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Fistule y'umutsi w'amaraso 'Herald Bleed' n'amaraso menshi yo hejuru y'amaraso inyuma yo kubagwa umutsi w'amaraso

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.

Aortoenteric fistule (AEF) ni ubucuti budasanzwe butera akaga, buca butera ubuzima ingorane hagati y’umutsi w’inda ufise umuvuduko munini n’umutsi w’insogi uri hafi, akenshi ni igice ca gatatu canke ica kane c’umutsi w’insogi aho ujabuka ataco uhinduye hejuru y’umugongo. Ivyiyumviro birenga 90 kw’ijana vy’abarwayi ni fistules aorto-enteriques secondaires zitera amezi gushika ku myaka 15 inyuma y’ugusanura Dacron graft canke endovascular stent-graft repair (EVAR) y’umutsi w’amaraso wo mu nda (AAA), iyo umuntu akoresheje ubuhinga bwo gutera umutsi w’amaraso n’ugutera umutsi w’amaraso mu nda. umurongo w’urudodo rw’umutsi w’amaraso. Kubera ko fistule aortoenterique itavuwe ishobora kwica 100 kw'ijana, kurokoka bivana n'ukwemera ikimenyetso cayo c'imburi: "amaraso y'umumenyeshamakuru" (amaraso y'umurinzi). Mu barwayi bashika kuri 60 gushika kuri 80 kw’ijana, ugusohoka kw’amaraso kw’agahomerabunwa kubanzirizwa n’ikintu kimeze nk’ikidatoyi, kigaca kigabanuka, co guruka amaraso makeyi atukura cane canke ibintu bikoreshwa mu gusesa ikawa (hematemesis), guca mu maraso y’umutuku canke y’umwirabura (hemmelenaef canke spell (syncope) ihagarara burundu ubwayo iyo amaraso y’igihe gito apfutse akarongo gatoyi k’umubiri w’umuntu (fistule) maze umuvuduko w’amaraso ugaca ugabanuka. Mu masaha makeyi canke mu misi mikeyi**, intungamubiri zifasha mu gufata ibiribwa n’umuvuduko w’amaraso uriko uraduga birasenyuka canke bikafuha iyo thrombus idakomeye, bikavamwo amaraso menshi cane, adashobora guhagarara, aja mu mara. Niba umuntu wese yigeze akora igikorwa co gusanura umutsi w’amaraso wo mu nda, guterwa umutsi w’amaraso wo mu nda, canke gutera umutsi w’amaraso wo mu nda uzwi, akagira amaraso yose yo mu nda, amavyi y’umwirabura, canke gusinzira ataco asigura, hamagara uwo mu karere iwanyu inomero z'ivyihutirwa ubwo nyene. Mu gihe urindiriye gutwara abarwayi, subiramwo ubuyobozi bujanye n’ivyihutirwa kuri gucagura umutsi w'amaraso n'ugucagura umutsi w'amaraso wo mu nda, amaraso ava mu nda, guruka amaraso, na melena ., na n’amarira ya Mallory-Weiss.

Kubera ko ubuhinga bwo gupima amaraso (EGD) bushika gusa ku gice ca mbere n’ica kabiri c’umubiri (kenshi bubura fistule yihishije cane mu gice ca gatatu c’umubiri) be n’uko gupompa amazi mu mutsi bikomeye bishobora gutuma umuvuduko w’amaraso uzamuka bihagije kugira ngo ushobore gukuraho umutsi w’amaraso ukingira amaraso uri imbere mu mubiri wawe. bwira mu buryo butomoye uwurungika 911, abaganga, n'umuganga w'ibihe vyihutirwa amajambo nyayo: "Uyu murwayi afise igihimba c'umubiri gitera umutsi w'amaraso mu nda kandi ariko arasohoka amaraso mu nda; ntushiremwo amaraso y'umutsi w'amaraso mu nda."

Ivyo ubikore ubu

  1. Hamagara ku nimero y’ivyihutirwa yo mu karere kawe ubwo nyene maze umenyeshe ko umuntu akekwaho kuba afise amaraso y’umugera wa Aortoenteric Fistula Herald Bleed. Hamagara 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 urutonde rwacu rw’amaraso inomero z'ivyihutirwa. Vuga neza: "Ivyihutirwa vy'ubuvuzi: ava amaraso mu nda ku murwayi afise amateka yo gusanura umutsi w'amaraso wo mu nda. Ivyiyumviro vy'amaraso bikekwa ko ari umutsi w'amaraso mu nda."
  2. Naho uguruka amaraso canke amaraso yo mu nda yoba yahagaze burundu kandi uwo muntu yumva asubiye mu buryo busanzwe 100 kw’ijana, bifate nk’ikintu gikomeye co kubagwa. Ntukigere wiyumvira ko igihe kimwe gusa c’amavyi y’umwirabura canke agakombe gatoyi k’amaraso yarutse cari igisebe co mu nda, hemorrhoid own, canke. Ico gihe c’ugutekana kihenda ni co gisobanuro nyaco c’ubuvuzi c’amaraso y’umumenyeshamakuru (aho vasospasm n’agace gatoyi k’amaraso k’igihe gito bishobora guhagarika umuvuduko wose w’amaraso y’inda).
  3. Urambike umurwayi ku mugongo (canke uzunguruke ku ruhande rw’ibubamfu mu gihe co gukira iyo afise iseseme canke ariko araruha) kandi ubuze guhagarara, kwicara canke kugenda. Guhaguruka bigabanya umuvuduko w’amaraso mu bwonko kandi bikongera umuvuduko w’uruhome rw’inda, bishobora gutuma umuntu agira ubumuga bwo mu nda canke ubumuga bwo mu nda. igihimba c’umubiri citwa aorte n’igihimba c’umubiri citwa duodenum.
  4. Gushitsa NPO ikomeye (nta kintu na kimwe mu kanwa: nta mazi, nta vyo kurya, nta miti igabanya aside yo mu kanwa, nta n’imiti igabanya aside canke imiti igabanya ububabare). Kumira amazi canke ivyokurya bitera aside yo mu nda, bile, n’intungamubiri zifasha mu maraso (trypsine na chymotrypsine) kugira ngo zibeho igihimba c’umubiri citwa fibrine c’igihe gito kizibira umutsi w’amaraso (fistule aortique) maze kigatuma umuntu ahita asohoka amaraso.
  5. NTUKANDE, ntukoreshe, canke ngo ukoreshe inda. Umuntu ariko arabona canke umuganga akanda cane hagati mu nda kugira ngo asuzume ko ata n’umwe afise ububabare canke ko hariho ikintu gitera, arashobora gukanda ku mubiri igihimba c’umubiri citwa duodenum ku gihimba c’umubiri c’umubiri kiri munsi y’igihimba c’umubiri citwa aorte graft, maze akagikuraho igihimba c’umubiri citwa sentinel clot.
  6. Rondera ikarata y’umurwayi yo kubagwa canke incamake y’ugusohoka mu bitaro yerekana itariki n’ubwoko bw’ugubagwa kw’umutsi w’amaraso, hanyuma uyihe abaganga. Kumenya nimba umurwayi afise igihimba c’umubiri gifunguye co mu mutsi w’amaraso, igihimba c’umubiri gitera umutsi w’amaraso canke igihimba c’umubiri gitera umutsi w’amaraso (AR-interposition graft**) ibitaro vyakira kugira ngo bikoreshe ikigo c’abaganga babaga imitsi n’igikoresho co gupima imitsi ya CT** imbere y’uko umurwayi mbere yinjira mu miryango.

