Rimwe rakasara rekubatsira mhepo (LVAD) inogadzirwa, uye inotungidzirwa nebheteri yakagadzirirwa kukurudzira chiito chekuputika kwechirwere chinotarisana nechokupedzisira chakange chisina simba kubva pamwoyo kusakwanisa kushanda zvakanaka pachako.
LVADs inoshanda sei?
Mhando dzakasiyana-siyana dzezvikwata zveLVAD zvakagadzirwa. Vakawanda vavo vanokwevera ropa kubva mubhuku rinowanikwa kuruboshwe rweruboshwe, ipapo inoputira ropa kuburikidza nedzimwe tube inowanikwa mu-aorta.
Gungano rekupemha pacharo rinowanzoiswa pasi pemwoyo, muchikamu chepamusoro chemuviri. Inotungamirira magetsi (duku duku) kubva kuLVAD inopinda ganda. Mutungamiri unobatanidza iLVAD kune imwe kunze yekugadzirisa unit uye kumabhatiriyoni anopa pombi.
LVADs inoshandiswa zvachose. Mabhatiri anodiwa uye maikirwe emabhadharo anosungirirwa nebhanhire kana chifukidzo chechifuva. LVADs inobvumira varwere kuti vave pamba uye vagoita mabasa mazhinji ezvisikwa.
Evhangeri yeLVADs
LVAD technology yakashanduka zvikuru sezvo izvozvi zvigadzirwa zvakatanga kushandiswa muma 1990. Pakutanga, LVADs yakaedza kubereka chirwere chepachimara chinotapukira sezvo zvaifungidzirwa kuti kupisa kwaizove kwakakosha kune chimiro chechimiro chemuviri.
Zvisinei, chero ipi neipi yeLVAD iyo inokonzera kubuda kwakachena inodikanwa nhengo dzakawanda dzinofambisa, dzinoshandisa simba rakawanda, uye dzinoita mukana wakakwana wekukundikana kwemagetsi. Chizvarwa chekutanga cheLVADs chakatambura nezvinetso zvose izvi.
Yakakurumidza kuziva kuti vanhu vakaita zvakanaka pamwe chete nekuenderera kweropa kunopfurikidza nekushamba kwemhepo. Izvi zvakabvumira chizvarwa chechipiri cheLVAD kuti chigadziridzwe chakanga chiri chiduku, chaingova nechikamu chimwe chete chinofambisa, uye chaida zvishoma simba. Aya maVVAD matsva anogara kwenguva yakareba uye anovimbika kudarika zvizvarwa zvekutanga.
HeartMate II naJarvik 2000 ndevechizvarwa chechipiri, kupfuurira-kuerera kweVVADs.
Chizvarwa chechitatu cheLVADs chiri kuuya pamutsara iwoyo kunyange maduku uye yakagadzirirwa kurarama kwemakore mashanu kusvika kune gumi. I HeartWare uye Heartmate III LVADs zvizvarwa zvechitatu.
Apo LVADs Dzinoshandiswa?
LVADS inoshandiswa mumatambudziko matatu emakiriniki. Muzviitiko zvose, maLVAD akachengeterwa varwere vari kuita zvisina kunaka pasinei nehutsinye hwemishonga inorapwa.
1) Bhuni Kuisa. LVADs inogona kushandiswa kutsigira varwere vane chirwere chisingaperi chisingakoshi chemoyo avo vari kumirira mwoyo kupindira.
2) Kuenda kunorapwa. LVADs inogona kushandiswa se "kuenda kuchipatara" kune vanhu vane chirwere chakanyanya-kuguma kwemoyo kusakatika avo vasina kubvumirwa kwekugadziriswa (nekuda kwezvimwe zvinhu zvakadai sezera, chirwere chepfungwa, kana chirwere chemapapu), uye avo vane urombo husina kunaka zvikuru vasingagadziri kutsigira. Mune varwere, LVAD ndiyo mushonga; pane zvishoma zvatinotarisira kuti LVAD inogona kubviswa.
