Ukwelashwa okuyinhloko kwegazi lomfutho wegazi kungukubamba inqubo ekuqaleni bese ubona futhi uphathe isizathu esiyimbangela. Kodwa-ke, ezigulini eziningi ezinalezi zimo, ukwelashwa okuphambili kakhulu kuyadingeka.
Ukuhlola okuyisisekelo
Isinyathelo sokuqala ekwelapheni umfutho wegazi ophezulu we-pulmonary ukuhlola ubunzima bokuqala besimo. Lokhu kuhlolwa kusiza udokotela ukuba anqume ukuthi unonya kangakanani ukwelashwa, futhi unikeza indlela yokuhlola impendulo yokwelapha.
Lokhu kuvame ukuqhutshwa ngokwenza i- echocardiogram , ezokwenza ukulinganisa ukucindezela komthambo we-pulmonary, nokuhlolwa kokuvivinya umzimba ukukala amandla okusebenza okuyisisekelo.
Ukwelashwa Kuhloselwe Isimo Sezokwelapha Esingaphansi
Ngokuvamile, ukwelapha ngokweqile imbangela eyimbangela yomshuwalense we-pulmonary isifo esibucayi kakhulu. Njengoba kunezinkinga eziningi zezokwelapha ezingabangela ukushisa komfutho we-pulmonary, lokhu ukwelashwa kungathatha izinhlobo eziningi ezahlukene.
Ukwelashwa Ngokuvamile Kuwusizo Kuwo Onomfutho Wegazi Ophezulu
Ngaphandle kokwelapha okuhloswe ngokukhethekile ekuphatheni imbangela eyinhloko, kunezindlela zokwelashwa ezivame ukusiza kunoma ubani onomfutho wegazi ophezulu we-pulmonary.
Lokhu kufaka:
- Izidakamizwa ezifana neLasix noma i-Bumex zivame ukusetshenziselwa ukuphatha ukugcinwa kwamanzi okuvame ukuvela ngegazi lomfutho wegazi. Nakuba izidakamizwa zingathuthukisa i- dyspnea ne-edema (ukuvuvukala), kumele zisetshenziswe ngokucophelela kusukela ekuqedeni uketshezi oluningi kweziguli ezinomfutho wegazi ophezulu we-pulmonary blood pressure kungenza kube nzima ukusebenza komzimba.
- Ukwelashwa kwe-oksijeni kubalulekile kunoma ubani onomfutho wegazi ophezulu we-pulmonary ophethe i- hypoxia (eyanciphise amazinga e-oxygen oxygen). Uma i-hypoxia ikhona, ukulawula i-oksijeni ngokuvamile kunganciphisa ukucindezelwa komthambo we-pulmonary. Iziguli ezinegazi lomfutho wegazi elibangelwa izifo zamaphaphu noma izifo zenhliziyo cishe ziba ne-hypoxia, kodwa noma ubani onomfutho wegazi ophezulu we-pulmonary kufanele abe namazinga e-oksijeni egazi ahlolwe.
- Ama-anticoagulants afana neCoumadin asetshenziswa njalo kwiziguli ezinegazi lomfutho wegazi. Lokhu kungenxa yokuthi umfutho wegazi ophezulu we-pulmonary ngokwayo ungabangela ukugeleza kwegazi okulukhuni ngokusebenzisa ukujikeleza kwe-pulmonary, okungaholela ekugubheni ngaphakathi kwemithwalo yegazi emaphashini. Funda mayelana nezidakamizwa ezisetshenziswa ukuvimbela ama-clots egazi .
- I-Digoxin ingathuthukisa ukusebenza komzimba kwezinye iziguli ezinegazi lomfutho wegazi.
- Ukuzivocavoca kukhonjisiwe ukuthi kuthuthukiswe ngokuphawulekayo amandla okusebenza abantu abanegazi lomfutho wegazi.
I-Advanced Therapy
"Ukwelashwa okuthuthukisiwe" ngenxa yomshuwalense we-pulmonary uhloselwe umfutho wegazi ophezulu we-pulmonary ngokwayo, kunokuba imbangela eyimbangela. Lokhu ukwelashwa ngokuvamile kubandakanya ukusebenzisa izidakamizwa ze-vasodilator ukuzama ukuhlanza ukujikeleza kwe-pulmonary nokunciphisa ukucindezelwa komthambo we-pulmonary.
Ukwelapha okuthuthukisiwe kubizwa ngokuthi "okuthuthukisiwe" hhayi ngoba kuphumelela kakhulu kunokwelashwa okuvamile, kodwa ngoba kuyinkimbinkimbi, inengozi kakhulu, ebiza kakhulu, futhi ngokuvamile ayinhle (isibonelo, kungadinga ukwelashwa kwangaphakathi). Ukwelapha okuthuthukisiwe kufanele kubekwe kuphela odokotela abanobuchwepheshe ekwelapheni umfutho wegazi ophezulu we-pulmonary.
