Tej zaum koj twb tau hnov txog Atrial Fibrillation (Afib), ib yam mob uas koj lub plawv dhia tsis xwm yeem thiab sai. Tej zaum koj lossis ib tug neeg hauv koj tsev neeg muaj tus mob no. Qhov kev pheej hmoo loj tshaj plaws ntawm Afib yog qhov muaj feem yuav mob stroke ntau dua. Ua ib qho kev daws teeb meem rau qhov no, cov kws kho mob feem ntau sau ntawv kom siv cov tshuaj thinner rau cov ntshav. Tab sis kev noj cov tshuaj no mus sij hawm ntev tsis yooj yim rau txhua tus. Rau cov neeg zoo li no, peb tab tom tham txog ib txoj kev kho mob tshwj xeeb uas tuaj yeem txo qhov kev pheej hmoo ntawm mob stroke.
Hais yooj yim xwb, qhov kev kaw sab laug ntawm lub plawv sab laug (LAA Closure) yog dab tsi?
Yuav kom nkag siab qhov no, cia peb xub kawm txog ib feem me me ntawm peb lub plawv. Hauv chav sab laug sab saud ntawm peb lub plawv, hu ua Left Atrium, muaj ib lub hnab me me zoo li lub hnab tawm. Qhov no yog qhov peb hu ua Left Atrial Appendage (LAA) .
Feem ntau, thaum lub plawv dhia ib lub suab, cov ntshav hauv LAA no raug thawb mus rau lwm qhov ntawm lub plawv. Txawm li cas los xij, rau ib tus neeg uas muaj Atrial Fibrillation (Afib) , lub plawv dhia tsis xwm yeem, yog li cov ntshav hauv lub hnab no hu ua LAA tsis thawb kom raug thiab pib sib sau ua ke. Qhov kev sib sau ua ke ntawm cov ntshav no thaum kawg tuaj yeem hloov mus ua cov ntshav txhaws .
Tu siab kawg li, yog tias cov ntshav txhaws no tawg thiab daig rau hauv cov hlab ntsha uas mus rau lub hlwb, nws tuaj yeem ua rau mob stroke . Kwv yees li 90% ntawm cov neeg mob Afib mob stroke yog tshwm sim los ntawm cov ntshav txhaws uas tsim nyob rau hauv LAA.
Yog li ntawd, hauv kev kho mob no hu ua LAA Closure, lub hnab hu ua LAA qhov twg cov ntshav txhaws tsim tau raug kaw, los ntawm kev phais lossis los ntawm kev phais me me. Tom qab qhov no raug kaw, txawm tias cov ntshav txhaws tsim los, lawv tsis tuaj yeem nkag mus rau hauv cov ntshav. Yog li ntawd, qhov kev pheej hmoo ntawm kev mob stroke raug txo qis heev.
Qhov tseem ceeb yog tias kev kho mob no tsis kho tau Afib, tab sis nws txo qhov kev pheej hmoo ntawm kev mob stroke los ntawm nws.
Txoj kev kho mob no zoo tshaj plaws rau leej twg? Vim li cas ho tsis siv cov tshuaj uas ua rau cov ntshav nyias xwb?
Kev kaw LAA tsis yog kev kho mob rau txhua tus neeg uas muaj feem yuav mob stroke vim yog Afib. Nws yog qhov tshwj xeeb tshaj yog rau cov neeg uas:
- Rau cov neeg uas tsis xav noj tshuaj anticoagulants ntev.
- Cov neeg uas ntog ntau zaus thiab yog li ntawd muaj feem yuav los ntshav ntau dua (vim tias txawm tias raug mob me me los kuj tuaj yeem ua rau los ntshav loj thaum noj cov tshuaj ua kom ntshav nyias).
- Rau cov neeg uas muaj lwm yam kev mob tshwm sim los ntawm cov tshuaj uas ua rau cov ntshav nyias.
- Rau cov neeg uas tsis muaj peev xwm them taus cov tshuaj uas ua rau cov ntshav nyias.
