Ingabe ngezinye izikhathi uthola ubuhlungu besifuba, noma uzizwe uphelelwa amandla ngemva kokuzikhandla kancane, bese uzibuza, "Ingabe kukhona ukuvaleka kwenye yemithambo yami yenhliziyo?" Uma unokungabaza okunjalo, udokotela angase akucele ukuba wenze i-coronary angiogram, okuwukuhlolwa okubandakanya ukuxiliswa kwenhliziyo. Kungahlola noma yikuphi ukuvaleka noma i-stenosis emithanjeni yenhliziyo enikeza igazi enhliziyweni. Kodwa ngezinye izikhathi, ngisho nangemva kokubona lokhu kuvimbeka, kunzima ukunquma kahle ukuthi kukhulu ngokwanele yini ukuthi kudingeke i-stent noma ukuthi ingalawulwa ngemithi yodwa. Yilapho lolu vivinyo olukhethekile olubizwa ngokuthi i-Fractional Flow Reserve noma i-FFR lusiza khona.
Kalula nje, iyini le FFR?
Ake sithi kukhona ipayipi lamanzi, futhi kukhona ucezu oluncane lodaka olunamathele phakathi kwepayipi. Manje, ingcindezi yamanzi ageleza ngepayipi ihlukile kancane ngaphambi nangemva kokuvaleka, akunjalo? Ukuhlolwa kwe-FFR kwenza into efanayo.
Kalula nje, i-FFR iyindlela yokulinganisa ukuthi kungakanani ukugeleza kwegazi okuya emisipheni yenhliziyo okuvinjiwe ngenxa yokuvaleka kwenye yemithambo yakho yenhliziyo. Kulokhu, umfutho wegazi ulinganiswa kuzo zombili izinhlangothi zokuvaleka. Ngokuqhathanisa amanani amabili okucindezela, udokotela unquma ukuthi ukuvaleka empeleni kuyingozi emisipheni yenhliziyo noma cha.
Lokhu kuhlolwa kuyinqubo engangenisi kakhulu eyenziwa ngesikhathi sokufakwa kwe-catheter yenhliziyo.
Kudingeka nini ukuhlolwa kwe-FFR?
Akuwona wonke umuntu odinga lokhu kuhlolwa. Udokotela ngokuvamile uzonquma ukwenza ukuhlolwa kwe-FFR ezimweni ezilandelayo:
- Ukuvaleka Okuphakathi: Uma i-angiogram ibonisa ukuvaleka okuphakathi kuka-50% no-70% womthambo, kunzima ukusho ngokuqinisekile ukuthi i-stent iyadingeka yini. Ezimweni ezinjalo, i-FFR ilinganisa ngqo ukuthi ukuvaleka kuvimbela kangakanani ukugeleza kwegazi.
- Uma kunezithiyo eziningi: Ngezinye izikhathi umuntu angaba nezithiyo eziningi ezincane emithanjeni yakhe. I-FFR ingasiza ekutholeni ukuthi yikuphi ukuthiyo okuthinta kakhulu ukugeleza kwegazi, ngaphandle kokubeka ama-stents kuleyo naleyo.
- Ngemva kokufakwa kwe-stent: Ngezinye izikhathi ngemva kokufakwa kwe-stent, ukuhlolwa kwe-FFR kungenziwa ukuqinisekisa ukuthi isebenza kahle nokuthi ukugeleza kwegazi kubuyele esimweni esijwayelekile.
Kodwa-ke, uma ukuvaleka komthambo kungaphansi kuka-30% (okusho ukuthi akukho ukuvaleka okukhulu) noma kungaphezu kuka-90% (okusho ukuthi kukhona ukuvaleka okukhulu okudinga ukwelashwa), ukuhlolwa kwe-FFR ngokuvamile akudingeki. Ngoba ngaleso sikhathi, isinqumo mayelana nokwelashwa singenziwa nge-angiogram uqobo.
Uyini umehluko phakathi kwe-FFR ne-iFR?
