Amahora ambalwa okuqala abalulekile
Ukuhlaselwa kwenhliziyo ejulile (okubizwa nangokuthi i- infarction ye-myocardial , noma i-MI) yisimo esiphuthumayo sezokwelapha. Ukuba ne-MI kusho ukuthi omunye wemithwalo yakho ye- coronary uye yavinjelwa ngokuzumayo, futhi imisipha yenhliziyo ehlinzekwa yilo mshini iqala ukufa. Imithi yokwelapha yasekuqaleni futhi enobudlova iyadingeka ukuze kuqiniswe uhlelo lwakho lwezinhliziyo nokuvimbela noma ukunciphisa izinkinga zesikhathi eside kusuka ekuhlaselweni kwenhliziyo.
Ukuqala Okusheshayo Kwe-Attack Heart Acute
Izinto eziqala kuqala emva kokufika esibhedlela nge-MI engenzeka yizo:
- Ukuqinisekisa ukuthi izibonakaliso zakho ezibalulekile (impulse negazi) zizinzile
- Ukuze ulungiselele ukubhekana nezimo ezisongela ukuphila ezingase zivele (njenge -fibrillation ye-ventricular )
- Ukuze unqume noma ngabe unayo i-MI noma cha
Ukuqaphela isimo esibi kunazo zonke sokuhlasela kwenhliziyo - isifo se- ST-IM se-ST-segment elevation (STEMI) - ngokuvamile kulula kakhulu odokotela ukuba benze. Kwenziwe ngokufuna izinguquko zesici ku- ECG .
Uma unesimo esibi kakhulu se-MI, okungewona i-STEMI (okusho ukuthi ngokuvamile umthambo awuvinjelwe ngokuphelele), ukuxilongwa kungadinga ukuhlolwa okungaphezulu - ikakhulukazi ukulinganisa kokuphakama kwamanzyme enhliziyo , amaprotheni akhishwe egazini ngamaseli omzimba we-cardiac ezilimele.
Uma kuvela ukuthi une-STEMI, izinyathelo ezisheshayo kufanele zithathwe ukuze kukhululwe ukuvinjelwa futhi uthole igazi ligeleza ngaphakathi komthambo we-coronary futhi.
Ukuthintwa Kwenzeka kanjani?
Kunezindlela ezimbili ezijwayelekile zokuvula umthambo we-coronary ovinjiwe: ukwelashwa kwe-thrombolytic kanye ne- angioplasty nge- stenting .
Ukwelashwa kwe-thrombolytic kuhlanganisa nokunikeza izidakamizwa (okuthiwa "i-clot-busters," njenge-Activase (t-PA), i-streptokinase, i-urokinase, noma i-anistreplase), esebenza ngokushesha ukuze ihlakaze i -clot yegazi evimbele umshini.
Ucwaningo luye lwabonisa ukuthi cishe amaphesenti angama-50 emithambo ejwayelekile engavulwa ngokunikeza lezi zidakamizwa ekuqaleni kokuhlaselwa kwenhliziyo nokuthi iziguli ezithinteka imicibisholo zivulwa ziphela ngokulimala kwenhliziyo encane kanye nethuba elingcono kakhulu lokuphila isikhathi eside.
Kuzo zonke izifundo, ekuqaleni imithi inikezwa, kungcono amathuba okuphumelela. Imiphumela emihle iyatholakala emahoreni amathathu okuqala; imiphumela eyanelisayo kakhulu ibonakala phakathi kwamahora amathathu kuya kweziyisithupha; kanti ezinye izinzuzo kubonakala kuze kube amahora angu-12, ngenzuzo encane noma engenayo ngemuva kwalokho.
Umthelela omkhulu wethrafikhi ye-thrombolytic iphuma, futhi le ndlela yokwelashwa akufanele isetshenziswe ezigulini ezinengozi enkulu yokuphuma kwamanzi (isibonelo, uma usanda kuhlinzwa, unomlando wesifo ngenxa yesifo socansi, noma unegazi eliphezulu kakhulu).
Ukusebenzisa i-angioplasty nokuphosa esikhundleni semithi ye-thrombolytic manje ibonakala sengathi iphumelela kakhulu ekuvuleni ngempumelelo umthambo we-coronary ovinjiwe ngesikhathi se-MI enzima. I- angioplasty esheshayo ne-stenting iphumelele ekuvuleni umthamo ovinjelwe cishe ngo-80% wesikhathi. Ukungahambi kwale ndlela ukuthi yinkambiso evumayo, futhi ngaphandle kokuthi isibhedlela senzelwe ukwenza i- angioplasty esiphuthumayo ngokushesha nangempumelelo, ukuvulwa kwesitsha segazi kungenziwa ngokushesha ngokutheleleka kwe-thrombolytic.
Iphuzu eliyinhloko, kungakhathaliseki ukuthi liyiphi indlela esetshenziselwa, ukuvula isitsha esivele sivele ngokushesha ngangokunokwenzeka. Lokhu kunjalo, ukukhetha phakathi kwe-thrombolytic therapy kanye ne-angioplasty kufanele ngokujwayelekile kusekelwe ezimweni.
Iningi lezinhliziyo ze-cardiologists lizokhetha ukungena nge-angioplasty uma ibhubhu labo lokuhlwanyela lingasheshe lihlangane, futhi abasebenzi abanolwazi olutholakala kalula bayatholakala kalula. Le ndlela engavamile nayo izokhethwa uma kunesizathu esihle sokugwema ukwelashwa okuthinta ukucindezeleka endaweni yakho.
Ngakolunye uhlangothi, uma kungase kube ukubambezeleka okukhulu ekwenzeni i-angioplasty, noma uma kunesizathu esihle sokugwema ukwenza inqubo engavamile, ukwelashwa kwe-thrombolytic kungaba yisinqumo esingcono.
