I-Pulmonary embolism (PE) ibangelwa i-clot yegazi eyenziwa kwi- pulmonary artery , isitya esikhulu segazi esiholele emiphakeni, okanye enye yamasebe awo. Ngokuqhelekileyo, i-PE ivela xa i-clot yegazi eyenza emilenzeni, inzulu ye-thrombosis (DVT), i-DVT kunye nokuhamba kwiimitha zegazi emiphakeni. Iimpawu ze-pulmonary embolism ziquka ukuphefumula, ukuhlunguzeka kwesifuba, nokukhwehlela igazi.
Uninzi lwabantu luphucula unyango, kodwa ukuya kuma-30 ekhulwini abo abangaphikanga i-PE abahlali. Xa unyango lwangonyango, izinga lokufa li-5%.
Iimpawu
Umthambo we-pulmonary unomsebenzi obalulekileyo wokuthwala igazi kwimiphunga ukuze igcwaliswe nge-oksijeni, ngoko ukuvinjelwa kwegazi kuphuma kulo mkhumbi wegazi kuthinta imiphunga kunye nentliziyo, kwaye ivelise iimpawu zomoya ophantsi kuwo wonke umzimba.
Iimpawu eziqhelekileyo zokugqithiswa kwamapulmoni zi:
- Ukuphefumula, okuqala ngokukhawuleza, ngokuqhelekileyo ngaphakathi kwemizuzwana embalwa ye-PE
- Ngokukhawuleza, intlungu yesifuba esibi
- Ukukhwehlela
- Ukuhlamba igazi
- Intlungu yesifuba sePleuritic, esibuhlungu besifuba esibi nakakhulu xa usuphefumula
- Ukugubha
- Uxinzelelo lwegazi oluphantsi, ukunyuka kwentliziyo, ukuphefumula ngokukhawuleza
- Imbonakalo ebomvu okanye emhlophe emilonyeni neminwe
- I-cardiac arrhythmias (izitenxo zeengqondo zentliziyo), ezinjenge- fibrillation ye-atrial , kunye neempawu ezihambelanayo okanye iziphumo ezinzima (umz.
- Iimpawu okanye iimpawu ze-DVT kwelinye okanye emilenzeni yomibini
Ubunzima be-pulmonary embolism ngokuqhelekileyo lugqitywe ngobungakanani be-clot. Ukuba i-pulmonary embolus inkulu, le meko idlalwa njenge-PE enkulu. Oku kungabangela ukukhutshwa okubalulekileyo kwipetrogram ye-pulmonary, ekhokelela ekuxakekeni okukhulu kwenhliziyo, ukunyuka kweengozi kwimixinzelelo yegazi, kunye nokunciphisa kakhulu umthamo we-oksijini wegazi, okanye i-oxygen starvation that affect the brain and the rest of the body.
I-pulmonary encolm embolus ibangela iimpawu ezingekho phantsi kwezona zinto kodwa ziyixakeko lezonyango ezingaba zibulalayo xa zishiywa zingaphendulwa. Iimbali zegazi ezincinci zivimbela enye yamagatsha amancinci omthi weplmonta kwaye inokufakela ngokupheleleyo isitya seplmonta encinci, ekugqibeleni iholele kwi- pulmary infarction , ukufa kwesahlulo semisipha yomphunga.
Izizathu
Iingubo zegazi, ezibizwa ngokuba yi- thromboemboli , ezivelisa i-PE zivame ukubangelwa yi-DVT kwiimvini ezinzulu ze-groin okanye intamo.
I-DVT kunye nemigodi
Kulinganiselwa ukuba malunga neepesenti ezingama-50 zabantu abane-DVT abangaphendulwanga baya kuba ne-pulmonary embolus.
