Kutora kwenguva refu kunokosha, asi kunetseka
Mumakumi mashoma makumi emakore adarika, stents yakave yakajairika mukurapa coronary artery chirwere . Munguva ino hufambira mberi dzakawanda dzakagadzirwa nekombiki yepamusoro. Matambudziko akaonekwa mumazuva okutanga ekumanikidzwa, zvakadai sekuparadzanisa stent mukati megoni yerononi , uye yakakwirira ye stent restenosis , yakaderedzwa zvikuru ne-newer stents (kunyanya, nekuiswa kwemishonga-eluting stents, iyo inhibitisa kukura kwemashuga iyo inonyanya kukonzerwa nekudzoka).
Asi chinetso chimwe chinonyanya kukanganisa chinoramba chiri ne-stents-pangozi ye stent thrombosis . Kugadziriswa kwakasimba ndiko kusanganisa kweropa ropa pachinzvimbo che stent, iyo inowanzokonzera kukurumidza uye kukwana kushandiswa kwegoniyoni. Kushungurudzika kwakasimba hakusi dambudziko rakajairika, asi kana zvichiitika iyo inoparadza, kazhinji inotungamirira kukurumidza kukurumidza kana kuti kukuvadza kwakakomba kwemoyo kubva mukurwara kwemoyo .
Ngozi yekushungurudzika kwepamusoro kune yakakwirira mumasvondo nemwedzi mushure mekugadziriswa. Asi pamakore aya zvishoma nezvishoma zvakava pachena kune vanachiremba kuti dambudziko iri haritomboperi zvachose, uye kuti "nguva yekupedzisira" stent thrombosis (kureva kuti, thrombosis inowanikwa gore kana kuti gare gare mushure mekunyanya kuiswa) inoramba ichitsemuka, asi yakaipisisa, mukana.
Ngozi yehutachiona hwepente inogona kuderedzwa zvakanyanya apo vanhu vakagamuchira stents vanyoreswa maviri anti-platelet drugs kuti vadzivise ropa rekuvhara ropa: aspirin , uye imwe yeP2Y12 receptor blockers.
P2Y12 blockers iyo inoshandiswa kudzivirira stent thrombosis ndeyevhapidogrel (Plavix - inowanzoshandiswa), prasugrel (Mhinduro), uye ticagrelor (Brilinta).
Kutora imwe yeP2Y12 zvinodhaka pamwe ne aspirin inonzi "vaviri-anti-platelet therapy," kana DAPT.
Nguva yeDAPT Kushandisa
DAPT inonyatsoshanda pakuderedza njodzi yenjodzi inokonzera kushungurudzika.
Pakutanga, DAPT yakashandiswa kwemwedzi mushure mekugadziriswa kwepamusoro, apo ngozi yeprombosis yakakwirira. Zvisinei, vanachiremba vakakurumidza kuziva kuti DAPT inofanira kushandiswa kwenguva yakareba, uye kwemakore anoverengeka chiyero cherapi chakanga chiri kuronga mwedzi mitanhatu yeDAPT.
Zvadaro, mumakore ekutanga kwema2000, dambudziko rekudzivirira kwemazuva ekupedzisira rakagamuchirwa, uye vanachiremba vakawanda vakatanga nguva dzose kurondedzera DAPT kwegore rose kana kupfuura.
Sezvo nguva yakapfuura, nhepfenyuro dzakatanga kuunganidza kuwanda kwepisitiki yakaitika kare (kunyange makore) mushure mekugadziriswa kwepakati. Zvizhinji zvezviitiko izvi zvakaitika munguva pfupi DAPT ichinge yarega, kunyange mushure mokurapa kwenguva refu. Vanachiremba vazhinji vane shungu kuti DAPT inofanira kurongerwa kwenguva yakareba yakareba-zvichida kwemakore, kana zvichida nokusingaperi. Zvisinei, zvishoma zvinyorwa zvaivepo zvekupa vanachiremba chinangwa chekutungamira pamusoro pehutano hwakakwana hweDAPT inotevera stent.
Studies
DAPT kudzidza yakagadzirirwa kuti ipe mhinduro yekupedzisira pamusoro penguva yakakwana yeDAPT mushure mekugadziriswa kwekusimudzira. Chidzidzo chacho chakanyoresa vanenge 10 000 varwere vane stent vakanga vatotora DAPT kwemwedzi 12. Vakanga vaine maitiro ekumisa DAPT panguva iyoyo, kana kuenderera mberi kwemamwe gumi nemwedzi gumi nematanhatu (kwehuwandu hwemwedzi makumi matatu).
Zvigumisiro, zvakasvikwa pakupera kwegore ra2014, zvakaratidza kuti mwedzi 30 yeDAPT yakabatanidzwa nehuwandu hunopedzisira huri hwehutachiona hwehutachiona hunopera, zvichienzaniswa nemwedzi gumi yekurapa. Chidzidzo chacho chakajekesawo kuti njodzi yeprombosi yakanyanya kuwedzera kwekanguva chemwedzi mitatu kana zvakadaro apo DAPT yakamira, kunyange mushure memakore ekushandisa.
DAPT yekudzidza yakaratidza kuti vanhu vakaporerwa kwemwedzi makumi matatu yakazara vakange vane zvirwere zvakanyanya kubuda ropa pane varwere vakabata kwemwedzi gumi nemaviri.
