Ukungenelela kwe-Vascular & Non-Vascular Pulmonary

I-Pulmonary Vascular & Non-Vascular Interventions e-Hyderabad, India

Igama elithi isifo semithambo libhekisela kunoma yisiphi isimo esithinta imithambo yakho yegazi. I-vascular or circulatory system ibhekisela kule nethiwekhi. Igama elithi "vascular" livela egameni lesiLatini elisho isitsha esingenalutho. Ngisho noma lonke uhlelo lwakho lwemithambo yegazi belunwetshwe ekupheleni, lungazungeza umhlaba izikhathi eziningana.

I-PVD ibhekisela ezinhlobonhlobo zezimo ezithinta imithambo yegazi kuwo wonke amaphaphu. Igazi eligcwele umoya-mpilo ligeleza lisuka kwesokudla senhliziyo liye emaphashini ngale mithambo. Phakathi nenqubo yokuthatha umoya-mpilo, igazi elingenawo umoya-mpilo lihamba emithanjeni yamaphaphu. Ngemva kokuphuma emaphashini, imithambo yamaphaphu ithatha igazi elinomoya-mpilo liyise ohlangothini lwesobunxele lwenhliziyo, lapho lisakazwa kuwo wonke umzimba. Ngokuqhubeka uphefumula i-carbon dioxide, igazi liphinde ligcwaliswe umoya-mpilo. Kanye nokubangela izinkinga zenhliziyo nemithambo yegazi, isifo se-pulmonary vascular disorder singanciphisa izinga lempilo yesiguli. 

Izibhedlela ze-CARE zinikeza ukunakekelwa okukhethekile, okuhlukahlukene ezigulini ezinezimo eziyinkimbinkimbi ze-pulmonary vascular. Odokotela bezifo zamaphaphu nodokotela benhliziyo eqenjini lethu basebenzisana eduze kanye nodokotela abahlinza inhliziyo nesifuba kanye nabanye odokotela benhliziyo.

Izimpawu ze-Pulmonary Vascular Disease

Embolism yamaphaphu

Izimpawu ezilandelayo ze-pulmonary embolism zingase zenzeke kubantu abane-pulmonary embolism:

• Ukuphefumula
• ubuhlungu besifuba
• Isikhukhula
• Ukukhwehlela igazi
• Fever
• Ukushaya kwenhliziyo okusheshayo
• Ukuphefumula okusheshayo
• Ukuphelelwa amandla
• Umfutho wegazi ophezulu wamaphaphu

Umfutho wegazi ophakeme we-pulmonary ungabangela lezi zimpawu ezilandelayo:

• Ukuphefumula
• Ukukhathala okukhulu (ukukhathala)
• Ukuncipha kwekhono lokuzivocavoca
• ubuhlungu besifuba
• Ukukhwehlela igazi
• Ukuthuthumela

Izinkinga ze-Pulmonary Vascular Disease

• Embolism Embolism Embolism: Ihlule legazi emilenzeni noma okhalweni ngokuvamile liphumela embolism yamaphaphu. Kuyenzeka ukuthi lelihlule legazi ligqabuke lidlule emthanjeni liye emthanjeni wamaphaphu. Abantu abasanda kwenziwa izinqubo zezokwelapha noma zokuhlinzwa okuholele ekuphumuleni kombhede isikhathi eside, abantu abanomlando wangaphambili wamahlule egazi, kanye nabantu abasebenzisa ukwelapha okushintshwa kwama-hormone noma izivimbela-nzalo ezithathwa ngomlomo basengozini enkulu yokuba namahlule egazi.
• Umfutho wegazi ophezulu wamaphaphu: Imbangela yomfutho wegazi ophezulu wamaphaphu ingaba izakhi zofuzo, noma ngezinye izikhathi asikho isizathu esaziwayo (idiopathic). I-hypertension yamaphaphu ithatha izinhlobo eziningi, ngayinye yazo iphathwa ngendlela ehlukile. Ngokusho kodokotela, ingahlukaniswa ngamaqembu amahlanu:
  • Izimbangela ezahlukene zingaholela ku-pulmonary arterial hypertension (PAH).
  • Izifo zenhliziyo yesobunxele zingabangela umfutho wegazi ophakeme we-pulmonary arterial.
  • Isimo sokuba nomfutho wegazi ophakeme ngenxa yesifo samaphaphu noma ukuntuleka komoyampilo (hypoxia).
  • I-Chronic thromboembolic pulmonary hypertension ibizwa nangokuthi i-thromboembolic pulmonary hypertension.
  • Izimbangela kanye nezimbangela ze-thromboembolic pulmonary hypertension azicaci.

Kuyini Ukuxilongwa Kwesifo Se-Pulmonary Vascular?

