Kutheni kufuneka i-D-dimer, i-FDP ibonwe kwi-cardiovascular and cerebrovascular patients?
1. I-D-dimer ingasetyenziselwa ukukhokela ukulungiswa kwamandla e-anticoagulation.
(1) Ubudlelwane phakathi kwenqanaba le-D-dimer kunye neziganeko zeklinikhi ngexesha lonyango lwe-anticoagulation kwizigulane emva kokutshintshwa kwevalve yentliziyo.
Iqela le-D-dimer-guided anticoagulation intensity adjustment treatment lilungelelanise ngokufanelekileyo ukhuseleko kunye nokusebenza kakuhle kwe-anticoagulation therapy, kwaye iziganeko zeziganeko ezimbi ezihlukeneyo zaziphantsi kakhulu kuneqela elilawulayo lisebenzisa i-anticoagulation esemgangathweni kunye nephantsi.
(2) Ukuqulunqwa kwe-cerebral venous thrombosis (CVT) inxulumene ngokusondeleyo nomgaqo-siseko we-thrombus.
Izikhokelo zokuxilongwa kunye nokulawulwa kwe-vein yangaphakathi kunye ne-venous sinus thrombosis (CVST)
Umgaqo-siseko we-Thrombotic: I-PC, i-PS, i-AT-lll, i-ANA, i-LAC, i-HCY
Ukuguqulwa kweGene: i-prothrombin gene G2020A, i-coagulation factor LeidenV
Izinto ezibeka phambili: ixesha lokubeleka, izithintelo zokukhulelwa, ukuphelelwa ngamanzi emzimbeni, ukwenzakala, utyando, usulelo, ithumba, ukwehla kobunzima.
2. Ixabiso lokufumanisa okudibeneyo kwe-D-dimer kunye ne-FDP kwi-cardiovascular and cerebrovascular disease.
(1) Ukunyuka kwe-D-dimer (ngaphezulu kwe-500ug / L) luncedo ekuxilongweni kwe-CVST.Isiqhelo asiyikhuphi i-CVST, ngakumbi kwi-CVST enentloko ebuhlungu mva nje.Ingasetyenziswa njengenye yezalathi zokuxilongwa kwe-CVST.I-D-dimer ephezulu kunesiqhelo ingasetyenziselwa njengenye yezibonakaliso zokuxilonga ze-CVST (isiphakamiso senqanaba III, ubungqina benqanaba C).
(2) Izalathisi ezibonisa unyango olusebenzayo lwe-thrombolytic: Ukubeka iliso kwe-D-dimer kwanda kakhulu kwaye emva koko kuncipha ngokuthe ngcembe;I-FDP iye yanda kakhulu kwaye emva koko yehla kancinci.Ezi zalathisi zibini zisisiseko esithe ngqo sonyango olusebenzayo lwe-thrombolytic.
Ngaphantsi kwesenzo seziyobisi ze-thrombolytic (SK, UK, rt-PA, njl.), i-emboli kwimithambo yegazi ichithwa ngokukhawuleza, kwaye i-D-dimer kunye ne-FDP kwi-plasma yanda kakhulu, ehlala ihlala iintsuku ezi-7.Ngethuba lonyango, ukuba i-dosage ye-thrombolytic drug ayinelanga kwaye i-thrombus ayichithwanga ngokupheleleyo, i-D-dimer kunye ne-FDP iya kuqhubeka ikwizinga eliphezulu emva kokufikelela phezulu;Ngokwezibalo, iziganeko zokuphuma kwegazi emva konyango lwe-thrombolytic ziphezulu kwi-5% ukuya kwi-30%.Ngoko ke, kwizigulane ezinezifo ze-thrombotic, irejimeni yechiza engqongqo kufuneka yenziwe, umsebenzi we-plasma coagulation kunye nomsebenzi we-fibrinolytic kufuneka ubekwe esweni ngexesha lokwenyani, kwaye umthamo wamachiza e-thrombolytic kufuneka ulawulwe kakuhle.Ingabonwa ukuba ukubonwa okuguquguqukayo kwe-D-dimer kunye noxinzelelo lwe-FDP lutshintsha ngaphambi, ngexesha nangemva konyango ngexesha le-thrombolysis inexabiso elikhulu leklinikhi yokubeka iliso ekusebenzeni kunye nokhuseleko lweziyobisi ze-thrombolytic.
Kutheni izigulane ezinentliziyo kunye nezifo ze-cerebrovascular zihlawule ingqalelo kwi-AT?
