Ake sifunde ngokuhlinzwa kokususa amahlule egazi emaphashini (i-Pulmonary Thromboendarterectomy - PTE)

Kungenzeka ukuthi ubulokhu unenkinga yokuphefumula isikhathi esithile, noma uzizwa uphelelwa umoya uma uhamba. Udokotela wakho kungenzeka ukuthi ukutshelile ukuthi une-pulmonary hypertension, okuyiqoqo lama-blood clots amadala emaphashini akho. Uma lesi simo singenakulawulwa ngemithi, sikhuluma ngokuhlinzwa okukhethekile okungasindisa impilo yakho.

Kalula nje, kuyini lokhu kuhlinzwa kwe-PTE?

Ungesabi igama elide elithi Pulmonary Thromboendarterectomy. Sizolibiza ngokuthi i-PTE ngamafuphi. I-PTE inqubo eyinkimbinkimbi kakhulu eyenziwa odokotela abangochwepheshe. Ihilela ukususa ngokuhlinzwa amahlule egazi amadala kanye nezicubu ezibomvu ezinamathele ezindongeni zemithambo yegazi eyinhloko ethwala igazi liye emaphashini akho (i-Pulmonary Arteries).

Cabanga ukuthi ipayipi lamanzi ekhaya lakho livalekile ngothuli futhi amanzi awagelezi. Ukuhlinzwa kwe-PTE kufana nokuhlanza ingaphakathi lepayipi nokwenza amanzi ageleze kahle futhi. Lena yindlela engcono kakhulu yokususa la mahlule egazi amadala futhi aqinile angenakuncibilikiswa ngemithi. Ngezinye izikhathi, lokhu kuhlinzwa kungaze kwelaphe lesi simo ngokuphelele.

Yiziphi izimo eziphathwa ngokuhlinzwa kwe-PTE?

Lokhu kuhlinzwa kwenziwa kakhulu kubantu abanesifo esibizwa ngokuthi i-Chronic Thromboembolic Pulmonary Hypertension (CTEPH) . Leli igama eliyinkimbinkimbi kancane, ngakho-ke masiliqonde.

• Okungalapheki: kusho "ukuhlala isikhathi eside."
• I-Thromboembolic: kusho ukuthi "kubangelwa ukuqhekeka kwegazi."
• Umfutho wegazi ophezulu emaphashini: Lokhu kusho "umfutho wegazi ophezulu emaphashini."

Kalula nje, i-CTEPH yilapho ihlule legazi (i-Pulmonary Embolism - PE) elake lakhiwa emaphashini lingancibiliki kahle, kodwa kunalokho linamathela ezindongeni zemithambo yegazi emaphashini, lakha izicubu zesilonda ngokuhamba kwesikhathi, livimbele ukugeleza kwegazi, okubangela ukwanda kwengcindezi emaphashini.

Ngokuvamile, uma umuntu ene-blood clot (PE) emaphashini, odokotela bamnika imithi yokunciphisa igazi. Esikhathini esiningi, le mithi iyawancibilikisa ama-blood clot. Kodwa kubantu abambalwa kakhulu, cishe u-2% - 4%, la ma-blood clot awancibiliki ngokuphelele. Ayaguga, anamathele ezindongeni zemithambo yegazi, futhi avimbe indlela yokugeleza kwegazi. Lokhu kubeka ukucindezeleka okukhulu ohlangothini lwesokudla lwenhliziyo, olupompa igazi liye emaphashini. Ngokuhamba kwesikhathi, lokhu kungaholela ekuhlulekeni kwenhliziyo , ekulimaleni kwamaphaphu, ngisho nasezinkingeni ezisongela ukuphila.

Ubani odinga lokhu kuhlinzwa? Ingabe wonke umuntu angakuthola?

Uma une-CTEPH, izici eziningana zizocatshangelwa ukuze kunqunywe ukuthi ungakwazi yini ukwenza lokhu kuhlinzwa.

• Ubukhali bezimpawu zakho.
• Ukuthi amahlule egazi atholakala kuphi, ukuthi asakazeke kangakanani, nokuthi avimbe kangakanani imithambo yegazi.
• Iminyaka yakho, impilo yakho iyonke, kanye nendlela inhliziyo namaphaphu akho asebenza ngayo.

Ngokusho kodokotela abahlinzayo, uma la mahlule egazi engasuswa ngokuphephile, ukwelashwa okukhethwa kukho kwe-CTEPH ukuhlinzwa kwe-PTE.

Kodwa-ke, akuwona wonke umuntu one-CTEPH ongenza lokhu kuhlinzwa. Cishe abantu abangu-40%, noma abane kwabayishumi, abafaneleki kulokhu kuhlinzwa. Isizathu esiyinhloko salokhu ukuthi kuwukuhlinzwa okuyinkimbinkimbi kakhulu.

Kungani lokhu kuhlinzwa kuyinkimbinkimbi kangaka?

