Ingabe "Ithempulethi" Liyiqiniso, Futhi Lisho Lithini?
Eminyakeni eminingi, ekamelweni lokuqapha le-odokotela (okuyinto efana kakhulu nezinye izinhlobo zamakamelo okuzulazula), odokotela abahlinzayo benhliziyo bayakhuluma omunye nomunye umcimbi abajwayele ukubizwa ngokuthi "ikhanda lokupompa." Inhloko yamapumpu yayiyigama elisetshenziselwa chaza ukukhubazeka emandleni okwengqondo abaye bawaqaphela ngeziguli zabo ngezikhathi ezithile emva kokuhlinzwa komzimba we-artery coronary .
Leli gama lalinalo igama ngoba ukucabangela kwakuwukuthi ukukhubazeka kwengqondo emva kokuhlinzwa kwe-bypass kuhlotshaniswa nokusetshenziswa kwe- cardiopulmonary bypass pump ngesikhathi senqubo.
Sekuyisikhathi eside, ukukhuluma ngalesi simo akuzange kufike ngaphesheya kwekamelo lokungena.
Kodwa ngo-2001, isifundo esivela kuDuke University sibonakala siqinisekisa ukuthi odokotela abaningi babesolwa kangakanani, kodwa bebengenqika ukuxoxa ngokukhululekile. Ngokusobala, inani elikhulu labantu ngemuva kokuhlinzwa komgogodla we-artery overpery kamuva libhekana nokukhubazeka okulinganiselwe (kodwa kaningi okwesikhashana) emandleni abo engqondo. Lesi sifundo sathola ukukhangiswa okuningi ngemuva kokushicilelwa kwayo eNew England Journal of Medicine , futhi kubangele ukukhathazeka okuningi phakathi kokubili odokotela kanye neziguli zabo. Kodwa ukukhathazeka ngokushesha kwaphela, futhi umphakathi jikelele awuzange uzwe okuningi ngakho kusukela.
Kodwa-ke, eminyakeni edlulayo okuningi okuningi kuye kwafundwa mayelana nezinguquko ezingokwenyama ngemuva kokuhlinzwa okweqile.
Okokuqala, lo mkhuba ungokoqobo. Ngolunye uhlangothi, cishe akuhlobene nokusetshenziswa kwempompo ye-bypass, kodwa kunalokho, kungenzeka ukuthi ihlobene nokuphathwa kabi kwemithambo yegazi edingekayo phakathi nalolu hlobo lokuhlinzwa.
Nakuba odokotela abahlinzayo bangase bangathandi ukukhuluma ngakho esidlangalaleni, ukukhubazeka kokuqaphela ukuhamba komuntu ngokuhamba phambili kuvamile ukuthi abantu abanalo lo msebenzi nabathandekayo babo kufanele baqaphele kusengaphambili, ngakho balungele ukubhekana nakho uma kufanele kwenzeke .
Kuyini Okushiwo Ukukhubazeka Okucatshangelwayo?
Ukukhuluma nje, "ukukhubazeka kwengqondo" kusho amagama odokotela abasebenzisa ukuhluleka okukhulu kwegazi okungabonakala emva kokuhlinzwa kokudlula.
Lokhu kungabandakanya noma yikuphi okulandelayo: ukubhekwa okuncane, ukukhumbula okubi, ukwenza izinqumo ezimbi, ukungakwazi ukugxila, ukunciphisa isivinini sokunyakaza, nokukhubazeka okuvamile ekukwazi ukucabanga ngokucacile. Izimpawu ezinzima ezifana nesiphuzo esiningi kungabonakala kungavamile. Lezi zimpawu zingabonakala ngokushesha ngemuva kokuhlinzwa, futhi zingaba nzima kakhulu ekukhulekeleni ukuba zingabonakali (lapho kwenzeka izifundo eziyinkimbinkimbi ezithinta izinkinga ezidingekayo).
Ukulahleka kwengqondo okuvame ukuxazulula kancane kancane, esikhathini esingamasonto ambalwa noma izinyanga ezimbalwa, kodwa kwezinye izimo bangaphikelela iminyaka.
Yeka Indlela Ejwayelekile Ngayo Inkinga?
