Wo koma reyɛ adwuma yiye dɛn? Momma yɛnka Cardiac Output ho asɛm!

Ɛnnɛ yɛrebɛka koma a ɛyɛ akwaa a ɛho hia paa wɔ yɛn nipadua mu no ho asɛm. Ne titiriw no, yɛrebɛka sɛnea koma no de mogya fa yɛn nipadua nyinaa mu yiye, a wɔfrɛ no koma mu nsu a ɛba . Ɛwom sɛ ebia ɛbɛyɛ te sɛ nea nsɛmfua yi yɛ foforo kakra ma wo de, nanso nokwarem no, ɛyɛ mmerɛw koraa. Ma yɛnhwɛ nea eyi kyerɛ ankasa, ɛnte saa?

Dɛn ne koma mu ahoɔden a ɛba? Sɛ yɛbɛka no tiawa a...

Sɛ yɛbɛka no tiawa a, koma mu nsu a ɛba no yɛ mogya dodow a wo koma de fa wo nipadua nyinaa mu wɔ simma biako mu nyinaa. Wɔtaa susuw eyi wɔ lita mu. Nnuruyɛfo de nsɛso a ɛnyɛ den na ebu eyi ho akontaa. Ɛhwehwɛ nneɛma abien:

1. Stroke Volume: Eyi ne mogya dodow a wo koma de kɔ wo nipadua mu bere biara a ɛbɔ, kyerɛ sɛ, bere a koma bɔ biako. Saa dodow yi betumi ayɛ soronko. Mogya dodow yi betumi akɔ soro anaasɛ akɔ fam a egyina wo koma akwahosan ne sɛ ebia woregye w’ahome anaasɛ woreyɛ adwuma bi so.

2. Koma a Ɛbɔ: Ebia woate eyi ho asɛm. Eyi ne mpɛn dodow a wo koma bɔ simma biako. Mpɛn pii no, ɛsɛ sɛ obi a ɔwɔ apɔwmuden koma bɔ 60 kosi 100 simma biara bere a ɔregye n’ahome no. Eyi kɔ soro bere a woteɛteɛ w’apɔw mu na ɛso tew bere a woagye w’ahome no.

Enti, sɛ yenim eyinom abien no nyinaa a, yebetumi ahu bo a ɛsom nyinaa denam nsɛso a ɛne Cardiac Output = Stroke Volume x Heart Rate .

Susuw ho saa kwan yi so. Woreforo antweri bi ntɛmntɛm. Wo ntini hia oxygen pii, ɛnte saa? Enti wo koma bɔ kɔ soro, na wo koma bɔ mmɔden sɛ ɛbɛma mogya dodow a ɛbɔ bere koro mu (stroke volume) no akɔ soro. Ɛno ne bere a wo koma mu ahoɔden kɔ soro, efisɛ wo nipadua hia mogya ne mframa pa pii.

Bere bɛn na nnuruyɛfo hwehwɛ koma mu ahoɔden yi?

Okay, afei wowɔ asɛmmisa bi, bere bɛn na nnuruyɛfo hwehwɛ saa koma mu nsunsuanso yi, ɛnte saa? Ntease ahorow bi betumi aba.

• Sɛ ɛyɛ den ma wo sɛ wobɛteɛteɛ w’apɔw mu sɛnea na woyɛ kan no a , anaasɛ ɛyɛ den ma wo sɛ wobɛhome bere a wobɔ mmɔden kakra mpo a.
• Sɛ wo duruyɛfo susuw sɛ wowɔ tebea bi te sɛ koma a entumi nyɛ adwuma yiye , a ɛyɛ tebea a koma no ntumi mfa mogya nkɔ yiye.
• Sɛ ɛho hia sɛ wuhu yare bi pɛpɛɛpɛ a.
• Wɔsusuw eyi nso de hwɛ hu sɛ aduru, mfiri, anaa ayaresa biara a wɔde ama wo no reyɛ adwuma yiye .

