Novemba 16, 2019 - Ngu-Tracie White
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UDavid Maron
Iziguli ezinesifo senhliziyo esinzima kodwa ezinzile ezilashwa ngemithi kanye nezeluleko zendlela yokuphila zizodwa azisekho engcupheni yokuhlaselwa yinhliziyo noma ukufa kunalezo ezihlinzwa ngendlela ehlaselayo, ngokusho kocwaningo lomtholampilo olukhulu oluxhaswe yi-federal oluholwa abacwaningi eStanford. Isikole Sezokwelapha kanye nesikole sezokwelapha saseNew York University.
Ukuhlolwa kwabonisa, nokho, ukuthi phakathi kweziguli ezinesifo se-coronary artery nazo ezazinezimpawu ze-angina - ubuhlungu besifuba obubangelwa ukugeleza kwegazi okulinganiselwe ukuya enhliziyweni - ukwelashwa ngezinqubo ezihlaselayo, njengama-stents noma ukuhlinzwa kwe-bypass, kwaphumelela kakhulu ekudambiseni izimpawu. kanye nokwenza ngcono izinga lempilo.
"Ezigulini ezinesifo senhliziyo esinzima kodwa esizinzile esingafuni ukwenza lezi zinqubo ezihlaselayo, le miphumela iqinisekisa kakhulu," kusho uDavid Maron, MD, uprofesa wezokwelapha wezokwelapha kanye nomqondisi we-cardiology yokuvimbela e-Stanford School of Medicine, futhi. usihlalo ohlanganyele wocwaningo, olubizwa nge-ISCHEMIA, lwe-International Study of Comparative Health Effectiveness with Medical and Invasive Approaches.
"Imiphumela ayisikiseli ukuthi kufanele balandele izinqubo ukuze bavimbele izehlakalo zenhliziyo," kwengeza uMaron, ophinde abe yisikhulu seStanford Prevention Research Center.
Izehlakalo zezempilo ezilinganiswe kulolu cwaningo zihlanganisa ukufa ngenxa yesifo senhliziyo, ukuhlaselwa yinhliziyo, ukulaliswa esibhedlela ngenxa ye-angina engazinzile, ukulaliswa esibhedlela ngenxa yokwehluleka kwenhliziyo nokuvuselela ngemva kokuboshwa kwenhliziyo.
Imiphumela yocwaningo, ehilela ababambiqhaza abangu-5,179 kumasayithi angu-320 emazweni angu-37, yethulwa ngoNovemba 16 ku-American Heart Association's Scientific Sessions 2019 e-Philadelphia.UJudith Hochman, MD, umqondisi omkhulu wesayensi yomtholampilo e-NYU Grossman School of Medicine, wayengusihlalo wecala.Ezinye izikhungo ezithintekayo ekuhlaziyeni lolu cwaningo yiSaint Luke's Mid America Heart Institute kanye neDuke University.INational Heart, Lung, and Blood Institute itshale imali engaphezu kwezigidi ezingu-$100 ocwaningweni, olwaqala ukubhalisa ababambiqhaza ngo-2012.
'Omunye wemibuzo esemqoka'
"Lona kube ngomunye wemibuzo eyinhloko yezokwelapha zenhliziyo isikhathi eside: Ingabe ukwelashwa kwezokwelapha kuphela noma ukwelapha okuhlangene nezinqubo ezivamile zokuhlasela kuwukwelashwa okungcono kakhulu kwaleli qembu leziguli ezizinzile?"kusho umphenyi ohlanganyele wocwaningo uRobert Harrington, MD, uprofesa kanye nosihlalo wezokwelapha e-Stanford kanye no-Arthur L. Bloomfield Professor of Medicine."Lokhu ngikubona njengokunciphisa inani lezinqubo ezihlaselayo."
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URobert Harrington
Ucwaningo lwaluklanyelwe ukubonisa umkhuba wamanje womtholampilo, lapho iziguli ezinokuvaleka okukhulu emithanjeni yazo ngokuvamile zenza i-angiogram kanye ne-revascularization ngokufakwa okuqinile noma ukuhlinzwa kwe-bypass.Kuze kube manje, kube nobufakazi obuncane besayensi obusekela ukuthi lezi zinqubo zisebenza kangcono yini ekuvimbeleni izehlakalo ezimbi zenhliziyo kunokwelapha iziguli ngemithi efana ne-aspirin nama-statins.
“Uma ucabanga kuvele kucace ukuthi uma kuvimbekile emthanjeni kanye nobufakazi bokuthi lokho kuvaleka kudala inkinga, ukuvuleka kokuvaleka kuzokwenza abantu bazizwe bengcono futhi baphile isikhathi eside,” kusho uHarrington ohlale ebona iziguli. ngesifo senhliziyo nemithambo yegazi eStanford Health Care.“Kodwa abukho ubufakazi bokuthi lokhu kuyiqiniso ngempela.Yingakho senze lolu cwaningo.”
