آنژیوپلاستی


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استفاده از داروها و تغییرات سالم در شیوه زندگی همیشه برای پیشگیری از حمله قلبی کافی نیستند. فردی که با آنژین شدید یا حمله قلبی به بیمارستان مراجعه می‌کند، احتمالا دارای یک یا چند سرخرگ کرونری کاملاً مسدود شده می‌باشد. اولویت نخست، برقراری سریع و دوباره جریان‌خون می‌باشد و اقدام بعدی تلاش برای کاهش میزان خطر وقوع یک حمله قلبی دیگر است. میزان خطر به خصوص زمانی بیشتر می‌شود که فعالیت پمپاژ قلب در اثر انسداد سه یا چند سرخرگ کرونری و یا انسداد سرخرگ کرونری اصلی سمت چپ (که خون عضلات بطن چپ قلب را تامین می‌نماید) دچار اشکال شود.

باز کردن عروق قلبی با بالون

آنژیوپلاستی یا آنژیوپلاستی بالونی روشی است که یک سرخرگ مسدود شده را از طریق فشار دادن پلاک به دیواره‌های سرخرگ، باز می‌کند. آنژیوپلاستی کرونری داخل مجرایی از طریق پوست (PTCA) نام دیگر آنژیوپلاستی می‌باشد. این روش از طریق وارد کردن یک کاتتر در یک سرخرگ (معمولا درکشاله‌ران) و عبور آن از آئورت به سمت قلب انجام می‌شود. وقتیکه این بالون به محل انسداد رسید، به منظور فشار دادن به پلاک و گشاد نمودن مجرای سرخرگ باد می‌شود.
با بازکردن یک سرخرگ، آنژیوپلاستی بطور موثری درد آنژین را تسکین داده و میزان آسیب وارده به قلب را کاهش می‌دهد. آنژیوپلاستی ممکن است به عنوان روشی اورژانسی در فردی انجام شود که در حین حمله قلبی به بیمارستان مراجعه نموده است. همچنین ممکن است آنژیوپلاستی به صورت غیراورژانسی برای تسکین علایم آنژین قلبی یا پیشگیری از حمله قلبی انجام شود.

استنت (فنر) گذاری عروق قلبی

در بیشتر مواردِ آنژیوپلاستی (۷۰ تا ۹۰ درصد موارد) پزشک یک استنت (فنر یا وسیله‌ای برای حمایت از دیواره‌های سرخرگ از درون) را داخل سرخرگ تعبیه خواهد کرد. برخی از استنت‌ها (فنرها) توسط داروهایی پوشانده می‌شوند که به کاهش میزان خطر تشکیل لخته خون کمک می‌نمایند. دلیل اینکه استنت‌ها در برخی افراد کارگذاشته نمی‌شوند، موقعیت و نوع ضایعه می‌باشد.
هدف اصلی از تعبیه یک استنت، کاهش احتمال تنگ شدن مجدد سرخرگ در همان محل می‌باشد، که به این فرآیند تنگی‌مجدد گفته می‌شود. تنگی مجدد در حدود۴۰ درصد افرادیکه فقط از آنژیوپلاستی استفاده می‌کنند و تنها در ۲۰ درصد افرادیکه از آنژیوپلاستی و استنت‌گذاری توام استفاده می‌کنند، دیده می‌شود. بنا به دلایل نامشخص، افراد مبتلا به دیابت (بیماری قند خون) در معرض خطر بیشتر تنگی مجدد قرار دارند.

اقدامات قبل از آنژیوپلاستی

اگر پزشک استفاده از آنژیوپلاستی را به شما پیشنهاد نماید، ابتدا قبل از انجام آنژیوپلاستی ممکن است از شما یک عکس قفسه سینه با استفاده از اشعه ایکس، یک نوارقلب و آزمایش‌های خونی گرفته شود. شما و پزشکتان می‌توانید درباره موارد زیر بحث کنید: اینکه چرا آنژیوپلاستی برای شما لازم است؟ آنژیوپلاستی چگونه انجام می‌شود؟ چه انتظاراتی می‌توانید از آن داشته باشید؟
حتما درباره داروهای مصرفی خود به پزشک اطلاعات لازم را بدهید. پزشک ممکن است از شما بخواهد که مصرف آنها (به ویژه ضدپلاکت‌ها و داروهای ضدانعقاد) را قبل از آنژیوپلاستی متوقف کنید. همچنین ممکن است از شما بخواهد که بعد از نیمه شب قبل از آنژیوپلاستی چیزی نخورید و نیاشامید. اگر مبتلا به دیابت (بیماری قند خون) هستید، با پزشکتان به دقت درباره میزان داروها و غذای مصرفی خود صحبت کنید، چون هریک از این عوامل برمیزان قندخون شما تاثیر می گذارند.

منبع: بیمارستان شهید رجایی

۵۰ دیدگاه

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