Icyo VAD ari cyo? Intego, Uburyo & Ibivamo

Icyuma gifasha umutima (VAD) ni icyuma gikora nk'ipompe gifasha umutima wawe kuzengurutsa amaraso mu mubiri wawe igihe imitsi y'umutima wawe iba yarushye cyane ku buryo itagishoboye gukora akazi kayo neza. Utekereze nk'umufatanyabikorwa w'umutima wawe, ugira uruhare mu gutuma ibice by'umubiri wawe bibona amaraso yuzuye umwuka wa oxygène bakeneye kugira ngo bikore neza.

Ubu buhanga burokorera ubuzima bwafashije ibihumbi by'abantu kubaho ubuzima bwuzuye, bufite imbaraga nyinshi mu gihe bafata imiti yo kuvura umutima udakora neza. Uramutse ushaka kumenya uburyo bwo kwivuza wowe ubwawe cyangwa uwo ukunda, gusobanukirwa n'uko VAD ikora bishobora kugufasha kumva ufite icyizere cyinshi ku cyemezo cy'ubuvuzi cy'ingenzi.

Icyo icyuma gifasha umutima ari cyo?

Icyuma gifasha umutima ni icyuma gikora nk'ipompe gikoresha umuriro gishyirwa mu buryo bw'ubuvuzi imbere cyangwa hanze y'igituza cyawe kugira ngo gifashe gupompa amaraso ava mu byumba byo hepfo by'umutima wawe (ventricles) ajye mu bindi bice by'umubiri wawe. Icyuma gikora gifatanya n'umutima wawe w'umwimerere, ntabwo gisimbura rwose.

VAD nyinshi zifasha ventricle y'ibumoso, ariyo cyumba cy'ingenzi cy'umutima wawe gishinzwe kohereza amaraso yuzuye umwuka wa oxygène mu mubiri wawe. Izi zitwa ibyuma bifasha ventricle y'ibumoso (LVADs). Abantu bamwe bashobora gukenera ubufasha bwa ventricle y'iburyo (RVAD) cyangwa impande zombi (BiVAD), bitewe n'uburwayi bw'umutima bwihariye.

Icyuma kigizwe n'ibice byinshi by'ingenzi bikorera hamwe neza. Uzagira ipompe ntoya, imiyoboro yoroshye yitwa cannulas ihuza n'umutima wawe, umurongo w'imbaraga usohoka mu ruhu rwawe, n'umuyobozi wo hanze ufite amabateri uzambara cyangwa uzajyana nawe.

Kuki icyuma gifasha umutima gikoreshwa?

VAD zishobora gukoreshwa igihe umutima wawe ucika intege cyane bitewe n'umutima wananiwe gukora neza kandi izindi nshuti zitatanze impinduka zihagije. Muganga wawe ashobora gutanga iyi nzira igihe imiti, impinduka mu mibereho, n'izindi nzira zitagishobora kugufasha kugabanya ibimenyetso cyangwa ibice by'umubiri wawe bikora neza.

Icyuma gifasha mu nshingano zitandukanye bitewe n'uko ubuzima bwawe bumeze n'intego z'ubuvuzi bw'igihe kirekire. Abantu bamwe bakoresha VAD nk'ikiraro cyo kwimurira umutima, bibafasha kuguma bahamye kandi bafite ubuzima bwiza mu gihe bategereje umutima wo gutanga. Iki gihe cyo gutegereza rimwe na rimwe gishobora kumara amezi cyangwa imyaka.

Abandi bakira VAD nk'ubuvuzi bw'ahantu, bisobanura ko bibaye ubuvuzi burambye igihe kwimurira umutima bitakwemerwa bitewe n'imyaka, izindi ndwara, cyangwa guhitamo ku giti cye. Abantu benshi bari muri iyi mimerere basanga bashobora gusubira mu bikorwa bakunda kandi bakamarana igihe cyiza n'umuryango n'inshuti.

