Ukuqonda Ukunyangwa Kwentliziyo
Ukubizwa ngokuba yi "CABG Surgery" okanye " ukuhlinzwa kwintliziyo evulekile ," utyando lwe- coronary bypass utyando lwabafakela ukhetho olukhethiweyo olukhethiweyo lwezithuthi ezijikeleze intliziyo.
Intliziyo igxotha igazi kuwo wonke umzimba kodwa ixhomekeke kwimizila yeemithwalo yegazi ebizwa ngokuba yimithambo ye-coronary yegazi layo. Ukuba iirriyiti zivaliwe kakhulu - imeko eyaziwa ngokuba yi-coronary artery disease - i-oksijini ayifinyeleli kwi -heart muscle kunye nomonakalo.
Ukuvulwa kwentliziyo , okanye ukugqithisa ukugqithwa , kuthathwa njengolu hlobo "lwezinga legolide" lwe-coronary disease .
Ukuthintela umonakalo entliziyweni, ukugqithisa kwiimitha ze-coronary arteries kufuneka zinyuswe. Ngethuba lokuvulwa kwentliziyo evulekileyo, iirriyiti ezivaliweyo zisuswe okanye zingaphantsi kwemithambo yegazi ethathwe kwenye inxalenye yomzimba. Kwiindlela ezininzi zokuhlinzwa, iirriyari ezimbini ukuya kwezine zixhunyelelwe ukuqinisekisa ukuhamba okwaneleyo entliziyweni.
Utyando lwe- bypass luvame ukuchazwa ngokweendlela ezininzi ezigqityiweyo, ezifana ne- doublepass , i-overpass kathathu okanye i- quadruple bypass .
Iimpawu zoVulelo lweNtsholongwane evulekileyo:
- Ukutya okuninzi kukutshintsha, ukuyeka ukutshaya nokunyusa umzimba akuzange kuphuculwe isifo somgulo.
- I-Angioplasty ayiphumelelanga, ayifanelekanga okanye i-artery ivalwe kwakhona emva kwe-angioplasty.
- Intlungu ebuhlungu yesifuba iyenzeka ngomsebenzi.
- Ukuvavanya kubonisa isifo esibi kwisicatshulwa esiphambili se-coronary .
- Ukuvavanya kubonisa izifo ezinzima kwimibhobho emininzi .
- Izitshixo azizange zisebenze, ayikwazi ukufakwa okanye zifuneka kwakhona.
- I-ventricle ekhohlo ayisebenzi kakuhle ngenxa yesifo somgudu we-coronary.
- Kukho umngcipheko we-heart damage.
Ukulungiselela Ukuvuthwa Kwentliziyo Evulekileyo:
Uninzi lwagqirha lwe-cardiac lwenza uvavanyo olunzulu ngaphambi kokuhlinzwa ukuba kutholwe iirriyiti ezithintekayo kunye nobunzima bokuvalwa.
I-angiogram ngumvavanyo omnye ophulukileyo osebenzisa ii-ray-ray ukucacisa ubunzima besifo se-coronary.
Uvavanyo loxinzelelo, i-electrocardiogram (EKG) kunye nokuhlolwa kwegazi ngokuqhelekileyo kwenziwa ngaphambi kokuhlinzwa. Iimvavanyo zegazi zingaphendulwa ngokukhawuleza phambi kokuhlinzwa ukuze zichonge ukuba isiguli singaphalaliswa ngexesha lotyando, kunye nempilo yabo jikelele.
Udokotela ogqirha unokuthi abe nemiyalelo ecacileyo kwisigulane esilungiselelwe ukuhlinzwa ngonyango. Le miyalelo ingabandakanya utshintsho kwimithi yokugonywa kwemithi, ukutya nokusela nokutshaya .
Ngolwazi olungakumbi malunga neNtliziyo yeNtliziyo kunye nokuPhepha kwentliziyo
Kwipompo Evulekileyo Intliziyo Yokuvuleka:
Intliziyo evulekileyo idlula ukuhlinzwa ngokuqhutywa kwe- anesthesia jikelele , efuna ukuba isigulane sibe sefenini ngexesha lotyando.
Ugqirha luqala ngokuvunwa kwemithambo yegazi eya kuba yi-grafts. Umtya wesinfanthe emlenzeni udla ukusetyenziswa ngenxa yokuba lide ngokwaneleyo ukudala iireferensi ezininzi. Ukuba i-vehen sapinous ayikwazi ukusetyenziswa, iinqanawa ezisesandleni zingasetyenziswa endaweni yoko. I-artery yangaphakathi kwesobunxele isetyenzisiweyo isetyenziselwa ukuxhunyelwa kunye kwaye kuthathwa xa isifuba sivulelwa ukuhlinzwa.
