I-thrombosis enobuhlungu obukhulu (DVT) yimeko apho i-clots yegazi ifom e-veins leg leg deep. I-DVT ibalulekileyo ngezizathu ezibini: I-DVT ngokwayo ingabangela iimpawu ezinzima, kwaye i-DVT ihlala ikhokelela kwisimo esisongela ubomi se- pulmonary embolus .
I-DVT inokuthi ivele kwiimvini ngaphaya kweedolo (oko kukuthi, kwiimvumba zeefemoral ze-groin kunye nomthanga wendawo) okanye kwiimvini ezantsi kweedolo (oko kukuthi, kwiimvini zethole).
Umngcipheko we-pulmonary embolus ungaphantsi kakhulu xa i-DVT ihlala yodwa kwenkomo.
Ngubani ofumana i-DVT?
I-DVT idla ngokubonakalayo kubantu abaye baxakeka ixesha elide, umzekelo, ukulandela ukuhlinzwa kwangoku, ukuphazamiseka , ukukhubazeka, okanye ukuphulukana kwintlungu. I-DVT iphinda ivele ngokuphindaphindiweyo kubantu abanokugula okanye isifo senhliziyo, kwaye (ikakhulukazi kwabasetyhini) ngokugqithiseleyo nangokutshaya. Ukusetyenziswa kweepilisi zokulawula ukuzalwa kunye ne-hormone ye-substitution yokwelapha kakhulu kwandisa ingozi ye-DVT.
Iimpawu zeDVT
Iimpawu eziqhelekileyo ze-DVT zikhukhumeza, intlungu kunye nokubomvu kumlenze ochaphazelekayo. Ezi zimpawu ziyahluka ukusuka kumnene ukuya kukhubaza.
Ukuchonga iDVT
Xa i-DVT ikhona, unyango olukhawulezileyo kunye neyeza-antiticoagulation (jonga ngezantsi) luya kunciphisa ngokuphawulekayo iimpawu, kunye neengxaki zokuphuhlisa i-pulmonary embolus. Nangona kunjalo, iimpawu ezifanayo ezibonwayo ne-DVT nazo zenzeka kwezinye iimeko zonyango - kubandakanya izifo zesikhumba, iinyembezi zomzimba, iintlobo zeedolo, kunye nokuvuvukala kwemifuno yomlenze ongasemthethweni - kwaye unyango lwazo zonke iimeko zihlukile .
Ngoko ke, nanini na xa i-DVT ikhunjulwa, kubakho ukubaluleka kokucacisa ngokucacileyo.
Kwixesha elidlulileyo, ukuxilongwa ngokuqinisekileyo kwe-DVT kwakudinga inkqubo enomthi ebizwa ngokuba yi-venography, apho idayi yayifakwe kwiimvini zomlenze, kwaye imifanekiso ye-x-ray yenziwe, ifuna ukuphazamiseka okubangelwa ngamacenge egazi. Ngenhlanhla, isidingo se-venography siye satshatyalaliswa ngokupheleleyo kwiminyaka yakutshanje ngokufumaneka kweemvavanyo ezimbini ezingekho-invasive- impedance plethysmography kunye ne- compress ultrasound .
Kwi-impedance plethysmography, i-cuff (efana ne-blood pressure coff) ifakwe ecaleni kwenzeni kwaye igxothwe, ukuze ixinzelele imilenze yemilenze. Umthamo wethole ulinganiswa (ngokusebenzisa i-electrode ezibekwe apha). Ikhuphe iyahlanjululwa, ivumele igazi "elibanjwe" kwenkonyane eliphuma kwiimvini. Isilinganiselo somthamo wethole siphindwa kwakhona. Ukuba i-DVT ikhona, umahluko kumthamo (kunye nekhofu ehluthwe ngokubhekiselele kwikhofu echaziweyo) iya kuba ngaphantsi kweqhelekileyo-ibonisa ukuba iimvumba ziphazamiseka ngokukodwa nge-clot yegazi.
