E aʻo kākou e pili ana i ke ʻoki kino e wehe i nā ʻōpū koko i loko o nā māmā (Pulmonary Thromboendarterectomy - PTE)

Ua pilikia paha ʻoe i ka hanu ʻana no kekahi manawa, a i ʻole ua manaʻo paha ʻoe i ka hanu ʻole i ka wā e hele ana. Ua haʻi aku paha kāu kauka iā ʻoe he maʻi hypertension pulmonary kou, ʻo ia hoʻi ka hōʻiliʻili ʻana o nā ʻōpū koko kahiko i loko o kou mau māmā. Ke hiki ʻole ke kāohi ʻia kēia ʻano me ka lāʻau lapaʻau, ke kamaʻilio nei mākou e pili ana i kahi ʻoki kino kūikawā e hiki ke hoʻopakele i kou ola.

I ka ʻōlelo maʻalahi, he aha kēia ʻoki PTE?

Mai hopohopo ʻoe i ka inoa lōʻihi ʻo Pulmonary Thromboendarterectomy. E kapa pōkole mākou iā ia ʻo PTE . He hana paʻakikī loa ka PTE i hana ʻia e nā kauka lapaʻau kūikawā. Pili ia i ka wehe ʻana i nā ʻōpū koko kahiko a me nā ʻiʻo ʻeha i hoʻopaʻa ʻia i nā paia o nā kīʻaha koko nui e lawe ana i ke koko i kou mau māmā (nā Pulmonary Arteries).

E noʻonoʻo ua paʻa kahi paipu wai i loko o kou hale i ka lepo a ʻaʻole kahe ka wai. Ua like ke ʻoki ʻana o PTE me ka hoʻomaʻemaʻe ʻana i loko o ka paipu a me ka hoʻomaʻemaʻe hou ʻana i ka wai. ʻO kēia ke ala maikaʻi loa e wehe ai i kēia mau ʻūpā koko kahiko a paʻakikī i hiki ʻole ke hoʻoheheʻe ʻia me ka lāʻau lapaʻau. I kekahi manawa, hiki i kēia ʻoki ke hoʻōla loa i ke kūlana.

He aha nā kūlana i mālama ʻia me ke ʻoki PTE?

Hana nui ʻia kēia ʻoki kino ma luna o ka poʻe me ke ʻano i kapa ʻia ʻo Chronic Thromboembolic Pulmonary Hypertension (CTEPH) . He inoa paʻakikī iki kēia, no laila e hoʻomaopopo kākou.

• Mau loa: ʻo ia hoʻi "e mau ana no ka manawa lōʻihi."
• Thromboembolic: ʻo ia hoʻi "i hana ʻia e ke koko."
• ʻO ke koko kiʻekiʻe o ka puʻuwai: ʻO ke ʻano kēia o ke "koko kiʻekiʻe i loko o nā māmā."

I ka ʻōlelo maʻalahi, ʻo CTEPH ka wā e hoʻoheheʻe pono ʻole ai kahi ʻūpā koko (Pulmonary Embolism - PE) i hana mua ʻia i loko o nā māmā, akā, e pipili ana i nā paia o nā kīʻaha koko i loko o nā māmā, e hana ana i nā ʻiʻo ʻeha i ka hala ʻana o ka manawa, e ālai ana i ke kahe koko, e hoʻonui ai i ke kaomi i loko o nā māmā.

ʻO ka maʻamau, ke loaʻa i kekahi kanaka kahi ʻūlū koko (PE) i loko o nā māmā, hāʻawi nā kauka iā lākou i nā lāʻau hoʻokahe koko. ʻO ka hapa nui o ka manawa, hoʻoheheʻe kēia mau lāʻau i nā ʻūlū koko. Akā i loko o kahi heluna liʻiliʻi loa o ka poʻe, ma kahi o 2% - 4%, ʻaʻole e hoʻoheheʻe loa kēia mau ʻūlū koko. Lilo lākou i ʻelemakule, pipili i nā paia o nā kīʻaha koko, a ālai i ke ala no ke kahe ʻana o ke koko. Hoʻokau kēia i ka nui o ke kaumaha ma ka ʻaoʻao ʻākau o ka puʻuwai, ka mea e pamu i ke koko i nā māmā. I ka hala ʻana o ka manawa, hiki i kēia ke alakaʻi i ka hāʻule ʻana o ka puʻuwai , ka hōʻino ʻana o ka māmā, a me nā pilikia e hoʻoweliweli ai i ke ola.