Sɛ koma no mu ahoɔden so tew a, sɛnkyerɛnne bɛn na ebetumi aba?

Sɛ mogya dodow a koma no de kɔ nipadua no mu, anaa koma no mu nsu no so tew a, yɛn nipadua no afã horow nnya mframa pa ne aduannuru a ɛdɔɔso. Eyi betumi de yare no ho sɛnkyerɛnne te sɛ:

• Ɛyɛ den yiye sɛ wobɛteɛteɛ w’apɔw mu:Bere a menantew kwan tiaa bi mpo no, me tirim yɛ me yaw na mabrɛ.
• Ɔbrɛ kɛse a wobɛte nka: Ɔbrɛ a wobɛte nka bere a ogyina hɔ ara kwa mpo.
• Wo nsa ne wo nan ho ahonhon: Nan no, titiriw wo nansoaa no, betumi ahonhon.
• Ahome tiaa: Ɛtɔ mmere bi a, ebetumi ayɛ den sɛ wobɛhome bere a woada fam mpo.
• Akisikuru ne ɔfe.
• Yafunu mu yaw.

Sɛ wunya saa sɛnkyerɛnne ahorow yi a, ɛnkyerɛ bere nyinaa sɛ wo koma no ntumi nkɔ nipadua no mu. Nanso, sɛ saa sɛnkyerɛnne ahorow yi kɔ so a, ɛbɛyɛ papa sɛ wobɛhwehwɛ aduruyɛfo afotu.

Ɔkwan bɛn so na nnuruyɛfo susuw sɛnea koma no mu yɛ den? Akwan ahorow pii wɔ hɔ!

Akwan pii wɔ hɔ a nnuruyɛfo fa so susuw sɛnea koma no mu yɛ den. Ebi yɛ mmerɛw koraa, bere a afoforo nso hia nnwinnade soronko. Momma yɛnhwɛ nea wɔyɛ:

• Oxygen dodow a wɔde susuw: Eyi kyerɛ oxygen dodow a akwaa anaa ntini pɔtee bi a ɛwɔ wo nipadua mu de redi dwuma. Wɔnam nsonsonoe a ɛda oxygen dodow a ɛwɔ wo ntini mu ne oxygen dodow a ɛwɔ wo ntini mu ntam a wɔhwɛ so, na afei wɔde ahoɔhare a mogya no kɔ so bu ho akontaa no so na ebu ho akontaa.
• Mogya mu hyew a wɔde toto ho: Wɔde afiri titiriw bi hyɛ koma no afã horow, sɛ nhwɛso no, vena cava anaa nifa so, na wɔde mogya a ɛwɔ hɔ no hyew toto mogya a ɛwɔ ahurututu mu ntini a ɛde mogya kɔ ahurututu mu no mu hyew ho. Wɔsan frɛ eyi thermodilution kwan .
• Nhyɛso ne ahoɔden a ɛko tia a wobɛsusu: Wobetumi ahu eyi denam nhyɛso a ɛwɔ wo ntini mu a wobɛfa (Mean Arterial Pressure) na woakyekyɛ mu denam mogya a ɛko tia mogya a ɛsen fa mogya ntini no mu (Systemic Vascular Resistance) so.
• Mfiri a wotumi fa so: Mfiri a wotumi fa so nso wɔ hɔ a mframa soronko bi wom a wubetumi afa w’ano ahome.
• Electrodes a Wɔde Di Dwuma: Sɔhwɛ bi wɔ hɔ a ɛfa electrode bɛyɛ asia a wɔde bɛto moma so. Eyi susuw koma a ɛbɔ ne nea ɛma obi hwe ase no kɛse, na ebu nea koma no fi mu ba no ho akontaa.
• Transthoracic Echocardiography: Eyi yɛ koma no mu nhwehwɛmu. Ebetumi ama woanya adwene pa wɔ stroke volume ho.
• Koma MRI: Wobetumi nso anya eyi ho nsɛm afi koma no MRI mfonini mu.
• Dye injection: Wɔnam dye soronko bi a wɔde gu koma no nifa so bere a mogya hyɛn mu no, na wɔsusuw dye dodow a efi koma no benkum mu ba no so.

