Sei D-dimer, FDP ichifanira kuonekwa muvarwere vemoyo uye cerebrovascular?
1. D-dimer inogona kushandiswa kutungamirira kugadziriswa kwesimba re anticoagulation.
(1) Ukama huri pakati peD-dimer nhanho uye zviitiko zvekiriniki panguva yeanticoagulation therapy muvarwere mushure me mechanical heart valve replacement.
I-D-dimer-inotungamirirwa ne-anticoagulation intensity adjustment treatment group yakanyatsogadzirisa kuchengetedzwa uye kushanda kweanticoagulation therapy, uye chiitiko chezviitiko zvakasiyana-siyana zvakashata zvakanyanya kuderera kupfuura izvo zveboka rekutonga rinoshandisa maitiro uye akaderera-anticoagulation.
(2) Kuumbwa kwecerebral venous thrombosis (CVT) inowirirana zvakanyanya nebumbiro rethrombus.
Nhungamiro yekuongororwa uye manejimendi yemukati tsinga uye venous sinus thrombosis (CVST)
Thrombotic Constitution: PC, PS, AT-ll, ANA, LAC, HCY
Gene mutation: prothrombin gene G2020A, coagulation factor LeidenV
Predisposing factors: perinatal period, contraceptive, dehydration, trauma, operation, infection, bundu, weight loss.
2. Kukosha kwekubatanidzwa kwekuonekwa kweD-dimer neFDP muhutano hwemwoyo uye cerebrovascular.
(1) D-dimer kuwedzera (kupfuura 500ug / L) inobatsira pakuongororwa kweCVST.Zvakajairwa hazviregi CVST, kunyanya muCVST ine musoro wega wega nguva pfupi yadarika.Inogona kushandiswa seimwe yezviratidzo zveCVST kuongororwa.D-dimer yakakwirira kupfuura yakajairika inogona kushandiswa seimwe yezviratidzo zvekuongorora zveCVST (level III kurudziro, nhanho C humbowo).
(2) Zviratidzo zvinoratidza thrombolytic therapy inoshanda: D-dimer monitoring yakawedzera zvakanyanya uye yakaderera zvishoma nezvishoma;FDP yakawedzera zvakanyanya ichibva yaderera zvishoma nezvishoma.Izvi zviratidzo zviviri ndiyo hwaro hwakananga hweiyo inoshanda thrombolytic therapy.
Pasi pechiito chemishonga yethrombolytic (SK, UK, rt-PA, nezvimwewo), iyo emboli mumidziyo yeropa inokurumidza kunyungudika, uye D-dimer uye FDP muplasma inowedzera zvakanyanya, iyo inowanzogara kwemazuva manomwe.Mukati mekurapa, kana kuyerwa kwemishonga yethrombolytic isina kukwana uye thrombus haina kunyungudika zvachose, D-dimer uye FDP icharamba iri pamatunhu akakwirira mushure mekusvika pakakwirira;Maererano nenhamba, chiitiko chekubuda ropa mushure mekurapa kwethrombolytic yakakura se5% kusvika 30%.Naizvozvo, kune varwere vane thrombotic zvirwere, chirongwa chakasimba chemushonga chinofanira kugadzirwa, chiitiko cheplasma coagulation uye chiitiko che fibrinolytic chinofanira kutariswa munguva chaiyo, uye chiyero chemishonga yethrombolytic chinofanira kudzorwa zvakanaka.Zvinogona kuonekwa kuti kuonekwa kwesimba kweD-dimer uye FDP kusanganiswa kunoshanduka nguva isati yasvika, panguva uye mushure mekurapa panguva yethrombolysis ine hutano hukuru hwekliniki yekutarisa kushanda nekuchengetedzwa kwemishonga yethrombolytic.
Sei varwere vane moyo uye cerebrovascular zvirwere vachifanira kuteerera AT?
