Created at:1/13/2025
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Ko te taurangi-waewae-ringa (ABI) he whakamātautau māmā, kāore he mamae e whakatairite ana i te pēhanga toto i tō waewae ki te pēhanga toto i tō ringa. Mā tēnei ine tere e āwhina ngā tākuta ki te kite i te mate ā-tāwāhi (PAD), he āhuatanga e whakaiti ana i te rere o te toto ki ō waewae me ō waewae.
Whakaarohia he tirotiro hauora mō tō rerenga toto. Ki te rere noa te toto i roto i ngā uaua hauora, me rite tonu ngā pānui pēhanga i waenga i tō waewae me tō ringa. Ki te nui te rerekētanga, ka tohu pea kāore ngā uaua o tō waewae e whiwhi ana i te rere toto e hiahiatia ana.
Ko te taurangi-waewae-ringa he ōwehenga e whakatairite ana i te pēhanga toto i tō waewae ki te pēhanga toto i tō ringa. Ka tātai tō tākuta i tēnei mā te wehe i tō pēhanga waewae ki tō pēhanga ringa, e hoatu ana ki a koe he tau e whakaatu ana i te pai o te rere o te toto ki ō pito o raro.
Ko te pānui ABI noa i te nuinga o te wā kei waenga i te 0.9 me te 1.3. Ko te tikanga ko te pēhanga toto i tō waewae kei te tata ki te 90% ki te 130% o te pēhanga i tō ringa. Ki te heke tēnei ōwehenga ki raro i te 0.9, e kī ana tōna whakaaro kua whāiti, kua aukatia rānei ō uaua waewae, ka tohu pea i te mate ā-tāwāhi.
He tino māmā te whakamātautau, ā, he meneti noa iho te roa. Kāore koe e hiahia ki te whakarite motuhake, ā, kāore he raruraru e pā ana. Koinei tētahi o ngā taputapu tātari tino pono e mau ana i ngā tākuta mō te hopu i ngā raruraru rerenga toto i te wā wawe.
Ka whakamahi ngā tākuta i te taurangi-waewae-ringa i te tuatahi ki te tātari mō te mate ā-tāwāhi, he āhuatanga e pā ana ki miriona tāngata puta noa i te ao. Ka puta te PAD i te wā e hanga ana ngā putunga momona i roto i ō uaua waewae, e whakaiti ana i te rere o te toto ki ō waewae me ō waewae.
He mea nui te kitenga wawe, na te mea he maha tonu te PAD e tupu puku ana, karekau he tohu e kitea ana. He tokomaha nga tangata karekau e mohio he raruraru to ratou tohanga toto tae noa ki te wa kua tino kaha te mate. Ka taea e te whakamatautau ABI te hopu i enei take i mua i te noho hei raruraru hauora nui.
Ka tohutohu pea to taakuta i tenei whakamatautau mena he take morearea koe mo te mate uaua. Kei roto i enei ko te mate huka, te toto tiketike, te cholesterol tiketike, te hitori o te kai paipa, te neke atu ranei i te 65 tau te pakeke. He pai hoki te whakamatautau mena kei te raru koe i te mamae waewae i te wa e hikoi ana, nga patunga e puhoi ana te rongoa i runga i ou waewae, te makariri ranei i ou waewae o raro.
I tua atu i te tirotiro, ka awhina te ABI i nga taakuta ki te aroturuki i te mate uaua o te taha me te arotake i te pai o te mahi o nga maimoatanga. He mea nui ano hoki mo te aromatawai i to tupono cardiovascular katoa, na te mea he maha tonu te PAD e tohu ana i nga raruraru rite i etahi atu uaua puta noa i to tinana.
He tino ngawari te tikanga taurangi rekereke-brachial, a ka pau te 10 ki te 15 meneti hei whakaoti. Ka takoto koe i runga i te tepu whakamatautau i te wa e ine ana to kaiwhakarato hauora i te toto i roto i ou ringa me ou rekereke ma te whakamahi i te cuff toto paerewa me tetahi taputapu ultrasound motuhake e kiia nei ko Doppler.
