Dikosolola dia aorte ne ditapuluka dia aorte wa mu difu (AAA) Triage¶

Dikosolola dia tshiadi tshia mu tshiadi ne tshiadi tshia mu tshiadi tshia mu tshifu (AAA) i bibidi bia ku bilumbu bia lukasa bia mutshima bidi bilomba lufu mu malu a luondapu, bidi mua kufikisha ku dipatuka dia mashi munda anyi dinyanguka dia bitupa bia mubidi mu minite mikese. Bu mudi aorta muikale mushipa munene udi ne bukole bua bungi udi ufila mashi adi ne oxygène buludiludi mu mutshima too ne ku buongo, ku maboko, ku bitupa bia mubidi ne ku maulu, dipanda dionso didi mu tshimanu tshiawu tshia munda (dipanda) anyi dibutuka dia tshitupa tshidi tshitekete (aneurysme ditshibuka) didi dilomba diambuluisha dia lukasa dia lukasa. Diambuluisha dia kumpala didi dimanyine pa dimanya dia lukasa dia bimanyinu bia disama, kubikila bena mudimu ba lupitadi lua lukasa lukasa ne dimanyisha dia malu a mishipa, kulama muntu mupuwe bua kuepuka dibandila dia mashi, ne kuepuka manga bu mudi aspirine adi akolesha dipatuka dia mashi.

Enza nunku mpindieu¶

1. Bikila nimero wa lupitadi lua muaba uudi musombele diakamue ne uleje ne: "Disama dia lukasa dia mu mikolo didibu bela meji" anyi "Disama dia mu mikolo didibu bela meji ne: didi dinyanguke." Ela 911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi. Ambila patoke muntu udi utuma bantu bikalaye ne disama dia aortic aneurysm, dia Marfan, dia bicuspid aortic valve, anyi dia tshimpitshimpi dia tshiadi, dia mukolo anyi dia mu difu ne dijimija dia lungenyi, bua bobu kutuma ambulanse wa diambuluisha dia muoyo ne kudimuija lupitadi ludi ne bukole bua kupanda mutshima anyi mishipa.
2. Teka muntu pa mukolo (anyi mu muaba muimpe wa kulala panshi pikalaye kayi ne mupuya) ne umuenzeje dikisha dia mubidi dionso. Kulekedi muntu au wimana, uya ku tshina tshia mâyi anyi uya ku ambulanse to. Kuenza mudimu mukole, kudienzeja, anyi kuimana mu tshimpitshimpi kudi kufikisha ku dikola dia mutshima ne dia mashi (shear stress) bidi mua kufikisha ku ditshibuka dia aorte anyi dia retroperitoneal hematoma bua kutshibuka tshijima mu tshiadi anyi mu tshifu.
3. Kulama biakudia bionso, mayi, bintu bia kunua, ne manga a ku mishiku, nangananga aspirine ne nitroglycérine. Kulama muntu nansha umue ku mishiku (NPO) bualu nebikengele anesthésie wa lukasa lukasa padiye ufika ku lupitadi. Kuena ne bua kufila manga a aspirine, clopidogrel, anyi manga a nitroglycerine adibu bafila muinshi mua dimi to, anu padi munganga umuambila patoke ne: udi ne disama dia aorte.
4. Lama muntu mupole, mupole, ne mupuya muimpe eku upuekesha miendu idi ikenka ne upuekesha buôwa bua mu lungenyi. Buôwa ne kanyinganyinga kakole bidi bipatuisha mavuala a bungi a adrenaline (epinephrine ne norepinephrine) mu mashi, bienza bua tension systolique ne tension wa tshimanu tshia aorte bibandile. Akula ne dîyi ditekete didi dikankamija, upuekesha mikaba mikole anyi bilamba bia mu nshingu, ne ubuikila muntu au kakese ne tshilamba tshimue bua kubenga kukankamana kuyi umupesha kapia kakole to.
5. Tangila mushindu udi mashi apita mu bianza bionso bibidi ne umone butekete buonso budi ku luseke lumue, dipanga dia lungenyi, anyi dishilangana dia mashi. Shi udi na tshiamu tshia ku nzubu tshia kupima natshi mashi, pima mashi mu maboko onso abidi a dia balume ne a dia bakaji paudi muindile baminganga, ne ufunde nomba. Teleja bitekete bitekete dikuma dia radial ku bianza bionso bibidi anyi tangila ni dikasa dimue didi ditoke, mashika anyi dinyanguka, bualu dipanda dia aorte ditu misangu ya bungi dikanga matamba adi adisha diboko dimue, buongo anyi maulu.
6. Kangula biibi, wangate mikanda ya luondapu anyi karte ka tshiamu tshia mudimu, ne udilongolole bua kuenza CPR diakamue pikala muntu mukuluke. Enza bua muntu udi pabuipi apu abulule tshiibi tshia kumpala ne alongolole njila bua tshibandilu tshia ambulanse. Muntu yeye mubenge kuteleja ne mulekele kupuyakana bimpe, tuadija diakamue CPR ne dikuma dia tshiadi ku 100 too ne ku 120 ku minite.

