Izifundo zibonisa ukulinganiselwa kweNkqubo eDumekayo
Ukuba wena okanye umntu obathandayo uye wafumanisa ukuba unesifo se-coronary disease (CAD) , unokunikezelwa ngolu hlobo lwenkqubo eyaziwa njengongenelelo lwe-coronary percutaneous (PCI). I-PCI ibandakanya iindlela ezimbini ezahlukeneyo:
- I-Angioplasty, apho ityhubhu ifakwe kwi-artery kwaye igxothwe ukukhulisa isitya kunye nokwandisa ukuhamba kwegazi
- Ukufakelwa kwe-stent, ityhubhu encinci ephethe intsimbi evulekileyo kwaye ivimbela ukukhutshwa ekuquluneni kwakhona.
Nangona inkqubo ihamba ngokuthe ngqo kwaye kulula ukuyiqonda, ingayinokwandisa ixesha lokuphila okanye iphucule ithuba lokuphila?
IsiFundo seZikliniki Sinikela Iziphumo Ezimangalisayo
Ekuphenduleni lo mbuzo oceliwe ngawo, iqela lophando elixhaswa yiCandelo loPhando loPhando kunye noPhuhliso lweeVeteran liqhathanise iziphumo kubantu ababonelelwe ngonyango olugqithiseleyo (OMT) ukuze baphathe i-CAD yabo kulabo banikwe i-OMT ne-PCI.
I-Dubbed i-COURAGE (Iziphumo zeeNtsholongwane ezisetyenziselwa i-Revascularization kunye noVavanyo lweMichiza yokuLawulwa kweMithi), uphando lwango-2007 luphelile ukuba abantu ababonelelwe nge-OMT bodwa babengenayo ingozi enkulu yokuhlaselwa yintliziyo okanye ukufa kunokuya kwe-OMT ne-PCI. Ngaphezu koko, i-PCI ayizange inikeze nayiphi na inzuzo ngaphezu kwe-OMT ekunciphiseni iimpawu ze-angina .
Ukulandelwa ngo-2015 kuqinisekisile le miphumo.
Ukuchaza iziphumo
Iziphumo zazimangalisa abaninzi kwiindawo zonyango ezazisoloko ziqwalasela i-PCI inzuzo kulabo abaneengxaki ezikhuselekileyo.
Kwaye kuphela emva kokuvavanya iimpawu zezigulane-kunye nokunciphisa inkqubo ngokwayo-abaphandi bakwazi ukuchaza iziphumo.
Phakathi kwezigqibo:
- Abantu abafumana i-PCI bavame ukubuyela kwimikhwa yabo yokudlulayo ngaphambili ekhaya (kubandakanywa ukusetyenziswa ngokugqithisileyo kokutya okubomvu kunye namafutha angenampilo ).
- I-PCI ngokwayo ihlaselela ukulimaza udonga lweerteri kwaye yandisa ingozi yokukhutshwa kwesibini. Enyanisweni, iipesenti ezingama-21 zeqela le-PCI zazifuna enye i-stent kwisithuba seenyanga ezintandathu, ngelixa iipesenti ezingama-60 zeempahla eziphathekayo zifunwa kwakhona.
- Inkqubo ye-PCI nayo idibene nomngcipheko omkhulu wokuxhamla kwegazi, ukuhlaselwa yintliziyo, nokubetha, ngokuchithwa ngokuphumelelayo ezininzi iinzuzo zonyango.
Enye into ebalulekileyo kukuba iiplathi eziphathwe kwi-PCI akuzona ezo zibangele ukuhlaselwa intliziyo okanye ukubetha. Kunoko, iinkxalabo zixhamle ngakumbi kwiiplantshi ezingabinqandeki ezincinci, ezincinci, kwaye zinokuthi zihlukane.
Nangona i-angioplasty kunye ne-stenting inokubonelela ngoncedo lwexeshana, umthwalo omkhulu wesi sifo uhlala uhambelana kunye nomngcipheko weemeko zomoya ezizayo.
