1. Kev siv tshuaj kho mob ntawm cov phiaj xwm ntshav coagulation hauv cov kab mob plawv thiab cerebrovascular
Thoob ntiaj teb, cov neeg uas muaj kab mob plawv thiab cov kab mob hlwb muaj coob heev, thiab nws qhia txog kev nce ntxiv txhua xyoo. Hauv kev kho mob, cov neeg mob feem ntau muaj lub sijhawm luv luv pib thiab muaj cov ntshav hauv hlwb, uas cuam tshuam tsis zoo rau kev kwv yees thiab ua rau cov neeg mob muaj kev nyab xeeb.
Muaj ntau yam kab mob ntawm cov kab mob plawv thiab cov kab mob cerebrovascular, thiab lawv cov yam ntxwv cuam tshuam kuj nyuaj heev. Nrog rau kev tshawb fawb txog kev coagulation tas mus li, nws pom tias hauv cov kab mob plawv thiab cov kab mob cerebrovascular, cov yam ntxwv coagulation kuj tseem siv tau ua cov yam ntxwv txaus ntshai rau tus kab mob no. Cov kev tshawb fawb hauv tsev kho mob tau qhia tias ob qho tib si txoj kev coagulation sab nraud thiab sab hauv ntawm cov neeg mob no yuav muaj feem cuam tshuam rau kev kuaj mob, kev ntsuam xyuas thiab kev kwv yees ntawm cov kab mob no. Yog li ntawd, kev ntsuam xyuas tag nrho ntawm kev pheej hmoo coagulation ntawm cov neeg mob yog qhov tseem ceeb heev rau cov neeg mob uas muaj kab mob plawv thiab cov kab mob cerebrovascular. qhov tseem ceeb.
2. 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 cov cim qhia txog kev coagulation
Cov kab mob plawv thiab cov kab mob cerebrovascular yog cov kab mob uas ua rau tib neeg muaj kev phom sij rau kev noj qab haus huv thiab lub neej, nrog rau kev tuag ntau thiab cov neeg xiam oob qhab ntau.
Los ntawm kev kuaj pom kev ua haujlwm ntawm cov ntshav coagulation hauv cov neeg mob uas muaj kab mob plawv thiab cerebrovascular, nws muaj peev xwm los ntsuas seb tus neeg mob puas muaj ntshav thiab qhov kev pheej hmoo ntawm kev mob venous thrombosis; nyob rau hauv cov txheej txheem ntawm kev kho mob anticoagulation tom qab, cov nyhuv anticoagulation kuj tseem tuaj yeem soj ntsuam thiab cov tshuaj kho mob tuaj yeem raug coj los siv kom tsis txhob los ntshav.
1). Cov neeg mob stroke
Kab mob cardioembolic yog ib hom kab mob stroke uas tshwm sim los ntawm kev tawg ntawm cov hlab ntsha hauv lub hlwb, uas yog li ntawm 14% txog 30% ntawm tag nrho cov kab mob stroke. Ntawm lawv, kab mob stroke uas cuam tshuam nrog atrial fibrillation yog ntau dua 79% ntawm tag nrho cov kab mob stroke cardioembolic, thiab kab mob stroke cardioembolic yog qhov hnyav dua, thiab yuav tsum tau kuaj xyuas thaum ntxov thiab ua haujlwm. Txhawm rau ntsuas qhov kev pheej hmoo ntawm kev txhaws thiab kev kho mob anticoagulation ntawm cov neeg mob, thiab kev kho mob anticoagulation hauv tsev kho mob yuav tsum siv cov ntsuas coagulation los ntsuas cov nyhuv anticoagulation thiab cov tshuaj anticoagulation kom raug kom tiv thaiv kev los ntshav.
