Chimene chiyeso cha ORBITA chiyenera kutanthauza kwa inu
Mu November 2017, zotsatira za mayesero apadera a zachipatala zinafotokozedwa ku Lancet , mwamsanga kuponyera dziko lamoyo kukhala chisokonezo. Chigamulo cha ORBITA chinatsutsa zaka makumi atatu za chiphunzitso cha moyo pokhudzana ndi kupambana kwa angina ndi stent . Ndondomeko, mayeso a ORBITA anamaliza, sanapereke chithandizo choyenera cha kuchipatala cha angina poyerekeza ndi njira yowonongeka.
Kodi zikhoza kukhala kuti ubwino wamaphunziro a cardiologists omwe amachitidwa kuti ndi owopsa nthawi zonse ndi chifukwa chokhacho chifukwa chokhala ndi placebo? Akatswiri amapanga mizere ya nkhondo usiku wonse. Gulu limodzi linalengeza kuti yesero la ORBITA liyenera kuthetsa kuyesa kwa angina bwinobwino. Gulu lachiwiri la akatswiri linalimbikira kuti mayeso a ORBITA, pokhala osangalatsa, anali olakwika, ndipo sayenera kusintha kayendedwe ka kuchipatala konse.
Nkhondo yosonkhanitsayi ikuwoneka ngati yomwe siidzathetsedwa kwa zaka zingapo. Izi, ndithudi, ndi momwe sayansi yachipatala imayendera. Funso lathu ndi lakuti: Kodi munthu amene akulimbana ndi angina lero (pamene akatswiri akukangana) akuyenera kuchita chiyani tsopano?
Ngati tibwerera ndikuyang'anitsitsa deta yomwe ilipo, sizikhala zovuta kupeza njira yochizira angina yotsimikizirika yomwe imakhala yomveka, komanso ikugwirizana ndi umboni kuchokera ku mayesero a chipatala (kuphatikizapo ORBITA) monga ilipo lero.
Mitsinje ya Stable Angina
Mphuno ndi ming'alu ya waya yomwe imatambasulidwa mkati mwa mitsempha yotsekedwa pa njira ya angioplasty. Mu angioplasty , buluni imakhutitsidwa pamalo omwe muli malo otchedwa atherosclerotic kuti athetse kutseka. Mpweyawu umagwiritsidwa ntchito nthawi imodzi kuti chisamaliro chikhale chotseguka.
Angioplasty kuphatikizapo kupwetekedwa nthawi zambiri amatchulidwa ndi madokotala monga "njira yowonjezera yowonjezera," kapena PCI.
PCI inakhazikitsidwa ngati chotsalira chochepa chotsutsana ndi mitsempha yamakono pophatikiza kumtenganitsa , njira yowatsitsimutsa mtima. Kuyambira pamene PCI inakonzedwa, chiwerengero cha odwala omwe ali ndi matenda a mitsempha omwe amachitidwa opaleshoni amatsika kwambiri.
Pali nthawi pamene kugwiritsa ntchito PCI ndikofunikira kwambiri. PCI yomweyo imakulitsa kwambiri zotsatira za anthu omwe akudwala matenda oopsa (ACS) -mabvuto osiyanasiyana omwe amawopsyeza moyo chifukwa cha kutsekedwa kwakukulu kwa mitsempha yamakono. Mankhwala atatu omwe amayamba chifukwa cha ACS ndi angina osasunthika , kutsika kwa ST-sepactial infarction (STEMI) , komanso kupitirira kwa mbali ya ST-infomction infarction (NSTEMI) . Kwa ambiri a syndromes awa, PCI yofulumira yakhazikitsidwa, ndi mayesero angapo a chipatala, monga chithandizo cha kusankha.
Kwa zaka zambiri, kununkhira kunalinso chithandizo cha anthu ambiri omwe anali ndi angina-angina okhazikika chifukwa cha kuwonongeka kwakukulu, kosasunthika, mosasintha. Pulezidenti wa PCI anamasula angina mwa anthuwa anali oonekera kwa onse, ndipo ankaganiza kuti angakhalenso ndi chiopsezo chochepa cha zotsatira za mtima.
Kenaka, kumapeto kwa zaka za m'ma 2000, mayeso a COURAGE anatsimikizira kuti PCI siidasokoneze chiwopsezo cha mtima kapena imfa mwa anthu omwe ali ndi angina okhazikika, poyerekeza ndi mankhwala oopsa . Kuchokera nthawi imeneyo, malangizo a zachipatala adalimbikitsa odwala matendawa kuti agwiritse ntchito PCI kukhala angina okhazikika kuti athetse zizindikiro za angina, komanso mwa anthu omwe sangawachiritsidwe ndi mankhwala.
Ngakhale kuti n'zovuta kufotokozera mwachilungamo, zikuwoneka kuti akatswiri a cardiologists (ngakhale kuti malangizowa akunena komanso ngakhale umboni wochokera ku mayesero a kuchipatala), apitiliza kugwiritsa ntchito mankhwala okhwima ngati mankhwala oyamba a angina, osati ngati mankhwala a mzere anthu omwe amalephera kugwiritsa ntchito mankhwala osokoneza bongo.
