Inkinga enkulu kakhulu yesibindi se -atrial is stroke . E-fibrillation ye-atrial, i-atria yenhliziyo ayishayi ngempumelelo, evumela igazi ukuba "lihlanganise" ngaphakathi kwala makamelo.
Ngenxa yalokho, i-thrombus ye-atrial (i-clot yegazi) ingafakela. Ekugcineni, i-thrombus ye-atrial ingakwazi ukufaka imbolize-okungukuthi, ingakwazi ukuphazamisa futhi ihambe ngezinyathelo zomzimba.
Ngokuvamile, lokhu kuhlanganiswa kuzofaka ebuchosheni, futhi umphumela uyingozi.
Ngakho uma une-fibrillation ye-atrial, udokotela wakho kufanele enze ukulinganisa okusemthethweni kwengozi yakho yokushaywa yisifo, futhi uma ngabe leyo ngozi ingaphezulu kakhulu, kufanele ubekwe ekwelapheni ukuvimbela ama-clots egazi ukuba akhiwe, futhi ngaleyo ndlela, ukuvimbela isifo.
Ukulinganisa Ingozi Yakho
Ukulinganisa ingozi yokushaywa yisifo uma unesibindi se-atrial kudinga ukucabangela iminyaka yakho, ubulili, kanye nezimo ezithile zezokwelapha ongase ube nazo. Okokuqala, uma une-valvular isifo senhliziyo ngaphezu kwe-fibrillation ye-atrial, uzodinga ukwelapha ukuvimbela ama-blood clots, ngoba ingozi yokushaywa isisu iphakeme kakhulu.
Uma ungenayo isifo se-valve senhliziyo, udokotela wakho cishe uzosebenzisa i-calculator engozini, ebizwa ngokuthi amaphuzu we-CHA2DS2-VASc, ukulinganisa ingozi yokushaya isifo. Kubantu abane-fibrillation ye-atrial, ukuphakama kwe-CHA2DS2-VASc score, kuphakamisa ingozi yokushaya isisu.
Amabalazwe we-CHA2DS2-VASc kusuka ku-zero kuya kumaphuzu ayisishiyagalolunye futhi kubalwa kanje:
- Ukuhluleka kwenhliziyo ukukhumula = iphuzu elilodwa
- I-hypertension = iphuzu elilodwa
- Ubuneminyaka engu-75 noma ngaphezulu = amaphuzu amabili
- Isifo sikashukela = iphuzu elilodwa
- Ukushaywa kanzima noma i-TIA = amaphuzu amabili
- I-artery peripheral disease = iphuzu elilodwa
- Ubudala obuphakathi kuka-64 kuya ku-74 = iphuzu elilodwa
- Ubulili besilisa = iphuzu elilodwa
Ukuphakama kwezinga le-CHA2DS2-VASc, kuphakama ingozi yonyaka yokushaywa yisifo. Ngakho-ke, uma ngabe isikolo sakho sinzima, ingozi yakho yokushaya isifo ngamaphesenti angu -2 ngonyaka, okuyinto ephansi kakhulu. Uma ngabe amaphuzu akho amabili, ingozi yonyaka ingamaphesenti angu-2.2, futhi iphuma ngokushesha ukusuka lapho. Amaphuzu ayisishiyagalolunye anika ingozi yonyaka yokushaywa ngamaphesenti angu-12.2. (Ngendlela yokuqhathanisa, kubo bonke abantu abangu-100 abangaphezu kweminyaka engu-65 abangenayo i-fibrillation ye-atrial, cishe eyodwa ngonyaka izoba nesifo sohlangothi.)
Ukunciphisa Ingozi Ye-Stroke
Ukusetshenziswa kwezidakamizwa ze-anticoagulant kunganciphisa kakhulu ingozi yokuthi i-embolus evela e-atrium kwesokunxele izobangela isifo kubantu abane-fibrillation ye-atrial. Kodwa-ke, lezi zidakamizwa zithwala ingozi yokukhiqiza isiqephu esikhulu sokugaya, kuhlanganise nesifo esiyingozi (ukuphuma echosheni). Kulinganiselwa ukuthi ingozi yeminyaka yonke yokushaywa isifo esibangelwa ama-anticoagulants ingamaphesenti angu-0.4.
