Ni iki Gushyira Ukwaha Imitsi y'Ibihaha? Intego, Uburyo & Ibivamo

Gushyira ukwaha imitsi y'ibihaha ni uburyo bwo mu mutima butagira ingaruka nyinshi buvura atrial fibrillation binyuze mu gukora ibikomere bigenzurwa hirya no hino y'imitsi y'ibihaha. Ibi bikomere bibuza ibimenyetso bitari bisanzwe by'amashanyarazi bituma umutima wawe utera mu buryo butajegajega, bigafasha gusubiza umutima mu murongo usanzwe.

Bitekereze nk'uko usubiza insinga mu buryo bw'amashanyarazi bw'umutima wawe. Ubu buryo bukoresha ubushyuhe cyangwa imbaraga zikonjesha kugira ngo hakorwe inzitizi ntoya, zihamye zibuza ibitutu by'amashanyarazi bitunguranye guhungabanya umutima wawe mu buryo busanzwe.

Ni iki gushyira ukwaha imitsi y'ibihaha?

Gushyira ukwaha imitsi y'ibihaha (PVI) ni uburyo bushingiye kuri catheter buvura atrial fibrillation binyuze mu gutandukanya imitsi y'ibihaha kuva muri atrium y'ibumoso. Imitsi y'ibihaha ni imitsi ine itwara amaraso arimo umwuka wa oxygen ava mu bihaha byawe asubira mu mutima wawe.

Mugihe cy'uburyo, muganga wawe akora urugero ruzenguruka rw'igikomere hirya no hino ku muryango wa buri mutsi w'ibihaha. Iki gikomere gikora nk'uruzitiro rw'amashanyarazi, kibuza ibimenyetso bitari bisanzwe by'amashanyarazi kuva mu mitsi bigera mu byumba byo hejuru by'umutima wawe.

Ubu buryo kandi bwitwa ablation y'imitsi y'ibihaha cyangwa ablation ya catheter. Bikorerwa muri laboratoire yihariye ya catheterization ya cardiac na electrophysiologist, umuganga w'umutima wihariye mu ndwara z'umutima.

Kuki gushyira ukwaha imitsi y'ibihaha bikorwa?

Gushyira ukwaha imitsi y'ibihaha ahanini bikorwa kugira ngo bivure atrial fibrillation (AFib), indwara isanzwe y'umutima ituma umutima utera mu buryo butajegajega kandi akenshi vuba. AFib ibaho iyo ibimenyetso by'amashanyarazi mu mutima wawe bihinduka ibintu bitajegajega, bituma ibyumba byo hejuru binyeganyega aho gutera neza.

Muganga wawe ashobora kugusaba gukora PVI niba ufite AFib ifite ibimenyetso idasubiza neza imiti. Ibi birimo ibihe uhuriramo n'umutima utera vuba, guhumeka bigoranye, kubabara mu gituza, kunanirwa, cyangwa kuribwa bikananiza ubuzima bwawe bwa buri munsi.

Ubu buryo bufitiye akamaro abantu bafite paroxysmal AFib, aho ibihe biza bigenda bitunguranye. Bishobora kandi gufasha abafite AFib ihoraho bifuza kugabanya kwishingikiriza ku miti y'igihe kirekire cyangwa badashobora kwihanganira imiti ya AFib kubera ingaruka zayo.

Mu bihe bimwe na bimwe, PVI ishobora gusabwa kugabanya ibyago bya stroke. AFib yongera ibyago bya stroke kuko umutima utera nabi ushobora gutuma amaraso avurirana mu mutima wawe, hanyuma akajya mu bwonko bwawe.

Ni iki gikorerwa gukora pulmonary vein isolation?

Pulmonary vein isolation ikorerwa muri laboratoire ya cardiac catheterization mugihe uri munsi ya sedation cyangwa anesthesia rusange. Ubu buryo busanzwe bufata amasaha 2 kugeza kuri 4, bitewe n'uburyo urubanza rwawe rumeze.

Muganga wawe atangira ashyiraho imiyoboro mito, yoroshye yitwa catheters binyuze mu miyoboro y'amaraso mu gatuza cyangwa mu ijosi ryawe. Izi catheters ziyoborwa mu mutima wawe hakoreshejwe amashusho ya X-ray na sisitemu zigezweho zikora ishusho ya 3D y'ibikorwa by'amashanyarazi by'umutima wawe.