Disungula dia tshimpitshimpi ne mutshi wa mapangadika a dishilangana¶

Ingidija tshimfuanyi etshi tshia luondapu bua kusunguluja pankatshi pa dipanda dia tshiadi tshia mu tshiadi, dinyanguka dia tshiadi tshia mu tshiadi, ne disama dia tshiadi anyi disama dia tshiadi mu minite ya kumpala ya lutatu.

flowchart TD
    Start["Disama dikole dia tshimpitshimpi mu tshiadi, mukolo, ku luseke,<br/>anyi mu difu NANSHA Disama dia tshimpitshimpi"] --> RedFlags{"Tangila diakamue bimanyinu bikunze bia mashi:<br/>1. Disama dia 'dikubakuba' dia lukasa?<br/>2. Tshintu tshidi tshituta mu difu + disama dia mukolo anyi dia ku luseke?<br/>3. Dipanga dia tshiadi anyi >20 mmHg dishilangana dia BP pankatshi pa maboko anyi?<br/>4. Disama dia mu tshiadi/mukolo + tshipupu anyi mashika/dikasa dinyanguke?<br/>5. AAA, Marfan syndrome, anyi disama dia valve aortique dimanyike anyi?"}

    RedFlags -->|"EYOWA: Tshimanyinu tshimue anyi bia bungi bia mashi"| SuspectAorta["KUELA MUSHINDU WA AORTIC CATASTROPHE<br/>(Aortic Dissection or Ruptured AAA)"]

    SuspectAorta --> CallEMS["Bikila ku 911 / 112 / 999 diakamue:<br/>Amba ne: 'Udi wela meji ne: udi ne disama dia aorte anyi AAA udi munyanguke'<br/>Lomba bua kuya nende ku Centre Vasculaire / Cardiothoracique"]

    CallEMS --> NoAspirin["BIDI BIKENEKA:<br/>1. KUPESHI Aspirine anyi manga adi atekesha mashi<br/>2. KUPESHI biakudia anyi mayi (Lama NPO bua dipanda)<br/>3. KULEKEDI mubedi wimana, wenda anyi udienzeja to"]

    NoAspirin --> LocationCheck{"Disama dia kumpala didi penyi<br/>ne bimanyinu kayi?"}

    LocationCheck -->|"Tshifu tshia kumpala anyi tshiadi tshia kuulu pankatshi pa maboko<br/>Dikuma dia diboko didi kadiyi dia muomumue / BP anyi bimanyinu bia stroke"| DissectionCare["Dikosolola dia mu tshiadi (Type A / B):<br/>- Ikala mutabale ne mupuwe (mupuwe anyi mupuwe)<br/>- Pima BP ku bianza bionso bibidi bia dia balume ne dia bakaji bikala tshiamu tshia ku tshianza tshikumbane<br/>- Tangila bimpe bua kumona ni udi ne disama dia stroke, tamponade, anyi dinyanguka dia njila wa luya"]

    LocationCheck -->|"Munkatshi mua difu, muinshi mua nyima, anyi ku luseke/ku tshiadi<br/>Mutoke, mupuya, mutu, mupuya wa mashi, anyi >60 yrs smoker"| AAACare["Disama dia tshiadi tshia mu tshifu (AAA):<br/>- Lala panshi pa nyima; KUFIKA bikole pa difu<br/>- Ikala ne luya ne tshilamba bua kuepuka hypothermie<br/>- Dilongolola bua hypovolemic shock ne dipanda dia lukasa"]

    RedFlags -->|"NO: Disama dia mu tshiadi didi dienda dikuma ku kakese ku kakese,<br/>dikuma dia tshianza dia muomumue, kakuyi dibanga dia ditshibuka"| CheckMI["Tangila disama dia tshiadi tshia mutshima anyi disama dia mutshima:<br/>Tangila mukanda wa disama dia mutshima bua EMS ne protocole wa aspirine"]

Kujingulula malu abidi adi mua kufikisha muntu ku lufu¶

Nansha mudi malu onso abidi aa alomba dinyanguka dia mushipa munene wa mubidi, dipanda dia mushipa wa tshiadi ne ditapuluka dia tshiadi tshia mu tshifu (AAA) bidi bienzeka ku diambuluisha dia mishindu mishilangane, bidi bikuata babedi bashilangane, ne bidi bilomba mishindu mishilangane ya lupitadi lua lukasa.

1. Dikosolola dia mu mikolo: Dikosolola dia munda dia bukole bua bungi¶

Tshimanu tshia aorta muimpe tshidi ne bitupa bisatu bia muinshi mua buloba: tshitupa tshia munda tshitekete (tunica intima), tshitupa tshia munkatshi tshidi ne misunyi mikola (tunica media), ne tshilamba tshia pambelu tshikole (tunica adventitia). Mu dipanda dia mutshima, ditshibuka dia tshimpitshimpi didi dipatuka mu tshitupa tshia munda tshia munda, pa tshibidilu mu tshiadi (aorte thoracique) mudi mashi apatuka mu mutshima ne lubilu lua bungi.

