He aha te Pūrere Āwhina Ventricular? Te Whāinga, te Hātepe & Ngā Hua

He pūrere āwhina ventricular (VAD) he pūmua mīhini e āwhina ana i tō ngākau ki te huri toto puta noa i tō tinana i te wā e ngoikore ana tō uaua ngākau ki te mahi i tēnei mahi whai hua anō. Whakaarohia he hoa tautoko mō tō ngākau, e uru mai ana ki te whakarite kia whiwhi ō rātou okana i te toto whai hāora e hiahiatia ana e rātou kia pai te mahi.

Kua āwhina tēnei hangarau whakaora-ora i ngā mano tāngata ki te noho i ngā oranga whānui, kaha ake i te wā e whakahaere ana i te ngoikoretanga ngākau nui. Ahakoa kei te tūhura koe i ngā kōwhiringa maimoatanga mō koe, mō tētahi rānei e arohaina ana, mā te māramatanga ki te mahi a ngā VAD ka āwhina koe ki te whai māia ake mō tēnei whakatau rongoā nui.

He aha te pūrere āwhina ventricular?

He pūrere āwhina ventricular he pūmua mīhini e whakahaeretia ana e te pākahiko, ka whakanohoia ki roto, ki waho rānei i tō pouaka kia āwhina i te pūmua toto mai i ngā ruma o raro o tō ngākau (ventricles) ki te toenga o tō tinana. E mahi ana te pūrere i te taha o tō ngākau tūturu, kāore i te whakakapi katoa.

Ko te nuinga o ngā VAD e tautoko ana i te ventricle mauī, koinei te ruma pūmua matua o tō ngākau e kawenga ana mō te tuku toto whai hāora puta noa i tō tinana. Ko ēnei e kīia ana ko ngā pūrere āwhina ventricular mauī (LVADs). Ka hiahia pea ētahi tāngata ki te tautoko mō tō rātou ventricle matau (RVAD) rānei, mō ngā taha e rua (BiVAD), i runga i tō rātou āhuatanga ngākau motuhake.

E whai ana te pūrere i ētahi wāhanga matua e mahi tahi ana. Ka whai koe i tētahi pūmua iti, ngā ngongo ngāwari e kīia ana ko cannulas e hono ana ki tō ngākau, he driveline e puta ana i tō kiri, me tētahi kaiwhakahaere o waho me ngā pākahiko e mau ana, e kawe ana rānei koe.

He aha te take i mahia ai te pūrere āwhina ventricular?

E taunakitia ana ngā VAD ina ngoikore rawa tō ngākau i te korenga o te ngākau, ā, kāore anō ētahi atu rongoā i whai hua. Ka tohutohu pea tō tākuta i tēnei kōwhiringa ina kore e taea e ngā rongoā, ngā huringa o te oranga, me ētahi atu tikanga te whakahaere i ō tohumate, i te mahi tika rānei o ō pūngao.

He rerekē ngā kaupapa o te pūrere i runga i tō āhuatanga takitahi me ngā whāinga rongoā wā-roa. Ka whakamahi ētahi tāngata i te VAD hei piriti ki te whakawhitinga ngākau, e āwhina ana i a rātou kia tū tika, kia hauora hoki i te wā e tatari ana kia wātea mai tētahi ngākau takoha. I ētahi wā ka roa pea tēnei wā tatari mō ngā marama, ētahi wā mō ngā tau.

Ka whiwhi ētahi atu i te VAD hei rongoā ū tonu, arā, ka noho tēnei hei rongoā tūturu ina kore e tika te whakawhitinga ngākau i runga i te pakeketanga, ētahi atu āhuatanga hauora, i te whiriwhiri whaiaro rānei. He tokomaha ngā tāngata i tēnei āhuatanga ka kite ka taea e rātou te hoki ki ngā mahi e pai ana ki a rātou, me te noho wā pai ki te whānau me ngā hoa.