Ibi nibyo bibaho mugihe cy'intambwe nyamukuru y'ubu buryo:

1. Gushushanya sisitemu y'amashanyarazi y'umutima wawe kugirango umenye neza aho ibimenyetso bidasanzwe bituruka
2. Gushyira catheter ya ablation ku muryango wa buri pulmonary vein
3. Gutanga ingufu za radiofrequency (ubushyuhe) cyangwa cryoenergy (ubukonje) kugirango habeho uruhu rwanduye rucungwa
4. Gupima isolation ukoresheje kureba ko ibimenyetso by'amashanyarazi biva muri pulmonary veins byahagaritswe rwose
5. Gukurikirana umutima wawe kugirango wemeze ko ubu buryo bwagenze neza

Igikomere gishobora kuvuka ako kanya ariko kigakomeza gukura mu byumweru byinshi. Ubu buryo bwo gukira bufasha kumenya ko gutandukanya amashanyarazi biguma burundu kandi neza mu gihe kirekire.

Ni gute witegura gutandukanya imitsi y'umutima?

Kwitegura gutandukanya imitsi y'umutima mubisanzwe bitangira mu byumweru byinshi mbere yo gukora uwo murimo. Muganga wawe azaguha amabwiriza yihariye yagenewe ibyo ukeneye n'amateka yawe y'ubuvuzi.

Birashoboka ko uzagomba guhagarika imiti imwe n'imwe mbere yo gukora uwo murimo, cyane cyane imiti ituma amaraso atavura. Ariko, ntuzigere uhagarika umuti uwo ari wo wose utabiherewe amabwiriza n'ikipe yawe y'ubuzima, kuko iki gihe ni ingenzi ku mutekano wawe.

Kwitwaza kwawe bishobora gukubiyemo iyi ntambwe z'ingenzi:

• Gukora ibizamini mbere yo gukora uwo murimo nk'ibizamini by'amaraso, X-ray y'igituza, na echocardiogram
• Gufata imiti yanditswe niba ufite indwara zimwe na zimwe z'umutima
• Kuzirikana amasaha 8-12 mbere yo gukora uwo murimo (ntukagire icyo urya cyangwa unywa uretse amazi make hamwe n'imiti)
• Gutegura umuntu wo kukujyana mu rugo nyuma yo gukora uwo murimo
• Gukuraho imitako, polish y'inzara, na contact lenses mbere yo kuhagera

Muganga wawe ashobora kandi kugusaba gukora transesophageal echocardiogram (TEE) kugirango arebe ibibumbye by'amaraso mu mutima wawe mbere yo gukora uwo murimo. Iki ni ikizamini cy'umutekano kugirango hamenyekane ko uwo murimo ushobora gukorwa neza.

Ni gute usoma ibisubizo byo gutandukanya imitsi y'umutima?

Intsinzi yo gutandukanya imitsi y'umutima ipimwa n'uburyo bigenzura neza ibimenyetso byawe bya atrial fibrillation kandi bikakumira ibihe bizaza. Muganga wawe azakurikiza iterambere ryawe binyuze mu nama zo gukurikirana no gukurikirana umuvuduko w'umutima.

Intsinzi yihuse imenyekana mugihe cyo gukora uwo murimo ubwawo. Muganga wawe agerageza niba imitsi y'umutima yatandukanijwe rwose akoresheje kureba ko nta bimenyetso by'amashanyarazi bishobora kunyura hagati y'imitsi n'umutima wawe w'ibumoso.

Uko bigenda neza mu gihe kirekire bisuzumwa mu mezi n'imyaka hakoreshejwe ubu buryo:

• Ibizamini bya EKG buri gihe kugira ngo barebe uko umutima wawe utera mu gihe uri kwa muganga
• Gukoresha Holter cyangwa ibikoresho byerekana uko umutima utera byandika uko umutima wawe utera mu masaha 24-48 cyangwa arenga
• Gukurikirana ibimenyetso kugira ngo urebe niba utagira ibihe byinshi byo gutera k'umutima vuba, guhumeka bigoranye, cyangwa kutumva neza mu gituza
• Ibizamini byo gukora imyitozo ngororamubiri kugira ngo barebe niba umutima wawe ukomeza gutera neza mu gihe ukora imyitozo ngororamubiri

Amahame yo kugenda neza aratandukanye, ariko ubushakashatsi bwerekana ko 70-80% by'abantu bafite paroxysmal AFib bakomeza kutagira ibihe bya AFib umwaka umwe nyuma y'ubwo buryo. Abantu bamwe bashobora gukenera gukora ubwo buryo bundi, niba AFib igarutse, ibyo bisanzwe kandi ntibisobanura ko ubwo buryo bwa mbere butagenze neza.

