Ukuqonda Ukuhlinzwa Kwe-Heart Bypass
Ngokuvamile okuthiwa "I-CABG Surgery" noma " ukuhlinzeka ngenhliziyo evulekile ," umthambo we-coronary overpass ukuhlinzwa kwe-graft yindlela yokwelapha yokukhetha ye-arteries evinjiwe ezungeze inhliziyo.
Inhliziyo iqhuma igazi kuwo wonke umzimba kodwa namanje incike ochungechungeni lwemithwalo yegazi okuthiwa i-coronary arteries yegazi layo. Uma imishanguzo ivinjelwa kakhulu - isimo esaziwa ngokuthi isifo somzimba we-coronary - oksijeni ayifinyeleli emzimbeni wenhliziyo kanye nokulimala kwenzeka.
Ukuhlinzwa kwe-heart , noma ukuguqulwa kokuhlinzwa , kubhekwa ukwelashwa kwe- standard standard ye-coronary artery disease .
Ukuvimbela ukulimala kwenhliziyo, ukugeleza emithanjeni ye-coronary kumele kwandiswe. Ngesikhathi sokuhlinzwa kwenhliziyo evulekile, imishanguzo evinjiwe isuswe noma idonswe ngemithwalo yegazi ethathwe kwenye ingxenye yomzimba. Ezinhlinzweni eziningi, imishanguzo ye-coronary emibili kuya kwezine ihlanganiswa ukuqinisekisa ukugeleza okwanele enhliziyweni.
Ukuhlinzeka nge-bypass kuvame ukuchazwa ngokwemingcele eminingi yokuphelelwa yisikhathi, njenge- bypass kabili , i- bypass kathathu noma i -bypass encane .
Izinkomba ze-Open Heart Bypass Surgery:
- Izinguquko ezinkulu zokudla, ukuyeka ukubhema nokunyuka kokuzivocavoca akuzange kuthuthukise isifo se-coronary artery.
- I-Angioplasty ayiphumelelanga, ayifanele noma umthambo uvinjelwe futhi ngemuva kwe-angioplasty.
- Ubuhlungu obukhulu besifuba bubonakala ngomsebenzi.
- Ukuhlolwa kubonisa isifo esinzima emthonjeni omkhulu we-coronary .
- Ukuhlolwa kuveza isifo esinzima emithanjeni eminingi .
- Izitshalo azizange zisebenze, azikwazanga ukufakwa noma ziyadingeka futhi.
- I-ventricle engakwesokunxele ayisebenzi kahle ngenxa yesifo se-artery coronary.
- Kukhona umonakalo oseduze wokulimala kwenhliziyo.
Ukulungiselela Ukuvulwa Kwenhliziyo Evulekile:
Abahlinzeki abaningi bezinhliziyo zomoya bahlinzeka ukuhlolwa okubanzi ngaphambi kokuhlinzwa ukuze banqume ukuthi yiziphi izidakamizwa ezivinjelwayo kanye nobukhulu bokuvinjelwa.
I-angiogram inguvivinyo olulodwa lwezilonda olusebenzisa i-x-ray ukucacisa ubukhulu besifo se-coronary.
Isivivinyo sokucindezeleka, i-electrocardiogram (EKG) nokuhlolwa kwegazi ngokuvamile kwenziwa ngaphambi kokuhlinzwa. Ukuhlolwa kwegazi kungahle kwenziwe ngokuphindaphindiwe ngaphambi kokuhlinzwa ukuze kunqume ukuthi isiguli singase siphume ngesikhathi sokuhlinzwa, kanye nempilo yabo jikelele.
Udokotela ohlinzayo angase abe nemiyalo eqondile yesiguli esilungiselelwe ukuhlinzwa kwe-bypass. Lezi ziqondiso zingase zibandakanye izinguquko emithini yemithi kadokotela, ukudla nokuphuza nokubhema .
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On Pump Open Heart Bypass Ukuhlinzwa:
Ukuhlinzwa kwenhliziyo okuvulekile kuqhutshwa ngaphansi kwe-anesthesia ejwayelekile , okudinga ukuthi isiguli sibe sesivinjini ngesikhathi sokuhlinzwa.
Ukuhlinzwa kuqala ngokuvuna imithwalo yegazi ezoba yi-grafts. I-vehen saphenous emlenzeni isetshenziswa kakhulu ngoba isikhathi eside ngokwanele ukwenza ama-graft amaningi. Uma i-vehen saphenous ingasetshenzisiwe, izitsha ezisuka engaleni zingasetshenziswa esikhundleni salokho. I-artery yangaphakathi yangasese yangasese isetshenziselwa ukuhlanganiswa okulodwa futhi kuthathwa uma isifuba sivulwa ukuhlinzwa.
