1. Kushandiswa kwekiriniki kwezvirongwa zvekuonda kweropa muzvirwere zvemwoyo nepfungwa
Munyika Yose, huwandu hwevanhu vanorwara nezvirwere zvemwoyo netsinga dzeropa hwakakura, uye huri kuramba huchiwedzera gore negore. Mukurapa, varwere vanowanzotanga kurwara kwenguva pfupi uye vanobuda ropa muuropi, izvo zvinokanganisa fungidziro yechirwere uye zvinotyisidzira hupenyu hwevarwere.
Kune zvirwere zvakawanda zvezvirwere zvemwoyo netsinga dzeropa, uye zvinhu zvinopesvedzera chirwere ichi zvakaomawo. Nekuwedzera kuri kuita tsvakurudzo yekiriniki pamusoro pekugwamba kweropa, zvakaonekwa kuti muzvirwere zvemwoyo netsinga dzeropa, zvinhu zvinogwamba zvinogona kushandiswawo sezvinhu zvinokonzera chirwere ichi. Zvidzidzo zvekiriniki zvakaratidza kuti nzira dzekugwamba kweropa dzekunze nedzemukati dzevarwere vakadaro dzine chekuita nekuongororwa, kuongororwa uye kufanotaura kwezvirwere zvakadaro. Nokudaro, kuongororwa kwakazara kwengozi yekugwamba kweropa kwevarwere kwakakosha zvikuru kune varwere vane zvirwere zvemwoyo netsinga dzeropa.
2. Nei varwere vane zvirwere zvemwoyo netsinga dzeropa vachifanira kutarisisa zviratidzo zvekugwamba kweropa
Zvirwere zvemwoyo netsinga dzeropa zvirwere zvinoisa panjodzi hutano nehupenyu hwevanhu zvakanyanya, zvine huwandu hwakawanda hwerufu uye huwandu hwakawanda hwekuremara.
Kuburikidza nekuona mashandiro ekugwamba kweropa muvarwere vane zvirwere zvemwoyo netsinga dzeropa, zvinokwanisika kuongorora kana murwere aine kubuda ropa uye njodzi yekubuda ropa mutsinga; mukurapa kunotevera kwekudzivirira kugwamba kweropa, mhedzisiro yekugwamba kweropa inogonawo kuongororwa uye mishonga yekiriniki inogona kutungamirirwa kudzivirira kubuda ropa.
1). Varwere vane sitiroko
Cardioembolic stroke chirwere chemwoyo chinokonzerwa nekubuda kweropa mutsinga dzeropa mutsinga dzeuropi, zvichikonzera 14% kusvika 30% yekurohwa kweropa mutsinga dzemwoyo. Pakati pazvo, chirwere chemwoyo chinokonzerwa neatrial fibrillation chinopfuura 79% yekurohwa kweropa mutsinga, uye chirwere chemwoyo chinokonzerwa nekurohwa kweropa mutsinga dzakakomba, uye chinofanira kuzivikanwa nekukurumidza uye kupindira. Kuti tiongorore njodzi yethrombosis uye kurapwa kwevarwere vanorwisa ropa, uye kurapwa kweropa mutsinga dzeropa, kliniki inoda kushandisa zviratidzo zveropa mutsinga kuti iongorore mhedzisiro yeropa mutsinga uye mishonga chaiyo yeropa mutsinga kudzivirira ropa kubuda.
Njodzi huru muvarwere vane atrial fibrillation iarterial thrombosis, kunyanya cerebral embolism. Zvinokurudzirwa kuti vanhu vasaungane ne cerebral infarction zvichitevera atrial fibrillation:
1. Kugara uchishandisa mishonga inorwisa ropa panguva imwe chete hakukurudzirwi kune varwere vane chirwere chepfungwa chisingaperi.
2. Kune varwere vanorapwa ne thrombolysis, hazvikurudzirwi kushandisa mishonga inorwisa ropa mukati memaawa makumi maviri nemana.
3. Kana pasina zvinorambidzwa zvakaita sekubuda ropa, chirwere chakakomba chechiropa neitsvo, BP >180/100mmHg, nezvimwewo, zvinotevera zvinogona kutorwa sekushandisa mishonga inorwisa ropa:
(1) Varwere vane chirwere chemwoyo (senge artificial valve, atrial fibrillation, myocardial infarction ine mural thrombus, left atrial thrombosis, nezvimwewo) vanowanzobatwa nechirwere chekurohwa nemusoro.
(2) Varwere vane chirwere che ischemic stroke pamwe chete nekushomeka kweprotein C, kushomeka kweprotein S, kuramba kushanda kweprotein C nevamwe varwere vane thrombosis; varwere vane zviratidzo zve extracranial dissecting aneurysm; varwere vane intracranial uye intracranial artery stenosis.
(3) Varwere vari pamubhedha vane cerebral infarction vanogona kushandisa heparin shoma kana LMWH inoenderana nayo kudzivirira deep vein thrombosis uye pulmonary embolism.
2). Kukosha kwekutarisa chiyero checoagulation index kana mishonga inorwisa coagulant ichishandiswa
• PT: Kushanda kweINR murabhoritari kwakanaka uye kunogona kushandiswa kutungamira kugadziriswa kwemushonga wewarfarin; kuongorora njodzi yekubuda ropa kwerivaroxaban ne edoxaban.
• APTT: Inogona kushandiswa kuongorora kushanda uye kuchengetedzeka kwe (madosi ari pakati nepakati) heparin isina kupatsanurwa uye kuongorora njodzi yekubuda ropa yedabigatran zvine hunhu.
• TT: Inonzwa dabigatran, inoshandiswa kuona kuti dabigatran yasara muropa.
• D-Dimer/FDP: Inogona kushandiswa kuongorora mhedzisiro yemishonga inorwisa ropa yakaita sewarfarin neheparin pakurapa; uye kuongorora mhedzisiro yemishonga inorwisa ropa yakaita seurokinase, streptokinase, uye alteplase pakurapa.
• AT-III: Inogona kushandiswa kutungamira mhedzisiro yemishonga yeheparin, heparin ine huremu hwakaderera, uye fondaparinux, uye kuratidza kana zvichidikanwa kuchinja mishonga inorwisa ropa mukurapa.
3). Kudzivirira ropa kuti risaungane ropa risati rabuda uye mushure mekubuda kweropa mumoyo.
Pane njodzi yekukuvadzwa kweropa panguva yekuchinja kwemwoyo neatrial fibrillation, uye kurapwa kwakakodzera kwekudzivirira kuvhara ropa kunogona kuderedza njodzi yekukuvadzwa kweropa neatrial fibrillation. Kune varwere vasina kugadzikana kweropa neatrial fibrillation vanoda kukurumidza kuchinja kwemoyo, kutanga kwekudzivirira kuvhara ropa hakufanirwe kunonotsa kuchinja kwemoyo. Kana pasina zvinopesana, heparin kana heparin yakaderera kana NOAC inofanira kushandiswa nekukurumidza, uye kuchinja kwemoyo kunofanira kuitwa panguva imwe chete.
Kadhi rebhizinesi
WeChat yeChinese