ʻO wai ka mea e pono ai kēia ʻoki kino? Hiki i nā kānaka a pau ke hana?

Inā loaʻa iā ʻoe ʻo CTEPH, e noʻonoʻo ʻia kekahi mau kumu e hoʻoholo ai inā hiki iā ʻoe ke hana i kēia ʻoki kino.

• Ke koʻikoʻi o kou mau hōʻailona.
• Ma hea kahi o nā ʻūpā koko, pehea ka mamao o ko lākou pālahalaha ʻana, a me ka nui o ko lākou ālai ʻana i nā kīʻaha koko.
• Kou makahiki, ke olakino holoʻokoʻa, a pehea e hana ai kou puʻuwai a me kou mau māmā.

Wahi a nā kauka ʻoki, inā hiki ke wehe palekana ʻia kēia mau ʻūpē koko, ʻo ke ʻano lapaʻau koho no CTEPH ʻo ia ke ʻoki ʻana iā PTE.

Eia naʻe, ʻaʻole hiki i nā kānaka a pau me CTEPH ke hana i kēia ʻoki kino. Ma kahi o 40%, a i ʻole ʻehā o ka ʻumi poʻe, ʻaʻole kūpono no kēia ʻoki kino. ʻO ke kumu nui o kēia, he ʻoki kino paʻakikī loa ia.

No ke aha i paʻakikī ai kēia ʻoki kino?

I loko o kēia ʻoki kino, hoʻoili ka hui lapaʻau i ka hana o kou puʻuwai a me kou mau māmā i kahi mīkini bypass cardiopulmonary . ʻO ke ʻano kēia e hoʻolako kēia mīkini i kou kino me ka oxygen a pamu i ke koko i ka wā o ke ʻoki kino.

ʻOi aku ka mea nui, i ka wā o ke ʻoki ʻana, pono ke kauka ʻoki e ʻike maopopo i nā kīʻaha koko palupalu i loko o nā māmā. No ka hana ʻana i kēia, hoʻohana ʻia kahi ʻano hana kūikawā e hoʻohaʻahaʻa i ka mahana o kou kino i 18 degere Celsius (65 Fahrenheit), e hoʻōki loa ana i ke kahe koko no kekahi manawa (Deep Hypothermic Circulatory Arrest). Hoʻomaʻalili ʻia ke kino ma kēia ʻano e pale aku ai i ka hōʻino ʻana i ka lolo. ʻAe kēia ʻano hana i ke kauka ʻoki e wehe pono i nā ʻōpū koko a me nā ʻiʻo ʻeha ma kahi kahua ʻoki koko maopopo ʻole.

Inā ʻaʻole hiki ke hana ʻoki kino, he aha nā koho ʻē aʻe i laila?

Inā hoʻoholo nā kauka ʻaʻole kūpono ʻoe no ke ʻoki PTE no kekahi kumu, e paipai lākou i nā lāʻau ʻē aʻe.

• Lāʻau lapaʻau waha: Aia nā lāʻau lapaʻau kūikawā e hiki ke kaohi i ke koko i loko o nā māmā.
• ʻO Balloon Pulmonary Angioplasty (BPA): Pili kēia i ka hoʻohana ʻana i kahi ʻōmole lahilahi i hoʻokomo ʻia ma o kahi aʻa koko i loko o ka wāwae e hiki ai i nā kīʻaha koko i paʻa i loko o nā māmā, a me ka hoʻopiha ʻana iā lākou me kahi mea like me ka pōpō e wehe ai i ke kahe koko.

Pehea ʻoe e hoʻomākaukau ai ma mua o ke ʻoki kino?

E hāʻawi kāu kauka iā ʻoe i nā kuhikuhi maopopo e pili ana i ke ʻano o ka hoʻomākaukau ʻana no ke ʻoki kino. He mea nui loa ia e hahai pololei i kēlā mau kuhikuhi.