I-anatomy yomzimba ihlelwe ngendlela eyenza i-DVTs ifumaneke ukuba ifakwe kwimiphunga. Imiva emilenzeni, apho i-DVTs inqwenela ukwenza, idibene kunye njengoko igazi libuyela ngakwesokunene senhliziyo nge-vein enkulu, i-inferior vena cava (IVC). Ukusuka kwicala lasekunene lentliziyo, igazi liye liya emapapeni ngokusebenzisa imithambo ye-pulmonary yokuvuselela ukunikezelwa kwe-oksijeni. Njengoko i-clot yegazi ihamba ngeemilenze kwimilenze entliziyweni, yonke imithwalo yegazi, kuquka neyentliziyo, inkulu kuneemvini emilenzeni. Xa i-clot yegazi ingena emaphapheni, ke ke, iinqwelo zihamba kancane kakhulu, kwaye yilapho iinqunqa zithinjwe kwelinye lamarriyamu e-pulmonary, ekhokelela kwi-PE.
Amacwecwe egazi angabanjelwa kuyo nayiphi na imithwalo yegazi yemiphunga. Amancinci egazi amancinci angeniswa kwimithambo encinci yegazi emiphakeni. Amagxa amakhulu egazi afaka kwiimitha ezinkulu zegazi, eziphazamisa amandla omphunga okwenza igazi lisebenzise ngokwaneleyo ukusetyenziswa kuwo wonke umzimba, kunye nemiphumo eyingozi.
Ukuqulunqwa kweMpahla yokuPhucula iIziphulo zeGazi
Uninzi lwabantu abane-PE, ngaphandle okanye ngaphandle kweDVT elandelelweyo, baneemeko zonyango okanye iimeko ezinxulumene nokungafani kwegazi. Izizathu eziqhelekileyo kunye nemingcipheko ye-blood clot form are:
- Ukungahambi kakuhle ngenxa yokukhubazeka ngokomzimba, ukuphumula kwexesha elide okanye ukulaliswa esibhedlele
- Ukuhlala ixesha elide ngexesha lokuhamba kweemoto okanye iindiza zeenqwelo zeenqwelo
- Imbali ye-pulmonary embolism yangaphambili
- Imbali yamagqabha egazi langaphambilini, njenge-DVT, i-stroke, okanye i-heart attack
- Iziphazamiso zegazi
- Ukutshaya
- Imbali yomhlaza kunye / okanye ukusebenzisa i-chemotherapy
- Imbali yokuhlinzwa
- Ukuphuka kwephunga, ngokukodwa i-femur (intamo) ithambo
- Ukunyanya
- I-hormone yonyango (kuquka i-hormone yonyango yokutshintsha indawo)
- Ukusetyenziswa kwepilisi yokuzalwa
- Ukukhulelwa okanye ukukhulelwa kwangoku
Ukuxilongwa
Ukuxilongwa kwe-PE kuqala ngovavanyo lwekliniki yakho kwaye ke kunokubandakanya iimvavanyo ezizodwa ezikwazi ukuxhasa, ukuqinisekisa okanye ukungabandakanyi ukuxilongwa kwe-PE.
Uvavanyo lweZonyango
Isinyathelo sokuqala ekufumaneni i-PE kukuqikelelwa kogqirha wakho nokuba ngaba ithuba lakho lokuba liphezulu okanye liphantsi. Ugqirha wakho wenza oku kuqikelelwa ngokwenza imbali yonyango ngokucophelela, ukuvavanya iimeko ezinobungozi kwi-DVT, ukwenza uvavanyo olusemzimbeni, ukulinganisa ukuxilongwa kwe-oksijini egazini lakho, kwaye mhlawumbi wenze uvavanyo lwe- ultrasound ukujonga i-DVT.
Iimvavanyo ezingabonakaliyo
Emva kokuhlolwa kliniki yakho, unokufuna ukuhlolwa okuthe ngqo, njengokuhlolwa kwegazi okanye iimvavanyo zokucinga.