Qhov kev pheej hmoo loj tshaj plaws rau cov neeg mob uas muaj atrial fibrillation yog arterial thrombosis, tshwj xeeb tshaj yog cerebral embolism. Cov lus qhia tiv thaiv kev coagulation rau cerebral infarction uas yog los ntawm atrial fibrillation:
1. Tsis pom zoo kom siv cov tshuaj anticoagulants tam sim ntawd rau cov neeg mob uas muaj mob hlwb loj heev.
2. Rau cov neeg mob uas tau kho nrog thrombolysis, feem ntau tsis pom zoo kom siv cov tshuaj anticoagulants hauv 24 teev.
3. Yog tias tsis muaj kev tsis pom zoo xws li kev los ntshav, kab mob siab thiab raum hnyav, ntshav siab >180/100mmHg, thiab lwm yam, cov mob hauv qab no tuaj yeem suav tias yog kev xaiv siv cov tshuaj anticoagulants:
(1) Cov neeg mob uas muaj mob plawv nres (xws li lub plawv dhia tsis ua haujlwm, atrial fibrillation, myocardial infarction nrog mural thrombus, sab laug atrial thrombosis, thiab lwm yam) feem ntau yuav mob stroke dua.
(2) Cov neeg mob uas muaj mob stroke ischemic nrog rau protein C tsis txaus, protein S tsis txaus, protein C tsis kam thiab lwm cov neeg mob thromboprone; cov neeg mob uas muaj cov tsos mob extracranial dissecting aneurysm; cov neeg mob uas muaj intracranial thiab intracranial artery stenosis.
(3) Cov neeg mob pw hauv txaj uas muaj mob hlwb infarction tuaj yeem siv cov tshuaj heparin tsawg lossis cov tshuaj LMWH sib xws los tiv thaiv kev txhaws ntawm cov hlab ntsha tob thiab pulmonary embolism.
2). Tus nqi ntawm kev saib xyuas cov ntsuas coagulation thaum siv cov tshuaj anticoagulant
• PT: Kev ua haujlwm ntawm INR hauv chav kuaj mob zoo thiab siv tau los coj kev hloov kho koob tshuaj ntawm warfarin; ntsuas qhov kev pheej hmoo ntawm kev los ntshav ntawm rivaroxaban thiab edoxaban.
• APTT: Siv tau los ntsuam xyuas qhov ua tau zoo thiab kev nyab xeeb ntawm (cov koob tshuaj nruab nrab) unfractionated heparin thiab los ntsuam xyuas qhov kev pheej hmoo ntawm kev los ntshav ntawm dabigatran.
• TT: Rhiab rau dabigatran, siv los xyuas seb dabigatran seem nyob hauv cov ntshav.
• D-Dimer/FDP: Nws siv tau los ntsuam xyuas cov txiaj ntsig kho mob ntawm cov tshuaj anticoagulant xws li warfarin thiab heparin; thiab los ntsuam xyuas cov txiaj ntsig kho mob ntawm cov tshuaj thrombolytic xws li urokinase, streptokinase, thiab alteplase.
• AT-III: Nws siv tau los qhia txog cov teebmeem ntawm cov tshuaj heparin, cov tshuaj heparin uas hnyav molecular tsawg, thiab fondaparinux, thiab los qhia seb puas tsim nyog hloov cov tshuaj anticoagulants hauv kev kho mob.
3). Kev tiv thaiv kev coagulation ua ntej thiab tom qab cardioversion ntawm atrial fibrillation
Muaj kev pheej hmoo ntawm thromboembolism thaum lub sijhawm cardioversion ntawm atrial fibrillation, thiab kev kho mob anticoagulation tsim nyog tuaj yeem txo qhov kev pheej hmoo ntawm thromboembolism. Rau cov neeg mob hemodynamically tsis ruaj khov uas muaj atrial fibrillation xav tau cardioversion sai, qhov pib ntawm anticoagulation yuav tsum tsis txhob ncua cardioversion. Yog tias tsis muaj kev tsis sib haum xeeb, heparin lossis low molecular weight heparin lossis NOAC yuav tsum tau siv sai li sai tau, thiab cardioversion yuav tsum tau ua tib lub sijhawm.
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