Me ako tātou mō te pokanga hei tango i ngā toto totoka i roto i ngā pukahukahu (Pulmonary Thromboendarterectomy - PTE)

Tērā pea kua roa koe e uaua ana ki te manawa, kua pōturi rānei tō manawa i a koe e hikoi ana. Tērā pea kua kōrero mai tō tākuta kei a koe te toto toto tiketike, arā, he putunga toto tawhito i roto i ō pukahukahu. Ina kore e taea te whakahaere i tēnei āhuatanga mā te rongoā, kei te kōrero tātou mō tētahi pokanga motuhake hei whakaora i tō ora.

He aha te tikanga o tēnei pokanga PTE?

Kaua e mataku i te ingoa roa ko te Pulmonary Thromboendarterectomy. Ka karanga poto mātou i tēnei ko te PTE . He tikanga tino uaua te PTE e mahia ana e ngā taote pokanga motuhake. Ko te tikanga he tango i ngā toto toto tawhito me ngā kiko whara kua piri ki ngā pakitara o ngā uaua toto matua e kawe ana i te toto ki ō pukahukahu (ngā Pulmonary Artery).

Whakaarohia kua purua he paipa wai i roto i tō whare i te paru, ā, kāore e rere te wai. He rite te pokanga PTE ki te horoi i te roto o te paipa, me te whakahoki anō i te rere o te wai kia maeneene. Koinei te huarahi pai ki te tango i ēnei toto toto tawhito, kua mārō hoki, kāore e taea te whakarewa ki te rongoā. I ētahi wā, ka taea e tēnei pokanga te whakaora katoa i te mate.

He aha ngā āhuatanga e rongoatia ana e te pokanga PTE?

Ko te nuinga o tēnei pokanga ka mahia ki te hunga whai mate e kiia nei ko te Chronic Thromboembolic Pulmonary Hypertension (CTEPH) . He ingoa uaua tēnei, nō reira kia mārama tātou.

• Pūmau: ko tōna tikanga "he roa te wā e mau ana".
• Thromboembolic: ko tōna tikanga "nā te toto totoka i puta mai."
• Te toto toto tiketike o te pūkahukahu: Ko te tikanga o tēnei ko te "toto toto tiketike i roto i ngā pūkahukahu."

Ki te kī māmā noa, ko te CTEPH te wā e kore ai e memeha tika te toto totoka (Pulmonary Embolism - PE) kua hangaia i roto i ngā pukahukahu, engari ka piri ki ngā pakitara o ngā oko toto i roto i ngā pukahukahu, ka hanga he kiko koha i roto i te wā, ka aukati i te rere o te toto, ka piki ake te pēhanga i roto i ngā pukahukahu.

I te nuinga o te wā, ina he toto totoka (PE) kei roto i te pukahukahu o te tangata, ka hoatu e ngā tākuta he rongoā whakangawari toto ki a rātou. I te nuinga o te wā, ka whakarewahia e ēnei rongoā ngā totoka. Engari i roto i te tokoiti o te tangata, tata ki te 2% - 4%, kāore ēnei totoka e memeha katoa. Ka tawhito, ka piri ki ngā pakitara o ngā uaua toto, ka ārai i te rere o te toto. Ka nui te taumahatanga o tēnei ki te taha matau o te ngākau, e pupuhi ana i te toto ki ngā pukahukahu. I roto i te wā, ka arahi pea tēnei ki te ngoikore o te ngākau , te kino o ngā pukahukahu, tae atu ki ngā raruraru e morearea ana ki te ora.

Ko wai e hiahia ana ki tēnei pokanga? Ka taea e te katoa te mahi?

Mena kei a koe te CTEPH, he maha ngā āhuatanga ka whakaarohia hei whakatau mēnā ka taea te mahi i tēnei pokanga.

• Te kaha o ō tohumate.
• Kei hea ngā toto totoka, te tawhiti kua horapa, me te nui kua ārai i ngā oko toto.
• Tō tau, tō hauora whānui, me te mahi a tō ngākau me ō pukahukahu.

E ai ki ngā taote pokanga, mēnā ka taea te tango haumaru i ēnei toto totoka, ko te maimoatanga pai mō te CTEPH ko te pokanga PTE.

Heoi, kāore e taea e te katoa he CTEPH te mahi i tēnei pokanga. Tata ki te 40%, arā, tokowhā i roto i te tekau tāngata, kāore e tika ana mō tēnei pokanga. Ko te take matua mō tēnei he tino uaua te pokanga.

