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Ubukonje butunguranye butagira umutima n'ububabare bukomeye bw'imitsi

Igitigiri c'ivyihutirwa gitandukanye hakurikijwe igihugu. Iyi paji ikoresha 911, inomero ya Leta Zunze Ubumwe za Amerika na Canada. Ibindi bihugu vyinshi bikoresha 112, 999 canke uwundi mubare. Rondera umubare w'igihugu cawe.

Acute limb ischemia (ALI) ni ikibazo c’ugubagwa kw’imitsi aho amaraso atera (embolus canke thrombus), umutsi w’amaraso utaburutse (dissection), canke ugukomeretswa bica bihagarika bukwi na bukwi amaraso y’umutsi nyamukuru aja mu kuguru canke mu kuboko. Nk'uko umutsi w'umutima uzibiye utuma umuntu agira indwara y'umutima, umutsi w'ubwonko uzibiye ugatuma umuntu agira indwara y'umutima, umutsi w'igitsina gore, w'ibirenge, w'ibirenge canke w'amaboko uzibiye utuma umuntu agira "igitero c'amaguru" aho imitsi y'inyuma n'imitsi y'amagufa itangura gupfa ursibly tours4.

Inshingano zawe zica zishika iyo umuntu agira ububabare butunguranye, buzimvye, bukonje, canke buzimye ukuguru canke ukuboko ni ukumenya "6 Ps" y'ugufunga kw'imitsi, guhamagara abaganga b'ivyihutirwa ubwo nyene kugira ngo umurwayi agende agororotse mu bitaro afise ubushobozi bwo kubaga imitsi, lightly sffeke munsi y’urugero rw’umutima) canke igororotse rero uburemere bw’isi burafasha amaraso gutemba mu kirenge canke mu kiganza, ntiwigere ushira hejuru igihimba c’umubiri, kandi ntiwigere ushirako amabarafu canke amapaki y’ugushusha ataco uhinduye ku ruhu rufise ububabare bw’amaraso.

Ivyo ubikore ubu

  1. Hamagara abaganga b’ivyihutirwa ubwo nyene: Hamagara inomero y’ivyihutirwa yo mu karere kawe (911 muri Leta Zunze Ubumwe za Amerika na Canada, 112 mu bihugu vyose vy’Ubumwe bw’Uburaya, 999 mu Bwongereza, 000 muri Australiya) canke urabe ububiko bwacu bwa inomero z'ivyihutirwa. Vuga neza: "Ivyiyumviro vy'uko umutsi ushobora guhagarara: umurwayi afise ubukonje butunguranye, ububabare, ububabare, ukuguru (canke ukuboko) kutagira umutima kandi akeneye ibitaro bibagwa imitsi."
  2. Shira igihimba c’umubiri munsi gatoyi y’urugero rw’umutima (Ntukigere uruduza): Umuntu yicare canke aryamye ukuguru canke ukuboko kwafashwe kuruhutse gupfutse canke gupfutse gatoyi munsi y’umutima wiwe (nk’akarorero, guca hasi ikirenge c’igitanda ku rugero rwa degre 10 gushika kuri 15). Mu buryo butandukanye n’ugutera amaraso mu mutsi canke gukomeretsa urutugu aho gushirwa hejuru bigabanya ukuvyimba, gushirwa hejuru kw’igihimba c’umubiri gifise umutsi uzibiye birarwanya uburemere bw’isi kandi bikafunga umuvuduko wa nyuma usigaye w’amaraso y’inyuma, bikaba vyihuta urupfu rw’imitsi.
  3. Kuraho inkweto zose, amasoseti, amasogisi yose, amasaha, n’impuzu zifatanye ubwo nyene: Kuraho ikintu cose gifatanya igihimba c’umubiri gifise ubumuga n’igihimba c’umubiri gihuye kugira ngo ushobore kugereranya ibara ry’urukoba n’ubushuhe iruhande n’uruhande maze ukureho umukazo wo hanze ku mitsi y’urukoba ishobora gusenyuka.
  4. Ntukigere ushirako ibikoresho vyo gushushanya, amacupa y’amazi ashushe, canke ibikoresho vyo gushushanya ku gice c’umubiri: Kubera ko igihimba c’umubiri gishonje amaraso y’imitsi gifise imitsi idakora neza kandi amaraso atagenda neza kugira ngo akureho ubushuhe, ibikoresho vyo gushushanya bisanzwe canke amazi asusurutse bizotuma umuntu agira **ububabare bw’ubushuhe bwimbitse, mu gihe immedice thermal burns, ugucika intege kw’imitsi n’ugukonja. Ahubwo, ushire igice gisigaye c’umubiri w’umuntu (umubiri n’amaguru bitagira ico bikoze) bishushe mu cumba ciza maze ushireko uburengeti busanzwe, bwumye, bupfutse canke igitambaro c’ipampa coroshe ku gice c’umubiri gifise iyo ndwara utakoze canke ngo ukande hasi ku mano.
  5. Suzuma nimba uwo muntu ashobora Gufata 160 gushika kuri 325 mg ya aspirine isanzwe (Igihe gusa atari umubabaro canke umutsi w’amaraso): Nimba umuntu ari maso neza, ata nkuru afise yo gufatwa n’indwara ya aspirine canke kuva amaraso, kandi igihimba c’umubiri gikanye gitunguranye cari not catewe n’ugukomeretswa ku mubiri canke gukomeretswa n’umugongo), umumenyeshamakuru w’ivyihutirwa nimba umurwayi akwiye guta miligarama 160 gushika kuri 325 z’imiti y’ibitera indwara y’ibicurane, idapfutse mu gihe arindiriye abaganga.
  6. Gushitsa NPO ikomeye (nta kindi kintu ukoresheje akanwa) kandi wandike ibimenyetso vy’umunota nyavyo vyatanguye: Ntuhe ivyo kurya canke amazi, kuko umurwayi ashobora kuja mu cumba co kubagiramwo canke mu cumba co gutereramwo amaraso kugira ngo bamubaze mu masaha makeyi ashitse.
flowchart TD
    Start["Ububabare bukomeye butunguranye, ubukonje, ububabare, canke ububabare mu kuguru kumwe, amaguru yose, canke ukuboko kumwe"] --> SixPs["1. Gereranya Amaguru Yompi Iruhande n’Iruhande ku 6 Ps: Ububabare, Uguhinduka kw’amaso, Poikilothermie (Imbeho), Ukubura umutima, Ugutahura, Ugusenyuka"]
    SixPs --> Call["2. Hamagara abajejwe ivy’ubutabazi (911 / 112 / 999) Ubwo nyene: Vuga ‘Ukekwa ko hariho ububabare bukomeye bw’imitsi, idirisha ryo gukiza amaguru n’amaboko ry’amasaha 6’."]
    Call --> CheckBothLegs{"3. Mbega Amaguru YOSE Arakonja Bukwi na bukwi, Arazimangana, Kandi Aracitse intege Kubera Ububabare bwo Mu Mugongo/Igikiriza?"}
    CheckBothLegs -->|Yes: Saddle Embolus or Aortic Dissection| Aorta["Hyperacute Aortic Crisis: Uryama Hasi, Ntuhe Aspirine Gushika Ugucagura Bivuyeho, Witegure Kwimurirwa Ubwo nyene"]
    CheckBothLegs -->|No: Single Leg or Arm Affected| Position["4. Gushiramwo Igihimba Gifashwe Munsi Gato y’Urugero rw’Umutima (Bivanye n’Umutima) canke Gisanzwe: NTUZIGEZE UDUZUZA Igihimba"]
    Position --> Thermal["5. Kuraho amasoseti/inkweto/impeta, ntukigere ushirako ibikoresho vyo gushusha canke ibikoresho vy’urubura, ushireko igitambaro c’umubiri c’umubiri"]
    Aorta --> Thermal
    Thermal --> NPO["6. Iyumvire Igihe nyaco Ibimenyetso Vyatanguriyeko, Gumana Umurwayi NPO (Ntaco Avuga) kugira ngo Abagwe Imitsi Vyihutirwa"]

