Umfutho wegazi ophezulu wamaphaphu

Ukwelashwa Kwe-Hypertension Yamaphaphu e-Hyderabad, eNdiya

Yelapha I-Pulmonary Hypertension Ezibhedlela ze-CARE eNdiya

I-pulmonary hypertension yisimo esiholela ekucindezelekeni ngokweqile noma okuphezulu. Kungaphazamisa futhi kuthinte imithambo yamaphaphu kanye nohlangothi lwenhliziyo olungakwesokudla. Lokhu kwaziwa nangokuthi yi-pulmonary arterial hypertension (PAH) futhi inesibopho sokuvimba kanye nokubopha imithambo yegazi. 

Zingalimala, zifinyezwe noma ziwe. Ukugeleza kwegazi kwamaphaphu kuyathinteka futhi kwehlisa umfutho wegazi emithanjeni yamaphaphu bese kuholela ekulimaleni. Inganezela ukucindezela kwenhliziyo futhi yenze buthaka imisebenzi yayo. Ukwehluleka kwenhliziyo kubangelwa ikakhulukazi ngenxa yokucindezela okungeziwe engxenyeni yenhliziyo.

Umfutho wegazi ophezulu wamaphaphu ungathuthuka ngesivinini esincane futhi ubulale. Izinhlobo eziningi zokwelapha ezibhedlela ze-CARE zingasiza ekudambiseni izimpawu. Singakwazi ukuhlinzeka ngekhwalithi entsha yempilo, kodwa khumbula ukuthi izimo eziningi azilapheki.

Yiziphi izinhlobo ezahlukene ze-pulmonary hypertension?

I-World Health Organization (WHO) ihlukanisa i-pulmonary hypertension ibe ngamaqembu amahlanu ngokusekelwe ezimbangela zayo.

• Iqembu 1: Umfutho wegazi ophakeme we-pulmonary ngenxa ye-pulmonary arterial hypertension (PAH). I-PAH ingabangelwa izici ezihlukahlukene, kuhlanganise nezifo ezikhona kanye nemithi ethile. Kuholela ekuncipheni, ukuqina, noma ukuqina kwemithambo yamaphaphu, kuvimbela ukugeleza kwegazi nokwanda komfutho we-pulmonary artery.
• Iqembu 2: Umfutho wegazi ophakeme wamaphaphu obangelwa isifo senhliziyo esingakwesokunxele. Lapho izingqinamba zithinta uhlangothi lwesobunxele lwenhliziyo olunesibopho sokumpompa igazi emzimbeni, kuba nomthelela ohlangothini lwesokudla lwenhliziyo kanye nokujikeleza kwawo wonke amaphaphu. Lokhu kungaholela ekugcinweni kwegazi enhliziyweni, kukhuphule umfutho we-pulmonary artery.
• Iqembu 3: I-hypertension yamaphaphu ehambisana nesifo samaphaphu noma i-hypoxia. Izimo ezithile zamaphaphu ziholela ekuvinjweni kwemithambo yamaphaphu, kwehlise ukugeleza kwegazi futhi kukhuphule umfutho we-pulmonary artery.
• Iqembu 4: Umfutho wegazi ophezulu wamaphaphu ngenxa yokuvaleka ngaphakathi kwamaphaphu. Amahlule egazi noma izibazi ezibangwa amahlule avimbela ukugeleza kwegazi okuvamile emaphashini, okubangela ukungezwani okwengeziwe kwesokudla senhliziyo nomfutho wegazi ophakeme wamaphaphu.
• Iqembu 5: I-hypertension ye-pulmonary ehlobene nezinye izifo. I-PH ihlangana nezimo ezihlukahlukene, ezifana nokuphazamiseka kwegazi kanye nokuphazamiseka kwezinqubo ze-metabolic, futhi izindlela ezinembile ezibangela i-PH kulezi zimo azichazwa kahle ngaso sonke isikhathi.

Izimpawu 

Kunezinkomba eziningi noma izimpawu ezingabonakala ngesikhathi sokuthuthukiswa kwe-hypertension yamaphaphu. Nakuba zingase zithathe iminyaka ukuthi zibe zimbi kakhulu, kuhlale kuphakanyiswa ukuthi ubonane nochwepheshe wezokwelapha uma lezi zimpawu ezilandelayo ziqhubeka:

• Ukuphefumula noma i-dyspnea- lokhu kungabonakala ekuqaleni ngenkathi uzivocavoca.

