Chifukwa chiyani D-dimer, FDP iyenera kuzindikirika mwa odwala amtima komanso a cerebrovascular?
1. D-dimer ingagwiritsidwe ntchito kutsogolera kusintha kwa mphamvu ya anticoagulation.
(1) Ubale pakati pa mlingo wa D-dimer ndi zochitika zachipatala panthawi ya anticoagulation therapy kwa odwala pambuyo pa makina a mtima wa valve.
Gulu la chithandizo chamankhwala chowongolera D-dimer-guided anticoagulation intensity kusintha moyenera chitetezo ndi mphamvu ya anticoagulation therapy, ndipo zochitika za zochitika zosiyanasiyana zoipa zinali zochepa kwambiri kusiyana ndi gulu lolamulira lomwe limagwiritsa ntchito anticoagulation yokhazikika komanso yochepa kwambiri.
(2) Mapangidwe a cerebral venous thrombosis (CVT) amagwirizana kwambiri ndi malamulo a thrombus.
Malangizo ozindikiritsa ndi kuyang'anira mitsempha yamkati ndi venous sinus thrombosis (CVST)
Thrombotic Constitution: PC, PS, AT-ll, ANA, LAC, HCY
Kusintha kwa gene: prothrombin jini G2020A, coagulation factor LeidenV
Predisposing zinthu: perinatal nthawi, kulera, kutaya madzi m'thupi, zoopsa, opaleshoni, matenda, chotupa, kuwonda.
2. Phindu la kuzindikira kophatikizana kwa D-dimer ndi FDP mu matenda a mtima ndi cerebrovascular.
(1) Kuwonjezeka kwa D-dimer (kuposa 500ug/L) ndikothandiza pa matenda a CVST.Chizoloŵezi sichimasokoneza CVST, makamaka mu CVST ndi mutu wapayekha posachedwapa.Itha kugwiritsidwa ntchito ngati chimodzi mwazowonetsa za CVST.D-dimer yapamwamba kuposa yachibadwa ingagwiritsidwe ntchito ngati chimodzi mwa zizindikiro za matenda a CVST (upangiri wa mlingo III, umboni wa C).
(2) Zizindikiro zosonyeza chithandizo chamankhwala cha thrombolytic: D-dimer monitoring inakula kwambiri ndipo kenako inachepa pang'onopang'ono;FDP idakula kwambiri kenako idatsika pang'onopang'ono.Zizindikiro ziwirizi ndizo maziko achindunji a chithandizo cha thrombolytic.
Pansi pa mankhwala a thrombolytic (SK, UK, rt-PA, etc.), emboli m'mitsempha yamagazi imasungunuka mofulumira, ndipo D-dimer ndi FDP mu plasma zimawonjezeka kwambiri, zomwe nthawi zambiri zimakhala kwa masiku 7.Pa nthawi ya chithandizo, ngati mlingo wa mankhwala a thrombolytic ndi wosakwanira ndipo thrombus sichimasungunuka kwathunthu, D-dimer ndi FDP idzapitirizabe kukhala pamiyeso yapamwamba ikafika pachimake;Malinga ndi ziwerengero, kuchuluka kwa magazi pambuyo pa chithandizo cha thrombolytic kumakhala 5% mpaka 30%.Chifukwa chake, kwa odwala omwe ali ndi matenda a thrombotic, dongosolo lokhazikika la mankhwala liyenera kupangidwa, ntchito ya plasma coagulation ndi zochitika za fibrinolytic ziyenera kuyang'aniridwa munthawi yeniyeni, ndipo mlingo wa mankhwala a thrombolytic uyenera kuyang'aniridwa bwino.Zitha kuwoneka kuti kuzindikira kwamphamvu kwa D-dimer ndi FDP kumasintha kusanachitike, panthawi komanso pambuyo pa chithandizo panthawi ya thrombolysis kuli ndi phindu lalikulu lachipatala pakuwunika mphamvu ndi chitetezo cha mankhwala a thrombolytic.
Chifukwa chiyani odwala omwe ali ndi matenda amtima ndi cerebrovascular ayenera kulabadira AT?