Ni iki cyiza cyo gukora mu gutandukanya imitsi y'imitsi y'umutima?

Icyiza cyo gukora mu gutandukanya imitsi y'imitsi y'umutima ni ukubona umudendezo wuzuye wo kutagira ibihe bya atrial fibrillation mu gihe umutima wawe ukora neza. Ibi bisobanura ko utagira umutima utera nabi, umutima utera cyane, cyangwa ibimenyetso bifitanye isano na AFib mu buzima bwawe bwa buri munsi.

Ibyiza kandi birimo no guteza imbere imibereho myiza. Abantu benshi bavuga ko babona imbaraga nyinshi mu gukora imyitozo ngororamubiri, bagabanya umunaniro, kandi ntibongera guhangayika ku bijyanye n'uburwayi bw'umutima nyuma yo gukora PVI neza.

Ibyiza by'igihe kirekire birimo ibi bintu by'ingenzi:

• Umutima ukomeza gutera neza nta bihe bya AFib
• Kugabanya gukenera imiti igabanya umutima
• Kugabanya ibyago byo guhura n'indwara ya stroke bitewe n'uko umutima ukomeza gutera neza
• Kongera ubushobozi bwo gukora imyitozo ngororamubiri n'imbaraga
• Guteza imbere imibereho myiza muri rusange no kwigirira icyizere mu bikorwa bya buri munsi

N'iyo ukeneye gukomeza gufata imiti nyuma ya PVI, gukora neza ubwo buryo akenshi bituma ufata imiti mike cyangwa mike kurusha mbere. Muganga wawe azakorana nawe kugira ngo abone uko byagenda neza ku miterere yawe.

Ni ibihe bintu bitera ibyago byo gukenera gutandukanya imitsi y'imitsi y'umutima?

Ibintu byinshi bishobora kongera amahirwe yo kurwara atrial fibrillation ikomeye bihagije kugirango bisabe gutandukanya imitsi ya pulmonary. Kumva ibyo bintu byongera ibyago bifasha wowe na muganga wawe gufata ibyemezo bifitiye akamaro ku bijyanye n'imiti.

Imyaka ni kimwe mu bintu byongera ibyago cyane, kuko AFib igenda yiyongera uko ugenda usaza. Ariko, abantu bakiri bato nabo barashobora kurwara AFib, cyane cyane niba bafite izindi ndwara zibitera.

Ibintu bisanzwe byongera ibyago bishobora gutuma ukeneye PVI birimo:

• Umubyibuho ukabije utagenzurwa neza uko igihe kigenda
• Indwara z'umutima zirimo indwara ya coronary artery, ibibazo bya valve y'umutima, cyangwa kunanirwa k'umutima
• Urubuto, cyane cyane iyo isukari yo mu maraso izamuka kenshi
• Umubyibuho ukabije, ushyira umutwaro wiyongera ku mutima wawe
• Sleep apnea, ishobora gutera imirimo y'umutima idasanzwe
• Indwara za thyroid, cyane cyane thyroid ikora cyane
• Kunywa inzoga nyinshi cyangwa kunywa inzoga nyinshi
• Amateka y'umuryango ya atrial fibrillation cyangwa izindi ndwara z'imirimo y'umutima

Abantu bamwe barwara AFib nta bintu byongera ibyago bigaragara, kandi ibyo ni ibisanzwe rwose. Ikintu cy'ingenzi ni ukubona imiti ikwiye iyo ibimenyetso bigira ingaruka zikomeye ku mibereho yawe.

Ni izihe ngaruka zishobora guterwa no gutandukanya imitsi ya pulmonary?

Mugihe gutandukanya imitsi ya pulmonary muri rusange bifite umutekano, nkuko bimeze kuri buri buryo bwo kuvura, bifite ibyago bimwe. Ingaruka nyinshi ni izitaramenyerewe kandi zishobora gucungwa neza iyo zibaye.

Ingaruka zisanzwe ni nto kandi zikemuka vuba. Ibi bishobora kuba birimo gukomeretsa by'agateganyo cyangwa kubabara ahantu hashyizweho catheter, bikunda gukira muminsi mike.

