E noʻonoʻo ʻoe ua like nā kīʻaha koko ma loko o ko kākou kino me kahi pūnaewele o nā alanui ma ke kūlanakauhale. Ma kēia mau alanui e hele ai ke koko, e lawe ana i ka oxygen a me nā meaʻai e pono ai kēlā me kēia cell i loko o ko kākou kino. Ke holo pono nā mea a pau, hana ʻia kēia kaʻa me ke keakea ʻole. Akā he aha ka mea e hana ʻia inā e ālai koke ʻia kēia alanui nui e kahi keakea nui, e like me ka pōhaku nui? Kū loa ke kaʻa, ʻeā? Pēlā nō ka mea e hana ʻia inā hana ʻia kahi clot koko (thrombus) i loko o kekahi o ko kākou mau kīʻaha koko. Hoʻōki kēia i ke kahe koko, e hōʻino nui ana i ke kino i hoʻolako ʻia e kēlā aa koko, a hiki ke hoʻoweliweli i ke ola. I kēia lā, ke kamaʻilio nei mākou e pili ana i kahi ʻoki kūikawā i hana ʻia e hoʻopakele i nā ola ma ia kūlana weliweli.
I ka ʻōlelo maʻalahi, he aha ka Thrombectomy?
He hana ʻoki kino ka Thrombectomy e wehe ai i kahi ʻūpā koko i paʻa i loko o kou kīʻaha koko (he aʻa a he aʻa paha). Ua like ia me ka wehe ʻana i kahi mea i paʻa i loko o kahi paipu wai a hoʻihoʻi hou i ke kahe ʻana. ʻO ka pahuhopu nui o kēia ʻoki kino, ʻo ia ka hoʻihoʻi ʻana i ke kahe koko maʻamau i ālai ʻia e kahi ʻūpā koko.
Hiki i kēia mau ʻūpā koko ke hana ʻia ma nā wahi like ʻole o ko kākou kino. ʻO nā mea maʻamau:
- Ma nā wāwae
- I loko o nā lima
- ʻōpū
- I loko o ka lolo
- I loko o nā māmā
- I loko o ka puʻuwai
I kekahi manawa, pono e hana ʻia kēia ʻoki kino i loko o kekahi mau hola, no ka mea, inā ʻaʻole hana pololei ʻia, nui ka manawa e nalowale ai kahi lālā a i ʻole ke ola.
ʻO wai ka mea e pono ai kēia ʻoki kino?
Inā he ʻūpā koko kou, e hoʻāʻo mua kāu kauka e mālama iā ia me nā lāʻau lapaʻau. No ka laʻana, hiki ke hāʻawi ʻia iā ʻoe nā anticoagulants a i ʻole thrombolytics. Eia nō naʻe, inā ʻaʻole kēia mau lāʻau lapaʻau e kāohi i ke ʻūpā koko, a inā he nui ke ʻūpā koko a i loko o kahi pilikia, hiki i kāu kauka ke hoʻoholo e hana i kahi thrombectomy.
ʻO nā kumu nui no kēia ʻoki kino:
- E pale i nā pilikia e hoʻoweliweli ana i ke ola: Inā hana ʻia kahi ʻaʻa koko i loko o kahi kīʻaha koko nui e alakaʻi ana i ka lolo a i ʻole ka puʻuwai, hiki ke make.
- E hoʻōki mau i ka hōʻino ʻana o ke kino: Inā ʻoki ʻia ke kahe koko i ka lima a i ʻole ka wāwae, e hoʻomaka ka make ʻana o nā ʻiʻo o kēlā kino. Inā ʻaʻole hoʻihoʻi koke ʻia ke kahe koko, hiki i ke kino ke kīnā a pono paha e ʻoki ʻia.
- E pale i ka embolus: ʻO kēia ka wā e haki ai kahi ʻūpā koko i hana ʻia ma kekahi wahi, hele pū me ke koko, a paʻa i kahi ʻāpana ʻē aʻe o ke kino, no ka laʻana, i loko o nā māmā. He kūlana weliweli loa nō hoʻi kēia.
Aia kekahi mau kumu e ʻole ai e hana i ke ʻoki thrombectomy?
ʻAe, ʻaʻole hiki i nā kānaka a pau ke hana i kēia ʻoki kino. I kekahi mau hihia, ʻoi aku ka nui o ka pōʻino o ka hana ʻana i kēia ma mua o nā pono. Inā loaʻa iā ʻoe kekahi o kēia mau kūlana, hiki i kāu kauka ke hoʻoholo ʻaʻole e hana i kēia ʻoki kino:
- Inā aia ke koko i kahi paʻakikī loa e hiki aku ai me ke ʻoki ʻana.