Xa i-vehenous vein ifumanekile, isifuba sivuliwe ngokwenza i -incternous, okanye isifuba.
Ugqirha ke uyanqumla i-sternum, ukuvumela ukuba igumbi lesifuba livule, unike ugqirha ukufikelela entliziyweni.
Kwinkqubo ye-CABG yendabuko, intliziyo igxinwe ngesisombululo se potassium ukuze ugqirha alingazami ukusebenza kwinqanawa ehambayo, kwaye igazi lijikelezwa ngumshini-umphunga. Ngeli xesha umshini-umphunga wenza umsebenzi weentliziyo nemiphunga, kwaye i-ventilator ayisebenzisi.
Udokotela ogqirha ubeka ingqungquthela, okanye ibuyele igazi ngokukhawuleka, okanye ukususa nokufaka endaweni yesitye esivinjiweyo. Ubungakanani besikhathi kwi- heart-lung bypass machine umiselwe ngesivinini apho ugqirha unako ukusebenza, ngokukodwa, ubuninzi beegrafts ezifunekayo.
Emva kokuba iirejista zizalisekile, intliziyo iqalile kwaye inikeza igazi kunye ne-oksijini emzimbeni. I-sternum ibuyiselwa kwisimo sayo sokuqala kwaye ivaliwe ngocingo olucubungelayo, ukunika amandla amathambo afanele aphilise, kwaye ukuvalwa kukuvalwa.
Iinkqubo zePompe Ukuvuleka kwentliziyo:
- Ugqirha unokusebenza ngokukhawuleza ngenxa yokuba intliziyo isaphila
- Igazi elincinane kakhulu lenza ukuhlinzwa ngokukhawuleza
- Ukulungele izigulane ezingaqinisekanga
Umxhelo wePompo Uvulo lweNtliziyo:
- Ukwanda kwesibindi / ukucima emva kokuhlinzwa
- Ukutshatyalaliswa ngokuphindaphindiweyo emva kokuhlinzwa kunokuphelisa umpompo
- Ukugcinwa kwamanzi amaninzi kunepompo
- Umngcipheko ophezulu wokulimala kweentso kunokuba uphume
- Ukuhlala esibhedlele eside kunokuba uphume
- Ukwanda komngcipheko wesifo
Ukukhutshwa kwePompo Ukuvuleka kwentliziyo:
Inkqubo yokubetha intliziyo, okanye ukutyunjwa kwe-"off-pump" ngokufanayo kufana nokuhlinzwa kwepom, kodwa ukuhamba kwegazi ngomzimba kugcinwa yintliziyo ngexesha le nkqubo. Esikhundleni sokusebenzisa umshini we-lung-lung, intliziyo iyaqhubeka ibetha kodwa indawo ekuxhaswa iqhutywe kusetyenziswa izixhobo zokucoca. Phantse i-20% yexesha lokuqala Iigulane ze-CABG ziyeke ukuhlinzwa kwepom .
Iiprojekthi ze-Off Pump Uvulo lwenhliziyo evulekileyo:
- Intliziyo ihamba, iyancipha ukuhlinzwa
- Ukulahleka kwegazi encinci kunye nokunyuswa okuncinci
- Umngcipheko wokunciphisa
- Ubude obude besibhedlele
- Ixabiso elincinci
I-Cons of Out Off Pump Open Heart Surgery:
- Ukufikelela kwi-70% yezigulane ezingenakuvunyelwa ngenxa ye-anatomy okanye imeko yonyango
- Ngokuqhelekileyo eyenziwa kwisigulane esingenasigxina
Ngolwazi olungakumbi malunga neNtliziyo yeNtliziyo kunye nokuPhepha kwentliziyo
Ukubuyiselwa kwi-Open Heart Heart Surgery:
Kwiindlela ezininzi zokuhlinzwa , izidakamizwa zinikezelwa ukuvusa isigulane ngokukhawuleza emva kokuvalwa kwesicatshulwa. Uninzi lwagqirha lukhetha ukuvumela izigulane ze-CABG ukuba zivuke ngokukhawuleza, ukukhusela nayiphi na ingcinezelo entliziyweni enokwenzeka xa uvuka ngokukhawuleza.