Ingaruka zikomeye ariko zitamenyerewe zirimo:

• Gushoka amaraso ahantu bashyize catheter bishobora gusaba igitutu cyangwa izindi nzego zivura
• Ududuko tw'amaraso dushobora kujya mu bindi bice by'umubiri wawe
• Ukwangirika kw'imitsi y'amaraso igihe bashyiraga catheter
• Ukwangirika kw'uruhago, rwegereye umutima
• Kugabanuka kw'imitsi ya pulmonary, aho imitsi yavuwe igabanuka
• Pericarditis, ni ukubyimbirwa kw'agahago kazengurutse umutima wawe
• Ibibazo bishya by'umuvuduko w'umutima, nubwo ibi bikunze kuba by'igihe gito

Ibikomere bikomeye ariko bidasanzwe birimo sitiroko, umutima guhagarara, cyangwa kwangirika kw'ibindi bice byegereye. Umuganga wawe w'inzobere mu by'amashanyarazi y'umutima azaganira nawe kuri ibi byago kandi akusobanurire uburyo babigabanya igihe bakora ubuvuzi.

Ni ryari nkwiriye kubona umuganga nyuma yo gutandukanya imitsi ya pulmonary?

Ukwiriye guhamagara umuganga wawe ako kanya niba wumva ibimenyetso bibangamiye nyuma yo gutandukanya imitsi ya pulmonary. Nubwo kutumva neza ari ibisanzwe, ibimenyetso bimwe na bimwe bisaba ubufasha bwihuse bw'abaganga.

Hamagara umuganga wawe ako kanya niba ubonye amaraso menshi, kubyimba, cyangwa kurushaho kubabara ahantu bashyize catheter. Kandi shaka ubufasha bwihuse niba urwaye mu gituza, guhumeka nabi cyane, cyangwa ibimenyetso by'ubwandu nk'umuriro cyangwa guhinda umushyitsi.

Aha hari ibihe bisaba ubufasha bwihuse bw'abaganga:

• Gushoka amaraso menshi ahantu bashyize catheter bitahagarara n'igitutu gito
• Ibimenyetso by'ubwandu birimo umuriro, umutuku, gushyuha, cyangwa amaraso ava ahantu bashyize catheter
• Kubabara cyane mu gituza cyangwa igitutu kitandukanye n'ibimenyetso bisanzwe bya AFib
• Gutangira guhumeka nabi cyane cyangwa kugorwa no guhumeka
• Ibimenyetso bya sitiroko nk'intege nke zidasanzwe, kugorana kuvuga, cyangwa guhinduka kw'ibyo ubona
• Kuruka bidahagarara, cyangwa kutabasha kunywa amazi

Mugihe cyo gukurikiranira hafi, mubisanzwe uzabona muganga wawe nyuma y'icyumweru kimwe cyangwa bibiri nyuma y'uburyo bwakoreshejwe. Iyi gahunda ituma ikipe y'ubuzima bwawe igenzura uko urimo gukira kandi igasubiza ibibazo cyangwa impungenge waba ufite.

Ibikunze kubazwa ku bijyanye no gutandukanya imitsi y'umutima

Ese gutandukanya imitsi y'umutima ni byiza ku bwoko bwose bwa atrial fibrillation?

Gutandukanya imitsi y'umutima bikora neza kuri paroxysmal atrial fibrillation, aho ibyiciro biza bigenda byonyine. Urwego rw'ubushobozi bwo gukira mubisanzwe ruri hejuru muri iri tsinda, aho 70-80% by'abantu baguma badafite ibyiciro bya AFib nyuma y'umwaka umwe.

Kuri persistent AFib, aho ibyiciro bimara iminsi irenga irindwi, PVI iracyashobora gukora neza ariko bishobora gusaba uburyo bwo gukoresha ablation. Muganga wawe ashobora gukenera gukora imirongo y'ibikomere byinshi mu mutima wawe urenze gusa gutandukanya imitsi y'umutima.

Abantu bafite long-standing persistent AFib bashobora kugira urwego rwo gukira ruto hamwe na PVI gusa. Ariko, ubu buryo buracyashobora gutanga imbaraga zikomeye zo kugabanya ibimenyetso no guteza imbere imibereho myiza, nubwo gukira neza kutagerwaho.

Ese gutandukanya imitsi y'umutima neza bikiza atrial fibrillation burundu?

Gutandukanya imitsi y'umutima birashobora gutanga umudendezo urambye kuva muri atrial fibrillation, ariko ntabwo buri gihe ari umuti urambye. Abantu benshi baguma badafite AFib imyaka myinshi nyuma y'uburyo bwakoreshejwe, mugihe abandi bashobora guhura n'ibyiciro bya hato na hato.