He aha ka mea e hana ʻia i ka wā o ke ʻoki kino?

Hoʻomaka pinepine kēia ʻoki kino i ke kakahiaka a he 6 mau hola ka lōʻihi. E hoʻomaʻemaʻe piha ʻia ʻoe no laila ʻaʻole ʻoe e manaʻo i kekahi mea.

1. Kōkua me ka hanu ʻana: ʻO ka mea mua, hoʻokomo ʻia kahi ʻōmole lahilahi (Endotracheal Tube - ETT) ma kou waha a i ʻole ihu, i lalo o kou ʻōpū hanu, a hoʻopili ʻia i kahi mīkini oxygen (ventilator). E kōkua kēia mīkini iā ​​ʻoe e hanu i loko o ke ʻoki kino.

2. Ke wehe ʻana i ka umauma: A laila, e ʻoki ke kauka lapaʻau ma kou iwi umauma (sternum) e hiki ai i ka puʻuwai a me nā māmā.

3. Hoʻohui i ka mīkini bypass: A laila e hoʻopili ʻia ʻoe i ka Mīkini Bypass Cardiopulmonary. E hana kēia mīkini i ka hana o ka puʻuwai a me nā māmā i ka wā o ke ʻoki ʻana.

4. Hoʻomaʻalili kino: ʻO ka mea aʻe, e hoʻohaʻahaʻa mālie ʻia ka mahana o kou kino i 18 degere Celsius.

5. Ka wehe ʻana i nā ʻūpā koko: Ma hope o ka hoʻomaʻalili ʻana i ke kino a me ka hoʻōki ʻana i ke kahe koko no kekahi manawa, wehe pono ke kauka ʻoki i nā ʻūpā koko a me nā ʻiʻo ʻeha mai loko mai o nā kīʻaha koko o nā māmā me ka hoʻohana ʻana i nā mea hana kūikawā.

6. Hoʻomehana hou: Ma hope o ka wehe ʻia ʻana o nā ʻūpā koko, hoʻihoʻi ʻia ka mahana o kou kino i ka maʻamau a ua hoʻokaʻawale ʻia ʻoe mai ka mīkini bypass. Akā, pili mau ʻoe i ka ventilator.

7. Pani ʻana o ka umauma:ʻO ka mea hope loa, e pani ke kauka lapaʻau i kou umauma a hoʻokomo i kekahi mau ʻōmole lahilahi e hoʻokahe i kekahi wai keu e hōʻiliʻili ana i loko o kou kino.

He aha ka mea e hana ʻia ma hope o ke ʻoki kino?

Ma hope o ke ʻoki kino, e hoʻokomo ʻia ʻoe i ka ʻāpana mālama koʻikoʻi (ICU) . E noho ʻoe ma ka ICU i kēlā pō. I ke kakahiaka aʻe, e nānā ke kime lapaʻau i kou hanu ʻana. Inā hiki iā ʻoe ke hanu iā ʻoe iho, e wehe ʻia ka ventilator.

ʻO ka maʻamau, pono ʻoe e noho ma ka haukapila no 7 a 10 mau lā. E noho mua ʻoe ma ka ICU, a laila e hoʻoneʻe ʻia ʻoe i kahi keʻena maʻamau i ka wā e hoʻomaikaʻi ai kou kūlana.

Ua like ke kaʻina hana hoʻōla me ka hoʻōla ʻana mai ke ʻoki puʻuwai hāmama. E hiki iā ʻoe ke hele i loko o kekahi mau lā a hiki mālie ke hana i kekahi mau hana. Ma mua o kou hoʻi ʻana i ka home, e loaʻa nō hoʻi iā ʻoe kekahi mau hoʻokolohua e ʻike ai inā pono ʻoe i ka oxygen.

He aha nā pōmaikaʻi a me nā pilikia o ke ʻoki PTE?

Nā Pōmaikaʻi

• ʻO kēia wale nō ke ala e ho'ōla loa ai i ka CTEPH.
• No nā kānaka he nui, ua holomua ke ʻoki kino, a ua holomua nui ka hana hanu a me ka hana māmā.
• He nui ka poʻe i hilinaʻi i ka oxygen ma mua o ke ʻoki ʻana, ʻaʻole lākou e pono hou i ka oxygen ma hope o ke ʻoki ʻana.
• Hoʻohuli pinepine ʻia ka pōʻino i hana ʻia ma ka ʻaoʻao ʻākau o ka puʻuwai e ka maʻi.
• He kiʻekiʻe loa ka manawa kūpono e ola ai ma hope o ke ʻoki ʻana.