- Uvavanyo lwe-D-dimer: Ukuba ubunokwenzeka bakho be-PE bacingelwa ukuba buphantsi, ugqirha wakho unokuyalela uvavanyo lwe- D-dimer . Uvavanyo lwe-D-dimer luvavanyo lwegazi olulinganisa nokuba ngaba kukho izinga elingavumelekanga lomsebenzi wokucima kwigazi lakho, elindeleke ukuba unayo i-DVT okanye i-PE. Ukuba ukwenzeka kweklinikhi ye-PE iphantsi kwaye uvavanyo lwakho lweD-dimer lubi, i-PE inokuphelelwa ngaphandle, kwaye ugqirha uya kuqhubeka eqwalasela ezinye izizathu ezibangelwa iimpawu zakho.
Ukuba ubuchule bakho be-PE bugwetywa ukuba buphezulu, okanye ukuba uvavanyo lwe-D-dimer luhle, ngoko ngokuqhelekileyo uvavanyo lweV / Q (ukutsalwa kwe-ventilation / perfusion) okanye i-CT scan yesifuba senziwa.
- Ukuskena kwe-V / Q: Ukuskena kwe-AV / Q kukukhenwa kwemiphunga esebenzisa idayi e-radioactive, injected into vein, ukuvavanya ukuhamba kwegazi kwimisipha yakho yamaphaphu. Ukuba umzobo we-pulmary pulmonary uvinjiwe ngumbumba, inxalenye ehambelanayo yamathambo emiphunga ifumana ngaphantsi komlinganiselo oqhelekileyo wedayi e-radioactive.
- I-CT scan: Inkqubo ye- CT yindlela engeyiyo ingavumelekanga, ikhompyutha ye-x-ray evumela ugqirha wakho ukuba acinge ngethambo yakho yepulmonary ukuze ubone ukuba unobungozi obangelwa yi-embolus.
I-Angiogram yePulmonary
I-pulmary angiogram sele ithathwa njengomgangatho wegolide wokuchonga i-PE, kodwa iimvavanyo ezingabonakaliyo zingaqinisekiswa okanye zilawule ukuxilongwa. Ukuba ukuxilongwa kwakho kungabonakali, unokufuna ukuba ne-pulmonary angiography.
I-pulmary angiogram ngumvavanyo wokuxilongwa apho idayi ifakwe kwi-tube kwi-pulmonary umthambo ukuze i-clots yegazi ibonakaliswe kwi-x-ray. Ngenxa yokuba i-pulmonary angiography ngumvavanyo olungenangxaki owenza ingozi yobunzima, ugqirha uya kuqikelela ingozi kunye neenzuzo ngaphambi kokucebisa lo vavanyo.
Unyango
Xa ukuxilongwa kwe-pulmonary embolus kuqinisekiswa, unyango luqaliswe ngokukhawuleza. Ukuba unako ukuphakama kakhulu kwe-pulmonary embolus, unyango lwezokwelapha lunokuqaliswa phambi kokuba uvavanyo lwakho luqinisekiswe.
I-Blood Thinners - iAnticoagulants
Unyango oluphambili lwe-pulmonary embolus kukusetyenziswa kweziyobisi ze-anticoagulant, abaxakeli begazi, ukuthintela ukwanda kwegazi.
Igalelo legazi eliqhelekileyo elisetyenziselwa unyango lwe-PE yi-IV (intravenous) i-heparin okanye i-heparin evela kwi-injection, njenge-Arixtra, okanye i-fondaparinux. Intsapho ye-heparin yeziyobisi inikezela ngokukhawuleza i-anticoagulant effect kwaye inokuthintela ukuthintela amanye amacwecwe egazi ekwenzeni.
I-Clot Busters- Thrombolytics
Xa i-PE inkulu okanye ibangela ukungazinzi kwe-cardiovascular, i-antiticoagulation yonyango ayinakwanela. Kule meko, amanxusa anamandla amakhulu, abizwa ngokuba yi-thrombolytics, anokuthi abe nejojo ukuze aphelise i-clot yegazi. Ezi zonyango, ezibandakanya i-fibrinolytic agents ezifana ne-streptokinase, zenzelwe ukutshabalalisa i-clot yegazi ephazamisa umthambo we-pulmonary.
