Uphuhliso oluphambili lwe- pulmonary hypertension kukubamba inkqubo ngokukhawuleza kwaye uchonge kwaye uphathise isizathu esiyintloko. Nangona kunjalo, kwizigulane ezininzi ezile meko, unyango oluphambili luyafuneka.
Uvavanyo lokuSiseko
Isinyathelo sokuqala ekunyangeni i-pulmonary blood pressure isokuhlola ubunzima bokuqala kwimeko. Olu vavanyo lunceda ugqirha ukuba anqabise indlela enonya ngayo kunyango, kwaye unikeza indlela yokuvavanya impendulo kwonyango.
Oku kufuthi kwenziwa ngokuqhuba i- echocardiogram , eya kubonelelwa ngophando lwe-pulmonary artery, kunye nokuvavanywa komzimba ukulinganisa amandla okusebenza esiseko.
Unyango olujoliswe kwiNgxelo yezoNyango
Ngokuqhelekileyo, ukunyanga ngokugqithiseleyo imbangela yecopherysi yomshumpulane yinkalo ebaluleke kakhulu yonyango. Ekubeni kuneengxaki ezininzi zezokwelapha ezingenza i-pulmonary blood pressure, le nonyango inokuthatha iifom ezininzi ezahlukeneyo.
Unyango oluqhelekileyo luncedo kunoma ubani ophethe i-Pulmonary Hypertension
Ukongezelela kwonyango ejoliswe ngokukodwa ekuphatheni imbangela engundoqo, kukho unyango oluye luncedo kunoma ubani ophethe ingozi yomshumpulane.
Ezi ziquka:
- I-Diuretics efana neLasix okanye i-Bumex isoloko isetyenziselwa ukuphatha ukugcinwa kwamanzi okwenzeka rhoqo ngexinzelelo lwe-pulmonary. Nangona i-diuretics ingakwazi ukuphucula i- dyspnea kunye ne-edema (ukuvuvukala), kufuneka isetyenziswe ngokucophelela ukususela ekufumaneni ukukhupha kwamanzi kwizigulane ezinegazi lokuxinzeleleka kwe-pulmonary kungenza kube nzima ukusebenza komzimba.
- Ulwaphulo lwe-oksijeni lubalulekile kunoma ubani onomfutho wegazi ophezulu we-pulmonary ophethe i- hypoxia (unciphise igazi le-oxygen). Xa i-hypoxia ikhoyo, ukulawula i-oksijinokuthi ihlawule ngokuthe ngqo ukunyanzeliswa komthambo we-pulmonary. Izigulane ezinegazi legazi elibangelwa zizifo zamaphaphu okanye izifo zentliziyo ziyakunokwenzeka ukuba zine-hypoxia, kodwa nabani na abanexinzelelo lwengcinezelo kufuneka babe negazi labo lizinga le-oxygen.
- Ama-Anticoagulants afana neCourmadin aqhelekileyo asetyenziswa kwizigulane ezinexinzelelo lwe-pulmonary. Oku kungenxa yokuba i-pulmonary blood pressure ngokwayo ingabangela ukuphuma kwegazi ephazamisayo kwi-pulmonary circulation, engakhokelela ekugqibeleni kwimida yegazi emiphakeni. Funda malunga neziyobisi ezisetyenziselwa ukukhusela ama-clots egazi .
- I-Digoxin inokuphucula umsebenzi wentliziyo kwezinye izigulane ezinegazi legazi.
- Ukuzivocavoca kuye kwaboniswa ukuba kuphuculwe ngokukodwa amandla okusebenza abantu abanegazi legazi.
Uphuhliso oluPhambili
"Uphuhliso oluphambili" lwexinzelelo lwe-pulmonary lugxininisekile kwi-pulmonary hypertension ngokwayo, kunokuba kungenxa yeso sizathu. Olu cwangciso lubandakanya ukusetyenziswa kweziyobisi ze-vasodilator ukuzama ukuphucula umjikelezo we-pulmonary kunye nokunciphisa umthamo we-pulmonary.
Uphuhliso oluphambili lubizwa ngokuba "oluphambili" kungekhona ngenxa yokuba lusebenza ngakumbi kunezo zonyango eziqhelekileyo, kodwa kuba luyinkimbinkimbi, luyingozi, lubiza kakhulu, kwaye kaninzi luphazamiseka (umzekelo, unokufuna unyango lwangaphakathi). Ulwaphulo oluphambili lufanele lugcinwe kuphela ngamagqirha ayingcali yokunyanga i-pulmonary blood pressure.
