I-aortic dissection yenzeka xa udonga lwe-aorta (umthambo omkhulu womzimba) luqala ukulila, okuvumela igazi ukuba lingene eludongeni lwesitya, ukuchithwa (okanye ukukrazula) iindidi zodonga. I-disorction ye-Aortic inokubangela ukulimala okubanzi kumalungu athile kunye nokufa ngokukhawuleza, kwaye kufuneka kuhlale kuthathwa njengongxamiseko lwezonyango.
Izizathu
Ukwahlukana kwe-Aortic kwenzeka xa uluhlu lwangaphandle lwodonga lwe-aortic luba buthathaka, luvumela ukuba iinyembezi zibe yinto.
Olu buthathaka lunxulumene kakhulu ngokuxinzelelo lwegazi . Ikwabonakala kwakhona ngeengxaki zokuxhamla izicubu ezifana ne- scleroderma kunye ne- Marfan syndrome , i-Turner syndrome, i- Ehlers-Danlos syndrome , ukulimala okubuhlungu (njengokuba kwenzeke ne-Princess Diana), kunye nokuvuvukala kwemithana yegazi. I-aortic dissection ibangelwa nokusetyenziswa kwe-cocaine.
I-disorction ye-Aortic ibonakala ngokubanzi kubantu abaphakathi kweminyaka eyi-50 ukuya kwe-70 ubudala kwaye iyenzeka ngokuphindaphindiweyo kumadoda kunabasetyhini.
Yintoni eyenzekayo nge-Aortic Dissection
Xa i-aortic dissection ivela, igazi elihamba ngaphantsi koxinzelelo oluphezulu ludinga ludonga lwe-aorta, luqhekeza iindawo zomda. Umthamo omkhulu wegazi ungangena eludongeni lwe-aortiki, kwaye legazi lilahlekile ukusabalalisa - njengokungathi ukuphuma kwegazi kwenzeka. Igazi lokusasaza lihamba ngokuhamba kwinqanaba le-aorta, ukufakela imithwalo yegazi ephuma kwi-aorta kwaye ibangele izilo ezinikezelwa yiloo mithana yegazi.
I-aortic dissection ingakhokelela ekubuyiselweni kwe- aortic , ukuchithwa kwe-pericardial , i- myocardial infarction , iimpawu ze-neurologic, ukungaphumeleli kwezintso kunye nokuphuma kwamagxathu . Ukongezelela, i-aortic dissection inokuphelisa ngokupheleleyo i-aorta, ekhokelela ekuphumeni kwamanzi kwangaphakathi.
Kuzo zonke ezi zizathu ukufa kwe-aortic dissection, nangona unyango olukhawulezayo nolushushu, luphezulu kakhulu.
Iimpawu
Ngokuqhelekileyo, i-aortic dissection ibangela ukuba ngokukhawuleza kuvele ngokukhawuleza, kunzima, "ukuphazamisa" iintlungu kwisifuba okanye emva, ezidla ngokukhawuleza kwisisu. Intlungu ingahamba kunye ne- syncope (ukulahlekelwa kwengqondo), ngokuphefumula okufutshane, okanye ngeempawu zesifo . Ngokuqhelekileyo, iimpawu nge-aortic dissection zisoyika kwaye zinzima kangangokuthi akukho mbuzo omncinci kwengqondo yexhoba malunga nokuba uncedo lwezonyango olufunekayo.
Unyango
Unyango luxhomekeke kuyo nayiphi na inxalenye ye-aorta, kwaye kwimeko yesigulane.
Kuzo zonke iziganeko, izigulane ezine-dissection ze-aortic ziziswa kwiyunithi yonyango kwaye zikhawuleza zibekwe kwiimithi zonyango (ngokuqhelekileyo nge nitroprusside ) ezijoliswe ekunciphiseni kakhulu ukunyanzelwa kwegazi . Ukunciphisa uxinzelelo lwegazi kunokunciphisa ukuqhubekiswa okuqhubekayo kodongeni lwe-aorta.
Ezi zi gulane zinikezwa nge- blocka blockers ezingenangqondo (mhlawumbe ipropranolol okanye i-labetalol) ukunciphisa izinga lentliziyo, nokunciphisa amandla e-pulse nganye. Eli nyathelo lijoliswe ekunciphiseni ukusabalalisa kwakhona.
