Gịnị mere e ji achọpụta D-dimer, FDP n'ime ndị nwere ọrịa obi na akwara ụbụrụ?
1. Enwere ike iji D-dimer duzie nhazi nke ike mgbochi coagulation.
(1) Mmekọrịta dị n'etiti ọkwa D-dimer na ihe omume ahụike n'oge ọgwụgwọ mgbochi coagulation n'ime ndị ọrịa mgbe ejiri valvụ obi mekaniki dochie ya.
Otu ọgwụgwọ mgbanwe n'ime usoro ọgwụgwọ nke D-dimer duziri na-edozi nchekwa na irè nke ọgwụgwọ nkwụsịtụ, na ihe omume dị iche iche na-adịghị mma dị obere karịa nke otu njikwa na-eji ọgwụ nkwụsịtụ nkịtị na obere ike.
(2) Mmepụta nke akwara ụbụrụ (CVT) nwere njikọ chiri anya na nhazi thrombus.
Ntuziaka maka nchọpụta na njikwa nke thrombosis nke akwara dị n'ime na nke dị n'ime sinus (CVST)
Usoro Thrombotic: PC, PS, AT-ll, ANA, LAC, HCY
Mgbanwe mkpụrụ ndụ ihe nketa: mkpụrụ ndụ ihe nketa prothrombin G2020A, ihe na-akpata coagulation LeidenV
Ihe ndị na-ebute ọrịa: oge ọmụmụ nwa, ọgwụ mgbochi afọ ime, akpịrị ịkpọ nkụ, mmerụ ahụ, ịwa ahụ, ọrịa, etuto ahụ, mbelata ibu.
2. Uru nke nchọpụta D-dimer na FDP jikọtara ọnụ na ọrịa obi na akwara ụbụrụ.
(1) Mmụba D-dimer (karịa 500ug/L) na-enyere aka maka nchọpụta CVST. Nha nha anaghị ewepụ CVST, ọkachasị na CVST nwere isi ọwụwa naanị n'oge na-adịbeghị anya. Enwere ike iji ya dị ka otu n'ime ihe na-egosi nchoputa CVST. Enwere ike iji D-dimer dị elu karịa nkịtị dị ka otu n'ime ihe na-egosi nchoputa CVST (nkwado ọkwa nke atọ, ihe akaebe ọkwa C).
(2) Ihe ngosi na-egosi ọgwụgwọ thrombolytic dị irè: Nleba anya D-dimer mụbara nke ukwuu wee belata nwayọ; FDP mụbara nke ukwuu wee belata nwayọ nwayọ. Ihe ngosi abụọ a bụ ntọala kpọmkwem maka ọgwụgwọ thrombolytic dị irè.
N'okpuru ọgwụ thrombolytic (SK, UK, rt-PA, wdg), a na-agbaze embol dị n'ime arịa ọbara ngwa ngwa, D-dimer na FDP dị na plasma na-amụba nke ukwuu, nke na-adịrukarị ụbọchị 7. N'oge ọgwụgwọ ahụ, ọ bụrụ na ọgwụ thrombolytic ezughi oke ma thrombus agbazeghị kpamkpam, D-dimer na FDP ga-anọgide na-adị elu mgbe ha ruru oke; Dịka ọnụ ọgụgụ si kwuo, ọnụọgụ ọbara ọgbụgba mgbe ọgwụgwọ thrombolytic gasịrị dị elu ruo 5% ruo 30%. Ya mere, maka ndị ọrịa nwere ọrịa thrombotic, a ga-ahazi usoro ọgwụ siri ike, a ga-enyocha ọrụ coagulation plasma na ọrụ fibrinolytic n'oge ahụ, a ga-ejikwa dose nke ọgwụ thrombolytic nke ọma. A pụrụ ịhụ na nchọpụta ike nke D-dimer na FDP na-agbanwe tupu, n'oge na mgbe ọgwụgwọ gasịrị n'oge thrombolysis nwere nnukwu uru ahụike maka inyocha irè na nchekwa nke ọgwụ thrombolytic.
Gịnị mere ndị ọrịa nwere ọrịa obi na akwara ụbụrụ ji kwesị ilebara AT anya?