Dɛn na ɛsɛ sɛ wohwɛ kwan bere a woreyɛ sɔhwɛ yi?

Sɛnea ɛbɛyɛ na woahu koma no mu ahoɔden pɛpɛɛpɛ no, ɛho behia sɛ wo duruyɛfo susuw mframa pa dodow a wohome na ogye mogya fi wo ntini mu ne catheter titiriw bi a wɔde ahyɛ w’ahurututu mu ntini mu (Catheter in Pulmonary Artery). Wɔtaa yɛ eyi bere a wɔreyɛ sɔhwɛ bi a wɔfrɛ no Right Heart Catheterization . Da a wɔbɛyɛ sɔhwɛ yi no, wubetumi ahu sɛnea wo koma no yɛ adwuma ne nhyɛso ahorow a ɛwɔ wo koma mu no.

Dɛn na efi mu ba? Dɛn na wɔka kyerɛ yɛn?

Okay, afei momma yɛnhwɛ nea nea afi mu aba yi ka.

Mpɛn pii no , koma mu ahoɔden a obi a ɔwɔ apɔwmuden bere a ɔregye n'ahome no yɛ lita 5 kosi 6 simma biara .

Nanso, wɔ ogumadifo a wɔatete no yiye fam no, saa bo yi betumi aboro lita 35 simma biara bere a wɔreyɛ apɔw-mu-teɛteɛ! Eyi kyerɛ sɛ wɔn koma reyɛ adwuma yiye.

Koma mu ahoɔden kɔ soro bere a obi a ɔnyɛ ogumadifo teɛteɛ n’apɔw mu no, nanso ɛnyɛ kɛse te sɛ ogumadifo. Afei nso, wɔ nyinsɛn mu no, mmea koma mu ahoɔden kɔ soro sen sɛnea ɛte daa , efisɛ saa bere no, ɛna no nipadua ne akokoaa a ɔrenyin no nyinaa hia mogya.

Nneɛma bɛn na ɛka yɛn koma mu ahoɔden?

Ɛnyɛ bere nyinaa na yɛn koma mu ahoɔden yɛ pɛ. Nneɛma pii wɔ hɔ a ɛka no. Momma yɛnhwɛ nneɛma atitiriw a ɛka no:

• Mogya Nhyɛso: Sɛ wowɔ mogya mmoroso a, ɛsɛ sɛ wo koma yɛ adwumaden na ama mogya afa wo ntini mu. Fa no sɛ ɛte sɛ nea wonam mframa a ano yɛ den mu, efisɛ nhyɛso a ɛwɔ wo ntini mu no yɛ kɛse. Afei nso, sɛ wo mogya mmoroso kɔ soro wɔ w’ahurututu mu (ebia esiane akuru a ɛwɔ w’ahurututu mu anaa tebea bi te sɛ emphysema ) a, ɛsɛ sɛ wo koma yɛ adwumaden kɛse na ama mogya akɔ hɔ. Eyi betumi atew wo koma mu ahoɔden so.
• Mpanyinyɛ: Bere a yɛrenyin no, yɛn koma afasu mu yɛ den na ɛyɛ den. Mogya nhyɛ koma no ma ntɛm anaa sɛnea na ɛte kan no. Eyi betumi atew mogya dodow a ɛde kɔ nipadua no mu no so.
• Sɛ komayare asɛe koma no a: Sɛ ɛba saa a, ebia koma no rentumi nkɔ mogya pii sɛnea na ɛyɛ ansa na komayare no reba no. Afei nso, ɔyare mmoawa a ɛba koma ntini a wɔfrɛ no myocarditis mu no betumi atew tumi a koma no tumi de pɔmpɛ no so.
• Koma no nnyigyei a ɛnteɛ, te sɛ atrial fibrillation: Wɔ tebea yi mu no, koma no atifi (atria) no ntumi mfa mogya nkɔ nipadua no mu yiye na mfa nkɔ nipadua no mu fa ase (mitra). Koma mu ahoɔden nso so tew.
• Aortic Stenosis yɛ valve a ɛkɔ aorta no mu a ɛyɛ teateaa:Aorta ne mogya ntini titiriw a ɛde mogya kɔ nipadua no mu. Enti sɛ valve a ɛkɔ hɔ no yɛ teateaa a, entumi mfa mogya a ɛdɔɔso nkɔ nipadua no mu.
• Constrictive Pericarditis: Sɛ kotoku a ɛbɔ koma no ho ban, pericardium , no mu yɛ den a, koma no ntumi nnye n’ahome yiye, nhyɛ mogya ma, na ɛmfa nsu nhyɛ mu yiye. Eyi nso sɛe koma no dwumadi.