Muaj ntau tus neeg ntsib ntau yam teeb meem thaum noj cov tshuaj thinning ntshav qub xws li Warfarin.
| Teeb meem nrog kev noj tshuaj xws li Warfarin |
|---|
| - Koj yuav tsum mus rau tsev kho mob tsis tu ncua kom kuaj koj cov ntshav kom paub tseeb tias cov tshuaj noj raug. |
| - Qee cov khoom noj uas muaj vitamin K (xws li spinach) yuav tsum tau noj tsawg. |
| - Qhov kev pheej hmoo ntawm kev los ntshav yog siab heev. |
| - Ib txhia neeg lub cev tsis kam noj cov tshuaj no. |
Txawm hais tias muaj cov tshuaj tshiab dua xws li Apixaban thiab Rivaroxaban los xij, lawv tus nqi kim heev thiab kev pheej hmoo ntawm kev los ntshav yog qhov teeb meem rau qee tus neeg. Koj yuav tsum nrog koj tus kws kho mob plawv tham kom txiav txim siab seb kev kho mob twg zoo tshaj plaws rau koj.
Yuav siv cov txheej txheem twg los kaw qhov LAA no?
Muaj ntau txoj kev thiab ntau yam khoom siv rau qhov no. Xav txog nws zoo li kaw lub qhov ncauj ntawm lub raj mis dej, lub cuab yeej no yog siv los kaw lub qhov ncauj ntawm lub hnab no hu ua LAA.
- Cov khoom siv thaiv sab hauv: Cov no zoo li lub kaus me me. Lawv raug ntxig rau hauv lub plawv siv lub catheter thiab siv los kaw qhov qhib ntawm LAA los ntawm sab hauv. Cov khoom siv nrov suav nrog WATCHMAN™ thiab Amulet™.
- Cov khoom siv kaw sab nraud: Qee zaum, thaum lub sijhawm phais plawv lwm yam, LAA tuaj yeem kaw sab nraud nrog ib qho clip (`AtriClip™`) lossis nrog ib txoj xov tshwj xeeb (`Lariat™`).
Txoj kev uas zoo rau koj yog xaiv tom qab kev sib tham ntawm koj thiab koj tus kws kho mob.
Kev npaj rau kev kho mob thiab yuav ua li cas kev kho mob tshwm sim
Ua ntej kev kho mob ...
Ua ntej txoj kev kho mob no, koj tus kws kho mob yuav tsum ntsuas qhov loj thiab cov duab ntawm koj lub LAA. Tsis yog txhua tus neeg lub LAA zoo ib yam. Ib txhia hais tias nws zoo li tis qaib, cactus, lossis paj noob hlis. Qhov no yuav suav nrog Transesophageal Echocardiogram (TEE) (kev ntsuas lub plawv ua los ntawm lub raj hu ua larynx) lossis Cardiac CT scan. Koj kuj tseem yuav raug qhia kom yoo mov (tsis txhob noj lossis haus) ob peb teev ua ntej txoj kev kho mob.
Thaum lub sijhawm kho mob ...
Qhov no ua tau ob txoj hauv kev tseem ceeb:
1. Nrog rau lwm yam kev phais plawv:Yog tias koj tab tom phais mob plawv loj lwm yam, xws li phais bypass, tus kws phais kuj tseem yuav tshem tawm lossis xaws lub LAA kaw tib lub sijhawm.
2. Kev Txhaj Tshuaj Me Me: Qhov no yog txoj kev siv ntau tshaj plaws. Ntawm no, ib lub raj nyias nyias, hu ua catheter, raug ntxig los ntawm koj lub puab tsaig mus rau hauv cov leeg ntshav thiab coj mus txog koj lub plawv. Tom qab ntawd, ib lub cuab yeej xaiv ua ntej raug muab tso rau hauv qhov qhib ntawm LAA thiab kaw kom tiv thaiv cov ntshav txhaws kom tsis txhob tawm mus. Tag nrho cov txheej txheem no yog ua raws li kev coj ua ntawm cov thev naus laus zis X-ray tshwj xeeb (Fluoroscopy) thiab scan (TEE/Intracardiac Ultrasound).
Tom qab kev kho mob ...
