Xa umntu efunyenwe ukuba ube ne-pulmonary acolus, ukunyanga okufanelekileyo kuxhomekeke ekubeni isimo sabo senhliziyo sisigxina okanye sizinzile.
Ngabantu abazinzileyo
Uninzi lwabantu abaxilongwa ngokuba ne-pulmonary embolus bazinzile ngokucacileyo kwimoya ye-cardiovascular. Oko kukuthi, bayazi kwaye baqaphele, kwaye uxinzelelo lwegazi alukho phantsi kwengozi.
Kwaba bantu, unyango ngeziyobisi ze-anticoagulant (igazi elincinci) lidla ngokukhawuleza. Ukunyango kwangaphambili kuncitshisa kakhulu umngcipheko wokufa ngenxa ye-pulmonary embolus.
Iintsuku eziyi-10 zokuqala
Kwiintsuku ezili-10 zokuqala emva kokuba i-pulmonary embolus yenzeke, unyango luqukethe esinye sezidakamizwa ezilandelayo ze-antiticoagulant:
- Isisindo esisezantsi sama-molecular (LMW) i-heparin, njengeLovenox okanye iFragmin. Ezi zixhobo ezihlanjululwayo ze-heparin ezinokuthi zinikezwe ngesikhumba sejoyile endaweni ye-intravenously.
- I-Fondaparinux, enye inkunkuma efana ne-heparin.
- I-heparin engabandakanywanga, "i-heparin endala" enikwa i-intravenously.
- I-Rivaroxiban (Xarelto) okanye i-apixaban (i-Eliquis), emibini "yezilwanyana zamachiza omlomo we-antiticoagulant" (i- NOAC ) engumtsalane ngomlomo weCoumadin . Ezi zi yobungozi ze-NOAC ziphela kuphela ezivunyiweyo ukwenzela unyango olunzulu lwe-pulmonary embolus.
Zonke ezi zi yobisi zisebenza ngokuthintela izinto zokuvala , iiprotheni egazini ezikhuthaza i-thrombosis.
Namhlanje, oogqirha abaninzi baya kusebenzisa i-rivaroxiban okanye i-apixaban ngexesha leentsuku ezi-10 zokuqala unyango kubantu abanokukwazi ukuthatha imithi yomlomo. Ngaphandle koko, i-LMW i-heparin isetyenziswa kakhulu.
Iintsuku ezili-10 ukuya kwiinyanga ezintathu
Emva kweentsuku ezili-10 zokuqala unyango, unyango lukhethwa ukuba luncedo lwexesha elide. Kwiimeko ezininzi, eli lonyango lexesha elide liqhutyelwa ubuncinane kwiinyanga ezintathu kwaye kwezinye iimeko ukuya kunyaka.
Olu unyango lwexesha elide phantse luhlala luqulethwe nenye yezilwanyana ze-NOAC. Kule nqanaba yonyango (oko kukuthi, emva kweentsuku ezili-10 zokuqala), izidakamizwa ze-NOAC dabigatran (Pradaxa) kunye ne-edoxaban (Savaysa) nazo zivunyelwe ukusetyenziswa, ngaphezu kwe-rivaroxiban kunye ne-apixaban. Ukongeza, iCourmadin ihlala yindlela yokwenza unyango olude.
Unyango lweNyango
Kwamanye abantu, unyango lwe-antiticoagulation lwangexesha elide kufuneka lusetyenziswe ngonaphakade emva kwe-pulmonary embolus, mhlawumbi kubo bonke ubomi babo. Ngokuqhelekileyo, aba bantu bawela kwelinye lamacandelo amabini:
- Abantu abane-pulmonary embolus okanye i- thrombosis ejulile ye-veinsis ngaphandle kwesizathu esichengayo.
- Abantu abangabangela isigxina esingasigxina, njengomdlavuza osebenzayo, okanye i-genetic predisposition kwi-blood cloting engavamile.
Ukuba izidakamizwa zeAnticoagulant ayikwazi ukusetyenziswa
Kwamanye abantu, iziyobisi ze-anticoagulant azikhethi. Oku kungenxa yokuba umngcipheko wokuphuma kwegazi uphezulu kakhulu okanye mhlawumbi ube ne-pulmonary embolus naphezu kwonyango efanelekileyo ye-antiticoagulation.
Kule bantu, isiqhotho se-vena cava kufuneka sisetyenziswe. Isihlungi se-vena cava yinkqubo ebeka kwi-vena cava engaphantsi (i-vein enkulu eqokelela igazi ukusuka kwimida engezantsi iphinde iyifake entliziyweni) ngenkqubo yokucoca.
Ezi zihlunu "i-trap" yegazi ephukile kwaye iwaphephe ukufikelela kumjikelezo wepulmonary.
