Uhlolojikelele lwe-MAZE Heart Process

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Fibrillation ye-Atrial

Inqubo ye-maze yindlela yokuhlinzwa esetshenziselwa ukulawula i-fibrillation ye-atrial, noma "i-fib," isimo senhliziyo lapho isigqi senhliziyo singavamile. Uma ingenakulawulwa yimithi noma ezinye izifo, inqubo ye-Maze ingase ibe yindlela yokwelapha efanelekile. Ithole leli gama kusuka kumacembe ahamba phambili asele ekuhlinzekeni kokuthunyelwa kwamakamelo enhliziyo, njenge-Maze.

I-fibrillation ye-atrial engalawuliwe ingandisa ingozi yokushaya imivimbo. Kungenza umuntu azizwe ebuthakathaka futhi ecindezelekile njengoba inhliziyo ishaya kancane kancane.

Ukuze uqonde inqubo, kubalulekile ukwazi ukuthi inhliziyo inehlelo layo lombane, eliqondisa imisebenzi ehlukene ye-muscle yenhliziyo. Enhliziyweni evamile, uhlelo lwegesi luqala kuqala i-atrium engakwesobunxele neya kwesokudla (izinyathelo ezingenhla zenhliziyo) ukuze zenze isivumelwano, ngakho-ke ama-ventricles (amakamelo aphansi enhliziyo).

Ngesikhathi i-fibrillation ye-atrial, isibonakaliso sihlukaniswa njengokungathi sithatha imizila eminingi ngokusebenzisa i-maze, okwenza izindawo ezihlukene ze-atrium zivumelane ngezikhathi ezihlukene njengoba umzila ngamunye uthatha isikhathi esingafani isikhathi sokuba isignali ukuhamba. Le mphumela yokuqhuma, enezingxenye ezahlukene ze-atrium enkontileka ngezikhathi ezihlukene, ibizwa ngokuthi i-fibrillation.

Inqubo ye-maze igimbela umfutho kagesi ekuthatheni izindlela eziningi futhi iphoqa isignali ibe yindlela eyodwa, okuvumela i-atrium yonke ukuba ixhumane ngesikhathi esisodwa.

Funda kabanzi: I- Heart Heart & Heart Surgery

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Ukufaneleka

Inqubo ye-Maze ayidingekile kuningi labantu abagulisa i-atrial fibrillation. Imithi isebenza kahle kubantu abaningi. Ngeziguli ezingasizwa ngemithi yedwa, i-cardioversion ingaba yisinyathelo esilandelayo. I-cardioversion yinkqubo lapho umfutho wegesi uthunyelwa enhliziyweni futhi ungabuyisa isiguli kwisigqi esivamile isikhathi eside.

Kwezinye izimo, iziguli zikhetha ukuhlala nezimpawu ezinomzimba kodwa zibheke ukuhlinzwa uma izimpawu zanda noma zicasula kakhulu noma ngokungazinaki. Ngokuhamba kwesikhathi, iziguli zingathola ukuthi irejista eyasebenza esikhathini esidlule angeke isakwazi ukulawula izimpawu ze-fibrillation ye-atrial. Uma ukulungiswa kokwelapha akuphumelelanga, inqubo ye-Maze ingaba yindlela yokukhetha, kodwa ngokuvamile kuphela uma zonke ezinye izinketho seziphelile.

Uma ubuke ngalolu khetho esikhathini esidlule, khumbula ukuthi kukhona manje indlela entsha yokunciphisa i- catheter entsha futhi engaphansi kokungafuni isidingo esikhulu sokufakela esifubeni nokubeka emshinini we-carpopmonary bypass , nakuba lobu buchwepheshe busha futhi bungaveli unikezwa kuzo zonke izibhedlela. Kwezinye izimo, inqubo ye-maze ingase ihlanganiswe nenqubo eyengeziwe, njengokuhlinzwa kwe-heart-overpery (CABG).

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Indlela Esebenza ngayo

Inqubo ingenziwa ngokuhlinzeka ngenhliziyo evulekile, noma ngenqubo encane encane esebenzisa i-catheter efakwe emithanjeni enkulu yegazi le-groin. Inqubo encane engavamile yenzelwa okwamanje ezibhedlela ezimbalwa ezikhethekile futhi isanda kusha.

Kuzo zombili izinqubo, umgomo ukulungisa umphumela wokuphulukana obangela izingxenye ezahlukene ze-atrium ukuze zivumelwano ngesikhathi esihlukile. Lokhu kwenziwa ngokuhlinzekela ukuphoqa umshini kagesi ngendlela eyodwa, okubangela ukuba i-atrium iqede ngokuphumelelayo. Esikhundleni sokuthatha izindlela eziningi ngokusebenzisa "i-maze" kuya kumfutho we-atrium, isibonakaliso kagesi siphoqeleka ukuba sithathe indlela eyodwa, siphele umphumela wokuhlanyela.

Lokhu kwenziwa ngokusika noma ukuphazamisa ezinye izindlela. Umfutho wegesi awukwazi ukuwela emgwaqweni noma emgwaqeni, ngakho-ke udokotela ohlinzayo usebenzisa i-scalpel, i-radio-frequency ablation (uhlobo lokushisa) noma i-cryonics (ebanda) ukuyeka izindlela ezingafuneki.

