Iiyure ezimbalwa zokuqala zibalulekile
Ukuhlaselwa kweentliziyo ezinzima (kwakhona okubizwa ngokuba yi- myocardial infarction , okanye i-MI) yinkxwaleko yonyango. Ukuba neM MI kuthetha ukuba enye yamarriyari yakho ye- coronary ikhutshwe ngokukhawuleza, kwaye intliziyo yesisu eyenziwa ngulo mzobo iqala ukufa. Kufuneka ukuba unyango lwezonyango kunye nolwaphulo lube lukhuni ukuze uzinze inkqubo yakho ye-cardiovascular system kwaye ukhusele okanye unciphise iimeko ezide zentsholongwane.
Iziganeko eziPhambili zeNtsholongwane yeNtliziyo eYilungileyo
Izinto eziphambili kuqala emva kokufika esibhedlele kunye ne-MI enokwenzeka kukuba:
- Ukuqinisekisa ukuba iimpawu zakho ezibalulekileyo (ipulse kunye noxinzelelo lwegazi) zizinzile
- Ukulungiselela ukujongana neemeko ezisongela ubomi ezingabonakala (njengefabrillation ye-ventricular )
- Ukugqiba nokuba ngaba unayo iM MI
Ukuchonga uhlobo olubi kakhulu lwe-intliziyo yokuhlasela - isigaba se-ST segment infyoction (STEMI) - ngokuqhelekileyo kulula ukuba oogqirha benze. Yenziwe ngokukhangela utshintsho lwezinto kwi- ECG .
Ukuba unesimo esincinci seMI, engekho i-STEMI (ngokuqhelekileyo ithetha ukuba umthamo awunqatshelwa ngokupheleleyo), ukuxilongwa kungadinga ukuvavanywa okungakumbi - ngokukodwa ukulinganisa kweemeyimu ze- cardiac , iiprotheni ezikhishwe kwigazi ngeeseli zesisu zomzimba ezinobungozi.
Ukuba kuvela ukuba unayo i-STEMI, kufuneka kuthathe amanyathelo okukhawuleza ukukhusela ukukhutshwa kunye nokufumana igazi eligeleza kwi-artery coronary kwakhona.
Uthintelo olunjani?
Kukho iindlela ezimbini eziqhelekileyo zokuvula umthambo we-coronary blocked: i-thrombolytic therapy kunye ne- angioplasty ene- stenting .
Ulwaphulo lwe-Thrombolytic luquka ukunika iziyobisi (oko kuthiwa "i-clot-busters", njenge-Activase (t-PA), streptokinase, urokinase, okanye i-anistreplase), esenza ngokukhawuleza ukuchitha i-clot yegazi evimbe umthamo.
Ucwaningo luye lwabonisa ukuba malunga neepesenti ezingama-50 zeetriyiti eziqhelekileyo zingavulwa ngokunika ezi zidakamizwa ekuqaleni kwexesha lokuhlaselwa kwentliziyo kunye nokuba izigulane ezinemivulo yazo zivuliwe ziphelile kunye nomonakalo ophantsi kwenhliziyo kunye nethuba elingcono kakhulu lokuphila kwangexesha elide.
Kuzo zonke iifundo, kwangaphambili isilwanyana sinikwe, bhetele amathuba okuphumelela. Iziphumo ezilungileyo zifumaneka kwiiyure zokuqala ezintathu; Iziphumo eziyanelisayo zibonwa phakathi kweeyure ezintathu ukuya ezintandathu; kwaye enye inzuzo ibonwa kwiiyure eziyi-12, ngaphandle kwenzuzo encinane okanye akukho nzuzo emva koko.
Impembelelo ephezulu yonyango le-thrombolytic iphuma, kwaye le fom yeyeza kufuneka ingasetyenziswanga kwizigulane ezinomngcipheko ophezulu wokukhupha (umzekelo, ukuba unokuhlinzwa okwenzeka kutshanje, unomlando wokubetha ngenxa yesifo somzimba, okanye unomfutho ophezulu wegazi ).
Ukusebenzisa i-angioplasty kunye ne-stenting endaweni yezidakamizwa eziprombolytic ngoku zivakala ukuba zisebenza ngokuphumelelayo ekuvuleni ngempumelelo umthambo we-coronary okhutshwe ngexesha le-MI. I- angioplasty ye- Rapid ne-stenting iphumelele ekuvuleni umthamo ovalwe malunga ne-80% yexesha. Ukungalunganga kweli ndlela kukuba yinkqubo engenayo, kwaye ngaphandle kokuba isibhedlele isetyenziselwe ukwenza i- angioplasty engxamisekileyo ngokukhawuleza nangempumelelo, ukuvula isitya segazi kunokufezekiswa ngokukhawuleza kunye nonyango lwe-thrombolytic.
Ingongoma ephambili, kungakhathaliseki ukuba yeyiphi indlela esetyenziswayo, kukuvula isikebhe esasikhutshwa ngokukhawuleza ngokusemandleni. Oku kunjalo, ukukhetha phakathi kwonyango lwe-thrombolytic kunye ne-angioplasty kufuneka ngokubanzi kusekelwe kwiimeko.
Uninzi lwabalandeli be-cardiologists luya kukhetha i-angioplasty ukuba ibhanti yabo yokutya i-catheterization iyakhutshwa ngokukhawuleza, kwaye abasebenzi abanolwazi bafumaneke ngokulula. Le ndlela ingabonakaliyo iya kukhethwa ukuba kukho isizathu esihle sokuphepha unyango lwe-thrombolytic kwimeko yakho.