Ukwelapha okuhlaselayo kuhilela ukufakwa kwe-catheterization, inqubo lapho i-catheter efana neshubhu isheleleka emthanjeni osesifundeni noma engalweni futhi ixhunywe emithanjeni yegazi iye enhliziyweni.Lokhu kulandelwa ukuvuselelwa kabusha kwemithambo, njengoba kudingekile: ukubekwa kwe-stent, efakwa nge-catheter ukuze kuvulwe umkhumbi wegazi, noma ukuhlinzwa kwe-cardiac bypass, lapho omunye umthambo noma umthambo ukhishwa kabusha ukuze udlule indawo yokuvinjelwa.
Abaphenyi bacwaninga iziguli zenhliziyo ezazisesimweni esizinzile kodwa eziphila ne-ischemia emaphakathi kuya kokuqina okubangelwa ngokuyinhloko i-atherosclerosis - ukufakwa koqweqwe emithanjeni.I-Ischemic heart disease, eyaziwa nangokuthi isifo se-coronary artery noma isifo senhliziyo, uhlobo oluvame kakhulu lwesifo senhliziyo.Iziguli ezinalesi sifo zinemithambo yenhliziyo emincane okuthi uma ivalekile ibangele isifo senhliziyo.Cishe abantu baseMelika abayizigidi eziyi-17.6 baphila nalesi simo, okuholela ekufeni kwabantu ababalelwa ku-450,000 unyaka ngamunye, ngokusho kwe-American Heart Association.
I-Ischemia, enciphisa ukugeleza kwegazi, ngokuvamile ibangela izimpawu zobuhlungu besifuba ezaziwa ngokuthi i-angina.Cishe izingxenye ezimbili kwezintathu zalezo ziguli zenhliziyo ezibhalise ocwaningweni zabhekana nezimpawu zobuhlungu besifuba.
Imiphumela yalolu cwaningo ayisebenzi kubantu abanezimo zenhliziyo ezibuhlungu, njengalabo abamelwa yinhliziyo, kusho abacwaningi.Abantu ababhekene nezigameko zenhliziyo ezibuhlungu kufanele bafune ngokushesha usizo lwezokwelapha olufanele.
Funda ngokungahleliwe
Ukwenza ucwaningo, abaphenyi bahlukanisa iziguli ngamaqembu amabili ngokungahleliwe.Womabili amaqembu athola imithi kanye nezeluleko zendlela yokuphila, kodwa yiqembu elilodwa kuphela elathola izinqubo ezihlaselayo.Ucwaningo lulandele iziguli eziphakathi kweminyaka engu-1½ kanye neminyaka eyisikhombisa, lugcina amathebhu kunoma yiziphi izenzakalo zenhliziyo.
Imiphumela yabonisa ukuthi labo abenze inqubo yokuhlasela babecishe babe nenani eliphakeme elingu-2% lezehlakalo zenhliziyo phakathi nonyaka wokuqala uma kuqhathaniswa nalezo ezitholakala ekwelashweni kwezokwelapha kuphela.Lokhu kubangelwa ubungozi obengeziwe obuhambisana nokuba nezinqubo ezihlaselayo, kusho abacwaningi.Ngonyaka wesibili, awukho umehluko obonisiwe.Ngonyaka wesine, izinga lezehlakalo laliphansi ngo-2% ezigulini ezelashwa ngezinqubo zenhliziyo kunalezo ezithola imithi nezeluleko zendlela yokuphila kuphela.Lo mkhuba awuzange ubangele umehluko omkhulu phakathi kwamasu amabili okwelapha, kusho abaphenyi.
Phakathi kweziguli ezabika ubuhlungu besifuba nsuku zonke noma masonto onke ekuqaleni kocwaningo, amaphesenti angu-50 alabo abaphathwa ngendlela engavamile atholakale engena-angina ngemva konyaka, uma kuqhathaniswa nama-20% alabo abaphathwa ngendlela yokuphila nemithi yodwa.
"Ngokusekelwe emiphumeleni yethu, sincoma ukuthi zonke iziguli zithathe imithi efakazelwe ukunciphisa ingozi yokuhlaselwa yinhliziyo, zisebenze ngokomzimba, zidle ukudla okunempilo futhi ziyeke ukubhema," kusho uMaron.“Iziguli ezingenayo i-angina ngeke ziyibone intuthuko, kodwa lezo ezine-angina yanoma ibuphi ubukhali zizothambekela ekubeni nentuthuko enkulu, ehlala njalo eqophelweni lempilo uma zinenqubo yenhliziyo ehlaselayo.Kufanele bakhulume nodokotela babo ukuze banqume ukuthi bazokwenziwa yini kabusha imithambo yegazi.”
Abaphenyi bahlela ukuqhubeka nokulandela ababambiqhaza bocwaningo eminye iminyaka emihlanu ukuze banqume ukuthi ingabe imiphumela iyashintsha yini ngokuhamba kwesikhathi eside.
“Kuzobaluleka ukuthi silandelele sibone ukuthi ngokuhamba kwesikhathi uzoba khona yini umehluko.Esikhathini esilandela abahlanganyeli, akukho nhlobo ukusinda esikuzuzayo esu elihlaselayo, ”kusho uMaron.“Ngicabanga ukuthi le miphumela kufanele iguqule ukusebenza komtholampilo.Izinqubo eziningi zenziwa kubantu abangenazo izimpawu.Kunzima ukuthethelela ukufaka ama-stents ezigulini ezizinzile futhi ezingenazimpawu.”
Isikhathi sokuthumela: Nov-10-2023