Kwazaka makumi angapo zapitazo, mphuno zasintha njira yothandizira matenda a mitsempha . Nsonga ndi zitsulo zopangira ma fini zomwe zimakhala mu mitsempha yowonjezera "kutsegula" mitsempha pambuyo pa angioplasty . Pafupifupi njira zonse za angioplasty masiku ano zikuphatikizapo kulowetsedwa kwa stent.
Cholinga cha Nsonga
Nsonga zapangidwa kuti zichepetse vuto la restenosis , limene limapezeka kawirikawiri pambuyo pa angioplasty yekha.
Restenosis imayambitsidwa ndi minofu yatsopano pa malo a angioplasty, mwinamwake kukhumudwa ndi vuto lomwe angioplasty limapangitsa kuti liwonongeke pamene likuphatikizapo chipika cha atherosclerotic .
Ndalama zoyambirira zinali zopangidwa ndi zitsulo zosasunthika (zitsulo zopanda utsi, kapena BMS). Zozizwitsa zamakono zamakono zimadzala ndi mankhwala omwe amaletsa kukula kwa minofu, motero amalepheretsa kupuma. Izi zimatchedwa mankhwala osokoneza bongo, kapena DES. Madzi - makamaka DES - akhala akuchepetsera vuto la kupuma.
Kodi Mizati Iikidwa Motani?
Nsonga zimalowetsedwa mwa kuika mbola yowonongeka pa bulloon yotayika pamapeto a catheter. Catheter yapita patsogolo ku gawo la ameri yomwe yangoyamba kuchitika ndi angioplasty, ndipo baluni imakhuthala, motero kumatulutsa mpweya wozungulira pakhoma la mitsempha. Bhaluni ndiyeno imasungunuka ndipo catheter imachotsedwa, kusiya ntchentche mmalo mwake. Kawirikawiri, kupuma kwa buluni komwe kumagwiritsidwa ntchito kupititsa patsogolo mbola kumagwiritsidwanso ntchito kupanga angioplasty weniweni, kotero kuti angioplasty / stenting ikuchitidwa mu sitepe imodzi.
Mphuno imabwera mu kukula kwakukulu ndi mawonekedwe kuti alole katswiri wamagetsi kuti asankhe chipangizo chomwe chingakwaniritse bwino mitsempha ya wodwalayo.
Zovuta Ndi Zovuta
Mavuto angakhoze kuchitika ngati mbola imakhala yosayenerera bwino, kapena ngati mbola ya kukula kapena mawonekedwe akugwiritsidwa ntchito. Kamodzi kokha ngati mbola imayikidwa mu mitsempha sizingathetsedwe, choncho mavuto okhudzana ndi "kupezeka kosavuta" koteroko ndi ovuta kuchiza, ndipo angafunike opaleshoni yopitirira .
Kusokoneza uku kunali kofala kwambiri m'masiku oyambirira a kugwiritsiridwa ntchito kosavuta, pamene panali mitundu yochepa chabe ya stenti yomwe ingasankhidwe. Mwamwayi, chiopsezo chokumana ndi mavuto kuchokera ku ntchito yosauka n'chochepa kwambiri kuposa 1% lero.
Chinthu chofunika kwambiri chomwe chimapezeka ndi mphamvu ndi thrombosis yolimba.
Thrombosis yolimba
Ngakhale kuti mphuno zakhala zikuyenda bwino pofuna kuchepetsa vuto lalikulu lomwe limagwirizanitsidwa ndi angioplasty - restenosis - ayambitsa vuto latsopano - thrombosis yolimba. Thrombosis yeniyeni ndikutuluka kwadzidzidzi kwa mitsempha yamakono pa malo a malo osungirako malo, chifukwa cha kupangika kwadzidzidzi kwa magazi. Chochitikachi mwadzidzidzi chimakhala choopsa, zomwe zimayambitsa matenda a myocardial (matenda a mtima) kapena imfa. Mwamwayi, chiwopsezo cha thrombosis yapamwamba ndi yaing'ono - bola ngati mankhwala osokoneza bongo amagwiritsidwa ntchito poletsa magazi kutsekemera.
- Werengani zambiri za thrombosis yolimba.
Odwala onse omwe akusowa thandizo amafunika kuikidwa pa "DPT" yothandizira (DAPT) ndi mankhwala osokoneza bongo awiri omwe amaletsa magazi: aspirin , ndi ena mwa P2Y12 receptor blockers. P2Y12 blockers omwe amagwiritsidwa ntchito popewera kupweteka kwapenti ndi clopidogrel ( Plavix ), prasugrel (Zotsatira), ndi ticagrelor (Brilinta).
DAPT imakhala ndi zoopsa zake, ndipo pali mikangano yambiri ponena za momwe odwala ayenera kukhalabe pa mankhwalawa atatha kulandira mankhwala. Chifukwa cha kutha kwa thrombosis kumapeto kwa nthawi (kutanthauza kuti thrombosis ikuchitika chaka chimodzi kapena kupitirira pambuyo poika malo opatsirana), ena akuyang'anira akudandaulira madokotala kusunga odwala awo odwala pa DAPT kwa zaka angapo, kapena kwanthawizonse.
Mfundo Yofunika Kwambiri
Chofunika kwambiri ndi chakuti mbolayi yachepetsa kuchepetsa chiopsezo cha kupuma, ndipo yapangitsa kuti (mankhwalawa) asagwirizane ndi mankhwala osokoneza bongo omwe amatha kukhala osakwanira.
Komabe, kulandira stent nthawi zonse kumayambitsa nkhani yatsopano-kuopsa kwa thrombosis yapamwamba - komanso kuyang'anira bwino chiopsezochi si vuto lalikulu.
Aliyense amene adokotala amamuuza kuti adziwe kuti amafunika kukhala ndi stent ayenera kuganizira mosamala zoopsa ndi phindu la mankhwalawa, komanso njira zonse zochiritsira zomwe zingapezeke ku matenda a mitsempha.
- Werengani za vutoli ndi masentimita.
- Kodi zimakhala zothandiza kwambiri pochiza angina?
- Werengani za njira zonse zothandizira mankhwala odwala matenda a mitsempha.
Zotsatira:
Fischman, DL, Leon, MB, Baim, DS, et al. Kuyerekezera mwadzidzidzi ndi malo opangira mavitamini ndi ma balloon angioplasty pochiza matenda a mitsempha. N Engl J Med 1994; 331: 496.
Colombo, A, Stankovic, G, Moses, JW. Kusankhidwa kwa stonary stents. J Am Coll Cardiol 2002; 40: 1021.
Mauri L, Kereiakes DJ, Yeh RW, et al. Miyezi khumi ndi iwiri kapena 30 yothandizira mankhwala opatsirana pogwiritsa ntchito mankhwala osokoneza bongo. N Engl J Med 2014; DOI: 10.1056NEJMoa1409312.
Columbo A ndi Chieffo A. Mankhwala osokoneza bongo amodzi pambuyo pa mankhwala osokoneza bongo-Kodi amatha nthawi yaitali bwanji kuchiza? N Engl J Med 2014; DOI: 10.1056 / NEJMe1413297.