Iwo amachita izi, adzatiuza, chifukwa palibe chomwe chimapweteka kwambiri pofuna kuchotsa angina.
Ndipotu, pafupifupi aliyense amakhulupirira kuti mphuno ndiyo njira yabwino kwambiri yothandizira angina, ngakhale omwe adalimbikitsa akatswiri a matenda a mtima kuti ayambe kumwa mankhwala oopsa poyamba. Zakhala ngati chiphunzitso: Ngakhale zovuta zake zonse, kutupa ndi njira yodalirika komanso yodalirika yochizira angina.
Koma tsopano, mayeso a ORBITA apangitsa chiphunzitsochi kukhala chisokonezo.
Zimene Ophunzira a ORBITA anachita
Ofufuza a ORBITA anayesa maganizo ochititsa mantha. Iwo anafunsa kuti: Nanga bwanji ngati chithandizo cha angina chimene odwala akudwala pambuyo pa stent sichifukwa cha kutsegula kwa mitsempha koma ndi zotsatira za placebo? Poyesa izi, iwo ankafanizira zenizeni zenizeni zowonongeka.
Iwo analembetsa anthu 200 okhala ndi angina okhazikika ndipo osachepera chimodzi chofunika kwambiri mu mitsempha yamakono (oposa 70 peresenti anatsekedwa). Pambuyo pa milungu isanu ndi umodzi yokonzetsa chithandizo chamankhwala, ndipo atatha kuyesedwa kwakukulu kuti azindikire kuchuluka kwa angina awo ndi mphamvu zawo zochita masewera, maphunzirowa adasankhidwa kuti adzalandire njira yowonjezera, kapena yachitsulo. Mchitidwe wa mankhwalawa, maphunzirowa analandira njira yonse ya PCI, kuphatikizapo kuika waya kudutsa, kupatula kuti palibe angioplasty kapena stent kwenikweni yomwe inkachitidwa. Ndondomekoyi itatha, magulu awiriwa adalandira mankhwala oopsa omwe amatha kugwiritsa ntchito pambuyo pa PCI .
Pambuyo pa masabata asanu ndi limodzi, maphunziro onse adayesedwa kachiwiri kuti ayese kuchuluka kwa angina ndi mphamvu zawo zolimbitsa thupi. Ofufuzawo anapeza kuti, pamene iwo omwe adalandira kwenikweni mafinya amawoneka kuti akukwera bwino kwambiri kuposa omwe anali ndi chizoloŵezi chamanyazi, kusiyana pakati pa magulu awiri sikunali kokwanira kukhala statistically significant.
Ndiye, iwo anatsiriza, kupsa mtima sikokwanira bwino kuposa njira yothandizira anthu odwala angina.
Zotsatirapo ku Phunziro la ORBITA
Msonkhano wolemba ku Lancet womwe unapereka chidziwitso cha kafukufuku wa ORBITA, unanena kuti phunziroli likhale "lozama komanso lofikirapo" ndipo adafunsira ndondomeko zothandizira kuti zithetsedwe pofuna "kuchepetsa" kugwiritsa ntchito PCI kwa odwala angina okhazikika.
Akatswiri a cardiologists (omwe amachita PCI), kupyolera mu bungwe lawo (Society for Cardiovascular Angiography and Interventions, SCAI), anatulutsa mwamsanga mfundo yaikulu ya ORBITA. SCAI inanena, mwa zina, kuti odwala omwe analembetsa anali ndi angina otsika kwambiri (ndiko kuti, ambiri sankasankhidwa ku PCI poyamba); Cholinga chachikulu pamayesero (nthawi yochita masewera olimbitsa thupi) ndizodziwika bwino komanso zimasiyana kwambiri; kuphunzira ndi kochepa komanso kochepa; ndipo chimodzimodzi cholingalira chenicheni cha ischemia chomwe chimachitidwa mu mayesero (chiyeso chotchedwa "chiwerengero chapamwamba cha makina oyendera mphindi") chinasonyeza kusintha kwakukulu ndi PCI. Choncho, iwo amatha, zotsatira za ORBITA, ngakhale zosangalatsa, siziyenera kugwiritsidwa ntchito kusintha machitidwe ochipatala.
Choncho, monga momwe mukuonera, magulu a nkhondo adakonzedwa, ndipo tiyenera kukonzekera zaka zingapo za nkhondo.
Kodi Tiyenera Kupanga Chiyani Zonsezi?
Chiwongolero cha ORBITA chimawatsutsa kuti PCI ikugwira ntchito motani pochiza zizindikiro za angina bwinobwino. Akatswiri a sayansi sayenera kuganiza, monga momwe adachitira, kuti kuchepetsa ngakhale kutsekula kwapamwamba pamasitomala amachititsa kuti zizindikiro ziwonongeke.