Uma isifuba se-saphenous seluliwe, isifuba sivuleka ngokwenza i -sternum, noma isifuba.
Udokotela ohlinzayo wabe eseqeda i-sternum, evumela ukuba igumbi lesifuba livuleke, linike udokotela ohlinzayo ukufinyelela enhliziyweni.
Enkambisweni ye-CABG yendabuko, inhliziyo imiswe ngesisombululo se-potassium ngakho udokotela ohlinzayo akazami ukusebenza emkhunjini ohambayo, futhi igazi lihanjiswa ngumshini wenhliziyo. Ngalesi sikhathi umshini we-heart-lung wenza umsebenzi wenhliziyo namaphaphu, futhi umshini wokuphuza umoya awusebenzi.
Udokotela ohlinzayo ubeka ama-graft, noma aphinde avuse igazi egazini lokuvimba, noma asuse futhi athathe isitsha esivinjiwe. Isikhathi sesikhathi emshinini we- heart-lung bypass sinqunywa isivinini lapho udokotela ohlinzayo ekwazi ukusebenza, ngokuyinhloko, kungakanani okudingekayo.
Uma ama-graft eseqedile, inhliziyo iqalwa futhi inikeza igazi ne-oksijini emzimbeni. I-sternum ibuyiselwa esimweni sayo sokuqala futhi ivaliwe ngokusebenzisa ucingo oluhlinzekwayo, ukunikeza amandla amathambo adinga ukuphulukisa, futhi ukuchotshozwa kuvaliwe.
Imikhiqizo yePompe Ukuhlinzwa Inhliziyo Evulekile:
- Udokotela ohlinzayo angasebenza ngokushesha ngoba inhliziyo isaphila
- Igazi elincane kakhulu lenza ukuhlinzwa ngokushesha
- Kuyafaneleka iziguli ezingazinzile
I-Cons of On Pump Yokuhlinzwa Inhliziyo Evulekile:
- Ukwanda ukuvuvukala / ukuvala isikhumba emva kokuhlinzwa
- Ukwedluliselwa okungaphezulu cishe ngemva kokuhlinzwa ngaphandle kokuvala ipompo
- Ukugcinwa okungaphezulu kwamanzi kagesi kunepompo elingaphandle
- Ingozi enkulu yokulimala kwezinso kunokuba ipompo
- Ukuhlala esibhedlela isikhathi eside kunokuba uphume
- Ingozi eyengeziwe yokushaywa yisifo
Ukuvala Pump Open Heart Heart:
Inqubo yokushaya inhliziyo, noma ukuhlinzwa okuphambene ne-off-pump kubonakala ngokufana nokuhlinzwa kwepompo, kodwa ukugeleza kwegazi emzimbeni kugcinwa yinhliziyo ngesikhathi senqubo. Esikhundleni sokusebenzisa umshini we-heart-lung, inhliziyo iyaqhubeka ishaya kodwa indawo ehlanganisiwe ibanjwe namanje ngezixhobo zokuhlinza. Cishe iziguli ezingu-20% zokuqala ze-CABG ziyeke ukuhlinzwa kwepompo .
Imikhiqizo ye-Off Pump Yokuhlinzwa Inhliziyo Evuliwe:
- Inhliziyo iyathutha, yehlisa ukuhlinzwa
- Ukulahlekelwa kwegazi okuncane kanye nokumpontshelwa okuncane
- Ukunciphisa ingozi yokushaywa yisisu
- Ukuhlala isikhathi eside sokuhlala esibhedlela
- Okubizayo kancane
I-Cons of Off Off Inhliziyo Yokuvuleka Inhliziyo:
- Iziguli ezingafika ku-70% azivumelekile ngenxa yesimo somzimba noma isimo sezokwelapha
- Ngokuvamile kwenziwa ngesiguli esingaqinile
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Ukubuyiselwa Kokuhlinzwa Okuvulekile Kwenhliziyo:
Ekuhlinzekeni okuningi , izidakamizwa zinikezwa ukuvusa isiguli ngokushesha ngemva kokuvalwa komshini. Odokotela abaningi abahlinzayo bakhetha ukuvumela iziguli ze-CABG ukuba zivuke kancane, ukuvimbela noma yikuphi ukucindezeleka enhliziyweni okungenzeka kwenzeke lapho evuka ngokungazelelwe.
