Ese umutima wawe urimo kubyimbirwa? (Kubyimbirwa kw'imibiri) Reka tuvuge kuri ibi!

Uyu munsi tugiye kuvuga ku kintu cy'ingenzi ku bantu benshi, ariko wenda ntibakizi neza. Ese rimwe na rimwe wumva igituza gifunganye, guhumeka bigoranye? Cyangwa wigeze wumva inshuti yawe ivuga ku ndwara z'umutima? Muri ibyo bihe, kimwe mu bibazo twumva ni ikibazo kijyanye n'imitsi y'amaraso y'umutima cyitwa 'Bifurcation Blockage'. Mu magambo make, iki ni ikibazo kibaho aho ishami ry'imitsi itanga amaraso ku mashami y'umutima. Reka tubirebe mu buryo burambuye, si byo se?

Uku 'gufungana hagati y'ibice bibiri' ni iki?

Noneho reka turebe icyo iyi 'Bifurcation Blockage' ari cyo. Tekereza, umutima wacu umeze nk'ipompo y'amazi. Kugira ngo iyi pompe ikomeze gukora, ikenera amaraso ahoraho. Ayo maraso ajyanwa mu mitsi y'umutima n'uburyo bwihariye bw'imitsi y'amaraso yitwa Coronary Arteries . Iyi mitsi mikuru y'amaraso igabanyukamo amashami mato ahantu hamwe na hamwe, nk'amashami y'igiti kinini gishamikiyeho. Cyangwa, ushobora kubifata nk'aho umuhanda ucikamo kabiri.

Aho umutsi mukuru wigabanyamo ishami rito witwa 'bifurcation' . Rero, niba uku kugabana, mu by'ukuri, kuri ahantu hameze nk'aho hahurira ibintu bifite ishusho ya 'Y', maze hakabaho kuziba imbere mu mutsi bitewe n'ibinure byinshi (tubyita 'plaque' ), icyo gihe byitwa 'bifurcation kuziba' . Iyi 'plaque' ni ububiko bugizwe na cholesterol, ibinure, na kalisiyumu. Abaganga kandi bita iyi mitsi mito y'amashami 'imitsi yo ku ruhande' . Ibinure biteza uku kuziba nabyo byitwa 'ibisebe byo ku ruhande' . Urabyumva? Ni nk'umuvuduko w'imodoka mu ihuriro ry'umuhanda.

Ese hari ubwoko bw'izi mbogamizi?

Yego, uku kuziba kw'imitsi bishobora no kuba mu bwoko butandukanye. Ni ukuvuga ko abaganga bagena uburemere bw'ibi bitewe n'uburyo imitsi iziba. Iyo imitsi ibaye mito, tuyita kandi 'Stenosis' mu buryo bw'ubuvuzi. Hari ubwoko bubiri bw' 'Bifurcation Blockage':

• Gufungana byoroshye: Ibi bibaho iyo munsi ya 70% by'umurambararo w'imbere w'imitsi ufunze. Ibi bivuze ko amaraso atembera neza, ariko hashobora kubaho imbogamizi.
• Gufungana gukomeye: Aha niho ikibazo kirushaho gukomera. Ibirenga 70% by'imitsi, cyangwa ibirenga bitatu bya kane by'imbere mu mitsi, bishobora kuziba. Hari igihe hashobora kuziba ahantu harenze hamwe. Cyangwa amaraso ashobora kugabanuka, cyangwa se calcium ishobora kuba yarakozwe (ibi twita 'calcification').(tuvuge) Urukuta rw'imitsi rushobora kuba rukomeye kandi rutoroshye koroha. Ikindi kintu ni uko, rimwe na rimwe uku kuziba gushobora kuba ahantu umutsi muto w'ishami ukururwa ku nguni ikarishye cyane (dogere zirenga 70). Iyo bibaye, biragoye kuvura, kuko bigoye kuvura hakoreshejwe ibikoresho byo kwa muganga.

Uku 'kuziba kw'ibice bibiri' kukunze kugaragara gute?

