Zvakatongwa neOrita zvinofanira kureva kwauri
MunaNovember 2017, migumisiro yechirongwa chekliniki yakasiyana-siyana yakashumwa muLancet , pakarepo kukanda nyika yepasiyo mukutambudzika. Kutongwa kwaOrbita kwakavhiringidza makumi matatu emakore ekurasika kwemafiro pamusoro pekubudirira kwekurapa angina akachengeteka ne stents . Nhengo, chirongwa che ORBITA chakapedzisa, hachina kupa chirongwa chekugadzirisa kliniki mumagariro angina akachengetedzwa paakaenzaniswa nemasaisai.
Zvingava here kuti zvikomborero zve cardiologists zvave zvichitaurirwa kune stents nguva ino yose ndeyechokwadi nekuda kwechimwe chinhu pane nzvimbo inonzi placebo? Nyanzvi dzakaumbwa mumiganhu yehondo usiku hwose. Rimwe boka rakazivisa kuti kutongwa kwaA ORB kunofanira kupedzisa tsika yekusimudzira angina yakasimba. Boka rechipiri rezvenyanzvi rakasimbisa kuti kutongwa kwaOrBita, panguva inonakidza, kwakanga kwakashata, uye haifaniri kushandura kliniki yekuita zvachose.
Iyi kuunganidza hondo inoratidzika seye isingazogadziriswa kwemakore akawanda. Izvi, zvechokwadi, ndiyo nzira yekurapa kwechiropiya. Mubvunzo kwatiri ndewokuti: Chii chiri munhu ari kutarisana nemaina angina nhasi (apo nyanzvi dzichiri kukakavara) dzinofanirwa kuita ikozvino?
Kana tikadzokera shure uye tine chinangwa chekutarisa data iripo, zvinenge zvisati zvave zvakaoma kuti tive nemafungiro ekurapa angina akachengetedza zvinonzwisisika, uye zvinowirirana nouchapupu hunobva kuchipatara miedzo (kusanganisira ORBITA) se iripo nhasi.
Stents for Stable Angina
Nhengo idzi dzinosungirirwa mumatare akavharidzirwa mukati mevharivha yakavharwa panguva yechirongwa chengioplasty. Muangioplasty , ibhoti inonatswa panzvimbo yeatrosclerotic plaque kuti ibvise kubviswa. Iyo stent iyo imwecheteyo inotumirwa kuitira kuti arteri ibudiswe pachena.
Angioplasty pamwe nekusimbiswa kunowanzotaurwa navanachiremba se "percutaneous coronary intervention" kana kuti PCI.
PCI yakagadziriswa sechinzvimbo chisina kupindira chinopindira chegoniyuta inopfurikidza nekubatanidza , nzira yekuvhiya yemwoyo yakazarurwa. Sezvo PCI yakagadzirwa, chiyero chevarwere vane chirwere chetachiona chetachiona avo vanorapwa nekuvhiyiwa kwakaderera zvikuru.
Pane nguva apo kushandisa PCI kunokosha zvakakosha. Pasi pfupi PCI inovandudza zvakanyanya zvibereko zvevanhu vanotambura neAacute coronary syndrome (ACS) -hutano hwehupenyu hunotyisidzira zvinokonzerwa nekuvharwa kwakanyanya kweyoronic artery. Aya matatu emakiriniki anokonzerwa neAACS anosanganisira angina asingagadziki , ST-sekuru elevation myocardial infarction (STEMI) , uye kwete-ST segment elevation myocardial infarction (NSTEMI) . Kune akawanda aya syndromes, PCI yakakurumidza yakagadziridzwa, nemitambo yakawanda yemakiriniki, sekurapa kwesarudzo.
Kwemakore mazhinji, kupisa kwakange kuriwo kurapwa kwekusarudza kwevanhu vakawanda vakange vakagadzikana angina-angina yakakonzerwa nehuwandu husingaperi, hwakagadziriswa, husina kuvharidzirwa muhutoriyano. Iyo PCI yakabvisa angina kuvanhu ava yakanga yakajeka kune vose, uye zvaifungidzirwa kuti vaizovawo nehuwandu huripo hwekupedzisira kwekurwa kwemwoyo.
Zvadaro, pakupera kwema2000, chirongwa cheCOURAGE chakaratidza kuti PCI haina kunyatsopedza dambudziko rekurwadziwa kwemoyo kana kufa kune vanhu vane angina akachengetedzeka, zvichienzanisa nehutano hwehutsinye hunotyisa . Kubvira panguva iyoyo, mazano echipiriniki akurudzira mapurodiologists kushandisa PCI muine angina akachengetedza chete kugadzirisa zviratidzo zveAngina, uye chete kune vanhu vasingagoni kurapwa zvakanaka nemishonga.
Kunyange zvazvo zvakaoma kunyora zvinonzwisisika, zvinoratidzika kuti vazhinji vane cardiologists (pasinei nezvinotaurwa nemitemo uye pasinei nouchapupu hunobva kuchirwere chetachiona), vakaramba vachishandisa stenting sokurapa kwekutanga kwemainestin angina, uye kwete sechipiri mishonga in vanhu vanokundikana nemishonga.
