Aliyense amene ali ndi matenda oopsa (CAD) ayenera kukhala ndi mankhwala oopsa komanso kusintha kwazidziwitso, kuti athetse chiopsezo cha mtima , komanso kuchepetsa zizindikiro za angina (ngati alipo).
Nthawi zina mankhwala azachipatala okha sali okwanira, ndipo revascularization therapy ndi yofunika. Revascularization amatanthawuza kuti malo omwe amalepheretsa kwambiri mu mitsempha ya coronary imachotsedwa ndi angioplasty ndi stent , kapena ndi opaleshoni yopitirira (yomwe imatchedwanso kuti mzere wamakono ophatikizidwa, kapena CABG).
Choncho, mwa munthu aliyense amene amapezeka ndi CAD, dokotala ndi wodwalayo ayenera kulingalira mafunso awiri. Choyamba, kodi mankhwala azachipatala okha ndi okwanira, kapena kodi revascularization iyeneranso kuchitidwa? Chachiwiri, ngati revascularization ikulimbikitsidwa, kodi izi ziyenera kukhala zovuta, kapena ndi CABG?
Kodi Revascularization Inakonzedwa Liti?
Anthu ambiri omwe ali ndi CAD, mankhwala azachipatala , pamodzi ndi moyo woyenera kusintha kusintha moyo wawo pachiswe , ayenera kukhala njira yoyenera. Mwachindunji, anthu omwe ali ndi angina (angina omwe amawoneka kuti akuyambirira, ndipo amangochitika pokhapokha ngati zochitika zolimbitsa thupi), mankhwalawa ndi othandiza monga revascularization poletsa matenda a mtima, komanso kuchepetsa chiopsezo cha mtima wa imfa. Choncho chithandizo chamankhwala pazochitika zotero nthawi zonse chimakhala chithandizo cha kusankha.
Komabe, chithandizo cha revascularization ndibwino koposa nthawi zina. Izi zikuphatikizapo:
- Anthu omwe ali ndi mtundu wa matenda a mtima omwe amadziwika ngati achulukidwe a ST-Segment elevation myocardial infarction (STEMI) .
- Anthu omwe ali ndi angina osakhazikika kapena osagwirizana ndi ST-segment infarction (NSTEMI) , omwe samakhazikika mofulumira ndi mankhwala achiwawa.
- Anthu omwe ali ndi angina okhazikika amalephera kuyang'aniridwa ngakhale kuti akudwala kwambiri, kapena ndani sangathe kulekerera chithandizo chamankhwala chofunikira kuchiletsa.
- Anthu omwe ali ndi kachilombo koyambitsa matendawa amawaika m'gulu lomwe revascularization ndilosavuta kuposa mankhwala omwe amathandiza kuti apulumuke. Izi zimaphatikizapo anthu omwe ali ndi mitsempha yambiri m'misewu yawo yowongoka, komanso omwe ali ndi mitsempha yambiri m'mitsempha itatu yoyamba - kumanja, kumanzere kumtunda komanso kumapeto kwa mitsempha yozungulira. Werengani zambiri zokhudzana ndi mitsempha yamatenda .
Kodi Ndi Ziti Zomwe Zimasankhidwa pa CABG?
Pomwe atsimikiziridwa kuti revascularization ikufunika, chisankho chotsatira ndicho kugwiritsa ntchito angioplasty ndi stenting, kapena CABG.
Kawirikawiri anthu amawakonda kwambiri pa CABG kwa odwala STEMI, chifukwa ndi njira yothamangira kutsegula mitsempha yowonongeka. Kuwombera kumayamikiranso anthu omwe ali ndi mitundu ina ya syndromes yamakono (ACS, monga NSTEMI kapena angina osakhazikika), pamene kutsegula mitsempha yamakono yotsekedwa ikuwoneka ngati kofunikira.
Kwa anthu omwe ali ndi angina okhazikika omwe alephera kuchipatala, kupweteka kwambiri kumakhala kosankhidwa kwa iwo omwe ali ndi CAD yokhudzana ndi mchitidwe umodzi wokhazikika.
Kwa iwo omwe ali ndi angina okhazikika omwe amafunikira revascularization ndipo ali ndi zida ziwiri za CAD, amawotchera amakhalanso operewera kupatula ngati iwo ali ndi matenda a shuga, kapena kuti matupi awo amatha kukhala ovuta.
Kodi CABG Imakhudzidwa Niti pa Stenti?
CABG imakhulupirira kuti imapereka zotsatira zabwino kwa nthawi yaitali kwa anthu okhala ndi CAD 3.
CABG ikuganiziranso kuti imapereka zotsatira zabwino kusiyana ndi kuuma kwa anthu ambiri omwe ali ndi matenda a mitsempha yamakono yowongoka. Komabe, mwa iwo omwe ali ndi ACS chifukwa chotsekeka mu mitsempha yayikulu yakumanzere, kupopera kungakhale chisankho chokhazikika chifukwa chikhoza kuchitidwa mofulumira kwambiri.
