KUTENDA kuongorora zvinetso zvinoshandiswa nemashizha muvatadzi vakagadzikana veCAD
Kushandiswa kwechirwere muvarwere vane chigarire coronary artery chirwere (CAD) yakanyatsopikiswa mukutongwa kweCOURAGE, yakatanga kutaurwa muna 2007. Muchiitiko ichi, varwere vane CAD vakasimba vakashandurwa kuti vawane kurapwa kwakanakisisa kwerapi chete kana kuti zvakanakisisa kurapwa kwechiremba pamwe chete stents. Chidzidzo chacho hachina kuratidza kusiyana kwezviitiko pakati pemapoka maviri mushure memakore 4.6.
Kurwisana nemigumisiro yeCOURAGE Chiedzo
Migumisiro yechirwere cheCOURAGE inofanira kunge yakaita kuti vose vane cardiologists vaongorore zvakare pavanoshandisa stents uye mune varwere. Asi vazhinji vane cardiologist havana kuchinja maitiro avo pamusoro pemakumbo. Nzira yavo ndeyekuti vazhinji vaidavira kuti kuvhura kwekuvhara nemakumbo kungofanirwa kuve kwakakosha kupfuura kurapwa kwechiremba mukudzivirira kushungurudzika kwemwoyo nekufa. Saka, zvabuda kubva kuCOURAGE zvinofanira kunge zvisina kunaka. Vakatenda kuti zvingangodaro kuti nguva yakareba yekutevera yaizozarura chokwadi.
Asi munaNovember 2015, migumisiro yekupedzisira kwenguva refu yeCOURAGE yakabudiswa. Mushure mekunge makore gumi nemaviri ekutevera-up, mapepa haasati anopa kubatsirwa pamusoro pehutano hwehutano hwakanaka.
Tsanangudzo yeCOURAGE Trial
Mune chirongwa cheCOURAGE, varwere 2 287 vane CAD yakasimba ("rakasimba" CAD rinoreva kuti acon coronary syndrome haisi kuitika) yakashandurwa kuti iwane chero yakakwana yerapi yehutachiga chete kana kuti yakanakisisa yemishonga inorapwa pamwe ne stents.
Chiitiko chekupedzisira kwekurwa kwemoyo nekufa kwakaiswa.
Kwakanga kusina kusiyana pakati pemapoka. Varwere vanogamuchira stents vakaita, asi zvakadaro, vanodzora zviri nani zviratidzo zvavo zvema angina kupfuura varwere vane mishonga yekurapa chete, asi dambudziko ravo rekurwadziwa kwemoyo uye rufu harina kusimbiswa.
Mutsvaga wekutsvakurudza kwegore ra2015 wakatarisa nguva yakareba yekufa kwekusiyana pakati pemapoka maviri. Mushure mekuvhara kwemakore 11.9, kwakanga kusina kusiyana kwakakosha. Twenty-five per cent of the patients receiving stents had died, compared to 24% of the patients treated with therapy alone.
Vatsvakurudzo vakatarisa pamapoka akawanda evarwere kuti vaone kana imwe shanduro ingadai yakaita zviri nani nemashizha. Havana kuwana chinhu chakaita.
Ndeipi Inofanira Kushandiswa?
Iko ikozvino inoratidzika zvakajeka kuti stents haifaniri kushandiswa seyero-line remishonga mumagadzirirwo eCAD kudzivirira kuchengetedza mwoyo nokuti stents haisi kunyanya kubudirira mukudzivirira hutambudzi hwemamiriro ezvinhu mumamiriro ezvinhu aya kupfuura zvakanakisisa kurapwa kwerapi. Ichokwadi, pane mubvunzo chaiwo wekuti maronda akawanda anobatsira sei zvachose mukurapa angina akachengetedzeka .
Nhengo dzinofanirwa kushandiswa , mumagariro eCAD, kana apo ingiro inokosha ichiri kuitika pasinei nehutano hwehutano hwakanaka.
Zvingangodaro ZVINOKUDZIDZWA ZVAZVAZVADZIDZIDZWA SEZVADZIDZWA?
Migumisiro yechirongwa cheCOURAGE inowirirana nehutsva hwekufunga pamusoro peCAD uye kuti kurwadziwa kwemoyo kunoitika sei. Kurwadziwa kwemoyo hausi kukonzerwa nedanda rakagadzikana rinokura zvishoma nezvishoma kuti rivhare arteri. Pane kudaro, dzinokonzerwa nechiganda chinoputika zvishoma, zvichiita kuti pakarepo kuumbwa kweropa mukati memhadhi, iyo inobva yavhara arteri kamwe kamwe .
Kuita rupturing uye kuvhara kungangodaro kunogona kuitika muvhara iyo inodzivirira 10 muzana chete yeyeri seinovhara 80 muzana.
Kushungurudza "zvakakosha" mapepa zvichabatsira kubvisa chero ingina inokonzerwa nekudzivirira pachako. Asi, zvinoratidzika, hazvizogadziri njodzi yekurwadza kwemoyo-kunyanya sezvo dzakawanda zvekurwadziwa kwemoyo zvinosanganiswa nemapande ayo mapurisa anonzi "cardiologists" anowanzoti "hauna basa."
Kudzivirira kuputika kwemavara, uye nokudaro kudzivirira mwoyo, zvinotarisisa zvakanyanya sechinetso chezvehutano panzvimbo ye "dambudziko rekupinza." Zvakanakisisa kurapwa nemishonga uye mararamiro ehupenyu .
"Kuchengetedza" maronary artery plaques (kuita kuti vasanyanya kuparara) kunoda kurwisa zvine utsinye kwecholesterol, ropa, uye kuputika. Icho chinodawo kuti muviri wose uite zvekuita muviri uye uchiita kuti zvive zvishoma. Kushandisa zvinodhaka zvinodhaka zvinosanganisira aspirin, statins, beta blockers, uye ropa remishonga mishonga (kana zvichidiwa).
Kana iwe uine CAD yakasimba- ingave kana stent inofanirwa kurapa angina yako-kunyatsodzivirira kutambudza kwemoyo iwe uchadikanwa kuva pane chirwere ichi chinotyisa. Iwe unofanirwa kuva nechokwadi chekukurukurirana ne cardiologist yako izvo zvingaita hutano hwakanakisisa kurapa mune yako.
> Sources:
> Boden WE, O'Rourke RA, Teo KK, et al. Yakanakisisa kurapwa kwechiremba kana kana pasina PCI yezvirwere zvakasimba zvakasimba. N Engl J Med 2007; DOI: 10.1056 / NEJMe070829.
> Borden WB, Redberg RF, Mushlin II, et al. Maitiro uye kusimba kwerapi yezvechirapa mune varwere vari kutarisana nekodonary coronary intervention. JAMA 2011; 305: 1882-1889.
> Sedlis SP, Hartigan PM, Teo KK, et al. Migumisiro yeCPI paKupona Kwemazuva Akareba Muvarwere vane Stable Ischemic Heart Disease. New England Journal of Medicine . 2015; 373 (20): 1937-1946. doi: 10.1056 / nejmoa1505532.