Kumvetsetsa opaleshoni ya mtima
Kawirikawiri amatchedwa "CABG Surgery" kapena " opaleshoni ya mtima yotseguka ," mitsempha yamakono opitirira opaleshoni yachitsulo ndizopaleshoni yopanga opaleshoni ya mitsempha yotsekedwa yomwe ikuzungulira mtima.
Mtima umapopera magazi kwa thupi lonse koma komabe zimadalira mitsempha yambiri ya mitsempha yotchedwa coronary mitsempha ya magazi ake omwe. Ngati mitsempha imakhala yotsekedwa kwambiri - chidziwitso chodziwika ngati matenda a mitsempha ya otero - mpweya sumafika pamtima ndi kuwonongeka kumachitika.
Kuchita opaleshoni ya mtima , kapena kupyolera opaleshoni , imatengedwa kuti ndi "njira ya golidi" yothandizira matenda a mitsempha .
Pofuna kuteteza kuwonongeka kwa mtima, kuyenderera m'mitsempha yowonjezera kuyenera kuwonjezeka. Pa opaleshoni ya mtima yotseguka, mitsempha yotsekedwa imachotsedwa kapena kupitirira ndi mitsempha ya mthupi yomwe imatengedwa kuchokera kumbali ina ya thupi. Mu opaleshoni yambiri, mitsempha iwiri kapena inayi yokhala ndi mitsempha yamtengowo imalumikizidwa kuti iwonetsetse kuyenda koyenera pamtima.
Kuchitidwa opaleshoni nthawi zambiri kumatanthauzidwa kuti ndizitali zingati, monga kuzungulira kawiri , kuzungulira katatu kapena katatu kuzungulira .
Zisonyezo za Opaleshoni Yoyamba Yowonekera:
- Zakudya zazikulu zimasintha, kusiyiratu kusuta ndi kuwonjezereka masewera olimbitsa thupi sizinapangitse kuti matenda a mitsempha asinthe.
- Angioplasty imalephera, osati yoyenera kapena mitsempha imatsekanso kachiwiri pambuyo pa angioplasty.
- Kupweteka kwambiri kwa chifuwa kumachitika ndi ntchito.
- Kuyezetsa kumayambitsa matenda aakulu mu mitsempha yamakono yowongoka .
- Kuyeza kumayambitsa matenda aakulu m'mitsempha yambiri .
- Mphuno sinagwire ntchito, sungakhoze kuikidwa kapena iyenso kachiwiri.
- Vutoli lamanzere silikugwira ntchito bwino chifukwa cha matenda a mitsempha yamakono.
- Pali ngozi yowononga mtima.
Kukonzekera Mtima Wosatseguka Kupitirira Opaleshoni:
Ochita opaleshoni ambiri a mtima amapanga mayeso aakulu asanachite opaleshoni kuti adziwe kuti mitsempha yotani imalepheretsedwa ndi kuwonongedwa kwa kutsekedwa.
Mng'onoting'ono ndi mayeso amodzi omwe amagwiritsira ntchito x-ray kuti adziwe kuopsa kwake kwa matenda a coronary.
Kuyesedwa kwapadera, electrocardiogram (EKG) ndi kuyesa magazi nthawi zambiri kumachitidwa opaleshoni. Mayesero a magazi akhoza kubwerezedwa mwamsanga musanachite opaleshoni kuti mudziwe ngati wodwalayo angapulumuke pamene akuchitidwa opaleshoni, pamodzi ndi thanzi lawo lonse.
Dokotala wa opaleshoni angakhale ndi malangizo apadera kwa wodwala wokonzekera opaleshoni. Malangizowo angaphatikizepo kusintha kwa mankhwala a mankhwala, zakudya ndi kumwa ndi kusuta .
Kuti mudziwe zambiri zokhudza mtima wa munthu ndi opaleshoni ya mtima
Pa Pump Opaleshoni Yowonekera Pogwiritsa Ntchito Opaleshoni:
Mtima wotseguka kupyola opaleshoni umachitidwa pansi pa anesthesia , yomwe imafuna kuti wodwalayo akhale pa mpweya panthawi yopaleshoni.
