1. Ukusetshenziswa kwezokwelapha kwemiklamo yokujiya kwegazi ezifweni zenhliziyo nemithambo yegazi
Emhlabeni wonke, inani labantu abahlushwa izifo zenhliziyo nemithambo yegazi likhulu, futhi libonisa ukuthambekela okwandayo unyaka nonyaka. Emtholampilo, iziguli ezivamile ziqala isikhathi esifushane futhi zihambisana nokopha ebuchosheni, okuthinta kabi ukubikezela futhi kusongela ukuphepha kweziguli.
Kunezifo eziningi zezifo zenhliziyo nemithambo yegazi, futhi izici zazo ezithonya nazo ziyinkimbinkimbi kakhulu. Njengoba ucwaningo lwezokwelapha luqhubeka lujula ngokujiya, kutholakale ukuthi ezifweni zenhliziyo nemithambo yegazi, izici zokugaya zingasetshenziswa njengezinto eziyingozi zalesi sifo. Izifundo zezokwelapha zikhombisile ukuthi zombili izindlela zokugaya zangaphandle nezangaphakathi zeziguli ezinjalo zizoba nomthelela ekuxilongweni, ekuhlolweni nasekubikezelweni kwezifo ezinjalo. Ngakho-ke, ukuhlolwa okuphelele kwengozi yokugaya kweziguli kubaluleke kakhulu ezigulini ezinezifo zenhliziyo nemithambo yegazi.
2. Kungani iziguli ezinezifo zenhliziyo nemithambo yegazi kufanele ziqaphele izinkomba zokuqina kwemithambo yegazi
Izifo zenhliziyo nemithambo yegazi yizifo ezibeka impilo nokuphila kwabantu engozini enkulu, kanye nokufa okuphezulu kanye namazinga aphezulu okukhubazeka.
Ngokuthola umsebenzi wokujiya kwegazi ezigulini ezinezifo zenhliziyo nemithambo yegazi, kungenzeka ukuhlola ukuthi isiguli sinokuphuma kwegazi kanye nengozi ye-venous thrombosis; enkambisweni yokwelashwa okulandelayo kokujiya kwegazi, umphumela wokujiya kwegazi ungahlolwa futhi imithi yokwelapha ingaqondiswa ukuze kugwenywe ukopha kwegazi.
1). Iziguli ezine-stroke
I-cardioembolic stroke iyi-ischemic stroke ebangelwa ukukhishwa kwe-cardiogenic emboli kanye nokufakwa kwemithambo yobuchopho ehambisanayo, okubalwa ku-14% kuya ku-30% yazo zonke izinhlungu ze-ischemic. Phakathi kwazo, i-atrial fibrillation-related stroke ibangela ngaphezu kuka-79% wazo zonke izinhlungu ze-cardioembolic, kanti i-cardioembolic stroke iyingozi kakhulu, futhi kufanele itholakale kusenesikhathi futhi ingenele ngenkuthalo. Ukuhlola ingozi ye-thrombosis kanye nokwelashwa kwe-anticoagulation kweziguli, kanye nokwelashwa kwe-anticoagulation, izidingo zezokwelapha zokusebenzisa izinkomba ze-coagulation ukuhlola umphumela we-anticoagulation kanye nemithi eqondile ye-anticoagulation ukuvimbela ukopha.
Ingozi enkulu ezigulini ezine-atrial fibrillation yi-arterial thrombosis, ikakhulukazi i-cerebral embolism. Izincomo zokuvimbela ukujiya kwegazi ngenxa ye-cerebral infarction zilandela i-atrial fibrillation:
1. Ukusetshenziswa njalo kwemithi yokuvimbela ukugabha kwegazi akukhuthazwa ezigulini ezine-cerebral infarction ebukhali.
2. Ezigulini ezelashwe nge-thrombolysis, ngokuvamile akukhuthazwa ukusebenzisa ama-anticoagulant zingakapheli amahora angama-24.
3. Uma kungekho ziphazamiso ezifana nokuthambekela kokopha, isifo esibi sesibindi nezinso, umfutho wegazi >180/100mmHg, njll., izimo ezilandelayo zingabhekwa njengokusetshenziswa okukhethekile kwama-anticoagulants:
(1) Iziguli ezine-infarction yenhliziyo (njenge-valve yokwenziwa, i-fibrillation ye-atrial, i-myocardial infarction ene-mural thrombus, i-left atrial thrombosis, njll.) zithambekele ekushayweni yisifo sohlangothi esiphindaphindayo.
(2) Iziguli ezine-ischemic stroke ehambisana nokuntuleka kwe-protein C, ukuntuleka kwe-protein S, ukumelana ne-protein C esebenzayo kanye nezinye iziguli ezisengozini yokuhlaselwa yi-thrombosis; iziguli ezine-aneurysm yokuhlinza i-extracranial dissecting izimpawu; iziguli ezine-stenosis yemithambo yegazi engaphakathi kwekhanda kanye nengaphakathi kwekhanda.
(3) Iziguli ezilele embhedeni ezine-cerebral infarction zingasebenzisa i-heparin yomthamo ophansi noma umthamo ohambisanayo we-LMWH ukuvimbela i-deep vein thrombosis kanye ne-pulmonary embolism.
2). Inani lokuqapha inkomba yokujiya kwegazi lapho kusetshenziswa imithi yokulwa nokujiya kwegazi
• I-PT: Ukusebenza kwe-INR kwelebhu kuhle futhi kungasetshenziswa ukuqondisa ukulungiswa komthamo we-warfarin; ukuhlola ingozi yokopha kwe-rivaroxaban kanye ne-edoxaban.
• I-APTT: Ingasetshenziswa ukuhlola ukusebenza kahle kanye nokuphepha kwe-heparin engaxutshwanga (imithamo emaphakathi) kanye nokuhlola ngokwekhwalithi ingozi yokopha kwe-dabigatran.
• I-TT: Izwela ku-dabigatran, isetshenziselwa ukuqinisekisa i-dabigatran esele egazini.
• I-D-Dimer/FDP: Ingasetshenziswa ukuhlola umphumela wokwelapha wemithi yokulwa nokuvuvukala njenge-warfarin ne-heparin; kanye nokuhlola umphumela wokwelapha wemithi ye-thrombolytic efana ne-urokinase, i-streptokinase, ne-alteplase.
• I-AT-III: Ingasetshenziswa ukuqondisa imiphumela yemithi ye-heparin, i-heparin enesisindo esiphansi sama-molecule, kanye ne-fondaparinux, kanye nokukhombisa ukuthi kuyadingeka yini ukushintsha ama-anticoagulant emtholampilo.
3). Ukuvimbela ukujiya kwegazi ngaphambi nangemva kokuguqulwa kwenhliziyo kwe-atrial fibrillation
Kukhona ingozi ye-thromboembolism ngesikhathi sokuguqulwa kwenhliziyo ngenxa ye-atrial fibrillation, futhi ukwelashwa okufanele kokuvimbela ukujiya kwegazi kunganciphisa ingozi ye-thromboembolism. Ezigulini ezingazinzile ngokwe-hemodynamic ezine-atrial fibrillation ezidinga ukuguqulwa kwenhliziyo ngokushesha, ukuqaliswa kokuguqulwa kwe-anticoagulation akufanele kulibazise ukuguqulwa kwenhliziyo. Uma kungekho ukuphikisana, i-heparin noma i-heparin enesisindo esiphansi sama-molecule noma i-NOAC kufanele isetshenziswe ngokushesha okukhulu, futhi ukuguqulwa kwenhliziyo kufanele kwenziwe ngesikhathi esifanayo.
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