Itegeko ryica ry’amaraso y’umumenyeshamakuru: Kubera iki amaraso ‘mato’ yo mu GI mu murwayi w’umutsi w’amaraso ari igisasu c’igihe gitera

Mu buvuzi bw’ibihe vyihutirwa no mu kubaga imitsi, hariho iciyumviro kidasanzwe: Amaraso yose yo mu nda mu murwayi yari afise umutsi w’inda mbere y’aho, ni fistule y’umutsi w’inda gushika bigaragajwe ko ataco bivuze biciye ku bipimo vy’imitsi y’amaraso n’ivy’ugubaga imitsi. fistula yari ifise amaraso y’umumenyeshamakuru wa kera amasaha gushika ku misi imbere y’aho; benshi baja mu kigo c’ubuvuzi bwihutirwa canke mu cumba c’ubuvuzi bwihutirwa aho ibimenyetso vyabo vy’ubuzima be n’umugera wa hemoglobine vyasa n’ibisanzwe mu gihe gito, bakabwirwa ko kumbure bafise indwara y’igifu canke igisebe co mu nda, canke bagakorwako endoscopie yo hejuru y’igihimba c’irondoka ihagarara gatoyi gushika ku gice ca gatatu c’igihimba c’umubiri citwa duodenum, maze bagasezererwa muhira canke bagashirwa mu bitaro, bagashirwa mu bitaro gusa. n’ugusohoka amaraso ataco ashobora gusubira gukora akaja mu nzira yabo y’amara haciye amasaha 6 gushika ku 48.

Igiti c'ingingo: hematemesis ikomeye, melena, canke gutoranya amaraso ava inyuma y'uguruka

flowchart TD
    Start["Gusesa amaraso cane (Hematemesis), Gusesa amaraso y’ikawa, amavyi y’umukara (Melena), canke amavyi y’umutuku"] --> CheckAorta{"Intambwe ya 1: Umurwayi yoba afise amateka yo gusanura umutsi w’amaraso wo mu nda (AAA) (Open Graft canke EVAR Stent), gutera umutsi w’amaraso mu nda (Aortoiliac Bypass), AAA izwi, canke gutera umutsi w’amaraso mu nda?"}

    CheckAorta -->|"EGO (Naho kubagwa haciye imyaka 5 gushika kuri 15 kandi amaraso akaba ari make canke ahagaze)"| HeraldAEF["GUKEKA AMARASO YO MU MURONGO (AEF): Hamagara 911 / 112 / 999 Ubwo nyene; Kubagwa kw'imitsi + Gusaba guhita gupima imitsi y'imitsi (CTA) imbere y'uko hakorwa Endoscopy"]

    CheckAorta -->|"NTA gitera umutsi w'amaraso canke umutsi w'amaraso uzwi"| CheckVomitContext{"Intambwe ya 2: Amaraso Yoba Yatanguye Gusohoka Ubwo nyene Inyuma Yo Gusuka Canke Gusuka Ku Nkomezi?"}

    CheckVomitContext -->|"EGO: Gukorora canke gukorora ku nguvu vyabanjirije ibimenyetso ."| CheckMackler{"Intambwe ya 3: Suzuma Boerhaave Rupture n’amarira ya Mallory-Weiss: Hoba hariho ububabare bubabaje 10/10 bwo gutabuka mu gikiriza canke mu mugongo, guhema nabi, canke umuyaga uca ibibatsi munsi y’urukoba rw’izosi (crepitus)?"}

    CheckMackler -->|"EGO: Ububabare bukomeye bwo mu gikiriza/mu mugongo, guhema nabi, canke gutera imbere mw’izosi"| Boerhaave["UMUNTU AKEKANWA KUBA AFITE INDWARA YA BOERHAAVE (UKUVUKA KW’INZOBA): Hamagara abajejwe ivy’ubutabazi bwihutirwa ubwo nyene; NPO ikomeye (Nta n’amazi 1), Icara Uhagaze Hafi 30 gushika kuri 45 Degrees"]

    CheckMackler -->|"NTA kubabara mu gikiriza canke guhema nabi: Amaraso atukura cane inyuma y’uguruka kenshi gusanzwe"| MalloryWeiss["Ivyiyumviro vy’uko Mallory-Weiss yacitse amarira: Gumana NPO ata gufyina; Gutwara abantu mu gisata c’ivy’ubuvuzi bw’ivyihutirwa kugira ngo basuzumwe Hemoglobine, Inhibiteur de la Pumpe de Proton IV, no Gusuzuma Endoscope"]

    CheckVomitContext -->|"NTA gusesa amaraso: Gusesa amaraso, ikawa canke amavyi y’umwirabura ata kubabara"| CheckCirrhosis{"Intambwe ya 4: Umurwayi yoba afise indwara y’igitigu, umuvuduko w’amaraso, canke amateka y’imiti y’ibisebe iremereye?"}

    CheckCirrhosis -->|"Cirrhose / Jaundice / Ascites CANKE amaraso menshi y'umusenyi"| VaricesUlcer["BIKEKA KO BIMENYETSO VY’IBIMENYETSO VYO MU MUZO CANKE BIMENYETSO VY’IBIMENYETSO VYO MU MITSI (DIEULAFOY): Hamagara Abajejwe Ivyihutirwa Ubwo nyene; Ikibanza co gukira, NPO ikomeye"]

    HeraldAEF --> AEFProtocol["Uburyo bwo gusubiza ubuzima mu mubiri: Guruhuka cane ku buriri, Gukora ku nda ataco ukora, NPO ikomeye, Gutera umuvuduko muto (Target Systolic BP 80 gushika kuri 100 mmHg kugira ngo igipfukisho c’amaraso ntikivuke), Gukingira umutsi w’amaraso (Stent-EVAR Control A Relining)"]