Anei nga mea ka tupu i te wa o to whakamatautau:
Ka whakanuia e te taputapu Doppler te tangi o te toto e rere ana i roto i ō uaua, kia māmā ai te kitea e tō kaiwhakarato i ngā pupuhi ngoikore. Ka rongo pea koe i ngā tangi whēwhē i te wā o te whakamātautau, he mea noa tēnei, he tangi noa iho o te rere o tō toto e whakanuia ana.
Kāore rawa he mamae o te tikanga. Ka rongo koe i te āhua e mōhiotia ana o te pūhi toto e pupuhi ana, e heke ana, engari kāore he mea e kore e pai ake i te tirotiro i te pūhi toto. He maha ngā tāngata e whakaaro ana he whakangāwari te whakamātautau.
Ko te mea whakamīharo mō te whakamātautau taurangi-pāmu-waewae, kāore rawa he whakarite e hiahiatia ana e koe. Ka taea e koe te kai noa, te tango i ō rongoā auau, me te haere i ō mahi o mua i mua i te pōhiri.
He torutoru noa ngā mea māmā hei whakaaro kia pai ai te haere o tō whakamātautau:
Mēnā he kai paipa koe, whakamātau ki te karo i te paipa mō te 30 meneti i mua i tō whakamātautau, nā te mea ka pā te nicotine ki ō pānui pūhi toto. Waihoki, mēnā kua whakangungu kaha koe, whakamōhio atu ki tō kaiwhakarato kia nui ake te wā mō te hoki mai o tō rerenga toto ki tō āhua okioki.
Ko te mea nui, kaua e māharahara mō ngā hua o te whakamātautau i mua. He taputapu tātari te ABI, ā, mēnā ka kitea ētahi take, ka mahi tō rōpū hauora ki a koe ki te whakatika i a rātou. Kia mahara, ko te kitea wawe o ngā raruraru rerenga toto ka whai wāhi pai koe ki te rongoā whai hua.
He mea māmā te māramatanga ki ngā hua o tō taurangi pūhihi-wāwae ina mōhio ana koe ki te tikanga o ngā tau. Ka whakaaturia tō hua hei tau ira, te nuinga mai i te 0.4 ki te 1.4, e whakaatu ana i te ōwehenga i waenga i ō pēhanga toto o te pūhihi me te ringa.
Anei me pēhea te whakamāori i ngā hua o tō ABI:
Ko te ABI noa, ehara i te mea he tino pai ō uaua, engari e tohu ana he pai te rerenga toto ki ō waewae. Ki te tōtōā, ki te hē rānei tō pānui, kaua e mataku. He maha ngā tāngata e mate ana i te PAD ngawari e ora ana i te oranga noa, i te oranga kaha me te whakahaere tika.
Ka whakaarohia e tō tākuta ō hua ABI me ō tohu, hītori hauora, me ngā āhuatanga tūpono ki te whakatau mehemea e hiahiatia ana ētahi atu whakamātautau, maimoatanga rānei. I ētahi wā, ka puta ngā rerekētanga iti i ngā pānui nā te mea he āhuatanga pēnei i te pāmahana rūma, i te mahi tinana tata nei rānei, nō reira ka tūtohu pea tō kaiwhakarato kia tōtōhia te whakamātautau hei whakapūmau i ngā hua.
Ko te whakapai ake i tō taurangi pūhihi-wāwae e arotahi ana ki te whakarei ake i te rerenga toto ki ō waewae me te ārai i te whāiti haere o ngā uaua. Ko te rongo pai, he maha ngā tāngata ka taea te whakapai ake i tō rātou rerenga toto mā ngā huringa oranga, me ngā maimoatanga hauora ina tika ana.
