Kunzima kangakanani ukuvaleka kwemithambo yenhliziyo yakho? (I-Fractional Flow Reserve - FFR) Ake sithole ngokuhlolwa!

Usola ukuthi unesifo senhliziyo? Noma ingabe udokotela wakho ukhulume ngokuvaleka kwemithambo yakho yenhliziyo? Kungenzeka ukuthi uke wezwa ngalolu vivinyo olubizwa ngokuthi i-Fractional Flow Reserve, noma i-FFR ngamafuphi. Nakuba kungase kuzwakale njengegama eliyinkimbinkimbi, luwuvivinyo olubaluleke kakhulu. Ngakho-ke, ake sixoxe ngalo namuhla ngesiSinhala esilula nesiqondakalayo.

Kuyini i-Fractional Flow Reserve (FFR)?

Kalula nje, i-(FFR) iyindlela yokulinganisa ukuthi i-stenosis inzima kangakanani, okungukuthi, ukuthi ivimbela kangakanani ukugeleza kwegazi, uma kukhona ukuvaleka endaweni ethile emithanjeni yenhliziyo enikeza igazi enhliziyweni yakho. Cabanga ukuthi lapho ipayipi lamanzi livalekile, isivinini kanye nokucindezela kwamanzi kuyehla, akunjalo? Ngendlela efanayo, lapho i-artery yenhliziyo ivalekile, ukucindezela kwegazi eligeleza kuyo kuyehla. Lokho okwenziwa yilolu vivinyo (FFR) ukukala lowo mehluko wokucindezela bese uthola ukuthi ukuvaleka kungakanani.

Odokotela bavame ukwenza lokhu kuhlolwa (i-FFR) ngesikhathi sokuhlolwa kwenhliziyo nge-catheterization noma i-coronary angiogram. Imiphumela yalokhu kuhlolwa isiza ekunqumeni ukuthi hlobo luni lokwelashwa okufanele uluthole (isibonelo, ukuthi kufanele uthathe imithi yodwa noma i-angioplasty kanye ne-stent). Lokhu kuhlolwa okubaluleke kakhulu okungakusiza ukuthi wenze izinqumo ezibalulekile.

Kudingeka nini ukuhlolwa kwe-FFR?

Akuwona wonke umuntu okuzodingeka enze lokhu kuhlolwa. Udokotela uzonquma ukwenza lokhu kuhlolwa (i-FFR) ezimweni ezimbalwa ezikhethekile.

• Uma izithombe zemithambo yakho yenhliziyo zibonisa ukuthi phakathi kuka-50% no-70% wobubanzi bomthambo kuvinjiwe (stenosis), lokhu kuhlolwa (FFR) kungasho ukuthi lokho kuvinjelwa kuvimbela kangakanani ukugeleza kwegazi.
• Ngezinye izikhathi, noma ngabe kukhona ukuvaleka okukhulu kwemithambo yegazi engaba ngu-90%, lokhu kuhlolwa kwenziwa ukuze kuhlolwe ngokunembile ubukhali bayo.

Kodwa-ke, uma ukuvaleka kwemithambo yakho yegazi kungaphansi kuka-30% noma ngaphezulu kakhulu kuka-70%, lokhu kuhlolwa ( i-FFR) ngokuvamile akudingeki. Ngoba uma ukuvaleka kuncane kakhulu (ngaphansi kuka-30%) khona-ke ukwelashwa (njengokwenza i-angioplasty) akunakwenzeka ukuthi kudingeke. Uma ukuvaleka kukhulu kakhulu (ngaphezu kuka-70%), ukwelashwa kuyadingeka nakanjani. Lokho i-(FFR) ekwenzayo ukusiza ekwenzeni isinqumo esifanele kulezo zimo eziphakathi.

Okubalulekile: Uma uke wahlinzwa i-angioplasty kanye ne-stent emithanjeni yakho, lokhu kuhlolwa (i-FFR) kungasiza futhi ekubikezeleni amathuba okuhlaselwa yinhliziyo okukhulu esikhathini esizayo.

Ingabe kukhona okungalungile ngalolu vivinyo (i-FFR)?

Njengazo zonke izivivinyo zezokwelapha, kunezinto ezincane okufanele uzicabangele.

• Ngezinye izikhathi, umphumela ojwayelekile oyiphutha ungaba khona. Lokhu kusho ukuthi empeleni kunenkinga, kodwa ukuhlolwa kungase kungayiboni. Esinye isizathu sokuthi lokhu kungenzeka uma imithambo yakho yegazi emincane kakhulu (ama-coronary arterioles) ingaphenduli kahle emuthini onikezwe ngesikhathi sokuhlolwa ukuze kwandiswe imithambo yegazi yakho.
• Futhi, ubude bendawo encishisiwe emthanjeni buthinta nenani le-FFR.