"6 Ps" za kera z'ubumuga bwo mu mutwe (ibimenyetso vya Pratt)

Abaganga babaga imitsi n’abaganga bavura indwara zihutirwa kw’isi yose bizigira Pratt’s 6 Ps kugira ngo bamenye ko umutsi uhagaze cane ku ruhande rw’igitanda. Imisi yose amaguru yompi (canke amaboko yompi) ushireko ubusa maze ugereranye igihimba gifashwe n’igihimba gifise amagara meza ukoresheje inyuma y’ukuboko kwawe:

Ikimenyetso ca "6 Ps" Insobanuro y'ubuvuzi Ivyo ubona n’ivyo wumva ku gice c’umubiri gifashwe Igihe n'insobanuro y'ubuhanuzi
1. Ububabare Igitera ubukene bw’umwuka mu mitsi no mu mitsi iri kure y’aho amaraso atera. Ububabare butunguranye, bukomeye, butagira aho bugarukira, ububabare butera ubwoba, canke ububabare bushasha mu kirenge, mu nyana canke mu kiganza butagenda iyo umuntu aruhutse kandi bukaja hejuru cane mu gice c’umubiri mu minota mikeyi. Ikimenyetso ca mbere: Mu embolus y’umutsi, ububabare buratera nk’umuravyo mu masegonda make, ku buryo umurwayi ashobora kukubwira umunota nyawo vyabayeko.
2. Ugutukura Gutakaza burundu amaraso y’imitsi y’amaraso yuzuye urukoba. Ikirenge, amano canke ukuboko bihinduka vyera nk’ivy’umukara, nk’umukara, canke nk’umukara w’umukara mu ntango; mu masaha 1 canke 3, amaraso ahagaze atagira umwuka w’ikirere mu mitsi y’urukoba, agahindura urukoba ubururu-butukura (mottled / cyanotic). Iyo ukanda urutoke ku gipande c’ibara ry’umuyugubwe gifise amabara y’umuyugubwe kigaca kiguma ari ibara ry’umuyugubwe ryirabura ritagira ibara ryera (fixed staining), tissue necrosis iratanguye.
3. Poikilothermie (Imbeho Ipfuye) Gutakaza amaraso asusurutse mu mitsi y’umubiri bituma igihimba c’umubiri gikonja gushika ku bushuhe bwo mu cumba. Ukoresheje umugongo (dorsum) w'ukuboko kwawe ataco ufise, ushire hasi kuva ku itako ry'ubushuhe gushika ku kirenge: uzokwiyumva "umurongo w'ubushuhe" (kenshi munsi y'ivi canke hagati y'inyana) aho urukoba ruhinduka bukwi na bukwi rukonje nk'urubura ugereranyije n'ukuguru ku rundi. Igipfukisho nyaco c’umutsi gikunda kuba urugingo rumwe ruri hejuru y’umurongo aho urukoba ruhinduka rukakonja (nk’akarorero, ikirenge gikanye n’inyana yo hasi bisigura ko hariho igihimba c’umubiri gipfutse ku ivi / umutsi w’ibirenge).
4. Ubutagira umutima Kubura imipfunda y’umuvuduko w’amaraso y’amaraso irenga aho umutsi w’amaraso uhagaze. Ntushobora kwumva imitsi isanzwe mu kirenge (dorsalis pedis hejuru y’ikirenge canke posterior tibial inyuma y’igufa ry’imbere ry’ikirenge) canke mu kiganza (radial artery), naho imitsi ikomeye mu gice c’umubiri gifise amagara meza gihushanye. Critical caveat: Abantu benshi bakuze bafise indwara y’imitsi idakira baragira ibirenge bigoye kwumva mu gihe c’intango; abaforomo bo mu bitaro bakoresha igikoresho co mu minwe citwa Doppler ultrasound kugira ngo bumvirize ibimenyetso vy’ugutemba kw’amaraso.
5. Paresthesi (Ugucika intege) Ischemic dysfunction y’imitsi mitoyi y’imitsi y’umubiri (ari yo mitsi ishobora gufata umwuka mwinshi cane mu gice c’umubiri). Uwo muntu yumva "ibipimo n'inshinge" bimutera ububabare, bimusha, canke bimutera ububabare mu mano canke mu ntoke kandi ntashobora kwumva igipfukisho c'ipampa gitoyi canke gukorako buhoro buhoro hejuru y'ikirenge canke ikiganza. Ibendera ry’umutuku ry’igihimba c’umubiri giteye ubwoba: Igihe ububabare bubonetse, isaha y’amasaha 4 gushika ku 6 yo gukiza igihimba c’umubiri gukomeretswa n’imitsi canke gucirwako igihimba c’umubiri ubudasiba irakora cane.
6. Ubumuga (Intege nke z'umubiri) Guhagarika kw’imitsi minini y’umubiri n’imitsi y’amagufa. Uwo muntu ntashobora gukwega amano canke ikirenge ciwe hejuru yerekeza ku rubavu rwiwe (loss of dorsiflexion / "foot drop") canke ntashobora gutera amano canke intoke ziwe iyo bamubajije, maze umutsi w'inyana ugatangura kwumva ukomeye canke ugira ifu. Ikimenyetso c’Ivyihutirwa Bikomeye / Ivyihutirwa: Iyo ubumuga bw’umubiri bubonetse, igihimba c’umubiri caca gitera ubwoba (Rutherford Class IIb) kandi bisaba ko amaraso asubirwamwo mu gihe c’amasaha atari munsi ya 2 canke 4 kugira ngo umuntu ntacike.