Kungenzeka ukuthi uke wezwa nge-iFR (isilinganiso esingenawo amagagasi ngokushesha). Zombili lezi zilinganisa ubukhulu bokuvinjelwa emthanjeni. Umehluko omkhulu ukuthi esivivinyweni se-FFR, kunikezwa umuthi okhethekile, njenge-adenosine, ukuze kwandiswe ukugeleza kwegazi enhliziyweni. Esivivinyweni se-iFR, esikhundleni sokunikeza umuthi onjalo, ingcindezi ilinganiswa ngesikhathi esithile ekushayweni kwenhliziyo. Udokotela wakho uzonquma ukuthi iyiphi kulezi zindlela ezimbili engcono kakhulu kuwe.
Kufanele uzilungiselele kanjani ngaphambi kokuhlolwa?
Udokotela wakho uzokunikeza imiyalelo ethile ekhethekile ngaphambi kwalolu vivinyo, futhi kubaluleke kakhulu ukuyilandela.
- Ulwazi ngemithi: Ungase ucelwe ukuthi uyeke ukuthatha imithi ethile, ikakhulukazi imithi yokunciphisa igazi, ezinsukwini ezimbalwa ngaphambi kokuhlolwa. Qiniseka ukuthi utshela udokotela wakho ngayo yonke imithi oyithathayo.
- Ukudla Nokuphuza: Uzokwaziswa ukuthi ungadli noma uphuze lutho ngemva kwamabili ebusuku ngaphambi kokuhlolwa.
- Umsizi: Njengoba uzonikezwa i-anesthesia ngesikhathi sokuhlolwa, kubalulekile ukuthi ube nomuntu ozokuthatha akuyise ekhaya ngemva kokuhlolwa.
Kwenzekani ngesikhathi sokuhlolwa?
Uma wenza ukuhlolwa kwe-FFR kuphela, kuthatha imizuzu engaphansi kwengu-60. Kodwa-ke, uma unquma ukubeka i-stent ngokushesha ngokusekelwe emiphumeleni, kuzothatha isikhathi eside. Yonke inqubo ihamba kanje:
1. Ukuba ndikindiki: Okokuqala, umjovo omncane womuthi wokwenza ndikindiki ufakwa emthanjeni ongalweni, esinqeni, noma entanyeni lapho kuzofakwa khona i-catheter.
2. Ukufakwa kwe-catheter: Okulandelayo, kufakwa ipayipi elincane (i-catheter) endaweni engenalutho liye komunye wemithambo yegazi yakho.
3. Ukuya enhliziyweni: Le catheter iqondiswa ngokucophelela emthanjeni wenhliziyo kusetshenziswa ubuchwepheshe be-X-ray (fluoroscopy).
4. Umjovo Wokudaya: Okulandelayo, kufakwa udayi okhethekile (i-contrast media) emithanjeni ngaleli payipi. Ingaphakathi lemithambo lingabonakala ngokucacile ku-X-ray.
5. Intambo Yokucindezela: Yilapho umsebenzi wangempela uqala khona. Intambo encane kakhulu enezinzwa idlula nge-catheter bese ifakwa emthanjeni ovalekile.
6. Ukulinganisa ukucindezeleka: Le ntambo yokucindezela isetshenziselwa ukukala ukucindezeleka kwegazi ngaphambi nangemva kokuba umthambo uvalekile.
7. Ukunikeza umuthi:Ukuze uthole ukufundwa okunembile, udinga ukwandisa ukugeleza kwegazi enhliziyweni yakho. Ngenxa yalokhu, uzonikezwa umuthi obizwa ngokuthi i-adenosine. Uma unikezwa lo muthi, ungase uzwe ubuhlungu obuncane esifubeni kanye nobunzima bokuphefumula cishe umzuzu. Lokhu kuvamile, ungakhathazeki. Lokhu kusho ukuthi umuthi uyasebenza futhi manje yisikhathi esifanele sokufunda.
8. Isinqumo Sokwelashwa: Ngemva kokuthola inani le-FFR, udokotela uzonquma ukuthi udinga yini ukufakwa kwe-stent noma cha. Uma kudingeka, i-stent ingafakwa ngokushesha ngemva kokwenza i-angioplasty.
9. Isiphetho: Uma umsebenzi usuqediwe, i-catheter iyasuswa, ingcindezi ifakwa endaweni yokufaka, bese kufakwa i-plaster.
Ungayiqonda kanjani imiphumela?
