Ukugqithiswa kwepulmonary yintlupheko yonyango eqhelekileyo enokuvelisa imiphumo emibi kakhulu. Ulwaphulo olufanelekileyo , olukhutshwa ngokukhawuleza, lubalulekile ekuphuculeni amathuba okubuyiswa ngokupheleleyo. Ukunika unyango olufanelekileyo kufuna ukuba uhlalutyo oluchanekileyo ngokukhawuleza.
Kodwa ukwenza ukuxilongwa ngokuchanekileyo kwe-pulmonary embolus, kwaye ukwenza ngokukhawuleza, ngamanye amaxesha kunokuba lunzima.
Iimvavanyo ezichanekileyo ze-pulmonary embolus zingaba zichitha ixesha, zibiza, kwaye ziquka ubuncinci bezonyango. Ezi mvavanyo akufanele zisetyenziswe ngokungakhethi.
Iingcali ziye zatshintsha iindlela ezintathu ezenzelwe ukulawula ngokukhawuleza okanye ukuxilonga i-pulmonary embolus ngaphandle kokubonakalisa abantu ekuvavanyeni okungadingekile. Ukuba ugqirha wakho ugxeka ukuba usenokuba ne-pulmonary embolus, unokulindela ukuba asebenzise le ndlela yesithathu yokuxilonga.
Inyathelo lokuqala
Kwinqanaba elinye ugqirha uvavanya ngokukhawuleza ukuba kwenzeka ukuba i-pulmonary embolus yenzeke. Uya kwenza lo vavanyo ngokuqwalasela iimpawu ezichazwe kunye neemeko zekliniki ezenzeke kuzo.
Zininzi iinkqubo zokubeka amanqaku eziye zaqulunqwa ukuba oogqirha basebenzise ekuqikeleleni ubunokwenzeka be-pulmonary embolus. Inkqubo yokubeka amanqaku isetyenziswa ngokuqhelekileyo inkqubo ye- Wells score , eqwalasela:
- Ingaba iimpawu zibonisa ukuba i-thrombosis ejulile ikhona
- Ingaba zonke ezinye izifo ezibonakalayo zibonakala zincinci kunokuba i-pulmonary embolus
- Ingaba inqanaba lentliziyo lingaphezu kwe-100 beats ngomzuzu
- Ingaba kukho imbali yokuhlinzwa okwangoku okanye ukuchithwa kweminye
- Ingaba kukho imbali yangaphambili ye-pulmonary embolus okanye i-vein thrombosis
- Ingaba kukho i- hemoptysis (ukukhwehlela igazi)
- Ingaba umdlavuza ukhona
Amanqaku okubaluleka anikezelwe nganye kwezi zinto ezi sixhenxe kwaye amanqaku onke aMahle ahlanganisiwe. Ngamanqaku e-Wells esandleni, ugqirha unokukwazi ukuba ubungakanani be-pulmonary embolus buphantsi, buphakathi, okanye buphakamileyo.
PERC
Ukuba kuvela ukuba kukho kuphela umlinganiselo ophantsi we-pulmonary embolus ngokusekelwe kulo vavanyo lweklinikhi, ugqirha unokusebenzisa isicelo sokongeza amanqaku: inkqubo yePulmonary Embolus-Out Out Criteria (PERC).
Iprogram ye-PERC inokumisela ukuba ubunokwenzeka be-pulmonary embolus buphantsi kangangokuba ukuqhubeka nokuvavanya kufuneka kuvalwe ngokupheleleyo. Iqulethe imigaqo yesibhozo:
- Ubudala obungaphantsi kweminyaka engama-50
- Inqanaba lentliziyo ngaphantsi kwe-100
- Igazi le- oxygen lizalise ubuncinane ama-95 ekhulwini
- Ayikho i-hemoptysis
- Akukho-estrogen
- Akukho mlando we-vein thrombosis okanye i-pulmonary embolus
- Akukho ukunyakaza komlenze
- Akukho utyando okanye ixhoba elidinga ukulaliswa esibhedlele kwiiveki ezine ezedlulileyo
Ukuba zonke iinkqubo ezisibhozo zePARC zikhoyo, akukho kuphinda kuhlolwe i-pulmonary embolus kunconywa kuba umngcipheko ophathelene nokuvavanywa okongeziweyo kuya kukhulula kakhulu ingozi yokulahleka i-pulmonary embolus.
Isinyathelo Sibini
Ukuba ubunokwenzeka be-pulmonary ehamba kwisinyathelo esinye sinqunywe ukuba sibe phakathi, okanye ukuba ukwakhiwa kwekliniki ye-pulmonary embolus iphantsi kodwa i-PERC imigaqo ayifumanekanga, isinyathelo esilandelayo kukufumana uvavanyo lwegazi lwe-D-dimer.
Uvavanyo lwe-D-dimer amanyathelo nokuba kukho i-level engavumelekanga yomsebenzi wokucima kwigazi, njengokuba kwakuya kuba khona ukuba umntu ube ne-thrombosis okanye i-pulmonary embolus.