Antithrombin (AT) akusowa Antithrombin (AT) imagwira ntchito yofunika kwambiri poletsa mapangidwe a thrombus, sikuti amangoletsa thrombin, komanso amalepheretsa zinthu za coagulation monga IXa, Xa, Xla, Xlla ndi Vlla.Kuphatikiza kwa heparin ndi AT ndi gawo lofunikira la AT anticoagulation.Pamaso pa heparin, ntchito ya anticoagulant ya AT imatha kukulitsidwa nthawi masauzande.Ntchito ya AT, kotero AT ndi chinthu chofunikira pakupanga anticoagulant ya heparin.
1. Kukana kwa heparin: Pamene ntchito ya AT imachepa, ntchito ya anticoagulant ya heparin imachepetsedwa kwambiri kapena yosagwira ntchito.Chifukwa chake, ndikofunikira kumvetsetsa mulingo wa AT musanayambe chithandizo cha heparin kuti mupewe chithandizo chamankhwala cha heparin chosafunikira ndipo chithandizocho sichigwira ntchito.
M'mabuku ambiri olembedwa, kufunika kwachipatala kwa D-dimer, FDP, ndi AT kumasonyezedwa mu matenda a mtima ndi ubongo, zomwe zingathandize kuti azindikire msanga, kuweruza kwa chikhalidwe ndi kuwunika kwa matendawa.
2. Kuwunika kwa etiology ya thrombophilia: Odwala omwe ali ndi vuto la thrombophilia amawonetseredwa ndi thrombosis yayikulu kwambiri ya mtsempha wakuya komanso thrombosis mobwerezabwereza.Kuwunika zomwe zimayambitsa thrombophilia zitha kuchitidwa m'magulu otsatirawa:
(1) VTE popanda chifukwa chodziwikiratu (kuphatikiza neonatal thrombosis)
(2) VTE ndi zolimbikitsa <40-50 zaka
(3) Kubwerezabwereza thrombosis kapena thrombophlebitis
(4) Mbiri ya banja la thrombosis
(5) Thrombosis pa malo achilendo: mtsempha wa mesenteric, ubongo wa venous sinus
(6) Kupita padera mobwerezabwereza, kubereka mwana wakufa, ndi zina zotero.
(7) Mimba, kulera, thrombosis yopangidwa ndi mahomoni
(8) Khungu necrosis, makamaka pambuyo ntchito warfarin
(9) Arterial thrombosis yosadziwika chifukwa <20 zaka
(10) Achibale a thrombophilia
3. Kuwunika kwa zochitika zamtima ndi kubwereranso: Kafukufuku wasonyeza kuti kuchepetsa ntchito ya AT kwa odwala omwe ali ndi matenda a mtima chifukwa cha kuwonongeka kwa maselo a endothelial omwe amachititsa kuti AT iwonongeke.Choncho, pamene odwala ali mu hypercoagulable boma, iwo sachedwa thrombosis ndi kukulitsa matenda.Ntchito ya AT inalinso yotsika kwambiri pakati pa anthu omwe ali ndi zochitika zapamtima mobwerezabwereza kusiyana ndi anthu omwe alibe zochitika zamtima zobwerezabwereza.
4. Kuwunika kwa chiopsezo cha thrombosis mu non-valvular atrial fibrillation: mlingo wochepa wa ntchito wa AT umagwirizana bwino ndi chiwerengero cha CHA2DS2-VASc;pa nthawi yomweyo, ali ndi mkulu zolozera mtengo kuwunika thrombosis mu non-valvular atrial fibrillation.
5. Ubale pakati pa AT ndi sitiroko: AT imachepetsedwa kwambiri kwa odwala omwe ali ndi vuto lalikulu la ischemic, magazi ali mu hypercoagulable state, ndipo anticoagulation therapy iyenera kuperekedwa panthawi;Odwala omwe ali ndi vuto la sitiroko ayenera kuyesedwa pafupipafupi kuti adziwe za AT, ndipo kuzindikira msanga kwa kuthamanga kwa magazi kwa odwala kuyenera kuchitidwa.The coagulation state iyenera kuthandizidwa munthawi yake kuti pasakhale stroko yowopsa.
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