Padi mashi apita mu tshitupa etshi tshia munda mu tshienzedi tshia systolique, adi apanda (apanda) tshitupa tshia munkatshi tshia mubidi, tshienza "lumen wa dishima" (tshitupa tshibidi tshia mashi tshidi katshiyi tshiakane) panshi anyi mulu mu bule bua aorta. Bu mudi njila wa dishima eu wenda uvula mashi, udi ufila njiwu inayi idi mua kunyanga muoyo: - Ditapuluka mu tshibombi tshia muoyo (Cardiac Tamponade): Shi dikosolola dienda dipingana mu mutshima mu tshibombi tshia muoyo tshidi tshinyunguluke mishipa ya mutshima, mashi adi awuja tshibombi ne afina mutshima too ne padiwu kauyi mua kupompa, ne bidi bifikisha ku lufu lua tshimpitshimpi. - Acute aortic valve regurgitation: Ditshibuka didi mua kupatula mabeji a aortic valve, kuenza bua mashi apingane panyima mu ventricule wa ku dia bakaji ne kuwuja mifuba ne mâyi (flash pulmonary edema). - Dikanga dia mushipa wa mutshima: Tshitupa tshia dikosolola tshidi mua kukosa mu tshibuelelu tshia mushipa wa mutshima wa ku dia balume anyi wa ku dia bakaji, ne kuenza bualu kampanda budi buenzeka musangu umue disama dia mutshima. - Dipanga dia mashi mu mishipa ya matamba (Stroke, Paraplegie, Visceral Ischémie): Padi lumen wa dishima wenda upueka mu aorta, tshitupa tshia munda tshidi tshipatuka tshidi mua kutapa mishipa ya carotide idi idisha buongo (bienzeja diakamue disama dia avc), mishipa ya muinshi mua dikasa idi idisha maboko (idi yenza bua tshianza tshipangile), mishipa ya mukolo idi idisha muonji wa mukolo (idi yenza bua maulu onso abidi anyanguke mu tshimpitshimpi), anyi mishipa ya mesenterique ne ya renal idi idisha mala ne mifuba.

Baminganga batu balongolola dipanda dia mishipa ya mu mikolo ku diambuluisha dia Stanford Classification System, udi ulomba diambuluisha dia lukasa dia kupanduka: - Stanford Type A Dissection: Didi ditangila aorta udi ubanda (tshitupa tshia kumpala tshidi tshipatuka buludiludi mu mutshima) ne/anyi tshitupa tshia aorte, nansha biobi bienda mutantshi kayi. Dipanda dia mushindu wa A ndisama dia tshimpitshimpi dia dipanda ne bungi bua bantu badi bafua budi buvula pabuipi ne 1 too ne ku 2 pa lukama ku dîba dionso dilongolola dia dipanda didi dienda dijika mu mêba 48 a kumpala. - Stanford Type B Dissection: Udi utuadija mu aorta thoracique udi upueka (kupita mushipa wa subclavian wa ku dia bakaji udi udisha diboko dia bakaji) ne udi uya panshi mutangile ku difu. Dikosolola dia mishindu ya B didi dilombodibua ku ntuadijilu ne dikosa dia mashi ne dikuba dia mutshima ("anti-impulse therapy"), pamue ne dilongolola dia stent-graft (TEVAR) pikala bitupa bia mubidi kabiyi ne mashi anyi tshimanu tshidi mua kupatuka.

2. Disama dia tshiadi tshia mu tshifu (AAA): Dibutuka dia tshimanu tshidi tshitekete¶

Aneurysm i divulangana dia kashidi, dia muaba umue (divulangana) dia bitupa bionso bisatu bia tshimanu tshia mashi tshidi tshifumina ku dinyanguka dia kashidi dia mionji ya elastic ne collagène. Nansha mudi aneurysme mua kuenzeka mu tshiadi (aneurysme wa aorte thoracique), udi utamba kuikala mu tshitupa tshia kuinshi kua difu tshidi kuinshi kua mishipa ya mfyo (infrarenal abdominal aortic aneurysm, anyi AAA), mudi aorta wa muntu mukole udi ne bunene bua 2,0 centimètres (0,8 inches) mu diamètre. Padi tshitupa atshi tshipita 3.0 centimètres (1.2 inches), tshidi tshiumvuija bu aneurysme; padiye upita 5.0 too ne ku 5.5 santimetre (2.0 too ne ku 2.2 inches), njiwu ya dinyanguka dia tshimanu idi ibanda bikole.