- Inā aia ke koko i loko o kahi kīʻaha koko liʻiliʻi loa , ʻo ke hoʻokomo ʻana i nā mea hana i loko o ia wahi e wehe ai i ke koko hiki ke hōʻino i ke aʻa koko ponoʻī.
- Inā hiki iā ʻoe ke kaohi maikaʻi i kou coagulation koko me ka lāʻau lapaʻau .
- Inā he maʻi koko mua kou.
- Inā he kahe koko i loko o ka lolo (hemorrhagic intracranial) .
- Inā he koko kiʻekiʻe kou, ʻaʻole hiki ke hoʻomalu ʻia me ka lāʻau lapaʻau.
- Inā ʻoi aku ka lōʻihi o ke koko ma mua o 30 mau lā a he maʻi mau .
ʻO ka mea nui loa, ʻo ke kauka wale nō e nānā pono ana i kou kūlana olakino e hiki ke hoʻoholo inā pono ʻoe i kahi thrombectomy a i ʻole.
Nā kūlana nui i mālama ʻia me ka thrombectomy
Hoʻohana ʻia kēia ʻoki kino no nā ʻano maʻi like ʻole. E nānā kākou i ko lākou ʻano.
| Kūlana | He wehewehe maʻalahi |
|---|---|
| ʻO ka Thrombosis Vein Hohonu (DVT) | Ka hoʻokumu ʻia ʻana o kahi ʻaʻa koko i loko o kahi aa koko hohonu i loko o ke kino (pinepine i ka wāwae). |
| ʻO ka Ischemia Limb Koʻikoʻi | He ālai koke ʻia e kahi ʻaʻa koko o kahi aʻa e hoʻolako ana i ke koko i ka lima a i ʻole ka wāwae. |
| Hahau | Ka hōʻino ʻana i kahi ʻāpana o ka lolo ma muli o ke ālai ʻana o kahi ʻaʻa koko i kahi kīʻaha koko e hoʻolako ana i ke koko i ka lolo. |
| Hoʻouka Puʻuwai (Myocardial Infarction) | Ka ālai ʻana o nā aʻa coronary e hoʻolako koko i ka puʻuwai ma o kahi ʻaʻa koko. |
| ʻO ka Embolism Pulmonary | ʻO kahi ʻūpē koko i hana ʻia ma kahi ʻē aʻe o ke kino (pinepine ma ka wāwae) e hemo a paʻa i loko o kahi aʻa koko i loko o nā māmā. |
| ʻO ka Ischemia Mesenteric ʻoi loa | Ka pale koke ʻana o kahi aa koko e hoʻolako ana i ke koko i nā ʻōpū. |
He aha nā ʻano o nā ʻokiʻoki thrombectomy?
ʻElua mau ʻano nui o ka hana ʻana i kēia ʻoki kino. E nānā kākou i nā ʻokoʻa ma waena o nā mea ʻelua.
| ʻOki kino / Thrombectomy hāmama | ʻO ka Thrombectomy Percutaneous / Minimally Invasive |
|---|---|
| Ma kēia ʻano, ʻoki ke kauka lapaʻau i ka ʻili ma luna o ke aʻa koko kahi i loaʻa ai ke koko, wehe i ke aʻa koko, a wehe pololei i ke koko. ʻOi aku ka pololei, ʻoki ʻia ke aʻa koko, hoʻokomo ʻia kahi mea liʻiliʻi e like me ka pōpō i loko, a huki ʻia ke koko i waho. A laila humuhumu hou ʻia ke aʻa koko. | ʻAʻole pili kēia i kahi ʻoki nui. Hana ʻia kahi lua liʻiliʻi ma ka ʻili, a hoʻokomo ʻia kahi ʻōmole lahilahi loa i kapa ʻia he catheter i loko o ke kīʻaha koko. A laila, me ka hoʻohana ʻana i nā ʻano hana kiʻi e like me nā X-ray, alakaʻi ʻia kēia ʻōmole i kahi o ke koko i hoʻopili ʻia. Ma laila, hoʻohana ʻia nā lako kūikawā e wāwahi i ke koko i mau ʻāpana a i ʻole e omo iā ia e like me ka mīkini hoʻomaʻemaʻe. |
| Hana pinepine ʻia kēia ma lalo o ka anesthesia laulā. | Hana pinepine ʻia kēia ma ka hāʻawi ʻana i ka mea maʻi i kahi mea hoʻomaha (sedation). ʻAʻole koi ʻia kahi anesthesia nui. |
He aha kāu e hana ai ma mua o ke ʻoki kino?
