Kufika kwa angioplasty ndi kupweteketsa mtima kwasintha njira yothandizira matendawa . M'malo mowa mankhwala ambiri a angina , m'malo mochita opaleshoni yayikulu, munthu amene ali ndi zida zapamwamba zogwiritsira ntchito mankhwala amatha kukhala ndi njira yothandizira odwala matenda opatsirana omwe amatha kusungunuka ndi buluni (angioplasty) lotseguka ndi stent.
Kulimbitsa thupi kwakhala kozolowereka komanso kosavuta, ndipo zithunzi zisanayambe ndi zotsatila za matendawa zimakhala zovuta kwambiri (ngakhale mtsogoleri wachisanu akudabwa), kuti phindu la njirayi ndi lodziwikiratu kwa dokotala ndi wodwala mofanana. Choncho, zambiri kapena sizinthu zambiri zokhudzana ndi mtima waumphawi zakhala zochepa kwambiri.
Chisokonezo cha Mavuto
Koma pansipa, kugwiritsa ntchito angioplasty ndi stents nthawi zonse kwakhazikitsa mavuto atsopano, kufuna njira zatsopano, zomwe zimayambitsa mavuto atsopano. Kutuluka kwa vuto - yankho - vuto - yankho - vuto liri ngati izi:
M'masiku oyambirira, angioplasty imagwiritsidwa ntchito yokha. Chipikacho "chinasweka" ndi buluni, kutsegula mitsempha yotsekedwa. Koma posakhalitsa zinaonekeratu kuti odwala ambiri anali ndi vuto lopumula - la regrowth la minofu, chifukwa cha vuto la angioplasty - lomwe pang'onopang'ono lidzatsegula mitsempha.
Nsonga (zowonjezera zitsulo zopangira zitsulo) zinapangidwa kuti zikhale ndi matope otseguka pambuyo pa angioplasty, ndi kuchepetsa kupuma. Choyambirira chitsulo chosakanizidwa (BMS) chinathandiza kwambiri (kuchepetsa chiopsezo cha kupumula ndi theka), koma chochitika cha restenosis chinakhala chokwanira kuti chikhale chovuta. Choncho mankhwala osokoneza bongo (DES) anapangidwa.
Mapulani amenewa amavala ndi mankhwala ena omwe amaletsa kukula, ndipo chifukwa chake, vuto la restenosis lachepetsedwa.
Koma ndi kugwiritsidwa ntchito kwa DES, vuto la late strombo thrombosis linazindikiridwa. Kuwopsa kwa thrombosis, mwadzidzidzi komanso kawirikawiri kutsekedwa kwa mitsempha yamakono pa malo a stent, nthawizonse yakhala vuto kwa masabata angapo kapena miyezi ingapo pambuyo pake. Kuopsa kwa thrombosis oyambirira kumachepetsedwa ndi kugwiritsa ntchito mankhwala oletsa antiplatelet omwe amaletsa kutseka (otchedwa "awiri-anti-platelet therapy," kapena DAPT).
Koma kenako kutupa kwapakhosi kwapenti - thrombosis yomwe imachitika chaka chimodzi kapena kuposera pambuyo poika malo opatsirana - kunakhala vuto lodziwikiratu ndi kugwiritsidwa ntchito kwa DES. Ngakhale kuti vutoli limakhala lochepa kwambiri - limayerekezera kuti likuchitika mwa odwala 200 kapena 300 chaka chilichonse chaka chotsatira - nthawi zonse ndizochitika zoopsa, zomwe zimapangitsa imfa kapena kuwonongeka kwa mtima.
Kuopsa kwa thrombosis kumapeto kwazomwe amaganiza ndi akatswiri ena kuti ali apamwamba ndi DES kusiyana ndi BMS, mwinamwake chifukwa mankhwala omwe amaletsa kukula kwa minofu amachokera ku chitsulo chosungunuka kupita ku magazi, moteronso amachititsa kuti kutsekemera kwadutse.
- Werengani za vuto lomwe liripo la thrombosis yolimba.
Chifukwa cha kuwopsa kwa thrombosis, tsopano akulimbikitsidwa kuti DAPT ipitirire kwa zaka zosachepera chaka chitatha. Koma chidziwitso chatsopano chochokera ku DAPT yophunzira (November 2014) chikuchititsa madokotala ambiri kutsimikizira kuti DAPT ikupitirira kwa miyezi 30 pambuyo poika malo, ndipo mwina kwanthawizonse.
Mwatsoka, DAPT yokha imayambitsa mavuto ambiri kwa odwala ambiri. Odwala omwe amatenga DAPT amakhala ovuta kwambiri kuika magazi, ena mwa iwo angathe kuopseza moyo. Kusokonezeka kwakukulu (monga ngozi ya galimoto) pamene kutenga DAPT kukhoza kuvulaza mopitirira muyeso.
