He okana whakamiharo tō tātou ngākau. He rite ki tētahi papu iti e mahi tonu ana. E whā ngā wāhanga o tēnei papu e āwhina ana ki te tuku toto ki te kotahi te huarahi, e kiia nei e tātou ko ngā takirere ngākau i roto i te rongoā. Whakaarohia te mea ka tupu mēnā ka pakaru tetahi o ēnei tatau, mēnā kāore e tuwhera, e kati tika rānei. Ka whakararuraruhia te rere o te toto puta noa i te tinana, kāore? I tēnei rā, kei te kōrero tātou mō tētahi pokanga uaua engari tino angitu e mahia ana ina mate te takirere aorta, tētahi o ngā takirere matua o te ngākau.
He aha te tikanga Ross?
He pokanga tino motuhake tēnei. E kiia ana tēnei e ngā tākuta he tikanga tāmi-pūkahukahu. He mea tino motuhake tēnei e tupu ana i konei. Ka mahia tēnei pokanga mā te whakamahi i tētahi wāhanga o tōu ake tinana.
Hei whakarāpopototanga, ko ngā mahi matua e rua e puta ana i konei ko:
1. Ka tangohia tō takirere aorta kore mahi, ka whakakapia ki tō ake takirere pūkahukahu hauora.
2. Kātahi ka whakatōkia he takirere pūkahukahu hauora (takirere kaituku) i tangohia mai i tētahi tangata kua mate ki te wāhi takoto kau i reira te takirere pūkahukahu.
Inaianei pea kei te whakaaro koe, "He aha ai? Te tango i tētahi ka tāpiri i tētahi atu, ka tāpiri i tētahi atu ki runga, he ahua uaua rawa atu tēnā, kāore?" Ae, he pono tēnā. Engari he take pai rawa atu mō tēnā. Me titiro tātou.
He aha te hiranga o tēnei pokanga? He aha koe i whakamahi ai i tō ake takirere pūkahukahu?
Ka pupuhihia e tō tātou ngākau te toto ma, he toto whai hāora puta noa i te tinana mā roto i tētahi takirere e kiia nei ko te takirere aorta. Koinei te takirere matua. Koia hoki te takirere e aukati ana i te rere whakamuri o te toto i te wā e patupatu ana te ngākau.
Engari i ētahi wā ka āraia tēnei takirere me te kore e tuwhera tika, e kiia nei e tātou ko te stenosis . Kāore rānei e taea te kati tika, ā, ka turuturu te toto ki muri, e kiia nei e tātou ko te regurgitation . Ki te haere tonu ēnei āhuatanga, he tino teitei te tūponotanga o te ngoikore o te ngakau me te mate.
Nō reira, i roto i tētahi āhuatanga kino pēnei, me tango te takirere pakaru, ka tāuta i tētahi mea hou.
Nā, he aha koe ka whakakapi ai i tō ake takirere pūkahukahu ki tētahi takirere horihori?
He maha ngā take mō tēnei:
- Ātete ki te pēhanga: Kei raro te takirere aorta i te toto toto tiketike. Nō reira, me tino kaha te takirere e whakanohoia ana ki reira. Nā te mea he kiko ora tō takirere pūkahukahu, ka taea e ia te tū atu ki tēnei pēhanga teitei, ā, ka roa ake te mau i ngā takirere horihori.
- He iti ake te mōrearea o te toto totoka: Ina whakauruhia he takirere horihori, he nui ake te mōrearea o te toto totoka. Nō reira, me tango e rātou ngā rongoā whakangawari toto mō te toenga o ō rātou oranga. Engari ina whakamahia ō rātou ake kiko, tata kore rawa taua mōrearea.
- Te wāhi o te takirere pūkahukahu:He iti te pēhanga o te takirere pūkahukahu, nō reira, kāore e tere te pakaru o te takirere i tukuna mai e te tangata kua mate. Waihoki, he tino rite te rahi me te āhua o te takirere aorta me te takirere pūkahukahu.
Hei whakarāpopototanga, ko tā ngā taote pokanga he whakanoho i tō takirere "taketake" kaha rawa atu ki te wāhanga tino nui o te ngākau, te wāhi e taumaha rawa ana, ā, ka whakanoho i tētahi takirere "kaituku" ki te wāhanga e iti rawa ana te taumaha.
