Ukwelashwa kwesikhathi eside kuyadingeka, kodwa kuyinkinga
Emashumini ambalwa ambalwa adlule, ama-stents aseye avame kakhulu ekwelapheni isifo se- coronary artery . Ngalesi sikhathi iningi lentuthuko yenziwe ngobuchwepheshe obuqinile. Izinkinga ezazibonwa ezinsukwini zokuqala zokudabuka, njengokuhlukaniswa kwe-stent ngaphakathi kwe- coronary artery , kanye nesilinganiso esiphezulu se- stent restenosis , kuye kwahliswa kakhulu nge-stents entsha (ikakhulukazi, ngokusungulwa kwe-drug-eluting stents, okuvimbela ukukhula kwamathambo okuyinhloko okubangelwa ukuphumula).
Kodwa okungenani inkinga eyodwa yokuqeda ihlala isinezinhlanzi-ingozi ye- thrombosis enamandla . I-thrombosis enamandla isakhiwe ngokuzumayo kwe-clot yegazi esakhiweni se-stent, okuyinto evame ukudala ukufakwa okusheshayo nokuphelele kwe-artery coronary. Ukucindezeleka okunamandla akuyona inkinga ejwayelekile kakhulu, kodwa lapho kwenzeka kwenzeka, kuyinto eholela ekufeni okusheshayo noma ekulimazeni okukhulu kwenhliziyo kusuka ekuhlaselweni kwenhliziyo .
Ingozi ye-thrombosis enamandla iphezulu emavikini nasezinyangeni emva kokubekwa kwe-stent. Kodwa ngokuhamba kwesikhathi sekuye kwacaca odokotela ukuthi le ngozi ayisoze yaphela ngokuphelele, nokuthi "ukuphefumula" kwe-stent "okuphuthumayo" (okungukuthi, i-thrombosis eyenzeka ngonyaka noma ngaphezulu ngemva kokufakwa kwe-stent) ihlala yinto encane, kodwa inhlekelele enkulu, kungenzeka.
Ingozi yokwehla kwesifo esibi kakhulu ingancishiswa kakhulu lapho abantu abathola ama-stents bamiswa izidakamizwa ezimbili eziphambene neplatelet ukuze zivimbele ukugaya igazi: i- aspirin , kanye ne-block2 ye-receptor blockers.
Ama-blockers e-P2Y12 asetshenziselwa ukuvimbela ukucindezeleka kwe-stent yi-clopidogrel (i-Plavix - ejwayelekile kakhulu), i-prasugrel (Umfutho), kanye ne-ticagrelor (i-Brilinta).
Ukuthatha esinye sezidakamizwa ze-P2Y12 kanye ne-aspirin kubizwa ngokuthi "ukwelashwa okubili-okuphambene ne-platelet," noma i-DAPT.
Isikhathi sokusetshenziswa kwe-DAPT
I-DAPT iphumelela kakhulu ekunciphiseni ingozi ye-stent thrombosis eyingozi.
Ekuqaleni, i-DAPT isetshenziswe inyanga emva kokubekwa kwe-stent, lapho ingozi ye-thrombosis iphezulu kakhulu. Kodwa-ke, odokotela baqaphela ngokushesha ukuthi i-DAPT kufanele isetshenziswe isikhathi eside, futhi iminyaka eminingana izinga lemithi yokwelapha lizobe linikeza izinyanga eziyisithupha ze-DAPT.
Khona-ke, ekuqaleni kwawo-2000, inkinga ye-thrombosis esebenzayo yasheshe yaqashelwa, futhi odokotela abaningi baqala ukubeka i-DAPT iminyaka yonke noma ngaphezulu.
