No ke aha e ʻike ʻia ai ka D-dimer, FDP i nā poʻe maʻi cardiovascular a me cerebrovascular?
1. Hiki ke hoʻohana ʻia ka D-dimer e alakaʻi i ka hoʻoponopono ʻana o ka ikaika anticoagulation.
(1) ʻO ka pilina ma waena o ka pae D-dimer a me nā hanana lapaʻau i ka wā o ka lāʻau anticoagulation i nā maʻi ma hope o ka hoʻololi ʻana o ka valve puʻuwai mechanical.
Ua hoʻohālikelike pono ka hui lapaʻau hoʻoponopono ikaika anticoagulation i alakaʻi ʻia e D-dimer i ka palekana a me ka pono o ka lāʻau anticoagulation, a ʻo ka nui o nā hanana ʻino like ʻole ua haʻahaʻa loa ia ma mua o ka hui kaohi e hoʻohana ana i ka anticoagulation maʻamau a me ka haʻahaʻa.
(2) Pili loa ka hoʻokumu ʻia ʻana o ka cerebral venous thrombosis (CVT) i ke ʻano o ka thrombus.
Nā alakaʻi no ka ʻike ʻana a me ka mālama ʻana i ka thrombosis vein kūloko a me ka venous sinus (CVST)
Ke ʻano o ka thrombosis: PC, PS, AT-lll, ANA, LAC, HCY
Hoʻololi ʻana o ka gene: gene prothrombin G2020A, coagulation factor LeidenV
Nā mea hoʻouluulu: ka wā perinatal, nā hana pale hānau, ka maloʻo ʻana o ka wai, ka trauma, ke ʻoki kino, ka maʻi, ka puʻupuʻu, ka pohō kaumaha.
2. ʻO ka waiwai o ka ʻike ʻana i hui pū ʻia o D-dimer a me FDP i nā maʻi cardiovascular a me cerebrovascular.
(1) He mea kōkua ka hoʻonui ʻia ʻana o ka D-dimer (ʻoi aku ma mua o 500ug/L) no ka ʻike ʻana i ka CVST. ʻAʻole hōʻole ka maʻamau i ka CVST, ʻoiai ma CVST me ka ʻeha poʻo i hoʻokaʻawale ʻia i kēia manawa wale nō. Hiki ke hoʻohana ʻia ma ke ʻano he hoʻokahi o nā hōʻailona o ka ʻike ʻana i ka CVST. Hiki ke hoʻohana ʻia ka D-dimer kiʻekiʻe ma mua o ka maʻamau ma ke ʻano he hoʻokahi o nā hōʻailona diagnostic o CVST (pae III, hōʻike pae C).
(2) Nā hōʻailona e hōʻike ana i ka lāʻau thrombolytic kūpono: Ua piʻi nui ka nānā ʻana o D-dimer a laila ua emi mālie; Ua piʻi nui ka FDP a laila ua emi mālie. ʻO kēia mau hōʻailona ʻelua ke kumu pololei no ka lāʻau thrombolytic kūpono.
Ma lalo o ka hana a nā lāʻau thrombolytic (SK, UK, rt-PA, a pēlā aku), ua hoʻoheheʻe koke ʻia nā emboli i loko o nā kīʻaha koko, a ua hoʻonui nui ʻia ka D-dimer a me FDP i loko o ka plasma, kahi e mau ai no 7 mau lā. I ka wā o ka mālama ʻana, inā lawa ʻole ka nui o nā lāʻau thrombolytic a ʻaʻole i hoʻoheheʻe loa ʻia ka thrombus, e hoʻomau ka D-dimer a me FDP i nā pae kiʻekiʻe ma hope o ka hiki ʻana i ka piko; Wahi a nā helu helu, ʻo ka nui o ke kahe koko ma hope o ka lāʻau thrombolytic he 5% a 30%. No laila, no nā maʻi me nā maʻi thrombotic, pono e hoʻokumu ʻia kahi regimen lāʻau paʻa, pono e nānā ʻia ka hana coagulation plasma a me ka hana fibrinolytic i ka manawa maoli, a pono e hoʻomalu maikaʻi ʻia ka nui o nā lāʻau thrombolytic. Hiki ke ʻike ʻia he waiwai nui ka ʻike ʻana o ka D-dimer a me ka FDP ma mua, i ka wā a ma hope o ka mālama ʻana i ka wā o ka thrombolysis no ka nānā ʻana i ka pono a me ka palekana o nā lāʻau thrombolytic.
No ke aha e pono ai i nā poʻe maʻi me nā maʻi puʻuwai a me nā maʻi cerebrovascular e hoʻolohe i ka AT?