Gutandukanya ugufunga kw'imitsi y'amaraso n'ugufunga kw'imitsi y'amaraso (DVT) n'ugufunga kw'imitsi y'amaraso

Kuko umutsi w’amaraso (ALI) n’umutsi w’amaraso (Indwara y'umutsi wimbitse / DVT)** bitera ububabare bukomeye mu kuguru kandi mu rurimi rw’ikirundi vyitwa "ugutera amaraso mu kuguru," abarwayi n’ababibona kenshi baravyivangamwo, bagakoresha ubufasha bwa mbere butari bwo nyabwo (gushira hejuru igihimba c’umubiri gifise umutsi canke gukoresha ubushuhe). Koresha iki kigereranyo c’uruhande ku rundi kugira ngo ubitandukanye ubwo nyene:

Ikiranga ubuvuzi Ugufunga kw'umutsi (umutsi wazibiye uzana amaraso) Thrombose y'umutsi wimbitse / DVT (Umutsi Uzitiye Usohora Amaraso HANZE) Sciatica / Umutsi w'umugongo Gufatanya imizi
Ubushuhe bw'urukoba Imbeho y’urubura (Poikilothermia): Ikirenge n’ukuguru kwo hasi bimeze nk’ibikonje cane kuruta ukuguru guhuye. Ishushe canke ishushe: Kubera ko imitsi iguma ipompa amaraso asusurutse mu kuguru mu gihe umutsi usohora amaraso uzibiye, ukuguru kurarumva gushushe. Ubushuhe busanzwe: Ibirenge vyose bifise ubushuhe bungana.
Ibara ry'urukoba Imweru y’agahama kare, igahinduka ubururu-bw’umutuku (bufise amabara) mu nyuma. Umutuku, utukura, canke utukura-umutuku w’agahama mu nyana yose canke mu itako ryavyimvye. Ibara ry'urukoba risanzwe.
Ukuvyimba kw'amaguru (Edema) Zero kuvyimba mu ntango (igihimba c’umubiri kimeze nk’igisanzwe canke gicitse gatoyi kandi gifise umwobo): Imitsi iri hejuru y’ikirenge isa n’iyisenyutse kandi ipfutse nk’imigende y’ubusa. Ikivyimba gigaragara: Inyana canke ukuguru kwose kurahinduka uburebure bwa santimetero 2 gushika ku 5 mu nzira y’uruzitiro kurusha ukuguru ku rundi, gufise imitsi y’imbere ipfutse kandi ipfutse. Nta kuvyimba.
Imitsi yo kure (Ikirenge/Ikiganza) Ntahari. Iriho kandi isanzwe (kiretse mu ndwara y’imitsi idasanzwe, myinshi cane yitwa phlegmasia cerulea dolens). Ibiriho n'ibisanzwe.
Ingaruka zo Gushira hejuru Ukuguru Guduza ukuguru bituma ububabare BUBA BUBI CANE kandi ikirenge kigahinduka cera nk’icapfuye; kumanika ukuguru hejuru y’uruhande rw’igitanda biragabanya gatoyi ububabare. Guduza ukuguru bigabanya ububabare buremereye, butera mu gufasha amaraso yo mu mitsi gusohoka aja mu mutima. Ububabare burahinduka iyo umuntu apfukamye mu mugongo, yicara canke aduza ukuguru kugororotse, atari iyo umuntu aduza ikirenge gusa.
Gushiramwo neza ubutabazi bwa mbere Guma wisunga gatoyi (munsi y’urugero rw’umutima) canke uhagaze; NTUZOKWIGEZE ushira hejuru. Duza gatoyi ku musego, uruhuke, kandi ntukore masaje. Uguhagarara neza mu kuruhuka (kenshi kuryama amavi apfutse).