3) Bhuni kuKutora. Mune vamwe varwere vane kukanganisa kwemwoyo, kuiswa kwechigadzirwa cheLVAD kunogona kubvumira kukanganiswa kwema ventricle kuruboshwe ku "zorora" uye kuzvigadzirisa pachavo kuburikidza ne " kuchinja kushandura ." Mienzaniso umo dambudziko remoyo wepfungwa dzimwe nguva rinogona kuvandudza nekuzorora rinosanganisira kushaya mwoyo mushure mekushaya chirwere chemoyo maitiro, kana nehukuru hwekurwa kwemoyo , kana neacute myocarditis .
Mune varwere vanowira mune imwe yezvikamu izvi, LVADs inowanzobudirira zvikuru kudzorera kuwanda kweropa mwoyo inoputira kumashure-pedyo nemazuva ose. Izvi zvinowanzopedza zviratidzo zve mwoyo kusakatika , kunyanya dyspnea uye kushaya simba kwakanyanya, zvikuru. Iyo inogonawo kuvandudza kushanda kweimwe nhengo dzinowanzoitwa nekushaya simba kwemoyo, dzakadai seitsvo uye chiropa.
Matambudziko Aine LVADs
Kuchengetedzwa kwemaLVAD kwakave kwakanyatsovandudzwa kwemakore, uye makambani ayo anovakurudzira akashanda zvakaoma zvikuru kuderedza hukuru hwavo kuti aite vakakodzera kuvaduku vaduku. Asi kune matambudziko akawanda anosangana neLVADs.
Izvi zvinosanganisira:
- LVADs inoda kunyatsogadzirisa zuva rega rega, uye kuchenjerera kuongorora kuti nguva dzose inowanikwa kune simba rine simba. Nokudaro murwere - kana nhengo dzemhuri - vanofanira kukwanisa kurarama nemitemo isingagumi ichaiswa pavari.
- Dambudziko rekuropapa kweropa richiri kuitika kusvika ku25% yevarwere vane LVAD, uye zvirwere izvi zvinowanzouraya.
- Matambudziko anokonzerwa nekubuda ropa anowanikwa mune vashomanana varwere.
- Ngozi yekurohwa (kubva muropa ropa) iri pakati pe10% ne15% pagore.
Aya matambudziko ari pachena zvikuru, saka chisarudzo chekuisa iLVAD ndechechokwadi chaizvo. Ichi chisarudzo chinofanirwa kutorwa chete kana kufa kwekutanga kuchionekwa kuti ndiyo inowanzoitika kunze kweiyo.
Zvichida kushandisa LVAD se "kuenda kuchipatara" chisarudzo chinonyanya kuoma, nokuti mumamiriro ezvinhu akadaro, pane tariro shoma yekukwanisa kubvisa chigadzirwa. Mumakiriniki makuru pane ose anoitwa kushandiswa achishandisa LVAD semishonga yekuenda kune imwe nzvimbo, 46% chete yevashandi veLVAD vose vari vapenyu uye vasina chirwere mumakore maviri.
Kunyange nematambudziko akasiiwa neLVADS, mazvigadziro aya anopa tariro yakakwana kuvarwere vakawanda vane kuguma kwepfungwa yekushaya simba avo vangadai vasina tariro kana makore mashomanana akapfuura.
Birks EJ, George RS, Hedger M, et al. Kudzoka kwekuoma kwekushaya kwemoyo nekuenderera-kupera-kuruka kuruboshwe rwemhepo inobatsira ruzivo uye chirwere chemapirmiki: aunotarisira kudzidza. Kurwisana 2011; 123: 381.
Sources:
Rose, EA, Gelijns, AC, Moskowitz, AJ, et al. Kushandiswa kwemazuva mashomanana ekusiyiwa kwechiremera chinonzi ventricular chigadziro chekupedzisira-kusagadzikana kwemoyo mwoyo. N Engl J Med 2001; 345: 1435.
Birks EJ, George RS, Hedger M, et al. Kudzoka kwekuoma kwekushaya kwemoyo nekuenderera-kupera-kuruka kuruboshwe rwemhepo inobatsira ruzivo uye chirwere chemapirmiki: aunotarisira kudzidza. Kurwisana 2011; 123: 381.