Mā wai tēnei pokanga e tino tika, ā, mā wai hoki e kore e tika?
Kāore tēnei pokanga e pai mō te katoa. Ka āta tirohia e ngā tākuta te āhua o te tūroro, ā, ka whakatau mēnā he pai, kāore rānei. Me titiro matatau tātou ki te ripanga i raro nei.
| Ko wai te tangata e tika ana mō tēnei pokanga? | Ngā tāngata kāore e tika ana mō tēnei pokanga |
|---|---|
| Ko te tikanga mō te hunga rangatahi me te hunga pakeke kei raro iho i te 60 tau te pakeke . | Ngā tāngata whai mate pūnaha ārai mate pērā i te lupus me te rumatiki rheumatoid. |
| Mō te hunga e pāngia ana e te stenosis aortic whānau. | Ngā tāngata whai mate hononga honohono pērā i te Marfan syndrome. |
| Mō te hunga e pāngia ana e ētahi atu momo mate takirere aortic. | Ngā tāngata he aukati kei roto i te toru, neke atu rānei o ngā oko toto matua e tuku toto ana ki te ngākau (mate pūkahukahu coronary). |
| Mō te hunga e pāngia ana e te endocarditis o te takirere aortic. | Mō te hunga he mate takirere pūkahukahu tō rātou. |
He aha ngā mea ka tupu i te wā o te pokanga?
He tikanga tino ātaahua, tino tupato hoki te tikanga Ross, e hia ngā hāora te roa. Ka mahia tēnei e tētahi rōpū taote ngakau tohunga. Me titiro tātou ki ngā mea ka puta i te wā o te tikanga.
1. Whakamoemiti: Tuatahi, ka tukuna koe ki raro i te whakamoemiti whānui. Ko te tikanga ka moe hohonu koe tae noa ki te mutunga o te pokanga, nō reira kāore koe e rongo i te mamae. Kāore koe e mahara ki tetahi mea mō te pokanga.
2. Te hono atu ki tētahi mīhini ngākau-pūkahukahu: Muri iho, ka hono atu ngā tākuta i a koe ki tētahi mīhini motuhake e kiia nei ko te mīhini cardiopulmonary bypass. Ka tangohia e tēnei mīhini te mahi a tō ngākau me ō pūkahukahu i te wā e pokanga ana. Mā tēnei ka taea e ngā taote pokanga te mahi haumaru i te pokanga me te kore e aukati i tō ngākau.
3. Te whakatuwhera i te uma: Ka tapahia e ngā taote pokanga te waenganui o tō uma, ka wehea te wheua uma (sternum) kia rua hei uru atu ki te ngākau. Ka kiia tēnei tikanga he sternotomy .
4. Te whakamātautau takirere: Muri iho, ka tirotirohia te takirere pūkahukahu kia kitea ai mēnā kei te ora pai, ā, he pai mō te whakawhitinga hei whakakapi mō te takirere aorta.
5. Whakakapinga takirere: Ki te pai ngā mea katoa, ka tangohia e ngā taote te takirere aorta kua pakaru, ka whakakapia ki tō ake takirere pūkahukahu. Kātahi ka whakatōkia he takirere pūkahukahu hauora mai i tētahi kaituku kua mate ki te wāhi takoto kau i reira te takirere pūkahukahu o mua.
6. Whakaora manawa: Kia tika te whakaurunga o ngā takirere hou e rua, ka tīmata anō tō manawa e ngā taote pokanga. Kātahi ka āta whakamutua tō mahi i te mīhini manawa-pūkahukahu.
7. Tirotiro whakamutunga me te katinga: Ka tirohia anō ngā takirere hou kua whakaurua kia tino tika ai te mahi. Mena ka angitu ngā mea katoa, ka honoa anō te sternum ki ngā waea, ā, ka tuia te tapahi o te uma kia kati.
He aha ngā painga me ngā mōrearea pea o tēnei pokanga?
