Chithandizo chachikulu cha matenda a m'magazi ndikutenga ndondomekoyi msanga ndikudziwitseni ndikusamalira chifukwa chake. Komabe, kwa odwala ambiri omwe ali ndi vutoli, chithandizo chopititsa patsogolo kwambiri chikufunika.
Kusanthula kwa Baseline
Chinthu choyamba chochiza kupatsirana kwapachiphuphu ndiko kuyesa kuopsa kwa chikhalidwe. Kuyesedwa kumathandiza dokotala kusankha chisangalalo chokhala ndi chithandizo, ndipo amapereka njira yowunikira yankho la mankhwala.
Izi kawirikawiri zimachitidwa mwa kupanga echocardiogram , yomwe idzapereka kulingalira kwa mitsempha ya pulmonary kukakamizidwa, ndi kuyesa zochita masewero kuti awonetse mphamvu yoyamba yamagetsi.
Kuchiza Kuchokera Pachikhalidwe Chachidokotala Chachidwi
Kawirikawiri, kuchiza mofulumira chomwe chimayambitsa matenda a shuga ndi mankhwala ovuta kwambiri. Popeza pali mavuto ambiri azachipatala omwe angabweretse vuto laumphawi, mankhwalawa akhoza kutenga mitundu yosiyanasiyana.
Mankhwala Ambiri Othandiza Kwa Aliyense Amene Ali ndi Kuthamanga Kwambiri kwa Magazi
Kuwonjezera pa mankhwala omwe cholinga chake chikuwunikira makamaka chifukwa chowunikira chifukwa chake, pali mankhwala omwe nthawi zambiri amathandiza kwa aliyense amene ali ndi matenda oopsa kwambiri.
Izi zikuphatikizapo:
- Diuretics monga Lasix kapena Bumex nthawi zambiri amagwiritsidwa ntchito pofuna kuteteza kusungunuka kwa madzi komwe kawirikawiri kumachitika ndi matenda opatsirana. Ngakhale kuti diuretic imatha kusintha dyspnea ndi edema (kutupa), ziyenera kugwiritsidwa ntchito mosamala popeza kuchotsa madzi ambiri kwa odwala omwe ali ndi matenda oopsa kwambiri akhoza kuwononga mphamvu ya mtima.
- Thandizo la okosijeni ndi lofunika kwa aliyense amene ali ndi matenda oopsa omwe ali ndi hypoxia (kuchepa kwa magazi). Pamene hypoxia ilipo, kupereka oxygen nthawi zambiri kumachepetsa msampha wamatope. Odwala omwe amatulutsa matenda a m'mapapo amayamba chifukwa cha matenda a m'mapapo kapena matenda a mtima, makamaka amakhala ndi hypoxia, koma aliyense amene ali ndi matenda oopsa a m'magazi ayenera kuyang'anitsitsa magazi ake.
- Anticoagulants monga Coumadin nthawi zambiri amagwiritsidwa ntchito kwa odwala omwe ali ndi matenda oopsa kwambiri. Izi zili choncho chifukwa kupweteka kwapopu kumapangitsa kuti magazi aziyenda bwino m'magazi, zomwe zingayambitse kutsekera m'mitsempha mwazi m'mapapo. Werengani za mankhwala ogwiritsidwa ntchito pofuna kuteteza magazi .
- Digoxin amatha kugwira ntchito ya mtima kwa odwala omwe ali ndi matenda oopsa a m'magazi.
- Kuchita masewera olimbitsa thupi kwasonyezedwa kuti ziwathandize kwambiri mphamvu zogwira ntchito za anthu omwe ali ndi matenda oopsa kwambiri.
Thandizo Labwino
"Kupititsa patsogolo mankhwala" kwapoponopayaloni kumayambitsa matenda a chiwopsezo, osati chifukwa choyambitsa. Mankhwalawa nthawi zambiri amagwiritsira ntchito mankhwala a vasodilator pofuna kuyesa kuchepetsa kapangidwe ka pulmonary ndikuchepetsanso mitsempha ya pulmonary.