• Ukukhathala

• Isiyezi noma ukuquleka

• Ukucindezela kwesifuba

• ubuhlungu besifuba

• Ukuvuvukala (i-oedema) emaqakaleni

• I-Edema emilenzeni

• I-Edema esiswini (i-ascites)

• Umbala oluhlaza okwesibhakabhaka wezindebe nesikhumba (cyanosis)

• Ukushaya kwenhliziyo okusheshayo

• Ukushaya kwenhliziyo eshaya ngamandla (palpitations)

Kungaba nezizathu eziningi zokuthi kungani unezimpawu ezibalwe ngenhla. Kuhlale kuphakanyiswa futhi kunconywa ukuthi kwenziwe ukuhlolwa komzimba waminyaka yonke ukuze kulandelelwe izimpawu nezimpawu. 

Namuhla abantu abaningi bakhetha amathuluzi okuxilongwa kwezempilo ekhaya- njengomshini womfutho wegazi. Le mishini ikwazi ukubona umfutho wegazi kanye nezinga lokushaya kwenhliziyo. Gcina ukuhlolwa ngokomzimba nsuku zonke uma unokuthambekela komfutho wegazi ophakeme noma ophansi.

Izingozi

Abantu abaneminyaka yobudala engama-30-60 bathambekele kakhulu ekubeni nomfutho wegazi ophakeme wamaphaphu kunalabo abaneminyaka engaphezu kuka-60. Ikakhulu ngenxa yokucindezeleka kwesigaba sabasebenzi ukuthi izimo ezifana nomfutho wegazi ophezulu wamaphaphu zenzeka. 

Ngokwezokwelapha, ukukhula umuntu omdala kungadala ukukhula komfutho wegazi ophakeme wamaphaphu. Abantu abasha nabo bahlangabezana ne-idiopathic PAH.

Kungase kube nezingozi ezengeziwe ekuthuthukisweni kwe-pulmonary hypertension- 

• Umlando womndeni noma izizathu zofuzo

• Ukuba ngokweqile

• Izinkinga zokuvala igazi

• Umlando wezakhi zofuzo zamahlule egazi emaphashini

• Ukuvezwa kwe-asbestos

• Isifo senhliziyo esizalwa naso

• Ukuhlala endaweni ephakeme

• Ukusetshenziswa kwemithi yokwehlisa isisindo

• Ukusetshenziswa kwezidakamizwa ezingekho emthethweni njenge-cocaine

• Ukusetshenziswa kwe-serotonin reuptake inhibitors (SSRIs) ekhethiwe ukwelapha ukucindezeleka nokukhathazeka.

Sifo

• Ukuhlolwa ngokomzimba nangokwezokwelapha akukwazi ukuhlonza isigaba sokuthuthuka somfutho wegazi ophezulu wamaphaphu. 

• Itholwa kuphela uma isisezingeni eliphezulu kodwa noma kunjalo izimpawu nezimpawu ziyefana namanye amaphaphu nezimo zenhliziyo.

• Odokotela ezibhedlela ze-CARE bazohlola umzimba futhi babuyekeze ukuze bahlaziye zonke izimpawu. Kudingeka ukuthi unikeze umndeni wakho nomlando wezokwelapha.

• Ukuhlola ikakhulukazi ukuhlolwa kwegazi nezithombe ezingahlola umfutho wegazi ophakeme wamaphaphu.

• Ukuhlolwa kwegazi- lokhu kungathola izinkinga nezinye izimbangela ze-pulmonary hypertension.

• I-X-ray yesifuba- odokotela bazothola isithombe senhliziyo, amaphaphu nesifuba ukukhombisa noma yikuphi ukukhuliswa kwemithambo ye-pulmonary kanye ne-ventricle yangakwesokudla.

• I-ECG scan noma i-electrocardiogram- Amaphethini kagesi wenhliziyo nokushaya kwenhliziyo okungavamile kungatholwa ngosizo lokuhlolwa kwe-ECG. Ayihlaseleki futhi iveza izimpawu zokukhuliswa kwe-ventricle elungile noma ubunzima.

• I-Echocardiogram- izithombe ezihambayo zenhliziyo zihlolwa ngosizo lwamaza omsindo- isiza odokotela ukuba bazi isimo samavalvu nokusebenza kwenhliziyo. Ukucindezelwa nokuqina kwe-ventricle efanele kungahlolwa. Lezi zivivinyo zingenziwa futhi ngenkathi uzivocavoca njengaku-treadmill noma ibhayisikili elimile. Imaski ingasetshenziswa futhi ukucacisa ukusebenza kwenhliziyo namaphaphu. 

• I-catheterization yenhliziyo yesokudla- Lokhu ukuhlolwa kokuxilongwa kokuqinisekisa ngemva kwe-echocardiogram lapho i-catheter ifakwe emthanjeni. I-catheter iyishubhu elincanyana, eligobekayo elifakwe i-groin. Izoqondiswa ku-ventricle efanele kanye ne-pulmonary arteries ukuze ihlaziywe. 