Njengoba udokotela wakho ezazi kahle zonke lezi zinto, uzothatha izinqumo ngemva kokucabangela zonke lezi zinto.

Kuyini (iFR) kanye (FFR)? Uyini umehluko phakathi kwalokhu okubili?

Kungenzeka ukuthi uke wezwa ngento ebizwa ngokuthi (iFR). (iFR) imele (isilinganiso esingenawo amagagasi ngokushesha). Zombili (iFFR) kanye (iFR) ziyizivivinyo ezilinganisa ukuthi ukuvaleka kukhulu kangakanani emithanjeni yenhliziyo. Kodwa kunomehluko omncane.

• Ngesikhathi sokuhlolwa (i-FFR): Umuthi okhethekile, njenge-adenosine (i-Adenocard® noma i-Adenoscan®), unikezwa ukuze kwandiswe imithambo yegazi futhi kwandiswe ukugeleza kwegazi.
• Esivivinyweni (se-iFR): Ngaphandle kokusebenzisa umuthi onjalo, ingcindezi ilinganiswa ngesikhathi esithile emjikelezweni wenhliziyo.

Nakuba umgomo wazo zombili ufana, kunomehluko omncane endleleni ezenziwa ngayo. Udokotela wakho uzonquma ukuthi yikuphi okungcono kakhulu kuwe.

Ubani owenza isivivinyo (i-FFR)?

Lolu ukuhlolwa kwezokwelapha okukhethekile. Ukuhlolwa (i-FFR) kwenziwa udokotela wenhliziyo , oqeqeshwe ngokukhethekile ngalokhu.

Ukuhlolwa (kwe-FFR) kusebenza kanjani?

Lokhu kungase kubonakale njengenqubo elula, kodwa kuhilela inqubo eyinkimbinkimbi. Umfutho wegazi ulinganiswa kokubili kude nokuvaleka kwemithambo yakho yenhliziyo kanye nokusondela kuyo . Okusho ukuthi, umfutho ulinganiswa ngaphambi nangemva kokuvaleka. Isilinganiso phakathi kwala manani amabili okucindezela sibizwa ngokuthi i-fractional fraction (FFR). Yilokhu okusinika umbono wokuthi kungakanani ukugeleza kwegazi okuvalekile.

Kufanele ngilungiselele kanjani ukuhlolwa (kwe-FFR)?

Lokhu kufana nokulungiselela ukuhlinzwa okuncane. Udokotela wakho uzokuchazela imininingwane, kodwa nazi izinto ezijwayelekile okuzodingeka uzenze:

• Udokotela wakho angase akucele ukuthi uyeke ukuthatha imithi ethile, ikakhulukazi imithi yokunciphisa igazi , ezinsukwini ezimbalwa ngaphambi kokuhlolwa.
• Ungadli noma uphuze lutho ngemva kwamabili ebusuku ngaphambi kokuhlolwa (i-NPO - ungaphuzi lutho ngomlomo).
• Ngenxa yokuthi uzonikezwa umuthi wokubulala izinzwa noma umuthi wokudambisa omnene phakathi nalolu vivinyo, uzodinga umuntu ozokuhambisa ekhaya ngemuva kokuhlolwa. Ngeke ukwazi ukushayela wena.

Yini ongayilindela ngosuku lokuhlolwa (i-FFR)?

Ukuhlolwa ngokwako kuvame ukuthatha isikhathi esingaphansi kwehora . Kodwa-ke, uma udokotela ehlola i-FFR yakho khona manjalo bese enquma ukwenza i-angioplasty noma i-stent, kuzothatha isikhathi esengeziwe. Ngakho-ke, kungumqondo omuhle ukubuza udokotela wakho kusenesikhathi ukuthi uzodinga ukuhlala isikhathi esingakanani esibhedlela, okuhlanganisa nesikhathi sokulungiselela nokuphumula ngemva kokuhlolwa.

Kwenzekani ngesikhathi sokuhlolwa (i-FFR)?

Kulungile, manje ake sibone ukuthi kwenzekani ngaphakathi kokuhlolwa. Nakuba lezi zinyathelo zingase zibonakale ziyinkimbinkimbi kancane, ithimba lezokwelapha lizokunakekela kahle.

1. Ukuba ndikindiki:Okokuqala, indawo encane yesikhumba sakho (engalweni yakho, entanyeni, noma embotsheni) ivalwa ngomuthi wokubulala izinzwa wendawo.

