Nabani na unesifo se-coronary disease (CAD) kufuneka abe neyeza lonyango elinamandla kunye nokuguqulwa komngcipheko, kokubili ukunciphisa umngcipheko wokuhlasela kwentliziyo , nokulawula iimpawu ze-angina (ukuba zikhoyo).
Ngamanye amaxesha unyango lwezokwelapha lodwa lusele, kwaye unyango lwe-revascularization luyadingeka. I-Revascularization ithetha ukuba iindawo ezinomqobo obunzima kwimibhobho ye-coronary zixhaswe nge- angioplasty kunye ne- stent , okanye nge- surpass operation (ebizwa ngokuba yi-coronary artery bypass grafting, okanye i-CABG).
Ngoko ke, nasiphi na umntu ofumene i-CAD, ugqirha kunye nesigulane kufuneka sicinge ngemibuzo emibini. Okokuqala, ingonyango yonyango yaneleyo, okanye kufuneka ihlaziywe kwakhona? Okwesibini, ukuba i-revascularization iphakanyiswa, ngaba kufuneka ibe ne-stenting, okanye ne-CABG?
Xa i-Revascularization ikhuthazwa?
Kwinkoliso yabantu abaneCAD, unyango lwezokwelapha , kunye neenguqu ezifanelekileyo zokuphila ukuze kuphuculwe ingozi yomzimba , kufuneka kube yindlela yokukhetha. Ngokukodwa, kubantu abanobunzima be-angina (i-angina echazwayo ekuqaleni, kwaye oko kwenzeka kuphela phantsi kweemeko ezithile ezifana nokuzilolonga), unyango lwezokwelapha lusebenza ngendlela efanelekileyo njenge-revascularization ekukhuseleni ukuhlaselwa kwentliziyo, nokunciphisa ingozi yokufa kwegazi. Ngoko unyango lwezonyango kwiimeko ezinjalo luhlala lunyango olukhethiweyo.
Nangona kunjalo, unyango lwe-revascularization ngokuqhelekileyo lukhethi olufanelekileyo phantsi kweemeko ezithile. Ezi ziquka:
- Abantu abanoluhlobo lwesifo senhliziyo esaziwa njengesigxina se -ST-Segment elevation myocardial infarction (STEMI) .
- Abantu abane- angina engaqinisekanga okanye abangenayo-ST-segment infarction (NSTEMI) , abangazange bazinze ngokukhawuleza kunye neyeza lonyango elinonya.
- Abantu abane-angina ezinzileyo ezilawulwa ngokungapheliyo nangona unyango olugqithiseleyo, okanye ngubani ongakwazi ukunyamezela unyango oluyimfuneko ukuyilawula.
- Abantu abane-anatomy CAD ababeka kwicandelo apho i-revascularization inokwenzeka ngaphezu kweyeza lonyango ukuphucula ubomi. Ezi zibandakanya abantu abanokukhutshwa okubalulekileyo kwi-artery coronary artery, kunye nalabo abaneempawu ezinqamlekileyo kwimibhobho emithathu ye-coronary - i-right, ye-left, ye-left and left cirflex arteries. Funda kabanzi malunga neeronomy .
Ziphi iindawo ezibalulekileyo ezikhethwa ngaphezu kweCABG?
Xa kunqunywe ukuba i-revascularization iyadingeka, isigqibo esilandelayo kukuba usebenzisa i-angioplasty kunye ne-CABG.
Ukugqithisa ngokuqhelekileyo kukhethwa ngaphezu kwe-CABG kwizigulane ezine-STEMI, kuba yindlela ekhawulezayo yokuvula umzobo we-coronary. I-stenting ihlala ikhethwa kubantu abanezinye iifom ze -coronary syndromes (ACS, ezifana ne-NSTEMI okanye i-angina engaqinisekanga), xa kuvulwa ngokukhawuleza umzobo we-coronary ovaliweyo kubonakala kuyimfuneko.
Kubantu abane-angina enesigxina abaphumelelanga ngonyango lwezokwelapha, ngokugqithiseleyo ukunyanzeliswa ngabantu abano-CAD ababandakanya i-artery coronary.
Kulabo abane-angina enesigxina abadinga i-revascularization kunye ne-CAD yesitya se-CAD, i-stenting iyanconywa ngokubanzi ngaphandle kokuba nayo isifo sikashukela, okanye i-coronary artery anatomy ibonwa yinto enzima.
Xa i-CABG ikhethwa ngaphezu kweStents?
I-CABG ikholelwa ukuba ivelise iziphumo ezingaphezulu kwexesha elide kubantu abane-CAD ye-3.
