Kunzwisisa Heart Bypass Surgery
Kazhinji inotumidzwa se "CABG Surgery" kana " kuvhima kwepfungwa yakazarurwa ," chironga chekugadzirira kupfurikidza nekuvhiyiwa kwekutsvaga kwekutsvaga ndiko kurapwa kwekusarudzwa kwemavhariyo akadzivirirwa akapoteredza mwoyo.
Moyo unoputira ropa muviri wose asi uchiripo unobva pane mutsara wemidziyo yeropa inonzi coronary arteries nokuda kweropa rayo. Kana mishonga inenge yakadzivirirwa zvakasimba - chirwere chinonzi coronary artery chirwere - oxygen haina kusvika pamwoyo wemisungo uye kukuvara kunoitika.
Kuvhiyiwa kwemoyo , kana kupfurikidza nekuvhiya , kunoonekwa se "chirongwa chegoridhe" kurapwa kwechironiyria chirwere .
Kudzivirira kukanganisa kumwoyo, kuyambuka kuburikidza neeronary coronary inofanira kuwedzerwa. Panguva yekuvhiyiwa kwomwoyo, mazamu akavharizwa anobviswa kana kuputirwa nemidziyo yeropa inotorwa kubva kune rumwe rutivi rwemuviri. Mune upiyona hwakawanda, maviri kana mana emakironi anonzi akabatanidzwa akabatanidzwa kuti ave nechokwadi chekufamba kwakakwana kusvika pamwoyo.
Kuvhiyiwa kwepabonde kunowanzotsanangurwa maererano nemitemo yakawanda inopedzwa, yakadai sepaspass mbiri , katatu kupfurikidza kana quadruple inpass .
Zviratidzo zveMwoyo Wakasununguka Pakuvhiya:
- Kudya kukuru kunoshanduka, kurega kusvuta uye kuwedzera kukurovedza muviri hazvina kusimbisa chirwere chegoni.
- Angioplasty haiti kubudirira, kwete kukodzera kana arteri iri kudziviswa zvakare mushure mekunge angioplasty.
- Uturu hwakanyanya hwepfupa hunowanikwa nebasa.
- Kuedza kunoratidzira chirwere chakakomba muyeri yepamusoro yerinoni .
- Kuedza kunoratidzira chirwere chakakomba mune mishonga yakawanda .
- Idzo dzisina kushanda, dzisingagoni kuiswa kana dzinodikanwazve.
- Ikoko kuruboshwe huri kushanda zvakanaka nekuda kwehutano hwehutano.
- Kune ngozi inowanikwa yekuparara kwemwoyo.
Kugadzirira Mwoyo Wakasununguka Purogiramu Yokuvhiya:
Vanachiremba vakawanda vane chirwere chepfungwa vanorayira zvakanyanya kuongororwa vasati vambovhiyiwa kuti vaone kuti mishonga ipi inogadziriswa uye kuoma kwekuvhara.
Chimwe chimiro chimwe chepfungwa chinoshandiswa kunze chinoshandisa x-rays kuti chione kuoma kwechirwere chirwere.
A test test, electrocardiogram (EKG) uye kuongororwa ropa kunowanzoitwa kusati kwaitika kuvhiyiwa. Kuyera ropa kunogona kudzokororwa pakarepo vasati vavhiyiwa kuti vaone kana murwere angave achibuda ropa panguva yekuvhiyiwa, pamwe chete nehutano hwavo hwose.
Mumwe chiremba anokwanisa kunge ane mirayiridzo yakajeka kune murwere akarongerwa kuporesa chirwere. Iyi mirayiridzo inogona kusanganisira kuchinja mishonga yemishonga, kudya uye kunwa uye kusvuta tsika .
Kuti Uwane Mashoko Akawanda Pamusoro peMunhu Mwoyo & Mwoyo Kupera
Pamupa Mwoyo Wakasununguka Purogiramu Yokuvhiya:
Mwoyo wakazaruka kupfurikidza nekuvhiya kunoitwa pasi peanesthesia , iyo inoda kuti murwere ave muvharidzi panguva yekuvhiyiwa.