Ma aneurysme a bungi a mu tshifu adi akola mu tshimpitshimpi munkatshi mua bidimu bia bungi kaayi afila tshimanyishilu nansha tshimue too ne padiwu avula anyi apatuka (ruptured AAA). Padi AAA upatuka, mashi adi apatuka mu aorta mu umue wa ku miaba ibidi eyi: - Ditapuluka dia munda mua difu dia tshianana: Tshimanu tshia kumpala tshia tshitupa tshia mashi tshidi tshipatuka buludiludi mu tshitupa tshia munda tshia difu tshidi tshiunzulula. Dipatuka dia mashi dia bungi didi dienzeka mu minite mikese, misangu ya bungi didi difikisha ku diimanyika dia muoyo dia lukasa kumpala kua ambulanse kufikaye. - Ditapuluka dia mu tshifu (Dididishi dia or dia triage): Mu babedi ba bungi badi bashala ne muoyo matuku a bungi bua kufika ku lupitadi, tshitupa tshia mashi tshidi tshipatuka mu muaba wa mu tshifu udi panyima pa tshifu (pabuipi ne mukolo ne misunyi ya psoas). Tshitupa tshia mubidi tshidi tshinyunguluke ne tension udi wenda upueka bidi bikanga (bikanga) tshitupa tshidi tshipatuka mu minite 30 too ne ku mêba a bungi. Ino, shi mubedi udienzeja, uditatshisha, nansha upeta mayi a bungi mu mushipa adi abandisha tension wende, tshitupa etshi tshia mu tshifu tshidi tshipatuka, tshikudimuna dipatuka dia mashi didi mua kushala ne muoyo mu dipatuka dia mashi adi kaayi ne lufu.

Difuanyikija dia malu onso: Dikosolola dia aorte ne AAA munyanguke ne disama dia mutshima¶

Bu mudi disama dia mu tshiadi, dia mukolo ne dia mu difu dikale malu adi bantu batamba kuela mbila, bantu badi batuma bantu badi bambuluisha bantu mu tshimpitshimpi ne bantu badi pabuipi batu batamba kuela meji bibi bua disama dia aorte bu disama dia mutshima, dia mabue a mu mifuba anyi dia sciatica. Tangila tshibambalu etshi tshia difuanyikija bua kumona bimanyinu bidi bishilangane:

Kujingulula bimanyinu bia dibendele dikunze mu bule ne mu butshiama¶

Bimanyinu bia kale ne bia patupu bia dikosolola dia mishipa ya mu mikolo¶

Bilondeshile bulongolodi bua matunga masanga bua dipanda dia mishipa (IRAD) ne mikenji ya ACC/AHA, babedi bapite pa 90 pa lukama badi ne dipanda dia mishipa ya mu mikolo batu bumvua kanyinganyinga ka tshimpitshimpi, kadi batue ku 30 pa lukama batu babapeta bibi ku ntuadijilu. Tangila bisumbu bia luondapu ebi:

1. Disama dia tshimpitshimpi, dia "dipanda" anyi dia "dipanda" dia tshimpitshimpi: Bishilangane ne disama dia mutshima didi dikola bitekete bitekete mu minite ya bungi, disama dia dikosolola dia aorte didi difika ku tshibungubungu mu sekonde wa kumpala padi tshitupa tshia munda tshipatuka. Babedi badi baleja mudibi "bu tshintu tshidi tshinyunguluke munda mua tshiadi tshianyi" anyi "bu mudibu bankuma pankatshi pa makaya."
2. Njila wa disama didi dienda: Padi dipanda dienda dipueka mu aorta kumbukila ku tshiadi too ne mu difu, disama didi mua kutuadija mu tshiadi tshia kumpala anyi ku nshingu, kuenda pankatshi pa maboko minite 10 pashishe, ne pashishe kuosha mu tshiadi tshia kuinshi anyi mu tshiadi.
3. "Disama dia pa mutu pa dimue" (Disama dia mu tshiadi anyi dia mukolo disangisha ne bimanyinu bia mu mitu anyi bia mu bitupa bia mubidi): Dîba dionso didi disama dia mu tshiadi anyi dia mukolo dienzeka ne dipanga dia mitu anyi dia tshiadi tshidi ne mashika, ela meji bua dipanda dia aorte kumpala:
4. Disama dia mu tshiadi/mukolo + Bimanyinu bia tshiadi: Divulangana mu mishipa ya tshiadi didi difikisha ku diteketa dia tshimpitshimpi dia luseke lumue, dikuluka dia mpala, anyi dijimija dia kuakula. (Didimuija dia lupitadi dia mushinga mukole: Kupesha mubedi wa AVC manga adi anyanga mashi bu mudi tPA/tenecteplase mu mishipa kudi mubedi wa AVC udi AVC wende mufumine ku dipanda dia aorte wa mushindu wa A udi musokome kudi kushipa bantu bonso.)
5. Disama dia mu tshiadi/mukolo + Paraplegie (Maulu adi kaayi ne bukole): Dikosa dia mishipa ya mukolo (nangananga mishipa ya Adamkiewicz) didi difikisha ku disama dia tshimpitshimpi ne dipanga dia lungenyi mu maulu onso abidi.
6. Disama dia mu tshiadi/mukolo + Disama dia mu tshiadi: Dikanga dia mushipa wa muinshi mua tshiadi anyi wa tshiadi didi dishiya diboko dimue anyi dikasa ditoke bu difue, mashika a mashika, kayi ne tshiadi, ne disama.
7. Painless Syncope (Fainting) in 5 to 10 percent of cases: Pabuipi ne 1 pa 10 babedi badi ne disama dia Type A udi ujimija lungenyi ne disama dikese anyi nansha dikese dia mu tshiadi, pa tshibidilu bualu mashi mmabuele mu tshibombi tshia mu tshiadi (tamponade cardiaque) anyi mmapangishe bua tshitupa tshîpi dienda dia mashi mu tshiadi.