2. Ukufaka inaliti: Okulandelayo, kufakwa inaliti encane emthanjeni endaweni lapho kubhotshozwe khona.

3. Ukufakwa kwe-catheter: Ngalesi simbozo, idivayisi encane kakhulu, ende efana ne-tube (catheter) idluliselwa emthanjeni wegazi lakho iye emithanjeni yenhliziyo yakho.

4. Ukubuka indlela: Indlela ekhethekile (efana ne-X-ray) ebizwa ngokuthi i-fluoroscopy isetshenziswa ukuhlola esikrinini ukuze kubonakale ukuthi i-catheter iya endaweni efanele yini.

5. Uketshezi oluhlukanisayo: Okulandelayo, kufakwa udayi okhethekile (i-contrast media) ngale catheter emithanjeni yenhliziyo yakho. Imithambo ivele ngokucacile ku-X-ray.

6. Ukuhlolwa kokuvaleka kwemithambo yegazi: Lokhu kusetshenziselwa ukuhlola ukuthi kukhona yini ukuvaleka kwemithambo yegazi yenhliziyo yakho.

7. Ukubuka ukugeleza kwegazi: Ngezinye izikhathi, idivayisi encane ye-ultrasound exhunywe ekugcineni kwale catheter ingasetshenziswa ukubuka ukugeleza kwegazi ngaphakathi kwemithambo yegazi.

8. Ukunikeza imithi: Ngaphambi kokuba kufakwe ucingo lokucindezela endaweni evinjiwe, kunikezwa imithi efana ne-heparin (ukuvimbela ukujiya kwegazi) kanye ne-nitroglycerin (yokwandisa imithambo yegazi) (i-Nitronal® noma i-Tridil®).

9. Ukulinganisa ingcindezi: Manje sekuza umsebenzi wangempela. Intambo ekhethekile (intambo yokucindezela) idlula endaweni evinjiwe, futhi izinzwa ezikuyo zilinganisa ingcindezi yegazi ngaphambi nangemva kokuba umthambo uvinjiwe. Ukuze kulinganiswe lokhu ngokunembile, ukuhamba kwegazi kulinganiswa ngesikhathi sokugeleza kwegazi okuphezulu. Ngenxa yalokho, kunikezwa umuthi (i-adenosine) noma (i-papaverine) ukuze kwandiswe ukugeleza kwegazi lakho okwesikhashana.

10. Ukwelashwa (uma kudingeka): Uma ukuvaleka kubhekwa njengokukhulu ngokusekelwe enanini le-FFR, i-angioplasty (ukwandisa umthambo ngebhaluni) ingenziwa khona lapho, futhi i-stent (ithubhu elincane elifana ne-mesh) ingafakwa ukuvimbela ukuvaleka okwengeziwe.

11. Ukuhlolwa kabusha: Ngemva kokufakwa kwe-stent, inani le-FFR liyahlolwa futhi ukuqinisekisa ukuthi ukwelashwa kuphumelele yini.

12. Ukuqeda: Ekugcineni, i-catheter kanye nocingo kuyasuswa, indawo yokubhoboza ibanjwa isikhashana, bese kufakwa i-plaster.

Yini ongayilindela ngemva kokuhlolwa (i-FFR)?

Iningi labantu alizizwa liphatheke kabi ngemva kwalokhu kuhlolwa (i-FFR), futhi izinkinga azivamile.

• Uma uhlolwe kuphela, ungabuya ekhaya emahoreni ambalwa.
• Kodwa-ke, uma une-angioplasty kanye ne-stent efakwe ngemuva kwe-FFR, kungadingeka uhlale esibhedlela ngalobo busuku ngaphansi kokuqashwa kwezokwelapha.

Yimiphi imiphumela emibi yokuhlolwa (i-FFR)?

Njenganoma iyiphi inqubo yezokwelapha, abanye abantu bangase bazizwe bengakhululekile kangako.

• Ungase uzwe ubuhlungu esifubeni noma ubunzima bokuphefumula cishe umzuzu owodwa ngemva kokunikezwa umuthi we-adenosine (kungaba nge-IV noma ngqo emthanjeni osenhliziyweni yakho).Lokhu kujwayelekile, ungakhathazeki. Kusho ukuthi ukugeleza kwegazi lakho sekuphezulu kakhulu, okusho ukuthi sekuyisikhathi sokulinganisa i-FFR yakho. Lokhu kungakhululeki kuzophela maduze.
• (I-Papaverine) ayivamile kakhulu (cishe abantu abangu-1%) ukubangela isigqi senhliziyo esingajwayelekile , kodwa lokhu kuvame ukuxazululeka ngemva kwesikhashana.
• Kubalulekile ukukhumbula ukuthi njengoba lokhu kuhlolwa (i-FFR) kwenziwa nge-catheterization yenhliziyo, kunezingozi ezithile ezihlobene nakho (isib. ukopha, ukutheleleka, ukungezwani komzimba ne-contrast medium). Kodwa-ke, lokhu akuvamile kakhulu.