Lokho kusho ukuthi ukusebenzisa izidakamizwa ze-anticoagulant kunengqondo uma ingozi yokushaywa yisifo sofuba e-atriyyria ikhulu kakhulu kunengozi yokushaywa yisifo esilweni. Odokotela bayavumelana, ikakhulukazi, ukuthi ezigulini ezine-nonvalvular fibrillation ye-atrial ezingenayo inombolo ye-CHA2DS2-VASc, i-anticoagulation akufanele isetshenziswe. Ngezibalo ezimbili noma ngaphezulu, izidakamizwa ze-anticoagulant kufanele zisebenze njalo.
Futhi eziningi, ukwelashwa kudinga ukuba kube ngabanye ngesiguli ngasinye.
Esikhathini esidlule, odokotela bacabanga ukuthi uma bephumelela ekusebenziseni " ukwelashwa kweghythm therapy " ye-fibrification ye-atrial (okungukuthi, ukwelashwa okuhloswe ukuvimba ukufiphaza kwe-atrial nokugcina isigqi senhliziyo evamile), ingozi yokushaywa yisifo ingase ilahle. Kodwa-ke, ubufakazi besibhedlela okwamanje behlulekile ukubonisa ukuthi ukulawula isigqi kunciphisa ingozi yokushaywa yisifo. Ngakho-ke ngisho noma wena nodokotela wakho ukhetha ukwelashwa kwesigqi, kufanele uphathwe ukuze uvimbele ukushaywa uma isaphulelo sakho se-CHA2DS2-VASc sikhulu ngokwanele.
Iziphi Izidakamizwa Okumele Zizisebenzise?
Izidakamizwa eziphumelelayo ekunciphiseni ingozi yokushaywa yisifo se-fibrification e-atrial yizidakamizwa ze-anticoagulant.
Lezi yizidakamizwa ezivimbela izimbangela zegazi , futhi kanjalo zivimbela ukubunjwa kwezindwangu zegazi. Ezigulini ezine-fibrillation e-atrial, i-anticoagulation inciphisa ingozi yokushaya isisu ngempela-cishe cishe kwezintathu.
Kuze kube yiminyaka embalwa eyedlule, isidakamizwa esisodwa esingapheli somlomo we-anticoagulant esasitholakala kwakuyi-warfarin (i- Coumadin ), isidakamizwa esivimbela amavithamini K. (Vitamin K inesibopho sokwenza izici eziningi zokuvala.) Ukuthatha i-Coumadin kuyaphazamisa futhi kuvamile kunzima, noma kunjalo. Ukuhlolwa kwegazi njalo futhi okuvame ukuhlolwa kwegazi kuyadingeka ukuze kulinganise "ukumbalwa" kwegazi bese ulungisa umthamo weCoumadin. Futhi, imingcele yokudla iyadingeka ngoba ukudla okuningi kungashintsha isenzo seCoumadin. Uma umthamo ungahle ulungiswe kahle noma uvame ukwanele, igazi lingase libe "mncane kakhulu" noma lingabi mncane ngokwanele, futhi noma enye ingabangela izinkinga ezinkulu.
Eminyakeni embalwa edlule, kuye kwaqalwa izidakamizwa ezintsha ezintsha ze-anticoagulation ezingenzi ngokuvimbela amavithamini K, kepha ngokuvimbela ngokuqondile izici ezithile zokuvala izinsimbi. Lezi zibizwa ngokuthi "i-novel anticoagulant" izidakamizwa, noma i-NOACs. Ama-NOAC okwamanje avunyelwe e-US yi-dabigatran (Pradaxa), i-rivaroxaban (i-Xarelto), i-apixaban (i-Eliquis), ne-edoxaban (i-Savaysa).
