Okuthi isilingo se-ORBITA kufanele sisho ukuthini kuwe
NgoNovemba 2017, imiphumela yecala elilindelekile lomtholampilo labikwa eLancet , ngokushesha liphonsa umhlaba wezinhliziyo ukuthi ube yingxabano. Isivivinyo se-ORBITA sabeka inselele emashumini amathathu eminyaka yezinhliziyo zokuphila ngokuphathelene nokuphumelela kokwelapha i- angina esinezinzile ngama- stents . Izitshalo, ukuhlolwa kwe-ORBITA kuphelile, akunikezanga ukuthuthukiswa komtholampilo okulinganiselwe ku-angina esinqabile uma kuqhathaniswa nenqubo ye-sham.
Kungenzeka yini ukuthi izinzuzo ze-cardiologists eziye zatshengiswa ukuthi zinama-stents sonke lesi sikhathi azibangelwa lutho ngaphandle komphumela we-placebo? Ochwepheshe babekwe emigqeni yempi ebusuku. Iqembu elilodwa labika ukuthi isilingo se-ORBITA kufanele siqede umkhuba wokugaya ama-angina azinzile. Iqembu lesibili lochwepheshe lathi ukuhlolwa kwe-ORBITA, ngenkathi kuthakazelisa, kwakungalungile, futhi akufanele kushintshe umkhuba wokwelashwa nhlobo.
Lokhu kuqoqa impi kubonakala njengento engeke ixazululwe iminyaka eminingana. Lokhu, kunjalo, indlela isayensi yezokwelapha eqhubeka ngayo. Umbuzo ngathi: Ungubani umuntu osebenzisana no-angina ozinzile namuhla (ngenkathi ochwepheshe bephikisana) kufanele bawenze manje?
Uma siphenduka futhi sibheke ukuhlolisisa idatha etholakalayo, kuvela ukuthi kungabi nzima ukuthola indlela yokuphatha i-angina enesimo esengqondo, futhi ihambisana nobufakazi obuvela ezivivinyweni zomtholampilo (kubandakanya i-ORBITA) njenge ikhona namuhla.
Izitebhisi ze-Stable Angina
Ama-stents ayizintambo ezinama-wire anwetshiwe ngaphakathi kwe-artery evinjiwe ngesikhathi senqubo ye-angioplasty. Nge- angioplasty , ibhaluni lihlonyelwe endaweni ye- plaque ye- atherosclerotic ukuze kutholakale ukuvinjelwa. I-stent iyasetshenziswa ngesikhathi esisodwa ukuze igcine ivuliwe.
I-Angioplasty kanye ne-stenting ngokuvamile ibizwa odokotela ngokuthi "ukungenelela kwe-coronary," noma i-PCI.
I-PCI yasungulwa njengengxenye engavamile engena esikhundleni se-artery coronary bypass ukuhlanganiswa , inqubo yokuhlinzwa enhliziyo evulekile. Njengoba i-PCI yasungulwa, inani leziguli ezine- artery disease isifo esiphathwayo ngokuhlinzwa ngokweqile sehlile kakhulu.
Kunezikhathi lapho usebenzisa i-PCI kubaluleke kakhulu. I-PCI esheshayo ithuthukisa ngokujulile imiphumela yabantu ababhekene ne- acute coronary syndrome (ACS) -ahlu lwezinkinga ezisongela ukuphila ezibangelwa ukuvinjelwa okunamandla komthambo we-coronary. Ama-syndromes amathathu omtholampilo abangwa yi-ACS afaka i- angina engaqiniseki , i- ST-se ele-ST-segment elevation infyoction (STEMI) , kanye ne -NSTEMI engenamaphesenti angama-ST elevation of myocardial . Eziningi zalawa ma-syndromes, i-PCI ephuthumayo isungulwe, ngokuhlolwa okuningana kwemitholampilo, njengokwelashwa kokukhetha.
