Dissection ʻaʻano

ʻO ke dissection Aortic kahi kūlana koʻikoʻi kahi e haehae ai ka paia o ka aʻa nui e lawe ana i ke koko mai ka puʻuwai (aorta). Ke hele nei ka waimaka ma ka paia o ke aorta, hiki i ke koko ke kahe ma waena o nā papa o ka paia kīʻaha koko (dissection). Hiki i kēia ke alakaʻi i ka haki aortic a i ʻole ke kahe o ke kahe o ke koko (ischemia) i nā meaola.

Ke haʻalele ia i ka puʻuwai, neʻe mua ke aorta ma o ka umauma i ke poʻo (ke aorta piʻi). Kūlou a piʻo paha ia, a neʻe i lalo i ka umauma a me ka ʻōpū (ke aorta e iho mai ana).

Kū pinepine ka dissection aortic ma muli o ka waimaka a i ʻole pohō i ka paia o loko o ka aorta. Kū pinepine kēia i ka ʻaoʻao o ka umauma (thoracic) o ke aʻa, akā hiki paha i ka aorta ʻōpū.

Ke kū mai kahi waimaka, hana ia i nā kahawai 2:

• Hoʻokahi e hoʻomau ka hele ʻana o ke koko
• ʻO kahi kahi e waiho mau ai ke koko

Inā piʻi nui aʻe ke kahawai me ke koko hele ʻole, hiki iā ia ke pahu i nā lālā ʻē aʻe o ka aorta. Hiki i kēia ke hōʻemi i nā lālā ʻē aʻe a hōʻemi i ke kahe o ke koko ma o lākou.

Hiki i kahi dissection aortic ke kumu i ka hoʻonui ākea a i ʻole ka ballooning ʻana o ka aorta (aneurysm).

ʻAʻole ʻike ʻia ke kumu kūpono, akā ʻo nā pilikia maʻamau ʻo:

• ʻElemakule
• Atherosclerosis
• Pōʻino hōʻino i ka umauma, e like me ke kuʻi ʻana i ka huila o ke kaʻa i ka wā o kahi ulia
• Piʻi koko kiʻekiʻe

ʻO nā kumu kūpilikiʻi ʻē aʻe a me nā kūlana i hoʻopili ʻia i ka dissection aortic me:

• ʻO ke kiwikā ākea Bicuspid
• Coarctation (ʻākiki) o ke aorta
• Nā maʻi maʻi pili (e like me Marfan Syndrome a me Ehlers-Danlos Syndrome) a me nā maʻi kūlohelohe maʻamau
• ʻOki a me nā kaʻina hana naʻau
• Hapai keiki
• ʻO ka pehu ʻana o nā kīʻaha koko ma muli o nā kūlana e like me arteritis a me syphilis

Hana ʻia ka dissort aortic ma kahi o 2 o kēlā me kēia 10,000 poʻe. Hiki iā ia ke hoʻopili i kekahi, akā ʻike pinepine ʻia i nā kāne 40 a 70 paha makahiki.

I ka hapanui o nā hihia, hoʻomaka koke nā ʻōuli, a hui pū me ka ʻeha o ka umauma koʻikoʻi. E like paha ka ʻeha me he puʻuwai lā.

• Hiki ke wehewehe ʻia ka ʻeha me he ʻoi, ʻāʻā, haehae, a haehae paha.
• ʻIke ʻia ia ma lalo o ka iwi umauma, a neʻe ma lalo o nā poʻohiwi a i ʻole ka hope.
• Hiki i ka ʻeha ke neʻe i ka poʻohiwi, ka ʻāʻī, ka lima, ka ʻāʻī, ʻōpū, a me nā pūhaka.
• Hoʻololi ka ʻeha i ke kūlana, neʻe pinepine i nā lima a me nā wāwae i ka ʻino o ka dissection aorta.

Hoʻokumu ʻia nā ʻōuli e ke kahe o ke koko e kahe ana i ke koena o ke kino, a hiki ke hoʻopili ʻia:

• Ka pīhoihoi a me ka manaʻo o ka make
• Pāleʻaleʻa a luʻuluʻu paha
• Kaumaha nui (ʻili clammy)
• ʻO Nusea a me ka luaʻi
• ʻO kaʻili pale (pallor)
• Wikiwiki, nāwaliwali lāʻau ikiʻai
• Ka hanu ʻana o ka hanu a me ka pilikia o ka hanu ʻana ke hiamoe (orthopnea)

Hiki i nā ʻōuli ʻē aʻe ke:

• ʻEha ma ka ʻōpū
• Nā hōʻailona hahau
• Ke ale nei i nā pilikia mai ke kaomi ma ka esophagus

E lawe ka mea mālama ola i ka mōʻaukala o kou ʻohana a hoʻolohe i kou puʻuwai, akemāmā, a me kou ʻōpū me kahi stethoscope. E ʻike paha ka hōʻike:

• ʻO kahi ʻōhumu "puhi" ma luna o ke aorta, ʻōhumu o ka puʻuwai, a i ʻole ke kani ʻē aʻe
• ʻOkoʻa ka hoʻokahe koko ma waena o nā lima ʻākau a hema, a ma waena o nā lima a me nā wāwae
• Kaomi haʻahaʻa
• Nā hōʻailona e like me ka hōʻeha puʻuwai
• Nā hōʻailona o ka pīhoihoi, akā me ke kaomi koko maʻamau

ʻIke ʻia ka aortic dissection a i ʻole aortic aneurysm ma:

• Angiography ʻaʻano
• Pākuʻi x-ray
• ʻO MRI umauma
• CT scan o ka umauma me ka kala
• ʻO Doppler ultrasonography (hana ʻia i kekahi manawa)
• ʻEchocardiogram
• Echocardiogram Transesophageal (TEE)

ʻO ka hana koko e hōʻole i ka hōʻeha puʻuwai e pono ai.