Njengoba isikhathi sihamba, imibiko yaqala ukuqoqwa kwe-stent thrombosis eyenzeka kakhulu kakhulu (ngisho neminyaka) ngemuva kokubekwa kwe-stent. Iningi lalezi zenzakalo zenzeke ngemuva nje kokuthi i-DAPT ishiywe, ngisho nangemva kokwelashwa kwesikhathi eside. Odokotela abaningi bakhathazekile ngokuthi i-DAPT kufanele imiswe isikhathi eside kakhulu-mhlawumbe iminyaka, noma mhlawumbe kuze kube phakade. Kodwa-ke, idatha encane yangempela yayikhona ukuze unike odokotela isiqondiso somgomo esikhathini esihle se-DAPT esilandelayo.
Izifundo
Isifundo se-DAPT senzelwe ukunikeza impendulo yokugcina mayelana nobude obuhle be-DAPT ngemuva kokubekwa kwe-stent. Ucwaningo lubhalise iziguli ezingaba ngu-10 000 ezivele zithathe i-DAPT izinyanga ezingu-12. Babenqatshelwe ukuthi bangamisa i-DAPT ngaleso sikhathi, noma baqhubeke nezinye izinyanga ezingu-18 (isikhathi esiphelele sezinyanga ezingu-30).
Imiphumela, kubikwa ngasekupheleni kuka-2014, yabonisa ukuthi izinyanga ezingu-30 ze-DAPT zihlotshaniswa nengozi ebaluleke kakhulu yokwehliswa kwe-stent ephuzile, uma kuqhathaniswa nezinyanga ezingu-12 zokwelashwa. Ucwaningo lubuye lwaveza ukuthi ingozi ye-thrombosis yanda kakhulu isikhathi esingangezinyanga ezintathu noma njalo lapho i-DAPT ivaliwe, ngisho nangemva kweminyaka yokusebenzisa.
Ucwaningo lwe-DAPT luye lwabonisa ukuthi abantu abaphathwa ngezinyanga ezingu-30 ezigcwele babe neziqephu ezingaphezulu kakhulu zokuphuza kuneziguli eziphathwe izinyanga ezingu-12.
Ngakho-ke, isifundo se-DAPT sibonise ukuthi izinyanga ezingu-30 ze-DAPT zingcono kunezinyanga ezingu-12 zokwelapha ekuvimbeleni ukucindezeleka kwe-stent.
Kubuye kuqinisekiswe ukuthi kune-spike ephawulekayo engozini ye-thrombosis lapho ivala i-DAPT, ngisho nangemva kokusebenzisa isikhathi eside. Okokugcina, kubonise ukuthi kukhona ukuhweba nge-DAPT eqhubekayo yokwelashwa okuncane kakhulu, kodwa kuneziqephu ezithinta impilo esongela ukuphila. Ezinye izilingo ezinzima ezibuke ukwelashwa kwe-DAPT isikhathi eside ngemuva kokugquma kubonise imiphumela efanayo.
Izinselelo
Ukuthatha i-DAPT ngokwayo kubangela ingozi yeziqephu ezinkulu zokugaya, kanti isifundo se-DAPT siqinisekisile ukuthi isikhathi eside umuntu ethatha i-DAPT, kuphakama ingozi yokuphuma okukhulu kwegazi. Kulawo muntu othatha i-DAPT, isiqephu sokuhlukunyezwa okulinganiselayo (njengengozi yemoto engabangela ingozi ngokuqondile yokufa) kungaba yingozi kakhulu ngenxa yokuphuma kwegazi.
Futhi, ngoba ukuphuma kwegazi kunzima kakhulu ukulawula ku-DAPT, odokotela abaningi abahlinzayo banqikazi kakhulu ukusebenzisana nanoma ubani othatha i-DAPT.
Ngempela, lolu daba ngokuphathelene nokuhlinza ludala inkinga enkulu kwiziguli eziningi ezinama-stents. Ngakolunye uhlangothi, i-cardiologist yabo ingabatshela ukuthi bangalokothi, bayeke ukuyeka i-DAPT (ngenxa yengozini enkulu yokucindezeleka okuqinile); Ngakolunye uhlangothi, udokotela ohlinzayo angase abatshele ukuthi badinga ukuhlinzwa, futhi ukuthi i-DAPT kumele imiswe ukuze kuvunyelwe ukuhlinzwa.