Ukugqithisa i-ultrasound yindlela eyahlukileyo yokusetyenziswa kwe-ultrasound, apho iifom zomsindo zisetyenziselwa izicubu ngeprojebthi, kwaye umfanekiso uwakhiwa ngamaza aphilileyo. Kwi-compress ultrasound, iprojeysi ye-ultrasound ifakwa phezu kwe-vein, kwaye umfanekiso weskrini we-vein uveliswa. I-vein iyaxinwa (ngokuyixhoma ngeprojeythi ye-ultrasound). Ukuba i-DVT ikhona, umvuthwandaba "uqine" (ngenxa yobunzima be-clot), kwaye ukuqinisekiswa kwayo kunciphise.
Xa i-DVT ikhunjulwa, i-diagnostic iyakwazi ukuqinisekiswa okanye iyanqatshwa ngokusebenzisa enye yeemvavanyo ezingenakuvuswa.
Ngenxa yokuba izibhedlele ezimbalwa zihlala ziqhuba i-plethysmography, ngelixa isibhedlele ngasinye senza izivavanyo ezininzi ze-ultrasound imihla ngemihla, ukuhlolwa kovavanyo lwe-ultrasound kusetyenziswa ngokubanzi ekufumaneni i-DVT.
Unyango lwe-DVT
Unyango olusisiseko lwe-DVT lusetyenziso lweziyobisi ze-anticoagulant ("abagcini begazi"), zombini ukukhusela ukuqhubela phambili kwegazi kwimithanjeni yomlenze, nokunciphisa amathuba okuphuhlisa i-pulmonary embolus.
Ngokukhawuleza ukuba i-DVT ifunyanwe, ngokuqhelekileyo kucetyiswa ukuba unyango luqaliswe ngokukhawuleza kunye nolunye lweziphumo ezivela kwi-heparin (njenge-Arixtra, okanye i-fondaparinux) enokunikezwa ngamagciwane angaphantsi (phantsi kwesikhumba).
Ezi zi yobisi zibonelela ngefuthe le-antiticoagulation.
Xa sele kuqaliswe unyango olunzima, unyango olungapheliyo kunye neCourmadin luya kuqalwa. Ngokuqhelekileyo kuthatha iintsuku eziliqela ukuya kwiveki okanye ngaphezulu ngaphambi kokuba iCoumadin isebenze ngokupheleleyo, kwaye i-dosage yayo echanekileyo imiselwe. Xa i-Coumadin isilinganisi ishintshiwe kwaye isilwanyana sisebenza ngokufanelekileyo, i-heparin derivative inokumiswa.
Ngoxa i-anti-antiticoagulation yezidakamizwa Pradaxa ( dabigatran ) iye yavavanywa kwizigulane ezine-DVT kwaye ibonakala iyasebenza, ayizange ivunyiwe yi-FDA kule ndlela yokusetyenziswa.
I-antiticoagulation yonyango ye-DVT idla ngokuqhubekayo ubuncinane kwiinyanga ezintathu. Ukuba i-DVT iphindaphindiweyo, ukuba isisiseko esiyimbangela (njengentliziyo yokuhluleka ) isaphila, okanye ukuba i-pulmonary big embolus yenzekile, unyango luhlala lugcinwa ngonaphakade.
Ukongeza kwi-antiticoagulation, kubalulekile ukuba abantu abane-DVT bahambe rhoqo, kwaye baphephe iimeko apho baya kufuna ukuba bahlale khona ixesha elide. Izitokhwe zokunyanzeliswa, ezinceda imilenze yomlenze ibuyele kwakhona entliziyweni, iyanceda kwaye kufuneka iqwalaselwe ngamandla ubuncinane kwiminyaka emibini emva kweDVT.
Xa unyango olufanelekileyo, uninzi lwabantu abane-DVT banokuyifumana ngokupheleleyo.
Imithombo:
Cushman M, Tsai AW, i-White RH, et al. I-deep vein thrombosis kunye ne-pulmonary embolism kwiingqungquthela ezimbini: uphando olude lwe-thromboembolism etiology. Ngomhla wama-2004; 117: 19.
I-Goodacre S. Klinikhi. I-thrombosis enobuhlungu. Ann Intern Med 2008; 149: ITC3.