Kodi "Mutu wa Pump" Ndi Weniweni, Ndipo Umatanthauzanji?
Kwa zaka zambiri, m'chipinda cha ochipatala (chomwe chiri chofanana kwambiri ndi zipinda zina zamakono), opaleshoni ya mtima amatha kutchula wina ndi mzake chodabwitsa chomwe nthawi zambiri amatcha "mutu wa pampu." Mutu wamutu unali mawu ogwiritsidwa ntchito Fotokozani kufooka kwa maganizo omwe nthawi zina amawawona mwa odwala awo pambuyo pochita opaleshoni yopitirira opaleshoni .
Iwo anali ndi dzina ili chifukwa choganiza kuti kupweteka kwa chidziwitso pambuyo poti opaleshoni yowonjezereka inali yogwirizana ndi kugwiritsidwa ntchito kwa mapiritsi oyenda pamtima panthawi yopangira.
Kwa nthawi yayitali, kukambilana za zochitika izi sikunapite patali kuposa chipinda chapafupi.
Koma mu 2001, kafukufuku wochokera ku yunivesite ya Duke adawoneka kuti atsimikizira zomwe madokotala ambiri adakayikirapo kale, koma adafuna kukambirana momasuka. Momwemonso, chiŵerengero chachikulu cha anthu pambuyo pa mitsempha ya opaleshoni opitirira opaleshoni amatha kuwona kuwonongeka (koma kawirikawiri) kuwonongeka pamalingaliro awo. Kafukufukuyu adalengezedwa kwambiri atatha kufalitsidwa ku New England Journal of Medicine , ndipo anadetsa nkhaŵa zambiri pakati pa madokotala ndi odwalawo. Koma kudandaula mofulumira kunatha, ndipo anthu ambiri sanamve zambiri za izo kuyambira.
Komabe, m'zaka zapitazi zambiri zakhala zitaphunzira za kusintha kwa maganizo pambuyo pa opaleshoni.
Choyamba, chodabwitsachi ndi chenichenicho. Zina, mwina sizogwirizana ndi kugwiritsa ntchito mpopu, koma zimakhala zogwirizana ndi kusokonezeka kwa mitsempha yambiri yamagazi yomwe ili yofunikira pa opaleshoni imeneyi.
Ngakhale kuti madokotala ochita opaleshoni angakhale osakonda kuyankhulapo pagulu, kupweteka kwa chidziwitso cha opaleshoni pambuyo pa opaleshoni kumakhala kofala kuti anthu omwe ali ndi opaleshoniyi ndi okondedwa awo ayenera kudziŵika kale, kotero iwo ali okonzeka kupirira ngati ziyenera kuchitika .
Kodi Ndikutanthauza Chiyani Chifukwa cha Kusokonezeka Maganizo?
Kulankhula mwachidule, "kupweteka kwa chidziwitso" ndizochipatala zimagwiritsira ntchito zovuta zambiri zomwe zimawoneka pambuyo pa opaleshoni.
Izi zingaphatikizepo chilichonse kapena zonsezi: kusasamala bwino, kukumbukira bwino, kusaganiza bwino, kusalephera kulingalira, kuchepa msinkhu, komanso kuwonongeka kwakukulu komwe kumatha kuganiza bwino. Zizindikiro zoopsa monga diri delirium zikhoza kuonanso kawirikawiri. Zizindikirozi zikhoza kuwonekera mwamsanga pambuyo pa opaleshoni, ndipo zikhoza kukhala zovuta kwambiri kuti zisasokonezeke mosavuta (pazifukwa zomwe maphunziro apamwamba odziwa za ubongo amayenera kuwazindikira).
Zolakolako zamaganizidwe kawirikawiri zimawongolera pang'onopang'ono, pakapita milungu ingapo kapena miyezi ingapo, koma nthawi zina zimatha kupitirira zaka.
Kodi Vutoli N'lofala Motani?