Ivyerekeye umubiri n’ivy’indwara: igituma umutsi w’amaraso ushobora gusenyuka ukaja mu gice ca gatatu c’umubiri

Kugira ngo umuntu atahure ingene umutsi munini wo mu gice c’inyuma c’umubiri ufatanya ataco uhinduye n’umubiri w’umuntu, n’igituma amaraso ava mu bice bibiri bitandukanye (amaraso aceceka amaraso y’imenyekanisha akurikirwa n’ugusohoka kw’amaraso kw’agahomerabunwa), birafasha gusuzuma imiterere y’umubiri w’inda yo hagati:

1. Ibarabara ry’umubiri riri ku gice ca gatatu c’umubiri (D3)

Mu buhinga bw’umubiri w’umuntu, umutsi w’amaraso wo mu nda ugenda uhagaze umanuka imbere y’umugongo w’inyuma imbere mu kibanza c’inyuma y’umubiri. Munsi gato y’aho imitsi y’amafyigo ikomoka (aho 95 kw’ijana vy’imitsi y’amafyigo ibaho kandi aho imitsi y’amafyigo idogwa mu kibanza cayo), igice ca gatatu (kiringaniye) c’igihimba c’irondoka (D3) kijabuka kiringaniye kuva iburyo kija ibubamfu umurongo w’ugudoda (anastomose)**, utandukanijwe gusa n’igice c’ibinure vyo mu nyuma y’igihimba c’irondoka n’igihimba c’irondoka gitoya nk’impapuro.

  • Igikoko c'umutsi w'amaraso (Rare, <10% of cases): Bishika ku murwayi afise umutsi w'amaraso wo mu nda utavuwe, utavuwe (kenshi ni umutsi w'amaraso "mycotic" wanduye, umutsi w'amaraso w'igituntu canke w'indwara ya sifilisi, igikomere giterwa n'imishwarara, canke igihimba c'amaraso c'amaraso) aho umutsi w'amaraso ugenda uragwira ushobora gutera n’uguca mu bindi.
  • Igisebe ca kabiri c'umutsi w'amaraso (Igisanzwe, >90% of cases): Bishika amezi gushika ku myaka 15+ (imyaka 3 gushika ku myaka 5) inyuma yo gusanura umutsi w’amaraso wo mu nda hakoreshejwe igihimba c’umubiri gipfutse canke gipfutse Dacron canke PTFE, canke inyuma y’ugusanura umutsi w’amaraso wo mu nda hakoreshejwe igihimba c’umubiri gipfutse (EVAR) Uburyo bubiri bukorana bwari bufise umugende uva mu mutsi w’amaraso uja mu mara:
  • Relentless Mechanical Pulsation Pressure Necrosis: Iyo igihimba c’umubiri gipfutse gishizwe hagati y’igihimba c’umubiri n’igihimba c’umubiri c’umubiri mu gihe c’ugubagwa kw’intango kigabanutse, umurongo w’umubiri ukomeye kandi utera imbere w’igihimba c’umubiri c’umubiri c’umubiri w’umubiri utera ku ruhome rw’inyuma rw’igihimba c’umubiri c’umubiri ca gatatu gikomeye a day00,000. Mu myaka, iyo jackhammering y’ubuhinga ituma umubiri ugira ububabare bw’umubiri n’ibisebe vyo mu ruhome rw’amaraso gushika aho izo nsinga z’umubiri zikozwe mu buryo bw’ubuhinga zigaragara ataco zitwaye imbere mu nzira y’amaraso.
  • Indwara y’imigera y’urugero rutoyi: Igihe imigera y’amara (Escherichia coli, Enterococcus, Staphylococcus epidermidis, Streptococcus, Bacteroides, na Candida) ishobora guhindura ubwoko bw’imigera y’amaraso. n’ibindi bihimba vy’umubiri, bikora igice c’umubiri kidakira gikikuje igihimba c’umubiri gifatanye n’umubiri, bikarekura amaproteine y’imigera asenya utudodo tw’uruhome rw’umutsi w’umubiri maze bikagira umurongo w’ibihimba vy’umubiri (paraprosthetic-enteric canke fistule aorto-duodenal).

2. Ibibanza vy’umubiri bifatwa n’indwara y’umutima

Naho igice cose c’umutsi w’insogi gikora ku nzira y’amaraso gishobora gusenyuka, ugusangira kw’umubiri kwibanda cane ku gice c’imbere c’umubiri:

  1. Igice ca gatatu n’ica kane c’igihimba c’irondoka (D3 / D4): 75 gushika kuri 80 kw’ijana vy’ibibazo vyose (kubera ko D3 iboshe ataco yinyiganza ijabuka umutsi w’amaraso wo hafi n’umutsi wa Treitz).
  2. Jejunum na Ileum (Amara mato): 10 gushika kuri 15 kw’ijana vy’abarwayi.
  3. Igikoko c’umubiri canke Cecum: 3 gushika kuri 5 kw’ijana (na cane cane iyo igihimba c’umubiri gica mu nzira y’umubiri (aortobifemoral bypass) gisenyutse kikaja mu gikoko c’umubiri c’umubiri kiri mu gitereko c’ibubamfu).
  4. Inda canke Umuhogo: 2 gushika kuri 5 kw’ijana (ibihimba vy’umubiri bifatanya n’umuhogo hagati, bizwi kw’izina rya aortoesophageal fistule, bigaragara n’ubutatu bwa Chiari**: ububabare bwo hagati mu gifu, umutsi w’umubiri uhagaze).

3. Biomechanique y'"Amaraso y'Umumenyeshamakuru" (Amaraso y'Umurinzi) n'igituma ihagarara ubwayo

Abarwayi, imiryango, mbere n’abaganga batazi utuntu n’utundi baratangazwa n’amaraso y’umumenyeshamakuru: "Ni gute umwobo uri mu mutsi w’amaraso wo mu nda woshobora gusohoka igikombe c’amaraso gusa hanyuma ugahagarara burundu ubwawo?" Uburyo bune bwo mu mubiri burasigura iyo nzira y’uguhagarara guhenda:

  1. Ikinogo c’intango c’umubiri gishobora gusenyuka: Iyo umurongo w’umubiri w’umubiri ugenda urasenyuka canke pseudoaneurysm ubanza guca mu mitsi n’umubiri w’umubiri w’umubiri w’umubiri wa gatatu, akenshi iyo nzira ifunguka iba milimetero 1 gushika kuri 3 gusa mu bwaguke aho kuba igifunguruzo gifunguye cane.
  2. Ugutera umuvuduko w’amaraso mu mitsi n’ugucika intege kw’amaraso mu gihe gito: Umuvuduko w’amaraso ushika ku militiro 200 gushika kuri 500 (ama ounce 7 gushika kuri 17) utera mu gitereko, umuvuduko w’amaraso ugabanuka (kenshi ugatuma umuntu agira umuvuduko mutoyi canke akagira iseseme) kandi akagira umuvuduko w’amaraso mu gihe gitoyi. fistule n’uruhome rw’ibihimba vy’irondoka.
  3. Guhingura igipfukisho c’amaraso c’igihe gito: Uko umuvuduko w’amaraso ugabanuka kandi fistule igaca igabanutse, plaquettes na fibrin bica bifatanya ningoga imbere mu nzira igoramye iri hagati y’igihimba c’umubiri n’igihimba c’umubiri c’umubiri, bikaba bifunga ico kinogo nk’igipfukisho kiri mu cupa.
  4. Ugufata ibiribwa n’ugufuha kw’igipfukisho c’amaraso (The Latent Window): Iyo amaraso amaze guhagarara, umuvuduko w’amaraso w’umurwayi urasubira ku rugero rwa kera (canke ukarushirizaho iyo umugwi w’ibitaro utanga amazi yihuta mu mutsi canke ukamutera amaraso kugira ngo "ubone" ibimenyetso vy’ubuzima). Ico gihe nyene, umutobe wo mu nda ufise aside, amaraso y’umubiri, be n’ibindi bihimba bikomeye vyo mu nda (trypsine, elastase, na lipase) biraguma bikaraba ku ruhande rw’amaraso rwitwa duodenal rwari rwerekanwa, bigatuma igipfukisho c’amaraso gisenyuka mu buryo bw’imiti. Inyuma y’idirisha ry’ubuzima ryihishijwe riva ku amasaha makeyi gushika ku misi myinshi (mu bice 50 kw’ijana mu masaha 6 gushika ku 24, no mu bice 90 kw’ijana mu ndwi 1 gushika ku 2**), igipfukisho c’amaraso kirapfuka burundu, kigafungura umuyoboro utaziguye, w’umuvuduko munini uva mu inte can1ta. umunota.

Gutandukanya amaraso 4 yo hejuru y'igihimba c'irondoka n'ivyihutirwa biva inyuma y'uguruka

Kubera ko amaraso ava mu nda yo hejuru be n’ibintu vyihutirwa vyo mu gikiriza/inda inyuma yo gukorora bisaba gufashwa vuba cane (kuva ku guhagarika umutima n’ugupima amaraso mu gifu ku ndwara ya Boerhaave), koresha iyi mbonerahamwe y’ukugereranya:

Ikiranga ubuvuzi Fistule y'umutsi w'amaraso (AEF) "Amaraso y'umumenyeshamakuru" Indwara ya Boerhaave (Ugucika kw'umuhogo) Amarira ya Mallory-Weiss (Igikoko co ku ruhande rwa GE-Ihuriro) Ivyiyumviro vy'umuhogo canke igisebe ca Dieulafoy
Iciyumviro nyamukuru c'amateka Imbere yo kubagwa umutsi w’amaraso wo mu nda (AAA) (gufungura Dacron graft canke EVAR stent-graft) amezi gushika ku myaka 15+ iheze, canke AAA izwi ko itavuwe. Gusukura canke gukorora ku nguvu (na cane cane kugerageza kwifata mu gukorora) bica bibanza ububabare bubabaje butunguranye mu gikiriza/mu mugongo. Gusubiramwo ibihe bisanzwe bitagira amaraso canke gusesa amaraso (nk’akarorero, kunywa inzoga nyinshi, ibicurane vyo mu nda, gutwara inda) bikurikirwa n’imirongo y’amaraso itukura cane. Kumenyekana indwara y’igitigu / umuvuduko w’amaraso wo mu rugi (varices) canke amateka y’indwara y’ibisebe vyo mu nda / gukoresha cane NSAID canke imiti igabanya amaraso.
Inyifato y'ugusohoka amaraso Biphasic ("Herald Bleed" -> Exsanguination): Amaraso ya mbere akenshi aba ari ugusesagura amaraso, ivyatsi vy'ikawa, canke ivy'amavyi y'umutuku/umwirabura bihagarara burundu ubwavyo, hanyuma haciye amasaha/imisi n'ugusohoka kw'amaraso menshi. Amaraso make, make, canke ATARI mu vyo gusesa: Amarira araturika hanze aciye mu bice vyose vy’umuhogo aja mu mfuruka y’igikiriza c’ibubamfu aho kuva amaraso menshi mu nda. Imirongo y’amaraso canke ibice vy’amaraso bitobito canke biringaniye bitukura cane mu vyo gutakara; 85% gushika kuri 90% bihagarara ubwavyo ntibisubira. Ugukomeza, guruka cane kw’amaraso atukura cane n’ibihimba vy’umubiri vyirabura + amavyi menshi y’umukara w’umukara (melena).
Ububabare, Umuriro, n'Ibimenyetso vyo ku Mubiri Classic Triad (mu 11% gushika kuri 25% gusa icarimwe): Gusohoka amaraso mu nda + Ububabare bwo hagati mu nda/mu mugongo + Ububabare bwo mu nda butera. Akenshi biherekezwa n’amayinga menshi y’umuriro w’agaciro gatoyi udasobanutse, ukubura umubiri, canke ububabare bwo mu mugongo bivuye ku ndwara idakira y’ibihimba vy’umubiri. Mackler’s Triad: Guruka + 10/10 gutabura ububabare bwo mu gikiriza/mu mugongo + Igipfunsi co munsi y’urukoba (uguca ibibatsi munsi y’urukoba rw’izosi), guhumeka nabi, n’ugusohoka kw’amaraso mu gifu c’ibubamfu. Ububabare buke canke zero mu gikiriza (ububabare bukeyi bwo mu gikiriza buva ku gusubira inyuma), uguhema neza, urukoba rw’izosi rusanzwe, n’imirasire y’izuba isanzwe. Akenshi nta kubabara (varices) canke gusha mu nda (ulcère peptique); ibimenyetso vy’ingwara y’igitigu idakira (umuhondo, angiomes y’igitagangurirwa, ascite).
Ikibazo co gupima indwara mu bitaro vyo ku murongo wa mbere Igishushanyo c’imitsi y’inda/igihimba c’irondoka (CTA) c’imitsi y’inda/igihimba c’irondoka (ata n’imwe ikoreshwa mu kanwa). EGD isanzwe irabura D3/D4 muri >50% vy’ibibazo. Igishushanyo c’umuhogo gifise igikoresho co mu kanwa gishobora gusenyuka mu mazi (Gastrografin) (NTIKIZOBA ari Barium). Endoscopie yo hejuru (EGD) inyuma yo gusubiza ubuzima mu mubiri no gukoresha umuti wo gukingira pompe ya proton IV. Igikorwa co gupima umubiri wo hejuru (EGD) mu masaha 12 (inyuma y’uguterwa umuti witwa octreotide, umuti witwa ceftriaxone, na PPI).
Umuvuduko w'amaraso n'ugusubiza ubuzima mu buzima Umuvuduko w’amaraso (Target Systolic BP 80 to 100 mmHg): NTUTERE amaraso menshi canke ngo ushire amaraso hejuru imbere y’uko ugenzura umutsi w’amaraso, canke uzofuha igipfukisho c’amaraso. Gusubiza ubuzima mu mubiri bikoresheje amazi akomeye + imiti igabanya ubukana bw’indwara y’ibicurane (fluconazole) + NPO ikomeye. Infashanyo y’amazi y’ikibiriti n’imiti igabanya ububabare/PPI; guterwa amaraso iyo hemoglobine igabanutse gusa 7 g/dL. Ingingo zo kubuza gutera amaraso (hemoglobine yihariye 7 to 8 g/dL) kugira ngo wirinde gutera umutsi w’urugi.