Kubera iki imitsi ifunga bukwi na bukwi: embolisme n’thrombose n’ugucagura aorte

Gutahura ingene uwo mutsi wazibiye birafasha abaganga bafasha mu bihe vy’ibihe vyihutirwa guhitamwo uburyo bwo gukiza amaguru n’amaboko bwihuta kuruta ubundi bwose (gukuraho umutsi w’amaraso, kubaga umutsi w’amaraso canke gusanura umutsi w’amaraso):

1. Arterial Embolism (Igitera giturumbuka kiva mu mutima canke mu mutsi w’amaraso)

Mu embolic occlusion, imitsi y’ukuguru canke y’ukuboko kw’umurwayi ishobora kuba isukuye neza kandi ifise amagara meza, ata nkuru y’imbere y’aho y’ugutembera nabi kw’amaraso. Igikoko c’amaraso kiratera hejuru, akenshi kikaba kiri imbere mu gice c’umutima c’ibubamfu kubera ugutera kw’umutima (AFib) (na cane cane iyo umurwayi abuze imiti y’imiti igabanya amaraso yiwe nka apixaban, rivaroxaban, dabigatran, canke warfarin), ku nzira y’umutima yononekaye inyuma y’ugutera umutima aneurysm**, iramenagurika, ikamanuka ku giti c’imitsi, igaca iguma aho umutsi munini uca mu mitsi ibiri mitoyi (a bifurcation, kenshi na kenshi umutsi w’igitsina gore uri mu rubavu canke umutsi w’ibirenge inyuma y’ivi).

  • Ikimenyetso c’ubuvuzi: Kubera ko umurwayi atigeze agira imitsi y’amaraso (collateral bypass vessels) ikikuje aho hantu, amaraso aragabanuka kuva ku 100 kw’ijana gushika ku 0 kw’ijana mu gutera rimwe gusa. Ububabare ni ubwo nyene, buratera akaga, kandi buratera nk’ibishashara.

2. Thrombose artérielle acute-in-situ (Uguca ibice imbere mu mutsi wacitse)

Mu thrombotic occlusion, umurwayi asanzwe afise indwara y’imitsi y’inyuma (PAD) idakira, imitsi y’amaguru ikomeye, ipfutse n’amaraso bitewe n’imyaka myinshi anywa itabi, indwara y’igisukari, umuvuduko munini w’amaraso, canke cholestérol nyinshi, kenshi afise amateka y’ugufunga kw’inyana iyo agenda a stent/ivyuma bifatanya n’ibindi. Iyo umutsi w’amaraso uri mu mutsi w’igitsina gore ucitse canke umurwayi akabura amazi cane, amaraso mashasha araza aho hantu maze agafunga ico kinogo c’ibara ry’agahama gisigaye.

  • Ikimenyetso c’ubuvuzi: Kubera ko ugucika intege guhoraho kwatuma umubiri ukura utugingo ngengabuzima dutoduto (collateral circulation) mu myaka imbere y’aho, intango y’ububabare n’ubukonje bishobora gutera mu amasaha menshi gushika ku musi aho gusa n’isegonda imwe, kandi ikirenge gishobora gusa n’ikidafise amabara menshi aho gusa nk’aho gifise amabara make indwara y’ibisebe.

3. Embolus y’umutsi w’amaraso n’ugucagura umutsi w’amaraso (Igihe amaguru YOSE akonje kandi akagira ububabare)

Iyo amaguru yompi icarimwe ababaye bukwi na bukwi, akakonja nk’urubura, akagira ibara ry’agahama, akagira amabara kuva mu bibero canke mu mafyinga gushika hasi, kandi akagoyagoya canke akarema:

  • Aortic Saddle Embolus: Amaraso menshi cane ava mu mutima yarashitse ahantu heza cane aortic bifurcation mu nda yo hasi aho aorta nyamukuru igabanywamwo imitsi y’ibubamfu n’iy’iburyo, igaca amaraso aja mu gice cose co hasi c’umubiri icarimwe.
  • Acute Aortic Dissection (Stanford Type A or Type B): Gutabuka mu gipfukisho c’imbere c’igikiriza canke c’inda bituma amaraso afise umuvuduko munini ashobora gucapura uruhome rw’umutsi w’amaraso, agaca imitsi y’imbere (canke umutsi wo munsi y’igihimba c’umubiri (canke umutsi wo munsi y’igihimba c’umubiri nk’umugozi w’inyuma**) n’umutsi w’inyuma w’umubiri. Iyo ubukonje butunguranye canke ukubura umuvuduko w’amaraso mu kuboko kumwe canke mu kuguru kumwe/kwompi biherekejwe n’ugutabura canke gutabura igifu, umugongo wo hejuru (hagati y’ibitugu), canke ububabare bwo mu nda, uce wikeka acute aortic dissection ubwo nyene. NTUHE aspirine iyo gucagura aorte bishoboka, kandi uce umenyesha abaganga ubwo nyene.

4. Indwara y'amano y'ubururu (Cholestérol microemboli)

Rimwe na rimwe, umurwayi aragaragaza urutoke rumwe canke zibiri rubabaza cane, rw'ubururu bwijimye canke rwirabura ("blue toe syndrome" canke "trash foot") mu gihe ikirenge gisigaye kiguma gishushe kandi gifise umuvuduko ukomeye ku ntugu. Ivyo bishika iyo utugingo ngengabuzima dutoduto tw’amaraso canke utugingo ngengabuzima tw’amaraso dusohotse ku gisebe canke ku mutsi w’amaraso (kenshi amasaha canke imisi inyuma y’aho umutima uterewe umuti canke utanguriye gufata imiti igabanya amaraso) maze ugafunga iyo mitsi y’amaraso y’agaciro gatoyi cane imbere mu mano. Naho umutsi w’amaguru ukomeye, indwara y’amano y’ubururu isaba ko umuntu asuzumwa vyihuse mu bitaro kugira ngo aronke aho akomoka no gukingira imbere y’uko hakurikiraho igihimba kinini c’amaraso.

