Ukunciphisa kwangaphandle okuthuthukisiwe (EECP) kuyindlela yokwelapha ye- angina . Nakuba izifundo eziningana zemitholampilo zibonakala zibonisa ukuthi lokhu ukwelashwa kungasiza ekunciphiseni izimpawu ze-angina kuziguli ezine- coronary artery disease (i-CAD) , i-EECP ingakamukelwa yizinhliziyo eziningi, futhi ayizange ifakwe emisebenzini ejwayelekile ye-cardiology.
Kuyini i-EECP?
I-EECP yinkambiso yomshini lapho amakherubi amancane ase-inflatable (afana ne-blood pressure cuffs) ahlanganiswe emilenzeni yomabili yesiguli. Ngenkathi isiguli sigqoke embhedeni, izinkemba zomlenze zihlanjululwa futhi zihlanjululwa ngokuvumelana nendawo ngayinye. I-inflation ne-deflation ilawulwa yi-computer, esebenzisa i- ECG yesiguli ukuze idale ukwehla kwemali ekuqaleni kwe-diastole (lapho inhliziyo ikhululeka futhi igcwele igazi), futhi i-deflation njengoba nje i-systole (inhliziyo contraction) iqala. I-inflation yamacube ivela ngokulandelana, kusukela engxenyeni engezansi emilenzeni kuya phezulu, ukuze igazi emilenzeni "likhishwe" phezulu, ngasenhliziyweni.
I-EECP inezinyathelo ezimbili ezinenzuzo enenhliziyo. Okokuqala, isenzo sokukhishwa kwamaketanga omlenze ukwandisa ukugeleza kwegazi kuya emithanjeni ye-coronary ngesikhathi se-diastole . (I-coronary arteries, ngokungafani nezinye izifo zomzimba emzimbeni, zithola ukugeleza kwegazi phakathi kwezinhliziyo, esikhundleni senhliziyo ngayinye.) Okwesibili, ngokuthi isenzo saso siphume njengoba nje inhliziyo iqala ukushaya, i-EECP idala into efana ne-vacuum ngokuzumayo imishanguzo, okunciphisa umsebenzi umsizi wenhliziyo ozowenza ekupompheni igazi.
Kucatshangwa ukuthi i-EECP ingasiza ekunciphiseni ukungasebenzi komzimba .
I-EECP ilawulwa njengokwelashwa kwemithi yokwelashwa. Iziguli zithola amaseshini amahora angu-1 ngesonto, amaviki angu-7 (isamba sezikhathi ezingu-35). Imihlangano engama-35 yehora ihlose ukugqugquzela izinguquko ezihlala njalo ezizuzisayo ohlelweni lokujikeleza.
Iphumelela kanjani i-EECP?
Ucwaningo oluthile lubonisa ukuthi i-EECP ingaba yindlela ephumelelayo ekwelapheni i-angina engapheli. Ucwaningo oluthile olwenziwe ngokungahleliwe lubonise ukuthi i-EECP ikhulise kakhulu kokubili izimpawu ze-angina (isilinganiso esiphezulu) nokubekezelelana kokuzivocavoca (ukulinganisa okungaphezu komgomo) kuziguli ezine-CAD. I-EECP iphinde ithuthukise kakhulu "izinga lokuphila," uma kuqhathaniswa nokwelashwa kwe-placebo. Ezinye izifundo zibonise ukuthi ukuthuthukiswa kwezibonakaliso ezilandela inkambo ye-EECP kubonakala sengathi kuqhubeka iminyaka emihlanu (nakuba iziguli ezingu-1 kwabahlanu zingadinga enye inkambo ye-EECP ukugcina ngcono).
I-EECP isebenza kanjani?
Inqubo yezinzuzo ezibonakalayo ezibonakalayo ezibonwa ne-EECP aziwa. Kukhona ubufakazi obusikisela ukuthi i-EECP ingasiza ekwakhiweni kwemikhumbi yezibambiso emthini we-artery coronary, ngokugqugquzela ukukhululwa kwe-nitric oxide nezinye izici zokukhula ngaphakathi kwamathambo e-coronary. Kukhona nobufakazi bokuthi i-EECP ingase isebenze njengendlela yokuzivocavoca, okuholela ezinhlotsheni ezifanayo zokuguquka okuqhubekayo okuqhubekayo ohlelweni lwezinzwa ezizimele olubonakala ngokuzivocavoca.
I-EECP ingaba yingozi yini?
I-EECP ingaba yinto engakhululekile, kodwa ngokuvamile ayibuhlungu.
Ezicwaningweni, iningi leziguli libekezelele le nqubo kahle.
