Kodi Kutseka Kachilombo Kosavomerezeka Kumateteza Kukwapula?
Tonsefe tinali ndi bowo m'mtima mwathu. Mwazi umayenda mosiyana kwambiri ndi thupi la mwana wosabadwa poyerekeza ndi wamkulu. Mmodzi, magazi amayenda kudzera pakati pa kumanzere ndi kumanja kwa mtima kudzera kutseguka kotchedwa foramen ovale.
Komabe, chifukwa cha mpweya wathu woyamba, mpweya wa pakati pa mbali ya kumanzere ndi kumanja kwa mtima umasintha, ndipo chidindo cha minofu chimakhala chophimba.
Kuchokera nthawi imeneyo, magazi amawoneka mu chitsanzo chofala kwa pafupifupi onse akuluakulu.
Komabe, nthawi zina, chombocho chimakhala chosasindikiza kwathunthu, kusiya zomwe zimatchedwa patent foramen ovale, kapena PFO. Izi ndizosangalatsa kwambiri ndipo zanenedwa kuti zimakhudza pafupifupi mmodzi mwa anthu asanu.
Zowopsya ngati zikuwoneka kukhala ndi mgwirizano pakati pa mbali ziwiri za mtima, kafukufuku ambiri akusonyeza kuti PFOs ndizosautsa nthawi zambiri. Madokotala ena amakhulupirira kuti PFO ingawononge chiopsezo.
Kodi Zimagwira Ntchito Bwanji?
Chiphunzitso chimapita monga chonchi: mawonekedwe a magazi mu miyendo ndikuyenda kupyolera m'matumbo. Magazi amatumizidwa kuchokera kumanja kwa mtima kupita m'mapapu kuti athane ndi carbon dioxide ndi kutulutsa oksijeni. Mitsempha ya magazi komwe kutengako mpweyawu kumapezeka ndi kochepa kwambiri, ndipo nsalu iliyonse yomwe imadutsa mumitsempha ( emboli ) ikhoza kusankhidwa m'mapapo.
Fyuluta yeniyeni ikhoza kudutsa, ngakhale, ngati magazi amatha kuyenda kuchoka kumanja kupita kumanzere kwa mtima popanda kupita m'mapapo. Zingachite izi ngati pali dzenje pakati pa mbali za mtima monga PFO, ndipo ngati nthawi yowonjezereka imakhala yapamwamba pambali ya mtima kusiyana ndi kumanzere (komwe kawirikawiri sikunaliko).
Pansi pazifukwazi, magazi amatha kuyenda kumbali ya kumanzere ya mtima, kumene amaponyedwa kulowa m'thupi, kuphatikizapo ubongo, kumene chikhocho chimapangitsa kuti magazi asapitirire komanso kumayambitsa matenda osokoneza bongo . Chovala chomwe chimayenda mwa mafashoni chimatchedwa embolus, kuyambira pa (awiri) ndi doxical (mbali).
Zosankha
Pali zochitika ziwiri pamene wina yemwe ali ndi PFO ali ndi matenda osokoneza bongo omwe alibe chifukwa chomveka. Njira yoyamba, monga ikulimbikitsiridwa ndi malangizo a 2012 a American College of Chest Physicians (ACCP), ndi kugwiritsa ntchito mankhwala oletsa antiplatelet monga aspirin. Ngati thrombus ilipo mu miyendo, anticoagulation ndi wothandizira monga heparin kapena warfarin amafunidwa.
Njira yachiwiri ndiyo kusindikiza PFO. Izi zikuwoneka bwino kwa odwala omwe adangokhala ndi stroke ndipo amalandira uthenga wochititsa mantha wakuti pali "dzenje m'mitima yawo." Pansi pazochitikazi, munthu angafune kuchita zonse zomwe zingatheke kuti asakhale ndi wina, mwina woopsa kwambiri.
Vuto ndilokuti pamene kusindikiza PFO kumawoneka ngati chinthu chanzeru kuchita, kufufuza kwakukulu sikuwonetsa phindu lenileni pa njirayi yovuta.