Zombili izindlela zingasebenza kakhulu uma zinikezwa ngokushesha. Into ebaluleke kunazo zonke akuyona indlela esetshenziselwa ngayo, kepha ukwenza ngokushesha. Isikhathi siyisisekelo, futhi indlela ekhethiwe kufanele ibe yiyo yonke indlela engase ivule ngayo umthamo ngokushesha.
Ngaphezu kokuthola umcibisholo ovinjiwe uvulwe ngokushesha, kunezinye izindlela eziningana zokwelashwa okudingeka zinikezwe ngesikhathi se-MI enzima.
Yiziphi Ezinye Izidakamizwa Okufanele Zinikezwe Ngesikhathi Ukuhlasela Kwenhliziyo Eyingozi?
Ngaphandle kokwenza ngokushesha ukuvula isitsha esivelele futhi ubuyekeze ukugeleza kwegazi ensikeni yakho yenhliziyo, ezinye izinyathelo eziningana kufanele zithathwe ekunakekeleni ngesikhathi se-MI enzima. Lokhu kufaka:
Aspirin
Ukuthatha i-aspirin (isigamu esisodwa ku-aspirin yomuntu wonke omdala ongafundile, ehlaselwe noma echotshoziwe ngokushesha ngangokunokwenzeka noma nini lapho i-MI (noma iluphi uhlobo lwe- acute coronary syndrome ) lusolakala ukuthi lungathuthukisa kakhulu imiphumela. I-aspirini isebenza ngokunciphisa "ukunamathela" kwamaplatelet wegazi futhi ngaleyo ndlela igweme ukukhula kwegazi elidala i-MI.
I-Heparin
Ukunikeza i- heparin enomfutho noma elinye igazi elincane ngesikhathi sokuqala kwamahora angu-24 wokuhlasela kwenhliziyo okudakayo cishe kunciphisa ukushona kwesikhathi eside. Izidakamizwa ze- anticoagulant , i-heparin enye, zisiza ukuvimbela ukwakheka kwegazi elisha .
Abavimba be-Beta
Abavimbela i-Beta, izidakamizwa ezivimbela umphumela we-adrenaline, ngokuphawulekayo zithuthukisa ukusinda kweziguli ezine-MIs, futhi kufanele zinikezwe kuzo zonke iziguli ngaphandle uma kunesizathu esinamandla sokuthi (njengokugula kwesifo, ukuhluleka kwenhliziyo , noma inhliziyo enhle kakhulu amazinga). Lezi zidakamizwa zivame ukuqala ngosuku emva kokuhlaselwa kwenhliziyo.
ACE Inhibitors
I-Angiotensin yokuguqula i-enzyme (ACE) inhibitors iye yaboniswa ekuthuthukiseni kakhulu umphumela weziguli ezinokuhlasela kwenhliziyo okukhulu noma izimpawu zokuhluleka kwenhliziyo. Lezi ziguli kufanele ziqaliswe i-ACE inhibitors phakathi namahora angu-24 okuqala ngemva kokuhlaselwa kwenhliziyo. Ama-inhibitors e-ACE angase azuze neziguli ezinokuhlaselwa kwenhliziyo encane.
Izitatimende
Ukwelapha ngeziqu kufanele kuqalwe kuzo zonke iziguli ezine-MI ngaphambi kokukhishwa kwesibhedlela, futhi mhlawumbe ngokushesha ngangokunokwenzeka emva kokuqala kwenhliziyo. Izitatimende zibonakala zithuthukisa ukusinda ngemuva kwe-MI kungakhathaliseki ukuthi yizinga le-cholesterol, mhlawumbe ngokunciphisa ukuvuvukala noma ukuzinzisa amakhemikhali we-artery coronary ngenye indlela.
Ngemuva kwamahora angu-24 okuqala
Amahora angu-24 okuqala ayigugu. Ukuthola usizo lwezokwelapha ngokushesha ngangokunokwenzeka kubalulekile ekuvimbeleni ukuboshwa kwenhliziyo , ukulondoloze imisipha yakho yezinhliziyo, nokuvimbela ukuqhuma kwamagciwane egazi ekusebenzeni emithanjeni yakho ye-coronary.
Kodwa ngisho nangemva kokuxoxisana ngempumelelo ngalolo suku lokuqala olubucayi, kusekhona umsebenzi omningi okumelwe ukwenze. Ukuhlaselwa kwenhliziyo akusona nje isenzakalo esiyingqayizivele ukuthi, lapho ekhuthazwe, ingabe ikhohliwe. Ngempela ukusinda ekuhlaselweni kwenhliziyo kudinga umzamo oqhubekayo ohlangothini lwakho, nangengxenye kadokotela wakho.
Imithombo:
> Antman, EM, Hand, M, Armstrong, PW, et al. Ukubuyekezwa okugxilwe ngo-2007 kwe-ACC / AHA 2004 Izinkombandlela Zokuphathwa Kweziguli Nge-ST-Elevation Myocardial Infarction: umbiko we-American College of Cardiology / American Heart Association Task Force on Iziqondiso Zokuzikhandla (Iqembu Lokubhala Ukubuyekeza Ubufakazi Obusha nokubuyekeza I-ACC / AHA 2004 Imihlahlandlela yokuphathwa kweziguli ezine-ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008; > 51: XXX >.
> Cannon, CP, Hand, MH, Bahr, R, et al. Izindlela ezibucayi zokuphathwa kweziguli ezine-coronary syndromes ezinzima: ukuhlolwa yiNational Heart Attack Alert Program. Am Heart J 2002; 143: 777.