1. Kugwiritsa ntchito mapulojekiti ochizira magazi m'matenda a mtima ndi mitsempha yamagazi
Mu Worldwide, chiwerengero cha anthu omwe akudwala matenda a mtima ndi mitsempha yamagazi ndi chachikulu, ndipo chikuwonetsa kuwonjezeka chaka ndi chaka. Muzochitika zachipatala, odwala wamba amayamba kuchepa kwa nthawi ndipo amatuluka magazi mu ubongo, zomwe zimakhudza kwambiri thanzi la odwala ndikuwopseza moyo wawo.
Pali matenda ambiri a matenda a mtima ndi mitsempha yamagazi, ndipo zinthu zomwe zimayambitsa matendawa zimakhala zovuta kwambiri. Ndi kuchulukirachulukira kwa kafukufuku wazachipatala pa matenda a mtima ndi mitsempha yamagazi, zapezeka kuti m'matenda a mtima ndi mitsempha yamagazi, zinthu zotsekeka zitha kugwiritsidwanso ntchito ngati zinthu zomwe zimayambitsa matendawa. Kafukufuku wazachipatala wasonyeza kuti njira zonse zakunja ndi zamkati zotsekeka kwa odwala otere zimakhudza kuzindikira, kuwunika, komanso kuneneratu za matendawa. Chifukwa chake, kuwunika kwathunthu kwa chiopsezo cha kutsekeka kwa magazi kwa odwala ndikofunikira kwambiri kwa odwala omwe ali ndi matenda amtima ndi mitsempha yamagazi.
2. N’chifukwa chiyani odwala matenda a mtima ndi mitsempha ya m’mitsempha ayenera kusamala ndi zizindikiro za magazi kuundana kwa magazi?
Matenda a mtima ndi mitsempha ya m'mitsempha ndi matenda omwe amaika pachiwopsezo thanzi ndi moyo wa anthu, omwe ali ndi chiwerengero chachikulu cha imfa ndi chiwopsezo chachikulu cha kulumala.
Kudzera mu kuzindikira momwe magazi amagwirira ntchito mwa odwala omwe ali ndi matenda a mtima ndi mitsempha yamagazi, n'zotheka kuwona ngati wodwalayo ali ndi magazi ambiri komanso chiopsezo cha venous thrombosis; panthawi yogwiritsira ntchito mankhwala oletsa magazi kuundana, zotsatira za magazi kuundana zimathanso kuyesedwa ndipo mankhwala azachipatala amatha kutsogozedwa kuti apewe kutuluka magazi.
1). Odwala sitiroko
Matenda a mtima ndi matenda a ischemic omwe amayamba chifukwa cha kutsekeka kwa mitsempha ya mtima ndi kutsekeka kwa mitsempha ya ubongo, zomwe zimapangitsa 14% mpaka 30% ya matenda onse a ischemic. Pakati pawo, matenda a atrial fibrillation-atrial fibrillation amachititsa oposa 79% ya matenda onse a mtima, ndipo matenda a mtima ndi oopsa kwambiri, ndipo ayenera kuzindikirika msanga ndikuchitapo kanthu mwachangu. Kuti muwone chiopsezo cha thrombosis ndi chithandizo cha mankhwala oletsa magazi kuundana kwa odwala, komanso chithandizo cha mankhwala oletsa magazi kuundana, madokotala ayenera kugwiritsa ntchito zizindikiro zosonyeza magazi kuundana kuti awone momwe magazi amayendera komanso mankhwala olondola oletsa magazi kuundana kuti apewe kutuluka magazi.
Chiwopsezo chachikulu mwa odwala omwe ali ndi vuto la atrial fibrillation ndi arterial thrombosis, makamaka cerebral embolism. Malangizo othandizira kuchepetsa magazi m'mitsempha ya ubongo chifukwa cha atrial fibrillation:
1. Kugwiritsa ntchito mankhwala oletsa magazi kutuluka magazi nthawi yomweyo sikuvomerezeka kwa odwala omwe ali ndi vuto la ubongo.
