Imithambo yamaphaphu idlala indima ebalulekile: ithwala igazi lisuka ku-ventricle efanele yenhliziyo liyise ezingxenyeni zamaphaphu, lapho lifakwa khona umoya-mpilo. Ukulandela i-phlebitis, kwenzeka ukuthi ihlule legazi likhuphukela kulo mthambo kanye nomlomo: i-pulmonary embolism.

I-pulmonary artery iqala ku-ventricle engakwesokudla yenhliziyo. Khona-ke ikhuphuka eduze kwe-aorta, futhi ifike ngezansi kwe-aorta, ihlukanise amagatsha amabili: umthambo we-pulmonary ongakwesokudla oya ngasephashini elingakwesokudla, nomthambo we-pulmonary wesokunxele ubheke ephashini lesokunxele.

Ezingeni le-hilum yephaphu ngalinye, imithambo yamaphaphu iphinde ihlukanise ibe okuthiwa yi-lobar arteries:

• emagatsheni amathathu omthambo we-pulmonary ongakwesokudla;
• emagatsheni amabili omshini wamaphaphu ongakwesobunxele.

Lawa magatsha wona ahlukana abe amagatsha amancane namancane, aze abe ama-capillaries e-lobule yamaphaphu.

Imithambo yamaphaphu yimithambo emikhulu. Ingxenye yokuqala yomthambo wamaphaphu, noma isiqu, ilinganiselwa ku-5 cm no-3,5 cm ububanzi. I-pulmonary artery engakwesokudla ingama-5 kuya ku-6 cm ubude, ngokumelene no-3 cm we-pulmonary artery yesokunxele.

Indima yomthambo wamaphaphu ukuletha igazi elikhishwe ku-ventricle elungile yenhliziyo liyise emaphashini. Lokhu okubizwa nge-venous blood, okusho ukuthi i-non-oxygenated, bese ifakwa umoya-mpilo emaphashini.

Embolism yamaphaphu

I-Deep vein thrombosis (DVT) kanye ne-pulmonary embolism (PE) yizimpawu ezimbili zomtholampilo zebhizinisi elifanayo, isifo se-venous thromboembolic (VTE).

I-pulmonary embolism ibhekisela ekuvinjweni komthambo we-pulmonary ngehlule legazi elakhiwe ngesikhathi se-phlebitis noma i-venous thrombosis, ngokuvamile emilenzeni. Lelihlule liyaphuka, likhuphuke liye enhliziyweni ngomfutho wegazi, bese likhishwa ku-ventricle engakwesokudla liye kweminye yemithambo yamaphaphu eligcina liyivimbile. Ingxenye yephaphu ibe isingasekho umoya-mpilo. Ihlule libangela ukuthi inhliziyo elungile iphampe ngamandla, okungabangela ukuthi i-ventricle efanele ivuleke.

I-pulmonary embolism izibonakalisa ngezimpawu ezahlukahlukene ezingaphezulu noma ezingezinhle ngokuya ngobukhulu bayo: ubuhlungu besifuba ohlangothini olulodwa bukhula ngokuphefumulelwa, ubunzima bokuphefumula, kwesinye isikhathi ukukhwehlela ngesikhwehlela negazi, futhi ezimweni ezinzima kakhulu, ukuphuma kwenhliziyo ephansi, i-hypotension yegazi isimo sokushaqeka, ngisho nokuboshwa kwe-cardio-circulatory.

I-pulmonary arterial hypertension (noma i-PAH)

Isifo esingavamile, i-pulmonary arterial hypertension (PAH) ibonakala ngomfutho wegazi ophezulu ngendlela engavamile emithanjeni emincane yamaphaphu, ngenxa yokuqina kolwelwesi lwemithambo yamaphaphu. Ukuze kunxeshezelwe ukugeleza kwegazi okuncishisiwe, i-ventricle engakwesokudla yenhliziyo kufanele-ke yenze umzamo owengeziwe. Uma ingasaphumeleli, kuvela ukungakhululeki kokuphefumula lapho uzikhandla. Esigabeni esithuthukisiwe, isiguli singase sibe nokuhluleka kwenhliziyo.

Lesi sifo singenzeka ngezikhathi ezithile (i-idiopathic PAH), esimweni somndeni (i-PAH yomndeni) noma senze inkambo yezifo ezithile (isifo senhliziyo esibelethwe, umfutho wegazi ophakeme, ukutheleleka nge-HIV).