Isayensi yezokwelapha ingakabi isisombululo kule nkinga evamile. Ngokuba ososayensi lokhu kuyinkinga ethakazelisayo yokusebenza; kwezinye izazi ze-cardiologists kuyinkinga enhle eyenziwa yisiguli ukungakwazi ukuzilimaza ngokwabo, noma ukuhluleka ukugwema isidingo sokuhlinzwa; iziguli zingenkinga yokuguqula impilo, futhi inkinga engabangela ukukhathazeka ngokukhethekile uma engakaziswa ngokwanele ngemiphumela ye-DAPT ngaphambi kokuba avume ukuthola i-stent.
Ezimweni eziningi uma ukuhlinzwa kungenakugwema, yonke imizamo yenziwa ukuqhubeka i-DAPT unyaka ngemuva kokubekwa kwe-stent-noma okungenani, ezinyangeni ezingu-6-ngaphambi kokuyiyeka.
Izincomo zamanje
Iningi lezinzwa zezinhliziyo lisho ukuthi iziguli zazo ezinamandla zithatha i-DAPT okungenani izinyanga ezingu-12, ngaphandle uma isiguli sinomngcipheko wegazi okhuphuka ngokucacile. Ngemuva kwezinyanga ezingu-12, ukuhlolwa kabusha kufanele kwenzeke, futhi uma kunokwenzeka, i-DAPT kufanele iqhutshekwe ezinye izinyanga ezingu-18.
Izwi elivela
I-DAPT iyadingeka ngemuva kokuba ne-stent, kodwa ingabonisa izinkinga zayo ezinzima. Umphakathi wezokwelapha usalokhu ukhipha isilinganiso sokungena engozini ye-DAPT yesikhathi eside, futhi kungenzeka ukuthi ube yisikhathi ngaphambi kokuba kuvunyelwane.
Okwamanje, lapho i-cardiologist iphakamisa ukwelashwa okwe-stent kumuntu one-coronary artery disease, kufanele azizwe enesibopho sokubukeza nesiguli, ngokuningiliziwe, konke okushiwo yiqiniso lokuthi i-DAPT yesikhathi eside manje iyinxenye engokwemvelo ye-stent ukwelapha. Zonke ezinye izindlela zokwelapha ezithinta ukwelashwa okunamandla nazo kudingeka zixoxwe ngokugcwele, ukuze kwenziwe isinqumo esinolwazi ngempela.
> Imithombo:
> I-Columbo A ne-Chieffo A. I-Dual Antiplatelet Therapy Ngemuva kokudakwa kwezidakamizwa-i-Eluting Stents-Kuyoze kube nini? N Engl J Med 2014; I-DOI: 10.1056 / NEJMe1413297.
> Mauri L, Kereiakes DJ, Yeh RW, et al. Izinyanga ezingu-12 noma ezingama-30 zohlelo lwe-Dual Antiplatelet Therapy Emva kweDrug-Eluting Stents. N Engl J Med 2014; I-DOI: 10.1056NEJMoa1409312.
> Sammy Elmariah, uLaura Mauri, uGheorghe Doros, et al. Isikhathi esongeziwe Ukwelapha okubili kwe-antiplatelet nokufa: ukubuyekezwa okuhlelekile kanye nokuhlaziywa kwe-Meta-Analysis. Lancet 2014; I-DOI: 10.1016 / S0140-6736 (14) 62052-3.
> Levine GN, uBates ER, Blankenship JC, et al. Umhlahlandlela we-ACCF / AHA / SCAI we-Acne Coronary Intervention: Umbiko we-American College of Cardiology Foundation / i-American Heart Association Task Force on Iziqondiso Zokuzikhandla kanye neNhlangano Yezinzwa Ze-Cardiovascular and Angerography. Ukujikeleza ngo-2011; 124: e574.