Kunenepa kwambiri ndi chinthu chowopsya pamtima kutaya kulemera koyambirira kumatha kuthandizira kupewa mtima pamapeto pake. Koma bwanji za njira zopangira opaleshoni zowononga kulemera, monga opaleshoni yachipatala (opaleshoni yolemetsa) ndi zipangizo zolimbitsa thupi ? Kodi iwo angapewe mtima kulephera mtima? Kafukufuku amatsimikizira izi.
Kunenepa Kwambiri ndi Matenda a Mtima
Kunenepa kwambiri ndi kunenepa kwambiri ndi zinthu zomwe, mwatsoka, zimayambitsa zochitika za mitundu yosiyanasiyana ya matenda a mtima kuphatikizapo kuthamanga kwambiri kwa magazi, matenda a mtima, matenda oopsa , kupwetekedwa mtima, ndi mtima wosalimba.
Kunenepa kwambiri ndi chifukwa chachikulu chodziwika bwino cha mtundu wa shuga wa mtundu wa 2 , womwe uli mkati mwawo wokha ndi chiwopsezo chachikulu cha matenda a mtima. Ndipo kunenepa kwambiri ndi chifukwa cha cholesterol chokwanira, chomwe chimayambanso kudziwika bwino chifukwa cha matenda a mtima.
Kuwonjezera apo, kunenepa kwambiri ndi chiopsezo cha mtima wosasinthasintha wamtima wodziwika ngati matenda opatsirana pogonana, ndipo anthu omwe ali ndi matenda a atrial ali pachiopsezo chowopsya. Kulemera kwambiri kumatha kukhudza mbali zambiri za thupi.
Monga tanena kale, pali njira zambiri zomwe kunenepa kwambiri kumapangitsa munthu kukhala pachiopsezo chosiyana ndi matendawa, koma ndibwino kukumbukira kuti kunenepa kwambiri kumawonjezera kutupa thupi lonse, ndipo kutupa kungathandizenso matenda a mtima.
Kunenepa Kwambiri ndi Kulephera kwa Mtima
Choyamba, ndikutani mtima? Mwachidule, pali mitundu iwiri ya mtima wosalimba : systolic mtima kulephera ndi diastolic mtima kulephera.
Mu kuchepa mtima kwa systolic, mtima umatha kupopera mwachizolowezi; Izi zimagwirizanitsidwa ndi kachigawo kakang'ono kamene kamakhala kochepa .
Mu diastolic mtima failure (posachedwa kudziwika kwa mtima ndi kachigawo kakang'ono kamene kamasungidwa), kachigawo kakang'ono ka ejection kameneka, koma mtima sichikuphulika kawirikawiri chifukwa cha minofu ya mtima kukhala yolimba kwambiri.
Matenda onse a systolic ndi diastolic ali ndi zifukwa zosiyanasiyana, ndipo amagawana zifukwa zina, monga kuthamanga kwa magazi, matenda a mitsempha, ndi kunenepa kwambiri .
Kulephera kwa mtima kulikonse kungayambitse zizindikiro za zomwe zimatchedwa congestive mtima kulephera, momwe madzi amadzimadzi amapezera m'mapapu, zomwe zimapangitsa kuti zikhale zovuta kupuma; Madzi amadzimadzi amatha kuwonjezereka m'milingo, kuchititsa kutupa komanso kusokonezeka.
Kotero, mu mtima wolephera, mtima sungakhoze kupopera bwinobwino kapena mwakhama kuti ukhale woyendayenda mokwanira mu thupi lonse.
Ndiye kunenepa kwambiri kumakhudzana bwanji ndi kulephera kwa mtima? Mu chitsogozo cha mtima wosatulutsidwa mu 2013 ndi American College of Cardiology Foundation ndi American Heart Association, kunenepa kwambiri kumayesedwa kukhala chiyambi cha mtima wosalimba.
Mtsogoleli uwu amalembetsa kunenepa kwambiri ngati matenda omwe angakhalepo, pokhapokha atha munthu mu Gawo A la mtima wosalimba. Gawo A, monga likufotokozedwa ndi ndondomeko iyi, ikuphatikizapo onse omwe ali "pachiopsezo cha mtima wosalimba koma alibe matenda a mtima kapena zizindikiro za mtima kulephereka." Izi zikutanthauza kuti, ngakhale kuti munthu wokhutira kwambiri sangakhale ndi zizindikiro kapena Zizindikiro za kufooka kwa mtima, zimaganiziridwa kuti zili pachiyambi cha mtima wosagonjetsedwa chifukwa chokhala ndi kunenepa kwambiri.
