Zvinoumba Coagulation Panguva Yepamuviri


Munyori: Mutsivi   

Muvakadzi vakajairwa, kubata, anticoagulation uye fibrinolysis mabasa mumuviri panguva yekuzvitakura uye kuzvara kuchinjwa zvakanyanya, zviri muthrombin, coagulation factor uye fibrinogen muropa zvinowedzera, anticoagulation uye fibrinolysis mabasa akadzikira, uye ropa riri muropa. hypercoagulable state.Shanduko yemuviri inopa hwaro hwezvinhu nekukurumidza uye hunoshanda postpartum hemostasis.Kutarisisa ropa coagulation basa panguva yekuzvitakura kunogona kuona shanduko isina kujairika muropa coagulation basa nekukurumidza, izvo zvine zvimwe zvakakosha pakudzivirira uye kununura matambudziko ekuzvara.

Muvakadzi vakazvitakura vakajairwa, nekuwedzera zera rekuzvitakura, kubuda kwemoyo kunowedzera uye peripheral resistance inodzikira.Zvinowanzotendwa kuti kubuda kwemoyo kunotanga kuwedzera pamavhiki masere kusvika gumi ekuberekwa uye kusvika panhongonya pamavhiki makumi matatu nemaviri kusvika kumakumi matatu nemana ekuberekwa, kuwedzera kwe30% kusvika ku45% kana ichienzaniswa nekusava nemimba, uye inochengetedza iyi nhanho kusvika pakusununguka.Kudzikira kweperipheral vascular resistance kunoderedza arterial pressure, uye diastolic blood pressure inodzikira zvakanyanya, uye musiyano wepulse pressure unowedzera.Kubva pa6 kusvika kumavhiki gumi ekuzvitakura, huwandu hweropa revakadzi vane pamuviri hunowedzera nekuwedzera kwezera rekuzvitakura, uye hunowedzera nezvikamu makumi mana kubva muzana pakupera kwemimba, asi kuwedzera kwehuwandu hweplasma kunopfuura nekure nhamba yemasero matsvuku eropa, plasma. inowedzera ne40% kusvika ku50%, uye masero matsvuku eropa anowedzera ne10% kusvika 15%.Nokudaro, pamuviri wepamuviri, ropa rinoderedzwa, rinoratidzwa sekuderera kweropa viscosity, kuderera kwehematocrit, uye kuwedzera erythrocyte sedimentation rate.

Ropa coagulation zvinhu Ⅱ, Ⅴ, VII, Ⅷ, IX, uye Ⅹ zvose zvinowedzera panguva yekuzvitakura, uye zvinogona kusvika 1.5 kusvika 2.0 nguva dzemazuva ose pakati nepakati nepamuviri, uye mabasa ekugadzirisa zvinhu Ⅺ uye  kuderera.Fibrinopeptide A, fibrinopeptide B, thrombinogen, platelet factor Ⅳ uye fibrinogen yakawedzera zvakanyanya, nepo antithrombin Ⅲ uye protein C uye protein S yakaderera.Panguva yekuzvitakura, nguva yeprothrombin uye yakagadziriswa chikamu cheprothrombin nguva inopfupiswa, uye plasma fibrinogen content inowedzera zvakanyanya, iyo inogona kuwedzera kusvika 4-6 g / L muchitatu trimester, iyo inenge 50% yakakwirira kudarika iyo isina pamuviri. period.Mukuwedzera, plasminogen yakawedzera, euglobulin dissolution nguva yakarebeswa, uye coagulation-anticoagulation shanduko yakaita kuti muviri uve mu hypercoagulable state, iyo yaibatsira kune inoshanda hemostasis mushure mekuputika kwepa placenta panguva yebasa.Mukuwedzera, zvimwe hypercoagulable zvinhu panguva yekuzvitakura zvinosanganisira kuwedzera kwecholesterol yakazara, phospholipids uye triacylglycerols muropa, androgen uye progesterone yakabudiswa ne placenta inoderedza kushanda kweimwe ropa coagulation inhibitors, placenta, uterine decidua uye embryos.Kuvapo kwezvinhu zve thromboplastin, nezvimwewo, zvinogona kukurudzira ropa kuti rive mu hypercoagulable state, uye kuchinja uku kunowedzera nekuwedzera kwezera rekudzivirira.Moderate hypercoagulation ndiyo physiological protective chiyero, iyo inobatsira kuchengetedza fibrin deposition mutsinga, uterine rusvingo uye placental villi, kubatsira kuchengetedza kutendeseka kwepa placenta uye kuumba thrombus nekuda kwekubvisa, uye kufambisa nekukurumidza hemostasis panguva uye mushure mekusununguka., inzira inokosha yekudzivirira kubuda ropa kwepashure.Panguva imwecheteyo yekubatana, yechipiri fibrinolytic basa rinotangawo kubvisa thrombus mu uterine spiral arteries uye venous sinuses uye kukurumidza kuberekwa patsva uye kugadziriswa kwe endometrium .

Nekudaro, iyo hypercoagulable state inogona zvakare kukonzera akawanda obstetric matambudziko.Mumakore achangopfuura, zvidzidzo zvakawana kuti vakadzi vakawanda vane pamuviri vane thrombosis.Ichi chirwere che thromboembolism muvakadzi vane pamuviri nekuda kwekuremara kwemajini kana kuwana njodzi dzakadai se anticoagulant proteins, coagulation factor, uye fibrinolytic proteins inonzi thrombosis.(thrombophilia), inozivikanwawo seprothrombotic state.Iyi prothrombotic state hairegi kutungamirira kuchirwere chethrombotic, asi inogona kutungamirira kumigumisiro yakaipa yepamuviri nekuda kwekusaenzana mukugadzirisa-anticoagulation nzira kana fibrinolytic basa, microthrombosis ye uterine spiral arteries kana villus, zvichiita kuti pave nekushaya simba kwepa placental perfusion kana kunyange infarction, yakadai sePreeclampsia. , placenta abruption, placental infarction, disseminated intravascular coagulation (DIC), kurambidzwa kwekukura kwe fetal, kupfupfudzika kunowanzoitika, kubereka uye kuberekwa nguva isati yakwana, nezvimwewo, zvinogona kutungamirira kurufu rwaamai uye perinatal mumatambudziko akaoma.