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استنت



_____________
استنت یک لوله توری سیمی کوچک می باشد که سبب باز شدن سرخرگ شده و به شکل دایمی داخل آن می ماند.

چرااز استنت استفاده می شود ؟

===================
هنگامی که یک سرخرگ کروناری (یک سرخرگ خونرسانی کننده به عضله قلبی ) به واسطه تجمع رسوباتی که در مجموع پلاک نامیده می شوند تنگ می شود، جریان خون عضله قلبی کاهش می یابد

اگر جریان خون به عضله قلبی کاهش پیدا کند، درد قفسه سینه رخ می دهد . اگر لخته ای هم تشکیل شده و جریان خون به بخشی از عضله قلبی را قطع کند، حمله قلبی رخ می دهد . استنت سبب باز نگه داشتن سرخرگ قلبی شده و احتمال بروز حمله قلبی را کاهش می دهد .

سرخرگها چگونه باز می شوند ؟
===================
جهت بازکردن یک سرخرگ تنگ شده، پزشک ممکن است عملی را انجام دهد که تحت عنوان مداخله کروناری از طریق پوست (PCI) یا آنژیوپلاستی نامیده می شود . در این روند، یک لوله که یک بادکنک (بالون) در سر آن قرار دارد و کاتتر نامیده می شود به داخل سرخرگ و به محل انسداد رانده می شود . سپس بادکنک باد شده و پلاک را تحت فشار قرار داده و محل دچار تنگی را باز می کند . پس از اتساع مجرای رگ ، بالون خالی شده و کاتتر بیرون کشیده می شود .

استنتها چگونه استفاده می شوند ؟
=====================
استنت قبل از استفاده، در اندازه کوچکی جمع شده و دور بالون کاتتر قرار می گیرد . سپس استنت به محل انسداد رانده می شود و زمانیکه بالون باد می شود، استنت باز شده و در محل خود قفل می گردد و یک داربست را تشکیل می دهد که سبب بازنگه داشتن رگ میشود

استنت به شکل دایمی داخل رگ باقی مانده و آن را باز نگه می دارد . این امر سبب بهبود جریان خون به عضله قلبی و رفع علایم (اغلب در قفسه سینه ) می شود .

استنت ها بر اساس برخی ازویژگی های خاص سرخرگ دچارانسداد ، استفاده می شوند . عواملی که برروی احتمال استفاده از استنت موثرند، اندازه سرخرگ و محل انسداد آن می باشند .

استنت گذاری به شدت رایج بوده و اکثر اعمال آنژیوپلاستی با استنت گذاری همراه می باشند .

فواید استفاده از استنت کدامند ؟
===================
در برخی از بیماران، استنت میزان ابتلا به تنگی مجدد را که پس از آنژیوپلاستی بالونی یا سایر روشها ی انجام گرفته توسط کاتتر رخ می دهد، کاهش می دهد .

افرادیکه تحت آنژیوپلاستی و استنت گذاری قرار می گیرند، نسبت به افرادیکه تحت عمل جراحی بای پس سرخرگ کروناری قرار می گیرند، بهبودی سریعتری دارند. هم چنین درد و احساس ناراحتی در آن ها کمتر است .

آیا ممکن است سرخرگهای استنت گذاری شده مجددا دچار تنگی شوند؟
=========================================
در حدود یک سوم ازبیمارانی که تحت آنژیوپلاستی بدون استنت گذاری قرار می گیرند، سرخرگ مربوطه دوباره شروع به تنگ شدن در عرض چند ماه پس از عمل می نماید . این کاهش دوباره قطر، تنگی مجددنامیده می شود .
استنت به پیشگیری از این حالت کمک می کند. در سالهای اخیر پزشکان از استنت های جدیدی استفاده می کنندکه استنت های آغشته به دارونامیده می شوند . این استنت ها با دارویی پوشیده شده اند که مانع از بسته شدن مجدد عروق خونی می شوند. استنت هایی که با دارو پوشیده نشده اند، استنتهای لخت فلزی نامیده می شوند .

بسیار مهم است که افراددارای هرکدام از انواع استنت ، داروهای ضد پلاکت خود را درست طبق دستور پزشک مصرف نمایند.

اگر استنت کار نکند و سرخرگها دوباره بسته شوند، ممکن است انجام جراحی بای پس سرخرگ کروناری در شما ضروری باشد .

پس از یک عمل استنت گذاری چه احتیاطاتی باید صورت گیرد ؟
===================================
بیمارانی که تحت عمل استنت گذاری قرار گرفته اند می بایست از یک یا تعداد بیشتری از داروهای رقیق کننده خون استفاده کنند.

