Noma ubani one- coronary artery disease (i-CAD) udinga ukwelapha okunomthelela wezokwelapha kanye nokuguqulwa kwesisindo, kokubili ukunciphisa ingozi yokuhlasela kwenhliziyo , nokulawula izimpawu ze-angina (uma zikhona).
Ngezinye izikhathi ukwelapha okwelashwa wedwa kuphela okwanele, futhi i-revascularization therapy iyadingeka. I-Revascularization isho ukuthi izindawo zokuvimbela okuphawulekayo emithanjeni ye-coronary zikhululeka nge- angioplasty kanye ne- stent , noma ngokuhlinzwa okwenziwe nge- bypass (ebizwa nangokuthi i-coronary artery bypass grafting, noma i-CABG).
Ngakho-ke, kunoma yimuphi umuntu otholakala ene-CAD, udokotela nesiguli kufanele bacabangele imibuzo emibili. Okokuqala, ingabe ukwelapha kwezokwelapha kwedwa okwanele, noma kufanele kuvuselelwe kabusha? Okwesibili, uma i-revascularization inconywa, ingabe kufanele ibe ne-stenting, noma ne-CABG?
Ngabe i-Revascularization iphakanyisiwe?
Kubantu abaningi abano-CAD, ukwelashwa kwezokwelapha , kanye nezinguquko ezifanele zokuphila zokuthuthukisa ingozi yomzimba , kufanele kube indlela yokuzikhethela. Ngokuyinhloko, kubantu abanesimo esingazinzile (angina esicacile ekuqaleni, futhi lokho kwenzeka kuphela ngaphansi kwezimo ezithile ezifana nokuzivocavoca), ukwelapha kwezokwelapha kusebenza ngendlela efana ne-revascularization ekuvimbeleni ukuhlaselwa kwenhliziyo, nokunciphisa ingozi yokufa kwenhliziyo. Ngakho ukwelapha kwezokwelapha ezimweni ezinjalo cishe njalo ukwelashwa kokukhetha.
Kodwa-ke, i-revascularization therapy ngokuvamile iyisinqumo esingcono ngaphansi kwezimo ezithile. Lokhu kufaka:
- Abantu abanezinhlobo ze-heart attack ezibizwa ngokuthi i-ST-I-ST-Segment elevation-infyoction (STEMI) ye-ST-Segment .
- Abantu abane- angina engazinzile noma abangenayo i-ST-segment infarction ye-myocardial (NSTEMI) , abangakwazi ukuzinza ngokushesha nge-treatment yokwelapha enobudlova.
- Abantu abane-angina ezinzile ezingalawulwa ngokungafanele naphezu kokwelashwa okuphezulu okuphezulu, noma ngubani ongakwazi ukubekezelela ukwelashwa okudingekayo ukuyilawula.
- Abantu abane-anatomy CAD ababeka esigabeni lapho i-revascularization iningi ngaphezu kwelashwa yokwelapha ukuthuthukisa ukusinda. Lezi zibandakanya abantu abanokuvinjelwa okuphawulekayo emthonjeni wabo we-coronary oyinhloko, nalabo abanezinkinga eziphawulekayo kuzo zonke izimbangela ezinkulu ezintathu ze-coronary - okulungile, kwesokunxele, kwesokunxele nokuhlaselwa kwe-circumflex. Funda kabanzi mayelana ne-coronary artery anatomy .
Ngabe Iziphi Izintandokazi Ezikhethwa Ngaphezu kwe-CABG?
Uma kunqunywe ukuthi i-revascularization iyadingeka, isinqumo esilandelayo ukuthi ngabe usebenzisa i-angioplasty ne-stenting, noma i-CABG.
Ukuncintisana ngokuvamile kukhethwa phezu kwe-CABG kuziguli ezine-STEMI, ngoba kuyindlela esheshayo yokuvula umthambo we-coronary ovinjiwe. Ukuvunguza kubuye kuvame kubantu abangezinye izinhlobo zama- acon coronary syndromes (i-ACS, njenge-NSTEMI noma i-angina engaqiniseki), uma kuvulwa ngokushesha umthambo we-coronary ovinjiwe kubonakala kuyadingeka.
Kubantu abane-angina abazinzile abaye bahluleka ukwelashwa kwezokwelapha, ngokuvamile ukugaya ama-stenting kukhethwe kulabo abane-CAD ababandakanya umshini owodwa we-coronary.
Kulabo abane-angina enesidingo abadinga i-revascularization futhi babe nesitsha se-CAD ezimbili, ama-stenting nawo aphakanyiswa ngaphandle uma esenaso nesifo sikashukela, noma umthambo wabo we-coronary artery kubhekwa kuyinkimbinkimbi.
Ngabe i-CABG ikhethwa ngaphezu kwama-stents?
I-CABG ikholelwa ukuthi izoletha imiphumela engcono yesikhathi eside kubantu abane-CAD engu-3.
I-CABG kucatshangwa ukuthi nayo inikeza imiphumela engcono kunokuba igxile kubantu abaningi abanezifo zethempeli eliyinhloko le-coronary. Kodwa-ke, kulabo abane-ACS ngenxa yokuvinjelwa komshini omkhulu ongakwesobunxele, ukugcoba kungase kube ukukhetha okuphephile ngoba kungenziwa ngokushesha kakhulu.
