Kutheni kufuneka i-D-dimer, i-FDP ifunyanwe kwizigulane ezineengxaki zentliziyo nezemithambo yegazi?
1. I-D-dimer ingasetyenziselwa ukukhokela uhlengahlengiso lwamandla okuthintela ukujiya kwegazi.
(1) Ubudlelwane phakathi kwenqanaba le-D-dimer kunye neziganeko zeklinikhi ngexesha lonyango lokuthintela ukujiya kwegazi kwizigulana emva kokutshintshwa kwevalvu yentliziyo yoomatshini.
Iqela lonyango lokulungisa i-anticoagulation intensity adjustment elikhokelwa yi-D-dimer lilinganise ngokufanelekileyo ukhuseleko kunye nokusebenza kakuhle konyango lwe-anticoagulation, kwaye ukuvela kweziganeko ezahlukeneyo ezimbi bekuphantsi kakhulu kunelo leqela lolawulo elisebenzisa i-anticoagulation eqhelekileyo kunye ne-low-intensity.
(2) Ukwakheka kwe-cerebral venous thrombosis (CVT) kunxulumene kakhulu nokwakheka kwe-thrombus.
Izikhokelo zokuxilonga nokulawula i-intravenous vein kunye ne-venous sinus thrombosis (CVST)
Ukwakheka kwe-Thrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Uguquko lwe-Gene: i-prothrombin gene G2020A, i-coagulation factor LeidenV
Izinto ezinokubangela ukuba umntwana abe sengozini: ixesha lokukhulelwa, iindlela zokuthintela ukukhulelwa, ukuphelelwa ngamanzi emzimbeni, ukwenzakala, utyando, usulelo, ithumba, ukwehla kobunzima.
2. Ixabiso lokufumanisa i-D-dimer kunye ne-FDP ngokudibeneyo kwizifo zentliziyo kunye nemithambo yegazi.
(1) Ukunyuka kwe-D-dimer (ngaphezulu kwe-500ug/L) kunceda ekuxilongweni kwe-CVST. Ukuhambelana ngokuqhelekileyo akuthethi ukuba i-CVST ayinakwenzeka, ingakumbi kwi-CVST enentloko ebuhlungu ethe kratya kutshanje. Ingasetyenziswa njengenye yezalathisi zokuxilongwa kwe-CVST. I-D-dimer ephezulu kuneqhelekileyo ingasetyenziswa njengenye yezalathisi zokuxilongwa kwe-CVST (ingcebiso yenqanaba lesi-III, ubungqina benqanaba C).
(2) Izalathisi ezibonisa unyango olusebenzayo lwe-thrombolytic: Ukubeka iliso kwi-D-dimer kwanda kakhulu kwaza kwehla kancinci kancinci; i-FDP yanda kakhulu yaza kwehla kancinci kancinci. Ezi zalathisi zimbini zisisiseko esithe ngqo sonyango olusebenzayo lwe-thrombolytic.
Phantsi kwesenzo samayeza e-thrombolytic (SK, UK, rt-PA, njl.njl.), i-emboli kwimithambo yegazi iyanyibilika ngokukhawuleza, kwaye i-D-dimer kunye ne-FDP kwi-plasma ziyanda kakhulu, ezihlala iintsuku ezi-7. Ngexesha lonyango, ukuba umthamo wamayeza e-thrombolytic awonelanga kwaye i-thrombus ayinyibiliki ngokupheleleyo, i-D-dimer kunye ne-FDP ziya kuqhubeka nokuba kumanqanaba aphezulu emva kokufikelela kwincopho; Ngokwezibalo, ukwanda kokopha emva konyango lwe-thrombolytic kuphezulu ukuya kwi-5% ukuya kwi-30%. Ke ngoko, kwizigulana ezinezifo ze-thrombotic, kufuneka kwenziwe inkqubo yamayeza engqongqo, umsebenzi we-plasma coagulation kunye nomsebenzi we-fibrinolytic kufuneka ujongwe ngexesha langempela, kwaye umthamo wamayeza e-thrombolytic kufuneka ulawulwe kakuhle. Kunokubonwa ukuba ukufunyanwa okunamandla koxinzelelo lwe-D-dimer kunye ne-FDP kuyatshintsha ngaphambi, ngexesha nasemva konyango ngexesha le-thrombolysis kunexabiso elikhulu leklinikhi lokujonga ukusebenza kakuhle kunye nokhuseleko lwamayeza e-thrombolytic.
Kutheni izigulane ezinezifo zentliziyo kunye nemithambo yegazi kufuneka ziqwalasele i-AT?