Bitari kenshi, VAD zishobora gukora nk'ikiraro cyo koroherwa ku bantu imitima yabo ishobora gukira hamwe n'igihe n'ubufasha. Ubu buryo rimwe na rimwe bukoreshwa nyuma y'umutima watewe n'umutima, indwara zimwe na zimwe, cyangwa mu gihe cyo koroherwa nyuma yo kubagwa umutima igihe abaganga bemeza ko imitsi y'umutima ishobora kongera imbaraga.

Ni iki gikorerwa mu gushyiraho igikoresho gifasha umutima?

Gushyiraho VAD ni kubagwa umutima gukomeye bisaba amasaha 4 kugeza kuri 6 kandi bisaba gutegura no gutegura neza. Uzahabwa anesthesia rusange kandi uhuzwe n'imashini y'umutima n'ibihaha ifata imirimo y'umutima n'ibihaha byawe mu gihe cyo gukora.

Umuvuzi wawe azakora igikomere hagati y'igituza cyawe kandi ahuzwe neza igikoresho ku mutima wawe. Pump ikunze gushyirwa mu gice cyo hejuru cyo mu nda yawe, munsi gato ya diaphragm yawe, aho yicara neza itabangamiye imyifatire yawe ya buri munsi.

Ibi nibyo bibaho mu gihe cyo kubagwa, intambwe ku yindi:

1. Umuvuzi wawe abanza gufungura igituza cyawe kandi ashobora gukenera gutandukanya ibice by’uruhu rwakomeretse niba warabazwe ku mutima mbere
2. Uruushinge rwo guhumeka n’umutima rufata akazi ko gutera amaraso mugihe umuvuzi wawe akora
3. Agatubuzo gato (inflow cannula) kadodwa muri ventricle yawe y'ibumoso kugirango akure amaraso muri ako gace
4. Urundi tubuzo (outflow cannula) ruhuzwa na aorta yawe kugirango risubize amaraso mu mikorere yawe
5. Pump ikoreshwa mu nda yawe kandi igeragerezwa kugirango imikorere yayo ikore neza
6. Urugero rwo gutwara ruzamurwa munsi y'uruhu rwawe rukava mu nda yawe
7. Igituza cyawe kirafungwa ukajyanwa mu kigo cyita ku barwayi barembye kugirango ukurikiranwe

Gukira mu bitaro mubisanzwe bifata ibyumweru 2 kugeza kuri 3, nubwo ibi bitandukanye bitewe n'ubuzima bwawe muri rusange n'uko ukira vuba. Uzafashanya cyane n'ikipe yihariye irimo abaganga babaga imitima, abaganga b'umutima, abaforomo, n'abandi bahanga bazi neza uburyo bwo kwita kuri VAD.

Ni gute witegura kubagwa igikoresho cyo gufasha ventricle yawe?

Kwitegura kubagwa VAD bikubiyemo kwitegura mu buryo bw'umubiri no mu byiyumvo, kandi ikipe yawe y'ubuvuzi izakuyobora mu ntambwe zose kugirango wumve ko witeguye uko bishoboka kose. Uzasuzumwa ibizamini byinshi kugirango wemeze ko ufite ubuzima bwiza buhagije kugirango ubazwe kandi ko VAD ariyo nzira ikwiriye kuri wowe.

Kwitegura kwawe birashoboka ko bizakubiyemo ibizamini by'amaraso, isesengura ry'umutima wawe n'izindi ngingo, n'ibiganiro n'abahanga batandukanye. Ibi biganiro bifasha ikipe yawe gusobanukirwa ubuzima bwawe muri rusange no gutegura uburyo bwiza bwo kubagwa.

Mu byumweru mbere yo kubagwa, wibande ku kwitaho neza ukurikiza izi ntambwe z'ingenzi:

• Fata imiti yose yandikiwe uko byategetswe, cyane cyane imiti y'umutima
• Fata ibiryo bifite intungamubiri kugira ngo bihe umubiri wawe imbaraga zo gukira
• Uruhuke bihagije kandi uryame igihe bibaye ngombwa
• Guma ukora imyitozo nk'uko muganga wawe abikugira inama mu byo ushoboye gukora ubu
• Irinde kunywa itabi kandi ugabanye inzoga, kuko ibi bishobora kubangamira gukira
• Kora isuku nziza y'amenyo kandi ukemure ibibazo byose by'amenyo
• Menya ibyerekeye kwitabwaho kwa VAD n'impinduka z'imibereho uzagomba gukora

Ntugatinye kubaza ibibazo cyangwa kugaragaza impungenge mu gihe cyo kwisuzumisha mbere yo kubagwa. Itsinda ryawe rirashaka ko wumva ufite amakuru ahagije kandi wishimye, kandi bariho kugira ngo bagushyigikire muri iki cyemezo n'inzira by'ingenzi.