I kekahi manawa hana ʻia kēia ma ke ʻano he ʻoki kino ulia pōpilikia, no laila ʻaʻole paha ʻoe e loaʻa ka manawa e hoʻomākaukau ai. Eia nō naʻe, inā he ʻoki kino i hoʻolālā ʻia, e haʻi aku kāu kauka iā ʻoe i kēia mau mea:
- Nā hoʻokolohua kiʻi: Hiki iā lākou ke kauoha i nā hoʻokolohua e like me ka ultrasound, MRI, a i ʻole CT scan e ʻike i ka nui a me kahi o ke koko koko.
- Ke haʻalele ʻana i ka puhipaka: Inā he mea puhipaka ʻoe, pono ʻoe e haʻalele koke ma mua o ke ʻoki ʻana. Hiki i ka puhipaka ke hana i nā pilikia ma hope o ke ʻoki ʻana.
- Ke hoʻōki ʻana i kekahi mau lāʻau lapaʻau: Pono ʻoe e haʻi i kāu kauka e pili ana i nā lāʻau lapaʻau āpau āu e lawe nei, me nā huaora a me nā lāʻau lapaʻau lāʻau. Hiki ke noi ʻia ʻoe e hoʻōki i ka lawe ʻana i nā lāʻau hoʻokahe koko (anticoagulants) i kekahi mau lā ma mua o ke ʻoki ʻana.
He aha ka mea e hana ʻia i ka wā o ke ʻoki kino?
Hiki ke ʻokoʻa kēia kaʻina hana ma muli o ke ʻano o ke ʻoki kino āu e hana nei. Ma muli o ka nui a me kahi o ke koko i hoʻopaʻa ʻia, hiki i ke kaʻina hana ke hala i hoʻokahi hola a i ʻole kekahi mau hola. Ma ke ʻano laulā, penei ka mea e hana ʻia:
1. Anesthesia/Sedation: E hoʻokomo ʻia ka anesthesia a i ʻole ka mea hoʻomaha i loko o kahi aa koko ma kou lima i ʻole ʻoe e ʻeha.
2. ʻOki/ʻoki ʻana: I ke ʻoki pololei ʻana, ʻoki ʻia ka ʻili ma kahi o ke kīʻaha koko. I ke ʻano ʻoki liʻiliʻi, hana ʻia kahi puka liʻiliʻi ma o ka ʻili a hiki i ke aʻa koko.
3. Cannulation (ʻano hana Percutaneous): Hoʻokomo ʻia ka cannula (catheter) a me nā uea i loko o ke aʻa ma o ka lua a alakaʻi ʻia i kahi o ke koko i ka wā e nānā ana i ke kiʻi.
4. Ka wehe ʻana i ke koko ʻūlū: I ke ʻoki pololei ʻana, huki ʻia ke koko ʻūlū me kahi cannula balloon. Ma nā ʻano hana ʻē aʻe, kuʻi ʻia ke koko ʻūlū, hoʻoheheʻe ʻia, a omo ʻia paha me nā mea hana kūikawā.
5. Pani ʻana: I ke ʻoki pololei ʻana, ua humuhumu ʻia ke kīʻaha koko a me ka ʻili i ʻoki ʻia. Ma ke ʻano ʻē aʻe, ua wehe ʻia ke cannula a ua hoʻopaʻa ʻia ka lua a i ʻole e hoʻohana ʻia kahi mea kūikawā (mea pani vascular) e pani i ka lua.
He aha ka mea e hana ʻia ma hope o ke ʻoki kino? A he aha nā pilikia?
Ma hope o ke ʻoki kino, e lawe ʻia ʻoe i kahi keʻena nānā a e nānā pono ʻia kāu mau hōʻailona koʻikoʻi (ke koko, ka helu o ka puʻuwai, a me nā mea ʻē aʻe). Hiki i kekahi poʻe ke hoʻi i ka home i ka lā hoʻokahi. Akā, pono kekahi poʻe e noho i ka haukapila no kekahi mau lā. Aia ia i kou kūlana.
Ma kou ala e hoʻi ai i ka home, e haʻi aku ke kauka iā ʻoe e pili ana i kēia mau mea:
- Pehea e mālama ai i ke ala ʻoki.