Kwase kuyiminyaka eminingi, ukuphahlazeka kwakubuye kube ukwelashwa kwabantu abaningi abano-angina-angina esinezinzile ezibangelwa ukuvinjelwa okungapheli, okuhleliwe, okuyingxenye emgodini we-coronary. Lokho i-PCI yanciphisa i-angina kulaba bantu kwakusobala kubo bonke, futhi kwakucatshangwa ukuthi bayoba nengozi encane yokuhlaselwa kwenhliziyo elandelayo.
Khona-ke, ngasekupheleni kweminyaka engu-2000, ukuhlolwa kwe- COURAGE kubonise ukuthi i-PCI ayinciphisi ngokulinganiselwe ingozi yokuhlaselwa yinhliziyo noma ukufa kubantu abane-angina esinezinzile, uma kuqhathaniswa nokwelashwa okunamandla . Kusukela ngalesosikhathi, imihlahlandlela yemitholampilo ikhuthaze izazi ze-cardiologists ukuthi zisebenzise i-PCI ngendlela engamazinyo eziqinile ukuze kutholakale izimpawu ze-angina, futhi kuphela kubantu abangazange baphathwe kahle ngemithi.
Ngenkathi kunzima ukubhala ngokucophelela, kubonakala sengathi abaningi be-cardiologists (naphezu kwalokho okushiwo yizinkombandlela naphezu kobufakazi obuvela ezivivinyweni zomtholampilo), baye baqhubeka nokusebenzisa ukugcoba njengendlela yokwelashwa kwe-line yokuqala ye-angina, futhi hhayi njengendlela yokwelapha emgqeni wesibili abantu abahluleka izidakamizwa.
Benza lokhu, bazositshela, ngoba akukho lutho olushaya i-stent yokuqeda i-angina.
Eqinisweni, cishe wonke umuntu ukholelwa ukuthi ama-stents iyindlela ephumelela kakhulu yokunciphisa i-angina, ngisho nalabo abagqugquzela izazi ze-cardiologists ukuba bazame ukwelapha okwelapha kuqala. Sekuyiqiniso ukuthi: Naphezu kwazo zonke izithiyo zalo, ukugaya kakhulu kuyindlela enokwethenjelwa futhi ephumelelayo yokuphatha ama-angina azinzile.
Kodwa manje, isilingo se-ORBITA siye saphonsela le nkinga ingxabano.
Okushiwo yi-ORBITA Study
Abaphenyi be-ORBITA bahlola i-hyppothesis emangazayo. Bambuza ukuthi: Kuthiwani uma ukuxoshwa kwe-angina okuhlangene neziguli ngemuva kwesiteji akubangelwa ukuvulwa komthambo kodwa kuyisici se-placebo? Ukuze avivinye le nhlobo, baqhathanisa ukugodla okwenziwe ngokuya kwenqubo yokuphoqa.
Bhalisa abantu abangu-200 abane-angina esinezinzile futhi okungenani ukuvinjelwa okuphawulekayo emthini we-coronary (ngaphezulu kwamaphesenti angu-70 avinjelwe). Ngemuva kwesikhathi seviki eziyisithupha sokuthuthukisa ukwelashwa, futhi emva kokuhlolwa okuyisisekelo okubanzi ukuze kulinganise ubukhulu be-angina yabo kanye nomthamo wabo wokuzivocavoca, izihloko zazingakapheli ukuthi zithole inqubo yokupholisa, noma inqubo ye-sham stent. Esikhathini senqubo ye-sham, izikhonzi zathola inqubo yonke ye-PCI, kufaka phakathi ukufaka ucingo kulokhu kuvinjelwa, ngaphandle kokuthi akukho-angioplasty noma i-stent empeleni eyenziwa. Ngemuva kwenqubo, amaqembu womabili athole ukwelapha okulwa nokulwa okunamahloni okuvame ukusetshenziswa emva kwe-PCI .
Ngemuva kwamasonto ayisithupha, zonke izifundo zihlolwe futhi ukuze zilinganisise ubukhulu be-angina kanye namandla okusebenzisa. Abaphenyi bathola ukuthi, kuyilapho labo abathola impela ama-stents kubonakala sengathi banokuthuthukiswa okuncane kakhulu kunelabo ababenenkambiso ye-sham, umehluko phakathi kwala maqembu amabili awusondelene nokuba nesibalo samanani.