Ukusilela kwe-Antithrombin (AT) I-Antithrombin (AT) idlala indima ebalulekileyo ekuvimbeleni ukubunjwa kwe-thrombus, ayithinteli nje kuphela i-thrombin, kodwa iphinda ivimbele izinto ezidibeneyo ezifana ne-IXa, Xa, Xla, Xlla kunye ne-Vlla.Ukudibanisa i-heparin kunye ne-AT yinxalenye ebalulekileyo ye-AT anticoagulation.Xa kukho i-heparin, umsebenzi we-anticoagulant we-AT unokunyuswa ngamaxesha angamawaka.Umsebenzi we-AT, ngoko ke i-AT yinto ebalulekileyo yenkqubo ye-anticoagulant ye-heparin.
1. Ukuxhatshazwa kwe-Heparin: Xa umsebenzi we-AT uyancipha, umsebenzi we-anticoagulant we-heparin uyancipha kakhulu okanye awusebenzi.Ngoko ke, kuyimfuneko ukuqonda inqanaba le-AT ngaphambi kokuba unyango lwe-heparin luthintele unyango olungeyomfuneko lwe-heparin ephezulu kwaye unyango alusebenzi.
Kwiingxelo ezininzi zeencwadi, ixabiso leklinikhi ye-D-dimer, i-FDP, kunye ne-AT ibonakaliswe kwi-cardiovascular and cerebrovascular disease, enokunceda ekuxilongweni kwangaphambili, ukugwetywa kwemeko kunye nokuhlolwa kwe-prognosis yesifo.
2. Ukuhlolwa kwe-etiology ye-thrombophilia: Izigulane ezine-thrombophilia zibonakaliswa ngekliniki yi-thrombosis enkulu ye-vein thrombosis kunye ne-thrombosis ephindaphindiweyo.Ukuhlolwa kwesizathu se-thrombophilia kunokwenziwa kumaqela alandelayo:
(1) I-VTE ngaphandle kwesizathu esicacileyo (kubandakanywa neonatal thrombosis)
(2) I-VTE enenkuthazo <40-50 iminyaka ubudala
(3) I-thrombosis ephindaphindiweyo okanye i-thrombophlebitis
(4) Imbali yentsapho ye-thrombosis
(5) I-Thrombosis kwiindawo ezingaqhelekanga: i-mesenteric vein, i-cerebral venous sinus
(6) Ukuphuphuma kwesisu okuphindaphindiweyo, ukuzala, njl.
(7) Ukukhulelwa, izithintelo zokukhulelwa, i-hormone-induced thrombosis
(8) I-Skin necrosis, ngakumbi emva kokusebenzisa i-warfarin
(9) I-Arterial thrombosis yesizathu esingaziwayo <iminyaka engama-20 ubudala
(10) Izihlobo ze-thrombophilia
3. Uvavanyo lweziganeko ze-cardiovascular and recurrence: Uphononongo lubonise ukuba ukunciphisa umsebenzi we-AT kwizigulane ezine-cardiovascular disease kubangelwa ukutshatyalaliswa kweeseli ze-endothelial ezikhokelela kwixabiso elikhulu le-AT.Ngoko ke, xa izigulane zikwimeko ye-hypercoagulable, zixhomekeke kwi-thrombosis kwaye zikhulise isifo.Umsebenzi we-AT wawuphantsi kakhulu kubantu abaneziganeko eziphindaphindiweyo ze-cardiovascular kunabantu abangenazo iziganeko eziphindaphindiweyo ze-cardiovascular.
4. Uvavanyo lwengozi ye-thrombosis kwi-fibrillation ye-atrial ye-non-valvular: inqanaba eliphantsi lomsebenzi we-AT lihambelana kakuhle nenqaku le-CHA2DS2-VASc;ngelo xesha, inexabiso eliphezulu lokubhekisela ekuhloleni i-thrombosis kwi-fibrillation ye-atrial non-valvular.
5. Ubudlelwane phakathi kwe-AT kunye ne-stroke: I-AT iyancipha kakhulu kwizigulane ezine-acute ischemic stroke, igazi likwimeko ye-hypercoagulable, kwaye unyango lwe-anticoagulation kufuneka lunikezwe ngexesha;izigulane ezinemingcipheko ye-stroke kufuneka zivavanyelwe rhoqo i-AT, kwaye ukufunyanwa kwangoko koxinzelelo lwegazi lwezigulane kufuneka kwenziwe.Imeko ye-coagulation kufuneka iphathwe kwangethuba ukuphepha ukwenzeka kwe-stroke ebukhali.
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