Ivyiyumviro vya Rutherford: ingene ibitaro bitanga urugero rw’idirisha ry’amasaha 6 ryo gukiza amaguru n’amaboko

Iyo abaganga bazanye umurwayi afise igihimba c’umubiri gikonje cane mu kigo c’ubuvuzi bw’ibihe vyihutirwa, umuganga w’imitsi aca ahita ashira igihimba c’umubiri muri kimwe mu bice bine Rutherford Acute Limb Ischemia Categories kugira ngo amenye nimba hari umwanya wo gupima amashusho (CT angiogram) canke nimba umurwayi ategerezwa kuja ku meza:

Ishure rya Rutherford Izina ry'Iciciro Gutakaza imitsi y'ibimenyetso (Ugucika intege) Intege nke z'imitsi y'umubiri (Ubumuga) Ibimenyetso vy'amajwi y'umubiri bifatwa mu minwe Ivyihutirwa n'Ibikorwa vy'Ibitaro
Ishure rya I Birashoboka (Ntibica bitera ubwoba) Nta: Inyiyumvo isanzwe yuzuye mu mano/intoke zose. Nta n’imwe: Inkomezi zisanzwe iyo upfutse ikirenge n’amano. Doppler y’imitsi yumvikana; Doppler y’imitsi yumvikana. Gutonyanga heparine unfractionné mu mutsi vyihutirwa vyatanguye ubwo nyene kugira ngo bihagarike gukwiragira kw’amaraso, hanyuma hakurikirwa CT angiography n’ugupima amaraso bikoresheje catheter canke gusubiramwo amaraso mu masaha 6 gushika kuri 24.
Ishure IIa Itera ubwoba rito (Ishobora gukizwa iyo ivuwe vuba) Minimal: Gucika intege canke gucika intege bigarukira cane ku songa ry’amano (canke intoke), n’ububabare buke canke nta bubabare bwo kuruhuka. Nta n'imwe: Umurwayi arashobora guca agendagenda mu rubavu n'amano n'inkomezi zose. Doppler y’imitsi kenshi ntiyumvikana; Doppler y’imitsi yumvikana. Ubwo nyene ugatera heparine IV n’ugusubira gutera imitsi mu mubiri canke mu kubagwa mu masaha atari munsi ya 6.
Ishure IIb Ubwo nyene batera ubwoba (Ivyihutirwa vy'amaguru n'amaboko) Ibirenze amano gusa: Ugucika intege gushika hejuru canke hasi y’ikirenge (canke ikiganza) biherekejwe n’ububabare bukomeye bwo kuruhuka. Intege nke zidakomeye canke ziringaniye: Gutera buhoro, gutera imbere kw'ibirenge ("foot drop") canke gutera imbere kw'amano bigoyagoya. Doppler y’imitsi ntiyumvikana; Doppler y’imitsi irumvikana. Ivyihutirwa vy’ukuri vyo kubaga: Umurwayi aja ubwo nyene mu cumba co kubagiramwo c’imiti itandukanye (kenshi akaja guca mu bipimo birebire) kugira ngo akore ivyihutirwa Embolectomy y’umupira w’amaguru wa Fogarty, guca mu nzira y’ugubaga, canke guca mu maraso y’umubiri mu masaha **atarenga 2 gushika kuri cumi n’amasaha la-four, gukuraho amagufa.
Ishure rya III Ntibisubira inyuma (Ischemie ikomeye / Urupfu rw'imitsi) Ugutera ububabare bukomeye, bushitse: Gutera ububabare bwose bw’ikirenge n’ukuguru kwo hasi. Ugusenyuka kw’ibirenge n’ugukomera: Ikirenge n’uburenge biraremvye vyose, kandi umutsi w’inyana wumva ukomeye nk’urutare kandi ukomeye (rigor mortis of the limb) ufise urukoba rw’ibara ry’umuyugubwe rudahinduka. Doppler y’imitsi ntiyumvikana; KANDI Doppler y’imitsi ntiyumvikana. Kugerageza gusubiza amaraso mu gice c’umubiri gipfuye kandi gikomeye co mu rwego rwa III, bisukura potassium, myoglobine n’aside lactique bishobora kwica biva mu misifa yapfuye bikaja mu mutima (reperfusion syndrome), bikaba bituma umutima uhagarara ubwo nyene, bigatuma umuntu apfa. Bisaba guca igihimba c’umubiri ca mbere kirokora ubuzima inyuma yo guhagarara neza.