Thandizo lapamwamba limatchedwa "lapamwamba" osati chifukwa chakuti ndi lothandiza kwambiri kuposa mankhwala ochiritsira, koma chifukwa ndi lovuta, losaopsa, lopambana kwambiri, ndipo nthawi zambiri limakhala lovuta (mwachitsanzo, lingathenso mankhwala opatsirana). Thandizo lapamwamba liyenera kuperekedwa ndi madokotala omwe ali katswiri pa kuchiza matenda a m'magazi.
Thandizo lapamwamba likuganiziridwa kwa odwala omwe ali ndi matenda oopsa omwe amachititsa kuti asamayambe kuchipatala, kapena makamaka, ngati palibe chifukwa chodziwikiratu (ndiko kuti, mwa anthu omwe ali ndi chiopsezo chachikulu cha pulmonary).
Thandizo lapamwamba silikugwiritsidwa ntchito konse kwa anthu omwe matenda awo a m'magazi amayamba chifukwa cha matenda a mtima (pamene mankhwala opatsirana amasonyeza kuti akhoza kuvulaza), kapena matenda a m'mapapo (kumene kulibe deta yosonyeza kupindula) .
Musanayambe kupita kuchipatala, kafukufuku wapadera wa kanyonga wa mtima ukuchitidwa kuti aone "zosavuta" zomwe zimachitika m'magazi. Pachiyeso ichi, mankhwala amaperekedwa kuti aone ngati mitsempha ya m'magazi ikhoza kuyendetsa. Ngati ndi choncho, mitundu ina ya mankhwala apamwamba ndi othandiza kwambiri.
Mankhwala ambiri apangidwa kuti athe kuchiza matenda a m'magazi, kuphatikizapo:
- Njira ya calcium yomwe imakhala ngati diltiazem ndi nifedipine
- Prostanoids monga Flolan (epoprostenol), Remodulin (treprostinil), ndi Ventavis (iloprost)
- Omaliza antchito a Endothelin monga Tracleer (abwana), Letaris (ambrisentan), ndi Opsumit (macitentan)
- PDE5 inhibitors monga Viagra (sildenafil), Cialis (tadalafil), ndi Levitra (vardenafil)
- Guanylate cyclase stimulant monga Adempas (riociguat)
Mndandanda wautali wa zisankho umapanga ndondomeko yosankha mankhwala abwino kwambiri kapena mankhwala osokoneza bongo kwambiri. Pali zinthu zingapo zomwe ziyenera kuganiziridwa pakupanga chisankho ichi, kuphatikizapo matenda opatsirana, kuopsa kwa pang'onopang'ono, kuthamanga kwa vasoreactivity, ngakhale mankhwala ena amadziwika ndi inshuwalansi ya zachipatala, komanso zotsatira zake. Ichi ndi chifukwa chake zisankho zoterezi ziyenera kupangidwa ndi madokotala omwe ali akatswiri ochizira matenda a m'magazi.
Chidule
Njira yabwino kwambiri yothandizira matenda a m'magazi angakhale ovuta komanso ovuta. Odwala omwe ali ndi matenda oopsa kwambiri amapanga mgwirizano wapamtima ndi madokotala awo, akugwira ntchito mwakhama posankha chithandizo, pofufuza ndi kuwonetsa mosamala za momwe zizindikiro zawo zimakhalira komanso mphamvu zawo zothandizira, ndikutsatira ndondomeko ya mankhwala ovomerezeka.
Zotsatira:
Galie, N, Hoeper, MM, Humbert, M, et al. Malangizo othandizira matenda ndi matenda a pulmonary hypertension. Eur Respir J 2009; 34: 1219.
McLaughlin VV, Archer SL, Badesch DB, et al. ACCF / AHA 2009 akatswiri ovomerezeka za chidziwitso chokhudzana ndi matenda oopsa kwambiri a zachipatala a Lipoti la American College of Cardiology Foundation Task Force on Expert Consensus Documents ndi American Heart Association ikugwirizana mogwirizana ndi American College of Chest Physicians; American Thoracic Society, Inc ;; ndi Association of Hypertension Association. J Am Coll Cardiol 2009; 53: 1573.
Galiè N, Corris PA, Frost A, et al. Anasinthidwa ndondomeko ya mankhwala ya pulmonary arterial hypertension. J ndi Coll Cardiol 2013; 62: D60.