Antithrombin (AT) inoshaya Antithrombin (AT) inobata basa rinokosha mukudzivisa kuumbwa kwethrombus, haisi kungodzivisa thrombin chete, asiwo inodzivisa coagulation zvinhu zvakadai seIXa, Xa, Xla, Xlla uye Vlla.Iko kusanganiswa kweheparin uye AT chikamu chakakosha cheAT anticoagulation.Muhupo hweheparin, iyo anticoagulant yeAT inogona kuwedzerwa nezviuru zvenguva.Basa reAT, saka AT chinhu chakakosha cheiyo anticoagulant process yeheparin.
1. Heparin kushorwa: Kana basa reAT richiderera, basa re anticoagulant reheparin rinonyanya kuderedzwa kana kusashanda.Naizvozvo, zvinodikanwa kuti unzwisise chiyero cheAT pamberi pekurapa kweheparin kudzivirira kusingakodzeri kukwira-dose heparin kurapwa uye kurapwa hakushande.
Muzvinyorwa zvakawanda zvezvinyorwa, kukosha kwekliniki yeD-dimer, FDP, uye AT inoratidzwa muhutano hwemwoyo uye cerebrovascular, iyo inogona kubatsira mukutanga kuongororwa, kutonga kwemamiriro ezvinhu uye kuongororwa kwechirwere chechirwere.
2. Kuongorora etiology yethrombophilia: Varwere vane thrombophilia vanoratidzwa nekliniki nehombe yetsinga yakadzika uye thrombosis inodzokororwa.Kuongororwa kwechikonzero chethrombophilia kunogona kuitwa mumapoka anotevera:
(1) VTE pasina chikonzero chiri pachena (kusanganisira neonatal thrombosis)
(2) VTE ine zvinokurudzira <40-50 makore
(3) Kudzokorora thrombosis kana thrombophlebitis
(4) Nhoroondo yemhuri yethrombosis
(5) Thrombosis panzvimbo dzisina kujairika: mesenteric tsinga, cerebral venous sinus
(6) Kudzokorora kupfupfudzika, kuzvara mwana akafa, nezvimwe.
(7) Kubata pamuviri, kudzivirira pamuviri, hormone-induced thrombosis
(8) Ganda necrosis, kunyanya mushure mekushandisa warfarin
(9) Arterial thrombosis yechikonzero chisingazivikanwi <makore makumi maviri
(10) Hama dze thrombophilia
3. Kuongororwa kwezviitiko zvemwoyo uye kudzokazve: Zvidzidzo zvakaratidza kuti kuderedzwa kweAT basa kune varwere vane chirwere chemwoyo chinokonzerwa nekuguma kwemasero endothelial anokonzera kuwanda kweAT kupedzwa.Saka, kana varwere vari mu hypercoagulable state, ivo vanowanzoita thrombosis uye vanowedzera chirwere chacho.Basa reAT raivewo rakaderera zvakanyanya muhuwandu hwevanhu vane zviitiko zvemoyo zvinowanzoitika kupfuura muhuwandu pasina zviitiko zvemoyo.
4. Kuongororwa kwehutachiwana hwe thrombosis mu-non-valvular atrial fibrillation: yakaderera AT yezinga rekuita inobatanidzwa zvakanaka neCHA2DS2-VASc chikamu;panguva imwecheteyo, ine yakakwirira yereferensi kukosha kwekuongorora thrombosis mune isiri-valvular atrial fibrillation.
5. Ukama huri pakati peAT uye sitiroko: AT yakanyanya kuderedzwa kune varwere vane acute ischemic stroke, ropa riri mu hypercoagulable state, uye anticoagulation therapy inofanira kupiwa munguva;varwere vane sitiroko zvinhu vanofanira kugara vachiongororwa AT, uye kukurumidza kuonekwa kwevarwere' high blood pressure inofanira kuitwa.Iyo coagulation state inofanirwa kurapwa nenguva kudzivirira kuitika kweacute sitiroko.
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