Kusetshenziswa uhla lokuhlola lokuxilonga ukuze kuhlonzwe isifo se-Peripheral Vascular Disease (PVD) futhi kucaciswe ukuphazamiseka okuthile, okuhambisana nokuhlolwa komlando wezokwelapha okuphelele. Lezi zivivinyo zinikeza imininingwane ebalulekile mayelana nemvelo yesimo nobukhali. Ukuhlola okulandelayo kuvame ukusetshenziswa: 

• I-CT Scan: Izikena ze-Computed Tomography (CT) zisebenzisa ama-X-ray ukuze zenze izithombe ezinemininingwane yezingxenye ezihlukene zomzimba. Kumongo we-PVD, ama-CT scan angaveza ukungahambi kahle emithanjeni yegazi futhi ahlole ukugeleza kwegazi.
• I-Echocardiogram: I-echocardiogram isebenzisa amaza e-ultrasound ukuze ikhiqize izithombe zesikhathi sangempela zenhliziyo. Lokhu kuhlola kusiza ukuhlola ukusebenza kokumpompa kwenhliziyo nokuthola noma yikuphi ukungahambi kahle emithanjeni yegazi.
• I-X-ray yesifuba: I-X-ray yesifuba isetshenziselwa ukubona inhliziyo namaphaphu ngeso lengqondo, inikeza ulwazi mayelana nesakhiwo sawo kanye nezimpawu ezingaba khona zezinkinga zemithambo noma izimo ezihlobene.
• I-Reight Heart Catheterization kanye nokuhlolwa kweVasodilator: Le nqubo ehlaselayo ihilela ukufakwa kwe-catheter enhliziyweni ukuze kulinganiswe izingcindezi nokuhlola ukugeleza kwegazi. Ukuhlolwa kwe-Vasodilator kuvame ukwenziwa kanyekanye ukuze kuhlolwe impendulo yemithambo yegazi emithini ethile.
• I-Pulmonary Angiogram: I-angiogram yamaphaphu yindlela yokuxilonga esebenzisa udayi ohlukile kanye nama-X-ray ukuze kubonakale imithambo yamaphaphu ngeso lengqondo. Ingakwazi ukubona amahlule egazi noma okunye okungavamile okuthinta ukugeleza kwegazi emaphashini.

Lokhu kuhlola kusiza odokotela baqonde ukuthi kwenzekani emzimbeni wakho futhi banqume indlela engcono yokwelapha inkinga ngokusekelwe kulokho abakutholayo.

Izinketho zokwelapha ze-Pulmonary Vascular Diseases

Ukwelashwa kwezifo ze-vascular pulmonary kuhilela indlela ebanzi ehloselwe ukulawula izimpawu, ukuthuthukisa izinga lokuphila, nokubhekana nezimbangela eziyinhloko. Ukukhethwa kokwelashwa kuncike ohlotsheni oluthile kanye nobunzima besifo se-pulmonary vascular. Nansi eminye imininingwane ejulile mayelana nezinketho zokwelapha:

• Imithi:
  • Ama-Vasodilators: Izidakamizwa eziphumuza futhi zandisa imithambo yegazi, zinciphisa umsebenzi wenhliziyo futhi zithuthukise ukugeleza kwegazi. Izibonelo zifaka ama-calcium channel blockers, ama-prostacyclin analogs, nama-phosphodiesterase-5 inhibitors.
  • Ama-Anticoagulants: Ukuvimbela amahlule egazi nokunciphisa ingozi ye-pulmonary embolism.
  • I-Diuretics: Ukulawula ukugcinwa kwamanzi nokunciphisa ubunzima enhliziyweni.
• I-Oxygen Therapy: I-oksijeni eyengeziwe ivame ukunikezwa ukuze kuqinisekiswe ukuthi umzimba uthola umoya-mpilo owanele. Lokhu kubaluleke kakhulu ezimeni lapho kunokushintshaniswa komoyampilo okuphazamisekile emaphashini.
• Ukuvuselelwa Kwe-Pulmonary: Izinhlelo zokuzivocavoca ezenziwe ngokwezifiso kanye nemfundo ukuze kuthuthukiswe ukukhuthazela ngokomzimba, ukusebenza kwamaphaphu, kanye nokuphila kahle.
• Ukufakelwa Kwephaphu: Ezimeni ezinzima lapho ezinye izindlela zokwelapha zingasebenzi, ukufakelwa kwamaphaphu kungase kucatshangelwe. Lokhu ngokuvamile kugcinelwe iziguli ezinesigaba sokugcina se-pulmonary vascular disease.
• I-Endarterectomy yamaphaphu: Ikakhulukazi ku-thromboembolic pulmonary hypertension (CTEPH), le nqubo yokuhlinzwa ihilela ukususa amahlule egazi emithanjeni yamaphaphu ukuze kuthuthukiswe ukugeleza kwegazi.
• I-Balloon Pulmonary Angioplasty: Okunye ukungenelela kwe-CTEPH, le nqubo ihilela ukufaka ibhaluni emithanjeni yamaphaphu emincane ukuze iyinwebe futhi ithuthukise ukugeleza kwegazi.
• Imithi Yokwelapha Ephefumulayo: Imithi ephefumulayo, efana ne-prostacyclin analogs noma i-nitric oxide, ingase isetshenziselwe ukukhulisa imithwalo yegazi ngqo emaphashini.
• Izindlela Zokwelapha Ezihlosiwe: Intuthuko ekuqondeni izindlela zamangqamuzana zezifo ze-pulmonary vascular ziye zaholela emithi yokwelapha ehlosiwe ehlose ukuguqula inqubo yesifo ezingeni lamaselula.
• Ama-antibiotics kanye nemithi elwa namagciwane: Ezimweni lapho izifo zinomthelela ezifweni ze-vascular pulmonary, ama-antibiotic afanelekile noma imithi elwa namagciwane ingase ibekwe.
• Ukuguqulwa Kwendlela Yokuphila: Ukuyeka ukubhema, ukugcina ukudla okunempilo, ukuvivinya umzimba njalo, nokulawula ezinye izimo zempilo ezifana nesifo sikashukela kanye nomfutho wegazi ophakeme kuyizici ezibalulekile zokulawula izifo zemithambo yamaphaphu.