Vanoita izvi, ivo vachatiudza, nokuti hapana chinokurova stent yekubvisa angina.
Ichokwadi, anenge munhu wose ave achitenda kuti stents ndiyo nzira yakanakisisa yekugadzirisa angina, kunyange avo vakakurudzira mapurodiologist kuti vaedze kurapwa kwechirwere chinotyisa kutanga. Ive yakava dzidziso yepamusoro: Pasinei nezvinetso zvaro zvese, kunhuwa kwemaitiro inzira yakatendeseka uye inobatsira yekurapa angina yakasimba.
Asi ikozvino, kutongwa kwaAORBITA kwakarasa dzidziso iyi mumhirizhonga.
Zvakaitwa neOrita Study Zvakaitwa
Vatsvakurudzi veOORBITA vakaedza pfungwa inoshamisa. Vakabvunza kuti: Ko kana chirwere chinonzi angina chinogarwa nevarwere mushure mekunge stent isiri yekuvhura kwetari asi iyo inonzi effectbo? Kuti vaedze iyi hypothesis, vakafananidza kunyatsokonzera kushandiswa kwehu sham stinging process.
Vakanyoresa vanhu 200 vane angina akachengeteka uye chimwe chinhu chakanyanya kuvharwa mumutambo wegononary (inopfuura 70 muzana yakavharwa). Mushure memavhiki masanhatu ekugadzirisa kurapwa, uye mushure mekuyera kwekuyera kwekuyera kuenzanisa kuwanda kweivo yavo uye maitiro avo ekudzidzira, zvidzidzo zvakaitwa kuti zviwane kana stent, kana sham sham stent. Muchizorwa chemadziti, zvidzidzo zvakagadziridzwa maitiro ese ePCI, kusanganisira kuisa tambo kuvhara kuvhara, kunze kwekuti hapana angioplasty kana stent yakaitwa. Mushure mekuita, mapoka maviri aya akagamuchira chirwere chinoshungurudza chinorwisa-platelet chinowanzoshandiswa pashure peCPI .
Mushure memavhiki matanhatu, zvidzidzo zvose zvakaedzwazve kuti zvive nekuyera kwemaawa avo uye simba rekushandisa. Vatsvakurudzi vakaona kuti, nepo avo avo vakagamuchira zvinyorwa zvakaonekwa seine humwe humwe huri nani huri nani kune avo vaive netsika yekunyadzisa, mutsauko pakati pemapoka acho maviri hausi pedyo nekuve nenhamba.
Nokudaro, vakagumisa, kusvetuka hakusi nani pane zvisingagoni kuenzaniswa kupfuura shamhu inoshandiswa pakurapa vanhu vane angina yakasimba.
Kugadziriswa kuHURBITA Yokudzidza
Imwe nhepfenyuro muLancet iyo yakaenderera mberi nekudhindwa kwechirongwa cheAORBITA yakaratidza kuti chidzidzo ichi "chakakura uye chakanyanya kusvika," uye yakadana kuti mitemo yekurapa yakarongeka idzokororwa kuitira "kuderedza" kushandiswa kwePCI kune varwere vane angina akachengetedza.
Inhengo dze cardiologists (avo vanoita PCI), kuburikidza nesangano ravo (Society for Cardiovascular Angiography and Interventions, SCAI), vakakurumidza kusunungura tsanangudzo yakawanda yeOrita. I-SCAI yakaratidza, pakati pezvimwe zvinhu, kuti varwere vakanyoresa vaiva ne-low-level angina (kureva, vazhinji havafanirwi kubvumirwa nePCI pakutanga); iyo huru yekupedzisira yekutongwa (nguva yekuishandisa) inonyanya kuzivikanwa uye ichienderana nekusiyana kukuru; chidzidzo chacho chiduku uye kwenguva shoma; uye icho chaicho chinangwa chinonzi ischemia chakaitwa mumuedzo (chiyero chinonzi "peak stress wall motion score index") yakaratidza kuchinja kukuru neCPI. Nokudaro, vanogumisa, migumisiro ye ORBITA, iyo inofadza, haifaniri kushandiswa kushandura kliniki yekuita.
Saka, sezvaunogona kuona, mitsara yehondo yakaswededzwa, uye isu tinofanira kugadzirira kwemakore akawanda emakungwa emvura.
Chii Chatinofanira Kuita paZvose Izvi?
Chirongwa che ORBITA chinonyatsopikisa mubvunzo kuti PCI inoshanda sei mukurapa zviratidzo zvekuchengetedza angina. VanaCardiologists havafanire kufunga, sezvavakaita, kuti kubvisa kunyange kukwirira kwepamusoro-goroka mumarita ekugadzirisa kunoita magetsi zviratidzo zvinonyangarika.