He aha i tino uaua ai tēnei pokanga?

I tēnei pokanga, ka whakawhitihia e te tīma hauora te mahi a tō ngākau me ō pukahukahu ki tētahi mīhini ārai manawa . Ko te tikanga o tēnei, ka tukuna e tēnei mīhini te hāora ki tō tinana, ka pupuhi hoki i te toto i te wā o te pokanga.

Heoi anō, i te wā e pokangahia ana, me mārama te kite a te taote pokanga i ngā oko toto ngawari o roto i ngā pukahukahu. Hei mahi i tēnei, ka whakamahia he tikanga motuhake hei whakaheke i te pāmahana o tō tinana ki te 18 nekehanga Celsius (65 Fahrenheit), ka mutu rawa te rere o te toto mō tētahi wā (Deep Hypothermic Circulatory Arrest). Ka whakamataohia te tinana i tēnei ara hei ārai i te kino o te roro. Mā tēnei tikanga ka taea e te taote pokanga te tango āta i ngā toto toto me ngā kiko whara i roto i tētahi wāhi pokanga mārama, kāore he toto.

Mena kāore e taea te pokanga, he aha atu ngā kōwhiringa kei reira?

Ki te whakatau ngā tākuta kāore koe e tika ana mō te pokanga PTE mō tētahi take, ka tūtohu rātou i ētahi atu maimoatanga.

• Rongoā ā-waha: He rongoā motuhake hei whakahaere i te toto totoka i roto i ngā pukahukahu.
• Angioplasty Pūkahukahu Pōro (BPA): Ko te whakamahi i tētahi ngongo angiangi ka whakaurua mā roto i tētahi uaua i te waewae hei toro atu ki ngā oko toto kua āraia i roto i ngā pukahukahu, ā, ka pupuhihia mā te whakamahi i tētahi taputapu rite ki te pōro hei whakatuwhera i te rere o te toto.

Me pēhea te whakarite i mua i te pokanga?

Ka hoatu e tō tākuta he tohutohu mārama ki a koe mō te whakarite mō te pokanga. He mea tino nui kia whai tika koe i aua tohutohu.

He aha ngā mea ka tupu i te wā o te pokanga?

Ka tīmata tēnei pokanga i te ata, ā, e ono hāora te roa. Ka whakamoea katoatia tō tinana, ā, kāore koe e rongo i tetahi mea.

1. Āwhina ki te manawa: Tuatahi, ka whakauruhia he ngongo angiangi (Endotracheal Tube - ETT) mā tō waha, mā tō ihu rānei, ka heke ki raro i tō puku manawa, ā, ka honoa ki tētahi mīhini hāora (ventilator). Mā tēnei mīhini koe e āwhina ki te manawa puta noa i te pokanga.

2. Te whakatuwhera i te uma: Muri iho, ka tapahia e te taote pokanga tō wheua uma (sternum) kia tae atu ai ki te ngākau me ngā pukahukahu.

3. Hononga ki te mīhini karo: Kātahi ka honoa koe ki te Mīhini Karo Manawa. Mā tēnei mīhini e mahi te mahi a te ngākau me ngā pukahukahu i te wā o te pokanga.

4. Te whakamatao i te tinana: Muri iho, ka whakahekehia mārire te pāmahana o tō tinana ki te 18 nekehanga Celsius.

5. Te tango i ngā toto totoka: Whai muri i te whakamatao i te tinana me te whakamutu i te rere o te toto mō te wā poto, ka ata tangohia e te taote pokanga ngā toto totoka me te kiko whara mai i roto i ngā oko toto o ngā pukahukahu mā te whakamahi i ngā taputapu motuhake.

6. Te whakamahana anō: Kia tangohia ngā toto totoka, ka whakahokia te pāmahana o tō tinana ki te āhua noa, ā, ka momotuhia tō hononga ki te mīhini whakawhiti. Engari ka mau tonu tō hononga ki te mīhini manawa.

7. Te katinga o te uma:Hei whakamutunga, ka kati te taote pokanga i tō uma ka whakauru i ētahi ngongo angiangi hei tango i te wai nui e kohia ana i roto i tō tinana.

He aha ngā mea ka tupu i muri i te pokanga?

I muri i te pokanga, ka whakaurua koe ki te wāhanga tiaki nui (ICU) . Ka noho koe i te ICU i taua pō. I te ata i muri mai, ka tirohia tō manawa e te tīma hauora. Mena ka taea e koe te manawa ko koe anake, ka tangohia te mīhini manawa.

