Sobanukirwa n’indwara ya “pulmonary embolism”, indwara yica vuba, ikibasira ab’igitsina gore batwite cyangwa abamaze kubyara

Pulmonary embolism mu magambo ahinnye PE (ambolie pulmonaire mu gifransa) ni kuziba ( obstruction), kwifunga gutunguranye kw’imitsi y’ibihaha kubera utubumbe tw’amaraso tuba twikoze ( blood clot) cyangwa ikindi kintu kiba cyinjiye mu maraso kivuye hanze.

Iyi ni indwara ikomeye cyane yibasira Ibihaha,Ku rwego rw’isi, iyi ndwara iri mu mpamvu nyamukuru z’urupfu rutunguranye, kandi mu buzima bw’abagore batwite cyangwa babyaye vuba ikaba ikibazo gikomeye cyane.

Imibare igaragaza ko ku bagore batwite 1 kuri 1000 afatwa n’ubu burwayi, ikaba ari imwe mu mpamvu zikomeye z’urupfu rw’ababyeyi mu bihugu bifite ubuvuzi budateye imbere.

Mu bihugu byinshi, pulmonary embolism iri mu mpamvu eshatu za mbere z’urupfu rw’abagore batwite cyangwa babyaye vuba. Ibi bigaragaza ko ari ikibazo gikomeye mu buzima bw’ababyeyi, gikwiye kwitabwaho n’inzego z’ubuzima rusange.

Nubwo iboneka gake, ubukana bwayo butuma iba ikibazo gikomeye mu buzima rusange, ikaba ikwiye kwitabwa nk’ ikibazo cy’ubuzima gikeneye ubutabazi bwihuse.

Muri iyi nkuru turagaruka ku miterere y’iyi ndwara, impamvu yibasira ab’igitsina gore n’uburyo bwo kuyirinda.

Pulmonary Embolism ni iki ?

Pulmonary embolism ni indwara ikomeye yibasira bihaha, aho ikirimvi (amaraso yafatanye), blood clot cyangwa ikindi kintu kiba cyinjiye mu maraso (corps etranger) kigafunga imitsi y’ibihaha (artères pulmonaires). Ibi bituma igice cy’ibihaha, ibi byabereyemo kidakomeza kubona na oxygen, bikaba bishobora guteza kubura umwuka cyangwa urupfu rutunguranye.

Thrombose: Ivura ry’amaraso mu mijyana (veine) intandaro ya pulmonary embolism

Iyo umuntu akomeretse akava amaraso, umubiri ukoresha uturemangingo tw’amaraso twitwa plaquettes n’ibindi bice by’amaraso kugira ngo ahagarike uko kuva kw’amaraso.
Iki ni igikorwa cy’ingenzi mu kurinda umuntu gupfa kubera gutakaza amaraso menshi kuko iyo amaraso yifunze neza aho hakomeretse, bituma igikomere gikira vuba.

Ariko nanone hari igihe amaraso yifunga mu mutsi imbere mu mubiri, n’aho nta gikomere gihari.
Iyo ibi bibaye, yabaye ikirimvi, yavuze, ashobora kubuza amaraso asanzwe gutembera neza.

Ibi bitera indwara yitwa thrombose (Deep Vein Thrombosis – DVT) .
Iyi ndwara ishobora guteza:
1. Uburibwe n’ububyimbirwe mu kaguru cyangwa ahandi.
2. Amaraso yavuze ashobora kwiyongera akagera mu bihaha (embolisme pulmonaire), bikaba byateza urupfu rutunguranye.

 

Nubwo akenshi thrombose iterwa n’ikirimvi (blood clot), hari n’igihe ishobora guterwa n’ibintu bintu byavuye hanze y’amaraso (corps étrangers) byinjiye mu maraso. Ibi bintu bishobora kuba:

1.Akabumbe k’amavuta (fat embolism): kava mu magufwa yakomeretse, kagakwirakwira mu maraso.

2.Umwuka cyangwa gazi (air/gas embolism): iyo byinjiye mu maraso bibyara ambolie iyo bigeze mu bihaha.

