Kungani kufanele kutholakale i-D-dimer, i-FDP ezigulini ezinezifo zenhliziyo nemithambo yegazi?
1. I-D-dimer ingasetshenziswa ukuqondisa ukulungiswa kwamandla okuvimbela ukujiya kwegazi.
(1) Ubudlelwano phakathi kwezinga le-D-dimer kanye nemicimbi yezokwelapha ngesikhathi sokwelashwa kokuvimbela ukujiya kwegazi ezigulini ngemva kokufakwa esikhundleni se-valve yenhliziyo ngomshini.
Iqembu lokwelashwa kokulungiswa kokuqina kokuqina kokuvimbela ukujiya kwegazi eliqondiswa yi-D-dimer lilinganise ngempumelelo ukuphepha kanye nokusebenza kahle kokwelashwa kokuvimbela ukujiya kwegazi, futhi izehlakalo zezehlakalo ezahlukene ezimbi zaziphansi kakhulu kuneqembu lokulawula elisebenzisa ukuvimbela ukujiya kwegazi okujwayelekile kanye nokwezinga eliphansi lokuqina kwegazi.
(2) Ukwakheka kwe-cerebral venous thrombosis (CVT) kuhlobene eduze nokwakheka kwe-thrombus.
Iziqondiso zokuxilonga nokuphatha i-intravenous vein kanye ne-venous sinus thrombosis (CVST)
Ukwakheka kwe-Thrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Ukuguquka kwezakhi zofuzo: i-prothrombin gene G2020A, i-coagulation factor LeidenV
Izici ezibangela ukukhubazeka: isikhathi sokubeletha, izindlela zokuvimbela inzalo, ukuphelelwa amanzi emzimbeni, ukulimala, ukuhlinzwa, ukutheleleka, isimila, ukwehla kwesisindo.
2. Inani lokutholwa okuhlangene kwe-D-dimer kanye ne-FDP ezifweni zenhliziyo nemithambo yegazi.
(1) Ukwanda kwe-D-dimer (okungaphezu kuka-500ug/L) kuyasiza ekuxilongweni kwe-CVST. Ukujwayelekile akukuvimbeli i-CVST, ikakhulukazi ku-CVST enekhanda elibuhlungu elihlukile muva nje. Ingasetshenziswa njengenye yezinkomba zokuxilongwa kwe-CVST. I-D-dimer ephakeme kunokujwayelekile ingasetshenziswa njengenye yezinkomba zokuxilongwa kwe-CVST (isincomo sezinga lesi-III, ubufakazi bezinga C).
(2) Izinkomba ezibonisa ukwelashwa okuphumelelayo kwe-thrombolytic: Ukuqapha i-D-dimer kukhuphuke kakhulu kwabe sekwehla kancane kancane; i-FDP ikhuphuke kakhulu yabe sekwehla kancane kancane. Lezi zinkomba ezimbili ziyisisekelo esiqondile sokwelashwa okuphumelelayo kwe-thrombolytic.
Ngaphansi kwesenzo semithi ye-thrombolytic (SK, UK, rt-PA, njll.), i-emboli emithanjeni yegazi iyancibilika ngokushesha, kanti i-D-dimer kanye ne-FDP eplasma ziyanda kakhulu, okuvame ukuhlala izinsuku eziyi-7. Ngesikhathi sokwelashwa, uma umthamo wemithi ye-thrombolytic unganele futhi i-thrombus ingancibiliki ngokuphelele, i-D-dimer kanye ne-FDP zizoqhubeka nokuba semazingeni aphezulu ngemva kokufinyelela esicongweni; Ngokwezibalo, ukwanda kokopha ngemva kokwelashwa kwe-thrombolytic kuphakeme njengo-5% kuya ku-30%. Ngakho-ke, ezigulini ezinezifo ze-thrombotic, kufanele kwakhiwe uhlelo oluqinile lwemithi, umsebenzi we-plasma coagulation kanye nomsebenzi we-fibrinolytic kufanele uqashwe ngesikhathi sangempela, futhi umthamo wemithi ye-thrombolytic kufanele ulawulwe kahle. Kungabonakala ukuthi ukutholakala okunamandla kwe-D-dimer kanye ne-FDP kushintshe ngaphambi, ngesikhathi nangemva kokwelashwa ngesikhathi se-thrombolysis kunenani elikhulu lezokwelapha lokuqapha ukusebenza kahle nokuphepha kwemithi ye-thrombolytic.
Kungani iziguli ezinezifo zenhliziyo nemithambo yegazi kufanele zinake i-AT?
