Ukususwa kwe-aortic kwenzeka lapho udonga lwe-aorta (umthambo omkhulu womzimba) luqala ukukhala, okuvumela igazi ukuba lingene odongeni lwesitsha, ukuhlukanisa (noma ukuhlukanisa) izingqimba zodonga. Ukususwa kwe-aortic kungabangela ukulimala okujulile ezithombeni ezihlukahlukene nokufa okusheshayo, futhi kufanele ngaso sonke isikhathi kuthathwe njengesimo esiphuthumayo sezokwelapha.
Izimbangela
Ukususwa kwe-aortic kwenzeka lapho ungqimba lwangaphandle lwodonga lwe-aorti luba buthakathaka, okuvumela izinyembezi zibe khona.
Lokhu kubuthakathaka kuhlotshaniswa kakhulu kakhulu nge- hypertension . Kungabonakala futhi ngezifo ezixhumene nezicubu ezifana ne- scleroderma kanye ne- Marfan syndrome , i-Turner syndrome, i- Ehlers-Danlos syndrome , ukulimala okubuhlungu (njengokungenzeka kwenzeke ne-Princess Diana), nokuvuvukala kwemithwalo yegazi. Ukususwa kwe-aortic kubangelwa nokusetshenziswa kwe-cocaine.
Ukusatshalaliswa kwe-Aortic kubonakala kakhulu kubantu abaphakathi kweminyaka engu-50 no-70 futhi kwenzeka kaningi emadodeni kunabesifazane.
Kwenzekani Nge-Disorction Aortic
Lapho i-aortic dissection ivela, igazi elihamba ngaphansi kwengcindezi ephakeme lizibophezela odongeni lwe-aorta, lihlukanisa izingxenye zodonga. Umthamo wegazi omkhulu kakhulu ungangena odongeni lwe-aortic, futhi leli gazi lilahlekelwa ukusabalalisa - njengokungathi ukuphuma okukhulu kwegazi kwenzeka. Igazi le-dissecting lingakwazi ukuhamba phakathi nobude be-aorta, okungaveli emithanjeni yegazi evela e-aorta futhi kubangele ukulimala ezithombeni ezihlinzekwe yizo mithini yegazi.
I-aortic dissection ingabangela ukuphindaphinda kwe-aortic , ukukhishwa kwe- pericardial , i- infarction ye-myocardial , izimpawu ze-neurologic, ukuhluleka kwezinso , nokugaya kwamathumbu . Ngaphezu kwalokho, i-aortic dissection ingakwazi ukuqeda ngokuphelele i-aorta, eholele ekuphumeni okukhulu kwangaphakathi.
Kuzo zonke lezi zizathu ukushona nge-aortic dissection, ngisho nangokwelashwa okusheshayo nolaka, kuphakeme kakhulu.
Izimpawu
Ngokuvamile, ukuxubana kwe-aortic kubangela ukuthi kungazelelwe ukuthi kube nokubuhlungu okukhulu, okunzima kakhulu, "ukuphahlaza" ubuhlungu esifubeni noma emuva, okuvame ukuphuma emathunjini. Ubuhlungu bungaphinde buhambisane ne- syncope (ukulahlekelwa kwesazi), ngokuphefumula okukhulu, noma ngezimpawu zesifo . Ngokuvamile, izimpawu nge-dissection ye-aor ziyesabisa kakhulu futhi zinzima kakhulu kangangokuthi akukho umbuzo omncane engqondweni yomuntu wesisulu mayelana nokuthi usizo oludingekayo lwezokwelapha luyadingeka yini.
Ukwelapha
Ukwelashwa kuxhomeke kunoma iyiphi ingxenye ye-aorta ehilelekile, futhi esimweni sesiguli.
Kuzo zonke izimo, iziguli ezine-dissection ze-aorti ziyiswa ekliniki yokunakekelwa okujulile futhi zifakwa ngokushesha emithini yemithi (ngokuvamile i- nitroprusside ) ehlose ukunciphisa kakhulu ukucindezelwa kwegazi . Ukunciphisa ukucindezelwa kwegazi kunganciphisa ukuqhuma okuqhubekayo kodonga lwe-aorta.
Lezi ziguli nazo zinikezwa i- beta blockers enomlomo (mhlawumbe i-propranolol noma i-labetalol) ukunciphisa isilinganiso senhliziyo, nokunciphisa amandla we-pulse ngayinye. Lesi sinyathelo siphinde senzelwe ukunciphisa ukuhlakazeka okwengeziwe.
Uma izibonakaliso ezibalulekile zesiguli sezizinzile ngokwanele, isifundo sokucwaninga (ngokuvamile esicwaninga nge- CT noma i- MRI ) senziwa ukuchaza ngokugcwele ukuthi iyiphi ingxenye ye-aorta ehilelekile.