3. Amniotic fluid Amazi yo mu ngobyi y’umwana:(liquide amniotique): mu gihe cyo kubyara ashobora kwinjira mu maraso, bikaba byatera trhrombose ikomeye.

3. Ibindi bice by’umubiri cyangwa ibintu bivuye hanze y’amaraso  bishobora kwinjira mu maraso mu gihe cyo kubagwa cyangwa mu mpanuka.

Ibyongerera ibyago byo kurwara PE: (Facteurs de risque)
– Kudakora siporo no kwicara igihe kirekire (immobilisation prolongée).
– Gutwita cyangwa kuba umaze kubyara.
– Kubagwa cyangwa gukomereka bikomeye.
– Karande mu muryango(antécédents familiaux) w’indwara z’amaraso.
– Indwara zongerera amaraso gufatana (cancer, indwara z’umutima).
– Imyaka ikuze cyangwa ibiro byinshi (obésité).

Intambwe ku yindi y’uburwayi bwa PE

Dore inzira zinyurwamo ngo habeho Pulmonary embolism
1. Kwirema kw’ikirimvi cy’amaraso mu mutsi minini yo mu maguru no ku kibuno, thrombus, ( Triade de Virchow) biturutse ku kwicara igihe kirekire (stase veineuse), uburwayi bw’umutsi (alteration de la paroi veineuse) cyangwa ifatana ry’amaraso ryatewe n’uburwayi (hypercoagulabilité sanguine). Bishobora kuba kandi ari ikindi kintu kidasanzwe cyinjiye mu maraso nk’uko twakomeje kubivuga.

2. Kwimuka kw’ikirimvi (ambolisation) kiva muri ya mitsi minini yo mu maguru no ku kibuno (veines profondes),kikerekeza mu dutsi duto two mu bihaha( arteres pulmonaires) kibanje kwambukiranya veine cave n’igice cy’iburyo cy’umutima ( oreilette droit na ventricule droit).

3. Ifungwa, kuziba k’udutsi two mu bihaha( obstruction): Trombose ifunga udutsi two mu bihaha, bityo kuri ibi bice, ibihaha bikakira oxygen ariko ntishobore guhura n’amaraso.
Iyo oxygen ibuze cyangwa ikaba nke biyera:
– Guhumeka bigoranye (dyspnée)
-Umutima utera vuba (tachycardie)
– Kuyoba cyangwa kutibuka neza (confusion)
– Uruhu ruba rufite ibara ry’ubururu (cyanose)
-Ndetse mu bihe bikomeye bikaba bishobora guteza arrêt cardiorespiratoire.

Icyitonderwa

– Igice cy’umutima cy’uburyo ni inzira,transit, gisunika amaraso yose ajya mu bihaha, nta mitsi mito yabangamira itemba ry’amaraso, niyo mpamvu embolism ikunda kugaragara mu bihaha ahari imitsi mito, capillaires.

– Igice cy’umutima cy’ibumoso: gikorerwamo imirimo yo kohereza amaraso mu bice byose by’umubiri. Kubera imitsi mito ihaboneka (coronary arteries, carotid arteries, mesenteric arteries, renal arteries), hashobora kuba isoko ya za embolism zishobora gufatirana aha,zigatera uburwayi ibindi bice by’umubiri.

Ibindi bice by’umubiri bishobora kwibasirwa ni ibi:

– Ubwonko: embolism iva mu mutima w’ibumoso ishobora kugera mu carotid arteries, bigatera stroke.

– Amara: embolism mu mesenteric arteries ishobora kubangamira amaraso ajya mu mara.

– Impyiko: embolism mu renal arteries ishobora kubangamira amaraso ajya mu mpiyiko.

Ibimenyetso bya Pulomonary Embolism (Symptômes)

– Kubura umwuka (dyspnée), rimwe na rimwe bitunguranye.
– Kubabara mu gituza, cyane iyo umuntu ahumeka cyane.
– Gucika intege cyangwa guhorana umunaniro.
– Kubyimba amaguru cyangwa kubabara mu kuguru (iyo ikirimvi cyaturutse mu mitsi y’amaguru).
– Kureba uruhu rwirabura, rw’ubururu cyangwa rwererana (cyanose) kubera ibura rya oxygen.

