I-Acute Limb Ischemia

Ukwelashwa Kwe-Acute Limb Ischemia e-Hyderabad

I-acute limb ischemia yisimo lapho kuba khona ukwehla okungazelelwe kokugeleza kwegazi ezithweni, ikakhulukazi emaphethelweni. Ukuvaleka okuyingxenye noma okuphelele kokunikezwa kwe-arterial emilenzeni kungaholela ku-ischemia esheshayo kanye nokusebenza kabi kwesitho phakathi nendaba yamahora.

Izibhedlela ze-CARE zihlinzeka ngezinsizakalo zokuxilonga nokwelapha ezihlanganisa yonke into zisebenzisa ingqalasizinda yesimanje efakwe ubuchwepheshe bamuva ukuze yenze izinqubo ezingangeneleli ezigulini ezinenqwaba yezifo nezidingo zezokwelapha. Eyethu ithimba lodokotela abahlukahlukene futhi abahlinzeki bokunakekelwa banikeza ukunakekelwa kokugcina kuso sonke isiguli sikhumbula izidingo zaso ukuze kuthuthukiswe yonke impilo nokuphepha kweziguli. Akusho ukuthi, uzonakekelwa ngenkathi ufuna Ukwelashwa kwe-Acute Limb Ischemia e-Hyderabad ezibhedlela ze-CARE. 

Izimbangela

Izimbangela ze-ischemia ze-acute zingahlukaniswa ngezigaba ezintathu ezibanzi:

• Embolisation: Lesi isizathu esivame kakhulu se-ischemia yesitho lapho i-thrombus esuka emthonjeni oseduze ihamba kude ukuze ivale umthambo obangela ukuvaleka kokugeleza kwegazi. Umthombo wokuqala we-thrombus ungase ube yi-post-MI mural-thrombus, i-aneurysm yesisu, noma ama-valve enhliziyo yokufakelwa.

• I-Thrombosis endaweni: Kulolu hlobo lwesimo, i-atheroma plaque esemthanjeni we-artery iyaphuka futhi i-thrombus yakheka khona lapho.

• ukuhlukumezeka: Lena imbangela engavamile kakhulu ye-acute limb ischemia futhi ingase ihlanganise i-compartment syndrome njengembangela.

Ezinye izimbangela ezivamile ze-acute limb ischemia zihlanganisa i-left ventricular wall thrombosis elandela infarction ye-myocardial (isifo senhliziyo), isimila senhliziyo/i-aortic, kanye ne-atrial fibrillation.

Izimpawu

Izimpawu nezimpawu ze-acute limb ischemia zichazwa kusetshenziswa ama-P ayisithupha:

• Ubuhlungu

• Pallor

• Ukungabi namandla

• I-Paresthesia (ukuluma kanye nokuba ndikindiki)

• Kubanda kakhulu

• ukukhubazeka

Lesi simo ngokuvamile sibonakala ngokuvela kwalezi zimpawu kungazelelwe. Ukungeniswa esibhedlela sekwephuzile ngenxa yokwelashwa kwe-ischemia yesitho esinamandla kungaholela ekulimaleni okungenakulungiseka ezakhiweni ze-neuromuscular okuholela ekukhubazekeni kwesitho esithintekile. Ezinye izimpawu ze-acute limb ischemia zingabalelwa kulokhu okulandelayo:

• I-ischemia yemilenze engapheli

• I-fibrillation ye-Atrial

• I-myocardial infarction yakamuva (MI)

• Ubuhlungu besisu noma beqolo

• I-Aneurysms ye-peripheral

Sifo

Ongoti bethu benhliziyo nemithambo yegazi izazi zenhliziyo thatha ukunakekelwa okukhulu ukuze unikeze ukuxilonga okufanele kweziguli ngokusekelwe empilweni yesiguli kanye nobukhulu noma ukuqhubeka kwe-ischemia yesitho. Ukuxilongwa kungenziwa ngokusekelwe emlandweni wezokwelapha, ukuhlolwa okubonakalayo, nokunye ukuhlola kokuxilonga. 

• I-Doppler ultrasound scan: I-Doppler ultrasound isebenzisa i-vascular ultrasonography ye-peripheral arterial pulse ingase yenziwe ilandelwe ukungafani kwe-CT angiography.

• I-Computed Tomography (CT) angiography: I-CT angiography kusetshenziswa udayi wokuqhathanisa ingenziwa ukuze kuhlolwe umzimba wonke ukuze kutholwe ama-embolism kanye nokunquma ububanzi besayithi elivalekile futhi kutholwe umthombo we-embolus.

Okunye ukuhlola kungenziwa ukuze kutholakale imbangela futhi kuhlolwe impilo jikelele yesiguli kusetshenziswa i-electrocardiography, i-thoracoabdominal radiography, ukuhlaziya umchamo negazi, kanye ne-echocardiography.

