Thandizo losavuta, kapena lachilendo, mankhwala?
Kodi Angina Angatani?
" Stable angina " amatchedwa kuti madokotala amagwiritsira ntchito kufotokoza zizindikiro za matenda a mitsempha yotchedwa coronary artery disease (CAD) yomwe imapangidwa ndi chikhomo chosasunthika. Chifukwa chakuti chipikacho sichikusintha (kapena chikusintha kokha pang'onopang'ono), zizindikiro zomwe zimabweretsa (kawirikawiri, kupweteka kwa chifuwa) zimakhala zosawerengeka.
Izi zimatchedwa angina.
Zolinga Zopangira Angina Wolimba
Dokotala akamalimbikitsa chithandizo kwa munthu yemwe ali ndi vuto la angina, pali zolinga zitatu zosiyana zomwe onse awiri ayenera kukumbukira:
- Kuchotsa kapena kuchepetsa zizindikiro za angina.
- Kuchepetsa kuchepa kwa matenda a atherosclerotic omwe amapanga mabala.
- Kuletsa kuyambitsa mavuto aakulu mtima, kuphatikizapo matenda aakulu (ACS) , mtima wosagonjetsedwa , ndi imfa.
Njira iliyonse yothandizira - mankhwala opatsirana kapena mankhwala a mankhwala - chithandizochi chiyenera kupititsa patsogolo mwayi wokwaniritsa zolinga zitatuzi.
Zovuta zotsutsana ndi Chithandizo Chosachitidwa
Njira yowonongeka ya angina yowonongeka ndiyo kuthetsa mitsempha yambiri mu mitsempha yamakono yomwe imadutsa opaleshoni , kapena angioplasty ndi stenting .
Ngakhale zikhoza kuwonekera ngati kuganiza kuti kuchepetsa kutsekula kwabwino kumapereka zotsatira zabwino, zaka zambiri za maphunziro a zachipatala zasonyeza kuti nthawi zambiri izi sizimene zimachitika. Nthaŵi zambiri, chithandizo chamankhwala chokha chimabweretsa zotsatira zachipatala zomwe ziri zabwino kapena zabwino kusiyana ndi zotsatira zomwe zimaperekedwa ndi opaleshoni kapena kupopera.
Akatswiri ambiri amalimbikitsanso kuyamba ndi njira zosavomerezeka, zamankhwala anthu ambiri okhala ndi angina okhazikika. Njira imeneyi "njira yothetsera mankhwala yoyamba" imasonyeza njira yatsopano yoganizira za CAD .
Komabe, pali zinthu ziwiri zomwe chithandizo chosafunika chiyenera kuganiziridwa mozama. Chithandizo chovuta chingakhale bwino kwa:
- Anthu omwe angina sangathe kulembedwa bwino ndi mankhwala.
- Anthu omwe ali ndi mitsempha yambiri yamakono, yomwe zotsatira zake ndi mankhwala ochiritsira okha adziwonetseratu kuti ndi oipitsitsa kusiyana ndi chithandizo chosautsa.
Gawo lotsirizali likuphatikizapo anthu omwe ali ndi mitsempha yamtundu wachitsulo, kapena omwe ali ndi nthenda zitatu, kapena omwe ali ndi matenda kumanzere kumanzere kutsika kwa mitsempha kuphatikizapo matenda m'thupi limodzi.
Kwa anthu ambiri okhala ndi angina okhazikika, komabe, chithandizo chamankhwala ndi njira yosankhika.
Chithandizo chachipatala cha Stable Angina
Kuti chithandizo chamankhwala chikhale chothandiza kuchepetsa zizindikiro, kupewa ACS, ndi kupititsa patsogolo moyo wa anthu omwe ali ndi angina okhazikika, ntchito zochiritsira zingapo ndizofunikira. Izi zikuphatikizapo mankhwala opatsirana ndi kukonzanso moyo.
(Kuti zikhale zomveka, kukhathamiritsa moyo ndi kofunika ngakhale ngati njira yosavuta yothetsera mankhwala imasankhidwa.)
Kuchiza Kuchotsa Angina
Mankhwala anayi osiyanasiyana amagwiritsidwa ntchito masiku ano pofuna kuthetsa zizindikiro za angina bwinobwino. Anthu ambiri omwe ali ndi vutoli adzalandira mankhwala awiri kapena kuposa awa:
Ophwanya Beta: Otseka Beta amachepetsa zotsatira za adrenaline pamutu wa mtima, zomwe zimachepetsa kuthamanga kwa mtima ndi mphamvu ya mitsempha ya mtima, kotero kuchepetsa kufunika kwa mpweya wa mtima. Mankhwalawa amathandizanso kuti odwala omwe ali ndi CAD apulumuke. Ayenera kugwiritsidwa ntchito kwa aliyense amene ali ndi angina wolimba.
Werengani za beta block mu chithandizo cha angina .
Calcium blockers: Ma calcium blockers amachepetsa calcium yambiri mu mtima, komanso imakhala ndi mitsempha ya mitsempha yosalala. Izi zimapangitsa kuti magazi aziwombera, kuchepetsa mtima, komanso kuchepetsa mphamvu ya kumenya mtima - zonse zomwe zimachepetsa mtima wa oxygen. Werengani za kashiamu ochizira matenda a angina .
Nitrates: Nitrates zimayambitsa mitsempha ya magazi, yomwe imachepetsa nkhawa pa minofu ya mtima, motero amachepetsa kufuna kwa mtima kwa mpweya. Werengani za nitrates pochiza angina .
