Kupititsa patsogolo kunja kwapadera (EECP) ndi njira yamagetsi yokha ya angina . Ngakhale kuti kafukufuku wamaphunziro angapo amasonyeza kuti chithandizochi chingakhale chothandiza kuchepetsa zizindikiro za angina kwa odwala omwe ali ndi matenda oopsa amtundu wa matenda (CAD) , EECP sichiyenera kuvomerezedwa ndi akatswiri ambiri a mtima, ndipo sichilowetsedwe kachitidwe ka mtima.
Kodi EECP ndi chiyani?
EECP ndiyo njira yomwe makina oteteza inflatable cuffs (monga magazi amakakamiza cuffs) amachitilira miyendo yonse ya wodwalayo. Pamene wodwalayo wagona pabedi, zikho zophimba mwendo zimakhutitsidwa ndi deflated synchronously ndi mtima uliwonse. Kupuma kwa mankhwala ndi kutentha kumayang'aniridwa ndi makompyuta, omwe amagwiritsa ntchito ECG wodwalayo kuti ayambe kutsika kwapang'onopang'ono kumayambiriro kwa diastole (pamene mtima umatsitsimula ndipo uli wodzazidwa ndi magazi), ndi kutaya monga momwe dongosolo la mtima limapangidwira. Kutsika kwa makapu kumachitika sequentially, kuchokera kumunsi kwa miyendo mpaka kumtunda, kuti magazi mu miyendo "amwedwe" mmwamba, kumtima.
EECP ili ndi zinthu ziwiri zomwe zingathandize pamtima. Choyamba, kuyendayenda kwa miyendo ya mwendo kumapangitsa kuti magazi alowe ku mitsempha yamakono pa diastole . (Mitsempha yotchedwa coronary arteries, mosiyana ndi mitsempha yina m'thupi, amalandira magazi awo pakati pa zipsinjo za mtima, m'malo mwa kugunda kwa mtima.) ChachiĊµiri, mwa kuwonongeka kwa mtima monga momwe mtima ukuyamba kumenyera, EECP imapanga chinthu chonga kutuluka mwadzidzidzi mu mitsempha, yomwe imachepetsa ntchito yomwe minofu ya mtima imachita popopera magazi.
Zanenanso kuti EECP ingathandize kuchepetsa kuperewera kwa matenda osatha.
EECP imayendetsedwa ngati mankhwala ochiritsira odwala. Odwala amalandira magawo 5 ora limodzi pa sabata, kwa masabata asanu ndi awiri (pa zokwana 35). Gawo la ora limodzi la 35 likukonzekera kusintha maulendo opindulitsa kwa nthawi yaitali m'thupi.
Kodi EECP Ndi Yothandiza Motani?
Kafukufuku wambiri akusonyeza kuti EECP ikhoza kukhala yothandiza kwambiri pakuchulukitsa angina osatha. Mayesero ang'onoang'ono owonetsa kuti EECP yakula bwino kwambiri zizindikiro za angina (chiwerengero chaumwini) ndi kupirira zolimbitsa thupi (chiwerengero cholingalira) kwa odwala omwe ali ndi CAD. EECP imathandizanso kwambiri "miyezo ya moyo" poyerekezera ndi mankhwala a placebo. Kafukufuku wina wasonyeza kuti kusintha kwa zizindikiro motsatira ndondomeko ya EECP ikuwoneka kuti ikupitirizabe kwa zaka zisanu (ngakhale odwala mmodzi pa asanu angafunike njira ina ya EECP kuti apitirize kusintha).
Kodi EECP Imagwira Ntchito Bwanji?
Njira yowoneka bwino yomwe ikuwonetsedwa ndi EECP sidziwika. Pali umboni wina wotsimikizira kuti EECP ikhoza kuthandizira kupanga zida zogwirira ntchito pamtengo wamitengo, polimbikitsa kutulutsa nitric okusayidi ndi zina zomwe zikukula mkati mwa mitsempha yamakono. Palinso umboni wakuti EECP ikhoza kukhala ngati "ntchito" yochititsa chidwi, zomwe zimayambitsa kusintha kosalekeza komwe kumakhalako mu dongosolo lachitetezo lokhazikika lomwe likuwoneka ndi kuchita masewera olimbitsa thupi.
Kodi EECP Ingakhale Yowopsa?
EECP ikhoza kukhala yosasangalatsa, koma kawirikawiri sikumvetsa chisoni.
