Stents, opaleshoni ya bypass sikuwonetsa phindu lililonse pakufa kwa matenda amtima pakati pa odwala okhazikika

Novembala 16, 2019 - Wolemba Tracie White

mayeso
David Maron

Odwala omwe ali ndi matenda amtima olimba koma okhazikika omwe amathandizidwa ndi mankhwala ndi upangiri wa moyo okha sakhala pachiwopsezo cha matenda a mtima kapena kufa kuposa omwe amachitidwa opaleshoni, malinga ndi kafukufuku wamkulu wothandizidwa ndi federal motsogozedwa ndi ofufuza ku Stanford. School of Medicine ndi sukulu yachipatala yaku New York University.

Mlanduwu unasonyeza, komabe, kuti mwa odwala omwe ali ndi matenda a mtsempha wamagazi omwe analinso ndi zizindikiro za angina - kupweteka pachifuwa chifukwa cha kuchepa kwa magazi kumtima - chithandizo ndi njira zowononga, monga ma stents kapena opaleshoni ya bypass, zinali zothandiza kwambiri kuthetsa zizindikiro. ndi kuwongolera moyo wabwino.

"Kwa odwala omwe ali ndi matenda a mtima ovuta koma osasunthika omwe safuna kutsata njira zowonongekazi, zotsatirazi ndi zolimbikitsa kwambiri," anatero David Maron, MD, pulofesa wa zachipatala ndi mkulu wa matenda a mtima ku Stanford School of Medicine, ndi wapampando wina wa mlanduwu, wotchedwa ISCHEMIA, wa International Study of Comparative Health Effectiveness with Medical and Invasive Approaches.

"Zotsatira sizikutanthauza kuti akuyenera kutsata njira zopewera matenda a mtima," anawonjezera Maron, yemwenso ndi wamkulu wa Stanford Prevention Research Center.

Zochitika zaumoyo zomwe zinayesedwa ndi phunziroli zinaphatikizapo imfa kuchokera ku matenda a mtima, matenda a mtima, kuchipatala chifukwa cha angina wosakhazikika, kuchipatala chifukwa cha kulephera kwa mtima ndi kutsitsimuka pambuyo pa kumangidwa kwa mtima.

Zotsatira za kafukufukuyu, zomwe zidakhudza otenga nawo gawo 5,179 pamasamba 320 m'maiko 37, zidaperekedwa Nov. 16 ku American Heart Association's Scientific Sessions 2019 yomwe idachitikira ku Philadelphia.Judith Hochman, MD, wothandizira wamkulu wa sayansi yachipatala ku NYU Grossman School of Medicine, anali mtsogoleri wa mayesero.Mabungwe ena omwe adakhudzidwa ndi kafukufukuyu anali Saint Luke's Mid America Heart Institute ndi Duke University.National Heart, Lung, and Blood Institute yayika ndalama zoposa $100 miliyoni pa kafukufukuyu, womwe unayamba kulembetsa otenga nawo gawo mu 2012.

'Limodzi mwamafunso apakati'
"Ili lakhala limodzi mwamafunso ofunika kwambiri pazamankhwala amtima kwa nthawi yayitali: Kodi chithandizo chamankhwala chokha kapena chithandizo chamankhwala chophatikizidwa ndi njira zachizoloŵezi zachizoloŵezi ndizo chithandizo chabwino kwambiri cha gulu la odwala mtima okhazikika?"anati kafukufuku co-wofufuza Robert Harrington, MD, pulofesa ndi mpando wa mankhwala pa Stanford ndi Arthur L. Bloomfield Pulofesa wa Medicine."Ndikuwona izi ngati kuchepetsa kuchuluka kwa njira zowononga."

mayeso
Robert Harrington

Phunziroli linapangidwa kuti liwonetsere zomwe zikuchitika masiku ano zachipatala, momwe odwala omwe ali ndi zotsekeka kwambiri m'mitsempha yawo nthawi zambiri amakhala ndi angiogram ndi revascularization ndi stent implant kapena bypass opaleshoni.Mpaka pano, pakhala pali umboni wochepa wa sayansi wotsimikizira ngati njirazi ndizothandiza kwambiri popewa zovuta zamtima kuposa kungochiza odwala ndi mankhwala monga aspirin ndi ma statins.

"Mukaganizira izi, pali chidziwitso choti ngati mtsempha watsekeka ndi umboni woti kutsekeka kumayambitsa vuto, kutsegula kutsekeka kumeneku kumapangitsa kuti anthu azikhala bwino komanso kukhala ndi moyo wautali," adatero Harrington, yemwe amawona odwala pafupipafupi. ndi matenda amtima ku Stanford Health Care.“Koma palibe umboni wosonyeza kuti zimenezi n’zoona.N’chifukwa chake tinachita phunziroli.”