Selashwa kanjani isifo se-Pulmonary Vascular?

Embolism yamaphaphu

• Ngokuvamile kunzima ukuxilonga i-pulmonary embolism. Ukuxilongwa kwenziwa ngokukhomba izimpawu nokubheka umlando wezokwelapha womuntu, kanye nokuhlolwa okuvamile okufana ne-x-ray yesifuba kanye nama-electrocardiograms. 
• Ukuhlolwa kwegazi, okubizwa ngokuthi i-D-dimer, kungenziwa ukuze kukhishwe i-pulmonary embolism, kanye ne-computed tomography (CT) angiography, indlela yokuthwebula ehlanganisa ama-x-reyi, ama-CT scan, ne-magnetic resonance imaging (MRI).
• Esimeni esiphuthumayo, ukuhlolwa okubizwa nge-echocardiogram eseceleni kombhede kungasiza ukuxilonga i-PE. I-Ultrasound isetshenziselwa ukudala izithombe zenhliziyo. Ngaphezu kwalokho, ama-ultrasounds angahlola amahlule emithanjeni ye-pelvic noma yomlenze, okungase kube nomthelela ku-PE. 
• I-pulmonary embolism ingelashwa ngezidakamizwa ezaziwa ngokuthi ama-anticoagulants. Abantu abanobunzima bokuphefumula nabo bangathola umoya-mpilo owengeziwe. Iziguli ezinokwehluleka kwenhliziyo okuphikelelayo kanye nengozi enkulu ye-PE zivame ukunqunywa izidakamizwa ze-thrombolytic, ezincibilikisa amahlule emithanjeni ye-pulmonary. Ukuhlinza ukususa ihlule kungenye inketho uma lezi zindlela zokwelapha zingasebenzi.

Umfutho wegazi ophezulu wamaphaphu

• Uma kukhulunywa nge-pulmonary arterial hypertension (PAH), kunzima ukusheshe uxilongwe ngoba iziguli eziningi zinezimpawu ezimbalwa noma azinazo nhlobo noma zivele zibonakale zingafanelekile. Umuntu okutholwe ukuthi une-PAH angase abe nayo kunoma ibuphi ubudala, kodwa isilinganiso (isilinganiso) seminyaka yobudala engama-50.
• Udokotela ubheka izimpawu zomuntu kanye nezinye izici ezifana neminyaka nezimo zezokwelapha ezikhona ukuze anqume ukuthi uphethwe yini. Abantu ababonisa izimpawu zokwehluleka kwenhliziyo okufanele bavame ukufuna usizo lwezokwelapha sekwephuzile inqubo yesifo. 
• Umfutho wegazi ophakeme wamaphaphu ayelapheki, nakuba izidakamizwa eziyisisekelo, njengama-anticoagulants noma izithasiselo zomoya-mpilo, zingadambisa izimpawu zako. Isiguli esinomfutho wegazi ophezulu wamaphaphu singase selashwe ngezindlela zokwelapha ezihlukahlukene, njenge-prostacyclin, i-endothelin receptor antagonists, noma uhlobo lwe-5 phosphodiesterase inhibitors.
• Ngokukhipha ihlule nezibazi emithanjeni yegazi (imithambo) yamaphaphu, i-endarterectomy yamaphaphu ingalapha umfutho wegazi ophakeme wamaphaphu obangelwa isifo esingelapheki sokufa kwe-thrombo-embolic.

 Ukufakelwa kwamaphaphu kungase kucatshangelwe uma isimo sisibi. Ukwelashwa kwesimo esiyisisekelo kunconywa uma umfutho wegazi ophezulu wamaphaphu uhlotshaniswa nesifo senhliziyo noma samaphaphu.