1. Kugwiritsa ntchito kwachipatala kwa ntchito zophatikiza magazi mu mtima ndi matenda a cerebrovascular
Padziko lonse lapansi, chiŵerengero cha anthu amene akudwala matenda a mtima ndi ubongo ndi chachikulu, ndipo chikusonyeza kuti chikukwera chaka ndi chaka.Mu ntchito zachipatala, odwala wamba ndi yochepa isanayambike nthawi ndi limodzi ndi ubongo kukha magazi, amene amakhudza kwambiri matenda ndi kuopseza moyo chitetezo cha odwala.
Pali matenda ambiri a mtima ndi matenda a cerebrovascular, ndipo zomwe zimawapangitsa kukhala zovuta kwambiri.Ndikukula kosalekeza kwa kafukufuku wazachipatala pa coagulation, amapezeka kuti mu matenda amtima ndi cerebrovascular, coagulation factor ingagwiritsidwenso ntchito ngati ziwopsezo za matendawa.Kafukufuku wachipatala awonetsa kuti njira zonse zotuluka kunja ndi mkati mwa odwala oterowo zitha kukhala ndi zotsatira pakuzindikira, kuwunika komanso kuwunika kwa matendawa.Chifukwa chake, kuwunika kwathunthu kwa chiwopsezo cha coagulation cha odwala ndikofunikira kwambiri kwa odwala omwe ali ndi matenda amtima ndi cerebrovascular.tanthauzo.
2. Chifukwa chiyani odwala mtima ndi cerebrovascular matenda ayenera kulabadira zizindikiro coagulation
Matenda a mtima ndi cerebrovascular ndi matenda omwe amaika pachiwopsezo thanzi la anthu ndi moyo, omwe amafa kwambiri komanso kulumala kwakukulu.
Kudzera kudziwika coagulation ntchito odwala mtima ndi cerebrovascular matenda, n`zotheka kuwunika ngati wodwalayo kukha mwazi ndi chiopsezo venous thrombosis;Potsatira mankhwala oletsa kukomoka, mphamvu ya anticoagulation imathanso kuyesedwa ndipo mankhwala azachipatala amatha kuwongolera kuti asatuluke magazi.
1).Odwala sitiroko
Cardioembolic stroke ndi sitiroko ya ischemic yomwe imayamba chifukwa cha kukhetsa kwa cardiogenic emboli and embolizing cerebral artery yofananira, yomwe imatenga 14% mpaka 30% ya zikwapu zonse za ischemic.Pakati pawo, sitiroko yokhudzana ndi kugunda kwa mtima imayambitsa kupitilira 79% ya zikwapu zonse zamtima, ndipo zikwapu za mtima ndizovuta kwambiri, ndipo ziyenera kuzindikirika msanga komanso kulowererapo mwachangu.Kuwunika chiopsezo cha thrombosis ndi anticoagulation chithandizo cha odwala, komanso chithandizo chamankhwala cha anticoagulation chiyenera kugwiritsa ntchito zizindikiro za coagulation kuti ziwone momwe anticoagulation imagwirira ntchito komanso mankhwala enieni a anticoagulation kuti asatuluke magazi.
Chiwopsezo chachikulu cha odwala omwe ali ndi vuto la mtima ndi arterial thrombosis, makamaka embolism yaubongo.Malangizo a Anticoagulation a cerebral infarction yachiwiri mpaka atrial fibrillation:
1. Kugwiritsa ntchito nthawi yomweyo kwa anticoagulants sikuvomerezeka kwa odwala omwe ali ndi vuto lalikulu la ubongo.
2. Odwala omwe amathandizidwa ndi thrombolysis, nthawi zambiri savomerezeka kugwiritsa ntchito anticoagulants mkati mwa maola 24.
3. Ngati palibe zotsutsana monga chizolowezi chotaya magazi, matenda oopsa a chiwindi ndi impso, kuthamanga kwa magazi> 180/100mmHg, ndi zina zotere, zotsatirazi zitha kuganiziridwa kuti ndizosankha kugwiritsa ntchito anticoagulants:
(1) Odwala omwe ali ndi vuto la mtima (monga valve yopangira, fibrillation ya atrial, infarction ya myocardial ndi mural thrombus, left atrial thrombosis, etc.) amatha kupwetekedwa mobwerezabwereza.
(2) Odwala ndi ischemic sitiroko limodzi ndi kusowa kwa mapuloteni C, kusowa kwa mapuloteni S, yogwira mapuloteni C kukana ndi odwala thromboprone;odwala symptomatic extracranial dissecting aneurysm;odwala omwe ali ndi intracranial ndi intracranial artery stenosis.
(3) Odwala omwe ali pabedi ndi cerebral infarction angagwiritse ntchito mlingo wochepa wa heparin kapena mlingo wofanana wa LMWH kuti ateteze mitsempha yakuya ya thrombosis ndi pulmonary embolism.
2).Phindu la kuwunika kwa coagulation index mukamagwiritsa ntchito anticoagulant
• PT: Ntchito ya INR ya labotale ndi yabwino ndipo ingagwiritsidwe ntchito kutsogolera kusintha kwa mlingo wa warfarin;kuyesa kuopsa kwa magazi kwa rivaroxaban ndi edoxaban.
• APTT: Itha kugwiritsidwa ntchito kuwunika mphamvu ndi chitetezo cha (milingo yocheperako) heparin yosagawika ndikuwunika bwino kuopsa kwa magazi kwa dabigatran.
• T.
• D-Dimer / FDP: Ikhoza kugwiritsidwa ntchito poyesa zotsatira za mankhwala a anticoagulant monga warfarin ndi heparin;ndikuwunika momwe achire amankhwala a thrombolytic monga urokinase, streptokinase, ndi alteplase.
• AT-III: Ikhoza kugwiritsidwa ntchito kutsogolera zotsatira za mankhwala a heparin, heparin yotsika kwambiri ya molekyulu, ndi fondaparinux, ndikuwonetsa ngati kuli kofunikira kusintha anticoagulants muzochita zachipatala.
3).Anticoagulation isanayambe kapena itatha cardioversion ya atria fibrillation
Pali chiopsezo cha thromboembolism panthawi ya cardioversion ya atria fibrillation, ndipo chithandizo choyenera cha anticoagulation chingachepetse chiopsezo cha thromboembolism.Kwa odwala omwe ali ndi vuto la hemodynamics omwe ali ndi vuto la mtima lomwe limafunikira kuthamanga kwa mtima mwachangu, kuyambitsa kwa anticoagulation kuyenera kuchedwetsa kugunda kwamtima.Ngati palibe contraindication, heparin kapena otsika molekyulu kulemera heparin kapena NOAC ayenera kugwiritsidwa ntchito mwamsanga, ndi cardioversion ayenera kuchitidwa nthawi yomweyo.
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