Saka: DAPT kudzidza yakaratidza kuti mwedzi 30 yeDAPT iri nani kupfuura mwedzi gumi yekurapa pakudzivirira stent thrombosis.
Yakavimbisawo kuti pane nharo inokosha muhutachiwana hweprombosi pavanorega DAPT, kunyange mushure mekushandisa kwenguva refu. Pakupedzisira, yakaratidza kuti kune basa rekushandira pamwe neDAPT kwenguva refu yekurapa-kwete kuderera kwepfungwa, asi hupenyu hwehupenyu hunopisa ropa. Zvimwe mimwe miedzo yakatarisa iyo yakatarisa kwenguva refu DAPT therapy mushure mekugadzikana kwakaratidzwa zvakafanana.
Matambudziko
Kutora DAPT pachako kunokonzera njodzi yezvikamu zvikuru zvekubuda ropa, uye DAPT kudzidza yakasimbisa kuti nguva refu munhu anotora DAPT, inowedzera dambudziko rekubuda ropa zvikuru. Kune chero munhu upi zvake anotora DAPT, chiitiko chekushungurudzika kwakakomba (zvakadai sekangozi yemotokari risingakonzeri kuisa mungozi chaiyo) rinogona kuva nengozi zvikuru nekuda kwekubuda ropa.
Uyewo, nokuti kubuda ropa kwakanyanya kuoma kuzvidzora paDAPT, vanachiremba vakawanda vanonyanya kushamisira kushanda kune ani zvake anotora DAPT.
Zvechokwadi, nyaya iyi pamusoro pekuvhiya inoita dambudziko guru kuvarwere vakawanda vane stents. Kune rumwe rutivi, nyanzvi yezvematapi inogona kunge ichivaudza kuti isamboiti, inomira DAPT (nemhaka yehutachiwana hwehutachiwana hwehutachiona); kune rumwe rutivi, chiremba chiremba angave achivaudza kuti vari kudiwa zvakanyanya kuvhiyiwa, uye kuti DAPT inofanira kurega kuti kubvumira kuenderere mberi.
Sayenzi yezvokurapa haisati yagadzirisa mhinduro yezvinetso zvinowanzoitika. Kune masayendisiti iyi inetso inonakidza yekushanda nayo; kune vamwe vane cardiologists ichinetso chisina kunaka chinounzwa nemurwere wekukundikana kuti asazvikuvadza ivo pachavo, kana kukundikana kudzivisa kudiwa kwekuvhiyiwa; kune varwere iyo inogona kuchinja dambudziko rehupenyu, uye nyaya inogona kunyanya kuora mwoyo kana isina kunyatsoziva nezvezvinoreva DAPT asati abvumirana kugamuchira stent.
Muzviitiko zvakawanda kana chirwere chisingagoni kudziviswa, kushanda kwose kunoitwa kuti ienderere mberi DAPT kwegore mushure mekugadziriswa kwema-stent-kana kunyanya, kwemwedzi mitanhatu-vasati vadzivisa.
Nhasi Mazano
Nyanzvi dzakawanda dzechirwere dzinoomesa varwere vadzo vanotora DAPT kwemwedzi 12, kunze kwekuti murwere ane ngozi yakajeka yokubuda ropa. Pashure pemwedzi gumi nembiri, kuongorora zvakare kunofanira kuitika, uye kana zvichibvira, DAPT inofanira kuenderera mberi kune imwe mwedzi 18.
Shoko Rinobva
DAPT inokosha mushure mekuve nesimba, asi inogona kupa zvinetso zvayo zvakaoma. Mushonga wezvezvehutano uchiri kukonzera huwandu hwezvengozi-kubhadhara kwenguva refu DAPT, uye inogona kunge iri nguva pasina kubvumirana.
Panguva ino, apo nyanzvi yemapurisa inorayira kuporesa kwechirwere kune mumwe munhu ane chirwere chegoni, anofanira kunzwa achifanira kubvunzurudzwa pamwe nemurwere, zvakanyatsojeka, zvose zvinokonzerwa nekuti DAPT yakareba ikozvino inowanikwa chikamu chechirwere therapy. Mamwe ose mamwe maitiro ekurapa kune stent therapy inodawo kunyatsokurukurwa, kuitira kuti chisarudzo chaicho chaicho chingaitwa.
> Sources:
> Columbo A uye Chieffo A. Dual Antiplatelet Therapy Mushure mekushandisa Drug-Eluting Stents-Inguva Yakareba Sei? N Engl J Med 2014; DOI: 10.1056 / NEJMe1413297.
> Mauri L, Kereiakes DJ, Yeh RW, et al. Gumi nemaviri kana 30 Mwedzi yeDual Antiplatelet Therapy Pashure pemishonga-Eluting Stents. N Engl J Med 2014; DOI: 10.1056NEJMoa1409312.
> Sammy Elmariah, Laura Mauri, Gheorghe Doros, et al. Yakawedzerwa Nguva Dual Antiplatelet Therapy uye Mortality: Chirongwa Chekugadzirisa uye Meta-Kuongorora. Lancet 2014; DOI: 10.1016 / S0140-6736 (14) 62052-3.
> Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF / AHA / SCAI Nhungamiro yePercutaneous Coronary Intervention: Nhoroondo yeAmerican College of Cardiology Foundation / American Heart Association Task Force pamusoro pekushandisa mazano uye Society for Cardiovascular Angiography and Interventions. Kurwisana 2011; 124: e574.