I te nuinga o te wā, ka taea e ngā VAD te mahi hei piriti ki te whakaora mō ngā tāngata ka ora pea ō rātou ngākau i te wā me te tautoko. I ētahi wā ka whakamahia tēnei huarahi i muri i ngā whakaeke ngākau, ētahi mate pāwera, i te wā rānei e ora ana i te pokanga ngākau ina whakapono ngā tākuta ka whakahoki mai pea te uaua ngākau i ētahi o ōna kaha.

He aha te tikanga mō te whakauru pūrere āwhina pūpū ngākau?

He pokanga ngākau nui te whakaurunga VAD e 4 ki te 6 haora te roa, ā, e hiahia ana kia āta whakamahere me te whakarite. Ka whiwhi koe i te rongoā whānui, ā, ka honoa ki tētahi mīhini ngākau-pūkahukahu e whakahaere ana i ō mahi ngākau me ō pūkahukahu i te wā o te tikanga.

Ka hanga e tō tākuta he tapahi ki waenganui o tō uma, ā, ka āta hono te pūrere ki tō ngākau. Ko te pūmpu te tikanga ka whakatakotoria ki tō puku o runga, i raro tonu i tō uaua kōpū, kei reira e noho pai ana me te kore e whakararu i ō nekehanga o ia rā.

Koinei te mea ka tupu i te wā o te pokanga, i te taahiraa i muri i te taahiraa:

1. Ka whakatuwherahia e tō tākuta pokanga tō uma, ā, tērā pea ka hiahia ki te wehe i ētahi kiko kiko mena i pā tētahi pokanga ngākau i mua
2. Ka whakahaere te mīhini ngākau-pūkahukahu i te pūngao toto i te wā e mahi ana tō tākuta pokanga
3. Ka tuituia tētahi ngongo iti (inflow cannula) ki tō pūkahukahu mauī hei tango toto ki roto i te pūrere
4. Ka honoa tētahi atu ngongo (outflow cannula) ki tō aorta hei whakahoki toto ki tō rerenga toto
5. Ka whakatakotoria te pūngao ki tō puku, ā, ka whakamātauria kia mōhio ai kei te tika te mahi
6. Ka āta hangaia te driveline i raro i tō kiri, ā, ka puta mai i tō puku
7. Ka katia tō uma, ā, ka haria koe ki te wae tiaki kaha mō te aroturuki

Ko te whakaora i te hōhipera te tikanga e rua ki te toru wiki, ahakoa he rerekē tēnei i runga i tō hauora whānui me te tere o tō whakaora. Ka mahi tahi koe me tētahi rōpū tohunga e uru ana ki ngā tākuta pokanga ngākau, ngā kairangahau ngākau, ngā nēhi, me ētahi atu tohunga e mōhio ana ki te tiaki VAD.

Me pēhea te whakarite mō tō pokanga pūrere āwhina pūkahukahu?

Ko te whakarite mō te pokanga VAD e uru ana ki te whakarite tinana me te ngākau, ā, mā tō rōpū hauora koe e ārahi i ia wāhanga kia āwhina i a koe kia rite ai. Ka whai koe i ētahi whakamātautau kia mōhio ai kei te hauora koe mō te pokanga, ā, ko te VAD te kōwhiringa tika mō tō āhuatanga.

Tērā pea ka uru tō whakarite ki ngā whakamātautau toto, ngā rangahau whakaahua o tō ngākau me ētahi atu okana, me ngā kōrero ki ngā tohunga rerekē. Mā ēnei whakaritenga e āwhina tō rōpū ki te māramatanga ki tō hauora whānui me te whakamahere i te huarahi haumaru mō tō pokanga.