Enweghị Antithrombin (AT) Antithrombin (AT) na-arụ ọrụ dị mkpa n'igbochi nhazi thrombus, ọ bụghị naanị na ọ na-egbochi thrombin, kamakwa ọ na-egbochi ihe ndị na-akpata coagulation dị ka IXa, Xa, Xla, Xlla na Vlla. Njikọta nke heparin na AT bụ akụkụ dị mkpa nke anticoagulation AT. N'ihu heparin, enwere ike ịbawanye ọrụ anticoagulant nke AT site na puku kwuru puku ugboro. Ọrụ nke AT, yabụ AT bụ ihe dị mkpa maka usoro anticoagulant nke heparin.
1. Mgbochi Heparin: Mgbe ọrụ nke AT belatara, ọrụ ọgwụ mgbochi nke heparin na-ebelata nke ukwuu ma ọ bụ na-adịghị arụ ọrụ. Ya mere, ọ dị mkpa ịghọta ọkwa nke AT tupu ọgwụgwọ heparin iji gbochie ọgwụgwọ heparin dị oke elu na-enweghị isi na ọgwụgwọ ahụ adịghị arụ ọrụ.
N'ọtụtụ akụkọ akwụkwọ, uru ahụike nke D-dimer, FDP, na AT na-apụta ìhè n'ọrịa obi na akwara ụbụrụ, nke nwere ike inye aka na nchọpụta mbụ, mkpebi ọnọdụ na nyocha amụma nke ọrịa ahụ.
2. Nnyocha maka isi ihe kpatara thrombophilia: Ndị ọrịa nwere thrombophilia na-egosipụta onwe ha site na nnukwu thrombosis miri emi na thrombosis ugboro ugboro. Enwere ike ime nyocha maka ihe kpatara thrombophilia n'ime otu ndị a:
(1) VTE na-enweghị ihe doro anya kpatara ya (gụnyere thrombosis nwa amụrụ ọhụrụ)
(2) VTE nwere ihe mkpali karịa afọ 40-50
(3) Ọkpụkpụ ọbara ma ọ bụ thrombophlebitis ugboro ugboro
(4) Akụkọ ihe mere eme nke thrombosis ezinụlọ
(5) Ọkpụkpụ ọbara n'ebe ndị na-adịghị mma: akwara mesenteric, sinus venous nke ụbụrụ
(6) Ịpụ ime ugboro ugboro, ịmụ nwa nwụrụ anwụ, wdg.
(7) Afọ ime, ọgwụ mgbochi ime, thrombosis nke hormone kpatara
(8) Nje akpụkpọ ahụ, ọkachasị mgbe ejiri warfarin mee ihe
(9) Ọkpụkpụ akwara nke a na-amaghị ihe kpatara ya nke na-erughị afọ 20
(10) Ndị ikwu nke thrombophilia
3. Nnyocha nke ihe ndị na-eme na obi na nlọghachi azụ: Nnyocha egosila na mbelata nke ọrụ AT n'ime ndị ọrịa nwere ọrịa obi na obi bụ n'ihi mmebi nke mkpụrụ ndụ endothelial nke na-eduga na nnukwu ọnụọgụ nke AT a na-aṅụ. Ya mere, mgbe ndị ọrịa nọ n'ọnọdụ hypercoagulable, ha na-enwekarị thrombosis ma na-eme ka ọrịa ahụ ka njọ. Ọrụ nke AT dịkwa obere nke ukwuu n'ime ndị nwere ihe ndị na-eme na obi na-emegharị ugboro ugboro karịa na ndị mmadụ na-enweghị ihe ndị na-eme na obi na-emegharị ugboro ugboro.
4. Nyocha nke ihe egwu nke thrombosis na fibrillation atrial na-abụghị valvụ: obere ọkwa ọrụ AT nwere njikọ dị mma na akara CHA2DS2-VASc; n'otu oge ahụ, ọ nwere uru ntụaka dị elu maka inyocha thrombosis na fibrillation atrial na-abụghị valvụ.
5. Mmekọrịta dị n'etiti AT na strok: AT na-ebelata nke ukwuu n'ime ndị ọrịa nwere ọrịa strok ischemic dị oke njọ, ọbara na-agbaze nke ukwuu, a ga-enyekwa ọgwụgwọ anticoagulation n'oge; a ga-enyocha ndị ọrịa nwere ihe egwu strok mgbe niile maka AT, a ga-achọpụtakwa ọbara mgbali elu nke ndị ọrịa n'oge. A ga-agwọ ọnọdụ coagulation n'oge iji zere ọrịa strok dị oke njọ.
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