Ukuntuleka kwe-Antithrombin (AT) I-Antithrombin (AT) idlala indima ebalulekile ekuvimbeleni ukwakheka kwe-thrombus, ayigcini nje ngokuvimbela i-thrombin, kodwa futhi ivimbela izici zokuqina kwegazi ezifana ne-IXa, i-Xa, i-Xla, i-Xlla kanye ne-Vlla. Ukuhlanganiswa kwe-heparin ne-AT kuyingxenye ebalulekile ye-AT anticoagulation. Uma kukhona i-heparin, umsebenzi we-AT anticoagulant ungandiswa izikhathi eziyizinkulungwane. Umsebenzi we-AT, ngakho-ke i-AT iyisithako esibalulekile senqubo ye-heparin anticoagulant.
1. Ukumelana ne-Heparin: Uma umsebenzi we-AT wehla, umsebenzi we-heparin wokulwa nokuqina kwegazi uyancipha kakhulu noma awusebenzi. Ngakho-ke, kubalulekile ukuqonda izinga le-AT ngaphambi kokwelashwa nge-heparin ukuze kuvinjelwe ukwelashwa nge-heparin okungadingekile ngemithamo ephezulu futhi ukwelashwa akusebenzi.
Emibhalweni eminingi yezincwadi, inani le-D-dimer, i-FDP, kanye ne-AT libonakala ezifweni zenhliziyo nemithambo yegazi, ezingasiza ekuxilongweni kwasekuqaleni, ekwahluleleni isimo kanye nasekuhlolweni kokubikezela kwesifo.
2. Ukuhlolwa kwembangela ye-thrombophilia: Iziguli ezine-thrombophilia zibonakaliswa ngokwezokwelapha nge-thrombosis enkulu yemithambo ejulile kanye ne-thrombosis ephindaphindwayo. Ukuhlolwa kwembangela ye-thrombophilia kungenziwa emaqenjini alandelayo:
(1) I-VTE ngaphandle kwesizathu esisobala (kufaka phakathi i-thrombosis yengane esanda kuzalwa)
(2) I-VTE enezikhuthazo ezingaphansi kweminyaka engama-40-50 ubudala
(3) Ukuvuvukala kwemithambo yegazi noma i-thrombophlebitis ephindaphindayo
(4) Umlando womndeni we-thrombosis
(5) I-Thrombosis ezindaweni ezingavamile: umthambo we-mesenteric, i-cerebral venous sinus
(6) Ukuphuphuma kwesisu okuphindaphindiwe, ukuzalwa komntwana eseshonile, njll.
(7) Ukukhulelwa, izindlela zokuvimbela inzalo, i-thrombosis ebangelwa ama-hormone
(8) Ukufa kwesikhumba, ikakhulukazi ngemva kokusebenzisa i-warfarin
(9) Ukuqina kwemithambo yegazi okungaziwa okubangela okungaphansi kweminyaka engama-20 ubudala
(10) Izihlobo ze-thrombophilia
3. Ukuhlolwa kwezehlakalo zenhliziyo nokuphindaphinda kwazo: Izifundo zibonise ukuthi ukwehla komsebenzi we-AT ezigulini ezinesifo senhliziyo kungenxa yokulimala kwamangqamuzana e-endothelial okuholela ekusetshenzisweni kwenani elikhulu le-AT. Ngakho-ke, lapho iziguli zisesimweni sokujiya kwegazi, zivame ukuba ne-thrombosis futhi zibhebhethekise lesi sifo. Umsebenzi we-AT nawo wawuphansi kakhulu kubantu abanezehlakalo zenhliziyo nokuphindaphinda kunakubantu abangenazo izehlakalo zenhliziyo nokuphindaphinda kwazo.
4. Ukuhlolwa kwengozi ye-thrombosis ku-non-valvular atrial fibrillation: izinga eliphansi lomsebenzi we-AT lihlobene kahle nesilinganiso se-CHA2DS2-VASc; ngesikhathi esifanayo, linenani eliphakeme lokubhekisela ekuhloleni i-thrombosis ku-non-valvular atrial fibrillation.
5. Ubudlelwano phakathi kwe-AT nesifo sohlangothi: I-AT incipha kakhulu ezigulini ezine-acute ischemic stroke, igazi lisesimweni sokujiya kakhulu, futhi ukwelashwa kokuvimbela ukujiya kwegazi kufanele kunikezwe ngesikhathi; iziguli ezine-stroke risk factors kufanele zihlolwe njalo i-AT, futhi kufanele kutholakale kusenesikhathi umfutho wegazi ophezulu weziguli. Isimo sokujiya kwegazi kufanele selashwe ngesikhathi ukuze kugwenywe ukwenzeka kwe-acute stroke.
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