I ngā wiki i mua i te pokanga, arotahi ki te tiaki pai i a koe anō mā ēnei mahi nui:

• Me tango nga rongoā katoa i whakaritea kia rite ki te tohutohu, ina koa nga rongoā ngakau
• Kai i nga kai whai kiko hei hoatu kaha ki tō tinana mō te whakaora
• Kia nui te okiokinga me te moe i te wā e taea ana
• Kia kaha tonu i runga i ngā tohutohu a tō tākuta i roto i ō rātou herenga o nāianei
• Kaua e paowa, me te whakaiti i te waipiro, nā te mea ka raru pea ēnei i te whakaora
• Whakahaerehia te akuaku niho pai me te whakatika i ngā raruraru niho
• Ako mō te manaakitanga VAD me ngā huringa o te oranga e hiahia ana koe ki te mahi

Kaua e whakaroa ki te pātai pātai, ki te whakaputa rānei i ngā āwangawanga i ngā wā whakarite i mua i te pokanga. E hiahia ana tō rōpū kia mōhio koe, kia pai hoki te noho, ā, kei reira rātou ki te tautoko i a koe i roto i tēnei whakatau me te tukanga nui.

Me pēhea te pānui i ngā hua o tō pūrere āwhina ventricular?

I muri i te whakaurunga o tō VAD, ka ako koe ki te aroturuki i ētahi inenga nui e whakaatu ana ki a koe me tō rōpū hauora te pai o te mahi o te pūrere. E whakaatu ana tō kaiwhakahaere VAD i ngā mōhiohio mō te tere o te papu, te whakamahi hiko, me te rere, he tohu nui ēnei mō te mahi o tō pūrere.

Ko te tere o te papu, e inea ana i roto i ngā hurihanga ia meneti (RPM), te tikanga ka whakatakotoria i waenga i te 2,400 me te 3,200 RPM, ahakoa ka whakatauhia tō awhe whāinga motuhake e tō tākuta i runga i ō hiahia takitahi. Ka taea te whakatika i tēnei tere i ngā wā whakarite whai muri hei whakapai ake i tō rere toto me te whakaiti i ngā tohu.

E whakaatu ana te whakamahi hiko i te nui o te pūngao e whakamahia ana e tō pūrere, ā, ko te tikanga kei waenga i te 3 ki te 8 watts. Ko ngā huringa i roto i te whakamahi hiko i ētahi wā ka tohu i ngā take pēnei i te pūmua toto, i ngā huringa rānei i te pai o te mahi o tō ngakau i te taha o te pūrere.

E whakatau ana ngā inenga rere i te nui o te toto e papu ana tō VAD ia meneti, te tikanga kei waenga i te 3 ki te 6 rita. Ko te tikanga, ko te rere nui ake te tikanga he pai ake te tohanga ki ō rātou okana, i te mea ko te rere iti ake pea e tohu ana i te hiahia mō ngā whakatikatika.

Ka ako hoki koe ki te mohio ki nga tangi whakaoho me nga karere e whakatūpato ana i a koe ki nga ahuatanga e hiahia ana kia aro. Ko te nuinga o nga whakaoho e pa ana ki nga take pākahiko, nga raruraru hononga, me nga huringa rangitahi ka taea te whakatika ngawari, engari ka whakaako to roopu ki a koe me pehea te rapu awhina tonu.

Me pehea te whakahaere i te oranga me to taputapu awhina ventricular?

Ko te noho me te VAD e hiahia ana etahi whakarereketanga ki to mahi o ia ra, engari ka kitea e te nuinga o nga tangata ka taea e ratou te hoki ki te maha o nga mahi e pai ana ki a ratou i muri i te whakaoranga mai i te pokanga. Ko te mea nui ko te ako ki te whakauru i te tiaki taputapu ki roto i to oranga i te wa e noho hohe ana me te whai waahi ki te whanau me nga hoa.

Ko to mahi o ia ra ka uru ki te tirotiro i o taputapu, te pupuri i to waahi driveline kia ma, kia maroke, me te whakahaere i o pākahiko kia kore ai to taputapu e ngaro te mana. Ka mau koe i nga pākahiko taapiri ka ako ki te huri marie kia kore ai e haukotia o mahi.

Ko te tiaki i to waahi puta driveline he mea nui ki te aukati i nga mate, koinei tetahi o nga raruraru tino nui. Ka horoi koe i te waahi i ia ra me nga taonga motuhake me te matakitaki i nga tohu o te whero, te waikeri, te ngawari ranei e tohu ana i te raru.

