1. Ukusetyenziswa kweklinikhi kweprojekthi zokujiya kwegazi kwizifo zentliziyo kunye nemithambo yegazi
Kwihlabathi liphela, inani labantu abanesifo sentliziyo kunye nezifo zemithambo-luvo likhulu, kwaye libonisa ukuthambekela okwandayo unyaka nonyaka. Kwimisebenzi yezonyango, izigulana eziqhelekileyo ziqala ixesha elifutshane kwaye zihamba nokopha kwegazi ebuchotsheni, nto leyo echaphazela kakubi i-prognosis kwaye isongela ubomi bezigulane.
Kukho izifo ezininzi zezifo zentliziyo kunye nemithambo yegazi, kwaye izinto ezichaphazelayo nazo ziyinkimbinkimbi kakhulu. Ngokuqhubeka kophando lwezonyango malunga nokujiya kwegazi, kufunyaniswe ukuba kwizifo zentliziyo kunye nemithambo yegazi, izinto ezijiya igazi zingasetyenziswa njengezinto ezibangela esi sifo. Izifundo zeklinikhi zibonise ukuba zombini iindlela zokujiya kwegazi zangaphandle kunye nezangaphakathi zezi zigulana ziya kuba nefuthe ekuxilongweni, kuvavanyo kunye nokuqikelela ezo zifo. Ke ngoko, uvavanyo olupheleleyo lomngcipheko wokujiya kwegazi kwizigulana lubaluleke kakhulu kwizigulana ezinezifo zentliziyo kunye nemithambo yegazi.
2. Kutheni izigulane ezinezifo zentliziyo kunye nemithambo yegazi kufuneka ziqwalasele izalathisi zokuxinana kwegazi
Izifo zentliziyo kunye nezifo zemithambo-luvo zizifo ezibeka impilo nobomi babantu emngciphekweni omkhulu, kunye nokufa okuphezulu kunye namazinga aphezulu okukhubazeka.
Ngokufumanisa umsebenzi wokujiya kwegazi kwizigulana ezinezifo zentliziyo nezemithambo yegazi, kunokwenzeka ukuvavanya ukuba isigulana sinokopha na kunye nomngcipheko we-venous thrombosis; kwinkqubo yonyango olulandelayo lokujiya kwegazi, isiphumo sokujiya kwegazi sinokuvavanywa kwaye amayeza eklinikhi anokukhokelwa ukuthintela ukopha.
1). Izigulane zestroke
I-Cardioembolic stroke sisifo se-ischemic esibangelwa kukuphuma kwe-cardiogenic emboli kunye nokukhupha imithambo yobuchopho ehambelanayo, ebalelwa kwi-14% ukuya kwi-30% yazo zonke izibetho ze-ischemic. Phakathi kwazo, isifo se-atrial fibrillation-related stroke sibangela ngaphezu kwe-79% yazo zonke izibetho ze-cardioembolic, kwaye izibetho ze-cardioembolic ziyingozi kakhulu, kwaye kufuneka zichongwe kwangethuba kwaye zingenelele ngokukhutheleyo. Ukuvavanya umngcipheko we-thrombosis kunye nonyango lwe-anticoagulation lwezigulane, kunye nonyango lwe-anticoagulation kufuneka kusetyenziswe izalathisi ze-coagulation ukuvavanya isiphumo se-anticoagulation kunye namayeza achanekileyo e-anticoagulation ukuthintela ukopha.
Eyona ngozi inkulu kwizigulana ezine-atrial fibrillation yi-arterial thrombosis, ingakumbi i-cerebral embolism. Iingcebiso zokuthintela ukugabha kwegazi kwi-cerebral infarction emva kwe-atrial fibrillation:
1. Ukusetyenziswa rhoqo kwe-anticoagulants akukhuthazwa kwizigulana ezine-cerebral infarction ebukhali.
2. Kwizigulane ezinyangwa nge-thrombolysis, akukhuthazwa ukuba zisebenzise amayeza okunciphisa igazi kwiiyure ezingama-24.
