Inkxalabo eyoyikrakra ye-fibrillation ye-atrial ishaqha . Kwi-fibrillation ye-atrial, i-atria yentliziyo ayibetha kakuhle, evumela igazi ukuba "lihlambe" ngaphakathi kwala macumbi.
Ngenxa yoko, i-thrombus yearriyiti (i-clot yegazi) inokwenza. Ekugqibeleni, i-thrombus yearriyiti ingayifaka-oko kukuthi, iyakwazi ukuphazamisa kwaye ihambe ngemizila.
Ngokuqhelekileyo, lo mboniso uza kufakwa kwingqondo, kwaye umphumo uyingozi.
Ngoko ukuba une-frill fibrification, ugqirha wakho kufuneka enze uqikelelo olusesikweni lomngcipheko wokubetha, kwaye ukuba loo mngcipheko uphakamileyo ngokwaneleyo, kufuneka ubekwe kunyango ukukhusela ama-clots yegazi ekumisekeni , kwaye ngoko, ukukhusela isifo.
Ukulinganisa Ingozi Yakho
Ukulinganisela umngcipheko wokuba ulwaphulo oludityanisiweyo xa ufuna ukuphefumula i-agrification kufuneka uqikelele ubudala bakho, ubulili kunye nezimo ezithile zonyango onokuzenza. Okokuqala, ukuba une-valvular isifo senhliziyo ngaphezu kwe-fibrillation ye-atrial, uya kufuna unyango lokuthintela i-clots yegazi, ekubeni umngcipheko we-stroke unyuke kakhulu.
Ukuba awunayo isifo se-valve senhliziyo, ugqirha wakho uya kusebenzisa i-calculator engozini, ebizwa ngokuba ngumlinganiselo we-CHA2DS2-VASc, ukuba uqikelele umngcipheko we-stroke. Kubantu abane-fibrillation ye-arrivals, ephakamileyo i-CHA2DS2-VASc amanqaku, ephakamileyo ingozi yokubetha.
Amanqaku angama-CHA2DS2-VASc ukusuka kwi-zero ukuya kwinqanaba elithoba kwaye ibalwa ngolu hlobo lulandelayo:
- Ukungaphumeleli kwentliziyo yekhenkce = inqaku elinye
- Ixinzelelo = enye ngongoma
- Ubudala obu-75 okanye ngaphezulu = amanqaku amabini
- Isifo sikashukela = enye inqaku
- I-stroke yangaphambili okanye i-TIA = amanqaku amabini
- I-arterial artery disease = enye inqaku
- Ubudala phakathi ko-64 ukuya ku-74 = enye ngongoma
- Ubundlobongela besini = enye inqaku
Ephakamileyo i-CHA2DS2-VASc amanqaku, ephakamileyo umngcipheko wonyaka we-stroke. Ngoko, ukuba amanqaku akho ayenayo, ingozi yakho yokushaya isifo ngu -2 ekhulwini ngonyaka, ophantsi kakhulu. Ukuba akho amanqaku amabini, umngcipheko wonyaka ngowama-2,2 ekhulwini, kwaye uphuma ngokukhawuleza ukusuka apho. Amanqaku asithoba avelisa umngcipheko wonyaka we-stroke we-12.2 ekhulwini. (Ngendlela yokuthelekisa, kubo bonke abantu abayi-100 abangaphezu kweminyaka yobudala engama-65 abangenayo i-fibrillation ye-atrial, malunga nomnyaka ngamnye uya kuba ne-stroke.)
Ukunciphisa Umngcipheko weStroke
Ukusetyenziswa kwezidakamizwa ze-anticoagulant kunokunciphisa kakhulu umngcipheko wokuba i-embolus evela kwi-atrium ekhohlo iya kubangela ukubetha kwabantu abantu abane-fibrillation ye-atrial. Nangona kunjalo, ezi ziyobisi zithwala ingozi yokuvelisa isiqendu esikhulu sokuphuma kwegazi, kubandakanywa isifo esibi (ukuphuma egazini). Kuqikelelwa ukuba umyinge wonyaka wengozi yokubethwa kwe-anticoagulants yi-0.4 ekhulwini.