Anei nga mahi whakahaere o ia ra e tika ana ka mohio koe:

• Tirohia to whakaaturanga kaiwhakahaere mo nga panui noa me nga whakaoho
• Horoi i to waahi puta driveline me te tikanga horoi
• Hurihia me te utu i nga pākahiko i runga i to waarangi
• Tangohia nga rongoa kua tohua, ina koa nga whakaiti toto
• Aroturukihia to taumaha me te ripoata i nga huringa nui
• Kia waiwai ana me te kai i te kai hauora-ngakau
• Kia nui te okiokinga me te whakahaere i te ahotea

Ko te nuinga o nga tangata whai VAD ka hoki haere ki te mahi, te haere, me nga mahi whakangahau me te whakamahere tika me nga whakatupatotanga. Ka awhina to roopu ki a koe ki te mohio ko wai nga mahi e haumaru ana me pehea te whakarereke i etahi atu kia uru ki to taputapu.

He aha nga mea morearea mo nga raruraru VAD?

Ahakoa he taputapu whakaora-ora nga VAD, pērā i ētahi atu wawaotanga rongoā nui, he raruraru ētahi e tika ana kia māramahia e koe i mua i tō whakatau. Ka kōrero tō rōpū rongoā i ēnei raruraru ki a koe i runga i te pono, ā, ka whakamārama me pēhea te mahi kia iti ake ai.

Ko te mate urutā tētahi o ngā raruraru tino noa, ina koa ki te wāhi putanga o te driveline kei reira te taura e puta ana i tō kiri. Ka waihanga tēnei i tētahi wāhi tuwhera tonu e hiahia ana ki te atawhai ia rā kia kore ai e uru ngā huakita ki tō tinana.

He maha ngā āhuatanga ka piki ake ai tō tūponotanga ki ngā raruraru, ā, mā te māramatanga ki ēnei ka āwhina i tō rōpū ki te whakarato i te manaakitanga pai rawa atu:

• Ngā pokanga ngākau o mua i waihanga i te kiko kōpiko
• Te mate huka, ētahi atu āhuatanga rānei e pā ana ki te whakaora
• Ngā raruraru tākihi, ate rānei e pā ana ki tō hauora whānui
• Te kai rawakore, te tino taumaha rānei, te iti rānei o te taumaha
• Ngā mate urutā kaha ki hea rānei i tō tinana
• Te uaua ki te whai i ngā hōtaka rongoā uaua
• Te tautoko pāpori iti mō te ako i te atawhai taputapu
• Te mate pūkahukahu nui, ētahi atu raruraru okana rānei

Ka āta arotake tō rōpū i ēnei āhuatanga i mua i te tūtohu i tētahi VAD kia mōhio ai koe ka whai hua koe i te taputapu i te wā e whakaiti ana i ngā raruraru pea. Ka mahi rātou ki a koe kia pai ake ai tō hauora i mua i te pokanga i te wā e taea ana.

He aha ngā raruraru ka puta mai i ngā taputapu āwhina ventricular?

Mā te māramatanga ki ngā raruraru pea ka āwhina i a koe ki te whakatau i tētahi whakatau mōhio, ā, kia mōhio ki ngā tohu hei mātakitaki i muri i te whakaurunga o tō VAD. Ahakoa ka puta ngā raruraru, he maha ngā tāngata e ora ana i te VAD mō ngā tau me te manaakitanga me te aroturuki tika.

Ko ngā raruraru tino noa ko te whakaheke toto, ngā kōpuku toto, me ngā mate urutā, e hiahia ana ia ki ngā rautaki aukati me ngā maimoatanga rerekē. Ka ako tō rōpū rongoā i a koe me pēhea te mōhio ki ngā tohu wawe o ēnei raruraru kia taea ai te whakatika wawe.