Isigulane siya kuthathwa kwindawo yokubuyisela, ngokuqhelekileyo iyunithi yonyango okanye yonyango olukhuselekileyo, ukunyamekela xa iphuma kwi-anesthesia. Ukubaluleka kokusingqongileyo kuyimfuneko ukubonelela isigulane enye ngononophelo olulodwa kunye nophando rhoqo. Ngelo xesha i-ventilator iya kuhlala isetyenziswa, ixhasa ukuphefumula xa isigulane sisahlala sihleli.
Enye okanye ezininzi iibhobho zesifuba, iipayipi ezinkulu ezifakwe kwi-site yokucoca, sinceda ukususa nayiphi na igazi elingase iqokelele entliziyweni. I-IV enkulu ebizwa ngokuba yi-Swan-Ganz iya kubakho, ukuvumela abasebenzi ukuba bajonge imisebenzi ebalulekileyo yeentliziyo kwaye banike imithi.
Emva kokuba izidakamizwa ze-anesthesia zithinte kwaye isigulane siphapheme, ithubhu yokuphefumula isuswe (inkqubo ebizwa ngokuba yi-extubation) kwaye isigulane sikwazi ukuphefumula ngokwabo. Ngokukhawuleza emva kokuba i-oksijeni eyongeziweyo ingaphunyezwa yinkomo, ukuncedisa ngokuphefumla. Amanqanaba e-oksijeni kunye nokuphefumla kuya kuhlolisiswa kwaye ukuba isiguli singakwazi ukuphefumula ngokwaneleyo ngaphandle kwendiza, umoya wokuphefumula uya kuphinda ungene.
Emva kokuvuka nokuphefumula ngokwabo, isigulane siza kuqala ukulungiswa ngokukhawuleza, ngokuqala ngokuhlala phantsi kombhede okanye ukuma nokuhamba amanyathelo ambalwa kwisihlalo. Isigulane siya kufundiswa ngeendlela zokwenza ukuba ukunciphisa intlungu kunye nendlela yokukhusela isilonda sokugonywa . Ngeli xesha, iyeza zentlungu ziyafumaneka ukuvumela isiguli ukuba siphume ngaphandle kwentlungu.
Isigulane se-CABG siyakuthi sihlale kwindawo yokukhathalela kakhulu ubuncinane ubuncinane kwiiyure ezingama-24. Iibhubhu zesifuba zisuswe kwisithuba seeyure ezimashumi mane anesibhozo sokuhlinzwa, ngaphambi kokutshintshela kwiyunithi ephantsi. Izigulane ezininzi ze-CABG zibonisa ukuphucuka okubalulekileyo kwinqanaba leentlungu xa kuthathwa isitulo sesifuba.
Ubomi Emva Kokuvuthwa Kwentliziyo Evulekileyo:
I-CABG ayiyonyango yesifo senhliziyo; lonyango olusebenza kakuhle. Isigulane se-CABG esingayithobeli imiyalelo yesigqirha sayo sokutshintsha ukutya kwabo, ukuyeka ukutshaya, ukuzivocavoca, ukunciphisa umzimba okanye ukulawula iswekile yegazi kunokufumana ukuba isifo sesifo se-coronary sabuyile, kwaye sivimbela iirejista ezintsha .
Ezinye izigulana zingadinga ukuvuselelwa emva kokubuyela ekhaya ukunceda ngamandla kunye nesigxina. Amanye amaziko anenkqubo ekhethekileyo yokuvuselela intliziyo ngelixa abanye basebenzisa iinkonzo zemithi yezobugcisa .
Ngolwazi olungakumbi malunga neNtliziyo yeNtliziyo kunye nokuPhepha kwentliziyo
> Imithombo:
> I-Pamphlet yolwazi lwesineke. Ilayibrari yezempilo yeMayo Clinic.com 1995-2007
> URaja S, uDreyfus G, "Ngaba ukupheliswa kombhobho we-coronary ophayibrari kuya kutshintsha indawo yokuqhutyelwa kweeronary?" I-Journal yeRoyal Society of Medicine, uMqulu 97, ngoJuni 2004.
> Turley A, Roberts AP, Morley R, Thornley AR, Owens WA, de Belder MA. "Ukuthintela kwinqanaba elilandelayo emva komgca we-coronary bypass grafting kuye kwaphucula kodwa ihlala iphezulu kakhulu: imfuno yokulandelelwa okujoliswe kuyo" Ukusebenza ngokugqithisileyo kweCardiothoracic. 30 uJanyi 2008