Kuuya kweiiioplasty uye kunokonzera kushanduka kwakashandura chirwere chekoronary artery chirwere . Panzvimbo pokutora mishonga yakawandisa kune angina , uye panzvimbo yekuve nepamusoro pekuvhiyiwa kwepamusoro , munhu ane ruzivo rwakakura rwearonic artery anogona kuve nemararamiro epakati ekugadzira catheterization umo kuvharwa kunoputirwa nebhaluni (angioplasty), uye arteri inobva yakachengetwa kuvhura ne stent.
Kushungurudza kwave kwakagadziriswa uye kwakagadzirika, uye mifananidzo yekare-uye-inotevera yehutano hwehutano ichitsvaira (kunyange iyo inofanirwa 5th grader ingashamiswa), kuti zvibatsiro zvemuitiro uyu zviri intuitively pachena kuna chiremba uye murwere zvakafanana. Saizvozvowo, maitiro mazhinji kana haasi maitiro epamusoro pemapindu ave ava pedyo ne-stent-based.
Chirwere cheMatambudziko
Asi pasi pekunze, kushandiswa kwei angioplasty uye stents nguva dzose kwakagadzira matambudziko matsva, zvinoda mitsva mitsva, iyo inogadzira matambudziko matsva. Kuparara kwechinetso - sarudzo - dambudziko - sarudzo - dambudziko raenda seizvi:
Mumazuva okutanga, angioplasty yakashandiswa yoga. Iri ndiro "rakaputika" nebhokisi, richizarura mhizha yakavharidzirwa. Asi zvakakurumidza kuve pachena kuti chikamu chikuru chevarwere vakagadzikana nekugadzikana - regrowth yezviviri, mukuratidzira kushungurudzika kweangioplasty - izvo zvishoma nezvishoma zvaizovhara arteri zvakare.
Nhengo (expandable metal mesh tubes) dzakagadzirirwa kuchengetedza arteri yakazaruka mushure mekunge angioplasty, uye kuderedza kupora. Nzira yekutanga yesimbi yakasimbiswa (BMS) yakabatsira chaizvo (kuderedza dambudziko rekuzorodzwa nehafu inenge yehafu), asi chiitiko che restenosis chakange chakakwirira zvakakwana kuti chive chinetso. Saka zvinodhaka-eluting stents (DES) zvakagadzirwa.
Idzi idzi dzakaputirwa nemumwe wemishonga yakawanda iyo inodzivisa maitiro ekukura, uye semugumisiro, dambudziko rekusununguka rakaderedzwa.
Asi nekushandiswa kwakapararira kwe DES, dambudziko rekudzivirira kwemaitiro ekupedzisira rakagamuchirwa. Kutapisa kwakasimba, kamwe-kamwe uye kazhinji kutyisa kubvisa kwechigoni chechigoni panzvimbo ye stent, yakagara iri nyaya kune vhiki shomanana kana mwedzi mushure mekugadziriswa. Dambudziko rekudzivirira kwepent stent rakanyanya kuderedzwa nekushandiswa kwemaviri antiplatelet zvinoderedza kuvhara (zvinonzi "vaviri-anti-platelet therapy," kana DAPT).
Asi kana nguva yekupedzisira yakagadziriswa -thrombose inowanikwa gore kana kupfuura mushure mekugadzirisa stent-yakava dambudziko rakajeka nekushandiswa kwakapararira kwe DES. Kunyange zvazvo chirwere ichi chichiri kurega kunonoka - chinofungidzirwa kuti chinoitika kune mumwe wevanenge 200 - 300 varwere gore negore mushure megore rokutanga - rinenge nguva dzose chiri chiitiko chinotyisa, chinotungamirira kurufu kana kukanganisa kwemwoyo.
Dambudziko rekudzivirira kwemazuva ekupedzisira kunofungidzirwa nedzimwe nyanzvi kuti dzive dzakakwirira neD kunze kune BMS, zvichida nokuti mishonga inodzivisa kukura kwemashuga inobva mumatare ehutu yakatambanudzirwa kuropa, uye nenzira iyo inogona kukonzera kuvhara.
- Verenga pamusoro pezvinetso zvinoramba zvichiitika zvehutachiona hwehutu.
Nemhaka yekutyisidzirwa kwekupedzisira kwechirwere, ikozvino yakakurudzirwa kuti DAPT inopfuurirwa kwekunenge gore rimwe mushure mekusimudzira kutsvaga. Asi ruzivo rutsva runobva kuDAPT rakabudiswa munguva ino (November 2014) riri kuita kuti vanachiremba vazhinji vataure kuti DAPT inopfuurirwa kwemwedzi inenge 30 mushure mekugadziriswa, uye zvichida nokusingaperi.
Zvinosuruvarisa, DAPT pachayo inokonzera matambudziko makuru kune varwere vakawanda. Varwere vanotora DAPT vanonyanya kutarisana nematambudziko ekubuda ropa, mamwe acho anogona kunge ari kutyisa upenyu. Kukanganisika kunokonzera (sekukanganisa kambani yemotokari) paunotora DAPT kunogona kukuvadza kukuvadza kuenzanisa kune imwe inouraya.
