Vim li cas thiaj yuav tsum kuaj pom D-dimer, FDP hauv cov neeg mob plawv thiab cov neeg mob hlwb?
1. D-dimer siv tau los coj kev hloov kho lub zog anticoagulation.
(1) Kev sib raug zoo ntawm D-dimer theem thiab cov xwm txheej hauv kev kho mob thaum lub sijhawm anticoagulation therapy rau cov neeg mob tom qab hloov lub plawv valve.
Pawg kho mob kho qhov hnyav ntawm kev siv tshuaj anticoagulation uas siv D-dimer ua tau zoo sib npaug rau kev nyab xeeb thiab kev ua haujlwm ntawm kev siv tshuaj anticoagulation, thiab qhov tshwm sim ntawm ntau yam teeb meem tsis zoo yog qis dua li pawg tswj hwm siv cov tshuaj anticoagulation txheem thiab qis.
(2) Kev tsim ntawm cerebral venous thrombosis (CVT) muaj feem cuam tshuam nrog rau cov thrombus constitution.
Cov lus qhia rau kev kuaj mob thiab kev tswj hwm ntawm cov hlab ntsha sab hauv thiab cov hlab ntsha venous sinus thrombosis (CVST)
Kev tsim cov ntshav txhaws: PC, PS, AT-lll, ANA, LAC, HCY
Kev hloov pauv ntawm cov noob caj noob ces: prothrombin gene G2020A, coagulation factor LeidenV
Cov yam ua rau ua rau muaj teeb meem: lub sijhawm perinatal, kev tiv thaiv kev xeeb tub, lub cev qhuav dej, raug mob, phais, kis kab mob, qog nqaij hlav, poob phaus.
2. Tus nqi ntawm kev kuaj pom ua ke ntawm D-dimer thiab FDP hauv cov kab mob plawv thiab cov hlab ntsha hauv lub hlwb.
(1) Kev nce D-dimer (ntau dua 500ug/L) pab tau rau kev kuaj mob CVST. Kev ntsuas ib txwm tsis txiav txim siab CVST, tshwj xeeb tshaj yog hauv CVST uas muaj mob taub hau cais tawm tsis ntev los no. Nws tuaj yeem siv ua ib qho ntawm cov cim qhia ntawm kev kuaj mob CVST. D-dimer siab dua li qub tuaj yeem siv ua ib qho ntawm cov cim qhia ntawm CVST (qib III kev pom zoo, qib C pov thawj).
(2) Cov cim qhia txog kev kho mob thrombolytic zoo: Kev saib xyuas D-dimer nce ntxiv ntau thiab tom qab ntawd txo qis maj mam; FDP nce ntxiv ntau thiab tom qab ntawd txo qis maj mam. Ob qho cim no yog lub hauv paus ncaj qha rau kev kho mob thrombolytic zoo.
Nyob rau hauv kev ua ntawm cov tshuaj thrombolytic (SK, UK, rt-PA, thiab lwm yam), cov emboli hauv cov hlab ntsha tau yaj sai, thiab D-dimer thiab FDP hauv cov ntshav tau nce ntxiv ntau, uas feem ntau kav ntev li 7 hnub. Thaum kho mob, yog tias cov tshuaj thrombolytic tsis txaus thiab cov thrombus tsis yaj tag, D-dimer thiab FDP yuav txuas ntxiv mus rau qib siab tom qab mus txog qhov siab tshaj plaws; Raws li cov ntaub ntawv txheeb cais, qhov tshwm sim ntawm kev los ntshav tom qab kev kho mob thrombolytic yog siab txog li 5% txog 30%. Yog li ntawd, rau cov neeg mob uas muaj kab mob thrombotic, yuav tsum tau tsim cov tshuaj nruj, cov dej num plasma coagulation thiab fibrinolytic yuav tsum tau saib xyuas lub sijhawm tiag tiag, thiab cov tshuaj thrombolytic yuav tsum tau tswj hwm zoo. Nws tuaj yeem pom tias qhov kev kuaj pom dynamic ntawm D-dimer thiab FDP concentration hloov pauv ua ntej, thaum lub sijhawm thiab tom qab kev kho mob thaum lub sijhawm thrombolysis muaj txiaj ntsig zoo rau kev saib xyuas qhov ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj thrombolytic.
Vim li cas cov neeg mob uas muaj kab mob plawv thiab cov hlab ntsha hauv lub hlwb yuav tsum tau ua tib zoo saib xyuas AT?