Nā Pōʻino a me nā Pilikia

ʻOiai he hana ʻoki kino nui kēia, aia kekahi mau pilikia. Eia nō naʻe, me ka holomua o ka ʻenehana i nā makahiki i hala iho nei, ua hoʻemi nui ʻia kēia mau pilikia.

• ʻO ka pilikia o ka make i ka wā o ke ʻoki ʻana ua emi iho i ka 1%.
• ʻO ka pilikia o ka hahau ʻana ma kahi o 1% - 2%.
• Loaʻa paha i kekahi poʻe kekahi pae o ke koko kiʻekiʻe pulmonary ma hope o ke ʻoki ʻana. Pono lākou e hoʻomau i ka lawe ʻana i ka lāʻau lapaʻau.
• I kekahi manawa, hiki ke hōʻiliʻili ʻia ka wai a puni ka puʻuwai (pericardial effusion).

Inā ʻike ʻoe i nā hōʻailona ma lalo nei, e kelepona koke iā 1990 a i ʻole e hele i ka haukapila kokoke loa ʻo Emergency Department (ETU):

• ʻEha nui o ka umauma
• Ka mae ʻana
• Ka pōkole koke o ka hanu

ʻEhia ka lōʻihi e ho'ōla ai?

Me ka hala ʻana o ka manawa, hiki iā ʻoe ke hoʻi i ke ola maʻamau. Akā, pono ʻoe e hoʻomanawanui iki.

• Nā pule mua 6: ʻAʻole hiki iā ʻoe ke hoʻokele kaʻa, hele i ka hana, a hāpai paha ma mua o 10 paona (ma kahi o 4.5 kg).
• Pule 7 a 12: Hiki ke hāpai a hiki i 25 paona (ma kahi o 11 kg).
• Ma hope o 12 mau pule: Hoʻopau pinepine ʻia nā kapu hāpai kaumaha.

Hiki i ka hapa nui o ka poʻe ke hoʻi i kā lākou hana maʻamau i loko o 3 mau mahina. E holomua mālie ana kou hanu ʻana a me kou hiki ke hoʻoikaika kino, a e ʻike paha ʻoe i nā holomua a hiki i 4 mau makahiki.

Pehea ke ʻano o ka mālama ʻana o ke kauka ma hope o ke ʻoki kino?

Ma hope o ke ʻoki kino, pono ʻoe e hoʻomau i ka ʻike ʻana i ke kauka.

• E loaʻa iā ʻoe kekahi mau hoʻokolohua kūikawā e nānā i kou mau māmā 6 mau pule ma hope o ke ʻoki ʻana a ma waena o 3-6 mau mahina ma hope.
• ʻO ka mea nui loa, pono ʻoe e lawe i nā anticoagulants/nā lāʻau hoʻokahe koko no ke koena o kou ola e pale aku ai i ke kūkulu ʻana o nā ʻōpū koko hou.

Inā loaʻa iā ʻoe kēia mau hōʻailona, ​​e kamaʻilio me kāu kauka.

• Inā ʻaʻole hiki ke hoʻomanawanui i ka ʻeha, a inā e emi ana ka ʻeha a laila hoʻonui hou.
• Inā wikiwiki a ʻano ʻē paha ka puʻuwai.
• Inā ʻulaʻula ka ʻeha ʻoki, pehu, kahe ka pus, a i ʻole he kuni (he mau hōʻailona kēia o ka maʻi).

He ʻoki kino waiwai nui ka PTE e hiki ke hāʻawi i ke ola lua i kahi mea e ʻeha nei i ka CTEPH. ʻOiai he ʻoki kino paʻakikī a lōʻihi ka manawa e hoʻōla ai, ʻo ka hopena o ia mea, ʻo ia ka manawa kūpono e ola kūʻokoʻa me ka ʻole o ka hanu ʻana, he mea waiwai ʻole ia.