I-Thrombosis , okanye ukungavumelekanga kwegazi , ihlala yimeko eyingozi kakhulu evelisa ezimbini iintlobo zeengxaki zonyango.
Okokuqala, i-thrombosis ngaphakathi kwidarethi ingavimbela ukugeleza kwegazi, ivelise umonakalo kwizitho ezibonelelwa ngumzobo ovalwe. Ukutshatyalaliswa kwe-Myocardial (ukuhlaselwa kwintliziyo) ngokuqhelekileyo kubandakanya i-thrombosis ngaphakathi kwintsimbi ye-coronary , kunye nezibetho ze-thrombotic zibangelwa yi-thrombosis ngaphakathi kweyodwa yemithambo ehambisa ingqondo.
Okwesibini, i-thrombosis eyenzeka ngaphakathi kwintlambo okanye ngaphakathi kwintliziyo inokubamba . Oko kukuthi, i-clot yegazi ingaphula kwaye ihambe nge-system ye-vascular, yenza umonakalo apho ifike khona. I- pulmonary embolus ibangelwa i-clot yegazi eyenza imiphunga emiphakeni (ngokuqhelekileyo, ukusuka emthanjeni emlenzeni). Izibetho ze-embolic zibangelwa i-clot yegazi ehamba engqondweni, ngokuqhelekileyo esuka kwi-thrombus ngaphakathi entliziyweni, ngokuqhelekileyo inxulumene ne- fibrillation ye-atrial .
Iziyobisi ezikhusela okanye Ukuphatha iingubo zegazi
Abantu abasengozini ephakamileyo yokuphuhlisa i-thrombosis eyingozi bahlala befuna unyango okanye ukukhusela le meko ukuba ingabikho okanye uzame ukutshabalalisa iingubo zegazi ezisele zenziwe. Kukho iintlobo ezintathu eziqhelekileyo zamachiza eziqhelekileyo ezisetyenziselwa ukukhusela okanye ukuphatha unyango lwe-thrombosis - iziyobisi ze-anticoagulant, izidakamizwa ze-fibrinolytic kunye neziyobisi eziphambene ne-platelet.
Ngelixa ngalinye lala machiza linempembelelo yalo yemiphumo emibi, enye impembelelo yecala eqhelekileyo kubo bonke i-bleeding excessive.
Ngoko zonke ezi zi yobisi kufuneka zisetyenziswe ngezilumkiso ezifanelekileyo.
Izidakamizwa zeAnticoagulant
Iziyobisi ze-anticoagulant zivimbela enye okanye ngaphezulu kwezinto zokuvala . Imiba yokuvala iqela leeprotheni zegazi ezijongene nokucima igazi.
Ezi zi yobisi ziquka:
Heparin. I-Heparin isichengiselwano esisisigxina esinexesha elifutshane (ngemizuzwana) ephazamisayo umphumo kwizinto zokuvala.
Oogqirha banako ukulungelelanisa i-dosage yabo rhoqo, njengoko kuyimfuneko, ngokujonga iliso le -thromboplastin yexesha (PTT) . I-PTT ibonisa ukuba zininzi izinto eziye zavalwa. (Oko kukuthi, kubonakalisa "ukucutha" kwegazi.) I-Heparin isetyenziselwa kuphela kwizigulane ezibhedlele.
I-Low molecular Weight Heparin: enoxaparin (Lovenox), dalteparin (Fragmin). Ezi zi yobisi ziphuma ezihlanjululwayo ze-heparin. Inzuzo yabo enkulu phezu kwe-heparin kukuba banokunikezwa njengengxakane yesikhumba (enoba phantse ubani unokufunda ukwenza imizuzu embalwa) endaweni ye-intravenously, kwaye akudingeki ukuba ihlolwe ngokukhawuleza ngeemvavanyo zegazi. Ngoko, ngokungafani ne-heparin, banokulawulwa ngokukhuselekileyo malunga nesiphene.