Kuthetha ukuthini ukuba ukusebenzisa izidakamizwa ze-anticoagulant kunengqiqo xa umngcipheko wokubanjwa kwesibindi kwi-fibrillation ye-atrial kukhulu kakhulu kunomngcipheko wokubethelwa kwesilwanyana. Oogqirha bayavumelana, ngokobuninzi, ukuba kwizigulane ezingenayo i-nonvalvular fibrillation ye-agriyo eline-CHA2DS2-VASc yamanqaku ayi-zero, i-antiticoagulation ayifanele isetyenziswe. Ukufumana amanqaku amabini okanye ngaphezulu, izidakamizwa ze-anticoagulant kufuneka zisetyenziswe rhoqo.
Kwaye ngamanani amaninzi, unyango kufuneka lube ngumntu ngamnye kwisigulane ngasinye.
Kwixesha elidlulileyo, oogqirha babecinga ukuba xa bephumelele ekusebenziseni " unyango lwe-rhythm ulwaphulo " kwi-fibrillation ye-atrial (oko kukuthi, unyango olujolise ekunqandeni i-fibrillation ye-atrial nokugcina isigqi sesimo senhliziyo), umngcipheko wokuba uhlangothi luya kuhla. Nangona kunjalo, ubungqina beklinikhi ngoku ahlulekile ukubonisa ukuba isigqithiso sokulawula isigulane sinciphisa umngcipheko wesifo. Ngoko ke ukuba wena kunye nodokotela wakho ukhetha ulwalamano lokulawula isigqirha, kufuneka uqhubeke unyangwa ukukhusela isifo xa isalathisi sakho se-CHA2DS2-VASc siphakeme ngokwaneleyo.
Ziziphi izidakamizwa zokusetyenziswa?
Amachiza asebenzayo ekunciphiseni umngcipheko wokubethelwa kwi-fibrillation ye-agrifu yizidakamizwa ze-anticoagulant.
Ezi zeziyobisi ezivimbela iimbali ze-clotting zegazi , kwaye ke zivimbela ukubunjwa kwamacwecwe egazi. Kwizigulane ezine-fibrillation ye-atrial, i-anticoagulation inciphisa umngcipheko wokuba nesifo esibi kakhulu-malunga neyesibini kwisithathu.
Kude nje kwiminyaka embalwa edlulileyo, isisigxina esisodwa esingapheliyo se-antiticoagulant ngomlomo esasifumaneka yi-warfarin (i- Coumadin ), isilwanyana esivimbela iivithamini K. (i-Vitamin K inomsebenzi wokwenza ezininzi izinto zokuvala.) Ukuthatha i-Coumadin kuyinto engathandekiyo kwaye kaninzi kunzima, nangona kunjalo. Ixesha eliqhelekileyo kwaye rhoqo rhoqo ukuhlolwa kwegazi kuyadingeka ukulinganisa "ukucuthwa" kwegazi nokulungelelanisa umthamo weCoumadin. Kwakhona, izithintelo zokutya zifunekayo kuba ukutya okuninzi kunokuguqula izenzo zaseCoumadin. Ukuba i-dosage ayilungiswanga ngokufanelekileyo okanye kaninzi ngokwaneleyo, igazi lingakwazi "lincinci" okanye lingabonakali ngokwaneleyo, kwaye enye ingabangela iingxaki ezinzulu.
Kwiminyaka embalwa edlulileyo, izidakamizwa ezintsha ze-antiticoagulation ziye zaphuhliswa ezingenzi ngokuvimbela i-vitamin K, kodwa kunoko ngokuzivimbela ngokuthe ngqo izinto ezithile. Ezi zibizwa ngokuba yi "inoveli ye-anticoagulant", okanye i-NOACs. I-NOACs ezivunyiwe njengamanje e-US ziyi-dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), kunye ne-edoxaban (Savaysa).
