Njira Zamankhwala ndi Zopangira Opaleshoni kwa Carotid Artery Yanu
Mitsempha ya carotid ndi mitsempha iwiri ya mitsempha yomwe imayenderera pambali pa khosi lanu kulowa mu ubongo wanu. Pamodzi ndi mitsempha iwiri yamtundu kumbuyo kwa khosi, carotids imapereka njira yoti ubongo ulandire magazi omwe amafunikira mpweya.
Mwachidule
Monga mitsempha ina iliyonse, carotids ikhoza kuonongeka. Kuthamanga kwa magazi, cholesterol kwambiri, ndi kusuta ndi njira zochepa zowonjezera pangozi ya zomangira zida za carotids ndi mitsempha ina.
Pamene chipika chimakwera mu chotengera cha mtima, chikhoza kuyambitsa matenda a mtima . Pamene pulasitiki ikamangika muziwiya zamagazi kapena poyenda kupita ku ubongo, ikhoza kuyambitsa sitiroko .
Carotid stenosis ndi mawu omwe amagwiritsidwa ntchito posonyeza kachipangizo kakang'ono ka karotid. Pamene chipika chimachepetsanso mitsempha ya carotid, imatha kuyambitsa sitiroko m'njira ziwiri. Njira yowonjezereka ndiyo mbali imodzi ya chipika kuti iwonongeke, kupanga mawonekedwe, ndikuyenda mumitsinje ya magazi mpaka itakhala yolimba ndipo imatseka kutuluka kwa magazi ku mbali ya ubongo. Minofu imamwalira chifukwa cha kusowa kwa mpweya - ichi chimatchedwa ischemia .
Carotid stenosis ingachepetsenso kuchepa kwa magazi ku ubongo kotero kuti ngati kuthamanga kwa magazi kudumpha, gawo la ubongo malinga ndi mzere umenewo sulandira magazi okwanira. Chochitikachi sichinthu chocheperapo kusiyana ndi kumangidwe chifukwa ubongo umamangidwa kuti uzipereka minofu kuchokera pa mzere umodzi pa nthawi imodzi, monga mtundu wochenjera pa kuwonongeka kwa ischemic.
Kuchiza
Chifukwa chakuti carotid stenosis ndi yoopsa kwambiri chifukwa cha kupwetekedwa, sizingangonyalanyazidwa. Komabe, pali kutsutsana kwina momwe carotid stenosis imathandizidwira bwino. Pali njira zitatu zowonetsera carotid stenosis:
- mankhwala
- chithandizo cha opaleshoni (carotid endarterectomy)
- zochepa zowonjezereka zopanda mphamvu .
Kuchiza
Mpaka pomwe, chithandizo chachipatala cha carotid stenosis chiri chonse choganiza kuti ndicho chabwino kwambiri. Mwachitsanzo, ngati mitsempha ya carotid ndi yochepa kwambiri kuposa 50%, kawirikawiri sikusowa mankhwala opatsirana.
M'malo mwake, chithandizo chimayang'ana pakuonetsetsa kuti phula silikula. Zinthu zoopsa monga kusuta fodya, kuthamanga kwa magazi komanso cholesterol chofunika kwambiri. Monga nthawi zonse, zakudya ndi mazochita olimbitsa thupi zimakhala zofunika kwambiri.
Kuonjezera apo, dokotala nthawi zambiri amapereka mtundu wina wa magazi wochepetsetsa pofuna kuteteza khungu kuti lisapangidwe ndi kutseka chida kapena kupita ku ubongo. Malingana ndi kuopsa kwake, izi zikhoza kukhala ndi aspirin monga chinthu china monga Coumadin.
Akatswiri ambiri amavomereza kuti chithandizo chamankhwala chabwino kwambiri chakhala chikupitirirabe bwino pakapita nthawi, kuti chikhale cholimba kwambiri poyerekeza ndi njira zowonjezera zambiri.
Kuchiza Opaleshoni
Carotid endarterectomy (CEA) ndi njira yopaleshoni yomwe mchere umatsegulidwa ndipo chipikacho chimasulidwa. Carotid endarterectomy yakhala ikuphunzitsidwa bwino, ndipo deta ikuwonetsa kuti izo zimapangitsa bwino kwambiri zotsatira pazochitika zosankhidwa. Izi zikuphatikizapo zotsatirazi:
- Ma carotid ayenera kutsekezedwa (nthawi zambiri oposa 60%) koma osatsekedwa kwathunthu.
- Dokotala wa opaleshoni ayenera kukhala wusowa, ali ndi chiwerengero chochepa chakumwalira chogwirizana ndi opaleshoniyo.
- Wodwalayo ayenera kukhala wathanzi kuti athe kuchira bwinobwino.
Zotsatira zoopsa za CEA zikuphatikizapo 3 kapena 6 peresenti ya chiopsezo cha mimba kapena imfa. Pakadutsa mwezi mutatha njirayi, chiopsezo cha matenda a mtima chimawoneka chachikulu kwa odwala omwe amalowa mu CEA kuposa momwe amachitira phokoso (onani m'munsimu). Komanso, chifukwa mitsempha yambiri yamagetsi imalandira magazi mwa chotengera ichi, ikhoza kuonongeka pa opaleshoni. Kuwonjezera apo, kutsegula carotid kungayambitse kuvulala kwa hyperperfusion , yomwe ndi pamene ubongo sungathe kulamulira kuwonjezeka kwatsopano m'magazi, zomwe zingayambitse kupweteka mutu, kugwidwa, ndi kuperewera kwa ubongo.