I-thrombolytic yonyango inomngcipheko omkhulu kunokuba unyango lwe-anticoagulants, kubandakanya umngcipheko ophezulu wokunciphisa igazi. Ukuba i-pulmonary embolus inzima ngokwaneleyo ukuba isongela ubomi, umngcipheko walezi zonyango zingadluliselwa ngamancedo.
Ukuhlinzwa
Ugqirha yindlela eya kushenxisa ngqo i-PE. Inkqubo yokugqithisa eqhelekileyo, ebizwa ngokuba ngumsebenzi wokuhlinzwa, iyingozi kakhulu kwaye ayisoloko isebenza kakuhle, ngoko igcinelwe abantu abanethuba eliphantsi kakhulu lokuphila ngaphandle kwalo.
Ukujamelana
Emva kwesigaba sokuqala se-PE, usenokufuna isicwangciso sesikhathi eside ukukhusela ama-PE angaphezulu, kwaye unokufuna ukulungelelanisa kwimiphumo ye-PE yakho ukuba ubangele umonakalo ongunaphakade.
Amachiza
Emva kokuba ufumene unyango olukhawulezileyo kunye negazi le-IV elincinci okanye i-agent clot-busting agent, ungadinga ukuthatha ngomlomo (ngomlomo) unyango lwe-anticoagulant ngeenyanga, okanye kwiminyaka. Ngokuqhelekileyo i-Coumadin ibe yinto ekhethiweyo, kodwa kwiminyaka yakutshanje izidakamizwa ezintsha ze-anticoagulation - apixaban (Eliquis), rivaroxaban (Xarelto), edoxaban (Savaysa) kunye ne-dabigatran (Pradaxa) - ziye zasetyenziswa ngokubanzi ukukhusela ixesha elide lokuphindaphinda PE.
I-IVC Ifayile
Ukuba uhlakulela ii-PE eziphindaphindiweyo, unokufuna ukuba isihlungi sibekwe kwindawo yakho engaphantsi kwe-vena cava, eyona misonto enkulu esiswini edibanisa imivilini yakho yomlenze entliziyweni yakho. Isihlungi se-IVC sinokunqambela amaqhekeza angaphezulu angawaphula emithanjeni emilenzeni yakho ngaphambi kokuba ahambe emipopeni.
Ukulandelwa kwePulmonary kunye nokuBuyiselwa
Ukuba ufumana ii-PE eziphindaphindiweyo, unokuhlakulela imiphumo emide yenkcitho efana ne- pulmonary hypertension okanye i-pulmary infarction (ukufa) yenxenye yomphunga. Ukuba ufumana ezi ngxaki, unokufuna ukulandelelana ne-pulmonologist ukuba umsebenzi wakho wokuphefumla uhlolwe kwaye uphathwe ngendlela efunekayo.
ILizwi
I-pulmonary embolus idla ngokubonakalayo kubantu abanesimo sengonyango okanye iimeko eziza ku-DVT.
Ukuba unempawu ezibonisa ukuxhamla kwe-pulmonary, njenge-short breathing breath of breath or breast pain, kubalulekile ukuba uhlolwe ngugqirha ngokukhawuleza.
Ngokubanzi, i-PE yimeko eqhelekileyo enesiphumo esingcono xa ilawulwa ngonyango olufanelekileyo.
> Imithombo:
> Barbero E, Bikdeli B Chiluiza D. Ukusebenza koVavanyo bokuQala kwePrognostic ngokuzimeleyo Kuxela iziphumo kwizigulane ezinezimpawu zokuQinisekisa kwePulmonary. Thromb Haemost. Ngo-2018 uMar 19. i-doi: 10.1055 / s-0038-1637746. [Epub ngaphambi kokuprinta]
> Bikdeli B, Jiménez D, Kirtane AJ, et al. Ukuphononongwa ngokuchanekileyo kokusebenza kunye nokukhuseleka kweefayile ezihlawulelwayo ezingenakufumaneka. Resrom Res. 2018 uMar 17; 165: 79-82. i-doi: 10.1016 / j.thromres.2018.03.014. [Epub ngaphambi kokuprinta]