Pamene munthu ali ndi stroke, mankhwala abwino (onse opatsirana kwambiri, ndi mankhwala oletsa kupweteka kwina) zimadalira zomwe zinapangitsa kuti zikhalepo . Choncho ndizofunika kwambiri kuti madokotala asamalire chifukwa chomwe akugwiritsira ntchito.
Mwamwayi, mpaka 40 peresenti ya anthu a ku America omwe ali ndi stroke amatha kusinthana ndi cryptogenic stroke , zomwe zikutanthauza kuti ngakhale atatha kuchipatala kwathunthu chifukwa cha kupweteka kwawo sichidziwika.
Popanda kudziwa chifukwa chake, njira yabwino yothandizira matendawa akhoza kungoganizira chabe.
Kwa zaka zingapo ofufuza akhala akuyesa kumvetsetsa kuti ndi chiti chomwe chithandizo cha mankhwala chikhoza kuchititsa zikwapu popanda kuyika zozizwitsa zomveka bwino, ndiko kuti, matenda omwe amachititsa kuti agwidwe ndi cryptogenic strokes. Zolakwa ziwiri zomwe zawasamalira kwambiri ndizovomerezeka kwa foramen ovale (PFO) ndi mafinya oopsa . Kusankha ngati PFO mwina ndi chifukwa cha kupweteka kwa cryptogenic kunatsimikizira kuti kuli kovuta ndi kutsutsana.
Zovuta kwambiri ndizoopsa zomwe zimayambitsa matenda a atrial. Kukwapulika, vuto loopsya kwambiri la tizilombo toyambitsa matenda, ndilo nthawi zambiri odwala omwe ali ndi arrhythmia. Ndipo tsopano zikuwoneka kuti kupha tizilombo toyambitsa matenda kungakhale chifukwa chofala kwambiri cha kupweteka kwa cryptogenic kusiyana ndi momwe tinkadziwira kale.
Matenda a Atrial & Cryptogenic Stroke
Ngakhale kuti kawirikawiri zimayambitsa zizindikiro zazikulu (monga mapiritsi ndi kumutu), zizindikiro za matenda opatsirana pogonana zingathe kuchitika popanda kuonetsa zizindikiro zilizonse. Pazochitikazi, ngakhalenso wodwala kapena dokotala angakhale ndi lingaliro loti mafinyria akuwopsa akuchitika. Tsopano zikuwonekera momveka bwino kuti zigawo zoterezi za "subclinical" (ndiko,, zosadziwika) zamagetsi ndizo chifukwa chachikulu cha kupweteka kwa cryptogenic.
Katswiri wa CRYSTAL-AF, womwe unayesera kufufuza momwe kuchulukitsidwa kwa mankhwala odwala matenda a atrial kungakhale koyambitsa zikwapu za cryptogenic, kuyang'ana pa 414 anthu omwe kale anali akukwapula cryptogenic. Ofufuza anaika pang'onopang'ono kagulu kakang'ono kakang'ono kakang'ono kakang'ono ka mtima, kachipangizo kowonetsa (Medtronic, Inc.) - mwa iwo omwe angathe kuyang'ana mtima wa munthu kwa zaka zitatu.
Pamapeto pa phunzirolo, 30 peresenti ya odwala omwe anali ndi ma cardiac oyang'anira anali ndi zizindikiro za matenda opatsirana pogonana. Mosiyana ndi zimenezi, mu gulu lolamulidwa la odwala 220 omwe ma stroke a cryptogenic adayesedwa popanda kuwonetsa mtima kwa nthawi yaitali, zigawo za matenda opatsirana pogonana anadziwika osachepera awiri peresenti.
Izi zimapereka zinthu ziwiri zatsopano za matenda a atrial ndi stroke cryptogenic. Choyamba, kugwiritsira ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana pogwiritsa ntchito mankhwala opatsirana mwinamwake kumayambitsa matenda ochulukirapo kwambiri a cryptogenic kuposa momwe tinkadziwira poyamba. Ndipo chachiwiri, kuyang'ana kwa mtima kwa nthawi yaitali kungakhale kofunikira kuti mudziwe odwala omwe ali ndi vutoli. (Kawirikawiri nthawi yomwe polojekitiyi imatha kuyendetsa polojekitiyi isanakhalepo mu phunziro ili asanathenso kugwiritsira ntchito mankhwala opatsirana pogonana anali masiku 84.)
Kafukufukuwa satsimikizira kuti mankhwala ophera tizilombo toyambitsa matenda amachititsa kuti odwala onsewa asokonezeke, komanso sizitsimikizira kuti kugwiritsa ntchito mankhwala osokoneza bongo kungapindulitse zotsatira zawo.
Mayesero omaliza omwe angapangidwenso padzakhala zofunikira kuti muwonetsetse bwinobwino zinthu izi. Koma tikudziwa kuti anthu omwe ali ndi matenda a cryptogenic ali ndi chiopsezo chachikulu cha kupwetekedwa kwapachilombo, kuti mafinya amachititsa kuti chiopsezo chachikulu chiwonjezeke, ndipo kuti mankhwalawa amachepetsa kwambiri chiopsezo cha matenda opatsirana pogonana. Poganizira zimenezi, 97 peresenti ya odwala a CRYSTAL-AF omwe anadziwika kuti anali ndi matenda oopsa a atrial anaikidwa pa mankhwala osokoneza bongo ndi madokotala awo.
Kuwunika Kwambiri Kwambiri Kwambiri
Malingana ndi zomwe tikudziŵa lero, kuyang'anitsitsa kwa mtima kwa nthawi yaitali kumafunika kuwerengedwa kwa odwala omwe ali ndi vuto la cryptogenic, makamaka ngati madokotala awo asintha malingaliro awo okhudzana ndi zotsatira za kuyang'anira.
Kuwonetsetsa kwa mtima kwa nthawi yaitali kumatheka kwambiri m'zinthu zamakono zochizira. Owonetsetsa a mtima wamtundu wambiri akhoza tsopano kugwiritsidwa ntchito kwa masiku 30, nthawi yowunikira yomwe yasonyezedwa kuti azindikire chiwerengero chachikulu cha odwala omwe ali ndi matenda opatsirana pogonana. Ndipo oyang'anitsitsa miyoyo ya nthawi yaitali-omwe amagwiritsidwa ntchito mu CRYSTAL-AF kuphatikizapo zitsanzo zochepa kwambiri "zam'badwo wotsatira" -zipezeka kupezetsa mankhwala.
Ngati inu kapena wokondedwa wanu muli ndi stroke cryptogenic, ndipo ngati dokotala wanu asintha mankhwala anu malinga ndi ngati kapena ayi mankhwala opatsirana pogonana amapezeka, ndiye muyenera kuyankhula ndi dokotala za kuthekera kwa kuyang'anitsitsa mtima kwa nthawi yaitali.
Zotsatira:
Zotsatira za CRYSTAL-AF Trial. Msonkhano wa International Stroke (ISC) 2014. Wosindikiza LB11. Yaperekedwa pa 14 February, 2014.
Liao J, Khalid Z, Scallan C, et al. Kuwonetsetsa kwina kwa mtima kuti munthu azindikire matenda oopsa a puloteni kapena phokoso pambuyo pa kupwetekedwa kwachilendo kosavuta. Stroke 2007; 38: 2935.
Hylek EM, Pitani AS, Chang Y, et al. Zotsatira za kuchuluka kwa chidziwitso chokamwa pamutu pa kudwala kwapakati komanso kufa kwa odwala. N Engl J Med 2003; 349: 1019.