I-Newer Intravenous okanye i-Subcutaneously-Administered Anticoagulant Drugs. Kuye kwaphuhliswa izidakamizwa ezininzi ze-heparin, ezibandakanya i-argatroban, i-bivalirudin (i-Angiomax), i-fondaparinux (i-Arixtra) ne-lepirudin (Refludan). Ixesha kunye nendawo efanelekileyo yokusebenzisa zonke ezi zi yobisi zisebenza ngokukhawuleza.
Warfarin (Coumadin). Kuze kube kutshanje, i- warfarin yayisisigxina esisodwa esilawulwa ngomlomo esisetyenziswayo.
Ingxaki enkulu kwi-warfarin sele ikulungiselele umlinganiselo wayo.
Xa kuthathwa kuqala, umlinganiselo we-warfarin kufuneka uzinze kwixesha leveki kunye nokuhlolwa kwegazi rhoqo (uvavanyo lwegazi lwe-INR). Nangona emva kokuzinzisa i-INR isadingeka ihlolwe rhoqo, kwaye i-dosage ye-warfarin idla ngokudinga ukulungiswa kwakhona. Ngoko, ukufikelela nokugcina "i-right" dose ye-warfarin bekulokhu kulukhuni kwaye kungathinteki.
I-New Oral Anticoagulant Izidakamizwa - I-NOAC izidakamizwa. Ngenxa yokuba isantya esiphezulu se-warfarin sinokuba nzima ukulawula, iinkampani zamachiza ziye zasebenzela iminyaka ukuba zifike "ngama-warfarin-substitutes" - oko kukuthi, iziyobisi ze-anticoagulant ezingathathwa ngomlomo.
Ezi zine kwezi zonyango ze-antiticoagulant (izidakamizwa ze-NOAC) zivunyiwe ngoku.
Lawa yi-dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), kunye ne-edoxaban (Savaysa). Inzuzo engundoqo yazo zonke izi yobisi kukuba ziyakunikwa kwiidayiti zemihla ngemihla, kwaye azidingi iimvavanyo zegazi okanye ukulungiswa kweeritha. Nangona kunjalo, njengokuba kunjalo nazo zonke iziyobisi, kukho izihlazo kwiidakamizwa ze-NOAC .
Izidakamizwa zeFibrinolytic
Streptokinase, urokinase, alteplase, reteplase, tenecteplase. Ezi ziyobisi ezinamandla zinikezwa ngokugqithiseleyo nangenqamle ukuba zichithe iinqwelo zegazi ezikwinkqubo yokwenza. Ngokona nxalenye, ukusetyenziswa kwabo kugcinwe kwizigulane ezingaphantsi kweeyure ezimbalwa zokuqala zokuhlaselwa kwentliziyo okanye ukubetha, kwaye zinikezelwa ukuzama ukuvula kwakhona umzobo ovinjiweyo kwaye ukhusele umonakalo osisigxina.
Izidakamizwa ze-fibrinolytic (ezidla ngokuba zibizwa ngokuthi "i-clot busters"), zinokuba nzima ukuzenza. kwaye zithwala ingozi enkulu yokuphazamiseka kwegazi. Nangona kunjalo, kwiimeko ezifanelekileyo, ukusetyenziswa kwezi zi yobisi kunokuthintela ukufa okanye ukukhubazeka kwi-heart attack or stroke. Kwezilwanyana ze-fibrinolytic, i-streptokinase isetyenziselwa kakhulu kwihlabathi jikelele, kuba ixabiso elincinci. EUnited States, i-tenecteplase okwangoku izidakamizwa ezikhethiweyo kuba zibonakala zibangele imiphumo emininzi yegazi, kwaye kulula ukulawula kunezinye iziyobisi kweli qela.