Ngakho-ke, baphetha ngokuthi, ukuthukuthela akuyona kangcono kakhulu kunendlela yokwenza imithi yokwelapha abantu abane-angina esinezinzile.
Ukuphendula ku-Study ORBITA
Umhleli we- Lancet ohambisane nokushicilelwa kwesilingo se-ORBITA umemezele ukuthi lolu cwaningo luyoba "olujulile futhi lufinyelele kakhulu," futhi ludinga imihlahlandlela yokwelashwa ehlelekile ukuze ibuyekezwe ukuze "idilize" ukusebenzisa i-PCI kuziguli ezine-angina ezinzile.
I-cardiologists yangaphakathi (labo abenza i-PCI), ngokusebenzisa inhlangano yabo (i-Society for Cardiovascular Angiography and Interventions, SCAI), ngokushesha bakhipha ukuhlaziywa okubanzi kwe-ORBITA. I-SCAI ibonise, phakathi kwezinye izinto, ukuthi iziguli ezibhalisile zinezinga eliphansi eliphansi (okungukuthi, abaningi akufanele babe ngabacwaningi be-PCI endaweni yokuqala); iphuzu eliyinhloko lokucubungula (isikhathi sokuzivocavoca) kuhlonishwa ngokweqile futhi kuncike ekuhlukeni okukhulu; isifundo sincane futhi sesikhathi esifushane; futhi isilinganiso esisodwa somgomo we- ischemia esenziwa ekuvivinyweni (isilinganiso esibizwa ngokuthi "isikhombisi sokunyakaza kwesiphakamiso sokunyakaza kwesigxila") sibonise ukuthuthukiswa okuphawulekayo ne-PCI. Ngakho-ke, baphetha ngokuthi, imiphumela ye-ORBITA, ngenkathi isithakazelisayo, akufanele isetshenziselwe ukushintsha umkhuba wokwelashwa.
Ngakho-ke, njengoba ubona, imidwebo yempi iye yakhishwa, futhi kufanele silungiselele iminyaka eminingana yempi yamanzi.
Yini Okufanele Siyenze Konke Lokhu?
Isivivinyo se-ORBITA sisho ngempela ukuthi i-PCI ephumelelayo kanjani ekunakekeleni izimpawu ze-angina eqinile. I-cardiologists akufanele icabange, njengoba seyenzile, ukuthi ukukhulula ngisho namabhodlela aphezulu e-artery coronary kuyokwenza ukuthi izimpawu ziphele.
Noma kunjalo, izazi ze-cardiologists ezithathelanayo ziphakamisa izinkinga eziningi ezisemthethweni nesifundo se-ORBITA. Lowo okufanele asithinte njengenkinga enkulu kakhulu yilezi: Iziguli ezihleliwe kulolu cwaningo zine-angina ephansi kakhulu, futhi ngaphansi kweziqondiso zamanje eziningi zazo azikaze zikhethwe njenge-PCI kuqala. Ngamanye amazwi, akufanele silindele ukuthi ukugcoba kuzoba nethonya elikhulu kulawo maguli. Ukuthi akuzange kube nomthelela omkhulu kufanele kube nokubikezelwa kusukela ekuqaleni.
Ngesikhathi esifanayo, ukungenelela akufanele bathathe induduzo enkulu ekuhloleni kwabo kwecala. I-ORBITA ukutadisha eqinisweni ikhombisa ukuthi, esigabeni esikhulu seziguli namuhla ezithola i-PCI ezweni langempela (okungukuthi, abantu abanezimpawu "eziphawulekayo" abanezibonakaliso zabo ezilinganiselwe ukuba zilinganiswe), ukuthukuthela akwenzi lutho okuhle okulinganiselwe.
Ngakho-ke, noma ngabe i-ORBITA ayilungisisi ukushintsha iziqondiso ezihlelekile zamanje, iqinisile iqondisa ukushintsha umkhuba wokwelashwa okhona manje.