• Ngemuva kokutholakala ukuthi une-hypertension ye-pulmonary, ezinye izivivinyo eziqinisekisayo ziyenziwa ukuze kwaziwe izikhundla zesitho.

• I-Computerized tomography- ukuhlolwa kwesithombe ukwazi isimo ngaphakathi futhi ubonise ukuvinjelwa. 

• I-MRI scan yenziwa ukuze kwaziwe ukugeleza kwegazi ngaphakathi emithanjeni yamaphaphu nokusebenza kwe-ventricle efanele.

• Ukuhlolwa kokusebenza kwamaphaphu kuyenziwa ukuze kwaziwe ukugeleza komoya ngaphakathi namandla wamaphaphu.

• Ukulala kufundwa ukuze kulinganiswe umsebenzi wobuchopho, izinga lokushaya kwenhliziyo, i-BP, izinga le-oxygen, njll. 

• Ukuskena kwe-V/Q kuhlanganisa i-tracer ekwazi ukulandelela ukugeleza kwegazi nokugeleza komoya. 

• I-open biopsy yamaphaphu ingenziwa futhi ukuze kuhlolwe imbangela ye-pulmonary hypertension.

• Odokotela bangase benze ukuhlolwa kofuzo ukuze kuqinisekiswe.

Ukwelashwa 

Ukwelashwa kwe- pulmonary hypertension (PH) kuqondene nomuntu ngamunye kakhulu, kuncike ohlotsheni oluthile lwe-PH kanye nezimo zakho zempilo eziyisisekelo. Ithimba lakho lezokunakekelwa kwezempilo lizokwenza ukwelashwa kuhambisane nezidingo zakho ezihlukile.

Njengamanje, ukwelashwa okuqondile kuyatholakala ezinhlotsheni ezimbili ze-PH:

• I-Pulmonary Artery Hypertension (PAH).
• I-Chronic Thromboembolic Pulmonary Hypertension (CTEPH).

Ku-PAH, izinketho zokwelashwa zifaka:

• I-Calcium Channel Blockers: Imithi enganciphisa umfutho wegazi emithanjeni yamaphaphu nasemzimbeni.
• I-Diuretics: "Amaphilisi Amanzi" ukusiza ukuqeda uketshezi okweqile.
• I-Oxygen Therapy: Uma igazi lakho lingenawo umoya-mpilo owanele.
• I-Pulmonary Vasodilators: Imithi ephumuza imithambo yamaphaphu, ithuthukisa ukugeleza kwegazi futhi inciphise ubunzima benhliziyo.

Ukwelashwa kwe-CTEPH kuhlanganisa:

• Ama-Anticoagulants: Imithi yokuvimbela amahlule egazi.
• I-Balloon Atrial Septostomy (BAS): Inqubo esetshenziselwa ukuzinzisa abantu abane- pulmonary hypertension ngenkathi belindele ukufakelwa kwamaphaphu.
• I-Balloon Pulmonary Angioplasty (BPA): Inqubo esekelwe ku-catheter esebenzisa ibhaluni ukwandisa umthambo wamaphaphu, ikakhulukazi uma ukuhlinzwa okuvulekile kungenakwenzeka.
• Umuthi: Ukusetshenziswa kwe-soluble guanylate cyclase stimulator (SGCS) ukuze kubambezeleke ukuqhubeka kwesifo.
• I-Pulmonary Endarterectomy (PEA): Ukuhlinzwa ukuze kukhishwe amahlule egazi lamaphaphu, okuhlinzeka ngekhambi elingaba khona leziguli ze-CTEPH.

Nge-PH exhunywe ezinkingeni zenhliziyo noma zamaphaphu, izikhungo zokwelapha ekubhekaneni nezimo ezikhona, ezingahluka kakhulu kumuntu nomuntu. Kungase kuhlanganise izinguquko zokudla nendlela yokuphila, imithi yokulawula izinkinga ezifana nomfutho wegazi ophakeme noma ukwehluleka kwenhliziyo, ukwelapha komoyampilo, kanye nezinqubo ezingase zibe khona zokuhlinza ezifana nokulungisa ama-valve enhliziyo.

Izinketho zokwelapha ze-PH ezihlotshaniswa nezinye izimo zezokwelapha (i-WHO Group 5) ziyaqhubeka nokuvela, nomhlinzeki wakho esebenza eduze nawe ukuze anqume uhlelo lokunakekela olufaneleka kakhulu.