Izi zimapereka chitsimikizo chokhudzana ndi kufunika kokhala ndi kunenepa kwambiri popeweratu mtima wolephera.
Opaleshoni ya Bariatri Inapezedwa Kuletsa Kulephera kwa Mtima
Mwamwayi, ntchito yolemetsa imaperekedwa, ndipo ngati muli ndi kunenepa mungathe kuchita bwino kwambiri kuti muteteze matenda a mtima, kuphatikizapo mtima wosalimba, mwa kuchepa thupi. Ngakhale pang'ono kulemera kwa thupi, mu magawo asanu peresenti mpaka khumi peresenti ya kulemera kwakukulu, kungapange kusiyana kwakukulu.
Ndipo tsopano kafukufuku apeza kuti opaleshoni yochitidwa opaleshoni, kuphatikizapo njira monga kupweteka kwa m'mimba , kugwiritsira ntchito manja, ndi kugwiritsira ntchito ma bandolo , kungathenso kuteteza matenda a mtima monga mtima wosalimba.
Pa 2016 American Heart Association Scientific Sessions, ofufuza omwe amatsogoleredwa ndi wolemba mabuku wamkulu John Sundstrom, MD, PhD, pulofesa wa matenda a matenda ku matenda a Edzi University ku Sweden, adafotokoza zotsatira za kufufuza kwakukulu (pafupifupi oposa 40,000 odwala) omwe adapeza kuti odwala ndi kunenepa kwambiri amene anali atachita opaleshoni zachipatala zinali zochepa kwambiri kuti asakhale ndi mtima wolephera kusiyana ndi omwe sanachite opaleshoni koma m'malo mwake adayesa kusintha moyo wawo monga kudya ndi kuchita masewera olimbitsa thupi.
Ofufuzawa amanena kuti zotsatira zochititsa chidwi za opaleshoni ya bariatric zikhoza kukhala chifukwa cha opaleshoni ya opaleshoni yomwe ikudziwika pochepetsa zoopsa za mtima, monga matenda a shuga, kuthamanga kwa magazi, ndi mafinya oopsa.
Mwachitsanzo, mu kafukufuku wopangidwa ndi Jamaly ndi anzake ndipo inafalitsidwa mu Journal of the American College of Cardiology mu December 2016, olembawo anapeza kuti "poyerekeza ndi chisamaliro chachizoloŵezi, kuperewera kwa thupi kudzera mu opaleshoni ya britatric kunachepetsera chiopsezo cha matenda operewera kwa anthu pakati pa anthu amachiritsidwa kwambiri. "N'zochititsa chidwi kuti zotsatira zochepetsa kuchepetsa chiopsezo choterezi zimatchulidwa kwambiri kwa achinyamata komanso anthu omwe ali ndi mavuto aakulu a magazi.
Ndiyeneranso kuzindikira kuti opaleshoni ya bariatric ingayambitse kuperewera kwakukulu kwa nthawi yayitali, monga momwe tawonera mu phunziro la Dr. Sundstrom, momwe, patatha chaka chimodzi atatha opaleshoni, odwala anali atasiya ndalama zokwana mapaundi 41 kuposa omwe adagwira ntchito Moyo wokha umasintha (koma palibe opaleshoni).
Ambiri mwazidzidzidzi chifukwa cha kuwonongeka kwa msinkhu woterewu, nthawi yayitali, opaleshoni yowonjezereka yapezeka mu maphunziro ambiri kuti athe kuchepa kwambiri mu chiwerengero cha shuga ndi kuthamanga kwa magazi, zomwe zimachepetsa chiopsezo chachikulu cha matenda a mtima ( popeza matenda a shuga ndi kuthamanga kwa magazi ndizifukwa zoopsa za matenda a mtima).
Kodi Ndiwe Wosankha Bwino Opaleshoni?
Kotero, mwina mukudabwa ngati ndinu woyenera kuchita opaleshoni ya bariatric. Kumbukirani kuti pali mitundu yosiyanasiyana ya opaleshoni yowonongeka, koma ambiri mwa njirazi ali ndi zofunikira zofanana.
Malinga ndi malangizo atsopano omwe amalembedwa ndi American Heart Association (AHA), American College of Cardiology (ACC), ndi The Obesity Society (TOS), opaleshoni yokhala ndi mwayi wokhala odwala akuluakulu omwe amakwaniritsa zofunikira zina.
Izi zimaphatikizapo thupi lachimake (BMI) la 40 kapena lalikulu, kapena BMI ya 35 kapena wamkulu mwa wodwala amene ali ndi matenda ena (omwe amadziwika kuti "comorbid conditions") amachititsidwa ndi kunenepa kwambiri. Komiti yoperewera kwambiri yotsogolerera wodwala sanapeze umboni wokwanira wolimbikitsa opaleshoni yokhala opaleshoni kwa odwala omwe ali ndi BMIs omwe amagwera pansi pa magawowa.