Kuvhiya kunotanga nekukohwa midziyo yeropa iyo ichava graft. Ive saphenous mumumugwagwa inowanzoshandiswa nekuti yakareba kwenguva yakareba yekuumba mafura akawanda. Kana sine saphenous isingagoni kushandiswa, midziyo kubva paruoko ingashandiswa panzvimbo. Iko kumusana wemamita yemazamu inoshandiswa inoshandiswa kune imwe chete iyo inotorwa uye inotorwa kamwe kana bhokisi rinosvinudzwa kuti rivhiwe.
Kana imwe nguva mheya yakasununguka yave yadzorerwa, chifuyo chinovhurwa nekuita kusungirirwa pamwe chete nesternum, kana kuti chifuva.
Chiremba wacho anochera sternum, achibvumira kuti chifukidzo chebhokisi chizarurire, achipa chiremba chiremba kupinda mukati memwoyo.
Muchidimbu cheCABG nzira, mwoyo inomiswa nehupamhi ye potassium kuitira kuti chiremba haana kuedza kushanda pamudziyo unofamba, uye ropa rinoparadzirwa nemoyo wemapapu. Panguva ino mwoyo wemapapu unoita basa remwoyo nemapapu, uye ventilator haisati yashandiswa.
Chiremba anovhiya anoisa mafuro, kana kuunza ropa panopoteredza kuvhara, kana kubvisa uye kutora chikamu chakavharwa. Nguva yakawanda pamwoyo-kumapapiro emakina anoshandiswa nehanho iyo chiremba anokwanisa kukwanisa kushanda, kunyanya, kuti ingani mabrithoro anodiwa.
Kamwe iyo mazai apera, mwoyo unotanga uye unopa ropa uye oksijeni mumuviri. Iyo sternum inodzoserwa panzvimbo yayo yepakutanga uye yakavharwa uchishandisa tambo yekuvhiya, kupa simba simba rinofanira kuporesa, uye kuvhara kwakavharwa.
Zvigadzirwa zvepa Pump Zvakazarurwa Mwoyo Wakachena:
- Chiremba anokwanisa kushanda nokukurumidza nokuti mwoyo ichiripo
- Ropa shoma shoma rinokuvhiya nokukurumidza
- Zvakakodzera kuvarwere vasina kugadzikana
Huru yePamu Purojekiti Yakasununguka Kuvhiya:
- Kuwedzera kuvhuvhuta / kuvhara shure kwekuvhiyiwa
- Kuwedzererwa kakawanda mushure mekuvhiyiwa pane kupera pombi
- Kunyanya kuchengetedza kwemvura kunopfuvura pombi
- Dambudziko rakakura repimpemhe rinoparadza kupfuura pombi
- Kubvira kwenguva refu kuchipatara kudarika pombi
- Kuwedzera kwengozi yekurohwa
Kuvhara Pombi Kuzarura Mwoyo Kuvhiya:
Nzira yekurova mwoyo, kana "off-pump" chirwere inonyanya kufanana neyo pamushonga wepombi, asi kubuda kweropa kuburikidza nemuviri kunochengetedzwa nemwoyo panguva iyo nzira. Panzvimbo yekushandisa mishonga yemwoyo-mapapu, mwoyo unoramba uchirova asi nzvimbo yakabatanidzwa inochengetwa ichiri nemichina yekuvhiya. Inenge 20 muzana yekutanga CABG varwere vakasiya chirwere chepombi .
Zvimwe Zvekuvhara Pump Inotanga Kuvhiya Mwoyo:
- Mwoyo uri kufamba, unonoka kuperevhirwa
- Kurasikirwa kweropa kurasikirwa uye kuderera kuwedzerwa
- Kuderedza ngozi yekurohwa
- Kupera kwekugara kwechipatara kugara
- Zvishoma kudhura
Cons of Off Off Pump Yakasununguka Mwoyo Kuvhiya:
- Kusvika kusvika ku70% yevarwere ineligible pamusana pematomu kana chirwere chekurapa
- Inowanzoitwa kune murwere asina kugadzikana
Kuti Uwane Mashoko Akawanda Pamusoro peMunhu Mwoyo & Mwoyo Kupera
Kudzoka Kubva Mwoyo Wakasununguka Kuvhiya:
Mukuvhiya akawanda , zvinodhaka zvinopiwa kumutsa murwere pakarepo mushure mokunge incision yavharwa. Nyanzvi dzakawanda dzechiremba dzinosarudza kubvumira varwere veCABG kuti vadzike zvishoma nezvishoma, kudzivirira chero kushungurudzika pamwoyo kunogona kuitika paanomuka pakarepo.