Ezimweni ezimbi kakhulu ze-hypertension yamaphaphu, ukufakelwa kwamaphaphu kungase kube inketho yokugcina.

Imithi 

Imithi eminingi inikezwa engathuthukisa izimo ezifana ne-pulmonary hypertension. Izimpawu nezimpawu zingancipha ngosizo loku-

• Ama-Vasodilators Lawa ama-dilators emithambo yegazi akwazi ukuphumuza futhi avule imithambo yegazi. Ikhuthaza ukugeleza kwegazi futhi inqunywe ngendlela ye-epoprostenol. 

• GSC Stimulators- Lokhu kwandisa i-nitric oxide ephinde ixegise imithambo yamaphaphu nokucindezela emaphashini. 

• I-Endothelin receptor antagonists- Lokhu kuzodala i-endothelin enganciphisa izindonga zemithambo yegazi. Isibonelo- i-Bosentan, i-macitentan, ne-ambrisentan. 

• I-calcium ephezulu - Lezi zibizwa ngokuthi ama-channel blockers futhi zizokhulula udonga lwemithambo yegazi nemisipha.

• I-Warfarin - Kuyi-anticoagulant futhi isiza ukuvimbela amahlule egazi emithanjeni yamaphaphu.

• I-Digoxin - ukusiza inhliziyo ukuthi ishaye ngokushesha futhi impompe igazi elengeziwe.

• Ama-diuretics - isiza izinso ukuthi zikhiphe uketshezi oluningi futhi zaziwa ngokuthi amaphilisi amanzi; ukunciphisa umthwalo enhliziyweni.

• Imithi yokwelapha ngomoya

Ukuhlinzwa

• I-Atrial septostomy - kuwukuhlinzwa kwenhliziyo evulekile okwenziwa lapho imithi ingasebenzi- udokotela ohlinzayo uzovula imbobo phakathi kwegumbi eliphezulu kwesokunxele nesokudla senhliziyo. Lokhu kwenzelwa ukunciphisa ukucindezeleka enhliziyweni.

• Ukufakelwa kwamaphaphu noma inhliziyo- uma othile ene-idiopathic pulmonary hypertension, angase afakwe ukufakelwa. 

Umuntu kufanele abonane nodokotela mayelana nayo yonke imiphumela emibi ngemva kokuhlinzwa ngaphambi kokuthola ukwelashwa. 

Prevention

Ukuvimbela umfutho wegazi ophakeme wamaphaphu akuhlali kungaphakathi kolawulo lwakho, njengoba izici ezithile zobungozi zingaphezu kwamandla akho. Uma unalezi zici zobungozi, umhlinzeki wakho wokunakekelwa kwezempilo angase atuse ukuhlolwa okuvamile ukuze kuhlolwe impilo yenhliziyo namaphaphu akho.

Kodwa-ke, kunezinyathelo ezisebenzayo ongazithatha ukuze unciphise ubungozi be-pulmonary hypertension:

• Yakha Umjikelezo Wokuzivocavoca: Xhumana nomhlinzeki wakho wokunakekelwa kwezempilo ukuze uthole ukuthi yiziphi izivivinyo eziphephile kuwe futhi wenze uhlelo olufanele lokuzivocavoca.
• Yamukela Ukudla Okunempilo Yenhliziyo: Yehlisa ubungozi bakho ngokugwema ukudla okugayiwe, ukudla okusheshayo, nezinto ezinosawoti omningi namafutha agcwele.
• Yeka Ukubhema nokusebenzisa Ugwayi: Ukubhema nokusebenzisa ugwayi yizici ezihamba phambili engcupheni yezinkinga zenhliziyo namaphaphu. Nakuba ukuyeka kungaba inselele, ikakhulukazi kubasebenzisi besikhathi eside, umhlinzeki wakho angakunikeza ngezinsiza, futhi amaqembu okusekela angaba yinzuzo.
• Namathela Kumithi Yemithi: Thatha imishanguzo ebekiwe yomfutho wegazi nezinye izimo njengoba uqondiswa umhlinzeki wakho wezempilo.

Kungani ukhethe Izibhedlela ze-CARE?

Izibhedlela ze-CARE e-India zaziwa ngokwelashwa okungcono kakhulu ezweni lonke ngobuchwepheshe obusezingeni lomhlaba nosizo oluvela kochwepheshe bezokwelapha abaphezulu. Sihlose ukuhlinzeka ngezinsiza ezingcono kakhulu zokuxilonga nezokwelapha ezigulini zethu. Ithimba lethu eliphelele lochwepheshe lizokuqondisa kuzo zonke izinqubo ezilandelwayo. Sithemba ukuthi sizokhipha okuhle kakhulu kulesi simo.