Kunyange zvakadaro, mapurodiologist anopindira anounza matambudziko akawanda anokodzera neOrita kudzidza. Iyo iyo inofanira kutirova sechinetso chakakura ndeichi: Varwere vanongorariswa mumutambo uyu vaiva ne-angina yakaderera-grade, uye pasi pemitungamiri yemazuva ano vazhinji vavo havafaniri kumbove vakatsvaga PCI munzvimbo yekutanga. Mune mamwe mazwi, hatifaniri kutarisira kuti kunhuwa kunogona kuva nemigumisiro yakawanda kune vakadai. Izvo zvaisina kuita zvakawanda zvinofanira kunge zvakagara zvichifanotaurwa kubvira pakutanga.
Panguva imwecheteyo, vapindi vezvematongerwo enyika havafaniri kutora kunyaradzwa kwakanyanya mukurudzirwa kwavo kwekutongwa. Iyo ORBITA yekudzidza iripo inoratidza kuti, mune boka guru revarwere avo nhasi vari kugara vachigamuchira PCI munyika chaiye (kureva, vanhu vane "zvakanyanya" blockages vane zviratidzo zvisingakoshi kuti vaenzanise), kunyorera hazviiti chero inogona kuenzaniswa zvakanaka.
Saka, kunyange kana ORBITA isinganzwisisi kuchinja mamiririro emitemo iye zvino, inofanirwa kuchinja kuchinja kwechirongwa chezvino chekurapa.
Kana Iwe Wakasimba Angina Nhasi
Nhengo dzakashandura kurapwa kwekodonary artery disease. Kune vanhu vane imwe yecononic syndromes yakaoma, PCI yakaguma mukuderedza kukuru mukufa kwekutanga nekuremara. Uye mune vanhu vakawanda vane vane simba, vanokanganisa angina (boka risina kuongororwa mumutongo weOORIBTA), PCI yakatungamirira kukuvandudza kukuru kwezviratidzo.
Zvisinei, magetsi anofanira kudziviswa kana zvichibvira. Mukuwedzera kune njodzi inobatanidzwa nekushanda kwePPI nzira yacho pachayo, kuvapo kwechigadziri kunouyisa dambudziko rekugara kwenguva refu, kune vose chiremba uye murwere, uyo ane chisarudzo chekupedzisira chisina kujeka. Nenzira, ndeyo nguva dzose yakachengeteka kumira simba rinorwisa anti-platelet rinodiwa pashure pePCI? (Hazvirevi kuti varwere vakawanda mumutongo weOORIBTA avo vaiva nematambo akaipa vakavhiringidza kubuda ropa munguva dzekutevera.) Verenga zvakawanda pamusoro pechinetso chinoramba chiripo nemashizha .
Kana iwe uine angina akachengetedza nhasi, nyanzvi yako inofanirwa kunge isina kufarira kuita PCI. Kutsiva hakuzogadziri zvachose dambudziko rako rezvehutano (kunyange kana richibudirira kubata mushandi wako); pane kudaro, kushungurudza kunotengeserana chimwe chinetso chisingaperi chinotungamirira kune mumwe.
Panzvimbo pokumhanyira kuCPI, kakawanda nyanzvi yemapurisa inofanira kukurudzira chirwere chinorwadza, chinotyisa-chengwaru chekurapa kwechirwere chinopesana, uye munhu ane angina akasimba anofanira kugamuchira pfungwa yekutanga kurapwa. Vose mapato vanofanira kunge vane mwoyo murefu, nokuti kuwana chiremba chaiyo yerapi inogona kutora mavhiki akawanda kana kunyange mwedzi.
Kana chinonzi angina chinoramba chichida kunyange mushure mekutsvaga kunorwadza kwerapi yezvechiremba, iyo ndiyo inofungidzirwa zvakanyanya kupiwa stent. Verenga zvakawanda pamusoro pekuti iwe unonyatsoda stent .
Shoko Rinobva
Kutongwa kwaOrBamba kuri kukonzera kudengenyeka kukuru mukati meyika yehupenyu hwemwoyo maererano nekurapwa kwemainina angina.
Zvisinei, kana iwe uine angina akachengeteka, migumisiro yechirwere ichi haifaniri kunge yakamanikidza mushonga wako zvikuru, chero bedzi iwe uye chiremba wako kutora chinangwa chekutarisa uchapupu.
Kunyange zvazvo kutongwa kwaOrbita kusingaoneki kunofanidza kuchinja kwokuti ingina yakasimba inofanirwa kurapwa sei, inofanirwa kuchinja maitiro ayo ave achiwanzobatwa nevanokonzera mapepa.
> Sources:
> Al-Lamee R, Thompson D, Dehbi HM, et al. Percutaneous Coronary Intervention In Stable Angina (Orbita): Dhiviri-Yakapofumadzwa, Yakarongedzwa Kutongwa. Lancet 2017; DOI: 10.1016 / S0140-6736 (17) 32714-9. Abstract
> Brown DL, Redberg RF. Nzira Yokupedzisira MuChipinki Pamusoro Pci MuStina Yakasimba? Lancet 2017; DOI: 10.1016 / S01406736 (17) 32757-5. Editorial
> Society of Cardiovascular Angiography and Interventions. SCAI Inoongorora Simba Uye Utera hwe Sham PCI Chiitiko. November 2, 2017. https://medicalxpress.com/news/2017-11-scai-strengths-weaknesses-sham-pci.html