Angioplasty-yomwe imatchedwanso "percutaneous transloninal coronary angioplasty," kapena PTCA-ndiyo njira yothandizira kuthetsa mitsempha mkati mwa mitsempha, makamaka m'mitsempha yamakono .
Angioplasty imagwira ntchito pogwiritsa ntchito kaloti kakang'ono pamalo omwe amapezeka pa malo omwe ali ndi malo omwe amakhulupirira kuti Mulungu alibe mphamvu , ndipo amachititsa kuti chipikacho chikhale chochepa kwambiri.
Pafupifupi vuto lililonse angioplasty limaphatikizidwa ndi kulembedwa kwa stent .
Momwe Angioplasty Yachitira
Kuti apange angioplasty, dokotala amagwiritsa ntchito catheter (yotalika, yochepa, yomwe imatha kusintha) yomwe ili ndi bulloon yomwe ili pambali pake. Catheter imadutsa pa chipika chomwe chikupanga kutseka, ndipo buluni imakhudzidwa pansi pa kupsyinjika. Kuwonjezera kwa buluni kumaphatikizapo chipikacho pambali ya khoma la mitsempha. Bhaluni ikasokonezedwa ndi kuchotsedwa, chikwangwanicho chimatsalira pang'ono kupanikizidwa, kotero kutseka kwachepa.
Ngakhale kuti angioplasty poyamba inkachitidwa ngati njira yokhazikika, lero lamadzimadzi amadziwika nthawi iliyonse pamene angioplasty imayambira pamtunda. Mphungu ndi "scaffold" yowonjezereka yomwe imathandiza kumanga khoma la mitsempha pa malo a angioplasty, pofuna kusunga chipikacho. Stent yagwetsedwa imayikidwa pamwamba pa buluni isanalowe.
Kenaka, pamene buluniyo imalowetsedwa, chipikacho chimakanikizidwa ndipo mbola imakula panthawi yomweyo. Pamene buluniyo imasungunuka ndi kuchotsedwa, mbola imasiyidwa m'malo, ndikuthandizira kusunga chipikacho ndi kutsegula mitsempha.
Pamene Zili Zothandiza
Angioplasty imathandiza kuchepetsa zizindikiro za angina bwinobwino .
Choncho chifukwa chachikulu chochitira angioplasty mu mitsempha ya mankhwala ndi kuchitira angina zomwe zikupitirirabe ngakhale kuti akuyesera kuchipatala. Ngakhale zimaoneka ngati zodabwitsa kwa anthu ambiri, angioplasty (ngakhale pamene mbola imayikidwa) sichinawonetsedwe kuti imakhala yothandiza kwambiri kusiyana ndi chithandizo chamankhwala pofuna kuchepetsa chiopsezo cha myocardial infarction (matenda a mtima), kapena kupititsa patsogolo kupulumuka. Ndiye chifukwa chachikulu chochitira angioplasty ndikutulutsa angina wokhazikika yomwe yapitirirabe ngakhale kuti ayesa kuchiza mankhwala.
Chifukwa chachiwiri cha angioplasty (ndi stenting) kawirikawiri amagwiritsidwa ntchito pochiza matenda a mitsempha mwa anthu omwe ali ndi matenda aakulu (ACS). Mu ACS, kuwonongeka kwakukulu kwa mitsempha yamakono kwachitika chifukwa chipika chaphulika ndipo chovala chimapangidwa mkati mwa mitsempha. Pamene ACS ikuchitika, vuto la mtima limakhalapo pokhapokha ngati atsegulidwa. Pakati pa ACS, umboni womwe ulipo umasonyeza kuti angioplasty ndi stenting zingathandize kwambiri kuti zitha kusintha zotsatira za mtima.
Mitsempha yotchedwa coronary mitsempha siye yokha mitsempha imene angioplasty imagwiritsidwa ntchito nthawi zonse pochiza mapulaneti osokoneza bongo. Angioplasty imagwiritsidwanso ntchito pa mitsempha ya carotid (yomwe imapereka ubongo), mitsempha yamphongo (yomwe imapereka impso) ndi mitsempha ya mwendo.
Mavuto
Mavuto ambiri omwe amatsatira angioplasty okha ndiwo kupuma kwapadera - kupanga mapangidwe atsopano pa malo a chipikacho. Restenosis ndi njira yochepa yomwe imayamba chifukwa cha kukula kwa minofu-mwinamwake poyang'ana zoopsa zomwe zimapezeka mkati ndi kuzungulira khoma la angioplasty palokha. Zotsatira za kupuma kwachepetsa kuchepa kwa kugwiritsidwa ntchito kwa ntchentche, makamaka mankhwala osokoneza bongo (DES), omwe amadzala ndi mankhwala omwe amaletsa kukula kwa minofu, motero kuchepetsa kupuma.
Asanafike nthawi yochuluka, kuchepa kwakumapeto kwachitika mwa odwala pafupifupi 30% omwe anali ndi angioplasty okha.
Kugwiritsidwa ntchito kwazitsulo zopanda zitsulo kunachepetsa chiopsezo ichi kuti chikhale zosachepera 15 peresenti, ndipo mankhwala osokoneza bongo amachepetsanso kupitirira 10%.
Vuto losavuta, koma lovulaza kwambiri, ndi thrombosis (magazi clotting) pamalo a angioplasty / stenting. Thrombosis yowonongeka ndizochitika mwadzidzidzi komanso kawirikawiri, zomwe zimapangitsa kuti zitha kusokonezeka mosavuta. Thrombosis imawoneka kawirikawiri ndondomeko ya angioplasty (kutanthauza, masiku angapo mpaka masabata). Komabe, pamene mbola yayikidwa mkati mwa angioplasty (yomwe nthawi zonse imakhala yotere), chiopsezo chochepa cha thrombosis chikupitirira kwa miyezi ingapo mpaka patapita zaka zambiri. Kuopsa kwa thrombosis kwachepetsedwa kwambiri ndi kugwiritsa ntchito mankhwala osokoneza bongo -omwe amachitanso ngozi.
Zovuta zina zomwe zimachitika panthawi ya angioplasty zimaphatikizapo kuwonongeka kwa chiwalo chomwe chimaperekedwa ndi magazi omwe amachiritsidwa (kuphatikizapo matenda a mtima, kupweteka kwa impso kapena kupweteka), ammimba a mtima, kapena magazi.
Werengani zambiri za njira zonse zothandizira mankhwala odwala matenda a mitsempha .
> Zotsatira:
> Olemba / Mamembala a Gulu la Ogwira Ntchito, Womangirira S, Kolh P, et al. 2014 ESC / EACTS Malangizo a Myocardial Revascularization: Task Force pa Myocardial Revascularization ya European Society ya Cardiology (ESC) ndi European Association for Cardio-Thoracic Surgery (EACTS) Yapangidwa ndi thandizo lapadera la European Association of Percutaneous Cardiovascular Interventions ( EAPCI). Mtima; 35: 2541.
> Fihn SD, Blankenship JC, Alexander KP, ndi al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS Kukonzekera Kwambiri kwa Chitsogozo cha Kuzindikira ndi Kusamalira Odwala Amene Ali ndi Matenda Ovuta Kwambiri a Ischemic Heart: Lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines, ndi Association Association of American Surgery Surgery, Association of Cardiovascular Nurses Association, Society of Cardiovascular Angiography and Interventions, ndi Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64: 1929.