Kungani kufanele kutholwe i-D-dimer, i-FDP ezigulini zenhliziyo nemithambo yegazi?
1. I-D-dimer ingasetshenziswa ukuqondisa ukulungiswa kwamandla e-anticoagulation.
(1) Ubudlelwano phakathi kwezinga le-D-dimer kanye nemicimbi yomtholampilo phakathi nokwelashwa kwe-anticoagulation ezigulini ngemva kokushintshwa kwevalvu yenhliziyo ngomshini.
Iqembu le-D-dimer-guided anticoagulation intensity adjustment treatment lilinganisela ngempumelelo ukuphepha nokusebenza kahle kwe-anticoagulation therapy, futhi izehlakalo zezenzakalo ezimbi ezihlukahlukene zaziphansi kakhulu kuneqembu lokulawula lisebenzisa i-anticoagulation evamile futhi ephansi.
(2) Ukwakheka kwe-cerebral venous thrombosis (CVT) kuhlobene eduze nomthethosisekelo we-thrombus.
Imihlahlandlela yokuxilongwa nokuphathwa kwe-vein yangaphakathi kanye ne-venous sinus thrombosis (CVST)
Umthethosisekelo we-Thrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Ukuguqulwa kofuzo: i-prothrombin gene G2020A, i-coagulation factor LeidenV
Izici ezicatshangelwayo: isikhathi sokubeletha, izinto zokuvimbela inzalo, ukuphelelwa amanzi emzimbeni, ukuhlukumezeka, ukuhlinzwa, ukutheleleka, isimila, ukulahlekelwa isisindo.
2. Inani lokutholwa okuhlanganisiwe kwe-D-dimer ne-FDP ezifweni zenhliziyo nemithambo yegazi.
(1) Ukwenyuka kwe-D-dimer (okungaphezulu kuka-500ug/L) kuyasiza ekuxilongweni kwe-CVST.Okujwayelekile akukhiphi i-CVST, ikakhulukazi ku-CVST enekhanda elingalodwa muva nje.Ingasetshenziswa njengenye yezinkomba zokuxilongwa kwe-CVST.I-D-dimer ephakeme kunokujwayelekile ingasetshenziswa njengenye yezinkomba zokuxilonga ze-CVST (izincomo zeleveli III, ubufakazi bezinga C).
(2) Izinkomba ezibonisa ukwelashwa okuphumelelayo kwe-thrombolytic: Ukuqapha kwe-D-dimer kwanda kakhulu kwase kuncipha kancane kancane;I-FDP yenyuka kakhulu futhi yabe seyehla kancane kancane.Lezi zinkomba ezimbili ziyisisekelo esiqondile sokwelashwa okuphumelelayo kwe-thrombolytic.
Ngaphansi kwesenzo sezidakamizwa ze-thrombolytic (SK, UK, rt-PA, njll.), i-emboli emithanjeni yegazi ichithwa ngokushesha, futhi i-D-dimer ne-FDP ku-plasma yanda kakhulu, ngokuvamile ehlala izinsuku ezingu-7.Ngesikhathi sokwelashwa, uma umthamo wezidakamizwa ze-thrombolytic unganele futhi i-thrombus ingaqedwa ngokuphelele, i-D-dimer ne-FDP izoqhubeka nokuba semazingeni aphezulu ngemva kokufinyelela phezulu;Ngokwezibalo, izehlakalo zokopha ngemva kokwelashwa kwe-thrombolytic ziphezulu njenge-5% kuya ku-30%.Ngakho-ke, ezigulini ezinezifo ze-thrombotic, kufanele kwakhiwe uhlobo oluqinile lwezidakamizwa, umsebenzi we-plasma coagulation kanye nomsebenzi we-fibrinolytic kufanele uqashwe ngesikhathi sangempela, futhi umthamo wezidakamizwa ze-thrombolytic kufanele ulawulwe kahle.Kungabonakala ukuthi ukutholwa okuguquguqukayo kwe-D-dimer ne-FDP kushintsha ngaphambi, ngesikhathi nangemuva kokwelashwa phakathi ne-thrombolysis kunenani elikhulu lomtholampilo lokuqapha ukusebenza nokuphepha kwezidakamizwa ze-thrombolytic.
Kungani iziguli ezinezifo zenhliziyo kanye ne-cerebrovascular kufanele zinake i-AT?