Ushobora kuba wibaza uburyo ibi bikunze kugaragara. Mu by’ukuri, bivugwa ko hagati ya 15% na 20% by’indwara zose z’imitsi itera umutima (CAD) zisaba ubufasha kwa muganga, cyangwa hafi umwe muri batanu, ziterwa n’uku 'kuziba kw’imitsi ibiri.' Rero, nubwo bishobora kuba bidakunze kugaragara, ni indwara ishobora kugira ingaruka ku bantu benshi.

Ni iki gitera ibi?

None se, ni iyihe mpamvu nyamukuru y’uku kuziba kw’amaraso? Nkuko nabivuze mbere, impamvu nyamukuru y’ibi ni ukwirundanya kw’amavuta n’ibinure, ni ukuvuga iyo 'plaque' , mu nkuta z’imitsi yacu y’amaraso. Ni nk’umuyoboro w’amazi ushaje uko igihe kigenda gihita ugwa ingese, ukarundanya umwanda ugafunga umuyoboro. Uko igihe kigenda gihita, iyi 'plaque' irarundanya kandi igafunga inzira iri imbere mu mitsi. Hanyuma ingano y’amaraso umutima ukeneye, ni ukuvuga ogisijeni n’intungamubiri, ntitembera neza. Iyi 'Bifurcation Blockage' nayo iri mu bwoko bumwe bw’indwara z’imitsi y’umutima (CAD) .

Ni nde ufite ibyago byinshi byo kurwara iyi ndwara?

Noneho reka turebe abashobora kurwara iyi ndwara, cyangwa se ibintu bishobora gutera iyi ndwara. Ni ngombwa cyane kubimenya, kuko hari ibintu dushobora kugenzura.

Muri rusange, abagore bafite amahirwe menshi yo kurwara indwara ya CAD na Bifurcation Blockage nyuma yo gucura , bivuze ko bahagarika kujya mu mihango buri kwezi, naho abagabo bakaba bafite amahirwe menshi yo kurwara indwara ya CAD nyuma y'imyaka 45.

Byongeye kandi, hari n'ibindi bintu byinshi bishobora gutera ibyago:

• Diyabete Mellitus: Abantu barwaye diyabete bashobora kugira ibibazo by’imitsi y’amaraso kuko diyabete ishobora kwangiza inkuta z’imitsi y’amaraso.
• Umubyibuho ukabije cyangwa umubyibuho ukabije: Iyo ibiro byiyongereye, umutima uragorwa no kubyihanganira kandi ugomba gukora cyane.
• Amateka y'indwara z'umutima n'imitsi mu muryango: Hari igihe ibi bishobora guterwa n'ingaruka z'uturemangingo.
• Umuvuduko ukabije w'amaraso (Hypertension): Umuvuduko ukabije w'amaraso bivuze ko hari umuvuduko uhoraho ku mitsi. Ibi bishobora kwangiza imitsi.
• Kolesteroli nyinshi: Kolesteroli ni yo mpamvu nyamukuru ituma habaho plaque , cyane cyane kolesteroli mbi (LDL) nyinshi.
• Kudakora imyitozo ngororamubiri:Iyo umubiri udafite imyitozo ngororamubiri, uba ushobora kurunda ibinure kandi ubuzima bw'umutima nabwo bugacika intege.
• Indyo mbi: Niba urya buri gihe ibiryo birimo amavuta menshi, isukari n'umunyu mwinshi, ibyago biba byinshi. Tekereza ku biribwa by'imyanda turya, ibiryo byihuse, ibinyobwa birimo isukari, n'ibiryo bikaranze... Iyo ukomeje kurya ibi, ibibazo bishobora kuvuka.
• Kunywa itabi cyangwa gukoresha ibikomoka ku itabi: Kunywa itabi ni kimwe mu byanzi bikomeye by'umutima. Ibinyabutabire biri mu itabi byangiza imiyoboro y'amaraso mu buryo butaziguye.

Ni ibihe bimenyetso by'ibi?

