Tiyeni tiphunzire za opaleshoni yochotsa magazi m'mapapo (Pulmonary Thromboendarterectomy - PTE)

Mwina mwakhala mukuvutika kupuma kwa kanthawi, kapena mukumva kupuma movutikira mukuyenda. Dokotala wanu mwina anakuuzani kuti muli ndi vuto la kuthamanga kwa magazi m'mapapo, lomwe ndi kuchulukana kwa magazi m'mapapo mwanu. Ngati vutoli silingathe kuthetsedwa ndi mankhwala, tikulankhula za opaleshoni yapadera yomwe ingakupulumutseni moyo.

Mwachidule, kodi opaleshoni ya PTE iyi ndi chiyani?

Musachite mantha ndi dzina lalitali lakuti Pulmonary Thromboendarterectomy. Tidzalitcha PTE mwachidule. PTE ndi njira yovuta kwambiri yomwe imachitidwa ndi madokotala odziwa bwino ntchito. Imafuna kuchotsa magazi akale ndi zipsera zomwe zakhazikika m'makoma a mitsempha yayikulu yamagazi yomwe imanyamula magazi kupita kumapapu anu (Pulmonary Arteries).

Tangoganizirani kuti chitoliro cha madzi m'nyumba mwanu chadzaza ndi dothi ndipo madzi sakuyenda. Opaleshoni ya PTE ili ngati kuyeretsa mkati mwa chitoliro ndikupangitsanso madzi kuyenda bwino. Iyi ndiyo njira yabwino kwambiri yochotsera magazi akale komanso olimba omwe sangasungunuke ndi mankhwala. Nthawi zina, opaleshoniyi imatha kuchiritsa vutoli kwathunthu.

Ndi matenda ati omwe amachiritsidwa ndi opaleshoni ya PTE?

Opaleshoni iyi imachitika makamaka kwa anthu omwe ali ndi vuto lotchedwa Chronic Thromboembolic Pulmonary Hypertension (CTEPH) . Dzinali ndi lovuta pang'ono, choncho tiyeni timvetse.

• Chikhalire: amatanthauza "kukhalapo kwa nthawi yayitali."
• Thromboembolic: amatanthauza "chomwe chimachitika chifukwa cha magazi kuundana."
• Kuthamanga kwa Magazi M'mapapo: Izi zikutanthauza "kuthamanga kwa magazi m'mapapo."

Mwachidule, CTEPH ndi pamene magazi kuundana (Pulmonary Embolism - PE) omwe adapangidwa kale m'mapapo sasungunuka bwino, koma m'malo mwake amamatira kumakoma a mitsempha yamagazi m'mapapo, ndikupanga minofu ya zipsera pakapita nthawi, kuletsa kuyenda kwa magazi, zomwe zimapangitsa kuti kuthamanga kwa magazi kukwere m'mapapo.

Kawirikawiri, munthu akakhala ndi magazi oundana (PE) m'mapapo, madokotala amamupatsa mankhwala ochepetsa magazi. Nthawi zambiri, mankhwalawa amasungunula magazi oundana. Koma mwa anthu ochepa kwambiri, pafupifupi 2% - 4%, magazi oundanawa sasungunuka kwathunthu. Amakalamba, amamatira ku makoma a mitsempha yamagazi, ndikutseka njira yoti magazi aziyenda. Izi zimapangitsa kuti mtima ukhale wovuta kwambiri, womwe umapompa magazi kupita ku mapapo. Pakapita nthawi, izi zingayambitse kulephera kwa mtima , kuwonongeka kwa mapapo, komanso mavuto omwe angawopseze moyo.

Ndani akufunika opaleshoni iyi? Kodi aliyense angaichite?

Ngati muli ndi CTEPH, zinthu zingapo zidzaganiziridwa kuti zitsimikizire ngati mungathe kuchita opaleshoniyi.

• Kuopsa kwa zizindikiro zanu.
• Kumene magazi amaundana, momwe afalikira, komanso kuchuluka kwa momwe atsekereza mitsempha ya magazi.
• Zaka zanu, thanzi lanu lonse, komanso momwe mtima ndi mapapo anu akugwirira ntchito.

Malinga ndi madokotala a opaleshoni, ngati magazi oundana awa angathe kuchotsedwa bwino, chithandizo chomwe chingasankhidwe pa CTEPH ndi opaleshoni ya PTE.

Komabe, si aliyense amene ali ndi CTEPH amene angapatsidwe opaleshoniyi. Pafupifupi 40%, kapena anthu anayi mwa khumi, sali oyenera opaleshoniyi. Chifukwa chachikulu cha izi ndi chakuti ndi opaleshoni yovuta kwambiri.