Tshisatu tshia kale ne "tshimfuanyi" tshia disama dia tshiadi tshia mu tshiadi (AAA)¶

Mukanda wa kale wa malu asatu adi atangila disama dia AAA didi ne: disama dia tshimpitshimpi dia mu difu/mukolo/dia ku luseke, disama dia mashi mu mashi anyi dia dipanga dia lungenyi, ne tshitupa tshia mu difu tshidi tshituta. Ino, malonga a mu UK National Institute for Health and Care Excellence (NICE) ne Society for Vascular Surgery (SVS) adi aleja ne: malu onso asatu adi enzeka pamue mu bantu batue ku 50 pa lukama badi ne disama dia AAA. Pamutu pa nanku, tangila malu asatu adi atamba kuenzeka mu lupitadi:

Nnganyi udi mu njiwu mikole: malu a tshilele, a luondapu, ne a nsombelu¶

Kuabanyangana malu a njiwu ne muena mudimu wa 911 / 112 / 999 ne munganga wa mu nzubu wa lupitadi lua lukasa ntshimue tshia ku mishindu ya lukasa ya kuenza ultrason anyi CT angiogramme diakamue.

Diambuluisha dia kumpala ne dilama dia kumpala kua lupitadi patudi bindile EMS¶

Padibu batabalela muntu udi ne disama dia aorte anyi disama dia aorte dia mu difu didi ditshibuka kumpala kua baminganga kufikabu, tshienzedi tshionso tshidi tshienza bua kukepesha lutatu lua dikosa dia tshimanu tshia aorte ne kulama tshitupa tshia mashi tshidi tshibuikila.

Tshitupa 1: Dilongolola bua kuikala ne bukole bua mashi¶

• Badi bela meji ne: badi ne disama dia mu tshiadi (disama dia mu tshiadi anyi dia mukolo, misangu ya bungi tension mubandile): Bambuluishe bua kulala mu muaba udi kauyi ne kanyinganyinga kakole ne udi mua kupuyakana bipepele, pa tshibidilu **muaba wa panshi (mupuya mutekete) anyi wa semi-Fowler (mutu ne makaya bimane bitekete bitekete ku 30-degre) angle. Kuenzeji mubedi udi uluangana bua kupuyakana bua kulala panshi to.
• Badi bela meji ne: AAA mmutshibuke anyi bimanyinu bia dikema (pale, cold, clammy, dizzy, faint): Ubateke bapuekele pa mukolo. KUbandishi maulu bikole pikalabi mua kukusama mu difu, ne kulekedi nansha kakese bua kusomba bululame anyi kuimana, bualu kusomba kudi kumbusha mashi adi mashale kule ne buongo ne mutshima.
• Kakuyi lungenyi anyi udi utua mikemu: Ubakuate bitekete bitekete ku luseke luabu mu muaba wa diondopangana ku luseke bu tshintu tshimue (mu mushindu wa log-roll, kuyi unyungisha mubidi) bua manyanu kaayi mua kubuela mu mikolo.

Tshitupa 2: KUTEKI anyi kufina bikole pa difu didi dienda dikuma to¶

Wewe mumone anyi wela meji ne: kudi tshintu tshidi tshituta munkatshi mua difu dia muntu, kufinyi bikole pa difu diende bua kutshitangila, ne kulekedi bantu badi ne meji mimpe bamufina pa difu to. Dienzeja dia tshianza tshikole pa tshimanu tshitekete, tshidi tshipatuka tshia mu tshiadi tshia mu tshiadi didi mua kunyangakaja tshitupa tshia mashi tshidi katshiyi tshikole tshia mu tshifu ne kufikisha ku ditshibuka dia lukasa.

Tshitupa 3: Mushindu kayi wa kuenza tshikebelu tshia mashi ne tshipiminu tshia maboko abidi¶

Shi tshiamu tshia kupima natshi mashi tshia ku nzubu tshidi pabuipi ne kutshienza mudimu katshiena mua kuenzeja bua kubikila bena mudimu ba lukasa lukasa anyi kunyangakaja mubedi to: 1. Pima ne funda tshipiminu tshia mashi ne dikuma dia mutshima ku diboko dia balume. 2. Diakamue, ela tshilamba tshia ku tshianza ku diboko dia kuulu dia dia bakaji ne upime tension kuntu aku. 3. Tshidi nomba yumvuija: Mu muntu udi ne makanda a mubidi mimpe, tension wa mashi udi pankatshi pa diboko dia balume ne dia bakaji udi mushilangane ne \(10\text{ mmHg}\). Dishilangana dia tension wa systolique dipite pa \(20\text{ mmHg}\) pankatshi pa diboko dia balume ne dia bakaji (disangisha ne disama dikole dia mu tshiadi anyi dia mukolo) didi dileja ne: tshitupa tshia dikosolola dia mashi tshidi mua kuikala tshikanga umue wa ku mishipa ya muinshi mua dikasa. Umanyishe nomba yonso ibidi mijalame kudi baminganga diakamue padibu bafika.