Ukwelashwa

I-acute limb ischemia iyisimo esiphuthumayo sokuhlinzwa. Umgomo oyinhloko wokwelashwa kwe-ischemia yesitho esinamandla kungase kube ukulondoloza isitho esithintekile. Ukuvaleka okuphelele kwe-arterial kungaholela ekulimaleni kwezicubu okungenakulungiseka. Izibhedlela ze-CARE zihlinzeka ngokwelashwa kwe-ischemia ye-acute isitho e-Hyderabad yiqembu lodokotela abahlinzayo benhliziyo abagunyazwe yibhodi abasebenza ndawonye nodokotela benhliziyo kanye nabanye ochwepheshe bezempilo ukuze balethe imiphumela engcono kakhulu ngokushesha ngangokunokwenzeka ngaphandle kokulimala okwengeziwe. Ukwelashwa kwe-Heparin kungase kunikezwe, noma kunjalo, ezimweni ezithuthukile, ukungenelela kokuhlinzwa kungase kudingeke. 

Lapho i-ischemia yesitho ibangelwa umcimbi we-embolic, ukungenelela okuningana kokuhlinzwa kungacatshangelwa:

• I-Embolectomy: Lena inqubo yokuhlinzwa okuhloswe ngayo ukususa i-embolus (ihlule legazi noma enye into) evimba ukugeleza kwegazi emithanjeni. Ngokuvamile kwenziwa kusetshenziswa i-catheter noma ukuhlinza ngokuqondile emthanjeni ukuze kususwe ukuvaleka. I-Embolectomy ivamise ukuba yindlela yokwelapha yomugqa wokuqala ye-acute embolic limb ischemia futhi iphumelela kakhulu ekubuyiseleni ukujikeleza kwegazi uma yenziwa kusenesikhathi.
• I-Local Intraarterial Thrombolysis: Lokhu kuhilela ukuphathwa kwezidakamizwa ezincibilikisa amahlule (i-thrombolytics) ngqo emithanjeni ethintekile nge-catheter. Imithi efana ne-tissue plasminogen activator (tPA) isetshenziselwa ukudiliza i-embolus, okuvumela ukugeleza kwegazi kubuyele esithweni. Le ndlela iwusizo ikakhulukazi uma i-embolus inkulu kakhulu noma isabalele ukuba isuswe ngokuhlinzwa.
• Ukuhlinzwa Kwe-Bypass: Ezimweni lapho i-embolus ilimaze kakhulu umthambo noma lapho i-embolectomy ne-thrombolysis ingasebenzi, ukuhlinzwa kwe-bypass kungase kudingeke. Lokhu kuhilela ukwakha umzila omusha wokugeleza kwegazi ezungeze umthambo ovalekile kusetshenziswa i-graft esuka komunye umthambo wegazi noma ishubhu lokwenziwa. Ukuhlinzwa kwe-bypass kuyindlela ehlasela kakhulu kodwa kungasindisa ukuphila, ikakhulukazi ezimeni ezithuthukile ze-ischemia yesitho.

Uma i-ischemia yesitho ingenxa yesifo se-thrombotic (lapho amahlule egazi enza khona emithanjeni ngokwawo), izinketho zokwelashwa zokuhlinzwa ziyahlukahluka kancane:

• I-Angioplasty ene-Stenting: Le nqubo yokuhlasela kancane ihilela ukusebenzisa i-catheter enesihloko sebhaluni ukuze kwandiswe umthambo owumngcingo. Lapho umthambo usunwetshiwe, kubekwa i-stent (ishubhu elincane elinenetha lensimbi) ukuze lihlale livulekile, liqinisekisa ukuthi igazi lingageleza ngokukhululekile emkhunjini. I-Angioplasty ivamise ukuhlanganiswa nokusetshenziswa kwezidakamizwa ezincibilikisa amahlule futhi ivame ukusetshenziswa ku-thrombotic limb ischemia.
• I-Intraarterial Thrombolysis yendawo: Ngokufana nokusetshenziswa kwayo ezenzakalweni ze-embolic, le ndlela ihilela ukuphatha izidakamizwa ezincibilikisa amahlule ngqo endaweni ye-thrombus. Kungase kusebenze ikakhulukazi ku-thrombotic ischemia, lapho amahlule akhula kancane kancane futhi maningi amathuba okuba aphendule emithini kunokuba ahlinzwe yedwa.
• Ukuhlinzwa Kwe-Bypass: Ezimweni ezithuthuke kakhulu ze-thrombotic ischemia, kungase kudingeke ukuhlinzwa kwe-bypass. Le nqubo idala enye indlela ukuze igazi ligeleze endaweni evinjiwe, okuvumela igazi elinomoya-mpilo ukuthi lifinyelele esithweni esithintekile. Ukuhlinzwa kwe-bypass kuyinqubo ebanzi kakhulu kodwa kungavimbela ukuqhubeka kwe-ischemia kanye nokulahleka kwemilenze okungenzeka.