Ngakolunye uhlangothi, ukuba kunokwenzeka ukuba kubambezeleka ngokukhawuleza ekwenzeni i-angioplasty, okanye ukuba kukho isizathu esilungileyo sokugwema ukwenza inkqubo enomngcipheko, unyango lwe-thrombolytic luya kuba lukhetho olungcono.
Zombini iindlela zinokusebenza kakuhle xa zinikezwa ngokukhawuleza. Into ebaluleke kakhulu ayiyiphi indlela esetyenziswayo, kodwa ukwenza ngokukhawuleza. Ixesha liyinto engundoqo, kwaye indlela ekhethiweyo kufuneka ukuba yintoni na indlela enokuthi ivule i-artery ngokukhawuleza.
Ukongezelela kokufumana umzobo ovaliweyo uvulwe ngokukhawuleza, kuninzi nezinye iindlela zokwelapha ezifunekayo zinikezelwa ngexesha leMIG.
Ziziphi ezinye iindlela zokwelapha ezifanele zinikezwe ngexesha lokuhlaselwa kweentliziyo ezinzima?
Ukongeza ekusebenzeni ngokukhawuleza ukuvula isitya esipheleleyo kunye nokubuyisela ukuhamba kwegazi entliziyweni yakho, ezinye iindlela ezininzi kufuneka zithathwe ekukuphatheni ngexesha leMIG. Ezi ziquka:
Aspirin
Ukuthatha i-aspirin (isiqingatha kwi-aspirin yabantu abadala abadala abangenayo i-aspirin, echekisiwe okanye echotshoziweyo) ngokukhawuleza xa kunokwenzeka ukuba i-MI (okanye nayiphi na uhlobo lwe -coronary syndrome ) ekhunjulwayo inokuphucula kakhulu iziphumo. I-Aspirin isebenza ngokunciphisa "ukunyaniseka" kweeplatelet zegazi kwaye ngokukhawuleza ukukhawuleza ukukhula kwe-clot yegazi eyenza i-MI.
Heparin
Ukunika i- heparin okanye i-blood thinner ngexesha lokuqala kweeyure ezingama-24 zokuhlaselwa kwentliziyo ngokukhawuleza kunciphisa ukufa kwexesha elide. Izidakamizwa ze- anticoagulant , enye i-heparin enye, inokunceda ukuthintela ukwakheka kwegazi elitsha .
Beta blockers
Iibet blockers, iziyobisi ezithintela umphumo we-adrenaline, ziphucule ngokukodwa ukusinda kwezigulane ezine-MIs, kwaye kufuneka zinikezelwe kuzo zonke izigulane ngaphandle kokuba kukho isizathu esinamandla sokuthi (njengesifo sesifo samaphaphu, ukusilela kwintliziyo ephosakeleyo, amazinga). Ezi ziyobisi zivame ukuqaliswa ngosuku emva kokuhlaselwa kwentliziyo.
ACE Inhibitors
I-Angiotensin eguqula i-enzyme (ACE) inhibitors ziye zaboniswa ukuba ziphucule kakhulu iziphumo zezigulane ezinokuhlasela kweentliziyo ezinkulu okanye iimpawu zesifo senhliziyo. Ezi zi gulane zifanele ziqaliswe i-ACE inhibitors ngexesha leeyure ezingama-24 zokuqala emva kokuhlaselwa kwentliziyo. I-ACE inhibitors ingaba luncedo kwizigulane ezinokuhlaselwa kancinci kwentliziyo.
ZeNkcazo
Ulwaphulo lweemimiselo kufuneka luqaliswe kuzo zonke izigulane ezine-MI phambi kokukhutshwa kwesibhedlele, kwaye mhlawumbi ngokukhawuleza emva kokuqala kokuhlaselwa kwentliziyo. Izitatimende zibonakala ziphucula ukusinda emva kokuba i-MI ingakhathaliseki ukuba yiyiphi i-cholesterol, mhlawumbi ngokunciphisa ukuvuvukala okanye ukuzinzisa izixhobo ze-coronary artery ngenye indlela.
Emva kweeyure ezingama-24 zokuqala
Iiyure ezingama-24 zokuqala zibaluleke kakhulu. Ukufumana uncedo lwezokwelapha ngokukhawuleza kunokwenzeka kubalulekile ekuthintela ukuboshwa kwentliziyo , ukulondoloza intliziyo yakho, kunye nokuthintela ukuqhubela phambili kwegazi ekuveleni kwimibhobho yakho ye-coronary.
Kodwa nangona emva kokuba uxoxisane ngokuphumelelayo ngaloo suku wokuqala wokubaluleka, kusekho umsebenzi omningi owenzayo. Ukuhlaselwa kwintliziyo akuyona nje isiganeko esicacileyo, esiye sinyamezela, sinokulibalelwa. Ngokuqinisekileyo ukusinda ekuhlaselweni kwentliziyo kudinga umzamo oqhubekayo kwinqanaba lakho, nangenxa yonyango wakho.
Imithombo:
> Antman, EM, isandla, M, Armstrong, PW, et al. Uhlaziyo olujoliswe ngo-2007 lwe-ACC / AHA 2004 Izikhokelo zokuLawula izigulane nge-ST-Elevation Myocardial Infarction: ingxelo ye-American College of Cardiology / i-American Heart Association Task Force kwiZikhokelo zoLwazi (iQela lokuBhala ukuBukeza ubungqina obutsha kunye nokuhlaziya i-ACC / AHA 2004 Izikhokelo zoLawulo lwezigulane nge-ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008; > 51: XXX >.
> Cannon, CP, Hand, MH, Bahr, R, et al. Iindlela eziphambili zokulawulwa kwezigulane ezine-syndromes eziphambili ze-coronary syndromes: uvavanyo lweNkqubo ye-Alert Programme ye-National Heart Attack. Inhliziyo J 2002; 143: 777.