Kodi Restenosis ndi Chiyani?

Zamkati

• Chidule
• Kupuma kwa restenosis (ISR)
• Zizindikiro za restenosis
• Zimayambitsa restenosis
• Nthawi yoti restenosis ichitike
• Matenda a restenosis
• Chithandizo cha restenosis
• Maonekedwe ndi kupewa restenosis

Chidule

Stenosis amatanthauza kuchepa kapena kutsekeka kwa mtsempha wamagazi chifukwa chodzaza ndi mafuta omwe amatchedwa plaque (atherosclerosis). Zikachitika m'mitsempha ya mumtima (mitsempha yamtundu), amatchedwa coronary artery stenosis.

Restenosis (“re” + “stenosis”) ndipamene gawo la mtsempha wamagazi omwe kale ankathandizidwira kutchinga amakhalanso ochepa.

Kupuma kwa restenosis (ISR)

Angioplasty, mtundu wa percutaneous coronary intervention (PCI), ndi njira yomwe imagwiritsidwa ntchito kutsegula mitsempha yotsekedwa. Pochita izi, chitsulo chaching'ono chachitsulo, chotchedwa mtima wa mtima, nthawi zambiri chimayikidwa mumtsempha momwe chimatsegulidwanso. Kutsekemera kumathandiza kuti mitsempha ikhale yotseguka.

Gawo lina lamtsempha lokhala ndi stent likatsekedwa, limatchedwa in-stent restenosis (ISR).

Pamene magazi amatseka, kapena thrombus, amapangidwa mu gawo la mtsempha wokhala ndi stent, amatchedwa in-stent thrombosis (IST).

Zizindikiro za restenosis

Restenosis, yokhala ndi stent kapena yopanda stent, imachitika pang'onopang'ono. Sizingayambitse zizindikilo mpaka kutsekeka kukukula kokwanira kuti mtima usapeze magazi ochepa omwe amafunikira.

Zizindikiro zikayamba, nthawi zambiri zimakhala zofanana ndi zomwe kutchinga koyambirira kumayambitsa kusanachitike. Nthawi zambiri izi ndi zomwe zimayambitsa matenda amitsempha (CAD), monga kupweteka pachifuwa (angina) ndi kupuma movutikira.

IST nthawi zambiri imayambitsa zizindikilo zowopsa mwadzidzidzi. Chotsekeracho nthawi zambiri chimatseka mtsempha wamagazi, choncho palibe magazi omwe amatha kufika mbali yomwe mtima umapereka, ndikupangitsa matenda amtima (myocardial infarction).

Kuphatikiza pa zizindikilo za matenda amtima, pakhoza kukhala zizindikilo za zovuta monga kulephera kwa mtima.

Zimayambitsa restenosis

Balloon angioplasty ndiyo njira yogwiritsira ntchito coronary stenosis. Zimaphatikizapo kulumikiza kateti m'mbali yochepetsetsa ya mtsempha wamagazi. Kukulitsa buluni pa nsonga ya catheter kumakankhira chikwangwani pambali, kutsegula mtsempha.

Njirayi imawononga makoma a mtsempha wamagazi. Minofu yatsopano imakula mumakoma ovulalawo pomwe mtsempha umachira. Pambuyo pake, mzere watsopano wamaselo athanzi, wotchedwa endothelium, umaphimba malowa.

Restenosis imachitika chifukwa makoma a zotanuka amatha kubwerera mmbuyo atatambasulidwa. Komanso, mtsempha wamagazi umachepetsa ngati kukula kwa minofu nthawi yakuchiritsa kumakhala kopitilira muyeso.

Zitsulo zachitsulo (BMS) zinapangidwa kuti zithandize kuthana ndi mitsempha yotsegulidwanso yotseka ikamachira.

BMS imayikidwa m'mbali mwa mtsempha wamagazi pomwe buluni imakhuta nthawi ya angioplasty. Zimalepheretsa makoma kuti abwererenso, koma kukula kwatsopano kumachitika chifukwa chovulala. Minofu ikakula kwambiri, mtsempha wamagazi umayamba kuchepa, ndipo restenosis imatha kuchitika.

Mankhwala osokoneza bongo (DES) tsopano ndi omwe amagwiritsidwa ntchito kwambiri. Achepetsa kwambiri vuto la restenosis, monga tawonera ndi ziwerengero za restenosis zomwe zidapezeka mu nkhani ya 2009 yofalitsidwa mu American Family Physician:

• balloon angioplasty wopanda stent: 40% ya odwala adayamba restenosis
• BMS: 30% adayamba restenosis
• DES: pansi pa 10% adayamba restenosis

Matenda a atherosclerosis amathanso kuyambitsa restenosis. DES imathandizira kupewa restenosis chifukwa cha kukula kwa minofu yatsopano, koma sizimakhudza zomwe zimayambitsa stenosis poyamba.

Pokhapokha ngati ziwopsezo zanu zisintha mutakhazikika, chikwangwani chizipitilizabe kukulira m'mitsempha yanu, kuphatikiza ma stents, omwe angayambitse restenosis.

Thrombosis, kapena magazi, amatha kupangika pamene magazi amatseka magazi amakumana ndi chinthu chachilendo mthupi, monga stent. Mwamwayi, malinga ndi, IST imangokhala pafupifupi 1% yamatenda amitsempha yama coronary.