Intambwe ku yindi amategeko agenga ubutabazi bwa mbere n'uburinzi bw'amaguru n'amaboko

Igihe urindiriye imodoka itwara abarwayi, igikorwa cose ukora kigamije kuzigama urukoba rudakomeye rw’igihimba c’umubiri gifise ubumuga bwo mu mutwe, gutuma amaraso agenda neza cane afashijwe n’uburemere bw’isi, no kwirinda gukomeretswa n’ubushuhe canke ubuhinga:

1. Uko wosuzuma neza ivyuma vy’ibirenge n’ivy’amaboko (utacereje guhamagara 911)

Ntukigere umara amasegonda arenga 30 urondera umuvuduko w’umutima imbere yo guhamagara abajejwe ivy’ubutabazi, kandi ntiwigere ukoresha urukumu rwawe kugira ngo usuzume umuvuduko w’umutima (urukumu rwawe rufise umutsi warwo ukomeye, rero uzokwiyumva umutima wawe ubwawe utera). Koresha ibipande vy'intoke zawe intoke zo hagati n'izo hagati ukanda buhoro buhoro:

  • Dorsalis Pedis (DP) Pulse (Hejuru y’ikirenge): Shira intoke zibiri mu bugwaneza ku ruhande rwo hejuru rwo hagati rw’ikirenge, gushika hanze gusa (uruhande rw’inyuma) rw’umutsi ugaragara cane uduza urutoke runini (extensor hallucis longus). Gereranya ibirenge vyose bibiri icarimwe.
  • Igitero c’inyuma c’ikirenge (PT) (Ikirenge c’imbere): Shira intoke zibiri mu mwobo woroshe utaziguye inyuma y’igufa ry’imbere ry’ikirenge (medial malleolus).
  • Radial Pulse (Ikiganza, ku bijanye n’ivyihutirwa vy’ukuboko): Shira intoke zibiri mu mfuruka iri ku ruhande rw’igikumwe c’ikiganza c’imbere, munsi gato y’ishingiro ry’ikiganza.

2. Kubera iki utegerezwa kurinda igitsintsiri n’amano ku ngorane z’amaterasi .

Urukoba rufise amagara meza rurashobora kwihanganira kuruhuka ku matela kubera ko umuvuduko w’amaraso usanzwe (30 gushika kuri 35 mmHg) urenga uburemere bw’ikirenge. Mu igihimba c’umubiri gifise ubumuga bwo mu mutwe, umuvuduko w’amaraso mu mitsi y’amaraso ugabanuka hafi y’i zero. Iyo igitsintsiri c’umurwayi kidafise ikintu kiruhukiye ku gitanda gikomeye canke ku gitanda gikomeye mu minota 60 gushika ku 90 gusa, uburemere bw’ikirenge buramenagura urukoba ruri inyuma y’igitsintsiri, bigatuma ubwo nyene ischemic pressure necrosis (igisebe c’igitsintsiri c’umwirabura).

  • Itegeko ry'"Igitsintsiri Gireremba": Shira umusego woroshe mu burebure munsi y'ukuguru kwo hasi n'inyana kugira ngo igitsintsiri kimanike mu kirere kidafise uburenganzira bwose ku ruhande rw'igitsintsiri ("uguterera igitsintsiri"), ata gupfuka ivi canke gukanda ku mutsi wa Achille.
  • Guma amashuka yo mu gitanda kure y’amano: Mbere n’uburemere bw’igitambaro kiremereye gikanda hasi ku mano yera nk’ibara ry’agahama burashobora kwonona urukoba rufise ubumuga bwo mu mutwe. Ushireko igitambaro c’ipampa canke igitambaro c’impuzu yoroshe cane ku kuguru.

3. Kubera iki ibikoresho vy’ubushuhe (ibikoresho vyo gushushanya n’urubura) bibujijwe cane

Iyo umurwayi yidoga "Ikirenge canje kimeze nk'igipande c'urubura, ndagusavye ugishireko igikoresho co gushusha canke icupa ry'amazi ashushe," abagize umuryango bafise intumbero nziza barakunda kuzingira ikirenge mu gikoresho co gushusha c'umuyagankuba canke bakagishira mu mazi yo kwoga ashushe.

Ntukigere ususurutsa igihimba c'umubiri gifise ubumuga bwo mu mutwe ukoresheje igikoresho co gushusha canke amazi ashushe

Gushushanya utugingo ngengabuzima hanze bituma urukoba n’imitsi bihindura ibiribwa, bikaba bituma bisaba umwuka mwinshi mu gihe nyaco umwuka wavyo uhagarara, ivyo bikaba bituma utugingo ngengabuzima twihuta gupfa n’ugufatwa n’indwara y’ibisebe. Ikibi kuruta, kubera ko amaraso atemba ari yo asanzwe atwara ubushuhe kure y’urukoba (nk’amazi yo mu radiator y’imodoka), igihimba c’umubiri kitagira umutima gifise ubushobozi bwo kwikonjesha kandi kigatuma imitsi idashobora kwumva ububabare busha. Igikoresho co gushushanya canke icapa c’amazi asusurutse gisanzwe gifise ubushobozi buke, kizoteka ikirenge gifise ubumuga bwo mu mutwe kibe igikomere giteye akaga, kitakira mu minota mikeyi, kenshi kigatuma umuntu ashobora guca igihimba c’umubiri abaganga babaga imitsi bari gushobora gukiza. Susurutsa icumba n’umubiri w’umurwayi, ntuzokwigere ususurutsa igihimba c’umubiri gikanye ubwaco.

4. Gukomeretswa no gusubira guterwa amaraso n'ukumenya indwara y'igice c'umubiri inyuma yo kubagwa

Abaganga babaga imitsi bamaze gukura neza iyo nkoko mu mutsi, amaraso asusurutse kandi afise umwuka w’ikirere agasubira mu kuguru kwari kwashonje amaraso amasaha 3 gushika ku 6, kenshi mu bitaro haca haba ikibazo ca kabiri c’ivyihutirwa: ischemie-reperfusion injury. Utugingo ngengabuzima twononekaye turasohoka amazi ningoga mu mitsi y’inyana, ivyo bikaba bituma ukuguru kwo hasi kuvyimba cane imbere mu gipfukisho caco c’imitsi y’inyana (indwara y'ibice bikomeye) no kwoza potasiyumu na myoglobine mu maraso (rabdomyolise). Kubera iyo mpamvu, abaganga babaga imitsi kenshi bakora igikorwa co kwirinda fasciotomy (gukora ibice birebire vy’ugubaga bimanuka ku mpande z’inyana kugira ngo barekure umutsi w’inyana ushikamye) mu gihe nyene bagasubizaho uruja n’uruza rw’amaraso, bagatera amazi mu mitsi n’imiti yitwa bicarbonate kugira ngo bakingire amafyigo.