Ko ngā whakarerekētanga oranga te pūtake o te whakapai ake i tō ABI me te hauora o ngā uaua katoa:
Me whai rongoā rongoā mō ngā raruraru tohanga nui ake. Ka tohutohu pea tō tākuta i ngā rongoā hei whakapai ake i te rere o te toto, hei ārai i ngā pūtau toto, hei whakahaere rānei i ngā āhuatanga e pā ana pēnei i te mate huka me te pēhanga toto tiketike. I ētahi wā, ka tūtohu pea ngā tikanga pēnei i te angioplasty, i te pokanga rānei hei whakahoki i te rere o te toto.
Ko te mea nui ko te mahi tahi me tō rōpū hauora ki te whakawhanake i tētahi mahere whānui i hangaia mō tō āhuatanga motuhake. He maha ngā tāngata e kite ana i ngā whakapainga nui i roto i tā rātou ABI i roto i ngā marama i muri i te whakarereketanga o te oranga, ina koa ki te whakangungu i ngā wā katoa me te whakamutu i te kai paipa.
Ko te tohu rekereke-brachial pai kei waenga i te 1.0 me te 1.2, e tohu ana he tata ōrite te pēhanga toto i tō rekereke ki te pēhanga i tō ringa, he paku teitei ake rānei. E whakaatu ana tēnei awhe i te tohanga tino pai kāore he aukati nui i roto i ō uaua waewae.
Ko te ABI o te 1.0 te tikanga he ōrite te pēhanga o tō rekereke ki tō ringa, he tino noa, he hauora hoki. Ko ngā pānui i waenga i te 1.0 me te 1.2 e kiia ana he pai rawa atu nā te mea e tohu ana i te rere toto pai kāore e whakaatu ana i ngā uaua mārō rawa atu.
Ahakoa e kiia ana he noa tonu nga panui tae atu ki te 1.3, ko nga uara teitei tonu i runga ake i te 1.3 tera pea e tohu ana kua maro, kua kowhatu ranei o ou uaua. Ko tenei ahuatanga, e kiia nei ko te sclerosis medial, he mea noa ake i roto i nga tangata e mate huka ana, e mate ana ranei i te mate whatukuhu tawhito. Ko nga uaua maro ka kore e pono nga panui ABI mo te kite i nga aukati.
He mea tika kia mohio ko te
Ko ētahi atu āhuatanga mōrearea, engari he mea nui, ko te mate tākihi mau tonu, ngā āhuatanga mumura pēnei i te rūmātiki, me te hītori o te mate ngākau, te whiu rānei. Ko ngā Amelikana Āwherika me ngā tāngata nō te takenga mai o Hispanic ka nui ake te mōrearea ki te whakawhanake i te mate uaua taha.
Ka nui ake ngā āhuatanga mōrearea kei a koe, ka nui ake te tūponotanga ki te whakawhanake i ngā raruraru tohanga. Heoi, he maha ngā āhuatanga ka taea te whakarereke mā ngā huringa o te oranga me te whakahaere rongoā tika, e whai mana nui ana koe ki tō hauora uaua.
Kāore he pānui taurangi rekereke-brachial tino tiketike, iti rānei e pai ana. Ko te whāinga kia whai ABI i roto i te awhe noa o te 0.9 ki te 1.3, e tohu ana i te tohanga hauora me te kore e mārō, e aukati rānei i ngā uaua.
E tohu ana te ABI iti (kei raro iho i te 0.9) kua whaiti, kua arai ranei ō uaua waewae, e whakaiti ana i te rere o te toto ki ō waewae me ō waewae. Ko tēnei āhuatanga, e mōhiotia ana ko te mate uaua ā-taha, ka puta he raruraru nui ki te kore e rongoatia. He tino mōrearea ngā pānui iti, ā, me āta tirotiro e te tākuta.