Kubera ko Bifurcation Blockage ari ubwoko bw'indwara y'imitsi itera umutima (CAD) , ibimenyetso birasa. Ariko, rimwe na rimwe iyi ndwara ishobora kubaho nta bimenyetso. Ariko, ibimenyetso bikunze kugaragara ni ibi bikurikira:

• Angina: Iyi ni ukumva ububabare cyangwa gufungana mu gituza, kumva umuntu afunganye. Hari abantu bayivuga nk'umutwaro uri ku gituza, cyangwa nk'aho igituza kirimo gukandamizwa. Ubu bubabare bukunze kwiyongera cyane mu gihe cy'imyitozo ngororamubiri, kuzamuka ingazi, cyangwa iyo umutima ufite igitutu.
• Ibyuya bikonje: Ushobora kumva ubukonje butunguranye ndetse n'ibyuya, cyane cyane iyo ubabara mu gatuza.
• Kuzungera cyangwa kumva ufite umutwe ukeye: Kumva udashobora guhagarara, amaso yawe ahinduka ubururu.
• Umunaniro n'intege nke: Ushobora kumva unaniwe kandi ntushobora gukora ikintu icyo ari cyo cyose. Ushobora kandi kugorwa no gukora imirimo yari yoroshye mbere.
• Umutima utera cyane: Ukumva umutima wawe utera cyane, cyangwa umutima wawe utera cyane, nk'aho igituza cyawe kirimo gutera cyane.
• Isesemi: Kumva urwaye, ndetse ushobora no kuruka.
• Guhumeka nabi: Uba wumva ufite umwuka mubi nubwo wamaze gukora imyitozo mike. Hari igihe ushobora kugira ikibazo cyo guhumeka nubwo waba usinziriye.
• Ububabare ku rutugu cyangwa ku kuboko: Hari igihe ubu bubabare bushobora gutangirira mu gituza bukanyura mu ijosi, mu rwasaya, ku rutugu, cyangwa ku kuboko kw'ibumoso.

Icy'ingenzi: Niba ufite kimwe cyangwa byinshi muri ibi bimenyetso, ntugafate ko ari indwara y'umubiri gusa. Shaka muganga ako kanya.

Abaganga babibona bate?

Iyo ufite ibi bimenyetso, iyo ugiye kwa muganga, ashobora gukora ibizamini byinshi kugira ngo amenye niba ari ikibazo cyo kubura umwuka cyangwa ikindi kibazo cy'umutima. Bimwe muri ibyo birimo:

• Gupima umutima hakoreshejwe catheter na angiogram:Ibi bikubiyemo kohereza umuyoboro muto (catheter) mu mitsi y'amaraso iri mu kuboko cyangwa ku kuguru kwawe ukayishyira mu mitsi y'umutima wawe, kuyitera irangi ryihariye, no gufata amashusho ya X-ray. Ibi bigufasha kubona neza niba hari aho imitsi yazibye n'ingano yayo.
• Angiogramu ya CT ( angiogramu ya CT ikoresha amashusho y’ibice bitatu (3D) kugira ngo harebwe uburyo amaraso atembera mu mutima ndetse niba hari imitsi ifunganye.
• Intravascular optique coherence tomography (IVOCT): Ubu ni uburyo bugezweho cyane. Iyo catheter ikimara gushyirwamo, ikindi gikoresho gito kiranyuzwamo maze plaque ishyirwa mu mitsi y'amaraso, imiterere y'urukuta rw'imitsi, igaragara mu mashusho asobanutse neza kandi asobanutse neza.
• Ultrasound yo mu mitsi (IVUS): Iki kandi ni ikizamini cya ultrasound kireba imbere mu mitsi y'amaraso. Kimwe na IVOC, gishobora gutanga ishusho nziza y'imiterere y'inkuta z'imitsi n'imiterere ya 'plaque'.
• Uburyo bwo kubika amaraso mu mitsi (FFR): Ibi bipima itandukaniro ry’umuvuduko w’amaraso mu mitsi, ku mpande zombi z’aho amaraso yazibye. Bishobora gusuzuma neza ingano y’aho amaraso yazibye no kumenya niba hakenewe kuvurwa.