Umphumela wokuhlolwa kwe-FFR uza ngenombolo. Le nombolo kulula kakhulu ukuyiqonda.
| Umphumela we-FFR | Kusho ukuthini? |
|---|---|
| 0.94 kuya ku-1.0 (okuvamile) | Kuhle kakhulu! Ukugeleza kwegazi kwenhliziyo yakho kuhle kakhulu. Ukuvaleka okubonakalayo emthanjeni wegazi akubangeli ukuphazamiseka okukhulu ekugelezeni kwegazi. I-stent ngokuvamile ayidingeki, futhi lesi simo singaphathwa ngemithi. |
| Uma kungaphansi kuka-0.80 | Kulesi simo, inani legazi eligeleza liye emisipheni yenhliziyo liye lehla kakhulu ngenxa yokuncipha komthambo wegazi. Udokotela cishe uzonquma ukwenza ukwelashwa okufana nokufaka i-stent (angioplasty). |
| Isibonelo: Kuthiwani uma inani le-FFR lingu-0.75? | Lokhu kusho ukuthi umfutho wegazi wehle ngo-25% ngenxa yokuncipha komthambo wegazi. Lokhu kusho ukuthi kukhona ukuvinjelwa okungu-25% kokugeleza kwegazi emisipheni yenhliziyo. |
Yini ongayilindela ngemva kokuhlolwa?
Izinkinga ezinkulu azivamile ukwenzeka ngemva kokuhlolwa kwe-FFR.
- Ukuya ekhaya:Uma i-stent ingafakwanga, uzokwazi ukuya ekhaya ngemva kwamahora ambalwa wokuhlolwa. Uma i-stent ifakiwe, kungase kudingeke uhlale esibhedlela ngalobo busuku.
- Ukuphumula: Kungcono ukuphumula usuku olulodwa noma ezimbili ngemva kokubuyela ekhaya. Kungase kube nokuklwebheka kanye nobuhlungu lapho kufakwe khona i-catheter.
- Imiphumela emibi: Izinto ezifana nobuhlungu besifuba obubangelwa umuthi we-adenosine zizonyamalala ngokuphelele ngemizuzu embalwa.
Uma uhlangabezana nalezi zimpawu, shayela udokotela wakho ngokushesha.
Uma uhlangabezana nanoma yiziphi izimpawu ezilandelayo ngemuva kokubuyela ekhaya uvela ekuhlolweni, yazisa udokotela wakho ngokushesha. Uma kudingeka, iya eMnyangweni Wezimo Eziphuthumayo (ETU) wesibhedlela esiseduze.
- Ubuhlungu obukhulu besifuba
- Ubunzima bokuphefumula
- Imfiva
- Ukopha, ukuvuvukala, noma ubuhlungu obukhulu endaweni yokufaka i-catheter
- Isiyezi
- Izinguquko ezingavamile ekushayeni kwenhliziyo (ukushaya kwenhliziyo)
I-FFR iyisivivinyo esibaluleke kakhulu ekwelapheni isifo senhliziyo. Sisiza odokotela ukuthi banqume ubukhulu bokuvinjelwa komthambo, bagweme ukufakwa kwe-stent okungadingekile, futhi bakhethe ukwelashwa okungcono kakhulu kuwe, kunokuthembela kuphela kulokho okubonwa ku-angiogram. Ngakho-ke, uma udokotela wakho ephakamisa lesi sivivinyo, ungesabi ukubuza noma yimiphi imibuzo ongase ube nayo.
Umlayezo Wokuya Nawe Ekhaya
- I-FFR (Fractional Flow Reserve) iyisivivinyo esikhethekile esilinganisa ubukhulu bokuvinjelwa kwemithambo yenhliziyo.
- Lokhu kubaluleke kakhulu ekunqumeni ukuthi i-stent iyadingeka yini ukuze kuvinjwe izinga eliphakathi (50%-70%) elibonwe ku-angiogram.
- Lokhu kuhlolwa kwenziwa ngesikhathi sokufakwa kwe-catheter yenhliziyo.
- Uma umphumela ungaphansi kuka-0.80, kusho ukuthi ukuvaleka kuvimbela kakhulu ukugeleza kwegazi futhi kungadinga ukwelashwa.
- Lokhu kuhlolwa kuvumela odokotela ukunciphisa ukufakwa kwe-stent okungadingekile futhi banikeze ukwelashwa okufanele kakhulu kwesiguli.
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