Uye kurapa kubuda ropa panguva yekuvhiyiwa mumurwere inotora DAPT inenge isingakwanisi - saka anenge asina chiremba anovhiya achishanda kune murwere achitora mishonga iyi. Panguva imwe chete, uchapupu hunoratidza kuti kana DAPT inomira chero chikonzero chipi nechipi chinotevera stent - kunyange makore akawanda mushure mekuti stent yaiswa - kune fikiti iripo munguva inonzi stent thrombosis chiitiko.
Saka varwere mushure mekugamuchira stent vanogona kuzviwana munzvimbo isina kukodzera. Nyanzvi yavo inogona kunge ichisimudzira kuti inomisa DAPT yavo kuitira kuti iite kuti gumbo ravo rive kunze kana kuti chiuno chadzo chikatsiviwa, uye nyanzvi yavo yemapurisa ingave ichisimbisa kuti haambomisi DAPT yavo, nokuda kwechikonzero chipi nechipi.
Kubvunza Mubvunzo Wakanaka
Zvinyorwa zvekare zvekare zvinotanga ne "chokwadi" icho chinokonzerwa nekusarudzwa, uye ndokubvunza kuti, "Zvichida kuti stent inodiwa, ndinogadzirisa sei mugumisiro wemurwere wangu?" Kana iwe ukapinda musangano wezuva ranhasi remapurisa, uchawana zvakasiyana-siyana nyanzvi dzakapfigirwa mukukakavadzana kukakavadzana pamusoro pokugadzirisa zvirwere zvevarwere mushure mekushandiswa kwemashoko. Ko BMS inofanira kushandiswa panzvimbo ye DES shure kwezvose here? Inguva ichangobva kuzvarwa yeCAR yakachengeteka kudarika zvizvarwa zvekare here? Ko DAPT inofanira kupiwa kwemwedzi 6, mwedzi 12, mwedzi makumi matatu, nokusingaperi? Zvakadini nevarwere vane simba vane matambudziko ekubuda ropa, kana vanoda kuvhiyiwa?
Kana iwe uri murwere ane chirwere chegoni uye chirwere chako chiri kukurudzira stent, iwe unofanirwa kuisa chiratidzo chekumira uye kumbira chiremba wako kuti aongorore zvakare. Zvichipa nyaya uye mibvunzo isina kupindurwa iyo inopinda kushandiswa kwemhando ipi neipi, iyo stent inonyatsodikanwa here? Ndeimwe mishonga inowanika iyo inogona kushandiswa musati tashandisa stent?
Kana iwe uine acon coronary syndrome - angina isina kugadzikana kana chirwere chemwoyo - ipapo chiremba wako anenge ane chokwadi chaizvo. Iwe uri pangozi yakakurumidza pfupi nekuda kwekusagadzikana kwekoniyuta yemaari, uye angioplasty / stenting inogona kunge iri nzira yakanakisisa yekusimudzira chimiro chako chepfungwa.
Asi kana iwe uri "wega" uchitambura neine angina yakasimba , kana kana iwe uine kuvhara kukuru kusina kubudisa zviratidzo zvachose, ipapo angioplasty uye kunyorera haisi iko chete sarudzo-uye haisi iyo yakanakisisa. Migumisiro inowanzove yakanaka kana kuti yakanaka kuburikidza nerapi yehutano uye mararamiro ehupenyu. Uye rangarira kuti stent haisi yambiro-uye-yakaitwa; kana ukawana stent, iwe uchange uine chirwere chekurapa kwenguva refu - chirwere chakakomba cherapi - chero zvakadaro. Uyezve, nyanzvi dzakawanda dziri kunyanya kubvunzurudza kubudirira kwehutachiona hwema stent hunosimudzira angina .
Saka: iwe unoda kubvunza chiremba wako kuti adzorere chikamu. Panzvimbo pokufungidzira kuti stent ndiyo mhinduro, uye zvino kuisa pfungwa pane dzose dzezvehutano dzinotarirwa nokukurumidza apo stent inoshandiswa, chiremba wako anofanirwa kubvunza kuti, "Kupiwa chirwere chepfungwa ichi, hutano hwehutano, uye maonero, tariro uye zvinangwa, chii chinonzi kurapa kwakanakisisa kwechirwere chake chemarita? "Pane kazhinji kacho nzira dzakasiyana-siyana dzokurapa - uye dzose dzinofanira kufungwa.
Simba rinogona kuve riri mhinduro yakarurama, asi iyo ndiyo inogona kugadziriswa mushure mokubvunza mubvunzo wakarurama.
Sources:
Mauri L, Kereiakes DJ, Yeh RW, et al. Mwedzi gumi nembiri kana makumi matatu eviri yekurwisa antiplatelet therapy mushure mekushandisa madhiragi-eluting stents. N Engl J Med 2014; DOI: 10.1056NEJMoa1409312.
Columbo A uye Chieffo A. Dual antiplatelet therapy pashure pemishonga-eluting stents-Inguva yakadini yekurapa? N Engl J Med 2014; DOI: 10.1056 / NEJMe1413297.
Lüscher TF, Steffel J, Eberli FR, et al. Kushandisa zvinodhaka-kusunungura stent uye kugadziriswa kwekoniyoni: nzira dzehupenyu uye chirwere chinorwara. Circulation 2007; 115: 1051.
Iakovou I, Schmidt T, Bonizzoni E, et al. Nharaunda, kufungidzira, uye mugumisiro we thrombosis mushure mokubudirira kuiswa kwemishonga-eluting stents. JAMA 2005; 293: 2126.