Mufukufuku, ambiri mwa odwala alekerera ndondomekoyi bwino.
Koma si aliyense amene angakhale ndi EECP. Anthu mwina sayenera kukhala ndi EECP ngati ali ndi vuto la aortic , kapena ngati ali ndi catheterization yamakono , mtima wamtundu wosasinthasintha monga matenda a atrial , matenda oopsa kwambiri , matenda a mitsempha ya miyendo, kapena mbiri ya thrombosis yakuya kwambiri . Kwa wina aliyense, komabe, ndondomekoyi ikuwoneka kukhala yotetezeka.
Kodi EECP Ikulangizidwa Liti?
Malinga ndi zomwe tikudziwa lero, EECP iyenera kuganiziridwa ndi aliyense yemwe ali ndi angina ngakhale kuti akudwala chithandizo chamankhwala , ndipo amene amachititsa opaleshoni kapena kupyola opaleshoni amaonedwa kuti si abwino.
Medicare yavomereza kuvomereza kwa EECP kwa odwala omwe ali ndi angina omwe atopa kwambiri zosankha zawo zonse.
Mu 2014, bungwe lina la akatswiri (America College of Cardiology, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Association Association, Society of Cardiovascular Angiography and Interventions, ndi Society of the Thoracic Surgeons) potsiriza adagwirizana pa mfundo yomwe EECP ziyenera kuganiziridwa ndi odwala omwe ali ndi angina akutsutsa mankhwala ena.
Nchifukwa chiyani EECP sinagwiritsidwe ntchito nthawi zambiri?
Kawirikawiri, anthu odwala matenda a mtima amasankha kunyalanyaza njira yotereyi, ndipo akatswiri a cardiologists satha ngakhale kuganiza kuti kupereka EECP ngati njira yokha. Chifukwa chake, odwala ambiri omwe ali ndi angina sanamvepo za izo.
Inde, EECP ndi yochepa chabe. Izo sizikuwoneka ngati zamoyo. Palibe amene angathe kufotokozera momwe zimagwirira ntchito. Ndipo, kuchokera ku katswiri wa zamoyo / maganizo, pamene mukuyerekeza zoyesayesa zapadera ndi kubwezera malipiro a EECP ku chinachake monga kuikapo stent (magawo 35 pa masabata asanu ndi asanu ndi asanu ndi asanu ndi atatu pamsana ndi mphindi 30) palibe mpikisano. Kuyembekeza akatswiri a cardilo kuti avomereze EECP ndi changu chilichonse chimanyalanyaza chikhalidwe cha umunthu.
Komabe, ngati chithandizo chosagwiritsidwa ntchito cha angina chiripo chomwe chiri chosalekerera ndi cholekerera, pamene umboni ulipo (monga wopanda ungwiro momwe ungakhalire) umasonyeza kuti mankhwalawa ndi othandiza kwa odwala ambiri, ndipo pamene wodwala akuchiritsidwa adzatha kunena zabwino Kuwonekeratu ngati mankhwalawa athandiza payekha (mwa kukhalapo kapena kuchepa kwa zizindikiro za angina), sizikuwoneka zopanda nzeru kulola odwala kukhala angina osasamala kuti asankhe mayeso a mankhwala osayenera, mwina ngakhale asanaloĊµetsedwe mu mankhwala opatsirana.
Ngati mukuchiritsidwa kuti mukhale angina wodalirika ndipo mulibe zizindikiro ngakhale mukuchiritsidwa, ndi zomveka kuti muthe kuyesa EECP. Dokotala wanu ayenera kukhala wokonzeka kuti akambirane zomwe zingatheke ndi inu, mosamalitsa komanso mopanda tsankho.
Zotsatira:
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.
Arora RR, Chou TM, Jain D, et al. Kuphunzira kwa mitundu yosiyanasiyana yowonjezereka kwapadera (MUST-EECP): zotsatira za EECP pa zochitika zolimbitsa thupi zamagetsi ndichemere. J Am Coll Cardiol 1999; 33: 1833.
Soran O, Kennard ED, Kfoury AG, et al. Zotsatira za zaka ziwiri zokhudzana ndi matenda opatsirana (EECP) odwala omwe ali ndi angina pectoris omwe amatsutsana ndi odwala matendawa (zolembedwa kuchokera ku International EECP Patient Registry). Am J Cardiol 2006; 97:17.