena miyezi ingapo. Momwemonso, aliyense angaganizidwe kuti ndiwothamangitsira STEMI ndi chizindikiro chochenjeza choyamba chomwe chimafunika kuchipatala.

Kusiyanitsa NSTEMI ku STEMI

Kuzindikira kwa NSTEMI kumapangidwa ngati munthu ali ndi zizindikiro za angina wosakhazikika.

Tikhoza kusiyanitsa STEMI ku NSTEMI mwa kuwerenga pa electrocardiogram (ECG) mu zomwe zimatchedwa "ST-gawo." Muzochitika zachilendo, gawo la ST ndilolumikizidwe bwino lomwe tikuwona pa ECG pakati pa mtima. Pa matenda a mtima, gawo la ST limakwezedwa. Momwemonso, NSTEMI imatchedwa dzina lake chifukwa palibe umboni wa mbali ya ST.

Chifukwa NSTEMI imayambitsa kupsinjika kwa mtima, madokotala adzalingalira kuti ndi matenda a mtima (ena anganene kuti "wofatsa"). Ndikunenedwa kuti, NSTEMI imagwirizana kwambiri ndi angina yosakhazikika ndipo, motere, nthawi zambiri, ili ndi zotsatira zabwino.

Kuchiza Mwadzidzidzi kwa NSTEMI

Chithandizo cha NSTEMI n'chofanana ndi cha angina chosakhazikika. Ngati munthu akuwoneka ndi zizindikiro za mtima (chifuwa cholimba, khungu la khungu, kupweteka kofuula kumanja kwamanzere, etc.), adokotala ayamba njira yothandizira kwambiri kuti atsimikizike mtima komanso kuti asawonongeke.

Kukhazikika kumayang'ana makamaka pa zinthu ziwiri:

• Kuchotsa vuto la ischemia , momwe mtima ulibe oxygen yokwanira, zomwe zimachititsa kuti maselo afe. Izi zimachitika, mwa zina, poyambitsa beta blockers kuti awononge kuwonongeka kwakukulu chifukwa cha kuchuluka kwa adrenaline ndi zizindikiro zapamwamba za dozi kuti zikhazikike pamapulumu ophulika ndi kuchepetsa kutupa kwa thupi. Kugwiritsira ntchito mankhwalawa kumachepetsa mtima wamagetsi mkati mwa mphindi. Oxygen ndi morphine amaperekedwa kuti athandize kupuma komanso kuchepetsa ululu.

• Kuyimitsa mapangidwe a magazi kumaphatikizapo kugwiritsa ntchito aspirin, Plavix, ndi mankhwala ena kuti azipopera magazi ndi kupewa kutsekemera kwa mapulogalamu. Zimaphatikizapo kupeŵa "buster clot," komwe amagwiritsidwa ntchito ku STEMI, zomwe zingapangitse zinthu kuipiraipira.

Chimachitika Pomwe Chikhalidwe Chikhala Chokhazikika

Pomwe wodwala atakhazikika, dokotalayo adzafufuza ngati pali zina zowonjezera zofunika. Akatswiri ambiri a zamoyo amatha kugwiritsa ntchito chiwerengero cha TIMI (thrombosis mu myocardial infarction) kuti azindikire zotsatira zake kwa munthu aliyense.

Maphunziro a TIMI amafufuza ngati munthuyo ali ndi zifukwa zotsatirazi:

• Ali ndi zaka 65 kapena kuposerapo
• Kukhalapo kwa zifukwa zosachepera zitatu za matenda a mtima
• Kutsekeka kwapadera kwapakati pa 50 peresenti
• Kusiyana kwa gawo la ST pa chilolezo cha ECG
• Zolemba ziwiri za angina m'maola 24 apitawo
• Mitundu yambiri ya michere ya mtima
• Gwiritsani ntchito aspirin m'masiku asanu ndi awiri apitayo

Ngati munthuyo ali ndi zifukwa ziwiri kapena zocheperako (TIMI chiwerengero cha 0-2), kufunika koyambako kungapewedwe. Ngati mpikisanoyo ndi yapamwamba, katswiri wa zamoyo angafunike kuchita catheterization ya mtima ndi angioplasty ndi stenting .

Kwa anthu amene amakana chithandizo chamankhwala, vuto lopanikizika lidzachitidwa musanafike. Ngati pali zizindikiro za kupitiriza matenda a ischemia, mankhwala opatsirana adzalangizidwa bwino.

> Chitsime

• > Amsterdam, E .; Wenger, N .; Brindis, R .; et al. "2014 AHA / ACC chitsogozo cha odwala omwe sali ndi ST-elevation syndromes aconic coronary: chidule cha executive: lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines." Kudutsa. 2014; 130: 2354.