Urutonde rw'ivyo kwirinda abarwayi bafise indwara y'umutima canke indwara y'imitsi y'inyuma

  • Ntukigere urenga urugero rumwe rw’imiti igabanya amaraso (anticoagulants): Niba ufise ububabare bwo mu mutima, ububabare bw’umutima bukora, amateka y’ugutera amaraso, canke imiti igabanya amaraso, ubuze mbere n’amasaha 24 gushika kuri 48 y’imiti yitwa apixafarin, warbixadoga, canke amasaha 24, n’amaraso kugira ngo akore mu mutima maze atere mu bwonko (stroke) canke mu maguru (ischemie aiguë des limbs).
  • Hagarika nikotine yose n’ibiva ku itabi burundu: Nikotine itera umutsi w’amaraso ubwo nyene kandi igatuma utugingo ngengabuzima twihuta gutera imbere mu mitsi y’amaguru yacitse intege no guca mu mitsi y’amaguru.
  • Fata "Intermittent Claudication" nk'ikimenyetso co kugabisha hakiri kare: Niwaba ufise ububabare bushobora gusubirwamwo, ububabare, canke urushe mu nyana yawe, mu itako, canke mu matako igihe cose ugenda urugendo runaka rugenda mu minota 5 gushika kuri 10 uhagaze, ushireho urutonde rw'ibikomere bitari ivyihutirwa A**an your va- umuganga imbere y’uko habaho ubuzibuzi bushitse.

Ibintu bidasanzwe: Ikibazo ca Raynaud, indwara y’ugusohoka mu gikiriza, n’ugukomeretswa kw’imitsi y’amaraso

Igihe umuntu asuzuma ikiganza canke ikirenge gikonje canke gihinduye ibara, indwara zitari nke zidasanzwe zijanye n’imitsi zirashobora kwigana canke zigatuma umuntu agira ischemie y’amaguru n’amaboko. Kumenya gutandukanya indwara y’imitsi y’amaraso iterwa n’ubukonje n’indwara y’imitsi y’amaraso y’ukuri, bituma umurwayi aronka ubuvuzi bwihuse mu bitaro iyo bikenewe:

Ivyariho Igitera n'ugushikiriza Ibintu nyamukuru bitandukanya Bisabwa gukorwa ubwo nyene
Ikintu ca mbere ca Raynaud (Ikibazo c'imitsi) Biterwa n’umuyaga ukonnye, gufata ikinyobwa gikonje, canke umubabaro wo mu mutima; igira ingaruka ku intoke nyinshi ku maboko yompi mu buryo buringaniye, ihinduka yera cane, hanyuma ihinduka ubururu, hanyuma ihinduka umutuku ukeye (ihinduka ry’ibara ry’ibice bitatu) mu minota 15 gushika kuri 30. Imitsi y’ibiganza y’imbere n’inyuma iguma ikomeye kandi isanzwe mu kiringo cose c’igitero, ububabare buratera ububabare bukeyi aho kuba ububabare bw’amaraso, kandi intoke zisubira gushuha burundu mu minota 20 mu cumba gishushe. Nimwinjire mu cumba gishushe, mushire ibiganza mu mazi asusurutse (atashushe) canke munsi y’ibibero, hanyuma muzunguze intoke mu bugwaneza. Rondera ubuvuzi bwihuse iyo gusa urutoke rugumye rwera/ubururu haciye iminota 60 canke rukagira igisebe.
Indwara y'umutsi w'igifu (aTOS) / Ukwiba kw'igifu Iboneka mu bakinyi bo hejuru (abatera umupira w’amaguru, abayoga, abaterura ibiremereye) canke abantu bafise urubavu rw’intanga rwongerekanye; gusubiramwo gufatanya umutsi wo munsi y’urutugu munsi y’igufa ry’urutugu bituma haba umutsi w’amaraso utera amaraso mu kiganza no mu kuboko kw’imbere. Igira ingaruka ku kuboko kumwe gusa n’ukuboko: Ukuboko kwumva gukanye, gutukura, kurushe, kandi kubabara iyo umuntu adugije ukuboko hejuru, umuvuduko w’amaraso ku kiganza urazimangana canke ugacika intege ugereranije n’ikindi kiganza, kandi ku mpera z’intoke zishobora gutera amabara y’ibice vyirabura. Fata nk’ischemie y’ukuri y’ibihimba vy’umubiri vyo hejuru: uruhutsa ukuboko munsi gatoyi y’urugero rw’umutima, ntuduze ukuboko hejuru, hanyuma utware mu kigo c’imitsi kugira ngo hakorwe CT angiography n’ugukuraho ububabare bw’imbavu za mbere.
Indwara y'umutsi w'ibirenge (PAES) mu bakinyi bakiri bato Itera abakiri bato, abarutsi bafise amagara meza, abakinyi b’umupira w’amaguru, abagendera ku makinga canke abasirikare (mu bisanzwe bafise imyaka 15 gushika kuri 35) ata cholestérol bafise; umutsi w’inyana udasanzwe urajanjagura umutsi w’inyuma w’ivi mu gihe umuntu ariko ariruka gushika uwo mutsi upfutse. Ububabare bw’inyana butunguranye, ikirenge gikanye, n’amano apfutse mu gihe c’ukwiruka canke inyuma y’ukwiruka mu mukinnyi akiri muto asa n’uwufise umubiri mwiza. Kenshi na kenshi bafatwa nabi nk'"umutsi w'inyana ukwezwe" gushika aho gangrene itera ubwoba ikirenge. Ntukigere uta ikirenge gikanye, gitukura, kidakora neza mu mwirutsi akiri muto nk'ugukomera kw'imitsi; reba umuvuduko w’ikirenge n’ikindi kirenge maze ugende ugororotse mu kigo c’abarwayi bihutirwa.
Inyuma y'ugutera umutsi / Thrombose y'umurongo w'amaraso Bishika amasaha canke imisi inyuma y’ugutera umutsi w’umutima, ugupima umutsi w’umutima, canke umurongo w’umuvuduko w’amaraso wo mu bitaro vya ICU ushizwe mu kuboko (umutsi w’imbere) canke mu rubavu (umutsi w’igitsina gore). Ikiganza canke ikirenge kiri munsi y’umugozi w’ivyuma bifata amaraso birahinduka bikaba ibitukura, bikakonja, birababaza canke bikagira amabara. Hamagara abajejwe ivy’ubutabazi canke usubire mu bitaro ubwo nyene; thrombectomy yo kubagwa canke yo gukoresha catheter irasubiza amaraso mu mubiri ningoga imbere y’uko umuntu atakaza ukuboko canke ikirenge ubudasiba.