I tērā taha, ehara i te mea pai ake te ABI tiketike (kei runga ake i te 1.3). Ko ngā pānui tiketike e tohu ana kua mārō, kua kōhatu rānei ō uaua, ka pēnei pea i te mate huka, te mate tākihi, te pakeketanga rānei. E kore e taea e ngā uaua mārō te kōpeke tika i te wā o te whakamātautau, e puta ana he pānui teka tiketike e kore e whakaatu tika i tō tūnga toto.
Ki te tiketike rawa tō ABI, ka hiahia pea tō tākuta ki ētahi atu whakamātautau pēnei i te taurangi maihao-pāmu, i ngā rekoata rōrahi ngāwari rānei kia whai whakaahua tika ake mō tō toto. Ka taea hoki e ngā pānui tino tiketike te tohu i te piki o te mōrearea ngākau, ahakoa te ahua pai o te toto o ō waewae.
Ko te wāhi pai ko te pupuri i te ABI i waenga i te 1.0 me te 1.2, e tohu ana i te rere toto pai me ngā uaua hauora, ngāwari. E tohu ana tēnei awhe kei te papu pai tō ngākau i te toto ki ō waewae me te kore e raru i te aukati nui mai i ngā uaua whaiti, mārō rānei.
E tohu ana te taurangi waewae-pāmu iti i te whakaitinga o te rere toto ki ō waewae, ka puta pea he raruraru nui ki te kore e āta whakahaere. Mā te māramatanga ki ēnei raruraru ka whakahihiri i ngā huringa o te oranga me te rongoā hauora ka ārai, ka whakaiti rānei i ēnei take.
Ko ngā raruraru tino noa o te rere toto waewae kino ka pōturi te whanake, ā, ka kaha ake pea i te wā:
Ka puta ngā raruraru nui ake i ngā take nui i te wā e tino raru ana te rere o te toto. Kei roto i ēnei ko te mamae tonu ahakoa i te okiokinga, ngā whewhe, ngā patunga rānei e kore e rongoa, ā, i ngā wā onge, te mate o te kiko (gangrene) e hiahia ana kia tapahia.
Ko ngā tāngata he iti te ABI ka tūpono hoki ki te whakaeke ngākau me te whiu i te mea ko te hātepe mate kotahi e pā ana ki ngā uaua waewae e pā ana ki ngā uaua kōrona me ngā uaua roro. Heoi, mā te manaaki hauora tika me ngā huringa o te noho, ka taea e te nuinga o ngā tāngata he PAD te ārai i ēnei raruraru nui me te pupuri i te kounga o te oranga.
Ahakoa te ahua pai ake o te taurangi-waewae-pāmu nui i te iti, ko ngā pānui i runga ake i te 1.3 ka tohu i te mārō o ngā uaua e mau ana i ōna ake raruraru. Ko ēnei take e pā ana ki ngā āhuatanga e takoto ana i te take o te mārō o ngā uaua, kaua ki te ABI nui ake.
Ko ngā pānui ABI nui ka puta i te nuinga o te wā i ngā tāngata he mate huka, he mate tākihi tawhito, he pakeke rānei, ā, ko ngā raruraru e whakaatu ana i ēnei āhuatanga e takoto ana:
Ko te āwangawanga nui ki te ABI tiketike ko te mea ka taea e ia te whakaputa i te whakapumautanga teka mō tō tūnga huriwā. Me hiahia pea tō tākuta ki ētahi atu whakamātautau kia whai pikitia tika mō te rere o te toto ki ō waewae me ō waewae. Kei roto pea i ēnei ko ngā inenga taupū maihao-brachial, ētahi atu rangahau whakaahua rānei.
Ko ngā tāngata e mau ana i ngā pānui ABI tiketike tonu me āta aroturuki mō te mate ngākau, ā, me nui ake pea te whakahaere i ngā āhuatanga o raro pēnei i te mate huka, i te mate whatukuhu rānei. Ko te whāinga ko te ārai i te piki haere o te mārō o ngā uaua i te wā e whakarite ana i te rere toto tika ki ō pito.
