He aha me kitea ai te D-dimer me te FDP i roto i ngā tūroro mate ngakau me ngā mate roro?
1. Ka taea te whakamahi i te D-dimer hei ārahi i te whakatikatika i te kaha ārai toto.
(1) Te whanaungatanga i waenga i te taumata D-dimer me ngā kaupapa haumanu i te wā o te rongoā ārai toto i roto i ngā tūroro i muri i te whakakapinga takirere ngākau ā-ringa.
I taurite pai te haumaru me te whai huatanga o te rongoā ārai toto i raro i te arataki a te D-dimer i te rōpū maimoatanga whakarerekētanga kaha ārai toto, ā, he iti iho te auau o ngā pānga kino i tērā o te rōpū whakahaere e whakamahi ana i te rongoā ārai toto paerewa me te rongoā ārai toto iti.
(2) He hononga tata te hanganga o te toto totoka o roto i ngā uaua roro (CVT) ki te hanganga o ngā toto totoka.
Ngā aratohu mō te tātaritanga me te whakahaere i te thrombosis o te uaua ā-roto me te sinus venous (CVST)
Te hanganga toto totoka: PC, PS, AT-lll, ANA, LAC, HCY
Ngā whakarerekētanga ira: te ira prothrombin G2020A, te ira toto totoka LeidenV
Ngā āhuatanga e pā ana ki te whānautanga: te wā whānau, ngā ārai hapūtanga, te maroke o te tinana, te whara, te pokanga, te mate pāwera, te pukupuku, te whakaheke taumaha.
2. Te uara o te kitenga ngātahi o te D-dimer me te FDP i roto i ngā mate pūnaha toto me ngā mate roro.
(1) He āwhina te pikinga o te D-dimer (neke atu i te 500ug/L) mō te tautuhi i te CVST. Kāore te noho noa e whakakore i te CVST, inā koa i roto i te CVST me te ānini takitahi i ēnei wā tata nei. Ka taea te whakamahi hei tetahi o ngā tohu o te tautuhi i te CVST. Ka taea te whakamahi i te D-dimer teitei ake i te noa hei tetahi o ngā tohu tautuhi i te CVST (tautohu taumata III, taunakitanga taumata C).
(2) Ngā tohu e tohu ana i te whai huatanga o te rongoā toto toto: I piki ake te aroturukitanga o te D-dimer, kātahi ka heke haere; I piki ake te FDP, kātahi ka heke haere. Ko ēnei tohu e rua te pūtake tika mō te rongoā toto toto toto whai hua.
I raro i te mahi a ngā rongoā thrombolytic (SK, UK, rt-PA, me ētahi atu), ka tere te memeha o ngā emboli i roto i ngā oko toto, ā, ka tino piki ake te D-dimer me te FDP i roto i te toto, e 7 ngā rā te roa. I roto i te maimoatanga, ki te kore e ranea te horopeta o ngā rongoā thrombolytic, ā, kāore i tino memeha te thrombus, ka noho tonu te D-dimer me te FDP ki ngā taumata tiketike i muri i te taenga ki te tihi; E ai ki ngā tatauranga, ko te maha o ngā toto i muri i te rongoā thrombolytic he 5% ki te 30%. Nō reira, mō ngā tūroro e mate ana i te thrombotic, me whakatakoto he tikanga rongoā tino pakari, me aroturuki i te mahi toto toto me te mahi fibrinolytic i te wā tūturu, ā, me whakahaere pai te horopeta o ngā rongoā thrombolytic. Ka kitea ko te kitenga hihiri o te D-dimer me te kukū FDP i mua, i te wā, me muri i te maimoatanga i te wā o te thrombolysis he uara haumanu nui mō te aroturuki i te whai huatanga me te haumaru o ngā rongoā thrombolytic.
He aha me aro atu ai ngā tūroro e pāngia ana e ngā mate ngakau me ngā mate roro ki te AT?