- Feem ntau koj yuav tsum tau nyob hauv tsev kho mob ib hmos.
- Yuav muaj kev kuaj TEE dua li ntawm 45 hnub kom pom tias kev kho mob puas ua tiav.
- Koj yuav tau muab tshuaj thinner ntshav thiab aspirin rau koj noj kom txog thaum cov nqaij ntawm lub cev loj hlob ncig lub cuab yeej no, uas yuav siv sijhawm li ib hlis thiab ib nrab.
- Tom qab ntawd, koj yuav tsum tsis txhob noj tshuaj uas ua rau cov ntshav nyias thiab noj Clopidogrel thiab aspirin li ntawm 6 lub hlis. Tej zaum koj yuav tsum noj aspirin mus tas koj lub neej. Tag nrho cov no yuav ua raws li koj tus kws kho mob qhia.
Cov txiaj ntsig thiab kev pheej hmoo ntawm kev kho mob no yog dab tsi?
Ib yam li lwm yam kev kho mob, qhov no muaj ob qho txiaj ntsig thiab kev pheej hmoo.
| Cov txiaj ntsig | Kev Pheej Hmoo/Teeb Meem |
|---|---|
| Txo qhov kev pheej hmoo ntawm mob stroke. | Muaj teeb meem nrog lub cuab yeej mounting. |
| Muaj peev xwm zam tsis txhob noj cov tshuaj uas ua rau cov ntshav nyias ntev (anticoagulants). | Kev tsis haum tshuaj rau tshuaj loog. |
| Rov zoo sai vim tias nws ua tiav los ntawm kev phais me me. | Los ntshav. |
| Txhim kho qhov zoo ntawm lub neej. | Mob hauv siab, kis kab mob. |
| Cov kua dej sib sau ua ke nyob ib puag ncig lub plawv (pericardial effusion). | |
| Ib qho mob uas tsis tshua muaj neeg mob xws li mob stroke. |
Txoj kev kho mob no zoo heev. Raws li qee qhov kev tshawb fawb, txoj kev no tuaj yeem txo qhov kev pheej hmoo ntawm kev mob stroke li ntawm 80%. Tab sis nco ntsoov, nws yog ib qho tseem ceeb uas yuav tsum tham txog txhua yam no nrog koj tus kws kho mob ua ntej txiav txim siab seb qhov no puas yog rau koj.
Kuv yuav tsum mus ntsib kws kho mob thaum twg?
Ntxiv rau qhov mus ntsib koj cov sijhawm teem tseg, qhia rau koj tus kws kho mob tam sim ntawd yog tias koj muaj cov tsos mob hauv qab no:
- Cov cim qhia txog kev kub taub hau lossis lwm yam kev kis kab mob
- Lub plawv dhia tsis xwm yeem
- Mob hauv siab
- Ua pa nyuaj
Yog tias koj muaj ib qho ntawm cov tsos mob no, mus rau chav kho mob ceev (ETU) ze tshaj plaws tam sim ntawd.
Cov Lus Qhia Txog Kev Coj Mus Tsev
- LAA Closure yog kev kho mob rau cov neeg uas muaj Atrial Fibrillation (Afib) kom txo qhov kev pheej hmoo ntawm kev mob stroke.
- Qhov no ua haujlwm los ntawm kev kaw ib lub hnab me me hauv lub plawv hu ua LAA, tiv thaiv cov ntshav txhaws uas tsim nyob ntawd kom tsis txhob nkag mus rau hauv lub cev.
- Txoj kev kho mob no yog lwm txoj hauv kev zoo rau cov neeg uas muaj teeb meem noj cov tshuaj thinner ntev.
- Qhov no yuav tsis kho tau Afib, tab sis nws tuaj yeem tiv thaiv kev pheej hmoo loj tshaj plaws, uas yog mob stroke.
- Tom qab koj nrog koj tus kws kho mob tham txog seb qhov kev kho mob no puas yog rau koj thiab nws cov txiaj ntsig thiab kev pheej hmoo yog dab tsi, txiav txim siab seb qhov kev kho mob no puas yog rau koj.
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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