Ka hemahema o Antithrombin (AT) He kuleana koʻikoʻi ko Antithrombin (AT) i ke kāohi ʻana i ka hoʻokumu ʻana o thrombus, ʻaʻole ia e kāohi wale i ka thrombin, akā e kāohi pū i nā mea coagulation e like me IXa, Xa, Xla, Xlla a me Vlla. ʻO ka hui pū ʻana o ka heparin a me AT he ʻāpana koʻikoʻi ia o ka anticoagulation AT. I ke alo o ka heparin, hiki ke hoʻonui ʻia ka hana anticoagulant o AT i nā tausani manawa. ʻO ka hana o AT, no laila he mea nui ʻo AT no ke kaʻina hana anticoagulant o heparin.
1. Ke kū'ē ʻana i ka Heparin: Ke emi ka hana o AT, ua emi nui ka hana anticoagulant o ka heparin a i ʻole hana ʻole. No laila, pono e hoʻomaopopo i ka pae o AT ma mua o ka mālama ʻana i ka heparin e pale aku i ka mālama ʻana i ka heparin kiʻekiʻe pono ʻole a me ka hopena ʻole o ka lāʻau.
Ma nā hōʻike moʻokalaleo he nui, ʻike ʻia ka waiwai lapaʻau o D-dimer, FDP, a me AT i nā maʻi cardiovascular a me cerebrovascular, hiki ke kōkua i ka ʻike mua ʻana, ka hoʻoholo ʻana i ke kūlana a me ka loiloi prognosis o ka maʻi.
2. Nānā ʻana no ke kumu o ka thrombophilia: ʻIke ʻia nā maʻi me ka thrombophilia e ka thrombosis vein hohonu nui a me ka thrombosis pinepine. Hiki ke hana ʻia ka nānā ʻana no ke kumu o ka thrombophilia ma nā hui aʻe:
(1) VTE me ke kumu ʻike ʻole ʻia (me ka thrombosis neonatal)
(2) VTE me nā mea hoʻoikaika <40-50 mau makahiki
(3) ʻO ka thrombosis a i ʻole ka thrombophlebitis i hana hou ʻia
(4) Moʻolelo ʻohana o ka thrombosis
(5) ʻO ka thrombosis ma nā wahi ʻē: mesenteric vein, cerebral venous sinus
(6) Hāʻule pinepine ʻana, hānau make ʻana, a pēlā aku.
(7) Hāpai keiki, nā mea pale hānau, ka thrombosis i hoʻoulu ʻia e ka hormone
(8) Necrosis ʻili, ʻoi aku hoʻi ma hope o ka hoʻohana ʻana i ka warfarin
(9) ʻO ka thrombosis arterial o ke kumu i ʻike ʻole ʻia <20 mau makahiki
(10) Nā hoahānau o ka thrombophilia
3. Ka loiloi ʻana i nā hanana cardiovascular a me ka hoʻi hou ʻana: Ua hōʻike ʻia nā haʻawina ʻo ka emi ʻana o ka hana AT i nā poʻe maʻi me ka maʻi cardiovascular ma muli o ka hōʻino ʻia ʻana o nā cell endothelial e alakaʻi ai i ka nui o ka AT e hoʻopau ʻia. No laila, i ka wā e noho ai nā poʻe maʻi i kahi kūlana hypercoagulable, ua maʻalahi lākou i ka thrombosis a hoʻonui i ka maʻi. Ua haʻahaʻa loa ka hana o AT i ka heluna kanaka me nā hanana cardiovascular hou ma mua o ka heluna kanaka me ka ʻole o nā hanana cardiovascular hou.
4. Ka loiloi ʻana o ka pilikia thrombosis i ka fibrillation atrial non-valvular: ua pili pono ka pae hana AT haʻahaʻa me ka helu CHA2DS2-VASc; i ka manawa like, he waiwai kuhikuhi kiʻekiʻe kona no ka loiloi ʻana i ka thrombosis i ka fibrillation atrial non-valvular.
5. Ka pilina ma waena o AT a me ka hahau ʻana: Ua emi nui ʻo AT i nā poʻe maʻi me ka hahau ischemic acute, aia ke koko i kahi kūlana hypercoagulable, a pono e hāʻawi ʻia ka lāʻau anticoagulation i ka manawa kūpono; pono e hoʻāʻo mau ʻia nā poʻe maʻi me nā mea pilikia o ka hahau ʻana no AT, a pono e hana ʻia ka ʻike mua ʻana i ke koko kiʻekiʻe o nā poʻe maʻi. Pono e mālama ʻia ke kūlana coagulation i ka manawa kūpono e pale aku ai i ka hanana ʻana o ka hahau ʻana acute.
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