Yɛbɛyɛ dɛn ama yɛn koma mu ahoɔden akɔ so ayɛ nea ɛfata?

Okay, seesei yɛnim nea enti a Cardiac Output ho hia ne nneɛma a ɛka no. Enti, dɛn na yebetumi ayɛ na ama akɔ so ayɛ nea ɛfata? Yɛn koma a yɛbɛma ayɛ den na yɛn mogya ntini a ɛyɛ den no ne ade titiriw. Nneɛma bi a ebetumi aboa wɔ saa asɛm no mu ni:

• Apɔw-mu-teɛteɛ daa: Yɛ biribi te sɛ nantew, mmirikatu, anaa sakre so anyɛ yiye koraa no simma 30 da biara.
• Di wo srade dodow so: Tew wo srade "bɔne" (LDL) so titiriw, na ma wo srade "papa" (HDL) dodow nkɔ soro.
• Sɛ wowɔ asikreyare a , ɛho hia sɛ wudi wo duruyɛfo akwankyerɛ akyi na wukura asetra pa mu.
• Tew nnuan a srade wom ne nea wɔayam no so sɛnea wubetumi: Eyinom betumi ama srade ayɛ kɛse wɔ mogya ntini no mu.
• Mu duru a ɛfata a wobɛkɔ so akura mu: Kɛse mmoroso de nhyɛso kɛse ba koma no so.
• Kwati sɛ wode tawa mu nneɛma bedi dwuma: Sigaretnom pira koma ne mogya ntini kɛse.
• Sɛ ɛho hia a, nom nnuru sɛnea wo duruyɛfo kyerɛ no na hwɛ wo mogya mmoroso so.

Nea etwa to no, nneɛma a ɛsɛ sɛ wokae (Take-Home Message) .

Ɛho hia sɛ wo duruyɛfo hu mogya dodow a wo koma bɔ, a wɔfrɛ no koma mu nsu a ɛba . Ebetumi aboa ma woahu yare bi, ahwɛ sɛ ayaresa bi reyɛ adwuma anaa, anaasɛ ama woanya wo koma akwahosan ho adwene.

Sɛ wunya saa nsɛm yi wie a, wo duruyɛfo betumi asi nea eye sen biara a ɛbɛboa wo ho gyinae. Sɛ wunnim biribi ho hwee a, nsuro sɛ wubebisa wo duruyɛfo nsɛm. Dodow a wuhu w’akwahosan ho nsɛm pii no, dodow no ara na hokwan a wowɔ sɛ wubenya nea eye sen biara no yɛ kɛse. Enti, hwɛ wo koma so yiye!

` Koma mu Nneɛma a Ɛba, Koma a Ɛbɔ, Stroke Volume, Koma Akwahosan, Koma a Ɛnyɛ Yiye, Mogya Nhyɛso, Mogya a Ɛkɔ