Koinei ngā raruraru e tika ana kia mōhio koe, kua whakarārangihia mai i te mea tino noa ki te mea iti:

• Ngā mate i te wāhi putanga o te driveline, e pā ana ki te whero, te mamae, te wai rānei
• Ngā raruraru toto nā te rongoā whakaheke toto e hiahiatia ana me ngā VAD
• Ngā kōpuku toto ka puta i roto i te pūrere, ka haere rānei ki ētahi atu okana
• Te ngoikore o te ngākau matau mēnā kāore e taea e tō ventricle matau te whai i te piki o te rere toto
• Te whiu mai i ngā kōpuku toto, i ngā huringa rānei i ngā tauira rere toto
• Te kore mahi o te pūrere e hiahia ana ki te whakatikatika, ki te pokanga whakakapi rānei
• Ngā raruraru tākihi mai i ngā huringa i te rere toto, i ngā rongoā rānei
• Te toto i roto i te puku, he mea noa ake pea ki ētahi momo VAD

Ko ngā raruraru iti noa iho engari he nui te kino ko te kore mahi o te pūrere, ngā mate kino e horapa ana puta noa i tō tinana, me ngā raruraru e pā ana ki ngā rongoā whakaheke toto. E mātakitaki ana tō rōpū i a koe mō ēnei take, ā, he tikanga ā rātou hei whakatika wawe i a rātou mēnā ka puta.

Kia mahara ahakoa te ahua o tēnei rārangi, he nui te wheako o tō rōpū hauora ki te whakahaere i ēnei raruraru, ā, he maha ka taea te ārai, te rongoā pai rānei mēnā ka kitea wawe.

Āhea au e kite ai i te tākuta mō ngā āwangawanga e pā ana ki te VAD?

Whai muri i te whiwhi i tō VAD, ka whai koe i ngā tūtohinga whai muri i te wā hei mātakitaki i tō pūrere me te hauora whānui, engari me mōhio hoki koe ki te wā ki te rapu āwhina hauora tonu. Mā te ako ki te mōhio ki ngā tohu whakatūpato ka āwhina i a koe ki te whiwhi i te manaakitanga wawe ina hiahiatia.

Me whakapā atu koe ki tō rōpū VAD tonu mēnā ka pā ki a koe ngā whakaoho pūrere kāore e whakatikahia me te rapu raruraru taketake, ngā tohu o te mate i te taha o tō driveline, i ngā tohu rānei e tohu ana i ngā raruraru pēnei i te whiu, i ngā raruraru ngākau rānei.

Rapua te manaakitanga ohorere tonu mō ēnei tohu whakatūpato kino:

• Ngā whakaoho pūrere tonu e kore e mutu, e kore rānei e tautuhi anō
• Te rahunga katoa o te pūrere, te ngaro rānei o te mana
• Te mamae nui o te uma, te uaua rānei ki te manawa
• Ngā tohu o te whiu pēnei i te ngoikoretanga ohorere, te rangirua, te raruraru rānei o te kōrero
• Te nui o te toto e kore e mutu mā te pēhi
• Te kirika nui me te wiri, te kore rānei e pai
• Te rārangi taraiwa kua tōia, kua pakaru rānei
• Te whanoke nui ohorere, te ngaro rānei o te mahara

Whakapā atu ki tō rōpū VAD i roto i ngā hāora 24 mō ēnei tohu e pā ana engari kāore i te tino ohorere: te rerenga wai, te whero haere rānei i te wāhi o tō rārangi taraiwa, te pikinga taumaha neke atu i te 3 pauna i te rā, te whakapairuaki tonu, te ruaki rānei, ētahi atu tohu hou e āwangawanga ana koe.

Kaua e whakaroa ki te waea mai mō ngā pātai, ngā āwangawanga rānei, ina koa i ngā marama tuatahi me te pūrere. He pai ake te rongo mai a tō rōpū i a koe mō tētahi mea iti iho i te tatari roa ki te whakatika i tētahi raruraru nui pea.

Ngā pātai e pātai pinepine ana mō ngā pūrere āwhina ventricular

Q.1 He pai te pūrere āwhina ventricular mō te ngoikore o te ngākau i te wā whakamutunga?