Ngakhale zili choncho, odwala matendawa amapereka mavuto ambiri ovomerezeka ndi maphunziro a ORBITA. Chimene chiyenera kutikakamiza kukhala vuto lalikulu ndi izi: Odwala omwe akhala akuyesedwa mwapadera mu mayeserowa anali angina otsika kwambiri, ndipo pansi pa zitsogozo zamakono ambiri a iwo sakanakhala ofunsira ku PCI poyamba. Mwa kuyankhula kwina, sitiyenera kuyembekezera kuti kutupa kumakhudza kwambiri odwala amenewa. Mfundo yakuti siidakhudze kwambiri kuyambira pachiyambi.
Pa nthawi yomweyi, otsogolera sayenera kutonthozedwa kwambiri pamutu wawo. Ophunzira a ORBITA akuwonetsa kuti, m'gulu lalikulu la odwala omwe masiku ano amalandira PCI mudziko lenileni (ndiko kuti, anthu okhala ndi "zazikulu" zomwe zizindikiro zawo sizingatheke), kupsa mtima sikuchita kalikonse zowoneka bwino.
Kotero, ngakhale ORBITA sichifukwa chomveka kusintha kusintha komwe kulipo panopa, zikuyeneradi kusintha kusintha kwakukulu komwe kumachitika masiku ano.
Ngati muli ndi Angina olimba lero
Nthongo zasinthira chithandizo cha matenda a mitsempha yamakono. Kwa anthu omwe ali ndi syndromes yodalirika, PCI yakhala ndi kuchepa kwakukulu kwa imfa yoyamba ndi kulemala. Ndipo mwa anthu ambiri omwe ali ndi vuto lalikulu, lofooketsa angina (gulu limene silinayesedwe mu mayeso a ORIBTA), PCI yakhala ikukula bwino.
Komabe, zimbudzi ziyenera kupeŵa ngati kuli kotheka. Kuphatikiza pa chiopsezo chomwe chimachitika potsatira njira ya PCI, kukhalapo kwa stent kumayambitsa vuto la nthawi yaitali la kasamalidwe, kwa adokotala ndi wodwala, amene chisankho chake chachikulu sichinaoneke bwino. Zili choncho, kodi nthawi zonse zimakhala zotetezeka kuti asiye mankhwala osokoneza bongo amphamvu omwe amafunikira pambuyo pa PCI? (Mwachidziŵikire, odwala ambiri mu mayeso a ORIBTA omwe anali ndi vutoli ankadwala magazi ambiri panthawi yotsatira.) Werengani zambiri za vuto lomwe limakhalapo ndi mbola .
Ngati muli ndi angina yolimba lerolino, katswiri wanu wa moyo sayenera kukhala wokondwa pochita PCI. Kuwongolera sikungathetseretu vuto lanu lachipatala (ngakhale ngati likugwira bwino angina anu); M'malo mwake, kupsa mtima kudzagulitsa vuto lalikulu la kasamalidwe kwa wina.
M'malo modumphira ku PCI, nthawi zambiri katswiri wa zamoyo ayenera kulimbikitsa mayesero aukali, omwe amatsutsa njira zothandizira kuchipatala, ndipo munthu yemwe ali ndi angina wodekha ayenera kulandira lingaliro la kuyamba mankhwala. Onse awiri ayenera kukhala oleza mtima, chifukwa kupeza chithandizo chabwino cha mankhwala kungatenge milungu ingapo kapena miyezi ingapo.
Ngati vuto la angina lidalibe vuto ngakhale pambuyo poyesedwa mwankhanza za mankhwala, ndiye kuti pakufunika kulingalira mozama kwa stent. Werengani zambiri ngati mukufunadi stent .
Mawu Ochokera
Chigamulo cha ORBITA chimachititsa chisokonezo chachikulu padziko lonse lapansi pokhudzana ndi chithandizo cha mankhwala a angina.
Komabe, ngati muli ndi angina yowonongeka, zotsatira za mayeserowa siziyenera kupweteka kwambiri mankhwala anu, malinga ngati inu ndi dokotala mukuyang'ana mozama umboni.
Ngakhale kuti mayeso a ORBITA sakuwoneka kuti akuyenera kusintha momwe angina ayenera kukhalira osasunthika, izo zikutanthauza kusintha kwa momwe wakhala akuchiritsidwa ndi akatswiri a cardiologists.
> Zotsatira:
> Lamee R, Thompson D, Dehbi HM, et al. Kuthamanga kwa Coronary Percutaneous In Stable Angina (Orbita): Kuyesedwa Kowonongeka, Kowonongeka. Lancet 2017; DOI: 10.1016 / S0140-6736 (17) 32714-9. Zosintha
> Brown DL, Redberg RF. Nsalu Yomaliza M'kabokosi Kwa Pci Mu Angina Wolimba? Lancet 2017; DOI: 10.1016 / S01406736 (17) 32757-5. Mkonzi
> Kampani Yogwiritsa Ntchito Angiography ndi Njira Zothandiza. SCAI ikuyesa mphamvu ndi zofooka za mayeso a Sham PCI. November 2, 2017. https://medicalxpress.com/news/2017-11-scai-strengths-weaknesses-sham-pci.html