Nthawi yoti restenosis ichitike

Restenosis, yokhala ndi stent kapena yopanda stent, imawonekera pakati pa miyezi itatu kapena isanu ndi umodzi mtsempha utatsegulidwanso. Pambuyo pa chaka choyamba, chiopsezo chokhala ndi restenosis kuchokera pakukula kwa minofu ndikochepa kwambiri.

Restenosis yochokera ku CAD imatenga nthawi yayitali kuti ikule, ndipo nthawi zambiri imachitika chaka chimodzi kapena kupitilira apo stenosis yoyambirira itachiritsidwa. Chiwopsezo cha restenosis chimapitilira mpaka ziwopsezo zamatenda amtima zitachepa.

Malinga ndi a, ma IST ambiri amapezeka miyezi yoyambirira atakhazikika, koma pali chiopsezo chochepa, koma chachikulu, mchaka choyamba. Kutenga opopera magazi kumachepetsa chiopsezo cha IST.

Matenda a restenosis

Ngati dokotala akukayikira restenosis, nthawi zambiri amagwiritsa ntchito mayeso atatu. Mayesowa amathandizira kudziwa zambiri za komwe kuli, kukula kwake, ndi mawonekedwe ena a kutsekeka. Ali:

• Coronary angiogram. Utoto umalowetsedwa mumtsempha kuti uwulule zotseka ndikuwonetsa momwe magazi amayendera bwino pa X-ray.
• Mitsempha yotchedwa ultrasound. Mafunde akumveka amatuluka mu catheter kuti apange chithunzi cha mkati mwa mtsempha.
• Kuphatikizika kwa tomography. Mafunde owala amatulutsidwa kuchokera ku catheter kuti apange zithunzi zokongola zamkati mwa mtsempha.

Chithandizo cha restenosis

Restenosis yomwe siyimayambitsa zizindikiro nthawi zambiri safuna chithandizo chilichonse.

Zizindikiro zikayamba kuonekera, nthawi zambiri zimawonjezeka pang'onopang'ono, motero pamakhala nthawi yothandizira restenosis mtsempha wamagazi usanatseke kwathunthu ndikupangitsa matenda amtima.

Restenosis mumtsempha wopanda stent nthawi zambiri amachiritsidwa ndi balloon angioplasty ndi DES mayikidwe.

ISR nthawi zambiri imathandizidwa ndikuyika stent ina (nthawi zambiri DES) kapena angioplasty pogwiritsa ntchito buluni. Baluniyo yokutidwa ndi mankhwala omwe amagwiritsidwa ntchito pa DES poletsa kukula kwa minofu.

Ngati restenosis ikupitilizabe kuchitika, dokotala angaganize zamitsempha yodutsa magazi (CABG) kuti apewe kuyika ma stents angapo.

Nthawi zina, ngati simukufuna kuchitidwa opaleshoni kapena kuchitidwa opaleshoni kapena simukanatha kulekerera bwino, matenda anu amathandizidwa ndi mankhwala okha.

IST nthawi zonse imakhala yadzidzidzi. Kufikira 40 peresenti ya anthu omwe ali ndi IST samapulumuka. Kutengera ndi zizindikilozo, amayamba chithandizo cha angina wosakhazikika kapena matenda amtima. Kawirikawiri PCI imachitidwa pofuna kuyesa kutsegula mitsempha posachedwa ndikuchepetsa kuwonongeka kwa mtima.

Ndi bwino kupewa IST kuposa kuyesa kuchiza. Ndicho chifukwa chake, pamodzi ndi aspirin ya tsiku ndi tsiku ya moyo, mungalandire magazi ena ochepetsa magazi, monga clopidogrel (Plavix), prasugrel (Effient), kapena ticagrelor (Brilinta).

Ochepetsa magazi awa amatengedwa osachepera mwezi umodzi, koma nthawi zambiri kwa chaka chimodzi kapena kupitilira apo, atakhazikika.

Maonekedwe ndi kupewa restenosis

Ukadaulo wapano wapangitsa kuti zisakhale zochepa kuti mudzakhale ndi restenosis kuchokera pakukula kwa minofu pambuyo poti angioplasty kapena kusunthika kwamphamvu.

Kubwerera pang'onopang'ono kwa zizindikilo zomwe mudali nazo musanatseke koyamba mu mtsempha wamagazi ndi chizindikiro choti restenosis ikuchitika, ndipo muyenera kukaonana ndi dokotala wanu.

Palibe zambiri zomwe mungachite kuti mupewe restenosis chifukwa cha kukula kwambiri kwa minofu panthawi yochiritsa. Komabe, mutha kuthandizira kupewa restenosis chifukwa cha matenda amitsempha yam'mimba.

Yesetsani kukhala ndi moyo wathanzi wophatikizapo kusasuta fodya, kudya zakudya zopatsa thanzi, komanso kuchita masewera olimbitsa thupi. Izi zitha kuchepetsa chiopsezo chazitsulo m'mitsempha yanu.

Mwinanso simungathe kupeza IST, makamaka mutakhala ndi stent kwa mwezi umodzi kapena kuposerapo. Mosiyana ndi ISR, komabe, IST nthawi zambiri imakhala yoopsa kwambiri ndipo nthawi zambiri imayambitsa zizindikilo zadzidzidzi zamatenda amtima.

Ndicho chifukwa chake kuteteza IST potenga oonda magazi malinga ndi momwe dokotala akuwalimbikitsira ndikofunikira kwambiri.