Ucwaningo lubonisa ukulinganiselwa kohlelo oludumile
Uma wena noma othandekayo uthola ukuthi une- coronary artery disease (CAD) , ungase unikezwe ngenketho yenqubo eyaziwa ngokuthi ukungenelela kwe-coronary percutaneous (PCI). I-PCI ihilela amasu amabili ahlukene:
- I-Angioplasty, lapho i-tube ishicilelwe khona emthini futhi ihlose ukukhulisa isitsha futhi ikhulise ukugeleza kwegazi
- Ukufakwa kwe-stent, ithubhu elincane elincane eligcina umkhumbi livulekile futhi livimbela ukuvinjelwa kokufakela kabusha.
Ngenkathi le nqubo iqondakala kahle futhi kulula ukuyiqonda, ingabe ingakwandisa isikhathi sokuphila noma ithuthukise ithuba lokuphila?
Isifundo Sokwelashwa Sinikeza Imiphumela Eyisimanga
Ephendula lo mbuzo oceliwe ngawo, ithimba lokucwaninga elixhaswe yi-Veteran Administration's Research and Development Unit liqhathanise imiphumela kubantu abahlinzekwe ngemithi yokwelapha efanele (OMT) ukuphatha ama-CAD abo kulabo abanikezwa i-OMT ne-PCI.
Kwafakwa i-COURAGE (Imiphumela Yomtholampilo esebenzisa i-Revascularization ne-Aggressive Drug Evaluation), isifundo se-2007 siphetha ngokuthi abantu abanikezwe i-OMT yedwa babengenayo ingozi enkulu yokuhlaselwa yinhliziyo noma ukufa kunalokho okwenziwe i-OMT ne-PCI. Ngaphezu kwalokho, i-PCI ayizange inikeze inzuzo ngaphezu kwe-OMT ekunciphiseni izimpawu ze-angina .
Ukulandelwa ngo-2015 kuqinisekisile le miphumela.
Ukuchaza imiphumela
Imiphumela yabamangaza abaningi emphakathini wezokwelapha okwakuyisikhathi eside becabanga ukuthi i-PCI inenzuzo kulabo abanokuvinjelwa okukhulu kwegazi.
Kwaphela ngemva kokuhlola ukuziphatha kweziguli-kanye nokulinganiselwa kwenqubo uqobo-ukuthi abacwaningi bakwazi ukuchaza lokho okutholwe.
Phakathi kweziphetho zabo:
- Abantu ababenama-PCI bavame ukubuyela emisebenzini yabo yokudlulela ngesikhathi esidlule ekhaya (kuhlanganise nokusetshenziswa ngokweqile inyama enomvu namafutha angenampilo ).
- I-PCI ngokwalo ijwayele ukulimaza udonga lwe-artery nokwandisa ingozi yokuvinjelwa kwesibili. Empeleni, amaphesenti angama-21 eqembu le-PCI adinga elinye i-stent zingakapheli izinyanga eziyisithupha, kuyilapho amaphesenti angama-60 wemikhumbi ephathekayo edinga ukuvuselelwa.
- Inqubo ye-PCI nayo ihlotshaniswa nenengozi enkulu yokucindezeleka kwegazi, ukuhlaselwa yinhliziyo, nokushaya isisu, ngokususa ngokuphumelelayo izinzuzo eziningi zokwelashwa.
Esinye esibalulekile ukuthi ama-plaques aphathwe ku-PCI akuzona okubangelwa ukuhlaselwa yinhliziyo noma isifo sohlangothi. Esikhundleni salokho, ukukhathazeka kuhlotshaniswa nakakhulu emigqeni engasivimbeli elula, engazinzile, futhi kungenzeka kakhulu ukuphuka.
Nakuba i-angioplasty ne-stenting ingahlinzeka ngezikhathi ezincane, umthwalo omkhulu waleso sifo uhlala unomthelela kanye nengozi yezenzakalo ze-cardiovascular future.