Kuye ngendawo yayo, ukuhlukaniswa kwe-dissection kubhalwe njengohlobo lwe-A noma uhlobo B.
Thayipha ukuphazamisa A. Thayipha izimpikiswano ze-A zibonakala e-aorta ekhuphuka (ingxenye yokuqala ye-aorta enika igazi enhliziyweni, ebuchosheni, nasezingalweni). Thayipha izimpikiswano ze-A ngokuvamile ziphathwa ngokukhanda okuhlinzekwa ukuhlinzwa, okuvame ukuhlanganisa nokususa ingxenye ewonakele ye-aorta nokuyishintsha nge-graph dacron. Ngaphandle kokuhlinzwa, lezi ziguli zisengozini enkulu kakhulu yokuvuselelwa kwe-aortic, infarction ye-myocardial noma isifo, futhi ngokuvamile bafe ngenxa yezimo ezinjalo. Ukwelashwa kunzima futhi kuyinkimbinkimbi, noma kunjalo, futhi ingozi yokufa nokuhlinzeka ingaphezulu kuka-35%.
Ukuhlinzekwa kunconywa ukuphazamiseka kohlobo lwe-A ngoba ukufa kuphakeme nakakhulu ukwelapha ngokwezokwelapha kuphela.
Thayipha iziphazamiso zeB. Ngohlobo B, i-dissection igcinwe e-aorta ehla (ingxenye ye-aorta elele phambi komgogodla futhi inikeza igazi ezithombeni zesisu nangemilenze). Kulezi zimo, ukufa akuyona kangcono kakhulu - futhi kungenzeka kube ngaphezulu - ngokuhlinzwa kunokunakekelwa kwezokwelapha. Ngakho ukwelashwa ngokuvamile kuvame ukwelashwa okuqhubekayo, okungukuthi, ukuqhubeka nokuphathwa kwengcindezi yegazi kanye ne-beta blockers. Uma ubufakazi buqhubeka nokulimala ezinso, emathunjini emathumbu, noma emaphethelweni aphansi , noma kunjalo, ukuhlinzwa kungadingeka.
Ukubuyiswa Kusuka ku-Disorction Aortic
Ngemva kokuphulukiswa kwesifo se-aortic esiphuthumayo, isiguli esilula kufanele sihlale ku-beta blockers impilo yakhe yonke, futhi ukulawulwa kwengcindezi ephakeme yegazi kuyadingeka. Phinda ukukhishwa kwe-MRI kwenziwa ngaphambi kokukhishwa esibhedlela, izikhathi ezimbalwa ngaphezulu konyaka ozayo, futhi njalo kuya eminyakeni emibili emva kwalokho. Lokhu kulandela okulandelayo kuyadingeka ngoba, ngeshwa, abangaba ngu-25% abasindile be-dissection e-aortic bazodinga ukuhlinzwa okuphindaphindiwe ngokusakazeka okuphindaphindiwe eminyakeni embalwa ezayo.
Ngenxa yokuthi ukuguqulwa kwe-aortic okungenani kuyashintsha ukuphila uma kungabhubhi, kungcono kakhulu ukuyivimbela kunokuyiphatha. Unganciphisa izinkinga zakho zokungabikho kwe-aortic dissection ngokubheka ngokucophelela izinkinga zakho zempilo yengqondo , ikakhulukazi umfutho wegazi ophezulu, futhi usebenze ngokufutheka ukuze uthuthukise iphrofayli yakho engozini.
> Imithombo:
> Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 I-ACCF / AHA / AATS / ACR / ASA / SCA / SCAI / SIR / STS / SVM Izikhombandlela Zokuthola Ukuxilongwa Nokuphathwa Kweziguli Eziphethe Izifo Ze-Thoracic Aortic: Umbiko We-American College of Cardiology Foundation / i-American Heart Association Task Force on Practice Imihlahlandlela, i-American Association ye-Thoracic Surgery, i-American College of Radiology, i-American Stroke Association, i-Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, kanye neSocial for Vascular Medicine. Ukujikeleza ngo-2010; 121: e266.
> LeMaire SA, Russell L. Epidemiology ye-Thoracic Aortic Dissection. Nat Rev Cardiol 2011; 8: 103.
> Melvinsdottir IH, Lund SH, Agnarsson BA, et al. Ukukhubazeka Nokufa Kwe-Acraction Aortic Yokunciphisa Okumangalisayo: Imiphumela Evela Esifundweni Sezwe Sonke. I-Eur J Cardiothorac Surg 2016; 50: 1111.