Ibendera ry'umutuku ry'ubuvuzi: Ubutatu bwa kera n'ibimenyetso vy'imburi "Graft Sepsis"

Naho ibitabu vy’inyigisho bidondora Classic Triad of Aortoenteric Fistula igizwe na (1) Kuva amaraso mu nda, (2) Ububabare bwo mu nda canke mu mugongo, na (3) Igikoko gikomeye co mu nda gishobora gufatwa n’amaboko, inyigisho zirerekana ko ivyo bimenyetso vyose bitatu bigaragara hamwe ku **ca1 kw’ijana vy’abarwayi. inkovu canke stent-grafts zo mu mitsi akenshi zituma umuntu adashobora kwumva ikintu gishobora gufatwa). Ahubwo, urabe neza ibi bimenyetso vy’ubuvuzi vy’ukuri:

1. Igishushanyo c'"Amaraso y'Umumenyeshamakuru + Syncope" (Iboneka mu bice 60% gushika kuri 80% vy'abantu)

  • Umurwayi aca yumva bukwi na bukwi asusurutse, akagira iseseme, akagira iseseme, canke akagira umutwe muto, kandi ashobora gucika intege gatoyi (syncope) hasi mu bwogero.
  • Baruka amaraso makeyi atukura canke "ibice vy'ikawa" vyirabura, CANKE bagaca mu mara rimwe gusa amaraso y'umutuku canke amavyi y'umutuku w'umukara (melena).
  • Mu minota 15 canke 30, ibara ryavyo riragaruka, amaraso agahagarara, bagashimika ko bumva bamerewe neza kandi ko badashaka kuja mu bitaro. Iki ni co gihe nyaco ivy'ugutwara abantu vyihutirwa bikiza ubuzima bwabo.

2. "Indwara y'ibihimba vy'umubiri + ububabare bwo mu mugongo" Prodrome

Mu barwayi benshi bafise fistule secondaire aorto-enterique, amayinga canke amezi imbere y’uko itosi rya mbere ry’amaraso aboneka riboneka, igihimba c’umubiri gica gisenyuka kirasenyuka imigera ku gihimba c’umubiri c’umubiri, kigatuma chronic perigraft sepsis: - Umuriro udasobanutse ugenda uhagarara, ivyuya mw’ijoro, canke ububabare bukomeye (kenshi bifatwa nabi mu kiringo c’amayinga menshi nk’indwara y’imigera, indwara y’amasobe, canke umuriro utazwi aho wavuye). - Ububabare bushasha, bukomeye, burambiranye hagati mu mugongo canke ububabare bwo mu nda buri hafi y’igifu (buterwa n’umururumba wo mu rubavu n’ukwaguka kw’imitsi y’ibinyoma ikanda ku mugongo). - Septic emboli ku maguru canke ku mano ("Blue Toe Syndrome"): Utugingo ngengabuzima dutoduto twanduye duca mu gice c'umubiri c'umutsi w'amaraso (aorte) twakolonijwe tukaja mu birenge, tugatuma haba amabara y'umutuku ababaza ku mano canke indwara y'amagufa y'amaguru y'uruhande rumwe. - Indwara y’imigera n’ibinyabuzima vyo mu mara: Ivyimburwa vy’amaraso bikura Escherichia coli, Interococcus, Streptococcus bovis/anginosus, Bacteroides, canke Candida ku murwayi uwo ari we wese afise igihimba c’umubiri gitera umutsi w’amaraso ni ikimenyetso c’indwara y’umutsi w’amaraso canke...

Imitego ibiri y'ibitaro yica: "Umutego w'Endoscopie Standard" n'"Umutego wo gusubiza ubuzima mu mubiri birenze urugero".

Igihe uherekejwe n’umuntu ukunda afise igihimba c’umubiri gitera umutsi w’amaraso mu bitaro vy’ibiza, kumenya imitego ibiri ikomeye cane yo mu buvuzi ivugwa na Ishirahamwe ry’abaganga b’imitsi (SVS) na Ishirahamwe ry’Uburaya ry’abaganga b’imitsi (ESVS) birashobora kugufasha kumenya neza ko ubuvuzi bwihuta kandi buhuye:

Umutego wa 1: Kubera iki igikoresho co gupima umubiri (EGD) gisanzwe kibura kenshi igihimba c’umubiri citwa Fistule Aortoenterique

Mu gihe umuntu ava amaraso mu nda yo hejuru, abaganga b’ibihe vyihutirwa bahamagara umuganga w’indwara z’amaraso kugira ngo akore isophagogastroduodenoscopy (EGD). Ariko rero, igikoresho co gupima mu nda gisanzwe gikoreshwa gusa kugira ngo kigere ku igice ca mbere n’ica kabiri c’igihimba c’umubiri (D1 na D2), kigahagarara hafi y’igihimba c’umubiri citwa ampulla ya Vater. Kubera ko 75 gushika ku 80 kw’ijana vy’ibisebe vy’amaraso biva mu gice ca gatatu n’ica kane c’amaraso (D3 na D4), EGD isanzwe isa n’iyisanzwe rwose mu bice birenga ica kabiri c’ibisebe vyose vy’amaraso.