Ni gute usoma ibisubizo byawe bya ventricular assist device?

Nyuma yo gushyirwaho VAD yawe, uziga gukurikirana ibipimo byinshi by'ingenzi bikubwira wowe n'ikipe yawe y'abaganga uko igikoresho gikora neza. Umuyobozi wa VAD yawe agaragaza amakuru yerekeye umuvuduko wa pompe, imbaraga zikoreshwa, n'umuvuduko w'amaraso, ibyo bikaba ari ibimenyetso by'ingenzi by'imikorere y'igikoresho cyawe.

Umuvuduko wa pompe, upimwa mu mpinduka ku munota (RPM), ubusanzwe ushyirwa hagati ya 2,400 na 3,200 RPM, nubwo urwego rwawe rwihariye ruzagenwa na muganga wawe hashingiwe ku byo ukeneye. Uyu muvuduko urashobora guhindurwa mu gihe cyo gusuzumwa nyuma yo kubagwa kugira ngo unoze umuvuduko w'amaraso yawe no kugabanya ibimenyetso.

Imbaraga zikoreshwa zerekana ingano y'imbaraga igikoresho cyawe gikoresha kandi ubusanzwe ziri hagati ya wati 3 na 8. Impinduka mu mikoreshereze y'imbaraga rimwe na rimwe zishobora kugaragaza ibibazo nk'amaraso yiziritse cyangwa impinduka mu buryo umutima wawe ukorana neza n'igikoresho.

Ibipimo by'umuvuduko w'amaraso bigereranya ingano y'amaraso VAD yawe ipompa ku munota, ubusanzwe iri hagati ya litiro 3 na 6. Umuvuduko mwinshi muri rusange uvuze kuzenguruka neza kw'amaraso mu ngingo zawe, mu gihe umuvuduko muto ushobora gutuma hakenewe guhindura.

Uziga kandi kumenya amajwi y'ibimenyetso n'ubutumwa bukumenyesha ibintu bisaba kwitabwaho. Ibimenyetso byinshi bifitanye isano n'ibibazo bya batiri, ibibazo byo guhuza, cyangwa impinduka z'agateganyo zishobora gukemurwa byoroshye, ariko ikipe yawe izakwigisha igihe cyo gushaka ubufasha bwihutirwa.

Ni gute wakwitwara mu buzima hamwe n'igikoresho cyawe gifasha umutima?

Kubaho hamwe na VAD bisaba impinduka zimwe na zimwe mu bikorwa byawe bya buri munsi, ariko abantu benshi basanga bashobora gusubira mu bikorwa byinshi bakunda iyo bamaze gukira kubagwa. Urufunguzo ni ukwiga gushyira mu buzima bwawe kwita ku gikoresho mugihe ukomeza gukora kandi ukifatanya n'umuryango n'inshuti.

Ibikorwa byawe bya buri munsi bizaba birimo kugenzura ibikoresho byawe, gukomeza ahantu driveline yawe isohokera isukuye kandi yumye, no gucunga batiri yawe kugirango wirinde ko igikoresho cyawe gitakaza umuriro. Uzajyana batiri zunganira kandi wige kuzihindura neza kugirango ibikorwa byawe bitahagarara.

Kwita ku hantu driveline yawe isohokera ni ngombwa mu kwirinda indwara zandura, zikaba ari zimwe mu ngorane zikomeye. Uzahagurukira ahantu buri munsi ukoresheje ibikoresho byihariye kandi urebe ibimenyetso by'umutuku, imyanda, cyangwa ubworoherane bushobora kugaragaza ikibazo.