Uma i-ischemia yesitho ifinyelela esigabeni esingenakuhlehliswa, kungase kudingeke ukunqunywa kwesitho.

Ukuphathwa Kwesikhathi Eside

Ukunciphisa ingozi yokufa kwenhliziyo kubalulekile kuleli qembu lesiguli. Amasu abalulekile ahlanganisa ukukhuthaza ukuvivinya umzimba njalo, ukuyeka ukubhema, nokukhuthaza ukuncipha kwesisindo lapho kudingeka.

Iziguli eziningi kufanele ziqaliswe ngemishanguzo ye-antiplatelet, njenge-aspirin yomthamo ophansi noma i-clopidogrel, noma ama-anticoagulant okungenzeka afane ne-warfarin noma i-DOAC. Kubalulekile ukuphatha noma yiziphi izimo ezingaphansi ezibangela i-ischemia ye-acute limb, njenge-fibrillation ye-atrial engalawuleki.

Ezimweni eziholela ekunqunyweni kwesitho, ukwelapha emsebenzini kanye nokwelapha umzimba kuyodingeka, kanye nohlelo olubanzi lokubuyisela esimweni esivamile, okungenzeka oluhilela ukudluliselwa esikhungweni sokulungisa isimo esimaphakathi.

Izinkinga

Inkinga ebaluleke kakhulu ye-acute limb ischemia ukulimala kabusha lapho kuba khona ukwanda okungazelelwe kwe-capillary permeability. Lokhu kungase kubangele:

• Isifo segumbi
• Ukukhishwa kwezinto ezivela kumaseli emisipha alimele, afana - K+ ions abangela i-hyperkalemia, ama-H+ ions abangela i-acidosis, i-Myoglobin ephumela ku-AKI ebalulekile.

I-ischemia ye-acute limb inezinga lokufa elicishe libe ngu-20%, ngakho-ke, kuyadingeka ukuthi kuqashwe i-reperfusion syndrome engadinga i-haemofiltration.

Prevention

Ukwehliswa kwengozi yokufa kwenhliziyo nemithambo yegazi yinto ebaluleke kakhulu okufanele ikhunjulwe ezigulini ezine-ischemia yemilenze eyingozi. Ukuvivinya umzimba njalo, ukuyeka ukubhema, futhi ngezinye izikhathi ukuncipha komzimba kungase kudingeke. Noma yisiphi isimo esicashile esingase siholele ku-ischemia yesitho esinamandla esikhathini esizayo kufanele selashwe.

Iziguli ezinqunywa izitho zidinga i-occupational physiotherapy okungenzeka iqondiswe odokotela bethu abanolwazi lokuvivinya umzimba. Kungase kudingeke uhlelo lwesikhathi eside lokuhlunyeleliswa kwezimilo ukuze iziguli ezinjalo zikwazi ukubhekana nemisebenzi yangemva kokuhlinzwa kanye nokuthi zingase zizizwe kanjani.

Ukubuyiselwa kwe-post-op nokunakekelwa kokulandelela 

Ukubuyisela emuva kokuhlinzwa nokunakekelwa kokulandelela kwe-Acute Limb Ischemia (ALI) kuhlanganisa lezi zinyathelo:

• Ukunakekelwa Ngokushesha: Ngemva kokuhlinzwa ukuze kubuyiselwe ukugeleza kwegazi:
  • Uzogadwa eduze endaweni yokutakula noma e-ICU.
  • Imithi izonikezwa ukulawula ubuhlungu nokuvimbela ukujiya.
• Ukuqapha: Ukuhlola ngokuqhubekayo izimpawu ezibalulekile kanye nesimo sesitho esithintekile ukuze kuqinisekiswe ukugeleza kwegazi kuyabuya.
• Ukunakekelwa Kwezilonda: Ukuphatha ngokucophelela amanxeba okuhlinzwa ukuze uvimbele ukutheleleka.
• Ukwelashwa Kwemvelo: Ukuvuselelwa kungase kuqale ukubuyisela amandla nokuhamba esithweni esithintekile.
• Ukuqokwa Okulandelwayo: Ukuvakashela njalo udokotela wakho ukuze uhlole ukuphulukiswa futhi uhlole noma yikuphi ukuphindaphinda kwe-ischemia.
• Imithi kanye Nendlela Yokuphila: Thatha imithi ebekiwe futhi wenze izinguquko zokuphila (njengokuyeka ukubhema) ukuze uthuthukise impilo yemithambo yegazi.