Ukwelashwa okuthuthukisiwe kubhekwa ezigulini ezinomfutho wegazi ophezulu ongenhliziyo ongaphenduli ngokwanele ukwelashwa okuhloswe imbangela eyimbangela, noma, ikakhulukazi, uma kungekho imbangela eyimbangela ekhonjisiwe (okungukuthi, kubantu abanegazi lomfutho wegazi ophezulu).
Ukwelapha okuthuthukisiwe akuvame ukusetshenziswa kuwo wonke abantu abacindezelwa yi-pulmonary hypertension ngenxa yesifo senhliziyo (lapho ukwelapha okuthuthukisiwe kuboniswe khona ukuthi kungabangela ukulimala), noma ukugula kwesifo (lapho kunesidingo semininingwane esibonisa inzuzo) .
Ngaphambi kokuzama ukwelapha okuthuthukisiwe, isifundo esiyingqayizivele sokucwaninga kwe- cardiac catheterization senziwa ukuze kuhlolwe "amandla omzimba" wegazi lomjikelezo we-pulmonary. Phakathi nalesi sivivinyo, izidakamizwa zinikezwa ukuhlola ukuthi imithini yegazi yamapulmoni iyakwazi yini ukuhlanza. Uma kunjalo, izinhlobo ezithile zokwelashwa okuthuthukisiwe cishe zisebenza kahle.
Imithi eminingi isetshenziselwe ukwelapha umfutho wegazi ophezulu we-pulmonary, okufaka:
- Abavimba be-calcium esiteshini njenge-diltiazem ne-nifedipine
- Ama-prostanoids afana ne-Flolan (epoprostenol), i-Remodulin (treprostinil), ne-Ventavis (iloprost)
- Abaphikisi be-Endothelin abamukelayo njenge Tracleer (bosentan), Letaris (ambrisentan), no-Opsumit (macitentan)
- I-PDE5 inhibitors njenge-Viagra (sildenafil), i-Cialis (i-tadalafil), ne-Levitra (i-vardenafil)
- I-Guanylate cyclase stimulant efana ne-Adempas (riociguat)
Lolu hlu olude lokuzikhethela lwenza inqubo yokukhetha imithi "engcono kakhulu" noma inhlanganisela "engcono kakhulu" yezidakamizwa ngokuyinkimbinkimbi. Kunezici eziningana okumelwe zicatshangelwe ekwenzeni lokhu kukhethwa, kuhlanganise nesifo esiyisisekelo, ubukhulu be-hypertension ye-pulmonary, izinga le-vasoreactivity, noma ngabe izidakamizwa ezithile zihlanganiswa nomshuwalense wezokwelapha, nemiphumela emibi eminye. Yingakho izinqumo ezinjalo kufanele zenziwe odokotela abanochwepheshe ekuphatheni umfutho wegazi ophezulu we-pulmonary.
Isifingqo
Ukwelashwa okunamandla kwe-pulmonary hypertension kungaba nzima futhi kuyinkimbinkimbi. Iziguli ezinomshuwalense we-pulmonary zenza kahle kakhulu ukuthi zakha ubudlelwane obuseduze nabodokotela bazo, zithatha indima ekunqumeni ukwelapha, ngokubheka ngokucophelela nokubika ngesimo sezimpawu zabo kanye namandla okusebenza, nokulandela uhlelo oluvunyelwene ngalo yokwelapha.
Imithombo:
UGalie, N, Hoeper, MM, Humbert, M, et al. Imihlahlandlela yokuxilongwa nokuphathwa kwegazi lomfutho wegazi. I-Eur Respir J 2009; 34: 1219.
McLaughlin VV, Archer SL, Badesch DB, et al. I-ACCF / AHA 2009 idokhumenti yokuvumelanisa ngolwazi mayelana nomfutho wegazi ophezulu we-pulmonary hypertension umbiko we-American College of Cardiology Foundation Task Force ku-Expert Consensus Documents kanye ne-American Heart Association eyakhiwe ngokubambisana ne-American College of Chest Physicians; I-American Thoracic Society, Inc .; kanye ne-Pulmonary Hypertension Association. J Am Coll Cardiol 2009; 53: 1573.
Galiè N, Corris PA, Frost A, et al. I-algorithm yokwelapha ebuyekeziwe ye-pulmonary arterial hypertension. J Am Coll Cardiol 2013; 62: D60.