Zvirwere Zvokurapa uye Zvokuvhiya nokuda kweCarotid yako Arteri
Mishonga yemakarotidi ndeye midzi miviri yeropa inomhanya pamativi emutsipa wako kupinda muuropi yako. Pamwe chete nemadziro maviri emaseroti mushure memutsipa, carotids inobvumira nzira yeuropi kugamuchira ropa inoda oxygen.
Overview
Kufanana nemamwe mimwe mitsetse, carotids inogona kukuvara. High blood pressure, high cholesterol, uye kusvuta ndezvipi nzira shoma dzekuwedzera kune njodzi yepaki buildup mumakarotids nemamwe midzi yeropa.
Apo bhokisi rinowedzera mumudziyo wemwoyo, rinogona kukonzera kurwisa kwemwoyo . Apo bhokisi rinowedzera muropa remudziyo riri mukati kana kuenda kune uropi, rinogona kukonzera chirwere .
Carotid stenosis ishoko rinoshandiswa kuratidza dare rakaoma raakarotid. Apo bhokisi rinopfutidza dare re carotid, rinogona kukonzera chirwere munzira mbiri. Nzira yakakurumbira ndeyekuti chikamu chechidimbu chiparadze, chigadzirisa kubatana, uye kufamba mumidziyo yeropa kusvikira ichigara yakasimba uye ichivhara kure nekubuda kweropa kusvika kune chimwe cheuropi. Mhuka yacho inofa nekuda kwekushayikwa kweokisijeni-ino inonzi ischemia .
Carotid stenosis inogonawo kuderedza kubuda kweropa kuuropi kuitira kuti kana ropa richiderera, chikamu cheropi zvichienderana neyeri iyo haina kuwana ropa rakakwana. Izvi hazviwanzozivikanwi kupfuura kuumbwa nokuti uropi hunovakwa kuti hupe mishonga kubva pane imwe yeriti imwechete panguva imwe, sechirongwa chekudzivirira kuparadza kwechemere.
Mishonga
Nokuti carotid stenosis inokonzera njodzi yekurohwa, haigoni kuregererwa. Zvisinei, pane mhirizhonga pamusoro pekuti carotid stenosis inonyatsorapwa sei. Pane nzira nhatu dzinokosha dzokurapa carotid stenosis:
- kuchirapa
- chirwere chokuvhiya (carotid endarterectomy)
- minimally invasive vascular stenting .
Chirapi
Kusvikira pane imwe nguva, kurapwa kwechirotid stenosis inofungidzirwa pasi rose kuti ndiyo yakanakisisa sarudzo. Semuenzaniso, kana arteri carotid iri pasi pe50% yakaderera, kazhinji haifaniri kutapurirwa kwechirwere.
Pane kudaro, kurapwa kunotarisa kuve nechokwadi chokuti chidimbu hachiwedzere. Njodzi dzinokonzera kusvuta, kuwedzera kwehutachiona uye cholesterol yakakwirira inofanira kurongedzwa. Sezvamazuva ose, kudya uye kudzidzira zvinoramba zvakakosha zvakakosha.
Uyezve, chiremba anowanzotaurira imwe nzira yeropa yakasimba kuderedza chivharo kubva pakuumba nekuvhara arteri kana kuenda kune uropi. Zvichienderana nekuoma kwechiitiko chacho, izvi zvinogona kubva pane chimwe chinhu chakajeka seAspirin kune chimwe chinhu chakafanana neCoumadin.
Nyanzvi dzakawanda dzinobvumirana kuti kurapa kwakanakisisa kurapwa kwezvirwere kwave kuchienderera mberi kunatsiridza nekufamba kwenguva, zvichiita kuti ive yakanyanya kusimba sarudzo ichienzaniswa nezvimwe zvinopesana nenzira.
Kurapa Kwokuvhiya
Carotid endarterectomy (CEA) inzira yekuvhiya iyo iyo carotid inozarurirwa uye ibwe rakacheneswa kunze. Carotid endarterectomy yakanyatsodzidza, uye data inoratidza kuti inowedzera zvakajeka zvikamu zvacho pasi pemamiriro ezvinhu akasarudzwa. Mamiriro aya anosanganisira zvinotevera:
- Iyo carotid inofanira kunge yakavharidzirwa (kazhinji inopfuura 60%) asi haina kudzivirirwa zvachose.
- Chiremba anovhiya anofanira kunge ane unyanzvi, ane chirwere chiduku zvikuru chekufa chinobatanidza nekuvhiyiwa.
- Murwere anofanira kunge ane hutano hwakakwana zvakakwana kuti awane zvakanaka kubva pakuvhiya.
Zvimwe zvinokonzerwa nemigumisiro yeEEC inosanganisira 3 kusvika ku6 muzana wekuda kwekurohwa kana kufa. Kunyanya mumwedzi mushure mekugadziriswa, dambudziko rekurwadziwa kwemoyo rinoratidzika rukuru kune varwere vanoenda kune CEA kupfuura carotid stenting (ona pasi apa). Uyezve, nokuti dzimwe nharo dzinokonzerwa neropa dzinogamuchira ropa razvo kubva mumudziyo uyu, dzinogona kuparadzwa panguva yekuvhiyiwa. Mukuwedzera, kuzarura carotid kunogona kutungamirira kukuvara kwe hyperperfusion , iyo apo uropi haigoni kutarisa kuwedzera kutsva kweropa, izvo zvinogona kukonzera kuora musoro, kugumburwa, uye kukanganiswa kwepfungwa.