Tshitupa 4: Ditalala dia mubidi ("Beta-Blockade Verbal")¶

Mu tshibambalu tshia lupitadi tshia lukasa lukasa, buanga bua kumpala bua dipanda dia mutshima budi buanga bua beta-bloquants (bu mudi esmolol anyi labetalol) bua kupuekesha dikuma dia mutshima muinshi mua \(60\text{ beats per minute}\) ne tension wa systolique pankatshi pa \(100\text{ ne }120\text{H\)}$ bidi bipuekesha dipuekesha dia tshiadi tshionso dikuma dia mutshima ku tshimanu tshia aorte tshipanduluke. Kumbelu, kumpala kua manga a IV kufika, buôwa ne kanyinganyinga ke baluishi: - Umbusha musumba wa bantu badi ne buôwa mu nzubu ne ulongeshe mubedi bua kuela mupuya bitekete bitekete, kuepuka bikole bua kulama mupuya anyi kuela panshi (epuka tshilele tshia Valsalva, tshidi tshibandisha tension wa aorte). - Lama muaba udibu basombele mupuwe ne ubajadikile ne: diambuluisha didi anu mu minite mikese.

Tshitupa 5: Kulama bukubi bua kapia (Kupangisha bisatu bia lufu)¶

Mu mubedi udi ne AAA mutshibuka udi ujimija mashi munda, luya lua mubidi ludi lupueka lukasa. Hypothermie (luya lua mubidi ludi muinshi mua \(35^\circ\text{C}\) anyi \(95^\circ\text{F}\)) ludi lupangisha enzyme ya mashi ne plakete, bienza bua mashi apatuka munda ikale mabi. Buikila mubedi kubangila ku tshibeku too ne ku makasa ne bilamba anyi bilamba biume, ne uteke tshilamba muinshi muabu pikalaye mulale panshi pa mashika.

Kujingulula malu a ambulanse ne a lupitadi: hypotension ne dilombola dia tshisumi¶

Kumanya tshikala ba munganga ne baminganga ba lukasa benza kudi kuambuluisha bena mu dîku bua kuyukila bimpe mu tshikondo tshia disama dia aorte:

1. Bua tshinyi baminganga badi benza mudimu ne "Permissive Hypotension" mu Ruptured AAA¶

Mu bilumbu bia bungi bia luondapu bidi bitangila dipueka dia mashi, baminganga batu bela mifuku minene ya saline mu mishipa lukasa bua kupingaja mashi too ne ku \(120/80\text{ mmHg}\). Mu disama dia tshiadi tshia mu difu anyi dipanda dia mashi adi apatuka, kufila mâyi a bungi a mu tshifu bua kulongolola tension kumpala kua munganga kukangaye tshiadi kudi ne njiwu. - Kubandisha tension wa systolique pa mutu pa \(90\text{ too ne ku }100\text{ mmHg}\) ne saline kudi kukepesha bintu bidi bienza bua mashi anyanguke, kuenza bua mashi ikale mashika, ne kupuekesha mashi a tshitupa tshîpi ("kupatula mashi") adi alama mubedi ne muoyo. - Nunku, mikenji ya matunga masanga (NICE NG156 mu Royaume-Uni, Société pour la chirurgie vasculaire mu États-Unis, ne Société européenne pour la chirurgie vasculaire) idi ilomba baminganga bua kuenza mudimu ne tension wa dipuekesha dia mashi mu mubidi: anu padi mubedi mubike, wakula, ne ulama tension wa mashi udi pabuipi ne \(70\xte {txt}{toxt}toxt mmHg}\), mayi adi mikandike padi ambulanse wenda buludiludi mu nzubu wa dipanda dia mishipa.

2. Bua tshinyi dipita dia lupitadi ku Centre Aortique didi disungila mioyo¶

Kakuena lupitadi luonso lua muaba udibu basombele ludi ne munganga wa muoyo (bua dipanda dia aorte wa mushindu wa A) anyi munganga wa mishipa udi ne tshiamu tshia dipanda dia mishipa (bua dipanda dia AAA) udi wenza mudimu mêba 24 ku dituku to. Paudi wamba patoke ne: "Udi wela meji ne: udi ne disama dia aorte" anyi "Disama dia aorte dia mu difu didi dimanyike ne disama dia tshimpitshimpi ne dipanga dia lungenyi" mu tshikondo tshia dibikila diebe dia kumpala dia lukasa, biamu bia EMS bia mu bitupa bia ditunga bidi mua kuenza mudimu ne Direct-to-OR "Code Rupture" anyi "Code Aorta" pathway, ku diambuluisha dia mubedi mukese udi uya buludiludi ku lupitadi lua buludiludi munkatshi.

Mukanda wa dimanyishangana wa 911 / 112 / 999 ne disungula dia lupitadi¶

Paudi wakula ne muena mudimu wa tshimpitshimpi anyi munganga wa disungula, enza mudimu ne muakulu wa luondapu eu:

• Bua dipanda dia aorte:

  *"Ndi dijinga ne ambulanse wa lukasa lukasa ku [Adrese mulelela]. Mubedi udi [Mulume/mukaji] wa bidimu [mulume/mukaji] uvua mupete kanyinganyinga ka lukasa, 10-pa-10 ka kutshibula [tshifu / mukolo] ku [Tshikondo]. [Yeye] udi kabidi ne [dishilangana dia tension wa X mmHg pankatshi pa diboko dia balume ne dikasa dia dia bakaji / dikasa dia mu tshimpitshimpi Syndrome / a bicuspid aortic valve]. Tudi tuela meji ne: tudi ne disama dia Acute Aortic Dissection.