Intsinzi ya PVI iterwa n'impamvu nyinshi zirimo ubwoko bwa AFib ufite, igihe umaze uyirwaye, n'ubuzima bw'umutima wawe muri rusange. Abantu bamwe bashobora gukenera uburyo bwo gusubiramo niba AFib isubiye, ibyo bikaba bisanzwe mu kuvurwa.

N'iyo AFib igaruka rimwe na rimwe, abantu benshi baracyahura n'iterambere rikomeye mu bimenyetso byabo no mu mibereho myiza. Ibyiciro bikunze kuba bike, bigufi mu gihe, kandi byoroshye gucunga hamwe n'imiti.

Ese nshobora gukora imyitozo nk'ibisanzwe nyuma yo gutandukanya imitsi y'umutima?

Abantu benshi bashobora gusubira gukora imyitozo ngororamubiri isanzwe n'ibikorwa bya buri munsi nyuma yo gukorerwa uburyo bwo gutandukanya imitsi y'umutima. Ariko, uzakenera gukurikiza gahunda yihariye yo gusubukura ubwoko butandukanye bw'ibikorwa.

Mu minsi mike ya mbere nyuma yo gukorerwa ubu buryo, ugomba kwirinda gukora imirimo ivunanye, imyitozo ikomeye, n'ibikorwa bishobora gushyira igitutu ku gice cyashyizwemo urushinge. Kugenda gake bikunze gushishikarizwa kugira ngo bikureho gukora ibibyimba by'amaraso.

Umuvuzi wawe azatanga amabwiriza yihariye ashingiye ku miterere yawe bwite. Abantu benshi basanga bashobora gukora imyitozo neza nyuma yo gukorerwa PVI yagenze neza kuko umutima wabo ukora neza kandi ntibagira umwuka muke cyane mu gihe bakora imyitozo ngororamubiri.

Ese nzakomeza gufata imiti igabanya amaraso nyuma yo gutandukanya imitsi y'umutima?

Niba uzakomeza gufata imiti igabanya amaraso nyuma yo gutandukanya imitsi y'umutima biterwa n'ibintu byihariye bigushyira mu kaga ko kurwara situroke. Icyemezo ntishingiye gusa ku kuba uburyo bwakoreshejwe bwaratsinze mu kugenzura AFib yawe.

Umuvuzi wawe azakoresha uburyo bwo gupima nka CHA2DS2-VASc kugira ngo asuzume ibyago byawe byo kurwara situroke ashingiye ku bintu nk'imyaka, igitsina, diyabete, umuvuduko ukabije w'amaraso, n'amateka ya situroke. Niba amanota yawe agaragaza ibyago byiyongereye, ushobora gukenera gukomeza gufata imiti igabanya amaraso igihe kirekire.

Abantu bamwe bafite amanota make y'ibibazo bya situroke bashobora guhagarika imiti igabanya amaraso nyuma yo gukorerwa PVI yagenze neza, ariko iki cyemezo kigomba gufatwa buri gihe hamwe n'ikipe yawe y'ubuvuzi. Bazatekereza ku ishusho yawe yuzuye y'ubuzima mugihe bafata iyi nama.

Bifata igihe kingana iki kugira ngo ukire nyuma yo gutandukanya imitsi y'umutima?

Abantu benshi bashobora gusubira mu bikorwa bya buri munsi bisanzwe mu minsi mike kugeza ku cyumweru nyuma yo gutandukanya imitsi y'umutima. Ariko, gukira neza no kungukirwa byuzuye n'ubu buryo bishobora gufata ibyumweru byinshi kugeza ku mezi menshi.

Ahantu bashyizeho catheter mubisanzwe hakira mu minsi 3-5, nubwo ushobora kugira ibibara cyangwa kubabara kugeza ku byumweru bibiri. Uzagomba kwirinda guhagarika ibintu biremereye no gukora imyitozo ikomeye mu gihe cy'icyumweru kugira ngo bikire neza.

Uduce tw'imitsi twakozwe mugihe cyo kubaga dukomeza gukura muminsi 2-3 nyuma ya PVI. Muri iki gihe, ushobora kugira umutima utera nabi cyangwa ibihe bya AFib, akenshi bikemuka mugihe gukira kurangira. Muganga wawe azakurikiza imiterere yawe neza muri iki gihe.