Opaleshoni imayamba ndi kukolola mitsempha ya mitsempha yomwe idzakhala grafts. Msempha wotchedwa saphenous mu mwendo umagwiritsidwa ntchito kawirikawiri chifukwa ndi nthawi yokwanira kupanga ma grafts ambiri. Ngati mitsempha yotchedwa saphenous sitingagwiritsidwe ntchito, zida za m'manja zingagwiritsidwe ntchito m'malo mwake. Mzere wamkati wamkati wamkati umagwiritsidwa ntchito pazitsulo limodzi ndipo amachotsedwa kamodzi pamene chifuwa chimatsegulidwa kwa opaleshoni.
Mitsempha yowonjezereka ikabwezeretsedwa, chifuwacho chimatsegulidwa mwa kupanga chowombera pamtunda, kapena m'mawere.
Dokotala wa opaleshoni ndiye amathyola sternum, kuti atsegule chifuwa cha chifuwa, ndikupatsa opaleshoni mwayi wopita ku mtima.
Mwachizolowezi cha CABG, mtima umayimitsidwa ndi njira ya potassium kotero dokotalayo sakuyesera kugwira ntchito pa chotengera choyenda, ndipo magazi amafalitsidwa ndi makina a mtima. Panthawiyi makina a mtima-mapapu amachita ntchito ya mtima ndi mapapo, ndipo mpweya wosagwiritsidwa ntchito sagwiritsidwa ntchito.
Dokotala wa opaleshoni amaika zitsulozo, mwina kubwezeretsa magazi palimodzi, kapena kuchotsa ndi kuchotsa chiwiya choletsedwa. Nthawi yambiri pamakina a mtima-amphuphu amadziwika ndi liwiro limene dokotalayo amatha kugwira ntchito, makamaka, ndi ma graft angati omwe amafunika.
Pamene ma graftswa atsirizidwa, mtima wayamba ndipo amapereka magazi ndi mpweya ku thupi. Sternum ikubwezeretsedwa ku malo ake oyambirira ndi kutsekedwa pogwiritsa ntchito waya wothandizira, kuti athandize fupa kuti lichiritsidwe, ndipo kutseka kumatsekedwa.
Mapulogalamu a Pampu Opaleshoni Yowonekera Mtima:
- Opaleshoni ingagwire ntchito mwamsanga chifukwa mtima ulipobe
- Magazi aang'ono kwambiri amapanga opaleshoni mofulumira
- Oyenerera odwala osakhazikika
Kuteteza pa Pump Opaleshoni Yowonekera Mtima:
- Kuchuluka kwa kutupa / kutsekemera pambuyo pa opaleshoni
- Kutulutsidwa kowonjezereka pambuyo pa opaleshoni kusiyana ndi kutulutsa mpope
- Zosungirako zamadzimadzi zambiri kuposa kupopera
- Kuopsa koopsa kwa impso kusiyana ndi mpope
- Kukhala kwachipatala kwa nthawi yayitali kusiyana ndi kupuma
- Kuwonjezeka kwa chiopsezo cha stroke
Kuchotsa Pump Opaleshoni Yowonekera Mtima:
Njira yothandizira mtima, kapena "opop-op" opaleshoni imakhala yofanana ndi ya opaleshoni ya pampu, koma kutuluka kwa magazi kupyolera mu thupi kumasungidwa ndi mtima panthawiyi. M'malo mogwiritsa ntchito makina a mtima, mapepala akupitirizabe kumenya koma malo omwe akuphatikizidwa amapitiriridwabe ndi zipangizo zopangira opaleshoni. Pafupifupi 20 peresenti ya odwala CABG oyamba opaleshoni ya kupopera .
Zotsatira za Kutulutsa Pula Opaleshoni Yowonekera Mtima:
- Mtima ukuyenda, wochepetsetsa opaleshoni
- Kuperewera kwa magazi ndi kuchepa pang'ono
- Kuchepetsa chiopsezo cha stroke
- Kutalika kwa chipatala
- Zosavuta mtengo
Kuthamanga kwa Kutulutsa Pula Opaleshoni Yowonekera Mtima:
- Odwala 70% amalephera kulandira chifukwa cha anatomy kapena matenda
- Amagwiritsidwa ntchito nthawi zambiri pa wodwala wosakhazikika
Kuti mudziwe zambiri zokhudza mtima wa munthu ndi opaleshoni ya mtima
Kuchokera kwa Opaleshoni Yowonekera Mtima:
Pa opaleshoni zambiri , mankhwala amachiritsidwa amadzutsa wodwalayo mwamsanga atangomaliza kutseka. Ochita opaleshoni ambiri amalola kuti odwala CABG ayambe kudzuka pang'onopang'ono, kuti athetse nkhawa iliyonse pamtima yomwe ikhoza kuchitika pamene ikuwuka mofulumira.