Ukunqongophala kwe-Antithrombin (AT) I-Antithrombin (AT) idlala indima ebalulekileyo ekuthinteleni ukwakheka kwe-thrombus, ayithinteli nje kuphela i-thrombin, kodwa ikwathintela nezinto ezijiyayo ezifana ne-IXa, iXa, iXla, iXlla kunye ne-Vlla. Ukudibana kwe-heparin kunye ne-AT yinxalenye ebalulekileyo ye-AT anticoagulation. Xa kukho i-heparin, umsebenzi we-AT anticoagulant unokwandiswa ngamawaka amaxesha. Umsebenzi we-AT, ngoko ke i-AT yinto ebalulekileyo kwinkqubo ye-heparin anticoagulant.
1. Ukumelana ne-Heparin: Xa umsebenzi we-AT uncipha, umsebenzi we-heparin othintela ukugabha kwegazi uyancipha kakhulu okanye awusebenzi. Ke ngoko, kubalulekile ukuqonda inqanaba le-AT ngaphambi konyango lwe-heparin ukuze kuthintelwe unyango lwe-heparin olungeyomfuneko olunedosi ephezulu kwaye unyango alusebenzi.
Kwiingxelo ezininzi zeencwadi, ixabiso leklinikhi le-D-dimer, i-FDP, kunye ne-AT libonakala kwizifo zentliziyo kunye nemithambo yegazi, ezinokunceda ekuxilongweni kwangethuba, ekugwebeni imeko kunye novavanyo lokubikezela isifo.
2. Ukuhlolwa kwesizathu se-thrombophilia: Izigulane ezine-thrombophilia zibonakaliswa ngokwezonyango yi-massive deep vein thrombosis kunye ne-thrombosis ephindaphindwayo. Ukuhlolwa kwesizathu se-thrombophilia kungenziwa kula maqela alandelayo:
(1) I-VTE ngaphandle kwesizathu esicacileyo (kuquka i-thrombosis yeentsana ezisandula ukuzalwa)
(2) I-VTE enezibonelelo ezingaphantsi kweminyaka engama-40-50 ubudala
(3) Ukuqhambuka kwemithambo yegazi okanye i-thrombophlebitis ephindaphindayo
(4) Imbali yosapho ye-thrombosis
(5) I-Thrombosis kwiindawo ezingaqhelekanga: umthambo we-mesenteric, i-cerebral venous sinus
(6) Ukuphuphuma kwesisu okuphindaphindiweyo, ukuzala umntwana eswelekile, njl.njl.
(7) Ukukhulelwa, iindlela zokuthintela ukukhulelwa, i-thrombosis ebangelwa yi-hormone
(8) Ukufa kwesikhumba, ingakumbi emva kokusebenzisa i-warfarin
(9) Ukuqina kwemithambo yegazi okubangelwa sisizathu esingaziwayo esingaphantsi kweminyaka engama-20 ubudala
(10) Izalamane ze-thrombophilia
3. Uvavanyo lweziganeko zentliziyo kunye nokubuyela kwakhona: Izifundo zibonise ukuba ukwehla komsebenzi we-AT kwizigulana ezinesifo sentliziyo kungenxa yomonakalo weeseli ze-endothelial okhokelela ekubeni kusetyenziswe i-AT eninzi. Ke ngoko, xa izigulana zikwimeko yokuxinana kwegazi, zisengozini yokuba ne-thrombosis kwaye ziyenze mandundu le sifo. Umsebenzi we-AT wawuphantsi kakhulu kubantu abaneziganeko zentliziyo eziphindaphindayo kunakubantu abangenazo iziganeko zentliziyo eziphindaphindayo.
4. Uvavanyo lomngcipheko we-thrombosis kwi-non-valvular atrial fibrillation: inqanaba eliphantsi lomsebenzi we-AT lihambelana kakuhle ne-CHA2DS2-VASc score; kwangaxeshanye, inexabiso eliphezulu lokujonga i-thrombosis kwi-non-valvular atrial fibrillation.
5. Ubudlelwane phakathi kwe-AT kunye ne-stroke: I-AT iyancipha kakhulu kwizigulane ezine-acute ischemic stroke, igazi likwimeko yokuxinana kwegazi, kwaye unyango lokuthintela ukuxinana kwegazi kufuneka lunikwe ngexesha; izigulane ezine-stroke risk factors kufuneka zivavanywe rhoqo i-AT, kwaye kufuneka kubonwe kwangethuba uxinzelelo lwegazi oluphezulu lwezigulane. Imeko yokuxinana kwegazi kufuneka inyangwe kwangethuba ukuze kuthintelwe ukwenzeka kwe-acute stroke.
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