Ulwaphulo oluphambili luqwalaselwa kwizigulane ezinexinzelelo oluphambili lwe-pulmonary ezingaphelelanga ngokwaneleyo unyango olujoliswe kwisizathu esiphezulu, okanye, ingakumbi, ukuba akukho nto ebangela ukuba ichongwe (oko kukuthi, kubantu abanegazi eliphambili le-pulmonary blood pressure).
I -rapy ephakamileyo ayisoloko isetyenziselwa bonke abantu abanesifo sengqondo soxinzelelo lwe-pulmonary ngenxa yesifo senhliziyo (apho unyango oluphambili luboniswe ukuba lunokulimaza), okanye isifo sesifo (apho kukho ukungabikho kwedatha ebonisa inzuzo) .
Ngaphambi kokuba uzame unyango oluphambili, uphando oluthile lwe- catheterization lwenzululwazi lwenziwe ukuba luhlolwe "i-vasoreactivity" ye-pulmonary circulation. Ngethuba lo vavanyo, iziyobisi zinikwa ukuvavanya ukuba imithambo yegazi i-pulmonary iyakwazi ukuhlaziya. Ukuba kunjalo, ezinye iintlobo zonyango oluphambili ziyakwazi ukusebenza kakuhle.
Zininzi iziyobisi ziye zaphuhliswa ekunyangeni ingozi yomshukela wegazi, kuquka:
- I-calcium i-block blockers njenge diltiazem kunye ne-nifedipine
- Iprostanoids ezifana ne-Flolan (epoprostenol), i-Remodulin (treprostinil) kunye ne-Ventavis (iloprost)
- I-Endothelin i-receptor antagonists ezifana ne-Tracleer (bosentan), i-Letaris (i-ambrisentan) kunye ne-Opsumit (macitentan)
- I-PDE5 inhibitors njenge-Viagra (sildenafil), i-Cialis (tadalafil), kunye ne-Levitra (vardenafil)
- Guanylate cyclase stimulant ezifana ne-Adempas (riociguat)
Olu luhlu olude lokhetho lwenza inkqubo yokukhetha "i-best" yezilwanyana okanye "ukulungelelaniswa" kwezilwanyana ezinzima kakhulu. Kufuneka kuthathelwe ingqalelo imigaqo emininzi ekwenzeni oku kukhethwa, kubandakanywa nesifo esisisiseko, ubunzima be-pulmonary hypertension, umlinganiselo we-vasoreactivity, nokuba ngaba iziyobisi ezithile zifunyenwe yinshuwalense yonyango, kunye nemiphumo emibi. Yingakho izigqibo ezinjalo kufuneka zenziwe oogqirha abaneengcali ekwelapheni i-pulmonary blood pressure.
Isishwankathelo
Unyango olungcono lwe-pulmonary blood pressure lungaba nzima kwaye luyinkimbinkimbi. Izigulane ezineengxowankulu zengxowankulu zisebenza ngokusemthethweni kunye noogqirha babo, ukuthatha inxaxheba enkulu ekunqumeni unyango, ngokuqwalasela ngokucophelela nokunika ingxelo ngeemeko zabo neempawu zokusebenza, kunye nokulandela imigaqo yonyango evunyelwene kakhulu.
Imithombo:
Galie, N, Hoeper, MM, Humbert, M, et al. Izikhokelo zokuxilongwa kunye nokunyangwa kwegazi lomnxeba. I-Eur Respir J 2009; 34: 1219.
McLaughlin VV, Archer SL, Badesch DB, et al. I-ACCF / AHA 2009 Ingxelo yokuvumelana kwengqondo malunga neengxowankulu zengxowankulu yengxelo ye-American College of Cardiology Foundation Task Force kwi-Expert Consensus Documents kunye ne-American Heart Association eyenziwe ngokubambisana ne-American College of Chest Physicians; I-American Thoracic Society, Inc .; kunye ne-Pulmonary Hypertension Association. J Am Coll Cardiol 2009; 53: 1573.
Galiè N, Corris PA, Frost A, et al. I-algorithm yonyango ehlaziyiweyo ye-pulmonary arterial blood pressure. J Am Coll Cardiol 2013; 62: D60.