Ranexa (ranolazine): Ranexa ndi mankhwala atsopano a anti-angina omwe amawoneka akugwira ntchito potseka zomwe zimatchedwa "latedium channel" m'maselo a mtima omwe akuvutika ndi ischemia. Kuletsa njira iyi ya sodium kumalimbitsa maselo a mtima wa ischemic, kuchepetsa kuwonongeka kwa minofu ya mtima, komanso kuchepetsa zizindikiro za angina. Werengani zambiri zokhudza Ranexa pochiza angina .
Kodi mankhwalawa amagwiritsidwa ntchito bwanji? Aliyense amene ali ndi malo abwino angina ayenera kuikidwa pa beta blocker. Nitroglycerin (imodzi mwa nitrates) iyenera kuperekedwa kuti ikhale yogwiritsidwa ntchito moyenera pamene ikuyenera kuthana ndi zochitika zonse za angina. Ngati beta blockers okha satha kuchotsa angina, ndiye mankhwala otalikitsa otchedwa nitrate therapy kapena calcium channel (kapena onse awiri) akuwonjezeredwa. Ranexa, akadali mankhwala atsopano, nthawi zambiri amaperekedwa ngati mankhwala achitatu kapena achinayi ngati kuli koyenera - koma akatswiri ena a cardiologists awona kuti ndi othandiza powonjezeredwa kale.
Kuchiza Kuchiritsa Kutentha kwa CAD
Thandizo la antiplatelet: Pofuna kuchepetsa chiopsezo cha ACS, aliyense amene ali ndi angina ayenera kukhala mankhwala kuti achepetse magazi. Kwa anthu ambiri izi zimatanthauza mankhwala a aspirin tsiku lililonse (75 mpaka 325 mg / tsiku). Plavix (clopidogrel) ingagwiritsidwe ntchito kwa anthu omwe amatsutsa aspirin.
Zinthu Zowopsya Kusintha: Kuchepetsa kukula kwa matenda a atherosclerosis n'kofunika kwambiri. Izi zikutanthauza kulamulira kuthamanga kwa magazi , osasuta fodya, kulamulira kulemera, kuchiza ndi statin , kuteteza shuga, ndi kuchita masewera olimbitsa thupi.
Mankhwala opatsirana: Kuwonjezera pa kuchepetsa kukula kwa matenda a atherosclerosis, kuchita masewera olimbitsa thupi nthawi zonse kungakhale mankhwala othandiza kuti angina akhale bwinobwino. Zochitika zosavuta, zochepa kwambiri zozizira (monga kuyenda, njinga zamoto) "amaphunzitsa" mtima wa mitsempha ndi minofu kuti zikhale bwino kwambiri. Izi zikutanthauza kuti masewero apamwamba a masewera olimbitsa thupi angapezeke popanda kuchititsa angina. Anthu odwala angina ayenera kufunsa dokotala wawo kuti atumizidwe ku pulogalamu ya kukonzanso mtima kuti awathandize kukhala ndi pulogalamu yowonongeka nthawi zonse.
Zina Zoganizira Pochiza Angina Wolimba
Kupanikizika Kwambiri: Kupanikizika kolakwika kungakhale kovulaza kwa aliyense amene ali ndi CAD, ndipo pulogalamu yochepetsa kuchepetsa nkhawa ingakhale yothandiza.
- Werengani za nkhawa ndi mtima.
- Werengani za kusamalira maganizo.
Kusuta fodya: Kutseka kusuta kunatchulidwa poyamba, koma izi ndi zofunika kwambiri kuti ziitanidwe kachiwiri. Kupitiriza kusuta kungakhale, ndipo nthawi zambiri, ndizoopsa kwa munthu yemwe ali ndi CAD. Kusuta fodya ndikoyenera.
Kupititsa patsogolo ntchito zowonongeka (EECP): EECP ndi mankhwala apadera a angina okhazikika omwe angakhale othandiza kwa odwala ena, koma omwe ambiri amatsitsi a mtima amanyalanyaza.
Pogwiritsidwa ntchito molimbika komanso moyenera, njira yodalirika yochizira angina yowonjezera imabweretsa zotsatira zomwe zingakhale zofanana, osati zabwino, kusiyana ndi zotsatira zomwe zimapezeka ndi mankhwala opatsirana. Komabe, pali njira iliyonse yomwe mungasankhe, kumbukirani kuti CAD ndi matenda aakulu omwe amayamba kupita patsogolo. Muyenera kugwira ntchito mwakhama ndi katswiri wanu wa cardiologist kuti muyang'ane ndikuyambiranso matenda anu pakapita nthawi, ndipo onetsetsani kuti mankhwala anu akusinthidwa mosalekeza.
Zotsatira:
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF / AHA / ACP / AATS / PCNA / SCAI / STS chitsogozo cha matenda ndi matenda a odwala omwe ali ndi matenda a mtima a Ischemic: Lipoti la American College Association la Cardiology Foundation / American Heart Association pazochita zogwiritsa ntchito, ndi American College of Physicians, American Association for Odwala Opaleshoni, Opaleshoni Yopereka Mavoti Achikondi, Association of Cardiovascular Angiography and Interventions, ndi Society of the Thoracic Surgeons. Kuthamanga kwa 2012; 126: e354.
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS ndondomeko yeniyeni ya chitsogozo cha matenda ndi matenda a odwala omwe ali ndi matenda a mtima a Ischemic: Report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines, ndi Association Association of American Surgery Surgery, Association of Cardiovascular Nurses Association, Society of Cardiovascular Angiography and Interventions, ndi Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64: 1929.