ʻO ka dissection Aortic kahi kūlana hoʻoweliweli i ke ola a pono e mālama koke ʻia.

• ʻO nā kuʻina i kū i ka ʻāpana o ka aorta e waiho nei i ka puʻuwai (e piʻi ana) e mālama ʻia me ke ʻoki kino.
• Hiki ke mālama ʻia nā kipi i nā ʻāpana ʻē aʻe o ka aorta (e iho ana) me ke ʻoki a me nā lāʻau.

Hiki ke hoʻohana ʻia i ʻelua mau hana no ke ʻoki kino:

• Maʻamau, ʻoki wehe. Pono kēia i kahi ʻoki lāʻau i hana ʻia i ka umauma a i ʻole ka ʻōpū.
• Hoʻoponopono aorta endovascular. Hana ʻia kēia ʻoki me ka ʻole o nā ʻoki lāʻau nui.

Hiki ke kuhikuhi ʻia nā lāʻau e hoʻohaʻahaʻa i ke koko. Hāʻawi ʻia kēia mau lāʻau i loko o kahi aa (intravenously). ʻO nā beta-blockers nā lāʻau mua loa i koho ʻia. Pono pinepine nā mea hōʻeha ʻeha.

Inā hōʻino ʻia ke kiʻiona aorta, pono ʻia ka pani pani. Inā pili ka ʻaʻa o ka puʻuwai, hana pū kekahi kahi byon coronary.

Hoʻoweliweli ke ola aortic dissection Hiki ke mālama ʻia ke ʻano me ke ʻoki inā hana ʻia ma mua o ka haki ʻana o ka aorta. Ma lalo o hoʻokahi hapalua o ka poʻe me kahi aorta ruptured i ola.

ʻO ka poʻe e ola ana e pono i kahi ola holoʻokoʻa, hana hoʻomāinoino i ke koko kiʻekiʻe. Pono lākou e ukali ʻia me CT scans i kēlā me kēia mau mahina e nānā i ke aorta.

Hiki i ka dissection Aortic ke hōʻemi a kū paha i ke kahe o ke koko i nā ʻāpana like ʻole o ke kino. E hopena paha kēia i nā pilikia pōkole a lōʻihi paha, a i ʻole hōʻino i ka:

• Lolo
• Puʻuwai
• Nā ʻōpū a i ʻole nā ​​ʻōpū
• Nā hakuʻala
• Nā wāwae

Inā loaʻa iā ʻoe nā ʻōuli o kahi dissort aortic a i ʻole ʻehaʻeha o ka umauma, e kāhea iā 911 a i ʻole kāu helu pilikia kūloko, a i ʻole e hele wikiwiki i ka lumi pilikia.

ʻAʻole hiki ke pale ʻia nā hihia he nui o ka dissort aortic.

Nā mea hiki iā ʻoe ke hana e hōʻemi i kou makaʻu pū me:

• Ka mālama ʻana a me ka kaohi ʻana i ka paʻakikī o nā aʻa (atherosclerosis)
• Ke mālama nei i ke koko kiʻekiʻe ma lalo o ka kaohi, keu hoʻi inā ʻoe i ka makaʻu no ka dissection
• Ke mālama nei i nā hana palekana e pale ai i nā hōʻeha e hiki ai i nā dissection
• Inā ua ʻike ʻia ʻoe me Marfan a i ʻole Ehlers-Danlos maʻi, e hōʻoiaʻiʻo nei i ka hoʻomau ʻana me kāu mea hāʻawi

Aneurysm ʻaʻano - dissecting; ʻEha umauma - aortic dissection; Anerysm aoric Thoracic - hoʻokaʻawale

• Haki ʻaʻa - pahu x-ray
• Aneurysm ʻaʻano
• Dissection ʻaʻano

Braverman AC, Schermerhorn M. Nā maʻi o ke aorta. I: Zipes DP, Libby P, Bonow RO, Mann, DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 63.

ʻO Conrad MF, ʻo Cambria RP. Hoʻokaʻawale Aortic: epidemiology, pathophysiology, hōʻike hōʻike maʻi, a me ka hoʻokele olakino a me ka lāʻau. I: Sidawy AN, Perler BA, hua. ʻO Rutherford's Vascular Surgery a me Endotherapy Therapy. 9th ed. Piladelapia, PA: Elsevier; 2019: chap 81.

Lederle FA. Nā maʻi o ke aorta. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 69.