Uko bita ku murwayi wa PE: Prise en charge
– Imiti ya Anticoagulants: imiti igabanya ifatana ry’amaraso ,ikabuza ikirimvi gukura.
– Thrombolytiques: imiti isenya ikirimvi mu gihe uburwayi bukomeye.
– Oxygénothérapie: gushyira umurwayi kuri oxygen kugira ngo bihaha bikomeze gukora.
– Chirurgie cyangwa catheter-directed therapy: mu gihe ikirimvi ari kinini cyane.
Cachéter ikoreshwa yinjizwa mu mitsi ijyana amaraso mu bihaha kugira ngo akuremo cyangwa asenye igipfundo cy’amaraso.

Icyitonderwa
Mu gihe Pulmonary Embolism iba ikomeye cyane, rimwe na rimwe hakenerwa uburyo bwo kuvura ikirimvi mu bihaha hakoreshejwe chirurgie cyangwa catheter-directed therapy. Ariko ibi ni ibintu bigoranye cyane mu buvuzi kubera impamvu zikurikira:

– Ikoranabuhanga rikomeye: bisaba ibikoresho bigezweho nka cathéter zishobora kugera mu mitsi y’ibihaha, cyangwa imashini zishobora gufata ikirimvi mu maraso.
– Abaganga babimenyereye: bisaba abahanga mu buvuzi bw’umutima n’ibihaha bafite ubumenyi buhanitse.
– Ibyago byinshi: kubaga embolie bifite ibyago bikomeye byo gutera kuva kw’amaraso, kubura umwuka, cyangwa crise y’umutima.
– Kubura ibikoresho mu bihugu bikiri mu nzira y’iterambere: ibi bituma kuvura embolie mu buryo bwa chirurgie biba ibintu bidashoboka, bikaba ari imwe mu mpamvu ikunze guhitana benshi aho ubuvuzi butaratera imbere.

Ab’igitsinagore batwite n’abamaze kubyara mu bakunze kwibasirwa na PE

Pulmonary embolism ni indwara ikunze kwibasira cyane abagore batwite ndetse n’abamaze kubyara. Ibi biterwa n’impinduka ziba mu mubiri w’umugore mu gihe cyo gutwita no mu gihe cya nyuma yo kubyara (postpartum).

Impamvu nyamukuru:
– Impinduka mu maraso (hypercoagulabilité): mu gihe cyo gutwita, amaraso y’umugore aba afite ubushobozi bwo gufatana cyane kugira ngo yirinde kuva kw’amaraso igihe cyo kubyara. Ariko ibi bituma ibyago byo kugira ikirimvi (blood clot) byiyongera.
– Inda ibyiga ibice by’umubiri (Compression mécanique): inda ikura igahindura uburyo amaraso atembera mu mitsi y’amaguru no mu kibuno, bigatuma amaraso agenda gahoro, bikorohera ikirimvi kwirema.
– Impinduka zikomeye nyuma yo kubyara, umubiri uba ukiri mu bihe byo guhinduka cyane mu maraso no mu mitsi, bikongera ibyago bya PE.
– Imibereho n’imiterere: kwicara cyangwa kuryama igihe kirekire mu gihe cyo gutwita, kubagwa (cesarienne), cyangwa kubyara bikomeye nabyo byongera ibyago.

Ibyongera ibyago byo kurwara PE byihariye ku bagore:
– Gutwita ku myaka ikuze.
– Kubagwa (cesarienne) cyangwa kubyara biruhanije.

Pulmonary Embolism nk’Ikibazo cy’Ubuzima gikeneye ubutabazi bwihuse (urgence médicale)

Pulmonary embolism ni indwara ikomeye cyane, ikwiye kwitabwaho, ni urgence médicale. Ibi bivuze ko igihe umuntu agaragaje ibimenyetso bya PE, agomba guhita ajyanwa kwa muganga vuba na bwangu, kuko gutinda bishobora gutuma apfa bitunguranye.