Ni ubuhe buryo bwo kuvura ibi?

Kuvura 'gufungana hagati y'imitsi' rimwe na rimwe bishobora kugorana. Kubera ko imiyoboro y'amaraso yo ku ruhande navuze ari mito cyane, kandi inguni iva ku mutsi mukuru nayo irahinduka. Bityo rero, kugeraho no kuvura bishobora kugorana kurusha imiyoboro y'amaraso mikuru.

Ubusanzwe abaganga bakora igikorwa cyitwa angioplasty . Ibi bikubiyemo kwagura imitsi ifunganye. Hanyuma, umuyoboro muto witwa stent ushyirwa mu mitsi kugira ngo amaraso akomeze gutembera nta kongera kubyimba. Angioplasty na stent byombi byitwa percutaneous coronary interventions (PCI) .

Muri make, ibi ni byo bibaho mu gihe cyo gupima no gushyira stent mu mwanya wayo:

1. Muganga agukomeretsa gato ku ruhu, haba ku kuboko kwawe cyangwa mu nda yawe, maze ashyiramo katheteri (umuyoboro muto kandi woroshye) ayinyuzamo mu mitsi y'amaraso.

2. Iyi catheter inyuzwa mu mitsi y'amaraso neza ikagera aho umutima wapfunditse. Ibi bikorwa hifashishijwe X-ray.

3. Hari agapira gato ku mpera ya catheter. Iyo kageze aho kafunze, iyo agapira kamaze kwiyongera, plaque ifatiwe muri uwo mutsi ifata ku nkuta z'umutsi, maze umutsi urushaho kuba munini.

4. Hanyuma hari stent.Imwe (haba hejuru y'ibaluni cyangwa ukwayo) ishyirwa mu mutsi, ibaluni irabyimba, hanyuma stent ikandwa ku rukuta rw'umutsi. Hanyuma ibaluni irakurwaho, stent igasigara mu mwanya wayo imbere mu mutsi, bigatuma umutsi udakomeza kugabanuka.

Nyuma y'ubu buvuzi, muganga wawe azaguha ubwoko bw'imiti igabanya amaraso yitwa 'dual anti-platelet therapy' (nka aspirine na clopidogrel) mu gihe runaka kugira ngo wirinde ko amaraso afungana muri stent. Ni ngombwa cyane gufata uyu muti neza nk'uko muganga wawe abikubwira, mu gihe cyose.

Uburyo bwihariye bwo gukoresha stent mu 'kuziba ibice bibiri'

Hari ubwoko bubiri bwa stent zikoreshwa mu kuvura indwara y'imitsi y'umutima (CAD) . Bumwe ni stent y'icyuma idafite ibara . Undi ni stent ikoresha imiti . Iyi stent ikoresha imiti igabanya ibyago byo kongera kugabanuka kw'imitsi (restenosis).

Hari uburyo bwinshi bw'ingenzi bwo gukaraba amenyo bukoreshwa mu kuvura kuziba kw'imitsi ibiri:

• Gutera stent by'agateganyo: Muri ibi, muganga ashyira stent mu mitsi mikuru gusa. Uruhande rw'imitsi ntabwo rugira stent. Ariko, iyo imitsi mikuru ifunze, cyangwa ugakomeza kugira ibimenyetso, stent ishobora gushyirwa muri iyo mitsi nyuma.
• Uburyo bwo gufunga amenyo abiri: Mu gihe hari uburyo bugoye cyane bwo kuziba, cyangwa niba kuziba kw'imitsi y'ishami na byo ari ingenzi, muganga azashyira amenyo mu mitsi mito y'amaraso ndetse no mu mitsi mito y'ishami. Hari uburyo butandukanye bwo kubikoresha (urugero: Culotte, T-stenting, Crush).

Ubu igeragezwa ry’ubuvuzi ririmo gukorwa ku mitsi yihariye y’amashami yagenewe kwinjira muri iyo mitsi mito y’amashami.

Ese ubuvuzi bushobora gutera ingorane?