Ndipo kutaya magazi pa nthawi yopaleshoni kwa wodwalayo kutenga DAPT ndizosatheka - kotero pafupifupi palibe opaleshoni adzagwira ntchito kwa wodwala kutenga mankhwalawa. Pa nthawi yomweyi, umboni umasonyeza kuti ngati DAPT yayimilira chifukwa china chotsatira stent - ngakhale zaka zingapo pambuyo poti stent yakhazikitsidwa - pali nthenda yomweyo pamsampha woopsa wa thrombosis.
Choncho odwala atalandira stent akhoza kudzipeza okha pamalo osadziwika. Dokotala wawo opaleshoni angakhale akuumirira kuti asiye DAPT kuti athe kutenga chifuwa chawo kapena chiuno chake m'malo mwake, ndipo katswiri wawo wa mtima angaumirire kuti asasiye DAPT yawo, pa chifukwa chilichonse.
Kufunsa Funso Loyenera
Ophunzira ambiri a cardiologists amayamba ndi "chowonadi" chomwe chimakhala chodziwika bwino ndikusankha mankhwala, ndiyeno nkufunsa kuti, "Popeza kuti ndikufunika kukhala ndi stent, ndingatani kuti ndithetse bwino zotsatira za wodwalayo?" Ngati mukupita ku msonkhano wamakono wamakono, mudzapeza zosiyanasiyana akatswiri anatsutsana pa zokangana zakatsutsana zokhutiritsa zotsatira za odwala mutagwiritsa ntchito stents. Kodi BMS iyenera kugwiritsidwa ntchito m'malo mwa DES pambuyo pa zonse? Kodi mbadwo watsopano wa DES uli wolimba kusiyana ndi mibadwo yakale? Kodi DAPT iyenera kuperekedwa kwa miyezi 6, miyezi 12, miyezi 30, kosatha? Nanga bwanji odwala odwala omwe akudwala matenda, kapena ndani amafunikira opaleshoni?
Ngati ndinu wodwala ndi matenda a mitsempha komanso dokotala akuyamikila stent, muyenera kuika chizindikiro choyimira ndikufunsa dokotala kuti ayang'anenso. Chifukwa cha mafunso ndi mayankho osayankhidwa omwe amapita ku ntchito ya stent iliyonse, kodi stent ndi yofunika kwambiri? Kodi mankhwala ena alipo omwe angagwiritsidwe ntchito musanayambe kugwiritsidwa ntchito?
Ngati muli ndi matenda oopsa a coronary syndrome - angina wosakhazikika kapena matenda a mtima - ndiye dokotala wanu ali pafupi ndithu. Muli pangozi yaikulu chifukwa cha chida chokhazikika cha mitsempha, ndipo angioplasty / stenting ndi njira yabwino kwambiri yothetsera chikhalidwe chanu cha mtima.
Koma ngati muli "wovutika" ndi angina , kapena ngati muli ndi chizindikilo chachikulu chomwe sichizindikiro, ndiye kuti angioplasty ndi stenting sizokhawo zokhazokha - ndipo sizingatheke. Zotsatira ndizo zabwino kapena zabwino ndi mankhwala ochizira komanso kusintha kwa moyo. Ndipo kumbukirani kuti ntchentche sizomwe zimapangidwa kamodzi ndi kachitidwe; Ngati mutakhala ndi stent, mudzakhala ndi mankhwala a nthawi yayitali - mankhwala aakulu kwambiri - mwinamwake. Komanso, akatswiri ambiri tsopano akukayikira kuti mankhwalawa ndi othandiza kwambiri .
Choncho: muyenera kufunsa dokotala wanu kuti abwerere. M'malo moganiza kuti yankho ndilo yankho, ndiyeno ndikuyang'ana pazochitika zonse zachipatala zomwe zimayenera kugwiritsidwa ntchito ngati dothi, dokotala wanu ayenera m'malo mwake kuti afunse, "Chifukwa cha mtima wa wodwalayo, umoyo wathanzi, ndi chiyembekezo, chiyembekezo ndi zokhumba, ndi chiyani chithandizo chabwino kwambiri cha matenda ake a mitsempha? "Kawirikawiri pali njira zambiri zothandizira - ndipo zonsezi ziyenera kuganiziridwa.
Sitifiketi ikhoza kukhala yankho lolondola, koma ndilo lingaliro lomwe lingapangidwe pambuyo pofunsa funso loyenera.
Zotsatira:
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.
Lüscher TF, Steffel J, Eberli FR, ndi al. Kugwiritsa ntchito mankhwala osokoneza bongo komanso kupweteka kwa mankhwala. Kuzungulira kwa 2007; 115: 1051.
Iakovou I, Schmidt T, Bonizzoni E, et al. Zochitika, zowonongeka, ndi zotsatira za thrombosis pambuyo poika bwino mankhwala osokoneza bongo. JAMA 2005; 293: 2126.