Ibalwa kanjani inani (le-FFR)?

Lokhu kufana nefomula yezibalo. Udokotela uhlukanisa ingcindezi emthanjeni wakho wenhliziyo ekude nokuvaleka (Pd) ngengcindezi emthanjeni wakho wenhliziyo eseduze nokuvaleka (Pa).

Kalula nje, i-FFR = Pd / Pa .

Lezi zilinganiso zokucindezela zithathwa udokotela esebenzisa imishini ekhethekile ngesikhathi sokufakwa kwe-catheter yenhliziyo.

Injani imiphumela? Isitshelani?

Uzothola inombolo enezindawo zamadesimali.

• Inani elijwayelekile le-FFR liphakathi kuka-0.94 no-1.0. Uma leli nani lifinyelelwa, kusho ukuthi akukho kuphazamiseka okukhulu ekugelezeni kwegazi emithanjeni.
• Uma inani le-FFR ngokuvamile lingaphansi kuka-0.80, kusho ukuthi ukuvaleka kubangela ukuvaleka okukhulu kwegazi, ngakho-ke kuyadingeka ukwelashwa (ngokuvamile i-angioplasty kanye ne-stenting).
• Isibonelo, uma i-FFR yakho ingu-0.75, kusho ukuthi umfutho wegazi wakho wehle ngo-25% ngenxa yokuncipha kwemithambo yakho yenhliziyo (1.00 - 0.75 = 0.25, noma 25%).
• Uma inani le-FFR libonisa ukuthi ukuvaleka akukubi kangako, khona-ke i-angioplasty kanye ne-stenting akudingekile. Kungelashwa ngemithi yodwa. Lokhu kungasiza ekugwemeni ukuhlinzwa okungadingekile.

Ngizoyazi nini imiphumela yokuhlolwa (kwe-FFR)?

Lokhu kuyinto engcono kakhulu. Udokotela uzokukhombisa amanani e-FFR kudivayisi yakhe ngokushesha nje lapho ehlola umfutho wegazi lakho. Ngakho-ke, kungaba ngesikhathi sokuhlolwa noma ngemva kokuphela, udokotela uzokutshela imiphumela nokuthi yini okufanele uyenze ngokulandelayo.

Kufanele ukhulume nini nodokotela? (Ngemva kokuhlolwa)

Uma ubuyela ekhaya ngemva kokuhlolwa, kufanele wazise udokotela wakho noma isibhedlela esiseduze ngokushesha uma unesinye noma ngaphezulu salezi zimpawu:

• Ubuhlungu besifuba (ikakhulukazi ubuhlungu obusha, obukhulu, noma obungapheli ngokuphumula)
• Ubunzima bokuphefumula
• Umkhuhlane (izinga lokushisa lomzimba eliphakeme)
• Ubuhlungu, ukuvuvukala, ukubomvu, noma ubomvu endaweni yokungena
• Ukuzizwa unesizungu noma ubuthakathaka
• Ukushaya kwenhliziyo okungavamile noma ukushaya kwenhliziyo okungavamile

Ungazinaki lezi zimpawu.

Ekugcineni, khumbula

Lokhu kuhlolwa (i-Fractional Flow Reserve - FFR) kuwukuhlolwa kwesifo sakho semithambo yenhliziyo.Indlela yesimanje nenembile ezosiza kakhulu udokotela ukuthi anqume ukuthi yikuphi ukwelashwa okungcono kakhulu. Abasebenzi bezokwelapha bazoqinisekisa ukuthi ukhululekile ngangokunokwenzeka ngesikhathi sokuhlolwa. Uma kukhona ongakuqondi noma uma wesaba, qiniseka ukuthi ubuza udokotela noma umhlengikazi. Kuyilungelo lakho.

Kuhle ukulungela lokho ngokwengqondo, njengoba kungase kudingeke ukuthi uhlinzwe i-angioplasty noma i-stent ngokushesha ngemva kokuhlolwa kwe-FFR yakho. Khumbula, konke kwenziwa ukuze kuvikelwe impilo yenhliziyo yakho.

Ngikufisela ukululama okusheshayo!

Isifo senhliziyo, isifo semithambo yenhliziyo, ukuhlolwa kwe-FFR, i-Fractional Flow Reserve, i-catheterization yenhliziyo, i-coronary angiogram, i-angioplasty, i-stent, ukuhlaselwa yinhliziyo, izimpawu zesifo senhliziyo