Hari igihe ingorane zishobora kubaho kuri bamwe, ariko si bose, abantu bagiye bakorerwa angioplasty na stent kubera 'Bifurcation Blockage' . Ingorane ebyiri z'ingenzi ni izi:

• Gusubira inyuma mu mitsi: Ibi bibaho iyo inkovu zivutse aho stent iri, munsi cyangwa imbere muri stent, bigatuma imitsi yongera kugabanuka. Ibi bikunze kubaho mu mezi atandatu kugeza kuri cumi n'abiri nyuma yo gushyirwaho stent. Ibi bibaye, imitsi izakenera kongera kwaguka hakoreshejwe angioplasty cyangwa ubundi buryo bwo kuvura. Imiti igabanya cyane iyi ngaruka.
• Kuziba kw'amaraso mu mitsi: Ibi bibaho iyo amaraso apfunditse aho stent iri no mu mitsi itwara amaraso. Ibi byitwa 'Thrombose'.Iki ni ikibazo gikomeye, kuko iki gice cy'amaraso gishobora kuziba imitsi y'amaraso mu buryo butunguranye bigatuma umutima urwara. Gufata 'uburyo bubiri bwo kurwanya platelet therapy' neza bishobora kugabanya cyane iki kibazo.

Ese ubwo bwoko bw'imizigo ntibushobora kwirindwa?

Ese koko hari ibintu dushobora gukora kugira ngo wirinde ubwo bwoko bw'imiziba? Yego rwose! Gukurikiza izi ntambwe zo kurinda umutima wawe bishobora kugabanya ibyago byo kurwara indwara z'imitsi itera umutima (CAD) na atherosclerosis - indwara aho ibinure byiyongera mu mitsi, bigatuma ibyimba kandi igatakaza ubushobozi bwo kuyihindura.

• Kugenzura umuvuduko ukabije w'amaraso: Ni ngombwa kugabanya umunyu mu mirire yawe, gufata imiti nk'uko muganga yabigutegetse, no gupimwa umuvuduko w'amaraso yawe buri gihe.
• Gabanya kunywa inzoga: Gabanya kunywa inzoga uko bishoboka kose. Irinde kunywa inzoga buri munsi. Niba warazize, shaka ubufasha.
• Kurya indyo yuzuye umutima: Ibi ni ingenzi cyane kugira ngo ugabanye urugero rwa cholesterol. Irinde ibiryo birimo ibinure byinshi, isukari nyinshi, n'ibiribwa byatunganyijwe, kandi urye imbuto nyinshi, imboga, ibinyamisogwe, ibiryo bikungahaye kuri fibre (nk'umuceri w'umukara, oats, na lentils), n'amafi (cyane cyane amafi akungahaye kuri omega-3 nka salmon na mackerel) .
• Menya ibinure byawe: Gabanya kurya ibiryo birimo ibinure byinshi n'ibikomoka ku bimera (urugero: inyama zitukura, inyama zatunganyijwe, ibiryo bitetse, ibiryo bikaranze). Urugero, amavuta ya kokonati si meza kuri wewe urenze urugero. Koresha amavuta meza nka amavuta ya elayo n'amavuta ya canola ku rugero ruciriritse.
• Kugenzura diyabete: Niba urwaye diyabete, ni ngombwa kuyigenzura neza. Indyo, imyitozo ngororamubiri, no gufata imiti yandikiwe na muganga ni ingenzi.
• Irinde kunywa itabi: Niba unywa itabi, shaka ubufasha bwo kurireka. Kuba hafi y'abantu banywa itabi (kunywa itabi ry'inzoga) nabyo bishobora kugira ingaruka mbi.
• Gira imyitozo ngororamubiri: Gukora imyitozo ngororamubiri nibura iminota 30 ku munsi, iminsi 5 mu cyumweru, bishobora gufasha kugumana ibiro byiza no gukomeza umutima wawe. Ushobora gukora ibintu nko kugenda n'amaguru, kugendera ku igare, cyangwa koga.
• Gabanya stress: Gerageza kuruhuka mu mutwe wawe ukoresheje ibintu nka yoga no gutekereza cyane.

