Ukufika kwe- angioplasty kunye ne- stenting kuye kwaguqula uphando lwe- coronary artery disease . Esikhundleni sokuthatha amaninzi amachiza e- angina , kwaye endaweni yokuba ube nokuhlinzwa okugqithiseleyo , umntu ophethe iiconic artery ebonakalayo angenakho inkqubo yokucoca i-catheterization apho i-blockage ixutywa ibhaluni (i-angioplasty), kwaye i-artery iya kugcinwa uvule nge stent.
Ukuqhaqhazela kuye kwaba yinto eqhelekileyo kwaye ihamba phambili, kwaye ngaphambi nangemva kwemifanekiso yesifo esibulalayo sichaphazelekayo (mhlawumbi umgca wesi-5 uya kuhlaziywa), ukuba iingeniso zalo mgaqo zibonakaliswe ngokugqithisileyo kugqirha kunye nesigulane ngokufanayo. Ngako oko, ezininzi ukuba azininzi iinkqubo ze-cardiology ziye zaba malunga nendawo esekelwe.
I-Cascade yeengxaki
Kodwa ngaphantsi komhlaba, ukusebenzisa i-angioplasty kunye nama-stents kuye kwakha iingxaki ezintsha, ezifuna izicombululo ezintsha, ezenza iingxaki ezintsha. Ukuhlaselwa kwengxaki - isisombululo - ingxaki - isisombululo - ingxaki ihambe kanje:
Ngeentsuku zokuqala, i-angioplasty yayisetyenziswe yodwa. I-plaque "yachithwa" ibhaluni, ivula umthamo ovalwe. Kodwa ngokukhawuleza kwacaca ukuba ininzi yezigulane zafumana ukuphumula - i-regrowth yeesisu, ekuphenduleni i-trayuma ye-angioplasty-eyayiza kuvimba ngokutsha intsimbi kwakhona.
Izicathulo (ezandisiweyo zetyhubhu zetsimbi) zaveliswa ukuba zibambe umzobo ovulekileyo emva kwe-angioplasty, kunye nokunciphisa ukuphumula. I-original bent metal (BMS) inceda kakhulu (ukunciphisa umngcipheko wokuphumula) malunga nesigxina, kodwa isigxina se-restenosis sahlala siphezulu kakhulu. Ngoko izidakamizwa-eluting stents (DES) zaphuhliswa.
Ezi zingu-DES ziboshwe enye yeziyobisi ezininzi ezivimbela ukukhula kweethambo, kwaye ngenxa yoko, ingxaki yokuphumula iyancishiswa.
Kodwa kunye nokusetyenziswa okubanzi kwe-DES, ingxaki yentsholongwane yokugqibela ye- stent yavunywa. I-thrombosis enamandla, ngokukhawuleza kwaye ngokuqhelekileyo ukugqithisa kwintlepheko ye-coronary artery kwisiza se-stent, kuye kube yinkinga kwiiveki ezimbalwa okanye kwiinyanga emva kokubekwa kwe-stent. Umngcipheko we-stent thrombosis uyancipha kakhulu ngokusetyenziswa kwezidakamizwa ezimbini ezichasene ne- antiplatelet ezivimbela ukunqanda (okubizwa ngokuba yi-"-al-anti-platelet", okanye i-DAPT).
Kodwa emva kwexesha elidlulileyo le- thrombosis - i-thrombosis eyenzeka ngonyaka okanye ngaphezulu emva kokubekwa kwe-stent-yaba yinkinga ecacileyo kunye nokusetyenziswa okubanzi kwe-DES. Nangona isiganeko se-stent thrombosis siphelile sihlala siphantsi kakhulu-siqikelelwa ukuba senzeke kwisigulane esisodwa kwi-200 ukuya ku-300 ngamnye ngonyaka emva komnyaka wokuqala-phantse kube sisiganeko esiyingozi, ekhokelela ekufeni okanye enomonakalo wentliziyo.
Ingozi yentsholongwane engapheliyo i-stent thrombosis icingelwa ukuba ezinye iingcali ziphakamileyo kunye ne-DES kunokuba ne-BMS, mhlawumbi ngenxa yokuba isilwanyana esivimbela ukukhula kweethambo sishiya isinyithi se-stent evezwe egazini, kwaye ngoko ke inokubangela ukuba i-clotting ibenze.
- Funda malunga neengxaki eziqhubekayo zesifo se-stent thrombosis.
Ngenxa yesongelo lokusasazeka kwexesha elidlulileyo, ngoku kuyacetyiswa ukuba i-DAPT iqhutyelwa ubuncinane ngonyaka emva kokufakwa kwesigxina. Kodwa ulwazi olutsha oluvela kwisifundo seDAPT esandula kutshicilelwa (ngoNovemba 2014) kubangela oogqirha abaninzi ukuba bacebise ukuba i-DAPT iqhutywe ubuncinane kwiinyanga ezingama-30 emva kokufakwa kwesigxina, kwaye mhlawumbi ngonaphakade.
Ngelishwa, i-DAPT ngokwayo ibangela ubunzima obukhulu kwizigulane ezininzi. Izigulana ezithatha i-DAPT zixhomekeke ngakumbi kwiingxaki zegazi, ezinye zazo zingasongela ubomi. Ingozi ephawulekayo (njengengozi yemoto) ngelixa uthabatha i-DAPT ingenza ukulimala okulinganayo kube yingozi.
