Ukuphuculwa kwezilwanyana zangaphandle (EECP) yindlela yokwenza unyango lwe- angina . Nangona uphando olunzulu lwezonyango lubonakala ukuba luncedo ekunciphiseni iimpawu ze-angina kwizigulane ezinezifo ze- coronary disease (CAD) , i-EECP ayisayi kwamkelwa yi-cardiologist ezininzi, kwaye ayizange ingene kwi-cardiology practice.
Yintoni i-EECP?
I-EECP yinkqubo yomatshini apho izitya ezinokukhupha i-inflatable cuffs (ezinjenge-blood pressure cuffs) zihlanganiswe emilenzeni yomibini. Nangona isigulane silele embhedeni, umlenze womlenze uhlonywe kwaye uhlanjululwe ngokuchanekileyo ngentliziyo nganye. Ukunyuka kwamaxabiso kunye nokuchaswa kulawulwa yikhomputha, esebenzisa i- ECG yesigulane ukudala ukunyuka kwamaxabiso ekuqaleni kwe-diastole (xa intliziyo igxila kwaye izaliswe ngegazi), kwaye i-deflation njengokuba i-systole (intliziyo yentambo) iqala. Ukunyuka kwamaxabiso kwee-cuffs kwenzeka ngo-sequentially, ukusuka kwicandelo elingaphantsi lemilenze ukuya phezulu, ukuze igazi emilenzeni "libiwe" phezulu, malunga nentliziyo.
I-EECP inamabinzana amabini anenzuzo entliziyweni. Okokuqala, isenzo sokubamba umlenze womlenze ukwandisa ukuhamba kwegazi ukuya kwimibhobho ye-coronary ngexesha le- diastole . (Iingxube ze-coronary, ngokungafani nezinye iirriyiti zomzimba, zifumana ukuhamba kwegazi phakathi kweentliziyo zentliziyo, endaweni yesimo ngasinye senhliziyo.) Okwesibini, ngesenzo salo esicacileyo njengokuba intliziyo iqala ukubetha, i-EECP yenza into efana nokucoca ngokukhawuleza iirriyiti, ezinciphisa umsebenzi intliziyo yesisu eyenzayo ekupompozeni igazi.
Kucatshangelwa ukuba i-EECP inokukunceda ukunciphisa ukungasebenzi komsebenzi .
I-EECP ilawulwa njengoluhlu lwezonyango zonyango. Izigulane zifumana iiseshoni zeeyure enye ngeveki, kwiiveki ezi-7 (kwiiyure ezingama-35). Iiseshoni ezingama-35 ngeyure zijoliswe ekubangela ukuba utshintsho olude oluhlala luhlala luncedo kwi-system circulatory system.
Iphumelela njani iECEC?
Uphando oluninzi lubonisa ukuba i-EECP inokusebenza kakuhle ekuphatheni ingqondo engapheliyo. Umlingo omncinci obonisa ukuba i-EECP iphucule kakhulu impawu ze-angina (isilinganiselo esifanelekileyo) kunye nokunyamezela (umlinganiselo ojoliswe ngakumbi) kwizigulane ezine-CAD. I-EECP iphinde iphuculwe ngokuphawulekayo "imilinganiselo yobomi", xa kuthelekiswa nophando lwe-placebo. Olunye uphando lubonise ukuba ukuphuculwa kweempawu ezilandela inkqubo ye-EECP kubonakala kuqhubekeka ukuya kwiminyaka emihlanu (nangona izigulane eziyi-1 kwezi-5 zingadinga enye inkqubo ye-EECP ukugcina uphuculo lwabo).
I-EECP isebenza njani?
Inkqubo yezinto ezibonakalayo ezibonakalayo ezibonwayo ne-EECP aziwa. Kukho ubungqina obubonisa ukuba i-EECP inokukunceda ekwakheni iinqanawa zokubambisa kwi-artery corridary tree, ngokuvuselela ukukhululwa kwe-nitric oxide kunye nezinye izinto zokukhula ngaphakathi kweeronari ze-coronary. Kukho ubungqina bokuba i-EECP inokusebenza njengesimo "sokungabonakali", okukhokelela kwiintlobo ezifanayo zokuguquka okuqhubekayo kwinkqubo ye-nervous autonomic ebonakalayo kunye nokusetyenziswa kwangempela.
Ngaba i-EECP ingaba yingozi?
I-EECP ingaba yinto engakhululekile, kodwa ngokuqhelekileyo ayibuhlungu.
Kwizifundo, ininzi yezigulane ziye zanyamezela le nkqubo ngokufanelekileyo.
Kodwa akusiyo wonke umntu onokuthi abe ne-EECP. Abantu mhlawumbi akufanele babe ne-EECP ukuba abanakho ukungafezeki kwe- aortic , okanye ukuba babe ne- catheterization yasandul 'i- cardiac , yintliziyo engavumelekanga njenge- fibrillation ye-atrial , i- hypertension ephezulu , isifo se-arterial echaphazelekayo imilenze, okanye imbali ye- thrombosis enzulu . Nangona kunjalo, nakubani na umntu, inkqubo leyo ibonakala ikhuselekile.
