Ukufika kwe- angioplasty kanye nokuphazamiseka kwemvelo kuye kwashintsha ukwelashwa kwesifo se- coronary artery . Esikhundleni sokuthatha imishanguzo eminingi ye- angina , futhi esikhundleni sokuba nokuhlinzwa okuphambene nomuntu omkhulu, umuntu onamakhemikhali omzimba we-coronary abalulekile angaba nenqubo yokuphulukisa iziguli lapho kuvinjelwa khona ibhaluni (i-angioplasty), futhi umthamo ugcinwa ngaleso sikhathi vula nge-stent.
Ukuthukuthela sekuye kwaba yinto evamile futhi elula, futhi izithombe ezingaphambi nangemva kwe-artery ezigulayo zihlaba umxhwele (ngisho nomgudu wesi-5 ozosizwa umxhwele), ukuthi izinzuzo zale nqubo zibonakala zibonakala ngokucacile kudokotela kanye nesiguli ngokufanayo. Ngakho-ke, imikhuba eminingi noma engeyona iningi yezinhliziyo isiphethe ngokugcwele.
I-Cascade of Problems
Kodwa ngaphansi, ukusebenzisa i-angioplasty ne-stents sekulokhu kudala izinkinga ezintsha, ezidinga izixazululo ezintsha, ezizenzele izinkinga ezintsha. Ukuhlaselwa kwenkinga - isisombululo - inkinga - isisombululo - inkinga ihambe kanje:
Ezinsukwini zakuqala, i-angioplasty yayisetshenziswa yedwa. I-plaque "yaphonswa" ibhaluni, ivula umthamo ovinjiwe. Kodwa ngokushesha kwabonakala ukuthi iziguli eziningi zathola ukuphumula - ukubuyiswa kwezicubu, ngenxa yokuhlukunyezwa kwe-angioplasty - okuzovimba kancane kancane umthambo.
Ama-stents (ama-tubes enamathemikhali anwebekayo) ayathuthuka ukuze abambe umthambo ngemuva kwe-angioplasty, futhi anciphise ukuphumula. I-original metal metal stents (BMS) yasiza kancane (ukunciphisa ingozi yokuphumula) cishe isigameko sokuphumula sasihlale sikhulu ngokwanele ukuba sibe nzima. Ngakho-ke izidakamizwa-eluting stents (DES) zakhiwe.
Lezi DES ziboshwe ngezinye zezidakamizwa eziningana ezivimbela ukukhula kwezicubu, futhi ngenxa yalokho, inkinga yokuphumula iyancishisiwe.
Kodwa ngokusetshenziselwa kabanzi kwe-DES, inkinga ye- thrombosis esebenzayo yamuva yaqashelwa. I-thrombosis enamandla, okungazelelwe futhi okuvame ukwesabeka kwe-artery coronary esiteshini se-stent, bekulokhu kuyinkinga yamasonto ambalwa noma izinyanga emva kokubekwa kwe-stent. Ingozi ye-stent thrombosis yokuqala iyancipha kakhulu ngokusebenzisa ukusetshenziswa kwezidakamizwa ezimbili ezivimbela ukuvimbela (okubizwa ngokuthi "ukwelapha okubili-anti-platelet" noma i-DAPT).
Kodwa-ke ukuhlushwa kwe-stent sekwephuzile - i-thrombosis eyenzeka ngonyaka noma ngaphezulu emva kokubekwa kwe-stent - yaba yinkinga ecacile nokusetshenziswa okubanzi kwe-DES. Ngenkathi isigameko se-stent thrombosis sekwephuzile sihlala siphansi kakhulu - kulinganiselwa ukuthi senzeke esigulini esisodwa kwabangama-200 kuya ku-300 unyaka ngamunye emva konyaka wokuqala - cishe kuyisenzakalo esiyingozi ngaso sonke isikhathi, okuholela ekufeni noma ekulimazeni okukhulu kwenhliziyo.
Ingozi yokuhlukunyezwa kwe-stent esekupheleni kwesikhathi kucatshangwa ukuthi ochwepheshe abathile baphakeme nge-DES kunokuba ne-BMS, mhlawumbe ngenxa yokuthi izidakamizwa ezivimbela ukukhula kwezicubu zishiya insimbi ye-stent evezwe egazini, futhi ngaleyo ndlela ingabangela ukuguqulwa.
- Funda mayelana nenkinga eqhubekayo ye-thrombosis enamandla.
Ngenxa yokusongelwa kwe-thrombosis esedlule, manje kunconywa ukuthi i-DAPT iqhutshwa okungenani ngonyaka ngemuva kokubekwa kwe-stent. Kodwa ulwazi olusha oluvela esifundweni seDAPT esanda kushicilelwa (Novemba 2014) kubangela odokotela abaningi ukuba batusa ukuthi i-DAPT iqhutshwa okungenani izinyanga ezingu-30 ngemuva kokubekwa kwe-stent, futhi mhlawumbe kuze kube phakade.
Ngeshwa, i-DAPT ngokwalo ibangela izinkinga ezinkulu ezigulini eziningi. Iziguli ezithatha i-DAPT zithandwa kakhulu ezinkingeni zegazi, ezinye zazo zingasongela ukuphila. Ukuhlukunyezwa okuphawulekayo (njengengozi yemoto) ngenkathi kuthatha i-DAPT kungenza ukulimala okulinganisela kube yingozi.