Antithrombin (AT) tsis txaus Antithrombin (AT) ua lub luag haujlwm tseem ceeb hauv kev tiv thaiv kev tsim thrombus, nws tsis tsuas yog tiv thaiv thrombin, tab sis kuj tiv thaiv cov yam ntxwv coagulation xws li IXa, Xa, Xla, Xlla thiab Vlla. Kev sib xyaw ua ke ntawm heparin thiab AT yog ib feem tseem ceeb ntawm AT anticoagulation. Thaum muaj heparin, cov haujlwm anticoagulant ntawm AT tuaj yeem nce ntxiv los ntawm ntau txhiab zaus. Cov haujlwm ntawm AT, yog li AT yog ib qho tseem ceeb rau cov txheej txheem anticoagulant ntawm heparin.
1. Kev tiv thaiv Heparin: Thaum cov haujlwm ntawm AT txo qis, cov haujlwm anticoagulant ntawm heparin raug txo qis lossis tsis ua haujlwm. Yog li ntawd, nws yog qhov tsim nyog los nkag siab txog qib ntawm AT ua ntej kev kho mob heparin kom tiv thaiv kev kho mob heparin ntau dhau thiab kev kho mob tsis zoo.
Hauv ntau cov ntawv sau txog kev kho mob, qhov tseem ceeb ntawm D-dimer, FDP, thiab AT tau pom tseeb hauv cov kab mob plawv thiab cov hlab ntsha hauv lub hlwb, uas tuaj yeem pab kuaj mob thaum ntxov, txiav txim siab txog tus mob thiab kev soj ntsuam kev kwv yees ntawm tus kab mob.
2. Kev tshuaj xyuas seb puas muaj kab mob thrombophilia: Cov neeg mob uas muaj kab mob thrombophilia feem ntau pom tias muaj cov hlab ntsha loj heev thiab cov ntshav rov qab los ntau zaus. Kev tshuaj xyuas seb puas muaj kab mob thrombophilia ua rau muaj kab mob no ua tau raws li cov pawg hauv qab no:
(1) VTE yam tsis muaj laj thawj pom tseeb (xws li cov menyuam mos uas muaj thrombosis)
(2) VTE nrog cov nyiaj pab txhawb nqa hnub nyoog qis dua 40-50 xyoo
(3) Mob ntshav txhaws rov qab los yog mob ntshav txhaws
(4) Keeb kwm tsev neeg ntawm thrombosis
(5) Kev txhaws ntawm cov qhov chaw tsis zoo: cov hlab ntsha mesenteric, cov hlab ntsha cerebral venous sinus
(6) Rov qab nchuav menyuam dua, yug menyuam tuag, thiab lwm yam.
(7) Kev xeeb tub, kev tiv thaiv kev xeeb tub, kev mob ntshav txhaws los ntawm cov tshuaj hormones
(8) Tawv nqaij lwj, tshwj xeeb tshaj yog tom qab siv warfarin
(9) Mob ntshav txhaws tsis paub vim li cas hnub nyoog qis dua 20 xyoo
(10) Cov txheeb ze ntawm cov neeg mob thrombophilia
3. Kev soj ntsuam cov teeb meem ntawm lub plawv thiab rov tshwm sim dua: Cov kev tshawb fawb tau qhia tias qhov txo qis ntawm AT kev ua haujlwm hauv cov neeg mob uas muaj kab mob plawv yog vim muaj kev puas tsuaj ntawm cov hlwb endothelial uas ua rau muaj ntau ntawm AT raug siv. Yog li ntawd, thaum cov neeg mob nyob rau hauv lub xeev hypercoagulable, lawv yuav muaj feem thrombosis thiab ua rau tus kab mob hnyav dua. Qhov kev ua haujlwm ntawm AT kuj tseem qis dua hauv cov pej xeem uas muaj cov teeb meem plawv rov tshwm sim dua li cov pej xeem uas tsis muaj cov teeb meem plawv rov tshwm sim.
4. Kev ntsuam xyuas qhov kev pheej hmoo ntawm thrombosis hauv cov atrial fibrillation uas tsis yog-valvular: qib AT ua haujlwm qis yog qhov sib raug zoo nrog CHA2DS2-VASc qhab nia; tib lub sijhawm, nws muaj tus nqi siv rau kev ntsuam xyuas thrombosis hauv cov atrial fibrillation uas tsis yog-valvular.
5. Kev sib raug zoo ntawm AT thiab mob stroke: AT raug txo qis heev rau cov neeg mob uas muaj mob stroke ischemic, cov ntshav nyob rau hauv lub xeev hypercoagulable, thiab kev kho mob anticoagulation yuav tsum tau muab raws sijhawm; cov neeg mob uas muaj cov yam ntxwv ua rau mob stroke yuav tsum tau kuaj xyuas AT tas li, thiab yuav tsum tau kuaj pom cov neeg mob ntshav siab thaum ntxov. Lub xeev coagulation yuav tsum tau kho raws sijhawm kom tsis txhob muaj mob stroke sai.
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