N’chifukwa chiyani opaleshoniyi ndi yovuta kwambiri?

Pa opaleshoni iyi, gulu lachipatala limasamutsa kwakanthawi ntchito ya mtima ndi mapapo anu kupita ku makina odutsa mpweya m'mapapo . Izi zikutanthauza kuti makinawa amapereka mpweya m'thupi lanu ndipo amapompa magazi panthawi ya opaleshoni.

Chofunika kwambiri, panthawi ya opaleshoni, dokotala wa opaleshoni ayenera kuona bwino mitsempha yamagazi yofewa m'mapapo. Kuti achite izi, njira yapadera imagwiritsidwa ntchito kuchepetsa kutentha kwa thupi lanu kufika madigiri 18 Celsius (65 Fahrenheit), kuletsa kuyenda kwa magazi kwa kanthawi (Deep Hypothermic Circulatory Arrest). Thupi limaziziritsidwa mwanjira imeneyi kuti lipewe kuwonongeka kwa ubongo. Njirayi imalola dokotala wa opaleshoni kuchotsa mosamala kwambiri magazi oundana ndi minofu ya zipsera pamalo owonekera bwino, opanda magazi.

Ngati opaleshoni sizingatheke, ndi njira zina ziti zomwe zilipo?

Ngati madokotala asankha kuti simukuyenera opaleshoni ya PTE pazifukwa zilizonse, adzakulangizani njira zina zochiritsira.

• Mankhwala Omwedwa: Pali mankhwala apadera omwe amatha kuchepetsa kuthamanga kwa magazi m'mapapo.
• Balloon Pulmonary Angioplasty (BPA): Izi zimaphatikizapo kugwiritsa ntchito chubu chopyapyala chomwe chimayikidwa kudzera mu mtsempha wa mwendo kuti chifike ku mitsempha yamagazi yotsekedwa m'mapapo, ndikuyidzaza ndi chipangizo chonga baluni kuti chitsegule magazi.

Kodi mumakonzekera bwanji musanachite opaleshoni?

Dokotala wanu adzakupatsani malangizo omveka bwino a momwe mungakonzekerere opaleshoni. Ndikofunikira kwambiri kutsatira malangizo amenewo molondola.

Kodi chimachitika ndi chiyani panthawi ya opaleshoni?

Opaleshoni iyi nthawi zambiri imayamba m'mawa ndipo imatenga pafupifupi maola 6. Mudzapatsidwa mankhwala oletsa ululu kuti musamve chilichonse.

1. Thandizo pa kupuma: Choyamba, chubu chopyapyala (Endotracheal Tube - ETT) chimayikidwa kudzera pakamwa kapena mphuno mwanu, pansi pa chitoliro chanu cha mpweya, ndikulumikizidwa ku makina opumira mpweya (ventilator). Makina awa adzakuthandizani kupuma nthawi yonse ya opaleshoni.

2. Kutsegula chifuwa: Kenako, dokotala adzadula fupa la pachifuwa chanu (sternum) kuti afike pamtima ndi mapapo.

3. Kulumikizana ndi makina odulira: Kenako mudzalumikizidwa ndi makina odulira mtima ndi mapapo. Makinawa adzagwira ntchito ya mtima ndi mapapo panthawi ya opaleshoni.

4. Kuziziritsa thupi: Kenako, kutentha kwa thupi lanu kumatsika pang'onopang'ono kufika madigiri 18 Celsius.

5. Kuchotsa magazi oundana: Pambuyo poziziritsa thupi ndikuletsa kuyenda kwa magazi kwakanthawi, dokotalayo amachotsa mosamala magazi oundana ndi zipsera zomwe zili mkati mwa mitsempha yamagazi ya mapapo pogwiritsa ntchito zida zapadera.

6. Kupatsa Mpumulo: Magazi akachotsedwa, kutentha kwa thupi lanu kumabwerera mwakale ndipo mumachotsedwa mu makina odutsa mpweya. Koma mumakhalabe olumikizidwa ndi chopumira mpweya.

7. Kutseka pachifuwa:Pomaliza, dokotalayo adzatseka chifuwa chanu ndikuyika machubu angapo opyapyala kuti atulutse madzi ochulukirapo omwe angakhale akusonkhana m'thupi lanu.

Kodi chimachitika ndi chiyani pambuyo pa opaleshoni?

Mukatha opaleshoni, mudzalowetsedwa mu chipinda chosamalira odwala kwambiri (ICU) . Mudzakhala mu chipinda chosamalira odwala kwambiri usiku womwewo. M'mawa wotsatira, gulu lachipatala lidzayesa kupuma kwanu. Ngati mungathe kupuma nokha, chopumira mpweya chidzachotsedwa.