Ngaphandle kokuba isifundo sokuqala ukubheka lesi simo, isifundo se-Duke sika-2001 senze kwacaca ukuthi ukukhubazeka kwengqondo kungasimangalisa njalo, futhi kuqhubeka njalo. Kulolu cwaningo abantu abangu-261 (isilinganiso seminyaka engu-61 ubudala) abahlinzekwa yi-bypass bavivinywa ngokwanele ukuze balinganise amandla abo okuqonda (okungukuthi ikhono lokucabanga) ngezikhathi ezine ezihlukene: ngaphambi kokuhlinzwa, emavikini ayisithupha, ezinyangeni eziyisithupha, futhi eminyakeni emihlanu emva kokuhlinzwa kwe-overpass.
Ababambiqhaza babhekwa ukuthi banokukhubazeka okuphawulekayo uma behlehliswa ngo-20% ezikoleni zokuhlolwa. Abaphenyi bathole ukuthi iziguli ezingu-42% zinehlasi engu-20% ezenzweni zokuhlolwa ngemuva kokuhlinzwa, futhi ukuthi ezimweni eziningi ukwehla kwamandla okuqonda kwaqhubeka iminyaka emihlanu.
Ukutholwa ukuthi ukukhubazeka kwengqondo kwenzeka emva kokuhlinzwa ngokungahambi kahle kwakungeyona isimanga kunoma ubani ozinakekela laba bantu. Kwakuyinto emangalisa ukuthi isifo esiphakeme senkinga ekufundweni kwamaDuke, nokuphikelela kwayo. Lolu cwaningo, ngokufanayo, lubangele ukucindezeleka kokubili odokotela kanye nomphakathi ngokujwayelekile.
Ucwaningo lwamaDuke luye lwagxeka ngokufanele ngoba lwangenalo iqembu lokulawulwa ngokungahleliwe. Esikhundleni salokho, abaphenyi baqhathanisa imiphumela yabo ngemiphumela yocwaningo olufanayo phakathi kweziguli ezine- coronary artery disease (i-CAD) yobudala obufanayo obengenakho ukuhlinzwa okuphambene nakho. Bathole ukuthi labo abathola ukuhlinzeka ngokweqile kwaba nesimo esiphezulu sokukhubazeka kwengqondo kunabantu abane-CAD abangenalo ukuhlinzwa. Kodwa-ke, ngoba abantu abasebenzisa ukuhlinzeka ngokweqile ngokuvamile babe ne-CAD enamandla kakhulu, lezi zizwe azifani ngokuqondile.
Noma kunjalo, ukutadisha okungahleliwe ngempela (lapho abantu abane-CAD beyohlinzwa ngokumelene nesinqumo esingekho ukuhlinzwa okwenziwe ngezikhathi ezithile) bekungeke kwenzeke (uma kungenjalo). Ukuze uzame ukuveza imvamisa yenkinga ngokucacile, ezinye izifundo eziningana zalezi zenzakalo ziye zaqhutshwa eminyakeni engenele, zisebenzisa izinqubo ezihlukahlukene zokuhlola i-neurocognitve, izinqubo ezahlukene zokuhlinzekwa kwe-bypass, nezinkathi ezihlukene zokulandela isikhathi.
Ngenkathi imiphumela evela kulezi zifundo ziguquke kakhulu (nge-incidence yokukhubazeka kwengqondo ehluke phakathi kuka-3% no-79%), akukho umbuzo okwamanje mayelana nokuthi lesi simo siyiqiniso noma cha. Ikona. Ngaphezu kwalokho, ukukhubazeka kwengqondo kuyingozi ekhethekile yokuhlinzwa kwenhliziyo, ngoba isifo esifanayo asibonwanga nezinye izinhlobo zokuhlinzeka ngezicathulo, njengokuhlinzekwa kwezifo ze-vascular peripheral .
Yini Ebangelwa Ukukhubazeka Okungqondweni Yemuva Ngemuva kokuhlinzwa Kwe-Bypass?
Isizathu esiqondile sokukhubazeka kwengqondo okulandelayo ngemuva kokuhlinzeka nge-overpass akuziwa. Kungenzeka ukuthi kunezici eziningana ezingabangela.
Ekucaleni kwakucatshangwa ukuba kubangelwa ama-clots amancane egazini ebuchosheni obuhlobene nokusetshenziswa kwenhliziyo yamaphaphu. Kodwa-ke, ucwaningo lwamuva luye lwabonisa ukuthi ukusebenzisa ezinye zanamuhla, "ukuphuma kwepom" ukuhlinzeka ngokweqile akunciphisanga ukukhubazeka kwengqondo.