Āe, he pai ngā VAD hei whiringa rongoā mō te hunga e ngoikore ana te ngākau i te wā whakamutunga, kāore i pai ake mā te rongoā me ētahi atu rongoā. Ka taea e ēnei pūrere te whakapai ake i te kounga o te oranga, te whakanui i te oranga, me te āwhina i a koe ki te hoki ki ngā mahi e pai ana ki a koe.

Mō te nuinga o te hunga e ngoikore ana te ngākau, ka whakawhiwhia e te VAD te tautoko tohanga e hiahiatia ana hei pupuri i ngā okana e mahi tika ana i te wā e whakaiti ana i ngā tohu pēnei i te poto o te manawa me te ngenge. E whakaatu ana ngā rangahau ko te hunga e whai VAD ana he maha ngā wā e pai ake ana te kaha o te whakakori tinana me te oranga whānui i te rongoā rongoā anake.

Q.2 Ko te whai VAD te tikanga e kore e taea e au te haere, te kaha rānei?

Ka taea e te nuinga o te tangata e mau ana i nga VAD te haere me te noho kaha i muri i te whakaoranga mai i te pokanga, me te ako ki te whakahaere tika i o raatau taputapu. Me whakamahere i mua, me mau ano etahi taputapu, engari he maha nga tangata e whiwhi ana i te VAD e haere ana i roto i te motu me te ao.

Ko nga mahi penei i te hikoi, te kauhoe i etahi ahuatanga, me te maha o nga mahi whakangahau ka taea i nga wa katoa me nga whakatupatotanga tika. Ka awhina to roopu i a koe ki te mohio ko wai nga mahi e haumaru ana, me pehea te whakarereke i etahi atu kia uru ki to taputapu i te wa e noho kaha ana koe me te whakauru.

Q.3 Kia pehea te roa ka taea e au te noho me te taputapu awhina ventricular?

He maha nga tangata e noho ana mo nga tau me o raatau VAD, a kei te pai haere tonu nga reeti oranga i te wa e ahu whakamua ana te hangarau. Kua noho etahi tangata neke atu i te tekau tau me o raatau taputapu, me te pupuri i te kounga pai o te oranga puta noa.

Kei te whakawhirinaki to tirohanga takitahi ki nga mea maha tae atu ki to hauora katoa, te pai o to tiaki i to taputapu, me te whakawhanake i nga raruraru. Ka taea e to roopu hauora te hoatu ki a koe etahi atu korero motuhake i runga i to ahuatanga me to mana hauora.

Q.4 Ka taea e au te rongo i te VAD e mahi ana i roto i taku tinana?

Ka urutau te nuinga o nga tangata ki o raatau VAD i roto i etahi wiki, kaore hoki e kite i te mahi i nga mahi o ia ra. I te timatanga ka rongo pea koe i etahi wiri, ka rongo ranei i te tangi hum hum, engari ka iti ake enei kare i te wa.

I hangaia te taputapu kia pai, kia haere tonu, no reira kaua koe e rongo i nga nekehanga papu, i nga nekehanga ranei. E kitea ana e etahi tangata he whakatenatena te wiri ngawari na te mea ka mohio ratou kei te pai te mahi o ta ratou taputapu.

Q.5 Ka taea te tango i te VAD mena ka ora taku ngakau?

I ngā wā onge ka tino pai te mahi o te ngākau, ka taea te tango i ngā VAD i ētahi wā, ahakoa he iti noa iho te hunga e pērā ana. He nui ake te tūponotanga o tēnei i roto i ngā tāngata i pā mai te ngoikore o te ngākau i ngā āhuatanga ka taea te rongoā, pērā i ētahi mate urutā, i ngā whakaeke ngākau tata rānei.

Ka aroturukihia e tō rōpū hauora te mahi o tō ngākau i ngā wā katoa, ā, ka kōrerohia te tūponotanga o te tango i te pūrere mēnā ka whakaatu tō ngākau i te whakaoranga nui. Heoi, ko te nuinga o te hunga e whiwhi ana i ngā VAD ka hiahia ki a rātou mō te wā roa, hei piriti ki te whakawhitinga, hei rongoā tūturu rānei.