No ke aha e ʻike ʻia ai ka D-dimer, FDP i nā maʻi cardiovascular a me ka cerebrovascular?
1. Hiki ke hoʻohana ʻia ka D-dimer e alakaʻi i ka hoʻoponopono ʻana i ka ikaika anticoagulation.
(1) ʻO ka pilina ma waena o ka pae D-dimer a me nā hanana lapaʻau i ka wā anticoagulation therapy i nā maʻi ma hope o ka hoʻololi ʻana o ka puʻuwai puʻuwai mechanical.
ʻO ka D-dimer-guided anticoagulation intensity adjustment treatment group i kaulike maikaʻi i ka palekana a me ka maikaʻi o ka anticoagulation therapy, a ʻo ka nui o nā hanana ʻino like ʻole he haʻahaʻa haʻahaʻa ma mua o ka hui hoʻomalu e hoʻohana ana i ka anticoagulation maʻamau a haʻahaʻa.
(2) ʻO ka hoʻokumu ʻana o ka cerebral venous thrombosis (CVT) pili pili i ke kumukānāwai thrombus.
Nā alakaʻi no ka hōʻoia ʻana a me ka mālama ʻana i ka vein kūloko a me ka thrombosis venous sinus (CVST)
Ke kumukānāwai thrombotic: PC, PS, AT-lll, ANA, LAC, HCY
Ka hoʻololi ʻana o ke ʻano: prothrombin gene G2020A, coagulation factor LeidenV
Nā mea predisposing: ka wā perinatal, nā mea hoʻopaʻapaʻa, dehydration, trauma, ʻokiʻoki, maʻi maʻi, ʻaʻa, pohō kaumaha.
2. ʻO ka waiwai o ka ʻike hui ʻana o D-dimer a me FDP i nā maʻi cardiovascular a me ka cerebrovascular.
(1) He mea kōkua ka hoʻonui D-dimer (ʻoi aku ma mua o 500ug/L) no ka hōʻoia ʻana o CVST.ʻAʻole ʻae ke ʻano maʻamau i ka CVST, ʻoi aku ka maʻi CVST me ke poʻo ʻeha kaʻawale i kēia manawa wale nō.Hiki ke hoʻohana ʻia e like me kekahi o nā hōʻailona o ka maʻi CVST.Hiki ke hoʻohana ʻia ʻo D-dimer kiʻekiʻe ma mua o ka mea maʻamau e like me kekahi o nā hōʻailona diagnostic o CVST (pae III manaʻo, pae C hōʻike).
(2) Nā hōʻailona e hōʻike ana i ka lāʻau thrombolytic maikaʻi: Ua piʻi nui ka nānā ʻana o D-dimer a laila hoʻemi mālie;Ua piʻi nui ka FDP a laila emi mālie.ʻO kēia mau hōʻailona ʻelua ke kumu kūpono no ka thrombolytic therapy.
Ma lalo o ka hana o nā lāʻau thrombolytic (SK, UK, rt-PA, a me nā mea'ē aʻe), ua hoʻopau kokeʻia ka emboli i loko o nā kīʻaha koko, a ua hoʻonui nuiʻia ka D-dimer a me ka FDP i loko o ka plasma, e mau ana no nā lā 7.I ka wā o ka mālama ʻana, inā ʻaʻole lawa ka nui o nā lāʻau thrombolytic a ʻaʻole i hoʻoheheʻe ʻia ka thrombus, e hoʻomau ʻia ʻo D-dimer a me FDP i nā pae kiʻekiʻe ma hope o ka hiki ʻana i ka piko;Wahi a nā helu helu, ʻo ka nui o ke koko ma hope o ka thrombolytic therapy e like me 5% a 30%.No laila, no nā poʻe maʻi me nā maʻi thrombotic, pono e hoʻokumu ʻia kahi regimen lāʻau koʻikoʻi, pono ke nānā ʻia ka hana coagulation plasma a me ka hana fibrinolytic i ka manawa maoli, a pono e hoʻomalu maikaʻi ʻia ka nui o nā lāʻau thrombolytic.Hiki ke ʻike ʻia ka hoʻololi ʻana o ka ʻike ikaika o D-dimer a me ka FDP ma mua, i ka wā a ma hope o ka mālama ʻana i ka wā thrombolysis he waiwai lapaʻau nui no ka nānā ʻana i ka pono a me ka palekana o nā lāʻau thrombolytic.
No ke aha e hoʻolohe ai nā poʻe maʻi me nā maʻi puʻuwai a me ka cerebrovascular iā AT?
