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درمان‌های جراحی


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درمان های جراحی بیماری های قلبی به سه گروه بای پس عروق کرونری ، ترمیم یا تعویض دریچه و پیوند قلب تقسیم می شوند.

جراحی بای پس عروق کرونری

عمل جراحی بای پاس سرخرگ کورونر قلب، نوعی از جراحی های عمده است و به بستری شدن یک هفته ای شما در بیمارستان می انجامد. تجربه ثابت کرده است که این عمل جراحی، برای کاهش عوارض آنژین و بهبود وضع بیمارانی که به شدت سرخرگ کورونر قلب آنان باریک شده بوده، موثر و مفید بوده است. خطر کوچکی در این عمل جراحی وجود دارد که تقریباً مانند عمل جراحی عمده بر روی شکم بیمار است.

هدف از این عمل آن است که با ایجاد یک گذرگاه فرعی از خیر آن قسمت از سرخرگی که باریک شده است در گذرند و از طریق آن راه فرعی به قلب خون برسانند. برای انجام این کار ، بر رگی که بین آئورت و نقطه ای بر روی سرخرگ که بالاتر از محل باریک شده، یا مسدود شده است رگ خونی تازه ای پیوند می زنند تا از قسمت مسدود شده، یا باریک شده صرفنظر نمایند و جریان خون در سرخرگ را دوباره برقرار نمایند.

سال های متمادی بود که برای این کار، از سیاهرگ پای بیمار استفاده می نمودند ولی بعداً تصمیم گرفته شد از دو سرخرگی که در جدار سینه قرار دارد استفاده نمایند. به نظر می رسد که احتمال باریک شدن این سرخرگها در مقام مقایسه با پیوند از سیاهرگهای پا، کمتر است. بیماران بسیاری هستند که مخلوطی از هر دو را دارند.

قبل از آنکه تصمیم به عمل جراحی بای پاس گرفته شود لازم است که شما عمل آنژیوپلاستی داشته باشید تا اطمینان یابند کدامیک از عروق کرونر شما باریک شده است.

برای رسیدن به قلب، لازم است جراح، استخوان سینه شمارا شکاف دهد. و به همین علت است که پس از عمل، اثر زخم آن شکاف بر روی سینه ی شما باقی می ماند. بلافاصله پس از عمل جراحی، شما در سینه خودتان احساس ناراحتی می کنید ولی این احساس پس از چند روز متدرجاً از بین می رود. اگر سیاهرگی را از بدن شما برداشته باشند، باز شما همان ناراحتی را دارید. پای شما ورم می کند و بر روی آن نیز اثر زخم باقی می ماند.

بیشتر بیماران، یک یا دو روز پس از جراحی می توانند خارج از تختخواب خود بر روی صندلی بنشینند و پس از یک هفته به منزل روند. بازگشت به کار معمولاً دو، یا سه ماه پس از ترخیص از بیمارستان امکان پذیر است.

پیوند قلب

اگرشما به نارسایی قلب مبتلا هستید چه بسا هم اکنون زیر نظر پزشک ویژه گر قلب خود هستید. این پزشک ویژه گر قلب قبل از آنکه شما را برای عمل پیوند قلب به مراکز عمده معرفی نماید خود، آزمایش های سنتی لازم را بعمل خواهد آورد. سر انجام، اگر لازم تشخیص داده شود شما را به یکی از مراکز  پیوند قلب معرفی می نماید.
اگر در مرکز پیوند قلب شما فرد مناسبی برای پیوند قلب تشخیص دهد ترتیباتی بعمل می آید که بلافاصله آزمایشهای لازم از شما بعمل آید. برای انجام این کارها یک اقامت چند روزه در بیمارستان ضروراست .با این وجود، مواردی نیز وجود دارد که این آزمایشات بطور سرپایی انجام خواهد شد.
انجام آزمایشات به این دلیل انجام می شود تا اطمینان یابند حالت بیماری شما وخیم است و شما به عمل پیوند قلب نیازمندید.

این تشخیص و ارزیابی به شما فرصت می دهد تا بطور کلی از عمل پیوند قلب و سایر اموری که به ،ن مربوط است آگاه شوید و بهتر بتوانید در باره ی انجام عمل پیوند تصمیم بگیرید.مهمترین قسمت تشخیص و بر آورد ها این است که اطمینان یابند شما میتوانید سختیهای عمل جراحی و مدتی را که پس از آن باید برای بهبودی کامل خود در انتظار بمانید تحمل نمایید. به عبارت دیگر سنجش تاب و توان و مقاومت شماست.

ترمیم یا تعویض دریچه قلب

افتادگی دریچه میترال به دو دسته با نارسایی و بدون نارسایی میترال تقسیم می شود. در افتادگی دریچه میترال بدون نارسایی هیچ خطری فرد را تهدید نمی کند ولی افرادی که دچار نارسایی میترال همراه با افتادگی دریچه قلب هستند، هنگام انقباض قلب خون مختصری به دهلیز چپ آنها وارد می شود. این مسئله موجب می شود تا دریچه میترال تحت فشاری نامتناسب قرار بگیرد و در این حالت فرد مستعد می شود تا میکروب ها روی لت دریچه قلبش بنشینند و ایجاد عفونت کنند.

بیماران علامت دار مبتلا به نارسایی میترال (MR) شدید باید نسبت به تعمیر دریچه میترال ارزیابی شوند که گاهی اوقات نیز تعویض دریچه ضروری است. جراحی دریچه برای بیماران بدون علامت اما مبتلا به نارسایی میترال (MR) شدید همراه با فیبریلاسیون دهلیزی یا هایپرتانسیون ریوی توصیه می شود. انواع مختلف روش های جراحی برای بیماران ترمیم و تعویض دریچه میترال هستند.

جراحی والوولوپلاستی یا آنولوپلاستی یا ترمیم دریچه میترال یک فرایند جراحی است که دریچه میترال بیمار را حفظ می کند. جراح تلاش می کند تا دریچه میترال اصلی را اصلاح کند تا برگشت جریان خون به عقب را از بین ببرد.
تعویض دریچه میترال هنگامی که ترمیم دریچه ممکن نیست انجام می شود. در این فرآیند جراح دریچه میترال آسیب دیده را با یک دریچه مصنوعی جایگزین می کند. دو نوع دریچه مصنوعی به کار می رود که دریچه های مکانیکی و بافتی نامیده می شوند. دریچه های مکانیکی از فلز ساخته می شوند. بیمارانی که این روش را انتخاب می کنند برای بقاء زندگی شان به یک داروی ضد انعقاد نیاز خواهند داشت. دریچه های بافتی از بافت بیولوژیک مانند دریچه های قلبی خوک یا گاو ساخته شده اند و بیماران نیازی به مصرف داروی ضد انعقاد ندارند. معمولاً دریچه های مکانیکی نسبت به دریچه های بافتی طول عمر طولانی تری دارند.

۹۶ دیدگاه

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