2. Kwa odwala omwe amalandira chithandizo cha thrombolysis, nthawi zambiri sikulimbikitsidwa kugwiritsa ntchito mankhwala oletsa magazi mkati mwa maola 24.
3. Ngati palibe zotsutsana monga kutayika kwa magazi, matenda aakulu a chiwindi ndi impso, kuthamanga kwa magazi >180/100mmHg, ndi zina zotero, zinthu zotsatirazi zitha kuonedwa ngati kugwiritsa ntchito mankhwala oletsa magazi m'thupi mwa munthu:
(1) Odwala omwe ali ndi matenda a mtima (monga valavu yopangira, fibrillation ya atrial, myocardial infarction yokhala ndi mural thrombus, left atrium thrombosis, ndi zina zotero) amakhala ndi vuto la sitiroko lobwerezabwereza.
(2) Odwala omwe ali ndi sitiroko ya ischemic limodzi ndi kusowa kwa mapuloteni C, kusowa kwa mapuloteni S, kukana kwa mapuloteni C ndi odwala ena omwe ali ndi vuto la thrombosis; odwala omwe ali ndi zizindikiro za aneurysm ya extracranial dissecting; odwala omwe ali ndi stenosis ya mitsempha yamkati ndi mkati mwa mutu.
(3) Odwala omwe ali ndi matenda a ubongo omwe ali ndi vuto la infarction angagwiritse ntchito heparin yochepa kapena mlingo wofanana wa LMWH kuti apewe kutsekeka kwa mitsempha yakuya komanso pulmonary embolism.
2) Kufunika kwa kuyang'anira kuchuluka kwa magazi m'magazi pamene mankhwala oletsa magazi m'magazi akugwiritsidwa ntchito
• PT: Kugwira ntchito kwa INR kwa labotale kuli bwino ndipo kungagwiritsidwe ntchito kutsogolera kusintha kwa mlingo wa warfarin; kuwunika chiopsezo cha kutuluka magazi cha rivaroxaban ndi edoxaban.
• APTT: Ingagwiritsidwe ntchito poyesa mphamvu ndi chitetezo cha (milingo yocheperako) heparin yosadulidwa komanso kuwunika bwino chiopsezo cha kutuluka magazi cha dabigatran.
• TT: Imamva bwino dabigatran, imagwiritsidwa ntchito kutsimikizira dabigatran yotsala m'magazi.
• D-Dimer/FDP: Ingagwiritsidwe ntchito poyesa momwe mankhwala oletsa magazi amagwirira ntchito monga warfarin ndi heparin amathandizira pochiza matenda; komanso poyesa momwe mankhwala oletsa magazi amagwirira ntchito monga urokinase, streptokinase, ndi alteplase amathandizira pochiza matenda.
• AT-III: Ingagwiritsidwe ntchito kutsogolera zotsatira za mankhwala a heparin, heparin yolemera pang'ono, ndi fondaparinux, komanso kusonyeza ngati ndikofunikira kusintha mankhwala oletsa magazi kuundana m'thupi.
3). Kuletsa magazi kuundana musanayambe komanso mutatha kudwala matenda a mtima otchedwa atrial fibrillation
Pali chiopsezo cha thromboembolism panthawi ya mtima wosintha magazi kukhala atrial fibrillation, ndipo chithandizo choyenera choletsa magazi kuundana chingachepetse chiopsezo cha thromboembolism. Kwa odwala omwe ali ndi vuto la hemodynamics omwe amafunikira kuthamanga kwa magazi mwachangu, kuyambitsa mankhwala oletsa magazi kuundana sikuyenera kuchedwetsa kuthamanga kwa magazi. Ngati palibe choletsa, heparin kapena heparin yolemera pang'ono kapena NOAC ziyenera kugwiritsidwa ntchito mwachangu momwe zingathere, ndipo kuthamanga kwa magazi kuyenera kuchitika nthawi yomweyo.
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