Kuwedzerwa kunze kwekuchengetedzwa kwemasimba (EECP) inzira yemishonga yekurapa ye angina . Kunyange zvazvo zvidzidzo zvakawanda zvekliniki zvinoratidzira kuratidza kuti kurapa uku kunogona kubatsira mukuderedza zviratidzo zveAngina kune varwere vane coronary artery disease (CAD) , EECP isati inofanira kugamuchirwa nevarapi vezvemapurisa, uye haina kupinda mukati memaitiro ehupenyu.
Chii chiri EECP?
EECP inzira inoshandiswa nemagetsi iyo kwenguva yakareba inflatable cuffs (yakadai seropa rinokonzera cuffs) yakakomberedzwa pamativi ose emurwere wemakumbo. Kunyange zvazvo murwere ari kurara pamubhedha, mheto dzemakumbo dzinokonzerwa uye dzakasvibiswa zvinyatsoenderana nechibvumirano chemweya. Iko kunotengesa uye kutengesa kunotungamirirwa nekombiyuta, iyo inoshandisa ECG murwere kurwisa kutengesa kwepakutanga kare mu diastole (apo mwoyo unodedera uye uzere neropa), uye kuperesa sezvinonzi systemole (mwoyo kuputsika) inotanga. Iko kuwedzera kwezviputi kunowanikwa sequentially, kubva kumucheto wezasi wemakumbo kusvikira kumusoro, kuitira kuti ropa mumakumbo "rive" rakakwira kumusoro, kumwoyo.
EECP ine zvisungo zviviri zvinogona kubatsira pamwoyo. Kutanga, chiito chekudzivirira chemakumbo makumbo chinowedzera kuerera kweropa kusvika kune coronary arteri panguva ye diastole . (Iro coronary arteries, kusiyana nemamwe mishonga mumumuviri, inogamuchira ropa ravo mukati mekushaya mwoyo, panzvimbo yepakati pemoyo mumwe nomumwe.) Chechipiri, kuburikidza nekuita kwechiito chayo sezvinotanga mwoyo kurova, EECP inoumba chimwe chinhu chisinganzwisisiki mumhepo mitsetse, iyo inoderedza basa iro musimba wemwoyo rinofanira kuita mukupura ropa.
Inofungidzirwawo kuti EECP inogona kubatsira kuderedza endothelial kudzvinyirira .
EECP inotarisirwa sezvikamu zvakasiyana-siyana zverapa. Varwere vanogamuchira zvidzidzo zveawa imwechete kwevhiki, kwemavhiki manomwe (pamusangano wezvikamu 35). Zvirongwa zvemaawa makumi matatu-imwe zvinotarisirwa kutsvaga hupenyu hunogara kwenguva refu hunobudirira muhutachiona.
Inobatsira Sei EECP?
Tsvakurudzo dzinoverengeka dzinoratidza kuti EECP inogona kunyatsoshanda mukurapa asingagumi angina akasimudzika. Mutsara muduku wakaita saromized wakaonesa kuti EECP yakanyatsovandudza zvose zviratidzo zve angina (a subjective measure) uye kubvumira kushivirira (chinangwa chinowedzera) kune varwere vane CAD. EECP yakanyatsogadzirisawo "hupenyu hwehupenyu" hutano, zvichienzanisa ne-placebo therapy. Zvimwe zvidzidzo zvakaratidza kuti kubudirira kwezviratidzo zvinotevera nzira yeEECP inoratidzika kuti inopfuurira kwemakore mashanu (kunyange zvazvo 1 mu5 varwere vangada imwe nzira yeEECP kuti varambe vachivandudza).
EECP Inoshanda Sei?
Iyo nzira yezvinoonekwa zvakachengetedzwa zvinobudirira zvakaonekwa neEECP hazvizivikanwi. Kune humwe humwe humwe hunoratidza kuti EECP inogona kubatsira kubatanidza kusungirwa kwemidziyo yemidziyo mumakoronary arteri muti, nekuita kuti kusunungurwa kwe nitric oxide uye zvimwe zviitiko zviri mukati mechironary arteries. Kune humwe uchapupu hwokuti EECP inogona kuita sechimiro che "kutsika" basa, zvichiita kuti zvive zvakasiyana siyana zvehupenyu huripo hunobudirira muhutongi hwehutongi hunoonekwa nekunyatsoshanda.
Ko EECP Inogona Kukuvadza Here?
EECP inogona kunge isinganzwisisiki, asi kazhinji haina kurwadza.
Mune zvidzidzo, ruzhinji rwevarwere rwakabvumira nzira yacho zvakanaka chaizvo.