Fata amashure yemewe y'ubutabazi bwa mbere

Kwiga ingene umuntu yosuzuma ingene amaraso agenda, kumenya ivyihutirwa vy’indwara y’umutima n’imitsi, no gucungera uguhungabana birashobora gukiza ubuzima canke igihimba c’umubiri. Niwiyumvire gufata inyigisho yemewe y’ubutabazi bwa mbere n’ubutabazi bwa CPR iva ku musaraba utukura, St John Ambulance, ishirahamwe ry’umutima ryo muri Amerika, canke umuganga wo mu karere kawe.

Ibibazo bikunda kubazwa

What are the "6 Ps" of a sudden blocked artery in the leg or arm?

The classic "6 Ps" of acute limb ischemia are Pain (sudden, severe resting pain), Pallor (chalky white or blotchy purple skin), Poikilothermia (the foot or hand feels ice-cold compared to the other side), Pulselessness (absent foot or wrist pulse), Paresthesia (pins-and-needles tingling or numbness), and Paralysis (inability to wiggle the toes or pull the foot upward). Once numbness or weakness appears, blood flow must be restored by a vascular surgeon within 4 to 6 hours to save the limb.

Should you elevate a leg that suddenly turns cold, pale, and painful?

No, never elevate a limb with a suspected arterial blockage. While elevating a leg helps drain fluid in a venous clot (DVT) or ankle sprain, elevating a leg with a blocked artery forces arterial blood to flow uphill against gravity, shutting down the last remaining trickle of collateral blood flow and accelerating tissue death. Keep the limb flat or slightly lower than the level of the heart.

Why must you never put a heating pad or warm water on a foot that feels freezing cold from poor circulation?

A limb with a blocked artery has no circulating blood to carry heat away and numb nerves that cannot feel burning pain, plus external heat increases the oxygen demand of cells that are already starving for oxygen. Placing a heating pad or hot water bottle on an ischemic foot causes deep, non-healing thermal burns and accelerates gangrene; instead, keep the person's torso warm and loosely drape a dry room-temperature towel over the leg.

How can you tell the difference between a deep vein thrombosis (DVT) and an acute arterial clot in the leg?

A deep vein thrombosis (DVT) blocks blood from draining out of the leg, making the calf swollen, warm to the touch, and reddish, with normal foot pulses and pain that feels better when elevated. An acute arterial occlusion blocks blood from entering the leg, making the foot ice-cold, chalky white or mottled purple, and NOT swollen, with absent pulses and pain that gets worse if you elevate the leg.

What does it mean if both legs suddenly go cold, pale, and numb at the same time?

Sudden pain, coldness, pallor, and numbness or paralysis in both legs simultaneously is a hyperacute life-threatening emergency caused either by a large "saddle embolus" (a blood clot straddling the bottom of the main abdominal aorta where it splits into both legs) or an acute aortic dissection (a tear in the wall of the aorta). Call your local emergency number immediately and keep the person lying flat.

Amasoko yasuzumwe

  • Ishirahamwe ry’Uburaya ryitaho abaganga b’imitsi (ESVS) n’ishirahamwe ry’abaganga babaga imitsi (SVS, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako z’ubuvuzi ku bijanye no kuvura indwara y’imitsi y’amaguru n’amaboko (Ivyigwa vya Rutherford n’ingingo ngenderwako zo gusubira gutera imitsi mu masaha 6).
  • Ishirahamwe ry’umutima ryo muri Amerika (AHA) n’ishure ryisumbuye ry’ubuvuzi bw’umutima ryo muri Amerika (ACC, Leta Zunze Ubumwe za Amerika): Ingingo ngenderwako za AHA/ACC ku bijanye no gufasha abarwayi bafise indwara y’imitsi y’amaguru yo hasi (PAD) n’indwara y’imitsi y’amaguru n’amaboko.
  • Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE, Ubwongereza): Indwara y'imitsi y'inyuma: Gupima no kuyivura (CG147) na Inzira zo gutoranya indwara y'imitsi y'amaguru n'amaboko.
  • Creager MA, Kaufman JA, Conte MS (Ikinyamakuru c’ubuvuzi c’Ubwongereza bushasha): Ischémie y’amaguru n’amaboko.
  • Ishirahamwe mpuzamakungu ry'imiryango y'umusaraba utukura n'ukwezi kw'ukwezi gutukura (IFRC, International): Ingingo ngenderwako z'ubutabazi bwa mbere ku bibazo vy'amaraso n'ibikomere vyo mu bihimba vy'umubiri.

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