Koj tus kws kho mob puas tau qhia rau koj tias koj muaj mob Atrial Fibrillation, uas yog lub plawv dhia ceev heev? Tej zaum koj yuav paub tias cov neeg uas muaj tus mob no muaj feem yuav mob stroke ntau dua li lwm tus peb txog tsib npaug. Qhov laj thawj tseem ceeb rau qhov no yog cov ntshav txhaws uas tsim hauv lub plawv. Yog li hnub no peb tab tom tham txog kev kho mob tshwj xeeb uas tau coj kev pab ntau rau ntau tus neeg thiab siv los txo qhov kev pheej hmoo txaus ntshai no.
Hais yooj yim xwb, qhov kev kaw ntawm sab laug Atrial Appendage yog dab tsi?
Zoo, qhov no yuav zoo li lub npe nyuaj, tab sis zaj dab neeg yooj yim heev. Xav txog sab laug atrium, chav sab saud ntawm peb lub plawv. Muaj ib feem me me zoo li lub hnab uas tawm ntawm phab ntsa ntawm chav no. Qhov ntawd yog qhov kws kho mob hu ua Left Atrial Appendage (LAA) .
Feem ntau, thaum lub plawv dhia zoo, cov ntshav ntws mus rau hauv lub hnab no thiab tom qab ntawd tawm dua. Tab sis rau ib tus neeg uas muaj Atrial Fibrillation (Afib), cov chav sab saud ntawm lub plawv tsis ua haujlwm zoo, tab sis hloov chaw tshee. Tom qab ntawd, cov ntshav sib sau ua ke hauv lub hnab ntawd hu ua LAA, thiab cov ntshav txhaws pib tsim. 90% ntawm cov ntshav txhaws uas ua rau mob stroke rau cov neeg uas muaj Afib tsim nyob rau hauv lub hnab me me no hu ua LAA.
Yog li, Kev Kaw Sab laug Atrial Appendage Closure (LAA Closure) yog ib txoj kev phais, lossis ib qho kev txiav me me, uas siv ib qho kev txiav me me los kaw LAA, lub hnab uas cov ntshav txhaws tsim. Thaum qhov no raug kaw, txawm tias cov ntshav txhaws tsim nyob ntawd los xij, lawv tsis tuaj yeem nkag mus rau hauv cov ntshav thiab mus rau lub hlwb. Qhov no txo qhov kev pheej hmoo ntawm kev mob stroke.
Qhov zoo tshaj plaws yog tias kaw qhov no ntawm LAA tsis cuam tshuam rau lwm yam haujlwm ntawm lub plawv. Lub plawv tuaj yeem ua haujlwm zoo yam tsis muaj nws.
Leej twg xav tau kev kho mob no?
Kev kho mob no feem ntau yog pom zoo rau cov neeg uas muaj Atrial Fibrillation (Afib) uas muaj feem yuav mob stroke. Nws yog ib qho kev daws teeb meem zoo rau cov neeg uas muaj teeb meem nrog cov tshuaj thinning ntshav.
Cov kws kho mob feem ntau sau ntawv kom siv cov tshuaj ua kom cov ntshav nyias xws li warfarin (Coumadin®) los txo qhov kev pheej hmoo ntawm kev mob stroke. Tab sis qee tus neeg muaj teeb meem nrog cov tshuaj no:
- Kev kuaj ntshav tsis tu ncua: Koj yuav tsum tau kuaj ntshav tsis tu ncua kom paub tseeb tias koj noj tshuaj kom raug.
- Kev tswj kev noj zaub mov: Tej zaum yuav tsum tau noj qee yam khoom noj, xws li zaub uas muaj vitamin K.
- Kev Pheej Hmoo Los Ntshav: Cov tshuaj no yuav ua rau cov txheej txheem los ntshav qeeb txawm tias raug mob me me los xij. Qhov no muaj kev phom sij rau ib tus neeg uas ntog ntau zaus lossis muaj kev pheej hmoo los ntshav ntawm txoj hnyuv.
- Cov tshuaj no tsis ua haujlwm rau qee tus neeg.
Apixaban (Eliquis®), rivaroxaban (Xarelto®) tsis muaj warfarinTxawm hais tias muaj cov tshuaj tshiab zoo li no los xij, lawv tsis ua haujlwm rau txhua tus. Lawv kim rau qee tus neeg, thiab lawv kuj muaj kev pheej hmoo ntawm kev los ntshav.