I-CABG iyindlela engcono kunokuba iphoyisa kubantu abane-CAD yesitsha esine-diabetes.
Okokugcina, ngokujwayelekile, abantu abavuselelekile nge-CABG bavame ukudinga ukuphindaphinda kabusha kunelabo abathola ama-stents. Ngenxa yalesi sizathu, i-CABG kumele okungenani ixoxwe njengendlela yokukhetha cishe cishe noma ubani odinga i-revascularization.
Isivivinyo se-SYNTAX
Uma sifuna ukufingqa izimo lapho i-CABG ikhethwa khona ngokuphefumula, singasho ukuthi imiphumela ijwayele ukuba ngcono ne-CABG kubantu "abanenkinga" ye-CAD. I-"Clex Complex" ihlanganisa abantu abanesifo se-3-isitsha, i-CAD eyinhloko yesokunxele, abanye abantu abanesifo se-2-isitsha, futhi cishe noma ubani onesifo sikashukela onesine-CAD.
Isivivinyo se-SYNTAX, esanyatheliswa ngo-2009, yisilingo esilungele ukuhlolwa komtholampilo sokuqhathanisa ama-stents ku-CABG kuziguli ezine-CAD eziyinkimbinkimbi. Lolu cwaningo lubonise ukuthi iziguli eziphathwe nge-CABG zazincane kakhulu izenzakalo zokugcina (okuyinhlanganisela yokufa, isifo sohlangothi, ukuhlasela kwenhliziyo, nesidingo sokuphindaphinda kwe-revascularization) kuneziguli ezithola ama-stents (12.4% vs 17.8% ngemva kwezinyanga ezingu-12). Imiphumela efanayo yabikwa kuhlolo lwe-BEST ngo-2015.
Ngakho-ke izivivinyo ezimbili zomtholampilo ezinkulu ezilandelanayo ngokuqhathanisa ama-stents ku-CABG kuziguli ezine-CAD eziyinkimbinkimbi zombili ziphuma zithanda i-CABG.
I-cardiologists iveza ukuthi esimweni se-SYNTAX, ngenkathi i-endpoint yokugcina ingozi kakhulu nge-stents, ingozi yesikhashana yokushaywa isifo ivela ephezulu ngemva kwe-CABG (0.6% yezinhlanzi ezihambisana no-2.2% we-CABG) ngemva kwezinyanga ezingu-12. Leli phuzu elizwakalayo, nakuba ingozi yokushaywa yisifo isisindo esifanayo emaqenjini womabili emva kweminyaka emithathu.
Abaphenyi abagijimela isilingo se-SYNTAX sebelokhu bahlakulela lokho ababiza ngokuthi "i-SYNTAX score", okuyiwona obala izici ze-CAD yesiguli ngokubunzima kwayo. Iziguli ezinezibalo eziphansi ze-SYNTAX zibonakala zenza kangcono ngama-stents kunalabo abanamazinga aphezulu we-SYNTAX. Kodwa-ke, ngenkathi abaningi be-cardiologists basebenzisa uphawu lwe-SYNTAX ukusiza ukuthi banqume ukuthi umuntu onenkinga ye-CAD eyinkimbinkimbi kufanele abe ne-stenting noma i-CABG, lesi simiso sokukhomba asizange sihlolwe esilingo somtholampilo.
Okubalulekile
Okubalulekile ukuthi abantu abaningi abadinga uketshezi lwe-coronary arsaticrization, futhi abane-CAD esine-triple-vessel noma ukuvinjelwa okuphawulekayo emthonjeni wabo we-coronary oyinhloko, ngokuvamile i-CABG kufanele ibhekwe njengendlela yokwelashwa eyinhloko.
Ukuncintisana kuvame ukukhetha kubantu abane-ACS, kubantu abane-CAD eyodwa-ye-vessel, nakubantu abaningi abane-CAD engu-2 abangenayo isifo sikashukela.
Ukusebenzisa ama-stents esikhundleni se-CABG ye-CAD eyinkimbinkimbi kufanele igcinwe kubantu abaye baqonda indlela engavumelani nayo emva kokuqonda zonke izingozi nezinzuzo.
> Imithombo:
> Farooq V, van Klaveren D, Steyerberg EW, et al. Izindlela Zokuzibulala Nezokwelapha Ukuze Uqondise Isinqumo Ukwenza Phakathi Kokuhlinzwa Kwama-coronary Artery Bypass Nokungenelela Kwe-Coronary Kwalabo Abagula Ngamanye Abantu: Ukuthuthukiswa Nokuqinisekiswa Kwama Score Syntax II. Lancet 2013; 381: 639.
> Park SJ, Ahn JM, Kim YH, et al. Isivivinyo Sama-Everolimus-U-Eluting Stents Noma Ukuhlinzwa Ngokwe-Bypass For Coronary Disease. N Engl J Med 2015; 372: 1204.
> Serruys P, Morice MC, Kappetein P, et al. I-Percutaneous Coronary Intervention Versus Coronary-I-Artery Bypass Ukuqoqwa Kwezifo Ezibuhlungu Izifo ZaseCoronary Artery. N Engl J Med 2009; 360: 961-972.