Ani naani ane chirwere chechirwere chirwere (CAD) chinoda kuva nehutano hwehutano hwehutano uye hutachiona hunochinja kuchinja, zvose kuti kuderedza dambudziko rekurwadziwa kwemoyo , uye kudzora zviratidzo zve angina (kana zviripo).
Dzimwe nguva kurapwa kwechiremba ndoga hakuna kukwana, uye revascularization therapy inodiwa. Revascularization zvinoreva kuti nzvimbo dzekudzivirira kukuru mumaketari e coronary dzinobudiswa ne angioplasty uye stent , kana kuti nekuvhiyiwa kwepamusoro (inonziwo coronary artery bypass grafting, kana CABG).
Saka, mumunhu chero upi zvake anonzi ane CAD, chiremba uye murwere anofanirwa kuongorora mibvunzo miviri. Chokutanga, chirwere chekurapa chete chinokwana, kana kuti revascularization inofanira kuitwawo here? Chechipiri, kana revascularization inokurudzirwa, inofanira kuva nekunhuwa, kana neCABG?
Apo Revascularization Inokurudzirwa?
Muvanhu vakawanda vane CAD, chirwere chekurapa , pamwe nemararamiro akakodzera ehupenyu hunochinja kukonzera njodzi yemwoyo , inofanira kunge iri nzira yokusarudza. Kunyanya, kune vanhu vakagadzirisa angina (angina iyo inofanirwa kuitika panguva yekutanga, uye iyo inowanikwa mumamiriro ezvinhu chaiwo akadai sekurovedza muviri), kurapwa kwehutano kunobudirira sevascularization mukudzivirira mwoyo kushungurudzwa kwemoyo, uye kuderedza dambudziko rehupenyu hwemwoyo. Saka kurapwa kwezvechiremba mumamiriro ezvinhu akadai nguva dzose kunogara kuchirapa kusarudzwa.
Zvisinei, revascularization therapy inowanzova sarudzo yakanaka pane mamwe mamiriro ezvinhu. Izvi zvinosanganisira:
- Vanhu vane rudzi rwekurwadziwa kwemoyo kunozivikanwa sehutachiwana ST-Segment elevation myocardial infarction (STEMI) .
- Vanhu vane angina vasina kusimba kana vasina-ST-segment myocardial infarction (NSTEMI) , avo vasingagadzikane nekugadzikana nekurapa kwechirwere chinotyisa.
- Vanhu vane angina yakasimba iyo inotadza kutongerwa pasinei nekurapa kurapa kurapa, kana kuti ndiani asingagoni kubvumira kurapwa kunofanirwa kuzvidzora.
- Vanhu avo vane CAD anatomy vanovaisa muboka umo revascularization inowanikwa kupfuura kurapwa kwechiremba kunatsiridza kupona. Izvi zvinosanganisira vanhu vane kuvhara kwakanyanya mumutambo wavo wekupedzisira weiyoroni, uye avo vane zvikwereti zvakakura mumatatu makuru emakoroniyamu-yakarurama, yakasara anterior ichiburuka uye yakasara mireteti inopflex. Verenga zvakawanda pamusoro pemakoroni arteri anatomy .
Ndeipi Iyo Inonzi Yakasarudzwa Pamusoro peCABG?
Kana ikasarudzwa kuti revascularization inotarisirwa, sarudzo inotevera ndeyokuti ingashandise angioplasty uye inopisa, kana CABG.
Kushungurudza kunowanzosarudzwa pamusoro peCABG kune varwere vane STEMI, sezvo ndiyo nzira inokurumidza kuzarura gonoroni yakavharidzirwa. Kushungurudza kunowanzosarudzwa kune vanhu vane mamwe maitiro eaconary syndromes (ACS, akadai saNSTEMI kana angina asina kugadzikana), kana kuvhura nokukurumidza aron coronary inodziviswa inonzi inokosha.
Mune vanhu vane angina vakagadzikana avo vakakundikana nerapi yezvechiremba, kupisa kunowanzosarudzwa kune avo vane CAD inosanganisira imwe saroni yeronary.
Kune avo vane angina akachengetedza avo vanoda revascularization uye vane zvidhi zviviri-CAD, kunyoresa kunowanzokurudzirwa kunze kwekuti vanewo chirwere cheshuga, kana kuti aroni yavo inogadziriswa inofungidzirwa yakaoma.
Apo CABG Inofanirwa pamusoro peStent?
CABG inotendwa kuti inobereka zvibereko zvenguva yakareba kune vanhu vane 3-vessel CAD.