نمونه این داروها کلوپیدوگرل و آسپیرین هستند . این داروها به کاهش احتمال ایجاد لخته در استنت و انسداد سرخرگ کمک می کنند.

آسپیرین ازنظر زمانی معمولابه صورت نامحدود مصرف می شود .

کلوپیدوگرل به مدت 12 ماه و یا شاید مدت طولانی تری پس از عمل (بسته به نوع استنت) مصرف می شود.

کلوپیدوگرل ممکن است سبب بروز عوارضی گردد، در نتیجه انجام دوره ای آزمایش خون صورت می گیرد . قطع نکردن این داروها به هر دلیلی بدون مشورت با متخصص قلبی که بیماری سرخرگ کروناری شما تحت درمان اوست، مهم می باشد .

در 4 هفته اول پس از استنت گذاری ، تصویربرداری بارزوناس مغناطیسی ( MRI ) نباید بدون تایید متخصص قلب صورت گیرد. البته ابزارهای شناسایی کننده فلز (مانند موارد موجود در فرودگاهها) اثری بر استنت ندارند .

دانشگاه علوم پزشكی 
مركز قلب تهران

 



نوشته شده توسط :سارا کریمی
جمعه 13 مرداد 1391-11:11
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צימרים
شنبه 8 تیر 1398 04:25
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נערת ליווי ברמת גן
پنجشنبه 6 تیر 1398 21:17
We're having coffee at Nylon Coffee Roasters on Everton Park in Singapore.
I'm having black coffee, he's possessing a cappuccino. He is
handsome. Brown hair slicked back, glasses that fit his face,
hazel eyes and the most wonderful lips I've seen. He's quality,
with incredible arms as well as a chest that stands out for this sweater.

We're standing ahead of each other dealing with our
lives, what we want in the future, what we're searching for on another person. He starts telling me that bigger been rejected a great deal of times.


‘Why Andrew? You're so handsome. I'd never reject you ', I have faith that He smiles at me, biting his lip.



‘Oh, I can't know. Everything happens for a good reason right.

But inform me, you would not reject me, would you Ana?' He said.



‘No, how could I?' , I replied

"So, would you mind if I kissed you at the moment?' he said as I recieve nearer to him and kiss him.

‘The next occasion don't ask, simply do it.' I reply.

‘I prefer the way you think.' , he said.

While waiting, I start scrubbing my rearfoot in her leg, massaging it slowly. ‘What exactly do you enjoy in females? And, Andrew, don't spare me the details.' I ask.

‘I like determined women. Someone that knows what they want. Someone that won't say yes although I said yes. Someone who's not afraid when trying interesting things,' he says. ‘I'm never afraid when you attempt new things, especially on the subject of making a new challenge in the bed room ', I intimate ‘And I adore girls who are direct, who cut with the chase, like you merely did. To generally be
honest, it really is a huge turn on.
נערות ליווי ברמת גן
چهارشنبه 5 تیر 1398 19:15
We're having coffee at Nylon Coffee Roasters on Everton Park
in Singapore. I'm having black coffee, he's creating a cappuccino.
They are handsome. Brown hair slicked back, glasses that
fit his face, hazel eyes and the most wonderful lips I've seen. They're well made, with incredible
arms and also a chest that sticks out with this sweater.
We're standing ahead of one another discussing our lives, what we really wish
for money for hard times, what we're looking for on another person. He starts saying
that they have been rejected loads of times.

‘Why Andrew? You're so handsome. I'd never reject you ', I say He smiles at me, biting his
lip.

‘Oh, I really don't know. Everything happens for grounds right.
But let me know, you wouldn't reject me,
would you Ana?' He said.

‘No, how could I?' , I replied

"So, can you mind if I kissed you today?' he said as I receive far better him and kiss him.

‘Next time don't ask, simply do it.' I reply.

‘I prefer how you think.' , he said.

Meanwhile, I start scrubbing my rearfoot in her leg, massaging it slowly. ‘What can you enjoy ladies? And, Andrew, don't spare me the details.' I ask.

‘I like determined women. Someone to know the things they want. Somebody who won't say yes even if I said yes. Someone who's not afraid when you attempt something totally new,' he says. ‘I'm never afraid of attempting new stuff, especially with regards to making a new challenge in the sack ', I intimate ‘And I enjoy women who are direct, who cut from the chase, like you merely did. For being
honest, this is a huge turn on.
 
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