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Ukuhlinzwa

Ukuhlinzwa kuqala nge- anesthesia jikelele . Uma i-anesthesia iqale ukusebenza futhi isiguli sitholwe (ukuphefumula ngosizo lomshini), udokotela ohlinzayo angase aqale ngokwenza ukuchotshozwa okuphakade, ukuhlaselwa phezu kwe-sternum (isifuba). I-sternum ihlukaniswa izingxenye ezimbili isebenzisa i-saw ekhethekile, ihlukanisa ithambo ngokuqondile. Lokhu kuvumela udokotela ohlinzayo ukuba afinyelele ngqo enhliziyweni.

Udokotela ohlinzayo angasebenzisa amathuluzi amaningana kuleli phuzu ukuze aphule izindlela ezingadingeki eziqhuba umqondo kagesi wenhliziyo, njenge-scalpel, noma ithuluzi elishisayo noma elibandayo kakhulu. Lapho udokotela ohlinzayo ekhetha ukuthi zonke izindlela ziye zahlukunyezwa, i-sternum, noma isifuba, ivaliwe besebenzisa ucingo oluhlinzekwa oyinyumba, liboshwe ndawonye ukuze likwazi ukuphulukisa kahle.

Kwezinye izimo, ukucubungula okuncane kungenziwa ngaphansi kwesifuba, futhi amashubhu esifubeni afakwa ukuze asuse noma yiliphi igazi elingase liqoqe nxazonke zenhliziyo. Ama-tubes axhunyiwe kudivayisi yokuqoqa oyinyumba ukuze ukukhishwa kwegazi kungalinganiswa, noma ngezinye izikhathi, igazi lingabuyiselwa isiguli ngemuva kokuhlinzwa.

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Ukubuyisela

Ngemuva kwenqubo ye-Maze, ungalindela ukuchitha izinsuku ezilodwa noma ngaphezulu ku-ICU noma endaweni yokunakekelwa kwenhliziyo ngokuqapha ngokucophelela. Ngokungafani nokuhlinza okuningi, akukho mithi enikezwa ukuba ivuse isiguli kusuka ku-anesthesia. Esikhundleni salokho, i-anesthesia ivunyelwe ukugqoka amahora amaningana.

Ngesikhathi sokubuyiselwa ku-ICU, umsebenzi wegesi wenhliziyo uzobe uhlolwe ngokucophelela ukuze ubone ukuthi inqubo iphumelele yini. Lapho i-anesthesia iphela, ithubhu lokuphefumula liyosuswa, futhi ngokuvamile ngaphakathi kwamahora angu-12 okuhlinzwa isiguli sizosizwa esihlalweni. Nakuba kungase kubonakale kungavamile ukuba uphinde uhambe ngokushesha ngemva kokuhlinzwa, lokhu kuyingxenye ebalulekile yokutakula futhi kusiza ukuvimbela izinkinga ezifana namacenge egazi kanye ne-pneumonia.

Kungenzeka kube nezintambo ze-pacemaker zesikhashana eziphuma ekufakweni ukuze i-pacemaker yangaphandle ingasetshenziswa uma kwenzeka kuphuthumayo. Ezimweni eziningi, lokhu akudingekile-izintambo ziyisilinganiso sokuqapha uma kwenzeka i-pacemaker iyadingeka ngesikhathi ilulameka.

Ezimweni ezingavamile kakhulu, kungenzeka ukuthi i-pacemaker engapheli ingadingeka, ngokuvamile uma indlela kagesi eshiywe ingacacile ayihambisani kahle ne-atrium. I-pacemaker ithumela umfutho kagesi ovame ukuqaliswa yinhliziyo futhi uhlelwe ukuthumela isignali kwenye i-atrium eyodwa noma kokubili, kuye ngokuthi indawo kanye nemvelo yenkinga.

Iziguli ezinezinqubo ezincane ezingenasidingo zivame ukuba yi-ICU izinsuku eziningana zokuqapha kodwa zingabuyela emisebenzini evamile futhi zisebenze ngokushesha kuneziguli ezinezinqubo ezivulekile zenhliziyo. Phakathi nalesi sikhathi, kanye namasonto alandelayo, ukunakekelwa kokukhungwa kubaluleke kakhulu ukuvimbela ukutheleleka .

Ukubuyiselwa okujwayelekile kusuka ekuhlinzekeni kwenhliziyo evulekile kungamasonto ayisishiyagalolunye noma ngaphezulu, kanti inqubo encane yokuhlasela incane kakhulu. Cishe amaphesenti angama-90 weziguli ezinenqubo enokuphumula ezivela embonini ye-fibrillation ye-atrial ngemuva kokuphulukana nokuhlinzwa. Ezinye iziguli zingase zidingeke ukuba zihlanganyele ekuvuselelweni kwenhliziyo ngemuva kokuhlinzwa, ukuze ziphinde zithole amandla namandla.

> Imithombo:

> I-Atrial Fibrillation Ablation. I-Mayo Clinic. Kufinyelelwe ngo-Ephreli, 2009 http://www.mayoclinic.org/atrial-fibrillation-ablation/

> Iyini Inqubo Ye-Cox-Maze. Umtholampilo waseCleveland. Kufinyelelwe ngo-Ephreli, 2009 http://my.clevelandclinic.org/heart/disorders/electric/surgtx.aspx