Carotid Artery Stenting
Carotid arteri inomesa (CAS) inosanganisira catheter yakaonda inosundwa nemidziyo yeropa, kazhinji inotanga kubva kune chikadzi chechikadzi muhudyu, kusvika muyaroti yemahara. Izvi zvinoitwa pasi pekushandura kwefosoroscopic , saka nyanzvi inogona kuona zvavari kuita. Kamwe katheter iri pachigaro, stent inowanikwa muyeri kuti ibatsire kuivhura uye ichichengetedze. Muzhinji, nguva yekudzikinura kubva kuCAS inokurumidza kupfuura yeEECA.
Vanhu vazhinji vanofarira pfungwa ye carotid inodedera nokuti inoratidzika seisingaiti yakawanda kupfuura carotid endarterectomy. Kunyange zvakadaro, kusvetuka hakuve kwakapoteredza chero nguva yakareba se CEA, uye ine ngoziwo. Zvidzidzo zvepakutanga zvairatidzika kuratidzira njodzi dzekumanikidzika dzaive dzakakura kudarika CEA inowanzo. Kunyange zvakadaro, zvidzidzo izvi zvakatsoropodzwa nekuenzanisa vanachiremba vasina ruzivo vanoita maitiro kune vanachiremba vane ruzivo vanoita CEA.
Imwe ongororo ye2010 muNew England Journal of Medicine yakaratidza kuti nepo kupisa kunogona kunge kwakabudirira se CEA mukuzarura mishonga, kungozi yekurohwa inobatanidza neyo nzira yakakwirira kudarika CEA, kunyanya mumwedzi wokutanga mushure mekuita.
Kurapa Kufungidzirwa
Danho rokutanga nderokusarudza kana chero mushonga unopfuura mishonga unoda zvachose. Chinhu chinokosha mukugadzirisa chisarudzo ndechekuti stenosis yakatoita kuti urove kana kwete. Kana zvisingaiti, uye kana stenosis isingasviki ne80%, vanachiremba vakawanda vanosarudza kungovhiya chete. Kana chirwere chikaitika, zvinogona kuva chiratidzo chekurwisa kwakanyanya kunodiwa. Kana chirwere chacho chakakura zvikuru, zvisinei, pane zvingasave zvakakwana zvakakwana zvehuropi kuti zvirevire njodzi dzenzira yacho.
Kubvira pakuparidzirwa kwayo mukati mekupera kwema1990, kupisa karotid zvishoma nezvishoma kwave kuchiwana mukurumbira. Medicare ikozvino inoshandisa nzira iri pasi pemamiriro ezvinhu akasarudzwa. Pakupedzisira, kurapa kwakanakisisa kunobva pane zvakasiyana-siyana zvevarwere, vanachiremba, uye kunyange inshuwarisi.
Imwe tsvakurudzo yakaratidza kuti zvinhu zvakadai sehurefu hwe stenosis uye chimiro chepakiti uye ropa remudziyo zvinogona kukanganisa mukana wekuti CAS ichaita kuti urove. Vaya vakwegura vanowanzoita zvakanyanya nehupenzi kune vaduku, kunyange munhu ane hutano hwakanaka angaita zvakanaka.
Inishuwarenzi inewo chimwe chinhu. Medicare inowanzovhara CAS kune varwere vane zvirwere vane ngozi yakawanda yeEEC avo vane 70% stenosis. Mamwe marudzi e stenosis (anenge 90% emhosva) anoda kuchengetwa mune imwe fashoni.
Pakupedzisira, kugadzira chisarudzo pamusoro pekugadzirisa carotid stenosis kune zvakasiyana nemunhu ane stenosis. Tsvakurudzo inowanzonyatsonzwisisika, uye nokuti pane mari inofanira kuitwa yakabatanidzwa nechisarudzo chimwe nechimwe, zvingava zvakaoma kuwana maonero asina kufanira. Usatya kubvunza vanopfuura kamwe chiremba nokuda kwemafungiro avo.
Sources:
Brott TG, et al. Kurwisana ne endarterectomy pakurapa karotid-artery stenosis. N Engl J Med . 2010 Jul 1; 363 (1): 11-23. Epub 26 Mbudzi 2010.
Ropper AH, Samuels MA. Adams naVictor's Principles of Neurology, 9th ed: The McGraw-Hill Companies, Inc., 2009. McCabe MP, O'Connor EJ.
Sharon Swain, Claire Turner, Pippa Tyrrell, Anthony Rudd vachitsvaga Guideline Development Group, Kuziva uye kutanga kutungamirirwa kwechirwere chakasimba uye chenguva ischemic attack: summary of NICE mazano, BMJ 2008; 337: a786, July 24, 2008
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ZVINOKUDZIDZA: Mashoko ari panzvimbo ino ndeongangwa dzekudzidzisa chete. Icho hachifaniri kushandiswa sechinzvimbo chekuchengetedza iwe pachako nechiremba ane chiremba. Ndapota ona chiremba wako kuti aongororwe uye kurapwa chero kupi zvako pamusoro pezviratidzo kana chirwere chechiremba .