Ko te tere o te memeha o ngā toto totoka e whakawhirinaki ana ki te rongoā. I ētahi wā, ka whakamahia hoki te pokanga thrombectomy.

Koinei te kupu whakataki taipitopito:

1 Te whakaheke toto i roto i te rongoā

1.1 Ngā rongoā e whakamahia whānuitia ana

Urokinase: he whākōkī tūturu i tangohia mai i te mimi tangata, i hangaia rānei e ngā pūtau tākihi. Ka taea e ia te mahi tika ki te pūnaha fibrinolytic taketake, te whakahohe i te plasminogen hei plasmin, ā, ka memeha ngā toto totoka.

Streptokinase: he pūmua i tangohia mai i te wai ahurea o te streptococci hemolytic. Ka taea e ia te here ki te plasminogen hei hanga i tētahi matatini, ka whakatairanga i te hurihanga o te plasminogen ki te plasmin, kātahi ka whakarewa i ngā toto totoka.

Kaiwhakaoho plasminogen kiko recombinant (rt-PA): he glycoprotein ka taea te whakahohe i te plasminogen, ā, he kaha te hononga ki te fibrin. Ka taea e ia te mahi motuhake ki te fibrin i roto i ngā toto toto hei whakaiti i a ia, hei whakatutuki i te kaupapa o te whakarewa i ngā toto toto. Ki te whakatauritea ki te urokinase me te streptokinase, he nui ake te whai huatanga o te rt-PA ki te whakaheke toto, ā, he iti ake ngā raruraru toto.

1.2 Te wā maimoatanga

Mō ngā mate pēnei i te mate ngakau nui me te mate roro nui, he mea tino nui te wā mō te rongoā thrombolytic. I te nuinga o te wā, me whiwhi te hunga mate ngakau nui i te rongoā thrombolytic i roto i ngā haora 12 i muri i te tīmatanga, pai ake i roto i ngā haora 3-6; ko te hunga mate ngakau nui kei roto i te wā koura mō te thrombolysis i roto i ngā haora 4.5-6 i muri i te tīmatanga.

2 Te tango i te toto i roto i te pokanga me te tango i te toto i roto i te pokanga

2.1 Te tango i te toto i roto i te toto

I raro i te arataki a te angiography tango matihiko (DSA), ka tukuna te taputapu thrombectomy ki te wāhi thrombus mā te catheter hei tango tika i te thrombus. He pai ngā painga o tēnei tikanga, arā, he iti ake te whara me te tere ake o te whakaoranga, ā, he pai mō ētahi tūroro kāore e taea te aro ki te thrombolysis rongoā, he kino rānei ngā pānga thrombolysis rongoā.

2.2 Te tango toto i roto i te pokanga

Tapahia tika ngā oko toto mā te pokanga hei tango i te thrombus. E whakamahia whānuitia ana tēnei tikanga i ngā āhuatanga ohorere ina kore e taea te whakamahi i te thrombolysis rongoā me te thrombectomy wawao, ina kore rānei e pai te pānga, pērā i te embolism uaua o raro o te peka. Ka taea e te thrombectomy pokanga te whakaora tere i te rere o te toto, engari he nui te whara o te pokanga, ā, he nui ake ngā raruraru i muri i te pokanga.

Ahakoa te tikanga e whiriwhiria ana, me whai maimoatanga takitahi i raro i te arataki a te tākuta i runga i te āhuatanga motuhake o te tūroro, pērā i te wāhi, te rahi, te wā hanganga o te thrombus, me te āhua tinana whānui o te tūroro. I taua wā anō, i muri i te tango i te thrombolysis, i te thrombectomy rānei, me whai maimoatanga anticoagulation, antiplatelet me ētahi atu hei ārai i te hanganga anō o te thrombus.