Ezi zonyango zonke zinenzuzo ngaphezu kweCourmadin. Basebenzisa i-doses imihla ngemihla, ngoko imfuneko yokulungiswa kwegazi rhoqo kunye nokulungiswa kwezilingo kupheliswe. Abafunanga nayiphi na imithintelo yokutya. Kwaye uphando lwekliniki lubonise ukuba ezi zonyango ziza kubonakala zisebenza kwaye zikhuselekile njengeCoumadin.
Kukho iingxaki ezithile kwi-NOACs, nangona kunjalo. Ziyabiza kakhulu kuneCoumadin, kwaye ngokungafani neCoumadin (leyo ingashukunyiswa ngokukhawuleza ngokunika i-vitamin K) kunzima ukuguqula umphumo wabo wokuba i-antiticoagulant ifanelekile. (Ngaphandle kwe Pradaxa, i-antidote yile chiza yavunywa ngo-Oktobha 2015.)
Uninzi lweengcali zikhetha ukusetyenziswa kwezidakamizwa ze-NOAC ngaphezu kwe-Coumadin kwizigulane ezine-fibrillation ye-agriyo. Nangona kunjalo, kukho abantu apho iCoumadin isona sikhethiweyo. U-Coumadin usoloko unyanzelekile ukuba uthatha u-Coumadin sele sele uzinzile ngokupheleleyo kwiziyobisi okanye ukuba ungakuthandi ukuthatha iipilisi kabini ngosuku (okufunekayo ku-Pradaxa no-Eliquis) okanye ukuba awukwazi ukufumana iindleko eziphezulu ngoku zamachiza ezintsha.
Izindlela zoMatshini
Ngenxa yeengxaki ezibandakanyeka ekuthatheni iziyobisi ze-antiticoagulant, iinzame ziqhubekile ukuphuhlisa unyango olwenziweyo ukuzama ukukhusela izigulane kwizigulane zeprivinsi. Ezi ndlela zenzelwe ukuhlukanisa i-appreage yangasese ekhohlo ("isikhwama" se-atrium eseleyo esishiywe ukusuka ekukhuleni komntwana). Kuye kwenzeka ukuba ininzi yamacangci athoba kwi-atrium ekhohlo ngexesha le-fibrillation ye-agrifu ikhona kwi-appendi ye-orrial.
I-appendage ye-orrial engasekhohlo isenokungabikho kwimida ngokusebenzisa iindlela zokugqirha okanye ngokufaka ifowuni ekhethekileyo kwi-appartage nge-catheter. Ngoxa basebenzisa iiklinikhi, zombini le ndlela zineengxaki ezinkulu, kwaye kule ngqalelo zigcinwe kwiimeko ezizodwa.
Isishwankathelo
I-Stroke iyona yongatshatyalaliswayo, kwaye ngelishwa yinkxalabo eqhelekileyo, inkxalabo enkulu ye-fibrillation ye-atrial. Ngoko ukunciphisa umngcipheko wokubethelwa yinto oyenzayo wena nodokotela wakho kufuneka uthathe ngokungathí sina. Ngethamsanqa, ukuba wena nogqirha wakho nifumana ingxaki ngokuchanekileyo-ukuqikelela ingozi yakho nokunyanga ngokufanelekileyo-iingxaki zakho zokuphepha lo mbandela ziya kuphucululwa kakhulu.
Imithombo:
Fuster, V, Ryden, LE, Cannom, DS, et al. I-ACC / AHA / ESC 2006 Izikhokelo zokuLawula izigulane ezine-Fibrillation ye-Atrial Ingxelo ye-American College of Cardiology / American Heart Association Umsebenzi wamaKhokelo kunye ne-European Society yeKomiti yeCardiology yokuSebenza ngeziKhokelo (iKomiti yokuBhala ukuHlola izikhokelo zika-2001 ukuLawula izigulane ezine-Fibrillation ze-Atrial). J Am Coll Cardiol 2006; 48: e149.
Fang MC, Hamba AS, Chang Y, et al. Ukuthelekiswa kwezicwangciso zokucwangcisa umngcipheko ekuqaliseni i-thromboembolism kubantu abane-fibrillation ye-non-ravular. J Am Coll Cardiol 2008; 51: 810.