CABG inofungidzirwawo kuti inopa migumisiro iri nani kudarika kutsvaira mune vanhu vakawanda vane zvirwere zveyeri yakakosha yeroniconary artery. Zvisinei, kune avo vane ACS nekuda kwekuvharwa mukati mekupedzisira kwetari, kupisa kunogona kuva sarudzo yakachengeteka sezvo inogona kuitwa nekukurumidza zvikuru.
CABG inzira yakanakisisa kudarika kutsvaga kune vanhu vane 2-vessel CAD avo vane chirwere cheshuga.
Pakupedzisira, kazhinji, vanhu vakashandurwa neCABG kazhinji havadi kudzokorora revascularization kune avo vanogamuchira stents. Nokuda kwechikonzero ichi, CABG inofanira kunge ichinyatsokurukurwa sechinhu chisarudzo pamwe nevanenge vanoda revascularization.
Icho SYNTAX Trial
Kudai taizopfupisa mamiriro ezvinhu apo CABG inosarudzwa pamusoro pekusimudzira, tinogona kutaura kuti migumisiro inowanzova nani neCABG kune vanhu vane "zvakaoma" CAD. "Makuru" CAD inosanganisira vanhu vane chirwere che-3-vessel, kusara kweCAD huru, vamwe vanhu vane chirwere chechipiri, uye vanenge vose vane chirwere cheshuga vane CAD.
Shanduro yeSNTAX, yakabudiswa muna 2009, ndiyo inonyatsotsanangurirwa kuongororwa kwekliniki yekuenzanisira kuenzanisa stents kune CABG kune varwere vane yakaoma CAD. Chidzidzo ichi chakaratidza kuti varwere vanorapwa neCABG vakanga vashoma kwazvo zviitiko zvekupedzisira (zvinoumba rufu, chirwere, kurwisa kwemwoyo, uye chido chokudzokorora revascularization) kupfuura varwere vanowana stents (12.4% vs 17.8% mushure memwedzi gumi nemaviri). Mhinduro yakafanana yakataurwa mumutambo mukuru mu 2015.
Saka iyo miviri mikuru yakashandiswa mumakiriniki kuenzanisa zvikwereti kune CABG kune varwere vane CAD yakaoma vose vakabuda vachifarira CABG.
Nyanzvi dzeCardiologist dzinotaura, zvisinei, kuti muSNTAX muedzo, apo purogiramu yemagumo yakanyanya kuipa nemashizha, pangozi yenguva pfupi yekupora inowedzera yakapfuura mushure meCABG (0.6% yezvakadzama ne 2.2% yeCABG) mushure memwedzi gumi nemaviri. Iyi ndiyo nheyo inobvumirwa, kunyange chiitiko chekurova chirwere chaive chichienzaniswa mumapoka maviri mushure memakore matatu.
Vatsvakurudzi vakakunda chirongwa cheSNTAX vakabva vadzidza zvavanoti "SYNTAX chikwata," iyo inonyanya kukosha maitiro eCAD murwere maererano nekuoma kwayo. Varwere vane mashoma eSNTAX maitiro anoita seanoita zviri nani nemashizha kune avo vane maSNX marefu. Zvisinei, nepo vakawanda vane cardiologists vanoshandisa chikwata cheSyTAX kuti vabatsire kusarudza kana munhu ane dzakaoma CAD aifanira kunge ane simba kana kuti CABG, iyi yekuongororwa chirongwa pachayo haina kuongororwa muchipatara chekuedza.
The Bottom Line
Chinokosha ndechekuti kune vanhu vakawanda vanoda ruzivo rwezvemutambo revascularization, uye vane vane CAD yakawanda-yeCAD mudziyo kana kuti kuvhara kwakanyanya mumasitoriro avo echechi ekupedzisira, CABG kazhinji inofanirwa kuonekwa seyekutanga nzira yekurapa.
Kushungurudza kunowanzodiwa kune vanhu vane ACS, kune vanhu vane imwe chete-mudziyo CAD, uye mune vanhu vakawanda vane 2-vessel CAD vasina chirwere cheshuga.
Kushandisa stents panzvimbo yeCABG yeCAD yakaoma inofanira kuchengeterwa vanhu avo, mushure mekunge vachinzwisisa zvisikwa zvose uye zvibatsiro, vachiri kusarudza nzira isina kuderedza.
> Sources:
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> Park SJ, Ahn JM, Kim YH, et al. Chiitiko CheEeverolimus-Eluting Stents Kana Kuputika Kwechirwere KuCononary Disease. N Engl J Med 2015; 372: 1204.
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