N’chifukwa chiyani D-dimer, FDP ziyenera kupezeka mwa odwala matenda a mtima ndi mitsempha ya m’mitsempha?
1. D-dimer ingagwiritsidwe ntchito kutsogolera kusintha kwa mphamvu yoletsa magazi kuundana.
(1) Ubale pakati pa mulingo wa D-dimer ndi zochitika zachipatala panthawi ya chithandizo cha mankhwala oletsa magazi kuundana kwa odwala pambuyo posintha ma valve a mtima.
Gulu lothandizira kusintha mphamvu ya magazi lotsogozedwa ndi D-dimer linalinganiza bwino chitetezo ndi mphamvu ya mankhwala oletsa magazi kuundana, ndipo kuchuluka kwa zochitika zosiyanasiyana zoyipa kunali kotsika kwambiri kuposa gulu lolamulira pogwiritsa ntchito mankhwala oletsa magazi kuundana omwe amagwiritsidwa ntchito muyezo komanso otsika mphamvu.
(2) Kupangika kwa thrombosis ya mitsempha ya m'mitsempha ya ubongo (CVT) kumagwirizana kwambiri ndi kapangidwe ka thrombus.
Malangizo odziwira ndi kusamalira matenda a mtsempha wamkati ndi venous sinus thrombosis (CVST)
Kapangidwe ka thrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Kusintha kwa majini: jini ya prothrombin G2020A, coagulation factor LeidenV
Zinthu zomwe zimayambitsa matenda: nthawi yobereka, njira zolerera, kutaya madzi m'thupi, kuvulala, opaleshoni, matenda, chotupa, kuchepetsa thupi.
2. Kufunika kopeza D-dimer ndi FDP pamodzi m'matenda a mtima ndi mitsempha yamagazi.
(1) Kuwonjezeka kwa D-dimer (koposa 500ug/L) kumathandiza pa matenda a CVST. Kukhala bwino sikuletsa CVST, makamaka mu CVST yokhala ndi mutu wokhawokha posachedwapa. Itha kugwiritsidwa ntchito ngati chimodzi mwa zizindikiro za matenda a CVST. D-dimer yokwera kuposa yachibadwa ingagwiritsidwe ntchito ngati chimodzi mwa zizindikiro za matenda a CVST (malangizo a level III, umboni wa level C).
(2) Zizindikiro zosonyeza chithandizo chogwira mtima cha thrombolytic: Kuwunika kwa D-dimer kunawonjezeka kwambiri kenako kunachepa pang'onopang'ono; FDP inawonjezeka kwambiri kenako inachepa pang'onopang'ono. Zizindikiro ziwirizi ndizo maziko enieni a chithandizo chogwira mtima cha thrombolytic.
Pogwiritsa ntchito mankhwala ochepetsa magazi (SK, UK, rt-PA, ndi zina zotero), mitsempha yamagazi imasungunuka mofulumira, ndipo D-dimer ndi FDP mu plasma zimawonjezeka kwambiri, zomwe nthawi zambiri zimakhalapo kwa masiku 7. Pa nthawi ya chithandizo, ngati mlingo wa mankhwala ochepetsa magazi sukwanira ndipo thrombus siisungunuka kwathunthu, D-dimer ndi FDP zidzapitirira kukhala pamlingo wapamwamba zitafika pachimake; Malinga ndi ziwerengero, kuchuluka kwa magazi pambuyo pa chithandizo cha thrombolytic kumakhala kwakukulu mpaka 5% mpaka 30%. Chifukwa chake, kwa odwala omwe ali ndi matenda ochepetsa magazi, njira yogwiritsira ntchito mankhwala iyenera kupangidwa, ntchito ya plasma coagulation ndi ntchito ya fibrinolytic ziyenera kuyang'aniridwa nthawi yeniyeni, ndipo mlingo wa mankhwala ochepetsa magazi uyenera kulamulidwa bwino. Zitha kuwoneka kuti kuzindikira kwamphamvu kwa kuchuluka kwa D-dimer ndi FDP kumasintha musanayambe, panthawi komanso pambuyo pa chithandizo panthawi ya thrombolysis kuli ndi phindu lalikulu pakuwunika momwe mankhwala ochepetsa magazi amagwirira ntchito komanso chitetezo chake.
N’chifukwa chiyani odwala matenda a mtima ndi mitsempha ya m’mitsempha ayenera kusamala ndi AT?
