Vim li cas thiaj yuav tsum tau kuaj D-dimer, FDP hauv cov neeg mob plawv thiab cerebrovascular?
1. D-dimer tuaj yeem siv los coj kev hloov kho ntawm anticoagulation zog.
(1) Kev sib raug zoo ntawm qib D-dimer thiab cov xwm txheej kho mob thaum lub sijhawm kho anticoagulation hauv cov neeg mob tom qab hloov kho lub plawv valve.
D-dimer-guided anticoagulation intensity adjustment group pab kho kom zoo sib npaug ntawm kev nyab xeeb thiab kev ua tau zoo ntawm kev kho anticoagulation, thiab qhov tshwm sim ntawm ntau yam xwm txheej tsis zoo tau qis dua li ntawm pawg tswj hwm siv cov qauv thiab kev siv tshuaj tiv thaiv qis.
(2) Kev tsim ntawm cerebral venous thrombosis (CVT) yog ze ze rau txoj cai thrombus.
Cov lus qhia rau kev kuaj mob thiab kev tswj hwm ntawm cov hlab ntsha sab hauv thiab venous sinus thrombosis (CVST)
Thrombotic Constitution: PC, PS, AT-lll, ANA, LAC, HCY
Gene mutation: prothrombin noob G2020A, coagulation factor LeidenV
Predisposing yam: lub sij hawm perinatal, contraceptives, lub cev qhuav dej, raug mob, phais, kab mob, qog, yuag poob.
2. Tus nqi ntawm kev sib xyaw ua ke ntawm D-dimer thiab FDP hauv cov kab mob plawv thiab cerebrovascular.
(1) D-dimer nce (ntau dua 500ug / L) yog pab tau rau kev kuaj mob ntawm CVST.Ib txwm tsis txiav txim siab CVST, tshwj xeeb tshaj yog nyob rau hauv CVST nrog kev mob taub hau tsuas yog tsis ntev los no.Nws tuaj yeem siv los ua ib qho ntawm cov cim qhia ntawm CVST kev kuaj mob.D-dimer siab dua li qub tuaj yeem siv los ua ib qho kev kuaj mob ntawm CVST (qib III pom zoo, qib C pov thawj).
(2) Cov cim qhia tau hais tias muaj txiaj ntsig zoo thrombolytic txoj kev kho: D-dimer saib xyuas tau nce zuj zus thiab tom qab ntawd txo qis;FDP tau nce ntau thiab tom qab ntawd maj mam txo qis.Ob qhov ntsuas no yog lub hauv paus ncaj qha rau kev kho thrombolytic zoo.
Raws li kev txiav txim ntawm cov tshuaj thrombolytic (SK, UK, rt-PA, thiab lwm yam), emboli hauv cov hlab ntsha yog sai sai, thiab D-dimer thiab FDP hauv cov ntshav tau nce zuj zus, uas feem ntau kav li 7 hnub.Hauv kev kho mob, yog tias qhov ntau npaum ntawm cov tshuaj thrombolytic tsis txaus thiab cov thrombus tsis ua tiav, D-dimer thiab FDP yuav txuas ntxiv mus rau theem siab tom qab ncav cuag lub ncov;Raws li kev txheeb cais, qhov tshwm sim ntawm los ntshav tom qab thrombolytic kho yog siab li 5% mus rau 30%.Yog li ntawd, rau cov neeg mob uas muaj kab mob thrombotic, yuav tsum tau tsim cov tshuaj nruj nruj, kev ua haujlwm plasma coagulation thiab fibrinolytic kev ua haujlwm yuav tsum tau saib xyuas raws sijhawm, thiab cov koob tshuaj thrombolytic yuav tsum tau tswj kom zoo.Nws tuaj yeem pom tias qhov kev tshawb pom zoo ntawm D-dimer thiab FDP concentration hloov ua ntej, thaum lub sijhawm thiab tom qab kev kho mob thaum lub sij hawm thrombolysis muaj txiaj ntsig zoo rau kev saib xyuas kev ua tau zoo thiab kev nyab xeeb ntawm cov tshuaj thrombolytic.
Vim li cas cov neeg mob plawv thiab kab mob cerebrovascular yuav tsum xyuam xim rau AT?