I te nuinga o te wā, me noho koe ki te hōhipera mō ngā rā e whitu ki te tekau. Ka noho koe ki te ICU i te tuatahi, kātahi ka whakawhitia koe ki tētahi wāhanga noa ina pai ake tō āhua.

He rite tonu te tukanga whakaora ki te whakaora i muri i te pokanga ngākau tuwhera. Ka taea e koe te hikoi i roto i ētahi rā, ā, ka taea e koe te mahi i ētahi mahi. I mua i tō hokinga ki te kāinga, ka whakamātauhia hoki koe mēnā e hiahiatia ana he hāora.

He aha ngā painga me ngā mōrearea o te pokanga PTE?

Ngā Painga

• Koinei anake te huarahi hei whakaora katoa i te CTEPH.
• Mō te tini o te tangata, kua angitu te pokanga, ā, kua tino pai ake te manawa me te mahi a ngā pukahukahu.
• He tokomaha te hunga i whakawhirinaki ki te hāora i mua i te pokanga, kāore e hiahia ana ki te hāora i muri i te pokanga.
• Ko te kino i puta mai i te mate ki te taha matau o te ngākau ka hurihia i te nuinga o te wā.
• He tino teitei te tūponotanga kia ora tonu i muri i te pokanga mō te wā roa.

Ngā Tūponotanga me ngā Whakararuraru

He pokanga nui tēnei, ā, kei reira ētahi mōrearea. Heoi, nā te whanaketanga o te hangarau i ngā tau kua pahure ake nei, kua tino whakaitihia ēnei mōrearea.

• Ko te mōrearea o te mate i te wā o te pokanga he iti iho i te 1%.
• Ko te mōrearea o te whiu he tata ki te 1% - 2%.
• Tērā pea kei te pāngia tonu ētahi tāngata e te toto toto tiketike i muri i te pokanga. Me haere tonu tā rātou tango rongoā.
• I ētahi wā, ka puta te kohikohinga wai i te taha o te ngākau (pericardial effusion).

Ki te pāngia koe e ēnei tohu, waea atu ki te 1990 tonu atu, haere rānei ki te Tari Whawhati Tata (ETU) o te hōhipera:

• Mamae nui o te uma
• Te hemo
• Te poto ohorere o te manawa

Kia pēhea te roa o te wā e ora ai?

I roto i te wā, ka taea e koe te hoki ki te oranga noa. Engari, me manawanui koe.

• Ngā wiki tuatahi e 6: Kāore e taea e koe te taraiwa, te haere ki te mahi, te hiki rānei i te taumaha neke atu i te 10 pauna (tata ki te 4.5 kg).
• Wiki 7 ki te 12: Ka taea te hapai i te taumaha tae atu ki te 25 pauna (tata ki te 11 kg).
• I muri i ngā wiki 12: Ka whakakorea ngā here hiki taumaha.

Ka taea e te nuinga o te tangata te hoki ki ā rātou mahi o ia rā i roto i ngā marama e 3. Ka pai haere tō manawa me tō kaha ki te whakakorikori tinana, ā, ka kite pea koe i ngā whakapainga tae atu ki te 4 tau.

He pēhea te tirotiro hauora i muri i te pokanga?

I muri i te pokanga, me haere tonu koe ki te kite i te tākuta.

• Ka whai whakamātautau motuhake koe hei tirotiro i ō pukahukahu i ngā wiki e 6 i muri i te pokanga, ā, i waenganui i ngā marama e 3-6 i muri mai.
• Ko te mea nui rawa atu, me tango e koe ngā rongoā ārai toto/ngā rongoā whakangawari toto mō te toenga o tō oranga hei ārai i te hanganga o ngā toto toto hou.

Mena kei a koe ēnei tohu, kōrero ki tō tākuta.

• Mena he mamae kore e taea te manawanui, ki te iti haere rānei te mamae, kātahi ka nui haere anō.
• Mena he tere, he koretake rānei te pao o te manawa.
• Mena he whero te patunga pokanga, he pupuhi, he pupuhi te wai, he kirika rānei (he tohu mate ēnei).

He tino whai hua te pokanga PTE, ka taea te hoatu he oranga tuarua ki te tangata e pāngia ana e te CTEPH. Ahakoa he pokanga uaua, ā, he roa te wā e ora ai, ko te hua o taua pokanga, arā, ko te whai wāhi ki te noho noa me te kore e whakamomori anō, he mea utu nui.