3. Ukuba akukho zithintelo ezifana nokopha, isifo sesibindi nesintso esibi, uxinzelelo lwegazi olungaphezulu kwe-180/100mmHg, njl.njl., ezi meko zilandelayo zinokuthathwa njengokusetyenziswa ngokukhethayo kwe-anticoagulants:
(1) Izigulana ezine-cardiac infarction (ezifana ne-artificial valve, i-atrial fibrillation, i-myocardial infarction ene-mural thrombus, i-left atrial thrombosis, njl.njl.) zinomngcipheko wokuhlaselwa sistroke esiphindaphindayo.
(2) Izigulana ezine-ischemic stroke ezihamba nokunqongophala kweproteni C, ukunqongophala kweproteni S, ukuxhathisa kweproteni C esebenzayo kunye nezinye izigulana ezisengozini yokuvaleka kwemithambo yegazi; izigulana ezine-aneurysm ye-dissecting engaphandle kwentloko; izigulana ezine-stenosis yemithambo yegazi engaphakathi kwentloko kunye nengaphakathi kwentloko.
(3) Izigulane ezilele ebhedini ezine-cerebral infarction zingasebenzisa i-heparin yedosi ephantsi okanye idosi ehambelanayo ye-LMWH ukuthintela i-deep vein thrombosis kunye ne-pulmonary embolism.
2). Ixabiso lokujonga isalathisi sokujiya kwegazi xa kusetyenziswa amayeza okuthintela ukujiya kwegazi
• PT: Ukusebenza kwe-INR yelebhu kulungile kwaye ingasetyenziselwa ukukhokela uhlengahlengiso lwedosi ye-warfarin; ukuvavanya umngcipheko wokopha kwe-rivaroxaban kunye ne-edoxaban.
• I-APTT: Ingasetyenziselwa ukuvavanya ukusebenza kakuhle kunye nokhuseleko lwe-heparin engaqhekezwanga (iidosi eziphakathi) kunye nokuvavanya ngokomgangatho umngcipheko wokopha we-dabigatran.
• TT: Ibuthathaka kwi-dabigatran, isetyenziselwa ukuqinisekisa intsalela ye-dabigatran egazini.
• I-D-Dimer/FDP: Ingasetyenziselwa ukuvavanya isiphumo sonyango seziyobisi ezilwa nokugabha igazi ezifana ne-warfarin kunye ne-heparin; kunye nokuvavanya isiphumo sonyango seziyobisi ezibangela ukugabha kwegazi ezifana ne-urokinase, i-streptokinase, kunye ne-alteplase.
• I-AT-III: Ingasetyenziselwa ukukhokela imiphumo yeyeza le-heparin, i-heparin enobunzima obuphantsi beemolekyuli, kunye ne-fondaparinux, kunye nokubonisa ukuba kuyimfuneko na ukutshintsha ii-anticoagulants kwizonyango.
3). Ukuthintela ukugabha kwegazi ngaphambi nasemva kokuguqulwa kwentliziyo yi-atrial fibrillation
Kukho umngcipheko we-thromboembolism ngexesha le-cardioversion ye-atrial fibrillation, kwaye unyango olufanelekileyo lwe-anticoagulation lunokunciphisa umngcipheko we-thromboembolism. Kwizigulane ezingazinzanga ngokwe-hemodynamics ezine-atrial fibrillation ezifuna i-cardioversion engxamisekileyo, ukuqaliswa kwe-anticoagulation akufanele kulibazise i-cardioversion. Ukuba akukho nto ichaseneyo, i-heparin okanye i-heparin ephantsi ye-molecular weight okanye i-NOAC kufuneka isetyenziswe ngokukhawuleza, kwaye i-cardioversion kufuneka yenziwe ngaxeshanye.
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