Yog li, rau cov neeg uas pom tias nws nyuaj rau txuas ntxiv noj cov tshuaj uas ua rau cov ntshav nyias vim yog cov laj thawj zoo li no, koj tuaj yeem tham nrog koj tus kws kho mob txog kev kho mob hu ua LAA Closure.
Yuav siv cov txheej txheem twg los kaw LAA?
Muaj ntau txoj kev thiab cov cuab yeej siv los kaw qhov no ntawm LAA. Qee qhov ntawm cov no yog:
| Hom ntaus ntawv | Nws ua haujlwm li cas | Piv txwv |
|---|---|---|
| Cov khoom siv uas kaw qhov qhib ntawm LAA | Cov no zoo li lub hau fwj. Lub qhov ncauj ntawm LAA, qhov chaw uas nws txuas rau sab laug atrium ntawm lub plawv, raug kaw nrog lub cuab yeej no. Tom qab ntawd, txawm tias cov ntshav txhaws tsim sab hauv, lawv tsis tuaj yeem tawm los. | WATCHMAN™, Amulet™, WaveCrest™ |
| Clip tuav lub hauv paus ntawm LAA | Qhov no zoo li lub koob dai khaub ncaws. Lub clip no siv los tuav lub LAA rau hauv qhov chaw (ntawm lub hauv paus) thiab kaw nws. | AtriClip™ |
| Cov txheej txheem kaw siv cov loops lossis stitches | Ib txoj hlua khi lossis lub voj tshwj xeeb raug muab tso rau ib puag ncig lub hauv paus ntawm LAA thiab nruj kom kaw nws. | Lariat™, Sierra™ |
Npaj thiab ua qhov kev kho mob
Ua ntej kev kho mob
Ua ntej koj yuav kho qhov teeb meem no, koj tus kws kho mob yuav kuaj koj lub plawv nrog Transesophageal Echocardiogram (TEE).Yuav ua ib qho kev ntsuas hu ua TEE lossis kev ntsuas CT ntawm lub plawv. Kev ntsuas TEE yuav tsum muab ib lub koob yees duab me me ntxig rau hauv txoj hlab pas kom ntsuas tau qhov zoo thiab qhov loj ntawm LAA hauv lub plawv. Qhov no yog vim tias tsis yog txhua tus neeg lub LAA zoo ib yam. Qee tus neeg lub LAA zoo li tis qaib, thaum lwm tus lub LAA zoo li npauj npaim. Daim kev ntsuas no yog siv los xaiv lub cuab yeej thiab qhov loj me uas haum rau koj.
Tsis tas li ntawd xwb, koj yuav raug qhia kom tsum tsis txhob noj thiab haus dej (yoo mov) ob peb teev ua ntej kev kho mob.
Thaum lub sijhawm kho mob
Muaj ob txoj hauv kev tseem ceeb los ua qhov no.
1. Ua tib lub sijhawm nrog lwm yam kev phais plawv: Yog tias koj muaj lwm yam kev phais plawv loj, xws li kev phais bypass, tus kws phais yuav txiav thiab tshem tawm qhov no ntawm LAA tib lub sijhawm, lossis xaws nws kaw.
2. Kev phais mob tsawg kawg nkaus: Qhov no yog txoj kev siv ntau tshaj plaws. Tsis muaj qhov phais loj ntawm no. Qhov no yog qhov tshwm sim:
- Yuav muab ib qho kev phais me me rau ntawm daim tawv nqaij ze ntawm qhov chaw mos, thiab muab ib lub raj nyias nyias hu ua catheter tso rau hauv lub plawv.
- Lub raj no yog ntxig los ntawm sab xis ntawm lub plawv mus rau sab laug ntawm lub plawv, los ntawm ib lub qhov me me hauv phab ntsa ntawm ob lub chambers. (Tsis txhob txhawj, lub qhov no feem ntau yuav kaw nws tus kheej hauv 6 lub hlis).
- Tom qab ntawd lub raj xa dej raug xa mus rau LAA, thiab lub cuab yeej uas tau xaiv ua ntej raug yuam kom kaw lub qhov ncauj ntawm LAA.