Ukuba ukwenzeka kweklinikhi ye-PE iphantsi okanye iphakathi kunye novavanyo lwe-D-dimer lubi, i-pulmonary embolus ngokubanzi ingagqitywa kwaye ugqirha uya kuqhubela phambili ukuqwalasela ezinye izizathu ezibangelwa iimpawu.
Uvavanyo lwe-D-dimer lungasetyenziselwa kuphela ukulawula i-pulmonary embolus, ukuba ingabonakali. Ngoko ukuba uvavanyo lwe-D-dimer luhle (okanye ukuba ukhenya komntu we-pulmonary embolus kuthathwa njengephezulu phezulu), lixesha lesithathu.
Isinyathelo Sithathu
Inyathelo lesithathu linomxholo wesifo sokuhlola. Ngokuqhelekileyo, enye yeentlobo zeemvavanyo ezintathu iya kusetyenziswa.
CT Scan
I- CT scan iyinkqubo ye-x-ray ekhompyutha evumela ugqirha ukuba ahlolisise imithambo ye-pulmonary ukuze abone ukuba kukho ukuphazamiseka okubangelwa i-clot yegazi. I-ejensi eyahlukileyo ijojowe kwigazi ngexesha lovavanyo ukwenzela ukukunceda ukujonga ngentsingiselo imitha.
I-CT scan ichanekile ngaphezu kweepesenti ezingama-90 zexesha ekufumaneni i-pulmonary embolus kwaye ngoku ithathwa njengolu vavanyo olukhethiweyo ukuba kucinga ukucinga ukuba kufuneka uhlolwe.
V / Q Scan
Ukukhishwa kwe-AV / Q (ebizwa ngokuba yi-ventilation / perfusion scan) yindlela yokukhangela imiphunga esebenzisa idayisi e-radioactive, injected in vein, ukuvavanya ukuhamba kwegazi kumathambo emiphunga. Ukuba umthambo we-pulmonary uvinjelwe ngokukodwa ngumbumba, inxalenye ehambelanayo yamathambo emiphunga athola ngaphantsi komlinganiselo oqhelekileyo wedayi e-radioactive.
Namhlanje i-V / Q isisetyenziselwa ukusetyenziswa kubantu abangabonakali kuyo yonke imirhumo efunwa yi-CT scan, kunye nalabo abathintekayo kwi-CT.
I-Angiogram yePulmonary
Kwiminyaka emininzi isifundo se-catheterization esaziwa njenge-pulmonary angiogram yayiyimilinganiselo yegolide yokuxilongwa kwe-pulmonary embolus, kodwa ngoku uvavanyo luye lwachithwa yi-CT scan.
Nge-pulmonary angiogram, idayi ijojowe ngekathetha efakwe kwi-pulmary artery ukuze i-clots yegazi ibonakaliswe kwi-ray-ray. Olu vavanyo olungenakunokwenzeka lungasadingeka ngezinye izihlandlo ukuba i-CT scan okanye i-V / Q ayikwazi ukusetyenziswa okanye iziphumo ezivela kule mvavanyo azihambelani.
Abantu abangaqinisekanga
I-pulmonary embolus ingabangela ukuwa kwe-cardiovascular ngokushesha. Enyanisweni, i-pulmonary embolus idla ngokuphindaphindiweyo ibe yintyala kubantu abaselula abafa ngokukhawuleza.
Ukuba umntu unesimo esingapheliyo senhliziyo kunye ne-pulmonary embolus kubonakala ngathi yimbangela, isicwangciso esilungelelwaniso sokwenza uvavanyo lwesithathu asinakwenzeka. Kula bantu, unyango luhlala lwenziwa ngokukhawuleza, kunye neminye imizamo yokuvuselela, ngaphambi kokuba kuhlolwe ukuxilongwa ngokucacileyo kwe-pulmonary embolus.
Ukuxilongwa ngokungafani
Xa ufumanisa i-pulmonary embolus, kubalulekile ukuba ugqirha ukuba alawule ezinye izifo zonyango ezineempawu ezinokuthi zifana nezo-pulmonary embolus. Imiqathango efuneka ukuba ithathelwe ingqalelo (oko kukuthi, ukuxilongwa kwesahluko) ngokuqhelekileyo kubandakanya ukuhlaselwa kwentliziyo, ukungaphumeleli kwentliziyo , i- pericarditis , i- tamponade ye-cardia , i-pneumonia, ne- pneumothorax .
I- electrocardiograms , i-chest x-rays, kunye ne- echocardiograms ezifunyanwa rhoqo ngexesha leemvavanyo zeklinikhi ngenxa yokukhathazeka kweentliziyo okanye imiphunga zidla ngokwaneleyo ukulawula ezinye iimeko.
Nangona enye yezi zifo zifunyenwe, oko akuthethi ukuba i-pulmonary embolus ilawulwa ngaphandle, kuba umntu unokuba neemeko ezimbini ngelo xesha-kwaye ezininzi izifo zesifo senhliziyo zandisa ingozi ye-pulmonary embolus. Ngoko ukuba kusekho isizathu sokusola ukuba i-pulmonary ifakwe emva kokunye ukuxilongwa, kubalulekile ukuthatha amanyathelo afanelekileyo okugqiba ukuvavanya uvavanyo.
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