Iifayile zeVena cava zingasebenza, kodwa azikhethwanga iziyobisi ze-antiticoagulant ngenxa yemingcipheko echaphazelekayo ekusebenziseni. Ezi zibandakanya i-thrombosis kwisayithi yecebo lokucoca (oko kungakhokelela ekugqibeleni kwe-pulmonary embolism), ukuphuma kwamanzi, ukufuduka kwefayili entliziyweni, kunye nokukhukhula kwefayile.
Uninzi lwe-vena cava ezifayili ziyakuthatyathwa emzimbeni ngenkqubo yesibini yokucwangcisa ukuba ayifuni.
Abantu abangaqinisekanga
Kwabanye abantu, i-pulmonary embolus yintlungu yesifo senhliziyo.
Kule bantu, i-embolus inkulu ngokwaneleyo ukuba ibangele ukukhutshwa kwegazi kwiimiphunga, okukhokelela ekuweleni kwenhliziyo. Aba bantu bavame ukubonisa i- tachycardia ephezulu (izinga lentliziyo elikhawulezayo) kunye nokunyanzeleka kwengcinezelo yegazi, isikhumba se-sweaty ephahleni, kunye nokuguqulwa kwengqondo.
Kule meko, i-antiticoagulation yonyango-eyona nto isebenza ngokuqiniswa kwegazi kunye nokukhusela ukunqanda okungekho-okwaneleyo. Esikhundleni saloo nto, kufuneka yenziwe into yokuba iphule i-embolus eyenze yenzeke, kwaye ubuyisele umjikelezo wepmonta.
I-Thrombolytic Therapy ("Clot Busters")
Ngonyango lwe-thrombolytic, izidakamizwa ezinobungozi zilawulwa ngokuthi "lyse" (qhekeza) iimbophu ezisele zenziwe. Ngokuqhekeza i-clot enkulu yegazi (okanye iiplanga) kwipetroli ye-pulmonary, bayakwazi ukubuyisela ukusasazwa komntu.
Ezi ziyobisi (eyaziwa nangokuthi izidakamizwa ze-fibrinolytic ngenxa yokuba zisebenza ngokuphazamisa i-fibrin emacaleni) zithatha ingozi enkulu yokuxakeka kweengxaki ukuze zisetyenziswe kuphela xa i-pulmonary embolus yangoko isongela ubomi. Iimpawu ezithintekayo ezinokusetyenziswa rhoqo kwi-embolism enamandla ye-pulmonary are alteplase, streptokinase, kunye ne-urokinase.
I-Embolectomy
Ukuba unyango lwe-thrombolytic alukwazi ukusetyenziswa ngenxa yokuba ingozi yokuphuma kwegazi ngokugqithiseleyo ibonakala iphezulu kakhulu, inzame ingenziwa kwi-embolectomy. Inkqubo yokwenza umkhondo izama ukuphelisa i-clot enkulu kwi-pulmonary artery, mhlawumbi ngokuhlinzwa okanye nge-cathter procedure.
Ukukhethwa phakathi kwe-catheter-based okanye ukupakisha okugqithiseleyo kuxhomekeke ekufumanekeni koogqirha abanamava kunye nale nkqubo, kodwa ngokukhethekileyo i-catheter-based embolectomy ikhethwayo kuba ngokuqhelekileyo kungenziwa ngokukhawuleza.
Nangona kunjalo, inkqubo yohlobo lwe-type yohlobo lwalo lonke uhlobo luba neengozi ezinkulu-kuquka ukugqithwa kwe-pulmonary artery, kunye ne- tamponade yesifo kunye ne-threatening hemoptysis yokuphila (ukuphuma kwi-airways). Ngoko ke, i-embolectomy ivame ukuqhutyelwa kubantu abagwetywe kakhulu kakhulu kwaye banomngcipheko omkhulu wokufa ngaphandle kokonyango olululo.
> Imithombo:
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> Kearon C, Akl EA, Comerota AJ, et al. Unyango lwe-Antithrombotic kwisifo se-VTE: Uthintelo lwe-Antithrombotic kunye noThintelo lwe-Thrombosis, 9th: Ikholeji yaseMerika yase-Chest Physicians Izikhokelo zengcebiso ngeeNtsholongwane. Ngomhla ka-2012; 141: e419S. INGXELO: 10.1378 / isifuba.11-2301
> Kuo WT, van den Bosch MAAJ, Hofmann LV, et al. I-Catheter-Directed Embolectomy, Ulwahlulo, kunye neThrombolysis yoNyango lwe-Massive Pulmonary Embolism emva kokusilela kweTrombolysis yesistim. Ngomhla we-2008; 134: 250. INGXELO: 10.1378 / i-chest.07-2846
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