Iinkqubo zezoLonyango ngaphantsi kokuhlola
Iingaphulelo zongeza kwiindlela zonyango. Uvavanyo lwango-2010 lwesilingo se-COURAGE lubhengeze ukuba ngaphantsi kwe-45 kweepesenti zezigulane ezine-CAD zenze uvavanyo loxinzelelo ngaphambi kwe-PCI ekhethiweyo. Oko oku kuphakanyisiweyo kukuba oogqirha abaninzi abahluleki ukujongana nezinye izinto ezinokuguqulwa, ezifana nokutya nokuzilolonga, ngaphambi kokunikezela inkqubo.
Ngenxa yoko, abaninzi abantu babengaqondi kakuhle isidingo sokutshintsha indlela yokuziphatha, kuquka ukuyeka ukutshaya , xa bekhishwa kwiinkathalo.
Oko Okusixelelayo
Ngenxa yesilingo se-COURAGE, i-American Heart Association kunye ne-American College of Cardiology yashicilela izikhokelo ezichaza ukusetyenziswa okufanelekileyo kwe-PCI kubantu abanesifo senhliziyo. Bacinezela ukuguquka kwendlela yokuphila kunye nokusetyenziswa okufanelekileyo kweyeza kwiinkqubo zokuqala zonyango apho isimo senhliziyo sinozinzile.
Izikhokelo ziqinisekisa kwakhona imfuneko yokuqinisekisa ukuba umntu uhambelana ngokupheleleyo kunyango phambi kokuqwalasela i-PCI. Kwiimeko ezininzi, ukuphucula ukuthobela ngqo kukuhambelana nokuphuculwa okanye ukuzinza kwemoya yentliziyo.
Kule nto, ukuba unesifo senhliziyo, akufanele ujonge i-PCI njengendlela "yokulungisa ngokukhawuleza." Isisombululo esisigxina esiya kuhlala sisisoloko siba ngumzimba wokuzivocavoca , ukutya okunokulinganisela , okuncinci , kunye nokunamathela ngokuthe ngqo kwimithi yakho engapheliyo.
> Imithombo:
> Boden, W; ORourke, R .; Teo, K. et al. "Unyango olufanelekileyo lwezonyango kunye okanye ngaphandle kwe-PCI kwisifo se-coronary disease." N Engl J Med. 2007, 356: 1503-16. INGXELO: 10.1056 / NEJMoa070829.
> Desai, N .; Bradley, S; Parzynski, C. et al. "Iimpawu ezifanelekileyo zokusetyenziswa kweCononary Revascularization kunye neMigudu yokuSebenza, ukuKhethwa kweMonde, kunye nokuLungelelaniswa kweCononary Coronary Intervention." JAMA. 2015; 314: 2045-53. INGXELO: 10.1001 / jama.2015.13764.
> Finn, A .; Nakano, M .; Narula, J. et al. "I-concept of vulnerable / unstable plaque". I-Arterioscler Thromb Vasc Biol . 2010; 30: 1282-92. INGXELO: 10.1161 / ATVBAHA.108.179739.
> Levine, G .; Amabhanki, E .; Ukungenanto, J .; okqhubekayo. Ukuhlaziywa okugxininiswe kwi-ACC / 2015 / AHA / SCAI kwi-Coronary Primary Curment for the Patients With ST-Elevation Myocardial Infarction .. " Ukuhamba. 2015; 87 (6): 1001-19. INGXELO: 10.1161 / CIR.0000000000000336.
> Sedlis, S .; Hartigan, P .; Teo, K. et al. "Impembelelo ye-PCI ekuPhuleni kwexesha elide kwizigulane ezineSifo esisisigxina senhliziyo." N Engl J Med . 2015; 373: 1937-46. INGXELO: 10.1056 / NEJMoa1505532.