Kodwa akuwona wonke umuntu ongaba ne-EECP. Kungenzeka ukuthi abantu abangeke babe ne-EECP uma bengenakho ukutholakala kwe-aortic , noma uma benesifo sokushaya inhliziyo senhliziyo yamuva, isisindo senhliziyo esingavamile njenge -fibrillation ye-atrial , isifo somfutho wegazi ophezulu , isifo se-artificial disease esihilela imilenze, noma umlando we- thrombosis ejulile . Noma ubani omunye, noma kunjalo, inqubo ibonakala iphephile.
I-EECP Inconywe nini?
Ngokusekelwe kulokho esikwaziyo namuhla, i-EECP kufanele ihlolwe kunoma ubani onamanje angina naphezu kokwelashwa okungcono kakhulu , futhi obani ama-stents noma abadluli ukuhlinzwa abhekwa njengabangakhetha kahle.
I-Medicare ivumile ukuhanjiswa kwe-EECP yeziguli ezine-angina eziphelile zonke ezinye izinqumo zabo.
Ngo-2014, izinhlangano eziningana zobuchwepheshe (i-American College of Cardiology, i-American Heart Association, i-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association Association, i-Society for Cardiovascular Angiography and Interventions, kanye neNhlangano Yezifo Ezihlinzeka Ngama-Thoracic) ekugcineni yavumelana ngokubuyekezwa okugxilwe yi-EECP kufanele kucatshangelwe iziguli ezine-angina zokuphikisa kwezinye izifo.
Kungani i-EECP ingasetshenziswa kaningi?
Ngokuvamile, umphakathi wezinhliziyo usukhethile ukhetha ukungazinaki uhlobo oluthile lokwelapha, futhi izazi eziningi ze-cardiologists zihluleka ngisho nokucabangela ukunikeza i-EECP njengendlela yokwelapha. Ngenxa yalokho, iziguli eziningi ezine-angina azange zizwe ngakho.
Ngempela, i-EECP iyingqayizivele. Ngokuqinisekile akubukeka njenge-cardiology. Akekho ongachaza ngempela ukuthi kusebenza kanjani. Futhi, kusukela kumqondo we-cardiologist / s, uma uqhathanisa imizamo yesihlobo nokubuyisela isihlobo se-EECP into efana nokufaka i-stent (amaseshini angu-35 ngaphezulu kwamasonto angu-7 ngokuya nenqubo yamaminithi angu-30) akukho mncintiswano. Ukulindela ukuthi izazi ze-cardiologists zamukele i-EECP nganoma yikuphi ukushisekela kungamane kunganaki imvelo yabantu.
Noma kunjalo, uma ukwelashwa okungaphephile kwe-angina kukhona okuphephile futhi okubekezeleleke kahle, uma ubufakazi obutholakalayo (njengengaphelele noma ngabe bungaphelele) bubonisa ngokuqinile ukuthi ukwelashwa kuphumelela kakhulu ezigulini eziningi, futhi uma isiguli siphathwa siyokwazi ukutshela okuhle ngokuqinisekile noma ngabe ukwelashwa kuye kwasiza yini esimweni sabo siqu (ngokuba khona noma ukungabikho kwezimpawu ezinzima ze-angina), akubonakali kungenangqondo ukuvumela iziguli zine-angina enhle ukuba zikhethe ukuhlolwa kwalolu cwaningo olungenakuvuthwa, mhlawumbe ngisho nangaphambi kokuba baphonswe ekwelapheni okuhlasela.
Uma uphathwa ukuze u-angina ozinzile futhi usenayo izimpawu naphezu kokwelashwa, kunengqondo ngokuphelele ukuba ukhulise amathuba okuzama ukuzama ukulinganisa i-EECP. Udokotela wakho kufanele azimisele ukuxoxa ngalokhu kungenzeka kuwe, ngokuhlulekayo futhi ngaphandle kokubandlulula.
Imithombo:
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS ukugxilwa okugxilwe kokuqondiswa kokuxilongwa nokuphathwa kweziguli ezinesifo senhliziyo esisimeme: umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice, kanye I-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association Association, Society for Cardiovascular Angiography and Interventions, kanye neNhlangano Yezifo Ezihlinza NgamaTriracic. J Am Coll Cardiol 2014; 64: 1929.
I-Arora RR, i-Chou TM, i-Jain D, et al. Ukutadisha okunomthelela ekuthuthukiseni kwangaphandle kwezilwane (MUST-EECP): umphumela we-EECP ngokusetshenziswa komzimba we-myocardial ischemia kanye nama-anginal episodes. J Am Coll Cardiol 1999; 33: 1833.
U-Soran O, Kennard ED, uKfoury AG, et al. Imiphumela emibili yemitholampilo ngemuva kokwelashwa kwangaphandle kokunciphisa ngaphandle (EECP) ukwelapha iziguli ezine-angina pectoris ezingenalutho kanye nokungasebenzi kokungena kwe-ventricular (umbiko ovela ku-International EECP Registry Patient Registry). Am J Cardiol 2006; 97:17.