Isiguli siyothathwa endaweni yokutakula, ngokuvamile i-unit cardiac noma yokunakekelwa okujulile yokunakekelwa, ngokunakekelwa ngenkathi iphuma e-anesthesia. Isimo sokunakekelwa okubucayi kuyadingeka ukuhlinzeka isiguli ngenye yokunakekelwa kwabahlengikazi kanye nokuqapha okuqhubekayo. Ngalesi sikhathi i-ventilator izohlala isebenza, ihlinzeke ukusekela ukuphefumula ngenkathi isiguli sigcina sisondeza.
I-tubes eyodwa noma ngaphezulu, ama-tubes amakhulu afakwa eduze kwendawo yokuhlinzeka, asize ukususa noma yikuphi igazi okungenzeka liqoqwe enhliziyweni. I-IV emikhulu ebizwa ngokuthi i-Swan-Ganz nayo izobe isendaweni, ivumele abasebenzi ukuba babheke imisebenzi enhle yezinhliziyo futhi banikeze imithi.
Uma izidakamizwa ze-anesthesia zigugile futhi isiguli siphapheme, ithubhu yokuphefumula isusiwe (inqubo ebizwa ngokuthi i-extubation) futhi isiguli sikwazi ukuphefumula sodwa. Ngokushesha ngemva kokuphefumula okwenziwe nge-oksijeni eyengeziwe inganikezwa ngekhala, ukusiza ngokuphefumula. Amazinga e-oksijeni nokuphefumula kuyolindelwa ngokucophelela futhi uma isiguli singenakuphefumula ngokwanele ngaphandle kwendiza, iphethini lokuphefumula lizophinde lifakwe.
Uma esevukile futhi ephefumula eyedwa, isiguli sizoqala ukuvuselelwa ngokuqinile, kuqala ngokuhlala emaphethelweni embhedeni noma ukuma nokuhamba ngezinyathelo ezimbalwa esihlalweni. Isiguli sizofundiswa ngezindlela zokuhambisa ukuthi ukunciphisa ubuhlungu nokuvikela isilonda sokuhlinzwa . Ngalesi sikhathi, imithi yobuhlungu iyatholakala ukuvumela isiguli ukuba siphume ngaphandle kobuhlungu obukhulu.
Isiguli se-CABG siyohlala esimweni sokunakekelwa okujulile okungenani amahora amabili namane. Ama-tubes esifubeni ngokuvamile asuswe ngaphakathi kokuhlinzwa kwamahora angu-8, ngaphambi kokudluliselwa ku-unit ephansi. Iziguli eziningi ze-CABG zikhombisa ukuthuthuka okuphawulekayo ezingeni lobuhlungu uma amashubhu esifuba isifuba asusiwe.
Ukuphila Ngemva Kokuvulwa Kwezinhliziyo Ezivulekile:
I-CABG ayisona isifo senhliziyo; kuyindlela yokwelapha ephumelela kakhulu. Isiguli se-CABG esingalandeli imiyalelo yabo kadokotela ukushintsha ukudla kwabo, ukuyeka ukubhema, ukuvivinya umzimba, ukunciphisa isisindo noma ukulawula ushukela egazini labo kungathola ukuthi izifo zabo ze-coronary disease sezibuyile, futhi zivimbela ama- grafts amasha .
Ezinye iziguli zingadinga ukuvuselelwa ngemuva kokubuyela ekhaya ukuzosiza ngamandla nokuqina. Ezinye izakhiwo zinehlelo olukhethekile lokuvuselela inhliziyo ngenkathi abanye basebenzisa izinsizakalo zezokwelapha .
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> Imithombo:
> Amapheshana enolwazi olulondekile. Umtapo wolwazi lwezempilo weMayo Clinic.com 1995-2007
> Raja S, uDreyfus G, "Ingabe ukuhlinzwa kwe-aronic-off-pump kuyokwenziwa esikhundleni sokuhlinzwa kwe-coronary artery?" I-Royal Society of Medicine, Volume 97, June 2004.
> Turley A, Roberts AP, Morley R, Thornley AR, Owens WA, de Belder MA. "Ukuvimbela kwesibili okulandela uketshezi lwe-coronary bypass grafting kuye kwathuthuka kodwa kuhlala kungcono kakhulu: isidingo sokulandelwa okuhlosiwe" Ukuhlinzekwa okusebenzayo kweCardiothoracic. 30 Jan. 2008