Emva kokuba izigulane ezibalulekileyo zenziwe zizinzile ngokwaneleyo, isifundo sokucinga (ngokuqhelekileyo i- CT scan okanye i- MRI ) senziwa ukucacisa ngokupheleleyo ukuba yiliphi iqela le-aorta echaphazelekayo.
Ngokuxhomekeka kwendawo yayo, i-dissection ibhalwe phantsi njengohlobo lwe-A okanye uhlobo B.
Thayipha i-A Dissections. Uhlobo lwe-A luya kubonakala kwi-aorta ephakamileyo (inxalenye yokuqala ye-aorta enika igazi entliziyweni, ingqondo kunye neengalo). Uhlobo lwe-A ukutshatyalaliswa ngokuqhelekileyo luphathwa ngokulungiswa kokucoca, okuqhelekileyo kubandakanya ukususa inxalenye ebhaliweyo ye-aorta nokuyifakela nge-graph dacron. Ngaphandle kokuhlinzwa, ezi zigulane zibeka ingozi ephezulu yokuvuselelwa kwe-aortic, infarction okanye i-stroke, kwaye zidla ngokufa kwiinkalo ezinjalo. Ukhuseleko lunzima kwaye luyinkimbinkimbi, nangona kunjalo, kwaye ingozi yokufa kunye nokuhlinzwa iyaphaya kwama-35%.
Ugqirha uphakanyiswa ukuphazamiseka kohlobo lwe-A kuba ukufa kufane kakhulu neyeza lonyango kuphela.
Uhlobo B Ukuphazamiseka. Ngohlobo lweB, i-dissection igcinwe kwi-aorta ehla (inxalenye ye-aorta ekhoyo phambi komgudu kunye nokunikezela igazi kwizitho zomzimba kunye nemilenze). Kule meko, ukufa akungcono ngokulinganiselayo kwaye kwaye kunokuphakanyiswa - kunye nokuhlinzwa kunokunyangwa kwonyango. Ngoko unyango oluqhelekileyo luquka rhoqo unyango lwezokwelapha, oko kukuthi, ukuqhubeka nokulawula uxinzelelo lwegazi kunye ne-beta blockers. Ukuba ubungqina bubangela umonakalo ezintsheni, emathunjini emathumbu, okanye kwiindawo eziphantsi , nangona kunjalo, utyando lungafuneka.
Ukubuyisela kwi-Aortic Dissection
Emva kokuba isifo se-aortic siphumelele siphathwe, isiguli esilulayo kufuneka sihlale kwi-beta blockers bonke ubomi bakhe, kwaye ukulawula uxinzelelo lwegazi kuyimfuneko. Ukuphinda kwakhona ukuhlolwa kwe-MRI kwenziwa ngaphambi kokukhutshwa esibhedlele, amaxesha ambalwa ngaphezulu kunyaka ozayo, kunye nanye ukuya kwiminyaka emibini emva koko. Ukulandelelaniswa okufutshane kuyimfuneko kuba, ngelishwa, malunga nama-25% abantu abasinda kwi-aortic dissection bafuna ukuphinda kuqhutywe ngokuphindaphindiweyo kokusabalalisa ngokuphindaphindiweyo kwiminyaka embalwa elandelayo.
Ngenxa yokuba i-aortic dissection ubuncinane ubomi obuguqukayo ukuba bengabulali, kubhetele kakhulu ukukhusela kunokuba uyiphathe. Unokunciphisa imilinganiselo yakho yokuba ne-aortic dissection ngokuhlawula ingqalelo kwiimeko zakho zobungozi bomzimba , ngokukodwa uxinzelelo lweengcinezelo, kwaye usebenze ngokukhawuleza ukuze uphucule iphrofayili yakho yengozi.
> Imithombo:
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> LeMaire SA, uRussell L. Epidemiology ye-Thoracic Aortic Dissection. Nat Rev Cardiol 2011; 8: 103.
> Melvinsdottir IH, Lund SH, Agnarsson BA, et al. I-Incidence And Mortality Ye-Disorction ye-Thoracic Aortic eyiyo: Iziphumo ezivela kwisiFundo seSizwe sonke. Eur J Cardiothorac Surg 2016; 50: 1111.