CABG ndi njira yabwino kusiyana ndi kuuma kwa anthu okhala ndi CAD 2 omwe ali ndi shuga.
Potsirizira pake, anthu ambiri omwe akuyambanso ndi CABG kawirikawiri amafunika kubwereza vascularization kuposa omwe amalandira mpweya. Pachifukwa ichi, CABG iyenera kukambirana moyenera ngati aliyense amene akufuna revascularization.
Chiyeso cha SYNTAX
Tikafuna kufotokozera mwachidule zochitika zomwe CABG imakondwera poyipitsa, tikhoza kunena kuti zotsatira zake zimakhala zabwino ndi CABG mwa anthu omwe ali ndi "CAD" yovuta. CAD "yovuta" ikuphatikizapo anthu omwe ali ndi matenda a 3, chotengera CAD, anthu ena okhala ndi matenda a 2-chotengera, komanso pafupifupi aliyense amene ali ndi matenda a shuga omwe ali ndi CAD.
Chigamulo cha SYNTAX, chomwe chinasindikizidwa mu 2009, ndi chidziwitso chodziwika bwino kwambiri choyesa kulandira chithandizo poyerekeza ndi CABG kwa odwala omwe ali ndi zovuta zambiri. Kafukufukuyu anawonetsa kuti odwala omwe anachitidwa ndi CABG anali ndi zochepa zochitika pamapeto (kuphatikizapo imfa, stroke, matenda a mtima, ndi kufunika kokonzanso revascularization) kuposa odwala omwe amalandira (12,4% vs 17.8% pambuyo pa miyezi 12). Zotsatira zofananako zinafotokozedwa mu kuyesedwa kopambana mu 2015.
Choncho, mayesero awiri akuluakulu ochizira matendawa akuyerekezera ndi CABG kwa odwala omwe ali ndi CAD ambiri omwe amachokera ku CABG.
Komabe, akatswiri a katswiri wa sayansi amatsutsa kuti mu kuyesedwa kwa SYNTAX, pamene mapeto ake amatha kukhala ochepa kwambiri, chiopsezo cha kanthawi kochepa kameneka chikuwoneka chapamwamba pambuyo pa CABG (0,6% poizoni ndi 2.2% kwa CABG) pambuyo pa miyezi 12. Ichi ndi chovomerezeka, ngakhale kuti chiopsezo cha matenda a stroke chinali chiwerengero chofanana m'magulu awiriwa pambuyo pa zaka zitatu.
Ofufuza omwe adathamanga mayeso a SYNTAX adayambitsa zomwe amachitcha "SYNTAX mkota," zomwe zimakhala zofanana ndi za CAD wodwalayo chifukwa cha zovuta zake. Odwala omwe ali ndi zochepa zochepa za SYNTAX zikuwoneka kuti ndi zabwino kwambiri ndi zochepa kuposa zomwe zili ndi zilembo zapamwamba za SYNTAX. Komabe, ngakhale akatswiri a cardiologists amagwiritsa ntchito mapepala a SYNTAX kuti athetse ngati munthu yemwe ali ndi zovuta za CAD ayenera kukhala akupsa mtima kapena CABG, izi zowonongeka sizinayesedwe pachiyeso cha mankhwala.
Mfundo Yofunika Kwambiri
Chofunika kwambiri ndi chakuti anthu ambiri omwe amafunikira zida zowononga mitsempha, ndipo omwe ali ndi CAD yokhala ndi zida zitatu kapena zofunikira kwambiri mu mitsempha yawo yambiri ya kumanzere, CABG kawirikawiri iyenera kukhala ngati njira yoyamba ya mankhwala.
Nthawi zambiri anthu amavutika kwambiri ndi anthu omwe ali ndi ACS, omwe ali ndi CAD imodzi, komanso anthu ambiri omwe ali ndi CAD 2 omwe alibe matenda a shuga.
Kugwiritsira ntchito ntchentche mmalo mwa CABG kwa CAD zovuta ziyenera kusungidwa kwa anthu omwe, atatha kumvetsa zoopsa zonse ndi zopindulitsa, amatha kusankha njira yochepetsetsa.
> Zotsatira:
> Farooq V, van Klaveren D, Steyerberg EW, et al. Zizindikiro Zomwe Amagwiritsa Ntchito Pachipatala Kuti Zitsogolere Kusankha Kupanga Pakati pa Opaleshoni Yachiwiri ya Coronary Arrative And Interconvention Coronary Intervention For Patients Individual: Development and Validation Of Syntax Score II. Lancet 2013; 381: 639.
> Park SJ, Ahn JM, Kim YH, et al. Chiyeso cha Zamoyo Zomwe Zimakhalapo-Zojambula Zomwe Zimapangidwira Kulimbana ndi Matenda a Coronary. N Engl J Med 2015; 372: 1204.
> Serruys P, Morice MC, Kappetein P, ndi al. Coronary-Artery Bypass Grafting Kwa Coronary Syndrome Artery Disease. N Engl J Med 2009; 360: 961-972.