Njira zochizira matenda zimaphatikizapo catheterization, njira yomwe catheter yonga chubu imalowetsedwa mumtsempha wapakati pa groin kapena mkono ndipo imalumikizidwa kudzera mumitsempha kupita kumtima.Izi zimatsatiridwa ndi revascularization, ngati pakufunika: kuyika kwa stent, komwe kumalowetsedwa kudzera mu catheter kuti atsegule chotengera cha magazi, kapena opaleshoni ya mtima, momwe mitsempha ina kapena mitsempha imayikidwanso kuti ipitirire malo otsekedwa.

Ofufuza anafufuza odwala amtima omwe anali okhazikika koma amakhala ndi ischemia yapakati mpaka yoopsa kwambiri chifukwa cha atherosclerosis - madipoziti a zolengeza m'mitsempha.Matenda a mtima a Ischemic, omwe amadziwikanso kuti matenda a mitsempha kapena matenda a mtima, ndi mtundu wofala kwambiri wa matenda a mtima.Odwala matendawa achepetsa mitsempha yamtima yomwe, ikatsekedwa kwathunthu, imayambitsa matenda a mtima.Pafupifupi 17.6 miliyoni aku America amakhala ndi vutoli, zomwe zimapangitsa kuti pafupifupi 450,000 amafa chaka chilichonse, malinga ndi American Heart Association.

Ischemia, yomwe imachepetsa kuthamanga kwa magazi, nthawi zambiri imayambitsa zizindikiro za kupweteka pachifuwa chotchedwa angina.Pafupifupi magawo awiri mwa atatu mwa odwala amtima omwe adalembetsa nawo kafukufukuyu adakumana ndi zizindikiro za kupweteka pachifuwa.

Zotsatira za phunziroli sizigwira ntchito kwa anthu omwe ali ndi vuto la mtima, monga omwe ali ndi vuto la mtima, ofufuzawo adanena.Anthu omwe ali ndi vuto lalikulu la mtima ayenera kupeza chithandizo choyenera chamankhwala nthawi yomweyo.

Phunzirani mwachisawawa
Kuti achite kafukufukuyu, ofufuza adagawa odwalawo m'magulu awiri.Magulu onse awiriwa adalandira mankhwala ndi uphungu wa moyo, koma gulu limodzi lokha ndilomwe linali ndi njira zowonongeka.Kafukufukuyu adatsata odwala pakati pa 1½ ndi zaka zisanu ndi ziwiri, kusunga ma tabu pazochitika zilizonse zamtima.

Zotsatira zinawonetsa kuti omwe adachitidwapo opaleshoni anali ndi chiwopsezo cha 2% chapamwamba cha zochitika zapamtima mkati mwa chaka choyamba poyerekeza ndi omwe adalandira chithandizo chamankhwala chokha.Izi zimachokera ku zoopsa zowonjezera zomwe zimabwera chifukwa chokhala ndi njira zowonongeka, ofufuzawo adanena.Pofika chaka chachiwiri, palibe kusiyana komwe kunawonetsedwa.Pofika chaka chachinayi, chiwerengero cha zochitikazo chinali chochepa 2% mwa odwala omwe amachiritsidwa ndi njira zamtima kusiyana ndi omwe amamwa mankhwala ndi malangizo a moyo okha.Izi sizinapangitse kusiyana kwakukulu pakati pa njira ziwiri zochiritsira, ofufuzawo adanena.

Pakati pa odwala omwe amamva kupweteka pachifuwa tsiku ndi tsiku kapena mlungu uliwonse kumayambiriro kwa phunzirolo, 50% mwa omwe adalandira chithandizo mosavutikira adapezeka kuti alibe angina pakatha chaka, poyerekeza ndi 20% mwa omwe amachiritsidwa ndi moyo ndi mankhwala okha.

"Malinga ndi zotsatira zathu, timalimbikitsa kuti odwala onse amwe mankhwala omwe amatsimikiziridwa kuti achepetse chiopsezo cha matenda a mtima, kukhala ochita masewera olimbitsa thupi, kudya zakudya zabwino komanso kusiya kusuta," adatero Maron."Odwala omwe alibe angina sangawone kusintha, koma omwe ali ndi angina yowawa kwambiri amakhala ndi kusintha kwakukulu, kosatha mu umoyo wa moyo ngati ali ndi njira yowonongeka ya mtima.Ayenera kukambirana ndi madotolo awo kuti asankhe ngati angachiritsidwe ndi revascularization.

Ofufuza akukonzekera kupitiriza kutsata ochita nawo kafukufuku kwa zaka zina zisanu kuti adziwe ngati zotsatira zikusintha pakapita nthawi yaitali.

"Zikhala zofunikira kutsata kuti muwone ngati, pakapita nthawi, padzakhala kusiyana.Kwa nthawi yomwe tidatsatira omwe adatenga nawo gawo, panalibe phindu lililonse lopulumuka ndi njira yowukirayi, "adatero Maron."Ndikuganiza kuti zotsatirazi ziyenera kusintha machitidwe azachipatala.Njira zambiri zimachitidwa kwa anthu omwe alibe zizindikiro.Zimakhala zovuta kulungamitsa kuyika ma stents kwa odwala omwe ali okhazikika komanso opanda zizindikiro. ”