• Bua AAA udibu bela meji ne: mmutshibuke:

  "Ndi dijinga ne ambulanse wa lukasa lukasa ku [Adrese mulelela]. Mubedi udi ne [Age]-aneurysm [mulume/mukaji] udi ne [A known Abdominal Aortic Aneurysm / a history of smoking and hypertension] uvua mupete tshimpitshimpi disama dikole [mu difu / muinshi mua tshiadi / ku luseke] ne [udi utshioka / udi utua mikemu, udi ne tshiji tshikole]. Disama dia tshiadi tshia mu tshifu tshidi tshitapuluke. Tudi tumulama [yeye] mulale panshi ne mupuwe."

Mulongo wa malu a dilongolola dia disungula padi mashinyi a lupitadi mu njila¶

• Dîba dilelela dia ntuadijilu wa disama difunda: Baminganga badi ne tshia kumanya minite menemene uvua disama dia ditshibuka anyi dijimija dia lungenyi dienzeke.
• Mashi a ku bianza onso abidi mafunda (bikalabu bapima): Funda BP wa ku diboko dia balume ne BP wa ku dia bakaji pa dibeji.
• Tshimfuanyi tshia kumpala tshia aorte anyi karte ka dipanda: Angata mukanda wonso wa dipatuka udi uleja bunene bua aneurysme wa kumpala (tshilejilu, "4.8 cm infrarenal AAA"), karte ka stent-graft, anyi karte ka valve wa muoyo.
• Mulongo mujima wa manga adi atekesha mashi adibu bapeta: Ambila diakamue baminganga pikala mubedi unua warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel, anyi aspirin wa ku dituku ne ku dituku, bua lupitadi luikale mua kulongolola manga a dipingaja dia mashi mu tshimpitshimpi (bu mudi 4-factor prothrombin concentrate [PCC], anderucinet, anderucinet alfa) kumpala kua dipanda.
• Kakuena bualu nansha bumue budibu bajadike ku mishiku to: Ambila baminganga dîba dia kudia anyi kunua dia ndekelu dia mubedi bua kulongolola diondapangana dimpe.

Dikuba ne dikonkonona: Kukuata mishipa ya mashi kumpala kua kuyitapa¶

Bu mudi tshitupa tshia mashi tshidi katshiyi tshinyanguke tshidi mua kulongolodibua ku budisuile ne tshitupa tshia 95 too ne ku 98 pa lukama tshia muoyo, kadi tshitupa tshia mubidi tshidi tshipanduluke tshidi ne tshitupa tshia lufu tshia 70 too ne ku 80 pa lukama, dipima dia ultrason ne dilama dia tension bidi bisungila muoyo:

1. Dikonkonona dia tshifu dia musangu umua:
2. Mu ditunga dia États-Unis (USPSTF & SVS Guidelines): Ultrason wa musangu umue wa mu difu udi muanyishibue kudi balume bonso ba bidimu 65 too ne ku 75 badi banji kunua makanya, ne kudi balume ne bakaji ba bidimu 65 too ne ku 75 badi ne muyuki wa kumpala mu dîku wa AAA.
3. Mu Royaume-Uni (NHS AAA Screening Programme): Bantu balume bonso badi babikidibue bua kuenza tshikebelu tshia tshianana mu tshidimu tshidibu bakumbaja 65, ne muntu yonso udi ne bidimu bipite pa 65 udi kayi muanji kuenza tshikebelu udi mua kudifila.
4. Dikonkonona dia malu a mubidi ne a mutshima bua disama dia mu tshiadi:
5. Balela ba mulongo wa kumpala (baledi, bana babu, ne bana) ba muntu yense udi ne disama dia tshiadi anyi udi ne tshiamu tshia bicuspid aortic badi ne tshia kuenza mibelu ya malu a ntuadijilu ne echocardiography anyi CT/MR angiography bua kupima diamètre wa miji ya aorte.
6. Dikuba dia nsombelu wa ku dituku ne ku dituku bua babedi badi ne disama dia mishipa:
7. Lekela dinua dia makanya (udi upuekesha tshipiminu tshia divulangana dia mashi mu bitupa bibidi) ne ikala ne tension wa mashi muinshi mua \(130/80\text{ mmHg}\).
8. Epuka dikolesha dia Valsalva dia bungi: Bantu badi ne disama dia aorte badi ne tshia kuepuka dibandisha dia bujitu bua isometric (muaba uudi ulama mupuya webe ne dikolesha pabuipi ne bukole bua bungi), budi mua kubandisha tension wa mu aorte kupita \(300\text{ mmHg}\). Dibidija dia mubidi dia pa tshibidilu didi dikankamijibua; tangila mikalu ya bujitu kampanda kudi mumanyi wa malu a mishipa.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi kutafuna aspirine kudi ne njiwu mu tshikondo tshia dipanda dia aorte padibu balomba bua kudia bua disama dia mutshima?¶

Disama dia mutshima didi difumina ku dibunda dia mashi didi dikanga mushipa wa mioyo, nunku kutafuna aspirine kudi kuimanyika dikola dia mashi adi. Bishilangane, dikosolola dia aorte anyi ditshibuka dia aneurysme didi dinyanguka dia tshimanu tshia aorte; kufila aspirine kudi kupangisha plakete, kupangisha dienza dia mashi adi akuba, ne kufikisha ku dipatuka dia mashi mu tshiadi, mu difu anyi mu tshibombi tshia mu tshiadi.