Ubuzima bw'umuntu ufite ikibazo cyo kubura ibice bibiri by'umubiri (bifurcation blockage) bumeze bute?

Ubushakashatsi bumwe na bumwe bugaragaza ko igipimo cyo kuvura indwara yo kubura ibice bibiri hakoreshejwe angioplasty na stent ni hafi 40%. Ariko, ibi bishobora gutandukana bitewe n'umurwayi, bitewe n'imiterere y'indwara yo kubura ibice. Ibi bivuze ko hari abantu bashobora kuba bagifite ibimenyetso by'umutima nyuma yo kuvurwa. Kubwibyo, ni ngombwa cyane gukomeza kurinda umutima wawe urya indyo yuzuye umutima, ugabanye ibiro nibiba ngombwa, kandi ugafata imiti wahawe. Ni ngombwa kandi guhora ubonana na muganga wawe kandi ugakorerwa ibizamini bikenewe.

Ni ryari ukwiye kujya kwa muganga?

Niba utekereza gutyo, woweNiba ufite indwara y'umutima (urugero: kubabara cyane mu gatuza, guhumeka nabi, kubira ibyuya, kuruka), hamagara 911 cyangwa serivisi y'imbangukiragutabara iri hafi yawe (urugero: 1990 Suwaseriya). Ntugapfushe ubusa!

Byongeye kandi, gana muganga niba ufite kimwe muri ibi bimenyetso bikomeza cyangwa bikunze kugaragara:

• Kubabara mu gituza (angina) , kubabara ukuboko cyangwa ku rutugu.
• Ibyuya bikonje.
• Kugorwa no guhumeka.
• Umunaniro ukabije cyangwa intege nke nta mpamvu.
• Kuzungera cyangwa kumva umutima utera cyane.

Ni iki ngomba kubaza muganga?

Ni byiza kubaza ibi bibazo igihe ugiye kwa muganga. Ibi bizagufasha gusobanukirwa neza ikibazo cyawe:

• Ni iyihe mpamvu ishobora kuba yaratumye nkora iyi 'Bifurcation Blockage' ?
• Ese ndi mu kaga ko kuziba kw'imitsi y'amaraso mu yindi miyoboro y'amaraso?
• Ni ubuhe buryo bwo kuvura nagirwa inama? Ni ku rugero rungana iki angioplasty na stenting bizafasha mu kugabanya ubu buryo bwo kuziba kw'imitsi?
• Ni ubuhe bwoko bwa stent usaba? (urugero, stent idafite imiti?)
• Nzakenera stenti zingahe?
• Ni izihe ngaruka n'inyungu zo kuvurwa?
• Ni igihe kingana iki ngomba gufata imiti nyuma yo kuvurwa?
• Ni izihe mpinduka ngomba gukora mu mibereho yanjye kugira ngo nkingire umutima wanjye?
• Ni izihe ngorane zishobora kubaho nyuma yo kuvurwa, kandi nkwiye kubyitwaramo nte?

Ikintu cy'ingenzi cyane dushobora kwigira kuri ibi (Ubutumwa bwo kujyana mu rugo)

Kuziba kw'imitsi y'umutima (Bifurcation) ni ukuziba kw'imitsi ifata umutima, bigatuma amaraso atembera mu mutima. Nubwo rimwe na rimwe bishobora kugorana kuvura, hari uburyo bugezweho bwo kuvura nka angioplasty na stent.

Ariko, icy'ingenzi ni ukugerageza gukumira iyi ndwara , ndetse no mu gihe uvurwa, ukinga umutima wawe uhindura imibereho yawe neza (indyo nziza, imyitozo ngororamubiri, no kureka kunywa itabi). Niba ufite ibimenyetso nko kubabara mu gatuza cyangwa kubura umwuka, ni ngombwa gushaka inama kwa muganga utirengagije. Wibuke ko umutima wawe ari wo mutungo wawe w'agaciro kanini! Ni inshingano zawe kuwubungabunga.

Indwara z'umutima, kuziba kw'imitsi ibiri, CAD, angioplasty, stent, ububabare mu gituza, umutima