Impamvu ikomeye yo kuba emergency
– PE ifunga imitsi y’ibihaha, bigatuma igice cy’ibihaha kidakomeza kubona amaraso n’oxygen.
– Kubura umwuka no gucika intege bishobora gutangira mu minota mike, bikaba byatera urupfu rutunguranye.
– Iyo itavuwe vuba, PE ishobora guteza indwara y’umutima, crise cardiaque cyangwa choc circulatoire (amaraso ntabe akigera neza mu bice binyuranye by’umubiri), akaba ari ikibazo gikomeye cyane.

Impamvu ikunze guhitana benshi mu bihugu bifite ubuvuzi butaratera imbere
– Kudashobora gusuzuma vuba: mu bihugu byinshi bidafite ibikoresho bigezweho (scanner, imiti yihuse), PE ikunze kwitiranywa n’izindi ndwara z’ibihaha cyangwa umutima.
– Kudashobora kubona imiti ikenewe: imiti igabanya amaraso gufatana (anticoagulants) cyangwa isenya ikirimvi (thrombolytiques) ikunze kubura.
– Kudashobora kubona oxygen cyangwa ubuvuzi bwihuse: ibi bituma abarwayi bagira ibibazo bikomeye mu bihaha no mu mutima.
– Kudashobora kubona abavuzi b’inzobere: PE ikunze kwitiranywa n’indwara zisanzwe zifata ibihaha (nk’igituntu cyangwa asthma), bigatuma itavurwa neza.

Inama zo kwirinda PE

Nubwo Pulmonary Embolism ari indwara ikomeye, hari uburyo bworoshye bwo kugabanya ibyago byo wakwibasirwa nayo:

– Kugira imyitozo yoroheje: kugenda, gukora siporo yoroheje cyangwa guhagarara buri kanya mu gihe umubyeyi atwite na nyuma yo kubyara, kugira ngo amaraso atembere neza.
– Kwambara bas de contention (stockings): bifasha kugabanya amaraso ahagarara mu mitsi y’amaguru.
– Kwirinda kwicara cyangwa kuryama igihe kirekire: guhaguruka no kugenda buri kanya, cyane cyane mu ngendo ndende cyangwa mu gihe cyo gutwita.
– Kwihutira kujya kwa muganga: igihe hagaragaye ibimenyetso nka kubura umwuka, kubabara mu gituza, cyangwa kubyimba amaguru.
– Kwitondera kubagwa (cesarienne) n’ibindi bikorwa bikomeye byatera kuvura kw’amaraso;

Impamvu nyamukuru zituma amaraso ashobora gufatana nyuma ya césarienne cyangwa operation ikomeye
– Immobilisation (kudakora): nyuma yo kubagwa, umurwayi akenshi amarana igihe kinini aryamye cyangwa yicaye, amaraso agahagarara mu mitsi y’amaguru. Ibi ni kimwe mu bituma ikirimvi cyikora.
– Trauma ku mitsi: kubagwa bigira ingaruka ku mitsi n’amaraso, bikaba bishobora gutuma amaraso atembera neza.
– Hypercoagulabilité naturelle mu gihe cyo gutwita: mu gihe cyo kubyara, amaraso y’umugore aba afite ubushobozi bwo gufatana cyane kugira ngo yirinde kuva kwinshi. Iyo bikomatanyijwe n’operation, ibyago biriyongera.
– Imiti ikoreshwa mu kubaga: koko hari imiti ikoreshwa mu kubaga ishobora kugira uruhare mu guhindura uburyo amaraso atembera cyangwa gufatana.
– Kugenzurwa n’abaganga: abagore batwite cyangwa babyaye bafite ibyago byinshi (obésité, indwara z’umutima, cancer, cyangwa amateka y’indwara z’amaraso) bagomba kugenzurwa kenshi.

Twifashishije: www.vidal.fr na www.ameli.fr

Umwandutsi: Musengimana Emmanuel