- Tag nrho cov no yog ua tiav los ntawm kev saib sab hauv nrog cov scans xws li Fluoroscopy (X-ray video) thiab TEE .
- Thaum ua tiav txoj haujlwm, lub catheter raug coj tawm.
Tom qab kho mob tas lawm, muaj dab tsi tshwm sim?
Yog tias kev kho mob no ua tiav los ntawm kev txiav me me, tej zaum koj tsuas yog yuav tsum tau nyob hauv tsev kho mob ib hmos xwb thiab yuav rov qab mus tsev tau rau hnub tom qab.
Daim phiaj xwm noj tshuaj yuav hloov me ntsis tom qab koj mus tsev.
- Feem ntau, rau 45 hnub thawj zaug , koj yuav raug qhia kom noj tshuaj anticoagulant thiab aspirin. Thaum lub sijhawm ntawd, cov nqaij tawv nqaij yuav tsim nyob ib puag ncig lub cuab yeej, kaw nws kom nruj.
- Thaum koj ua qhov kev kuaj TEE tom qab 45 hnub lawm ces koj paub tseeb tias LAA kaw tag lawm, koj tsis tas yuav noj cov tshuaj uas ua rau cov ntshav nyias. Tom qab ntawd koj yuav tau noj clopidogrel (Plavix®) thiab aspirin rau 6 lub hlis .
- Qee zaum tus kws kho mob qhia kom noj tshuaj aspirin ntev.
Qhov tseem ceeb tshaj plaws yog, tsis txhob tsum noj tshuaj kom txog thaum koj tus kws kho mob hais kom koj tsum. Nco ntsoov mus ntsib kws kho mob raws sijhawm.
Cov txiaj ntsig thiab kev pheej hmoo yog dab tsi?
Ib yam li kev kho mob, muaj cov txiaj ntsig thiab cov kev pheej hmoo me me. Koj tus kws kho mob yuav piav qhia txhua yam no rau koj.
| Cov txiaj ntsig ntawm kev kho mob | Tej Yam Yuav Ua Tau/Teeb Meem |
|---|---|
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Thaum twg koj yuav tsum tau nrog kws kho mob tham?
Yog tias koj muaj ib qho ntawm cov tsos mob hauv qab no tom qab mus tsev tom qab kho mob, qhia rau koj tus kws kho mob tam sim ntawd.
- Kub taub hau los yog lwm yam cim qhia txog kev kis kab mob (o, liab ntawm qhov phais).
- Lub plawv dhia tsis zoo li qub, zoo li lub suab co hauv siab.
- Mob hauv siab hnyav heev.
- Ua pa nyuaj.
Nyob nrog Afib tuaj yeem ua rau koj ntxhov siab, tshwj xeeb tshaj yog tias koj muaj teeb meem nrog koj cov tshuaj thinning ntshav. LAA Closure tsis yog rau txhua tus, tab sis nws yuav yog ib qho kev xaiv rau koj. Yog li ntawd, qhib siab txog nws nrog koj tus kws kho mob plawv, nug koj cov lus nug, thiab txiav txim siab qhov zoo tshaj plaws rau koj.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- Kev kaw lub plawv sab laug (LAA) yog ib txoj kev kho mob zoo los txo qhov kev pheej hmoo ntawm kev mob hlwb hauv cov neeg uas muaj Atrial Fibrillation (Afib).
- Qhov no yog ua los tiv thaiv cov ntshav txhaws kom tsis txhob tsim nyob rau hauv ib lub hnab me me hauv lub plawv hu ua LAA, los ntawm kev kaw lub hnab ntawd.
- Qhov no yuav yog ib qho kev daws teeb meem zoo rau cov neeg uas muaj teeb meem txuas ntxiv noj cov tshuaj thinning ntshav.
- Koj yuav tsum nrog koj tus kws kho mob tham seb qhov kev kho mob no puas yog rau koj.
- Tom qab kho mob tas, nws yog ib qho tseem ceeb heev uas yuav tsum noj koj cov tshuaj raws nraim li koj tus kws kho mob pom zoo thiab mus kuaj mob raws sijhawm.
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Tsis muaj lus teb tau muab tso tawm. Ntxiv koj cov lus tawm ntawm no thawj zaug.
Ntxiv koj cov lus