Sei D-dimer, FDP zvichifanira kuonekwa muvarwere vane chirwere chemwoyo netsinga dzeropa?
1. D-dimer inogona kushandiswa kutungamira kugadziriswa kwesimba rekudzivirira ropa kupwanya.
(1) Hukama huripo pakati pezinga reD-dimer nezviitiko zvekiriniki panguva yekurapwa kwekudzivirira ropa kuputika muvarwere mushure mekutsiviwa kwemavharuvhu emwoyo.
Boka rekurapa rekudzivirira ropa kusingapindi ropa rakatungamirirwa neD-dimer rakanyatsoenzanisa kuchengetedzeka nekushanda kwekurapa kwekudzivirira ropa kusingapindi ropa, uye kuwanda kwezviitiko zvakasiyana-siyana zvakaipa kwakaderera zvakanyanya pane kweboka rekutonga richishandisa nzira dzakajairwa uye nzira dzakaderera dzekudzivirira ropa kusingapindi ropa kusingapindi ropa.
(2) Kuumbwa kwe cerebral venous thrombosis (CVT) kwakabatana zvakanyanya nekugadzirwa kwe thrombus.
Nhungamiro dzekuongorora nekutarisira thrombosis yemukati metsinga netsinga yeropa (CVST)
Muviri weThrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Kuchinja kwemajini: prothrombin gene G2020A, coagulation factor LeidenV
Zvinhu zvinokonzera chirwere ichi: nguva yekusununguka, mishonga yekudzivirira pamuviri, kushaya mvura mumuviri, kukuvara, kuvhiyiwa, hutachiona, bundu, kudzikira kwehuremu.
2. Kukosha kwekuona pamwe chete D-dimer neFDP muzvirwere zvemwoyo netsinga dzeropa.
(1) Kuwedzera kweD-dimer (inopfuura 500ug/L) kunobatsira pakuongorora CVST. Kugara kwenguva refu hakubvisi CVST, kunyanya muCVST ine musoro wakasiyana-siyana munguva pfupi yapfuura. Inogona kushandiswa sechimwe chezviratidzo zvekuongororwa kweCVST. D-dimer yakakwira kupfuura yakajairika inogona kushandiswa sechimwe chezviratidzo zvekuongororwa kweCVST (kurudziro yedanho rechitatu, humbowo hwedanho rechitatu).
(2) Zviratidzo zvinoratidza kurapa kwethrombolytic kunoshanda: Kuongororwa kweD-dimer kwakawedzera zvakanyanya uye kwakazodzikira zvishoma nezvishoma; FDP yakawedzera zvakanyanya uye yakazodzikira zvishoma nezvishoma. Zviratidzo zviviri izvi ndizvo zvinotungamira kurapa kwethrombolytic kunoshanda.
Pasi pekushanda kwemishonga ye thrombolytic (SK, UK, rt-PA, nezvimwewo), emboli mutsinga dzeropa inonyungudika nekukurumidza, uye D-dimer neFDP muplasma zvinowedzerwa zvakanyanya, izvo zvinowanzogara kwemazuva manomwe. Munguva yekurapwa, kana dosi yemishonga ye thrombolytic isina kukwana uye thrombus isina kunyungudika zvachose, D-dimer neFDP zvicharamba zviri padanho repamusoro mushure mekusvika padanho repamusoro; Zvichienderana nehuwandu, kuwanda kwekubuda ropa mushure mekurapwa kwe thrombolytic kwakakwira kusvika 5% kusvika 30%. Saka, kune varwere vane zvirwere zve thrombotic, mushonga wakasimba unofanirwa kuumbwa, chiitiko che plasma coagulation uye chiitiko che fibrinolytic chinofanira kutariswa munguva chaiyo, uye dosi yemishonga ye thrombolytic inofanira kudzorwa zvakanaka. Zvinogona kuonekwa kuti kuona kweD-dimer neFDP kunochinja pamberi, panguva uye mushure mekurapwa panguva ye thrombolysis kune kukosha kukuru kwekiriniki kwekutarisa kushanda uye kuchengetedzeka kwemishonga ye thrombolytic.
Sei varwere vane zvirwere zvemwoyo netsinga dzeropa vachifanira kungwarira AT?