I-Anti-Platelet yobisi
Amaqela amathathu eziyobisi asetyenziselwa ukunciphisa "ukunamathela" kweeplatelet , izinto ezincinci zegazi ezenza i-nucleus ye-clot yegazi. Ngokumvimbela amandla amacwecwe ukuba aqoke kunye, izidakamizwa ezichasene neziplatelet zivimbela i-clotting yegazi. La machiza asebenza kakhulu ekukhuseleni amaqhekeza egazi engavamile ukusuka kumatriyiti kwaye asebenze kangangoko ekukhuseleni i-thrombosis kwimifuno.
I-Aspirin ne-dipyridamole (Aggrenox). Ezi zi yobisi zinefuthe elincinci kwi-platinlet "stickiness" kodwa zibangele imiphumo embi echaphazelekayo yokuphuma kwamanzi kunezinye iziyobisi ezichasene neziplatesti. Zihlala zisetyenziswe kwisilingo sokunciphisa umngcipheko wokuhlaselwa intliziyo okanye ukubethelwa kwabantu abanomngcipheko ophezulu.
Ticlopidine (Ticlid), clopidogrel (Plavix) kunye ne-prasugrel (Umphumo). Ezi zi yobisi zinamandla kakhulu (kwaye ke zingozi) kune-aspirin kunye ne-dipyridamole. Zivame ukusetyenziswa xa umngcipheko wokuqhawula i-arterial clotting iphezulu kakhulu. Isicelo sabo esivame kakhulu kubantu abaye bafumana i- coronary artery stents . Ukusetyenziswa kwabo ngokubhekiselele kwi-stents - ngokukodwa, izigqibo malunga nokuba kwaye lide kangakanani ukuzisebenzisa- ziye zaphikisana .
IIb / IIIa Inhibitors: abciximab (ReoPro), eptifibatide (Integrilin), tirofiban (Aggrastat). Izidakamizwa ze-IIb / IIIa ze-inhibitor yiyona nto inamandla kunazo zonke ze-platelet inhibitors. Bavimbela i-receptor phezu kweeplatelet (okubizwa ngokuba yi-IIb / IIIa receptor) eyimfuneko yokubamba iplatelet. Ukusetyenziswa kwabo okuyiNtloko kukuthintela ukucima ngokukhawuleza emva kweenkqubo zokungenelela (ezifana ne- angioplasty kunye nokubekwa kwe- stent ), kunye nezigulane ezine -aconic acid syndrome . Ezi zonyango zibiza kakhulu kwaye (ngokubanzi) kufuneka zinikezwe kwangaphakathi.
ILizwi
Amachiza amaninzi asetyenziselwa ukliniki ukunceda ukukhusela okanye ukuphatha ama-clots egazi. Zineendlela ezahlukeneyo zokwenza, izingozi ezahlukeneyo, kwaye zisetyenziswe phantsi kweemeko ezahlukeneyo zeklinikhi. Ukusebenzisa naziphi na ezi ziyeza zihlala zibeka umngcipheko wokuphuma kwegazi, kwaye zifanele ziqeshwe kuphela xa iinzuzo zabo zinokuthi zigqithise loo mingcipheko. Xa ulawula i-thrombosis, kubaluleke kakhulu ukuba ugqirha ukhethe isigqibo esifanelekileyo, phantsi kweemeko ezifanelekileyo.
> Imithombo:
> Franchini M, Mannucci PM. AmaAnticoagulants amatsha kwiMedical Internal Medicine: Isibuyekezo. I-Eur J Intern Med 2010; 21: 466.
> Kearon C, Akl E, Omelas J, et al. I-Antithrombotic Therapy yeVTE Izifo. INKQUBO YOKUPHATHWA KWEENKQUBO NENKQUBO YENKQUBO YENKONZO Inkunzi ye-2016; 149: 315.
> Weitz JI, Hirsh J, uSamama MM, i-American College ye-Chest Physicians. Izidakamizwa ezitsha ze-Antithrombotic: I-American College ye-Chest Physicians Izikhokelo zoBukhompyutheni ezisekelwe kwiZikliniki (8th Edition). Ngomhla we-2008; 133: 234S.