Mmunyi mundi mua kumanya dishilangana pankatshi pa disama dia tshiadi tshia mu tshifu ne dibue dia mu tshifu kudi muntu mukulumpe?¶

Bionso bibidi bidi mua kufikisha ku disama dia tshimpitshimpi dia ku luseke lumue didi difika too ne mu tshiadi bualu mashi a mu tshifu adi anyanga mijilu ne tshifu tshia mu tshifu bu mudi dibue. Ino, muntu mukulumpe yense udi na myaka mipite pa 55 (nangananga udi unua makanya anyi udi ne disama dia mashi a bungi) udi upeta disama dia mabue a mu tshiadi bua musangu wa kumpala ne tshiji, dikoba dimpe, dijimija lungenyi, anyi dipueka dia mashi udi ne tshia kuondopibua bu disama dia aortic aneurysm ditshibuka too ne padi ultrason anyi CT scan mua kumumbusha.

Dishilangana dia mashi pankatshi pa diboko dia bakaji ne dia balume didi diumvuija tshinyi padi muntu usama mu tshiadi?¶

Mu muntu mukole udi ne makanda a mubidi mimpe, tshipiminu tshia mashi tshidi pankatshi pa diboko dia balume ne dia bakaji tshidi tshishilangane ne milimetre 10 ya mercury (mmHg). Shi muntu udi na disama dia tshimpitshimpi dia mu tshiadi anyi dia mukolo udi ne dishilangana dia tension wa systolique dipite pa 20 mmHg pankatshi pa maboko ende (anyi dikuma dia tshianza ditekete ku luseke lumue), tshitupa tshia dikosolola dia aorte tshidi mua kuikala tshikanga mushipa wa subclavian udi ufila diboko adi.

Bikala muntu udi ne disama dia tshimpitshimpi dia mukolo anyi dia mu difu mupue muoyo ne pashishe ujuka umvua bimpe menemene panshi, bualu bua lukasa budiku bujika anyi?¶

Tòo, diondapibua dia tshitupa tshîpi kunyima kua dijimija dia lungenyi ntshimanyinu tshia kale tshia dinyanguka dia tshiadi tshia mu tshiadi anyi dipanda dia tshiadi didi dipatuka. Padi tension upueka mu tshikondo tshia dijimija dia lungenyi ne mubedi mulale panshi, tshitupa tshia panyima pa tshifu tshidi tshikanga tshitupa tshidi tshipatuka; bobu bimana anyi balengulula bua kubikila bena mudimu ba lukasa, tshitupa tshia mashi tshidi katshiyi tshikole tshitu tshitamba kupatuka mashi adi afua mu minite mikese anyi mêba makese.

Miaba mifumina¶

• Tshilongelu tshia bena Amerika tshia malu a muoyo (ACC) ne tshisumbu tshia bena Amerika tshia malu a muoyo (AHA, États-Unis): 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease (Circulation / Journal of the American College of Cardiology).
• Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE, Royaume-Uni): Disama dia mu tshifu: Dimanya ne dilama (NICE Guideline NG156, kusangisha ne difila dia lukasa ne mikenji ya dipuekesha dia mashi).
• Society for Vascular Surgery (SVS, United States) and European Society for Vascular Surgery (ESVS): Clinical Practice Guidelines on the Care of Patients with an Abdominal Aortic Aneurysm (Chaikof et al., Journal of Vascular Surgery; Wanhainenen et al., Endopeacular Journals and Endovascular Journals Dipanda, 2024).
• European Society of Cardiology (ESC): ESC Guidelines for the Management of Peripheral Arterial Arterial and Aortic Diseases (2024 update on acute thoracic aortic syndromes, Stanford Type A and Type B triage, and blood pressure targets).
• International Registry of Acute Aortic Dissection (IRAD) & Marfan Foundation / John Ritter Foundation for Aortic Health (United States): Ritter Rules for Triage and Emergency Recognition of Thoracic Aortic Dissection.

Malu adi apetangana¶

• Dimanya dia disama dia mutshima ne diambuluisha dia lukasa
• Dijingulula dia tshipupu ne dilombola dia diambuluisha dia kumpala
• Dijingulula dia tshipupu (FAST) ne diandamuna dia tshimpitshimpi
• Dikolesha dia mutshima ne mikolo (CPR) ne bulombodi bua AED
• Disama dia Cauda equina ne dikuma dia muonji wa mukolo bidi bimueneka