Ithiyori ene-traction kakhulu namuhla ukuthi ukuphathwa kwenhliziyo ne-aorta kungaveza ama-clots amancane, okuthiwa yi-microemboli, engakwazi ukuya ebuchosheni futhi abangela umonakalo lapho. Ucwaningo lwe-intraoperative usebenzisa ama- Doppler amathekisthi aqinisekisile ukuthi ukushisa kwe-microemboli ebuchosheni kuvamile ngesikhathi sokuhlinzwa, kanti ezinye izifundo ezisebenzisa ukuhlolwa kwe- MRI zangaphambili nezokuthutha zibonise izilonda ezincane zesischemic (izinhlangothi ezincane) ebuchosheni babantu abahlangabezana nakho ukuncipha kwengqondo. Kodwa-ke, ngisho nalezi zifundo ziye zaveza imiphumela exutshwe, futhi indima ye-causative ye-microemboli ingakabonakali.
Ezinye izimbangela ezingase zibe khona, ezifana nokuwa kwegazi, i- hyperthermia (izinga eliphezulu lokushisa komzimba), nokunciphisa isikhathi eside amazinga e-oksijeni egazini, konke okungenzeka ngesikhathi sokuhlinzwa kwenhliziyo noma ngokushesha ngemuva kwalokho, kungase kudlale indima.
Lokho esikwaziyo ngokuqinisekile ukuthi abantu abanezici ezibangela ingozi enkulu yezifo eziyinkimbinkimbi zomzimba kungenzeka ukuthi banokukhubazeka okungqondweni. Lezi zici zengozi zihlanganisa izifo ze-artery carotid , ubudala obudala, umfutho wegazi ophezulu , nomlando wesifo esidlule.
Izwi elivela
Uma wenza izinqumo ezinkulu mayelana nokunakekelwa kwezokwelapha, uzofuna ukuqinisekisa ukuthi udokotela wakho ucabangela zonke izingozi nezinzuzo ezingase zibe khona - ngisho nezinto ezingathandeki ukukhuluma ngazo, njengengozi yokukhubazeka kwengqondo.
Uma udokotela wakho ekhuthaza ukuhlinzwa kwe-coronary artery overpery, kufanele uqiniseke ukuthi unezimpendulo zemibuzo elandelayo:
- Ingabe ukuhlinzwa kungase kwandise isikhathi sakho sokuphila, noma kwenzeke ngokucophelela nje ukukhulula izimpawu?
- Zikhona yini ezinye izindlela ezisebenzayo, ezifana nemithi , noma i- stent ?
- Ziyini izingozi kanye nezinzuzo ezihlobene nalezi zindlela?
- Uma uhlinzwa futhi ubona izimpawu zengqondo, yiziphi izinsiza udokotela wakho abenezo zokubhekana nabo, ukukusiza ukuba ululame, futhi ukukusiza wena nabathandekayo bakho ukuba babhekane kuze kube yilapho izimpawu zakho zithuthuka?
Uma ukuhlinzwa kunconywa futhi kungacatshangwa ukuthi kuyisimo esiphuthumayo, lesi sinqumo esisodwa ongase ucabange ngokuqinile ukuthola umbono wesibili .
Uma ukhetha ukuba nokuhlinzwa okuphambene nendawo, khumbula ukuthi iningi labantu kulezi zifundo eziningi alizange lenze ukukhubazeka kwengqondo yabo ukuthi bayibona empilweni yabo yansuku zonke, nokuthi iningi labo wenza, ukukhubazeka kwabo kokuziphendulela ekugcineni kwaxazululwa.
> Imithombo:
> I-Fontes MT, i-Swift RC, i- Phillips-Bute B, et al. Abaqapheli bokuvuselelwa kwengqondo Ngemva kokuhlinzwa kwe-Cardiac Surgery. Anesth Analg 2013; 116: 435.
> Newman MF, Kirchner JL, Phillips-Bute B, et al. Ukuhlolwa Okude Kwesikhathi Sokusebenza Nge-Neurocognitive Ngemva Kokuhlinzwa Kwama-Coronary-Artery Bypass Surgery. N Engl J Med 2001; 344: 395.
> Rudolph JL, Schreiber KA, uCulley DJ, et al. Ukulinganisa Ukusebenza Okungaqondakali Kokusebenza Kwangemva Kamuva Ngemva Kokuhlinzwa Kwezinhliziyo: Ukubuyekezwa Okuhlelekile. I-Anaesthesiol Scand 2010; 54: 663.
> Selnes OA, Grega MA, Bailey MM, et al. Ukuqashelwa 6 Iminyaka Emva Kokuhlinzekwa Okuhlinzekwayo noma Kwezokwelapha kwe-Coronary Artery Disease. U-Ann Neurol 2008; 63: 581.