Uma Unamandla Angina Anganamuhla
Izitshalo ziye zashintsha ukwelashwa kwesifo se-coronary artery. Kubantu abanesifo esisodwa se-coronary syndromes, i-PCI iholele ekunciphiseni okukhulu ekufeni nokukhubazeka kokuqala. Futhi kubantu abaningi abanezinkinga ezinzima, ezingabhubhisa ama-angina (iqembu elalingakahlolwa ekulingweni kwe-ORIBTA), i-PCI ibangele ukuthuthukiswa okukhulu kwezimpawu.
Noma kunjalo, ama-stents kufanele agwenywe noma kunini lapho kungenzeka khona. Ngaphezu kwengozi ehilelekile ekusebenzeni kwenqubo ye-PCI ngokwayo, ukuba khona kwe-stent kudala inkinga yokuphatha isikhathi eside, kokubili udokotela nesiguli, isinqumo sakhe esiphezulu asihlali ngokucacile. Ngokufanayo, ingabe iphephile njalo ukuyeka izidakamizwa ezinamandla zokulwa nama-platelet ezidingekayo emva kwe-PCI? (Ngokusobala, iziguli eziningana ekulingweni kwe-ORIBTA ezazinenqubo ye-sham zibhekene nezinkinga ezinkulu zokuphuza ngesikhathi sokulandelwa.) Funda kabanzi mayelana nenkinga eqhubekayo nge-stents .
Uma u-angina ozinzile namuhla, i-cardiologist yakho akufanele ibe nesifiso sokwenza i-PCI. Ukuphoqa ngeke kukhululeke ngokuphelele inkinga yakho yezokwelapha (ngisho noma iphatha ngempumelelo i-angina yakho); Kunalokho, ukuthukuthela kuyodayisa inkinga eyodwa yokuphathwa okungapheli komunye.
Esikhundleni sokugxila ngqo ku-PCI, ezimweni eziningi i-cardiologist kufanele ikhuthaze isilingo esinonya, esinezinyathelo ezihlakaniphile zokwelashwa okulwa no-anginal, futhi umuntu onama-angina azinzile kufanele amukele umbono wokuqala ukwelashwa. Bobabili amaqembu kufanele abe nesineke, ngoba ukuthola ukwelashwa okuhle kakhulu kungathatha amasonto ambalwa noma ngisho nezinyanga.
Uma i-angina ephawulekayo isalokhu inkinga ngisho nangemva kokuvivinywa okunomthelela wezokwelapha, kungukuthi ukucatshangelwa okujulile kufanele kunikezwe isithunzi. Funda kabanzi mayelana nokuthi udinga ngempela i-stent .
Izwi elivela
Icala le-ORBITA lidala ukuphazamiseka okuphawulekayo emhlabeni jikelele wezinhliziyo ngokuphathelene nokwelashwa kwama-angina azinzile.
Kodwa-ke, uma une-angina eqinile, imiphumela yalolu vivinyo akufanele iphoqele kakhulu ukwelashwa kwakho, uma nje wena nodokotela wakho nibheka ubufakazi obunombono.
Ngenkathi isilingo se-ORBITA singabonakali ukuthi kufanele sishintshe ukuthi ingculazi enesimo esifanele kufanele iphathwe kanjani, itholakala ukuthi ishintshe indlela eye yabuzwa ngayo kaningi ngabahlengikazi be-cardiologists.
> Imithombo:
> Al-Lamee R, Thompson D, Dehbi HM, et al. Ukungenelela kweCononary Coronary In Stable Angina (Orbita): Isivivinyo Esilawulwa Ngokuphindaphindiwe, Esibukhali. Lancet 2017; I-DOI: 10.1016 / S0140-6736 (17) 32714-9. Abstract
> Brown DL, i-Redberg RF. I-Nail yokugcina e-Coffin For Pci E-Stable Angina? Lancet 2017; I-DOI: 10.1016 / S01406736 (17) 32757-5. Ukuhlela
> Umphakathi we-Angiography and Interventions. I-SCAI Ihlola Amandla Nokwehluleka Kwe-Sham PCI Trial. NgoNovemba 2, 2017. https://medicalxpress.com/news/2017-11-scai-strengths-weaknesses-sham-pci.html