Hano hari imirimo y'ingenzi ya buri munsi uzamenya:

• Genzura icyerekano cyawe cya kontiroleri kugirango usome ibisanzwe n'ibimenyetso byose
• Sukuza ahantu driveline yawe isohokera ukoresheje uburyo bwo gukoresha imiti idafite mikorobe
• Hindura no gushariza batiri ukurikije gahunda yawe
• Fata imiti yategetswe, cyane cyane imiti ituma amaraso atavura
• Genzura uburemere bwawe kandi utangaze impinduka zikomeye
• Guma mu mazi kandi urye indyo ifitiye umutima akamaro
• Kuruhuka bihagije kandi ucunge umunaniro

Abantu benshi bafite VAD bashobora gake gake gusubira mu kazi, kugenda, no gukora ibikorwa byo kwidagadura hamwe no gutegura neza no kwitonda. Ikipe yawe izagufasha gusobanukirwa ibikorwa bifite umutekano kandi uko wahindura abandi kugirango bakire igikoresho cyawe.

Ni iki gitera ingaruka ziterwa na VAD?

Nubwo VADs ari ibikoresho by'agaciro gakomeye mu buzima, kimwe n'izindi nzego z'ubuvuzi zikomeye, bifite ibyago byinshi ugomba gusobanukirwa mbere yo gufata icyemezo. Itsinda ryawe ry'abaganga rizaganira kuri ibyo byago mu kuri kandi rikusobanurire uko bakora kugira ngo babigabanye.

Uburwayi bw'inkorora ni kimwe mu bibazo bikunze kubaho, cyane cyane ahantu umugozi uca mu ruhu. Ibi bituma habaho umwanya uhoraho usaba kwitabwaho buri munsi kugira ngo wirinde ko mikorobe yinjira mu mubiri wawe.

Impamvu nyinshi zirashobora kongera ibyago byo guhura n'ibibazo, kandi kubisobanukirwa bifasha itsinda ryawe gutanga ubuvuzi bwiza bushoboka:

• Kubagwa umutima mbere byateje ibibazo byo gukomeretsa
• Indwara ya diyabete cyangwa izindi ndwara zigira ingaruka ku gukira
• Ibibazo by'impyiko cyangwa umwijima bigira ingaruka ku buzima bwawe muri rusange
• Imirire mibi cyangwa kuba ufite umubyibuho ukabije cyangwa ufite ibiro bicye cyane
• Uburwayi bukomeye ahantu hose mu mubiri wawe
• Kugorana gukurikiza gahunda zikomeye z'imiti
• Ubufasha buke mu mibanire y'abantu mu kwiga kwita ku gikoresho
• Indwara zikomeye z'ibihaha cyangwa ibindi bibazo by'ingingo

Itsinda ryawe risuzuma neza izo mpamvu mbere yo kugusaba VAD kugira ngo rimenye niba ushobora kungukirwa n'igikoresho mu gihe rigabanya ibyago bishoboka. Bazakorana nawe kugira ngo bazahure ubuzima bwawe mbere yo kubagwa igihe bibaye ngombwa.

Ni ibihe bibazo bishobora guterwa n'ibikoresho bifasha umutima?

Kumenya ibibazo bishobora kuvuka bifasha gufata icyemezo gifitiye inyungu kandi ukamenya ibimenyetso byo kwitondera nyuma yo gushyirwaho VAD yawe. Nubwo ibibazo bishobora kubaho, abantu benshi babaho neza bafite VADs imyaka myinshi bafashwe neza kandi bakagenzurwa.

Ibibazo bikunze kubaho birimo kuva amaraso, amaraso yiziritse, n'indwara z'inkorora, buri kimwe gikeneye ingamba zitandukanye zo kwirinda n'imiti. Itsinda ryawe ry'abaganga rizakwigisha uburyo bwo kumenya ibimenyetso bya mbere by'izo ngorane kugira ngo zivurwe vuba.