Kusowa kwa Antithrombin (AT) Antithrombin (AT) imagwira ntchito yofunika kwambiri poletsa kupanga kwa thrombin, sikuti imangoletsa thrombin, komanso imaletsa zinthu zotsekeka monga IXa, Xa, Xla, Xlla ndi Vlla. Kuphatikiza kwa heparin ndi AT ndi gawo lofunika kwambiri la AT anticoagulation. Pakakhala heparin, mphamvu ya AT anticoagulant imatha kuwonjezeka kangapo. Ntchito ya AT, kotero AT ndi chinthu chofunikira kwambiri pa njira ya heparin anticoagulant.
1. Kukana kwa Heparin: Pamene ntchito ya AT yachepa, mphamvu ya heparin yoletsa magazi kuundana imachepa kwambiri kapena sigwira ntchito. Chifukwa chake, ndikofunikira kumvetsetsa kuchuluka kwa AT musanalandire chithandizo cha heparin kuti mupewe chithandizo cha heparin chosayenera komanso kuti chithandizocho chisagwire ntchito.
M'mabuku ambiri, kufunika kwa D-dimer, FDP, ndi AT kumaonekera m'matenda a mtima ndi mitsempha yamagazi, zomwe zingathandize kuzindikira matenda msanga, kuweruza momwe alili komanso kuwunika momwe matendawa alili.
2. Kuwunika chomwe chimayambitsa thrombophilia: Odwala omwe ali ndi thrombophilia amawonetsedwa m'chipatala ndi thrombosis yayikulu ya m'mitsempha yakuya komanso thrombosis yobwerezabwereza. Kuwunika chomwe chimayambitsa thrombophilia kungachitike m'magulu otsatirawa:
(1) VTE popanda chifukwa chomveka bwino (kuphatikizapo thrombosis ya makanda obadwa kumene)
(2) VTE yokhala ndi zolimbikitsa zosakwana zaka 40-50
(3) Kutsekeka kwa magazi m'mitsempha kapena kutsekeka kwa magazi m'mitsempha mobwerezabwereza
(4) Mbiri ya banja la matenda a thrombosis
(5) Kutsekeka kwa magazi m'malo osazolowereka: mtsempha wa mesenteric, sinus ya mitsempha ya ubongo
(6) Kutaya mimba mobwerezabwereza, kubereka mwana wakufa, ndi zina zotero.
(7) Mimba, njira zolerera, kutsekeka kwa magazi komwe kumachitika chifukwa cha mahomoni
(8) Kutupa kwa khungu, makamaka mukatha kugwiritsa ntchito warfarin
(9) Kutsekeka kwa mitsempha yamagazi komwe sikudziwika chifukwa chake ndi zaka zosakwana 20
(10) Achibale a thrombophilia
3. Kuwunika matenda a mtima ndi kubwereranso: Kafukufuku wasonyeza kuti kuchepa kwa ntchito ya AT mwa odwala omwe ali ndi matenda a mtima kumachitika chifukwa cha kuwonongeka kwa maselo a endothelial komwe kumapangitsa kuti AT yambiri igwiritsidwe ntchito. Chifukwa chake, odwala akakhala kuti ali ndi vuto la magazi ambiri, amakhala pachiwopsezo cha thrombosis ndipo amawonjezera matendawa. Ntchito ya AT inalinso yotsika kwambiri mwa anthu omwe ali ndi matenda a mtima omwe amabwerezabwereza kuposa anthu omwe alibe matenda a mtima omwe amabwerezabwereza.
4. Kuwunika chiopsezo cha thrombosis mu non-valvular atrial fibrillation: kuchuluka kwa ntchito ya AT komwe kumagwirizana bwino ndi CHA2DS2-VASc score; nthawi yomweyo, ili ndi phindu lalikulu powunika thrombosis mu non-valvular atrial fibrillation.
5. Ubale pakati pa AT ndi sitiroko: AT imachepa kwambiri mwa odwala omwe ali ndi sitiroko yoopsa ya ischemic, magazi amakhala m'malo oti magazi azitsekeka kwambiri, ndipo chithandizo choletsa magazi kutsekeka chiyenera kuperekedwa nthawi yake; odwala omwe ali ndi zinthu zomwe zimayambitsa matenda a sitiroko ayenera kuyesedwa nthawi zonse kuti adziwe AT, ndipo kuzindikira kuthamanga kwa magazi kwa odwala kuyenera kuchitika msanga. Mkhalidwe wa magazi otsekeka uyenera kuthandizidwa nthawi yake kuti apewe sitiroko yoopsa.
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