I-Chronic thromboembolic pulmonary hypertension (HTPTEC)

Kuwuhlobo olungavamile lwe-pulmonary hypertension, engenzeka ngenxa yokungaxazululwa kwe-pulmonary embolism. Ngenxa yehlule elivala umthambo wamaphaphu, ukugeleza kwegazi kuncipha, okwandisa umfutho wegazi emthanjeni. I-HPPTEC ibonakala ngezimpawu ezihlukene, ezingase zivele phakathi kwezinyanga ezingu-6 neminyaka engu-2 ngemva kwe-pulmonary embolism: ukuphefumula, ukuquleka, i-edema emilenzeni, ukukhwehlela ngesikhwehlela esinegazi, ukukhathala, ubuhlungu besifuba.

Ukwelashwa kwe-pulmonary embolism

Ukuphathwa kwe-pulmonary embolism kuncike ezingeni layo lobunzima. I-Anticoagulant therapy ngokuvamile yanele embolism yamaphaphu ethambile. Isekelwe kumjovo we-heparin izinsuku eziyishumi, bese uthatha ama-anticoagulants omlomo oqondile. Uma kwenzeka kuba nengozi enkulu ye-pulmonary embolism (ukushaqeka kanye / noma i-hypotension), umjovo we-heparin wenziwa kanye ne-thrombolysis (umjovo we-intravenous womuthi ozoncibilikisa ihlule) noma, uma lokhu kokugcina kuphikisana, i-embolectomy yokuhlinzwa yamaphaphu, ukubuyisela ngokushesha amaphaphu.

Ukwelashwa kwe-pulmonary arterial hypertension

Ngaphandle kwentuthuko yezokwelapha, alikho ikhambi le-PAH. Ukunakekelwa kwemikhakha eminingi kuhlanganiswa esinye sezikhungo zamakhono ezingama-22 eziqashelwa ukuphatha lesi sifo eFrance. Isekelwe ekwelashweni okuhlukahlukene (ikakhulukazi ngokuqhubekayo emthanjeni), imfundo yokwelapha kanye nokujwayela indlela yokuphila.

Ukwelashwa kwe-thromboembolic pulmonary hypertension engapheli

Ukuhlinzwa kwe-endarterectomy yamaphaphu kuyenziwa. Lokhu kungenelela kuhlose ukususa i-fibrotic thrombotic material evimbela imithambo yamaphaphu. Ukwelashwa nge-Anticoagulant nakho kunqunyiwe, imvamisa impilo yonke.

Ukuxilongwa kwe-pulmonary embolism kusekelwe ekuhlolweni okuphelele komtholampilo okubheka, ikakhulukazi, izimpawu ze-phlebitis, izimpawu ezivuna i-pulmonary embolism enzima (umfutho wegazi ophansi we-systolic kanye nesilinganiso senhliziyo esisheshayo). Ukuhlolwa okuhlukahlukene kwenziwa ngokuya ngokuhlolwa komtholampilo ukuze kuqinisekiswe ukuxilongwa nokuhlola ubulukhuni be-pulmonary embolism uma kunesidingo: ukuhlolwa kwegazi kwe-D-dimers (ukuba khona kwabo kuphakamisa ukuba khona kwehlule, igesi legazi le-arterial. CT i-angiography yamaphaphu iyindinganiso eyigolide yokuhlonza i-arterial thrombosis umthelela ekusebenzeni kwamaphaphu, i-ultrasound yezitho ezingezansi ukuze kubhekwe i-phlebitis.

Esimeni sokusolwa kwe-hypertension ye-pulmonary, i-ultrasound yenhliziyo yenziwa ukuze kugqanyiswe ukukhuphuka komfutho we-arterial wamaphaphu kanye nokunye okungavamile kwenhliziyo. Ihlanganiswe ne-Doppler, inikeza ukubonwa kokujikeleza kwegazi. I-catheterization yenhliziyo ingaqinisekisa ukuxilongwa. Okwenziwa kusetshenziswa i-catheter ende efakwe emthanjeni futhi ikhuphuke iye enhliziyweni bese ifinyelela emithanjeni yamaphaphu, kwenza kube nokwenzeka ukukala umfutho wegazi ezingeni le-atria yenhliziyo, umfutho we-arterial wamaphaphu kanye nokugeleza kwegazi.

I-Chronic pulmonary thromboembolic hypertension ngezinye izikhathi kunzima ukuyixilonga ngenxa yezimpawu zayo ezingaguquki. Ukuxilongwa kwayo kusekelwe ekuhlolweni okuhlukahlukene: i-echocardiography ukuqala nge-scintigraphy yamaphaphu futhi ekugcineni i-catheterization yenhliziyo efanele kanye ne-angiography yamaphaphu.