1. Kliniki yekushandiswa kweropa coagulation mapurojekiti mumoyo uye cerebrovascular hosha
Munyika yose, nhamba yevanhu vanotambura nezvirwere zvemwoyo uye cerebrovascular yakakura, uye iri kuratidza kuwedzera gore negore.Muchiito chekiriniki, varwere vanowanzova nenguva pfupi uye vanoperekedzwa necerebral hemorrhage, iyo inokanganisa kufungidzira uye inotyisidzira hupenyu hwevarwere.
Kune dzakawanda zvirwere zvemoyo uye cerebrovascular zvirwere, uye izvo zvinofurira zvinhu zvakare zvakaoma zvikuru.Nekuramba kuchidzika kwekiriniki yekutsvagisa nezve coagulation, zvinoonekwa kuti mune zvemoyo uye cerebrovascular zvirwere, coagulation zvinhu zvinogona zvakare kushandiswa senjodzi dzechirwere ichi.Zvidzidzo zvekiriniki zvakaratidza kuti ese ari maviri ekunze uye emukati coagulation nzira dzevarwere vakadai zvichave nemhedzisiro pakuongororwa, kuongororwa uye kufungidzira kwezvirwere zvakadaro.Naizvozvo, kuongororwa kwakazara kweiyo coagulation njodzi yevarwere yakakosha zvikuru kune varwere vane moyo uye cerebrovascular zvirwere.kukosha.
2. Sei varwere vane mwoyo uye cerebrovascular zvirwere vanofanira kuteerera coagulation zviratidzo
Zvirwere zvemoyo uye cerebrovascular zvirwere zvinoisa panjodzi hutano hwevanhu nehupenyu, nekufa kwakanyanya uye hurema hwakanyanya.
Kuburikidza nekuona kwekuita coagulation muvarwere vane chirwere chemwoyo uye cerebrovascular, zvinokwanisika kuongorora kana murwere ane kubuda ropa uye njodzi yevenous thrombosis;mukugadzirisa kunotevera anticoagulation therapy, iyo anticoagulation effect inogonawo kuongororwa uye mishonga yekiriniki inogona kutungamirirwa kudzivirira kubuda ropa.
1).Varwere vesitiroko
Cardioembolic sitiroko ischemic sitiroko inokonzerwa ne cardiogenic emboli kubuda uye embolizing inoenderana cerebral arteries, inoverengera 14% kusvika 30% yeese ischemic sitiroko.Pakati pavo, sitiroko ine chekuita neatrial fibrillation inopfuura 79% yeese cardioembolic sitiroko, uye cardioembolic sitiroko zvakanyanya, uye zvinofanirwa kuzivikanwa nekukurumidza uye nekupindira zvine simba.Kuongorora njodzi ye thrombosis uye kurapwa kweanticoagulation kwevarwere, uye anticoagulation kurapwa kwekiriniki inoda kushandisa coagulation zviratidzo kuongorora iyo anticoagulation mhedzisiro uye chaiyo anticoagulation mushonga kudzivirira kubuda ropa.
Ngozi huru muvarwere vane atrial fibrillation ndeye arterial thrombosis, kunyanya cerebral embolism.Anticoagulation kurudziro yecerebral infarction yechipiri kune atrial fibrillation:
1. Kushandiswa kwekukurumidza kushandiswa kweanticoagulants hakukurudzirwi kune varwere vane acute cerebral infarction.
2. Muvarwere vanorapwa ne thrombolysis, kazhinji hazvikurudzirwe kushandisa anticoagulants mukati memaawa makumi maviri nemana.
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(1) Varwere vane cardiac infarction (yakadai sevhavha yakagadzirwa, atrial fibrillation, myocardial infarction ne mural thrombus, left atrial thrombosis, etc.) vanowanzoita sitiroko inowanzoitika.
(2) Varwere vane ischemic sitiroko inoperekedzwa neprotein C kushomeka, kushaikwa kweprotein S, kushingaira kweprotein C kushorwa uye vamwe varwere vane thromboprone;varwere vane symptomatic extracranial dissecting aneurysm;varwere vane intracranial uye intracranial artery stenosis.
(3) Varwere vari pamubhedha vane cerebral infarction vanogona kushandisa yakaderera-dose heparin kana inowirirana dose yeLMWH kudzivirira yakadzika vein thrombosis uye pulmonary embolism.
2).Iko kukosha kweiyo coagulation index yekutarisa kana anticoagulant mishonga inoshandiswa
• PT: The laboratory's INR performance yakanaka uye inogona kushandiswa kutungamirira kurongeka kwepimo ye warfarin;ongorora njodzi yekubuda ropa ye rivaroxaban uye edoxaban.
• APTT: Inogona kushandiswa kuongorora kushanda uye kuchengetedzeka kwe (yepakati madosi) heparin isina kupatsanurwa uye kuongorora zvine hungwaru njodzi yekubuda ropa kwedabigatran.
• TT: Inonzwa kune dabigatran, inoshandiswa kuongorora dabigatran yasara muropa.
• D-Dimer / FDP: Inogona kushandiswa kuongorora maitiro ekurapa kwemishonga inonzi anticoagulant yakadai sewarfarin uye heparin;uye kuongorora kurapa kwemishonga yethrombolytic yakadai seurokinase, streptokinase, uye alteplase.
• AT-III: Inogona kushandiswa kutungamirira mishonga yemishonga yeheparin, yakaderera molecular weight heparin, uye fondaparinux, uye kuratidza kana zvakakosha kushandura anticoagulants mumakiriniki maitiro.
3).Anticoagulation pamberi uye shure kwe cardioversion yeatrial fibrillation
Pane ngozi ye thromboembolism panguva ye cardioversion yeatrial fibrillation, uye zvakakodzera anticoagulation therapy inogona kuderedza ngozi ye thromboembolism.Kune varwere vane hemodynamically vasina kugadzikana vane atrial fibrillation inoda kukurumidza cardioversion, kutanga kwe anticoagulation hakufaniri kunonoka cardioversion.Kana pasina kupesana, heparin kana yakaderera molecular weight heparin kana NOAC inofanira kushandiswa nokukurumidza sezvinobvira, uye cardioversion inofanira kuitwa panguva imwe chete.
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