Kwaye ukulawula ukuphuma kwegazi ngexesha lokuhlinzwa kwisigulana esithatha i-DAPT kunzima ukuba kwenzeke - ngoko akukho phantse oya kuthi asebenze kwisigulane esithatha leziyobisi. Ngexesha elifanayo, ubungqina bubonisa ukuba ukuba i-DAPT igqityiwe nayiphi na isizathu esilandelayo isitofu-nangona emininzi kwiminyaka emva kokuba i-stent isetyenziswe - kukho i-spike esheshayo kwisiganeko se-thrombosis.
Ngoko izigulane emva kokufumana i-stent zingayifumana kwindawo engasilindelekanga. Udokotela wabo ogqirha unokuthi ugxininise ukuba bayeke i-DAPT ukuze bafumane indawo yabo ye-gallbladder okanye i-hip yabo ishintshwe, kwaye i-cardiologist yabo ingabinzela ukuba abayikuyeka i-DAPT yabo, nayiphi na isizathu.
Ukubuza umbuzo ofanelekileyo
Uninzi lwezifo ze-cardiologists ziqala nge "inyaniso" ukuba i-stents ibonakala yonyango olukhethiweyo, kwaye ubuze, "Ngenxa yokuba kufuneka i-stent iyimfuneko, ndingayenza njani imiphumo yesigulane sam?" Ukuba unayo nayiphi na inkomfa ye-cardiology yenkomfa, uya kufumana iingcali zivaliwe kwiingxoxo eziphikisanayo malunga nokuphucula iziphumo zezigulane emva kokusetyenziswa kweentente. Ngaba i-BMS kufuneka isetyenziswe endaweni ye-DES emva kwayo yonke into? Ingaba isizukulwana sakutsha se-DES siphephile kunezizukulwana zangaphambili? Ngaba i-DAPT iya kunikwa iinyanga ezintandathu, iinyanga ezili-12, iinyanga ezingama-30, ngonaphakade? Kuthiwani ngabagulane abanegulane abanengxaki yokuphuma, okanye ngubani ofuna ukuhlinzwa?
Ukuba unesigulane kunye nesifo somgudu wegrionary kwaye ugqirha wakho uyakhuthaza i-stent, kufuneka ubeke uphawu lokuma kwaye ubuze ugqirha wakho ukuba acinge kwakhona. Ngenxa yeengxaki kunye nemibuzo engaphenduliweyo ehambayo ekusebenziseni nanoma yiyiphi i-stent, ngaba i-stent iyimfuneko ngempela? Ngaba ezinye iindlela zokwelapha ziyafumaneka ngaphambi kokusebenzisa i-stent?
Ukuba une -coronary syndrome enamandla-inganginya engaqinisekiyo okanye ukuhlaselwa kwentliziyo - ngoko ugqirha wakho ngokuqinisekileyo ulungile. Unobungozi obukhawulezileyo ngenxa yecala le-coronary, kwaye i-angioplasty / stenting inokuba yindlela efanelekileyo yokuzinzisa isimo sakho senhliziyo.
Kodwa ukuba "kuphela" ukuxhatshazwa kwi- angina , okanye ukuba unento ekhuselekileyo engabonakali nayiphi na impawu, ngoko-angioplasty kunye ne-stenting ngokuqinisekileyo akuyiyo yodwa inketho-kwaye mhlawumbi ayilona khetho. Iziphumo ngokuqhelekileyo zilungile okanye zilungele unyango lwezonyango kunye neenguqu zokuphila. Yaye ukhumbule ukuba i-stent ayiyiphakamiso esisodwa kunye nesenziwe; Ukuba ufumana i-stent, uya kuba neyeza lonyango lexesha elide - unyango olunzulu kakhulu-nangona kunjalo. Ukongezelela, ezininzi iingcali ngoku zibuza ukuphumelela kwonyango olusisigxina .
Ngoko: kufuneka ucele ugqirha wakho ukuba avuselele isinyathelo. Kunokuba ucinge ukuba i-stent yimpendulo, kwaye ubeke ingqalelo kuzo zonke iinkqubo zonyango eziye zenziwa ngokukhawuleza xa isetyenziswe, ugqirha wakho makabeke abuze, "Ukunikezelwa kwesi simo sengqondo somgulane, imeko yezempilo jikelele kunye nemibono, ithemba kunye neenqwenelo, yintoni na unyango olungcono kwi-coronary artery disease? "Ngokuqhelekileyo kukho iindlela ezininzi zokonyango - kwaye zonke zifanele ziqwalaselwe.
I-stent ingaba yimpendulo eyiyo, kodwa yinto enokuyenza kuphela emva kokubuza umbuzo ofanelekileyo.
Imithombo:
Mauri L, Kereiakes DJ, Yeh RW, et al. Ezilishumi elinambini okanye kwiinyanga ezingama-30 zonyango oluphambili lwe-antiplatelet emva kwe-drug-eluting stents. N Engl J Med 2014; INGXELO: 10.1056NEJMoa1409312.
I-Columbo A ne-Chieffo A. Ulwaphulo oluninzi lwe-antiplatelet emva kwe-drug-eluting stents-Kuze kube nini ukunyanga? N Engl J Med 2014; INGXELO: 10.1056 / NEJMe1413297.
ULüscher TF, uSteffel J, uEberli FR, et al. I-drug-eluting stent kunye ne-coronary thrombosis: iindlela ze-biological kunye neempembelelo zekliniki. Ukuhamba ngo-2007; 115: 1051.
Iakovou I, uSmmidt T, uBonizzoni E, et al. Isiganeko, izibikezelo, kunye nesiphumo se-thrombosis emva kokufakela ngokuphumelelayo kwe-stuting-eluting stents. JAMA 2005; 293: 2126.