Lezi zidakamizwa zonke zinenzuzo ngaphezu kweCoumadin. Basebenzisa ama-dose ajwayelekile nsuku zonke, ngakho-ke isidingo sokuhlolwa kwegazi njalo kanye nokulungiswa kwesilinganiso kuqedwa. Azidingi imingcele yokudla. Futhi ucwaningo lwezokwelapha luye lwabonisa ukuthi lezi zidakamizwa ezintsha zisebenza okungenani njengeziphumelelayo futhi ziphephile njengeCoumadin.
Kukhona izinselelo ezithile ku-NOACs, noma kunjalo. Ziyabiza kakhulu kuneCoumadin, futhi ngokungafani neCoumadin (okungasheshe iguqulwe ngokunikeza i-vitamin K) kunzima ukuguqula umphumela wabo we-anticoagulant uma kunenkinga enkulu yokuphuza okufanele ivele. (Ngaphandle kwalokho iPradaxa, i-antidote yalesi sidakamizwa yavunywa ngo-Okthoba 2015.)
Iningi labachwepheshe manje bakhetha ukusebenzisa isidakamizwa se-NOAC ngaphezu kwe-Coumadin ezigulini ezine-fibrillation e-atrial. Kodwa-ke, kuneziqu lapho u-Coumadin okwamanje engakhetha kukho. U-Coumadin usalokhu ukhetha kahle uma uthatha u-Coumadin kakade futhi uqiniseke ngokuphelele kulesi sidakamizwa noma uma ungakufuni ukuthatha amaphilisi kabili ngosuku (okudingekayo ku-Pradaxa no-Eliquis) noma uma ungakwazi ukukhokhela izindleko eziphezulu zamanje izidakamizwa ezintsha.
Izindlela Zokusebenza
Ngenxa yezinkinga ezithatha izidakamizwa ze-anticoagulant, imizamo iye yaqhubeka ukuthuthukisa ukwelashwa okwenziwe ngezindlela zokuzama ukuvimbela ukushaywa kweziguli ezinokuphefumula kwama-atrial. Lezi zindlela ziye zahloswe ekuhlukaniseni ukwahlukanisa kwesokunxele (a "isikhwama" se-atrium esisele kwesokunxele). Kuvela ukuthi ama-clots amaningi enza i-atrium engakwesobunxele ngesikhathi se-fibrillation ye-atrial ayatholakala ku-appendage ye-atrial.
I-appendage engakwesobunxele engakwesokunxele ingahlukaniswa nokusakazwa ngokusebenzisa izindlela zokuhlinza noma ngokufaka idivaysi ekhethekile engxenyeni ye-catheter. Ngesikhathi besetshenziswe emitholampilo, zombili lezi zindlela zinezinkinga ezinkulu, futhi kule ndawo zigcinwe amacala akhethekile.
Isifingqo
Ukushaywa yisisu kunesabekayo kakhulu, futhi ngeshwa iningi elivame kakhulu, ukucindezeleka okukhulu kwe-fibrillation ye-atrial. Ngakho ukwehlisa ingozi yokushaywa yisifo kungukuthi wena nodokotela wakho kufanele nithathe ngokungathí sina. Ngenhlanhla, uma wena nodokotela wakho sondela kule nkinga ngendlela ehlelekile-ukulinganisa ingozi yakho nokuphatha ngendlela efanele-izimo zakho zokugwema lolu daba zizothuthukiswa kakhulu.
Imithombo:
I-Fuster, V, Ryden, LE, i-Cannom, i-DS, ne-al. I-ACC / AHA / ESC 2006 Imihlahlandlela yokuphathwa kweziguli ezine-fridaying ye-Atrial Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice kanye ne-European Society of Cardiology Committee for Guiding Practice (Ikomiti Yokubhala Ukubuyekeza Iziqondiso Zika-2001 for the Management of Patients With Fibrillation Atrial). J Am Coll Cardiol 2006; 48: e149.
Fang MC, Hamba AS, Chang Y, et al. Ukuqhathaniswa kwama-stratification schemes ukubikezela i-thromboembolism kubantu abane-fibrification ye-atrial nonvalvular. J Am Coll Cardiol 2008; 51: 810.