Wodwala adzatengedwera kumalo osungirako zinthu, kawirikawiri ndi chipangizo chamagetsi kapena chochita opaleshoni chachikulu, kuti asamalire atabwera kuchokera ku anesthesia. Malo osamalidwa bwino ndi ofunikira kupereka wodwala limodzi pa chisamaliro chimodzi ndi kuyang'anira nthawi zonse. Panthawiyi mpweya wabwino udzapitirizabe kugwiritsidwa ntchito, kupereka chithandizo chopuma pamene wodwalayo akhalabe pansi.
Miphika imodzi kapena zingapo zapachifuwa, zida zazikulu zomwe zimayikidwa pafupi ndi malo opangira opaleshoni, zithandizani kuchotsa magazi aliwonse amene angakhale nawo pamtima. Mayi wamkulu wotchedwa Swan-Ganz adzalowanso, kuti antchito ayang'ane ntchito zovuta za mtima ndikupatsa mankhwala.
Mankhwala a anesthesia atatha ndipo wodwala akugalamuka, chubu lopuma limachotsedwa (njira yotchedwa extubation) ndipo wodwalayo amatha kupuma yekha. Pambuyo pokhapokha mpweya wochulukitsa wodwalayo ungaperekedwe ndi mphuno, kuti uthandizire kupuma. Mpweya wa okosijeni ndi kupuma zidzayang'anitsitsa mosamala ndipo ngati wodwala sangathe kupuma mokwanira popanda mpweya wabwino, pulogalamu yopuma imathandizidwanso.
Akadzuka ndi kupuma payekha, wodwalayo ayamba kukonzanso bwino, kuyambira kumakhala pamphepete mwa bedi kapena kuima ndikuyenda pang'ono pa mpando. Wodwalayo adzalangizidwa njira zothetsera ululu ndi momwe angatetezere bala la opaleshoni . Panthawiyi, mankhwala opweteka amapezeka kuti alole wodwala kusuntha popanda kupweteka kwambiri.
Wodwala wa CABG nthawi zambiri amakhala m'malo odwala kwambiri kwa maola makumi awiri ndi anayi. Mipata ya chifuwa nthawi zambiri imachotsedwa mkati mwa opaleshoni maola makumi asanu ndi atatu mphambu zisanu ndi zitatu, musanatumizidwe ku unit unit-down. Odwala ambiri a CABG amasonyeza kusintha kwakukulu kwa msinkhu wa mafupa pamene mabomba a chifuwa amachotsedwa.
Moyo Pambuyo Opanda Opaleshoni Yokwanira Kupaleshoni:
CABG si mankhwala a matenda a mtima; ndi mankhwala othandiza kwambiri. Wodwala wa CABG yemwe samatsatira malangizo a dokotala kuti asinthe zakudya zawo, asiye kusuta, kuchita masewera olimbitsa thupi, kuchepa thupi kapena kuwonetsa shuga awo amagazi angapezeke kuti matenda awo amatha kubwerera, ndipo akuletsa ma graft atsopano .
Odwala ena angafune kubwezeretsedwa atabwerera kunyumba kuti athandize ndi mphamvu ndi mphamvu. Maofesi ena ali ndi pulogalamu yapadera yokonzanso mtima pamene ena amagwiritsa ntchito othandizira odwala .
Kuti mudziwe zambiri zokhudza mtima wa munthu ndi opaleshoni ya mtima
> Zotsatira:
> Patient Information Pamphlet. Laibulale ya Mayo Clinic.com Zaumoyo Wathanzi 1995-2007
> Raja S, Dreyfus G, "Kodi opaleshoni ya opaleshoni yopanga opaleshoni idzakhala m'malo mwa opaleshoni yamakono?" Journal ya Royal Society of Medicine, Voliyumu 97, June 2004.
> Turley A, Roberts AP, Morley R, Thornley AR, Owens WA, wa Belder MA. "Kupewera kwachiwiri pambuyo poti mitsempha yowonongeka imakhala bwino koma imakhala yosakwanira: kufunika kokwanira kutsatiridwa" Opaleshoni ya Cardiothoracic. 30 Jan. 2008