Kushaikwa kweAntithrombin (AT) Antithrombin (AT) inoita basa rakakosha mukudzivirira kuumbwa kwethrombus, haingodziviriri thrombin chete, asiwo inodzivirira zvinhu zvakaita seIXa, Xa, Xla, Xlla neVlla. Kusanganiswa kweheparin neAT chikamu chakakosha cheAT anticoagulation. Kana paine heparin, basa reAT anticoagulant rinogona kuwedzerwa nezviuru zvenguva. Basa reAT, saka AT chinhu chakakosha pakuita kweheparin anticoagulant.
1. Kusagona kushandisa heparin: Kana kushanda kweAT kwadzikira, kushanda kweheparin kunoderedza ropa kana kuti kusashanda. Saka, zvakakosha kunzwisisa huwandu hweAT usati watanga kurapwa neheparin kuti udzivise kurapwa kweheparin kwakanyanya uye kurapwa kwacho hakushande.
Muzvinyorwa zvakawanda, kukosha kweD-dimer, FDP, uye AT kunoratidzwa muzvirwere zvemwoyo netsinga dzeropa, izvo zvinogona kubatsira mukuongorora chirwere ichi nekukurumidza, kuongorora mamiriro acho ezvinhu uye kuongorora fungidziro yechirwere.
2. Kuongororwa kwechikonzero chethrombophilia: Varwere vane thrombophilia vanoratidzwa nekuva nethrombosis yakakura yetsinga dzakadzika uye thrombosis inodzokororwa. Kuongororwa kwechikonzero chethrombophilia kunogona kuitwa mumapoka anotevera:
(1) VTE isina chikonzero chakajeka (kusanganisira thrombosis yevana vacheche)
(2) VTE ine zvinokurudzira pasi pemakore 40-50 ekuberekwa
(3) Kudzokororwa kweropa rakaita se ...
(4) Nhoroondo yemhuri yechirwere chethrombosis
(5) Thrombosis panzvimbo dzisina kujairika: mutsinga wemesenteric, sinus yetsinga yeuropi
(6) Kubvisa pamuviri kakawanda, kubereka mwana akafa, nezvimwewo.
(7) Pamuviri, mishonga yekudzivirira pamuviri, thrombosis inokonzerwa nemahormone
(8) Kubuda kweganda, kunyanya mushure mekushandisa warfarin
(9) Kupwanywa kwetsinga dzeropa dzisingazivikanwi chikonzero chiri pasi pemakore makumi maviri
(10) Hama dzevane thrombophilia
3. Kuongororwa kwezviitiko zvemwoyo nekudzoka kwechirwere: Ongororo dzakaratidza kuti kudzikira kweAT activity muvarwere vane chirwere chemwoyo kunokonzerwa nekukuvara kwemasero emukati memuviri izvo zvinoita kuti AT ishandiswe yakawanda. Saka, kana varwere vari mumamiriro ezvinhu akaomarara, vanowanzobatwa nethrombosis uye vanowedzera chirwere ichi. Mabasa eAT aivewo akaderera zvakanyanya muvanhu vane zviitiko zvemwoyo nemwoyo zvinodzoka kupfuura muvanhu vasina zviitiko zvemwoyo zvinodzoka.
4. Kuongororwa kwenjodzi ye thrombosis mu non-valvular atrial fibrillation: AT activity level yakaderera inoenderana zvakanaka neCHA2DS2-VASc score; panguva imwe chete, ine kukosha kwakakwirira kwekuongorora thrombosis mu non-valvular atrial fibrillation.
5. Hukama huripo pakati peAT nestroke: AT inodzikira zvakanyanya muvarwere vane acute ischemic stroke, ropa riri mumamiriro ekugwamba kweropa zvakanyanya, uye mushonga wekudzivirira kugwamba kweropa unofanirwa kupihwa nenguva; varwere vane stroke risk factors vanofanira kuongororwa nguva dzose kuti vaone AT, uye kuongororwa kweBP yevarwere kunofanirwa kuitwa nekukurumidza. Mamiriro ekugwamba kweropa anofanira kurapwa nenguva kuti adzivise acute stroke.
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