Mitsinje ya Carotid Yowopsya
Mitsempha ya karotidi yowuma (CAS) imaphatikizapo catheter yopyapyala yomwe imatengedwa kudzera m'mitsempha ya mitsempha, kawirikawiri imayamba kuchokera ku mitsempha ya chikazi mu ntchafu, mpaka kumtambo wa carotid. Izi zimachitika pansi pa chitsogozo cha fluoroscopic , kotero katswiri akhoza kuona zomwe akuchita. Katheta ikakhala pamalo, mbola imayikidwa mu mitsempha kuti itsegule ndikutsegula. Nthawi zambiri, nthawi yowonongeka kuchokera ku CAS ndi yofulumira kuposa ya CEA.
Anthu ambiri amakonda lingaliro la carotid lopweteka chifukwa limawoneka ngati losawonongeka kusiyana ndi carotid endarterectomy. Komabe, kupweteketsa sikunayambe konse ngati CEA, ndipo kuli ndi ngozi. Maphunziro oyambirira ankawoneka kuti kuopsa kwa kupsa mtima kunali kwakukulu kuposa CEA. Komabe, maphunzirowa akhala akudzudzulidwa poyerekeza madokotala omwe sadziwa zambiri akuchita madokotala kwa madokotala odziwa zambiri a CEA.
Kafukufuku wa 2010 ku New England Journal of Medicine wasonyeza kuti ngakhale kupweteka kungakhale kogwira mtima ngati CEA potsegula mitsempha, chiopsezo cha kugwidwa kogwirizanitsa ndi ndondomekoyi ndipamwamba kuposa ku CEA, mwinamwake mwezi woyamba utatha.
Zotsatira za Chithandizo
Choyamba ndi kusankha ngati chithandizo chilichonse chopanda mankhwala chikufunikanso. Chofunika chachikulu pakupanga zisankho ndi chakuti stenosis yayambitsa kale matenda kapena ayi. Ngati sichoncho, ndipo ngati stenosis ilibe pafupi 80%, madokotala ambiri amasankha okha chithandizo chamankhwala. Ngati sitiroko yachitika, zikhoza kukhala chisonyezero chakuti chithandizo chowawa choposa chikufunika. Ngati stroke ndi yaikulu kwambiri, komabe sipangakhale zokwanira za ubongo kuti ziwonetsere kuopsa kwa njirayi.
Kuchokera kumayambiriro kwake kumapeto kwa zaka za m'ma 1990, kuphulika kwa carotid kwapang'onopang'ono kwayamba kutchuka. Medicare tsopano ikukhudzana ndi ndondomeko pansi pazimene zimasankhidwa. Pamapeto pake, chithandizo chabwino chidzadalira khalidwe lapadera la wodwala, madokotala, ngakhale inshuwalansi.
Kafukufuku wina wasonyeza kuti zinthu monga kutalika kwa stenosis ndi mawonekedwe a chikhomo ndi chotengera cha magazi zingakhudze mwayi kuti CAS idzapweteka. Okalamba amakhala ochepa kwambiri kuposa achinyamata, ngakhale munthu wachikulire wathanzi angachite bwino.
Inshuwalansi imathandizanso. Medicare kawirikawiri imaphimba CAS kwa odwala omwe ali ndi chiopsezo chachikulu kwa CEA omwe ali ndi 70% stenosis. Mitundu ina ya stenosis (pafupifupi 90%) imayenera kusamalidwa mwanjira ina.
Pamapeto pake, kupanga chisankho chokhudza momwe mungagwiritsire ntchito carotid stenosis ndipadera ngati munthu amene ali ndi stenosis. Kafufuzidwe kaŵirikaŵiri kawirikawiri, ndipo chifukwa chakuti pali ndalama zopangidwira ndi njira iliyonse, zingakhale zovuta kupeza malingaliro osakondera. Musawope kufunsa dokotala oposa mmodzi pazochita zawo.
Zotsatira:
Brott TG, et al. Kulimbana ndi matenda otchedwa endarterectomy kuchiza carotid-artery stenosis. N Engl J Med . 2010 Jul 1; 363 (1): 11-23. Epub 26 May 2010.
Ropper AH, Samuels MA. Adams ndi Victor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009. McCabe MP, O'Connor EJ.
Sharon Swain, Claire Turner, Pippa Tyrrell, Anthony Rudd m'malo mwa Guideline Development Group, Kuzindikira ndi kuyang'aniridwa koyamba kwa masewera olimbitsa thupi ndi osakhalitsa a ischemic: chidule cha malangizo a NICE, BMJ 2008; 337: a786, July 24, 2008
Tu JV et al. Zowopsa za imfa kapena kupwetekedwa pambuyo pa carotid endarterectomy: zochokera ku Ontario Carotid Endarterectomy Registry. Sitiroko . 2003 Nov; 34 (11): 2568-73.
KUDZIZIRANI: Zomwe zili pa tsamba ili ndi zolinga za maphunziro okha. Sitiyenera kugwiritsidwa ntchito ngati choloweza m'malo mwa chisamaliro cha munthu wodwala wovomerezeka. Chonde funsani dokotala wanu kuti apeze matenda ndi chithandizo cha chilichonse chokhudza zizindikiro kapena matenda .