Ibi ni ibibazo bikomeye ugomba kumenya, bikurikije uko bikunda kugaragara:

• Udukoko twandurira ahantu hose umugozi uca, bigatuma habaho umutuku, ububabare, cyangwa amazi ava ahantu hose
• Ibibazo byo kuva amaraso bitewe n'imiti ituma amaraso ataguma, ikoreshwa hamwe na VAD
• Uduce tw'amaraso dushobora kwibumbira muri ako gace cyangwa tukajya mu zindi ngingo z'umubiri
• Kunanirwa k'umutima w'iburyo niba umutima wawe w'iburyo udashobora gukurikirana n'amaraso yiyongereye
• Uburwayi bwo mu bwonko buturutse ku duce tw'amaraso cyangwa impinduka mu mikorere y'amaraso
• Imikorere mibi y'igikoresho bisaba kubanza gukosorwa cyangwa kubisimbuza
• Ibibazo by'impyiko bitewe n'impinduka mu mikorere y'amaraso cyangwa imiti
• Kuva amaraso mu gifu, bishobora kugaragara cyane hamwe n'ubwoko bumwe na bumwe bwa VAD

Ibibazo bikunda kubaho ariko bikomeye harimo kunanirwa kw'igikoresho, indwara zikomeye zikwirakwira mu mubiri wawe, n'ibibazo bifitanye isano n'imiti ituma amaraso ataguma. Itsinda ryawe rigukurikiranira hafi ibi bibazo kandi rifite uburyo bwo kubikemura vuba niba bibaye.

Wibuke ko nubwo urutonde rushobora gutera impungenge, itsinda ryawe ry'abaganga rifite uburambe bwinshi mu gukemura ibi bibazo, kandi byinshi birashobora gukumirwa cyangwa bikavurwa neza iyo byamenyekanye hakiri kare.

Ni ryari nkwiriye kubona umuganga kubera ibibazo bifitanye isano na VAD?

Nyuma yo kubona VAD yawe, uzagira gahunda zisanzwe zo gukurikirana kugirango ukurikirane igikoresho cyawe n'ubuzima bwawe muri rusange, ariko ugomba no kumenya igihe ugomba gushaka ubufasha bwihutirwa. Kwiga kumenya ibimenyetso byo kwirinda bifasha kumenya ko ubona ubuvuzi bwihuse igihe bibaye ngombwa.

Ugomba guhamagara itsinda ryawe rya VAD ako kanya niba ubonye ibimenyetso by'igikoresho bitakemuka hamwe no gukemura ibibazo byibanze, ibimenyetso byose byo kwandura ahantu hose umugozi uca, cyangwa ibimenyetso bishobora kugaragaza ibibazo nk'indwara yo mu bwonko cyangwa ibibazo by'umutima.

Shaka ubufasha bwihutirwa bw'ubuvuzi kubera ibi bimenyetso bikomeye byo kwirinda:

• Uburyo bwo gukoresha ibikoresho budahagarara cyangwa budasubizwa
• Ibyuma byose byanze gukora cyangwa kubura umuriro
• Urubavu rwo mu gituza rubabaza cyane cyangwa guhumeka bigoye
• Ibimenyetso bya sitiroki nk'intege nke zitunguranye, urujijo, cyangwa ibibazo byo kuvuga
• Kuva amaraso menshi adahagarara n'umuvuduko
• Urubavu rwo hejuru hamwe n'ubukonje cyangwa kumva utameze neza
• Umuvuduko wakuweho cyangwa wangiritse
• Kuribwa cyane cyangwa guta ubwenge bitunguranye

Vugana n'ikipe yawe ya VAD mu masaha 24 kuri ibi bimenyetso bikomeye ariko bidahutirwa: imyanda cyangwa kwiyongera kw'umutuku ahantu hawe, kongera ibiro birenga ibiro 3 ku munsi, isesemi idahagarara cyangwa kuruka, cyangwa ibindi bimenyetso bishya bikubabaza.

Ntugatinye guhamagara ufite ibibazo cyangwa impungenge, cyane cyane mu mezi yawe ya mbere ukoresha igikoresho. Ikipe yawe yifuza kukumva ku kintu gito kuruta ko utegereza igihe kirekire kugira ngo ukemure ikibazo gishobora kuba gikomeye.

Ibikunze kubazwa ku byerekeye ibikoresho bifasha umutima

Q.1 Ese igikoresho gifasha umutima ni cyiza ku bantu bafite umutima utagikora neza?