Malangizowo amalangiza madokotala oyang'anira chisamaliro ndi ena omwe akusamalira odwala omwe ali olemera kwambiri ndi BMI kuti ayesere "kuchipatala popanda mankhwala apamtima" choyamba, ndiye ngati izi sizinagwire ntchito limodzi ndi zakudya zina ndi miyeso ya moyo kuti akwaniritse zolemetsa zochepa, ariatric opaleshoni ingaganizidwe.
Kotero ndi kofunika kuti mukambirane ndi dokotala wanu, ndani angakuthandizeni kusankha ngati mulidi woyenera kuchita opaleshoni ya bariatric ndipo, ngati muli, ndi njira iti yomwe mungakhale nayo.
Njira Zina Mungathe Kuchepetsera Vuto Lanu la Matenda a Mtima
Kuphatikiza pa kulemera kwa thupi, pali njira zingapo zofunika zomwe mungachepetsere chiopsezo cha matenda a mtima mwawo ndi mtima wosalimba makamaka.
Choyamba, dziwani manambala anu. Izi zikutanthauza kuyang'anitsitsa cholesterol yanu, kuthamanga kwa magazi, ndipo shuga lanu la magazi likuyang'aniridwa kuti asadwale shuga kapena shuga. Kulandira thanzi lanu kumaphatikizapo kudziŵa kumene mukuyambira, kotero mutha kudziwa zomwe muli nazo komanso kuthana ndi wina aliyense kuti muchepetse chiopsezo chanu chonse.
Zomwe zikuchitika, zambiri zomwe zimasintha zomwe zimapangitsa kuti zonsezi zikhale zofanana, ndipo zidzakuthandizani kukhala ndi kulemera kwathanzi. Kukhala ndi moyo wathanzi kumatanthauza kutenga masewera olimbitsa thupi tsiku ndi tsiku ndikutsatira ndondomeko yodyera .
Njira imodzi yodyera, makamaka, yasonyezedwa, mobwerezabwereza, kwa zaka zambiri zafukufuku, pofuna kupewa matenda a mtima, ndipo ndi zakudya za Mediterranean.
M'malo mokhala chakudya cha fad kuti munthu amasankha yekha cholinga chochepa cha kuchepa kwa thupi, chakudya cha Mediterranean ndi njira ya moyo, njira yodyera kwa moyo wonse. Ichi ndi chikhalidwe chachikhalidwe cha kudya kwa anthu ambiri okhala m'mayiko ozungulira nyanja ya Mediterranean-choncho dzina.
Zakudya za Mediterranean zimatsindika za kudya zipatso ndi ndiwo zamasamba , mbewu zonse, mtedza wamtengo wapatali, mafuta a azitona, nsomba ndi nkhuku, komanso vinyo (makamaka vinyo wofiira).
Monga bonasi yowonjezera, chakudya cha Mediterranean chinapezeka kuti chimapangitsa kulemera kwa thupi komanso chiopsezo chochepa cha khansa ya m'mawere .
> Zotsatira:
Estruch R, Ros E, Salas-Salvadó J, et al. Kupewa kwakukulu kwa matenda a mtima ndi zakudya za Mediterranean. N Engl J Med 2013; 368: 1279-1290.
> Jamaly S, Carlsson L, Peltonen M, Jacobson P, ndi al. Kuchita opaleshoni ya bariatric ndi chiopsezo chotenga kachilombo koyambitsa matenda osokoneza bongo m'zinthu zovuta kwambiri ku Sweden. J Am Coll Cardiol. 2016; 68: 2497-2504.
> Jensen MD, Ryan DH, Apovian CM, ndi al. 2013 AHA / ACC / TOS chitsogozo cha kulemera kwa kunenepa kwambiri ndi kunenepa kwambiri kwa akuluakulu: lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines ndi The Obesity Society [yofalitsidwa pa Intaneti pa November 27, 2013]. J Am Coll Cardiol.
> Sundstrom J, Bruze G, Ottosson J, Marcus C, ndi al. Bungwe la American Heart Association Scientific Sessions 2016. Zosindikiza (gawo la poster) zakhala zikukhala pa November 14, 2016.
> Yancy CW, Jessup M. Bozkurt B, Butler J, et al. 2013 ACCF / AHA kutsogolera kuyang'anira mtima kulephera: lipoti la American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines. Chizunguliro 2013 Jun 5 [Epub patsogolo pa kusindikiza].