I-EECP ikhuthazwa nini?
Ngokusekelwe kwinto esaziyo namhlanje, i-EECP kufuneka iqwalaselwe kumntu othe wayenaye angina nangona unyango ophezulu , kwaye otyunjwa okanye ogqithiseleyo utyalwa ukuba awunakukhetha.
I-Medicare ivumile ukuhanjiswa kwe-EECP kwizigulane ezine-angina eziphelile zonke ezinye izigqibo.
Ngomhla wama-2014, imibutho emininzi yobungcali (i-American College of Cardiology, i-American Heart Association, i-American Association ye-Thoracic Surgery, i-Preventive Cardiovascular Association, i-Society for Cardiovascular Angiography ne-Interventions) kunye ne-Society of the Thoracic Surgeons) ekugqibeleni yavumelana ngokuhlaziywa okujoliswe ku-EECP Kufuneka kuqwalaselwe izigulane ezine-angina zokukhanyela kwezinye iindlela.
Kutheni i-EECP ingasetyenziswanga ngakumbi?
Ngokubanzi, i-cardiology yoluntu sele ikhethwe ngokunyanisekileyo ukuba ingayinaki indlela enobungcali bonyango, kwaye abaninzi abanomdla we-cardiologists abahluleki ukuba baqwalasele ukunikela nge-EECP njengendlela yokwelapha. Ngenxa yoko, ezininzi izigulane ezingenayo i-angina zange zive ngako.
Enyanisweni, i-EECP yinto encane. Ngokuqinisekileyo ayibonakali njenge-cardiology. Akukho mntu unokuyichaza ngokwenene indlela esebenza ngayo. Kwaye, kwi-cardiologists / imbono, xa uthelekisa umgudu onxulumene nawo kunye nokubuyisela i-EECP into efana nokufakela i-stent (iiseshoni ezingama-35 kwiiveki ezi-7 kunye nomgaqo-mfutshane wama-30) akukho mpikiswano. Ukulindela i-cardiologists ukuba yamkele i-EECP nayiphi na inzondelelo iyalulahla nje ubuntu buntu.
Sekunjalo, xa unyango olungenakuvakalayo lwe-angina olukhoyo lukhuselekile kwaye lunxinzeleleke, xa ubungqina obukhoyo (njengengaphelelekanga njengoko kubonakalayo) bubonisa ngokucacileyo unyango lusebenza kakuhle kwizigulane ezininzi, kwaye xa isigulane siphethwe siya kukwazi ukuxelela ngokuqinisekileyo ukuba ingekho unyango oluye lunceda kwiimeko zabo (ngobukho okanye ukungabikho kokubonakalisa ukunciphisa impawu ze-angina), kubonakala kungenangqiqo ukuvumela izigulane zine-stable angina ukuba zikhethe uvavanyo lwaloo lonyango olungenakuvuthwa, mhlawumbi nangaphambi kokuba baqhutywe kwi-anti-invasive.
Ukuba unyango lwe-angina oluzinzile kwaye unemiqondiso nangona kukho unyango, kunengqiqo ngokupheleleyo ukuba uvelise ithuba lokuzama u-EECP. Ugqirha wakho kufuneka azimisele ukuxoxa ngale ndlela, nawe kwaye ungenanto.
Imithombo:
Fihn SD, Blankenship JC, uAlexander KP, et al. U-ACC / AHA / AATS / PCNA / SCAI / STS ukuhlaziywa okugxilweyo kwesikhokelo sokuxilongwa nokulawulwa kwezigulane ezinezifo zesifo senhliziyo esisisigxina: ingxelo ye-American College of Cardiology / i-American Heart Association Task Force kwiZikhokelo zokuSebenza, kunye Umbutho waseMerika woTyhutyrikhi, i-Preventive Cardiovascular Association, uMbutho weeNdiovvascular Angeography kunye neNguqulelo, kunye noMbutho weeTrhage zoTyholo. J Am Coll Cardiol 2014; 64: 1929.
Arora RR, Chou TM, Jain D, et al. Ukufundwa kwamaninzi okuphambaniswa kwangaphandle (UMTHETHO-EECP): umphumo we-EECP malunga ne-myocardial ischemia ne-anginal episodes. J Am Coll Cardiol 1999; 33: 1833.
U-Soran O, uKennard ED, uKfoury AG, et al. Iziphumo zeminyaka emibili yeekliniki emva kokunyanga okukhutshwe ngaphandle kwe-EECP (i-EECP) kwizigulane ezine-angina pectoris kunye ne-left-ventricular disperction (ingxelo evela kwi-International EECP Registry Patient Registry). Ngaba uJ Cardiol 2006; 97:17.