Nthawi zambiri mumayenera kukhala m'chipatala kwa masiku 7 mpaka 10. Choyamba mudzakhala mu ICU, kenako mudzasamutsidwira ku chipinda chogona anthu odwala nthawi zonse pamene vuto lanu likukula.

Kuchira kuli ngati kuchira pambuyo pa opaleshoni ya mtima. Mudzatha kuyenda mkati mwa masiku ochepa ndipo pang'onopang'ono mudzatha kugwira ntchito zina. Musanapite kunyumba, mudzayesedwanso kuti muwone ngati mukufuna mpweya.

Kodi ubwino ndi zoopsa za opaleshoni ya PTE ndi ziti?

Ubwino

• Iyi ndiyo njira yokhayo yochiritsira CTEPH kwathunthu .
• Kwa anthu ambiri, opaleshoniyi yayenda bwino, ndipo kupuma ndi mapapo zimakula bwino kwambiri.
• Anthu ambiri omwe ankadalira mpweya asanachite opaleshoni sadzafunikiranso mpweya pambuyo pa opaleshoni.
• Kuwonongeka komwe kumachitika kumbali yakumanja ya mtima chifukwa cha matendawa nthawi zambiri kumasinthidwa.
• Mwayi wopulumuka kwa nthawi yayitali mutachita opaleshoni ndi wokwera kwambiri.

Zoopsa ndi Zovuta

Popeza opaleshoniyi ndi yaikulu, pali zoopsa zina. Komabe, chifukwa cha kupita patsogolo kwa ukadaulo m'zaka zingapo zapitazi, zoopsazi zachepa kwambiri.

• Chiwopsezo cha imfa panthawi ya opaleshoni tsopano chatsika kufika pa 1%.
• Chiwopsezo cha sitiroko ndi pafupifupi 1% - 2%.
• Anthu ena angakhalebe ndi vuto la kuthamanga kwa magazi m'mapapo atachitidwa opaleshoni. Adzafunika kupitiriza kumwa mankhwala.
• Nthawi zina, madzimadzi amasonkhana mozungulira mtima (pericardial effusion) amatha kuchitika.

Ngati mukukumana ndi zizindikiro zotsatirazi, imbani 1990 nthawi yomweyo kapena pitani ku chipatala chapafupi cha Emergency Department (ETU):

• Kupweteka kwambiri pachifuwa
• Kukomoka
• Kupuma movutikira mwadzidzidzi

Zimatenga nthawi yayitali bwanji kuti munthu achire?

Pakapita nthawi, mutha kubwerera ku moyo wabwinobwino. Koma, muyenera kukhala oleza mtima pang'ono.

• Masabata 6 oyambirira: Simungathe kuyendetsa galimoto, kupita kuntchito, kapena kunyamula katundu wolemera makilogalamu oposa 4.5.
• Masabata 7 mpaka 12: Amatha kunyamula makilogalamu 25 (pafupifupi 11 kg).
• Pambuyo pa masabata 12: Zoletsa zonyamula zolemera nthawi zambiri zimachotsedwa.

Anthu ambiri amatha kubwerera ku zochita zawo zachizolowezi mkati mwa miyezi itatu. Kupuma kwanu ndi luso lanu lochita masewera olimbitsa thupi zidzasintha pang'onopang'ono, ndipo mutha kuwona kusintha kwa zaka 4.

Kodi kuyang'aniridwa ndi dokotala kumakhala bwanji pambuyo pa opaleshoni?

Pambuyo pa opaleshoni, muyenera kupitiriza kukaonana ndi dokotala.

• Mudzayesedwa mapapu anu milungu 6 mutachita opaleshoni komanso miyezi 3-6 pambuyo pake.
• Chofunika kwambiri ndichakuti muyenera kumwa mankhwala oletsa magazi kuundana/ochepetsa magazi kwa moyo wanu wonse kuti magazi asaundane.

Ngati muli ndi zizindikiro izi, lankhulani ndi dokotala wanu.

• Ngati ululu sungathe kupirira, kapena ngati ululuwo wachepa kenako n’kuwonjezekanso.
• Ngati kugunda kwa mtima kuli kofulumira kapena kosasinthasintha.
• Ngati bala la opaleshoni lili lofiira, lotupa, lotulutsa mafinya, kapena lili ndi malungo (izi ndi zizindikiro za matenda).

PTE ndi opaleshoni yamtengo wapatali kwambiri yomwe ingapereke moyo wachiwiri kwa munthu amene akudwala CTEPH. Ngakhale kuti ndi opaleshoni yovuta komanso imatenga nthawi yayitali kuti achire, zotsatira zake, zomwe ndi mwayi wokhala momasuka popanda kupuma kachiwiri, ndizosayerekezeka.