Pērā i ngā pokanga katoa, he pai, he mōrearea hoki ngā pokanga Ross. Ka taea te whakaiti i ngā mōrearea mā te whai maimoatanga i raro i te mana o tētahi taote pokanga mohio he nui ōna wheako ki tēnei pokanga, ā, e mahi tonu ana i tēnei tikanga.
| Ngā Painga | Ngā Tūponotanga |
|---|---|
| Kāore koe e hiahia ki te tango i ngā rongoā whakaiti toto mō te toenga o tō oranga. | Te whakawhanuitanga o te aorta tata ki te takirere hou kua whakatōkia (te whakawhanuitanga o te aorta). |
| Ka taea e koe te noho ora kaha me te kore he here, mā te mahi i ngā mea pēnei i te whakakorikori tinana me te taraiwa. | Ngā rerekētanga o te pā o te ngakau (Arrhythmia). |
| Ka taea e ngā wāhine e whakamahere ana kia hapu te whānau haumaru i te tamaiti. | Te whakaekenga o te ngākau. |
| He tino pai te rere o te toto puta noa i te tinana (He tino pai te hemodynamics). | Te toto nui rawa (Hemorrhage). |
| I muri tata iho i te pokanga, ka memeha haere ngā tohu, ā, ka tīmata koe te rongo i te tere o te ora . | Te mate urutā. |
| Nā te mea ko tōna ake kiko, he tino pakari tōna. | He turuturu o te takirere ngākau. |
He pēhea te roa o te wā whakaora i muri i te pokanga?
I muri i te pokanga, ka ara ake koe i roto i te ICU o te Ngākau. Mō ngā haora tuatahi, ka honoa pea koe ki tētahi mīhini manawa hei āwhina i a koe ki te manawa. Ka aroturukitia tonutia te mahi a tō ngākau. I te nuinga o te wā ka noho koe ki te ICU mō te 5 rā pea.
E hia pea ngā marama ka roa hei whakaora katoa i muri i tō hokinga ki te kāinga. I tēnei wā, he mea noa te wheako i ngā āhuatanga pēnei i:
- Te kōroke
- Ngā mate hinengaro pēnei i te pouri
- Te kore moe
- Hiahia kai
- Te ngoikore me te pupuhi huri noa i te wahi i tapahia
I tēnei wā, he mea tino nui kia tino whai koe i ngā tohutohu a tō tākuta, kia haere hoki ki ngā wāhi mahi hauora i ngā rā kua whakaritea.
Me whai maimoatanga mō te wā katoa?
Āe. Whai muri i te tikanga Ross, me noho koe i raro i te tirotiro hauora mō te toenga o tō oranga. Me whai matawai koe i ngā wā katoa hei tirotiro kei te mahi tika ngā takirere e rua kua whakatōkia.
Kia maumahara, kāore te whakawhitinga takirere pūkahukahu a te kaituku e roa mō te wā katoa. Tērā pea me whakakapi anō, i muri i te 15-20 tau. Kaua e manukanuka. I ēnei āhuatanga, he maha ngā wā ka whakakapia te takirere e ngā tākuta mā te whakamahi i ngā tikanga iti rawa te whakaekenga, me te kore e tapahia he tapahi nui. Nō reira, he poto ake te wā whakaora.
Āhea koe me toro atu ki te tākuta?
He mea tino nui kia mōhio koe ki ngā tohu o ngā raruraru ina hoki koe ki te kāinga i muri i te pokanga. Mēnā ka pāngia koe e tētahi o ngā tohu e whai ake nei, waea atu ki tō tākuta tonu.
- Mamae o te uma
- Ki te pāngia koe e te kirika, e te makariri rānei
- Ki te pōuri koe, ki te kikorangi rānei ō kanohi
- Ki te maremare koe i te toto
- Mena he marō, he toto rānei ōu, he rerekē te āhua
- Mena ka puta te ruaki
- Ki te ngoikore ō waewae
- Mena he whero kanapa te tūtae
Karere Tangohia ki te Kāinga
- He maimoatanga tino angitu te pokanga Ross mō te hunga e pāngia ana e te mate takirere aorta kino.
- Nā te mea e whakamahia ana tō ake takirere pūkahukahu i konei, he tino pai ngā hua, ā, he roa hoki te wā e mau ana.
- Ko tētahi o ngā painga nui o tēnei pokanga ko te kore koe e hiahia ki te tango i ngā rongoā whakaiti toto mō te toenga o tō oranga.
- I muri i te pokanga, ka taea e koe te noho ora tonu me te kore he arai.
- Nā te mea he pokanga uaua rawa tēnei, he mea tino nui kia rapu maimoatanga mai i tētahi taote pokanga he nui ōna wheako ki tēnei mara.
- Me aroturukitia te hauora me te whakamātautau i muri i te pokanga mō te wa katoa.
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