Kuwonjezera pokhala phunziro loyambirira kuti tiyang'ane kwenikweni chodabwitsa ichi, phunziro la Duke la 2001 linanenanso momveka bwino kuti kuwonongeka kwa chidziwitso kungakhale kozizwitsa kawirikawiri, ndipo kumapitirizabe. Mu phunziroli anthu 261 (omwe ali ndi zaka zakubadwa 61) opatsidwa opaleshoni yowonongeka anayesedwa kuti azindikire mphamvu zawo zamaganizo (mwachitsanzo, luso la kulingalira) pa nthawi zinayi zosiyana: asanachitidwe opaleshoni, pa masabata asanu ndi limodzi, pa miyezi isanu ndi umodzi, ndipo patapita zaka zisanu opaleshoni yapitayi.
Ophunzirawo adawona kuti ali ndi vuto lalikulu ngati ali ndi kuchepa kwa 20% pa masewera oyesa. Ofufuzawo anapeza kuti odwala 42% anali ndi dontho la 20% m'masewero oyesa atatha opaleshoni, ndipo nthawi zambiri kuchepa kwa chidziwitso kunapitirira kwa zaka zisanu.
Kupeza kuti kukhumudwa kwadzidzidzi kumachitika pambuyo pa opaleshoni sikunadabwitsa kwa aliyense kusamalira anthu awa. Chodabwitsa chinali choopsa cha vutoli mu phunziro la Duke, ndi kulimbikira kwake. Phunziroli, motero, linayambitsa mavuto ambiri pakati pa madokotala ndi anthu onse.
Kuphunzira kwa a Duke kwatsutsidwa moyenera chifukwa kunalibe gulu lolamulira. M'malo mwake, ofufuzira amayerekezera zotsatira zawo ndi zotsatira zofanana ndi zomwe odwala omwe ali ndi matenda odwala matenda amtundu (CAD) a m'badwo womwewo omwe analibe opaleshoni. Iwo adapeza kuti omwe adalandira opaleshoni yopitirira malire anali ndi vuto lalikulu la chidziwitso kuposa anthu omwe ali ndi CAD omwe sanachite opaleshoni. Komabe, chifukwa anthu omwe amapita opaleshoni nthawi zambiri amakhala ndi CAD yovuta kwambiri, anthuwa sali ofanana mofanana.
Komabe, phunziro lodziwika bwino (limene anthu omwe ali ndi CAD akanachita opaleshoni yawo osasankha opaleshoni mwachisawawa) zikanakhala zosatheka (ngati siziri zosayenera). Poyesera kusonyeza kuti nthawi zambiri vutoli limatsimikiziridwa bwino, zochitika zina zambiri za zochitikazi zakhala zikuchitika pazaka zotsatizana, pogwiritsa ntchito njira zosiyanasiyana zoyesera, njira zosiyana siyana za opaleshoni, ndi nthawi zina zozengereza.
Ngakhale zotsatira za maphunzirowa zimakhala zosiyana (zomwe zimakhala zovuta zoganizira za pakati pa 3% ndi 79%), palibe funso lina loti kaya chochitikacho chiri chenicheni kapena ayi. Ndi. Kuwonjezera apo, kuvutika kwa chidziwitso ndi chiopsezo chapadera ndi opaleshoni ya mtima, chifukwa chiwerengero chomwecho sichikuwoneka ndi machitidwe ena opaleshoni, monga opaleshoni ya mitsempha ya m'mimba .
Kodi Chimachititsa Bwanji Kuvutika Maganizo Pambuyo Opaleshoni Yopangidwira?
Chifukwa chenicheni cha vuto la chidziwitso chotsatira opaleshoni sichidziwika. Pali zifukwa zambiri zomwe zingabweretse.
Poyambirira ankaganiza kuti amayamba chifukwa chazing'ono zamagazi ku ubongo wokhudzana ndi kugwiritsidwa ntchito kwa mtima-mpweya wopitirira mpweya. Komabe, kafukufuku waposachedwapa awonetsa kuti kugwiritsa ntchito zamakono, "kuchoka pampu" kupyolera mu opaleshoni sikunachepetse chidziwitso cha kuwonongeka kwa chidziwitso.