Futhi ukulawula ukuphuma kwegazi ngesikhathi sokuhlinzwa esigulini esithatha i-DAPT cishe akunakwenzeka - ngakho cishe akekho ohlinzayo ozosebenza esibhedlela esithatha lezi zidakamizwa. Ngesikhathi esifanayo, ubufakazi bubonisa ukuthi uma i-DAPT ivaliwe nganoma yisiphi isizathu esilandelayo isiteji - ngisho neminyaka eminingana emva kokubekwa kwe-stent - kunesipike esheshayo esihlakalweni se-thrombosis esiphezulu.
Ngakho iziguli emva kokuthola i-stent zingase zizitholele endaweni engavumelekile. Udokotela wabo odokotela angase abekezele ukuthi bayeka i-DAPT yabo ukuze bakwazi ukungena esikhundleni sabo noma isinqamulo sabo sithathe indawo, futhi i-cardiologist yabo ingase igcizelele ukuthi ayigodli i-DAPT yabo, nganoma yisiphi isizathu.
Ukubuza umbuzo ofanele
Abaningi be-cardiologists baqala nge "iqiniso" ukuthi ama-stents ngokusobala ukwelashwa okukhethayo, bese ubuza, "Njengoba kunesidingo esidingekayo, ngingayenza kanjani umphumela wesiguli sami?" Uma uhambela noma iyiphi inkomfa yesimanje yezinhliziyo, uzothola ezahlukeneyo ochwepheshe bavala izingxabano eziphikisanayo mayelana nokuthuthukisa imiphumela yeziguli ngemuva kokusebenzisa ama-stents. Kufanele i-BMS isetshenziswe esikhundleni se-DES ngemuva kwakho konke? Ingabe isizukulwane sakamuva se-DES sivikelekile kunezizukulwane zangaphambili? Ingabe i-DAPT kufanele inikwe izinyanga ezingu-6, izinyanga ezingu-12, izinyanga ezingu-30, kuze kube phakade? Kuthiwani ngeziguli ezinomsoco ezinenkinga yokuphuma, noma ngubani odinga ukuhlinzwa?
Uma unesifo sokugula komgogodla futhi udokotela wakho uncoma i-stent, kufanele ubeke isibonakaliso sokuma bese ubuza udokotela wakho ukuba abuyisele kabusha umbono wakhe. Njengoba kunikezwe izimpendulo futhi imibuzo engaphenduliwe ekhona ekusetshenzisweni kwanoma yikuphi ukugaya, ingabe i-stent iyadingeka ngempela? Ingabe ezinye izindlela zokwelashwa ezitholakalayo ezingasetshenziswa ngaphambi kokusebenzisa i-stent?
Uma unayo i-coronary syndrome eyingozi - angina engaqiniseki noma isifo senhliziyo - khona-ke udokotela wakho cishe ulungile. Unengozi esheshayo ngenxa yesikhala se-aron coronary engaqiniseki, futhi i-angioplasty / stenting cishe iyindlela engcono kakhulu yokuqiniswa isimo sakho senhliziyo.
Kodwa uma "kuphela" ukuhlupheka nge- angina esimile , noma uma uvinjelwe ngokuphawulekayo okwenzile noma yiziphi izimpawu, khona-ke i-angioplasty ne-stenting akuyona yedwa okukhethwa kukho - futhi kungenzeka ukuthi akuyona indlela engcono kakhulu. Imiphumela ngokuvamile inhle noma ingcono ngemithi yokwelashwa kanye nezinguquko zokuphila. Futhi khumbula ukuthi i-stent ayiyona isisodwa esisodwa nesenziwe; uma uthola i-stent, uzoba ukwelashwa kwezempilo isikhathi eside - ukwelashwa okunamandla kakhulu - noma kunjalo. Ngaphezu kwalokho, ochwepheshe abaningi manje bebabuza ukuphumelela kwe-stent therapy ukuze i-angina igxile .
Ngakho-ke: udinga ukucela udokotela wakho ukuba avuselele isinyathelo. Esikhundleni sokucabanga ukuthi i-stent iyimpendulo, bese igxila kuzo zonke izimpikiswano zezokwelapha ezizisebenzisayo ngokushesha uma isilonda sisetshenzisiwe, udokotela wakho kufanele esikhundleni sakhe acele, "Ukunikezwa kwesimo sengqondo senhliziyo yesiguli, isimo sempilo jikelele, kanye nemibono, ithemba kanye nezifiso, yiluphi ukwelashwa okunamandla kokugula kwakhe komzimba we-coronary? "Ngokuvamile kunezinketho eziningi zokwelapha - futhi kufanele zibhekwe zonke.
I-stent ingase ibe yimpendulo efanele, kodwa lokho kungenziwa kuphela emva kokubuza umbuzo ofanele.
Imithombo:
Mauri L, Kereiakes DJ, Yeh RW, et al. Ezinyangeni eziyishumi nambili noma ezingu-30 zomuthi we-antiplatelet owodwa ngemuva kokusebenzisa izidakamizwa-e-stuting. N Engl J Med 2014; I-DOI: 10.1056NEJMoa1409312.
I-Columbo A ne-Chieffo A. Ukwelashwa kwe-antiplatelet ka-Dual ngemuva kokudakwa kwezidakamizwa-eziphuthumayo-Kuzoze kube nini ukuphatha? N Engl J Med 2014; I-DOI: 10.1056 / NEJMe1413297.
Lüscher TF, Steffel J, Eberli FR, et al. I-drug-eluting-stuting-stingary thrombosis: izinqubo zezinto eziphilayo kanye nemiphumela yomtholampilo. Ukujikeleza kuka-2007; 115: 1051.
Iakovou I, Schmidt T, Bonizzoni E, et al. Isigameko, ukubikezela, kanye nomphumela we-thrombosis ngemuva kokufakelwa ngokuphumelelayo kwezidakamizwa-e-stuting stents. I-JAMA 2005; 293: 2126.