- Nā lāʻau lapaʻau e lawe ai a me nā lāʻau lapaʻau ʻaʻole e lawe.
- Āhea e hiki ai ke hoʻomaka hou i ka hana maʻamau?
E like me nā ʻoki kino āpau, loaʻa i ka thrombectomy kekahi mau pilikia, akā he liʻiliʻi kēia mau pilikia i ka hoʻohālikelike ʻia me ka pōʻino i hana ʻia e ka loaʻa ʻana o kahi ʻūpā koko.
E nānā kākou i nā pono nui a me nā pilikia.
| Nā Pōmaikaʻi | Nā Pōʻino |
|---|---|
| ʻO ka hiki ke hoʻōla i nā ola. | Ka hōʻino ʻana i ke kīʻaha koko a i ʻole kona ʻūlū ʻana (stenosis). |
| Ke pale nei i ka nalowale ʻana o kahi lālā, e like me ka lima a i ʻole ka wāwae. | Ke kahe koko nui ʻana. |
| Ka hoʻēmi ʻana i ka hōʻino ʻana o ka lolo i hoʻokumu ʻia e nā kūlana e like me ka maʻi lolo. | Ka hōʻiliʻili ʻana o ke koko ma lalo o ka ʻili (Hematoma). |
| Hoʻihoʻi koke i ke kahe koko a hoʻōki i ka hōʻino ʻana i nā ʻōpū. | Nā kūlana maʻi. |
| Wehe ʻia kahi ʻūpā koko a paʻa i loko o nā māmā (pulmonary embolism). | |
| ʻO kekahi ʻūpā koko. |
Nā kūlana pilikia e pono ai ke kipa ʻana i ke kauka
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona ma hope o kou hoʻi ʻana i ka home mai ke ʻoki ʻana, pono ʻoe e kāhea koke aku i kāu kauka me ka hoʻokaʻulua ʻole . A i ʻole, e hele i ka Emergency Department (ETU) o ka haukapila kokoke loa.
- Ke kahe ʻana o ke koko: Inā he kahe koko mai ka wahi i ʻoki ʻia ai.
- ʻEha umauma: Inā ʻoe e manaʻo koke i ka ʻeha o ka umauma a i ʻole ka paʻa.
- Paʻakikī ka hanu ʻana (dyspnea): Inā paʻakikī koke ʻoe i ka hanu ʻana.
- Huikau: Inā manaʻo ʻoe ua poniuniu a poʻo māmā paha, a inā paha ʻoe e like me ka nalowale ʻana o ka ʻike.
- Poniuniu a nalowale paha ke kaulike: Inā manaʻo ʻoe ua poniuniu a paʻakikī ke hele wāwae.
- Kuni: Inā he kuni kou, he hōʻailona paha ia o kahi maʻi.
- ʻEha, pehu, a ʻeha paha i nā lima a i ʻole nā wāwae.
- Puka mai kahi wai e like me ka pea mai ka ʻoki ʻana.
Hiki i kēia mau hōʻailona ke hōʻailona o kahi pilikia koʻikoʻi, no laila mai hoʻowahāwahā iā lākou.
Leka Lawe-Home
- He mea nui ka Thrombectomy, kahi e wehe ai i ke koko i paʻa i loko o ke kīʻaha koko ma ke ʻoki ʻana.
- ʻAʻole pono kēia ʻoki kino i nā ʻōpū koko āpau. Hiki ke mālama ʻia ka hapa nui me ka lāʻau lapaʻau. Hana ʻia kēia ʻoki kino i nā hihia pilikia a koʻikoʻi.
- ʻElua mau ʻano nui o ka hana ʻana i kēia ʻoki kino (ʻoki kino pololei a me ke ʻoki kino minimally invasive). Na kāu kauka e hoʻoholo i ke ʻano hana kūpono loa iā ʻoe.
- He mea nui loa ka hahai pono ʻana i nā ʻōlelo a ke kauka (nā lāʻau lapaʻau, nā hoʻololi ʻana i ke ʻano o ka nohona) i mea e pale ai i ke kūkulu hou ʻana o nā ʻūpā koko ma hope o ke ʻoki ʻana.
- E makaʻala i nā hōʻailona e hiki mai ana ma hope o ke ʻoki kino. Inā ʻike ʻia kekahi mau hōʻailona o ia ʻano, e ʻimi koke i ke kōkua lapaʻau.
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