Ngesikhathi sokuhlinzwa, ithimba lezokwelapha lidlulisela okwesikhashana umsebenzi wenhliziyo namaphaphu akho liye emshinini we-cardiopulmonary bypass . Lokhu kusho ukuthi lo mshini unikeza umzimba wakho umoya-mpilo futhi upompa igazi ngesikhathi sokuhlinzwa.

Okubaluleke nakakhulu, ngesikhathi sokuhlinzwa, udokotela ohlinzayo udinga ukubona ngokucacile imithambo yegazi ethambile emaphashini. Ukuze kwenziwe lokhu, kusetshenziswa indlela ekhethekile yokwehlisa izinga lokushisa lomzimba wakho liye kuma-degree Celsius angu-18 (65 Fahrenheit), ukuvimba ngokuphelele ukujikeleza kwegazi isikhashana (Deep Hypothermic Circulatory Arrest). Umzimba upholiswa ngale ndlela ukuvimbela umonakalo ebuchosheni. Le ndlela ivumela udokotela ohlinzayo ukuthi asuse ngokucophelela amahlule egazi kanye nezicubu zesibazi endaweni ecacile, engenagazi.

Uma ukuhlinzwa kungenzeki, yiziphi ezinye izinketho ezikhona?

Uma odokotela benquma ukuthi awufaneleki ukuhlinzwa kwe-PTE nganoma yisiphi isizathu, bazoncoma ezinye izindlela zokwelapha.

• Imithi Yomlomo: Kunemithi ekhethekile engalawula umfutho wegazi emaphashini.
• I-Balloon Pulmonary Angioplasty (BPA): Lokhu kuhilela ukusebenzisa ithubhu elincane elifakwe ngomthambo osemlenzeni ukuze kufinyelelwe emithanjeni yegazi evinjiwe emaphashini, bese uyifutha ngedivayisi efana nebhaluni ukuvula ukugeleza kwegazi.

Uzilungiselela kanjani ngaphambi kokuhlinzwa?

Udokotela wakho uzokunikeza imiyalelo ecacile yokuthi ungalungiselela kanjani ukuhlinzwa. Kubaluleke kakhulu ukulandela leyo miyalelo ngqo.

Kwenzekani ngesikhathi sokuhlinzwa?

Lokhu kuhlinzwa kuvame ukuqala ekuseni futhi kuthatha cishe amahora ayisithupha. Uzonikezwa i-anesthesia ephelele ukuze ungezwa lutho.

1. Usizo ngokuphefumula: Okokuqala, kufakwa ipayipi elincane (i-Endotracheal Tube - ETT) ngomlomo noma ekhaleni lakho, phansi komphimbo wakho, bese lixhunywe emshinini we-oxygen (ventilator). Lo mshini uzokusiza ukuphefumula phakathi nokuhlinzwa.

2. Ukuvula isifuba: Okulandelayo, udokotela ohlinzayo uzosika ithambo lesifuba sakho (sternum) ukuze afinyelele enhliziyweni nasemaphashini.

3. Ukuxhumeka emshinini we-bypass: Uzobe usuxhunywe emshinini we-Cardiopulmonary Bypass. Lo mshini uzokwenza umsebenzi wenhliziyo namaphaphu ngesikhathi sokuhlinzwa.

4. Ukupholisa umzimba: Okulandelayo, izinga lokushisa lomzimba wakho liyehliswa kancane kancane libe ngama-degree Celsius angu-18.

5. Ukususa amahlule egazi: Ngemva kokupholisa umzimba nokuvimba ukujikeleza kwegazi okwesikhashana, udokotela ohlinzayo ususa ngokucophelela amahlule egazi kanye nezicubu zesilonda ngaphakathi kwemithambo yegazi yamaphaphu esebenzisa amathuluzi akhethekile.

6. Ukuvuselela: Ngemva kokususwa kwamahlule egazi, izinga lokushisa lomzimba wakho libuyiselwa esimweni esijwayelekile futhi unqanyuliwe emshinini wokudlula. Kodwa uhlala uxhumene nomshini wokuphefumula.

7. Ukuvalwa kwesifuba:Ekugcineni, udokotela ohlinzayo uzovala isifuba sakho bese efaka amapayipi amaningana amancane ukuze akhiphe noma yiluphi uketshezi oluningi olungase luqongelelane emzimbeni wakho.

Kwenzekani ngemva kokuhlinzwa?

Ngemva kokuhlinzwa, uzolaliswa egunjini lokunakekela abagula kakhulu (ICU) . Uzohlala e-ICU ngalobo busuku. Ngakusasa ekuseni, ithimba lezokwelapha lizohlola ukuphefumula kwakho. Uma ukwazi ukuphefumula wedwa, umshini wokuphefumula uzosuswa.

Ngokuvamile kuzodingeka uhlale esibhedlela izinsuku eziyi-7 kuya kweziyi-10. Uzoqala ube se-ICU, bese udluliselwa ewadini evamile njengoba isimo sakho sithuthuka.