Njira yotchuka kwambiri yosindikiza patent foramen ovale ili ndi ndondomeko yowonjezera.
Dokotala wophunzitsidwa amawongolera catheter kudzera m'mitsempha ya thupi kulowa mu mtima, kumene chipangizo chimagwiritsidwa ntchito kusindikiza PFO. Njira ina imaphatikizapo opaleshoni yowonjezereka.
Kuphunzira kwakukulu kwa PFO kutsegulidwa pamasewero a sitiroko kulibe phindu lililonse. Imodzi mwa mayesero abwino kwambiri, otchulidwa mwachindunji KUYAMBIRA 1, inayang'ana anthu osapitirira zaka 60 ndi PFO omwe anavutika ndi matenda osokoneza bongo kapena kusachedwa . Sikuti pokhapokha kunalibe phindu pambuyo pa zaka ziwiri, koma anthu omwe adachitapo kale anali ndi mavuto akuluakulu kapena mafinya oopsa kuposa omwe adalandira chithandizo chamankhwala.
Zotsatira zawo zinali zokhumudwitsa kwa anthu omwe adawona kuti mwa ena, ofooka amaphunzira kuti kutseka kwa chipangizo kunkawoneka kugwira ntchito. Monga mayesero aliwonse, KUYAMBA 1 kunali ndi zolakwika. Otsutsa ankanena kuti mwina chipangizo chabwino chingachepetse chiopsezo cha mavuto, kapena kuti kukula kwake sikunali kokwanira. Icho chinati, KUYAMBIRA 1 kuli ndi umboni wabwino wa yesero lirilonse lakale, ndipo zotsatira ziri zogwirizana kwambiri. pamene ena adatsutsa kuti kupita patsogolo kwa njira zomwe zagwiritsidwa ntchito mu kutseka PFO kungakhale zomveka zogwiritsiridwa ntchito kwake, zotsutsana ndizoti chithandizo chachipatala chikupitanso patsogolo, ndipo chikanatha kupikisana ndi kutsekedwa kwa PFO.
Zotsatira
The American Academy of Neurology ndi ena adatsimikiza kuti palibe phindu ku PFO, ngakhale kutsekedwa mwadzidzidzi kungakhale koyeneredwa ndi njira zochepetsera komanso zovuta kwambiri zokulankhulana pakati pa mtima wakumanzere ndi wolondola wa mtima. Nkhani zoterezi zikuphatikizapo vuto lalikulu la atrial septal.
Palinso madokotala omwe ali okonzeka kuchita izi kwa iwo amene amaumirira kukhala ndi patent foramen ovale atsekedwa. Anthu ena sangathe kuganiza kuti pali dzenje mu mtima, ngakhale dzenje lomwe tonse tiri nalo, ndipo anthu ambiri akupitiriza kukhala opanda mavuto. Kwa iwo omwe amakhalabe osangalatsidwa ngakhale kuti alibe chitsimikiziro chotsimikizirika, ndikofunikira kupeza lingaliro kuchokera kwa dokotala yemwe alibe ndalama zogwirira ntchitoyo.
Zotsatira:
Furlan AJ, Reisman M, Massaro J, et al. Kutsekedwa kapena mankhwala achipatala chifukwa cha kupweteka kwa cryptogenic ndi patent foramen ovale. N Engl J Med 2012; 366: 991.
Hagen PT, Scholz DG, Edwards WD. Kuwonjezeka ndi kukula kwa patent foramen ovale m'zaka khumi zoyambirira za moyo: kufufuza kwa autopsy kwa mitima 965 yachibadwa. Mayo Clin Proc. 1984; 59: 17-20.
Lansberg MG, O'Donnell MJ, Khatri P, et al. Matenda a Antithrombotic ndi a thrombolytic for stroke: Athithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Malangizo Othandizira Malangizo Othandizira Odwala. Chifuwa cha 2012; 141: e601S.