Me whakaaro koe ki te whakamātau i te taupū pōkai-brachial mēnā he āhuatanga tūpono tōu mō te mate uaua ā-pito, kei te pā rānei i ngā tohumate e tohu ana i ngā raruraru huriwā. Ka taea e te kitenga me te rongoā wawe te ārai i ngā raruraru nui me te whakapai ake i tō kounga o te ora.
He maha ngā āhuatanga e tika ana kia kōrerohia ki tō tākuta mō te whakamātau ABI:
Me rapu tonu koe i te āwhina hauora mēnā ka pā mai te mamae nui o te waewae i te okiokinga, ngā patunga tuwhera kāore e rongoā, i ngā tohu rānei o te mate i ngā patunga i ō waewae. Ko ēnei tohu pea e tohu ana i ngā raruraru tohanga toto e hiahia ana kia tere te rongoā.
Mēnā kua whai koe i te whakamātautau ABI, ā, he rereke ō hua, whai i ngā tohutohu a tō tākuta mō te aroturuki me te whakamātautau whai muri. Mā te tirotiro i ngā wā katoa e āwhina ana ki te whai i ngā huringa i tō tohanga toto me te whakatika i te rongoā i te mea e tika ana.
Kaua e tatari kia kaha rawa ngā tohu i mua i te rapu aromātai. He maha ngā tāngata e mate ana i te mate uaua o te taha i te wā tuatahi kāore he tohu, nā reira he mea nui ngā whakamātautau tirotiro pēnei i te ABI mō te kitenga wawe me te aukati.
He pai rawa te whakamātautau taurangi-poto-poto mō te kitenga i te mate uaua o te taha i ō waewae, ā, ka taea e ia te whakarato i ngā mōhiohio nui mō tō hauora ngākau katoa. Ahakoa kāore e tika ana te tātai i te mate ngākau, ko te ABI iti te tikanga he atherosclerosis tō (te whāiti o te uaua) tera pea ka pā ki ō uaua ngākau.
He nui ake te tūponotanga o te hunga e mate ana i te mate o te uaua o te taha ki te ngakau me te whiu, nā te mea ko te mate kotahi e aukati ana i ngā uaua o te waewae ka pā tonu ki ngā uaua o te ngakau me te roro. E whakaatu ana ngā rangahau ko te hunga he iti te ABI he 2-3 ngā wā te nui ake o te tūponotanga o ngā huihuinga ngākau i te hunga he pānui noa.
Ka whakamahi tō tākuta i ngā hua ABI hei wāhanga o te aromatawai mōrearea ngākau whānui. Mēnā he rerekē tō ABI, ka tūtohu pea rātou i ētahi atu whakamātautau mō tō ngākau, pēnei i te EKG, te whakamātautau ahotea, te echocardiogram rānei kia whai pikitia katoa mō tō hauora ngākau.
Kāore te taurangi rekereke-peka iti e pā tika ana i te mamae o te waewae, engari e tohu ana i te hekenga o te rere toto ka pā ki te mamae i te wā o te mahi tinana. Ko tēnei momo mamae, e kīia ana ko te claudication, ka puta i te wā kāore ō uaua waewae e whiwhi toto nui-hāora i te wā o te whakakori tinana, te hīkoi rānei.
Ko te tikanga o te claudication he rite ki te kōpiko, te mamae, te ngenge rānei i ō uaua kuao, huha, pūtake rānei. Ko te tikanga ka tīmata te mamae i muri i te hīkoi i tētahi tawhiti, ka ngaro ka okioki koe. I te kino haere o te rere, ka heke haere pea te tawhiti ka taea e koe te hīkoi i mua i te mamae.
Kāore ngā tāngata katoa he iti te ABI e pā ana ki te mamae o te waewae. Ka whakawhanake ētahi tāngata i ngā ara toto kē (collateral circulation) hei āwhina i te pupuri i te rere toto tika ahakoa ngā uaua whāiti. Heoi, mēnā he iti tō ABI me te mamae o te waewae, he mea nui kia mahi tahi koe me tō tākuta ki te whakapai ake i te rere me te whakahaere i ngā tohumate.