Hariho ibindi bigeragezo bibiri mu gihe c’ugupima umubiri: - Umutego w'"Igisebe c'Impanuka": Abarwayi b'imitsi bakuze bakunda gufata aspirine canke imiti igabanya amaraso ku musi kandi kenshi baragira indwara y'igifu idakomeye, utugingo ngengabuzima dutoduto two mu nda, canke igisebe gitoyi co mu nda gikira. Iyo umuganga w’ivy’imbere mu nda abonye indwara y’igifu idakomeye cane, agahagarika ikizame atasuzumye gushika mu gice ca kane c’igifu (canke atategetse ko bamupima amaraso), boshobora kwihenda ngo ayo maraso y’umumenyeshamakuru ari indwara y’igifu mu gihe fistule aortique yicaye kure cane yiteguriye guca. - Gukuraho igihimba c’umubiri citwa Herald Clot imbere muri GI Lab: Iyo umuganga w’amaraso asunikiye igikoresho kirekire c’abana canke igikoresho co gupima amaraso mu gice ca gatatu c’igihimba c’irondoka, abona igihimba c’amaraso c’umwirabura gitera kifatanye n’uruhome rw’igihimba c’irondoka, maze akagerageza kugisukura, c eop birashobora gukura igipfukisho c’umutsi w’amaraso wo mu nda maze bigatuma umuntu ahita asohoka amaraso, akamwica kure y’icumba co kubagiramwo. Rero, iyo hakoreshejwe endoscopie kugira ngo umuntu asuzume D3/D4, amabwirizwa y’ugubaga imitsi avuga ko bikwiye gukorwa mu cumba co kubagiramwo, umugwi w’abaganga babaga imitsi ukaba uriko urasukurwa kandi witeguriye gufata umutsi w’amaraso ubwo nyene.

Umutego wa 2: Kubera iki "Ugutera umuvuduko muto" gukiza ubuzima imbere y'uko umutsi w'amaraso ukingirwa

Mu gihe c’idirisha ryihishije inyuma y’ugusohoka kw’amaraso, igihimba c’umubiri citwa plaquettes-fibrine gishobora gusenyuka ni co conyene gitandukanya amaraso y’umutsi w’amaraso afise umuvuduko munini n’amaraso y’insogi yuguruye. Iyo abaganga canke abakozi bo mu bitaro bamuhaye amalita y’umunyu wihuta mu mitsi canke bakamutera utugingo ngengabuzima dutukura twinshi kugira ngo umuvuduko w’amaraso w’umurwayi ugere kuri 100.000. 130 to 150 mmHg, iyo hydrostatique pressure spike izo gukuraho igipfukisho c’amaraso kiva mu nzira y’amaraso (nk’uko nyene bigenda iyo umuntu afise umutsi w’amaraso wo mu nda).

  • Itegeko ry’ugutera umuvuduko w’amaraso: Igihe cose umurwayi ari maso, ari maso, kandi ariko aravuga (vyerekana ko amaraso atemba bihagije mu bwonko no mu mutima), amabwirizwa yerekeye ugukomeretswa kw’imitsi n’ugusubiza ubuzima mu mubiri ashimikiye ku ugutera umuvuduko w’amaraso (umuvuduko w’amaraso w’umubiri (systolic blood pressure of roughly 80 to 100 mmHg) hakoreshejwe amazi yitonze, afise ivyiyumviro vyinshi gushika umuganga abaga imitsi apfutse umutsi w’amaraso biciye ku gikoresho co gutera umutsi w’amaraso canke igikoresho co gutera umutsi w’amaraso.

Gupima neza ibitaro no kubagwa: CTA, EVAR bridging, no gusubira kwubaka

Iyo umurwayi akekwaho kuba afise fistule aorto-entérique ashitse mu bitaro vyihutirwa, ibitaro birakoresha inzira yo kubaga imitsi yihuta:

  1. Ikigeragezo ca mbere c’inzahabu: Multiphasic CT Angiography (CTA) y’inda n’igihimba c’irondoka: Gikorwa ata ikintu ciza co gutandukanya amaraso mu kanwa (coshobora guhisha amaraso akora imbere mu gitereko), CTA ifata iminota itarenga 5, ifise 85 gushika ku 95 kw’ijana vy’ibimenyetso vy’ububabare,
  2. Ectopic perigraft gas: Ivyuka vy’umuyaga bikikuje igihimba c’umubiri gitera (vyama bidasanzwe mu ndwi zirenga 4 canke 6 inyuma yo kubagwa).
  3. Gutakaza indege y’ibinure y’umutsi w’amaraso: Gufatanya umutsi w’amaraso wa gatatu mu ruhome rw’imbere rw’igihimba c’umubiri canke pseudoaneurysm.
  4. Active contrast extravasation: Igikoresho co gutandukanya amaraso kiva mu mutsi w’amaraso kija mu nzitiramibu y’amaraso.
  5. Intambwe ya mbere y'ugukiza: Gusubiramwo stent-Graft y'imitsi ("EVAR Bridge to Surgery"): Mu gihe c'amabwirizwa ya SVS na ESVS, aho guca ubwo nyene gukora laparotomy (ishobora gutuma umuntu apfa 50 gushika kuri 70 kw'ijana mu gihe c'ugusohoka kw'amaraso), stent-graft y’umutsi w’amaraso y’imbere mu mubiri ipfutse imbere mu gitereko ca kera gica mu fistule (canke gutera umupira w’amaraso w’amaraso REBOA mu guhagarika). Mu minota 20, amaraso arahagarara, umuvuduko w’amaraso ugahagarara. Imiti igabanya ubukana bw’indwara (piperacillin-tazobactam canke meropenem + vancomycine) hamwe n’imiti igabanya ububabare (fluconazole canke micafungin) iratangura ubwo nyene.
  6. Intambwe ya 2 Gusanura: Iyo abaganga bamaze kuzuka, barakuraho maze bagasanura igihimba ca gatatu c’umubiri, bagashiramwo igice kinini c’igihimba c’umubiri citwa greater omentum hagati y’amara n’umutsi w’amaraso, bagakuraho igihimba c’umubiri canduye, bagasubiza amaraso gutemba biciye ku extra-fetu-sianato- gusubira kwubaka umutsi w’amaraso** hakoreshejwe umutsi w’igihimba c’irondoka (NAIS), umutsi w’igihimba c’irondoka (homograft) uzigamiwe mu mazi, canke Dacron ishizwemwo rifampin/ifeza.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo

Iyo umuntu yikekwa ko afise fistule aortoenterique, bisaba ko ahita atwarwa n’imodoka itwara abarwayi mu kigo ca gatatu Ikigo co kubaga imitsi gifise amasaha 24 CT Angiography, Ivyumba vyo kubaga vy’imitsi y’amaraso, uburyo bwo gutera amaraso menshi, n’ubuvuzi bw’imitsi y’amaraso:

  • Leta Zunze Ubumwe za Amerika na Canada: Hamagara 911. Bwira abaganga ko umurwayi yasanuwe umutsi w’amaraso wo mu nda kandi akeneye ibitaro bikomeye bifise 24/7 Vascular Surgery (ntivyigeze biba ER yigenga canke ivuriro ry’abanyagihugu). Irongowe hakurikijwe Ishirahamwe ry’abaganga b’imitsi (SVS) ry’amabwirizwa y’ibikorwa ku kwitwararika abarwayi bafise ubumuga bwo mu nda na Ishirahamwe ry’umutima ryo muri Amerika (AHA) ry’amajambo y’ubuhinga yerekeye indwara y’imitsi.
  • Ubwongereza: Hamagara 999 kugira ngo ubone imodoka itwara abarwayi yo mu rwego rwa ½ ija mu karere kagenewe Ikigo c'imitsi y'amaraso. Irongowe hakurikijwe amategeko ya Ikigo c’Igihugu c’Ubuzima n’Ukwitwararika (NICE NG156) na Ishirahamwe ry’Imitsi y’Ubwongereza na Irlande (VSGBI).
  • Ubumwe bw'Uburaya: Hamagara 112. Irongowe hakurikijwe Ishirahamwe ry’Uburayi ry’Ivy’Ukubaga Imitsi (ESVS) 2020 Amabwirizwa y’Ibikorwa vy’Ubuvuzi ku bijanye no Gucungera Indwara z’Imitsi n’Imitsi y’Imitsi.
  • Ostraliya na Nouvelle-Zélande: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande. Irongowe hakurikijwe amategeko y’ishirahamwe ry’abaganga b’imitsi ryo muri Ostraliya na Nouvelle-Zélande (ANZSVS)**.
  • Ubuhindi na Aziya-Pasifike: Hamagara 112 (canke 108 mu Buhindi), 995 muri Singapore, 119 mu Buyapani na Koreya y’Epfo, canke 999 muri Maleziya na Hong Kong. Gusaba ikigo ca gatatu gifise ubushobozi bwo kubaga imitsi yo mu mutima n’iyo mu mutima/imitsi.

Ibibazo bikunda kubazwa

"Amaraso y'umumenyeshamakuru" (amaraso y'umurinzi) mu fistule aorto-entrique ni iki?

Amaraso y’umumenyeshamakuru ni ikintu gihenda, kigaca kigabanya amaraso yo mu nda (nk’uguruka amaraso makeyi canke ibintu bivuye mu kafe, guca mu nzira imwe y’amaraso y’umukara canke y’umukara w’umukara, canke gucika intege mu gihe gitoyi) bishika ku barwayi 60 gushika ku 80 kw’ijana bafise indwara y’umutima canke indwara y’umutima. Igihe igihimba c’umubiri gica mu mutsi w’amaraso (aorte) gica kigira umwobo w’ibara ry’agahama, umuvuduko w’amaraso ugabanuka mu gihe gitoyi be n’ugucika kw’imitsi y’amaraso bituma agace k’amaraso gatoyi gafunga ico kinogo, bigatuma amaraso ahagarara burundu mu masaha makeyi canke imisi mikeyi. Igihe aside yo mu nda, enzymes zo mu maraso be n’umuvuduko w’amaraso uriko uraduga bimaze gusenyuka canke gupfuka iyo nzira y’amaraso ishobora gusenyuka, haca hatangura kuva amaraso menshi cane kandi ashobora gutuma umuntu apfa. Guhamagara abajejwe ivy’ubutabazi mu gihe c’idirisha ry’amaraso ry’umumenyeshamakuru ry’agacerere ni co kintu kimwe rudende gikomeye kuruta ibindi vyose kigaragaza ko umuntu azorokoka.

Mbega fistule aorto-enterique yoba ishobora gushika imyaka 10 canke 15 inyuma y’aho umuntu abazwe umutsi w’amaraso wo mu nda?

Egome. Naho hariho ibisebe bimwebimwe vy’umubiri bishobora gutera mu mezi makeyi umuntu abazwe canke amaze gusanura umutsi w’umubiri (EVAR), igihe gisanzwe kuva umuntu abazwe umutsi w’umubiri (EVAR), igihe gisanzwe kuva umuntu abazwe umutsi w’umubiri gushika aho afise amafistule ni imyaka 3 gushika ku myaka 5, kandi ibibazo vyemewe neza bisubira kubaho ubudasiba inyuma y’imyaka 10,50. Mu buzima bwose bw’umurwayi inyuma y’ugutera umutsi w’amaraso mu nda canke gutera stent, igihe cose umuntu yoruha amaraso, amavyi y’umukara, amaraso ava mu nda, canke umuriro udasobanutse ufise ububabare bwo hagati mu mugongo, bitegerezwa gufatwa nk’aho yoba ari fistule aortoenterique gushika bikurweho n’igipimo ca CT angiogram.

Ni kuki CT Angiogram (CTA) ari nziza kuruta Endoscopie yo hejuru (EGD) nk’ikibazo ca mbere co gupima umuntu akekwaho ko afise fistule y’umutsi w’amaraso?

Igikoresho co hejuru gikoreshwa mu gupima umuhogo, inda, n’igice ca mbere n’ica kabiri c’umubiri w’umuntu, kigahagarara hafi y’igice ca gatatu n’ica kane c’umubiri kiri kure cane aho 75 gushika ku 80 kw’ijana vy’ibihimba vyose vy’umubiri vy’umubiri biri. Ivyo bituma, iyo umuntu akoresheje ubuhinga bwo gupima amaraso yo hejuru, akabura ibice birenga ica kabiri c’ibihimba vyose vy’umubiri bita aortoenteric fistules kandi yoshobora kwihenda akavuga ko amaraso ava ari indwara y’igifu idakomeye cane. Mu buryo butandukanye n’ubwo, igipimo c’amaraso (CTA) c’inda n’igihimba c’irondoka gifata iminota itarenga 5, kigaca kibona mu ciyumviro umutsi wose w’amaraso n’igihimba c’irondoka icarimwe, kandi kigaca kibona 85 gushika ku 95 kw’ijana vy’ibivyimba vy’amaraso mu kwerekana ibibumbano vy’umuyaga bifunzwe biva ku gitereko c’amaraso n’igitereko c’amaraso, loss the aorta mu mara.

Ni kuki abaganga bafasha abagwayi n'abaganga bafasha abantu mu bihe vy'ivyago bategerezwa kwirinda kuduza cane umuvuduko w'amaraso ("permissive hypotension") inyuma y'aho umuntu avuye amaraso?