Ukushoda kwe-Antithrombin (AT) I-Antithrombin (AT) idlala indima ebalulekile ekuvimbeleni ukwakheka kwe-thrombus, ayivimbi kuphela i-thrombin, kodwa futhi ivimbela izici zokuhlangana ezifana ne-IXa, Xa, Xla, Xlla ne-Vlla.Inhlanganisela ye-heparin ne-AT iyingxenye ebalulekile ye-AT anticoagulation.Lapho kukhona i-heparin, umsebenzi we-anticoagulant we-AT ungakhuphuka ngezinkulungwane zezikhathi.Umsebenzi we-AT, ngakho-ke i-AT iyinto ebalulekile yenqubo ye-anticoagulant ye-heparin.
1. Ukumelana ne-Heparin: Lapho umsebenzi we-AT wehla, umsebenzi we-anticoagulant we-heparin uyancipha kakhulu noma awusebenzi.Ngakho-ke, kuyadingeka ukuqonda izinga le-AT ngaphambi kokwelashwa kwe-heparin ukuvimbela ukwelashwa okungadingekile kwe-heparin ephezulu futhi ukwelashwa kungasebenzi.
Emibikweni eminingi yezincwadi, ukubaluleka komtholampilo kwe-D-dimer, i-FDP, ne-AT kubonakala ezifweni zenhliziyo kanye ne-cerebrovascular, ezingasiza ekuxilongweni kokuqala, ukwahlulela kwesimo kanye nokuhlolwa kwe-prognosis yesifo.
2. Ukuhlolwa kwe-etiology ye-thrombophilia: Iziguli ezine-thrombophilia zibonakaliswa ngokomtholampilo nge-thrombosis enkulu ye-vein deep and thrombosis ephindaphindiwe.Ukuhlolwa kwembangela ye-thrombophilia kungenziwa ngamaqembu alandelayo:
(1) I-VTE ngaphandle kwesizathu esisobala (kuhlanganise ne-neonatal thrombosis)
(2) I-VTE enezinxephezelo <iminyaka engama-40-50 ubudala
(3) I-thrombosis ephindaphindiwe noma i-thrombophlebitis
(4) Umlando womndeni we-thrombosis
(5) I-thrombosis ezindaweni ezingavamile: umthambo we-mesenteric, i-cerebral venous sinus
(6) Ukuphuphuma kwesisu okuphindaphindiwe, ukubeletha, njll.
(7) Ukukhulelwa, izinto zokuvimbela inzalo, i-thrombosis ebangelwa ama-hormone
(8) I-skin necrosis, ikakhulukazi ngemva kokusebenzisa i-warfarin
(9) I-Arterial thrombosis yesizathu esingaziwa esingaphansi kweminyaka engama-20 ubudala
(10) Izihlobo ze-thrombophilia
3. Ukuhlolwa kwezenzakalo zenhliziyo nokuphindaphinda: Ucwaningo luye lwabonisa ukuthi ukunciphisa umsebenzi we-AT ezigulini ezinesifo senhliziyo kungenxa yokulimala kwe-endothelial cell okuholela ekutheni inani elikhulu le-AT lidliwe.Ngakho-ke, lapho iziguli zisesimweni se-hypercoagulable, zivame ukuba ne-thrombosis futhi zibhebhethekise lesi sifo.Umsebenzi we-AT nawo ubuphansi kakhulu kubantu abanezehlakalo zenhliziyo nemithambo yegazi eziphindaphindayo kunabantu abangenaso izenzakalo zenhliziyo nemithambo yegazi.
4. Ukuhlolwa kwengozi ye-thrombosis ku-fibrillation ye-atrial engeyona i-valvular: izinga eliphansi lomsebenzi we-AT lihlotshaniswa kahle nesikolo se-CHA2DS2-VASc;ngesikhathi esifanayo, inenani eliphakeme lokubhekisela ekuhloleni i-thrombosis ku-fibrillation ye-atrial engeyona i-valvular.
5. Ubuhlobo phakathi kwe-AT ne-stroke: I-AT iyancipha kakhulu ezigulini ezine-acute ischemic stroke, igazi lisesimweni se-hypercoagulable, futhi ukwelashwa kwe-anticoagulation kufanele kunikezwe ngesikhathi;iziguli ezisengozini yokushaywa unhlangothi kufanele zihlolwe njalo i-AT, futhi kusheshe kutholwe umfutho wegazi ophakeme weziguli.Isimo se-coagulation kufanele selashwe kusenesikhathi ukugwema ukuvela kwesifo sohlangothi esibi.
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