Āe, ka huri tonu ngā hua taurangi rekereke-peka i te roanga o te wā, ā, ko te aroturuki i ēnei huringa ka āwhina i tō tākuta ki te whai i te haere o te mate o te uaua o te taha me te aromatawai i te whai huatanga o te maimoatanga. Ka puta ngā huringa i ngā taha e rua, i runga i ngā momo āhuatanga e pā ana ki tō rere.
Ka pai ake pea tō ABI mā ngā huringa o te oranga pēnei i te whakakori tinana i ngā wā katoa, te whakamutu i te kai paipa, me te pai ake o te whakahaere i te mate huka, te pēhanga toto, me te cholesterol. He maha ngā tāngata e kite ana i ngā whakapainga nui i roto i tō rātou ABI i roto i te 6-12 marama o te whakatutuki i ngā huringa hauora, ina koa ki ngā hōtaka whakakori tinana e tirotirohia ana.
Engari, ka kino pea tō ABI mēnā ka piki ake te mate o te uaua o te taha, ina koa mēnā kāore i te pai te whakahaere i ngā āhuatanga tūpono. Koinei te take ka tūtohu pea tō tākuta i te whakamātautau ABI i ia wā ki te aroturuki i tō rerenga toto i roto i te wā, me te whakatika i te rongoā i te mea e tika ana.
Kāore rawa he mamae o te whakamātautau taurangi-pāmu-pāmu, ā, he rite tonu te āhua ki te whai i tō pēhanga toto i te wā o te haerenga rongoā. Ka rongo koe i te āhua e mōhiotia ana o te pūhi pēhanga toto e pupuhi ana i te taha o tō ringa me tō pāmū, engari kāore he mea e kore e pai ake i tērā.
I te wā o te whakamātautau, ka takoto koe i runga i te tēpu whakamātau i te wā e whakamahi ana tō kaiwhakarato hauora i te hinu ultrasound ki tō kiri me te whakamahi i te pūrere Doppler ki te kimi i ō pupuhi. Ka āhua mātao pea te hinu, engari kāore i te pai. Ka noho noa te pūrere Doppler ki runga i tō kiri, ā, kāore e pā ana ki te āhua.
Tata ki te 10-15 meneti te roa o te katoa o te tukanga, ā, he maha ngā tāngata e kite ana he tino whakangā. Ka rongo pea koe i ngā oro whakanuia o tō rerenga toto mā te pūrere Doppler, he mea noa tēnei, ā, e tohu ana kei te pai te mahi o te whakamātautau.
Kei runga i ō āhuatanga tūpono takitahi, ō tohumate, me ngā hua whakamātautau o mua te auau o te whakamātautau taurangi-pāmu-pāmu. Mō te nuinga o ngā tāngata, ka whakamahia te ABI hei taputapu tātari kotahi anake, engari e hiahia ana ētahi āhuatanga ki te aroturuki i ngā wā katoa.
Mēnā he pai tō ABI tuatahi, ā, kāore ō tohu, ā, kāore he āhuatanga tūpono, kāore pea koe e hiahia ki te whakamātau anō, ki te kore e huri tō āhua hauora. Heoi anō, ki te whanake ō tohu hou, ā, he āhuatanga tūpono pēnei i te mate huka, tērā pea ka tūtohu tō tākuta kia arotakehia i ia wā.
Ko ngā tāngata he hua ABI kāore i te pai, te tikanga me whakamātau anō ia 6-12 marama ki te aroturuki i te pikinga o te mate me te urupare ki te rongoā. Mā tō tākuta e whakatau te wā tika mō te whakamātau i runga i tō āhuatanga, ō tohu, me te mahere rongoā. Ko te whāinga he hopu i ngā huringa i te wā wawe, me te karo i ngā whakamātau kāore i te tika.