Te ngoikore o te antithrombin (AT) He mea nui te mahi a te antithrombin (AT) ki te aukati i te hanganga thrombus, ehara i te mea ka aukati noa i te thrombin, engari ka aukati hoki i ngā āhuatanga toto toto pērā i te IXa, Xa, Xla, Xlla me te Vlla. Ko te whakakotahitanga o te heparin me te AT he wāhanga nui o te AT anticoagulation. I te aroaro o te heparin, ka taea te whakanui ake i te mahi anticoagulant o te AT ki ngā mano tini wā. Ko te mahi a te AT, nō reira he matū nui te AT mō te tukanga anticoagulant o te heparin.
1. Te ātete ki te heparin: Ina heke te mahi a te AT, ka tino heke te mahi ārai toto o te heparin, ka kore rānei e mahi. Nō reira, me mārama ki te taumata o te AT i mua i te maimoatanga heparin hei ārai i te horopeta nui o te maimoatanga heparin me te kore e whai hua.
I roto i ngā pūrongo tuhinga maha, ka kitea te uara haumanu o te D-dimer, te FDP, me te AT i roto i ngā mate ngakau me ngā mate roro, ā, ka āwhina ēnei i te tautuhi wawe, te whakatau i te āhua me te aromatawai i te matapae o te mate.
2. Te tirotiro i te pūtake o te thrombophilia: Ko ngā tūroro e pāngia ana e te thrombophilia ka kitea i roto i te mate pukupuku uaua hohonu nui me te thrombosis auau. Ka taea te tirotiro i te pūtake o te thrombophilia i roto i ngā rōpū e whai ake nei:
(1) VTE kāore he take mārama (tae atu ki te totohu o te pēpi hou)
(2) VTE me ngā whakatenatena mō te hunga e <40-50 tau te pakeke
(3) Te toto toto, te toto toto toto rānei e hokihoki ana
(4) Hītori whānau mō te toto toto
(5) Te toto toto i ngā wāhi rerekē: te uaua mesenteric, te sinus venous cerebral
(6) Te materoto tonu, te whānautanga mate, me ētahi atu.
(7) Te haputanga, ngā ārai hapūtanga, te toto toto i puta mai i ngā homoni
(8) Te pirau o te kiri, inā koa i muri i te whakamahinga o te warfarin
(9) Te toto toto o te uaua kāore i te mōhiotia te take <20 tau te pakeke
(10) Ngā whanaunga o te thrombophilia
3. Aromatawai i ngā mate pūnaha toto me te hokinga mai o te toto: Kua whakaatuhia e ngā rangahau ko te whakahekenga o te mahi AT i roto i ngā tūroro e mate ana i te mate pūnaha toto nā te kino o ngā pūtau endothelial e arahi ana ki te nui o te AT e kainga ana. Nō reira, ina kei roto ngā tūroro i te āhua hypercoagulable, ka ngāwari rātou ki te thrombosis me te whakanui ake i te mate. He iti ake hoki te mahi a te AT i roto i te taupori e mau tonu ana ngā mate pūnaha toto i te taupori kāore he mate pūnaha toto e mau tonu ana.
4. Aromatawai i te mōrearea o te toto toto i roto i te fibrillation atrial kore-valvular: he hononga pai te taumata ngohe AT iti ki te kaute CHA2DS2-VASc; i te wa ano, he uara tohutoro teitei mō te aromatawai i te toto toto i roto i te fibrillation atrial kore-valvular.
5. Te whanaungatanga i waenga i te AT me te whiu: Ka tino heke te AT i roto i ngā tūroro e pāngia ana e te whiu ischemic acute, kei roto te toto i te āhua hypercoagulable, ā, me hoatu te rongoā anticoagulant i te wā tika; me whakamātautau auau ngā tūroro he take mōrearea whiu mō te AT, ā, me mahi wawe te kitenga o te toto toto tiketike o ngā tūroro. Me rongoā i te wā tika te āhua coagulant hei karo i te putanga mai o te whiu acute.
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