Asi havasi vose vanogona kuva neEECP. Vanhu zvichida havafaniri kuva neEECP kana vane aortic isingakwanisi , kana kuti vane chirwere chemazuva ano chekare, chirwere chemwoyo chisina kujeka chakadai seairusibrillation , chirwere chakanyanya kuwedzerwa , chirwere cheperiyuta chirwere chinosanganisira makumbo, kana nhoroondo yehutachiona hwehutachiona . Kune chero ani zvake, zvisinei, iyo nzira inoita seyo yakachengeteka.
Apo EECP Inokurudzirwa?
Kubva pane zvatinoziva nhasi, EECP inofanirwa kuonekwa kune ani zvake anoramba ane angina pasinei nekurapa kurapwa kwerapi , uye kune uyo ane simba kana kupfuura kuporesa anoonekwa seasina kunaka.
Medicare yakabvumira kugoverwa kweEECP kune varwere vane angina avo vakaneta pane dzimwe sarudzo dzavo dzose.
Muna 2014, masangano akawanda emasvomhu (American College of Cardiology, American Heart Association, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, uye Society of Thoracic Surgeons) pakupedzisira vakabvumirana mune imwe nyaya yakanyatsojeka iyo EECP inofanira kuonekwa kune varwere vane angina refractory kune dzimwe mishonga.
Sei Hasi EECP Inoshandiswa Zvakawanda Kazhinji?
Nenzira yakawanda, mharaunda yevanhu vane chirwere chepfungwa yakanyanya kusarudzwa kusazvidza nzira yakadaro yekurapa, uye vazhinji vane cardiologist vanokundikana kutotanga kupa EECP senzira yekurapa. Nemhaka yeiyo, varwere vakawanda vane angina havana kumbonzwa nezvazvo.
Zvechokwadi, EECP inonyadzisa. Zvechokwadi haisi kutaridzika sehupenyu. Hapana munhu anogona kunyatsotsanangura kuti inoshanda sei. Uye, kubva kune nyanzvi yemapfungwa / maonero, kana iwe uchienzanisa kushanda nesimba uye kubhadharwa kweEECP pane chimwe chinhu chakaisa kuisa stent (masangano 35 pamusoro pemavhiki manomwe kusvika kumaminitsi makumi matatu nemakumi matatu) hapana kukwikwidza. Kutarisira kuti mapurisa evanhu vabvumire EECP nechinangwa chero chipi zvacho chinongorasha vanhu.
Kunyange zvakadaro, kana kurapa kusina kunaka kune angina kune iko kwakachengeteka uye kwakanyatsorambidzwa, apo uchapupu huripo (husina kukwana sezvaungave huripo) hunoratidza zvakasimba kurapwa kunoshanda chaizvo kune varwere vakawanda, uye kana murwere achirapa achakwanisa kutaura zvakanaka kusimbisa kana kuti kwete here kurapwa kwakabatsira munyaya yavo pachavo (kuburikidza kana kuvapo kana kusavapo kwekuderedza kukuru kwezviratidzo zveAngina), hazvirati zvisinganzwisisi kubvumira varwere vakatsiga angina kusarudza kuedza kwechirwere ichocho chisingaiti, zvichida kunyange vasati vamanikidzwa kupinda mushonga unorwisa.
Kana iwe uri kurapwa kuti uchengetedze angina uye uchiri nezviratidzo pasinei nekurapa, zvakanyatsokwana iwe kuti uwedzere mukana wokuedza EECP. Chiremba wako anofanira kunge achinyatsoda kukurukura izvi zvichida newe, zvakajeka uye pasina rusaruro.
Sources:
Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC / AHA / AATS / PCNA / SCAI / STS yakarongedza tsanangudzo yehutungamiri hwekuongororwa uye kutarirwa kwevarwere vane hutano hwakasimba hwechirwere chepfungwa: mushumo weAmerican College of Cardiology / American Heart Association Task Force pamusoro Pemitemo Yezvokuita, uye American Association for Chipatracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, uye Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64: 1929.
Arora RR, Chou TM, Jain D, et al. Dzidziso yakawanda yekusimudzirwa kwekunze kwenyika (MUST-EECP): zvinoitwa neEECP pamusana pekuvhima-induced myocardial ischemia uye anginal episodes. J Am Coll Cardiol 1999; 33: 1833.
Soran O, Kennard ED, Kfoury AG, et al. Zviviri zvemakore zvinokonzerwa nekliniki mushure mekusimbiswa kwekunze kwekuchengetedzwa kwemasimba (EECP) therapy kune varwere vane chirwere chengalingani chinonzi angina pectoris uye vakasiyiwa ventricular dysfunction (mushumo unobva ku International International EECP Patient Registry). Am J Cardiol 2006; 97:17.