ʻO ka hemahema Antithrombin (AT) He hana koʻikoʻi ka Antithrombin (AT) i ke kāohi ʻana i ka hoʻokumu ʻana o ka thrombus, ʻaʻole ia e pale wale i ka thrombin, akā e pale pū kekahi i nā mea coagulation e like me IXa, Xa, Xla, Xlla a me Vlla.ʻO ka hui pū ʻana o ka heparin a me AT he ʻāpana koʻikoʻi o ka anticoagulation AT.I ke alo o ka heparin, hiki ke hoʻonui ʻia ka hana anticoagulant o AT e nā kaukani mau manawa.ʻO ka hana o AT, no laila he mea koʻikoʻi ʻo AT no ke kaʻina anticoagulant o ka heparin.
1. Ke kū'ē i ka Heparin: Ke emi iho ka hana o AT, ho'emi nui 'ia ka hana anticoagulant o ka heparin.No laila, pono e hoʻomaopopo i ke kiʻekiʻe o ka AT ma mua o ka mālama ʻana i ka heparin i mea e pale ai i ka mālama heparin kiʻekiʻe pono ʻole a ʻaʻole pono ka mālama ʻana.
I loko o nā moʻolelo palapala he nui, ʻike ʻia ka waiwai lapaʻau o D-dimer, FDP, a me AT i nā maʻi cardiovascular a me ka cerebrovascular, hiki ke kōkua i ka ʻike mua ʻana, ka hoʻoholo kūlana a me ka loiloi prognosis o ka maʻi.
2. Ka nānā ʻana no ka etiology o ka thrombophilia: ʻO nā maʻi me ka thrombophilia e hōʻike ʻia e ka thrombosis hohonu hohonu a me ka thrombosis hou.Hiki ke hana ʻia ka nānā ʻana no ke kumu o ka thrombophilia i nā hui aʻe:
(1) VTE me ke kumu maopopo ole (me ka thrombosis neonatal)
(2) VTE me nā mea hoʻoikaika <40-50 makahiki
(3) ʻO ka thrombosis hou a i ʻole ka thrombophlebitis
(4) Moʻolelo ʻohana o ka thrombosis
(5) ʻO ka thrombosis ma nā wahi kūpono ʻole: mesenteric vein, cerebral venous sinus
(6) Hānau hāʻule hou, hānau keiki, a pēlā aku.
(7) ʻO ka hāpai ʻana, nā mea hōʻemi, ka thrombosis i hoʻokomo ʻia i ka hormone
(8) Necrosis o ka ʻili, ʻoi aku ma hope o ka hoʻohana ʻana i ka warfarin
(9) ʻO ka thrombosis arterial o ke kumu ʻike ʻole ʻia <20 makahiki
(10) ʻO nā ʻohana o ka thrombophilia
3. ʻO ka loiloi o nā hanana cardiovascular a me ka hoʻi hou ʻana: Ua hōʻike nā haʻawina i ka emi ʻana o ka hana AT i nā maʻi me ka maʻi cardiovascular ma muli o ka pōʻino o ka endothelial cell e alakaʻi ai i ka nui o ka AT e hoʻopau ʻia.No laila, i ka wā i loaʻa ai nā mea maʻi i kahi kūlana hypercoagulable, hiki lākou i ka thrombosis a hoʻonui i ka maʻi.ʻOi aku ka haʻahaʻa o ka hana o AT i ka heluna kanaka me nā hanana cardiovascular recurrent ma mua o ka heluna me ka ʻole o nā hanana cardiovascular recurrent.
4. Ka loiloi o ka thrombosis pilikia ma non-valvular atrial fibrillation: haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa haʻahaʻa AT ua hoʻopili maikaʻi me CHA2DS2-VASc helu;i ka manawa like, loaʻa iā ia kahi waiwai kuhikuhi kiʻekiʻe no ka loiloi ʻana i ka thrombosis i ka fibrillation atrial non-valvular.
5. ʻO ka pilina ma waena o AT a me ka hahau: Ua hoʻemi nui ʻia ka AT i nā maʻi me ka maʻi ischemic acute, aia ke koko i kahi kūlana hypercoagulable, a pono e hāʻawi ʻia ka lāʻau anticoagulation i ka manawa;pono e ho'āʻo mau ʻia ka poʻe maʻi me nā kumu pilikia o ka hahau ʻana no ka AT, a pono e hana ʻia ka ʻike mua ʻana o ke koko kiʻekiʻe o nā maʻi.Pono e mālama ʻia ke kūlana coagulation i ka manawa e pale aku ai i ka hiki ʻana mai o ka hahau ʻana.
Kāleka pāʻoihana
Pākē WeChat
English WeChat