Chiphunzitso chomwe chimagwira ntchito kwambiri masiku ano ndi chakuti kusokonezeka kwa mtima ndi aorta kungapangitse tizilombo toyambitsa magazi, zotchedwa microemboli, zomwe zingathe kupita ku ubongo ndi kuwononga kutero. Kafukufuku wophatikizapo ntchito pogwiritsira ntchito njira zamagetsi zowonongeka zatsimikiziranso kuti mvula yambiri ya ubongo imakhala yofala panthawi ya opaleshoni, ndipo maphunziro ena pogwiritsa ntchito machitidwe a MRI asanayambe ndi kutumiza amasonyeza zilonda zazing'onoting'ono (masikito ang'onoang'ono) mu ubongo wa anthu omwe amamva kuchepetsa chidziwitso. Komabe, ngakhale maphunziro awa apereka zotsatira zotsatizana, ndipo gawo la causative la microemboli silinatsimikizidwebe.
Zina zomwe zingayambitse, monga kutaya magazi, hyperthermia (kutentha kwambiri kwa thupi), ndi kuchepetsa kwa nthawi yaitali mpweya wa mpweya m'magazi, zonsezi zomwe zimachitika pakuchita opaleshoni ya mtima kapena nthawi yomweyo, zimathandizanso.
Zomwe timadziwira ndizakuti anthu omwe ali ndi zifukwa zoopsa za matenda opatsirana aumphawi ambiri amakhala ndi vuto lakumvetsetsa. Zowopsazi zimaphatikizapo matenda a mitsempha ya carotid , ukalamba, matenda oopsa , ndi mbiri ya mliri wammbuyo.
Mawu Ochokera
Mukamapanga zisankho zazikulu zokhudza chithandizo chamankhwala, muyenera kuonetsetsa kuti dokotala akuganizira zonse zomwe zingakhale zoopsa komanso zopindulitsa - ngakhale zomwe sizili zokondweretsa kunena, monga chiopsezo cha kukhumudwa kwa chidziwitso.
Ngati dokotala akulangiza opaleshoni ya opaleshoni, muyenera kutsimikiza kuti muli ndi mayankho a mafunso awa:
- Kodi opaleshoniyo ingachititse kuti mupitirize kukhala ndi moyo, kapena kodi mukuchita bwino mwachangu pofuna kuthetsa zizindikiro?
- Kodi pali njira zina zothandiza, monga mankhwala , kapena stent ?
- Kodi zotsatira zake ndi zowopsa komanso zopindulitsa zotani?
- Ngati mwachitidwa opaleshoni ndikudziwa zizindikiro zamaganizo, kodi dokotala wanu ali ndizinthu zotani zomwe angachite kuti akuthandizeni, ndikuthandizani inu ndi okondedwa anu kuti mupirire mpaka zizindikiro zanu zisintha?
Ngati opaleshoni ikulimbikitsidwa ndipo sichikudziwika kuti ndivuto, ichi ndi chisankho chomwe mungaganize kuti mutenge kachiwiri .
Ngati mwasankha kukhala opaleshoni yambiri, kumbukirani kuti ambiri mwa ambiri mwa maphunzirowa sanawonongeke maganizo awo omwe adawawona mu moyo wawo wa tsiku ndi tsiku, ndipo ambiri mwa iwo omwe adatero, vuto lawo lakumvetsetsa linatha.
> Zotsatira:
> Font MT, Swift RC, Phillips-Bute B, et al. Zomwe Zidzakhala Zosamalidwa Pambuyo Pambuyo Opanga Opaleshoni. Anesth Analg 2013; 116: 435.
> Newman MF, Kirchner JL, Phillips-Bute B, ndi al. Kufufuza Kwambiri Kwambiri Pogwiritsa Ntchito Ntchito Yopanda Kudziwa Pambuyo pa Opaleshoni Yoyamba Kwambiri ya Coronary. N Engl J Med 2001; 344: 395.
> Rudolph JL, Schreiber KA, Culley DJ, et al. Kuyeza kwa Kusokonezeka Kwachidziwitso kwa Pambuyo Pambuyo Opaleshoni ya Mtima: Kusanthula Kwambiri. Chokhalira; 54: 663.
> Selnes OA, Grega MA, Bailey MM, et al. Kuzindikiritsidwa 6 Zaka Zitatha Zopereka Opaleshoni Kapena Zamankhwala Thandizo la Coronary Artery Disease. Ann Neurol 2008; 63: 581.