Antithrombin (AT) deficiency Antithrombin (AT) plays lub luag haujlwm tseem ceeb hauv inhibiting thrombus tsim, nws tsis tsuas yog inhibits thrombin, tab sis kuj inhibits coagulation yam xws li IXa, Xa, Xla, Xlla thiab Vlla.Kev sib xyaw ntawm heparin thiab AT yog ib feem tseem ceeb ntawm AT anticoagulation.Nyob rau hauv lub xub ntiag ntawm heparin, anticoagulant kev ua ntawm AT tuaj yeem nce ntau txhiab zaus.Kev ua haujlwm ntawm AT, yog li AT yog ib qho tseem ceeb rau cov txheej txheem anticoagulant ntawm heparin.
1. Heparin tsis kam: Thaum qhov kev ua ntawm AT txo qis, qhov kev ua haujlwm ntawm cov tshuaj tiv thaiv heparin txo qis lossis tsis ua haujlwm.Yog li ntawd, nws yog ib qho tsim nyog yuav tsum nkag siab txog qib ntawm AT ua ntej kev kho mob heparin los tiv thaiv kev kho mob heparin tsis tsim nyog thiab kev kho mob tsis zoo.
Hauv ntau cov ntaub ntawv tshaj tawm, cov nqi kho mob ntawm D-dimer, FDP, thiab AT yog cuam tshuam rau hauv cov kab mob plawv thiab cov hlab ntsha, uas tuaj yeem pab tau rau kev kuaj mob ntxov, kev txiav txim siab thiab kev soj ntsuam ntawm tus kab mob.
2. Kev tshuaj ntsuam xyuas etiology ntawm thrombophilia: Cov neeg mob uas muaj thrombophilia tau kuaj pom los ntawm cov hlab ntsha sib sib zog nqus loj heev thiab rov ua thrombosis.Kev tshuaj ntsuam xyuas qhov ua rau thrombophilia tuaj yeem ua tau hauv cov pab pawg hauv qab no:
(1) VTE yam tsis muaj qhov laj thawj pom tseeb (nrog rau cov mob qog nqaij hlav neonatal)
(2) VTE nrog kev txhawb siab <40-50 xyoo
(3) Rov ua thrombosis lossis thrombophlebitis
(4) Tsev neeg keeb kwm ntawm thrombosis
(5) Thrombosis ntawm qhov chaw txawv txav: mesenteric vein, cerebral venous sinus
(6) Rov qab nchuav menyuam, tseem yug menyuam, thiab lwm yam.
(7) Kev xeeb tub, tshuaj tiv thaiv kab mob, tshuaj hormone-induced thrombosis
(8) Daim tawv nqaij necrosis, tshwj xeeb tshaj yog tom qab siv warfarin
(9) Arterial thrombosis ntawm qhov tsis paub ua rau hnub nyoog qis dua 20 xyoo
(10) Cov txheeb ze ntawm thrombophilia
3. Kev soj ntsuam ntawm cov xwm txheej ntawm cov hlab plawv thiab rov tshwm sim: Cov kev tshawb fawb tau pom tias qhov txo qis ntawm AT kev ua haujlwm hauv cov neeg mob uas muaj kab mob plawv yog vim kev puas tsuaj ntawm cov cell endothelial uas ua rau muaj kev noj ntau ntawm AT.Yog li ntawd, thaum cov neeg mob nyob rau hauv lub xeev hypercoagulable, lawv nquag ua rau thrombosis thiab ua rau tus kab mob hnyav dua.Qhov kev ua ntawm AT kuj tseem qis dua hauv cov pej xeem uas muaj cov xwm txheej mob plawv dua li cov pej xeem uas tsis muaj cov xwm txheej hauv plawv.
4. Kev soj ntsuam ntawm kev pheej hmoo ntawm thrombosis nyob rau hauv uas tsis yog-valvular atrial fibrillation: qis AT kev ua ub no muaj kev cuam tshuam zoo nrog CHA2DS2-VASc qhab nia;Nyob rau tib lub sijhawm, nws muaj txiaj ntsig zoo siv rau kev ntsuas thrombosis hauv cov tsis-valvular atrial fibrillation.
5. Kev sib raug zoo ntawm AT thiab mob stroke: AT yog txo qis hauv cov neeg mob uas mob stroke ischemic, cov ntshav nyob rau hauv lub xeev hypercoagulable, thiab kev kho anticoagulation yuav tsum tau muab rau lub sijhawm;Cov neeg mob uas muaj mob stroke yuav tsum tsis tu ncua kuaj AT, thiab kev kuaj pom ntxov ntawm cov neeg mob ntshav siab yuav tsum tau ua.Lub xeev coagulation yuav tsum tau kho raws sij hawm kom tsis txhob muaj qhov tshwm sim ntawm mob stroke.
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