I-CABG icingelwa ukuba iphinde ibe nemiphumo engcono kunokuba ifumaneke kubantu abaninzi abanesifo se-coronary artery. Nangona kunjalo, kulabo abane-ACS ngenxa yokucima kwi-artery eyona nto ekhohlo, ukhetho olunokuthi lube lukhuseleko olukhuselekileyo kuba luyakwenziwa ngokukhawuleza ngokukhawuleza.
I-CABG yindlela ekhethekileyo kunokuba ifumaneke kubantu abane-CAD yesitya se-2 abanesifo sikashukela.
Ekugqibeleni, ngokuqhelekileyo, abantu abahlaziyiweyo kunye neCABG bahlala besidinga ukuphindaphinda i-revascularization kunabo bafumana i-stents. Ngenxa yeso sizathu, i-CABG kufuneka ibe ncinane ixutywe njengento yokukhetha kunye nabani na ofuna i-revascularization.
I-SYNTAX Trial
Ukuba siza kufutshane neemeko apho iCABG ikhethwa ngokugqithiseleyo, siya kuthi iziphumo ziba ngcono nakwi-CABG kubantu "abaneenkcukacha" zeCAD. I-"Complex" i-CAD iquka abantu abanesifo se-3-isitya, i-CAD ehamba phambili, abanye abantu abanesifo se-2, kunye nabani na abanesifo sikashukela abane-CAD.
Icandelo le-SYNTAX, elinyatheliswa ngo-2009, lilinge elilona lugqirha elichanekileyo lokuhlalutya i-CABG kwizigulane ezineCAD ezinzima. Olu pho nonongo luboniswe ukuba izigulane eziphathwe nge-CABG zazininzi ezimbalwa iziganeko zokugqibela (ukudibanisa ukufa, ukubetha, ukuhlasela kwentliziyo, kunye nesidingo sokuphindaphinda i-revascularization) kunokuba izigulane zifumana i-stents (12.4% vs 17.8% emva kweenyanga ezili-12). Iziphumo ezifanayo zichazwe kwilingo elincinci ngo-2015.
Ngoko ke izilingo ezimbini ezibalulekileyo zeklinikhi ezilinganisa i-CABG kwizigulane ezine-CAD eziyinkxalabo zombini ziphuma ziyakuthanda i-CABG.
Iingcali zeCardiologists zichaza, nangona kunjalo, ukuba kuvavanyo lwe-SYNTAX, ngelixa i-endpoint engummiselo yayibi kakhulu ngeentsholongwane, umngcipheko wexeshana wokuba uhlangothi lubonakala luphezulu emva kwe-CABG (0.6% kwi-stents no-2.2% kwi-CABG) emva kweenyanga ezili-12. Le ngongoma esemthethweni, nangona ingozi yokubetha i-stroke yayilingana namaqela emibini emva kweminyaka emithathu.
Abaphandi abagijimayo isilingo se-SYNTAX baye bahlakulela oko bakubiza ngokuba "uphawu lwe-SYNTAX," okubaluleka ngokubaluleka kwiimpawu zeCAD yesigulane ngokuxakeka kwayo. Izigulane ezinamanani amaninzi e-SYNTAX zibonakala zenza ngcono ngeentsholongwane kunezo ziphezulu ze-SYNTAX izikolo. Nangona kunjalo, ngelixa amaninzi e-cardiologists asebenzisa amanqaku e-SYNTAX ukuze ancede ukuba anqume ukuba umntu onenkathazo ye-CAD kufuneka abe ne-stenting okanye i-CABG, le nkqubo yokumakisha ayizange ivavanywe kwilingo leklinikhi.
Ngaphantsi
Umgca wenyani kukuba abantu abaninzi abadinga i-coronary artery revascularization, kwaye ngubani ophethe i-CAD yesitrato esinamandla okanye ukukhutshwa okubalulekileyo kwi-artery coronary artery, i-CABG ngokuqhelekileyo kufuneka ibhekwe njengendlela yokuqala yonyango.
Ukugqithisa ngokuqhelekileyo kukhethwa kubantu abane-ACS, kubantu abane-CAD enye, kunye nakubantu abaninzi abane-CAD yesitya se-2 abangenayo isifo sikashukela.
Ukusebenzisa ama-stents esikhundleni se-CABG kwiCAD eyinkimbinkimbi kufuneka igcinwe kubantu, emva kokuqonda yonke ingozi kunye neenzuzo, basenokukhetha indlela encinci yokungena.
> Imithombo:
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> I-Park SJ, Ahn JM, Kim YH, et al. Uvavanyo lwe-Everolimus-Eluting Stents okanye Utyando lwe-Bypass kwi-Coronary Disease. N Engl J Med 2015; 372: 1204.
> Serruys P, Morice MC, Kappetein P, et al. I-Coronary Intervention Versus Coronary-I-Artery Bypass Ukulungiswa Kwee-Coronary Artery Disease. N Engl J Med 2009; 360: 961-972.