Izenzo Zezokwelapha Ngaphansi Kokuhlola
Ukwehluleka kubuye kube nemikhuba yezokwelapha. Ukuhlaziywa kuka-2010 kwesilingo se-COURAGE kubike ukuthi amaphesenti angaphansi kuka-45 weziguli ezine-CAD ahlolwa ukucindezeleka ngaphambi kwe-PCI ekhethiwe. Lokhu okusikisela ukuthi odokotela abaningi behlulekile ukubhekana nezinye izinto ezingaguquguquki, njengokudla nokuzivocavoca, ngaphambi kokunikeza inqubo.
Ngenxa yalokhu, abantu abaningi kungenzeka babengazi kangako isidingo sokushintsha ukuziphatha, kuhlanganise nokuyeka ukubhema , uma bekhishwe ekunakekeleni.
Lokho Okusitshelayo
Ngenxa yesilingo se-COURAGE, i-American Heart Association kanye ne-American College of Cardiology yashicilela imihlahlandlela echaza ukusetshenziswa okufanele kwama-PCI kubantu abanesifo senhliziyo. Bakhuthaza izinguquko zokuphila kanye nokusetshenziswa okufanele kwemithi ekwelapheni kokuqala lapho isimo senhliziyo sinozinzile.
Lezi ziqondiso nazo ziqinisekisa isidingo sokuqinisekisa ukuthi umuntu uhambisana ngokugcwele nokwelashwa ngaphambi kokucubungula i-PCI. Ezimweni eziningi, ukuthuthukiswa kokunamathela ngokuqondile kuhambisana nokuthuthukiswa noma ukuqiniswa kwesimo senhliziyo.
Kulokhu, uma unesifo senhliziyo, akufanele nanini ubuke i-PCI ngokuthi "ukulungisa okusheshayo." Isixazululo esihlala isikhathi eside siyohlale siwukuzivocavoca umzimba , ukudla okulinganiselayo, okunamafutha okuphansi , nokunamathela kahle emithini yakho engapheli.
> Imithombo:
> Boden, W .; ORourke, R .; Teo, K. et al. "Ukwelapha okunezokwelapha okuqondile noma ngaphandle kwe-PCI yezifo eziqinile eziphethwe yi-coronary disease." N Engl J Med. 2007, 356: 1503-16. I-DOI: 10.1056 / NEJMoa070829.
> Desai, N .; UBradley, uS .; Parzynski, C. et al. "Izimpawu zokusetshenziswa ezifanele ze-Coronary Revascularization kanye nezendinganiso zokusetshenziswa, ukukhethwa kweziguli, nokufaneleka kweCononary Coronary Intervention." I-JAMA. 2015; 314: 2045-53. I-DOI: 10.1001 / jama.2015.13764.
> Finn, A .; Nakano, M .; UNarula, J. et al. "I-plaque engcupheni / engazinzile." I-Arterioscler Thromb Vasc Biol . 2010; 30: 1282-92. I-DOI: 10.1161 / ATVBAHA.108.179739.
> Levine, G .; Amabhange, E .; Ukungenwa kwe-Blankenship, J .; et al. "Ukubuyekezwa okugxilwe ku-ACCA ka-2015 / AHA / SCAI kwi-Coronary Primary Intervention Intervention for Iziguli ezine-ST-Elevation Myocardial Infarction." Ukujikeleza. 2015; 87 (6): 1001-19. I-DOI: 10.1161 / CIR.0000000000000336.
> Sedlis, S .; I-Hartigan, P .; Teo, K. et al. "Impumelelo ye-PCI ekuPhelelweni Kwesikhathi Eside Ezinganeni Eziphethwe Izifo Zezinhliziyo Eziqinile." N Engl J Med . 2015; 373: 1937-46. I-DOI: 10.1056 / NEJMoa1505532.