Inqubo yokululama ifana kakhulu nokululama ekuhlinzweni kwenhliziyo okuvulekile. Uzokwazi ukuhamba zingakapheli izinsuku ezimbalwa futhi kancane kancane ukwazi ukwenza umsebenzi othile. Ngaphambi kokuba uye ekhaya, uzobe uhlolwa ukuze ubone ukuthi uyawudinga yini umoya-mpilo.

Yiziphi izinzuzo nezingozi zokuhlinzwa kwe-PTE?

Izinzuzo

• Lena yindlela kuphela yokwelapha i-CTEPH ngokuphelele .
• Kwabaningi, ukuhlinzwa kuyaphumelela, futhi ukusebenza kokuphefumula namaphaphu kuyathuthuka kakhulu.
• Abantu abaningi ababethembele kumoya-mpilo ngaphambi kokuhlinzwa ngeke besawudinga umoya-mpilo ngemva kokuhlinzwa.
• Umonakalo obangelwa yisifo ohlangothini lwesokudla lwenhliziyo uvame ukuguqulwa.
• Amathuba okusinda isikhathi eside ngemva kokuhlinzwa aphezulu kakhulu.

Izingozi Nezinkinga

Njengoba lokhu kuwukuhlinzwa okukhulu, kunezingozi ezithile. Kodwa-ke, ngokuthuthuka kobuchwepheshe eminyakeni embalwa edlule, lezi zingozi zincishiswe kakhulu.

• Ingozi yokufa ngesikhathi sokuhlinzwa manje iphansi njenge-1%.
• Ingozi yokushaywa yisifo sohlangothi icishe ibe ngu-1% - 2%.
• Abanye abantu bangase babe nezinga elithile lomfutho wegazi ophakeme emaphashini ngemva kokuhlinzwa. Kuzodingeka baqhubeke nokuphuza imithi.
• Ngezinye izikhathi, uketshezi lunqwabelana nxazonke zenhliziyo (i-pericardial effusion) lungenzeka.

Uma uhlangabezana nalezi zimpawu ezilandelayo, shayela u-1990 ngokushesha noma uye eMnyangweni Wezimo Eziphuthumayo (ETU) wesibhedlela esiseduze:

• Ubuhlungu obukhulu besifuba
• Ukuquleka
• Ukuphefumula kanzima okungazelelwe

Kuthatha isikhathi esingakanani ukuphulukiswa?

Ngokuhamba kwesikhathi, ungabuyela empilweni evamile. Kodwa, kufanele ubekezele kancane.

• Amaviki okuqala ayisithupha: Awukwazi ukushayela, ukuya emsebenzini, noma ukuphakamisa isisindo esingaphezu kwamakhilogremu angu-10 (cishe amakhilogremu angu-4.5).
• Amaviki 7 kuya ku-12: Ingaphakamisa isisindo esingafika kumakhilogremu angu-25 (cishe amakhilogremu angu-11).
• Ngemva kwamasonto ayi-12: Imikhawulo yokuphakamisa izinsimbi ivame ukuqedwa.

Iningi labantu lingabuyela emisebenzini yalo evamile zingakapheli izinyanga ezintathu. Ukuphefumula kwakho kanye nekhono lakho lokuzivocavoca kuzothuthuka kancane kancane, futhi ungase ubone ukuthuthuka kuze kube yiminyaka emi-4.

Kunjani ukuphathwa kwezokwelapha ngemva kokuhlinzwa?

Ngemva kokuhlinzwa, kuzodingeka uqhubeke nokubona udokotela.

• Uzoba nokuhlolwa okukhethekile okuningana ukuhlola amaphaphu akho emavikini ayi-6 ngemuva kokuhlinzwa futhi futhi phakathi kwezinyanga ezi-3-6 kamuva.
• Into ebaluleke kakhulu ukuthi kuzodingeka uphuze imithi yokunciphisa igazi/imithi yokunciphisa igazi impilo yakho yonke ukuze uvimbele ukwakheka kwamahlule amasha egazi.

Uma unalezi zimpawu, khuluma nodokotela wakho.

• Uma ubuhlungu bungabekezeleleki, noma uma ubuhlungu buncipha bese buphinde bukhula.
• Uma ukushaya kwenhliziyo kushesha noma kungajwayelekile.
• Uma inxeba lokuhlinzwa libomvu, livuvukile, likhipha ubomvu, noma linomkhuhlane (lezi yizimpawu zokutheleleka).

I-PTE iwukuhlinzwa okuwusizo kakhulu okunganikeza impilo yesibili kumuntu ohlushwa yi-CTEPH. Nakuba kuwukuhlinzwa okuyinkimbinkimbi futhi kuthatha isikhathi eside ukululama, umphumela wako, okuyithuba lokuphila ngokukhululeka ngaphandle kokuminyana futhi, awunakuqhathaniswa.