Murwere achaendeswa kunzvimbo yekudzorera, kazhinji kacho chikwata chemwoyo kana chirwere chokuvhiya chakanyanya, chekuchengetedza paunenge uchibuda anesthesia. Nzvimbo yakakosha yekuchengetedza yakakosha kuti ipe murwere pamwe chete pane imwe yekuyamwisa uye nguva dzose kuongororwa. Panguva ino ventilator icharamba iri kushandiswa, ichipa rubatsiro rwekufema apo murwere acharamba aripo.
Chimwe chefu kana mamwe mapfupa, mabhuru makuru akaiswa mukati mekutsvaga, anobatsira kubvisa chero ropa ripi zvingangodaro rakaungana mukati memwoyo. A huru IV inonzi Swan-Ganz ichavawo panzvimbo, zvichibvumira vashandi kuongorora mabasa epfungwa zvakanyanya uye kupa mishonga.
Kamwe iyo anesthesia madhiragi akadzimwa uye murwere wacho akamuka, kufema kunobviswa (inonzi inonzi extubation) uye murwere anokwanisa kufema oga. Pakarepo mushure mekuwedzera kwekuwedzera kwomweya wegorosi kunogona kupiwa nemhino, kubatsira mukufema. Oxygen mazinga uye kufema kuchacherechedzwa uye kana murwere asingakwanisi kufema zvakanaka pasina ventilator, kuputika kweputi kuchadzorerwa zvakare.
Pane imwe nguva akamuka uye achifema ari oga, murwere achazotanga kugadziriswa zvakasimba, achitanga nekugara pamucheto wemubhedha kana kumira nekufamba masitepisi mashoma kuchigaro. Murwere acharayirirwa nzira dzokufamba nadzo kuderedza marwadzo uye nzira yekudzivirira maronda ekuvhiya . Panguva ino, mishonga inorwadza inowanikwa kuitira kuti murwere aende kunze kwekutambudzika kukuru.
Mumwe murwere weCABG anowanzogara munzvimbo yakasimba yekuchengetedza kwemaawa anenge makumi maviri nemana. Mafupa ebhokisi anowanzobviswa mukati maawa makumi mana masere ekuvhiya, asati atumirwa kune imwe nhanho-pasi. Vakawanda veCABG varwere vanoratidza kuwedzera kwakanyanya muhutano hwepamusoro apo mafupa emapfupa ari kubviswa.
Upenyu Pashure Pekuvhura Mwoyo Kuputika Kwakaitwa:
CABG haisi mushonga wechirwere chemwoyo; iyo inobatsira zvikuru kurapwa. Mumwe murwere weCABG asingateereri murairo wechiremba wavo kuti achinje kudya kwavo, kurega kusvuta, kurovedza muviri, kuora muviri kana kudzora shuga yavo yeropa kunogona kuwana kuti chirwere chavo chetachiona chakadzoka, uye chiri kudzivirira itsva graft .
Vamwe varwere vangada kudzorerwa shure mushure mokudzokera kumusha kunobatsira nesimba uye simba. Zvimwe zvivako zvine hurongwa hwepamusoro hwekuvandudza mwoyo apo vamwe vanoshandisa zvipatara zvepanyama .
Kuti Uwane Mashoko Akawanda Pamusoro peMunhu Mwoyo & Mwoyo Kupera
> Sources:
> Patient Information Information Pamphlet. Mayo Clinic.com mabhuku ehutano wehutano 1995-2007
> Raja S, Dreyfus G, "Kubviswa kwepompiyuniyuta yemajoini inoshandiswa inoshandura nzvimbo inowanzogadzirwa here?" Journal of the Royal Society of Medicine, Volume 97, June 2004.
> Turley A, Roberts AP, Morley R, Thornley AR, Owens WA, de Belder MA. "Kuchengetedza kwechipiri mushure mekugadzirisa arteri inopesana nekugadzira hurairi hunovandudzwa asi inoramba ichinyatsogadzirisa: chidimbu chekutsvaga-tarisa" Interactive Cardiothoracic Surgery. 30 Jan. 2008