Inyuma y’aho amaraso y’umumenyeshamakuru ahagarikiye ubwayo, ikintu conyene kibuza umutsi w’amaraso wo mu nda ufise umuvuduko munini gupompa amalita y’amaraso mu mara mato ni akagingo ngengabuzima gatoyi kandi gashobora gusenyuka kitwa plaquettes-fibrines kazibira umutsi w’amaraso witwa fistule. Iyo imigwi y’abaganga itanga amazi menshi mu mutsi canke igatera amaraso vyihuta kugira ngo umuvuduko w’amaraso w’umurwayi ugere ku rugero rusanzwe canke rwo hejuru (nk’urwa 130 gushika ku 150 mmHg) imbere y’uko umuganga abaga imitsi afunga umutsi w’amaraso, iyo nzira y’amaraso ishobora gutuma umuvuduko w’amaraso w’umurwayi uhagarara. gusohoka amaraso. Keretse iyo umurwayi afise ubumuga bukomeye bwo mu bwonko, imigwi y'imitsi iragumya "permissive hypotension" (umuvuduko w'amaraso systolic wo hagati ya 80 na 100 mmHg, bihagije gusa kugira ngo umurwayi agume ari maso kandi avuga) gushika aho stent-graft canke clamp yo kubaga ipfutse aorta.

Ni kuki umuntu akekwa ko afise amaraso y’umumenyeshamakuru adakwiye kunywa amazi canke gufata umuti w’ibisebe vyo mu kanwa i muhira?

Ica mbere, kunywa amazi, kurya ivyokurya canke gufata imiti yo mu kanwa bituma inda, umuhogo w’amaraso n’amaraso y’umubiri bisohora aside hydrochlorique, bile be n’ibindi bihimba bikomeye bifasha mu gufata poroteyine (trypsine na chymotrypsine) bikaja mu gice ca gatatu c’igihimba c’umubiri citwa duodenum, aho bica bifatanya n’amaraso. Ubwa kabiri, umurwayi azokenera gukorwako CT scan y’ubudasa (CT scan) n’uguterwa umuti w’ububabare bwihutirwa (anesthésie générale) kugira ngo abagwe mu mitsi canke mu mutsi w’amaraso, aho kugira amazi canke ivyokurya mu nda bituma umuntu agira ingorane nyinshi zo gukorora no guhumeka mu mahaha mu gihe ariko araterwa.

"Ikiraro ca EVAR" ni iki kandi catumye umuntu ashobora kurokoka gute mu ndwara ya fistule aorto-enterique?

Kera, uburyo bumwe rudende bwo guhagarika fistule aortoenterique iva amaraso cane bwari uguca inda yose mu buryo bwihutirwa, gucapura inkovu nyinshi, no gufata umutsi w’amaraso), ivyo bikaba vyatuma abantu 50 gushika ku 70 kw’ijana bapfa kubera gutakaza amaraso no guhungabana. Ubu, abaganga babaga imitsi bakoresha "ikiraro ca EVAR": biciye ku rushinge rutoyi rutoboye mu mutsi w'imbere, batera stent-graft y'imbere mu mubiri ipfutse hejuru imbere mu gitereko ca kera c'imitsi y'amaraso maze bakayishira hejuru y'ico kinogo mu minota itarenga 20. Ivyo bica bihagarika ubwo nyene amaraso ava mu mubiri, bigatuma umurwayi ahagarara neza kugira ngo gusanura neza igihimba c’umubiri citwa duodenum be n’igihimba c’umubiri cafashwe n’indwara bishobore gukorwa ata nkomanzi iyo umurwayi amaze gusubira kubaho neza.

Amasoko n'ubuyobozi buzwi

  • Ishirahamwe ry'Uburaya ry'Ivy'Ukubaga Imitsi (ESVS, Uburayi): ESVS 2020 Amabwirizwa y'Ibikorwa vy'Ubuvuzi ku bijanye no Gucungera Indwara ziterwa n'Imitsi n'Imitsi y'Imitsi (Chakfe n'abandi, Ikinyamakuru c'Uburayi kijejwe kubaga imitsi n'imitsi, Igice ca kwemerwa, CTA y’ibice vyinshi nk’uburyo bwo gupima indwara bwa mbere, gukorana n’imitsi y’imbere mu mubiri mu barwayi badashikamye, no gusubira kwubaka umubiri mu nzu n’inyuma y’umubiri).
  • Ishirahamwe ry’abaganga b’imitsi (SVS, Leta Zunze Ubumwe za Amerika): Ishirahamwe ry’abaganga b’imitsi ry’imitsi ry’amabwirizwa yerekeye kwitwararika abarwayi bafise umutsi w’amaraso wo mu nda (Chaikof n’abandi, Ikinyamakuru c’abaganga b’imitsi y’amaraso, gupima no gufasha mu buryo bwihutirwa indwara y’umutsi w’amaraso y’intango n’iya kabiri).
  • Ishirahamwe ry’umutima ryo muri Amerika (AHA, Leta Zunze Ubumwe za Amerika): Indwara ziterwa n’imitsi, imitsi y’amaraso, n’indwara ziterwa n’imitsi yo mu mubiri: Itangazo ry’ubuhinga ry’ishirahamwe ry’umutima ryo muri Amerika (Imitsi y’umutima, ubuhinga bw’imigera, ivy’ugutera indwara z’ibinyabuzima, ugupfuka imiti irwanya imigera n’ibicurane, n’ubuvuzi bw’imitsi y’amaraso).
  • Ishure ryisumbuye ry'Amerika ry'Ivy'Inda (ACG) & Ishirahamwe ry'Uburaya ry'Ivy'Inda (ESGE): Ingingo ngenderwako z'ubuvuzi ku bijanye no gufasha amaraso ava mu nda yo hejuru (kwemera fistule aortoenterique mu barwayi bafise CTA4D n'imipaka ya DTA4D).
  • Ikigo c'Igihugu c'Ubuzima n'Ukwitwararika (NICE, Ubwongereza): Indwara y'umutsi w'amaraso mu nda: Gupima no kuyivura (Ingingo ngenderwako ya NICE NG156).

Fata amashure yemewe y'ubutabazi bwa mbere maze ubaze abahinga

Iyi nkuru itanga inyigisho z’ukwemera vyihutirwa n’ubutabazi bwa mbere kandi ntisubirira ubuvuzi bw’abahinga bwo gupima indwara canke ubuvuzi bwo kubaga imitsi. Kugira ngo wige ubuhinga ngirakamaro bwo kumenya amaraso ava mu mubiri, gucungera uguhungabana kw’amaraso, no gukora CPR, fata inyigisho y’ubutabazi bwa mbere yemejwe biciye ku Musaraba Mutukura, St John Ambulance, canke umuganga wo mu karere.

Inyobora zifitaniye isano