Yego, VADs irashobora kuba uburyo bwiza bwo kuvura abantu bafite umutima utagikora neza bataravuzweho neza n'imiti n'ubundi buvuzi. Ibi bikoresho birashobora kunoza cyane imibereho, kongera imibereho, no kugufasha gusubira mu bikorwa ukunda.

Ku bantu benshi bafite umutima utagikora neza, VAD itanga ubufasha bwo gutembera amaraso bukenewe kugira ngo imyanya ikore neza mugihe igabanya ibimenyetso nk'umwuka mubi no kunanirwa. Ubushakashatsi bwerekana ko abantu bafite VADs akenshi bagira ubushobozi bwo gukora imyitozo no kumva neza muri rusange ugereranije n'ubuvuzi bwonyine.

Q.2 Ese kugira VAD bisobanura ko ntashobora kugenda cyangwa gukora imyitozo?

Abantu benshi bafite VAD bashobora kugenda no gukomeza gukora imirimo yabo nyuma yo gukira kubaga no kwiga gucunga neza ibikoresho byabo. Uzaba ukeneye gutegura mbere kandi ukagira ibikoresho byinshi, ariko abantu benshi bakira VAD bagenda mu gihugu no mu mahanga.

Ibikorwa nk'ukugenda, koga mu bihe bimwe na bimwe, n'ibindi bikorwa byinshi by'imyidagaduro akenshi bishoboka hamwe n'ingamba zikwiye. Itsinda ryawe rizagufasha gusobanukirwa ibikorwa bifite umutekano n'uburyo bwo guhindura ibindi kugirango bikore neza ibikoresho byawe mugihe ukomeza gukora imirimo yawe kandi witabira ibikorwa.

Q.3 Nzamara igihe kingana iki nshobora kubaho mfite igikoresho gifasha umutima?

Abantu benshi bamara imyaka myinshi bafite VAD zabo, kandi imibare yo kubaho ikomeza kuzamuka uko ikoranabuhanga rigenda ritera imbere. Abantu bamwe bamaze imyaka irenga icumi bafite ibikoresho byabo, bakomeza kugira ubuzima bwiza.

Uburyo bwawe bwihariye bushingiye ku bintu byinshi harimo ubuzima bwawe muri rusange, uburyo witaho ibikoresho byawe, niba ugize ibibazo. Itsinda ryawe ry'abaganga rishobora kuguha amakuru arambuye ashingiye ku miterere yawe yihariye n'ubuzima bwawe.

Q.4 Nshobora kumva VAD ikora imbere mu mubiri wanjye?

Abantu benshi bamenyera VAD yabo muminsi mike kandi ntibabona ikora mugihe bakora imirimo yabo ya buri munsi. Ushobora gutangira kumva ikintu gihinda cyangwa ukumva urusaku ruto, ariko ibyo byiyumvo akenshi bigabanuka uko igihe kigenda.

Icyuma cyakozwe kugirango gikore neza kandi gikomeze, bityo ntugomba kumva utishimye mugihe gipompa cyangwa imyenda igenda. Abantu bamwe basanga guhinda gake bibashimisha kuko bibamenyesha ko igikoresho cyabo gikora neza.

Q.5 VAD irashobora gukurwaho niba umutima wanjye ukize?

Mu bihe bidasanzwe umutima ugenda ukora neza cyane, VAD zishobora gukurwaho rimwe na rimwe, nubwo ibi bibaho ku gice gito cyane cy'abarwayi. Ibi bishoboka cyane ku bantu barwaye umutima kubera indwara zishobora gukira, nk'indwara zimwe na zimwe zandura cyangwa umutima watewe n'ibibazo vuba.

Itsinda ryawe ry'abaganga rikora isuzuma ry'imikorere y'umutima wawe buri gihe kandi bazaganira ku bushobozi bwo gukuraho igikoresho niba umutima wawe ugaragaza imikoreshereze myiza. Ariko, abantu benshi bakoresha VAD bazazikeneye igihe kirekire, haba nk'ikiraro cyo kwimurwa cyangwa nk'ubuvuzi burambye.